1
|
Chang C, Lidbury J, Suchodolski JS, Steiner JM. Effect of oral or subcutaneous administration of cyanocobalamin in hypocobalaminemic cats with chronic gastrointestinal disease or exocrine pancreatic insufficiency. J Vet Intern Med 2024; 38:2464-2479. [PMID: 39268979 PMCID: PMC11423444 DOI: 10.1111/jvim.17195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND No prospective study has evaluated the efficacy of oral supplementation with cobalamin in hypocobalaminemic cats. OBJECTIVES To investigate the efficacy of oral or SC supplementation with cyanocobalamin in normalizing serum cobalamin and methylmalonic acid (MMA) concentrations in hypocobalaminemic cats with chronic gastrointestinal disease (CGID) or exocrine pancreatic insufficiency (EPI). ANIMALS Forty-eight client-owned hypocobalaminemic (<290 ng/L) cats with normal or abnormally high serum MMA concentrations. METHODS This study was conducted based on the prospective randomized clinical trial method. Cats with CGID or EPI were randomly assigned to 2 groups that received either oral or SC supplementation with cobalamin (250 μg/cat) for 12 and 10 weeks, respectively, in addition to other medical and dietary interventions. Each cat was evaluated 3 times (baseline, 6-week postsupplementation, and 1-week postcompletion) by measuring serum cobalamin and MMA concentrations. RESULTS In cats with CGID or EPI, cobalamin concentrations were normalized in all cats that received either oral or SC supplementation (mean 100% [95% CI: 80.6%-100%] in both groups in cats with CGID and 100% [67.6%-100%] in both groups in cats with EPI). Among 37 cats with elevated MMA concentrations at baseline (21 cats with CGID and 16 cats with EPI), MMA concentrations were normalized in most cats with CGID (70% in oral and 82% in SC group) or EPI (88% in both groups). CONCLUSIONS AND CLINICAL IMPORTANCE In hypocobalaminemic cats with CGID or EPI, in conjunction with other medical and dietary interventions, both oral and SC supplementation are effective at normalizing serum cobalamin and MMA concentrations.
Collapse
Affiliation(s)
- Chee‐Hoon Chang
- Gastrointestinal Laboratory, College of Veterinary Medicine & Biomedical SciencesTexas A&M UniversityCollege StationTexasUSA
| | - Jonathan Lidbury
- Gastrointestinal Laboratory, College of Veterinary Medicine & Biomedical SciencesTexas A&M UniversityCollege StationTexasUSA
| | - Jan S. Suchodolski
- Gastrointestinal Laboratory, College of Veterinary Medicine & Biomedical SciencesTexas A&M UniversityCollege StationTexasUSA
| | - Joerg M. Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine & Biomedical SciencesTexas A&M UniversityCollege StationTexasUSA
| |
Collapse
|
2
|
Dor C, Nixon S, Salavati Schmitz S, Bazelle J, Černá P, Kilpatrick S, Harvey ND, Dunning M. Efficacy and tolerance of oral versus parenteral cyanocobalamin supplement in hypocobalaminaemic dogs with chronic enteropathy: a controlled randomised open-label trial. J Small Anim Pract 2024; 65:317-328. [PMID: 38354724 DOI: 10.1111/jsap.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Determine comparative tolerance of daily oral and weekly parenteral cobalamin supplementation, in hypocobalaminaemic dogs with chronic enteropathy. Determine whether oral is as effective as parenteral supplementation at achieving eucobalaminaemia, in hypocobalaminaemic dogs with protein-losing enteropathy, severe hypocobalaminaemia or high canine inflammatory bowel disease activity index at inclusion. MATERIALS AND METHODS Thirty-seven client-owned dogs with hypocobalaminaemia and clinical signs of chronic enteropathy were prospectively enrolled in three UK referral centres. Dogs were randomly allocated to daily oral for 12 weeks or weekly parenteral cobalamin supplementation for 6 weeks and one additional dose 4 weeks later. Serum cobalamin, body condition score, canine inflammatory bowel disease activity index and bodyweight were assessed at inclusion, weeks 7 and 13. Serum methylmalonic acid concentration was evaluated at inclusion and at week 13. Owners completed treatment adherence, palatability, tolerance and satisfaction questionnaires at week 13. RESULTS Nineteen dogs completed the study. All dogs orally supplemented achieved normal or increased cobalaminaemia at weeks 7 and 13. There was no statistical difference in cobalamin concentration at week 13 in dogs treated with oral or parenteral supplementation, regardless of presence of protein-losing enteropathy, severity of hypocobalaminaemia or canine inflammatory bowel disease activity index at inclusion. Serum methylmalonic acid concentration was not significantly different between oral and parenteral groups, neither were treatment adherence, satisfaction, and tolerance scores at week 13. CLINICAL SIGNIFICANCE Oral is as effective and as well-tolerated as parenteral cobalamin supplementation in hypocobalaminaemic dogs with chronic enteropathy and severe clinical or biochemical phenotypes, and should be considered as a suitable treatment option regardless of disease severity.
Collapse
Affiliation(s)
- C Dor
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - S Nixon
- ADM Protexin Ltd, Lopen Head, Somerset, UK
| | - S Salavati Schmitz
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, The Hospital for Small Animals, University of Edinburgh, Edinburgh, UK
| | - J Bazelle
- Davies Veterinary Specialists, Manor Farm Business Park, Hitchin, Hertfordshire, UK
| | - P Černá
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - S Kilpatrick
- Idexx Laboratories, Grange House, Sandbeck Way, Wetherby, West Yorkshire, UK
| | - N D Harvey
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - M Dunning
- Department of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| |
Collapse
|
3
|
Marsilio S, Freiche V, Johnson E, Leo C, Langerak AW, Peters I, Ackermann MR. ACVIM consensus statement guidelines on diagnosing and distinguishing low-grade neoplastic from inflammatory lymphocytic chronic enteropathies in cats. J Vet Intern Med 2023; 37:794-816. [PMID: 37130034 PMCID: PMC10229359 DOI: 10.1111/jvim.16690] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/10/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Lymphoplasmacytic enteritis (LPE) and low-grade intestinal T cell lymphoma (LGITL) are common diseases in older cats, but their diagnosis and differentiation remain challenging. OBJECTIVES To summarize the current literature on etiopathogenesis and diagnosis of LPE and LGITL in cats and provide guidance on the differentiation between LPE and LGITL in cats. To provide statements established using evidence-based approaches or where such evidence is lacking, statements based on consensus of experts in the field. ANIMALS None. METHODS A panel of 6 experts in the field (2 internists, 1 radiologist, 1 anatomic pathologist, 1 clonality expert, 1 oncologist) with the support of a human medical immunologist, was formed to assess and summarize evidence in the peer-reviewed literature and complement it with consensus recommendations. RESULTS Despite increasing interest on the topic for clinicians and pathologists, few prospective studies were available, and interpretation of the pertinent literature often was challenging because of the heterogeneity of the cases. Most recommendations by the panel were supported by a moderate or low level of evidence. Several understudied areas were identified, including cellular markers using immunohistochemistry, genomics, and transcriptomic studies. CONCLUSIONS AND CLINICAL IMPORTANCE To date, no single diagnostic criterion or known biomarker reliably differentiates inflammatory lesions from neoplastic lymphoproliferations in the intestinal tract of cats and a diagnosis currently is established by integrating all available clinical and diagnostic data. Histopathology remains the mainstay to better differentiate LPE from LGITL in cats with chronic enteropathy.
Collapse
Affiliation(s)
- Sina Marsilio
- Department of Veterinary Medicine and EpidemiologyUC Davis School of Veterinary MedicineDavisCaliforniaUSA
| | - Valerie Freiche
- Ecole Nationale Vétérinaire d'AlfortCHUVA, Unité de Médecine InterneMaisons‐AlfortFrance
| | - Eric Johnson
- Department of Surgical & Radiological SciencesUC Davis School of Veterinary MedicineDavisCaliforniaUSA
| | - Chiara Leo
- Anicura Istituto Veterinario NovaraNovaraItaly
| | | | | | - Mark R. Ackermann
- Oregon Veterinary Diagnostic Laboratory, Oregon State UniversityCorvallisOregonUSA
- Present address:
US Department of AgricultureNational Animal Disease CenterAmesIowaUSA
| |
Collapse
|
4
|
Siani G, Mercaldo B, Alterisio MC, Di Loria A. Vitamin B12 in Cats: Nutrition, Metabolism, and Disease. Animals (Basel) 2023; 13:ani13091474. [PMID: 37174511 PMCID: PMC10177498 DOI: 10.3390/ani13091474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Cobalamin is a water-soluble molecule that has an important role in cellular metabolism, especially in DNA synthesis, methylation, and mitochondrial metabolism. Cobalamin is bound by intrinsic factor (IF) and absorbed in the ileal tract. The IF in cats is synthesized exclusively by pancreatic tissue. About 75% of the total plasma cobalamin in cats is associated with transcobalamin II, while in this species, transcobalamin I is not present. In cats, the half-life of cobalamin is 11-14 days. Diagnostic biomarkers for B12 status in cats include decreased levels of circulating total cobalamin and increased levels of methylmalonic acid. The reference interval for serum cobalamin concentrations in cats is 290-1500 ng/L, and for the serum methylmalonic acid concentration, it is 139-897 nmol/L. Therapy for hypocobalaminemia mainly depends on the underlying disease. In some cases, subcutaneous or intramuscular injection of 250 μg/cat is empirically administered. In recent years, it has been demonstrated that oral cobalamin supplementation can also be used successfully in dogs and cats as a less invasive alternative to parental administration. This review describes the current knowledge regarding B12 requirements and highlights improvements in diagnostic methods as well as the role of hypocobalaminemia in its associated diseases.
Collapse
Affiliation(s)
| | - Beatrice Mercaldo
- Department of Veterinary Medicine and Animal Productions, University Federico II of Napoli, Via F. Delpino 1, 80137 Napoli, Italy
| | - Maria Chiara Alterisio
- Department of Veterinary Medicine and Animal Productions, University Federico II of Napoli, Via F. Delpino 1, 80137 Napoli, Italy
| | - Antonio Di Loria
- Department of Veterinary Medicine and Animal Productions, University Federico II of Napoli, Via F. Delpino 1, 80137 Napoli, Italy
| |
Collapse
|
5
|
Serial Measurement of Serum Pancreatic Lipase Immunoreactivity, Feline Trypsin-like Immunoreactivity, and Cobalamin Concentrations in Kittens. Vet Sci 2022; 9:vetsci9090469. [PMID: 36136684 PMCID: PMC9501717 DOI: 10.3390/vetsci9090469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Serum concentrations of feline pancreatic lipase immunoreactivity (fPLI), feline trypsin-like immunoreactivity (fTLI), and cobalamin are commonly used for the diagnostic investigation of cats with gastrointestinal signs. No information on these parameters in healthy cats less than 1 year of age exists. We aimed to evaluate serum concentrations of fPLI, fTLI, and cobalamin in healthy cats at different time-points during their first 12 months of life. Fourteen healthy 2-month-old kittens were included. Blood was collected at 2, 3, 4, 6, and 12 months of age, and serum concentrations of fPLI, fTLI, and cobalamin were measured. While there was a statistically significant difference in serum fPLI concentrations over time, there was no statistically significant difference between individual time-points. There was no significant difference in serum fTLI concentrations over time. Serum cobalamin concentrations were below the reference interval in 3/13 cats at 2 months of age and were significantly lower by 3 months, when 13/14 had hypocobalaminemia. By 12 months, serum cobalamin had significantly increased, yet 4/12 cats still had hypocobalaminemia. Serum fPLI and fTLI concentrations did not show any statistically or clinically significant differences in young kittens. In contrast, serum cobalamin concentrations were commonly below the reference interval in kittens. Serum fPLI and fTLI concentrations are not practically affected by age in kittens as young as 2 months of age and could be used for the investigation of pancreatic diseases.
Collapse
|
6
|
Chang CH, Lidbury JA, Suchodolski JS, Steiner JM. Effect of oral or injectable supplementation with cobalamin in dogs with hypocobalaminemia caused by chronic enteropathy or exocrine pancreatic insufficiency. J Vet Intern Med 2022; 36:1607-1621. [PMID: 36054643 PMCID: PMC9511088 DOI: 10.1111/jvim.16528] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Recent studies have shown similar efficacy of oral supplementation of cobalamin compared to injectable supplementation in dogs, but few prospective, randomized studies have been published. Objectives To evaluate efficacy of oral or injectable supplementation with cobalamin in normalizing serum cobalamin and methylmalonic acid (MMA) concentrations in dogs with hypocobalaminemia caused by either chronic enteropathy (CE) or exocrine pancreatic insufficiency (EPI). Animals Forty‐six client owned dogs with hypocobalaminemia. Methods Prospective randomized clinical trial. Dogs were divided into 2 groups (CE or EPI), and randomized to receive oral or injectable supplementation of cobalamin. Each dog had 3 visits and serum cobalamin and MMA concentrations were measured at each visit. Results In dogs with CE, serum cobalamin concentrations increased with oral (P = .02; median 149 [range 149‐231] to 733 [166‐1467] ng/L, median difference 552 [95% CI: 181‐899] ng/L) or injectable (P < .01; 168 [149‐233] to 563 [234‐965] ng/L, 367 [187‐623] ng/L) supplementation. In dogs with EPI, serum cobalamin concentrations increased with oral (P = .01; 162 [149‐214] to 919 [643‐3863] ng/L, 705 [503‐3356] ng/L) or injectable (P = .01; 177 [149‐217] to 390 [243‐907] ng/L, 192 [89‐361] ng/L) supplementation. Serum MMA concentrations decreased with oral or injectable supplementation in dogs with CE, but only with oral supplementation in dogs with EPI. Conclusions and Clinical Importance Oral supplementation is an alternative for cobalamin supplementation in dogs with hypocobalaminemia caused by CE or EPI.
Collapse
Affiliation(s)
- Chee-Hoon Chang
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Jonathan A Lidbury
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Jan S Suchodolski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Joerg M Steiner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
7
|
BIOMARKERS OF GASTROINTESTINAL DISEASE IN CHEETAHS ( ACINONYX JUBATUS). J Zoo Wildl Med 2021; 52:886-892. [PMID: 34687504 DOI: 10.1638/2021-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 11/21/2022] Open
Abstract
Gastrointestinal disease is a common clinical problem in captive cheetahs (Acinonyx jubatus). It is reported that gastritis affects the vast majority of the captive population of cheetahs. Pancreatitis and acute and chronic enteritis have also been reported. These issues pose significant long-term health and welfare implications for cheetahs. Cobalamin, folate, methylmalonic acid (MMA), gastrin, feline pancreatic-specific lipase immunoreactivity (fPLI), and feline trypsin-like immunoreactivity (fTLI) immunoassays are important biomarkers of gastrointestinal disease in domestic cats. The goal of this study was to determine if these immunoassays validated in domestic cats could be used clinically in cheetahs, by establishing reference intervals (RI) for these biomarkers in cheetahs. A cohort of 40 clinically healthy cheetahs was selected from three zoological institutions on the basis of being free of clinical gastrointestinal disease and extra-gastrointestinal disease that could affect biomarkers, as well as having banked frozen serum. Cheetah biomarker RI, with domestic cat RI for comparison in parentheses, are as follows: cobalamin 470-618 pg/ml (290-1500 pg/ml), folate 2.2-15.7 ng/ml (9.7-21.6 ng/ml), MMA 365-450 nM/L (139-897 nM/L), fPLI 0.5-1.2 µg/L (0-4 µg/L), and gastrin 30-50 pg/ml (<10-39.5 pg/ml). This study shows that RI for gastrointestinal biomarkers can be notably different, even between species that are as closely related as the domestic cat and the cheetah. Additionally, it was found that the fTLI assay does not cross-immunoreact with cheetahs. In conclusion, this study emphasizes the importance of developing species-specific RI for biomarker assays and using caution when extrapolating RI from other species.
Collapse
|
8
|
Martín L, Añor S, Lloret A, Encinoso MÓ, de la Fuente C. What Is Your Diagnosis? J Am Vet Med Assoc 2021; 259:245-248. [PMID: 34242079 DOI: 10.2460/javma.259.3.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Hunt A, Jugan MC. Anemia, iron deficiency, and cobalamin deficiency in cats with chronic gastrointestinal disease. J Vet Intern Med 2020; 35:172-178. [PMID: 33226151 PMCID: PMC7848310 DOI: 10.1111/jvim.15962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Iron deficiency and cobalamin deficiency, as sequelae to chronic gastrointestinal (GI) disease, could result in anemia and increased morbidity in cats with chronic enteropathies. OBJECTIVE To evaluate iron deficiency in cats with chronic GI disease and its relationship with hypocobalaminemia, anemia, and disease severity. ANIMALS Twenty client-owned cats with primary GI disease. METHODS Prospective, cross-sectional study. Cats were enrolled at the time of evaluation for chronic GI disease, after exclusion of comorbidities. CBC with reticulocyte indices, iron metabolism (serum iron and ferritin concentrations, total iron binding capacity [TIBC]), serum methylmalonic acid (MMA), cobalamin, and folate concentrations, pancreatic lipase and trypsin-like immunoreactivity, and disease severity were evaluated. RESULTS Anemia (hematocrit <30%), iron deficiency, and cobalamin deficiency were diagnosed in 4/20, 7/20, and 8/20 cats, respectively. Hematocrit (rs = -.45; P < .05) and body condition score (rs = -.60; P < .01) negatively correlated with MMA. Median TIBC was lower in cats with increased vs normal MMA (218 μg/mL; range, 120-466 μg/mL vs 288 μg/mL; range, 195-369 μg/mL; P = .02). Hematocrit (rs = .51; P = .02), reticulocyte MCV (rs = .52; P = .02), reticulocyte hemoglobin content (rs = .71; P < .001), and percent transferrin saturation (rs = .79; P < .0001) positively correlated with serum iron concentration. CONCLUSIONS AND CLINICAL IMPORTANCE Functional iron deficiency was common in cats with chronic GI disease. Associations between hypocobalaminemia, iron parameters, and hematologic parameters warrant further investigation on the impact of iron deficiency on chronic GI disease morbidity in cats.
Collapse
Affiliation(s)
- Adam Hunt
- Department of Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Tennessee, USA
| | - Maria C Jugan
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| |
Collapse
|
10
|
Kook PH, Melliger RH, Hersberger M. Efficacy of intramuscular hydroxocobalamin supplementation in cats with cobalamin deficiency and gastrointestinal disease. J Vet Intern Med 2020; 34:1872-1878. [PMID: 32815652 PMCID: PMC7517839 DOI: 10.1111/jvim.15865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022] Open
Abstract
Background In humans, absorption and tissue retention rates of intramuscularly administered hydroxocobalamin (OH‐Cbl) are superior compared to cyanocobalamin (CN‐Cbl). Supplementation with OH‐Cbl has not been described in cats. Objectives To evaluate effects of parenteral OH‐Cbl supplementation on clinical signs, serum Cbl and methylmalonic acid (MMA) concentrations in hypocobalaminemic cats with gastrointestinal disease. Animals Twenty‐three client‐owned cats. Methods Prospective study. Serum Cbl and MMA concentrations were determined at enrollment (t0), immediately before the 4th OH‐Cbl IM injection (300 μg, given q2 weeks) (t1), and 4 weeks after the 4th injection (t2). Severity of clinical signs (activity, appetite, vomiting, diarrhea, body weight) was graded at each time point and expressed as clinical disease activity score. Results Median clinical disease activity score decreased significantly from t0 (6; range, 2‐10) to t1 (1; range, 0‐6) and t2 (1; range, 0‐9). Median serum Cbl concentration increased significantly from 111 pmol/L (range, 111‐218; reference range, 225‐1451 pmol/L) at t0 to 1612 pmol/L (range, 526‐14 756) (P < .001) at t1, and decreased again significantly to 712 pmol/L (range, 205‐4265) (P < .01) at t2. Median baseline serum MMA concentration at t0 (802 nmol/L; range, 238‐151 000; reference range, 120‐420 nmol/L) decreased significantly (P < .001) to 199 nmol/L (range, 29‐478) at t1, and was 205 nmol/L (range, 88‐734) at t2. Serum MMA concentrations normalized in 22/23 cats at t1, and were not significantly higher at t2 compared to t1. Conclusions and Clinical Importance The herein described OH‐Cbl injection scheme appears efficacious for normalization of cellular Cbl deficiency in cats with gastrointestinal disease.
Collapse
Affiliation(s)
- Peter H Kook
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Martin Hersberger
- Department of Clinical Chemistry, University Children's Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Grützner N, Opriessnig T, Lopes R, Suchodolski JS, Nathues H, Steiner JM. Assessment of folate and cobalamin concentrations in relation to their dependent intracellular metabolites in serum of pigs between 6 and 26 weeks of age. Res Vet Sci 2020; 130:59-67. [PMID: 32145458 DOI: 10.1016/j.rvsc.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/29/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Abstract
Folate (vitamin B9) and cobalamin (vitamin B12) play an important role in amino acid metabolism, nucleic acid synthesis, and methyl group transfer. Two intracellular enzymes, methionine synthase and methylmalonyl-CoA mutase, are folate and/or cobalamin-dependent, respectively. At the cellular level, a lack of folate and cobalamin leads to accumulation of serum homocysteine (HCY) and a lack of cobalamin leads to increased methylmalonic acid (MMA) concentrations. Altered serum HCY and MMA concentrations can influence amino acid metabolism and nucleic acid synthesis in pigs. Therefore, we aimed to evaluate serum folate, cobalamin, HCY, and MMA concentrations in postweaning pigs between 6 and 26 weeks of age. Serum samples from 12 pigs collected at week 6, 7, 8, 9, 10, 14, 18, 22, and 26 as part of an unrelated study were analyzed. Serum folate (p < .0001), cobalamin (p = .0001), HCY (p < .0001), and MMA (p < .0001) concentrations differed significantly during the postweaning period between 6 and 26 weeks of age; with significantly higher serum HCY (at weeks 6 and 7 compared to weeks 9, 14, 18, 22, and 26) and MMA concentrations (at weeks 6, 7, and 8 compared to weeks 14, 18, 22, and 26) and an overall decrease of serum MMA concentrations from week 6 to week 14 in the pigs studied. This study suggests age-dependent changes in intracellular folate- and cobalamin-dependent metabolites (i.e., HCY and MMA) in pigs between 6 and 26 weeks of age, possibly reflecting decreased availability of intracellular folate and/or cobalamin for amino acid metabolism, nucleic acid synthesis, and methyl group transfer.
Collapse
Affiliation(s)
- Niels Grützner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA; Clinic for Swine, Vetsuisse Faculty, University of Bern, BE, CH, Switzerland; Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), SA, GER, Germany.
| | - Tanja Opriessnig
- The Roslin Institute, University of Edinburgh, Midlothian, UK; Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Iowa, IA, USA
| | - Rosana Lopes
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Jan S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Heiko Nathues
- Clinic for Swine, Vetsuisse Faculty, University of Bern, BE, CH, Switzerland
| | - Jörg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| |
Collapse
|
12
|
Kempf J, Melliger RH, Reusch CE, Kook PH. Effects of storage conditions and duration on cobalamin concentration in serum samples from cats and dogs. J Am Vet Med Assoc 2019; 252:1368-1371. [PMID: 29772976 DOI: 10.2460/javma.252.11.1368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of storage conditions and duration on cobalamin concentration in serum samples from dogs and cats. DESIGN Experiment. SAMPLE Serum samples from 9 client-owned cats and 9 client-owned dogs. PROCEDURES Serum harvested from freshly obtained blood samples was separated into 11 aliquots/animal. One aliquot (baseline sample) was routinely transported in light-protected tubes to the laboratory for cobalamin assay; each of the remaining aliquots was stored in a refrigerator (6°C; n = 5) or at room temperature (20°C) with exposure to daylight (5) for 24, 48, 72, 96, or 120 hours. Aliquots were subsequently wrapped in aluminum foil, frozen (-20°C), and then transported to the laboratory for measurement of cobalamin concentration, all in the same run. Percentage decrease in cobalamin concentration from baseline was analyzed by means of linear mixed modeling. RESULTS No differences in cobalamin values were identified between cats and dogs; therefore, data for both species were analyzed together. Median baseline serum cobalamin concentration was 424 ng/L (range, 178 to 1,880 ng/L). Values for serum samples stored with daylight exposure at room temperature were significantly lower over time than were values for refrigerated samples. Although values for refrigerated samples did not decrease significantly from baseline values over time, values for the other storage condition did; however, the mean percentage decrease for serum samples stored at room temperature was small (0.14%/h; 95% confidence interval, 0.07% to 0.21%/h). CONCLUSIONS AND CLINICAL RELEVANCE Overall, serum cobalamin concentration appeared stable for 5 days when feline and canine serum samples were refrigerated at 6°C. The effect of light and room temperature on serum cobalamin concentration, although significant, was quite small for samples stored with these exposures for the same 5-day period.
Collapse
|
13
|
Gianella P, Pietra M, Crisi PE, Famigli Bergamini P, Fracassi F, Morini M, Boari A. Evaluation of clinicopathological features in cats with chronic gastrointestinal signs. Pol J Vet Sci 2017; 20:403-410. [PMID: 28865226 DOI: 10.1515/pjvs-2017-0052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Food-responsive enteropathy (FRE), idiopathic inflammatory bowel disease (IBD), and alimentary tract lymphoma (AL) are often the remaining differentials for cats presenting with chronic gastrointestinal (GI) signs. Differential diagnosis is further complicated by overlapping clinicopathological features and histopathological changes, however. In this study we describe the clinical presentation of cats with chronic GI signs secondary to FRE, IBD, and AL, and evaluate possible associations between clinical, clinicopathological, ultrasonographic findings and diagnosis. The medical records of client-owned cats with chronic GI signs secondary to FRE, IBD, and AL were reviewed. Univariate and multivariate logistic regression models and receiver-operating characteristic curve (ROC) analysis were used for testing the data. Of the 56 cats included in the study, 22 were diagnosed with FRE (mean age, 70 months ± 49), 17 with IBD (mean age, 101 months ± 40), and 17 with AL (mean age, 122 months ± 45). Cats with FRE were younger and presented more often with diarrhea and less frequently with muscle wasting than cats with IBD or AL. In cats with AL, serum cobalamin levels were lower than in those with FRE or IBD (239 ± 190 ng/L vs. 762 ± 408 ng/L and 625 ± 443 ng/L, respectively) and folate levels were higher than in cats with IBD (18.2 ± 4.2 μg/L vs. 9.1 ± 4.7 μg/L, respectively). Multivariate/ROC curve analysis showed increased values of BUN (sensitivity 100, specificity 29.4, criterion >37 mg/dl) and serum folate (sensitivity 80, specificity 100, criterion >15.6 μg/L) and reduced values of cobalamin (sensitivity 100, specificity 62.5, criterion ≤540 ng/L), which suggested a diagnosis of AL versus IBD. Some clinicopathological features evaluated at diagnosis might suggest AL; however, because differentiating AL from IBD is often difficult, definitive diagnosis should be based on invasive diagnostic workup.
Collapse
|
14
|
Kempf J, Hersberger M, Melliger RH, Reusch CE, Kook PH. Effects of 6 Weeks of Parenteral Cobalamin Supplementation on Clinical and Biochemical Variables in Cats with Gastrointestinal Disease. J Vet Intern Med 2017; 31:1664-1672. [PMID: 28895200 PMCID: PMC5697208 DOI: 10.1111/jvim.14830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/17/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022] Open
Abstract
Background Effects and duration of commonly used protocols for cobalamin (Cbl) supplementation on cellular Cbl deficiency have not been determined in hypocobalaminemic cats. Hypothesis/Objectives To evaluate effect of Cbl supplementation on clinical signs, serum and urine methylmalonic acid (MMA) concentrations over 16 weeks. Animals Twenty client‐owned hypocobalaminemic cats with enteropathy. Methods Prospective study. Serum Cbl and serum and urine MMA concentrations were determined prospectively in cats at enrollment (t0), immediately before (t6), and 4 (t10) and 10 weeks (t16) after 6th Cbl injection (250 μg, IM q 7 days). Clinical signs severity (activity, appetite, vomiting, diarrhea, body weight) graded at each time point and expressed as clinical disease activity score. Results Clinical disease activity score decreased during supplementation and increased after treatment discontinuation. Median serum Cbl concentration increased significantly from t0 (111 pmol/L, range 111–212) to t6 (2,332.5 pmol/L, range 123–22,730) (P < 0.01). Values at t10 were 610.5 pmol/L (range, 111–2,527) and 180.5 pmol/L (range, 111–2,262) at t16 (P < 0.01). Median baseline serum MMA concentration (372 μmol/L, range 0.39–147,000) decreased significantly to 1.62 μmol/L (range, 0.18–806) at t6 (P < 0.01) and gradually increased to 5.34 μmol/L (range, 0.13–1,730) at t10 and 189 μmol/L (range, 0.4–983) at t16. Similar, nonsignificant, pattern observed for urine MMA concentration. Serum and urine MMA concentrations had not normalized in 12 and 6 cats, respectively, at t6. Conclusion and Clinical Importance The Cbl supplementation protocol used here did not lead to complete normalization of cellular Cbl deficiency in all examined cats, and biochemical improvements were transient.
Collapse
Affiliation(s)
- J Kempf
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - M Hersberger
- Department of Clinical Chemistry, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - C E Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - P H Kook
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| |
Collapse
|
15
|
Jugan MC, August JR. Serum cobalamin concentrations and small intestinal ultrasound changes in 75 cats with clinical signs of gastrointestinal disease: a retrospective study. J Feline Med Surg 2017; 19:48-56. [PMID: 26239940 PMCID: PMC10816748 DOI: 10.1177/1098612x15598184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The aim of the study was to evaluate ultrasonographic changes in the small intestine of cats with clinical signs of gastrointestinal disease and low or low-normal serum cobalamin concentrations. Methods Records for client-owned cats presenting to the small animal hospital with signs of gastrointestinal disease and in which serum cobalamin concentrations were measured from 2000-2013 were reviewed. Inclusion criteria were cobalamin concentrations <500 ng/l, abdominal ultrasound within 1 month of cobalamin testing and definitive diagnosis. Results Of 751 serum cobalamin measurements, hypocobalaminemia or low-normal cobalamin was identified in 270 cats, abdominal ultrasound was performed in 207 of those cats and a diagnosis was available for 75 of them. Small intestinal ultrasound changes were detected in 49/75 (65%) cats. Abnormalities included thickening, loss of wall layer definition, echogenicity alterations and discrete masses. Serum cobalamin concentrations <500 ng/l were observed with diagnoses of inflammatory disease, neoplasia, infectious disease and normal histopathology. Cobalamin concentration was significantly lower in cats with lymphoma or inflammatory bowel disease compared with other gastrointestinal neoplasia ( P = 0.031). No difference was found between cobalamin concentration and the presence of ultrasound abnormalities, specific ultrasound changes or albumin concentration. Conclusions and relevance One-third of symptomatic cats with hypocobalaminemia or low-normal cobalamin concentrations may have an ultrasonographically normal small intestine. For the majority of cats in this study, histopathologic abnormalities were observed in the small intestine, regardless of ultrasound changes. These findings suggest gastrointestinal disease should not be excluded based on low-normal cobalamin concentrations, even with a concurrent normal ultrasound examination. Additional studies are needed in cats with low-normal serum cobalamin concentrations, as a definitive diagnosis was not pursued consistently in those cats. However, data from this study suggest that careful monitoring, histopathologic evaluation and future cobalamin supplementation may be warranted.
Collapse
Affiliation(s)
- Maria C Jugan
- Department of Small Animal Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - John R August
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| |
Collapse
|
16
|
Xenoulis PG, Zoran DL, Fosgate GT, Suchodolski JS, Steiner JM. Feline Exocrine Pancreatic Insufficiency: A Retrospective Study of 150 Cases. J Vet Intern Med 2016; 30:1790-1797. [PMID: 27641602 PMCID: PMC5115185 DOI: 10.1111/jvim.14560] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/19/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022] Open
Abstract
Background Little information is available about the clinical presentation and response to treatment of cats with exocrine pancreatic insufficiency (EPI). Objectives To describe the signalment, clinical signs, concurrent diseases, and response to treatment of cats with EPI. Animals One hundred and fifty cats with EPI. Methods Retrospective case series. Results Questionnaires were sent to 261 veterinarians, and 150 (57%) were returned with data suitable for statistical analysis. The median age of the cats with EPI was 7.7 years. The median body condition score was 3 of 9. Ninety‐two of 119 cats (77%) had hypocobalaminemia, and 56 of 119 cats (47%) had increased and 6 of 119 cats (5%) had decreased serum folate concentrations. Clinical signs included weight loss (91%), unformed feces (62%), poor hair coat (50%), anorexia (45%), increased appetite (42%), lethargy (40%), watery diarrhea (28%), and vomiting (19%). Eighty‐seven cats (58%) had concurrent diseases. Treatment response was reported to be good in 60%, partial in 27%, and poor in 13% of 121 cats. Trypsin‐like immunoreactivity <4 μg/L was associated with a positive response to treatment (OR, 3.2; 95% CI, 1.5–7.0; P = .004). Also, cobalamin supplementation improved the response to treatment (OR, 3.0; 95% CI, 1.4–6.6; P = .006). Conclusions and Clinical Importance Exocrine pancreatic insufficiency in cats often has a different clinical presentation than in dogs. The age range for EPI in cats is wide, and many cats can be ≤5 years of age. Most cats respond well to appropriate treatment for EPI, and cobalamin supplementation appears to be necessary for a good response.
Collapse
Affiliation(s)
- P G Xenoulis
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX
| | - D L Zoran
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX
| | - G T Fosgate
- Department of Production Animal Studies, University of Pretoria, Onderstepoort, South Africa
| | - J S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX
| | - J M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX
| |
Collapse
|
17
|
Grützner N, Knabe D, Lawhorn BD, Dominguez B, Kauffold J, Suchodolski JS, Steiner JM. Analytic validation of commercially available immunoassays for the measurement of serum cobalamin and folate concentrations in pigs. Vet Clin Pathol 2016; 45:311-9. [DOI: 10.1111/vcp.12361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Niels Grützner
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - Darrel Knabe
- Department of Animal Science; Texas A&M University; College Station TX USA
| | - Bruce D. Lawhorn
- Department of Veterinary Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - Brandon Dominguez
- Department of Veterinary Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - Johannes Kauffold
- New Bolton Center; School of Veterinary Medicine; University of Pennsylvania; Kennett Square PA USA
| | - Jan S. Suchodolski
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - Jörg M. Steiner
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| |
Collapse
|
18
|
Geesaman BM, Whitehouse WH, Viviano KR. Serum Cobalamin and Methylmalonic Acid Concentrations in Hyperthyroid Cats Before and After Radioiodine Treatment. J Vet Intern Med 2016; 30:560-5. [PMID: 26934857 PMCID: PMC4913605 DOI: 10.1111/jvim.13918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/24/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Hyperthyroidism, the most common endocrine disorder in cats, has been associated with low serum cobalamin concentrations. Whether this is a functional cobalamin deficiency of clinical importance has not been assessed. HYPOTHESIS/OBJECTIVES Cats with hyperthyroidism experience a functional cobalamin deficiency which correlates with their clinical catabolic state and is reversible with return of the euthyroid state. ANIMALS Thirty-nine client-owned hyperthyroid cats. METHODS Prospective observational study. Serum cobalamin, methylmalonic acid, and clinical scores were determined in each hyperthyroid cat at enrollment and when euthyroid (60 days after radioiodine treatment). RESULTS Five of the 39 hyperthyroid cats (13%) had a low serum cobalamin concentration ranging from <150 to 290 ng/L. Serum cobalamin concentrations normalized to >350 ng/L in 2 of the hypocobalaminemic cats once euthyroid. None of the hyperthyroid/hypocobalaminemic cats had increased serum methylmalonic acid concentrations (175-601 nmol/L). In cats with clinical and biochemical hyperthyroidism, there was no correlation between serum cobalamin concentrations with total T4 concentration (P = .12) or clinical scores including body weight (P = .11) and BCS (P = .54). CONCLUSIONS AND CLINICAL IMPORTANCE In this population of hyperthyroid cats, the prevalence of hypocobalaminemia was low. Specifically, hyperthyroid cats, in which concurrent gastrointestinal disease is unlikely. Hypocobalaminemia is not a functional deficiency requiring supplementation in hyperthyroid cats without gastrointestinal disease.
Collapse
Affiliation(s)
- B M Geesaman
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI
| | - W H Whitehouse
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI
| | - K R Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI
| |
Collapse
|
19
|
Grützner N, Gebhart CJ, Lawhorn BD, Suchodolski JS, Steiner JM. Serum folate, cobalamin, homocysteine and methylmalonic acid concentrations in pigs with acute, chronic or subclinical Lawsonia intracellularis infection. Vet J 2014; 203:320-5. [PMID: 25618855 DOI: 10.1016/j.tvjl.2014.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 10/02/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
Abstract
Lawsonia intracellularis is the causative agent of porcine proliferative enteropathy. The clinical presentation can be acute (i.e. proliferative hemorrhagic enteropathy, PHE), chronic (i.e. porcine intestinal adenomatosis, PIA) or subclinical. In humans with chronic enteropathies, low serum folate (vitamin B(9)) and cobalamin (vitamin B(12)) concentrations have been associated with increased serum concentrations of homocysteine and methylmalonic acid (MMA), which reflect the availability of both vitamins at the cellular level. The aim of this study was to evaluate serum folate, cobalamin, homocysteine and MMA concentrations in serum samples from pigs with PHE, PIA or subclinical L. intracellularis infection, and in negative controls. Serum folate, cobalamin, homocysteine and MMA concentrations differed significantly among pigs in the PHE, PIA, subclinical and negative control groups. Serum folate concentrations in the PHE and PIA groups were lower than in the subclinical and negative control groups, while serum cobalamin concentrations were lower in the PIA group than in other groups. Serum concentrations of homocysteine were higher in the PHE, PIA and subclinical groups than in the negative control group. Serum concentrations of MMA were higher in the subclinical and PIA groups than in the control group. These data suggest that pigs infected with L. intracellularis have altered serum cobalamin, folate, homocysteine and MMA concentrations.
Collapse
Affiliation(s)
- Niels Grützner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
| | - Connie J Gebhart
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Bruce D Lawhorn
- Veterinary Large Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
| | - Jan S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Jörg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| |
Collapse
|
20
|
Trehy MR, German AJ, Silvestrini P, Serrano G, Batchelor DJ. Hypercobalaminaemia is associated with hepatic and neoplastic disease in cats: a cross sectional study. BMC Vet Res 2014; 10:175. [PMID: 25103858 PMCID: PMC4236818 DOI: 10.1186/s12917-014-0175-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/22/2014] [Indexed: 11/24/2022] Open
Abstract
Background When increased serum cobalamin concentrations are encountered clinically they are usually attributed to parenteral supplementation, dietary factors, or otherwise ignored. However, recently, hypercobalaminaemia has been associated with numerous diseases in humans, most notably neoplastic and hepatic disorders. The aim of this retrospective, observational, cross-sectional study was to determine the significance of increased cobalamin in cats. Results In total, 237 records were retrieved and 174 cats, of various ages and sexes met the inclusion criteria. A total of 42 cats had increased serum cobalamin concentration, and had not received prior supplementation. Multiple logistic regression analysis revealed that increased serum cobalamin concentration was positively related to pedigree breed (pedigree breeds more likely to have increased cobalamin concentration, odds ratio [OR] 4.24, 95% CI 1.78-10.15, P = 0.001), to having liver disease (OR 9.91, 95% CI 3.54-27.68), and to having a solid neoplasm (OR 8.54, 95% CI 1.10-66.45). Conclusions The results of the current study suggest that increased serum cobalamin concentrations should not be ignored in cats with no history of supplementation, and investigation for underlying hepatic or neoplastic disease is warranted.
Collapse
Affiliation(s)
| | - Alexander J German
- School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, UK.
| | | | | | | |
Collapse
|
21
|
Worhunsky P, Toulza O, Rishniw M, Berghoff N, Ruaux CG, Steiner JM, Simpson KW. The relationship of serum cobalamin to methylmalonic acid concentrations and clinical variables in cats. J Vet Intern Med 2013; 27:1056-63. [PMID: 23875847 DOI: 10.1111/jvim.12152] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/09/2013] [Accepted: 06/06/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Serum cobalamin concentration [CBL] suggests CBL deficiency in cats but serum methylmalonic acid concentration [MMA] more accurately indicates CBL deficiency. OBJECTIVE To examine the ability of [CBL] to predict CBL deficiency defined by increased [MMA], and relationships of [CBL] and [MMA] with select clinical and clinicopathological variables. ANIMALS One hundred sixty-three client-owned cats with [CBL] measurements, 114 cats with simultaneous [MMA] measurements; 88 cats with medical information. METHODS Prospectively collected [CBL] and [MMA] were compared using scatter plots, receiver operating characteristic and correlative analyses with historical [CBL] thresholds and those identified in the study. [CBL] and [MMA] were compared retrospectively to specific clinical and clinicopathological variables. RESULTS [CBL] correlated negatively with [MMA] (τ = -0.334, P < .0001). [MMA] ≥ 1,343 nmol/L identified CBL deficiency. [CBL] = 209 pg/mL optimized sensitivity (0.51), specificity (0.96), PPV (0.89), and NPV (0.74) for detecting [MMA] ≥ 1,343 nmol/L. Prevalence of CBL deficiency was 42% (48/114) when defined by [MMA] ≥ 1,343 nmol/L versus 23% (27/114) by [CBL] ≤ 209 pg/mL. Unexpectedly, 23 and 45% of 48 cats with [MMA] ≥ 1,343 nmol/L had [CBL] > 900 pg/mL and 290 pg/mL (historical thresholds). [CBL] correlated with mean corpuscular volume (τ = -0.199, P = .013) and [MMA] with hematocrit (τ = -0.28, P = .006). CONCLUSIONS AND CLINICAL IMPORTANCE Cobalamin deficiency ([MMA] ≥ 1,343 nmol/L) occurred in 42% of cats and is predicted with high specificity by [CBL] ≤ 209 pg/mL. CBL status correlates with microcytosis and anemia. Discordance between [CBL] and [MMA] cautions against relying on any single marker for determining CBL status.
Collapse
Affiliation(s)
- P Worhunsky
- College of Veterinary Medicine, Cornell University, Ithaca, NY
| | | | | | | | | | | | | |
Collapse
|
22
|
Verbrugghe A, Bakovic M. Peculiarities of one-carbon metabolism in the strict carnivorous cat and the role in feline hepatic lipidosis. Nutrients 2013; 5:2811-35. [PMID: 23877091 PMCID: PMC3739000 DOI: 10.3390/nu5072811] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/18/2013] [Accepted: 06/21/2013] [Indexed: 12/24/2022] Open
Abstract
Research in various species has indicated that diets deficient in labile methyl groups (methionine, choline, betaine, folate) produce fatty liver and links to steatosis and metabolic syndrome, but also provides evidence of the importance of labile methyl group balance to maintain normal liver function. Cats, being obligate carnivores, rely on nutrients in animal tissues and have, due to evolutionary pressure, developed several physiological and metabolic adaptations, including a number of peculiarities in protein and fat metabolism. This has led to specific and unique nutritional requirements. Adult cats require more dietary protein than omnivorous species, maintain a consistently high rate of protein oxidation and gluconeogenesis and are unable to adapt to reduced protein intake. Furthermore, cats have a higher requirement for essential amino acids and essential fatty acids. Hastened use coupled with an inability to conserve certain amino acids, including methionine, cysteine, taurine and arginine, necessitates a higher dietary intake for cats compared to most other species. Cats also seemingly require higher amounts of several B-vitamins compared to other species and are predisposed to depletion during prolonged inappetance. This carnivorous uniqueness makes cats more susceptible to hepatic lipidosis.
Collapse
Affiliation(s)
- Adronie Verbrugghe
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - Marica Bakovic
- Department of Human Health and Nutritional Sciences, College of Biological Science, University of Guelph, Guelph, ON N1G 2W1, Canada; E-Mail:
| |
Collapse
|
23
|
Kook PH. Cobalamin deficiency states: a fine example of the One Medicine concept. Vet J 2013; 196:137-8. [PMID: 23642465 DOI: 10.1016/j.tvjl.2013.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/12/2013] [Accepted: 03/15/2013] [Indexed: 11/24/2022]
|
24
|
Ruaux CG. Cobalamin in companion animals: diagnostic marker, deficiency states and therapeutic implications. Vet J 2013; 196:145-52. [PMID: 23518469 DOI: 10.1016/j.tvjl.2013.01.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 01/08/2013] [Accepted: 01/17/2013] [Indexed: 11/16/2022]
Abstract
Measurement of the water-soluble vitamin cobalamin has long been of interest as a marker of gastrointestinal disease in companion animals due to the highly localized presence of cobalamin receptors in the ileum. An increasing body of evidence suggests that cobalamin deficiency is an important co-morbidity in many companion animal patients with gastrointestinal and pancreatic disease. Congenital disorders of cobalamin absorption and cellular metabolism are also increasingly recognized in companion animal breeds. The early recognition of these disorders and timely treatment with parenteral cobalamin can be life-saving. In this article, the normal mechanisms of cobalamin absorption, the use of cobalamin as a marker of intestinal disease and data on the prevalence of hypocobalaminemia in a variety of diseases are described. The prognostic impact of and rational therapy for hypocobalaminemia in domestic animals are discussed.
Collapse
Affiliation(s)
- C G Ruaux
- Department of Clinical Sciences, Oregon State University, College of Veterinary Medicine, Corvallis, OR 97331, USA.
| |
Collapse
|
25
|
Grützner N, Heilmann RM, Stupka KC, Rangachari VR, Weber K, Holzenburg A, Suchodolski JS, Steiner JM. Serum homocysteine and methylmalonic acid concentrations in Chinese Shar-Pei dogs with cobalamin deficiency. Vet J 2013; 197:420-6. [PMID: 23499543 DOI: 10.1016/j.tvjl.2013.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/21/2012] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
Cobalamin deficiency is suspected to be hereditary in Chinese Shar-Pei dogs (Shar-Peis), and inherited causes of cobalamin deficiency may affect the cellular processing of cobalamin. In humans, a defect of the two main cobalamin-dependent intracellular enzymes (i.e., methionine synthase and methylmalonyl-CoA mutase) may lead to hyperhomocysteinemia and hypermethylmalonic acidemia. The aim of this retrospective study was to evaluate serum homocysteine (HCY) and methylmalonic acid (MMA) concentrations in cobalamin-deficient Shar-Peis and dogs of six other breeds. Serum samples (n=297) from cobalamin-deficient dogs (Shar-Peis, German Shepherd dogs, Labrador Retrievers, Yorkshire Terriers, Boxers, Cocker Spaniels, and Beagles) were analyzed for serum HCY and MMA concentrations. A Fisher's exact test was used to evaluate if cobalamin deficiency in Shar-Peis is associated with hyperhomocysteinemia. Serum HCY and MMA concentrations were higher in cobalamin-deficient Shar-Peis compared to cobalamin-deficient dogs of the six other breeds (P<0.0001). Hyperhomocysteinemia was associated with cobalamin deficiency in Shar-Peis (P=0.009). In addition, serum HCY and MMA concentrations did not differ between cobalamin-deficient German Shepherd dogs with and without exocrine pancreatic insufficiency (EPI), a potential cause of secondary cobalamin deficiency. These findings suggest that the function of the two intracellular cobalamin-dependent enzymes is impaired in Shar-Peis with cobalamin deficiency.
Collapse
Affiliation(s)
- Niels Grützner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Grützner N, Bishop MA, Suchodolski JS, Steiner JM. Evaluation of the MYC_CANFA gene in Chinese Shar Peis with cobalamin deficiency. Vet Clin Pathol 2012; 42:61-5. [DOI: 10.1111/vcp.12010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Niels Grützner
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station; TX; USA
| | - Micah A. Bishop
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station; TX; USA
| | - Jan S. Suchodolski
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station; TX; USA
| | - Jörg M. Steiner
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station; TX; USA
| |
Collapse
|
27
|
Krick E, Cohen R, Gregor T, Salah Griessmayr P, Sorenmo K. Prospective Clinical Trial to Compare Vincristine and Vinblastine in a COP-Based Protocol for Lymphoma in Cats. J Vet Intern Med 2012; 27:134-40. [DOI: 10.1111/jvim.12006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 08/20/2012] [Accepted: 09/25/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- E.L. Krick
- Department of Clinical Studies; University of Pennsylvania School of Veterinary Medicine; Philadelphia PA 19104
| | - R.B. Cohen
- Department of Clinical Studies; University of Pennsylvania School of Veterinary Medicine; Philadelphia PA 19104
| | - T.P. Gregor
- Department of Clinical Studies; University of Pennsylvania School of Veterinary Medicine; Philadelphia PA 19104
| | - P.C. Salah Griessmayr
- Department of Clinical Studies; University of Pennsylvania School of Veterinary Medicine; Philadelphia PA 19104
| | - K.U. Sorenmo
- Department of Clinical Studies; University of Pennsylvania School of Veterinary Medicine; Philadelphia PA 19104
| |
Collapse
|
28
|
Maunder CL, Day MJ, Hibbert A, Steiner JM, Suchodolski JS, Hall EJ. Serum cobalamin concentrations in cats with gastrointestinal signs: correlation with histopathological findings and duration of clinical signs. J Feline Med Surg 2012; 14:686-93. [PMID: 22577047 PMCID: PMC11104096 DOI: 10.1177/1098612x12447730] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
The aims of this study were to investigate the prevalence of hypocobalaminaemia in UK cats presented for referral investigation of gastrointestinal signs and to ascertain whether the duration of clinical signs or severity of disease (based on WSAVA Gastrointestinal Standardization histopathological grading) related to cobalamin concentration. The study population comprised 39 cats, of which 11 (28.2%) had hypocobalaminaemia. Eight of these cats were diagnosed with a single cause of gastrointestinal signs: intestinal inflammation (five); alimentary lymphoma (two); and cholangitis (one). Two or more concurrent diseases were diagnosed in the three remaining cases. Alimentary lymphoma and the most severe grade of histological intestinal inflammation were associated most commonly with concurrent hypocobalaminaemia, but there was no statistically significant correlation between serum cobalamin concentrations and histopathological score or duration of clinical signs.
Collapse
Affiliation(s)
- Christina L Maunder
- Department of Clinical Veterinary Science, Division of Companion Animal Studies, Small Animal Hospital, University of Bristol, Bristol, UK.
| | | | | | | | | | | |
Collapse
|
29
|
Simpson K, Battersby I, Lowrie M. Suspected acquired hypocobalaminaemic encephalopathy in a cat: resolution of encephalopathic signs and MRI lesions subsequent to cobalamin supplementation. J Feline Med Surg 2012; 14:350-5. [PMID: 22511477 PMCID: PMC11132261 DOI: 10.1177/1098612x12439358] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
UNLABELLED PRESENTING SIGNS AND INITIAL INVESTIGATIONS: An 8-year-old female spayed British shorthair cat was presented with a history of waxing and waning neurological signs. Neuroanatomical localisation was consistent with a diffuse forebrain disease. Blood ammonia concentration was increased. Abdominal ultrasonography and a bile acid stimulation test were normal. Magnetic resonance imaging (MRI) revealed hyperintense, bilaterally symmetrical, diffuse lesions on T2-weighted sequences, predominantly, but not exclusively, affecting the grey matter. Serum cobalamin (vitamin B12) concentration was low. Hypocobalaminaemia resulting in a urea cycle abnormality was considered a likely cause of the hyperammonaemia. TREATMENT Daily cobalamin injections resulted in a rapid clinical improvement. Eight weeks into treatment neurological examination was unremarkable and there was complete resolution of the MRI lesions. CLINICAL IMPORTANCE This is the first reported case of acquired feline hypocobalaminaemia resulting in an encephalopathy. Additionally, this case is unique in describing reversible brain MRI abnormalities in a cobalamin-deficient companion animal.
Collapse
Affiliation(s)
- Katherine Simpson
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin SG5 3HR, UK
| | - Ian Battersby
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin SG5 3HR, UK
| | - Mark Lowrie
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin SG5 3HR, UK
| |
Collapse
|
30
|
Berghoff N, Suchodolski JS, Steiner JM. Association between serum cobalamin and methylmalonic acid concentrations in dogs. Vet J 2012; 191:306-11. [DOI: 10.1016/j.tvjl.2011.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/26/2011] [Accepted: 03/07/2011] [Indexed: 12/27/2022]
|
31
|
Dossin O. Laboratory tests for diagnosis of gastrointestinal and pancreatic diseases. Top Companion Anim Med 2011; 26:86-97. [PMID: 21596348 PMCID: PMC7104967 DOI: 10.1053/j.tcam.2011.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/28/2011] [Indexed: 11/11/2022]
Abstract
The panel of laboratory tests available for diagnosis of gastrointestinal (GI) diseases in dogs and cats is wide, and, recently, several new tests have been developed. This article will focus on advances in laboratory tests that are available for the general practitioner for diagnosis of GI diseases. Laboratory tests for diagnosis of gastric and intestinal infectious diseases include fecal parasite screening tests, enzyme-linked immunosorbent assays for parvoviral enteritis, and some specific bacterial tests like fluorescent in situ hybridization for identification of specific bacteria attached to the intestinal epithelial cells. Serum concentrations of folate and cobalamin are markers of intestinal absorption, but are also changed in exocrine pancreatic insufficiency and intestinal bacterial overgrowth. Hypocobalaminemia is common in GI and pancreatic disease. Decreased serum trypsin-like immunoreactivity is a very sensitive and specific test for the diagnosis of exocrine pancreatic insufficiency in dogs and cats. Serum pancreatic lipase is currently the most sensitive and specific test to identify pancreatic cell damage and acute pancreatitis. However, serum canine pancreas-specific lipase is less sensitive in canine chronic pancreatitis. Increased serum trypsin-like immunoreactivity is also specific for pancreatic damage but is less sensitive. It is very likely that further studies will help to better specify the role of these new tests in the diagnosis of canine and feline pancreatic diseases.
Collapse
Affiliation(s)
- Olivier Dossin
- Internal Medicine, Department of Clinical Sciences, National Veterinary School, Toulouse, France.
| |
Collapse
|
32
|
Cook AK, Suchodolski JS, Steiner JM, Robertson JE. The prevalence of hypocobalaminaemia in cats with spontaneous hyperthyroidism. J Small Anim Pract 2011; 52:101-6. [DOI: 10.1111/j.1748-5827.2010.01027.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|