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Hoopes PJ, Tavakkoli AD, Moodie KA, Maurer KJ, Meehan KR, Wallin DJ, Aulwes E, Duval KEA, Chen KL, -Burney MAC, Li C, Fan X, Evans LT, Paulsen KD. Porcine-human glioma xenograft model. Immunosuppression and model reproducibility. Cancer Treat Res Commun 2024; 38:100789. [PMID: 38262125 PMCID: PMC11026118 DOI: 10.1016/j.ctarc.2024.100789] [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: 08/08/2023] [Revised: 09/19/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Glioblastoma is the most common primary malignant and treatment-resistant human brain tumor. Rodent models have played an important role in understanding brain cancer biology and treatment. However, due to their small cranium and tumor volume mismatch, relative to human disease, they have been less useful for translational studies. Therefore, development of a consistent and simple large animal glioma xenograft model would have significant translational benefits. METHODS Immunosuppression was induced in twelve standard Yucatan minipigs. 3 pigs received cyclosporine only, while 9 pigs received a combined regimen including cyclosporine (55 mg/kg q12 h), prednisone (25 mg, q24 h) and mycophenolate (500 mg q24 h). U87 cells (2 × 106) were stereotactically implanted into the left frontal cortex. The implanted brains were imaged by MRI for monitoring. In a separate study, tumors were grown in 5 additional pigs using the combined regimen, and pigs underwent tumor resection with intra-operative image updating to determine if the xenograft model could accurately capture the spatial tumor resection challenges seen in humans. RESULTS Tumors were successfully implanted and grown in 11 pigs. One animal in cyclosporine only group failed to show clinical tumor growth. Clinical tumor growth, assessed by MRI, progressed slowly over the first 10 days, then rapidly over the next 10 days. The average tumor growth latency period was 20 days. Animals were monitored twice daily and detailed records were kept throughout the experimental period. Pigs were sacrificed humanely when the tumor reached 1 - 2 cm. Some pigs experienced decreased appetite and activity, however none required premature euthanasia. In the image updating study, all five pigs demonstrated brain shift after craniotomy, consistent with what is observed in humans. Intraoperative image updating was able to accurately capture and correct for this shift in all five pigs. CONCLUSION This report demonstrates the development and use of a human intracranial glioma model in an immunosuppressed, but nongenetically modified pig. While the immunosuppression of the model may limit its utility in certain studies, the model does overcome several limitations of small animal or genetically modified models. For instance, we demonstrate use of this model for guiding surgical resection with intraoperative image-updating technologies. We further report use of a surrogate extracranial tumor that indicates growth of the intracranial tumor, allowing for relative growth assessment without radiological imaging.
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Affiliation(s)
- P Jack Hoopes
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Thayer School of Engineering, Dartmouth College, Hanover, NH, USA; Center for Comparative Medicine and Research, Dartmouth College, Lebanon, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA.
| | | | - Karen A Moodie
- Center for Comparative Medicine and Research, Dartmouth College, Lebanon, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
| | - Kirk J Maurer
- Center for Comparative Medicine and Research, Dartmouth College, Lebanon, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
| | - Kenneth R Meehan
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
| | | | - Ethan Aulwes
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Kayla E A Duval
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Kristen L Chen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Margaret A Crary -Burney
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Center for Comparative Medicine and Research, Dartmouth College, Lebanon, NH, USA
| | - Chen Li
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Linton T Evans
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
| | - Keith D Paulsen
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Thayer School of Engineering, Dartmouth College, Hanover, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
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Beasley MJ, Shores A. Perspectives on pharmacologic strategies in the management of meningoencephalomyelitis of unknown origin in dogs. Front Vet Sci 2023; 10:1167002. [PMID: 37234070 PMCID: PMC10205981 DOI: 10.3389/fvets.2023.1167002] [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: 02/15/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
There are many non-infectious inflammatory diseases, assumed to be immune-mediated in origin, recognized to affect the nervous system in canine patients. Concentrating on meningoencephalomyelitis of unknown origin, we will discuss the medications used to treat the underlying disease process, focusing on their adverse effects, therapeutic monitoring when necessary and effectiveness. The literature overwhelmingly supports the use of a steroid/ Cytosar® or steroid/ cyclosporine treatment protocol with the steroid tapered after the acute phase of the disease, leaving the secondary medication to control the disease long term. The decision on when and how quickly to taper the steroid is clinician dependent as a best practices has not been established in the literature. Also discussed will be the supportive care treatments often needed in the acute phase of these patients' diagnosis and treatment such as anti-edema and anti-epileptic agents.
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Affiliation(s)
- Michaela J. Beasley
- College of Veterinary Medicine, Mississippi State University, Starkville, MS, United States
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Goggs R. Therapeutic Strategies for Treatment of Immune-Mediated Hemolytic Anemia. Vet Clin North Am Small Anim Pract 2020; 50:1327-1349. [PMID: 32814628 DOI: 10.1016/j.cvsm.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Immune-mediated hemolytic anemia is a common hematologic disorder in dogs. Disease management involves immunosuppression using glucocorticoids, potentially in combination with other medications such as azathioprine, cyclosporine, or mycophenolate mofetil. Therapeutic drug monitoring may enhance the utility and maximize the safety of cyclosporine and mycophenolate mofetil. The disease is proinflammatory and prothrombotic. Antithrombotic drug administration is therefore essential, and anticoagulant therapy should be initiated at the time of diagnosis. Additional therapies include red blood cell transfusion to support blood oxygen content. Future therapies may include therapeutic plasma exchange, anti-CD20 monoclonal antibodies, and complement inhibitors.
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Affiliation(s)
- Robert Goggs
- Emergency and Critical Care, Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY 14853, USA.
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Sato M, Veir JK, Shropshire SB, Lappin MR. Ehrlichia canis in dogs experimentally infected, treated, and then immune suppressed during the acute or subclinical phases. J Vet Intern Med 2020; 34:1214-1221. [PMID: 32267035 PMCID: PMC7255653 DOI: 10.1111/jvim.15750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/19/2020] [Indexed: 11/30/2022] Open
Abstract
Background Concerns for recrudescence of Ehrlichia canis infection arise when immunosuppressive drugs are used to treat immune‐mediated diseases in dogs previously infected with E. canis. Objectives Determine whether administration of prednisolone and cyclosporine would reactivate E. canis infection in dogs previously treated with doxycycline during the acute or subclinical phases. Animals Seven beagles previously experimentally infected with E. canis and administered doxycycline for 4 weeks were included. Three of the 7 dogs were incidentally concurrently infected with Anaplasma platys and Babesia vogeli and were administered 2 doses of imidocarb 2 weeks apart before enrollment in the current study. Methods Experimental study. Each dog was administered prednisolone and cyclosporine for 6 weeks. Clinical signs, complete blood cell count (CBC), polymerase chain reaction (PCR) assays for E. canis, A. platys, and B. vogeli DNA in blood, E. canis indirect fluorescent antibodies (IFA) titers, and flow cytometry for antiplatelet antibodies were monitored. Results All dogs completed the immunosuppressive protocol. No evidence for recrudescence of E. canis, A. platys, or B. vogeli were detected based on clinical signs or results of CBC, PCR, IFA, and flow cytometry for antiplatelet antibodies. E. canis IFA titers were negative in 5/7 dogs at the end of immunosuppressive protocol and were negative 6 months after the protocol in 5/5 dogs available for testing. Conclusions and Clinical Importance Dogs administered with a 4‐week course of doxycycline with or without imidocarb failed to show evidence of activation of E. canis infection after administration of a commonly used immune suppressive protocol.
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Affiliation(s)
- Masahiko Sato
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Julia K Veir
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Sarah B Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Michael R Lappin
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Mackin AJ, Riggs C, Beatty T, Mealey K, Boothe D, Archer T. Excessive Cyclosporine-Associated Immunosuppression in a Dog Heterozygous for the MDR1 (ABCB1-1Δ) Mutation. J Am Anim Hosp Assoc 2020; 56:190. [PMID: 32182109 DOI: 10.5326/jaaha-ms-7004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pharmacodynamic monitoring was used to titrate cyclosporine dosing in a dog with immune-mediated hemolytic anemia. Development of a suspected secondary infection, with subsequent discovery of an unexpectedly high level of T-cell suppression despite a relatively low cyclosporine dose, prompted an investigation into the cause of possible excessive immunosuppression. Blood cyclosporine concentrations were within expected target ranges, and the dog was determined to be heterozygous for the multidrug resistance protein 1 (MDR1; ATP-binding cassette sub family B member 1-1Δ) gene mutation. The MDR1 mutation was suspected to have contributed to the excessive immunosuppression experienced by this patient. This case highlights the need to monitor immunosuppressive therapy in the individual patient, especially when the patient is not responding to therapy at typical dosages or when secondary infections develop at dosages lower than expected to cause significant immunosuppression. Pharmacodynamic monitoring can be used to help identify unexpected excessive immunosuppression in dogs receiving cyclosporine, and MDR1 genotyping should be further explored as a potential method of predicting and preventing its occurrence.
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Affiliation(s)
- Andrew J Mackin
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Caitlin Riggs
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Todd Beatty
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Katrina Mealey
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Dawn Boothe
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Todd Archer
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
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Archer TM, Mulligan C, Narayanan L, Riggs C, Fellman C, Thomason JM, Wills RW, Boothe DM, Cruz-Espindola C, Harmon R, Mackin AJ. Effects of oral administration of 5 immunosuppressive agents on activated T-cell cytokine expression in healthy dogs. J Vet Intern Med 2020; 34:1206-1213. [PMID: 32052895 PMCID: PMC7255661 DOI: 10.1111/jvim.15729] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/31/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Dogs are often adminstered >1 immunosuppressive medication when treating immune-mediated diseases, and determining whether these different medications affect IL-2 expression would be useful when performing pharmacodynamic monitoring during cyclosporine therapy. HYPOTHESIS/OBJECTIVES To determine the effects of 5 medications (prednisone, cyclosporine, azathioprine, mycophenolate mofetil, and leflunomide) on activated T-cell expression of the cytokines IL-2 and interferon-gamma (IFN-γ). ANIMALS Eight healthy dogs. METHODS Randomized, cross-over study comparing values before and after treatment, and comparing values after treatment among drugs. Dogs were administered each drug at standard oral doses for 1 week, with a washout of at least 21 days. Activated T-cell expression of IL-2 and IFN-γ mRNA was measured by quantitative reverse transcription polymerase chain reaction. Blood drug concentrations were measured for cyclosporine, mycophenolate, and leflunomide metabolites. RESULTS Least squares means (with 95% confidence interval) before treatment for IL-2 (2.91 [2.32-3.50] ΔCt) and IFN-γ (2.33 [1.66-3.00 ΔCt]) values were significantly lower (both P < .001) than values after treatment (10.75 [10.16-11.34] and 10.79 [10.11-11.46] ΔCt, respectively) with cyclosporine. Similarly, least squares means before treatment for IL-2 (1.55 [1.07-2.02] ΔCt) and IFN-γ (2.62 [2.32-2.92] ΔCt) values were significantly lower (both P < .001) than values after treatment (3.55 [3.06-4.00] and 5.22 [4.92-5.52] ΔCt, respectively) with prednisone. Comparing delta cycle threshold values after treatment among drugs, cyclosporine was significantly different than prednisone (IL-2 and IFN-γ both P < .001), with cyclosporine more suppressive than prednisone. CONCLUSIONS AND CLINICAL IMPORTANCE Prednisone and cyclosporine both affected expression of IL-2 and IFN-γ, suggesting that both have the ability to influence results when utilizing pharmacodynamic monitoring of cyclosporine treatment.
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Affiliation(s)
- Todd M Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Charlee Mulligan
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Lakshmi Narayanan
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Caitlin Riggs
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Claire Fellman
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi.,Department of Clinical Sciences, Tufts University, North, MA
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Robert W Wills
- Department of Population and Preventative Medicine, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Dawn M Boothe
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Crisanta Cruz-Espindola
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Roy Harmon
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
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Narayanan L, Mulligan C, Durso L, Thames B, Thomason J, Fellman C, Mackin A, Wills R, Archer T. Recovery of T-cell function in healthy dogs following cessation of oral cyclosporine administration. Vet Med Sci 2020; 6:277-282. [PMID: 31914237 PMCID: PMC7397919 DOI: 10.1002/vms3.230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/30/2019] [Accepted: 12/08/2019] [Indexed: 11/30/2022] Open
Abstract
Cyclosporine is a potent immunosuppressive agent used to treat immune‐mediated disorders in dogs. Secondary infections sometimes necessitate withdrawal of cyclosporine, but it is not known how long it takes for the immune system to recover after cessation of cyclosporine. Our goal was to utilize a validated RT‐qPCR assay in dogs to assess recovery time of the T‐cell cytokines IL‐2 and IFN‐γ after discontinuation of cyclosporine. Six healthy dogs were given oral cyclosporine (10 mg/kg every 12 hr) for 1 week, with samples collected for measurement of cytokine gene expression prior to treatment, and on the last day of therapy. Cyclosporine was then discontinued, and samples were collected daily for an additional 7 days. Results revealed that there was a significant difference in cytokine expression when comparing pre‐treatment and immediate post‐treatment values, corresponding to marked suppression of T‐cell function. There was no significant difference between pre‐treatment values for either cytokine when compared with any day during the recovery period. Cytokine expression, evaluated as a percentage of pre‐treatment baseline samples, demonstrated progressing return of T‐cell function after drug cessation, with full recovery seen in all dogs by Day 4 of the recovery period.
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Affiliation(s)
- Lakshmi Narayanan
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Charlee Mulligan
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Lisa Durso
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Brittany Thames
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - John Thomason
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Claire Fellman
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Andrew Mackin
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Robert Wills
- Department of Pathobiology and Population Medicine, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Todd Archer
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
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Cridge H, Kordon A, Pinchuk LM, Wills RW, Thomason JM, Mackin AJ, Archer TM. Effects of cyclosporine on feline lymphocytes activated in vitro. Vet Immunol Immunopathol 2019; 219:109962. [PMID: 31710907 DOI: 10.1016/j.vetimm.2019.109962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
Cyclosporine A (CsA) is a calcineurin inhibitor that is known to decrease lymphocyte expression of NFAT-regulated cytokines in humans, dogs and cats, and thereby depress lymphocyte function. Less is known about the effects of CsA on lymphocytes in cats than in other species. Peripheral blood mononuclear cells (PBMCs) were isolated from 6 healthy cats. PBMCs were exposed to i) no treatment, ii) 5 μg/ml concavalin A (ConA), iii) 500 ng/ml CsA and iv) 5 μg/ml ConA and 500 ng/ml CsA. The effects of CsA on cell proliferation were assessed via live and necrotic cell counts from day 1 to day 6. Additionally, flow cytometry was utilized to determine the effect of CsA on apoptosis in feline lymphocytes at day 1 and day 5. ConA exposure resulted in increases in cell counts from day 1 to 6, peaking at day 5. CsA inhibited cell proliferation, indicated via decreased live lymphocyte cell counts in the cell cultures exposed to ConA and CsA, compared to the cell cultures exposed to ConA only. Furthermore, CsA induced early and late apoptotic changes in feline PBMCs. Differences in these responses may influence an individual cat's response to cyclosporine therapy.
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Affiliation(s)
- Harry Cridge
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA.
| | - Adef Kordon
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Leysa M Pinchuk
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Robert W Wills
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Todd M Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
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Ullal T, Ambrosini Y, Rao S, Webster CRL, Twedt D. Retrospective evaluation of cyclosporine in the treatment of presumed idiopathic chronic hepatitis in dogs. J Vet Intern Med 2019; 33:2046-2056. [PMID: 31393054 PMCID: PMC6766481 DOI: 10.1111/jvim.15591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 07/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background The etiology of idiopathic chronic hepatitis (ICH) in dogs is poorly understood, but evidence supports an immune‐mediated pathogenesis in some dogs. Objectives To describe a case series of dogs with presumed ICH treated with cyclosporine (CsA) with or without concurrent medications and to document the incidence of biochemical remission and factors associated with failure to attain remission. Animals Forty‐eight client‐owned dogs diagnosed with presumed ICH, treatment of which included CsA. Methods Two‐institution, retrospective case series of dogs between 2010 and 2017. All dogs were treated with CsA with or without concurrent medications for ≥2 weeks. Data were collected from medical records. Results Biochemical remission (<1.1 times the upper limit of normal for alanine aminotransferase activity) was attained in 79% of dogs (38/48). Median dose of CsA at remission was 7.9 mg/kg/d (range, 2.5‐12.7 mg/kg/d) and median time to remission was 2.5 months (range, 0.75‐18 months). Concurrent hepatoprotectant treatment was not associated with likelihood of remission. Clinical score, ascites, hypoalbuminemia, hyperbilirubinemia, prolonged coagulation times, dose, and duration of treatment were not associated with the probability of remission or time to remission. Common adverse effects of CsA were gastrointestinal signs in 38% (18/48) and gingival hyperplasia in 25% (12/48) of treated dogs. Conclusion and Clinical Importance A treatment regimen including CsA and frequent hepatoprotectant use resulted in biochemical remission of ICH in most dogs. None of the evaluated factors, including hepatoprotectant use, were significantly associated with likelihood of remission. Future prospective studies are indicated to evaluate CsA monotherapy in ICH dogs.
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Affiliation(s)
- Tarini Ullal
- Colorado State University, Fort Collins, Colorado
| | - Yoko Ambrosini
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts
| | - Sangeeta Rao
- Colorado State University, Fort Collins, Colorado
| | - Cynthia R L Webster
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts
| | - David Twedt
- Colorado State University, Fort Collins, Colorado
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Effects of cyclosporine and dexamethasone on canine T cell expression of interleukin-2 and interferon-gamma. Vet Immunol Immunopathol 2019; 216:109892. [PMID: 31446206 DOI: 10.1016/j.vetimm.2019.109892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/07/2018] [Accepted: 07/08/2019] [Indexed: 12/12/2022]
Abstract
Cyclosporine and glucocorticoids are powerful immunosuppressive agents used to treat many inflammatory diseases in dogs. Cyclosporine inhibits calcineurin-dependent pathways of T cell activation and resultant T cell cytokine production, and glucocorticoids directly inhibit genes coding for cytokines. Little work has been done comparing the effects of these agents on T cell cytokine production in dogs. Our study measured T cell interleukin-2 (IL-2) and interferon-gamma (IFN-γ) production using flow cytometry and T cell IL-2 and IFN-γ gene expression using quantitative reverse transcription polymerase chain reaction (qRT-PCR) in activated canine T cells incubated with cyclosporine and dexamethasone in vitro. For flow cytometric assays, diluted whole blood was cultured for 7 h in the presence of cyclosporine (10, 100, 500, and 1000 ng/mL) or dexamethasone (10 ng/mL, 100 ng/mL, 1 μg/mL, and 10 μg/mL). For qRT-PCR, whole blood was cultured for 5 h with the same drugs at the same concentrations, and RNA was then extracted from leukocytes. Flow cytometry and qRT-PCR both demonstrated inhibition of IL-2 and IFN-γ that was concentration-dependent in response to cyclosporine, and was more variable for dexamethasone. Quantitative RT-PCR but not flow cytometry documented significant reduction of IL-2 expression after dexamethasone treatment, while both methods showed concentration-dependent suppression of IFN-γ. Quantitative RT-PCR also revealed additional cytokine suppression at higher cyclosporine concentrations, an effect not found using flow cytometry, and may therefore be the preferred method for cytokine determination in dogs. Suppression of IL-2 and IFN-γ in activated T cells may have potential as an indicator of the efficacy of cyclosporine and glucocorticoids in suppressing canine T cell function in vivo, and may therefore be of value for characterizing the immunosuppression induced by these drugs in clinical patients.
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Dandrieux JR, Narayanan L, Firestone S, Archer TM, Mansfield CS. Effect of immunosuppressive drugs on cytokine production in canine whole blood stimulated with lipopolysaccharide or a combination of ionomycin and phorbol 12-myristate 13-acetate. Vet Med Sci 2019; 5:199-205. [PMID: 30663866 PMCID: PMC6498811 DOI: 10.1002/vms3.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A pharmacodynamic assay has been previously developed to monitor ciclosporin treatment in dogs by assessing inhibition of cytokine transcription after whole blood stimulation with 12-myristate 13-1 acetate and ionomycin (PMA/I). In this study, whole blood stimulation with either PMA/I or lipopolysaccharide (LPS) was used to assess the effect of multiple drugs (azathioprine, ciclosporin, mycophenolate, leflunomide and prednisone) after a 7-day treatment course on production of cytokines measured with a multiplex assay in healthy dogs (n = 4 for each treatment). Interleukin-10 (IL-10), interferon gamma (IFNγ) and tumour necrosis factor alpha (TNFα) were significantly activated by PMA/I stimulation and IL-6, IL-10 and TNFα by LPS stimulation, in the absence of immunosuppressive drugs. After ciclosporin treatment, IL-10, IFNγ and TNFα production was significantly reduced after stimulation with PMA/I compared to pre-treatment. After prednisone treatment, TNFα production was significantly reduced after stimulation with PMA/I or LPS compared to pre-treatment. No significant change was observed after treatment with azathioprine, leflunomide or mycophenolate. This methodology may be useful to monitor dogs not only treated with ciclosporin, but also with prednisone or a combination of both. Further studies are needed to assess the use of this assay in a clinical setting.
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Affiliation(s)
- Julien R.S. Dandrieux
- Department of Veterinary Clinical SciencesFaculty of Veterinary and Agricultural SciencesMelbourne Veterinary SchoolUniversity of MelbourneWerribeeVicAustralia
| | - Lakshmi Narayanan
- Department of Sustainable BioproductsMississippi State UniversityStarkvilleMSUSA
| | - Simon Firestone
- Faculty of Veterinary and Agricultural SciencesAsia‐Pacific Centre for Animal HealthUniversity of MelbourneParkvilleVicAustralia
| | - Todd M. Archer
- Department of Clinical SciencesCollege of Veterinary MedicineMississippi State UniversityMSMississippi
| | - Caroline S. Mansfield
- Department of Veterinary Clinical SciencesFaculty of Veterinary and Agricultural SciencesMelbourne Veterinary SchoolUniversity of MelbourneWerribeeVicAustralia
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Pepper A, Mansfield C, Stent A, Johnstone T. Toxoplasmosis as a cause of life-threatening respiratory distress in a dog receiving immunosuppressive therapy. Clin Case Rep 2019; 7:942-948. [PMID: 31110720 PMCID: PMC6509888 DOI: 10.1002/ccr3.2121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/09/2022] Open
Abstract
Disseminated toxoplasmosis is a potentially fatal complication in dogs receiving immunosuppressive therapy, particularly if multiple immunosuppressive drugs are used. Toxoplasmosis should be considered if signs of acute respiratory or hepatic disease develop, and diagnosis would rely on demonstration of organisms via cytology or PCR rather than a single time-point serological assay.
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Affiliation(s)
- Amy Pepper
- Faculty of Veterinary and Agricultural Sciences, Translational Research and Animal Clinical Trial Study Group (TRACTS), U‐Vet Animal Hospital WerribeeThe University of MelbourneMelbourneVictoriaAustralia
| | - Caroline Mansfield
- Faculty of Veterinary and Agricultural Sciences, Translational Research and Animal Clinical Trial Study Group (TRACTS), U‐Vet Animal Hospital WerribeeThe University of MelbourneMelbourneVictoriaAustralia
| | - Andrew Stent
- Faculty of Veterinary and Agricultural Sciences, Translational Research and Animal Clinical Trial Study Group (TRACTS), U‐Vet Animal Hospital WerribeeThe University of MelbourneMelbourneVictoriaAustralia
| | - Thurid Johnstone
- Faculty of Veterinary and Agricultural Sciences, Translational Research and Animal Clinical Trial Study Group (TRACTS), U‐Vet Animal Hospital WerribeeThe University of MelbourneMelbourneVictoriaAustralia
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13
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Riggs C, Narayanan L, Mulligan C, Wills R, Mackin A, Fellman C, Thomason J, Archer T. Alterations in activated T-cell cytokine expression in healthy dogs over the initial 7 days of twice daily dosing with oral cyclosporine. J Vet Pharmacol Ther 2019; 42:385-391. [PMID: 30933369 DOI: 10.1111/jvp.12762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 01/10/2023]
Abstract
Cyclosporine is a powerful T-cell inhibitor used in the treatment of immune-mediated and inflammatory diseases in the dog. There is limited information on how to best monitor patients on cyclosporine therapy. Currently, pharmacokinetic and pharmacodynamic assays are available. Pharmacokinetic assays that measure the concentration of cyclosporine in the blood are used to assess if an appropriate drug concentration has been achieved; however, target blood drug concentrations have not been shown to reliably correlate with suppression of T-cell function in the dog. In human transplant recipients, therapeutic drug monitoring has shifted to include pharmacodynamic-based monitoring. Our laboratory has validated a RT-qPCR assay to measure the pharmacodynamic effects of cyclosporine in the dog. In this study, activated T-cell expression of IL-2 and IFN-γ was measured using RT-qPCR daily for 7 consecutive days in 8 healthy Walker hounds receiving oral cyclosporine at a dosage of 10 mg/kg every 12 hr. Cytokine production was found to be markedly decreased within 24 hr after the initiation of cyclosporine and remained significantly decreased for the duration of the project. Based on these results, cyclosporine causes a rapid drop in T-cell cytokine production that is sustained with continued dosing in healthy dogs. Although performed in healthy dogs, this study demonstrated a marked decrease in cytokine suppression within 24 hr of drug administration, suggesting that pharmacodynamic monitoring of cyclosporine's effects on T cells could be considered within several days of commencing therapy in dogs suffering from life-threatening immune-mediated disorders.
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Affiliation(s)
- Caitlin Riggs
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Lakshmi Narayanan
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Charlee Mulligan
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Robert Wills
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Andrew Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Claire Fellman
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - John Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Todd Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
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14
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Peace AC, Kumar S, Wills R, Mackin A, Hoh CM, Archer T. Pharmacodynamic evaluation of the effects of oral melatonin on expression of the T‐cell cytokines interleukin‐2 and interferon gamma in the dog. J Vet Pharmacol Ther 2019; 42:278-284. [DOI: 10.1111/jvp.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 09/24/2018] [Accepted: 12/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Santosh Kumar
- Department of Clinical SciencesCollege of Veterinary MedicineMississippi State University Mississippi State Mississippi
| | - Robert Wills
- Department of Pathobiology and Population MedicineCollege of Veterinary MedicineMississippi State University Mississippi State Mississippi
| | - Andrew Mackin
- Department of Clinical SciencesCollege of Veterinary MedicineMississippi State University Mississippi State Mississippi
| | - Crystal M. Hoh
- BluePearl Veterinary Partners Overland Park Kansas
- Heart of Texas Veterinary Specialty Center Round Rock Texas
| | - Todd Archer
- Department of Clinical SciencesCollege of Veterinary MedicineMississippi State University Mississippi State Mississippi
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15
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Klotsman M, Sathyan G, Anderson WH, Garden OA, Shivanand P. Mycophenolic acid in patients with immune-mediated inflammatory diseases: From humans to dogs. J Vet Pharmacol Ther 2018; 42:127-138. [PMID: 30375004 DOI: 10.1111/jvp.12731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 12/26/2022]
Abstract
Mycophenolic acid (MPA), a noncompetitive, selective and reversible inhibitor of inosine 5'-monophosphate dehydrogenase (IMPDH), is an immunosuppressive agent that has a long history in medicine. Mechanistically, the inhibition of IMPDH leads to the selective and eventual arrest of T- and B-lymphocyte proliferation. Mycophenolate mofetil (MMF), the first MPA-based product to receive marketing approval over two decades ago, was originally indicated for the prophylaxis of organ rejection in human transplant patients. Given its broad immunosuppressive properties and ability to selectively inhibit lymphocyte division and effector functions, the clinical utility of MPA was subsequently explored in a host of autoimmune diseases. Human clinical studies have shown MPA to be safe and effective and support its off-label administration for immune-mediated diseases such as lupus, myasthenia gravis and atopic dermatitis. MMF became generically available in the United States in 2008, and its clinical utility is increasingly being explored as a treatment option for dogs with immune-mediated diseases. This review summarizes the available literature for MPA pharmacokinetics and pharmacodynamics, and the current status of MPA as a treatment for client-owned dogs diagnosed with immune-mediated diseases.
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Affiliation(s)
| | | | - Wayne H Anderson
- Okava Pharmaceuticals, San Francisco, California.,Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Oliver A Garden
- Clinical Sciences & Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
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16
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Kulling PM, Olson KC, Olson TL, Hamele CE, Carter KN, Feith DJ, Loughran TP. Calcitriol-mediated reduction in IFN-γ output in T cell large granular lymphocytic leukemia requires vitamin D receptor upregulation. J Steroid Biochem Mol Biol 2018; 177:140-148. [PMID: 28736298 PMCID: PMC5775933 DOI: 10.1016/j.jsbmb.2017.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023]
Abstract
Constitutively activated STAT1 and elevated IFN-γ are both characteristic of T cell large granular lymphocytic leukemia (T-LGLL), a rare incurable leukemia with clonal expansion of cytotoxic T cells due to defective apoptosis. Interferon gamma (IFN-γ) is an inflammatory cytokine that correlates with worse progression and symptomology in multiple autoimmune diseases and cancers. In canonical IFN-γ-STAT1 signaling, IFN-γ activates STAT1, a transcription factor, via phosphorylation of tyrosine residue 701 (p-STAT1). p-STAT1 then promotes transcription of IFN-γ, creating a positive feedback loop. We previously found that calcitriol treatment of the TL-1 cell line, a model of T-LGLL, significantly decreased IFN-γ secretion and p-STAT1 while increasing the vitamin D receptor (VDR) protein. Here we further explore these observations. Using TL-1 cells, IFN-γ decreased starting at 4h following calcitriol treatment, with a reduction in the intracellular and secreted protein levels as well as the mRNA content. A similar reduction in IFN-γ transcript levels was observed in primary T-LGLL patient peripheral blood mononuclear cells (PBMCs). p-STAT1 inhibition followed a similar temporal pattern and VDR upregulation inversely correlated with IFN-γ levels. Using EB1089 and 25(OH)D3, which have high or low affinity for VDR, respectively, we found that the decrease in IFN-γ correlated with the ability of EB1089, but not 25(OH)D3, to upregulate VDR. However, both compounds inhibited p-STAT1; thus the reduction of p-STAT1 is not solely responsible for IFN-γ inhibition. Conversely, cells treated with VDR siRNA exhibited decreased basal IFN-γ production upon VDR knockdown in a dose-dependent manner. Calcitriol treatment upregulated VDR and decreased IFN-γ regardless of initial VDR knockdown efficiency, strengthening the connection between VDR upregulation and IFN-γ reduction. Our findings suggest multiple opportunities to further explore the clinical relevance of the vitamin D pathway and the potential role for vitamin D supplementation in T-LGLL.
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Affiliation(s)
- Paige M Kulling
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA; Department of Pathology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Kristine C Olson
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Thomas L Olson
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Cait E Hamele
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Kathryn N Carter
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - David J Feith
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Thomas P Loughran
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA.
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17
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In vivo effects of aspirin and cyclosporine on regulatory T cells and T-cell cytokine production in healthy dogs. Vet Immunol Immunopathol 2018; 197:63-68. [DOI: 10.1016/j.vetimm.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/06/2018] [Accepted: 01/09/2018] [Indexed: 11/20/2022]
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