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Kim SH, Oh YI, Park SM, An JH, Kim TH, Kim SS, Ah JG, Seo KW, Youn HY. Retrospective evaluation of prognosis and survival with various immunosuppressants in 82 dogs diagnosed with meningoencephalitis of unknown etiology (2010-2021). BMC Vet Res 2023; 19:269. [PMID: 38087262 PMCID: PMC10714563 DOI: 10.1186/s12917-023-03800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Meningoencephalomyelitis of unknown etiology (MUE) is a comprehensive term for non-infectious inflammatory brain diseases of the central nervous system (CNS) caused by abnormal autoimmune responses. This study aims to compare the differences in survival and clinical response of MUE according to the adjuvant immunosuppressant use. Medical records of 82 dogs diagnosed with MUE were reviewed retrospectively. RESULTS The overall survival time was 769 days (range 14-2687 days). The median survival time for each adjunctive was: leflunomide 1035 days (range 126-2163 days), mycophenolate mofetil 865 days (range 39-2191 days), cyclosporin 441 days (range 11-2176 days), cytosine arabinoside 754 days (range 6-1898 days) and a combination of mycophenolate mofetil and cytosine arabinoside 132 days (range 23-1227 days). There was no significant difference in the incidence rate of adverse events according to the immunosuppressants, but moderate to severe anemia was confirmed in 3 patients (18.7%) in the leflunomide group. CONCLUSIONS The survival time and response rate of MUE dogs differed depending on which adjunctive immunosuppressants were used. Leflunomide showed a long survival time and a relatively good response rate in dogs with MUE. However, a large-scale further study with standardized doses of immunosuppressants and supportive treatment and constant monitoring interval is needed.
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Affiliation(s)
- So-Hee Kim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Ye-In Oh
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Su-Min Park
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Ju Hyun An
- Department of Veterinary Emergency and Critical Care Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Kangwon National University, Chuncheon-si, 24341, Republic of Korea
| | - Tae-Hee Kim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Sung-Soo Kim
- VIP Animal Medical Center KR, Seoul, 02830, Republic of Korea
| | - Jae-Gon Ah
- VIP Animal Medical Center KR, Seoul, 02830, Republic of Korea
| | - Kyoung-Won Seo
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Hwa-Young Youn
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea.
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Song JH, Yu DH, Hwang TS, Seung BJ, Sur JH, Kim YJ, Jung DI. Expression of platelet-derived growth factor receptor-α/ß, vascular endothelial growth factor receptor-2, c-Abl, and c-Kit in canine granulomatous meningoencephalitis and necrotizing encephalitis. Vet Med Sci 2020; 6:965-974. [PMID: 32585777 PMCID: PMC7738704 DOI: 10.1002/vms3.314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 01/21/2023] Open
Abstract
Background Given the active research on targeted therapy using tyrosine kinase (TK) inhibitors (TKIs) in the field of oncology, further studies have recently been conducted to evaluate their use in autoimmune disorders. Based on immunological investigations, previous studies have suggested that granulomatous meningoencephalomyelitis (GME) and necrotizing encephalomyelitis (NE) are similar to multiple sclerosis (MS), which is a human autoimmune demyelinating central nervous system disease. Objectives Considering this perspective, we hypothesized that canine GME and NE have significant expression of one or more TKs, which are associated with human MS pathogenesis. Methods To determine the possible use of conventional multi‐targeted TKIs as a treatment for canine GME and NE, we characterized the immunohistochemical expression of platelet‐derived growth factor receptor (PDGFR)‐α, PDGFR‐ß, vascular endothelial growth factor receptor (VEGFR)‐2, c‐Abl and c‐Kit in GME and NE samples. Results Histological samples from four dogs with GME and three with NE were retrieved. All samples stained positive for PDGFR‐ß (7/7 [100%]). PDGFR‐α and c‐Kit were expressed in 3/7 (42.8%) samples each. c‐Abl was identified in 2/7 (28.5%) samples; no sample showed VEGFR‐2 (0%) expression. Co‐expression of TKs was identified in 6/7 (85.7%) dogs. Conclusions All samples were positive for at least one or more of PDGFR‐α, PDGFR‐ß, c‐Kit and c‐Abl, which are known as the target TKs of conventional multi‐targeted TKIs. Their presence does suggest that these TKs may play a role in the pathogenesis of GME and NE. Therefore, multi‐targeted TKIs may provide benefits in the treatment of canine GME and NE by suppressing the activity of these TKs.
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Affiliation(s)
- Joong-Hyun Song
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Do-Hyeon Yu
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Tae-Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Byung-Joon Seung
- Department of Pathobiology, Small Animal Tumor Diagnostic Center, College of Veterinary Medicine, Konkuk University, Seoul, 05029, Republic of Korea
| | - Jung-Hyang Sur
- Department of Pathobiology, Small Animal Tumor Diagnostic Center, College of Veterinary Medicine, Konkuk University, Seoul, 05029, Republic of Korea
| | - Young Joo Kim
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, 91766-1854, USA
| | - Dong-In Jung
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
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Coates JR, Jeffery ND. Perspectives on Meningoencephalomyelitis of Unknown Origin. Vet Clin North Am Small Anim Pract 2014; 44:1157-85. [DOI: 10.1016/j.cvsm.2014.07.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Lowrie M, Smith PM, Garosi L. Meningoencephalitis of unknown origin: investigation of prognostic factors and outcome using a standard treatment protocol. Vet Rec 2013; 172:527. [DOI: 10.1136/vr.101431] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M. Lowrie
- Davies Veterinary Specialists; Manor Farm Business Park, Higham Gobion Hitchin Hertfordshire SG5 3HR UK
| | - P. M. Smith
- Davies Veterinary Specialists; Manor Farm Business Park, Higham Gobion Hitchin Hertfordshire SG5 3HR UK
| | - L. Garosi
- Davies Veterinary Specialists; Manor Farm Business Park, Higham Gobion Hitchin Hertfordshire SG5 3HR UK
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Park ES, Uchida K, Nakayama H. Th1-, Th2-, and Th17-Related Cytokine and Chemokine Receptor mRNA and Protein Expression in the Brain Tissues, T Cells, and Macrophages of Dogs With Necrotizing and Granulomatous Meningoencephalitis. Vet Pathol 2013; 50:1127-34. [DOI: 10.1177/0300985813488957] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- E.-S. Park
- Department of Veterinary Pathology, Faculty of Agriculture, University of Tokyo, Tokyo, Japan
| | - K. Uchida
- Department of Veterinary Pathology, Faculty of Agriculture, University of Tokyo, Tokyo, Japan
| | - H. Nakayama
- Department of Veterinary Pathology, Faculty of Agriculture, University of Tokyo, Tokyo, Japan
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Park ES, Uchida K, Nakayama H. Comprehensive Immunohistochemical Studies on Canine Necrotizing Meningoencephalitis (NME), Necrotizing Leukoencephalitis (NLE), and Granulomatous Meningoencephalomyelitis (GME). Vet Pathol 2012; 49:682-92. [DOI: 10.1177/0300985811429311] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In dogs, there are several idiopathic meningoencephalitides, such as necrotizing meningoencephalitis (NME), necrotizing leukoencephalitis (NLE), and granulomatous meningoencephalomyelitis (GME). Although they are often assumed to be immune mediated, the etiology of these diseases remains elusive. In this study, the histopathology of the lesions caused by these conditions and the inflammatory cell populations produced in response to them were examined among dogs affected with GME, NME, or NLE to understand their pathogeneses. The brain tissues of dogs with NME (n = 25), NLE (n = 5), or GME (n = 9) were used. The inflammatory cells were identified by immunohistochemistry using antibodies against CD3, IgG, CD20, CD79acy, and CD163. In NME and NLE, malacic changes were located in the cerebral cortex, as well as the cerebral white matter and thalamus, respectively. The distribution of the brain lesions in NME and NLE was breed specific. In GME, granulomatous lesions that were mostly composed of epithelioid macrophages were observed in the cerebral white matter, cerebellum, and brainstem. Although the proportions of IgG-, CD20-, and CD79acy-positive cells (B cells) were not significantly different among the GME, NME, and NLE lesions, that of CD3-positive cells (T cells) was increased in GME. In NME and NLE, CD163-positive cells (macrophages) had diffusely infiltrated the cerebral cortex and white matter, respectively. However, in GME, CD163-positive cells accumulated around the blood vessels in the cerebral and cerebellar white matter. The distributions of these lesions were quite different among GME, NME, and NLE, whereas there were no marked differences in the proportions of inflammatory cells.
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Affiliation(s)
- E. S. Park
- Department of Veterinary Pathology, Faculty of Agriculture, University of Tokyo, Tokyo, Japan
| | - K. Uchida
- Department of Veterinary Pathology, Faculty of Agriculture, University of Tokyo, Tokyo, Japan
| | - H. Nakayama
- Department of Veterinary Pathology, Faculty of Agriculture, University of Tokyo, Tokyo, Japan
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8
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Granger N, Smith PM, Jeffery ND. Clinical findings and treatment of non-infectious meningoencephalomyelitis in dogs: a systematic review of 457 published cases from 1962 to 2008. Vet J 2010; 184:290-7. [PMID: 19410487 DOI: 10.1016/j.tvjl.2009.03.031] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 03/25/2009] [Accepted: 03/27/2009] [Indexed: 11/22/2022]
Abstract
Non-infectious meningoencephalomyelitis (NIME) presents clinicians with diagnostic problems because specific diagnosis requires histopathological examination of central nervous system (CNS) tissue. In the absence of a precise diagnosis, clinicians refer instead to 'meningoencephalomyelitis of unknown origin' (MUO). This article compares published data on histopathologically diagnosed disease (granulomatous meningoencephalomyelitis and necrotising encephalitis) with information available on the clinically-defined category of MUO. Small, middle-aged female dogs are most commonly affected by all types of NIME, but there is considerable overlap in diagnostic parameters of these diseases. Future clinical trials must aim to compare prospectively two or more randomly allocated treatments and to include pre-trial power calculations. This article provides the necessary background information to permit rational patient selection on clinical presentation alone, rather than requiring CNS biopsy, thus maximising patient recruitment whilst minimising heterogeneity.
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Affiliation(s)
- Nicolas Granger
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
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Lowrie M, Penderis J, McLaughlin M, Eckersall P, Anderson T. Steroid Responsive Meningitis-Arteritis: A Prospective Study of Potential Disease Markers, Prednisolone Treatment, and Long-Term Outcome in 20 Dogs (2006-2008). J Vet Intern Med 2009; 23:862-70. [DOI: 10.1111/j.1939-1676.2009.0337.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Menaut P, Landart J, Behr S, Lanore D, Trumel C. Treatment of 11 dogs with meningoencephalomyelitis of unknown origin with a combination of prednisolone and cytosine arabinoside. Vet Rec 2008; 162:241-5. [DOI: 10.1136/vr.162.8.241] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P. Menaut
- Service de Pathologie Médicale des Carnivores Domestiques; Ecole Nationale Vétérinaire de Toulouse; 23 Chemin des Capelles 31076 Toulouse Cedex France
| | - J. Landart
- Service de Pathologie Médicale des Carnivores Domestiques; Ecole Nationale Vétérinaire de Toulouse; 23 Chemin des Capelles 31076 Toulouse Cedex France
| | - S. Behr
- Davies Veterinary Specialists; Manor Farm Business Park Higham Gobion Hertfordshire SG5 3HR
| | - D. Lanore
- Clinique Vétérinaire de la Rivière; 1 rue Pierre Loti 31830 Plaisance du Touch France
| | - C. Trumel
- Service de Pathologie Médicale des Carnivores Domestiques; Ecole Nationale Vétérinaire de Toulouse; 23 Chemin des Capelles 31076 Toulouse Cedex France
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Abstract
: Granulomatous meningoencephalomyelitis (GME) is an inflammatory disease of the central nervous system in dogs that is characterised by focal or disseminated granulomatous lesions within the brain and/or spinal cord, non-suppurative meningitis and perivascular mononuclear cuffing. The aetiology of the disease remains unknown, although an immune-mediated cause is suspected. This article reviewed the typical history, clinical signs and pathology of the condition along with current opinions on pathogenesis. The potential differential diagnoses for the disease were discussed along with current treatment options.
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Affiliation(s)
- Emma J O'Neill
- Department of Small Animal Clinical Studies, Faculty of Veterinary Medicine, University College Dublin, Ireland.
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Suzuki M, Uchida K, Morozumi M, Hasegawa T, Yanai T, Nakayama H, Tateyama S. A Comparative Pathological Study on Canine Necrotizing Meningoencephalitis and Granulomatous Meningoencephalomyelitis. J Vet Med Sci 2003; 65:1233-9. [PMID: 14665754 DOI: 10.1292/jvms.65.1233] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Canine necrotizing meningoencephalitis (NME) and granulomatous meningoencephalomyelitis (GME) were compared pathologically. Gross observation exhibited lateral ventricular dilation and discoloration, malacia and/or cavitation of the cerebrum in NME. On the contrary, gross changes were milder in GME, except for occasional visible granulomatous mass formation. Histopathologically, the lesions of NME were distributed predominantly in the cerebral cortex and various degrees of inflammatory and necrotic changes were observed according to clinical stages. Besides, microscopic lesions of GME were mainly distributed in the white matter of the cerebrum, cerebellum and brainstem, which are characterized by perivascular cuffing, multiple granulomas and leptomeningeal infiltrates. Although macrophages and lymphocytes were predominant in the inflammatory lesions of both disorders, macrophages in GME transformed into epithelioid cells and exhibited more massive infiltration. Although lectin RCA-1-reactive cells were numerous in both disorders, lysozyme immunoreactive cells in NME were fewer than that in GME. Parenchymal infiltration of MAC387-positive cells was common in GME and limited in NME. The number of CD3-positive lymphocytes in the GME lesions tended to be greater than in NME, though the difference was not statistically significant. Morphological and immunohistochemical differences of the lesions, in particular, the characteristics of infiltrative macrophages may reflect these different pathogeneses of the two disorders.
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Affiliation(s)
- Mari Suzuki
- Department of Veterinary Pathology, Faculty of Agriculture, Miyazaki University, Miyazaki, Japan
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