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Takáčová M, Bomba A, Tóthová C, Micháľová A, Turňa H. Any Future for Faecal Microbiota Transplantation as a Novel Strategy for Gut Microbiota Modulation in Human and Veterinary Medicine? Life (Basel) 2022; 12:723. [PMID: 35629390 PMCID: PMC9146664 DOI: 10.3390/life12050723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Alterations in the composition of the intestinal microbiome, also known as dysbiosis, are the result of many factors such as diet, antibiotics, stress, diseases, etc. There are currently several ways to modulate intestinal microbiome such as dietary modulation, the use of antimicrobials, prebiotics, probiotics, postbiotics, and synbiotics. Faecal microbiota transplantation (FMT) represents one new method of gut microbiota modulation in humans with the aim of reconstructing the intestinal microbiome of the recipient. In human medicine, this form of bacteriotherapy is successfully used in cases of recurrent Clostridium difficile infection (CDI). FMT has been known in large animal medicine for several years. In small animal medicine, the use of FMT is not part of normal practice.
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Affiliation(s)
- Martina Takáčová
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 041 81 Košice, Slovakia
| | - Alojz Bomba
- Prebiotix s.r.o., 024 01 Kysucké Nové Mesto, Slovakia
| | - Csilla Tóthová
- Clinic of Ruminants, University of Veterinary Medicine and Pharmacy, 041 81 Košice, Slovakia
| | - Alena Micháľová
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 041 81 Košice, Slovakia
| | - Hana Turňa
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 041 81 Košice, Slovakia
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Ziese AL, Suchodolski JS. Impact of Changes in Gastrointestinal Microbiota in Canine and Feline Digestive Diseases. Vet Clin North Am Small Anim Pract 2020; 51:155-169. [PMID: 33131916 DOI: 10.1016/j.cvsm.2020.09.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The intestinal microbiome is an important immune and metabolic organ in health and disease. Recent molecular and metabolomic approaches have provided a better characterization of different types of dysbiosis, including mucosa-adherent bacteria and functional changes in the microbiome. This article summarizes recent advances in assessment of dysbiosis, the importance of the bile acid-converting Clostridium hiranonis as an important beneficial bacterium in the canine gut, and different therapeutic approaches to dysbiosis.
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Affiliation(s)
- Anna-Lena Ziese
- Clinic of Small Animal Medicine, Ludwig Maximilian University of Munich, Veterinärstrasse 13, Munich 80539, Germany
| | - Jan S Suchodolski
- Gastrointestinal Laboratory, College of Veterinary Medicine, Texas A&M University, 4474 TAMU, College Station, TX 77845, USA.
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Lyu Y, Su C, Verbrugghe A, Van de Wiele T, Martos Martinez-Caja A, Hesta M. Past, Present, and Future of Gastrointestinal Microbiota Research in Cats. Front Microbiol 2020; 11:1661. [PMID: 32793152 PMCID: PMC7393142 DOI: 10.3389/fmicb.2020.01661] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022] Open
Abstract
The relationship between microbial community and host has profound effects on the health of animals. A balanced gastrointestinal (GI) microbial population provides nutritional and metabolic benefits to its host, regulates the immune system and various signaling molecules, protects the intestine from pathogen invasion, and promotes a healthy intestinal structure and an optimal intestinal function. With the fast development of next-generation sequencing, molecular techniques have become standard tools for microbiota research, having been used to demonstrate the complex intestinal ecosystem. Similarly to other mammals, the vast majority of GI microbiota in cats (over 99%) is composed of the predominant bacterial phyla Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria. Many nutritional and clinical studies have shown that cats' microbiota can be affected by several different factors including body condition, age, diet, and inflammatory diseases. All these factors have different size effects, and some of these may be very minor, and it is currently unknown how important these are. Further research is needed to determine the functional variations in the microbiome in disease states and in response to environmental and/or dietary modulations. Additionally, further studies are also needed to explain the intricate relationship between GI microbiota and the genetics and immunity of its host. This review summarizes past and present knowledge of the feline GI microbiota and looks into the future possibilities and challenges of the field.
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Affiliation(s)
- Yang Lyu
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Chunxia Su
- Department of Green Chemistry and Technology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Adronie Verbrugghe
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Tom Van de Wiele
- Center of Microbial Ecology and Technology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Ana Martos Martinez-Caja
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Myriam Hesta
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Strong SJ, Gookin JL, Correa MT, Banks RE. Interventions and observations associated with survival of orphaned shelter kittens undergoing treatment for diarrhea. J Feline Med Surg 2020; 22:292-298. [PMID: 30920335 PMCID: PMC10814671 DOI: 10.1177/1098612x19840459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study was to identify significant associations between treatment interventions and survival of orphaned shelter kittens with diarrhea. METHODS Orphaned kittens admitted to a large open-intake municipal animal shelter and entering a volunteer foster care provider network between April 2016 and July 2017 were studied. Individual orphaned kittens for which the care provider sought examination by shelter veterinarians because of clinical signs of diarrhea were included. Treatments administered were recorded and their association with kitten survival to adoption or transfer to a rescue partner was statistically examined. RESULTS A total of 1718 orphaned kittens were fostered, among which 220 kittens (12.8%) from 118 different litters were presented for evaluation of diarrhea. A total of 172 (78.2%) kittens underwent treatment for their diarrhea, among which 153 (89.0%) survived to adoption or transfer to a rescue partner and 19 (11.0%) died or were humanely euthanized. Kittens with diarrhea that were ⩾4 weeks of age were 24.8 times more likely to survive (95% confidence interval [CI] 6.8-89.8; P <0.0001). While controlling for age, kittens that received a vitamin and mineral supplement were 12.8 times more likely to survive (95% CI 3.1-52.5; P = 0.0004) than kittens with diarrhea that did not receive the supplement. Treatment with subcutaneous fluids, penicillin G, tube feeding, a probiotic containing Enterococcus faecium SF68, ponazuril or metronidazole did not statistically significantly increase the survival of kittens with diarrhea. CONCLUSIONS AND RELEVANCE Age ⩾4 weeks and treatment of diarrhea with a vitamin and mineral supplement favorably improves survival of orphaned kittens to adoption. Application of these findings are likely to improve the health and welfare of this population and contribute to a refinement in use of shelter resources.
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Affiliation(s)
- Sandra J Strong
- Department of Environmental Services, Wake County Animal Center, Raleigh, NC, USA
| | - Jody L Gookin
- North Carolina State University College of Veterinary Medicine, Raleigh, NC, USA
| | - Maria T Correa
- North Carolina State University College of Veterinary Medicine, Raleigh, NC, USA
| | - Ron E Banks
- Division of Comparative Medicine, University of Oklahoma, Oklahoma City, Oklahoma, USA
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Krentz T, Allen S. Bacterial translocation in critical illness. J Small Anim Pract 2017; 58:191-198. [PMID: 28186322 DOI: 10.1111/jsap.12626] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/18/2016] [Accepted: 11/08/2016] [Indexed: 12/19/2022]
Abstract
Bacterial translocation involves the passage of intestinal bacteria to extraintestinal sites and has been shown to increase morbidity and mortality in critical illness. This review outlines the pathophysiology of bacterial translocation, host defence mechanisms, and reviews the evidence for the clinical management of critically ill patients in order to minimise the negative outcomes associated with bacterial translocation.
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Affiliation(s)
- T Krentz
- Department of Emergency and Critical Care, Massachusetts Veterinary Referral Hospital, Woburn, MA, 01801, USA
| | - S Allen
- Department of Emergency and Critical Care, Massachusetts Veterinary Referral Hospital, Woburn, MA, 01801, USA
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Harada K, Sasaki A, Shimizu T. Effects of oral orbifloxacin on fecal coliforms in healthy cats: a pilot study. J Vet Med Sci 2015; 78:83-9. [PMID: 26311787 PMCID: PMC4751121 DOI: 10.1292/jvms.15-0407] [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] [Indexed: 11/22/2022] Open
Abstract
The study objective was to determine the effect of oral orbifloxacin (ORB) on antimicrobial susceptibility and composition of fecal coliforms in cats. Nine cats were randomized to two groups administered a daily oral dose of 2.5 and 5.0 mg ORB/kg for 7 days and a control group (three cats per group). Coliforms were isolated from stool samples and were tested for susceptibilities to ORB and 5 other drugs. ORB concentration in feces was measured using high-performance liquid chromatography (HPLC). The coliforms were undetectable after 2 days of ORB administration, and their number increased in most cats after termination of the administration. Furthermore, only isolates of Escherichia coli were detected in all cats before administration, and those of Citrobacter freundii were detected after termination of the administration. E. coli isolates exhibited high ORB susceptibility [Minimum inhibitory concentration (MIC), ≤0.125 µg/ml] or relatively low susceptibility (MIC, 1-2 µg/ml) with a single gyrA mutation. C. freundii isolates largely exhibited intermediate ORB susceptibility (MIC, 4 µg/ml), in addition to resistance to ampicillin and cefazolin, and harbored qnrB, but not a gyrA mutation. HPLC revealed that the peaks of mean concentration were 61.3 and 141.0 µg/g in groups receiving 2.5 and 5.0 mg/kg, respectively. Our findings suggest that oral ORB may alter the total counts and composition of fecal coliform, but is unlikely to yield highly fluoroquinolone-resistant mutants of E. coli and C. freundii in cats, possibly because of the high drug concentration in feces.
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Affiliation(s)
- Kazuki Harada
- Department of Veterinary Internal Medicine, Tottori University, 4-101 Minami, Koyama-Cho, Tottori-Shi, Tottori 680-8553, Japan
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Abstract
The close relationship between gastrointestinal (GI) microbiota and its host has an impact on the health status of an animal that reaches beyond the GI tract. A balanced microbiome stimulates the immune system, aids in the competitive exclusion of transient pathogens and provides nutritional benefits to the host. With recent rapid advances in high-throughput sequencing technology, molecular approaches have become the routinely used tools for ecological studies of the feline microbiome, and have revealed a highly diverse and complex intestinal ecosystem in the feline GI tract. The major bacterial groups are similar to those found in other mammals, with Firmicutes, Bacteroidetes, Actinobacteria and Proteobacteria constituting more than 99% of intestinal microbiota. Several nutritional studies have demonstrated that the feline microbiota can be modulated by the amount of soluble fibers (i.e., prebiotics) and macronutrients (i.e., protein content) in the diet. Initial clinical studies have suggested the presence of a dysbiosis in feline inflammatory bowel disease (IBD). Recently, metagenomic approaches have attempted to characterize the microbial gene pool. However, more studies are needed to describe the phylogenetic and functional changes in the intestinal microbiome in disease states and in response to environmental and dietary modulations. This paper reviews recent studies cataloging the microbial phylotypes in the GI tract of cats.
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Papich MG, LeVine DN, Gookin JL, Davidson GS, Stagner WC, Hayes RB. Ronidazole pharmacokinetics in cats following delivery of a delayed-release guar gum formulation. J Vet Pharmacol Ther 2012; 36:399-407. [DOI: 10.1111/jvp.12019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/14/2012] [Indexed: 11/28/2022]
Affiliation(s)
- M. G. Papich
- Department of Molecular Biomedical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
| | - D. N. LeVine
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
| | - J. L. Gookin
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
| | - G. S. Davidson
- Clinical Pharmacy Services; College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
| | - W. C. Stagner
- Department of Pharmaceutical Sciences; School of Pharmacy; Campbell University; Buies Creek NC USA
| | - R. B. Hayes
- Clinical Pharmacy Services; College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
- Rex Inpatient Pharmacy; Rex University of North Carolina Health Care; Raleigh NC USA
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Digestive System, Liver, and Abdominal Cavity. THE CAT 2012. [PMCID: PMC7158306 DOI: 10.1016/b978-1-4377-0660-4.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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.
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Affiliation(s)
- Olivier Dossin
- Internal Medicine, Department of Clinical Sciences, National Veterinary School, Toulouse, France.
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Sekis I, Ramstead K, Rishniw M, Schwark WS, McDonough SP, Goldstein RE, Papich M, Simpson KW. Single-dose pharmacokinetics and genotoxicity of metronidazole in cats. J Feline Med Surg 2009; 11:60-8. [PMID: 19155181 PMCID: PMC10832785 DOI: 10.1016/j.jfms.2008.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2008] [Indexed: 11/24/2022]
Abstract
Single-dose pharmacokinetics and genotoxicity of metronidazole in cats were evaluated. Cats received either 5mg/kg metronidazole intravenously, or 20mg/kg metronidazole benzoate (12.4mg/kg metronidazole base) orally in a single dose. Serial plasma samples were collected and assayed for metronidazole using high pressure liquid chromatography (HPLC). Genotoxicity was assessed in vitro in feline peripheral blood mononuclear cells (PBMC) and a feline T-cell lymphoma line incubated with metronidazole, and in vivo in PBMC collected before, during and 7 days after oral metronidazole, by use of the COMET assay. Systemic absorption of metronidazole was variable (mean=65+/-28%) with a peak of 8.84+/-5.4microg/ml at 3.6+/-2.9h. The terminal half-life was 5.34h from the intravenous dose and 5.16h from the oral dose. Systemic clearance was low (mean=91.57ml/h/kg [1.53ml/kg/min]), and the apparent volume of distribution (steady state) was 0.650+/-0.254l/kg. Genotoxicity was detected at all concentrations of metronidazole in feline PBMC and the T-cell lymphoma line in vitro. Genotoxicity was also observed in PBMC collected from cats after 7 days of oral metronidazole but resolved within 6 days of discontinuing metronidazole.
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Affiliation(s)
- Ivana Sekis
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Tower Road, Ithaca, NY 14853, United States
| | - Kerry Ramstead
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Tower Road, Ithaca, NY 14853, United States
| | - Mark Rishniw
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Tower Road, Ithaca, NY 14853, United States
| | - Wayne S. Schwark
- Department of Molecular Medicine, Cornell University, Tower Road, Ithaca, NY 14853, United States
| | - Sean P. McDonough
- Department of Biomedical Sciences, Cornell University, Tower Road, Ithaca, NY 14853, United States
| | - Richard E. Goldstein
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Tower Road, Ithaca, NY 14853, United States
| | - Mark Papich
- College of Veterinary Medicine, North Carolina State University, 4700 Hillsborough Street, Raleigh, NC 27606, United States
| | - Kenneth W. Simpson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Tower Road, Ithaca, NY 14853, United States
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Desai AR, Musil KM, Carr AP, Hill JE. Characterization and quantification of feline fecal microbiota using cpn60 sequence-based methods and investigation of animal-to-animal variation in microbial population structure. Vet Microbiol 2008; 137:120-8. [PMID: 19167842 DOI: 10.1016/j.vetmic.2008.12.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 12/11/2008] [Accepted: 12/17/2008] [Indexed: 12/27/2022]
Abstract
The complex microbial community of the intestine plays a major role in animal health and diseases. Despite its significance to feline health and the significance of intestinal and fecal populations to the public health, little is known about the actual composition of the normal microbiota of the cat. To create a sequence-based inventory of feline fecal microbiota, we applied established methods exploiting the gene encoding the universal 60kDa chaperonin (cpn60) to create libraries of cloned cpn60 sequences from pooled fecal samples from five exclusively indoor and four outdoor, known predatory cats. Sequencing of 1248 clones from each library revealed diverse populations dominated by Actinobacteria (particularly bifidobacteria) and Firmicutes (particularly lactobacilli). To investigate the degree of animal-to-animal variation in species abundance, ten targets were selected from the libraries for analysis by quantitative real-time PCR. Quantitative PCR results showed substantial animal-to-animal variation in target abundance although most targets were detected in all cats. This study lays the foundation for future work aimed at understanding the dynamics of intestinal microbial communities and their role in feline health.
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Affiliation(s)
- Atul R Desai
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4, Canada
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Abstract
We have come a long way in understanding and managing the FHL syndrome since it was first described nearly 30 years ago. Increased sensitivity of clinicians for recognizing the syndrome has improved case outcome by arresting this metabolic syndrome in its earliest stages. Simply ensuring adequate intake of a complete and balanced feline diet can rescue cats just developing clinical signs; however, full metabolic support as described herein provides the best chance for recovery of cats demonstrating the most severe clinicopathologic features. It remains possible that adjustments in recommended micronutrient and vitamin intake for healthy cats may pivotally change feline susceptibility to FHL over the coming years.
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Affiliation(s)
- Sharon A Center
- College of Veterinary Medicine, Cornell University, PO Box 33, Ithaca, NY 14853, USA.
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Johnston KL, Ballèvre OP, Batt RM. Use of an orally administered combined sugar solution to evaluate intestinal absorption and permeability in cats. Am J Vet Res 2001; 62:111-8. [PMID: 11197547 DOI: 10.2460/ajvr.2001.62.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate intestinal permeability and absorption in healthy cats in association with diet and normal intestinal microflora. ANIMALS 6 healthy domestic shorthair cats. PROCEDURE A sugar solution containing D-xylose, 30-methyl-D-glucose, L-rhamnose, lactulose, and 51Cr-EDTA was administered intragastrically to healthy cats, and urinary excretion of ingested sugars was determined 5 hours after administration. After the same cats had received metronidazole for 1 month, the study was repeated. A final study was performed while cats were maintained on a new diet differing in composition and processing. RESULTS Lactulose-to-rhamnose ratios, reflecting intestinal permeability, were higher in cats, compared with values for humans or dogs, and values obtained before and after metronidazole administration (mean +/- SEM; before, 0.40 +/- 0.08; after, 0.45 +/- 0.09) were not significantly different. Intestinal absorption also was unaltered after antibiotic administration, and the xylose-to-glucose ratio was 0.70 +/- 0.03 before and 0.71 +/- 0.06 after metronidazole administration. Sugar recovery did not differ significantly while cats were maintained on canned or dry food. CONCLUSIONS AND CLINICAL RELEVANCE Reference ranges were established for the percentage urinary recovery of orally administered D-xylose, 3-0-methyl-D-glucose, L-rhamnose, lactulose, and 51Cr-EDTA obtained after 5 hours in healthy cats. The intestines of cats appear to be more permeable than those of other species, although the normal bacterial microflora does not appear to influence the integrity or function of the feline intestine, because values obtained for the measured variables before or after antibiotic administration were not significantly different. In addition, differences were not detected when the diet was completely altered.
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Affiliation(s)
- K L Johnston
- Department of Small Animal Medicine and Surgery, The Royal Veterinary College, University of London, Hatfield, Herts, UK
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