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Hart KA, Kimura S. Pharmacologic Interventions to Immunologic and Immune-Mediated Conditions in Horses. Vet Clin North Am Equine Pract 2024:S0749-0739(24)00033-6. [PMID: 38852015 DOI: 10.1016/j.cveq.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024] Open
Abstract
Immunomodulators can stimulate, suppress, or regulate one or many aspects of the immune response. Use of a variety of immunostimulants, immunosuppressors, and anti-inflammatory drugs are described in horses, but the evidence supporting their efficacy is variable. Corticosteroids and nonsteroidal anti-inflammatory drugs are the best characterized immunomodulators in horses, but further study is needed to fully define their ideal dosing protocols and indications and to characterize the efficacy of other immunomodulators in equine medicine.
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Affiliation(s)
- Kelsey A Hart
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, 2200 College Station Road, Athens, GA 30602, USA.
| | - Shune Kimura
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, 2200 College Station Road, Athens, GA 30602, USA
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Easton-Jones CA. Clinical Approach to Immune-Mediated Hemolytic Anemia and Thrombocytopenia. Vet Clin North Am Equine Pract 2024:S0749-0739(24)00032-4. [PMID: 38839435 DOI: 10.1016/j.cveq.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Primary immune mediated hemolytic anemia (IMHA) and thrombocytopenia (IMTP) are rare in horses with the conditions more commonly occurring secondary to underlying disease. Several case reports have suggested a link between neoplasia and immune-mediated destruction of platelets and red blood cells. Diagnostic investigations should therefore focus on identifying possible underlying causes such as infections and neoplasia. Immunosuppressive therapy with corticosteroids and azathioprine is the mainstay of treatment but should be used cautiously in cases where underlying infection has not been excluded. Given the frequent association of secondary IMHA and IMTP cases with neoplasia, primary cases generally have a better prognosis.
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Marsella R. Autoimmune Dermatopathies of Horses. Vet Clin North Am Equine Pract 2024:S0749-0739(24)00027-0. [PMID: 38821844 DOI: 10.1016/j.cveq.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Abstract
Autoimmune dermatopathies are not common in horses. These autoimmune diseases can be idiopathic or triggered by an antigen such as drugs, vaccines, or neoplasia. The most common one is pemphigus foliaceus, which manifests as a pustular, crusting eruption. Other more common pustular diseases should be ruled out before considering pemphigus. Vasculitis is relatively common in horses and can be triggered by a variety of antigenic stimulations. Systemic lupus and true idiopathic autoimmune vasculitis are very rare in horses. Every effort should be made to reach a final diagnosis, as the prognosis for true idiopathic autoimmune skin diseases is poor.
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Affiliation(s)
- Rosanna Marsella
- Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA.
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Timko K. Approach to Inflammatory Bowel Disease. Vet Clin North Am Equine Pract 2024:S0749-0739(24)00030-0. [PMID: 38789349 DOI: 10.1016/j.cveq.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
Inflammatory bowel disease (IBD) in the horse encompasses a group of infiltrative gastrointestinal disorders resulting in malabsorption, maldigestion, weight loss, colic, and sometimes diarrhea. The type of IBD can be classified as granulomatous, lymphocytic-plasmacytic, or eosinophilic enterocolitis. The diagnosis of IBD in equids is based on consistent clinical signs and clinicopathologic findings in conjunction with confirmatory histopathology from a gastrointestinal biopsy. Treatment usually consists of a combination of immunosuppressive medications, anthelmintics, and dietary modifications. The prognosis of IBD in horses is variable and dependent on the horse's response to treatment; however, horses can show improvement or resolution of clinical signs.
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Affiliation(s)
- Kathryn Timko
- College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp Street, Columbus, OH 43201, USA.
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Knych HK, McKemie DS, Kanarr KL, White SD. Pharmacokinetics of mycophenolate mofetil following single-dose intravenous and single- and multiple-dose oral administration and clinicopathologic effects of mycophenolate mofetil following long-term oral administration in healthy horses. Am J Vet Res 2021; 82:502-509. [PMID: 34032479 DOI: 10.2460/ajvr.82.6.502] [Citation(s) in RCA: 1] [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 characterize the pharmacokinetics of mycophenolate mofetil (MMF) following single-dose IV or PO administration, characterize the pharmacokinetics of MMF following long-term PO administration, and describe the clinicopathologic effects of long-term MMF administration in horses. ANIMALS 12 healthy adult horses. PROCEDURES In phase 1, 6 horses received a single IV (2.5 mg/kg) or PO (5 mg/kg) dose of MMF in a randomized balanced crossover assessment (≥ 2-week interval between administrations). In phase 2, 6 other horses received MMF for 60 days (5 mg/kg, PO, q 24 h for 30 days and then 5 mg/kg, PO, q 48 h for an additional 30 days). RESULTS Following IV (single-dose) or PO (single- or multiple-dose) administration, MMF was rapidly converted to mycophenolic acid. For single-dose PO administration, mean ± SD maximum plasma mycophenolic acid concentration was 1,778.3 ± 441.5 ng/mL at 0.71 ± 0.29 hours. For single-dose IV administration, mean systemic clearance and volume of distribution at steady state were 0.689 ± 0.194 L/h/kg and 1.57 ± 0.626 L/kg, respectively. Following single doses, mean terminal half-life was 3.99 ± 0.865 hours for IV administration and 4.02 ± 1.01 hours for PO administration. The accumulation index following long-term PO administration was 1.0 ± 0.002, and the terminal half-life was 4.59 ± 1.25 hours following the final dose on day 60. None of the horses developed abnormal clinical signs or had any consistently abnormal clinicopathologic findings. CONCLUSIONS AND CLINICAL RELEVANCE Further investigation of the clinical efficacy of long-term MMF treatment of horses with autoimmune diseases is warranted.
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Ehrmann C, Hartung S, Hirz M, Fey K. [Therapy of bullous pemphigoid in a Warmblood gelding]. TIERARZTLICHE PRAXIS. AUSGABE G, GROSSTIERE/NUTZTIERE 2021; 49:139-144. [PMID: 33902144 DOI: 10.1055/a-1395-6307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 15-year-old Warmblood gelding was presented with multiple large, ulcerative, and crusty dermal lesions that had been existing for 4 years. Histopathology of a skin biopsy revealed cleft formation at the dermal-epidermal junction beneath the basal cells and above the basement membrane leading to the diagnosis of bullous pemphigoid. Immunosuppressive therapy with dexamethasone and azathioprine was initiated and after 14 weeks full remission of the ulcers was achieved. Scar tissue formation was evident in the areas of the formerly affected lesions. Following medication tapering over a period of 5 months, long-term therapy was continued with a maintenance dose of 0.5 mg/kg azathioprine daily. The ulcerative lesions recurred after 63 weeks of disease stabilization. Additionally, adverse drug reactions (acute laminitis and increased susceptibility to infections) were evident and the gelding was euthanized due to animal welfare considerations.
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Affiliation(s)
- Carolin Ehrmann
- Klinik für Pferde, Innere Medizin, Justus-Liebig-Universität Gießen
| | - Svenja Hartung
- Institut für Veterinär-Pathologie, Justus-Liebig-Universität Gießen
| | - Manuela Hirz
- Institut für Veterinär-Pathologie, Justus-Liebig-Universität Gießen
| | - Kerstin Fey
- Klinik für Pferde, Innere Medizin, Justus-Liebig-Universität Gießen
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Rostang A, Desjardins I, Espana B, Panzuti P, Berny P, Prouillac C, Pin D. Pharmacokinetics of low-dose methotrexate in horses. J Vet Pharmacol Ther 2020; 43:461-469. [PMID: 32216109 DOI: 10.1111/jvp.12857] [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: 11/13/2019] [Revised: 02/10/2020] [Accepted: 02/28/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to investigate both the pharmacokinetic behavior and tolerance of methotrexate (MTX) in horses to design a specific dosing regimen as a new immunomodulatory drug for long-term treatment. To determine the primary plasma pharmacokinetic variables after single intravenous, subcutaneous or oral administration, six horses were administered 0.3 mg/kg MTX in a crossover design study. After a 10-week washout, MTX was administered subcutaneously to three of the six previously treated horses at a dose of 0.3 mg/kg once per week for 3 months. In both studies, MTX and metabolite concentrations were measured using LC-MS/MS. The absolute bioavailability of MTX was 73% following subcutaneous administration but less than 1% following oral administration. The plasma clearance was 1.54 ml min-1 kg-1 (extraction ratio = 2%). After 24 hr, plasma concentrations were below the LOQ. No adverse effects were noted except for a moderate reversible elevation in liver enzymes (GLDH). With regards to the main metabolites of MTX, very low concentrations of 7-hydroxy-MTX were found, whereas polyglutamated forms (mainly short chains) were found in red blood cells. A subcutaneous dose of 0.2 mg kg-1 week-1 may be safe and relevant in horses, although this has yet to be clinically confirmed.
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Affiliation(s)
- Antoine Rostang
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Isabelle Desjardins
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Bernadette Espana
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Pauline Panzuti
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Philippe Berny
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Caroline Prouillac
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
| | - Didier Pin
- Université de Lyon, VetAgro Sup, UPSP ICE 'Interactions Cellules Environnement', Marcy l'Etoile, France
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Leclere M. Corticosteroids and Immune Suppressive Therapies in Horses. Vet Clin North Am Equine Pract 2017; 33:17-27. [PMID: 28325178 DOI: 10.1016/j.cveq.2016.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Immune suppressive therapies target exaggerated and deleterious responses of the immune system. Triggered by exogenous or endogenous factors, these improper responses can lead to immune or inflammatory manifestations, such as urticaria, equine asthma, or autoimmune and immune-mediated diseases. Glucocorticoids are the most commonly used immune suppressive drugs and the only ones supported by robust evidence of clinical efficacy in equine medicine. In some conditions, combining glucocorticoids with other pharmacologic and nonpharmacologic treatments, such as azathioprine, antihistamine, bronchodilators, environmental management, or desensitization, can help to decrease dosages and associated side effects.
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Affiliation(s)
- Mathilde Leclere
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, 3200 Sicotte, St-Hyacinthe, Quebec J2S 7C6, Canada.
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Affiliation(s)
- S. D. White
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California; Davis USA
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Abstract
Pemphigus foliaceus is the most common autoimmune skin disease in horses and is associated with the production of autoantibodies directed against surface proteins of the keratinocyte. Pemphigus vulgaris is a rare autoimmune skin disease in horses. Systemic lupus erythematosus and cutaneous lupus erythematosus are recognized in horses and both are rare. Bullous pemphigoid is a rare autoimmune disease in horses caused by immunologic attack of the basement membrane zone by autoantibodies. Erythema muliforme is an immunologic reaction in the skin in which keratinocyte cell death is the prominent change seen on biopsy. Purpura hemorrhagica is thought analogous to nonthrombocytopenic purpura in humans.
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Affiliation(s)
- Wayne Rosenkrantz
- Animal Dermatology Clinic, 2965 Edinger Avenue, Tustin, CA 92780, USA.
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Caniglia CJ, Davis JL, Schott HC, Brakenhoff JE. Septic funiculitis caused byStreptococcus equisubspeciesequiinfection with associated immune-mediated haemolytic anaemia. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C. J. Caniglia
- University of Tennessee College of Veterinary Medicine; Knoxville USA
| | - J. L. Davis
- North Carolina State University College of Veterinary Medicine; Raleigh USA
| | - H. C. Schott
- Michigan State University College of Veterinary Medicine; East Lansing USA
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Anderson FL, Secombe CJ, Lester GD. Clostridial myonecrosis, haemolytic anaemia, hepatopathy, osteitis and transient hypertrophic cardiomyopathy after intramuscular injection in a Thoroughbred gelding. Aust Vet J 2013; 91:204-8. [PMID: 23614516 DOI: 10.1111/avj.12021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2012] [Indexed: 01/06/2023]
Abstract
A 9-year-old Thoroughbred gelding was presented for swelling over the left neck and inappetence. There was recent history of intramuscular administration of flunixin meglumine into the left neck. On examination, there was evidence of focal myositis, anaemia, haemolysis and pigmenturia. Culture of aspirated fluid from the left side of the neck produced a heavy growth of a Clostridium species. Complications of infection included haemolytic anaemia, hepatopathy, osteitis and transient hypertrophic cardiomyopathy. Treatment included intravenous fluid therapy, antibiotics, anti-inflammatory drugs, blood transfusion and surgical debridement. There was complete resolution of clinical, haematological, biochemical and echocardiographic abnormalities, and the horse returned to ridden work. This report highlights the complications that can arise from clostridial myonecrosis, including the effect on the myocardium.
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Affiliation(s)
- F L Anderson
- Murdoch University School of Veterinary and Biomedical Sciences, Murdoch, Western Australia, 6150, Australia.
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Winfield LD, White SD, Affolter VK, Renier AC, Dawson D, Olivry T, Outerbridge CA, Wang YH, Iyori K, Nishifuji K. Pemphigus vulgaris in a Welsh pony stallion: case report and demonstration of antidesmoglein autoantibodies. Vet Dermatol 2013; 24:269-e60. [DOI: 10.1111/vde.12002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Laramie D. Winfield
- William R. Pritchard Veterinary Medical Teaching Hospital; University of California; Davis; CA; USA
| | - Stephen D. White
- Department of Medicine and Epidemiology; University of California; Davis; CA; USA
| | - Verena K. Affolter
- Department of Pathology; Microbiology and Immunology; University of California; Davis; CA; USA
| | - Anna C. Renier
- William R. Pritchard Veterinary Medical Teaching Hospital; University of California; Davis; CA; USA
| | - Dominic Dawson
- William R. Pritchard Veterinary Medical Teaching Hospital; University of California; Davis; CA; USA
| | - Thierry Olivry
- Department of Clinical Sciences; College of Veterinary Medicine & Center for Comparative Medicine and Translational Research; North Carolina State University; Raleigh; NC; USA
| | | | - Yu Hsuan Wang
- Department of Veterinary Medicine; Tokyo University of Agriculture and Technology; 3-5-8 Saiwai-cho; Fuchu; Tokyo; 183-8509; Japan
| | - Keita Iyori
- Department of Veterinary Medicine; Tokyo University of Agriculture and Technology; 3-5-8 Saiwai-cho; Fuchu; Tokyo; 183-8509; Japan
| | - Koji Nishifuji
- Department of Veterinary Medicine; Tokyo University of Agriculture and Technology; 3-5-8 Saiwai-cho; Fuchu; Tokyo; 183-8509; Japan
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Väänänen L, Sihvo HK, Hewetson M. Cerebral haemorrhage in a pregnant Standardbred mare with Evan's syndrome. EQUINE VET EDUC 2012. [DOI: 10.1111/j.2042-3292.2012.00432.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hardefeldt LY, Schambow R, Peek SF. Successful treatment of presumptive immune mediated thrombocytopenia and dermatitis with azathioprine in a pregnant mare. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2010.00109.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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GRABOWSKI T, JAROSZEWSKI JJ. Bioavailability of veterinary drugsin vivoandin silico. J Vet Pharmacol Ther 2009; 32:249-57. [DOI: 10.1111/j.1365-2885.2008.01034.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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