Effect of oral administration of cyclosporine on Toxoplasma gondii infection status of cats

Pharmacology of drugs used in autoimmune dermatopathies in cats and dogs: A narrative review

Immunosuppressive drugs are the mainstay of treatment for many feline and canine autoimmune skin diseases, either as monotherapy or in combination with other drugs. Treatment with these drugs is often lifelong and may have long-term consequences on the affected animal's overall quality-of-life. Clinicians need to understand the pharmacology of immunosuppressants in planning and executing the treatment regimen for the best possible clinical outcome, as well as reducing the risk of adverse effects. This review paper will focus on the mechanism of action, pharmacokinetics and pharmacodynamics, clinical uses and adverse effects of immunosuppressive drugs used to treat autoimmune dermatoses in cats and dogs. These include glucocorticoids, ciclosporin A, azathioprine, chlorambucil, mycophenolate mofetil, oclacitinib and Bruton's tyrosine kinase inhibitors.

Prevalence of Toxoplasma gondii IgM and IgG positive cats in Los Angeles County, California

Objectives

The objective of this study was to determine the prevalence of Toxoplasma gondii IgM and IgG positive cats in Los Angeles County, California. T gondii antibodies are common in sera from cats in most reported studies around the world. Although the majority of infected cats never develop clinical disease, development of acute infection and recrudescence of latent infection secondary to immunosuppression has been reported. Knowledge of the serologic status of T gondii may be important when considering immunosuppressive treatments.

Methods

T gondii IgM and IgG antibody titers were measured in 225 cats. Sera from owned cats tested at a multispecialty veterinary hospital were included both retrospectively and prospectively (n = 125). Sera from feral cats tested through a collaborating humane society were included prospectively (n = 100).

Results

Of the 13 (5.8%) cats with IgM titers, 10 were positive at the minimal cut-off titer (1:64), one cat was clinically ill and none were currently positive for IgG antibodies, suggesting false-positive results for nine cats, giving an adjusted IgM prevalence rate of 1.8% (95% CI 0.7-4.5). A total of five (2.2%) cats were positive for IgG antibodies and no cat was positive for both antibodies.

Conclusions and relevance

Most studies of T gondii antibodies in cat sera from California have shown higher prevalence rates, suggesting the cats in this municipality have a low risk of exposure. The study emphasizes that serological test results do not necessarily correlate to the presence of clinical illness.

The Pharmacokinetic and Absolute Bioavailability of Cyclosporine (Atopica for Cats®) in Cats

This study aimed to evaluate the absolute bioavailability of cyclosporine in cats by investigating the pharmacokinetic profile after intravenous and oral administration, respectively. Twenty-four clinically healthy cats were enrolled in this study and randomly divided into four groups, namely the intravenous group (3 mg/kg), low oral group (3.5 mg/kg), medium oral group (7 mg/kg), and high oral group (14 mg/kg). Whole blood was obtained at the scheduled time points after a single dose administration and cyclosporine was determined using ultra-performance liquid chromatography-tandem mass spectrometry technology (UPLC-MS/MS). Pharmacokinetic parameters were calculated using the WinNonlin 8.3.4 software via compartmental and non-compartmental models. As a result, the bioavailability values for the low, medium, and high oral groups were 14.64%, 36.98%, and 13.53%, respectively. The nonlinear pharmacokinetic profile was observed in the range from 3.5 mg/kg to 14 mg/kg in cats following oral administration. Whole blood concentrations taken 4 h after oral administration were better correlated with the area under the blood concentration-time curve AUC_0-24 with a high regression coefficient (R² = 0.896). This concentration would be a greater predictor in the following therapeutic drug monitoring. No adverse effect was observed in the whole study process.

Vaccination of Immunocompromised Cats

Immunocompromise is a common condition in cats, especially due to widespread infections with immunosuppressive viruses, such as feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV), but also due to chronic non-infectious diseases, such as tumours, diabetes mellitus, and chronic kidney disease, as well as treatment with immunosuppressive drugs, such as glucocorticoids, cyclosporins, or tumour chemotherapy. In this review, the European Advisory Board on Cat Diseases (ABCD), a scientifically independent board of experts in feline medicine from eleven European countries, discusses the current knowledge and rationale for vaccination of immunocompromised cats. So far, there are few data available on vaccination of immunocompromised cats, and sometimes studies produce controversial results. Thus, this guideline summarizes the available scientific studies and fills in the gaps with expert opinion, where scientific studies are missing. Ultimately, this review aims to help veterinarians with their decision-making in how best to vaccinate immunocompromised cats.

Dynamics and epidemiology of Toxoplasma gondii oocyst shedding in domestic and wild felids

Oocyst shedding in domestic and wild felids is a critical yet understudied topic in Toxoplasma gondii ecology and epidemiology that shapes human and animal disease burden. We synthesized published literature dating from the discovery of felids as the definitive hosts of T. gondii in the 1960s through March 2021 to examine shedding prevalence, oocyst genotypes, and risk factors for shedding. Oocyst shedding prevalence in many geographic regions exceeded the commonly accepted 1% reported for domestic cats; crude prevalence from cross-sectional field studies of domestic cat shedding ranged from 0% in Australia to 18.8% in Africa, with greater variation in reports of oocyst shedding in free-ranging, wild felids. Shedding in wild felid species has primarily been described in captive animals, with attempted detection of oocyst shedding reported in at least 31 species. Differences in lifestyle and diet play an important role in explaining shedding variation between free-ranging unowned domestic cats, owned domestic cats and wild felids. Additional risk factors for shedding include the route of infection, diet, age and immune status of the host. It is widely reported that cats only shed oocysts after initial infection with T. gondii, but experimental studies have shown that repeat oocyst shedding can occur. Factors associated with repeat shedding are common amongst free-ranging felids (domestic and wild), which are more likely to eat infected prey, be exposed to diverse T. gondii genotypes, and have coinfections with other parasites. Repeat shedding events could play a significant yet currently ignored role in shaping environmental oocyst loading with implications for human and animal exposure. Oocyst presence in the environment is closely linked to climate variables such as temperature and precipitation, so in quantifying risk of exposure, it is important to consider the burden of T. gondii oocysts that can accumulate over time in diverse environmental matrices and sites, as well as the spatial heterogeneity of free-ranging cat populations. Key directions for future research include investigating oocyst shedding in under-sampled regions, genotyping of oocysts detected in faeces and longitudinal studies of oocyst shedding in free-ranging felids.

Intradermal immunotherapy with actinomycetales preparations as treatment for feline atopic syndrome: a randomized, placebo-controlled, double-blinded study

BACKGROUND

Feline atopic syndrome (FAS) is a common disease. Single intradermal injections of heat-killed actinomycetales have shown beneficial effects in canine allergies.

HYPOTHESIS/OBJECTIVE

To evaluate the clinical effects of heat-killed actinomycetales [Gordonia bronchialis (GB) and Rodococcus coprophilus (RC)], alone or in combination, in FAS.

METHODS AND MATERIALS

Privately owned cats with a diagnosis of FAS were assigned randomly in three treatment groups (GB, RC and GB/RC combination) or placebo. Five intradermal injections were performed over a one year period. At each visit [Day (D)0, D20, D40, D60, D90, D180 and D365], clinical signs, global owner assessment score, use of rescue medications, clinical adverse effects, skin hydration and cutaneous pH were assessed.

RESULTS

Seventeen cats were enrolled. When compared to the placebo group and improvement in treatment GB was sustained from D90. When compared with D0 significant improvement in the GB group was seen from D60. Over one year, a complete remission of the clinical signs was seen in 30-67% of cats in the treatment groups. A reduction in the pruritus score was seen for RC after 365 days of treatment (P = 0.04). Differences in the other variables were not seen.

CONCLUSIONS AND CLINICAL IMPORTANCE

The use of multiple intradermal injections of heat-killed GB shows promise as effective and well-tolerated treatment for FAS. Because of the low cost and the lack of adverse effects, GB could be a beneficial treatment option for FAS. A larger study is needed to confirm these data and to evaluate the immunological changes occurring in the treated cats.

Treatment of the feline atopic syndrome - a systematic review

BACKGROUND

Feline allergic skin disease and asthma occur regularly in small animal practice.

OBJECTIVES

To provide evidence-based recommendations for small animal practitioners on the treatment of feline atopic syndrome (FAS).

METHODS AND MATERIALS

The authors reviewed the literature available before February 2020, prepared a detailed evidence-based literature review and made recommendations based on the evaluated evidence.

RESULTS

Sixty-six papers and abstracts were identified describing treatment interventions for FAS and evaluated to establish treatment recommendations. For many treatment options, the papers were retrospective, open studies or case reports.

CONCLUSION AND CLINICAL RELEVANCE

In this review, there was good evidence for the efficacy of systemic glucocorticoids and ciclosporin, and limited evidence for the efficacy of topical glucocorticoids, oclacitinib and allergen-specific immunotherapy in feline atopic skin syndrome. Evidence pointed to low-to-moderate efficacy for antihistamines, fatty acids and palmitoyl ethanolamide. In feline asthma, there was good evidence for the efficacy of oral and inhaled glucocorticoids, and limited evidence of moderate efficacy for allergen-specific immunotherapy. Evidence supported low-to-moderate efficacy of mesenchymal stem cells, inhaled lidocaine and oclacitinib as treatments for feline asthma. For almost all therapeutic options (with the exception of glucocorticoids and ciclosporin), more randomised controlled trials are needed.

All about toxoplasmosis in cats: the last decade

Toxoplasma gondii infections are common in humans and animals worldwide. Toxoplasmosis continues to be of public health concern. Cats (domestic and wild felids) are the most important host in the epidemiology of toxoplasmosis because they are the only species that can excrete the environmentally resistant oocysts in feces. Cats can excrete millions of oocysts and a single cat can spread infection to many hosts. The present paper summarizes information on prevalence, persistence of infection, clinical signs, and diagnosis of T. gondii infections in domestic and wild cats for the past decade. Special emphasis is paid to genetic diversity of T. gondii isolates from cats. Review of literature indicates that a unique genotype (ToxoDB genotype #9 or Chinese 1) is widely prevalent in cats in China and it has been epidemiologically linked to outbreaks of clinical toxoplasmosis in pigs and deaths in humans in China; this genotype has rarely been detected in other countries. This review will be of interest to biologists, parasitologists, veterinarians, and public health workers.

2019 AAFP Feline Zoonoses Guidelines

AIM

The overarching purpose of the 2019 AAFP Feline Zoonoses Guidelines (hereafter referred to as the 'Guidelines') is to provide accurate information about feline zoonotic diseases to owners, physicians and veterinarians to allow logical decisions to be made concerning cat ownership.

SCOPE AND ACCESSIBILITY

The Panelists are physicians and veterinarians who worked closely together in an attempt to make these Guidelines a document that can be used to support the International One Health movement. This version of the Guidelines builds upon the first feline zoonosis panel report, published in 2003 ( catvets.com/guidelines ), and provides an updated reference list and recommendations. Each of the recommendations received full support from every Panelist. Primary recommendations are highlighted in a series of 'Panelists' advice' boxes.

Effects of cyclosporine on feline lymphocytes activated in vitro

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.

Feline non-regenerative anemia: Diagnostic and treatment recommendations

PRACTICAL RELEVANCE

Non-regenerative anemia, or anemia with reticulocytopenia, is a daily diagnosis in feline practice.

CLINICAL CHALLENGES

The disease processes underlying non-regenerative anemia are many and diverse. A major diagnostic evaluation may be required to correctly diagnose and treat the underlying cause.

AUDIENCE

All veterinarians caring for cats will face the diagnostic and therapeutic challenge of non-regenerative anemia. Readers will benefit from the review of diagnostic testing and therapeutic options for non-regenerative anemia.

EVIDENCE BASE

This review summarizes the currently available literature informing diagnostic and treatment recommendations related to non-regenerative anemia. The evidence available to support the recommendations in this review is graded as low and includes predominantly expert opinion, case reports and cases series, on which the authors' interpretation/consensus is based.

Prevalence of antibody seroconversion to Toxoplasma gondii in uveitis and non-uveitis dogs

Objectives

To evaluate the prevalence of seroconversion to Toxoplasma gondii in dogs with uveitis and dogs without uveitis.

Methods

In total, 135 dogs were evaluated: 51 dogs were diagnosed with uveitis, and 84 dogs were without uveitis. Latex agglutination tests were performed on all sera, and the results were evaluated.

Results

Overall, 7.8 and 6.0 per cent of sera were positive for the presence of anti-T gondii antibodies (dilution ≥1:64) in the groups with uveitis and non-uveitis dogs, respectively. The frequency distribution of variables (positive and negative results in the uveitis and the non-uveitis group of dogs) was tested with Fisher’s exact test. There was no statistically significant difference between groups (P=0.73).

Clinical significance

These findings suggest that evidence of exposure to T gondii was not significantly different between uveitis and non-uveitis groups of dogs and that the possible association between exposure to T gondii and canine uveitis requires further investigation. This study is the first to report the seroprevalence of anti-T gondii antibodies in dogs in the UK population and the first to report the seroprevalence of anti-T gondii antibodies in dogs with uveitis.

Toxoplasmosis as a cause of life-threatening respiratory distress in a dog receiving immunosuppressive therapy

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.

Ciclosporin and the cat: Current understanding and review of clinical use

Practical relevance: Ciclosporin (CsA) is a systemic immuno-modulatory drug widely used to treat immune-mediated diseases in humans and veterinary species. CsA was registered for use in cats in the USA and Europe in 2011, and is indicated for the treatment of chronic allergic dermatitis at a recommended daily dose of 7 mg/kg PO.

AUDIENCE

This review will be of interest to all veterinarians working with cats, given the wide range of potential applications of CsA and its safety profile. Although the drug is currently only licensed to treat chronic allergic dermatitis in cats, a small number of reports describe its use in non-dermatological conditions. Evidence base: This article reviews the mechanism of action, pharmacokinetics, drug interactions, adverse effects and clinical use of CsA, both for the licensed indication and for off-label use in the feline patient. Information presented has been summarised from the existing literature on CsA, with specific interest in studies carried out in cats. For its licensed indication, chronic allergic dermatitis, evidence provided includes randomised, placebo or prednisolone-controlled studies (EBM grade I) and prospective or retrospective open trials.

Skin as a marker of general feline health: Cutaneous manifestations of infectious disease

Practical relevance: Infectious disease in feline patients often presents a diagnostic challenge. This article reviews the most relevant viral, bacterial and protozoal diseases and their cutaneous manifestations. Many of the diseases discussed have overlapping presentations or may mimic more common noninfectious disease processes. The purpose of the article is to reinforce knowledge of common and uncommon infectious diseases, help practitioners identify possible infectious dermatoses, create a comprehensive and prioritized differential list, and provide guidance for the diagnosis of these diseases. A working knowledge of these clinical syndromes is important if what is thought to be a case of a common disease does not respond to conventional management.

AUDIENCE

This review is aimed at veterinarians who treat cats and especially those with an interest in feline dermatology. Tables are included to allow the reader to formulate a concise list of differential diagnoses for clinically similar presentations. The diagnostic approach to a case of ulcerative facial dermatitis is reviewed in a Case Notes quiz. Evidence base: This article includes up-to-date information regarding dermatologic manifestations of less commonly encountered feline cutaneous infectious diseases. Information has been drawn from the published, peer-reviewed literature and the most recent textbook chapters with a particular aim of describing and differentiating clinical lesions and the diagnostic approach to cutaneous disease, especially in unusual cases.

Clinical efficacy and safety following dose tapering of ciclosporin in cats with hypersensitivity dermatitis

Objectives This study was designed to evaluate the efficacy and safety of reducing ciclosporin (CsA) dosing frequency from daily to every other day (EOD) or twice a week (TW) according to clinical response in cats with hypersensitivity dermatitis (HD) and treated with CsA. Methods One hundred and ninety-one cats with HD were given 7 mg/kg CsA daily for at least 4 weeks. Depending on clinical response, the dosing frequency was tapered from daily to EOD over the next 4 weeks and further to TW for an additional 4 weeks. Safety was evaluated through physical examinations, clinical pathology and the monitoring of adverse events (AEs). Results The majority of cats were able to have their dose of CsA tapered to either EOD (15.5%) or TW (62.9%) according to the clinical response. Observed AEs were most frequently mild and self-limiting vomiting and diarrhea. A higher percentage of AEs occurred with daily administration (73%) compared with other dosing regimens (27%). Conclusions and relevance Following 4 weeks of daily dosing at 7 mg/kg, CsA may be tapered to EOD or TW while maintaining the desired therapeutic response in cats with HD. Additionally, CsA appears to be well tolerated with fewer AEs at EOD or TW dosing. Establishing the lowest effective dosing frequency of CsA improves the drug's safety profile.