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Wilkinson V, Richards SA, Carver S, Næsborg-Nielsen C, Cray C, Rossi G. Non-specific markers of inflammation in bare-nosed wombats ( Vombatus ursinus) with sarcoptic mange. Front Vet Sci 2024; 11:1403221. [PMID: 39005722 PMCID: PMC11240855 DOI: 10.3389/fvets.2024.1403221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
Sarcoptic mange, caused by epidermal infection with Sarcoptes scabiei, negatively impacts the health, welfare, and local abundance of bare-nosed wombats (Vombatus ursinus) in Australia. Improved understanding of the host immune response to disease and its contribution to pathophysiology could be used to inform management actions for this species in and ex situ. To evaluate the immune response of bare-nosed wombats to sarcoptic mange, we validated three assays (haptoglobin, agarose gel electrophoresis, and micro-erythrocyte sedimentation rate) measuring non-specific markers of inflammation using serum samples from free-living wombats from Tasmania (n = 33). We then analysed correlations between the assay results for each non-specific marker of inflammation and wombat's sarcoptic mange scores, and performed histopathological examinations to investigate association of the acute phase response with systemic amyloidosis. We present evidence that haptoglobin and erythrocyte sedimentation rate increased, and albumin decreased, in association with sarcoptic mange scores. This research demonstrates links between the acute phase response and sarcoptic mange severity in bare-nosed wombats, highlighting the utility of non-specific markers of inflammation for aiding assessment of the systemic effects of mange. Showing the value of agarose gel electrophoresis, we also identified specific acute phase proteins warranting future evaluation and found evidence of an immunoglobulin response in mange-affected wombats, revealed by increasing γ-globulins in association with apparent disease severity. Meanwhile, owing to its relatively low resource requirements and rapidity, the erythrocyte sedimentation rate assay may be useful as a point-of-care test to support therapeutic decisions in the field. Our methods and findings are likely to be applicable to a range of other clinical and population health scenarios in captive and free-living wombats, and species impacted by sarcoptic mange globally.
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Affiliation(s)
- Vicky Wilkinson
- School of Natural Sciences, University of Tasmania, Hobart, TAS, Australia
| | - Shane A Richards
- School of Natural Sciences, University of Tasmania, Hobart, TAS, Australia
| | - Scott Carver
- School of Natural Sciences, University of Tasmania, Hobart, TAS, Australia
| | | | - Carolyn Cray
- Division of Comparative Pathology, Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL, United States
| | - Gabriele Rossi
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
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Fayette MA, Minich DJ, Sylvester H, Latimer E. FIRST DETECTION OF CLINICAL DISEASE DUE TO ELEPHANT ENDOTHELIOTROPIC HERPESVIRUS 7A IN TWO AFRICAN ELEPHANTS ( LOXODONTA AFRICANA) IN HUMAN CARE. J Zoo Wildl Med 2024; 55:290-294. [PMID: 38453514 DOI: 10.1638/2023-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 03/09/2024] Open
Abstract
Multiple species of elephant endotheliotropic herpesvirus (EEHV) have caused fatal hemorrhagic disease in African (Loxodonta africana) and Asian (Elephas maximus) elephants. To date, EEHV7 has been detected only in benign pulmonary and skin nodules and in saliva of African elephants and has not been associated with clinical illness. Low-level viremia due to EEHV7A was detected via qPCR in two subadult African elephants during routine surveillance. Hematologic changes were noted in both elephants, including leukopenia, lymphopenia, monocytopenia, and band heterophilia. Treatment was initiated with famciclovir, antimicrobials, and rectal fluids, and one elephant received plasma transfusions due to a progressive decrease in platelet count. Both elephants remained asymptomatic throughout the viremias, with rapid resolution of hematologic abnormalities. These cases add to the current understanding of the epidemiology of EEHV in African elephants; to the authors' knowledge, they represent the first documentation of clinical disease due to EEHV7 infection in any elephant.
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Affiliation(s)
| | | | - Hannah Sylvester
- National Elephant Herpesvirus Laboratory, Smithsonian's National Zoo and Conservation Biology Institute, Washington, DC 20008, USA
| | - Erin Latimer
- National Elephant Herpesvirus Laboratory, Smithsonian's National Zoo and Conservation Biology Institute, Washington, DC 20008, USA
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Steyrer C, Miller M, Hewlett J, Buss P, Hooijberg EH. Markers of inflammation in free-living African elephants (Loxodonta africana): Reference intervals and diagnostic performance of acute phase reactants. Vet Clin Pathol 2023; 52 Suppl 1:75-86. [PMID: 36303463 DOI: 10.1111/vcp.13197] [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: 03/27/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acute phase reactants (APRs) have not been investigated in free-living African elephants (Loxodonta africana), and there is little information about negative APRs albumin and serum iron in elephants. OBJECTIVES We aimed to generate reference intervals (RIs) for APRs for free-living African elephants, and to determine the diagnostic performance of APRs in apparently healthy elephants and elephants with inflammatory lesions. METHODS Stored serum samples from 49 apparently healthy and 16 injured free-living elephants were used. The following APRs and methods were included: albumin, bromocresol green; haptoglobin, colorimetric assay; serum amyloid A (SAA), multispecies immunoturbidometric assay, and serum iron with ferrozine method. Reference intervals were generated using the nonparametric method. Indices of diagnostic accuracy were determined by receiver-operator characteristic (ROC) curve analysis. RESULTS Reference intervals were: albumin 41-55 g/L, haptoglobin 0.16-3.51 g/L, SAA < 10 mg/L, and serum iron 8.60-16.99 μmol/L. Serum iron and albumin concentrations were lower and haptoglobin and SAA concentrations were higher in the injured group. Serum iron had the best ability to predict health or inflammation, followed by haptoglobin, SAA, and albumin, with the area under the ROC curve ranging from 0.88-0.93. CONCLUSIONS SAA concentrations were lower in healthy African vs Asian elephants, and species-specific RIs should be used. Serum iron was determined to be a diagnostically useful negative APR which should be added to APR panels for elephants.
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Affiliation(s)
- Christine Steyrer
- Department of Companion Animal Clinical Studies and Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Michele Miller
- Department of Science and Innovation-National Research Foundation Centre of Excellence for Biomedical TB Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jennie Hewlett
- Department of Production Animal Studies and Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Peter Buss
- Department of Production Animal Studies and Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa.,Veterinary Wildlife Services, South African National Parks, South Africa
| | - Emma H Hooijberg
- Department of Companion Animal Clinical Studies and Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
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Hooijberg EH, Cray C. Acute phase reactants in nondomesticated mammals-A veterinary clinical pathology perspective. Vet Clin Pathol 2023; 52 Suppl 1:19-36. [PMID: 36289012 DOI: 10.1111/vcp.13189] [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: 04/29/2022] [Revised: 07/04/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Abstract
Applications for acute phase reactants (APRs) in nondomesticated mammals include identifying inflammatory disease, monitoring the course of specific disease processes and recovery during rehabilitation, detecting preclinical or subclinical disease, being used as bioindicators for monitoring population and ecosystem health, and as markers of stress and animal welfare. Serum amyloid A, haptoglobin, C-reactive protein, fibrinogen, albumin, and iron are most commonly measured. The procedure for evaluating an APR in a nondomesticated mammalian species should follow a stepwise approach beginning with an assessment of analytical performance, followed by an evaluation of overlap performance, clinical performance, and impact on patient outcomes and management. The lack of species-specific standards and antibodies for nondomesticated mammals presents a challenge, and more attention needs to be focused on assessing cross-reactivity and ensuring adequate analytical performance of APR assays. Sample selection for the initial evaluation of APRs should consider preanalytical influences and should originate from animals with confirmed inflammatory disease and healthy animals. Reference intervals should be generated according to published guidelines. Further evaluation should focus on assessing the diagnostic utility of APRs in specific disease scenarios relevant to a species. Greater attention should be paid to assay performance and uniformity of methods when using APRs for population and ecosystem surveillance. Veterinary clinical pathologists should work closely with zoo veterinarians and wildlife researchers to optimize the accuracy and utility of APR measurements in these various conservation medicine scenarios.
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Affiliation(s)
- Emma H Hooijberg
- Department of Companion Animal Clinical Studies and Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Carolyn Cray
- Division of Comparative Pathology, Department of Pathology & Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Rossi G. Acute phase proteins in cats: Diagnostic and prognostic role, future directions, and analytical challenges. Vet Clin Pathol 2023; 52 Suppl 1:37-49. [PMID: 36740231 DOI: 10.1111/vcp.13238] [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: 09/06/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 02/07/2023]
Abstract
While clinical studies on acute phase proteins (APPs) have significantly increased in the last decade, and most commercial labs are now offering major APPs in their biochemical profiles, APP testing has not been widely adopted by veterinary clinical pathologists and veterinarians. Measurement of APP concentration is a useful marker for detecting the presence or absence of inflammation in cats with various diseases. APPs can also be reliably measured in different biological fluids (eg, effusions and urine) to improve their diagnostic utility. Measurement of APPs can be extremely beneficial in cats with feline infectious peritonitis (FIP) to discriminate between FIP and non-FIP cats with similar clinical presentations. Additional benefits come from multiple and sequential measurements of APPs, particularly in the assessment of therapeutic efficacy. APPs are more sensitive than WBC counts for early detection of inflammation and to demonstrate an early remission or recurrence of the diseases. Given the potential utility of APPs, more studies are warranted, with a particular focus on the applications of APPs to guide the length of antimicrobial therapies, as suggested by the antimicrobial stewardship policy. New inflammatory markers have been discovered in human medicine, with a higher specificity for distinguishing between septic versus nonseptic inflammatory diseases. It is desirable that these new markers be investigated in veterinary medicine, to further test the power of APPs in diagnostic setting.
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Affiliation(s)
- Gabriele Rossi
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia.,Centre for Animal Production and Health, Murdoch University, Murdoch, Western Australia, Australia
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Edes AN, Zimmerman D, Jourdan B, Brown JL, Edwards KL. Value Ranges and Clinical Comparisons of Serum DHEA-S, IL-6, and TNF-α in Western Lowland Gorillas. Animals (Basel) 2022; 12:2705. [PMID: 36230446 PMCID: PMC9559573 DOI: 10.3390/ani12192705] [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: 07/14/2022] [Revised: 09/12/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
Physiological data can provide valuable information about the health and welfare of animals. Unfortunately, few validated assays and a lack of information on species-typical levels of circulating biomarkers for wildlife make the measurement, interpretation, and practical application of such data difficult. We validated commercially available kits and calculated reference intervals (herein called "value ranges") for dehydroepiandrosterone-sulfate (DHEA-S), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) in a sample of zoo-housed western lowland gorillas due to the roles these biomarkers play in stress and immune responses. For each biomarker, we present species-specific value ranges for a sample of gorillas in human care (n = 57). DHEA-S did not vary significantly by sex or age, while IL-6 was higher in males and older gorillas and TNF-α was higher in females but not associated with age. We also compared non-clinical with clinical samples (n = 21) to explore whether these biomarkers reflect changes in health status. There was no significant difference between clinical and non-clinical samples for DHEA-S, but both IL-6 and TNF-α were significantly higher in gorillas showing clinical symptoms or prior to death. Additional work is needed to improve our understanding of normal versus clinical variation in these biomarkers, and we encourage continued efforts to identify and validate additional biomarkers that can be used to inform assessments of health and welfare in wildlife.
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Affiliation(s)
- Ashley N. Edes
- Department of Reproductive and Behavioral Sciences, Saint Louis Zoo, St. Louis, MO 63110, USA
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA 22630, USA
| | - Dawn Zimmerman
- Veterinary Initiative for Endangered Wildlife, Bozeman, MT 59715, USA
- Smithsonian Global Health Program, National Zoological Park, Smithsonian Institution, Washington, DC 20008, USA
| | - Balbine Jourdan
- Veterinary Teaching Hospital, University of Illinois College of Veterinary Medicine, Urbana, IL 61802, USA
| | - Janine L. Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA 22630, USA
| | - Katie L. Edwards
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA 22630, USA
- North of England Zoological Society, Chester Zoo, Caughall Road, Upton-by-Chester CH2 1LH, UK
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Padariya M, Jooste ML, Hupp T, Fåhraeus R, Vojtesek B, Vollrath F, Kalathiya U, Karakostis K. The Elephant evolved p53 isoforms that escape mdm2-mediated repression and cancer. Mol Biol Evol 2022; 39:6632613. [PMID: 35792674 PMCID: PMC9279639 DOI: 10.1093/molbev/msac149] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The p53 tumor suppressor is a transcription factor with roles in cell development, apoptosis, oncogenesis, aging, and homeostasis in response to stresses and infections. p53 is tightly regulated by the MDM2 E3 ubiquitin ligase. The p53–MDM2 pathway has coevolved, with MDM2 remaining largely conserved, whereas the TP53 gene morphed into various isoforms. Studies on prevertebrate ancestral homologs revealed the transition from an environmentally induced mechanism activating p53 to a tightly regulated system involving cell signaling. The evolution of this mechanism depends on structural changes in the interacting protein motifs. Elephants such as Loxodonta africana constitute ideal models to investigate this coevolution as they are large and long-living as well as having 20 copies of TP53 isoformic sequences expressing a variety of BOX-I MDM2-binding motifs. Collectively, these isoforms would enhance sensitivity to cellular stresses, such as DNA damage, presumably accounting for strong cancer defenses and other adaptations favoring healthy aging. Here we investigate the molecular evolution of the p53–MDM2 system by combining in silico modeling and in vitro assays to explore structural and functional aspects of p53 isoforms retaining the MDM2 interaction, whereas forming distinct pools of cell signaling. The methodology used demonstrates, for the first time that in silico docking simulations can be used to explore functional aspects of elephant p53 isoforms. Our observations elucidate structural and mechanistic aspects of p53 regulation, facilitate understanding of complex cell signaling, and suggest testable hypotheses of p53 evolution referencing Peto’s Paradox.
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Affiliation(s)
- Monikaben Padariya
- International Centre for Cancer Vaccine Science, University of Gdansk , ul. Kładki 24, 80-822 Gdansk , Poland
| | - Mia-Lyn Jooste
- Institute of Genetics and Cancer, University of Edinburgh , Edinburgh EH4 2XR, UK
| | - Ted Hupp
- Institute of Genetics and Cancer, University of Edinburgh , Edinburgh EH4 2XR, UK
| | - Robin Fåhraeus
- International Centre for Cancer Vaccine Science, University of Gdansk , ul. Kładki 24, 80-822 Gdansk , Poland
- Inserm UMRS1131, Institut de Génétique Moléculaire , Université Paris 7, Hôpital St. Louis, F-75010 Paris , France
- Research Centre for Applied Molecular Oncology (RECAMO), Masaryk Memorial Cancer Institute , 65653 Brno , Czech Republic
- Department of Medical Biosciences, Umeå University , 90185 Umeå , Sweden
| | - Borek Vojtesek
- Research Centre for Applied Molecular Oncology (RECAMO), Masaryk Memorial Cancer Institute , 65653 Brno , Czech Republic
| | - Fritz Vollrath
- Department of Zoology, Zoology Research and Administration Building, University of Oxford , Oxford, UK
- Save the Elephants Marula Manor , Marula Lane, Karen P.O. Box 54667. Nairobi 00200. Kenya Office: +254 720 441 178
| | - Umesh Kalathiya
- International Centre for Cancer Vaccine Science, University of Gdansk , ul. Kładki 24, 80-822 Gdansk , Poland
| | - Konstantinos Karakostis
- Inserm UMRS1131, Institut de Génétique Moléculaire , Université Paris 7, Hôpital St. Louis, F-75010 Paris , France
- Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona , 08193 Bellaterra (Barcelona) , Spain
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Observable Metabolites and Metabolomic Sampling Protocols for Managed African Savanna Elephant (Loxodonta africana) Whole Blood Using H-NMR Spectroscopy. Metabolites 2022; 12:metabo12050400. [PMID: 35629905 PMCID: PMC9143938 DOI: 10.3390/metabo12050400] [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] [Received: 01/07/2022] [Revised: 04/17/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023] Open
Abstract
We used nuclear magnetic spectroscopy (NMR) to evaluate the metabolomics of heparinized whole blood drawn from six African savanna elephants (Loxodonta africana) maintained on a well characterized diet. Whole blood samples obtained under behavioral restraint, then quickly frozen in liquid nitrogen, were stored at −80 °C until analysis. Frozen samples were thawed under controlled conditions and extracted with methanol and chloroform to separate the polar and non-polar metabolites. We identified 18 polar metabolites and 14 non-polar lipids using one-dimensional (1D) and two-dimensional (2D) NMR spectra. Despite unexpected rouleaux formation in the thawed frozen samples, spectra were consistent among animals and did not vary dramatically with age or the sex of the animal.
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Pomorska-Mól M, Libera K, Larska M, Krzysiak MK. Acute-phase protein concentrations in serum of clinically healthy and diseased European bison (Bison bonasus) - preliminary study. BMC Vet Res 2022; 18:28. [PMID: 35012560 PMCID: PMC8744219 DOI: 10.1186/s12917-021-03133-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the first report describing levels of APPs in European bison. Serum concentration of acute phase proteins (APPs) may be helpful to assess general health status in wildlife and potentially useful in selecting animals for elimination. Since there is a lack of literature data regarding concentration of APPs in European bisons, establishment of the reference values is also needed. METHODS A total of 87 European bison from Polish populations were divided into two groups: (1) healthy: immobilized for transportation, placing a telemetry collar and routine diagnostic purposes; and (2) selectively culled due to the poor health condition. The serum concentration of haptoglobin, serum amyloid A and α1-acid-glycoprotein were determined using commercial quantitative ELISA assays. Since none of the variables met the normality assumptions, non-parametric Mann-Whitney U test was used for all comparisons. Statistical significance was set at p < 0.05. Statistical analyses were performed using Statistica 13.3 (Tibco, USA). RESULTS The concentration of haptoglobin and serum amyloid A was significantly higher in animals culled (euthanised) due to the poor condition in respect to the clinically healthy European bison. The levels of α1-acid-glycoprotein did not show statistical difference between healthy and sick animals. CONCLUSIONS Correlation between APPs concertation and health status was proven, therefore the determination of selected APPs may be considered in future as auxiliary predictive tool in assessing European bison health condition.
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Affiliation(s)
- Małgorzata Pomorska-Mól
- Department of Preclinical Sciences and Infectious Diseases, Faculty of Veterinary Medicine and Animal Science, Poznań University of Life Sciences, ul. Wołyńska 35, 60-637, Poznań, Poland.
| | - Kacper Libera
- Department of Preclinical Sciences and Infectious Diseases, Faculty of Veterinary Medicine and Animal Science, Poznań University of Life Sciences, ul. Wołyńska 35, 60-637, Poznań, Poland
| | - Magdalena Larska
- Department of Virology, National Veterinary Research Institute, Al. Partyzantów 57, 24-100, Puławy, Poland
| | - Michał K Krzysiak
- Białowieża National Park, Park Pałacowy 11, 17-230, Białowieża, Poland.,Institute of Forest Sciences, Faculty of Civil Engineering and Environmental Sciences, Bialystok University of Technology, Białystok, Poland
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Patterns of serum immune biomarkers during elephant endotheliotropic herpesvirus viremia in Asian and African elephants. PLoS One 2021; 16:e0252175. [PMID: 34793450 PMCID: PMC8601435 DOI: 10.1371/journal.pone.0252175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/02/2021] [Indexed: 12/23/2022] Open
Abstract
Hemorrhagic disease (HD) caused by a group of elephant endotheliotropic herpesviruses (EEHV) is one of the leading causes of death for young elephants in human care. These viruses are widespread and typically persist latently in adult elephants with no negative effects; however, in juvenile Asian and more recently young African elephants, the onset of disease can be rapid and the mortality rate high. Measuring biomarkers associated with the immune response could be beneficial to understanding underlying disease processes, as well as the management of infection and HD. The goal of this study was to measure acute phase proteins and cytokines in serum collected from elephants infected with EEHV (13 Asian and 1 African) and compare concentrations according to presence, severity and outcome of disease. Serum amyloid A (SAA) and haptoglobin (HP) were higher in elephants with EEHV viremia than those without; concentrations increased with increasing viral load, and were higher in fatal cases compared to those that survived. In Asian elephants, SAA was also higher during EEHV1 viremia compared to EEHV5. Cytokine concentrations were typically low, and no statistical differences existed between groups. However, in individuals with detectable levels, longitudinal profiles indicated changes in tumor necrosis factor alpha (TNF-α) and interleukin-2 (IL-2) that may reflect an immune response to EEHV infection. However, the overall low concentrations detected using previously validated assays do not support the presence of a 'cytokine storm' and suggest more work is needed to understand if sub-optimal immune responses could be involved in disease progression. These results highlight the potential benefit of measuring circulating biomarker concentrations, such as APPs and cytokines, to improve our understanding of EEHV viremia and HD, assist with monitoring the progression of disease and determining the impact of interventions.
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