Cyclosporine Treatment in Cats with Presumed Chronic Pancreatitis—A Retrospective Study

Chronic pancreatitis (CP) is a common disease in middle-aged to older cats. Cyclosporine has been suggested as an alternative treatment when other immunosuppressive treatments are insufficient or contraindicated. However, no published studies have investigated its efficacy on feline CP. The aim of this retrospective study was to evaluate the efficacy of cyclosporine on supranormal serum feline pancreas-specific lipase (Spec fPL) concentrations in cats with presumed CP. Inclusion criteria were history and clinical signs suggestive of CP, serum Spec fPL concentrations above 5.3 μg/L (reference range 0–3.5 μg/L, equivocal range 3.6–5.3 μg/L) on at least two occasions and treatment with cyclosporine for at least three weeks. Serum Spec fPL was analyzed at Idexx Laboratories, Kornwestheim, Germany. Nineteen cats, aged 6.9–17.5 years (median 11.6), were included. No pancreatic biopsies were available. Median (range) serum Spec fPL concentration was 14.2 μg/L (6.1–43.3) at baseline and 6.7 μg/L (0.9–23.6) at follow-up. Cyclosporine treatment (5.0–7.9 mg/kg orally SID) was associated with a significant reduction in serum Spec fPL concentrations (p < 0.001) at follow-up after 23–206 days (median 35). Body weight decreased significantly between inclusion and follow-up (p = 0.013). Significant improvement of clinical signs could not be measured (p = 0.781). This study has several limitations, including unstandardized treatment length and dose, no control group and lack of pancreatic biopsies. Despite the limitations, our results suggest that cyclosporine treatment reduces supranormal serum Spec fPL concentrations in cats with presumed CP

Cyclosporine Treatment in Cats with Presumed Chronic Pancreatitis—A Retrospective Study

Chronic pancreatitis (CP) is a common disease in middle-aged to older cats. Cyclosporine has been suggested as an alternative treatment when other immunosuppressive treatments are insufficient or contraindicated. However, no published studies have investigated its efficacy on feline CP. The aim of this retrospective study was to evaluate the efficacy of cyclosporine on supranormal serum feline pancreas-specific lipase (Spec fPL) concentrations in cats with presumed CP. Inclusion criteria were history and clinical signs suggestive of CP, serum Spec fPL concentrations above 5.3 μg/L (reference range 0–3.5 μg/L, equivocal range 3.6–5.3 μg/L) on at least two occasions and treatment with cyclosporine for at least three weeks. Serum Spec fPL was analyzed at Idexx Laboratories, Kornwestheim, Germany. Nineteen cats, aged 6.9–17.5 years (median 11.6), were included. No pancreatic biopsies were available. Median (range) serum Spec fPL concentration was 14.2 μg/L (6.1–43.3) at baseline and 6.7 μg/L (0.9–23.6) at follow-up. Cyclosporine treatment (5.0–7.9 mg/kg orally SID) was associated with a significant reduction in serum Spec fPL concentrations (p < 0.001) at follow-up after 23–206 days (median 35). Body weight decreased significantly between inclusion and follow-up (p = 0.013). Significant improvement of clinical signs could not be measured (p = 0.781). This study has several limitations, including unstandardized treatment length and dose, no control group and lack of pancreatic biopsies. Despite the limitations, our results suggest that cyclosporine treatment reduces supranormal serum Spec fPL concentrations in cats with presumed CP

Cholestyramine treatment in two dogs with presumptive bile acid diarrhoea: a case report

Background: In people, bile acid diarrhoea is a prevalent complication of Crohn’s disease and diarrhoea- associated irritable bowel syndrome. Affected patients typically respond to bile acid sequestrants, such as cholestyramine, but human gastroenterologists often fail to recognize bile acid diarrhoea. Consequently, bile acid diarrhoea is regarded as an underrecognized and undertreated condition in human medicine. Due to lack of diagnostic tools, clinical response to bile acid sequestrants is often used to confirm a diagnosis of bile acid diarrhoea in people. Several recent studies have shown that bile acid dysmetabolism also occurs in dogs with chronic enteropathies. It has further been shown that dogs with chronic enteropathies have significantly decreased expression of a bile acid transport protein in the ileum compared to healthy dogs, which correlates with faecal bile acid dysmetabolism. Consequently, in spite of the lack of reports in the literature, bile acid diarrhoea is likely to exist in dogs as well. Case descriptions: Two dogs, an 8-year old Rottweiler and a 4.5-year old Siberian Husky were evaluated for chronic watery diarrhoea. Neither dog responded to dietary trials, probiotics, cyclosporine, faecal microbial transplantations or metronidazole. One of the dogs responded to high daily doses of corticosteroids, which were however associated with unacceptable side effects. The other dog was refractory to all standard treatment protocols, including cyclosporine and corticosteroids. Since none of the dogs responded satisfactorily to standard treatment or modulation of the intestinal microbiome, a suspicion of possible bile acid diarrhoea was raised. Treatment with cholestyramine, a bile acid sequestrant was initiated and resulted in marked improvement of faecal consistency, frequency of defecation and activity level in both dogs. Conclusion: This report presents two dogs with presumed bile acid diarrhoea that were successfully treated with cholestyramine. Therefore, bile acid diarrhoea should be considered as a possible diagnosis in dogs with treatment-refractory chronic diarrhoea. Keywords: Bile acids, Diarrhoea, Dog, CholestyraminePeer reviewe

Cobalamin deficiency in dogs and cats

Cobalamin is a member of the B-group of vitamins and a cofactor for metabolic processes like nucleic acid synthesis, amino acid synthesis, and the citric acid cycle. Mammals are unable to synthesize cobalamin and therefore rely on adequate food intake. Cobalamin absorption is a complex process in the stomach, duodenum, and ileum, requiring a functional exocrine pancreas. Thus, a great number of gastrointestinal diseases like chronic enteropathies, intestinal lymphoma, or exocrine pancreatic insufficiency can lead to hypocobalaminemia. Furthermore, some dog breeds (Giant Schnauzer, Border Collie, Australian Sheperd Dog, and Beagle) can have a primary, hereditary cobalamin deficiency (Imerslund-Grasbeck syndrome). Clinical signs of cobalamin deficiency comprise anorexia, vomiting, diarrhoea, failure to thrive, and neuro-pathies. Laboratory findings like non-regenerative anemia, leukopenia, hypoglycemia, and hyperammonaemia have also been described. When hypocobalaminemia is suspected usually in dogs and cats, the cobalamin concentration is usually measured by immunoassay. Because the concentrations of cobalamin in blood and cells can differ the sole measurement of the vitamin concentration is of limited informative value. Treatment depends on the underlying disease aiming at eliminating the cause of hypocobalaminemia. However, successful therapy of gastrointestinal diseases often requires an additional oral or parenteral cobalamin supplementation. In patients with Imerslund-Grasbeck syndrome, a regular and lifelong cobalamin supplementation is essential.Peer reviewe

Kombiuppdrag - vara eller icke vara

Syftet med uppsatsen är att diskutera och analysera huruvida de från 2007 nya bestämmelserna om byråjäv uppnår sitt syfte, genom att undersöka dess påverkan på revisorns oberoende med avseende på kvalitet, tilltro och överensstämmelse. Uppsatsen är av induktiv karaktär med ett deskriptivt syfte. En kvalitativ metod valdes som forskningsstrategi för att samla in information. Vidare användes semistrukturerade intervjuer för datainsamlingen. Uppsatsens teoretiska referensram baseras på ämnesspecifika begrepp samt den internationella och svenska oberoenderegleringen. Det empiriska underlaget hämtas från de fyra internationellt största revisionsbyråerna. Respondenterna har en ledande position inom byrån eller annan spetskompetens som är av relevans för området. Empiri hämtas även från sju företag som påverkas av de nya bestämmelserna angående byråjäv

Effects of oral cobalamin supplementation on serum cobalamin concentrations in dogs with exocrine pancreatic insufficiency: A pilot study

The objective of this retrospective study was to evaluate serum cobalamin concentrations before and after oral cobalamin supplementation in dogs with low serum cobalamin concentrations and exocrine pancreatic insufficiency (EPI). Eighteen dogs with serum trypsin-like immunoreactivities between <1.0-2.7 μg/L (reference interval, 5.2-35 μg/L) and serum cobalamin concentrations ≤350 ng/L (reference interval, 244-959 ng/L) were enrolled. All dogs were treated with oral cyanocobalamin according to a previously described protocol (0.25-1.0 mg daily, depending on bodyweight). Median (range) serum cobalamin concentrations at inclusion was 188 ng/L (<111-350 ng/L), which increased significantly to 1000 ng/L (794-2385 ng/L; P < 0.001) after cobalamin supplementation for 19-199 days (median, 41 days). Oral cobalamin supplementation is a potential alternative to parenteral supplementation in dogs with EPI.The objective of this retrospective study was to evaluate serum cobalamin concentrations before and after oral cobalamin supplementation in dogs with low serum cobalamin concentrations and exocrine pancreatic insufficiency (EPI). Eighteen dogs with serum trypsin-like immunoreactivities between < 1.0-2.7 mu g/L (reference interval, 5.2-35 mu g/L) and serum cobalamin concentrations < 350 ng/L (reference interval, 244-959 ng/L) were enrolled. All dogs were treated with oral cyanocobalamin according to a previously described protocol (0.25-1.0 mg daily, depending on bodyweight). Median (range) serum cobalamin concentrations at inclusion was 188 ng/L (< 111-350 ng/L), which increased significantly to 1000 ng/L (794-2385 ng/L; P < 0.001) after cobalamin supplementation for 19-199 days (median, 41 days). Oral cobalamin supplementation is a potential alternative to parenteral supplementation in dogs with EPI.Peer reviewe

The fecal microbiome in dogs with acute diarrhea and idiopathic inflammatory bowel disease.

Recent molecular studies have revealed a highly complex bacterial assembly in the canine intestinal tract. There is mounting evidence that microbes play an important role in the pathogenesis of acute and chronic enteropathies of dogs, including idiopathic inflammatory bowel disease (IBD). The aim of this study was to characterize the bacterial microbiota in dogs with various gastrointestinal disorders. Fecal samples from healthy dogs (n = 32), dogs with acute non-hemorrhagic diarrhea (NHD; n = 12), dogs with acute hemorrhagic diarrhea (AHD; n = 13), and dogs with active (n = 9) and therapeutically controlled idiopathic IBD (n = 10) were analyzed by 454-pyrosequencing of the 16S rRNA gene and qPCR assays. Dogs with acute diarrhea, especially those with AHD, had the most profound alterations in their microbiome, as significant separations were observed on PCoA plots of unweighted Unifrac distances. Dogs with AHD had significant decreases in Blautia, Ruminococcaceae including Faecalibacterium, and Turicibacter spp., and significant increases in genus Sutterella and Clostridium perfringens when compared to healthy dogs. No significant separation on PCoA plots was observed for the dogs with IBD. Faecalibacterium spp. and Fusobacteria were, however, decreased in the dogs with clinically active IBD, but increased during time periods of clinically insignificant IBD, as defined by a clinical IBD activity index (CIBDAI). Results of this study revealed a bacterial dysbiosis in fecal samples of dogs with various GI disorders. The observed changes in the microbiome differed between acute and chronic disease states. The bacterial groups that were commonly decreased during diarrhea are considered to be important short-chain fatty acid producers and may be important for canine intestinal health. Future studies should correlate these observed phylogenetic differences with functional changes in the intestinal microbiome of dogs with defined disease phenotypes

Clinical Guidelines for Fecal Microbiota Transplantation in Companion Animals

The Companion Animal Fecal Microbiota Transplantation (FMT) Consortium is an international group of veterinary experts that are currently performing FMT in dogs and cats. Based on available evidence and expert opinions, the Companion Animal FMT Consortium developed the first clinical guidelines for FMT in companion animals aimed at increasing the accessibility of this microbial-directed therapeutic in veterinary medicine. These clinical guidelines include recommendations and protocols for fecal donor screening, FMT product processing and preparation, and current FMT clinical indications and administration. These clinical guidelines are intended to be utilized by veterinarians in all practice types

Correlation between Targeted qPCR Assays and Untargeted DNA Shotgun Metagenomic Sequencing for Assessing the Fecal Microbiota in Dogs

DNA shotgun sequencing is an untargeted approach for identifying changes in relative abundances, while qPCR allows reproducible quantification of specific bacteria. The canine dysbiosis index (DI) assesses the canine fecal microbiota by using a mathematical algorithm based on qPCR results. We evaluated the correlation between qPCR and shotgun sequencing using fecal samples from 296 dogs with different clinical phenotypes. While significant correlations were found between qPCR and sequencing, certain taxa were only detectable by qPCR and not by sequencing. Based on sequencing, less than 2% of bacterial species (17/1190) were consistently present in all healthy dogs (n = 76). Dogs with an abnormal DI had lower alpha-diversity compared to dogs with normal DI. Increases in the DI correctly predicted the gradual shifts in microbiota observed by sequencing: minor changes (R = 0.19, DI 2, DI > 5, and DI > 8, respectively), compared to dogs with a normal DI (DI < 0, all targets within the RI), as higher R-values indicated larger dissimilarities. In conclusion, the qPCR-based DI is an effective indicator of overall microbiota shifts observed by shotgun sequencing in dogs

Oral cobalamin supplementation in dogs with chronic enteropathies and low serum cobalamin concentrations : Comparative studies and effects on biochemical markers of intracellular cobalamin deficiency

Cobalamin (cbl) deficiency is a common sequela to chronic enteropathies (CE) in dogs. Numerous metabolic and clinical consequences have been reported in association with cbl deficiency, as has a poorer prognosis of the underlying disease. The recommended treatment for dogs is multiple parenteral cbl injections. However, to the best of our knowledge, no studies have been performed on dogs with CE and low cbl concentrations to evaluate the effect of oral cbl supplementation, nor has the currently recommended parenteral cbl protocol been systematically validated. This is in contrast to human medicine, where comparative studies have shown equal efficacy of parenteral and high-dose oral cbl supplementation. Oral supplementation is a cost-effective and very simple treatment in human patients since it can be performed at home, as opposed to parenteral treatment. This thesis aimed to evaluate the effects of oral cbl supplementation on serum cbl concentrations in dogs with CE and low serum cbl concentrations. Further, a comparison of oral and parenteral supplementation was performed and intracellular markers of cbl deficiency, such as homocysteine (HCY) and methylmalonic acid (MMA), were analyzed and compared during the treatment period. First, a retrospective study was performed on dogs with CE and low serum cbl concentrations that had received oral cbl supplementation in clinical practice by the author. A significant difference was found when comparing serum cbl concentrations before and after supplementation. All dogs had serum concentrations within or above the cbl reference interval after supplementation. The increase in serum cbl concentrations was not correlated to Canine Inflammatory Bowel Disease Activity Index at inclusion, degree of cobalamin deficiency or if a change of diet or addition of immunosuppressive treatment was started during supplementation. Second, a prospective block-randomized study was performed, comparing serum cbl concentrations in dogs treated with peroral (PO) versus parenteral (PE) cbl supplementation. All dogs of both groups were within the upper half of the reference interval or above the reference interval limit after 28 days of cbl supplementation. The PO group had significantly lower serum cbl concentrations at this time-point than the the PE group. Ninety days after starting supplementation, the PO group had a significantly higher serum cbl concentration than the PE group. Methylmalonic acid (MMA) decreased significantly in both groups between baseline and 28 days of treatment, with no further reduction after 90 days compared to 28 days in either group. No significant differences in MMA concentrations emerged between the groups at any time-point. Serum HCY concentrations did not differ between baseline and 28 days after initiation of cbl supplementation in any group. Ninety days after cbl supplementation was started, a small increase in serum HCY concentration compared to 28 days was noted in both groups. In parallel with the MMA results, there were no significant differences in HCY concentrations between the groups at any time point. The studies on intracellular markers of cbl deficiency suggest that both treatment protocols are equally effective on a cellular level. In conclusion, this thesis provides evidence-based data that oral cbl supplementation can be used as an alternative treatment to the traditional parenteral protocol. Our results suggest that, similar to humans, an alternative intestinal absorptive pathway of cbl may exist in dogs.Kobalaminbrist (vitamin B12-brist) kan uppstå hos hund som en följd av kronisk tarminflammation. Om kobalaminbrist uppstår leder det till försämrad prognos och ökad risk för avlivning. Den rekommenderade behandlingen vid kobalaminbrist hos hund är upprepade injektioner med kobalamin. Ingen har tidigare undersökt om det fungerar att ge kobalamintabletter i stället. Tablettbehandling skulle vara betydligt billigare och mycket enklare för djurägaren. Flera studier har visat att det går lika bra att ge kobalamin i tablettform som i injektionsform till människor med kobalaminbrist av olika anledningar. De flesta människor föredrar att få kobalamintabletter i stället för injektioner, eftersom det är enklare att ta tabletter, är smärtfritt och behandlingen kan skötas i hemmet. Denna avhandling syftar till att utvärdera om kobalamin kan ges i tablettform till hundar med kronisk tarminflammation och kobalaminbrist. Vi har jämfört kobalaminkoncentrationen i blodet mellan hundar som fått kobalamin i tablettform och hundar som fått det i injektionsform. Vi har också jämfört de intracellulära markörerna metylmalonsyra (MMA) och homocystein (HCY) mellan de två behandlingsgrupperna. Både nivåerna av MMA och HCY kan stiga vid kobalaminbrist. Först utfördes en retrospektiv studie hos hundar med kronisk tarminflammation och kobalaminbrist som tidigare behandlats med kobalamintabletter av huvudförfattaren. Resultaten visade att kobalaminkoncentrationen i blodet steg markant efter tablettbehandling. Alla hundar fick kobalaminvärden som var normala eller högre än det normala av tablettbehandlingen. Det fanns inget samband mellan hur mycket kobalaminkoncentrationen i blodet steg och hur hög sjukdomsaktivitet hundarna hade. Inte heller påverkades förhöjningen av kobalaminnivåerna av hur låga kobalaminvärdena var från början, eller om hundarna fick byta diet eller sattes på annan parallell behandling förutom kobalamin. Därefter utfördes en prospektiv ramdomiserad jämförande studie mellan tablett- och injektionsbehandling hos hundar med kronisk tarminflammation och kobalaminbrist. Hundarna svarade bra på båda behandlingsalternativen. De som hade fått tabletter hade lägre ökning av kobalaminvärdena än de som fått injektioner efter 28 dagar, men efter 90 dagar hade hundarna som fått tabletter högre kobalaminvärden än de som fått injektioner. Metylmalonsyrakoncentrationen sjönk markant i både den grupp som fått kobalamintabletter och de som fått injektioner efter 28 dagars behandling. Det var ingen skillnad mellan de två behandlingsgrupperna. Homocysteinkoncentrationerna var normala hos nästan alla hundarna när studien började, och var oförändrade i båda grupperna efter 28 dagars behandling. Det var ingen skillnad mellan tablett- och injektionsgruppen i detta avseende heller. Våra studier visar att båda behandlingsprotokollen är likvärdiga på cellnivå. Sammanfattningsvis har våra studier visat att vitamin B12 i tablettform fungerar bra till hund med kobalaminbrist, vilket för de flesta djurägare är en både enklare och billigare behandling än kobalamininjektioner