A Case of Protein-Losing Enteropathy Treated with Methotroexate in Dog

Yuki, Masashi; Sugimoto, Noriaki; Takahashi, Kuniaki; Otsuka, Hiromi; Nishii, Naohito; Suzuki, Keitarou; Yamagami, Takeshi; Itoh, Hiroshi

doi:10.1292/jvms.68.397

Cited by 9 publications

(11 citation statements)

References 14 publications

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“…In contrast to people, PLE in dogs is usually associated with lymphoplasmacytic enteritis (LPE) rather than PIL (Table ). In the last 30 years, published data on PLE includes 23 articles, spanning from 1977 to 2018 (Table ) . Taken together, they describe in total 469 dogs of 61 different breeds, most prevalent the Yorkshire Terrier (YT), Border Collie, German Shepherd, and Rottweiler (Figures and ).…”

Section: Lymphatic Structure and Functionmentioning

confidence: 99%

“…Cumulative data from 23 PLE articles spanning from 1977 to 2017, involving a total of 469 dogs. HypoCa, hypocalcemia; MST, median survival time; PLE, protein‐losing enteropathy; SCWT, Soft Coated Wheaten Terrier; T‐embolism, thromboembolism …”

Section: Lymphatic Structure and Functionmentioning

confidence: 99%

“…Breed frequencies represented across canine PLE publications; numbers on bars indicate the number of dogs within the breed . PLE, protein‐losing enteropathy…”

Section: Lymphatic Structure and Functionmentioning

confidence: 99%

“…Treatment was described in 16 of 23 reports . An immune‐mediated cause was nearly always presumed, as shown by the use of immune suppressive medication in 15 of 16 publications (Figure ) . Prednisolone was most frequently used (15 studies) followed by azathioprine (9 studies), cyclosporine (9 studies), chlorambucil (4 studies), and methotrexate (1).…”

Section: Lymphatic Structure and Functionmentioning

confidence: 99%

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Comparative pathophysiology and management of protein‐losing enteropathy

Craven

Washabau

2019

Veterinary Internal Medicne

116

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Protein‐losing enteropathy, or PLE, is not a disease but a syndrome that develops in numerous disease states of differing etiologies and often involving the lymphatic system, such as lymphangiectasia and lymphangitis in dogs. The pathophysiology of lymphatic disease is incompletely understood, and the disease is challenging to manage. Understanding of PLE mechanisms requires knowledge of lymphatic system structure and function, which are reviewed here. The mechanisms of enteric protein loss in PLE are identical in dogs and people, irrespective of the underlying cause. In people, PLE is usually associated with primary intestinal lymphangiectasia, suspected to arise from genetic susceptibility, or “idiopathic” lymphatic vascular obstruction. In dogs, PLE is most often a feature of inflammatory bowel disease (IBD), and less frequently intestinal lymphangiectasia, although it is not proven which process is the true driving defect. In cats, PLE is relatively rare. Review of the veterinary literature (1977‐2018) reveals that PLE was life‐ending in 54.2% of dogs compared to published disease‐associated deaths in IBD of <20%, implying that PLE is not merely a continuum of IBD spectrum pathophysiology. In people, diet is the cornerstone of management, whereas dogs are often treated with immunosuppression for causes of PLE including lymphangiectasia, lymphangitis, and crypt disease. Currently, however, there is no scientific, extrapolated, or evidence‐based support for an autoimmune or immune‐mediated mechanism. Moreover, people with PLE have disease‐associated loss of immune function, including lymphopenia, severe CD4+ T‐cell depletion, and negative vaccinal titers. Comparison of PLE in people and dogs is undertaken here, and theories in treatment of PLE are presented.

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Section: Lymphatic Structure and Functionmentioning

confidence: 99%

Section: Lymphatic Structure and Functionmentioning

confidence: 99%

“…Breed frequencies represented across canine PLE publications; numbers on bars indicate the number of dogs within the breed . PLE, protein‐losing enteropathy…”

Section: Lymphatic Structure and Functionmentioning

confidence: 99%

Section: Lymphatic Structure and Functionmentioning

confidence: 99%

See 2 more Smart Citations

Comparative pathophysiology and management of protein‐losing enteropathy

Craven

Washabau

2019

Veterinary Internal Medicne

116

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show abstract

“…In moderate or severe forms, dietary management should be combined with pharmacologic treatment. Methotrexate, an antimetabolite of folic acid, has immunosuppressant and anti-inflammatory activities and has been effectively used in a dog with protein-loss enteropathies and lymphocytic enteritis that were unresponsive to steroids and cyclosporine (Yuki et al 2006). They have often been combined with azathioprine or metronidazole for more aggressive treatment and to reduce the dosage needed (Saxena et al 1985).…”

Section: Discussionmentioning

confidence: 99%