Abstract
A 2-year-old intact female Toy poodle was referred with a 2-week history of diarrhea. Blood examination findings indicated thrombocytosis, severe hypoproteinemia, and hypoalbuminemia; endoscopy revealed duodenal mucosal irregularity and increased graininess. Based on these results and additional histopathological findings, we made a diagnosis of protein-losing enteropathy caused by lymphocytic-plasmacytic enteritis with lymphangiectasia. The dog was initially treated with prednisolone. Improvement was only observed with high-dose prednisolone; its dose could not be reduced without relapse. When cyclosporin, methotrexate, and chlorambucil were combined with prednisolone, no further beneficial effect was observed. When tacrolimus was combined with prednisolone, improvement was seen and the dose of prednisolone could be reduced. Tacrolimus is both a calcineurin inhibitor and a multi-drug-resistant inhibitor, so it may be an effective treatment choice for a dog refractory to standard inflammatory bowel disease treatment. This is the first report of tacrolimus for the treatment of inflammatory bowel disease in dogs.
Highlights
Canine inflammatory bowel disease (IBD) is a chronic, immunologically mediated intestinal disorder resulting from the complex interaction of environmental, genetic, and immune factors [1]
Blood examination findings indicated thrombocytosis, severe hypoproteinemia, and hypoalbuminemia; endoscopy revealed duodenal mucosal irregularity and increased graininess. Based on these results and additional histopathological findings, we made a diagnosis of protein-losing enteropathy caused by lymphocytic-plasmacytic enteritis with lymphangiectasia
Tacrolimus binds to immunophilins, which are cytoplasmic binding proteins
Summary
Canine inflammatory bowel disease (IBD) is a chronic, immunologically mediated intestinal disorder resulting from the complex interaction of environmental, genetic, and immune factors [1]. The immune-mediated basis of the disease can be inferred by the response to the administration of immunosuppressive drugs [4]. Immunosuppressive drugs such as prednisolone, azathioprine, chlorambucil, cyclosporin, and methotrexate are often used in the treatment of this disorder [5], but achievement and maintenance of remission may be difficult using these agents. Tacrolimus is an immunosuppressive macrolide isolated from the fermentation broth of Streptomyces tsukubaensis It potently inhibits helper T lymphocyte activation [6]. Despite using a combination of prednisolone and cyclosporin, methotrexate, and chlorambucil, which is a potent, immunosuppressive agent, the expected effect was not obtained. Improvement was confirmed when tacrolimus was substituted for the trio of cyclosporin, methotrexate, and chlorambucil, and rapid remission was achieved and maintained
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