Immunology

Question 1

what breeds are commonly affected by cutaneous plasmacytosis? What drugs have been used and what is the response rates? what was the PFI and MST?

Answer 1

JVIM 2017: Golden and labradors, drugs included melphalan and prednisolone with a response rate of 73%. Single agent lomustine had a similar response rate. PFI 153 days, MST 542 days. Similar survival to multiple myeloma

Question 2

what CD expression do Treg cells have?

Answer 2

VCNA review 2017: CD4+ CD25+

Question 3

What % of feline ProCyte samples had falsely increased lymphocyte and decreased neutrophil counts? How is this avoided?

Answer 3

JVIM 2017: 13%. Rejecting dot plots that appear incorrect avoided this; sharp lines through cell clusters is an indication

Question 4

What is the difference between older and younger cats in regards to their LN on CT?

Answer 4

JVIM 2018: Older cats have smaller and less sacral LN

Question 5

What of the following has been found to be prognostically significant in dogs with SIRS: IL6, CRP or cholesterol concentrations?

Answer 5

JVECC 2018: Low cholesterol was associated with cardiac arrest. Seperate JVECC paper but CRP and IL6 were not prognostically significant

Question 6

What echocardiographic method is able to detect with more sensitivity myocardial dysfunction in SIRS?

Answer 6

JVIM 2019: Speckle tracking echocardiography. Standard echo measurements like EF and FS% are not as sensitive

Question 7

What is Angiopoietin 2?

Answer 7

JVIM 2019: Produced by endothelial cells, promoting inflammation, adhesions and vascular dysfunction, In this paper on dogs with SIRS it was higher in non survivors, so could be another biomarker

Question 8

What drug is associated with opportunistic, invasive fungal infections in dogs? Name a fungal species associated and another risk factor.

Answer 8

JVIM 2017: Cyclosporine. Males also more at risk. Infections included phaeohyphomycosis

Question 9

What is mycophenolate the pro-drug of? What is its MOA? Do cats biotransform this drug in a reliable way?

Answer 9

JVIM 2017: Mycophenolic acid, MOA is inhibition of purine synthesis in lymphocytes via IMPDH enzyme inhibition (type 2 affinity). All cats in this study biotransformed but plasma levels were highly variable.

Question 10

What is the effect of prednisolone on cystatin C in dogs?

Answer 10

JVIM 2017: increases

Question 11

What is the median time of onset for hepatotoxicity with azathioprine use and the incidence? what breed is over represented?

Answer 11

JVIM 2015: Median time of 14 days (13-22 days), occurred in 15% of dogs with GSD over represented. Cytopenias occurred later, median 53 days but up to 196 days

Question 12

What are some side effect associated with leflunomide use? are they dose dependent? what is the recommended starting dose?

Answer 12

JVIM 2017: diarrhoea, lethargy, unexplained haemorrhage and increased liver enzymes. Dose differences between those experiencing and not experiencing, whereas no difference in dose between clinical efficacy groups. 2mg/kg/day recommended based on this paper

Question 13

what are the signs of immune mediated destruction you are evaluating for with IMHA?

Answer 13

Consensus: spherocytes (dogs), positive agglutination (with or without washing - washing more significant), positive direct antibody test

Question 14

Which anti-thrombotic is recommended as first line by the ACVIM consensus on IMHA? What monitoring is recommended by this consensus and CURATIVE?

Answer 14

Unfractioned heparin. Based on a study in dogs with IMHA, individually dosed dogs targeting a range of 0.35-0.7IU/ml had improved survival. Weak recommendation.

Question 15

What is the effect of TPE on dogs with IMHA?

Answer 15

JAVMA 2018: case report, documented decrease in IgG and IgM

Question 16

What are Microparticles? in what disease are tissue factor and phosphatidylserine factor positive Microparticles sometimes present in?

Answer 16

JVIM 2015; plasma membrane blebs. they may contribute to thrombosis. Microparticle associated procoagulant activity is increased in some dogs with IMHA

Question 17

What % of dogs with immune mediated disease are vitamin D deficient?

Answer 17

JVIM 2017: 92%

Question 18

What is the reported Sn and Sp for CRP in detecting poorly controlled IMPA?

Answer 18

JVIM 2017: Sn 13% and Sp 100%

Question 19

What occurs to cfDNA in IMHA?

Answer 19

JVIM 2017: increased, with normal DNAase activity, implying increased release. No association with thrombosis, but may be prognostic

Question 20

What complement inhibiting drug has shown in vitro efficacy in blocking complement mediated hemolysis in dogs in VITRO?

Answer 20

JVIM 2018: Recombinant human C1-esterase inhibitor (C1-INH) reduced 80% of hemolysis at 500ug/ml and 60% at 31.25ug/ml. Computation was minimally and variably effective

Question 21

What markers of NETosis were found to be most reliably increased in dogs with IMHA

Answer 21

JVIM 2018: histone DNA and citrullinated histone H3 (former on ELISA, latter Western blot) increased in 94 and 84% of IMHA dogs respectively. cfDNA only increased in 17%

Question 22

What is MPC and what is its significance?

Answer 22

JVIM 2018: MPC = mean platelet component. it is a marker of platelet activation. Activated platelet = degranulation = lowering of the MPC (a refractile index). In IMHA it was shown to be lower compared to healthy and sick dogs AND lower = increased risk of death. Cut off of <19.1 associated with non-survival. For every 1 unit increase in MPC, risk of death decreased by 16%

Question 23

What is a clinical severity score for IMHA which has been able to predict outcome? what patient variables are prognostically significant?

Answer 23

JVIM 2015; CHAOS score. Bilirubin, Urea and ASA score are also independently predictive of survival

Question 24

What factors were associated with poor prognosis (mortality) in feline IMHA and positive prognosis?

Answer 24

JVIM 2016: Negative; increased TBIL, older. Positive; increased lymphocytes and globulins

Question 25

What is the median reported time to regeneration and remission in PIMA?

Answer 25

JAVMA 2019: Median 29 days for regeneration and 59 days for remission, In this paper mature targeting was uncommon and Myelofibrosis was detected in approximately 50%. MCST 913 days

Question 26

What joint is most affected by erosive IMPA and what are the cell count differences compared with non erosive IMPA?

Answer 26

JAVMA 2016: Carpal joint. Higher lymphocyte counts

Question 27

Has a non neoplastic splenic nodule been associated with IMPA?

Answer 27

JAVMA 2019; yes, a case report