Hello, and welcome to Chattering With iCatCare.
I'm Yaiza Gomez, iCatCare Veterinary Community Coordinator
and host of this podcast.
Today our clinical spotlight is focused on treatment tools.
Dr Kelly St Dennis will be interviewing William Whitehouse and Katrina Viviano
on a JFMS article about updates on feline clinical therapeutics, but
before Sam Taylor will be interviewing Gabriele Ratti, who was awarded
the ABCD Young Scientist Award this year for his study focused on
emerging infectious threats in cats.
Welcome Dr Ratti and thank you for joining us.
What is it that you find so fascinating about feline infectious diseases?
Infectious disease are interesting because they are ever changing.
If you think about emerging pathogen especially, we work with
microorganism that are in evolution run, so they change a lot over time.
This is the main thing that I found so interesting about infectious
disease apart also from the pathogen to host interaction.
cats in this topic are really, really strange if you think about compared to
other animals, we have a lot of virus with strange biological characteristic
or biological behaviour, such as FIP.
cats are so interesting.
So picture, when you think about infectious diseases and they also
have zoonotic pathogen, for example staphylococcus aureus is more common
in cat compared to other species.
And is that to do with their lifestyle and their varied lifestyles as well
as their physiology, is it to do with the fact that cats live differently
in different parts of the world?
Is that part of that?
Absolutely.
If you go to the evolution of felids in general, you will see a lot of fun stuff.
For example, lion have FIV, such as cat, but its not a pathogen for that species.
And of course cat have a lifestyle.
I used to work with stray cats and I try to understand by reading article and
stuff like that, how stray cat behave, where did they roam within the territory?
They have, they, they are really fascinating by a ecological point of
view also and yes, absolutely, these are things to keep in mind when you
study cat in general because cats are so different compared to other animal,
especially by ethological points of view and this kind of ethology
every precaution on feline infectious disease epidemiology, for example.
Okay.
It is, that is fascinating and you brought up then your work with stray
cats, and I think you've done quite a bit with unowned cats, haven't you?
So people who are not aware of some of your research, obviously would
encourage them to go and read all your papers, but you have published a number
looking at E. coli in unowned cats.
Is that correct?
Could you tell us a bit about why, and also I'm really interested
in how do you study unowned cats?
Because they're not known for being cats that you can catch easily or handle or.
We got fortunate about stray cats because when I was in the
University of Lodi we have a
contract with the health care system that work with the stray cat population
and in order to do nurturing program for population control, we used to capture
a lot of stray cat, put that on the generalisation to perform a sterilisation
and so we were able to collect sample for screening of SARS-CoV-2, antimicrobial
resistance and stuff like that.
Because at that time we were in the early stage of pandemic and
we actually, in Lodi, we had the first SARS-CoV-2 cases reported
in Europe, if I remember correctly.
And so we had a lot of interest, especially in the early stage of
pandemic because there was a paper that say that under experimental condition
cats were able to contract SARS-CoV-2 and transmit it to other cats.
We were really curious about the epidemiological stuff
going on, feline colonies, the
stray population in general after that paper and so we start
to collect swab from both stray
cat and also by owned cat that were admitted to the veterinary hospital
for general practice, basically.
And yes, we do a little bit of comparison with the antimicrobial
resistance between the two population in our study basically.
Before I let you go, obviously we're all cat lovers here, but you have done some
work with lions and tigers and big cats.
I wondered if you could tell us about your work looking at infectious
diseases in the non-domestic cat.
Actually, it was my graduation thesis, the search for feline coronavirus
of Tiger Lion and stuff like that.
But we search also for
other pathogen in
that kind of animal, which are really interesting also by
the infectious point of view.
And basically, once again, we don't find nothing because when you
think about captive population, they are really, really controlled by
not only by the diagnostic point of view, so biosecurity and stuff like
that, but also for the breeding lion.
So you will get a lot of struggle to find infectious diseases in this
animal, but because the, there is a big detection to biosecurity in zoo,
which is really good in my opinion.
And there are a lot of diagnostic going on this animal to keep this
population free from pathogen, which is really good because if you think
about these species of feline, they are greatly in danger basically.
So you had to work a lot on disease prevention in this animal species rather
than cure when the disease is manifested.
So do they get FIP?
Yes.
It is really rare, I have to be honest.
But there are a lot of reports, particularly in cheetah.
They got a lot of genetic problems, genetic issue, and they are
susceptible of a lot of infectious disease and particularly FIP.
Did I hear you mention lions can get FIV as well?
Yes.
Yes, but it's not pathogenic?
Pathogen in lion, they, they used to search for viral lymphocy depletion,
but at the end of the day, they use the integration of FIV to track the breeding
in Africa between lion from different group because you search for the viral
transmission light to understand the behaviour of this animal, but in general,
big cat are quite strange in infectious disease epidemiology because they are
like dog and like cat in the meaning that they can get this type of virus.
This is pathology typical of dog.
They get FIV, but it's not pathogen.
They, for example, lynx have
FLD.
But it is really amazing because you think about lion, tiger and stuff like that as
big cat but, but the infectious disease point of view, they are not, they're more
or less a bridge between dog and cat.
So they are so interesting.
Oh, that's fascinating.
Now, Dr Kelly St Dennis will be interviewing Katrina Viviano and
William Whitehouse on their recent JFMS article titled 'Clinical
Therapeutics in Feline and Medicine, Updates for Old and New Drugs.'
One of the things I found very exciting in my career is that the advancement
of analgesics in cats and our ability to detect pain in cats with different
things like feline grimace scale.
So you covered 12 different drugs or drug classes.
Some of them are analgesics, anxiolytics, diabetes medications
and treatments for FIP and HCM.
How did you end up narrowing it down to these 12?
It was a pretty collaborative effort between kind of Dr Viviano and
myself, I guess it was, oh, a little over a year ago, and I did a locum
at the University of Wisconsin.
We were talking about one of the drugs we covered, but we had previously done
a review article about a decade ago now on kind of new therapeutics in
feline medicine at that point in time and just with the influx of new agents
that are coming onto the market, getting approved for cats, as well as learning
about kind of new uses for old drugs.
We thought it would be a great time to revisit this and explore
and summarise again what is out there for feline practitioners.
We started off with, I guess, just looking at what is new and then trying to think
about what important papers have come about for more traditional drugs, and
there are probably those out there that we just weren't aware of or didn't include,
but these are the 12 we ended up with.
I think it's an amazing list.
Some diseases that were previously not treatable, HCM and FIP probably being
the most notable based on the, the drugs that you have in this article,
like what are your thoughts on drugs that are changing the way we do things?
I remember early in my career like having to help so many families
say goodbye to their cat, like after diagnosing them with FIP.
It's remarkable that we have a treatment that works quite well.
It's wonderful to see the complete 180 and prognosis for these patients
happening during our lifetime.
Mm-hmm.
I think for HCM is a similar thing.
We're starting to see exciting advancements.
As someone who practices in Northern Ontario, we don't have
access to a lot of referral.
We don't have echocardiogram here.
So when we diagnose heart disease in a cat, we don't always, in the
past, have gone for any diagnostics because there wasn't a lot for us to
do if they did receive a diagnosis.
But now things that, again, that has changed where we can say to people,
look, if we can get the diagnosis, then there's probably some things we can do.
And I wondered if you wanted to touch on the new drugs available for HCM?
Yeah.
So that I would say with regards to rapamycin, I think is still something
that is, is truly up and coming and we're still learning about.
So the initial studies look very promising with regards to what it does for
progression of ventricular hypertrophy.
I do know a lot of cardiologists who are really excited to see
the results of the HCM study.
There really is a lack of evidence for kind of benefit of other
therapeutics for that disease.
I haven't treated a lot of HCM, but I have treated a lot of kind of chronic
kidney disease in cats, and we all know that there's a lot of negative prognostic
indicators regarding disease progression.
Of all the things we do only a small handful of things show improved outcomes.
It would be great to have another agent in our arsenal to help them.
I think as you kind of alluded to, its use is most optimal in
association with subclinical HCM.
Reaching out to get that diagnosis earlier to intervene is probably gonna
change how we approach these cats.
I think it's something that's gonna evolve with time.
Yeah, and I think it's gonna be even just understanding when a cat has heart
disease is such a challenge with murmurs and no murmurs, a percentage of diseased
cats walking into my office every day, and I don't know if they could have HCM.
So that even and of itself is trying to get those cats identified as a
potential issue so that we can send them for diagnostics is something
I'm looking forward to learning more about as we see research unfold.
Dr Whitehouse, since you are focusing on kidney, did you wanna
talk about the agent that helps with feline chronic kidney disease?
Traditionally, Darbepoetin has been used as an erythrocyte stimulating agent to
treat anaemia associated with CKD in cats.
It does seem to be effective.
It does have some side effects as well.
One of the biggest limiting factors, especially for the cases that kind of,
I've Personally seen is the cost kind of associated with that medication.
It can be cost prohibitive for a lot of clients.
So it's great to have another option, an oral option in a liquid, which we
know for the majority of cats, usually it's a little bit easier to administer
than tablet or pill form, but it's also shown to be beneficial for treating
anaemia, which we again know is a negative prognostic indicator and is something
that does contribute to a decreased quality of life with them as well too.
So there's no kind of head to head right now showing which one is better but
having varenzin, which is molidustat, does offer an alternative option for these
patients and is comparably less expensive.
I know we have so many drugs to talk about and not enough time, but I wanted
to just look at analgesics in general.
But Frunevetmab was one of the things I wanted to talk to you about today
because it's been around for a while.
Everyone's generally very happy with its outcome and how it helps
quality of life for patients with degenerative joint disease.
As with everything we start to see cautionary tales, rightly or wrongly.
I wanted to talk about your feelings about the drug safety profile.
If we do see some concerns, what are those concerns?
It's one of those drugs that really addresses a need.
A lot more cats have osteoarthritis than we clinically appreciate and this
giving us an alternative option to NSAIDs makes it exciting because most of the
cats that, not all of them, but a large majority of them are gonna be older
cats and they have comorbidities, and I think that's where the challenge is.
When they look at a drug and working on approval, they're looking not only
at safety and toxicity, but they're also looking at a specific clinical
population that otherwise are healthy cats that just have osteoarthritis and
then it gets put out into the public in terms of use, once it's approved,
there's probably a lot of diversity in the patient population that gets treated.
What you're alluding to is the discussion that's come up with librela in dogs.
That's one of the post-approval reporting information that's out there, which is
super important for any drug because now we're using it in a lot,broader
population of dogs or cats and then we may see things that didn't show
up initially on the approval study.
So I think they're all warranted and important to report and investigate.
The challenging thing is we're using a monoclonal antibody against nerve
growth factor, and we have to remember the target is thought to be that nerve
growth factor is increased in joints of patients with osteoarthritis, and that's
our target, is the inflammatory piece or the inflammatory role that's sort of
negative associated with osteoarthritis.
But nerve growth faster also has other roles in terms of neuroprotection.
It's neurotrophic.
Can we potentially see adverse effects that we didn't actually predict?
And that's always possible with a new drug.
So I think it's an exciting area and it offers another way to
treat osteoarthritis in cats.
Anecdotally, the cats I've known that have had it, it helps quite a bit.
And so I think it's just like any other drug or even a drug that's known,
is having your clinical criteria of what is effective and what isn't.
And then also close monitoring, especially when you're starting to use it in an
individual patient, knowing that a lot of our cats with osteoarthritis
are gonna have comorbidities, probably on other therapies, and so is there
also the risk that we may see more adverse effects than we anticipate?
And that's always possible.
I would say know your patient population, baseline kidney function,
but like their level of pain, their level of activity, so you can make
objective assessments as is it working?
And always balancing that risk benefit ratio for any drug.
It's exciting in that it's another way.
Maybe it's gonna end up being an adjuvant therapy in some cats.
It's yet to be determined as we use it more.
Thank you for listening.
If you’re an iCatCare Veterinary Society Member, don't forget that you can access
all member benefits, including the full version of this podcast episode and
other recordings at portal.icatcare.org.
If you're looking for more free CPD from International Cat Care, we have
several open access webinars coming.
On the 3rd of November, Cat Henstridge and Dr Cecilia Villaverde will discuss
misconceptions in feline nutrition.
On the 12th, Gonzalo da Graca will share some tips on how to make veterinary
visits less stressful for cats.
We'll be back again next month with more from the world of feline medicine and
the journal of feline medicine and surgery.