Comparative pathophysiology and management of protein-losing enteropathy.

Authors:
Robert J Washabau
Robert J Washabau
University of Pennsylvania
United States

J Vet Intern Med 2019 Mar 14;33(2):383-402. Epub 2019 Feb 14.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota.

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.

Download full-text PDF

Source
http://dx.doi.org/10.1111/jvim.15406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430879PMC
March 2019
1 Read

Publication Analysis

Top Keywords

protein-losing enteropathy
8
lymphatic system
8
intestinal lymphangiectasia
8
ple
7
disease
5
genetic susceptibility
4
lymphangiectasia suspected
4
primary intestinal
4
susceptibility "idiopathic"
4
suspected genetic
4
"idiopathic" lymphatic
4
dogs ple
4
ple feature
4
obstruction dogs
4
vascular obstruction
4
lymphatic vascular
4
associated primary
4
underlying people
4
enteric protein
4
protein loss
4

References

(Supplied by CrossRef)
Lymphatic vessels: structure and function
Rovensk√° E et al.
Isr Med Assoc J 2011
Significance of rapid turnover proteins in protein‚Äźlosing gastroenteropathy
Takeda H et al.
Hepatogastroenterology 2003

Similar Publications