Myocarditis in Cats with Feline Infectious Peritonitis Can Be Cured with GS-441524 and Symptomatic Cardiovascular Treatment
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population and Protocol
2.2. Cardiac Examination
2.3. Diagnosis of FIP-Induced Myocarditis
3. Results
3.1. Cardiac Findings
3.2. Outcome
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
LMU | Ludwig Maximilians University |
FIP | Feline infectious peritonitis |
FCoV | Feline coronavirus |
cTnI | Cardiac Troponin I |
ECG | Electrocardiography |
FIV | Feline immunodeficiency virus |
HCM | Hypertrophic cardiomyopathy |
SARS-CoV-2 | Severe acute respiratory syndrome coronavirus 2 |
IHC | Immunohistochemistry |
DCM | Dilated cardiomyopathy |
FeLV | Feline leukemia virus |
RT-qPCR | Reverse transcription quantitative polymerase chain reaction |
A/G | Albumin/globulin ratio |
q24h | Every 24 h |
PO | Per os |
CBC | Complete blood cell count |
RI | Reference interval |
VPCs | Ventricular premature contractions |
APCs | Atrial premature contractions |
VT | Ventricular tachycardia |
IVSd | Interventricular septal thickness in end-diastole |
LVPWd | Left ventricular posterior wall thickness in end-diastole |
LV | Left ventricular |
LA/Ao | Left atrial-to-aortic root ratio |
LAD | Left atrial diameter |
RAD | Right atrial diameter |
LVIDs | Left ventricular internal diameter in end-systole |
LVIDd | Left ventricular internal diameter in end-systole |
GLS | Global longitudinal strain |
CHF | Congestive heart failure |
q8h | Every 8 h |
q12h | Every 12 h |
q6h | Every 6 h |
COVID-19 | Coronavirus disease 2019 |
TMT | Transient myocardial thickening |
UK | United Kingdom |
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Parameter | Study Patients Days After the Start of Treatment | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Cat 1 | Cat 2 | Cat 3 | Cat 4 | |||||||||
D1 | D42 | D84 | D1 | D42 | D84 | D1 | D42 | D84 | D1 | D42 | D84 | |
Signalment | ||||||||||||
Age (months) | 70.10 | 71.60 | 73.10 | 48.10 | 49.60 | 51.10 | 5.70 | 7.20 | 8.70 | 104.20 | 105.70 | 107.20 |
Sex | male neutered | male neutered | male | female spayed | ||||||||
Breed | Ragdoll | Domestic Shorthair | Holy Birman | Oriental Shorthair | ||||||||
Weight (kg) | 5.30 | 4.95 | 5.40 | 4.66 | 4.73 | 4.80 | 1.95 | 2.67 | 3.85 | 4.40 | 4.20 | 4.10 |
Clinical signs on D1 | reduced general condition, hyporexia, fever | reduced general condition, hyporexia, fever | reduced general condition, hyporexia, fever | reduced general condition, hyporexia | ||||||||
Neurological/ ocular signs | −/− | −/− | −/uveitis and chorioretinitis | −/− | ||||||||
Location of effusion on D1 | ascites, pleural effusion | ascites | ascites | ascites | ||||||||
Volume of effusion on D1 * | +++ | +++ | +/− | ++ | ||||||||
Ultrasonography findings on D1 | severe volume of ascites, hyperechoic mesentery, lymphadenomegaly, hypoechoic pancreas | severe volume of ascites, hyperechoic mesentery, lymphadenomegaly, gallbladder wall edema | small volume of ascites, hyperechoic mesentery, lymphadenomegaly, hypoechoic pancreas, gallbladder wall edema, renomegaly | moderate volume of ascites, hyperechoic mesentery, lymphadenomegaly, hypoechoic pancreas, gallbladder wall edema, nephrolithiasis | ||||||||
Lakhdhir criteria for diagnosis of myocarditis on D1 | cTnI = 1.37 diagnosed FIP # | cTnI = 1.20 diagnosed FIP # | cTnI = 2.27 diagnosed FIP # | cTnI = 5.84 diagnosed FIP # | ||||||||
Complete blood cell count | ||||||||||||
Hematocrit (L/L) RI: 33–44 | 29.20 | 35.60 | 31.60 | 38.80 | 41.80 | 38.50 | 22.90 | 37.10 | 33.80 | 26.70 | 40.80 | 47.20 |
Platelet count (×109/L) RI: 180–550 | 36.0 § | 300.0 | 313.0 | 282.0 | 321.0 | 310.0 | 21.0 § | 113.0 ¶ | 274.0 | 78.0 § | 219.0 | 200.0 |
White blood cell count (×109/L) RI: 6–11 | 16.94 | 7.08 | 7.57 | 13.74 | 7.88 | 6.60 | 2.72 | 10.70 | 11.13 | 18.45 | 10.16 | 8.78 |
Neutrophil count (×109/L) RI: 3–11.6 | 15.87 | 3.74 | 4.14 | 12.84 | 4.38 | 3.05 | 1.33 | 5.95 | 5.66 | 16.79 | 6.96 | 5.24 |
Lymphocyte count (×109/L) RI: 1–4 | 0.36 | 2.65 | 1.94 | 0.65 | 2.43 | 2.37 | 1.25 | 3.08 | 4.37 | 0.45 | 2.36 | 2.66 |
Eosinophil count (×109/L) RI: 0.04–0.6 | 0.06 | 0.41 | 1.00 | 0.02 | 0.83 | 0.95 | 0.05 | 1.01 | 0.70 | 0.00 | 0.39 | 0.44 |
Monocyte count (×109/L) RI: 0.04–0.5 | 0.65 | 0.27 | 0.45 | 0.23 | 0.20 | 0.17 | 0.08 | 0.65 | 0.41 | 0.37 | 0.37 | 0.36 |
Serum Biochemistry | ||||||||||||
Bilirubin (µmol/L) RI: 0–4.74 | 15.20 | 0.30 | 0.40 | 24.60 | 0.30 | 0.40 | 12.60 | 0.30 | 0.10 | 71.50 | 1.10 | 0.60 |
Total protein (g/L) RI: 60–85 | 55.40 | 67.70 | 63.30 | 78.90 | 75.50 | 67.50 | 104.50 | 67.30 | 66.90 | 47.90 | 73.40 | 68.20 |
Albumin (g/L) RI: 26–56 | 20.40 | 31.30 | 30.60 | 26.60 | 35.30 | 34.40 | 21.90 | 38.60 | 37.10 | 16.50 | 33.60 | 34.10 |
Globulins (g/L) RI: <55 | 35.00 | 36.40 | 32.70 | 52.30 | 40.20 | 33.10 | 82.60 | 28.70 | 29.80 | 31.40 | 39.80 | 34.10 |
A/G ratio RI: >0.6 | 0.58 | 0.86 | 0.94 | 0.51 | 0.88 | 1.04 | 0.27 | 1.34 | 1.24 | 0.53 | 0.84 | 1.00 |
SAA (mg/L) RI: <3.9 | 46.00 | 4.00 | 2.00 | 96.70 | 1.20 | 5.70 | 76.20 | 2.10 | 0.80 | 77.90 | 1.50 | <0.30 |
AGP (µg/mL) RI: <567 | 3924.4 | 330.6 | 173.0 | 3595.4 | 226.1 | 191.1 | 1854.4 | 341.0 | 452.5 | 4778.9 | 315.7 | 271.0 |
Viral Parameters | ||||||||||||
Blood viral load (copies/mL) | 3625 | 0 | 0 | 0 | 0 | 0 | 182,012 | 0 | 0 | 726 | 0 | 0 |
Effusion viral load (copies/mL) | 3.4 Mio. | − + | − + | 95,381 | − + | − + | 28,073 | − + | − + | 3.7 Mio. | − + | − + |
Fecal viral load (copies/g) | 2.0 Mio. | 0 | 0 | 2.9 Mio. | 0 | 0 | − + | 0 | 0 | 4561 | 0 | 0 |
Anti-FCoV antibody titers | 1:400 | 1:400 | 1:400 | 1:400 | 1:400 | 1:400 | 1:1600 | 1:400 | 1:100 | 1:400 | 1:400 | 1:100 |
Additional Treatment | ||||
---|---|---|---|---|
Initial symptomatic treatment + | fluid therapy 1, amoxicillin/clavulanic acid (15 mg/kg, q8h, IV), mirtazapine, maropitant (1 mg/kg, q24h, IV), probiotics, buprenorphine (0.01 mg/kg, q8h, IV) | fluid therapy 1, mirtazapine, maropitant (1 mg/kg, q24h, IV) | fluid therapy 1, amoxicillin/clavulanic acid (15 mg/kg, q8h, IV), mirtazapine, maropitant (1 mg/kg, q24h, IV), ondansetron (0.2 mg/kg, q8h, IV), prednisolone acetate eye drops, atropine ointment | fluid therapy 1, amoxicillin/clavulanic acid (15 mg/kg, q8h, IV), mirtazapine, maropitant (1 mg/kg, q24h, IV), ondansetron (0.2 mg/kg, q8h, IV), terazosin (0.5 mg/cat, q24h, PO), fentanyl (6 µg/kg/h IV), methadone (0.2 mg/kg, q6h, IV) |
Cardiovascular treatment after cardiac assessment | none | atenolol (1.5 mg/kg, q12h, PO) | furosemide (1.25 mg/kg, q12h, PO), pimobendan (0.3 mg/kg, q12h, PO), rivaroxaban (0.6 mg/kg, q24h, PO) | pimobendan (0.24 mg/kg, q12h, PO) clopidogrel (18.75 mg/cat, q24h, PO) |
Other unrelated diseases developing during treatment | ||||
eye discharge and fever on day 35; trauma treated with meloxicam and antibiotics on day 62 | none | reduced general condition, fever, vomiting, erythema cutis, sinus tachycardia with a single episode of VT on day 12 | pyelectasis (treated with a subcutaneous ureteral bypass) on day 42 |
Values | Before Treatment | Day 42 | Day 84 | ||||
---|---|---|---|---|---|---|---|
RI | C38 | C40 | C38 | C40 | C38 | C40 | |
IVSd | <5.00 | 5.30 | 5.10 | 4.80 | 4.90 | 4.70 | 4.30 |
LVIDd | 13.40–20.90 | 15.70 | 16.60 | 17.00 | 17.60 | 15.80 | 18.20 |
LVPWd | <5.00 | 5.40 | 5.60 | 4.90 | 4.80 | 4.90 | 4.90 |
LVIDs | 6.00–13.70 | 10.40 | 9.70 | 10.50 | 11.70 | 9.30 | 11.10 |
LA/Ao | <1.60 | 1.22 | 1.32 | 1.44 | 1.44 | 1.30 | 1.18 |
LAD | <16.00 | 14.00 | 15.00 | 13.00 | 14.00 | 13.00 | 13.00 |
RAD | <12.00 | 11.20 | 10.90 | 9.70 | 11.50 | 11.80 | 11.70 |
GLS | >−21.18 | −23.71 | −22.19 | −23.67 | −25.15 | −24.97 | −28.77 |
cTnI | <0.06 | 1.37 | 1.20 | – * | − * | − * | −* |
Values | Before Treatment | Day 42 | Day 84 | ||||
---|---|---|---|---|---|---|---|
RI | C24 | C39 | C24 | C39 | C24 | C39 | |
IVSd | <5.00 | 2.80 | 3.60 | 3.70 | 3.60 | 3.70 | 3.50 |
LVIDd | 11.40–17.80 (C24) 12.20–19.20 (C39) | 16.00 | 16.40 | 17.00 | 16.80 | 14.50 | 16.40 |
LVPWd | <5.00 | 3.70 | 4.50 | 3.80 | 4.00 | 4.60 | 4.10 |
LVIDs | 5.10–11.70 (C24) 5.50–12.60 (C39) | 13.50 | 13.10 | 12.90 | 12.40 | 10.60 | 8.90 |
LA/Ao | <1.60 | 2.43 | 1.75 | 1.75 | 1.38 | 1.42 | 1.44 |
LAD | <16.00 | 19.00 | 17.00 | 15.00 | 14.00 | 14.00 | 13.00 |
RAD | <12.00 | 13.10 | 14.90 | 11.50 | 11.50 | 10.90 | 10.70 |
GLS | >−21.18 | −10.19 | −16.22 | −17.22 | −24.64 | −28.29 | −30.34 |
cTnI | <0.06 | 2.27 | 5.84 | – * | – * | – * | – * |
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Buchta, K.; Friederich, J.; Zuzzi-Krebitz, A.-M.; Schöbel, J.; Eberhard, J.; Zwicklbauer, K.; Spiri, A.M.; Hofmann-Lehmann, R.; Hartmann, K.; Wess, G. Myocarditis in Cats with Feline Infectious Peritonitis Can Be Cured with GS-441524 and Symptomatic Cardiovascular Treatment. Animals 2025, 15, 1660. https://doi.org/10.3390/ani15111660
Buchta K, Friederich J, Zuzzi-Krebitz A-M, Schöbel J, Eberhard J, Zwicklbauer K, Spiri AM, Hofmann-Lehmann R, Hartmann K, Wess G. Myocarditis in Cats with Feline Infectious Peritonitis Can Be Cured with GS-441524 and Symptomatic Cardiovascular Treatment. Animals. 2025; 15(11):1660. https://doi.org/10.3390/ani15111660
Chicago/Turabian StyleBuchta, Katharina, Jana Friederich, Anna-Maria Zuzzi-Krebitz, Jessica Schöbel, Jenny Eberhard, Katharina Zwicklbauer, Andrea M. Spiri, Regina Hofmann-Lehmann, Katrin Hartmann, and Gerhard Wess. 2025. "Myocarditis in Cats with Feline Infectious Peritonitis Can Be Cured with GS-441524 and Symptomatic Cardiovascular Treatment" Animals 15, no. 11: 1660. https://doi.org/10.3390/ani15111660
APA StyleBuchta, K., Friederich, J., Zuzzi-Krebitz, A.-M., Schöbel, J., Eberhard, J., Zwicklbauer, K., Spiri, A. M., Hofmann-Lehmann, R., Hartmann, K., & Wess, G. (2025). Myocarditis in Cats with Feline Infectious Peritonitis Can Be Cured with GS-441524 and Symptomatic Cardiovascular Treatment. Animals, 15(11), 1660. https://doi.org/10.3390/ani15111660