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Another guest post by Ingrid R Niesman, MSc PhD
Despite parasitism from COVID-19, or possibly due to an epidemic, more and more cats with feline peritonitis (FIP) are surviving and thriving in 2022. Just a few years ago, all cats with FIP died.
I attended the inaugural FIP seminar in November 2019 sponsored by the Winn Feline Foundation, now EveryCAT Health Foundation. Honestly, at the time, I had no idea how common this disease was, and the despair of cat parents and a lack of money for research. But most importantly, I came to understand the true, tangible hope that owners, vets, and scientists first tested over 60 years ago.
What is FIP?
FIP The coronavirus disease remains a mystery. The virus is easily transmitted between cats, and just as easily by most cats, but unfortunately in a small subset of cats, the virus changes from a non-pathogenic form to one that severely infects intestinal macrophages. As supervisors of the branch of innate immunity, macrophages release a periodic inflammatory storm that we now understand as FIP.
FIP exists in several different forms, making definitive diagnosis a problem. However, signs, such as elevated serum amyloid (SAA) as potential diagnostic keys to early detection, are being investigated. Currently, tedious microscopic examinations of tissue effusion are still the most accurate tests for a complete diagnosis. As you’ve learned, early diagnosis and treatment can be the difference between life and death for a stricken cat.
History of FIP Treatments and Prevention
Coronaviruses are among the most complex and difficult to treat. Acquired immunity can diminish rapidly and antiviral drugs prove difficult to detect and easily overcome through viral resistance. Historically, coronavirus vaccines for common animal diseases have short protection periods and, due to genetic variants, must be given frequently and in mass measures to control the disease.
The first real breakthroughs in finding effective antivirals for FIP came in 2016. Dr. Nils Pedersen published the first of several studies showing effective treatment, and remarkably potential treatments, for two drugs, Gilead Sciences GS-441524 and a drug developed in Kansas. Now acquired by Anivive Lifesciences, Inc. GC-376. Many of the original cats that survived those trials still live today.
Anivive Lifesciences, Inc. On the way to obtaining FDA approval for GC-376. Gilead Sciences is an entirely different story. Whether it was just greed or a belief that treating human cats and kittens with essentially the same drug would complicate human FDA approval or accelerate viral resistance, they have chosen to withdraw animal use of GS-441524 for FIP within the United States. The irony is that remdesivir, the human version, has won restricted FDA approval for COVID-19 and is available worldwide to treat high-risk patients and hospitalized patients, although the effectiveness of this treatment is under evaluation. However, Gilad remains steadfast in its resistance to saving the lives of the cats.
With FDA approval of animal use for GS-441524 highly unlikely in the United States, other countries have taken a different path. Remdesivir is approved for veterinary use and clinics can legally prescribe the drug for FIP in the UK and Australia. Because Gilead has licensed foreign manufacturers, but not US manufacturers, the rest of the world has access to Remdesivir for FIP. Since 2020, doctors in Australia have treated cats with cat-specific Remdesivir formulations for intravenous or subcutaneous injection. Recently, British vehicle manufacturer BOVA started distribution within the UK as well.
What are some new ways to look for new treatments?
Paxlovid, marketed by Pfizer and conditionally approved for human use by the U.S. Food and Drug Administration, is a combination of a modified version of GC-373 (a prodrug for GC-376) and an anti-HIV. This combo showed some hope for the treatment of FIP. Unfortunately, there are anecdotal reports of relapses of COVID-19 in humans with committed increases in disease severity after Paxlovid treatment.
Merck & Co. entered. field by modifying an old drug to increase oral absorption. EIDD-2801, also known as molnopiravir, has been shown to be effective in FIPV cell-based experiments. The FDA has given human approval for emergency use but not animal approval. In an unpublished global trial, there was a 100% survival of FIP cats, some within 6 weeks of treatment. Given this information, the availability of oral administration and its potential for use in GS-441524-resistant cats, there is already a crowdsourcing market for the development of this drug. Perhaps Merck will do the compassionate thing and seek animal approval as quickly as possible, allowing cats to have immediate access to this life-saving treatment.
Overcoming panic – start treatment today
Despite the legal implications and fear of using untested vials of liquid or generic white pills, cat parents around the world trust themselves rather than our medical and veterinary community. In an unprecedented way, excited personnel worked under the radar to provide GS-441524 to panicked customers, usually within 24 hours or less. Medicinal chemists work unorganized to synthesize high quality medicines to meet the growing demand. Untrained people learn to calculate doses and how to inject cats with a painful drug daily and treat and comfort sick cats.
All this is not cheap. People pay on average about $5,000 to save their pets. The question we should all be asking is why isn’t the company catering to this clearly lucrative market?
To better understand this unique situation, researchers studied the effectiveness of unlicensed drugs and untrained people in keeping cats in FIP. Published in 2021, this survey-based study reveals that to this The system can work (Jones, Novikov, Nadeau, Evans 2021). Among the 393 responders, a significant proportion of 96.7% of the treated cats were alive.
“Everyone wants to know if unlicensed medications are effective, but the compelling part of this survey is how non-veterinary professionals are figuring out how to successfully inject their cats for 84 days and still be effective,” explains author Wendy Novikov, Ph.D. . Since we used social media to find participants, there may have been some enthusiasm bias. However, in the prospective studies we are currently doing, we are still seeing an 85-90% cure rate. You can’t beat that.”
Random citizens shook control of the veterinary world
The whole story of this underground movement sounds like a work of fiction. In fact, when sanity and rationality prevail over poor business decisions, we all win or in this case, our cats win. Desperate people have found a way to save cats’ lives outside of mainstream medicine and do so without supervision. Only 9% of parents surveyed received any significant veterinary assistance.
Doctors warn against any involvement with any illegal drug. According to the information provided during the symposium, carrying out diagnostic follow-up through examination and supportive care during treatment is not an offense. Assistance during treatment will allow data to be collected and analyzed more seriously in the future. Lots of doctors have no idea what’s going on.
“Without random citizens stepping up to fill the void, there would be no FIP Warriors or other support groups,” according to Dr. Novikov. “Approximately 50,000 cats worldwide will die today.”
As I wrote earlier, losing a cat to FIP remains an open wound, often for decades. For Dr. Novikov, her grief turned into action, “not to start a movement, but to amplify it.”
Why is FIP research important, now and in the future
If we as humans have learned anything from the past two and a half years, it is that microbes should be able to defeat us all. Viruses evolve easily. Bacteria can live in expanding ecological zones. There are unknown or undisturbed reservoirs of pathogens circulating throughout the world. All life is interconnected and the help of one kind helps us all.
The search for and discovery of antiviral drugs has been a much lower priority for human medicine for decades. Interest has waned and waned with the emergence of each new scary virus; SARS, MERS, Ebola. Little attention has been paid to viral infections in our companion animals. However, without the pioneering work of dedicated feline virologists, our understanding of human coronaviruses would remain in the dark ages. Companies like Gilead Sciences owe it to feline medicine researchers for their dedication and preliminary work. There is no way we can move so quickly in terms of vaccination or treatment against COVID-19 without the work of animal virologists.
Ingrid R. Nisman Master Ph.D is director SDSU Electron Microscopy Facility at San Diego State University. She graduated from Utah State University and received her MA from the University of Illinois-Urbana-Champaign. After 30 years of technical electron microscopy, cell biology, neuroscience and infectious disease research, Dr Nisman has completed her PhD in the UK at the University of Sunderland. Her work experience includes time at LSU Medical School, University of Washington, UAMS in Little Rock, UCSD, TSRI, and a postdoctoral year at CALIBR in La Jolla, California. She has worked with at least two members of the National Academy of Sciences and is credited with more than 50 publications. It can be accessed at iniesmanphd@gmail.com
Picture of Pixabay
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