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Equine Clinical Immunology offers comprehensive information on equine immunological disorders. * Provides a complete, equine-specific reference on clinical immunology * Focuses on clinically relevant information for the diagnosis and treatment of horses with immune disorders * Illustrates the concepts discussed using drawings, photographs, and tables * Presents key concepts, clinical assessment information, and treatment approaches in text boxes for ease of use * Offers a practical, clinically oriented approach ideal for equine specialists
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Cover
Title Page
Copyright
Dedication
Contributors
Preface
Chapter 1: The Immune System
1.1 Definition
1.2 The organs of the immune system
1.3 The immune cells and soluble molecules
1.4 B and T cell activation in lymphoid tissues
1.5 When the immune response goes wrong
References
Chapter 2: The Immune System of the Young Horse
2.1 Definition
2.2 Equine immune system development
2.3 Unique susceptibilities and disorders of young horses
2.4 Vaccinology teaches about neonatal immunity
References
Chapter 3: The Immune System of the Older Horse
3.1 Definition
3.2 Clinical conditions associated with aging
3.3 Immunosenescence and vaccination
3.4 Nutrition in enhancing immunity in the old horse
3.5 Conclusion
References
Chapter 4: Anaphylaxis
4.1 Definition
4.2 Signalment and clinical signs
4.3 Immunologic mechanisms and etiologic associations
4.4 Diagnostics
4.5 Treatment
4.6 Prevention
4.7 Prognosis and clinical outcomes
References
Chapter 5: Allergy
5.1 Definition
5.2 Culicoides hypersensitivity
5.3 Urticaria
5.4 Recurrent airway obstruction
References
Chapter 6: Immune-Mediated Cytopenias
6.1 Definition
6.2 Immune-mediated hemolytic anemia
6.3 Immune-mediated thrombocytopenia
6.4 Immune-mediated neutropenia
References
Chapter 7: Bullous Diseases of the Skin and Mucosa
7.1 Definition
7.2 Immune-mediated bullous dermatoses
7.3 Pemphigus complex
7.4 Cutaneous adverse drug reactions
7.5 Erythema multiforme
7.6 Lupus erythematosus
References
Chapter 8: Serum Sickness
8.1 Definition
8.2 Signalment and clinical signs
8.3 Immunologic mechanisms and etiologic associations
8.4 Diagnostics
8.5 Treatment and prevention
References
Chapter 9: Vasculitis
9.1 Definition
9.2 Signalment and clinical signs
9.3 Immunologic mechanisms and etiologic associations
9.4 Diagnostics
9.5 Treatment
9.6 Thrombophlebitis
9.7 Pastern and cannon leukocytoclastic vasculitis
9.8 Drug-induced vasculitis
9.9 Photo-activated vasculitis (photodynamic drugs)
9.10 Strongylus vulgaris
9.11 Equine granulocytic anaplasmosis
9.12 Equine viral arteritis
9.13 Equine herpesvirus-1
9.14 African horse sickness
References
Chapter 10: Purpura Hemorrhagica
10.1 Definition
10.2 Signalment and clinical signs
10.3 Immunologic mechanisms and etiologic associations
10.4 Diagnostics
10.5 Treatment and prevention
References
Chapter 11: Glomerulonephritis
11.1 Definition
11.2 Signalment and clinical signs
11.3 Immunologic mechanisms and etiologic associations
11.4 Diagnostics
11.5 Treatment and prognosis
References
Chapter 12: Inflammatory and Immune-Mediated Muscle Disorders
12.1 Definition
12.2 Infarctive purpura hemorrhagica
12.3 Rhabdomyolysis associated with Streptococcus equi
12.4 Immune-mediated myositis in Quarter Horse-related breeds
12.5 Systemic calcinosis
12.6 Uncharacterized immune-mediated and inflammatory myopathies
12.7 Sarcocystis myositis
References
Chapter 13: Granulomatous Diseases
13.1 Definition
13.2 Signalment and clinical signs
13.3 Immunologic mechanisms and etiologic associations
13.4 Diagnostics
13.5 Treatment and prevention
13.6 Types of cell-mediated hypersensitivity reactions
References
Chapter 14: Chronic Inflammatory Bowel Disease
14.1 Definition
14.2 Signalment and clinical signs
14.3 Immunologic mechanisms and etiologic associations
14.4 Diagnostics
14.5 Treatment and prognosis
References
Chapter 15: Recurrent Uveitis
15.1 Definition
15.2 Signalment and clinical signs
15.3 Immunologic mechanisms and etiologic associations
15.4 Diagnostics
15.5 Treatment and prevention
15.6 Prognosis and clinical outcomes
References
Chapter 16: Recurrent Airway Obstruction and Summer Pasture-Associated Obstructive Pulmonary Disease
16.1 Definition
16.2 Signalment and clinical signs
16.3 Immunologic mechanisms and etiologic associations
16.4 Diagnostics
16.5 Treatments and prevention
References
Chapter 17: Inflammatory Airway Disease
17.1 Definition
17.2 Signalment and clinical signs
17.3 Immunologic mechanisms and etiologic associations
17.4 Types of bronchoalveolar lavage fluid inflammation and cytokine profile
17.5 Links between IAD and heaves
17.6 Links between IAD and EIPH
17.7 Diagnostics
17.8 Treatment and prevention
17.9 Prognosis and clinical outcomes
References
Chapter 18: Inflammation, Endotoxemia and Systemic Inflammatory Response Syndrome
18.1 Definition
18.2 Signalment and clinical signs
18.3 Immunologic mechanisms and etiologic associations
18.4 Multi-systemic response triggered by inflammatory mediators
18.5 Diagnostics
18.6 Treatment
18.7 Prognosis and clinical outcome
References
Chapter 19: Leukemia
19.1 Definition
19.2 Classification of leukemias
19.3 Specialized diagnostic techniques for leukemia
19.4 Chronic leukemia
19.5 Acute leukemia
References
Chapter 20: Lymphoma
20.1 Definition
20.2 Signalment and clinical signs
20.3 Forms of equine lymphoma
20.4 Immunologic mechanisms and etiologic associations
20.5 Diagnostics
20.6 Classification of lymphomas
20.7 Prognosis and treatment
20.8 Monitoring
References
Chapter 21: Immunodeficiencies
21.1 Definition
21.2 Classification of immunodeficiencies
References
Chapter 22: Immunologic Testing
22.1 Definition
22.2 Types of immunologic testing
References
Chapter 23: Non-Steroidal Anti-Inflammatories
23.1 Definition
23.2 Non-steroidal anti-inflammatory drugs
References
Chapter 24: Immunosuppressive Therapy
24.1 Definition
24.2 Types of immunosuppressive drugs
References
Chapter 25: Immunomodulators
25.1 Definition
25.2 Immunologic mechanisms
25.3 Commercially available immunostimulants for use in horses
References
Chapter 26: Immunoglobulin Therapy
26.1 Definition
26.2 Immunologic mechanisms
References
Chapter 27: Plasmapheresis
27.1 Definition
27.2 Methods for preparing plasma products
27.3 Apheresis
27.4 Therapeutic plasmapheresis
27.5 Complications of therapeutic plasmapheresis
References
Chapter 28: Principles of Vaccination
28.1 Definition
28.2 Efficacy and effectiveness of vaccines
28.3 Safety of vaccines
28.4 Key knowledge-gaps in equine vaccinology
28.5 Protocols for vaccination
References
Chapter 29: Types of Vaccines
29.1 Definition
29.2 Immunologic mechanisms
29.3 Immune responses to vaccination
29.4 Routes of vaccination
29.5 Adjuvants and vaccine delivery systems
29.6 Important diseases with unavailable effective vaccines
References
Chapter 30: Transplantation Immunology
30.1 Definition
30.2 Equine MHC genes: genomic organization and variation
30.3 Determining equine MHC haplotypes
30.4 Immunosuppression and engraftment
30.5 Graft rejection
30.6 Current transplantation applications
References
Chapter 31: Mesenchymal Stem Cell Therapy
31.1 Definition
31.2 Regenerative functions of mesenchymal stem cells
31.3 Immunologic mechanisms and associations
31.4 Sources of equine mesenchymal stem cells
31.5 Characterization of equine mesenchymal stem cells
31.6 Applications of equine mesenchymal stem cells in equine regenerative medicine
References
Chapter 32: Hematopoietic Stem Cell Transplantation
32.1 Definition
32.2 Hematopoietic stem cell sources
32.3 Pre-transplantation conditioning
32.4 Post-transplantation immunosuppression
32.5 Hematopoietic stem cell transplantation in the horse
References
Index
End User License Agreement
Table 1.1
Table 2.1
Table 7.1
Table 7.2
Table 9.1
Table 10.1
Table 13.1
Table 15.1
Table 17.1
Table 18.1
Table 18.2
Table 18.3
Table 18.4
Table 19.1
Table 20.1
Table 20.2
Table 21.1
Table 23.1
Table 23.2
Table 23.3
Table 25.1
Table 26.1
Table 28.1
Table 28.2
Table 28.3
Table 28.4
Table 28.5
Table 28.6
Table 28.7
Table 29.1
Table 30.1
Table 31.1
Table 31.2
Table 31.3
Figure 1.1
Figure 1.2
Figure 1.3
Figure 1.4
Figure 1.5
Figure 1.6
Figure 1.7
Figure 1.8
Figure 2.1
Figure 2.2
Figure 2.3
Figure 2.4
Figure 4.1
Figure 4.2
Figure 5.1
Figure 5.2
Figure 5.3
Figure 5.4
Figure 6.1
Figure 6.2
Figure 6.3
Figure 6.4
Figure 6.5
Figure 6.6
Figure 7.1
Figure 7.2
Figure 7.3
Figure 7.4
Figure 8.1
Figure 8.2
Figure 9.1
Figure 9.2
Figure 9.3
Figure 9.4
Figure 9.5
Figure 10.1
Figure 10.2
Figure 10.3
Figure 10.4
Figure 12.1
Figure 12.2
Figure 12.3
Figure 12.4
Figure 12.5
Figure 12.6
Figure 12.7
Figure 13.1
Figure 13.2
Figure 13.3
Figure 15.1
Figure 15.2
Figure 16.1
Figure 16.2
Figure 16.3
Figure 16.4
Figure 17.1
Figure 17.2
Figure 18.1
Figure 19.1
Figure 20.1
Figure 20.2
Figure 20.3
Figure 21.1
Figure 21.2
Figure 21.3
Figure 22.1
Figure 22.2
Figure 22.3
Figure 22.4
Figure 22.5
Figure 22.6
Figure 23.1
Figure 24.1
Figure 24.2
Figure 25.1
Figure 25.2
Figure 25.3
Figure 29.1
Figure 30.1
Figure 31.1
Figure 31.2
Figure 31.3
Figure 31.4
Figure 32.1
Figure 32.2
Figure 32.3
Cover
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Edited by
M. Julia B. Felippe
MedVet, MSc, PhD, Diplomate ACVIM Associate Professor of Large Animal Medicine College of Veterinary Medicine, Cornell University Ithaca, New York, USA
This edition first published 2016 © 2016 by John Wiley & Sons, Inc.
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Library of Congress Cataloging-in-Publication Data
Equine clinical immunology / [edited by] M. Julia B. Felippe.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-118-55887-4 (cloth)
1. Horses--Immunology. 2. Horses--Diseases. I. Felippe, M. Julia B. (Maria Julia B.), editor.
[DNLM: 1. Horse Diseases–immunology. 2. Immune System Diseases–veterinary. 3. Immunotherapy–veterinary. SF 951]
SF951.E5423 2016
636.1′0896079–dc23
2015019958
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
To Nora and Robin.
To my family, friends and mentors who shared their support all the way.
Amanda A. Adams, PhD
Department of Veterinary Science
Gluck Equine Research Center
University of Kentucky
Lexington, Kentucky
Michelle H. Barton, DVM, PhD, Diplomate ACVIM
Department of Large Animal Medicine
College of Veterinary Medicine
University of Georgia
Athens, Georgia
Angela I. Bordin, DVM, MS, PhD
Department of Large Animal Clinical Sciences
College of Veterinary Medicine and Biomedical Sciences
Texas A&M University
College Station, Texas
Michela Bullone, DVM, MSc
Département de Sciences Cliniques
Faculté de Médecine Vétérinaire
Université de Montréal
Montréal, Canada
Noah D. Cohen, VMD, MPH, PhD, Diplomate ACVIM
Department of Large Animal Clinical Sciences
College of Veterinary Medicine and Biomedical Sciences
Texas A&M University
College Station, Texas
Lais R.R. Costa, MedVet, MS, PhD, Diplomate ACVIM, Diplomate ABVP
Department of Clinical Sciences
College of Veterinary Medicine
Mississippi State University
Mississippi State, Mississippi
Elizabeth G. Davis, DVM, PhD, Diplomate ACVIM
Department of Clinical Sciences
College of Veterinary Medicine
Kansas State University
Manhattan, Kansas
Catharina De Schauwer, DVM, PhD, Diplomate ECAR
Department of Obstetrics, Reproduction, and Herd Health
Ghent University, Belgium
Merelbeke, Belgium
Thomas J. Divers, DVM, Diplomate ACVIM, Diplomate ACVECC
Department of Clinical Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Sian Durward-Akhurst, BVMS
Department of Veterinary Population Medicine
College of Veterinary Medicine
University of Minnesota
St. Paul, Minnesota
M. Julia B. Felippe, MedVet, MSc, PhD, Diplomate ACVIM
Department of Clinical Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Lisa A. Fortier, DVM, PhD, Diplomate ACVS
Department of Clinical Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Brian C. Gilger, DVM, MS, Diplomate ACVO, Diplomate ABT
Department of Clinical Sciences
College of Veterinary Medicine
North Carolina State University
Raleigh, North Carolina
Kelsey A. Hart, DVM, PhD, Diplomate ACVIM
Department of Large Animal Medicine
College of Veterinary Medicine
University of Georgia
Athens, Georgia
David W. Horohov, PhD
Department of Veterinary Science
Gluck Equine Research Center
University of Kentucky
Lexington, Kentucky
Laszlo L. Hunyadi, DVM, MS, PhD
Veterinary Medical Teaching Hospital
UC-Davis School of Veterinary Medicine
University of California
Davis, California
Jean-Pierre Lavoie, DMV, Diplomate ACVIM
Département de Sciences Cliniques
Faculté de Médecine Vétérinaire
Université de Montréal
Montréal, Canada
Mathilde Leclère, DMV, PhD, Diplomate ACVIM
Département de Sciences Cliniques
Faculté de Médecine Vétérinaire
Université de Montréal
Montréal, Canada
Erin L. McConachie, DVM, Diplomate ACVIM
Department of Large Animal Medicine
College of Veterinary Medicine
University of Georgia
Athens, Georgia
SallyAnne L. Ness, DVM, Diplomate ACVIM
Department of Clinical Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Gillian A. Perkins, DVM, Diplomate ACVIM
Department of Clinical Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Jeanine Peters-Kennedy, DVM, Diplomate ACVP, Diplomate ACVD
Department of Biomedical Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Jamie W. Prutton, BVSc, MRCVS, Diplomate ACVIM
Veterinary Medical Teaching Hospital
UC-Davis School of Veterinary Medicine
University of California
Davis, California
Nicola Pusterla, DVM, PhD, Diplomate ACVIM
Department of Medicine and Epidemiology
UC-Davis School of Veterinary Medicine
University of California,
Davis, California
Rolfe M. Radcliffe, DVM, Diplomate ACVS, Diplomate ACVECC
Department of Clinical Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Rebecca E. Ruby, BVSc, MS
Department of Biomedical Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Nathan M. Slovis, DVM, CHT, Diplomate ACVIM
Hagyard Equine Medical Institute
Lexington, Kentucky
Tracy Stokol, BVSc, PhD, Diplomate ACVP (Clinical Pathology)
Department of Population Medicine and Diagnostic Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Rebecca L. Tallmadge, PhD
Department of Clinical Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
Stephanie J. Valberg, DVM, PhD, Diplomate ACVIM
Department of Veterinary Population Medicine
College of Veterinary Medicine
University of Minnesota
St. Paul, Minnesota
Gerlinde R. Van de Walle, DVM, PhD
Baker Institute for Animal Health
College of Veterinary Medicine
Cornell University
Ithaca, New York
Bettina Wagner, DVM, Dr.vet.med. habilitation
Department of Population Medicine and Diagnostic Sciences
College of Veterinary Medicine
Cornell University
Ithaca, New York
The major motivation for gathering the information in this book was to highlight the field of clinical immunology using accessible and applied approaches for students and practitioners with interest in furthering horse health. The topics covered include developmental immunology, immunodeficiencies, inflammation, hypersensitivity reactions, immune-mediated diseases, oncology, vaccinology, transplantation, and regenerative medicine. These areas cover both routine and advanced equine clinical cases.
Clinical immunology is grounded on the history of infectious disease outbreaks in humans and animals but this is just the beginning. A dysfunctional immune system has been associated with the pathophysiology of tissue damage, poor healing, and cancer, involving one or multiple organs. Organ-specific specialties investigate diseases that one way or another implicate the immune system, and much of the gathered clinical immunology knowledge and principles come from these basic applied studies. Natural immunodeficiencies have taught us about mechanisms of immune response and immunity. In addition, the growing fields of transplantation and regenerative medicine attempt to explore the connection and involvement of the immune system with their success in cell and tissue restoration.
The chances of an effective treatment increase with our ability to diagnose and understand the mechanisms of disease. Working as a large animal internist in a referral hospital, and as a clinical immunologist with emphasis in immunodeficiencies, I am reminded about the broad participation of the immune system in the cause and/or effect of the great majority of diseases. However, it is at the primary care level that clinical immunology offers the most significant contributions to patient care, when the curiosity of a clinician brings questions about the role of the immune system in a clinical context, and allows the early considerate intervention before tissue damage ensues.
Inspiration is the fuel for moving forward and, in the planning of this book, I got mine from my patients and students throughout the years. Some of my patients came with aberrant susceptibility to infections or excessive inflammatory response, and my students were curious about explanations for the cause and approaches for treatment. My inspiration also came from the pioneers in the studies of equine clinical immunology, who identified and characterized the first primary immunodeficiency of the horse, shared their discoveries on developmental immunology of the fetus and foal, described the mechanisms of endotoxemia, and created the critical reagents and diagnostic tools for basic and applied research of the immune system of the horse. Although we have achieved answers to many of our questions, the gaps are still considerable, and much work is ahead of us in order to better define diseases, promote healing and, ultimately, ensure prevention.
I hope this book inspires you in pursuing knowledge and training in clinical immunology.
M. Julia B. Felippe
M. Julia B. Felippe
The immune system is a network of cells and proteins that interact in tissues and organs to protect the body from infection, and also to promote healing. In general, immunity involves: the generation of inflammation; the removal and destruction of pathogens; the expansion of immune cell population and development of memory, specifically against the antigenic insult; control of inflammation; and tissue repair. The immune mechanisms aim to recognize and attack non-self molecules, although dysregulation can cause immunodeficiencies (e.g., insufficient protective response) or immune-mediated damage of self-molecules (i.e., autoimmune diseases and hypersensitivity reactions).
Classically defined, the immune system promotes immunity through innate and adapted segments. The innate immune cells and proteins provide immediate response and action against pathogens in a somewhat unspecific manner, while the adapted immune cells require priming with pathogen, cell co-stimulation and activation before function, and development of memory.
Immune cells cross-activate or cross-repress each other through cell-cell interactions, and in response to cytokines and chemokines, which are secreted proteins that function primarily in autocrine and paracrine manners and, sometimes, endocrine. Ligand-receptor or cytokine-cytokine receptor interactions lead to corresponding cell signaling, transcription and translation for immunostimulatory or immunosuppressive outcomes.
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