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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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CONTENTS

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

List of Tables

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

List of Illustrations

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

Guide

Cover

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Equine Clinical Immunology

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.

Editorial offices: 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA

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9600 Garsington Road, Oxford, OX4 2DQ, UK

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-1-1185-5887-4 / 2016

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.

The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

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.

Dedication

To Nora and Robin.

To my family, friends and mentors who shared their support all the way.

Contributors

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

Preface

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

1The Immune System

M. Julia B. Felippe

1.1 Definition

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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