Oral cobalamin supplementation in dogs with chronic enteropathies and low serum cobalamin concentrations : Comparative studies and effects on biochemical markers of intracellular cobalamin deficiency
Year: 2018
Type: dissertation
Abstract: Cobalamin (cbl) deficiency is a common sequela to chronic enteropathies (CE) in dogs. Numerous metabolic and clinical consequences have been reported in association with cbl deficiency, as has a poorer prognosis of the underlying disease. The recommended treatment for dogs is multiple parenteral cbl injections. However, to the best of our knowledge, no studies have been performed on dogs with CE and low cbl concentrations to evaluate the effect of oral cbl supplementation, nor has the currently recommended parenteral cbl protocol been systematically validated. This is in contrast to human medicine, where comparative studies have shown equal efficacy of parenteral and high-dose oral cbl supplementation. Oral supplementation is a cost-effective and very simple treatment in human patients since it can be performed at home, as opposed to parenteral treatment. This thesis aimed to evaluate the effects of oral cbl supplementation on serum cbl concentrations in dogs with CE and low serum cbl concentrations. Further, a comparison of oral and parenteral supplementation was performed and intracellular markers of cbl deficiency, such as homocysteine (HCY) and methylmalonic acid (MMA), were analyzed and compared during the treatment period. First, a retrospective study was performed on dogs with CE and low serum cbl concentrations that had received oral cbl supplementation in clinical practice by the author. A significant difference was found when comparing serum cbl concentrations before and after supplementation. All dogs had serum concentrations within or above the cbl reference interval after supplementation. The increase in serum cbl concentrations was not correlated to Canine Inflammatory Bowel Disease Activity Index at inclusion, degree of cobalamin deficiency or if a change of diet or addition of immunosuppressive treatment was started during supplementation. Second, a prospective block-randomized study was performed, comparing serum cbl concentrations in dogs treated with peroral (PO) versus parenteral (PE) cbl supplementation. All dogs of both groups were within the upper half of the reference interval or above the reference interval limit after 28 days of cbl supplementation. The PO group had significantly lower serum cbl concentrations at this time-point than the the PE group. Ninety days after starting supplementation, the PO group had a significantly higher serum cbl concentration than the PE group. Methylmalonic acid (MMA) decreased significantly in both groups between baseline and 28 days of treatment, with no further reduction after 90 days compared to 28 days in either group. No significant differences in MMA concentrations emerged between the groups at any time-point. Serum HCY concentrations did not differ between baseline and 28 days after initiation of cbl supplementation in any group. Ninety days after cbl supplementation was started, a small increase in serum HCY concentration compared to 28 days was noted in both groups. In parallel with the MMA results, there were no significant differences in HCY concentrations between the groups at any time point. The studies on intracellular markers of cbl deficiency suggest that both treatment protocols are equally effective on a cellular level. In conclusion, this thesis provides evidence-based data that oral cbl supplementation can be used as an alternative treatment to the traditional parenteral protocol. Our results suggest that, similar to humans, an alternative intestinal absorptive pathway of cbl may exist in dogs.
Source: Työväentutkimus Vuosikirja
Author: Linda Toresson
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2908311187