Due to unforeseen circumstances, the Pharmacodynamic Lab at Mississippi State University will be shutting down at the end of this month and be back up and running in early 2019. The last day to receive samples will be November 15, 2018. All samples received that week will be processed as usual and reports generated on time. Until further notice, after November 15, 2018, no further samples will be able to be processed. Our anticipation is that the lab will be back up and running in early 2019.
We will increase the fee for our assay when we re-open in 2019. The new price for our assay, effective once we begin receiving samples in 2019, will be $125 per assay. As always, each assay will come with our recommendations for case management in patients not clinically controlled (as well as any case with a request for recommendations even if clinically controlled) as well as phone consultation on cases as requested.
The Mississippi State University College of Veterinary Medicine Pharmacodynamic Laboratory has been established to conduct basic and clinical research into the pharmacodynamic monitoring of immunosuppressive therapy, and to provide a diagnostic service for North American veterinarians. Our current research and diagnostic focus is the monitoring of cyclosporine therapy in dogs. Our laboratory analyzes blood samples submitted by practitioners from dogs receiving cyclosporine to determine the adequacy of drug-associated immunosuppression, and members of our team are available for consultation regarding immunosuppressive therapy in dogs, and cats. Currently, our Pharmacodynamic Laboratory offers molecular (PCR-based) assays of activated T-cell mRNA IL-2 expression as a measure of adequacy of immunosuppression in dogs receiving cyclosporine. Interestingly, using our assay, we have discovered that some dogs are inadequately immunosuppressed despite receiving high dosages of cyclosporine, and that other dogs are markedly immunosuppressed despite receiving low drug dosages that have typically been considered to not be immunosuppressive, thereby establishing the need for pharmacodynamic assays to enable accurate dose adjustments in the individual dog (individualized drug therapy).
When to Use Our Assay:
- During the initial weeks of high dose cyclosporine therapy (typically, 5-10 mg/kg twice daily) in dogs with life-threatening or severe diseases, such as immune-mediated hemolytic anemia, immune-mediated thrombocytopenia, glomerulonephritis, severe inflammatory bowel disease, immune-mediated polyarthritis, or other significant immune-mediated disorders, in order to rapidly and conclusively establish adequacy of immunosuppression at current drug doses.
- During subsequent therapy in patients receiving cyclosporine that have failed to demonstrate an adequate clinical response, in order to establish that the drug is effectively suppressing T-cell function: poor clinical response despite documented suppression of T-cell function would suggest the need for alternative management strategies, whereas inadequate suppression of T-cell function would suggest the need for a cyclosporine dosage increase.
- During low dose cyclosporine therapy (5 mg/kg once or twice daily) for conditions such as atopy, anal furunculosis, or mild inflammatory bowel disease, if excessive and undesirable immunosuppression is suspected based on the development of unexpected infectious complications such as urinary tract infection, pneumonia, pyoderma, superficial or deep fungal infections, demodecosis, dermatophytosis or toxoplasmosis.
- In dogs receiving cyclosporine, the assay can be performed even if the patient is concurrently receiving other drugs.
Due to the increasing costs of running our lab, the cost for each sample (or set of samples) sent in will be $75 beginning July 1st.
For dogs receiving cyclosporine with twice daily dosing, we recommend a single peak sample (2-3 hours post dosing). In dogs receiving cyclosporine with once daily dosing, we recommend both peak (2-3 hours post dosing) and trough samples (right before the next dosage). Please see below for more information.
- We require a minimum of 3 ml of whole blood in heparin (green top). Ideally, this sample is collected 7 days or longer after beginning cyclosporine therapy. Samples can be submitted earlier than one week into treatment, at any time during the first week of drug dosing, but please contact our clinicians before collection to discuss how this may influence interpretation.
- The most reliable results are obtained if the sample is submitted chilled (that is, refrigerator temperature), but not frozen. The sample is therefore best submitted with an icepack in an insulated container. Samples should ideally be double bagged and shipped within a Styrofoam box. Samples should be shipped the same day of their draw for overnight delivery and should be received the following day, as they must be processed within 48 hours of blood collection. For processing, samples should be received by our laboratory Monday through Thursday. Samples should not be sent that will be received by our laboratory on Friday or be sent during holidays. Results are available the week after the sample is received by our laboratory, typically by late Wednesday afternoons. We will contact the veterinarian with results.
- For dogs on twice daily dosing, we request a single peak sample be submitted (2-3 hours post dosing).
- For dogs on once a day dosing, ideally, we would receive a peak (2-3 hours post dosing) as well as trough sample (right before the next dosage) in order to determine the amount of immune suppression and recovery that is occurring in the individual animal during the dosing interval. We ask for both samples because we have seen huge variations in the amount of immune system recovery over a 24-hour period in dogs receiving once daily dosing, and having both samples will allow us to generate a more accurate report with recommendations.
- After we analyze samples in an individual patient, we may request something different than the above sample schedule, if deemed necessary, in order to better assess the level of immune suppression in the individual patient. If this occurs, we will contact you directly with such a request.
Further shipping details are included in the above Sample submission form and details link.
Reports from Our Assay:
An individualized report is generated with each sample that is submitted. The reports are designed to give you recommendations on the next steps in the management of your case. There are 5 possible levels of immune suppression that we assign each individual patient in our reports:
- Marked Level of Immune Suppression. This corresponds to maximal suppression of T-cells with an inability for T-cells to increase IL-2 production with activation. If the patient’s disease is well controlled, a dosage reduction may be considered. Note, however, that some patients may need a higher level of cytokine suppression to maintain disease control, and patients should always be monitored closely after any dose decrease. If the patient’s disease is not stable or well-controlled, increasing the cyclosporine dose is unlikely to be helpful, as the maximal benefit of cyclosporine therapy has already been achieved in this individual patient. Clinicians should consider additional, or alternative immunosuppressive agents. Because of how significant immune suppression is at this level, the patient may be at significant risk for secondary infections if the dosage is left alone.
- Moderate High Level of Immune Suppression. This corresponds to a significant suppression of T-cells, but the T-cells do retain some ability to activate and are not maximally suppressed. If the patient’s disease is well controlled, a dosage adjustment is not indicated. If the patient’s disease is not well controlled and clinicians want to consider a cyclosporine dosage increase, only a small dosage increase would be indicated to obtain maximal suppression.
- Moderate Level of Immune Suppression. This corresponds to moderate suppression of T cells. T-cell cytokine expression is not completely suppressed, and the cells retain a reasonable ability to activate. If the patient’s disease is well controlled, a dosage adjustment is not indicated. If the patient’s disease is not well controlled, a dosage increase is possible to achieve additional suppression of T cells.
- Low Level of Immune Suppression. This corresponds to minimal suppression of T cells. T-cell cytokine expression is not completely suppressed, and the cells have maintained a substantial ability to activate and produce cytokines. If the patient’s disease is well controlled, a dosage adjustment may not be indicated. Caution should be exercised in reducing the dose if the patient’s disease is not fully stable. If the patient’s disease is not well controlled, a dosage increase is certainly warranted in order to achieve additional suppression of T cells.
- No Suppression. This corresponds to no suppression of T cells. T-cell cytokine expression is not affected by cyclosporine therapy, and the cells retain the same ability to activate as that seen in our control normal healthy dogs. If the patient’s disease is well controlled, a dosage adjustment may not be indicated. Caution should be exercised in reducing the dose if the patient’s disease is not fully stable. If the patient’s disease is not well controlled, a dosage increase is certainly warranted in order to achieve additional suppression of T cells.
Dr. Todd Archer
Office Phone: 662-325-1226
Dr. Andrew Mackin
Office Phone: 662-325-6631