Comparative pathophysiology and management of protein-losing enteropathy

Melanie D. Craven, Robert J Washabau, VMD, PhD

Research output: Contribution to journalReview article

Abstract

Protein-losing enteropathy, or PLE, is not a disease but a syndrome that develops in numerous disease states of differing etiologies and often involving the lymphatic system, such as lymphangiectasia and lymphangitis in dogs. The pathophysiology of lymphatic disease is incompletely understood, and the disease is challenging to manage. Understanding of PLE mechanisms requires knowledge of lymphatic system structure and function, which are reviewed here. The mechanisms of enteric protein loss in PLE are identical in dogs and people, irrespective of the underlying cause. In people, PLE is usually associated with primary intestinal lymphangiectasia, suspected to arise from genetic susceptibility, or “idiopathic” lymphatic vascular obstruction. In dogs, PLE is most often a feature of inflammatory bowel disease (IBD), and less frequently intestinal lymphangiectasia, although it is not proven which process is the true driving defect. In cats, PLE is relatively rare. Review of the veterinary literature (1977-2018) reveals that PLE was life-ending in 54.2% of dogs compared to published disease-associated deaths in IBD of <20%, implying that PLE is not merely a continuum of IBD spectrum pathophysiology. In people, diet is the cornerstone of management, whereas dogs are often treated with immunosuppression for causes of PLE including lymphangiectasia, lymphangitis, and crypt disease. Currently, however, there is no scientific, extrapolated, or evidence-based support for an autoimmune or immune-mediated mechanism. Moreover, people with PLE have disease-associated loss of immune function, including lymphopenia, severe CD4+ T-cell depletion, and negative vaccinal titers. Comparison of PLE in people and dogs is undertaken here, and theories in treatment of PLE are presented.

Original languageEnglish (US)
Pages (from-to)383-402
Number of pages20
JournalJournal of veterinary internal medicine
Volume33
Issue number2
DOIs
StatePublished - Mar 1 2019

Fingerprint

Protein-Losing Enteropathies
pathophysiology
digestive system diseases
Dogs
dogs
inflammatory bowel disease
Lymphangiectasis
lymphangitis
Intestinal Lymphangiectasis
Lymphangitis
Inflammatory Bowel Diseases
lymphatic system
Lymphatic System
proteins
lymphatic diseases
Lymphopenia
protein depletion
intestinal obstruction
immunosuppression
Lymphatic Diseases

Keywords

  • PLE
  • crypt
  • hypoalbuminemia
  • lymphangiectasia
  • lymphatic
  • panhypoproteinemia

PubMed: MeSH publication types

  • Journal Article
  • Review

Cite this

Comparative pathophysiology and management of protein-losing enteropathy. / Craven, Melanie D.; Washabau, VMD, PhD, Robert J.

In: Journal of veterinary internal medicine, Vol. 33, No. 2, 01.03.2019, p. 383-402.

Research output: Contribution to journalReview article

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