Emily N. Gould, DVM, MS, PhD, DACVIM (SAIM): No financial relationships to disclose
Presentation Description / Summary: Acid suppressant medications (e.g., histamine 2 receptor antagonists [H2RAs] and proton pump inhibitors [PPIs]) are commonly prescribed by veterinarians for management of disorders associated with gastrointestinal (GI) hyperacidity in companion animals. These include GI ulceration and bleeding, gastroesophageal reflux disease (GERD), and mast cell tumors (MCTs). While all of the aforementioned conditions are appropriate indications for use, both H2RAs and PPIs are also often prescribed for non-specific GI “upset” in the absence of true hyperacidity. Though resolution of clinical signs in these patients is usually attributed to “pH dependent” gastric acid production blockade, both classes of drugs have been shown to possess impressive anti-inflammatory, antioxidant, and even cytotoxic effects on certain leukocyte and neoplastic cell populations. Importantly, PPIs are able to inhibit extra-GI ATPase pumps critical for not only normal leukocyte function and trafficking, but also often upregulated by certain neoplasms to promote chemotherapy resistance. It is plausible that these “pH independent”, immunomodulatory properties might be playing a larger role in the clinical improvement of these patients than those of gastric acid suppression alone. Identification of similar effects in dogs and cats will likely allow better optimization of acid suppressant use in veterinary medicine.
This session will review the most important “pH independent” effects of H2RAs and PPIs from a One Health perspective, highlighting what is known in other species that now demands further research in dogs and cats. It will also summarize the limited body of existing companion animal studies that have started to answer these important unknowns.
Learner Outcomes: After this session, attendees will feel comfortable:
Identifying the comparative anti-inflammatory, immunomodulatory, and cytotoxic properties of H2RAs and PPIs that have been previously discovered in humans and rodents.
Discussing with colleagues the general mechanisms by which acid suppressants might be influencing white blood cell and cytokine populations in our veterinary patients.
Identifying existing knowledge gaps in the current, peer reviewed veterinary literature about what effects these medications might be having on the immune system of patient populations for which they are commonly prescribed. Especially for patients receiving concurrent immunomodulatory or anti-inflammatory therapies.
Learning Objectives:
Identify the comparative anti-inflammatory, immunomodulatory, and cytotoxic properties of H2RAs and PPIs that have been previously discovered in humans and rodents.
Discuss with colleagues the general mechanisms by which acid suppressants might be influencing white blood cell and cytokine populations in our veterinary patients.
Identify existing knowledge gaps in the current, peer reviewed veterinary literature about what effects these medications might be having on the immune system of patient populations for which they are commonly prescribed. Especially for patients receiving concurrent immunomodulatory or anti-inflammatory therapies.
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