Effects of Buprenorphine,Chlorhexidine, and Low-level Laser Therapy on Wound Healing in Mice

Systemic buprenorphine and topical antiseptics such as chlorhexidine are frequently used in research animals to aid in pain control and to reduce infection, respectively. These therapeutics are controversial, especially when used in wound healing studies, due to conflicting data suggesting that they delay wound healing. Low-level laser therapy (LLLT) has been used to aid in wound healing without exerting the systemic effects of therapies such as buprenorphine. We conducted 2 studies to investigate the effects of these common treatment modalities on the rate of wound healing in mice. The first study used models of punch biopsy and dermal abrasion to assess whether buprenorphine HCl or 0.12% chlorhexidine delayed wound healing. The second study investigated the effects of sustained-released buprenorphine, 0.05% chlorhexidine, and LLLT on excisional wound healing. The rate of wound healing was assessed by obtaining photographs on days 0, 2, 4, 7, and 9 for the punch biopsy model in study 1, days 0, 1, 2, 4, 6, 8, 11, and 13 for the dermal abrasion model in study 1, and days 0, 3, 6, and 10 for the mice in study 2. Image J software was used to analyze the photographed wounds to determine the wound area. When comparing the wound area on the above days to the original wound area, no significant differences in healing were observed for any of the treatment groups at any time period for either study. Given the results of these studies, we believe that systemic buprenorphine, topical chlorhexidine, and LLLT can be used without impairing or delaying wound healing in mice.

A recent retrospective analysis using a medical insurance dataset estimated that approximately 8.2 million people experienced wounds ranging from acute to chronic conditions within the particular year analyzed, and estimated that the cost of acute and chronic wound treatments ranged from $28.1 to $96.8 billion dollars.⁵² The projected rise in the number of people experiencing wounds and the cost of wound care products⁵² have made wound healing a growing area of interest in both clinical medicine and research. Wound healing is a complex process that involves many overlapping, intricate physiologic processes. Each step can have associated deviations that may lead to enhanced, altered, impaired, or delayed healing. Animal research has been used to develop a better understanding of the basic, physiologic mechanisms of wound healing. Mice are the most commonly used animal in biomedical research, and they are used to model a host of conditions, including wound healing. Despite known anatomic and physiologic differences between murine and human skin,^17,53 this species is commonly used due to their small size, ease of handling, and relatively low cost. In addition, the overlapping phases of the wound healing process are similar in mice and humans, making mice a valuable model.⁶⁵Pain is inherent to the development of wound models. Pain receptors in the skin are sensitized during the actual wounding process and during the inflammatory response that occurs immediately after wounding.¹⁹ Pain can also occur during the cleansing and treatment of wounds.¹⁹ Just as managing wound pain is critical in human patients, The Guide for the Care and Use of Laboratory Animals (the Guide)³⁰ and other federal guidelines and regulations governing the care and use of laboratory animals strongly encourages the use of analgesics for animals that experience pain and/or distress.³⁰ Pain, which can also cause stress, may evoke a persistent catabolic state and may ultimately delay wound healing.^19,28,31,43 Therefore, adequate pain control is necessary to avoid negatively affecting or altering the wound healing process.As in human medicine, opioids are commonly used to provide analgesia to research rodents. Buprenorphine, a mixed agonist-antagonist opioid,^26,54 is a common analgesic that acts as a very weak partial agonist of the mu opioid receptor and an antagonist of the κ opioid receptor.²⁶ Buprenorphine is frequently used in animals as both a pre- and post-operative analgesic. It works by binding to the opioid receptors in the skin and other tissues. This ligand-receptor binding regulates the physiologic responses of nociception and inflammation,⁷ which are key factors in the process of healing and regeneration. Buprenorphine is often used instead of full mu-opioid receptor agonist drugs, such as morphine or hydromorphone, because it has fewer systemic side effects.²⁸ Despite their common use as analgesics, reports are mixed in terms of whether opioids, as a class, delay or impair wound healing.^11,28,35,40In addition to controlling pain, minimizing wound contamination and preventing infection is critical to wound healing. The use of antiseptics is often favored over the use of antibiotics as the former presents less chance for developing antibiotic resistance.⁶ As an antiseptic, chlorhexidine is commonly used to irrigate, cleanse, and treat cutaneous wounds. Chlorhexidine has high antimicrobial activity against gram-positive and gram-negative bacteria and some fungi and viruses.⁴ Although considered to be relatively safe, reports are conflicting with regard to whether chlorhexidine delays or impairs wound healing.^4,9,50,57Laser techniques have been used medically for many years, and their powerful, but precise capabilities have rendered them a unique surgical and therapeutic modality. In brief, when the electrons of atoms move to higher energy levels, these electrons absorb energy. This excited energy state is unstable and temporary. The natural return of electrons to their more stable ground state releases energy in the form of photons or light. Light Amplification by Stimulated Emission of Radiation (LASERS) are characterized by the photon stimulation of an already excited electron. This stimulation causes the emitted light to be amplified, as demonstrated by the intense, bright light that is emitted from lasers.⁶³ The concept of low-level laser therapy (LLLT) has garnered interest as a therapeutic modality in both human and veterinary medicine. Specifically characterized as laser therapy using a low power output and a low power range, LLLT is distinguished from other forms of laser therapies by certain parameters such as wavelength, pulse rate and duration, total irradiation time, and dose.⁴⁴ Although the mechanism of action for LLLT is not completely understood,^46,64 the absorption of red and near infrared light energy may reduce detrimental, inflammatory substances^13,15,24,56 while simultaneously stimulating restorative processes.^15,24,46,64 The reduced photothermal impact of LLLT⁴⁴ is reported to produce beneficial physiologic and biologic effects including analgesia, reduction in inflammation, and acceleration of healing.⁴⁸ The initial report of LLLT as a therapeutic modality found accelerated wound healing and fur regrowth in mice exposed to LLLT.^13,44,46,64 LLLT has since been used as a sole or adjunct therapy for a variety of conditions including tooth root resorption,⁵⁵ traumatic brain injuries,⁵⁸ and tendon, muscle, and bone injuries.^2,3,25,38Studies conducted to assess the effects of LLLT on healing often use parameters of normal wound healing to analyze how LLLT influences those parameters in comparison to healthy, undamaged tissue and damaged tissue not receiving laser therapy. Despite the numerous studies designed to investigate the effects of LLLT on wound healing, conflicting reports exist regarding its efficacy.^{15,17,46,22,23,24,29,34,38,39,55,56,60,64} A recent study in dogs reported accelerated healing and improved cosmetic appearance of a hemilaminectomy surgical site after LLLT,⁶⁰ while other canine studies reported no significant differences in the healing of surgically induced skin wounds between dogs that did and did not receive LLLT.^22,34 Similarly, in an attempt to study the effects of LLLT in pigs, an animal with skin very similar to that of humans, no significant differences were reported in the healing of surgically created skin wounds between swine that did and did not receive LLLT.²⁹ Studies using diabetic rats with excisional cutaneous wounds reported accelerated wound healing,^17,46 and beneficial results were reported in a similar study using diabetic mice.^56,64 While fewer studies have been conducted on the use of LLLT in rodents without concomitant comorbidities, LLLT has been reported to accelerate wound healing in healthy rodents.^15,24 Conversely, some studies found that LLLT does not accelerate or significantly improve wound healing in rodents.^24,39We performed 2 separate studies to investigate the effects of a commonly used opioid, a topical antiseptic solution, and LLLT on excisional wound healing in mice. At the time the initial study (study 1) was conducted, some of our investigators were reluctant to use the recommended analgesic, buprenorphine, due to concern about interference with their study outcomes. Therefore, we conducted study 1 to determine if a single dose of peri-operative buprenorphine would delay healing of a full-thickness excisional wound or a partial-thickness felt wheel dermal abrasion. We also examined the effects of topical chlorhexidine solution on wound healing. The chlorhexidine concentrations used in study 1 were prepared using our standard operating procedure at that time. Study 2 was conducted after study 1, with the design expanded to evaluate a sustained release buprenorphine formulation and LLLT. Study 2 used a full-thickness excisional biopsy to determine the effect of LLLT on excisional wound healing. Commonly used doses of systemic Buprenorphine Sustained Release (SR) and topical chlorhexidine were also included to evaluate their effect on excisional wound healing. The concentration of chlorhexidine in the revised, approved standard operating procedure had been decreased due to literature suggesting that higher concentrations may inhibit healing.^4,49,61 For both studies, we hypothesized that the use of buprenorphine and chlorhexidine would have no effect on the rate of wound healing, and that LLLT would accelerate wound healing in a full-thickness excision as compared with a control.     

Comparison of Insulins Glargine and Degludec in Diabetic Rhesus Macaques (Macaca mulatta) with CGM Devices

Treating and monitoring type 2 diabetes mellitus (T2DM) in NHP can be challenging. Multiple insulin and hypoglycemic therapies and management tools exist, but few studies demonstrate their benefits in a NHP clinical setting. The insulins glargine and degludec are long-acting insulins; their duration of action in humans exceeds 24 and 42 h, respectively. In the first of this study''s 2 components, we evaluated whether insulin degludec could be dosed daily at equivalent units to glargine to achieve comparable blood glucose (BG) reduction in diabetic rhesus macaques (Macaca mulatta) with continuous glucose monitoring (CGM) devices. The second component assessed the accuracy of CGM devices in rhesus macaques by comparing time-stamped CGM interstitial glucose values, glucometer BG readings, and BG levels measured by using an automated clinical chemistry analyzer from samples that were collected at the beginning and end of each CGM device placement. The CGM devices collected a total of 21,637 glucose data points from 6 diabetic rhesus macaques that received glargine followed by degludec every 24 h for 1 wk each. Ultimately, glucose values averaged 29 mg/dL higher with degludec than with glargine. Glucose values were comparable between the CGM device, glucometer, and chemistry analyzer, thus validating that CGM devices as reliable for measuring BG levels in rhesus macaques. Although glargine was superior to degludec when given at the same dose (units/day), both are safe and effective treatment options. Glucose values from CGM, glucometers, and chemistry analyzers provided results that were analogous to BG values in rhesus macaques. Our report further highlights critical clinical aspects of using glargine as compared with degludec in NHP and the benefits of using CGM devices in macaques.

Diabetes is a group of metabolic diseases that cause hyperglycemia secondary to deficient insulin response, secretion, or both.⁴ Diabetes is categorized by the American Diabetes Association into 4 types: 1) type 1 diabetes mellitus, in which the pancreas is unable to produce insulin for glucose absorption; 2) type 2 diabetes mellitus (T2DM), when the body does not use insulin correctly; 3) gestational diabetes, in which the body is insulin-intolerant during pregnancy (or is first discovered then); and 4) other specific forms of diabetes in which the patient is particularly predisposed to becoming diabetic due to various comorbidities or to inadvertent induction caused by some medications.⁴ In 2018, 34.2 million (10.5%) Americans of all ages were diagnosed with diabetes.^22,23,30 Approximately 90% to 95% of Americans with diabetes have T2DM,²⁴ making T2DM the most common form of diabetes diagnosed in humans.T2DM is a multifactorial disease primarily determined by genetics, behavioral and environmental factors (for example, age, diet, sedentary lifestyle, obesity).^4,46,50,74 As a consequence of these factors, the pancreas increases insulin secretion to maintain normal glucose tolerance.⁷⁴ Over time, the high insulin demand causes pancreatic β-cell destruction, resulting in reduced production of insulin.^39,50,74 As β-cell destruction increases, hyperglycemia and T2DM develop. Insulin resistance and hyperglycemia are tolerated for a period of time^19,82,83 before clinical signs associated with T2DM develop (e.g., polydipsia, polyuria, polyphagia with concurrent weight loss).⁴ Once clinical signs develop, T2DM is most commonly diagnosed as a fasting blood glucose level (FBG) of 126 mg/dL or greater,^2,4 2-h plasma glucose value of 200 mg/d or greater during a 75-g oral glucose tolerance test,^2,4 and/or glycosylated hemoglobin (HbA1c) of 6.5% or greater.^2,4 Depending on the FBG, oral glucose tolerance test, and HbA1c results, various treatment options are recommended by the American Diabetes Association. Most importantly, lifestyle changes, including diet and exercise, are recommended as the first line of treatment, along with oral antihyperglycemic drugs such as metformin.^5,25,46 Treatment efficacy is evaluated with self-monitoring blood glucose or continuous glucose monitoring (CGM) devices.³ Human patients using CGM devices have achieved considerable reductions in HbA1c compared with patients not using them.³ As CGM devices have become more readily available, user friendly, and affordable, they have become an essential tool in managing T2DM.Similar to humans, most NHP affected by diabetes are diagnosed with T2DM.^80,83 NHP are predisposed to similar genetic, behavioral and environmental factors (e.g., age, diet, sedentary lifestyle, obesity);^{6,18,19,37,44,52,82,83} have similar pathophysiology;^38,81-83 are diagnosed via FBG,^39,83 HbA1c,^21,31,49,56 fructosamine,^20,83,87 and weight loss;^49,80,83,86 and are treated with exercise and diet modifications as a first line of treatment.^{11,19,39,53,79} Although the human and NHP conditions are similar, the treatment and management of T2DM is somewhat different, especially when NHP have restricted physical activity due to housing constraints.Previous studies indicate that daily dosing with insulin glargine achieves appropriate glycemic control in NHP.⁴⁸ Therefore, we implemented glargine, along with some diet modification, to improve glycemic control in our diabetic colony. Other noninsulin therapies, such as metformin, had been used, but compliance was low (for example, due to large pill size, unpleasant taste, etc.). However, achieving glycemic control using diet modification, insulin glargine treatment, monthly scheduled FBG, quarterly HbA1c, and regular weight monitoring was challenging in a large colony. Monthly FBG and fructosamine testing were performed due to affordability and practicality for NHP in a research setting. Given that fructosamine levels correlate with BG concentrations for the preceding 2 to 3 wk and HbA1c percentages relate to BG concentration over 1.5 to 3 mo,^49,87 HbA1C was selected over fructosamine for T2DM management in our colony. Determining which T2DM treatment and diagnostics are most effective can be difficult in large colonies of NHP. Therefore, improved treatment and management strategies would help to manage T2DM in NHP more efficiently.Insulin glargine is a long-acting insulin, with a half-life of 12 h and duration of action of 12 to 24 h in humans^40,55 and 12 h in dogs.^34,43,60 Once injected subcutaneously, insulin glargine forms a microprecipitate in the neutral pH environment, which delays and prolongs absorption in subcutaneous tissues.¹² Insulin degludec is a newer form of long-acting insulin, with a half-life of 25 h^41,63,62,77 and duration of action that exceeds 42 h in humans.^40,41,68,77 Insulin degludec forms a soluble and stable dihexamer in the pharmaceutical formulation, which includes phenol and zinc.^63,78 The phenol diffuses away, leading to the formation of a soluble depot in the form of long multihexamer chains in which zinc slowly diffuses from the end of the multihexamers, causing a gradual, continuous, and extended-release of monomers from the depot of the injection site.^63,78 Pharmacodynamic studies in humans, demonstrate that the “glucose-lowering effect” of insulin degluc⁴⁰ is evenly distributed over 24 h, allowing a more stable steady-state and improved wellbeing.⁷⁸ This approach could potentially reduce the number of hypoglycemic events and provide a less rigid daily injection schedule,⁵⁸ thus potentially making insulin degludec—compared with insulin glargine—a safer, alternative diabetes therapy.In addition to medical intervention, glycemic control is achieved through regular management and monitoring of BG. Self-monitoring blood glucose checks in humans^3,5 and glucose curves in animals¹⁰ are some of the management tools used to determine or evaluate therapy for T2DM patients. Telemetry systems like CGM devices are used to monitor interstitial glucose and have been used extensively in humans^3,17,33 and animals^{16,27,36,42,47,84,85} to monitor BG in real-time. Using CGM devices 1) reduces or eliminates the number of blood draws needed to collect FBG,⁶¹ 2) accurately assesses insulin therapy via a real-time glucose curve,^72,84,85 3) allows patients and clinicians to titrate treatment^61,73 as indicated, and 4) obtains continuous glucose data with reduced manipulation and subsequent decreased stress.^72,84,85 Therefore, CGM devices can be a safe and informative tool in monitoring spontaneous T2DM in NHP.Between 2015 and 2030, the prevalence of diabetes is predicted to increase by 54% to more than 54 million Americans affected by diabetes (i.e., diabetes mellitus types 1 and 2).⁷⁰ NHP are an essential model for human T2DM because of their similar pathophysiology, diagnostics, treatment, and management. As more people develop diabetes, novel therapies will continue to be developed. Studying new treatments and management tools in NHP can further human and NHP T2DM research to prevent the progression of T2DM and hopefully diminish projections for the number of future diabetes cases. Human medical literature, American Diabetes Association, and drug manufacturers all recommend giving equal doses (i.e., number of units/day) of long-acting insulins when changing from one long-acting insulin to degludec.^26,63,67 Therefore, we hypothesized that insulin degludec would provide effective glycemic control for rhesus macaques with T2DM when dosed at equivalent doses (that is, the same number of units/day) as insulin glargine. In addition, we hypothesized that CGM devices would provide accurate BG readings as compared with chemistry analyzer and glucometer BG readings, making it a more efficient and effective tool for measurement of BG levels in rhesus macaques with T2DM.     

Comparative Efficacy of Two Types of Antibiotic Mixtures in Gut Flora Depletion in Female C57BL/6 Mice

Over the last decade, interest in the role of the microbiome in health and disease has increased. The use of germ-free animals and depletion of the microbial flora using antimicrobials are 2 methods commonly used to study the microbiome in laboratory mice. Germ-free mice are born, raised, and studied in isolators in the absence of any known microbes; however, the equipment, supplies, and training required for the use of these mice can be costly and time-consuming. The use of antibiotics to decrease the microbial flora does not require special equipment, can be used for any mouse strain, and is relatively inexpensive; however, mice treated in this manner still retain microbes and they do not live in a germ-free environment. One commonly used antibiotic cocktail regimen uses ampicillin, neomycin, metronidazole, and vancomycin in the drinking water for 2 to 4 wk. We found that the palatability of this mixture is low, resulting in weight loss and leading to removal of mice from the study. The addition of sucralose to the medicated water and making wet food (mash) with the medicated water improved intake; however, the low palatability still resulted in a high number of mice requiring removal. The current study evaluated a new combination of antibiotics designed to reduce the gut microbiota while maintaining body weights. C57BL/6NCrl mice were placed on one of the following drinking water regimens: ampicillin/neomycin/metronidazole/vancomycin water (n = 16), enrofloxacin/ampicillin water (n = 12), or standard reverse osmosis deionized water (RODI) (n = 11). During an 8 day regimen, mice were weighed and water consumption was measured. Feces were collected before and after 8 d of treatment. Quantitative real-time PCR (real-time qPCR) for 16S bacterial ribosome was performed on each sample, and values were compared among groups. The combination of enrofloxacin and ampicillin improved water intake, together with a greater reduction in gut flora.

Interest in the intestinal microbiome and its role in human health has increased dramatically over the last decade. The microbiota has been implicated in metabolic, infectious, and inflammatory disease, and its role has been investigated not only in the gut,^2,8,18,38 but also in vasculature,^5,6,19,39 kidney,¹³ liver,²⁸ lung,^9,34,37 and brain.^12,15 Animal models have been important in furthering our understanding of the microbiota. Two approaches to studying microbiota in mice are the use of germ-free mice^22,35,42 and depletion of the flora with oral administration of antibiotics.^12,17,18 Both approaches have advantages and disadvantages. Germ-free mice are bred in isolators and are free of microorganisms from birth, allowing studies in mice with no microbes present; mice can then be used to generate gnotobiotic mice in which only known microbes are present. However, to remain germ-free, mice must be maintained in isolators under aseptic housing conditions, which is both costly and labor intensive. In addition, alterations of microbiota in early life may cause sustained effects on body composition¹⁰ and lasting negative consequences on the host immune system.³¹ A more economic approach has been to deplete mouse gut microflora using a combination of broad-spectrum antibiotics given either by oral gavage or in the drinking water. The primary limitation with antibiotic treatment of mice is that not all microbes are eliminated; which can potentially make reproducibility in certain types of studies such as those involving microbial transplantation²⁹ very difficult. However, antibiotic-induced gut dysbiosis can be used on conventionally raised mice without the limitations imposed by maintaining a sterile living environment. Direct handling of the mice is possible, allowing behavioral and imaging assessments, which are not be feasible for mice housed in isolators. Several broad-spectrum antibiotic treatment regimens in the drinking water have been used for gut microbe depletion.^{7,16,20,25-27,41} One of the more commonly used combinations is comprised of 4 antibiotics (ampicillin, neomycin, metronidazole, and vancomycin) added to the drinking water for periods ranging from 1 to 4 wk.^{5,9,13,19,23,30,32,34} This cocktail is effective at depleting gut microbes; however, a previous study in our laboratory found it to be highly unpalatable. Dehydration and weight loss can occur in mice receiving antibiotics in the drinking water, and the magnitude of the effect can be significant, depending on the mouse strain.^21,30,33 The weight loss can result in a substantial number of mice being removed from studies due to animal welfare concerns as reported in a previous study in which 5 of 5 mice given ampicillin, neomycin, metronidazole, and vancomycin reached eighty percent of baseline body weight and were subsequently removed.³³ A reduction in water consumption is also likely to interfere with effective antibiotic treatment and may prolong the time necessary to achieve adequate microbial depletion. Palatability enhancers such as glucose,^5,13 sucrose,⁴¹ and flavored water²³ are sometimes combined with the antibiotics in drinking water. The aim of the current study was to determine whether 8 days of treatment with an alternative mixture comprised of 2 antibiotics (enrofloxacin and ampicillin) was sufficient to deplete the gut flora as compared with the widely used combination of ampicillin, neomycin, metronidazole, and vancomycin. We hypothesized that the combination of 2 antibiotics would be at least equivalent to the combination of 4 antibiotics in reducing the gut flora while causing less weight loss.     

Inflammatory Responses with Left Ventricular Compromise after Induction of Myocardial Infarcts in Sheep (Ovis aries)

Ischemic myocardial disease is a major cause of death among humans worldwide; it results in scarring and pallor of the myocardium and triggers an inflammatory response that contributes to impaired left ventricular function. This response includes and is evidenced by the production of several inflammatory cytokines including TNFα, IL1β, IL4, IFNγ, IL10 and IL6. In the current study, myocardial infarcts were induced in 6 mo old male castrated sheep by ligation of the left circumflex obtuse marginal arteries (OM 1 and 2). MRI was used to measure parameters of left ventricular function that include EDV, ESV, EF, SVI, dp/dt max and dp/dt min at baseline and at 4 wk and 3 mo after infarct induction. We also measured serum concentrations of an array of cytokines. Postmortem histologic findings corroborate the existence of left ventricular myocardial injury and deterioration. Our data show a correlation between serum cytokine concentrations and the development of myocardial damage and left ventricular functional compromise.

Heart failure is a globally significant problem in both humans and lower animals.^3,18 The medical literature is replete with predisposing causes of heart disease,¹³ yet the prevalence of heart failure remained high.^4,5,16 Regardless of the cause of myocardial damage and subsequent left ventricular compromise, the literature indicated that the proinflammatory response that occurs after myocardial infarction is an important contributor to the deterioration of the myocardium^{1,9,12,14,17,18,20,21} Sheep and pigs are excellent translational models of human cardiology because their hearts bear many physiologic and anatomic similarities to the human heart.^4,8,15 The primary use of these models in cardiology is primarily to study myocardial infarction^5,13,16 and to a lesser extent, physiologic processes that develop after myocardial insult.Our study measured some of the major proinflammatory cytokines that contribute to myocardial damage. Most of these cytokines, including: TNFα, IL6, and IFNγ, are important correlates of myocardial ischemia that contribute to a decline in left ventricular myocardial function.^1,9,14 In our study, we detected left ventricular compromise as early as 4 wk after the infarction, while the proinflammatory response was recorded at 48 h after the infarct and peaked at 4 wk. Cardiac functional parameters began to decline early in the study consistent with the proinflammatory response. The cardiac functional parameters continued to decline until 3 mo, which was the termination of the study. These findings may support antiinflammatory intervention as an important adjunct of any therapeutic regimen.     

A One Health Perspective for Defining and Deciphering Escherichia coli Pathogenic Potential in Multiple Hosts

E. coli is one of the most common species of bacteria colonizing humans and animals. The singularity of E. coli’s genus and species underestimates its multifaceted nature, which is represented by different strains, each with different combinations of distinct virulence factors. In fact, several E. coli pathotypes, or hybrid strains, may be associated with both subclinical infection and a range of clinical conditions, including enteric, urinary, and systemic infections. E. coli may also express DNA-damaging toxins that could impact cancer development. This review summarizes the different E. coli pathotypes in the context of their history, hosts, clinical signs, epidemiology, and control. The pathotypic characterization of E. coli in the context of disease in different animals, including humans, provides comparative and One Health perspectives that will guide future clinical and research investigations of E. coli infections.

Escherichia coli (E. coli) is the most common bacterial model used in research and biotechnology. It is an important cause of morbidity and mortality in humans and animals worldwide, and animal hosts can be involved in the epidemiology of infections.^{240,367,373,452,727} The adaptive and versatile nature of E. coli argues that ongoing studies should receive a high priority in the context of One Health involving humans, animals, and the environment.^{240,315,343,727} Two of the 3 E. coli pathogens associated with death in children with moderate-to-severe diarrhea in Asia and Africa are classified into 2 E. coli pathogenic groups (also known as pathotypes or pathovars): enterotoxigenic E. coli (ETEC) and enteropathogenic E. coli (EPEC).³⁶⁷ In global epidemiologic studies, ETEC and EPEC rank among the deadliest causes of foodborne diarrheal illness and are important pathogens for increasing disability adjusted life years.^355,382,570 Furthermore, in humans, E. coli is one of the top-ten organisms involved in coinfections, which generally have deleterious effects on health.²⁷⁰ETEC is also an important etiologic agent of diarrhea in the agricultural setting.¹⁸³ E. coli-associated extraintestinal infections, some of which may be antibiotic-resistant, have a tremendous impact on human and animal health. These infections have a major economic impact on the poultry, swine, and dairy industries.^{70,151,168,681,694,781,797} The pervasive nature of E. coli, and its capacity to induce disease have driven global research efforts to understand, prevent, and treat these devastating diseases. Animal models for the study of E. coli infections have been useful for pathogenesis elucidation and development of intervention strategies; these include zebrafish, rats, mice, Syrian hamsters, guinea pigs, rabbits, pigs, and nonhuman primates.^{27,72,101,232,238,347,476,489,493,566,693,713,744,754} Experiments involving human volunteers have also been important for the study of infectious doses associated with E. coli-induced disease and of the role of virulence determinants in disease causation.^{129,176,365,400,497,702,703} E. coli strains (or their lipopolysaccharide) have also been used for experimental induction of sepsis in animals; the strains used for these studies, considered EPEC, are not typically involved in systemic disease.^{140,205,216,274,575,782}This article provides an overview of selected topics related to E. coli, a common aerobic/facultative anaerobic gastrointestinal organism of humans and animals.^{14,277,432,477,716} In addition, we briefly review: history, definition, pathogenesis, prototype (archetype or reference) strains, and features of the epidemiology and control of specific pathotypes. Furthermore, we describe cases attributed to different E. coli pathotypes in a range of animal hosts. The review of scientific and historical events regarding the discovery and characterization of the different E. coli pathotypes will increase clinical awareness of E. coli, which is too often regarded merely as a commensal organism, as a possible primary or co- etiologic agent during clinical investigations. As Will and Ariel Durant write in The Lessons of History: “The present is the past rolled up for action, and the past is the present unrolled for understanding”.     

Fibrous Osteodystrophy,Chronic Renal Disease,and Uterine Adenocarcinoma in Aged Gray Mouse Lemurs (Microcebus murinus)

The gray mouse lemur (Microcebus murinus, GML) is a nocturnal, arboreal, prosimian primate that is native to Madagascar. Captive breeding colonies of GMLs have been established primarily for noninvasive studies on questions related to circadian rhythms and metabolism. GMLs are increasingly considered to be a strong translational model for neurocognitive aging due to overlapping histopathologic features shared with aged humans. However, little information is available describing the clinical presentations, naturally occurring diseases, and histopathology of aged GMLs. In our colony, a 9 y-old, male, GML was euthanized after sudden onset of weakness, lethargy, and tibial fracture. Evaluation of this animal revealed widespread fibrous osteodystrophy (FOD) of the mandible, maxilla, cranium, appendicular, and vertebral bones. FOD and systemic metastatic mineralization were attributed to underlying chronic renal disease. Findings in this GML prompted periodic colony-wide serum biochemical screenings for azotemia and electrolyte abnormalities. Subsequently, 3 additional GMLs (2 females and 1 male) were euthanized due to varying clinical and serum biochemical presentations. Common to all 4 animals were FOD, chronic renal disease, uterine adenocarcinoma (females only), cataracts, and osteoarthritis. This case study highlights the concurrent clinical and histopathologic abnormalities that are relevant to use of GMLs in the expanding field of aging research.

Within the past 5 y, recognition of the translational utility of the gray mouse lemur (Microcebus murinus, GML) has greatly expanded, in part due to the sequencing of its genome.²⁷ GMLs have been proposed as an animal model in the context of aging research,^14,35 most notably within the fields of Alzheimer disease and dementia^33,39 and circadian rhythms.^15,20 GMLs are nocturnal, arboreal, prosimian primates (family Cheirogaleidae) that are endemic to Madagascar. They are among the smallest primates, with a body weight of 49 to 80 g in the wild³⁷ (60 to 110 g in captivity) and have a life expectancy of approximately 8 to 10 y in captivity.¹⁴ A small number of captive breeding colonies have been established throughout Europe and the United States, many of which have arisen from a closed captive breeding colony at the Muséum National d''Histoire Naturelle (MNHN) in Brunoy, France.Despite an ever-growing interest in the GML as a model organism, clinical and pathologic case reports focusing on naturally occurring disease are rare for this species.^{1,4,10,16,17,20,28,31,34,38} Reports of spontaneous disease often focus on neoplasia^28,31,34 or on ocular abnormalities, which are accessible without invasive interventions.^1,4,12 Apart from age-related neurodegenerative disease and cognitive impairment,^{5,23,25,26,32,36} little is known about the natural disease predilection and histologic aging phenotypes of GMLs.In June 2017, a 9 y-old male GML was euthanized after the sudden onset of weakness, lethargy, and tibial fracture. Necropsy and histopathology revealed chronic renal disease, widespread fibrous osteodystrophy (FOD), and systemic metastatic mineralization. These findings prompted colony-wide serum biochemical screenings for potential underlying renal disease and subsequent metabolic bone disease within the population.Herein, we report the clinical, gross, and histologic multisystemic pathology of 4 aged GMLs. This is the first documentation of FOD secondary to chronic renal disease in GMLs in a captive research colony. In addition, we corroborate previous reports^31,34 of uterine adenocarcinoma in aged female GMLs. Together, these findings aid in providing appropriate clinical care to GMLs as their use in the field of aging research continues to expand.     

Indicators of Postoperative Pain in Syrian Hamsters (Mesocricetus auratus)

Despite the use of Syrian hamsters (Mesocricetus auratus) in research, little is known about the evaluation of pain in this species. This study investigated whether the frequency of certain behaviors, a grimace scale, the treat-take-test proxy indicator, body weight, water consumption, and coat appearance could be monitored as signs of postoperative pain in hamsters in a research setting. Animals underwent no manipulation, anesthesia only or laparotomy under anesthesia. An ethogram was constructed and used to determine the frequencies of pain, active and passive behaviors by in-person and remote videorecording observation methods. The Syrian Hamster Grimace Scale (SHGS) was developed for evaluation of facial expressions before and after the surgery. The treat-take-test assessed whether surgery would affect the animals’ motivation to take a high-value food item from a handler. The hypothesis was that behavior frequency, grimace scale, treat-take-test score, body weight, water consumption, and coat appearance would change from baseline in the surgery group but not in the no-intervention and anesthesia-only groups. At several time points, pain and passive behaviors were higher than during baseline in the surgery group but not the anesthesia-only and no-intervention groups. The SHGS score increased from baseline scores in 3 of the 9 animals studied after surgery. The frequency of pain behaviors and SHGS scores were highly specific but poorly sensitive tools to identify animals with pain. Behaviors in the pain category were exhibited by chiefly, but not solely, animals that underwent the laparotomy. Also, many animals that underwent laparotomy did not show behaviors in the pain category. Treat-take-test scores, body weight, water consumption, and coat appearance did not change from baseline in any of the 3 groups. Overall, the methods we tested for identifying Syrian hamsters experiencing postoperative pain were not effective. More research is needed regarding clinically relevant strategies to assess pain in Syrian hamsters.

Pain experienced by laboratory animals can affect both animal welfare and research results. Little is known about the evaluation of pain in Syrian hamsters (Mesocricetus auratus) in the laboratory setting. However, various research models using Syrian hamsters involve surgery and are presumed to cause pain.^16,47,49 In 2018 alone, the USDA reported that 35,695 hamsters were used for research studies involving painful procedures.⁴⁸ Previously published behaviors exhibited by hamsters in response to pain include hunched posture with head down, reluctance to move, increased depression or aggression, extended sleep periods, and weight loss.^7,8,10,16,21 How these behaviors are affected by factors such as the type of painful stimulus, anesthetic protocol, handling procedures, and environmental conditions is unclear. The practicality of observing these signs in the research environment is uncertain and likely complicated by the nocturnal nature of Syrian hamsters and an assumed propensity of this species to mask pain, much like other prey species.^8,14,16A significant need exists for published data investigating whether behavioral observations or other clinical indicators can help recognize, quantify, or monitor pain in hamsters in a research setting. Detailed behavioral observations and well-controlled studies are needed to develop a system to assess postoperative pain in laboratory animals.^8,33 Moreover, little information is available on the efficacy of analgesic agents in hamsters.¹ The few studies of analgesics in hamsters rely on the mitigation of evoked pain responses (such as using a hot plate), which has limited relevance to clinical situations such as postoperative pain.^8,32,36,51 To date, no published literature has evaluated the efficacy or safety of analgesics to treat postoperative pain in hamsters. Validated real-time and practical methods for evaluating pain in Syrian hamsters would support the evaluation of analgesic efficacy in this species.Various assessments have been developed to identify signs of pain in other species. Behavioral ethograms have been used to evaluate pain and analgesic efficacy in mice, rats, rabbits, and guinea pigs in the research environment.^{5,6,20,23,25,34,35,39-41,53} Another tool used to evaluate pain in animals is the grimace scale, which has been developed for mice, rats, rabbits, ferrets, cats, sheep, pigs, horses, and even harbor seals.^{3,4,9,11,13,15,19,22,26,30,37,45,50} The use of a proxy indicator, such as burrowing and time-to-integrate-to-nest in mice and time-to-consume in guinea pigs, can be used as an additional tool for the evaluation of pain.^{5,17,18,35,38}Because none of the previously mentioned assessment techniques were specific to hamsters, we here explored using these approaches to detect pain in Syrian hamsters that underwent laparotomy in a laboratory setting. We developed a species-specific ethogram and the Syrian Hamster Grimace Scale (SHGS). We also devised a novel proxy indicator of pain for use in Syrian hamsters, the treat-take-test (TTT), which is based on hamsters’ natural behavior to hoard food.^16,46,49,52 Although water intake, body weight, and coat appearance are non-specific indicators of pain, we also measured these parameters.^5,19,23,33 Furthermore, we analyzed the effects of the presence of an observer and time of day. We hypothesized that behavior frequency, grimace scale, treat-take-test score, body weight, water consumption, and coat appearance would change from baseline in the surgery group but not in the no-intervention and anesthesia-only groups.     

Evaluation of Nutritional Gel Supplementation in C57BL/6J Mice Infected with Mouse-Adapted Influenza A/PR/8/34 Virus

Mice are a common animal model for the study of influenza virus A (IAV). IAV infection causes weight loss due to anorexia and dehydration, which can result in early removal of mice from a study when they reach a humane endpoint. To reduce the number of mice prematurely removed from an experiment, we assessed nutritional gel (NG) supplementation as a support strategy for mice infected with mouse-adapted Influenza A/Puerto Rico/8/34 (A/PR/8/34; H1N1) virus. We hypothesized that, compared with the standard of care (SOC), supplementation with NG would reduce weight loss and increase survival in mice infected with IAV without impacting the initial immune response to infection. To assess the effects of NG, male and female C57BL/6J mice were infected with IAV at low, intermediate, or high doses. When compared with SOC, mice given NG showed a significant decrease in the maximal percent weight loss at all viral doses in males and at the intermediate dose for females. Mice supplemented with NG had no deaths for either sex at the intermediate dose and a significant increase in survival in males at the high viral dose. Supplementation with NG did not alter the viral titer or the pulmonary recruitment of immune cells as measured by cell counts and flow cytometry of cells recovered in bronchoalveolar lavage (BAL) fluid in either sex. However, mice given NG had a significant reduction in IL6 and TNFα in BAL fluid and no significant differences in CCL2, IL4, IL10, CXCL1, CXCL2, and VEGF. The results of this study show that as compared with infected SOC mice, infected mice supplemented with NG have reduced weight loss and increased survival, with males showing a greater benefit. These results suggest that NG should be considered as a support strategy and indicate that sex is an important biologic variable in mice infected with IAV.

Influenza A virus (IAV) infections place a major strain on public health services world-wide. The World Health Organization estimates that influenza viral infections cause severe illness in 3 to 5 million people and death estimated at 145,000 to 650,000 people each year.^{22,27,35,40,48} Due to the significant burden that influenza places on public health, the need to learn more about the interactions of this virus with the mammalian immune system continues. This need has led to studies that use a variety of species to examine the host response to IAV. Mice are the most common species used to study influenza.^10,47 Clinical signs of influenza in mice include anorexia, dehydration, respiratory distress, hypothermia, hunched posture, unkempt hair coat and ocular discharge.^10,43,49,51 Anorexia and dehydration are common signs of influenza infection that lead to excessive weight loss in mice.Weight loss in mice infected with influenza virus is associated with anorexia induced by systemic inflammation. Proinflammatory cytokines have been shown to inhibit normal feeding behavior in mice with IAV, specifically through increased expression of tumor necrosis factor-α (TNFα), interleukin-1β (IL1β) and interleukin-6 (IL6).^{8,12,16,19,24,38,51} For example, after infection with IAV, the levels of both TNFα and IL6 begin to rise around 2 to 3 d post infection (dpi) and peak at 7 dpi.^12,24 Mice begin to lose weight at approximately 4 dpi, with peak weight loss around 9 dpi, which correlates with the levels of TNFα, IL6 and other proinflammatory mediators.^12,24,31 Weight loss is routinely used as a euthanasia endpoint criterion for mice infected with IAV. The early removal of mice from a study can have a negative impact on sample size and may compromise the accuracy of a study by introducing survivor bias.⁴³Under the guidance of Institutional Animal Care and Use Committees (IACUCs), a 20 to 30% loss in body weight is a common endpoint criterion in studies of IAV.⁴³ However, an IACUC may be reluctant to justify a weight loss of over 30%. Based on the 3 Rs, replacement, reduction, and refinement, scientists should refine techniques used in animal models of disease to minimize discomfort.²⁰ In addition, finding ways to provide physiologic support for mice in order to reduce the loss of animals in IAV studies will lead to a reduction in the number of animals required to adequately power a study. Therefore, whether supportive care reduces weight loss and consequently mortality in mice infected with IAV is an important question.The objective of the work performed here was to identify a support strategy that resulted in reduced weight loss and increased survival in mice infected with IAV, without altering the nature or degree of their immune response. The overall goal of this investigation is to improve the standard of care for influenza infected mice. If an appropriate strategy is identified, the number of mice needed for IAV studies may be reduced and providing additional support for infected mice will refine the model. To accomplish this goal, the effects of nutritional gel (NG) supplementation were evaluated in mice infected with IAV and compared with the SOC, defined as moist chow and hydrogel. Due to its physical (soft consistency) and nutritional properties, along with the minimal handling required to provide the supplement, we hypothesized that NG (DietGel Recovery) would minimize weight loss and increase the number of mice reaching the end of study as compared with the current SOC.In this paper we show that NG supplementation benefited influenza infected mice by reducing weight loss and the number of mice euthanized based on the endpoint criteria of 30% weight loss. These effects were seen at all doses in male mice, and at the low and intermediate doses in female mice. Evaluation of the immune response to influenza infection using the 0.5 EuD50 dose revealed no significant differences in the number of immune cells in mice given SOC or NG. Measurements of cytokines in BAL fluid showed lower recovery of IL6 in female mice and TNFα in male mice supplemented with NG. Thus, to summarize, both sexes should be included in study design, and mice infected with mouse-adapted IAV and supplemented with NG demonstrate less weight loss and increased survival than do SOC mice. Our data suggest that NG should be considered as a support strategy for mice infected with IAV.     

Alpha-1 Acid Glycoprotein as a Biomarker for Subclinical Illness and Altered Drug Binding in Rats

Alpha-1 acid glycoprotein (AGP) is a significant drug binding acute phase protein that is present in rats. AGP levels are known to increase during tissue injury, cancer and infection. Accordingly, when determining effective drug ranges and toxicity limits, consideration of drug binding to AGP is essential. However, AGP levels have not been well established during subclinical infections. The goal of this study was to establish a subclinical infection model in rats using AGP as a biomarker. This information could enhance health surveillance, aid in outlier identification, and provide more informed characterization of drug candidates. An initial study (n = 57) was conducted to evaluate AGP in response to various concentrations of Staphylococcus aureus (S. aureus) in Sprague–Dawley rats with or without implants of catheter material. A model validation study (n = 16) was then conducted using propranolol. Rats received vehicle control or S. aureus and when indicated, received oral propranolol (10 mg/kg). Health assessment and blood collection for measurement of plasma AGP or propranolol were performed over time (days). A dose response study showed that plasma AGP was elevated on day 2 in rats inoculated with S. aureus at 10⁶, 10⁷ or, 10⁸ CFU regardless of implant status. Furthermore, AGP levels remained elevated on day 4 in rats inoculated with 10⁷ or 10⁸ CFUs of S. aureus. In contrast, significant increases in AGP were not detected in rats treated with vehicle or 10³ CFU S. aureus. In the validation study, robust elevations in plasma AGP were detected on days 2 and 4 in S. aureus infected rats with or without propranolol. The AUC levels for propranolol on days 2 and 4 were 493 ± 44 h × ng/mL and 334 ± 54 h × ng/mL, respectively), whereas in noninfected rats that received only propranolol, levels were 38 ± 11 h × ng/mL and 76 ± 16.h × ng/mL, respectively. The high correlation between plasma propranolol and AGP demonstrated a direct impact of AGP on drug pharmacokinetics and pharmacodynamics. The results indicate that AGP is a reliable biomarker in this model of subclinical infection and should be considered for accurate data interpretation.

Protein binding is an important component of pharmacokinetic/pharmacodynamic (PK/PD) research. In vitro measurement of protein drug binding is an essential component of the research and development of novel drugs. However, in vitro studies often poorly mirror the in vivo condition.^9,42 Pharmacokinetic studies early in drug development provide a means to assess the time course of drug effects in the body and drug distribution and availability.⁴² From a PK/PD modeling perspective, protein binding is an important factor in the kinetics and dynamics of drug availability in vivo.^21,35,36,40 These complex relationships are used to project efficacious doses in humans and take into consideration differences in plasma protein binding between preclinical species and humans.^8,44A variety of acute phase proteins (APP) exist across all species and increase in response to inflammatory, infectious and traumatic events.^{5,9,12,13,19,21,22,29,45,53} APPs are potential biomarkers for detection and monitoring of various disease states including cancer.^{2,18,24,34,39,40,47,50,52} Because of this, enhanced understanding of drug binding characteristics to APPs early in the development phase will promote the design of more efficacious therapeutics. Alpha-1 acid glycoprotein (AGP), a ubiquitous major APP that is present in rats,^9,46 has significant drug binding properties and binds to many basic and neutral compounds. Normal AGP levels in plasma of naïve rats range from 0.1 to 0.32 mg/mL.⁴⁴ The importance of AGP as related to drug discovery and development will be bolstered by greater understanding of the sources of AGP stimulation in established animal models. For example, AGP modulates the immune response in a rodent shock model in which it is thought to maintain normal capillary permeability to ensure perfusion of vital organs.^30,33 In addition, elevated AGP levels are present in animal models of infection and inflammation.^{11,20,27,32,41,48}In surgically modified animals, AGP levels may be elevated after surgical manipulation, which unavoidably induces local transient inflammatory responses.^8,25,51 In addition, infections may develop postoperatively leading to increased AGP levels. Chronic catheterization has been linked to increased incidence of infection.^3,8,37 Surgically modified animals should not be placed on study if aseptic technique was not adhered to during surgical preparation and instrumentation.^6,37 Contamination may occur within or at the external portion of a catheter, usually resulting in more obvious signs of infection. Routine PK studies in rats involve implantation of vascular catheters through which drugs are administered and blood samples are taken over time. Catheterized animals are typically perceived as being healthy and thus are enrolled in and remain on study unless they develop obvious clinical signs of infection or illness. However, an occult infection may be present even with a patent catheter. As such, understanding the direct effect of subclinical infection in modulating AGP levels and drug binding is critical, as AGP levels may affect drug levels in study animals with persistent subclinical infection. In this event, the PK data generated may be altered due to selective binding to AGP, thus confounding data interpretation.A possible application of AGP is its potential utility as a biomarker for evaluating health status animals in drug development. The use of AGP as a select biomarker for monitoring and identifying sick animals and/or predicting the potential impact of subclinical infection on drug PK/PD is highly desirable. A screening tool such as this could help to optimize animal selection by reliably identifying healthy animals. Improved intra-study health monitoring would promote confidence in PK/PD data and its predictive value.The focus of this research was to develop a sensitive, reliable and reproducible model of subclinical infection in the rat using the ubiquitous skin contaminant, S. aureus. We selected AGP as a biomarker that would promote health status screening and enhance PK/PD characterization of AGP binding drugs (that is basic and neutral) in the presence or absence of subclinical infection. The model was validated by evaluating the impact of increased AGP levels on propranolol, a drug known to have high binding affinity to AGP.^{4,7,10,26,28,31,49} Ultimately, establishing this model will provide heightened visibility of the protein binding characteristics of drugs and yield more informed data interpretation.     

Effects of Individual and Coexisting Diabetes and Cardiomyopathy on Diastolic Function in Rats (Rattus norvegicus domestica)

The goal of this study was to evaluate diastolic intraventricular pressure gradients (IVPG) and 2-dimensional tissue tracking (2DTT) patterns during diabetes and cardiomyopathy. Rats (n = 60) were induced to become diabetic (DM group, n = 15) by using streptozotocin, to become cardiomyopathic (CM group, n = 15) by using isoproterenol, and to become both diabetic and cardiomyopathic (DMCM group, n = 15); control rats (CT group, n = 15) were injected with saline. Two months after induction, all rats underwent conventional echocardiography, IVPG, and 2DTT and then were euthanized for microscopic examination of cardiac fibrosis. Compared with the controls, all 3 treated groups showed diastolic dysfunction and delayed cardiac relaxation. DMCM rats showed the most pronounced cardiac abnormalities. In addition, CM and DMCM groups had showed decreased middle IVPG, whereas DMCM rats had decreased midapical IVPG. Although the overall IVPG of the CM group was normal, the middle segment was significantly decreased. 2DTT results showed that the DMCM group had a delay in relaxation compared with other groups. IVPG and 2DTT can be used to overcome the limitation of conventional echocardiographic methods and reveal diastolic dysfunction. DM worsened diastolic function during cardiac disease.

Diabetes mellitus (DM) is a chronic disease identified by hyperglycemia.¹ DM and associated insulin abnormalities result in hypertension, cardiovascular disease, and multiple organ dysfunction.¹⁸ Diabetic cardiomyopathy is defined as abnormal myocardial structure and performance in the absence of other cardiac risk factors, such as coronary artery disease, hypertension, and significant valvular disease, in patients with DM.³ A previous study showed that diastolic dysfunction could result from DM; and cardiac fibrosis in the interstitial and perivascular areas was a hallmark of long-term DM.²³ Cardiac fibrosis in DM rats results from myocardial infarction.Cardiomyopathy can be induced in rats by using isoproterenol.¹⁷ Cardiomyopathy refers to the cardiac disorder in which myocardial abnormalities result from myocyte injury. Cardiomyopathy has several etiologies, including chronic hypertension, valvular abnormality, and toxin.¹⁵ Both DM and cardiomyopathy are fibrotic heart diseases, but their pathogenesis differs. Moreover, DM and CM cause fibrosis in different heart locations.The diastolic function of the left ventricle (LV) can be defined as the pull of blood into the LV under low filling pressure. Two groups have described the pressure differences that pull the blood through the mitral valve into the ventricle during diastole.^6,16 The difference of pressure between the LV and aorta during systole and the importance of regional pressure differences within the ventricle during relaxation has recently gained attention.^9,29 The diastolic intraventricular pressure gradient (IVPG) in the LV is closely related to LV relaxation. Deterioration of the IVPG is associated with abnormal LV blood flow patterns.²2D tissue tracking (2DTT) echocardiography is a promising technique that quantifies myocardial deformation by tracking the ultrasonographic speckle pattern of the cardiac cycle.¹³ Because of the importance of measuring diastolic function, we used conventional echocardiography, IVPG and 2DTT to evaluate the diastolic impairment without altering systolic function. We studied the relationship between mild (DM rats) and moderate (CM rats) cardiac fibrosis due to myocardial injury and infarction together with the severe fibrosis that develops due to the combination of DM and cardiomyopathy.Streptozotocin and isoproterenol were used to induce DM and cardiomyopathy, respectively. Both cause cardiac fibrosis, but the pathogenesis and affected location are different. Our study was designed to evaluate diastolic IVPG and 2DTT as diastolic indices. Our goal was to delineate IVPG and 2DTT patterns in DM, CM, and very severe fibrotic heart disease induced by combining DM and cardiomyopathy.     

Hemochromatosis in Two Female Olive Baboons (Papio anubis)

This report describes hemochromatosis associated with chronic parenteral iron dextran administration in 2 female olive baboons (Papio anubis). These baboons were enrolled on an experimental protocol that induced and maintained anemia by periodic phlebotomy for use in studying potential treatments for sickle cell anemia. The 2 baboons both presented with clinical signs consistent with iron overload, including decreased appetite, weight loss, elevated liver enzymes, and hepatosplenomegaly. Histopathologic findings supported a morphologic diagnosis of systemic hemosiderosis, as evidenced by the overwhelming presence of iron in the reticuloendothelial system and liver after the application of Prussian blue stain. This finding, combined with the clinical presentation, lead to a final diagnosis of hemochromatosis. This case report suggests that providing anemic patients with chronic parenteral iron supplementation in the absence of iron deficiency can result in iatrogenic iron overload and subsequent systemic toxicity. Furthermore, these subjects may present with hemochromatosis and its associated clinical signs many years after cessation of iron supplementation.

Iron is an essential micronutrient that plays an important role in cellular proliferation, oxygen transport, and cellular energy generation.^13,26,31 The highest levels of iron in the body is found in the erythrocytes, followed by the liver, reticuloendothelial system, and skeletal muscle.⁹ Three main mechanisms regulate iron: 1) dietary absorption through the proximal duodenum; 2) recycling of senescent red blood cells by macrophages; and 3) storage in the liver. The liver produces the hormone hepcidin, which is the primary negative regulator of systemic iron metabolism.³⁸ Hepcidin controls the release of iron from enterocytes and macrophages into the circulation by binding to and degrading ferroportin, the only mammalian iron exporter.³⁵ When plasma iron levels are high, hepatocytes increase hepcidin synthesis. The increased hepcidin subsequently suppresses gastrointestinal absorption of exogenous iron and iron release from macrophages into circulation.³¹Approximately 1 to 2 mg of iron is lost per day through enterocyte and skin sloughing.³⁸ Iron can also be lost by hemorrhage, menstruation, and parasitic infestation.³⁸ Other than these, the body has no active mechanism for iron excretion. Iron overload can result from acute iron toxicity or chronic accumulation of iron over time.³⁵ Iron is primarily stored in the liver in the form of ferritin, and excess iron is transformed into hemosiderin, an oxidized form of ferritin. Hemosiderin is an iron-containing pigment found primarily in macrophages and hepatocytes.³⁵Hemosiderosis occurs when iron accumulates in tissues, but causes no subsequent organ injury or dysfunction. It is not typically pathologic and can be reversed.⁹ In contrast, hemochromatosis occurs when iron accumulation results in organ injury and dysfunction.³⁵ The 2 types of hemochromatosis are primary and secondary. Primary hemochromatosis, also known as hereditary hemochromatosis, is the result of inherited mutations in genes that are important for iron homeostasis. The most common gene involved in primary hemochromatosis is HFE, an autosomal recessive trait.¹¹ Almost all forms of primary hemochromatosis involve low levels of hepcidin expression.¹¹ Secondary hemochromatosis can occur due to iron-loading anemias such as thalassemia and sideroblastic anemia, chronic liver disease (for example, hepatitis C), and iatrogenic causes, such as excess iron in the diet or parenteral administration.¹⁶ Hemolytic anemia and repeated blood transfusions can also result in secondary hemochromatosis.³⁵ In primary hemochromatosis, iron typically accumulates in the liver, pancreas, heart, and endocrine glands for many years.^16,24 In contrast, secondary hemochromatosis patients often accumulate iron in the reticuloendothelial system, bone marrow, and lymph nodes¹⁶ over a shorter time period,²⁴ with excess iron accumulating in the hepatocytes after the reticuloendothelial system has become saturated with iron.¹⁶ Symptoms of iron overload can vary among individuals due to the number of organ systems affected. These symptoms may include lethargy, arthralgia, skin hyperpigmentation, abdominal pain, abnormal liver chemistry tests, and hepatomegaly.¹⁵ In the current report, we describe 2 cases of hemochromatosis in female baboons after chronic parenteral administration of iron dextran as part of an anemia maintenance protocol used to study sickle cell anemia treatments.     

Cotton Rat Placenta Anatomy and Fc Receptor Expression and Their Roles in Maternal Antibody Transfer

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and viral pneumonia in infants and young children worldwide. Currently no vaccine is available to prevent RSV infection, but virus-neutralizing monoclonal antibodies can be given prophylactically, emphasizing the protective potential of antibodies. One concept of RSV vaccinology is mothers’ immunization to induce high antibody titers, leading to passive transfer of high levels of maternal antibody to the fetus through the placenta and to the neonate through colostrum. Cotton rats are an excellent small animal model for RSV infection and have been used to test maternal immunization. To mechanistically understand antibody transfer in the cotton rat model, we characterized the cotton rat placenta and Fc receptor localization. Placentas from cotton rats at midgestation (approximately day 14) and at late gestation (approximately day 25) and neonatal (younger than 1 wk) gastrointestinal tracts were collected for light microscopy, immunohistochemistry, and transmission electron microscopy. The cotton rat placenta is hemotrichorial and has 5 distinct layers: decidua, junctional zone, labyrinth, chorionic plate, and yolk sac. Consistent with the transfer of maternal antibodies, the majority of the Fc receptors are present in the yolk sac endoderm and fetal capillary endothelium of the chorionic plate, involving 10% of the cells within the labyrinth. In addition, Fc receptors are present on duodenal and jejunal enterocytes in cotton rats, similar to humans, mice, and rats. These findings provide the structural basis for the pre- and postnatal transfer of maternal antibodies described in cotton rats.

Cotton rats (Sigmodon hispidus) have been used to study the pathogenesis of human respiratory syncytial virus (RSV) infection.^6,15,29 This species is considered the best small animal model for RSV pathogenesis, because RSV replicates similarly in cotton rats as in infants and induces an adaptive immune response, as is seen in infants with moderately severe RSV infection.^4,5,33,38 Cotton rats have been used to accurately predict the efficacy of the only prophylactic treatment for RSV, a monoclonal antibody against the fusion protein.^5,17,31 In addition, cotton rats are the ‘gold standard’ for RSV vaccine development.^6,15,29,39A proposed method to protect infants from RSV-induced severe respiratory disease is to vaccinate pregnant mothers to increase the level of maternal antibodies transferred to fetuses and infants.² Human gestation has a duration of approximately 270 d, with midgestation corresponding to approximately day 135 and late gestation to approximately day 225. The human placenta is hemomonochorial in that trophoblasts are in direct contact with the maternal blood supply. A single continuous laver of trophoblasts separates fetal capillaries from the maternal blood.^23,34 Maternal antibodies are predominantly transferred in utero through the placenta. Maternal IgG is endocytosed by syncytiotrophoblasts, where IgG₁ and IgG₄ bind to the neonatal Fc receptor (FnRn) at an acidic pH in early endosomes.^11,25 The endosomal IgG-FcRn complex undergoes transcytosis and fuses with the basal membrane where IgG disassociates from the FcRn. The FcRn is then recycled back to the maternal blood surface of the syncytiotrophoblasts.^11,25,28,30 After birth, the FcRn in the intestine binds maternal IgG in the milk at the acidic apical surface of the epithelium and transports it in an endosome to the basolateral surface, where the maternal IgG disassociates and enters the neonatal blood stream.^20,21In cotton rats, gestation is 28 d in duration, with midgestation at approximately day 15 and late gestation at about day 25. The average litter size is 6 pups, with a range of 4 to 8 pups. Reportedly, maternal antibodies to RSV are transferred to cotton rat pups both prenatally and postnatally.³² Maternal immunization with RSV vaccine candidates in cotton rats has demonstrated that maternal antibodies are transferred to pups and confer protection, but this protection is only short-lived.² In contrast, maternal antibodies after measles immunization provide long-term protection in cotton rats.²⁸ Further investigation of the mechanisms of prenatal and postnatal antibody transfer in cotton rats is necessary to understand these differences and evaluate RSV vaccine candidates. As a basis for these physiologic studies, the placental anatomy and the expression of FcRn in cotton rat must be characterized. In this study, we report the histologic and ultrastructural characterization of the cotton rat placenta at mid- and late gestation and the localization of FcRn in the placenta and neonatal intestine.     

Strategies to Improve Survival from Surgery for Heart Valve Implantation in Sheep

Sheep are a commonly used and validated model for cardiovascular research and, more specifically, for heart valve research. Implanting a heart valve on the arrested heart in sheep is complex and is often complicated by difficulties in restarting the heart, causing significant on-table mortality. Therefore, optimal cardioprotective management during heart valve implantation in sheep is essential. However, little is known about successful cardioprotective management techniques in sheep. This article reports our experience in the cardioprotective management of 20 female sheep that underwent surgical aortic valve replacement with a stented tissue-engineered heart valve prosthesis. During this series of experiments, we modified our cardioprotection protocol to improve survival. We emphasize the importance of total body hypothermia and external cooling of the heart. Furthermore, we recommend repeated cardioplegia administration at 20 min intervals during surgery, with the final dosage of cardioplegia given immediately before the de-clamping of the aorta. To reduce the number of defibrillator shocks during a state of ventricular fibrillation (VF), we have learned to restart the heart by reclamping the aorta, administering cardioplegia until cardiac arrest, and de-clamping the aorta thereafter. Despite these encouraging results, more research is needed to finalize a protocol for this procedure.

Sheep are a commonly used and well-validated model for cardiovascular research, particularly for heart valve research, as blood pressure, heart rate, cardiac output, and intracardiac pressures are similar between sheep and humans. Sheep are particularly useful for heart valve research because observable changes in implanted heart valve bioprostheses that would take several years to develop in humans are apparent after only a few months in sheep.^3,11 This feature allows the ovine model to provide relevant and important information about heart valve prostheses in a relatively short time span. The first preclinical step in developing novel heart valves is to test the valve in the pulmonary position in sheep. This surgical technique is relatively easy, as the procedure can be performed on a beating heart in a low-pressure circulation. However, aortic valve surgery is the most frequently performed valvular surgical intervention in human patients.¹² Thus, an important next step is to prove the clinical applicability of a new valve by testing the valve in-vivo in the aortic position in an animal model. In contrast to pulmonary valve replacement, aortic valve replacement must be performed on an arrested heart, which makes the surgical procedure significantly more complex. The sheep is a difficult model for aortic valve replacements due to its narrow annulus, short distance between the annulus and coronary ostia, a short ascending aorta, and difficulty in de-airing of the heart prior to suturing the aortotomy.¹⁹ Consequently, high on-table mortality rates, ranging from 9% to 33%, have been reported.^1,18,21,24 Furthermore, the incidence of mortality during the first 30 d after surgery, directly related to the surgical procedure, is often high, ranging from 17% to 50%.^1,2,16,18,21 Therefore, optimizing cardioprotective strategies during surgery would improve postoperative survival. However, little is known about protective strategies in sheep. In the current series of experiments, we implanted stented, tissue engineered, aortic heart valve prostheses in 20 adult domestic sheep and developed cardioprotective techniques to increase survival rates. In this observational study, we share our experience and insights regarding cardioprotective management to potentially improve the outcome of future surgeries that require an arrested heart in sheep.     

Hematology and Culture Assessment of Cranially Implanted Rhesus Macaques (Macaca mulatta)

The use of percutaneous cranial implants in rhesus macaques (Macaca mulatta) has long been a valuable tool for neuroscience research. However, when treating and assessing these animals, veterinarians are required to make assumptions about diagnostic results due to a lack of research into how these implants affect physiology. Microbial cultures of cranial implant sites show an abundance of colonizing bacteria, but whether these microbes affect animal health and wellbeing is poorly understood. In addition, microbial antibiotic resistance can present significant health concerns for both the animals and the researchers. To help elucidate the relationship between percutaneous cranial implants and blood parameters, complete blood cell counts and serum chemistry results were assessed on 57 nonhuman primates at our institution from September 2001 to March 2017. Generalized estimating equations were used to compare the results before and after an animal''s first implant surgery. This modelling showed that cranial implants were a significant predictor of alterations in the number of neutrophils, lymphocytes, and red blood cells, and in the concentration of hemoglobin, alkaline phosphatase, creatinine, calcium, phosphorus, total protein, albumin, and globulin. Anaerobic and aerobic bacterial cultures were performed to identify bacteria associated with cranial implants. Staphylococcus spp., Streptococcus spp., and Corynebacterium spp. comprised the majority of the aerobic bacterial isolates, while Fusobacterium spp., Peptostreptococcus spp. and Bacterioides fragilis comprised the majority of anaerobic bacterial isolates. Using a Pearson r correlation for statistical analysis, we assessed whether any of these bacterial isolates developed antibiotic resistances over time. Cefazolin, the most frequently used antibiotic in monkeys in this study, was the only antimicrobial out of 41 agents tested to which bacteria developed resistance over time. These results indicate that percutaneous implants are associated with a generalized inflammatory state, multiple bacterial species are present at the implant site, and these bacteria may contribute to the inflammatory response.

Neuroscience research often employs in vivo analysis of neuronal distribution, activity, and function, all of which require visualization and manipulation of the brain in living animals. To achieve this, cortical structures are accessed by the placement of percutaneous implants that are anchored to the skull and outfitted with transcranial ports. Studies of the auditory system,^72,78 visual cortex,^20,22,46,54 motor cortex,^23,44 perception,⁷⁰ and optogenetics^23,80 have all benefitted from the use of these implants in multiple laboratory species. However, few studies have investigated the effects of these implants on the general physiology of research animals.³²Due to human similarities in neuroanatomy, physiology, social behavior, and cognition, rhesus macaques (Macaca mulatta) have proven invaluable in translational studies of cortical structures. This species has long been the recipient of percutaneous cranial implants²⁹ and therefore, has been the subject of many refinements in their construction to improve research outcomes.^{3,11,40,43,60} Traditionally, these implants are constructed out of titanium or titanium alloy hardware that is anchored in place with acrylic or bone cement. Recording chambers provide access points through craniotomy sites where devices are implanted into deeper structures of the brain. Titanium alloys have been shown to provide a good bone/implant interface through the development of titanium oxides;^17,32,59 however, these implants may leach ions into surrounding tissues, with unknown health or research implications.³² Acrylics provide a moldable and easily repairable substrate, but have poor biocompatibility.^5,53 Their addition to implants increases exposed tissue surface area, creating ideal environments for infectious agents to thrive.^2,43Cranial implants can develop complications, including inflammation and infections at skin margins and the bone/implant interface.³² Multiple species of bacteria, including Staphylococcus spp., Corynebacterium spp., Enterococcus spp., and Providencia rettgeri, have been recovered from the chambers and skin edges of cranial implants in rhesus macaques.^10,43,88 These infections may be due to manipulation and contamination of implants by the animals themselves. Chronicity of infections is also likely due to the inability to apply therapeutic agents to deeper regions of tissue shielded by the implant. Chronic pathology is evident in deeper structures at the neural-implant interface.⁶⁷ For example, sustained glial responses and neural degeneration have been identified at sites where electrodes and arrays contact brain tissue.^12,74Chronic inflammation has well-established effects on hematologic values, such as red and white blood cell counts, platelet numbers, and total protein measurements. Few studies are currently available that link chronic percutaneous implants to changes in hematology in rhesus macaques, requiring clinicians to use established reference intervals of nonimplanted animals when analyzing bloodwork. This requires assumptions about effects of implants on overall health; these assumptions may or may not be correct, but are the necessary basis for assessments and therapies. In this study, systemic physiologic changes were identified in clinically healthy, implanted animals to provide a framework for analysis of complete blood cell counts (CBC) and serum chemistry (CHEM) values for clinicians working with rhesus macaques with percutaneous implants. We also assess bacterial cultures taken from these implants to identify common contaminants and their antibiotic resistance profiles. We hypothesize that clinically healthy rhesus macaques with percutaneous implants have significantly different hematology profiles than those without implants, despite a lack of clinical signs. By understanding how implants and associated bacteria affect routine blood test results, observed changes can be better characterized as normal or abnormal, so that veterinary care can be tailored as needed. This important step will allow improved care and welfare of animals used in neuroscience research.