Jeffery Nick, Granger Nicolas
Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States.
Bristol Vet Specialists, CVS Referrals & Bristol Translational Health Sciences, University of Bristol, Bristol, United Kingdom.
Front Vet Sci. 2023 Mar 15;10:1114798. doi: 10.3389/fvets.2023.1114798. eCollection 2023.
"Meningoencephalomyelitis of unknown origin" (MUO)-a collective term for a group of clinically-indistinguishable (but pathologically distinct) autoimmune diseases of the CNS-has become increasingly commonly recognized throughout the world. In the 1960s-1980s the focus was primarily on the pathological description of these conditions and, largely anecdotally, their response to glucocorticoids. The subsequent availability of magnetic resonance imaging for companion animals led to a focus on imaging characteristics and response of MUO to various immunosuppressive medications. Previous reviews have not found clear evidence of superiority of any specific treatment regimen. Here, we review outcomes in a further 671 dogs treated with various combinations of glucocorticoids and immunosuppressive drugs and reported since 2009, aiming to determine whether recommendations can be drawn from the material published during more recent decades. We observe that: (i) there is more complete information on outcome of MUO-affected dogs solely receiving glucocorticoids and these reports provide evidence to undermine the dogma that MUO inevitably requires treatment with glucocorticoids an immunosuppressive drug; (ii) there is far more information on the pharmacokinetics of cytarabine delivered by a variety of routes, revealing that previous dosing and duration of administration in dogs with MUO may not have been optimal; and, (iii) there is a large number of cases that could be available for entry into multi-institutional randomized controlled trials. Finally, we suggest new research avenues that might aid future clinical trials in MUO through improved understanding of etiological triggers and individual patterns of immune response, such as the impact of the gut microbiome, the potential of CSF flow cytometry, and the establishment of robust clinical scores for evaluation of treatment success.
“不明原因的脑膜脑脊髓炎”（MUO）——一组中枢神经系统临床难以区分（但病理上有差异）的自身免疫性疾病的统称——在全球范围内已越来越被广泛认识。在20世纪60年代至80年代，重点主要是对这些病症的病理描述，以及很大程度上基于轶事的它们对糖皮质激素的反应。随后伴侣动物磁共振成像的出现使得关注点转向MUO的成像特征以及其对各种免疫抑制药物的反应。以往的综述未发现任何特定治疗方案具有明显优越性的确切证据。在此，我们回顾了自2009年以来用糖皮质激素和免疫抑制药物的各种组合治疗的另外671只犬的治疗结果，旨在确定能否从近几十年发表的数据中得出相关建议。我们观察到：（i）关于仅接受糖皮质激素治疗的MUO患犬的治疗结果有更完整信息，且这些报告提供的证据削弱了MUO必然需要用糖皮质激素加免疫抑制药物治疗的教条；（ii）关于多种给药途径的阿糖胞苷的药代动力学有更多信息，这表明之前MUO患犬的给药剂量和给药持续时间可能并非最佳；以及（iii）有大量病例可用于纳入多机构随机对照试验。最后，我们提出了新的研究途径，通过更好地理解病因触发因素和个体免疫反应模式，如肠道微生物群的影响、脑脊液流式细胞术的潜力以及建立用于评估治疗成功的可靠临床评分，可能有助于未来MUO的临床试验。
