Advances in Neonatal Feline Medicine at UC Davis
By Ellie Purpura
Ellie (pictured on the left) with a kitten patient
My name is Ellie (I use both he and she pronouns), and I am the Senior Project Manager on several clinical trials at the UC Davis Veterinary Medicine Teaching Hospital! I am also the Feline Director for Yolo County SPCA and a Veterinary Technician at MarQueen Emergency Clinic. Basically, I speak all things “kitten” and am devoted to advancing the field of neonatal medicine for both kittens and puppies. I myself have a six month old Border Collie named Maverick and 2 cats- who are the loves of my life!
While I feel that the vast majority of theory based science education teaches us to define and execute a specific experimental plan, the reality of clinical research (in my semi-professional opinion), is that things rarely go as intended. What began as a simple triple masked* clinical trial meant to evaluate the effectiveness of a relatively new antiviral medication in kittens, has since diverged into multiple side projects, case studies, and two new grant applications for extended research.
*Triple masked: neither the researchers, data analysts nor the foster parents involved in this project know which of our two treatments is the active medication vs. our placebo
Starting from the top, about 2 years ago, my principal investigator (PI) and I began treating kittens with ocular disease secondary* to Feline Herpes Virus-1 infections. About 90% of kittens and cats are infected with herpes, but similar to humans, fail to show any symptoms of the disease unless under duress. If you ask any animal shelter employee what the hardest time of the year is, they will undoubtedly tell you about “kitten season.” During the warmer months of the year, shelters and rescues are flooded with orphaned kittens in critical need of foster care. As you can imagine, being orphaned is an incredibly stressful event that produces a strong immune response in many of these kittens, resulting in FHV-1 associated sickness. Sick kittens in a shelter at full capacity proves to be a very difficult set of circumstances for staff. Herpes is an incredibly strong ulcerative agent, often causing significant damage to the cornea of the eye. In extreme cases, FHV-1 infections can lead to the rupture of the eye and subsequent need for surgical removal (what we call enucleation). This places an extreme financial burden on the kitten’s respective rescue organization, a heavy emotional toll on its foster parent, and additional stress of surgery on the kitten itself.
*Secondary: in this case, Feline Herpes Virus is our active disease process. As a result of the disease within the body, we can see a range of symptoms including changes to the eyes. Hence, our ocular signs are secondary to our disease.
Graphic provided by Ellie illustrating ocular disease
The current standard of treatment for this population is oral antibiotics and eye drops, which unfortunately do little to help battle a viral infection. Famciclovir is a relatively new antiviral medication that has shown to be effective in reducing the duration and severity of FHV-1 infections in older cats, but it has never been evaluated in a younger population. My team felt it more than worthwhile to examine its effect in underage shelter kittens, who arguably have the most to gain from such a drug. A more effective treatment for this population will mean reduced medical costs, fewer enucleation surgeries, and a much more manageable foster commitment from shelters and rescue groups.
Our project originally aimed to treat 300 kittens less than 12 weeks of age, who have been diagnosed with ocular disease secondary to FHV-1 infection. Our data is stratified into three age groups; 0-4 weeks, 4-8 weeks and 8-12 weeks, as well as by two severity categories; mild and severe. All kittens are treated with oral antibiotics (doxycycline) and eye drops. Kittens are then randomly assigned to receive either the study treatment (famciclovir) or the study placebo (lactose powder), but neither I, my P.I., nor our foster parents who administer the medications know which treatment is which (hence our triple masked protocol). Our foster parents score their kittens daily based on symptom severity. At the conclusion of our enrollment, we will analyze our data to see if the study treatment allowed for a more rapid recovery (and reduction of symptom scores) compared to the study placebo. By stratifying our data, we will also be able to see if famciclovir is more or less effective at each age milestone, and whether it is more effective in treating mild vs. severe cases.
We hope to ultimately be able to recommend this treatment to shelters and rescues so that sick kittens are at a lesser risk for euthanasia and/or mortality because of this disease.
About 10 years ago, foster care for kittens less than 8 weeks of age simply did not exist. It has only been in the last decade that foster training, funding, and programs have sprouted up across the country. Because this population primarily used to be euthanized, what is considered “normal” for kittens in this age group is essentially unknown- leaving an entire field of research open for exploration. We are still attempting to understand what normal reference ranges are for vital signs in kittens, how their blood work should read, what their bones look like on radiographs compared to adults, etc, etc. I could go on!
We have currently enrolled 360 kittens into this research project, and are just scratching the surface of what we call neonatal feline medicine. Stay tuned here at SciGal to learn more about the first successful diagnosis and treatment of congenital hypothyroidism, a miraculous recovery from a severe cardiac defect, DNA sequencing to identify genetic anomalies and more about our upcoming research!
Photos of Ellie’s patients
Keep up with Ellie’s work on Instagram @ejpfosters or at her personal website elliepurpura.wixsite.com/mysite or for specific inquiries email him at elliepurpura@gmail.com