Pet-Specific Care for the Veterinary Team. Группа авторов

family has two indoor cats and a terrier mix who is a house dog but also enjoys the outdoors. On a recent hike in the neighboring woods, the family came across a friendly puppy with no collar. Of course, they picked him up and brought him home to see if they could find the owner. Although the puppy had several areas of hair loss and was scratching itself, they didn't worry because their own dog had a mild case of demodicosis as a puppy and they remembered their veterinarian saying it is rarely transferable to people. They called the veterinarian's office to see if they knew of anyone that had recently lost a puppy, but were told to call the local humane society. No other issues were discussed.

      After a week, the family hadn't found the puppy's owner and took the puppy to the humane society. By now, the family's dog was itching and starting to lose fur. After a veterinary visit, he was diagnosed with sarcoptic mange, likely acquired from the visiting stray puppy. Unlike Demodex mites, sarcoptic mites can be easily spread to other animals and people. Now all the family members were at risk. This situation might have been prevented if the staff at the veterinary hospital had advised the owners to keep the puppy isolated from the house and the other pets and children.

Mr Bay raises beagle puppies for hunting and typically takes very good care of them. He is concerned about one of the puppies he has decided to keep. The puppy is staggering and not eating well. Although the technician knows Mr Bay and all about how he raises puppies, she quizzes him about the puppy's diet, travels, and where he has been keeping him. Because of the thoroughness of her questioning, it is revealed that Mr Bay recently discovered a family of raccoons in one of his barns where the puppy plays. The veterinary team warn the owner of the risk of roundworms from the raccoon's feces, as well as rabies. They also educate him about the zoonotic potential of both of these diseases. The owner chooses euthanasia of the puppy and a necropsy confirms neurological migration of Baylisascaris procyonis (raccoon roundworms).

TAKE‐AWAYS

       The VHT is a vitally important connection for keeping pets, people, and the ecosystem healthy.

       VHT members need to be aware of potential zoonotic diseases that will affect their clients and patients and educate clients appropriately.

       Clients preparing home‐made pet diets need special instruction in safe food handling practices.

       The VHT plays an important role in preventing the misuse of antibiotics, which contributes to antibiotic resistance.

       Clients need education from the VHT about handling exotic animals and wildlife to be safe from zoonotic diseases.

MISCELLANEOUS

      Reference

      1 1 Schwabe, C.W. (1984). Veterinary Medicine and Human Health. Baltimore.: Williams & Wilkins.

2.20 Cancer Precision Medicine

       Anna Katogiritis, BSc, DVM1 and Chand Khanna, DVM, PhD, DACVIM (Onc), DACVP (Hon)2

       1 I ndependent SA and Wildlife Emergency Veterinarian and NGO Consultant, USA

       2 Ethos Veterinary Health, Woburn, MA, USA

BASICS

      2.20.1 Summary

      Cancer is a disease of dysregulated genes. Personalized cancer medicine (Pmed) is a therapeutic approach to pet‐specific care that most often analyzes the molecular features of a patient's cancer, and uses this information to design treatment plans that target critical genetic alterations in that patient's tumor. In so doing, this field hopes to select approaches that may more specifically target cancer cells. This approach may also allow rapid alterations in treatment in response to patient‐specific drug resistance signals that emerge during therapy and individualize monitoring of therapeutic responses. It is nearly certain that aspects of this overriding Pmed approach represent the future of cancer medicine.

      2.20.2 Terms Defined

      Genome: This term refers to an organism's complete sequence of DNA.

      Genomics: A field of molecular biology that focuses on the structure, function, mapping, and evolution of the genome.

      Mutations: Permanent alterations in the DNA sequence. These can occur due to mistakes that arise during the DNA replication process, environmental factors (e.g., ultraviolet light), or infections (e.g., viruses).

      Precision Cancer Medicine: An emerging field in oncology and molecular biology through which a patient's cancer is analyzed to a molecular level with the goal of identifying unique characteristics (most often specific mutations) that may respond more favorably to specific (targeted) treatments.

MAIN CONCEPTS

      2.20.3 Cancer is a Disease of Dysregulated Genes

      It is clear that cancer is a disease of dysregulated genomics. New genomic characterizations of cancer (combined with dramatic reductions in the cost of genomic analysis and computing power, and the parallel genomic and biological annotation, i.e., “naming,” of cancer‐associated genes) has fueled the field of precision medicine as a therapeutic approach, delivered recent drug approvals in human oncology, and is increasingly available to all species of cancer patients.

      2.20.3.1 Precision Medicine for Oncology

      In many disease conditions, it is well understood that conventional methods of disease characterization are insufficient to fully inform clinicians of an individual patient's needs. For the most part, the genomic characterization of many disease states can better account for these needs. As such, Pmed can allow clinicians to select better initial approaches to therapy, more rapidly alter treatment approach, and individualize plans for disease monitoring. From the perspective of need and opportunity, the field of oncology is most ready and in need of this evolution in medicine. Collectively, this has created the opportunity for relatively inexpensive genomic and molecular characterizations of disease states.

      2.20.4 Cancer Precision Medicine for Individualized and Molecular Therapy

      In the delivery of Pmed, a tissue biopsy or blood sample (liquid biopsy) from the patient will be used to extract nucleic acids for genomic sequencing. Altered genes are prioritized as therapeutic targets. These are then matched with specific drugs that inhibit the altered gene or its pathway. An individualized cocktail of therapeutics, matched to the patient's cancer genome, is then delivered to the patient. Adjustments can then be made after reanalysis of liquid biopsy signals.

      2.20.5 Challenges and Solutions for Precision Medicine and Veterinary Oncology

      Challenges to the field of precision medicine, and more generally to molecularly targeted therapy, must be addressed before this important and novel approach to cancer therapy will improve outcomes. These challenges include, but are not limited to, the following.

       Cancer evolution. Most precision medicine platforms analyze patient tissue from a primary tumor resection. As a consequence, subsequent molecular treatment is based on the characteristics of a patient's primary tumor. Unfortunately, metastases from a primary tumor often exhibit distinct molecular