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Acute Phase Proteins – Motivation for Use - AbstractInflammation, resulting from any form of tissue injury causes an increase in concentration of plasma/serum proteins – the acute phase proteins (APP). In horses, Serum Amyloid A (SAA) shows the greatest response to injury, followed by Haptoglobin and Fibrinogen, see table 1. Table 1: Equine acute phase proteins
Clinical utilityThe most commonly measured proteins in the veterinary practice are Fibrinogen, SAA and Haptoglobin (Table 1). These proteins have been used to identify clinical and sub clinical disease in horses (Hulten et al., 2002).Acute phase protein determination is useful:
An early increase of acute phase protein concentration is demonstrated for horses with viral and bacterial infections (Cohen et al. 2005, Hultén & Demmers 2002, Hultén et al. 1999), surgery (Pollock et al. 2005), colic (Vandenplas et al. 2005), chronic infection (Hultén & Demmers 2002) and experimental induced inflammatory arthritis (Jacobsen et al. 2006) which also make acute phase proteins useable as indicators for health and fitness. Stine Jacobsen and colleges from The Royal Veterinary and Agricultural University of Copenhagen found SAA useful in early recognition of excessive inflammation and infectious complications after surgery, leading to early institution of therapy, reduced post-operative discomfort and facilitating recovery (Jacobsen et al. 2005). Furthermore they saw a clear correlation correlation between the severity of inflammation and the concentration of SAA. ML Vandenplas and colleges from College of Veterinary Medicine, University of Georgia, USA found a higher blood concentration of SAA in nonsurvived than in survived horses with colic (Vadenplas et al. 2005). Just recently and not yet published (Am. J. Vet. Res.) Stine Jacobsen shows that SAA correlates with deployed therapy of arthritis/synovitis in horses. Haptoglobin and Fibrinogen are good markers of chronic inflammatory disease and very useful for monitoring out-patients for whom samples are taken less frequently (Paolaggi et al. 1982). Haptoglobin correlate well with the clinical status of disease in cases of musculoskeletal, respiratory and digestive pathologies. The presence of an inflammation process was better confirmed by Fibrinogen in case of cutaneous and musculoskeletal pathologies. When considering a wide range of diseased horses, it appeared that Haptoglobin has a better sensitivity than Fibrinogen (Oukacha et al. 2005). Usefulness of acute phase proteins compared with WBCSome vets do try to rely on white cell count and differential to help in diagnosing acute phase reactions - but any rise in cortisol due to fear, excitement or infection will cause an increase in white cell count and an increase in neutrophils. Further the kinetics of WBC is limited.Serum SAA profiles reflected the course of inflammation and their levels correlated with the clinical severity of inflammation. In contrast, fever and changes in leucocyte numbers, which are usually considered to be hallmarks of inflammation and infection, were not useful for monitoring post operative recovery (Jacobsen et. al 2005). Foals with Rhodococcus equi pneumonia had increased concentrations of SAA, Fibrinogen and WBC on admission. On discharge, recovered foals had normal SAA concentrations, whereas fibrinogen and total white blood cell count and neutrophil counts were still increased (Hultén & Demmers, 2002) References Cohen et al. 2005, Equine Vet J. 2005 May;37(3):212-6.
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