Treatment for FIP in Cats, It’s A Corona Virus and It May Help People
Feline infectious peritonitis (FIP) might just be the worst possible diagnosis, but that’s changing – unfortunately, though, just like the disease itself the story is complicated. And because FIP is a mutation (which occurs inside cats) from the feline corona virus, the medication discovered to treat is now in the news.
At the Winn Feline Foundation symposium PURRsing FIP and WINNing held at the University of California, Davis last November, attending researchers agreed the FIP designation should now be called “treatable”, at least potentially, and perhaps “curable.”
Distinguished professor emeritus Dr, Niels Pedersen, legendary veterinary researcher is greatly responsible for describing FIP many decades ago, and he’s been chasing a potential treatment for decades. In his talk, which kicked off the day and a half-long symposium, he explained how two drugs may now actually cure FIP. The one significant complication that these drugs aren’t currently available. And now those drugs, which Winn has funded studies, are now in the news.
A few years back Pedersen approached pharmaceutical company, Gilead Sciences, with a hunch about using its antiviral drug—GS-441524—to combat FIP. This compound is nearly identical Remdesivir.
Remdesivir is the drug mentioned on March 19 by U.S. Food and Drug Administration commissioner Stephen Hahn and President Donald Trump at a press conference. Remdesivir was originally created to combat the Ebola virus, but turned out to be only moderately successful. However, a nearly identical compound GS-44124, has worked to treat FIP.
Pedersen added, “We chose to use GS-441424 for treatment of the coronavirus disease FIP because it had identical antiviral properties to Remdesivir and at the time was not under consideration by Gilead Sciences for use in humans. GS-441524 is also much cheaper to make than Remdesivir. Therefore, there was no apparent conflict with using one form for cats and another form for humans. However, Gilead came to believe that our cat research would interfere with their ability to get Remdesivir approved for humans and refused to grant animal rights for GS-441524.”
That refusal coupled with the desperate need around the world for the treatment of FIP, led to a Chinese black market for GS-441524.
Chinese companies began to offer compounds (presumably like GS-441524 and therefore similar to Remdesivir – but they don’t disclose exactly what their compounds are), and at least the leading company has anecdotally seen inspired success in treating cats with FIP around the world.
Will Remdesivir be the magic bullet to treat COVID-19 as GS-441524 can be in some cats to treat FIP? Only time will tell.
Opening the Door to Treating FIP: Pedersen Persevered
For cats, at least for now, the story of GS-441524 ends there despite the fact that it works. Gilead refused to allow approval of the drug from the U.S. Food and Drug Administration (FDA) to treat FIP or to give up its patent.
Pedersen was disappointed. Still, he persevered. Pedersen, with collaborators at Kansas State University, including Dr. Yunjeong Kim, associate professor in the department of pathobiology and diagnostics in the school’s College of Veterinary Medicine, demonstrated a similar antiviral compound they developed—known as GC376—also had a high degree of success in treating the wet form of FIP. But now what?
Anivive Lifesciences, an animal health pharma company, recognized potential. Dr. Dave Bruyette, its chief medical officer, announced at the symposium the company is in the process in getting GC376 FDA-approved for treating FIP, but seeing it come to market could be a long way off. “Realistically, it takes approximately 10 to 14 years to get a drug approved from the time some guy in the lab discovers a molecule until the time you can purchase an FDA-approved drug, and it costs more than $2 billion to go from a small molecule to get it through to FDA approval process and to market,” he said.
However, Bruyette is under pressure to move faster. First off, there’s clearly a need, and then there’s the competition. So, he’s asked FDA’s Center for Veterinary Medicine to accept GC376 for minor use for major species (MUMS) approval, but even a speedier process will still take years. And if you happen to have a an FIP cat, years away is no help.
Welcome to the Black Market
More than one Chinese company has figured that out. They’re selling compounds online via the co-called black market, which they maintain can cure FIP. And by all accounts, at least some cats are getting better with some of the black market products.
The most prominent of these Chinese sellers is a company called Mutian Biotechnology. Several company representatives attended the symposium, including its chief executive officer Lu Ziyu. Also, in attendance were cat owners whose cats have reportedly been cured using Mutian’s compound to the tune of approximately $4,000 for a 6 or 7 lb. cat (the cost varies depending on the patient’s weight).
Other Chinese companies have popped up and have undercut Mutian’s cost to consumers. “The difference between Mutian and the other brands is we are the only good manufacturing practices (GMP) standards manufacturer in China to produce these kinds of products,” Ziyu said from the audience during panel discussion. “[The other companies] are currently illegal in China.”
So, what is in the Mutian drug? Ziyu won’t be specific, noting that information is proprietary, but he says it’s not exactly either GS-441524 or GC376.
“We don’t know what this stuff really is,” Pedersen warned. “And this is black market. It’s definitely the Wild West out there.” He cautions veterinary professionals against ordering the black-market product but adds there is nothing preventing a cat’s owner from doing so. So, should you support that client? Pedersen added, “A client is desperate. ‘Do I have some sort of a duty?’ Veterinarians do also have the right to say, ‘No, I don’t want anything to do with this.’ And I can understand because that ends the possibility for any legal problems. I would answer it this way. Is there anything you’re doing in this situation that would be counter to it or is your participation supportive of what your oath is?”
Dr. Glenn Olah, immediate past president of the Winn Feline Foundation and a feline veterinarian in Albuquerque, NM said, “It’s definitely an individual decision, I’ve supported one client so far, and the cat is thriving (on the Mutian drug). I figured if the client is game, we all want these kittens to live.”
Several in the room showed videos on their phone of their now thriving kittens, who otherwise would have certainly succumbed to FIP. “This drug is a miracle,” cheered on cat owner, who also happens to breed pedigreed cats.
Alternative Treatments; Will They Work?
Susan Gingrich, who raises money for FIP studies and founded the nonprofit Winn Foundation Bria Fund (named for her own kitty who succumbed to FIP), isn’t a fan of the black market. “There are things out there that can help cats live longer and better with FIP, living with a chronic disease is possible. The best thing is to get that diagnosis as soon as you can. Start something, be it doxycycline and prednisolone, or polyprenyl immunostimulant (PPI). It may work, it might not. I don’t believe we should make a scientific experiment of our own cats.”
Dr. Al Legendre, professor emeritus from the College of Veterinary Medicine at the University of Tennessee– Knoxville, researched PPI and conceded only a very small subset of cats with dry FIP may benefit long term from the biologic if treatment begins early on in the disease process. And as a side note, he added, “Cats that received PPI and prednisolone lived a significantly shorter period of time than the ones that received PPI alone. So, it does seem like it has a significant suppressive effect on the immune system.”
Dr. Katrin Hartmann, professor of internal medicine and head of the clinic of small animal medicine at Ludwig Maximilian University Munich in Germany, added, “Yes, of course you give symptomatic treatments such as esophageal tubes to make sure they get enough nutrition, supporting nutrition in other ways, draining cats with effusive FIP, and so on. We have done a lot of things. But if prednisolone does something, it usually makes them feel better and gives them more appetite. And there’s a chance they’ll get better, but mostly they eventually just go downhill.”
Peter Cohen, who is based in California, raises money for FIP studies via his nonprofit Zen By Cat said, “Today, the only way to cure an FP cat is through these Chinese companies. Sometimes (what clients order) may even be intercepted (by U.S. Customs) and there’s a pretty expensive price tag. This isn’t ideal. We’d rather have an approved drug. But cats with FIP can’t wait.”
Pointing to Prevention
Dr. Gregg Dean, professor and Department Head in the Department of Microbiology, Immunology, and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, said, “When it comes to vaccines, we all have a home run in mind, one shot and durable lifelong immunity. Or maybe there’s a vaccine needed to protect cats only when in high density situations, such as shelters or catteries.”
Many shelter professionals discussed how minimizing stress in shelters has indeed lessened the volume of FIP in shelters. “Today the highest risk groups are fosters and sanctuary kittens and cats,” said Dr. Kate Hurley, director of the UC Davis Koret Shelter Medicine Program. “As there are often too many of them, and that volume is stressful.”
Many discussed how stress does seem related to at least one explanation regarding why some kittens develop FIP and others do not.
Pedersen said that after spay/neuter, he believes returning the cats to their home as soon as possible is beneficial because the kitties are less stressed in their own homes.
When talking about stress, it’s not uncommon for kittens to be spay/neutered, and then return home to very quickly develop FIP. “The experience is that the outcomes are not worse for the cats that have surgery at one and a half pound,” added Hurley. “We now have years of data on this. Additionally, if it’s somebody’s pet kittens, and they’re raised up in a home, and there’s no time pressure, or anything fine. Wait until two, two and a half, three pounds, that’s fine. But there is risks to being in a shelter, or overwhelming of foster programs, so that litters start doubling up, or the kitten starts staying an extra week, or 10 days in the shelter. In our experience, very often those risks outweigh.”
Geneticist Leslie Lyons, PhD, a Gilbreath McLorn Endowed Professor of Comparative Medicine in the Department of Veterinary Medicine & Surgery, College of Veterinary Medicine, University of Missouri –Columbia, MO. said, “I want to know if there a genetic reason why only 11 percent of cats infected with the corona virus get FIP. The answer is we really don’t know anything about the genetics for FIP at this point in time. We make presumptions regarding (some) breeds (being more predisposed) but we need to know much more.”
A video was screened at the Symposium from University of Glasgow researcher Diane Addie, (since she was unable to attend in person). She said, “I wondered if the cat litter itself could be used to prevent virus transmission, and tested 15 cat litters in the laboratory at Glasgow Veterinary School. “We found that bentonite-based cat litters prevented infection of subculture, then we looked at virus shedding while cats were using flat cat litters in two Danish multi-cat households which hadn’t any coronavirus infection.” She added, “Dr. Elsey Cat Attract was introduced, the number of cats shedding coronavirus reduced. When the litter was changed, virus shedding ramped up again. When we reintroduced it, again the virus shedding reduced.”
It’s likely that never before in the history of feline medicine been such an impressive gathering of a wide variety of stakeholders—from veterinary professionals to shelter workers/volunteers to cat fanciers to adoring cat lovers – and from around the globe (since there was a live feed available) to discuss one single issue in feline health.
HEAR a conversation with Dr. Pedersen about all this from Steve Dale’s Pet World, national radio.