Winn Feline Foundation Symposium on “Ending FIP, Is There Hope?” Symposium Notes 2017.

Luna Goes to Chicago (Her 7th State)

This is my recap of the information presented at the Winn Feline Foundation "Ending FIP, Is There Hope" Symposium. I took notes as Dr. Niels Pedersen talked about current FIP research. It was fantastic to hear so much of the overwhelming FIP data we read about, presented in a way that put many of the pieces of the FIP puzzle together for a better understanding. As new cat owners, we’d never heard of FIP. In just a few weeks of cat ownership, we were hit with words that we never expected to hear, "your kitten has FIP and only a few weeks to live; let us know when you feel the time has come to put her down"” Having a medical background further perpetuates my thirst for knowledge about this disease and how I can help others understand it.

When I learned that Dr. Pedersen would present his research just six hours away from home, I knew we had to go! Not only did Luna receive this brand-new life-saving trial drug under his expert guidance, but I’ve also developed an interest in learning more about the science behind these evidence-based treatment approaches and helping to encourage donations to fund his work. As with our other recent road trips, Luna accompanied us to Chicago. We took her to the meeting area beforehand so that some of the wonderful people we met through this endeavor could meet her (photos above).

The Winn Foundation, specifically the Bria Fund, founded by Susan Gingrich after the loss of her cat, Bria, provides much of the funding for these clinical research trials for which we all are excited and even a bit impatient. That leads me to request that everyone reading this consider giving to the Bria Fund to help keep these trials moving forward. To quote Peter Cohen, founder of www.zenbycat.org (another means of donating money for FIP research and purchasing products that contribute to ZenByCat), "We not only need the money to find a cure, we now need it to fund the cure.”

Please consider setting up a monthly recurring donation of only $10. I say "only $10" because that’s a reasonable amount that just about anyone can afford—and if it's recurring AND if hundreds of people do it...well, I don't need to tell you how that adds up! The Winn Feline Foundation has granted over $675,000 over the last 25 years to the FIP research cause. Please take the time to watch this video that was shown at the symposium and created by Peter Cohen, founder of ZenByCat and owner of two UCD trial kitties: one who has so far beaten FIP, Smokey (a cat that was accepted into the program who’s owner could not make the trip to UCD) and Miss Bean, whose disease was sadly too far advanced and did not survive the trial.

Dr. Pedersen, Peter Cohen of ZenbyCat and myself

FIP Warrior Video

Here’s my summary and notes from the symposium.

Feline Infectious Peritonitis is the most complex and fatal of all feline infectious diseases. Corona is an RNA virus with multiple strains more prone to mutation. It is similar to the viruses that cause Ebola, Aids, Influenza, and Rhinovirus. Feline Enteric Corona Virus (FECV) is transmitted via fecal/oral mode by seemingly healthy cats. Cats shed the virus quickly due to their concise intestinal tracts (the shortest species). Because cats are only meat-eaters, their digestion is quite simple. Hence, they have a shorter tract.

The presence of FECV itself is not a diagnosis of huge importance because it’s found anywhere there’s an increased number of cats, catteries, shelters, and homes with many cats. FECV generally starts around nine weeks after birth in nursing kittens. The more kittens in any given environment, the more prevalent FECV becomes.

The incidence of FIP is .3% or three cats in 1000; 1-5% of cattery and shelter cats. FIP incidence is climbing partly due to bottle-fed rescue kittens, such as those weaned too early and thus exposed to mass amounts of pathogens. Another contributor is from pedigreed catteries, leading to a 50% increased risk due to a lack of genetic diversity.

FIP occurs in older cats because they lose their immunity as they age. In many cases of multiple cat homes, when an older cat dies, the owner often gets a new kitten so the existing [older] cat can have a buddy, which then causes the older cat to get sick from FECV from the kitten.

Clinical signs of FECV are often unapparent, and reinfection is possible. The virus attacks the intestinal villi, then settles in the colon, causing vomiting, mild diarrhea, and loss of appetite in cats showing symptoms.

Mutant FIPV is not infectious from cat to cat and is comparable to Tuberculosis in humans. The mutation becomes active through a process called "Reverse Transcription." RNA converts to DNA, which converts to Protein, meaning it takes three stages for the mutation to occur.

Causes of FIPV mutation include early spay/neuter in the 8-10-week age group, early weaning, and stress in general. Even the idea of mating a pair of FIP-immune cats will not stop the progression, and in fact, those kittens are at a higher risk due to polygenic factors.

Dry or neurological FIP causes tumor-like lesions (polygranulomas) on the organs, leading to organ failure. Effusive or wet FIP causes fluid to accumulate in the abdomen or chest wall. This fluid does not need to be removed unless it is causing breathing difficulty (if around the lungs/heart), as it will always return within a few days. Cats with dry FIP can live for months or even years in rare cases since the progression is slower than effusive FIP. While cats progress quickly once diagnosed with wet FIP, the most common cause of death from FIP is euthanasia, as most vets recommend putting the cat down since there are no curative treatments.

Symptoms of FIP include Cyclic fever that does not respond to antibiotics, increased bilirubin (jaundice), failure to thrive (weight loss), effusion (fluid-retained, swollen abdomen), and anemia. Anemic cats have generally been sick longer than you think.

Diagnosis of FIP is not as complicated as it is made out to be, even though there is no single test to diagnose FIP. Multiple vet visits/opinions are not always needed with effusive FIP, which presents with a light to dark yellow colored abdominal or chest fluid, a non-responsive (to antibiotics) fever, and failure to thrive. CBC, total serum protein, albumin, and globulin (a low A: G ratio) can further confirm suspicions. FIP-infected cats are generally anemic and have elevated leukocytes and neutrophils, increased bilirubin, and decreased lymphocytes.

Prevention of FIP can be improved by keeping rescue organizations and catteries small and for breeders to avoid mating cats that have produced kittens known to have died from FIP.

Treatments: Immunostimulants/suppressors have no curative powers, only serve to make the cat feel better, and are extremely expensive. Plant-based compounds or other therapies that claim to prolong the lives of FIP cats have not been adequately tested. Vaccines have not been proven effective since most kittens are exposed to FECV before 16 weeks. What has been proven effective and has curative effects are anti-viral drugs. For the first time, two drugs have been found to have caused remission, if not a cure.

GC376 is the first drug. Collaborators with Kansas State and Wichita State developed this drug. The drug belongs to a class called “Protease Inhibitors,” which stops the virus from replicating, allowing the body to heal. It does this by inhibiting protease, an enzyme the virus needs to infect more cells. Twenty-three cats were given GC376, with seven cats saved, meaning they continued to show no present signs of disease. Thirteen cats either relapsed or showed signs of neurological symptoms/brain infections. This is because this drug cannot cross the blood-brain barrier. The blood-brain barrier is the body’s natural defense that keeps viruses from causing coma; however, it is problematic when treated with anti-viral therapies for the dry FIP form.

One cat in this trial relapsed four times, resulting in each re-treatment time being longer, and ultimately, a 12-week course of the drug allowed the cat to stay in remission. The newer anti-viral drug, a Nucleoside Inhibitor of Reverse Transcription (NRT) that Luna and a few other cats are taking now works earlier in the cycle to halt replication by stopping RNA from becoming DNA and is having excellent results thus far. I know of at least four other cats whose owners have reached out to me, who are responding as well as Luna is to the treatment, and one that showed signs of the dry form that did not survive despite several weeks of the drug therapy. These trials can be tedious and time-consuming without guarantees of immediate or sustained remission. The mere fact that there are cats up to one year out shows that the researchers are on the right track to finding a cure for FIP.

Why are only a small number of cats used in the trials, and why can’t more cats be treated? First, these trials do not require a large number; 20 is enough. You need the proper criteria to be met. Conducting these trials is also very expensive; as always, funding and the drugs are limited. (A FIP cat owner tried to “buy their way into the trial" by offering excessive money!) The criteria for these trials are simple:  Ideally, <18 weeks of age, but some cats have been up to one year, a confident wet FIP diagnosis, and no signs of neurological symptoms. Once several cats have been given the drug, it takes the research team time to evaluate preliminary results and response times and calculate dosage regimens before findings can be reported and a trial advanced to the following stages.

Our Luna is one of Dr. Pedersen’s success stories on the second drug. She is the first privately owned, naturally-acquired FIP cat to receive the NRT drug, so we only know what we see now: normal lab values and no visible disease symptoms nine weeks in. GC376 has seven of the same and is 9-12 months out. If this isn’t a reason to think this could be the answer, I don’t know what is!

To recap, these drugs are NOT yet commercially available nor in production and won’t be for an undefined period. Therefore, no matter how much we want/wish for them to be, it’s essential to understand that approval and production are FDA and drug-company-dependent. Rather than complaining that they aren’t yet available, the best approach is to put that energy into raising FIP awareness, education, and prevention and helping fund the process to make more trials possible. It is through our donations that grants can be given to research and development teams to continue finding viable treatments. To quote Dr. Pedersen: “Results from our laboratory and elsewhere studies indicate that we have entered a new era in FIP prevention and treatment.”