Overview

Hypochlorhydria is a deficiency of hydrochloric acid in the stomach. Stomach secretions are made up of hydrochloric acid, several enzymes, and a mucus coating that protects the lining of your stomach.

Hydrochloric acid helps your body to break down, digest, and absorb nutrients such as protein. It also eliminates bacteria and viruses in the stomach, protecting your body from infection.

Low levels of hydrochloric acid can have a profound impact on the body’s ability to properly digest and absorb nutrients. Left untreated, hypochlorhydria can cause damage to the gastrointestinal (GI) system, infections, and a number of chronic health issues.

Symptoms of low stomach acid are related to impaired digestion, increased susceptibility to infection, and reduced absorption of nutrients from food. 


Please note, I appreciate this article but there is a lot of conflicting information about the real cause of acid reflux. Many doctors believe it is because of too much acid in the stomach, whereas more and more doctors are starting to see that it's the opposite.... what happens is, if there's not enough stomach acid, then teh esophageal sphincter can't close properly, so acid leaks and gets into the esophagus, where it is NOT supposed to be. This causes the acid reflux. If the cat had enough stomach acid, the esophageal sphincter would have closed properly, and you wouldn't have that acid "spillage." 


Can Cats Have Acid Reflux?

https://www.innovetpet.com/blogs/cats/cats-acid-reflux


Can Cats Get Acid Reflux?

Yes, cats can have acid reflux. In fact, it's pretty common. It can happen to any cat, but it is more likely to occur in young and senior cats. Unfortunately, because they can't talk to us, in human anyway, it's hard for them to tell us they're having heartburn or that their coughing or puking is from acid.

What is acid reflux in cats?

Can Cats Have Acid Reflux? | Innovet Pet

Feline acid reflux is very similar to acid reflux in humans. Like us, cats are supposed to have a high amount of stomach acid, but there is such a thing as too much.  With acid reflux, the cat produces more stomach acid than normal and it weakens their esophageal sphincter muscle, or this muscle becomes weakened for another reason. Either way, stomach acid starts coming up into the cat's esophagus and the esophagus is not equipped to handle stomach acid, burning and damaging the tissue. It's called acid for a reason.

Acid reflux is often also called GERD or gastroesophageal reflux disease, a more descriptive and specific term. When it becomes severe enough to damage the esophagus, it becomes esophagitis.

Age

Younger cats are more likely to develop acid reflux than adult cats because their esophageal sphincter muscle is not fully developed.

Senior cats may have an increased risk because they are more likely to need surgeries, treatments, and medications that may cause temporary acid reflux or esophageal sphincter damage.

Stress

Like humans, the cat body just doesn't work right when they're stressed. One of the ways this presents itself is that they can produce more stomach acid than their bodies can really handle. Too much stomach acid and gas can put excess pressure on the esophageal muscle and cause acid reflux.

Treating acid reflux in cats

Acid reflux isn't a disease that strikes a cat and can be eradicated like a cancer, it is a situation that arises from certain factors and can result again any time those factors are present. It can be chronic. To protect your cat, you have to diligently prevent those factors from rearing their head. This requires a long-term management plan and for you to be on the lookout for symptoms that the problem is recurring.

Antacid for cats

As far as medicine goes, your vet will probably prescribe a low dose antacid for cats to manage the acid levels in their stomach.

The word "antacid" may make you think of your medicine cabinet or the digestive aid aisle in the grocery store. But don't get too excited. Human antacids have spotty records for helping with feline acid reflux.

Pepcid

It is possible for you to give your cat Pepcid, but you should only do so with the guidance of a vet because you have to be mindful of creating a situation where the cat doesn't have enough stomach acid. This can cause serious issues that are as dangerous or even more so than the acid reflux. Long term or excessive Pepcid use can also damage the cat's kidneys.

Pepto-Bismol

Do not give Pepto-Bismol to cats as the Bismuth subsalicylate that makes it work is dangerous to them.

Kaopectate

Kaopectate contains the same harmful substance as Pepto-Bismol as well as aspirin. Do not give this to your cat either.

With any human medication or treatment, it is best to ask your vet before trying it out. Many will say it is fine to give your cat Pepcid, and go ahead, but with the vet's guidance.

Diet

A wise acid reflux treatment in cats will include diet management. They should be eating higher-quality cat foods and less human food. Avoid giving them high fat foods as fat weakens the esophageal sphincter muscle. Lower protein food may also be advisable as protein does increase stomach acid. Soft food like more wet foods or dry food moistened with water or a wet food may help as they are easier to digest.

Changing the amount of food and frequency of the food may be helpful as well. It is easier to digest food, and therefore less stomach acid is needed, to eat less food at a time. You might try feeding your cat less food more frequently so they get what they need without getting too full. This will require filling their bowl with less food to leave out or feeding them only on a schedule.

When you start reading the ingredients and nutritional lists of popular commercial cat foods, you may think it'd be easier to make your own cat food. It may be a good idea to go the homemade cat food route, if you can, provided you make the cat food to your vet's specifications. It is common for people to think they're creating a healthy cat food for their cat and really be messing up their nutritional balance. There's a lot of complex planning in making a decent cat food that requires special knowledge of what cats at different ages need.

Food restriction

Some vets will tell you not to feed your cat for a period of time after the visit to give the cat time to empty the food that is already in their digestive system before adding more. They will probably tell you what foods to begin feeding your cat when it is time for eating to resume.

Esophageal sphincter muscle repair

With mild to moderate forms of acid reflux, the esophageal sphincter is usually able to strengthen itself when there is less acid to irritate it.

Some medications to strengthen the muscle can facilitate matters.

Severe GERD - esophagitis in cats

The most severe forms of acid reflux, where the esophagus has been badly damaged, occurs when it turns into esophagitis. This is when very serious conditions develop.

Carafate can line an ulcerated esophagus to protect it from further damage and promote healing.

Antibiotics may be given to prevent infections in damaged tissues of the esophagus, and pain medications may be given if the damage has progressed to a point where the cat's discomfort and pain cannot be alleviated by simply reducing the acid content in their stomach.




Please note, this study mentions proton pump inhibititors, which I am not a big fan of. I also believe they can do more harm than good in a person with COVID-19,, simply because I know they tend to cause inflammation in humans, and they also lower the production of stomach acid that is necessary to kill viruses. 

https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11181&id=3852215

An Overview of Gastric Mucosal Injury and Healing
World Small Animal Veterinary Association World Congress Proceedings, 2004
Colin F. Burrows, BVetMed, PhD, MRCVS, DACVIM
University of Florida, College of Veterinary Medicine
Gainesville, FL, USA

The canine and feline stomach suffers from a wide spectrum of primary and secondary disease. Most, if not all of these can cause vomiting and abdominal pain and are associated with some degree of damage to the gastric mucosa. The purpose of this paper is to review the mechanisms that facilitate or impair gastric mucosal protection in order to permit better understanding and treatment of gastric disease.

Why doesn't the stomach digest itself? Physicians, physiologists and many others have been puzzled by this question since René Antonoine Ferchault de Réamur, the 18th century man of many sciences, showed that juice secreted by the stomach could digest meat. One answer of course is that it sometimes does. Under some circumstances gastric juice can produce ulcers and even destroy most of the stomach lining. Normally, however, the stomach wall staunchly resists attack; as Claude Bernard observed, it behaves as if it was made of porcelain.

Gastric juice contains hydrochloric acid, one of the most corrosive acids known. At the concentration secreted by the gastric mucosa this acid is capable of dissolving zinc and is deadly to cells. Yet in the stomach it ordinarily acts only to perform the useful actions of killing ingested bacteria, softening fibrous foods and promoting pepsin formation. In the normal stomach this corrosive juice is prevented from contacting and damaging the stomach wall by a complex and interrelated series of physical and chemical processes that are only now beginning to be fully understood. Collectively these processes are called the gastric mucosal barrier and comprise the structural and functional protection of the stomach against its own secreted acid and pepsin as well as against the ravages of refluxed bile and pancreatic enzymes and ingested abrasive or toxic materials. There are five interrelated components: 1) the gastricepithelial cells; 2) gastric mucosal blood flow and local acid base balance; 3) gastric mucus; 4) mucosal prostaglandins and associated cytoprotection; and 5) the epithelial cell basement membrane.

The Gastric Epithelial Cells

The epithelial cells of the gastric mucosa form a formidable barrier against penetration by luminal contents, including hydrogen ions. The cells have very tight junctions, a lipid-rich, hydrophobic, acid-repelling mucosal surface, and secrete bicarbonate and mucus.

The gastric mucosa is routinely exposed to trauma, indeed, focal destruction of the mucosal barrier is a normal physiologic event, occurring for example, during intragastric digestion of a meal, after thermal, mechanical or osmolar damage and after ingestion of several different types of drug. Normally, however, the mucosa can repair or minimize this damage almost as soon as it occurs by a process of epithelial cell migration called restitution. This is a physiological event in which the epithelial cells at the mouth of the gastric glands adjacent to a damaged area flatten themselves and project finger like processes called lamellipodia. These extend over the underlying basal membrane and eventually fuse to form a new intact epithelial barrier.

Gastric Mucosal Blood Flow

The gastric mucosal blood supply has been called the mainstay of the gastric mucosal defense mechanisms that sustain a healthy gastric mucosa. Mucosal blood flow is achieved in a variety of ways, foremost of which is a unique vascular supply that maximizes mucosal oxygenation, bicarbonate delivery and buffering. Bicarbonate, a byproduct of acid production, is carried up to the mucosal surface by capillaries that surround each gastric gland. This bicarbonate escapes from the capillaries into the submucosa underneath the mucosa from where it is taken up by the epithelial cells and secreted into the surface mucus layer. The bicarbonate is trapped here and neutralizes any hydrogen ions that may diffuse into the mucus layer. As a result, the surface of the mucosa is maintained at a pH of about 7.2 while the pH of the lumen may be as low as 1.5. The bicarbonate-rich mucosal blood flow also maintains intramucosal acid base neutrality such that any hydrogen ions that may leak into the submucosa through a damaged epithelium are quickly neutralised. A decrease in mucosal blood flow however, will result in an increase in mucosal hydrogen ion concentration with subsequent tissue damage.

Mucus Secretion

Mucus neck cells produce the bulk of gastric mucus. This forms a viscid unstirred protective layer of varying thickness over the surface mucosa that traps secreted bicarbonate and lubricates the lining of the stomach. When damaged the epithelial cells themselves rupture and release copious quantities of protective mucus that forms a bicarbonate-rich protective mucus cap over the denuded area. Surrounding epithelial cells can migrate over the basal membrane and under this protective mucus cap.

Prostaglandin Secretion and Cytoprotection

Cytoprotection refers to the ability of certain substances to maintain tissue or cellular integrity in the face of mucosal damage. The term was originally coined to describe the ability of prostaglandins to reduce or eliminate hemorrhagic damage in mucosa exposed to injury. The term has been extended however, to describe a similar protective ability for a large number of endogenous and exogenously administered substances with anti-ulcerogenic effects. Cytoprotection is based upon the ability of these substances to inhibit acid secretion, stimulate mucus and bicarbonate secretion, and increase mucosal cell turnover and blood flow. Prostaglandins PGE2 and PGF2aare perhaps the best known examples of cytoprotectants. However, IL-1 and TNF released during inflammation increase mucosal blood flow and cytoprotection, as do exogenously administered sulfhydryl compounds such as acetylcysteine, glutathione and penicillamine. Epidermal growth factor which is found in saliva as well as in the gastric mucosa plays an important role in maintaining and stimulating mucosal cell turnover.

The Basal Membrane

This, the last defensive barrier is important for the process of restitution. The basal membrane is permeable to fluid and electrolytes and when disrupted allows an inrush of hydrogen ions and proteases from the gastric lumen. These invoke an inflammatory response and mark the changeover from physiologic to pathologic (i.e., inflammatory) repair of the mucosa.

BARRIER DISRUPTION

Pathologic and inflammatory barrier disruption occurs in virtually every type of gastric disease as well as in a variety of less well appreciated circumstances such as stress, brain and spinal cord injury, hypotension, hypoadrenocorticism, sepsis, uremia, liver disease, hypoproteinemia and protein-calorie malnutrition (Table 1). Most instances of barrier disruption associated with this diverse group of disorders can be attributed to a decrease in gastric mucosal blood flow, except for the hypoproteinemic or cachectic patient in which decreased cell turnover also plays a role.

Table 1. Disorders associated with a disrupted mucosal barrier

 Gastric Disease

 Hypoadrenocorticism

 Liver disease

 Acidosis

 Sepsis (esp. peritonitis)

 Shock (septic > hypovolemic > traumatic)

 "Stress"

 Protein-calorie malnutrition

 Hypoproteinemia

 Enteritis (with vomiting)

 Uremia

 Hypoxemia

 NSAID therapy

 CNS and spinal cord injury

In humans and some other species, infection with the Gram negative gastric bacteria Helicobacter is associated with gastric and duodenal injury. Mucosal damage from infection with H. pylori in humans is associated with the cytotoxic effects of a number of bacterial metabolites including ammonia, endotoxin, and a variety of inflammatory peptides. The organism also inhibits somatostatin secretion allowing an increase in acid secretion. Strangely, these properties do not appear to be present in the Helicobacter species (e.g., H. felis, H. bizzozeroni) that infect the dog and cat. Gastric structure and function for example, are no different between infected and uninfected dogs. The exact role of Helicobacter infection, if any, in the genesis of gastric lesions in the dog and cat therefore remains to be elucidated.

Virtually every critically ill patient has some degree of gastric mucosal damage that is evidenced by gastric erosions or ulceration with associated hemorrhage. This sometimes "hidden" injury very often prolongs patient morbidity, and if unappreciated or untreated may progress to a serious or life-threatening condition. An appreciation of the processes of barrier disruption and repair, together with an understanding of current methods for facilitating or enhancing the repair process are therefore important for most clinicians.

THE RESPONSE TO INJURY

A break in the gastric mucosal barrier allows hydrogen ions and pepsin to diffuse into the mucosa from the lumen and sodium ions to diffuse in the opposite direction. Back-diffusion of acid and pepsin into the tissues stimulates further acid and pepsin secretion, decreases mucosal blood flow and decreases gastric motility. The acid also damages connective tissue and submucosal capillaries to cause focal mucosal hemorrhage and microulceration. If sufficiently severe and prolonged overt gastric ulceration may occur.

Mucosal integrity, however, is rapidly reestablished if the inciting cause is removed or if appropriate and prompt treatment is given. Of concern to the clinician are factors that may delay or impair epithelial cell restitution and the repair process, such as hypoxia, sepsis or concomitant drug therapy. Corticosteroids for example, decrease gastric epithelial cell renewal and while relatively harmless in the healthy animal may delay repair or exacerbate mucosal injury in the sick one. It should be noted however that methyl prednisolone sodium succinate at a dose of 30mg/kg/day for two days induced gastric hemorrhage in 100% of healthy normal dogs and that the synthetic prostaglandin misoprostol did not prevent the hemorrhage. Nonsteroidal anti-inflammatory drugs (NSAIDs) are another group of compounds that exacerbate underlying disease and delay repair, primarily through their inhibition of cyclooxygenase and a decrease in mucosal prostaglandin concentration. Recent attention has focused on the fact that there are two types of cyclooxygenase (cyclooxygenase 1 and 2 or COX-1 and COX-2). COX-1 is constitutively expressed in most cells and tissues, notably platelets, endothelial cells, stomach and kidney. COX-1 plays a key role in the synthesis of prostaglandins responsible for mucosal cytoprotection. COX-2 on the other hand is typically undetectable in normal tissue but is induced in inflammatory conditions by cytokines or lipopolysaccharides. NSAIDs exert their antiinflammatory effect through the inhibition of COX-2 whereas many of their adverse effects are due primarily to the inhibition of COX-1. Several COX-2 specific antiinflammatory drugs have recently been introduced and purportedly reduce inflammation while sparing the gastric mucosa. Aspirin inhibits both cyclooxygenases but in addition, when the intragastric pH is less than 4.0, it undergoes a change in lipid permeability and is absorbed directly into the gastric epithelial cell where it disrupts cellular function. The drug is also purported to facilitate bile reflux in the dog. The canine stomach is particularly sensitive to NSAIDs and none of these drugs should be considered "safe" in this species.

FACILITATION OF MUCOSAL REPAIR

The most important concept in dealing with the disrupted mucosal barrier is to recognize that disruption is widespread and that it can occur in such a wide variety of diseases (Table 1). Barrier disruption occurs routinely for example in hypoadrenocorticism, peritonitis, pyometra, pneumonia, liver disease, hypoproteinemia, severe trauma, uremia and in most if not all primary gastric diseases. The most important remedy in all these disorders is to treat the underlying disease. All other actions are of secondary, but nevertheless still considerable importance.

Drug therapy, however, remains the mainstay of treatment. These fall into two main groups 1) antisecretory drugs and 2) cytoprotectants that are usually combined to achieve an optimum effect (Table 2).

Table 2. Drugs that augment the mucosal barrier

Antisecretory

Cytoprotectants

Cimetidine 5mg/kg q8h

Misoprostol 3-4μg/kg q12h

Ranitidine 2mg/kg q12h

Sucralfate 0.25-1.0g/patient q8-12h

Famotidine 1mg/kg q24h

Aluminum ions to effect

Omeprazole 0.7mg/kg q24h

Bismuth subsalts to effect

Antisecretory Drugs

A variety of compounds have been used to reduce acid secretion but most widely used are the H2 receptor antagonists such as cimetidine, ranitidine and famotidine.

Cimetidine interferes with the cytochrome p450 system in the liver and can influence the action of some drugs (e.g., ketoconazole, theophylline, propranolol, quinidine and metronidazole) and the absorption or effect of others (e.g., metoclopramide and sucralfate). Cimetidine, however, is ineffective against aspirin-induced mucosal injury in dogs. Ranitidine binds much more strongly to the H2 receptor on the parietal cell and therefore requires a lower frequency of administration as well as indirectly increasing gastric motility. Cimetidine also has additional protective effects on the mucosal barrier (increased cell turnover, mucus production, mucosal blood flow, bicarbonate secretion and cellular integrity). Famotidine inhibits stress-induced decreases in gastric mucosal blood flow and has the benefit of once daily dosage which makes it attractive to many clients. The prophylactic use of H2 receptor antagonists should therefore be routine in critically ill patients.

Omeprazole, is another very effective antisecretory drug. Cimetidine, famotidine and ranitidine block only histamine-induced acid secretion but omeprazole blocks all acid secretion by inhibiting H+K+ATP'ase at the luminal surface of the parietal cell. While a major portion of the therapeutic efficacy of omeprazole involves inhibition of gastric acid secretion, some of its cytoprotective properties are probably associated with its action on the mucosal vasculature. Oral omeprazole for example, maintains mucosal blood flow in the face of mucosal damage and decreases mucosal production of the vasoconstrictor phospholipid platelet activating factor (PAF).

Cytoprotective Drugs

These include synthetic prostaglandins, sucralfate, antacids containing aluminum, and the bismuth sub-salts. Sucralfate is a complex polymer of sucrose with multiple substitutions of sulfate and aluminum salts. At a pH <4.0 it undergoes a change in chemical configuration, developing a positive charge which binds electrochemically with the negative charge in serum protein to form a protective layer over ulcerated areas which protects the mucosa against further injury by acid, pepsin and bile salts. The drug also stimulates the synthesis and release of prostaglandins, epidermal growth factor and nitric oxide as well as augmenting other aspects of the mucosal barrier such as gastric mucosal blood flow, bicarbonate secretion and mucus production. Sucralfate also stimulates angiogenesis in injured gastric mucosa.

The bismuth subsalts and aluminum containing antacids at doses less than those required to neutralize acid also exert beneficial effects on the mucosal barrier through augmented prostaglandin synthesis.

CONCLUSION

Gastric mucosal damage and repair are ongoing processes in the normal stomach with repair, primarily through epithelial cell restitution, rapidly restoring the ravages of normal wear and tear. The repair process however, may be impaired in gastric disease as well as in a variety of other diseases that weaken gastric defenses. If unrecognized and untreated this will increase patient morbidity with the likelihood of overt ulceration. Treatment with H2 receptor antagonists and cytoprotective drugs is critical to patient well being.

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Colin F. Burrows, BVetMed, PhD, MRCVS, DACVIM
University of Florida, College of Veterinary Medicine
Gainesville, FL



I was surprised to read, tonight, that dogs don't appear to be susceptible to SARS-COV2, whereas cats are (see highlights from the study further down the page).  Then I thought, wait a minute... that makes sense, because I've worked with a lot of animal rescue groups, and have seen many cats die from FIP (Feline Infectious Peritonitis), which is a coronavirus... but for whatever reason, you never hear about dogs getting any type of Infectious Peritonitis.

I had to wonder: Why does COVID-19 affect Cats, but not dogs?

Here's an excerpt from the article I read:

https://www.nature.com/articles/s41579-020-00459-7

Besides wildlife, researchers investigated the susceptibility of domesticated and laboratory animals to SARS-CoV-2 infection. The study demonstrated experimentally that SARS-CoV-2 replicates efficiently in cats and in the upper respiratory tract of ferrets, whereas dogs, pigs, chickens and ducks were not susceptible to SARS-CoV-2 (ref.43). The susceptibility of minks was documented by a report from the Netherlands on an outbreak of SARS-CoV-2 infection in farmed minks. Although the symptoms in most infected minks were mild, some developed severe respiratory distress and died of interstitial pneumonia44. Both virological and serological testing found evidence for natural SARS-CoV-2 infection in two dogs from households with human cases of COVID-19 in Hong Kong, but the dogs appeared asymptomatic45. Another serological study detected SARS-CoV-2 neutralizing antibodies in cat serum samples collected in Wuhan after the COVID-19 outbreak, providing evidence for SARS-CoV-2 infection in cat populations in Wuhan, although the potential of SARS-CoV-2 transmission from cats to humans is currently uncertain46. 

That got me trying to find a connection between cats and humans, that we don't share with dogs, so tonight I did some research on Feline Infection Peritonitis.  I've done a good amount of research on FIP in the past, because I was trying to figure out a treatment for it myself! FIP is like a death sentence, and no vet could seem to figure out how to treat it. I, too, had a cat that passed away, over 10 years ago, from FIP, and it was horrible. They go downhill very quickly when the virus takes hold. 

Well, last year, not even 6 moths before the COVID pandemic, I was talking to someone who works with the Nine Lives Foundation (a nonprofit that has helped me get a lot of rescue cats spayed and neutered).  She told me that 9 Lives has just discovered a veterinarian who discovered a cure for FIP, and they're sending their FIP-positive cats there. 

Naturally, I've been wondering if that cure is related somehow to changing the cat's pH, to make them more alkaline.  I've wanted to meet this doctor in person and ask him questions about the treatment, but it's on a very long list of things I need to do, and I just hadn't gotten around to it yet.

 


Last year, I met a couple who was distraught because their kitten whom they had adopted from 9 Lives, had FIP, and they were told he was going to die and there was no cure.  I tried to help this couple, giving them antioxidant alkaline water. 

I also gave them some hypochlorous acid (HOCl), since that stuff seemed to work like a miracle for my 2 cats that got extremely sick a few years ago (it seems to do a really good job of killing worms).  I was hoping there was a chance maybe it could kill the virus, since I've never seen any virus it did not kill.  But sadly, it just wasn't enough to save the kitty, and she still passed away. I was really heartbroken that she didn't live, and kept wondering what could have been done differently.

If I could do it all over again, I would skip the HOCl altogether, now that I know coronaviruses seem to thrive in an acidic environment. Because I now know that a coronavirus has a fatty lipid bilayer that appears to break down when exposed to a surfactant or emulsifier, I would have given that couple just the 11.5 pH water our machine makes, and skipped the 2.5. 

When I did my own experiments to see how quickly I could dissolve a layer of fat with this 11.5 pH liquid, I have to say it was one of the things that worked well (Note: as a distributor of these machines, I am not able to tell any person they should drink this water - the company is very adamant about the fact that the only waters they recommend for drinking are the ones in the 7.0 to 9.5 range).  

I'm just bringing this up because I know of other people who have the machines, who consumed very small amounts of the other "strong" types of water, but they drank it entirely at their own risk, knowing the company does NOT recommended those waters for human consumption. I can report that when I gave my cats the 2.5 pH water (aka hypochlorous acid), I was shocked to see how much it helped them. 

I don't remember exactly what city she said he was in, but I remember it was somewhere up north, about an hours' drive from 9 Lives. I remember this because I was thinking, wow, that's about an hour-long drive, to take all the cats there.  Also, I had thought to myself, I want to meet this guy and buy him lunch and ask him about his methods! And I remember thinking it would take me about an hour of driving (with no traffic) to get to where he was.


I had been meaning to get in touch with the gal I spoke with at Nine Lives, to ask her for the name of the doctor who found a cure for FIP, but... it's on a VERY long to-do list and I just hadn't had the time to make the calls, yet. 

Then, tonight, I was doing some research on FIP in cats, after learning SARS-2 seems to affect cats, but not Dogs (I highlighted what I read, below). In trying to figure out what the connection is between humans and cats (but not humans and dogs), I did some FIP research on YouTube (knowing cats are susceptible to FIP), and stumbled upon this video below. This has got to be the same guy 9 Lives is sending their FIP+ cats to (I need to double check with 9 Lives, but I'd bet money on  it).  

    


UC Davis professor who created cure for coronavirus in cats says drug should 'receive more attention'

Sadly, it doesn't come as a surprise that this drug isn't getting much attention, despite the fact that it's really incredible that anyone could have come up with a treatment for FIP, given how long a cure has eluded veterinarians. Sadly, it really does seem as if the things that work REALLY WELL just never seem to come to light if it's not a big money maker.

For anyone who thinks this sounds like some kind of conspiracy theory, you may want to do some research on Fenbendazole.

Fenbendazole is a cheap dog-deworming drug that has been used by many people to reduce or even eliminate their cancer. Last year, I saw a news story about a guy named Joe Tippens who had Stage 4 cancer in his lungs, liver, pancreas, neck and bones.  His insurance company spent over a million dollars treating him with modern methods, which were unsuccessful. He was basically sent home to die. But then one day, a veterinarian told him about a cheap dog de-worming medication that cost 5 bucks, that had been helping a lot of people with cancer. 

Figuring he had nothing to lose, Joe Tippens took the medication,  and guess what? ONE HUNDRED PERCENT of his cancer went away.  I realize that, for anyone who's never read about this before, that is going to sound way too good to be true. Well, the guy sure sounds like he's telling the truth, and he has the proof that not only did he have several types of stage 4 cancer, and he also has proof that he was declared cancer free.  You can read about his story by clicking HERE, and decide for yourself.

This is a bittersweet story for me, because I lost a close family friend to Cancer, and I only learned about this treatment about 6 months after she passed away. I sure wish one of the doctors at her hospital could have told us about this treatment, but... nope!

Fenbendazole and Mebendazole discovered to be effective at killing cancer cells over ten years ago. In fact, John Hopkins University even mentioned it in their newsletter! So...how come we never heard about it?

I don't have a definite answer for that one, and I really do not want to believe that this lack of publicity could have anything to do with the fact that there are a lot of people out there who would lose a lot of money, if it was discovered that cancer was something that was dirt cheap, and people could buy it right off Amazon. But I can't rule that out, either.

Not surprisingly, the price of Fenbendazole has gone up somewhat (and Joe Tippens said the manufacturer tried to raise the price WAY up, but you can still get it fairly cheap - maybe because it's a common drug that's manufactured all over the world). The cost is nowhere close to the cost of chemotherapy.


It's profitable for humans to be sick - but not livestock

Years ago, I listened to this audiobook by Joel Wallach, called "Dead Doctors Don't Lie," and Dr. Wallach noticed that animals were being given a lot more nutrition than most humans were. Why? Because it meant the farmers would get more profits. It is far more profitable for livestock animals to be healthy, than it is for humans, because livestock animals are a commodity that can be sold. A sick cow cannot (or should I say should not) be sold. A sick human being becomes a commodity in the U.S.. when they get sick. 

I highly recommend listening to this presentation by Dr. Wallach:

Dead Doctors Don't Lie (Original Audio)


https://www.catvirus.com/treatment.htm


 

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Note: this section is intended for veterinary surgeons only and should NOT be used by cat guardians to attempt to treat cats themselves. However, before leaving the page, guardians please download the following to take to your veterinary surgeons:

FIP diagnosis algorithm (this will open in a new window)

Questionnaires for step 1 of the FIP diagnosis algorithm for guardians to complete and give to your veterinarian to save time during your veterinary consultation

FIP treatment summary information sheet – vets, if you don’t want to go through all of this webpage, this sheet cuts to the chase in regards to dosages, etc.

10 rules for preventing relapses in FIP treatment

Note - these downloads should open in a new window and in some browsers will simply automatically download.

Click here for printer friendly version (i.e. black writing on white background) (this version is still the old page: until that is updated, you'd be better with the FIP treatment summary which is a printable pdf giving drugs and doses).

 

FIP is now a curable condition: but prevention is better than cure!

When I first came to Feline Infectious Peritonitis (FIP) research, FIP was regarded as an incurable condition. However, with the introduction of feline interferon and more recently GS-441524, the nucleoside analogue, we now have hope for more than remission of weeks to months: we have hope of complete recovery for some cats, especially those diagnosed in early infection. However, more work requires to be done so that an affordable treatment protocol can be established for people whose cats are not insured. Therefore the emphasis must still be on totally preventing cats ever developing FIP in the first place, and on accurate diagnosis, so that cats with non-FIP conditions are not needlessly euthanased.

This webpage represents only the personal opinions of the author, not all opinion leaders agree with me.

Disclaimer: this website and webpage are for information purposes only, I accept no responsibility for how you decide to use this information.

Remember that many treatments listed here would be off label and that you must inform your client of this fact and have your client sign your practice's legal disclaimer form.

Updates on treatment will appear in the English version of the website before the translated pages.

golddot 1. DOUBLE CHECK THE DIAGNOSIS

golddot 2. NUTRITION

golddot 3. ANTIVIRALS

golddot 4. ANTI-INFLAMMATORIES, CORTICOSTEROIDS / IMMUNOSUPPRESSANTS - given to both effusive and non-effusive FIP cases

golddot 5. IMMUNE SUPPORT

golddot 6. EFFUSIVE FIP - treatment for cats with wet FIP

golddot 7. NON-EFFUSIVE FIP - treatment for cats with dry FIP

golddot 8 . FCoV- ASSOCIATED ENTERITIS / DIARRHOEA 

golddot 9. SUPPLEMENTS: VITAMINS AND ANTIOXIDANTS

golddot 10. PROGNOSIS AND MONITORING FIP TREATMENT

golddot 11. DRUGS NOT RECOMMENDED

golddot 12. MISCELLANEOUS NOTES

golddot 13. References and further reading

 

1. DOUBLE CHECK THE DIAGNOSIS: 40% of cats diagnosed with FIP actually have some other disease
Before commencing treatment, make absolutely certain that the cat really does have FIP: around 40% of cases presented to me as FIP (especially non-effusive FIP) turn out to have some other condition. Work through the FIP diagnosis algorithm and be sure that the cat ticks most of the boxes of all of the steps. It is essential to ensure that the diagnosis is correct: immunosuppressive drugs will markedly worsen other conditions (such as bacterial peritonitis or pleurisy) and even be fatal in other cases, for example toxoplasmosis, leishmaniasis.

To see me working through FIP diagnosis algorithm on a real life case, watch "Does Pancho Have FIP?" or Does Tommy Have FIP? (These films will count towards your Continuing Professional Development /Veterinary Continuing Education.) Subscribe to my YouTubeBitchute, and Rumble channels to see new cases when they are uploaded. Also see the FIP diagnosis webpages.

You can only be really confident of an FIP diagnosis if you have a positive FCoV RT-PCR result on the effusion of a wet FIP case, or a mesenteric lymph node (MLN) fine needle aspirate (FNA) or aqueous humour in a non-effusive FIP case. Note that cats without FIP can have viral RNA (i.e. a positive RT-PCR result) in their CSF: that is NOT diagnostic of FIP.

Do NOT send blood samples for FCoV RT-PCR testing, even if the laboratory asks for that sample because you are more likely to get a negative result even if the cat has FIP: send either effusion of MLN FNA.

2. NUTRITION  - this section applies to cats with wet or dry FIP; FCoV associated diarrhoea and asymptomatic healthy FCoV infected cats

The beauty of altering nutrition immediately is that it will help in any condition, not just FIP—and it is safe.  If you have read The China Study, watched Forks Over Knives, or heard Dr Michael Greger’s famous top human killer diseases lecture, you will already be familiar with the enormous impact diet has on preventing, and even curing, the majority of causes of human deaths - the situation in cats and dogs may well be similar.

It is my opinion that feeding as varied and natural a diet as possible to cats with FCoV infection and FIP is essential: avoiding highly processed, pro-inflammatory grain-based commercial foods (even the expensive so-called “veterinary” diets are usually cereal based). 

Unlike humans, arginine is an essential amino acid in the cat (Morris & Rogers, 1978): this is why they are obligate carnivores. Arginine is essential not only for the urea cycle but also for the normal functioning of monocytes and endothelial cells. To see an animation of feline coronavirus infecting a monocyte/macrophage, and wet FIP developing, visit: https://www.youtube.com/watch?v=6RyI2LI9R9Q

Give real meat daily to augment arginine levels: even just a tablespoonful a day will make a difference to FCoV infected cats.  It is important that the meat or liver come from free range animals because they will have eaten grass which is rich in omega 3. Alternatively, regularly use commercially available real meat based cat foods e.g. Applaws (MPM products, available from the Zooplus website in Europe); Almo Nature Cat Food. 


Feed cats with FIP a little salmon, sardines, pilchards or other fish rich in omega 3
Cereal based foods contain too much omega 6 polyunsaturated fatty acids and too little omega 3, leading to a state of chronic inflammation – we have seen this in human beings over the past couple of decades: an unprecedented rise in inflammatory conditions such as allergies, asthma and arthritis.  We see a similar rise in inflammatory conditions being recognised in the cat.

Increase the anti-inflammatory omega 3 fatty acid content of the cat’s diet (i.e. add sardines, pilchards, salmon, mackerel twice a wk for 6 weeks). Both Applaws and Almo Nature have canned food including real fish. However remember the risk of hypervitaminosis A (excessive laying down of bone at the joints) so be wary of feeding too much real fish – reassess the situation after 6 weeks.

Remember to instruct the cat’s guardian in a gradual changeover of the food: to change it over a period of weeks otherwise the cat will wolf down the new food for a few days, then get sick of it and never touch it again!  The way to introduce a new food is to give it for one meal, then go back to the customary diet for the next few meals, then give a little of the new food again, and so on, gradually increasing the frequency of the new foods, until giving a different food every meal becomes the norm for the cat.  To introduce new foods gradually properly will take at least a month.  

FCoV associated diarrhoea helped by chicken and pumpkin cat food and Protexin Pro-kolin enterogenic probiotics
I’ve had remarkable success using Applaws or Almo Nature chicken and pumpkin tinned food in these cases.

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3. ANTIVIRAL DRUGS

My FIP treatment protocol at time of writing (2022) is as follows: Virbagen Omega (s/c for effusive FIP, oral in non-effusive FIP); meloxicam, Vitamin B12 (Cobalaplex pills by Protexin: half every day or a whole capsule every other day) and other treatments tailored to each individual cat: these will keep the cat going until you are able to obtain a specific anti-coronavirus drug. The best anti-viral drugs to treat FIP are GS-441524 pills rather than injections (Krentz et al, 2021) because the injections are very painful and destroy the patient / human bond. Some cats develop weeping, painful lesions at the site of injection (Pedersen et al, 2019). In addition, the injections are less effective than pills and do not reliably stop FCoV shedding in the faeces. I am now being consulted about cats who are in relapse following a 12 week course of FIP treatment: these cats were almost always treated with injections, rather than pill forms, or their treatment was begun with an injectable anti-viral. Liver support using S-adenosyl-L-methionine is essential for longer term use with nucleoside analogue antiviral compounds. Once we have two consecutive normal AGP results at least one week apart, we stop the oral GS-441524 and go onto low dose oral Virbagen Omega until the cat's FCoV antibody titre drops significantly (Addie et al, 2022). In-contact cats are tested for FCoV shedding and we stop them shedding virus to prevent re-infection of the patient. Details of this protocol can be found below.

A major hurdle in some countries is that none of the anti-coronavirus treatments for FIP is yet approved, therefore an alternative protocol needs to be found.

GS-441524 pills

GS-441524 injectionsnot recommended

GC376

Itraconazole

Interferon / Virbagen Omega

Adenosine nucleoside analog GS-441524 pills: treatment of choice for feline infectious peritonitis

GS-441524 is an adenosine nucleoside analogue that terminates the RNA chain of viral RNA-dependent RNA polymerase. In the UK and Australia, veterinary surgeons can obtain VMD and Australian Pesticides and Veterinary Medicines Authority (APVMA) approved GS-441524 pills from Bova. (Cat guardians - you are not allowed to buy these pills directly, your vet will supply them for you.)

The Bova UK website is: https://bova.co.uk/ and the UK sales manager contact is Emma@bova.co.uk

I'm sorry I don't have a contact for Bova Australia, but this is their website: https://bovavet.com.au/

Bova GS-441524 pills contain 50mg of active ingredient: the pills are scored and can easily be broken into halves or quarters.

Dose: 20mg / kg bodyweight per day Bova GS-441524 pills for cats with neurological or ocular signs and 10mg/kg for cats without neurological / ocular signs.

Note that this dose is double that used in Mutian X studies (Addie et al, 2020; Krentz et al, 2021): this is because an analysis of Mutian done by Bova Specials Ltd claimed that Mutian X contains more of the GS-441524 component than is claimed by the manufacturers. This claim has not been independently verified. I have to admit that I have not yet supervised treatment of a cat with FIP using Bova pills therefore I am extrapolating dosages from what we know about treatment with Mutian X pills.

In my protocol, all cats with FIP have the double dose of pills for about 10 days in order to clear virus from the brain to avoid neurological relapses, then in effusive cases and non-effusive cases with no neurological or intra-ocular signs, the dose reduces to 5mg/kg per day (for Mutian X) or 10mg/kg q24h for Bova GS-441524 in divided doses and followed by food.

PILLING: please warn the cat's guardian about the risks of oesophagitis following pilling, and that it's important to follow a pill with some food or drink to ensure it is properly washed down into the stomach and doesn't lodge in the oesophagus. Another reason for giving the antiviral with food is because we want the active antiviral to be absorbed and not simply pass through the intestinal tract rapidly, so giving with food delays the passage through the gut. For cats who are difficult to pill, try a pill popper; wrapping the pill in tuna or salmon pate; or using Royal Canin's Pill AssistTM. If the cat tends to vomit with the antiviral, then give a little food before pilling.

Please see the section on supplements and use S-adenosyl-L-methionine (SAMe, e.g. Denamarin, Hepatosyl) to protect the liver when using GS-441524.

Be aware that high doses of nucleoside analogue may damage the kidneys therefore monitor SDMA and reduce dosage to 5mg active ingredient per bodyweight q24 hrs (in divided doses) as soon as clinical signs resolve.

Remember that this treatment would be off label and that you may want to have your client sign your practice's legal disclaimer form. Check with your own regulatory body for advice about the legality of its use in your own country.

In China, Mutian Xraphconn (Mutian X or simply Mutian), which contains GS-441524 (Krentz et al, 2021), is available as capsules or tablets: the Mutian 200 pill contains 10mg of active ingredient. Their website is www.mutianstore.com.

GS-441524 injections: NOT RECOMMENDED, use oral treatment preferably

GS-441524 is the metabolite of Remdesivir (Gilead Sciences, USA). There were promising results with GS-441524 in vitro and in one in vivo experimental study, Murphy et al., 2018 and the eagerly awaited clinical trial was published in 2019. (Pedersen et al, 2019) Thirty-one cats were enrolled in the field study: 17 of 20 with effusive FIP, 2 developed neurological signs and were euthanased and one died due to cardiomyopathy. Eleven other cats were treated with GS-441524 injections: 4 died shortly after treatment commenced, and of the remaining cats, 3 with presumptive non-effusive FIP recovered as did 4 dry-to-wet cases. Thus of the 31 cats treated, 24 survived by time of writing up the paper.

Dose: GS-441524 injection treatment at a dosage of 4 mg/kg SC sid for up to 12 weeks (until the acute phase protein level is normal for two consecutive weeks), repeating the course if clinical signs recur. The dose can be increased to 5mg/kg Murphy et al., 2018 in severe cases and 10mg/kg in neurological (Dickinson et al, 2020) or ocular cases.

I do not recommend using GS-441524 or Remdesivir (Veklury) injections (unless the cat is absolutely impossible to pill) for the following reasons:

  • the treatment stings on administration and injection site reactions occurred in 16 of 26 cats treated (Pedersen et al, 2019). Injection site reactions are worrisome in cats, because they can lead to fibrosarcoma formation (Hartmann et al, 2015).
  • the cats being referred to my online practice now as FIP relapses were began treatment with injectable antivirals instead of oral antivirals.
  • in Dr Pedersen's the field study, about one third of the cats required subsequent courses of treatment and one cat appeared to have a virus which was resistant to the drug. (Pedersen et al, 2019)
  • the only FIP cat I've lost since the antivirals have become available was on Mutian II injections (which presumably contain GS-441524).
  • one of my cases treated with GS-441524 injection continued to shed virus 2 years on despite his FIP signs having resolved.
  • resistance to Remdesivir arises rapidly in SARS-CoV2 viruses (Szemiel et al, 2021), therefore probably does so in feline coronaviruses: certainly one of Dr Pedersen's patients had a FCoV resistant to injectable GS-441524 (Pedersen et al, 2019).

Giving GS-441524 pills targets FCoV where it replicates: in the intestine, whereas if you inject it, penetration to the inside of the intestine will presumably be less (Addie et al, 2022). Drug-resistant SARS-CoV2 mutants have arisen because of poor penetration of the lung, the site where SARS-CoV2 mainly replicates.

Monitoring cats on GS-441524 or molnupiravir treatment

Stop the GS-441524 pills when alpha-1 acid glycoprotein (AGP) levels consistently return to normal (Addie et al, 2022) and put the cat onto 100,000 units of Virbagen Omega per cat sid per os instead. The best indicator that FCoV no longer exists within the body is when the FCoV antibody titre reduces significantly (preferably to under 1:10), using a sensitive FCoV antibody test: see the FCoV antibody page for which test is best. However, the FCoV antibody titre is the slowest parameter to return to normal (i.e. zero) when a cat recovers from FIP.

Monitor weight to assess response to treatment: see my video www.bitchute.com/video/Vr3wkoW8SkrP/.

Mutian X pills are effective at stopping FCoV shedding: the dose for clearing FCoV infection is 4mg/kg for five to seven days (minimum 4 days: see Addie et al, 2020a). Although there is no published report showing efficacy of Bova GS-441524 pills for clearing FCoV infection, one of my colleagues informs me that it does: the dose is 10mg/kg for 5-7 days. I am investigating another treatment for stopping FCoV shedding, but have not got enough evidence yet to report upon it.

Below is Skywise, who featured in a case study published in the peer-reviewed journal Viruses:

FIP_eye_Mutian

 

Skywise had been blind: his sight was restored and he is alive and well almost one year following treatment.

This is Bea whose effusive FIP was treated with Mutian pills:

Wet_FIP_cured

 

Further information

Watch this space for updates on antivirals, and follow me on:

MeWe (a privacy honouring  alternative to Facebook): www.mewe.com/i/catvirus1

Bastyon (a free speech alternative to Twitter)
https://pocketnet.app/catvirus?msocialshare=true&ref=PXAY6Ttdx4uZrpyGuyDRktDzm47YZz8jTg

Seek advice from your own veterinary body about using anti-coronavirus antivirals in your country. Disclaimer: I am not a lawyer, I do NOT know if this is legal, and I am not responsible for your choices about whether or not to use it: you do so at your own risk.

A report of Dr Pedersen’s presentation can be found here: www.vin.com/apputil/Project/DefaultAdv1.aspx?pId=99&catId=102069&id=8124390.

Watch Dr Pedersen’s SOCK website for news of updates and new clinical trials. www.sockfip.org
There is a clinical trial advertised on the Anivive website, which may or may not involve GS-441524: https://www.anitrial.com/trial/feline-infectious-peritonitis.  

There is an article about a cat called Luna, who was in Dr Pedersen's GS 441524 treatment trial here: https://pethelpful.com/cats/Hope-for-Feline-Infectious-Peritonitis-aka-FIP-Lunas-Story

Download a pdf of Dr Pedersen's statement on purchasing GS-441524 or GC 376

GS-441524 not working in your patient?

In my experience, the main reason for this is that the cat is not, in fact, suffering from FIP: 40% of the cats referred to me - usually from referral practices - have had some disease other than FIP. Please download my 10 Rules for Preventing FIP Relapses to obtain further insight into the possible reasons.

To obtain a consultation with me, please visit the www.catvirus.com home page.

GC376

GC376 is a 3C-like protease inhibitor antiviral drug, not currently commercially available so far as I know. In my opinion, it has been eclipsed by GS-441524 (see above). In the most recent field trial, 6 of 20 cats experienced remission. Here is a figure from the publication by Prof Pedersen et al:

GC376

As you would expect, the antiviral was most effective against cats with the acute form of FIP, effusive FIP, but less so against non-effusive FIP. One advantage of GC376 over GS-441524 is that it can be dissolved in water, so the injections aren't as nasty.

I have heard that the patent for GC376 was bought by Anvive and that they will market it as an FIP treatment in future, but I do not have evidence for this to show you. However, it may be worth watching the Anvive website.

 

 

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INTERFERON

Interferons are the broad-spectrum antivirals that the body produces. They are fairly species specific, so it is more effective to use feline interferon than human interferon, although the latter is better than nothing. Until GS-441524 pills become commercially available, Feline Interferon Omega (Virbagen Omega) remains my go-to treatment for cats with FIP, although I am looking at another option at present.

Feline interferon omega

Human interferon alpha

Feline interferon omega (Virbac, France)
Virbagen Omega (made by Virbac) is recombinant feline interferon omega (IFN omega) and is available in many countries now. This product was first used in treatment of FIP by Japanese vet and scientist Takuo Ishida in a study in which 4 cats of 12 completely recovered and two survived 4 and 5 months. Those cats which recovered completely all had the effusive form of FIP and were relatively older cats. This treatment protocol is based on Dr Ishida's:

Dr Ishida used corticosteroids in his study, but they reduce the life span of cats with FIP (Legendre et al, 2017), so for many years now I have been recommending meloxicam instead (provided blood pressure and kidney function are normal), and have been achieving remission and even some cures (Addie et al, 2022).

Dose for effusive FIP: IFN omega was initially given subcutaneously at 1 MU/kg every other day, and then twice every week for variable period if remission was seen.

Dose for non-effusive FIP: 100,000 Units per cat per day (dilution instructions are below). Once diluted (in water or saline) IFN Omega maintains its potency in the fridge for up to 3 weeks, so keep most IFN Omega in the freezer until needed.

It is very important to begin treatment as soon as possible after the onset of clinical signs.

Diluting feline interferon
Download Virbagen Omega dilution sheet to print out / give to your veterinary surgeon

Virbagen Omega comes in vials of 10 million units. It is reconstituted with 1ml of diluent. To get 100,000 Units/ml, divide one vial into 10 x 0.1ml aliquots in 10 one ml syringes and freeze 9 of them. Put 4.9mls of saline or water into a small clean tube and add one of the 0.1mls of Virbagen Omega to it: you now have 5 mls of diluted interferon: store it in the fridge (where it will keep up to 3 weeks). Show the cat's guardian how to withdraw 0.5mls of the diluted interferon (which now has 100,000 units of interferon per dose). Get the cat's guardian to do the syringe filling and the dosing in front of you: we vets are so used to handling syringes that we forget that most people have never handled a syringe in their lives. Some cats will take the interferon on food, but to be certain the cat gets the dose, tilt the head with the mouth closed and introduce into the commisure of the lips, wait until you see the cat swallow before releasing the head.

Remember that reconstituted, diluted Virbagen Omega lasts only up to 3 weeks in the fridge.

Suppliers: Virbagen Omega can be obtained from your Virbac representative. From abroad, it can be bought from Abbeyvet, who can be contacted at info@abbeyvet-export.co.uk (you need to email them, because Virbagen isn't obvious from their website) .

In the USA, Virbagen Omega is stocked by The Animal Medical Centre, 510 East 62nd Street, New York, NY 10065. Telephone: (212)-329-8724

Reference: Ishida et al, 2004. Journal of Feline Medicine and Surgery. Vol 6 Issue 2 pp 107-110

Human interferon alpha
Dose: Non-effusive feline infectious peritonitis (FIP): 30 i.u./daily or for 7 days at alternate weeks given by mouth.

In effusive FIP 30 i.u./daily can be used, or larger doses of interferon can be given by intramuscular injection daily (104 - 106 i.u. per day). By 6-7 weeks, if the cat is still alive, interferon will no longer work at this dose because the cat will make antibodies against it.

To obtain human interferon-alpha (Roferon or Intron A), write a prescription for your local pharmacist. Obviously, in areas where feline interferon is available it is preferable as it is likely to have more effect than the human interferon.

Diluting human interferon
To get 30 i.u./ml: Intron A can be obtained as 1 million i.u. for about £10.00. Dilute whole vial in one litre of saline, giving 3000 i.u./ml. Put one ml of 3000 i.u./ml into 99ml of saline, to get 30 i.u. per millilitre. Aliquot into 1ml volumes* and freeze for up to a year. Defrost as required, keep refrigerated for up to a week.

*In the UK: 2ml tubes are available from Sarstedt, supplier's ref: 72.694.006. Fax: 0116 236 66099 Tel: 0116 235 9023.

To get 104 i.u./ml put 1 x 1 million i.u. vial of Intron A or Roferon into 99ml sterile saline and divide into 1ml doses and freeze. For 105 i.u./ml use 9mls saline and proceed as above. For 106 i.u./ml use the whole vial.

ITRACONAZOLE: NOT RECOMMENDED

Itraconazole is an anti-fungal but was recently reported to be able to reduce type I feline coronavirus in the laboratory. (Takano et al, 2019) Unlike GS-441524, there is a commercially available veterinary preparation for cats. This can be given to tide cats over until a specific anti-viral is available, but it does NOT cure FIP, even in combination with meloxicam and VIrbagen Omega feline interferon. Nor does it reliably stop cats from shedding virus in their faeces: sometimes it reduces the virus quantity, but it does not consistenly prevent FCoV shedding as far as we know at time of writing. In addition, cats lose weight while on this treatment.

Dose: 10mg/kg orally

Do NOT use Entyce along with Itraconazole.

golddot 4. ANTI-INFLAMMATORIES, CORTICOSTEROIDS AND IMMUNOSUPPRESSANTS

Because FIP is an immune mediated disease, therapy sometimes includes suppressing the immune response, for example, with glucocorticoids, which can have lethal consequences if the diagnosis is erroneous (e.g. in toxoplasmosis, or bacterial peritonitis or pleurisy). Before embarking on any of the following therapies, it is essential to ensure that the diagnosis is correct. See Diagnosis of FIPCats receiving immunosuppressants should also receive antibiotic cover to protect them against other infections. It is also important to maintain the cat's general nutrition status, by adding real meat, vitamins and antioxidants.

 Prednisolone - NOT RECOMMENDED

Meloxicam (Metacam, Boehringer Ingelhiem)

 Thalidomide

Prednisolone - NOT RECOMMENDED unless for palliative end of life care
Prednisolone was the main anti-inflammatory and immunosuppressant used in feline infectious peritonitis
, but since 2017 I completely stopped advising corticosteroids in FIP treatment and advocated meloxicam and Virbagen Omega instead: my survival rates improved dramaticallyOf course we now have specific antiviral drugs available in some countries which render these treatments obsolete.

Presnisolone is relatively safe and tends to make the cat feel better, it stimulates his or her appetite; prednisolone is inexpensive and available everywhere. However, prednisolone suppresses both the humoral and cell-mediated immune response and alternative anti-inflammatory treatments are more effective in the treatment of FIP: Hugo and Reading (2015) reported prolonged survival—787 days—in a 4 year old cat with effusive FIP, whom they treated with meloxicam and one month of metronidazole and Tramadol.

When prednisolone is used, it is absolutely essential that the doses BE REDUCED to a level which keeps the individual cat comfortable. I am frequently shocked to learn of veterinary surgeons who forget the half the dose of corticosteroids every 7-10 days: for example, this was not done in the Ritz study and 13 of the cats died of secondary bacterial infections.

Prednisolone has the advantage of also being the treatment for lymphocytic cholangitis, which can be mistaken for FIP, so where the diagnosis is in doubt between FIP and lymphocytic cholangitis, prednisolone can be given to assess the response: the cat with lymphocytic cholangitis has a good chance of recovery, the cat with FIP unfortunately will die. Prednisolone should never be used in cats with toxoplasmosis, or leishmaniasis, neither is it safe in cases of septic peritonitis or pleurisy, which is why cytology is a very important part of effusive FIP diagnosis, as there will be many more white blood cells in the effusion of a cat with sepsis, and a good cytologist will detect the bacteria or fungi.

Dose2 mg/kg/sid given by mouth for 7-10 days
         then 1 mg/kg/sid given by mouth for 7-10 days
         then 0.5mg/kg/sid given by mouth for 7-10 days
         then 0.5 mg/kg every other day until recovery or death

Prednisone is not effective in cats (Trepanier, 2009)

Meloxicam (Metacam, Boehringer Ingelheim)

Provided kidney function and blood pressure are normal, consider using the non-steroidal anti-inflammatory meloxicam instead of corticosteroids.   Meloxicam was used for 119 days, along with one month of metronidazole, in one FIP case report in a cat who survived 787 days. (Hugo and Reading, 2015) Meloxicam, rather than glucocorticoids, was also used in 10 experimentally-infected cats who recovered using an antiviral called GS-441524. (Murphy et al, 2018)

Dose: 0.05 mg/kg BW, per os, q24h

Thalidomide
The rationale of using thalidomide in the treatment of feline infectious peritonitis is to reduce inflammation and the humoral immune response to feline coronavirus while leaving the cell mediated (anti-viral) immune response intact. Only 4 cats with FIP have been treated with thalidomide so far and unfortunately all died. However, one with a thoracic effusion did eliminate his effusion and had a remission of 3 months. I think that, to be effective, thalidomide would need to be used very early in the disease, before too many blood vessels became damaged.

Be sure to obtain the owner's consent for using a drug not licenced for cats.

Dose: 50-100mg at night. CANNOT BE USED IN PREGNANT CATS as it is teratogenic.


golddot 5. IMMUNE SUPPORT- treatment for cats with both wet and dry FIP

Polyprenyl immunostimulant (PI) - do NOT use corticosteroids along with PPI

Although publications on PI were both on non-effusive cases, PI is recommended in any case of FIP who is lymphopenic. In work I have not yet published, I saw a dramatic improvement in lymphocyte levels in 5 cats out of 6. In my recent paper, four cats in the recovered group and one in the remission group were treated with PI amongst other things. Even if the cat is being treated with GS-441524, GC376 or Mutian X, I would recommend also treating with PPI if the lymphocyte count is below normal.

In a study by Legendre et al, 2017, survival was better in cats not concurrently treated with systemic corticosteroids, but it is probably safe to use topical ophthalmic corticosteroid treatment along with PPI in cats with intra-ocular signs of non-effusive FIP.


Dose: 3.0 mg/kg orally of Polyprenyl Immunostimulant three times a week.
Cost: about £230 to get 60ml (6x 10ml bottles) including postage from America
To obtain PI: email orders@vetimmune.com, or visit www.vetimmune.com. 
UK veterinary surgeons will need to apply to the VMD for special import permission.

I found the following video made by a cat's guardian, demonstrating how she doses her pet:

 

 

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golddot 6. EFFUSIVE FIP - treatment for cats with wet FIP

If the anti-FCoV nucleoside analog GS-441524 pills (Krentz et al, 2021) are licensed in your country, that would be the treatment of choice.

Doses:

GS-441524 pills: 5mg of active ingredient per kg bodyweight until acute phase protein (alpha-1 acid glycoprotein (AGP) or serum amyloid A, SAA) levels consistently return to normal, or for up to 12 weeks. Most cats only require up to 7 or 8 weeks of treatment. I recommend giving 7-10 days of a double dose of antiviral at the outset of treatment to clear the brain of virus: this precaution seems to prevent neurological FIP relapses.

If using the Bova GS-441524 they recommend doubling the dosage that is used for Mutian.

Once the cat has had two consecutive AGP or SAA tests within normal limits:then stop the pills and use oral Virbagen Omega at 100,000 units per cat per day per os.

In some countries, vets are able to use Remdesivir injections to treat FIP and that may be the only option, but it's not the best option (see above).

If GS-441524 pills are not available, my go-to protocol to treat effusive FIP is to drain the effusion, give Virbagen Omega to the site of the effusion, then s/c q48 hours after resolution of the effusion, and meloxicam as the anti-inflammatory of choice.

Doses:

Feline interferon omega: 1 million units/kg/sc/q48 hours until recovery

Meloxicam (provided blood pressure and kidney function are normal): 0.05 mg/kg per os, sid.

 

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golddot 7. NON-EFFUSIVE FIP - treatment for cats with dry FIP

If GS-441524 or EIDD (molnupiravir) pills are not available (see above) then my go-to protocol for non-effusive FIP therapy would be Virbagen Omega at 100,000 units per cat per day by mouth. and meloxicam (provided the cat's kidney function and blood pressure are normal). I have I have little personal experience of Polyprenyl Immunostimulant, the person with most experience using it is Dr Legendre whose paper is open access. However, in my experience it is effective at reversing lymphopenia.

Diluting feline interferon
Virbagen Omega comes in vials of 10 million units. It is reconstituted with 1ml of diluent. To get 100,000 Units/ml, divide one vial into 10 x 0.1ml aliquots in 10 one ml syringes and freeze 9 of them. Put 4.9mls of saline or water into a small clean tube and add one of the 0.1mls of Virbagen Omega to it: you now have 5 mls of diluted interferon: store it in the fridge (where it will keep up to 3 weeks).

Show the cat's guardian how to withdraw 0.5mls of the diluted interferon (which now has 100,000 units of interferon per dose). Get the cat's guardian to do the syringe filling and the dosing in front of you: we vets are so used to handling syringes that we forget that most people have never handled a syringe in their lives. Some cats will take the interferon on food, but to be certain the cat gets the dose, tilt the head with the mouth closed and introduce into the commisure of the lips, wait until you see the cat swallow before releasing the head.

Remember that reconstituted, diluted Virbagen Omega lasts only up to 3 weeks in the fridge.

Supplier: Virbac

Doses:

Feline interferon omega: 100,000 units/kg/per os sid until recovery

Meloxicam (provided blood pressure and kidney function are normal): 0.05 mg/kg per os, sid.

GS-441524: 5mg/kg (e.g. Mutian X pills, twice this dose for Bova GS-441524) for up to 12 weeks. If neurological or intra-ocular signs are present: 10mg/kg is required. Note: it is best to ask the antiviral supplier about their recommended doses for the clinical presentation of an individual cat.

 

golddot 8. FCoV-ASSOCIATED ENTERITIS / DIARRHOEA 

GS-441524 pills: 5-10mg/kg for 5 to 7 days (depending on the drug brand) unless the diarrhoea is caused by the colonic form of FIP, in which case the non-effusive protocol should be used.

Ivermectin dose: 0.2mg/kg q24h in divided doses for 2 weeks, plus zinc picolinate (quarter of a 22mg pill per cat q24h for 2 weeks).

Vitamin B12 injections should be given to all cats with FCoV-associated diarrhoea once a week.

FCoV-associated diarrhoea is ameliorated (but not totally cured) by chicken and pumpkin cat food (e.g. Applaws or Almo Nature chicken and pumpkin tinned food) and Protexin Pro-kolin enterogenic probiotics.

golddot 9. SUPPLEMENTS: VITAMINS AND ANTIOXIDANTS

S-adenosyl-L-methionine (SAMe, e.g. Denamarin, Hepatosyl)

Used to protect the liver if using a nucleoside analog drug which can be hepatotoxic, or if FIP itself has caused raised liver enzymes.

Vitamin B12

Vitamin B12 (e.g. Cobalaplex pills by Protexin) should be given to all cats with FIP or FCoV-associated diarrhoea for several reasons:

  • to stimulate the appetite
  • to support red blood cell produation
  • for its anti-inflammatory properties

Vitamin B complex

Multivitamins B are a good appetite stimulant and can be obtained from health food shops or chemists (I particularly like the one from Boots chemists in the UK). Dose: paediatric dose.

Vitamin B1 (thiamine)
Vitamin B1 (thiamine): 100 ug/day given orally (i.e. by mouth or in food).

Vitamin A
Vitamin A is an antioxidant. The dose of Vitamin A is 200 i.u./day given by mouth or in the food. Cats cannot metabolise the beta-carotene form so must be given vitamin A as fish oil, e.g. halibut liver oil. Too much vitamin A can cause excessive laying down of bone at the joints, so don't use this supplement for more than 4-6 weeks.

Vitamin C
Ascorbic acid 125 mg twice daily given by mouth or in food. Vitamin C is an antioxidant. Remember that given over a long period of time, vitamin C can predispose to oxalate crystals in the urine, so only use with caution.

Vitamin E
Dose of vitamin E: 25-75 i.u./cat twice dailty given by mouth or in food. Vitamin E is an antioxidant.


Other supportive drugs

Probiotics
Probiotics such as Protexin Pro-Kolin enterogenic  can help cats with FCoV associated diarrhoea and with FIP since the functioning of the immune system is dependent upon the health of the microbiome.

Aspirin
For anti-inflammatory activity and pain relief.

Dose: 10mg/kg every 48-72 hrs per os.

Antibiotics
Antibiotic cover is essential when immunosuppressing a cat.  Your choice of antibiotics will depend on what your major differential diagnoses are, given the presenting clinical signs.  For example, if you are awaiting FIP confirmation from your laboratory and your major differential diagnoses are toxoplasmosis, or bacterial peritonitis / pleurisy, then clindamycin (Antirobe) will be your antibiotic of choice because it covers both aerobic and anaerobic infections; if your major differential is infectious anaemia, then doxycycline or oxytetracycline will be your choice (give food first to avert vomiting).  Metronidazole is effective against anaerobic organisms, so is a good choice where bacterial pleurisy is a differential diagnosis.  It inhibits TNF-alpha—i.e. is anti-inflammatory—and was used for one month, along with meloxicam, in one FIP case who survived 787 days. Hugo and Reading, 2015   However, it is horrible to taste and can be difficult to administer to cats.  

Avoid amoxycillin/clavulanic acid because it can inhibit interferon-gamma, which is essential for FIP survival. 

Anabolic steroids
For appetite encouragement and anti-catabolism, especially if the kidneys are affected.

Choose from the following (in the UK):
Laurabolin injection: 2-5mg/kg every 21 days.
Nandrolin injection: 2-5mg/kg as a weekly injection.
Nandoral tablets - one a day either whole or crushed into food.
Retarbolin injection: 1mg/kg every 21 days.
Orandrone tablets: 0.5mg/kg daily (the tablets are 5mg).

Remember to warn the owner that the cat's urine could become more strong smelling with this treatment.
The injectables usually require to be kept in the dark.

 

 

9. PROGNOSIS AND MONITORING TREATMENT


Whatever treatment you opt for, it is important to monitor the cat's progress. Initially, I measure the haematocrit (Hct), lymphocyte count, globulins, albumin to globulin ratio (A:G), alpha1-acid glycoprotein (AGP) and the cat's weight every 7-14 days to see how the cat is progressing. Later
, examinations might only be monthly if the cat is doing well. It is not worth measuring the FCoV antibody titre more often than every 2-3 months, there will be no discernible difference within a shorter period.

The AGP level is often the first to fall if treatment is having a positive effect because the acute phase proteins are a measure of inflammation, although in some cats the Hct rises to normal before AGP returns to normal (Addie et al, 2022). Other positive signs include resolution of clinical signs, lymphocyte count increasing, globulin levels decreasing, and the albumin: globulin ratio(A:G) increasing, Hct increasing and reticulocytes appearing in blood smears and weight increasing. Negative signs are AGP remaining high, globulins staying high or increasing, A:G decreasing, lymphocyte count decreasing, weight loss. An increase in bilirubin is a very poor prognostic sign (Tsai et al, 2011). When Hct gets to below 20% and stays there, i.e. is non-regenerative (no reticulocytes seen on blood smear examination) then the cat should probably be humanely euthanased if your clinical opinion is that he or she is no longer getting any happiness out of life. Clearly, if the cat is distressed at any point in the treatment, then euthanasia will be required.

Sadly, without treatment cats with effusive feline infectious peritonitis usually only survive a few days, possibly weeks at best. Cats with non-effusive FIP can last many weeks or months, though after neurological signs begin euthanasia usually ensues fairly rapidly.

For AGP testing see Veterinary Diagnostic Services at the University of Glasgow, Scotland, UK.

Staging for effusive FIP prognosis to help you to assess whether treatment has a chance of helping or not

In this staging system (based on the study of Tsai et al, 2011) shown in the video below the severity of effusive FIP can be worked out, which will give you an idea of whether or not it is worth obtaining special drugs to treat, or whether it is worthwhile continuing treating a case.  Look at the parameter in the left hand column, then look at where the result of your case falls in the range, then put the score for that parameter into the next free column in the grey shaded cells. Finally work out the total score for your case. You can download the excel file here: https://www.catvirus.com/downloads.html: the total score will automatically fill in the cell at the bottom.

Interpreting the total score for your case:

  • 0-4: survival time more than 2 weeks
  • 5-11: survival time less than 2 weeks
  • over 12: survival time less than 3 days

While this isn’t an absolutely exact predictor, it does give a ballpark indicator of prognosis.
Remember that even giving the cat a few more days can help the cat’s guardian come to terms with the imminent demise of their pet: corticosteroids don’t cost much and will help ease those last days. Draw off the effusion to make the pet more comfortable.  FIP doesn’t seem to be a painful condition.  This is a video I made of using the staging excel file:

 

10. NOT RECOMMENDED

L-lysine should NEVER be given to a cat with FCoV infection or FIP because it is antagonistic to arginine which is essential for immune function.

Corticosteroids - see above.

Itraconazole - see above.

Thromboxane Synthetase Inhibitors

Two cats with abdominal effusions were treated with ozagrel hydrochloride with success (Watari et al, 1998).   However, follow up studies failed to confirm the usefulness of this compound.
Dose: 5-10mg/kg twice daily and prednisolone at 2mg/kg/day.

 

Further reading

""Feline Infectious Peritonitis and Coronavirus" - download an ebook written for cat guardians or purchase the physical version from Amazon.

This book is written for anybody unfortunate enough to have had FIP diagnosed in their cat. It will help you through the maze that is FIP diagnosis, to decide what your options are for treatment and to safeguard your other cats, or how and when to safely add a new cat to your household.

Please let us know if you encounter any problems downloading it (email e-books [at]catvirus.com). You can still use the regular Buy Now buttons below to purchase the e-book if you prefer.

To buy the book in USD, GB pounds or Euros, please use the Paypal links below and you should receive a link from which to download it. A physical version can be obtained from any of the Amazon websites:

English version (2nd edition):
UK: https://www.amazon.co.uk/dp/1070597422
USA: https://www.amazon.com/dp/1070597422
France: https://www.amazon.fr/dp/1070597422
Spanish version (1st edition):  www.amazon.com/peritonitis-infecciosa-felina-PIF-coronavirus-ebook/dp/B01MT1DTU2/

Note that everything in these books is available for free here on the website!

FIPbook

Download the photographs from the book in colour (this will open as a .pps in a new window).

To buy in UK pounds
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THANK YOU!

I'd like to thank all the donors to the Angelica FIP trust, to the catvirus subscribers whose generous donations made my research possible. Enormous thanks go to the human families of cats who have had FIP, who have generously given of their time, and samples and data from their cats, to enable research without deliberate infection of laboratory cats. A BIG THANK YOU also to all the veterinary surgeons who have contributed to my studies.

13. References and further reading

Addie D.D., 2004 Feline Infectious Peritonitis. Veterinary Interferon Handbook. Ed: Karine de Mari. Virbac. 108-117

Addie D.D 2008  Feline Infectious Peritonitis   Veterinary Interferon Handbook 2nd edition.  Ed. K. de Mari. Virbac SA, BP 27, O6510 CARROS, France. 132 - 146

Addie D.D.2008  Feline infectious peritonitis – therapy and prevention.  Kirk’s Current Veterinary Therapy XIV Edited by: John D. Bonagura, DVM, MS, DACVIM, David C. Twedt, DVM, DACVIM. Saunders, Elsevier.1295 – 1299

Addie, D.D.. Feline coronavirus. 2012  Infectious Diseases of the Dog and Cat.  4th edition.  Editor: Greene, Craig. Published by W.B. Saunders Elsevier Company, 11830 Westline Industrial Drive, St. Louis, Missouri 63146, USA. ISBN 978-1-4160-6130-4   92-108

Addie DD.  Curran S, Bellini F, Crowe B, Sheehan E,  Ukrainchuk L, Decaro N.  2020a. Oral Mutian® X stopped faecal feline coronavirus shedding by naturally infected cats.   Res. Vet. Sci. 130:222-229. doi: 10.1016/j.rvsc.2020.02.012.

Addie DD, Covell-Ritchie J, Jarrett O, Fosbery M. 2020b. Rapid Resolution of Non-Effusive Feline Infectious Peritonitis Uveitis with an Oral Adenosine Nucleoside Analogue and Feline Interferon Omega. Viruses 12, 1216; doi:10.3390/v12111216

Addie, D.D.; Silveira, C.; Aston, C.; Brauckmann, P.; Covell-Ritchie, J.; Felstead, C.; Fosbery, M.; Gibbins, C.; Macaulay, K.; McMurrough, J.; Pattison, E.; Robertson, E. Alpha-1 Acid Glycoprotein Reduction Differentiated Recovery from Remission in a Small Cohort of Cats Treated for Feline Infectious Peritonitis. Viruses 2022, 14, 744. https://doi.org/10.3390/v14040744

Dickinson PJ, Bannasch M, Thomasy SM, Murthy VD, Vernau KM, Liepnieks M, Montgomery E, Knickelbein KE, Murphy B, Pedersen NC. 2020. Antiviral treatment using the adenosine nucleoside analogue GS-441524 in cats with clinically diagnosed neurological feline infectious peritonitis. J Vet Intern Med. 34(4):1587-1593. doi: 10.1111/jvim.15780.

Gunn-Moore D, McCann T.  2004 Use of recombinant feline interferon to treat feline infectious peritonitis.  Veterinary Interferon Handbook. Ed. Karine de Mari. Virbac  118-124

Hartmann K, Ritz S.  2008 Treatment of cats with feline infectious peritonitis.  Vet Immunol Immunopathol.  123(1-2):172-5.

Hartmann K, Day MJ, Thiry E, Lloret A, Frymus T, Addie D, Boucraut-Baralon C, Egberink H, Gruffydd-Jones T, Horzinek MC, Hosie MJ, Lutz H, Marsilio F, Pennisi MG, Radford AD, Truyen U, Möstl K; European Advisory Board on Cat Diseases. Feline injection-site sarcoma: ABCD guidelines on prevention and management. J Feline Med Surg. 2015;17(7):606-13.

Hugo TB, Heading KL. Prolonged survival of a cat diagnosed with feline infectious peritonitis by immunohistochemistry. The Canadian Veterinary Journal. 2015;56(1):53-58.

Ibarrola PBlackwood LGraham PAEvans HGerman AJ.  2005 Hypocobalaminaemia is uncommon in cats in the United Kingdom. J Feline Med Surg. 7(6):341-8.

Ishida T, Shibanai A, Tanaka S, Uchida K, Mochizuki M. 2004 Use of recombinant feline interferon and glucocorticoid in the treatment of feline infectious peritonitis. JFMS 6 107-110

Krentz, D.; Zenger, K.; Alberer, M.; Felten, S.; Bergmann, M.; Dorsch, R.; Matiasek, K.; Kolberg, L.; Hofmann-Lehmann, R.; Meli, M.L.; Spiri, AM., Horak J.,Weber, S., Holicki, CM., Groschup, MH., Zablotski, Y., Lescrinier, E., Koletzko, B., von Both, U., Hartmann, K. 2021. Curing Cats with Feline Infectious Peritonitis with an Oral Multi-Component Drug Containing GS-441524. Viruses. 13, 2228.

Legendre AM, Bartges JW. 2009  Effect of Polyprenyl Immunostimulant on the survival times of three cats with the dry form of feline infectious peritonitis.  J Feline Med Surg. 11 624-626

Legendre AM. 2013 Polyprenyl Immunostimulant presentation to AAHA abstract

Legendre AM, Kuritz T, Galyon G, Baylor VM, Heidel RE. 2017 Polyprenyl Immunostimulant Treatment of Cats with Presumptive Non-Effusive Feline Infectious Peritonitis In a Field Study.  Front Vet Sci. 4:7.

Maunder CLDay MJHibbert ASteiner JMSuchodolski JSHall EJ.  2012
Serum cobalamin concentrations in cats with gastrointestinal signs: correlation with histopathological findings and duration of clinical signs. J Feline Med Surg. 14(10):686-93.

Morris JG, Rogers QR.  1978  Arginine: an essential amino acid for the cat.  J Nutr. 108(12):1944-53.

Murphy BG, Perron M, Murakami E, Bauer K, Park Y, Eckstrand C, Liepnieks M, Pedersen NC. The nucleoside analog GS-441524 strongly inhibits feline infectious peritonitis (FIP) virus in tissue culture and experimental cat infection studies.   Vet Microbiol. 2018 Jun;219:226-233.

O'Brien, DP & Packer, RA (2010) Metabolic encephalopathy: organic acidurias. In August, JR (Ed): Consultations in feline internal medicine. Vol 6. Elsevier Saunders, Philadelphia. pp:595

Pedersen NC, Kim Y, Liu H, Galasiti Kankanamalage AC, Eckstrand C, Groutas WC, Bannasch M, Meadows JM, Chang KO. Efficacy of a 3C-like protease inhibitor in treating various forms of acquired feline infectious peritonitis. J Feline Med Surg. 2017 Sep 1:1098612X17729626.

Pedersen NC, Perron M, Bannasch M, Montgomery E, Murakami E, Liepnieks M, Liu H. 2019. Efficacy and safety of the nucleoside analog GS-441524 for treatment of cats with naturally occurring feline infectious peritonitis. J Feline Med Surg. 21(4):271-281

Reed NGunn-Moore DSimpson K. 2007 Cobalamin, folate and inorganic phosphate abnormalities in ill cats. J Feline Med Surg.  9(4):278-88.

Ritz S, Egberink H, Hartmann K.  2007  Effect of feline interferon-omega on the survival time and quality of life of cats with feline infectious peritonitis.  J Vet Intern Med. 21(6):1193-7.

Simpson KW, John Fyfe, Angelyn Cornetta, Amy Sachs, Dalit Strauss-Ayali, Stephen V. Lamb, Thomas J. Reimers 2001 Subnormal Concentrations of Serum Cobalamin (Vitamin B12) in Cats with Gastrointestinal Disease  J Vet Intern Med  15:26–32

Swann  JW, Szladovits B, Glanemann B: Demographic Characteristics, Survival and Prognostic Factors for Mortality in Cats with Primary Immune-Mediated Hemolytic Anemia. Journal of Veterinary Internal Medicine 2016, 30:147-156.
Takano T, Hohdatsu T, Toda A, Tanabe M, Koyama H. 2007a  TNF-alpha, produced by feline infectious peritonitis virus (FIPV)-infected macrophages, upregulates expression of type II FIPV receptor feline aminopeptidase N in feline macrophages.  Virology. 364(1):64-72

Szemiel AM, Merits A, Orton RJ, MacLean OA, Pinto RM, Wickenhagen A, Lieber G, Turnbull ML, Wang S, Furnon W, Suarez NM, Mair D, da Silva Filipe A, Willett BJ, Wilson SJ, Patel AH, Thomson EC, Palmarini M, Kohl A, Stewart ME. In vitro selection of Remdesivir resistance suggests evolutionary predictability of SARS-CoV-2. PLoS Pathog. 2021;17(9):e1009929. doi: 10.1371/journal.ppat.1009929.

Takano T, Hohdatsu T, Hashida Y, Kaneko Y, Tanabe M, Koyama H. 2007b  A "possible" involvement of TNF-alpha in apoptosis induction in peripheral blood lymphocytes of cats with feline infectious peritonitis.  Vet Microbiol.  119(2-4):121-31

Takano T, Azuma N, Satoh M, Toda A, Hashida Y, Satoh R, Hohdatsu T.  2009 Neutrophil survival factors (TNF-alpha, GM-CSF, and G-CSF) produced by macrophages in cats infected with feline infectious peritonitis virus contribute to the pathogenesis of granulomatous lesions.  Arch Virol.  154(5):775-81.

Takano T, Akiyama M, Doki T, Hohdatsu T. Antiviral activity of itraconazole against type I feline coronavirus infection. Vet Res. 2019 Jan 18;50(1):5.

Tanaka Y, Sato Y, Osawa S, Inoue M, Tanaka S, Sasaki T. 2012. Suppression of feline coronavirus replication in vitro by cyclosporin A. Vet Res. 43(1):41.

Tanaka Y, Sato Y, Takahashi D, Matsumoto H, Sasaki T: Treatment of a case of feline infectious peritonitis with cyclosporin A. Veterinary Record Case Reports 2015, 3:e000134

Trepanier L. 2009. Idiopathic inflammatory bowel disease in cats. Rational treatment selection.  J Feline Med Surg.  11(1):32-8..

Tsai HY, Chueh LL, Lin CN, Su BL. 2011 Clinicopathological findings and disease staging of feline infectious peritonitis: 51 cases from 2003 to 2009 in Taiwan.  J Feline Med Surg.  13(2):74-80.

Watari T, Kaneshima T, Tsujimoto H, Ono K, Hasegawa A. 1998 Effect of thromboxane synthetase inhibitor on feline infectious peritonitis in cats. J Vet Med Sci. 60(5):657-9.

Weiss Richard C. 1994 Feline Infectious Peritonitis Virus: Advances in Therapy and Control in Consultations in Feline Internal Medicine 2. Edited by John R. August. Published by W.B. Saunders Company. Harcourt Brace Jovanovich, Inc., The Curtis Center, Independence Square West, Philadelphia, PA 19106. pages 3-12
ISBN 0-7216-4674-3

 

 

 

Dr Diane D. Addie 11 Aug 2022

 

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