Two researchers believe the status quo will soon go out the window in veterinary medicine, and they are advising veterinarians to consider updating their education if they’ve been out of vet school very long. Individualized veterinary medicine, or IM, is a game changer, they say. IM is the use of a pet’s genetic information to optimize drug therapy or to institute preventive measures suited to that patient, according to researchers Katrina Mealey, DVM, and Michael Court, BVSc. Both are professors and endowed chairs in the Washington State University College of Veterinary Medicine. They are also key parts of the WSU Individualized Medicine Program, which is studying hundreds of animals with the goal of identifying predictors of drug effects. Why is this so important? They say such research will help veterinarians more safely and effectively treat patients with drugs. It’s common knowledge that there is high variability in drug efficacy and safety in many drugs used in veterinary patients. Some cancers, for example, can be fought with a drug to which 50 percent of patients will respond well, while other cancer drugs can positively affect 90 percent of the patients. For other drugs, most of the population can be treated safely, and yet in some cases 1 percent of animals treated can die from the drug. Being able to predict these reactions genetically, rather than by trial and error, is what the WSU IM program is about. Genome The researchers credit their work in part to progress made in the late 1990s in the Human Genome Project. Mapping the human genome sped up genetic discoveries, allowing veterinary researchers to identify genetic diseases in patients as well as genetic traits that help predict drug response. This field, known as pharmacogenomics, has introduced a new and improved approach to drug development, disease diagnosis and therapeutics, the researchers say. Mealey, Ph.D., Dipl. ACVIM and Dipl. ACVCP, was the first to discover the MDR1 gene mutation, which causes collies and other herding breeds to be extraordinarily sensitive to a number of drugs. Dr. Mealey heads the world’s only known individualized veterinary medicine program. Mealey and Court, Ph.D., Dipl. DACVA, are studying how people and animals metabolize a drug, and how their systems transport a drug, by looking at specific genes and what effects certain drugs have on animals with these genes. "Those are the typical genes that are likely to impact how toxic a drug is for a pet or how likely it is to be effective,” Mealey said. As an example, Dr. Court offered up clopidogrel bisulfate, known by the brand name Plavix for humans, which is being used to prevent adverse blood clotting in cats with heart disease. Court said research on the effects of certain drugs on people often parallels research in pets. In some people, this drug doesn’t work due to a gene called CYP2C19. An enzyme called CYP2C19 activates the drug. A defect in the gene coding for CYP2C19 prevents clopidogrel bisulfate from being activated in about 5 percent of people; even though these people are taking the "usual” dose, the drug is not protecting them from blood clots, Court noted. "In some cats, this drug also doesn’t work, and it may be the same gene defect in cats,” Court said. Thanks to such research, Mealey and Court expect more tests similar to the MDR1 gene test to be developed. "There will be genetic tests [that] predict whether different drugs should be used, and drugs to be avoided in particular patients,” Mealey said. They are working on a test they believe will have a great effect on veterinary medicine. But they were guarded, declining to talk about the nature of the test. The researchers credited veterinarians in the field with helping raise awareness for the need for better genetic testing and individualized medicine. "Veterinarians have driven this,” Mealey said. She pointed out that veterinarians were the first to notice that collies were sensitive to ivermectin, and her laboratory discovered around 2001 that a genetic mutation on the MDR1 gene drove this reaction. "We are making sense of observations that veterinarians make on a daily basis,” Mealey said. Not only do these drug reactions vary by breeds, but also within breeds, Court added. "Most of that is driven by genetic differences,” Court said. "What we are trying to do is bring some sense to it.” As more research comes to fruition, Court believes genetic testing, which is already being marketed heavily, will be increasingly offered to owners and to breeders. Mealey suggested that vets who have been out of school get up to speed on genetics. "Those who haven’t graduated within the past five or 10 years probably need to find some continuing education courses to brush up on genetics,” she said. "Pet owners are going to be coming to them with questions about this testing, asking questions like, ‘What does this mean?’” The Techology: Digital Imaging Duncan K. Hockley, DVM, director of the Veterinary Medical Centre at the Western College of Veterinary Medicine at the University of Saskatchewan, believes the most spoken-about technical advancements will be in digital imaging. "In 2014, veterinarians should expect to see continued advancements and improvements in the field of medical imaging equipment such as ultrasonography, digital radiology, CT, MRI, nuclear scintigraphy and others,” Dr. Hockley said. Hockley sees a new door opening in veterinary consultative medicine with the improving ability to send and share images with specialists anywhere in the world. And because medical imaging is such an important component in diagnostic workups, many technology developers are focusing on improving imaging products for veterinarians, he said. "Advancements in diagnostic equipment, imaging equipment and communication equipment will drive change in veterinary medicine in the future,” Hockley said. "While change may be challenging, veterinarians are very quick to adopt new technologies to provide the highest veterinary care possible or develop referral centers of excellence when necessary. After all, our clients will expect nothing else.” Rachel Pollard, DVM, Ph.D., Dipl. ACVR, an associate professor of diagnostic imaging at the University of California, Davis, School of Veterinary Medicine, said big advances are in the works for the imaging modalities most commonly used in veterinary practice, ultrasound and radiography. Ultrasound machines are becoming increasingly cost-effective and portable, and they may soon become even more portable. Dr. Pollard sees the next advancement as just a short step away, with hand-held units now available in human medicine soon being transitioned to the veterinary market. "These units could be easily moved to the exam room or cage-side to perform quick examinations focused on particular problems,” she said. "In general, image quality is not that of a larger, more expensive unit, but the portability is a huge advantage.” With digital X-ray technology, on the other hand, the problem has been that most high-end digital detectors are connected to a computer by a cord or require a large reader to translate the image. But Pollard expects breakthroughs to make those units more efficient. "On the horizon is the cordless digital detector that does not require a reader,” Pollard said. "The main advantage of this detector is in the equine veterinary world, where dragging a cord under a horse creates a hazardous situation. The cordless technology allows for rapid image acquisition without the dangers associated with the cord.” Another big breakthrough Pollard expects is in three-dimensional technology. Both CT and MRI now acquire 3-D data sets, and technology is available to recreate 3-D images. However, a recent advance in printer technology allows for translation of that 3-D data into an actual model. "3-D printers can be linked to CT data so that a 3-D model of the body part can be made,” Pollard said. "This is potentially invaluable for surgical planning. For example, if a skull fracture is identified on CT, a 3-D model of the skull can be printed so that the surgeon can plan the approach and mold the plate to the bone prior to placing the animal under anesthesia for the fracture repair.” Such changes will soon change life for general practitioners, not only by giving them more tools to better evaluate their patients’ needs. Because the technology is becoming more affordable, more practices will be able to get their own ultrasound and digital X-ray equipment, Pollard said. "Since the trend is toward minimally invasive diagnostic and therapeutic techniques, I see imaging playing an increasingly large role in patient evaluation,” Pollard said. "This will require more training for the general practitioner and more access to radiologists so that maximal information can be garnered from the images.” The Technology: Social Media Some observers believe social media in 2014 will grow beyond mere outreach and marketing to existing and potential clients. Diane McClure, DVM, Ph.D., Dipl. ACLAM, an associate professor in laboratory animal medicine for the college of veterinary medicine at Western University of Health Sciences in Pomona, Calif., attended a recent disaster training conference for Los Angeles County. Dr. McClure is also associated with the California Veterinary Medical Reserve Corps, and in her work with it McClure often uses social media to ask for help. "During fires we may use Facebook to say, ‘We need more large dog cages, not small ones,’ or ‘We need more food,’” she said. McClure sees other forms of social media being increasingly used for educational purposes—a trend she believes will continue. For example, she uses Pinterest to make a photo collection of what goes in a pet evacuation kit to help pet owners be better prepared for a disaster. "Our profession is beginning to engage social media as a marketing tool and an educational tool, so that is still emerging,” she said. Hockley, of the University of Saskatchewan, agrees. "The area that will change the most in the next few years will be how veterinarians engage with their clients and new communication technologies and applications—Facebook, Twitter, etc.,” Hockley said. "The clients’ expectations of service will drive these changes.” In fact, McClure believes Twitter will be an even larger presence in all spaces, including the veterinary space, in the coming year. Why? "Twitter gets information out fast,” she said. McClure believes social media will help improve veterinarians’ role as a second responder during disasters. "As we build identities and build followings, we will be able to leverage that,” she said. The professor communicates with colleagues and students regularly via Facebook, texting, email and increasingly through video conferencing. She said she was most impressed with the potential posed by the video conferencing capabilities of Google+ hangout. McClure recently had a conference with other professors around the world. The eight participants represented locales including Australia, Africa, the Philippines, China, Ohio and McClure in California."It was phenomenal,” said McClure, who sees video chats beginning to occur between veterinarians and their clients. <HOME>
