Clinical and Histopathological Comparison of Prednisolone and Ursodeoxycholic Acid for the Treatment of Feline Lymphocytic Cholangitis

Developing effective treatments for feline lymphocytic cholangitis (LC) is a problem, since its aetiology remains enigmatic.

A retrospective study was used to evaluate the effect of prednisolone or ursodeoxycholic acid (UDCA) treatment on survival times and determine prognostic factors. Additionally, the effect of these therapeutics on liver tissue was determined.

Twenty-six patients diagnosed according to WSAVA standards, were identified at the Department of Clinical Sciences of Companion Animals of the University of Utrecht. Information obtained including breed, sex, age at time of diagnosis, clinical symptoms, results from blood analyses, cytological and histopathological results, ultrasound findings, therapy protocol, and date and cause of death.

Twenty-seven sequential archival biopsies from 11 patients were evaluated for regeneration and proliferation with immunohistochemical stainings for Cytokeratin19 and Ki67. HE was used to detemine the inflammatory component and the localization. In LC there is a consistent infiltrate of lymphocytes mainly restricted to the portal areas, often associated with fibrosis (reticulin stain) and biliary ductular proliferation (HE and Cytokeratin 19).

The majority of patients were males (76.9%, P=0.006) and a breed predisposition was demonstrated (P=0.021). Clinical signs included weight loss, icterus, anorexia, vomiting, and listlessness. Blood analyses revealed elevated activities of hepatic enzymes, increased levels of bile acids, and hypergammaglobulinemia. In general, cats treated with prednisolone (n=8; median survival 1.7 years, range 30 days to 3.4 years) had better survival times than cats treated with UDCA (n=8; median survival 1.0 years, range25daysto2.2years).

Proliferation of hepatocytes, lymphocytes and fibroblasts, and regeneration did not differ between the treatment groups. However, at follow-up, the prednisolone group demonstrated less progression of fibrosis and the percentage of inflammatory cell present in the biopsies decreased more in this group.

Based on these results, prednisolone is the preferred treatment for feline LC.