About Protein-Losing Enteropathy  in Manchester Terriers

Protein-Losing Enteropathy (PLE) is an umbrella term referring to any condition of the gastrointestinal tract (i.e., damage to the gut wall) that affects the ability of the intestines to absorb protein from the diet. Dogs with Protein-Losing Enteropathy lose more protein than they are able to take in from their food. This can affect the dog’s health quite severely, as proteins play an important role in the body. 
Protein-Losing Enteropathy includes:
  • Intestinal Lymphangiectasia (primary or secondary);
  • Inflammatory Bowel Disease; and,
  • May be suspected in any condition characterized by persistent diarrhea where low blood albumin levels are found
​The damage to a dog's intestinal wall that results in Protein-Losing Enteropathy can be related to a number of conditions.  The two most common are Inflammatory Bowel Disease and Intestinal Lymphangiectasia (a condition where lymph vessels in the intestine become dilated).  Other related conditions include Amyloidosis, Systemic Lupus Erythematosus (SLE), and food allergies.  To-date, biopsies have revealed Intestinal Lymphangiectasia as the most common cause of Protein-Losing Enteropathy in Toy Manchester Terriers, although results of testing on more dogs are needed.

Other breeds pre-disposed to Protein-Losing Enteropathy include Soft-Coated Wheaten Terriers, Basenjis, Yorkshire Terriers, Poodles, Maltese and Norwegian Lundehunds.

Symptoms

Often, the first symptom indicating Protein-Losing Enteropathy is weight loss, which can occur very rapidly.

Additional symptoms may include:
  • chronic and persistent diarrhea
  • vomiting
  • lethargy
  • swollen, fluid-filled abdomen or extremeties
  • muscle wasting
Unfortunately, Protein-Losing Enteropathy often appears suddenly and progression to acute illness can be very fast.
Albumin

​One of the main proteins that is lost in Protein-Losing Enteropathy is albumin. Albumin is the most abundant blood plasma protein and is responsible for transporting important biological and chemical compounds. Because vital biological systems depend on it, loss of albumin is bad news for the body as a decrease in albumin (called hypoalbuminemia) will cause the breakdown of other proteins such as muscle. This muscle wasting, coupled with diarrhea and vomiting will result in noticeable weight loss.

Diagnosis

The symptoms of Protein-Losing Enteropathies can look like many other conditions, so in order to help your veterinarian it is important to let him/her know early that this condition is found in Manchester Terriers and that it is currently being studied. 

To rule out or confirm Protein-Losing Enteropathy, your veterinarian may do some or all of the following tests:

  • Complete blood count (CBC) to look at the white and red blood cells and platelets
  • Chemistry panel to look at kidney and liver functions and also to measure the amount of proteins like albumin in the blood* (it is extremely important that albumin levels be checked early in investigations of symptomatic dogs!!) 
  • Electrolytes to look at the calcium, phosphorous and salt balance (e.g., sodium and potassium)
  • Urinalysis to look for loss of protein from the kidneys (called Protein-Losing Nephropathy)
  • Fecal exam (to rule out intestinal parasites)
  • X-rays of the chest and abdomen to rule out evidence of heart disease, fungal infections, cancer or abnormal fluid accumulation
  • Abdominal ultrasound to measure the size of the intestines and look for evidence of increased lymph nodes, foreign bodies, cancer, etc.
  • Endoscopy to biopsy the stomach, intestines and rectum and/or surgical exploration to evaluate all of the organs and perform multiple, full-thickness biopsies necessary to rule out certain types of disease like intestinal lymphangiectasia

Note: For definitive diagnosis, a GI specific blood panel (such as the one offered through Texas A & M University) and endoscopy/biopsies are recommended.

Concurrent Conditions

While Protein-Losing Enteropathy has been observed alone in some Manchester Terriers, in others it has been seen alongside or in addition to liver issues, pancreatitis, itchy skin and/or kidney issues (read more about Protein-Losing Nephropathy in Manchesters).  We are interested in learning more about how often these  conditions occur together and urge owners with dogs diagnosed with a protein-losing disease to contact the study team.

Treatment

Because the underlying issues causing Protein-losing Enteropathy can vary, appropriate treatment needs to be determined by your veterinarian.  Your veterinarian knows your pet's test results and is best positioned to make decisions about his/her care.

As you consider treatment of Protein-Losing Enteropathy, you and your veterinarian may find the experiences of other Manchester Terrier owners dealing with dogs affected by the disease helpful. With this in mind, several owners of Toy Manchesters diagnosed with Intestinal Lymphangiectasia (a form of Protein-Losing Enteropathy) have reported success with the following course of treatments (note: these recommendations have been reviewed by several practicing veterinarians, however every dog is different and your veterinarian is best placed to determine treatment for your individual dog):
  • Immediate transition to an ultra-low fat diet (i.e., Royal Canin Digestive Low-Fat, Hill I/D Low-Fat, etc.).  Some dogs in early stages of the disease may do well with just this one change on its own, in which case the dog should remain on this diet for life. (Note: A diet of boiled, fat-free turkey and rice may be helpful in the short term, but would require supplementation if used longer than 2-3 weeks)
  • Administration of anti-inflammatories (i.e., prednisone, azathioprine, cyclosporine, etc.) to reduce inflammation.  While initial high doses are often warranted, many Manchesters can be successfully weened to low doses when not symptomatic.  (Note: Use of an antacid/acid reducer like Pepcid while the dog is taking anti-inflammatories is highly recommended to reduce stomach irritation, which may cause vomiting.)
  • Injections of cyanocobalamin or oral B12 supplementation to boost serum vitamin B12.  
  • If the dog is not eating well, appetite stimulants like Entyce should be considered.
  • Once the dog is stabilized, some owners have found success in using medium chain triglycerides, such a coconut oil, to boost digestible fats and help dogs gain weight.  These fats don't work well in all dogs though so it is extremely important to discuss this addition with your veterinarian in advance and to introduce the new fat source very slowly. 

Early Intervention is Key!

In Manchester Terriers, early intervention is extremely important. Because the breed is small and relatively slight of build, they do not have large reserves of body fat to rely on.  As a result, the effects of persistent nausea and diarrhea can be acute with rapid weight loss quickly leading to life-threatening anorexia and illness.  Early and aggressive treatment is recommended.

Prognosis

We are in the early stages of monitoring these diseases in Manchester Terriers so it is difficult to provide an estimate of how often treatment is or isn't successful in our breed. We do know that, unfortunately, PLE's are sometimes fatal. We also know that early diagnosis and treatment can make an incredible difference in long term survival, which is why it is important for owners to ensure their veterinarians are aware that PLE and PLN can be an issue in the breed as this will help them make important decisions about early testing and treatment.

If your dog does have a PLE, it is important to ensure that you share information with our team.  Details you share on your dog's journey, including treatment and test results, will add to our knowledge of these diseases in our breed and may help other owners. Participation in DNA sample collection may also eventually help us find a test for the disease.

Learn more about what you can do to help!