Human anemia drugs took the life of our cat. Now we are making a safe anemia drug for all cats and dogs. We are veterinarian Dr. Nicole Paccione-Gerbe, Dr. Pete Schatz, and Tom Gerbe - AUA!

When hiding pills in their food doesn't work, do you have any tips on how to get a cat to take their medicine without hurting them?

Our cat loves pill pockets, by Greenies. Also, many medications can be compounded into a liquid form that might be easier to dose. There are online compounding pharmacies that will also make them into treats.

My dog won't take his pills unless they're in those pill pockets. Then he inhales them...

Our cat loves the pill pockets. Fortunately he is only two, and does not require any medication. When he does, we know he will chow down on his meds.

I've heard that some cat foods can cause kidney disease in cats, is there a particular brand / type of cat food that you recommend?

Unless it was recalled for a toxin that may cause damage to the kidneys, food should not cause kidney disease. However, as pets age, their diet may need to change. Usually this change will be based on blood work the vet does as your pet gets older. If your cat is prone to stone formation, the diet may also need to change.

Edit: As far as brands, we like Hills.

Wet vs dry food regarding kidney disease?

Many kidney diets are made in both wet and dry forms. Although you want as much fluid in a CKD pet as reasonable, dry food is OK. Kidney diets primarily limit phosphorus, which is particularly hard on the kidneys.

Have you ever heard of the "Evolve" brand cat food? It's first ingredient is chicken, and seems to be very healthy but I was surprised of how cheap it was

I know of it, and hear that it is good. However, I have no personal experience with the brand.

What are your opinions about fish in canned cat food? I volunteer at a shelter, and their official policy is no fish, claiming that "cats don't eat fish in the wild" (I don't even know where to start with that one. Of course they eat fish if they're near fish!). What do you think?

I think they're making a blanket policy to avoid any problems. Fish based diets have been associated with higher rates of urinary stone formation in cats. Eating fish as part of their diet won't generally hurt, but having it be the only protein in their diet could cause a problem. Don't tell the cats on the docks in Key West though, they seem to really enjoy it when the fishing boats come in!

Hey, is the anemia drug the only problem like this? That seems like a really common illness to not have a working drug for an entire incredibly common species, do we have any others like that?

We were shocked as well, that modern science has not provided a solution for such a common disease. Anemia affects approximately 1.2 Million cats and dogs each year. There are many human drugs that vets use off-label because there isn't a vet-specific drug for animals. Epilepsy would be one example of a common problem in animals for which we don't have a vet-specific drug. Fortunately, the available human drugs for that condition work well and have relatively few side effects. Epogen, the human drug used for anemia, can also be effective in cats and dogs, but the side effects can be very severe.

what causes kidney disease?

Various things can cause renal disease in cats and dogs. Many develop it as they age, but previous infections, toxins, and congenital disease can also be causes.

In all seriousness, when I am gone from home longer than I would like, my doggy is just The Best and has never relieved herself inside my home (of which I am aware) and the thought that makes me wince each time is kidney disease. Maybe bc the dog from my youth passed from this, or maybe bc I previously lived with someone battling renal failure. Are you saying that, other than making sure I do my best to get her outside as soon as I can each day, this is one less worry that I may allow to linger? Kudos to, and thank for, your researching and caring.

Edit: a. Hit enter too soon; b. UserName is a goal, not a given. :)

Other than the possibility of stone formation or infection, from not voiding enough, simply having her hold it a few hours shouldn't be enough alone to cause renal disease. Sounds like you are doing just fine.

"Many develop it as they age, but previous infections, toxins, and congenital disease can also be causes."

"Other than the possibility of stone formation or infection"

If infection can contribute to kidney disease is it not the case that chronic infections caused by infrequent opportunities to eliminate could contribute to CKD?

I was referring to renal infection in the first case, perhaps due to an infection like leptospirosis, and a bladder infection in the second case. Sorry for the confusion. Although you could get a renal infection that ascends from a bladder infection, it would have to be quite a severe, recurring, chronic problem to lead to significant renal changes.

firstly, I'd just like to say thank you for what you're doing.

pet owners, please run a blood test for your lil babies if they're showing signs of anemia, no matter how mild. my cat hid his kidney problems extremely well. It got him fast, within 3 days. give them the opportunity to get treatment.

are there any minor warning signs that people should be looking out for besides the three listed? we picked up on my cat having anemia because he started to chew his cat litter. are there any other not-so-obvious signs like that for either cats or dogs?

Most often, the first signs of renal (kidney) disease that become noticeable are increased thirst and/or urination. It is not specific to renal disease, though, there are other conditions that share these early signs. It can be very difficult to spot diseases early in cats, as they are very good at hiding illness, as you experienced. Especially if there is more than one cat in the household - it is sometimes easier to assess that there are more or less urine clumps in the litter if you only have one cat, and if they eat from the same dish, it can be difficult to tell if one cat is eating more or less than usual. For these reasons, we encourage all cat owners to bring their cats in for regular (usually annually) veterinary visits. With the new vaccine protocols, they may not need a vaccine every year, but they should still have a check up. Weight loss is another early sign of many diseases, and we keep a record of your pet's weight at each visit. It can be difficult to notice if your pet loses a pound in a year by picking him up, but by keeping track of his/her weight each visit, we can see if the weight loss is becoming a dangerous trend. Also, as cats get to be 9-10 years old, I recommend doing yearly blood tests to look for early changes that may indicate that they are developing disease. If caught early enough, simple diet changes can help prolong your pet's life if they do have renal changes.

What are your thoughts on raw diets vs kibble?

The AVMA recommends against raw diets because of the risk to both human and animal health. Pets are susceptible to salmonella and other bacteria present in raw meats, and humans feeding the raw diets are also susceptible, through touching the food and contact with the pet's feces. I often work with clients who want to make food for their pets, but I always recommend cooking the food to reduce the risk of pathogen transmission.

Are there other causes of anemia in pets, besides kidney disease? Are there any symptoms to look out for that your pet may have it?

Anemia may also be caused by cancer, infectious disease, and some toxins (like onions). Also blood loss causes anemia - blood loss you can see, like a cut, and blood loss that is harder to see, like gastrointestinal ulceration. Pets that seem weak or lethargic or have a decreased appetite may have anemia, and keeping an eye on your pet's stool for color changes, particularly if it looks black or tarry is also a good idea.

I have seen a pet with such a flea infestation that it had severe anemia. (PCV of 6%). My kitty gave him a transfusion and the poor fleabait cat did well!

Wow. A pcv of 6℅ is extremely low. Cassie at her worst was at 8℅. Fortunately, as long as the kitty is regenerative, eliminating the cause (fleas) can resolve the anemia. Glad everything worked out, and that your other cat was a match for transfusion.

It seems like there's more cats getting CKD then there used to be. I know so may people who are giving fluids to their cats. Am I correct, or is it just being caught earlier?

I think the fact is that we're seeing more of it because many pets are living much longer now than they were previously, and we are able to detect it earlier. Also, more people are bringing their pets to the vet on a regular basis, which allows us to find these problems earlier.

I'm currently a pharmacy student. I am very much interested in veterinary compounding. Do you see veterinary compounding as a possible role in treating animals/ pets or even a field that is worth going into?

Veterinary compounding has been getting a lot of attention lately, for both good and bad reasons. On the good side: veterinarians use compounding pharmacies to obtain drugs that are easier to administer (like liquid, treat and topical forms), drugs that are very specialized (it's easier to treat ear infections when you can get a topical medication specifically formulated with the antibiotics needed based on culture results), and drugs that may be currently unavailable from the manufacturers. On the bad side, there have been problems with compounded medications that have led to the deaths of some animals - the one I can remember specifically had to do with racehorses in Florida, but I think there was another more recent incident. Based on the frequency with which the practice I work for uses compounded medications, I think there is a definite need.

Nicole, what's your favorite memory of Cornell?

Certainly not Freshman writing seminar. There are so many good memories, not sure I could pick just one. Most of them involve wonderful friends, many of them involve the Chapter House, none of them involve slogging through snow in the winter. Wednesdays were always special though, hanging out with great friends in the Statler lounge after wines class :)

So... why was an immune reaction to human protein injected into a cat's bloodstream not expected?

Also how you extract huge-ass proteins (cat erythropoetin) at commercial levels and quality? If it is not purified enough, it will also cause an immune reaction.

The drug we're developing is not a human protein, it is a synthetic peptide that is not likely to cause an immune response.

I have an idea for a new medical procedure for cats, dogs, and humans with non cancerous fatty tumors. It would be noninvasive - no breaking the skin and no anesthesia of any kind.

I'm not a vet. How on earth do I get started doing something like this? I think it would help out a lot of pets and people.

The hard part is that everything takes money, and few investors want to get in early. We regularly hear people tell us that they would invest after we prove that it works in animals. By that point, we wouldn't need investors. It can be very frustrating.

One possibility would be to approach a university to help develop your idea. They work cheap, and the government likes to give grants to researchers that collaborate with universities. Also, there are a number of foundations who provide grants for companion animal studies.

I'm looking at your gofundme page now... $5million to bring it to market? Man - that is outrageous!

Have you ever thought about approaching any of the various pet magazines like Bark or Cat Fancy to do a story about you? I think if you got in front of dog/cat owners and explained that if they donated a few dollars today to help develop the drug now that it might save their pet's life in the future.

We are approaching several publications next week to get the word out. Anemia affects so many dogs and cats that our hope is if we can get in front of enough people, we can raise enough capital to get to the next milestone. Every little bit helps.

Five million sounds crazy, but an equivalent human drug would cost close to 1 Billion. Comparatively, animal drugs are inexpensive to develop.

Regarding a starting point for your idea, the FDA center for veterinary medicine has a primer on how to get started. This is where I began then journey. At least you can understand the regulatory process, which guides your development project.

A few of us read your initial post and like your idea. There is definitely an market for it. We wish you luck. If we can help guide you we are happy to do so.

Thank you both so much for your help!

I'm going to spread the word about what you're doing.

Honestly, with social media, the internet etc. - I believe that there must be a simple and better way for people like you to get the support you need - and fast.

All I can think of is as a pet owner - I would donate $1... $5... now - to make sure that if my pets need your medicine in the future they will have the opportunity. $1 from 1 million people - now you're in business!

Have you ever thought about approaching youtubers? Like Grav3yardGirl (she has a cat!) or Bethany Mota (she has a dog!) or the Fowler Sisters (they basically have a zoo!)? They have tons of followers (millions) and a great platform for getting the word out. You could ask them to volunteer some air time in a video to explain your project and ask for a small donation.

And yes - when I interned at my University my boss would run full speed to any meeting that had free food! : )

Wishing you the best.

Thank you so much for your kind words and encouragement. There needs to be a better solution for anemic cats and dogs. We hope that if we can reach enough people, we can achieve a critical mass that allows us to complete development of this medication.

Where do you get grants for your research? Is it difficult to gather money for developing veterinarian drugs?

We have applied for several grants from animal foundations. Some universities also have grants, but often the research has to be done on campus. NIH has a competitive SBIR grant, of which the center for veterinary medicine is a participant.

Hello there! Great AMA. I fully support your work and research. I have been a veterinary assistant at a small animal emergency/specialty hospital for about a year and a half and am nearly done with my pre requisites for veterinary school. I spend a lot of time shadowing our internal medicine team as that is my primary interest. My question for you since I have so little experience with the current drugs out there is what is the known incidence of side effects using the human drugs? I know of at least three IM patients in our practice who have done well on darbopoetin, but as I am not always able to be present for their visits I have no idea about their progress at home, etc, over the long term.

More of a "just wondering" sort of Q! Thanks!!

No one can predict which animals will have this reaction to human anemia drugs. However, it appears that the frequency and amount of dose have an impact. Because Darbepoetin is given less frequently, and in smaller doses, the immune response occurs less often than with Epogen. Darbepoetin is newer, and there is less research available, so it is tough to know for sure what percentage have a reaction to it. The handful of studies available show that animals could react to Darbepoetin 10 - 15% of the time, as opposed to Epogen, where the immune response rate is up to 50% after 6 months of dosing.

Do you test on animals?

At this point, we are manipulating cells only. In order to receive FDA approval, we will have to test on a small number of animals. We will need to prove that what we are making is safe and effective before making it available to pet owners. I must admit, the animal testing part of this project makes me uncomfortable, although it is not as bad as it sounds. Years ago, when testing for toxicity, a very high dose was administered, followed by necropsy if the animal did not survive. Newer FDA regulations only require a multitude of the recommended dose to prove that the drug is safe, and necropsy is no longer required. Also, there are strict rules that must be followed regarding animal welfare during the course of the study, and often, animals are adopted out after a single trial.

Dr. Pete could speak to this, but it is my understanding that with this type of drug, we will either see an increased red blood cell count or it will be ineffective. In either case, it is unlikely to harm the animals. From speaking with other scientists, who had conducted feline EPO trials, they spoke of super charged cats running around the lab. EPO is what Lance Armstrong admitted to using in order to boost his performance in cycling. After some time, the animal's red blood cell count will revert back to normal on it's own.

Years ago, when testing for toxicity, a very high dose was administered, followed by necropsy if the animal did not survive.

Yeeks, That is terrifying. How would you even select which animal would be subjected to this?

We have no idea. We are very grateful that we will not have to find out.

This is more of a curiosity question than anything. I have a 9 year old cat. He was diagnosed at age 3 (I believe) with renal failure that they believer might have actually been caused by either a deformity in his kidneys or (my belief) a reaction to a medication. He was given a 2-3 year life span estimate, which he's obviously outlived. I've been keeping him going on eod sq lrs and Purina's NF (and I think he keeps going just out of spite). I know that this is the norm for renal kitties, but I wanted to know if there is any research being done to alternative treatment to renal failure that you know of?

Homeopathy and complimentary medicine are always evolving, but I have not seen anything recently involving renal disease. We know that diet plays a big role (you can certainly attest to the efficacy of the NF!) by controlling phosphorus levels, which can exacerbate the kidney damage. There are two supplements available, azodyl and epakitin, which are manufactured by Vetoquinol that can be used in some pets with renal disease. Epakitin works as a phosphate binder - this is very important when the diet alone does not lower the phosphorus level in the blood to an acceptable level. There are other phosphate binders available as well. Azodyl is a beneficial bacteria that helps to reduce BUN and creatinine (products of protein metabolism usually filtered out of the blood by the kidneys) through a process described as enteric dialysis. Both of these supplements have been available for some time. Acupuncture may also be used in pets with renal disease.

Humans can develop PRCA in response to ESAs (esp. Epo) as well, but I assume the risk of PRCA is much higher in nonhuman species since Epogen is simply recombinant human erythropoietin.

Theoretically, using a dog or cat sequence to express the respective cat/dog epo should be easy, but are there any particular scientific hurdles you anticipate encountering in your effort? The fact that humans can also develop PRCA in response to Epo therapy suggests that there are additional factors independent of the peptide sequence that influence its immunogenicity.

We are not making recombinant cat or dog EPO. About 10 years ago, a group at Cornell published a study where they tried to make useful quantities of cat EPO and use it to treat anemic animals (Randolph et al. Am J Vet Res. 2004 Oct;65(10):1355-66.). They made it in cultured mammalian cells similarly to the way the human drugs are still made, using recombinant DNA constructs. Unfortunately, they found that it caused the same problems as the human drugs - a cross reactive antibody response. Since then, no one has produced an FDA approved drug based on cat EPO. By contrast, we are making a drug that has the same activity as EPO, but has a completely different structure. Therefore it should not cause the formation of antibodies that will wipe out the cat or dog's own EPO.

Very cool. Thank you for your response Dr. Schatz. I apologize for not reading the description at the top of the page more carefully and simply assuming that you were trying to produce recombinant cat EPO. Do you anticipate that your compound(s) will also show EPO-R agonism in humans? For example, for use in patients who are at high risk of developing an autoimmune response to Epogen.

Lately I've been interested in the relationship between human and animal medicine, and how one side can help to inform the other. This interest was initially stimulated by this TED talk I saw last year: (http://www.ted.com/talks/barbara_natterson_horowitz_what_veterinarians_know_that_doctors_don_t). I feel that the world would have a lot less problems if we would start to see humans as animals, or animals as nonhuman persons (but thats outside the scope of this conversation).

The one health initiative is finding that there is a strong relationship between human and animal health: http://www.onehealthinitiative.com/

How do you feel about purebred dogs?

Purebred dogs have their place. Responsible breeders serve a purpose by preserving traits in breeds that many people find desirable. Those who breed responsibly try to recognize and avoid undesirable results, like hip dysplasia, through testing and careful selection of breeding pairs. Of course adoption of pets is a wonderful option too! I had a great mixed breed dog when I was younger....wouldn't have traded her for a Westminster winner!