If you search for “monoclonal antibodies”, most of the search results are about COVID-19 and its variants. But did you know that monoclonal antibodies form the basis of the newest treatment for arthritis in cats? This new treatment is called Solensia.  Solensia is a monthly injection for arthritic cats that won FDA approval this  month. It should be available through your veterinarian later this year.

arthritis in cats: a tale of biotech and a chinese hamster


what are monoclonal antibodies?


  • Monoclonal: refers to a cell or organism that comes from a single individual or cell.
  • Antibodies are proteins in the blood that our immune system produces to counteract a foreign substance such as a bacteria or virus (think COVID-19).

antibodies and the immune system


Immune cells in our bodies called B-lymphocytes mount a response to a foreign substance or antigen (e.g. a virus), binding to it and deactivating it. The presence of the antigen and immune cells called T cells activate the B-cells. The B cells then propagate and release antibodies that are able to bind to and deactivate the specific antigen that stimulated their formation!

Monoclonal antibodies are derived from clones or copies of activated B cells. They can be harvested and grown in the laboratory and used to fight infections caused by the antigen they were developed to target.

Where do monoclonal antibodies come from?


  • Blood cells from convalescing patients: Due to the large numbers of convalescing COVID patients, there was a ready source of blood cells containing B-cells with antibodies to COVD 19 that could be used to make monoclonal antibodies to treat newly infected patients.
  • Transgenic mice: Mice that have been genetically altered to carry human antibody genes instead of mouse antibody genes are the usual source for monoclonal antibodies. These mice can be injected with a specific antigen and produce fully human antibodies that can be used by human patients to combat that antigen.  Being human antibodies, they are less likely to be rejected by the human immune system.

Arthritis in cats: using monoclonal antibodies


Nerve growth factor (NGF) is a protein that is key to the development and survival of nerve cells or neurons, particularly sensory neurons that transmit pain, temperature, and touch sensations.

When NGF binds to pain receptors inside the sensory neuron, a series of events is triggered that ultimately sends a “pain” signal to the brain.

Instead of binding to a structure on a virus, monoclonal antibodies can be developed to recognize and attach to NGF, preventing NGF from binding to the pain receptors on the sensory neruron, blocking the pain signal.

Motion is Medicine

A reduction in pain means our arthritic cats will be more likely to move around more. Increased mobility will strengthen the cat’s muscles, so they can better support and assist the deteriorating joints.  Increased activity and reduced pain result in a better quality of life.

Biotech Magic

The active ingredient in Solensia is frunevetmab, a monoclonal antibody that targets NGF. The antibodies are sourced from Chinese hamster ovary cells. Like the mice that have human antibodies instead of mouse antibodies, the hamster cells are “felinised”using recombinant biotechnology. Sections of the hamster antibodies are replaced with their feline counterparts. “Felinization” ensures that the cat’s immune system will not reject the monoclonal antibodies but allow them to function as part of the cat’s immune system.

Of cats and hamsters: no hamsters harmed


Frunevetmab is sourced from the cells of Chinese hamster ovaries. In fact, cells from an individual Chinese hamster, harvested back in the 1950s, produced the cell line which dominates biotechnology today. These cells are easy to propagate and maintain in the lab, providing a ready source of monoclonal antibodies.

multimodal therapy for arthritis in cats


Solensia is a pain medication and does not directly aid in preserving the synovial tissues. Most likely, Solensia will be part of a multimodal treatment that will include drugs and supplements like Adequan or glucosamine that are thought to help maintain synovial tissues in addition to weight loss and exercise.

Unlike other arthritis pain treatments such as NSAID’s, monoclonal antibodies are eliminated in the same way other proteins are, with minimal effect on the kidneys and liver, a concern for our cats with Chronic Kidney Disease.

Treatment using Solensia will consist of monthly injections under the skin. Most cat owners can become proficient in giving subcutaneous injections and treatment can be done in the safety and comfort of the cat’s home.

Thanks to a Chinese hamster years ago and advances in biotechnology, our cats may be able to spend their “ golden years” without pain from osteoarthritis!

 

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Giving your cat a pill can be a challenge for many cat owners. Often, the pills are bitter or seem too big. The veterinary staff demonstrates the technique but when you get home, you end up with a cat under the bed and the pill on the floor!

I had medicated cats before I became a veterinary technician, using a plunger style pet piller. In tech school, I adopted a 3 yr old Birman cat, Marley, who needed a daily dose of medication for anxiety. It was a daily struggle giving that little blue pill, which could end up in his mouth, but I often found it under the bed or in the hallway on the floor.  Marley would see the pet piller in my hand and run.

Giving your cat a pill – daily medications


So, I cringed when my cat Athena was found to be hypothyroid after radioactive iodine treatment. She needed thyroid pills twice a day. She is a cat who could be difficult to handle alone. However Athena liked the soft treats the pill was hidden in, and life was good, for a time….

After a while she tired of the pill treats and we were back to the drawing board. I turned to some low stress techniques –  I first offer Athena a treat, then the treat-coated pill, and follow with a few more treats.  When I adopted Zelda and Gus, who will eat anything that is not locked up, I finally trained all the cats to sit in a circle and stay, while Athena takes her medication. Then all the cats get treats!

I still have to “pill” Athena occasionally – she does not like having something slid down her throat and quickly goes back to eating the pill by herself. 

cat whispering – pill training


Giving your cat a pill for a chronic condition can be different than medicating her when she does not feel well. Say she is diagnosed with pancreatitis or an upper respiratory infection. Either one of these can reduce appetite and then your cat is not interested in treats. This is when having done some “pill training” comes in handy.

If you are doing a treat time every day or a treat time a few times a week, mix it up a bit and give some treats using “pilling” techniques.

A Pet Piller to give medication
A pet piller with a hard treat.

Treats by Pet Piller

  • Start by offering your cat the pet piller with a lickable treat on it.
  • Then try offering hard treats using the piller
  • Get your cat accustomed to having you behind him while giving treats.
  • When your cat needs medication and he is not well enough to take it in treats, the pet piller will be familiar.

 

Giving your cat a pill – think outside the box


Sometimes, you need to think outside the box when giving your cat a pill. A few months ago, my youngest cat, Gus, got loose with his harness and leash on when we were hiking. After 2 hours, we found him – his harness and leash were gone, and he was painful when walking. An MRI of his spine showed lots of inflammation but fortunately, no nerve damage. He was so painful that he would growl when he changed positions. His appetite was down and taking a pain medication in a treat was not an option.

I considered using the pet piller since he is familiar with it but then decided to try a technique I had recently seen at a conference on senior cat care. This technique uses one of the popular “squeeze up” treats for cats that come in tubes (Delectables, Churu).

Cut the end of the tube so that you can squeeze the paste up for the cat to lick.

Put the tablet or capsule in the opening.

Squeeze the tube and the tablet goes up into the cat’s mouth with the paste.

 

 

 

 

 

 

 

giving your cat a pill – practice makes purrfect!


Why wait until your cat is sick to come up with a strategy for giving your cat a pill? Do some “pill training” – set aside some time to accustom your cat to different ways of taking “pills” (disguised treats).  When the time comes to give that pill, your cat will be familiar with the pet piller or squeeze-up treat and you will have had some practice with pilling.

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Cats are not only predators, they are also prey for larger carnivores like coyotes. A predator will target a weak or injured prey animal so it is important that prey animals hide their pain, so they don’t become some else’s snack. Cats are no exception and are masters at hiding pain. As a veterinary technician, I have found clients often do not give pain medication that we send home because “he didn’t seem painful”.

Painful cat?

how do I know if my cat is painful?


It is hard to assess pain in animals and young children.  They can’t tell you how it hurts. There has been interest in  developing methodology for computer assessment of pain in human children using facial expressions. Humans have expressive faces, with 42 facial muscles; there is a universal “pain face”, with lowered eyebrows, eyes squeezed together, nose wrinkled, raised upper lip and open mouth.

Like us, cats also have a “pain face” but it takes some practice to become attuned to it. The Feline Grimace Scale (FGS) was developed to give veterinary professionals an easy-to-use tool to assess whether a cat needs pain medication. With some practice and attention to your cat’s environment, you can tell if your cat is painful.

The FGS focuses on 5 facial features:

  1. position of the ears
  2. shape of the eyes
  3. shape of the muzzle
  4. attitude of the whiskers
  5. position of the head

Each feature is assigned a score of 0, 1 or 2.

“0” = no pain

“1” = moderate appearance of pain

“2” = obvious appearance of pain

The highest pain score with this system is 10; a score of 4/10 indicates the need for pain medication.

The Kitty Pain Face


scoring The Ears

  • Score = 0  Ears are up and facing forward
  • Score = 1   Ears are not facing forward and further apart; they are a little “flat” 
  • Score = 2   Ears are flattened and rotated out, like the wings of an airplane

scoring the eyes

  • Score =0     Eyes are open
  • Score = 1     Eyes partially closed
  • Score =2      Eyes are “squeezed shut”

scoring the muzzle

  • Score = 0    Muzzle is relaxed and round in shape
  • Score = 1     Muzzle is tense and starting to become flatter
  • Score = 2    Muzzle is tense and elliptical in shape

scoring the whiskers

  • score = 0   Whiskers are relaxed and curved downwards
  • Score = 1    Whiskers are beginning to straighten, as the muzzle becomes tense
  • Score = 3    Whiskers are straight or forward

scoring the head

  • Score = 0  The head is up and above the line of the shoulders
  • Score = 1  The head is in line with the shoulders
  • Score = 2   The is below the line of the shoulder

Using the FGS


The FGS was developed for veterinary staff to monitor hospitalized patients.  In the validation studies, cats were observed undisturbed for 30 seconds.  This could be a challenge in the home, where the cat is not in a kennel and can move around.

Pain causes anxiety and stress. The expressions making up the cat’s  “pain face” overlap with the body language of stress. How can you eliminate environmental stress when scoring your cat for pain?

getting a valid score for your cat


Don’t have 30 seconds?

If you’re having trouble watching your cat for 30 seconds, try scoring your cat, then score him again in 15-20 minutes and see if you get the same results as before.

Pain or environmental stress?

Reduce the effect of the environment on your cat. Don’t have someone hold him or rub his head. Try to observe him when there is not a lot of activity in the house – try guiding him to a quiet room and let him settle down before you try to score him.  Don’t interact with him – he may respond by hiding his pain.

If your cat is grooming, eating, or vocalizing, wait until she is finished before assessing her. If sleeping, wait until she is awake. 

practice telling if a cat is painful


Using the FGS can be challenging but it can help you decide sometimes if your cat needs veterinary treatment. Practice observing cats that are painful or not painful to give yourself a mental map of the cat’s face and demeanor.

  1. Go to  felinegrimacescale.com, and download the FGS manual.
  2. Using the FGS manual, practice your skills with the series of 11 cat photos on the website.
  3. Compare your results with those of the researchers.

 

Other indications that your cat is painful


  • she is hiding or you find her in a place she usually does not frequent
  • she is more subdued than usual
  • there is a decrease in appetite and activity

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We want to feel good; we want our cats to feel good. Supplements that can be bought over the counter are popular. The claims are appealing – there are dietary supplements to make you feel happy, calm, or pain-free; there are also essential oils that make  similar claims.

Supplements for Cats -Which Ones are Safe and Effective?


The Center for Veterinary Medicine (CVM) is a branch of the U.S. Food and Drug Administration (FDA). The CVM regulates food and drugs for animals. There is not a separate category for animal supplements – a supplement is either determined to be a food or a drug. If the product claims to treat or prevent disease, it is a drug.

There are many veterinary supplements available over the counter. Many of these supplements claim to treat medical conditions, for example, urinary tract infections, and are basically unapproved drugs.

An Unregulated Market


Unofficially, supplements for cats are treated like supplements for humans – they are not reviewed for safety, effectiveness or quality prior to being marketed. The active ingredient can vary among different supplement brands. If problems arise with one of these supplements while it is being sold, the FDA can take action against the manufacturer – this process would most likely take a long time.

The National Animal Supplement Counsel is a group of supplement manufacturers that is trying to regulate the safety of commercial supplements. They require their members to provide a certificate of analysis indicating potency, per-dosing unit, all ingredients and the presence of metals or pesticides.
Cat with catnipn plant
Marley nibbles (supervised!) on a catnip plant. A little catnip is OK; too much can cause GI distress.

Herbal Supplements for Cats


Herbs like chamomile and lavender are touted as calming for humans. These herbs can actually be toxic to cats. There are few clinical studies showing any benefit of herbal infusions for cats. Even catnip is not 100% safe – if a cat eats too much of the herb, he can have vomiting and diarrhea. Do your homework with herbs and check their safety.

Essential Oils and Cats


Just because something is natural does not mean it may not be harmful. Essential oils can be found in diffusers and can also be applied topically. Many of these oils are actually toxic to cats.

  • Diffusers release droplets of these essential oils into the air. If your cat breathes in these toxic droplets, her lungs can become inflamed. She may cough, vomit or drool; her eyes may water. In some instances, your kitty can develop pneumonia.
  • Topical administration of essential oils also present risks due to toxicity and possible ingestion. Kitty can ingest the oil while grooming.

Human Drugs/Supplements – NOT for Cats!


  • Cats’ DNA lacks certain genes that code for some of the enzymes that metabolize human drugs and supplements. Notable examples are aspirin, acetaminophen and ibuprofen.
  • The length of time a drug stays in your cat is different than how long it remains in your body – they are smaller and have a gastrointestinal tract that is different than ours.

     

Dietary Supplements for Cats


There are lots of supplements on the market meant for cats to take by mouth.

  • If you are feeding a high-quality cat food, supplementation with vitamins and minerals is most likely unnecessary.
  • Other popular supplements for cats include fatty acids for skin/haircoat and joint support, such as glucosamine.
  • While most of these supplements are safe, consult your veterinarian regarding which supplement to buy and how much to give.

 

Choosing a Supplement for Your Cat – An Example


What do you need the supplement to do?

Make an older cat with arthritis more comfortable.

Are there any environmental changes that can help?

Steps to high places, heated beds, low walled litter boxes, daily play time can help. Caring for Your Older Cat

Clinical studies for this supplement?

Few clinical studies for cats – some studies in dogs

What form is the supplement? Will you be able to give it easily?

Glucosamine  and Green Lipped Mussel come in capsules and chews; Adequan is an injection that is approved for dogs that can be used in cats

Side effects? Other concerns?

Arthritis supplements may effect how long it takes for your cat’s blood to clot – they must be dosed properly.

If your cat is overweight, losing weight can reduce the load on her joints.

Is your cat on any prescription drugs? Are there any interactions with these and the supplement?

Your veterinary team is your primary resource when navigating the stormy sea of supplements. Your veterinarian can recommend a supplement if your cat needs one, advise you of possible side effects and monitor your cat while taking the supplement.

If you are concerned about the feline expertise of a veterinary practice, consider choosing one of the American Association of Feline Practitioners’   Cat Friendly Practices.

 

Where the Pills goes

 

Giving your cat a pill is not difficult if she will readily eat the pill in a treat. However, she may refuse to eat her medication in a treat if the medication is bitter or she does not feel well. Regardless, she needs her medication.

Other Techniques for Giving Your Cat a Pill


What about giving the tablet or contents of a capsule in his favorite food?

Pros


  • Not very stressful for your cat
  • Some medications, for example, the antibiotic doxycycline, are associated with inflammation and narrowing of the esophagus when given directly
  • It is often recommended to open the doxycycline capsule and mix the powder in tuna fish (or other strongly flavored food)

Cons


  • Many pills are bitter and may result in your cat refusing to eat his food
  • If you mix the crushed pill in his food, he may not get the full dose if he does not eat the entire portion
  • If your cat is on a restricted diet for, say, food allergies, avoid putting crushed pills in his food – you don’t want him to develop an aversion to the one kind of food he can eat
  • If you need to give medication in food, choose a different food than the one your cat usually eats.
  • Limit the amount of this “doctored” food to about a teaspoon, so that you can be sure your cat gets his full dose of medication

  • Make sure your cat is hungry when he is offered the medication in food – you may need to pick food up several hours before giving medication.

Giving Your Cat a Pill “by Hand”


Often, you will get a demonstration of how to pill your cat at your vet. The accepted technique is to hold your cat’s head like a baseball with your non-dominant hand, tilt his head back, gently open the lower jaw with your third finger, then pop the pill in as far back in the throat as possible with your index finger. Often, the vet team will recommend “massaging” your cat’s throat to help him swallow the pill.  IT IS A GOOD IDEA TO FOLLOW THE PILL WITH SOME FOOD, WATER OR TUNA JUICE.

This technique takes practice to master and a wily cat can still manage to gag and spit the pill back up! At the veterinary hospital giving a pill may seem to go smoothly – Please remember, the veterinary team pills cats frequently AND your cat is not in the comfort of his home.

Using a towel wrap when pilling


Does your cat like to snuggle? She may appreciate a towel wrap or a ThunderShirt when being medicated to make her feel more secure.  A towel wrap is also helpful if your cat paws at your hands when you are giving the pill.

Test your cat’s acceptance to these when NOT giving a pill. Your cat may struggle initially with towels or pressure wraps but should calm and STOP struggling. Count slowly to 5 – if she is still struggling at that time, these are not for her.

Giving Your Cat a Pill using a “Pet Piller”


A Pet Piller to give medication

Another technique to aid in giving oral medication to your cat is using a pill gun. A pill gun is a plastic tube with a plunger. The tip should be soft so that it does not cause any trauma to the throat when pilling.

Introduce your cat to the pill gun by letting her examine it and lick some baby food or other treat off the end. If she likes hard treats, see if she will take a treat from the pill gun.

  1. Lubricate the tablet or capsule with petroleum jelly or butter.
  2. Load the lubricated tablet into the pill gun.
  3. Have some snacks ready for rewarding your cat after the pill is given.
  4. Kneel down on the floor and gently snug your cat between your legs – this will keep him from backing up, away from the pill gun
  5. Hold kitty’s head gently and
    gently guide the piller into the side of Kitty’s mouth.
  6. Depress the plunger to release the pill.
  7. REWARD!

Contercondition Pet Piller

Offer Treats with the Pet Piller


Guiding the Piller into Kittys mouthGuide the Piller into the side of Kitty’s mouth


 

Pilling a Cat with Pet Piller

Work the Piller toward the back of the mouth and depress the plunger


 

Giving My Cat a Pill is Impossible!


If you are running into difficulties…Take a break and come back to giving the pill in 15 minutes or so.
Are there other treats you have not tried – “lickable treats” in tubes? Chicken baby food? Catnip or playtime?
Talk to your veterinary team – are there other forms of the medication?  Some medications are effective as transdermal gels that can be applied to the inside of your cat’s ear; other medications can compounded into flavored tablets or liquids or given by subcutaneous injection.

Make giving the pill a positive experience – have something good happen!