Serum Canine Pancreatic Lipase Immunoreactivity Assay (cPLI) in Diagnosing Canine Pancreatitis

Maigan Espinili Maruquin

The lipases are present from a variety of cells, including pancreatic, hepatic, and gastric cells, with similar function, ie , hydrolysis of triglycerides (Xenoulis and Steiner 2012)( Steiner JM, 2000)(Dröes and Tappin 2017). From the pancreatic origin, the canine pancreatic lipase increases in the event of pancreatic inflammation (Steiner and Williams 2003, Haworth, Hosgood et al. 2014).

The canine pancreatic lipase immunoreactivity (cPLI) assay was first a radioimmunoassay, and subsequently an enzyme immunoassay, eventually developed into a commercially available specific canine pancreatic lipase assay (Steiner, Teague et al. 2003, Steiner and Williams 2003, Haworth, Hosgood et al . 2014). The serum cPLI is now used as an important specific, and sensitive marker for the exocrine pancreas (Steiner, Newman et al. 2008, Neilson-Carley, Robertson et al. 2011, Trivedi, Marks et al. 2011, Xenoulis and Steiner 2012, Mawby, Whittemore et al. 2014, Dröes and Tappin 2017).

Canine Pancreatitis

Disorders originating from the liver and pancreas are considered important causes of morbidity and mortality in both dogs and cats, which presents different sets of challenges in diagnosis (Lidbury and Suchodolski 2016). Dogs have several exocrine pancreas diseases including exocrine pancreatic insufficiency (EPI), pancreatic carcinoma, and pancreatitis (Lidbury and Suchodolski 2016). Among them, pancreatitis is the most common disorder and are mostly considered idiopathic (Xenoulis and Steiner 2012).

Pancreatitis is the inflammation of the exocrine pancreas, wherein there is an infiltration with inflammatory cells. The term is usually expanded to include other diseases of the exocrine pancreas by necrosis or necrotising pancreatitis, or irreversible structural changes such as fibrosis (chronic pancreatitis) (Xenoulis and Steiner 2012). The pancreatitis is in acute stage when there is neutrophilic inflammation while chronic is characterized by the acinar atrophy and fibrosis (Newman, Steiner et al. 2006, Watson, Roulois et al. 2007, Mansfield, Anderson et al. 2012 , Watson 2015, Dröes and Tappin 2017).

Fig. 01. An illustration of the difference of healthy pancreas vs. inflamed pancreas in dogs


Despite being a common disorder in canines, the antemortem diagnosis of pancreatitis is clinically challenging (Trivedi, Marks et al. 2011). Clinical signs are non-specific and varies greatly. Subclinical diseases are evident in most cases while others may display mild and non -specific clinical signs (Xenoulis 2015) which may include anorexia, vomiting, lethargy, diarrhea, melena, weight loss, hematemesis, and hematochezia (Hess, Saunders et al. 1998, Trivedi, Marks et al. 2011). Dogs with acute pancreatitis are at risk of developing obesity, diabetes mellitus, hyperadrenocortcisim, hypothyroidism, prior gastrointestinal disease, and epilepsy (Cook, Breitschwerdt et al. 1993, Trivedi, Marks et al. 2011). On the other hand, cardiovascular shock,disseminated intravascular coagulation (DIC) or multi-organ failure and death within hours of the development of clinical signs are presented in severe cases (Xenoulis 2015, Dröes and Tappin 2017).

As diagnosis of pancreatitis remains a challenge, histopathology is considered the gold standard for diagnosis of pancreatitis. However, with procedural risks and difficulty to determine the right area for biopsy, obtaining the samples is hard (Newman, Steiner et al. 2004, Dröes and Tappin 2017). Therefore, considering the improving sensitivity and specificity of laboratory tests, using a combination of different methods can be best used (Dröes and Tappin 2017).

On the other hand, there are treatments for acute pancreatitis infected dogs. Treatments consider Intravenous Fluid Therapy, knowing that pancreatitis disturbs pancreatic microcirculation (Bassi, Kollias et al. 1994, Mansfield 2012). The administration of plasma is claimed to correct hypoalbuminemia, replacement of circulating α-macroglobulins, replacement of coagulation factors, and amelioration of systemic inflammation, however, no controlled studies on plasma transfusion in dogs with naturally occurring acute pancreatitis has proven its benefit (Mansfield 2012).

Due to vomiting of infected dogs, anti-emetics are used to manage acute pancreatitis (Mansfield 2012). On the other hand, corticosteroids enhance apoptosis, and increase the production of pancreatitis-associated protein, giving protective effect against pancreatic inflammation (Zhang, Kandil et al. 2004, Mansfield 2012). Moreover, diet should also be managed including the treatment of the complications of the disease (Mansfield 2012)

Canine Pancreatic Lipase Immunoreactivity Assay

Due to the limitations of the traditional golden standard, histopathology, diagnosis has relied on clinical criteria as an alternative gold standard (Graca, Messick et al. 2005, McCord, Morley et al. 2012, Cridge, MacLeod et al. 2018, Gori, Lippi et al. 2019, Nielsen, Holm et al. 2019, Okanishi, Nagata et al. 2019, Cridge, Mackin et al. 2020) and this includes measurement of cPLI (Cridge, Mackin et al. 2020). It has been proven over the decade that the PLI assay development, analytical validation, and evaluation is very useful for the diagnosis of pancreatitis in both dogs and cats (Xenoulis and Steiner 2012)( Xenoulis PG, Steiner JM, 2013).

Pancreatic lipase is expressed exclusively by pancreatic acinar cells and thus plays an important role in assessing the exocrine pancreas (Steiner, Berridge et al. 2002, Steiner, Rutz et al. 2006, Neilson-Carley, Robertson et al. 2011, Xenoulis and Steiner 2012). The serum cPLI has been reported to detect specifically localized lipase in pancreatic acinar cells (Steiner, Berridge et al. 2002, Dröes and Tappin 2017). This makes increase in serum PLI concentrations unlikely coming from the lipase of other tissues (Lidbury and Suchodolski 2016). Considering the localization of the pancreatic lipase and the capacity of immunoassays to detect the unique protein structure of pancreatic lipase are known to be the advantages of measuring the serum cPLI during the diagnosis of exocrine pancreas diseases, resulting to high analytic specificity (Steiner,Rutz et al. 2006, Xenoulis and Steiner 2012) (Steiner JM, 2000; Hoffmann WE, 2008) (Steiner, Berridge et al. 2002, Neilson-Carley, Robertson et al. 2011).

Nowadays, diagnosis of canine pancreatitis has mostly considered serum cPLI assays as the most specific serum biomarkers (Neilson-Carley, Robertson et al. 2011, Trivedi, Marks et al. 2011, Mawby, Whittemore et al. 2014). However, the serum cPLI concentration doesn’t define the severity of pancreatitis (Steiner, Newman et al. 2008, Trivedi, Marks et al. 2011, Xenoulis and Steiner 2012).




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