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nient to culture than the cells normally Taurine (2-aminoethanesulfonic acid) is
Rennard, R. G. Crystal, J. Clin. Invest. 68, 889
(1981).
responsible for producing ox1AT, such as 6. J. E. Gadek et al., ibid., p. 1158. an essential nutrient for cats and possibly
hepatocytes and mononuclear phagocytes 7. primates, including humans (3). The most
M. Wewers et al., Am. Rev. Respir.Dis. 133, A103
(1986).
(2, 3, 17). Nevertheless, the fibroblasts pro- H. Varmus and R. Swanstrom, in RNA Tumor
8. prominent clinical sign associated with tau-
duced human oc1AT that diffused into the rine deficiency in humans and animals is
Viruses,R. Weiss, N. Teich, H. Varmus, J. Coffin,
Eds. (Cold Spring Harbor Laboratory, Cold Spring
blood and, more importantly, reached the Harbor, NY, 1984), pp. 423-428.
photoreceptor cell degeneration (3). Tau-
lower respiratorytract of the lung. Although W. F. Anderson, Science226, 401 (1984).
9. rine is not a constituent of mammalian
D. A. Williams and S. H. Orkin,J. Clin. Invest. 77,
10.
large amounts would have to be produced 1053 (1986). proteins and its major metabolic role has
by such cells in order to effectively treat D. Armentano et al., J. Virol., in press.
11. been attributed to bile salt conjugation (4).
oc1AT deficiency, modifications such as the R. I. Garver, Jr., et al., Proc. Natl. Acad. Sci. U.SA.
12. Myocardium and retina have the highest
84, 1050 (1987).
transplantation of clones containing multi- S. J. Chen et al., ibid. 82, 7284 (1985).
13. concentration of free taurine in the body,
ple copies of the integrated gene could make A. F. Voronova and B. M. Sefton, Nature (London)
14. ranging between 100 and 400 times that
319, 682 (1986).
this a feasible approach (18). found in plasma. This concentration gradi-
S. HartuLng,R. Jacnisch, M. Breindl, ibid. 320, 365
15.
In addition to the long-term application (1986). ent is maintained by an energy-dependent
P. W. Kantoffet al., Trans.Assoc.Am. Phys., in press.
16.
of this approach to the therapy of hereditary transport
D. H. Pertmutter, F. S. Cole, P. Kilbridge, T. H.
17. process that is saturable and is
disorders, transplantation of retroviral vec- mediated, at least in part, by adrenergic
Rossing, H. R. Colten, Proc.Natl. Acad. Sci. U.S.A.
82, 795 (1985).
tor-produced clones secreting other proteins mechanisms (5). Taurine may play a role in
E. Robertson, A. Bradlev, M. Kuehn, M. Evans,
18.
active in the extracellularmilieu might pro- Nature (London) 323, 445 (1986). the inotropic, metabolic, and osmotic regu-
M. A. Courtney et al., Proc. Natl. Acad. Sci. U.SA.
19.
vide a new approach to study the in vivo 81, 669 (1984).
lation of the myocardium (6). In addition,
effects of such hormones and growth fac- congestive heart failure in humans, dogs,
A. D. Miller, M.-F. Law, I. M. Verma, Mol. Cell.
20.
Biol. 5, 431 (1985).
tors. and rabbits is associated with increased
R. A. Jorgensen, S. J. Rothstein, W. S. Reznelkoff,
21.
Mol. Gen. Genet. 177, 65 (1979). myocardial taurine concentrations (7). Al-
R. Mann, R. C. Mulligan, D. Baltimore, Cell 33,
22. though several studies imply that taurine
REFERENCES AND NOTES 153 (1983).
V. Klement, W. P. Rowe, J. W. Hartley, W. E.
23. affects the inotropic properties of the heart
1. J. E. Gadek and R. G. Crystal, in TheMetabolicBasisPugh, Proc. Natl. Acad. Sci. U.SA. 63, 753 (1969).
of Inherited Disease, J. B. Stanbury, J. B. Wyngaar- 24. in vivo and in vitro in several species, includ-
J.-F. Mornex et al., J. Clin. Invest. 77, 1952 (1986).
den, D. S. Frederickson, J. L. Goldstein, M. S. ing humans (8), the basic physiologic func-
S. I. Rennard et al.,J.Appl. Physiol.60, 532 (1986).
25.
Brown, Eds. (McGraw-Hill, New York, 1982), pp. 26. J. P. Michalski, C. C. McCombs, S. Sheth, M.
1450-1467. tion of taurine in the heart is unknown.
McCathy, R. deShazo,J. I'mmunol.Methods 83, 101
2. R. W. Carrell,J. Clin. Invest. 78, 1427 (1986). (1985). Taurine depletion is difficult to induce in
3. J. Travis and G. S. Salvesen,Annu. Rev. Biochem.52,We are indebted to G. Fells and R. Seabron for their
655 (1983).
27. most species. In cats, however, the biosyn-
help in carrying out this work.
4. J. Bieth, Front. Matrix Biol. 6, 1 (1978). thesis of taurine is minimal and conjugation
5. J. E. Gadek, G. A. Fells, R. L. Zimmerman, S. I. 4 February 1987; accepted 27 May 1987
of bile acids with taurine is obligatory.
Feeding taurine-deficientdiets to cats results
in low concentrations of taurine in plasma
and tissues, including the retina and myocar-
dium (3, 9). Taurine depletion for more
than 6 months may produce feline central
Myocardial Failure in Cats Associated with Low retinal degeneration (FCRD) (3, 9). In tau-
Plasma Taurine: A Reversible Cardiomyopathy rine-depleted rats, no mechanical cardiac
abnormalitieshave been noted, and mechan-
ical function of the heart has not been
P. D. PION, M. D. KIITLESON, Q. R. ROGERS, J. G. MORRIS specifically investigated in taurine-depleted
cats (9). In this report we present results
Thousands of pet cats die each year with dilated cardiomyopathy, the cause of which is that implicate low concentrations of taurine
unknown. Although taurine is present in millimolar concentrations in the myocardium in the plasma [and therefore by deduction in
of all tnammals, taurine depletion has not previously been associated with a decrease in myocardial tissues (5, 9)] as a major causal
myocardial function in any species. In this study, low plasma taurine concentrations factor of DCM in cats.
associated with echocardiographic evidence of myocardial failure were observed in 21 Twenty-three cases of DCM were diag-
cats fed commercial cat foods and in 2 of 11 cats fed a purified diet containing nosed at the University of California Veteri-
marginally low concentrations of taurine for 4 years. Oral supplementation of taurine nary Medical Teaching Hospital between 1
resulted in increased plasma taurine concentrations and was associated with normaliza- December 1986 and 1 April 1987. DCM
tion of left ventricular function in both groups of cats. Since myocardial concentrations was diagnosed by echocardiography in 21
of taurine are directly related to plasma concentrations and low plasma concentrations client-owned cats (group 1) and in 2 of 11
were found to be associated with myocardial failure in cats, a direct link between female cats maintained in a specific patho-
decreased taurine concentration in the myocardium and decreased myocardial mechan- gen-free (SPF) colony fed a purified diet
ical function is proposed. containing marginal concentrations of tau-
rine (250 or 500 mg per kilogram of dry
DI ILATED CARDIOMYOPATHY (DCM), poor (1). The incidence of DCM in domes- diet) for 4 years (group 2). M-mode echo-
a degenerative disease of the myo- tic cats is unknown, but a retrospective cardiograms, indirect funduscopic examina-
cardium, results in decreased myo- study at a large urban veterinary referral tions, plasma taurine concentrations, and
cardial contractility (myocardial failure). center revealed that 193 (3.0%) of 6385 dietary histories were obtained for all cats.
DCM has been reported in humans, dogs, consecutive necropsy reports on pet cats that Four cats died from congestive heart fail-
cats, and other species (1). The etiology of died between January 1962 and December ure within hours of arriving at the clinic.
primary DCM in most cases, regardless of 1977 indicated a gross pathologic diagnosis School of Veterinary Medicine, University of California,
the species, is unknown and the prognosis is of DGM (2). Davis, Davis, CA 95616.
14 AUGUST I987
REPORTS 765
In normal cats, the ratio between myocardial intraventricularfilling pressures and volume increase in end-systolic diameter and the
and plasma taurine concentrations is about (preload). This could have contributed to compensatory increase in end-diastolic di-
100: 1 (9). In taurine-depleted cats the ratio the observed decrease in end-diastolic diam- ameter is characteristicof a profound chron-
is reported to be about 250:1 (9). There- eter in the 14 client-owned cats given these ic decrease in myocardial contractility (16).
fore, the measured plasma taurine concen- drugs to control signs of congestive heart The decrease in end-systolic diameter after
trations in cats with DCM, which ranged failure. An alternative explanation, indepen- taurine supplementation could have been
from 1 to 20 nmol/ml, suggests that myocar- dent of fuirosemideor captopril, is that the the result of improved myocardial function
dial taurine concentrations were between improved systolic performance increased or a decrease in afterload (16). The shorten-
250 and 5000 nmol per gram of tissue (wet stroke volume (that is, the volume of blood ing fraction (Fig. 2C) was initially low.
weight). Normal cat myocardial taurine pumped per heart beat), increasing blood Shortening fraction is an index of left ven-
concentration is 6,000 to 18,000 nmol per flow to the kidneys and glomerular filtration tricular function providing information
gram of tissue (9). It is therefore reasonable and thus decreasing sodium and water reten- analogous to the angiographic ejection frac-
to deduce that myocardial concentrations of tion. The resultant net sodium and water tion (10). Again, the magnitude and time
taurine were subnormal in the cats that we excretion could have decreased intravascular course of change in end-systolic diameter
found had chronically low plasma taurine volume and contributed to the decreased and shortening fraction suggest a marked
concentrations. With the possible but un- end-diastolic diameter (16). Diuretics and improvement in myocardial performance.
likely exception of the presence of a myocar- captopril decrease intravascularvolume and Captopril can decrease afterload via arterio-
dial taurine transport defect, it is also rea- ventricular filling pressures within a few lar dilation but this effect would be apparent
sonable to deduce that myocardial taurine days of starting therapy (17). The time within hours to days ratherthan weeks (17).
concentrations were normal to increased in course of the decrease in end-diastolic diam- Similarly, an acute pharmacologic effect of
cats supplemented with taurine. eter suggests that improved systolic per- taurine on myocardium can be ruled out
The end-diastolic diameter was initially formance rather than diuretic or ATCEI since a significant decrease in end-systolic
enlarged in cats with DCM but decreased therapy was the major influence since end- diameter and increase in shortening fraction
after taurine administration (Fig. 2A, Table diastolic diameter did not decrease signifi- was not observed before period 3 (5 to 6
2). There are two possible explanations for cantly until 5 to 6 weeks after the initiation weeks) and period 2 (3 to 4 weeks), respec-
this decrease. First, both furosemide (a di- of taurine supplementation, coincident with tively. These results therefore suggest that
uretic) and captopril [an angiotensin con- improved systolic performance. taurine supplementation corrects an unex-
verting enzyme inhibitor (ATCEI)] de- The end-systolic diameter (Fig. 2B) was plained myocardial abnormality caused by
crease intravascularvolume and can decrease initially increased. The magnitude of the taurine deficiency.
Table 1. Demographic information, clinical and dietary history, and initial taurine concentration in the 23 cats with DCM. The data under "Outcome" show
weeks from time of diagnosis to last observation or A, died of noncardiac cause; B, died within hours of hospitalization; C, humanely killed at the owner's re-
quest after 4 weeks of taurine supplementation. Plasma taurine concentrations were measured at the time each cat first arrived at the hospitaL
Dict; Diet
1 26 5 F DSH 5 No P D 4 Yes
2 26 5 F DSH 8 Yes P D 4 Yes
3 20 12 FS DLH 11 No a W 3.5 Yes
4 20 5 MC Siamese 15 No b W/D 2 No
5 21 3 FS Manx 15 No a W/D 3 Yes
6 15 7 MC DSH 2 Yes a D/W 5 No
7 18 5 M Himal/X 4 Yes d D 5 Yes
8 27 10 MC DSH 7 Yes d D 10 No
9 16 12 MC DLH 7 Yes d D 12 No
10 16 10 FS DSH 4 Yes a D 3 No
11 20 12 FS DLH 6 No b W/D 1 No
12 15 4 MC ABY 3 No a, c W 1 No
13 17 5 FS DLH 19 No d, b D 5 Yes
14 18 8 FS DSH 30? No a D 3.5 Yes
15 14 4 FS DSH 4 No a W 3.5 Yes
16 12 2 MC DSH 15 No b W/D 1 Yes
17 16 5 FS DSH 20 No a D/W 1 Yes
18 A 7 FS DSH 20 Yes e W 7 No
19 B 5 M DSH 5111 Yes b D 4
20 B 8 FS DLH 5 NOE1 a W 3
21 B 7 MC Somali 17 NOE a W 3.5
22 C 4 FS DSH 13 NOE f, g W 4
23 B 7 FS DSH 1 NOE a W 2
Average 18.8 6.7 9.7# 4.0
SD 4.3 2.9 6.2 2.7
*M, male;MC, castratedmale;F, female;FS, spayedfemale. tDSH, domesticshorthair;DLH, domesticlong ho.ir;ABY,Abyssinian;Himnal/X, Himalayancross. tP,
c, Hill'sH/D; d, PurinaCatChow;e, 9 LivesBeefandLiver;f, CarnationFancyFeastBeefandLiver;g, BlueMountain
purified;a, Hill'sCID;b, Hill'sScienceDiet Maintenance;
KittyO's;D, dry;W, wet; foodsarelistedin the orderof mostto leastcommonivfed. ?Cat'sdietwas changedto a mixtureof foods 2 monthspriorto presentation. I Cat
diagnosedas having an aorticthromboembolism;the normaltaurineconcentrationmay be explainedby releaseof taurinefrom ischemicskeletalmuscle. ?NOE, no
ophthalmologic examinationwas performedpriorto death. #Cats 14 and 19 werenot includedin the taurinesummarystatisticsfor reasonsstatedabove.