Hepatopathy following consumption of a commercially available blue-green algae dietary supplement in a dog

Abstract

BackgroundDietary supplement use in both human and animals to augment overall health continues to increase and represents a potential health risk due to the lack of safety regulations imposed on the manufacturers. Because there are no requirements for demonstrating safety and efficacy prior to marketing, dietary supplements may contain potentially toxic contaminants such as hepatotoxic microcystins produced by several species of blue-green algae.Case presentationAn 11-year-old female spayed 8.95 kg Pug dog was initially presented for poor appetite, lethargy polyuria, polydipsia, and an inability to get comfortable. Markedly increased liver enzyme activities were detected with no corresponding abnormalities evident on abdominal ultrasound. A few days later the liver enzyme activities were persistently increased and the dog was coagulopathic indicating substantial liver dysfunction. The dog was hospitalized for further care consisting of oral S-adenosylmethionine, silybin, vitamin K, and ursodeoxycholic acid, as well as intravenous ampicillin sodium/sulbactam sodium, dolasetron, N-acetylcysteine, metoclopramide, and intravenous fluids. Improvement of the hepatopathy and the dog’s clinical status was noted over the next three days. Assessment of the dog’s diet revealed the use of a commercially available blue-green algae dietary supplement for three-and-a-half weeks prior to hospitalization. The supplement was submitted for toxicology testing and revealed the presence of hepatotoxic microcystins (MCs), MC-LR and MC-LA. Use of the supplement was discontinued and follow-up evaluation over the next few weeks revealed a complete resolution of the hepatopathy.ConclusionsTo the authors’ knowledge, this is the first case report of microcystin intoxication in a dog after using a commercially available blue-green algae dietary supplement. Veterinarians should recognize the potential harm that these supplements may cause and know that with intervention, recovery is possible. In addition, more prudent oversight of dietary supplement use is recommended for our companion animals to prevent adverse events/intoxications.

Evaluation of microcystin contamination in blue-green algal dietary supplements using a protein phosphatase inhibition-based test kit

“…Both products had recommended starting daily consumption rates that depended on the weight of the animal, but both also had the additional statement on suggested use of “One or more times daily as desired”. Bautista et al. (2015) documented a case of apparent hepatic toxicity in a dog after dietary supplementation with an AFA-containing BGA product that was found to contain 1.1 μg/g MC, with resolution of symptoms upon treatment and discontinuation of product use.…”

Microcystin-LR induced liver injury in mice and in primary human hepatocytes is caused by oncotic necrosis

“…In rat primary hepatocyte culture, exposure to MC-LR results in rapid mitochondrial dysfunction, and prototypical apoptosis (Ding et al, 2000). As such, apoptosis has become the most commonly cited mechanism for MC-LR induced cell death in most models (Kleppe et al, 2015; Chen and Xie, 2016); however, considerable alanine aminotransferase (ALT) release (van der Merwe et al, 2012), and hemorrhagic necrosis (Theiss et al, 1988; Bautista et al, 2015), have been consistently noted in pathological reports of animal exposure to MC-LR. Moreover, MCF-7 breast cancer cells with a defective caspase-3 enzyme, which are highly resistant to apoptosis, are sensitive to MC-LR (Fladmark et al, 1999).…”

Presumptive Iatrogenic Microcystin‐Associated Liver Failure and Encephalopathy in a Holsteiner Gelding

“…Most microcystin toxicoses result from contaminated water consumption; however, important exceptions exist including recent water contamination in a dialysis center that led to twenty‐six human deaths from liver failure . A case of hepatic failure in a dog was attributed to high levels of microcystin detected in a A. flos aquae supplement harvested from Upper Klamath Lake in Oregon . These algae are harvested during algal blooms in an open environment making inadvertent collection of M. aeruginosa, a microcystin‐producing blue‐green algae, and microcystin a real concern.…”

“…10,11 A case of hepatic failure in a dog was attributed to high levels of microcystin detected in a A. flos aquae supplement harvested from Upper Klamath Lake in Oregon. 12 These algae are harvested during algal blooms in an open environment making inadvertent collection of M. aeruginosa, a microcystin-producing blue-green algae, and microcystin a real concern. In 1996, 85 of 87 blue-green algae supplements derived from this lake were contaminated with microcystin and 72% of those samples exceeded the Oregon Health Department 1 lg/g limit (reaching up to 16.4 lg/g), 13 a limit based on the World Health Organization (WHO) recommendation on drinking water for people.…”