Fresh insights on pugs’ PLE survival fuel call for further disease research

A study has shed new light on protein-losing enteropathy (PLE) in pugs and a potential treatment that can increase short-term survival.

Published in the Journal of Small Animal Practice, the paper details a retrospective study of RVC VetCompass primary care clinical data for pugs with a recorded PLE diagnosis.

Researchers investigated the clinicopathological results, referral status, treatment and outcome of 51 pugs which were diagnosed with PLE in the UK between 2017 and 2024.

Common clinical signs at diagnosis included diarrhoea, vomiting, inappetence, lethargy, weight loss and increased drinking, while commonly reported clinical signs at the time of death or euthanasia included anaemia, pale mucous membranes and seizures.

Future investigation

The authors noted their findings on clinical signs at time of death “have not previously been reported in the literature and are therefore worthy of further discussion and future investigation”.

Twenty-two of the pugs died due to PLE during the study, while four died of causes unrelated to their PLE.

Of the 22, 14 were euthanised and eight had an unassisted death, with 12 dying within three months of diagnosis at a median of 22 days.

Treatment for the pugs included dietary therapy, cobalamin supplementation, prednisolone, chlorambucil and clopidogrel. Of the 14 dogs that received clopidogrel at diagnosis, 13 also received prednisolone.

Treated

Pugs treated with prednisolone or clopidogrel were significantly more likely to be alive after three months – all 14 dogs that received clopidogrel were still alive, as were 28 of 34 on prednisolone – but these treatment effects were no longer significant at the one-year or two-year outcome analysis.

The finding that prednisolone may improve short-term survival was said to be unsurprising.

But the authors argued the findings on clopidogrel “highlight some potential value from clopidogrel medication in pugs with PLE” and that “future studies should prioritise confirming if clopidogrel helps increase survival, as well as defining which pugs with PLE are to gain the greatest benefit from this treatment at diagnosis, as this may help improve outcome in this breed”.

The researchers also found no significant difference in outcome between pugs referred for their PLE versus those managed entirely under primary care, suggesting a generally poor prognosis independent of treatment setting.

Severe cases

They noted this could also be explained by more severe cases being referred and milder cases remaining under primary care, and called for further studies accounting for the severity of the disease when assessing the impact of referral.

Aarti Kathrani, lead author of the study, said: “The results of our study will help to increase awareness and highlight the outcome and various causes of death in pugs with protein-losing enteropathy.

“We hope the results will also help drive much-needed further research into the mechanism, pathophysiology and consequence of this disease, which is needed to help discover effective therapeutic targets that could help improve the prognosis of this guarded condition.”