View
5
Download
0
Category
Preview:
Citation preview
1
NONHUMAN PRIMATE NONHUMAN PRIMATE PATHOLOGYPATHOLOGY
Srinivas S RaoSrinivas S RaoSrinivas S. Rao Srinivas S. Rao DVM, DVM, Ph.DPh.D, MBA, , MBA,
Diplomate ACVPDiplomate ACVP
srao1@mail.nih.govsrao1@mail.nih.gov
srinirao3@gmail.comsrinirao3@gmail.com
Acknowledgements Acknowledgements
Gross Photos/Histology Gross Photos/Histology ImagesImages: Gary Baskin, Anne : Gary Baskin, Anne LewisLewis
Rick J. Montali and Ira Rick J. Montali and Ira Baum for images,Baum for images,
Thank you to:
Baum for images, Baum for images, summaries, and referencessummaries, and references
Alyse Zajac and Patrick Alyse Zajac and Patrick GorresGorres
New Iberia and staffNew Iberia and staff Univ of MD and staffUniv of MD and staff Bioqual and StaffBioqual and Staff JHU and staffJHU and staff Tulane Primate CenterTulane Primate Center
Goals of this talkGoals of this talk
Present an overview of the ‘natural’ disease Present an overview of the ‘natural’ disease entities of NHPsentities of NHPs--specially Macaques spp.specially Macaques spp.
Discuss ‘most important’ disease entities in Discuss ‘most important’ disease entities in more detailmore detailmore detailmore detail
Discuss ‘not so important’ disease entities as Discuss ‘not so important’ disease entities as appropriateappropriate
Make a case that the disease processes in NHP Make a case that the disease processes in NHP are similar to other higher order mammalsare similar to other higher order mammals
2
Now for the punch line(s)…Now for the punch line(s)… The response to an ‘insult’ in NHP is The response to an ‘insult’ in NHP is
almost exactly similar to those in other almost exactly similar to those in other higher order mammals…a granuloma is a higher order mammals…a granuloma is a granuloma is a granulomagranuloma is a granuloma
Beware of ‘unique’ anatomic features andBeware of ‘unique’ anatomic features and Beware of unique anatomic features and Beware of unique anatomic features and corresponding pathology. Eg., cheek pouch corresponding pathology. Eg., cheek pouch infection (airsacculitis) ; diverticulosis; infection (airsacculitis) ; diverticulosis;
If you are unable to get a Stromberg style If you are unable to get a Stromberg style “shoot from the hip” answer, go to your “shoot from the hip” answer, go to your basics…again, a granuloma is a ….basics…again, a granuloma is a ….
Now for the punch line(s) (cont.)…Now for the punch line(s) (cont.)…
Even if you don’t learn anything in the next 2 Even if you don’t learn anything in the next 2 hours, KNOW THE FOLLOWING:hours, KNOW THE FOLLOWING: Assure yourself of minimum protective conditions Assure yourself of minimum protective conditions
while doing a monkey necropsywhile doing a monkey necropsy Know “THE” B virusKnow “THE” B virus
Very high mortality rate in humans (80%)Very high mortality rate in humans (80%) Very high mortality rate in humans (80%)Very high mortality rate in humans (80%) Asymptomatic carriers can shed virusAsymptomatic carriers can shed virus
Know TBKnow TB Know SIV + opportunistic infections (especially Know SIV + opportunistic infections (especially
histopathhistopath); have Bruce’s’ “CAN diagnosis(); have Bruce’s’ “CAN diagnosis(eses)”)” Know the invading bugsKnow the invading bugs-- salsal, , shishi, , yeryer, , EntomebaEntomeba Know EndometriosisKnow Endometriosis Know BloatKnow Bloat KnowKnow--KnowKnow--Know Know -------- you get the idea!!!you get the idea!!!
CatarrhineCatarrhine (down(down--nosed) or nosed) or Old World MonkeysOld World Monkeysmacaque
Common chimpanzee
patas
baboonmandrill
Cercopithecus aethiops
langur
proboscis
colobus
aethiops Swamp monkey
gibbon orangutan
guenon
Vervet monkeybonobo
Leaf monkey
3
PlatyrrhinePlatyrrhine (flat(flat--nosed) or nosed) or New World Monkeys New World Monkeys
Family Aotidaenight monkeys
Family Alouatta howler monkeys
Family: Ateles geoffroyi
Central American spider monkey
F il C lli b
Family Callithrix jacchus
white-tufted-ear marmoset
Family Callicebus molochdusky titi
Genus Cacajao (uakaris)
Family Leontopithecus rosalia
golden lion tamarin
Family Cebus capucinuscapuchin monkey
Family Saimiri sciureusSouth American squirrel monkey
Callithrix pygmaeapygmy marmoset
Genus Pithecia(saki monkeys)
BACTERIAL DISEASESBACTERIAL DISEASES Mycobacterium Mycobacterium
tuberculosis tuberculosis
Streptococcus Streptococcus pneumoniaepneumoniae
KlebsiellaKlebsiella pneumoniaepneumoniae
YersiniosisYersiniosis
SalmonellaSalmonella
CampylobacteriosisCampylobacteriosis
ListeriosisListeriosis
E h i hi liE h i hi liKlebsiellaKlebsiella pneumoniaepneumoniae Mycobacterium Mycobacterium
lepraemuriumlepraemurium Staphylococcus Staphylococcus aureusaureus ShigellosisShigellosis
Escherichia coliEscherichia coli BordetellaBordetella bronchisepticabronchiseptica ClostriduiumClostriduium tetanitetani
* Gram* Gram--positivepositive* Gram* Gram--negative negative
TuberculosisTuberculosisM. tuberculosis M. tuberculosis and and M. M. bovisbovis
4
TB Slide – Human lung histology
Central necrosis
Langhans-type giant cells
5
Hepatic Tuberculosis Hepatic Tuberculosis
6
IMMUNODEFICIENCY-ASSOCIATED MYCOBACTERIOSIS
Mycobacterium avium paratuberculosis (Johne’s Disease)
Streptococcus pneumoniaeStreptococcus pneumoniae(Diplococcus pneumoniae, Pneumococcus pneumoniae(Diplococcus pneumoniae, Pneumococcus pneumoniae))
7
Klebsiella pneumoniaeKlebsiella pneumoniae
8
Leprosy Leprosy -- Hansen's diseaseHansen's diseaseMycobacterium Mycobacterium lepraeleprae
Staphylococcus Staphylococcus aureusaureus
9
Bacterial Bacterial EnteritidiesEnteritidies SalmonellaSalmonella ShigellaShigella YersiniaYersinia CampylobacterCampylobacter E. ColiE. Coli EntamoebaEntamoeba histolyticahistolytica (parasite)(parasite)
ShigellosisShigellosisShigella flexneri Shigella flexneri Shigella sonneiShigella sonnei
Gram negative, aerobic, invasive
10
YersiniosisYersiniosisYersinia pseudotuberculosis Yersinia enterocoliticaYersinia pseudotuberculosis Yersinia enterocolitica
*from squirrel monkey
11
Affected
Normal
Yersiniosis Histopathology
Common histopathology:
•Leukocytosis
Yersinia colonies
Hepatic microabscess
Leukocytosis
•Hyponatremia
•Hypochloremia
•Prerenal azotemia
•hyperfibrinogenemia
12
CampylobacteriosisCampylobacteriosisCampylobacter fetus ss. JejuniCampylobacter fetus ss. JejuniCampylobacter fetus ss. coliCampylobacter fetus ss. coli
ListeriosisListeriosisListeria monocytogenesListeria monocytogenes
13
Escherichia coliEscherichia coli
•• ETEC: ETEC: EnterotoxigenicEnterotoxigenic E. coliE. coli AdhesinsAdhesins to bind to bind enterocytesenterocytes
ProteinaceousProteinaceous enterotoxinsenterotoxins –– LT and LT and STST
NonNon--invasiveinvasiveKoushik Roy, et al. Enterotoxigenic Escherichia coli EtpA mediates adhesion between flagella and host cells. Nature. 457: 594-598, 2008.
•• EPECEPEC: : EnteropathogenicEnteropathogenic E. coliE. coli Lack Lack fimbriaefimbriae, , ST ST and LT and LT enterotoxinsenterotoxins
Shiga Shiga toxintoxin
ActinActin rearrangementrearrangement
Associated Associated with ulcerative colitis in with ulcerative colitis in cotton top cotton top tamarinstamarins and marmosetsand marmosets
Escherichia coli Escherichia coli (cont.)(cont.)•• EHEC: EHEC: EnterohemorrhagicEnterohemorrhagic E. E.
colicoli HemolyticHemolytic--uremic uremic syndrome and syndrome and
sudden kidney failuresudden kidney failure
FimbriaeFimbriae
Shiga Shiga toxintoxin
•• EAECEAEC: : EnteroaggregativeEnteroaggregative E. E. colicoli Aggregative Aggregative fimbriaefimbriae
HemolysinHemolysin and ST and ST enterotoxinenterotoxin
•• EIECEIEC: : EnteroinvasiveEnteroinvasive E. coliE. coli Resembles Resembles ShigellosisShigellosis
Xicohtencatl-Cortes Juan, et al. Intestinal adherence associated with type IV pili of enterohemorrhagic Escherichia coli O157:H7. Journal of Clinical Investigation. 117(11): 3519-3529. 2007.
http://www.cdc.gov/ncidod/eid/vol4no2/nataro.htm
14
Bordetella bronchisepticaBordetella bronchiseptica
TetanusTetanusClostridium tetaniClostridium tetani
15
Common Viral Diseases in NHPsCommon Viral Diseases in NHPs
DNA VirusesDNA Viruses
Herpes virusesHerpes viruses Herpes BHerpes B Herpes Simplex virusHerpes Simplex virus
PapillomaPapilloma virusvirus AdenovirusAdenovirus Simian virus 40 (SVSimian virus 40 (SV--40)40)
HerpesvirusHerpesvirus saimirisaimiri EpsteinEpstein--Barr VirusBarr Virus Simian Simian VaricellaVaricella VirusVirus
Pox viruses Pox viruses MonkeypoxMonkeypox YabapoxYabapox
Simian virus 40 (SVSimian virus 40 (SV 40)40) SRVSRV--22
B VirusB Virus
16
17
Herpes Simplex VirusHerpes Simplex Virus
Herpes Herpes saimirisaimiri
*squirrel monkey
*from marmoset
18
Herpes Virus Saimiri
*from marmoset
Herpes Virus Saimiri
EpsteinEpstein--Barr VirusBarr Virus
19
Simian Varicella VirusSimian Varicella Virus
Orthopoxviridae (Monkeypox)Orthopoxviridae (Monkeypox)
20
Benign Epidermal Monkey Pox Benign Epidermal Monkey Pox (BEMP)(BEMP)
OrTeCa Pox VirusOrTeCa Pox Virus
RNA VIRUSESRNA VIRUSES Simian hemorrhagic fever virusesSimian hemorrhagic fever viruses
Measles virusMeasles virus
Simian TSimian T--lymphotropiclymphotropic virus Ivirus I
Simian TSimian T--cell leukemia virus (STLVcell leukemia virus (STLV--1)1)
Y ll F iY ll F i Yellow Fever virusYellow Fever virus
SIVSIV
RabiesRabies
Lymphocytic Lymphocytic choriomeningitischoriomeningitis virus (LCMV)virus (LCMV)
Hepatitis A virusHepatitis A virus
EncephalomyocarditisEncephalomyocarditis virus (EMCV)virus (EMCV)
Simian Foamy VirusSimian Foamy Virus
21
Measles (Rubeola) VirusMeasles (Rubeola) Virus
Measles Virus
Measles Virus
22
Measles Virus Histology
NHP Measles VaccineNHP Measles Vaccine Discontinuation of ATTENUVAXDiscontinuation of ATTENUVAX®® Measles vaccine by Merck & Measles vaccine by Merck &
Co. routinely used for NHPsCo. routinely used for NHPs
Other options to consider:Other options to consider:
MM--MM--RR®® II VaccineII Vaccine Live virus human vaccine for Measles, Mumps and RubellaLive virus human vaccine for Measles, Mumps and Rubella
Highly immunogenic and generally well tolerated in humansHighly immunogenic and generally well tolerated in humans
VanguardVanguard®® Canine DistemperCanine Distemper--Measles VaccineMeasles Vaccine Canine DistemperCanine Distemper--Adenovirus Type 2Adenovirus Type 2--MeaslesMeasles--Parainfluenza VaccineParainfluenza Vaccine
High degree of High degree of epitopicepitopic homology between MV, CDV, and RPVhomology between MV, CDV, and RPV
Contains Adenovirus which can interfere with vaccine researchContains Adenovirus which can interfere with vaccine research
RinderpestRinderpest VaccineVaccine single single vacciniavaccinia virus recombinants expressing the H and F genes of RPV. virus recombinants expressing the H and F genes of RPV.
((GiavedoniGiavedoni L, et al, 1991 and Jones L, et al, 1997)L, et al, 1991 and Jones L, et al, 1997)
Provides partial protection; multiple vaccinations requiredProvides partial protection; multiple vaccinations required
Simian Immunodeficiency VirusSimian Immunodeficiency Virus ClassificationClassification::
Family: Family: RetroviridaeRetroviridae Genus: Genus: LentivirinaeLentivirinae Species: Species: SIVmacSIVmac, , SIVcynSIVcyn, , SIVsmSIVsm, , SIVmneSIVmne, , SIVstmSIVstm, , SIVagmSIVagm, , SIVmndSIVmnd, , SIVcmzSIVcmz, ,
SIVsykSIVsyk Very similar to HIV in humansVery similar to HIV in humans
Species effectedSpecies effected: Old World NHPs: Old World NHPs Clinical SignsClinical Signs::gg
Animals become Animals become immunosuppressedimmunosuppressed and are susceptible to and are susceptible to opportunistic opportunistic infectionsinfections Infection by cytomegalovirus, adenovirus, Infection by cytomegalovirus, adenovirus, papoviruspapovirus, , PnemocystisPnemocystis cariniicarinii, Mycobacterium , Mycobacterium
aviumavium complexcomplex, Cryptosporidium sp., , Cryptosporidium sp., CrytococcusCrytococcus neoformansneoformans, , ToxoplasmaToxoplasma gondiigondii, and , and CandiddiaCandiddiaalbicansalbicans
Chronic diarrhea and wastingChronic diarrhea and wasting Disseminated Disseminated cutaneouscutaneous eruptioneruption on the trunk, groin, medial thighs and face on the trunk, groin, medial thighs and face
with resolution in 1with resolution in 1--7 weeks7 weeks Generalized Generalized lymphadenopathylymphadenopathy and/or and/or splenomegalysplenomegaly
Pathology:Pathology: Lesions independent of Lesions independent of immunosuppressionimmunosuppression in a variety of organ systems: skin, GI in a variety of organ systems: skin, GI
tract, cardiopulmonary, nervous and lymphoid systemstract, cardiopulmonary, nervous and lymphoid systems
23
SIV (cont’d)SIV (cont’d)
Diagnosis of Simian Type D RetrovirusDiagnosis of Simian Type D Retrovirus--Induced AIDSInduced AIDS Generalized Generalized lymphadenopathylymphadenopathy and/or and/or splenomegalysplenomegaly accompanied by at least accompanied by at least
four of the following clinical and laboratory findings:four of the following clinical and laboratory findings: Weight loss (>10%)Weight loss (>10%) Fever (>103Fever (>103°°F)F) Persistent refractory diarrheaPersistent refractory diarrhea Chronic infections unresponsive to therapyChronic infections unresponsive to therapy Opportunistic infectionsOpportunistic infections Opportunistic infectionsOpportunistic infections NomaNoma ((cancrumcancrum orisoris)) Retroperitoneal or SQ Retroperitoneal or SQ fibromatosisfibromatosis Hematologic abnormalities:Hematologic abnormalities:
Anemia (PCV <30%)Anemia (PCV <30%) NeutropeniaNeutropenia (<1700)(<1700) LymphopeniaLymphopenia (<1600)(<1600) Thrombocytopenia (<50,000)Thrombocytopenia (<50,000) PancytopeniaPancytopenia
Bone marrow hyperplasiaBone marrow hyperplasia Characteristic lymph node lesionsCharacteristic lymph node lesions
Where Does HIV Come From?Where Does HIV Come From?
Sooty mangabey
SIVsyk
Sykes monkey
SIVcol SIVgsn
SIVsmm
Greater spot-nosed
HIV-2
SIVmac
SIVcpz
ChimpanzeeHIV-1
SIVcol
Mantled guereza
L’Hoest’s monkey Mandrill
SIVlho
SIVrcm
g
SIVmnd
Red-capped mangabey
SIVver
Vervet monkey
Slide adapted from Beatrice Hahn
SIV
Pneumocystis carinii
Opportunistic Infections associated with SIV
24
Pneumocystis carinii
Opportunistic Infections associated with SIV
Retroperitoneal Fibromatosis
Lymphocryptovirus-induced hairy leukoplakia
Simian/Human Immunodeficiency Virus (SHIV)
Although SIV causes AIDSAlthough SIV causes AIDS--like like disease in monkeys, immune reactive disease in monkeys, immune reactive epitopesepitopes of SIV env are different from of SIV env are different from HIVHIV--1 1 diminishes predictive value diminishes predictive value of SIV modelof SIV model
SIV
of SIV modelof SIV model SHIV is molecular hybrid of SIV and SHIV is molecular hybrid of SIV and
HIVHIV--1, replacing 1, replacing env, tat, env, tat, and and revrevgenes of SIVgenes of SIV--mac239 with HIVmac239 with HIV--1 1 counterpartscounterparts
Combines SIV’s Combines SIV’s replicativereplicative ability in ability in macaques with ability to encode macaques with ability to encode HIVHIV--1 envelope proteins 1 envelope proteins more more valid model for assessing HIV valid model for assessing HIV vaccine efficacy vaccine efficacy
HIV
25
Recent Detection of Simian Foamy Virus in Bushmeat
April 2010: Two strains of April 2010: Two strains of HIVHIV--like virus detected in like virus detected in bushmeatbushmeat from two from two mangabeysmangabeys and chimpanzeeand chimpanzeemangabeysmangabeys and chimpanzeeand chimpanzee
Can infect humans but longCan infect humans but long--term effects unknownterm effects unknown
BushmeatBushmeat trade a threat to trade a threat to public health and wildlife public health and wildlife populationspopulations
Simian TSimian T--Cell Leukemia Virus I Cell Leukemia Virus I (STLV(STLV--I)I)
Simian Hemorrhagic Fever VirusSimian Hemorrhagic Fever Virus
26
Ebola VirusEbola Virus
Larsen, et al. Pathologic Findings Associated with Delayed Death in Nonhuman Primates Experimentally Infected with Zaire Ebola Virus. J Infect Dis. 2007
Marburg VirusMarburg Virus
From: CDC/PHIL
Lymphocytic Lymphocytic ChoriomeningitisChoriomeningitis Virus Virus (LCMV)(LCMV)
* Marmoset
27
Family Family AdenoviridaeAdenoviridae
FUNGAL DISEASESFUNGAL DISEASES
HistoplasmosisHistoplasmosis
HistoplasmaHistoplasma capsulatumcapsulatum varvar duboisiiduboisii
Candida Candida albicansalbicans
Pneumocystis Pneumocystis cariniicarinii
Miscellaneous Miscellaneous fungal infectionsfungal infections
28
HistoplasmosisHistoplasmosisHistoplasma capsulatum var capsulatumHistoplasma capsulatum var capsulatum
African African HistoplasmosisHistoplasmosisHistoplasmaHistoplasma capsulatumcapsulatum varvar duboisiiduboisii
http://upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Histoplasma_capsulatum_var._duboisii._PHIL_4221_lores.jpg/280px-Histoplasma_capsulatum_var._duboisii._PHIL_4221_lores.jpg
29
CandidiasisCandidiasis, , moniliasismoniliasis, or “Thrush”, or “Thrush”Candida Candida albicansalbicans
Miscellaneous Fungal infection in NHP
Pyogranulomatous panniculitisCoccidioides immitis
30
Parasitic DiseasesParasitic Diseases Internal Parasites:Internal Parasites:
Plasmodium (Malaria)Plasmodium (Malaria)
EntamoebaEntamoeba histolyticahistolytica
AcantocephalaAcantocephala (Thorny(Thorny--headed worms)headed worms)
HepatocystisHepatocystis kochikochi
BalantidiumBalantidium colicoli
SarcocystisSarcocystis spp.spp.
Cryptosporidium sp.Cryptosporidium sp.))
Respiratory mitesRespiratory mites
PentastomesPentastomes
CestodesCestodes
External Parasites:External Parasites:
LiceLice
CutaneousCutaneous mitesmites
Cryptosporidium sp.Cryptosporidium sp.
TrichomonasTrichomonas sp.sp.
NochtiaNochtia nochtinochti
MalariaMalaria
Plasmodium Plasmodium cynomolgicynomolgi
P. P. inuiinui
PP knowlesiknowlesi P. P. knowlesiknowlesi
P. P. gonderigonderi
P. P. brasilianimbrasilianim
P. P. coatneyicoatneyi
31
EntamoebaEntamoeba histolyticahistolytica((amebiasisamebiasis))
32
33
AcantocephalaAcantocephala(Thorny(Thorny--headed Worms)headed Worms)
ProsthenorchisProsthenorchis eleganselegans ProsthenorchisProsthenorchis spirulaspirula
*White-footed Tamarin
34
RespiratoryRespiratory MitesMitesPneumonyssus simicola, Pneumonyssoides sp., Rhinophaga sp.Pneumonyssus simicola, Pneumonyssoides sp., Rhinophaga sp.
35
Pentastomes (Pentastomiasis)ArmilliferArmillifer porocephalusporocephalus
36
Cestodes (Cestodiasis)
Adults Cyclophyllidean
LarvaeC l h llid Cyclophyllidean cysticercoid, cycticercus,
coenurus, hydatid);
Pseudophyllidean spargana
Cysticercus cellulosaeCysticercus cellulosae
Cysticercus cellulosaeCysticercus cellulosae
37
CestodiasisCestodiasis
*from Greater galago
Hepatocystis kochiHepatocystis kochi
38
Balantidium coliBalantidium coli
Sarcocystis sp.Sarcocystis sp.
39
Cryptosporidium sp.Cryptosporidium sp.
TrichomonasTrichomonas spp.spp.
40
Nochtia nochtiNochtia nochti
External Parasites: LiceExternal Parasites: Lice
41
External Parasites: External Parasites: CutaneousCutaneous MitesMites
Sarcoptes sp.Sarcoptes sp.
Demodex sp.Demodex sp.
Psorergates sp.Psorergates sp.
Systemic PathologySystemic Pathology
Periodontal DiseasePeriodontal Disease
Gingival Gingival HyperplasiaHyperplasia
A G iA G i
ArterioArterio--venus fistulavenus fistula
Generalized Generalized amyloidosisamyloidosis
I l l id iI l l id i Acute Gastric Acute Gastric Dilation/ BloatDilation/ Bloat
Gastric InfarctionGastric Infarction
DiverticulosisDiverticulosis
Insular amyloidosisInsular amyloidosis
EndometriosisEndometriosis
Periodontal DiseasePeriodontal Disease
42
Gingival HyperplasiaGingival Hyperplasia
Acute Gastric Dilatation (Bloat)Acute Gastric Dilatation (Bloat)
43
Gastric infarctionGastric infarction
DiverticulosisDiverticulosis
Tenia coli
Diverticulosis Histology
44
Generalized AmyloidosisGeneralized Amyloidosis
45
EndometriosisEndometriosis
46
Nutritional & Metabolic DiseasesNutritional & Metabolic Diseases
Vitamin C deficiency (scurvy)Vitamin C deficiency (scurvy) Fat necrosisFat necrosis Fatal fatty liver syndrome Fatal fatty liver syndrome Simian Bone Disease (Vitamin DSimian Bone Disease (Vitamin D33 deficiency deficiency (( 33 yy
in NWM)in NWM) Anemia of owl monkeysAnemia of owl monkeys Chronic colitis of macaquesChronic colitis of macaques HypoglycemiaHypoglycemia
Vitamin C DeficiencyVitamin C DeficiencyScurvyScurvy
*squirrel monkey
47
Fatty Liver Syndrome Or Fatal Fasting Fatty Liver Syndrome Or Fatal Fasting Syndrome Of Obese MacaquesSyndrome Of Obese Macaques
48
Vitamin D3 Deficiency In New World Vitamin D3 Deficiency In New World Monkeys, Simian Bone DiseaseMonkeys, Simian Bone Disease
*cotton top tamarin
49
Anemia Of Owl MonkeysAnemia Of Owl Monkeys
http://www.monkeyland.co.za/Images/Douroucouli2.jpg
*owl monkey
50
Chronic Colitis Of MacaquesChronic Colitis Of Macaques
51
Hypoglycemia
blood glucose < 40 mg/dl
Squirrel monkeys predisposed high metabolic rate
limited glycogen reserves
low body fat
limited ability to utilize ketones & fatty acids
Thank You!!!Thank You!!!
http://www.andyw.com/ruth/pics/funny%20monkey.jpg
Recommended