Veterinary Vertex

Beyond the Surface: Rethinking Fish Wound Care with Naltrexone

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We take a fascinating dive into aquatic medicine as Drs. Anthony Cerreta and Karisa Tang share groundbreaking findings on fish wound healing. Their study reveals that topical naltrexone in iLEX ointment significantly accelerates cutaneous wound healing in black belt cichlids—a discovery with profound implications for aquatic veterinary care.

Anthony and Karisa explain how fish wounds present unique challenges due to the constant exposure to water-borne pathogens, making effective treatments critically important yet notoriously difficult to develop. What makes their findings particularly remarkable is the simplicity of the approach: applying naltrexone ointment just once every 3-4 days produced visible healing by day 19, much faster than untreated wounds. Even more surprising was how effective the treatment proved despite minimal contact time with the wounds—challenging conventional wisdom about topical treatments in aquatic animals.

This work builds on previous clinical observations at major aquariums where naltrexone showed promise treating head and lateral line erosion (HLLE). Anthony and Karisa meticulously designed their study to provide the aquatic veterinary community with solid evidence of naltrexone's efficacy. They're now expanding their research to chronic wounds across various species, potentially revolutionizing treatment protocols for fish in both professional and home aquarium settings. Their message to veterinarians and aquarists alike is refreshingly practical: this treatment is inexpensive, easy to apply, and remarkably effective despite the aquatic environment—making it a valuable addition to the limited toolkit available for fish wound management.

Have you encountered challenging wound healing cases in your aquatic patients? Try incorporating this evidence-based approach and share your experiences with the growing community of aquatic veterinary practitioners.

AJVR article: https://doi.org/10.2460/ajvr.24.04.0099

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Sarah Wright:

You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode, we chat about how topical natroxone potentiates cutaneous wound healing in black belt cichlids, with our guests Anthony Cerreta and Karisa Tang.

Lisa Fortier:

Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have Anthony and Karisa joining us. Thank you guys so much for joining us here on Veterinary Vertex Podcast.

Karisa Tang:

Thanks for having us!

Sarah Wright:

All right, let's swim on over. So, Anthony, your AJVR article discusses how topical naltrexone potentiates cutaneous wound healing in black belt cichlids. Please share with our listeners the background on this article.

Anthony Cerreta:

Cutaneous wounds are pretty commonly seen in fish, both in public and home aquaria settings, and that equates environment is pretty conducive to developing secondary infections. So we felt it was pretty important to investigate strategies that will help improve wound healing and kind of mitigate these secondary effects. And the topical naltrexone in Ilex ointment was chosen because it's successfully been used in the treatment of lateral line depigmentation in TLA, which is a multifactorial, chronic integumentary condition that results in these depigmented to ulcerated skin lesions. So our objective was to evaluate this topical naltrexone in this kind of acute wound healing model.

Sarah Wright:

Yeah, super cool article. Very clinically applicable too, so I really enjoyed reading it. And then what are some of the important take-home messages?

Anthony Cerreta:

Um, two big ones is a topical naltrexone in ilex ointment, when it's applied every three to four days, resulted in significant improvement both in the time to visualizing the resolution of the wound healing and then also significantly decreased wound area. And then we didn't see any adverse effects during routine health monitoring following these repeated treatments, because we were repeating the treatments every three to four days.

Lisa Fortier:

Karisa, let's turn it over to you now. What sparked your interest in fish wound healing? Were you a student before a student, a resident? Was there a particular case?

Karisa Tang:

We were all students all the time and forever for sure.

Karisa Tang:

But, as Anthony mentioned, fish get wounds all the time for various reasons social complexities, really every animal but the difference is they're aquatic, so things are a little bit harder.

Karisa Tang:

And actually it started with Dr Greg Lubart at North Carolina State University, who was collaborating with Dr Megan Strobel at the time at National Aquarium, now at Shedd yay, who had mentioned hey, I wonder if naltrexone works, like there were some papers and rodents and humans and maybe it would work in a fish, I don't know. So Dr Megan Strobel actually used it in head and lateral line erosion in a population of fish at National Aquarium this one time and they all got better pretty much and it was really really profound. And so she and I are friends because our entire community is very small and we were talking about it and I started using it in a host of different species and realized that you know, we think it works, but of course that's not strict science. So we really wanted to design something that could be more perspective to be able to share with the rest of the community. This works or this doesn't work. So that was the inspiration.

Lisa Fortier:

That's awesome, Anthony. Sarah asked you just a minute ago what are some of the major findings, but every time we do a study, we find something that's surprising, which leads to more research. What did you find in this article when you were doing this work that you found surprising?

Anthony Cerreta:

Zinc funding was just how quickly the wounds actually healed. So the wounds were treated with naltrexone every three to four days, healed around day 19. So these were cichlids that were kept in kind of traditional warm, tropical fresh water, freshwater, temperate environments and in fish. There is a positive correlation between overall water temperature and how quickly the wounds will close. But we were pretty surprised just to see how rapid the wounds visually resolved.

Sarah Wright:

Yeah, also thank you, Karisa, for doing the Greg Lubart shout out. He actually was my first research mentor, took a chance on me as a student when I was like I want a project.

Sarah Wright:

So, thank you to Greg

Karisa Tang:

Yeah he is a lot of people's first mentor. Truly shout out to Greg for all he has done for the entire community.

Sarah Wright:

Agreed.

Sarah Wright:

So this is in cichlids specifically, but do you guys have any plans to look at naltrexone and other species?

Karisa Tang:

Yeah, so in anything zoo-related you're looking for a sample size, and so we had a lot of black belt cichlids and that's why ultimately, the study was in them. But, as Anthony said, like what we did was kind of prospectively, make these very regular, very shallow wounds and see how they healed. But in reality we're looking at chronic wounds, like when we have things that don't heal well on their own. How do we fix that? And it's really hard to be able to design a study that's perfect to be able to account for that. So, right now we're kind of taking cases where we have chronic wounds already in the collection and taking lots of photos and treating them with naltrexone in different ways so that we can kind of write it up as a more retrospective thing, because we're so interested in chronicity.

Sarah Wright:

Very cool. We hope to see that manuscript in our journals in the future. And then, Anthony, do you see a role for AI in this area of research?

Anthony Cerreta:

Really good question. One aspect of this study we were measuring how we were measuring the wound area. So, we were taking photographs, kind of from set distances, of each of the wounds and then using an image processing software and actually we were kind of manually tracing out the wounds that it would then use to kind of calculate that wound area. But I think AI would be really interesting, both calculating that wound area and then overall the scoring system that we were using and kind of grading how these wounds were healing.

Sarah Wright:

Super cool. I love everyone's responses to that question. And then, for those of you just joining us, we're discussing how topical naltrexone potentiates cutaneous wound healing in black belt cichlids with our guests Anthony and Karisa.

Lisa Fortier:

Anthony, how did your training help you get through the study design, complete the project and then get across the finish line and get this article submitted and published?

Anthony Cerreta:

Yeah, I think, speaking with Greg Lubart, I was incredibly lucky to have him as a mentor throughout veterinary school and then kind of through internship, just really gaining that experience with study design and writing. And then both Karisa and I completed the Illinois Zoological and Aquatic Animal Medicine residency and that provides both guidance and kind of mentorship on prospective study design and executing these studies and completed a master's as part of that program. So ultimately kind of that culmination helped with both kind of learning how to conduct these projects and execute and write the papers afterwards.

Sarah Wright:

Good job, my mentor, Karisa. Now this next set of questions is going to be really important for our listeners. So, Anthony, what is one piece of information the veterinarian should know about Topical naltrexone for wound healing in fish?

Anthony Cerreta:

I think topical naltrexone it's cheap, easy to apply and even with a short contact time if you're applying it every three to four days will help heal acute wounds in fish quicker.

Sarah Wright:

Very well said. And then Karisa, on the other side of the relationship. What's one thing a querist should know about using naltrexone to help with wound healing?

Karisa Tang:

It may seem ridiculous to think about topical treatments in fish. Like they're in the water you put them in. It falls off almost immediately a lot of the time, except with Ilex. But it's not actually ridiculous. And what's great is that this paper, you know, says that and that, like Anthony said, very short contact times can lead to beneficial conclusions.

Karisa Tang:

So even though it is extra handling time, it can be very, very worth it

Lisa Fortier:

yeah, I'm an equine orthopedic surgeon, so I learned a lot reading this manuscript, and even more just now. So thank you, uh, as we wind down, we like to ask a little more of a personal question, so I'll start with you, Anthony. What is the oldest or the most interesting item on your desk or in your desk drawer?

Anthony Cerreta:

yeah, I think this is a good one because I think it's also probably the strangest. Um, but we just recently moved, uh removed a trichobesaur from an echidna, so I currently have a piece of that because we sent it out to a forensics lab to try to figure out what the hair is actually. So that is probably the interesting, or most likely strangest thing on my desk right now.

Lisa Fortier:

Yep, that's strange. What was the hair?

Anthony Cerreta:

It's looking like it's actually echidna hair which stumped every lab because no one had that hair.

Lisa Fortier:

Huh, fascinating Karisa. How about you?

Karisa Tang:

Oh, we're just sitting at my desk Shoot. Okay, I thought I was going to. I have porcupine quills on my desk. We don't currently have porcupines, but we did at some point. So, yeah, I think that's going to take that cake.

Lisa Fortier:

Were they from the porcupine or were they from a patient? That the porcupine won the battle?

Karisa Tang:

You know, that's a very fantastic question. It's from the porcupine itself, naturally.

Sarah Wright:

Yeah, well, that's the first time we've had either of those answers to that question, so we can lecture diplomats of ACZM. Well, thank you so much, Anthony and Karisa, for being here today. We really appreciate your time and for sharing your manuscript, too, with our readers.

Karisa Tang:

Thank you so much for having us.

Anthony Cerreta:

Yeah, and for having us.

Sarah Wright:

And to our listeners. You can read Anthony and Karisa's article on AJVR. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.

People on this episode

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Lisa Fortier, DVM, PhD, DACVS

Co-host
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Sarah Wright, DVM

Co-host
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Anthony Cerreta, DVM, MS, DACZM

Guest