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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Episode Transcript

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Sarah Wright (00:31):
You're listening to Veterinary Vertex, a podcast
of the AVMA Journals.
In this episode, we chat abouthow topical natroxone
potentiates cutaneous woundhealing in black belt cichlids,
with our guests Anthony Cerretaand Karisa Tang.

Lisa Fortier (00:50):
Welcome to Veterinary Vertex.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Anthony andKarisa joining us.
Thank you guys so much forjoining us here on Veterinary
Vertex Podcast.

Karisa Tang (00:58):
Thanks for having us!

Sarah Wright (00:59):
All right, let's swim on over.
So, Anthony, your AJVR articlediscusses how topical naltrexone
potentiates cutaneous woundhealing in black belt cichlids.
Please share with our listenersthe background on this article.

Anthony Cerreta (01:12):
Cutaneous wounds are pretty commonly seen
in fish, both in public and homeaquaria settings, and that
equates environment is prettyconducive to developing
secondary infections.
So we felt it was prettyimportant to investigate
strategies that will helpimprove wound healing and kind
of mitigate these secondaryeffects.
And the topical naltrexone inIlex ointment was chosen because

(01:35):
it's successfully been used inthe treatment of lateral line
depigmentation in TLA, which isa multifactorial, chronic
integumentary condition thatresults in these depigmented to
ulcerated skin lesions.
So our objective was toevaluate this topical naltrexone
in this kind of acute woundhealing model.

Sarah Wright (01:58):
Yeah, super cool article.
Very clinically applicable too,so I really enjoyed reading it.
And then what are some of theimportant take-home messages?
Um, two big ones is a topicalnaltrexone in ilex ointment,
when it's applied every three tofour days, resulted in
significant improvement both inthe time to visualizing the
resolution of the wound healingand then also significantly

(02:20):
decreased wound area.
And then we didn't see anyadverse effects during routine
health monitoring followingthese repeated treatments,
because we were repeating thetreatments every three to four
days.

Lisa Fortier (02:32):
Karisa, let's turn it over to you now.
What sparked your interest infish wound healing?
Were you a student before astudent, a resident?
Was there a particular case?

Karisa Tang (02:42):
We were all students all the time and
forever for sure.
But, as Anthony mentioned, fishget wounds all the time for
various reasons socialcomplexities, really every
animal but the difference isthey're aquatic, so things are a
little bit harder.
And actually it started with DrGreg Lubart at North Carolina
State University, who wascollaborating with Dr Megan

(03:03):
Strobel at the time at NationalAquarium, now at Shedd yay, who
had mentioned hey, I wonder ifnaltrexone works, like there
were some papers and rodents andhumans and maybe it would work
in a fish, I don't know.
So Dr Megan Strobel actuallyused it in head and lateral line
erosion in a population of fishat National Aquarium this one
time and they all got betterpretty much and it was really

(03:27):
really profound.
And so she and I are friendsbecause our entire community is
very small and we were talkingabout it and I started using it
in a host of different speciesand realized that you know, we
think it works, but of coursethat's not strict science.
So we really wanted to designsomething that could be more
perspective to be able to sharewith the rest of the community.

(03:48):
This works or this doesn't work.
So that was the inspiration.

Lisa Fortier (03:51):
That's awesome, Anthony.
Sarah asked you just a minuteago what are some of the major
findings, but every time we do astudy, we find something that's
surprising, which leads to moreresearch.
What did you find in thisarticle when you were doing this
work that you found surprising?

Anthony Cerreta (04:09):
Zinc funding was just how quickly the wounds
actually healed.
So the wounds were treated withnaltrexone every three to four
days, healed around day 19.
So these were cichlids thatwere kept in kind of traditional
warm, tropical fresh water,freshwater, temperate
environments and in fish.
There is a positive correlationbetween overall water

(04:30):
temperature and how quickly thewounds will close.
But we were pretty surprisedjust to see how rapid the wounds
visually resolved.

Sarah Wright (04:43):
Yeah, also thank you, Karisa, for doing the Greg
Lubart shout out.
He actually was my firstresearch mentor, took a chance
on me as a student when I waslike I want a project.
So, thank you to Greg

Karisa Tang (04:51):
Yeah he is a lot of people's first mentor.
Truly shout out to Greg for allhe has done for the entire
community.

Sarah Wright (04:58):
Agreed.
So this is in cichlidsspecifically, but do you guys
have any plans to look atnaltrexone and other species?
Yeah, so in anythingzoo-related you're looking for a
sample size, and so we had alot of black belt cichlids and
that's why ultimately, the studywas in them.
But, as Anthony said, like whatwe did was kind of

(05:19):
prospectively, make these veryregular, very shallow wounds and
see how they healed.
But in reality we're looking atchronic wounds, like when we
have things that don't heal wellon their own.
How do we fix that?
And it's really hard to be ableto design a study that's
perfect to be able to accountfor that.
So, right now we're kind oftaking cases where we have
chronic wounds already in thecollection and taking lots of

(05:41):
photos and treating them withnaltrexone in different ways so
that we can kind of write it upas a more retrospective thing,
because we're so interested inchronicity.
Very cool.
We hope to see that manuscriptin our journals in the future.
And then, Anthony, do you see arole for AI in this area of
research?

Anthony Cerreta (05:57):
Really good question.
One aspect of this study wewere measuring how we were
measuring the wound area.
So, we were taking photographs,kind of from set distances, of
each of the wounds and thenusing an image processing
software and actually we werekind of manually tracing out the
wounds that it would then useto kind of calculate that wound

(06:18):
area.
But I think AI would be reallyinteresting, both calculating
that wound area and then overallthe scoring system that we were
using and kind of grading howthese wounds were healing.

Sarah Wright (06:29):
Super cool.
I love everyone's responses tothat question.
And then, for those of you justjoining us, we're discussing
how topical naltrexonepotentiates cutaneous wound
healing in black belt cichlidswith our guests Anthony and
Karisa.

Lisa Fortier (06:43):
Anthony, how did your training help you get
through the study design,complete the project and then
get across the finish line andget this article submitted and
published?

Anthony Cerreta (06:54):
Yeah, I think, speaking with Greg Lubart, I was
incredibly lucky to have him asa mentor throughout veterinary
school and then kind of throughinternship, just really gaining
that experience with studydesign and writing.
And then both Karisa and Icompleted the Illinois
Zoological and Aquatic AnimalMedicine residency and that

(07:14):
provides both guidance and kindof mentorship on prospective
study design and executing thesestudies and completed a
master's as part of that program.
So ultimately kind of thatculmination helped with both
kind of learning how to conductthese projects and execute and
write the papers afterwards.

Sarah Wright (07:35):
Good job, my mentor, Karisa.
Now this next set of questionsis going to be really important
for our listeners.
So, Anthony, what is one pieceof information the veterinarian
should know about Topicalnaltrexone for wound healing in
fish?

Anthony Cerreta (07:48):
I think topical naltrexone it's cheap, easy to
apply and even with a shortcontact time if you're applying
it every three to four days willhelp heal acute wounds in fish
quicker.

Sarah Wright (08:01):
Very well said.
And then Karisa, on the otherside of the relationship.
What's one thing a queristshould know about using
naltrexone to help with woundhealing?

Karisa Tang (08:09):
It may seem ridiculous to think about
topical treatments in fish.
Like they're in the water youput them in.
It falls off almost immediatelya lot of the time, except with
Ilex.
But it's not actuallyridiculous.
And what's great is that thispaper, you know, says that and
that, like Anthony said, veryshort contact times can lead to
beneficial conclusions.
So even though it is extrahandling time, it can be very,

(08:31):
very worth it

Lisa Fortier (08:34):
yeah, I'm an equine orthopedic surgeon, so I
learned a lot reading thismanuscript, and even more just
now.
So thank you, uh, as we winddown, we like to ask a little
more of a personal question, soI'll start with you, Anthony.
What is the oldest or the mostinteresting item on your desk or
in your desk drawer?

Anthony Cerreta (08:52):
yeah, I think this is a good one because I
think it's also probably thestrangest.
Um, but we just recently moved,uh removed a trichobesaur from
an echidna, so I currently havea piece of that because we sent
it out to a forensics lab to tryto figure out what the hair is
actually.
So that is probably theinteresting, or most likely
strangest thing on my desk rightnow.

Lisa Fortier (09:13):
Yep, that's strange.
What was the hair?

Anthony Cerreta (09:22):
It's looking like it's actually echidna hair
which stumped every lab becauseno one had that hair.

Lisa Fortier (09:26):
Huh, fascinating Karisa.
How about you?

Karisa Tang (09:27):
Oh, we're just sitting at my desk Shoot.
Okay, I thought I was going to.
I have porcupine quills on mydesk.
We don't currently haveporcupines, but we did at some
point.
So, yeah, I think that's goingto take that cake.

Lisa Fortier (09:44):
Were they from the porcupine or were they from a
patient?
That the porcupine won thebattle?

Karisa Tang (09:49):
You know, that's a very fantastic question.
It's from the porcupine itself,naturally.

Sarah Wright (09:54):
Yeah, well, that's the first time we've had either
of those answers to thatquestion, so we can lecture
diplomats of ACZM.
Well, thank you so much,Anthony and Karisa, for being
here today.
We really appreciate your timeand for sharing your manuscript,
too, with our readers.

Karisa Tang (10:09):
Thank you so much for having us.

Anthony Cerreta (10:11):
Yeah, and for having us.

Sarah Wright (10:12):
And to our listeners.
You can read Anthony andKarisa's article on AJVR.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.