Treatment Factors Influencing the Use of Recombinant Platelet-Derived Growth Factor (Regranex®) For Head and Lateral Line Erosion Syndrome in Ocean Surgeons (Acanthurus bahianus)
IAAAM 2005
Greg Fleming; A. Jeanene McCoy; Allison Corwin; M. Andrew Stamper
Disney's Animal Programs, Walt Disney World® Resort
Lake Buena Vista, FL, USA


Head and Lateral Line Erosion Syndrome (HLLES) in fish has long been a frustration of the aquarium and pet industry. The disease syndrome, which causes dermal erosions of the head and or body regions along the lateral line, has been well described, but the pathophysiology and underlying cause remains unclear and has been a focus of much debate.1 Staff from the New England Aquarium and Angiogenesis Foundation has demonstrated resolution of HLLES with the use of becaplermin (Regranex®, Ortho-McNeil Pharmaceutical, Inc., Raritan, New Jersey 08869) when the drug was applied weekly for eight weeks.2 Since Regranex® is extremely expensive and repetitive anesthesias are stressful on fish, this study was designed to determine how to most efficiently use the drug.

This study examined the use of Regranex® applied once, and then every three weeks, to determine whether a reduction either in the number of treatments or frequency would have a similar healing effect. Twelve juvenile ocean surgeons with HLLES were equally and randomly divided between the two treatment groups and a control group. Every three weeks, progression of the disease was monitored through photo documentation, and the surface area was calculated through computer assisted analysis. After a 12-week treatment period, the fish were anesthetized every three weeks for an additional six weeks for follow-up with photo documentation and surface area analysis. Prior to the study, the development of HLLES in the experimental fish was determined to be static or slightly progressing. The HLLES visually healed in both treatment groups, but not the control group. HLLES in the one-time treatment fish was not clinically or significantly different from the fish treated every three weeks. To study the effects of environmental conditions of treatment efficacy, eleven unaffected ocean surgeons were placed in water known to create HLLES and photo documented. After three weeks they developed moderate to severe HLLES. The fish were then treated once with Regranex®. The one-time treatment did not have an effect, and lesions progressed throughout the study, which was terminated early after only two weeks time.

By examining the treatment effects of a single application versus multiple applications of the drug, and of differing physical environments, this study was to determine the maximum efficacy of Regranex® to stimulate epithelial growth in ocean surgeons (Acanthurus bahianus) with HLLES. It was found that a one-time application was as effective as treatments performed once every three weeks. It was also determined that when applied to fish in an environment which created HLLES, the one-time treatment regime did not work and the erosions quickly progressed.


The authors wish to thank Scott Barrie, Sarah Wickman, Jennifer Thompson, Brian Dorn, and Allen McDowell for their assistance with fish husbandry and data collection. We would also like to acknowledge Scott Terrell for his histological assessment of the fish tissues.


1.  Blasiola GC. 1989. Description, preliminary studies and probable etiology of head and lateral line erosions (HLLE) of the palette tang, Paracanthurus hepatus (Linnaeus, 1758) and other Acanthurids. Deuxième Congrès International d'Aquariologie (1988) Monaco, 1989. Bulletin de l-Institut océanographique, Monaco, n° spécial 5: 255-263.

2.  Boerner L, K Dube, K Peterson, S Weber, V Li, W Li, C Bonar. 2003. Angiogenic growth factor therapy using recombinant platelet-derived growth factor (Regrenex) for lateral line disease in marine fish. Proceedings for the 34th Annual Conference of the International Association for Aquatic Animal Medicine. May 9th-14th, 2003 Waikoloa, HI, vol 34: 117-119.

3.  Wieman TJ, Smiell JM, Su Y. 1998. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic naturopathic diabetic ulcers. A phase III randomized placebo-controlled double-blind study. Diabetes Care. 21: 822-827.

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Gregory J. Fleming, DVM