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Airaksinen J, Siimes S, Hartikainen J, Ylä-Herttuala S. Long-term continuous monitoring of arrhythmias in pigs with insertable cardiac monitors. Pflugers Arch 2024; 476:1145-1154. [PMID: 38703193 PMCID: PMC11166848 DOI: 10.1007/s00424-024-02962-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
Arrhythmia detection is essential when assessing the safety of novel drugs and therapies in preclinical studies. Many short-term arrhythmia monitoring methods exist, including non-invasive ECG and Holter. However, there are no reliable, long-term, non-invasive, or minimally invasive methods for cardiac arrhythmia follow-up in large animals that allows free movement with littermates. A long follow-up time is needed when estimating the impact of long-lasting drugs or therapies, such as gene therapy. We evaluated the feasibility and performance of insertable cardiac monitors (ICMs) in pigs for minimally invasive, long-term monitoring of cardiac arrhythmias that allows free movement and species-specific behavior. Multiple implantation sites were tested to assess signal quality. ICMs recognized reliably many different arrhythmias but failed to detect single extrasystoles. They also over-diagnosed T-waves, resulting in oversensing. Muscle activity and natural startles of the animals caused noise, leading to a heterogeneous signal requiring post-recording evaluation. In spite of these shortcomings, the ICMs showed to be very useful for minimally invasive long-term monitoring of cardiac rhythm in pigs.
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Affiliation(s)
- Jonna Airaksinen
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Satu Siimes
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Seppo Ylä-Herttuala
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
- Heart Center, Kuopio University Hospital, Kuopio, Finland.
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Engwall MJ, Baublits J, Chandra FA, Jones ZW, Wahlstrom J, Chui RW, Vargas HM. Evaluation of levocetirizine in beagle dog and cynomolgus monkey telemetry assays: Defining the no QTc effect profile by timepoint and concentration-QTc analysis. Clin Transl Sci 2023; 16:436-446. [PMID: 36369797 PMCID: PMC10014691 DOI: 10.1111/cts.13454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Abstract
In prior clinical studies, levocetirizine (LEVO) has demonstrated no effect on ventricular repolarization (QTc intervals), therefore it is a relevant negative control to assess in nonclinical assays to define low proarrhythmic risk. LEVO was tested in beagle dog and cynomolgus monkey (nonhuman primate [NHP]) telemetry models to understand the nonclinical-clinical translation of this negative control. One oral dose of vehicle, LEVO (10 mg/kg/species) or moxifloxacin (MOXI; 30 mg/kg/dog; 80 mg/kg/NHP) was administered to instrumented animals (N = 8/species) using a cross-over dosing design; MOXI was the in-study positive control. Corrected QT interval values (QTcI) were calculated using an individual animal correction factor. Blood samples were taken for drug exposure during telemetry and for pharmacokinetic (PK) analysis (same animals; different day) for exposure-response (C-QTc) modeling. Statistical analysis of QTc-by-timepoint data showed that LEVO treatment was consistent with vehicle, thus no effect on ventricular repolarization was observed over 24 h in both species. PK analysis indicated that LEVO-maximum concentration levels in dogs (range: 12,300-20,100 ng/ml) and NHPs (range: 4090-12,700 ng/ml) were ≥4-fold higher than supratherapeutic drug levels in clinical QTc studies. Slope analysis values in dogs (0.00019 ms/ng/ml) and NHPs (0.00016 ms/ng/ml) were similar to the human C-QTc relationship and indicated no relationship between QTc intervals and plasma levels of LEVO. MOXI treatment caused QTc interval prolongation (dog: 18 ms; NHP: 29 ms). The characterization of LEVO in these non-rodent telemetry studies further demonstrates the value and impact of the in vivo QTc assay to define a "no QTc effect" profile and support clinical safety assessment.
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Affiliation(s)
- Michael J Engwall
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
| | - Joel Baublits
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
| | - Fiona A Chandra
- Amgen Clinical Pharmacology Modeling & Simulation, Thousand Oaks, California, USA
| | - Zack W Jones
- Amgen Clinical Pharmacology Modeling & Simulation, Thousand Oaks, California, USA
| | - Jan Wahlstrom
- Pharmacokinetics, Amgen Research, Thousand Oaks, California, USA
| | - Ray W Chui
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
| | - Hugo M Vargas
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
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Improving corrected QT; Why individual correction is not enough. J Pharmacol Toxicol Methods 2021; 113:107126. [PMID: 34655760 DOI: 10.1016/j.vascn.2021.107126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 01/10/2023]
Abstract
The use of QT-prolongation as a biomarker for arrhythmia risk requires that researchers correct the QT-interval (QT) to control for the influence of heart rate (HR). QT correction methods can vary but most used are the universal correction methods, such as Bazett's or Van de Water's, which use a single correction formula to correct QT-intervals in all the subjects of a study. Such methods fail to account for differences in the QT/HR relationship between subjects or over time, instead relying on the assumption that this relationship is consistent. To address these changes in rate relationships, we test the effectiveness of linear and non-linear individual correction methods. We hypothesize that individual correction methods that account for additional influences on the rate relationship will result in more effective and consistent correction. To increase the scope of this study we use bootstrap sampling on ECG recordings from non-human primates and beagle canines dosed with vehicle control. We then compare linear and non-linear individual correction methods through their ability to reduce HR correlation and standard deviation of corrected QT values. From these results, we conclude that individual correction methods based on post-treatment data are most effective with the linear methods being the best option for most cases in both primates and canines. We also conclude that the non-linear methods are more effective in canines than primates and that accounting for light status can improve correction while examining the data from the light periods separately. Individual correction requires careful consideration of inter-subject and intra-subject variabilities.
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Hong M, Wei L, Duan H, Chen T, Shi L, You Y, Chen Y, Li H, Ma J. Biological variations in hemodynamics and electrocardiogram rhythms among telemetered cynomolgus monkeys. J Pharmacol Toxicol Methods 2021; 112:107108. [PMID: 34363962 DOI: 10.1016/j.vascn.2021.107108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Telemetered cynomolgus monkeys are widely used in cardiovascular toxicology research. However, the biological variations in their hemodynamics and electrocardiogram rhythms have not been fully elucidated. METHOD To determine the potential effects of sex, handling stress, and circadian rhythm on the hemodynamics and electrocardiogram rhythms, data from 23 cynomolgus monkeys, implanted with DSI telemetry devices were examined. RESULTS Our data showed that males had a longer RR interval (RRi), slower heart rate (HR), shorter QT and corrected QT intervals (QTc), and lower blood pressure than females. During the night time, the animals showed a longer RRi, PRi, QTi, and QTc; slower HR, and lower blood pressure. Handling stress at 0.25- to 1-h post-treatment caused a decrease in RRi and increase in HR and QTi. For RRi, HR, and systolic, diastolic, and mean blood pressure, the coefficients of variation (CVs) between studies of individual animals were less than 30%; for other parameters, the CVs were less than 20%. DISCUSSION We demonstrated that sex, circadian rhythms, and handling stress all contributed towards variations in telemetry data, albeit to different extents. For each individual animal, the biological variation across different studies was relatively small and acceptable.
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Affiliation(s)
- Min Hong
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Liping Wei
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Huailong Duan
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Tao Chen
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Lei Shi
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Yanfei You
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Yan Chen
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Hua Li
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Jing Ma
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
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Chui RW, Baublits J, Chandra FA, Jones ZW, Engwall MJ, Vargas HM. Evaluation of moxifloxacin in canine and non-human primate telemetry assays: Comparison of QTc interval prolongation by timepoint and concentration-QTc analysis. Clin Transl Sci 2021; 14:2379-2390. [PMID: 34173339 PMCID: PMC8604216 DOI: 10.1111/cts.13103] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022] Open
Abstract
The in vivo correct QT (QTc) assay is used by the pharmaceutical industry to characterize the potential for delayed ventricular repolarization and is a core safety assay mentioned in International Conference on Harmonization (ICH) S7B guideline. The typical telemetry study involves a dose‐response analysis of QTc intervals over time using a crossover (CO) design. This method has proven utility but does not include direct integration of pharmacokinetic (PK) data. An alternative approach has been validated and is used routinely in the clinical setting that pairs pharmacodynamic (PD) responses with PK exposure (e.g., concentration‐QTc (C‐QTc) analysis. The goal of our paper was to compare the QTc sensitivity of two experimental approaches in the conscious dog and non‐human primate (NHP) QTc assays. For timepoint analysis, a conventional design using eight animals (8 × 4 CO) to detect moxifloxacin‐induced QTc prolongation was compared to a PK/PD design in a subset (N = 4) of the same animals. The findings demonstrate that both approaches are equally sensitive in detecting threshold QTc prolongation on the order of 10 ms. Both QTc models demonstrated linearity in the QTc prolongation response to moxifloxacin dose escalation (6 to 46 ms). Further, comparison with human QTc findings with moxifloxacin showed agreement and consistent translation across the three species: C‐QTc slope values were 0.7‐ (dog) and 1.2‐ (NHP) fold of the composite human value. In conclusion, our data show that dog and NHP QTc telemetry with an integrated PK arm (C‐QTc) has the potential to supplement clinical evaluation and improve integrated QTc risk assessment.
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Affiliation(s)
- Ray W Chui
- Amgen Research, Thousand Oaks, California, USA
| | | | - Fiona A Chandra
- Amgen Translational Medicine, Thousand Oaks, California, USA
| | - Zack W Jones
- Amgen Translational Medicine, Thousand Oaks, California, USA
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Genetic Toxicology and Safety Pharmacological Evaluation of Forsythin. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6610793. [PMID: 34239584 PMCID: PMC8233079 DOI: 10.1155/2021/6610793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/21/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022]
Abstract
Introduction Forsythin is the main ingredient of Forsythia suspensa and is widely used in treatment of fever, viral cold, gonorrhea, and ulcers clinically. This study aimed to evaluate the potential genetic toxicity of forsythin and its safety for human use. Methods Based on the Good Laboratory Practice regulations and test guidelines, the genetic toxicity of forsythin was assessed by the Ames test, chromosome aberration (CA) test, and bone marrow micronucleus (MN) test in vivo. In the Ames test, five strains of Salmonella typhimurium were exposed to different concentrations of forsythin in the presence or absence of the S9 mixture, and then, the number of His + revertant colonies was counted. In the CA test, Chinese hamster lung (CHL) fibroblast cells were treated with different concentrations of forsythin, mitomycin C, or cyclophosphamide in the presence or absence of the S9 mixture, and the chromosomal aberrations were determined. In the MN test, bone marrow was isolated from the mice with different treatments, and the ratios of polychromatic erythrocytes (PCE) and erythrocytes (PCE/(PCE + NCE)) were measured. Finally, beagle dogs were divided into four groups (negative control, low dose, medium dose, and high dose groups), and then, a telemetry system was used to evaluate the safe use of forsythin. Results Ames test results showed that the number of colonies in all test strains with different treatments showed no significantly dose-dependent increase in the presence or absence of the S9 mixture (p > 0.05). In the CA test, the number of cells with aberrations in the CHL fibroblast cells treated with low, medium, and high doses of forsythin for 24/48 h in the absence of the S9 mixture was, respectively, 5.0/2.5, 4.5/1.5, and 5.0/5.0, and in the presence of the S9 mixture, the number was, respectively, 5.0, 5.0, and 4.5. These results showed that there was no significant difference compared to the negative control group either in the presence (2.0) or in the absence (4.0/2.5 for 24/48 h) of the S9 mixture (p > 0.05). The MN test showed that the values of PCE/(PCE + NCE) in the negative, positive controls, and forsythin treatment groups were all more than 20%, which indicated that forsythin had no cytotoxicity. Additionally, no significant toxicological effects of forsythin on blood pressure, respiration, temperature, electrocardiogram, and other physiological indicators in the conscious beagle dogs of different groups were observed by the telemetry method. Conclusion Our findings showed that forsythin has low probability of genetic toxicity and no significant toxicological effects, which implied that forsythin is suitable for further development and potential application.
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Lee NN, Salzer E, Bach FC, Bonilla AF, Cook JL, Gazit Z, Grad S, Ito K, Smith LJ, Vernengo A, Wilke H, Engiles JB, Tryfonidou MA. A comprehensive tool box for large animal studies of intervertebral disc degeneration. JOR Spine 2021; 4:e1162. [PMID: 34337336 PMCID: PMC8313180 DOI: 10.1002/jsp2.1162] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
Preclinical studies involving large animal models aim to recapitulate the clinical situation as much as possible and bridge the gap from benchtop to bedside. To date, studies investigating intervertebral disc (IVD) degeneration and regeneration in large animal models have utilized a wide spectrum of methodologies for outcome evaluation. This paper aims to consolidate available knowledge, expertise, and experience in large animal preclinical models of IVD degeneration to create a comprehensive tool box of anatomical and functional outcomes. Herein, we present a Large Animal IVD Scoring Algorithm based on three scales: macroscopic (gross morphology, imaging, and biomechanics), microscopic (histological, biochemical, and biomolecular analyses), and clinical (neurologic state, mobility, and pain). The proposed algorithm encompasses a stepwise evaluation on all three scales, including spinal pain assessment, and relevant structural and functional components of IVD health and disease. This comprehensive tool box was designed for four commonly used preclinical large animal models (dog, pig, goat, and sheep) in order to facilitate standardization and applicability. Furthermore, it is intended to facilitate comparison across studies while discerning relevant differences between species within the context of outcomes with the goal to enhance veterinary clinical relevance as well. Current major challenges in pre-clinical large animal models for IVD regeneration are highlighted and insights into future directions that may improve the understanding of the underlying pathologies are discussed. As such, the IVD research community can deepen its exploration of the molecular, cellular, structural, and biomechanical changes that occur with IVD degeneration and regeneration, paving the path for clinically relevant therapeutic strategies.
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Affiliation(s)
- Naomi N. Lee
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - Elias Salzer
- Orthopaedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Frances C. Bach
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Andres F. Bonilla
- Preclinical Surgical Research Laboratory, Department of Clinical SciencesColorado State UniversityColoradoUSA
| | - James L. Cook
- Thompson Laboratory for Regenerative OrthopaedicsUniversity of MissouriColumbiaMissouriUSA
| | - Zulma Gazit
- Department of SurgeryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | | | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Lachlan J. Smith
- Departments of Neurosurgery and Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrea Vernengo
- AO Research Institute DavosDavosSwitzerland
- Department of Chemical EngineeringRowan UniversityGlassboroNew JerseyUSA
| | - Hans‐Joachim Wilke
- Institute of Orthopaedic Research and BiomechanicsUniversity Hospital UlmUlmGermany
| | - Julie B. Engiles
- Department of Pathobiology, New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
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Zhang Y, Jiang Y, Chang P, Kang Y, Gong D, Liu J, Zhang W. Safety Pharmacology Study of ET-26 Hydrochloride, a Potential Drug for Intravenous General Anesthesia, in Rats and Beagle Dogs. Front Pharmacol 2021; 12:679381. [PMID: 34135759 PMCID: PMC8201096 DOI: 10.3389/fphar.2021.679381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023] Open
Abstract
Background: ET-26 hydrochloride (ET-26HCl), a class 1 new drug, was developed to reserve the advantages of etomidate with a mild adrenocortical inhibition. Purpose: this study was to evaluate the potential adverse effects on the cardiovascular system of beagle dogs and the respiratory and central nervous systems of rats. Methods: three established methods, the whole-body plethysmography for respiratory function, the prototype telemetry transmitter for cardiovascular function, and the standardized functional observational battery for central nervous system function, were accomplished with Good Laboratory Practice standards. Results: no significant difference in the tidal volume, but the respiratory rate and minute ventilation were reduced. The degree of inhibition was the most serious in the first 15 min after dosing and function fully recovered after 1 h. For male rats, the respiratory rate of male rats was reduced significantly at 15 min after injection with ET-26HCl (4 mg/kg, 28.6%, p ≤ 0.01; 8 mg/kg, 24.5%, p ≤ 0.01; 16 mg/kg, 44.5%, p ≤ 0.001), and the minute ventilation at 15 min was decreased by 20.1% (4 mg/kg, p = 0.034), 22.2% (8 mg/kg, p = 0.019), and 44.6% (16 mg/kg, p ≤ 0.001) as compared to control group. As with male rats, the respiratory rate of the female rats was reduced significantly at 15 min (4 mg/kg, 23.3%, p ≤ 0.01; 8 mg/kg, 29.2%, p ≤ 0.001; 16 mg/kg, 44.1%, p ≤ 0.001), and the minute ventilation was decreased by 25.2% (4 mg/kg, p ≤ 0.001), 23.0% (8 mg/kg, p ≤ 0.01), and 47.6% (16 mg/kg, p ≤ 0.001). Then, all the variations in cardiovascular functions were within the expected range for normal biological variation, we concluded that ET-26HCl, even at 10-fold ED50, still does not exert toxicological effects on the cardiovascular system. For male beagle dogs, the systolic blood pressure after 24 h following administration of vehicle control or 8, 12, or 16 mg/kg ET-26HCl was 137.80 ± 5.55, 131.76 ± 10.03, 139.88 ± 8.35, and 141.28 ± 8.75 mmHg, respectively. The diastolic blood pressure was 71.16 ± 4.84, 66.52 ± 8.50, 73.64 ± 8.51, and 74.24 ± 8.68 mmHg, respectively. For female beagle dogs, the systolic blood pressure after 24 h following administration of vehicle control or 8, 12, or 16 mg/kg ET-26HCl was 128.28 ± 5.22, 124.76 ± 7.29, 134.88 ± 5.56, and 135.36 ± 8.72 mmHg, respectively. The diastolic blood pressure was 67.00 ± 4.10, 62.12 ± 7.87, 69.44 ± 6.40, and 70.20 ± 8.42 mmHg, respectively. In central nervous system function experiment, all the changes observed in the functional observational battery tests, including motor activity, behavior, coordination, and sensory and motor reflex responses, and reduced body temperature, were resulted in general anesthesia effect of ET-26HCl. Conclusion: ET-26HCl exerts mild, reversible effects on respiratory, cardiovascular, and central nervous system function as verified by standard in vivo animal models.
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Affiliation(s)
- YuJun Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - YingYing Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Pan Chang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Kang
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - DeYing Gong
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - WenSheng Zhang
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.,National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
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The in vivo QTc core assay: An evaluation of QTc variability, detection sensitivity and implications for the improvement of conscious dog and non-human primate telemetry studies. J Pharmacol Toxicol Methods 2021; 109:107067. [PMID: 33857614 DOI: 10.1016/j.vascn.2021.107067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/26/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022]
Abstract
The ICH S7B guideline describes the requirement to conduct an in vitro IKr (hERG) and in vivo QTc assay for human risk assessment of new drug products, but the guidance is devoid of recommendations on study execution or quality. In the absence of standard practice, multiple study designs and experimental approaches have been utilized, especially with the nonclinical QTc assay. Since 2009, our approach to the in vivo QTc assay has been consistent for small molecules and yields reproducible and sensitive levels for QTc signal detection. Our database and experience indicate that nonrodent telemetry studies can achieve high sensitivity and a calculated metric of study power can be used to indicate study quality. Using a retrospective statistical power analysis of multiple studies (n = 14 dog; n = 6 NHP), the detection sensitivity for a specific study design (N = 8; double Latin square cross-over) was determined. The output of the power analysis is the minimal detectable effect at 80% power and a 95% probability level. The design provided an average sensitivity to detect a 4.7 (2.0%) and 6.5 (1.9%) msec QTcI change in dog and NHP, respectively. These findings suggest that this experimental approach has a consistent and reproducible sensitivity to enable a robust QTcI risk evaluation and can be used confidently to support an integrated nonclinical-clinical pro-arrhythmia risk assessment. The inclusion of power analysis (i.e., QTc sensitivity) data in a regulatory submission provides key information to critical stakeholders about the quality of the in vivo QTc assessment and its value for human safety testing.
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Baldrick P. Core battery safety pharmacology testing - An assessment of its utility in early drug development. J Pharmacol Toxicol Methods 2021; 109:107055. [PMID: 33813006 DOI: 10.1016/j.vascn.2021.107055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/11/2021] [Accepted: 03/27/2021] [Indexed: 02/06/2023]
Abstract
Requirements for safety pharmacology testing have been in place since the issue of initial regulatory guidance over 20 years ago. An evaluation of such testing, supporting first clinical entry of 105 small molecule drug candidates over the last decade, showed that a "core battery" of in vitro electrophysiological (hERG), conscious non-rodent telemetry cardiovascular, rodent central nervous system (CNS) (modified Irwin's or functional observational battery [FOB] test) and respiratory function (plethysmography) studies was performed. Routine use of the latter 2 studies appears to have limited utility, with only 21% and 28% of studies, respectively, giving findings of which none were identified as of obvious concern to moving the affected drugs into the clinic. The use of a stand-alone hERG assay does not appear to be particular sensitive in predicting proarrythmic risk as a tool by itself. Telemetry study testing had utility especially for identifying effects on QTc interval (about 10% of studies), resulting on some occasions in a lower clinical starting dose and/or increased awareness for potential effects on the cardiovascular system in the Phase I study. Overall, this investigation provides information supporting an overhaul of the current "box ticking" core battery approach used for safety pharmacology testing. However, in order to achieve a more focused examination to investigate potential undesirable pharmacodynamic effects of a new candidate drug and also support 3Rs (Replacement, Reduction and Refinement) thinking in performing unnecessary studies, there will not only need to be a sea change by drug developers but also a change in current regulatory guidance.
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Affiliation(s)
- Paul Baldrick
- Strategic Product Development Consulting, Covance Clinical & Commercialisation Services, Covance, Harrogate, North Yorkshire HG3 1PY, United Kingdom.
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Vargas HM, Rolf MG, Wisialowski TA, Achanzar W, Bahinski A, Bass A, Benson CT, Chaudhary KW, Couvreur N, Dota C, Engwall MJ, Michael Foley C, Gallacher D, Greiter-Wilke A, Guillon JM, Guth B, Himmel HM, Hegele-Hartung C, Ito M, Jenkinson S, Chiba K, Lagrutta A, Levesque P, Martel E, Okai Y, Peri R, Pointon A, Qu Y, Teisman A, Traebert M, Yoshinaga T, Gintant GA, Leishman DJ, Valentin JP. Time for a Fully Integrated Nonclinical-Clinical Risk Assessment to Streamline QT Prolongation Liability Determinations: A Pharma Industry Perspective. Clin Pharmacol Ther 2020; 109:310-318. [PMID: 32866317 PMCID: PMC7891594 DOI: 10.1002/cpt.2029] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/13/2020] [Indexed: 02/03/2023]
Abstract
Defining an appropriate and efficient assessment of drug‐induced corrected QT interval (QTc) prolongation (a surrogate marker of torsades de pointes arrhythmia) remains a concern of drug developers and regulators worldwide. In use for over 15 years, the nonclinical International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) S7B and clinical ICH E14 guidances describe three core assays (S7B: in vitro hERG current & in vivo QTc studies; E14: thorough QT study) that are used to assess the potential of drugs to cause delayed ventricular repolarization. Incorporating these assays during nonclinical or human testing of novel compounds has led to a low prevalence of QTc‐prolonging drugs in clinical trials and no new drugs having been removed from the marketplace due to unexpected QTc prolongation. Despite this success, nonclinical evaluations of delayed repolarization still minimally influence ICH E14‐based strategies for assessing clinical QTc prolongation and defining proarrhythmic risk. In particular, the value of ICH S7B‐based “double‐negative” nonclinical findings (low risk for hERG block and in vivo QTc prolongation at relevant clinical exposures) is underappreciated. These nonclinical data have additional value in assessing the risk of clinical QTc prolongation when clinical evaluations are limited by heart rate changes, low drug exposures, or high‐dose safety considerations. The time has come to meaningfully merge nonclinical and clinical data to enable a more comprehensive, but flexible, clinical risk assessment strategy for QTc monitoring discussed in updated ICH E14 Questions and Answers. Implementing a fully integrated nonclinical/clinical risk assessment for compounds with double‐negative nonclinical findings in the context of a low prevalence of clinical QTc prolongation would relieve the burden of unnecessary clinical QTc studies and streamline drug development.
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Affiliation(s)
- Hugo M Vargas
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
| | - Michael G Rolf
- Research & Development, Clinical Pharmacology & Safety Sciences, AstraZeneca, Gothenburg, Sweden
| | - Todd A Wisialowski
- Global Safety Pharmacology, Pfizer Global Research and Development, Groton, Connecticut, USA
| | | | | | - Alan Bass
- Merck & Co., Inc., Boston, Massachusetts, USA
| | | | | | - Nicolas Couvreur
- Safety Pharmacology, Institute de Recherches Servier, Suresnes, France
| | - Corina Dota
- Research & Development, Chief Medical Officer Organization, AstraZeneca, Gothenburg, Sweden
| | - Michael J Engwall
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
| | - C Michael Foley
- Integrative Pharmacology, Abbvie, Inc, North Chicago, Illinois, USA
| | - David Gallacher
- Global Safety Pharmacology, Janssen Research & Development, Beerse, Belgium
| | | | | | - Brian Guth
- Department of Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | | | | | - Maki Ito
- Japan Pharmaceutical Manufacturers Association, Tokyo, Japan
| | - Stephen Jenkinson
- Global Safety Pharmacology, Pfizer Global Research and Development, San Diego, California, USA
| | - Katsuyoshi Chiba
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | | | - Paul Levesque
- BMS Bristol-Myers Squibb Company, Princeton, New Jersey, USA
| | - Eric Martel
- Department of Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Yoshiko Okai
- Takeda Pharmaceutical Company Ltd., Fujisawa, Kanagawa, Japan
| | - Ravikumar Peri
- Takeda Pharmaceutical Company Ltd., Cambridge, Massachusetts, USA
| | - Amy Pointon
- Research & Development, Clinical Pharmacology & Safety Sciences, AstraZeneca, Cambridge, UK
| | - Yusheng Qu
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
| | - Ard Teisman
- Global Safety Pharmacology, Janssen Research & Development, Beerse, Belgium
| | - Martin Traebert
- Safety Pharmacology, Novartis Institute of Biomedical Research, Basel, Switzerland
| | | | - Gary A Gintant
- Integrative Pharmacology, Abbvie, Inc, North Chicago, Illinois, USA
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Pereira PJS, Pugsley MK, Troncy E, Tan W, Pouliot M, Harper C, Prefontaine A, Easter A, Wallis R, Miraucourt L, Huang H, Accardi MV, Boulay E, Maghezzi MS, Authier S. Incidence of spontaneous arrhythmias in freely moving healthy untreated Sprague-Dawley rats. J Pharmacol Toxicol Methods 2019; 99:106589. [PMID: 31154034 DOI: 10.1016/j.vascn.2019.106589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/07/2019] [Accepted: 05/25/2019] [Indexed: 12/18/2022]
Abstract
Spontaneous arrhythmia characterization in healthy rats can support interpretation when studying novel therapies. Male (n = 55) and female (n = 40) Sprague-Dawley rats with telemetry transmitters for a derivation II ECG. Arrhythmias were assessed from continuous ECG monitoring over a period of 24-48 h, and data analyzed using an automated detection algorithm with 100% manual over-read. While a total of 1825 spontaneous ventricular premature beats (VPB) were identified, only 7 rats (or 7.4%) did not present with any over the recording period. Spontaneous episode(s) of ventricular tachycardia (VT) were noted in males (27%) and females (3%). The incidence of VPB was significantly higher (p < 0.01) during the night time (7 pm-7 am) compared to daytime, while males presented with significantly (p < 0.001) more VPB than females. Most VPB were observed as single ectopic beats, followed by salvos (2 or 3 consecutive VPBs), and VT (i.e. 4 consecutive VPBs). Most VPBs were single premature ventricular contractions (PVCs) (57%), while the remaining were escape complexes (43%). Spontaneous premature junctional complexes (PJC) were also observed and were significantly more frequent during the night, and in males. Lastly, 596 episodes of spontaneous 2nd-degree atrioventricular (AV) block were identified and were significantly more frequent during the day time in males. Most 2nd-degree AV block episodes were Mobitz type I (57%), with a significantly (p < 0.05) higher incidence in males. This work emphasizes the importance of obtaining sufficient baseline data when undertaking arrhythmia analysis in safety study and provides a better understanding of both sex- and time- dependent effects of spontaneous arrhythmias in rats.
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Affiliation(s)
| | | | - Eric Troncy
- Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, QC, Canada
| | - Wendy Tan
- Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, QC, Canada
| | | | | | | | - Alison Easter
- Praxis Precision Medicines, Cambridge, MA, United States of America
| | - Rob Wallis
- Safety Pharmacology Consultant, London, United Kingdom
| | | | | | | | - Emmanuel Boulay
- Citoxlab, Laval, QC, Canada; Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, QC, Canada
| | | | - Simon Authier
- Citoxlab, Laval, QC, Canada; Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, QC, Canada.
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Woodger T. Smart undershirt. Lab Anim (NY) 2017; 46:406-407. [PMID: 28984850 DOI: 10.1038/laban.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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Prior H, Bottomley A, Champéroux P, Cordes J, Delpy E, Dybdal N, Edmunds N, Engwall M, Foley M, Hoffmann M, Kaiser R, Meecham K, Milano S, Milne A, Nelson R, Roche B, Valentin JP, Ward G, Chapman K. Social housing of non-rodents during cardiovascular recordings in safety pharmacology and toxicology studies. J Pharmacol Toxicol Methods 2016; 81:75-87. [PMID: 27039257 PMCID: PMC5056765 DOI: 10.1016/j.vascn.2016.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The Safety Pharmacology Society (SPS) and National Centre for the Replacement, Refinement & Reduction of Animals in Research (NC3Rs) conducted a survey and workshop in 2015 to define current industry practices relating to housing of non-rodents during telemetry recordings in safety pharmacology and toxicology studies. The aim was to share experiences, canvas opinion on the study procedures/designs that could be used and explore the barriers to social housing. METHODS Thirty-nine sites, either running studies (Sponsors or Contract Research Organisations, CROs) and/or outsourcing work responded to the survey (51% from Europe; 41% from USA). RESULTS During safety pharmacology studies, 84, 67 and 100% of respondents socially house dogs, minipigs and non-human primates (NHPs) respectively on non-recording days. However, on recording days 20, 20 and 33% of respondents socially house the animals, respectively. The main barriers for social housing were limitations in the recording equipment used, study design and animal temperament/activity. During toxicology studies, 94, 100 and 100% of respondents socially house dogs, minipigs and NHPs respectively on non-recording days. However, on recording days 31, 25 and 50% of respondents socially house the animals, respectively. The main barriers for social housing were risk of damage to and limitations in the recording equipment used, food consumption recording and temperament/activity of the animals. CONCLUSIONS Although the majority of the industry does not yet socially house animals during telemetry recordings in safety pharmacology and toxicology studies, there is support to implement this refinement. Continued discussions, sharing of best practice and data from companies already socially housing, combined with technology improvements and investments in infrastructure are required to maintain the forward momentum of this refinement across the industry.
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Affiliation(s)
- Helen Prior
- National Centre for the Replacement, Refinement & Reduction of Animals in Research (NC3Rs), UK.
| | - Anna Bottomley
- National Centre for the Replacement, Refinement & Reduction of Animals in Research (NC3Rs), UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kathryn Chapman
- National Centre for the Replacement, Refinement & Reduction of Animals in Research (NC3Rs), UK
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Cordes JS, Heyen JR, Volberg ML, Poy N, Kreuser S, Shoieb AM, Steidl-Nichols J. Validation and utility of the PhysioTel™ Digital M11 telemetry implant for cardiovascular data evaluation in cynomolgus monkeys and Beagle dogs. J Pharmacol Toxicol Methods 2016; 79:72-9. [DOI: 10.1016/j.vascn.2016.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/15/2015] [Accepted: 01/27/2016] [Indexed: 11/26/2022]
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Abstract
Attrition due to nonclinical safety represents a major issue for the productivity of pharmaceutical research and development (R&D) organizations, especially during the compound optimization stages of drug discovery and the early stages of clinical development. Focusing on decreasing nonclinical safety-related attrition is not a new concept, and various approaches have been experimented with over the last two decades. Front-loading testing funnels in Discovery with in vitro toxicity assays designed to rapidly identify unfavorable molecules was the approach adopted by most pharmaceutical R&D organizations a few years ago. However, this approach has also a non-negligible opportunity cost. Hence, significant refinements to the "fail early, fail often" paradigm have been proposed recently to reflect the complexity of accurately categorizing compounds with early data points without taking into account other important contextual aspects, in particular efficacious systemic and tissue exposures. This review provides an overview of toxicology approaches and models that can be used in pharmaceutical Discovery at the series/lead identification and lead optimization stages to guide and inform chemistry efforts, as well as a personal view on how to best use them to meet nonclinical safety-related attrition objectives consistent with a sustainable pharmaceutical R&D model. The scope of this review is limited to small molecules, as large molecules are associated with challenges that are quite different. Finally, a perspective on how several emerging technologies may impact toxicity evaluation is also provided.
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Affiliation(s)
- Eric A G Blomme
- Global Preclinical Safety, AbbVie Inc. , 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Yvonne Will
- Drug Safety Research and Development, Pfizer , Eastern Point Road, Groton, Connecticut 06340, United States
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Kremer JJ, Bills AJ, Hanke NJ, Chen H, Meier WA, Osinski MA, Foley CM. Evaluation of cardiovascular changes in dogs administered three positive controls using jacketed external telemetry-blood pressure (JET-BP). J Pharmacol Toxicol Methods 2015; 75:27-37. [DOI: 10.1016/j.vascn.2015.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 12/17/2022]
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Xing G, Lu J, Hu M, Wang S, Zhao L, Zheng W, Schofield J, Oldman K, Adkins D, Yu H, Platz S, Ren J, Skinner M. Effects of group housing on ECG assessment in conscious cynomolgus monkeys. J Pharmacol Toxicol Methods 2015; 75:44-51. [DOI: 10.1016/j.vascn.2015.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/06/2015] [Accepted: 04/15/2015] [Indexed: 12/27/2022]
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Xing G, Lu J, Hu M, Wang S, Zhao L, Zheng W, Schofield J, Oldman K, Adkins D, Yu H, Platz S, Ren J, Skinner M. Effects of group housing on ECG assessment in conscious cynomolgus monkeys. J Pharmacol Toxicol Methods 2015; 73:72-79. [PMID: 25901446 DOI: 10.1016/j.vascn.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/06/2015] [Accepted: 04/15/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Assessing the cardiovascular safety of new chemical or biological entities is important during pre-clinical development. Electrocardiogram (ECG) assessments in non-human primate (NHP) toxicology studies are often made using non-invasive telemetry systems. We investigated whether ECG recording was feasible during group housing of NHPs, rather than the usual single housed arrangement, and whether it would impact the data collected or affect the ability to detect drug-induced changes in QTc interval. METHODS Following a period of acclimatisation to jackets, cynomolgus monkeys (3 males and 3 females) were housed in same sex groups of 3. Female monkeys were administered 4 doses of vehicle whilst male monkeys were administered vehicle, 15, 45 and 135mg/kg moxifloxacin. Each dose was administered on a separate dosing day. The same dosing protocol was repeated with the animals singly housed and the results from the two phases were compared including assessment of statistical power. RESULTS Heart rate (HR) was significantly lower, and PR and QT interval significantly higher, at multiple time points when the animals were group housed compared with the singly housed phase. QRS duration and QTc interval were less affected. Moxifloxacin increased QT and QTc intervals but had no consistent effect on HR, QRS duration or PR interval under group housed or singly housed conditions. Power analysis suggested that group housing did not adversely affect the magnitude of detectable changes of ECG parameters. In general, detection of slightly smaller changes was achieved under conditions of group housing. DISCUSSION The current study shows group housing to be technically possible during non-invasive ECG recording, resulting in lower resting heart rates and small improvements in sensitivity of detection of drug-induced effects. Given the psychological benefits of group housing for NHPs, it is a refinement that should be considered when conducting ECG assessments in NHP toxicology studies.
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Affiliation(s)
- Guozhen Xing
- Center for Drug Safety Evaluation and Research (CDSER), State Key Laboratory of New Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Haike Road 501, Shanghai 201203, China
| | - Jing Lu
- Center for Drug Safety Evaluation and Research (CDSER), State Key Laboratory of New Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Haike Road 501, Shanghai 201203, China
| | - Miaomiao Hu
- Center for Drug Safety Evaluation and Research (CDSER), State Key Laboratory of New Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Haike Road 501, Shanghai 201203, China
| | - Shaodong Wang
- Center for Drug Safety Evaluation and Research (CDSER), State Key Laboratory of New Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Haike Road 501, Shanghai 201203, China
| | - Li Zhao
- Center for Drug Safety Evaluation and Research (CDSER), State Key Laboratory of New Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Haike Road 501, Shanghai 201203, China
| | - Weijun Zheng
- Center for Drug Safety Evaluation and Research (CDSER), State Key Laboratory of New Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Haike Road 501, Shanghai 201203, China
| | - Jason Schofield
- Department of Safety and Metabolism, AstraZeneca R&D, Mereside, Alderley Park, Macclesfield SK10 4TG, United Kingdom
| | - Karen Oldman
- Discovery Sciences - Statistics, AstraZeneca R&D, Mereside, Alderley Park, Macclesfield SK10 4TG, United Kingdom
| | - Debbie Adkins
- Discovery Sciences - Statistics, AstraZeneca R&D, Mereside, Alderley Park, Macclesfield SK10 4TG, United Kingdom
| | - Hong Yu
- Center for Drug Safety Evaluation and Research (CDSER), State Key Laboratory of New Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Haike Road 501, Shanghai 201203, China
| | - Stefan Platz
- Department of Safety and Metabolism, AstraZeneca R&D, Mereside, Alderley Park, Macclesfield SK10 4TG, United Kingdom
| | - Jin Ren
- Center for Drug Safety Evaluation and Research (CDSER), State Key Laboratory of New Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Haike Road 501, Shanghai 201203, China.
| | - Matthew Skinner
- Department of Safety and Metabolism, AstraZeneca R&D, Mereside, Alderley Park, Macclesfield SK10 4TG, United Kingdom.
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Abstract
Whereas pharmacological responses tend to be fairly rapid in onset and are therefore detectable after a single dose, some diminish on repeated dosing, and others increase in magnitude and therefore can be missed or underestimated in single-dose safety pharmacology studies. Safety pharmacology measurements can be incorporated into repeat-dose toxicity studies, either routinely or on an ad hoc basis. Drivers for this are both scientific (see above) and regulatory (e.g. ICH S6, S7, S9). There are inherent challenges in achieving this: the availability of suitable technical and scientific expertise in the test facility, unsuitable laboratory conditions, use of simultaneous (as opposed to staggered) dosing, requirement for toxicokinetic sampling, unsuitability of certain techniques (e.g. use of anaesthesia, surgical implantation, food restriction), equipment availability at close proximity and sensitivity of the methods to detect small, clinically relevant, changes. Nonetheless, 'fit-for-purpose' data can still be acquired without requiring additional animals. Examples include assessment of behaviour, sensorimotor, visual and autonomic functions, ambulatory ECG and blood pressure, echocardiography, respiratory, gastrointestinal, renal and hepatic function. This is entirely achievable if the safety pharmacology measurements are relatively unobtrusive, both with respect to the animals and to the toxicology study itself. Careful pharmacological validation of any methods used, and establishing their detection sensitivity, is vital to ensure the credibility of generated data.
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Affiliation(s)
- Will S Redfern
- Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building, 310 Cambridge Science Park, Cambridge, CB4 0WG, UK,
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Amouzadeh HR, Engwall MJ, Vargas HM. Safety Pharmacology Evaluation of Biopharmaceuticals. Handb Exp Pharmacol 2015; 229:385-404. [PMID: 26091648 DOI: 10.1007/978-3-662-46943-9_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Biotechnology-derived pharmaceuticals or biopharmaceuticals (BPs) are molecules such as monoclonal antibodies, soluble/decoy receptors, hormones, enzymes, cytokines, and growth factors that are produced in various biological expression systems and are used to diagnose, treat, or prevent various diseases. Safety pharmacology (SP) assessment of BPs has evolved since the approval of the first BP (recombinant human insulin) in 1982. This evolution is ongoing and is informed by various international harmonization guidelines. Based on these guidelines, the potential undesirable effect of every drug candidate (small molecule or BP) on the cardiovascular, central nervous, and respiratory systems, referred to as the "core battery," should be assessed prior to first-in-human administration. However, SP assessment of BPs poses unique challenges such as choice of test species and integration of SP parameters into repeat-dose toxicity studies. This chapter reviews the evolution of SP assessment of BPs using the approval packages of marketed BPs and discusses the past, current, and new and upcoming approach and methods that can be used to generate high-quality data for the assessment of SP of BPs.
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Affiliation(s)
- Hamid R Amouzadeh
- Global Patient Safety, Global Regulatory Affairs & Safety, Amgen Inc, Thousand Oaks, CA, USA
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Niehoff MO, Niggemann B, Sternberg J, Jenkins A, Holbrook M. Measurement of hyper- and hypotension during repeated dose toxicity studies in either freely moving or physically restrained cynomolgus monkeys. J Pharmacol Toxicol Methods 2014; 70:268-75. [DOI: 10.1016/j.vascn.2014.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/12/2014] [Accepted: 09/04/2014] [Indexed: 11/27/2022]
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Derakhchan K, Chui RW, Stevens D, Gu W, Vargas HM. Detection of QTc interval prolongation using jacket telemetry in conscious non-human primates: comparison with implanted telemetry. Br J Pharmacol 2014; 171:509-22. [PMID: 24372552 DOI: 10.1111/bph.12484] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 09/30/2013] [Accepted: 10/11/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE During repeat-dose toxicity studies, ECGs are collected from chemically or physically-restrained animals over a short timeframe. This is problematic due to cardiovascular changes caused by manual restraint stress and anesthesia, and limited ECG sampling. These factors confound data interpretation, but may be overcome by using a non-invasive jacket-based ECG collection (JET). The current study investigated whether a jacketed external telemetry system could detect changes in cardiac intervals and heart rate in non-human primates (NHPs), previously implanted with a PCT transmitter. EXPERIMENTAL APPROACH Twelve male cynomolgus monkeys were treated weekly with vehicle or sotalol (8, 16, 32 mg kg⁻¹) p.o. ECGs were collected continuously for 24 hours, following treatment, over 4 weeks. A satellite group of six NHPs was used for sotalol toxicokinetics. KEY RESULTS Sotalol attained Cmax values 1-3 hours after dosing, and exhibited dose-proportional exposure. In jacketed NHPs, sotalol dose-dependently increased QT/QTc intervals, prolonged PR interval, and reduced heart rate. Significant QTc prolongation of 27, 54 and 76 msec was detected by JET after 8, 16, and 32 mg kg⁻¹ sotalol, respectively, compared with time-matched vehicle-treated animals. Overall, JET-derived PR, QT, QTc intervals, QRS duration, and heart rate correlated well with those derived from PCT. CONCLUSIONS AND IMPLICATIONS The current findings clearly support the use of JET to quantify cardiac interval and rhythm changes, capable of detecting QTc prolongation caused by sotalol. JET may be a preferred method compared to restraint-based ECG because high-density ECG sampling can be collected in unstressed conscious monkeys, over several weeks.
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Affiliation(s)
- K Derakhchan
- Safety and Exploratory Pharmacology, Toxicology Sciences, CBSS, Amgen Inc., Thousand Oaks, CA, USA
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Comparison of freely-moving telemetry Chinese Miniature Experiment Pigs (CMEPs) to beagle dogs in cardiovascular safety pharmacology studies. J Pharmacol Toxicol Methods 2014; 70:19-28. [DOI: 10.1016/j.vascn.2014.03.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 11/20/2022]
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Berman CL, Cannon K, Cui Y, Kornbrust DJ, Lagrutta A, Sun SZ, Tepper J, Waldron G, Younis HS. Recommendations for safety pharmacology evaluations of oligonucleotide-based therapeutics. Nucleic Acid Ther 2014; 24:291-301. [PMID: 24946015 DOI: 10.1089/nat.2013.0477] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This document was prepared by the Safety Pharmacology Subcommittee of the Oligonucleotide Safety Working Group (OSWG), a group of industry and regulatory scientists involved in the development and regulation of therapeutic oligonucleotides. The mission of the Subcommittee was to develop scientific recommendations for the industry regarding the appropriate scope and strategies for safety pharmacology evaluations of oligonucleotides (ONs). These recommendations are the consensus opinion of the Subcommittee and do not necessarily reflect the current expectations of regulatory authorities. 1) Safety pharmacology testing, as described in the International Conference on Harmonisation (ICH) S7 guidance, is as applicable to ONs as it is to small molecule drugs and biotherapeutics. 2) Study design considerations for ONs are similar to those for other classes of drugs. In general, as with other therapeutics, studies should evaluate the drug product administered via the clinical route. Species selection should ideally consider relevance of the model with regard to the endpoints of interest, pharmacological responsiveness, and continuity with the nonclinical development program. 3) Evaluation of potential effects in the core battery (cardiovascular, central nervous, and respiratory systems) is recommended. In general: a. In vitro human ether-a-go-go-related gene (hERG) testing does not provide any specific value and is not warranted. b. Emphasis should be placed on in vivo evaluation of cardiovascular function, typically in nonhuman primates (NHPs). c. Due to the low level of concern, neurologic and respiratory function can be assessed concurrently with cardiovascular safety pharmacology evaluation in NHPs, within repeat-dose toxicity studies, or as stand-alone studies. In the latter case, rodents are most commonly used. 4) Other dedicated safety pharmacology studies, beyond the core battery, may have limited value for ONs. Although ONs can accumulate in the kidney and liver, evaluation of functional changes in these organs, as well as gastrointestinal (GI) and unintended "pro-inflammatory" effects, may be best evaluated during repeat-dose toxicity studies. Broad receptor- or ligand-binding profiling has not historically been informative for most ON subclasses, but may have value for investigative purposes.
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Himmel HM. Drug-induced functional cardiotoxicity screening in stem cell-derived human and mouse cardiomyocytes: effects of reference compounds. J Pharmacol Toxicol Methods 2013; 68:97-111. [PMID: 23702537 DOI: 10.1016/j.vascn.2013.05.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 05/10/2013] [Accepted: 05/10/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Early prediction of drug-induced functional cardiotoxicity requires robust in-vitro systems suitable for medium/high throughput and easily accessible cardiomyocytes with defined reproducible properties. The xCELLigence Cardio system uses 96-well plates with interdigitated electrodes that detect the impedance changes of rhythmic contractions of stem cell-derived cardiomyocyte (SC-CM) layers. Here, we report on our initial screening experience in comparison to established (multi)cellular and in-vivo models. METHODS Impedance signals from human iPSC-CM (iCells™) and mouse eSC-CM (Cor.At™) were analyzed for contraction amplitude (CA) and duration, rise/fall time, beating rate (BR) and irregularity. RESULTS Following solution exchange, impedance signals re-approximated steady-state conditions after about 2 (Cor.At™) and 3h (iCells™); these time points were used to analyze drug effects. The solvent DMSO (≤1%) hardly influenced contraction parameters in Cor.At™, whereas in iCells™ DMSO (>0.1%) reduced CA and enhanced BR. The selective hERG K⁺ channel blockers E-4031 and dofetilide reduced CA and accelerated BR (≥30 nM) according to the analysis software. The latter, however, was due to burst-like contractions (300 nM) that could be detected only by visual inspection of recordings, and were more pronounced in Cor.At™ as in iCells™. In cardiac myocytes and tissue preparations, however, E4031 and dofetilide have been reported to increase cell shortening and contractile force and to reduce BR. Compounds (pentamidine, HMR1556, ATX2, TTX, and verapamil) with other mechanisms of action were also investigated; their effects differed partially between cell lines (e.g. TTX) and compared to established (multi)cellular models (e.g. HMR1556, ouabain). CONCLUSION Mouse and human stem cell-derived cardiomyocytes respond differently to drugs and these responses occasionally also differ from those originating from established in-vitro and in-vivo models. Hence, drug-induced cardiotoxic effects may be detected with this system, however, the predictive or even translational value of results is considered limited and not yet firmly established.
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Redfern WS, Ewart LC, Lainée P, Pinches M, Robinson S, Valentin JP. Functional assessments in repeat-dose toxicity studies: the art of the possible. Toxicol Res (Camb) 2013. [DOI: 10.1039/c3tx20093k] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Vargas HM, Amouzadeh HR, Engwall MJ. Nonclinical strategy considerations for safety pharmacology: evaluation of biopharmaceuticals. Expert Opin Drug Saf 2012; 12:91-102. [DOI: 10.1517/14740338.2013.745851] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yang B, Papoian T. Tyrosine kinase inhibitor (TKI)-induced cardiotoxicity: approaches to narrow the gaps between preclinical safety evaluation and clinical outcome. J Appl Toxicol 2012; 32:945-51. [PMID: 22961481 DOI: 10.1002/jat.2813] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 12/29/2022]
Abstract
Although therapies targeted to inhibit the activity of certain tyrosine kinases (TK) have helped advance cancer therapy in recent years, reports of cardiac toxicity following treatment with tyrosine kinase inhibitors (TKIs) were unexpected and not well predicted by preclinical studies. Such clinical findings exposed gaps in current preclinical drug testing for predicting the development of cardiac toxicities in humans. These gaps included a lack of a comprehensive TKI mechanism of action determination and appropriate cardiac functional evaluation. New preclinical approaches are suggested to address these issues. In addition to tyrosine kinase inhibition, other factors that may play a role in drug-induced cardiac effects should be assessed, such as unintended secondary targets of TKIs, toxic drug metabolites and drug accumulation in the heart. Both on-target and off-target toxic effects of TKIs on cultured cardiac myocytes have now been shown to be detectable, providing a rationale for using cardiomyocytes as a screening tool to study potential TKI-mediated cardiotoxicity. Incorporating isolated perfused heart methodology to chronic/subchronic rodent studies or including echocardiography in chronic large animal toxicity studies may improve the detection of changes in cardiac function over current methods, and they may eventually become a routine tool for screening drugs with suspected cardiotoxic potential. Further, assessing drug toxicity and efficacy together in an animal model of disease is highly informative for candidate drug selection, and should be encouraged to assess specific safety endpoints, such as cardiovascular function. Together, these approaches will help better close the gaps between preclinical testing and clinical outcomes.
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Affiliation(s)
- Baichun Yang
- Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.
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Chui RW, Derakhchan K, Vargas HM. Comprehensive analysis of cardiac arrhythmias in telemetered cynomolgus monkeys over a 6month period. J Pharmacol Toxicol Methods 2012; 66:84-91. [DOI: 10.1016/j.vascn.2012.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/05/2012] [Accepted: 05/05/2012] [Indexed: 11/24/2022]
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Ward G, Milliken P, Patel B, McMahon N. Comparison of non-invasive and implanted telemetric measurement of blood pressure and electrocardiogram in conscious beagle dogs. J Pharmacol Toxicol Methods 2012; 66:106-13. [DOI: 10.1016/j.vascn.2012.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/26/2012] [Accepted: 04/06/2012] [Indexed: 10/28/2022]
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Evaluation of an algorithm for highly automated measurements of QT interval. J Pharmacol Toxicol Methods 2011; 64:16-24. [DOI: 10.1016/j.vascn.2011.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 05/17/2011] [Accepted: 05/17/2011] [Indexed: 11/22/2022]
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Cools F, Janssens S, Vanlommel A, Teisman A, Towart R, Gallacher DJ. ECG arrhythmias in non-implanted vs. telemetry-implanted dogs: Need for screening before and sufficient recovery time after implantation. J Pharmacol Toxicol Methods 2011; 64:60-7. [DOI: 10.1016/j.vascn.2011.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/16/2011] [Accepted: 04/01/2011] [Indexed: 11/16/2022]
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Authier S, Gervais J, Fournier S, Gauvin D, Maghezzi S, Troncy E. Cardiovascular and respiratory safety pharmacology in Göttingen minipigs: Pharmacological characterization. J Pharmacol Toxicol Methods 2011; 64:53-9. [DOI: 10.1016/j.vascn.2011.04.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 04/19/2011] [Accepted: 04/23/2011] [Indexed: 11/30/2022]
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Authier S, Pugsley MK, Troncy E, Curtis MJ. Arrhythmogenic liability screening in cardiovascular safety pharmacology: Commonality between non-clinical safety pharmacology and clinical thorough QT (TQT) studies. J Pharmacol Toxicol Methods 2010; 62:83-8. [DOI: 10.1016/j.vascn.2010.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 06/11/2010] [Indexed: 01/10/2023]
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Pugsley MK, Authier S, Towart R, Gallacher DJ, Curtis MJ. Beyond the safety assessment of drug-mediated changes in the QT interval... what's next? J Pharmacol Toxicol Methods 2009; 60:24-7. [PMID: 19616107 DOI: 10.1016/j.vascn.2009.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 07/07/2009] [Indexed: 10/20/2022]
Abstract
Assessing drug-induced changes (particularly prolongation) in the QT interval has been the major preoccupation of safety pharmacology since its inception, under the assumption that QT widening represents a surrogate biomarker for torsades de pointes (TdeP) liability. While evidence of changes in QT remains a bane to the development of novel therapeutic agents, non-clinical and clinical methods have been developed (with a certain amount of validation) to limit this potential liability of a new chemical entity (NCE). Because of the associated withdrawal of numerous drugs from clinical use, determining whether or not a drug development candidate exhibits a TdeP liability has been the motivation in the implementation of discussions between 'pharmaceutical companies', academicians, clinicians and regulatory authorities worldwide that has led to the development of the ICHS7A and ICHS7B guidance documents (Anon, 2001, 2005). Simultaneously, it has resulted in the firm establishment of safety pharmacology as a standalone discipline within the drug development scheme (Pugsley et al., 2008). As far as TdeP liability is concerned, QT widening remains the most poignant issue, in that QT widening in humans is immediately regarded as a cause for concern, yet QT widening in preclinical models (and indeed in man) is not a quantitative predictor of TdeP liability (and indeed may not even be a qualitative predictor by itself (Pugsley et al., 2008). The present focused issue of the journal returns to safety pharmacology, and contains papers arising from the 8th annual SPS Meeting that was held in Madison, WI in 2008. Indeed, so many papers have arisen from the meeting that this issue of the Journal is only part 1. Part 2 will be published as the next issue of the Journal. Some topics which have been addressed include whether an assessment method for drugs that produce a shortened QT interval is needed, what the role of the slow component of the delayed rectifier K current (I(Ks)) should be in a safety assessment and whether safety pharmacology endpoints can or should be added to repeat dose Toxicology studies.
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Affiliation(s)
- Michael K Pugsley
- Global Preclinical Toxicology/Pathology, Johnson & Johnson PR&D, 1000 Route 202 South, Raritan, New Jersey 00869, USA.
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Chui RW, Vargas HM. A comparison of three software platforms for automated ECG analysis. J Pharmacol Toxicol Methods 2009; 60:28-38. [DOI: 10.1016/j.vascn.2009.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 05/10/2009] [Indexed: 10/20/2022]
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