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Kim HS, Kang GH, Yang MJ, Joo YJ, Lee DG, Lee HS, Lee JS, Hwang JH. Toxicity of a novel antifungal agent (ATB1651 gel) in Yucatan minipigs (Sus scrofa) following 4 weeks of daily dermal administration. Toxicol Res 2024; 40:247-258. [PMID: 38525130 PMCID: PMC10959866 DOI: 10.1007/s43188-023-00222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 03/26/2024] Open
Abstract
ATB1651 gel is an antifungal drug candidate that enhances antifungal activity through substitution of several aryl rings, alkyl chains, and methyl groups. To ensure safety of use of ATB1651 gel, assessment of its potentially toxic side effects is necessary. In this study, we examined the repeated-dose toxicity of ATB1651 gel to Yucatan minipigs (Sus scrofa) in accordance with the Good Laboratory Practice guidelines. Five doses of ATB1651 gel (0%, 0.2%, 0.5%, 1.0%, 3.0%) were administered dermally to the left and right flanks of 38 minipigs daily for 4 weeks. Mortality, clinical symptoms, dermal scores, body weights, and physiological, biochemical, pathological, and toxicokinetic analyses were performed after the treatment period. No systemic toxicological damage was observed in either male or female minipigs regardless of dose; however, dermal application of ATB1651 gel caused some skin alterations at the application sites. Specifically, erythema and eschar formation, edema, and scabs or raise spots were observed at the application site(s) in males in the 3.0% ATB1651 gel treatment group and in females at ATB1651 gel concentrations ≥ 1.0%, with dermal scores ranging from grade 1 to 2. Additionally, histopathological assay indicated infiltration of different types of inflammatory cells and the presence of pustule/crust at the application site(s) in both males and females at ATB1651 gel concentrations ≥ 0.5%. However, these changes were reversible after a 2-week recovery period and were considered a local irritation effect of ATB1651 gel. The no-observed-adverse-effect level of ATB1651 gel was 3.0% with regard to topical and systemic toxicity in both male and female minipigs. Collectively, our results imply that ATB1651 gel is a safe candidate for clinical development as an antifungal drug with a wide therapeutic window.
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Affiliation(s)
- Hyung-Sun Kim
- Animal Model Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk 56212 Republic of Korea
| | - Goo-Hwa Kang
- Animal Model Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk 56212 Republic of Korea
| | - Mi-Jin Yang
- Jeonbuk Pathology Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk 56212 Republic of Korea
| | - Yun-Jeong Joo
- Jeonbuk Quality Assurance Unit, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk 56212 Republic of Korea
| | - Dong-Gi Lee
- AmtixBio Co., Ltd., Hanam-si, Gyeonggi-do 12925 Republic of Korea
| | - Han-Seung Lee
- AmtixBio Co., Ltd., Hanam-si, Gyeonggi-do 12925 Republic of Korea
| | - Jong-Seung Lee
- AmtixBio Co., Ltd., Hanam-si, Gyeonggi-do 12925 Republic of Korea
| | - Jeong Ho Hwang
- Animal Model Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk 56212 Republic of Korea
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Pharmacological characterisation of electrocardiogram J-T peak interval in conscious Guinea pigs. Eur J Pharmacol 2022; 927:175065. [PMID: 35640715 DOI: 10.1016/j.ejphar.2022.175065] [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: 02/15/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
Drug-induced human ether-à-go-go-related gene (hERG) channel block and QT interval prolongation increase torsade de pointes (TdP) risk. However, some drugs block hERG channels and prolong QT interval with low TdP risk, likely because they block additional inward currents. We investigated the utility of J-Tpeak interval, a novel biomarker of inward current block and TdP risk, in conscious telemetered guinea pigs. Electrocardiogram parameters were analysed in Hartley guinea pigs orally administered one of eight test compounds (dofetilide, flecainide, nifedipine, quinidine, quinine, ranolazine, sotalol, verapamil) or vehicle alone as controls. Heart rate-corrected QT (QTcX) and J-Tpeak (J-TpeakcX) were calculated to evaluate the relations of QT-RR and J-Tpeak-RR. Dofetilide and sotalol significantly increased ΔQTcX and ΔJ-TpeakcX intervals to similar degrees. Quinidine, quinine and flecainide also increased ΔQTcX and ΔJ-TpeakcX intervals, but the degrees of ΔJ-TpeakcX interval prolongation were shorter than those of ΔQTcX interval prolongation. Ranolazine showed slight increasing trends in ΔQTcX and ΔJ-TpeakcX intervals, but the differences were not significant. Verapamil and nifedipine did not increase the ΔQTcX or ΔJ-TpeakcX intervals. Based on the relations of ΔΔJ-TpeakcX and ΔΔQTcX intervals, dofetilide, sotalol and quinidine were classified as high risk for TdP, quinine, flecainide and ranolazine were classified as intermediate risk and verapamil and nifedipine were classified as low risk. These results supported the usefulness of J-Tpeak interval assessment in conscious guinea pigs for predicting drug-induced balanced block of inward currents and TdP risk in early-stage preclinical studies.
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Stracina T, Ronzhina M, Redina R, Novakova M. Golden Standard or Obsolete Method? Review of ECG Applications in Clinical and Experimental Context. Front Physiol 2022; 13:867033. [PMID: 35547589 PMCID: PMC9082936 DOI: 10.3389/fphys.2022.867033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular system and its functions under both physiological and pathophysiological conditions have been studied for centuries. One of the most important steps in the cardiovascular research was the possibility to record cardiac electrical activity. Since then, numerous modifications and improvements have been introduced; however, an electrocardiogram still represents a golden standard in this field. This paper overviews possibilities of ECG recordings in research and clinical practice, deals with advantages and disadvantages of various approaches, and summarizes possibilities of advanced data analysis. Special emphasis is given to state-of-the-art deep learning techniques intensely expanded in a wide range of clinical applications and offering promising prospects in experimental branches. Since, according to the World Health Organization, cardiovascular diseases are the main cause of death worldwide, studying electrical activity of the heart is still of high importance for both experimental and clinical cardiology.
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Affiliation(s)
- Tibor Stracina
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marina Ronzhina
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic
| | - Richard Redina
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Marie Novakova
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Y. Tan A, Kearney K, Jenkins C, Karumanchi SA, Bee W, Kussie P. Cardiovascular and hemodynamic consequences of recombinant placental growth factor administration in Guinea pigs. Hypertens Pregnancy 2022; 41:99-106. [DOI: 10.1080/10641955.2022.2048390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Ken Kearney
- Charles River Laboratories, Ashland, Ohio, USA
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Zieglowski L, Kümmecke AM, Tolba RH, Ernst L. Re-Sterilisation of Single-Use Telemetric Devices. Eur Surg Res 2021; 62:271-275. [PMID: 34082422 DOI: 10.1159/000516829] [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: 03/10/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022]
Abstract
Implantable telemetric transponders for contactless measurement of physiological parameters are often used in animal-based research. After explantation, single-use devices cannot be re-implanted because of non-validated functionality and necessary re-sterilisation. This is disadvantageous because the battery life would enable a second implantation cycle in another animal. To save costs and time taken for the manufacturer's refurbishing process, we validated and implemented a re-sterilisation protocol for single-use transponders using hydrogen peroxide gas. The described protocol was established with models, i.e., for large (n = 7) and small (n = 3) animals, of telemetric device from 2 different manufacturers (Data Science International and EMKA). All transponders, prepared according to the protocol, were previously implanted subcutaneously in the flank of pigs or rats for a duration of 21 days. Our investigations demonstrate that disinfection only is not sufficient against bacterial contamination and that sterility can only be achieved by additional gas sterilisation with hydrogen peroxide. Furthermore, re-implantation of the re-sterilised transponders into pigs caused neither undesired tissue reactions along the transponder nor impairment of the measured values when compared to the first implantation and after necropsy in 4 cases. We were able to demonstrate that, using our protocol, re-implantation of reprocessed single-use telemetric devices can be performed without compromising transponder quality.
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Affiliation(s)
- Leonie Zieglowski
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Faculty of Medicine, Aachen, Germany,
| | - Anna M Kümmecke
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Faculty of Medicine, Aachen, Germany
| | - René H Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Faculty of Medicine, Aachen, Germany
| | - Lisa Ernst
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Faculty of Medicine, Aachen, Germany
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Kim HS, Kang GH, Yang MJ, Ahn HJ, Han SC, Hwang JH. Toxicity of diclofenac sodium salt in Yucatan minipigs (Sus scrofa) following 4 weeks of daily intramuscular administration. Toxicol Rep 2021; 8:557-570. [PMID: 33777702 PMCID: PMC7985715 DOI: 10.1016/j.toxrep.2021.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 12/02/2022] Open
Abstract
Four-week repeated-dose toxicity of intramuscular DSS was studied in minipigs. DSS administration at ≥10 mg/kg/day causes toxicity and injection-site reaction. The NOAEL of DSS after 4-week administration was 2 mg/kg/day in minipigs.
Diclofenac sodium salt (DSS) is a widely used nonsteroidal anti-inflammatory drug. The present study was performed under good laboratory practice (GLP) regulations to investigate the toxicity of DSS after 4 weeks of repeated intramuscular administration at doses of 0, 2, 10, or 20 mg/kg/day in 32 minipigs and to evaluate the DSS effect following a 2-week recovery period. Dose-related clinical signs and alterations of hematological or clinical chemistry parameters, organ weight, and macroscopic as well as histopathological findings in hepatic, renal, gastrointestinal, skin and injection sites were observed in both sexes’ animals of the 10 or 20 mg/kg/day group. With the exception of the skin-related findings, most symptoms showed a tendency to resolve after the 2-week recovery period. The systemic exposure (AUClast) of DSS in plasma showed similar pattern to the increase rate of the dose and similar values between males and females except for the female 20 mg/kg dose group (56 %) on Day1. The systemic exposure showed a decreasing trend in the 10 or 20 mg/kg group after 4-week of repeated administration compared to Day1. The no-observed-adverse-effect level of DSS in this study was considered to be 2 mg/kg/day in both male and female minipigs.
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Key Words
- 4-Week repeated toxicity
- AAALAC, association for assessment and accreditation of laboratory animal care
- ALT, alanine aminotransferase
- AP, Alkaline phosphatase
- AST, aspartate aminotransferase
- AUC, area under the concentration-time curve
- BUN, blood urea nitrogen
- BW, body weight
- CAS, chemical abstracts service
- CL, clearance
- COX, cyclooxygenase
- CREA, creatine
- CRO, contract research organization
- CV, coefficients of variation
- Cmax, maximum plasma concentration
- DSS, diclofenac sodium salt
- Diclofenac sodium salt
- ECG, Electrocardiogram
- GI, gastrointestinal
- GLP, good laboratory practice
- H&E, hematoxylin and eosin
- HED, human effective dose
- HR, heart rate
- IACUC, institutional animal care and use committee
- Minipig
- NDA, new drug application
- NOAEL, No-observed-adverse-effect levels
- NSAIDs, nonsteroidal anti-inflammatory drugs
- No-observed-adverse-effect level
- RBC, red blood cell
- SD, standard deviation
- TK, toxicokinetics
- TP, total protein
- Tmax, time to maximum plasma concentration
- WBC, white blood cell
- aVF, augmented vector foot
- aVL, augmented vector left
- aVR, augmented vector right
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Affiliation(s)
- Hyung-Sun Kim
- Animal Model Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk, 56212, Republic of Korea
| | - Goo-Hwa Kang
- Animal Model Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk, 56212, Republic of Korea
| | - Mi-Jin Yang
- Jeonbuk Pathology Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk, 56212, Republic of Korea
| | - Hee-Jeong Ahn
- Jeonbuk Quality Assurance Unit, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk, 56212, Republic of Korea
| | - Su-Cheol Han
- Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk, 56212, Republic of Korea
| | - Jeong Ho Hwang
- Animal Model Research Group, Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongup, Jeonbuk, 56212, Republic of Korea
- Corresponding author.
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Cooper TK, Byrum RA, Cooper K, DeWald LE, Aiosa NM, Feuerstein IM, St Claire MC. Cranial Vena Cava Syndrome in Guinea Pigs with Chronic Jugular Vein Catheters. Comp Med 2020; 70:87-92. [PMID: 31948513 PMCID: PMC7024777 DOI: 10.30802/aalas-cm-19-000051] [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: 05/01/2019] [Revised: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 11/05/2022]
Abstract
Guinea pigs are a premier small animal model for infectious disease research, and chronic indwelling venous access ports may be used to facilitate various procedures. Here we report catheter-related lesions in 5 uninfected Dunkin-Hartley guinea pigs with chronic jugular vein catheters used for imaging studies. Three guinea pigs were found dead with no premonitory signs. At necropsy, there was severe bilateral pulmonary atelectasis due to 20 to 29 mL of pleural effusion resulting from catheter-related thrombosis and cranial vena cava syndrome. In addition, one of these 3 guinea pigs had a polymicrobial catheter infection with abscessation. A 4th clinically normal guinea pig was euthanized at the end of the study, having spontaneously lost its catheter 7 mo prior, and had 17 mL of pleural effusion. The 5th guinea pig was euthanized following pooling of contrast material around the distal catheter in the cranial vena cava on CT. By histology, affected animals had recent and remote thrombosis or fibrosis (or both) of the cranial vena cava and right atrial wall, with osseous and cartilaginous metaplasia. Cranial vena cava syndrome should be considered as a differential for dyspnea or death in chronically catheterized laboratory animals.
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Affiliation(s)
- Timothy K Cooper
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland;,
| | - Russell A Byrum
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
| | - Kurt Cooper
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
| | | | - Nina M Aiosa
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
| | - Irwin M Feuerstein
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
| | - Marisa C St Claire
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
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Kirchhoff JE, Skarsfeldt MA, Muthukumarasamy KM, Simó-Vicens R, Bomholtz SH, Abildgaard L, Jespersen T, Sørensen US, Grunnet M, Bentzen BH, Diness JG. The K Ca2 Channel Inhibitor AP14145, But Not Dofetilide or Ondansetron, Provides Functional Atrial Selectivity in Guinea Pig Hearts. Front Pharmacol 2019; 10:668. [PMID: 31275147 PMCID: PMC6593233 DOI: 10.3389/fphar.2019.00668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Prolongation of cardiac action potentials is considered antiarrhythmic in the atria but can be proarrhythmic in ventricles if the current carried by Kv11.1-channels (IKr) is inhibited. The current mediated by KCa2-channels, IKCa, is considered a promising new target for treatment of atrial fibrillation (AF). Selective inhibitors of IKr (dofetilide) and IKCa (AP14145) were used to compare the effects on ventricular and atrial repolarization. Ondansetron, which has been reported to be a potent blocker of both IKr and IKCa, was included to examine its potential atrial antiarrhythmic properties. Experimental Approach: The expression of KCa2- and Kv11.1-channels in the guinea pig heart was investigated using quantitative polymerase chain reaction (qPCR). Whole-cell patch clamp technique was used to investigate the effects of dofetilide, AP14145, and ondansetron on IKCa and/or IKr. The effect of dofetilide, AP14145, and ondansetron on atrial and ventricular repolarization was investigated in isolated hearts. A novel atrial paced in vivo guinea pig model was further validated using AP14145 and dofetilide. Key Results: AP14145 increased the atrial effective refractory period (AERP) without prolonging the QT interval with Bazett's correction for heart rate (QTcB) both ex vivo and in vivo. In contrast, dofetilide increased QTcB and, to a lesser extent, AERP in isolated hearts and prolonged QTcB with no effects on AERP in the in vivo guinea pig model. Ondansetron did not inhibit IKCa, but did inhibit IKr in vitro. Ondansetron prolonged ventricular, but not atrial repolarization ex vivo. Conclusion and Implications: IKCa inhibition by AP14145 selectively increases atrial repolarization, whereas IKr inhibition by dofetilide and ondansetron increases ventricular repolarization to a larger extent than atrial repolarization.
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Affiliation(s)
| | - Mark Alexander Skarsfeldt
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kalai Mangai Muthukumarasamy
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rafel Simó-Vicens
- Acesion Pharma, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofia Hammami Bomholtz
- Acesion Pharma, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Bo Hjorth Bentzen
- Acesion Pharma, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Botelho AF, Joviano-Santos JV, Santos-Miranda A, Menezes-Filho JE, Soto-Blanco B, Cruz JS, Guatimosim C, Melo MM. Non-invasive ECG recording and QT interval correction assessment in anesthetized rats and mice. PESQUISA VETERINARIA BRASILEIRA 2019. [DOI: 10.1590/1678-6160-pvb-6029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT: Rats and mice are the most common species used in experimental cardiac electrophysiology studies. Electrocardiogram (ECG) recording shows paramount importance for monitoring arrhythmias and cardiac function in several disease models, including QT syndrome. However, the lack of standardized reference values and QT correction formula for different animal species and lineages represent a challenge for ECG interpretation. The aim of this study is to provide an improved method for ECG recording, establishing reference range values and determine the QT formulas with higher correlation to heart rate (HR). A total of 10 Wistar rats, 10 Swiss mice, 10 C57BL/6 mice and 10 FVB/NJ mice were used in the study. Animals were submitted to anesthesia with isoflurane and ECG recording was performed using a six-channel non-invasive electrocardiograph. QT was corrected using the following formulas: Bazzett, Fridericia, Mitchell, Hodges, Van der Water and Framingham. Normal range values for ECG parameters were established in all animals studied. Pearsons’ correlation defined Hodges formula as the most suitable for QT correction. This study demonstrated an improved method of ECG recording with reference values for Swiss, FVB/NJ, C57BL/6 mice, and Wistar rats. Hodges’ formula was the most effective formula for QT correction in rodents, whereas Bazett’s and Friderica formulas were ineffective for such animals. The present work contributes to arrhythmias investigation in experimental cardiology and may reduce misinterpretations in rodents’ ECG.
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Sánchez-Macías D, Barba-Maggi L, Morales-delaNuez A, Palmay-Paredes J. Guinea pig for meat production: A systematic review of factors affecting the production, carcass and meat quality. Meat Sci 2018; 143:165-176. [DOI: 10.1016/j.meatsci.2018.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 12/23/2022]
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Turner JR, Rodriguez I, Mantovani E, Gintant G, Kowey PR, Klotzbaugh RJ, Prasad K, Sager PT, Stockbridge N, Strnadova C. Drug-induced Proarrhythmia and Torsade de Pointes: A Primer for Students and Practitioners of Medicine and Pharmacy. J Clin Pharmacol 2018; 58:997-1012. [PMID: 29672845 DOI: 10.1002/jcph.1129] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/05/2018] [Indexed: 12/11/2022]
Abstract
Multiple marketing withdrawals due to proarrhythmic concerns occurred in the United States, Canada, and the United Kingdom in the late 1980s to early 2000s. This primer reviews the clinical implications of a drug's identified proarrhythmic liability, the issues associated with these safety-related withdrawals, and the actions taken by the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) and by regulatory agencies in terms of changing drug development practices and introducing new nonclinical and clinical tests to asses proarrhythmic liability. ICH Guidelines S7B and E14 were released in 2005. Since then, they have been adopted by many regional regulatory authorities and have guided nonclinical and clinical proarrhythmic cardiac safety assessments during drug development. While this regulatory paradigm has been successful in preventing drugs with unanticipated potential for inducing the rare but potentially fatal polymorphic ventricular arrhythmia torsade de pointes from entering the market, it has led to the termination of drug development programs for other potentially useful medicines because of isolated results from studies with limited predictive value. Research efforts are now exploring alternative approaches to better predict potential proarrhythmic liabilities. For example, in the domain of human electrocardiographic assessments, concentration-response modeling conducted during phase 1 clinical development has recently become an accepted alternate primary methodology to the ICH E14 "thorough QT/QTc" study for defining a drug's corrected QT interval prolongation liability under certain conditions. When a drug's therapeutic benefit is considered important at a public health level but there is also an identified proarrhythmic liability that may result from administration of the single drug in certain individuals and/or drug-drug interactions, marketing approval will be accompanied by appropriate directions in the drug's prescribing information. Health-care professionals in the fields of medicine and pharmacy need to consider the prescribing information in conjunction with individual patients' clinical characteristics and concomitant medications when prescribing and dispensing such drugs.
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Affiliation(s)
- J Rick Turner
- Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
| | - Ignacio Rodriguez
- Cardiac Safety Research Consortium, Roche TCRC, Inc., New York, NY, USA
| | - Emily Mantovani
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | | | - Peter R Kowey
- Lankenau Heart Institute and Jefferson Medical College, Philadelphia, PA, USA
| | - Ralph J Klotzbaugh
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Krishna Prasad
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Philip T Sager
- Sager Consulting and Stanford University, San Francisco, CA, USA
| | - Norman Stockbridge
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Colette Strnadova
- Therapeutic Products Directorate, Health Canada, Ottawa, Ontario, Canada
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12
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Pugsley MK, Authier S, Hayes ES, Hamlin RL, Accardi MV, Curtis MJ. Recalibration of nonclinical safety pharmacology assessment to anticipate evolving regulatory expectations. J Pharmacol Toxicol Methods 2016; 81:1-8. [PMID: 27343819 DOI: 10.1016/j.vascn.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Safety pharmacology (SP) has evolved in terms of architecture and content since the inception of the SP Society (SPS). SP was initially focused on the issue of drug-induced QT prolongation, but has now become a broad spectrum discipline with expanding expectations for evaluation of drug adverse effect liability in all organ systems, not merely the narrow consideration of torsades de pointes (TdP) liability testing. An important part of the evolution of SP has been the elaboration of architecture for interrogation of non-clinical models in terms of model development, model validation and model implementation. While SP has been defined by mandatory cardiovascular, central nervous system (CNS) and respiratory system studies ever since the core battery was elaborated, it also involves evaluation of drug effects on other physiological systems. The current state of SP evolution is the incorporation of emerging new technologies in a wide range of non-clinical drug safety testing models. This will refine the SP process, while potentially expanding the core battery. The continued refinement of automated technologies (e.g., automated patch clamp systems) is enhancing the scope for detection of adverse effect liability (i.e., for more than just IKr blockade), while introducing a potential for speed and accuracy in cardiovascular and CNS SP by providing rapid, high throughput ion channel screening methods for implementation in early drug development. A variety of CNS liability assays, which exploit isolated brain tissue, and in vitro electrophysiological techniques, have provided an additional level of complimentary preclinical safety screens aimed at establishing the seizurogenic potential and risk for memory dysfunction of new chemical entities (NCEs). As with previous editorials that preface the annual themed issue on SP methods published in the Journal of Pharmacological and Toxicological Methods (JPTM), we highlight here the content derived from the most recent (2015) SPS meeting held in Prague, Czech Republic. This issue of JPTM continues the tradition of providing a publication summary of articles primarily presented at the SPS meeting with direct bearing on the discipline of SP. Novel method development and refinement in all areas of the discipline are reflected in the content.
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Affiliation(s)
- Michael K Pugsley
- Department of Toxicology & PKDM, Purdue Pharma LP., 6 Cedar Brook Dr., Cranbury, NJ 08512, U.S.A..
| | - Simon Authier
- CiToxLAB Research Inc., 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | | | | | - Michael V Accardi
- CiToxLAB Research Inc., 445 Armand Frappier, Laval, QC H7V 4B3, Canada
| | - Michael J Curtis
- Cardiovascular Division, Rayne Institute, St Thomas' Hospital, London, SE17EH, UK
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