A review of critical factors in the conduct and interpretation of the human repeat insult patch test

In Silico Prediction of Skin Sensitization for Compounds via Flexible Evidence Combination Based on Machine Learning and Dempster-Shafer Theory

Skin sensitization is increasingly becoming a significant concern in the development of drugs and cosmetics due to consumer safety and occupational health problems. In silico methods have emerged as alternatives to traditional in vivo animal testing due to ethical and economic considerations. In this study, machine learning methods were used to build quantitative structure-activity relationship (QSAR) models on five skin sensitization data sets (GPMT, LLNA, DPRA, KeratinoSens, and h-CLAT), achieving effective predictive accuracies (correct classification rates of 0.688-0.764 on test sets). To address the complex mechanisms of human skin sensitization, the Dempster-Shafer theory was applied to merge multiple QSAR models, resulting in an evidence-based integrated decision model. Various evidence combinations and combination rules were explored, with the self-defined Q3 rule showing superior balance. The combination of evidence such as GPMT and KeratinoSens and h-CLAT achieved a correct classification rate (CCR) of 0.880 and coverage of 0.893 while maintaining the competitiveness of other combinations. Additionally, the Shapley additive explanations (SHAP) method was used to interpret important features and substructures related to skin sensitization. A comparative analysis of an external human test set demonstrated the superior performance of the proposed method. Finally, to enhance accessibility, the workflow was implemented into a user-friendly software named HSkinSensDS.

Skin Sensitization Testing: The Ascendancy of Non-Animal Methods

A century ago, toxicology was an empirical science identifying substance hazards in surrogate mammalian models. Over several decades, these models improved, evolved to reduce animal usage, and recently have begun the process of dispensing with animals entirely. However, despite good hazard identification, the translation of hazards into adequately assessed risks to human health often has presented challenges. Unfortunately, many skin sensitizers known to produce contact allergy in humans, despite being readily identified as such in the predictive assays, continue to cause this adverse health effect. Increasing the rigour of hazard identification is inappropriate. Regulatory action has only proven effective via complete bans of individual substances. Since the problem applies to a broad range of substances and industry categories, and since generic banning of skin sensitizers would be an economic catastrophe, the solution is surprisingly simple—they should be subject to rigorous safety assessment, with the risks thereby managed accordingly. The ascendancy of non-animal methods in skin sensitization is giving unparalleled opportunities in which toxicologists, risk assessors, and regulators can work in concert to achieve a better outcome for the protection of human health than has been delivered by the in vivo methods and associated regulations that they are replacing.

Weight of Evidence Approach for Skin Sensitization Potency Categorization of Fragrance Ingredients

Reliable human potency data are necessary for conducting quantitative risk assessments, as well as development and validation of new nonanimal methods for skin sensitization assessments. Previously, human skin sensitization potency of fragrance materials was derived primarily from human data or the local lymph node assay.

Approaches to Safety Evaluation of Baby Wipes

Disposable baby wipes manufactured by Procter & Gamble, soft sheets bearing lotion that is balanced to maintain natural skin pH, are convenient for cleaning the diaper area and a quick cleanup on baby’s face and hands.

Derivation of the no expected sensitization induction level for dermal quantitative risk assessment of fragrance ingredients using a weight of evidence approach

Some fragrance ingredients may have the potential to induce skin sensitization in humans but can still be safely formulated into consumer products. Quantitative Risk Assessment (QRA) for dermal sensitization is required to determine safe levels at which potential skin sensitizers can be incorporated into consumer products. The no expected sensitization induction level or NESIL is the point of departure for the dermal QRA. Sensitization assessment factors are applied to the NESIL to determine acceptable exposure levels at which no skin sensitization induction would be expected in the general population. This paper details the key steps involved in deriving a weight of evidence (WoE) NESIL for a given fragrance ingredient using all existing data, including in vivo, in vitro, and in silico. Read-across can be used to derive a NESIL for a group of structurally similar materials when data are insufficient. When sufficient target and read-across data are lacking, exposure waiving threshold (the DST) may be used. We outline the process as it currently stands at the Research Institute for Fragrance Materials Inc. (RIFM) and provide examples, but it is dynamic and is bound to change with evolving science as new approach methodologies (NAMs) are actively incorporated.

Tolerability profile of topical cannabidiol and palmitoylethanolamide: a compilation of single-centre randomized evaluator-blinded clinical and in vitro studies in normal skin

BACKGROUND

An increasing number of studies have investigated the adverse effect profile of oral cannabinoids; however, few studies have provided sufficient data on the tolerability of topical cannabinoids in human participants.

AIM

To assess the tolerability profile of several commercial topical formulations containing cannabidiol (CBD) and palmitoylethanolamide (PEA) on the skin of healthy human participants.

METHODS

Three human clinical trials and one in vitro study were conducted. The potential for skin irritation, sensitization and phototoxicity of several products, were assessed via patch testing on healthy human skin. The products assessed included two formulations containing CBD and PEA, one containing hemp seed oil and four concentrations of CBD alone. Ocular toxicity was tested using a traditional hen's egg chorioallantoic membrane model with three CBD, PEA and hemp seed oil formulations.

RESULTS

There was no irritation or sensitization of the products evident via patch testing on healthy participants. Additionally, mild phototoxicity of a hemp seed oil product was found at the 48-h time point compared with the negative control. The in vitro experiment demonstrated comparable effects of cannabinoid products with historically nonirritating products.

CONCLUSION

These specific formulations of CBD- and PEA-containing products are nonirritating and nonsensitizing in healthy adults, and further encourage similar research assessing their long-term safety and efficacy in human participants with dermatological diseases. There are some limitations to the study: (i) external validity may be limited as formulations from a single manufacturer were used for this study, while vast heterogeneity exists across unregulated, commercial CBD products on the market; and (ii) products were assessed only on normal, nondiseased human skin, and therefore extrapolation to those with dermatological diseases cannot be assumed.

Draize human repeat insult patch test (HRIPT): Seven decades of pitfalls and progress

Allergic contact dermatitis, a Type IV delayed hypersensitivity reaction, can result in dermatologic signs/symptoms for patients/workers. The likelihood of this phenomenon has been estimated/predicted for numerous chemicals/drugs by animal model and human patch testing protocols developed over the last century. Karl Landsteiner initiated testing with guinea pig studies; further studies based on his initial concept were in continual development. John Draize extended Landsteiner's guinea pig studies (which led to development of blood transfusions) to a human assay documenting irritant and allergic contact dermatitis potential - for drugs, chemicals, mixtures and products. We performed a literature search of major Draize derived protocols of the human repeat insult patch test (HRIPT). Our results reveal minor and major differences between protocols and lack of international standardization. Key clarification and principles post-Draize modified and improved usefulness of the HRIPT. Without a standard method of performing the HRIPT, it is problematic to generalize results of studies summarized here. Furthermore, we suggest a potential standardization procedure/protocol combining the work of the most satisfactory HRIPT methods. As the HRIPT constitutes a key parameter in current quantitative risk assessment for chemicals/drugs, such standardization should aid potential prediction of allergic contact dermatitis potential.

Fragrance Skin Sensitization Evaluation and Human Testing: 30-Year Experience

Background

The human repeated insult patch test (HRIPT) has a history of use in the fragrance industry as a component of safety evaluation, exclusively to confirm the absence of skin sensitization at a defined dose.

Objective

The aim of the study was to document the accumulated experience from more than 30 years of conducting HRIPTs.

Methods

A retrospective collation of HRIPT studies carried out to a consistent protocol was undertaken, with each study comprising a minimum of 100 volunteers.

Conclusions

The HRIPT outcomes from 154 studies on 134 substances using 16,512 volunteers were obtained. Most studies confirmed that at the selected induction/challenge dose, sensitization was not induced. In 0.12% of subjects (n = 20), there was induction of allergy. However, in the last 11 years, only 3 (0.03%) of 9854 subjects became sensitized, perhaps because of improved definition of a safe HRIPT dose from the local lymph node assay and other skin sensitization methodologies, as well as more rigorous application of the standard protocol after publication in 2008. This experience with HRIPTs demonstrates that de novo sensitization induction is rare and becoming rarer, but it plays an important role as an indicator that toxicological predictions from nonhuman test methods (in vivo and in vitro methods) can be imperfect.

The safety of a therapeutic product composed of a combination of stem cell released molecules from adipose mesenchymal stem cells and fibroblasts

Aim:

We sought to determine the safety profile of a therapeutic candidate composed of the released molecules from a combination of human adipose-derived mesenchymal stem cells and fibroblasts. Although stem cells, their progenitor cells and the molecules that are released from these cells have some demonstrated therapeutic value, much more needs to learn about the efficacy, mechanism of action and the safety profiles of these stem cell-based therapeutics.

Methods:

A number of cellular, in vitro, in vivo and human studies were performed to analyze cellular, tissue and systemic safety profiles of the combinatorial product.

Results:

At the levels tested in this study, ranging from demonstrated therapeutic doses to supratherapeutic doses, the combinatorial product demonstrated an excellent safety profile in all in vitro, cellular, tissue and systemic studies.

Conclusions:

We found evidence that a therapeutic candidate composed of the molecules released from human adipose-derived mesenchymal stem cells and human fibroblasts has an excellent safety profile, and that the product warrants further studies for safety and efficacy where dosing may include topical application, injection and oral application.

Stem cell transplants have demonstrated life-saving capabilities for some diseases, and the molecules released from stem cells are currently in therapeutic development for a number of conditions. Stem cell science is a relatively new science and is in need of a better understanding of mechanisms of action and acute and long-term safety profiles. Here, we performed a number of safety tests for stem cell released molecules from a combination of adipose-derived mesenchymal stem cells and fibroblasts that have demonstrated efficacy in a number of conditions. Using in vitro, in vivo and skin sensitivity studies in humans, the stem cell therapeutic was found to have an excellent safety profile when tested for toxicity, mutagenicity, tumorigenesis, ocular toxicity, inflammation and irritation.

Adjustment of a no expected sensitization induction level derived from Bayesian network integrated testing strategy for skin sensitization risk assessment

Skin sensitization is a key adverse effect to be addressed during hazard identification and risk assessment of chemicals, because it is the first step in the development of allergic contact dermatitis. Multiple non-animal testing strategies incorporating in vitro tests and in silico tools have achieved good predictivities when compared with murine local lymph node assay (LLNA). The binary test battery of KeratinoSens^TM and h-CLAT could be used to classify non-sensitizers as the first part of bottom-up approach. However, the quantitative risk assessment for sensitizing chemicals requires a No Expected Sensitization Induction Level (NESIL), the dose not expected to induce skin sensitization in humans. We used Bayesian network integrated testing strategy (BN ITS-3) for chemical potency classification. BN ITS-3 predictions were performed without a pre-processing step (selecting data from their physic-chemical applicability domains) or post-processing step (Michael acceptor chemistry correction), neither of which necessarily improve prediction accuracy. For chemicals within newly defined applicability domain, all under-predictions fell within one potency class when compared with LLNA results, indicating no chemicals that were incorrectly classified by more than one class. Considering the potential under-prediction by one class, a worst case value to each class from BN ITS-3 was used to derive a NESIL. When in vivo and human data from suitable analogs cannot be used to estimate the uncertainty, adjusting the NESIL derived from BN ITS-3 may help perform skin sensitization risk assessment. The overall workflow for risk assessment was demonstrated by incorporating the binary test battery of KeratinoSens^TM and h-CLAT.

The 21st Century movement within the area of skin sensitization assessment: From the animal context towards current human-relevant in vitro solutions

In a regulatory context, skin sensitization hazard and risk evaluations of manufactured products and their ingredients (e.g. cosmetics) are mandatory in several regions. Great efforts have been made within the field of 21st Century Toxicology to provide non-animal testing approaches to assess the skin allergy potential of materials (e.g. chemicals, mixtures, nanomaterials, particles). Mechanistic understanding of skin sensitization process through the adverse outcome pathway (AOP) has promoted the development of in vitro methods, demonstrating accuracies superior to the traditional animal testing. These in vitro testing approaches are based on one of the four AOP key events (KE) of skin sensitization: formation of immunogenic hapten-protein complexes (KE-1 or the molecular initiating event, MIE), inflammatory keratinocyte responses (KE-2), dendritic cell activation (KE-3), and T-lymphocyte activation and proliferation (KE-4). This update provides an overview of the historically used in vivo methods as well as the current in chemico and in cell methods with and without OECD guideline designations to analyze the progress towards human-relevant in vitro test methods for safety assessment of the skin allergenicity potential of materials. Here our focus is to review 96 in vitro testing approaches directed to the KEs of the skin sensitization AOP.

Design Methodology for the Development of a New Cosmetic Active Based on Prunus domestica L. Leaves Extract

When it comes to the development of new active ingredients for cosmetics, biodiversity is a rich source for inspiration that must be tapped in a sustainable manner to cause no social nor ecological damage. Agri-food by-products are therefore more and more considered as available biomass that can be reused to extract their maximum value to produce new cosmetic ingredients before returning to the biosphere. The process to transform plant waste materials into powerful cosmetic actives is thoroughly described in the present paper via the example of the design of a liquid anti-aging ingredient based on a Prunus domestica L. extract obtained by maceration of plums’ dried leaves in propylene glycol. The subsequent development of an SPE (solid-phase extraction) methodology used to remove the propylene glycol to get access to the extracted molecules is thoroughly described as a means to follow the stability of the ingredient over time once formulated into a finished product.

Topical Products for the Aging Face

This article focuses on nonprescription home-use topical treatment technologies for the aging face and is intended to serve as a guide for the core cosmeceutical technologies currently used and to help educate and assist the selection of topical antiaging products by the professional staff and their patients. Antiaging topical treatments for patient home use should be nonirritating, compatible with the patient skin type, effective, and complementary to surgical and minimally invasive office procedures, and aesthetically elegant. New topical antiaging technologies, formulated as monotherapy or as combinations with well-known cosmeceuticals, should present adequate clinical studies to support their selection for use.

Immunotoxicology and its application in risk assessment

Immunotoxicology is the study of undesired modulation of the immune system by extrinsic factors. Toxicological assessments have demonstrated that the immune system is a target following exposure to a diverse group of xenobiotics including ultraviolet radiation, chemical pollutants, therapeutics, and recreational drugs. There is a well-established cause and effect relationship between suppression of the immune response and reduced resistance to infections and certain types of neoplasia. In humans, mild-to-moderate suppression of the immune response is linked to reduced resistance to common community-acquired infections, whereas opportunistic infections, which are very rare in the general population, are common in individuals with severe suppression. Xenobiotic exposure may also result in unintended stimulation of immune function. Although a cause and effect relationship between unintended stimulation of the immune response and adverse consequences has yet to be established, evidence does suggest that hypersensitivity, autoimmunity, and pathological inflammation may be exacerbated in susceptible populations exposed to certain xenobiotics. Xenobiotics can act as allergens and elicit hypersensitivity responses, or they can modulate hypersensitivity responses to other allergens such as pollen or dust mite by acting as adjuvants, enhancing the development or expression of hypersensitivity. Allergic contact dermatitis, allergic rhinitis, and asthma are the most commonly encountered types of hypersensitivity reactions resulting from chemical exposure. The immunologic effectors and mechanisms involved in autoimmune reactions are the same as those associated with responses to foreign antigens; however, the reactions are directed against the host's own cells. Thus, chemicals that induce immune suppression, nonspecific immunostimulation, or hypersensitivity may also impact autoimmunity. Risk assessment for immunotoxicity should be performed using the same approaches and principles for other noncancer effects. However, since xenobiotics may have effects on more than one aspect of immune function, immunotoxicity data should be evaluated separately for evidence of suppression, stimulation, hypersensitivity, and autoimmunity.

Non-animal test methods for predicting skin sensitization potentials

Contact allergies are complex diseases, and it is estimated that 15-20 % of the general population suffers from contact allergy, with increasing prevalence. Evaluation of the sensitization potential of a substance is usually carried out in animal models. Nowadays, there is much interest in reducing and ultimately replacing current animal tests. Furthermore, as of 2013, the EU has posed a ban on animal testing of cosmetic ingredients that includes skin sensitization. Therefore, predictive and robust in vitro tests are urgently needed. In order to establish alternatives to animal testing, the in vitro tests must mimic the very complex interactions between the sensitizing chemical and the different parts of the immune system. This review article summarizes recent efforts to develop in vitro tests for predicting skin sensitizers. Cell-based assays, in chemico methods and, to a lesser extent, in silico methods are presented together with a discussion of their current status. With considerable progress having been achieved during the last years, the rationale today is that data from different non-animal test methods will have to be combined in order to obtain reliable hazard and potency information on potential skin sensitizers.

Strategies for the optimisation of in vivo experiments in accordance with the 3Rs philosophy

There are a large number of chemicals in current use for which adequate toxicity data are not available. Whilst there are clear ethical and legal obligations to obtain data from sources other than in vivo experiments wherever possible, in certain cases in vivo assays may be deemed necessary. In such circumstances, it is essential to ensure that the maximum amount of high quality data is obtained from the minimum number of animals, using the most humane procedures, in accordance with the philosophy of reduction, refinement and replacement (3Rs). The aim of this report is to provide a strategy for anyone involved in animal experimentation, for either toxicological or pharmacological purposes, as to how in vivo experiments may be optimised. The impact of generic and endpoint specific sources of variability has been highlighted in a proof-of-principle analysis considering the variation in protocols for assays for four human health endpoints (skin sensitisation, reproductive/developmental toxicity, mutagenicity and carcinogenicity). Other factors such as operator training, experimental/statistical design, use of lower species and use of combined assays are also discussed. Recommendations for optimisation of in vivo assays, in terms of the 3Rs philosophy, applied to performing tests, harvesting data and appropriate reporting are summarised as a checklist of issues to be addressed prior to undertaking such assays.

Perspectives on Non-Animal Alternatives for Assessing Sensitization Potential in Allergic Contact Dermatitis

Skin sensitization remains a major environmental and occupational health hazard. Animal models have been used as the gold standard method of choice for estimating chemical sensitization potential. However, a growing international drive and consensus for minimizing animal usage have prompted the development of in vitro methods to assess chemical sensitivity. In this paper, we examine existing approaches including in silico models, cell and tissue based assays for distinguishing between sensitizers and irritants. The in silico approaches that have been discussed include Quantitative Structure Activity Relationships (QSAR) and QSAR based expert models that correlate chemical molecular structure with biological activity and mechanism based read-across models that incorporate compound electrophilicity. The cell and tissue based assays rely on an assortment of mono and co-culture cell systems in conjunction with 3D skin models. Given the complexity of allergen induced immune responses, and the limited ability of existing systems to capture the entire gamut of cellular and molecular events associated with these responses, we also introduce a microfabricated platform that can capture all the key steps involved in allergic contact sensitivity. Finally, we describe the development of an integrated testing strategy comprised of two or three tier systems for evaluating sensitization potential of chemicals.

Allergic contact dermatitis caused by farnesol: clinical relevance

CONTEXT

The fragrance material farnesol is cited as an infrequent but important cause of allergic contact dermatitis (ACD). It is included in the fragrance mix II patch series and requires labeling in the European Union if it is used in a consumer product.

OBJECTIVE

To review the existing literature to determine the causative role of farnesol in clinical contact allergy.

MATERIALS AND METHODS

Survey of the literature on farnesol studies; predictive and clinical elicitation tests in case reports, reviews, and abstracts.

RESULTS

Predictive animal studies demonstrated in most cases that farnesol was a nonsensitizer. However, 2 local lymph node assays (LLNAs) indicated strong sensitization potential. Predictive human test data indicated a low potential, if any, for sensitization in human tests with farnesol at 10% or 12%. A few clinical reports indicated low-level allergy or questionable reactions to farnesol, with 5% being the most commonly used. There were also reports in which no reactions were seen.

DISCUSSION

Predictive testing on farnesol in animals shows conflicting results depending on the study methodology used. Human predictive patch-test data also had gaps that prevented it from being definitive in pointing to a causative relationship between farnesol and contact dermatitis. The real sensitizing potential of a material can best be determined by evaluating the clinical and epidemiological data so as to help resolve the conflicting animal and human predictive test data.

CONCLUSIONS

This literature and scoring exercise showed that predictive and clinical elicitation data do not document a clear causative determination that farnesol is a frequent contact allergen. Detailed clinical relevance and patient studies should clarify the clinical problem farnesol represents.

The human repeated insult patch test in the 21st century: a commentary

The human repeated insult patch test (HRIPT) is over half a century old, but is still used in several countries as a confirmatory test in the safety evaluation of skin sensitizers. This is despite the criticism it receives from an ethical perspective and regarding the scientific validity of such testing. In this commentary, the HRIPT is reviewed, with emphasis on ethical aspects and where the test can, and cannot, contribute in a scientifically meaningful manner to safety evaluation. It is concluded that where there is a specific rationale for testing, for example, to substantiate a no-effect level for a sensitizing chemical or to ensure that matrix effects are not making an unexpected contribution to sensitizing potency, then rigorous independent review may confirm that an HRIPT is ethical and scientifically justifiable. The possibility that sensitization may be induced in volunteers dictates that HRIPTs should be conducted rarely and in cases where the benefits overwhelmingly outweigh the risk. However, for the very large majority of HRIPTs conducted concerning the risk of skin sensitization, there is neither scientific justification nor any other merit.

The Dermal Sensitisation Threshold- a TTC approach for allergic contact dermatitis

The Threshold of Toxicological Concern (TTC) is a useful concept that is becoming of increasing interest as an addition to the arsenal of tools used for characterising the toxicological risk of human exposure to chemicals. Traditionally used for low level indirect additives, flavours and contaminants in foods, the TTC obviates the need for toxicological testing of chemicals where human exposure is low. Proposals have recently been made for the use of the TTC for low level ingredients in cosmetic and personal care products. However, use of the TTC is only protective for systemic toxicity endpoints, and cannot be used for local endpoints such as contact sensitisation. In this paper a probabilistic analysis of available sensitisation data, similar to that used in the development of the TTC, is presented. The incidence of sensitisers in the world of chemicals was estimated using the ELINCS (European List of Notified Chemical Substances) data set, and a distribution for sensitisation potency was established using a recently published compilation of Local Lymph Node Assay data. From the analysis of these data sets it is concluded that a Dermal Sensitisation Threshold (DST) can be established below which there is no appreciable risk of sensitisation, even for an untested ingredient. Use of a DST would preclude the need for sensitisation testing of ingredients where dermal exposure is sufficiently low.

Dermal sensitization quantitative risk assessment (QRA) for fragrance ingredients

Based on chemical, cellular, and molecular understanding of dermal sensitization, an exposure-based quantitative risk assessment (QRA) can be conducted to determine safe use levels of fragrance ingredients in different consumer product types. The key steps are: (1) determination of benchmarks (no expected sensitization induction level (NESIL)); (2) application of sensitization assessment factors (SAF); and (3) consumer exposure (CEL) calculation through product use. Using these parameters, an acceptable exposure level (AEL) can be calculated and compared with the CEL. The ratio of AEL to CEL must be favorable to support safe use of the potential skin sensitizer. This ratio must be calculated for the fragrance ingredient in each product type. Based on the Research Institute for Fragrance Materials, Inc. (RIFM) Expert Panel's recommendation, RIFM and the International Fragrance Association (IFRA) have adopted the dermal sensitization QRA approach described in this review for fragrance ingredients identified as potential dermal sensitizers. This now forms the fragrance industry's core strategy for primary prevention of dermal sensitization to these materials in consumer products. This methodology is used to determine global fragrance industry product management practices (IFRA Standards) for fragrance ingredients that are potential dermal sensitizers. This paper describes the principles of the recommended approach, provides detailed review of all the information used in the dermal sensitization QRA approach for fragrance ingredients and presents key conclusions for its use now and refinement in the future.