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Boulay E, Authier S, Bartko T, Greiter-Wilke A, Leishman D, Li D, Nichols JV, Pierson J, Rossman EI, Valentin JP, Vicente J, Walisser J, Troncy E, Wisialowski TA. Assessment of corrected JT-peak (JTpc) and Tpeak-to-Tend (TpTec) as proarrhythmia biomarkers in non-human primates: Outcome from a HESI consortium. J Pharmacol Toxicol Methods 2024; 129:107543. [PMID: 39019200 DOI: 10.1016/j.vascn.2024.107543] [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: 05/01/2024] [Revised: 07/03/2024] [Accepted: 07/12/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Corrected QT interval (QTc)is an established biomarker for drug-induced Torsade de Pointe (TdP), but with concerns for a false positive signal. Clinically, JTpc and TpTec have emerged as ECG sub-intervals to differentiate predominant hERG vs. mixed ion channel blocking drugs that prolong QTc. METHODS In a multicentric, prospective, controlled study, different proarrhythmic drug effects on QTc, JTpc and TpTec were characterized with cynomolgus monkeys using telemetry in a Lead II configuration for internal and external telemetry.Drugs and vehicle were administered orally (PO) to group size of 4 to 8 animals, in 4 laboratories. RESULTS In monkeys, dofetilide (0.03-0.3 mg/kg) was associated with exposure dependent QTc and JTpc increase, but no significant TpTec effect. Similarly, quinidine (2-50 mg/kg) increased QTc and JTpc but did not change TpTec. Mexiletine (1-15 mg/kg) and verapamil (50 mg/kg) did not induce any significant effect on QTc, JTpc or TpTec. DISCUSSION Clinically, predominant hERG blockers (dofetilide and quinidine) prolong QTc, JTpc and TpTec and are associated with increased risk for TdP. Results from this study demonstrate that ECG changes after dofetilide and quinidine administration to telemetered monkeys differ from the clinical response, lacking the expected effects on TpTec. Potential explanations for the lack of translation include physio-pharmacology species differences or ECG recording and analysis methodology variations. Mixed ion channel blockers verapamil and mexiletine administered to monkeys showed no significant QTc, JTpc or TpTec prolongation as expected based on the similar clinical response for these agents.
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Affiliation(s)
- Emmanuel Boulay
- Charles River Laboratories, Laval, Quebec, Canada; GREPAQ (Groupe de recherche en pharmacologie animale du Québec), Université de Montréal, St-Hyacinthe, Québec, Canada
| | - Simon Authier
- Charles River Laboratories, Laval, Quebec, Canada; GREPAQ (Groupe de recherche en pharmacologie animale du Québec), Université de Montréal, St-Hyacinthe, Québec, Canada.
| | - Theresa Bartko
- Labcorp Early Development Laboratories Inc, Madison, WI, USA
| | | | | | | | - Jill V Nichols
- Labcorp Early Development Laboratories Inc, Madison, WI, USA
| | - Jennifer Pierson
- Health and Environmental Sciences Institute (HESI), Washington, DC, USA
| | | | | | - Jose Vicente
- Center for Drug Evaluation and Research, US Food & Drug Administration (FDA), Silver Spring, MD, USA
| | | | - Eric Troncy
- GREPAQ (Groupe de recherche en pharmacologie animale du Québec), Université de Montréal, St-Hyacinthe, Québec, Canada
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2
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Lester RM, Engel C, van Haarst AD, Paglialunga S. Should You Run a Dedicated TQT Study? Sponsor and Regulatory Considerations on Substitution Pathways to Assess QT Liability. Clin Pharmacol Ther 2024; 116:42-51. [PMID: 38698592 DOI: 10.1002/cpt.3284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
Cardiac safety regulatory guidance for drug development has undergone several monumental shifts over the past decade as technological advancements, analysis models and study best practices have transformed this landscape. Once, clinical proarrhythmic risk assessment of a new chemical entity (NCE) was nearly exclusively evaluated in a dedicated thorough QT (TQT) study. However, since the introduction of the International Council for Harmonisation (ICH) E14/S7B Q&A 5.1 and 6.1 TQT substitutions, drug developers are offered an alternative pathway to evaluate proarrhythmic risk during an ascending dose study in healthy volunteers or during a powered patient study, respectively. In addition, the findings as well as the manner in which nonclinical studies are conducted (i.e., utilizing best practices) can dictate the need for a positive control in the clinical study and/or affect the labeling outcome. Drug sponsors are now faced with the option of pursuing a dedicated TQT study or requesting a TQT substitution. Potential factors influencing the choice of pathway include the NCE mechanism of action, pharmacokinetic properties, and safety profile, as well as business considerations. This tutorial will highlight the regulatory framework for integrated arrhythmia risk prediction models to outline drug safety, delineate potential reasons why a TQT substitution request may be rejected and discuss when a standalone TQT is recommended.
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Bétat AM, Delaunois A, Delpy E, Loiseau M, Maurin A, Poizat G, Possémé C, Weinelt F, Drieu la Rochelle C, Martel E, Valentin JP. Results from a Joined Prospective Study to Evaluate the Sensitivity of the In Vivo Dog QT Assay in Line with the ICH E14/S7B Q&A Best Practices. Clin Pharmacol Ther 2024; 116:106-116. [PMID: 38709223 DOI: 10.1002/cpt.3283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Abstract
The ICH E14/S7B Q&As highlighted the need for best practices concerning the design, execution, analysis, interpretation, and reporting of the in vivo non-rodent QT assay as a component of the integrated risk assessment to potentially support a TQT waiver or substitute. We conducted a dog telemetry study to assess the effects on QTc of six reference compounds (five positive and one negative) previously evaluated by Darpo et al. (2015) in humans. The sensitivity of the assay to detect QTc increases was determined, and exposure-response analysis was performed, as done in clinical practice. By-timepoint analysis showed QTc prolongation induced by moxifloxacin, dofetilide, dolasetron, ondansetron, and quinine within human relevant plasma exposures ranges. Moreover, a hysteresis was observed for quinine. As expected, levocetirizine showed no statistically significant effect on QTc across a range of exposure, well exceeding the therapeutic Cmax. Power analyses confirmed the study ability to detect statistically significant QTc changes of less than 10 milliseconds with 80% probability, even with a sample size as low as n = 4 animals. Finally, concentration-QTc modeling enabled to predict the minimal plasma concentration needed to detect a 10 milliseconds QTc prolongation, including for quinine. The comparison with clinical available data supported the relevance of dogs under these experimental conditions as a robust translational predictor of drug-induced QTc prolongation in humans as a key pillar of the integrated risk assessment.
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Affiliation(s)
| | - Annie Delaunois
- Early Clinical Development & Translational Science Department, UCB Biopharma SRL, Braine-l'Alleud, Belgium
| | - Eric Delpy
- Non-Clinical Department, Biotrial Pharmacology, Rennes, France
| | | | - Anne Maurin
- Non-Clinical Department, Biotrial Pharmacology, Rennes, France
| | | | - Celine Possémé
- Non-Clinical Department, Biotrial Pharmacology, Rennes, France
| | - Ferdinand Weinelt
- Department of Drug Discovery Sciences-PKPD Modeling, Boehringer Ingelheim Pharma, Biberach/Riss, Germany
| | | | - Eric Martel
- Department of Drug Discovery Sciences-General Pharmacology, Boehringer Ingelheim Pharma, Biberach/Riss, Germany
| | - Jean-Pierre Valentin
- Early Clinical Development & Translational Science Department, UCB Biopharma SRL, Braine-l'Alleud, Belgium
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4
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Leishman DJ, Brimecombe J, Crumb W, Hebeisen S, Jenkinson S, Kilfoil PJ, Matsukawa H, Melliti K, Qu Y. Supporting an integrated QTc risk assessment using the hERG margin distributions for three positive control agents derived from multiple laboratories and on multiple occasions. J Pharmacol Toxicol Methods 2024; 128:107524. [PMID: 38852689 DOI: 10.1016/j.vascn.2024.107524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Determination of a drug's potency in blocking the hERG channel is an established safety pharmacology study. Best practice guidelines have been published for reliable assessment of hERG potency. In addition, a set of plasma concentration and plasma protein binding fraction data were provided as denominators for margin calculations. The aims of the current analysis were five-fold: provide data allowing creation of consistent denominators for the hERG margin distributions of the key reference agents, explore the variation in hERG margins within and across laboratories, provide a hERG margin to 10 ms QTc prolongation based on several newer studies, provide information to use these analyses for reference purposes, and provide recommended hERG margin 'cut-off' values. METHODS The analyses used 12 hERG IC50 'best practice' data sets (for the 3 reference agents). A group of 5 data sets came from a single laboratory. The other 7 data sets were collected by 6 different laboratories. RESULTS The denominator exposure distributions were consistent with the ICH E14/S7B Training Materials. The inter-occasion and inter-laboratory variability in hERG IC50 values were comparable. Inter-drug differences were most important in determining the pooled margin variability. The combined data provided a robust hERG margin reference based on best practice guidelines and consistent exposure denominators. The sensitivity of hERG margin thresholds were consistent with the sensitivity described over the course of the last two decades. CONCLUSION The current data provide further insight into the sensitivity of the 30-fold hERG margin 'cut-off' used for two decades. Using similar hERG assessments and these analyses, a future researcher can use a hERG margin threshold to support a negative QTc integrated risk assessment.
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Affiliation(s)
| | | | - William Crumb
- Nova Research Laboratories, New Orleans, Louisiana, USA
| | | | | | - Peter J Kilfoil
- Pfizer Global Research & Development, Groton, Conneticut, USA
| | | | - Karim Melliti
- Labcorp Early Development Laboratories Inc., Harrogate, UK
| | - Yusheng Qu
- Amgen Research, Thousand Oaks, California, USA
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5
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Hughes JH, Bertz R, Bhardwaj R, Donohue MK, Madonia J, Anderson MS, Morris BA, Croop RS, Liu J. Concentration-QTc and cardiac safety analysis of single and multiple zavegepant nasal spray doses in healthy participants to support approval. CPT Pharmacometrics Syst Pharmacol 2024; 13:1044-1054. [PMID: 38812357 PMCID: PMC11179704 DOI: 10.1002/psp4.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 05/31/2024] Open
Abstract
Zavegepant is a novel gepant administered as a nasal spray approved in the United States at a 10 mg dose for the acute treatment of migraine with or without aura in adults. The cardiovascular safety of zavegepant nasal spray was assessed in both single-ascending dose (SAD) and multiple-ascending dose (MAD) studies in healthy participants. The SAD study included 72 participants (54 active/18 placebo) who received 0.1-40 mg zavegepant or placebo. The MAD study included 72 participants (56 active/16 placebo) who received 5-40 mg zavegepant or placebo for 1-14 days. Plasma zavegepant pharmacokinetics and electrocardiographic (ECG) parameters (Fridericia-corrected QT interval [QTcF], heart rate, PR interval, ventricular depolarization [QRS], T-wave morphology, and U-wave presence) were analyzed pre- and post-zavegepant administration. Using pooled data from the SAD and MAD studies, the relationship between time-matched plasma zavegepant concentrations and QTc interval was assessed using a linear mixed-effects model to evaluate the potential for QTc interval prolongation. Results showed that single and multiple doses of zavegepant had no significant impact on ECG parameters versus placebo, and there was no concentration-dependent effect on QTcF interval. The estimated slope of the plasma zavegepant concentration-QTcF model was -0.053 ms per ng/mL with a 90% confidence interval of -0.0955 to -0.0110 (p = 0.0415), which is not considered clinically meaningful. At doses up to four times the recommended daily dose, zavegepant does not prolong the QT interval to any clinically relevant extent.
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Affiliation(s)
- Jim H Hughes
- Pfizer Research and Development, Pfizer, Groton, Connecticut, USA
| | - Richard Bertz
- Biohaven Pharmaceuticals Inc, New Haven, Connecticut, USA
| | | | - Mary K Donohue
- Biohaven Pharmaceuticals Inc, New Haven, Connecticut, USA
| | | | | | - Beth A Morris
- Biohaven Pharmaceuticals Inc, New Haven, Connecticut, USA
| | - Robert S Croop
- Biohaven Pharmaceuticals Inc, New Haven, Connecticut, USA
| | - Jing Liu
- Pfizer Research and Development, Pfizer, Groton, Connecticut, USA
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Pierson JB, Berridge B, Blinova K, Brooks MB, Eldridge S, O'Brien CE, Pugsley MK, Schultze AE, Smith G, Stockbridge N, Valentin JP, Vicente J. Collaborative science in action: A 20 year perspective from the Health and Environmental Sciences Institute (HESI) Cardiac Safety Committee. J Pharmacol Toxicol Methods 2024; 127:107511. [PMID: 38710237 DOI: 10.1016/j.vascn.2024.107511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024]
Abstract
The Health and Environmental Sciences Institute (HESI) is a nonprofit organization dedicated to resolving global health challenges through collaborative scientific efforts across academia, regulatory authorities and the private sector. Collaborative science across non-clinical disciplines offers an important keystone to accelerate the development of safer and more effective medicines. HESI works to address complex challenges by leveraging diverse subject-matter expertise across sectors offering access to resources, data and shared knowledge. In 2008, the HESI Cardiac Safety Committee (CSC) was established to improve public health by reducing unanticipated cardiovascular (CV)-related adverse effects from pharmaceuticals or chemicals. The committee continues to significantly impact the field of CV safety by bringing together experts from across sectors to address challenges of detecting and predicting adverse cardiac outcomes. Committee members have collaborated on the organization, management and publication of prospective studies, retrospective analyses, workshops, and symposia resulting in 38 peer reviewed manuscripts. Without this collaboration these manuscripts would not have been published. Through their work, the CSC is actively addressing challenges and opportunities in detecting potential cardiac failure modes using in vivo, in vitro and in silico models, with the aim of facilitating drug development and improving study design. By examining past successes and future prospects of the CSC, this manuscript sheds light on how the consortium's multifaceted approach not only addresses current challenges in detecting potential cardiac failure modes but also paves the way for enhanced drug development and study design methodologies. Further, exploring future opportunities and challenges will focus on improving the translational predictability of nonclinical evaluations and reducing reliance on animal research in CV safety assessments.
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Affiliation(s)
| | | | | | - Marjory B Brooks
- Comparative Coagulation Section, Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Sandy Eldridge
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Claire E O'Brien
- Health and Environmental Sciences Institute, Washington, DC, USA.
| | - Michael K Pugsley
- Toxicology & Safety Pharmacology, Cytokinetics, South San Francisco, CA, USA
| | - A Eric Schultze
- Pathology, Lilly Research Laboratories, Indianapolis, IN, USA
| | - Godfrey Smith
- Clyde Biosciences Ltd, Newhouse, UK; University of Glasgow, Scotland, UK
| | | | - Jean-Pierre Valentin
- UCB Biopharma SRL, Development Science, Non-Clinical Safety Evaluation, Braine l'Alleud, Belgium
| | - Jose Vicente
- Food and Drug Administration, Silver Spring, MD, USA
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7
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De Alwis D, Foley CM, Herman E, Hill AP, Hoffmann PK, Kanda Y, Kaushik E, Pierson J, Puglisi R, Shi H, Yang X, Pugsley MK. Development of a pharmaceutical database as an aid to the nonclinical detection of drug-induced cardiac toxicity. J Pharmacol Toxicol Methods 2024; 127:107507. [PMID: 38636673 DOI: 10.1016/j.vascn.2024.107507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
The Health and Environmental Sciences Institute (HESI) Cardiac Safety Committee designed and created a publicly accessible database with an initial set of 128 pharmacologically defined pharmaceutical agents, many with known cardiotoxic properties. The database includes specific information about each compound that could be useful in evaluating hypotheses around mechanisms of drug-induced cardiac toxicity or for development of novel cardiovascular safety assays. Data on each of the compounds was obtained from published literature and online sources (e.g., DrugBank.ca and International Union of Basic and Clinical Pharmacology (IUPHAR) / British Pharmacological Society (BPS) Guide to PHARMACOLOGY) and was curated by 10 subject matter experts. The database includes information such as compound name, pharmacological mode of action, characterized cardiac mode of action, type of cardiac toxicity, known clinical cardiac toxicity profile, animal models used to evaluate the cardiotoxicity profile, routes of administration, and toxicokinetic parameters (i.e., Cmax). Data from both nonclinical and clinical studies are included for each compound. The user-friendly web interface allows for multiple approaches to search the database and is also intended to provide a means for the submission of new data/compounds from relevant users. This will ensure that the database is constantly updated and remains current. Such a data repository will not only aid the HESI working groups in defining drugs for use in any future studies, but safety scientists can also use the database as a vehicle of support for broader cardiovascular safety studies or exploring mechanisms of toxicity associated with certain pharmacological modes of action.
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Affiliation(s)
- Donald De Alwis
- Health and Environmental Sciences Institute, Washington, DC 20005, USA
| | | | | | - Adam P Hill
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
| | | | - Yasunari Kanda
- National Institute of Health Sciences (NIHS), Kawasaki, Japan.
| | - Emily Kaushik
- Takeda Pharmaceuticals Company Ltd., Cambridge, MA 02139, USA.
| | - Jennifer Pierson
- Health and Environmental Sciences Institute, Washington, DC 20005, USA.
| | - Raechel Puglisi
- Health and Environmental Sciences Institute, Washington, DC 20005, USA.
| | - Hong Shi
- Bristol-Myers Squibb Co., Princeton, NJ 08543, USA.
| | - Xi Yang
- RTI International, Washington, DC 20005, USA.
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Bhardwaj R, Hanna MS, Morris BA, Matschke KT, Bertz R, Croop RS, Liu J. No clinically relevant electrocardiogram effects in a randomized TQT study of single therapeutic/supratherapeutic rimegepant doses in healthy adults. Clin Transl Sci 2024; 17:e13727. [PMID: 38440916 PMCID: PMC10912979 DOI: 10.1111/cts.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/22/2023] [Accepted: 01/06/2024] [Indexed: 03/06/2024] Open
Abstract
A single-center, phase I, partially double-blind (double-blind regarding doses of rimegepant and placebo, and open label with respect to moxifloxacin), randomized, 12-sequence, four-period crossover study of therapeutic (75 mg) and supratherapeutic (300 mg) doses of rimegepant with placebo and moxifloxacin (400 mg) controls was designed to evaluate drug effect on the Fridericia corrected QT (QTcF) interval in healthy fasted adults. A total of 38 participants were randomized and dosed in the study. Electrocardiogram (ECG) data were available from 37 participants in the rimegepant 75-mg group, 38 participants in the rimegepant 300-mg group, and 36 participants in the moxifloxacin and placebo groups. Both the 75- and 300-mg doses of rimegepant had no clinically relevant effect on ECG parameters, including QTcF, heart rate, PR and QRS interval, T-wave morphology, and U-wave presence. All upper 90% confidence intervals for the QTcF effect with rimegepant were less than or equal to 4.69 ms, well below the 10-ms threshold for potential clinical significance. Assay sensitivity was demonstrated by the QT effect of moxifloxacin. Using both by-timepoint and concentration-QTc analysis, a placebo-corrected change-from-baseline QTcF greater than 10 ms could be excluded for rimegepant plasma concentrations up to ~10,000 ng/mL, representing concentrations at least 10.8-fold the maximum observed concentration of the 75-mg therapeutic dose of rimegepant.
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Affiliation(s)
| | | | | | | | - Richard Bertz
- Biohaven Pharmaceuticals Inc.New HavenConnecticutUSA
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9
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Berry K, Postlmayr L, Shiltz D, Parker J, Ice C. Impact of an inpatient pharmacist-driven renal dosing policy on order verification time and patient safety. SAGE Open Med 2024; 12:20503121241233223. [PMID: 38379810 PMCID: PMC10878201 DOI: 10.1177/20503121241233223] [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: 10/11/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Research regarding pharmacist-driven renal dosing policies has focused on cost savings or prevention of adverse drug events. However, little is known about how these policies influence time from order signature to order verification or how this efficiency may reduce the incidence of adverse outcomes. Objectives: The primary endpoint compared time from prescriber electronic order signature to pharmacist electronic order verification between pre- and post-renal dosing policy implementation. The secondary endpoint evaluated electrocardiogram QTc prolongation attributed to fluconazole accumulation in renal impairment. Methods: This retrospective analysis included adults with a creatine clearance ⩽50 mL/min who received at least two inpatient doses from a 34-medication renal dosing protocol between January-February 2020 and April-May 2020. Results: 502 patients met eligibility for the primary outcome. The pre- and post-policy cohorts shared similar baseline characteristics. Time from order signature to verification was 9 and 8 min in the pre- and post-policy groups, respectively (p = 0.0861). In all, 56 patients met inclusion criteria for the secondary outcome. The QTc interval during fluconazole increased relative to baseline in 3 of 7 (43%) pre-policy and 4 of 5 (80%) post-policy. The QTc interval exceeded 500 ms in two patients, both in the post-policy cohort. Conclusions: There was no difference in order signature to verification time. Post-policy fluconazole renal adjustment did not reduce QTc prolongation.
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Affiliation(s)
- Kayla Berry
- Michigan Medicine, University of Michigan Health, Ann Arbor, MI, USA
| | - Laura Postlmayr
- Sinai-Grace Hospital—Detroit Medical Center, Detroit, MI, USA
| | - Dane Shiltz
- College of Pharmacy, Ferris State University, Grand Rapids, MI, USA
- Butterworth Hospital Pharmacy, Spectrum Health, Grand Rapids, MI, USA
| | - Jessi Parker
- Scholarly Activity and Scientific Support Spectrum Health, Grand Rapids, MI, USA
| | - Calvin Ice
- Butterworth Hospital Pharmacy, Spectrum Health, Grand Rapids, MI, USA
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10
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Goineau S, Gallet L, Froget G. Whole-Cell Configuration of the Patch-Clamp Technique in the hERG Channel Assay. Curr Protoc 2024; 4:e959. [PMID: 38334240 DOI: 10.1002/cpz1.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
In vitro electrophysiological safety studies have become an integral part of the drug development process because, in many instances, compound-induced QT prolongation has been associated with a direct block of human ether-a-go-go-related gene (hERG) potassium channels or their native current, the rapidly activating delayed rectifier potassium current (IKr ). Therefore, according to the ICH S7B guideline, the in vitro hERG channel patch-clamp assay is commonly used as an early screen to predict the ability of a compound to prolong the QT interval prior to first-in-human testing. The protocols described in this article are designed to assess the effects of acute or long-term exposure to new chemical entities on the amplitude of IKr in HEK293 cells stably transfected with the hERG channel (whole-cell configuration of the patch-clamp technique). Examples of results obtained with moxifloxacin, terfenadine, arsenic, pentamidine, erythromycin, and sotalol are provided for illustrative purposes. © 2024 Wiley Periodicals LLC. Basic Protocol: Measurement of the acute effects of test items in the hERG channel test Alternate Protocol: Measurement of the long-term effects of test items in the hERG channel test.
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Affiliation(s)
- Sonia Goineau
- Porsolt Research Center, Le Genest-Saint-Isle, France
| | - Lucie Gallet
- Porsolt Research Center, Le Genest-Saint-Isle, France
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11
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Valentin JP, Sibony A, Rosseels ML, Delaunois A. "Appraisal of state-of-the-art" The 2021 Distinguished Service Award of the Safety Pharmacology Society: Reflecting on the past to tackle challenges ahead. J Pharmacol Toxicol Methods 2023; 123:107269. [PMID: 37149063 DOI: 10.1016/j.vascn.2023.107269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Abstract
This appraisal of state-of-the-art manuscript highlights and expands upon the thoughts conveyed in the lecture of Dr. Jean-Pierre Valentin, recipient of the 2021 Distinguished Service Award of the Safety Pharmacology Society, given on the 2nd December 2021. The article reflects on the strengths, weaknesses, opportunities, and threats that surrounded the evolution of safety and secondary pharmacology over the last 3 decades with a particular emphasis on pharmaceutical drug development delivery, scientific and technological innovation, complexities of regulatory framework and people leadership and development. The article further built on learnings from past experiences to tackle constantly emerging issues and evolving landscape whilst being cognizant of the challenges facing these disciplines in the broader drug development and societal context.
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Affiliation(s)
- Jean-Pierre Valentin
- UCB-Biopharma SRL, Early Solutions, Development Science, Non-Clinical Safety Evaluation, Braine L'Alleud, Belgium.
| | - Alicia Sibony
- UCB-Biopharma SRL, Early Solutions, Development Science, Non-Clinical Safety Evaluation, Braine L'Alleud, Belgium
| | - Marie-Luce Rosseels
- UCB-Biopharma SRL, Early Solutions, Development Science, Non-Clinical Safety Evaluation, Braine L'Alleud, Belgium
| | - Annie Delaunois
- UCB-Biopharma SRL, Early Solutions, Development Science, Non-Clinical Safety Evaluation, Braine L'Alleud, Belgium
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12
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Alizadeh EA, Graf K, Schiwon J, Trautmann T, Krause F, Mayer W, Christ K, Martel E, Guth BD, Markert M. Thirty years of telemetry-based data acquisition for cardiovascular drug safety evaluation: Applications and optimization. J Pharmacol Toxicol Methods 2023:107279. [PMID: 37257761 DOI: 10.1016/j.vascn.2023.107279] [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: 02/06/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
Conducting safety evaluations of new drugs using conscious animals has been a specialty of our working group for thirty years. In this article, we review the various technical challenges and solutions dealt with over the years to improve both the data quality and the well being of our animal subjects. Of particular interest for us has been the use of telemetry-based data acquisition for conducting studies on cardiovascular (CV) function. This includes the evolving technical aspects of the studies, as well as the development of new applications that take advantage of this technical approach.
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Affiliation(s)
- Elham Ataei Alizadeh
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Karin Graf
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Jessica Schiwon
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Thomas Trautmann
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Florian Krause
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Werner Mayer
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Katrin Christ
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Eric Martel
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Brian D Guth
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Michael Markert
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany.
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13
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Alizadeh EA, Trautmann T, Krause F, Knoeferl B, Guns PJ, De Meyer G, Guth BD, Markert M. The impact of environmental and biological factors on the resting heart rate of dogs as assessed using 20 years of data from safety pharmacology studies. J Pharmacol Toxicol Methods 2023; 121:107263. [PMID: 36965603 DOI: 10.1016/j.vascn.2023.107263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/09/2023] [Accepted: 03/16/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION A safety pharmacology study detects and evaluates potential side effects of a new drug on physiological function at therapeutic levels and above and, in most cases, prior to the initiation of clinical trials. The aim of this study was to investigate the effects of environmental and biological factors on resting heart rate (HR), a representative cardiac parameter in cardiovascular safety pharmacology. METHODS Over twenty years, 143 dogs (Beagles, Labradors and mongrels) received implanted telemetry transmitters to measure aortic pressure (AP), left ventricular pressure (LVP), Electrocardiogram (ECG) and body temperature. Throughout the 7-h period of data collection, data were continuously recorded without drug treatment and included the range of HRs resulting from spontaneous physiological changes. Statistics and visualizations were calculated using R and Spotfire. RESULTS Beagles had a higher HR than the mongrels, while Labradors had a lower HR than mongrels. Labradors were found to have a sex-based difference in HR, with females having a higher HR. A higher HR was observed in young animals of all breeds when they were in contact with humans. The cage system affected the HR of Labradors and mongrels more than Beagles. Larger dogs (e.g. Labrador) have a lower HR than smaller dogs (Beagles). Animals that are younger were found to have more HR variability and have a higher HR than older animals. In addition, older animals reacted less to the application period and human interaction than younger animals. The HR response of animals inside a cage system may depend on the cage system in which they were bred. A familiar cage system typically has less impact on HR. DISCUSSION This retrospective data base evaluation has demonstrated the impact of environmental and biological factors on cardiovascular parameters in the context of performing safety pharmacology studies. Breed, sex, age and the type of cage system used affected, at least in some cases, the HR and its variability. They should therefore be carefully considered when designing safety pharmacology studies to have the highest possible test sensitivity.
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Affiliation(s)
- Elham Ataei Alizadeh
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Thomas Trautmann
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Florian Krause
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Benjamin Knoeferl
- Department of Global Biostatistics & Data Sciences, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Pieter-Jan Guns
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Guido De Meyer
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Brian D Guth
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany
| | - Michael Markert
- Department of Drug Discovery Sciences, General Pharmacology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Germany.
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14
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Vargas HM, Rossman EI, Wisialowski TA, Nichols J, Pugsley MK, Roche B, Gintant GA, Greiter-Wilke A, Kleiman RB, Valentin JP, Leishman DJ. Improving the in Vivo QTc assay: The value of implementing best practices to support an integrated nonclinical-clinical QTc risk assessment and TQT substitute. J Pharmacol Toxicol Methods 2023; 121:107265. [PMID: 36997076 DOI: 10.1016/j.vascn.2023.107265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
Recent updates and modifications to the clinical ICH E14 and nonclinical ICH S7B guidelines, which both relate to the evaluation of drug-induced delayed repolarization risk, provide an opportunity for nonclinical in vivo electrocardiographic (ECG) data to directly influence clinical strategies, interpretation, regulatory decision-making and product labeling. This opportunity can be leveraged with more robust nonclinical in vivo QTc datasets based upon consensus standardized protocols and experimental best practices that reduce variability and optimize QTc signal detection, i.e., demonstrate assay sensitivity. The immediate opportunity for such nonclinical studies is when adequate clinical exposures (e.g., supratherapeutic) cannot be safely achieved, or other factors limit the robustness of the clinical QTc evaluation, e.g., the ICH E14 Q5.1 and Q6.1 scenarios. This position paper discusses the regulatory historical evolution and processes leading to this opportunity and details the expectations of future nonclinical in vivo QTc studies of new drug candidates. The conduct of in vivo QTc assays that are consistently designed, executed and analyzed will lead to confident interpretation, and increase their value for clinical QTc risk assessment. Lastly, this paper provides the rationale and basis for our companion article which describes technical details on in vivo QTc best practices and recommendations to achieve the goals of the new ICH E14/S7B Q&As, see Rossman et al., 2023 (this journal).
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15
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Delaunois A, Mathy F, Cornet M, Gryshkova V, Korlowski C, Bonfitto F, Koch J, Schlit A, Hebeisen S, Passini E, Rodriguez B, Valentin J. Testing the nonclinical Comprehensive In Vitro Proarrhythmia Assay (CiPA) paradigm with an established anti-seizure medication: Levetiracetam case study. Pharmacol Res Perspect 2023; 11:e01059. [PMID: 36748725 PMCID: PMC9903303 DOI: 10.1002/prp2.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/08/2023] Open
Abstract
Levetiracetam (LEV), a well-established anti-seizure medication (ASM), was launched before the original ICH S7B nonclinical guidance assessing QT prolongation potential and the introduction of the Comprehensive In Vitro Proarrhythmia Assay (CiPA) paradigm. No information was available on its effects on cardiac channels. The goal of this work was to "pressure test" the CiPA approach with LEV and check the concordance of nonclinical core and follow-up S7B assays with clinical and post-marketing data. The following experiments were conducted with LEV (0.25-7.5 mM): patch clamp assays on hERG (acute or trafficking effects), NaV 1.5, CaV 1.2, Kir 2.1, KV 7.1/mink, KV 1.5, KV 4.3, and HCN4; in silico electrophysiology modeling (Virtual Assay® software) in control, large-variability, and high-risk human ventricular cell populations; electrophysiology measurements in human induced pluripotent stem cell (hiPSC)-derived cardiomyocytes and dog Purkinje fibers; ECG measurements in conscious telemetered dogs after single oral administration (150, 300, and 600 mg/kg). Except a slight inhibition (<10%) of hERG and KV 7.1/mink at 7.5 mM, that is, 30-fold the free therapeutic plasma concentration (FTPC) at 1500 mg, LEV did not affect any other cardiac channels or hERG trafficking. In both virtual and real human cardiomyocytes, and in dog Purkinje fibers, LEV induced no relevant changes in electrophysiological parameters or arrhythmia. No QTc prolongation was noted up to 2.7 mM unbound plasma levels in conscious dogs, corresponding to 10-fold the FTPC. Nonclinical assessment integrating CiPA assays shows the absence of QT prolongation and proarrhythmic risk of LEV up to at least 10-fold the FTPC and the good concordance with clinical and postmarketing data, although this does not exclude very rare occurrence of QT prolongation cases in patients with underlying risk factors.
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Affiliation(s)
| | | | - Miranda Cornet
- Development SciencesUCB Biopharma SRLBraine‐l'AlleudBelgium
| | | | | | | | - Juliane Koch
- Patient Safety, UCB Biosciences GmbHMonheimGermany
| | | | | | - Elisa Passini
- Department of Computer ScienceUniversity of OxfordOxfordUK
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16
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Juhl CR, Burgdorf J, Knudsen C, Lubberding AF, Veedfald S, Isaksen JL, Hartmann B, Frikke-Schmidt R, Mandrup-Poulsen T, Holst JJ, Kanters JK, Torekov SS. A randomized, double-blind, crossover study of the effect of the fluoroquinolone moxifloxacin on glucose levels and insulin sensitivity in young men and women. Diabetes Obes Metab 2023; 25:98-109. [PMID: 36054143 PMCID: PMC10087839 DOI: 10.1111/dom.14851] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
AIM The voltage-gated potassium channel Kv 11.1 is important for repolarizing the membrane potential in excitable cells such as myocytes, pancreatic α- and β-cells. Moxifloxacin blocks the Kv 11.1 channel and increases the risk of hypoglycaemia in patients with diabetes. We investigated glucose regulation and secretion of glucoregulatory hormones in young people with and without moxifloxacin, a drug known to block the Kv 11.1 channel. MATERIALS AND METHODS The effect of moxifloxacin (800 mg/day for 4 days) or placebo on glucose regulation was assessed in a randomized, double-blind, crossover study of young men and women (age 20-40 years and body mass index 18.5-27.5 kg/m2 ) without chronic disease, using 6-h oral glucose tolerance tests and continuous glucose monitoring. RESULTS Thirty-eight participants completed the study. Moxifloxacin prolonged the QTcF interval and increased heart rate. Hypoglycaemia was more frequently observed with moxifloxacin, both during the 8 days of continuous glucose monitoring and during the oral glucose tolerance tests. Hypoglycaemia questionnaire scores were higher after intake of moxifloxacin. Moxifloxacin reduced the early plasma-glucose response (AUC0-30 min ) by 7% (95% CI: -9% to -4%, p < .01), and overall insulin response (AUC0-360 min ) decreased by 18% (95% CI: -24% to -11%, p < .01) and plasma glucagon increased by 17% (95% CI: 4%-33%, p = .03). Insulin sensitivity calculated as the Matsuda index increased by 11%, and MISI, an index of muscle insulin sensitivity, increased by 34%. CONCLUSIONS In young men and women, moxifloxacin, a drug known to block the Kv 11.1 channel, increased QT interval, decreased glucose levels and was associated with increased muscle insulin sensitivity and more frequent episodes of hypoglycaemia.
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Affiliation(s)
- Christian R Juhl
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Josephine Burgdorf
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Knudsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anniek F Lubberding
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simon Veedfald
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas L Isaksen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Mandrup-Poulsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen K Kanters
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Signe S Torekov
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Vedam VAV, Ghanta MK, Kantipudi SJ, David DC, Vijayalakshmi M, Nuthalapati P. Homocysteine Levels and Clinical Outcomes in Schizophrenia—A Pilot Randomized Controlled Trial. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221128649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: There is an increasing need for proactive and individualized responses to various diseases in today’s progressive health-care fraternity. Accordingly, the approach to schizophrenia patients encompasses novel developments in the area of personalized medicine. Antipsychotic drugs in clinical practice necessitate biomarkers for the prediction of treatment outcomes and monitoring to ensure an appropriate choice of duration of chronic therapies. Hence, we studied the relation between homocysteine levels in peripheral blood and the effectiveness as well as the safety of haloperidol and olanzapine in schizophrenia treatment. Materials and Methods: A prospective randomized parallel-group open-label interventional clinical trial was conducted on 40 mild to moderate schizophrenia patients. To compare the efficacy of olanzapine and haloperidol Brief Psychiatric Rating Scale (BPRS) score was used. Homocysteine levels of peripheral blood and Abnormal Involuntary Movement Scale scores were evaluated. Results: BPRS score improved in both groups on day 14 and day 28. But significantly more with olanzapine ( P value =.001). The olanzapine group showed a higher reduction (13.91±0.47 to 9.74±0.5) in homocysteine levels than the haloperidol group. Also, the BPRS scores negatively correlated ( r = –0.66) to homocysteine levels. Conclusion: Therefore, our study shows that peripheral blood homocysteine levels can be used to predict and assess the treatment outcome in schizophrenia patients. Biomarker driven approach in schizophrenia will allow the patients to be treated promptly with the right drug. In this light, personalized treatment holds great potential in the future.
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Affiliation(s)
| | - Mohan Krishna Ghanta
- Department of Pharmacology, MVJ Medical College and Research Hospital, Hoskote, Bangalore, Karnataka, India
| | - Suvarna Jyothi Kantipudi
- Department of Psychiatry, Sri Ramachandra Medical College and Research Institute, SRIHER-DU, Chennai, Tamil Nadu, India
| | - Darling Chellathai David
- Department of Pharmacology, Sri Ramachandra Medical College and Research Institute, SRIHER-DU, Porur, Chennai, Tamil Nadu, India
| | - Melanathuru Vijayalakshmi
- Department of Biotechnology, Dr M.G.R Educational, and Research Institute Maduravoyal Chennai, Tamil Nadu, India
| | - Poojith Nuthalapati
- Sri Ramachandra Medical College and Research Institute, SRIHER-DU, Porur, Chennai, Tamil Nadu, India
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18
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Visone R, Lozano-Juan F, Marzorati S, Rivolta MW, Pesenti E, Redaelli A, Sassi R, Rasponi M, Occhetta P. Predicting human cardiac QT alterations and pro-arrhythmic effects of compounds with a 3D beating heart-on-chip platform. Toxicol Sci 2022; 191:47-60. [PMID: 36226800 PMCID: PMC9887672 DOI: 10.1093/toxsci/kfac108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Determining the potential cardiotoxicity and pro-arrhythmic effects of drug candidates remains one of the most relevant issues in the drug development pipeline (DDP). New methods enabling to perform more representative preclinical in vitro studies by exploiting induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM) are under investigation to increase the translational power of the outcomes. Here we present a pharmacological campaign conducted to evaluate the drug-induced QT alterations and arrhythmic events on uHeart, a 3D miniaturized in vitro model of human myocardium encompassing iPSC-CM and dermal fibroblasts embedded in fibrin. uHeart was mechanically trained resulting in synchronously beating cardiac microtissues in 1 week, characterized by a clear field potential (FP) signal that was recorded by means of an integrated electrical system. A drug screening protocol compliant with the new International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines was established and uHeart was employed for testing the effect of 11 compounds acting on single or multiple cardiac ion channels and well-known to elicit QT prolongation or arrhythmic events in clinics. The alterations of uHeart's electrophysiological parameters such as the beating period, the FP duration, the FP amplitude, and the detection of arrhythmic events prior and after drug administration at incremental doses were effectively analyzed through a custom-developed algorithm. Results demonstrated the ability of uHeart to successfully anticipate clinical outcome and to predict the QT prolongation with a sensitivity of 83.3%, a specificity of 100% and an accuracy of 91.6%. Cardiotoxic concentrations of drugs were notably detected in the range of the clinical highest blood drug concentration (Cmax), qualifying uHeart as a fit-to-purpose preclinical tool for cardiotoxicity studies.
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Affiliation(s)
| | | | | | | | | | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy
| | - Roberto Sassi
- Department of Computer Science, Università degli Studi di Milano, Milan, 20133, Italy
| | - Marco Rasponi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy
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19
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Parker JA, Fung ES, Trejo-Martin A, Liang L, Gibbs K, Bandara S, Chen S, Sandhu R, Bercu J, Maier A. The utility of hERG channel inhibition data in the derivation of occupational exposure limits. Regul Toxicol Pharmacol 2022; 134:105224. [PMID: 35817210 DOI: 10.1016/j.yrtph.2022.105224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/20/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
Inhibition of the human ether-à-go-go (hERG) channel may lead to QT prolongation and fatal arrhythmia. While pharmaceutical drug candidates that exhibit potent hERG channel inhibition often fail early in development, many drugs with both cardiac and non-cardiac indications proceed to market. In this study, the relationship between in vitro hERG channel inhibition and published occupational exposure limit (OEL) was evaluated. A total of 23 cardiac drugs and 44 drugs with non-cardiac indications with published hERG channel IC50 and published OELs were identified. There was an apparent relationship between hERG IC50 potency and the OEL for cardiac and non-cardiac drugs. Twenty cardiac and non-cardiac drugs were identified that had a potent hERG IC50 (≤25 μM) and a contrastingly large OEL value (≥100 μg/m3). OELs or hazard banding corresponding to ≤100 μg/m3 should be sufficiently protective of effects following occupational exposure to the majority of APIs with hERG IC50 values ≤ 100 μM. It is important to consider hERG IC50 values and possible cardiac effects when deriving OEL values for drugs, regardless of indication. These considerations may be particularly important early in the drug development process for establishing exposure control bands for drugs that do not yet have full clinical safety data.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Joel Bercu
- Gilead Sciences, Inc., Nonclinical Safety and Pathobiology, Foster City, CA, USA
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