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Snodin DJ, Trejo-Martin A, Ponting DJ, Smith GF, Czich A, Cross K, Custer L, Elloway J, Greene N, Kalgutkar AS, Stalford SA, Tennant RE, Vock E, Zalewski A, Ziegler V, Dobo KL. Mechanisms of Nitrosamine Mutagenicity and Their Relationship to Rodent Carcinogenic Potency. Chem Res Toxicol 2024; 37:181-198. [PMID: 38316048 DOI: 10.1021/acs.chemrestox.3c00327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
A thorough literature review was undertaken to understand how the pathways of N-nitrosamine transformation relate to mutagenic potential and carcinogenic potency in rodents. Empirical and computational evidence indicates that a common radical intermediate is created by CYP-mediated hydrogen abstraction at the α-carbon; it is responsible for both activation, leading to the formation of DNA-reactive diazonium species, and deactivation by denitrosation. There are competing sites of CYP metabolism (e.g., β-carbon), and other reactive species can form following initial bioactivation, although these alternative pathways tend to decrease rather than enhance carcinogenic potency. The activation pathway, oxidative dealkylation, is a common reaction in drug metabolism and evidence indicates that the carbonyl byproduct, e.g., formaldehyde, does not contribute to the toxic properties of N-nitrosamines. Nitric oxide (NO), a side product of denitrosation, can similarly be discounted as an enhancer of N-nitrosamine toxicity based on carcinogenicity data for substances that act as NO-donors. However, not all N-nitrosamines are potent rodent carcinogens. In a significant number of cases, there is a potency overlap with non-N-nitrosamine carcinogens that are not in the Cohort of Concern (CoC; high-potency rodent carcinogens comprising aflatoxin-like-, N-nitroso-, and alkyl-azoxy compounds), while other N-nitrosamines are devoid of carcinogenic potential. In this context, mutagenicity is a useful surrogate for carcinogenicity, as proposed in the ICH M7 (R2) (2023) guidance. Thus, in the safety assessment and control of N-nitrosamines in medicines, it is important to understand those complementary attributes of mechanisms of mutagenicity and structure-activity relationships that translate to elevated potency versus those which are associated with a reduction in, or absence of, carcinogenic potency.
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Affiliation(s)
| | - Alejandra Trejo-Martin
- Gilead Sciences Inc. Nonclinical Safety and Pathobiology (NSP), Foster City, California 94404, United States
| | | | - Graham F Smith
- AstraZeneca, Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, Research and Development, CB2 0AA Cambridge, U.K
| | - Andreas Czich
- Sanofi, Research and Development, Preclinical Safety, 65926 Frankfurt, Germany
| | - Kevin Cross
- Instem, Conshohocken, Pennsylvania 19428, United States
| | - Laura Custer
- Bristol-Myers Squibb, Nonclinical Safety, New Brunswick, New Jersey 08903, United States
| | - Joanne Elloway
- AstraZeneca, Safety Sciences, Clinical Pharmacology and Safety Sciences Research and Development, CB2 0AA Cambridge, U.K
| | - Nigel Greene
- AstraZeneca, Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, Research and Development, Waltham, Massachusetts 02451, United States
| | - Amit S Kalgutkar
- Medicine Design, Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | | | | | - Esther Vock
- Boehringer-Ingelheim Pharma GmbH & Co., KG, 88397 Biberach an der Riss, Germany
| | - Adam Zalewski
- Bayer AG, Pharmaceuticals, Genetic and Computational Toxicology, 13342 Berlin, Germany
| | - Verena Ziegler
- Bayer AG, Pharmaceuticals, Genetic and Computational Toxicology, 13342 Berlin, Germany
| | - Krista L Dobo
- Drug Safety Research and Development, Global Portfolio and Regulatory Strategy, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
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2
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Ponting DJ, Dobo KL, Kenyon MO, Kalgutkar AS. Strategies for Assessing Acceptable Intakes for Novel N-Nitrosamines Derived from Active Pharmaceutical Ingredients. J Med Chem 2022; 65:15584-15607. [PMID: 36441966 DOI: 10.1021/acs.jmedchem.2c01498] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The detection of N-nitrosamines, derived from solvents and reagents and, on occasion, the active pharmaceutical ingredient (API) at higher than acceptable levels in drug products, has led regulators to request a detailed review for their presence in all medicinal products. In the absence of rodent carcinogenicity data for novel N-nitrosamines derived from amine-containing APIs, a conservative class limit of 18 ng/day (based on the most carcinogenic N-nitrosamines) or the derivation of acceptable intakes (AIs) using structurally related surrogates with robust rodent carcinogenicity data is recommended. The guidance has implications for the pharmaceutical industry given the vast number of marketed amine-containing drugs. In this perspective, the rate-limiting step in N-nitrosamine carcinogenicity, involving cytochrome P450-mediated α-carbon hydroxylation to yield DNA-reactive diazonium or carbonium ion intermediates, is discussed with reference to the selection of read-across analogs to derive AIs. Risk-mitigation strategies for managing putative N-nitrosamines in the preclinical discovery setting are also presented.
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Affiliation(s)
- David J Ponting
- Lhasa Limited, Granary Wharf House, 2 Canal Wharf, Leeds LS11 5PS, United Kingdom
| | - Krista L Dobo
- Drug Safety Research and Development, Global Portfolio and Regulatory Strategy, Pfizer Worldwide Research, Development, and Medical, Eastern Point Road, Groton, Connecticut 06340, United States
| | - Michelle O Kenyon
- Drug Safety Research and Development, Global Portfolio and Regulatory Strategy, Pfizer Worldwide Research, Development, and Medical, Eastern Point Road, Groton, Connecticut 06340, United States
| | - Amit S Kalgutkar
- Medicine Design, Pfizer Worldwide Research, Development, and Medical, 1 Portland Street, Cambridge, Massachusetts 02139, United States
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3
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Dobo KL, Kenyon MO, Dirat O, Engel M, Fleetwood A, Martin M, Mattano S, Musso A, McWilliams JC, Papanikolaou A, Parris P, Whritenour J, Yu S, Kalgutkar AS. Practical and Science-Based Strategy for Establishing Acceptable Intakes for Drug Product N-Nitrosamine Impurities. Chem Res Toxicol 2022; 35:475-489. [PMID: 35212515 PMCID: PMC8941624 DOI: 10.1021/acs.chemrestox.1c00369] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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The potential for N-nitrosamine impurities in
pharmaceutical products presents a challenge for the quality management
of medicinal products. N-Nitrosamines are considered
cohort-of-concern compounds due to the potent carcinogenicity of many
of the structurally simple chemicals within this structural class.
In the past 2 years, a number of drug products containing certain
active pharmaceutical ingredients have been withdrawn or recalled
from the market due to the presence of carcinogenic low-molecular-weight N,N-dialkylnitrosamine impurities. Regulatory
authorities have issued guidance to market authorization holders to
review all commercial drug substances/products for the potential risk
of N-nitrosamine impurities, and in cases where a
significant risk of N-nitrosamine impurity is identified,
analytical confirmatory testing is required. A key factor to consider
prior to analytical testing is the estimation of the daily acceptable
intake (AI) of the N-nitrosamine impurity. A significant
proportion of N-nitrosamine drug product impurities
are unique/complex structures for which the development of low-level
analytical methods is challenging. Moreover, these unique/complex
impurities may be less potent carcinogens compared to simple nitrosamines.
In the present work, our objective was to derive AIs for a large number
of complex N-nitrosamines without carcinogenicity
data that were identified as potential low-level impurities. The impurities
were first cataloged and grouped according to common structural features,
with a total of 13 groups defined with distinct structural features.
Subsequently, carcinogenicity data were reviewed for structurally
related N-nitrosamines relevant to each of the 13
structural groups and group AIs were derived conservatively based
on the most potent N-nitrosamine within each group.
The 13 structural group AIs were used as the basis for assigning AIs
to each of the structurally related complex N-nitrosamine
impurities. The AIs of several N-nitrosamine groups
were found to be considerably higher than those for the simple N,N-dialkylnitrosamines, which translates
to commensurately higher analytical method detection limits.
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Affiliation(s)
- Krista L Dobo
- Drug Safety Research and Development, Global Portfolio and Regulatory Strategy, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Michelle O Kenyon
- Drug Safety Research and Development, Global Portfolio and Regulatory Strategy, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Olivier Dirat
- Global Product Development, Pfizer Worldwide Research, Development, and Medical, Sandwich CT13 9NJ, United Kingdom
| | - Maria Engel
- Drug Safety Research and Development, Global Portfolio and Regulatory Strategy, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Andrew Fleetwood
- East Kent Pharma Consulting Ltd., 10408413, England CT1 2TU, United Kingdom
| | - Matthew Martin
- Drug Safety Research and Development, Global Computational Safety Sciences, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Susan Mattano
- Sue Mattano Consulting, Mystic, Connecticut 06355, United States
| | - Alyssa Musso
- Drug Safety Research and Development, Genetic Toxicology, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - James Christopher McWilliams
- Pharmaceutical Sciences Small Molecules, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Alexandros Papanikolaou
- Drug Safety Research and Development, Global Portfolio and Regulatory Strategy, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Patricia Parris
- Drug Safety Research and Development, Global Portfolio and Regulatory Strategy, Pfizer Worldwide Research, Development, and Medical, Sandwich CT13 9NJ, United Kingdom
| | - Jessica Whritenour
- Drug Safety Research and Development, Global Portfolio and Regulatory Strategy, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Shu Yu
- Pharmaceutical Sciences Small Molecules, Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Amit S Kalgutkar
- Medicine Design, Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
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Aloisi CMN, Escher NA, Kim HS, Geisen SM, Fontana GA, Yeo JE, Schärer OD, Sturla SJ. A combination of direct reversion and nucleotide excision repair counters the mutagenic effects of DNA carboxymethylation. DNA Repair (Amst) 2022; 110:103262. [PMID: 35030424 PMCID: PMC9232693 DOI: 10.1016/j.dnarep.2021.103262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023]
Abstract
Distinct cellular DNA damage repair pathways maintain the structural integrity of DNA and protect it from the mutagenic effects of genotoxic exposures and processes. The occurrence of O6-carboxymethylguanine (O6-CMG) has been linked to meat consumption and hypothesized to contribute to the development of colorectal cancer. However, the cellular fate of O6-CMG is poorly characterized and there is contradictory data in the literature as to how repair pathways may protect cells from O6-CMG mutagenicity. To better address how cells detect and remove O6-CMG, we evaluated the role of two DNA repair pathways in counteracting the accumulation and toxic effects of O6-CMG. We found that cells deficient in either the direct repair protein O6-methylguanine-DNA methyltransferase (MGMT), or key components of the nucleotide excision repair (NER) pathway, accumulate higher levels O6-CMG DNA adducts than wild type cells. Furthermore, repair-deficient cells were more sensitive to carboxymethylating agents and displayed an increased mutation rate. These findings suggest that a combination of direct repair and NER circumvent the effects O6-CMG DNA damage.
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Affiliation(s)
- Claudia M N Aloisi
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Nora A Escher
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Hyun Suk Kim
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan 44919, Republic of Korea
| | - Susanne M Geisen
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Gabriele A Fontana
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Jung-Eun Yeo
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan 44919, Republic of Korea; Department of Biological Sciences, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Orlando D Schärer
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan 44919, Republic of Korea; Department of Biological Sciences, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea.
| | - Shana J Sturla
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland.
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Li K, Ricker K, Tsai FC, Hsieh CJ, Osborne G, Sun M, Marder ME, Elmore S, Schmitz R, Sandy MS. Estimated Cancer Risks Associated with Nitrosamine Contamination in Commonly Used Medications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9465. [PMID: 34574388 PMCID: PMC8467924 DOI: 10.3390/ijerph18189465] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 12/31/2022]
Abstract
Many nitrosamines are potent carcinogens, with more than 30 listed under California's Proposition 65. Recently, nitrosamine contamination of commonly used drugs for treatment of hypertension, heartburn, and type 2 diabetes has prompted numerous Food and Drug Administration (FDA) recalls in the US. These contaminants include the carcinogens NDMA (N-nitrosodimethylamine) and NDEA (N-nitrosodiethylamine) and the animal tumorigen NMBA (N-nitroso-N-methyl-4-aminobutyric acid). NMBA and NDEA are metabolically and/or structurally related to NDMA, an N-nitrosomethyl-n-alkylamine (NMA), and 12 other carcinogenic NMAs. These nitrosamines exhibit common genotoxic and tumorigenic activities, with shared target tumor sites amongst chemicals and within a given laboratory animal species. We use the drug valsartan as a case study to estimate the additional cancer risks associated with NDMA and NDEA contamination, based on nitrosamine levels reported by the US FDA, cancer potencies developed by California's Proposition 65 program and the US Environmental Protection Agency (EPA), and specific exposure scenarios. These estimates suggest that nitrosamine contamination in drugs that are used long-term can increase cancer risks and pose a serious concern to public health.
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Affiliation(s)
- Kate Li
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Oakland, CA 94612, USA; (K.L.); (K.R.); (F.C.T.); (G.O.); (S.E.)
| | - Karin Ricker
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Oakland, CA 94612, USA; (K.L.); (K.R.); (F.C.T.); (G.O.); (S.E.)
| | - Feng C. Tsai
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Oakland, CA 94612, USA; (K.L.); (K.R.); (F.C.T.); (G.O.); (S.E.)
| | - ChingYi J. Hsieh
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Sacramento, CA 95812, USA; (C.J.H.); (M.S.); (M.E.M.); (R.S.)
| | - Gwendolyn Osborne
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Oakland, CA 94612, USA; (K.L.); (K.R.); (F.C.T.); (G.O.); (S.E.)
| | - Meng Sun
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Sacramento, CA 95812, USA; (C.J.H.); (M.S.); (M.E.M.); (R.S.)
| | - M. Elizabeth Marder
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Sacramento, CA 95812, USA; (C.J.H.); (M.S.); (M.E.M.); (R.S.)
| | - Sarah Elmore
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Oakland, CA 94612, USA; (K.L.); (K.R.); (F.C.T.); (G.O.); (S.E.)
| | - Rose Schmitz
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Sacramento, CA 95812, USA; (C.J.H.); (M.S.); (M.E.M.); (R.S.)
| | - Martha S. Sandy
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Oakland, CA 94612, USA; (K.L.); (K.R.); (F.C.T.); (G.O.); (S.E.)
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6
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Cancer risk from nitrosamine-contaminated valsartan. Drug Ther Bull 2021; 59:147. [PMID: 34301726 DOI: 10.1136/dtb.2021.000041] [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: 11/04/2022]
Abstract
Overview of: Gomm W, Röthlein C, Bowl K, et al Valsartan contaminated with N-nitrosodimethylamine and cancer risk: a longitudinal cohort study with German health insurance data. Dtsch Arztebl Int 2021; 118:357-62. doi: 10.3238/arztebl.m2021.0129.
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