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Hall AP, Tepper JS, Boyle MH, Cary MG, Flandre TG, Piaia A, Tarnow I, Macri NP, Freke MC, Nikula KJ, Paul GR, Cauvin A, Gregori M, Haworth R, Naylor S, Price M, Robinson IN, Allen A, Gelzleichter T, Hohlbaum AM, Manetz S, Wolfreys A, Colman K, Fleurance R, Jones D, Mukaratirwa S. BSTP Review of 12 Case Studies Discussing the Challenges, Pathology, Immunogenicity, and Mechanisms of Inhaled Biologics. Toxicol Pathol 2021; 49:235-260. [PMID: 33455525 DOI: 10.1177/0192623320976094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The inhalation route is a relatively novel drug delivery route for biotherapeutics and, as a result, there is a paucity of published data and experience within the toxicology/pathology community. In recent years, findings arising in toxicology studies with inhaled biologics have provoked concern and regulatory challenges due, in part, to the lack of understanding of the expected pathology, mechanisms, and adversity induced by this mode of delivery. In this manuscript, the authors describe 12 case studies, comprising 18 toxicology studies, using a range of inhaled biotherapeutics (monoclonal antibodies, fragment antigen-binding antibodies, domain antibodies, therapeutic proteins/peptides, and an oligonucleotide) in rodents, nonhuman primates (NHPs), and the rabbit in subacute (1 week) to chronic (26 weeks) toxicology studies. Analysis of the data revealed that many of these molecules were associated with a characteristic pattern of toxicity with high levels of immunogenicity. Microscopic changes in the airways consisted of a predominantly lymphoid perivascular/peribronchiolar (PV/PB) mononuclear inflammatory cell (MIC) infiltrate, whereas changes in the terminal airways/alveoli were characterized by simple ("uncomplicated") increases in macrophages or inflammatory cell infiltrates ranging from mixed inflammatory cell infiltration to inflammation. The PV/PB MIC changes were considered most likely secondary to immunogenicity, whereas simple increases in alveolar macrophages were most likely secondary to clearance mechanisms. Alveolar inflammatory cell infiltrates and inflammation were likely induced by immune modulation or stimulation through pharmacologic effects on target biology or type III hypersensitivity (immune complex disease). Finally, a group of experts provide introductory thoughts regarding the adversity of inhaled biotherapeutics and the basis for reasonable differences of opinion that might arise between toxicologists, pathologists, and regulators.
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Affiliation(s)
| | | | | | | | - Thierry G Flandre
- 98560Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Alessandro Piaia
- 98560Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | | | - Mark C Freke
- 70294Charles River Laboratories Montreal ULC, Senneville, Quebec, Canada
| | | | | | | | | | | | - Stuart Naylor
- Charles River Laboratories, Edinburgh, United Kingdom
| | - Mark Price
- 1929GlaxoSmithKline, Ware, United Kingdom
| | | | | | | | | | | | | | - Karyn Colman
- 70089Genomics Institute for the Novartis Research Foundation, San Diego, CA, USA
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Affiliation(s)
- Osamu Ohgoda
- Clinical Pharmacology & Drug Safety and Metabolism Department, Science and Data Technology Division, R&D, AstraZeneca K.K
| | - Ian N. Robinson
- Regulatory Safety Centre of Excellence, Clinical Pharmacology and Safety Sciences, R&D BioPharmaceuticals, AstraZeneca UK Ltd, United Kingdom
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