Healthy volunteers in first-in-human oncology drug development for small molecules

This review provides tools to consider the inclusion of healthy volunteers (HVs) in first-in-human (FIH) oncology clinical trials with small molecules, including targeted and immunomodulatory agents, a strategy that was not envisioned with classic chemotherapy. To enable an FIH oncology trial in HVs compared to cancer patients (CPs), a robust nonclinical package must be generated, which includes toxicokinetic and pharmacokinetic studies, as well as more extensive safety pharmacology, toxicology and genotoxicity studies. This strategy could provide an early clinical characterization of the pharmacokinetic parameters and clinical safety profile in the absence of comorbidities and concomitant medication. It also avoids the ethical issue of administrating subtherapeutic doses to CPs, and could potentially help to accelerate the timelines of clinical drug development for patient care. That being said, stakeholders involved in these studies need to proceed with caution, fully understand the regulatory guidance and thoroughly evaluate the benefits and risks. This paper serves to address the regulatory guidance and other considerations needed when using healthy volunteers in early oncology trials.

Investigation of multiple whole smoke dosimetry techniques using a VITROCELL®VC10® smoke exposure system

The Vitrocell® VC10® smoke exposure system offers multiple platforms for air liquid interface (ALI) and air agar interface (AAI) exposure that mimic in vivo conditions for assessing toxicological impact of whole smoke using in vitro assays. The aim of this study was to investigate and compare multiple dosimetry techniques that may be employed during combustible cigarette whole smoke exposure using the Vitrocell® VC10® smoking robot. The following techniques were assessed: (1) quartz crystal microbalances (QCMs), (2) aerosol photometers (using area under curve, AUC), and (3) fluorescence of anhydrous dimethyl sulfoxide (DMSO)-captured smoke constituents. Results showed that each of the dosimetry techniques was able to distinguish different levels of whole smoke airflow in a concentration-related manner. When compared to each other, the three techniques showed a high level of consistency and all were considered efficient tools in quantifying dose during an exposure, although higher variation was observed at the higher airflows tested. Overall, the dosimetry tools investigated here provide effective measures of the whole smoke concentrations tested during the exposure.

Development, qualification, validation and application of the Ames test using a VITROCELL® VC10® smoke exposure system

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Smoke-induced mutagenicity at air agar interface was developed and validated.

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The VITROCELL^® VC10^® system was validated by equipment qualification protocols.

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Differentiation of mutagenicity by 3R4F and Eclipse cigarettes was demonstrated.

The Ames test has established use in the assessment of potential mutagenicity of tobacco products but has generally been performed using partitioned exposures (e.g. total particulate matter [TPM], gas vapor phase [GVP]) rather than whole smoke (WS). The VITROCELL^®VC10^® smoke exposure system offers multiple platforms for air liquid interface (ALI), or air agar interface (AAI) in the case of the Ames test exposure to mimic in vivo-like conditions for assessing the toxicological impact of fresh WS in in vitro assays.

The goals of this study were to 1) qualify the VITROCELL^®VC10^® to demonstrate functionality of the system, 2) develop and validate the Ames test following WS exposure with the VITROCELL^®VC10^® and 3) assess the ability of the Ames test to differentiate between a reference combustible product (3R4F Kentucky reference cigarette) and a primarily tobacco heating product (Eclipse). Based on critical function assessments, the VITROCELL^®VC10^® was demonstrated to be fit for the purpose of consistent generation of WS. Assay validation was conducted for 5 bacterial strains (TA97, TA98, TA100, TA1535 and TA102) and reproducible exposure–related changes in revertants were observed for TA98 and TA100 in the presence of rat liver S-9 following exposure to 3R4F WS. In the comparative studies, exposure-related changes in in vitro mutagenicity following exposure of TA98 and TA100 in the presence of S9 to both 3R4F and Eclipse WS were observed, with the response for Eclipse being significantly less than that for 3R4F (p < 0.001) which is consistent with the fewer chemical constituents liberated by primarily-heating the product.

Development, qualification, validation and application of the neutral red uptake assay in Chinese Hamster Ovary (CHO) cells using a VITROCELL® VC10® smoke exposure system

Cytotoxicity assessment of combustible tobacco products by neutral red uptake (NRU) has historically used total particulate matter (TPM) or solvent captured gas vapor phase (GVP), rather than fresh whole smoke. Here, the development, validation and application of the NRU assay in Chinese Hamster Ovary (CHO) cells, following exposure to fresh whole smoke generated with the VITROCELL® VC10® system is described. Whole smoke exposure is particularly important as both particulate and vapor phases of tobacco smoke show cytotoxicity in vitro. The VITROCELL® VC10® system provides exposure at the air liquid interface (ALI) to mimic in vivo conditions for assessing the toxicological impact of smoke in vitro. Instrument and assay validations are crucial for comparative analyses.

GOALS OF THIS STUDY

1) demonstrate functionality of the VITROCELL® VC10® system by installation, operational and performance qualification, 2) develop and validate a cellular system for assessing cytotoxicity following whole smoke exposure and 3) assess the whole smoke NRU assay sensitivity for statistical differentiation between a reference combustible cigarette (3R4F) and a primarily "heat-not-burn" cigarette (Eclipse).

RESULTS

The VITROCELL® VC10® provided consistent generation and delivery of whole smoke; exposure-related changes in in vitro cytotoxicity were observed with reproducible IC50 values; comparative analysis showed that the heat-not-burn cigarette was significantly (P<0.001) less cytotoxic than the 3R4F combustible cigarette, consistent with the lower levels of chemical constituents liberated by primarily-heating the cigarette versus burning.

Biocompatibility assessments for medical devices - evolving regulatory considerations

INTRODUCTION

Biocompatibility assessment provides key data supporting medical device development and marketing. Although regional and international guidance is available, differences in proposed biocompatibility assessments or test methods lead to confusion and inefficiencies in generating the package of supporting nonclinical data. Areas covered: Modifications to available guidance for biological safety testing of medical devices, as described by the International Organisation for Standardisation (ISO) and the US Food and Drug Administration (FDA), have, over time, sometimes increased and sometimes decreased the level of harmonisation in testing requirements. These requirements continue to evolve, as shown by refinements and supplements to existing ISO 10,993 standards, new ISO standards under development and new finalised guidance from the FDA - which shows a shift away from routine testing-based approaches and much greater emphasis on characterisation, with use of existing literature or demonstration of equivalence to established comparator products, where possible. Expert commentary: This article examines the impact of recent changes in guidance for biocompatibility assessment of new medical devices and shows that, although a high level of consistency now occurs in ISO and FDA requirements, there are still areas where a 'standard approach' is not possible, allowing hurdles for global development of medical devices to persist.

Carcinogenicity Evaluation: Comparison of Tumor Data from Dual Control Groups in the CD–1 Mouse

Current regulatory thinking allows for the use of single control groups for rodent carcinogenicity testing although there has been a trend until recently to use dual control groups. To date, virtually nothing has been published on whether a shift from dual to single control groups will affect the identification of tumorigenic risk potential in these studies. A recent evaluation of dual control carcinogenicity data in the rat (Baldrick, Toxicol Pathol 2005, 33: 283–291) showed that although no major differences in tumor incidences between the control groups were found, some interstudy variation occurred and in cases were a notable difference was seen, the use of 2 control groups, as well as robust, contemporary background data, allowed an easier interpretation of findings in drug-treated groups. In this paper, the results of 10 mouse carcinogenicity studies, performed between 1991 and 2004, with 2 control groups, are presented. As in the rat, interstudy variation was seen and in some cases, the use of dual control groups assisted in the tumor risk assessment. Thus, the continued use of 2 control groups can have a vital role in mouse carcinogenicity studies. The paper also presents an update on survival, on the range and extent of background spontaneous neoplasms and comments on genetic drift in this commonly used mouse strain.

Scaling behavior near jamming in random sequential adsorption

For the random sequential adsorption model, we introduce the "availability" as a variable corresponding to the number of available locations in which an adsorbate can be accommodated. We investigate the relation of the availability to the coverage of the adsorbent surface over time. Power law scaling between the two is obtained both through numerical simulations and analytical techniques for both one- and two-dimensional random sequential adsorption, as well as in the case of competitive random sequential adsorption in one dimension.

A core in vitro genotoxicity battery comprising the Ames test plus the in vitro micronucleus test is sufficient to detect rodent carcinogens and in vivo genotoxins

In vitro genotoxicity testing needs to include tests in both bacterial and mammalian cells, and be able to detect gene mutations, chromosomal damage and aneuploidy. This may be achieved by a combination of the Ames test (detects gene mutations) and the in vitro micronucleus test (MNvit), since the latter detects both chromosomal aberrations and aneuploidy. In this paper we therefore present an analysis of an existing database of rodent carcinogens and a new database of in vivo genotoxins in terms of the in vitro genotoxicity tests needed to detect their in vivo activity. Published in vitro data from at least one test system (most were from the Ames test) were available for 557 carcinogens and 405 in vivo genotoxins. Because there are fewer publications on the MNvit than for other mammalian cell tests, and because the concordance between the MNvit and the in vitro chromosomal aberration (CAvit) test is so high for clastogenic activity, positive results in the CAvit test were taken as indicative of a positive result in the MNvit where there were no, or only inadequate data for the latter. Also, because Hprt and Tk loci both detect gene-mutation activity, a positive Hprt test was taken as indicative of a mouse-lymphoma Tk assay (MLA)-positive, where there were no data for the latter. Almost all of the 962 rodent carcinogens and in vivo genotoxins were detected by an in vitro battery comprising Ames+MNvit. An additional 11 carcinogens and six in vivo genotoxins would apparently be detected by the MLA, but many of these had not been tested in the MNvit or CAvit tests. Only four chemicals emerge as potentially being more readily detected in MLA than in Ames+MNvit--benzyl acetate, toluene, morphine and thiabendazole--and none of these are convincing cases to argue for the inclusion of the MLA in addition to Ames+MNvit. Thus, there is no convincing evidence that any genotoxic rodent carcinogens or in vivo genotoxins would remain undetected in an in vitro test battery consisting of Ames+MNvit.

Endometriosis affects sperm–endosalpingeal interactions

BACKGROUND

The interaction between spermatozoa and the epithelium of the isthmic region of the uterine tube is thought to be an important part of the mechanisms of sperm transport to the site of fertilization and in preparing them for fertilization. However, it is unclear whether a dysfunction of this mechanism may contribute to subfertility in some individuals.

METHODS

The sperm-binding characteristics of the epithelium from the uterine tubes of three groups of women were examined: (i) eight with pelvic endometriosis (not involving the uterine tubes); (ii) five women who had been receiving zoladex injections to control their symptoms; and (iii) as controls 10 women undergoing an elective procedure for benign gynaecological problems but with no other pathology of the reproductive tract.

RESULTS

Significantly more spermatozoa bound per unit area to the ampullary epithelium of the uterine tubes taken from women with a previous diagnosis of endometriosis.

CONCLUSIONS

These findings suggest that the characteristics of sperm binding to tubal epithelium may be disrupted in women with a gynaecological pathology such as endometriosis. It is suggested that this may have the potential to interfere with the availability of freely motile spermatozoa, of the appropriate physiological status, to take part in fertilization. This may be a newly described mechanism by which endometriosis can cause infertility.

Does the Arg-Gly-Asp (RGD) adhesion sequence play a role in mediating sperm interaction with the human endosalpinx?

BACKGROUND

Sperm from several species, including the human, make direct contact with the endosalpinx. Although this is known to be beneficial to sperm function, the specific mechanisms mediating the adhesion are poorly understood.

METHODS

Short linear oligopeptides containing the amino acid sequence Arg-Gly-Asp (RGD) or a scrambled sequence (GRGES) were incorporated into an established sperm-endosalpingeal binding assay. In addition, the ability of fluorescent latex beads coated with an RGD oligopeptide to bind specifically to sperm and/or epithelium was also determined.

RESULTS

Significantly fewer sperm associated per field of isthmic epithelium in the presence of 62.5 micro mol/l GRGDTP (1.18 +/- 0.41; mean +/- SEM, P < 0.05) and 250 micro mol/l RGDV (1.17 +/- 0.29; P < 0.01) compared with the control incubation (3.34 +/- 0.45). There was no difference in sperm binding to ampullary epithelium in the presence of any of the oligopeptides tested. Moreover, no beads were observed bound to sperm whereas significantly more RGD-coupled beads bound to isthmic epithelium compared with ampullary epithelium (1.47 +/- 0.26 versus 0.72 +/- 0.16 P < 0.01) and this increased in a dose-dependent manner.

CONCLUSIONS

These findings indicate that the recognition between the RGD sequence and integrin receptors may contribute to the interaction between sperm and the human endosalpinx in the isthmic but not in the ampullary region of the uterine tube.

Cord blood progenitor cells have greater transendothelial migratory activity and increased responses to SDF-1 and MIP-3beta compared with mobilized adult progenitor cells

When cord blood is used as a source of haemopoietic stem cells for transplantation, fewer cells are required per kg of recipient. This greater engraftment efficiency of cord blood cells may relate to an increased ability to traverse sinusoidal endothelium, a crucial step in the homing of stem cells. We report that freshly isolated cord blood progenitors migrated more efficiently than mobilized adult cells. Cord blood progenitors responded rapidly to growth factor stimulation with an increase in migratory ability within 24 h whereas mobilized adult cells responded only after 72 h (P < 0.01). Cord blood cells also exited G0/G1 rapidly; after 24 h of growth factor exposure, 20.2 +/- 1.2% of cord blood CD34+ cells were in S + G2/M compared to 6.9 +/- 1.2% of adult CD34+ cells (P < 0.01). Proliferating CFC migrated more efficiently (13.3 +/- 3.4% for GM-CFC) than non-proliferating CFC (1.4 +/- 0.5%, P < 0.01) as determined using a 3H-thymidine suicide assay. Cord blood progenitor cells also demonstrated a greater transmigratory response to chemokine stimulation compared with adult cells; this was manifested as a differential response of freshly isolated cells to SDF-1, and of growth factor activated cells to MIP-3beta. Finally, cord blood CD34+ cells express higher levels of the chemokine receptor for SDF-1, CXCR4, when compared with mobilized adult CD34+ cells (P < 0. 05).

New technology in the analytical cell sciences: the laser scanning cytometer

New technologies are making a major contribution to progress in applied clinical research in surgical oncology. The laser scanning cytometer is a new machine which combines the analytical capabilities of flow cytometry with the ability to inspect and visualize labelled cells and particles. This substantially reduces the uncertainty associated with assays in a wide range of surgical oncology research applications. This article introduces this new technology.

A parametric variation of delayed reinforcement in infants

This study is an exploration of the parameters of delayed reinforcement with 6 infants (2 to 6 months old) in two experiments using single-subject repeated-reversal designs. In Experiment 1, unsignaled 3-s delayed reinforcement was used to increase infant vocalization rate when compared to a differential-reinforcement-of-other-than-vocalization condition and a yoked, no-contingency comparison condition. In Experiment 2, unsignaled 5-s delayed reinforcement was used to increase infant vocalization rate when compared to an alternating-treatments comparison condition. The alternating-treatments comparison consisted of 3-min components of differential reinforcement of other behavior and 3-min components of a nontreatment baseline. Successful conditioning was obtained in both experiments. These results contrast with those of previous infancy researchers who did not obtained conditioning with delays of 3 s and who attributed their findings to the limitations of the infant's memory capacity. We present an alternative conceptual framework and methodology for the analysis of delayed reinforcement in infants.

Effects of delayed reinforcement on infant vocalization rate

Three previous studies have failed to demonstrate conditioning in infants using a 3-s delay of reinforcement. The effects of a delayed reinforcement schedule on vocalization rates therefore were explored in a single-subject repeated-reversal experimental design for 3 4- to 6-month-old normally developing infants. Each infant received delayed social reinforcement from his or her parent for vocalizing. The comparison condition was a schedule of differential reinforcement of behavior other than vocalizations to control for elicitation by social stimulation. An operant level of infant vocalizations was the initial condition, after which the differential reinforcement schedule was implemented in an across-subjects multiple baseline design. Infants' vocalization rates increased above levels measured during differential reinforcement following onset of the delayed reinforcement condition. Also, vocalization rates decreased during differential reinforcement compared to operant levels. The successful use of delayed reinforcement schedules with infants in this study, as opposed to others, is discussed in terms of procedural differences among them.

Generalized vocal imitation in infants

Effects of modeling and response-contingent social praise on the vocal imitation of three 9- to 13-month-old infants were analyzed. Three infants and parents participated in 2 to 4 experimental sessions a week for 2 to 4 months. During each 20-min-long session, the parent presented vocal models for the infant to imitate. During the model-alone condition, no social praise was programmed for infant imitation. During the model-and-praise condition, social praise was provided by the parent for infant imitation on training trials, but not probe trials. All three infants showed systematic increases in matching during training trials following the introduction of the model-and-praise condition. Although matching during probe trials was not directly reinforced, probe-trial responding increased systematically with training-trial responding. Furthermore, non-matching infant vocalizations did not increase systematically with the introduction of the model-and-praise procedure. Together these findings provide a demonstration of generalized vocal imitation in infants, a population in which it had not previously been shown to occur.

Studies on the site of 1,25-dihydroxyvitamin D3 synthesis in vivo

Anephric, vitamin D-deficient male rats were injected with a physiologic dose of 25-hydroxy[26,27-3H]vitamin D3 (specific activity of 160 Ci/mmol), and 18-20 h later, intestine, bone, and serum were analyzed by high performance liquid chromatography for 1,25-dihydroxy-[26,27-3H]vitamin D3. Identical studies were carried out using sham-operated rats and rats with ligated ureters. No 1,25-dihydroxy[26,27-3H]vitamin D3 was detected in the tissues from anephric rats, while large amounts were detected in sham-operated and ureteric ligated controls. This result demonstrates that in the nonpregnant rat, 1,25-dihydroxyvitamin D3 is either not synthesized or is synthesized in vanishingly small amounts in bone and intestine in vivo, casting considerable doubt of the physiological importance of reports of in vitro synthesis of 1,25-dihydroxyvitamin D3 by cells in culture derived from bone and elsewhere.

Structural analogs of 1alpha,25-dihydroxycholecalciferol: preparation and biological assay of 1alpha-hydroxypregnacalciferol

The synthesis of 1alpha-hydroxypregnacalciferol, a side chain analog of 1alpha,25-dihydroxycholecalciferol (1alpha,25-dihydroxyvitamin D3), is described. Pregnenolone acetate was converted in five steps to 5-pregnen-1alpha,3beta-diol. Conversion of the diol to pregna-5,7-diene-1alpha,3beta diol diacetate followed by ultraviolet irradiation gave the corresponding previtamin derivative. Thermal isomerization, hydrolysis and chromatography then furnished the desired analog, 1alpha-hydroxypregnacalciferol. The compound was tested in vivo for its effect on intestinal calcium transport, serum calcium and phosphate levels and bone calcification, and in vitro for its effect on bone resorption. When given to intact rats, either as a single dose or in repeated daily doses, the analog even at high dose levels, exhibited no biological activity. The compound stimulated bone resorption in vitro, but only at high concentrations.