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To illustrate the process of addressing adverse preclinical findings (APFs) as outlined in the first part of this review, a number of cases with unexpected APF in toxicity studies with drug candidates is discussed in this second part. The emphasis is on risk characterization, especially regarding the mode of action (MoA), and risk evaluation regarding relevance for man. While severe APFs such as retinal toxicity may turn out to be of little human relevance, minor findings particularly in early toxicity studies, such as vasculitis, may later pose a real problem. Rodents are imperfect models for endocrine APFs, non-rodents for human cardiac effects. Liver and kidney toxicities are frequent, but they can often be monitored in man and do not necessarily result in early termination of drug candidates. Novel findings such as the unusual lesions in the gastrointestinal tract and the bones presented in this review can be difficult to explain. It will be shown that well known issues such as phospholipidosis and carcinogenicity by agonists of peroxisome proliferator-activated receptors (PPAR) need to be evaluated on a case-by-case basis. The latter is of particular interest because the new PPAR α and dual α/γ agonists resulted in a change of the safety paradigm established with the older PPAR α agonists. General toxicologists and pathologists need some understanding of the principles of genotoxicity and reproductive toxicity testing. Both types of preclinical toxicities are major APF and clinical monitoring is difficult, generally leading to permanent use restrictions.

Unexpected adverse preclinical findings (APFs) are not infrequently encountered during drug development. Such APFs can be functional disturbances such as QT prolongation, morphological toxicity or carcinogenicity. The latter is of particular concern in conjunction with equivocal genotoxicity results. The toxicologic pathologist plays an important role in recognizing these effects, in helping to characterize them, to evaluate their risk for man, and in proposing measures to mitigate the risk particularly in early clinical trials. A careful scientific evaluation is crucial while termination of the development of a potentially useful drug must be avoided. This first part of the review discusses processes to address unexpected APFs and provides an overview over typical APFs in particular classes of drugs. If the mode of action (MoA) by which a drug candidate produces an APF is known, this supports evaluation of its relevance for humans. Tailor-made mechanistic studies, when needed, must be planned carefully to test one or several hypotheses regarding the potential MoA and to provide further data for risk evaluation. Safety considerations are based on exposure at no-observed-adverse-effect levels (NOAEL) of the most sensitive and relevant animal species and guide dose escalation in clinical trials. The availability of early markers of toxicity for monitoring of humans adds further safety to clinical studies. Risk evaluation is concluded by a weight of evidence analysis (WoE) with an array of parameters including drug use, medical need and alternatives on the market. In the second part of this review relevant examples of APFs will be discussed in more detail.

Many compounds giving a positive result in animal carcinogenicity studies through mechanisms involving secondary carcinogenesis pose little or no risk to humans. This article provides an overview of current understanding, with particular reference to renal tumors in male rats with alpha 2mu-globulin nephropathy, urinary bladder neoplasia in rodents, mesovarian leiomyomas induced in rats by beta 2-receptor stimulants, carcinoid tumors in the rodent stomach induced by prolonged suppression of acid secretion, thyroid follicular cell tumors in rodents, canine mammary neoplasia due to administration of progestagens, rodent mammary neoplasia induced by estrogens, uterine endometrial carcinomas of rats induced by dopamine agonists, Leydig cell tumors in the testis of rats, and ovarian tubulostromal adenomas in mice. A positive result on a rodent carcinogenicity study should not automatically preclude further development of a compound; future progress in this field should increase the accuracy of the rodent carcinogenicity study as a tool in human safety assessment.

Peto test procedures for the statistical evaluation of carcinogenicity studies require that each tumor in an animal that died intercurrently (or was sacrificed in extremis) be classified as either fatal, probably fatal, incidental, or probably incidental. There is considerable controversy as to whether or not the cause of death can be established with accuracy in rodent studies. In the present article, the causes of death or ill-being as found in 10 consecutive carcinogenicity studies--5 studies with 2400 OFA (Sprague-Dawley-derived) and Wistar rats and 5 studies with 2400 OF1 and NMRI mice--were re-examined. A cause of death or moribund state had been established in more than 80% of the cases in rats and in more than 70% in mice. These causes were, in rats, mainly pituitary tumors, chronic progressive nephropathy (males), mammary gland tumors (females), and subcutaneous tumors (males); in mice, mainly hemolymphoreticular tumors, lung tumors, liver tumors (males), and glomerulonephropathy. The criteria used for determining the tumorous or non-tumorous lesions as the cause of death were based on in-life and pathological findings. The validity of such procedures, the possibility of improving criteria in the future, and the usefulness of establishing causes of death in safety assessment are discussed.

Calcitonin, a calcium-lowering hormone, has been associated with an increased incidence of nonfunctioning pituitary tumors in rats. In this study, rats were treated with calcitonin (80 IU/kg/d) for 52 weeks. After treatment with calcitonin, immunohistochemistry and in situ hybridization analyses demonstrated that most pituitary tumors expressed the glycoprotein hormone alpha-subunit. Expression of the alpha-subunit was identified rarely in hyperplastic lesions of control animals. Serum levels of GH, PRL, ACTH, LH, and FSH were unchanged in calcitonin-treated rats relative to controls. However, TSH levels were increased 2.1 fold after chronic treatment with calcitonin in both male and female rats (P less than 0.001). The level of glycoprotein hormone alpha-subunit was markedly increased (20-fold) in male rats with smaller elevations in female rats. Time course studies demonstrated that increases in serum alpha-subunit levels could be detected by 24 weeks of treatment and that elevations in alpha-subunit were present in the majority of animals by 40 weeks of treatment with calcitonin. The authors conclude that high doses of calcitonin, administered to rats for 6 months or longer, increases the incidence of alpha-subunit-producing pituitary tumors.

During a routine long-term drug safety study, lasting approximately 2 1/2 yr, male Wistar rats, treated with a prolactin-inhibiting compound, developed an excess of Leydig cell tumors (LCTs). Most tumors were typical for the rat but a small number showed an unusual variation and some appeared malignant. The variation consisted of glandular and/or tubular structures within the tumor mass which occasionally anastomosed and contained an eosinophilic periodic-acid Schiff (PAS) positive material. In a few of these variants, malignant features such as cellular atypia, capsular, and lymphatic invasion and necrosis were seen. No metastases were detected. Detailed morphological and immunohistochemical investigations were conducted in order to establish the cell of origin of these variants. Glandular/tubular structures were found to stain with varying intensity for vimentin and cytokeratin, but were always negative for beta-tubulin. The results indicated that the cell of origin of these LCT variants was indeed the Leydig cell and that glandular and/or tubular structures within LCTs represented a form of Leydig cell metaplasia.

Single doses of antigen suspension (alum-precipitated canine serum proteins) were administered intratracheally to SPF rats. After periods of 1, 2 and 3 weeks rats were killed and their lungs examined histologically. After an initial macrophage and perivascular lymphoid reaction, dose-related increases were found in the amount of bronchus-associated lymphoid tissue (BALT) and in the amount of DNA within BALT cells, indicating increased cell division. Immunoglobulin-containing cells were demonstrated within BALT 3 weeks after the exposure to antigen. A prominent and extensive bronchial lympho-epithelium was seen overlying BALT follicles in antigen-treated rats, while in control animals the respiratory epithelium overlying BALT was predominantly normal ciliated epithelium. The significance of these findings is discussed in the light of the possible defensive role of BALT in cases of respiratory disease of man and animals.

In juvenile wild rats, bronchus-associated lymphoid tissue (BALT) development was similar to that seen in adult specified-pathogen-free rats. In adult wild rats the BALT was widespread. In one animal infected with a mycoplasma-like organism, a region of bronchoepithelium overlying a large BALT nodule was seen, through which lymphocytes appeared able to pass to make direct contact with the bronchial lumen: the significance of this observation is discussed. There was no evidence of infection in lungs from any of the specified-pathogen-free animals, where small foci of BALT were seen.

The fine structure of rhesus monkey renomedullary interstitial cells was studied by electron microscopy. These stellate cells contained variable numbers of lipid droplets, moderate numbers of mitochondria, moderate amounts of rough endoplasmic reticulum, and prominent Golgi zones. In rare instances, apparent release of lipid droplets into the interstitium was observed. The most prominent feature of the interstitial cells was larger nuclear pseudoinclusions which were observed in a high proportion of the animals examined.

The pattern of development of bronchus-associated lymphoid tissue (BALT) in specified-pathogen-free and conventional (non-barrier maintained) rats over the initial 4 weeks of life appeared to be similar. BALT first appeared around the 2nd week of life and increased in amount over the following 2 weeks. Overlying large nodules of BALT the bronchial epithelium becomes infiltrated by lymphocytes to form a lymphoepithelium. This transformation occurs earlier in conventional rats, possibly because of the differing antigen levels to which they are exposed.

A mononuclear cell leukemia in Sprague-Dawley rats is described in which liver, spleen, and lung involvement was a constant feature. The cell was 16 to 25 microns in diameter with round, oval or indented nucleus, and the cytoplasm contained bright red granules. This is the first report of such a leukemia in Sprague-Dawley rats and a comparison with mononuclear cell leukemia in other strains of laboratory rats is made.

Six young Beagle dogs had non-inflammatory pancreatic atrophy associated with lack of weight gain and low serum protein levels. Histologically there was severe atrophy with loss of acinar architecture and absence of islets of Langerhans (type 1), or partial atrophy with ppreserved islets (type 2). The correlation between histological type and clinical severity was poor.

The relationship between the acute toxicity of orally-administered chloroform and its long-term tumorigenic potential was studied in male mice of the CFLP outbred Swiss albino mouse strain. A single dose of approximately 18 mg CHCl3/kg had no detectable acute toxic effect on the liver or kidneys and did not stimulate regenerative activity, whereas both toxicity and subsequent tissue regeneration were observed with single doses of about 60 mg/kg or higher. The severity of the toxic effects and regenerative changes was greater when corn oil was used as a vehicle for chloroform than when the vehicle was a toothpaste base. In earlier long-term studies in mice of the same strain, kidney tumours occurred in males given 60 mg/kg/day throughout life but not in mice given 17 mg/kg/day. The tumour response was greater when the 60-mg/kg/day dose was given in an oily vehicle than when it was given in toothpaste. The findings are consistent with the hypothesis that early acute toxic change and subsequent repair are a sine qua non for tumorigenesis in the kidney and liver in response to chloroform.

Segmental aplasia of the vaginal mucosa was discovered in 3 beagle bitches at the end of a routine toxicological experiment. Anomalies of Müllerian duct development in the bitch are discussed.

The histology and ultrastructure of the rat laryngeal epithelia are described. Five epithelial types were identified. Stratified squamous epithelium was found over most of the epiglottis, arytenoid projections and lateral ventricles. The vocal folds were covered by a low squamoid type of epithelium. Respiratory epithelium, similar to that found elsewhere in the respiratory tract, occupied all the mucosa caudal to the vocal folds, small areas at the base of the epiglottis and along the inner aspects of the arytenoid projections. Two forms of relatively unusual pseudostratified cuboidal epithelium were present in the ventrolateral aspect at the level of the arytenoid projections and within the ventral pouch. Non-myelinated, intro-epithelial nerve fibres were found throughout the larynx, and were abundant in areas at the base of the epiblottis covered by respiratory epithelium and to a lesser extent in the cuboidal epithelium of the ventral pouch. Globule leucocytes were frequently found within respiratory epithelium, less frequently in cuboidal epithelium and only rarely in squamous areas.