The Cancer Research UK experience of pre-clinical toxicology studies to support early clinical trials with novel cancer therapies.

Pre-clinical toxicology studies in rodents and Phase I clinical trial data are summarised for 14 novel anticancer therapies. With only one exception, an antifolate antimetabolite, rodent toxicology predicted a safe Phase I trial starting dose and the majority of the dose limiting toxicities, in particular haematological toxicity. For targeted agents with well-defined pharmacodynamic markers, illustrated in the current study by 3 anti-endocrine drugs and one resistance modifier, the definition of a maximum tolerated dose can be avoided. Together with earlier data, the current study confirms that pre-clinical toxicology studies in a non-rodent species are not routinely needed for the safe conduct of early clinical trials with new cancer chemotherapies.

In vitro primary responses of human T cells to soluble protein antigens.

The optimum culture conditions to support in vitro proliferative responses to conventional soluble protein antigens by human CD4+ T cells from healthy non-immunised donors have been determined. These responses were blocked by anti-HLA-DR monoclonal antibodies (mAbs) and were strictly dependent on the presence of antigen-presenting cells (APCs). Primary responses showed a reproducible pattern of proliferation kinetics which distinguished them from secondary in vitro T cells reactions. T cells specific for the sensitising antigen were recovered from primary cultures.

The effect of neonatal tolerance to bovine gamma globulin (BGG) on BGG-reactive CD4+ T lymphocytes.

Compelling evidence has been presented that tolerance to major histocompatibility complex (MHC) and other antigens expressed on cells of the thymus is due to clonal deletion. However, it has not been determined conclusively how tolerance to diverse antigens, which may initially interact with the immune system in the periphery, is induced and maintained. Considerable evidence exists to suggest that mechanisms other than deletion, such as clonal anergy or immunoregulation, may be involved. We have previously shown that the clonal deletion of CD4+ cells specific for bovine gamma globulin (BGG) does not occur during induction of tolerance to this soluble antigen in adult life. In this study we have extended our previous findings by examining unresponsiveness to BGG which had been established during early ontogeny, when natural tolerance of self-antigens is likely to develop. It is demonstrated here that BGG-reactive, CD4+8- T cells, which proliferate and secrete interleukin-2 on stimulation with BGG in vitro, can be obtained from mice rendered tolerant of BGG as neonates. Even though the mice from which they were derived were unable to respond to BGG, these BGG-reactive T cells, by the parameters tested here, could not readily be distinguished from the corresponding cells in BGG-immune and non-immune animals. It is therefore evident that this tolerant state is not simply the result of clonal deletion of BGG-reactive CD4+ T cells but is more likely to be due to a reversible mechanism which controls their responsiveness in vivo.

Absence of T cell tolerance to pancreatic islet cells.

To examine whether the lack of self-tolerance to beta cells is responsible for the development of type I diabetes in nonobese diabetic (NOD) mice, we attempted to induce T cell responses to cells from the islets of Langerhans. The data show that all NOD mice, irrespective of age, sex, and disease progression, possess islet cell-specific CD4+, MHC class II-restricted T cells. Both primary and secondary proliferative responses to islet cells were readily induced. The activation of T cells required presentation of islet cell Ag by APC in the responding lymph node cell population. Cells from other tissues, e.g., salivary gland, adrenal gland, and spleen, failed to activate autologous T lymphocytes. T cells specific for other Ag did not respond to islet cells, indicating that the proliferation is not the result of nonspecific stimulation by islet cell products. The presence of islet cell-reactive T cells is, however, not unique to NOD mice, because similar T cell reactivity was also demonstrated in non-diabetes-prone mouse strains. Hence, self-tolerance to islet cells appears to be absent. The results indicate a normal occurrence of islet cell-reactive T cells in both diabetes-prone as well as non-diabetes-prone mice. Thus, the lack of tolerance cannot be the initial cause of diabetes, but the activation of such autoreactive T cells may be important for the development of the disease.

Bovine gamma globulin-specific CD4+ T cells are retained by bovine gamma-globulin-tolerant mice.

Immunological tolerance is an acquired state of antigen-specific nonresponsiveness which is generally attributed to either the deletion or suppression of tolerogen-specific T helper cell clones. Unresponsiveness to xenogeneic immunoglobulins can be readily induced and has been extensively studied in order to ascertain the means by which tolerance is established and maintained. As an absence of reactivity to foreign immunoglobulin has been noted in situations where suppressor cell activity was minimized, this tolerant state has often been ascribed to clonal deletion. The present study demonstrates that bovine gamma-globulin (BGG)-tolerant mice are unable to generate humoral responses to BGG in vivo and yet harbor BGG-specific CD4+CD8- T cells which can divide and secrete interleukin 2 when stimulated in vitro. Indeed, the in vitro reactivity to BGG of these cells exceeded that of a similar population of non-immune cells. This is in direct opposition to the loss of response that would be expected if clonal deletion were operative. The presence of BGG-specific CD4+ T cells, which appear to be at least partly primed, in mice unresponsive to BGG, indicates that tolerance to BGG is likely to be dependent on unidentified immunoregulatory processes rather than clonal deletion.

Erythrocyte antioxidant enzymes in multiple sclerosis and the effect of hyperbaric oxygen.

The activities of catalase, glutathione peroxidase, and glutathione reductase, were not significantly different from normal whereas that of superoxide dismutase was decreased (P less than 0.05) in erythrocytes from patients with multiple sclerosis. Assay of the lipid peroxidation product, malondialdehyde, after incubation of erythrocytes with 10 mM H2O2 under carefully controlled conditions (peroxide stress test) demonstrated that MS erythrocytes are significantly (P less than 0.001) less susceptible to H2O2-induced lipid peroxidation in vitro. This finding suggests that the level of an endogenous antioxidant, possibly vitamin E, may be elevated in MS red cells. After treatment with hyperbaric O2, the activity of MS erythrocyte catalase is significantly (P less than 0.01) elevated by 2-6-fold.

Primary and secondary human in vitro T-cell responses to soluble antigens are mediated by subsets bearing different CD45 isoforms.

A culture system has been developed which consistently supports in vitro proliferative responses to conventional soluble antigens by human CD4+ T cells from non-immunized donors. T cells exposed to an antigen in primary cultures could be restimulated in vitro in an antigen-specific manner to give secondary responses with greater magnitudes and a more rapid onset than the initial reaction. To characterize further the responding T-cell population in primary compared with secondary reactions, T cells were depleted of CD45RA+ or CD45RO+ cells and stimulated with recall and non-recall antigens. It was found that the soluble non-recall antigen keyhole limpet haemocyanin did not stimulate CD45RO+ T cells, yet induced strong proliferative responses from CD45RA+ T cells. Conversely, it was confirmed that human CD45RO+ T cells respond to the recall antigen-purified protein derivative from Mycobacterium tuberculosis. Cell mixing experiments indicated that CD45RO+ T cells are unlikely to have any suppressive effect on the reactivity of CD45RA+ cells to non-recall antigens. These data provide new support for the hypothesis that CD45RA+ represents the naive and CD45RO+ the memory phenotype of human CD4+ T cells.

Evaluation of rodent-only toxicology for early clinical trials with novel cancer therapeutics.

Preclinical toxicology studies are performed prior to phase I trials with novel cancer therapeutics to identify a safe clinical starting dose and potential human toxicities. The primary aim of this study was to evaluate the ability of rodent-only toxicology studies to identify a safe phase I trial starting dose. In addition, the ability of murine studies to predict the quantitative and qualitative human toxicology of cancer therapeutics was studied. Data for 25 cancer drugs were collated for which the preclinical and clinical routes and schedules of administration were either the same (22/25), or closely matched. The maximum tolerated dose/dose lethal to 10% of mice (MTD/LD10) was identified for 24 drugs, and in patients the maximum administered dose (MAD) was associated with dose-limiting toxicity (DLT) in initial clinical trials with 20 compounds. In addition, for 13 agents, the toxicity of the drug at one-tenth the mouse MTD/LD10 was also investigated in rats, following repeated administration (20 doses). A phase I trial starting dose of one-tenth the mouse MTD/LD10 (mg m(-2)) was, or would have been, safe for all 25 compounds. With the exception of nausea and vomiting, which cannot be assessed in rodents, other common DLTs were accurately predicted by the murine studies (i.e. 7/7 haematological and 3/3 neurological DLTs). For two of the 13 drugs studied in rats, repeated administration of one-tenth the mouse MTD/LD10 was toxic, leading to a reduction in the phase I trial starting dose; however, one-tenth the mouse MTD/LD10 was subsequently tolerated in patients. For the 20 drugs where clinical DLT was reached, the median ratio of the human MAD to the mouse MTD/LD10 was 2.6 (range 0.2-16) and the median ratio of the clinical starting dose to the MAD was 35 (range 2.3-160). In contrast, in 13 subsequent phase I trials with 11 of the initial 25 drugs, the median ratio of the clinical starting dose to the MAD was 2.8 (range 1.6-56), emphasizing the value of early clinical data in rapidly defining the dose range for therapeutic studies. For all 25 drugs studied, rodent-only toxicology provided a safe and rapid means of identifying the phase I trial starting dose and predicting commonly encountered DLTs. This study has shown that the routine use of a non-rodent species in preclinical toxicology studies prior to initial clinical trials with cancer therapeutics is not necessary.

Cancer Research UK procedures in manufacture and toxicology of radiotracers intended for pre-phase I positron emission tomography studies in cancer patients.

Radiolabelled compounds formulated for injection (radiopharmaceuticals), are increasingly being employed in drug development studies. These can be used in tracer amounts for either pharmacokinetic or pharmacodynamic studies. Such radiotracer studies can also be carried out early in man, even prior to conventional Phase I clinical testing. The aim of this document is to describe procedures for production and safety testing of oncology radiotracers developed for imaging by positron emission tomography in cancer patients. We propose strategies for overcoming the inability to produce compounds in sufficient quantities via the radiosynthetic routes for full chemical characterisation and toxicology testing including (i) independent confirmation as far as possible that the stable compound associated with the radiopharmaceutical is identical to the non-labelled compound, (ii) animal toxicity studies with > or = 10 times (typically 100 times) the intended tracer dose in humans scaled by body surface area, and (iii) patient monitoring during the radiotracer positron emission tomography clinical trial.