Métodos alternativos para determinação da potência de veneno e antiveneno botrópico: aplicações e perspectivas para o controle da qualidade / Alternative methods for potency evaluation for Bothrops venom and antivenom: applications and perspectives for quality control

Introdução: Acidentes com animais peçonhentos são classificados como doenças tropicais negligenciadas e são atualmente a mais frequente causa de intoxicação em humanos no Brasil. O único tratamento disponível é a rápida administração de antivenenos específicos e de qualidade garantida. Para assegurar a eficácia e a segurança desses produtos, são realizados ensaios de determinação da potência in vivo para veneno e antiveneno, desde as etapas de produção até sua liberação final. Apesar dos diversos estudos sobre métodos   alternativos ao ensaio murino, nenhum método foi efetivamente validado. Objetivo: Compilar os métodos alternativos desenvolvidos para os antivenenos botrópicos, avaliando sua disponibilidade, perspectivas e aplicações em laboratórios de produção e controle da qualidade. Método: Foi realizada uma busca nas bases PubMed, BVS e Scopus entre novembro de 2021 e junho de 2022. Foram identificados 89 trabalhos, dos quais 31 foram selecionados de acordo com os critérios de elegibilidade. Resultados: Nos métodos alternativos identificados, observamos a preferência de 42,80% dos estudos por metodologias que utilizem linhagens celulares como método alternativo aos ensaios murinos, sendo que a maioria destes trabalhos 58,30% optou pela linhagem celular Vero. Conclusões: Pela diversidade das toxinas encontradas em cada gênero de serpentes, entende-se que é de extrema importância que o ensaio de potência dos antivenenos tenha como base a avaliação e a quantificação precisa da inibição da atividade biológica dos venenos. Ensaios de citotoxicidade são amplamente utilizados e têm acumulado evidências de sua adequação como importante ferramenta alternativa ao ensaio murino para o controle da qualidade de veneno e antiveneno antibotrópico.

Introduction: Accidents with venomous animals are classified as neglected tropical diseases and are currently the most frequent cause of intoxication in humans in Brazil. The only available treatment is the rapid administration of specific, quality-assured antivenoms. To ensure the efficacy and safety of these products, in vivo potency determination tests for venom and antivenom are performed during the production stages, until final release. Despite several studies on alternative methods to the murine assay, no method has been effectively validated. Objective: To compile alternative methods developed for Bothrops antivenoms, assessing the availability of the methods and the prospects and applications in Bothrops venom and antivenom production and quality control laboratories. Method: A search was conducted in PubMed, BVS, and Scopus databases between November 2021 and June 2022. 89 articles were identified, of which 31 were selected according to the eligibility criteria. Results: We observed in the alternative methods identified a preference of 42.80% of the studies for methodologies that use cell lines as an alternative method to the murine assays, and most of these works (58.30%) opted for a VERO cell line. Conclusions: Due to the diversity of toxins found in each genus of snakes, it is understood that the potency assay for antivenoms should be based on the evaluation and precise quantification of the inhibition of biological activity of venoms. Cytotoxicity assays are widely used and have been accumulating evidence of their suitability as an important alternative tool to the murine assay for quality control for Bothrops venom and antivenom.

Comparison of the different protocols of the Hen's Egg Test-Chorioallantoic Membrane (HET-CAM) by evaluating the eye irritation potential of surfactants.

The Hen's Egg Test - Chorioallantoic Membrane (HET-CAM) is a valid alternative method used to assess the potential for eye irritation from chemicals. This method is the only one that mimics the conjunctivae of the eye and aims to semi-quantitatively evaluate the irritant potential of a chemical on the chorioallantoic membrane surrounding the chicken embryo in egg by observing the irritation effects on the membrane immediately after the pure or diluted chemical is applied. The purpose of this study was to compare the different protocols of the HET-CAM, the French and German protocols, by evaluating the eye irritation potential of surfactants. The comparison led to the optimization of the French protocol, generating an adapted one, to reduce subjectivity in the test evaluation, ensuring more accurate results and greater quality control. The comparison showed that there are no significant differences between the results obtained in the French and German protocols. HET-CAM is known to overestimate the results and to be able to accurately identify non-irritant products and it is a great candidate to be part of a Bottom-up test strategy. It also can be used in a battery of tests to completely replace rabbits.

Applicability of the Monocyte Activation Test (MAT) in the quality control of the 17DD yellow fever vaccine.

The need for alternatives to animal use in pyrogen testing has been driven by the Three Rs concept. This has resulted in the inclusion of the monocyte activation test (MAT) in the European Pharmacopoeia, 2010. However, some technical and regulatory obstacles must be overcome to ensure the effective implementation of the MAT by the industry, especially for the testing of biological products. The yellow fever (YF) vaccine (17DD-YFV) was chosen for evaluation in this study, in view of: a) the 2016-2018 outbreak of YF in Brazil; b) the increase in demand for 17DD-YFV doses; c) the complex production process with live attenuated virus; d) the presence of possible test interference factors, such as residual process components (e.g. ovalbumin); and e) the need for the investigation of other pyrogens that are not detectable by the methods prescribed in the YF vaccine monograph. The product-specific testing was carried out by using cryopreserved and fresh whole blood, and IL-6 and IL-1ß levels were used as the marker readouts. After assessing the applicability of the MAT on a 1:10 dilution of 17DD-YFV, endotoxin and non-endotoxin pyrogens were quantified in spiked batches, by using the lipopolysaccharide and lipoteichoic acid standards, respectively. The quantitative analysis demonstrated the correlation between the MAT and the Limulus amoebocyte lysate (LAL) assays, with respect to the limits of endotoxin recovery in spiked batches and the detection of no pyrogenic contamination in commercial batches of 17DD-YFV. The data demonstrated the applicability of the MAT for 17DD-YFV pyrogen testing, and as an alternative method that can contribute to biological quality control studies.

Métodos alternativos para a detecção de pirogênios em produtos e ambientes sujeitos a Vigilância Sanitária: avanços e perspectivas no Brasil a partir do reconhecimento internacional do Teste de Ativação de Monócitos / Alternative methods for the detection of pyrogens in products and environment subject to public health surveillance: advances and perspectives in Brazil based on the international recognition of the Monocyte Activation Test

Introduction: The detection of pyrogens is essential for the quality control of injectable products. The Rabbit Pyrogen Test remains widely used, despite the existence of alternative methods such as the Monocyte Activation Test (MAT). Objective: To review the use of alternative methods for pyrogen testing, pointing out advances and perspectives from the recognition of MAT by the European pharmacopoeia and its acceptance for regulatory purposes in Brazil. Method: A search was performed on the PubMed and BVS databases, with further classification, categorization by topic and critical analysis of the results. Results: Twenty-four papers were identified, addressing topics such as applications of MAT, its validation and comparisons with in vivo tests. MAT presented better results when compared to other tests, both in the evaluation of biological products and in the detection of non-endotoxin pyrogens. Limitations to diffusion include difficulties in obtaining whole human blood as a source of monocytes, for which several alternatives have been proposed. Conclusions: MAT is a promising method, with application in safety evaluation of new technologies. Its application in Brazil depends on a national implementation policy, which might include greater integration between BraCVAM, Concea and RENAMA in search for its recognition for regulatory purposes.

Introdução: A detecção de pirogênios é imprescindível no controle da qualidade de produtos injetáveis. O Teste de Pirogênio em coelhos ainda tem larga aplicação, apesar da existência de métodos alternativos como o Teste de Ativação de Monócitos (MAT). Objetivo: Revisar o uso dos métodos alternativos no teste de pirogênio, apontando avanços e perspectivas a partir do reconhecimento do MAT pela Farmacopeia Europeia e sua aceitação para fins regulatórios no Brasil. Método: Uma busca foi realizada nas bases PubMed e BVS, com posterior classificação, categorização por assuntos e análise crítica dos resultados. Resultados: Foram identificados 24 trabalhos, abordando temas como as aplicações do MAT, sua validação e comparação com testes in vivo. O MAT apresentou melhores resultados quando comparado a outros testes, tanto na avaliação de produtos biológicos como na detecção de pirogênios não-endotoxinas. Limitações para sua difusão incluem a dificuldade de obtenção de sangue total humano como fonte de monócitos, para o qual diversas alternativas têm sido propostas. Conclusões: O MAT se mostra um método promissor, com aplicação na avaliação da segurança de novas tecnologias. Sua aplicação no Brasil depende de uma política nacional de implantação, que inclua maior Integração entre BraCVAM, Concea e RENAMA na busca por seu reconhecimento para fins regulatórios.

Applicability of the Monocyte Activation Test (MAT) for hyperimmune sera in the routine of the quality control laboratory: Comparison with the Rabbit Pyrogen Test (RPT).

Pyrogen tests are safety assays performed during the routine quality control of injectable products required by regulatory agencies. Currently, there are three available testing possibilities: 1) the Rabbit Pyrogen Test (RPT); 2) the Bacterial Endotoxin Test (BET); and 3) test systems using human whole-blood or monocytes, termed Monocyte Activation Test (MAT). Although BET is often considered as a replacement for the animal test, it is unable to detect pyrogens other than endotoxin. MAT is based on the human fever reaction and thus, most closely reflects the human response. The aim of this study was to conduct a parallel comparison of the RPT and MAT for hyperimmune sera (HS) batches analyzed during the routine of a quality control laboratory. MAT was performed in the same 43 batches of HS previously tested using RPT. The results showed that MAT presented 100% sensitivity and approximately 85% specificity as compared to RPT, i.e., no false-negative results were obtained. Few suspicious samples, which were negative in the RPT after retesting, provided divergent positive results suggesting a lower limit of detection of MAT. MAT is thus able to detect contaminants in biological products such as HS batches.

Assessment of pyrogenic response of lipoteichoic acid by the monocyte activation test and the rabbit pyrogen test.

Lipoteichoic acid (LTA) is a non-endotoxin pyrogen of a great importance in the pathogenesis of sepsis. The Rabbit Pyrogen Test (RPT) is able to detect all types of pyrogens but involves the use of animals. The Bacterial Endotoxin Test (BET) cannot fully replace the RPT because it only detects endotoxins. The Monocyte Activation Test (MAT) is sensitive to all types of pyrogens and it is based on the same biological mechanism that is responsible for the fever reaction in humans. Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) has recommended its use for other pyrogens than endotoxin because its equivalence to RPT can be demonstrated. The aim of this study was to evaluate the pyrogenic responses of the RPT and MAT that was induced by LTA. Different LTA concentrations were assayed by the MAT in parallel to the RPT. The results showed that the MAT was more sensitive than the RPT, demonstrating that the MAT detected LTA. This result may contribute to the acceptance of this test by the Brazilian regulatory agencies as a replacement for the animals used in the RPT.

A Reassessment of the in vitro total protein content determination (TPC) with SIRC and 3T3 cells for the evaluation of the ocular irritation potential of shampoos: comparison with the in vivo Draize rabbit test

The aim of this work was to determine the correlation between results obtained from the Draize test and from the Total Protein Content Determination (TPC) to assess the ocular irritancy potential of 20 shampoos. For TPC, two established cell lines (SIRC and 3T3) were used. The concentration that induced 50 percent inhibition relative to controls (IC50) was calculated for each product. Among shampoos tested with SIRC, only one had a false positive result. However, for the 3T3, three false-negative results were found. Pearson coefficient related to the in vivo value of maximum average score (MAS) was -0.58 (p=0.007) with SIRC and -0.73 (p=0.007) with 3T3. These results showed that the TPC assay was capable to predict the ocular irritant potential of shampoos, and therefore was a promissory tool to be used as a preliminary assay for the detection of irritant products and to be part of a battery of screening tests to minimize the animal use in the Draize Test.

Influência do erro de micropipetas na dosagem espectrofotométrica do ensaio de endotoxina bacteriana (LAL cromogênico) aplicável a produtos sujeitos à Vigilância Sanitária / Effect of micropipette inaccuracy on performance of spectrophotometric assay for bacteria endotoxin dosage (chromogenic LAL) employed in products subjected to sanitary surveillance

Segundo a norma ISO 17.025, os instrumentos usados em experimento devem ser calibrados. No caso de micropipetas não há limite máximo de erro definido, sendo difícil estipular até que ponto uma micropipeta pode continuar a ser usada. O objetivo do trabalho foi o de determinar a porcentagem de erro no volume da micropipeta que não interfira nos resultados das diferentes etapas do ensaio toxicológico Lisado de Amebócitos de Limulus (LAL). Os percentuais de erro foram obtidos do levantamento de 44 certificados de micropipetas. Foram utilizados uma pipeta monocanal calibrada, de volume variável e kit LAL Cromogênio QCL-1000 (Lonza). A curva de endotoxina foi construída com as concentrações de 0,1; 0,25; 0,5 e 1 UE/mL. Os percentuais de erro de ±2%, ±4% e±10% foram comparados com a concentração de referência (0,5 UE/mL), e analisados pelo Student t-test (p<0,05). A análise estatística mostrou que, para a endotoxina padrão e para o substrato do LAL, erro acima de 2% interferenos resultados, cuja correção deve ser feita pelo ajuste do volume na pipeta. Nenhum erro testado causou interferência estatisticamente significativa na reação da cor do substrato. Micropipetas com erro superior a ±2% devem ser corrigidas.

A reassessment of the in vitro RBC haemolysis assay with defibrinated sheep blood for the determination of the ocular irritation potential of cosmetic products: comparison with the in vivo Draize rabbit test.

We examined the correlation between results obtained from the in vivo Draize test for ocular irritation and in vitro results obtained from the sheep red blood cell (RBC) haemolytic assay, which assesses haemolysis and protein denaturation in erythrocytes, induced by cosmetic products. We sought to validate the haemolytic assay as a preliminary test for identifying highly-irritative products, and also to evaluate the in vitro test as alternative assay for replacement of the in vivo test. In vitro and in vivo analyses were carried out on 19 cosmetic products, in order to correlate the lesions in the ocular structures with three in vitro parameters: (i) the extent of haemolysis (H50); (ii) the protein denaturation index (DI); and (iii) the H50/DI ratio, which reflects the irritation potential (IP). There was significant correlation between maximum average scores (MAS) and the parameters determined in vitro (r = 0.752-0.764). These results indicate that the RBC assay is a useful and rapid test for use as a screening method to assess the IP of cosmetic products, and for predicting the IP value with a high level of concordance (94.7%). The assay showed high sensitivity and specificity rates of 91.6% and 100%, respectively.

Biodistribution study of the anaesthetic sodium phenobarbital labelled with technetium-99m in Swiss mice infected with Schistosoma mansoni Sambon, 1907

Technetium-99 (99m Tc) is a radionuclide that has negligible enviromnental impact, is easily available, inexpensive and can be used as a radioactive tracer in biological experiences. In order to know the mode of action of sodium phenobarbital in moving adult Schistosoma mansoni worms from mesenteric veins to the liver, we labelled sodium phenobarbital (PBBT) with 99m Tc and a biodistribution study in infected and non-infected Swiss mice was performed. The PBBT was incubated with stannous chloride used as reducing agent and with 99m Tc, as sodium pertechnetate. The radioactivity labelling (per cent) was determined by paper ascending chromatography performed with acetone (solvent). The 99m Tc-PBBT was administered by intraperitoneal route to Swiss mice infected eight weeks before. The animals were perfused after diferent periods of time (0,1,2,3,4 hr) when blood, spleen, liver, poral, vein, mesenteric veins, stomach, kidneys and adult worms were isolated. The radioactivity present in these samples was counted in a well counter and the percentage was determined. The radioactivity was mainly taken up by the blood, kidney, liver and spleen. No radioactivity was found on the worms. We concluded that the worm shiff was due to an action on the lost of the sodium phenobarbital.

Schistosoma mansoni Sambon, 1907: comparative morphological studies of some brazilian strains

A morfologia de vermes adultos machos de tres cepas de Schistosoma mansoni, mantidas por variacoes em camundongos albinos, foi comparada com uma cepa isolada do hospedeiro natural Nectomys squamipes (Rodentia:Maridae) e mantida, em laboratorio, neste mesmo roedor silvestre. Como caracteres taxonomicos foram analisados o comprimento total, o numero de testiculos, a distancia entre as ventosas e a distancia ocupada pelos testiculos nos especimes. Os vermes recuperados de N. squamipes apresentaram diferencas significativas (p<0,01) em relacao as outras cepas para quaisquer caracteres morfologicos estudados. A cepas mantidas em camundongos apresentaram diferenca estatistica em varios caracteres (p<0,01). Alguns vermes adultos alem da disposicao normal dos testiculos apresentaram tambem uma localizacao atipica destas glandulas sexuais.

Host-induced morphological changes of Schistosoma mansoni Sambon, 1907 male worms

In order to evaluate the permissiveness of Nectomys squamipes to Schistosoma mansoni and the influence of the albino mice on the morphological aspects of adult worms derived from a population isolated from N. squamipes, the morphology of adult S. mansoni Sambon, 1907 male worms was studied using a digital image analyser (MOP VIDEOPLAN) and light microscopy. Their sources were as follows: (1) recovered from the wild rodent N. squamipes Brants naturally infected from Sumidouro, RJ, Brazil; (2) recovered from albino mice experimentally infected with the strain derived from N. squamipes; (3) recovered after the isolation of a strain derived from aboriginal human infections in Sumidouro. Worms recovered from N. squamipes (group 1) showed body lenght and distance between suckers significantly bigger than those of the specimens maintained in mice (groups 2 and 3). The number of tests in group 1 was statistically less than of groups 2 and 3. Group 2 strains which were maintained in mice, presented the lenght of the worms as the only significant different character. Data show that: (1) N. squamipes is a more suitable host for the development of S. mansoni when compared to the albino mice; (2) a strain of S. mansoni isolated from a natural host undergoes morphological changes after its passage in the white mouse.