QT PRODACT: comparison of non-clinical studies for drug-induced delay in ventricular repolarization and their role in safety evaluation in humans.

Drug concentrations that would prolong repolarization parameters by 10%, including action potential duration (APD90, APD30-90), in in vitro assays using guinea-pig papillary muscle and QTc intervals in in vivo assays using conscious dogs, conscious monkeys, and anesthetized dogs were compared. Although, both the in vitro and in vivo assays showed concentration-dependent responses for compounds that have been classified as torsadogenic in humans, only a weak correlation in EC10 values was observed between the in vitro and in vivo assays. Among the in vivo QT assays, the EC10 values obtained from conscious dogs, conscious monkeys, and anesthetized dogs correlated well with each other, but the EC10 values in monkeys were somewhat lower in comparison to those in dogs. When in vivo QT assay EC10 values were compared to the respective human effective therapeutic plasma concentration (ETPC), the ratios of EC10 values to ETPCs were less than 20 for most torsadogenic compounds. In conclusion, the relationships between the extent of QTc interval prolongation and the concentration of drugs was highly consistent among the three in vivo models, suggesting that the ratios of EC10 values in in vivo QT assays are useful for estimating the safety margin of drugs that prolong the QTc interval.

[Pharmacological and clinical profile of exemestane (Aromasin), a novel irreversible aromatase inhibitor].

Aromatase is the rate-limiting enzyme playing a role at the final step of estrogen biosynthesis, which is attracting attention as the target enzyme of hormone therapy of postmenopausal breast cancer. Exemestane (Aromasin) is a novel steroidal irreversible aromatase inhibitor that was approved in Japan as a therapeutic drug for postmenopausal breast cancer. Exemestane selectively inhibits aromatase activity in vitro, in a time-dependent and irreversible manner, suggesting the mechanism of action that exemestane covalently binds to aromatase as a pseudo-substrate and inactivates the enzyme. In vivo studies show the inhibitory effect of exemestane on the ovarian aromatase activity and plasma estradiol level of PMSG-primed rats. In studies using DMBA-induced rat mammary tumor models, exemestane shows antitumor activity in both conventional (premenopausal) and ovariectomized, testosterone-treated postmenopausal models. Despite its steroidal structure, exemestane does not have hormonal or anti-hormonal activity, except for a slight androgenic activity. In the early and late phase II clinical trials conducted in Japan on postmenopausal breast cancer patients who received 25 mg/day of exemestane, the response rates were 31.4% and 24.2%, respectively. Blood estrogen levels were also markedly reduced. These results confirmed the clinical relevance of non-clinical study results, as well as the possibility of extrapolation to foreign trial data.

[Draft ICH guideline S7B: guideline on safety pharmacology studies for assessing the potential for delayed ventricular repolarization (QT interval prolongation) by human pharmaceuticals].

Nonclinical assessment of potential of QT interval prolongation caused by non-antiarrhythmic drugs has been an issue for drug development because QT interval prolongation increases the risk of ventricular tachyarrhythmia, including torsade de pointes when combined with other risk factors. However, there is no scientific consensus on approaches and no international consensus on regulatory recommendations. This guideline is being developed to provide the general nonclinical testing strategy for evaluating the potential risk of QT prolongation and presents some major principles for in vitro and in vivo electrophysiology studies. The basis of this guideline is the integrated risk assessment that provides overall evaluations based on nonclinical study results and chemical/pharmacological class information to predict the potential of a test substance to prolong QT interval in humans (i.e., evidence of risk) and that contributes clinical study design and interpretation of clinical results. Safety margins are also components of integrated risk assessment. Since this guideline addresses a field of research that is in a state of rapid evolution, the proposed concept for evidence of risk and safety margins needs to be further refined based on the data being collected by international initiatives. In this article, the draft S7B guideline is outlined.

Bioinformatics research on inter-racial difference in drug metabolism I. Analysis on frequencies of mutant alleles and poor metabolizers on CYP2D6 and CYP2C19.

The enzyme activities of CYP2D6 and CYP2C19 show a genetic polymorphism, and the frequency of poor metabolizers (PMs) on these enzymes depends on races. In the present study, the frequencies of mutant alleles and PMs in each race were analyzed based on information from published studies, considering the genetic polymorphisms of CYP2D6 and CYP2C19 as the causal factors of racial and inter-individual differences in pharmacokinetics. As a result, it was shown that there were racial differences in the frequencies of each mutant allele and PMs. The frequencies of PMs on CYP2D6 are 1.9% of Asians and 7.7% of Caucasians, and those of PMs on CYP2C19 are 15.8% of Asians and 2.2% of Caucasians. Based on the results, it was suggested that there would be racial differences in the frequencies of PM subjects whose blood concentrations might be higher for drugs metabolized by these enzymes. Additionally, it was suggested that enzyme activities would vary according to the number of functional alleles even in subjects judged to be extensive metabolizers (EMs). In the bridging study, genetic information regarding CYP2D6 and CYP2C19 of the subjects will help extrapolate foreign clinical data to a domestic population.

Bioinformatics research on inter-racial difference in drug metabolism II. Analysis on relationship between enzyme activities of CYP2D6 and CYP2C19 and their relevant genotypes.

The enzyme activities of CYP2D6 and CYP2C19 show a genetic polymorphism, and the frequency of poor metabolizers (PMs) on these enzymes depends on races. We have analyzed frequencies of mutant alleles and PMs based on the published data in previous study (Shimizu, T. et al.: Bioinformatics research on inter-racial difference in drug metabolism, I. Analysis on frequencies of mutant alleles and poor metabolizers on CYP2D6 and CYP2C19.). The study shows that there were racial differences in the frequencies of each mutant allele and PMs. In the present study, the correlation between genotypes and drug-metabolizing enzyme activities was investigated. The result showed that enzyme activities varied according to the genotypes of subjects even in the same race. On the other hand, if subjects had the same genotypes, almost no racial differences were observed in drug-metabolizing enzyme activities. From these results, it was supposed that the racial differences in activities of these enzymes could be explained by the differences in distribution of genotypes. It would be possible to explain the racial differences in drug-metabolizing enzyme activities based on the differences on individual pharmacogenetic background information, not merely by comparison of frameworks such as races and nations.

[Antimicrobial and clinical effect of linezolid (ZYVOX), new class of synthetic antibacterial drug].

Linezolid (ZYVOX), a novel synthesized antibacterial drug, was first approved in April 2001, as an antibacterial against vancomycin (VCM)--resistant enterococci in Japan. LZD has a wide spectrum of antibacterial activity against gram-positive bacteria with MIC90 of 0.5-4 mcg/mL. These antibacterial activities of LZD are similar to those of vancomycin (VCM). LZD also has similar antibacterial activities against drug-resistant bacteria including VRE and MRSA. Protein-synthesis inhibitors, e.g., macrolides, tetracycline, aminoglycosides, and chloramphenicol, are known to bind the 30S and 50S subunits of ribosomes and inhibit the elongation cycle of protein synthesis. In contrast, LZD was found to inhibit the process of formation of the 50S, 30S-mRNA, and fMet-tRNA complex in the ribosome cycle, but not the elongation cycle. Due to this novel mechanism of action, LZD does not have a cross-resistance to drug-resistant bacteria and development of its resistance is quite slow. The antibacterial activity of LZD against VRE is bacteriostatic. In vivo antibacterial activity of orally administered LZD was demonstrated in a mouse model of systemic infection by VRE. When administered orally prior to the abscess formation in a mouse model of soft tissue infection by VRE, LZD showed similar antibacterial activity against VRE infection to that against VCM-susceptible enterococci. LZD is rapidly absorbed following oral administration and bioavailability when compared with intravenous administration is almost 100%. LZD administered orally twice-daily showed excellent efficacy in clinical trials with VRE-infected patients.