Dermal and inhalation acute toxic class methods: test procedures and biometric evaluations for the Globally Harmonized Classification System.

The acute toxic class (ATC) methods were developed for determining LD(50)/LC(50) estimates of chemical substances with significantly fewer animals than needed when applying conventional LD(50)/LC(50) tests. The ATC methods are sequential stepwise procedures with fixed starting doses/concentrations and a maximum of six animals used per dose/concentration. The numbers of dead/moribund animals determine whether further testing is necessary or whether the test is terminated. In recent years we have developed classification procedures for the oral, dermal and inhalation routes of administration by using biometric methods. The biometric approach assumes a probit model for the mortality probability of a single animal and assigns the chemical to that toxicity class for which the best concordance is achieved between the statistically expected and the observed numbers of dead/moribund animals at the various steps of the test procedure. In previous publications we have demonstrated the validity of the biometric ATC methods on the basis of data obtained for the oral ATC method in two-animal ring studies with 15 participants from six countries. Although the test procedures and biometric evaluations for the dermal and inhalation ATC methods have already been published, there was a need for an adaptation of the classification schemes to the starting doses/concentrations of the Globally Harmonized Classification System (GHS) recently adopted by the Organization for Economic Co-operation and Development (OECD). Here we present the biometric evaluation of the dermal and inhalation ATC methods for the starting doses/concentrations of the GHS and of some other international classification systems still in use. We have developed new test procedures and decision rules for the dermal and inhalation ATC methods, which require significantly fewer animals to provide predictions of toxicity classes, that are equally good or even better than those achieved by using the conventional LD(50)/LC(50) methods. In order to cope with rather narrow dose/concentration classes of the GHS we have, as in our previous publications, combined the outcome of all results that can be obtained during testing for the allocation to one of the defined toxicity classes of the GHS. Our results strongly recommend the deletion of the dermal LD(50) and the inhalation LC(50) test as regulatory tests and the adoption of the dermal and inhalation ATC methods as internationally accepted alternatives.

Pro- and anticoagulatory factors under sodium valproate-therapy in children.

OBJECTIVE: To evaluate sodium valproate-induced hemostatic side effects in children. METHODS: A variety of both pro- and anticoagulatory parameters were longitudinally investigated in 80 children before therapy and up to 720 days after initiation of sodium valproate (VPA) therapy. RESULTS: VPA caused a significant reduction in platelet count (309,000/ micro l +/- 122,000 before treatment to 261,000/ micro l +/- 150,000 under VPA therapy, p = 0.007). However platelet function was not impaired. While vWF antigen was reduced during VPA therapy (1.05 U/ml +/- 0.4 U/ml before therapy, 0.95 +/- 0.4 U/ml under VPA therapy), the in vivo activity of vWF (ratio between function and antigen concentration) increased significantly (1.06 +/- 0.2 before therapy, 1.36 +/- 0.3 under VPA therapy, p = 0.01). Both procoagulatory and anticoagulatory factors were significantly reduced (fibrinogen: 264.5 +/- 64.5 mg/dl before therapy, 221.4 +/- 47.5 mg/dl under therapy, p = 0.001; protein C: 81.3 % +/- 18 before therapy, 65.6 % +/- 21.4 under VPA therapy, p = 0.005, antithrombin: 122.7 % +/- 23.7 before therapy, 101.7 % +/- 18 under VPA therapy, p = 0.04). With the exception of fibrinogen, these effects were identical in children treated either with monotherapy or with polytherapy. CONCLUSIONS: Besides already known alterations of a variety of procoagulatory parameters, a relevant influence of VPA on the anticoagulatory system is demonstrated. We hypothesize that this additional alteration of anticoagulatory parameters might reduce the absolute bleeding risk of children treated with VPA.

Nonconvulsive status epilepticus--a possible cause of mental retardation in patients with Lennox-Gastaut syndrome.

Lennox-Gastaut syndrome (LGS) is one of the most severe types of childhood epilepsy. It is usually resistant to treatment and associated with mental retardation. To delineate the risk factors associated with the outcome of LGS, we evaluated, in a retrospective and multicentre study, the course of the disease, EEG tracings, and intellectual function in 101 patients. Inclusion criteria were the presence of tonic seizures as well as slow spike and wave complexes in the EEG. The average documented observation period was 16 years (range 4-31 years). Overall, the intellectual and neurological outcome was poor. At the last follow-up, 38% of the patients could not speak, 21% were unable to walk and only 4% were free of seizures. Four independent risk factors for severe mental retardation were identified by multivariate analysis. These were in a decreasing order of importance: nonconvulsive status epilepticus (NCSE), odds ratio (OR) 25.2, a previous diagnosis of West syndrome (OR 11.6), a symptomatic etiology of epilepsy (OR 9.5), and an early age at onset of epilepsy (OR 4.7). The results highlight the association between NCSE and the severity of mental retardation in patients with LGS; this association appears to be independent of symptomatic etiology. Our data provide an indirect evidence that, at least in some of the patients, NCSE is not only a concomitant feature, but also a cause of severe mental retardation.

Acute Toxic Class Methods: Alternatives to LD/LC50 Tests.

The Acute Toxic Class (ATC) Methods for the oral, dermal and inhalation routes were developed as alternatives to the respective LD/LC50 Tests. The ATC Methods use at least 40% (and up to 90%) fewer animals and their reliability with respect to classification probabilities into one of several toxicity classes is in the same order of magnitude or even better in comparison to the LD/LC50 Tests. The ATC Methods are stepwise procedures with the use of three fixed starting doses/concentrations, three animals per step and a maximum of 6 animals per dose/concentration. The outcome (numbers of dead or moribund animals) will determine if further testing is necessary or if the test is terminated. Like the previous tests the biometric basis of the ATC Methods is the Probit model. The oral ATC Method is already an official Test Guideline of the OECD and the EU and it is widely used for the notification of new chemicals in the EU. This oral ATC Method was validated by two animal ring studies together with biometric evaluations. With respect to classification probabilities and expected animal numbers the agreement between animal data and biometric evaluations was very good. Therefore for the dermal and inhalation routes of administration the ATC Methods were entirely developed on a biometric basis. These two methods have still to be adopted by OECD. However, in view of the recently agreed Global Harmonisation System (GHS) of classification for acute toxicity all three ATC Methods have to be revised in order to include these new classification systems.

Panniculitis due to potassium bromide.

Potassium bromide again is well known to be surprisingly effective in patients with severe myoclonic epilepsy in infants (SME). Rare side effects on the skin reappeared, such as the febrile nodular panniculitis (Weber-Christian syndrome). In 1993 we described the first three cases of necrotizing panniculitis and introduced the term 'halogen panniculitis'. It is a systemic disease with crops of subcutaneous nodules, fever, elevated sedimentation rate, hepatosplenomegalia, and abdominal pain. Later severe necrosis of the skin and adipose tissue may happen with deep ulcerations. History and course of five cases, described in this paper, suggest either an allergy or toxic reason. Histologic picture shows inflammation of adipose tissues with infiltrating lymphocytes, but lymphocyte transformation test (LTT) was not reliable in diagnosing the disease. Possibly, bromides act as a chemokine and stimulate inflammatory processes. Bromide can be transformed into a bromine radical/free electron pair under UV irradiation at 228.8 nm in aqueous solution. The bromine radical may have detrimental effects on the tissue. However, despite some research, the origin of halogen panniculitis and similar diseases remains unclear.

The dermal acute toxic class method: test procedures and biometric evaluations.

A dermal acute toxic class (ATC) method is presented with the use of significantly fewer animals in comparison with the classical dermal 50% lethal dose (LD50) test. The principle of the dermal ATC method is based on the oral and the inhalation ATC method. The method was developed for three fixed starting doses. Depending on the dermal LD50, the slope, the classification system and the starting dose on average 40 to 90% fewer animals will be used in comparison to at least 30 animals with the dermal LD50 test. The method was biometrically evaluated by using the Probit model for dose-response relationships. At present, there are eight different international classification systems based on dermal LD50 values. The test procedures and the calculations of the classification probabilities demonstrate that the dermal ATC method is a reliable alternative to the dermal LD50 test with the use of significantly fewer animals. Classification probabilities are presented for all classification systems currently in use, and expected numbers of experimental and of moribund/dead animals are demonstrated for the system of chemicals in the European Union for all three starting doses. The conclusion is justified that, similarly to the inhalation ATC method, there is no need to validate the dermal ATC method with the use of experimental animals.

The inhalation acute toxic class method: test procedures and biometric evaluations.

A method of inhalation acute toxic (ATC) classification is presented with the use of significantly fewer animals in comparison with the classical LC50 test. The principle of the inhalation ATC method is based on the oral ATC method, which has been adopted in 1996 as an official test guideline of the OECD and the European Union. The inhalation ATC method, like the oral ATC method, is a stepwise procedure; three animals of each sex are used simultaneously for each tested concentration, and not, as in the oral ATC method, three animals of each sex separately for each dose. The method was developed for three starting concentrations and two reference systems (based on ppm and mg/l). Depending on the LC50, slope, classification system and starting concentration, on average 50 to 80% fewer animals will be used in comparison to at least 30 animals with the classical LC50 test. The method was biometrically evaluated with the use of the probit model for dose-response relationships. At present, there are 12 different international classification systems based on LC50 values: 6 systems referring to mg/litre and 6 systems based on ppm values, and exposure time varying from 1 to 4 h. The test procedures and the calculations of the classification probabilities demonstrate that the inhalation ATC method is a reliable alternative to the classical LC50 test with the use of significantly fewer animals. Classification probabilities are presented for all classification systems currently in use, and expected numbers of experimental and of moribund/dead animals are demonstrated for one system of each reference system and for all three starting concentrations. The conclusion is justified that there is no need to validate the inhalation ATC method with the use of experimental animals.

The international validation study of the acute toxic class method (oral).

An alternative to the oral LD50 test, the acute toxic class (ATC) method (oral), was validated with 20 substances in an international collaborative study with nine laboratories in five countries. The ATC method is a stepwise procedure with the use of three animals per step. It has been designed with three fixed doses (25, 200 and 2000 mg/kg). In general, this testing is sufficient for allocation to the toxicity classes of the majority of the international classification systems currently in use. The selection of testing at additional fixed doses (5, 50 and 500 mg/kg) may be considered if further refinement is necessary or for specific allocation to those international classification systems with a cut-off value of 5 mg/kg. On average, two to four steps are necessary to complete a test. With the ATC method substances can be ranked in a similar or even better manner than with an LD50 test but it uses up to 90% fewer animals, the average being 70% fewer. This also results in substantially fewer moribund/dead animals. The ATC method is based on biometric evaluations that, together with the experimental results, demonstrate that this method is a sensitive and reliable alternative to the LD50 test.

Altered nucleus/cytoplasm relationship and degenerative structural changes in human dilated cardiomyopathy.

We investigated systematically the structure of the myocardium obtained from patients with dilated cardiomyopathy undergoing transplantation because of intractable heart failure. Hearts were explanted at the time of surgery from 12 patients (10 men and 2 women, aged 31-57 years, ejection fraction < 20%) and numerous samples were taken for light and electron microscopy. Biopsies from the left ventricle of 8 patients during operations for atrial septal defect served as control tissue. The most obvious qualitative findings were focal hypertrophy and atrophy of myocytes, enlargement and bizarre shape of nuclei, lack of contractile material and occurrence of numerous small mitochondria. On a quantitative level, the nuclear density was reduced (18%, p < 0.05) but the nuclear profile area was significantly increased (85%, p < 0.001). Thus the nucleus/cytoplasm relationship was altered. The volume density of the contractile filaments was decreased (25%, p < 0.001), but the mitochondrial volume density was unchanged. There was an increase in cell width (39%, p < 0.01) and of the connective tissue content (= fibrosis) (112%, p < 0.001). It is suggested that the nuclear abnormalities may be the primary event in the pathogenesis of dilated cardiomyopathy. These may then lead to a reduced transcriptional rate which most probably is the cause of the lack of myofilaments and other degenerative changes. The deterioration of the structural quality of the hypertrophied myocytes results finally in atrophy and fibrosis and may be the structural correlate of functional disturbances in dilated cardiomyopathy.

The biometric evaluation of the acute-toxic-class method (oral).

The acute toxic class method (ATC method) is an alternative to the LD50 test, with the use of substantially fewer animals needed for the classification of substances. Like the classical LD50 test the biometry of the ATC method is based on the probit model. The biometric calculations of the ATC method were carried out not only for the classification categories of the European Union but also for the classification criteria of various countries and organizations, currently in use. It is demonstrated that in comparison with the LD50 test in general the same classification is obtained with the ATC method and with the use of substantially fewer animals. Substances with high slopes are likely to be allocated to the predicted toxicity class in comparison with substances having low slopes, with both the ATC method and the LD50 test. Substances are more likely to be allocated into a lower toxicity class with the LD50 test than with the ATC method.

[Halogen-induced panniculitis caused by potassium bromide]. / Halogenpannikulitis auf Kaliumbromid.

Necrotizing panniculitis due to potassium-bromide is a drug induced allergic reaction following stimulation of lymphocytes as demonstrated for the first time by a lymphocyte transformation test (LTT). We named the disease "halogen panniculitis" because of similar generally known reactions to iodides and describe the typical symptoms in three own cases. Bromoderma tuberosum tends to be a similar kind of allergy. For the first time pancreatitis to potassium bromide in men has been observed, which has already been described in epileptic dogs treated with potassium bromide.

Endogenous nitrate synthesis in selected infectious diseases and ulcerative colitis.

Investigations into acute and chronic diarrheal patients confirmed the results of animal experiments on the role of cytotoxic activated macrophages in endogenous formation of nitrates. Because a number of inflammatory diseases did not cause a nitrate release in urine, blood, and saliva, the general importance of nitrates to characterize the initiation and course of inflammations must be questioned.

[Nitrate and nitrite concentrations in gastric juice with regard to the physiologic condition of the gastric mucosa]. / Nitrat- und Nitritkonzentrationen im Magensaft unter Berücksichtigung des physiologischen Zustandes der Magenschleimhaut.

In a random sample comprising 101 test persons (35 without and 66 with gastric disorders) nitrate and nitrite concentrations in gastric juice were determined. It was shown that parameters like pH, physiological stage of gastric mucosa, concentrations of bacteria and fungi in gastric juice or nitrate and nitrite concentrations, fungi and bacteria in saliva do not sufficiently characterize the dynamics of nitrate and nitrite in human stomach.

[Results of clinical and epidemiologic studies of the nitrate problem]. / Ergebnisse klinischer und epidemiologischer Untersuchungen zum Nitratproblem.

Small differences in nitrate intake with the drinking water are not reflected in nitrate contents of saliva and urine of test persons. A correlation of nitrate concentration in body fluids and cancer incidence can be expected hardly. Inflammatory diseases of the gut are frequently accompanied by enhanced endogenous nitrate synthesis and have an essential influence on total nitrate load of the human organism. Nitrate contents in saliva and/or urine are not general indicators of inflammatory processes. As the role of the nitrate ion in humans is not yet understood, the claim remains for a nitrate intake being as low as possible.

[Nitrate and nitrite in the urine, saliva and blood of urologic patients]. / Nitrat und Nitrit in Urin, Speichel und Blut urologischer Patienten.

Nitrate and nitrite contents were determined in urine, saliva, and blood of 298 patients suffering from urological diseases. Crude values of nitrate and nitrite in morning urine without any correction due to density and creatinine are sufficient for epidemiological purposes. Significant correlations exist with vegetables intake and bacteriuria, but not with age, sex, disease, smoking, and medicaments. Neither nitrate nor nitrite may be considered to be general indicators of inflammatory processes in the urogenital tract. According to recent investigations nitrite formation during bacterial infections must be seen in connection with simultaneously occurring macrophage activation, as the latter one is catalyzing the formation of carcinogenic N-nitroso compounds from nitrite and secondary amines.

[Nitrate and nitrite content of the saliva, urine, blood and cerebrospinal fluid in patients at an infection clinic]. / Nitrat- und Nitritgehalt in Speichel, Urin, Blut und Liquor von Patienten einer Infektionsklinik.

In 254 patients of a ward for infectious diseases the authors demonstrated that inflammatory diseases are frequently accompanied by an increase in nitrate content of the blood, urine and saliva. This effect is especially evident in gastrointestinal disorders. Correlations of nitrate with indicators of the inflammatory process are, if at all, very weak. The endogenous synthesis of nitrate may be of importance for the total nitrate load to the organism especially in children or patients with long-lasting inflammatory disease.