RESUMO

As injectable therapeutics, snake antivenoms must meet specifications for endotoxin content. The Limulus amebocyte lysate (LAL) test was used to evaluate the endotoxin content in several commercially available antivenoms released for clinical use. It was found that some products have endotoxin concentrations higher than the accepted limit for these contaminants. These results emphasize the need to include endotoxin determination as part of the routine evaluation of antivenoms by manufacturers and regulatory agencies.

RESUMO

Pyrogens are substances capable of inducing mild reactions such as fever or severe systemic reactions that can lead to death. Injectable products need to be free of pyrogens when released by the quality control of the pharmaceutical industries, to meet good manufacturing practices. Currently there are 3 types of tests for pyrogen detection, the Monocyte Activation Test, the Bacterial Endotoxin Test and the Pyrogen Test in Rabbits, which is widely used in the release of injectable products. However, the pyrogen test in rabbits requires the use of many animals and cannot be used in certain substances such as anti-inflammatory drugs. The alternative method of bacterial endotoxin testing is not able to detect other pyrogens such as products of the metabolism of fungi, viruses and gram-positive bacteria. The Monocytes Activation Test is an alternative method that covers a wide range of pyrogens, can be used on a large scale for the release of injectable products and is more sensitive because it uses human blood as substrate. This study aimed to evaluate the applicability of the use of the monocytes activation test in place of the pyrogen test in rabbits used in biological quality control in the release of batches of injectable products produced by the Butantan Institute.

Pirogênios são substâncias capazes de induzir reações leves como febre ou reações sistêmicas severas que podem levar à morte. Os produtos injetáveis necessitam ser livres de pirogênios quando da sua liberação pelo controle de qualidade das indústrias farmacêuticas, para atender as Boas Práticas de Fabricação. Atualmente existem 3 tipos de testes para detecção de pirogênio, o teste de Ativação de Monócitos, o Teste de Endotoxina Bacteriana e o Teste de Pirogênio em Coelhos, sendo esse amplamente empregado na liberação dos produtos injetáveis. Porém, o teste de pirogênio em coelhos é um teste que demanda a utilização de muitos animais e não pode ser usado em determinadas substâncias como antinflamatórios. O método alternativo de teste de endotoxina bacteriana não é capaz de detectar outros pirogênios como os produtos do metabolismo de fungos, vírus e bactérias gram-positivas. Já o teste de Ativação de Monócitos é um método alternativo que abrange uma ampla gama de pirogênios, pode ser usado em grande escala para liberação dos produtos injetáveis e é mais sensível, pois utiliza como substrato sangue humano. Este trabalho teve como objetivo avaliar a aplicabilidade da utilização do teste de ativação de monócitos em substituição ao teste de pirogênio em coelhos empregado no Controle Qualidade Biológico na liberação dos lotes dos produtos injetáveis produzidos pelo Instituto Butantan.

RESUMO

Body-temperature elevations are multifactorial in origin and classified as hyperthermia as a rise in temperature due to alterations in the thermoregulation mechanism; the body loses the ability to control or regulate body temperature. In contrast, fever is a controlled state, since the body adjusts its stable temperature range to increase body temperature without losing the thermoregulation capacity. Fever refers to an acute phase response that confers a survival benefit on the body, raising core body temperature during infection or systemic inflammation processes to reduce the survival and proliferation of infectious pathogens by altering temperature, restriction of essential nutrients, and the activation of an immune reaction. However, once the infection resolves, the febrile response must be tightly regulated to avoid excessive tissue damage. During fever, neurological, endocrine, immunological, and metabolic changes occur that cause an increase in the stable temperature range, which allows the core body temperature to be considerably increased to stop the invasion of the offending agent and restrict the damage to the organism. There are different metabolic mechanisms of thermoregulation in the febrile response at the central and peripheral levels and cellular events. In response to cold or heat, the brain triggers thermoregulatory responses to coping with changes in body temperature, including autonomic effectors, such as thermogenesis, vasodilation, sweating, and behavioral mechanisms, that trigger flexible, goal-oriented actions, such as seeking heat or cold, nest building, and postural extension. Infrared thermography (IRT) has proven to be a reliable method for the early detection of pathologies affecting animal health and welfare that represent economic losses for farmers. However, the standardization of protocols for IRT use is still needed. Together with the complete understanding of the physiological and behavioral responses involved in the febrile process, it is possible to have timely solutions to serious problem situations. For this reason, the present review aims to analyze the new findings in pathophysiological mechanisms of the febrile process, the heat-loss mechanisms in an animal with fever, thermoregulation, the adverse effects of fever, and recent scientific findings related to different pathologies in farm animals through the use of IRT.

RESUMO

The Bacterial Endotoxin Test (BET) is a method for exclusion of endotoxin-related pyrogen contamination in pharmaceutical products, as an alternative to the Rabbit Pyrogen Test (RPT). However, BET does not detect a broad range of biologically relevant pyrogens, and interferences can limit its practical use for different medical products. This work aimed to scope the evidence in the scientific literature for case-by-case validity assessments of BET in different uses for medical products. A search strategy was conducted in PubMed, Scopus, and Web of Science in April 2020, according to the PRISMA-ScR statement. Twenty-two references were included, evaluating medical products for endotoxin contamination through both BET and RPT according to standardized protocols. A critical appraisal was performed through ToxRTool, followed by data extraction and qualitative synthesis of outcomes and methodological issues. Four classes of products assessed by BET were identified, including nanoparticles, drugs, blood and biological products. A considerable variation was observed on the BET methods used. Collectively, the evidence indicates different factors influencing the outcome of BET, including the chemical nature of samples that may cause interference depending on the selected method. While some applications to medical products appear adequate, others, such as nanoparticles, may require the use of different in vitro pyrogen testing methods, reinforcing the need for case-by-case validation for each BET method and type of medical product.

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RESUMO

Injectable products including vaccines must be safe and pyrogen free. Pyrogens are molecules that once recognized by immune system can result in inflammatory responses of IL-1β e IL-6 cytokines release, leading to fever. In order to reduce number of laboratory animals, this study aimed to evaluate Monocyte Activation Test (MAT) efficiency at pyrogen detection in Zika Vaccine. The test was performed with PyroDetect System Merck Millipore, according supplier instructions. Zika vaccine was tested pure and diluted at 1/10, 1/20 and 1/40. Pyrogen recovery was tested by using spiked and non-spiked samples. After incubation with human cryopreserved blood Cryoblood® 16-18h, 37°C and CO2 5%, the incubation mixture blood and samples was collected to quantify IL-1β levels by ELISA. The results indicate low cytokine levels at tested samples, including spiked samples. This suggests vaccine had some interferers that might hinder the monocytes response. Furthermore, standard curves resulted lower absorbance values than expected, which would lead to misestimated endotoxin concentration in the samples. To assess test accuracy the calculated endotoxin recovery must be between 80 and 120% of spiked endotoxin. The results demonstrated variable recovery to same endotoxin concentration. We concluded this test seemed instable and it did not comply with accuracy and reproducibility parameters, for Zika Vaccine in the tested condition.

As vacinas, bem como todas as formulações injetáveis para uso humano, devem ser seguras e livres de pirogênio. Os pirógenos podem ser descritos como substâncias que, quando reconhecidas pelo sistema imune inato, desencadeiam respostas inflamatórias que resultam na liberação de citocinas, como IL-1β e IL-6, e podem ocasionar diversos sintomas, entre eles a febre. Com o intuito de substituir o uso de coelhos, esse estudo buscou verificar a eficiência do Teste de Ativação de Monócitos (MAT) para sua validação analítica na detecção de pirógenos, lipopolissacarídeos (LPS) e ácido lipoteicóico (LTA), no concentrado da Vacina Zika Inativada através da quantificação do mediador inflamatório IL-1β. Para isso, foi utilizado o PyroDetect System Merck Millipore, seguindo as orientações do fabricante. O concentrado da vacina Zika foi testado puro e em diluições de 1/10, 1/20 e 1/40, com e sem a contaminação por LPS ou LTA. As amostras foram incubadas com sangue humano criopreservado Cryoblood® – Kit PyroDetect por 16-18h a 37oC e, em seguida, foi realizado um ensaio de ELISA para quantificar os níveis de IL-1β liberados no sobrenadante. Os resultados dos testes indicaram baixos níveis de detecção de IL-1β nas diluições testadas, inclusive nas amostras que foram contaminadas por endotoxina. Esses resultados sugerem que a vacina Zika possa ter algum componente que cause interferência no teste. Além disso, verificou-se menor liberação de IL-1β nos ensaios do que o esperado, o que poderia levar a resultados superestimados da concentração de endotoxina nas amostras. Para determinar a exatidão do teste, foram calculadas as taxas de recuperação de endotoxina para cada ensaio, e estas deveriam estar em uma faixa entre 80 e 120% para a validação. No entanto, os resultados demonstraram taxas de recuperação fora da faixa esperada. Sendo assim, concluímos que os parâmetros de exatidão, precisão e reprodutibilidade não foram atingidos para a Vacina Zika nas condições testadas.

RESUMO

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.

RESUMO

The use of a commercial kit for the monocyte-activation test (MAT) was evaluated for assessing pyrogenic contamination of hyperimmune sera. Three batches of sera, two pyrogen free and one pyrogenic, were tested. Endotoxin spike recover indicated that sample dilutions from 1/2 to 1/10 are suitable. Kit transport and storage conditions were also evaluated, proving that an adequate cold chain must be assured to achieve good results. Furthermore, the commercial MAT kit seemed suitable to replace the rabbit pyrogen test (RPT) for pyrogen testing of hyperimmune sera, although further tests are needed to a full validation.

RESUMO

ABSTRACT The use of a commercial kit for the monocyte-activation test (MAT) was evaluated for assessing pyrogenic contamination of hyperimmune sera . Three batches of sera, two pyrogen free and one pyrogenic, were tested. Endotoxin spike recover indicated that sample dilutions from 1/2 to 1/10 are suitable. Kit transport and storage conditions were also evaluated, proving that an adequate cold chain must be assured to achieve good results. Furthermore, the commercial MAT kit seemed suitable to replace the rabbit pyrogen test (RPT) for pyrogen testing of hyperimmune sera, although further tests are needed to a full validation.

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RESUMO

In the present study, we aimed to determine the influence of ß-(1,3)-d-glucans on the LPS-induced pro-inflammatory cytokine response in the Monocyte Activation Test (MAT) for pyrogens, and on the LPS-induced febrile response in the Rabbit Pyrogen Test (RPT), thus evaluating the resulting effect in the outcome of each test. It was found that ß-(1,3)-d-glucans elicited the production of pro-inflammatory cytokines IL-1ß, IL-6 and TNF-α, also known as endogenous pyrogens, but not enough to classify them as pyrogenic according to MAT. The same ß-(1,3)-d-glucans samples were non-pyrogenic by RPT. However, ß-(1,3)-d-glucans significantly enhanced the LPS-induced pro-inflammatory cytokines response in MAT, insomuch that samples containing non-pyrogenic concentrations of LPS become pyrogenic. On the other hand, ß-(1,3)-d-glucans had no effect on sub-pyrogenic LPS doses in the RPT, but surprisingly, inhibited the LPS-induced febrile response of pyrogenic LPS concentrations. Thus, while ß-(1,3)-d-glucans could mask the LPS pyrogenic activity in the RPT, they exerted an overstimulation of pro-inflammatory cytokines in the MAT. Hence, MAT provides higher safety since it evidences an unwanted biological response, which is not completely controlled and is overlooked by the RPT.

Assuntos

RESUMO

Snake antivenoms are parenterally administered; therefore, endotoxin content must be strictly controlled. Following international indications to calculate endotoxin limits, it was determined that antivenom doses between 20 mL and 120 mL should not exceed 17.5 Endotoxin Units per milliliter (EU/mL) and 2.9 EU/mL, respectively. The rabbit pyrogen test (RPT) has been used to evaluate endotoxin contamination in antivenoms, but some laboratories have recently implemented the LAL assay. We compared the capability of both tests to evaluate endotoxin contamination in antivenoms, and we found that both methods can detect all endotoxin concentrations in the range of the antivenom specifications. The acceptance criteria of RPT and LAL must be harmonized by calculating the endotoxin limit as the quotient of the threshold pyrogenic dose and the therapeutic dose and the dose administered to rabbits as the quotient of the threshold pyrogenic dose and the endotoxin limit. Since endotoxins from Gram-negative bacteria exert different pyrogenicity, if contamination occurred, antivenom batches that induce pyrogenic reactions may be found in spite of passing LAL specifications. Although LAL assay can be used to assess endotoxin content throughout the antivenom manufacturing process, we recommend that the release of final products be based on the results of both methods.

Assuntos