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Hemorrhagic Cardiomyopathy in Male Mice Treated with an NNRTI: The Role of Vitamin K
1 Johnson & Johnson Pharmaceutical Research & Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium and Correspondence: Address correspondence to: Sandra De Jonghe, Johnson & Johnson Pharmaceutical Research & Development, Turnhoutseweg 30, B-2340 Beerse, Belgium; e-mail: sdjonghe{at}prdbe.jnj.com. Dietary dosing of the non-nucleoside reverse transcriptase inhibitor (NNRTI) TMC125, under development for treatment of HIV-1, resulted in a syndrome in male mice in a previous experiment that was termed hemorrhagic cardiomyopathy. In literature, this syndrome, which was described in rodent species only, was linked to vitamin K deficiency. Two mechanistic studies were conducted, one with dietary administration and a second with gavage. The syndrome was reproduced in only 1 male mouse after continuous dietary dosing, and TMC125 was demonstrated to affect coagulation parameters (prothrombin time [PT], activated partial thromboplastin time [APTT], clotting factors II, VII and XI), particularly in males. This was counteracted by vitamin K supplementation, supporting the hypothesis that the effects were mediated via a vitamin K deficiency. It is therefore concluded that the observed cardiac changes were not caused by a direct cardiotoxic effect but occurred after a state of disabled clotting ability with subsequent effects on mouse cardiac muscle. Therefore, clotting times can be used as adequate safety biomarkers in clinical trials. To date, no changes have been observed at therapeutic doses of TMC125, following human monitoring of PT and APTT. One other NNRTI, Efavirenz (Sustiva), has been reported to cause prolongation of coagulation times in rats and monkeys.
Key Words: Heart • cardiomyopathy • vitamin K • mouse • coagulation • hemorrhage • NNRTI Abbreviations: APTT, activated partial thromboplastin time • AUC, area under the curve • b.e., base equivalent • Cmax, peak plasma concentrations • CYP, cytochrome P450 • ELISA, enzyme-linked immunosorbent assay • F (e.g., F II), coagulation factor • H.E., haematoxylin-eosin • HBr, hydrobromide • HIV, human immunodeficiency virus • HPMC MCC, hydroxypropyl methyl cellulose and microcrystalline cellulose • PEG40, polyethylene Glycol 400 • PT, prothrombin time • NNRTI, non-nucleoside reverse transcriptase inhibitor • ppm, parts per million • SD, spray dried • SPF, specific pathogen free • TK, toxicokinetics • tmax, peak plasma concentration times • V, vehicle • Vit, vitamin
This version was published on February
1, 2008 Toxicologic Pathology, Vol. 36, No. 2,
321-329 (2008) |
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