| INTRODUC TI ONClinical pathologists working in the industry setting provide specialized expertise in the interpretation of clinical pathology results to support nonclinical animal studies for the purposes of pharmaceutical, agrochemical, food additive, and medical device safety assessment. As the number and complexity of clinical pathology and biomarker assays used in these studies has steadily grown over the last several decades, so has the specialized discipline of Toxicologic Clinical Pathology. Test article-related (TAR) clinical pathology findings must not only be accurately reflected in an interpretive report, but they must also be integrated with other relevant study data (eg, anatomic pathology, in-life, toxicokinetic). Although the task of interpretation of clinical pathology results is sometimes assigned to individuals with little to no formal clinical pathology training, we recommend that clinical pathology interpretive reports be authored by veterinary clinical pathologists with specialized training and experience in toxicologic clinical pathology, especially for pivotal (early and late stage) nonclinical studies. The purpose of this manuscript is to present an overview of current interpretive practices within the pharmaceutical industry and to propose guidelines that will help authors draft accurate, industry-standard clinical pathology interpretive reports. | ROLE AND QUALIFI C ATI ON S OF THE CONTRIBUTING SCIENTIS TClinical pathology evaluations are an integral part of most nonclinical pharmaceutical and agrochemical research projects ranging from proof of concept to general toxicology studies, target animal safety (in the development of animal health products), and medical Abstract The interpretation of clinical pathology results from nonclinical safety studies is a fundamental component in hazard identification of new drug candidates. The everincreasing complexity of nonclinical safety studies and sophistication of modern analytical methods have made the interpretation of clinical pathology information by a highly trained subject matter expert imperative. Certain interpretive techniques are particularly effective in the identification and characterization of clinical pathology effects. The purpose of this manuscript is to provide an overview of contemporary interpretive practices for clinical pathology results and to provide nonbinding recommendations aimed at improving consistency, quality, and overall value of clinical pathology interpretations generated in support of nonclinical toxicology studies.
| INTRODUC TI ONAccurate, informative, and integrated reporting of toxicologic clinical pathology results has become a fundamental expectation in contemporary drug safety submission packages. The approach to clinical pathology reporting has historically been quite diverse due to the wide spectrum of individuals and organizations tasked with clinical pathology interpretations and generating reports, and the lack of specific regulatory guidance on reporting standards. The purpose of this manuscript is to present an overview of current clinical pathology reporting practices within the drug development industry, as well as to provide a framework that will help authors draft meaningful clinical pathology interpretive reports in support of nonclinical toxicology studies. The suggestions provided are neither intended to be prescriptive nor to constrain report authors to follow a rigid, standardized structure. Reporting practices should be appropriately adjusted according to organizational standards, study design, and results of each study. By using these principles, the clinical pathology report can serve as an essential asset in support of nonclinical safety studies, and not become just a data dump of statistically significant differences or values that fall outside of historical control ranges. | COMP ONENTS OF A CLINIC AL PATHOLOGY REP ORTEffective communication of clinical pathology findings can be performed in a variety of ways, including (a) a stand-alone clinical pathology subreport, (b) an integrated anatomic and clinical pathology report, or (c) incorporation of clinical pathology results into the main study (toxicology) report. Because there is no formal regulatory guidance specifically addressing clinical pathology reporting Abstract Clinical pathology reporting practices are diverse among individuals and organizations involved in nonclinical toxicology studies. Clear, informative, and consistent reporting of clinical pathology results increases their value and avoids misinterpretation, resulting in decreased drug development costs. In recent years, certain common practices in clinical pathology reporting have been embraced by industry leaders and more consistently utilized across the pharmaceutical industry. The purpose of this manuscript is to review current clinical pathology reporting practices and to provide nonbinding suggestions to improve consistency, quality, and value of clinical pathology reports generated in support of nonclinical toxicology studies. K E Y W O R D S clinical pathology, interpretation, nonclinical studies, reporting, toxicology
A number of factors related to study design have the potential to impact clinical pathology test results during the conduct of nonclinical safety studies. A thorough understanding of these factors is paramount in drawing accurate conclusions from clinical pathology data generated during such studies, particularly when attempting to make the distinction between test article and nontest article-related effects. Study design and conduct variables with potential to impact clinical pathology data discussed in this overview include those related to species and test system, animal age, animal care and husbandry practices, fasting, acclimatization periods, effects of transportation and stressors, route of administration, effects of in-life and surgical procedures, influence of study length, timing of blood collections, impact of vehicle/formulation composition, and some general concepts related to drug class. The material presented here is a summary based on information presented at the 35th Annual Symposium of the Society of Toxicologic Pathology (June 2016), during Symposium Session 2 titled "Deciphering Sources of Variability in Clinical Pathology-It's Not Just about the Numbers."
The provision of nesting material benefits mice by reducing cold stress, improving feed conversion, increasing litter size, and improving adaptive immunity. The effects of toxins are sensitive to environmental changes, and the introduction of novel items can alter results in some toxicologic studies. We hypothesized that nesting material would reduce stress and positively alter immunologic parameters in Crl:CD1(ICR) mice, thus changing typical results from a well-studied immunomodulating drug, cyclophosphamide. A 13-wk study assessed the following treatments in a factorial design (n = 4; 32 cages total): nesting (0 or 10 g) and drug (50 mg/kg cyclophosphamide or 10 mL/kg saline; IP weekly). Detailed examinations and body weights were recorded weekly, and nests were scored twice weekly. Fecal pellets were collected at 0, 4, 6, and 12 wk for analysis of corticosterone metabolites. At study termination, clinical pathology and immune parameters were collected, a necropsy performed, and lymphoid organs and adrenal glands were submitted for histopathology. All expected results due to cyclophosphamide were observed. Nesting reduced the proportion of mice with piloerection, and body weights were highest in saline-nested male mice. No differences in hematology, clinical chemistry, or absolute lymphocyte counts were observed. Corticosterone metabolites in all nested groups were not different from baseline levels but all nonnested groups had higher levels than baseline. Nested cyclophosphamide-treated groups had significantly lower corticosterone levels than nonnested cyclophosphamide-treated groups. This study illustrates that nesting material does not alter the results of a standard toxicology study of cyclophosphamide but alleviates study-related stress and improves mouse welfare.
The objectives of this session were to explore causes of variability in clinical pathology data due to preanalytical and analytical variables as well as study design and other procedures that occur in toxicity testing studies. The presenters highlighted challenges associated with such variability in differentiating test article-related effects from the effects of experimental procedures and its impact on overall data interpretation. These presentations focused on preanalytical and analytical variables and study design-related factors and their influence on clinical pathology data, and the importance of various factors that influence data interpretation including statistical analysis and reference intervals. Overall, these presentations touched upon potential effect of many variables on clinical pathology parameters, including animal physiology, sample collection process, specimen handling and analysis, study design, and some discussion points on how to manage those variables to ensure accurate interpretation of clinical pathology data in toxicity studies. This article is a brief synopsis of presentations given in a session entitled "Deciphering Sources of Variability in Clinical Pathology-It's Not Just about the Numbers" that occurred at the 35th Annual Symposium of the Society of Toxicologic Pathology in San Diego, California.
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