Brent Robert L
Thomas Jefferson University, Alfred I. duPont Hospital for Children, Laboratory of Clinical and Environmental Teratology, Wilmington, Delaware 19899, USA.
Pediatrics. 2004 Apr;113(4 Suppl):984-95.
Toxicology studies using animals and in vitro cellular or tissue preparations have been used to study the toxic effects and mechanism of action of drugs and chemicals and to determine the effective and safe dose of drugs in humans and the risk of toxicity from chemical exposures. Studies in pregnant animals are used to determine the risk of birth defects and other reproductive effects. There is no question that whole animal teratology studies are helpful in raising concerns about the reproductive effects of drugs and chemicals, but negative animal studies do not guarantee that these agents are free from reproductive effects. There are examples in which drug testing was negative in animals (rat and mouse) but was teratogenic in the human (thalidomide), and there are examples in which a drug was teratogenic in an animal model but not in the human (diflunisal). Testing in animals could be improved if animal dosing using the mg/kg basis were abandoned and drugs and chemicals were administered to achieve pharmacokinetically equivalent serum levels in the animal and the human. Because most human teratogens have been discovered by alert physicians or epidemiology studies, not animal studies, animal studies play a minor role in discovering teratogens. In vitro studies play an even less important role, although they are helpful in describing the cellular or tissue effects of the drugs or chemicals. One cannot determine the magnitude of human risks from these in vitro studies. Performing toxicology studies on adult animals is performed by pharmaceutical companies, chemical companies, the Food and Drug Administration, many laboratories at the National Institutes of Health, and scientific investigators in laboratories throughout the world. Although a vast amount of animal toxicology studies are performed on pregnant animals and numerous toxicology studies are performed on adult animals, there is a paucity of animal studies using newborn, infant, and juvenile animals. This deficiency is compounded by the fact that there are very few toxicology studies performed in children. That is why pregnant women and children are referred to as "therapeutic orphans." When animal studies are performed with newborn and developing animals, the results demonstrate that generalizations are less applicable and less predictable than the toxicology studies in pregnant animals. Although many studies reveal that the infant and the developing animal have difficulty in metabolizing drugs and are more vulnerable to the toxic effects of environmental chemicals, there are exceptions that indicate that infant and developing animals may be less vulnerable and more resilient to some drugs and chemicals. In other words, the generalization indicating that developing animals are always more sensitive to environmental toxicants is not valid. For animal toxicology studies to be useful, animal studies have to use modern concepts of pharmacokinetics and toxicokinetics, as well as method-of-action studies to determine whether animal data can be used for determining human risk. One example is the inability to determine carcinogenic risks in humans for some drugs and chemicals that produce tumors in rodents, because the oncogenesis is the result of peroxisome proliferation, a reaction that is of diminished importance in humans. Scientists can use animal studies to study the toxicokinetic and toxicodynamic aspects of environmental toxicants, but they have to be performed with the most modern techniques and interpreted with the highest level of scholarship and objectivity. Threshold exposures, maximum permissible exposures, and toxic effects can be estimated but have to be interpreted with caution when applying them to the human. Well-performed epidemiology studies are still the best method for determining the human risk and the effects of environmental toxicants.
利用动物以及体外细胞或组织制剂进行的毒理学研究,已被用于研究药物和化学物质的毒性作用及作用机制,确定药物在人体中的有效和安全剂量,以及化学物质暴露导致的毒性风险。对怀孕动物的研究用于确定出生缺陷及其他生殖影响的风险。毫无疑问,完整动物的致畸学研究有助于引发人们对药物和化学物质生殖影响的关注,但动物研究结果为阴性并不能保证这些物质不会产生生殖影响。有一些例子表明,药物在动物(大鼠和小鼠)身上的测试结果为阴性,但在人类身上却具有致畸性(沙利度胺);也有药物在动物模型中具有致畸性,但在人类中却没有(二氟尼柳)。如果摒弃基于毫克/千克的动物给药方式,改为给药以使动物和人类的血清水平在药代动力学上等效,那么动物测试可能会得到改进。由于大多数人类致畸物是由警觉的医生或流行病学研究发现的,而非动物研究,所以动物研究在发现致畸物方面作用较小。体外研究的作用更小,尽管它们有助于描述药物或化学物质对细胞或组织的影响。无法根据这些体外研究确定人类风险的程度。制药公司、化工公司、食品药品监督管理局、美国国立卫生研究院的许多实验室以及世界各地实验室的科研人员都会对成年动物进行毒理学研究。虽然对怀孕动物进行了大量的动物毒理学研究,对成年动物也进行了众多毒理学研究,但使用新生、婴儿和幼年动物进行的研究却很少。儿童进行的毒理学研究极少这一事实,使这一缺陷更加严重。这就是孕妇和儿童被称为“治疗孤儿”的原因。当对新生和发育中的动物进行动物研究时,结果表明,与对怀孕动物进行的毒理学研究相比,得出的一般性结论适用性更低、可预测性更差。尽管许多研究表明,婴儿和发育中的动物在代谢药物方面存在困难,且更容易受到环境化学物质毒性作用的影响,但也有例外情况表明,婴儿和发育中的动物可能对某些药物和化学物质的敏感性较低且更具恢复力。换句话说,认为发育中的动物总是对环境毒物更敏感的一般性结论并不成立。要使动物毒理学研究有用,就必须运用现代药代动力学和毒代动力学概念以及作用机制研究,以确定动物数据是否可用于确定人类风险。一个例子是,某些在啮齿动物身上产生肿瘤的药物和化学物质,无法确定其对人类的致癌风险,因为肿瘤发生是过氧化物酶体增殖的结果,而这种反应在人类中的重要性较低。科学家可以利用动物研究来研究环境毒物的毒代动力学和毒效动力学方面,但必须采用最现代的技术进行研究,并以最高水平的学术素养和客观性进行解读。可以估算阈暴露量、最大允许暴露量和毒性作用,但将其应用于人类时必须谨慎解读。精心开展的流行病学研究仍然是确定人类风险和环境毒物影响的最佳方法。