title: Increase in thyroid follicular cell tumors in nelfinavir-treated rats observed in a 2-year carcinogenicity study is consistent with a rat-specific mechanism of thyroid neoplasia.
abstract: The carcinogenic potential of nelfinavir mesylate (nelfinavir) was evaluated in a 2-year oral (gavage) study on Sprague-Dawley rats at dose levels of 0 (control), 0 (vehicle control), 100, 300 and 1000 mg/kg per day. At the end of the treatment, increased incidences of thyroid follicular cell hyperplasia and neoplasms were observed at 300 (males) and 1000 mg/kg per day (both sexes). There were no other treatment-related effects and no tumors at other sites. Results from previous studies indicated a number of effects in the liver and thyroid, as well as metabolic profiles that suggested nelfinavir might cause thyroid hyperplasia/neoplasia secondary to hormone imbalance by altering thyroid hormone disposition. To investigate this hypothesis, the effects of nelfinavir on gene expression in rat hepatocytes and liver slices (in vitro), thyroxine plasma clearance, and thyroid gland function were evaluated. Compared to controls, gene expression analyses demonstrated an increased expression of glucuronyltransferase (UDPGT) and CYP450 3A1 in nelfinavir-treated rat hepatocytes and liver slices. In rats treated with nelfinavir (1000 mg/kg per day) for 4 weeks, liver weights and centrilobular hepatocellular hypertrophy were increased and minimal to mild diffuse thyroid follicular cell hypertrophy and follicular cell hyperplasia were evident in the thyroid gland. Thyroid-stimulating hormone (TSH) levels were significantly increased (three-fold), while tri-iodothyronine (T3)/tetra-iodothyronine (T4) and reverse T3(rT3) levels were unchanged, indicating that a compensated state to maintain homeostasis of T3/T4 had been achieved. Plasma 125I-thyroxine clearance was increased and the plasma thyroxine AUC0-48 was decreased (24%) compared to control. In conclusion, these data indicate that thyroid neoplasms observed in the nelfinavir-treated rats were secondary to thyroid hormone imbalance. Increased thyroxine clearance contributes to the effects of nelfinavir on thyroid gland function and is probably a result of UDPGT induction that leads to elevated TSH levels in the rat and eventual thyroid neoplasia. These results are consistent with a well-recognized rat-specific mechanism for thyroid neoplasms.
authors.affiliation: Pfizer Global Research and Development, San Diego, CA 92121, USA. leighann.burns@pfizer.com
authors.forename: L A
authors.initials: LA
authors.lastname: Burns-Naas
authors.forename: M
authors.initials: M
authors.lastname: Zorbas
authors.forename: B
authors.initials: B
authors.lastname: Jessen
authors.forename: W
authors.initials: W
authors.lastname: Evering
authors.forename: G
authors.initials: G
authors.lastname: Stevens
authors.forename: J L
authors.initials: JL
authors.lastname: Ivett
authors.forename: T E
authors.initials: TE
authors.lastname: Ryan
authors.forename: J C
authors.initials: JC
authors.lastname: Cook
authors.forename: C C
authors.initials: CC
authors.lastname: Capen
authors.forename: M
authors.initials: M
authors.lastname: Chen
authors.forename: G
authors.initials: G
authors.lastname: Furman
authors.forename: J C
authors.initials: JC
authors.lastname: Theiss
authors.forename: S
authors.initials: S
authors.lastname: Webber
authors.forename: E
authors.initials: E
authors.lastname: Wu
authors.forename: B
authors.initials: B
authors.lastname: Shetty
authors.forename: R
authors.initials: R
authors.lastname: Gasser
authors.forename: R M
authors.initials: RM
authors.lastname: McClain
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D000284:Administration, Oral; D000818:Animals; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics / Q000378:metabolism; D015197:Carcinogenicity Tests; D002470:Cell Survival / Q000187:drug effects; D002478:Cells, Cultured; D051544:Cytochrome P-450 CYP3A; D004305:Dose-Response Relationship, Drug; D005260:Female; D015870:Gene Expression / Q000187:drug effects; D014453:Glucuronosyltransferase / Q000235:genetics / Q000378:metabolism; D017320:HIV Protease Inhibitors / Q000493:pharmacokinetics / Q000633:toxicity*; D022781:Hepatocytes / Q000187:drug effects / Q000201:enzymology / Q000473:pathology; D006965:Hyperplasia / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology; D008136:Longevity / Q000187:drug effects; D008297:Male; D019888:Nelfinavir / Q000493:pharmacokinetics / Q000633:toxicity*; D012333:RNA, Messenger / Q000378:metabolism; D051381:Rats; D017207:Rats, Sprague-Dawley; D013045:Species Specificity; D013961:Thyroid Gland / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D013963:Thyroid Hormones / Q000097:blood; D013964:Thyroid Neoplasms / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D013974:Thyroxine / Q000097:blood / Q000493:pharmacokinetics
chemical_list: D017320:HIV Protease Inhibitors; D012333:RNA, Messenger; D013963:Thyroid Hormones; D001189:Aryl Hydrocarbon Hydroxylases; C465138:Cyp3a23-3a1 protein, rat; D051544:Cytochrome P-450 CYP3A; D014453:Glucuronosyltransferase; D019888:Nelfinavir; D013974:Thyroxine