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<article article-type="research-article" dtd-version="1.1" xml:lang="EN" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Toxicol</journal-id><journal-id journal-id-type="publisher-id">IJT</journal-id><journal-title-group><journal-title>International Journal of Toxicology</journal-title></journal-title-group><issn pub-type="ppub">1091-5818</issn><issn pub-type="epub">1092-874X</issn><publisher><publisher-name>SAGE Publications</publisher-name><publisher-loc>Sage CA: Los Angeles, CA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">10.1177_10915818241237992</article-id><article-id pub-id-type="doi">10.1177/10915818241237992</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Hepatitis A Virus Infection in Cynomolgus Monkeys Confounds the Safety Evaluation of a Drug Candidate</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3591-3593</contrib-id><name><surname>Powell</surname><given-names>Chris J.</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1-10915818241237992">1</xref><xref ref-type="corresp" rid="corresp1-10915818241237992"/></contrib><contrib contrib-type="author"><name><surname>Kapeghian</surname><given-names>John C.</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff2-10915818241237992">2</xref></contrib><contrib contrib-type="author"><name><surname>Bernal</surname><given-names>John C.</given-names></name><degrees>DVM</degrees><xref ref-type="aff" rid="aff3-10915818241237992">3</xref></contrib><contrib contrib-type="author"><name><surname>Foster</surname><given-names>John R.</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff4-10915818241237992">4</xref></contrib><aff id="aff1-10915818241237992"><label>1</label>MRC Toxicology Unit, <institution-wrap><institution-id institution-id-type="Ringgold">2152</institution-id><institution content-type="university">University of Cambridge</institution></institution-wrap>, Cambridge, UK</aff><aff id="aff2-10915818241237992"><label>2</label><institution-wrap><institution content-type="university">Preclinical Safety Associates, LLC</institution></institution-wrap>, The Woodlands, TX, USA</aff><aff id="aff3-10915818241237992"><label>3</label><institution-wrap><institution content-type="university">CORES Veterinary Consulting</institution></institution-wrap>, Walnut Grove, TX, USA</aff><aff id="aff4-10915818241237992"><label>4</label><institution-wrap><institution content-type="university">ToxPath Sciences Ltd</institution></institution-wrap>, Congleton, UK</aff></contrib-group><author-notes><corresp id="corresp1-10915818241237992">Chris J. Powell, MRC Toxicology Unit, University of Cambridge, Tennis Court Road, Cambridge CB2 1QR, UK. Email: <email>cp729@cam.ac.uk</email></corresp></author-notes><pub-date pub-type="epub"><day>19</day><month>3</month><year>2024</year></pub-date><volume>43</volume><issue>4</issue><fpage>368</fpage><lpage>376</lpage><permissions><copyright-statement>© The Author(s) 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder content-type="sage">American College of Toxicology</copyright-holder><license><ali:license_ref start_date="2024-03-19" xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by/4.0/</ali:license_ref><license-p>This article is distributed under the terms of the Creative Commons Attribution 4.0 License (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">https://creativecommons.org/licenses/by/4.0/</ext-link>) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the Sage and Open Access page (<ext-link ext-link-type="uri" xlink:href="https://us.sagepub.com/en-us/nam/open-access-at-sage">https://us.sagepub.com/en-us/nam/open-access-at-sage</ext-link>).</license-p></license></permissions><abstract><p>In a 3-month toxicity study in cynomolgus monkeys at a European contract laboratory, animals were infected with HAV, initially resulting in hepatic injury being incorrectly attributed to the test compound. Elevated serum ALT/AST/GLDH (5- to 10-fold) were noted in individual animals from all groups including controls, with no apparent dose, exposure, or time-related relationship. Liver histopathology revealed minimal to slight inflammatory cell accumulation in periportal zones of most animals, and minimal to slight hepatocyte degeneration/necrosis in 10/42 animals from all groups. As these findings were more pronounced in 6 drug-treated animals, including 2/6 in the low dose group, the draft report concluded: “<italic>treatment-related hepatotoxicity at all dose levels precluded determination of a NOAEL</italic>.” However, the unusual pattern of hepatotoxicity suggested a factor other than drug exposure might have caused the hepatic effects. Therefore, snap-frozen liver samples were tested for hepatitis viruses using a PCR method. Tests for hepatitis B, C, and E virus were negative; however, 20/42 samples were positive for hepatitis A virus (HAV). Infection was strongly associated with increased serum ALT/GLDH, and/or hepatocyte degeneration/necrosis. Re-evaluation of the study in light of these data concluded that the hepatic injury was not drug-related. A subsequent 6-month toxicology study in HAV-vaccinated cynomolgus monkeys confirmed the absence of hepatotoxicity. Identification of HAV infection supported progression of the drug candidate into later clinical trials. Although rarely investigated, subclinical HAV infection has occasionally been reported in laboratory primates, including those used for toxicology studies and it may be more prevalent than the literature indicates.</p></abstract><kwd-group><kwd>toxicology</kwd><kwd>hepatitis A virus</kwd><kwd>cynomolgus monkey</kwd><kwd>non-human primate</kwd><kwd>hepatotoxicity</kwd><kwd>hepatic pathology</kwd><kwd>safety evaluation</kwd><kwd>drug development</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>typesetter</meta-name><meta-value>ts10</meta-value></custom-meta><custom-meta><meta-name>cover-date</meta-name><meta-value>July/August 2024</meta-value></custom-meta></custom-meta-group></article-meta></front></article>