Oral administration of BL-634 1 hydrochloride, a long-acting histamine H2-receptor antagonist, to rats for 2 years at doses of 10, 55 or 300 rng/kdday resulted in several changes in the fundic (oxyntic) mucosa of the glandular stomach. The most significant alteration was a proliferation of argyrophil endocrine cells that was demonstrated to be enterochromaffin-like (ECL) cells. The ECL cell proliferation consisted of a continuum of changes involving diffuse hyperplasia, focal adenomatous hyperplasia, and carcinoid tumor formation at the highest dose level of 300 mg/kg. At 55 mg/kg only ECL celI hyperpIasia occurred, and at the low dose of 10 mg/kg there were no remarkable proliferative changes. The reference compound, cimetidine (950 mg/ kg), produced a degree of ECL cell proliferation that was slightly less, but not significantly different than, that observed with 55 mg/kg of BL-6341. Dose-related elevations of serum gastrin were observed with BL-634 1 , while cimetidine produced hypergastrinemia that was generally intermediate between that produced by the middle and low doses of BL-634 1. The hypergastrinemia resulted from the pharmacologic inhibition of acid secretion, which is the negative feedback mechanism controlling the production of gastrin. Only the 300 rng/kg dose of BL-6341 produced a significant, sustained (24 hours) hypergastrinemia and carcinoid tumors. The chronic, sustained hypergastrinemia was considered to be the primary cause of the ECL cell carcinoid neoplasia. All genetic toxicology tests performed with BL-634 1 were negative. It was concluded that the demonstrated hypergastrinemia represents an indirect, hormonal, epigenetic mechanism of tumorigenesis.
INTRODU~IONThe toxicologic testing of new, potent, long-acting histamine H,-receptor antagonists and H+, K+-ATPase inhibitors has resulted in several types of proliferative gastric changes in chronic rat studies. The most noteworthy of these is the occurrence of gastric carcinoid tumors in the oxyntic mucosa (2, 18, 34). These proliferative endocrine changes are distinct from those produced by the gastric carcinogen, N-methyl-N-nitro-N-nitrosoguanidine (MNNG), that produces adenocarcinomas primarily in the pylonc region of the stomach (28). The histamine H,-blocker, tiotidine, has produced a dysplasiakarcinoma syndrome in rats that resembles the lesions associated with MNNG (38).This report describes the occurrence of proliferative, gastric, endocrine cell changes in the fundic stomach of rats administered the long-acting H,-antagonist, BL-6341 hydrochloride. It discusses the significance of these lesions, proposes a mechanism of tumorigenesis, and compares these observations with similar findings associated with other anti-secretagogues and those reported in man.
METHODS
Two-Year RatStudy. The carcinogenicity study was composed of 60 male and 60 female Charles R.iver, Sprague-pawley CD rats per dose group, and 110 male and 110 female negative controls. Rats were 8 weeks of age when the study was initiated.. They were administered ei...