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BCG Live
»BCG Live (intravesical)for immunotherapy is a freeze-dried preparation of attenuated live bacteria derived from a culture of Bacillus Calmette-Guérin (Mycobacterium bovis,var.BCG)and used intravesically in the treatment of carcinoma in situand papilloma tumors of the urinary bladder.The bacteria are grown in a medium that does not contain substances known to cause toxic or allergic reactions in human beings or to cause the bacteria to become virulent for guinea pigs.The culture is harvested and formulated to contain one or more excipients.The freeze-dried preparation is reconstituted and further diluted aseptically with a sterile diluent for use.Areconstituted dose contains 1.0–19.2×108colony-forming units (cfu).BCG Live does not contain a preservative.
Packaging and storage— BCG Live is sensitive to light and therefore must be preserved and stored in a glass container where it is protected from direct light at a temperature between 2and 8.
Expiration date— The product is stable for 3years when stored between 2and 8.
Labeling— Label it to indicate the dry weight of bacteria in a vial,cfu per dose,the storage conditions,the expiration date,and that it is not to be used after the expiration date given on the package.Label it to state that it should be protected from light and that it should be used immediately after reconstitution/dilution.Label it to indicate that it is “for intravesical use”.
Identification— BCG Live is identified by microscopic examination of the bacilli in stained smears demonstrating their acid-fast property.Alternatively,validated molecular biology techniques may be used.
General safety— It meets the requirements as set forth for Safety Tests—Biologicalsunder Biological Reactivity Tests,In Vivo á88ñ,modified as follows.Guinea pigs are injected intraperitoneally with 3.0mLof the reconstituted product.
Sterility á71ñ It meets the requirements when tested as directed for Direct Inoculation of the Culture Mediumunder Test for Sterility of the Product to be Examined.
Virulent mycobacteria—
Test suspension— Reconstitute the freeze-dried BCG Live as per the manufacturer's instructions for human use with the diluent recommended by the manufacturer,and dilute aseptically to about 2mg per mLwith sterile BCGdiluent.
Procedure— Randomly select not fewer than six guinea pigs of the same sex,each weighing 250to 300g.Inject each animal with a total of at least 4mg of the Test suspension intramuscularly or subcutaneously in the rear left internal thigh,and observe them for a period of 6weeks.Note the number of animals that survive at the end of the observation period,and then sacrifice them.Perform autopsies of all animals postmortem to examine them for evidence of tuberculous infections,particularly at the popliteal and inguinal lymph nodes,liver,spleen,pancreas,and lungs,as well as at the injection site.If any abnormalities are found,perform a histological examination using standard and Acid-Fast staining techniques to detect Acid-Fast organisms.The product complies with the test if none of the animals show signs of tuberculosis and not more than one-third of the animals die during the observation period.
Skin reactivity—
Test suspensions— Using the same diluent and the Test suspension prepared as directed in the test for Virulent mycobacteria,further dilute aseptically by making three serial tenfold dilutions.
Procedure— Randomly select two guinea pigs (male or female),each weighing 250to 300g.Inject 0.1mLof each of the four suspensions intradermally at different sites on the back of each animal.After 4weeks,the animals are shaved so that the injection sites and any reactions are made clearly visible.The diameters of the reactions are measured,and the presence of necrosis or nodules are noted.The reaction for the largest dose is between 4and 10mm and the smallest dose induces a nodule less than or equal to 4mm.Each animal gains weight during the observation period.
Tuberculin sensitivity—
Tuberculin solution— Use tuberculin,purified protein derivative,to prepare a solution containing 25U.S.Tuberculin Units per 0.1mL.Dilute aseptically,if necessary,with sterile 0.9%sodium chloride solution.
Procedure— Use the same animals on which the Skin reactivitytest is performed.After the Skin reactivitytest is completed,inject each animal intradermally on the back with 0.1mLof the Tuberculin solution,and observe after 18to 24hours.An erythematous reaction of not less than 10mm in diameter is measured on each animal.
Residual moisture: Not greater than the limit approved for the particular product,determined by a suitable validated method.Limits vary in accordance with the method.
Viability— Determine the potencies of BCG Live using not less than 5containers before freeze-drying and an equal number of containers after freeze-drying,following the procedure described under Potency,except use the suspension before freeze-drying as is.The loss in viability due to freeze-drying is not more than 90%.
Potency— Determine the number of viable units per mLby viable count on solid medium using a method suitable for the product to be examined.Alternatively,a validated biochemical method may be used.USP28
Auxiliary Information— Staff Liaison:Tina S.Morris,Ph.D.,Senior Scientist
Expert Committee:(VVI)Vaccines,Virology,and Immunology
USP28–NF23Page 221
Pharmacopeial Forum:Volume No.30(2)Page 452
Phone Number:1-301-816-8397