Characterization of potential chemical-induced developmental neurotoxicity (DNT) hazard is considered for risk assessment purposes by many regulatory sectors. However, due to test complexity, difficulty in interpreting results and need of substantial resources, the use of the in vivo DNT test guidelines has been limited and animal data on DNT are scarce. To address challenging endpoints such as DNT, the Organisation for Economic Co-Operation and Development (OECD) chemical safety program has been working lately toward the development of integrated approaches for testing and assessment (IATA) that rely on a combination of multiple layers of data (e.g., in vitro, in silico and non-mammalian in vivo models) that are supported by mechanistic knowledge organized according to the adverse outcome pathway (AOP) framework. In 2017, the OECD convened a dedicated OECD expert group to develop a guidance document on the application and interpretation of data derived from a DNT testing battery that relies on key neurodevelopmental processes and is complemented by zebrafish assays. This review will provide a brief overview of the OECD DNT project and summarize various achievements of relevance to the project. The review also presents an opportunity to describe considerations for uptake of the DNT in an in vitro battery in a regulatory context.

Loss of the sense of smell (anosmia) has been included as a COVID-19 symptom by the World Health Organization. The majority of patients recover the sense of smell within a few weeks postinfection (short-term anosmia), while others report persistent anosmia. Several studies have investigated the mechanisms leading to anosmia in COVID-19; however, the evidence is scattered, and the mechanisms remain poorly understood. Based on a comprehensive review of the literature, we aim here to evaluate the current knowledge and uncertainties regarding the mechanisms leading to short-term anosmia following SARS-CoV-2 infection. We applied an adverse outcome pathway (AOP) framework, well established in toxicology, to propose a sequence of measurable key events (KEs) leading to short-term anosmia in COVID-19. Those KEs are (1) SARS-CoV-2 Spike proteins binding to ACE-2 expressed by the sustentacular (SUS) cells in the olfactory epithelium (OE); (2) viral entry into SUS cells; (3) viral replication in the SUS cells; (4) SUS cell death; (5) damage to the olfactory sensory neurons and the olfactory epithelium (OE). This AOP-aligned approach allows for the identification of gaps where more research should be conducted and where therapeutic intervention could act. Finally, this AOP gives a frame to explain several disease features and can be linked to specific factors that lead to interindividual differences in response to SARS-CoV-2 infection.

Several reports have shown that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential to also be neurotropic. However, the mechanisms by which SARS-CoV-2 induces neurologic injury, including neurological and/or psychological symptoms, remain unclear. In this review, the available knowledge on the neurobiological mechanisms underlying COVID-19 was organized using the AOP framework. Four AOPs leading to neurological adverse outcomes (AO), anosmia, encephalitis, stroke, and seizure, were developed. Biological key events (KEs) identified to induce these AOs included binding to ACE2, blood–brain barrier (BBB) disruption, hypoxia, neuroinflammation, and oxidative stress. The modularity of AOPs allows the construction of AOP networks to visualize core pathways and recognize neuroinflammation and BBB disruption as shared mechanisms. Furthermore, the impact on the neurological AOPs of COVID-19 by modulating and multiscale factors such as age, psychological stress, nutrition, poverty, and food insecurity was discussed. Organizing the existing knowledge along an AOP framework can represent a valuable tool to understand disease mechanisms and identify data gaps and potentially contribute to treatment, and prevention. This AOP-aligned approach also facilitates synergy between experts from different backgrounds, while the fast-evolving and disruptive nature of COVID-19 emphasizes the need for interdisciplinarity and cross-community research.

Chemical exposure during critical stages of nervous system development can lead to adverse neurotoxic effects, known as developmental neurotoxicity (DNT). Although standardized in vivo test guidelines (TGs) are required under various regulatory frameworks, compared to other TGs few in vivo DNT studies have been conducted. The complexity, interpretative limitations, high cost and resource demands of these studies have prompted regulatory agencies and stakeholders to emphasize the need for developing and standardizing NAMs (New Approach Methodologies) that capture relevant endpoints and biomarkers of DNT effects. Recent advances in in vitro neural models and high throughput analytical technologies have enabled the creation of a battery of assays -the DNT In Vitro Battery (DNT-IVB)- designed to rapidly assess chemicals for their impact on critical neurodevelopmental processes in in vitro test systems. In response to the regulatory needs and the scientific advancements, an international collaboration led by regulatory agencies from both sides of the Atlantic under the auspices of OECD was initiated about a decade ago. Since then, substantial progress has been made. The DNT-IVB provides a structured approach for integrating human-relevant in vitro assay data into chemical DNT assessments. Its application is supported by guidance in the OECD Initial Recommendations for evaluating DNT-IVB data, along with case examples that apply the IATA (Integrated Approaches to Testing and Assessment) framework. Ongoing efforts aim to address remaining challenges and consolidate the guidance needed for standardizing and expanding the application of NAMs to assess DNT across various regulatory contexts. The DNT-IVB now represents a flagship OECD project, testing the paradigm of applying NAMs and IATA in risk assessment and paving the way for broader worldwide alignment on NAMs standardization and use.