Header Artwork
Header Artwork



A Stepwise Approach to Deal with In Vitro Cytotoxicity Failures

Six steps to assess the situation and determine how to move forward…

Each medical device present or coming on the market needs to have a demonstrated
biocompatibility to protect users from potential biological risks arising from its intended
clinical use.

Therefore, it is required for manufacturers to perform a biological evaluation of
their medical device as outlined in ISO 10993-1:2018 “Biological evaluation of medical devices
– Part 1: Evaluation and testing within a risk management process”. This biological evaluation is
carried out within a risk management process, meaning that relevant existing data is reviewed
and evaluated and, where necessary, additional testing is selected and applied. The ISO 10993-1
guideline identifies several biological endpoints for which the product needs to be evaluated,
either through existing data or testing. One particular endpoint that has to be evaluated for
every medical device, no matter its classification, is cytotoxicity. Due to the highly sensitive
nature of the cytotoxicity test combined with its low cost and short turnaround time, this
endpoint is most often expected to be evaluated through testing, wherein an in vitro cell
culture system is used to evaluate the potential cytotoxic effects of the final finished form of
a medical device. However, it is known that in vitro cytotoxicity testing is a sensitive assay that
can often result in failures. The first reaction to a failing result is often a state of panic. This is
understandable given that it may feel like the complete submission of the medical device is
compromised and that a product will not be approved for commercialization.

ISO 10993-5:2009 “Biological evaluation of medical devices – Part 5: Tests for in vitro
cytotoxicity” provides an apt statement on the assessment of in vitro cytotoxicity results: ‘Any
cytotoxic effect can be of concern. However, it is primarily an indication of potential for in vivo
cytotoxicity and the device cannot necessarily be determined unsuitable for a given clinical
application based solely on cytotoxicity data’. Consequently, any in vitro cytotoxicity failure is
a source of concern that should be investigated to identify whether there is a risk for in vivo
cytotoxicity, but this does not automatically mean a medical device is not biocompatible. Indeed,
provided that a proper biological risk assessment is performed, there are several alternatives to
defend such a result and move towards a successful submission. That being said, figuring out
how to move forward in light of a cytotoxicity failure can be challenging.

This document aims at providing the reader with a step-by-step guide on how to
investigate and assess in vitro cytotoxicity failures in order to determine the appropriate way

Please, fill in your data below to download the document and I wish you a very interesting reading…

Lise Vanderkelen, PhD

Lise Vanderkelen, PhD

Pharmaceuticals and Microbiology Expert

Lise Vanderkelen received her Ph.D. from the Faculty of Bioscience Engineering at the University of Leuven (Belgium) in 2012. She started at Nelson Labs Europe in 2013 as Study Director Extractables & Leachables, focusing on parenteral applications, and in 2014, she became responsible for the chemical characterization testing of medical devices (ISO 10993-18). In 2016,...

Audrey Turley

Audrey Turley

Director of Expert Advisory Services & Biocompatibility Expert

Audrey Turley has over 25 years of experience working in research, laboratory, and test design functions in the medical device industry. She is a biocompatibility expert, having performed all the in vitro tests offered at Nelson Labs, which include cytotoxicity (MEM and agar overlay), hemolysis (PTT, PT, complement activation, blood circulation, ASTM, and NIH methods),...

Katleen Peymen, PhD

Katleen Peymen, PhD

Study Director Healthcare reprocessing and Microbiology

Katleen Peymen received her PhD in Biochemistry and Biotechnology from the Faculty of Science at the University of Leuven (Belgium) in 2019. After her career as a post-doctoral researcher, she started at Nelson Labs Europe in 2020 as a Study Director for Healthcare reprocessing and Microbiology. She is responsible for the study design, analysis and reporting of healthcare reprocessing validations for reusable medical devices, such as cleaning, disinfection, and steam sterilization validations, and is an active member of several International Organization for Standardization (ISO) committees related to healthcare reprocessing.

Complete the information in the form below to access the whitepaper.