Use of epidemiology and clinical toxicology to determine human risk in regulating polychlorinated biphenyls in the food supply

Polychlorinated biphenyls (PCBs) became a national problem in 1971 when several accidental contaminations of foods were reported. Extensive efforts were successfully undertaken by FDA to reduce the residues of PCBs in food. However, the PCB levels in several species of freshwater fish have raised concern about PCB residues from environmental contamination. This concern prompted a reassessment of the human risk involved in consumption of such fish. The best evidence that a chemical may produce adverse health effects in humans is provided by adequate epidemiologic data confirmed or supplemented by data from valid animal tests. Traditionally, where the regulatory agencies have used results of animal toxicology experiments to evaluate hazard and predict hypothetical safety for humans, “safety factors” such as 1 to 10 or 1 to 100 have been used. The size of the safety factor and the potential exposure to a chemical are established by properly informed scientific judgment. More recent efforts have involved use of a combination of human and animal data and a variety of mathematical models to determine risk. The human epidemiology data and the animal toxicity data of PCB exposure are reviewed, as well as risk assessment in general. Specific examples of risk assessment are presented in which animal data are extrapolated to humans, based on several levels of human exposure to PCBs in fish.     

Epidemiologic studies of glyphosate and cancer: A review

The United States Environmental Protection Agency and other regulatory agencies around the world have registered glyphosate as a broad-spectrum herbicide for use on multiple food and non-food use crops. Glyphosate is widely considered by regulatory authorities and scientific bodies to have no carcinogenic potential, based primarily on results of carcinogenicity studies of rats and mice. To examine potential cancer risks in humans, we reviewed the epidemiologic literature to evaluate whether exposure to glyphosate is associated causally with cancer risk in humans. We also reviewed relevant methodological and biomonitoring studies of glyphosate. Seven cohort studies and fourteen case-control studies examined the association between glyphosate and one or more cancer outcomes. Our review found no consistent pattern of positive associations indicating a causal relationship between total cancer (in adults or children) or any site-specific cancer and exposure to glyphosate. Data from biomonitoring studies underscore the importance of exposure assessment in epidemiologic studies, and indicate that studies should incorporate not only duration and frequency of pesticide use, but also type of pesticide formulation. Because generic exposure assessments likely lead to exposure misclassification, it is recommended that exposure algorithms be validated with biomonitoring data.     

Integrating epidemiology and toxicology in neurotoxicity risk assessment

Neurotoxicity risk assessments depend on the best available scientific information, including data from animal toxicity studies, human experimental studies and human epidemiology studies. There are several factors to consider when evaluating the comparability of data from studies. Regarding the epidemiology literature, issues include choice of study design, use of appropriate controls, methods of exposure assessment, subjective or objective evaluation of neurological status, and assessment and statistical control of potential confounding factors, including co-exposure to other agents. Animal experiments must be evaluated regarding factors such as dose level and duration, procedures used to assess neurological or behavioural status, and appropriateness of inference from the animal model to human neurotoxicity. Major factors that may explain apparent differences between animal and human studies include: animal neurological status may be evaluated with different procedures than those used in humans; animal studies may involve shorter exposure durations and higher dose levels; and most animal studies evaluate a single substance whereas humans typically are exposed to multiple agents. The comparability of measured outcomes in animals and humans may be improved by considering functional domains rather than individual test measures. The application of predictive models, weight of evidence considerations and meta-analysis can help evaluate the consistency of outcomes across studies. An appropriate blend of scientific information from toxicology and epidemiology studies is necessary to evaluate potential human risks of exposure to neurotoxic substances.     

U.S. EPA health assessment for diesel engine exhaust: a review

In 2002 the U.S. Environmental Protection Agency (EPA) released a Health assessment Document for Diesel Engine Exhaust. The objective of this assessment was to examine the possible health hazards associated with exposure to diesel engine exhaust (DE). The assessment concludes that long-term inhalation exposure is likely to pose a lung cancer hazard to humans as inferred from epidemiologic and certain animal studies. Estimation of cancer potency from available epidemiology studies was not attempted because of the absence of a confident cancer dose-response and animal studies were not judged appropriate for cancer potency estimation. A noncancer chronic human health hazard is inferred from rodent studies which show dose-dependent inflammation and histopathology in the rat lung. For these noncancer effects a safe exposure concentration for humans was estimated. Short-term exposures were noted to cause irritation and inflammatory symptoms of a transient nature, these being highly variable across an exposed population. The assessment also indicates that there is emerging evidence for the exacerbation of existing allergies and asthma symptoms; however, as of 2002 the data were inadequate for quantitative dose-response analysis. The assessment conclusions are based on studies that used exposures from engines built prior to the mid 1990s. More recent engines without high-efficiency particle traps would be expected to have exhaust emissions with similar characteristics. With additional cancer epidemiology studies expected in 2007-2008, and a growing body of evidence for allergenicity and cardiovascular effects, future health assessments will have an expanded health effects data base to evaluate.     

Safety assessment of butylated hydroxyanisole and butylated hydroxytoluene as antioxidant food additives.

Butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT) are widely used antioxidant food additives. They have been extensively studied for potential toxicities. This review details experimental studies of genotoxicity and carcinogenicity which bear on cancer hazard assessment of exposure to humans. We conclude that BHA and BHT pose no cancer hazard and, to the contrary, may be anticarcinogenic at current levels of food additive use.     

Carcinogenicity of ethylene oxide: key findings and scientific issues

In support of the Integrated Risk Information System (IRIS), the U.S. Environmental Protection Agency (EPA) completed an evaluation of the inhalation carcinogenicity of ethylene oxide (EtO) in December 2016. This article reviews key findings and scientific issues regarding the carcinogenicity of EtO in EPA’s Carcinogenicity Assessment. EPA’s assessment critically reviewed and characterized epidemiologic, laboratory animal, and mechanistic studies pertaining to the human carcinogenicity of EtO, and addressed some key scientific issues such as the analysis of mechanistic data as part of the cancer hazard evaluation and to inform the quantitative risk assessment. The weight of evidence from the epidemiologic, laboratory animal, and mechanistic studies supports a conclusion that EtO is carcinogenic in humans, with the strongest human evidence linking EtO exposure to lymphoid and breast cancers. Analyses of the mechanistic data establish a key role for genotoxicity and mutagenicity in EtO-induced carcinogenicity and reveal little evidence supporting other mode-of-action hypotheses. In conclusion, EtO was found to be carcinogenic to humans by inhalation, posing a potential human health hazard for lymphoid and breast cancers.     

Zero tolerances in food and animal feed -- are there any scientific alternatives? A European point of view on an international controversy

A number of zero tolerance provisions are contained in both food and animal feed law, e.g. for chemical substances whose occurrence is not permitted or is directly prohibited in food or animal feed. In the European Union, bans of this kind were introduced to give consumers and animals the greatest possible protection from substances with a possible hazard potential within the intendment of the hazard prevention principles and current precautionary measures. This also applies to substances for which an acceptable daily intake cannot be derived and a maximum residue limit cannot, therefore, be established, e.g. due to missing or inadequate toxicological data. Zero tolerances are also under discussion as trade barriers because their use has triggered numerous legal disputes. This paper draws together the results of an evaluation of alternative risk assessment methods to be used for the risk assessment of substances to which currently only zero tolerances apply. It will demonstrate that, depending on the available toxicological data, a scientifically sound risk assessment may still be possible. In this context, the two concepts - margin of exposure and threshold of toxicological concern - are very promising approaches. Until the scientific and sociopolitical discussions have been completed, it is essential that the principle of zero tolerances be upheld, especially for those substances which may be genotoxic carcinogens. In microbiology, there is no legal room for manoeuvre with regard to food safety criteria established for reasons of consumer health protection on the basis of scientific assessments.     

State of the art in benefit-risk analysis: Food and nutrition

Benefit-risk assessment in food and nutrition is relatively new. It weighs the beneficial and adverse effects that a food (component) may have, in order to facilitate more informed management decisions regarding public health issues. It is rooted in the recognition that good food and nutrition can improve health and that some risk may be acceptable if benefit is expected to outweigh it. This paper presents an overview of current concepts and practices in benefit-risk analysis for food and nutrition. It aims to facilitate scientists and policy makers in performing, interpreting and evaluating benefit-risk assessments.Historically, the assessments of risks and benefits have been separate processes. Risk assessment is mainly addressed by toxicology, as demanded by regulation. It traditionally assumes that a maximum safe dose can be determined from experimental studies (usually in animals) and that applying appropriate uncertainty factors then defines the ‘safe’ intake for human populations. There is a minor role for other research traditions in risk assessment, such as epidemiology, which quantifies associations between determinants and health effects in humans. These effects can be both adverse and beneficial. Benefit assessment is newly developing in regulatory terms, but has been the subject of research for a long time within nutrition and epidemiology. The exact scope is yet to be defined. Reductions in risk can be termed benefits, but also states rising above ‘the average health’ are explored as benefits. In nutrition, current interest is in ‘optimal’ intake; from a population perspective, but also from a more individualised perspective.In current approaches to combine benefit and risk assessment, benefit assessment mirrors the traditional risk assessment paradigm of hazard identification, hazard characterization, exposure assessment and risk characterization. Benefit-risk comparison can be qualitative and quantitative. In a quantitative comparison, benefits and risks are expressed in a common currency, for which the input may be deterministic or (increasingly more) probabilistic. A tiered approach is advocated, as this allows for transparency, an early stop in the analysis and interim interaction with the decision-maker. A general problem in the disciplines underlying benefit-risk assessment is that good dose-response data, i.e. at relevant intake levels and suitable for the target population, are scarce.It is concluded that, provided it is clearly explained, benefit-risk assessment is a valuable approach to systematically show current knowledge and its gaps and to transparently provide the best possible science-based answer to complicated questions with a large potential impact on public health.     

About hazard and risk assessment: Regulatory approaches in assessing safety in the European Union chemicals legislation

Hazard classification and labelling is the main and basic requirement for all industrial and consumer chemicals in the European Union, if they are not regulated under more specific legislation such as drugs, food ingredients or cosmetics. The first approach in hazard classification is hazard identification describing the hazardous properties of chemicals. Refinements in the classification criteria include the assessment of toxic potency (hazard characterisation) where feasible and the possibility to set higher or lower specific concentration limits for classification. In the past only a minor portion of the classified chemicals underwent a risk assessment including exposure assessment and risk characterisation. Risk assessment will become more frequent with the implementation of REACH. However, as risk assessment is rather labour-intensive even under REACH risk assessment will be performed in a targeted approach for a selected number of chemical substances while hazard classification and labelling will remain the basic approach for all chemicals.     

Risk assessment of substances that are both genotoxic and carcinogenic report of an International Conference organized by EFSA and WHO with support of ILSI Europe.

The European Food Safety Authority (EFSA) and the World Health Organization (WHO), with the support of the International Life Sciences Institute, European Branch (ILSI Europe), organized an international conference on 16-18 November 2005 to discuss how regulatory and advisory bodies evaluate the potential risks of the presence in food of substances that are both genotoxic and carcinogenic. The objectives of the conference were to discuss the possible approaches for risk assessment of such substances, how the approaches may be interpreted and whether they meet the needs of risk managers. ALARA (as low as reasonably achievable) provides advice based solely on hazard identification and does not take into account either potency or human exposure. The use of quantitative low-dose extrapolation of dose-response data from an animal bioassay raises numerous scientific uncertainties related to the selection of mathematical models and extrapolation down to levels of human exposure. There was consensus that the margin of exposure (MOE) was the preferred approach because it is based on the available animal dose-response data, without extrapolation, and on human exposures. The MOE can be used for prioritisation of risk management actions but the conference recognised that it is difficult to interpret it in terms of health risk.     

Hazard identification by methods of animal-based toxicology.

This paper is one of several prepared under the project "Food Safety In Europe: Risk Assessment of Chemicals in Food and Diet" (FOSIE), a European Commission Concerted Action Programme, organised by the International Life Sciences Institute, Europe (ILSI). The aim of the FOSIE project is to review the current state of the science of risk assessment of chemicals in food and diet, by consideration of the four stages of risk assessment, that is, hazard identification, hazard characterisation, exposure assessment and risk characterisation. The contribution of animal-based methods in toxicology to hazard identification of chemicals in food and diet is discussed. The importance of first applying existing technical and chemical knowledge to the design of safety testing programs for food chemicals is emphasised. There is consideration of the presently available and commonly used toxicity testing approaches and methodologies, including acute and repeated dose toxicity, reproductive and developmental toxicity, neurotoxicity, genotoxicity, carcinogenicity, immunotoxicity and food allergy. They are considered from the perspective of whether they are appropriate for assessing food chemicals and whether they are adequate to detect currently known or anticipated hazards from food. Gaps in knowledge and future research needs are identified; research on these could lead to improvements in the methods of hazard identification for food chemicals. The potential impact of some emerging techniques and toxicological issues on hazard identification for food chemicals, such as new measurement techniques, the use of transgenic animals, assessment of hormone balance and the possibilities for conducting studies in which common human diseases have been modelled, is also considered.     

Review of carbon nanotubes toxicity and exposure—Appraisal of human health risk assessment based on open literature

Carbon nanotubes (CNTs) possess many unique electronic and mechanical properties and are thus interesting for numerous novel industrial and biomedical applications. As the level of production and use of these materials increases, so too does the potential risk to human health. This study aims to investigate the feasibility and challenges associated with conducting a human health risk assessment for carbon nanotubes based on the open literature, utilising an approach similar to that of a classical regulatory risk assessment. Results indicate that the main risks for humans arise from chronic occupational inhalation, especially during activities involving high CNT release and uncontrolled exposure. It is not yet possible to draw definitive conclusions with regards the potential risk for long, straight multi-walled carbon nanotubes to pose a similar risk as asbestos by inducing mesothelioma. The genotoxic potential of CNTs is currently inconclusive and could be either primary or secondary. Possible systemic effects of CNTs would be either dependent on absorption and distribution of CNTs to sensitive organs or could be induced through the release of inflammatory mediators. In conclusion, gaps in the data set in relation to both exposure and hazard do not allow any definite conclusions suitable for regulatory decision-making. In order to enable a full human health risk assessment, future work should focus on the generation of reliable occupational, environmental and consumer exposure data. Data on toxicokinetics and studies investigating effects of chronic exposure under conditions relevant for human exposure should also be prioritised.     

Human and ecological risk assessment of a crop protection chemical: a case study with the azole fungicide epoxiconazole

Conventional risk assessments for crop protection chemicals compare the potential for causing toxicity (hazard identification) to anticipated exposure. New regulatory approaches have been proposed that would exclude exposure assessment and just focus on hazard identification based on endocrine disruption. This review comprises a critical analysis of hazard, focusing on the relative sensitivity of endocrine and non-endocrine endpoints, using a class of crop protection chemicals, the azole fungicides. These were selected because they are widely used on important crops (e.g. grains) and thereby can contact target and non-target plants and enter the food chain of humans and wildlife. Inhibition of lanosterol 14α-demethylase (CYP51) mediates the antifungal effect. Inhibition of other CYPs, such as aromatase (CYP19), can lead to numerous toxicological effects, which are also evident from high dose human exposures to therapeutic azoles. Because of its widespread use and substantial database, epoxiconazole was selected as a representative azole fungicide. Our critical analysis concluded that anticipated human exposure to epoxiconazole would yield a margin of safety of at least three orders of magnitude for reproductive effects observed in laboratory rodent studies that are postulated to be endocrine-driven (i.e. fetal resorptions). The most sensitive ecological species is the aquatic plant Lemna (duckweed), for which the margin of safety is less protective than for human health. For humans and wildlife, endocrine disruption is not the most sensitive endpoint. It is concluded that conventional risk assessment, considering anticipated exposure levels, will be protective of both human and ecological health. Although the toxic mechanisms of other azole compounds may be similar, large differences in potency will require a case-by-case risk assessment     

Use of epidemiology data to assess the cancer risk of 2,3,7,8-tetrachlorodibenzo-p-dioxin.

Most countries have assessed the human cancer risk of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) by extrapolating from animal data. The 1600-fold variation for acceptable intakes estimated by the Americans, Canadians, and Europeans, however, indicates a large scientific uncertainty about TCDD toxicity. Regulators are attempting to use human epidemiology data to eliminate some of the limitations inherent in using animal data to quantitatively assess cancer risk in humans, particularly now that techniques for measuring TCDD levels in adipose tissue and serum are available. This paper presents an overview of the major epidemiologic studies that associate cancer with TCDD exposure. The actual exposures experienced by the study populations are emphasized. The TCDD serum levels of the Seveso, Italy, residents and of the NIOSH Dioxin Registry participants indicate that these populations hold the best promise for future assessment of the human carcinogenic risk of dioxin. Based on the animal data, however, the calculated risk from these exposures is still moderate compared with high background cancer incidence present in most industrialized countries.     

Pesticide Exposures and Fetal Death: A Review of the Epidemiologic Literature

Despite considerable concern regarding the effects on reproductive outcome of exposures to pesticides, convincing evidence for the developmental toxicity of occupational and environmental pesticide exposure in humans is lacking. In this comprehensive review of the English language epidemiologic literature, we summarize studies that have examined potential associations between fetal deaths (both spontaneous abortions and stillbirths) and specific pesticides, as well as maternal and paternal employment in occupations with potential for exposure. While many of the epidemiologic studies to date suffer from methodologic problems, the data are suggestive of increased risks of fetal deaths associated with pesticides in general and maternal employment in the agricultural industry. There is a clear need for epidemiologic research that focuses on specific pesticide products or chemical families, with improved exposure assessment. The potential role of solvents in developmental toxicity associated with pesticide use by both males and females should also be considered.     

Safety assessment of allylalkoxybenzene derivatives used as flavouring substances - methyl eugenol and estragole.

This publication is the seventh in a series of safety evaluations performed by the Expert Panel of the Flavor and Extract Manufacturers' Association (FEMA). In 1993, the Panel initiated a comprehensive program to re-evaluate the safety of more than 1700 GRAS flavouring substances under conditions of intended use. In this review, scientific data relevant to the safety evaluation of the allylalkoxybenzene derivatives methyl eugenol and estragole is critically evaluated by the FEMA Expert Panel. The hazard determination uses a mechanism-based approach in which production of the hepatotoxic sulfate conjugate of the 1'-hydroxy metabolite is used to interpret the pathological changes observed in different species of laboratory rodents in chronic and subchronic studies. In the risk evaluation, the effect of dose and metabolic activation on the production of the 1'-hydroxy metabolite in humans and laboratory animals is compared to assess the risk to humans from use of methyl eugenol and estragole as naturally occurring components of a traditional diet and as added flavouring substances. Both the qualitative and quantitative aspects of the molecular disposition of methyl eugenol and estragole and their associated toxicological sequelae have been relatively well defined from mammalian studies. Several studies have clearly established that the profiles of metabolism, metabolic activation, and covalent binding are dose dependent and that the relative importance diminishes markedly at low levels of exposure (i.e. these events are not linear with respect to dose). In particular, rodent studies show that these events are minimal probably in the dose range of 1-10 mg/kg body weight, which is approximately 100-1000 times the anticipated human exposure to these substances. For these reasons it is concluded that present exposure to methyl eugenol and estragole resulting from consumption of food, mainly spices and added as such, does not pose a significant cancer risk. Nevertheless, further studies are needed to define both the nature and implications of the dose-response curve in rats at low levels of exposure to methyl eugenol and estragole.     

Strategic biomonitoring initiatives: moving the science forward.

Biomonitoring programs in the United States and Europe demonstrate the vast array of data that are publicly available for the evaluation of exposure trends, identification of susceptible populations, detection of emerging chemical risks, the conduct of epidemiology studies, and evaluation of risk reduction strategies. To cultivate international discussion on these issues, the ILSI Health and Environmental Sciences Institute convened a scientific session at its annual meeting in January 2006 on "Integration of Biomonitoring Exposure Data into the Risk Assessment Process." This Forum paper presents perspectives from session speakers on the biomonitoring activities of the Centers for Disease Control and Prevention, the U.S. Environmental Protection Agency, the National Research Council Committee on Human Biomonitoring for Environmental Toxicants, the German Commission on Human Biomonitoring, and the Health and Environmental Sciences Institute Biomonitoring Technical Committee. Speakers noted that better estimates of biological concentrations of substances in the tissues of human populations can be combined with other exposure indices, as well as epidemiological and toxicologic data, to improve risk estimates. With this type of combined data, the potential also exists to define exposure levels at which hazard and risk are of minimal concern. Limitations in interpreting biomonitoring data were discussed, including the need for different criteria for applying biomonitoring data for exposure assessment, risk assessment, risk management, or disease prevention purposes. As efforts and resources are expended to improve the ability to apply biomonitoring exposure data in the risk assessment process, it is equally important to communicate the significance of such data to the public.     

Assessment of three approaches for regulatory decision making on pesticides with endocrine disrupting properties

Recent EU legislation has introduced endocrine disrupting properties as a hazard-based “cut-off” criterion for the approval of active substances as pesticides and biocides. Currently, no specific science-based approach for the assessment of substances with endocrine disrupting properties has been agreed upon, although this new legislation provides interim criteria based on classification and labelling.Different proposals for decision making on potential endocrine disrupting properties in human health risk assessment have been developed by the German Federal Institute for Risk Assessment (BfR) and other regulatory bodies. All these frameworks, although differing with regard to hazard characterisation, include a toxicological assessment of adversity of the effects, the evaluation of underlying modes/mechanisms of action in animals and considerations concerning the relevance of effects to humans.Three options for regulatory decision making were tested upon 39 pesticides for their applicability and to analyze their potential impact on the regulatory status of active substances that are currently approved for use in Europe: Option 1, based purely on hazard identification (adversity, mode of action, and the plausibility that both are related); Option 2, based on hazard identification and additional elements of hazard characterisation (severity and potency); Option 3, based on the interim criteria laid down in the recent EU pesticides legislation. Additionally, the data analysed in this study were used to address the questions, which parts of the endocrine system were affected, which studies were the most sensitive and whether no observed adverse effect levels were observed for substance with ED properties.The results of this exercise represent preliminary categorisations and must not be used as a basis for definitive regulatory decisions. They demonstrate that a combination of criteria for hazard identification with additional criteria of hazard characterisation allows prioritising and differentiating between substances with regard to their regulatory concern. It is proposed to integrate these elements into a decision matrix to be used within a weight of evidence approach for the toxicological categorisation of relevant endocrine disruptors and to consider all parts of the endocrine system for regulatory decision making on endocrine disruption.     

Tools for the prioritization of substances on the Domestic Substances List in Canada on the basis of hazard

A precedent setting legislative mandate under the Canadian Environmental Protection Act 1999 to establish priorities for assessment based on systematic consideration of all of the approximately 23,000 Existing Chemicals in Canada required the development and refinement of methodology in a number of important areas. This included development of simple and complex exposure and hazard tools for priority setting which draw maximally and efficiently on available data to systematically identify substances that are highest priorities in relation to their potential to cause adverse effects on the general population. The hierarchical approach in the simple and complex hazard tools described here efficiently and effectively sets substances aside as non-priorities, or prioritizes them for consideration additionally in assessment. The hazard tools efficiently incorporate previous work, contributing to consistency internationally, and involve hierarchical consideration of sources of information based on their relative weighting. They are health protective, based on their incorporated degree of conservatism, and provide direction for additional assessment for substances deemed to be priorities. Although designed for prioritization of Existing Substances in Canada, these tools have potential for broader application in other national and international programs to provide focus and increase efficiency in human health risk assessment.     

Tools for the prioritization of substances on the Domestic Substances List in Canada on the basis of hazard

A precedent setting legislative mandate under the Canadian Environmental Protection Act 1999 to establish priorities for assessment based on systematic consideration of all of the approximately 23,000 Existing Chemicals in Canada required the development and refinement of methodology in a number of important areas. This included development of simple and complex exposure and hazard tools for priority setting which draw maximally and efficiently on available data to systematically identify substances that are highest priorities in relation to their potential to cause adverse effects on the general population. The hierarchical approach in the simple and complex hazard tools described here efficiently and effectively sets substances aside as non-priorities, or prioritizes them for consideration additionally in assessment. The hazard tools efficiently incorporate previous work, contributing to consistency internationally, and involve hierarchical consideration of sources of information based on their relative weighting. They are health protective, based on their incorporated degree of conservatism, and provide direction for additional assessment for substances deemed to be priorities. Although designed for prioritization of Existing Substances in Canada, these tools have potential for broader application in other national and international programs to provide focus and increase efficiency in human health risk assessment.