Assessment of associations between inhaled formaldehyde and lymphohematopoietic cancer through the integration of epidemiological and toxicological evidence with biological plausibility.

Formaldehyde is recognized as carcinogenic for the portal of entry sites, though conclusions are mixed regarding lymphohematopoietic (LHP) cancers. This systematic review assesses the likelihood of a causal relationship between formaldehyde and LHP cancers by integrating components recommended by NASEM. Four experimental rodent bioassays and 16 observational studies in humans were included following the implementation of the a priori protocol. All studies were assessed for risk of bias (RoB), and meta-analyses were conducted on epidemiological studies, followed by a structured assessment of causation based on GRADE and Bradford Hill. RoB analysis identified systemic limitations precluding confidence in the epidemiological evidence due to inadequate characterization of formaldehyde exposure and a failure to adequately adjust for confounders or effect modifiers, thus suggesting that effect estimates are likely to be impacted by systemic bias. Mixed findings were reported in individual studies; meta-analyses did not identify significant associations between formaldehyde inhalation (when measured as ever/never exposure) and LHP outcomes, with meta-SMRs ranging from 0.50 to 1.51, depending on LHP subtype. No associations with LHP-related lesions were reported in reliable animal bioassays. No biologically plausible explanation linking the inhalation of FA and LHP was identified, supported primarily by the lack of systemic distribution and in vivo genotoxicity. In conclusion, the inconsistent associations reported in a subset of the evidence were not considered causal when integrated with the totality of the epidemiological evidence, toxicological data, and considerations of biological plausibility. The impact of systemic biases identified herein could be quantitatively assessed to better inform causality and use in risk assessment.

Updated systematic assessment of human, animal and mechanistic evidence demonstrates lack of human carcinogenicity with consumption of aspartame.

Aspartame has been studied extensively and evaluated for its safety in foods and beverages yet concerns for its potential carcinogenicity have persisted, driven primarily by animal studies conducted at the Ramazzini Institute (RI). To address this controversy, an updated systematic review of available human, animal, and mechanistic data was conducted leveraging critical assessment tools to consider the quality and reliability of data. The evidence base includes 12 animal studies and >40 epidemiological studies reviewed by the World Health Organization which collectively demonstrate a lack of carcinogenic effect. Assessment of >1360 mechanistic endpoints, including many guideline-based genotoxicity studies, demonstrate a lack of activity associated with endpoints grouped to key characteristics of carcinogens. Other non-specific mechanistic data (e.g., mixed findings of oxidative stress across study models, tissues, and species) do not provide evidence of a biologically plausible carcinogenic pathway associated with aspartame. Taken together, available evidence supports that aspartame consumption is not carcinogenic in humans and that the inconsistent findings of the RI studies may be explained by flaws in study design and conduct (despite additional analyses to address study limitations), as acknowledged by authoritative bodies.

Development of a Range of Plausible Noncancer Toxicity Values for 2,3,7,8-Tetrachlorodibenzo-p-Dioxin Based on Effects on Sperm Count: Application of Systematic Review Methods and Quantitative Integration of Dose Response Using Meta-Regression.

Regulatory agencies have derived noncancer toxicity values for 2,3,7,8-tetrachlorodibenzo-p-dioxin based on reduced sperm counts relying on single studies from a large body of evidence. Techniques such as meta-regression allow for greater use of the available data while simultaneously providing important information regarding the uncertainty associated with the underlying evidence base when conducting risk assessments. The objective herein was to apply systematic review methods and meta-regression to characterize the dose-response relationship of gestational exposure and epididymal sperm count. Twenty-three publications (20 animal studies consisting of 29 separate rat experimental data sets, and 3 epidemiology studies) met inclusion criteria. Risk of bias evaluation was performed to critically appraise study validity. Low to very low confidence precluded use of available epidemiological data as candidate studies for dose-response due to inconsistencies across the evidence base, high risk of bias, and general lack of biological coherence, including lack of clinical relevance and dose-response concordance. Experimental animal studies, which were found to have higher confidence following the structured assessment of confidence (eg, controlled exposure, biological consistency), were used as the basis of a meta-regression. Multiple models were fit; points of departure were identified and converted to human equivalent doses. The resulting reference dose estimates ranged from approximately 4 to 70 pg/kg/day, depending on model, benchmark response level, and study validity integration approach. This range of reference doses can be used either qualitatively or quantitatively to enhance understanding of human health risk estimates for dioxin-like compounds.

Systematic review of the potential adverse effects of caffeine consumption in healthy adults, pregnant women, adolescents, and children.

To date, one of the most heavily cited assessments of caffeine safety in the peer-reviewed literature is that issued by Health Canada (Nawrot et al., 2003). Since then, >10,000 papers have been published related to caffeine, including hundreds of reviews on specific human health effects; however, to date, none have compared the wide range of topics evaluated by Nawrot et al. (2003). Thus, as an update to this foundational publication, we conducted a systematic review of data on potential adverse effects of caffeine published from 2001 to June 2015. Subject matter experts and research team participants developed five PECO (population, exposure, comparator, and outcome) questions to address five types of outcomes (acute toxicity, cardiovascular toxicity, bone and calcium effects, behavior, and development and reproduction) in four healthy populations (adults, pregnant women, adolescents, and children) relative to caffeine intake doses determined not to be associated with adverse effects by Health Canada (comparators: 400 mg/day for adults [10 g for lethality], 300 mg/day for pregnant women, and 2.5 mg/kg/day for children and adolescents). The a priori search strategy identified >5000 articles that were screened, with 381 meeting inclusion/exclusion criteria for the five outcomes (pharmacokinetics was addressed contextually, adding 46 more studies). Data were extracted by the research team and rated for risk of bias and indirectness (internal and external validity). Selected no- and low-effect intakes were assessed relative to the population-specific comparator. Conclusions were drawn for the body of evidence for each outcome, as well as endpoints within an outcome, using a weight of evidence approach. When the total body of evidence was evaluated and when study quality, consistency, level of adversity, and magnitude of response were considered, the evidence generally supports that consumption of up to 400 mg caffeine/day in healthy adults is not associated with overt, adverse cardiovascular effects, behavioral effects, reproductive and developmental effects, acute effects, or bone status. Evidence also supports consumption of up to 300 mg caffeine/day in healthy pregnant women as an intake that is generally not associated with adverse reproductive and developmental effects. Limited data were identified for child and adolescent populations; the available evidence suggests that 2.5 mg caffeine/kg body weight/day remains an appropriate recommendation. The results of this systematic review support a shift in caffeine research to focus on characterizing effects in sensitive populations and establishing better quantitative characterization of interindividual variability (e.g., epigenetic trends), subpopulations (e.g., unhealthy populations, individuals with preexisting conditions), conditions (e.g., coexposures), and outcomes (e.g., exacerbation of risk-taking behavior) that could render individuals to be at greater risk relative to healthy adults and healthy pregnant women. This review, being one of the first to apply systematic review methodologies to toxicological assessments, also highlights the need for refined guidance and frameworks unique to the conduct of systematic review in this field.

Development of a neurotoxic equivalence scheme of relative potency for assessing the risk of PCB mixtures.

PCBs produce adverse effects in humans and animals by several modes of action. The first mode of action is binding of coplanar or mono-ortho-PCBs to the aryl hydrocarbon (Ah) receptor leading to effects associated with the activation of this receptor. The remaining PCB congeners do not activate this receptor and have different modes of action underlying their toxic effects. One mode of action that has been shown for di-ortho-substituted non-coplanar PCBs (PCB congeners with two or more chlorines in the ortho-positions) is the interference with intracellular signaling pathways dependent on Ca(2+) homeostasis and the resulting cellular, organ-level and organismal effects. The ortho-substituted non-coplanar congeners produce other cellular or organ-level effects including changes in protein kinase C translocation, changes in cellular dopamine (DA) uptake, formation of reactive oxygen species, and thyroid effects. Here, we propose a scheme for developing relative potency estimates (REP) for the PCB congeners not considered in the TEF scheme used to assess the toxicity of coplanar and mono-ortho-PCBs and chlorinated dioxins and furans. Because a number of the modes of action listed here for the ortho-substituted non-coplanar PCB congeners have been implicated in the neurotoxic effects of these PCBs congeners, this relative potency scheme is referred to here as the Neurotoxic Equivalent (NEQ) scheme for estimating toxicity of PCB mixtures. The Neurotoxic Equivalent (NEQ) values are developed in a way similar in concept to the derivation of the well-known TEF congener values. Although this scheme is in its infancy and the set of NEQ values are limited by the current data, there are several compelling reasons for proposing such a scheme now. First, it should open discussions as to how different modes of action can be utilized to predict congener potency differences for the effects they produce. Second, consideration and evaluation of the ability of the proposed NEQ scheme to predict the toxicity of PCB mixtures will assist in the identification of the specific modes of action relevant to the effects produced by non-coplanar PCBs. If other modes of action are suggested and subsequently identified, then other schemes of relative potency could be developed specifically for those modes of action, distinct from either the TEF scheme or the NEQ scheme. Knowing these other modes of action and the relative toxicity of the various congeners would advance our understanding of PCB toxicology and thereby ultimately improve our ability to estimate the toxic potency of PCB mixtures for each identified mode of action. Third, a quantitative scheme for assessing the toxicity of the non-coplanar PCB congeners present in a mixture has the potential to improve significantly future risk assessments of PCB mixtures.

Development of an oral cancer slope factor for Aroclor 1268.

Rodent cancer bioassays indicate that substantial differences exist among PCB mixtures in terms of tumorigenic response, although no bioassay has been conducted with Aroclor 1268. The USEPA has used data from these studies to develop three sets of PCB cancer slope factors (CSFs) ranging from 0.07 to 2.0(mg/kg-day)(-1). Selection of the appropriate CSF for risk assessment purposes is largely a function of the exposure circumstances rather than the PCB mixture involved. Since the congener composition of Aroclor 1268 differs substantially from that of the predominant PCB mixture (Aroclor 1254) used to derive the CSFs, the validity of applying existing CSFs to Aroclor 1268 is questionable. We have therefore undertaken the task of developing cancer potency estimates specifically for Aroclor 1268. Potency estimation approaches for Aroclor 1268 were based in part on existing potency estimates for other PCB mixtures, coupled with the relative 2,3,7,8-tetrachlorodibenzo-p-dioxin toxic equivalents (TEQ) content and bioaccumulation potential of PCB mixtures. As such, both Ah-dependent and independent mechanisms of tumorigenesis were considered relevant. Both empirical evidence and mechanistic considerations indicate Aroclor 1268 is substantially less toxic and carcinogenic than the PCB mixtures that have been used by the USEPA to develop CSFs. The present analysis indicates that Aroclor 1268 is likely to be 1-2 orders of magnitude less potent than Aroclor 1254 in terms of potential tumorigenicity. Therefore, we suggest an upper-bound cancer potency factor of 0.27(mg/kg-day)(-1) for Aroclor 1268, a value that is 7- to 8-fold lower than the USEPA's current default, but nonetheless adequately conservative.

Evaluation of the carcinogenicity of 1,1-dichloroethylene (vinylidene chloride).

The U.S. Environmental Protection Agency has classified 1,1-dichloroethylene (vinylidene chloride; VDC) as a "C" carcinogen and has developed an inhalation unit risk value and an oral cancer slope factor for this chemical. The development and use of these cancer potency estimates for risk assessment purposes are questionable. The inhalation unit risk value is based on increased kidney adenocarcinomas in Swiss mice from one study. This type of cancer was not increased in female mice or in rats or hamsters in the same study nor in male mice of a similar strain in another study with higher VDC exposures. The VDC oral cancer slope factor is based on a non-statistically significant increase in adrenal pheochromocytomas in male rats following oral exposure in a standard National Toxicology Program chronic bioassay. Both human and animal literature relevant to VDC carcinogenicity was reviewed according to the USEPA draft Guidelines for Carcinogen Risk Assessment with the objective of determining the weight-of-evidence for VDC carcinogenicity. We conclude that information currently available for VDC is most appropriately characterized in a weight-of-evidence narrative by the descriptor "inadequate for an assessment of human carcinogenic potential." For chemicals with this descriptor, dose-response assessment is not indicated. Under this guidance, quantitative estimates of cancer risks associated with VDC exposure are inappropriate until additional, more definitive evidence for human carcinogenicity becomes available.