Adverse Outcome Pathway for Antimicrobial Quaternary Ammonium Compounds.

Quaternary ammonium compounds (QACs) or quats are a large class of antimicrobial chemicals used in households and institutions as sanitizers and disinfectants. These chemicals are utilized as food processing sanitizers, algicides, in the process of water treatment, and preservatives in cosmetics. The aim of this study was to determine an Adverse Outcome Pathway (AOP) whereby two widely used QACs, alkyl dimethyl benzyl ammonium chloride (ADBAC) and didecyl dimethyl ammonium chloride (DDAC), may result in respiratory tract and gastrointestinal tract effects. When inhaled or ingested, these QACs are incorporated into the epithelial cell membrane at the point of contact. With sufficient dosage, the epithelial membrane is disrupted, reducing its fluidity, and releasing cellular contents. Further, ADBAC and DDAC might disrupt mitochondrial functions leading to decreased ATP production. Both events might lead to cell death, either attributed to direct lysis, necrosis, or apoptosis. Pro-inflammatory mediators are recruited to the tissue, inducing inflammation, edema, and excess mucus production. The primary tissue-level adverse outcome is epithelial degeneration and dysplasia. Most important, no apparent metabolism or distribution is involved in QAC action. Based upon this knowledge, it is suggested to replace default Uncertainty Factors for risk assessments with a set of Data Derived Extrapolation Factors.

Post-market surveillance of consumer products: Framework for adverse event management.

Analysis of spontaneous reports of adverse events is an important source of information that can be used to improve consumer products. Various agencies have adverse event reporting requirements and many companies collect such data directly from consumers. Nonetheless, a universal framework is absent that identifies and evaluates spontaneously reported adverse events, and, most important, assesses the potential association between exposure and adverse events. We are presenting a three-part framework: Phase I - Intake and Documentation of Original Incidents; Phase II - In Depth Review and Follow-up of Phase I Incidents (enhanced, tailored questionnaire); Phase III - Association Assessment. The basis for scoring the strength of association between exposure and adverse events requires assessment of standard factors of association including: temporality; biological, physiological, or pharmacological plausibility; results of de-challenge; results of re-challenge; and consideration of confounding factors. Scores tied to the answers to these questions are totaled for each incident to determine the strength of association between exposure and reported adverse event. We propose that consumer product companies come together to adopt such an association assessment framework to improve adverse event management, obtain maximum value from the data obtained, and use the knowledge derived to improve overall product safety for consumers.

Adverse events associated with the use of insect repellents containing N,N-diethyl-m-toluamide (DEET).

DEET is the major component of most topically applied insect repellents used in the US. The DEET Registry is a post-marketing surveillance system to provide systematic and detailed information about medical events temporally associated with DEET use. From 1995 to 2001, 296 moderate and major severity cases were included in the DEET Registry. Of these, 36 (14.5%) cases were deemed to be probably and 157 (65%) cases possibly related to DEET exposure. Insufficient data prevented determination of causality in the remaining 49 (20.2%) cases. Forty-one percent of the cases were in children 19 or younger. Forty-two percent of children experienced a seizure of moderate or major severity. The widely variable spectrum of other neurological symptoms reported in the Registry makes it unlikely they were due to one agent. People with an underlying neurological disorder were not disproportionately represented in the DEET Registry. Data showed no clear relationship between case severity and DEET concentration or concurrent use of common medicines. Recognizing the extensive use of DEET in the US and considering the information about the more serious adverse events described in the Registry, the risk of serious neurological events following the use of DEET repellents is quite low.

Biomonitoring and whole body cotton dosimetry to estimate potential human dermal exposure to semivolatile chemicals.

Current methods of estimating absorbed dosage (AD) of chemicals were evaluated to determine residue transfer from a carpet treated with chlorpyrifos (CP) to humans who performed a structured exercise routine. To determine the dislodgeability of residue, a California Department of Food and Agriculture (CDFA) roller was applied to a flat cotton cloth upon a treated carpet. Levels ranged from 0.06 to 0.99 microg CP/cm2. Cotton whole body dosimeters (WBD) were also used to assess residue transfer. The dosimeters retained 1.5 to 38 mg CP/person. Urine biomonitoring (3 days) for 3,5,6-trichloro-2-pyridinol (TCP) of persons who wore only swimsuits revealed a mean AD of 176 microg CP equivalents/person. The results show that the AD depends on the extent of contact transfer and dermal absorption of the residue. Default exposure assessments based upon environmental levels of chemicals and hypothetical transport pathways predict excessive exposure. The cotton WBD retains chemical residues and may be effectively used to predict dermal dose under experimental conditions.

Absorption and mass balance of piperonyl butoxide following an 8-h dermal exposure in human volunteers.

Dermal absorption, metabolism and excretion of piperonyl butoxide (PBO) was studied using 14C-PBO either by itself as a 3% (w/w) solution in isopropyl alcohol or as a 4% (w/w) solution in an aqueous end-use formulation. Each of these two formulations were tested on four young, healthy male volunteers, using a single topical application on the ventral forearm under non-occlusive conditions for an 8-h period. The application sites were thoroughly cleaned with cotton swabs moistened with isopropyl alcohol, then rinsed with isopropyl alcohol. Blood from the ipsilateral and contralateral arms, urine and feces were collected at selected intervals during the 8-h application and through a 120-h post-application period. The application area was also tape-stripped to determine if any of the test material accumulated in the stratum corneum. These samples provided data which permitted insight into the kinetics of penetration and elimination processes of PBO. The absorption of PBO either by itself or formulated was very poor, as demonstrated by the radioactivity excreted in the urine, and radioactivity in the ipsilateral plasma. When dosed by itself, approximately 1.78% of the dose was excreted in the urine. In contrast, only 0.47% of the formulated PBO was excreted in the urine. Trace radioactivity was detected in the feces from both formulations. The absorbed radioactivity was rapidly eliminated in the urine. There was no evidence of accumulation of PBO in the skin as evidenced by low amounts of radioactivity in the tape-strippings. The majority of the applied radioactivity was recovered from the skin surface. Total recovery of the applied radioactivity was 100.86 and 104.22% for PBO and the formulated product respectively. Absorbed PBO was completely metabolized to at least three major metabolites prior to its excretion in the urine. The three metabolites represented over 70% of the excreted radioactivity for PBO. The HPLC retention times for these metabolites are different than that seen in rats. The structures of these metabolites have not been elucidated.

Evaluation of the chronic toxicity and oncogenicity of N,N-diethyl-m-toluamide (DEET).

Chronic toxicity and/or oncogenicity studies were conducted in rats, mice, and dogs with the insect repellent DEET. DEET was mixed in the diet and administered to CD rats for two years at concentrations that corresponded to dosage levels of 10, 30 or 100 mg/kg/day for males and 30, 100, or 400 mg/kg/day for females; to CD-1 mice for 18 months at dosage levels of 250, 500, or 1000 mg/kg/day; and to dogs for one year, via gelatin capsules, at dosage levels of 30, 100, or 400 mg/kg/day. In the rodent studies, each group consisted of 60 animals of each sex, and two concurrent independent control groups, each containing 60 animals/sex were included in each study. Each group in the dog study consisted of four male and four female dogs and one control group was included in the study. Treatment-related effects were observed at the highest dose level in all three studies. For rats, the effects included decreases in body weight and food consumption and an increase in serum cholesterol in females only. In mice, the effects observed were decreases in body weight and food consumption in both sexes. The effects observed in dogs included increased incidences of emesis and ptyalism, and levels of transient reduction in hemoglobin and hematocrit, increased alkaline phosphatase (males only), decreased cholesterol, and increased potassium. One male dog in the high-dose group also exhibited ataxia, tremors, abnormal head movements, and/or convulsions on several occasions during the study. The highest no-observed-effect levels (NO-ELs) for rats, mice and dogs were determined to be 100, 500, and 100 mg/kg/day, respectively. No specific target organ toxicity or oncogenicity was observed in any of the studies.

Oncogenicity studies of piperonyl butoxide in rats and mice.

1. The oncogenicity of Piperonyl butoxide (PBO) has been studied in the mouse and rat. CD-1 mice were administered PBO in the diet at target doses of 0, 30, 100 and 300 mg/kg/day for 79 weeks and Sprague-Dawley rats 0, 30, 100 and 500 mg/kg/day for 104/105 weeks. 2. At termination of the study in the mouse there was evidence of increased liver weights and an increased incidence of eosinophilic adenomas at 100 and 300 mg/kg/day in males and 300 mg/kg/day in females. 3. In rats there was increased liver weights at 100 and 500 mg/kg/day associated with hepatocyte hypertrophy in both male and female rats. There was no increased incidence of neoplasia at any site. Hypertrophy and hyperplasia of thyroid follicles was observed at 500 mg/kg/day in both sexes. 4. The observations reflect the expected changes related to the induction of the mixed function oxygenase group of enzymes. In the mouse the increased incidence of eosinophilic adenomas is not considered relevant for human risk evaluation.

Effect of piperonyl butoxide on cell replication and xenobiotic metabolism in the livers of CD-1 mice and F344 rats.

Male CD- 1 mice were fed diets containing 0 (control), 10, 30, 100, and 300 mg/kg/day piperonyl butoxide (PBO) and 0.05% sodium phenobarbital (NaPB) and male F344 rats were fed diets containing 0 (control), 100, 550, 1050, and 1850 mg/kg/day PBO and 0.5% NaPB for periods of 7 and 42 days. In both species PBO and NaPB increased relative liver weight and whereas PBO produced a midzonal (mouse) or periportal/midzonal (rat) hypertrophy, NaPB produced a centrilobular hypertrophy. In the rat, individual cell necrosis was also observed at 42 days after high doses of PBO. Replicative DNA synthesis, assessed as the hepatocyte labeling index following implantation of 7-day osmotic pumps containing 5-bromo-2'-deoxyuridine during Study Days 0-7 and 35-42, was increased in mice given 300 mg/kg/day PBO and NaPB for 7 days and in rats given 550 and 1050 mg/kg/day PBO and NaPB for 7 days and 1050 mg/kg/day PBO for 42 days. While PBO had no effect on body weights in mice, the body weights of rats given 550, 1050, and 1850 mg/kg/day PBO for 42 days were reduced to 92, 89, and 70% of control, respectively. PBO induced microsomal cytochrome P450 content and mixed function oxidase activities in the mouse and rat, although the effects were less marked than those produced by NaPB. In summary, this data demonstrates that PBO can produce liver enlargement in the mouse and the rat which is associated with induction of xenobiotic metabolism, hypertrophy, and hyperplasia. The hepatic effects of PBO in the mouse were similar to but less marked than those produced by NaPB. In the rat high doses of PBO were hepatotoxic and resulted in a marked reduction in body weight. Thus while the reported formation of eosinophilic nodules in mouse liver by PBO may occur by a mechanism(s) similar to that of NaPB and other nongenotoxic enzyme inducers, the reported tumor formation in rats at greater than the maximum tolerated dose is most likely associated with marked enzyme induction in conjunction with a regenerative hyperplasia resulting from PBO-induced hepatotoxicity.

Neurological effects associated with use of the insect repellent N,N-diethyl-m-toluamide (DEET).

BACKGROUND: N,N-Diethyl-m-toluamide, an effective tick repellent, when applied to the skin, is the major component of essentially all of the products marketed for this purpose. It is used by about 30% of the US population, and by 23-29% of children in this population. Reports of neurologic adversity and death are rare and primarily involve children, but the dose relationship between N,N-diethyl-m-toluamide exposure and the symptoms reported in the clinical literature is difficult to establish. METHODS: Animal toxicology studies, clinical reports of neurological adversities in children and adults, and the available Poison Control Center records have been reviewed in an effort to understand the relationship between the N,N-diethyl-m-toluamide exposure and reported adverse events. CONCLUSIONS: Based on (1) the animal toxicology database on N,N-diethyl-m-toluamide, (2) the reports of adverse events in humans, and (3) the possible alternate etiologies for the symptoms reported in most patients, the risk of adversity from label-directed use of N,N-diethyl-m-toluamide appears low. Future efforts should focus on the prospective collection of adversity data with special attention paid to the documentation of clinical effects.

Lack of genotoxicity of piperonyl butoxide.

The genotoxicity of piperonyl butoxide has been investigated in bacterial mutation assays using tester strains TA98, TA100, TA1535, TA1537 and TA1538. The assays were conducted both with and without metabolic activation. Piperonyl butoxide was tested for mutation with and without metabolic activation in the CHO/HGPRT assay. Chromosomal aberrations were investigated also using Chinese hamster ovary (CHO) cells and effects on DNA were evaluated by in vitro unscheduled DNA synthesis (UDS) test using rat liver primary cell cultures. Piperonyl butoxide was not shown to be genotoxic in any assay system. The data presented supports the view that the liver tumors observed in rodents at dose levels above the maximally tolerated dose (MTD) result from a secondary non-genotoxic mechanism.

Lack of effect of piperonyl butoxide on unscheduled DNA synthesis in precision-cut human liver slices.

In this study the effect of piperonyl butoxide (PBO) on unscheduled DNA synthesis in precision-cut human liver slices has been examined. Liver slices prepared from tissue samples from five human donors were cultured in medium containing [3H]thymidine and 0-2.5 mM PBO using a dynamic organ culture system. After 24 h the liver slices were processed for autoradiographic examination of UDS. As positive controls, liver slices were also cultured with three known genotoxic agents, namely 2-acetylaminofluorene (2-AAF), aflatoxin B1 (AFB1) and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP). UDS was quantified as the net grain count in centrilobular hepatocytes and as the percentage of centrilobular hepatocyte nuclei with > 5 and > 10 net grains. Compared to control liver slice cultures PBO had no effect on UDS. In contrast, treatment with 0.02 and 0.05 mM 2-AAF, 0.002 and 0.02 mM AFB1 and 0.005 and 0.05 mM PhIP produced significant increases in net grain counts of centrilobular hepatocytes. The greatest induction of UDS was observed in liver slices treated with 0.05 mM PhIP. Treatment with 2-AAF, AFB1 and PhIP also produced increases in the number of centrilobular hepatocyte nuclei with > 5 and > 10 net grains. At the concentrations examined neither PBO, 2-AAF nor PhIP had any significant effect on replicative DNA synthesis in 24 h cultured human liver slices. In cultured liver slices treated with 0.02, but not 0.002, mM AFB1 a significant reduction in the rate of replicative DNA synthesis was observed. These results demonstrate that PBO does not induce UDS in cultured human liver slices. However, all three positive control compounds produced marked significant increases in UDS, thus confirming the functional viability of the human liver slice preparations used in this study. In conclusion, these results provide further evidence that PBO is a non-genotoxic agent which does not damage DNA in human liver.

Absorption, distribution, metabolism, and excretion of N,N-diethyl-M-toluamide in the rat.

This study was conducted to evaluate the pharmacokinetic parameters of absorption, distribution, metabolism, and excretion (ADME) of the personal insect repellent N,N-diethyl-m-toluamide (DEET) after oral or dermal administration of [14C]DEET in the rat. Six experiments were conducted using separate groups, each consisting of five male and five female rats. Three experiments involved the determination of ADME patterns after oral administration of [14C]DEET as: 1) a single low dose (100 mg DEET/kg body weight); 2) a single high dose (500 mg DEET/kg body weight); and 3) a repeated low dose (100 mg DEET/kg body weight daily for 14 days). A fourth experiment involved the determination of ADME patterns after dermal administration of [14C]DEET at a single low dose of 100 mg DEET/kg body weight. In these four experiments, urine and feces were collected over a 7-day posttreatment period, after which time the animals were euthanized and selected tissues and organs were harvested. Urine, feces, and tissues were analyzed for total 14C content. The major urinary metabolites were identified, and the urinary metabolic profile for each dosage regimen was determined. The remaining two experiments examined the distribution of radioactivity in tissues of animals euthanized at peak 14C blood levels after receiving a single oral low dose or a dermal low dose. In the three experiments designed to determine the ADME patterns of DEET after oral administration, 85-91% of the administered radioactivity was found in the urine and 3-5% was found in the feces. The overall quantitative pattern of excretion of radioactivity into the urine and feces was similar for males and females in the three groups; however, the rate at which the radioactivity was excreted into the urine differed noticeably between individual oral dosing regimens. The fastest rate was observed in the repeated oral low-dose group, followed by the single oral low-dose and the single oral high-dose groups. In the group of rats that received the dermal low dose, 74-78% of the administered dose was found in the urine and 4-7% was found in the feces. An additional 6.5% was found on the surface of the skin at the application site or in association with the occlusive enclosure. The rate of absorption and subsequent excretion of administered radioactivity into the urine and feces was much slower after dermal administration than after all oral dosing regimens. Total tissue residues of 14C activity at 7 days ranged from 0.15 to 0.67% of the administered dose for all dosage regimens. At peak 14C blood levels, the percentages of administered dose reaching the systemic circulation and total 14C tissue residues were significantly higher in the group of animals administered [14C]DEET orally vs. the animals administered [14C]DEET by the dermal route of administration. In both cases, the only tissues with 14C residues consistently higher than that of plasma were the liver, kidney, and fat. HPLC analysis of urine from rats in the ADME phase of the study showed that DEET was metabolized completely in all treatment groups, with little or no parent compound excreted in the urine. Two major urinary metabolites were identified by mass spectroscopy. In both metabolites, the aromatic methyl substituent in the DEET molecule was oxidized to a carboxylic acid moiety. One of the metabolites also had undergone N-dealkylation of an ethyl substituent on the amide moiety.

The present safety assessment of deet.

Deet is considered to be the best "all around" insect repellent ever developed and is the most widely used insect repellent in the world. Since its first use in a consumer product in 1956, billions of applications have been made to human skin. Information about the safety of deet comes from the human clinical literature, animal toxicology studies, and poison control centers' experiences with deet. The clinical literature reports the association of deet with neurotoxicity in 14 individuals. Three of the cases resulted in death, whereas all of the other patients completely recovered. The exact role of deet in the toxicity reported is difficult to determine from the reports. Recently reported animal safety studies have examined potential neurotoxicity following multigenerational dosing. Effects on the nervous system were only seen when generalized toxicity was also observed. Thus deet is not a selective neurotoxin. Important information about deet also comes from an investigation into the reports of adverse affects reported to 71 poison control centers in the USA. An important conclusion from this study is that there is no evidence that increasing deet concentration has any effect on the severity of the symptoms reported. The vast majority of reported cases had either no symptoms or ones that resolved rapidly. In conclusion, a thorough examination of all information available indicates that the risk of serious adverse effects following the use of deet is extremely low.

Absorption, metabolism, and excretion of N,N-diethyl-m-toluamide following dermal application to human volunteers.

The absorption, metabolism, and excretion of N,N-diethyl-m-toluamide (DEET) in male human volunteers following dermal application of [14C]DEET was studied. DEET was applied to two groups of six volunteers either as the undiluted technical grade material or as a 15% solution in ethanol. The material was applied over a 4 x 6-cm area on the volar surface of the forearm and was left in contact with the skin for 8 hr, then rinsed off the skin. Application sites also were tape stripped at 1, 23, and 45 hr after rinsing. Serial blood samples and all urine and feces were collected for 5 days after application. Aliquots of these materials were analyzed for total radioactivity in order to define absorption and excretion patterns. Urine samples also were analyzed by HPLC to characterize the metabolic profile and/or to identify metabolites. Absorption of DEET as evidenced by plasma radioactivity occurred within 2 hr after dose application. Elimination of radioactivity from plasma was rapid and quantifiable levels of radioactivity were observed in plasma for only 4 hr after the end of the 8-hr exposure period. Urine was the principal route of excretion of radioactivity and accounted for an average of 5.61 and 8.33% of the applied dose in the undiluted DEET and 15% DEET in ethanol groups, respectively. Excretion of radioactivity in the feces was less than 0.08% of the applied dose in both groups. DEET did not accumulate in the superficial layers of the skin as evidenced by low amounts of radioactivity in the tape strippings.(ABSTRACT TRUNCATED AT 250 WORDS)

Retrospective analysis of calls to poison control centers resulting from exposure to the insect repellent N,N-diethyl-m-toluamide (DEET) from 1985-1989.

This study analyzed 9,086 human exposures involving N,N-diethyl-m-toluamide--containing insect repellents that were reported to Poison Control Centers from 1985-1989. Nearly two-thirds of those exposed had no adverse effects or only experienced minor symptoms that resolved rapidly. Symptoms were more likely to occur after ocular or inhalation exposures and least likely to occur if the product was ingested. The only reported death occurred in a patient who suicidally ingested 8 oz of an insect repellent containing N,N-diethyl-m-toluamide. Five patients may have experienced a serious or potentially life-threatening effect but the poison center record did not provide unequivocal substantiation of the effect or clearly establish N,N-diethyl-m-toluamide as the causative agent. From the analysis of those patients calling Poison Control Centers, it appears the risk of serious medical effects with the labeled use of N,N-diethyl-m-toluamide-containing insect repellents is low in comparison with its reported annual use by about 30% of Americans. For patients contacting Poison Control Centers, the occurrence of adverse effects appears to be related to the route of exposure rather than age or gender of the patient or the concentration of N,N-diethyl-m-toluamide in the product.

Polyamine effects on cytochrome P-450- and flavin-containing monooxygenase-mediated oxidation of xenobiotics.

The effects of in vitro addition of polyamines on the female mouse hepatic microsomal cytochrome P-450- and flavin-containing monooxygenase-dependent oxidation of xenobiotics were examined. Putrescine, spermine, and spermidine all caused a different degree of stimulation of oxidative dearylation of parathion and O-ethyl-O-p-nitrophenylphosphonothioate, epoxidation of aldrin, and O-deethylation of 7-ethoxycoumarin. The degree of stimulation was greatest in the presence of spermidine. Enhancement of aldrin epoxidation by spermidine was higher in pregnant mice as compared to nonpregnant mice. Total phorate S-oxidation was stimulated by all the polyamines tested. Phorate S-oxidation, mediated by microsomal flavin-containing monooxygenase, was only slightly increased by spermine and spermidine while putrescine caused slight inhibition. Of the various steps involved in the monooxygenation cycle examined, only the rates of NADPH oxidation and cytochrome P-450 reduction were significantly increased. Efficient coupling of NADPH utilization with substrate oxidation appears to be the underlying mechanism responsible for the polyamine-stimulated xenobiotic oxidation.

Mixed-function oxidase system induction and propylene hepatotoxicity.

Propylene is hepatotoxic to male Charles River COBS Sprague-Dawley rats pretreated with polychlorinated biphenyls (PCB: Aroclor 1254). Four-hour inhalation exposure to 50,000 ppm propylene increased liver weight/body weight ratios and elevated serum enzyme activities in PCB-pretreated animals. Hepatic microsomal cytochrome P-450 content of PCB-pretreated rats dropped profoundly during propylene exposure and remained depressed for at least 24 h. In addition, PCB-pretreated, propylene-exposed rats exhibited a decrease in the specific activity of hepatic microsomal aniline hydroxylase. However, there was no change in activities of either hepatic microsomal aminopyrine demethylase or glucose-6-phosphatase. Propylene exposure of rats pretreated with beta-naphthoflavone (BNF), phenobarbital (PB), or a mixture of BNF and PB was not hepatotoxic. However, there was, in these animals, a substantial decline in hepatic microsomal cytochrome P-450 levels 24 h after the start of propylene exposure. Hence, the propylene-dependent process resulting in hepatic cytochrome P-450 destruction is qualitatively or quantitatively different from the process that causes acute hepatotoxicity. Preexposure fasting had no effect on the hepatotoxicity resulting from a 4-h exposure of PCB-pretreated rats to 50,000 ppm propylene. Administration of SKF-525A to PCB-pretreated rats immediately prior to propylene exposure completely prevented elevations in serum enzyme activities and liver weight/body weight ratios. In vitro incubation of hepatic microsomes prepared from either BNF-, PB-, or PCB-pretreated rats with an atmosphere of 20% propylene/80% air produced in NADPH-dependent decrease in cytochrome P-450 content. These results suggest that PCB pretreatment is a prerequisite for propylene hepatotoxicity in the rat. Cytochrome P-450-dependent bioactivation of propylene is associated with this hepatotoxicity, but further studies are needed to characterize the mechanism of the PCB-propylene interaction.