Expert consensus on low-calorie sweeteners: facts, research gaps and suggested actions.

A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.

Towards the use of ion mobility mass spectrometry derived collision cross section as a screening approach for unambiguous identification of targeted pesticides in food.

RATIONALE: Mass spectrometry (MS) is the reference method for the screening of ultra-trace residues of pesticides in food because MS offers the required selectivity/sensitivity to gather information and enable the analyst to make informed decisions during the identification process. Here we present and discuss the use of collision cross section (CCS) values in addition to mass accuracy and retention times in a pesticide screening method that integrates all the features offered by coupling ultra-performance liquid chromatography (UPLC) with ion mobility mass spectrometry (IMS-MS). METHODS: All experiments were carried out using UHPLC coupled to a travelling wave ion mobility mass spectrometer equipped with an electrospray ionization (ESI) source working in positive mode. An in-house library containing 200 pesticides was built using standard solutions and used as reference for a TWCCS calibration study. Matrix extracts were analyzed to evaluate the performance of different screening workflows based on TWCCS, mass accuracy and retention times. RESULTS: The results proved that TWCCS values are very consistent, as the measured values do not differ more than 1% from the in-house reference data library and emphasized the importance of the first low m/z mobility calibration point to guarantee full independence from instrument parameters and calibrant. The screening procedure was simplified to a single step by fully exploiting the content of ion mobility without generating any false detections, either positive or negative, from spiked samples and a previous proficiency test. CONCLUSIONS: The screening approach proposed in this study is unconventional and based on large mass accuracy (20 ppm) and retention time windows (0.5 min) to capture, in a first step, a maximum of detected compounds. Compounds of interest are then identified by comparing measured collision cross sections with the measured reference library collision cross sections (with relative error tolerance lower than 2%).

Exploring the Complexity of Steviol Glycosides Analysis Using Ion Mobility Mass Spectrometry.

A proof of principle method using ion mobility-mass spectrometry (IM-MS) and collision induced dissociation (CID) coupled with micro flow ultra high-performance chromatography (UHPLC-IM-MS) has been developed to screen for steviol glycosides. Traveling wave ion mobility was used to determine rotationally averaged collision cross sections in nitrogen buffer gas (TWCCSN2). To explore the evolving applicability of ion mobility screening, the analytical approach was initially developed and applied to the analysis of a steviol/steviol glycoside spiked chocolate spread extract. Subsequently 55 food commodities were screened using a steviol glycoside TWCCSN2 library. IM analyses produced TWCCSN2 values, enabling the unequivocal identification of the steviol glycosides and isomeric pairs (negating the reliance on product ions). In addition, coeluting isomeric species, comprising (labile fragment ions, doubly charged dimers, and multiply charged species) have been identified and resolved. Isomeric false detections were avoided, with the coeluting isomeric species quantified. A quantitative assessment of TWCCSN2 in the analysis of steviol glycosides was performed.

Occurrence of Organophosphorus Flame Retardants and Plasticizers (PFRs) in Belgian Foodstuffs and Estimation of the Dietary Exposure of the Adult Population.

The occurrence of 14 organophosphorus flame retardants and plasticizers (PFRs) was investigated in 165 composite food samples purchased from the Belgian market and divided into 14 food categories, including fish, crustaceans, mussels, meat, milk, cheese, dessert, food for infants, fats and oils, grains, eggs, potatoes and derived products, other food (stocks), and vegetables. Seven PFRs [namely, tri-n-butyl phosphate (TnBP), tris(2-chloroethyl) phosphate (TCEP), tris(1-chloro-2-propyl) phosphate (TCIPP), tris(1,3-dichloro-2-propyl) phosphate (TDCIPP), triphenyl phosphate (TPHP), 2-ethylhexyldiphenyl phosphate (EHDPHP), and tris(2-ethylhexyl) phosphate (TEHP)] were detected at concentrations above quantification limits. Fats and oils were the most contaminated category, with a total PFR concentration of 84.4 ng/g of wet weight (ww), followed by grains (36.9 ng/g of ww) and cheese (20.1 ng/g of ww). Our results support the hypothesis that PFR contamination may occur during industrial processing and manipulation of food products (e.g., packaging, canning, drying, etc.). Considering the daily average intake of food for the modal adult Belgian (15-64 years of age), the dietary exposure to sum PFRs was estimated to be ≤7500 ± 1550 ng/day [103 ± 21 ng/kg of body weight (bw)/day]. For individual PFRs, TPHP contributed on average 3400 ng/day (46.6 ng/kg of bw/day), TCIPP 1350 ng/day (18.5 ng/kg of bw/day), and EHDPHP 1090 ng/day (15 ng/kg of bw/day), values that were lower than their corresponding health-based reference doses. The mean dietary exposure mainly originated from grains (39%), followed by fats and oils (21%) and dairy products (20%). No significant differences between the intakes of adult men and women were observed.

Occurrence and Synthesis Pathways of (Suspected) Genotoxic α,ß-Unsaturated Carbonyls in Chocolate and Other Commercial Sweet Snacks.

α,ß-Unsaturated carbonyls are highly reactive and described as structural alerts for genotoxicity. Ten of them (either commercially available or synthesized here by combinatorial chemistry) were first investigated throughout the chocolate-making process by solvent-assisted flavor evaporation (SAFE) coupled to GC-MS/SIM. Monitored α,ß-unsaturated aldehydes were formed during chocolate production, primarily through aldol condensation of Strecker aldehydes triggered by bean roasting. Notably, levels of 2-phenylbut-2-enal (up to 399 µg·kg-1) and 5-methyl-2-phenylhex-2-enal (up to 216 µg·kg-1) increased up to 40-fold. Dry conching caused evaporation of α,ß-unsaturated carbonyls, while wet conching partially restored or increased their levels due to cocoa butter addition. Further analyses showed that α,ß-unsaturated aldehydes also occurred in most commercial sweet snacks (up to 16 µg·kg-1), although often at lower concentrations than in roasted cocoa or derived chocolates. In the end, none of the monitored α,ß-unsaturated aldehydes did raise a health concern compared to current maximum use levels (2-5 mg·kg-1). On the other hand, much higher levels of genotoxic furan-2(5H)-one were found in crepe and cake samples (up to 4.3 mg·kg-1).

Occurrence of Perillaldehyde and Other (Suspected) Genotoxic Flavoring Substances in Water-Based Beverages Consumed by Belgian Children.

Despite the extensive use of flavoring substances in food, their monitoring for regulatory purposes is currently limited. This raises public health issues, especially as some compounds are prohibited due to (geno)toxicity. A solvent-assisted flavor evaporation (SAFE) method coupled with GC/MS (SIM) was validated here for diverse water-based beverages. Thirty flavoring substances out of the 38 targeted were validated, showing good analytical performances and confirming the versatility of the SAFE technique. The method was then applied to 94 samples, including fruit juices, iced teas, lemonades, colas, and sports beverages. Overall, seven different flavoring substances of interest were detected in the samples. Perillaldehyde and furan-2(5H)-one, two genotoxic flavoring substances, were found at concentrations up to 153 and 143 µg·kg-1, respectively. Perillaldehyde levels were significantly higher in commercial citrus juices than in freshly squeezed juices. Food control laboratories could use the developed method to face the current growing need to improve flavoring substance monitoring and conduct risk assessments.

Towards Less Plastic in Food Contact Materials: An In-Depth Overview of the Belgian Market.

The food contact materials (FCMs) industry is forced to develop substitute materials due to constant pressure from consumers and authorities to reduce fossil-based plastic. Several alternatives are available on the market. However, market share, trends, and consumer preferences are still unclear. Therefore, this study aims to provide an overview of the Belgian FCMs market, the available substitute materials, and their uses. The market analysis was performed with an integrated web-based approach. Fifty-two sources were investigated, covering e-shops selling materials intended to replace disposable plastic materials or being advertised as environmentally friendly and websites describing homemade FCMs. The first screening identified 10,523 articles. The following data cleaning process resulted in a homogeneous dataset containing 2688 unique entries, systematically categorised into fifteen material categories and seven utilisation classes. Paper and board was the most popular material category (i.e., 37% of the entries), followed by bagasse, accounting for 9% of the entries. Takeaway and food serving (44.4% and 22.8% of the entries) were the most common usage categories. The study pursued to provide insights into current trends and consumer preferences, highlighting priorities for safety assessment and future policy making.

Investigation of potential migratables from paper and board food contact materials.

Since the ban on single-use plastic articles in Europe, the food contact material (FCM) industry has been forced to move to more sustainable alternatives. Paper and board FCM are convenient alternatives but must be safe for consumers. This study aims to investigate potential migrations of various substances (e.g., plasticizers, photoinitiators, primary aromatic amines, mineral oil, and bisphenols) from straws and takeaway articles made of paper and board. Twenty straws and fifty-eight takeaway articles were carefully selected and investigated using liquid and gas chromatography coupled with tandem mass spectrometry or flame ionization detector. Fourteen substances of all the targeted categories were found in takeaway articles, including seven plasticizers, two photoinitiators, one primary aromatic amine, two bisphenols, and the saturated and aromatic fraction of mineral oil (MOSH and MOAH, respectively). In straws, fewer substances were detected, i.e., six substances, including three plasticizers, one photoinitiator, MOSH, and MOAH. At least one of the target substances was detected in 88% of the samples, demonstrating the importance of further evaluation of these materials. Finally, the associated risks were assessed, highlighting the potential risks for several types of articles regarding bisphenol A, one primary aromatic amine (3.3-DMB), and MOSH and MOAH.

Development, validation and application of multi-class methods for the analysis of food additives by liquid chromatography coupled to tandem mass spectrometry.

Food additives are used in numerous food products and are characterised by various physicochemical properties. In European member states, their use in food is regulated by the European Union. This work aimed to develop an accurate and high-throughput analytical method enabling the simultaneous determination of additives from different functional classes to facilitate controls and generate occurrence data for exposure assessments. The QuEChERS principle was applied due to its ease of implementation and flexibility to adjust to various food matrices. However, very polar substances could not be extracted with sufficient recoveries. Consequently, an alternative basic methanol sample-preparation methodology was developed. After sample preparation, the obtained extracts were analysed using ultra-high-performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). Overall, the developed methodology allowed the quantification of 27 additives from the functional classes of colours, sweeteners, preservatives, and antioxidants in various foods (e.g. beverages, dairies, processed meals). The methods were also validated in terms of selectivity, linearity, matrix effect, limit of quantification, accuracy, repeatability, and intra-laboratory reproducibility. Finally, the methods were successfully applied to eighty-four actual samples. All additives were found below authorised levels. However, irregularities were spotted in labelling.

Pharmacokinetics of Oral Rebaudioside A in Patients with Type 2 Diabetes Mellitus and Its Effects on Glucose Homeostasis: A Placebo-Controlled Crossover Trial.

BACKGROUND AND OBJECTIVES: Rebaudioside A, a steviol glycoside, is deglycosylated by intestinal microflora prior to the absorption of steviol and conjugation to steviol glucuronide. While glucose-lowering properties are observed for rebaudioside A in mice, they have been attributed to the metabolites steviol and steviol glucuronide. We aimed to characterize the pharmacokinetic and pharmacodynamic properties of rebaudioside A and its metabolites in patients with early-onset type 2 diabetes mellitus (T2DM). METHODS: This randomized, placebo-controlled, open-label, two-way crossover trial was performed in subjects with T2DM on metformin or no therapy at the University Hospitals Leuven, Belgium. Following oral rebaudioside A (3 g), plasma concentrations of rebaudioside A, steviol and steviol glucuronide were determined. The effect on glucose homeostasis was examined by an oral glucose tolerance test (OGTT) performed 19 h following rebaudioside A administration, i.e. the presumed time of maximal steviol and steviol glucuronide concentrations. The primary pharmacodynamic endpoint was the difference in area under the blood glucose concentration-time curve during the first 2 h of the OGTT (AUCGlucose(0-2h)) for rebaudioside A vs. placebo. RESULTS: In total, 30 subjects [63.5 (57.8-69.0) years of age, 86.7% male] completed the trial. Rebaudioside A was detected as early as 1 h after administration in nearly all subjects. As expected, steviol and steviol glucuronide reached their maximal concentrations at 19.5 h following rebaudioside A administration. Rebaudioside A did not lower the AUCGlucose(0-2h) compared to placebo (- 0.7 (95% CI - 22.3; 20.9) h·mg/dL, P = 0.95). Insulin and C-peptide concentrations were also comparable between both conditions (P > 0.05). CONCLUSION: Rebaudioside A is readily absorbed after oral administration and metabolized to steviol and steviol glucuronide. However, no effect on glucose nor insulin or C-peptide excursion was observed during the OGTT at the time of maximal metabolite concentrations. Thus, no antidiabetic properties of rebaudioside A could be observed in patients with T2DM after single oral use. CLINICAL TRIAL REGISTRATION: Registered on ClinicalTrials.gov (NCT03510624).

Investigations into pesticide charge site isomers using conventional IM and cIM systems.

A growing number of pesticides are being used around the world necessitating strict regulatory policies to guarantee consumer safety. Liquid Chromatography - Mass Spectrometry (LC-MS) is a highly sensitive method for pesticide screening, which provides retention time, mass/charge ratios and the relative abundances of characteristic product ions. Variability in the latter necessitates relatively large tolerances (±30%, SANCO/12682/2019, current EU regulation). One cause of this variability may stem from the presence of different charge-site isomers (charge carrier being a proton, sodium cation, potassium cation and alike); each yielding a set of different product ions, of which the relative ratios are influenced by solution and ion source conditions. Consequently, varying relative abundances may be observed for analyte ions produced from calibration standards, chemical residues in food matrices and across different instruments. Ion Mobility Spectrometry (IMS) is a fast, gas phase separation technique which can resolve charge-site isomers based on differences in their collisional cross sections (CCSs). We previously used the IM device embedded in LC-IM-MS geometry to generate a pesticide CCS database and subsequently focussed upon identification of pesticides which form charge-site isomers. Latterly, we applied this approach to screen food commodities for pesticide residues. In some instances, isomer separation was clear, however sometimes broad, unresolved distributions were observed. Using a high-resolution cyclic IM device (cIM) we resolved and determined CCS values of species of indoxacarb, spinosad, fenpyroximate, epoxiconazole, metaflumizone and avermectin. Furthermore, utilising novel cIM functionalities (tandem-IM) we discovered that two spinosyn sodimers can interconvert in the gas phase.

Assessment of hazards and risks associated with dietary exposure to mineral oil for the Belgian population.

Recently collected dietary exposure data on mineral oil saturated (MOSH) and aromatic (MOAH) hydrocarbons were used to evaluate the risks associated with exposure to mineral oil through food for the Belgian population. For MOSH, the no observed adverse effect level (NOAEL) value of 19 mg kg-1 bw day-1 based on the hepatic inflammation-associated granulomas found in a 90-day oral study in F-344 rats was used as point of departure (PoD). Due to existing toxicological uncertainties, the margin of exposure (MOE) approach was applied. In all investigated scenarios, the MOE values were well above 100, indicating that there is no direct health concern related to MOSH exposure for the Belgian population. Nevertheless, more appropriate risk assessment approaches for MOSH based on adequate PoD are needed. For dietary exposure to MOAH, which are potentially genotoxic and carcinogenic, no MOE values could be calculated due to the lack of adequate dose-response carcinogenicity data. In two investigated worst-case scenarios, a health concern related to MOAH exposure could not be excluded, highlighting that more data are needed to perform an adequate risk assessment. The possibility to use in vitro bioassays to collect such additional toxicological information for MOAH present in food samples was also investigated.

Targeted LC-MS/MS combined with multilocus DNA metabarcoding as a combinatory approach to determine the amount and the source of pyrrolizidine alkaloids contamination in popular cooking herbs, seeds, spices and leafy vegetables.

Pyrrolizidine alkaloids (PAs) and their corresponding N-oxides (PANOs) are natural protoxins biosynthesised by many plant species and are responsible for occasional fatal intoxication outbreaks due to the consumption of contaminated food. However, only in rare cases has the origin of the contamination been determined. Although their presence has been studied in many matrices, occurrence data on popular widely used cooking herbs, seeds, spices and leafy vegetables is very scarce. Therefore, a systematic study on the occurrence of PA/PANOs contaminations in these popular herbal items, available on the Belgian market, was performed, by means of a validatedtargeted LC-MS/MS analysis, followed by multilocus DNA metabarcoding to track back the origin of the contamination for seven highly to moderately contaminated samples. Our results clearly indicate that 21% of the seed spices and 25% seed-based aromatic mixes contain an amount higher than 400 µg of the 30 summed targeted PAs and PANOs per kg, the value which is currently under discussion by the European member states to be set as a maximum threshold. For both the herbs and the herb-based mixes only 7% of analysed samples exceeded these levels. As a proof of concept, multilocus DNA metabarcoding was performed on six highly contaminated samples, belonging to each subtype matrix, containing high levels of heliotrine type of PA/PANOs. Each time the analysis demonstrated the presence of DNA from a plant species belonging to the plant genus Heliotropium. Moreover, a contaminated leafy vegetable sample, containing solely senecionine type PA/PANOs, contained DNA from Senecio vulgaris. Taken together, it can be stated that the proposed combinatory chemical and molecular techniques could be used to verify if a PA/PANO(s) contamination occurred in these popular cooking items and to pinpoint the origin the contamination, which is pivotal in the case of a detrimental intoxication or intoxication outbreak.

Monitoring of pyrrolizidine alkaloids in beehive products and derivatives on the Belgian market.

Pyrrolizidine alkaloids (PAs) and related N-oxides (PANOs) are secondary plant metabolites thought to be found in approximately 3% of the flowering plants worldwide and exhibiting hepatotoxic properties to humans. As a consequence, beehive products are prone to be contaminated with those compounds by bees foraging PA-producing plants. Downstream contamination can also occur through food items containing honey. Analytical methods based on UHPLC separation and MS/MS detection were developed with a focus on very low LOQs and validated for the analysis of 16 PAs and 14 PANOs in honey, honey-based candies and snacks, as well as beehive product-based food supplements. A maximum level of 182 ng/g of PAs was detected in a Mediterranean honey, and high levels of heliotrine-type compounds were reported for the first time. An extensive sampling of honeys harvested in Belgium was performed (N = 374), the concentration levels were more limited with a maximum of 60 ng/g, and the contamination pattern was dominated by senecionine-type PAs. The PA levels in honey-based candies and snacks were very low, with respective maxima of 7.61 ng/g and 0.36 ng/g. Seventy-five percent among the pre-dosed food supplements based on beehive products were contaminated, with a maximum of 43 ng/g. The highest level was detected in a bee-collected pollen sample (1672 ng/g). The analytical results were consistent with the previously reported data for beehive products and confirmed that PA/PANO contamination in these food commodities is recurrent.

Enantiomeric fraction of hexabromocyclododecanes in foodstuff from the Belgian market.

Diet is considered a major route of human exposure to hexabromocyclododecane, a chiral environmental contaminant. A previous study reported on the occurrence of hexabromocyclododecane diastereoisomers in food items of animal origin collected in Belgium. The present study reports further results on corresponding enantiomeric fractions of the same samples. None of the samples could be considered as racemic for the α-isomer suggesting that foodstuff contamination occurred prior to death of the corresponding producing animal and was not the result of the food item being in contact with technical HBCDD. Non-racemic chiral signatures were also observed for ß- and γ-isomers. We conclude that, depending on their dietary habits, different individuals might be overall exposed to non-racemic profiles. Considering that toxicological effects are enantiomer-dependent, this could modulate potential adverse effects.

Dietary exposure of the Belgian population to mineral oil.

Recently, presence of mineral oil in numerous foods has been detected. The analysis of mineral oil in food is convoluted since it comprises MOSH (saturated hydrocarbons) and variable amounts of mainly alkylated MOAH (aromatic hydrocarbons). Both fractions have a different toxicological profile and therefore they need to be assessed separately. For Belgium, occurrence data are available comprising concentrations of 217 food samples. These data were used, in combination with the 2014/15 Belgian Food Consumption Survey data, in a lower bound scenario to evaluate the dietary exposure of the Belgian population. Exposure to mineral oil was much lower compared to the results previously reported by EFSA and RIVM. The main contributors in Belgium were similar to previous studies (i.e. cereal products and oils), but an important additional contribution of non-alcoholic drinks was identified due to the presence of mineral oil in coffee. However, the concentration of mineral oil was determined from the dry product by applying a dilution factor with transfer rate of 100%, and not in the prepared coffee.This study gives an account of the dietary exposure of the Belgian population to mineral oil for the first time and reports the associated uncertainties.

Analytical strategies for the determination of pyrrolizidine alkaloids in plant based food and examination of the transfer rate during the infusion process.

Two sample preparation methods were developed (graphitised carbon and C18 solid phase extraction clean-up) and validated in house using liquid chromatography and tandem mass spectrometry (MS/MS) for the determination of 30 pyrrolizidine alkaloids (PAs) in salads, herbs, tea, herbals teas as well as tea infusion and ice-tea beverages. Total PAs concentration of samples purchased on the Belgian market varied greatly with matrix type ranging from

Occurrence of selected halogenated flame retardants in Belgian foodstuff.

This paper reports on the occurrence of halogenated flame retardants (HFRs), namely PBDEs, HBCDs, TBBPA, brominated phenols (BrPhs), dechlorane plus (DP) and emerging FRs in a variety of Belgian foodstuffs. A total of 183 composite food samples were analyzed by GC-MS and LC-MS/MS techniques for the presence of HFRs. The analyses revealed that 72% of the samples was contaminated with HFRs to some extent. The highest number of contaminated samples was observed within the group 'Potatoes and derived products', 'Fish and fish products' and 'Meat and meat products', while the least contaminated group was 'Food for infants and small children'. The total HFR content ranged from

Impurity profiling of the most frequently encountered falsified polypeptide drugs on the Belgian market.

Advances in biotechnology and the chemical synthesis of peptides have made biopharmaceuticals and synthetic peptide drugs viable pharmaceutical compounds today and an important source for tomorrow's drugs and therapies. Unfortunately, also falsifications and counterfeit versions of these powerful and promising drugs are offered illegally via the internet. Since these falsified preparations are produced outside the legally required quality systems, end-users have no guarantee regarding the efficacy and safety of these products. Although falsified samples of biotherapeutics were already analysed, looking at a specific aspect of their quality or identity, no systematic studies have been performed regarding the presence of different impurities or possible contaminations. Therefore, in order to obtain a better understanding of the potential health risks related to the usage of falsified polypeptide drugs we performed a systematic screening of the ten most frequently encountered falsified peptide drugs on the Belgian market acquired from three different suspected illegal internet pharmacies. The screening incorporated the analysis of the active pharmaceutical ingredient (API), API-related impurities, small molecule contaminants (defined as organic small molecules not belonging to the other categories), elemental impurities and residual solvents. This comprehensive study showed that these type of falsified drugs not only have a high variation in amount of drugs per unit and a low purity (ranging between 5% and 75% for cysteine containing peptides), but also contained the known toxic class one elemental impurities arsenic (As) and lead (Pb). One sample was contaminated with Pb while multiple samples were found with concentrations up to ten times the ICH toxicity limit for parenteral drugs. Subsequent speciation of As confirmed the elevated concentrations for As and demonstrated that all As was present in the more toxic inorganic form. Together with the (sometimes) high amount of peptide impurities and the inherent dangers associated with the use of unauthorized peptide drugs (such as doping peptides or preclinical drugs) this study confirms the reported potential health risks patients/users take when resorting to falsified peptide drugs. Moreover, the presence of the carcinogen As and the known accumulation in human tissues of Pb raises questions about potential sub-acute to chronic toxicity due to the long term administration of these falsified peptide drugs.