Implications of chemical mixtures in public health practice.

The Agency for Toxic Substances and Disease Registry (ATSDR) is a federal public health agency that investigates and strives to prevent human health problems produced by exposure to toxic chemicals and their mixtures in the environment. Most human exposures involving toxic chemicals or mixtures are thought to originate from environmental and occupational sources; however, concurrent exposures are also likely from other sources, such as prescription and nonprescription drugs, indoor air pollutants, alcohol, and tobacco smoke. Thus, in evaluating the potential hazard following exposure to environmental mixtures, ATSDR not only considers the inherent joint toxicity of the mixture but also the influence of environmental, demographic, occupational, and lifestyle factors. To foster these goals, ATSDR has pursued a Mixtures Research and Assessment Program that consists of three component efforts: trend analysis, joint toxicity assessment, and experimental testing. Through trend analysis, ATSDR sets priorities for environmental mixtures of concern for which joint toxicity assessments are conducted as needed. If data are not available to conduct appropriate assessments, a research agenda is pursued through established extramural mechanisms. Ultimately, the data generated are used to support ATSDR's work at sites involving exposure to chemical mixtures. This pragmatic approach allows testable hypotheses or research needs to be identified and resolved and enhances our understanding of the mechanisms of joint toxicity. Several collaborative and cooperative efforts with national and international organizations such as the Toxicology and Nutrition Office, the Netherlands, and the Department of Energy are being pursued as part of these activities. ATSDR also develops guidance manuals to consistently and accurately apply current methodologies for the joint toxicity assessment of chemicals. Further, expert panels often are assembled to resolve outstanding scientific issues or obtain expert advice on pertinent issues. Recently, the need for studies on chemical mixtures has been proposed as one of the six priority areas the agency identified in its agenda for public health environmental research. This has been reinforced through the agency's close work with communities whose leaders have spoken passionately about their concern for information on exposures to chemical mixtures. The five other priority research areas the agency identified are exposure, susceptible populations, communities and tribal involvement, evaluation/surveillance of health effects, and health promotion/prevention.

Seeking solutions to chemical mixtures challenges in public health.

The Agency for Toxic Substances and Disease Registry (ATSDR) identifies people near hazardous waste sites who are at potential health risk because of their exposure to environmental chemicals. Nearly, 2000 chemicals have been associated with such sites. Residents of U.S. communities are potentially exposed to hazardous substances through air, soil, drinking water, and food. The agency has determined that more than 73 million people live within a 4-mile radius of waste sites. More than 14 million Americans live within 1 mile of a National Priorities List site, of which 11% are 7 years of age or younger, 12% are 64 years of age or older, 24% are women of childbearing age, and 25% are minorities. The lack of adequate environmental sampling and information on human exposures often restricts ATSDR's evaluation and assessment activities. Assessing human exposure with its attendant health risks and outcomes is complex because many populations have a wide range of reported illnesses, and generally exposures are to mixtures of chemicals. This prompted ATSDR to consider mixtures issues more in depth and to establish a formal mixtures assessment and research program in 1994. In this paper, we present an overview of the agency activities, the genesis, legislative mandates, and pertinence of the mixtures program including applied research and the development of methods for evaluating the impact of multiple-chemical exposure. On the basis of 20-year experience of evaluating and researching environmental chemical mixtures at waste sites, ATSDR convened the International Conference on Chemical Mixtures (ICCM) in 2002. The conference was supported by several federal agencies and scientific organizations and attended by international and national experts. The conference addressed broad topics such as prevalence of exposures to chemical mixtures, importance of interactions at environmentally relevant levels, validity of assuming additivity (dose or response) as default for mixtures assessment, and promising avenues in the three broad areas, viz., research, assessment, and computational tools.

Neurodevelopmental effects: making the case for biologic plausibility.

It has been suggested that the most critical missing link between science and policy is causality; that is, the establishment of a definite cause-effect relationship between exposure and adverse health effects. As has been clearly demonstrated by the decades-long tobacco debate, causality is extremely difficult to establish with absolute certainty, particularly in the minds of scientists. Because of this, it has been suggested that a "weight of evidence" approach based on biologic plausibility should be used as a surrogate for causality when translating science into policy and public health practice. In the case of neurodevelopmental effects, the case for biologic plausibility is supported by scientific findings from three broad areas consisting of wildlife biology, toxicology, and epidemiology. A striking example of this is provided by research findings from the Great Lakes Basin, an area which has been the focus of significant scientific research for the last thirty years in these three broad areas. In this paper, we examine relevant findings from the Great Lakes Basin and elsewhere as they relate to establishing and supporting the biologic plausibility of neurodevelopmental effects associated with environmental exposures to persistent toxic substances.

Research management in the Great Lakes and St. Lawrence River basins: challenges and opportunities.

Research management in the Great Lakes and St. Lawrence River basins is both challenging and filled with opportunities. From the perspective of public health practice, research management is more than just research managers managing discrete programs; it requires everyone involved in the process to become active participants, including researchers, communities, potential interest groups, policymakers, and other stakeholders. Agencies, organizations, and individuals responsible for managing research and resources in the Great Lakes and St. Lawrence River basins are facing problems of decreased research funding, data gaps, and research quality. Managers of research and resources in the basins face many challenges as they address these problems. They are challenged with strengthening the link between research and management in the face of decreasing resources and increasing expectations of results and findings while extending those results and findings to public health practice. A number of actions and activities have been proposed that can lead to better management of constrained programs, pooled resources, partnerships, targeted priorities, and improved effectiveness. With guidance and assistance from the International Joint Commission (IJC), research managers in the Great Lakes and St. Lawrence River basins who have initiated and maintained traditional research programs based on sound science are now adopting different and innovative management strategies. The research community must be proactive in articulating the role of science in bridging the gaps in knowledge between public health practice and regulatory programs. Supported by a firm foundation of credible science, critical assessment, and public service, basin research managers are recognizing the need to move outside the comfort zone and extend to areas previously unwelcomed or uncomfortable.

ATSDR evaluation of health effects of chemicals. IV. Polycyclic aromatic hydrocarbons (PAHs): understanding a complex problem.

Polycyclic Aromatic Hydrocarbons (PAHs) are a group of chemicals that are formed during the incomplete burning of coal, oil, gas, wood, garbage, or other organic substances, such as tobacco and charbroiled meat. There are more than 100 PAHs. PAHs generally occur as complex mixtures (for example, as part of products such as soot), not as single compounds. PAHs are found throughout the environment in the air, water, and soil. As part of its mandate, the Agency for Toxic Substances and Disease Registry (ATSDR) prepares toxicological profiles on hazardous chemicals, including PAHs (ATSDR, 1995), found at facilities on the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) National Priorities List (NPL) and which pose the most significant potential threat to human health, as determined by ATSDR and the Environmental Protection Agency (EPA). These profiles include information on health effects of chemicals from different routes and durations of exposure, their potential for exposure, regulations and advisories, and the adequacy of the existing database. Assessing the health effects of PAHs is a major challenge because environmental exposures to these chemicals are usually to complex mixtures of PAHs with other chemicals. The biological consequences of human exposure to mixtures of PAHs depend on the toxicity, carcinogenic and noncarcinogenic, of the individual components of the mixture, the types of interactions among them, and confounding factors that are not thoroughly understood. Also identified are components of exposure and health effects research needed on PAHs that will allow estimation of realistic human health risks posed by exposures to PAHs. The exposure assessment component of research should focus on (1) development of reliable analytical methods for the determination of bioavailable PAHs following ingestion, (2) estimation of bioavailable PAHs from environmental media, particularly the determination of particle-bound PAHs, (3) data on ambient levels of PAHs metabolites in tissues/fluids of control populations, and (4) the need for a critical evaluation of current levels of PAHs found in environmental media including data from hazardous waste sites. The health effects component should focus on obtaining information on (1) the health effects of mixtures of PAHs particularly their noncarcinogenic effects in humans, and (2) their toxicokinetics. This report provides excerpts from the toxicological profile of PAHs (ATSDR, 1995) that contains more detailed information.

An integrated framework to identify significant human exposures (SHELs).

Typically, health risk assessment methodologies have been designed to assess risks associated with exposure to individual chemicals through one specific medium, such as air, water, or food. This is partly because classical experimental methodology is used to study pure chemicals, and partly because a majority of early promulgated environmental laws (e.g., Clean Air Act, Clean Water Act) regulated chemicals in a given matrix via a specific route. Often, however, exposures in the ambient environment are through multiple routes, multiple media and to multiple chemicals. Presented here is a multimedia framework that health risk assessors can use to identify significant human exposure levels (SHELs) on a site-specific basis. This framework is presented in the context of a decision tree that links health guidance values such as minimal risk levels (MRLs) with site-specific data, using a range of decision-support models. It includes a provision to estimate a level of concern by comparing the estimated total dose (exposures) with guidance values established by the Agency, by other federal organizations, and by basket-survey results. If a SHEL has been identified, a range of follow-up public health actions may be indicated (i.e., surveillance, health education, or other preventive interventions). This framework serves to (1) integrate the overall health assessment process, (2) evaluate the need for public health interventions, (3) incorporate innovative decision-support methods/models, and (4) demonstrate utility of such methods in public health practice and the pursuit of the Agency's mission.

The Agency for Toxic Substances and Disease Registry's role in development and application of biomarkers in public health practice.

An overview of the Agency for Toxic Substances and Disease Registry's (ATSDR) biomarker program is presented in the context of the paradigm for biomarkers developed by the National Research Council (NRC, 1987, 1991). The status and projected utility of four biomarker studies conducted by NRC and sponsored by ATSDR, the Environmental Protection Agency (EPA), and the National Institute of Environmental Health Sciences (NIEHS) are discussed. These studies include a review of relevant research on biomarkers for specific toxicologic end points, including reproductive toxicology, pulmonary toxicology, neurotoxicology, and immunotoxicology. Also, the scope of related research on exposure characterization being conducted by the ATSDR-sponsored research program at Rutgers University is reviewed. The potential impact of biomarkers on public health assessments and on the range of ATSDR programs is described. Specifically, the role of biomarkers in dose reconstruction, in ATSDR's health studies program, and in the emerging field of molecular epidemiology is reviewed. In addition, future directions and research needs are addressed.

Toluene diisocyanate-induced airway hyperreactivity in guinea pigs depleted of granulocytes.

The influence of cyclophosphamide-induced granulocyte depletion on toluene diisocyanate (TDI)-related changes in airway reactivity and pathology was assessed in guinea pigs. Twelve cyclophosphamide-treated and 12 control animals comprising each group were studied physiologically before and 2 h after a single 10-min exposure to 3 ppm of TDI. Reactivity was determined in intact unanesthetized animals by measuring specific airway conductance before and during intravenous acetylcholine infusion. After testing, tracheal tissue for light microscopic examination was obtained from three hyperreactive guinea pigs in each exposed group and compared with tissue from treated and control animals (n = 3 each) that had not been TDI exposed. Cyclophosphamide treatment caused substantial decreases in both circulating and airway granulocyte counts. However, the incidence and degree of bronchial hyperreactivity that occurred 2 h post-TDI was similar in the untreated and treated groups. Our results indicate that TDI-induced bronchial hyperreactivity 1) occurs shortly after a brief high concentration exposure and 2) appears independent of circulating or airway granulocyte counts.

Toluene diisocyanate-induced airway hyperreactivity and pathology in the guinea pig.

We assessed the nature and progression of airway mucosal disease and histaminic reactivity in English short-haired guinea pigs at 2, 24, 72, 168, and 504 hours after toluene diisocyanate (TDI) exposure (4 hours of 3 ppm of TDI for 5 consecutive days). To also determine whether TDI-specific, IgE-like antibodies developed in TDI-exposed animals, passive cutaneous anaphylaxis testing was done 28 days after TDI. Bronchial reactivity was determined serially by measuring specific airway conductance as a function of increasing doses of aerosolized histamine in six exposed and three control animals studied intact and unanesthetized. The remaining 10 exposed and 10 control guinea pigs were sacrificed in groups of two at each time point to obtain airway tissue for light microscopic examination. We found that airway hyperreactivity to histamine occurred after TDI in all animals tested. It was maximal 2 hours after the 5-day exposure and remitted by 72 hours. In addition, marked airway obstruction occurred after TDI that persisted for at least 168 hours. There were dramatic signs of airway mucosal damage associated with the bronchial hyperreactivity that included substantial decreases in epithelial cilia, mucin content, and mast cells, as well as squamous metaplasia, numerous mitotic figures, and a prominent polymorphonuclear leukocytic infiltrate. Passive cutaneous anaphylaxis tests in exposed animals were negative. Our results suggest that TDI-induced bronchial hyperreactivity may be related to airway mucosal injury and inflammation.

Morphology of tracheal and bronchial epithelium and type II cells of the peripheral lung of the guinea pig after inhalation of toluene diisocyanate vapors.

Toluene diisocyanate (TDI), a polymerizing agent used in production of plastics, can cause airways disease in some exposed individuals. Using guinea pigs as a model, the response of the airways and the type II cells of the peripheral lung was monitored morphologically and morphometrically after exposure to TDI vapors at 30 ppb, 260 ppb, and 3100 ppb. The two low doses of TDI caused little change in airways epithelium. There was no gross inflammatory cell infiltrate, however, surface infoldings and intracellular ciliated cysts increased in numbers. Animals exposed to 3100 ppb TDI 4 h/day for 5 days, sustained considerable damage to the epithelium, and stratified nonkeratinizing cells lined the airways until one week after exposure. Polymorphonuclear leukocytes were present in the early period after exposure. Increased numbers of eosinophils were present between one and two weeks following exposure. Mitoses in the epithelium were common during recovery. In the peripheral lung, though a modest subjective increase in the number of type II cells was seen after 3100 ppb TDI, the volume density of type II cells, and organellar components (lamellar bodies, mitochondria, cisternal bodies) did not change significantly after any exposure level of TDI.

A comparative study of ethchlorvynol levels in blood versus bone marrow.

Bone marrow may be utilized as an alternative biological sample in cases where uncontaminated blood samples are not available for analyses. Bone marrow/blood ratios of ethchlorvynol as a function of time and dosage level were determined in 40 rabbits. A modified quantitative analysis that produced accurate and reproducible results was employed for the determination of ethchlorvynol levels. Further, ten blood and bone marrow samples containing ethchlorvynol were chosen to study the effects of storage for a period of 24 hours. Studies of blood and bone marrow ethchlorvynol levels with time showed no linear relationship. Bone marrow/blood ratios as a function of dose resulted in close mean averages with a wide range of values. Significant losses in both blood and bone marrow ethchlorvynol levels were evidenced in most of the samples subjected to the 24-hour storage study.