73 Introduction ...73 Factors affecting toxicants in water ...74 Exchange of toxicants in an ecosystem...74 Factors modifiers affecting uptake of toxicants from the environment...74 Abio
Trang 2SECOND EDITION
Toxicology and Environmental Hazards
HUMAN HEALTH
Ecosystems
and
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Trang 4and
Trang 5This book contains information obtained from authentic and highly regarded sources Reprinted material
is quoted with permission, and sources are indicated A wide variety of references are listed Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use.
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No claim to original U.S Government works International Standard Book Number 1-56670-568-1 Library of Congress Card Number 2001001149 Printed in the United States of America 1 2 3 4 5 6 7 8 9 0
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Trang 6Elizabeth, Brendan, Douglas, Danielle, William, Nathan, Danny, Anders, Margaret, Matthew, Jemma, Lauren, and kids everywhere Perhaps this book will help them to look after this place better than we did Also for my wife Joan,
who is my calm harbor in a stormy world.
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Trang 8There is a commonly held myth in our society that anything that is “natural”
is good, wholesome, and healthful, whereas anything that is “synthetic” is
to strike terror into the heart of any food faddist This attitude is, at best,nạve and, at worst, dangerous Toxic substances abound in nature, rangingfrom inorganic heavy metals such as arsenic and mercury, through organicsubstances such as hydrocyanic acid, to complex enzymes and other proteins
of the neurotoxins and coagulant-anticoagulants present in venoms andtoxins One of the more serious environmental hazards may be natural radongas, and cancer from solar radiation is a real concern
Increasingly, it is becoming necessary for students of environmental ences to know something of toxicology and for students of toxicology to knowsomething of the environment This text is designed to bridge these fields byacquainting the student with the major environmental hazards — both man-made and natural — and with the risks to human health that they pose It isdesigned such that topics are generally introduced in the early chapters andcovered in greater detail in subsequent ones This is neither an environmen-talist's handbook nor does it deal exclusively with toxicology; rather, itattempts to strike a balance between the extremes of opinion and to indicatewhere information is inconclusive Examples of major accidental exposures
sci-of humans to chemical toxicants are used liberally and case studies takenfrom reported incidents are provided Historical background of the develop-ment of a class of chemicals or a particular environmental problem is oftenprovided in the belief that an educated student should know more thanmerely the technical aspects of the field It is hoped that this text will assiststudents in acquiring the information and judgmental skills necessary todifferentiate between real and perceived risks, as well as acquaint them withthe toxicology of important chemicals in the environment Because mostpeople spend 8 hours daily, 5 days weekly in the workplace, it constitutes animportant component of our environment and it will be considered as such
Richard B Philp, D.V.M., Ph.D.
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Trang 10About the Author
of the Department of Pharmacology and Toxicology at the University ofWestern Ontario After graduating from the Ontario Veterinary College, hepracticed veterinary medicine in Illinois and in Ontario and also served as
a public health officer in a small Ontario town He obtained his Ph.D inpharmacology from the University of Western Ontario and did postdoctoralstudies at the Royal College of Surgeons of England in London He hasserved on advisory committees to Canadian federal and provincial govern-ments regarding the use of antibiotics in agriculture He was HonoraryVisiting Professor in the School of Pathology, University of New South Wales,and has authored or co-authored over 90 scientific papers, two books, andseveral book chapters His current research involves the study of pollutionalong the Florida Gulf Coast and its effects on a species of marine sponge
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Trang 12Chapter 1 Principles of pharmacology and toxicology 1
Introduction 1
Pharmacokinetics 4
Absorption 4
Distribution 5
Biotransformation 6
Elimination 10
Pharmacodynamics 12
Ligand binding and receptors 12
Biological variation and data manipulation 13
Dose response 14
Probit analysis 17
Cumulative effects 19
Factors influencing responses to xenobiotics 20
Age 20
Body composition 21
Sex 21
Genetic factors 22
Presence of pathology 24
Xenobiotic interactions 25
Some toxicological considerations 26
Acute vs chronic toxicity 26
Acute toxicity 27
Peripheral neurotoxins 27
Central neurotoxins 27
Inhibitors of oxidative phosphorylation 27
Uncoupling agents 28
Inhibitors of intermediary metabolism 28
Chronic toxicity 28
Mutagenesis and carcinogenesis 29
Sites of intracellular damage 29
DNA repair 32
Genetic predisposition to cancer 33
Epigenetic mechanisms of carcinogenesis 33
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Trang 13The role of cell repair and regeneration in toxic reactions 34
Response of tissues to chemical insult 35
Fetal toxicology 35
Teratogenesis 35
Transplacental carcinogenesis 37
Further reading 38
Review questions 39
Answers 42
Chapter 2 Risk analysis and public perceptions of risk 45
Introduction 45
Assessment of toxicity vs risk 45
Predicting risk: workplace vs the environment 46
Acute exposures 46
Chronic exposures 46
Very low-level, long-term exposures 46
Carcinogenesis 47
Risk assessment and carcinogenesis 47
Sources of error in predicting cancer risks 50
Portal-of-entry effects 50
Age effects 52
Exposure to co-carcinogens and promoters 52
Species differences 52
Extrapolation of animal data to humans 54
Hormesis 54
Natural vs anthropogenic carcinogens 55
Reliability of tests of carcinogenesis 55
Environmental monitoring 56
Setting safe limits in the workplace 57
Environmental risks: problems with assessment and public perceptions 59
The psychological impact of potential environmental risks 60
Voluntary risk acceptance vs imposed risks 60
Costs of risk avoidance 61
Some examples of major industrial accidents and environmental chemical exposures with human health implications 62
Radiation 62
Formaldehyde 62
Dioxin (TCDD) 63
Some legal aspects of risk 64
De minimis concept 64
Delaney Amendment 64
Statistical problems with risk assessment 65
Risk management 66
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Trang 14The precautionary principle 67
Further reading 68
Review questions 69
Answers 71
Case study 1 71
Case study 2 72
Chapter 3 Water and soil pollution 73
Introduction 73
Factors affecting toxicants in water 74
Exchange of toxicants in an ecosystem 74
Factors (modifiers) affecting uptake of toxicants from the environment 74
Abiotic modifiers 76
Biotic modifiers 77
Some important definitions 78
Toxicity testing in marine and aquatic species 79
Water quality 79
Sources of pollution 80
Some major water pollutants 81
Chemical classification of pesticides 82
Health hazards of pesticides and related chemicals 83
Chlorinated hydrocarbons 83
Chlorphenoxy acid herbicides 83
Organophosphates (organophosphorus insecticides) 84
Carbamates 84
Acidity and toxic metals 84
Chemical hazards from waste disposal 86
The Love Canal story 87
Problems with Love Canal studies 89
Toxicants in the Great Lakes: implications for human health and wildlife 90
Evidence of adverse effects on human health 91
Evidence of adverse effects on wildlife 93
Global warming and water levels in the Great Lakes 93
The marine environment 93
Aquatic toxicology 94
Biological hazards in drinking water 95
Anatomy of a small town disaster 96
Further reading 98
Review questions 100
Answers 102
Chapter 4 Airborne hazards 103
Introduction 103
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Trang 15Types of air pollution 103
Gaseous pollutants 103
Particulates 104
Smog 104
Sources of air pollution 104
Atmospheric distribution of pollutants 105
Movement in the troposphere 105
Movement in the stratosphere 106
Water and soil transport of air pollutants 106
Types of pollutants 106
Gaseous pollutants 106
Particulate pollutants 107
Health effects of air pollution 107
Acute effects 107
Chronic effects 108
Air pollution in the workplace 108
Asbestos 108
Silicosis 109
Pyrolysis of plastics 109
Dust 110
CO and NO2 110
Multiple chemical sensitivity 111
Chemical impact of pollutants on the environment 114
Sulfur dioxide and acid rain 114
The chemistry of ozone 115
Chlorine 116
Global warming 116
Water 116
Carbon dioxide 117
Methane 118
Subtle greenhouse effects 119
Global cooling: new Ice Age? 119
Sulfur dioxide 120
Motor vehicle exhaust 120
Natural factors and climate change 121
Remedies 122
Further reading 123
Review questions 124
Answers 126
Case study 3 126
Case study 4 127
Case study 5 127
Case study 6 127
Case study 7 128
Case study 8 128
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Trang 16Chapter 5 Halogenated hydrocarbons and halogenated aromatic
hydrocarbons 129
Introduction 129
Early examples of toxicity from halogenated hydrocarbons 129
Physicochemical characteristics and classes of halogenated hydrocarbons 130
Antibacterial disinfectants 130
Herbicides 131
Dioxin (TCDD) toxicity 131
Hepatotoxicity 132
Porphyria 132
Chloracne 132
Cardiovascular effects 133
Carcinogenicity 133
Neurotoxicity 135
Reproductive toxicity 135
Metabolic disturbances 135
The role of the aryl hydrocarbon receptor (AhR) and enzyme induction 135
Paraquat toxicity 137
Insecticides 137
Industrial and commercial chemicals 138
Biphenyls 138
Toxicity 138
Pharmacokinetics and metabolism 139
Biodegradation 139
Accidental human exposures 139
The problem of disposal 140
Solvents 140
Toxicity 140
Mechanism of toxicity 141
Trihalomethanes (THMs) 141
Further reading 142
Review questions 143
Answers 145
Case study 9 145
Case study 10 146
Chapter 6 Toxicity of metals 147
Introduction 147
Lead (Pb) 148
Toxicokinetics of lead 149
Cellular toxicity of lead 149
Fetal toxicity 150
Treatment 150
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Trang 17Mercury (Hg) 151
Elemental mercury toxicity 152
Inorganic mercurial salts 152
Organic mercurials 152
Mechanism of mercury toxicity 153
Treatment of mercury poisoning 153
The Grassy Narrows story 154
Cadmium (Cd) 155
Cadmium toxicokinetics 156
Cadmium toxicity 156
Treatment 157
Arsenic (As) 157
Toxicokinetics of arsenicals 157
Toxicity 158
Treatment 158
Environmental effects of arsenic 158
Chromium (Cr) 158
Other metals 159
Metallothioneins 160
Carcinogenicity of metals 160
Unusual sources of heavy metal exposure 161
Further reading 161
Review questions 162
Answers 164
Case study 11 164
Case study 12 165
Case study 13 165
Chapter 7 Organic solvents and related chemicals 167
Introduction 167
Classes of solvents 168
Aliphatic hydrocarbons 168
Halogenated aliphatic hydrocarbons 168
Aliphatic alcohols 169
Glycols and glycol ethers 171
Aromatic hydrocarbons 171
Solvent-related cancer in the workplace 172
Benzene 172
Bis(chloromethyl) ether (BCME) 173
Dimethylformamide (DMF) and glycol ethers 174
Ethylene oxide (CH2CH2O) 174
Factors influencing the risk of a toxic reaction 175
Non-occupational exposures to solvents 175
Further reading 175
Review questions 176
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Trang 18Answers 177
Case study 14 177
Case studies 15 and 16 178
Case study 15 178
Case study 16 178
Chapter 8 Food additives, drug residues and other food toxicants 179
Food additives 179
Food and drug regulations 179
Some types of food additives 180
Artificial food colors 182
Emulsifiers 184
Preservatives and anti-oxidants 184
Artificial sweeteners 185
Flavor enhancers 187
Drug residues 187
Antibiotics and drug resistance 188
Infectious drug resistance (IDR) 189
Infectious diseases 193
Allergy 193
Diethylstilbestrol 193
Bovine growth hormone 196
Natural toxicants and carcinogens in human foods 197
Some natural toxicants 198
Favism 198
Toxic oil syndrome 198
Herbal remedies 199
Natural carcinogens in foods 200
Bracken fern “fiddleheads” 200
Others 200
Further reading 201
Review questions 203
Answers 205
Case study 17 206
Chapter 9 Pesticides 207
Introduction 207
Classes of insecticides 209
Organochlorines (chlorinated hydrocarbons) 209
Organophosphorus insecticides 211
Carbamate insecticides 212
Botanical insecticides 213
Herbicides 213
Chlorphenoxy compounds 213
Dinitrophenols 213
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Trang 19Carbamate herbicides 215
Triazines 215
Fungicides 215
Dicarboximides 215
Newer biological control methods 216
Government regulation of pesticides 216
Problems associated with pesticides 217
Development of resistance 217
Multiple resistance 217
Nonspecificity 218
Environmental contamination 218
Balancing the risks and the benefits 218
Toxicity of pesticides for humans 219
Further reading 220
Review questions 221
Answers 222
Case study 18 222
Case study 19 223
Chapter 10 Mycotoxins and other toxins from unicellular organisms 225
Introduction 225
Some human health problems due to mycotoxins 225
Ergotism 225
Aleukia 227
Aflatoxins 227
Fumonisins 228
Other mycotoxic hazards to human health 230
Economic impact of mycotoxins 230
Fusarium life cycle 231
Trichothecenes 231
Zearalonone 231
Vomitoxin (deoxynivalenol or DON) 231
Species differences in DON toxicokinetics 231
Other trichothecenes 233
Detoxification of grains 234
Harvesting and milling 234
Chemical treatments 234
Binding Agents 234
Other techniques 234
Other toxins in unicellular members of the plant kingdom 235
Further reading 236
Review questions 236
Answers 239
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Trang 20Chapter 11 Animal and plant poisons 241
Introduction 241
Toxic and venomous animals 242
Toxic and venomous marine animals 242
Scalefish toxins 242
Ciguatoxin 242
Tetrodotoxin 243
Scombroid poisoning 243
Icthyotoxin 244
Shellfish toxins 244
Saxitoxin 244
Domoic acid 244
Okadaic acid 244
Direct toxicity from dinoflagellates 244
Stinging fishes 245
Mollusk venoms 245
Conotoxins 245
Coelenterate toxins 246
Echinoderm venoms 246
Toxic and venomous land animals 246
Venomous snakes 246
Snake venoms 247
First aid 249
Venomous arthropods 249
Toxic plants and mushrooms 250
Vesicants 250
Cardiac glycosides 251
Astringents and gastrointestinal irritants (pyrogallol tannins) 251
Autonomic agents 251
Dissolvers of microtubules 252
Phorbol esters 252
Cyanogenic glycosides 253
Detoxification of hydrogen cyanide 253
Convulsants 254
Use in research and treatment 254
Further reading 255
Review questions 257
Answers 258
Case study 20 258
Case study 21 259
Case study 22 259
Case study 23 259
Case study 24 260
Case study 25 260
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Trang 21Chapter 12 Environmental hormone disrupters 261
Introduction 261
The Lake Apopka incident 262
A brief review of the physiology of estrogens and androgens 262
Mechanisms of hormone disruption 263
Methods of testing for hormone disruption 263
Some examples of xenoestrogen interactions with E2 receptors or effects in vivo or in vitro 264
Some effects on the male reproductive system 265
Modulation of hormone activity through effects on the Ah receptor 265
Phytoestrogens 266
Results of human studies 266
Males 266
Females 268
Effects in livestock and wildlife 270
Problems in interpreting and extrapolating results to humans 270
Further reading 271
Review questions 272
Answers 273
Chapter 13 Radiation hazards 275
Introduction 275
Sources and types of radiation 276
Sources 276
Natural sources of radiation 276
Man-made sources of radiation 276
The cause of radiation 276
Types of radioactive energy resulting from nuclear decay 277
Measurement of radiation 277
Measures of energy 277
Measures of damage 278
Major nuclear disasters of historic importance 278
Hiroshima 278
Chernobyl 279
Three Mile Island 280
The Hanford release 280
Radon gas: the natural radiation 281
Tissue sensitivity to radiation 282
Microwaves 283
Ultraviolet radiation 284
Medical uses of UV radiation 284
Extra-low-frequency (ELF) electromagnetic radiation 285
Irradiation of foodstuffs 287
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Trang 22Further reading 288Review questions 289Answers 290
The Gaia hypothesis 291Chaos theory 293Other examples of interconnected systems 294
A vicious circle 294Domino effects of global warming 294
A feedback loop 297Food production and the environment 297Meat vs grain 297Genetically modified plant foods 300The environment and cancer 302Further reading 302
Case study 1 305Case study 2 305Case study 3 306Case study 4 306Case study 5 306Case study 6 307Case study 7 307Case study 8 307Case study 9 308Case study 10 308Case study 11 308Case study 12 309Case study 13 309Case study 14 310Case studies 15 and 16 311Case study 17 311Case study 18 311Case study 19 312Case study 20 312Case study 21 313Case study 22 313Case study 23 314Case study 24 314Case study 25 314
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Trang 24chapter one
Principles of pharmacology and toxicology
The right dose differentiates a poison and a remedy
— Paracelsus, 1493–1541
Introduction
The past century has seen a tremendous expansion in the number of syntheticchemicals employed by humankind as materials, drugs, preservatives forfoods and other products, pesticides, cleaning agents, and even weapons ofwar An estimated 64,000 chemicals are currently in use commercially, with
5 billion tons being produced annually in the world Some 4000 chemicalsare used as medicinals and at least 1200 more as household products Anestimated 700 new chemicals are synthesized each year Add to this thenumerous natural substances, both inorganic and organic, that possess toxicpotential, and it is little wonder that the public expresses concern and even,sometimes, panic about the harmful effects these agents may exert on theirhealth and on the environment Many of these agents, perhaps 50,000 ofthem, have never been subjected to a thorough toxicity testing
Approximately 500 chemicals have been evaluated for carcinogenicpotential Some 44 have been designated as possible human carcinogens onthe basis of evidence, either limited or conclusive, obtained from humanstudies Of these, 37 tested positive for carcinogenicity in animal tests andwere later shown to be carcinogens for humans There are, however, numer-ous other agents that have been shown to be carcinogenic in rodents butwhich have yet to be identified as human carcinogens This creates signif-icant problems regarding the legislative and regulatory decisions that need
to be made about their use Some of the areas of uncertainty that surroundthe extrapolation of data from the animal setting to the human setting arediscussed in the following chapter The process of extrapolation requires
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input from many different disciplines that may include engineering, ics, biology, chemistry, pathology, pharmacology, physiology, public health,immunology, epidemiology, biostatistics, and occupational health The field
phys-of toxicology thus depends on all phys-of these, but perhaps draws most heavily
on pharmacology, biochemistry, and pathology It is the identification of thedegree of risk to which individuals or groups are exposed in a given set ofcircumstances that directs all of this activity
Other forms of toxicity, hepatotoxicity, nephrotoxicity, and neural ity, for example, may be more important in acute exposures such as mightoccur in the industrial setting Reproductive and fetal toxicity has beenfrequently demonstrated experimentally, but their significance for the gen-eral population exposed to low levels of toxicants in the environmentremains unclear
toxic-The (U.S.) Agency for Toxic Substances and Disease Registry, and the(U.S.) Environmental Protection Agency jointly maintain a priority list of 275toxic substances The “top 20” include arsenic, lead, metallic mercury, vinylchloride, benzene, polychlorinated biphenyls (PCBs), cadmium,benzo[a]pyrene, benzo(b)fluoranthene, polycyclic aromatic hydrocarbons
chromium(+6), and dibenz[a,h]anthracene The complete list can be viewed
on the internet at http://atsdrl.atsdr.cdc.gov:8080/97list.html
Considerable difficulty attends efforts to extrapolate the results of icity tests in experimental animals to humans exposed to very low levels intheir environment, especially with regard to the risk of cancer Current leg-islation requires testing in two species with sufficient numbers for reliablestatistical analysis Rats and mice are generally used, as hamsters are resistant
tox-to many carcinogens and primates are tox-too expensive and, in the case of somespecies, too environmentally threatened For statistical purposes, cancerincludes all tumors, whether benign or malignant A 2-year carcinogenstudy — one for analysis (pathology, etc.) and one for documentation andstatistics — employing two species cost, in 1991, at least $1,000,000 plus thecosts of 1 year for preparation Because it is not practical to test every chem-ical, several factors should be considered in selecting test chemicals Theseinclude the frequency and severity of observed effects, the extent to whichthe chemical is used, its persistence in the environment (examples of persis-tent chemicals include chlorinated hydrocarbons), and whether transforma-tions to more toxic agents occur
Heavy metals, the by-products of most mining and ore extraction cesses, are examples of ubiquitous toxicants with almost infinite half-lives.Mercury (Hg), for example, is present in all canned tuna at about 5 ppm,mostly from natural sources Aquatic bacteria can transform mercury tomethylmercury This has a different toxicity profile Cadmium (Cd) entersthe environment at about 7000 tons/year and is concentrated by livestock
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because they recycle it in feces used for fertilizer It is then passed on toforage grasses Radioactive isotopes of cesium and iodine entered the foodchain after Chernobyl
The estimation of the degree of risk associated with the presence of apotentially toxic substance in the environment is the basis for all decisionsrelating to the legislative controls over that chemical, including its industrialuse and eventual disposal Pharmacological/toxicological principles areessential in understanding the processes involved in toxicity testing
Pharmacology can be defined as the science of drugs It includes a study
(pharmacodynamics); the manner in which they are absorbed, movedaround in the body, and excreted (pharmacokinetics); their use in medicine
is any substance used as a medicine but pharmacology generally includesthe study of substances of abuse, and in the broadest sense deals with the
In this sense, toxicology can be considered to be a branch of pharmacology.Xenobiotics can also be exploited as research tools to reveal mechanismsunderlying physiological processes
Toxicology is the study of the harmful effects of xenobiotics on livingorganisms, the mechanisms underlying those effects, and the conditions
the effects of incidental or accidental exposure of organisms, includinghuman beings (the focus of this text), to toxins in the environment (i.e., air,water, and food) While the greatest concern today centers on pollutants ofhuman origin, it should not be forgotten that toxic substances, includingcarcinogens, abound in nature The subject of environmental toxicologyembraces the study of the causes, conditions, environmental impact, andmeans of controlling pollutants in the environment It can also be extended
to include the environment of the workplace (industrial hygiene) The related
anthropogenic origin, on ecosystems
Economic toxicology is the study of chemicals that are developed expresslyfor the purpose of improving economic gain by selectively eliminating aspecies (insecticides and herbicides), by improving health and productivity(drugs), by preserving foodstuffs (food additives), or for the manufacture of
a marketable product (industrial solvents, cleaning agents, etc.)
Forensic toxicology refers to the medico-legal aspects of the harmful effects
of drugs and poisons administered or taken deliberately or accidentally.Detection of xenobiotics in tissues and fluids and in, or on, objects is animportant aspect of this field as is the preparation of evidence for submission
in court
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There has been a trend in recent years to attempt to separate toxicology
toxico-dynamics The distinction is largely semantic as the principles are the same
The response of organisms to drugs and chemicals is governed by
absence of a transport system, chemicals in solution will move from an area
of high concentration to one of low concentration If a semi-permeable brane is interposed between these areas, the chemical will move across it,assuming the chemical can penetrate the membrane In reality, moleculeswander randomly across the barrier, but the frequency of transfers will begreater from the area of high concentration to that of the low one untilequilibrium is established Cell walls and other biological membranes func-tion as semi-permeable membranes, and the Law of Mass Action influencesthe uptake of most drugs and toxicants by living organisms The concentra-tion of a toxicant in the environment (water, air, and soil) is thus an importantdeterminant affecting its uptake Transport mechanisms are dealt with in the
mem-“Absorption” and “Distribution” subsections of this chapter
The partition coefficient is the ratio of a chemical’s relative solubility intwo different phases The ratio of solubility in oil (often n-octanol) to that inwater is frequently used to predict the distribution of a xenobiotic betweenthe aqueous and lipid phases in the body
Absorption
Whether or not a xenobiotic is toxic, and how that toxicity is manifested,depends primarily on how the body deals with it Substances that are notabsorbed from the gastrointestinal tract have no systemic toxicity This factallows barium to be used as an X-ray contrast medium, despite its toxicity
by other routes of administration The selective toxicity of most insecticidesdepends solely on a greater ability to penetrate the chitin of the insect’sexoskeleton than to penetrate human skin A substance that is not readilyexcreted by the body (usually through the kidneys or in the feces) willaccumulate to toxic levels
The primary routes of absorption for toxicants are the skin, the lungs,and the gastrointestinal tract The latter two are important for the population
at large, but the skin may be a very significant site in certain industrial
toxicology, can have a significant influence on the toxicity of a substance.Larger molecules require a degree of lipid solubility to cross biologicalbarriers because cell membranes consist of a fluid phospholipid matrix withembedded proteins that can penetrate part way or all the way through themembrane Factors that influence the lipophilicity of a chemical will therefore
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affect its absorption Many chemicals are weak acids or bases that may exist
in an ionized (polar) or a non-ionized (nonpolar) state with equilibriumestablished between them For example:
The polar form is water soluble, whereas the nonpolar form is lipid-soluble.The pH will influence the equilibrium and hence the amount of the lipid-
substance is defined as the pH at which 50% of it will exist in each state.Weakly acidic drugs are shifted to the nonpolar state in an acid medium and
to the polar state in an alkaline medium The reverse is true for weaklyalkaline drugs Because the pH of the stomach and upper small bowel isacidic (pH 2–4), acidic chemicals will be absorbed here Alkaline substancestend to be absorbed in the lower small bowel and the upper colon whichare more alkaline, whereas the descending colon, becomes acidic again.Lipid solubility is not essential for the passage of all molecules acrossmembranes There is the bulk transfer of water across the cell membranethat can carry very small (less than 200 Daltons), water-soluble moleculeswith it Metallic ions such as calcium, sodium, and potassium, as well aschlorine, can pass through special channels, some of which are regulated bythe trans-membrane potential (voltage regulated) and others by specificreceptors (receptor activated) Specialized exchangers also exist; for example,the sodium pump
Active transport is an energy-consuming process by which a substancecan be moved against a concentration gradient Active transport is important
in the kidney and the liver In addition to energy consumption, it is alsocharacterized by saturability, selectivity for specific chemical configurations,
Facil-itated diffusion is similar except that no energy is consumed and it cannotoccur against an electrochemical gradient
Pinocytosis is a process whereby a segment of the plasma membrane of
a cell invaginates to form a sack in which extracellular fluid and colloidalparticles can be taken into the cell by pinching off the “mouth” of the sack.This is an important mechanism by which the mucosal cells of the intestinaltract take up nutrients and some drugs and chemicals
Distribution
Once absorbed, the agent can be distributed throughout various ments in the body Serum albumin possesses many nonspecific binding sitesfor xenobiotics, especially weakly acidic ones, and it therefore becomes atransport system for many substances The balance between dissociated(polar) and undissociated (nonpolar) states affects the distribution of a
compart-R–H R–– + H+Nonpolar Polar
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chemical as well, because pH changes from the extracellular fluid (pH 7)
to the plasma (pH 7.4) The partition coefficient of a substance also ences its distribution, determining, for example, the extent to which it will
influ-be sequestered in fat Highly lipid-soluble substances will influ-be sequestered
in body fat where they may remain for long periods Everyone has DDTand its metabolites dissolved in his/her fat The amount varies with ageand location
The use of DDT in North America was drastically reduced in the 1970sand a complete ban was legislated in Canada in 1990 Substances such asDDT that are sequestered in fat can be released during periods of fat loss(starvation, extreme dieting), as a result of illness, and even during lactationwhen lipids are transferred to milk The released toxicant may reach con-centrations at target sites sufficient to cause a toxic response Figure 1 illus-trates these relationships among storage fat, blood, and target organ.The rate of distribution of a substance is a function of the rate of bloodflow through the tissues (tissue perfusion) Highly vascular organs willaccumulate it first; organs that are poorly perfused will accumulate it last.The substance is thus distributed initially on the basis of tissue perfusion;then as equilibrium states are reached, it will redistribute on the basis of itssolubility Following the intravenous injection of a chemical with a highpartition coefficient, equilibrium will be established instantly with the kid-ney and liver because of their high vascularity, almost as quickly with thebrain, with muscle in about 30 min, and with fat in about 3 hr The mem-branes surrounding the brain and separating it from its blood vessels con-
agents, such as all anesthetics
Thus, tissue perfusion and the partition coefficient may play importantroles in determining the onset and termination of either a therapeutic or atoxic response Sodium thiopental, an ultrashort-acting barbiturate, is usedfor anesthetic induction The rate of biotransformation is so slow as to havelittle effect on recovery The drug readily penetrates the blood-brain barrierbecause of its high lipid solubility and the brain, which is richly perfused,rapidly takes it up and anesthesia ensues This effect is terminated becausethe drug is redistributed to other tissues, including depot fat, which is poorlyperfused New equilibria are established among blood, brain, and othertissues so that, while initial recovery is rapid, a state of sedation may persistfor several hours Figure 2 shows the effects of perfusion and partition
Biotransformation
Biotransformations of xenobiotics are classified as either Phase I reactions
biotrans-formations, convert a lipophilic (fat-soluble) substance to a more polar and,hence, more water-soluble substance This metabolite is excreted morereadily by the kidneys than the parent compound, but it usually retains
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significant bioactivity It may be more active, or less active, than the parentsubstance If the parent chemical is nontoxic but the metabolite is toxic, this
is a toxication reaction A drug that requires biotransformation to become
reactions and their consequences
Phase I chemical reactions include oxidation, reduction, and hydrolysisand generally unmask or introduce a functional (reactive) group such as
O-dealkylations, side-chain and aromatic hydroxylations, N-oxidation andhydroxylation, sulfoxide formation, and desulfuration Hydrolysis of estersand amides also occurs Reduction reactions may involve azo (RN = NR) or
weight loss.
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various tissues.
than the parent chemical, or it may be inactive.
12010080604020
Time in Hours
TISSUE WASHOUTS OF SODIUM THIOPENTAL
APPROXIMATE TISSUE TI/2 VALUES Plasma 40 min.
CH3O
NCH3 CH3CH2CH2CH
NO2 S
P O
C2H5O
C2H5O
NO2 O
O
O
H
N ONa
O
HO
NCH3 H
HO O
1 Parathion ( inactive ) Paraoxon ( active )
Cytochrome P450 monooxygenase
2 Pentobarbital ( active ) Hydroxypentobarbital ( inactive )
3 Codeine ( poorly active ) Morphine ( very active )
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Many oxidation reactions are under the control of a group of function oxidases for which cytochrome P-450 (CYP450) serves as a catalyst.These are located primarily in the smooth endoplasmic reticulum (SER) ofhepatic cells, but they exist in many tissues as well as many species, includingsingle-celled organisms The CYP450 monooxygenases have tremendoussubstrate versatility, being able to oxidize lipophilic xenobiotics plus fattyacids, fat-soluble vitamins, and various hormones This is, in part, becausethere are at least 20 variants of the enzyme (isoenzymes) and because each
mixed-is capable of accepting many substrates CYPs 1, 2, and 3 are mixed-isozymesespecially involved in xenobiotic transformations It should be noted thatpro-carcinogens are converted to carcinogens by Phase I reactions Examples
syn-thetic estrogen diethylstilbestrol This process often involves the formation
of an epoxide compound, as it does in the three examples given in Figure 3
An epoxide has the chemical configuration shown in Figure 4, making ithighly nucleophilic and chemically reactive Many epoxides are carcinogens.Figure 4 shows this chemical transformation for stilbestrol andbenzo[a]pyrene, which is an example of a polyaromatic hydrocarbon (PAH).Many of these are carcinogenic and are environmental pollutants Otherenzymes, called epoxide hydrolases, can detoxify the epoxides
Phase II reactions are conjugation (synthetic) reactions that render theagent not only more water-soluble, but biologically inactive, with a very fewexceptions A common conjugation reaction is with glucuronic acid Conju-gation also occurs with sulfuric acid, acetic acid, glycine, and glutathione.Many Phase I metabolites are still too lipophilic (fat soluble) to be excreted
by the kidneys and are subjected to Phase II conjugation All chemicals neednot be subjected first to Phase I transformations Many, if they possess the
9
8 10
BP-7 , 8-DIOL-9 , 10-EPOXIDE ( CARCINOGEN)
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An important concept in understanding toxication and detoxication of
reticulum can be stimulated to a higher level of activity by many highlylipophilic agents Because these enzymes are nonspecific, this has conse-quences for many other agents transformed by the same enzymes Induction
is accomplished by the increased synthesis of more enzyme, so the SERactually increases in density The result may be increased detoxication of achemical or the increased synthesis of a toxic metabolite Cigarette smokecontains many inducers and may increase the breakdown of many drugs(theophylline, phenacetin, etc.) but, conversely, it may act through this mech-anism as a promoter or as a co-carcinogen
Elimination
Every secretory or excretory site in the body is a potential route of eliminationfor xenobiotics Thus, they may be excreted in saliva, sweat, milk, tears, bile,mucus, feces, and urine Of these, the most significant site is urine, followed
by feces and bile The kidney is the principal organ for the elimination ofnatural waste metabolites Most of these are toxic if they exceed normallevels The kidney is also the main organ for maintaining fluid and electrolytebalance It is therefore not surprising that the kidney also is the main site ofelimination of xenobiotics, including drugs Although it constitutes only0.4% of total body weight, it takes 24% of the cardiac output It is a highlyefficient filter of blood
The basic physiological unit of the kidney is the nephron (see Figure 5),which is composed of the glomerulus (a tightly wound bundle of bloodvessels) and the tubule, which is closed at the glomerular end to provide asemi-permeable membrane The tubule is composed of several segmentswith different functions Substances smaller than 66,000 Daltons (Da) arepassed through the glomerulus They may be reabsorbed further down thetubule and even re-secreted This occurs with uric acid, which is completelypassed through the filter, 98% reabsorbed, and further secreted The pH ofurine will determine the degree of dissociation of acids and bases and, hence,influence their movement across the reabsorption sites Passive diffusionacross the distal tubule depends on the degree of ionization in the plasmaand extracellular fluid as only the lipid-soluble form will be diffused Thus,the concentration gradient is also an important rate-limiting factor Verywater-soluble agents are passed through the glomerulus if they are smallenough, and this is the reason why most biotransformations result inincreased water solubility Other substances are actively secreted (an energy-consuming process) at tubular sites (see Figure 5)
It should be noted that the lungs are a very important site of eliminationfor volatile substances, including solvents, alcohols, and volatile and gaseousanesthetics These can, in fact, be smelled on the breath, which can be animportant first-aid procedure to determine the cause of unconsciousness orstupor Ketoacidosis in diabetics can also be detected by the acetone-like
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odor on the breath Young diabetics have been suspected of glue sniffingwhen brought to an emergency department in a stupor or coma because ofthis fact
Many drugs and chemicals are excreted into the bile These tend to bepolar agents, both cationic and anionic, the latter including glucuronideconjugates Nonselective active transport systems, similar to those in thekidneys, are involved in the excretory processes Once they enter the smallintestine, these chemical metabolites can be excreted in the feces or reab-sorbed back into the bloodstream Enzymatic hydrolysis of glucuronide con-jugates favors a return to the more lipid-soluble state and hence reabsorption.The excretion of xenobiotics in mother’s milk may not be an importantroute of elimination, but it can have significance for toxicity in the infant.The chloracne rash associated with the now-obsolete bromide sedatives
Glomerulus
Passively filters out
molecules > mol wt.
66,000 Filtration rate
is dependent on blood pressure,
degree of protein binding.
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appears to be related to the secretion of this halogen in sweat It is distributed
in the body as chloride ion
Extensive batteries of enzymes in the body may render the chemicalnontoxic (detoxication), more water soluble, and hence more easily excreted,
or they may activate it to a toxic form (toxication) The liver is the primarysite of xenobiotic biotransformation in the mammalian body but it is by nomeans the only one Indeed, significant biotransformation can occur at theportal of entry The chemical pathways are often the same The response ofthe body to chemical insult also depends on the mitotic activity of the targettissue Rapidly dividing tissues allow little time for repair to occur beforecell division, so that the chance of a mutation is increased Moreover, tissuesthat regenerate poorly are vulnerable to permanent damage by toxicants
Pharmacodynamics
Ligand binding and receptors
Because only the molecules that are free in solution contribute to the centration gradient, their binding to tissue components or their chemicalalteration by tissue enzymes will contribute to the maintenance of the gra-dient The nature and strength of the chemical bond determines how easilythe xenobiotic will dissociate when the concentration gradient is reversed.Drugs interact with specific sites (receptors) on proteins such as plasmamembrane proteins, cytosolic enzymes, membranes on cell organelles, and
con-in some cases, nucleic acids (e.g., certacon-in antcon-ineoplastic drugs) Membranereceptors and enzymes have molecular configurations that will react onlywith certain molecules in a kind of “lock-and-key” manner Ease of revers-ibility is an important characteristic for most drugs, so that as concentration
of the free substance falls, the drug comes off the receptor and its effect isterminated This is often expressed by the equation:
The magnitude of the response is determined by the number (percentage)
of receptors occupied at any given time Neither the drug nor the receptor
In many cases, drugs and toxicants interact with receptors that normallyaccept physiological ligands such as neurotransmitters, hormones, ions, andnutritional elements The proteins of cell surface receptors can penetrate tothe interior of the cell in the case of ion channels and exchangers, or theycan connect with other proteins in the membrane to transduce signals Manyneurotransmitters operate through a family of receptors that share the prop-erty of connecting to a protein having seven membrane-spanning peptidechains These G proteins (G for guanosine triphosphate or GTP) are trans-ducers that interact with enzymes such as adenylcyclase or phospholipase
C to initiate intracellular second messengers G proteins may be inhibitory
Drug (D) + Receptor (R) DR complex Response
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seroto-nin, histamine, gamma-aminobutyric acid (GABA), glycine, and glutamicacid have been shown to act through G-protein receptors Many centrallyacting drugs work through these receptors
Steroid receptors also exist These are soluble cytosolic receptors thatbind to the steroid after it diffuses into the cell and carry it to the nucleus.Opioid receptors in the CNS (central nervous system) accept the endogenouspeptide endorphins and enkephalins These receptors are the site of action
of the narcotic analgesics
Any receptor is a potential target for a toxicant interaction A specialcase is the aryl hydrocarbon, or Ah, receptor This cytosolic receptor binds
to aromatic hydrocarbons such as dioxins and it is believed that it is involved
in their toxicity No natural ligand for this receptor has yet been identified
in mammals This subject is discussed in detail in Chapter 5 on halogenatedhydrocarbons
The chemical bond with the target receptor can involve covalent bonds,
as well as non-covalent bonds including ionic, hydrogen, and van der Waal’sforces If the xenobiotic interacts irreversibly with a component of a cell, theeffect may be long-lasting Indeed, irreversibility of effect is an importantcharacteristic of many toxicants (organophosphorus insecticides are exam-ples of irreversible inhibitors of the enzyme acetylcholinesterase) If a chem-ical reacts irreversibly with DNA, a mutation may result in carcinogenesis
or teratogenesis This effect is sometimes described as “hit-and-run” because
it is unrelated to any measurable concentration of the agent in the serum(see below)
Irreversibility of binding does not always mean irreversibility of effect.The drug acetylsalicylic acid (aspirin) is an irreversible inhibitor of theenzyme cyclooxygenase, which accounts for many of its pharmacologicalactions Provided that exposure to aspirin is terminated, the effect declines
as new enzyme is synthesized
Biological variation and data manipulation
Within any given population of organisms, there will be some that willrespond to a drug or toxicant at the lowest concentration, others that onlyrespond at the very highest concentration, but most subjects will be groupedaround the mean response This is true of all organisms, including humanbeings and single-celled ones It is even true of populations of like cells (livercells, kidney cells, and blood cells) within the body, and may partly explainwhy some cells may become malignant while others do not It is the existence
of biological variation that necessitates the use of large populations of testsubjects and the development of mathematical treatments of data to permitthe comparison of different populations of test subjects If the responses ofthe species in question are grouped symmetrically about the mean response,
a “normal” or Gaussian distribution curve is obtained (see Figure 6) In this
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case, 68.3% of the population will fall within plus or minus one standarddeviation (±1 SD) of the arithmetic mean, 95.5% between ±2 SD, and 99.7%between ±3 SD A data point lying outside these limits is assumed not tobelong to the test population Sometimes the population is skewed, withmore subjects falling on one side of the mean than on the other Factorsaccounting for variability could include differences in the rate and degree
of uptake, distribution, biotransformation, excretion, and even the natureand number of binding sites and receptors for the agent These factors may
be under genetic control or they may be due to environmental differences
in such things as temperature, nutrition, disease, the presence of other biotics including medications, etc They also tend to vary with age and sex
dose-dependent response There is another type of response that can be
is an example For graded responses, it is important to establish standard
100 90 80 70 60 50 40 30 20 10 0
Normal (Gaussian) Distribution of a Population Responding to Different Drug Doses
Dose of Drug Increasing to Right
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points of comparison because comparing a dose at the low end of theresponse for one chemical with one at the top end for another is not statis-tically reliable The point usually chosen is that dose which produces 50%
to the test subjects and “concentration” when it is added to the surroundingmedium, such as the water in an aquarium or the fluid bathing an isolatedtissue in an organ bath
A quantal response can be converted to a graded one using several testgroups, each receiving a different dose of the agent being tested The percent
of animals showing the expected response can then be plotted against dose.Thus, one can calculate the dose that, on average, will kill 50% of the test
Lethal Dose Values such as the LD1 and the LD10 are replacing the LD50 inmany jurisdictions
In attempting to compare responses to two different chemicals, it isuseful to perform a mathematical manipulation on the data so that differ-ences or similarities in the shapes of the dose response curves are moreobvious This involves plotting the logarithm of the dose against theresponse, and this converts the exponential curve shown in Figure 7 to thesigmoidal one (S-shaped) shown in Figure 8
doses might not have included it) and to compare these points Using thelog of the dose tends to overcome the fact that large increases in dose result
Dose (eg mg/kg body weight)
A Graded Dose Response to a Drug i.e., % Maximal Response vs Dose
0 0 10 20 30 40 50 60 70 80 90
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in small increases in response on the right side of the curve, whereas small
increases in dose result in large increases in response on the left side of the
reliability Parallel slopes of curves suggest similar mechanisms of action,
and comparisons based on molar concentrations provide information on
relative potencies Toxicity comparisons can be done by calculating the
Ther-apeutic Index (TI) if the substance is a therTher-apeutic agent This is the
safety, more appropriate to toxicity studies of nontherapeutic agents, involve
It is important to note that all toxicity tests contain a temporal factor in
that the determination of toxic effects is conducted at a specific time after
exposure Acute toxicity studies generally involve determinations made
72 hr after a single high dose, whereas long-term toxicity requires multiple
exposures with measurements made at least 28 days later These studies are
defined by government regulations in jurisdictions where there is a legal
requirement for testing new chemicals
Another value that is frequently used is NOEL (or NOAEL), the No
Observable (Adverse) Effect Level The NOEL includes effects, such as minor
weight loss, that are not considered to be adverse These values are applicable
only to that species in which the test was conducted Extrapolation to other
species will require dosage adjustment
2030405060708090100
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Probit analysis
It is often desirable to compare the toxicity of one xenobiotic to that of
another This information may help to determine whether a substance used
commercially or industrially can be replaced with a safer one, or whether
a metabolite of a parent compound is more or less toxic than the compound
itself For this purpose, probit analysis is often used When a toxic reaction
is expressed as the number of experimental animals in a group displaying
that reaction (e.g., kidney failure), the percent of a group responding to a
given dose (or exposure) can be expressed as units of deviation from the
mean These are called normal equivalent deviations (NEDs) The NED for
the group in which there were 50% responders would be zero because it
lies right on the mean A NED of +1 corresponds to 84.1% responders
NEDs are positive or negative relative to the mean; thus, a value of 5 is
added to each to make them all positive The result is called a probit (for
probability unit) Table 1 shows the equivalent probits and NEDs for given
percent responses
When quantal data are plotted as probit units against the log of the dose,
a straight line results, regardless of whether the original data were distributed
normally or skewed The method, in fact, assumes that the data were
distrib-uted normally It is now easier to compare the quantal data for two different
xenobiotics exhibiting the same toxic manifestation (or their lethality) These
concepts apply equally to toxicological studies in mammals and in
nonmam-malian species The following example illustrates these concepts using
hypo-thetical toxicity data (see Table 2) for two toxicants tested in fathead minnows
(0.25–0.5 g) Each test group consisted of 100 fish Values listed are mg/L
concentration in water Tables are available for conversion to probits
When using aquatic or marine organisms for toxicity studies, it is
impor-tant to remember that they are continuously exposed to a given concentration
of the test substance, but they may not take it up instantly or even rapidly
A consistent time of exposure must therefore be incorporated into the
exper-imental design Figures 9 through 11 illustrate arithmetic, semi-logarithmic,
and probit plots for these data
% Responding NED Probit