The effects of multiple administrations of sevoflurane to cynomolgus monkeys: clinical pathologic, hematologic, and pathologic study

The effect of multiple administrations of sevoflurane was evaluated by several measures of toxicity. Cynomolgus monkeys assigned to a control group and three treatment groups were anesthetized with sevoflurane at 1.0, 1.6, and 2.0 times the minimum alveolar anesthetic concentration (MAC) for 3 h/day, 3 days/wk for 8 wk. Reductions in total erythrocyte and leukocyte counts and increases in serum enzymes were the only changes noted. The increases in the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactic dehydrogenase (LDH), and creatinine kinase (CK), occurred at Week 1 at all three concentrations of sevoflurane. These increases were dose-related, and returned to baseline by Week 2 for 1.0 MAC. All serum enzyme concentrations had returned to baseline by the end of the study. There were no gross pathologic, histopathologic, or ultrastructural differences found in any of the four groups of monkeys. At 2.0 MAC, three deaths occurred. The multiple administrations of 1.0 and 1.6 MAC sevoflurane anesthesia were well tolerated by the monkeys. The techniques of this study did not detect adverse effects from the above enzyme changes.

Mutagenicity and cytotoxicity of 2-butoxyethanol and its metabolite, 2-butoxyacetaldehyde, in Chinese hamster ovary (CHO-AS52) cells

2-Methoxyethanol (2-ME) is being substituted by 2-butoxyethanol (2-BE) as a solvent for the preparation of industrial and consumer products. Since we have shown that a metabolite of 2-methoxyethanol, methoxyacetaldehyde (MALD), is mutagenic in a subline of Chinese hamster ovary cells (CHO-AS52), we have conducted a similar study using 2-BE and its metabolite, butoxyacetaldehyde (BALD). The results indicate that 2-BE and BALD are not mutagenic to CHO-AS52 cells. However, 2-BE is more cytotoxic than 2-ME. In comparison of our study with others on glycol ethers, the data indicate that, for glycol ethers, cytotoxicity increased with chain length of the alkyl groups. For their metabolites, mutagenicity increases with reduced chain length. Therefore, we suggest that safer solvents should be developed for use in preparation of products.

Nephrotoxicity of sevoflurane compound A [fluoromethyl-2,2-difluoro-1-(trifluoromethyl)vinyl ether] in rats: evidence for glutathione and cysteine conjugate formation and the role of renal cysteine conjugate beta-lyase

Compound A, which is a breakdown product of the volatile anesthetic sevoflurane, is nephrotoxic in rats, although the mechanism of this toxicity is unknown. In the present investigation, the role of glutathione conjugation, glutathione conjugate processing to cysteine conjugates, and renal cysteine conjugate beta-lyase in the pathogenesis of Compound A nephrotoxicity was investigated in the rat. Following intraperitoneal administration of Compound A (1 mmol/kg), the presence of bile of two types of Compound A-glutathione conjugates, and the urinary excretion of two types of Compound A-mercapturic acid conjugates, was demonstrated by ionspray-tandem mass spectrometry. Aminooxyacetic acid, a competitive inhibitor of renal cysteine conjugate beta-lyase, partially protected against Compound A-induced diuresis and proteinuria. These results suggest that glutathione conjugate formation, subsequent processing to cysteine conjugates, and cysteine conjugate metabolism by renal beta-lyase may be important factors in the pathogenesis of Compound A-mediated nephrotoxicity in rats.

Summary of the carcinogenicity assessment of MTBE conducted by the Secretary's Scientific Advisory Board on Toxic Air Pollutants

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Misunderstood MTBE

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Depletion of glutathione and hepato-toxicity caused by vinyl ethers in mice

4-Nitrophenyl vinyl ether (NPVE) and phenyl vinyl ether (PVE) administered i.p. in mice lowered hepatic non-protein sulfhydryl (NP-SH) content, but did not elevate the serum glutamate pyruvate transaminase (GPT) activity. n-Butyl vinyl ether (BVE) showed no significant effects either on the NP-SH content or on the serum GP activity. Mice pretreated with buthionine sulfoximine were sensitive to the potential toxicity of NPVE. These results showed that aryl vinyl ethers, NPVE and PVE, are more toxic than the alkyl vinyl ether, BVE, and that glutathione plays an important role on the protection of hepatic injury by reactive metabolite(s) derived from vinyl ethers.

Histopathological changes in the respiratory tract of mice exposed to ten families of airborne chemicals

The objective of this experimental work was to identify and compare the histopathological changes induced in the respiratory tract of Swiss mice exposed to repeated inhalation (4, 9 or 14 days) at typical concentrations of RD50, 0.3 x RD50 and 3 x RD50 of airborne chemicals. These substances were selected from ten chemical families: aldehydes, organic acids, alcohols, ketones, ethers, aromatic hydrocarbons, halogenated aromatic hydrocarbons, inorganic bases, amines and isocyanates. These experiments showed that the lesion intensity observed in the nasal passages varied with exposure duration and type of airborne chemical, but did not depend on the concentration of the substance. Results did not allow us to establish a relationship between the histopathological changes and the type of chemical family. No injuries were observed in trachea and lungs.

Toxic effects of cholelitholytic solvents on gallbladder and liver. A piglet model study

We evaluated the toxic effects of four currently used chemolytic solvents--dimethyl sulfoxide (DMSO, 99%), ethyl propionate (EP, 99%), tetrasodium ethyl-dimethyl tetraacetate (4Na-EDTA, 2%, pH 11), and methyl tert-butyl ether (MTBE, purity = 99.5%) in an animal model. Each solvent was tested in nine farm piglets (Landrace), weighing between 20 and 25 kg. A solvent-resistant catheter was inserted transhepatically into the gallbladder (GB) using sonographic guidance 24 hr prior to each experiment. Seventy-five milliliters of each solvent was infused over 3 hr into the gallbladder. The following day, a laparotomy was performed in order to assess for possible damage to the liver, GB, bile ducts (BD), or intestines. The GB and liver were resected and their histology examined. The following pathologic grades were assigned to GB, BD, and liver specimens to describe the tissue damage: normal (0), mild (1), moderate (2), and severe (3). We found that DMSO had the highest score on gallbladder and bile duct injury (49, 3), followed by EP (36, 2), EDTA (14, 1) and MTBE (16, 0), respectively; the difference in gallbladder damage was statistically significant. Very mild hepatocyte damage was present in the DMSO (2) and MTBE (2) groups. The administration of EP and EDTA resulted in no liver injury at all. Piglets within each treatment group suffered from varying degrees of tissue injury. No deaths were attributed to the administered solvents. We concluded that DMSO, EP, EDTA, and MTBE do not have serious local toxic effect on the GB, BD, and intestine; nor do they lead to severe hepatotoxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Mutagenicity of ethylene glycol ethers and of their metabolites in Salmonella typhimurium his-

Ethylene glycol ethers, their aldehyde and their acid metabolites were evaluated for their mutagenicity with the Ames test. The Salmonella typhimurium his- tester strains TA 97a, TA 98, TA 100 and TA 102 were used with and without rat S9 mix. Ethylene glycol monomethyl ether, ethylene glycol monoethyl ether, ethylene glycol n-butyl ether and their corresponding aldehyde and acid derivatives were tested up to 10(-4) mol/plate (around 10 mg/plate) or up to cytotoxic concentrations. All tested substances gave negative results with TA 98, TA 100 and TA 102 either with or without S9 mix. In contrast, ethylene glycol n-butyl ether (EGBE) and the aldehyde metabolite of ethylene glycol monomethyl ether, methoxyacetaldehyde (MALD), displayed mutagenic potency in strain TA 97a with and without S9 mix at high concentrations. A significant number of revertants was obtained from 19 mumol/plate EGBE (2.2 mg/plate) and from 34 mumol/plate MALD (2.5 mg/plate). At these concentrations the level of revertants reached up to 7-fold and 3-fold the control values for EGBE and MALD respectively.

In vivo and in vitro sevoflurane-induced lipid peroxidation in guinea-pig liver microsomes

Sevoflurane is a recently introduced volatile inhalation anaesthetic and is already used commonly in Japan. We investigated the potential of sevoflurane to cause lipid peroxidation in vivo and in vitro. For the in vitro study, pentane formation in a mixture of guinea pig liver microsomes and sevoflurane in the presence of nicotinamide adenine dinucleotide phosphate (NADPH) was analyzed by gas chromatography. Under anaerobic conditions, pentane formed without sevoflurane, but sevoflurane potentiated this anaerobic pentane formation. Two antioxidant agents, vitamine E and glutathione, reduced the pentane formation induced by sevoflurane. In the in vivo study, 18 guinea pigs were exposed to air (control), 0.5% halothane, or 1.2% sevoflurane. The extent of lipid peroxidation and liver damage was investigated by measuring the level of thiobarbituric acid reactive products and serum transaminase (alanine-aminotransferase: ALAT and aspartate-aminotransferase: ASAT) activity 12 hr after exposure. Both halothane and sevoflurane significantly increased thiobarbituric acid-reactive products. The increase in thiobarbituric acid-reactive products seen with sevoflurane administration was half that seen with halothane. Sevoflurane increased the ALAT activity to the same extent as did halothane but did not increase the ASAT activity. We conclude that sevoflurane potentiates lipid peroxidation in guinea pig liver microsomes in vivo and in vitro. However, because the degree of liver damage as measured by transaminase activity was minimal and the mechanism of sevoflurane-induced lipid peroxidation is still unknown, we must be cautious in applying these results to humans.

[Analysis of acute toxicity (LD50-value) of organic chemicals to mammals by solubility parameter (delta) (3). Acute dermal toxicity to rabbits]

Acute dermal toxicity (LD50-value) of organic chemicals to rabbits was analyzed by using solubility parameter (delta c), a thermodynamic parameter, of the chemicals. As it was observed in the previous studies with rats and mice, parabolic correlations were also established between logarithm of LD50-value (mmol/kg body weight, rabbits) and delta c of all the collected chemicals (n = 56, R = 0.498), alcohols (n = 19, R = 0.857), ketones (n = 7, R = 0.711), aldehydes (n = 7, R = 0.633) and aromatics (n = 20, R = 0.613). Introduction of molar volume (Vc) to the above equations did not improve the correlations. In the study, we assumed that chemicals absorbed dermally by the mammals similarly disturb the homeostasis, as in acute oral toxicities of organic chemicals to rats and mice. We successfully confirmed the theoretical equation regardless of species and routes of administration by establishing statistically significant correlations with all the collected chemicals, alcohols and aromatics. By analysis, we could determine the solubility parameter of 2.24 x 10(4) (J/m3)1/2 for the biological membrane (absorption site) of rabbits. As the dermal delta c-values which dip the LD50-values for rabbits are approximately the same as in acute oral toxicities with rats and mice, common deleterious effects and mechanism may be working at the common target sites. The regression curves of LD50-values of rabbits, however, are slightly higher than those of rats and mice, which may reflect the difference in amounts of the chemicals absorbed by the body.(ABSTRACT TRUNCATED AT 250 WORDS)

[Analysis of acute toxicity (LD50-value) of organic chemicals to mammals by solubility parameter (delta). (1) Acute oral toxicity to rats]

Acute oral toxicity (LD50-value) of organic chemicals to rats was analyzed by using solubility parameter (delta c), a thermodynamic parameter, of the chemicals. Certain parabolic correlations were established between logarithm of LD50-value (mmol/kg body weight, rats) and delta c of all the collected chemicals (n = 144, R = 0.578), alcohols (n = 29, R = 0.587), ketones (n = 7, R = 0.962), aldehydes (n = 9, R = 0.621), ethers (n = 5, R = 0.890), acetates (n = 7, R = 0.670) and aromatics (n = 84, R = 0.736). Introducing molar volume (Vc) to the above equations could not improve the correlation. In the study, we assumed that as for acute toxicity, chemicals taken into the mammals through biological membrane first disturb the homeostasis, which causes certain biological reactions (i.e. death) and that amounts of the chemicals intaken are regulated by their solubility in the membrane. Based on the assumption, we drew a theoretical equation, which describes LD50 by a parabolic function of delta c. A regression analysis using the equation gave significant correlations as stated above, which incarnates the assumption. A solubility parameter of 2.30 x 10(4) (J/m3)1/2 was also determined for the biological membrane (absorption site) of rats. For comparison, log P was used to describe LD50 of all the chemicals, but no correlation was established (R = 0.164-0.443).

Clinical toxicology of ethylene glycol monoalkyl ethers

The glycol ethers constitute a family of organic solvents commonly found in industrial and household products. Because of their widespread availability and potential for serious toxicity, physicians should be aware of the clinical toxicology of these compounds. Until recently, knowledge of the toxic effects of glycol ethers has been derived from animal studies and a limited number of case reports and small case series. A growing body of data from epidemiological studies, controlled human studies, and studies using human tissue now allows for advancement in the understanding of the acute and chronic toxicity of these compounds. This review summarizes and evaluates human and pertinent animal literature on the clinical toxicology of glycol ethers, with a focus on the commonly encountered monoalkyl ethers of ethylene glycol. Management options for acute poisoning, as well as measures for the control of workplace exposures, are discussed.

Toxicity of compound A in rats. Effect of increasing duration of administration

BACKGROUND

An olefin called compound A (CF2 = C(CF3)OCH2F) results from the action of soda lime or Baralyme on sevoflurane. We have demonstrated that rats exposed to the olefin for 3 h died at or were injured by olefin concentrations lower than those previously reported to produce these effects. The present report examines the impact of duration of exposure to the olefin on such effects.

METHODS

Twenty-three groups of ten Wistar rats breathed 0, 12.5, 25, 50, 75, 100, 125, 150, 175, 200, 225, and 250 ppm of the olefin in oxygen for 6 or 12 h. Rats that survived were killed on day 1 or day 4 after breathing the olefin, and specimens of brain, kidney, lung, liver, and small intestine were obtained from all rats for examination by microscopy using hematoxylin and eosin stain and a stain (proliferating cell nuclear antigen) for cell growth (regeneration).

RESULTS

The lethal concentrations in 50% of rats equaled 203 +/- 4 ppm (mean +/- SE) for a 6-h exposure period and 127 +/- 9 ppm for a 12-h exposure period, and both values were less than the previously determined value of 331 +/- 7 ppm for a 3-h exposure period. Compared with results from control rats (those breathing oxygen for 6 h or 12 h), only renal and pulmonary injury were found. Pulmonary injury only occurred at near-lethal concentrations. Renal injury (defined as necrosis of the outer stripe of the outer medullary layer or corticomedullary junction necrosis) occurred at and above 25-50 ppm for 6-h and 12-h exposures, respectively, a result similar to that previously obtained with a 3-h exposure. Exposure to 25-50 ppm stimulated cell regeneration in a dose-related manner.

CONCLUSIONS

In rats, lethal concentrations of the olefin and concentrations producing severe renal injury are inversely related to the duration of exposure to the olefin, exceeding by two- to fourfold peak concentrations that can be obtained in clinical practice. The threshold concentrations for nephrotoxicity (i.e., minimal toxicity) equal concentrations that can be produced in clinical practice. However, even if these threshold effects in rats apply to humans, they probably would not alter renal function. Although dose-related, neither the lethal nor the toxic effects are simply a function of cumulative dose (concentration-time).

Toxicity of compound A in rats. Effect of a 3-hour administration

BACKGROUND

Soda lime converts sevoflurane to CF2 = C(CF3)OCH2F, an olefin called compound A, whose toxicity raises concerns regarding the safe administration of sevoflurane via rebreathing circuits. The present report extends the findings of a previous investigation by others of the toxicity of this olefin, and establishes concentration-response relationships for such toxicity.

METHODS

Eighteen groups of ten Wistar rats breathed 0, 25, 50, 100, 200, 300, 350, and 400 ppm of the olefin in oxygen for 3 h. The olefin concentrations were developed in a square-wave manner by injection of saturated vapor followed by a continuous delivery of dilute vapor. The lethal concentration in 50% (LC50) of animals was estimated by logistic regression. Rats were killed on day 1 or day 4 after breathing the olefin, and specimens of brain, kidney, lung, liver, and small intestine were obtained from all rats for examination using light microscopy.

RESULTS

The LC50 equaled 331 ppm (95% confidence limits +/- 13 ppm). No injury resulted to lung or small intestine in either the experimental or the control group (those breathing only oxygen for 3 h). Renal injury (necrosis of the outer strip of the outer medulla, defined in this report as corticomedullary tubular necrosis) occurred at 50 ppm and greater; hepatic injury at 350 ppm and greater; and cerebral injury only at 400 ppm.

CONCLUSIONS

The lethal concentration and the threshold for toxicity of the olefin are less than previously reported. The threshold for nephrotoxicity reaches the range of values for the olefin that have been attained in clinical practice. Further studies are required to determine whether these results in rats can be extrapolated to patients.

Immunosuppressive effects of highly chlorinated biphenyls and diphenyl ethers on T-cell dependent and independent antigens in mice

The dose-dependent effects of 2,2',3,3',4,4',5,5',6-nonachlorobiphenyl (nonaCB), 2,2',3,3',4,4',5,6,6'-nonaCB, 2,2',3,3',4,5,5',6,6'-nonaCB and decaCB on the suppression of the splenic plaque-forming cell (PFC) response to the T-cell-dependent antigen, sheep red blood cells (SRBCs) and the T-cell-independent antigen, trinitrophenyl-lipopolysaccharide (TNP-LPS), were determined in genetically inbred mice. In addition, the induction of hepatic microsomal ethoxyresorufin O-deethylase (EROD) activity was also measured. The highly chlorinated biphenyls suppressed the splenic PFC response to SRBCs in C57BL/6 and DBA/2 mice and were relatively more active in the former strain. The C57BL/6 mice are more responsive to aryl hydrocarbon (Ah) receptor agonists than DBA/2 mice and these data support a possible role for the Ah receptor in mediating this response. However, previous studies with polychlorinated biphenyls (PCBs) indicate that congeners with 3 or 4 ortho-chloro substituents are inactive as Ah receptor agonists and this was consistent with the minimal induction of hepatic microsomal EROD activity by the highly chlorinated biphenyls in both strains of mice. Thus, the results suggest that the inhibition of the splenic PFC response to SRBCs observed in this study was primarily an Ah receptor-independent response. Some of the highly chlorinated diphyenyl ethers namely decachlorodiphenyl ether and 2,2',3,3',4,4',5,6,6'-nonachlorodiphenyl ether, inhibited the antigenic response to TNP-LPS in C57 BL/6 mice. The results indicate that the suppression of the TNP-LPS-mediated immune response may be a more reliable indicator of the Ah receptor-dependent immunotoxicity of halogenated hydrocarbons.

Health effects of oxygenated fuels

The use of oxygenated fuels is anticipated to increase over the next decades. This paper reviews the toxicological and exposure information for methyl tertiary-butyl ether (MTBE), a fuel additive, and methanol, a replacement fuel, and discusses the possible health consequences of exposure of the general public to these compounds. For MTBE, the health effects information available is derived almost exclusively from rodent studies, and the exposure data are limited to a few measurements at some service stations. Based on these data, it appears unlikely that the normal population is at high risk of exposure to MTBE vapor. However, in the absence of health and pharmacokinetic data in humans or in nonhuman primates, this conclusion is not strongly supported. Similarly, there are a number of uncertainties to take into consideration in estimating human risk from the use of methanol as a fuel. Although methanol may be toxic to humans at concentrations that overwhelm certain enzymes involved in methanol metabolism, the data available provide little evidence to indicate that exposure to methanol vapors from the use of methanol as a motor vehicle fuel will result in adverse health effects. The uncertainties in this conclusion are based on the lack of information on dose-response relationship at reasonable, projected exposure levels and of studies examining end points of concern in sensitive species. In developing a quantitative risk assessment, more needs to be known about health effects in primates or humans and the range of exposure expected for the general public for both compounds.

Reaction of sevoflurane and its degradation products with soda lime. Toxicity of the byproducts

Sevoflurane previously has been reported to undergo extensive degradation in the presence of soda lime. To more completely characterize the extent and significnce of this reaction, we studied degradation of sevoflurane with and without soda lime, as well as the toxicity and mutagenicity of the degradation products. Two degradation products detected were CF2 = C(CF3)OCH2F (compound A) and CH3OCF2CH(CF3)OCH2F (compound B). During circulation of 1%, 2%, and 3% sevoflurance in a closed anesthesia circuit for 8 h, peak concentrations of compound A were 13.3 +/- 0.27, 30.2 +/- 0.10, and 42.1 +/- 1.07 ppm at 2 h, respectively. The concentrations of compound B did not exceed 2 ppm. The temperature of the soda lime was 43.3 +/- 2.8 degrees C at 1 h and increased gradually to 47.9 +/- 1.5 degrees C after 8 h. In closed flasks with soda lime, the magnitude of the decrease in sevoflurance concentrations (3%) and of the increase in compound A concentrations was temperature dependent. The peak concentrations of compound A at 23 degrees C, 37 degrees C, and 54 degrees C were 32.8 +/- 6.8 at 2 h, 46.6 +/- 1.0 at 0.5 h, and 78.5 +/- 2.3 ppm at 0.5 h, respectively. The LC50 (50% lethal concentration) of compound A in Wistar rats was 1,090 ppm in males and 1,050 ppm in females exposed for 1 h. The LC50 was 420 ppm in males and 400 ppm in females exposed for 3 h. The chronic toxicity of compound A in Wistar rats was studied by exposing rats 24 times, for 3 h each, to initial concentrations of 30, 60, or 120 ppm in a ventilated chamber. At all concentrations, there were no apparent effects other than a loss of body weight in females (120 ppm) on the final day (P < 0.01). Compound A did not induce mutation on the reverse (Ames) test at less than 2,500 micrograms/dish (culture medium 2.7 ml) with activation by S-9 mixture, and below 1,250 micrograms/dish (culture medium 2.7 ml) without activation, in four strains of S. typhimurium and in 1 strain of E. coli. Exposure of fibroblasts to 7,500 ppm of compound A for 1 h, compound A did not induce structural change. In a study of acute toxicity of compound B, there was no toxicity in Wistar rats after 3 h of exposure at 2,400 ppm. The reverse (Ames) test for compound B was negative at 625-1,250 micrograms/dish.(ABSTRACT TRUNCATED AT 400 WORDS)