A Review of Probiotic Ingredient Safety Supporting Monograph Development Conducted by the United States Pharmacopeia (USP)

The United States Pharmacopeia (USP) is an independent, nonprofit science-based organization whose mission is to improve global health through public standards and related products for medicines, food and dietary supplements. Probiotic-based dietary supplements are increasingly popular in the marketplace and USP has developed fourteen monographs specific to probiotic ingredients, including representatives from the Genera Lactobacillus, Bacillus, Streptococcus, and Bifidobacterium. These monographs include the definition of the article, tests for identification, quantification assays (enumeration in the case of probiotics), limits for contaminants, and other quality parameters when appropriate. In addition to quality, the USP also considers the safety of probiotics for monograph development. This report includes an overview of the USP admission evaluation process for probiotics as well as a tabular summary of the probiotic monographs currently available. Pharmacopeia monographs can guide manufacturers and brand owners and protect consumers through establishment of quality standards.

Improving the rigor and utility of botanical toxicity studies: Recommended resources

Interest in botanicals, particularly as dietary supplement ingredients, is growing steadily. This growth, and the marketing of new ingredients and combination products as botanical dietary supplements, underscores the public health need for a better understanding of potential toxicities associated with use of these products. This article and accompanying template outline the resources to collect literature and relevant information to support the design of botanical toxicity studies. These resources provide critical information related to botanical identification, characterization, pre-clinical and clinical data, including adverse effects and interactions with pharmaceuticals. Toxicologists using these resources should collaborate with pharmacognosists and/or analytical chemists to enhance knowledge of the botanical material being tested. Overall, this guide and resource list is meant to help locate relevant information that can be leveraged to inform on decisions related to toxicity testing of botanicals, including the design of higher quality toxicological studies.

Dietary Supplements as Source of Unintentional Doping

Background

The substances used in sport could be divided into two major groups: those banned by the World Anti-Doping Agency and those which are not. The prohibited list is extremely detailed and includes a wide variety of both medicinal and nonmedicinal substances. Professional athletes are exposed to intense physical overload every day. They follow a relevant food regime and take specific dietary supplements, which is essential for the better recovery between trainings and competitions. However, the use of “nonprohibited” dietary supplements (DS) is not always completely safe. One of the risks associated with the use of dietary supplements is the risk of unintended doping—originating from contaminated products. The presence of undeclared compounds in the composition of DS is a serious concern. The aim of this study is to evaluate the risk of unintentional doping.

Materials and Methods

Literature search was done through PubMed, Science Direct, Google Scholar, and Web of Science. Studies investigating the presence of undeclared compounds, in dietary supplements, banned by WADA met the inclusion criteria. The last search was conducted in June 2021. The present review is based on a total of 50 studies, which investigated the presence of undeclared compounds in DS.

Results

The total number of analyzed DS is 3132, 875 of which were found to contain undeclared substances. Most frequently found undeclared substances are sibutramine and anabolic-androgenic steroids.

Conclusion

More than 28% of the analyzed dietary supplements pose a potential risk of unintentional doping. Athletes and their teams need to be aware of the issues associated with the use of DS. They should take great care before inclusion of DS in the supplementation regime.

United States Pharmacopeia comprehensive safety review of Styphnolobium japonicum flower and flower bud

The dried flower and flower bud of Styphnolobium japonicum (L.) Schott (Japanese Sophora flower and Japanese Sophora flower bud, respectively) have long been used as herbal medicines in Asia. Today, they are marketed as dietary supplements in the United States for their anti-oxidative properties and as a source of flavonoids, including rutin and quercetin. This review focused on the safety of S. japonicum flower and flower bud as dietary supplement ingredients. No serious adverse events or toxicity were reported in the clinical or experimental animal studies we reviewed. Although some studies indicated that rutin or quercetin may have potential for drug interactions, none were identified for S. japonicum flower or flower bud. S. japonicum flower and flower bud are not known to have been associated with serious health risks when appropriately consumed in dietary supplements and have been admitted to the U.S. Pharmacopeial Convention monograph development process. However, pregnant and breastfeeding women should seek the advice of a healthcare professional because no data are available on their use by these special populations.

Safety of Cranberry: Evaluation of Evidence of Kidney Stone Formation and Botanical Drug-Interactions

Cranberry is a popular ingredient in dietary supplements in the U. S. and is commonly used for preventing urinary tract infections. Because of its popularity in dietary supplements, the U. S. Pharmacopeial Convention has developed quality standards for cranberry ingredients. The purpose of this review was to determine if there are safety issues that should preclude the admission of cranberry ingredients from the development of U. S. Pharmacopeial Convention quality standards. Based on the totality of the data, the U. S. Pharmacopeial Convention concluded that cranberry ingredients are not known to be associated with serious risks to human health when consumed properly in dietary supplements and therefore were admitted for standard development. Although published clinical and animal data indicated that cranberry is not associated with serious adverse effects, interactions with warfarin and kidney stone formation were identified as potential risks. Studies have reported contradictory data regarding the role of cranberry in kidney stone formation, with some reports suggesting cranberry is associated with a reduced risk of kidney stones. Interactions with warfarin were not associated with moderate intakes of cranberry juice (240 - 480 mL). Some reports suggested that the potential for warfarin interactions requires excessive intakes of cranberry juice (1 - 2 L/day) or cranberry extracts (3000 mg/day). Cases of warfarin interactions with cranberry have mostly involved patients with serious illnesses and/or individuals taking concomitant medications. Based on these findings, the U. S. Pharmacopeial Convention concluded that the use of cautionary labeling statements regarding interactions with warfarin or kidney stone formation is not necessary in the development of quality standards for cranberry ingredients.

Deep learning approaches for extracting adverse events and indications of dietary supplements from clinical text

OBJECTIVE

We sought to demonstrate the feasibility of utilizing deep learning models to extract safety signals related to the use of dietary supplements (DSs) in clinical text.

MATERIALS AND METHODS

Two tasks were performed in this study. For the named entity recognition (NER) task, Bi-LSTM-CRF (bidirectional long short-term memory conditional random field) and BERT (bidirectional encoder representations from transformers) models were trained and compared with CRF model as a baseline to recognize the named entities of DSs and events from clinical notes. In the relation extraction (RE) task, 2 deep learning models, including attention-based Bi-LSTM and convolutional neural network as well as a random forest model were trained to extract the relations between DSs and events, which were categorized into 3 classes: positive (ie, indication), negative (ie, adverse events), and not related. The best performed NER and RE models were further applied on clinical notes mentioning 88 DSs for discovering DSs adverse events and indications, which were compared with a DS knowledge base.

RESULTS

For the NER task, deep learning models achieved a better performance than CRF, with F1 scores above 0.860. The attention-based Bi-LSTM model performed the best in the RE task, with an F1 score of 0.893. When comparing DS event pairs generated by the deep learning models with the knowledge base for DSs and event, we found both known and unknown pairs.

CONCLUSIONS

Deep learning models can detect adverse events and indication of DSs in clinical notes, which hold great potential for monitoring the safety of DS use.

Contaminants: a dark side of food supplements?

Food supplements (FS) are often consumed as one of the strategies to fight ageing-associated pathologies, especially in the case of oxidative stress-related diseases. Despite the popularity of FS, some concerns about their quality and safety have been raised, especially regarding the presence of contaminants. This paper reviews and discusses the occurrence of contaminants in marketed samples of FS in the last two decades, considering both scientific literature and notifications registered on RASFF portal. The most relevant classes of contaminants were included namely metals, toxins, pesticides, dioxins and PCBs, as well as pharmacologically active ingredients. Variable amounts of contaminants were reported in a significant number of commercially available FS. Although the presence of contaminants does not necessarily mean that their levels exceed the regulatory limits or that the FS intake constitutes a risk to human health, it alerts for the need to further monitor FS safety. The evaluation of the risk associated to the consumption of FS, especially in the elderly population, is particularly challenging due to the frequent exposure to multiple toxicants and to different exposure sources, as well as due to possible pre-existing diseases and respective therapeutics. Therefore, improved quality control procedures and monitoring programs should be pursued in order to avoid undesirable products and assure the safety of FS.