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vom Saal FS, Antoniou M, Belcher SM, Bergman A, Bhandari RK, Birnbaum LS, Cohen A, Collins TJ, Demeneix B, Fine AM, Flaws JA, Gayrard V, Goodson WH, Gore AC, Heindel JJ, Hunt PA, Iguchi T, Kassotis CD, Kortenkamp A, Mesnage R, Muncke J, Myers JP, Nadal A, Newbold RR, Padmanabhan V, Palanza P, Palma Z, Parmigiani S, Patrick L, Prins GS, Rosenfeld CS, Skakkebaek NE, Sonnenschein C, Soto AM, Swan SH, Taylor JA, Toutain PL, von Hippel FA, Welshons WV, Zalko D, Zoeller RT. The Conflict between Regulatory Agencies over the 20,000-Fold Lowering of the Tolerable Daily Intake (TDI) for Bisphenol A (BPA) by the European Food Safety Authority (EFSA). ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:45001. [PMID: 38592230 PMCID: PMC11003459 DOI: 10.1289/ehp13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The European Food Safety Authority (EFSA) recommended lowering their estimated tolerable daily intake (TDI) for bisphenol A (BPA) 20,000-fold to 0.2 ng / kg body weight ( BW ) / day . BPA is an extensively studied high production volume endocrine disrupting chemical (EDC) associated with a vast array of diseases. Prior risk assessments of BPA by EFSA as well as the US Food and Drug Administration (FDA) have relied on industry-funded studies conducted under good laboratory practice protocols (GLP) requiring guideline end points and detailed record keeping, while also claiming to examine (but rejecting) thousands of published findings by academic scientists. Guideline protocols initially formalized in the mid-twentieth century are still used by many regulatory agencies. EFSA used a 21st century approach in its reassessment of BPA and conducted a transparent, but time-limited, systematic review that included both guideline and academic research. The German Federal Institute for Risk Assessment (BfR) opposed EFSA's revision of the TDI for BPA. OBJECTIVES We identify the flaws in the assumptions that the German BfR, as well as the FDA, have used to justify maintaining the TDI for BPA at levels above what a vast amount of academic research shows to cause harm. We argue that regulatory agencies need to incorporate 21st century science into chemical hazard identifications using the CLARITY-BPA (Consortium Linking Academic and Regulatory Insights on BPA Toxicity) nonguideline academic studies in a collaborative government-academic program model. DISCUSSION We strongly endorse EFSA's revised TDI for BPA and support the European Commission's (EC) apparent acceptance of this updated BPA risk assessment. We discuss challenges to current chemical risk assessment assumptions about EDCs that need to be addressed by regulatory agencies to, in our opinion, become truly protective of public health. Addressing these challenges will hopefully result in BPA, and eventually other structurally similar bisphenols (called regrettable substitutions) for which there are known adverse effects, being eliminated from all food-related and many other uses in the EU and elsewhere. https://doi.org/10.1289/EHP13812.
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Affiliation(s)
- Frederick S. vom Saal
- Division of Biological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Michael Antoniou
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, London, UK
| | - Scott M. Belcher
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Ake Bergman
- Department of Environmental Science (ACES), Stockholm University, Stockholm, Sweden
| | - Ramji K. Bhandari
- Division of Biological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Linda S. Birnbaum
- Scientist Emeritus and Former Director, National Toxicology Program (NTP), National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, North Carolina, USA
- Scholar in Residence, Duke University, Durham, North Carolina, USA
| | - Aly Cohen
- Integrative Rheumatology Associates, Princeton, New Jersey, USA
| | - Terrence J. Collins
- Department of Chemistry, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Barbara Demeneix
- Comparative Physiology Laboratory, Natural History Museum, Paris, France
| | - Anne Marie Fine
- Environmental Medicine Education International, Mancos, Colorado, USA
| | - Jodi A. Flaws
- Department of Comparative Biosciences, University of Illinois Urbana—Champaign, Urbana-Champaign, Illinois, USA
| | - Veronique Gayrard
- ToxAlim (Research Centre in Food Toxicology), University of Toulouse, Toulouse, France
| | - William H. Goodson
- California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Andrea C. Gore
- Division of Pharmacology and Toxicology, University of Texas at Austin, Austin, Texas, USA
| | - Jerrold J. Heindel
- Healthy Environment and Endocrine Disruptor Strategies, Raleigh, North Carolina, USA
| | - Patricia A. Hunt
- School of Molecular Biosciences, Center for Reproductive Biology, Washington State University, Pullman, Washington, USA
| | - Taisen Iguchi
- Graduate School of Nanobioscience, Yokohama City University, Yokohama, Japan
| | - Christopher D. Kassotis
- Institute of Environmental Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacology, Wayne State University, Detroit, Michigan, USA
| | - Andreas Kortenkamp
- Centre for Pollution Research and Policy, Brunel University London, Uxbridge, UK
| | - Robin Mesnage
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, London, UK
| | - Jane Muncke
- Food Packaging Forum Foundation, Zurich, Switzerland
| | | | - Angel Nadal
- Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE) and CIBERDEM, Miguel Hernandez University of Elche, Elche, Alicante, Spain
| | - Retha R. Newbold
- Scientist Emeritus, NTP, NIEHS, Research Triangle Park, North Carolina, USA
| | - Vasantha Padmanabhan
- Department of Pediatrics, Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Paola Palanza
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Stefano Parmigiani
- Unit of Evolutionary and Functional Biology, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Lyn Patrick
- Environmental Medicine Education International, Mancos, Colorado, USA
| | - Gail S. Prins
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cheryl S. Rosenfeld
- Biomedical Sciences, Thompson Center for Autism and Neurobehavioral Disorders, University of Missouri—Columbia, Columbia, Missouri, USA
- MU Institute of Data Science and Informatics, University of Missouri—Columbia, Columbia, Missouri, USA
| | - Niels E. Skakkebaek
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Carlos Sonnenschein
- Department of Immunology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ana M. Soto
- Department of Immunology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Shanna H. Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julia A. Taylor
- Division of Biological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Pierre-Louis Toutain
- Royal Veterinary College, University of London, London, UK
- NTHERES, INRAE, ENVT, Université de Toulouse, Toulouse, France
| | - Frank A. von Hippel
- Department of Community, Environment & Policy, University of Arizona, Tucson, Arizona, USA
| | - Wade V. Welshons
- Department of Biomedical Sciences, University of Missouri—Columbia, Columbia, Missouri, USA
| | - Daniel Zalko
- ToxAlim (Research Centre in Food Toxicology), University of Toulouse, Toulouse, France
| | - R. Thomas Zoeller
- Department of Biology, University of Massachusetts, Amherst, Massachusetts, USA
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vom Saal FS, Vandenberg LN. Update on the Health Effects of Bisphenol A: Overwhelming Evidence of Harm. Endocrinology 2021; 162:6124507. [PMID: 33516155 PMCID: PMC7846099 DOI: 10.1210/endocr/bqaa171] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 12/14/2022]
Abstract
In 1997, the first in vivo bisphenol A (BPA) study by endocrinologists reported that feeding BPA to pregnant mice induced adverse reproductive effects in male offspring at the low dose of 2 µg/kg/day. Since then, thousands of studies have reported adverse effects in animals administered low doses of BPA. Despite more than 100 epidemiological studies suggesting associations between BPA and disease/dysfunction also reported in animal studies, regulatory agencies continue to assert that BPA exposures are safe. To address this disagreement, the CLARITY-BPA study was designed to evaluate traditional endpoints of toxicity and modern hypothesis-driven, disease-relevant outcomes in the same set of animals. A wide range of adverse effects was reported in both the toxicity and the mechanistic endpoints at the lowest dose tested (2.5 µg/kg/day), leading independent experts to call for the lowest observed adverse effect level (LOAEL) to be dropped 20 000-fold from the current outdated LOAEL of 50 000 µg/kg/day. Despite criticism by members of the Endocrine Society that the Food and Drug Administration (FDA)'s assumptions violate basic principles of endocrinology, the FDA rejected all low-dose data as not biologically plausible. Their decisions rely on 4 incorrect assumptions: dose responses must be monotonic, there exists a threshold below which there are no effects, both sexes must respond similarly, and only toxicological guideline studies are valid. This review details more than 20 years of BPA studies and addresses the divide that exists between regulatory approaches and endocrine science. Ultimately, CLARITY-BPA has shed light on why traditional methods of evaluating toxicity are insufficient to evaluate endocrine disrupting chemicals.
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Affiliation(s)
- Frederick S vom Saal
- University of Missouri – Columbia, Division of Biological Sciences, Columbia, Missouri
- Correspondence: Dr. Frederick vom Saal, University of Missouri-Columbia, Division of Biological Sciences, 105 Lefevre Hall, Columbia, MO, 65211, USA. E-mail:
| | - Laura N Vandenberg
- University of Massachusetts – Amherst, Department of Environmental Health Sciences, Amherst, Massachusetts
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Brescia S. Thresholds of adversity and their applicability to endocrine disrupting chemicals. Crit Rev Toxicol 2020; 50:213-218. [PMID: 32228218 DOI: 10.1080/10408444.2020.1740973] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Within the European Union, various legislative acts contain specific provisions on endocrine disruption, requiring the regulation of substances with endocrine disrupting properties via a hazard-based approach. Presumably this is due to an assumed lack of thresholds for the adverse effects of such substances. Conversely, in other jurisdictions, such as USA, Canada, Australia and Japan, endocrine disruptors (EDs) are regulated using a risk-based approach. As a consequence, in recent years there has been increasing controversy on whether thresholds can be inferred for endocrine-mediated effects. There is concern that the endocrine system is too complex to allow estimation of safe levels of exposure to such chemicals. This brief review aims to evaluate the available scientific evidence in this area and offer a sound and robust conclusion supported by this analysis. It is concluded that there is nothing special or unique about endocrine disruption or greater uncertainties in its assessment compared to other non-genotoxic forms of toxicity to justify adopting a non-threshold approach by default. Biology predicts that thresholds of adversity exist and are the rule for all endpoints, including those arising from endocrine disruption. A threshold approach to the risk assessment of endocrine disrupting chemicals is scientifically justified.
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Affiliation(s)
- Susy Brescia
- Health and Safety Executive (HSE), Chemicals Regulation Division (CRD), Merseyside, UK
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Vom Saal FS. TRIENNIAL REPRODUCTION SYMPOSIUM: Environmental programming of reproduction during fetal life: Effects of intrauterine position and the endocrine disrupting chemical bisphenol A. J Anim Sci 2017; 94:2722-36. [PMID: 27482660 DOI: 10.2527/jas.2015-0211] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
During critical periods in fetal life, there is an increased vulnerability to perturbations in endocrine function due to environmental factors. Small shifts in concentrations of hormones that regulate the differentiation of organs, such as estradiol and testosterone, can have permanent effects on morphology, enzymatic activity, and hormone receptors in tissues as well as neurobehavioral effects. These changes can lead to effects throughout life, including impacting the risk for various diseases (referred to as the Developmental Origins of Adult Health and Disease hypothesis). The intrauterine position phenomenon concerns the consequence for fetuses of randomly implanting next to embryos of the same or opposite sex. An intrauterine position next to males vs. females results in small differences in serum testosterone and estradiol during fetal life that are associated with marked effects on life history (such as lifetime fecundity) in both males and females born in litters (mice, rats, gerbils, rabbits, and swine) as well as human twins. Research with mice subsequently demonstrated that a very small experimental change in fetal serum estradiol levels altered organogenesis and caused permanent changes in organ function. Taken together, these findings led to the hypothesis that environmental chemicals that mimic or antagonize hormone action (e.g., endocrine disrupting chemicals) could also be causing harm at very low exposures (the "low dose" hypothesis) within the range of exposure of humans, domesticated animals, and wildlife. There is now extensive evidence from experimental laboratory animals, sheep, and humans that fetal exposure to very low (presumably safe) doses of the endocrine disrupting chemical bisphenol A (BPA), which exhibits estrogenic activity, can cause permanent changes that can increase the risk of a wide array of diseases. The reasons that federal regulatory agencies are ignoring the massive literature showing adverse effects of BPA and other endocrine disrupting chemicals are discussed.
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Perharič L, Fatur T, Drofenik J. European Union's strategy on endocrine disrupting chemicals and the current position of Slovenia. Arh Hig Rada Toksikol 2016; 67:99-105. [PMID: 27331297 DOI: 10.1515/aiht-2016-67-2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 06/01/2016] [Indexed: 11/15/2022] Open
Abstract
In view of the European Union regulations 1107/2009 and 528/2012, which say that basic substances in plant protection and biocidal products marketed in the European Union (EU) should not have an inherent capacity to cause endocrine disruption, an initiative was started to define scientific criteria for the identification of endocrine disruptors (EDs). The objectives of the EU strategy on EDs are to protect human health and the environment, to assure the functioning of the market, and to provide clear and coherent criteria for the identification of EDs that could have broad application in the EU legislation. Policy issues were to be addressed by the Ad-hoc group of Commission Services, EU Agencies and Member States established in 2010, whereas the scientific issues were to be addressed by the Endocrine Disruptors Expert Advisory Group (ED EAG), established in 2011. The ED EAG adopted the 2002 World Health Organization (WHO) definition of endocrine disruptor and agreed that for its identification it is necessary to produce convincing evidence of a biologically plausible causal link between an adverse effect and endocrine disrupting mode of action. In 2014, the European Commission proposed four ED identification criteria options and three regulatory options, which are now being assessed for socio-economic, environmental, and health impact. Slovenia supports the establishing of identification criteria and favours option 4, according to which ED identification should be based on the WHO definition with the addition of potency as an element of hazard characterisation. As for regulatory options, Slovenia favours the risk-based rather than hazard-based regulation.
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Myers JP, Antoniou MN, Blumberg B, Carroll L, Colborn T, Everett LG, Hansen M, Landrigan PJ, Lanphear BP, Mesnage R, Vandenberg LN, Vom Saal FS, Welshons WV, Benbrook CM. Concerns over use of glyphosate-based herbicides and risks associated with exposures: a consensus statement. Environ Health 2016; 15:19. [PMID: 26883814 PMCID: PMC4756530 DOI: 10.1186/s12940-016-0117-0] [Citation(s) in RCA: 378] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 02/06/2016] [Indexed: 05/17/2023]
Abstract
The broad-spectrum herbicide glyphosate (common trade name "Roundup") was first sold to farmers in 1974. Since the late 1970s, the volume of glyphosate-based herbicides (GBHs) applied has increased approximately 100-fold. Further increases in the volume applied are likely due to more and higher rates of application in response to the widespread emergence of glyphosate-resistant weeds and new, pre-harvest, dessicant use patterns. GBHs were developed to replace or reduce reliance on herbicides causing well-documented problems associated with drift and crop damage, slipping efficacy, and human health risks. Initial industry toxicity testing suggested that GBHs posed relatively low risks to non-target species, including mammals, leading regulatory authorities worldwide to set high acceptable exposure limits. To accommodate changes in GBH use patterns associated with genetically engineered, herbicide-tolerant crops, regulators have dramatically increased tolerance levels in maize, oilseed (soybeans and canola), and alfalfa crops and related livestock feeds. Animal and epidemiology studies published in the last decade, however, point to the need for a fresh look at glyphosate toxicity. Furthermore, the World Health Organization's International Agency for Research on Cancer recently concluded that glyphosate is "probably carcinogenic to humans." In response to changing GBH use patterns and advances in scientific understanding of their potential hazards, we have produced a Statement of Concern drawing on emerging science relevant to the safety of GBHs. Our Statement of Concern considers current published literature describing GBH uses, mechanisms of action, toxicity in laboratory animals, and epidemiological studies. It also examines the derivation of current human safety standards. We conclude that: (1) GBHs are the most heavily applied herbicide in the world and usage continues to rise; (2) Worldwide, GBHs often contaminate drinking water sources, precipitation, and air, especially in agricultural regions; (3) The half-life of glyphosate in water and soil is longer than previously recognized; (4) Glyphosate and its metabolites are widely present in the global soybean supply; (5) Human exposures to GBHs are rising; (6) Glyphosate is now authoritatively classified as a probable human carcinogen; (7) Regulatory estimates of tolerable daily intakes for glyphosate in the United States and European Union are based on outdated science. We offer a series of recommendations related to the need for new investments in epidemiological studies, biomonitoring, and toxicology studies that draw on the principles of endocrinology to determine whether the effects of GBHs are due to endocrine disrupting activities. We suggest that common commercial formulations of GBHs should be prioritized for inclusion in government-led toxicology testing programs such as the U.S. National Toxicology Program, as well as for biomonitoring as conducted by the U.S. Centers for Disease Control and Prevention.
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Affiliation(s)
- John Peterson Myers
- Environmental Health Sciences, Charlottesville, VA, and Adjunct Professor, Carnegie Mellon University, Pittsburg, PA, USA.
- Environmental Health Sciences, 421 Park St, Charlottesville, VA, 22902, USA.
| | - Michael N Antoniou
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Bruce Blumberg
- Department of Developmental and Cell Biology, University of California, Irvine, CA, USA
| | - Lynn Carroll
- The Endocrine Disruption Exchange, Paonia, CO, USA
| | - Theo Colborn
- The Endocrine Disruption Exchange, Paonia, CO, USA
| | | | | | - Philip J Landrigan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce P Lanphear
- Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Robin Mesnage
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts - Amherst, Amherst, MA, USA
| | | | - Wade V Welshons
- Department of Biomedical Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - Charles M Benbrook
- Benbrook Consulting Services, 90063 Troy Road, Enterprise, OR, 97828, USA.
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Abstract
Possible harm from endocrine disrupting chemicals (EDCs) in humans is speculated based on two types of evidence; 1) increasing trends of suspected diseases in ecological studies of populations and 2) findings from traditional epidemiological studies of individuals. However, ecological findings are not regarded as direct human evidence of the relation between EDCs and disease, while the evidence among epidemiological studies of individuals is often inconsistent. Thus, a criticism is that linking EDCs and health in human is naively presumed without solid evidence. However, human studies of EDCs are methodologically complex and understanding methodological issues will help to interpret findings from existing human studies and to properly design optimal human studies. The key issues are low reliability of exposure assessment of EDCs with short half-lives, EDC mixtures, possibility of non-monotonic dose-response relationships, non-existence of an unexposed group, difficulties in measuring exposure during critical periods, and interactions with established risk factors. Furthermore, EDC mixtures may affect human health through other mechanisms than traditional endocrine disruption, for example glutathione depletion or mitochondrial dysfunction. Given this complexity, the most plausible scenario in humans is that exposure to EDC mixtures leads to increasing risk of related diseases at the ecological level, but inconsistent associations would be expected in traditional epidemiological studies. Although epidemiologists have long relied on Bradford Hill's criteria to objectively evaluate whether associations observed in epidemiology can be interpreted as causal, there are challenges to use these criteria for EDCs, particularly concerning consistency across studies and the findings of linear dose-response relationships. At the individual level, compared to EDCs with short half-lives, epidemiological studies of EDCs with long half-lives among populations with a relatively low exposure dose range of exposure can likely produce relatively more reliable results, because the measurement of EDCs with long half-lives likely represents typical long-term exposure and populations with exposure in the low range of doses are likely to have a reference group closer to non-exposure.
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Affiliation(s)
- Duk-Hee Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, 101 Dongin-dong, Jung-gu, Daegu, Korea, 700-422.
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Korea.
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN, 55454-1075, USA.
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Futran Fuhrman V, Tal A, Arnon S. Why endocrine disrupting chemicals (EDCs) challenge traditional risk assessment and how to respond. JOURNAL OF HAZARDOUS MATERIALS 2015; 286:589-611. [PMID: 25646754 DOI: 10.1016/j.jhazmat.2014.12.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/02/2014] [Accepted: 12/08/2014] [Indexed: 05/11/2023]
Abstract
Endocrine disrupting compounds (EDCs) are a diverse group of "chemicals of emerging concern" which have attracted much interest from the research community since the 1990s. Today there is still no definitive risk assessment tool for EDCs. While some decision making organizations have attempted to design methodology guidelines to evaluate the potential risk from this broadly defined group of constituents, risk assessors still face many uncertainties and unknowns. Until a risk assessment paradigm is designed specifically for EDCs and is vetted by the field, traditional risk assessment tools may be used with caution to evaluate EDCs. In doing so, each issue of contention should be addressed with transparency in order to leverage available information and technology without sacrificing integrity or accuracy. The challenges that EDCs pose to traditional risk assessment are described in this article to assist in this process.
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Affiliation(s)
- Vivian Futran Fuhrman
- Institute for Dryland, Environmental and Desert Research, The Jacob Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Sede Boqer 84990, Israel.
| | - Alon Tal
- Institute for Dryland, Environmental and Desert Research, The Jacob Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Sede Boqer 84990, Israel.
| | - Shai Arnon
- Zuckerberg Institute for Water Research, The Jacob Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Sede Boqer 84990, Israel.
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Gore AC, Balthazart J, Bikle D, Carpenter DO, Crews D, Czernichow P, Diamanti-Kandarakis E, Dores RM, Grattan D, Hof PR, Hollenberg AN, Lange C, Lee AV, Levine JE, Millar RP, Nelson RJ, Porta M, Poth M, Power DM, Prins GS, Ridgway EC, Rissman EF, Romijn JA, Sawchenko PE, Sly PD, Söder O, Taylor HS, Tena-Sempere M, Vaudry H, Wallen K, Wang Z, Wartofsky L, Watson CS. Policy decisions on endocrine disruptors should be based on science across disciplines: a response to Dietrich et al. Horm Res Paediatr 2014; 80:305-8. [PMID: 24107550 DOI: 10.1159/000355668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- A C Gore
- Division of Pharmacology and Toxicology, The University of Texas, Austin, Tex., USA
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Gore AC, Balthazart J, Bikle D, Carpenter DO, Crews D, Czernichow P, Diamanti-Kandarakis E, Dores RM, Grattan D, Hof PR, Hollenberg AN, Lange C, Lee AV, Levine JE, Millar RP, Nelson RJ, Porta M, Poth M, Power DM, Prins GS, Ridgway EC, Rissman EF, Romijn JA, Sawchenko PE, Sly PD, Söder O, Taylor HS, Tena-Sempere M, Vaudry H, Wallen K, Wang Z, Wartofsky L, Watson CS. Reprint of: policy decisions on endocrine disruptors should be based on science across disciplines: a response to Dietrich et al. Horm Behav 2014; 65:190-3. [PMID: 24289987 DOI: 10.1016/j.yhbeh.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A C Gore
- Division of Pharmacology and Toxicology, The University of Texas, Austin, TX 78712, USA.
| | - J Balthazart
- University of Liège, GIGA Neurosciences, B-4000 Liège, Belgium
| | - D Bikle
- VA Medical Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - D O Carpenter
- Institute for Health and the Environment, University at Albany, State University of New York, Albany, NY 12222, USA
| | - D Crews
- Section of Integrative Biology, The University of Texas, Austin, TX 78712, USA
| | | | | | - R M Dores
- Department of Biological Sciences, University of Denver, Denver, CO 80208, USA
| | - D Grattan
- Department of Anatomy, University of Otago, North Dunedin 9016, New Zealand
| | - P R Hof
- Icahn School of Medicine at Mt Sinai, New York, NY 10029, USA
| | - A N Hollenberg
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - C Lange
- University of Minnesota Masonic Cancer Center, Minneapolis, MN 55455, USA
| | - A V Lee
- University of Pittsburgh Cancer Institute, Magee Women's Research Institute, Pittsburgh, PA 15213, USA
| | - J E Levine
- Wisconsin National Primate Research Center, Madison, WI 53715, USA
| | - R P Millar
- UCT/MRC Receptor Biology Unit, University of Cape Town, Cape Town, South Africa
| | - R J Nelson
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - M Porta
- Hospital del Mar Institute of Medical Research, School of Medicine, Universitat Autònoma de Barcelona, 080041 Barcelona, Spain
| | - M Poth
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - D M Power
- Department of Biosciences, Universidade do Algarve, 8005-139 Faro, Portugal
| | - G S Prins
- Department of Physiology and Biophysics, University of Illinois, Chicago, IL 60612, USA
| | - E C Ridgway
- Department of Medicine, University of Colorado School of Medicine, Denver, CO 80208, USA
| | - E F Rissman
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - J A Romijn
- Division of Medicine, Academic Medical Center, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - P E Sawchenko
- Laboratory of Neuronal Structure and Function, The Salk Institute, La Jolla, CA 92037, USA
| | - P D Sly
- Queensland Children's Medical Institute, University of Queensland, Royal Children's Hospital, Brisbane, Queensland 4000, Australia
| | - O Söder
- Karolinska Institutet at Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
| | - H S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
| | - M Tena-Sempere
- Department of Cell Biology and Physiology, University of Córdoba, 14071 Córdoba, Spain
| | - H Vaudry
- Institut National de la Santé et de la Recherche Médicale U982, University of Rouen, 76821 Rouen, France
| | - K Wallen
- Department of Psychology, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30322, USA
| | - Z Wang
- Department of Psychology and Neuroscience, Florida State University, Tallahassee, FL 32306, USA
| | - L Wartofsky
- Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA
| | - C S Watson
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
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11
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Gore AC, Balthazart J, Bikle D, Carpenter DO, Crews D, Czernichow P, Diamanti-Kandarakis E, Dores RM, Grattan D, Hof PR, Hollenberg AN, Lange C, Lee AV, Levine JE, Millar RP, Nelson RJ, Porta M, Poth M, Power DM, Prins GS, Ridgway EC, Rissman EF, Romijn JA, Sawchenko PE, Sly PD, Söder O, Taylor HS, Tena-Sempere M, Vaudry H, Wallen K, Wang Z, Wartofsky L, Watson CS. Reprint of: policy decisions on endocrine disruptors should be based on science across disciplines: a response to Dietrich, et al. Front Neuroendocrinol 2014; 35:2-5. [PMID: 24268499 DOI: 10.1016/j.yfrne.2013.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 11/24/2022]
Affiliation(s)
- A C Gore
- Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX 78712, United States.
| | - J Balthazart
- University of Liège, GIGA Neurosciences, B-4000 Liège, Belgium
| | - D Bikle
- VA Medical Center and University of California, San Francisco, San Francisco, CA 94143, United States
| | - D O Carpenter
- Institute for Health and the Environment, University at Albany, State University of New York, Albany, NY 12222, United States
| | - D Crews
- Section of Integrative Biology, The University of Texas, Austin, TX 78712, United States
| | - P Czernichow
- Professor Emeritus of Pediatrics, University of Paris, 75006 Paris, France
| | | | - R M Dores
- Department of Biological Sciences, University of Denver, Denver, CO 80208, United States
| | - D Grattan
- Department of Anatomy, University of Otago, North Dunedin 9016, New Zealand
| | - P R Hof
- Icahn School of Medicine at Mt Sinai, New York, NY 10029, United States
| | | | - C Lange
- University of Minnesota Masonic Cancer Center, Minneapolis, MN 55455, United States
| | - A V Lee
- University of Pittsburgh Cancer Institute and Magee Women's Research Institute, Pittsburgh, PA 15213, United States
| | - J E Levine
- Wisconsin National Primate Research Center, Madison, WI 53715, United States
| | - R P Millar
- UCT/MRC Receptor Biology Unit, University of Cape Town, Cape Town, South Africa
| | - R J Nelson
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - M Porta
- Hospital del Mar Institute of Medical Research and School of Medicine, Universitat Autònoma de Barcelona, 080041 Barcelona, Spain
| | - M Poth
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States
| | - D M Power
- Department of Biosciences, Universidade do Algarve, 8005-139 Faro, Portugal
| | - G S Prins
- Department of Physiology and Biophysics, University of Illinois, Chicago, IL 60612, United States
| | - E C Ridgway
- Department of Medicine, University of Colorado School of Medicine, Denver, CO 80208, United States
| | - E F Rissman
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Virginia, Charlottesville, VA 22908, United States
| | - J A Romijn
- Division of Medicine, Academic Medical Center, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - P E Sawchenko
- Laboratory of Neuronal Structure and Function, The Salk Institute, La Jolla, CA 92037, United States
| | - P D Sly
- Queensland Children's Medical Institute, University of Queensland, Royal Children's Hospital, Brisbane, Queensland 4000, Australia
| | - O Söder
- Karolinska Institutet at Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
| | - H S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, United States
| | - M Tena-Sempere
- Department of Cell Biology and Physiology, University of Córdoba, 14071 Córdoba, Spain
| | - H Vaudry
- Institut National de la Santé et de la Recherche Médicale U982, University of Rouen, 76821 Rouen, France
| | - K Wallen
- Department of Psychology and Yerkes National Primate Research Center, Emory University, Atlanta, GA 30322, United States
| | - Z Wang
- Department of Psychology and Neuroscience, Florida State University, Tallahassee, FL 32306, United States
| | - L Wartofsky
- Department of Medicine, Washington Hospital Center, Washington, DC 20010, United States
| | - C S Watson
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, United States
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12
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Gore AC, Balthazart J, Bikle D, Carpenter DO, Crews D, Czernichow P, Diamanti-Kandarakis E, Dores RM, Grattan D, Hof PR, Hollenberg AN, Lange C, Lee AV, Levine JE, Millar RP, Nelson RJ, Porta M, Poth M, Power DM, Prins GS, Ridgway EC, Rissman EF, Romijn JA, Sawchenko PE, Sly PD, Söder O, Taylor HS, Tena-Sempere M, Vaudry H, Wallen K, Wang Z, Wartofsky L, Watson CS. Policy decisions on endocrine disruptors should be based on science across disciplines: a response to Dietrich et al. Eur J Endocrinol 2013; 169:E1-4. [PMID: 24057478 DOI: 10.1530/eje-13-0763] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- A C Gore
- Division of Pharmacology and Toxicology, The University of Texas, Austin, Texas 78712, USA
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13
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Scientifically unfounded precaution drives European Commission's recommendations on EDC regulation, while defying common sense, well-established science and risk assessment principles. Toxicon 2013; 76:A1-A2. [DOI: 10.1016/j.toxicon.2013.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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15
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Gore AC, Balthazart J, Bikle D, Carpenter DO, Crews D, Czernichow P, Diamanti-Kandarakis E, Dores RM, Grattan D, Hof PR, Hollenberg AN, Lange C, Lee AV, Levine JE, Millar RP, Nelson RJ, Porta M, Poth M, Power DM, Prins GS, Ridgway EC, Rissman EF, Romijn JA, Sawchenko PE, Sly PD, Söder O, Taylor HS, Tena-Sempere M, Vaudry H, Wallen K, Wang Z, Wartofsky L, Watson CS. Policy decisions on endocrine disruptors should be based on science across disciplines: a response to Dietrich et al. Endocrinology 2013; 154:3957-60. [PMID: 24048095 PMCID: PMC5398595 DOI: 10.1210/en.2013-1854] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- A C Gore
- PhD, Editor-in-Chief, Endocrinology, Gustavus, Louise Pfeiffer Professor of Pharmacology, Toxicology, The University of Texas at Austin, Austin, Texas 78712.
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16
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Gore AC, Balthazart J, Bikle D, Carpenter DO, Crews D, Czernichow P, Diamanti-Kandarakis E, Dores RM, Grattan D, Hof PR, Hollenberg AN, Lange C, Lee AV, Levine JE, Millar RP, Nelson RJ, Porta M, Poth M, Power DM, Prins GS, Ridgway EC, Rissman EF, Romijn JA, Sawchenko PE, Sly PD, Söder O, Taylor HS, Tena-Sempere M, Vaudry H, Wallen K, Wang Z, Wartofsky L, Watson CS. Policy decisions on endocrine disruptors should be based on science across disciplines: a response to Dietrichet al. Andrology 2013; 1:802-5. [DOI: 10.1111/j.2047-2927.2013.00151.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. C. Gore
- Division of Pharmacology and Toxicology; The University of Texas; Austin TX USA
| | - J. Balthazart
- University of Liège; GIGA Neurosciences; Liège Belgium
| | - D. Bikle
- VA Medical Center and University of California, San Francisco; San Francisco CA USA
| | - D. O. Carpenter
- Institute for Health and the Environment; University at Albany; State University of New York; Albany NY USA
| | - D. Crews
- Section of Integrative Biology; The University of Texas; Austin TX USA
| | | | | | - R. M. Dores
- Department of Biological Sciences; University of Denver; Denver CO USA
| | - D. Grattan
- Department of Anatomy; University of Otago; North Dunedin New Zealand
| | - P. R. Hof
- Icahn School of Medicine at Mt Sinai; New York NY USA
| | - A. N. Hollenberg
- Beth Israel Deaconess Medical Center; Harvard Medical School; Boston MA USA
| | - C. Lange
- University of Minnesota Masonic Cancer Center; Minneapolis MN USA
| | - A. V. Lee
- University of Pittsburgh Cancer Institute and Magee Women's Research Institute; Pittsburgh PA USA
| | - J. E. Levine
- Wisconsin National Primate Research Center; Madison WI USA
| | - R. P. Millar
- UCT/MRC Receptor Biology Unit; University of Cape Town; Cape Town South Africa
| | - R. J. Nelson
- Department of Neuroscience; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - M. Porta
- Hospital del Mar Institute of Medical Research and School of Medicine; Universitat Autònoma de Barcelona; Barcelona Spain
| | - M. Poth
- Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - D. M. Power
- Department of Biosciences; Universidade do Algarve; Faro Portugal
| | - G. S. Prins
- Department of Physiology and Biophysics; University of Illinois; Chicago IL USA
| | - E. C. Ridgway
- Department of Medicine; University of Colorado School of Medicine; Denver CO USA
| | - E. F. Rissman
- Department of Biochemistry and Molecular Genetics; School of Medicine; University of Virginia; Charlottesville VA USA
| | - J. A. Romijn
- Division of Medicine; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - P. E. Sawchenko
- Laboratory of Neuronal Structure and Function; The Salk Institute; La Jolla CA USA
| | - P. D. Sly
- Queensland Children's Medical Institute; University of Queensland; Royal Children's Hospital; Brisbane Qld Australia
| | - O. Söder
- Karolinska Institutet at Karolinska University Hospital Solna; Stockholm Sweden
| | - H. S. Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences; Yale School of Medicine; New Haven CT USA
| | - M. Tena-Sempere
- Department of Cell Biology and Physiology; University of Córdoba; Córdoba Spain
| | - H. Vaudry
- Institut National de la Santé et de la Recherche Médicale U982; University of Rouen; Rouen France
| | - K. Wallen
- Department of Psychology and Yerkes National Primate Research Center; Emory University; Atlanta GA USA
| | - Z. Wang
- Department of Psychology and Neuroscience; Florida State University; Tallahassee FL USA
| | - L. Wartofsky
- Department of Medicine; Washington Hospital Center; Washington DC USA
| | - C. S. Watson
- Department of Biochemistry and Molecular Biology; University of Texas Medical Branch; Galveston TX USA
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Vandenberg LN. Non-monotonic dose responses in studies of endocrine disrupting chemicals: bisphenol a as a case study. Dose Response 2013; 12:259-76. [PMID: 24910584 DOI: 10.2203/dose-response.13-020.vandenberg] [Citation(s) in RCA: 237] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Non-monotonic dose response curves (NMDRCs) have been demonstrated for natural hormones and endocrine disrupting chemicals (EDCs) in a variety of biological systems including cultured cells, whole organ cultures, laboratory animals and human populations. The mechanisms responsible for these NMDRCs are well known, typically related to the interactions between the ligand (hormone or EDC) and a hormone receptor. Although there are hundreds of examples of NMDRCs in the EDC literature, there are claims that they are not 'common enough' to influence the use of high-to-low dose extrapolations in risk assessments. Here, we chose bisphenol A (BPA), a well-studied EDC, to assess the frequency of non-monotonic responses. Our results indicate that NMDRCs are common in the BPA literature, occurring in greater than 20% of all experiments and in at least one endpoint in more than 30% of all studies we examined. We also analyzed the types of endpoints that produce NMDRCs in vitro and factors related to study design that influence the ability to detect these kinds of responses. Taken together, these results provide strong evidence for NMDRCs in the EDC literature, specifically for BPA, and question the current risk assessment practice where 'safe' low doses are predicted from high dose exposures.
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Dietrich D, von Aulock S, Marquardt HWJ, Blaauboer BJ, Dekant W, Kehrer J, Hengstler JG, Collier AC, Gori GB, Pelkonen O, Lang F, Nijkamp FP, Stemmer K, Li A, Savolainen K, Hayes AW, Gooderham N, Harvey A. Open letter to the European Commission: scientifically unfounded precaution drives European Commission's recommendations on EDC regulation, while defying common sense, well-established science, and risk assessment principles. Arch Toxicol 2013; 87:1739-41. [PMID: 23979651 DOI: 10.1007/s00204-013-1117-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 11/25/2022]
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Dietrich DR, von Aulock S, Marquardt H, Blaauboer B, Dekant W, Kehrer J, Hengstler J, Collier A, Gori GB, Pelkonen OP, Lang F, Nijkamp FP, Stemmer K, Li A, Savolainen K, Hayes AW, Gooderham N, Harvey A. Scientifically unfounded precaution drives European Commission's recommendations on EDC regulation, while defying common sense, well-established science and risk assessment principles. Toxicol In Vitro 2013; 27:2110-4. [PMID: 23850741 DOI: 10.1016/j.tiv.2013.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Dietrich DR, von Aulock S, Marquardt H, Blaauboer B, Dekant W, Kehrer J, Hengstler J, Collier A, Gori GB, Pelkonen O, Lang F, Nijkamp FP, Stemmer K, Li A, Savolainen K, Hayes AW, Gooderham N, Harvey A. Scientifically unfounded precaution drives European Commission's recommendations on EDC regulation, while defying common sense, well-established science and risk assessment principles. Food Chem Toxicol 2013; 62:A1-4. [PMID: 23835284 DOI: 10.1016/j.fct.2013.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Dietrich DR, Aulock SV, Marquardt H, Blaauboer B, Dekant W, Kehrer J, Hengstler J, Collier A, Gori GB, Pelkonen O, Lang F, Barile FA, Nijkamp FP, Stemmer K, Li A, Savolainen K, Hayes AW, Gooderham N, Harvey A. Scientifically unfounded precaution drives European Commission's recommendations on EDC regulation, while defying common sense, well-established science and risk assessment principles. Chem Biol Interact 2013; 205:A1-5. [PMID: 23832050 DOI: 10.1016/j.cbi.2013.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Scientifically unfounded precaution drives European Commission's recommendations on EDC regulation, while defying common sense, well-established science and risk assessment principles. Toxicol Res (Camb) 2013. [DOI: 10.1039/c3tx90013d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Zoeller RT, Brown TR, Doan LL, Gore AC, Skakkebaek NE, Soto AM, Woodruff TJ, Vom Saal FS. Endocrine-disrupting chemicals and public health protection: a statement of principles from The Endocrine Society. Endocrinology 2012; 153:4097-110. [PMID: 22733974 PMCID: PMC3423612 DOI: 10.1210/en.2012-1422] [Citation(s) in RCA: 694] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An endocrine-disrupting chemical (EDC) is an exogenous chemical, or mixture of chemicals, that can interfere with any aspect of hormone action. The potential for deleterious effects of EDC must be considered relative to the regulation of hormone synthesis, secretion, and actions and the variability in regulation of these events across the life cycle. The developmental age at which EDC exposures occur is a critical consideration in understanding their effects. Because endocrine systems exhibit tissue-, cell-, and receptor-specific actions during the life cycle, EDC can produce complex, mosaic effects. This complexity causes difficulty when a static approach to toxicity through endocrine mechanisms driven by rigid guidelines is used to identify EDC and manage risk to human and wildlife populations. We propose that principles taken from fundamental endocrinology be employed to identify EDC and manage their risk to exposed populations. We emphasize the importance of developmental stage and, in particular, the realization that exposure to a presumptive "safe" dose of chemical may impact a life stage when there is normally no endogenous hormone exposure, thereby underscoring the potential for very low-dose EDC exposures to have potent and irreversible effects. Finally, with regard to the current program designed to detect putative EDC, namely, the Endocrine Disruptor Screening Program, we offer recommendations for strengthening this program through the incorporation of basic endocrine principles to promote further understanding of complex EDC effects, especially due to developmental exposures.
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Affiliation(s)
- R Thomas Zoeller
- Biology Department, University of Massachusetts, 611 North Pleasant Street, Amherst, Massachusetts 01003, USA.
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24
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Viñas R, Jeng YJ, Watson CS. Non-genomic effects of xenoestrogen mixtures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:2694-714. [PMID: 23066391 PMCID: PMC3447581 DOI: 10.3390/ijerph9082694] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 07/09/2012] [Accepted: 07/17/2012] [Indexed: 12/13/2022]
Abstract
Xenoestrogens (XEs) are chemicals derived from a variety of natural and anthropogenic sources that can interfere with endogenous estrogens by either mimicking or blocking their responses via non-genomic and/or genomic signaling mechanisms. Disruption of estrogens' actions through the less-studied non-genomic pathway can alter such functional end points as cell proliferation, peptide hormone release, catecholamine transport, and apoptosis, among others. Studies of potentially adverse effects due to mixtures and to low doses of endocrine-disrupting chemicals have recently become more feasible, though few so far have included actions via the non-genomic pathway. Physiologic estrogens and XEs evoke non-monotonic dose responses, with different compounds having different patterns of actions dependent on concentration and time, making mixture assessments all the more challenging. In order to understand the spectrum of toxicities and their mechanisms, future work should focus on carefully studying individual and mixture components across a range of concentrations and cellular pathways in a variety of tissue types.
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Affiliation(s)
- René Viñas
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA.
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25
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Vandenberg LN, Colborn T, Hayes TB, Heindel JJ, Jacobs DR, Lee DH, Shioda T, Soto AM, vom Saal FS, Welshons WV, Zoeller RT, Myers JP. Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses. Endocr Rev 2012; 33:378-455. [PMID: 22419778 PMCID: PMC3365860 DOI: 10.1210/er.2011-1050] [Citation(s) in RCA: 1980] [Impact Index Per Article: 165.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 02/07/2012] [Indexed: 02/08/2023]
Abstract
For decades, studies of endocrine-disrupting chemicals (EDCs) have challenged traditional concepts in toxicology, in particular the dogma of "the dose makes the poison," because EDCs can have effects at low doses that are not predicted by effects at higher doses. Here, we review two major concepts in EDC studies: low dose and nonmonotonicity. Low-dose effects were defined by the National Toxicology Program as those that occur in the range of human exposures or effects observed at doses below those used for traditional toxicological studies. We review the mechanistic data for low-dose effects and use a weight-of-evidence approach to analyze five examples from the EDC literature. Additionally, we explore nonmonotonic dose-response curves, defined as a nonlinear relationship between dose and effect where the slope of the curve changes sign somewhere within the range of doses examined. We provide a detailed discussion of the mechanisms responsible for generating these phenomena, plus hundreds of examples from the cell culture, animal, and epidemiology literature. We illustrate that nonmonotonic responses and low-dose effects are remarkably common in studies of natural hormones and EDCs. Whether low doses of EDCs influence certain human disorders is no longer conjecture, because epidemiological studies show that environmental exposures to EDCs are associated with human diseases and disabilities. We conclude that when nonmonotonic dose-response curves occur, the effects of low doses cannot be predicted by the effects observed at high doses. Thus, fundamental changes in chemical testing and safety determination are needed to protect human health.
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Affiliation(s)
- Laura N Vandenberg
- Tufts University, Center for Regenerative and Developmental Biology, Department of Biology, 200 Boston Avenue, Suite 4600, Medford, Massachusetts 02155, USA.
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27
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Crews D, Gore AC. Life imprints: living in a contaminated world. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:1208-10. [PMID: 21571618 PMCID: PMC3230404 DOI: 10.1289/ehp.1103451] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 05/13/2011] [Indexed: 05/07/2023]
Abstract
BACKGROUND The links between nature and nurture need to be redefined to accommodate anthropogenic chemical contamination. Although some local remediation of contamination has occurred, at the global level this is simply not possible. Contaminants are spread by population migration, by introduction via the food chain, and through air and water currents, even to regions that were never exposed directly to these environmental insults. In recognizing and accepting this worldwide change, we must move on and consider the types of adaptations that could occur as a consequence. OBJECTIVES We propose a paradigm shift in the field that integrates various disciplines involved in the study of environmental contamination to recognize that contamination is widespread and cannot be remedied at the global level. DISCUSSION Greater effort must be placed on integrative and interdisciplinary studies that explicitly illuminate how the causal mechanisms and functional outcomes of related processes operate at each level of biological organization while at the same time revealing the relations among the levels. CONCLUSIONS To anticipate and understand the future, we must devote more study to what is likely to happen and less to what has happened. Only then will we begin to understand how ancestral environmental exposures act at both the level of the individual and the level of their descendants to influence all aspects of life history.
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Kuczenski B, Geyer R, Boughton B. Tracking toxicants: toward a life cycle aware risk assessment. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2011; 45:45-50. [PMID: 20977239 DOI: 10.1021/es101467z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Brandon Kuczenski
- Department of Environmental Science and Management, University of California, Santa Barbara, California, USA.
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29
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Watson CS, Alyea RA, Cunningham KA, Jeng YJ. Estrogens of multiple classes and their role in mental health disease mechanisms. Int J Womens Health 2010; 2:153-66. [PMID: 21072308 PMCID: PMC2971739 DOI: 10.2147/ijwh.s6907] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Indexed: 12/21/2022] Open
Abstract
Gender and sex hormones can influence a variety of mental health states, including mood, cognitive development and function, and vulnerability to neurodegenerative diseases and brain damage. Functions of neuronal cells may be altered by estrogens depending upon the availability of different physiological estrogenic ligands; these ligands and their effects vary with life stages, the genetic or postgenetic regulation of receptor levels in specific tissues, or the intercession of competing nonphysiological ligands (either intentional or unintentional, beneficial to health or not). Here we review evidence for how different estrogens (physiological and environmental/dietary), acting via different estrogen receptor subtypes residing in alternative subcellular locations, influence brain functions and behavior. We also discuss the families of receptors and transporters for monoamine neurotransmitters and how they may interact with the estrogenic signaling pathways.
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30
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Marques NFQ, Marques APBM, Iwano AL, Golin M, De-Carvalho RR, Paumgartten FJR, Dalsenter PR. Delayed ossification in Wistar rats induced by Morinda citrifolia L. exposure during pregnancy. JOURNAL OF ETHNOPHARMACOLOGY 2010; 128:85-91. [PMID: 20038450 DOI: 10.1016/j.jep.2009.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 12/18/2009] [Accepted: 12/18/2009] [Indexed: 05/28/2023]
Abstract
UNLABELLED Different products of plant Morinda citrifolia L. (noni) have been marketed and used around the world based on properties described by Polynesian people that use them for more than 2000 years. Marketing of these products is based on their presumptive phytotherapic properties. However there is little scientific evidence about their safety, especially when used during pregnancy. AIM OF THE STUDY Evaluate the possible developmental toxicity of the noni fruit aqueous extract and commercial product of TAHITIAN NONI juice in rats exposed during pregnancy. MATERIALS AND METHODS Pregnant Wistar rats were exposed by gavage to 7, 30 and 300 mg/kg bw (body weight) of noni aqueous extract or to 0.4, 2 and 20 mL/kg bw (body weight) of noni juice between day 7 and day 15 of pregnancy. Caesarean sections were performed on day 20 of pregnancy and reproductive parameters were evaluated. Implantations sites and postimplantation losses were recorded. Fetuses were weighted and examined for externally visible anomalies. After, the fetuses were cleared with KOH and the bones stained with alizarin red. Skeletal alterations of the skull, vertebral column, ribs, forelimbs, hindlimbs, sternum, sings of delayed ossification and variations were examined in accordance with pre-defined criteria and identified using harmonized and internationally accepted nomenclature recommended by the International Federation of Teratology Societies. RESULTS Exposure with extract and juice of Morinda citrifolia did not induce maternal toxicity at the tested doses, but induced delayed ossification in fetuses. CONCLUSION The exposure of pregnant rats to aqueous extract or juice Morinda citrifolia during organogenesis period may induce adverse effects on the normal development of fetuses. These findings indicate the need for further studies with noni derivates preceding their use in pregnant women.
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Maruyama K, Oshima T, Ohyama K. Exposure to exogenous estrogen through intake of commercial milk produced from pregnant cows. Pediatr Int 2010; 52:33-8. [PMID: 19496976 DOI: 10.1111/j.1442-200x.2009.02890.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Modern genetically improved dairy cows continue to lactate throughout almost the entire pregnancy. Therefore, recent commercial cow's milk contains large amounts of estrogens and progesterone. With regard to the exposure of prepubertal children to exogenous estrogens, the authors are particularly concerned about commercial milk produced from pregnant cows. The purpose of the present study was therefore to examine concentrations of serum and urine sex hormones after the intake of cow milk. METHODS Subjects were seven men, six prepubertal children, and five women. The men and children drank 600 mL/m(2) of cow milk. Urine samples were collected 1 h before the milk intake and four times every hour after intake. In men the serum samples were obtained before and 15, 30, 45, 60, 90 and 120 min after milk intake. Women drank 500 mL of cow's milk every night for 21 days beginning on the first day of the second menstruation. In three successive menstrual cycles, the day of ovulation was examined using an ovulation checker. RESULTS After the intake of cow milk, serum estrone (E1) and progesterone concentrations significantly increased, and serum luteinizing hormone, follicle-stimulating hormone and testosterone significantly decreased in men. Urine concentrations of E1, estradiol, estriol and pregnanediol significantly increased in all adults and children. In four out of five women, ovulation occurred during the milk intake, and the timing of ovulation was similar among the three menstrual cycles. CONCLUSIONS The present data on men and children indicate that estrogens in milk were absorbed, and gonadotropin secretion was suppressed, followed by a decrease in testosterone secretion. Sexual maturation of prepubertal children could be affected by the ordinary intake of cow milk.
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Affiliation(s)
- Kazumi Maruyama
- Interdisciplinary Graduate School of Medicine and Engineering, Department of Clinical Nursing and Pediatrics, University of Yamanashi, Yamanashi, Japan
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Talsness CE, Andrade AJM, Kuriyama SN, Taylor JA, vom Saal FS. Components of plastic: experimental studies in animals and relevance for human health. Philos Trans R Soc Lond B Biol Sci 2009; 364:2079-96. [PMID: 19528057 DOI: 10.1098/rstb.2008.0281] [Citation(s) in RCA: 334] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Components used in plastics, such as phthalates, bisphenol A (BPA), polybrominated diphenyl ethers (PBDE) and tetrabromobisphenol A (TBBPA), are detected in humans. In addition to their utility in plastics, an inadvertent characteristic of these chemicals is the ability to alter the endocrine system. Phthalates function as anti-androgens while the main action attributed to BPA is oestrogen-like activity. PBDE and TBBPA have been shown to disrupt thyroid hormone homeostasis while PBDEs also exhibit anti-androgen action. Experimental investigations in animals indicate a wide variety of effects associated with exposure to these compounds, causing concern regarding potential risk to human health. For example, the spectrum of effects following perinatal exposure of male rats to phthalates has remarkable similarities to the testicular dysgenesis syndrome in humans. Concentrations of BPA in the foetal mouse within the range of unconjugated BPA levels observed in human foetal blood have produced effects in animal experiments. Finally, thyroid hormones are essential for normal neurological development and reproductive function. Human body burdens of these chemicals are detected with high prevalence, and concentrations in young children, a group particularly sensitive to exogenous insults, are typically higher, indicating the need to decrease exposure to these compounds.
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Affiliation(s)
- Chris E Talsness
- Department of Toxicology, Institute of Clinical Pharmacology and Toxicology, Charité University Medical School Berlin, Berlin, Germany.
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BOOBIS ALANR, DASTON GEORGEP, PRESTON RJULIAN, OLIN STEPHENS. Application of key events analysis to chemical carcinogens and noncarcinogens. Crit Rev Food Sci Nutr 2009; 49:690-707. [PMID: 19690995 PMCID: PMC2840875 DOI: 10.1080/10408390903098673] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The existence of thresholds for toxicants is a matter of debate in chemical risk assessment and regulation. Current risk assessment methods are based on the assumption that, in the absence of sufficient data, carcinogenesis does not have a threshold, while noncarcinogenic endpoints are assumed to be thresholded. Advances in our fundamental understanding of the events that underlie toxicity are providing opportunities to address these assumptions about thresholds. A key events dose-response analytic framework was used to evaluate three aspects of toxicity. The first section illustrates how a fundamental understanding of the mode of action for the hepatic toxicity and the hepatocarcinogenicity of chloroform in rodents can replace the assumption of low-dose linearity. The second section describes how advances in our understanding of the molecular aspects of carcinogenesis allow us to consider the critical steps in genotoxic carcinogenesis in a key events framework. The third section deals with the case of endocrine disrupters, where the most significant question regarding thresholds is the possible additivity to an endogenous background of hormonal activity. Each of the examples suggests that current assumptions about thresholds can be refined. Understanding inter-individual variability in the events involved in toxicological effects may enable a true population threshold(s) to be identified.
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Affiliation(s)
- ALAN R. BOOBIS
- Department of Experimental Medicine and Toxicology, Imperial College London, London W12 0NN, UK
| | - GEORGE P. DASTON
- Miami Valley Laboratories, The Procter & Gamble Company, Cincinnati, OH, USA
| | - R. JULIAN PRESTON
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
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Patisaul HB, Adewale HB. Long-term effects of environmental endocrine disruptors on reproductive physiology and behavior. Front Behav Neurosci 2009; 3:10. [PMID: 19587848 PMCID: PMC2706654 DOI: 10.3389/neuro.08.010.2009] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 06/10/2009] [Indexed: 01/05/2023] Open
Abstract
It is well established that, over the course of development, hormones shape the vertebrate brain such that sex specific physiology and behaviors emerge. Much of this occurs in discrete developmental windows that span gestation through the prenatal period, although it is now becoming clear that at least some of this process continues through puberty. Perturbation of this developmental progression can permanently alter the capacity for reproductive success. Wildlife studies have revealed that exposure to endocrine disrupting compounds (EDCs), either naturally occurring or man made, can profoundly alter reproductive physiology and ultimately impact entire populations. Laboratory studies in rodents and other species have elucidated some of the mechanisms by which this occurs and strongly indicate that humans are also vulnerable to disruption. Use of hormonally active compounds in human medicine has also unfortunately revealed that the developing fetus can be exposed to and affected by endocrine disruptors, and that it might take decades for adverse effects to manifest. Research within the field of environmental endocrine disruption has also contributed to the general understanding of how early life experiences can alter reproductive physiology and behavior through non-genomic, epigenetic mechanisms such as DNA methylation and histone acetylation. These types of effects have the potential to impact future generations if the germ line is affected. This review provides an overview of how exposure to EDCs, particularly those that interfere with estrogen action, impacts reproductive physiology and behaviors in vertebrates.
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Affiliation(s)
- Heather B Patisaul
- Department of Biology, North Carolina State University Raleigh, NC 27695, USA.
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Eichenlaub-Ritter U, Vogt E, Cukurcam S, Sun F, Pacchierotti F, Parry J. Exposure of mouse oocytes to bisphenol A causes meiotic arrest but not aneuploidy. Mutat Res 2007; 651:82-92. [PMID: 18096426 DOI: 10.1016/j.mrgentox.2007.10.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 10/28/2007] [Indexed: 11/28/2022]
Abstract
Mouse oocytes isolated from large antral follicles were exposed to a wide range of concentrations of bisphenol A (BPA) during maturation in vitro (50 ng/ml to 10 microg/ml BPA in medium). Exposure to high concentrations of BPA (10 microg/ml) affected spindle formation, distribution of pericentriolar material and chromosome alignment on the spindle (termed congression failure), and caused a significant meiotic arrest. However, BPA did not increase hyperploidy at meiosis II at any tested concentration. Some but not all meiosis I arrested oocytes had MAD2-positive foci at centromeres of chromosomes in bivalents, suggesting that they had failed to pass the spindle checkpoint control. In a second set of experiments prepubertal mice were exposed sub-chronically for 7 days to low BPA by daily oral administration, followed by in vitro maturation of the denuded oocytes to metaphase II in the absence of BPA, as this treatment protocol was previously reported to induce chromosome congression failure and therefore suspected to cause aneuploidy in oocytes. The sub-chronic exposure subtly affected spindle morphology and oocyte maturation. However, as with the exposure in vitro, there was no evidence that low BPA doses increased hyperploidy at meiosis II. In conclusion, the data suggest that mouse oocytes from mice respond to BPA-induced disturbances in spindle formation by induction of meiotic arrest. This response might result from an effective checkpoint mechanism preventing the occurrence of chromosome malsegregation and aneuploidy. Low chronic BPA exposure in vivo as such does not appear to pose a risk for induction of errors in chromosome segregation at first meiosis in mouse oocytes. Additional factors besides BPA may have caused the high rate of congression failure and the temporary increase in hyperploidy in mouse metaphase II oocytes reported previously.
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Affiliation(s)
- Ursula Eichenlaub-Ritter
- University of Bielefeld, Faculty of Biology, Institute of Gene Technology/Microbiology, D-33501 Bielefeld, Germany.
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Mushak P. Hormesis and its place in nonmonotonic dose-response relationships: some scientific reality checks. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:500-6. [PMID: 17450215 PMCID: PMC1852676 DOI: 10.1289/ehp.9619] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 01/04/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This analysis is a critical assessment of current hormesis literature. I discuss definitions, characterization, generalizability, mechanisms, absence of empirical data specific for hormesis hypothesis testing, and arguments that hormesis be the "default assumption" in risk assessment. DATA SOURCES Hormesis, a biological phenomenon typically described as low-dose stimulation from substances producing higher-dose inhibition, has recently garnered interest in several quarters. The principal sources of published materials for this analysis are the writings of certain proponents of hormesis. Surprisingly few systematic critiques of current hormesis literature exist. Limits to the phenomenon's appropriate role in risk assessment and health policy have been published. DATA SYNTHESIS Serious gaps in scientific understanding remain: a stable definition; generalizability, especially for humans; a clear mechanistic basis; limitations in the presence of multiple toxic end points, target organs, and mechanisms. Absence of both arms-length, consensus-driven, scientific evaluations and empirical data from studies specifically designed for hormesis testing have limited its acceptance. CONCLUSIONS Definition, characterization, occurrence, and mechanistic rationale for hormesis will remain speculative, absent rigorous studies done specifically for hormesis testing. Any role for hormesis in current risk assessment and regulatory policies for toxics remains to be determined.
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Affiliation(s)
- Paul Mushak
- PB Associates, 714 9th Street, Durham, NC 27705, USA.
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Aksglaede L, Juul A, Leffers H, Skakkebaek NE, Andersson AM. The sensitivity of the child to sex steroids: possible impact of exogenous estrogens. Hum Reprod Update 2006; 12:341-9. [PMID: 16672247 DOI: 10.1093/humupd/dml018] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The current trends of increasing incidences of testis, breast and prostate cancers are poorly understood, although it is assumed that sex hormones play a role. Disrupted sex hormone action is also believed to be involved in the increased occurrence of genital abnormalities among newborn boys and precocious puberty in girls. In this article, recent literature on sex steroid levels and their physiological roles during childhood is reviewed. It is concluded that (i) circulating levels of estradiol in prepubertal children are lower than originally claimed; (ii) children are extremely sensitive to estradiol and may respond with increased growth and/or breast development even at serum levels below the current detection limits; (iii) no threshold has been established, below which no hormonal effects can be seen in children exposed to exogenous steroids or endocrine disruptors; (iv) changes in hormone levels during fetal and prepubertal development may have severe effects in adult life and (v) the daily production rates of sex steroids in children estimated by the Food and Drug Administration in 1999 and still used in risk assessments are highly overestimated and should be revised. Because no lower threshold for estrogenic action has been established, caution should be taken to avoid unnecessary exposure of fetuses and children to exogenous sex steroids and endocrine disruptors, even at very low levels.
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Affiliation(s)
- Lise Aksglaede
- University Department of Growth and Reproduction, GR 5064, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
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