Benchmark dose in the presence of coexposure to melamine and diethylhexyl phthalate and urinary renal injury markers in pregnant women

Associations of gestational exposure to organophosphate esters with thyroid hormones in cord plasma and the safety threshold of exposure in pregnant women

BACKGROUND

As a class of synthetic chemicals, organophosphate esters (OPEs) were shown to have thyroid hormones (THs) disrupting potentials in animal studies, while epidemiological evidence on gestational exposure to OPEs and thyroid disruption is limited. Besides, assessment on the safety threshold of OPEs exposure during gestation is especially scarce.

METHODS

Based on the Shanghai Minhang Birth Cohort Study, we measured maternal urine concentration of 8 OPE metabolites and THs levels in cord plasma and examined their associations using multiple linear regression and quantile g-computation (QGC) models. The benchmark dose (BMD) and its lower limit (BMDL) of urine OPE metabolites concentrations were further estimated via the Bayesian Benchmark Dose Analysis System (BBMD) to reflect the safety threshold of exposure in pregnant women. The corresponding daily intake (DI) of BMDL was then calculated and compared with the current oral reference dose (RfD).

RESULTS

A total of 309 mother-newborn pairs were included in this study. Gestational bis (2-butoxyethyl) phosphate (BBOEP) exposure was associated with higher total triiodothyronine (TT3), free triiodothyronine (FT3), total thyroxine (TT4), and free thyroxine (FT4) in cord plasma, while bis(1,3-dichloro-2-propyl) phosphate (BDCPP) was observed to be associated with lower TT3 and FT3/FT4 but higher thyroid stimulating hormone (TSH). In addition, sex-specific effects were observed for bis (2-chloroethyl) phosphate (BCEP), which was associated with lower TT3 in cord plasma of female newborns, and lower TT4 and FT4 in male newborns. Similar results were obtained through QGC model and BBOEP was identified as the main contributor to the higher levels of TT3 and FT3. With benchmark response (BMR) of 10% and background response (P0) of 97.5% for both TT3 and FT3, the BMDL10 of urine BBOEP concentration was 0.50 μg/L. Further, the corresponding DI of tris (2-butoxyethyl) phosphate (TBOEP), which is the precursor of BBOEP, was 2.53 μg/kg BW/d.

CONCLUSIONS

Our findings suggest associations between gestational exposure to OPEs and altered THs biomarkers. According to the estimated BMD10 (BMDL10) of BBOEP and the corresponding DI, the current RfD of 15 μg/kg BW/d for TBOEP may not protect pregnant women and their newborns from thyroid disruption.

Benchmark Dose for Dioxin Based on Gestational Diabetes Mellitus Using Coexposure Statistical Methods and an Optimized Physiologically Based Toxicokinetic Model

Dioxins are ubiquitous endocrine-disrupting substances, but determining the effects and benchmark doses in situations of coexposure is highly challenging. The objective of this study was to assess the relationship between dioxin andgestational diabetes mellitus (GDM), calculate the benchmark dose (BMD) of dioxin in coexposure scenarios, and derive a daily exposure threshold using an optimized physiologically based toxicokinetic (PBTK) model. Based on a nested case-control study including 77 cases with GDM and 154 controls, serum levels of 29 dioxin-like compounds (DLCs) along with 10 perfluoroalkyl acids (PFAAs), seven polybrominated diphenyl ethers (PBDEs), and five non-dioxin-like polychlorinated biphenyls (ndl-PCBs) were measured at 9-16 weeks of gestation. Bayesian machine kernel regression (BKMR) was employed to identify significant chemicals, and probit and logistic models were used to calculate BMD adjusted for significant chemicals. A physiologically based toxicokinetic (PBTK) model was optimized using polyfluorinated dibenzo-p-dioxins and dibenzofurans (PFDD/Fs) data by the Bayesian-Monte Carlo Markov chain method and was used to determine the daily dietary exposure threshold. The median serum level of total dioxin toxic equivalent (TEQ) was 7.72 pg TEQ/g fat. Logistic regression analysis revealed that individuals in the fifth quantile of total TEQ level had significantly higher odds of developing GDM compared to those in the first quantile (OR, 8.87; 95% CI 3.19, 27.58). The BKMR analysis identified dioxin TEQ and BDE-153 as the compounds with the greatest influence. The binary logistic and probit models showed that the BMD10 (benchmark dose corresponding to a 10% extra risk) and BMDL10 (lower bound on the BMD10) were 3.71 and 3.46 pg TEQ/g fat, respectively, when accounting for coexposure to BDE-153 up to the 80% level. Using the optimized PBTK model and modifying factor, it was estimated that daily exposure should be below 4.34 pg TEQ kg-1 bw week-1 in order to not reach a harmful serum concentration for GDM. Further studies should utilize coexposure statistical methods and physiologically based pharmacokinetic (PBTK) models in reference dose calculation.

Benchmark Dose of Melamine Exposure for a Renal Injury Marker Mediated by Oxidative Stress: Examples in Patients with Urolithiasis and Occupational Workers

Establishing a safe exposure level from epidemiological studies while providing direct hazard characterization in humans often faces uncertainty in causality, especially cross-sectional data. With advances in molecular epidemiology, it is reasonable to integrate identified intermediate biomarkers into health risk assessment. In this study, by considering the mediation of the oxidative stress marker malondialdehyde (MDA), we explored the exposure threshold of melamine on the early renal injury marker N-acetyl-β-D glucosaminidase (NAG). The benchmark dose (BMD) was derived from model averaging of the composite direct effect of melamine exposure and the indirect effect through the mediation of MDA on NAG levels. As illustrative examples, we analyzed 309 adult patients with calcium urolithiasis and 80 occupational workers for the corresponding exposure thresholds. The derived threshold was subpopulation-dependent, with the one-sided lower bound BMDL10 for the patients with urolithiasis with (without) the mediator MDA for the patients with kidney stones and the occupational workers being 0.88 (0.96) μg/kg_bw/day and 22.82 (18.09) μg/kg_bw/day, respectively. The derived threshold levels, considering the oxidative stress marker MDA, were consistent with those without adjusting for the mediation effect. However, the study outcomes were further supported by the suggested mechanism pathway. The threshold for the patients with urolithiasis was up to two orders lower than the current tolerable daily intake level of 200 μg/kg_bw/day recommended by the WHO (EFSA).

Dynamic Source Distribution and Emission Inventory of a Persistent, Mobile, and Toxic (PMT) Substance, Melamine, in China

Persistent, mobile, and toxic (PMT) substances are affecting the safety of drinking water and are threatening the environment and human health. Many PMT substances are used in industrial processing or consumer products, but their sources and emissions mostly remain unclear. This study presents a long-term source distribution and emission estimation of melamine, a high-production-volume PMT substance of emerging global concern. The results indicate that in China, approximately 1858.7 kilotonnes (kt) of melamine were released into the water (∼58.9%), air (∼27.0%), and soil systems (∼14.1%) between 1995 and 2020, mainly from its production and use in the decorative panels, textiles, and paper industries. The textile and paper industries have the highest emission-to-consumption ratios, with more than 90% emissions per unit consumption. Sewage treatment plants are the largest source of melamine in the environment for the time being, but in-use products and their wastes will serve as significant melamine sources in the future. The study prompts priority action to control the risk of PMT substances internationally.

Sex-specific interactive effect of melamine and DEHP on a marker of early kidney damage in Taiwanese adults: A national population-based study from the Taiwan Biobank

Taiwan had the high incidence of chronic kidney disease (CKD) worldwide. Our objective was to examine associations between daily exposure of phthalates and melamine, two common nephrotoxins, and kidney damage risk in a well-established nationwide cohort. Study subjects were from Taiwan Biobank (TWB) with existing data of questionnaire and biochemical examinations. Average daily intake (ADI) levels of melamine and seven parental phthalates, including DEHP (di-2-ethylhexylphthalate), DiBP (Dibutyl phthalate), DnBP (Di-n-butyl phthalate), BBzP (Butyl benzyl phthalate), DEP (Diethyl phthalate), and DMP (Dimethyl phthalate) were estimated using a creatinine excretion-based model from urine melamine and 10 phthalate metabolites. Urine microalbumin to creatinine ratio (ACR) was used to represent for the outcome of kidney damage. Two statistical strategies were used: First, a weighted quantile sum (WQS) regression model to select the most important exposure variables of ADI levels of phthalates and melamine associated with ACR; Second, to examine effects of those most important exposure variables on ACR in multivariable linear regression models. In total, 1153 eligible adults were left for analyses. Of them, 591 (51.3%) and 562 (48.7%) were men and women, respectively, with a median age of 49 years old. By WQS, a significant and positive association was found between ADI of melamine and phthalates and ACR (β = 0.14, p = 0.002). ADI levels of melamine had the highest weight (0.57), followed by DEHP (0.13). Next, examining the two most important exposures in association with ACR, we found that the higher the melamine and DEHP intakes, the higher the ACR levels were found. An interaction effect was also found between melamine and DEHP intakes on urine ACR (p = 0.015). This result was more prominent in men (p = 0.008) than in women (p = 0.651). Environmental co-exposure of melamine and DEHP can potentially affect ACR in the community-dwelling Taiwanese adult population.

Environmental melamine exposure and adverse kidney outcomes in patients with type 2 diabetes mellitus

The impact of melamine exposure on kidney outcomes in type 2 diabetes mellitus (T2D) patients remains unclear. In this prospective cohort study, 561 T2D patients during October 2016 and June 2020 were enrolled and followed until December 2021. Baseline one-spot urinary corrected melamine levels were measured by LC-MS/MS. Average daily intake (ADI) of melamine represented environmental melamine exposure in daily life, and was estimated using urinary corrected melamine level by creatinine excretion (CE)-based model. Primary kidney outcomes were defined as doubling of serum creatinine levels or end stage kidney disease (ESKD), and secondary kidney outcomes included rapid decline in kidney function as estimated glomerular filtration rate (eGFR) decline >5 ml/min/1.73 m²/year. Baseline median urinary corrected melamine levels and estimated DI of melamine were 0.8 μg/mmol and 0.3 μg/kg/day in 561 T2D patients. During 3.7 years of follow-up, urinary corrected melamine level was positively correlated with reaching composite outcomes of either doubling of serum creation levels or ESKD and rapid decline in kidney function. Those with the highest quartile of urinary corrected melamine had 2.96-fold risk of composite outcomes of either doubling of serum creation levels or ESKD and 2.47-fold risk of eGFR decline >5 ml/min/1.73 m²/year. Estimated ADI of melamine also had significant correlation with adverse kidney outcomes. Furthermore, the positive relationship between melamine exposure and rapid decline in kidney function was only found in T2D patients with male, baseline eGFR ≥60 ml/min/1.73 m² or glycated hemoglobin ≤7%. In conclusion, melamine exposure is significantly associated with adverse kidney outcomes in T2D patients, especially in those with male, well sugar control or good baseline kidney function.

The Relationship between Typical Environmental Endocrine Disruptors and Kidney Disease

Endocrine disrupting chemicals (EDCs) are exogenous substances that alter the endocrine function of an organism, to result in adverse effects on growth and development, metabolism, and reproductive function. The kidney is one of the most important organs in the urinary system and an accumulation point. Studies have shown that EDCs can cause proteinuria, affect glomeruli and renal tubules, and even lead to diabetes and renal fibrosis in animal and human studies. In this review, we discuss renal accumulation of select EDCs such as dioxins, per- and polyfluoroalkyl substances (PFAS), bisphenol A (BPA), and phthalates, and delineate how exposures to such EDCs cause renal lesions and diseases, including cancer. The regulation of typical EDCs with specific target genes and the activation of related pathways are summarized.