Problems in testing and risk assessment of endocrine disrupting chemicals with regard to developmental toxicology

Apparent Khat chewers exposure to DDT in Ethiopia and its potential toxic effects: A scoping review

Dichlorodiphenyltrichloroethane (DDT) is an insecticide, a member of dirty dozen persistent organic pollutants, used widely in the world until it was banned in the 1970s.The banning of DDT was strengthened by the Stockholm Convention in 2001. DDT is allowed only for malaria control in Ethiopia. However, farmers are misusing DDT and applying it to Khat (Catha edulis) farming. So, this review analyzes available data in the literature on the current trend, application, occurrence, fate and effects of DDT and its metabolites, dichlorodiphenyldichloroethane (DDD), dichlorodiphenyldichloroethylene (DDE), in the chewable parts of Khat. Generally, the concentration level of DDT, DDD, and DDE, designated as DDTs, is detected in different farmlands of Ethiopia. Some of the DDTs concentrations detected are very high (141.2-973 μg/kg (Gelemso), 194.4-999 μg/kg (Aseno) and 6253-8413.3 μg/kg (Gurage), and these concentrations may indicate increasing recent unmonitored application of DDT on Khat leaves. Some of the detected concentrations of DDT in the literature were above the maximum residue limit (MRL) set by FAO/WHO (100 μg/kg) and the European Commission 10 μg/kg in vegetables and 50 μg/kg in cereals. DDT exposure of Khat chewers linked to the concentration of DDT on Khat leaves and the amount of Khat consumed. DDT might pose health risks to chewers due to chronic toxicity, bioaccumulation, persistent and endocrine disruption properties.

A Retrospective Observational Study Using Administrative Databases to Assess the Risk of Spontaneous Abortions Related to Environmental and Socioeconomic Conditions

Miscarriage is one of the most frequent adverse events that occurs during pregnancy. This retrospective study aimed to verify if the environmental and socioeconomic conditions related to geographical areas where women live, and the socio-demographic and clinical factors play a role in the risk of spontaneous abortion (SA). The analyses were conducted by hospital discharge records (HDRs) from public and private hospitals in Apulia from 1 January 2021 to 31 December 2021. Women with an age over 40 years old had a major risk of SA compared with women under 18 years (OR 2.30, IC95%1.16-4.54). A reduction in the risk of SA was found for women with an endocrinological or metabolic disease (OR 0.28, 95% CI 0.19-0.41), while genetic disease greatly increases the risk (OR 9.63, IC95% 1.98-46.86). The greatest risk of spontaneous abortion was found in the province of Taranto compared to the province of Foggia (OR 2.01, 95% CI 1.52-2.64). The provinces with a higher risk of SA in the multiple comparisons were Taranto, Brindisi, and BAT. Municipalities with socioeconomic disadvantages classified as very low, low, and medium had a higher risk of SA compared to the municipalities with a high disadvantage. In conclusion, our study indicates the possible association between SA rate and environmental conditions. Additionally, the socioeconomic, clinical, and demographic factors were related to the risk of SAs.

Effects of Lead on Reproduction Physiology and Liver and Gonad Histology of Male Cyprinus carpio

Sera 17β-estradiol (E2), 11-ketotesteron (11-KT) and 17,20-β-dihydroxy-4-pregnen-3-one (17,20βP) levels and hepatosomatic-gonadosomatic indexes (HSI-GSI) were determined after exposing male C. carpio to 0.13 and 0.26 mg L^-1 lead after 7, 14 and 21 days. Histological changes in liver and gonad tissues of male C. carpio were also determined. Sera E2, 11-KT and 17,20βP levels of male fish although showed differences from the control fish, these differences were not statistically significant. This was also true for the HSI values, the GSI values however, decreased on day 7 under the effect of 0.26 mg L^-1 Pb. Dilatation in bile duct and sinusoids and lymphocyte infiltration were observed under histopathological examination. Low intensities of fibrosis were detected in testis tissues. Exposure to low concentrations of Pb did not cause endocrine disrupting and extensive histopathologic effects in C. carpio at the exposure periods tested.

Activity measurement of arylsulfatase and β-glucuronidase in activated sludge: HPLC-based versus classical spectrophotometric method

Arylsulfatase and β-glucuronidase are two important enzymes in wastewater and surface water, which play important roles on cleavage of sulfate/glucuronide estrogens. In this work, a high-performance liquid chromatography (HPLC)-based new method was firstly established for arylsulfatase/β-glucuronidase with determination of p-nitrophenyl sulfate (pNPS)/p-nitrophenyl-β-D-glucuronide (pNPG). The limits of detections (LODs) of the developed method for pNPS and pNPG were 0.164 and 0.098 μM, respectively. Intraday and interday reproducibility expressed as relative standard deviation (RSD) values of retention times and peak areas was 0.39%-3.68% and 0.23%-4.74%, respectively. The respective recovery efficiencies of this HPLC-based method spiking at three different concentrations for p-nitrophenol (pNP), pNPS, and pNPG in activated sludge were 76.5%-88.1%, 79.2%-93.1%, and 84.2%-96.1%, with RSD below 3.9%. The HPLC-based method was finally applied to estimate the enzyme activity of arylsulfatase/β-glucuronidase in one activated sludge system and along which the classical spectrophotometric method was also evaluated. Compared with the classic spectrophotometric analytical method, the HPLC-based new method could simultaneously measure arylsulfatase/β-glucuronidase one time, which was convenient and time-saving. Moreover, the developed method could effectively avoid possible underestimation that the spectrophotometric method might encounter. PRACTITIONER POINTS: A new HPLC-based method for activity estimation of arylsulfatase and β-glucuronidase was developed. The HPLC-based method can simultaneously estimate enzyme activity of both arylsulfatase and β-glucuronidase. The HPLC-based method can avoid possible underestimation that spectrophotometric method may encounter.

The influence of socio-demographic factors on miscarriage incidence among Italian and immigrant women: a critical analysis from Italy

Miscarriage is one of the most relevant adverse events in women's reproductive life. The purpose of the study was to describe miscarriage trend in Italy during the last years among Italian and immigrant women, to compare miscarriage rates of the two groups and to evaluate the effect of age, nationality and educational level on the incidence of having a miscarriage. Then, a brief critical review of other miscarriage risk factors was performed. This study is based on ISTAT database. All data were analyzed through the statistical software SPSS and the following analytical techniques were used: multivariate logistic regression, factorial analysis of variance and Chi square test. Immigrant miscarriage rates resulted higher than Italian ones and they decreased from 2003 to 2009 unlike Italian ones, which remained unchanged. The effect of maternal age on the miscarriage incidence resulted different, depending on the nationality; for Italian women it increased with increasing of age and for immigrant women the opposite trend was found. Moreover, miscarriage incidence resulted significantly different depending on the maternal educational level. Whereas immigrant women considered did not belong to the same ethnic group, biological or genetic factors underlying these differences were excluded and a socioeconomic explanation was provided. Finally, in order to provide more complete information, other miscarriage risk factors were discussed through a brief review of the literature.

A critical appraisal of the process of regulatory implementation of novel in vivo and in vitro methods for chemical hazard and risk assessment

Regulatory toxicology urgently needs applicable alternative test systems that reduce animal use, testing time, and cost. European regulation on cosmetic ingredients has already banned animal experimentation for hazard identification, and public awareness drives toward additional restrictions in other regulatory frameworks as well. In addition, scientific progress stimulates a more mechanistic approach of hazard identification. Nevertheless, the implementation of alternative methods is lagging far behind their development. In search for general bottlenecks for the implementation of alternative methods, this manuscript reviews the state of the art as to the development and implementation of 10 diverse test systems in various areas of toxicological hazard assessment. They vary widely in complexity and regulatory acceptance status. The assays are reviewed as to parameters assessed, biological system involved, standardization, interpretation of results, extrapolation to human hazard, position in testing strategies, and current regulatory acceptance status. Given the diversity of alternative methods in many aspects, no common bottlenecks could be identified that hamper implementation of individual alternative assays in general. However, specific issues for the regulatory acceptance and application were identified for each assay. Acceptance of one-in-one replacement of complex in vivo tests by relatively simple in vitro assays is not feasible. Rather, innovative approaches using test batteries are required together with metabolic information and in vitro to in vivo dose extrapolation to convincingly provide the same level of information of current in vivo tests. A mechanistically based alternative approach using the Adverse Outcome Pathway concept could stimulate further (regulatory) acceptance of non-animal tests.

Uterotrophic and Hershberger assays for endocrine disruption properties of plastic food contact materials polypropylene (PP) and polyethylene terephthalate (PET)

Plasticizers or plastic materials such as phthalates, bisphenol-A (BPA), and styrene are widely used in the plastic industry and are suspected endocrine-disrupting chemicals (EDC). Although plastic materials such as polypropylene (PP) and polyethylene terephthalate (PET) are not EDC and are considered to be safe, their potential properties as EDC have not been fully investigated. In this study, plastic samples eluted from plastic food containers (PP or PET) were investigated in Sprague-Dawley rats using Hershberger and uterotrophic assays. In the Hershberger assay, 6-wk-old castrated male rats were orally treated for 10 consecutive days with plastic effluent at 3 different doses (5 ml/kg) or vehicle control (corn oil, 1 ml/100 g) to determine the presence of both anti-androgenic and androgenic effects. Testosterone (0.4 mg/ml/kg) was subcutaneously administered for androgenic evaluation as a positive control, whereas testosterone (0.4 mg/ml/kg) and flutamide (3 mg/kg/day) were administered to a positive control group for anti-androgenic evaluation. The presence of any anti-androgenic or androgenic activities of plastic effluent was not detected. Sex accessory tissues such as ventral prostate or seminal vesicle showed no significant differences in weight between treated and control groups. For the uterotrophic assay, immature female rats were treated with plastic effluent at three different doses (5 ml/kg), with vehicle control (corn oil, 1 ml/100 g), or with ethinyl estradiol (3 μg/kg/d) for 3 d. There were no significant differences between test and control groups in vagina or uterine weight. Data suggest that effluents from plastic food containers do not appear to produce significant adverse effects according to Hershberger and uterotrophic assays.

Spontaneous abortion in spouses of greenhouse workers exposed to pesticides

OBJECTIVE

The aim of this study was to explore the association between exposure to specific pesticides (including endocrine disrupters) of greenhouse workers and spontaneous abortion in their spouses.

METHODS

A group of exposed workers was compared with a non-exposed group. The risk of spontaneous abortion was evaluated using a logistic regression model.

RESULTS

A significantly higher rate of spontaneous abortion was observed among spouses of workers exposed to specific compounds (atrazine, benomyl-carbendazim, carbaryl and DDT) in comparison with spouses of the unexposed group. The logistic regression model confirmed the increased risk of spontaneous abortion (OR=11.8; 95% CI 2.3-59.6).

CONCLUSIONS

These findings suggest that occupational exposure to pesticides might have an adverse effect on the partner's reproductive health.

The importance of the suspended solids parameter on the quantitative analysis of di-n-butyl phthalate in a wastewater treatment system

The present study has investigated the influence of the filtration step of the liquid-liquid extraction (LLE) on the quantitative analysis of di-n-butyl phthalate (DnBP) in the wastewater treatment system of the University of Caxias do Sul (WWTS-UCS). During five months, five wastewater samples from the inflow and outflow points were collected and submitted to LLE with and without the filtration step. The organic extracts were analyzed by Gas Chromatography with Flame Ionization Detection (GC/FID). The DnBP removal in the filtered samples was 36%, and the median DnBP concentration at the outflow point was 17.45 μg/mL. For the unfiltered samples, the DnBP removal was 39%, and the median DnBP concentration at the outflow point was 21.45 μg/mL. According to these results, an important fraction of the contaminant is retained in the LLE filtration step leading to considerable errors in the quantification of the target compounds.

Prioritizing research for trace pollutants and emerging contaminants in the freshwater environment

Organic chemicals have been detected at trace concentrations in the freshwater environment for decades. Though the term trace pollutant indicates low concentrations normally in the nanogram or microgram per liter range, many of these pollutants can exceed an acceptable daily intake (ADI) for humans. Trace pollutants referred to as emerging contaminants (ECs) have recently been detected in the freshwater environment and may have adverse human health effects. Analytical techniques continue to improve; therefore, the number and frequency of detections of ECs are increasing. It is difficult for regulators to restrict use of pollutants that are a human health hazard; scientists to improve treatment techniques for higher priority pollutants; and the public to modify consumption patterns due to the vast number of ECs and the breadth of literature on the occurrence, use, and toxicity. Hence, this paper examines literature containing occurrence and toxicity data for three broad classes of trace pollutants and ECs (industrials, pesticides, and pharmaceuticals and personal care products (PPCPs)), and assesses the relevance of 71 individual compounds. The evaluation indicates that widely used industrials (BPF) and PPCPs (AHTN, HHCB, ibuprofen, and estriol) occur frequently in samples from the freshwater environment but toxicity data were not available; thus, it is important to establish their ADI. Other widely used industrials (BDE-47, BDE-99) and pesticides (benomyl, carbendazim, aldrin, endrin, ethion, malathion, biphenthrin, and cypermethrin) have established ADI values but occurrence in the freshwater environment was not well documented. The highest priority pollutants for regulation and treatment should include industrials (PFOA, PFOS and DEHP), pesticides (diazinon, methoxychlor, and dieldrin), and PPCPs (EE2, carbamazepine, βE2, DEET, triclosan, acetaminophen, and E1) because they occur frequently in the freshwater environment and pose a human health hazard at environmental concentrations.

The effects of metals as endocrine disruptors

This review reports current knowledge regarding the roles that cadmium (Cd), mercury (Hg), arsenic (As), lead (PB), manganese (Mn), and zinc (Zn) play as endocrine-disrupting chemicals (EDCs). The influence of these metals on the endocrine system, possible mechanisms of action, and consequent health effects were correlated between experimental animals and humans. Analysis of the studies prompted us to identify some critical issues related to this area and showed the need for more rigorous and innovative studies. Consequently, it was recommended that future studies need to: (1) identify the mechanisms of action, because at the present time only a few have been elucidated-in this context, the possible presence of hormesis need to be determined, as currently this was reported only for exposure Cd and As; (2) study the possible additive, synergistic, or antagonistic effects on the endocrine system following exposure to a mixture of metals since there is a lack of these studies available, and in general or occupational environments, humans are simultaneously exposed to different classes of xenobiotics, including metals, but also to organic compounds that might also be EDCs; (3) assess the potential adverse effects on the endocrine system of low-level exposures to metals, as most of the information currently available on EDCs originates from studies in which exposure levels were particularly high; and (4) assess the effects on the endocrine and reproductive systems of other metals that are present in the general and occupational environment that have not yet been evaluated.

DDT reintroduction for malaria control: the cost-benefit debate for public health

DDT is a persistent insecticide that was widely used in the world from the 1940s until the 70s, when it was banned in the United States and other countries. Most of its toxic effects are not observed in the acute forms, but particularly after chronic exposure. These long-term issues include reproductive effects, varying according to the time of life in which the individuals were exposed. The aims of the current study were to review the principal toxicological effects of DDT on reproduction, stratifying by physiological periods of exposure, and based on the magnitude of these effects, to discuss the cost-benefit relationship of reintroducing DDT with the specifically defined vector control criteria.

Decreased serum free testosterone in workers exposed to high levels of di-n-butyl phthalate (DBP) and di-2-ethylhexyl phthalate (DEHP): a cross-sectional study in China

BACKGROUND

Observations of adverse developmental and reproductive effects in laboratory animals and wildlife have fueled increasing public concern regarding the potential for various chemicals to impair human fertility.

OBJECTIVE

Our objective in this study was to assess the effect of occupational exposure to high levels of phthalate esters on the balance of gonadotropin and gonadal hormones including luteinizing hormone, follicle-stimulating hormone, free testosterone (fT), and estradiol.

METHODS

We examined urine and blood samples of 74 male workers at a factory producing unfoamed polyvinyl chloride flooring exposed to di-n-butyl phthalate (DBP) and di-2-ethylhexyl phthalate (DEHP) and compared them with samples from 63 male workers from a construction company, group matched for age and smoking status.

RESULTS

Compared to the unexposed workers, the exposed workers had substantially and significantly elevated concentrations of mono-n-butyl phthalate (MBP; 644.3 vs. 129.6 microg/g creatinine, p < 0.001) and mono-2-ethylhexyl phthalate (MEHP; 565.7 vs. 5.7 microg/g creatinine, p < 0.001). fT was significantly lower (8.4 vs. 9.7 microg/g creatinine, p = 0.019) in exposed workers than in unexposed workers. fT was negatively correlated to MBP (r = -0.25, p = 0.03) and MEHP (r = -0.19, p = 0.095) in the exposed worker group. Regression analyses revealed that fT decreases significantly with increasing total phthalate ester score (the sum of quartiles of MBP and MEHP; r = -0.26, p = 0.002).

CONCLUSION

We observed a modest and significant reduction of serum fT in workers with higher levels of urinary MBP and MEHP compared with unexposed workers.

Risk Assessment of Endocrine Disrupters: The Role of Toxicological Studies

Endocrine disrupters (ED) represent a good challenge for experimental toxicology. In order to deal with several critical points relevant to risk assessment: (a) ED may induce long-term effects upon exposure in susceptible developmental phases, including postnatal life up to puberty; thus, efforts are required to refine testing strategies, for example, by supporting the two-generation rodent study with a comprehensive in vitro/in vivo screening battery; (b) due to the regulatory role of endocrine homeostasis, mechanisms of endocrine disruption may impact on immune, neurobehavioral, and reproductive development, as well as on susceptibility to cancer; (c) the potential multiple exposure to ED with common targets through diet and/or living environment calls for the development of models to understand mechanisms of interactions and effects of mixtures; and (d) last but not least, ED may interact with a number of factors related to differential vulnerability of individuals or population subgroups, including the intake of nutrients or bioactive food components. Besides reducing the chance for noxious chemicals to enter our life, toxicological research on mechanisms may also lead to the definition of possible biomarkers of exposure, effect, and susceptibility that may be further exploited in human health surveillance.

Exposures to estradiol, ethinylestradiol and octylphenol affect survival and growth of Rana pipiens and Rana sylvatica tadpoles

Endocrine disrupting compounds (EDCs) are often detected in the aquatic environment and can negatively affect the health of wildlife populations. However, little is known about the sensitivity of native amphibians to EDCs. Wood frogs (Rana sylvatica) and Northern leopard frogs (Rana pipiens) were exposed to three estrogenic EDCs: estradiol (E2), ethinylestradiol (EE2), and 4-tert-octylphenol (OP). In addition, R. pipiens were exposed during two developmental stages (Gosner stages 26 and 36) to examine life-stage differences in sensitivity. Tadpoles were exposed for 2 wk to 8 nominal concentrations (0.25 microM-10 microM) of each compound. Individual mortality was recorded during the exposure period, while body weight was measured at the end of 2 wk. LC50 values were calculated, and differences in body weight between vehicle control and exposed groups were assessed. Rank order toxicity of the compounds for both R. pipiens stages and both species was OP > EE2 > E2. Gosner stage 26 tadpoles were more sensitive (LC50: E2 [5.57 microM], EE2 [3.01 microM], OP [1.36 microM]) to all three compounds when compared to stage 36 tadpoles (LC50: E2 [>10 microM], EE2 [4.17 microM], OP [2.80 microM]). Interspecies comparisons revealed R. sylvatica tadpoles (LC50: E2 [2.50 microM], EE2 [1.89 microM], OP [0.74 microM]) as being more sensitive to the three compounds than R. pipiens (LC50: E2 [4.56 microM], EE2 [2.75 microM], OP [1.42 microM]). Xenoestrogen exposure also affected tadpole body weight which may have long-term adverse effects on the rate of metamorphosis. These results provide toxicological data needed for assessing sublethal effects of estrogenic compounds on amphibian development and suggest that environmental levels of OP may pose a serious risk to the health of amphibian populations.

Occupational exposure and effects on the male reproductive system

A significant increase in the incidence of male infertility has been described in the international literature, raising questions about its causes. Part of this effect may result from synthetic toxic substances acting on the endocrine system (endocrine disruptors), many of which are routinely used in work processes. We provide a critical review of the specialized literature on work-related chemical substances capable of causing male infertility. Pesticides such as DDT, linuron, and others, heavy metals like mercury, lead, cadmium, and copper, and substances from various industrial uses and residues such as dioxins, polychlorinated biphenyls (PCBs), ethylene dibromide (EDB), phthalates, polyvinyl chloride (PVC), and ethanol are among the main endocrine disruptors that can cause male infertility. Based on the literature, gonadal dysfunction and congenital malformation are the main alterations caused by these substances in the male reproductive system. We conclude that despite the relative lack of studies on this issue, the relevance of such risk calls for further studies as well as measures to prevent workers' exposure to the various substances.

Environmental xenobiotics and nuclear receptors--interactions, effects and in vitro assessment

A group of intracellular nuclear receptors is a protein superfamily including arylhydrocarbon AhR, estrogen ER, androgen AR, thyroid TR and retinoid receptors RAR/RXR as well as molecules with unknown function known as orphan receptors. These proteins play an important role in a wide range of physiological as well as toxicological processes acting as transcription factors (ligand-dependent signalling macromolecules modulating expression of various genes in a positive or negative manner). A large number of environmental pollutants and other xenobiotics negatively affect signaling pathways, in which nuclear receptors are involved, and these modulations were related to important in vivo toxic effects such as immunosuppression, carcinogenesis, reproduction or developmental toxicity, and embryotoxicity. Presented review summarizes current knowledge on major nuclear receptors (AhR, ER, AR, RAR/RXR, TR) and their relationship to known in vivo toxic effects. Special attention is focused on priority organic environmental contaminants and experimental approaches for determination and studies of specific toxicity mechanisms.

Effects of the endocrine disrupter chemicals chlordane and lindane on the male green neon shrimp (Neocaridina denticulata)

The purpose of this study was to investigate the effect of chlordane and lindane on morphological changes and endocrine disruption in male Green neon shrimp (Neocaridina denticulata). In this experiment, individuals of N. denticulata, a common inhabitant of freshwater systems in Taiwan, were exposed to chlordane (1 and 10 ng/l and lindane (0.1 and 1 microg/l morphological changes and reproductive hormone levels were observed following four weeks exposure. According to our findings, an increase in estrogen, a reduction in testosterone, and morphological alternations of the masculine appendage were observed in both chlordane- and lindane-treated shrimp, while induction of a vitellogenin-like protein appeared only in shrimp treated with 10 ng/l chlordane. An endocrine disruption effect on N. denticulata was demonstrated, and may apply to other organochlorine pesticides or endocrine disruption chemicals.

Xenoestrogenic effects of ethinylestradiol in zebrafish (Danio rerio)

To assess the estrogenic effects of ethinylestradiol on zebrafish, zebrafish at different developmental stages (embryos, juveniles, and adults) were exposed to the synthetic hormone ethinylestradiol (EE2) in concentrations of 1, 10, and 100 ng/L for up to 33 days. Survival, hatching, length, weight, growth, condition, hepatosomatic index, gonadosomatic index, and vitellogenin (VTG) production were examined. Exposure of zebrafish juveniles and embryos to 100 ng EE2/L for up to 33 days had significant effects on survival, growth, and hatching. Two VTG fragments with molecular weights of approximately 140 and 170 kDa were detected with protein electrophoresis and Western blotting in the blood of exposed males and exposed and unexposed females, as well as in whole-body homogenates of exposed and unexposed juveniles. Significantly higher VTG concentrations (compared to controls) were measured in adults exposed to 10 and 100 ng EE2/L for 14 days, but not in fish exposed to 1 ng EE2/L. This study demonstrated that (1) zebrafish juveniles, larvae, and embryos are sensitive to the toxic effects of the endocrine disrupter EE2; (2) the effects on VTG production in adults are detected after exposure to environmentally relevant concentrations of EE2; (3) unexposed juvenile zebrafish produce measurable concentrations of VTG.

Hazard identification and risk assessment of endocrine disrupting chemicals with regard to developmental effects

Endocrine Disrupting Chemicals (EDC) may affect mammalian development either indirectly (by affecting implantation, placenta, lactation, etc.) or directly, altering the maturation of target tissues. Studies on reproductive and developmental effects are likely to provide the critical information for risk assessment of most EDC, when proper endpoints are investigated. Toxicity testing guidelines, and especially the two-generation test, are currently being updated with regard to risk assessment of EDC. Particular emphasis is put on selection and validation of the parameters most sensitive to given chemicals and/or mechanisms of action; therefore, a screening battery it is important to address further testing. Under this respect the future use of gene arrays might be a most promising development, when more data will be available. Further points to be considered in a biologically-based assessment of developmental risks include: the identification of critical effects also through the evaluation of dose-response curves; the assessment of the actual exposure and different susceptibility of target tissues; the identification of possible factors of susceptibility and gene-environment interactions; the elaboration of models to estimate the possible additional risk deriving from combined exposures to EDC having similar mechanisms and/or targets.