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George R, Haywood A, Good P, Hennig S, Khan S, Norris R, Hardy J. Can Saliva and Plasma Methadone Concentrations Be Used for Enantioselective Pharmacokinetic and Pharmacodynamic Studies in Patients With Advanced Cancer? Clin Ther 2017; 39:1840-1848. [DOI: 10.1016/j.clinthera.2017.07.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/15/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
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Guinan TM, Neldner D, Stockham P, Kobus H, Della Vedova CB, Voelcker NH. Porous silicon mass spectrometry as an alternative confirmatory assay for compliance testing of methadone. Drug Test Anal 2016; 9:769-777. [PMID: 27364015 DOI: 10.1002/dta.2033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/07/2022]
Abstract
Porous silicon based surface-assisted laser desorption ionization mass spectrometry (pSi SALDI-MS) is an analytical technique well suited for high throughput analysis of low molecular weight compounds from biological samples. A potential application of this technology is the compliance monitoring of opioid addiction programmes, where methadone is used as a pharmacological treatment for drugs such as heroin. Here, we present the detection and quantification of methadone and 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) from water and clinical samples (saliva, urine, and plasma) from opioid dependent participants using pSi SALDI-MS. A one-step solvent phase extraction using chloroform was developed for the detection of methadone from clinical samples for analysis by pSi SALDI-MS. Liquid chromatography-mass spectrometry (LC-MS) was used as a comparative technique for the quantification of methadone from clinical saliva and plasma samples. In all cases, we obtained a good correlation of pSi SALDI-MS and LC-MS results, suggesting that pSi SALDI-MS may be an alternative procedure for high-throughput screening and quantification for application in opioid compliance testing. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Taryn M Guinan
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Mawson Institute, Australia.,Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Declan Neldner
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Peter Stockham
- Forensic Science SA, Adelaide, South Australia, Australia
| | - Hilton Kobus
- School of Chemical and Physical Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Christopher B Della Vedova
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nicolas H Voelcker
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Mawson Institute, Australia.,Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia
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George R, Lobb M, Haywood A, Khan S, Hardy J, Good P, Hennig S, Norris R. Quantitative determination of the enantiomers of methadone in human plasma and saliva by chiral column chromatography coupled with mass spectrometric detection. Talanta 2016; 149:142-148. [DOI: 10.1016/j.talanta.2015.11.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
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Bista SR, Haywood A, Norris R, Good P, Tapuni A, Lobb M, Hardy J. Saliva versus Plasma for Pharmacokinetic and Pharmacodynamic Studies of Fentanyl in Patients with Cancer. Clin Ther 2015; 37:2468-75. [PMID: 26404396 DOI: 10.1016/j.clinthera.2015.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Fentanyl is widely used to relieve cancer pain. However there is great interpatient variation in the dose required to relieve pain and little knowledge about the pharmacokinetic and pharmacodynamic (PK/PD) relationship of fentanyl and pain control. Patients with cancer are fragile and there is reluctance on the part of health professionals to take multiple plasma samples for PK/PD studies. The relationship between plasma and saliva fentanyl concentrations was investigated to determine whether saliva could be a valid substitute for plasma in PK/PD studies. METHODS One hundred sixty-three paired plasma and saliva samples were collected from 56 patients prescribed transdermal fentanyl (Durogesic, Janssen-Cilag Pty Limited, NSW, Australia) at varying doses (12-200 µg/h). Pain scores were recorded at the time of sampling. Fentanyl and norfentanyl concentrations in plasma and saliva were quantified using HPLC-MS/MS. FINDINGS Saliva concentrations of fentanyl (mean = 4.84 μg/L) were much higher than paired plasma concentrations of fentanyl (mean = 0.877 μg/L). Both plasma and saliva mean concentrations of fentanyl were well correlated with dose with considerable interpatient variation at each dose. The relationship between fentanyl and norfentanyl concentrations was poor in both plasma and saliva. No correlation was observed between fentanyl concentration in plasma and saliva (r(2) = 0.3743) or free fentanyl in plasma and total saliva concentrations (r(2) = 0.1374). Pain scores and fentanyl concentration in either of the matrices were also not correlated. IMPLICATIONS No predictive correlation was observed between plasma and saliva fentanyl concentration. However the detection of higher fentanyl concentrations in saliva than plasma, with a good correlation to dose, may allow saliva to be used as an alternative to plasma in PK/PD studies of fentanyl in patients with cancer.
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Affiliation(s)
- Sudeep R Bista
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Alison Haywood
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Ross Norris
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; SydPath, St Vincent's Hospital, Sydney, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Phillip Good
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Queensland, Australia; Palliative Care, St Vincent's Private Hospital, Brisbane, Queensland, Australia
| | - Angela Tapuni
- Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Queensland, Australia
| | - Michael Lobb
- Mater Pathology Services, South Brisbane, Queensland, Australia
| | - Janet Hardy
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; Department of Palliative and Supportive Care, Mater Health Services, Brisbane, Queensland, Australia
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Miguez-Díez E, Modamio P, Vázquez M, Lastra CF, Montes MJ, Retamoso I, Papa P, Fagiolino P, Mariño EL. Correlation of methadone concentrations in plasma and saliva collected with and without stimulation in pain management patients. Clin Chem Lab Med 2014; 53:e109-12. [PMID: 25241729 DOI: 10.1515/cclm-2014-0738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/22/2014] [Indexed: 11/15/2022]
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Bista SR, Lobb M, Haywood A, Hardy J, Tapuni A, Norris R. Development, validation and application of an HPLC-MS/MS method for the determination of fentanyl and nor-fentanyl in human plasma and saliva. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 960:27-33. [PMID: 24780703 DOI: 10.1016/j.jchromb.2014.04.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/24/2022]
Abstract
Monitoring fentanyl concentration in saliva and plasma may be useful in pharmacokinetic/pharmacodynamic studies. Salivettes(®) have been used widely for collecting saliva samples. However due to its lipophilicity, fentanyl adsorbs to the cotton dental bud (CDB) used in this device. Furthermore, due to dry mouth being a common adverse effect seen in patients treated with opioids, obtaining enough saliva for analysis is often a challenge. Hence, a simple simultaneous method to quantify fentanyl and its metabolite in both human plasma and saliva was developed and validated. A novel extraction method was also developed and validated to recover fentanyl in saliva directly from the CDB. This extraction method utilises acetonitrile to recover the fentanyl directly from the CDB rather than recovery by centrifugation, which is not always possible. Reverse phase chromatographic separation was performed on a Shimadzu LC 20A HPLC system using gradient elution. The electrospray ion source (ESI) was operated in positive ion mode using an Applied Biosystems API 3200 LC/MS/MS as detector. Deuterated fentanyl (D5) and nor-fentanyl (D5) were used as internal standards (IS). The retention times for fentanyl and nor-fentanyl were 3.70 min and 3.20 min respectively. The lower limit of quantitation (LLOQ) was determined to be 0.030 μg/L in plasma and 0.045 in saliva for fentanyl and nor-fentanyl. Acceptable linearity for fentanyl and nor-fentanyl in both plasma and saliva was demonstrated from 0.02 to 10 μg/L (R(2) 0.9988-0.9994). Accuracy for fentanyl and nor-fentanyl in both plasma and saliva samples was between 96% and 108%. Total imprecision expressed as the co-efficient of variation was between 1.0 and 15.5% for both analytes in both matrices. The validated method was applied successfully in 11 paired plasma and saliva samples obtained from patients with cancer pain receiving transdermal fentanyl (Duragesic(®)) at doses from 25 μg to 100 μg.
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Affiliation(s)
- Sudeep R Bista
- School of Pharmacy, Gold Coast Campus, Griffith Health Institute, Griffith University, Qld 4222, Australia.
| | - Michael Lobb
- Mater Research Institute & Mater Pathology Services (Australian Centre for Paediatric Pharmacokinetics), South Brisbane, Qld 4101, Australia
| | - Alison Haywood
- School of Pharmacy, Gold Coast Campus, Griffith Health Institute, Griffith University, Qld 4222, Australia
| | - Janet Hardy
- Mater Research Institute & Mater Pathology Services (Australian Centre for Paediatric Pharmacokinetics), South Brisbane, Qld 4101, Australia
| | - Angela Tapuni
- Mater Research Institute & Mater Pathology Services (Australian Centre for Paediatric Pharmacokinetics), South Brisbane, Qld 4101, Australia
| | - Ross Norris
- School of Pharmacy, Gold Coast Campus, Griffith Health Institute, Griffith University, Qld 4222, Australia; Mater Research Institute & Mater Pathology Services (Australian Centre for Paediatric Pharmacokinetics), South Brisbane, Qld 4101, Australia; School of Pharmacy, University of Queensland, St Lucia, Qld, Australia
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Miguez-Díez E, Modamio P, Lastra CF, Arrufat FX, Serra M, Reig S, Mariño EL. Development and validation of a rapid and reliable high-performance liquid chromatography method for methadone quantification in human plasma and saliva. Clin Chem Lab Med 2013; 51:e309-12. [DOI: 10.1515/cclm-2013-0546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/23/2013] [Indexed: 11/15/2022]
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Hsu YC, Chen BG, Yang SC, Wang YS, Huang SP, Huang MH, Chen TJ, Liu HC, Lin DL, Liu RH, Jones AW. Methadone concentrations in blood, plasma, and oral fluid determined by isotope-dilution gas chromatography–mass spectrometry. Anal Bioanal Chem 2012; 405:3921-8. [DOI: 10.1007/s00216-012-6460-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 08/29/2012] [Accepted: 09/26/2012] [Indexed: 11/24/2022]
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Pharmacokinetic-pharmacodynamic modeling of mood and withdrawal symptoms in relation to plasma concentrations of methadone in patients undergoing methadone maintenance treatment. J Clin Psychopharmacol 2012; 32:666-71. [PMID: 22926601 DOI: 10.1097/jcp.0b013e3182664ecd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aims of the present study were to characterize the relationship between plasma racemic methadone and its enantiomers' concentrations with respect to their pharmacodynamic effects and to investigate the influence of potential covariates on the pharmacodynamic parameters in patients on methadone maintenance treatment (MMT). Eighty-eight regular subjects at the Sheffield Care Trust Substance Misuse Services were studied. Samples of blood and urine were collected before the daily dose of methadone. Blood samples were taken up to 5 hours after dose. Total plasma concentrations of (RS)-methadone and total and unbound plasma concentrations of both enantiomers were measured by liquid chromatography-mass spectrometry. The Total Mood Disturbance Score (TMDS), the Objective Opioid Withdrawal Scale (OOWS), and the Subjective Opioid Withdrawal Scale (SOWS) were used as measures of mood and withdrawal. Population pharmacokinetic/pharmacodynamic analysis and subsequent multiple regression analysis were used to determine the factors influencing the pharmacodynamic effects of methadone. Significant decreases (P ≤ 0.04) were observed in the scores for the TMDS, SOWS, and OOWS for 5 hours after methadone dosage. The TMDS had returned to baseline by 10 hours after dose (P = 0.98), at which time the SOWS remained significantly below baseline (P = 0.001). Multiple regression analysis revealed that 33% of the overall variation in unbound (R)-methadone EC50 was explained by 3 variables, namely CYP3A activity (9%), age (16%), and sex (8%). Age also accounted for 8% and 9% of the variation in total (rac)- and (R)-methadone EC50. The present study has confirmed that the duration of mood change in the present study was shorter than the effect of methadone in stabilizing withdrawal symptoms. Thus, it is likely that a once-daily dose of methadone, albeit effective for preventing withdrawal, may not be sufficient to improve mood in some patients. Finally, it was established that CYP3A activity, years of dependent use, sex, and age are major determinants of methadone EC50 with respect to TMDS.
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Hardy J, Norris R, Anderson H, O’Shea A, Charles B. Is saliva a valid substitute for plasma in pharmacokinetic studies of oxycodone and its metabolites in patients with cancer? Support Care Cancer 2011; 20:767-72. [DOI: 10.1007/s00520-011-1147-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 03/28/2011] [Indexed: 11/29/2022]
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Abstract
Drug oral fluid analysis was first used almost 30 years ago for the purpose of therapeutic drug monitoring. Since then, oral fluid bioanalysis has become more popular, mainly in the fields of pharmacokinetics, workplace drug testing, criminal justice, driving under the influence testing and therapeutic drug monitoring. In fact, oral fluid can provide a readily available and noninvasive medium, without any privacy loss by the examinee, which occurs, for instance, during the collection of urine samples. It is believed that drug concentrations in oral fluid may parallel those measured in blood. This feature makes oral fluid an alternative analytical specimen to blood, which assumes particular importance in roadside testing, the most published application of this sample. Great improvements in the development of accurate and reliable methods for sample collection, in situ detection devices (on-site drug detection kits), and highly sensitive and specific analytical methods for oral fluid testing of drugs have been observed in the last few years. However, without mass spectrometry-based analytical methods, such as liquid chromatography coupled to mass spectrometry (LC–MS) or tandem mass spectrometry (LC–MS/MS), the desired sensitivity would not be met, due to the low amounts of sample usually available for analysis. This review will discuss a series of published papers on the applicability of oral fluid in the field of analytical, clinical and forensic toxicology, with a special focus on its advantages and drawbacks over the normally used biological specimens and the main technological advances over the last decade, which have made oral fluid analysis of drugs possible.
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Shiran MR, Lennard MS, Iqbal MZ, Lagundoye O, Seivewright N, Tucker GT, Rostami-Hodjegan A. Contribution of the activities of CYP3A, CYP2D6, CYP1A2 and other potential covariates to the disposition of methadone in patients undergoing methadone maintenance treatment. Br J Clin Pharmacol 2009; 67:29-37. [PMID: 19133059 DOI: 10.1111/j.1365-2125.2008.03312.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS To investigate the influence of different cytochrome P450 (CYP) activities and other potential covariates on the disposition of methadone in patients on methadone maintenance therapy (MMT). METHODS Eighty-eight patients (58 male; 21-55 years; 84 White) on MMT were studied. CYP2D6 activity [3 h plasma metabolic ratio of dextromethorphan (DEX) to dextrorphan (DOR)] was determined in 44 patients (29 male; 24-55 years), CYP1A2 activity (salivary caffeine elimination half-life) in 44 patients (21 male; 24-55 years) and CYP3A activity (oral clearance of midazolam) in 49 patients (33 male; 23-55 years). Data on all three CYPs were obtained from 32 subjects. Total plasma concentrations of (RS)-methadone and total and unbound plasma concentrations of both enantiomers were measured by LC/MS. Population pharmacokinetics and subsequent multiple regression analysis were used to calculate methadone oral clearance and to identify its covariates. RESULTS Between 61 and 68% of the overall variation in total plasma trough concentrations of (RS)-, (R)- and (S)-methadone was explained by methadone dose, duration of addiction before starting MMT, CYP3A activity and illicit morphine use. CYP3A activity explained 22, 16, 15 and 23% of the variation in unbound (R)-, unbound (S)-, total (RS)- and total (S)-methadone clearances, respectively. Neither CYP2D6 nor CYP1A2 activity was related to methadone disposition. CONCLUSIONS CYP3A activity has a modest influence on methadone disposition. Inhibitors and inducers of this enzyme should be monitored in patients taking methadone.
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Affiliation(s)
- Mohammad-Reza Shiran
- Academic Unit of Clinical Pharmacology, University of Sheffield and Sheffield Care Trust, Substance Misuse Services, Sheffield, UK
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Dasgupta A. Usefulness of monitoring free (unbound) concentrations of therapeutic drugs in patient management. Clin Chim Acta 2007; 377:1-13. [PMID: 17026974 DOI: 10.1016/j.cca.2006.08.026] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 08/11/2006] [Accepted: 08/24/2006] [Indexed: 11/28/2022]
Abstract
Drugs are bound to various serum proteins in different degrees and only unbound or free drug is pharmacologically active. Although free drug concentration can be estimated from total concentration, for strongly bound drugs, prediction of free level is not always possible. Conditions like uremia, liver disease and hypoalbuminemia can lead to significant increases in free drug resulting in drug toxicity even if the concentration of total drug is within therapeutic range. Drug-drug interactions may also lead to a disproportionate increase in free drug concentrations. Elderly patients may have increased free drug concentrations due to hypoalbuminemia. Elevated free phenytoin concentrations have also been reported in patients with AIDS and pregnancy. Currently free drug concentrations of anticonvulsants such as phenytoin, carbamazepine and valproic acid are widely measured in clinical laboratories. Newer drugs such as mycophenolic acid mofetil and certain protease inhibitors are also considered as candidates for monitoring free drug concentration.
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Affiliation(s)
- Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, 6431 Fannin, MSB 2.292, Houston, TX 77030, United States.
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Paustenbach D, Galbraith D. Biomonitoring and biomarkers: exposure assessment will never be the same. ENVIRONMENTAL HEALTH PERSPECTIVES 2006; 114:1143-9. [PMID: 16882516 PMCID: PMC1552022 DOI: 10.1289/ehp.8755] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Using modern analytical technology, it is now possible to measure almost any chemical present in our bodies. The future role of classical exposure assessment will perhaps be marginalized because biomonitoring programs can directly measure the concentration of chemicals that are present in biologic matrices. Although the concentration of chemicals in the environment will continue to be measured and related to exposure parameters, the prioritization of the national environmental agenda will be dictated by biomonitoring. Recent biomonitoring studies have examined the levels of >200 chemicals. Biomonitoring data, by themselves, are not informative in helping consumers understand their individual health risk. A major challenge facing those who conduct biomonitoring programs is how to best communicate the information to the public. In this article, we review benefits and challenges, along with select results from the Centers for Disease Control and Prevention's 2005 National Report on Human Exposure to Environmental Chemicals. We recommend that these data be carefully interpreted, with the goal of establishing baseline exposure information, rather than creating surrogates for conclusions about human health risk.
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