Chloroform: a review of its metabolism, teratogenic, mutagenic, and carcinogenic potential

Phage Therapy-Challenges, Opportunities and Future Prospects

The increasing drug resistance of bacteria to commonly used antibiotics creates the need to search for and develop alternative forms of treatment. Phage therapy fits this trend perfectly. Phages that selectively infect and kill bacteria are often the only life-saving therapeutic option. Full legalization of this treatment method could help solve the problem of multidrug-resistant infectious diseases on a global scale. The aim of this review is to present the prospects for the development of phage therapy, the ethical and legal aspects of this form of treatment given the current situation of such therapy, and the benefits of using phage products in persons for whom available therapeutic options have been exhausted or do not exist at all. In addition, the challenges faced by this form of therapy in the fight against bacterial infections are also described. More clinical studies are needed to expand knowledge about phages, their dosage, and a standardized delivery system. These activities are necessary to ensure that phage-based therapy does not take the form of an experiment but is a standard medical treatment. Bacterial viruses will probably not become a miracle cure-a panacea for infections-but they have a chance to find an important place in medicine.

A metabolomic platform to identify and quantify polyphenols in coffee and related species using liquid chromatography mass spectrometry

INTRODUCTION

Products of plant secondary metabolism, such as phenolic compounds, flavonoids, alkaloids, and hormones, play an important role in plant growth, development, stress resistance. The plant family Rubiaceae is extremely diverse and abundant in Central America and contains several economically important genera, e.g. Coffea and other medicinal plants. These are known for the production of bioactive polyphenols (e.g. caffeine and quinine), which have had major impacts on human society. The overall goal of this study was to develop a high-throughput workflow to identify and quantify plant polyphenols.

METHODS

First, a method was optimized to extract over 40 families of phytochemicals. Then, a high-throughput metabolomic platform has been developed to identify and quantify 184 polyphenols in 15 min.

RESULTS

The current metabolomics study of secondary metabolites was conducted on leaves from one commercial coffee variety and two wild species that also belong to the Rubiaceae family. Global profiling was performed using liquid chromatography high-resolution time-of-flight mass spectrometry. Features whose abundance was significantly different between coffee species were discriminated using statistical analysis and annotated using spectral databases. The identified features were validated by commercially available standards using our newly developed liquid chromatography tandem mass spectrometry method.

DISCUSSION

Caffeine, trigonelline and theobromine were highly abundant in coffee leaves, as expected. Interestingly, wild Rubiaceae leaves had a higher diversity of phytochemicals in comparison to commercial coffee: defense-related molecules, such as phenylpropanoids (e.g., cinnamic acid), the terpenoid gibberellic acid, and the monolignol sinapaldehyde were found more abundantly in wild Rubiaceae leaves.

A lipidomics platform to analyze the fatty acid compositions of non-polar and polar lipid molecular species from plant tissues: Examples from developing seeds and seedlings of pennycress (Thlaspi arvense)

The lipidome comprises the total content of molecular species of each lipid class, and is measured using the analytical techniques of lipidomics. Many liquid chromatography-mass spectrometry (LC-MS) methods have previously been described to characterize the lipidome. However, many lipidomic approaches may not fully uncover the subtleties of lipid molecular species, such as the full fatty acid (FA) composition of certain lipid classes. Here, we describe a stepwise targeted lipidomics approach to characterize the polar and non-polar lipid classes using complementary LC-MS methods. Our "polar" method measures 260 molecular species across 12 polar lipid classes, and is performed using hydrophilic interaction chromatography (HILIC) on a NH2 column to separate lipid classes by their headgroup. Our "non-polar" method measures 254 molecular species across three non-polar lipid classes, separating molecular species on their FA characteristics by reverse phase (RP) chromatography on a C30 column. Five different extraction methods were compared, with an MTBE-based extraction chosen for the final lipidomics workflow. A state-of-the-art strategy to determine and relatively quantify the FA composition of triacylglycerols is also described. This lipidomics workflow was applied to developing, mature, and germinated pennycress seeds/seedlings and found unexpected changes among several lipid molecular species. During development, diacylglycerols predominantly contained long chain length FAs, which contrasted with the very long chain FAs of triacylglycerols in mature seeds. Potential metabolic explanations are discussed. The lack of very long chain fatty acids in diacylglycerols of germinating seeds may indicate very long chain FAs, such as erucic acid, are preferentially channeled into beta-oxidation for energy production.

Standardized bacteriophage purification for personalized phage therapy

The world is on the cusp of a post-antibiotic era, but researchers and medical doctors have found a way forward-by looking back at how infections were treated before the advent of antibiotics, namely using phage therapy. Although bacteriophages (phages) continue to lack drug approval in Western medicine, an increasing number of patients are being treated on an expanded-access emergency investigational new drug basis. To streamline the production of high-quality and clinically safe phage preparations, we developed a systematic procedure for medicinal phage isolation, liter-scale cultivation, concentration and purification. The 16- to 21-day procedure described in this protocol uses a combination of modified classic techniques, modern membrane filtration processes and no organic solvents to yield on average 23 mL of 10¹¹ plaque-forming units (PFUs) per milliliter for Pseudomonas, Klebsiella, and Serratia phages tested. Thus, a single production run can produce up to 64,000 treatment doses at 10⁹ PFUs, which would be sufficient for most expanded-access phage therapy cases and potentially for clinical phase I/II applications. The protocol focuses on removing endotoxins early by conducting multiple low-speed centrifugations, microfiltration, and cross-flow ultrafiltration, which reduced endotoxins by up to 10⁶-fold in phage preparations. Implementation of a standardized phage cultivation and purification across research laboratories participating in phage production for expanded-access phage therapy might be pivotal to reintroduce phage therapy to Western medicine.

Retreatability of two endodontic sealers, EndoSequence BC Sealer and AH Plus: a micro-computed tomographic comparison

OBJECTIVES

Recently, bioceramic sealers like EndoSequence BC Sealer (BC Sealer) have been introduced and are being used in endodontic practice. However, this sealer has limited research related to its retreatability. Hence, the aim of this study was to evaluate the retreatability of two sealers, BC Sealer as compared with AH Plus using micro-computed tomographic (micro-CT) analysis.

MATERIALS AND METHODS

Fifty-six extracted human maxillary incisors were instrumented and randomly divided into 4 groups of 14 teeth: 1A, gutta-percha, AH Plus retreated with chloroform; 1B, gutta-percha, AH Plus retreated without chloroform; 2A, gutta-percha, EndoSequence BC Sealer retreated with chloroform; 2B, gutta-percha, EndoSequence BC Sealer retreated without chloroform. Micro-CT scans were taken before and after obturation and retreatment and analyzed for the volume of residual material. The specimens were longitudinally sectioned and digitized images were taken with the dental operating microscope. Data was analyzed using an ANOVA and a post-hoc Tukey test. Fisher exact tests were performed to analyze the ability to regain patency.

RESULTS

There was significantly less residual root canal filling material in the AH Plus groups retreated with chloroform as compared to the others. The BC Sealer samples retreated with chloroform had better results than those retreated without chloroform. Furthermore, patency could be re-established in only 14% of teeth in the BC Sealer without chloroform group.

CONCLUSION

The results of this study demonstrate that the BC Sealer group had significantly more residual filling material than the AH Plus group regardless of whether or not both sealers were retreated with chloroform.

Noteworthy Chemistry of Chloroform

Inhaled chloroform anesthesia was introduced in 1847. Soon thereafter, the chemical reactivity of aerobically heated chloroform permitted John Snow and Claude Bernard to do seminal experiments in the assay of drug levels and drug metabolism. However, it was not widely appreciated until a clinical mishap in 1899 that thermal decomposition generated significant levels of toxic phosgene from air-polluting quantities of chloroform in poorly ventilated operating rooms that were illuminated by flames. Phosgene is also generated metabolically from chloroform. A clue appeared in the 1950s when subanesthetic traces of inhaled chloroform proved accidentally lethal to strains of male mice spontaneously expressing high levels of chloroform-metabolizing enzymes. Furthermore, in microbial experiments of 1967, the reactive chloroform molecule was inadvertently discovered to selectively inactivate vitamin B12-dependent enzymes. Chloroform can also activate enzymes. As a solvent, it was serendipitously found in 1903 to activate what is now known as plasminogen to plasmin.

Genotoxicity of drinking water disinfection by-products (bromoform and chloroform) by using both Allium anaphase-telophase and comet tests

Genotoxic effects of bromoform and chloroform, disinfection by-products of the chlorination of drinking water, were examined by using mitotic index (MI), mitotic phase, chromosome aberrations (CAs) and comet assay on root meristematic cells of Allium cepa. Different concentrations of bromoform (25, 50, 75 and 100 μg/mL) and chloroform (25, 50, 100 and 200 μg/mL) were introduced to onion tuber roots. Distilled water was used as a negative control and methyl methansulfonate (MMS-10 μg/mL) as positive control. All obtained data were subjected to statistical analyses by using SPSS 15.0 for Windows software. For comparison purposes, Duncan multiple range tests by using one-way analysis of variance were employed and p < 0.05 was accepted as significant value. Exposure of both chemicals (except 25 μg/mL applications of bromoform) significantly decreased MI. Bromoform and chloroform (except 25 μg/mL applications) increased total CAs in Allium anaphase-telophase test. A significant increase in DNA damage was also observed at all concentrations of both bromoform and chloroform examined by comet assay. The damages were higher than that of positive control especially at 75-100 μg/mL for bromoform and 100-200 μg/mL for chloroform.

Oxidation of chloroform in an aerobic soil exposed to natural gas

Acclimation of a sandy soil to an air-natural gas mixture stimulated the biological oxidation of chloroform to carbon dioxide. Acetylene and methane inhibited chloroform oxidation. Chloroform oxidation continued up to 31 days in the absence of methane. Chloroform oxidation rates increased at chloroform concentrations up to 5 mug g of soil.

Chloroform uptake by gutta-percha and assessment of its concentration in air during the chloroform-dip technique

The use of chloroform as an adjunct to the practice of endodontics has been a matter of debate. In the present study the chloroform uptake of gutta-percha cones was determined by a gravimetric assay for different times of chloroform dip. In conjunction with an assessment of the amount of gutta-percha dissolved during dip, this provided an estimate of the amount of chloroform that patients are exposed to in clinical conditions. An assay was also performed of the chloroform concentration in the air in a dental office. Chloroform uptake was shown to increase with an increasing dipping time. There also seems to be a difference in this uptake between pure chloroform and a chloroform preparation with colophonium. The concentration levels of chloroform evaporated during the practice of chloroform dip within a dental office do not exceed the safety limits.

Field bean protease inhibitor mitigates the sister-chromatid exchanges induced by bromoform and depresses the spontaneous sister-chromatid exchange frequency of human lymphocytes in vitro

The mutagenicity of a trihalomethane-bromoform (CHBr3)-was assessed by the in vitro sister-chromatid exchange (SCE) assay using human peripheral blood lymphocytes. CHBr3 was found to induce SCEs significantly in a dose-dependent manner. When the cells were exposed to 600 ng CHBr3/ml of the medium, the SCE/cell mean reached a value as high as 18.78 +/- 0.17. Beyond this concentration. CHBr3 proved to be cytotoxic. A protease inhibitor (PI), purified appreciably by affinity chromatography from fieldbean (FB), was able to suppress significantly in a dose-dependent way the high SCE frequencies induced by this specific concentration of CHBr3 (600 ng/ml). Addition of 600 micrograms of FBPI/ml of the medium brought down the CHBr3-induced high SCEs to near (8.80 +/- 0.15) base line or control value (8.45 +/- 0.21). A study of the effect of FBPI on the normal low SCE frequencies in these cells indicated that the FBPI has the intrinsic property to suppress in a dose-dependent manner these SCEs in the lymphocytes. This functional property of FBPI, which is related to its protease inhibitory activity and which is destroyed when it is inactivated by autoclaving, makes it an effective antimutagenic/chemopreventive agent.

Chloroform degradation in methanogenic methanol enrichment cultures and by Methanosarcina barkeri 227

The effects of methanol addition and consumption on chloroform degradation rate and product distribution in methanogenic methanol enrichment cultures and in cultures of Methanosarcina barkeri 227 were investigated. Degradation of chloroform with initial concentrations up to 27.3 microM in enrichment cultures and 4.8 microM in pure cultures was stimulated by the addition of methanol. However, methanol consumption was inhibited by as little as 2.5 microM chloroform in enrichment cultures and 0.8 microM chloroform in pure cultures, suggesting that the presence of methanol, not its exact concentration or consumption rate, was the most significant variable affecting chloroform degradation rate. Methanol addition also significantly increased the number of moles of dichloromethane produced per mole of chloroform consumed. In enrichment cultures, the number of moles of dichloromethane produced per mole of chloroform consumed ranged from 0.7 (methanol consumption essentially uninhibited) to 0.35 (methanol consumption significantly inhibited) to less than 0.2 (methanol not added to the culture). In pure cultures, the number of moles of dichloromethane produced per mole of chloroform consumed was 0.47 when methanol was added and 0.24 when no methanol was added. Studies with [14C]chloroform in both enrichment and pure cultures confirmed that methanol metabolism stimulated dichloromethane production compared with CO2 production. The results indicate that while the addition of methanol significantly stimulated chloroform degradation in both methanogenic methanol enrichment cultures and cultures of M. barkeri 227, the prospects for use of methanol as a growth substrate for anaerobic chloroform-degrading systems may be limited unless the increased production of undesirable chloroform degradation products and the inhibition of methanol consumption can be mitigated.

Aerobic Mineralization of Trichloroethylene, Vinyl Chloride, and Aromatic Compounds by Rhodococcus Species

Two Rhodococcus strains which were isolated from a trichloroethylene (TCE)-degrading bacterial mixture and Rhodococcus rhodochrous ATCC 21197 mineralized vinyl chloride (VC) and TCE. Greater than 99.9% of a 1-mg/liter concentration of VC was degraded by cell suspensions. [1,2- 14 C]VC was degraded by cell suspensions, with the production of greater than 66% 14 CO 2 and 20% 14 C-aqueous phase products and incorporation of 10% of the 14 C into the biomass. Cultures that utilized propane as a substrate were able to mineralize greater than 28% of [1,2- 14 C]TCE to 14 CO 2 , with approximately 40% appearing in 14 C-aqueous phase products and another 10% of 14 C incorporated into the biomass. VC degradation was oxygen dependent and occurred at a pH range of 5 to 10 and temperatures of 4 to 35°C. Cell suspensions degraded up to 5 mg of TCE per liter and up to 40 mg of VC per liter. Propane competitively inhibited TCE degradation. Resting cell suspensions also degraded other chlorinated aliphatic hydrocarbons, such as chloroform, 1,1-dichloroethylene, and 1,1,1-trichloroethane. The isolates degraded a mixture of aromatic and chlorinated aliphatic solvents and utilized benzene, toluene, sodium benzoate, naphthalene, biphenyl, and n -alkanes ranging in size from propane to hexadecane as carbon and energy sources. The environmental isolates appeared more catabolically versatile than R. rhodochrous ATCC 21197. The data report that environmental isolates of Rhodococcus species and R. rhodochrous ATCC 21197 have the potential to degrade TCE and VC in addition to a variety of aromatic and chlorinated aliphatic compounds either individually or in mixtures.

Sister-chromatid exchanges induced by trihalomethanes in rat erythroblastic cells and their suppression by crude catechin extracted from green tea

An in vitro sister-chromatid exchange (SCE) assay using rat erythroblastic leukemia cells was conducted with four major trihalomethanes (THMs): chloroform, CHCl3; dichlorobromomethane, CHCl2Br, dibromochloromethane, CHClBr2; bromoform, CHBr3. In the absence of S9 mix, CHBr3, CHClBr2 and CHCl2Br significantly induced SCEs in a clear dose-dependent manner, while CHCl3 did not significantly induce SCEs. On the other hand, the incidence of CHCl3-induced SCEs significantly increased, although the incidence of CHBr3-induced SCEs decreased by the addition of S9 mix. However, there was no difference between the incidence of SCEs induced by CHBr3, CHClBr2 or CHCl2Br in the absence of S9 mix and that in the presence of S9 mix. The addition of crude catechin to the SCE assay system suppressed the ability of CHCl3 or CHBr3 to induce SCEs but had no suppressive effect on the other THM-induced SCEs. The suppression of SCEs induced by CHCl3 or CHBr3 depended on the crude catechin dose.

Bioactivation of halogenated hydrocarbons by cytochrome P4502E1

Numerous halogenated hydrocarbons of the alkane, alkene, and alkyne classes are metabolized by P450 enzymes to products that elicit cytotoxic and/or carcinogenic effects. Such halogenated hydrocarbons include anesthetics (e.g., halothane and enflurane) and industrial solvents (e.g., carbon tetrachloride, chloroform, and vinylidine chloride). Formation of reaction intermediates from these compounds occurs via P450-promoted dehalogenation, reduction, or reductive oxygenation, with certain hydrocarbons undergoing all three reaction types. Of the multiple forms of P450 present in liver microsomes, P4502E1 has been identified as the primary catalyst of hydrocarbon bioactivation in animals and, most likely, in humans as well. As hepatic concentrations of this P450 enzyme are highly inducible by ethanol and similar agents, prior exposure to 2E1-inducing compounds can play a pivotal role in halogenated hydrocarbon toxicity. Considering that metabolism governs the cytotoxicity and carcinogenicity of halogenated hydrocarbons, an understanding of the mechanism(s) underlying 2E1 induction in man becomes all the more important.

Consideration of the target organ toxicity of trichloroethylene in terms of metabolite toxicity and pharmacokinetics

Trichloroethylene (TRI) is readily absorbed into the body through the lungs and gastrointestinal mucosa. Exposure to TRI can occur from contamination of air, water, and food; and this contamination may be sufficient to produce adverse effects in the exposed populations. Elimination of TRI involves two major processes: pulmonary excretion of unchanged TRI and relatively rapid hepatic biotransformation to urinary metabolites. The principal site of metabolism of TRI is the liver, but the lung and possibly other tissues also metabolize TRI, and dichlorovinyl-cysteine (DCVC) is formed in the kidney. Humans appear to metabolize TRI extensively. Both rats and mice also have a considerable capacity to metabolize TRI, and the maximal capacities of the rat versus the mouse appear to be more closely related to relative body surface areas than to body weights. Metabolism is almost linearly related to dose at lower doses, becoming dose dependent at higher doses, and is probably best described overall by Michaelis-Menten kinetics. Major end metabolites are trichloroethanol (TCE), trichloroethanol-glucuronide, and trichloroacetic acid (TCA). Metabolism also produces several possibly reactive intermediate metabolites, including chloral, TRI-epoxide, dichlorovinyl-cysteine (DCVC), dichloroacetyl chloride, dichloroacetic acid (DCA), and chloroform, which is further metabolized to phosgene that may covalently bind extensively to cellular lipids and proteins, and, to a much lesser degree, to DNA. The toxicities associated with TRI exposure are considered to reside in its reactive metabolites. The mutagenic and carcinogenic potential of TRI is also generally thought to be due to reactive intermediate biotransformation products rather than the parent molecule itself, although the biological mechanisms by which specific TRI metabolites exert their toxic activity observed in experimental animals and, in some cases, humans are not known. The binding intensity of TRI metabolites is greater in the liver than in the kidney. Comparative studies of biotransformation of TRI in rats and mice failed to detect any major species or strain differences in metabolism. Quantitative differences in metabolism across species probably result from differences in metabolic rate and enterohepatic recirculation of metabolites. Aging rats have less capacity for microsomal metabolism, as reflected by covalent binding of TRI, than either adult or young rats. This is likely to be the same in other species, including humans. The experimental evidence is consistent with the metabolic pathways for TRI being qualitatively similar in mice, rats, and humans. The formation of the major metabolites--TCE, TCE-glucuronide, and TCA--may be explained by the production of chloral as an intermediate after the initial oxidation of TRI to TRI-epoxide.(ABSTRACT TRUNCATED AT 400 WORDS)

Evaluation of alternatives to chloroform in endodontic practice

Chloroform is used in endodontics for plasticizing gutta-percha points and for facilitating removal of gutta-percha root canal fillings in need of re-treatment. Adverse health effects from exposure to chloroform have been reported, and to improve occupational health, it would be advantageous if a less hazardous solvent could replace chloroform. In this study, methylene chloride, methyl chloroform, tetrahydrofuran, xylol and eucalyptol were tested for their capacity to dissolve or soften gutta-percha points compared with chloroform. The effect of the test solvents was assessed by measuring the depth of penetration of a small indentor of fixed weight and shape into a gutta-percha disk covered with the test solution for various time periods. Chloroform showed the most pronounced effect, followed by methylene chloride, tetrahydrofuran, and methyl chloroform. When both occupational health and gutta-percha solvent capacity were considered, methyl chloroform seemed to be an interesting alternative to chloroform.

Mechanism of nephrotoxic action due to organohalogenated compounds

A number of organohalogenated chemicals cause nephrotoxicity in experimental animals and man. Studies in animals have shown that metabolic activation of the chemical is required to produce toxicity. Currently, two major pathways of metabolism, mediated either via cytochrome P-450 or glutathione conjugation, have been implicated. Chloroform is discussed as an example of cytochrome P-450-mediated activation and dihaloethanes and hexachloro-1,3-butadiene as examples of glutathione conjugation followed by activation. Acute human exposure to certain organohalogenated compounds can sometimes result in proximal tubular injury. These intoxications usually occur after either accidental or deliberate ingestion and are rarely occupational. Chronic low-level exposure can occur in the work place, and several biological tests have been developed to detect chronic nephrotoxicity. A few studies have been undertaken of workers exposed to organohalogenated chemicals; these have provided no indication that exposure to these chemicals causes chronic renal damage.

Biological basis for extrapolation across mammalian species

The rationale for extrapolation or "scaling" across species is founded in the commonality of anatomic characteristics and the universality of physiologic functions and biochemical reactions. The development of the allometric equation, Y = aWn, relating species body size (W) with various morphological, physiological, biochemical, pharmacological, and toxicological characteristics, as the fundamental basis for extrapolation of biological data from laboratory animals to man is outlined. The familiar methods of extrapolation on the basis of "milligrams per kilogram body weight" and "body surface area" are simply examples, W1.0 and W0.67, respectively, of this equation. The experimental observations used to support these two, and other extrapolation bases, are reviewed. Criteria for the selection of an appropriate base for transfer of specific biologic data from laboratory animals to man, and the expected reliability of the extrapolation, are discussed with the enunciation of four guiding principles. The application of these principles to the extrapolation to man of dose-tumor incidence data from carcinogenicity bioassays of laboratory animals is discussed. The components are identified, and illustrative examples are given.

Syntheses of tetra- and pentapeptides from skin extracts of Phyllomedusa rhodei (tryptophyllins)

Syntheses by solution methods of tryptophyllins -4 and -5 (TPH-4 and TPH-5), tetra- and pentapeptides isolated from the skin extracts of the South American frog Phyllomedusa rhodei, are reported. The incorporation of the Pro2-Pro3 sequence into pentapeptides and the use of flash chromatography for purification of intermediates and target compounds are discussed. Preliminary biological results seem to indicate a growth-promoting activity for this peptide family.

Chemically induced nephrotoxicity: role of metabolic activation

Renal xenobiotic metabolism can result in production of electrophiles or free radicals that may covalently bind macromolecules or initiate lipid peroxidation. The mechanisms of renal xenobiotic metabolism may vary in different anatomical regions. Kidney cortex contains a cytochrome P-450 system while medulla contains a prostaglandin endoperoxidase. Recently cysteine conjugated-lyase has been implicated in production of reactive intermediates. Metabolic activation may be amplified by accumulation of xenobiotics within renal cells due to tubular concentrating and/or secretory mechanisms. Additionally, renal xenobiotic detoxicification can occur by conjugation with glucuronide, sulfate or glutathione.

The importance of metabolite identification in quantitative risk estimation

In the search to define the mechanisms by which xenobiotics produce their toxic effects in biological systems, the importance of metabolism data is clear. Although the detection of electrophilic metabolites and reactive intermediates may challenge our analytical technology, the toxic responses manifested by these agents are often obvious. The identification of toxicologically significant minor metabolites may exceed the state of the art in analytical methodology. New advances in technology may provide the needed answers. As we begin to face the significance of activation reactions, particularly in the area of carcinogenesis, it becomes apparent that metabolism to electrophiles that react covalently with DNA, is not the only mechanism by which the tumorigenic response is produced. The production of tumors by nongenotoxic (epigenetic) means is also important. Exposure to high and sustained levels of exposure to a xenobiotic that leads to a perturbation in metabolic, endocrine or physiologic pathways or tissue injury may also produce tumors. Only through investigations which include definitive metabolite identification and quantitation can the mechanism by which these agents exert their toxicity be identified. The ramification of dose response relationships for genotoxic and nongenotoxic carcinogens will be presented to demonstrate the impact of metabolite identification in quantitative risk estimation.