Exposure of babies to C15–C45 mineral paraffins from human milk and breast salves

Update of the risk assessment of mineral oil hydrocarbons in food

Mineral oil hydrocarbons (MOH) are composed of saturated hydrocarbons (MOSH) and aromatic hydrocarbons (MOAH). Due to the complexity of the MOH composition, their complete chemical characterisation is not possible. MOSH accumulation is observed in various tissues, with species-specific differences. Formation of liver epithelioid lipogranulomas and inflammation, as well as increased liver and spleen weights, are observed in Fischer 344 (F344) rats, but not in Sprague-Dawley (SD) rats. These effects are related to specific accumulation of wax components in the liver of F344 rats, which is not observed in SD rats or humans. The CONTAM Panel concluded that F344 rats are not an appropriate model for effects of MOSH with wax components. A NOAEL of 236 mg/kg body weight (bw) per day, corresponding to the highest tested dose in F344 rats of a white mineral oil product virtually free of wax components, was selected as relevant reference point (RP). The highest dietary exposure to MOSH was estimated for the young population, with lower bound-upper bound (LB-UB) means and 95th percentiles of 0.085-0.126 and 0.157-0.212 mg/kg bw per day, respectively. Considering a margin of exposure approach, the Panel concluded that the present dietary exposure to MOSH does not raise concern for human health for all age classes. Genotoxicity and carcinogenicity are associated with MOAH with three or more aromatic rings. For this subfraction, a surrogate RP of 0.49 mg/kg bw per day, calculated from data on eight polycyclic aromatic hydrocarbons, was considered. The highest dietary exposure to MOAH was also in the young population, with LB-UB mean and 95th percentile estimations of 0.003-0.031 and 0.011-0.059 mg/kg bw per day, respectively. Based on two scenarios on three or more ring MOAH contents in the diet and lacking toxicological information on effects of 1 and 2 ring MOAH, a possible concern for human health was raised.

Lack of human-relevant adversity of MOSH retained in tissues: Analysis of adversity and implications for regulatory assessment

Mineral oils (food grade white oil or liquid paraffin) have historically been safely used in a number of sensitive end-uses, including pharmaceutical, cosmetic and food. Recent concern that certain mineral hydrocarbons (branched and cyclo-alkanes) may accumulate in human tissues has prevented European Food Safety Authority (EFSA) from deriving guidance values for food exposures. Analysis of human and animal tissue indicate that an unresolved cloud of mostly highly branched alkanes and alkylated cycloalkanes within the C20-C35 range is consistently present in all tissues. This critical review thoroughly assesses the retention of "mineral oil saturated hydrocarbons" (MOSH) in human and animal tissues and evaluates if the presence of MOSH is considered adverse and appropriate to use for risk assessment, generation of guidance values for food exposure and/or generation of derivation of health-based guidance values. An adversity framework was utilized to perform an in-depth weight of the evidence analysis, and it was concluded that mere presence of MOSH does not translate to hazard identification, and is not considered adverse. In light of this conclusion, it would not be appropriate to utilize this endpoint as the point of departure to calculate a health guidance value.

Untethered Single Cell Grippers for Active Biopsy

Single cell manipulation is important in biosensing, biorobotics, and quantitative cell analysis. Although microbeads, droplets, and microrobots have been developed previously, it is still challenging to simultaneously excise, capture, and manipulate single cells in a biocompatible manner. Here, we describe untethered single cell grippers, that can be remotely guided and actuated on-demand to actively capture or excise individual or few cells. We describe a novel molding method to micropattern a thermally responsive wax layer for biocompatible motion actuation. The multifingered grippers derive their energy from the triggered release of residual differential stress in bilayer hinges composed of silicon oxides. A magnetic layer enables remote guidance through narrow conduits and fixed tissue sections ex vivo. Our results provide an important advance in high-throughput single cell scale biopsy tools important to lab-on-a-chip devices, microrobotics, and minimally invasive surgery.

Mineral oil in food, cosmetic products, and in products regulated by other legislations

For a few years, mineral oils and their potential adverse health effects have been a constant issue of concern in many regulatory areas such as food, cosmetics, other consumer products, and industrial chemicals. Analytically, two fractions can be distinguished: mineral oil saturated hydrocarbons (MOSH) and mineral oil aromatic hydrocarbons (MOAH). This paper aims at assessing the bioaccumulative potential and associated histopathological effects of MOSH as well as the carcinogenic potential of MOAH for consumer-relevant mineral oils. It also covers the absorption, distribution, metabolism, and excretion of MOSH and MOAH upon oral and dermal exposures. The use and occurrence of consumer-relevant, highly refined mineral oils in food, cosmetics and medicinal products are summarized, and estimates for the exposure of consumers are provided. Also addressed are the challenges in characterizing the substance identity of mineral oil products under REACH. Evidence from more recent autopsy and biopsy studies, along with information on decreasing food contamination levels, indicates a low risk for adverse hepatic lesions that may arise from the retention of MOSH in the liver. With respect to MOAH, at present there is no indication of any carcinogenic effects in animals dermally or orally exposed to highly refined mineral oils and waxes. Such products are used not only in cosmetics but also in medicinal products and as additives in food contact materials. The safety of these mineral oil-containing products is thus indirectly documented by their prevalent and long-term use, with a simultaneous lack of clinical and epidemiological evidence for adverse health effects.

Evaluating the risk to humans from mineral oils in foods: Current state of the evidence

Key issues around the evaluation of risks to humans from mineral oils in food and feedstuffs are discussed. MOHs (MOAH and MOSH) occur in food due to intentional use, contamination from environmental sources and during transport/processing, or through migration from food contact materials. Problems in setting and enforcing human health guidelines for MOH include uncertainty around MOH toxicity and the specialist expertise needed for analysis of complex food matrices. Currently, the method of choice for measuring mineral oils is LC-GC-FID, however some complex food matrices also require additional analytical techniques to differentiate between some naturally occurring hydrocarbons and those from other sources, including of petrogenic origin. This requires the skills of an experienced analyst. Significant toxicological gaps for MOHs prevent robust human health risk assessment and the derivation of guidance values. As food-grade mineral oils are virtually MOAH-free, the key issue explored here is the relevance to humans of liver (micro)granulomas observed in F344 rats following oral intake. Available data suggest that despite the ubiquitous nature of MOH in the human diet, the prevalence of liver lipogranulomas in the population is low. These are not associated with inflammation and based on current evidence are not considered of human health significance.

Management of autoimmune blistering diseases in pregnancy and the neonate

The management of autoimmune blistering diseases (AIBD) is therapeutically challenging, particularly in patients who plan to conceive, or are pregnant or breastfeeding. Not only is a patient's immune system altered by pregnancy-associated hormonal changes, but several medications used for AIBD treatment are not recommended for use in pregnancy or lactation. The data acquired regarding the safety and efficacy of these therapeutic interventions are gathered from studies or case reports from other diseases, as the treatment modalities are similar and randomized controlled trials are typically not performed in the setting of pregnancy. Although some medications for AIBD treatment are considered unsafe for use in pregnancy, many effective and tolerable therapies are able to provide benefit to these patients. In fact, most first-line agents may be used in pregnancy, to a given extent. This article discusses the medications used to treat AIBD prior to conception, during pregnancy, and while breastfeeding, as well as highlights those that are contraindicated. The preferred approach to management in these patients is also discussed. Additionally, we present the available information regarding neonates of mothers with a diagnosis of AIBD, including the likelihood, identification, and management of neonatal blistering and the effects from medication exposure in utero.

Toxicological Assessment of Mineral Hydrocarbons in Foods: State of Present Discussions

The evaluation of mineral oils by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) provided high acceptable daily intakes for classes largely falling into the mass range strongly accumulated by humans. Because they are roughly 2 orders of magnitude above the present exposure, they authorize strongly increased exposure. An approach based on accumulation seems more adequate. Increased organ weights might be more critical than granulomas. Aromatic hydrocarbons with 1-2 aromatic rings should be distinguished from those with at least 3 aromatic rings. If mineral oil saturated hydrocarbon limits were low, no limit might be needed for the 1-2 ring aromatics. It should be considered to phase out substantial use of mineral oils in food application.

Psoriasis in those planning a family, pregnant or breast-feeding. The Australasian Psoriasis Collaboration

The Australasian Psoriasis Collaboration has reviewed the evidence for managing moderate to severe psoriasis in those who are pregnant or are breast-feeding, or planning a family. The severity of the psoriasis, associated comorbidities and specific anti-psoriasis treatment, along with other exposures, can have a deleterious effect on pregnancy outcomes. Psoriasis itself increases the risk of preterm and low birthweight babies, along with spontaneous and induced abortions, but no specific birth defects have been otherwise demonstrated. The baseline risk for a live born baby to have a major birth defect is 3%, and significant neuro-developmental problem is 5%. In Australia, pregnant women with psoriasis are more likely to be overweight or obese, depressed, or smoke in their first trimester, and are also less likely to take prenatal vitamins or supplements. Preconception counselling to improve maternal, pregnancy and baby health is therefore strongly encouraged. The topical and systemic therapies commonly used in psoriasis are each discussed separately, with regards to pregnancy exposure, breast-feeding and effects on male fertility and mutagenicity. The systemic therapies included are acitretin, adalimumab, apremilast, certolizumab, ciclosporin, etanercept, infliximab, ixekizumab, methotrexate, NBUVB, prednisone, PUVA, secukinumab and ustekinumab. The topical therapies include dithranol (anthralin), calcipotriol, coal tar, corticosteroids (weak, potent and super-potent), moisturisers, salicylic acid, tacrolimus, and tazarotene. As a general recommendation, effective drugs that have been widely used for years are preferable to newer alternatives with less foetal safety data. It is equally important to evaluate the risks of not treating, as severe untreated disease may negatively impact both mother and the foetus.

Mineral oil saturated hydrocarbons (MOSH) in female Fischer 344 rats; accumulation of wax components; implications for risk assessment

Female Fischer 344 rats were exposed to three MOSH mixtures: oils largely below and above C₂₅ (S-C25 and L-C25) and a 1:1 mixture of L-C25 with a wax; doses of 400, 1000 and 4000mg/kg feed were administered during 120days. MOSH were determined by on-line HPLC-GC-FID in liver, spleen, adipose tissue and the carcass. The composition of the hydrocarbons accumulated in the tissues was further analyzed by comprehensive two-dimensional GC (GC×GC). MOSH in the mass range of C_26-30 were more strongly accumulated than those between C_20-25, which does not support the present classification of MOSH differentiating at n-C₂₅ for risk assessment. Compared to the total of the MOSH, n-alkanes and n-alkyl monocyclic naphthenes were generally enriched in adipose tissue. In liver and spleen, n-alkanes up to C₂₅ were eliminated, but strongly accumulated at around C₃₀. Based on this profile, poor solubility and the melting points, it is hypothesized that crystallization protects these wax components against metabolism and elimination. In the liver, relative retention of n-alkanes decreased again beyond C₃₀, accentuated at high exposure, suggesting reduced absorption. Compared to the animal data, accumulation of n-alkanes from food sources, such as apples, into human tissues seems low, perhaps because of low absorption due to their presence in crystalline form. A series of dominant isoalkanes, accumulated in all tissues analyzed, was characterized, though without proposing a structure. Implications on present regulation of white mineral oil products are discussed.

Effect of dietary pristane and other saturated mineral oils (MOSH) on autoimmune arthritis in rats

Pristane and other adjuvants based on mineral oil saturated hydrocarbons (MOSH) may induce autoimmunity in rodents after intradermal injection; however there is a lack of information on immune effects after oral MOSH exposure. The aim of our study was to determine the impact of dietary exposure to pristane and other MOSH on the development of autoimmune arthritis.

Dark Agouti (DA) rats were given feed containing 4000 mg/kg pristane or a broad MOSH mixture in various concentrations (0–4000 mg/kg) for 90 days, or a single intradermal injection of 200 μl pristane (positive control). Arthritis scores, and serum and splenocyte markers previously associated with arthritis development, were determined.

All rats injected with pristane displayed arthritis symptoms and higher levels of certain serum markers. None of the rats fed pristane or MOSH developed arthritis symptoms or demonstrated clear changes in any measured arthritis-associated biological markers in serum or splenocytes.

The absence of clinical arthritis symptoms or any increase in common arthritis-associated biological markers in sera and spleen following dietary exposure to pristane or a broad MOSH mixture in a sub-chronic rat model of arthritis suggest that dietary MOSH have low capacity to promote development of autoimmunity.

Accumulation of mineral oil saturated hydrocarbons (MOSH) in female Fischer 344 rats: Comparison with human data and consequences for risk assessment

Female Fischer 344 rats were orally exposed to a mixture of mineral oil saturated hydrocarbons (MOSH) of broad molecular mass range at doses of 40, 400 and 4000mg/kg feed. Amounts and compositions of the MOSH were analyzed in liver, spleen, adipose tissue and the carcass after exposure during 30, 60, 90 and 120d as well as after 90d exposure followed by 30d depuration. At 40mg/kg in the feed, after 30d of exposure, 10.9% of the ingested MOSH were recovered from the animal body; after 90d plus 30d depuration it was 3.9%. In liver and spleen, the maximum retention in terms of molecular mass (simulated distillation) was at n-C₂₉; in adipose tissue and carcass it was at n-C_15/16. The differentiation between MOSH below and above n-C₂₅ (Class I versus Class II and III oils), used for present regulation, is not supported by the present data on accumulation; structural characteristics seem more pertinent than molecular mass. Concentrations in the tissues increased far less than proportionally with the dose, rendering linear extrapolation to low doses questionable. No steady state was reached after 120d. In fact, comparing with the concentrations in human tissues at the estimated exposure, extrapolation from animal experiments seems to grossly underestimate human internal exposure. Comprehensive two-dimensional gas chromatography (GCxGC) was used to characterize the MOSH residues in the tissues with the aim of identifying the most strongly accumulated types. In the liver and spleen, the highly branched hydrocarbons dominated, whereas in the adipose tissue it was the n-alkanes and species with main n-alkyl moieties. Strong MOSH accumulation is not of concern per se, but the safety at the high concentrations in human tissues needs to be re-evaluated, possibly taking into account also end points other than granuloma formation.

Antiinfective therapy for pregnant or lactating patients in the emergency department

PURPOSE

Special considerations in pharmacotherapy for infectious diseases in pregnant and lactating women in the emergency department (ED) setting are reviewed.

SUMMARY

With many women turning to the ED as a source of primary care, it is essential for pharmacists involved in providing ED services to guide the selection of appropriate antiinfective agents during pregnancy and lactation; this area of practice is complicated by the very limited body of published data on the safety and efficacy of maternal antimicrobial use and potential fetal or neonatal adverse effects. Infectious diseases commonly encountered in the ED include sexually transmitted diseases, bacterial vaginosis and other vaginal infections, respiratory and urinary tract infections, and pneumonia. Recommended first-line therapies for pregnant or lactating women may differ from those recommended for other patient populations. Although some widely used antiinfective classes and agents are generally considered safe for use in pregnant women, others (e.g., clarithromycin, fluoroquinolones) have been linked to birth defects and neonatal adverse effects. In addition to guiding ED practitioners in the appropriate use of antiinfective agents in pregnant women and nursing mothers, pharmacists can reinforce the importance of appropriate follow-up care (including specialist referral or culture testing in some cases) and ongoing preventive health measures such as vaccine administration.

CONCLUSION

The use of antiinfective agents in pregnant or lactating women requires consideration not only of the drugs' effectiveness but also their possible effects on the fetus or newborn and the nature of follow-up care. References are available to help clinicians make treatment decisions.

Mineral oil in human tissues, part II: characterization of the accumulated hydrocarbons by comprehensive two-dimensional gas chromatography

Mineral oil hydrocarbons are by far the largest contaminant in the human body. Their composition differs from that in the mineral oils humans are exposed to, and varies also between different tissues of the same individual. Using the presently best technique for characterizing the composition of mineral oil hydrocarbons, comprehensive two-dimensional gas chromatography (GC×GC), the hydrocarbons in human tissues were compared to those of various mineral oils. This provided information about the strongly accumulated species and might give hints on the flow path through the human body. The selectivity of accumulation is probably also of interest for the risk assessment of synthetic hydrocarbons (polyolefins). GC×GC grouped the MOSH into classes of n-alkanes, paraffins with a low degree of branching, multibranched paraffins and naphthenes (alkylated cyclic hydrocarbons) with 1-4 rings. Metabolic elimination was observed for constituents of all these classes, but was selective within each class. The MOSH in the subcutaneous abdominal fat tissues and the mesenteric lymph nodes (MLN) had almost the same composition and included the distinct signals observed in mineral oil, though in reduced amounts relative to the cloud of unresolved hydrocarbons. The MOSH in the liver and the spleen were different from those in the MLN and fat tissue, but again with largely identical composition for a given individual. Virtually all constituents forming distinct signals were eliminated, leaving an unresolved residue of highly isomerized hydrocarbons.

Contamination of grape seed oil with mineral oil paraffins

The contamination of 11 commercial grape seed oils with paraffins of mineral oil origin was analyzed by online-coupled HPLC-HPLC-GC-FID and ranged from 43 to 247 mg kg(-1). The analysis of the marc and seeds indicated that the contamination is primarily from the peels. Since superficial extraction of the seeds with hexane removed most of the mineral paraffins, the contamination of the seeds is largely on the surface, perhaps transferred from the peels during storage of the marc. Mechanical purification of the seeds combined with washing with hexane reduced the contamination of the oil by a factor of about 10. The refining process removed 30% of the mineral paraffins, primarily the more volatile components. Oil obtained from the seeds of fresh grapes, including grapes not having undergone any phytochemical treatment, contained clearly less mineral paraffins (up to 14 mg kg(-1)), and the peels were less contaminated, suggesting an environmental background contamination. To this an additional contamination might be added by a treatment of the grapes used for wine making.

Relative hopane content confirming the mineral origin of hydrocarbons contaminating foods and human milk

Hopanes, triterpenoid hydrocarbons formed under geological conditions, were analysed to confirm the mineral origin of the unresolved complex mixtures of hydrocarbons observed in the gas chromatography with flame ionization detection chromatograms of human milk and certain foodstuffs. The 'relative hopane content' (RHC) is introduced, i.e. it is the area ratio of the sum of the hopanes and the paraffins in the same segment of the chromatogram. The RHC in various mineral oil products (motor oils, hydraulic oils, lubricating oils, Vaseline) was 3.4%, with a relative standard deviation of 19%. The RHC determined in samples of vegetable oils, mussels and clams as well as of human milk containing an unresolved complex mixture of hydrocarbons was in the same range, confirming that these samples were contaminated by mineral oil material.