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Petersen EJ, Ceger P, Allen DG, Coyle J, Derk R, Garcia-Reyero N, Gordon J, Kleinstreuer NC, Matheson J, McShan D, Nelson BC, Patri AK, Rice P, Rojanasakul L, Sasidharan A, Scarano L, Chang X. U.S. Federal Agency interests and key considerations for new approach methodologies for nanomaterials. ALTEX 2022; 39:183–206. [PMID: 34874455 PMCID: PMC9115850 DOI: 10.14573/altex.2105041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/02/2021] [Indexed: 12/22/2022]
Abstract
Engineered nanomaterials (ENMs) come in a wide array of shapes, sizes, surface coatings, and compositions, and often possess novel or enhanced properties compared to larger sized particles of the same elemental composition. To ensure the safe commercialization of products containing ENMs, it is important to thoroughly understand their potential risks. Given that ENMs can be created in an almost infinite number of variations, it is not feasible to conduct in vivo testing on each type of ENM. Instead, new approach methodologies (NAMs) such as in vitro or in chemico test methods may be needed, given their capacity for higher throughput testing, lower cost, and ability to provide information on toxicological mechanisms. However, the different behaviors of ENMs compared to dissolved chemicals may challenge safety testing of ENMs using NAMs. In this study, member agencies within the Interagency Coordinating Committee on the Validation of Alternative Methods were queried about what types of ENMs are of agency interest and whether there is agency-specific guidance for ENM toxicity testing. To support the ability of NAMs to provide robust results in ENM testing, two key issues in the usage of NAMs, namely dosimetry and interference/bias controls, are thoroughly discussed.
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Affiliation(s)
- Elijah J Petersen
- U.S. Department of Commerce, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Patricia Ceger
- Integrated Laboratory Systems, LLC, P.O. Box 13501, Research Triangle Park, NC 27709, USA
| | - David G Allen
- Integrated Laboratory Systems, LLC, P.O. Box 13501, Research Triangle Park, NC 27709, USA
| | - Jayme Coyle
- National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Morgantown, WV, USA.,Current affiliation: UES, Inc., Dayton, OH, USA
| | - Raymond Derk
- National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Morgantown, WV, USA
| | | | - John Gordon
- U.S. Consumer Product Safety Commission, Bethesda, MD, USA
| | - Nicole C Kleinstreuer
- National Institute of Environmental Health Sciences, National Toxicology Program Interagency Center for the Evaluation of Alternative Toxicological Methods, Research Triangle Park, NC, USA
| | | | - Danielle McShan
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - Bryant C Nelson
- U.S. Department of Commerce, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Anil K Patri
- U.S. Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, USA
| | - Penelope Rice
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Liying Rojanasakul
- National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Morgantown, WV, USA
| | - Abhilash Sasidharan
- U.S. Environmental Protection Agency, Office of Pollution Prevention and Toxics, Washington, DC, USA
| | - Louis Scarano
- U.S. Environmental Protection Agency, Office of Pollution Prevention and Toxics, Washington, DC, USA
| | - Xiaoqing Chang
- Integrated Laboratory Systems, LLC, P.O. Box 13501, Research Triangle Park, NC 27709, USA
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2
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Chinta ML, Velidandi A, Pabbathi NPP, Dahariya S, Parcha SR. Assessment of properties, applications and limitations of scaffolds based on cellulose and its derivatives for cartilage tissue engineering: A review. Int J Biol Macromol 2021; 175:495-515. [PMID: 33539959 DOI: 10.1016/j.ijbiomac.2021.01.196] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 01/16/2023]
Abstract
Cartilage is a connective tissue, which is made up of ~80% of water. It is alymphatic, aneural and avascular with only one type of cells present, chondrocytes. They constitute about 1-5% of the entire cartilage tissue. It has a very limited capacity for spontaneous repair. Articular cartilage defects are quite common due to trauma, injury or aging and these defects eventually lead to osteoarthritis, affecting the daily activities. Tissue engineering (TE) is a promising strategy for the regeneration of articular cartilage when compared to the existing invasive treatment strategies. Cellulose is the most abundant natural polymer and has desirable properties for the development of a scaffold, which can be used for the regeneration of cartilage. This review discusses about (i) the basic science behind cartilage TE and the study of cellulose properties that can be exploited for the construction of the engineered scaffold with desired properties for cartilage tissue regeneration, (ii) about the requirement of scaffolds properties, fabrication mechanisms and assessment of cellulose based scaffolds, (iii) details about the modification of cellulose surface by employing various chemical approaches for the production of cellulose derivatives with enhanced characteristics and (iv) limitations and future research prospects of cartilage TE.
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Affiliation(s)
- Madhavi Latha Chinta
- Stem Cell Research Lab, Department of Biotechnology, National Institute of Technology, Warangal, Telangana, India
| | - Aditya Velidandi
- Department of Biotechnology, National Institute of Technology, Warangal, Telangana, India
| | | | - Swati Dahariya
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Sreenivasa Rao Parcha
- Stem Cell Research Lab, Department of Biotechnology, National Institute of Technology, Warangal, Telangana, India.
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3
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Halappanavar S, Ede JD, Mahapatra I, Krug HF, Kuempel ED, Lynch I, Vandebriel RJ, Shatkin JA. A methodology for developing key events to advance nanomaterial-relevant adverse outcome pathways to inform risk assessment. Nanotoxicology 2020; 15:289-310. [PMID: 33317378 DOI: 10.1080/17435390.2020.1851419] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Significant advances have been made in the development of Adverse Outcome Pathways (AOPs) over the last decade, mainly focused on the toxicity mechanisms of chemicals. These AOPs, although relevant to manufactured nanomaterials (MNs), do not currently capture the reported roles of size-associated properties of MNs on toxicity. Moreover, some AOs of relevance to airborne exposures to MNs such as lung inflammation and fibrosis shown in animal studies may not be targeted in routine regulatory decision making. The primary objective of the present study was to establish an approach to advance the development of AOPs of relevance to MNs using existing, publicly available, nanotoxicology literature. A systematic methodology was created for curating, organizing and applying the available literature for identifying key events (KEs). Using a case study approach, the study applied the available literature to build the biological plausibility for 'tissue injury', a KE of regulatory relevance to MNs. The results of the analysis reveal the various endpoints, assays and specific biological markers used for assessing and reporting tissue injury. The study elaborates on the limitations and opportunities of the current nanotoxicology literature and provides recommendations for the future reporting of nanotoxicology results that will expedite not only the development of AOPs for MNs but also aid in application of existing data for decision making.
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Affiliation(s)
- Sabina Halappanavar
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | | | - Indrani Mahapatra
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Harald F Krug
- Retired International Research Cooperation Manager, Empa - Swiss Federal Laboratories for Science and Materials Technology, St. Gallen, Switzerland.,NanoCASE GmbH, Engelburg, Switzerland
| | - Eileen D Kuempel
- National Institute for Occupational Safety and Health, Nanotechnology Research Center, Cincinnati, OH, USA
| | - Iseult Lynch
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Rob J Vandebriel
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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4
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Ede JD, Ong KJ, Goergen M, Rudie A, Pomeroy-Carter CA, Shatkin JA. Risk Analysis of Cellulose Nanomaterials by Inhalation: Current State of Science. NANOMATERIALS (BASEL, SWITZERLAND) 2019; 9:E337. [PMID: 30832338 PMCID: PMC6474143 DOI: 10.3390/nano9030337] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/31/2019] [Accepted: 02/23/2019] [Indexed: 01/04/2023]
Abstract
Cellulose nanomaterials (CNs) are emerging advanced materials with many unique properties and growing commercial significance. A life-cycle risk assessment and environmental health and safety roadmap identified potential risks from inhalation of powdered CNs in the workplace as a key gap in our understanding of safety and recommended addressing this data gap to advance the safe and successful commercialization of these materials. Here, we (i) summarize the currently available published literature for its contribution to our current understanding of CN inhalation hazard and (ii) evaluate the quality of the studies for risk assessment purposes using published study evaluation tools for nanomaterials to assess the weight of evidence provided. Our analysis found that the quality of the available studies is generally inadequate for risk assessment purposes but is improving over time. There have been some advances in knowledge about the effects of short-term inhalation exposures of CN. The most recent in vivo studies suggest that short-term exposure to CNs results in transient inflammation, similarly to other poorly soluble, low toxicity dusts such as conventional cellulose, but is markedly different from fibers with known toxicity such as certain types of multiwalled carbon nanotubes or asbestos. However, several data gaps remain, and there is still a lack of understanding of the effects from long-term, low-dose exposures that represent realistic workplace conditions, essential for a quantitative assessment of potential health risk. Therefore, taking precautions when handling dry forms of CNs to avoid dust inhalation exposure is warranted.
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Affiliation(s)
- James D Ede
- Vireo Advisors, LLC, Boston, MA 02130-4323, USA.
| | | | - Michael Goergen
- P3Nano, U.S. Endowment for Forestry and Communities, Greenville, SC 29601, USA.
| | - Alan Rudie
- Forest Products Laboratory, USDA Forest Service, Madison, WI 53726-2398, USA.
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5
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Stone V, Führ M, Feindt PH, Bouwmeester H, Linkov I, Sabella S, Murphy F, Bizer K, Tran L, Ågerstrand M, Fito C, Andersen T, Anderson D, Bergamaschi E, Cherrie JW, Cowan S, Dalemcourt JF, Faure M, Gabbert S, Gajewicz A, Fernandes TF, Hristozov D, Johnston HJ, Lansdown TC, Linder S, Marvin HJP, Mullins M, Purnhagen K, Puzyn T, Sanchez Jimenez A, Scott-Fordsmand JJ, Streftaris G, van Tongeren M, Voelcker NH, Voyiatzis G, Yannopoulos SN, Poortvliet PM. The Essential Elements of a Risk Governance Framework for Current and Future Nanotechnologies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:1321-1331. [PMID: 29240986 DOI: 10.1111/risa.12954] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/13/2017] [Accepted: 11/06/2017] [Indexed: 06/07/2023]
Abstract
Societies worldwide are investing considerable resources into the safe development and use of nanomaterials. Although each of these protective efforts is crucial for governing the risks of nanomaterials, they are insufficient in isolation. What is missing is a more integrative governance approach that goes beyond legislation. Development of this approach must be evidence based and involve key stakeholders to ensure acceptance by end users. The challenge is to develop a framework that coordinates the variety of actors involved in nanotechnology and civil society to facilitate consideration of the complex issues that occur in this rapidly evolving research and development area. Here, we propose three sets of essential elements required to generate an effective risk governance framework for nanomaterials. (1) Advanced tools to facilitate risk-based decision making, including an assessment of the needs of users regarding risk assessment, mitigation, and transfer. (2) An integrated model of predicted human behavior and decision making concerning nanomaterial risks. (3) Legal and other (nano-specific and general) regulatory requirements to ensure compliance and to stimulate proactive approaches to safety. The implementation of such an approach should facilitate and motivate good practice for the various stakeholders to allow the safe and sustainable future development of nanotechnology.
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Affiliation(s)
| | - Martin Führ
- Darmstadt University of Applied Sciences, Department of Social and Cultural Sciences, Society for Institutional Analysis (Sofia), Darmstadt, Germany
| | - Peter H Feindt
- Wageningen University & Research, Wageningen, The Netherlands
| | - Hans Bouwmeester
- Wageningen University & Research, Wageningen, The Netherlands
- RIKILT Wageningen UR, Wageningen, The Netherlands
| | - Igor Linkov
- Carnegie Mellon University and the U.S. Army Engineer Research and Development Center, Concord, MA, USA
| | | | - Finbarr Murphy
- Kemmy Business School, University of Limerick, Limerick, Ireland
| | - Kilian Bizer
- Georg August University Göttingen, Göttingen, Lower Saxony, Germany
| | - Lang Tran
- Institute of Occupational Medicine, Edinburgh, UK
| | - Marlene Ågerstrand
- Department of Environmental Science and Analytical Chemistry (ACES), Stockholm University, Stockholm, Sweden
| | - Carlos Fito
- Instituto Tecnológico del Embalaje, Transporte y Logística (ITENE), Spain
| | | | | | - Enrico Bergamaschi
- Department of Public Health and Pediatrics, University of Turin, Torino, Italy
| | - John W Cherrie
- Heriot-Watt University, Edinburgh, UK
- Institute of Occupational Medicine, Edinburgh, UK
| | - Sue Cowan
- Heriot-Watt University, Edinburgh, UK
| | | | - Michael Faure
- Maastricht University, Maastricht, The Netherlands
- Erasmus School of Law, Rotterdam, The Netherlands
| | - Silke Gabbert
- Wageningen University & Research, Wageningen, The Netherlands
| | - Agnieszka Gajewicz
- Laboratory of Environmental Chemometrics, University of Gdańsk, Gdańsk, Poland
| | | | | | | | | | | | | | - Martin Mullins
- Kemmy Business School, University of Limerick, Limerick, Ireland
| | - Kai Purnhagen
- Wageningen University & Research, Wageningen, The Netherlands
| | - Tomasz Puzyn
- Laboratory of Environmental Chemometrics, University of Gdańsk, Gdańsk, Poland
| | | | | | | | - Martie van Tongeren
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Nicolas H Voelcker
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - George Voyiatzis
- Foundation for Research & Technology, Institute of Chemical Engineering Sciences (FORTH/ICE-HT), Patras, Greece
| | - Spyros N Yannopoulos
- Foundation for Research & Technology, Institute of Chemical Engineering Sciences (FORTH/ICE-HT), Patras, Greece
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6
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Schulte PA, Kuempel ED, Drew NM. Characterizing risk assessments for the development of occupational exposure limits for engineered nanomaterials. Regul Toxicol Pharmacol 2018; 95:207-219. [PMID: 29574195 PMCID: PMC6075708 DOI: 10.1016/j.yrtph.2018.03.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/05/2018] [Accepted: 03/20/2018] [Indexed: 12/16/2022]
Abstract
The commercialization of engineered nanomaterials (ENMs) began in the early 2000's. Since then the number of commercial products and the number of workers potentially exposed to ENMs is growing, as is the need to evaluate and manage the potential health risks. Occupational exposure limits (OELs) have been developed for some of the first generation of ENMs. These OELs have been based on risk assessments that progressed from qualitative to quantitative as nanotoxicology data became available. In this paper, that progression is characterized. It traces OEL development through the qualitative approach of general groups of ENMs based primarily on read-across with other materials to quantitative risk assessments for nanoscale particles including titanium dioxide, carbon nanotubes and nanofibers, silver nanoparticles, and cellulose nanocrystals. These represent prototypic approaches to risk assessment and OEL development for ENMs. Such substance-by-substance efforts are not practical given the insufficient data for many ENMs that are currently being used or potentially entering commerce. Consequently, categorical approaches are emerging to group and rank ENMs by hazard and potential health risk. The strengths and limitations of these approaches are described, and future derivations and research needs are discussed. Critical needs in moving forward with understanding the health effects of the numerous EMNs include more standardized and accessible quantitative data on the toxicity and physicochemical properties of ENMs.
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Affiliation(s)
- P A Schulte
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States.
| | - E D Kuempel
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States
| | - N M Drew
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States
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7
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Linkov I, Trump BD, Anklam E, Berube D, Boisseasu P, Cummings C, Ferson S, Florin MV, Goldstein B, Hristozov D, Jensen KA, Katalagarianakis G, Kuzma J, Lambert JH, Malloy T, Malsch I, Marcomini A, Merad M, Palma-Oliveira J, Perkins E, Renn O, Seager T, Stone V, Vallero D, Vermeire T. Comparative, collaborative, and integrative risk governance for emerging technologies. ENVIRONMENT SYSTEMS & DECISIONS 2018; 38:170-176. [PMID: 37829286 PMCID: PMC10569133 DOI: 10.1007/s10669-018-9686-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Various emerging technologies challenge existing governance processes to identify, assess, and manage risk. Though the existing risk-based paradigm has been essential for assessment of many chemical, biological, radiological, and nuclear technologies, a complementary approach may be warranted for the early-stage assessment and management challenges of high uncertainty technologies ranging from nanotechnology to synthetic biology to artificial intelligence, among many others. This paper argues for a risk governance approach that integrates quantitative experimental information alongside qualitative expert insight to characterize and balance the risks, benefits, costs, and societal implications of emerging technologies. Various articles in scholarly literature have highlighted differing points of how to address technological uncertainty, and this article builds upon such knowledge to explain how an emerging technology risk governance process should be driven by a multi-stakeholder effort, incorporate various disparate sources of information, review various endpoints and outcomes, and comparatively assess emerging technology performance against existing conventional products in a given application area. At least in the early stages of development when quantitative data for risk assessment remain incomplete or limited, such an approach can be valuable for policymakers and decision makers to evaluate the impact that such technologies may have upon human and environmental health.
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Affiliation(s)
- Igor Linkov
- Risk & Decision Science Team, Environmental Risk Assessment Branch, US Army Engineer Research and Development Center, 696 Virginia Road, Concord, MA 01742, USA
| | - Benjamin D Trump
- Risk & Decision Science Team, Environmental Risk Assessment Branch, US Army Engineer Research and Development Center, 696 Virginia Road, Concord, MA 01742, USA
| | - Elke Anklam
- European Commission, Joint Research Centre, Antwerp, Belgium
| | - David Berube
- Center for Genetic Engineering in Society, North Carolina State University, Raleigh, NC, USA
| | | | | | - Scott Ferson
- Institute for Risk and Uncertainty, University of Liverpool, Liverpool, UK
| | | | | | | | | | | | - Jennifer Kuzma
- Center for Genetic Engineering in Society, North Carolina State University, Raleigh, NC, USA
| | - James H Lambert
- University of Virginia, Charlottesville, VA, USA
- Society for Risk Analysis, McLean, VA, USA
| | - Timothy Malloy
- University of California at Los Angeles, Los Angeles, CA, USA
| | - Ineke Malsch
- Malsch TechnoValuation, Utrecht, The Netherlands
| | | | - Myriam Merad
- UMR ESPACE and UMR LAMSADE PSL, CNRS, Paris, France
| | | | - Edward Perkins
- Risk & Decision Science Team, Environmental Risk Assessment Branch, US Army Engineer Research and Development Center, 696 Virginia Road, Concord, MA 01742, USA
| | - Ortwin Renn
- Institute for Advanced Sustainability Studies, Potsdam, Germany
| | | | | | - Daniel Vallero
- National Exposure Research Laboratory, US Environmental Protection Agency, Washington, DC, USA
| | - Theo Vermeire
- National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands
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8
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Stone V, Johnston HJ, Balharry D, Gernand JM, Gulumian M. Approaches to Develop Alternative Testing Strategies to Inform Human Health Risk Assessment of Nanomaterials. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1538-1550. [PMID: 27285586 DOI: 10.1111/risa.12645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 02/11/2016] [Accepted: 04/12/2016] [Indexed: 06/06/2023]
Abstract
The development of alternative testing strategies (ATS) for hazard assessment of new and emerging materials is high on the agenda of scientists, funders, and regulators. The relatively large number of nanomaterials on the market and under development means that an increasing emphasis will be placed on the use of reliable, predictive ATS when assessing their safety. We have provided recommendations as to how ATS development for assessment of nanomaterial hazard may be accelerated. Predefined search terms were used to identify the quantity and distribution of peer-reviewed publications for nanomaterial hazard assessment following inhalation, ingestion, or dermal absorption. A summary of knowledge gaps relating to nanomaterial hazard is provided to identify future research priorities and areas in which a rich data set might exist to allow ATS identification. Consultation with stakeholders (e.g., academia, industry, regulators) was critical to ensure that current expert opinion was reflected. The gap analysis revealed an abundance of studies that assessed the local and systemic impacts of inhaled particles, and so ATS are available for immediate use. Development of ATS for assessment of the dermal toxicity of chemicals is already relatively advanced, and these models should be applied to nanomaterials as relatively few studies have assessed the dermal toxicity of nanomaterials to date. Limited studies have investigated the local and systemic impacts of ingested nanomaterials. If the recommendations for research prioritization proposed are adopted, it is envisioned that a comprehensive battery of ATS can be developed to support the risk assessment process for nanomaterials. Some alternative models are available for immediate implementation, while others require more developmental work to become widely adopted. Case studies are included that can be used to inform the selection of alternative models and end points when assessing the pathogenicity of fibers and mode of action of nanomaterial toxicity.
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Affiliation(s)
- Vicki Stone
- School of Life Sciences, Nano Safety Research Group, Heriot-Watt University, Edinburgh, UK
| | - Helinor J Johnston
- School of Life Sciences, Nano Safety Research Group, Heriot-Watt University, Edinburgh, UK
| | - Dominique Balharry
- School of Life Sciences, Nano Safety Research Group, Heriot-Watt University, Edinburgh, UK
- Centre for Genomic & Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Jeremy M Gernand
- Department of Energy and Mineral Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Mary Gulumian
- Toxicology and Biochemistry Section NIOH, Johannesburg, South Africa
- Haematology and Molecular Medicine Department School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
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