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Liquid chromatography-mass spectrometry in forensic toxicology.

Liquid chromatography-mass spectrometry has evolved from a topic of mainly research interest into a routinely usable tool in various application fields. With the advent of new ionization approaches, especially atmospheric pressure, the technique has established itself firmly in many areas of research. Although many applications prove that LC-MS is a valuable complementary analytical tool to GC-MS and has the potential to largely extend the application field of mass spectrometry to hitherto "MS-phobic" molecules, we must recognize that the use of LC-MS in forensic toxicology remains relatively rare. This rarity is all the more surprising because forensic toxicologists find themselves often confronted with the daunting task of actually searching for evidence materials on a scientific basis without any indication of the direction in which to search. Through the years, mass spectrometry, mainly in the GC-MS form, has gained a leading role in the way such quandaries are tackled. The advent of robust, bioanalytically compatible combinations of liquid chromatographic separation with mass spectrometric detection really opens new perspectives in terms of mass spectrometric identification of difficult molecules (e.g., polar metabolites) or biopolymers with toxicological relevance, high throughput, and versatility. Of course, analytical toxicologists are generally mass spectrometry users rather than mass spectrometrists, and this difference certainly explains the slow start of LC-MS in this field. Nevertheless, some valuable applications have been published, and it seems that the introduction of the more universal atmospheric pressure ionization interfaces really has boosted interests. This review presents an overview of what has been realized in forensic toxicological LC-MS. After a short introduction into LC-MS interfacing operational characteristics (or limitations), it covers applications that range from illicit drugs to often abused prescription medicines and some natural poisons. As such, we hope it can act as an appetizer to those involved in forensic toxicology but still hesitating to invest in LC-MS.

Chromatography, Liquid↗

The contribution of veterinary toxicology to environmental health.

An account is given of three major functions of veterinary toxicology in relation to environmental health. These are: 1) Environmental (epidemiological) toxicology with reference to mass intoxications in domestic animals and wildlife and their role in the early detection of detrimental environmental quality caused by toxic chemicals. 2) Comparative pharmacology and toxicology: The impact of animal poisonings on discoveries in human health or on the development of novel concepts in these disciplines. 3) Regulatory toxicology: The role of the veterinary profession is emphasized in the safeguarding of food with special reference to meat inspection regulations and biological residues in edible tissues.

Animals↗

Toxicological barriers to providing better drugs.

The unmet needs of the sick demand that toxicologic requirements do not stifle the rational search for new and better remedies. A number of conceptual problems hamper the rational use of toxicological testing. These include: a misplaced confidence in the value of animal testing, a failure to make sophisticated risk-benefit analyses, the proliferation of new tests of uncertain validity, and improperly executed retrospective case control studies. Rugulatory barriers include the ever increasing bureaucratic demand for toxicological testing, the unseemly willingness of regulatory agencies to yield to hysterical or cynical consumer group pressures, the unreasonable demand for "superiority" of new products before the granting of registration, and the temptation to institute expensive but untested post-marketing surveillance schemes. Economic obstacles to new drug development have become formidable, and new demands for toxicologic studies in animals and humans are adding to these problems. Finally, some examples of unwise regulatory decisions involving saccharin, spray adhesives, Depo-Provera, and a new anti-metabolite are given.

Animals↗

Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit.

Although morbidity and mortality of acute poisoning are increased in elderly compared to younger patients, little has been published on this topics in the last years (Medline search). To investigate the influence of age on the clinical course of acute poisoning with different toxic agents, a longitudinal retrospective study at the Toxicological Intensive Care Unit (ICU) of the 2nd Department of Internal Medicine (Klinikum Nürnberg, Germany) was performed.A total of 5883 patients treated at our toxicological ICU were enrolled into the study, including all patients of the years 1982, 1992, and 1997. These three years were selected to investigate possible time-dependent changes of intoxication characteristics and quality of therapy at our ICU over a time span of 15 years. For each patient the following data were obtained from a standardized toxicological record: age, gender, toxic agents responsible for acute poisoning, and length of stay at the toxicological ICU. For a subgroup of 3740 patients, the cause of acute poisoning and the clinical outcome was also recorded. As compared with younger patients, mean length of stay at the ICU, indicating a more serious course of acute poisoning, was prolonged in elderly and, i. e., in very old patients (p <0.001). However, this prolongation of time at the ICU was only observed in elderly patients poisoned with drugs or with mixed poisoning including drugs, while mean length of stay was not prolonged in elderly patients poisoned with alcohol, with illegal drugs, chemicals, animal/plant poison, or other toxic agents. Patients with the highest risk of dying in the ICU after acute poisoning were elderly patients attempting suicide with drugs. Mortality in 3740 patients with acute poisoning was 0.24%, while it was 2.17% in the 184 patients being 65 years old or older. Thus, mortality was 9-fold higher in the elderly. Mean length of stay at the ICU decreased significantly from 1982 to 1992 and to 1997 (p <0.001) indicating an improvement of the therapeutical ICU management of acute poisoning and/or less dangerous toxic agents (i. e. less barbiturates). The age-dependent increase of the length of stay at the ICU until very old age (> 80 years) was most pronounced in 1982 and also declined markedly until 1997.Age, suicide attempt, and ingestion of (multiple) drugs seem to be risk factors for a higher mortality and a prolonged stay in the ICU after acute poisoning. Although in general the clinical course after poisoning has more complications and an impaired prognosis in old age, each category of toxic agents (drugs, alcohol, chemicals, etc.) has its own special "risk profile" for elderly patients. However, due to advances in modern ICU medicine the general prognosis of acute poisoning is good in old and even in oldest old patients.

Acute Disease↗

The failure of dose-response models to predict low dose effects: a major challenge for biomedical, toxicological and aging research.

Recent detailed evaluations of the pharmacological, toxicological, and biogerontological literature indicate that the hormetic dose-response is quite common and highly generalizable by biological model, endpoint, and chemical class. Head-to-head comparisons of the hormetic model with the traditional threshold model have revealed the hormetic model to occur with considerably greater frequency in the biomedical literature. Despite these developments, the history of both pharmacology and toxicology reflects a strong acceptance and centralizing of the threshold model concept while profoundly marginalizing of the hormetic dose-response. This commentary will address why the biomedical community especially those in the areas of pharmacology and toxicology made an incorrect judgment that the most fundamental nature of the dose-response was threshold rather than hormetic and why this conclusion has continued to dominate these fields and their numerous applications despite convincing evidence to the contrary. These findings have particular relevance to the area of biogerontology since this discipline often resides at the pharmacological-toxicological interface.

Aging↗

The positive approach to negative results in toxicology studies.

Negative results in toxicology studies are often as noteworthy as are results that detect significant toxicological effects. The results of 49.1% of all t tests published in Ecotoxicology and Environmental Safety in 1985 and 1986 were negative. However, despite the importance and prevalence of negative results in toxicology studies, they are frequently misinterpreted. Negative results from statistical tests that have poor statistical power can only be considered to be inconclusive. Because toxicology studies often use small sample sizes, such studies often have poor power to detect small, but biologically significant, effects. Toxicologists may improve the power of their tests by improving experiment design, increasing alpha, increasing sample size, or limiting the analysis to detection of large differences among samples. Selection of both sample size and alpha level should take considerations of statistical power into account.

Research↗

Systematic toxicological analysis of drugs and their metabolites by gas chromatography-mass spectrometry.

Gas chromatographic-mass spectrometric (GC-MS) procedures for the systematic toxicological analysis of several categories of drugs relevant to clinical toxicology, forensic toxicology and doping control are reviewed. Papers from 1981 to 1991 are taken into consideration. They describe the detection of acute or chronic intoxication and the detection of drug abuse. Screening procedures are included for the following categories: barbiturates and other sedative-hypnotics, anticonvulsants, benzodiazepines, antidepressants, phenothiazine and butyrophenone neuroleptics, central stimulants (amphetamines, cocaine), hallucinogens (LSD, phencyclidine, tetrahydrocannabinol), opioid (narcotic) and other potent analgesics, non-opioid analgesics, antihistamines (histamine H1-receptor blockers), antiparkinsonian drugs, beta-blockers (beta-adrenoceptor blockers), antiarrhythmics (class I and IV), diuretics, laxatives and their metabolites. Methods for confirmation of results obtained by screening procedures using immunoassay or chromatographic techniques are also included. GC-MS procedures for the simultaneous detection of several categories of drugs, the so-called "general unknown analysis", are reviewed. The toxicological question to be answered and the consequence for the choice of an adequate method, the sample preparation and the chromatography itself are discussed. The basic information about the biosample assayed, work-up, GC column, mass spectral detection mode, reference data and sensitivity of each procedure are summarized in tables, arranged according to the category of drug. Examples of typical GC-MS applications are presented. Fragment ions that are suitable for mass spectral screening for particular categories of drugs and for general unknown are tabulated.

Gas Chromatography-Mass Spectrometry↗

Application of radioreceptor assays for systematic toxicological analysis--2. Theoretical considerations and evaluation.

In this paper the applicability of radioreceptor assays for systematic toxicological analysis will be evaluated on a theoretical basis as well as on the basis of the outcomes of the analysis of a large number of urine samples collected after administration of a selected number of drugs to healthy volunteers and patients. Many drugs and other substances of toxicological relevance exert their action through an interaction with one or more receptor (sub)types. Whether the number of persons are using particular drugs intentionally or unintentionally, radioreceptor assays can be a useful tool for systematic toxicological analysis in that they can be applied to the identification of entire pharmacological classes of substances as well as pharmacologically active metabolites. In part 1 of this paper detailed procedures for radioreceptor assays for benzodiazepines, anticholinergics and antihistaminics have been described in detail in order to illustrate not only the potentials but also the limitations of assay conditions. Fifteen drugs were administered to patients and volunteers and urine samples were collected and determined with the three radioreceptor assays. The results of this study underline the theoretical applicability of receptor assays in systematic toxicological analysis though sample pretreatment procedures may contribute to an improvement in sensitivity and applicability to other biofluids.

Benzodiazepines↗

Objectives to direct the training of emergency medicine residents of off-service rotations: toxicology.

Toxicology is an integral component in the training of the emergency physician. This is the 27th article in a continuing series of goals and objectives. The article provides basic guidelines for the organization of the toxicology elective with specific goals and objectives and a list of the contents of the toxicology briefcase. This information should aid in providing a comprehensive experience in toxicology for emergency medicine residents.

Emergency Medicine↗

Challenges to environmental toxicology and epidemiology: where do we stand and which way do we go?

Modern toxicology investigates a wide array of both old and new health hazards. Priority setting is needed to select agents for research from the plethora of exposure circumstances. The changing societies and a growing fraction of the aged have to be taken into consideration. A precise exposure assessment is of importance for risk estimation and regulation. Toxicology contributes to the exploration of pathomechanisms to specify the exposure metrics for risk estimation. Combined effects of co-existing agents are not yet sufficiently understood. Animal experiments allow a separate administration of agents which can not be disentangled by epidemiological means, but their value is limited for low exposure levels in many of today's settings. As an experimental science, toxicology has to keep pace with the rapidly growing knowledge about the language of the genome and the changing paradigms in cancer development. During the pioneer era of assembling a working draft of the human genome, toxicogenomics has been developed. Gene and pathway complexity have to be considered when investigating gene-environment interactions. For a best conduct of studies, modern toxicology needs a close liaison with many other disciplines like epidemiology and bioinformatics.

Animals↗

Toxicological evaluation of chemical mixtures.

This paper addresses major developments in the safety evaluation of chemical mixtures during the past 15 years, reviews today's state of the art of mixture toxicology, and discusses challenges ahead. Well-thought-out tailor-made mechanistic and empirical designs for studying the toxicity of mixtures have gradually substituted trial-and-error approaches, improving the insight into the testability of joint action and interaction of constituents of mixtures. The acquired knowledge has successfully been used to evaluate the safety of combined exposures and complex mixtures such as, for example, the atmosphere at hazardous waste sites, drinking water disinfection by-products, natural flavouring complexes, and the combined intake of food additives. To consolidate the scientific foundation of mixture toxicology, studies are in progress to revisit the biological concepts and mathematics underlying formulas for low-dose extrapolation and risk assessment of chemical mixtures. Conspicuous developments include the production of new computer programs applicable to mixture research (CombiTool, BioMol, Reaction Network Modelling), the application of functional genomics and proteomics to mixture studies, the use of nano-optochemical sensors for in vivo imaging of physiological processes in cells, and the application of optical sensor micro- and nano-arrays for complex sample analysis. Clearly, the input of theoretical biologists, biomathematicians and bioengineers in mixture toxicology is essential for the development of this challenging branch of toxicology into a scientific subdiscipline of full value.

Air Pollutants↗

Experimental designs and risk assessment in combination toxicology: panel discussion.

Advancing our knowledge on the toxicology of combined exposures to chemicals and implementation of this knowledge in guidelines for health risk assessment of such combined exposures are necessities dictated by the simple fact that humans are continuously exposed to a multitude of chemicals. A prerequisite for successful research and fruitful discussions on the toxicology of combined exposures (mixtures of chemicals) is the use of defined terminology implemented by an authoritative international body such as, for example, the International Union of Pure and Applied Chemistry (IUPAC) Toxicology Committee. The extreme complexity of mixture toxicology calls for new research methodologies to study interactive effects, taking into account limited resources. Of these methodologies, statistical designs and mathematical modelling of toxicokinetics and toxicodynamics seem to be most promising. Emphasis should be placed on low-dose modelling and experimental validation. The scientifically sound so-called bottom-up approach should be supplemented with more pragmatic approaches, focusing on selection of the most hazardous chemicals in a mixture and careful consideration of the mode of action and possible interactive effects of these chemicals. Pragmatic approaches may be of particular importance to study and evaluate complex mixtures; after identification of the 'top ten' (most risky) chemicals in the mixture they can be examined and evaluated as a defined (simple) chemical mixture. In setting exposure limits for individual chemicals, the use of an additional safety factor to compensate for potential increased risk due to simultaneous exposure to other chemicals, has no clear scientific justification. The use of such an additional factor is a political rather than a scientific choice.

Hazardous Substances↗

The role of time in toxicology or Haber's c x t product.

It happened exactly 100 years ago that Warren established for the first time a quantitative link between dose and time while studying the toxicity of sodium chloride in Daphnia magna (Straus). During this century many toxicologists in different contexts returned to this idea, which has become known as Haber's rule of inhalation toxicology. Most attempts to explore this relationship ended in frustration because of the supposed occurrence of exceptions. Thus, toxicologists concentrated on the quantitative relationship between dose and effect under mostly isotemporal conditions while time took a back seat and was assigned such arbitrary, semiquantitative designations as acute, subacute, subchronic and chronic. Time itself as a quantifiable variable of toxicity was seldom studied and when it was studied, it was often not under isodosic (steady state) conditions as required by theory. A recent analysis of toxicological time indicated the impact of three independent time scales (toxicokinetic, toxicodynamic, exposure frequency/duration) in toxicological studies, which interact with dose and effect to yield the enormous complexity known to every toxicologist. Based on prototypical examples when toxicokinetic (dioxins), toxicodynamic (nitrosamines, benzene) or exposure frequency (methylene chloride, chloroacetic acid, HgCl(2), CdCl(2), etc.) represent the critical time scale, the general validity of the c x t=k concept will be discussed as a starting point for a theory of toxicology. As endpoints of toxicity, (delayed) acute toxicity, blood dyscrasias and cancer will be used to illustrate the critical conditions needed to demonstrate the validity of this theory.

Animals↗

Professional toxicology societies: web based resources.

The number of digital tools available for use by researchers continues to rapidly increase as does the quantity of information available on the web. However, judging the reliability, quality and timeliness of this information is not always easy. One source of information about the profession of toxicology comes from the web sites of the various professional organizations that exist in this field. Given the broad nature of toxicology, there are a large number of such organizations. Some serve broader segments of the profession, while others have a more narrow focus. The web sites they have created are similarly variable, although there are some consistencies in the type of information that is provided. These include mission statements, information on joining the organization, and details on their annual meetings. There is also a consistent decision by these sites not to provide toxicologic information per se, although links to sites that do contain such information are occasionally provided. Overall, the information and tools provided by professional toxicology societies around the world appears to be similar in both quantity and quality to other scientific organizations. It is also apparent that this information is rapidly evolving and will likely be much different within the next 5 years.

Certification↗

Forensic toxicology: web resources.

Forensic toxicology is the study and practice of the application of toxicology to the purposes of the law. The internet provides abundant web-sites and resources for the practicing forensic toxicologist and those interested in the field of forensic toxicology. This review includes a description of web-sites, databases of toxicological and analytical data, and web-based journals, forums and mailing lists.

Databases as Topic↗

Online information resources of toxicology in Sweden.

This article presents toxicological information resources in Sweden available to the public on the Internet. The main focus is on websites of organizations and universities with toxicological information in English. For example, the National Chemicals Inspectorate (KemI) has several databases with information on chemical substances on their website as well as regulatory information about chemicals. The Swedish Environmental Protection Agency has a database containing environmental information and on the website of the National Institute of Working Life a database on occupational health is available. An important part of toxicological research is carried out at the Institute of Environmental Medicine at the Karolinska Institute. Several universities and colleges are responsible for research, education and training in toxicology and ecotoxicology.

Academies and Institutes↗

From clinical to human toxicology: linking animal research and risk assessment in man.

Since the 1960s, clinical toxicologists have primarily focused on acute poisonings. This proved very successful as the prognosis markedly improved with the use of resuscitation methods, evidence-based management and new antidotes. This latter area was the first major instance linking animal research and clinical toxicology, as illustrated with N-acetyl-cysteine or specific antibodies. Simultaneously the evolution of poison centers was a critical turning point as '2nd generation' centers are increasingly involved in risk assessment and toxicovigilance. Human toxicology is a broader area in that it is also involved in the toxicity evaluation of xenobiotics with the resulting need to link animal research and risk assessment to match the results of preclinical studies with clinical observations. However, this is not an easy task as experimental and clinical toxicologists seldom share ideas and expertise. Immunotoxicology is an example of this situation. Most of the available data on immunosuppression was obtained in animals and not in man, whereas allergic reactions have been extensively investigated in man, but overlooked in animals until recently. One of the major challenges facing toxicology is to bridge the gap between animal research and risk assessment in man. Human toxicology is expected to play a role in taking up this challenge.

Animals↗

Principles in toxicological risk analysis.

Toxicological risk analysis comprises a process of hazard identification, dose-response assessment and exposure assessment, providing as an output the estimation of the incidence and severity of adverse effects likely to occur in a human population in relation to actual or eventual exposure to hazardous compounds. Within this respect, toxicological risk analysis represents a scientific activity, which uses data from toxicological research, and serves as a basis for risk management which is the decision-making process which is performed by regulators and politicians, considering also non-scientific aspects such as socioeconomic and political factors. The predominant step in hazard identification is the answer to the question whether a compound must be classified as a genotoxic carcinogen, epigenetic carcinogen or non-carcinogen. Additional important aspects concern the questions how to extrapolate from high to low dose, as well as how to deal with exposures to complex mixtures of carcinogens. Also, the question is addressed whether it is required in toxicological risk analysis to consider susceptible subgroups in the population, for instance on the basis of specific genetic predispositions.

Animals↗