United States Environmental Protection 1=1 m m Agency EPA/690/R-15/009F Final 9-30-2015 Provisional Peer-Reviewed Toxicity Values for Lewisite (CASRN 541-25-3) Superfund Health Risk Technical Support Center National Center for Environmental Assessment Office of Research and Development U.S. Environmental Protection Agency Cincinnati, OH 45268 ------- AUTHORS, CONTRIBUTORS, AND REVIEWERS CHEMICAL MANAGER Dan D. Petersen, PhD, DABT National Center for Environmental Assessment, Cincinnati, OH DRAFT DOCUMENT PREPARED BY SRC, Inc. 7502 Round Pond Road North Syracuse, NY 13212 PRIMARY INTERNAL REVIEWERS Jeffery Swartout, PhD, DABT National Center for Environmental Assessment, Cincinnati, OH This document was externally peer reviewed under contract to: Eastern Research Group, Inc. 110 Hartwell Avenue Lexington, MA 02421 3136 Questions regarding the contents of this document may be directed to the U.S. EPA Office of Research and Development's National Center for Environmental Assessment, Superfund Health Risk Technical Support Center (513-569-7300). li Lewisite ------- TABLE OF CONTENTS COMMONLY USED ABBREVIATIONS AND ACRONYMS iv BACKGROUND 1 DISCLAIMERS 1 QUESTIONS REGARDING PPRTVs 1 INTRODUCTION 2 REVIEW OF POTENTIALLY RELEVANT DATA (NONCANCER AND CANCER) 5 HUMAN STUDIES 10 Oral Exposures 10 Inhalation Exposures 10 ANIMAL STUDIES 10 Oral Exposures 10 Inhalation Exposures 17 OTHER DATA (SHORT-TERM TESTS, OTHER EXAMINATIONS) 17 Genotoxicity 17 Acute Toxicity Studies 27 Metabolism/Toxicokinetic Studies 28 Mode-of-Action/Mechanistic Studies 29 DERIVATION OI PROVISIONAL VALUES 31 DERIVATION OF ORAL REFERENCE DOSES 31 Derivation of a Subchronic p-RfD 33 Derivation of Chronic p-RfD 35 DERIVATION OF INHALATION REFERENCE CONCENTRATIONS 36 CANCER WEIGHT-OF-EVIDENCE DESCRIPTOR 37 DERIVATION OF PROVISIONAL CANCER POTENCY VALUES 37 APPENDIX A. SCEENING VALUES 38 APPENDIX B. DATA TABLES 39 APPENDIX C. BENCHMARK DOSE MODELING 44 APPENDIX D. REFERENCES 63 in Lewisite ------- COMMONLY USED ABBREVIATIONS AND ACRONYMS a2u-g alpha 2u-globulin MN micronuclei ACGIH American Conference of Governmental MNPCE micronucleated polychromatic Industrial Hygienists erythrocyte AIC Akaike's information criterion MOA mode of action ALD approximate lethal dosage MTD maximum tolerated dose ALT alanine aminotransferase NAG N-acetyl-P-D-glucosaminidase AST aspartate aminotransferase NCEA National Center for Environmental atm atmosphere Assessment ATSDR Agency for Toxic Substances and NCI National Cancer Institute Disease Registry NOAEL no-observed-adverse-effect level BMD benchmark dose NTP National Toxicology Program BMDL benchmark dose lower confidence limit NZW New Zealand White (rabbit breed) BMDS Benchmark Dose Software OCT ornithine carbamoyl transferase BMR benchmark response ORD Office of Research and Development BUN blood urea nitrogen PBPK physiologically based pharmacokinetic BW body weight PCNA proliferating cell nuclear antigen CA chromosomal aberration PND postnatal day CAS Chemical Abstracts Service POD point of departure CASRN Chemical Abstracts Service Registry PODadj duration-adjusted POD Number QSAR quantitative structure-activity CBI covalent binding index relationship CHO Chinese hamster ovary (cell line cells) RBC red blood cell CL confidence limit RDS replicative DNA synthesis CNS central nervous system RfC inhalation reference concentration CPN chronic progressive nephropathy RfD oral reference dose CYP450 cytochrome P450 RGDR regional gas dose ratio DAF dosimetric adjustment factor RNA ribonucleic acid DEN diethylnitrosamine SAR structure activity relationship DMSO dimethylsulfoxide SCE sister chromatid exchange DNA deoxyribonucleic acid SD standard deviation EPA Environmental Protection Agency SDH sorbitol dehydrogenase FDA Food and Drug Administration SE standard error FEVi forced expiratory volume of 1 second SGOT glutamic oxaloacetic transaminase, also GD gestation day known as AST GDH glutamate dehydrogenase SGPT glutamic pyruvic transaminase, also GGT y-glutamyl transferase known as ALT GSH glutathione SSD systemic scleroderma GST glutathione-S-transferase TCA trichloroacetic acid Hb/g-A animal blood-gas partition coefficient TCE trichloroethylene Hb/g-H human blood-gas partition coefficient TWA time-weighted average HEC human equivalent concentration UF uncertainty factor HED human equivalent dose UFa interspecies uncertainty factor i.p. intraperitoneal UFh intraspecies uncertainty factor IRIS Integrated Risk Information System UFS subchronic-to-chronic uncertainty factor IVF in vitro fertilization UFd database uncertainty factor LC50 median lethal concentration U.S. United States of America LD50 median lethal dose WBC white blood cell LOAEL lowest-observed-adverse-effect level iv Lewisite ------- FINAL 09-30-2015 PROVISIONAL PEER-REVIEWED TOXICITY VALUES FOR LEWISITE (CASRN 541-25-3) BACKGROUND A Provisional Peer-Reviewed Toxicity Value (PPRTV) is defined as a toxicity value derived for use in the Superfund Program. PPRTVs are derived after a review of the relevant scientific literature using established Agency guidance on human health toxicity value derivations. All PPRTV assessments receive internal review by a standing panel of National Center for Environment Assessment (NCEA) scientists and an independent external peer review by three scientific experts. The purpose of this document is to provide support for the hazard and dose-response assessment pertaining to chronic and subchronic exposures to substances of concern, to present the major conclusions reached in the hazard identification and derivation of the PPRTVs, and to characterize the overall confidence in these conclusions and toxicity values. It is not intended to be a comprehensive treatise on the chemical or toxicological nature of this substance. The PPRTV review process provides needed toxicity values in a quick turnaround timeframe while maintaining scientific quality. PPRTV assessments are updated approximately on a 5-year cycle for new data or methodologies that might impact the toxicity values or characterization of potential for adverse human health effects and are revised as appropriate. It is important to utilize the PPRTV database (http://hhpprtv.ornl.gov) to obtain the current information available. When a final Integrated Risk Information System (IRIS) assessment is made publicly available on the Internet (http://www.epa.eov/iris). the respective PPRTVs are removed from the database. DISCLAIMERS The PPRTV document provides toxicity values and information about the adverse effects of the chemical and the evidence on which the value is based, including the strengths and limitations of the data. All users are advised to review the information provided in this document to ensure that the PPRTV used is appropriate for the types of exposures and circumstances at the site in question and the risk management decision that would be supported by the risk assessment. Other U.S. Environmental Protection Agency (EPA) programs or external parties who may choose to use PPRTVs are advised that Superfund resources will not generally be used to respond to challenges, if any, of PPRTVs used in a context outside of the Superfund program. This document has been reviewed in accordance with U.S. Environmental Protection Agency policy and approved for publication. Mention of trade names or commercial products does not constitute endorsement or recommendation for use. QUESTIONS REGARDING PPRTVs Questions regarding the contents and appropriate use of this PPRTV assessment should be directed to the EPA Office of Research and Development's National Center for Environmental Assessment, Superfund Health Risk Technical Support Center (513-569-7300). 1 Lewisite ------- FINAL 09-30-2015 INTRODUCTION Lewisite, CASRN 541-25-3, was manufactured as a poison gas and skin blistering agent (vesicant). It has an odor like geraniums (HSI)B, 2010). This chemical was proclaimed a high risk chemical with little or no use for peaceful purposes and is listed in Schedule 1 of the Annex on Chemicals for the Chemical Weapons Convention. Lewisite may exist as the trans or cis isomer, but in aqueous solution, the cis isomer is photoconverted to the trans isomer (NRC. 2013). Lewisite has moderate vapor pressure, and if released into the air, it is expected to exist solely in the vapor phase. Once in the air, lewisite is expected to degrade slowly. Although lewisite has low water solubility, it rapidly hydrolyzes. As such, volatilization of lewisite from an aquatic source is expected to decrease over time when released in an aqueous environment (HSI)B, 2010). The empirical formula for lewisite is C:H:AsCb (see Figure 1). A table of physicochemical properties for lewisite is provided below (see Table 1). Figure 1. Lewisite Structure Table 1. Physicochemical Properties of Lewisite (CASRN 541-25-3)a Property (unit) Value Boiling point (°C) Decomposes at 190 Melting point (°C) 0.1 Density (g/cm3 at 20°C) 1.888 Vapor pressure (mmHg at 25°C) 0.58 pH (unitless) ND Solubility in water (mg/L; temperature not reported) 500, rapid hydrolysis Relative vapor density (air =1) 7.1 Molecular weight (g/mol) 207.32 •'HSDB (2010). ND = no data. Lewisite is an unstable compound; thus, environmental exposures may be to a mixture of lewisite with one or more of its degradation products and/or frequently occurring impurities. Reactions and reaction products of lewisite under various conditions have been reviewed by Munro et al. (1999). As noted by the authors, lewisite hydrolyzes readily in water, forming the water-soluble product 2-chlorovinyl arsonous acid (CVAA) and hydrochloric acid. The equilibrium between lewisite, lewisite oxide and CVAA is not a true equilibrium, because once 2 Lewisite ------- FINAL 09-30-2015 in solution, lewisite is completely converted to CVAA. Dehydration of CVAA forms the insoluble 2-chloroarsenous oxide (lewisite oxide). In basic solution, the trans isomer of lewisite is cleaved to yield acetylene and sodium arsenite. In addition, the cis isomer of lewisite may be photoconverted to the trans isomer, and the trivalent form of arsenic in lewisite oxide is generally oxidized to pentavalent arsenic under environmental conditions. Impurities found in the synthesized form of lewisite include bis(2-chlorovinyl)chloroarsine (also known as lewisite-2 or L-2), tris(2-chlorovinyl)arsine (also known as lewisite-3 or L-3), and arsenic trichloride [reviewed by NRC (2013); Munro et al. (1999)1. A summary of available toxicity values for lewisite from EPA and other agencies/organizations is provided in Table 2. The only organizations that have derived chronic toxicity values for lewisite are the U.S. Army and the National Research Council (NRC). In 1996, the U.S. Army derived an interim chronic oral reference dose (RfD) [documented in SERDP (1997)1 of 1 10 4 mg/kg-day based on a no-observed-adverse-effect level (NOAEL) of 0.6 mg/kg-day (the highest dose tested) for forestomach lesions in male and female rats exposed via intragastric intubation 5 days/week for 23 weeks in a two-generation reproductive toxicity study (Sasser et al.. 1999; Sasser et al.. 1989b). Forestomach lesions were observed at higher doses in a subchronic-duration toxicity study in rats (Sasser et al.. 1996; Sasser et al.. 1989a). The U.S. Army authors converted the NOAEL to a continuous exposure dose of 0.44 mg/kg-day and divided this point-of-departure by a total uncertainty factor (UF) of 3,000 (including UFs of 10 each for interspecies extrapolation, variability in human sensitivity, and extrapolation from subchronic- to chronic-duration exposure; and a UF of 3 for database deficiencies) to obtain the interim RfD. In 1996, the Material/Chemical Risk Assessment (MCRA) Working Group of the Environmental Risk Assessment Program, a multiagency work group consisting of EPA, U.S. Department of Defense (DOD), and U.S. Department of Energy (DOE) representatives, reviewed the U.S. Army's interim RfD (SERDP. 1997). The working group concluded that the RfD was not verifiable due to deficiencies in the lewisite database. The group recommended that inorganic arsenic (RfD, 3 x 10 4 mg/kg-day) be used as a surrogate for lewisite based on its similarity to the interim RfD for lewisite, and the observation that lewisite would degrade to inorganic arsenic in the environment. The NAS (1999) was asked to review the Army's interim RfD. Upon review of the available data, the NAS' NRC recommended against using the proposed RfD and suggested instead that the RfD should be based on a lowest-observed-adverse-effect level (LOAEL) of 0.07 mg/kg-day for mortality and gastric lesions in rabbits exposed during gestation (Hackett et al., 1987). The NRC reasoned that rabbits might be more susceptible to lewisite than rats, and that this increased susceptibility outweighed concerns raised in the U.S. Army's assessment regarding the small numbers of surviving rabbits in each dose group. The NRC suggested that the LOAEL of 0.07 mg/kg-day in rabbits be combined with a total UF of 9,000 (with UFs of 3 each for interspecies extrapolation and variability in human sensitivity and UFs of 10 each for extrapolation from a LOAEL to a NOAEL, extrapolation from a 14-day exposure to a chronic-duration exposure, and database deficiencies) to obtain an RfD that rounded to 1 x 10~5 mg/kg-day. 3 Lewisite ------- FINAL 09-30-2015 Table 2. Summary of Available Toxicity Values for Lewisite (CASRN 541-25-3) Source/ Parameter*'1' Value (applicability) Notes Reference Noncancer IRIS NV NA U.S. EPA (2015) HEAST NV NA U.S. EPA (201 la) DWSHA NV NA U.S. EPA (2012a) ATSDR NV NA ATSDR (2015) WHO NV NA WHO (2015) Cal/EPA NV NA Cal/EPA (2014); Cal/EPA (2015a): Cal/EPA (2015b) U.S. Army (RfD) 1 x 10 4 mg/kg-d Route: oral, intragastric intubation Species: rat Duration: 23 wk in a 2-generation reproduction study SERDP (1997) NRC (RfD) 1 x 10 s mg/kg-d Route: oral, intragastric intubation Species: rabbit Duration: 14 d during gestation NAS (1999) OSHA NV NA OSHA (2006) NIOSH NV NA NIOSH (2015) ACGIH NV NA ACGIH (2015) Cancer IRIS NV NA U.S. EPA (2015) HEAST NV NA U.S. EPA (2011a) DWSHA NV NA U.S. EPA (2012a) NTP NV NA NTP (2014) IARC NV NA IARC (2015) Cal/EPA NV NA Cal/EPA (2011): Cal/EPA (2015a): Cal/EPA (2015b) ACGIH NV NA ACGIH (2015) aSources: ACGIH = American Conference of Governmental Industrial Hygienists; ATSDR = Agency for Toxic Substances and Disease Research; Cal/EPA = California Environmental Protection Agency; DWSHA = Drinking Water Standards and Health Advisories; HEAST = Health Effects Assessment Summary Tables; IARC = International Agency for Research on Cancer; IRIS = Integrated Risk Information System; NIOSH = National Institute for Occupational Safety and Health; NRC = National Resource Council; NTP = National Toxicology Program; OSHA = Occupational Safety and Health Administration; WHO = World Health Organization. Parameters: RfD = reference dose NA = not applicable; NV = not available. 4 Lewisite ------- FINAL 09-30-2015 After reviewing the NAS (1999) recommendations, the U.S. Army (2000) concluded that the interim RfD of 1 x 10 4 mg/kg-day is a more appropriate estimate of the toxicity from chronic-duration oral exposure to lewisite and should be used when lewisite or its degradation products (CVAA or lewisite oxide) are present in the environment. The Army indicated that these products are unlikely to be present in the environment and that risk evaluations of other lewisite degradation products (arsenicals) in the environment should employ the EPA RfD for inorganic arsenic (0.003 mg/kg-day). Literature searches were conducted in July 2013, June 2014 and updated in September 2015 for studies relevant to the derivation of provisional toxicity values for lewisite (CASRN 541-25-3). Searches were conducted using EPA's Health and Environmental Research Online (HERO) database of scientific literature. The following databases were searched: PubMed, ToxLine (including TSCATS1), and Web of Science. The following databases were searched outside of HERO for health-related values: ACGIH, ATSDR, Cal/EPA, U.S. EPA IRIS, U.S. EPA HEAST, U.S. EPA OW, U.S. EPA TSCATS2/TSCATS8e, NIOSH, NTP, OSHA, and RTECS. REVIEW OF POTENTIALLY RELEVANT DATA (NONCANCER AND CANCER) Tables 3A and 3B provide an overview of the relevant databases for lewisite and include all potentially relevant and repeated short term-, subchronic-, and chronic-duration studies. Principal studies are identified in bold. The phrase "statistical significance," used throughout the document, indicates ap-walue of <0.05 unless otherwise noted. 5 Lewisite ------- Table 3A. Summary of Potentially Relevant Noncancer Data for Lewisite (CASRN 541-25-3) Category Number of Male/Female, Strain, Species, Study Type, Study Duration Dosimetry3 Critical Effects NO A EL1 BMDL/ BMCLa LOAEL1 Reference (comments) Notesb Human 1. Oral (mg/kg-d)a ND 2. Inhalation (mg/m3) ND Animal 1. Oral (mg/kg-d)a Subchronic 10 M/10 F, S-D rat, lewisite in sesame oil via intragastric intubation, 5 d/wk, 13 wk 0,0.01,0.10, 0.50,1.0, or 2.0 mg/kg-d ADD: 0,0.0071, 0.071, 0.36, 0.71,1.4 Mortality due to inflammatory lesions of the respiratory tract at >0.36 mg/kg-d. 0.071 0.0049 (F) 0.36 (FEL) Sasser et al. PR PS (1996); Sasser et al. (1989a) Subchronic/ chronic 10 rats, sex and strain unspecified, 98 d at 10 ppm, 133 d at 16 ppm, in drinking water 0, 10°, 16dppm Mortality NDr NDr ND U.S. Armv. 1941 NPR Reproductive 20 M/25 F, S-D rat, lewisite in sesame oil via intragastric intubation, 5 d/wk, 23 wk each generation (13 wk premating, and during mating, gestation, and lactation) 0,0.10, 0.25, or 0.60 mg/kg-d ADD: M: 0.071,0.18, 0.43 F: 0.076,0.19, 0.46 Mortality due to inflammatory lesions of the respiratory tract at >0.071 mg/kg-d. NDr 0.0052 (F) 0.071 (FEL) for mortality in F1 male rats Sasser et al. (1999); Sasser et al. (1989b) PR ------- Table 3A. Summary of Potentially Relevant Noncancer Data for Lewisite (CASRN 541-25-3) Category Number of Male/Female, Strain, Species, Study Type, Study Duration Dosimetry3 Critical Effects NOAEL3 BMDL/ BMCL3 LOAEL3 Reference (comments) Notesb Developmental 0 M/10 F, CD rat, dose-range-finding study, lewisite in sesame oil via intragastric intubation on GDs 6-15 0,0.5, 1.0,2.0, or 2.5 mg/kg-d ADD: 0, 0.5, 1.0,2.0,2.5 Mortality and gross gastrointestinal lesions at >2.0 mg/kg-d. Due to uncertainty regarding the possible contribution of toxicity towards one death attributed to dosing trauma at 1.0 mg/kg-d, the next lower dose of 0.5 mg/kg-d, at which no effects were reported, was designated the NOAEL. 0.5 NDr 2.0 (FEL) Hackett et al. (1992); Hackett et al. (1987) NPR 0 M/25 F, CD rat, main developmental study, lewisite in sesame oil via intragastric intubation on GDs 6-15 0, 0.5, 1.0, and 1.5 mg/kg-d ADD: 0, 0.5, 1.0, 1.5 No effects observed. 1.5 NDr NDr Hackett et al. (1992); Hackett et al. (1987) NPR Developmental 0 M/8 F, New Zealand rabbit, dose-range-finding study, lewisite in sesame oil via intragastric intubation on GDs 6-19 0,0.5, 1.0, 1.5, or 2.0 mg/kg-d ADD: 0, 0.5, 1.0, 1.5,2.0 Hemorrhage of the gastric mucosa at >0.5 mg/kg-d. The study authors attributed high mortality at this dose entirely to dosing trauma, but there is some uncertainty regarding the possible contribution of lewisite toxicity to these deaths. Deaths attributed to lewisite toxicity (sans gavage error) were reported at >1.0 mg/kg-d. NDr NDr 0.5 (FEL) Hackett et al. (1992); Hackett et al. (1987) NPR Developmental 0 M/18 F, New Zealand rabbit, main developmental study, lewisite in sesame oil via intragastric intubation on GDs 6-19 0, 0.07, 0.20, and 0.60 mg/kg-d ADD: 0, 0.07, 0.20, 0.60 Mortality due to gastric lesions at >0.07 mg/kg-d. NDr 0.002 0.07 (FEL) Hackett et al. (1992); Hackett et al. (1987) NPR ------- Table 3A. Summary of Potentially Relevant Noncancer Data for Lewisite (CASRN 541-25-3) Number of Male/Female, Strain, Species, Study Type, BMDL/ Reference Category Study Duration Dosimetry3 Critical Effects NO A EL1 BMCLa LOAEL1 (comments) Notesb 2. Inhalation (mg/m3) ND aDosimetry: Oral doses are expressed as adjusted daily dose (ADD in mg/kg-day). bNotes: PS = principal study; PR = peer reviewed; NPR = not peer reviewed. °Exposed to 10 ppm for 98 days. dExposedto 16 ppm for 133 days. Bold text indicates the principal study. Treatment/exposure duration (unless otherwise noted): Short-term = repeated exposure for >24 hours <30 days (U.S. EPA. 20021: long-term (subchronic) = repeated exposure for >30 days <10% lifespan for humans (more than 30 days up to approximately 90 days in typically used laboratory animal species) (U.S. EPA. 20021: chronic = repeated exposure for >10% lifespan for humans (more than approximately 90 days to 2 years in typically used laboratory animal species) (U.S. EPA. 20021. ADD = adjusted daily dose; F = female(s); FEL = frank effect level; GD = Gestation Day; M = male(s); ND = no data; NDr = not determined. ------- FINAL 09-30-2015 Table 3B. Summary of Potentially Relevant Cancer Data for Lewisite (CASRN 541-25-3) Category Number of Male/Female, Strain, Species, Study Type, Study Duration Dosimetry Critical Effects BMDL/ BMCL Reference (comments) Notes Human 1. Oral (mg/kg-d) ND 2. Inhalation (mg/m3) Carcinogenicity 55 male workers engaged in manufacture of lewisite at a poison gas factory in Japan were followed for lung cancer incidence for 50 yr. 969 workers at the same factory but not engaged in poison gas manufacture served as controls. Based on job description only; no quantitative exposure data. 2 cases of lung cancer were observed in the lewisite-exposed group (3.6%); 38 lung cancers were observed in the control group (3.9%). Statistical analysis was not performed due to the small number of lewisite-exposed workers. NDr Doi et al. PR (2011) Animal 1. Oral (mg/kg-d) ND 2. Inhalation (mg/m3) ND PR = peer reviewed; ND = no data; NDr = not determined. 9 Lewisite ------- FINAL 09-30-2015 HUMAN STUDIES Oral Exposures No studies have been identified. Inhalation Exposures Doi et al. (2011) evaluated the incidence of lung cancers in former workers in a lewisite production facility in Okunojima Island in Hiroshima Prefecture, Japan (see Table 3B). The factory primarily produced mustard gas, but lewisite and other poison gases were also produced. Former workers were recruited through a variety of means including house-to-house canvassing, television advertisement, and inquiry upon admittance to hospitals in the area. Workers directly engaged in the manufacture of poison gases were selected for participation; selection criteria included male gender, living continuously in the Hiroshima Prefecture after retirement from the factory, and follow-up data available for more than 2 years. Lung cancer diagnosis (confirmed by pathology) was obtained from clinical records, postmortem examinations, or notification from hospitals or public health authorities. A group of 55 male workers (mean age at first employment, 22 years) directly engaged in the manufacture of lewisite was included. Controls (n = 969) were selected from among job titles other than manufacturing (carriers, construction workers, clerks, housekeepers or medical staff). A total of two incident lung cancer cases, both squamous cell carcinomas, occurred in the group exposed to lewisite over the 50-year follow-up (3.6%); while there were 38 lung cancer cases among controls (3.9%). Statistical comparison to control incidence rates was not performed due to the small numbers of subjects and cases, however, there does not appear to be an increase in those exposed. Previous studies of these workers (Yamakido et al.. 1996; Shakil et al.. 1993; Yamakido et al.. 1985; Nishimoto et al.. 1983) grouped workers exposed to lewisite with the much larger numbers of workers exposed to mustard gas [480 men in Doi et al. (2011)1. diphenylcyanoarsine (178 men), and/or other poison gases produced at the facility; thus, these earlier studies provide little information on the effects of occupational exposure to lewisite. ANIMAL STUDIES Oral Exposures Overview of Animal Oral Exposure Studies Potentially relevant data for noncancer effects come from a sub chronic-duration study in rats exposed to lewisite via intragastric intubation for 13 weeks (Sasser et al.. 1996; Sasser et al.. 1989a). a subchronic-duration drinking water study in rats (U.S. Army. 1941). a two-generation reproductive toxicity study in rats exposed via intragastric intubation (Sasser et al.. 1999; Sasser et al.. 1989b), and unpublished developmental toxicity studies in rats and rabbits exposed to lewisite via intragastric intubation (Hackett et al.. 1992; Hackett et al.. 1987). No chronic-duration or cancer bioassays using oral exposure to lewisite have been identified in the available literature. Subchronic-Duration Studies Sasser et al. (1996): Sasser et al. (1989a) In a 13-week study, ultimately chosen as the principal study, rats were exposed to lewisite (95.8% trans isomer, 4% cis isomer, and 0.2% unknown compounds) in sesame oil via intragastric intubation was conducted by (Sasser et al.. 1996; Sasser et al.. 1989a). Groups of 10 male and 10 female Sprague-Dawley (S-D) rats received doses of 0.01, 0.1, 0.5, 1.0, or 2.0 mg/kg-day, 5 days/week for 13 weeks (equivalent to continuous doses of 0.0071, 0.071, 0.36, 0.71, or 1.4 mg/kg-day). The animals were observed daily for mortality and morbidity, and 10 Lewisite ------- FINAL 09-30-2015 clinical signs of toxicity were evaluated weekly. Body weight was measured before and at the end of the study, as well as at weekly intervals. Ocular examinations were performed before and after the study in the control and 0.71- and 1.4 mg/kg-day exposure groups. Blood was collected at Week 6 and at the terminal sacrifice for evaluation of hematology endpoints (platelets [PLAT], total and differential leukocyte counts, red blood cell [RBC] and reticulocyte counts [Ret], hemoglobin [Hb], hematocrit [Hct], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], and mean corpuscular hemoglobin concentration [MCHC]). In addition, blood collected at sacrifice was analyzed for serum chemistry parameters including blood urea nitrogen (BUN), creatinine, total protein, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). At sacrifice or unscheduled death, all animals were subjected to gross necropsy, and the liver, thymus, right kidney, right gonad, heart, brain, and adrenal glands were weighed. Comprehensive histopathology examination (tissues not specified) was limited to the control and highest-dose group; tissues identified as target organs in the high-dose animals were examined microscopically in the lower dose groups. The data were analyzed by analysis of variance (ANOVA) and Tukey's studentized range test. Mortality among lewisite-treated animals was high (see Table B-l); a total of 28 toxicity-related deaths (or moribund sacrifices) were reported, including two males and three females exposed to 0.36 mg/kg-day, seven males and six females exposed to 0.71 mg/kg-day, and three males and seven females exposed to 1.4 mg/kg-day (Sasser et al.. 1996; Sasser et al.. 1989a). An additional male of the 0.71-mg/kg-day group died due to an overdose of anesthetic given for blood sampling. Toxi city-related deaths occurred throughout the study, some as early as Week 1 and some as late as Week 13. The cause of death was severe, acute inflammation of the respiratory tract. Signs of toxicity such as dyspnea, drooling, and listlessness occurred 1-2 days prior to death. In survivors, signs of toxicity included drooling, nasal discharge, and mouth breathing among rats exposed to >0.36 mg/kg-day. Body weights of surviving rats were not affected by exposure, and ocular examinations did not indicate any treatment-related effects. Statistically significant increases were seen in lymphocytes at Week 6 (but not Week 13) and in platelets at Week 13 in 1,4-mg/kg-day female rats, based on only three or four animals in this group (see Table B-2). No hematological changes were seen in lower-dose females or in males. Changes in serum chemistry parameters were limited to small, statistically significant decreases of uncertain toxicological significance in serum protein, creatinine, ALT, and AST in male rats at Week 13 (see Table B-2). No serum chemistry changes were seen in females. No treatment-related alterations in absolute or relative organ weight were observed at any dose of lewisite. Grossly visible masses on the mucosal surface of the forestomach were noted in 8/10 males and 4/10 females exposed to 1.4 mg/kg-day and 1/10 males exposed to 0.71 mg/kg-day (Sasser et al.. 1996; Sasser et aL 1989a). No gross lesions were reported at doses <0.36 mg/kg-day. Microscopic lesions were observed in the respiratory tract and forestomach (Sasser et al.. 1996; Sasser et al.. 1989a). Severe, acute inflammatory lesions of the respiratory tract were observed in all animals that died early; tissues affected by the lesions included the lungs, trachea, larynx, and nasal passages (Sasser et al.. 1996; Sasser et al.. 1989a). The larynx and trachea were noted to be edematous with acute epithelial necrosis and neutrophil infiltration; the lumens were typically filled with exudate. The large intrapulmonary and terminal airways were affected less frequently. Nasal lesions were more severe in the posterior areas than in anterior regions. 11 Lewisite ------- FINAL 09-30-2015 The study authors suggested that the respiratory lesions most likely resulted from induced reflux or aspiration of lewisite into the respiratory tract and that volatilization of lewisite from the stomach or esophagus may also have played a role. The location of the most severely affected tissues supports this supposition. Forestomach lesions noted at the highest dose were characterized by necrosis of the squamous epithelium with neutrophil and macrophage infiltration, hemorrhage, edema, and fibroblast proliferation (Sasser et al.. 1996; Sasser et aL 1989a). Among premature deaths, mild acute inflammation of the glandular stomach was noted in 1/10 males and 3/10 females exposed to 1.4 mg/kg-day; the study authors noted that these lesions may not have been detected in other animals that died prematurely because the lesions disappeared due to autolysis. Survivors of the highest exposure, along with two animals that died after 79 days on study, exhibited forestomach ulcerations. The one surviving male exposed to 0.71 mg/kg-day showed epithelial hyperplasia and hyperkeratosis of the forestomach without ulceration. The 0.36-mg/kg-day dose is a frank effect level (FEL) for mortality (two males and three females) and severe inflammation of the respiratory tract, and the 0.071-mg/kg-day dose is a NOAEL for this study, as no meaningful effects were observed at this dose. U.S. Army (1941) In an unpublished study conducted by the Medical Research Division of Edgewood Arsenal (U.S. Army. 1941) for which the full text is not available, rats were exposed for 98-133 days to lewisite (purity 98.6-99.3%) in drinking water. This study lacked information on several aspects of study design and results, as noted below. The strain or sex of rat tested was not reported. Groups of 10 rats were exposed to 0 or 10 ppm lewisite for 98 days, followed by 21 untreated days; additional groups of 10 rats were exposed to 0 or 16 ppm lewisite for 133 days followed by 14 untreated days. The exposure solution was prepared 6 days prior to the start of the experiments, and concentrations in the solution provided to the animals were not quantified analytically. Lewisite in aqueous solution is rapidly hydrolyzed to CVAA and hydrochloric acid, although available data do not provide a quantitative estimate of the rate of hydrolysis (HSDB, 2010). Given the low concentration of lewisite relative to its aqueous solubility [500 mg/L or ppm; HSDB (2010)1 and the duration of time between preparation of the solution and administration to the animals, it is very likely that the animals were exposed primarily to the degradation products of lewisite rather than to lewisite itself. As a result, it is not possible to estimate the dose of lewisite, if any, to which the animals were exposed. The animals were weighed weekly during the study, and water consumption was recorded 3 times/week (U.S. Army. 1941). Upon death or sacrifice, the animals were necropsied, and the kidney, liver, spleen, stomach, and duodenum were examined microscopically. Arsenic content of the liver, kidney, and spleen was measured. The report did not discuss any statistical analyses. In the 98-day study, four treated animals and two untreated animals were found dead prior to study termination. The cause of death was reported as pulmonary disease (not further detailed) in one control and three treated rats. Causes of the remaining deaths were not determined. In addition to these deaths, there were periodic sacrifices of individual treated and control animals over the course of the study, but it is not clear from the report whether these were moribund sacrifices or sacrifices that were planned. At the end of the treatment period (Day 98), only five treated and four untreated animals remained. In discussing the body-weight 12 Lewisite ------- FINAL 09-30-2015 effects in this study, the study authors noted that both controls and treated rats exhibited slight weight loss over the study, and attributed this to the rats' age and the poor conditions of the animal facility (authors noted excessive temperature, humidity, and drafts). In addition, the authors noted that initial weights were highly variable; average initial weights of the treated and control groups were 254 and 233 g, respectively, a difference of 8%. The average body weight of treated rats remained higher than controls over the duration of the study, suggesting little or no effect of exposure on body weight. Average water consumption over the course of the study was -29% lower among treated rats (77 g/kg-day) than controls (108 g/kg-day). The authors stated that there were no pathology findings related to treatment (data not reported). In the 133-day exposure study, two controls and one lewisite-treated rat died prematurely. The controls reportedly died from pulmonary disease, and the cause of death in the lewisite-treated rat was not determined. Two rats per group were sacrificed after 98 days (the reason for sacrifice was not reported). Seven treated and six control rats remained at the end of the study. As with the other study, average initial body weights differed by -8% (183 g in treated rats and 169 g in controls) and weights of treated rats remained higher than that of controls. In addition, average water consumption by treated rats was reduced (89 g/kg-day) compared with controls (120 g/kg-day). Exposure did not result in pathology findings (data not shown). An effect level cannot be determined for this study due to the lack of information on the concentration and/or identity of compounds in the test solution. Chronic-Duration or Carcinogenicity Studies No studies have been identified. Reproductive Studies Sasser et al. (1999); Sasser et al. (1989b) Sasser et al. (1999) and Sasser et al. (1989b) conducted a two-generation reproductive study in S-D rats. Groups of 20 male and 25 female adult rats (F0 parents) received lewisite (95.8% trans isomer, 4% cis isomer, and 0.2% unknown compounds) in sesame oil via intragastric intubation at doses of 0, 0.10, 0.25, or 0.60 mg/kg-day on 5 days/week (females were dosed daily during gestation). These doses are equivalent to continuous doses of 0.071, 0.18, or 0.43 mg/kg-day in males, and doses of 0.076, 0.19, or 0.46 mg/kg-day in females (assuming 5 days/week except during 3 weeks of gestation, when dosing was 7 days/week). The animals were exposed prior to mating (13 weeks), during mating (3 weeks), and after mating until the birth of offspring; dams continued to receive lewisite during lactation. After weaning, randomly selected F1 male and female offspring were exposed to the same doses via intragastric intubation throughout adolescence, mating, and gestation. F0 and F1 male parents were sacrificed when the next generation was born, while F0 and F1 female parents continued exposure during lactation and were sacrificed at weaning of the next generation. F2 pups were sacrificed at weaning. Evaluations of all parental animals included mortality, body weight (measured weekly), gross necropsy, and organ weights (testis, epididymis, ovary, and uterus). Reproductive organs (ovaries, uterus, vagina, testes, seminal vesicles, prostate, and epididymis) of control and high-dose F0 and F1 adults were examined for histopathology; tissues with gross lesions in adults of lower dose groups were also examined for histopathology. Upon delivery, pups were counted, sexed, weighed, and examined for gross abnormalities. Litters were culled to four pups per sex per litter on Postnatal Day (PND) 4. Body weights of pups were recorded on PNDs 4, 14, and 21. The authors reported that statistical analysis of body and organ weights and forestomach lesions was performed using ANOVA followed by Tukey's studentized range test. 13 Lewisite ------- FINAL 09-30-2015 Repeated measures on the same animal were analyzed for trends by orthogonal contrast. Growth curves were compared using a nonparametric method (not specified further), while the %2 test was used for binary variables. Mortalities among parental animals occurred at all doses (see Table B-3), with greater mortality in the high-dose group (Sasser et aL 1999; Sasser et aL 1989b). At the high dose, 11 F0 females, 4 F0 males, 18 F1 females, and 6 F1 males died. In the mid-dose group, 4 F0 females, 5 F1 females, and 2 F1 males died. At the low dose, 2 F1 females and 1 F1 male died. A single control female died during parturition due to breach birth. The study authors reported that one high-dose female death also occurred during parturition, and that three other deaths (two F1 females and one F1 male) were attributable to dosing error; however, the distribution of the latter deaths across dose groups was not given. The remaining deaths were attributed to aspiration of the test material into the respiratory tract, as indicated by pulmonary lesions including edema, hemorrhage, acute inflammation of the airways and alveoli, subacute inflammation of the pleura and mediastinal tissues, and presence of foreign material in the lungs at necropsy. The authors postulated that the irritating effect of lewisite administration may have triggered a reflex reaction in the animals, leading to aspiration of the test material. There were no treatment-related effects on body weight, mating or fertility indices, or reproductive organ weights of F0 or F1 male or female parental animals (Sasser et aL 1999; Sasser et aL 1989b). Likewise, litter size, pup birth weight, sex ratio, numbers of stillbirths, and abnormal pups, and pup weight and survival through weaning were not affected by exposure to lewisite. Histopathology examination did not indicate any treatment-related effects on reproductive organs of parental adults. The only treatment-related microscopic findings consisted of the pulmonary effects noted above as the cause of early mortality (incidences of lesions were not reported). The study authors reported that the high dose was a NOAEL for reproductive toxicity; however, as three F1 deaths occurred at the low dose (0.071 mg/kg-day for males and 0.076 mg/kg-day for females), and it is not clear that the deaths were due to dosing error or breach birth, this dose is considered a FEL. Developmental Studies Hackett etal (1992): Hackett etal (1987) The developmental toxicity of lewisite was evaluated in rats and rabbits by Hackett et al. (1992) and Hackett et al. (1987). Lewisite (95.8% trans isomer, 4% cv'.v isomer, and 0.2% unknown compounds) was administered in sesame oil by intragastric intubation using a dosing needle (rats) or 22-inch feeding tube (rabbits). In the dose-range-finding study in rats, groups of 10 (11 at the high-dose) pregnant CD rats were given daily doses of 0, 0.5, 1.0, 2.0, or 2.5 mg/kg-day lewisite on GDs 6-15. The dose-range-finding study in rabbits employed groups of eight pregnant New Zealand white rabbits receiving daily doses of 0, 0.5, 1.0, 1.5, or 2.0 mg/kg-day on GDs 6-19. Maternal animals were observed for clinical signs of toxicity and weighed regularly (GDs 0, 6-16, and 20 in rats; GDs 0, 6-19, and 30 in rabbits). Upon sacrifice (GD 20 in rats and GD 30 in rabbits), ovaries were examined for corpora lutea, and uteri were removed and evaluated for implantation sites, resorptions, and living and dead fetuses. Maternal Hct, body weights, and uterine weights were measured. Gross necropsies were also performed on maternal animals. Fetuses were weighed, sexed, and examined for gross morphologic defects. 14 Lewisite ------- FINAL 09-30-2015 The main developmental study used groups of 25 pregnant CD rats and 18 or 19 (depending on dose) pregnant New Zealand white rabbits exposed on the same schedule as the dose-range-finding study; rats were given doses of 0, 0.5, 1.0, and 1.5 mg/kg-day, while rabbits were given daily doses of 0, 0.07, 0.2, and 0.6 mg/kg-day. The endpoints evaluated in the dose-range-finding study were also assessed in the main developmental study. In addition, fetal crown-rump length and placental weight were recorded. Half of the fetuses were examined for skeletal abnormalities and half for visceral abnormalities. Statistical analysis of continuous data was performed using ANOVA and Dunnett's test; quantal data were analyzed using %2 tests (for fetal data) or Fisher's exact test (for litter data). For the developmental study, which was conducted before the subchronic-duration and reproductive rat toxicity studies by the same research group (Sasser et al.. 1999; Sasser et al.. 1996; Sasser et al.. 1989a. b), deaths were reported separately for dosing trauma and lewisite toxicity. However, in light of the finding in the later studies of lewisite-related toxicity in the respiratory tract from aspiration of the test material, there is some uncertainty in the attribution of deaths in this study, because deaths associated with damage to tissues of the respiratory tract during dosing were apparently automatically categorized as trauma, without consideration of possible toxicity. The study authors acknowledged that assignment of a "probable cause of death" to individual animals using only the gross observations at necropsy was often difficult and may appear to be arbitrary in some cases. In the dose-range-finding study in rats (Hackett et al. 1992; Hackett et al. 1987). deaths attributed to lewisite toxicity occurred at 2.0 mg/kg-day (one rat) and 2.5 mg/kg-day (two rats) (see Table B-4). Additional deaths attributed to dosing trauma included one death at 1.0 mg/kg-day, two deaths at 2.0 mg/kg-day, and one death at 2.5 mg/kg-day. Observations at necropsy of the deaths reported to be toxicity related included gas-filled gastrointestinal tracts containing yellow and bloody fluids. Maternal body weights were decreased with dose by the end of the dosing period (see Table B-4); at the time of sacrifice, a statistical and biological significant decrease in body weight was noted in the 2.5-mg/kg-day group (18% lower than controls). Maternal Hct at sacrifice was not affected by treatment. Among pregnant survivors of the high-dose group, a reduction (not statistically significant) in the percentage of implantations (implantations/corpora lutea) was noted (66 vs. 86% in controls). However, a statistically significant reduction in the number of implantations was noted per dam (mean of 10 per dam in the high-dose group compared with 15 per dam in the controls). A statistically significant increase in the percentage of mid-gestation resorptions was observed at the 2.0-mg/kg-day dose (but not the 2.5-mg/kg-day dose); a higher percentage of early gestation resorptions occurred at the highest dose, but the increase was not statistically significant (see Table B-4). The percentage of litters with resorptions was not affected by treatment. As a result of the decrease in implantations and increase in resorptions at the higher doses, the numbers of live fetuses/litter were significantly lower than controls at 2.0 and 2.5 mg/kg-day (see Table B-4); there were no dead fetuses in any litter at any dose. Fetal body weights in the two highest dose groups (especially in females) were biologically significantly lower than controls (13 and 19% for males and females, respectively), but the differences were not statistically significant, possibly due to the small group sizes. Stunted pups were observed in one litter in each of the 1.0, 2.0, and 2.5-mg/kg-day groups. The only gross abnormality observed in any fetus in the study occurred in the vehicle control group. Based on the effects seen at 2.0 and 2.5 mg/kg-day, the top dose for the main teratology study was set at 1.5 mg/kg-day. The 2.0-mg/kg-day dose is a FEL for mortality; due to uncertainty regarding the possible contribution of toxicity towards the death 15 Lewisite ------- FINAL 09-30-2015 attributed to dosing trauma at 1.0 mg/kg-day, as discussed above, the next lower dose of 0.5 mg/kg-day was designated as the NOAEL. In the main developmental study in rats, one control dam and two dams in the 1.0-mg/kg-day group died due to dosing trauma; no deaths were attributed to lewisite toxicity (Hackett et aL 1992; Hackett et aL 1987). Exposure did not affect maternal body weight, gravid uterine weight, or hematocrit. In addition, there were no treatment-related effects on numbers of implantation sites, percentages of resorptions, numbers of live or dead fetuses per litter, or percentage of live fetuses. Fetal body weight, crown-rump length, sex ratio, and placental weights were not biologically and/or statistically significantly different among the groups. No dose-related increases in the litter incidence of gross, skeletal, or visceral abnormalities or variations were observed. The highest dose in this study (1.5 mg/kg-day) is a NOAEL for developmental and maternal toxicity in rats. The dose-range-finding study conducted in rabbits (Hackett et aL 1992; Hackett et aL 1987) was hampered by mortality at all dose levels (see Table B-5); dosing trauma was reported to be responsible for deaths of 1/8, 5/8, 1/8, 3/8, and 0/8 animals in the 0-, 0.5-, 1.0-, 1.5-, and 2.0-mg/kg-day groups respectively, while toxicity-related deaths occurred at 1.0 mg/kg-day (6/8 does), 1.5 mg/kg-day (5/8 does), and 2.0 mg/kg-day (8/8 does). Necropsy findings in the deaths attributed to lewisite toxicity (in all affected dose groups) included inflammation and hemorrhage of the mucosa in the pyloric and cardiac regions of the stomach. Duodenal hemorrhage and necrosis and hemorrhagic foci of the cecum were noted in animals of the 1.0-mg/kg-day group that died from lewisite toxicity. No gross lesions were seen in the respiratory tract, esophagus, or thorax of these animals, but it is unclear whether the occurrence of such lesions would have caused a reclassification of these deaths as trauma-related, as suggested by the reported methodology. Evidence of lewisite toxicity observed at necropsy of animals that reportedly died from dosing trauma and in animals that survived to terminal sacrifice included hemorrhage of the gastric mucosa in doses of the 0.5-mg/kg-day group that reportedly died from dosing trauma and inflammation of the gastric mucosa and accumulation of peritoneal or pericardial fluid in 2/3 rabbits at scheduled sacrifice of the 0.5-mg/kg-day group. The lowest dose (0.5 mg/kg-day) is a FEL for hemorrhage of the gastric mucosa. The study authors attributed the high mortality at this dose entirely to dosing trauma, but there is some uncertainty regarding the possible contribution of toxicity to these deaths, as discussed above. Among surviving rabbits, 3/7 controls, 3/3 rabbits exposed to 0.5 mg/kg-day, and 1/1 rabbit exposed to 1.0 mg/kg-day were pregnant (see Table B-5) (Hackett et aL 1992; Hackett et aL 1987). providing limited data on endpoints other than mortality. Body weights of treated survivors were lower than controls. The available data on other endpoints were too limited to draw any conclusions given the small numbers of pregnant survivors. Based on the toxicity seen in the dose-range-finding study, the authors selected doses of 0, 0.07, 0.2, and 0.6 mg/kg-day for the main teratology study in rabbits. Maternal mortality was also observed in the main teratology study (see Table B-6), including deaths of 1/19, 5/18, 5/18, and 3/19 animals attributed to dosing trauma, stress, handling trauma, or pregnancy complications in the control, 0.07-, 0.2-, and 0.6-mg/kg-day groups (respectively), as well as deaths of 0/19, 2/18, 6/18, and 11/19 animals attributed to lewisite toxicity in the same dose groups (Hackett et aL 1992; Hackett et aL 1987). Necropsy findings of gastric ulcerations in decedents were similar to those seen in the dose-range-finding 16 Lewisite ------- FINAL 09-30-2015 study; no lesions of the respiratory tract were noted. The numbers of pregnant rabbits among survivors in the control through high-dose groups were 9/18, 6/11, 5/7, and 3/5 (pregnant rabbits/survivors). Gestational weight gain among survivors of the high-dose group was statistically significantly lower than controls from GDs 12-20 (data shown graphically); the study authors noted that a large number of animals exposed to the high dose were anorexic during the exposure period. Maternal body weights and weight gain did not differ significantly from controls in the lower dose groups, although the authors noted that qualitatively observed anorexia occurred more frequently in all exposed animals between GDs 20 and 30. Maternal Hct decreased (not statistically significant) with increasing lewisite dose, from 43% in controls to 33% in does exposed to 0.6 mg/kg-day (see Table B-6). The differences did not reach statistical significance, potentially due to the small sample-size of survivors in the higher dose groups. The small numbers of animals and high variability within dose groups limited the conclusions that could be drawn regarding other developmental parameters evaluated in the study. However, some trends with increasing dose were noted, including fewer implantations per corpus luteum (at the high dose only); higher intrauterine mortality; lower placental weights, fetal body weights, and crown-rump lengths; and lower proportions of male fetuses (see Table B-6). A statistically significant increase in the incidence of litters with stunted fetuses was observed in the high-dose group. In addition, the incidences of fetuses (but not litters) with supernumerary ribs and reduced ossification of the pelvis were statistically significantly increased at the high dose. The low dose in this study (0.07 mg/kg-day) is a FEL for mortality due to gastric lesions. However, uncertainties in the attributions of death due to dosing trauma vs toxicity and the small numbers of surviving animals in dose groups makes the interpretation of this study unclear. Inhalation Exposures No repeated-dose studies examining effects of lewisite in animals exposed via inhalation for >4 hours on a single day have been identified. Acute studies are presented in Table 5. OTHER DATA (SHORT-TERM TESTS, OTHER EXAMINATIONS) Table 4A provides an overview of genotoxicity studies of lewisite and Table 4B provides an overview of other supporting studies on lewisite, including acute toxicity studies, studies of lewisite toxicokinetics, and mechanistic studies of lewisite. Genotoxicity Lewisite did not induce mutations in Salmonella typhimurium strains TA97, TA98, TA100, or TA102 with or without metabolic activation at concentrations up to those that were cytotoxic (cytotoxicity was noted at 0.01 [j,g/plate in TA102 and at 5 [j,g/plate in other strains tested) (U.S. Army. 1989b). Likewise, lewisite was negative for mutation at the HGPRT locus in Chinese hamster ovary (CHO) cells when tested up to cytotoxic concentrations (cytotoxicity was observed at concentrations >1 (.iM) (U.S. Army, 1989a). Lewisite did not induce sister chromatid exchanges at concentrations up to 1 [xM, but did induce chromosomal aberrations in CHO cells at concentrations >0.50 [xM (U.S. Army. 1989a). Lewisite was negative in the Drosophilla melanogaster sex-linked recessive lethal assay (Auerbach and Robson. 1947). No evidence of dominant lethal toxicity was observed when male CD rats were exposed via gavage to doses of up to 1.5 mg/kg for 5 consecutive days (Bucci et aL 1993). Bucci et al. (1993) Bucci et al. (1993) conducted a study of dominant lethal toxicity in CD rats. Groups of 20 male rats received lewisite in sesame oil via intragastric intubation on 5 consecutive days, and 17 Lewisite ------- FINAL 09-30-2015 then were mated to two untreated females per week for 10 consecutive weeks. Doses used in the study were 0, 0.375, 0.75, or 1.5 mg/kg lewisite. Body weights of the male rats were recorded during treatment and subsequent mating. At the end of the mating period, males were sacrificed and the left testis and brain were weighed.1 Epididymal sperm was evaluated for motility and morphology. In addition, testes were examined microscopically. Student's t-test was used for statistical comparison with control data, and regression analysis was used to assess dose-response relationship. The proportion of females with one or more dead implants was evaluated by the %2 test. Animals of all dose groups survived until scheduled sacrifice (Bucci et al.. 1993). Body weights of treated males did not differ from controls during treatment or the subsequent mating period. There were no treatment-related or statistically significant effects on the number or percent of pregnancies, total implants, live or dead fetuses, or early, late, or total resorptions. Furthermore, sperm morphology, testes weight, seminiferous tubule diameter, and testes histopathology did not differ between treated and untreated males; however, it should be noted that these assessments occurred 10 weeks after the end of exposure. Sperm motility was significantly higher in the rats exposed to 1.5 mg/kg-day lewisite, but this effect is not likely to be toxicologically meaningful. 'The methods section in Bucci et al. (1993) indicated that the epididymis, seminal vesicles, prostate, and pituitary gland were also weighed, but the results of these organ weights were neither reported nor discussed. Lewisite 18 ------- FINAL 09-30-2015 Table 4A. Summary of Lewisite Genotoxicity Endpoint Test System Dose/ Concentration3 Resultsb Comments References Without Activation With Activation Genotoxicity studies in prokaryotic organisms Mutation S. typhimurium TA97, TA98, TA100, TA102 1 or 5 (ig/plate Both plate incorporation and preincubation assays performed. Cytotoxicity observed at higher doses, but nontoxic doses were also tested, so the study is considered adequate. U.S. Armv (1989b) Genotoxicity studies in mammalian cells—in vitro Mutation CHO cells 2 \M - - Cytotoxicity observed at higher doses, but nontoxic doses were also tested, so the study is considered adequate. Cell survival was -30% at 1 |iIVI in the absence of S9 and -100% in the presence of S9. U.S. Armv (1989a) SCEs CHO cells 1 \M - - CAs CHO cells 0.5 \M + — Genotoxicity studies—in vivo Dominant lethal CD rats 0, 0.375, 0.75, 1.5 mg/kg NA Groups of 20 male rats dosed daily by gavage for 5 d and then mated to 2 females/wk for the next 10 wk. Bucci et al. (1993) Mutation (sex-linked recessive lethal) D. melanogaster NR — NA Aueibach and Robson (1947) aLowest effective dose for positive results, highest dose tested for negative results. b+ = positive; - = negative. CHO = Chinese hamster ovary (cell line cells); NA = not available; NR = not reported. 19 Lewisite ------- FINAL 09-30-2015 Table 4B. Other Studies Test Materials and Methods Results Conclusions References Acute studies Dogs (breed not reported) were exposed to lewisite vapor at concentrations of 139-384 mg/m3 for 10 or 30 min in a study assessing the efficacy of BAL treatment. Mortality over 7 d follow-up was assessed and survivors were sacrificed >7 d after exposure for gross inspection of the larynx, trachea, and lungs. 22/27 dogs exposed to 0.139 mg/L for 30 min died, most within the first 48 hr. 8/10 dogs exposed to 0.143 mg/L for 30 min died. 4/6 dogs exposed to 0.384 mg/L for 10 min died. Signs of toxicity included retching, vomiting, urination, defecation, respiratory distress, and marked salivation. The cause of early deaths was generally respiratory obstruction; dogs dying later, and some surviving dogs, showed signs of pneumonic consolidation. Treatment with BAL reduced mortality. Concentrations >0.139 mg/L (139 mg/m3) for 30 min or 0.384 mg/L (384 mg/m3) for 10 min are acutely lethal to dogs. Harrison and Ordwav (1946) Acute studies other than oral/inhalation In a study of skin decontaminants, 4,671 men received dermal applications of 50-400 |ig lewisite. The application site was examined 48 hr later and the occurrence and size of blisters and erythemas were recorded. Results were not reported by dose of lewisite. Across all doses, blisters were evident on skin of 4,331 men treated with lewisite; erythemas were evident in 4,568 men. Dermal exposure to lewisite at doses between 50 and 400 |ig may cause blisters and erythemas. Thomson et al. (1947) Groups of 3 male Dutch rabbits were treated percutaneously with neat lewisite for 6 hr for estimation of the dermal LD5o. Animals were observed for up to 30 d. Separate groups of 9 rabbits were treated percutaneously with 10, 14, 20, or 28 mg/kg lewisite and observed for 28 d for comparison with exposed rabbits subsequently treated with chelation therapy. Authors estimated anLDsoof 5.3 mg/kg (95% CI of 3.5-8.5). Deaths typically occurred between 1 and 2 d after exposure. Survivors exhibited significant weight loss over the observation period. Among rabbits treated with 10 mg/kg lewisite, 5/9 had died by 1 d after treatment and 9/9 were dead by 7 d after treatment. Rabbits treated with 10 mg/kg lewisite exhibited focal hepatocellular degeneration, transmural necrosis of the gallbladder, and focal mucosal necrosis of the duodenum. In addition, small bile duct proliferation associated with early portal tract fibrosis was observed in some rabbits (incidence not reported). More severe effects, in addition to sinusoidal congestion of the spleen, kidney congestion, and venous congestion of the lungs, were seen in rabbits receiving doses >10 mg/kg. The percutaneous LD5o in male rabbits is 5.3 mg/kg (95% CI 3.5-8.5). Chelation therapy reduced the severity and extent of pathologic changes seen with percutaneous lewisite exposure. Inns and Rice (1993) 20 Lewisite ------- FINAL 09-30-2015 Table 4B. Other Studies Test Materials and Methods Results Conclusions References Acute studies other than oral/inhalation Groups of 5 male New Zealand white rabbits were given i.v. injections of 1.4, 1.8, 2.0, or 2.4 mg/kg lewisite in propylene glycol. Survivors were sacrificed on D 7; the liver, heart, spleen, kidneys, lungs, stomach, duodenum, and gall bladder were examined microscopically. Mortality incidences were 0/5, 2/5, 3/5, and 5/5 at 1.4, 1.7, 2.0, and 2.4 mg/kg. Average time to death was 4 hr; all deaths occurred within the first 21 hr. Survivors lost weight for 1-2 d. Histopathology findings in decedents included pulmonary edema and hemorrhage accompanied by lymphocyte infiltration. The biliary epithelium was necrotic in most cases, and adjacent hepatocytes were swollen and sometimes necrotic. 1 animal also exhibited small areas of epithelial necrosis in the duodenum, as well as nuclear debris beneath the epithelium. The i.v. LD5o in male rabbits was 1.8 mg/kg (95% CI 1.6-2.1). Effects were compared with those of sodium arsenite, which had a much higher LD50 (7.6 mg/kg) and resulted in histological changes primarily in the kidneys. Inns et al. (1990); Inns et al. (1988) Groups of 3 male New Zealand white rabbits were given i.v. injections of 0.5 mg/kg lewisite in propylene glycol. Groups were sacrificed 6 and 24 hr after dosing for histological examination (organs not specified) and comparison with rabbits treated with sodium arsenite. Lungs exhibited patchy alveolar edema and hemorrhage; in addition, 2 of the 3 rabbits showed gall bladder damage (inflammatory cell infiltration and/or frank necrosis). Sodium arsenite exposure did not result in histological changes. Histological changes in the lungs and gall bladder were observed after exposure of rabbits to an LD10 dose of lewisite (0.5 mg/kg) but not after an LD10 dose of sodium arsenite. Inns et al. (1988) Groups of 12 or 18 male New Zealand white rabbits received single subcutaneous doses of 29.7 |imol/kg lewisite in a study of chelation therapies. Mortality was recorded. Mortality across both groups was 29/30 rabbits. No other information was provided. A subcutaneous dose of 29.7 (imol/kg (6.16 mg/kg) lewisite is lethal to rabbits. Aooshian et al. (1982) Lewisite in absolute ethanol was injected subcutaneously into groups of 8 male New Zealand rabbits to obtain lethality data for subsequent pharmacokinetic study. Doses between 0.5 and 5.0 mg/kg were tested; rabbits were observed for 14 d. The following mortality incidences were observed at doses of 2.0, 2.4, 2.9, 3.5, 4.2, and 5.0 mg/kg: 1/24, 1/16, 3/16, 8/16, 8/16, and 19/24, respectively. The subcutaneous LD50 in male rabbits is 3.79 (95% CI 3.44-4.25) mg/kg. Snider et al. (1990): U.S. Arrnv (1987) 21 Lewisite ------- FINAL 09-30-2015 Table 4B. Other Studies Test Materials and Methods Results Conclusions References Acute studies other than oral/inhalation Groups of 8 female domestic white pigs were exposed (skin only) to saturated lewisite vapor via inverted chambers attached to shaved skin for 6 hr; authors estimated total dose as 0.3 mg/cm2. Skin injury at various time points after exposure was evaluated by histopatholoev examination (Rice and Brown. 19991 laser Dotroler imasins (Brown et al.. 19981 or erythema, skin brightness, skin blueness (cyanosis), and TEWL (Chilcott et al.. 2000). Pig skin exposed to saturated lewisite vapor showed acute inflammation as early as 1 hr after exposure, with coagulative necrosis of the epidermis and papillary dermis by 24 hr after exposure, and necrosis extending into subcutaneous connective and adipose tissue by 48 hr. Laser Doppler imaging and other measurement techniques were useful for clinical evaluation of injury. Exposure of pig skin to saturated lewisite vapors for 6 hr rapidly causes severe damage to the skin. Chilcott et al. (2000); Rice and Brown (1999); Brown et al. (1998) Groups of 5 SKH-1 hairless mice were exposed (skin only) to saturated lewisite vapor via inverted chambers for 8 min, and subsequently treated with B AL, DMSA, or left untreated. Skin damage was evaluated by macroscopic assessment, skin color measurement, TEWL measured, and histopathology. Treatment with lewisite vapor resulted in increased redness, decreased brightness, and increased TEWL (statistical analysis not reported). Histopathology findings in lewisite-exposed skin included severe necrosis of the epidermis and upper dermis, alteration of dermis fibers, and massive dermal neutrophil infiltration. Exposure of mouse skin to saturated lewisite vapors for 8 min causes damage to the skin. Mouret et al. (2013) Groups of 5 male athymic SKH-1 hairless mice were exposed (skin only) to saturated lewisite vapor via inverted chambers for 8 min. Skin damage was evaluated at various time points up to 21 d after exposure by macroscopic assessment, skin color measurement, TEWL, skin elasticity, and histopathology. TEWL was strongly correlated with macroscopic and histopathology changes over time. Microscopic examination of skin biopsies showed inflammatory cell infiltration and microvesications by D 1 postexposure, with wound closure occurring by D 21. TEWL measurement provided the best index to track progression of the lesions. Nguon et al. (2014) 22 Lewisite ------- FINAL 09-30-2015 Table 4B. Other Studies Test Materials and Methods Results Conclusions References Metabolism/toxico kinetic ADME Groups of 100 male New Zealand white rabbits received a subcutaneous injection of 2.4 or 3.5 mg/kg lewisite in absolute ethanol; half of the animals were subsequently treated with B AL. Groups of 5 rabbits were sacrificed at 4, 12, 24, 48, and 96 hr after dosing for analysis of arsenic in blood, brain, spinal cord, liver, kidney, fat, testes, lung, injection site skin, and adjacent normal skin. The blood concentrations of arsenic in lewisite-treated rabbits were highest at the first time point (4 hr postdosing) and declined gradually. Apart from injection site skin, the highest tissue concentrations were in the liver, lung, and kidney, which equilibrated rapidly with blood (peak observed 4-12 hr after dosing; average tissue:blood partition coefficients based on areas under the curve ranged from 7.41-14.50). Brain, spinal cord, and testes tissue concentrations increased between 4 and 96 hr, reflecting slow movement across the blood:tissue barriers (average tissue :blood partition coefficients from 0.59-1.76). Skin and fat exhibited low affinity for arsenic (average tissue :blood partition coefficients from 0.18-2.17). Clearance of arsenic from blood was estimated to be 112-129 mL/min/kg depending on dose. Volume of distribution was 7.67-12.7 L/kg, reflecting wide distribution. The half-life of arsenic in blood (terminal phase) was 54.7-75 hr. Large difference between arsenic content of injection-site skin and blood suggests that arsenic migration from skin is diffusion rate limited. BAL treatment decreased arsenic tissue-to-blood partitioning and increased clearance of arsenic from blood. Snider et al. (1990): U.S. Amw (1987) In a report of a new analytical method for measuring exposure to lewisite, 4 guinea pigs (strain and sex not reported) received a subcutaneous dose of 0.25 mg/kg lewisite. Urine was collected hourly after exposure and analyzed for CVAA. One guinea pig was sacrificed after 24, 72, and 240 hr postexposure; blood was collected and analyzed for the CVAA. One guinea pig was sacrificed after 48 hr for analysis of CVAA in whole blood, globin, and dialyzed globin. CVAA was detected in urine during the first 12 hr after exposure; by determining bound and unbound CVAA in blood; exposure was detectable 240 hr after exposure. Exposure to lewisite can be monitored by measuring hemoglobin-bound and unbound CVAA in blood. Fidder et al. (2000) 23 Lewisite ------- FINAL 09-30-2015 Table 4B. Other Studies Test Materials and Methods Results Conclusions References ADME Groups of 5 male New Zealand white rabbits were given i.v. injections of 0.5 mg/kg lewisite in propylene glycol or sodium arsenite. Survivors were sacrificed on D 7; arsenic in liver and kidney was quantified. Arsenic concentrations in liver and kidney were 4 (ig/g (95% CL ± 1.7) and 5.5 (ig/g (±1.4), respectively. Comparable exposure to sodium arsenite yielded 2-5-fold higher liver and kidney concentrations of arsenic than lewisite. Exposure to lewisite results in arsenic deposition in the liver and kidney. Inns et al. (1988) Groups of 3 male New Zealand white rabbits were given i.v. injections of 1.5 mg/kg lewisite in propylene glycol and sacrificed after 10 min, 30 min, or 2, 6, 24, or 72 hr for measurement of arsenic in lung, liver, kidney, duodenum, stomach, bladder, and brain. Peak arsenic concentrations in lung, liver, kidney, duodenum, stomach, bladder, and brain were 10.2, 2.7, 2.7, 2.3, 0.7, 0.5, and 0.1 jxg/g, respectively. Concentration in the lung peaked at 10 min; those in the liver, kidney, duodenum and stomach peaked at 30 min; and those in the bladder and brain peaked at 6 and 24 hr, respectively. Arsenic is widely distributed in the body after i.v. exposure to lewisite. Inns et al. (1988) Human blood was exposed to 14C-lewisite at concentrations from 20-0.2 mM for 6 hr. Globin and albumin were isolated and radioactivity measured. 90% of radioactivity in blood was found in erythrocytes, and 25-50% of the radioactivity was associated with globin. No binding to albumin was detected. The study authors suggested that localization to erythrocytes reflected binding to glutathione, which is present in high levels in erythrocytes. Fidder et al. (2000) Porcine skin flaps were exposed to undiluted lewisite (0.1-150 |iL) for 10 min in a Franz cell. Arsenic contents in the skin and receptor medium were measured. Dose-dependent increases in the arsenic concentration in the skin and medium were reported; the maximum arsenic concentration in skin was observed at 50 |iL. Postexposure treatment with decontaminants decreased the arsenic content of the skin and medium. Lewisite or its arsenic-containing degradation product traverses excised porcine skin in culture. Haeser et al. (1997) 24 Lewisite ------- FINAL 09-30-2015 Table 4B. Other Studies Test Materials and Methods Results Conclusions References Mode of action/mechanistic Cell metabolism Primary human keratinocytes and cells from a keratinocyte-derived line (SCLII) were exposed to 60 (iM lewisite for 5 min. For 6 hr after exposure, glucose consumption, lactate production, intracellular ATP content, and tetrazolium reduction (a measure of mitochondrial dehydrogenase activity) were measured, as was lactate dehydrogenase in the supernatant. Exposure of keratinocytes to lewisite reduced glucose consumption and lactate formation, inhibited hexokinase activity, increased leakage of lactate dehydrogenase, and decreased ATP content. Lewisite interferes with cell metabolism in keratinocytes in culture. Kehe et al. (2001) Skin exposure to lewisite vapor Yucatan minipigs were exposed (skin only) to saturated lewisite vapor via inverted chambers attached to shaved skin for 24 hr. Exposed skin tissue was excised and evaluated for glycoproteins known to mediate dermo-epidermal attachment (laminin and Type IV collagen). Degradation of laminin and Type IV collagen, but not Type III collagen, was observed in treated pig skin. Study authors suggested that damage to laminin and collagen may mediate dermo-epidermal separation seen after vesicant exposure. Lindsav et al. (2004) Groups of 5 male athymic SKH-1 hairless mice were exposed (skin only) to saturated lewisite vapor via inverted chambers for 8 min. Inflammatory cytokines and chemokines in skin were evaluated. The following cytokines were rapidly upregulated (within 6 hr after exposure): IL-6, CXCL1, CXCL2, and CCL9. In addition, 1 matrix metalloproteinases (MMP-2 and MMP-9) were also upregulated. Expression of MMP-9 was selectively upregulated after exposure. Downregulated cytokines included IL-lra, IL-la, and IL-1|3. Study authors suggested that MMP-9 could be effector of vesication process. Nguon et al. (2014) 25 Lewisite ------- FINAL 09-30-2015 Table 4B. Other Studies Test Materials and Methods Results Conclusions References Cytotoxicity Human leukocytes in culture were exposed to lewisite for varying durations up to 20 hr. Flow cytometry was used to evaluate cytotoxicity markers. At a concentration of >3 x 10 s M for 1 hr, lewisite reduced cell survival to 20% of control during the first 4 hr after exposure. Exposure to lewisite resulted in a time-and dose-dependent increase in the binding of cytotoxicity markers including annexin V, viaprobe, and propidium iodide. Cells exposed to lewisite entered the necrotic cell death pathway as early as the first hour after exposure. Meier (2003); Meier (2004); Meier et al. (1993) ADME = adsorption, distribution, metabolism, elimination; ATP = adenosine triphosphate; BAL = British Anti-Lewisite; CI = confidence interval; CVAA = cold water vapor atomic absorption; DMSA = meso-2,3-dimercaptosuccinic acid; i.v. = intravenous; LD5o = median lethal dose; TEWL = transepidermal water loss. 26 Lewisite ------- FINAL 09-30-2015 Acute Toxicity Studies The acute lethality of lewisite has been estimated in animals exposed via inhalation, oral, dermal, intravenous (i.v.), and subcutaneous routes. Table 5 shows acute lethality data across species and exposure routes. A complete review of the acute lethality and toxicity of lewisite is available in NRC (2013). Table 5. Acute Lethality Estimates for Lewisite Exposure Route Species Exposure Duration LCso (mg/m3) or LDso (mg/kg) Reference Inhalation Rat 9 min 166 mg/m3 Gates. 1946 as cited in NRC (2013) Mouse 10 min 190-200 mg/m3 Silver and McGrath, 1943 as cited in NRC (2013) Guinea pig 9 min 111 mg/m3 Gates. 1946 as cited in NRC (2013) 60 min 8 mg/m3 Rabbit 7.5 min 160 mg/m3 60 min 25 mg/m3 Goat 100 min 12.5 mg/m3 Dog 7.5 min 176 mg/m3 Armstrong. 1923 as cited in NRC 15 min 100 mg/m3 (2013) 30 min 48 mg/m3 60 min 25.4 mg/m3 120 min 11.8 mg/m3 240 min 6.24 mg/m3 Oral Rat NA 50 mg/kg U.S. Armv. 1974 as cited in NRC (2013) Dermal Rabbit 6 hr 5.3 mg/kg (95% CI 3.5-8.5 mg/kg) Inns and Rice (1993) Rat NR 24 mg/kg Cameron etal. (1946) Guinea pig 12 mg/kg Rabbit 6 mg/kg Dog 15 mg/kg Goat 15 mg/kg Subcutaneous Rat NA 1 mg/kg Guinea pig 1 mg/kg Rabbit 2 mg/kg Dog 2 mg/kg Rabbit 3.79 mg/kg (05% CI 3.44-4.25 mg/kg) Snider et al. (1990); U.S. Army (1987) i.v. Rabbit NA 0.5 mg/kg Cameron etal. (1946) 1.8 mg/kg (95% CI 1.6-2.1 mg/kg) Inns et al. (1990); Inns et al. (1988) i.v. = intravenous; NA = not applicable; NR = not reported 27 Lewisite ------- FINAL 09-30-2015 As indicated in Table 5, inhalation of lewisite vapor at concentrations as low as 8 mg/m3 for 1 hour can be lethal in some species [reviewed by NRC (2013)1. The cause of death in exposed animals is generally respiratory obstruction, with necropsy findings consisting of pulmonary congestion, edema, and hemorrhage, accompanied by inflammation of the entire respiratory tract [reviewed by NRC (2013); see also Harrison and Durlacher (1946)1. The available literature included a single oral median lethal dose (LD50) estimate of 50 mg/kg in rats [U.S. Army (1974) as cited in NRC (2013)1; the primary document is not available for review, and the secondary source provided no additional details beyond the LD50 estimate. Dermal exposure to neat lewisite is lethal to rabbits; Inns and Rice (1993) estimated the LD50 to be 5.3 mg/kg (95% confidence interval [CI] of 3.5-8.5 mg/kg). The rabbits in the study showed a profound dose-related weight loss, with some animals losing as much as 72% of initial weight during the 14-day observation period; however, the degree of weight loss was similar in animals that died and those that survived. There were no pathologic effects on the lungs; instead, the animals that died exhibited focal hepatocellular degeneration as well as transmural necrosis of the gallbladder and focal mucosal necrosis of the duodenum. Liver injury was also seen in survivors, in the form of bile duct proliferation and early portal tract fibrosis, with some histopathology findings mimicking cirrhosis (Inns and Rice. 1993). The localized effects of acute exposure to lewisite (as a liquid or saturated vapor) on skin and eyes of both humans and animals, as well as methods to assess and therapeutic interventions to mitigate this injury, have been well studied (Mouret et al.. 2013; Sawyer and Nelson. 2008; Nelson et al.. 2006; Lam et al.. 2002; Chilcott et al.. 2000; Rice and Brown. 1999; Brown et al.. 1998; Qlaios et al.. 1998; Mitcheltree et al.. 1989; Hughes. 1947; Thomson et al.. 1947; Cameron et al.. 1946; Hughes, 1946; Mann et al.. 1946). Briefly, direct contact of skin or eyes with lewisite is highly irritating. On skin, depending on the exposure concentration and time since exposure, erythema and edema or burning and blistering are observed [reviewed by Goldman and Dacre (1989)1. Similarly, in the eye, edema and ulceration of the epithelial surfaces may occur shortly after exposure, followed by corneal damage or destruction. It has been estimated that skin vesication and serious corneal damage would occur with lewisite exposure of 1.5 mg/minute/L (equivalent to 1,500 mg/m3 for 1 minute or 1.5 mg/m3 for -17 hours) [reviewed by Goldman and Dacre (1989)1. In rabbits exposed intravenously (1.4-2.4 mg/kg lewisite) in a study of acute lethality and chelation therapy, the lung was the primary target organ, and the cause of death was severe lung damage as shown by pulmonary edema and hemorrhage accompanied by lymphocyte infiltration (Inns et al.. 1990; Inns et al.. 1988). Perivascular edema and moderate venous congestion, as well as necrosis in the epithelium of the gall bladder and duodenal mucosa, were also seen in decedents. Animals that survived showed multifocal alveolar hemorrhage and lymphocyte infiltration (without pulmonary edema) in addition to liver damage (bile duct proliferation and portal tract fibrosis) and regeneration in the gall bladder and duodenal epithelia (Inns et al.. 1990; Inns et al.. 1988). Metabolism/Toxicokinetic Studies The toxicokinetic behavior of lewisite has been studied in rabbits exposed intravenously (Snider et al.. 1990; U.S. Army. 1987). but there are few data on the absorption, distribution. 28 Lewisite ------- FINAL 09-30-2015 metabolism, and excretion after exposure via other routes. Reviews suggest that lewisite penetrates skin readily due to its lipophilicity [reviewed by SERDP (1997); Pechura (1993)1. However, as discussed in the introduction, lewisite itself is unstable, so the conditions of exposure will markedly affect the chemical species that contact the body and the disposition of the compounds in the body. For example, lewisite in contact with moist surfaces may undergo hydrolysis to CVAA. Further, under acidic conditions such as in the stomach, lewisite is hydrolyzed to CVAA and hydrochloric acid, and further to lewisite oxide (2-chlorovinyl arsenous oxide) [reviewed by Munro et al. (1999)1. The chemical compound(s) responsible for the vesicant effects of lewisite are not known. In rabbits exposed to lewisite via i.v. or subcutaneous injection, the highest tissue concentrations (apart from the injection site) were in the liver, lung, and kidney (Snider et al.. 1990; Inns et al.. 1988; U.S. Army. 1987). Brain, spinal cord, and testes tissue concentrations increased over time, reflecting slow movement across the blood-tissue barriers, and skin and fat exhibited low affinity for arsenic (Snider et al.. 1990; U.S. Army. 1987). Arsenic is widely distributed in the body of the rabbits exposed via i.v. or subcutaneous injection (Snider et al.. 1990; Inns et al.. 1988; U.S. Army, 1987). In the study using subcutaneous exposure (Snider et al.. 1990; U.S. Army. 1987) estimated the volume of distribution to be 7.67-12.7 L/kg; clearance of arsenic from blood was estimated to be 112-129 mL/minute/kg, and the half-life (terminal phase) was 54.7-75 hours. Mode-of-Action/Mechanistic Studies Acute exposure to high levels of lewisite via dermal or i.v. exposure is believed to result in increased capillary permeability in the skin or lungs (respectively), leading to loss of blood plasma and the characteristic "lewisite shock," a sequence of events mimicking shock in burn victims [reviewed by NRC (2013); Goldman and Dacre (1989)1. Perturbation of osmotic equilibrium can result in the dysfunction of numerous biological system including the lungs, kidneys, cardiovascular, and lymphatic systems. A comparison of the pathology seen in acute lethality studies of lewisite in rabbits exposed percutaneously (Inns and Rice. 1993) or intravenously (Inns et al.. 1990; Inns et al.. 1988) shows marked route differences in effect: the liver and gall bladder are the primary targets after dermal exposure, while the lung is primarily affected after i.v. exposure. It has been suggested that the primary injury is to the first capillary bed encountered as lewisite is transported through the body (Inns and Rice. 1993); this would suggest that the liver and gall bladder would be most affected after oral or dermal exposure, while the lung would be affected after inhalation or i.v. exposure. Lewisite and other arsenicals bind strongly to sulfhydryl groups of functionally important proteins and thiol cofactors, forming stable complexes with critical proteins and enzymes, such as dihydrolipoic acid, keratin, alcohol dehydrogenase, pyruvate dehydrogenase, succinic dehydrogenase, succinic oxidase, and hexokinase [reviewed by NRC (2013); McManus and I luebner (2005); Pechura (1993)1. Inactivation of critical enzymes disrupts cell metabolism. These effects coupled with cell membrane damage lead to cell death and tissue necrosis. Evidence for disruption of cell metabolism and membrane damage comes from in vitro studies in which exposure to lewisite reduced glucose consumption and lactate formation, 29 Lewisite ------- FINAL 09-30-2015 inhibited hexokinase activity, increased leakage of lactate dehydrogenase, and decreased adenosine triphosphate (ATP) content (Kehe et aL 2001; Flohe et al.. 1996). Treatment with the chelating agents meso-2,3-dimercaptosuccinic acid (DMSA) or 2,3-dimercapto-l-propane- sulphonic acid (DMPS) immediately after lewisite exposure prevented effects on glucose, lactate, and lactate dehydrogenase (Kehe et aL. 2001). Incubation of lewisite (60-600 (.imol/L) for 5 minutes with pure hexokinase, a key enzyme in glucose metabolism, was shown to result in inhibition (40-100% inhibited) of hexokinase activity (Flohe et al.. 1996). Decreases in glucose utilization and increased lactate dehydrogenase leakage were noted in isolated perfused porcine skin flaps exposed to lewisite concentrations ranging from 0.07-5.0 mg/mL (King et al.. 1992; Nlonteiro-Riviere et al.. 1990). Several studies have demonstrated the efficacy of chelation therapy (British Anti Lewisite [BAL] or dimercaprol; DMSA; and DMPS) in mitigating the lethal effects of lewisite (Inns and Rice. 1993; Inns et al.. 1990; Aposhian et al. 1984; Aposhian et al.. 1982; Harrison and Ordwav. 1946). Chelating agents have also been shown to be effective against lewisite-induced skin and eye injury in humans and rabbits (Mouret et al.. 2013; Hughes. 1947; Thomson et al.. 1947; Hughes. 1946). The chelating agents may reduce absorption of lewisite and/or may inhibit the interaction of lewisite with key thiol-containing macromolecules. Limited data are available on the toxicity of lewisite degradation products and impurities. Based primarily on lethality data comparisons, reviews have suggested that the impurities known as lewisite-2 and lewisite-3 are of similar or lower toxicity than lewisite-1 (NRC. 2013; Munro et al.. 1999; Lindberg et al. 1997). 30 Lewisite ------- FINAL 09-30-2015 DERIVATION OF PROVISIONAL VALUES Tables 6 and 7 present summaries of the derived noncancer and cancer references values, respectively. Table 6. Summary of Noncancer Reference Values for Lewisite (CASRN 541-25-3) Toxicity Type (units) Species/Sex Critical Effect p-Reference Value POD Method POD UFc Principal Study Subchronic p-RfD (mg/kg-d) Rat/females Mortality 5 x 1(T6 BMDLoi 0.0049 1,000 Sasser et al.. 1996; Sasser et al.. 1989a Chronic p-RfD (mg/kg-d) Rat/females Mortality 5 x 1(T6 BMDLoi 0.0049 1,000 Sasser et al.. 1996; Sasser et al.. 1989a Subchronic p-RfC (mg/m3) NDr Chronic p-RfC (mg/m3) NDr BMDL = benchmark dose lower confidence limit; NDr = not determined. Table 7. Summary of Cancer Reference Values for Lewisite (CASRN 541-25-3) Toxicity Type Species/Sex Tumor Type Cancer Value Principal Study p-OSF NDr p-IUR NDr NDr = not determined DERIVATION OF ORAL REFERENCE DOSES Information on the effects of oral exposure to lewisite is available from a subchronic-duration study in rats (Sasser et al.. 1996; Sasser et aL 1989a). a two-generation reproductive toxicity study of rats (each generation exposed for 23 weeks) (Sasser et al.. 1999; Sasser et al.. 1989b). and developmental toxicity studies in rats and rabbits (Hackett et at., 1992; Hackett et al.. 1987). A study of drinking water exposure (U.S. Army, 1941) is not considered suitable due to the rapid hydrolysis of lewisite in water and the lack of analytical data on the test solutions used. In addition, a dominant lethal toxicity study in male rats (Bucci et al.. 1993) was not considered usable because the exposure duration was only 5 days. All of the potential key studies administered lewisite in sesame oil via intragastric intubation at adjusted daily doses ranging from 0.007-2.5 mg/kg-day. LOAELs were not identified in any of the potential key studies; the only effect levels identified were FELs for mortality (see Table 3A). FELs based on mortality were identified as low as 0.07 mg/kg-day in rabbits exposed during gestation (in the main developmental toxicity study) and in rats in the two-generation reproductive study. In the subchronic-duration study of rats, the FEL was 0.36 mg/kg-day for mortality; in the developmental dose-range-finding study in rats, the FEL for mortality was 2.0 mg/kg-day. In the developmental dose-range-finding study in rabbits, the lowest dose tested (0.5 mg/kg-day) was 31 Lewisite ------- FINAL 09-30-2015 considered a FEL based on gastric hemorrhage in does. High mortality at this dose was attributed entirely to dosing trauma by the study authors, but there is some uncertainty regarding the possible contribution of toxicity to these deaths; deaths attributed to lewisite toxicity due to gastric hemorrhage occurred at the next higher dose of 1.0 mg/kg-day. No deaths were seen in rats exposed to 0.071 or 0.0071 mg/kg-day in the sub chronic-duration study, or in the preliminary and main developmental toxicity studies of rats at doses up to 0.5 and 1.5 mg/kg-day, respectively. Deaths in the subchronic-duration and two-generation reproductive toxicity studies in rats were attributed to severe inflammatory lesions of the respiratory tract; the authors postulated that these lesions resulted from induced regurgitation or accidental deposition of lewisite into the pharynx and subsequent aspiration (Sasser et aL 1999; Sasser et aL 1996; Sasser et al.. 1989a. b). The location of the lesions (posterior nasal passages, larynx, trachea, and large intrapulmonary airways) was consistent with this hypothesis; the terminal airways and parenchyma were less frequently affected. In contrast, deaths in the developmental toxicity studies in both rats and rabbits (Hackett et al. 1992; Hackett et al. 1987) were attributed to inflammatory lesions and hemorrhage in the stomach. However, there is some uncertainty in the attribution of deaths in this study because deaths associated with damage to tissues of the respiratory tract during dosing were apparently automatically categorized as dosing trauma without consideration of possible toxicity. The authors acknowledged that assignment of a "probable cause of death" to individual animals was often difficult and may appear to be arbitrary in some cases. The mode of administration in all of the pertinent studies (Sasser et al.. 1999; Sasser et al.. 1996; Sasser et al.. 1992; Sasser et al.. 1989a. b) was intragastric intubation of a bolus dose of lewisite. This exposure route leads to direct contact of stomach tissues to high concentrations of lewisite. Hackett et al. (1987) suggested that the higher mortality of rabbits (compared to rats) in the developmental toxicity study may have been partly due to the higher test material concentrations (and consequent stronger vesicant effect on the gastric tissues in contact with the administered solution) in the solutions administered to rabbits than in rats. However, comparison of FELs on the basis of measured lewisite concentration in the test solution does not support this hypothesis, as rabbit deaths were seen at a lower measured concentration of lewisite (0.11-0.22 mg/mL) than the concentration that yielded no rat deaths (0.47 mg/mL). The study authors also suggested that use of a 22-inch feeding tube for the rabbit studies, rather than the dosing needle used for the rat studies, may have contributed to the higher number of dosing trauma-related deaths in the rabbit studies. The lowest effect levels in any study were freestanding FELs of 0.07 mg/kg-day in the two-generation study of rats (Sasser et al.. 1999; Sasser et al.. 1989b) and the developmental toxicity study in rabbits (Hackett et al.. 1992; Hackett et al. 1987). However, benchmark dose modelling of the dose-response curves is the favored approach, and this yields several alternative PODs (see Table 8 below). The subchronic study in rats is selected as the principal study for deriving a subchronic p-RfD for lewisite (Hackett et al.. 1992; Hackett et al. 1987). Based on the available toxicity data for lewisite, it is apparent that mortality is a common effect of oral exposure (see Table 3 A). As noted previously, the lowest effect levels in any study of lewisite (see Table 3 A) were freestanding frank effect levels (FELs) of 0.07 mg/kg-day for mortality and stomach and/or 32 Lewisite ------- FINAL 09-30-2015 respiratory tract lesions in the two-generation study of rats (Sasser et al.. 1999; Sasser et al.. 1989b) and the developmental toxicity study in rabbits (Hackett et al. 1992; Hackett et al. 1987). Examining the PODs calculated from the lewisite database as a whole (see Table 8), only one dose lower than the FEL of 0.07 mg/kg-day is available; the sub chronic-duration study of rats (Sasser et al.. 1996; Sasser et al.. 1989b) included a group exposed to 0.007 mg/kg-day in which no deaths or other adverse effects were seen (see Table 3 A). Data sets for mortality from the available toxicity studies for lewisite were selected to derive potential PODs via BMD modeling (see Table 8, and Appendix C for model outputs). The dose-range-finding studies in rats and rabbits (Hackett et al.. 1992; Hackett et al.. 1987) were not considered for sub chronic p- RfD derivation because there are more comprehensive, definitive studies that tested more animals (Hackett et al.. 1992; Hackett et al.. 1987). Confidence in the rabbit data is reduced because of uncertainties in the attribution of mortalities (e.g., dosing trauma) and the short duration of exposure. BMDs and BMDLs from the best fitting models for the selected dichotomous data sets are presented in Table 8. Table 8. Possible Subchronic PODs for Lewisite" Effect Sex/Species Duration NOAEL (mg/kg-d) LOAEL (mg/kg-d) BMDLoi Study Mortality Males/Rat Subchronic 13 wk 0.071 0.36 NF Sasser et al. (1996); Sasser et al. (1989a) Mortality Females/Rat Subchronic 13 wk 0.071 0.36 0.0049 Sasser et al. (1996); Sasser et al. (1989a) Mortality F0 Females/Rat Repro 23 wk 0.076 0.19 0.007 Sasser et al. (1996); Sasser et al. (1989a) Mortality F0 Males/Rat Repro 23 wk 0.18 0.43 0.0155 Sasser et al. (1996); Sasser et al. (1989a) Mortality F1 Males/Rat Repro 23 wk NDr 0.071 0.0069 Sasser et al. (1999); Sasser et al. (1989b) Mortality F1 Females/Rat Repro 23 wk NDr 0.076 0.0052 Sasser et al. (1999); Sasser et al. (1989b) Mortality Females/Rat Developmental Range Finding 10 d 0.5 2.0 Not run Hackett et al. (1987); Hackett et al. (1992) Mortality Females/Rabbit Developmental Range Finding 14 d NDr 0.5 Not run Hackett et al. (1987); Hackett et al. (1992) Mortality Females/Rabbit Developmental Range Finding 14 d NDr 0.07 0.002 Hackett et al. (1987); Hackett et al. (1992) aNDr = not determinable; NF = no fit. Derivation of a Subchronic p-RfD The BMDLoi of 0.0049 mg/kg-day in rats exposed to lewisite in the subchronic study (Sasser et al.. 1996; Sasser et al.. 1989a) was selected as the POD for the subchronic p-RfD derivation. The critical effect for the subchronic p-RfD is mortality due to lesions triggered by 33 Lewisite ------- FINAL 09-30-2015 the test chemical. These lesions reflect portal-of-entry effects. Because available dosimetric scaling approaches (body weight and skin surface area scaling) may not be appropriate for portal-of-entry effects, a dosimetric adjustment of the POD was not used, following EPA guidance (U.S. EPA. 201 lb). The subchronic p-RfD for lewisite was derived as follows: Subchronic p-RfD = BMDLoi ^ UFc = 0.0049 mg/kg-day 1,000 = 5 x 10"6 mg/kg-day Table 9 summarizes the uncertainty factors (UFs) for the subchronic p-RfD for lewisite. Table 9. Uncertainty Factors for the Subchronic p-RfD for Lewisite UF Value Justification UFa 10 A UFa of 10 is applied to account for uncertainty in extrapolating from animals to humans, in the absence of information to assess species differences in toxicokinetic and toxicodynamic characteristics of lewisite and in the absence of a rationale to support use of HED for a POD based on portal-of-entry effects. UFh 10 A UFh of 10 is applied to account for human variability in susceptibility, in the absence of information to assess toxicokinetic and toxicodynamic variability of lewisite in humans. UFd 10 A UFd of 10 is applied to account for deficiencies and uncertainties in the database, especially the lack of identification of a critical effect other than mortality associated with severe stomach and/or respiratory lesions and uncertainty in relative sensitivity of rabbit compared to rat. UFl 1 A UFl of 1 is applied because the POD is a BMDL, not a LOAEL. UFS 1 A UFS of 1 is applied because the principal study is a subchronic study. UFC 1,000 Composite UF = UFA x UFH x UFD x UFL x UFS. BMDL = benchmark dose lower confidence limit; HED = human equivalent dose; LOAEL = lowest-observed- adverse-effect level; POD = point-of-departure. The confidence descriptors for the subchronic p-RfD are explained in Table 10. 34 Lewisite ------- FINAL 09-30-2015 Table 10. Confidence Descriptors for Subchronic p-RfD for Lewisite Confidence Categories Designation Discussion Confidence in study M The principal study included appropriate numbers of animals in exposure and control groups for meaningful statistical analyses and assessment of a wide range of toxicological endpoints (clinical signs, body weight, food consumption, hematology, serum chemistry, urinalysis, selected organ weights, and comprehensive gross and microscopic pathology). The major factor restricting confidence in the principal study is the failure to identify endpoints other than mortality. Confidence in database M Confidence in the database is medium. The database for noncancer effects of lewisite consists of a subchronic study in rats, and reproductive and developmental toxicity studies in rats and rabbits. There are no pertinent human data. Confidence in subchronic p-RfC M The overall confidence in the subchronic p-RfD is medium. M = medium. Derivation of Chronic p-RfD The BMDLoi of 0.0049 mg/kg-day in rats exposed to lewisite in the subchronic study (Sasser et ai, 1996; Sasseretai, 1989a) was also selected as the POD for chronic p-RfD derivation. As with the subchronic p-RfD, a dosimetric adjustment of the POD was not used. A comparison of the potential PODs between the 13-week rat subchronic study and the 23-week rat reproductive study (see Table 8) reveals that there was no change in POD associated with increased duration of exposure. As mortality is the most sensitive endpoint, and the chronic (23-week) is slightly less sensitive than the subchronic (13-week) endpoint, no additional uncertainty is incorporated to account for duration for use of a subchronic study in the chronic RfD derivation. The chronic p-RfD for lewisite is thus derived as follows: Chronic p-RfD = BMDLoi UFc = 0.0049 mg/kg-day 1,000 = 5 x 10"6 mg/kg-day Table 11 summarizes the UFs for the chronic p-RfD for lewisite. 35 Lewisite ------- FINAL 09-30-2015 Table 11. Uncertainty Factors for the Chronic p-RfD for Lewisite UF Value Justification UFa 10 A UFa of 10 is applied to account for uncertainty in extrapolating from animals to humans, in the absence of information to assess species differences in toxicokinetic and toxicodynamic characteristics of lewisite and in the absence of a rationale to support use of HED for a POD based on portal-of-entry effects. UFh 10 A UFh of 10 is applied to account for human variability in susceptibility, in the absence of information to assess toxicokinetic and toxicodynamic variability of lewisite in humans. UFd 10 A UFd of 10 is applied to account for deficiencies and uncertainties in the database, especially the lack of identification of a critical effect other than mortality associated with severe forestomach and/or respiratory lesions and uncertainty in relative sensitivity of rabbit compared to rat. UFl 1 A UFl of 1 is applied because the POD is a BMDL, not a LOAEL. UFS 1 A UFS of 1 is applied because there is no apparent change in POD when exposure duration increases (see Table 8). UFC 1,000 Composite UF = UFA x UFH x UFD x UFL x UFS. BMDL = benchmark dose lower confidence limit; HED = human equivalent dose; LOAEL = lowest-observed- adverse-effect level; POD = point-of-departure. The confidence descriptors for the chronic p-RfD are explained in Table 12. Table 12. Confidence Descriptors for Chronic p-RfD for Lewisite Confidence Categories Designation Discussion Confidence in study M The principal study included appropriate numbers of animals in exposure and control groups for meaningful statistical analyses and assessment of a wide range of toxicological endpoints (clinical signs, body weight, food consumption, hematology, serum chemistry, urinalysis, selected organ weights, and comprehensive gross and microscopic pathology). The major factor restricting confidence in the principal study is the failure to identify endpoints other than mortality Confidence in database M Confidence in the database is medium. The database for noncancer effects of lewisite consists of a subchronic study in rats, and reproductive and developmental toxicity studies in rats and rabbits. There are no pertinent human data. Confidence in subchronic p-RfC M The overall confidence in the chronic p-RfD is medium. M = medium. DERIVATION OF INHALATION REFERENCE CONCENTRATIONS No studies of humans or animals exposed to lewisite via inhalation for >4 hours on a single day have been identified in the available literature, precluding derivation of inhalation RfCs. 36 Lewisite ------- FINAL 09-30-2015 CANCER WEIGHT-OF-EVIDENCE DESCRIPTOR Table 13 identifies the cancer weight-of-evidence (WOE) descriptor for lewisite. Table 13. Cancer WOE Descriptor for Lewisite Possible WOE Descriptor Designation Route of Entry (oral, inhalation, or both) Comments "Carcinogenic to Humans " NS NA There are no human data to support this. "Likely to Be Carcinogenic to Humans " NS NA There are no suitable animal studies to support this. "Suggestive Evidence of Carcinogenic Potential" NS NA There are no suitable animal studies to support this. "Inadequate Information to Assess Carcinogenic Potential" Selected NA The available human study on the potential carcinogenicity of lewisite (Poi et al.. 2011) lacks exposure information. There are no chronic-duration or carcinogenicity studies of animals exposed to lewisite. "Not Likely to Be Carcinogenic to Humans " NS NA There are no suitable animal studies to support this. NA = not applicable; NS = not selected. DERIVATION OF PROVISIONAL CANCER POTENCY VALUES There are no suitable carcinogenicity studies of lewisite in humans or animals; thus, neither cancer provisional oral slope factor (p-OSF) nor provisional inhalation unit risk (p-IUR) values have been derived. 37 Lewisite ------- FINAL 09-30-2015 APPENDIX A. SCEENING VALUES There are no screening values derived. 38 Lewisite ------- FINAL 09-30-2015 APPENDIX B. DATA TABLES Table B-l. Mortality in Male and Female Sprague-Dawley Rats Exposed to Lewisite by Gastric Intubation for 13 Weeks" Dose (mg/kg BW) Endpoint 0 0.0071 0.071 0.36 0.71 1.4 Males 0/10 0/10 0/10 2/10 8/10b 3/10 Females 0/10 0/10 0/10 3/10 6/10 7/10 aSasser et al. (1996): Sasser et al. (1989a) includes one rat that died from anesthetic overdose. 39 Lewisite ------- FINAL 09-30-2015 Table B-2. Selected Hematology and Serum Chemistry Changes in Male and Female Sprague-Dawley Rats Exposed to Lewisite by Gastric Intubation for 13 Weeks" Endpoint Dose (mg/kg BW) 0 0.0071 0.071 0.36 0.71 1.4 Hematology Males, Week 6 Number evaluated 10 10 10 8 8 9 Lymphocytes (X 103/(iL) 12.15 ± 1.18b 12.05 ± 1.28 10.48 ±0.60 11.19 ± 1.48 11.95 ± 1.11 11.99 ±0.91 Platelets (x 1057|iL) 786 ±31 805 ± 39 800 ±21 817 ±48 764 ± 40 829 ±35 Males, Week 13 Number evaluated 10 10 10 8 1 7 Lymphocytes (x 1057|iL) 8.53 ±0.77 7.34 ±0.71 6.02 ±0.39 6.88 ±0.74 5.81 5.52 ±0.71 Platelets (x 1 ()3/|llL) 820 ± 25 916 ±46 849 ±31 1,073 ± 100 802 833 ±32 Females, Week 6 Number evaluated 10 10 10 8 5 4 Lymphocytes (x 107|iL) 8.03 ±0.53 8.27 ±0.69 9.05 ± 0.64 9.92 ± 1.19 8.24 ±0.81 12.03 ±0.60* Platelets (x 1 ()3/|llL) 836 ± 28 762 ± 33 848 ± 26 763 ± 30 780 ± 34 964±171 Females, Week 13 Number evaluated 10 10 10 7 4 3 Lymphocytes (x 107|iL) 5.16 ±0.81 4.61 ±0.66 3.86 ±0.52 5.80 ± 1.10 3.75 ± 1.28 5.03 ±0.74 Platelets (x 1 ()3/|llL) 898 ± 39 831 ±47 966 ± 58 901 ± 94 928 ± 78 1,319 ± 164* Serum chemistry Males, Week 13 Number evaluated 10 10 10 8 2 7 Protein (g/dL) 7.4 ± 0.11 7.4 ±0.13 7.1 ±0.08 7.1 ± 0.14 7.1 ±0.10 6.7 ±0.05* Creatinine (mg/dL) 1.3 ±0.030 1.2 ±0.045 1.1 ±0.034 1.0 ±0.044* 1.0 ±0.200* 0.9 ±0.052* AST (IU) 94 ±6 83 ±3* 82 ±4* 83 ±4* 114 ±38 83 ±4* ALT (IU) 41 ±4.2 33 ± 1.4 31 ± 1.9 32 ±2.9 30 ±3.0 21 ±3.1* Females, Week 13 Number evaluated 10 10 9 7 4 3 Protein (g/dL) 7.9 ±0.18 7.9 ±0.16 7.9 ±0.19 7.8 ±0.09 8.0 ±0.25 7.2 ±0.10 40 Lewisite ------- FINAL 09-30-2015 Table B-2. Selected Hematology and Serum Chemistry Changes in Male and Female Sprague-Dawley Rats Exposed to Lewisite by Gastric Intubation for 13 Weeks" Creatinine (mg/dL) 1.4 ±0.065 1.4 ±0.065 1.3 ±0.056 1.2 ±0.044 1.2 ±0.091 1.2 ±0.067 AST (IU) 121 ±20 98 ±9 107 ± 10 108 ± 15 162 ± 42 96 ±9 ALT (IU) 62 ± 15.6 39 ±7.2 53 ± 10.3 47 ± 10.1 83 ±27.8 29 ±4.8 aSasser et al. (1996): Sasser et al. (1989a) bMean± SE. 'Significantly different from control value by Tukey 's test (p < 0.05), as reported by study authors. ALT = alanine aminotransferase; AST = aspartate aminotransferase Table B-3. Mortality in Adult Male and Female Sprague-Dawley Rats Exposed to Lewisite by Gastric Intubation for 23 Weeksa'b Dose (mg/kg BW) Endpoint 0 0.071-0.076 0.18-0.19 0.43-0.46 F0 parents Males 0/20 0/20 0/20 4/20 Females 1/25 0/25 4/25 11/25 F1 parents Males 0/20 1/20 2/20 6/20 Females 0/25 2/25 5/25 18/25 aSasser et al. (1999): Sasser et al. (1996): Sasser et al. (1989b) bThe authors indicated that one control and one high-dose F0 female died during parturition, and one F1 male and two F1 females of unspecified dose groups died due to dosing error; the remaining deaths were attributed to toxicity. 41 Lewisite ------- FINAL 09-30-2015 Table B-4. Mortality and Other Effects in Dose-Range-Finding Developmental Study of Rats Exposed to Lewisite by Gastric Intubation on GDs 6-15a Endpoint Dose (mg/kg BW) 0 0.5 1.0 2.0 2.5 Mortality due to dosing error 0/10 0/10 1/10 2/10 1/11 Mortality due to lewisite exposure (number deaths/number dosed) 0/10 0/10 0/10 1/10 2/11 Mortality due to lewisite exposure corrected for other causes of death (number of deaths/[number dosed - number dying from other causes]) 0/10 0/10 0/9 1/8 2/10 Pregnant rats among survivors 6/10 9/10 8/9 6/7 5/8 Maternal body weight at GD 20 (g) 382 ± 10.5b 375 ± 11.4 371 ±9.7 339 ±21.9 314 ±32.8* Number of implantations/dam 15 ± 1.2 14 ± 1.0 16 ± 1.1 13 ± 1.7 10 ± 3.1* Implantations/corpora lutea (%) 86 ±6.8 91 ±2.7 81 ±5.4 74 ±8.9 66 ± 18.3 Early resorptions (%) 6.5 ±3.0 13.6 ±7.6 4.3 ± 1.9 5.5 ±3.4 24.0 ± 19.2 Mid gestation resorptions (%) 0 0 0.7 ±0.6 28 ± 16.4* 1.3 ± 1.3 Total resorptions (%) 6.5 ±3.0 13.6 ±7.6 5.0 ±2.1 34.6 ± 16.2 25.3 ± 19.0 Live fetuses/litter 15 ± 1.5 12 ± 1.4 15 ±0.9 8 ±2.4* 8 ± 3.1* Fetal body weight, male (g) 3.29 ±0.08 3.60 ±0.06 3.37 ±0.12 3.47 ±0.12 2.86 ±0.65 Fetal body weight, female (g) 3.22 ±0.12 3.35 ±0.08 3.22 ±0.10 2.98 ±0.38 2.62 ±0.58 aHackett et al. (1992): Hackett et al. (1987) bMean± SE. * Statistically significant (p < 0.05) compared with control by Duncan's multiple range test conducted by study authors. Table B-5. Mortality in Dose-Range-Finding Developmental Study of Rabbits Exposed to Lewisite by Gastric Intubation on GDs 6-19a Endpoint 0 0.5 1.0 1.5 2.0 Mortality due to dosing error 1/8 5/8 1/8 3/8 0/8 Mortality due to lewisite exposure (number deaths/number dosed) 0/8 0/8 6/8 5/8 8/8 Mortality due to lewisite exposure corrected for other causes of death (number of deaths/[number dosed - number dying from other causes]) 0/7 0/3 6/7 5/5 8/8 Pregnant rabbits among survivors 3/7 3/3 1/1 0/0 0/0 aHackett et al. (1992): Hackett et al. (1987) 42 Lewisite ------- FINAL 09-30-2015 Table B-6. Mortality and Other Selected Endpoints in Main Developmental Study of Rabbits Exposed to Lewisite by Gastric Intubation on GDs 6-19a Endpoint Dose (mg/kg body weight) 0 0.07 0.2 0.6 Mortality due to dosing error, stress, handling trauma, or pregnancy complications 1/19 5/18 5/18 3/19 Mortality due to lewisite exposure (number deaths/number dosed) 0/19 2/18 6/18 11/19 Mortality due to lewisite exposure corrected for other causes of death (number of deaths/[number dosed - number dying from other causes]) 0/18 2/13 6/13 11/16 Pregnant rabbits among survivors 9/18 6/11 5/7 3/5 Maternal hematocrit (%) 43 ± 0.9b 42 ±3.0 37 ± 1.7 33 ±0 Implantations/corpora lutea (%) 74.4 ±6.7 84.9 ±7.4 100.8 ±5.0* 57.0 ±7.2 Total resorptions per litter (%) 11.0 ± 5.9 33.0 ± 16.6 23.1 ± 19.5 34.7 ± 19.3 Fetal body weight, male (g) 44.2 ±2.4 46.8 ±8.2 41.4 ±2.6 38.7 ±7.9 Fetal body weight, female (g) 44.1 ±3.0 45.9 ±5.2 41.1 ±2.0 38.6 ±9.3 Crown-rump length, male (mm) 98 ±3.0 97 ±4.3 94 ±2.1 91 ±3.7 Crown-rump length, female (mm) 98 ±3.4 96 ±2.9 93 ±3.0 89 ±7.0 Placental weight, male (g) 5.54 ±0.47 5.12 ± 1.39 4.32 ±0.41 4.80 ±0.70 Placental weight, female (g) 5.30 ±0.46 5.74 ± 1.84 4.58 ±0.56 4.97 ±0.97 Sex ratio (% male) 52 ±5.7 31 ± 16.3 42 ± 11.1 33 ± 17.6 Stunted fetuses (litters with stunted fetuses) 0/63 (0/9) 0/23 (0/4) 2/39 (2/4) 5/16° (2/3* Fetuses (litters) with supernumerary ribs 28/63 (8/9) 6/23 (2/4) 11/39(2/4) 13/16* (3/3) Fetuses (litters) with reduced ossification of the pelvis 0/63 (0/9) 0/23 (0/4) 0/39 (0/4) 3/16* (1/3) aHackett et al. (1992): Hackett et al. (1987) bMean± SE. 'Statistically significant (p < 0.05) difference from control incidence by Fisher's exact test conducted by study authors. 43 Lewisite ------- FINAL 09-30-2015 APPENDIX C. BENCHMARK DOSE MODELING MODELING PROCEDURE FOR DICHOTOMOUS DATA The benchmark dose (BMD) modeling of dichotomous data was conducted with the EPA's Benchmark Dose Software (BMDS) (Version 2.6). For mortality data, all of the dichotomous models (i.e., Gamma, Multistage, Logistic, Log-logistic, Probit, Log-probit, and Weibull models) available within the software were fit using a benchmark response (BMR) of 1% extra risk based on the EPA's Benchmark Dose Technical Guidance Document (U.S. LP A. 2012b). Adequacy of model fit was judged based on the %2 goodness-of-fit /rvalue (p> 0.1), magnitude of scaled residuals in the vicinity of the BMR, and visual inspection of the model fit. Among all models providing adequate fit, the lowest benchmark dose lower confidence limit (BMDL) was selected if the BMDLs estimated from different models varied greater than threefold; otherwise, the BMDL from the model with the lowest Akaike's information criterion (AIC) was selected as a potential point of departure (POD) from which to derive a provisional oral reference dose (p-RfD). For mortality data in male rats treated with lewisite for 13 weeks (Sasser et al.. 1996; Sasser et al.. 1989a\ no model provided adequate fit to the data as shown in Table C-l. Table C-l. Model Data for Mortality from Male Rats Exposed to Lewisite for 13 Weeks" Model Name AIC /j-valuc Specified Effect Risk Type BMD BMDL Gamma 46.6223 0.0333 0.01 Extra risk 0.015172 0.00985486 Logistic 57.4655 0.0004 0.01 Extra risk 0.0563967 0.035462 LogLogistic 47.4174 0.0325 0.01 Extra risk 0.0128316 0.00586856 LogProbit 46.5792 0.0257 0.01 Extra risk 0.0857313 0.0586518 Multistage 46.6223 0.0333 0.01 Extra risk 0.015172 0.00985486 Multistage 46.6223 0.0333 0.01 Extra risk 0.015172 0.00985486 Probit 56.6455 0.0005 0.01 Extra risk 0.0521553 0.0334274 Weibull 46.6223 0.0333 0.01 Extra risk 0.015172 0.00985486 aSasser et al. (1996); Sasser et al. (1989a) AIC = Akaike's information criterion; BMD = benchmark dose; BMDL = benchmark dose lower confidence limit 44 Lewisite ------- FINAL 09-30-2015 For mortality data in female rats treated with lewisite for 13 weeks (Sasser et aL 1996; Sasser et al.. 1989a). all models provided adequate fit by the %2 goodness-of-fit criteria (see Table C-2). Among the models with acceptable fits, there was more than a three-fold variation in BMDL values. Therefore, the model with lowest BMDL was selected (LogLogistic). The plot of the LogLogistic Model is shown in Figure C-l, while the text output from the model run follows. Table C-2. Model Data for Mortality from Female Rats Exposed to Lewisite for 13 Weeks" Model Name AIC /j-valuc Specified Effect Risk Type BMD BMDL Gamma 43.5714 0.8577 0.01 Extra risk 0.0262234 0.00712875 Logistic 50.336 0.1441 0.01 Extra risk 0.0474142 0.0278098 LogLogistic 42.9525 0.9389 0.01 Extra risk 0.0378891 0.00492191 LogProbit 40.6884 0.9838 0.01 Extra risk 0.064487 0.043871 Multistage 41.9246 0.9349 0.01 Extra risk 0.010406 0.00694656 Multistage 41.9246 0.9349 0.01 Extra risk 0.010406 0.00694656 Probit 49.6021 0.1669 0.01 Extra risk 0.0453868 0.0267235 Weibull 43.7222 0.8519 0.01 Extra risk 0.0187729 0.00704865 aSasser et al. (1996); Sasser et al. (1989a) AIC = Akaike's information criterion; BMD = benchmark dose; BMDL = benchmark dose lower confidence limit. 45 Lewisite ------- FINAL 09-30-2015 Log-Logistic Model, with BMR of 1% Extra Risk for the BMD and 0.95 Lower Confidence Limit for the BMDL 14:43 09/15 2015 Figure C-l. LogLogistic Model of Mortality Data from Female Rats Treated with Lewisite for 13 Weeks (Sasser et al., 1996; Sasser et al., 1989a). Text output from the benchmark dose response modeling software for the chosen model for the POD: Logistic Model. (Version: 2.14; Date: 2/28/2013) Input Data File: C:/Users/DPETERSE/Desktop/BMDS260/Data/lnl_Lewisite Rat Female 13 wk_Lnl-BMR01-Restrict.(d) Gnuplot Plotting File: C:/Users/DPETERSE/Desktop/BMDS260/Data/lnl_Lewisite Rat Female 13 wk_Lnl-BMR01-Restrict.pit Mon Sep 28 08:20:30 2015 BMDS Model Run The form of the probability function is: P[response] = background+(1-background)/[1+EXP(-intercept-siope*Log(dose))] Dependent variable = Effect Independent variable = Dose Slope parameter is restricted as slope >= 1 Total number of observations = 6 Total number of records with missing values = 0 Maximum number of iterations = 5 00 Relative Function Convergence has been set to: le-008 Parameter Convergence has been set to: le-008 46 Lewisite ------- FINAL 09-30-2015 User has chosen the log transformed model Default Initial Parameter Values background = 0 intercept = 0.315332 slope = 1 Asymptotic Correlation Matrix of Parameter Estimates ( *** The model parameter(s) -background have been estimated at a boundary point, or have been specified by the user, and do not appear in the correlation matrix ) intercept slope intercept 1 0.55 slope 0.55 1 Parameter Estimates Interval Variable Limit background intercept 1.58696 slope 2 .70718 Estimate 0 0.66621 1.60745 Std. Err. NA 0. 469779 0.561096 NA - Indicates that this parameter has hit a bound implied by some ineguality constraint and thus has no standard error. 95.0% Wald Confidence Lower Conf. Limit Upper Conf. -0.25454 0.507721 Analysis of Deviance Table Model Full model Fitted model Reduced model Log(likelihood) # Param' -18.9474 6 -19.4762 2 -34.7949 1 Deviance Test d.f. 1.05767 31.695 P-value 0.9009 <.0001 AIC: 42.9525 Dose Est. Prob. Goodness of Fit Expected Observed Size Scaled Residual 0.0000 0.0071 0.0710 0.3600 0.7100 1.4000 0.0000 0.0007 0.0270 0.2737 0.5289 0.7698 0.000 0.007 0.270 2 .737 5.289 7.698 0.000 0.000 0.000 3.000 6.000 7.000 10.000 10.000 10.000 10.000 10.000 10.000 0. 000 -0.083 -0.526 0.187 0. 451 -0.524 Chi^2 = 0.80 d.f. = 4 P-value = 0.9389 47 Lewisite ------- FINAL 09-30-2015 Benchmark Dose Computation Specified effect = 0.01 Risk Type = Extra risk Confidence level = 0.95 BMD = 0.0378891 BMDL = 0.00492191 For mortality data in F1 male rats treated with lewisite in a reproductive study (Sasser et ai, 1996; Sasser et ai, 1989a), all models provided adequate fit by the %2 goodness-of-fit criteria (see Table C-3). Among the models with acceptable fits, there was more than a three-fold variation in BMDL values. Therefore, the model with lowest BMDL was selected (LogLogistic). The plot of the LogLogistic Model is shown in Figure C-2, and the text output of the model run follows. Table C-3. Model Data for Mortality from F1 Male Rats Exposed to Lewisite in a Reproductive Study" Model Name AIC />-value Specified Effect Risk Type BMD BMDL Gamma 49.4889 0.9467 0.01 Extra risk 0.0211277 0.00817782 Logistic 50.5704 0.6919 0.01 Extra risk 0.0520948 0.0290168 LogLogistic 49.5109 0.9362 0.01 Extra risk 0.0228707 0.00693045 LogProbit 50.392 0.6482 0.01 Extra risk 0.0687452 0.0444701 Multistage 49.447 0.9659 0.01 Extra risk 0.0177185 0.00820791 Multistage 49.4238 0.9771 0.01 Extra risk 0.0166431 0.00822471 Probit 50.3887 0.7292 0.01 Extra risk 0.0468449 0.02598 Weibull 49.4821 0.9497 0.01 Extra risk 0.020814 0.00818271 aSasser et al. (1996): Sasser et al. (1989a) AIC = Akaike's information criterion; BMD = benchmark dose; BMDL = benchmark dose lower confidence limit. 48 Lewisite ------- FINAL 09-30-2015 Log-Logistic Model, with BMR of 1% Extra Risk for the BMD and 0.95 Lower Confidence Limit for the BMDL dose 14:09 09/15 2015 Figure C-2. LogLogistic Model of Mortality Data from F1 Male Rats Treated with Lewisite in a Reproductive Study (Sasser et al., 1996; Sasser et al., 1989a) Text output from the benchmark dose response modeling software for the chosen model: Logistic Model. (Version: 2.14; Date: 2/28/2013) Input Data File: C:/Users/DPETERSE/Desktop/BMDS260/Data/lnl_Lewisite F1 Males 23 wk_Lnl-BMR01-Restrict.(d) Gnuplot Plotting File: C:/Users/DPETERSE/Desktop/BMDS260/Data/lnl_Lewisite F1 Males 23 wk_Lnl-BMR01-Restrict.pit Fri Sep 25 10:23:01 2015 BMDS Model Run The form of the probability function is: P[response] = background+(1-background)/[1+EXP(-intercept-siope*Log(dose))] Dependent variable = Effect Independent variable = Dose Slope parameter is restricted as slope >= 1 Total number of observations = 4 Total number of records with missing values = 0 Maximum number of iterations = 5 00 Relative Function Convergence has been set to: le-008 Parameter Convergence has been set to: le-008 49 Lewisite ------- FINAL 09-30-2015 User has chosen the log transformed model Default Initial Parameter Values background = 0 intercept = 0.016284 slope = 1.1602 6 Asymptotic Correlation Matrix of Parameter Estimates ( *** The model parameter(s) -background have been estimated at a boundary point, or have been specified by the user, and do not appear in the correlation matrix ) intercept slope intercept 1 0.91 slope 0.91 1 Parameter Estimates Interval Variable Limit background intercept 1.91464 slope 2.47191 Estimate 0 0.167448 1.26064 Std. Err. NA 0.891442 0.618007 NA - Indicates that this parameter has hit a bound implied by some ineguality constraint and thus has no standard error. 95.0% Wald Confidence Lower Conf. Limit Upper Conf. -1.57975 0.0493673 Analysis of Deviance Table Model Full model Fitted model Reduced model Log(likelihood) # Param' -22.6893 4 -22.7555 2 -28.1368 1 Deviance Test d.f. 0.132415 10.8952 P-value 0.9359 0.01231 AIC: 49.5109 Dose Est. Prob. Goodness of Fit Expected Observed Size Scaled Residual 0.0000 0.0710 0.1800 0.4300 0.0000 0.0404 0.1198 0.2898 0.000 0.809 2 .396 5 .795 0.000 1.000 2.000 6.000 20.000 20.000 20.000 20.000 0. 000 0.217 -0.273 0.101 Chi^2 =0.13 d.f. = 2 P-value = 0.93 62 50 Lewisite ------- FINAL 09-30-2015 Benchmark Dose Computation Specified effect = 0.01 Risk Type = Extra risk Confidence level = 0.95 BMD = 0.0228707 BMDL = 0.00693045 For mortality data in F1 female rats treated with lewisite in a reproductive study (Sasser et al.. 1996; Sasser et aL 1989a). all models provided adequate fit by the %2 goodness-of-fit criteria (see Table C-4). Among the models with acceptable fits, there was more than a three-fold variation in BMDL values. Therefore, the model with lowest BMDL was selected (Multistage 3rd Degree). The plot of the Multistage 3rd Degree Model is shown in Figure C-3. Table C-4. Model Data for Mortality from F1 Female Rats Exposed to Lewisite in a Reproductive Study" Model Name AIC />-value Specified Effect Risk Type BMD BMDL Gamma 73.3461 0.6877 0.01 Extra risk 0.0310001 0.00668997 Logistic 74.4998 0.5709 0.01 Extra risk 0.0287477 0.0168832 LogLogistic 73.6338 0.5867 0.01 Extra risk 0.0343067 0.0105866 LogProbit 74.1361 0.4624 0.01 Extra risk 0.0428324 0.0249112 Multistage 72.8949 0.8648 0.01 Extra risk 0.017047 0.00548079 Multistage 72.6466 0.9798 0.01 Extra risk 0.0107259 0.00519058 Probit 74.0341 0.6485 0.01 Extra risk 0.0268908 0.0153729 Weibull 73.0866 0.781 0.01 Extra risk 0.0265364 0.00688619 aSasser et al. (1996); Sasser et al. (1989a) AIC = Akaike's information criterion; BMD = benchmark dose; BMDL = benchmark dose lower confidence limit. 51 Lewisite ------- FINAL 09-30-2015 Multistage Model, with BMR of 1% Extra Risk for the BMD and 0.95 Lower Confidence Limit for the BMDL dose 14:14 09/15 2015 Figure C-3. Multistage Model of Mortality Data from F1 Female Rats Treated with Lewisite in a Reproductive Study (Sasser et al., 1996; Sasser et al., 1989a) Text output from the benchmark dose response modeling software for the chosen model: Multistage Model. (Version: 3.4; Date: 05/02/2014) Input Data File: C:/Users/DPETERSE/Desktop/BMDS260/Data/mst_Lewisite Rat F1 Females 23 wk_mst3-BMR01-Restrict.(d) Gnuplot Plotting File: C:/Users/DPETERSE/Desktop/BMDS260/Data/mst_Lewisite Rat F1 Females 23 wk_mst3-BMR01-Restrict.pit Mon Sep 28 12:47:08 2015 BMDS Model Run The form of the probability function is: P[response] = background + (1-background)*[1-EXP( -betal*dose/sl-beta2*dose/s2-beta3* doseA3)] The parameter betas are restricted to be positive Dependent variable = Effect Independent variable = Dose Total number of observations = 4 Total number of records with missing values = 0 Total number of parameters in model = 4 Total number of specified parameters = 0 Degree of polynomial = 3 52 Lewisite ------- FINAL 09-30-2015 Maximum number of iterations = 5 00 Relative Function Convergence has been set to: le-008 Parameter Convergence has been set to: le-008 Default Initial Parameter Values Background = 0.00547098 Beta(1) = 0.843746 Beta(2) = 0 Beta(3) = 9.03136 Asymptotic Correlation Matrix of Parameter Estimates ( *** The model parameter(s) -Background -Beta(2) have been estimated at a boundary point, or have been specified by the user, and do not appear in the correlation matrix ) Beta(1) Beta (3) Beta (1) 1 -0.67 Beta (3) -0.67 1 Parameter Estimates Interval Variable Limit Background Beta(1) 1.91169 Beta(2) Beta(3) 17.0384 Estimate 0 0.936033 0 8.57316 Std. Err. NA 0. 497796 NA 4.3191 NA - Indicates that this parameter has hit a bound implied by some ineguality constraint and thus has no standard error. 95.0% Wald Confidence Lower Conf. Limit Upper Conf. -0.0396283 0.10788 Analysis of Deviance Table Model Full model Fitted model Reduced model Log(likelihood) -34.3031 -34.3233 -56.2335 # Param's Deviance Test d.f. P-value 4 2 0.0403374 2 0.98 1 43.8608 3 <.0001 AIC: 72.6466 Dose Est. Prob. Goodness of Fit Expected Observed Size Scaled Residual 0.0000 0.0760 0.1900 0.0000 0.0722 0.2107 0.000 1.804 5 .268 0.000 2.000 5.000 25.000 25.000 25.000 0. 000 0.151 -0.132 53 Lewisite ------- FINAL 09-30-2015 0.4600 0.7178 17.944 18.000 25.000 Chi^2 =0.04 d.f. =2 P-value = 0.9798 0. 025 Benchmark Dose Computation Specified effect Risk Type Confidence level BMD BMDL BMDU 0. 01 Extra risk 0. 95 0.0107259 0.00519058 0.0663656 Taken together, (0.00519058, 0.0663656) is a 90 interval for the BMD two-sided confidence For mortality data in F0 male rats treated with lewisite for 23 weeks in a reproductive study (Sasser et aL 1996; Sasser et aL 1989a). all models provided adequate fit by the X2 goodness-of-fit criteria (see Table C-5). Among the models with acceptable fits, there was more than a three-fold variation in BMDL values. Therefore, the model with lowest BMDL was selected (Quantal Linear). The plot of the Quantal Linear Model is shown in Figure C-4, and the text output from the model run follows. Table C-5. Model Data for Mortality from F0 Male Rats Exposed to Lewisite for 23 weeks in a Reproductive Study" Model Name AIC /j-valuc Specified Effect Risk Type BMD BMDL Gamma 22.0184 1 0.01 Extra risk 0.287832 0.0612538 Logistic 24.0161 1 0.01 Extra risk 0.385147 0.090797 LogLogistic 22.0161 1 0.01 Extra risk 0.359789 0.0612721 LogProbit 24.0161 1 0.01 Extra risk 0.330848 0.0859863 Multistage 23.6451 0.8228 0.01 Extra risk 0.101073 0.0243082 Multistage 22.6824 0.9505 0.01 Extra risk 0.157315 0.0322242 Probit 24.0161 1 0.01 Extra risk 0.354374 0.0822947 Weibull 22.0161 1 0.01 Extra risk 0.361966 0.0594456 Quantal Linear 23.0259 0.4577 0.01 Extra risk 0.032012 0.0155141 aSasser et al. (1996); Sasser et al. (1989a) AIC = Akaike's information criterion; BMD = benchmark dose; BMDL = benchmark dose lower confidence limit. 54 Lewisite ------- FINAL 09-30-2015 Quantal Linear Model, with BMR of 1% Extra Risk for the BMD and 0.95 Lower Confidence Limit for the BMDL 10:01 09/25 2015 Figure C-4. Quantal-Linear Model of the 23 Week FO Male Rat Data (Sasser et al., 1996; Sasser et al., 1989a) Text output from the benchmark dose response modeling software for the chosen model: Quantal Linear Model using Weibull Model (Version: 2.16; Date: 2/28/2013) Input Data File: C:/Users/DPETERSE/Desktop/BMDS260/Data/qln_Lewisite Rate FO Males 23wk_Qln-BMR01.(d) Gnuplot Plotting File: C:/Users/DPETERSE/Desktop/BMDS260/Data/qln_Lewisite Rate FO Males 23wk_Qln-BMR01.pit Fri Sep 25 10:01:39 2015 BMDS_Model_Run The form of the probability function is: P[response] = background + (1-background)*[1-EXP(-slope*dose)] Dependent variable = Effect Independent variable = Dose Total number of observations = 4 Total number of records with missing values = 0 Maximum number of iterations = 5 00 Relative Function Convergence has been set to: le-008 Parameter Convergence has been set to: le-008 Default Initial (and Specified) Parameter Values Background = 0.0454545 Slope = 0.491416 Power = 1 Specified 55 Lewisite ------- FINAL 09-30-2015 Asymptotic Correlation Matrix of Parameter Estimates the user, Slope ( *** The model parameter(s) -Background -Power have been estimated at a boundary point, or have been specified by and do not appear in the correlation matrix ) Slope 1 Parameter Estimates Interval Variable Limit Background Slope 0.62186 Estimate 0 0.313956 Std. Err. NA 0.157097 NA - Indicates that this parameter has hit a bound implied by some ineguality constraint and thus has no standard error. 95.0% Wald Confidence Lower Conf. Limit Upper Conf. 0.00605107 Analysis of Deviance Table Model Full model Fitted model Reduced model Log(likelihood) -10.008 -12.0129 -15.8812 # Param's 4 1 1 Deviance Test d.f. 4.00977 11.7463 P-value 0.2604 0.008305 AIC: 26.0259 Dose Est. Prob. Goodness of Fit Expected Observed Size Scaled Residual 0.0000 0.0710 0.1800 0.4300 Chi^2 = 2.60 0.0000 0. 0220 0. 0549 0.1263 d.f. = 3 0.000 0.000 20.000 0.441 0.000 20.000 1.099 0.000 20.000 2.526 4.000 20.000 P-value = 0.4577 0. 000 -0.671 -1.078 0. 992 Benchmark Dose Computation Specified effect = 0.01 Risk Type = Extra risk Confidence level = 0.95 BMD = 0.032012 BMDL = 0.0155141 56 Lewisite ------- FINAL 09-30-2015 For mortality data in F0 female rats treated with lewisite for 23 weeks in a reproductive study (Sasser et aL 1996; Sasser et aL 1989a). all models provided adequate fit by the X2 goodness-of-fit criteria (see Table C-6). Among the models with acceptable fits, there was more than a three-fold variation in BMDL values. Therefore, the model with lowest BMDL was selected (Quantal-Linear). The plot of the Quantal Linear Model is shown in Figure C-5. The text output from the chosen model follows. Table C-6. Model Data for Mortality from F0 Female Rats Exposed to Lewisite in a Reproductive Study" Model Name AIC />-value Specified Effect Risk Type BMD BMDL Gamma 73.1496 0.2001 0.01 Extra risk 0.0668565 0.0131271 Logistic 72.0049 0.3369 0.01 Extra risk 0.0408858 0.0244533 LogLogistic 73.1796 0.2004 0.01 Extra risk 0.062954 0.0150912 LogProbit 72.7821 0.2356 0.01 Extra risk 0.0781818 0.0425468 Multistage 71.3586 0.4105 0.01 Extra risk 0.060283 0.0104785 Multistage 71.3586 0.4105 0.01 Extra risk 0.060283 0.010126 Probit 71.8411 0.3598 0.01 Extra risk 0.0364795 0.0218079 Weibull 73.354 0.1858 0.01 Extra risk 0.057685 0.0116653 Quantal-Linear 74.3328 0.1685 0.01 Extra Risk 0.0107542 0.00701412 aSasser et al. (1996); Sasser et al. (1989a) AIC = Akaike's information criterion; BMD = benchmark dose; BMDL = benchmark dose lower confidence limit. 57 Lewisite ------- FINAL 09-30-2015 Quantal Linear Model, with BMR of 1% Extra Risk for the BMD and 0.95 Lower Confidence Limit for the BMDL 0.2 dose 07:59 09/28 2015 Figure C-5. Quantal-Linear Model of the 23 Week FO Female Rat Data (Sasser et al., 1996; Sasser et al., 1989a) Text output from the benchmark dose response modeling software for the chosen model: Quantal Linear Model using Weibull Model (Version: 2.16; Date: 2/28/2013) Input Data File: C:/Users/DPETERSE/Desktop/BMDS260/Data/qln_Lewisite Rat FO Female 23 wk_Qln-BMR01.(d) Gnuplot Plotting File: C:/Users/DPETERSE/Desktop/BMDS260/Data/qln_Lewisite Rat FO Female 23 wk_Qln-BMR01.pit Mon Sep 28 07:59:57 2015 BMDS Model Run The form of the probability function is: P[response] = background + (1-background)*[1-EXP(-slope*dose)] Dependent variable = Effect Independent variable = Dose Total number of observations = 4 Total number of records with missing values = 0 Maximum number of iterations = 5 00 Relative Function Convergence has been set to: le-008 Parameter Convergence has been set to: le-008 Default Initial (and Specified) Parameter Values Background = 0.0740741 Slope = 1.11049 Power = 1 Specified 58 Lewisite ------- FINAL 09-30-2015 Asymptotic Correlation Matrix of Parameter Estimates ( *** The model parameter(s) -Power have been estimated at a boundary point, or have been specified by the user, and do not appear in the correlation matrix ) Background Slope Background 1 -0.23 Slope -0.23 1 Interval Variable Limit Background 0.0616091 Slope 1.45689 Estimate 0.0210426 0.934553 Parameter Estimates Std. Err. 0.0206976 0.266503 95.0% Wald Confidence Lower Conf. Limit Upper Conf. -0.0195239 0. 412217 Model Full model Fitted model Reduced model AIC: Analysis of Deviance Table Log(likelihood) -32.3386 -35.1664 -43.967 74.3328 # Param's 4 2 1 Deviance Test d.f. 5.65565 23.2568 P-value 0.05914 <.0001 Dose Goodness of Fit Est. Prob. Expected Observed Size Scaled Residual 0.0000 0.0760 0.1900 0.4600 Chi^2 = 3.5 6 0.0210 0.0882 0.1803 0.3631 d.f. = 2 0.526 1.000 25.000 2.204 0.000 25.000 4.508 4.000 25.000 9.078 11.000 25.000 P-value = 0.1685 0. 660 -1.555 -0.264 0.799 Benchmark Dose Computation Specified effect = 0.01 Risk Type = Extra risk Confidence level = 0.95 BMD = 0.0107542 BMDL = 0.00701412 59 Lewisite ------- FINAL 09-30-2015 For mortality data in female rabbits treated with lewisite during gestation in a developmental study (Sasser et al.. 1996; Hackett et al.. 1992; Sasser et al.. 1989a; Hackett et al.. 1987). several models provided adequate fit by the %2 goodness-of-fit criteria (see Table C-7). Among the models with acceptable fits, there was more than a three-fold variation in BMDL values. Therefore, the model with lowest BMDL was selected (Loglogistic). The plot of the Loglogistic Model is shown in Figure C-6. The text output of the model follows. Table C-7. Model Data for Mortality in Female Rabbits Exposed to Lewisite in a Reproductive Study3 Model Name AIC /j-valuc Specified Effect Risk Type BMD BMDL Gamma 51.7504 0.8506 0.01 Extra risk 0.00442511 0.00304123 Logistic 59.8177 0.0701 0.01 Extra risk 0.0171768 0.0109278 LogLogistic 53.1903 0.9013 0.01 Extra risk 0.00451531 0.00162205 LogProbit 52.7548 0.5767 0.01 Extra risk 0.0256647 0.0180007 Multistage 51.7504 0.8506 0.01 Extra risk 0.00442511 0.00304123 Multistage 51.7504 0.8506 0.01 Extra risk 0.00442511 0.00304123 Probit 59.3935 0.079 0.01 Extra risk 0.0158485 0.010443 Weibull 51.7504 0.8506 0.01 Extra risk 0.00442511 0.00304123 Quantal-Linear 51.7504 0.8506 0.01 Extra Risk 0.00442511 0.00304123 aHackett et al. (1992); Hackett et al. (1987) AIC = Akaike's information criterion; BMD = benchmark dose; BMDL = benchmark dose lower confidence limit Log-Logistic Model, with BMR of 1 % Extra Risk for the BMD and O.05 Lower Confidence Limit for the BMDL dose 08:49 09/28 2015 Figure C-6 LogLogistic Model of the 6-19 day Female Rabbit Data (Hackett et al., 1992; Hackett et al., 1987) 60 Lewisite ------- FINAL 09-30-2015 Text output from the benchmark dose response modeling software for the chosen model: Logistic Model. (Version: 2.14; Date: 2/28/2013) Input Data File: C:/Users/DPETERSE/Desktop/BMDS260/Data/lnl_Lewisite Rabbit Female 13 corrected_Lnl-BMR01-Restrict.(d) Gnuplot Plotting File: C:/Users/DPETERSE/Desktop/BMDS260/Data/lnl_Lewisite Rabbit Female 13 corrected_Lnl-BMR01-Restrict.pit Mon Sep 28 08:49:08 2015 BMDS Model Run The form of the probability function is: P[response] = background+(1-background)/[1+EXP(-intercept-siope*Log(dose))] Dependent variable = Effect Independent variable = Dose Slope parameter is restricted as slope >= 1 Total number of observations = 4 Total number of records with missing values = 0 Maximum number of iterations = 5 00 Relative Function Convergence has been set to: le-008 Parameter Convergence has been set to: le-008 User has chosen the log transformed model Default Initial Parameter Values background = 0 intercept = 1.4883 slope = 1.15813 Asymptotic Correlation Matrix of Parameter Estimates ( *** The model parameter(s) -background have been estimated at a boundary point, or have been specified by the user, and do not appear in the correlation matrix ) intercept slope intercept 1 0.8 6 slope 0.86 1 Parameter Estimates 95.0% Wald Confidence Interval Variable Estimate Std. Err. Lower Conf. Limit Upper Conf. Limit background 0 NA intercept 1.45129 0.681821 0.11495 2.78764 61 Lewisite ------- FINAL 09-30-2015 slope 1.11965 0.415855 0.304587 1.93471 NA - Indicates that this parameter has hit a bound implied by some inequality constraint and thus has no standard error. Analysis of Deviance Table Model Full model Fitted model Reduced model Log(likelihood) -24.491 -24.5951 -37.4599 # Param's 4 2 1 Deviance Test d.f. 0.208309 25.9378 P-value 0.9011 <.0001 AIC: 53.1903 Dose Est. Prob. Goodness of Fit Expected Observed Size Scaled Residual 0.0000 0.0700 0.2000 0.6000 0.0000 0.1786 0.4132 0.7067 0.000 2 .321 5 .372 11.307 0.000 2.000 6.000 11.000 18.000 13.000 13.000 16.000 0. 000 -0.233 0.354 -0.169 Chi^2 = 0.21 d.f. = 2 P-value = 0.9013 Benchmark Dose Computation Specified effect = 0.01 Risk Type = Extra risk Confidence level = 0.95 BMD = 0.00451531 BMDL = 0.00162205 62 Lewisite ------- FINAL 09-30-2015 APPENDIX D. 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