Antimony Trioxide October 2018
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Report on Carcinogens Monograph on Antimony Trioxide October 2018 Report on Carcinogens Monograph on Antimony Trioxide October 19, 2018 Office of the Report on Carcinogens Division of the National Toxicology Program National Institute of Environmental Health Sciences U.S. Department of Health and Human Services RoC Monograph on Antimony Trioxide 10/19/18 Foreword The National Toxicology Program (NTP) is an interagency program within the Public Health Service (PHS) of the Department of Health and Human Services (HHS) and is headquartered at the National Institute of Environmental Health Sciences of the National Institutes of Health (NIEHS/NIH). Three agencies contribute resources to the program: NIEHS/NIH, the National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention (NIOSH/CDC), and the National Center for Toxicological Research of the Food and Drug Administration (NCTR/FDA). Established in 1978, the NTP is charged with coordinating toxicological testing activities, strengthening the science base in toxicology, developing and validating improved testing methods, and providing information about potentially toxic substances to health regulatory and research agencies, scientific and medical communities, and the public. The Report on Carcinogens (RoC) is prepared in response to Section 301 of the Public Health Service Act as amended. The RoC contains a list of identified substances (i) that either are known to be human carcinogens or are reasonably anticipated to be human carcinogens and (ii) to which a significant number of persons residing in the United States are exposed. The NTP, with assistance from other Federal health and regulatory agencies and nongovernmental institutions, prepares the report for the Secretary, Department of HHS. The most recent RoC, the 14th Edition (2016), is available at http://ntp.niehs.nih.gov/go/roc. Nominations for (1) listing a new substance, (2) reclassifying the listing status for a substance already listed, or (3) removing a substance already listed in the RoC are evaluated in a scientific review process (http://ntp.niehs.nih.gov/go/rocprocess) with multiple opportunities for scientific and public input and using established listing criteria (http://ntp.niehs.nih.gov/go/15209). A list of candidate substances under consideration for listing in (or delisting from) the RoC can be obtained by accessing http://ntp.niehs.nih.gov/go/37893. i RoC Monograph on Antimony Trioxide 10/19/18 Abstract Background and Objective: Antimony trioxide (Sb2O3) is a synergist in flame retardants, a catalyst in polyethylene terephthalate (PET) production, and a material used in various industrial process and consumer goods. Antimony trioxide is a potential public health concern because of occupational exposure and a suggested association with cancer based on animal studies. The National Toxicology Program (NTP) conducted a cancer hazard assessment of Sb2O3 for possible listing in the Report on Carcinogens (RoC), a document mandated by the U.S. Congress to provide information on cancer hazards for people residing in the United States. Methods: Using a systematic review approach, NTP evaluated evidences on human exposure, cancer studies in humans and experimental animals, mechanisms, and other relevant information. Studies identified via a systematic literature search of three databases were selected using pre- defined inclusion and exclusion criteria. Using a structured framework, multiple reviewers assessed human and animal cancer studies for the study quality (potential biases and study sensitivity) and utility of informing Sb2O3 carcinogenicity. NTP also evaluated mechanistic data, using the 10 key characteristics of carcinogens as a guide, and reviewed other relevant data, such as metabolism and toxicokinetic studies. Because Sb2O3 may exert its effects through released trivalent antimony ions, biological effects observed with other compounds containing trivalent antimony were also considered. Conclusions on the level of evidence (e.g., sufficient, limited, or inadequate) of the carcinogencity of antimony trioxide from cancer studies in experimental animals and humans, and the final listing recommendation (not to list, known or reasonably anticipated to be a human carcinogen) were reached by applying the RoC listing criteria to the body of evidence. Results and Discussion: Among over 5,500 references identified, 256 references were cited in the monograph. This included an evaluation of 5 cancer studies in experimental animals and 4 human cancer studies of independent populations. Antimony trioxide administered by inhalation caused lung tumors (i.e., malignant tumors and/or combined benign and malignant tumors) in rats and mice of both sexes and tumors at several other tissue sites (adrenal gland in female rats, skin in male mice, and lymphatic system in female mice). All studies, except one study in which the high dose was too low, reported increase in tumors. In human cancer studies, elevated mortality of lung cancer was seen in all three cohort studies of antimony-exposed smelter workers; however, it is unclear whether the increased risk was due to exposure to antimony or concurrent exposure to other lung carcinogens. An increased risk of stomach cancer was found in one case-control study and only one of two antimony smelter cohort studies. Evidence for antimony-induced biological effects potentially contributing to carcinogenicity include oxidative stress (and consequently oxidative damage) seen in cultured cells treated with Sb2O3 or other antimony compounds, and inhibition of DNA repair seen in cultured cells treated with antimony trichloride. Furthermore, trivalent antimony inhibits cell differentiation in cultured skin cells treated with antimony trichloride or ii RoC Monograph on Antimony Trioxide 10/19/18 antimony potassium tartrate, which also contains trivalent antimony, and consequently increase the potential for tumor development. Conclusions: NTP recommends that antimony trioxide is reasonably anticipated to be a human carcinogen based on sufficient evidence of carcinogenicity from studies in experimental animals and supporting evidence from mechanistic studies. The data available from studies in humans are inadequate to evaluate the relationship between human cancer and exposure specifically to Sb2O3 or antimony in general. iii RoC Monograph on Antimony Trioxide 10/19/18 Collaborators, Contributors and Acknowledgments Collaborators Role Collaborator Affiliation Project lead Responsible for execution and H.S. Amy Wang, PhD NIEHS, DNTP* coordination of project activities, including conception, design, planning, conduct, and technical review of cancer hazard evaluation RoC Evaluation Team Contributed to the coordination of project Ruth M. Lunn, DrPH NIEHS, DNTP* activities, conception, design, conduct, technical review, and interpretation of studies for the cancer hazard evaluation Contributed to design, conduct, technical Sanford C. Garner, PhD ILS review, and interpretation of studies for the Joanne Trgovcich, PhD ICF cancer hazard evaluation Suril S. Mehta, MPH NIEHS, DNTP* Andrew D. Ewens, PhD ILS Alton F. Peters, MS ILS Kristine L. Witt, MS NIEHS, DNTP Contributors Role Contributor Affiliation Provided scientific input or technical Gloria D. Jahnke, DVM NIEHS, DNTP* assistance with the monograph preparation Jui-Hua Hsieh, PhD NIEHS, DNTP Melanie C. Buser, MPH ATSDR Kristina M. Hatlelid, PhD, MPH CPSC Linda M. Sargent, PhD CDC Yin-tak Woo, PhD EPA Whitney D. Arroyave, PhD ILS NIEHS internal review committee Provided critical review of the monograph Stephen S. Ferguson, PhD NIEHS, DNTP Gordon P. Flake†, MD NIEHS, DNTP Michelle J. Hooth, PhD NIEHS, DNTP B. Alex Merrick, PhD (Chair) NIEHS, DNTP Daniel L. Morgan, PhD NIEHS, DNTP Arun K.R. Pandiri, BVSc, MS, PhD NIEHS, DNTP Matthew D. Stout, PhD NIEHS, DNTP Kyla W. Taylor, PhD NIEHS, DNTP Erik J. Tokar, PhD NIEHS, DNTP Suramya Waidyanatha, PhD NIEHS, DNTP iv RoC Monograph on Antimony Trioxide 10/19/18 Acknowledgements Role Participant Affiliation Provided technical input or review Michael A. Babich, PhD CPSC Alison H. Harrill, PhD NIEHS, DNTP Sharon L. Oxendine, PhD EPA Nisha S. Sipes, PhD NIEHS, DNTP Stanley T. Atwood, MS ILS Organized the peer review of the Mary S. Wolfe, PhD NIEHS, DNTP monograph Developed a web-based database Andy J. Shapiro, MS NIEHS, DNTP (formerly) Provided editorial assistance Susan Dakin, PhD Independent consultant Provided administrative assistance Ella J. Darden, BS ILS Tracy L. Saunders, BS ILS Designed and performed literature Jessica A. Geter, MSLS ILS (formerly) searches Lara Handler, MSLS ILS Provided logistical support for the peer- F. Louise Assem, PhD ICF review meeting Susan Blaine, BA ICF Canden N. Byrd, BS ICF Anna N. Stamatogiannakis, BS ICF *Members of the Office of the Report on Carcinogens (ORoC). †Deceased July 30, 2018. ICF = ICF Incorporated, LLC (Support provided through NIEHS Contract Number GS00Q14OADU417/HHSN273201600015U). ILS = Integrated Laboratory Systems, Inc. (Support provided through subcontract number 16EDBO0078 with ICF). DNTP = Division of National Toxicology Program. NIEHS = National Institute of Environmental Health Sciences. v RoC Monograph on Antimony Trioxide 10/19/18 Peer Review Peer review of the Draft RoC Monograph on Antimony Trioxide was conducted by an ad hoc expert panel at a public meeting held on January 24 2018, in the Rodbell Auditorium at the National Institute of Environmental Health Sciences, David P. Rall Building, Research