|
CFSAN/Office of Food Additive Safety
March 2004
Date of Submission:
Title of Petition or Notification:
Name and Address of Petitioner or Notifier:
1. Targeted dose levels:
Table # [Heading]
|
test group |
conc. in diet |
dose to animals |
number of males |
number of females |
|---|---|---|---|---|
|
Control |
|
|
|
|
|
Low |
|
|
|
|
|
Mid |
|
|
|
|
|
High |
|
|
|
|
2. Total
number of animals:
3. Duration
of study (including recovery period, if any):
4. Length
of exposure to test substance:
5. Were
animals randomized?
6. Recovery
period:
7. Comments:
Parameter examined:
Table # [Heading]
|
Examined |
Not Examined |
|---|---|
|
|
Feed Intake*
|
*These parameters are recommended in REDBOOK for subchronic toxicity studies.
2. Comments: (e.g., list frequency)
1. Parameter examined:
Table # [Heading]
|
Examined |
Not Examined |
|---|---|
|
|
Appearance*
|
*These parameters are recommended in REDBOOK for subchronic toxicity studies.
**The parameters for neurotoxicity screening may include, but are not limited to, the following:
2. Comments:
1. Fasting duration prior to blood collection:
2. When were the blood samples collected?
3. How were the blood samples drawn?
4. Dose groups and number of animals tested:
5. Parameter examined:
Table # [Heading]
|
Measurement |
Examined |
Not Examined |
|---|---|---|
|
Red Blood Cells |
|
Hematocrit (Hct)*
|
|
White Blood Cells |
|
Basophils*
|
|
Clotting Potential
|
|
Activated Partial-Thromboplastin Time*
|
|
Others |
|
Bone Marrow Cytology* |
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
6. Comments:
1. Fasting duration prior to blood collection:
2. When in the study were the blood samples collected?
3. How were the blood samples drawn?
4. Dose groups and number of animals tested:
5. Parameter examined:
Table # [Heading]
|
Measurement Related To |
Examined |
Not Examined |
|---|---|---|
|
Electrolyte Balance |
|
Calcium* Chloride*,** Phosphorus* Potassium*,** Sodium*,** |
|
Carbohydrate Metabolism |
|
Glucose*,** |
|
Liver Function:
B) Hepatobiliary
|
|
Alanine Aminotransferase
|
|
|
Alkaline Phosphatase (ALP)*,**,
|
|
|
Kidney Function |
|
Creatinine*,**, |
|
Others |
|
Albumin (A)*
|
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
** These parameters should generally be given priority when adequate volumes of blood samples cannot be obtained from test animals.
6. Comments:
1. When
and how were urine samples collected?
2. Dose
groups and number of animals tested:
3. Parameter
examined:
Table # [Heading]
|
Examined |
Not Examined |
|---|---|
|
|
Glucose*, Microscopic evaluation for sediment and presence of blood/blood cells*, pH*, Protein*, Specific Gravity*, Volume* |
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
4. Comments:
1. Organs weighed:
Table # [Heading]
|
Examined |
Not Examined |
|---|---|
|
|
Adrenals*, Brain*, Epididymides*, Heart*, |
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
2. Comments:
1. Organs
were collected from which dose groups?
2. Organs
were examined from which dose groups?
3. How
were the organs/tissues prepared for histopathology observation?
4. Organs/tissues
collected:
Table # [Heading]
|
System |
Examined
|
Not Examined |
|---|---|---|
|
Digestive |
|
Salivary Gland*, Esophagus*, Stomach*, Duodenum*, Jejunum*, Ileum*, Cecum*, Colon*, Rectum*, Gall Bladder*, Liver (middle, left and triangular lobes)*, Pancreas* |
|
Respiratory |
|
Nasal Turbinates*, Trachea*, |
|
Cardiovascular |
|
Aorta*, Heart* |
|
Reticulo- Endothelial/ |
|
Bone Marrow (sternum)*, |
|
Urogenital |
|
Kidneys*, Ovaries*, Urinary Bladder*; As applicable: fallopian tubes*, Corpus Uteri*, Cervix Uteri*, Vagina*, Prostate*, Seminal Vesicle*, Testes* |
|
|
Brain (at least 3 different levels)*, Spinal-Cervical*, |
|
|
Glandular |
|
Adrenals*, Mammary Glands*, Pituitary Glands*, Thyroid/Parathyroid Glands*, Thymus* |
|
Other |
|
Bone (Femur)*, Eyes*, Skeletal Muscle*, Skin*, Epididymis* |
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
5. Comments:
1. Methods of statistical analysis:
Table # [Heading]
|
Methods Of Statistical Analysis |
Parameters Tested |
|---|---|
|
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|
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|
|
2. Comments:
We suggest using an Excel file to calculate the Means and Standard Deviations (SD). (Optional): A sample Excel file (calculation.xls) is provided.
Table # [Heading]
|
Dose Groups |
Targeted Daily Dose |
Targeted Concentration In Feed |
Concentrations Found In Feed |
Standarddeviation |
N*
|
|---|---|---|---|---|---|
|
Low |
|
|
|
|
|
|
Mid |
|
|
|
|
|
|
High |
|
|
|
|
|
* Number of measurements (N)
2. Verified by:
3. Comments:
1. Observations:
Table # [Heading]
|
|
Daily Feed Consumption (gram of feed consumed/day) |
|||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Sex |
Males |
Females |
||||||||||||||
|
Targeted Daily Dose |
0 |
|
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|
0 |
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|
Number of Animals |
|
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||||||||
|
|
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
|
0 week |
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1st week |
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2nd week |
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3rd week |
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4th week |
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5th week |
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6th week |
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7th week |
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8th week |
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9th week |
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10th week |
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11th week |
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12th week |
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13th week |
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X: Mean, SD: Standard Deviation
2. Comments:
1. Observations:
Table # [Heading]
|
|
Body Weights (kg body weight/day) |
|||||||||||||||
|
Sex |
Males |
Females |
||||||||||||||
|
Targeted Daily Dose |
0 |
|
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|
0 |
|
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|
||||||||
|
Number Of Animals |
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||||||||
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X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
|
0 week |
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1st week |
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2nd week |
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3rd week |
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4th week |
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5th week |
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6th week |
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7th week |
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8th week |
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9th week |
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10th week |
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11th week |
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12th week |
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13th week |
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X: Mean, SD: Standard Deviation
2. Comments:
1. Observations:
Table # [Heading]
|
|
Daily Intake Of Test Material (mg/kg body-weight/day)) |
|||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Sex |
Males |
Females |
||||||||||||||
|
Targeted Daily Dose |
0 |
|
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|
0 |
|
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||||||||
|
Number Of Animals |
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||||||||
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X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
|
0 week |
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1st week |
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2nd week |
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3rd week |
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4th week |
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5th week |
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6th week |
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7th week |
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8th week |
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9th week |
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10th week |
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11th week |
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12th week |
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13th week |
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X: Mean, SD: Standard Deviation
2. Comments:
1. Observations:
Table # [Heading]
|
Sex |
Males |
Females |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
Daily Dose |
0 |
|
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|
0 |
|
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|
||
|
Number Of Animals |
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||
|
Red Blood Cells |
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||
|
Hematocrit (Hct) |
% |
|
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|
Hemoglobin Conc. (Hb) |
g/L |
|
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Mean Corp. Hb. (MCH) |
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Mean Corp. Hb. Conc. (MCHC) |
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Mean Corp. Volume (MCV) |
L/L |
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Total Erythrocyte Count (RBC) |
1012/L |
|
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White Blood Cells |
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||
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Basophils |
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Eosinophils |
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Lymphocytes |
109/L |
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Macrophage/ |
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Neutrophils |
109/L |
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Total Leukocytes (WBC) |
109/L |
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Clotting Potential |
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||
|
Activated Partial-Thromboplastin Time |
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Clotting Time |
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Platelet Count |
109/L |
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Prothrombin Time |
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Others |
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||
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Bone marrow cytology |
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Reticulocyte counts |
1012/L |
|
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(Specify a method of statistical analysis): * p<0.05, ** p<0.01
2. Comments:
1. Observations:
Table # [Heading]
|
Sex |
Males |
Females |
|||||||
|
Daily Dose |
0 |
|
|
|
0 |
|
|
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|
|
Number Of Animals |
|
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Electrolyte Balance |
|
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Calcium |
mmol/L |
|
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Chloride |
mmol/L |
|
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Phosphorus |
mmol/L |
|
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Potassium |
mmol/L |
|
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Sodium |
mmol/L |
|
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Carbohydrate Metabolism |
|
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Glucose |
mmol/L |
|
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Liver Function: |
|
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Alanine Amino-transferase |
U/L |
|
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Aspartate Amino-transferase |
U/L |
|
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Glutamate Dehydrogenase |
U/L |
|
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Sorbitol Dehydrogenase |
U/L |
|
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Liver Function: |
|
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Alkaline Phosphatase (ALP) |
U/L |
|
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Gamma-Glutamyl Transferase (GGT) |
U/L |
|
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Total Bile Acids |
mmol/L |
|
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Total Bilirubin |
mmol/L |
|
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5' Nucleotidase |
U/L |
|
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Kidney Function |
|
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Creatinine |
mmol/L |
|
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Urea Nitrogen |
Mg/dL |
|
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Others |
|
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|
Albumin (A) |
g/L |
|
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Globulin (G, calculated) |
g/L |
|
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A/G Ratio |
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Total protein |
g/L |
|
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Total Cholesterol |
mmol/L |
|
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Fasting Triglycerides |
mmol/L |
|
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Cholinesterase |
U/L |
|
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|
(Specify statistical method of analysis): * p<0.05, ** p<0.01
2. Comments:
1. Observations:
Table # [Heading]
|
Sex |
|||||