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CFSAN/Office of Food Additive Safety
April 2005
Date of Submission:
Title of Petition or Notification:
Name and Address of Petitioner or Notifier:
KEYWORDS: 4
1. CAS
name:
2. Other
name(s):
3. CAS
registry number:
4. Molecular
structure: http://www.chemfinder.com7 /
5. Purity:
6. Impurities:
7. Stability:
8. Comments:
1. Feed
2. Water
1. Targeted dose levels:
Table # [Heading]
| test group | conc. in diet(ppm or mg/kg) | dose to animals(mg/kg body-weight/day) | 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:
(e.g. dose selection rationale, dosing differences in males and females, etc.)
1. Parameter examined:
Table # [Heading]
|
examined |
not examined |
|---|---|
| Feed Intake*, Water Intake*, Body Weight*, Body Weight Changes* |
*These parameters are recommended in Toxicological Principles for the Safety of Food Ingredients: Redbook 2000 for chronic toxicity studies.
2. Comments: (e.g., list frequency; control vs. treatment group measurements)
1. Parameter examined:
Table # [Heading]
|
examined |
not examined |
|---|---|
| Appearance*, Abnormal Stool*, Morbidity*, Mortality*, Neurotoxicity Screening (Specify parameters)** |
*These parameters are recommended in Toxicological Principles for the Safety of Food Ingredients: Redbook 2000 for chronic toxicity studies.
**The parameters for neurotoxicity screening may include, but are not limited to, the following:
2. Comments: (e.g., list frequency)
Table # [Heading]
| measurement related to | examined | not examined |
|---|---|---|
| red blood cells | Hematocrit (Hct)*,Hemoglobin Conc. (Hb)*, Mean Corp. Hb. (MCH)*,Mean Corp. Hb. Conc. (MCHC)*, Mean Corp. Volume (MCV)*, Total Erythrocyte Count (RBC)* | |
| white blood cells | Basophils*, Eosinophils*, Lymphocytes*,Macrophage/Monocytes*, Neutrophils*,Total Leukocytes (WBC)* | |
| clotting potential | Activated Partial-Thromboplastin Time*, Clotting Time*, Platelet Count*, Prothrombin Time* | |
| others | Bone Marrow Cytology*,Reticulocyte Counts* |
* These parameters are recommended in Toxicological Principles for the Safety of Food Ingredients: Redbook 2000 for chronic toxicity studies.
6. Comments:
Table # [Heading]
| measurement related to | examined | not examined |
|---|---|---|
|
electrolyte
balance |
Calcium*, Chloride*,**, Phosphorus*, Potassium*,**, Sodium*,** | |
|
carbohydrate
metabolism |
Glucose*,** | |
|
liver
function:
A) hepatocellular (recommend at least 3 out of 5) B) hepatobiliary (recommend at least 3 out of 5) |
Alanine Aminotransferase, (ALT or SGPT) *,**,Aspartate Aminotransferase, (AST or SGOT)*,Glutamate Dehydrogenase*,Sorbitol Dehydrogenase*,Total Bile Acids* | |
| Alkaline Phosphatase (ALP)*,**,Gamma-Glutamyl Transferase (GGT)*,**, Total Bile Acids*,Total Bilirubin*,5' Nucleotidase* | ||
|
kidney
function |
Creatinine*,**, Urea Nitrogen*,** |
|
|
others (acid/base balance, cholinesterases, hormones, lipids, methemoglobin, and proteins) |
Albumin (A)*, Globulin (G, calculated) or A/G Ratio*, Total Cholesterol*, Cholinesterase*, Total Protein*,**,Fasting Triglycerides* |
* These parameters are recommended in Toxicological Principles for the Safety of Food Ingredients: Redbook 2000 for chronic toxicity studies.
** These parameters should generally be given priority when adequate volumes of blood samples cannot be obtained from test animals.
6. Comments
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 Toxicological Principles for the Safety of Food Ingredients: Redbook 2000 for chronic toxicity studies.
4. Comments:
Table # [Heading]
| examined | not examined |
|---|---|
| Adrenals*, Brain*, Epididymides*, Heart*, Kidneys*, Liver*, Spleen*, Testes*, Thyroid/parathyroid*, Thymus*, Ovaries*, Uterus* |
* These parameters are recommended in Toxicological Principles for the Safety of Food Ingredients: Redbook 2000 for chronic toxicity studies.
2. Comments: (e.g., note scheduled or unscheduled necropsy)
1. Organs weighed:
Table # [Heading]
| examined | not examined |
|---|---|
| Adrenals*, Brain*, Epididymides*, Heart*, Kidneys*, Liver*, Spleen*, Testes*, Thyroid/parathyroid*, Thymus*, Ovaries*, Uterus* |
* These parameters are recommended in Toxicological Principles for the Safety of Food Ingredients: Redbook 2000 for chronic toxicity studies.
2. Comments:
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*, Lung (with main-stem bronchi)* | |
|
cardiovascular |
Aorta*, Heart* | |
|
reticulo- endothelial/hematopoietic |
Bone Marrow (sternum)*, Lymph Nodes (1 related to route of administration, and 1 from a distant location)*, Spleen*, Thymus* | |
|
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*, Spinal-Lumbar*, Spinal-Midthoracic*, Sciatic Nerve*, Harderian Gland (if present)* | ||
|
glandular |
Adrenals*, Mammary Glands*, Pituitary Glands*, Thyroid/Parathyroid Glands*, Thymus* | |
|
other |
Bone (Femur)*, Eyes*, Skeletal Muscle*, Skin*, Epididymis* |
* These parameters are recommended in Toxicological Principles for the Safety of Food Ingredients: Redbook 2000 for chronic toxicity studies.
5. Comments:
Table # [Heading]
| methods of statistical analysis | parameters tested |
|---|---|
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(mg/kg body-weight/day) | targeted concentration in feed(ppm or mg/kg) | concentrations found in feed(ppm or mg/kg) | standardDeviation | N* |
|---|---|---|---|---|---|
| LOW | |||||
| MID | |||||
| HIGH |
* Number of measurements (N)
2. Verified by:
1. Observations: We suggest using an Excel file to calculate the Means and Standard Deviations (SD).
Table # [Heading]
| Weekly Summary of daily feed consumption (mean gram of feed consumed/day) | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SEX | males | females | ||||||||||||||
| TARGETED DAILY DOSE(mg/kg body-weight/day) |
0 CONTROL |
0 CONTROL | ||||||||||||||
| NUMBER OF ANIMALS | ||||||||||||||||
| Week | X | SD | X | SD | X | SD | X | SD | X | SD | X | SD | X | SD | X | SD |
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X: Mean, SD: Standard Deviation
2. Comments:
1. Observations: We suggest using an Excel file to calculate the Means and Standard Deviations (SD).
Table # [Heading]
| Weekly Summary of body weights (mean kg body weight/day) | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SEX | males | females | ||||||||||||||
| TARGETED DAILY DOSE(mg/kg body-weight/day) |
0 CONTROL |
0 CONTROL | ||||||||||||||
| NUMBER OF ANIMALS | ||||||||||||||||
| Week | X | SD | X | SD | X | SD | X | SD | X | SD | X | SD | X | SD | X | SD |
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X: Mean, SD: Standard Deviation
2. Comments:
1. Observations: We suggest using an Excel file to calculate the Means and Standard Deviations (SD).
Table # [Heading]
| Weekly Summary of daily intake of test material (mg/kg body-weight/day) | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SEX | males | females | ||||||||||||||
| TARGETED DAILY DOSE(mg/kg body-weight/day) |
0 CONTROL |
0 CONTROL | ||||||||||||||
| NUMBER OF ANIMALS | ||||||||||||||||
| Week | X | SD | X | SD | X | SD | X | SD | X | SD | X | SD | X | SD | X | SD |
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X: Mean, SD: Standard Deviation
2. Comments:
1. Observations:
2. Comments:
1. Observations:
2. Comments:
1. Observations:
(n.b.; include dates and times of blood sampling and alter table as necessary)
Table # [Heading]
| SEX | males | females | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| DAILY DOSE (mg/kg body-weight/day) |
0 CONTROL |
0 CONTROL |
||||||||
| NUMBER OF ANIMALS | ||||||||||
| red blood cells | ||||||||||
|
Hematocrit (Hct) |
% |
|||||||||
|
Hemoglobin Conc. (Hb) |
g/L |
|||||||||
|
Mean Corp. Hb. (MCH) |
||||||||||
|
Mean Corp. Hb. Conc. (MCHC) |
||||||||||
|
Mean Corp. Volume (MCV) |
L/L |
|||||||||
|
Total Erythrocyte Count (RBC) |
1012/L |
|||||||||
| white blood cells | ||||||||||
|
Basophils |
||||||||||
|
Eosinophils |
||||||||||
|
Lymphocytes |
109/L | |||||||||
|
Macrophage/Monocytes |
||||||||||
|
Neutrophils |
109/L | |||||||||
|
Total Leukocytes (WBC) |
109/L | |||||||||
| clotting potential | ||||||||||
|
Activated Partial-Thromboplastin Time |
||||||||||
|
Clotting Time |
||||||||||
|
Platelet Count |
109/L | |||||||||
|
Prothrombin Time |
||||||||||
| others | ||||||||||
|
Bone marrow cytology |
||||||||||
|
Reticulocyte counts |
1012/L | |||||||||
(Specify a method of statistical analysis): * p<0.05, ** p<0.01
2. Comments:
1. Observations: (n.b.; include dates and times of clinical chemistry sampling and alter table as necessary)
Table # [Heading]
| SEX | males | females | |||||||
|---|---|---|---|---|---|---|---|---|---|
| DAILY DOSE (mg/kg body-weight/day) |
0 CONTROL |
0 CONTROL |
|||||||
| NUMBER OF ANIMALS | |||||||||
| electrolyte balance | |||||||||
|
Calcium |
mmol/L | ||||||||
|
Chloride |
mmol/L | ||||||||
|
Phosphorus |
mmol/L | ||||||||
|
Potassium |
mmol/L | ||||||||
|
Sodium |
mmol/L | ||||||||
|
carbohydrate metabolism |
|||||||||
|
Glucose |
mmol/L | ||||||||
|
liver
function: A) hepatocellular |
|||||||||
|
Alanine Amino-transferase (ALT or SGPT) |
U/L | ||||||||
|
Aspartate Amino-transferase (AST or SGOT) |
U/L | ||||||||
|
Glutamate Dehydrogenase |
U/L | ||||||||
|
Sorbitol Dehydrogenase |
U/L | ||||||||
|
liver
function:
B) hepatobiliary |
|||||||||
|
Alkaline Phosphatase (ALP) |
U/L | ||||||||
|
Gamma-Glutamyl Transferase (GGT) |
U/L | ||||||||
|
Total Bile Acids |
mmol/L | ||||||||
|
Total Bilirubin |
mmol/L | ||||||||
|
5' Nucleotidase |
U/L | ||||||||
| kidney function | |||||||||
|
Creatinine |
mmol/L | ||||||||
|
Urea Nitrogen |
mg/dL | ||||||||
| others | |||||||||
|
Albumin (A) |
g/L | ||||||||
|
Globulin (G, calculated) |
g/L | ||||||||
|
A/G Ratio |
|||||||||
|
Total protein |
g/L | ||||||||
|
Total Cholesterol |
mmol/L | ||||||||
|
Fasting Triglycerides |
mmol/L | ||||||||
|
Cholinesterase |
U/L | ||||||||
(Specify statistical method of analysis): * p<0.05, ** p<0.01
2. Comments:
1. Observations: (n.b.; include dates and times of urine sampling and alter table as necessary)
Table # [Heading]
| SEX | males | females | |||||||
|---|---|---|---|---|---|---|---|---|---|
| DAILY DOSE (mg/kg body-weight/day) |
0 CONTROL |
0 CONTROL | |||||||
| NUMBER OF ANIMALS | |||||||||
| Glucose | mmol/L | ||||||||
|
Microscopic evaluation for sediment and presence of
blood/blood cells |
|||||||||
|
pH |
|||||||||
|
Protein |
g/L | ||||||||
|
Specific Gravity |
|||||||||
|
Volume |
L/time | ||||||||
2. Comments:
1. Observations: (n.b.; include dates and times of neurotox screening and alter table as necessary)
Table # [Heading]
| NUMBER OF ANIMALS | ||||||||
|---|---|---|---|---|---|---|---|---|
| SEX | males | females | ||||||
| DAILY DOSE (MG/KG BODY-WEIGHT/DAY) |
0 CONTROL |
0 CONTROL | ||||||
| NUMBER OF ANIMALS EXAMINED | ||||||||
| OBSERVATIONS OF NERVOUS SYSTEM TOXICITY + | ||||||||
|
OBSERVATION |
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|
OBSERVATION |
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|
OBSERVATION |
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| GROSS- AND HISTO-PATHOLOGY CHANGES IN THE NEUROLOGIC SYSTEM # | ||||||||