Clinical Trial Details
— Status: Withdrawn
Administrative data
NCT number |
NCT04708704 |
Other study ID # |
2000026634 |
Secondary ID |
|
Status |
Withdrawn |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
September 1, 2022 |
Est. completion date |
December 31, 2024 |
Study information
Verified date |
October 2022 |
Source |
Yale University |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Assess and contrast the effect of erythrosine and photodegraded erythrosine on thyroid
function. Thyroid function will be evaluated as serum triiodothyronine (T3), thyroxine (T4),
thyroid stimulating hormone (TSH), T3 resin uptake as well as measures of iodine in serum and
plasma before and after a 14-day repeat administration of these edible dyes in drinking
water. Dose-related increases in serum and plasma-bound iodine are expected for both
erythrosine and photodegraded erythrosine over the 14-day exposure period. TSH is also
expected to increase following repeat administration of erythrosine and photodegraded
erythrosine. Erythrosine and photodegraded erythrosine are expected to induce an equivalent
dose-response increase in thyroid function-related hormone levels.
Description:
Access to safe drinking water is a fundamental human right recognized by the United Nations,
yet achieving universal access in the developing world has been impeded by insufficient water
treatment infrastructure and lack of sustained maintenance. As of 2015, 844 million
individuals in low- and lower-middle-income countries (LMICs) did not have access to improved
drinking water sources and 159 million people directly used untreated surface water,
resulting in the loss of 502 thousand lives annually by diarrheal diseases from
pathogen-contaminated water. Because drinking water inequity and the associated mortality
disproportionally burden the rural developing world, the provision of improved point-of-use
(POU) water treatment technologies that are low cost, simple, and require minimal
infrastructure is crucial for achieving ubiquitous access to safe drinking water.
Several POU water treatment methods are currently applied in LMICs (e.g., solar disinfection
(SODIS), granular media or ceramic pot filtration, chlorination, etc.). Although effective
against bacteria, most perform relatively poorly for virus removal, and all POU technologies
demonstrate lower efficacy in the field due to compromised initial water quality and
operation by relatively unskilled users. While POU technologies have contributed to the
reduction of bacterial and parasitic gastroenteritis, instances of viral gastroenteritis have
not declined, with viral agents observed in 43% of developing world diarrheal cases.
One POU technology in development that has demonstrated potential for inactivating viruses in
drinking water is the application of an edible photosensitizing dye to the water for
disinfection. When exposed to sunlight, the photosensitizing dye produces singlet oxygen, a
reactive oxygen species (ROS) capable of inactivating a wide range of viruses. Erythrosine,
an FDA-approved dye, has proven its ability to disinfect drinking water, achieving 4-log
inactivation of bacteriophage MS2 in under 10 minutes of sunlight exposure. Furthermore, the
dye photobleaches upon exposure to light, and the accompanying distinct color change (e.g.,
from erythrosine red to transparent) occurs at a rate comparable to the disinfection,
providing a safety indication that disinfection has completed, a much-needed function lacking
in other POU technologies. At a total cost of $0.002-0.003 per liter of treated water, it is
cheaper than boiling water in several developing nations and is a financially viable water
disinfection technology.
Erythrosine, also known as FD&C Red No. 3 in the USA, is approved by the FDA for use in
foods, drugs, and cosmetics, with an acceptable daily intake (ADI) of 2.5 mg/kg bw/day. The
concentration recommended by literature for disinfection in drinking water is 5.0 µM
erythrosine, or approximately 4.4 mg/L. With the average American consuming 2.38 L of
drinking water and beverages per day, a daily exposure of 10.5 mg erythrosine/day is
expected. Assuming the total water consumption per day in LMICs matches the American
consumption of 2.38 L, then a 60-kg individual would experience a daily erythrosine dose of
0.17 mg/kg bw/day, well below the established FDA ADI.
The motivation for investigating the human health effects of erythrosine stems from the
unknown behavior of the photodegradation products. While the molecular structure of
erythrosine will change upon oxidation by singlet oxygen, the typical reactions of singlet
oxygen are addition reactions that do not typically lead to cleavage of the molecular
structure. As a result, it is not expected that the absorption rates of erythrosine to change
significantly upon oxidative photobleaching. However, these oxidative products have not been
previously tested for toxicity and should be examined before allowing erythrosine-based water
disinfection to be further developed. Recent tests have attempted to characterize the
photooxidation products of erythrosine but were inconclusive.
Furthermore, previous literature states that ~19% of iodine in the molecular structure of
erythrosine is released to the solution after exposure to light and oxidation by singlet
oxygen. If the previous water treatment parameters are followed (5.0 µM erythrosine, 2.38 L
water/day, 60 kg individual), the daily consumption of iodine released from erythrosine would
be 1.1 mg I/day. The lowest observed adverse effect level (LOAEL) and no-observed adverse
effect level (NOAEL) for iodine are 1.7 mg I/day and 1.0-1.2 mg I/day, resulting in the
tolerable upper intake level (UL) of 1.1 mg I/day. If the literature-reported release of
iodine from erythrosine is correct, then exposures are at the UL for iodine. Due to the poor
absorption of erythrosine by the gastrointestinal tract, it is not expected that the iodine
which remains bound to erythrosine to significantly impact the total iodine consumption.
While it is not expected that erythrosine-based water treatment to result in adverse outcomes
due to exposure to erythrosine photoproducts or overexposure to iodine, it is important to
follow a cautious approach and test for its impact before allowing for the further
development of a technology that would be consumed daily by individuals in the developing
world.