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Currently no specific assessment factor for mixtures is employed in the traditional chemical-by-chemical risk assessment [ 5].
Inspired by the Combination Index theorem offered by Chou-Talalay [ 10, 11], here we introduce an operational concept, "Synergism Assessment Factor", for addressing the interaction of drug combination.
The hazard is expressed in quantitative terms by the NOAEL, which is adjusted by an assessment factor for interspecies differences and intraspecies/intersubject variability.
This gap between cystatin C and creatinine was probably a clue about the difference in their predictive power, so we compared the AUC value of each kidney assessment factor for renal dysfunction.
The major difference is the stage at which to extrapolate from experimental data to humans: for each chemical separately (allowing different assessment factors for each chemical) in the case of MOE; or after combining their doses/effects (using thus one assessment factor for all chemicals in the mixture) in the case of the TEF/RFP approach.
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Due to the relative scarcity of long-term toxicity data, assessment factors for extrapolation from relatively short to chronic exposures have an important role in the risk assessment of chemicals.
The intention of using assessment factors for mixture effects was abandoned thirty years ago.
In addition, the use of human data reduces uncertainty since assessment factors for interspecies extrapolation are superfluous when human data are used.
Critics of the U.S. EPA draft assessment factors also argued that assessment factors for external information created the undesirable appearance of a double standard and opened the door to arbitrary agency decisions to exclude otherwise appropriate information received from external sources on the basis of the selective application of assessment factors to information products.
The U.S. EPA draft "Assessment Factors for Evaluating the Quality of Information from External Sources" (U.S. EPA 2002b) noted that the Agency... receives information that is voluntarily submitted to EPA by external sources ('third parties') in hopes of influencing Agency actions.
This indicates that no assessment factor is needed for extrapolation from rats to humans (Nielsen and Wolkoff 2010).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com