SACCHARIN Explanation Saccharin was evaluated by the Joint Expert Committee on Food Additives in 1967, 1974, 1978 and 1980 (see Annex I, Refs. 14, 34, 48 and 54). In 1978, the Committee changed the ADI from 5 mg/kg to a temporary ADI of 2.5 mg/kg and withdrew the conditional ADI of 15 mg/kg for dietetic purposes only. The decision to reduce the ADI and to restrict the use of saccharin was based primarily on the results of animal studies which indicated that excessive and long-term ingestion of saccharin was potentially a carcinogenic hazard for humans. At the 1980 meeting the temporary ADI of 2.5 mg/kg was extended pending the completion of current investigations. Further studies have been received and evaluated and the previous monograph has been revised. Saccharin may be produced in various ways, starting from toluene (Remsen & Fahlberg, 1879), phthalic anhydride or phthalic acid (Maumee, 1951) and o-chlorotoluene (Bungard, 1967). Accordingly, a series of different chemical impurities could find their way to the final product. The most widely used methods for the manufacture of saccharin are the Remsen-Fahlberg and the Maumee processes (Munro et al., 1974). Although a universally applicable method for identification of impurities in saccharin regardless of its production method is not available, a recently published procedure (Stavric et al., 1976) for isolation and identification of organic solvent soluble impurities gives very satisfactory results for saccharin produced by the Remsen- Fahlberg method. The major impurity in saccharins produced by this procedure was identified as o-toluene-sulfonamide, one of the intermediate reaction products in the preparation of saccharin (Stavric et al., 1974b). Methods for isolation, identification and quantitation of water-soluble impurities have also been reported (Stavric et al., 1974a; Nelson, 1976). BIOLOGICAL DATA BIOCHEMICAL ASPECTS Saccharin and saccharin salts (sodium, ammonium, calcium) have been in use since the late nineteenth century, salt forms being more soluble but of the same sweetening power as the acid form. Absorption The absorption of ingested saccharin in animals and man occurs rapidly. With a pKa of 2.2, saccharin exists in acidic media predominantly in the unionized form, which is the more readily absorbed form in a number of animal species. Saccharin is more completely absorbed from the guinea-pig (pH 1.4) and rabbit (pH 1.9) stomach, than from the rat's stomach (gastric pH 4.2) (Ball, 1973; Minegishi et al., 1972). In vitro perfusion of rat stomach and small intestine with a solution of saccharin demonstrated considerable absorption from the stomach at pH 1.0 and slow absorption from the small intestine, i.e. less than 9% in 2 hours (Kojima et al., 1966). The gastrointestinal absorption of saccharin appears to be somewhat greater in monkeys than in rats (Pitkin et al., 1971a). In monkeys, and also most probably in man, both gastric acidity and degree of absorption are intermediate between those of the rabbit and guinea-pig on one side, and the rat on the other (Ball, 1973). This also means that the degree of absorption of saccharin could be dependent on food intake which affects the acidity of the gastric contents. Distribution and excretion Lethco & Wallace (1975) studied the distribution of radioactivity in organs and tissues of rats at various time intervals (1, 2, 4, 8, 24, 48 and 72 hours) following a single oral administration of (3-14C)saccharin (50 mg/kg). Traces of radioactivity were found in almost all organs 1 hour after dosing. Fat, brain and spleen contained only minute quantities of 14C. Kidney, urinary bladder and liver contained the highest amount of 14C, which peaked at 4 and 8 hours. In subsequent experiments, rinsing the bladders of the treated rats with 8, 0.5 ml portions of a 0.9% saline solution, they found that a significant portion of the 14C activity was retained by or bound to the bladder tissue (Lethco & Wallace, 1975). In similar experiments, Matthews et al. (1973) found that a single oral dose (1 mg/kg bw) of 14C-saccharin (labelled in the carbonyl group) was rapidly absorbed from the gastrointestinal tract, with peak tissue radioactivity occurring within 15 minutes of dosing. With repeated dosing, within a single day or over a period of several days, there was an accumulation of saccharin in some tissues, particularly in the urinary bladder. The bladders of rats which received daily doses of saccharin contained 19 times as much saccharin as did the bladders of animals which received only a single dose. After the removal of saccharin from the diet, almost complete tissue clearance resulted in 3 days (Matthews et al., 1973). Saccharin crosses the placenta of the rat (West, 1979; Ball et al., 1977) and monkeys (Pitkin et al., 1971a,b) to a limited extent. However, clearance from foetal tissues may be slower than from maternal tissues, particularly the urinary bladder (Ball et al., 1977; Pitkin et al., 1971a,b). Additionally, saccharin has also been found to be excreted in the milk of goats (Carlson et al., 1923) and rats (West, 1979). Recently, Sweatman & Renwick (1980) studied the tissue distribution and pharmacokinetics of saccharin in a series of experiments. When saccharin was included in the diet of rats at a level of 5%, there was a marked diurnal variation in the concentration of saccharin in their plasma. Feeding male rats diets containing 1-10% saccharin for 22 days resulted in tissue concentrations of saccharin in the kidney and bladder which were greater than the concentration of saccharin in the plasma, while the concentrations of saccharin in the liver, lungs, spleen, adrenal, fat and muscle were less than in the plasma. When female rats were fed a diet containing 5% saccharin, the concentration of saccharin in the plasma and organs was greater than for the male rats fed the 5% diet, particularly the concentration in the kidney and urinary bladder. Additionally, the concentrations of saccharin in the plasma and tissues of the male rats fed the diets containing 7.5% or 10% saccharin had a higher than predicted concentration, based on a linear extrapolation from the lower dose levels. The authors attributed this to the animals' reduced ability to eliminate saccharin. A single i.v. dose of [3H] saccharin was given to male and female anaesthetized rats at levels from 1 to 1000 mg/kg. The plasma clearance of the [3H] saccharin was found to be dose dependent with the high dosages resulting in a 60% decrease in clearance. When rats were pretreated with probenecid prior to the i.v. administration of [3H] saccharin at levels of 50-200 mg/kg, a 70% reduction in plasma clearance was observed (Sweatman & Renwick, 1980). These findings were similar to those of Bourgoignie et al. (1980) who used unanaesthetized male and female rats to examine the mechanism by which saccharin was excreted via the kidneys, using a range of [3H] saccharin concentrations from 1 to 80 mg/dl in plasma. The authors concluded that saccharin was excreted by a combination of filtration and tubular excretion without resorption. The latter appeared to be carrier mediated, since competitive inhibition was observed between saccharin and para-aminohippurate. Side-effects During its long history of use, saccharin has been accused of being responsible for a number of adverse effects both in human beings and laboratory animals. Saccharin has been implicated in the development of photosensitive skin eruptions in humans (Taub, 1972), and as a hypoglycaemic agent in animals (Thompson & Mayer, 1959). Low dietary concentrations of saccharin have been shown to alter the concentration of serum lipid components in rats fed chemically-defined diets (Purdom et al., 1973). No effect was noted on human nitrogen balance or protein utilization in man by doses up to 4 g of saccharin/day. Daily doses of 5 g of saccharin reduced albumin absorption and utilization by 0.94% (Neumann, 1926a,b). No abnormal effects on total urinary nitrogen excretion or uric acid output were noted by other investigators after giving saccharin orally (Folin & Herter, 1912). No deleterious effects on blood sugar, kidney function, vitamin utilization, blood coagulation or enzyme activity were detected in man (NAS-NRC, 1955). Metabolism It has long been assumed that saccharin undergoes very little metabolic conversion under normal dietary usage in animals and man (NRC, 1974). Rat Four male and 2 female Sprague-Dawley rats were dosed with 14C-saccharin (40 mg/kg) uniformly labelled in the benzene ring. More than 90% of the radioactivity was recovered in the urine collected for 96 hours after dosing. Only 1 radioactive spot was detected on the TLC of the whole urine, which was identified as saccharin (Byard & Golberg, 1973). Three to 4% of the dose was excreted in the 48-hour collection of faeces as unmetabolized saccharin. During the first 4-8-hour collection period, no more than 0.3% of an oral dose of 14C-saccharin was excreted in the bile as unchanged saccharin. Induction of mixed function oxidase activity in rat liver by treatment with phenobarbitone had no influence on saccharin metabolism (Byard & Golberg, 1973). Kennedy et al. (1972), using albino rats treated with 10 or 20 µC of sodium saccharin labelled with 14C in the carbonyl group, obtained rapid excretion with total recovery from 90.21% to 100.57%. In 3 of the 4 rats the amount recovered in the urine ranged from 82.65% to 96.95%, while in 1 animal it was only 67.91%. However, in this animal a total of 31.34% of the radioactive material appeared in the faeces. Most of the radioactivity excreted was within 24 hours of ingestion. Expired air and tissues contributed very little to the total 14C recovery. The same authors demonstrated the presence of trace amounts of 2 hydrolytic products of saccharin (o-sulfamoylbenzoic acid and ammonium carboxybenzene sulfonate) in urinary extracts. Minegishi et al. (1972) failed to demonstrate the presence of any hydrolytic products in the urine of rats given 35S-saccharin. Urine contained 70% of the administered saccharin and the remainder was in the faeces. Similar results were found for rats given repeated daily doses of saccharin for 4-5 weeks prior to 35S-saccharin administration, indicating the lack of an induction mechanism for saccharin metabolism (Minegishi et al., 1972). Lethco & Wallace (1975) obtained 56-87% of the administered 14C-carbonyl labelled saccharin in urine and 10-40% in the faeces. Ninety-nine per cent. of the urinary 14C was unchanged saccharin, while the remainder was identified as the metabolite o-sulfamoylbenzoic acid. Matthews et al. (1973) also failed to demonstrate the presence of any saccharin metabolites in the urine of rats given multiple low doses of 14C-saccharin (1 mg/kg bw). Mouse, hamster, rabbit, guinea-pig and dog Metabolism and rates of saccharin elimination appear similar in these species. The fate of radioactive saccharin in the rabbit was studied by Ball (1973) and by Lethco & Wallace (1975). Lethco & Wallace (1975) made comparative studies of the metabolism of saccharin in dog, rabbit, guinea-pig and hamster. Similar comparative studies by Byard (1972) were done with mice, golden hamsters, guinea-pigs and dogs, while Minegishi et al. (1972) studied saccharin metabolism in guinea-pigs. These authors concluded that these species do not metabolize saccharin. Ball et al. (1974) failed to detect any metabolites in the urine of female Wistar albino rabbits treated orally with a single dose of 20 mg/kg of (3-14C)saccharin. Seventy-two per cent. of the 14C was excreted in the urine in 24 hours and 15% in the faeces. In 48 hours, 96% of the radioactivity was recovered. Similarly no metabolites were found in urine of rats treated in the same way, which were kept up to 12 months on diets containing 1% or 5% sodium saccharin. Monkey Following a single oral dose of uniformly ring-labelled 14C-saccharin (1 mg/kg and 10 mg/kg) to young female rhesus monkeys, 98% of the radioactivity was excreted in the urine within 96 hours. A very small amount of 2 hydrolytic products of saccharin (o-sulfamoylbenzoic acid and ammonium carboxybenzene sulfonate) were detected in urinary extracts (prepared by ethyl acetate extraction of acidified urines) (Pitkin et al., 1971a). Byard & Golberg (1973) found that 14C-saccharin (40 mg/kg) was not metabolized in male rhesus monkeys. They also demonstrated that "artifactual metabolites" of saccharin were produced if the urine was extracted under acidic conditions. No induction of saccharin metabolism was found in groups of rhesus monkeys receiving sodium saccharin (0, 20, 100 and 500 mg/kg/day) for 79 months. Metabolic studies conducted using radioactive saccharin with these monkeys on several occasions during the test indicated rapid, almost exclusively urinary excretion of unmetabolized saccharin (McChesney et al., 1977). Man Orally administered saccharin appeared in the urine of man within a half hour of dosing and was completely eliminated unchanged in 16-18 hours (Staub & Staehelin, 1936), some 90% being excreted in the urine within 24 hours (Folin & Herter, 1912). Intravenous sodium saccharin in doses of 2.5 g has been used without adverse effects in sick and healthy people to determine circulation time (Fishberg et al., 1933). Studies conducted with human subjects (McChesney & Golberg, 1973) suggested that some degree of saccharin metabolism may occur in man, since oral doses of saccharin could not be recovered quantitatively as saccharin in the urine. Subsequent, more definitive studies, using 14C-labelled saccharin (Byard et al., 1974) demonstrated that the reduced recovery was an artifact thought to be due to the binding of a portion of the urinary saccharin to unidentified urinary constituents. Four men received 500 mg of 14C-saccharin (uniformly labelled in the benzene ring) and excreta was collected at intervals up to 96 hours post-dosing. More than 98% of the 14C was recovered within 48 hours (92.3% in urine, 5.8% in faeces). An additional 0.3% was excreted in the 48-72-hour collection interval. None of the detected saccharin was found to have been metabolized. Consequently, it was concluded that man, like other species, does not metabolize saccharin (Byard et al., 1974). TOXICOLOGICAL STUDIES Special studies on carcinogenicity: other than dietary exposure Saccharin and croton oil together were tested for dermal co-carcinogenicity in mice. Although the treated group showed a greater incidence of skin papillomas compared with the control, the difference was not statistically significant (Salaman & Roe, 1956). Paraffin wax pellets containing saccharin when implanted in the mouse bladder induce a significant incidence of bladder tumours and this was interpreted as demonstrating a co-carcinogenic effect (Allen et al., 1957). Hicks et al. (1973, 1975) reported a rat model system for testing bladder carcinogens wherein each rat was subjected to a pre-test treatment consisting of a single instillation into the bladder of up to 2 mg of methyl-N-nitrosourea (MNU). The test treatment consisted of adding saccharin either to the diet or drinking-water at dosage levels up to 4 g/kg/day. This treatment produced a significantly higher incidence of bladder tumours with a dramatically reduced latent period in the MNU plus saccharin treated rats compared to the untreated control or animals receiving a single instillation of MNU or animals receiving saccharin in their diet or drinking-water without any MNU pretreatment. Although there does not appear to be any correlation between the incidence of bladder tumours or bladder calculi (Hicks et al., 1975), considerably more research is needed to evaluate the biological significance of this model. Additionally, other laboratories have been unable to reproduce these results (Mohr et al., 1978; Green & Rippel, 1979; Green et al., 1980; Hooson et al., 1980). Some of the suggested experimental variables which may have affected the results include the quantity of MNU required to produce a subcarcinogenic or initiator dose (Hooson et al., 1980); the length and/or storage conditions for MNU; purity of MNU; or time lapse between preparation of the MNU solutions and the treatment of the animals (Mohr et al., 1978). Subsequently, Cohen et al. (1978, 1979) developed a similar 2-stage cancer model wherein N[4-(5-nitro-2-furyl)-2-thiazolyl] formamide (FANFT) served as the initiator, being administered in the diet to rats at a level of 0.2%. In their initial studies, FANFT was included in the diet for 6 weeks prior to feeding a saccharin (5%) containing diet or a control diet for 2 weeks prior to the saccharin (5%) diet. Both regimes resulted in a significant increase in the incidence of bladder tumours. In subsequent studies on the rat, the use of FANFT was decreased to 4 (Fukushima et al., 1981) and then 2 weeks (Cohen et al., 1982). The latter study employed various treatment regimes that included FANFT- and saccharin-containing diets, freeze ulceration, and the i.p. injection of cyclophosphamide. The authors found that when bladder mucosal proliferation was increased, following freeze ulceration and cyclophosphamide injection, the bladder appears to be more sensitive to the promoting effects of saccharin. Using an experimental model similar to that of Cohen et al. (1979), Nakanishi et al. (1980) administered N-butyl-N- (4-hydroxybutyl) nitrosamine (BBN) in the drinking-water at a level of 0.001% for 4 weeks, either concurrently with or prior to feeding a diet containing 5% saccharin. In the co-administration study, saccharin enhanced the induction of urinary bladder hyperplasia (simple, papillary or nodular) and papillomas, while the sequential administration only enhanced the induction of papillary or nodular hyperplasia. In vitro promotional assay systems using saccharin have also been reported. Mondal et al. (1978) reported that an initiating but non-transforming dose of 3-methylcholanthrene (3MC) was needed in a C3H/10T1/2 oncogenic transformation system before saccharin produced a significant number of transformed cells. Sivak & Tu (1980) initiated BALB/c3T3 cells with 3MC prior to the addition of saccharin, which was not found to be active as a direct transforming or promoting agent of Type III transformed foci. Special studies on carcinogenicity: feeding studies Mouse Groups of 50 female Swiss mice (9-14 weeks of age) were fed one of the following diets for 18 months: control (2 groups); 10% sucrose; or 5% saccharin. Seven days prior to the start of the study, half of the mice received a single intragastric instillation of 0.2 ml polyethylene glycol while a similar group of mice received an equal amount of polyethylene glycol which contained 50 µg benzo(a) pyrene (BP), to ascertain whether the dietary treatments might be co-carcinogenic with BP. Neither body weight nor survival in any of the treatment groups was different from controls. The administration of BP clearly increased the incidence of neoplasms arising in the forestomach epithelium, but the other dietary treatments had no effect upon this type of neoplasm. Although no neoplasms of the urinary bladder were seen on careful macroscopic examination of all animals, the bladders were not examined microscopically (Roe et al., 1970). Kroes et al. (1977) fed diets containing 0, 0.2 and 0.5% sodium saccharin during a 6-generation study in which 50 male and 50 female mice from the F0, F3b and F6a generations remained on the test diets for 20 months. There were no significant treatment-related tumorigenic effects. In a study performed in duplicate at the Bio-Research Consultants Inc., groups of 25 male and 25 female mice (8 weeks of age) were fed diets containing 0, 10 000 or 50 000 ppm (0, 1 or 5%) saccharin in the diet for 24 months. The incidence of bladder tumours in the various groups was as follows: male controls, 1 of 19; 1% saccharin (males), none of 14 in the first replicate and none of 15 in the second; 5% saccharin (males), 1 of 15 in the first replicate and 2 of 19 in the second. Similar groups of female mice were also tested and none of the female mice developed bladder tumours (Homburger, 1978). Miyaji (1974) fed 50 male and 50 female mice (30 days of age) diets containing 0, 0.2, 1.0 or 5.0% saccharin for 21 months. No adverse treatment-related effects were reported. Hamster Groups of 30 male and 30 female hamsters, 8 weeks of age, received the following levels of saccharin in their drinking-water for the balance of their lifetime: 0, 0.156, 0.312, 0.625 or 1.25%. Average survival time was 50-60 weeks. The overall incidence of tumours in the control animals was 10.1% in 168 controls, while in the saccharin group consisting of 299 animals the incidence was 14.7%. The tumour types were similar in both groups and no urinary tract neoplasms were found in either group (Althoff et al., 1975). Rat (1-generation feeding studies) Fitzhugh et al. (1951) performed the first 2-year saccharin feeding study, where rats received a control diet (7 male and 9 female), or diets containing 1.0% (10 male and 10 female) or 5.0% saccharin (9 male and 9 female). Saccharin had no apparent effect upon mortality, haematology or organ weight (liver, kidney and spleen), but did result in a slight growth depression in the 5% group. The only significant pathological changes observed were in the 5% group where 7 animals (sex unspecified) had lymphosarcomas as well. The urinary bladder was not histologically examined. In another study, groups of 20 male and 20 female rats were fed diets containing 0, 0.005, 0.05, 0.5 or 5.0% saccharin for 2 years. A similar group was also given 1 ml of a 1% aqueous solution of trypan blue s.c. every 2 weeks for 1 year as a positive control. In the 5% group and the trypan blue group, mortality was higher than in the controls. Mortality was lower than for the controls in the 0.005% group. Retardation of growth was observed in the males and females of the 5% group despite greater feed consumption. One female and 4 male rats in the 5% saccharin group had bladder calculi and 1 male had kidney calculi. The female rat with calculi had an extensive transitional cell papilloma of the bladder, while another 5% female without calculi had hyperplasia and papillomatosis. No evidence of nematodes was found in any of these animals (Lessel, 1967). Schmahl (1973) reported spontaneous tumours in rats which were fed diets containing either 0, 100 or 250 mg/kg of sodium saccharin (52 males and 52 females per group). The incidence of Trichosomoides crassicauda was 16% and was associated with a mild cystitis condition, but no bladder tumours were observed in the control or saccharin-treated groups. Miyaji (1974) fed groups of 54 male rats, which were 40 days of age, diets containing 0, 0.2, 1.0 or 5% saccharin for 28 months. No significant tumorigenic effects were observed. In a study conducted by Litton Bionetics, which was performed in duplicate, 26 male and 26 female rats were fed diets containing 0, 1 or 5% saccharin for 24 months (NRC, 1974). The following was reported: "The incidence of all tumors at 24 months in the untreated control groups was 45% and 60% for the males, 80% and 55% for the females in the two replicate experiments. It is important to note the extent of the variation, indicative of the great variability of the assay as well as the high tumor incidence in the controls." However, "a single papilloma of the urinary bladder was found in a female of the high dose saccharin group in the second replicate; no other bladder tumor was found in the study". Homburger (1978) fed groups of 25 male rats (8 weeks of age) diets containing 0, 10 000 or 50 000 ppm (0, 1 or 5%) saccharin for 24 months. The study was performed in duplicate. The incidence of bladder tumours in the various groups was as follows: controls, 1 of 16; 1% saccharin, 1 of 13 in the first replicate and 1 of 15 in the second; 5% saccharin, 1 of 12 in the first replicate and none of 14 in the second. Groups of 54-56 male rats were fed either a control diet or a diet containing 2.5 g of sodium saccharin/kg/day for 28 months. Ten to 16 rats in each group were killed at 12 months. Haematological-blood- biochemistry and pathological examinations were performed on the rats when sacrificed. The internal organs of all rats dying during the study were examined macroscopically. A significant growth depression was observed in the treated group, but no differences in mortality were found. No bladder abnormalities were reported for either control or treated animals (Furuya et al., 1975). Groups of 60 male and 60 female weanling rats were fed diets containing sodium saccharin produced by the Remsen-Fahlberg procedure to provide daily doses of 0, 90, 270, 810 or 2430 mg of saccharin/kg/ day. The study ran for 26 months. Food consumption, body weight and clinical examinations were conducted weekly on all rats. The animals were free of the bladder parasite Trichosomoides crassicauda. One bladder tumour was found in a male control, 1 each in a male and female of the 90 mg/kg group and 2 male animals in the 810 mg/kg group. The tumours were all transitional cell papillomas. Three bladder calculi were observed grossly and 67 animals were found to have bladder calculi small enough to pass through the urethra. The presence of bladder calculi was not associated with the saccharin treatment or with the presence of bladder tumours. Saccharin administration was not accompanied by an increase in tumour incidence, although high doses were associated with reduced body weight in both sexes. No decrease in food consumption was observed. There was a decreased longevity in male rats. Diarrhoea was observed in the highest dose group, but was not accompanied by pathological evidence of enteritis. The haematological parameters measured were not affected by saccharin and saccharin had no effect upon the chemical composition of the urine (Munro et al., 1975). Rat (2-generation studies) Tisdel et al. (1974) fed 20 male and 20 female rats one of the following saccharin-containing diets for approximately 3 months prior to mating: 0, 0.05, 0.5 or 5.0%. The saccharin used in this study was produced by the Remsen-Fahlberg procedure. Following weaning, the F0 generation was killed and the F1 generation was weaned on to their parents' diet, which they consumed until the study was terminated 100 weeks later. Thus, the F1 generation animals were exposed to saccharin and its impurities during gestation, throughout lactation via the dam's milk and for the remainder of their lifetime via the diet. Transitional cell carcinomas of the urinary bladder were found exclusively in the males of the 5.0% group with an incidence rate of 7 animals. One male in the 0.5% group had an epithelial hyperplasia of the urinary bladder which the authors considered to be of a precancerous type. Although no bladder tumours were observed in the female rats, squamous cell carcinomas of the uterus were found in 1 animal in the 0.05% group and 2 animals in the 0.5% and 5.0% groups. In a combination 3-generation chronic feeding study reported by Taylor & Friedman (1974) and Taylor et al. (1980), 10 males and 20 females were fed one of the following diets containing sodium saccharin produced by the Remsen-Fahlberg procedure: 0, 0.01, 0.1, 1.0, 5.0 or 7.5%. These animals were mated after 3 months on test on a 1 male to 2 female basis. The pups were weaned on to their parents' diet and the F0 generation was killed. The study was terminated after 28 months. The reproductive data for this study are presented in another section. The average body weights of treated groups was generally less than that of the control animals; the lowest body weights were observed in the 7.5% group in which the body weight was depressed by 15% compared to the control, but survival was not affected by dietary treatment. The most significant pathological finding was the incidence of bladder tumours, with 1 tumour being found in a male control, 1 in a male on 5% sodium saccharin and a total of 9 fed the 7.5% sodium saccharin diet (7 males and 2 females). All the tumours were diagnosed as transitional cell carcinomas except for 1 tumour in a male in the 7.5% saccharin group which was diagnosed as a transitional cell papilloma. Since the Tisdel et al. (1974) study and the study by Taylor & Friedman (1974) have used saccharin which contained levels of o-TS up to 4660 ppm (0.466%) (Stavric et al., 1973), it was suggested (NRC, 1974) that o-TS might be the chemical responsible for the bladder tumours observed in these 2-generation studies. Arnold et al. (1977, 1980) fed groups of 50 male and 50 female rats one of the following diets for 141 weeks: control, 2.5 mg o-TS/kg/day, 25 mg o-TS/kg/day, 250 mg o-TS/kg/day with 1% NH4Cl in the drinking-water or 5% sodium saccharin. The saccharin used in these experiments was produced by the Maumee procedure containing no detectable amounts of o-TS. After the F0 animals had been on test for 3 months, they were mated on a 1:1 basis. The pups were weaned on to their parents' diet and both generations remained on their respective diets for their lifetime (30-32 months). The reproductive data are presented in another section. The animals were free of the bladder parasite Trichosomoides crassicauda. The only treatment-related effects, other than on lactation index and litter size, were a decreased growth rate in the 2 250 mg/kg o-TS groups and the saccharin group, and the incidence of bladder tumours. This is the first study where F0 male animals receiving sodium saccharin in their diet had a statistically higher incidence of bladder tumours than did the control groups (P <0.05). The authors suggest this observation may be attributable to the length of time on test plus the fact that the animals were only 30 days old when the experiment was initiated. Special epidemiological studies Available reports of epidemiological studies do not provide clear evidence to support or refute an association between bladder cancer in males and the use of saccharin. Evaluation of these studies on saccharin is difficult for many reasons. In some cases, only a very limited number of patients was studied. In others, a distinction between consumption of saccharin and cyclamates was not made, or smoking had a confounding effect. In 2 recently published epidemiological studies in humans, the authors concluded that no association between saccharin consumption and the incidence of bladder cancer was present (Morrison & Buring, 1980; Wynder & Stillman, 1980). Special studies on mutagenicity A review on this subject was recently published (Kramers, 1975). A predominant feature emerging from a review of the literature on saccharin's mutagenic effects is a lack of consistency in the results. As an explanation, it was suggested that the detected effects might be due to a contaminant(s), present in varying amounts in different samples of saccharin (Kramers, 1975). This suggestion is supported by the findings of Stoltz et al. (1977) who reported mutagenic activity with the Ames Salmonella assay for some, but not all, samples of organic solvent extracts of various saccharin samples produced by the Maumee and Remsen-Fahlberg methods. The US Technology Assessment panel (OTA, 1977) commissioned a battery of 12 short-term tests, of which 10 had been completed prior to the publication of the panel's report. The sister chromatid exchange studies conducted with human lymphocytes, the mouse lymphoma forward mutation test and the Chinese hamster ovary cell test for chromosome aberration all gave positive results, while negative tests included the Ames Salmonella test, mitotic recombination in yeast, unscheduled DNA synthesis, the Pol A test, Drosophila sex-linked recessive lethal test, in vitro transformation test and the induction of plasminogen activator. Subsequently, Mondal et al. (1978) reported that saccharin did not produce oncogenic transformation of mouse embryo fibroblasts (C3H/10T1/2) unless an initiating dose of 3-methylcholanthrene was used. Batzinger et al. (1977) orally administered saccharins of differing degrees of purity to mice and then collected the urine to test for mutagenic activity in the Ames Salmonella test. By modifying the growth and selection medium, they were able to detect mutagenic activity for all but the most purified samples of saccharin. When yeast was grown in a medium containing saccharin of different purities, Moore & Schmick (1979) found an inverse relationship between the incidence of mitotic crossing-over and the purity of the saccharin sample. The results of Saxholm et al. (1979) with the mouse embryo fibroblast test (C3H/10T1/2) and sister chromatid exchange, as well as those by Abe & Sasaki (1977) and Wolfe & Rodin (1978), are somewhat divergent, possibly due to use of saccharins with different purities or the use of different endpoints. Simmon et al. (1982) reported on the results of the two independent laboratories which attempted to confirm previous short-term positive studies when saccharin was introduced into the medium of the following tests: mouse lymphoma, human lymphocyte SCE, the CHO cytogenetic analyses as well as the standard and modified Salmonella test. As the findings from both laboratories were not always similar, the authors concluded that the differences observed were attributable in part to intrinsic test system variability generated at high concentrations of a relatively non-toxic material. Various impurities found in Remsen-Fahlberg-produced saccharin have been tested in the following systems: ortho- and para- toluenesulfonamide were negative with Drosophila (Kramers, 1977) and in a modified Salmonella assay (Poncelet et al., 1979, 1980) but weakly mutagenic in the Ames Salmonella test and the Basc test in Drosophila melanogaster (Eckhardt et al., 1980), while ortho- and para-sulfamoylbenzoic acid were ineffective mutagens in the Ames Salmonella assay, the Basc test in Drosophila melanogaster and micronucleus test in mice (Eckhardt et al., 1980). Such impurities as o-sulfobenzoic acid, ammonium o-sulfobenzate, p-sulfobenzoic acid and p-sulfamoylbenzoic acid were also negative in a modified Salmonella assay (Poncelet et al., 1979, 1980). Special studies on pharmacokinetics Following the oral administration of 14C-saccharin to pregnant rats on the twenty-first day of gestation, Ball et al. (1977) found that 0.6% of the administered dose was detectable in the foetuses and radioactivity in their urinary bladder was 10 times higher than in other tissues 26 hours post-dosing. The pharmacokinetic properties of saccharin in man have recently been reported. Colburn et al. (1981) had a man (who had not previously consumed saccharin on a routine basis) and a woman (who was a regular user of saccharin) ingest a single 100 mg dose of saccharin, following which blood and urine samples were obtained during the next 24 hours. The authors calculated the half-life and apparent volume of distribution to be 1.2 and 6.6 hours, and 41.6 and 13.1 litres, respectively. While no measurable saccharin was detected in the plasma of either subject prior to the test, the female subject was found to be excreting 17.4 µg/hour during the 12 hours prior to the start of the test. The female subject had chronically used saccharin up to 10 days prior to the test period. The authors proposed that a deep peripheral second compartment existed in the female subject due to her chronic use of saccharin. Sweatman et al. (1981) administered saccharin to 3 adult male subjects and periodically determined the concentration of saccharin during the next 400 minutes after oral (2 g) and i.v. (10 mg/kg) doses. The authors found that their i.v. data fitted a two-compartment open model with the half-life of the second phase being 70 minutes. Following oral ingestion, the decrease in plasma saccharin levels was more complex; however, if the same dose of saccharin was given after a meal, the peak plasma levels were lower and were delayed by 100-120 minutes versus the i.v. dosing situation. After 96 hours, 90% of the latter dose had been recovered in the urine and 8% in the faeces. Special studies on reproduction Mouse Groups of 21 pregnant mice received 40-168 mg/kg bw per day of saccharin through the production of 3 successive litters without deleterious effect on growth, litter number and pups per litter when compared with controls fed sugar. No histological studies were performed (Lehmann, 1929). A 6-generation study was carried out by Kroes et al. (1977) in which mice were fed diets containing 0, 0.2 or 0.5% sodium saccharin during the entire study. The criteria of reproductive performance were: fertility index; viability index (percentage survival at 5 days); lactation index (percentage survival at 21 days); body weight at 21 days; and number of infertile males. No consistent changes in any of these parameters over the 6 generations were observed. Although body weight at 21 days was suppressed in some groups of some generations, this response was not consistently observed in later generations at the same treatment level. Additionally, there was no evidence of any teratogenic effects. Rat One aspect of a long-term feeding study with saccharin performed at the Wisconsin Alumni Research Foundation (WARF) reported by Tisdel et al., 1974 involved the mating of rats from the same treatment groups, on a 1:1 basis, after they had received one of the following diets for 14 weeks: 0, 0.05, 0.5 or 5% saccharin, produced by the Remsen-Fahlberg procedure. The mothers continued to receive the test diets during mating, gestation and lactation. "Pregnant animals were isolated about 5 days before parturition and allowed to deliver and care for their young until the litters were weaned 21 days after birth. Survival of progeny was recorded through day 28." "Data recorded for each litter included: identification of parents, number of pups born (total, alive and dead); number of survivors 4 and 21 days after birth; and weight of survivors through 28 days of age. The results showed no effect of saccharin on mating efficiency, survival of pups born alive, or weight gain of surviving offspring. All groups fed saccharin had smaller average litter sizes and reduced average percent live births, when compared to controls, but neither response appeared to be related to dose level." "The differences were not statistically analyzed, but examination of data on individual animals shows that the lower average values are attributable to extremely poor performance of one or two animals in each group, not to a general reduction. The apparent effect is therefore probably within the customary experimental variability." "Surviving and dead fetuses were examined for gross abnormalities; no evidence of teratogenicity was found" (NAS, 1974). A 3-generation reproductive study (Taylor & Friedman, 1974; Taylor et al., 1980) was carried out in which rats were continuously fed diets containing 0, 0.01, 0.1, 1.0, 5.0 and 7.5% sodium saccharin produced by the Remsen-Fahlberg procedure. In the F1a animals, the male offspring of dams receiving 5.0% or 7.5% saccharin weighed 12-20% less than controls and the females weighed 17-29% less than control animals, but both sexes were able to overcome some of these initial weight differences during a chronic feeding portion of the study. In the F2a litters, the fertility and viability indices were unaffected by treatment, but average litter size was slightly decreased for dams receiving 5.0% or 7.5% sodium saccharin; the survival index, weaning index and body weights of these pups were below controls. In the F2b litters, only body weight at weaning was lower than controls for these same two groups. During a 2-generation lifetime feeding study by Arnold et al. (1977, 1980), 50 male and 50 female rats were fed one of the following diets (tap water ad libitum except where noted): control; 2.5 mg/kg ortho-toluene-sulfonamide (o-TS); 25 mg/kg o-TS; 250 mg/kg o-TS plus drinking-water containing 1% NH4Cl; or 5% sodium saccharin produced by the Maumee procedure, which contained no detectable o-TS. o-TS is a major impurity in Remsen-Fahlberg-produced saccharin, and o-TS is a known inhibitor of the enzyme carbonic anhydrase (Miller et al., 1956). The animals were mated on a 1:1 basis after 3 months on test. The only treatment-related effect on reproduction was a significant depression in the lactation index in the 2.5 mg/kg o-TS group and a significant decrease in the litter size of the 250 mg/kg o-TS group. There were no treatment-related effects upon fertility, gestation or viability indices or any effect upon the body weight of pups or the number of males in the litter. Special studies on teratology Teratogenic studies with mice (Tanaka, 1964; Lorke, 1969; Kroes et al., 1977), rats (Bough et al., 1967; Fritz & Hess, 1968; Lessel, 1970; Taylor & Friedman, 1974) and rabbits (Bough et al., 1967; Klotzsche, 1969; Lessel, 1970; Tanaka et al., 1973) have been negative to date. Lederer & Pottier-Arnould (1973) fed pregnant female rats diets containing 0.3% saccharin throughout gestation. The pups from saccharin-treated dams had a 37.9% incidence of lens anomalies versus 12.4% incidence for the control animals. Acute toxicity LD50 Animal Route (mg/kg bw) Reference Mouse Oral 17 500 Taylor et al., 1968 i.p. 6 300 Taylor et al., 1968 17 500 Tanaka, 1964 Hamster Oral (F) 8 700 (8-day LD50 value) (M) 7 400 Althoff et al., 1975 Rat Oral 14 200-17 000 Taylor et al., 1968 i.p. 7 100 Taylor et al., 1968 Rabbit Oral 5 000-8 000 (LD) Folin & Herter, 1912 Dog i.v. 2 500 (LD) Becht, 1920 Short-term studies Rat Kennedy et al. (1976) fed groups of 10 male and female weanling rats one of the following diets for 13 weeks: (1) control; (2) 20 000 ppm (2%) sodium saccharin; (3) 20 000 ppm (2%) o-sulfamoylbenzoic acid (o-SABA); (4) 20 000 ppm (2%) ammonium o-carboxybenzene sulfonate (A-o-CBS); (5) 100 ppm (0.01%) sodium saccharin plus 450 ppm (0.045%) o-SABA and 450 ppm (0.045%) A-o-CBS; (6) 500 ppm (0.05%) sodium saccharin plus 2250 ppm (0.225%) o-SABA and 2250 ppm (0.225%) A-o-CBS; (7) 2000 ppm (0.2%) sodium saccharin plus 9000 ppm (0.9%) of o-SABA and 9000 ppm (0.9%) A-o-CBS. (A-o-CBS and o-SABA are hydrolytic products of saccharin.) Weight gain and feed consumption were determined on a weekly basis and behavioural changes were looked for. Haematological studies (RBC, total and differential WBC, Hgb and haematocrit), clinical blood chemistry (glucose, BUN, serum alkaline phosphatase and SGPT) and urinalysis (albumin, glucose, microscopic elements, pH and specific gravity) were conducted prior to starting the study, at the midpoint and upon termination. Every animal was autopsied and examined histologically. The liver, kidney, spleen and gonad weights were determined and organ/body weight ratios calculated. No consistent or significant changes in any parameter were observed. Groups of 14 male and 14 female rats (75-100 g) received either a control diet or one containing 0.5% sodium saccharin for 38 days. The inclusion of saccharin in the diet depressed body weight gains and feed intake, but efficiency of feed utilization was similar to controls. Although diarrhoea was a common observation, no overt behavioural changes were apparent. Gross and microscopic inflammatory and hydropic changes in the liver and kidneys of the saccharin-treated group were reported, but the extent of these changes was not described (Taylor et al., 1968). Groups of 25 rats (5 males and 20 females) were fed diets containing 0, 1.0 or 10% saccharin for 36 weeks. Similar groups of rats were fed diets containing 0, 0.1 or 1.0% saccharin for a lifetime. One female from each group in the second experiment was mated and 4 progeny from each litter were fed a diet containing the same amount of saccharin as their parents for a lifetime. Growth was retarded at the 10% level, but no adverse effects were seen at the lower levels upon histological examination of the major organs (Fantus & Hektoen, 1923). In a 4-week feeding study, Anderson (1979) fed rats diets containing 0, 1, 3, 5 or 7.5% sodium saccharin and observed: (1) transient diarrhoea in the 5% and 7.5% group; (2) a dose-dependent decrease in urinary ammonia; and (3) a decreased faecal odour. These observations led the author to hypothesize that diets with high levels of sodium saccharin may lead to changes in the intestinal microflora. To test the hypothesis, Anderson & Kirkland (1980) fed rats diets containing 0 or 7.5% saccharin for 10 days. The saccharin diet produced an increased weight of the caecal tissues and contents; did not decrease the total number of anaerobic microbes, but did result in the inability to detect a specific anaerobic microbe; increased the number of aerobic microbes; and reduced the amount of ammonia produced from urea by Proteus vulgaris. Dog In addition to the rat study cited above, Kennedy et al. (1976) also fed the same 7 diets to groups of 3 male and 3 female beagle dogs for 16 weeks. In addition to the parameters indicated for the rats, the authors also determined SGOT and protein-bound iodine in this study. No significant treatment-related effects were observed. One male and 1 female dog received 150 mg/day of saccharin in their food for 18 months without any adverse effects on weight, fertility or other bodily functions. Their pups developed normally (Bonjean, 1922). When given doses of 175-350 mg/day for 100 days, dogs developed hyperaemia of the lungs, liver, myocardium and kidney, as well as cloudy swelling of renal glomeruli and convoluted tubules (de Nito, 1936). Groups of 4 dogs (sex unspecified) received 6 daily doses of sodium saccharin (0.065 g/kg dissolved in water) for 11 months via intragastric intubation. The dogs were observed daily for survival, general physical condition, behaviour, food and water consumption, and character and frequency of excreta. The animals were weighed weekly. Laboratory tests included renal and hepatic function tests which were performed at 0, 1, 2, 4, 9 and 11 months on test. During the second half of the study, 1 dog receiving saccharin became anorexic and eventually died, but no abnormal organ pathology was observed. After 10 months of test, all saccharin-treated dogs developed soft, poorly- formed stools without frank diarrhoea. Body weight, haemoglobin, total leucocyte count, non-protein nitrogen and phenosulfonephthalein retention were within normal limits and total erythrocyte count, bilirubin and urinary analyses were also unaffected. Gross and histological appearance of viscera were normal in the test group (Taylor et al., 1968). Monkey McChesney et al. (1977) reported no pathological or any other significant changes in growth, haematology or clinical chemistry in groups of 3 rhesus monkeys of each sex receiving 0 (control) or 500 mg of saccharin/kg/day and in groups of 2 male and 2 female monkeys receiving 20 or 100 mg of saccharin/kg/day 6 days per week for 79 months. One animal in each experimental group and 2 control animals died before termination of the experiment. None of the deaths were attributable to the treatment. Metabolic studies conducted on several occasions during the test indicated a rapid, almost exclusively urinary excretion of unmetabolized saccharin. OBSERVATIONS IN MAN Doses of 1.5-3.0 g of saccharin/day in man caused a persistent sweet metallic taste (Carlson et al., 1923). Single doses of 5-10 g have been tolerated and even 100 g orally is said to have caused no harm. A few non-fatal cases of acute poisoning and allergic response have been reported (NAS-NRC, 1955). During high-intake balance studies, 3 male volunteers received 0.3 g of sodium saccharin/day for a maximum of 4 months and 1-1.5 g of sodium saccharin/day for a maximum of 2 months. All of the administered saccharin was fully accounted for. Seven volunteers received 0.15-0.3 g of saccharin/day for 1.3 months without adverse effects except for an increased urine output (Folin & Herter, 1912). Doses of 90-180 mg of saccharin/day were well tolerated by children aged 10-12 years for 13 months (Jessen, 1890). Diabetic patients have received as much as 4.8 g daily for 5 months without adverse effect (Neumann, 1926a,b) and 0.4-0.5 g/day for 15-24 years without any adverse effects (National Academy of Sciences - National Research Council, 1955). The principal adverse effects that have been reported from saccharin are as follows: (1) Mild digestive disturbances were noted by Herter & Folin (1911) in volunteers ingesting doses of 1-1.5 g of saccharin/day. Loose stools were observed in clinical studies when subjects consumed cyclamates plus saccharin in doses of about 7 g/day (Berryman et al., 1968). At these dosages, the saccharin intake was about 0.7 g/day. Evidence from other studies indicates that cyclamate alone at intakes of 5-7 g/day may cause loose stools. (2) Allergic responses, principally skin reactions of a phototoxic or photosensitivity type occur but appear to be of low incidence and, in some cases, may have been due to cyclamate being ingested at the same time (Fujita et al., 1965; Stritzler & Samuels, 1956; Kingsley, 1966; Boros, 1965; Meisel, 1952; Gordon, 1972; Taub, 1972). Some authors have suggested that there may be a cross-sensitivity to sulfonylureas and similar drugs known to cause phototoxic skin reactions. Contact dermatitis and photosensitivity or phototoxic reactions have not been noted in persons occupationally exposed to saccharin (NAS, 1974). Comments The present Committee reviewed further findings from epidemiological studies that did not reveal any evidence for a saccharin-associated increase in bladder tumours. Final assessment of the epidemiological aspect of saccharin consumption will be made following the review of a large-scale study, now in progress but nearing completion. The Committee decided to extend the temporary ADI of 0-2.5 mg/kg for saccharin to 1984 and required the submission of the results of a long-term feeding study in rats and epidemiological studies. EVALUATION Estimate of temporary acceptable daily intake for man 0-2.5 mg/kg bw. FURTHER WORK OR INFORMATION Required by 1984 (1) Submission of the results of a long-term feeding study, currently in progress. (2) Submission of the results of the epidemiological study, currently in progress. REFERENCES Abe, S. & Sasaki (1977) Chromosome aberrations and sister chromatid exchanges in Chinese hamster cells exposed to various chemicals, J. natl. Cancer Inst., 58, 1645 Allen, M. J. et al. (1957) Cancer of the urinary bladder induced in mice with metabolites of aromatic amines and tryptophan, Br. J. 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See Also: Toxicological Abbreviations Saccharin (FAO Nutrition Meetings Report Series 44a) Saccharin (FAO Nutrition Meetings Report Series 48a) SACCHARIN (JECFA Evaluation) Saccharin (IARC Summary & Evaluation, Supplement7, 1987) Saccharin (IARC Summary & Evaluation, Volume 22, 1980)