Compendium of the most significant studies with reference to properties, intake, effects.

Sheehan PJ, Lewis RC, Kirman CR, Watson HN, Winegar ED, Bus JS. Ethylene Oxide Exposure in U.S. Populations Residing Near Sterilization and Other Industrial Facilities: Context Based on Endogenous and Total Equivalent Concentration Exposures. Int J Environ Res Public Health. 2021 Jan 12;18(2):607. doi: 10.3390/ijerph18020607. 

Abstract. Given ubiquitous human exposure to ethylene oxide (EO), regardless of occupation or geography, the current risk-specific concentrations (RSCs: 0.0001-0.01 ppb) from the U.S. Environmental Protection Agency (EPA) cancer risk assessment for EO are not useful metrics for managing EO exposures to the general U.S. population.

Thier R, Bolt HM. Carcinogenicity and genotoxicity of ethylene oxide: new aspects and recent advances. Crit Rev Toxicol. 2000 Sep;30(5):595-608. doi: 10.1080/10408440008951121.

Abstract. Long-term inhalation studies in rodents have presented unequivocal evidence of experimental carcinogenicity of ethylene oxide, based on the formation of malignant tumors at multiple sites. However, despite a considerable body of epidemiological data only limited evidence has been obtained of its carcinogenicity in humans.

Jinot J, Fritz JM, Vulimiri SV, Keshava N. Carcinogenicity of ethylene oxide: key findings and scientific issues. Toxicol Mech Methods. 2018 Jun;28(5):386-396. doi: 10.1080/15376516.2017.1414343.

Abstract. In support of the Integrated Risk Information System (IRIS), the U.S. Environmental Protection Agency (EPA) completed an evaluation of the inhalation carcinogenicity of ethylene oxide (EtO) in December 2016. This article reviews key findings and scientific issues regarding the carcinogenicity of EtO in EPA's Carcinogenicity Assessment.

Filser JG, Klein D. A physiologically based toxicokinetic model for inhaled ethylene and ethylene oxide in mouse, rat, and human. Toxicol Lett. 2018 Apr;286:54-79. doi: 10.1016/j.toxlet.2017.07.896.

Abstract. Ethylene (ET) is the largest volume organic chemical. Mammals metabolize the olefin to ethylene oxide (EO), another important industrial chemical. The epoxide alkylates macromolecules and has mutagenic and carcinogenic properties. 

Haufroid V, Merz B, Hofmann A, Tschopp A, Lison D, Hotz P. Exposure to ethylene oxide in hospitals: biological monitoring and influence of glutathione S-transferase and epoxide hydrolase polymorphisms. Cancer Epidemiol Biomarkers Prev. 2007 Apr;16(4):796-802. doi: 10.1158/1055-9965.EPI-06-0915.

Abstract. Ethylene oxide is considered as a human carcinogen. A biomarker of exposure would be a useful instrument to assess the risk in occupationally exposed workers. This cross-sectional study aimed at examining (a) whether the urinary excretion of a metabolite of ethylene oxide, 2-hydroxyethyl mercapturic acid (HEMA), could be used for monitoring occupational exposure and (b) whether glutathione S-transferase (GST) and epoxide hydrolase genotypes influenced biological monitoring.

 Shintani H. Ethylene Oxide Gas Sterilization of Medical Devices. Biocontrol Sci. 2017;22(1):1-16. doi: 10.4265/bio.22.1.

Abstract. Ethylene oxide gas is an agent in the sterilization of medical devices due to its effectiveness and compatibility with most materials. The advantages and disadvantages, as well as its recommended uses, are explored in this review article. 

Kelsey JR. Ethylene oxide derived glycol ethers: A review of the alkyl glycol ethers potential to cause endocrine disruption. Regul Toxicol Pharmacol. 2021 Dec 30;129:105113. doi: 10.1016/j.yrtph.2021.105113.

Abstract. This review systematically evaluates all of the available and relevant in vitro and in vivo data across this family of substances using an approach based around the EFSA/ECHA 2018 guidance for the identification of endocrine disruptors.

McEvoy B, Wiehle SB, Gordon K, Kearns G, Laranjeira P, McLees N. Advancing the Sustainable Use of Ethylene Oxide through Process Validation. Biomed Instrum Technol. 2021 Mar 1;55(s3):35-44. doi: 10.2345/0899-8205-55.s3.35.

Abstract. This article presents relevant experiences and describes challenges and considerations encountered in delivering EO process optimization.

Kirman CR, Li AA, Sheehan PJ, Bus JS, Lewis RC, Hays SM. Ethylene oxide review: characterization of total exposure via endogenous and exogenous pathways and their implications to risk assessment and risk management. J Toxicol Environ Health B Crit Rev. 2021 Jan 2;24(1):1-29. doi: 10.1080/10937404.2020.1852988.

Abstraqct. This review is intended to provide risk assessors and risk managers with a better understanding of issues associated with total exposures of human populations to ethylene oxide from endogenous and exogenous pathways. 

Pohan G, Mattiassi S, Yao Y, Zaw AM, Anderson DEJ, Cutiongco MFA, Hinds MT, Yim EKF. Effect of Ethylene Oxide Sterilization on Polyvinyl Alcohol Hydrogel Compared with Gamma Radiation. Tissue Eng Part A. 2020 Oct;26(19-20):1077-1090. doi: 10.1089/ten.TEA.2020.0002.

Abstract.  This study investigated the effects of terminal sterilization of polyvinyl alcohol (PVA) biomaterials using clinically translatable techniques, specifically ethylene oxide (EtO) and gamma (γ) irradiation. While a few studies have reported the possibility of sterilizing PVA with γ-radiation, the use of EtO sterilization of PVA requires additional study. 

Jain RB. Associations between observed concentrations of ethylene oxide in whole blood and smoking, exposure to environmental tobacco smoke, and cancers including breast cancer: data for US children, adolescents, and adults. Environ Sci Pollut Res Int. 2020 Jun;27(17):20912-20919. doi: 10.1007/s11356-020-08564-z.

Abstract. This study was undertaken to evaluate the associations between concentrations of ETO in whole blood and smoking, exposure to environmental tobacco smoke (ETS), and self-reported diagnosis of cancers including breast cancer.