Pulmonary fibrosis in an individual occupationally exposed to inhaled indium-tin oxide

Indium lung--case reports and epidemiology

PURPOSE

The present review is aimed to introduce an new occupational lung disease, Indium Lung.

METHODS

We searched case reports and epidemiological studies concerning indium-related lung diseases and reviewed.

RESULTS

Up to March, 2010, 7 cases of interstitial pneumonia in Japanese indium-exposed workers, two cases of pulmonary alveolar proteinosis (PAP) in US indium-exposed workers, one case of PAP in a Chinese indium-exposed worker, and 4 cross-sectional surveys in Japan had been published. All cases and epidemiological studies in Japan indicate that exposure to hardly soluble indium compounds causes interstitial as well as emphysematous lung damages, which we call "Indium Lung". Based on the epidemiological studies, the Japan Society for Occupational Health proposed 3 μg/l of indium in serum as an occupational exposure limit based on biological monitoring to prevent significant increase of KL-6.

COMMENTS

Long-term follow-up of currently and formerly indium-exposed workers is essential not only to clarify the natural history of indium lung but also to trace the incidence of lung cancer. It is also necessary to elucidate the mechanism of indium lung and difference in clinical manifestations between Japanese and US cases.

Pulmonary alveolar proteinosis in workers at an indium processing facility

Two cases of pulmonary alveolar proteinosis, including one death, occurred in workers at a facility producing indium-tin oxide (ITO), a compound used in recent years to make flat panel displays. Both workers were exposed to airborne ITO dust and had indium in lung tissue specimens. One worker was tested for autoantibodies to granulocytemacrophage-colonystimulating factor (GM-CSF) and found to have an elevated level. These cases suggest that inhalational exposure to ITO causes pulmonary alveolar proteinosis, which may occur via an autoimmune mechanism.

Pleural effects of indium phosphide in B6C3F1 mice: nonfibrous particulate induced pleural fibrosis

The mechanism(s) by which chronic inhalation of indium phosphide (InP) particles causes pleural fibrosis is not known. Few studies of InP pleural toxicity have been conducted because of the challenges in conducting particulate inhalation exposures, and because the pleural lesions developed slowly over the 2-year inhalation study. The authors investigated whether InP (1 mg/kg) administered by a single oropharyngeal aspiration would cause pleural fibrosis in male B6C3F1 mice. By 28 days after treatment, protein and lactate dehydrogenase (LDH) were significantly increased in bronchoalveolar lavage fluid (BALF), but were unchanged in pleural lavage fluid (PLF). A pronounced pleural effusion characterized by significant increases in cytokines and a 3.7-fold increase in cell number was detected 28 days after InP treatment. Aspiration of soluble InCl(3) caused a similar delayed pleural effusion; however, other soluble metals, insoluble particles, and fibers did not. The effusion caused by InP was accompanied by areas of pleural thickening and inflammation at day 28, and by pleural fibrosis at day 98. Aspiration of InP produced pleural fibrosis that was histologically similar to lesions caused by chronic inhalation exposure, and in a shorter time period. This oropharyngeal aspiration model was used to provide an initial characterization of the progression of pleural lesions caused by InP.

Chronic pulmonary toxicity study of indium-tin oxide and indium oxide following intratracheal instillations into the lungs of hamsters

OBJECTIVES

The aim of this study was to clarify the chronic toxicological effects of indium-tin oxide (ITO) and indium oxide (In(2)O(3)) on laboratory animals.

METHODS

Male Syrian golden hamsters were intratracheally administered 3 mg/kg or 6 mg/kg of ITO particles, or 2.7 mg/kg or 5.4 mg/kg of In(2)O(3) particles, containing 2.2 mg/kg or 4.5 mg/kg of indium, twice a week, for 8 wk. Control hamsters were given vehicle of distilled water only. The hamsters were euthanized serially up to 78 wk after the final instillation and the toxicological effects were determined.

RESULTS

Body weight gain was significantly suppressed in the ITO 6 mg/kg-treated hamsters compared with the control group, but not in the ITO 3 mg/kg-treated or In(2)O(3)-treated hamsters. Relative lung weights among all the indium-treated groups were significantly increased compared to that in the control group throughout the observation period. The serum indium concentration among all the indium-treated groups gradually increased up to the end of the observation period. Histopathologically, foci of slight to severe pulmonary inflammatory response with diffuse alveolar or bronchiolar cell hyperplasia, expansion of the alveolar spaces and interstitial fibrotic proliferation were present in all the indium-treated hamsters and the severity of these lesions worsened with the passage of time. Lung benign adenomas were only manifest in 3 out of 15 of the ITO 6 mg/kg-treated hamsters.

CONCLUSIONS

The present results clearly demonstrate that ITO and In(2)O(3) particles caused chronic pulmonary toxicity when repeated intratracheal instillations were given to hamsters.

Causal relationship between indium compound inhalation and effects on the lungs

BACKGROUND

Recent case reports and epidemiological studies suggest that inhalation of indium dust induces lung damage.

OBJECTIVES

To elucidate the dose-dependent effects of indium on the lungs and to prove a causal relationship more clearly.

METHODS

A baseline observation was conducted on 465 workers currently exposed to indium, 127 workers formerly exposed to indium and 169 workers without indium exposure in 12 factories and 1 research laboratory from 2003 to 2006. Indium in serum (In-S) was determined as an exposure parameter, and its effects on the lungs were examined.

RESULTS

The means of In-S in the current, former and no exposure workers were 8.35, 9.63 and 0.56 ng/ml, respectively. The current and former exposure workers had significantly higher levels of KL-6, and showed significant dose-dependent increases in KL-6, SP-D, and SP-A. Current exposure workers with In-S of 3 ng/ml or above demonstrated a significant increase of KL-6 in both GM and prevalence exceeding the reference value. Approximately a quarter of the former exposure workers had interstitial changes as seen on chest HRCT. In-S of exposed workers who had been working before improvements of the working environment (Group Bef) and those who started working after improvements (Group Aft) were 12.29 and 0.81 ng/ml, respectively. Adjusted odds ratios indicated 87%, 71% and 44% reductions among Group Aft workers who exceeded the reference values of KL-6, SP-D and SP-A, respectively.

CONCLUSION

Dose-dependent lung effects due to indium exposure were shown, and a decrease of indium exposure reduced the lung effects. An In-S value of 3 ng/ml may be a cut-off value which could be used to prevent early effects on the lungs.

The effect of the atmosphere on the optical properties of as-synthesized colloidal indium tin oxide

The optical properties of indium tin oxide (ITO) have often been explored when it is in the form of deposited thin films. In this study, a colloidal chemistry approach is taken to investigate the influence of the atmosphere on the optical properties of ITO nanoparticles. X-ray diffraction (XRD), transmission electron microscopy (TEM), absorption spectroscopy and photoluminescence (PL) were used to characterize colloidal ITO samples, synthesized under aerated and inert conditions, with the same composition. In both cases, the ITO can be completely dispersed in a non-polar solvent without any evidence of agglomeration. For the ITO made in air, the nanoparticle-solvent solution exhibits a pale green color, and XRD and TEM indicate an average particle size of approximately 7 nm and small shrinkage in the lattice structure. When the ITO is synthesized under inert conditions, the solution turns blue, and XRD and TEM indicate an average particle size of approximately 8 nm and even less strain in the lattice than for the ITO synthesized under aerated conditions. The change in color and lattice strain is attributed to the difference in oxygen vacancy concentration for the ITO nanoparticles synthesized under aerated and inert conditions, which exhibit different optical band gap values of 3.89 eV and 4.05 eV, respectively. Our work here shows that thin film deposition or sintering steps may not be required for studying the optical properties of as-synthesized ITO nanoparticles.

Sintered indium-tin-oxide (ITO) particles: a new pneumotoxic entity

Indium-Tin-Oxide (ITO) is a sintered mixture of indium- (In(2)O(3)) and tin-oxide (SnO(2)) in a ratio of 90:10 (wt:wt) that is used for the manufacture of LCD screens and related high technology applications. Interstitial pulmonary diseases have recently been reported in workers from ITO producing plants. The present study was conducted to identify experimentally the exact chemical component responsible for this toxicity and to address possible mechanisms of action. The reactivity of respirable ITO particles was compared with that of its single components alone or their unsintered 90:10 mixture (MIX) both in vivo and in vitro. For all endpoints considered, ITO particles behaved as a specific toxic entity. In vivo, after a single pharyngeal administration (2-20 mg per rat), ITO particles induced a strong inflammatory reaction. At day 3, the inflammatory reaction (cell accumulation, LDH and protein in bronchoalveolar lavage fluid) appeared more marked with ITO particles than with each oxide separately or the MIX. This inflammatory reaction persisted and even worsened after 15 days. After 60 days, this inflammation was still present but no significant fibrotic response was observed. The cytotoxicity of ITO was assessed in vitro in lung epithelial cells (RLE) and macrophages (NR8383 cell line). While ITO particles (up to 200 microg/ml) did not affect epithelial cell integrity (LDH release), a strong cytotoxic response was found in macrophages exposed to ITO, but not to its components alone or mixed. ITO particles also induced an increased frequency of micronuclei in type II pneumocytes in vivo but not in RLE in vitro, suggesting the preponderance of a secondary genotoxic mechanism. To address the possible mechanism of ITO toxicity, reactive oxygen species production was assessed by electron paramagnetic resonance spectrometry in an acellular system. Carbon centered radicals (COO-.) and Fenton-like activity were detected in the presence of ITO particles, not with In(2)O(3), SnO(2) alone, or the MIX. Because the unsintered mixture of SnO(2) and In(2)O(3) particles was unable to reproduce the reactivity/toxicity of ITO particles, the sintering process through which SnO(2) molecules are introduced within the crystal structure of In(2)O(3) appears critical to explain the unique toxicological properties of ITO. The inflammatory and genotoxic activities of ITO dust indicate that a strict control of exposure is needed in industrial settings.

An old threat in a new setting: High prevalence of silicosis among jewelry workers

BACKGROUND

Silicosis is caused by inhaling free crystalline silica. Few case reports have addressed the risk of silicosis in the jewelry trade where chalk molds containing a high percentage of silica are used in casting. We conducted a cross-sectional study involving 100 goldsmiths exposed to silica.

METHODS

All workers replied to a questionnaire and underwent a clinical examination, pulmonary function tests, a chest X-ray and a high-resolution CT scan.

RESULTS

High-resolution CT visualized signs of silicosis in 23 cases, confirmed by standard chest X-rays in 10. In the 23 workers with CT evidence of silicosis Total Lung Capacity, FEV1 and the Lung Diffusing Capacity did not differ from the workers without the disease. Pulmonary function tests did not correlate with silica exposure.

CONCLUSION

In this study we demonstrate that use of chalk molds in casting in jewelry causes silicosis. The composition of the dust could be responsible of the high prevalence observed.