Concentrated ambient air particles induce mild pulmonary inflammation in healthy human volunteers

Identification of gene biomarkers for respiratory syncytial virus infection in a bronchial epithelial cell line

Respiratory syncytial virus (RSV) infection involves complex virus-host interplay. In this study, we analyzed gene expression in RSV-infected BEAS-2B cells to discover novel signaling pathways and biomarkers. We hybridized RNAs from RSV- or vehicle-treated BEAS-2B to Affymetrix HU133 plus 2.0 microarrays (n = 4). At 4 and 24 h post-infection, 277 and 900 genes (RSV/control ratio >/=2.0 or </=0.5), and 1 and 12 pathways respectively were significantly altered. Twenty-three and 92 genes at 4 and 24 h respectively matched respiratory disease biomarkers with ARG2 flagged at 24 h and SCNN1G, EPB41L4B, CSF1, PTEN, TUBB1 and ESR2 at both time points. Hierachical clustering showed a cluster containing ARG2 and IL8. In human bronchial epithelial cells, RSV upregulated arginase II protein. Knockdown of ARG2 increased RSV-induced IL-8, LDH and histone release. With microarray, we identified novel proximal airway epithelial cell genes that may be tested in the sputum samples as biomarkers of RSV infection.

The limits of testing particle-mediated oxidative stress in vitro in predicting diverse pathologies; relevance for testing of nanoparticles

In vitro studies with particles are a major staple of particle toxicology, generally used to investigate mechanisms and better understand the molecular events underlying cellular effects. However, there is ethical and financial pressure in nanotoxicology, the new sub-specialty of particle toxicology, to avoid using animals. Therefore an increasing amount of studies are being published using in vitro approaches and such studies require careful interpretation. We point out here that 3 different conventional pathogenic particle types, PM10, asbestos and quartz, which cause diverse pathological effects, have been reported to cause very similar oxidative stress effects in cells in culture. We discuss the likely explanation and implications of this apparent paradox, and its relevance for testing in nanotoxicology.

Levels of pollutants in indoor air and respiratory health in preschool children: a systematic review

The aim of this paper is thus to identify, evaluate, and summarize in a systematic fashion all the epidemiological studies that have analyzed the association between exposure to specific indoor air pollutants and respiratory disease among children under the age of five. A search was carried out in the main biomedical bibliographic sources in December 2006 and updated in February 2008. The study period covered 12 years (1996-2007). All the selected papers were carefully read. We focused on studies that analyzed at least one indicator of respiratory health and which included one or more indoor air pollutants in relation to the respiratory health of children under the age of 5. Studies that analyzed passive smoking as the sole source of indoor air pollution were not included. Fourteen studies were considered to be relevant. The most analyzed pollutant was nitrogen dioxide, followed by volatile organic compounds, airborne particulates and other pollutants; phthalates and CO(2). The literature reviewed within our criteria seems to indicate that several indoor pollutants, even at the moderate levels found in the developed countries, could be harmful to the respiratory health of very young children. Future research should focus on conducting more studies, preferably making use of cohorts, with adequate techniques for measuring indoor pollution levels.

Fine ambient particles induce oxidative stress and metal binding genes in human alveolar macrophages

Exposure to pollutant particles increased respiratory morbidity and mortality. The alveolar macrophages (AMs) are one cell type in the lung directly exposed to particles. Upon contact with particles, AMs are activated and produce reactive oxygen species, but the scope of this oxidative stress response remains poorly defined. In this study, we determined the gene expression profile in human AMs exposed to particles, and sought to characterize the global response of pro- and antioxidant genes. We exposed AMs obtained by bronchoscopy from normal individuals to Chapel Hill particulate matter of 2.5-microm diameter or smaller (PM(2.5); 1 microg/ml) or vehicle for 4 hours (n = 6 independent samples). mRNAs were extracted, amplified, and hybridized to Agilent human 1A microarray. Significant genes were identified by significance analysis of microarrays (false discovery rate, 10%; P < or = 0.05) and mapped with Gene Ontology in the Database for Annotation, Visualization, and Integrated Discovery. We found 34 and 41 up- and down-regulated genes, respectively; 22 genes (approximately 30%) were involved in metal binding, and 11 were linked to oxidative stress, including up-regulation of five metallothionein (MT)-1 isoforms. Exogenous MT1 attenuated PM(2.5)-induced H2O2 release. PM(2.5) premixed with MT1 stimulated less H2O2 release. Knockdown of MT1F gene increased PM(2.5)-induced H2O2 release. PM(2.5) at 1 microg/ml did not increase H2O2 release. Mount St. Helens PM(2.5) and acid-extracted Chapel Hill PM(2.5), both poor in metals, did not induce MT1F or H2O2 release. Our results show that PM(2.5) induced a gene expression profile prevalent with genes related to metal binding and oxidative stress in human AMs, independent of oxidative stress. Metals associated with PM may play an important role in particle-induced gene changes.

Concentrated ambient ultrafine particle exposure induces cardiac changes in young healthy volunteers

RATIONALE

Exposure to ambient ultrafine particles has been associated with cardiopulmonary toxicity and mortality. Adverse effects specifically linked to ultrafine particles include loss of sympathovagal balance and altered hemostasis.

OBJECTIVES

To characterize the effects of acute exposure to ambient ultrafine particles in young healthy humans.

METHODS

Nineteen healthy nonsmoking male and female subjects between the ages of 18 and 35 were exposed to filtered air or to an atmosphere in which captured ultrafine (<0.16 microm) particles were concentrated by a factor of up to 20-fold over ambient levels with the use of particle concentrators fitted with size-selective outlets (ultrafine concentrated ambient particles [UFCAPs]). Subjects underwent bronchoalveolar lavage 18 hours after each exposure. Cardiovascular endpoints measured included pulmonary function, clinical chemistry, and hematological parameters, as well as heart rate variability and repolarization indices.

MEASUREMENTS AND MAIN RESULTS

Exposure to UFCAPs was statistically associated with an increase in frequency domain markers of heart rate variability, specifically indicative of elevated vagal input to the heart. Consistent with this finding were increases in the variance associated with the duration of the QT interval. In addition, UFCAP exposure resulted in a significant increase in blood levels of the fibrin degradation product D-dimer as well as a modest elevation in the inflammatory chemokine IL-8 recovered in the lavage fluid.

CONCLUSIONS

These findings show mild inflammatory and prothrombic responses and are suggestive of alterations in cardiac repolarization induced by UFCAP inhalation.

Particulate matter inhalation during hay storing activity induces systemic inflammation and platelet aggregation

The aim of this study was to investigate possible pathomechanisms behind the cardiovascular morbidity caused by inhalation of particulate matter (PM(10)). For that purpose, healthy volunteers were exposed to high PM(10) concentrations during a 2 h hay storing activity. Blood was drawn in the evening before and after PM(10) exposure and in the morning and evening of the day after exposure. The leukocyte count increased after PM(10) exposure with an initial increase of segmented neutrophils followed by banded forms. C-reactive protein increased over time. Fibrinogen and plasma viscosity became increased in the evening of the day after PM(10) exposure. Platelet aggregation was increased in the evening after PM(10) exposure. At the same time von Willebrand factor and factor VIII were increased, reflecting endothelial activation. These results confirm that acute inhalative exposure to high PM(10) concentrations during hay storage activity leads to a systemic inflammatory reaction, endothelial activation, and platelet aggregation.

Adverse cardiovascular effects of air pollution

Air pollution is increasingly recognized as an important and modifiable determinant of cardiovascular disease in urban communities. Acute exposure has been linked to a range of adverse cardiovascular events including hospital admissions with angina, myocardial infarction, and heart failure. Long-term exposure increases an individual's lifetime risk of death from coronary heart disease. The main arbiter of these adverse health effects seems to be combustion-derived nanoparticles that incorporate reactive organic and transition metal components. Inhalation of this particulate matter leads to pulmonary inflammation with secondary systemic effects or, after translocation from the lung into the circulation, to direct toxic cardiovascular effects. Through the induction of cellular oxidative stress and proinflammatory pathways, particulate matter augments the development and progression of atherosclerosis via detrimental effects on platelets, vascular tissue, and the myocardium. These effects seem to underpin the atherothrombotic consequences of acute and chronic exposure to air pollution. An increased understanding of the mediators and mechanisms of these processes is necessary if we are to develop strategies to protect individuals at risk and reduce the effect of air pollution on cardiovascular disease.

Age-related differences in pulmonary and cardiovascular responses to SiO2 nanoparticle inhalation: nanotoxicity has susceptible population

Epidemiologic studies have revealed that pollution by ambient particulates is associated with respiratory and cardiovascular diseases, particularly in older people. Toxicologic sensitivity of nanoparticles in different ages was investigated for the first time to demonstrate and explain an age-related difference in response to manufactured nanoparticles. Young, adult, and old rats physiologically inhaled air containing aerosol of manufactured SiO2 nanoparticles (24.1 mg/m3; 40 min/day) for four weeks. Changes in serum biomarkers, hemorheologic, pulmonary inflammation, heart injury, and pathology in rats of different ages and their corresponding controls were compared. Inhalation of SiO2 nanoparticles under identical conditions caused pulmonary and cardiovascular alterations in old rats, yet less change in young and adult rats, including pulmonary inflammation, myocardial ischemic damage, atrio-ventricular blockage, and increase in fibrinogen concentration and blood viscosity. Old individuals were more sensitive to nanoparticle exposure than the young and adult rats. The risk of causing pulmonary damages was: old > young > adult The risk of cardiovascular disorder was observed only in old age. Our results suggest that different ages may require different biomarkers for identifying pulmonary toxicity during inhalation of nanoparticles.

Diesel exhaust inhalation increases thrombus formation in man

AIMS

Although the mechanism is unclear, exposure to traffic-derived air pollution is a trigger for acute myocardial infarction (MI). The aim of this study is to investigate the effect of diesel exhaust inhalation on platelet activation and thrombus formation in men.

METHODS AND RESULTS

In a double-blind randomized crossover study, 20 healthy volunteers were exposed to dilute diesel exhaust (350 microg/m(3)) and filtered air. Thrombus formation, coagulation, platelet activation, and inflammatory markers were measured at 2 and 6 h following exposure. Thrombus formation was measured using the Badimon ex vivo perfusion chamber. Platelet activation was assessed by flow cytometry. Compared with filtered air, diesel exhaust inhalation increased thrombus formation under low- and high-shear conditions by 24% [change in thrombus area 2229 microm(2), 95% confidence interval (CI) 1143-3315 microm(2), P = 0.0002] and 19% (change in thrombus area 2451 microm(2), 95% CI 1190-3712 microm(2), P = 0.0005), respectively. This increased thrombogenicity was seen at 2 and 6 h, using two different diesel engines and fuels. Diesel exhaust also increased platelet-neutrophil and platelet-monocyte aggregates by 52% (absolute change 6%, 95% CI 2-10%, P = 0.01) and 30% (absolute change 3%, 95% CI 0.2-7%, P = 0.03), respectively, at 2 h following exposure compared with filtered air.

CONCLUSION

Inhalation of diesel exhaust increases ex vivo thrombus formation and causes in vivo platelet activation in man. These findings provide a potential mechanism linking exposure to combustion-derived air pollution with the triggering of acute MI.

Differential oxidative stress response in young children and the elderly following exposure to PM(2.5)

OBJECTIVES

The mechanism of the adverse health effects of ambient particulate matter on humans has not been well-investigated despite many epidemiologic association studies. Measurement of personal exposure to particulate pollutants and relevant biological effect markers are necessary in order to investigate the mechanism of adverse health effects, particularly in fragile populations considered to be more susceptible to the effects of pollutants.

METHODS

We measured personal exposure to PM(2.5) and examined oxidative stress using urinary malondialdehyde three times in 51 preschoolers and 38 elderly subjects. A linear mixed-effects model was used to estimate PM(2.5) effects on urinary MDA levels.

RESULTS

Average personal exposure of the children and elderly to PM(2.5) was 80.5 +/- 29.9 and 20.7 +/- 12.7 mug/m(3), respectively. Mean urinary MDA level in the children and the elderly was 3.6 +/- 1.9 and 4.0 +/- 1.6 mumol/g creatinine. For elderly subjects the PM(2.5) level was significantly associated with urinary MDA after adjusting for age, sex, BMI, passive smoking, day-care facility site, alcohol consumption, cigarette smoking, and medical history (heart disease, hypertension and bronchial asthma). However, there was no significant relationship for children.

CONCLUSIONS

The elderly were more susceptible than young children to oxidative stress as a result of ambient exposure to PM(2.5). Identification of oxidative stress induced by PM(2.5) explains the mechanism of adverse health effects such as cardiovascular or respiratory diseases, particularly in the elderly.

A controlled challenge study on di(2-ethylhexyl) phthalate (DEHP) in house dust and the immune response in human nasal mucosa of allergic subjects

BACKGROUND

Few studies have yet addressed the effects of di(2-ethylhexyl) phthalate (DEHP) in house dust on human nasal mucosa.

OBJECTIVES

We investigated the effects of house dust containing DEHP on nasal mucosa of healthy and house dust mite (HDM)-allergic subjects in a short-term exposure setting.

METHODS

We challenged 16 healthy and 16 HDM-allergic subjects for 3 hr with house dust at a concentration of 300 microg/m(3) containing either low (0.41 mg/g) or high (2.09 mg/g) levels of DEHP. Exposure to filtered air served as control. After exposure, we measured proteins and performed a DNA microarray analysis.

RESULTS

Nasal exposure to house dust with low or high DEHP had no effect on symptom scores. Healthy subjects had almost no response to inhaled dust, but HDM-allergic subjects showed varied responses: DEHP(low) house dust increased eosinophil cationic protein, granulocyte-colony-stimulating factor (G-CSF), interleukin (IL)-5, and IL-6, whereas DEHP(high) house dust decreased G-CSF and IL-6. Furthermore, in healthy subjects, DEHP concentration resulted in 10 differentially expressed genes, whereas 16 genes were differentially expressed in HDM-allergic subjects, among them anti-Müllerian hormone, which was significantly up-regulated after exposure to DEHP(high) house dust compared with exposure to DEHP(low) house dust, and fibroblast growth factor 9, IL-6, and transforming growth factor-beta1, which were down-regulated.

CONCLUSIONS

Short-term exposure to house dust with high concentrations of DEHP has attenuating effects on human nasal immune response in HDM-allergic subjects, concerning both gene expression and cytokines.

Relation of heart failure hospitalization to exposure to fine particulate air pollution

Cardiopulmonary disease has been associated with particulate matter (PM) air pollution. There is evidence that exposure to elevated PM concentrations increases risk of acute ischemic heart disease events, alters cardiac autonomic function, and increases risk of arrhythmias. It is plausible, therefore, that PM exposure may exacerbate heart failure (HF). A case-crossover study design was used to explore associations between fine PM (PM(2.5): particles with an aerodynamic diameter < or =2.5 microm) and 2,628 HF hospitalizations. Patients lived on Utah's Wasatch Front and were drawn from those hospitalized at Intermountain Healthcare facilities with a primary diagnosis of HF. A 14-day lagged cumulative moving average of 10 microg/m(3) PM(2.5) was associated with a 13.1% (95% confidence interval 1.3 to 26.2) increase in HF admissions. The strongest PM(2.5)-HF associations were for elderly patients who had previously been admitted for HF and who required only a short period of hospitalization. HF hospitalizations are associated with lagged cumulative exposure to PM(2.5) of approximately 2 weeks. In conclusion, particulate air pollution may play a role in precipitating acute cardiac decompensation in otherwise well-managed patients with HF, perhaps through effects of PM on myocardial ischemia, cardiac autonomic function, and/or arrhythmic effects.

Apoptotic and Inflammatory Effects Induced by Different Particles in Human Alveolar Macrophages

Pollutant particles induce apoptosis and inflammation, but the relationship between these two biological processes is not entirely clear. In this study, we compared the proapoptotic and proinflammatory effects of four particles: residual oil fly ash (ROFA), St. Louis particles SRM 1648 (SL), Chapel Hill PM10 (CHP), and Mount St. Helens dust (MSH). Human alveolar macrophages (AM) were incubated with these particles at 100 microg/ml. Cell death was assessed by annexin V (AV) expression, histone release, nuclear morphology, caspase 3-like activity and release of caspase 1 for apoptosis, and propidium iodide (PI) for necrosis, and inflammation was measured by interleukin (IL)-1beta and IL-6. We found that particle effects on these cell death measurements varied, and ROFA affected most (four out of five) endpoints, including nuclear morphological changes. CHP and SL also caused necrosis. For cytokine release, the potency was CHP > SL > ROFA > MSH. The proapoptotic and proinflammatory effects induced by the whole particles were unaltered after the particles were washed with water. The water-soluble fraction was relatively inactive, as were individual soluble metals (V, Ni, Fe). ROFA-induced nuclear fragmentation was associated with upregulation and mitochondrial release of apoptosis-inducing factor (AIF), a caspase-independent chromatin condensation factor, and upregulation of DNase II, a lysosomal acid endonuclease. These results indicate that the potential for particles to induce apoptosis does not correlate with their proinflammatory properties, although active components for both processes reside in the water-insoluble core. Both apoptosis and inflammatory endpoints should be included when the toxicity of different pollutant particles is assessed.

Relative Contributions of PM2.5Chemical Constituents to Acute Arterial Vasoconstriction in Humans

Studies have shown associations between acute ambient particulate matter (PM) levels and increases in morbidity and mortality from cardiovascular diseases. We have previously reported in 24 healthy adults that exposure to concentrated ambient particles plus ozone (CAP + O(3)) caused a mean decrease of 0.09 mm in brachial artery diameter (BAD), which was significantly larger than a mean increase of 0.01 mm among the same individuals exposed to filtered air (FA). Our current objective is to examine the relationship between total and constituent PM(2.5) mass concentrations and the acute vascular response. We have analyzed both ambient and exposure filters from the brachial artery study for major chemical constituents, allowing us to compare the strength of the associations between each constituent and an individual's arterial response. We determined gravimetric PM(2.5) mass concentration and inorganic ion content from exposure filters. Twenty-three-hour ambient PM(2.5) filters collected from the same site and on the same day were used to estimate exposure concentrations of trace elements and organic and elemental carbon. We performed linear regression analyses on the levels of measured or estimated PM constituents using each subject's FA exposure as a control. We found, from our regression analyses, a significant negative association between both the organic and elemental carbon concentrations and the difference in the postexposure change in the BAD (Delta BAD) between and CAP + O(3) and FA exposure days. An understanding of the PM constituents most responsible for adverse health outcomes is critical for efforts to develop pollution abatement strategies that maximize benefits to public health.

Exposures of Elderly Volunteers with and without Chronic Obstructive Pulmonary Disease (COPD) to Concentrated Ambient Fine Particulate Pollution

The elderly and individuals who have chronic obstructive pulmonary disease (COPD) may be sensitive to particulate matter (PM) air pollution. We evaluated short-term health responses of 13 elderly volunteers with COPD and 6 age-matched healthy adults to controlled exposures of ambient PM pollution in suburban Los Angeles. Using a Harvard particle concentrator and a whole-body chamber, we exposed each person on separate occasions to approximately 200 microg/m(3) concentrated ambient particles (CAP) less than 2.5 mum in diameter and to filtered air (FA). Each exposure lasted 2 h with intermittent mild exercise. We found no significant effects of CAP on symptoms, spirometry, or induced sputum. A significant negative effect of CAP on arterial oxygenation (measured by pulse oximetry) immediately postexposure was more pronounced in healthy subjects. Peripheral blood basophils increased after CAP in healthy but not in COPD subjects. In both groups, red cell counts increased slightly 1 day after exposure to FA but not to CAP. Preexposure ectopic heartbeats were infrequent in healthy subjects, but increased modestly during/after CAP exposure relative to FA. Ectopic beats were more frequent in COPD subjects, but decreased modestly during/after CAP relative to FA. Heart-rate variability over multi-hour intervals was lower after CAP than after FA in healthy elderly subjects but not in COPD subjects. Thus, in this initial small-scale study of older volunteers experimentally exposed to ambient PM, some acute cardiopulmonary responses were consistent with effects reported from epidemiologic studies. Unexpectedly, individuals with COPD appeared less susceptible than healthy elderly individuals. Further investigation of older adults is warranted to understand the pathophysiology and public health significance of these findings.

Exposure to Concentrated Ambient Particles (CAPs): A Review

Epidemiologic studies support a participation of fine particulate matter (PM) with a diameter of 0.1 to 2.5 microm in the effects of air pollution particles on human health. The ambient fine particle concentrator is a recently developed technology that can enrich the mass of ambient fine particles in real time with little modification. The advantages of concentrators are that the particles produced are "real world" and they allow exposure at pertinent masses. Limitations include variability in both particle mass and composition and some uncertainty over the best statistical approach to analyze the data. Cumulative evidence provided by the body of initial investigation shows that exposures to concentrated ambient particles (CAPs) can be accomplished safely in both humans and animals. Human investigation using the CAPs has shown acute lung inflammation and changes in both blood indices and heart rate variability. Animal studies support a potential pulmonary inflammation, blood changes, alterations of specific cardiac endpoints, and an increased susceptibility of specific models. These studies have helped establish the causal relationship between find particle exposure and adverse health effects in the lung and cardiovascular system. In addition, it appears that specific components in CAPS may differentially affect these tissues.

Involvement of alveolar macrophages in the formation of 8-oxodeoxyguanosine associated with exogenous particles in human lungs

Lung specimens were collected from 161 non-smoking male patients with carcinoma to determine the deposition of carbon particles and oxidative damage in lung tissues. Morphologically, carbon particles deposited in human lungs with carcinoma were similar to those of diesel exhaust like particles, and mass of particles showed a significant increase with the increasing age of the patients. An increasing age of patient with carcinomas was also associated with 8-oxodeoxy-guanosine (8-oxo-dG) formation, which was analyzed using the HPLC-electrochemical detector method. In addition, it was found that 8-oxo-dG increased in cancerous tissues rather than in non-cancerous ones. To determine whether particles in lung tissues were associated with 8-oxo-dG formation, carbon particles deposited in lung tissues were partially purified by cycling of alkali fusion with 1 M KOH; mutagenic chemicals in particles were extracted and excluded by removal with an equal volume of benzene/methanol and dichloromethane. It was also found that 8-oxo-dG was formed by non-mutagenic particles, and enhanced in the in vivo test using mouse rather than in the in vitro using RAW 254.7 tissue cultured cells. The 8-oxo-dG formation in vivo was due to the fact that hydroxyl radicals might be involved with phagocytosis of non-mutagenic particles in inflammatory cells, and the mutation was induced by hydroxylation of guanine residue on DNA. These results were also demonstrated by the occurrence of alveolar macrophages and neutrophils after intratracheal instillation of particles. These observations suggest that small particles from lung cancer patients further promote oxidative damage when used to treat the mouse lung. Especially, particles from which organic chemicals were removed were highly reactive to oxidative damage and formed 8-oxo-dG.

Evidence of Health Impacts of Sulfate-and Nitrate-Containing Particles in Ambient Air

Ambient particulate matter (PM) is a complex mixture of inorganic and organic compounds. The U.S. Environmental Protection Agency (EPA) regulates PM as a criteria pollutant and promulgates National Ambient Air Quality Standards for it. The PM indicator is based on mass concentration, unspecified as to chemical composition, for specific size fractions. The numerical standards are based on epidemiologic evidence of associations between the various size-related particle mass concentrations as indicators and excess mortality and cardiorespiratory health effects as endpoints. The U.S. National Research Council has stated that more research is needed to differentiate the apparent health effects associated with different particle chemical constituents. Sulfate and nitrate constitute a significant portion of the particle mass in the atmosphere, but are accompanied by similar amounts of carbonaceous material, along with low concentrations of various species, including bioactive organic compounds and redox cycling metals. Extensive animal and human toxicology data show no significant effects for particles consisting only of sulfate and nitrate compounds at levels in excess of ambient air concentrations. A few epidemiologic studies, including both short-term time-series studies and long-term cohort studies, have included the sulfate content of PM as a specific variable in health effect analyses. There are much less data for nitrate. The results from the epidemiologic studies with PM sulfate are inconsistent. A detailed analysis of the time-series epidemiological studies shows that PM sulfate has a weaker "risk factor" than PM2.5 for health effects. Since sulfate is correlated with PM2.5, this result is inconsistent with sulfate having a strong health influence. However, there are many limitations with these types of studies that warrant caution for any comparison between a chemical component and mass concentration. In total, the epidemiologic and toxicologic evidence provide little or no support for a causal association of PM sulfate and health risk at ambient concentrations. For nitrate-containing PM, virtually no epidemiological data exist. Limited toxicological evidence does not support a causal association between particulate nitrate compounds and excess health risks. There are some possible indirect processes through which sulfate and nitrate in PM may affect health-related endpoints, including interactions with certain metal species and a linkage with production of secondary organic matter. There is insufficient evidence to include or exclude these processes as being potentially important to PM-associated health risk.

Evaluating the Health Risk from Secondary Sulfates in Eastern North American Regional Ambient Air Particulate Matter

Epidemiological studies of particulate matter (PM) using central area monitors have associated total PM mass, as well as certain individual components of PM, including sulfate, with adverse human health effects. However, some recent studies that used concentrated ambient particles (CAPs) or analyzed the effects of air pollution from different sources or geographic areas suggest that while some particles may be harmful, other particulate species including secondary sulfates may have negligible health effects. Toxicology studies to date also suggest that secondary sulfates pose little health risk. While studies using central-area monitors implicitly assume that all residents of the area are exposed to the same levels of pollution, newer studies find substantial health effects for those in close proximity to major roads. These latter studies recognize that although population exposure to widespread pollutants, such as total PM mass and sulfates, may be relatively uniform over a wide area, exposure to pollutants from local sources is not. While there is an emerging literature associating several adverse health effects with proximity to local pollution sources, the current database provides limited information that allows identification of specific particulate species that may cause little to no harm. In this article, we suggest that ambient secondary sulfates, and eastern North American regional air masses generally, appear to have little adverse impact on public health. This suggestion is based on evidence gleaned from eight avenues of investigation: (1) recent non-central-area monitor studies, including exposure gradient or proximity studies; (2) CAPs studies; (3) studies that examine effects related to different geographic areas or sources; (4) toxicology studies; (5) the limited number of studies that analyze existing central-area monitor data to explicitly examine the health impacts of sulfate and acidity versus PM mass; (6) "modern" area monitor studies with additional capabilities to distinguish among sources of pollution; (7) partial reinterpretation of two pivotal cohort studies; and (8) studies separating effects of secondary sulfates from those of primary metal sulfates. However, uncertainties remain regarding the role that secondary sulfates may play in ambient PM chemistry pathways leading to potentially harmful products, such as the possible effects of secondary organic aerosols that may be the product of acid catalysis of sulfur dioxide. Thus, more targeted study is needed, and some research suggestions are made in this regard.

Disruption of Iron Homeostasis as a Mechanism of Biologic Effect by Ambient Air Pollution Particles

Several features of the clinical presentation and changes in physiology and pathology following exposure to many diverse ambient air pollution particles are comparable, suggesting a common mechanism for their biological effect. We propose that a mechanism of biological effect common to many ambient air pollution particles is a disruption of iron homeostasis in cells and tissues. Among traits shared by every particle-related lung injury is the introduction of a solid-liquid interface into the respiratory tract. All surfaces of particulate matter have some concentration of oxygen-containing functional groups. As a result of its electropositivity, Fe(3+) has a high affinity for oxygen-donor ligands and will react with these groups at the particle surface. Retained particles accumulate metal from available sources in a cell and tissue, and this complexed iron mediates oxidant generation. In addition to complexation onto the solid-liquid interface provided by the surface of particulate matter (PM), there are several alternative pathways by which metal homeostasis in the lower respiratory tract can be disrupted following exposure to ambient air pollution particles to affect an oxidative stress. Evidence suggests that disruption in iron homeostasis following exposures to ambient air pollution particles is an initial event in their biological effect. An association between metal equilibrium in the lower respiratory tract and biological effect in the lung could explain the observed differential toxicity of ultrafine, fine, and coarse particles and disparities in host susceptibility.

Experimental Exposure to Wood-Smoke Particles in Healthy Humans: Effects on Markers of Inflammation, Coagulation, and Lipid Peroxidation

Particulate air pollution is known to increase cardiovascular morbidity and mortality. Proposed mechanisms underlying this increase include effects on inflammation, coagulation factors, and oxidative stress, which could increase the risk of coronary events and atherosclerosis. The aim of this study was to examine whether short-term exposure to wood smoke affects markers of inflammation, blood hemostasis, and lipid peroxidation in healthy humans. Thirteen subjects were exposed to wood smoke and clean air in a chamber during two 4-h sessions, 1 wk apart. The mass concentrations of fine particles at wood smoke exposure were 240-280 mug/m3, and number concentrations were 95,000-180,000/cm3. About half of the particles were ultrafine (< 100 nm). Blood and urine samples were taken before and after the experiment. Exposure to wood smoke increased the levels of serum amyloid A, a cardiovascular risk factor, as well as factor VIII in plasma and the factor VIII/von Willebrand factor ratio, indicating a slight effect on the balance of coagulation factors. Moreover, there was an increased urinary excretion of free 8-iso-prostaglandin2alpha, a major F2-isoprostane, though this was based on nine subjects only, indicating a temporary increase in free radical-mediated lipid peroxidation. Thus, wood-smoke particles at levels that can be found in smoky indoor environments seem to affect inflammation, coagulation, and possibly lipid peroxidation. These factors may be involved in the mechanisms whereby particulate air pollution affects cardiovascular morbidity and mortality. The exposure setup could be used to establish which particle characteristics are critical for the effects.

Dosimetric Comparisons of Particle Deposition and Retention in Rats and Humans

Much of the information on the toxicity of particulate matter (PM) comes from studies in which laboratory rats were exposed to PM by inhalation or instillation. Optimal use of these toxicologic data requires extrapolation to the human scenario. Assuming that comparable doses should cause comparable effects across species and that species respond similarly to a given dose at a target site, extrapolations only require that dose be defined and then characterized. Dose may be defined in terms of a PM indicator (e.g., particle number or mass), a respiratory region, and the time over which the dose is integrated (i.e., deposited versus retained dose and incremental versus accumulated dose). Dose must also be normalized: for example, unit of dose per body mass, respiratory region surface area, or number of alveolar macrophages. The parameters chosen to define a normalized dose can drastically affect the rat exposure concentration required to provide a normalized dose equivalent to that occurring in a human. The publicly available multiple path particle dosimetry model developed by CIIT Centers for Health Research was used to predict particle deposition and retention in rats and humans. Estimates of particle concentration and exposure duration required for a rat to receive the same dose as received by a human were obtained with consideration of daily activity levels and ambient PM size distributions. These techniques were also used to compare dose and response between rats and humans in several published studies. Results indicate that the relationship between PM dose and response may differ between rats and humans. For acute PM exposures, rats may be less susceptible to inflammatory responses than humans. For chronic exposures to high levels of PM, however, an overload of alveolar clearance in rats may cause them to become more susceptible than humans to adverse pulmonary effects. The dosimetric calculations indicate that to achieve nominally similar acute doses per surface area in rats, relative to humans undergoing moderate to high exertion, PM exposure concentrations for rats would need to be somewhat higher than for humans. Since the clearance of PM is faster from the lung of rats than humans, much higher exposure concentrations are required for the rat to simulate retained burdens. In other cases, rats will require lower exposures than humans to have comparable doses, illustrating the complexity of such analyses. To make accurate estimates of dose, it is essential to have accurate and complete information regarding exposure conditions-that is, not only concentration and duration of exposure, but also the aerosol size distribution. Establishing a firm linkage between exposure and dose requires that consideration be given to particle characteristics, definitions of dose metrics, and biological normalizing factors.

A systematic review of the relation between long-term exposure to ambient air pollution and chronic diseases

We conducted a systematic review of all studies published between 1950 and 2007 of associations between long-term exposure to ambient air pollution and the risks in adults of nonaccidental mortality and the incidence and mortality from cancer and cardiovascular and respiratory diseases. We searched bibliographic databases for cohort and case-control studies, abstracted characteristics of their design and conduct, and synthesized the quantitative findings in tabular and graphic form. We assessed heterogeneity, estimated pooled effects for specific pollutants, and conducted sensitivity analyses according to selected characteristics of the studies. Our analysis showed that long-term exposure to PM2.5 increases the risk of nonaccidental mortality by 6% per a 10 microg/m3 increase, independent of age, gender, and geographic region. Exposure to PM2.5 was also associated with an increased risk of mortality from lung cancer (range: 15% to 21% per a 10 microg/m3 increase) and total cardiovascular mortality (range: 12% to 14% per a 10 microg/m3 increase). In addition, living close to busy traffic appears to be associated with elevated risks of these three outcomes. Suggestive evidence was found that exposure to PM2.5 is positively associated with mortality from coronary heart diseases and exposure to SO2 increases mortality from lung cancer. For the other pollutants and health outcomes, the data were insufficient data to make solid conclusions.

Cardiovascular effects of air pollution

Air pollution is a heterogeneous mixture of gases, liquids and PM (particulate matter). In the modern urban world, PM is principally derived from fossil fuel combustion with individual constituents varying in size from a few nanometres to 10 μm in diameter. In addition to the ambient concentration, the pollution source and chemical composition may play roles in determining the biological toxicity and subsequent health effects. Nevertheless, studies from across the world have consistently shown that both short- and long-term exposures to PM are associated with a host of cardiovascular diseases, including myocardial ischaemia and infarctions, heart failure, arrhythmias, strokes and increased cardiovascular mortality. Evidence from cellular/toxicological experiments, controlled animal and human exposures and human panel studies have demonstrated several mechanisms by which particle exposure may both trigger acute events as well as prompt the chronic development of cardiovascular diseases. PM inhaled into the pulmonary tree may instigate remote cardiovascular health effects via three general pathways: instigation of systemic inflammation and/or oxidative stress, alterations in autonomic balance, and potentially by direct actions upon the vasculature of particle constituents capable of reaching the systemic circulation. In turn, these responses have been shown to trigger acute arterial vasoconstriction, endothelial dysfunction, arrhythmias and pro-coagulant/thrombotic actions. Finally, long-term exposure has been shown to enhance the chronic genesis of atherosclerosis. Although the risk to one individual at any single time point is small, given the prodigious number of people continuously exposed, PM air pollution imparts a tremendous burden to the global public health, ranking it as the 13th leading cause of morality (approx. 800000 annual deaths).

Airborne particulate matter exposure and urinary albumin excretion: the Multi-Ethnic Study of Atherosclerosis

OBJECTIVES

Understanding mechanistic pathways linking airborne particle exposure to cardiovascular health is important for causal inference and setting environmental standards. We evaluated whether urinary albumin excretion, a subclinical marker of microvascular function which predicts cardiovascular events, was associated with ambient particle exposure.

METHODS

Urinary albumin and creatinine were measured among members of the Multi-Ethnic Study of Atherosclerosis at three visits during 2000-2004. Exposure to PM(2.5) and PM(10) (microg/m(3)) was estimated from ambient monitors for 1 month, 2 months and two decades before visit one. We regressed recent and chronic (20 year) particulate matter (PM) exposure on urinary albumin/creatinine ratio (UACR, mg/g) and microalbuminuria at first examination, controlling for age, race/ethnicity, sex, smoking, second-hand smoke exposure, body mass index and dietary protein (n = 3901). We also evaluated UACR changes and development of microalbuminuria between the first, and second and third visits which took place at 1.5- to 2-year intervals in relation to chronic PM exposure prior to baseline using mixed models.

RESULTS

Chronic and recent particle exposures were not associated with current UACR or microalbuminuria (per 10 microg/m(3) increment of chronic PM(10) exposure, mean difference in log UACR = -0.02 (95% CI -0.07 to 0.03) and relative probability of having microalbuminuria = 0.92 (95% CI 0.77 to 1.08)) We found only weak evidence that albuminuria was accelerated among those chronically exposed to particles: each 10 microg/m(3) increment in chronic PM(10) exposure was associated with a 1.14 relative probability of developing microalbuminuria over 3-4 years, although 95% confidence intervals included the null (95% CI 0.96 to 1.36).

CONCLUSIONS

UACR is not a strong mechanistic marker for the possible influence of air pollution on cardiovascular health in this sample.

Indoor air pollution from biomass fuel smoke is a major health concern in the developing world

One-third of the world's population burn organic material such as wood, dung or charcoal (biomass fuel) for cooking, heating and lighting. This form of energy usage is associated with high levels of indoor air pollution and an increase in the incidence of respiratory infections, including pneumonia, tuberculosis and chronic obstructive pulmonary disease, low birthweight, cataracts, cardiovascular events and all-cause mortality both in adults and children. The mechanisms behind these associations are not fully understood. This review summarises the available information on biomass fuel use and health, highlighting the current gaps in knowledge.

Hazard and risk assessment of a nanoparticulate cerium oxide-based diesel fuel additive - a case study

Envirox is a scientifically and commercially proven diesel fuel combustion catalyst based on nanoparticulate cerium oxide and has been demonstrated to reduce fuel consumption, greenhouse gas emissions (CO(2)), and particulate emissions when added to diesel at levels of 5 mg/L. Studies have confirmed the adverse effects of particulates on respiratory and cardiac health, and while the use of Envirox contributes to a reduction in the particulate content in the air, it is necessary to demonstrate that the addition of Envirox does not alter the intrinsic toxicity of particles emitted in the exhaust. The purpose of this study was to evaluate the safety in use of Envirox by addressing the classical risk paradigm. Hazard assessment has been addressed by examining a range of in vitro cell and cell-free endpoints to assess the toxicity of cerium oxide nanoparticles as well as particulates emitted from engines using Envirox. Exposure assessment has taken data from modeling studies and from airborne monitoring sites in London and Newcastle adjacent to routes where vehicles using Envirox passed. Data have demonstrated that for the exposure levels measured, the estimated internal dose for a referential human in a chronic exposure situation is much lower than the no-observed-effect level (NOEL) in the in vitro toxicity studies. Exposure to nano-size cerium oxide as a result of the addition of Envirox to diesel fuel at the current levels of exposure in ambient air is therefore unlikely to lead to pulmonary oxidative stress and inflammation, which are the precursors for respiratory and cardiac health problems.

Exposure to concentrated ambient particles does not affect vascular function in patients with coronary heart disease

BACKGROUND

Exposure to fine particulate air pollution is associated with increased cardiovascular morbidity and mortality. We previously demonstrated that exposure to dilute diesel exhaust causes vascular dysfunction in humans.

OBJECTIVES

We conducted a study to determine whether exposure to ambient particulate matter causes vascular dysfunction.

METHODS

Twelve male patients with stable coronary heart disease and 12 age-matched volunteers were exposed to concentrated ambient fine and ultrafine particles (CAPs) or filtered air for 2 hr using a randomized, double-blind cross-over study design. We measured peripheral vascular vasomotor and fibrinolytic function, and inflammatory variables-including circulating leukocytes, serum C-reactive protein, and exhaled breath 8-isoprostane and nitrotyrosine-6-8 hr after both exposures.

RESULTS

Particulate concentrations (mean +/- SE) in the exposure chamber (190+/-37 microg/m(3)) were higher than ambient levels (31+/-8 microg/m(3)) and levels in filtered air (0.5+/-0.4 microg/m(3); p<0.001). Chemical analysis of CAPs identified low levels of elemental carbon. Exhaled breath 8-isoprostane concentrations increased after exposure to CAPs (16.9+/-8.5 vs. 4.9+/-1.2 pg/mL, p<0.05), but markers of systemic inflammation were largely unchanged. Although there was a dose-dependent increase in blood flow and plasma tissue plasminogen activator release (p<0.001 for all), CAPs exposure had no effect on vascular function in either group.

CONCLUSIONS

Despite achieving marked increases in particulate matter, exposure to CAPs--low in combustion-derived particles--did not affect vasomotor or fibrinolytic function in either middle-aged healthy volunteers or patients with coronary heart disease. These findings contrast with previous exposures to dilute diesel exhaust and highlight the importance of particle composition in determining the vascular effects of particulate matter in humans.

Short-term exposure to air pollution and inflammation-sensitive biomarkers

OBJECTIVES

To evaluate the effect of short-term exposure to air pollutants on inflammation-sensitive biomarkers in apparently healthy individuals.

METHODS

We enrolled all participants from The Tel-Aviv Sourasky Medical Center inflammation survey held between 2003 and 2006, excluding participants with an acute or chronic inflammatory disease, pregnancy, steroidal or nonsteroidal treatment, or a recent invasive procedure. Additional subjects were excluded for living more than 11km from the nearest air pollution monitoring station. Analysis was performed separately for men and women. Linear regression models were fitted for each inflammatory variable against air pollutant variables (particulate matter under 10microm, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone) for increasing lag times of up to 7 days, and adjusted for all possible and known confounding parameters.

RESULTS

The study population comprised 3659 individuals (2203 males and 1456 females). We found a statistically significant negative correlation in the male population between air pollutants, mainly NO2, SO2, and CO, and fibrinogen in several lag days. A positive correlation was found for PM10 at day 7. No such correlation was found for CRP and WBC, or for the female population.

CONCLUSION

Our findings do not support the potential link between short-term exposure to air pollution and enhanced inflammation as a possible explanation for increased cardiovascular morbidity. Additional large-scale population-based studies with good methodological design are needed in order to clarify this issue.

A comparison of studies on the effects of controlled exposure to fine, coarse and ultrafine ambient particulate matter from a single location

Particle size has been implicated by epidemiological and toxicological studies as an important determinant of the toxicity of ambient particulate matter (PM). In an effort to characterize the cardiovascular, hematological and pulmonary effects of different PM size fractions in humans, we have conducted controlled human exposures of normal volunteers to ultrafine-, fine- and coarse- fraction PM concentrated from ambient air in Chapel Hill, North Carolina. Healthy non-smoking male and female subjects between the ages of 18 and 35 participated in these studies. Exposures were undertaken with the use of particle concentrators fitted with size-selective outlets. These devices are capable of generating concentration factors between 10- and 20-fold over ambient levels. Cardiovascular endpoints measured include heart rate variability and T-wave alternans, as well as pulmonary function parameters. Subjects underwent bronchoscopy and bronchoalveolar lavage 18 hrs following exposure to PM or to clean air. Lavage fluids and blood samples were assayed for a battery of markers of hematological, cytotoxic and inflammatory injury. The design of these studies permits direct comparison of the effects of concentrated ambient PM as a function of particle size. The data to be presented reveal modest size fraction-dependent effects of concentrated PM exposure on cardiovascular, pulmonary and hematological parameters in normal adult human subjects. These findings have relevant implications for the design of future chamber studies and the role of particle size fraction in the adverse health effects of PM exposure in humans.

PM2.5 and PM10 induce the expression of adhesion molecules and the adhesion of monocytic cells to human umbilical vein endothelial cells

Exposure to airborne particles has been associated with an increase in cardiopulmonary events. Endothelial cells could be playing an important role in the response to airborne particles due their involvement in proinflammatory events, and there is some evidence of particle translocation from lung into circulation. One of the initiating events of inflammation is endothelial activation. We determined the concentration-response effect of a particulate matter with different aerodynamic sizes (PM2.5 [particulate matter with aerodynamic diameter of 2.5 microm and less] and PM10 [particulate matter with aerodynamic diameter of 10 microm and less]) obtained from Mexico City on human umbilical vein endothelial cells (HUVEC). The adhesion of monocytic U937 cells to HUVEC and the expression of early (E- and P-selectins) and late (ICAM-1, PECAM-1, VCAM-1) adhesion molecules were tested. Adhesion of U937 cells to HUVEC was evaluated by coculture experiments using [3H]thymidine-labeled U937 cells and the expression of adhesion molecules was evaluated by flow cytometry. Tumor necrosis factor (TNF)-alpha was used as a positive control of endothelial activation. Our results showed that both PM2.5 and PM10 induced the adhesion of U937 cells to HUVEC, and their maximal effect was observed at 20 microg/cm2. This adhesion was associated with an increase in the expression of all adhesion molecules evaluated for PM10, and E-selectin, P-selectin, and ICAM-1 for PM2.5. In general, maximum expression of adhesion molecules induced by PM2.5 and PM10 was obtained with 20 microg/cm2; however, PM10-induced expression was observed from 5 microg/cm2. E-selectin and ICAM-1 had the strongest expression in response to particles. In conclusion, PM2.5 and PM10 induce the activation of HUVEC, leading to monocytic adhesion via the expression of adhesion molecules, suggesting that these particles may participate in the development of inflammatory diseases. The role of these events in the development of diseases such as atherosclerosis is likely to be evaluated.

Short-term effects of particulate matter: an inflammatory mechanism?

"Would you tell me please, which way I ought to go from here," asked Alice. "That depends a good deal on where you want to go to," said the cat. (Lewis Carroll, Alice's Adventures in Wonderland) A large number of epidemiological studies show positive correlations between increasing levels of particulate matter (PM) in urban air and short-term morbidity and mortality for diverse acute cardiopulmonary diseases. Brought about by PM increments, inflammation is thought to exacerbate preexisting inflammatory diseases. Experimental evidence suggests a hierarchical oxidative stress model, in which a weakened antioxidant defense, as observed in disease or induced by inhaled particles, increases the PM ability to cause lung inflammation, accounting for exacerbations that occur in asthmatics and in patients with chronic obstructive lung disease. The role of PM-induced inflammation leading to acute cardiovascular events such as arrhythmia, heart failure, and myocardial infarction is more speculative. There is neither clear-cut evidence in humans that inhaled PM could get as far as blood circulation nor that proinflammatory mediators are significantly released from inflamed lung tissues, nor that blood coagulability is critically altered. As a whole, data in humans indicate that short-term inflammatory responses to PM are not always detected; they are usually mild and loosely correlated with functional changes. Among these studies, the diversity of PM characteristics, dose metrics, and endpoints hampers a clear discerning of inflammatory mechanism(s). Thus, the question arises as to whether inflammation represents the mechanism of acute cardiopulmonary PM toxicities in susceptible individuals, or rather an event that may coexist with other relevant mechanism(s). This review article discusses the evidence in humans linking short-term PM increments to inflammation and to exacerbations of cardiopulmonary diseases. Although there is a large amount of data available, there still remains a gulf between the number of epidemiological and panel studies and that of controlled exposures. Research on controlled exposure needs expanding, so that the results of time-series and panel studies will be better understood and short-term standards for human exposure may be more confidently allocated.

Ambient particulate matter accelerates coagulation via an IL-6-dependent pathway

The mechanisms by which exposure to particulate matter increases the risk of cardiovascular events are not known. Recent human and animal data suggest that particulate matter may induce alterations in hemostatic factors. In this study we determined the mechanisms by which particulate matter might accelerate thrombosis. We found that mice treated with a dose of well characterized particulate matter of less than 10 microM in diameter exhibited a shortened bleeding time, decreased prothrombin and partial thromboplastin times (decreased plasma clotting times), increased levels of fibrinogen, and increased activity of factor II, VIII, and X. This prothrombotic tendency was associated with increased generation of intravascular thrombin, an acceleration of arterial thrombosis, and an increase in bronchoalveolar fluid concentration of the prothrombotic cytokine IL-6. Knockout mice lacking IL-6 were protected against particulate matter-induced intravascular thrombin formation and the acceleration of arterial thrombosis. Depletion of macrophages by the intratracheal administration of liposomal clodronate attenuated particulate matter-induced IL-6 production and the resultant prothrombotic tendency. Our findings suggest that exposure to particulate matter triggers IL-6 production by alveolar macrophages, resulting in reduced clotting times, intravascular thrombin formation, and accelerated arterial thrombosis. These results provide a potential mechanism linking ambient particulate matter exposure and thrombotic events.

The health impact of common inorganic components of fine particulate matter (PM2.5) in ambient air: a critical review

Ambient air particulate matter (PM) originates as either primary particles emitted directly into the atmosphere from a specific source or as secondary particles produced from atmospheric chemical reactions between precursor gases or between these gases and primary particles. PM can derive from both natural and anthropogenic sources, resulting in a complex chemical mix. The "fine" size mode of ambient PM, designated as PM(2.5), is defined as comprising those particles having aerodynamic diameters below 2.5 microm. While the total mass of PM(2.5) has been associated with adverse human health outcomes, the relationship between these and specific chemical components has not been resolved. This article provides a perspective on the current state of the science concerning health effects from a major group of chemical species found within PM(2.5), namely common inorganic constituents. The specific chemical classes discussed herein are secondary inorganic species, namely, sulfate, nitrate, and acidity, and generally crustal-derived species, namely, phosphate, sodium, potassium, calcium, magnesium, silicon, and aluminum. The article discusses evidence for adverse health effects from inorganic PM(2.5) components within the framework of various caveats surrounding both epidemiology and toxicology assessments. The largest database exists for sulfate, but conclusions that attribute sulfate to health outcomes have not been consistent across all epidemiology studies, and there is a lack of coherence with toxicology studies, which show biological responses only at high levels of exposure. Limited epidemiological and toxicological data for nitrate suggests little or no adverse health effects at current levels. Epidemiological studies specifically identifying crustal components of PM(2.5) suggest that they are not likely, by themselves, to produce a significant health risk, and these components do not have unequivocal biological plausibility from toxicological studies for being significant contributors to adverse health outcomes.

Health effects of airborne particulate matter: do we know enough to consider regulating specific particle types or sources?

Researchers and regulators have often considered preferentially regulating the types of ambient airborne particulate matter (PM) most relevant to human health effects. While few would argue the inherent merits of such a policy, many believe there may not yet be enough information to differentially regulate PM species. New evidence, using increasingly sophisticated methodologies, has become available in the last several years, allowing more accurate assessment of exposure and resultant associations with specific types of PM, or PM derived from different sources. Such new studies may also allow differentiation of effects from different chemical components in the same study against the same health endpoints. This article considers whether this new evidence might be adequate to allow us to "speciate" PM types or sources by severity of health effects. We address this issue with respect to two widespread sources of PM, emissions from motor vehicles and coal-fired power plants. Emissions from less widespread sources, residual oil and steel/coking facilities, are also discussed in order to illustrate how health effects associated with such emissions might instead be associated with more widespread sources when accurate exposure information is unavailable. Based upon evaluation of studies and methodologies which appear to contain the most accurate information on exposure and response to important emissions, including variable local emissions, it is concluded that public health will likely be better protected by reduction of various vehicular emissions than by continued regulation of the total mass of fine PM (PM <2.5 microm, or PM2.5) as if all PM in this mode is equitoxic. However, the knowledge base is incomplete. Important remaining research questions are identified.

Persistent endothelial dysfunction in humans after diesel exhaust inhalation

RATIONALE

Exposure to combustion-derived air pollution is associated with an early (1-2 h) and sustained (24 h) rise in cardiovascular morbidity and mortality. We have previously demonstrated that inhalation of diesel exhaust causes an immediate (within 2 h) impairment of vascular and endothelial function in humans.

OBJECTIVES

To investigate the vascular and systemic effects of diesel exhaust in humans 24 hours after inhalation.

METHODS

Fifteen healthy men were exposed to diesel exhaust (particulate concentration, 300 microg/m(3)) or filtered air for 1 hour in a double-blind, randomized, crossover study. Twenty-four hours after exposure, bilateral forearm blood flow, and inflammatory and fibrinolytic markers were measured before and during unilateral intrabrachial bradykinin (100-1,000 pmol/min), acetylcholine (5-20 microg/min), sodium nitroprusside (2-8 microg/min), and verapamil (10-100 microg/min) infusions.

MEASUREMENTS AND MAIN RESULTS

Resting forearm blood flow, blood pressure, and basal fibrinolytic markers were similar 24 hours after either exposure. Diesel exhaust increased plasma cytokine concentrations (tumor necrosis factor-alpha and interleukin-6, p < 0.05 for both) but appeared to reduce acetylcholine (p = 0.01), and bradykinin (p = 0.08) induced forearm vasodilatation. In contrast, there were no differences in either endothelium-independent (sodium nitroprusside and verapamil) vasodilatation or bradykinin-induced acute plasma tissue plasminogen activator release.

CONCLUSIONS

Twenty-four hours after diesel exposure, there is a selective and persistent impairment of endothelium-dependent vasodilatation that occurs in the presence of mild systemic inflammation. These findings suggest that combustion-derived air pollution may have important systemic and adverse vascular effects for at least 24 hours after exposure.

Ambient particulate air pollution from vehicles promotes lipid peroxidation and inflammatory responses in rat lung

Oxidative stress plays a major role in the pathogenesis of particle-dependent lung injury. Ambient particle levels from vehicles have not been previously shown to cause oxidative stress to the lungs. The present study was conducted to a) determine whether short-term exposure to ambient levels of particulate air pollution from vehicles elicits inflammatory responses and lipid peroxidation in rat lungs, and b) determine if intermittent short-term exposures (every 4 days) induce some degree of tolerance. Three-month-old male Wistar rats were exposed to ambient particulate matter (PM) from vehicles (N = 30) for 6 or 20 continuous hours, or for intermittent (5 h) periods during 20 h for 4 consecutive days or to filtered air (PM <10 microm; N = 30). Rats continuously breathing polluted air for 20 h (P-20) showed a significant increase in the total number of leukocytes in bronchoalveolar lavage compared to control (C-20: 2.61 x 105 +/- 0.51;P-20: 5.01 x 105 +/- 0.81; P < 0.05) and in lipid peroxidation ([MDA] nmol/mg protein: C-20: 0.148 +/- 0.01; P-20: 0.226 +/- 0.02; P < 0.05). Shorter exposure (6 h) and intermittent 5-h exposures over a period of 4 days did not cause significant changes in leukocytes. Lipid damage resulting from 20-h exposure to particulate air pollution did not cause a significant increase in lung water content. These data suggest oxidative stress as one of the mechanisms responsible for the acute adverse respiratory effects of particles, and suggest that short-term inhalation of ambient particulate air pollution from street with high automobile traffic represents a biological hazard.

Air pollution and inflammation (interleukin-6, C-reactive protein, fibrinogen) in myocardial infarction survivors

BACKGROUND

Numerous studies have found that ambient air pollution has been associated with cardiovascular disease exacerbation.

OBJECTIVES

Given previous findings, we hypothesized that particulate air pollution might induce systemic inflammation in myocardial infarction (MI) survivors, contributing to an increased vulnerability to elevated concentrations of ambient particles.

METHODS

A prospective longitudinal study of 1,003 MI survivors was performed in six European cities between May 2003 and July 2004. We compared repeated measurements of interleukin 6 (IL-6), fibrinogen, and C-reactive protein (CRP) with concurrent levels of air pollution. We collected hourly data on particle number concentrations (PNC), mass concentrations of particulate matter (PM) < 10 microm (PM(10)) and < 2.5 microm (PM(2.5)), gaseous pollutants, and meteorologic data at central monitoring sites in each city. City-specific confounder models were built for each blood marker separately, adjusting for meteorology and time-varying and time-invariant covariates. Data were analyzed with mixed-effects models.

RESULTS

Pooled results show an increase in IL-6 when concentrations of PNC were elevated 12-17 hr before blood withdrawal [percent change of geometric mean, 2.7; 95% confidence interval (CI), 1.0-4.6]. Five day cumulative exposure to PM(10) was associated with increased fibrinogen concentrations (percent change of arithmetic mean, 0.6; 95% CI, 0.1-1.1). Results remained stable for smokers, diabetics, and patients with heart failure. No consistent associations were found for CRP.

CONCLUSIONS

Results indicate an immediate response to PNC on the IL-6 level, possibly leading to the production of acute-phase proteins, as seen in increased fibrinogen levels. This might provide a link between air pollution and adverse cardiac events.

Air pollution and emergency admissions in Boston, MA

STUDY OBJECTIVE

Many studies have shown that ambient particulate air pollution (PM) is associated with increased risk of hospital admissions and deaths for cardiovascular or respiratory causes around the world. In general these have been analysed in association with PM(10) and ozone, whereas PM(2.5) is now the particle measure of greatest health and regulatory concern. And little has been published on associations of hospital admissions and PM components.

DESIGN

This study analysed hospital admissions for myocardial infarction (15 578 patients), and pneumonia (24 857 patients) in associations with fine particulate air pollution, black carbon (BC), ozone, nitrogen dioxide (NO(2)), PM not from traffic, and carbon monoxide (CO) in the greater Boston area for the years 1995-1999 using a case-crossover analysis, with control days matched on temperature.

MAIN RESULTS

A significant association was found between NO(2) (12.7% change (95% CI: 5.8, 18)), PM(2.5) (8.6% increase (95% CI: 1.2, 15.4)), and BC (8.3% increase (95% CI: 0.2, 15.8)) and the risk of emergency myocardial infarction hospitalisation; and between BC (11.7% increase (95% CI: 4.8, 17.4)), PM(2.5) (6.5% increase (95% CI: 1.1, 11.4)), and CO (5.5% increase (95% CI: 1.1, 9.5)) and the risk of pneumonia hospitalisation.

CONCLUSIONS

The pattern of associations seen for myocardial infarction and pneumonia (strongest associations with NO(2), CO, and BC) suggests that traffic exposure is primarily responsible for the association with heart attacks.

Particulate air pollution, progression, and survival after myocardial infarction

OBJECTIVE

Several studies have examined the effect of particulate pollution (PM) on survival in general populations, but less is known about susceptible groups. Moreover, previous cohort studies have been cross-sectional and subject to confounding by uncontrolled differences between cities.

DESIGN

We investigated whether PM was associated with progression of disease or reduced survival in a study of 196,000 persons from 21 U.S. cities discharged alive following an acute myocardial infarction (MI), using within-city between-year exposure to PM. We constructed city-specific cohorts of survivors of acute MI using Medicare data between 1985 and 1999, and defined three outcomes on follow-up: death, subsequent MI, and a first admission for congestive heart failure (CHF). Yearly averages of PM(10) (particulate matter with aerodynamic diameter < 10 microm) were merged to the individual annual follow-up in each city. We applied Cox's proportional hazard regression model in each city, with adjustment for individual risk factors. In the second stage of the analysis, the city-specific results were combined using a meta-regression.

RESULTS

We found significant associations with a hazard ratio for the sum of the distributed lags of 1.3 [95% confidence interval (CI), 1.2-1.5] for mortality, a hazard ratio of 1.4 (95% CI, 1.2-1.7) for a hospitalization for CHF, and a hazard ratio of 1.4 (95% CI, 1.1-1.8) for a new hospitalization for MI per 10 microg/m(3) PM(10).

CONCLUSIONS

This is the first long-term study showing a significant association between particle exposure and adverse post-MI outcomes in persons who survived an MI.

The effect of urban air pollution on inflammation, oxidative stress, coagulation, and autonomic dysfunction in young adults

RATIONALE

The biological mechanisms linking air pollution to cardiovascular events still remain largely unclear.

OBJECTIVES

To investigate whether biological mechanisms linking air pollution to cardiovascular events occurred concurrently in human subjects exposed to urban air pollutants.

METHODS

We recruited a panel of 76 young, healthy students from a university in Taipei. Between April and June of 2004 or 2005, three measurements were made in each participant of high-sensitivity C-reactive protein (hs-CRP), 8-hydroxy-2'-deoxyguanosine (8-OHdG), plasminogen activator fibrinogen inhibitor-1 (PAI-1), tissue-type plasminogen activator (tPA) in plasma, and heart rate variability (HRV). Gaseous air pollutants were measured at one air-monitoring station inside their campus, and particulate air pollutants were measured at one particulate matter supersite monitoring station 1 km from their campus. We used linear mixed-effects models to associate biological endpoints with individual air pollutants averaged over 1- to 3-day periods before measurements were performed.

MEASUREMENTS AND MAIN RESULTS

We found that increases in hs-CRP, 8-OHdG, fibrinogen, and PAI-1, and decreases in HRV indices were associated with increases in levels of particles with aerodynamic diameters less than 10 microm and 2.5 microm, sulfate, nitrate, and ozone (O(3)) in single-pollutant models. The increase in 8-OHdG, fibrinogen, and PAI-1, and the reduction in HRV remained significantly associated with 3-day averaged sulfate and O(3) levels in two-pollutant models. There were moderate correlations (r = -0.3) between blood markers of hs-CRP, fibrinogen, PAI-1, and HRV indices.

CONCLUSIONS

Urban air pollution is associated with inflammation, oxidative stress, blood coagulation and autonomic dysfunction simultaneously in healthy young humans, with sulfate and O(3) as two major traffic-related pollutants contributing to such effects.

Is air pollution a cause of cardiovascular disease? Updated review and controversies

Particulate matter (PM) air pollution is associated with an increased risk of cardiovascular morbidity and mortality. The focus of this review will be on the role that both acute and chronic exposure to PM plays in causing cardiovascular disease and on the latest major new findings and controversies in this field of research. Even short-term exposure to PM2.5 over a few hours can trigger myocardial infarctions, cardiac ischemia, arrhythmias, heart failure, stroke, exacerbation of peripheral arterial disease, and sudden death. Chronic exposure to moderately elevated levels also enhances the risk for developing a variety of cardiovascular diseases, possibly including hypertension and systemic atherosclerosis. Recent epidemiologic studies have furthered our understanding of the linkage between air pollutants and human health, with a multitude of plausible mechanistic explanations having been demonstrated experimentally during the past few years. Although a number of finer details relating to both the epidemiology and the mechanisms involved require more investigation, the overall weight of evidence is now sufficient to implicate PM exposure as a cause of cardiovascular disease. Without doubt, exposure to particulate matter can play a causal role in triggering a host of acute cardiovascular events via many mechanisms. Although long-term air pollution exposure has been shown to promote the development of atherosclerosis, the clinical significance of this relation requires more investigation.

Ambient and microenvironmental particles and exhaled nitric oxide before and after a group bus trip

OBJECTIVES

Airborne particles have been linked to pulmonary oxidative stress and inflammation. Because these effects may be particularly great for traffic-related particles, we examined associations between particle exposures and exhaled nitric oxide (FE(NO)) in a study of 44 senior citizens, which involved repeated trips aboard a diesel bus.

METHODS

Samples of FE(NO) collected before and after the trips were regressed against microenvironmental and ambient particle concentrations using mixed models controlling for subject, day, trip, vitamins, collection device, mold, pollen, room air nitric oxide, apparent temperature, and time to analysis. Although ambient concentrations were collected at a fixed location, continuous group-level personal samples characterized microenvironmental exposures throughout facility and trip periods.

RESULTS

In pre-trip samples, both microenvironmental and ambient exposures to fine particles were positively associated with FE(NO). For example, an interquartile increase of 4 microg/m(3) in the daily microenvironmental PM(2.5) concentration was associated with a 13% [95% confidence interval (CI), 2-24%) increase in FE(NO). After the trips, however, FE(NO) concentrations were associated pre-dominantly with microenvironmental exposures, with significant associations for concentrations measured throughout the whole day. Associations with exposures during the trip also were strong and statistically significant with a 24% (95% CI, 15-34%) increase in FE(NO) predicted per interquartile increase of 9 microg/m(3) in PM(2.5). Although pre-trip findings were generally robust, our post-trip findings were sensitive to several influential days.

CONCLUSIONS

Fine particle exposures resulted in increased levels of FE(NO) in elderly adults, suggestive of increased airway inflammation. These associations were best assessed by microenvironmental exposure measurements during periods of high personal particle exposures.

Associations of Fine and Ultrafine Particulate Air Pollution With Stroke Mortality in an Area of Low Air Pollution Levels

Background and Purpose— Daily variation in outdoor concentrations of inhalable particles (PM 10 <10 μm in diameter) has been associated with fatal and nonfatal stroke. Toxicological and epidemiological studies suggest that smaller, combustion-related particles are especially harmful. We therefore evaluated the effects of several particle measures including, for the first time to our knowledge, ultrafine particles (<0.1 μm) on stroke.

Methods— Levels of particulate and gaseous air pollution were measured in 1998 to 2004 at central outdoor monitoring sites in Helsinki. Associations between daily levels of air pollutants and deaths caused by stroke among persons aged 65 years or older were evaluated in warm and cold seasons using Poisson regression.

Results— There was a total of 1304 and 1961 deaths from stroke in warm and cold seasons, respectively. During the warm season, there were positive associations of stroke mortality with current- and previous-day levels of fine particles (<2.5 μm, PM 2.5 ) (6.9%; 95% CI, 0.8% to 13.8%; and 7.4%; 95% CI, 1.3% to 13.8% for an interquartile increase in PM 2.5 ) and previous-day levels of ultrafine particles (8.5%; 95% CI, −1.2% to 19.1%) and carbon monoxide (8.3; 95% CI, 0.6 to 16.6). Associations for fine particles were mostly independent of other pollutants. There were no associations in the cold season.

Conclusions— Our results suggest that especially PM 2.5 , but also ultrafine particles and carbon monoxide, are associated with increased risk of fatal stroke, but only during the warm season. The effect of season might be attributable to seasonal differences in exposure or air pollution mixture.