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Miller A. Recognizing the pleura in asbestos-related pleuropulmonary disease: Known and new manifestations of pleural fibrosis. Am J Ind Med 2024; 67:73-80. [PMID: 38030592 DOI: 10.1002/ajim.23553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
Pleural thickening (PT) is a major consequence of exposure to all fiber types of asbestos. In recent decades, it is more prevalent than parenchymal asbestosis. Its manifestations occupy a full clinical and radiographic spectrum. Six major manifestations can be identified: (a) acute pleuritis generally with effusion; (b) diffuse PT or fibrous pleuritis; (c) rounded atelectasis; (d) circumscribed PT or plaques; (e) chronic pleuritic pain; and (f) mesothelioma. Review of the experience of workers and community members in Libby, MT to asbestiform fibers in vermiculite has confirmed the appearance of these previously known benign and malignant asbestos-related diseases as well as a unique pleuropulmonary disease characterized as lamellar PT and associated with progressive decline in pulmonary function and pleuritic pain. Despite previous literature asserting that PT represents a marker for asbestos exposure without significant effect on pulmonary function and physiology, the experience of Libby amphibole (LA) disease, along with other studies, indicates that PT plays a role in declining vital capacity in those with prolonged or unusual exposures such as those arising from LA.
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Affiliation(s)
- Albert Miller
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, New York, USA
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Wang A, Gupta A, Grimm MD, Pressburger DT, Sparrow BR, Richey JS, Shaw JR, Elsass KE, Roberts GK, Yao PL, Stout MD, Ellis BJ, Ray RL. Natural mineral fibers: conducting inhalation toxicology studies-part B: development of a nose-only exposure system for repeat-exposure in vivo study of Libby amphibole aerosol. Inhal Toxicol 2023; 35:214-229. [PMID: 37339372 PMCID: PMC11059106 DOI: 10.1080/08958378.2023.2220735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Exposure to asbestos is associated with malignant and nonmalignant respiratory disease. To strengthen the scientific basis for risk assessment on fibers, the National Institute of Environmental Health Sciences (NIEHS) has initiated a series of studies to address fundamental questions on the toxicology of naturally occurring asbestos and related mineral fibers after inhalation exposure. A prototype nose-only exposure system was previously developed and validated. The prototype system was expanded to a large-scale exposure system in this study for conducting subsequent in vivo rodent inhalation studies of Libby amphibole (LA) 2007, selected as a model fiber. RESULTS The exposure system consisting of six exposure carousels was able to independently deliver stable LA 2007 aerosol to individual carousels at target concentrations of 0 (control group), 0.1, 0.3, 1, 3, or 10 mg/m3. A single aerosol generator was used to provide aerosol to all carousels to ensure that exposure atmospheres were chemically and physically similar, with aerosol concentration as the only major variable among the carousels. Transmission electron microscopy (TEM) coupled with energy dispersive spectrometry (EDS) and selected area electron diffraction (SAED) analysis of aerosol samples collected at the exposure ports indicated the fiber dimensions, chemical composition, and mineralogy were equivalent across exposure carousels and were comparable to the bulk LA 2007 material. CONCLUSION The exposure system developed is ready for use in conducting nose-only inhalation toxicity studies of LA 2007 in rats. The exposure system is anticipated to have applicability for the inhalation toxicity evaluation of other natural mineral fibers of concern.
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Affiliation(s)
| | - Amit Gupta
- Battelle Memorial Institute, Columbus, OH, USA
| | | | | | | | | | | | | | - Georgia K. Roberts
- Division of Translational Toxicology, National Institute of Environmental Health Sciences of the U.S., RTP, NC, USA
| | - Pei-Li Yao
- Division of Translational Toxicology, National Institute of Environmental Health Sciences of the U.S., RTP, NC, USA
| | - Matthew D. Stout
- Division of Translational Toxicology, National Institute of Environmental Health Sciences of the U.S., RTP, NC, USA
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Wang A, Gupta A, Grimm MD, Pressburger DT, Sparrow BR, Richey JS, Shaw JR, Elsass KE, Roberts GK, Yao PL, Stout MD, Ellis BJ, Ray RL. Natural mineral fibers: conducting inhalation toxicology studies - part A: Libby Amphibole aerosol generation and characterization method development. Inhal Toxicol 2023; 35:201-213. [PMID: 37339371 PMCID: PMC11062073 DOI: 10.1080/08958378.2023.2220737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Asbestos has been classified as a human carcinogen, and exposure may increase the risk of diseases associated with impaired respiratory function. As the range of health effects and airborne concentrations that result in health effects across asbestos-related natural mineral fiber types are not fully understood, the National Institute of Environmental Health Sciences has established a series of research studies to characterize hazards of natural mineral fibers after inhalation exposure. This paper presents the method development work of this research project. RESULTS A prototype nose-only exposure system was fabricated to explore the feasibility of generating natural mineral fiber aerosol for in vivo inhalation toxicity studies. The prototype system consisted of a slide bar aerosol generator, a distribution/delivery system and an exposure carousel. Characterization tests conducted using Libby Amphibole 2007 (LA 2007) demonstrated the prototype system delivered stable and controllable aerosol concentration to the exposure carousel. Transmission electron microscopy (TEM) analysis of aerosol samples collected at the exposure port showed the average fiber length and width were comparable to the bulk LA 2007. TEM coupled with energy dispersive spectrometry (EDS) and selected area electron diffraction (SAED) analysis further confirmed fibers from the aerosol samples were consistent with the bulk LA 2007 chemically and physically. CONCLUSIONS Characterization of the prototype system demonstrated feasibility of generating LA 2007 fiber aerosols appropriate for in vivo inhalation toxicity studies. The methods developed in this study are suitable to apply to a multiple-carousel exposure system for a rat inhalation toxicity testing using LA 2007.
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Affiliation(s)
| | - Amit Gupta
- Battelle Memorial Institute, Columbus, OH, USA
| | | | | | | | | | | | | | - Georgia K. Roberts
- Division of Translational Toxicology, National Institute of Environmental Health Sciences of the U.S., RTP, NC, USA
| | - Pei-Li Yao
- Division of Translational Toxicology, National Institute of Environmental Health Sciences of the U.S., RTP, NC, USA
| | - Matthew D. Stout
- Division of Translational Toxicology, National Institute of Environmental Health Sciences of the U.S., RTP, NC, USA
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Chen L, Zhu M, Lu H, Yang T, Li W, Zhang Y, Xie Q, Li Z, Wan H, Luo F. Quantitative evaluation of disease severity in connective tissue disease-associated interstitial lung disease by dual-energy computed tomography. Respir Res 2022; 23:47. [PMID: 35248040 PMCID: PMC8897904 DOI: 10.1186/s12931-022-01972-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background High-resolution computed tomography (HRCT) is recommended diagnosing and monitoring connective tissue disease-associated interstitial lung disease (CTD-ILD). Quantitative computed tomography has the potential to precisely assess the radiological severity of CTD-ILD, but has still been under study. Objective To investigate whether dual-energy computed tomography (DECT), a novel quantitative technique, can be used for quantitative severity assessment in CTD-ILD. Methods This cross sectional study recruited adult CTD-ILD patients who underwent DECT scans from the ICE study between October 2019 and November 2021. DECT parameters, including effective atomic number (Zeff), lung (lobe) volume, and monochromatic CT number (MCTN) of each lung lobe, were evaluated. CTD-ILD was classified into extensive CTD-ILD and limited CTD-ILD by staging algorithm using combined forced vital capacity (FVC)%predicted and total extent of ILD (TEI) on CT. Dyspnea, cough, and life quality were scored by Borg dyspnea score, Leicester cough questionnaire (LCQ), and short-form 36 health survey questionnaire (SF-36), respectively. Results There was a total of 147 patients with DECT scans enrolled. Higher Zeff value (3.104 vs 2.256, p < 0.001), higher MCTN (− 722.87 HU vs − 802.20 HU, p < 0.001), and lower lung volume (2309.51cm3 vs 3475.21cm3, p < 0.001) were found in extensive CTD-ILD compared with limited CTD-ILD. DECT parameters had significant moderate correlations with FVC%predicted (|r|= 0.542–0.667, p < 0.01), DLCO%predicted (|r|= 0.371–0.427, p < 0.01), and TEI (|r|= 0.485–0.742, p < 0.01). Receiver operating characteristic (ROC) analysis indicated MCTN averaged over the whole lung had the best performance for extensive CTD-ILD discrimination (AUC = 0.901, cut-off: − 762.30 HU, p < 0.001), with a sensitivity of 82.1% and a specificity of 85.4%. The Zeff value was the independent risk factor for dyspnea (OR = 3.644, 95% CI: 1.846–7.192, p < 0.001) and cough (OR = 3.101, 95% CI: 1.528–6.294, p = 0.002), and lung volume significantly contributed to the mental component summary (MCS) in SF-36 (standardized β = 0.198, p < 0.05). Conclusions DECT can be applied to evaluate the severity of CTD-ILD. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-01972-4.
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Miller A, Black CB, Loewen G, Noonan CW, McNew T, Whitehouse AC, Frank AL. Case-fatality study of workers and residents with radiographic asbestos disease in Libby, Montana. Am J Ind Med 2022; 65:196-202. [PMID: 34961951 PMCID: PMC9303583 DOI: 10.1002/ajim.23320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022]
Abstract
Background Vermiculite ore from Libby, Montana contains on average 24% of a mixture of toxic and carcinogenic amphibole asbestiform fibers. These comprise primarily winchite (84%), with smaller quantities of richterite (11%) and tremolite (6%), which are together referred to as Libby amphibole (LA). Methods A total of 1883 individuals who were occupationally and/or environmentally exposed to LA and were diagnosed with asbestos‐related pleuropulmonary disease (ARPPD) following participation in communitywide screening programs supported by the Agency for Toxic Substances and Disease Registry (ATSDR) and followed up at the Center for Asbestos Related Disease (CARD) between 2000 and 2010. There were 203 deaths of patients with sufficient records and radiographs. Best clinical and radiologic evidence was used to determine the cause of death, which was compared with death certificates. Results Asbestos‐related mortality was 55% (n = 112) in this series of 203 patients. Of the 203 deaths, 34 (17%) were from asbestos‐related malignancy, 75 (37%) were from parenchymal asbestosis, often with pleural fibrosis, and 3 (1.5%) were from respiratory failure secondary to pleural thickening. Conclusions Asbestos is the leading cause of mortality following both occupational and nonoccupational exposure to LA in those with asbestos‐related disease.
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Affiliation(s)
- Albert Miller
- Icahn School of Medicine at Mount Sinai New York New York USA
| | | | | | | | - Tracy McNew
- Center for Asbestos Related Disease Libby Montana USA
| | | | - Arthur L. Frank
- Department of Environmental and Occupational Health Drexel University School of Public Health, Philadelphia Pennsylvania USA
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Badger R, Park K, Pietrofesa RA, Christofidou-Solomidou M, Serve KM. Late Inflammation Induced by Asbestiform Fibers in Mice Is Ameliorated by a Small Molecule Synthetic Lignan. Int J Mol Sci 2021; 22:ijms222010982. [PMID: 34681644 PMCID: PMC8537122 DOI: 10.3390/ijms222010982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Exposure to Libby amphibole (LA) asbestos-like fibers is associated with increased risk of asbestosis, mesothelioma, pulmonary disease, and systemic autoimmune disease. LGM2605 is a small molecule antioxidant and free radical scavenger, with anti-inflammatory effects in various disease models. The current study aimed to determine whether the protective effects of LGM2605 persist during the late inflammatory phase post-LA exposure. Male and female C57BL/6 mice were administered daily LGM2605 (100 mg/kg) via gel cups for 3 days before and 14 days after a 200 µg LA given via intraperitoneal (i.p.) injection. Control mice were given unsupplemented gel cups and an equivalent dose of i.p. saline. On day 14 post-LA treatment, peritoneal lavage was assessed for immune cell influx, cytokine concentrations, oxidative stress biomarkers, and immunoglobulins. During the late inflammatory phase post-LA exposure, we noted an alteration in trafficking of both innate and adaptive immune cells, increased pro-inflammatory cytokine concentrations, induction of immunoglobulin isotype switching, and increased oxidized guanine species. LGM2605 countered these changes similarly among male and female mice, ameliorating late inflammation and altering immune responses in late post-LA exposure. These data support possible efficacy of LGM2605 in the prolonged treatment of LA-associated disease and other inflammatory conditions.
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Affiliation(s)
- Reagan Badger
- Department of Biological Sciences, Idaho State University, Pocatello, ID 83209, USA;
| | - Kyewon Park
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (K.P.); (R.A.P.); (M.C.-S.)
| | - Ralph A. Pietrofesa
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (K.P.); (R.A.P.); (M.C.-S.)
| | - Melpo Christofidou-Solomidou
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (K.P.); (R.A.P.); (M.C.-S.)
| | - Kinta M. Serve
- Department of Biological Sciences, Idaho State University, Pocatello, ID 83209, USA;
- Correspondence:
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Copper Oxide Nanoparticle-Induced Acute Inflammatory Response and Injury in Murine Lung Is Ameliorated by Synthetic Secoisolariciresinol Diglucoside (LGM2605). Int J Mol Sci 2021; 22:ijms22179477. [PMID: 34502389 PMCID: PMC8430773 DOI: 10.3390/ijms22179477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Metal-oxide nanoparticles (MO-NPs), such as the highly bioreactive copper-based nanoparticles (CuO-NPs), are widely used in manufacturing of hundreds of commercial products. Epidemiological studies correlated levels of nanoparticles in ambient air with a significant increase in lung disease. CuO-NPs, specifically, were among the most potent in a set of metal-oxides and carbons studied in parallel regarding DNA damage and cytotoxicity. Despite advances in nanotoxicology research and the characterization of their toxicity, the exact mechanism(s) of toxicity are yet to be defined. We identified chlorination toxicity as a damaging consequence of inflammation and myeloperoxidase (MPO) activation, resulting in macromolecular damage and cell damage/death. We hypothesized that the inhalation of CuO-NPs elicits an inflammatory response resulting in chlorination damage in cells and lung tissues. We further tested the protective action of LGM2605, a synthetic small molecule with known scavenging properties for reactive oxygen species (ROS), but most importantly, for active chlorine species (ACS) and an inhibitor of MPO. CuO-NPs (15 µg/bolus) were instilled intranasally in mice and the kinetics of the inflammatory response in lungs was evaluated 1, 3, and 7 days later. Evaluation of the protective action of LGM2605 was performed at 24 h post-challenge, which was selected as the peak acute inflammatory response to CuO-NP. LGM2605 was given daily via gavage to mice starting 2 days prior to the time of the insult (100 mg/kg). CuO-NPs induced a significant inflammatory influx, inflammasome-relevant cytokine release, and chlorination damage in mouse lungs, which was mitigated by the action of LGM2605. Preventive action of LGM2605 ameliorated the adverse effects of CuO-NP in lung.
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Miller A, Loewen GM, Szeinuk J. Follow-Up of the Libby, Montana Screening Cohort: A 17-Year Mortality Study: Likely Underestimation of Nonmalignant Asbestos-Related Disease. J Occup Environ Med 2020; 62:e233-e234. [PMID: 32398507 DOI: 10.1097/jom.0000000000001838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Albert Miller
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, The Barry Commoner Center for Health and the Environment, Queens College, CUNY, Flushing, New York
| | - Gregory M Loewen
- The Center for Asbestos Related Disease, Libby, Montana, Division of Pulmonary Medicine, Arnold Ogden Medical Center, Elmira, New York
| | - Jaime Szeinuk
- Department of Occupational Medicine, Epidemiology, and Prevention, Northwell Health System, Manhasset, New York
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Winters CA, Kuntz SW. A Comparison of Environmental Concerns in Two Disparate Montana and Nevada Communities. ANNUAL REVIEW OF NURSING RESEARCH 2019; 38:113-130. [PMID: 32102958 DOI: 10.1891/0739-6686.38.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Asbestos refers to six fibrous minerals that occur naturally in the environment in the United States and throughout the world. Deposits may be found in soil, rocks, and deposits of other minerals such as vermiculite and talc. These naturally occurring asbestos (NOA) minerals belong to the serpentine and amphibole family of minerals. This chapter reports shared components of community-driven environmental concerns related to exposure to NOA in a rural Montana and a suburban Nevada community. The specific aim is to establish an understanding of the community and community member's primary concern(s) related to NOA in both communities. The knowledge that NOA is commonly found in areas across the United States supports the need for additional research into the health effects of environmental exposure and best-practices to reduce exposure risk while allowing communities to thrive economically.
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Pfau JC, McNew T, Hanley K, Swan L, Black B. Autoimmune markers for progression of Libby amphibole lamellar pleural thickening. Inhal Toxicol 2019; 31:409-419. [PMID: 31814459 DOI: 10.1080/08958378.2019.1699616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Exposure to Libby Asbestiform Amphibole (LAA) is associated with asbestos-related diseases, including mesothelioma, pulmonary carcinoma, pleural fibrosis, and systemic autoimmune diseases. The pleural fibrosis can manifest as a rapidly progressing lamellar pleural thickening (LPT), which causes thoracic pain, dyspnea, and worsening pulmonary function tests (PFT). It is refractory to treatment and frequently fatal.Objective: Because of the immune dysfunction that has been described in the LAA-exposed population and the association of pleural manifestations with the presence of autoantibodies, this study tested whether specific immunological factors were associated with progressive LPT and whether they could be used as markers of progressive disease.Methods: Subjects were placed into three study groups defined as (1) progressive LPT, (2) stable LPT, (3) no LPT. Serum samples were tested for antinuclear autoantibodies, mesothelial cell autoantibodies, anti-plasminogen antibodies, IL1 beta, and IL17; which have all been shown to be elevated in mice and/or humans exposed to LAA.Results: Group 1 had significantly higher mean values for all of the autoantibodies, but not IL1 or IL-17, compared to the control Group 3. All three autoantibody tests had high specificity but low sensitivity, but ROC area-under-the-curve values for all three antibodies were over 0.7, statistically higher than a test with no value. When all LPT subjects were combined (Progressive plus Stable), no marker had predictive value for disease.Conclusion: The data support the hypothesis that progressive LPT is associated with immunological findings that may serve as an initial screen for progressive LPT.
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Affiliation(s)
- Jean C Pfau
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT, USA
| | - Tracy McNew
- Center for Asbestos Related Diseases, Libby, MT, USA
| | | | - Lindsay Swan
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT, USA
| | - Brad Black
- Center for Asbestos Related Diseases, Libby, MT, USA
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Loewen G, Black B, McNew T, Miller A. Lung cancer screening in patients with Libby amphibole disease: High yield despite predominantly environmental and household exposure. Am J Ind Med 2019; 62:1112-1116. [PMID: 31535393 PMCID: PMC6899927 DOI: 10.1002/ajim.23042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 01/11/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022]
Abstract
Background Lung cancer screening with low‐dose computed tomography (CT) scanning (LDCT) is accepted as a screening tool, but its application to populations exposed to recognized occupational or environmental carcinogens is limited. We apply LDCT to a population with a predominantly nonoccupational exposure to a recognized human lung carcinogen, Libby amphibole asbestos (LA). Methods Patients in an asbestos disease clinic in Libby, Montana who were aged 50 to 84 years, greater than or equal to 20 pack‐year history of tobacco use (irrespective of quit date), and asbestos‐related pleuropulmonary disease on high‐resolution CT scan were offered free annual lung cancer screening over a 39‐month period. Results Of 2897 clinic patients, 1149 (39.7%) met eligibility criteria, and 567 (49%) were screened with 1014 low‐dose CT scans. Most screened patients had principally environmental (333 or 59%) or household exposure (145 or 25%) to LA. Seventeen primary lung cancers were identified, mostly in early stages: 10 at stage 1, two at stage 2, three at stages 3 to 4, and two at limited small‐cell cancers. The screening yield was 1.9 at baseline scan and 1.5% on the first annual scan. Conclusions Consistent with the guidelines of the National Comprehensive Cancer Network and American Association of Thoracic Surgery, LDCT for early lung cancer detection should be offered to people with significant exposure to occupational or environmental human lung carcinogens.
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Affiliation(s)
- Gregory Loewen
- Washington State University Spokane Washington
- Center for Asbestos‐Related Disease Libby Montana
| | - Brad Black
- Center for Asbestos‐Related Disease Libby Montana
| | - Tracy McNew
- Center for Asbestos‐Related Disease Libby Montana
| | - Albert Miller
- Barry Commoner Center for the Environment and Health, Queens CollegeCity University of New York Flushing New York
- Division of Pulmonary and Critical Care MedicineMount Sinai Beth Israel Medical Center New York New York
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Libby Amphibole Disease: Pulmonary Function and CT Abnormalities in Vermiculite Miners. J Occup Environ Med 2019; 60:167-173. [PMID: 29200190 DOI: 10.1097/jom.0000000000001178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This article describes radiologic and pulmonary function findings among miners exposed to Libby amphibole. Computed tomography (CT) permits the detection of the characteristic thin, lamellar pleural thickening (LPT). METHODS Individuals who worked at the mine for a minimum of 6 months had chest CT and pulmonary function tests. RESULTS Pleural thickening was noted in 223 (87%) of the 256 miners, parenchymal abnormalities in 49 (19%). LPT, found in 151 (68%), was associated with low values of forced vital capacity and diffusion capacity and significantly lower values in all pulmonary function tests when associated with parenchymal abnormalities. CONCLUSION Eighty-seven percent of miners exposed to Libby Amphibole had pleural abnormalities on CT. LPT alone, and more so with parenchymal abnormalities, resulted in decreased pulmonary function. The importance of this easily missed LPT is demonstrated by its high frequency and significant functional effects.
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Konen T, Johnson JE, Lindgren P, Williams A. Cancer incidence and mortality associated with non-occupational and low dose exposure to Libby vermiculite in Minnesota. ENVIRONMENTAL RESEARCH 2019; 175:449-456. [PMID: 31158563 DOI: 10.1016/j.envres.2019.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND A vermiculite processing plant in a Minneapolis, Minnesota neighborhood utilized asbestos-containing ore from Libby, Montana from the late 1930's until 1989. Multiple pathways of exposure to Libby asbestos were characterized in a cohort of over 6000 plant workers and residents living near the plant. OBJECTIVE We conducted a cohort linkage study to assess the impact of cumulative low dose exposure and the role of occupational history on asbestos-related mortality and cancer morbidity among cohort members residing near a vermiculite plant. METHODS Cohort members alive in 1988 (n = 5848) were linked to the Minnesota Cancer Surveillance System to identify incident cases of mesothelioma, lung cancer, and all-cancer diagnosed from 1988 to 2010. Proportional incidence ratios (PIRs) were calculated for mesothelioma and lung cancer. Vital status and cause of death were ascertained from Minnesota vital records and the National Death Index (1988-2011). Mortality rates of the cohort (2001-2011) for asbestos-related outcomes were compared to the Minnesota population to estimate standardized mortality ratios (SMRs) and stratified by gender, exposure, and occupational history categories. RESULTS We identified seven cases of mesothelioma, with elevated incidence only in females (PIR = 11.76, 95% CI: 3.17, 30.12). Lung cancer was elevated in both genders: PIR = 1.54 (95% CI: 1.19, 2.0) in males and 1.62 (95% CI: 1.21, 2.12) in females. We found elevated mortality from COPD, lung cancer, and mesothelioma among females (SMR for mesothelioma in females = 18.97, CI: 3.91, 55.45), among the 546 deaths identified. All four deaths from mesothelioma occurred in the >75th percentile of exposure (>0.0156 fiber/cc x months). The SMR for lung cancer and all respiratory cancer was elevated even after controlling for occupation. CONCLUSIONS Community exposure to Libby amphibole asbestos from a vermiculite processing plant is associated with increased risk of COPD, lung cancer and mesothelioma incidence and mortality, most notably among females, and is likely to remain a public health issue for years to come.
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Affiliation(s)
- Tess Konen
- Minnesota Department of Health, 85 East 7th Place, PO Box 64882, St. Paul, MN 55164, USA.
| | - Jean E Johnson
- Minnesota Department of Health, 85 East 7th Place, PO Box 64882, St. Paul, MN 55164, USA
| | - Paula Lindgren
- Minnesota Department of Health, 85 East 7th Place, PO Box 64882, St. Paul, MN 55164, USA
| | - Allan Williams
- Minnesota Department of Health, 85 East 7th Place, PO Box 64882, St. Paul, MN 55164, USA
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Macedo RF, Cerqueira EMFP, Algranti E, Silva D, Capitani EM. High frequency and severity of pleural changes in former workers exposed to anthophyllite associated with other contaminating amphibole asbestos in Brazil. Am J Ind Med 2019; 62:503-510. [PMID: 31046142 DOI: 10.1002/ajim.22977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the frequency and severity of pleuropulmonary alterations in anthophyllite-exposed former workers in Itapira, São Paulo, Brazil. The amphibole anthophyllite, a magnesium-iron silicate, had its mining, marketing, and use forbidden in Brazil in 1995. METHODS Former workers were followed from 1999 to 2011. All completed chest X-ray interpreted using the International Labour Office (ILO) classification. High-resolution computed tomography was used at the final evaluation. Spirometry assessed forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC throughout the follow-up period. Samples from the mined ore were analyzed by X-ray diffraction (XRD) and scanning electron microscopy coupled to energy dispersive spectroscopy (SEM-EDS). RESULTS XRD and SEM-EDS confirmed the presence in ore of anthophyllite at a concentration of 75%, in addition to tremolite and other amphiboles in lower concentrations. Twenty-eight subjects were evaluated. Median time of exposure was 3 years (minimum = 1; maximum = 18; interquartile interval = 1-4). Twenty cases of pleural abnormalities were diagnosed in 26 evaluated (77%). The average latency time was 25.6 ± 7.4 years. Two individuals (7.7%) showed progressive worsening of diffuse pleural thickening (DPT) and exhibited an annual FVC decrease of 85 mL and 150 mL, respectively. CONCLUSION This small sample showed a very high index of nonmalignant pleural abnormalities in anthophyllite-exposed workers compared with workers exposed to other kinds of fibers. Rapidly progressive DPT, defined by the severity of pleural compromise, was possibly secondary to the presence of other amphibole types in the inhaled dust. No significant loss of FVC was found in the studied group as a whole. No cases of asbestosis, lung carcinoma, and mesothelioma were diagnosed in this cohort.
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Affiliation(s)
- Ronaldo Ferreira Macedo
- Department of Internal Medicine, Division of PulmonologySchool of Medicine, University of CampinasSão Paulo Brazil
| | | | - Eduardo Algranti
- Division of MedicineFUNDACENTRO, Ministry of Labor São Paulo Brazil
| | - Dailto Silva
- Laboratory of Mineral Quantification, Department of Geology and Natural ResourcesInstitute of Geosciences, University of CampinasSão Paulo Brazil
| | - Eduardo Mello Capitani
- Department of Internal Medicine, Division of PulmonologySchool of Medicine, University of CampinasSão Paulo Brazil
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Christofidou-Solomidou M, Pietrofesa RA, Park K, Albelda SM, Serve KM, Keil DE, Pfau JC. Synthetic secoisolariciresinol diglucoside (LGM2605) inhibits Libby amphibole fiber-induced acute inflammation in mice. Toxicol Appl Pharmacol 2019; 375:81-93. [PMID: 31022494 DOI: 10.1016/j.taap.2019.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exposure to the Libby amphibole (LA) asbestos-like fibers found in Libby, Montana, is associated with inflammatory responses in mice and humans, and an increased risk of developing mesothelioma, asbestosis, pleural disease, and systemic autoimmune disease. Flaxseed-derived secoisolariciresinol diglucoside (SDG) has anti-inflammatory, anti-fibrotic, and antioxidant properties. We have previously identified potent protective properties of SDG against crocidolite asbestos exposure modeled in mice. The current studies aimed to extend those findings by evaluating the immunomodulatory effects of synthetic SDG (LGM2605) on LA-exposed mice. METHODS Male and female C57BL/6 mice were given LGM2605 via gavage initiated 3 days prior to and continued for 3 days after a single intraperitoneal dose of LA fibers (200 μg) and evaluated on day 3 for inflammatory cell influx in the peritoneal cavity using flow cytometry. RESULTS LA exposure induced a significant increase (p < 0.0001) in spleen weight and peritoneal influx of white blood cells, all of which were reduced with LGM2605 with similar trends among males and females. Levels of peritoneal PMN cells were significantly (p < 0.0001) elevated post LA exposure, and were significantly (p < 0.0001) blunted by LGM2605. Importantly, LGM2605 significantly ameliorated the LA-induced mobilization of peritoneal B1a B cells. CONCLUSIONS LGM2605 reduced LA-induced acute inflammation and WBC trafficking supporting its possible use in mitigating downstream LA fiber-associated diseases. SUMMARY Following acute exposure to Libby amphibole (LA) asbestos-like fibers, synthetic SDG (LGM2605), a small synthetic molecule, significantly reduced the LA-induced increase in spleen weight and peritoneal inflammation in C57BL/6 male and female mice. Our findings highlight that LGM2605 has immunomodulatory properties and may, thus, likely be a chemopreventive agent for LA-induced diseases.
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Affiliation(s)
- Melpo Christofidou-Solomidou
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3450 Hamilton Walk, Stemmler Hall, Office Suite 227, Philadelphia, PA 19104, United States of America.
| | - Ralph A Pietrofesa
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3450 Hamilton Walk, Stemmler Hall, Office Suite 227, Philadelphia, PA 19104, United States of America.
| | - Kyewon Park
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3450 Hamilton Walk, Stemmler Hall, Office Suite 227, Philadelphia, PA 19104, United States of America.
| | - Steven M Albelda
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3450 Hamilton Walk, Stemmler Hall, Office Suite 227, Philadelphia, PA 19104, United States of America.
| | - Kinta M Serve
- Department of Biological Sciences, Life Sciences 207, Idaho State University, Pocatello, ID 83209, United States of America.
| | - Deborah E Keil
- Department of Microbiology and Immunology, Montana State University, Health Sciences Building Rm 133, PO Box 173610, Bozeman, MT 59717, United States of America.
| | - Jean C Pfau
- Department of Microbiology and Immunology, Montana State University, Health Sciences Building Rm 133, PO Box 173610, Bozeman, MT 59717, United States of America.
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Diegel R, Black B, Pfau JC, McNew T, Noonan C, Flores R. Case series: rheumatological manifestations attributed to exposure to Libby Asbestiform Amphiboles. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2018; 81:734-747. [PMID: 29927712 DOI: 10.1080/15287394.2018.1485124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED An increased risk for Systemic Autoimmune Diseases (SAID) has been reported in Libby, Montana, where extensive exposures to fibrous amphiboles occurred due to mining and use of asbestos-laden vermiculite. In addition, positive antinuclear autoantibody tests are associated with exposure to Libby Asbestiform Amphiboles (LAA) in both humans and mice. Among 6603 subjects who underwent health screening at the Center for Asbestos Related Diseases (CARD, Libby MT), 13.8% were diagnosed with an autoimmune disease, with prevalence values for the most common SAID being significantly higher than expected in the United States. Among the CARD screening population, serological and clinical profiles are diverse, representing symptoms and autoantibodies reflective of systemic lupus erythematosus (SLE), scleroderma, rheumatoid arthritis, and other rheumatic syndromes, including undifferentiated connective tissue disease (UCTD). Based upon screening of medical records by physicians with rheumatology expertise, the evolving nature of rheumatological disease in these patients is often atypical, with mixed diagnostic criteria and with a 1:1 male-to-female ratio. Through the Libby Epidemiology Research Program, cases were identified that illustrate clinical autoimmune outcomes with LAA exposure. Our goal was to better characterize SAID in Libby, MT in order to improve recognition of autoimmune outcomes associated with this exposure. In view of recent discoveries of widespread exposure to fibrous minerals in several areas of the U.S. and globally, it is critical to evaluate rheumatologic manifestations in other cohorts so that screening, surveillance, and diagnostic procedures are able to detect and recognize potential autoimmune outcomes of asbestos exposure. ABBREVIATIONS ANA, antinuclear autoantibody; ARD, Asbestos-Related Diseases; ATSDR, Agency for Toxic Substances & Disease Registry; CARD, Center for Asbestos Related Diseases; CCP, Cyclic citrullinated peptide antibody; CREST, limited cutaneous form of scleroderma; CT, computed tomography; DIP, Distal Interphalangeal Joint; DLCO, Diffusing Capacity of the Lung for CO2; DMARD, Disease Modifying Anti-Rheumatic Drugs; ENA, Extractable Nuclear Antigen antibodies; FVC, Forced Vital Capacity; LAA, Libby Asbestiform Amphiboles; LERP, Libby Epidemiology Research Program; MCP, Metacarpal Phalangeal Joint; PIP, Proximal Interphalangeal Joint; PIP, rheumatoid arthritis; RV, Residual Volume; SAID, Systemic autoimmune diseases; SLE, systemic lupus erythematosus; SSc, Systemic Sclerosis; TLC, Total Lung Capacity.
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Affiliation(s)
| | - Brad Black
- b Center for Asbestos Related Diseases , Libby , MT
| | - Jean C Pfau
- c Department of Microbiology and Immunology , Montana State University , Bozeman , MT
| | - Tracy McNew
- b Center for Asbestos Related Diseases , Libby , MT
| | - Curtis Noonan
- d Department of Biomedical and Pharmaceutical Sciences , University of Montana , Missoula , MT
| | - Raja Flores
- e Icahn School of Medicine at Mt Sinai , New York NY
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Noonan CW. Environmental asbestos exposure and risk of mesothelioma. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:234. [PMID: 28706902 DOI: 10.21037/atm.2017.03.74] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mesothelioma is commonly considered an occupational disease occurring as a result of asbestos exposure in the workplace. Several avenues for environmental asbestos exposures have been described and may be associated with asbestos related disease, including mesothelioma. Worker take-home asbestos, or para-occupational exposure, has been well documented and is the most commonly reported pathway for asbestos exposure among mesothelioma cases that do not have history of occupational asbestos exposure. Observational studies have evaluated several communities with elevated mesothelioma incidence and environmental exposures attributed to local asbestos-related industries. Potential, but uncertain, mesothelioma risk also may be associated with general population asbestos exposure through contact with asbestos-containing commercial products, particularly housing materials that can be easily disturbed through normal activity. Finally, studies have described elevated mesothelioma incidence in several areas where populations are exposed to naturally occurring asbestos materials. These various environmental asbestos exposure pathways are poorly understood, and further studies should be pursued to evaluate their respective importance for population mesothelioma risk.
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Affiliation(s)
- Curtis W Noonan
- Center for Environmental Health Sciences, University of Montana, Missoula, Montana, USA
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Schikowsky C, Felten MK, Eisenhawer C, Das M, Kraus T. Lung function not affected by asbestos exposure in workers with normal Computed Tomography scan. Am J Ind Med 2017; 60:422-431. [PMID: 28370144 DOI: 10.1002/ajim.22717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND It has been suggested that asbestos exposure affects lung function, even in the absence of asbestos-related pulmonary interstitial or pleural changes or emphysema. METHODS We analyzed associations between well-known asbestos-related risk factors, such as individual cumulative asbestos exposure, and key lung function parameters in formerly asbestos-exposed power industry workers (N = 207) with normal CT scans. For this, we excluded participants with emphysema, fibrosis, pleural changes, or any combination of these. RESULTS The lung function parameters of FVC, FEV1, DLCO/VA, and airway resistance were significantly associated with the burden of smoking, BMI and years since end of exposure (only DLCO/VA). However, they were not affected by factors directly related to amount (eg, cumulative exposure) or duration of asbestos exposure. CONCLUSIONS Our results confirm the well-known correlation between lung function, smoking habits, and BMI. However, we found no significant association between lung function and asbestos exposure.
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Affiliation(s)
- Christian Schikowsky
- Institute for Occupational and Social Medicine; RWTH Aachen University; Aachen Germany
| | - Michael K. Felten
- Institute for Occupational and Social Medicine; RWTH Aachen University; Aachen Germany
| | - Christian Eisenhawer
- Institute for Occupational and Social Medicine; RWTH Aachen University; Aachen Germany
| | - Marco Das
- Department of Diagnostic Radiology; RWTH Aachen University; Aachen Germany
- Department of Radiology; Maastricht University Medical Center; Maastricht The Netherlands
| | - Thomas Kraus
- Institute for Occupational and Social Medicine; RWTH Aachen University; Aachen Germany
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