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Stefanescu K, Timlin CL, Moy AS, Zapotoczny G. Reduced Isocyanate Release Using a Waterproof, Resin-Based Cast Alternative Relative to Fiberglass Casts. TOXICS 2023; 11:1002. [PMID: 38133403 PMCID: PMC10747184 DOI: 10.3390/toxics11121002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
The effects of occupational isocyanate exposure range from asthma and contact dermatitis to neurotoxicity and cancer. Respiratory sensitization due to orthopedic cast application has been well documented. This study aims to compare the safety of standard-of-care fiberglass casts and a novel waterproof cast alternative by measuring the amount of isocyanate released during off-gassing over time. A 3D-printed arm simulator with comparable casing material amounts was placed in a sealed chamber. An isocyanate-sensing color-changing (SafeAir) tag was used to measure the levels of toxic exposure. Triplicate trials were conducted across all time periods (15 min, 1 h, and 24 h) and conditions. The bare arm simulator and freshly opened tags served as negative controls. Normalized pixel intensity indexes and isocyanate release estimates in ppb were derived from ImageJ-analyzed SafeAir tag photos. Fiberglass casts exhibited greater isocyanate release than both the waterproof alternative (p = 0.0002) and no-cast controls (p = 0.0006), particularly at 24 h. The waterproof alternative and no-cast control did not statistically differ (p = 0.1603). Therefore, the waterproof alternative released less isocyanate than the fiberglass casts. Waterproof cast alternatives may be safer than fiberglass by limiting medical professionals' exposure to toxic isocyanates and, thus, decreasing their risk of suffering occupational asthma.
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Affiliation(s)
- Kristen Stefanescu
- Keck School of Medicine of the University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA;
| | | | | | - Grzegorz Zapotoczny
- Consortium for Technology & Innovation in Pediatrics, Lurie Children’s Hospital, 225 E Chicago Ave., Chicago, IL 60611, USA;
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2
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Dalbøge A, Albert Kolstad H, Ulrik CS, Sherson DL, Meyer HW, Ebbehøj N, Sigsgaard T, Zock JP, Baur X, Schlünssen V. The Relationship Between Potential Occupational Sensitizing Exposures and Asthma: An Overview of Systematic Reviews. Ann Work Expo Health 2023; 67:163-181. [PMID: 36472234 DOI: 10.1093/annweh/wxac074] [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: 07/13/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim was to identify, appraise, and synthesize the scientific evidence of the relationship between potential occupational sensitizing exposures and the development of asthma based on systematic reviews. METHODS The study was conducted as an overview of systematic reviews. A systematic literature search was conducted for systematic reviews published up to 9 February 2020. Eligibility study criteria included persons in or above the working age, potential occupational sensitizing exposures, and outcomes defined as asthma. Potential occupational sensitizing exposures were divided into 23 main groups comprising both subgroups and specific exposures. Two reviewers independently selected studies, extracted study data, assessed study quality, and evaluated confidence in study results and level of evidence of the relationship between potential occupational sensitizing exposures and asthma. RESULTS Twenty-seven systematic reviews were included covering 1242 studies and 486 potential occupational sensitizing exposures. Overall confidence in study results was rated high in three systematic reviews, moderate in seven reviews, and low in 17 reviews. Strong evidence for the main group of wood dusts and moderate evidence for main groups of mites and fish was found. For subgroups/specific exposures, strong evidence was found for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals, whereas moderate evidence was found for 52 subgroups/specific exposures. CONCLUSIONS This overview identified hundreds of potential occupational sensitizing exposures suspected to cause asthma and evaluated the level of evidence for each exposure. Strong evidence was found for wood dust in general and for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals.
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Affiliation(s)
- Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre University Hospital, 2650 Hvidovre, Denmark
| | - David Lee Sherson
- Department of Occupational and Environmental Medicine, Odense University Hospital, 5000 Odense, Denmark.,Department of Pulmonary Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Harald William Meyer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Niels Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
| | - Jan-Paul Zock
- National Institute for Public Health and the Environment (RIVM), Bilthoven, 3721 MA, The Netherlands
| | - Xaver Baur
- Institut für Arbeitsmedizin, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.,Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
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3
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Antoniou EE, Zeegers MP. The relationship between toluene diisocyanate exposure and respiratory health problems: A meta-analysis of epidemiological studies. Toxicol Ind Health 2022; 38:595-605. [PMID: 35543628 DOI: 10.1177/07482337221095386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human epidemiological studies have shown inconclusive results over the effects of diisocyanates on respiratory health problems. A meta-analysis combined evidence on the association between occupational asthma (OA), respiratory function, and toluene diisocyanate (TDI) inhalation exposure. Sixty-one articles on occupational toluene diisocyanate exposure were identified via two databases. Fourteen studies were included in the meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies. Odds ratios (ORasthma) for the association between TDI exposure compared to non-exposure and OA were calculated. The difference in mean differences (MD) of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), and the annual mean change differences-in milliliters per year (mL/yr)-in FEV1 and FVC pulmonary function between TDI exposed and non-exposed, were calculated. When applicable, a random effects meta-analysis was performed. The overall summary ORasthma for TDI exposed versus non-exposed was 1.18 (95% CI = 0.78-1.79). The summary of the predicted mean percentage difference (MD%predicted) between exposed versus non-exposed was 2.96% for FEV1 and 3.75% for FVC. A very small decrease of 5 mL/yr for FEV1 and 10 mL/yr for FVC, respectively, was observed between the exposed and the non-exposed groups. There was moderate to low heterogeneity between study results, and most studies were evaluated as high-quality. This meta-analysis found no statistically significant adverse association between TDI occupational exposure and OA. No meaningful differences in lung function were detected between exposed and unexposed groups.
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Affiliation(s)
| | - Maurice P Zeegers
- Care and Public Health Research Institute, School of Nutrition and Translational Research in Metabolism, 5211Maastricht University, Maastricht, the Netherlands.,MyBasePair Holding, Heerlen, the Netherlands
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4
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Schupp T, Plehiers PM. Absorption, distribution, metabolism, and excretion of methylene diphenyl diisocyanate and toluene diisocyanate: Many similarities and few differences. Toxicol Ind Health 2022; 38:500-528. [PMID: 35301910 DOI: 10.1177/07482337211060133] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Methylene diphenyl diisocyanate (MDI) and toluene diisocyanate (TDI) are high production volume chemicals used for the manufacture of polyurethanes. For both substances, the most relevant adverse health effects after overexposure in the workplace are isocyanate-induced asthma, lung function decrement and, to a much lesser extent, skin effects. Over the last two decades many articles have addressed the reactivity of MDI and TDI in biological media and the associated biochemistry, which increased the understanding of their biochemical and physiological behavior. In this review, these new insights with respect to similarities and differences concerning the adsorption, distribution, metabolism, and excretion (ADME) of these two diisocyanates and the implications on their toxicities are summarized. Both TDI and MDI show very similar behavior in reactivity to biological macromolecules, distribution, metabolism, and excretion. Evidence suggests that the isocyanate (NCO) group is scavenged at the portal-of-entry and is not systemically available in unbound reactive form. This explains the lack of other than portal-of-entry toxicity observed in repeated-dose inhalation tests.
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Affiliation(s)
- Thomas Schupp
- 39002Münster University of Applied Sciences, Steinfurt, Germany
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5
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Chappelle AH. Letter to the Editor concerning Park 2021;12:174-183. Saf Health Work 2022; 13:129-130. [PMID: 35936204 PMCID: PMC9347006 DOI: 10.1016/j.shaw.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/02/2022] Open
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6
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Osman-Sypher S. Letter to the editor regarding “Risk Assessment for Toluene Diisocyanate and Respiratory Disease Human Studies”. Saf Health Work 2022; 13:126-128. [PMID: 35936199 PMCID: PMC9347001 DOI: 10.1016/j.shaw.2021.12.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Sahar Osman-Sypher
- American Chemistry Council, Washington, DC, USA
- Corresponding author. American Chemistry Council, 700 2nd Street, NE, Washington, DC 20002, USA
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7
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Song J, Yao L, Shi J, Li J, Xu C. Protective effects of N-acetylcysteine on a chemical-induced murine model of asthma. J Asthma 2021; 58:1208-1215. [PMID: 32546031 DOI: 10.1080/02770903.2020.1781166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Oxidative stress is involved in the pathophysiology of inflammatory airway diseases, including asthma. In this study, we elucidated the possible protective effects of the antioxidant N-acetylcysteine (NAC) on a toluene diisocyanate (TDI)-induced murine asthma model. METHODS Male BALB/c mice were sensitized and challenged with TDI to generate a chemical-induced asthma model. NAC was given intraperitoneally to mice immediately after each TDI challenge. Airway reactivity to methacholine and bronchoalveolar lavage fluid was analyzed. Lungs were examined by histology. RESULTS NAC treatment dramatically reduced the increased airway hyperresponsiveness, inflammatory infiltration, and goblet cell metaplasia in TDI-exposed mice. Numbers of total cells, neutrophils, and eosinophils in the bronchoalveolar lavage fluid of TDI-challenged mice were significantly higher than vehicle control, but the administration of NAC decreased these inflammatory cell counts. TDI exposure led to significantly increased levels of interleukin 4 (IL-4) and IL-5, which were also suppressed by NAC. In addition, diminished lung reduced oxidized glutathione ratio and superoxide dismutase activity were observed after TDI challenge, and these changes were attenuated by NAC. CONCLUSION NAC treatment has beneficial effects in TDI-induced asthma.
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Affiliation(s)
- Jiafu Song
- Department of Respiratory and Critical Care Medicine, Lianyungang First People's Hospital, Affiliated Hospital of Xuzhou Medical College, Lianyungang, China
| | - Lihong Yao
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Jiaxin Shi
- Department of Respiratory and Critical Care Medicine, Lianyungang First People's Hospital, Affiliated Hospital of Xuzhou Medical College, Lianyungang, China
| | - Jiashu Li
- Department of Respiratory and Critical Care Medicine, Lianyungang First People's Hospital, Affiliated Hospital of Xuzhou Medical College, Lianyungang, China
| | - Caiyun Xu
- Department of Critical Care Medicine, Lianyungang First People's Hospital, Affiliated Hospital of Xuzhou Medical College, Lianyungang, China
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8
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Raghavan S, Tiwari RR, Doctor PB, RekhaKashyap, Mahamad AM, Mansuri PR. Exposure to Toluene Di-isocyanate and Respiratory Effects in Flexible Polyurethane Foam Industries in Western India. Indian J Occup Environ Med 2021; 25:106-110. [PMID: 34421247 PMCID: PMC8341414 DOI: 10.4103/ijoem.ijoem_158_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/13/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Flexible foam industry largely uses 2,4 and 2,6 Toluene di-isocyanate as main raw materials and chronic exposure to its result in occupational asthma. The exposure to di-isocyanates might be higher due to the usage of obsolete technology, hand-mixing methods and working in confined spaces with insufficient local exhaust ventilation systems in developing countries. Exposure studies in flexible foam industries have not been done in developing countries. Objective: The present cross-sectional study was conducted to evaluate toluene di-isocyanate (TDI) exposures and respiratory health of the workers working in the seven flexible polyurethane foam industries located in Western India during 2010-2013. Method: A total of 128 personal air samples collected and evaluated for total TDI concentration using improved Occupational Safety and Head Administration method number 42. Then 194 workers were covered for complete clinical examination and spirometry for assessing respiratory health. Results: In all, 17.83% of air samples exceeded the ACGIH TWA-TLV of 0.005 ppm for TDI. Though only 11 (5.6%) workers had respiratory complaints, the spirometry revealed that 19 (9.8%) and four (2.1%) had restrictive and obstructive type of pulmonary function impairment, respectively. Conclusion: The TWA concentration of TDI exceeded at raw material storage, mixing, foaming, block cutting and curing areas in four out of seven industries even in the presence of local exhaust systems. The respiratory health effect is less when compared to exposure to TDI, suitable preventive and control measures were suggested based on the study findings to the stakeholders to prevent the increase of respiratory health effects.
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Affiliation(s)
- S Raghavan
- Department of Occupational Hygiene, ICMR-Regional Occupational Health Center-Southern (NIOH), Bengaluru, Karnataka, India
| | - Rajnarayan R Tiwari
- ICMR-National Institute for Research in Environmental Health (ICMR), Bhopal Bypass Road, Bhauri, Bhopal, Madhya Pradesh, India
| | - Pankaj B Doctor
- ICMR-National Institute of Occupational Health (ICMR), Meghaninagar, Ahmedabad, Gujarat, India
| | - RekhaKashyap
- ICMR-National Institute of Occupational Health (ICMR), Meghaninagar, Ahmedabad, Gujarat, India
| | - Asif M Mahamad
- ICMR-National Institute of Occupational Health (ICMR), Meghaninagar, Ahmedabad, Gujarat, India
| | - Parveen R Mansuri
- ICMR-National Institute of Occupational Health (ICMR), Meghaninagar, Ahmedabad, Gujarat, India
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9
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Jiao B, Guo S, Yang X, Sun L, Sai L, Yu G, Bo C, Zhang Y, Peng C, Jia Q, Dai Y. The role of HMGB1 on TDI-induced NLPR3 inflammasome activation via ROS/NF-κB pathway in HBE cells. Int Immunopharmacol 2021; 98:107859. [PMID: 34153664 DOI: 10.1016/j.intimp.2021.107859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 01/03/2023]
Abstract
To explore the potential role of HMGB1 on TDI-induced NLRP3 inflammasome activation, HBE cells were treated with TDI-HSA conjugate to observe the changes of HMGB1, TLR4, NF-κB, Nrf2 and NLRP3 inflammasome related proteins expressions, ROS release and MMP. NAC, TPCA-1 and Resatorvid pre-treatments were applied to explore the effects of ROS, NF-κB and TLR4 on TDI-induced NLRP3 inflammasome activation. The CRISPR/Cas9 system was used to construct HMGB1 gene knockout HBE cell line and then to explore the role of HMGB1 on TDI-HSA induced NLRP3 inflammasome activation. GL pre-treatment was applied to further confirm the role of HMGB1. Results showed that TDI increased HMGB1, TLR4, P-p65, Nrf2 proteins expressions and ROS release, decreased MMP level and activated NLRP3 inflammasome in HBE cells in a dose dependent manner. NAC, TPCA-1 and Resatorvid pre-treatments decreased the expression of P-p65 and inhibited NLRP3 inflammasome activation. Inhibition of HMGB1 decreased Nrf2 expression and ROS release, improved MMP level and reduced NLRP3 inflammasome activation. GL ameliorated NLRP3 inflammasome activation via inhibiting HMGB1 regulated ROS/NF-κB pathway. These results indicated that HMGB1 was involved in TDI-induced NLRP3 inflammasome activation as a positive regulatory mechanism. The study provided a potential target for early prevention and treatment of TDI-OA.
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Affiliation(s)
- Bo Jiao
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Sumei Guo
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Xiaohan Yang
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Lei Sun
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Linlin Sai
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Gongchang Yu
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Cunxiang Bo
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Yu Zhang
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China
| | - Cheng Peng
- Queensland Alliance for Environmental Health Sciences (QAEHS), University of Queensland, Brisbane, Queensland 4029, Australia
| | - Qiang Jia
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250062, China.
| | - Yufei Dai
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention (CDC), Beijing 100050, China.
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10
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PARK RM. Risk Assessment for Toluene Diisocyanate and Respiratory Disease Human Studies. Saf Health Work 2021; 12:174-183. [PMID: 34178394 PMCID: PMC8209360 DOI: 10.1016/j.shaw.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Toluene diisocyanate (TDI) is a highly reactive chemical that causes sensitization and has also been associated with increased lung cancer. A risk assessment was conducted based on occupational epidemiologic estimates for several health outcomes. METHODS Exposure and outcome details were extracted from published studies and a NIOSH Health Hazard Evaluation for new onset asthma, pulmonary function measurements, symptom prevalence, and mortality from lung cancer and respiratory disease. Summary exposure-response estimates were calculated taking into account relative precision and possible survivor selection effects. Attributable incidence of sensitization was estimated as were annual proportional losses of pulmonary function. Excess lifetime risks and benchmark doses were calculated. RESULTS Respiratory outcomes exhibited strong survivor bias. Asthma/sensitization exposure response decreased with increasing facility-average TDI air concentration as did TDI-associated pulmonary impairment. In a mortality cohort where mean employment duration was less than 1 year, survivor bias pre-empted estimation of lung cancer and respiratory disease exposure response. CONCLUSION Controlling for survivor bias and assuming a linear dose-response with facility-average TDI concentrations, excess lifetime risks exceeding one per thousand occurred at about 2 ppt TDI for sensitization and respiratory impairment. Under alternate assumptions regarding stationary and cumulative effects, one per thousand excess risks were estimated at TDI concentrations of 10 - 30 ppt. The unexplained reported excess mortality from lung cancer and other lung diseases, if attributable to TDI or associated emissions, could represent a lifetime risk comparable to that of sensitization.
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Affiliation(s)
- Robert M. PARK
- Division of Science Integration, Risk Evaluation Branch, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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11
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Blomme EE, Provoost S, Bazzan E, Van Eeckhoutte HP, Roffel MP, Pollaris L, Bontinck A, Bonato M, Vandenbroucke L, Verhamme F, Joos GF, Cosio MG, Vanoirbeek JAJ, Brusselle GG, Saetta M, Maes T. Innate lymphoid cells in isocyanate-induced asthma: role of microRNA-155. Eur Respir J 2020; 56:13993003.01289-2019. [PMID: 32499335 DOI: 10.1183/13993003.01289-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 05/10/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Occupational asthma, induced by workplace exposures to low molecular weight agents such as toluene 2,4-diisocyanate (TDI), causes a significant burden to patients and society. Little is known about innate lymphoid cells (ILCs) in TDI-induced asthma. A critical regulator of ILC function is microRNA-155, a microRNA associated with asthma. OBJECTIVE To determine whether TDI exposure modifies the number of ILCs in the lung and whether microRNA-155 contributes to TDI-induced airway inflammation and hyperresponsiveness. METHODS C57BL/6 wild-type and microRNA-155 knockout mice were sensitised and challenged with TDI or vehicle. Intracellular cytokine expression in ILCs and T-cells was evaluated in bronchoalveolar lavage (BAL) fluid using flow cytometry. Peribronchial eosinophilia and goblet cells were evaluated on lung tissue, and airway hyperresponsiveness was measured using the forced oscillation technique. Putative type 2 ILCs (ILC2) were identified in bronchial biopsies of subjects with TDI-induced occupational asthma using immunohistochemistry. Human bronchial epithelial cells were exposed to TDI or vehicle. RESULTS TDI-exposed mice had higher numbers of airway goblet cells, BAL eosinophils, CD4+ T-cells and ILCs, with a predominant type 2 response, and tended to have airway hyperresponsiveness. In TDI-exposed microRNA-155 knockout mice, inflammation and airway hyperresponsiveness were attenuated. TDI exposure induced IL-33 expression in human bronchial epithelial cells and in murine lungs, which was microRNA-155 dependent in mice. GATA3+CD3- cells, presumably ILC2, were present in bronchial biopsies. CONCLUSION TDI exposure is associated with increased numbers of ILCs. The proinflammatory microRNA-155 is crucial in a murine model of TDI asthma, suggesting its involvement in the pathogenesis of occupational asthma due to low molecular weight agents.
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Affiliation(s)
- Evy E Blomme
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
| | - Sharen Provoost
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
| | - Erica Bazzan
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Hannelore P Van Eeckhoutte
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
| | - Mirjam P Roffel
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium.,University of Groningen, University Medical Center Groningen, GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands
| | - Lore Pollaris
- Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Annelies Bontinck
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
| | - Matteo Bonato
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Louise Vandenbroucke
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
| | - Fien Verhamme
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
| | - Guy F Joos
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
| | - Manuel G Cosio
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.,Meakins Christie Laboratories, Respiratory Division, McGill University, Montreal, QC, Canada
| | | | - Guy G Brusselle
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
| | - Marina Saetta
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tania Maes
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
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12
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Plehiers PM, Chappelle AH, Spence MW. Practical learnings from an epidemiology study on TDI-related occupational asthma: Part I-Cumulative exposure is not a good indicator of risk. Toxicol Ind Health 2020; 36:876-884. [PMID: 32862785 PMCID: PMC7750668 DOI: 10.1177/0748233720947202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The anonymized data of an epidemiology study on incidence of toluene diisocyanate
(TDI)-related occupational asthma in three US-based TDI production facilities
have been reanalyzed to identify where to best focus exposure reduction efforts
in industrial practice to reduce the risk of sensitization to TDI. Since the
induction of sensitization has sometimes been attributed to cumulative exposure,
this relationship was examined first. Gross cumulative exposure values (i.e. not
taking into account whether respiratory protection was used or not) and net
cumulative exposure values (i.e. accounting for the use of respiratory
protection) per participant were calculated based on the duration of their study
participation and the average time-weighted average value of the exposure group
to which they belonged. These two sets of cumulative exposure data were compared
with asthma incidence using logistic regression. Incidence was zero among
workers who rarely come into contact with open plant systems (e.g. during
maintenance or spills). Notwithstanding, no statistically significant
relationship between asthma incidence and either gross or net cumulative
exposure could be determined. This is shown to be consistent with the results of
several other epidemiology studies on TDI-related occupational asthma. In
conclusion, cumulative exposure values are not a good indicator of the risk of
developing TDI-related occupational asthma.
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Affiliation(s)
| | | | - Mark W Spence
- 550512International Isocyanate Institute, Inc. (III), Boonton, NJ, USA
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13
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Abstract
PURPOSE OF REVIEW The aim of this review is to emphasize the role of neutrophils in patients with occupational asthma. This review facilitates a better understanding, accurate diagnosis, and proper management of asthmatic reactions provoked at the workplace. RECENT FINDINGS Increased recruitment and infiltration of neutrophils are found in patients with occupational asthma. Activated neutrophils release several mediators including pro-inflammatory cytokines and extracellular traps, leading to stimulation of airway epithelium and other inflammatory cells. SUMMARY New insights into neutrophils in the pathogenesis of occupational asthma may provide a novel approach to the individual patient with occupational asthma.
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Choi Y, Sim S, Park HS. Is TLR4 Critical for Neutrophil Apoptosis in Occupational Asthma? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:560-562. [PMID: 32400124 PMCID: PMC7225003 DOI: 10.4168/aair.2020.12.4.560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Youngwoo Choi
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Soyoon Sim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Leslie MD, Ridoli M, Murphy JG, Borduas-Dedekind N. Isocyanic acid (HNCO) and its fate in the atmosphere: a review. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2019; 21:793-808. [PMID: 30968101 DOI: 10.1039/c9em00003h] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Isocyanic acid (HNCO) has recently been identified in ambient air at potentially concerning concentrations for human health. Since its first atmospheric detection, significant progress has been made in understanding its sources and sinks. The chemistry of HNCO is governed by its partitioning between the gas and liquid phases, its weak acidity, its high solubility at pH above 5, and its electrophilic chemical behaviour. The online measurement of HNCO in ambient air is possible due to recent advances in mass spectrometry techniques, including chemical ionization mass spectrometry for the detection of weak acids. To date, HNCO has been measured in North America, Europe and South Asia as well as outdoors and indoors, with mixing ratios up to 10s of ppbv. The sources of HNCO include: (1) fossil fuel combustion such as coal, gasoline and diesel, (2) biomass burning such as wildfires and crop residue burning, (3) secondary photochemical production from amines and amides, (4) cigarette smoke, and (5) combustion of materials in the built environment. Then, three losses processes can occur: (1) gas phase photochemistry, (2) heterogenous uptake and hydrolysis, and (3) dry deposition. HNCO lifetimes with respect to photolysis and OH radical oxidation are on the order of months to decades. Consequently, the removal of HNCO from the atmosphere is thought to occur predominantly by dry deposition and by heterogeneous uptake followed by hydrolysis to NH3 and CO2. A back of the envelope calculation reveals that HNCO is an insignificant global source of NH3, contributing only around 1%, but could be important for local environments. Furthermore, HNCO can react due to its electrophilic behaviour with various nucleophilic functionalities, including those present in the human body through a reaction called protein carbamoylation. This protein modification can lead to toxicity, and thus exposure to high concentrations of HNCO can lead to cardiovascular and respiratory diseases, as well as cataracts. In this critical review, we outline our current understanding of the atmospheric fate of HNCO and its potential impacts on outdoor and indoor air quality. We also call attention to the need for toxicology studies linking HNCO exposure to health effects.
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Affiliation(s)
- Michael David Leslie
- Department of Chemistry, University of Toronto, 80 St George Street, Toronto, Ontario M5S 3H6, Canada
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Abstract
Occupational exposures are a major cause of lung disease and disability worldwide. This article reviews the broad range of types of occupational lung diseases, including airways disease, pneumoconioses, and cancer. Common causes of occupational lung disease are reviewed with specific examples and clinical features. Emphasis on the importance of a detailed history to make an accurate diagnosis of an occupational lung disease is discussed.
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Affiliation(s)
- David M Perlman
- Division of Pulmonary and Critical Care Medicine, University of Minnesota, MMC # 276, 420 Delaware Street Southeast, Minneapolis, MN 55045, USA
| | - Lisa A Maier
- Division of Environmental and Occupational Health Sciences, National Jewish Health, 1400 Jackson Street, G212, Denver, CO 80206, USA; Division of Pulmonary and Critical Care Sciences, Environmental Occupational Health Department, School of Medicine, Colorado School of Public Health, University of Colorado, Denver, CO, USA.
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17
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Lau A, Tarlo SM. Update on the Management of Occupational Asthma and Work-Exacerbated Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:188-200. [PMID: 30661311 PMCID: PMC6340795 DOI: 10.4168/aair.2019.11.2.188] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 12/16/2022]
Abstract
Work-related asthma is the most common occupational lung disease encountered in clinical practice. In adult asthmatics, work-relatedness can account for 15%-33% of cases, but delays in diagnosis remain common and lead to worse outcomes. Accurate diagnosis of asthma is the first step to managing occupational asthma, which can be sensitizer-induced or irritant-induced asthma. While latency has traditionally been recognized as a hallmark of sensitizer-induced asthma and rapid-onset a defining feature of irritant-induced asthma (as in Reactive Airway Dysfunction Syndrome), there is epidemiological evidence for irritant-induced asthma with latency from chronic moderate exposure. Diagnostic testing while the patient is still in the workplace significantly improves sensitivity. While specific inhalational challenges remain the gold-standard for the diagnosis of occupational asthma, they are not available outside of specialized centers. Commonly available tests including bronchoprovocation challenges and peak flow monitoring are important tools for practicing clinicians. Management of sensitizer-induced occupational asthma is notable for the central importance of removal from the causative agent: ideally, removal of the culprit agent; but if not feasible, this may require changes in the work process or ultimately, removal of the worker from the workplace. While workers' compensation programs may reduce income loss, these are not universal and there can be significant socio-economic impact from work-related asthma. Primary prevention remains the preferred method of reducing the burden of occupational asthma, which may include modification to work processes, better worker education and substitution of sensitizing agents from the workplace with safer compounds.
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Affiliation(s)
- Ambrose Lau
- Respiratory Division, Department of Medicine, Toronto Western Hospital and St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan M Tarlo
- Respiratory Division, Department of Medicine, Toronto Western Hospital and St. Michael's Hospital, Toronto, Ontario, Canada.
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18
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Lynch HN, Prueitt RL, Goodman JE. Critique of the ACGIH 2016 derivation of toluene diisocyanate Threshold Limit Values. Regul Toxicol Pharmacol 2018; 97:189-196. [PMID: 29964120 DOI: 10.1016/j.yrtph.2018.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022]
Abstract
In 2016, the American Conference of Governmental Industrial Hygienists (ACGIH) lowered the 8-hr Threshold Limit Value - time-weighted average (TLV-TWA) for toluene diisocyanate (TDI) from 5 ppb to 1 ppb, and the 15-min short-term exposure limit (STEL) from 20 ppb to 5 ppb. We evaluated ACGIH's basis for lowering these values. It is our opinion that the ACGIH's evaluation of the evidence for occupational asthma and respiratory effects from TDI exposure does not fully integrate the results of all the available human and animal studies. We found that some studies reported occupational asthma cases at TWAs less than 5 ppb, but these cases were likely caused by peak exposures above 20 ppb. Advances in industrial hygiene have reduced peak exposures and the incidence of upset conditions, such as spills and accidents, in modern TDI facilities. Taken together, the human evidence indicates that adherence to the previous 8-hr TLV-TWA and 15-min STEL (5 ppb and 20 ppb, respectively) prevents most, if not all, cases of occupational asthma, and eliminates or reduces the risk of lung function decrements and other respiratory effects. While limited, the animal literature supports the human evidence and indicates that TDI-induced asthma is a threshold phenomenon. We conclude that ACGIH's decision to lower the TLV-TWA and STEL values for TDI is not adequately supported.
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