Iron miners--a ten year follow-up

Systematic review of the evidence relating FEV1 decline to giving up smoking

BACKGROUND

The rate of forced expiratory volume in 1 second (FEV1) decline ("beta") is a marker of chronic obstructive pulmonary disease risk. The reduction in beta after quitting smoking is an upper limit for the reduction achievable from switching to novel nicotine delivery products. We review available evidence to estimate this reduction and quantify the relationship of smoking to beta.

METHODS

Studies were identified, in healthy individuals or patients with respiratory disease, that provided data on beta over at least 2 years of follow-up, separately for those who gave up smoking and other smoking groups. Publications to June 2010 were considered. Independent beta estimates were derived for four main smoking groups: never smokers, ex-smokers (before baseline), quitters (during follow-up) and continuing smokers. Unweighted and inverse variance-weighted regression analyses compared betas in the smoking groups, and in continuing smokers by amount smoked, and estimated whether beta or beta differences between smoking groups varied by age, sex and other factors.

RESULTS

Forty-seven studies had relevant data, 28 for both sexes and 19 for males. Sixteen studies started before 1970. Mean follow-up was 11 years. On the basis of weighted analysis of 303 betas for the four smoking groups, never smokers had a beta 10.8 mL/yr (95% confidence interval (CI), 8.9 to 12.8) less than continuing smokers. Betas for ex-smokers were 12.4 mL/yr (95% CI, 10.1 to 14.7) less than for continuing smokers, and for quitters, 8.5 mL/yr (95% CI, 5.6 to 11.4) less. These betas were similar to that for never smokers. In continuing smokers, beta increased 0.33 mL/yr per cigarette/day. Beta differences between continuing smokers and those who gave up were greater in patients with respiratory disease or with reduced baseline lung function, but were not clearly related to age or sex.

CONCLUSION

The available data have numerous limitations, but clearly show that continuing smokers have a beta that is dose-related and over 10 mL/yr greater than in never smokers, ex-smokers or quitters. The greater decline in those with respiratory disease or reduced lung function is consistent with some smokers having a more rapid rate of FEV1 decline. These results help in designing studies comparing continuing smokers of conventional cigarettes and switchers to novel products.

Persistence of respiratory symptoms in ex-underground iron ore miners

AIMS

To assess the persistence of respiratory symptoms in ex-miners after cessation of mining exposure.

METHODS

Population-based cross-sectional study using a postal questionnaire comparing prevalence of symptoms between ex-miners who had stopped mining at least 1 year before the study and referents not occupationally exposed to irritants or dust. Age, smoking and a family history of asthma were considered as possible confounders in the analysis.

RESULTS

A total of 206 ex-miners and 4,560 referents participated. Ex-miners had on average been working as miners for 13 years and had stopped mining 16 years before the study. Chronic productive cough and physician-diagnosed chronic bronchitis were significantly more common among ex-miners (P < 0.05 and <0.01, respectively). Furthermore, there was a trend that other respiratory symptoms were more common in ex-miners.

CONCLUSION

Ex-miners had an increased risk of chronic productive cough and physician-diagnosed chronic bronchitis many years after they had stopped working as a miner.

Hematite (Fe2O3) acts by oxydative stress and potentiates benzo[a]pyrene genotoxicity

Since epidemiological studies have implicated the co-exposition of iron oxides and polycyclic aromatic hydrocarbons as potential etiological factors involved in the excess of mortality from lung cancer in miners, experimental studies have been performed to investigate the role of iron on benzo[a]pyrene (B[a]P)-induced lung pathogenesis. We demonstrated previously that in vivo damage was higher when B[a]P was coated onto hematite than when B[a]P was administered alone. In order to determine the role of (i) different cell types and (ii) adsorption of hematite in this potentiation, in vitro studies were developed. The Comet assay was first used to measure DNA damage in four isolated cell types from Sprague-Dawley rats at 1, 2, 4, 8 and 24h after in vitro treatment with hematite (Fe2O3) or B[a]P or B[a]P coated onto hematite. For the two treatments with B[a]P, no damage was observed in alveolar macrophages, but significant increases in damage were seen in lymphocytes, hepatocytes and lung cells (where the effects of B[a]P coated onto hematite were stronger than those of B[a]P alone). In a second part of the study, the Comet assay was conducted with lung cells to measure the in vitro effect of (i) the coating and (ii) the role of the physical properties of Fe2O3. A statistically significant increase in damage was observed for the coating of B[a]P onto Fe2O3 compared (i) with their simple addition and (ii) with the coating of B[a]P onto graphite used as an inert compound. This study showed that (i) Fe2O3/B[a]P acts essentially in lung cells, (ii) the coating is a primordial step and (iii) the physical properties of Fe2O3 play a very minor role, which suggests another mechanism of action to explain the higher toxicity. Hence, our data may contribute to explain the excess of mortality in epidemiological studies and overall why exposures to B[a]P coated onto Fe2O3 resulted in higher toxicity in rodents compared to exposure to B[a]P alone.

Effect of Fe2O3 on the capacity of benzo(a)pyrene to induce polycyclic aromatic hydrocarbon-metabolizing enzymes in the respiratory tract of Sprague–Dawley rats

In this work, the question that needs to be answered was whether concurrent exposure to iron oxides and polycyclic aromatic hydrocarbons (PAHs) could affect the induction of PAH-metabolizing enzymes. Male Sprague-Dawley rats were intratracheally instilled with hematite (Fe(2)O(3); 3mg), benzo(a)pyrene (B(a)P; 3mg), or B(a)P (3mg)-coated onto Fe(2)O(3) particles (3mg). Forty-eight hours later, we investigated mRNA expressions of cytochrome p4501a1 (cyp1a1), microsomal epoxide hydrolase (meh), and glutathione-S-transferase-ya and -yc (gst-ya and gst-yc, respectively), protein concentrations of CYP1A1, and 7-ethoxyresorufin O-deethylase (EROD) activities in lungs. Exposure to B(a)P alone or coated-onto Fe(2)O(3) particles induced cyp1a1 gene transcription (P < 0.01) and increased both the CYP1A1 protein levels (P < 0.01) and the EROD activities (P < 0.001). However, in this work, we focused our attention on the potential of Fe(2)O(3) in B(a)P/Fe(2)O(3) mixtures to affect the capacity of B(a)P to induce PAH-metabolizing enzymes. Exposure to B(a)P-coated onto Fe(2)O(3) particles increased meh mRNA expressions (1.15-fold, P < 0.05), CYP1A1 protein concentrations (1.85-fold, P < 0.05), and EROD activities (1.95-fold, P < 0.01), versus exposure to B(a)P alone. Hence, animal short-term exposure to B(a)P-coated onto Fe(2)O(3) particles favored dramatically the induction of PAH-bioactivating enzymes to the detriment of PAH-inactivating enzymes in lungs. Taken together, these results support the hypothesis that the Fe(2)O(3)-induced increase of the metabolic activation of B(a)P might rely on several properties of Fe(2)O(3), including its capacity to enhance the rate of CYP1A1 hemoprotein elaboration. The influence of Fe(2)O(3) in B(a)P/Fe(2)O(3) mixtures on the ability of B(a)P to induce PAH-metabolizing enzymes will also be one of the fundamental ways that Fe(2)O(3) can affect B(a)P carcinogenicity in lungs.

Hematite (Fe(2)O(3)) enhances benzo[a]pyrene genotoxicity in endotracheally treated rat, as determined by Comet Assay

Since epidemiological studies have firmly implied the co-exposition between iron oxides and polycyclic aromatic hydrocarbons (PAH) as potential etiological factor involved in the excess of mortality by lung cancer in miners, experimental studies have been performed to investigate the role of iron particles on benzo[a]pyrene (B[a]P)-induced lung pathogenesis. In the present study, the alkaline single-cell gel electrophoresis (SCGE; Comet Assay) was used to measure DNA single-strand breaks in four cell types (alveolar macrophages, lung cells, peripheral lymphocytes and hepatocytes) of OFA Sprague-Dawley rats 24h after endotracheal administration of a single dose of an iron oxide (hematite; Fe(2)O(3)) (0.75mg) or B[a]P (0.75mg) or B[a]P (0.75mg) coated onto hematite particles (0.75mg). No damage was observed in cell from the four investigated organs in rats treated with iron oxide alone, while a statistically significant increase in DNA damage was observed compared with control animals in all tested cell types of rats treated with B[a]P alone or in association with hematite. The highest levels of damage were observed in lung cells and peripheral lymphocytes; the levels of damage in alveolar macrophages and hepatocytes were increased, but to a lesser extent compared with the first two cell types. The main finding was to notice a statistically significant increase of the damage in all organs of rats treated with B[a]P coated onto hematite (approximately two-fold increases; P<0.001), versus B[a]P alone. The current study shows that iron particles increase the genotoxic properties of B[a]P in the respiratory tract of endotracheally treated OFA Sprague-Dawley rats. Hence, our data may contribute to explain the excess mortality by lung cancer in epidemiological studies and overall why exposures to B[a]P coated onto Fe(2)O(3) particles resulted in higher toxicity in rodents compared with exposure to B[a]P alone.