Rapid determination of six urinary benzene metabolites in occupationally exposed and unexposed subjects

False positives and false negatives in benzene biological monitoring

Benzene is a commonly used industrial chemical that is a significant environmental pollutant. Occupational health specialists and industrial toxicologists are concerned with determining the exact amount of exposure to chemicals in the workplace. There are two main approaches to assess chemical exposure; air monitoring and biological monitoring. Air monitoring has limitations, which biological monitoring overcomes and could be used as a supplement to it. However, there are several factors that influence biological monitoring results. It would be possible to assess exposure more accurately if these factors were taken into account. This study aimed to review published papers for recognizing and discussing parameters that could affect benzene biological monitoring. Two types of effects can be distinguished: positive and negative effects. Factors causing positive effects will increase the metabolite concentration in urine more than expected. Furthermore, the parameters that decrease the urinary metabolite level were referred to as false negatives. From the papers, sixteen influential factors were extracted that might affect benzene biological monitoring results. Identified factors were clarified in terms of their nature and mechanism of action. It is also important to note that some factors influence the quantity and quality of the influence of other factors. As a result of this study, a decision-making protocol was developed for interpreting the final results of benzene biological monitoring.

Global Profiling of Urinary Mercapturic Acids Using Integrated Library-Guided Analysis

Urinary mercapturic acids (MAs) are often used as biomarkers for monitoring human exposures to occupational and environmental xenobiotics. In this study, we developed an integrated library-guided analysis workflow using ultraperformance liquid chromatography-quadrupole time-of-flight mass spectrometry. This method includes expanded assignment criteria and a curated library of 220 MAs and addresses the shortcomings of previous untargeted approaches. We employed this workflow to profile MAs in the urine of 70 participants─40 nonsmokers and 30 smokers. We found approximately 500 MA candidates in each urine sample, and 116 MAs from 63 precursors were putatively annotated. These include 25 previously unreported MAs derived mostly from alkenals and hydroxyalkenals. Levels of 68 MAs were comparable in nonsmokers and smokers, 2 MAs were higher in nonsmokers, and 46 MAs were elevated in smokers. These included MAs of polycyclic aromatic hydrocarbons and hydroxyalkenals and those derived from toxicants present in cigarette smoke (e.g., acrolein, 1,3-butadiene, isoprene, acrylamide, benzene, and toluene). Our workflow allowed profiling of known and unreported MAs from endogenous and environmental sources, and the levels of several MAs were increased in smokers. Our method can also be expanded and applied to other exposure-wide association studies.

Analysis of 10 Urinary BTEX Metabolites by Liquid Chromatography Tandem Mass Spectrometry

Benzene, toluene, ethylbenzene and xylene (BTEX) are a group of volatile organic compounds that are ubiquitous in the environment due to the numerous anthropogenic sources. Exposure to BTEX pose a health risk by increasing probability for damage to multiple organs, neurocognitive impairment and birth defects. Urinary BTEX metabolites are useful biomarkers for evaluation of BTEX exposure, because of easiness of sampling and their longer physiological half-lives compared with parent compounds. A method that utilizes liquid chromatography coupled to electrospray ionization tandem mass spectrometry (LC-MS/MS) was developed and validated for simultaneously monitoring ten urinary BTEX metabolites. During the sample preparation an aliquot of urine was diluted by the equal volume of 1% formic acid, internal standards solution was added, then the sample was centrifuged and analyzed. The analytes were separated on the Kinetex-F5 column by applying a linear gradient, consisting of 0.1 % formic acid and methanol. The method was validated according to the FDA Bioanalytical Method Validation Guidance for Industry. The mean method's accuracies of the spiked matrix were 81-122%; the interday precision ranged from 4% to 20%; limits of quantitation were 0.5-2 μg/L. The method was used for evaluation of baseline levels of urinary BTEX metabolites in 87 firefighters.

Metabolome-wide association study of occupational exposure to benzene

Benzene is a recognized hematotoxin and leukemogen; however, its mechanism of action in humans remain unclear. To provide insight into the processes underlying benzene hematotoxicity, we performed high-resolution metabolomic profiling of plasma collected from a cross-sectional study of 33 healthy workers exposed to benzene (median 8-h time-weighted average exposure; 20 ppma), and 25 unexposed controls in Shanghai, China. Metabolic features associated with benzene were identified using a metabolome-wide association study (MWAS) that tested for the relationship between feature intensity and benzene exposure. MWAS identified 478 mass spectral features associated with benzene exposure at false discovery rate < 20%. Comparison to a list of 13 known benzene metabolites and metabolites predicted using a multi-component biotransformation algorithm showed five metabolites were detected, which included the known metabolites phenol and benzene diolepoxide. Metabolic pathway enrichment identified 41 pathways associated with benzene exposure, with altered pathways including carnitine shuttle, fatty acid metabolism, sulfur amino acid metabolism, glycolysis, gluconeogenesis and branched chain amino acid metabolism. These results suggest disruption to fatty acid uptake, energy metabolism and increased oxidative stress, and point towards pathways related to mitochondrial dysfunction, which has previously been linked to benzene exposure in animal models and human studies. Taken together, these results suggest benzene exposure is associated with disruption of mitochondrial pathways, and provide promising, systems biology biomarkers for risk assessment of benzene-induced hematotoxicity in humans.

Ethyl chloroformate mediated gas chromatographic-mass spectrometric biomonitoring of acidic biomarkers of occupational exposure and endogenous metabolites in human urine

Numerous industrial organic pollutants such as aromates, alkoxyalcohols, other organic solvents and monomers are absorbed, metabolized, and finally excreted in urine mostly as carboxylic acids that are determined as biomarkers of exposure. For a number of these xenometabolites, biological limits (levels of biomarkers in biological material) have been established to prevent damage to human health. Till now, most of the analytical procedures used have been optimized for one or a few analytes. Here, we report a more comprehensive approach enabling rapid GC-MS screening of sixteen acidic biomarkers in urine that are metabolized in the human body from several important industrial chemicals; benzene, toluene, styrene, xylenes, alkoxyalcohols, carbon disulfide, furfural and N,N-dimethylformamide. The new method involves immediate in situ derivatization - liquid liquid microextraction of urine by an ethyl chloroformate-ethanol-chloroform-pyridine medium and GC-MS analysis of the derivatized analytes in the lower organic phase. The xenometabolite set represents diverse chemical structures and some of hippuric and mercapturic acids also provided unusual derivatives that were unambiguously elucidated by means of new ethyl chloroformates labeled with stable isotopes and by synthesis of the missing reference standards. In the next step, an automated routine was developed for GC-MS/MS analysis using a MetaboAuto® sample preparation workstation and the new method was validated for fourteen metabolites over the relevant concentration range of each analyte in the spiked pooled human urine. It shows good linearity (R² ≥ 0.982), accuracy (from 85% to 120%), precision (from 0.7% to 20%) and recovery (from 89% to 120%). The method performance was further successfully proved by GC-MS/MS analysis of the certified IP45 and RM6009 reference urines. Moreover, we show that the new method opens up the possibility for biomonitoring of combined and cumulative occupational exposures as well as for urinary metabolite profiling of persons exposed to harmful industrial chemicals.

Urinary levels of the acrolein conjugates of carnosine are associated with inhaled toxicants

OBJECTIVE

The inhalation of air-borne toxicants is associated with adverse health outcomes which can be somewhat mitigated by enhancing endogenous anti-oxidant capacity. Carnosine is a naturally occurring dipeptide (β-alanine-L-histidine), present in high abundance in skeletal and cardiac muscle. This multi-functional dipeptide has anti-oxidant properties, can buffer intracellular pH, chelate metals, and sequester aldehydes such as acrolein. Due to these chemical properties, carnosine may be protective against inhaled pollutants which can contain metals and aldehydes and can stimulate the generation of electrophiles in exposed tissues. Thus, assessment of carnosine levels, or levels of its acrolein conjugates (carnosine-propanal and carnosine-propanol) may inform on level of exposure and risk assessment.

METHODS

We used established mass spectroscopy methods to measure levels of urinary carnosine (n = 605) and its conjugates with acrolein (n = 561) in a subset of participants in the Louisville Healthy Heart Study (mean age = 51 ± 10; 52% male). We then determined associations between these measures and air pollution exposure and smoking behavior using statistical modeling approaches.

RESULTS

We found that higher levels of non-conjugated carnosine, carnosine-propanal, and carnosine-propanol were significantly associated with males (p < 0.02) and those of Caucasian ethnicity (p < 0.02). Levels of carnosine-propanol were significantly higher in never-smokers (p = 0.001) but lower in current smokers (p = 0.037). This conjugate also demonstrated a negative association with mean-daily particulate air pollution (PM_2.5) levels (p = 0.01).

CONCLUSIONS

These findings suggest that urinary levels of carnosine-propanol may inform as to risk from inhaled pollutants.

New fully automated gas chromatographic analysis of urinary S-phenylmercapturic acid in isotopic dilution using negative chemical ionization with isobutane as reagent gas

The determination of urinary S-phenylmercapturic acid (S-PMA) represents the most reliable biomarker to monitor the intake risk of airborne benzene. Recently, the European Chemical Agency deliberated new occupational exposure limits for benzene and recommended an S-PMA biological limit value of 2-μg/g creatinine. This limit is an order of magnitude lower than the previous one, and its determination constitutes a challenge in the analytical field. We developed and validated a method that allows the fully automated and sensitive determination of S-PMA by the use of gas-chromatography negative chemical ionization tandem mass spectrometry in isotopic dilution. For negative chemical ionization, we selected a mixture of 1% isobutane in argon as reactive gas, by studying its chemical ionization mechanism and optimal parameters compared with pure isobutane or pure methane. This gas mixture produces a more abundant signal of the target analyte than isobutane or methane, and it extended the operative lifetime of the ion source, enabling us to start a high-throughput approach of the S-PMA analysis. Moreover, energy-resolved mass spectrometry experiments were carried out to refine the MS/MS analysis conditions, testing nitrogen and argon as collision gases. The method optimization was pursued by a chemometric model by using the experimental design. The quantification limit for S-PMA was 0.10 μg/L. Accuracy (between 98.3% and 99.6%) and precision (ranging from 1.6% to 6.4%) were also evaluated. In conclusion, the newly developed assay represents a powerful tool for the robust, reliable, and sensitive quantification of urinary S-PMA, and because of its automation, it is well suited for application in large environmental and biological monitoring.

Environmental Assessment and Evaluation of Oxidative Stress and Genotoxicity Biomarkers Related to Chronic Occupational Exposure to Benzene

Environmental and occupational exposure to benzene from fuels is a major cause for concern for national and international authorities, as benzene is a known carcinogen in humans and there is no safe limit for exposure to carcinogens. The objective of this study was to evaluate the genotoxic effects of chronic occupational exposure to benzene among two groups of workers: filling station workers (Group I) and security guards working at vehicles entrances (Group II), both on the same busy highway in Rio de Janeiro, Brazil. Sociodemographic data on the workers were evaluated; the concentration of benzene/toluene (B/T) in atmospheric air and individual trans,trans-muconic acid (ttMA) and S-phenylmercapturic acid (S-PMA) were measured; oxidative stress was analyzed by catalase (CAT), glutathione S-transferase (GST), superoxide dismutase (SOD), thiol groups (THIOL) and malondialdehyde (MDA); genotoxicity was measured by metaphases with chromosomal abnormalities (MCA) and nuclear abnormalities, comet assay using the enzyme formamidopyrimidine DNA glycosylase (C-FPG), and methylation of repetitive element LINE-1, CDKN2B and KLF6 genes. Eighty-six workers participated: 51 from Group I and 35 from Group II. The B/T ratio was similar for both groups, but Group I had greater oscillation of benzene concentrations because of their work activities. No differences in ttMA and S-PMA, and no clinical changes were found between both groups, but linearity was observed between leukocyte count and ttMA; and 15% of workers had leukocyte counts less than 4.5 × 10⁹ cells L^-1, demanding close worker's attention. No differences were observed between the two groups for THIOL, MDA, MCA, or nuclear abnormalities. A multiple linear relationship was obtained for the biomarkers MCA and C-FPG. A significant correlation was found between length of time in current job and the biomarkers C-FPG, MCA, GST, and MDA. Although both populations had chronic exposure to benzene, the filling station workers were exposed to higher concentrations of benzene during their work activities, indicating an increased risk of DNA damage.

Benzene exposure is associated with cardiovascular disease risk

Benzene is a ubiquitous, volatile pollutant present at high concentrations in toxins (e.g. tobacco smoke) known to increase cardiovascular disease (CVD) risk. Despite its prevalence, the cardiovascular effects of benzene have rarely been studied. Hence, we examined whether exposure to benzene is associated with increased CVD risk. The effects of benzene exposure in mice were assessed by direct inhalation, while the effects of benzene exposure in humans was assessed in 210 individuals with mild to high CVD risk by measuring urinary levels of the benzene metabolite trans,trans-muconic acid (t,t-MA). Generalized linear models were used to assess the association between benzene exposure and CVD risk. Mice inhaling volatile benzene had significantly reduced levels of circulating angiogenic cells (Flk-1⁺/Sca-1⁺) as well as an increased levels of plasma low-density lipoprotein (LDL) compared with control mice breathing filtered air. In the human cohort, urinary levels of t,t-MA were inversely associated several populations of circulating angiogenic cells (CD31⁺/34⁺/45⁺, CD31⁺/34⁺/45⁺/AC133^–, CD34⁺/45⁺/AC133⁺). Although t,t-MA was not associated with plasma markers of inflammation or thrombosis, t,t-MA levels were higher in smokers and in individuals with dyslipidemia. In smokers, t,t-MA levels were positively associated with urinary metabolites of nicotine (cotinine) and acrolein (3-hydroxymercapturic acid). Levels of t,t-MA were also associated with CVD risk as assessed using the Framingham Risk Score and this association was independent of smoking. Thus, benzene exposure is associated with increased CVD risk and deficits in circulating angiogenic cells in both smokers and non-smokers.

Estratégias analíticas com cromatografia e espectrometria de massas para biomonitorização da exposição ao benzeno pela determinação do ácido S-fenilmercaptúrico urinário

Resumo Introdução: o benzeno é uma substância de reconhecida toxicidade e sua biomonitorização torna-se fundamental para a prevenção de danos à saúde humana, principalmente em situações de exposição ocupacional. Dentre os biomarcadores de exposição, o ácido S-fenilmercaptúrico é considerado o único específico, mas, devido a suas baixas concentrações na urina, é requerido o uso de técnicas analíticas sensíveis capazes de quantificar traços. Objetivo: revisar metodologias baseadas na cromatografia e na espectrometria de massas para a determinação do ácido S-fenilmercaptúrico. Método: revisão da literatura sobre a determinação do ácido S-fenilmercaptúrico urinário por técnicas de cromatografia e espectrometria de massas, nas principais bases de dados científicas, considerando o período entre 1951 e 2015. Resultados: 120 documentos serviram como base teórica para a construção desta revisão. A técnica analítica mais empregada foi o acoplamento da cromatografia a líquido com a espectrometria de massas. Contudo, os métodos diferem quanto ao preparo das amostras. Conclusão: o alto custo de aquisição e a manutenção de equipamentos são fatores limitantes para a difusão dos sistemas de cromatografia e espectrometria de massas. No entanto, sua elevada sensibilidade e seletividade faz com que essas técnicas, acopladas, possibilitem elucidar situações de exposição ocupacional e ambiental a poluentes, como o benzeno.

[Occupational exposure to benzene in Brazil: estimates based on an occupational exposure matrix]

This study estimates the number of exposed workers and the prevalence of occupational benzene exposure in Brazil. Due to the lack of available local measurements for the study, data were used from an occupational exposure matrix, the Finnish National Job-Exposure Matrix (FINJEM), which covers proportions of individuals exposed to benzene, calculated as environmental measures. In Brazil, the 2010 Demographic Census identified 86,353,839 workers in the workforce and employed. Applying the FINJEM parameters, an estimated 7,376,761 (8.5%) belonged to potentially exposed occupational groups, while 770,212 were considered exposed to benzene, corresponding to an occupational group-weighted prevalence of 0.9%, higher in men (1.1%) than in women (0.6%). Exposed individuals were concentrated in the category of Machine and Motor Operators and Mechanics (62%). The number of exposed and prevalence of occupational exposure to benzene are high, even when compared to Finnish parameters, suggesting the need for monitoring and control of this carcinogen in Brazil.

Glutathione S-Transferase Gene Polymorphisms: Modulator of Genetic Damage in Gasoline Pump Workers

This study investigated genetic damage in gasoline pump workers using the cytokinesis blocked micronucleus (CBMN) assay. Blood and urine samples were collected from 50 gasoline pump workers and 50 control participants matched with respect to age and other confounding factors except for exposure to benzene through gasoline vapors. To determine the benzene exposure, phenol was analyzed in urinary samples of exposed and control participants. Urinary mean phenol level was found to be significantly high (P < 0.05) in exposed workers. The CBMN frequency was found to be significantly higher in gasoline pump workers (6.70 ± 1.78) when compared to control individuals (2.20 ± 0.63; P < 0.05). We also investigated influence of polymorphisms of GSTM1, GSTT1, and GSTP1 genes on CBMN frequency. The individuals having GSTM1 and GSTT1 null genotypes had significantly higher frequency of CBMN (P < 0.05). Our study indicates that chronic and long-term exposure of gasoline vapors can increase genotoxic risk in gasoline pump workers.

Characterization of quinone derived protein adducts and their selective identification using redox cycling based chemiluminescence assay

The cytotoxic mechanism of many quinones has been correlated to covalent modification of cellular proteins. However, the identification of relevant proteins targets is essential but challenging goals. To better understand the quinones cytotoxic mechanism, human serum albumin (HSA) was incubated in vitro with different concentration of menadione (MQ). In this respect, the initial nucleophilic addition of proteins to quinone converts the conjugates to redox-cycling quinoproteins with altered conformation and secondary structure and extended life span than the short lived, free quinones. The conjugation of MQ with nucleophilic sites likewise, free cysteine as well as ɛ-amino group of lysine residue of HSA has been found to be in concentration dependent manner. The conventional methods for modified proteins identification in complex mixtures are complicated and time consuming. Herein, we describe a highly selective, sensitive, simple, and fast strategy for quinoproteins identification. The suggested strategy exploited the unique redox-cycling capability of quinoproteins in presence of a reductant, dithiothreitol (DTT), to generate reactive oxygen species (ROS) that gave sufficient chemiluminescence (CL) when mixed with luminol. The CL approach is highly selective and sensitive to detect the quinoproteins in ten-fold molar excess of native proteins without adduct enrichment. The approach was also coupled with gel filtration chromatography (GFC) and used to identify adducts in complex mixture of proteins in vitro as well as in rat plasma after MQ administration. Albumin was identified as the main protein in human and rat plasma forming adduct with MQ. Overall, the identification of quinoproteins will encourage further studies of toxicological impact of quinones on human health.

Urinary S-phenylmercapturic acid as a key biomarker for measuring occupational exposure to low concentrations of benzene in Chinese workers: a pilot study

OBJECTIVE

This study analyzed the level of urinary S-phenylmercapturic acid (U-SPMA) for low benzene exposure in a group of Chinese shoe-making workers.

METHODS

Urinary samples from 55 workers exposed to benzene at levels lower than 10 parts per million (ppm) were collected at postshift. U-SPMA level was determined using high-performance liquid chromatography/mass spectrography (HPLC/MS) method.

RESULTS

Good linearity of U-SPMA was observed within the range from 10 to 320 μg/L (r = 0.9994). Concentration of airborne benzene ranged from 0.71 to 32.17 mg/m³, and three segments were divided with different levels of exposure (≤6.0, 6.0 to 10.0, 10 to 32.5 mg/m³), the median U-SPMA concentrations were 49.55, 102.15, and 335.69 μg/g Cr, respectively.

CONCLUSION

A good linear correlation was found between U-SPMA levels and airborne benzene concentrations. The selected method could be applied for detecting other working conditions in China.

Genotoxic and hematological effects in children exposed to a chemical mixture in a petrochemical area in Mexico

Children living in Coatzacoalcos, Veracruz, and in nearby surrounding areas are exposed to a mixture of pollutants from different sources. Previous studies in the area have reported genotoxic and haematotoxic compounds, such as lead (Pb), benzene, toluene, and polycyclic aromatic hydrocarbons (PAHs), in environmental and biological samples. The final toxic effects of these compounds are unknown because the toxic behaviour of each compound is modified when in a complex mixture. This is the first study on the exposure and effect of chemical mixtures on children who live near a petrochemical area. The aim of this study was to evaluate genotoxicity and haematological effects in children environmentally exposed to such mixtures and to determine whether the final effect was modified by the composition of the mixture composition. Biomarkers of exposure to Pb, benzene, toluene, and PAHs were quantified in urine and blood samples of 102 children. DNA damage was evaluated using comet assay, and haematological parameters were determined. Our results show that Pb and toluene did not surpass the exposure guidelines; the exposure was similar in all three localities (Allenede, Mundo Nuevo, and López Mateos). In contrast, exposure to PAHs was observed at three levels of exposure: low, medium, and high. The most severe effects of these mixtures were strictly related to coexposure to high levels of PAHs.

Spectrophotometric analysis of phenols, which involves a hemin-graphene hybrid nanoparticles with peroxidase-like activity

Phenols are well known noxious compounds, which are often found in various water sources. A novel analytical method has been researched and developed based on the properties of hemin-graphene hybrid nanosheets (H-GNs). These nanosheets were synthesized using a wet-chemical method, and they have peroxidase-like activity. Also, in the presence of H2O2, the nanosheets are efficient catalysts for the oxidation of the substrate, 4-aminoantipine (4-AP), and the phenols. The products of such an oxidation reaction are the colored quinone-imines (benzodiazepines). Importantly, these products enabled the differentiation of the three common phenols - pyrocatechol, resorcin and hydroquinone, with the use of a novel, spectroscopic method, which was developed for the simultaneous determination of the above three analytes. This spectroscopic method produced linear calibrations for the pyrocatechol (0.4-4.0 mg L(-1)), resorcin (0.2-2.0 mg L(-1)) and hydroquinone (0.8-8.0 mg L(-1)) analytes. In addition, kinetic and spectral data, obtained from the formation of the colored benzodiazepines, were used to establish multi-variate calibrations for the prediction of the three phenol analytes found in various kinds of water; partial least squares (PLS), principal component regression (PCR) and artificial neural network (ANN) models were used and the PLS model performed best.

Urinary biomarkers of smokers' exposure to tobacco smoke constituents in tobacco products assessment: a fit for purpose approach

There are established guidelines for bioanalytical assay validation and qualification of biomarkers. In this review, they were applied to a panel of urinary biomarkers of tobacco smoke exposure as part of a "fit for purpose" approach to the assessment of smoke constituents exposure in groups of tobacco product smokers. Clinical studies have allowed the identification of a group of tobacco exposure biomarkers demonstrating a good doseresponse relationship whilst others such as dihydroxybutyl mercapturic acid and 2-carboxy-1-methylethylmercapturic acid - did not reproducibly discriminate smokers and non-smokers. Furthermore, there are currently no agreed common reference standards to measure absolute concentrations and few inter-laboratory trials have been performed to establish consensus values for interim standards. Thus, we also discuss in this review additional requirements for the generation of robust data on urinary biomarkers, including toxicant metabolism and disposition, method validation and qualification for use in tobacco products comparison studies.

A calibrated human PBPK model for benzene inhalation with urinary bladder and bone marrow compartments

A physiologically-based pharmacokinetic (PBPK) model of benzene inhalation based on a recent mouse model was adapted to include bone marrow (target organ) and urinary bladder compartments. Empirical data on human liver microsomal protein levels and linked CYP2E1 activities were incorporated into the model, and metabolite-specific conversion rate parameters were estimated by fitting to human biomonitoring data and adjusting for background levels of urinary metabolites. Human studies of benzene levels in blood and breath, and phenol levels in urine were used to validate the rate of human conversion of benzene to benzene oxide, and urinary benzene metabolites from Chinese benzene worker populations provided model validation for rates of human conversion of benzene to muconic acid (MA) and phenylmercapturic acid (PMA), phenol (PH), catechol (CA), hydroquinone (HQ), and benzenetriol (BT). The calibrated human model reveals that while liver microsomal protein and CYP2E1 activities are lower on average in humans compared to mice, the mouse also shows far lower rates of benzene conversion to MA and PMA, and far higher conversion of benzene to BO/PH, and of BO/PH to CA, HQ, and BT. The model also differed substantially from existing human PBPK models with respect to several metabolic rate parameters of importance to interpreting benzene metabolism and health risks in human populations associated with bone marrow doses. The model provides a new methodological paradigm focused on integrating linked human liver metabolism data and calibration using biomonitoring data, thus allowing for model uncertainty analysis and more rigorous validation.

The use of biomonitoring data in exposure and human health risk assessment: benzene case study

Abstract A framework of "Common Criteria" (i.e. a series of questions) has been developed to inform the use and evaluation of biomonitoring data in the context of human exposure and risk assessment. The data-rich chemical benzene was selected for use in a case study to assess whether refinement of the Common Criteria framework was necessary, and to gain additional perspective on approaches for integrating biomonitoring data into a risk-based context. The available data for benzene satisfied most of the Common Criteria and allowed for a risk-based evaluation of the benzene biomonitoring data. In general, biomarker (blood benzene, urinary benzene and urinary S-phenylmercapturic acid) central tendency (i.e. mean, median and geometric mean) concentrations for non-smokers are at or below the predicted blood or urine concentrations that would correspond to exposure at the US Environmental Protection Agency reference concentration (30 µg/m(3)), but greater than blood or urine concentrations relating to the air concentration at the 1 × 10(-5) excess cancer risk (2.9 µg/m(3)). Smokers clearly have higher levels of benzene exposure, and biomarker levels of benzene for non-smokers are generally consistent with ambient air monitoring results. While some biomarkers of benzene are specific indicators of exposure, the interpretation of benzene biomonitoring levels in a health-risk context are complicated by issues associated with short half-lives and gaps in knowledge regarding the relationship between the biomarkers and subsequent toxic effects.

Low-dose metabolism of benzene in humans: science and obfuscation

Benzene is a ubiquitous air pollutant that causes human leukemia and hematotoxic effects. Although the mechanism by which benzene causes toxicity is unclear, metabolism is required. A series of articles by Kim et al. used air and biomonitoring data from workers in Tianjin, China, to investigate the dose-specific metabolism (DSM) of benzene over a wide range of air concentrations (0.03-88.9 p.p.m.). Kim et al. concluded that DSM of benzene is greatest at air concentrations <1 p.p.m. This provocative finding motivated the American Petroleum Institute to fund a study by Price et al. to reanalyze the original data. Although their formal 'reanalysis' reproduced Kim's finding of enhanced DSM at sub-p.p.m. benzene concentrations, Price et al. argued that Kim's methods were inappropriate for assigning benzene exposures to low exposed subjects (based on measurements of urinary benzene) and for adjusting background levels of metabolites (based on median values from the 60 lowest exposed subjects). Price et al. then performed uncertainty analyses under alternative approaches, which led them to conclude that '… the Tianjin data appear to be too uncertain to support any conclusions …' regarding the DSM of benzene. They also argued that the apparent low-dose metabolism of benzene could be explained by 'lung clearance.' In addressing these criticisms, we show that the methods and arguments presented by Price et al. are scientifically unsound and that their results are unreliable.

Trans, trans-muconic acid as a biomarker of occupational exposure to high-level benzene in China

OBJECTIVE

The work aimed to study the potential correlation between the high-level benzene exposure and its urinary metabolites S-phenylmercapturic acid (SPMA) and trans, trans-muconic acid (t,t-MA) in Chinese shoe-making workers.

METHODS

Individual benzene-exposed levels were determined by gas chromatography analysis, urinary t,t-MA, and urinary SPMA were determined by high performance liquid chromatography-an ultraviolet detector and liquid chromatography/electrospray tandem mass spectrometry method, respectively.

RESULTS

The concentration of benzene ranged from 2.57 to 146.11 mg/m³. And the correlation between benzene and t,t-MA was significantly higher than that of SPMA at the postshift, for example, the correlation coefficient was 0.905 and 0.537 for t,t-MA and SPMA, respectively. Moreover, The relative internal exposure index of t,t-MA (0.28 mg/g Cr: mg/m³) was more similar to the data supplied by American Conference of Governmental Industrial Hygienists compared to the index of SPMA (0.025 mg/g Cr:mg/m³).

CONCLUSIONS

t,t-MA appeared to be a more specific biomarker than SPMA at high-level benzene exposure.

Categorizing biomarkers of the human exposome and developing metrics for assessing environmental sustainability

The concept of maintaining environmental sustainability broadly encompasses all human activities that impact the global environment, including the production of energy, use and management of finite resources such as petrochemicals, metals, food production (farmland, fresh and ocean waters), and potable water sources (rivers, lakes, aquifers), as well as preserving the diversity of the surrounding ecosystems. The ultimate concern is how one can manage Spaceship Earth in the long term to sustain the life, health, and welfare of the human species and the planet's flora and fauna. On a more intimate scale, one needs to consider the human interaction with the environment as expressed in the form of the exposome, which is defined as all exogenous and endogenous exposures from conception onward, including exposures from diet, lifestyle, and internal biology, as a quantity of critical interest to disease etiology. Current status and subsequent changes in the measurable components of the exposome, the human biomarkers, could thus conceivably be used to assess the sustainability of the environmental conditions with respect to human health. The basic theory is that a shift away from sustainability will be reflected in outlier measurements of human biomarkers. In this review, the philosophy of long-term environmental sustainability is explored in the context of human biomarker measurements and how empirical data can be collected and interpreted to assess if solutions to existing environmental problems might have unintended consequences. The first part discusses four conventions in the literature for categorizing environmental biomarkers and how different types of biomarker measurements might fit into the various grouping schemes. The second part lays out a sequence of data management strategies to establish statistics and patterns within the exposome that reflect human homeostasis and how changes or perturbations might be interpreted in light of external environmental stressors. The underlying concept is to identify probative outliers from the "unremarkable exposome" in individuals or subpopulations that could be used for discerning deviations from the healthy environment, much like current diagnostic medicine uses batteries of blood and urine tests to screen for preclinical disease conditions. Such empirically derived human in vivo data could subsequently be integrated into high-throughput in vitro and in silico testing of environmental and manufactured chemicals to support real-world toxicity evaluations.

Assessment of xenobiotic biotransformation including reactive oxygen species generation in the embryo using benzene as an example

Quantification of embryonic metabolic capacity is an important tool in developmental toxicology research. Bioactivation of xenobiotics into reactive intermediates often contributes to embryo toxicity; thus, identification and quantification of these toxic metabolites is essential to gain further understanding of developmental toxicity. This chapter uses the environmental chemical benzene as a model xenobiotic to describe the detection of both metabolites and reactive oxygen species (ROS) in fetal liver. Briefly, mice are bred and the presence of a vaginal plug in a female mouse indicates gestational day 1. On the desired gestational day, pregnant dams are exposed to benzene followed by sacrifice at the desired time-point after exposure. Using gas chromatography coupled to mass spectrometry, the detection of benzene metabolites can be achieved. Additionally, we describe the measurement of ROS by flow cytometry using the fluorescent probe 5-(and-6)-chloromethyl-2',7'-dichlorofluorescein diacetate, which readily diffuses into cells and, upon oxidation by any ROS, is converted to the highly fluorescent, negatively charged carboxydichlorofluorescein, which remains trapped within the cells.

The utility of naphthyl-keratin adducts as biomarkers for jet-fuel exposure

We investigated the association between biomarkers of dermal exposure, naphthyl-keratin adducts (NKA), and urine naphthalene biomarker levels in 105 workers routinely exposed to jet-fuel. A moderate correlation was observed between NKA and urine naphthalene levels (p = 0.061). The NKA, post-exposure breath naphthalene, and male gender were associated with an increase, while CYP2E1*6 DD and GSTT1-plus (++/+-) genotypes were associated with a decrease in urine naphthalene level (p < 0.0001). The NKA show great promise as biomarkers for dermal exposure to naphthalene. Further studies are warranted to characterize the relationship between NKA, other exposure biomarkers, and/or biomarkers of biological effects due to naphthalene and/or PAH exposure.

The impact of saturable metabolism on exposure-response relations in 2 studies of benzene-induced leukemia

Enzymatic saturation of metabolic pathways is one factor that potentially contributes to the nonlinear exposure-response relations that are frequently reported in occupational epidemiologic studies. The authors propose an approach to explore the contribution of saturable metabolism to previously reported exposure-response relations by integrating predictive models of relevant biomarkers of exposure into the epidemiologic analysis. The approach is demonstrated with 2 studies of leukemia in benzene-exposed workers, one conducted in the Australian petroleum industry (1981-1999) and one conducted in a US rubber hydrochloride production factory in Ohio (1940-1996). The studies differed greatly in their magnitudes and durations of exposure. Substitution of biomarker levels for external estimates of benzene exposure reduced the fold difference of the log relative risk of leukemia per unit of cumulative exposure between the 2 studies by 11%-44%. Nevertheless, a considerable difference in the log relative risk per unit of cumulative exposure remained between the 2 studies, suggesting that exposure misclassification, differences in study design, and potential confounding factors also contributed to the heterogeneity in risk estimates.

A kinetic spectrophotometric method for simultaneous determination of phenol and its three derivatives with the aid of artificial neural network

A novel kinetic spectrophotometric method was developed for determination of pyrocatechol, resorcin, hydroquinone and phenol based on their inhibitory effect on the oxidation of Rhodamine B (RhB) in acid medium at pH=3.0. A linear relationship was observed between the inhibitory effect and the concentrations of the compounds. The absorbance associated with the kinetic reactions was monitored at the maximum wavelength of 557nm. The effects of different parameters such as pH, concentration of RhB and KBrO(3), and temperature of the reaction were investigated and optimum conditions were established. The linear ranges were 0.22-3.30, 0.108-0.828, 0.36-3.96 and 1.52-19.76μg mL(-1) for pyrocatechol, resorcin, hydroquinone and phenol, respectively, and their corresponding detection limits were 0.15, 0.044, 0.16 and 0.60μg mL(-1). The measured data were processed by several chemometrics methods, such as principal component regression (PCR), partial least squares (PLS) and artificial neural network (ANN), and a set of synthetic mixtures of these compounds was used to verify the established models. It was found that the prediction ability of PLS, PCR and RBF-ANN was similar, however, the RBF-ANN model did perform somewhat better than the other methods. The proposed method was also applied satisfactorily for the simultaneous determination of pyrocatechol, resorcin, hydroquinone and phenol in real water samples.

Determination of genetic damage and urinary metabolites in fuel filling station attendants

Fuel (diesel and petrol) constitutes a complex mixture of volatile flammable liquid hydrocarbons among them benzene (BZ), toluene (TOL), and xylene (XYL) are considered to be the most hazardous, predominantly BZ because of its carcinogenic potency. Exposure to these compounds may have an impact on the health of the exposed subjects. Hence, genotoxicity and quantitative analysis of these compounds was performed in blood and urine samples of 200 workers exposed to fuel in filling stations and compared to controls. The level of genetic damage was determined by micronucleus test (MNT) in buccal epithelial cells (BEC) and chromosomal aberrations (CA) assay in peripheral blood lymphocytes (PBL) of fuel filling station attendants (FFSA) and compared to a matched control group. Urine analysis for BZ and its metabolites, phenol (Ph), trans, trans-Muconic Acid (t, t-MA), and S-Phenyl Mercapturic Acid (S-PMA) was done in all the study subjects. The results of our study revealed that exposure to BTX in petrol vapors induced a statistically significant increase in the frequency of micronuclei (MN) and CA in the exposed subjects than in controls (P < 0.05). There was a significant rise in the levels of urinary BZ, Ph, t, t-MA, and S-PMA in the exposed subjects. Our study highlights the significance of MNT, CA, and urinary metabolites as potential biological exposure indices of genetic damage in FFSA. This study suggests the need for regular monitoring of FFSA for possible exposure to BTX as a precautionary and preventive step to minimize exposure and reduce the associated health risks.

Benzene exposure near the U.S. permissible limit is associated with sperm aneuploidy

BACKGROUND

Benzene is a common industrial chemical known to induce leukemia and other blood disorders, as well as aneuploidy, in both human blood cells and sperm at exposures > 10 ppm. Recent reports have identified health effects at exposure levels < 1 ppm, the permissible exposure limit (PEL; 8 hr) set by the U.S. Occupational Safety and Health Administration.

OBJECTIVE

We investigated whether occupational exposures to benzene near 1 ppm induce aneuploidy in sperm.

METHODS

We used multicolor fluorescence in situ hybridization to measure the incidence of sperm with numerical abnormalities of chromosomes X, Y, and 21 among 33 benzene-exposed men and 33 unexposed men from Chinese factories. Individual exposures were assessed using personal air monitoring and urinary concentrations of benzene and trans,trans-muconic acid (E,E-MA). Air benzene concentrations were not detectable in unexposed men; in exposed men, concentrations ranged from below the detection limit to 24 ppm (median, 2.9 ppm), with 27% of exposed men (n = 9) having concentrations of <or= 1 ppm. Exposed men were categorized into low and high groups based on urinary E,E-MA (median concentrations of 1.9 and 14.4 mg/L, respectively; median air benzene of 1 and 7.7 ppm, respectively), and aneuploidy frequencies were compared with those of unexposed men.

RESULTS

Sperm aneuploidy increased across low- and high-exposed groups for disomy X [incidence rate ratio (IRR) = 2.0; 95% confidence interval (CI), 1.1-3.4; and IRR = 2.8; 95% CI, 1.5-4.9, respectively], and for overall hyperhaploidy for the three chromosomes investigated (IRR = 1.6; 95% CI, 1.0-2.4; and IRR = 2.3; 95% CI, 1.5-3.6, respectively). We also found elevated disomy X and hyperhaploidy in the nine men exposed to <or= 1 ppm benzene compared with unexposed men (IRR = 1.8; 95% CI, 1.1-3.0; and IRR = 2.0; 95% CI, 1.1-3.9, respectively).

CONCLUSIONS

Benzene appeared to increase the frequencies of aneuploid sperm for chromosomes associated with chromosomal abnormality syndromes in human offspring, even in men whose air benzene exposure was at or below the U.S. permissible exposure limit.

Transplacental benzene exposure increases tumor incidence in mouse offspring: possible role of fetal benzene metabolism

Childhood cancer is the leading cause of disease-related death in children aged 1-14 years in Canada and the USA and it has been hypothesized that transplacental exposure to environmental carcinogens such as benzene may contribute to the etiology of these cancers. Our objectives were to determine if transplacental benzene exposure increased tumor incidence in mouse offspring and assess fetal benzene metabolism capability. Pregnant CD-1 and C57Bl/6N mice were given intraperitoneal injections of corn oil, 200 mg/kg, or 400 mg/kg benzene on gestational days 8, 10, 12 and 14. A significant increase in tumor incidence was observed in CD-1, but not C57BL/6N, 1-year-old offspring exposed transplacentally to 200 mg/kg benzene. Hepatic and hematopoietic tumors were predominantly observed in male and female CD-1 offspring, respectively. Female CD-1 offspring exposed transplacentally to 200 mg/kg benzene had significantly suppressed bone marrow CD11b(+) cells 1 year after birth, correlating with reduced colony-forming unit granulocyte/macrophage numbers in 2-day-old pups. CD-1 and C57Bl/6N maternal blood benzene levels and fetal liver benzene, t, t-muconic acid, hydroquinone and catechol levels were analyzed by gas chromatography/mass spectrometry. Significant strain-, gender- and dose-related differences were observed. Male CD-1 fetuses had high hydroquinone levels, whereas females had high catechol levels after maternal exposure to 200 mg/kg benzene. This is the first demonstration that transplacental benzene exposure can induce hepatic and hematopoietic tumors in mice, which may be dependent on fetal benzene metabolism capability.

Human benzene metabolism following occupational and environmental exposures

We previously reported evidence that humans metabolize benzene via two enzymes, including a hitherto unrecognized high-affinity enzyme that was responsible for an estimated 73% of total urinary metabolites [sum of phenol (PH), hydroquinone (HQ), catechol (CA), E,E-muconic acid (MA), and S-phenylmercapturic acid (SPMA)] in nonsmoking females exposed to benzene at sub-saturating (ppb) air concentrations. Here, we used the same Michaelis-Menten-like kinetic models to individually analyze urinary levels of PH, HQ, CA and MA from 263 nonsmoking Chinese women (179 benzene-exposed workers and 84 control workers) with estimated benzene air concentrations ranging from less than 0.001-299 ppm. One model depicted benzene metabolism as a single enzymatic process (1-enzyme model) and the other as two enzymatic processes which competed for access to benzene (2-enzyme model). We evaluated model fits based upon the difference in values of Akaike's Information Criterion (DeltaAIC), and we gauged the weights of evidence favoring the two models based upon the associated Akaike weights and Evidence Ratios. For each metabolite, the 2-enzyme model provided a better fit than the 1-enzyme model with DeltaAIC values decreasing in the order 9.511 for MA, 7.379 for PH, 1.417 for CA, and 0.193 for HQ. The corresponding weights of evidence favoring the 2-enzyme model (Evidence Ratios) were: 116.2:1 for MA, 40.0:1 for PH, 2.0:1 for CA and 1.1:1 for HQ. These results indicate that our earlier findings from models of total metabolites were driven largely by MA, representing the ring-opening pathway, and by PH, representing the ring-hydroxylation pathway. The predicted percentage of benzene metabolized by the putative high-affinity enzyme at an air concentration of 0.001 ppm was 88% based upon urinary MA and was 80% based upon urinary PH. As benzene concentrations increased, the respective percentages of benzene metabolized to MA and PH by the high-affinity enzyme decreased successively to 66 and 77% at 0.1 ppm, 20 and 58% at 1 ppm, and 2.7 and 17% at 10 ppm. This indicates that the putative high-affinity enzyme was active primarily below 1 ppm and favored the ring-opening pathway.

Enrichment of cysteinyl adducts of human serum albumin

We report a method to enrich cysteinyl adducts of human serum albumin (HSA), representing biomarkers of exposure to systemic electrophiles. Because the major site of HSA adduction is the single free sulfhydryl group at Cys34, we used thiol-affinity resins to remove mercaptalbumin (i.e., unadducted HSA) from the cysteinyl adducts. Electrospray ionization mass spectrometry was used to detect mercaptalbumin and HSA-Cys34 modifications before and after enrichment of HSA. Differences in adduct content were detected across samples of freshly isolated, archived, and commercial HSA. Cysteinylated and glycosylated adducts were present in all samples, with abundances decreasing in the following order: commercial HSA>archived HSA>fresh HSA. After enrichment of HSA, mercaptalbumin was no longer observed in mass spectra. The ratios of HSA adducts post-/preenrichment, quantified via the Bradford assay and gel electrophoresis, were 0.029 mg adducts/mg HSA in fresh HSA and 0.323 mg adducts/mg HSA in archived HSA. The apparent elevation of adduct levels in archived samples could be due to differences in specimen preparation and storage rather than to differences in circulating HSA adducts. We conclude that thiol-affinity resins can efficiently remove mercaptalbumin from HSA samples prior to characterization and quantitation of protein adducts of reactive systemic electrophiles.

Evidence that humans metabolize benzene via two pathways

BACKGROUND

Recent evidence has shown that humans metabolize benzene more efficiently at environmental air concentrations than at concentrations > 1 ppm. This led us to speculate that an unidentified metabolic pathway was mainly responsible for benzene metabolism at ambient levels.

OBJECTIVE

We statistically tested whether human metabolism of benzene is better fitted by a kinetic model having two pathways rather than one.

METHODS

We fit Michaelis-Menten-like models to levels of urinary benzene metabolites and the corresponding air concentrations for 263 nonsmoking Chinese females. Estimated benzene concentrations ranged from less than 0.001 ppm to 299 ppm, with 10th and 90th percentile values of 0.002 ppm and 8.97 ppm, respectively.

RESULTS

Using values of Akaike's information criterion obtained under the two models, we found strong statistical evidence favoring two metabolic pathways, with respective affinities (benzene air concentrations analogous to K(m) values) of 301 ppm for the low-affinity pathway (probably dominated by cytochrome P450 enzyme 2E1) and 0.594 ppm for the high-affinity pathway (unknown). The exposure-specific metabolite level predicted by our two-pathway model at nonsaturating concentrations was 184 muM/ppm of benzene, a value close to an independent estimate of 194 muM/ppm for a typical nonsmoking Chinese female. Our results indicate that a nonsmoking woman would metabolize about three times more benzene from the ambient environment under the two-pathway model (184 muM/ppm) than under the one-pathway model (68.6 muM/ppm). In fact, 73% of the ambient benzene dose would be metabolized via the unidentified high-affinity pathway.

CONCLUSION

Because regulatory risk assessments have assumed nonsaturating metabolism of benzene in persons exposed to air concentrations well above 10 ppm, our findings suggest that the true leukemia risks could be substantially greater than currently thought at ambient levels of exposure-about 3-fold higher among nonsmoking females in the general population.

Genotoxicity of intermittent co-exposure to benzene and toluene in male CD-1 mice

Benzene is an important industrial chemical. At certain levels, benzene has been found to produce aplastic anemia, pancytopenia, myeloblastic anemia and genotoxic effects in humans. Metabolism by cytochrome P450 monooxygenases and myeloperoxidase to hydroquinone, phenol, and other metabolites contributes to benzene toxicity. Other xenobiotic substrates for cytochrome P450 can alter benzene metabolism. At high concentrations, toluene has been shown to inhibit benzene metabolism and benzene-induced toxicities. The present study investigated the genotoxicity of exposure to benzene and toluene at lower and intermittent co-exposures. Mice were exposed via whole-body inhalation for 6h/day for 8 days (over a 15-day time period) to air, 50 ppm benzene, 100 ppm toluene, 50 ppm benzene and 50 ppm toluene, or 50 ppm benzene and 100 ppm toluene. Mice exposed to 50 ppm benzene exhibited an increased frequency (2.4-fold) of micronucleated polychromatic erythrocytes (PCE) and increased levels of urinary metabolites (t,t-muconic acid, hydroquinone, and s-phenylmercapturic acid) vs. air-exposed controls. Benzene co-exposure with 100 ppm toluene resulted in similar urinary metabolite levels but a 3.7-fold increase in frequency of micronucleated PCE. Benzene co-exposure with 50 ppm toluene resulted in a similar elevation of micronuclei frequency as with 100 ppm toluene which did not differ significantly from 50 ppm benzene exposure alone. Both co-exposures - 50 ppm benzene with 50 or 100 ppm toluene - resulted in significantly elevated CYP2E1 activities that did not occur following benzene or toluene exposure alone. Whole blood glutathione (GSH) levels were similarly decreased following exposure to 50 ppm benzene and/or 100 ppm toluene, while co-exposure to 50 ppm benzene and 100 ppm toluene significantly decreased GSSG levels and increased the GSH/GSSG ratio. The higher frequency of micronucleated PCE following benzene and toluene co-exposure when compared with mice exposed to benzene or toluene alone suggests that, at the doses used in this study, toluene can enhance benzene-induced clastogenic or aneugenic bone marrow injury. These findings exemplify the importance of studying the effects of binary chemical interactions in animals exposed to lower exposure concentrations of benzene and toluene on benzene metabolism and clastogenicity. The relevance of these data on interactions for humans exposed at low benzene concentrations can be best assessed only when the mechanism of interaction is understood at a quantitative level and incorporated within a biologically based modeling framework.

Genetic polymorphisms and benzene metabolism in humans exposed to a wide range of air concentrations

Using generalized linear models with natural-spline smoothing functions, we detected effects of specific xenobiotic metabolizing genes and gene-environment interactions on levels of benzene metabolites in 250 benzene-exposed and 136 control workers in Tianjin, China (for all individuals, the median exposure was 0.512 p.p.m. and the 10th and 90th percentiles were 0.002 and 6.40 p.p.m., respectively). We investigated five urinary metabolites (E,E-muconic acid, S-phenylmercapturic acid, phenol, catechol, and hydroquinone) and nine polymorphisms in seven genes coding for key enzymes in benzene metabolism in humans {cytochrome P450 2E1 [CYP2E1, rs2031920], NAD(P)H: quinone oxidoreductase [NQO1, rs1800566 and rs4986998], microsomal epoxide hydrolase [EPHX1, rs1051740 and rs2234922], glutathione-S-transferases [GSTT1, GSTM1 and GSTP1(rs947894)] and myeloperoxidase [MPO, rs2333227]}. After adjusting for covariates, including sex, age, and smoking status, NQO1*2 (rs1800566) affected all five metabolites, CYP2E1 (rs2031920) affected most metabolites but not catechol, EPHX1 (rs1051740 or rs2234922) affected catechol and S-phenylmercapturic acid, and GSTT1 and GSTM1 affected S-phenylmercapturic acid. Significant interactions were also detected between benzene exposure and all four genes and between smoking status and NQO1*2 and EPHX1 (rs1051740). No significant effects were detected for GSTP1 or MPO. Results generally support prior associations between benzene hematotoxicity and specific gene mutations, confirm earlier evidence that GSTT1 affects production of S-phenylmercapturic acid, and provide additional evidence that genetic polymorphisms in NQO1*2, CYP2E1, and EPHX1 (rs1051740 or rs2234922) affect metabolism of benzene in the human liver.

A critique of benzene exposure in the general population

Benzene risk assessment indicates that exposure to a time-weighted average (TWA) of 1-5 parts per million (ppm) benzene in ambient air for 40 years is associated with an increased risk of acute myeloid leukemia. Decreased white blood cell count, platelet count and other hematological indices have also been observed in persons exposed to as low as 1 ppm airborne benzene. Evidence from studies worldwide consistently shows elevated levels of benzene biomarkers that are equivalent to 0.1-2 ppm benzene in ambient air, or even higher in the general population without occupational exposure to benzene (including children). The public health significance of these observations depends on to what extent these levels reflect actual benzene exposure, and whether such exposures are life-long or at least occur frequently enough to pose a possible health threat. We reviewed the evidence and discussed possible explanations for these observations. It was concluded that while there is reason to suspect that benzene contributes significantly to elevated levels of biomarkers in the general population, there is growing concern that this cannot be definitively ascertained without concomitant consideration of the role of other factors such as metabolic polymorphisms and sources of biomarkers other than benzene, which have been insufficiently studied to date. Such studies are urgently needed for valid assessment of this potential public health problem.