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Mhaouty-Kodja S, Zalko D, Tait S, Testai E, Viguié C, Corsini E, Grova N, Buratti FM, Cabaton NJ, Coppola L, De la Vieja A, Dusinska M, El Yamani N, Galbiati V, Iglesias-Hernández P, Kohl Y, Maddalon A, Marcon F, Naulé L, Rundén-Pran E, Salani F, Santori N, Torres-Ruiz M, Turner JD, Adamovsky O, Aiello-Holden K, Dirven H, Louro H, Silva MJ. A critical review to identify data gaps and improve risk assessment of bisphenol A alternatives for human health. Crit Rev Toxicol 2024; 54:696-753. [PMID: 39436315 DOI: 10.1080/10408444.2024.2388712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 10/23/2024]
Abstract
Bisphenol A (BPA), a synthetic chemical widely used in the production of polycarbonate plastic and epoxy resins, has been associated with a variety of adverse effects in humans including metabolic, immunological, reproductive, and neurodevelopmental effects, raising concern about its health impact. In the EU, it has been classified as toxic to reproduction and as an endocrine disruptor and was thus included in the candidate list of substances of very high concern (SVHC). On this basis, its use has been banned or restricted in some products. As a consequence, industries turned to bisphenol alternatives, such as bisphenol S (BPS) and bisphenol F (BPF), which are now found in various consumer products, as well as in human matrices at a global scale. However, due to their toxicity, these two bisphenols are in the process of being regulated. Other BPA alternatives, whose potential toxicity remains largely unknown due to a knowledge gap, have also started to be used in manufacturing processes. The gradual restriction of the use of BPA underscores the importance of understanding the potential risks associated with its alternatives to avoid regrettable substitutions. This review aims to summarize the current knowledge on the potential hazards related to BPA alternatives prioritized by European Regulatory Agencies based on their regulatory relevance and selected to be studied under the European Partnership for the Assessment of Risks from Chemicals (PARC): BPE, BPAP, BPP, BPZ, BPS-MAE, and TCBPA. The focus is on data related to toxicokinetic, endocrine disruption, immunotoxicity, developmental neurotoxicity, and genotoxicity/carcinogenicity, which were considered the most relevant endpoints to assess the hazard related to those substances. The goal here is to identify the data gaps in BPA alternatives toxicology and hence formulate the future directions that will be taken in the frame of the PARC project, which seeks also to enhance chemical risk assessment methodologies using new approach methodologies (NAMs).
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Affiliation(s)
- Sakina Mhaouty-Kodja
- CNRS UMR 8246, INSERM U1130, Neuroscience Paris Seine - Institut de Biologie Paris Seine, Sorbonne Université, Paris, France
| | - Daniel Zalko
- INRAE, UMR1331 Toxalim (Research Center in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UT3, Toulouse, France
| | - Sabrina Tait
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Emanuela Testai
- Department of Environment and Health, Mechanisms, Biomarkers and Models Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Catherine Viguié
- INRAE, UMR1331 Toxalim (Research Center in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UT3, Toulouse, France
| | - Emanuela Corsini
- Department of Pharmacological and Biomolecular Sciences 'Rodolfo Paoletti', Università degli Studi di Milano - School of Pharmacy, Milan, Italy
| | - Nathalie Grova
- Department of Infection and Immunity, Immune Endocrine Epigenetics Research Group, Luxembourg Institute of Health, Esch-Sur-Alzette, Luxembourg
| | - Franca Maria Buratti
- Department of Environment and Health, Mechanisms, Biomarkers and Models Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Nicolas J Cabaton
- INRAE, UMR1331 Toxalim (Research Center in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UT3, Toulouse, France
| | - Lucia Coppola
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Antonio De la Vieja
- Endocrine Tumor Unit from Chronic Disease Program (UFIEC), Instituto de Salud Carlos III (ISCIII), Majadahonda, Madrid, Spain
| | - Maria Dusinska
- Department for Environmental Chemistry, Health Effects Laboratory, NILU-Norwegian Institute for Air Research, Kjeller, Norway
| | - Naouale El Yamani
- Department for Environmental Chemistry, Health Effects Laboratory, NILU-Norwegian Institute for Air Research, Kjeller, Norway
| | - Valentina Galbiati
- Department of Pharmacological and Biomolecular Sciences 'Rodolfo Paoletti', Università degli Studi di Milano - School of Pharmacy, Milan, Italy
| | - Patricia Iglesias-Hernández
- Endocrine Tumor Unit from Chronic Disease Program (UFIEC), Instituto de Salud Carlos III (ISCIII), Majadahonda, Madrid, Spain
| | - Yvonne Kohl
- Fraunhofer Institute for Biomedical Engineering IBMT, Sulzbach, Germany
| | - Ambra Maddalon
- Department of Pharmacological and Biomolecular Sciences 'Rodolfo Paoletti', Università degli Studi di Milano - School of Pharmacy, Milan, Italy
| | - Francesca Marcon
- Department of Environment and Health, Mechanisms, Biomarkers and Models Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Lydie Naulé
- CNRS UMR 8246, INSERM U1130, Neuroscience Paris Seine - Institut de Biologie Paris Seine, Sorbonne Université, Paris, France
| | - Elise Rundén-Pran
- Department for Environmental Chemistry, Health Effects Laboratory, NILU-Norwegian Institute for Air Research, Kjeller, Norway
| | - Francesca Salani
- Department of Environment and Health, Mechanisms, Biomarkers and Models Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Nicoletta Santori
- Department of Environment and Health, Mechanisms, Biomarkers and Models Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Mónica Torres-Ruiz
- National Center for Environmental Health (CNSA), Instituto de Salud Carlos III (ISCIII), Majadahonda, Madrid, Spain
| | - Jonathan D Turner
- Department of Infection and Immunity, Immune Endocrine Epigenetics Research Group, Luxembourg Institute of Health, Esch-Sur-Alzette, Luxembourg
| | - Ondrej Adamovsky
- Faculty of Science, Masaryk University, RECETOX, Brno, Czech Republic
| | | | - Hubert Dirven
- Department of Chemical Toxicology - Division of Climate and the Environment, Norwegian Institute of Public Health, Oslo, Norway
| | - Henriqueta Louro
- Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- Centre for Toxicogenomics and Human Health, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Maria João Silva
- Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- Centre for Toxicogenomics and Human Health, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
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Maddalon A, Cari L, Iulini M, Alhosseini MN, Galbiati V, Marinovich M, Nocentini G, Corsini E. Impact of endocrine disruptors on peripheral blood mononuclear cells in vitro: role of gender. Arch Toxicol 2023; 97:3129-3150. [PMID: 37676302 PMCID: PMC10567873 DOI: 10.1007/s00204-023-03592-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
Humans can be exposed to endocrine disruptors (EDs) in numerous ways. EDs can interfere with endogenous hormones at different levels, resulting in numerous adverse human health outcomes, including immunotoxicity. In this regard, this study aimed to investigate in vitro the possible effects of EDs on immune cells and possible gender differences. Peripheral blood mononuclear cells from healthy humans, both males and females, were exposed to 6 different EDs, namely atrazine (herbicide), cypermethrin (insecticide), diethyl phthalate (plasticizer), 17α-ethynylestradiol (contraceptive drug), perfluorooctanesulfonic acid (persistent organic pollutant), and vinclozolin (fungicide). We evaluated the effect of EDs on RACK1 (receptor for activated C kinase 1) expression, considering it as a bridge between the endocrine and the immune system, and putatively used as screening tool of immunotoxic effects of EDs. The exposure to EDs resulted at different extent in alteration in RACK1 expression, pro-inflammatory activity, natural killer lytic ability, and lymphocyte differentiation, with sex-related differences. In particular, diethyl phthalate and perfluorooctanesulfonic acid resulted the most active EDs tested, with gender differences in terms of effects and magnitude. The results from our study evidenced the ability of EDs to directly affect immune cells.
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Affiliation(s)
- Ambra Maddalon
- Laboratory of Toxicology, Department of Pharmacological and Biomolecular Sciences, Rodolfo Paoletti', Università Degli Studi Di Milano, Via Balzaretti 9, 20133, Milan, Italy
| | - Luigi Cari
- Department of Medicine and Surgery, Section of Pharmacology, Università Degli Studi Di Perugia, Building D, Severi Square 1, 06129, Perugia, Italy
| | - Martina Iulini
- Laboratory of Toxicology, Department of Pharmacological and Biomolecular Sciences, Rodolfo Paoletti', Università Degli Studi Di Milano, Via Balzaretti 9, 20133, Milan, Italy
| | - Mahdieh Naghavi Alhosseini
- Department of Medicine and Surgery, Section of Pharmacology, Università Degli Studi Di Perugia, Building D, Severi Square 1, 06129, Perugia, Italy
| | - Valentina Galbiati
- Laboratory of Toxicology, Department of Pharmacological and Biomolecular Sciences, Rodolfo Paoletti', Università Degli Studi Di Milano, Via Balzaretti 9, 20133, Milan, Italy
| | - Marina Marinovich
- Laboratory of Toxicology, Department of Pharmacological and Biomolecular Sciences, Rodolfo Paoletti', Università Degli Studi Di Milano, Via Balzaretti 9, 20133, Milan, Italy
| | - Giuseppe Nocentini
- Department of Medicine and Surgery, Section of Pharmacology, Università Degli Studi Di Perugia, Building D, Severi Square 1, 06129, Perugia, Italy.
| | - Emanuela Corsini
- Laboratory of Toxicology, Department of Pharmacological and Biomolecular Sciences, Rodolfo Paoletti', Università Degli Studi Di Milano, Via Balzaretti 9, 20133, Milan, Italy
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Tseng YT, Schaefke B, Wei P, Wang L. Defensive responses: behaviour, the brain and the body. Nat Rev Neurosci 2023; 24:655-671. [PMID: 37730910 DOI: 10.1038/s41583-023-00736-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/22/2023]
Abstract
Most animals live under constant threat from predators, and predation has been a major selective force in shaping animal behaviour. Nevertheless, defence responses against predatory threats need to be balanced against other adaptive behaviours such as foraging, mating and recovering from infection. This behavioural balance in ethologically relevant contexts requires adequate integration of internal and external signals in a complex interplay between the brain and the body. Despite this complexity, research has often considered defensive behaviour as entirely mediated by the brain processing threat-related information obtained via perception of the external environment. However, accumulating evidence suggests that the endocrine, immune, gastrointestinal and reproductive systems have important roles in modulating behavioural responses to threat. In this Review, we focus on how predatory threat defence responses are shaped by threat imminence and review the circuitry between subcortical brain regions involved in mediating defensive behaviours. Then, we discuss the intersection of peripheral systems involved in internal states related to infection, hunger and mating with the neurocircuits that underlie defence responses against predatory threat. Through this process, we aim to elucidate the interconnections between the brain and body as an integrated network that facilitates appropriate defensive responses to threat and to discuss the implications for future behavioural research.
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Affiliation(s)
- Yu-Ting Tseng
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Guangdong Provincial Key Laboratory of Brain Connectome and Behaviour, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bernhard Schaefke
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Pengfei Wei
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Liping Wang
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
- Guangdong Provincial Key Laboratory of Brain Connectome and Behaviour, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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Otaru S, Lawrence DA. Autism: genetics, environmental stressors, maternal immune activation, and the male bias in autism. EXPLORATION OF NEUROPROTECTIVE THERAPY 2022. [DOI: 10.37349/ent.2022.00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/20/2022] [Indexed: 01/05/2025]
Abstract
Autism spectrum disorder (ASD) is a class of neurodevelopmental disorders (NDD) characterized by deficits in three domains: impairments in social interactions, language, and communication, and increased stereotyped restrictive/repetitive behaviors and interests. The exact etiology of ASD remains unknown. Genetics, gestational exposure to inflammation, and environmental stressors, which combine to affect mitochondrial dysfunction and metabolism, are implicated yet poorly understood contributors and incompletely delineated pathways toward the relative risk of ASD. Many studies have shown a clear male bias in the incidence of ASD and other NDD. In other words, being male is a significant yet poorly understood risk factor for the development of NDD. This review discusses the link between these factors by looking at the current body of evidence. Understanding the link between the multiplicity of hits—from genes to environmental stressors and possible sexual determinants, contributing to autism susceptibility is critical to developing targeted interventions to mitigate these risks.
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Affiliation(s)
- Sarah Otaru
- Department of Environmental Health Sciences, University at Albany School of Public Health, Rensselaer, New York 12144, USA
| | - David A. Lawrence
- Department of Environmental Health Sciences, University at Albany School of Public Health, Rensselaer, New York 12144, USA;Clinical and Experimental Immunology, Wadsworth Center, New York State Department of Health, Albany, NY 12208, USA
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Segner H, Rehberger K, Bailey C, Bo J. Assessing Fish Immunotoxicity by Means of In Vitro Assays: Are We There Yet? Front Immunol 2022; 13:835767. [PMID: 35296072 PMCID: PMC8918558 DOI: 10.3389/fimmu.2022.835767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
There is growing awareness that a range of environmental chemicals target the immune system of fish and may compromise the resistance towards infectious pathogens. Existing concepts to assess chemical hazards to fish, however, do not consider immunotoxicity. Over recent years, the application of in vitro assays for ecotoxicological hazard assessment has gained momentum, what leads to the question whether in vitro assays using piscine immune cells might be suitable to evaluate immunotoxic potentials of environmental chemicals to fish. In vitro systems using primary immune cells or immune cells lines have been established from a wide array of fish species and basically from all immune tissues, and in principal these assays should be able to detect chemical impacts on diverse immune functions. In fact, in vitro assays were found to be a valuable tool in investigating the mechanisms and modes of action through which environmental agents interfere with immune cell functions. However, at the current state of knowledge the usefulness of these assays for immunotoxicity screening in the context of chemical hazard assessment appears questionable. This is mainly due to a lack of assay standardization, and an insufficient knowledge of assay performance with respect to false positive or false negative signals for the different toxicant groups and different immune functions. Also the predictivity of the in vitro immunotoxicity assays for the in vivo immunotoxic response of fishes is uncertain. In conclusion, the currently available database is too limited to support the routine application of piscine in vitro assays as screening tool for assessing immunotoxic potentials of environmental chemicals to fish.
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Affiliation(s)
- Helmut Segner
- Centre for Fish and Wildlife Health, Department of Pathobiology and Infectious Diseases, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Kristina Rehberger
- Centre for Fish and Wildlife Health, Department of Pathobiology and Infectious Diseases, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Jun Bo
- Laboratory of Marine Biology and Ecology, Third Institute of Oceanography, Xiamen, China
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Natale NR, Kent M, Fox N, Vavra D, Lambert K. Neurobiological effects of a probiotic-supplemented diet in chronically stressed male Long-Evans rats: Evidence of enhanced resilience. IBRO Neurosci Rep 2021; 11:207-215. [PMID: 34849506 PMCID: PMC8607205 DOI: 10.1016/j.ibneur.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Probiotics that regulate the microbiome-gut-brain axis and provide mental health benefits to the host are referred to as psychobiotics. Preclinical studies have demonstrated psychobiotic effects on early life stress-induced anxiety- and depression-related behavior in rodents; however, the specific mechanisms remain ill-defined. In the current study, we investigated the effects of probiotic supplementation on neurobiological responses to chronic stress in adult male Long-Evans rats. Twenty-four rats were randomly assigned to probiotic (PB) or vehicle control (VEH) groups, then to either chronic unpredictable stress (CUS) or no-stress control (CON) conditions within each group (n = 6/subgroup). We hypothesized that PB supplementation would reduce markers of anxiety and enhance emotional resilience, especially in the CUS animals. In the cognitive uncertainty task, a nonsignificant trend was observed indicating that the PB-supplemented animals spent more time oriented toward the food reward than VEH animals. In the open-field task, CUS-PB animals spent more time in the center of the arena than CUS-VEH animals, an effect not observed between the two CON groups. In the swim task, the PB animals, regardless of stress assignment, exhibited increased floating, suggesting a conserved response in a challenging context. Focusing on the endocrine measures, higher dehydroepiandrosterone (DHEA)-to-corticosterone fecal metabolite ratios, a correlate of emotional resilience, were observed in PB animals. Further, PB animals exhibited reduced microglia immunoreactivity in the basolateral amygdala, possibly indicating a neuroprotective effect of PB supplements in this rodent model. These results provide evidence that PB supplementation interacts with stress exposure to influence adaptive responses associated with endocrine, neural, and behavioral indices of anxiety.
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Affiliation(s)
- Nick R. Natale
- Dept of Psychology, University of Richmond, VA 23173, USA
| | - Molly Kent
- Dept of Biology, Virginia Military Institute, Lexington, VA 24450, USA
| | - Nathan Fox
- Dept of Psychology, University of Richmond, VA 23173, USA
| | - Dylan Vavra
- Dept of Psychology, University of Richmond, VA 23173, USA
| | - Kelly Lambert
- Dept of Psychology, University of Richmond, VA 23173, USA
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7
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Of Whales and Genes: Unraveling the Physiological Response to Stressors in Belugas (Delphinapterus leucas) at the Molecular Level. JOURNAL OF ZOOLOGICAL AND BOTANICAL GARDENS 2021. [DOI: 10.3390/jzbg2040040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Marine mammals, now more than ever, are exposed to environmental and anthropogenic stressors. A better understanding of stress physiology in marine mammals is warranted in order to assist in conservation efforts. This study screened gene expression profiles (cytokines, stress-response markers) in blood samples collected opportunistically under controlled conditions from aquarium belugas during transport and introduction to a novel environment (T/NEnv), participation in out-of-water examinations (OWE) and from wild belugas during live capture–release health assessments (WLCR). Quantitative-PCR was used to measure gene expression involved in physiological and immune responses at different time scales. Linear mixed models with repeated measures and pairwise comparisons were used for analysis. Overall, a generalized down-regulation of relative gene expression when compared to samples collected under behavioral control from aquarium whales or to pre-assessment samples of wild whales was observed, with genes IFNγ, IL2, TGFβ and Nr3c1 displaying the largest significant (p < 0.05) changes. Significant (p < 0.05) negative associations of inflammatory gene expression with norepinephrine suggest inhibitory effects of catecholamines on the inflammatory response. Overall, this study contributes to our understanding of the physiological response to stressors at the molecular level in belugas, and the genes suggested here can further be utilized as additional tools in beluga health assessments and monitoring.
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8
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Kim E, Zhao Z, Rzasa JR, Glassman M, Bentley WE, Chen S, Kelly DL, Payne GF. Association of acute psychosocial stress with oxidative stress: Evidence from serum analysis. Redox Biol 2021; 47:102138. [PMID: 34555595 PMCID: PMC8458980 DOI: 10.1016/j.redox.2021.102138] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 02/08/2023] Open
Abstract
Growing evidence implicates an association between psychosocial stress and oxidative stress (OxSt) although there are not yet reliable biomarkers to study this association. We used a Trier Social Stress Test (TSST) and compared the response of a healthy control group (HC; N=10) against the response of a schizophrenia group (SCZ; N=10) that is expected to have higher levels of OxSt. Because our previous study showed inconsistent changes in conventional molecular markers for stress responses in the neuroendocrine and immune systems, we analyzed the same serum samples using a separate reducing capacity assay that provides a more global measurement of OxSt. This assay uses the moderately strong oxidizing agent iridium (Ir) to probe a sample's reducing capacity. Specifically, we characterized OxSt by this Ir-reducing capacity assay (Ir-RCA) using two measurement modalities (optical and electrochemical) and we tuned this assay by imposing an input voltage sequence that generates multiple output metrics for data-driven analysis. We defined five OxSt metrics (one optical and four electrochemical metrics) and showed: (i) internal consistency among each metric in the measurements of all 40 samples (baseline and post TSST for N=20); (ii) all five metrics were consistent with expectations of higher levels of OxSt for the SCZ group (three individual metrics showed statistically significant differences); and (iii) all five metrics showed higher levels of OxSt Post-TSST (one metric showed statistically significant difference). Using multivariant analysis, we showed that combinations of OxSt metrics could discern statistically significant increases in OxSt for both the SCZ and HC groups 90 min after the imposed acute psychosocial stress. Ir-reducing capacity assay (Ir-RCA) provides a robust global measure of oxidative stress in serum. The multiple oxidative stress (OxSt) output metrics of this Ir-RCA are useful for data-driven analysis. The combination of OxSt metrics can discern significant increases in OxStwithin 90 mins of an imposed psychosocial stress.
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Affiliation(s)
- Eunkyoung Kim
- Institute for Bioscience & Biotechnology Research, University of Maryland, College Park, MD, 20742, USA; Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, MD, 20742, USA
| | - Zhiling Zhao
- Institute for Bioscience & Biotechnology Research, University of Maryland, College Park, MD, 20742, USA; Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, MD, 20742, USA
| | - John Robertson Rzasa
- Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, MD, 20742, USA
| | - Matthew Glassman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, 21228, USA
| | - William E Bentley
- Institute for Bioscience & Biotechnology Research, University of Maryland, College Park, MD, 20742, USA; Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, MD, 20742, USA
| | - Shuo Chen
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, 21228, USA
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, 21228, USA
| | - Gregory F Payne
- Institute for Bioscience & Biotechnology Research, University of Maryland, College Park, MD, 20742, USA; Robert E. Fischell Institute for Biomedical Devices, University of Maryland, College Park, MD, 20742, USA.
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9
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Kataoka C, Kashiwada S. Ecological Risks Due to Immunotoxicological Effects on Aquatic Organisms. Int J Mol Sci 2021; 22:8305. [PMID: 34361068 PMCID: PMC8347160 DOI: 10.3390/ijms22158305] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 12/19/2022] Open
Abstract
The immunotoxic effects of some anthropogenic pollutants on aquatic organisms are among the causes of concern over the presence of these pollutants in the marine environment. The immune system is part of an organism's biological defense necessarily for homeostasis. Thus, the immunotoxicological impacts on aquatic organisms are important to understand the effects of pollutant chemicals in the aquatic ecosystem. When aquatic organisms are exposed to pollutant chemicals with immunotoxicity, it results in poor health. In addition, aquatic organisms are exposed to pathogenic bacteria, viruses, parasites, and fungi. Exposure to pollutant chemicals has reportedly caused aquatic organisms to show various immunotoxic symptoms such as histological changes of lymphoid tissue, changes of immune functionality and the distribution of immune cells, and changes in the resistance of organisms to infection by pathogens. Alterations of immune systems by contaminants can therefore lead to the deaths of individual organisms, increase the general risk of infections by pathogens, and probably decrease the populations of some species. This review introduced the immunotoxicological impact of pollutant chemicals in aquatic organisms, including invertebrates, fish, amphibians, and marine mammals; described typical biomarkers used in aquatic immunotoxicological studies; and then, discussed the current issues on ecological risk assessment and how to address ecological risk assessment through immunotoxicology. Moreover, the usefulness of the population growth rate to estimate the immunotoxicological impact of pollution chemicals was proposed.
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Affiliation(s)
- Chisato Kataoka
- Graduate School of Life Sciences, Toyo University, 1-1-1 Izumino, Itakura, Gunma 374-0193, Japan
| | - Shosaku Kashiwada
- Department of Life Sciences, Toyo University, 1-1-1 Izumino, Itakura, Gunma 374-0193, Japan;
- Research Centre for Life and Environmental Sciences, Toyo University, 1-1-1 Izumino, Itakura, Gunma 374-0193, Japan
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10
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Xiao R, Ali S, Caligiuri MA, Cao L. Enhancing Effects of Environmental Enrichment on the Functions of Natural Killer Cells in Mice. Front Immunol 2021; 12:695859. [PMID: 34394087 PMCID: PMC8355812 DOI: 10.3389/fimmu.2021.695859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/14/2021] [Indexed: 01/02/2023] Open
Abstract
The environment of an organism can convey a powerful influence over its biology. Environmental enrichment (EE), as a eustress model, has been used extensively in neuroscience to study neurogenesis and brain plasticity. EE has also been used as an intervention for the treatment and prevention of neurological and psychiatric disorders with limited clinical application. By contrast, the effects of EE on the immune system are relatively less investigated. Recently, accumulating evidence has demonstrated that EE can robustly impact immune function. In this review, we summarize the major components of EE, the impact of EE on natural killer (NK) cells, EE's immunoprotective roles in cancer, and the underlying mechanisms of EE-induced NK cell regulation. Moreover, we discuss opportunities for translational application based on insights from animal research of EE-induced NK cell regulation.
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Affiliation(s)
- Run Xiao
- Department of Cancer Biology and Genetics, College of Medicine, The Ohio State University, Columbus, OH, United States
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, Columbus, OH, United States
| | - Seemaab Ali
- Department of Cancer Biology and Genetics, College of Medicine, The Ohio State University, Columbus, OH, United States
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, Columbus, OH, United States
- Medical Scientist Training Program, The Ohio State University, Columbus, OH, United States
| | - Michael A. Caligiuri
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center and the Beckman Research Institute, Los Angeles, CA, United States
| | - Lei Cao
- Department of Cancer Biology and Genetics, College of Medicine, The Ohio State University, Columbus, OH, United States
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, Columbus, OH, United States
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11
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Galbiati V, Buoso E, d'Emmanuele di Villa Bianca R, Paola RD, Morroni F, Nocentini G, Racchi M, Viviani B, Corsini E. Immune and Nervous Systems Interaction in Endocrine Disruptors Toxicity: The Case of Atrazine. FRONTIERS IN TOXICOLOGY 2021; 3:649024. [PMID: 35295136 PMCID: PMC8915797 DOI: 10.3389/ftox.2021.649024] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022] Open
Abstract
Endocrine disruptors (ED) are natural and anthropogenic chemicals that can interfere with hormonal systems at different levels. As such, ED-induced alterations in hormone functions have been implicated in many diseases and pathological conditions, including adverse developmental, reproductive, neurological, cardiovascular, and immunological effects in mammals. The fact that ED may compete with several endogenous hormones for multiple receptors and pathways is not always fully considered. This results in a complex response that depends on the cellular context in terms of receptors and interacting proteins and, thus, may differ between tissues and circumstances. Microglia, neurons, and other immune cells are potential targets and still underappreciated actors in endocrine disruption. Due to the large scale of this topic, this review is not intended to provide a comprehensive review nor a systematic review of chemicals identified as endocrine disruptors. It focuses on the immune-neuro-endocrine network in ED toxicity and research gaps, using atrazine as an example to highlight this complexity and the interrelationship between the immune, endocrine, and nervous systems, and ED.
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Affiliation(s)
- Valentina Galbiati
- Università degli Studi di Milano, Milano, Italy
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
- *Correspondence: Valentina Galbiati
| | - Erica Buoso
- Università degli Studi di Pavia, Pavia, Italy
- Department of Drug Sciences, Università degli Studi di Pavia, Pavia, Italy
| | | | - Rosanna Di Paola
- Università degli Studi di Messina, Messina, Italy
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Università degli Studi di Messina, Messina, Italy
| | - Fabiana Morroni
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giuseppe Nocentini
- Università degli Studi di Perugia, Perugia, Italy
- Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
| | - Marco Racchi
- Università degli Studi di Pavia, Pavia, Italy
- Department of Drug Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Barbara Viviani
- Università degli Studi di Milano, Milano, Italy
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Emanuela Corsini
- Università degli Studi di Milano, Milano, Italy
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
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12
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Bhuiyan P, Wang YW, Sha HH, Dong HQ, Qian YN. Neuroimmune connections between corticotropin-releasing hormone and mast cells: novel strategies for the treatment of neurodegenerative diseases. Neural Regen Res 2021; 16:2184-2197. [PMID: 33818491 PMCID: PMC8354134 DOI: 10.4103/1673-5374.310608] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Corticotropin-releasing hormone is a critical component of the hypothalamic–pituitary–adrenal axis, which plays a major role in the body’s immune response to stress. Mast cells are both sensors and effectors in the interaction between the nervous and immune systems. As first responders to stress, mast cells can initiate, amplify and prolong neuroimmune responses upon activation. Corticotropin-releasing hormone plays a pivotal role in triggering stress responses and related diseases by acting on its receptors in mast cells. Corticotropin-releasing hormone can stimulate mast cell activation, influence the activation of immune cells by peripheral nerves and modulate neuroimmune interactions. The latest evidence shows that the release of corticotropin-releasing hormone induces the degranulation of mast cells under stress conditions, leading to disruption of the blood-brain barrier, which plays an important role in neurological diseases, such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, autism spectrum disorder and amyotrophic lateral sclerosis. Recent studies suggest that stress increases intestinal permeability and disrupts the blood-brain barrier through corticotropin-releasing hormone-mediated activation of mast cells, providing new insight into the complex interplay between the brain and gastrointestinal tract. The neuroimmune target of mast cells is the site at which the corticotropin-releasing hormone directly participates in the inflammatory responses of nerve terminals. In this review, we focus on the neuroimmune connections between corticotropin-releasing hormone and mast cells, with the aim of providing novel potential therapeutic targets for inflammatory, autoimmune and nervous system diseases.
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Affiliation(s)
- Piplu Bhuiyan
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yi-Wei Wang
- Department of Anesthesiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Huan-Huan Sha
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hong-Quan Dong
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yan-Ning Qian
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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13
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Essa HH, Jasim HS, Kadhim HA. Immunological and Hematological Response to Local Transplantation of Stem Cells in Injured Radial Nerve of Dogs. THE IRAQI JOURNAL OF VETERINARY MEDICINE 2020. [DOI: 10.30539/ijvm.v44i2.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The current study was carried out to investigate the immunological and hematological changes due to local transplantation of human umbilical cord-mesenchymal-stem cells (HUC-MSCs) and scaffold-stem cells (SSCs) into the injured radial nerve. Therefore, three equal groups of dogs were subjected to this study; experimental (EG), positive control (PCG) and negative control (NCG). At 1st week, dogs of EG were showed an obvious mobility dysfunction. At 2nd and 4th weeks, there were apparent improvements reported on general and physical activities as well as functional ability of forelimb with the presence of slight lameness that was cured completely at 5th week. Regarding to immunobiomarkers, insignificant differences were showed at 1st week. However, significantly increase in IgG and TNF-α, and decrease in IL-10 was reported at 2nd, 4th, and 6th weeks. Regarding to hematologic parameters, significantly increases were recorded in total WBCs from 2nd week onwards, lymphocytes and neutrophils at 2nd week, monocytes at the 2nd and 4th weeks, and total RBCs at the 8th and 16th weeks. Significant differences were not reported in values of PCV and Hb throughout this study. In conclusion, HUC-MSCs and SSCs confirmed high activities in supporting of immunological and hematological responses, and in restoration of nerve function
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Blackmore D, Li L, Wang N, Maksymowych W, Yacyshyn E, Siddiqi ZA. Metabolomic profile overlap in prototypical autoimmune humoral disease: a comparison of myasthenia gravis and rheumatoid arthritis. Metabolomics 2020; 16:10. [PMID: 31902059 DOI: 10.1007/s11306-019-1625-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 12/02/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Myasthenia gravis (MG) and rheumatoid arthritis (RA) are examples of antibody-mediated chronic, progressive autoimmune diseases. Phenotypically dissimilar, MG and RA share common immunological features. However, the immunometabolomic features common to humoral autoimmune diseases remain largely unexplored. OBJECTIVES The aim of this study was to reveal and illustrate the metabolomic profile overlap found between these two diseases and describe the immunometabolomic significance. METHODS Metabolic analyses using acid- and dansyl-labelled was performed on serum from adult patients with seropositive MG (n = 46), RA (n = 23) and healthy controls (n = 49) presenting to the University of Alberta Hospital specialty clinics. Chemical isotope labelling liquid chromatography mass spectrometry (CIL LC-MS) methods were utilized to assess the serum metabolome in patients; 12C/13C-dansyl chloride (DnsCl) was used to label amine/phenol metabolites and 12C/13C-p-dimethylaminophenacyl bromide (DmPA) was used for carboxylic acids. Metabolites matching our criteria for significance were selected if they were present in both groups. Multivariate statistical analysis [including principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA)] and biochemical pathway analysis was then conducted to gain understanding of the principal pathways involved in antibody-mediated pathogenesis. RESULTS We found 20 metabolites dysregulated in both MG and RA when compared to healthy controls. Most prominently, observed changes were related to pathways associated with phenylalanine metabolism, tyrosine metabolism, ubiquinone and other terpenoid-quinone biosynthesis, and pyruvate metabolism. CONCLUSION From these results it is evident that many metabolites are common to humoral disease and exhibit significant immunometabolomic properties. This observation may lead to an enhanced understanding of the metabolic underpinnings common to antibody-mediated autoimmune disease. Further, contextualizing these findings within a larger clinical and systems biology context could provide new insights into the pathogenesis and management of these diseases.
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Affiliation(s)
- Derrick Blackmore
- Division of Neurology, University of Alberta, 7th Floor, Clinical Sciences Building, 11350 - 83 Ave NW, Edmonton, AB, T6G 2G3, Canada
| | - Liang Li
- Department of Chemistry, University of Alberta, Chemistry Centre Room W3-39C, Edmonton, AB, T6G 2G2, Canada
| | - Nan Wang
- Department of Chemistry, University of Alberta, Chemistry Centre Room W3-39C, Edmonton, AB, T6G 2G2, Canada
| | - Walter Maksymowych
- 568A Heritage Medical Research Centre, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, University of Alberta, 8-130 Clinical Sciences Building, 11350 - 83 Ave NW, Edmonton, AB, Canada
| | - Zaeem A Siddiqi
- Division of Neurology, University of Alberta, 7th Floor, Clinical Sciences Building, 11350 - 83 Ave NW, Edmonton, AB, T6G 2G3, Canada.
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15
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Ogungbesan A, Neal-Kluever A, Rice P. Exploring the use of current immunological assays for the developmental immunotoxicity assessment of food contact materials. Food Chem Toxicol 2019; 133:110801. [PMID: 31499121 DOI: 10.1016/j.fct.2019.110801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/23/2019] [Accepted: 09/01/2019] [Indexed: 02/07/2023]
Abstract
The mammalian immune system is a highly complex, interactive network of cells that facilitates innate and adaptive immune responses. The neonatal immune system may be more susceptible to chemical perturbations than that of the adult. The effects of immunotoxicants during development may not be fully detected in toxicity studies performed on adult animals. Studies characterizing the ontogeny of the immune system in developing animals have shown that there are different critical windows of susceptibility to immunotoxicants. Developmental differences are evident among species compared to humans. Functional immune assays, such as the T-cell antibody dependent response assay, in rat models have been validated for use in the assessment of immunotoxicity with other assays. Recently, published studies have explored the feasibility of using additional techniques, such as in vitro studies using human whole blood cells or cell lines, mostly lacking either sensitivity or proper validation for regulatory purposes. However, some techniques may be developed further to enable translation of animal toxicity findings to human risk assessment of potential immunotoxicants. This paper summarizes the information on the developing immune system in humans versus rats and how the currently available assays might be used to contribute to the safety assessment of food contact substances.
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Affiliation(s)
- Adejoke Ogungbesan
- FDA/CFSAN/OFAS, 5001 Campus Drive, HFS 275, College Park, MD, 20740, USA.
| | - April Neal-Kluever
- FDA/CFSAN/OFAS, 5001 Campus Drive, HFS 275, College Park, MD, 20740, USA
| | - Penny Rice
- FDA/CFSAN/OFAS, 5001 Campus Drive, HFS 275, College Park, MD, 20740, USA
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16
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Blackmore D, Siddiqi Z, Li L, Wang N, Maksymowych W. Beyond the antibodies: serum metabolomic profiling of myasthenia gravis. Metabolomics 2019; 15:109. [PMID: 31372762 DOI: 10.1007/s11306-019-1571-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Myasthenia gravis (MG) is a chronic, potentially debilitating autoimmune disease characterized by weakness and rapid fatigue of the voluntary muscles that worsens on exertion. Left untreated, MG symptoms may cause significant morbidity or even death. To date, no robust biological marker is available to follow the course of the disease. Therefore, new diagnostic approaches and biological markers are essential not only for improved diagnosis of the disease but for improved outcomes. OBJECTIVES The present study applied a two-control, multi-label metabolomics profiling approach as a potential strategy for the identification of biomarkers unique to myasthenia gravis (MG). METHODS Metabolic analyses using acid- and dansyl-labelled serum from seropositive MG (n = 46), rheumatoid arthritis (RA) (n = 23) and healthy controls (HC) (n = 49) were performed on samples from adult patients presenting to the University of Alberta Hospital neuromuscular and rheumatology clinics. Comparisons between patients with MG vs. HC, and RA vs. HC were made using univariate and multivariate statistics. RESULTS Serum biomarker patterns were statistically significantly different between groups. Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) models exhibited considerable distinction between all groups. Metabolites were then filtered to remove peak pairs common to both disease cohorts. Combined metabolite panels revealed clear separation between MG and HC for both library-matched (AUROC: 0.92 ± 0.03) and highest AUC patients (AUROC: 0.94 ± 0.05). CONCLUSION In patients presenting to the clinic with seropositive MG, metabolomic profiling is capable of distinguishing patients with disease from those without. These results provide an important first step towards a potential biomarker for improving MG identification.
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Affiliation(s)
- Derrick Blackmore
- Division of Neurology, University of Alberta, 7th floor, Clinical Sciences Building, 11350 - 83 Ave NW, Edmonton, AB, T6G 2G, Canada.
| | - Zaeem Siddiqi
- Division of Neurology, University of Alberta, 7th floor, Clinical Sciences Building, 11350 - 83 Ave NW, Edmonton, AB, T6G 2G, Canada
| | - Liang Li
- Department of Chemistry, University of Alberta, Chemistry Centre Room W3-39C, Edmonton, AB, T6G 2G2, Canada
| | - Nan Wang
- Department of Chemistry, University of Alberta, Chemistry Centre Room W3-39C, Edmonton, AB, T6G 2G2, Canada
| | - Walter Maksymowych
- 568A Heritage Medical Research Centre, University of Alberta, Edmonton, AB, T6G 2S2, Canada
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17
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Rychlik KA, Sillé FCM. Environmental exposures during pregnancy: Mechanistic effects on immunity. Birth Defects Res 2019; 111:178-196. [PMID: 30708400 DOI: 10.1002/bdr2.1469] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/16/2019] [Indexed: 12/21/2022]
Abstract
In human studies, it is well established that exposures during embryonic and fetal development periods can influence immune health. Coupled with genetic predisposition, these exposures can alter lifetime chronic and infectious disease trajectory, and, ultimately, life expectancy. Fortunately, as research advances, mechanisms governing long-term effects of prenatal exposures are coming to light and providing the opportunity for intervention and risk reduction. For instance, human association studies have provided a foundation for the association of prenatal exposure to particulate matter with early immunosuppression and later allergic disease in the offspring. Only recently, the mechanisms mediating this response have been revealed and there is much we have yet to discover. Although cellular immune response is understood for many exposure scenarios, molecular pathways are still unidentified. This review will provide commentary and synthesis of the current literature regarding environmental exposures during pregnancy and mechanisms determining immune outcomes. Shared mechanistic features and current gaps in the state of the science are identified and discussed. To such purpose, we address exposures by their immune effect type: immunosuppression, autoimmunity, inflammation and tissue damage, hypersensitivity, and general immunomodulation.
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Affiliation(s)
- Kristal A Rychlik
- Department of Environmental Health and Engineering, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Fenna C M Sillé
- Department of Environmental Health and Engineering, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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