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Normann SS, Beck IH, Nielsen F, Andersen MS, Bilenberg N, Jensen TK, Andersen HR. Prenatal exposure to pyrethroids and chlorpyrifos and IQ in 7-year-old children from the Odense Child Cohort. Neurotoxicol Teratol 2024; 103:107352. [PMID: 38636567 DOI: 10.1016/j.ntt.2024.107352] [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: 11/23/2023] [Revised: 03/07/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Organophosphates and pyrethroids are two major groups of insecticides used for crop protection worldwide. They are neurotoxicants and exposure during vulnerable windows of brain development may have long-term impact on human neurodevelopment. Only few longitudinal studies have investigated associations between prenatal exposure to these substances and intelligence quotient (IQ) at school age in populations with low, mainly dietary, exposure. OBJECTIVE To investigate associations between maternal urinary concentrations of insecticide metabolites at gestational week 28 and IQ in offspring at 7-years of age. MATERIALS AND METHODS Data was derived from the Odense Child Cohort (OCC). Metabolites of chlorpyrifos (TCPy) and pyrethroids (3-PBA, cis- and trans-DCCA, 4-F-3PBA, cis-DBCA) were measured in maternal urine collected at gestational week (GW) 28. An abbreviated version of the Danish Wechsler Intelligence Scale for Children fifth edition (WISC-V) consisting of four subtests to estimate full scale IQ (FSIQ) was administered by trained psychologists. Data were analyzed by use of multiple linear regression and adjusted for confounders. RESULTS 812 mother/child-pairs were included. Median concentrations were 0.21 μg/L for 3-PBA, 1.67 μg/L for TCPy and the mean IQ for children were 99.4. Null association between maternal 3-PBA and child IQ at 7 years was seen, but with trends suggesting an inverse association. There was a significant association for maternal TCPy and child IQ at mid-level exposure. Trans-DCCA above the level of detection (LOD) was also associated with slightly lower child IQ, but the association was also not statistically significant. CONCLUSIONS We found no significant associations between maternal 3-PBA metabolites and child IQ at 7 years, but with trends suggesting an inverse association. A non-significant trend between maternal TCPy exposure and child IQ in 7-year-children was seen even in this low exposed population. Given the widespread exposure and increasing use of insecticides, this should be elaborated in future studies.
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Affiliation(s)
- Stine Søgaard Normann
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Iben Have Beck
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Flemming Nielsen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Niels Bilenberg
- Department of Child and Adolescent Psychiatry, Mental Health Services in Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Tina Kold Jensen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; OPEN Patient data Explorative Network, Odense, Denmark
| | - Helle Raun Andersen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Antonangeli LM, Kenzhebekova S, Colosio C. Neurobehavioral Effects of Low-Dose Chronic Exposure to Insecticides: A Review. TOXICS 2023; 11:192. [PMID: 36851066 PMCID: PMC9963921 DOI: 10.3390/toxics11020192] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
The modes of action of insecticides frequently involve a neurotoxic effect; therefore, the study of neurotoxic effects caused by long-term and low-dose insecticide exposure is of particular interest. This study looks at whether or not new studies conducted after 2009 and up to 2021 have provided new evidence for a better understanding of the actual neurobehavioral risk associated with long-term insecticide exposure. We selected and reviewed studies carried out on the neurobehavioral effects of neurotoxic insecticides (organophosphates and/or carbamates, pyrethroids, multiple or undefined insecticides, and organochlorines) considering occupational and non-occupational exposures. The articles were also scored and ranked based on seven parameters. Eighty-six studies were chosen for a final review process from among the 950 scientific papers identified. Twenty-six addressed occupational exposure and six environmental exposure. Among the latter group of studies, 17 focused on rural residents, to be assumed exposed because of living in rural areas, and 43 on the general population. Pending doubts have not been resolved in the last ten years due to the presence of contradictory and hardly comparable results and the fact that in most of the studies showing an evident neurobehavioral impairment the frequent presence of a previous episode of poisoning and hospitalization, with severe brain hypoxia, impaired the possibility of confirming the presence of a causal association with insecticide exposure. Interestingly, the most severely exposed groups, such as applicators who did not wear personal protective equipment, performed worse on neurobehavioral tests. As for residential exposure, there is sufficient evidence to suggest that prenatal OP exposure may increase the risk of ADHD in children.
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Affiliation(s)
| | - Saniya Kenzhebekova
- Department of Health Sciences, University of Milan, International Centre for Rural Health of the Santi Paolo e Carlo ASST of Milan, 20142 Milano, Italy
| | - Claudio Colosio
- Department of Health Sciences, University of Milan, International Centre for Rural Health of the Santi Paolo e Carlo ASST of Milan, 20142 Milano, Italy
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Lin S, Li J, Wu J, Yang F, Pei L, Shang X. Interactive effects of maternal exposure to chemical fertilizer and socio-economic status on the risk of low birth weight. BMC Public Health 2022; 22:1206. [PMID: 35710359 PMCID: PMC9204990 DOI: 10.1186/s12889-022-13604-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Maternal exposure to chemical fertilizer and disadvantaged maternal socio-economic status (SES) have been found to associate with increased risk of low birth weight (LBW). However, whether the two factors would interact to elevate the risk of LBW remains unknown. The present study aimed to explore the interactive effects of maternal exposure to chemical fertilizer during pregnancy and low SES on the risk of term LBW (tLBW). Methods In this population-based case–control study, 179 tLBW cases (birthweight < 2500 g and gestational age ≥ 37 weeks) and 204 controls (birthweight ≥ 2500 g and gestational age ≥ 37 weeks) were chosen from the Perinatal Health Care Surveillance System of Pingding County, Shanxi Province, China between 2007 and 2012. Data on basic socio-demographic, dietary and lifestyle characteristics and environmental exposure were directly extracted from the system. Maternal exposure to chemical fertilizer was measured at both household level and village level. Household-level exposure was indicated by household chemical fertilizer use in farming during pregnancy and the data was collected by trained healthcare workers after the selection of cases and controls in 2013. Village-level exposure was indicated by annual amount of village chemical fertilizer consumption per acre and the data came from the Annals of National Economics Statistics of Pingding County in 2010. Interactions between maternal exposure to chemical fertilizer and SES were assessed in logistic regressions using relative excess risk due to interaction (RERI), which indicates an additive interaction if larger than 0. Results The combination of low maternal SES and high exposure to village-level chemical fertilizer consumption was associated with increased risk of tLBW (aOR = 2.62, 95%CI: 1.44 ~ 4.77); The combination of low maternal SES and exposure to household chemical fertilizer use was associated with elevated risk of tLBW (aOR = 2.18, 95%CI: 1.24 ~ 3.83). Additive interactions were detected between high exposure to village-level chemical fertilizer consumption and low maternal SES (RERI:1.79, P < 0.001) and between exposure to household chemical fertilizer use and low maternal SES (RERI:0.77, P < 0.05). Conclusions Our study suggested negative impacts of potential agricultural pollutants on adverse pregnancy outcomes, especially in disadvantaged socio-economic populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13604-z.
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Affiliation(s)
- Shiqi Lin
- Institute of Population Research/China Center on Population Health and Development, Peking University, Beijing, 100871, China
| | - Jiajia Li
- Institute of Population Research/China Center on Population Health and Development, Peking University, Beijing, 100871, China
| | - Jilei Wu
- Institute of Population Research/China Center on Population Health and Development, Peking University, Beijing, 100871, China
| | - Fan Yang
- Institute of Population Research/China Center on Population Health and Development, Peking University, Beijing, 100871, China
| | - Lijun Pei
- Institute of Population Research/China Center on Population Health and Development, Peking University, Beijing, 100871, China.
| | - Xuejun Shang
- Department of Andrology, School of Medicine, Jinling Hospital, Nanjing University, No.305, East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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Andersen HR, Dalsager L, Jensen IK, Timmermann CAG, Olesen TS, Trecca F, Nielsen F, Schoeters G, Kyhl HB, Grandjean P, Bilenberg N, Bleses D, Jensen TK. Prenatal exposure to pyrethroid and organophosphate insecticides and language development at age 20-36 months among children in the Odense Child Cohort. Int J Hyg Environ Health 2021; 235:113755. [PMID: 33962121 DOI: 10.1016/j.ijheh.2021.113755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prenatal exposure to organophosphate and pyrethroid insecticides has been associated with impaired neurodevelopment. Few longitudinal studies have investigated associations with early language development in populations with mainly low dietary exposure. OBJECTIVE To investigate associations between biomarkers of maternal gestational exposure to organophosphate and pyrethroid insecticides and the child's language development at age 20-36 months in the prospective Odense Child Cohort. METHODS Metabolites of organophosphate and pyrethroid insecticides were measured in maternal urine samples collected at gestational week 28. Language development was assessed among 755 singletons at age 20-36 months using the Vocabulary and Complexity scores of the MacArthur-Bates Communicative Development Inventories, standardized into age and sex specific percentile scores according to a Danish reference study. Multiple logistic regression models were used to estimate the odds of scoring below the 15th percentile scores in relation to maternal urinary insecticide metabolite concentrations after adjustment for confounders. RESULTS The generic pyrethroid metabolite 3-phenoxybenzoic acid (3-PBA) and the chlorpyrifos metabolite 3,5,6-trichloro-2-pyridinol (TCPY) were detectable in more than 90% of the urine samples analyzed. Likewise, 82.2% had detectable concentrations of diethyl phosphates (DE) and 58.4% of dimethyl phosphates (DM), both of which are common metabolites of organophosphate insecticides. None of the metabolites was associated with higher odds of delayed results below the 15th percentile language scores. In contrast, reduced probability for scoring below the 15th percentile Vocabulary score was seen for the highest tertile of 3-PBA in boys and for the upper tertile of TCPY and DE in girls. CONCLUSION In this prospective cohort, with predominantly dietary insecticide exposure, we found no evidence that gestational exposure to organophosphate or pyrethroid insecticides adversely affected early language development in the children. The observed indication of a positive effect of insecticides on language development may be explained by residual and unmeasured confounding from socioeconomic factors and dietary habits. Follow-up of these children should include assessment of more complex cognitive functions in later childhood, as well as associations with their own postnatal insecticide exposure.
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Affiliation(s)
- Helle Raun Andersen
- Department of Public Health, University of Southern Denmark, Odense, J.B. Winsløws Vej 17A, 5000, Odense, Denmark.
| | - Louise Dalsager
- Department of Public Health, University of Southern Denmark, Odense, J.B. Winsløws Vej 17A, 5000, Odense, Denmark
| | - Inge Kjær Jensen
- Department of Public Health, University of Southern Denmark, Odense, J.B. Winsløws Vej 17A, 5000, Odense, Denmark
| | - Clara Amalie Gade Timmermann
- Department of Public Health, University of Southern Denmark, Odense, J.B. Winsløws Vej 17A, 5000, Odense, Denmark
| | - Trine Staak Olesen
- Department of Public Health, University of Southern Denmark, Odense, J.B. Winsløws Vej 17A, 5000, Odense, Denmark
| | - Fabio Trecca
- School of Communication and Culture - Trygfondens Centre for Child Research, Aarhus University, Denmark
| | - Flemming Nielsen
- Department of Public Health, University of Southern Denmark, Odense, J.B. Winsløws Vej 17A, 5000, Odense, Denmark
| | - Greet Schoeters
- Department of Public Health, University of Southern Denmark, Odense, J.B. Winsløws Vej 17A, 5000, Odense, Denmark; Environmental Risk and Health, Flemish Institute for Technological Research (VITO), University of Antwerp, Belgium
| | - Henriette Boye Kyhl
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark; Odense Patient Data Explorative Network (OPEN), Odense, Denmark
| | - Philippe Grandjean
- Department of Public Health, University of Southern Denmark, Odense, J.B. Winsløws Vej 17A, 5000, Odense, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Dorthe Bleses
- School of Communication and Culture - Trygfondens Centre for Child Research, Aarhus University, Denmark
| | - Tina Kold Jensen
- Department of Public Health, University of Southern Denmark, Odense, J.B. Winsløws Vej 17A, 5000, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
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Cartier C, Warembourg C, Monfort C, Rouget F, Limon G, Durand G, Cordier S, Saint-Amour D, Chevrier C. Children’s contrast sensitivity function in relation to organophosphate insecticide prenatal exposure in the mother-child PELAGIE cohort. Neurotoxicology 2018; 67:161-168. [DOI: 10.1016/j.neuro.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 01/11/2023]
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Wieck S, Olsson O, Kümmerer K. Consumers’ perceptions of biocidal products in households. Int J Hyg Environ Health 2018; 221:260-268. [DOI: 10.1016/j.ijheh.2017.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/09/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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Gascon M, Guxens M, Vrijheid M, Torrent M, Ibarluzea J, Fano E, Llop S, Ballester F, Fernández MF, Tardón A, Fernández-Somoano A, Sunyer J. The INMA—INfancia y Medio Ambiente—(Environment and Childhood) project: More than 10 years contributing to environmental and neuropsychological research. Int J Hyg Environ Health 2017; 220:647-658. [DOI: 10.1016/j.ijheh.2017.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 12/01/2022]
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Handal AJ, Hund L, Páez M, Bear S, Greenberg C, Fenske RA, Barr DB. Characterization of Pesticide Exposure in a Sample of Pregnant Women in Ecuador. ARCHIVES OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2016; 70:627-39. [PMID: 26311023 PMCID: PMC4769681 DOI: 10.1007/s00244-015-0217-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 08/07/2015] [Indexed: 05/13/2023]
Abstract
Few studies have detailed the prenatal pesticide exposure levels of women employed in or residing near large-scale agricultural industries. This study reports pesticide metabolite levels during and shortly after pregnancy in a pilot study of workers in Ecuador. Urine samples were collected for 16 rose workers and 10 nonagricultural workers enrolled into the study in early pregnancy. We measured six nonspecific organophosphatedialkylphosphate (DAP) pesticide metabolites, two alkylenebis-dithiocarbamate pesticide metabolites [ethylene thiourea (ETU) and propylene thiourea (PTU)], 3,5,6-trichloro-2-pyridinol (TCPy), malathion dicarboxylic acid, and two pyrethroid metabolites (2,2-dimethylcyclo propanecarboxylic acid and 3-phenooxybenzoic acid). We collected 141 urine samples (mean: 5.4 per woman). We observed high detection frequencies for five DAP metabolites and ETU, PTU, and TCPy. We report elevated levels of ETU in the entire sample (median 4.24 ng/mL, IQR 2.23, 7.18), suggesting other possible non-occupational pathways of exposure. We found no statistical differences in pesticide levels by current employment status, although the highest pesticide levels were among rose workers. We observed within-woman correlation in TCPy and PTU levels, but not in ETU or DAP levels. The present study is the first to characterize prenatal pesticide exposure levels among working women in Ecuador. Limitations include a small sample size and use of a convenience sample. Strengths include a longitudinal design and multiple urine samples per woman. Results provide an initial characterization of prenatal pesticide exposure levels and how these levels vary over pregnancy in a community impacted by agricultural industry and will inform further studies in the region.
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Affiliation(s)
- Alexis J Handal
- Public Health Program, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Lauren Hund
- Biostatistics and Epidemiology, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Maritza Páez
- College of Health Sciences, Universidad San Francisco de Quito, Cumbaya, Ecuador
| | - Samantha Bear
- Public Health Program, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Carolyn Greenberg
- Public Health Program, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Richard A Fenske
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Dana Boyd Barr
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Butler-Dawson J, Galvin K, Thorne PS, Rohlman DS. Organophosphorus pesticide exposure and neurobehavioral performance in Latino children living in an orchard community. Neurotoxicology 2016; 53:165-172. [PMID: 26820522 DOI: 10.1016/j.neuro.2016.01.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 01/29/2023]
Abstract
Children living in agricultural communities have a greater risk from pesticides due to para-occupational pathways. The goal of this study was to assess the impact of exposure to organophosphorus pesticides on the neurobehavioral performance of school-aged Latino children over time. Two exposure measures were used to estimate children's pesticide exposure: parent's occupation (agricultural or non-agricultural) and organophosphate residues in home carpet dust samples. During 2008-2011, 206 school-aged children completed a battery of neurobehavioral tests two times, approximately one year apart. The associations between both exposure measures and neurobehavioral performance were examined. Pesticide residues were detected in dust samples from both agricultural and non-agricultural homes, however, pesticides were detected more frequently and in higher concentrations in agricultural homes compared to non-agricultural homes. Although few differences were found between agricultural and non-agricultural children at both visits, deficits in learning from the first visit to the second visit, or less improvement, was found in agricultural children relative to non-agricultural children. These differences were significant for the Divided Attention and Purdue Pegboard tests. These findings are consistent with previous research showing deficits in motor function. A summary measure of organophosphate residues was not associated with neurobehavioral performance. Results from this study indicate that children in agricultural communities are at increased risk from pesticides as a result of a parent working in agricultural. Our findings suggest that organophosphate exposure may be associated with deficits in learning on neurobehavioral performance, particularly in tests of with motor function. In spite of regulatory phasing out of organophosphates in the U.S., we still see elevated levels and higher detection rates of several organophosphates in agricultural households than non-agricultural households, albeit lower levels than prior studies.
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Affiliation(s)
- Jaime Butler-Dawson
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States
| | - Kit Galvin
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, United States
| | - Peter S Thorne
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States
| | - Diane S Rohlman
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States; Oregon Institute for Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States.
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Putative Epimutagens in Maternal Peripheral and Cord Blood Samples Identified Using Human Induced Pluripotent Stem Cells. BIOMED RESEARCH INTERNATIONAL 2015; 2015:876047. [PMID: 26339649 PMCID: PMC4538592 DOI: 10.1155/2015/876047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/26/2015] [Accepted: 03/09/2015] [Indexed: 01/08/2023]
Abstract
The regulation of transcription and genome stability by epigenetic systems are crucial for the proper development of mammalian embryos. Chemicals that disturb epigenetic systems are termed epimutagens. We previously performed chemical screening that focused on heterochromatin formation and DNA methylation status in mouse embryonic stem cells and identified five epimutagens: diethyl phosphate (DEP), mercury (Hg), cotinine, selenium (Se), and octachlorodipropyl ether (S-421). Here, we used human induced pluripotent stem cells (hiPSCs) to confirm the effects of 20 chemicals, including the five epimutagens, detected at low concentrations in maternal peripheral and cord blood samples. Of note, these individual chemicals did not exhibit epimutagenic activity in hiPSCs. However, because the fetal environment contains various chemicals, we evaluated the effects of combined exposure to chemicals (DEP, Hg, cotinine, Se, and S-421) on hiPSCs. The combined exposure caused a decrease in the number of heterochromatin signals and aberrant DNA methylation status at multiple gene loci in hiPSCs. The combined exposure also affected embryoid body formation and neural differentiation from hiPSCs. Therefore, DEP, Hg, cotinine, Se, and S-421 were defined as an “epimutagen combination” that is effective at low concentrations as detected in maternal peripheral and cord blood.
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Andersen HR, Debes F, Wohlfahrt-Veje C, Murata K, Grandjean P. Occupational pesticide exposure in early pregnancy associated with sex-specific neurobehavioral deficits in the children at school age. Neurotoxicol Teratol 2015; 47:1-9. [DOI: 10.1016/j.ntt.2014.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 12/19/2022]
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