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Chen CHS, Yuan TH, Lu TP, Lee HY, Chen YH, Lai LC, Tsai MH, Chuang EY, Chan CC. Exposure-associated DNA methylation among people exposed to multiple industrial pollutants. Clin Epigenetics 2024; 16:111. [PMID: 39164771 PMCID: PMC11337639 DOI: 10.1186/s13148-024-01705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 07/08/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Current research on the epigenetic repercussions of exposure to a combination of pollutants is limited. This study aims to discern DNA methylation probes associated with exposure to multiple pollutants, serving as early effect markers, and single-nucleotide polymorphisms (SNPs) as surrogate indicators for population susceptibility. The investigation involved the analysis of urine exposure biomarkers for 11 heavy metals (vanadium, arsenic, mercury, cadmium, chromium, nickel, lead, manganese, copper, strontium, thallium), polycyclic aromatic hydrocarbon (PAHs) (1-hydroxypyrene), genome-wide DNA methylation sequencing, and SNPs array on all study participants. The data were integrated with metabolomics information and analyzed both at a community level based on proximity to home addresses relative to the complex and at an individual level based on exposure biomarker concentrations. RESULTS On a community level, 67 exposure-related CpG probes were identified, while 70 CpG probes were associated with urine arsenic concentration, 2 with mercury, and 46 with vanadium on an individual level. These probes were annotated to genes implicated in cancers and chronic kidney disease. Weighted quantile sum regression analysis revealed that vanadium, mercury, and 1-hydroxypyrene contributed the most to cg08238319 hypomethylation. cg08238319 is annotated to the aryl hydrocarbon receptor repressor (AHRR) gene, and AHRR hypomethylation was correlated with an elevated risk of lung cancer. AHRR was further linked to deregulations in phenylalanine metabolism, alanine, aspartate, and glutamate metabolism, along with heightened oxidative stress. Additionally, three SNPs (rs11085020, rs199442, and rs10947050) corresponding to exposure-related CpG probes exhibited significant interaction effects with multiple heavy metals and PAHs exposure, and have been implicated in cancer progression and respiratory diseases. CONCLUSION Our findings underscore the pivotal role of AHRR methylation in gene-environment interactions and highlight SNPs that could potentially serve as indicators of population susceptibility in regions exposed to multiple heavy metals and PAHs.
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Affiliation(s)
- Chi-Hsin Sally Chen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tzu-Hsuen Yuan
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsin-Ying Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsuen Chen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Liang-Chuan Lai
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mong-Hsun Tsai
- Institute of Biotechnology, College of Bio-Resources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Eric Y Chuang
- Department of Electrical Engineering, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan.
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan.
- Research and Development Center for Medical Devices, National Taiwan University, Taipei, Taiwan.
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Monteiro V, Dias da Silva D, Martins M, Guedes de Pinho P, Pinto J. Metabolomics perspectives of the ecotoxicological risks of polycyclic aromatic hydrocarbons: A scoping review. ENVIRONMENTAL RESEARCH 2024; 249:118394. [PMID: 38307181 DOI: 10.1016/j.envres.2024.118394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024]
Abstract
Polycyclic Aromatic Hydrocarbons (PAHs) represent persistent environmental pollutants ubiquitously distributed in the environment. Their presence alongside various other contaminants gives rise to intricate interactions, culminating in profound deleterious consequences. The combination effects of different PAH mixtures on biota remains a relatively unexplored domain. Recent studies have harnessed the exceptional sensitivity of metabolomic techniques to unveil the significant ecotoxicological perils of PAH pollution confronting both human populations and ecosystems. This article furnishes a comprehensive overview of current literature focused on the metabolic repercussions stemming from exposure to complex mixtures of PAHs or PAH-pollution sources using metabolomics approaches. These insights are obtained through a wide range of models, including in vitro assessments, animal studies, investigations on human subjects, botanical specimens, and soil environments. The findings underscore that PAH mixtures induce cellular stress responses and systemic effects, leading to metabolic dysregulations in amino acids, carbohydrates, lipids, and other key metabolites (e.g., organic acids, purines), with specific variations observed based on the organism and PAH compounds involved. Additionally, the ecological consequences of PAH pollutants on plant and soil microbial responses are emphasized, revealing significant changes in stress-related metabolites and nutrient cycling in soil ecosystems. The complex interplay of various PAHs and their metabolic effects on several models, as elucidated through metabolomics, highlight the urgency of further research and the need for comprehensive strategies to mitigate the risks posed by these widespread environmental pollutants.
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Affiliation(s)
- Vânia Monteiro
- Associate Laboratory i4HB ‒ Institute for Health and Bioeconomy, University of Porto, 4050-313 Porto, Portugal; UCIBIO ‒ Applied Molecular Biosciences Unit, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal.
| | - Diana Dias da Silva
- Associate Laboratory i4HB ‒ Institute for Health and Bioeconomy, University of Porto, 4050-313 Porto, Portugal; UCIBIO ‒ Applied Molecular Biosciences Unit, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; 1H-TOXRUN - One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU CRL, Rua Central de Gandra, 4585-116 Gandra, Portugal
| | - Marta Martins
- MARE ‒ Marine and Environmental Sciences Centre & ARNET - Aquatic Research Network Associated Laboratory, Department of Sciences and Environmental Engineering, NOVA School of Science and Technology (FCT NOVA), NOVA University of Lisbon, 2829-516 Caparica, Portugal
| | - Paula Guedes de Pinho
- Associate Laboratory i4HB ‒ Institute for Health and Bioeconomy, University of Porto, 4050-313 Porto, Portugal; UCIBIO ‒ Applied Molecular Biosciences Unit, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Joana Pinto
- Associate Laboratory i4HB ‒ Institute for Health and Bioeconomy, University of Porto, 4050-313 Porto, Portugal; UCIBIO ‒ Applied Molecular Biosciences Unit, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal.
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Lee SJ, Prithiviraj B, Lee HY, Kim SJ, Seo YK, Kim H, Choi SD. Geographic information system-based determination of priority monitoring areas for hazardous air pollutants in an industrial city. ENVIRONMENTAL MONITORING AND ASSESSMENT 2024; 196:506. [PMID: 38702588 DOI: 10.1007/s10661-024-12626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024]
Abstract
Industrial cities are hotspots for many hazardous air pollutants (HAPs), which are detrimental to human health. We devised an identification method to determine priority HAP monitoring areas using a comprehensive approach involving monitoring, modeling, and demographics. The methodology to identify the priority HAP monitoring area consists of two parts: (1) mapping the spatial distribution of selected categories relevant to the target pollutant and (2) integrating the distribution maps of various categories and subsequent scoring. The identification method was applied in Ulsan, the largest industrial city in South Korea, to identify priority HAP monitoring areas. Four categories related to HAPs were used in the method: (1) concentrations of HAPs, (2) amount of HAP emissions, (3) the contribution of industrial activities, and (4) population density in the city. This method can be used to select priority HAP monitoring areas for intensive monitoring campaigns, cohort studies, and epidemiological studies.
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Affiliation(s)
- Sang-Jin Lee
- Department of Civil, Urban, Earth, and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Balasubramanian Prithiviraj
- Department of Civil, Urban, Earth, and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Ho-Young Lee
- Department of Civil, Urban, Earth, and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Seong-Joon Kim
- Department of Civil, Urban, Earth, and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Young-Kyo Seo
- Air Quality Research Division, National Institute of Environmental Research, Incheon, 22689, Republic of Korea
| | - Hyunjoo Kim
- Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital, Seoul, 07985, Republic of Korea
| | - Sung-Deuk Choi
- Department of Civil, Urban, Earth, and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea.
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Chang Y, Chiang CK. The Impact of Thallium Exposure in Public Health and Molecular Toxicology: A Comprehensive Review. Int J Mol Sci 2024; 25:4750. [PMID: 38731969 PMCID: PMC11084277 DOI: 10.3390/ijms25094750] [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: 03/18/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
This review offers a synthesis of the current understanding of the impact of low-dose thallium (Tl) on public health, specifically emphasizing its diverse effects on various populations and organs. The article integrates insights into the cytotoxic effects, genotoxic potential, and molecular mechanisms of thallium in mammalian cells. Thallium, a non-essential heavy metal present in up to 89 different minerals, has garnered attention due to its adverse effects on human health. As technology and metallurgical industries advance, various forms of thallium, including dust, vapor, and wastewater, can contaminate the environment, extending to the surrounding air, water sources, and soil. Moreover, the metal has been identified in beverages, tobacco, and vegetables, highlighting its pervasive presence in a wide array of food sources. Epidemiological findings underscore associations between thallium exposure and critical health aspects such as kidney function, pregnancy outcomes, smoking-related implications, and potential links to autism spectrum disorder. Thallium primarily exerts cellular toxicity on various tissues through mitochondria-mediated oxidative stress and endoplasmic reticulum stress. This synthesis aims to shed light on the intricate web of thallium exposure and its potential implications for public health, emphasizing the need for vigilant consideration of its risks.
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Affiliation(s)
- Yung Chang
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 100233, Taiwan;
| | - Chih-Kang Chiang
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 100233, Taiwan;
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei 100225, Taiwan
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Doccioli C, Sera F, Francavilla A, Cupisti A, Biggeri A. Association of cadmium environmental exposure with chronic kidney disease: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 906:167165. [PMID: 37758140 DOI: 10.1016/j.scitotenv.2023.167165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Several observational studies investigated the relationship between environmental cadmium exposure and risk of chronic kidney disease (CKD). However, results from epidemiological studies are conflicting and wide variabilities have been reported. OBJECTIVES We conducted a meta-analysis to evaluate the relationship between environmental cadmium exposure and CKD risk, as assessed by decreased estimated Glomerular Filtration Rate (eGFR) in adults. METHODS PubMed, Embase and the Cochrane library databases were searched for studies published up to July 2023. A random-effects model using the restricted maximum likelihood (REML) method was used to calculate the overall estimate to assess the association between cadmium exposure and eGFR. Subgroup analysis, funnel plot, Egger's test, and the trim-and-fill method were also conducted. RESULTS Thirty-one articles, 3 cohorts, 2 case-control and 26 cross-sectional studies, across 8 countries, involving 195.015 participants were included. The meta-analysis demonstrated an inverse association between high cadmium exposure and eGFR levels (standardized regression coefficient β = -0.09; 95 % CI = -0.15, -0.04). The subgroup analysis showed that the inverse association was significantly higher for blood cadmium exposure (β = -0.12; 95 % CI = -0.18, -0.06) than for urinary concentrations (β = -0.04; 95 % CI: -0.10, 0.03) or dietary exposure (β = -0.03; 95 % CI = -0.19, 0.14). Stratified analysis by different study design also showed an inverse association between cadmium exposure and eGFR, more evident in the cross-sectional studies (β = -0.11; 95 % CI = -0.18, -0.03) than in the cohort (β = -0.05; 95 % CI = -0.26, 0.17) and in the case-control studies (β = -0.05; 95 % CI = -0.32, 0.21). DISCUSSION Our meta-analysis indicated that environmental cadmium exposure is associated with increased risk of CKD, as assessed by decreased eGFR, and this association is more evident for blood cadmium concentrations than for urinary concentrations or dietary exposure. Nevertheless, additional high quality prospective studies are needed to confirm the association between cadmium exposure and risk of CKD.
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Affiliation(s)
- Chiara Doccioli
- Department of Statistic, Computer Science and Applications "G.Parenti", University of Florence, Florence, Italy.
| | - Francesco Sera
- Department of Statistic, Computer Science and Applications "G.Parenti", University of Florence, Florence, Italy
| | - Andrea Francavilla
- Department of Cardio, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Annibale Biggeri
- Department of Cardio, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Huang Y, Wan Z, Zhang M, Hu L, Song L, Wang Y, Lv Y, Wang L. The association between urinary metals/metalloids and chronic kidney disease among general adults in Wuhan, China. Sci Rep 2023; 13:15321. [PMID: 37714886 PMCID: PMC10504376 DOI: 10.1038/s41598-023-42282-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023] Open
Abstract
The relation between exposure to single metal/metalloid and the risk of chronic kidney disease (CKD) remains unclear. We aimed to determine the single and mixed associations of 21 heavy metals/metalloids exposure and the risk of CKD. We performed a cross-sectional study that recruited 4055 participants. Multivariate logistic regression, linear regression and weighted quantile sum (WQS) regression were conducted to explore the possible effects of single and mixed metals/metalloids exposure on the risk of CKD, the risk of albuminuria and changes in the estimated glomerular filtration rate (eGFR). In single-metal models, Cu, Fe, and Zn were positively associated with increased risks of CKD (P-trend < 0.05). Compared to the lowest level, the highest quartiles of Cu (OR = 2.94; 95% CI: 1.70, 5.11; P-trend < 0.05), Fe (OR = 2.39; 95% CI: 1.42, 4.02; P-trend < 0.05), and Zn (OR = 2.35; 95% CI: 1.31, 4.24; P-trend < 0.05) were associated with an increased risk of CKD. After multi-metal adjustment, the association with the risk of CKD remained robust for Cu (P < 0.05). Weighted quantile sum regression revealed a positive association between mixed metals/metalloids and the risk of CKD, and the association was largely driven by Cu (43.7%). Specifically, the mixture of urinary metals/metalloids was positively associated with the risk of albuminuria and negatively associated with eGFR.
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Affiliation(s)
- Yuchai Huang
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhengce Wan
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingye Zhang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liu Hu
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yongman Lv
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Le Wang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, Hubei, China.
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Di D, Zhang R, Zhou H, Wei M, Cui Y, Zhang J, Yuan T, Liu Q, Zhou T, Liu J, Wang Q. Exposure to phenols, chlorophenol pesticides, phthalate and PAHs and mortality risk: A prospective study based on 6 rounds of NHANES. CHEMOSPHERE 2023; 329:138650. [PMID: 37037349 DOI: 10.1016/j.chemosphere.2023.138650] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Human exposure to various endocrine disrupting chemicals (EDCs) is widespread and long-lasting. The primary objective of this study was to prospectively evaluate the association of combined exposure of phenols, chlorophenol pesticides, phthalate and polycyclic aromatic hydrocarbons (PAHs) and mortality risk in a representative US population. METHODS The data on urinary levels of phenols, chlorophenol pesticides, phthalates, and PAH metabolites, were collected from participants aged ≥20 years in six rounds of the National Health and Nutrition Examination Survey (NHANES) (2003-2014). NHANES-linked death records up to December 31, 2015 were used to ascertain mortality status and cause of death. Cox proportional hazards and competing risk models were mainly used for chemical and mortality risk association analysis. The weighted quantile sum (WQS) regression and the least absolute shrinkage and selection operator regression were employed to estimate the association between EDC co-exposure and mortality risk. RESULTS High levels of mono-n-butyl phthalate, monobenzyl phthalate, and 1-napthol were significantly associated with increased risk of all cause, cardiovascular disease (CVD) and cancer mortality among all participants. WQS index was associated with the risks of all-cause (hazard ratio [HR] = 1.389, 95%CI: 1.155-1.669) and CVD mortality (HR = 1.925, 95%CI: 1.152-3.216). High co-exposure scores were associated with elevated all-cause (HR = 2.842, 95% CI: 1.2.094-3.858), CVD (HR = 1.855, 95% CI: 1.525-2.255), and cancer mortality risks (HR = 2.961, 95% CI: 1.468-5.972). The results of subgroup analysis, competing risk model, and sensitivity analysis were generally consistent with the findings from the main analyses, indicating the robustness of our findings. CONCLUSIONS This study provided the first epidemiological evidence that co-exposure to EDC at fairly low levels contributed to elevated mortality risk among US adults. The underlying mechanisms for the effects of EDC co-exposure on human health are worthy of future exploration.
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Affiliation(s)
- Dongsheng Di
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ruyi Zhang
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Haolong Zhou
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Muhong Wei
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuan Cui
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jianli Zhang
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tingting Yuan
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qian Liu
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tingting Zhou
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Junan Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qi Wang
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Iron Deficiency and Nephrotoxic Heavy Metals: A Dangerous Interplay? Int J Mol Sci 2023; 24:ijms24065315. [PMID: 36982393 PMCID: PMC10049453 DOI: 10.3390/ijms24065315] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Heavy metals are common in our environment, and all individuals are exposed to them to some extent. These toxic metals have several harmful effects on the body, including the kidney, which is a very sensitive organ. Indeed, heavy metal exposure has been linked to an increased risk of chronic kidney disease (CKD) and its progression, which may be explained by the well-established nephrotoxic effects of these metals. In this hypothesis and narrative literature review, we will shed light on the potential role that another highly common problem in patients with CKD, iron deficiency, may play in the damaging effects of heavy metal exposure in this patient group. Iron deficiency has previously been linked with an increased uptake of heavy metals in the intestine due to the upregulation of iron receptors that also take up other metals. Furthermore, recent research suggests a role of iron deficiency in the retention of heavy metals in the kidney. Therefore, we hypothesize that iron deficiency plays a crucial role in the damaging effects of heavy metal exposure in patients with CKD and that iron supplementation might be a strategy to combat these detrimental processes.
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Choi JY, Kim SY, Kim T, Lee C, Kim S, Chung HM. Ambient air pollution and the risk of neurological diseases in residential areas near multi-purposed industrial complexes of korea: A population-based cohort study. ENVIRONMENTAL RESEARCH 2023; 219:115058. [PMID: 36521536 DOI: 10.1016/j.envres.2022.115058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/25/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Emerging evidence suggest that long-term exposure to air pollution may induce adverse effects on the central nervous system. However, no study explored the associations in large industrial complex (IC) areas which are one of the major contributors to air pollution. Therefore, we aimed to investigate the pollution status and the association between residential proximity and incidence of neurological diseases near two major ICs characterized as multi-purposed ICs in Korea. A retrospective cohort of residents near the ICs was constructed using Korea's health insurance data and monitored from 2008 to 2019. Emission amounts of the ICs and the air pollution status in the nearby (exposed) and remote (control) area were evaluated using data from national regulatory networks, and hazard ratios (HRs) and 95% confidence intervals (CIs) for neurological diseases of the exposed group compared to the control group were calculated using Cox proportional regression models. Overall, the complexes emitted large amounts of VOCs, CO, NOx, and PM10, and annual levels of ambient PM (2.5, 10), gaseous substances (NO2, SO2), VOCs and PAHs were higher in the exposed area compared to the control and/or the national average. The risk of inflammatory disease of the CNS (G00-09) and extrapyramidal and movement disorders (G20-26) were higher in the exposed area with a HR (95% CI) of 1.36 (1.10-1.68) and 1.33 (1.27-1.39) respectively. Among the subclasses, other extrapyramidal and movement disorders (G25) and epilepsy (G40) were associated with higher risks in the exposed area (HR (95%CI): 1.11 (1.04-1.18), 1.08 (1.00-1.16)) after adjusting for potential confounders. These results suggest that people living near ICs are more likely to be exposed to higher air pollution levels and have higher risks of developing several neurological disorders. However, further epidemiological studies in these industrial areas supplemented with other indicators of environmental exposure and control of other diverse factors are warranted.
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Affiliation(s)
- Ji Yoon Choi
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon, 22689, Republic of Korea
| | - Sung Yeon Kim
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon, 22689, Republic of Korea.
| | - Taekyu Kim
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon, 22689, Republic of Korea
| | - Chulwoo Lee
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon, 22689, Republic of Korea
| | - Suejin Kim
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon, 22689, Republic of Korea
| | - Hyen-Mi Chung
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon, 22689, Republic of Korea
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Gao H, Zhu N, Deng S, Du C, Tang Y, Tang P, Xu S, Liu W, Shen M, Xiao X, Yang F. Combination Effect of Microcystins and Arsenic Exposures on CKD: A Case-Control Study in China. Toxins (Basel) 2023; 15:144. [PMID: 36828458 PMCID: PMC9964595 DOI: 10.3390/toxins15020144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/12/2023] Open
Abstract
Evidence has shown that exposure to environmental pollutants such as microcystins (MCs), arsenic (As), and cadmium (Cd) can lead to the occurrence and development of chronic kidney disease (CKD). There is a synergistic effect between MCs and Cd. However, the combined effect of MCs and As exposures on CKD remains unclear. In Hunan province, China, 135 controls and 135 CKD cases were enrolled in a case-control study. Serum MCs, plasma As and Cd concentrations were measured for all participants. We investigated the association between MCs/As and CKD risk using conditional logistic regression. The additive model explored the interaction effect, and the Bayesian kernel machine regression (BKMR) models investigated the combined effects of MCs, As, and Cd on CKD. The results showed that MCs and As were significantly associated with CKD risk. Participants in the highest MCs concentration had a 4,81-fold increased risk of CKD compared to those in the lowest quartile (95% confidence interval [CI]: 1,96 to 11,81). The highest quartile of As concentrations corresponded to an adjusted odds ratio of 3.40 (95% CI: 1.51, 7.65) relative to the lowest quartile. MCs/As and CKD risk exhibited significant dose-response correlations (all p for trend < 0.01). In addition, a positive interaction effect of MCs and As on CKD was also reported. The CKD risk due to interaction was 2.34 times (95% CI: 0.14, 4.54) relative to the CKD risk without interaction, and the attributable proportion of CKD due to interaction among individuals with both exposures was 56% (95% CI: 0.22, 0.91). In the BKMR, the combined effect of MCs, As, and Cd was positively associated with CKD. In conclusion, both MCs and As are independent risk factors for CKD, exerting a synergistic effect between them. Combined exposure to MCs, As, and Cd can increase the risk of CKD.
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Affiliation(s)
- Hong Gao
- Nursing Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, China
- School of Nursing, University of South China, Hengyang 421001, China
| | - Na Zhu
- Nursing Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, China
- School of Nursing, University of South China, Hengyang 421001, China
| | - Shuxiang Deng
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
| | - Can Du
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410000, China
| | - Yan Tang
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
| | - Peng Tang
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
| | - Shuaishuai Xu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410000, China
| | - Wenya Liu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410000, China
| | - Minxue Shen
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410000, China
| | - Xinhua Xiao
- Department of Metabolism and Endocrinology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, China
| | - Fei Yang
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
- Department of Metabolism and Endocrinology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, China
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11
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Little BB, Vu GT, Walsh B. Cadmium exposure is associated with chronic kidney disease in a superfund site lead smelter community in Dallas, Texas. Ann Hum Biol 2023; 50:360-369. [PMID: 37615209 DOI: 10.1080/03014460.2023.2236017] [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: 03/28/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 08/25/2023]
Abstract
Background: The study was conducted in a Dallas lead smelter community following an Environmental Protection Agency (EPA) Superfund Cleanup project. Lead smelters operated in the Dallas community since the mid-1930s.Aim: To test the hypothesis that cadmium (Cd) exposure is associated with chronic kidney disease (CKD) ≥ stage 3.Subjects and methods: Subjects were African American residents aged ≥19 to ≤ 89 years (n=835). CKD ≥ stage 3 was predicted by blood Cd concentration with covariates.Results: In logistic regression analysis, CKD ≥ stage 3 was predicted by age ≥ 50 years (OR = 4.41, p < 0.0001), Cd level (OR = 1.89, p < .05), hypertension (OR = 3.15, p < 0.03), decades living in the community (OR = 1.34, p < 0.003) and T2DM (OR = 2.51, p < 0.01). Meta-analysis of 11 studies of Cd and CKD ≥ stage 3 yielded an ORRANDOM of 1.40 (p < 0.0001). Chronic environmental Cd exposure is associated with CKD ≥ stage 3 in a Dallas lead smelter community controlling covariates.Conclusion: Public health implications include screening for heavy metals including Cd, cleanup efforts to remove Cd from the environment and treating CKD with newer renal-sparing medications (e.g., SGLT-2 inhibitors, GLP-1s).
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Affiliation(s)
- Bert B Little
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Giang T Vu
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
| | - Brad Walsh
- Parkland Hospital and Health System, Dallas, TX, USA
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12
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Okoye OC, Awunor N. Is exposure to hydrocarbons associated with chronic kidney disease in young Nigerians? A case-control study. FRONTIERS IN NEPHROLOGY 2022; 2:1010080. [PMID: 37675025 PMCID: PMC10479625 DOI: 10.3389/fneph.2022.1010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/27/2022] [Indexed: 09/08/2023]
Abstract
Introduction Although environmental exposure to hydrocarbons has been linked to non-communicable diseases, its association with chronic kidney disease (CKD) is still an emerging area. Epidemiological studies associating CKD with prolonged exposure to hydrocarbons have mostly focused on occupational exposure, with fewer studies on environmental exposure from residing in contaminated areas. The aim of this study was to determine any association between long-term exposure to petrochemical products and the risk of CKD by comparing the residence and occupational history of young patients with CKD and non-CKD controls. Materials and methods A case-control study of 74 cases and 74 age- and sex-matched non-CKD controls was carried out. Cases were patients with CKD who were aged 18-44 years and diagnosed with suspected chronic glomerulonephritis (CGN). Patients were recruited from an outpatient nephrology clinic and medical wards. Patients with CKD from traditional causes were excluded. Data were collected using a pre-tested structured questionnaire adapted from the WHO STEPwise approach to the non-communicable disease risk factor surveillance (STEPS) instrument. To assess exposure, a detailed work history and all residential addresses where the patients have lived for at least 5 years were recorded. 'Exposed' status was regarded as long-term residence in a known oil-polluted area and jobs involving crude oil exploration, processing, transportation and sales, and cleanup of crude oil hazards. Absence of a history of chronic exposure or any form of exposure was regarded as 'less exposed'. Results There were 52 (70.3%) cases categorized as exposed, compared with 21 (28.4%) controls (p < 0.001). There were 34 (45.9%) cases born near petrochemical refineries and plants, compared with 11 (14.9%) controls (p ≤ 0.001). There were 34 (45.9%) cases residing near petrochemical refineries and plants, compared with 8 (10.9%) controls (p ≤ 0.001). When asked 'Do you think you have been significantly exposed to crude oil?', 15 (20.3%) cases and 2 (2.7%) controls answered 'yes' (p ≤ 0.001). Conclusion Our findings suggest an association between exposure to petrochemicals and CKD in young Nigerians diagnosed with suspected CGN. Exposure is significantly associated with a higher mean age, waist circumference, and blood sugar levels; however, other traditional risk factors for CKD were not considerably more prevalent in this unique patient population. These findings should prompt more emphasis on occupational history, residential history, and other relevant environmental exposures in the assessment of patients at risk for CKD.
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Affiliation(s)
- Ogochukwu Chinedum Okoye
- Department of Medicine, Delta State University, Abraka, Nigeria
- Department of Internal Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
| | - Nyemike Awunor
- Department of Community Medicine, Delta State University, Abraka, Nigeria
- Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
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13
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Lin XY, Liu YX, Zhang YJ, Shen HM, Guo Y. Polycyclic aromatic hydrocarbon exposure and DNA oxidative damage of workers in workshops of a petrochemical group. CHEMOSPHERE 2022; 303:135076. [PMID: 35649444 DOI: 10.1016/j.chemosphere.2022.135076] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
The petrochemical industry has promoted the development of economy, while polycyclic aromatic hydrocarbons (PAHs) produced by the industry become the threat for environment and humans. Data on human occupational exposure in petrochemical industry are limited. In the present study, urinary hydroxylated PAH metabolites (OH-PAHs) and a biomarker of DNA oxidative damage (8-hydroxy-2'-deoxyguanosine (8-OHdG)) were measured in 546 workers of a petrochemical group in Northeast China, to investigate PAH exposure and related potential health risk. The concentrations of ∑9OH-PAH in all workers were 0.25-175 μg/g Cre with a median value of 4.41 μg/g Cre. Metabolites of naphthalene were the predominant compounds. The levels of PAH metabolites were significantly different for workers with different jobs, which were the highest for recycling workers (13.7 μg/g Cre) and the lowest for agency managers (5.12 μg/g Cre). Besides, higher levels of OH-PAHs were usually found in males and older workers. There was a dose-response relationship between levels of 8-OHdG and ∑9OH-PAHs (p < 0.01). No difference was observed in concentrations of 8-OHdG for workers of different gender or ages, work history as well as noise. Furthermore, workers simultaneously exposed to other potential pollutants and higher levels of ∑9OH-PAH had significantly higher levels of 8-OHdG compared with those in the corresponding subgroups. Our results suggested that exposure to PAHs or co-exposure to PAHs and potential toxics in the petrochemical plant may cause DNA damage. We call for more researches on the associations among noise, chemical pollution and oxidative stress to workers in the real working environment.
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Affiliation(s)
- Xiao-Ya Lin
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou, 510632, China
| | - Yan-Xiang Liu
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou, 510632, China
| | - Ying-Jie Zhang
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou, 510632, China
| | - Hui-Min Shen
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou, 510632, China
| | - Ying Guo
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou, 510632, China.
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Liao KW, Chien LC, Chen YC, Kao HC. Sex-specific differences in early renal impairment associated with arsenic, lead, and cadmium exposure among young adults in Taiwan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:52655-52664. [PMID: 35274206 PMCID: PMC8911167 DOI: 10.1007/s11356-022-19521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/25/2022] [Indexed: 05/06/2023]
Abstract
Exposure to a single metal has been reported to damage renal function in humans. However, information regarding the association between multiple-metal exposure and markers for early renal impairment in different sexes among the young adult Taiwanese population is scarce. We assessed the association between exposure to arsenic (As), cadmium (Cd), and lead (Pb), and early renal impairment markers using urinary microalbumin (MA), β2-microglobulin (β2MG), and N-acetyl-beta-D-glucosaminidase (NAG) by analyzing 157 young adults aged 20‒29 years, in Taiwan. Inductively coupled plasma mass spectrometry was used to determine urinary As, Cd, and Pb levels. Regression models were applied to different sex groups. The results showed that after adjusting for potential confounding factors and each metal, urinary Cd levels were significantly positively associated with urinary MA (β = 0.523, 95% CI: 0.147-0.899) and β2MG (β = 1.502, 95% CI: 0.635-2.370) in males. However, the urinary Cd level was significantly positively associated with only urinary NAG (β = 0.161, 95% CI: 0.027-0.296) in females. This study thus indicates that the effect of exposure to metals (especially Cd) on early renal impairment among young adults in Taiwan is sex-specific. Our study results could contribute toward developing early intervention programs for decreasing the incidence of renal dysfunction. Further studies are warranted to confirm our findings and clarify the potential mechanisms involved.
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Affiliation(s)
- Kai-Wei Liao
- School of Food Safety, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan.
- Research Center of Food Safety Inspection and Function Development, Taipei Medical University, Taipei, Taiwan.
| | - Ling-Chu Chien
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ho-Ching Kao
- Master Program in Food Safety, College of Nutrition, Taipei Medical University, Taipei, Taiwan
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15
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Chin WS, Pan SC, Huang CC, Chen YC, Hsu CY, Lin P, Chen PC, Guo YL. Proximity to petrochemical industrial parks and risk of chronic glomerulonephritis. ENVIRONMENTAL RESEARCH 2022; 208:112700. [PMID: 35016869 DOI: 10.1016/j.envres.2022.112700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/13/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
This study determined whether individuals residing near petrochemical industrial parks (PIPs) have a higher risk of chronic glomerulonephritis (CGN). We performed population-based 1:4 case-control study by using Taiwan's National Health Insurance Research Database from 2000 to 2016. The subjects were aged 20-65 years, residing in western Taiwan, and did not have a history of any renal or urinary system disease in 2000. The case cohort included those who had at least three outpatient visits or one hospitalization between 2001 and 2016 with codes for CGN as per International Classification of Diseases (ICD)-Ninth and Tenth Revisions. Controls were randomly sampled age-, sex-, and urbanization-matched individuals without renal and urinary system diseases. Petrochemical exposure was evaluated by the distance to the nearest PIP of the residential township, and petrochemical exposure probability was examined considering the monthly prevailing wind direction. Conditional logistic regression was used to determine the association between petrochemical exposure and CGN risk. A total of 320,935 subjects were included in the final analysis (64,187 cases and 256,748 controls). After adjustment for potential confounders, living in townships within a 3-km radius of PIPs was associated with a higher risk of CGN (adjusted odds ratio [aOR] = 1.32, 95% confidence interval [CI] = 1.28-1.37). Compared with townships more than 20 km away from PIPs, those within 10 km of PIPs were associated with significantly increased risks of CGN in a dose-dependent manner. When prevailing wind was considered, townships with high exposure probability were associated with a significantly increased risk of CGN. We found that those residing near PIPs or with high petrochemical exposure probability had a higher risk of CGN. These findings highlight the need for monitoring environmental nephrotoxic substances and the renal health of residents living near PIPs.
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Affiliation(s)
- Wei-Shan Chin
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Chun Pan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ching-Chun Huang
- Environmental and Occupational Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Cheng Chen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chin-Yu Hsu
- Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan; Center for Environmental Sustainability and Human Health, Ming Chi University of Technology, New Taipei City, Taiwan
| | - Pinpin Lin
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Pau-Chung Chen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taiwan
| | - Yue Leon Guo
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Environmental and Occupational Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taiwan.
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16
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Okoye OC, Carnegie E, Mora L. Air Pollution and Chronic Kidney Disease Risk in Oil and Gas- Situated Communities: A Systematic Review and Meta-Analysis. Int J Public Health 2022; 67:1604522. [PMID: 35479765 PMCID: PMC9035494 DOI: 10.3389/ijph.2022.1604522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Objective: This systematic review and meta-analysis aimed at synthesising epidemiological data on the association between long-term air pollution and kidney-related outcomes in oil and natural gas (ONG) situated communities. Methods: We synthesised studies using the PRISMA 2020 guideline. We searched databases including Medline, Cochrane Library, CIHANL, CAB Abstracts, Greenlife, African Journal Online, Google Scholar and Web of Science, from inception to April 2021. Heterogeneity across studies and publication bias were assessed. Results: Twenty-five studies were systematically reviewed but only 14 were included in the meta-analysis and categorised based on the outcome studied. Residents of exposed communities have increased risk for Chronic Kidney Disease (CKD) (OR = 1.70, 95% CI 1.44–2.01), lower eGFR (OR = 0.55, 95% CI 0.48–0.67) and higher serum creatinine (OR = 1.39, 95% CI 1.06–1.82) compared to less exposed or unexposed populations. The risks for hypertension and kidney cancer between the two populations were not significantly different. Conclusion: We report an increased risk for CKD and kidney dysfunction in populations residing near petrochemical plants, although from a limited number of studies. The scientific community needs to explore this environment and non-communicable disease relationship, particularly in vulnerable populations.
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Affiliation(s)
- Ogochukwu Chinedum Okoye
- Department of Internal Medicine, Delta State University, Abraka, Nigeria
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- *Correspondence: Ogochukwu Chinedum Okoye,
| | - Elaine Carnegie
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Luca Mora
- Urban Innovation, Business School, Edinburgh Napier University, Edinburgh, United Kingdom
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17
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Nsonwu-Anyanwu AC, Ndudi Idenyi A, Offor SJ, Chinenyenwa Thomas C, Okpotu F, Edet CE, Opara Usoro CA. Association of exposure to polycyclic aromatic hydrocarbons with inflammation, oxidative DNA damage and renal-pulmonary dysfunctions in barbecue makers in Southern Nigeria. Rep Biochem Mol Biol 2022; 11:74-82. [PMID: 35765524 PMCID: PMC9208567 DOI: 10.52547/rbmb.11.1.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 04/16/2023]
Abstract
BACKGROUND Multiple organ dysfunctions have been linked to exposure to polycyclic aromatic hydrocarbons (PAH) and oxidative stress (OS), oxidative DNA damage, and inflammatory response to PAH have been implicated. The biomarkers of OS (malondialdehyde (MDA), total plasma peroxide (TPP), total antioxidant capacity (TAC), glutathione (GSH), nitric oxide (NO), oxidative stress index (OSI)); 8-hydroxy-2-deoxyguanosine (8-OHdG)); tumor necrosis factor-alpha (TNF-α)); 1-hydroxy pyrene (1-HOP)), serum and urine creatinine, uric acid (UA), estimated glomerular filtration rate (eGFR) and peak expiratory flow rate (PEFR) were assessed in barbecue makers. METHODS One hundred barbecue makers and 50 controls were enrolled into the study. Serum and urine creatinine, UA, TAC, MDA, GSH, NO and TPP were estimated by colorimetry, 8-OHdG and TNF-α by ELISA, PEFR using peak flow meter, 1-HOP by HPLC, eGFR and OSI by calculation. RESULTS Barbecue makers had lower TAC, PEFR, and higher TNF-α and OS compared to controls (p<0.05). Higher TNF-α, lipid peroxidation, and lower antioxidants were observed in barbecue makers who had worked for >5years compared to <5years (p <0.05). Increasing number of working hours was associated with higher NO, lipid peroxidation, OS and lower antioxidants in barbecue makers (p <0.05). Positive associations were observed between 1-HOP and TPP (r=0.570, p=0.000), OSI (r=0.299, p=0.035) and negative association between TAC and TNF-α (r=-0.209, p=0.037), MDA (r=-0.265, p=0.008) in barbecue makers. CONCLUSION Increased lipid peroxidation, OS, inflammation and depressed antioxidants and lung function observed in barbecue makers suggest increased risk of chronic lung conditions which may be associated with exposure to PAH in barbecue fumes.
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Affiliation(s)
- Augusta Chinyere Nsonwu-Anyanwu
- Department of Medical Laboratory Science, University of Calabar, PMB 1115, Calabar, Nigeria.
- Corresponding author: Augusta Chinyere Nsonwu-Anyanwu; Tel: +234 8033515095; E-mail:
| | - Augusta Ndudi Idenyi
- Department of Medical Laboratory Science, University of Calabar, PMB 1115, Calabar, Nigeria.
| | - Sunday Jeremiah Offor
- Department of Medical Laboratory Science, University of Calabar, PMB 1115, Calabar, Nigeria.
| | | | - Friday Okpotu
- Department of Medical Laboratory Science, University of Calabar, PMB 1115, Calabar, Nigeria.
| | - Clement Emmanuel Edet
- Department of Medical Laboratory Science, University of Calabar, PMB 1115, Calabar, Nigeria.
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18
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Rahman HH, Niemann D, Munson-McGee SH. Association of chronic kidney disease with exposure to polycyclic aromatic hydrocarbons in the US population. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:24024-24034. [PMID: 34822075 DOI: 10.1007/s11356-021-17479-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants formed from the incomplete combustion of carbon-containing products. Exposure can occur through ingestion or inhalation and has been linked to depression, stroke, liver disease, asthma, diabetes, heart failure, and cancer. Few studies have investigated the association between exposure to PAHs and chronic kidney disease (CKD) in humans. This study aims to investigate the association between seven urinary PAH concentrations (1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene 2-hydroxyfluorene, 1-hydroxyphenanthrene, 1-hydroxypyrene, and 2 & 3-hydroxyphenanthrene) and CKD in the US adult population. A cross-sectional analysis using the 2015-2016 National Health and Nutrition Examination Survey (NHANES) dataset was conducted. CKD was defined with estimated glomerular filtration rate (eGFR) and albumin to creatinine ratio (ACR). Participants with an eGFR < 60 ml/min/1.73m2 or ACR > 30 mg/gm were considered to have CKD. A specialized complex survey design analysis package using R version 4.0.3 was used in the data analysis. Multivariate logistic regression was used to study the correlation between seven forms of urinary PAH concentrations and CKD associated with abnormal eGFR or ACR. The models were adjusted for lifestyle and demographic factors. The study included a total of 4117 adults aged ≥ 20 years, with 49.6% males and 50.4% females. Urinary 2-hydroxynaphthalene (OR: 1.600, 95% CI: 1.141, 2.243) was significantly associated with an increased odds of CKD; the other six forms of urinary PAHs were not associated with CKD. Non-Hispanic Black (OR: 1.569, 95% CI: 1.168, 2.108), age of 60 years and older (OR: 2.546, 95% CI: 1.865, 3.476), and BMIs of underweight (OR: 2.386, 95% CI: 1.259, 4.524) and obese (OR: 1.407, 95% CI: 1.113, 1.778) all had significantly increased odds for CKD. Our study concluded that urinary 2-hydroxynaphthalene, a form of PAH, is significantly associated with CKD.
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Affiliation(s)
| | - Danielle Niemann
- Burrell College of Osteopathic Medicine, 3501 Arrowhead Dr, Las Cruces, NM, 88003, USA
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Díaz de León-Martínez L, Ortega-Romero M, Gavilán-García A, Barbier OC, Carrizalez-Yáñez L, Van-Brusel E, Díaz-Barriga F, Flores-Ramírez R. Assessment of biomarkers of early kidney damage and exposure to pollutants in artisanal mercury mining workers from Mexico. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:13333-13343. [PMID: 34590225 DOI: 10.1007/s11356-021-16628-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
Artisanal mercury mining (AMM) is an informal economic activity that employs low technology and limited protection, and poses a risk to workers and their families; due to the extraction process, these scenarios involve exposure to complex mixtures of pollutants that synergistically aggravate the health of miners and people living near the site. Although mercury is the predominant pollutant, there are others such as polycyclic aromatic hydrocarbons (PAHs), toluene, arsenic, and lead which have been classified as nephrotoxic pollutants. Therefore, the purpose of this research was to evaluate the association between exposure to a complex mixture of pollutants (mercury, lead, arsenic, PAHs, and toluene) and kidney damage in artisanal Hg mining workers through early kidney damage proteins (KIM-1, OPN, RBP-4, NGAL, and Cys-C). The results demonstrate the presence of OH-PAHs at concentrations of 9.21 (6.57-80.63) μg/L, hippuric acid as a biomarker of exposure to toluene, As and Pb (655. 1 (203.8-1231) mg/L, 24.05 (1.24-42.98) g/g creatinine, and 4.74 (2.71-8.14) g/dL, respectively), and urinary Hg (503.4 (177.9-878.7) g/g creatinine) in the study population. As well as biomarkers of kidney damage, NGAL and RPB-4 were found in 100% of the samples, KIM-1 and Cys-C in 44.1%, and OPN in 41% of the miners. Significant correlations were found between several of the evaluated pollutants and early kidney damage proteins. Our results demonstrate the application of the early kidney damage biomarkers for the assessment of damage caused by the exposure to mixtures of pollutants and, therefore, the urgent need for monitoring in AMM areas.
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Affiliation(s)
- Lorena Díaz de León-Martínez
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Avenida Sierra Leona No. 550, CP 78210, Colonia Lomas Segunda Sección, San Luis Potosí, SLP, Mexico
| | - Manolo Ortega-Romero
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de Mexico, Mexico, Mexico
| | - Arturo Gavilán-García
- National Institute of Ecology and Climate Change, SEMARNAT, Blvd. Adolfo Ruíz Cortines 4209, Jardines en la Montaña, Ciudad de Mexico, Mexico
| | - Olivier C Barbier
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de Mexico, Mexico, Mexico
| | - Leticia Carrizalez-Yáñez
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Avenida Sierra Leona No. 550, CP 78210, Colonia Lomas Segunda Sección, San Luis Potosí, SLP, Mexico
| | - Evelyn Van-Brusel
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Avenida Sierra Leona No. 550, CP 78210, Colonia Lomas Segunda Sección, San Luis Potosí, SLP, Mexico
| | - Fernando Díaz-Barriga
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Avenida Sierra Leona No. 550, CP 78210, Colonia Lomas Segunda Sección, San Luis Potosí, SLP, Mexico
| | - Rogelio Flores-Ramírez
- CONACYT Research Fellow, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Avenida Sierra Leona No. 550, CP 78210, Colonia Lomas Segunda Sección, San Luis Potosí, SLP, Mexico.
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Huang CH, Huang TJ, Lin YC, Lin CN, Chen MY. Factors Associated with Urinary 1-Hydroxypyrene and Malondialdehyde among Adults near a Petrochemical Factory: Implications for Sex and Lifestyle Modification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031362. [PMID: 35162385 PMCID: PMC8835126 DOI: 10.3390/ijerph19031362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/15/2022] [Accepted: 01/22/2022] [Indexed: 11/16/2022]
Abstract
Background: The association between the biomarkers of environmental exposure, oxidative stress, and health-related behaviors in community residents living in an endemic viral hepatitis area and near petrochemical industrial complexes remains unclear. From a health promotion perspective, healthcare providers must know what to do for residents concerned about their health and living environment, especially for individual-level and modifiable risk factors. Therefore, we aimed to explore the factors associated with urinary 1-hydroxypyrene (1-OHP) and malondialdehyde (MDA). Methods: A community-based, cross-sectional study was conducted between July 2018 and February 2019 in western coastal Yunlin County, Taiwan. All participants lived within a 10 km radius of a large petrochemical complex and did not work in the factory. This study was conducted with the local hospital through annual community health screening. Biological samples were collected and biomarkers determined and quantified in the central laboratory of the collaborating hospital. Results: A total of 6335 adult residents completed the study. The mean age was 47.7 (SD = 16) years. Out of the total population, 56.4% were female, 30.1% had metabolic syndrome (MetS), and 16.8% and 14.3% had hepatitis B virus antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) positivity, respectively. The median 1-OHP and MDA level was 0.11 and 0.9 μg/g creatinine with an interquartile range of 0.07–0.18, and 0.4–1.5, respectively. The MDA levels correlated with specific diseases. The multivariable ordinal logistic regression model revealed that female sex, smoking, betel nut use, HBsAg, and anti-HCV positivity were associated with higher 1-OHP levels. In men, MetS was associated with higher 1-OHP levels and regular exercise with lower 1-OHP levels. High MDA levels were associated with smoking, betel nut users, HBsAg, and anti-HCV positivity. Conclusions: The findings highlight the importance of initiating individualized health promotion programs for residents near petrochemical factories, especially for adults with substance-use and cardiometabolic risk factors. Furthermore, it is crucial to provide further treatment to patients with viral hepatitis.
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Affiliation(s)
- Cheng-Hsien Huang
- Department of Family Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
| | - Tung-Jung Huang
- Department of Pulmonary Disease and Critical Care, Chang Gung Memorial Hospital, Yunlin 638, Taiwan;
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
| | - Yu-Chih Lin
- Department of Family Medicine, Chang Gung Memorial Hospital, Yunlin 638, Taiwan;
| | - Chia-Ni Lin
- Department of Laboratory Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
- School of Nursing, Chang Gung University, Taoyuan 333, Taiwan
- Research Fellow, Department of Cardiology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Correspondence: ; Tel.: +886-(5)-3628800 (ext. 2301); Fax: +886-(5)-3628866
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21
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Chen CHS, Kuo TC, Kuo HC, Tseng YJ, Kuo CH, Yuan TH, Chan CC. Lipidomics of children and adolescents exposed to multiple industrial pollutants. ENVIRONMENTAL RESEARCH 2021; 201:111448. [PMID: 34119529 DOI: 10.1016/j.envres.2021.111448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There are limited studies on the lipidomics of children and adolescents exposed to multiple industrial pollutants. OBJECTIVES In this study, we aimed to investigate lipid profile perturbations in 99 children and adolescents (aged 9-15) who lived in a polluted area surrounding the largest petrochemical complex in Taiwan. Previous studies have reported increased risks of acute and chronic diseases including liver dysfunctions and chronic kidney disease (CKD) in residents living in this area. METHODS We measured urinary concentrations of 11 metals and metalloids and polycyclic aromatic hydrocarbons (PAHs) metabolite 1-hydroxypyrene (1-OHP) as exposure biomarkers, and urinary oxidative stress biomarkers and serum acylcarnitines as early health effect biomarkers. The association between individual exposure biomarkers and early health effect biomarkers were analyzed using linear regression, while association of combined exposure biomarkers with four oxidative stress biomarkers and acylcarnitines were analyzed using weighted quantile sum (WQS) regression. Lipid profiles were analyzed using an untargeted liquid chromatography mass spectrometry-based technique. "Meet-in-the-middle" approach was applied to identify potential lipid features that linked multiple industrial pollutants exposure with early health effects. RESULTS We identified 15 potential lipid features that linked elevated multiple industrial pollutants exposure with three increased oxidative stress biomarkers and eight deregulated serum acylcarnitines, including one lysophosphatidylcholines (LPCs), four phosphatidylcholines (PCs), and two sphingomyelins (SMs) that were up-regulated in high exposure group compared to low exposure group, and two LPCs, four PCs, and two phosphatidylinositols (PIs) down-regulated in high exposure group compared to low exposure group. CONCLUSION Our findings could provide information for understanding the health effects, including early indicators and biological mechanism identification, of children and adolescents exposed to multiple industrial pollutants during critical stages of development.
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Affiliation(s)
- Chi-Hsin S Chen
- Master of Public Health Program, College of Public Health, National Taiwan University. No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan
| | - Tien-Chueh Kuo
- The Metabolomics Core Laboratory, Center of Genomic Medicine, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Han-Chun Kuo
- The Metabolomics Core Laboratory, Center of Genomic Medicine, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Yufeng J Tseng
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan; Department of Computer Science and Information Engineering, College of Electrical Engineering and Computer Science, National Taiwan University. No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University. No. 33, Linsen S. Road, Taipei, 10055, Taiwan
| | - Tzu-Hsuen Yuan
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan. No.101, Sec. 2, Zhongcheng Rd., Shilin Dist., Taipei City, 11153, Taiwan
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University. No. 17, Xu-Zhou Road, Taipei, 10055, Taiwan.
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22
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Chen X, Chen X, Wang X, Wang M, Liang Y, Zhu G, Jin T. The association between estimated glomerular filtration rate and cadmium exposure: An 8-year follow-up study. Int J Hyg Environ Health 2021; 235:113774. [PMID: 34052740 DOI: 10.1016/j.ijheh.2021.113774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The associations between cadmium exposure and chronic kidney disease have rarely been reported in longitudinal studies. In this study, we investigated the associations between the estimated glomerular filtration rate and cadmium exposure in a cross-sectional study in a longitudinal cohort. MATERIALS AND METHODS In total, 790 subjects (≥35 years of age) living in southeastern China were included at 1998. Cadmium in blood (BCd) and urine (UCd) as well as renal dysfunction biomarkers, urinary N-acetyl-β d-glucosaminidase (UNAG) and albumin (UALB), were determined. 497 subjects were followed at 2006 and a total of 456 subjects were finally included after excluding subjects that did not have exposure or effects biomarkers. The BCd, UCd, UNAG and UALB were determined using baseline methods. At follow-up, the estimated glomerular filtration rate (eGFR) was computed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Single nucleotide polymorphisms (SNPs) in metallothioneins 1A (MT1A) rs11076161 and MT2A rs28366003 in blood sample were detected using TaqMan allelic discrimination assays. RESULTS The median of UCd and BCd at baseline was 5.38 μg/g cr and 4.69 μg/L, respectively, and the median UCd and BCd at follow-up was 4.88 μg/g cr and 2.20 μg/L at follow-up. The mean eGFR at follow-up was 88.0 mL/min/1.73 m2 and 15 subjects had new onset of eGFR <60 mL/min/1.73 m2. The eGFR at follow-up was associated with baseline age (β = -0.66, 95% confidence interval (CI): 0.80 to -0.52), BCd (β = -0.46, 95% CI: 0.68 to -0.25) and UALB (β = -0.29, 95% CI: 0.41 to -0.16) after adjusting for confounders. Subgroup analysis in subjects who had low baseline UALB or subjects with or without hypertension showed similar results. A logistic regression model further showed that baseline BCd and UALB were independent risk factors for follow-up CKD. The odds ratios (ORs) were 1.09 (95% CI:1.03-1.16) for UALB, 1.16 (95% CI:1.01-1.33) for BCd, and 6.74 (0.87-29.63) for current hypertension. Baseline BCd, UALB and current hypertension were used to construct the nomogram. Linear discriminant analysis (LCA) showed that 87.6% of CKD was accurately predicted based on the three factors. CONCLUSION Baseline age, BCd and UALB were associated with follow-up eGFR, and baseline BCd and UALB were predictive factors for incidence of CKD.
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Affiliation(s)
- Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
| | - Xin Chen
- Department of Radiology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, #600 Yishan Road, Shanghai, 200233, China
| | - Xinru Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Miaomiao Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Yihuai Liang
- Department of Occupational and Environmental Medicine, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Guoying Zhu
- Institute of Radiation Medicine, Fudan University, Shanghai, 200032, China
| | - Taiyi Jin
- Department of Occupational and Environmental Medicine, School of Public Health, Fudan University, Shanghai, 200032, China.
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Jalili C, Kazemi M, Cheng H, Mohammadi H, Babaei A, Taheri E, Moradi S. Associations between exposure to heavy metals and the risk of chronic kidney disease: a systematic review and meta-analysis. Crit Rev Toxicol 2021; 51:165-182. [PMID: 33960873 DOI: 10.1080/10408444.2021.1891196] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We performed a systematic review and meta-analysis to examine the relationship between heavy metals (HMs) exposure and the risk of chronic kidney disease (CKD). Databases of Web of Science, Embase, MEDLINE, and Scopus were searched through June 2020 to identify studies assessing the relationships between exposure to HMs (i.e. cadmium, lead, arsenic, mercury) and the risk of CKD, evaluated by decreased estimated glomerular filtration rate (eGFR) and/or increased proteinuria risks in adults (≥18 years). Data were pooled by random-effects models and expressed as weighted mean differences and 95% confidence intervals. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Twenty-eight eligible articles (n = 107,539 participants) were included. Unlike eGFR risk (p = 0.10), Cadmium exposure was associated with an increased proteinuria risk (OR = 1.35; 95% CI: 1.13, 1.61; p < 0.001; I2 = 79.7%). Lead exposure was associated with decreased eGFR (OR = 1.12; 95%CI: 1.03, 1.22; p = 0.008; I2 = 87.8%) and increased proteinuria (OR = 1.25; 95% CI: 1.04, 1.49; p = 0.02; I2 = 79.6) risks. Further, arsenic exposure was linked to a decreased eGFR risk (OR = 1.55; 95% CI: 1.05, 2.28; p = 0.03; I2 = 89.1%) in contrast to mercury exposure (p = 0.89). Only two studies reported the link between arsenic exposure and proteinuria risk, while no study reported the link between mercury exposure and proteinuria risk. Exposure to cadmium, lead, and arsenic may increase CKD risk in adults, albeit studies were heterogeneous, warranting further investigations. Our observations support the consideration of these associations for preventative, diagnostic, monitoring, and management practices of CKD.
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Affiliation(s)
- Cyrus Jalili
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Kazemi
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, New York, USA
| | - Hefa Cheng
- MOE Key Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefeh Babaei
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ensiyeh Taheri
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajjad Moradi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Halal Research Center of IRI, FDA, Tehran, Iran
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24
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Yuan TH, Jhuang MJ, Yeh YP, Chen YH, Lu S, Chan CC. Relationship between renal function and metal exposure of residents living near the No. 6 Naphtha Cracking Complex: A cross-sectional study. J Formos Med Assoc 2021; 120:1845-1854. [PMID: 33933337 DOI: 10.1016/j.jfma.2021.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/19/2021] [Accepted: 04/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND/PURPOSE Heavy metals impair renal function, causing chronic kidney disease (CKD), and the petrochemical industry is one of the major environmental metal emission sources. This study aimed to investigate the relationship between renal function and metal exposure among the Taiwanese residents living near a petrochemical industry site. METHODS We recruited residents near the No. 6 Naphtha Cracking Complex, and they were categorized into a high-exposure (HE) group (N = 190) in Taisi Village and a low-exposure (LE) group (N = 1184) in other villages of Dacheng Township in Changhua County of Taiwan. The urinary nickel, chromium, and vanadium levels of the study subjects were measured and the levels were standardized by urine creatinine, and the estimated glomerular filtration rates (eGFRs) were calculated to estimate renal function by one-time health data. Linear regression models were applied to illustrate the correlations between the distance to the complex and urinary metal levels and renal function; linear and logistic regression models were applied to evaluate the associations between urinary metal levels and renal function indicators. RESULTS The study subjects living closer to the petrochemical complex had significantly higher urinary nickel, chromium, and vanadium levels and worse renal function than study subjects living farther away. The urinary nickel and chromium levels of the study subjects were associated with their renal function indicators. When the subject's urinary nickel level increased 1-fold, the eGFR level significantly decreased by 0.820 ml/min/1.73 m2. CONCLUSION Residents living closer to the petrochemical industry were exposed to higher metal levels and had worse renal function, and the nickel exposure of residents was potentially related to their decline in renal function.
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Affiliation(s)
- Tzu-Hsuen Yuan
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan
| | - Ming-Jie Jhuang
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Po Yeh
- Changhua County Public Health Bureau, Changhua, Taiwan
| | - Yi-Hsuan Chen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sasha Lu
- Head-Royce School, Oakland, CA, United States
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan; Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University, Taipei, Taiwan.
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25
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Yang K, Chen C, Brockman J, Shikany JM, He K. Low- and moderate- levels of arsenic exposure in young adulthood and incidence of chronic kidney disease: Findings from the CARDIA Trace Element Study. J Trace Elem Med Biol 2021; 63:126657. [PMID: 33069098 PMCID: PMC7722195 DOI: 10.1016/j.jtemb.2020.126657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/23/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND It is unclear whether arsenic exerts adverse health effects on the kidney at low- and moderate- levels of exposure. We prospectively examined toenail arsenic concentrations measured during young adulthood in relation to incidence of chronic kidney disease (CKD) in midlife. METHODS A total of 3768 participants (53 % female and 48 % blacks) in the Coronary Artery Risk Development in Young Adults (CARDIA) study were included. Arsenic concentration in toenail clippings was assessed by using inductively coupled plasma mass spectrometry at CARDIA exam year 2. Incident CKD was identified if having estimated glomerular filtration rate <60 mL/min per 1.73 m² or albuminuria >30 mg/g. The association between toenail arsenic levels and CKD incidence over a mean of 24 years of follow-up was examined using multivariable-adjusted Cox proportional hazards models. RESULTS After controlling for potential confounders, including demographics, socioeconomics, lifestyle factors, clinical measurements of blood pressure, lipids, and glucose, and medical history, arsenic exposure measured in toenails was not associated with CKD incidence (quintile 5 versus quintile 1: hazard ratio = 1.04, 95 % confidence interval = 0.78-1.40, P for trend = 0.38). CONCLUSION This longitudinal study does not support the hypothesis that low- and moderate- levels of arsenic exposure are associated with elevated incidence of CKD in the US general population. Further studies are need to investigate species of arsenic biomarkers in relation to nephrotoxicity.
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Affiliation(s)
- Kefeng Yang
- Department of Nutrition, Xin Hua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Chen
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - John Brockman
- Columbia Research Reactor, University of Missouri, Columbia, MO, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ka He
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Feng Y, Xiao A, Jia R, Zhu S, Gao S, Li B, Shi N, Zou B. Emission characteristics and associated assessment of volatile organic compounds from process units in a refinery. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 265:115026. [PMID: 32593904 DOI: 10.1016/j.envpol.2020.115026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
The accuracy and reliability of volatile organic compound (VOC) emission data are essential for assessing emission characteristics and their potential impact on air quality and human health. This paper describes a new method for determining VOC emission data by multipoint sampling from various process units inside a large-scale refinery. We found that the emission characteristics of various production units were related to the raw materials, products, and production processes. Saturated alkanes accounted for the largest fraction in the continuous catalytic reforming and wastewater treatment units (48.0% and 59.2%, respectively). In the propene recovery unit and catalytic cracking unit, alkenes were the most dominant compounds, and propene provided the largest contributions (57.8% and 23.0%, respectively). In addition, n-decane (12.6%), m,p-xylene (12.4%), and n-nonane (8.9%) were the main species in the normal production process of the delayed coking unit. Assessments of photochemical reactivity and carcinogenic risk were carried out, and the results indicate that VOC emissions from the propene recovery unit and catalytic cracking unit should be controlled to reduce the ozone formation potential; in addition, alkenes are precedent-controlled pollutants. The cancer risk assessments reveal that 1,2-dibromoethane, benzene, 1,2-dichloroethane, and chloroform were the dominant risk contributors, and their values were much higher than the standard threshold value of 1.0 × 10-6 but lower than the significant risk value defined by the US Supreme Court. Based on the VOC composition and a classification algorithm, the samples were classified into eight main groups that corresponded to different process units in the petroleum refinery. In conclusion, this work provides valuable data for investigating process-specific emission characteristics of VOCs and performing associated assessments of photochemical reactivity and carcinogenic risk in petrochemical refineries.
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Affiliation(s)
- Yunxia Feng
- State Key Laboratory of Safety and Control for Chemicals, SINOPEC Research Institute of Safety Engineering, Qingdao, Shandong, 266101, PR China.
| | - Anshan Xiao
- State Key Laboratory of Safety and Control for Chemicals, SINOPEC Research Institute of Safety Engineering, Qingdao, Shandong, 266101, PR China
| | - Runzhong Jia
- State Key Laboratory of Safety and Control for Chemicals, SINOPEC Research Institute of Safety Engineering, Qingdao, Shandong, 266101, PR China
| | - Shengjie Zhu
- State Key Laboratory of Safety and Control for Chemicals, SINOPEC Research Institute of Safety Engineering, Qingdao, Shandong, 266101, PR China
| | - Shaohua Gao
- State Key Laboratory of Safety and Control for Chemicals, SINOPEC Research Institute of Safety Engineering, Qingdao, Shandong, 266101, PR China
| | - Bo Li
- State Key Laboratory of Safety and Control for Chemicals, SINOPEC Research Institute of Safety Engineering, Qingdao, Shandong, 266101, PR China
| | - Ning Shi
- State Key Laboratory of Safety and Control for Chemicals, SINOPEC Research Institute of Safety Engineering, Qingdao, Shandong, 266101, PR China
| | - Bing Zou
- State Key Laboratory of Safety and Control for Chemicals, SINOPEC Research Institute of Safety Engineering, Qingdao, Shandong, 266101, PR China
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Chuang HC, Shie RH, Lee CH, Chio CP, Yuan TH, Lee JH, Chan CC. Associations of soluble metals and lung and liver toxicity in mice induced by fine particulate matter originating from a petrochemical complex. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:34442-34452. [PMID: 32557032 DOI: 10.1007/s11356-020-09644-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
Adverse health effects have been observed in nearby residents due to exposure to petrochemical-derived chemicals. The objective of this study was to examine associations of soluble metals with lung and liver toxicity in fine particulate matter (PM2.5) in the vicinity of a petrochemical complex. PM2.5 was collected in the vicinity of a petrochemical complex of Mailiao Township (Yunlin County, Taiwan) to investigate lung and liver toxicity in BALB/c mice. The PM2.5 concentration was 30.2 ± 11.2 μg/m3, and the PM2.5 was clustered in major local emissions (19.1 μg/m3) and minor local emissions (14.1 μg/m3) using a k-means clustering model. The PM2.5 (50 and 150 μg/kg) and PM2.5-equivalent soluble nickel (Ni), vanadium (V), and lead (Pb) concentrations were intratracheally instilled into BALB/c mice. PM2.5 and V significantly decreased the tidal volume after exposure (p < 0.05). The peak expiratory flow (PEF) and peak inspiratory flow (PIF)/PEF ratio were significantly altered by 150 μg/kg V (p < 0.05). V and Pb significantly increased total protein and lactate dehydrogenase (LDH) levels in bronchoalveolar lavage fluid (BALF) (p < 0.05). Interleukin (IL)-6 in BALF significantly increased after exposure to Pb (p < 0.05) accompanied by lung inflammatory infiltration. PM2.5 and Pb significantly increased levels of 8-isoprostane (p < 0.05). The level of caspase-3 activity significantly increased after exposure to Pb (p < 0.05). LDH in the liver was significantly increased by PM2.5 (p < 0.05). 8-Isoprostane in the liver was significantly increased by PM2.5 and Pb (p < 0.05). IL-6 in the liver was significantly increased by PM2.5, Ni, V, and Pb after exposure (p < 0.05), accompanied by liver inflammatory infiltration. Our results demonstrated that V in PM2.5 was associated with an increase in 8-isoprostane for all emissions and major local petrochemical emissions. In conclusion, V contributes to in vivo liver toxicity induced by PM2.5 in the vicinity of a petrochemical complex.
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Affiliation(s)
- Hsiao-Chi Chuang
- Taiwan CardioPulmonary Research (T-CPR) Group, School of Respiratory Therapy, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan.
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Ruei-Hao Shie
- Green Energy and Environment Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chii-Hong Lee
- Department of Pathology, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
| | - Chia-Pin Chio
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tzu-Hsuen Yuan
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jui-Huan Lee
- Green Energy and Environment Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chang-Chuan Chan
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Marquès M, Domingo JL, Nadal M, Schuhmacher M. Health risks for the population living near petrochemical industrial complexes. 2. Adverse health outcomes other than cancer. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 730:139122. [PMID: 32388111 DOI: 10.1016/j.scitotenv.2020.139122] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 05/12/2023]
Affiliation(s)
- Montse Marquès
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
| | - José L Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia, Spain.
| | - Martí Nadal
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
| | - Marta Schuhmacher
- Departament d'Enginyeria Química, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007 Tarragona, Catalonia, Spain
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29
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Sotomayor CG, Groothof D, Vodegel JJ, Gacitúa TA, Gomes-Neto AW, Osté MCJ, Pol RA, Ferreccio C, Berger SP, Chong G, Slart RHJA, Rodrigo R, Navis GJ, Touw DJ, Bakker SJL. Circulating Arsenic is Associated with Long-Term Risk of Graft Failure in Kidney Transplant Recipients: A Prospective Cohort Study. J Clin Med 2020; 9:417. [PMID: 32028652 PMCID: PMC7073559 DOI: 10.3390/jcm9020417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 12/24/2022] Open
Abstract
Arsenic is toxic to many organ systems, the kidney being the most sensitive target organ. We aimed to investigate whether, in kidney transplant recipients (KTRs), the nephrotoxic exposure to arsenic could represent an overlooked hazard for graft survival. We performed a prospective cohort study of 665 KTRs with a functional graft ≥1 year, recruited in a university setting (2008‒2011), in The Netherlands. Plasma arsenic was measured by ICP-MS, and dietary intake was comprehensively assessed using a validated 177-item food-frequency questionnaire. The endpoint graft failure was defined as restart of dialysis or re-transplantation. Median arsenic concentration was 1.26 (IQR, 1.04‒2.04) µg/L. In backwards linear regression analyses we found that fish consumption (std β = 0.26; p < 0.001) was the major independent determinant of plasma arsenic. During 5 years of follow-up, 72 KTRs developed graft failure. In Cox proportional-hazards regression analyses, we found that arsenic was associated with increased risk of graft failure (HR 1.80; 95% CI 1.28-2.53; p = 0.001). This association remained materially unaltered after adjustment for donor and recipient characteristics, immunosuppressive therapy, eGFR, primary renal disease, and proteinuria. In conclusion, in KTRs, plasma arsenic is independently associated with increased risk of late graft failure.
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Affiliation(s)
- Camilo G. Sotomayor
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (D.G.); (J.J.V.); (T.A.G.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Dion Groothof
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (D.G.); (J.J.V.); (T.A.G.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Joppe J. Vodegel
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (D.G.); (J.J.V.); (T.A.G.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Tomás A. Gacitúa
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (D.G.); (J.J.V.); (T.A.G.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - António W. Gomes-Neto
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (D.G.); (J.J.V.); (T.A.G.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Maryse C. J. Osté
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (D.G.); (J.J.V.); (T.A.G.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Robert A. Pol
- Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, Pontificia Universidad Católica de Chile, 8330033 Santiago, Chile;
| | - Stefan P. Berger
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (D.G.); (J.J.V.); (T.A.G.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Guillermo Chong
- Department of Radiology, Clínica Alemana de Santiago, Universidad del Desarrollo, 7610658 Santiago, Chile;
| | - Riemer H. J. A. Slart
- Department of Nuclear and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
| | - Ramón Rodrigo
- Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, CP 8380453 Santiago, Chile;
| | - Gerjan J. Navis
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (D.G.); (J.J.V.); (T.A.G.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Daan J. Touw
- Department of Pharmacy and Clinical Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
| | - Stephan J. L. Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (D.G.); (J.J.V.); (T.A.G.); (S.P.B.); (G.J.N.); (S.J.L.B.)
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