From lung to liver: how does airborne particulate matter trigger NASH and systemic insulin resistance?

Long-term exposure to ambient fine particulate matter and risk of liver cancer in the NIH-AARP Diet and Health Study

BACKGROUND

Fine particulate matter (PM2.5) exposure has been associated with liver cancer incidence and mortality in a limited number of studies. We sought to evaluate this relationship for the first time in a U.S. cohort with historical exposure assessment.

METHODS

We used spatiotemporal prediction models to estimate annual average historical PM2.5 concentrations (1980-2015) at residential addresses of 499,729 participants in the NIH-AARP Diet and Health Study, a cohort in 6 states (California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania) and 2 metropolitan areas (Atlanta, Georgia, and Detroit, Michigan) enrolled in 1995-1996 and followed up through 2017. We used a time-varying Cox model to estimate the association for liver cancer and the predominant histologic type, hepatocellular carcinoma (HCC), per 5 µg/m3 increase in estimated outdoor PM2.5 levels, incorporating a 5-year average, lagged 10 years prior to cancer diagnosis and adjusting for age, sex, race/ethnicity, education level and catchment state. We also evaluated PM2.5 interactions with hypothesized effect modifiers.

RESULTS

We observed a non-significantly increased risk of liver cancer associated with estimated PM2.5 exposure (Hazard ratio [HR] = 1.05 [0.96-1.14], N = 1,625); associations were slightly stronger for HCC, (84 % of cases; HR = 1.08 [0.98-1.18]). Participants aged 70 or older at enrollment had an increased risk of liver cancer versus other age groups (HR = 1.50 [1.01-2.23]); p-interaction = 0.01) and risk was elevated among participants who did not exercise (HR = 1.81 [1.22-2.70]; p-interaction = 0.01). We found no evidence of effect modification by sex, smoking status, body mass index, diabetes status, or alcohol consumption (p-interaction > 0.05).

CONCLUSIONS

Our findings in this large cohort suggest that residential ambient PM2.5 levels may be associated with liver cancer risk. Further exploration of the variation in associations by age and physical activity are important areas for future research.

Histological features of non-alcoholic fatty liver disease revealed in response to mixed vehicle emission exposure and consumption of a high-fat diet in wildtype C57Bl/6 male mice

Non-alcoholic fatty liver disease (NAFLD) is currently plaguing the population at pandemic proportions and is expected to become more prevalent over the next decade. Recent epidemiological studies have demonstrated a correlation between the manifestation of NAFLD and ambient air pollution levels, which is exacerbated by other risk factors, such as diabetes, dyslipidemia, obesity, and hypertension. Exposure to airborne particulate matter has also been associated with inflammation, hepatic lipid accumulation, oxidative stress, fibrosis, and hepatocyte injury. While prolonged consumption of a high-fat (HF) diet is associated with NAFLD, little is known regarding the effects of inhaled traffic-generated air pollution, a ubiquitous environmental pollutant, on the pathogenesis of NAFLD. Therefore, we investigated the hypothesis that exposure to a mixture of gasoline and diesel engine emissions (MVE), coupled with the concurrent consumption of a HF diet, promotes the development of a NAFLD phenotype within the liver. Three-month-old male C57Bl/6 mice were placed on either a low-fat or HF diet and exposed via whole-body inhalation to either filtered (FA) air or MVE (30 µg PM/m³ gasoline engine emissions + 70 µg PM/m³ diesel engine emissions) 6 hr/day for 30 days. Histology revealed mild microvesicular steatosis and hepatocyte hypertrophy in response to MVE exposure alone, compared to FA controls, yielding a classification of "borderline NASH" under the criteria of the modified NAFLD active score (NAS) system. As anticipated, animals on a HF diet exhibited moderate steatosis; however, we also observed inflammatory infiltrates, hepatocyte hypertrophy, and increased lipid accumulation, with the combined effect of HF diet and MVE exposure. Our results indicate that inhalation exposure to traffic-generated air pollution initiates hepatocyte injury and further exacerbates lipid accumulation and hepatocyte injury induced by the consumption of a HF diet, thereby contributing to the progression of NAFLD-related pathologies.

Self-Reported Primary Cooking Fuels Use and Risk of Chronic Digestive Diseases: A Prospective Cohort Study of 0.5 Million Chinese Adults

BACKGROUND

Household air pollution (HAP) from inefficient combustion of solid fuels is a major health concern worldwide. However, prospective evidence on the health impacts of solid cooking fuels and risks of chronic digestive diseases remains scarce.

OBJECTIVES

We explored the effects of self-reported primary cooking fuels on the incidence of chronic digestive diseases.

METHODS

The China Kadoorie Biobank recruited 512,726 participants 30-79 years of age from 10 regions across China. Information on primary cooking fuels at the current and previous two residences was collected via self-reporting at baseline. Incidence of chronic digestive diseases was identified through electronic linkage and active follow-up. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of self-reported long-term cooking fuel patterns and weighted duration of self-reported solid cooking fuel use with chronic digestive diseases incidence. Linear trend was tested by assigning the medians of weighted duration in each group and then taking those as continuous variables in the models. Subgroup analyses were undertaken across the baseline characteristics of participants.

RESULTS

During 9.1 ± 1.6 y of follow-up, 16,810 new cases of chronic digestive diseases were documented, among which 6,460 were diagnosed as cancers. Compared with long-term cleaner fuel use, self-reported long-term use of solid cooking fuels (i.e., coal, wood) was associated with elevated risks of chronic digestive diseases (HR = 1.08 ; 95% CI: 1.02, 1.13), including nonalcoholic fatty liver disease (NAFLD) (HR = 1.43 ; 95% CI: 1.10, 1.87), hepatic fibrosis/cirrhosis (HR = 1.35 ; 95% CI: 1.05, 1.73), cholecystitis (HR = 1.19 ; 95% CI: 1.07, 1.32), and peptic ulcers (HR = 1.15 ; 95% CI: 1.00, 1.33). The longer the weighted duration of self-reported solid cooking fuel use, the higher the risks of chronic digestive diseases, hepatic fibrosis/cirrhosis, peptic ulcers, and esophageal cancer (p Trend < 0.05 ). The aforementioned associations were modified by sex and body mass index (BMI). Positive associations of always solid cooking fuel use with chronic digestive disease, hepatic fibrosis/cirrhosis, NAFLD, and cholecystitis were observed among women but not men. The longer the weighted duration of self-reported solid cooking fuel use, the higher the risk of NAFLD among those with a BMI ≥ 28   kg / m 2 .

DISCUSSION

Long-term self-reported solid cooking fuels use was associated with higher risks of chronic digestive diseases. The positive association of HAP from solid cooking fuels with chronic digestive diseases indicates for an imminent promotion of cleaner fuels as public health interventions. https://doi.org/10.1289/EHP10486.

State of the science on outdoor air pollution exposure and liver cancer risk

Background

There is emerging evidence that air pollution exposure increases the risk of developing liver cancer. To date, there have been four epidemiologic studies conducted in the United States, Taiwan, and Europe showing generally consistent positive associations between ambient exposure to air pollutants, including particulate matter <2.5 μm in aerodynamic diameter (PM2.5) and nitrogen dioxide (NO2), and liver cancer risk. There are several research gaps and thus valuable opportunities for future work to continue building on this expanding body of literature. The objectives of this paper are to narratively synthesize existing epidemiologic literature on the association between air pollution exposure and liver cancer incidence and describe future research directions to advance the science of understanding the role of air pollution exposure in liver cancer development.

Future research directions

include 1) accounting for potential confounding by established risk factors for the predominant histological subtype, hepatocellular carcinoma (HCC); 2) examination of incident primary liver cancer outcomes with consideration of potential differential associations according to histology; 3) air pollution exposure assessments considering early-life and/or historical exposures, residential histories, residual confounding from other sources of air pollution (e.g., tobacco smoking), and integration of geospatial ambient exposure modeling with novel biomarker technologies; 4) examination of air pollution mixtures experienced in the exposome; 5) consideration of increased opportunities for exposure to outdoor air pollution due to climate change (e.g., wildfires); and 6) consideration of modifying factors for air pollution exposure, such as socioeconomic status, that may contribute to disparities in liver cancer incidence.

Conclusions

In light of mounting evidence demonstrating that higher levels of air pollution exposure increase the risk for developing liver cancer, methodological considerations primarily concerning residual confounding and improved exposure assessment are warranted to robustly demonstrate an independent association for air pollution as a hepatocarcinogen.

Long-term exposure to ambient air pollution and serum liver enzymes in older adults: a population-based longitudinal study

PURPOSE

To investigate the association of long-term exposure to ambient air pollution with serum liver enzymes in older adults.

METHODS

In this longitudinal study, we investigated 318,911 adults aged ≥65 years and assessed their long-term residential exposure to particulate matter with an aerodynamic diameter ≤2.5 µm (PM_2.5), particulate matter with an aerodynamic diameter ≤10 µm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃). Linear mixed models and generalized linear mixed models were implemented for exposure-response analyses.

RESULTS

Each interquartile range (IQR) increase of PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃ exposures was significantly associated with a 4.6%, 4.6%, 5.6%, 4.6%, 6.2%, and 3.6% increase in alanine aminotransferase (ALT), and a 4.6%, 5.2%, 3.6%, 3.3%, 6.1%, and 4.0% increase in aspartate aminotransferase (AST), respectively. Each IQR increase of PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃ exposures was significantly associated with a 23%, 24%, 28%, 17%, 31%, and 19% increase in odds of elevated ALT (>40 U/L), and a 32%, 39%, 40%, 32%, 57%, and 25% increase in odds of elevated AST (>40 U/L), respectively.

CONCLUSIONS

Long-term exposure to ambient air pollution was significantly associated with increased serum liver enzyme levels in older adults, suggesting that air pollution exposures may induce hepatocellular injury.

Long-term exposure to air pollution and liver cancer incidence in six European cohorts

Particulate matter air pollution and diesel engine exhaust have been classified as carcinogenic for lung cancer, yet few studies have explored associations with liver cancer. We used six European adult cohorts which were recruited between 1985 and 2005, pooled within the "Effects of low-level air pollution: A study in Europe" (ELAPSE) project, and followed for the incidence of liver cancer until 2011 to 2015. The annual average exposure to nitrogen dioxide (NO₂ ), particulate matter with diameter <2.5 μm (PM_2.5 ), black carbon (BC), warm-season ozone (O₃ ), and eight elemental components of PM_2.5 (copper, iron, zinc, sulfur, nickel, vanadium, silicon, and potassium) were estimated by European-wide hybrid land-use regression models at participants' residential addresses. We analyzed the association between air pollution and liver cancer incidence by Cox proportional hazards models adjusting for potential confounders. Of 330 064 cancer-free adults at baseline, 512 developed liver cancer during a mean follow-up of 18.1 years. We observed positive linear associations between NO₂ (hazard ratio, 95% confidence interval: 1.17, 1.02-1.35 per 10 μg/m³ ), PM_2.5 (1.12, 0.92-1.36 per 5 μg/m³ ), and BC (1.15, 1.00-1.33 per 0.5 10^-5 /m) and liver cancer incidence. Associations with NO₂ and BC persisted in two-pollutant models with PM_2.5 . Most components of PM_2.5 were associated with the risk of liver cancer, with the strongest associations for sulfur and vanadium, which were robust to adjustment for PM_2.5 or NO₂ . Our study suggests that ambient air pollution may increase the risk of liver cancer, even at concentrations below current EU standards.

A cohort study on long-term exposure to air pollution and incidence of liver cirrhosis

Cirrhosis is an advanced liver disease affecting millions of people worldwide, involving high healthcare costs. Despite experimental evidence suggesting a possible role of airborne pollutants in liver diseases, epidemiological studies are lacking. We aimed at investigating the association between exposure to air pollutants and incidence of cirrhosis in a large population-based cohort in Rome.

Methods

We used an administrative cohort established from the 2001 census. We included all adults of 30 years of age or older who were free of cirrhosis, resulting in a study population of over 1.2 million subjects. Follow-up of the subjects ended on 31 December 2015. We ascertained incident cases of cirrhosis from regional mortality and hospital discharge registries using a validated algorithm. We assessed exposure of the subjects to PM₁₀, PM coarse, PM_2.5, PM_2.5 absorbance, NO₂, NOx, and PM metal components at their residential address using Land Use Regression models. We used Cox regression models, adjusted for relevant covariates, to estimate the association between air pollution exposure and cirrhosis incidence.

Results

We observed 10,111 incident cases of cirrhosis, with a crude incidence rate of 67 × 100,000 person-years. Long-term exposure to all pollutants tested was significantly associated with cirrhosis, e.g., PM₁₀ (hazard ratios [HR], 1.05; 95% confidence interval [CI], 1.01-1.09, per 10 µg/m³ increments), PM coarse (HR, 1.11; 95% CI, 1.05-1.17, per 10 µg/m³ increments), PM_2.5 (HR, 1.08; 95% CI, 1.03-1.13, per 5 µg/m³ increments), and NO₂ (HR, 1.03; 95% CI, 1.02-1.05, per 10 µg/m³ increments). The associations were robust in secondary analyses.

Conclusions

Our findings suggest a possible contribution of air pollution to the development of cirrhosis.

Air pollution-derived particulate matter dysregulates hepatic Krebs cycle, glucose and lipid metabolism in mice

Exposure to ambient air particulate matter (PM_2.5) is well established as a risk factor for cardiovascular and pulmonary disease. Both epidemiologic and controlled exposure studies in humans and animals have demonstrated an association between air pollution exposure and metabolic disorders such as diabetes. Given the central role of the liver in peripheral glucose homeostasis, we exposed mice to filtered air or PM_2.5 for 16 weeks and examined its effect on hepatic metabolic pathways using stable isotope resolved metabolomics (SIRM) following a bolus of ¹³C₆-glucose. Livers were analyzed for the incorporation of ¹³C into different metabolic pools by IC-FTMS or GC-MS. The relative abundance of ¹³C-glycolytic intermediates was reduced, suggesting attenuated glycolysis, a feature found in diabetes. Decreased ¹³C-Krebs cycle intermediates suggested that PM_2.5 exposure led to a reduction in the Krebs cycle capacity. In contrast to decreased glycolysis, we observed an increase in the oxidative branch of the pentose phosphate pathway and ¹³C incorporations suggestive of enhanced capacity for the de novo synthesis of fatty acids. To our knowledge, this is one of the first studies to examine ¹³C₆-glucose utilization in the liver following PM_2.5 exposure, prior to the onset of insulin resistance (IR).

Hepatic alterations associated with fine particulate matter exposure

Several studies have pointed to fine particulate matter (PM_2.5) as the main responsible for air pollution toxic effects. Indeed, PM_2.5 may not only cause respiratory and cardiovascular abnormalities but it may also affect other organs such as the liver. Be that as it may, only a few studies have evaluated the PM_2.5 effects on hepatic tissue. Moreover, most of them have not analyzed the relationship between particles composition and toxicological effects. In this study, healthy rats were subjected to urban levels of PM_2.5 particles in order to assess their structural and functional effects on the liver. During the exposure periods, mean PM_2.5 concentrations were slightly higher than the value suggested by the daily guideline of the World Health Organization. The exposed rats showed a hepatic increase of Cr, Zn, Fe, Ba, Tl and Pb levels. This group also showed leukocyte infiltration, sinusoidal dilation, hydropic inclusions and alterations in carbohydrates distribution. These histologic lesions were accompanied by serological changes, such as increase of total cholesterol and triglycerides, as well as genotoxic damage in their nuclei. We also observed significant associations between several biomarkers and PM_2.5 composition. Our results show that exposure to low levels of PM_2.5 might cause histologic and serological changes in liver tissue, suggesting that PM_2.5 toxicity is influenced not only by their concentration but also by their composition and the exposure frequency.

Ambient air pollution and primary liver cancer incidence in four European cohorts within the ESCAPE project

BACKGROUND

Tobacco smoke exposure increases the risk of cancer in the liver, but little is known about the possible risk associated with exposure to ambient air pollution.

OBJECTIVES

We evaluated the association between residential exposure to air pollution and primary liver cancer incidence.

METHODS

We obtained data from four cohorts with enrolment during 1985-2005 in Denmark, Austria and Italy. Exposure to nitrogen oxides (NO₂ and NO_X), particulate matter (PM) with diameter of less than 10µm (PM₁₀), less than 2.5µm (PM_2.5), between 2.5 and 10µm (PM_2.5-10) and PM_{2.5 absorbance} (soot) at baseline home addresses were estimated using land-use regression models from the ESCAPE project. We also investigated traffic density on the nearest road. We used Cox proportional-hazards models with adjustment for potential confounders for cohort-specific analyses and random-effects meta-analyses to estimate summary hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Out of 174,770 included participants, 279 liver cancer cases were diagnosed during a mean follow-up of 17 years. In each cohort, HRs above one were observed for all exposures with exception of PM_{2.5 absorbance} and traffic density. In the meta-analysis, all exposures were associated with elevated HRs, but none of the associations reached statistical significance. The summary HR associated with a 10-μg/m³ increase in NO₂ was 1.10 (95% confidence interval (CI): 0.93, 1.30) and 1.34 (95% CI: 0.76, 2.35) for a 5-μg/m³ increase in PM_2.5.

CONCLUSIONS

The results provide suggestive evidence that ambient air pollution may increase the risk of liver cancer. Confidence intervals for associations with NO₂ and NO_X were narrower than for the other exposures.

The association between air pollutants and morbidity for diabetes and liver diseases modified by sexes, ages, and seasons in Tianjin, China

With the generalized linear model and natural splines (ns), we examined the association between outdoor air pollutants and daily morbidity for diabetes and liver disease stratified by sexes and ages based on 4 years of daily data (2008-2011) in Tianjin, China. Season effects of air pollutants including particulate matter (PM), sulfur dioxide (SO2), and nitrogen dioxide (NO2) were also investigated. An increase of 10 μg/m(3) in a 2-day average concentrations of particulate matter with diameters of 10 μm or less (PM10), SO2, and NO2 corresponds to increases in diabetes morbidity of 0.39 % (95 % confidence interval (CI), -0.42-1.12), 0.15 % (95 % CI, -0.25-0.54), and 1.22 % (95 % CI, 0.51-2.96), respectively. As for liver morbidity, the increases were -0.84 % (95 % CI, -2.33-0.62), 0.90 % (95 % CI, 0.50-1.74), and 1.10 % (95 % CI, -2.58-4.78), respectively. The effects were stronger in the cool season than those in the warm season; females and the elderly were generally more vulnerable to outdoor air pollution. This study possesses scientific implications and instructional significance for local environmental standards and medical policymaking.

Repeated intratracheal instillation of PM10 induces lipid reshaping in lung parenchyma and in extra-pulmonary tissues

Adverse health effects of air pollution attributed mainly to airborne particulate matter have been well documented in the last couple of decades. Short term exposure, referring to a few hours exposure, to high ambient PM10 concentration is linked to increased hospitalization rates for cardiovascular events, typically 24 h after air pollution peaks. Particulate matter exposure is related to pulmonary and cardiovascular diseases, with increased oxidative stress and inflammatory status. Previously, we have demonstrated that repeated intratracheal instillation of PM10sum in BALB/c mice leads to respiratory tract inflammation, creating in lung a condition which could potentially evolve in a systemic toxic reaction. Additionally, plasma membrane and tissue lipids are easily affected by oxidative stress and directly correlated with inflammatory products. With this aim, in the present investigation using the same model, we analyzed the toxic potential of PM10sum exposure on lipid plasma membrane composition, lipid peroxidation and the mechanisms of cells protection in multiple organs such as lung, heart, liver and brain. Obtained results indicated that PM10 exposure led to lung lipid reshaping, in particular phospholipid and cholesterol content increases; concomitantly, the generation of oxidative stress caused lipid peroxidation. In liver we found significant changes in lipid content, mainly due to an increase of phosphatidylcholine, and in total fatty acid composition with a more pronounced level of docosahexaenoic acid; these changes were statistically correlated to lung molecular markers. Heart and brain were similarly affected; heart was significantly enriched in triglycerides in half of the PM10sum treated mice. These results demonstrated a direct involvement of PM10sum in affecting lipid metabolism and oxidative stress in peripheral tissues that might be related to the serious systemic air-pollution effects on human health.

The role of air pollutants in initiating liver disease

Recent episodes of severe air pollution in eastern Asia have been reported in the scientific literature and news media. Therefore, there is growing concern about the systemic effects of air pollution on human health. Along with the other well-known harmful effects of air pollution, recently, several animal models have provided strong evidence that air pollutants can induce liver toxicity and act to accelerate liver inflammation and steatosis. This review briefly describes examples where exposure to air pollutants was involved in liver toxicity, focusing on how particulate matter (PM) or carbon black (CB) may be translocated from lung to liver and what liver diseases are closely associated with these air pollutants.