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Yang H, Niu S, Guo M, Xue Y. Applications of 3D organoids in toxicological studies: a comprehensive analysis based on bibliometrics and advances in toxicological mechanisms. Arch Toxicol 2024:10.1007/s00204-024-03777-4. [PMID: 38806717 DOI: 10.1007/s00204-024-03777-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/29/2024] [Indexed: 05/30/2024]
Abstract
A mechanism exploration is an important part of toxicological studies. However, traditional cell and animal models can no longer meet the current needs for in-depth studies of toxicological mechanisms. The three-dimensional (3D) organoid derived from human embryonic stem cells (hESC) or induced pluripotent stem cells (hiPSC) is an ideal experimental model for the study of toxicological effects and mechanisms, which further recapitulates the human tissue microenvironment and provides a reliable method for studying complex cell-cell interactions. This article provides a comprehensive overview of the state of the 3D organoid technology in toxicological studies, including a bibliometric analysis of the existing literature and an exploration of the latest advances in toxicological mechanisms. The use of 3D organoids in toxicology research is growing rapidly, with applications in disease modeling, organ-on-chips, and drug toxicity screening being emphasized, but academic communications among countries/regions, institutions, and research scholars need to be further strengthened. Attempts to study the toxicological mechanisms of exogenous chemicals such as heavy metals, nanoparticles, drugs and organic pollutants are also increasing. It can be expected that 3D organoids can be better applied to the safety evaluation of exogenous chemicals by establishing a standardized methodology.
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Affiliation(s)
- Haitao Yang
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Shuyan Niu
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Menghao Guo
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Yuying Xue
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China.
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Taylor BK, Pulliam H, Smith OV, Rice DL, Johnson HJ, Coutant AT, Glesinger R, Wilson TW. Effects of chronic home radon exposure on cognitive, behavioral, and mental health in developing children and adolescents. Front Psychol 2024; 15:1330469. [PMID: 38469220 PMCID: PMC10925658 DOI: 10.3389/fpsyg.2024.1330469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction It is well-established that chronic exposure to environmental toxins can have adverse effects on neuropsychological health, particularly in developing youths. However, home radon, a ubiquitous radiotoxin, has been seldom studied in this context. In the present study, we investigated the degree to which chronic everyday home radon exposure was associated with alterations in transdiagnostic mental health outcomes. Methods A total of 59 children and adolescents ages 6- to 14-years-old (M = 10.47 years, SD = 2.58; 28 males) completed the study. Parents completed questionnaires detailing aspects of attention and executive function. We used a principal components analysis to derive three domains of neuropsychological functioning: 1) task-based executive function skills, 2) self-and emotion-regulation abilities, and 3) inhibitory control. Additionally, parents completed a home radon test kit and provided information on how long their child had lived in the tested home. We computed a radon exposure index per person based on the duration of time that the child had lived in the home and their measured home radon concentration. Youths were divided into terciles based on their radon exposure index score. Using a MANCOVA design, we determined whether there were differences in neuropsychological domain scores across the three groups, controlling for age, sex, and socioeconomic status. Results There was a significant multivariate effect of radon group on neuropsychological dysfunction (λ = 0.77, F = 2.32, p = 0.038, ηp2 = 0.12). Examination of univariate effects revealed specific increases in self-and emotion-regulation dysfunction among the youths with the greatest degree of chronic home radon exposure (F = 7.21, p = 0.002, ηp2 = 0.21). There were no significant differences by group in the other tested domains. Discussion The data suggest potential specificity in the neurotoxic effects of everyday home radon exposure in developing youths, with significant aberrations in self-and emotion-regulation faculties. These findings support the need for better public awareness and public health policy surrounding home radon safety and mitigation strategies.
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Affiliation(s)
- Brittany K. Taylor
- Institute for Human Neuroscience Boys Town National Research Hospital, Omaha, NE, United States
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Omaha, NE, United States
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, United States
| | - Haley Pulliam
- Institute for Human Neuroscience Boys Town National Research Hospital, Omaha, NE, United States
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Omaha, NE, United States
| | - OgheneTejiri V. Smith
- Institute for Human Neuroscience Boys Town National Research Hospital, Omaha, NE, United States
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Omaha, NE, United States
| | - Danielle L. Rice
- Institute for Human Neuroscience Boys Town National Research Hospital, Omaha, NE, United States
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Omaha, NE, United States
| | - Hallie J. Johnson
- Institute for Human Neuroscience Boys Town National Research Hospital, Omaha, NE, United States
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Omaha, NE, United States
| | - Anna T. Coutant
- Institute for Human Neuroscience Boys Town National Research Hospital, Omaha, NE, United States
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Omaha, NE, United States
| | - Ryan Glesinger
- Institute for Human Neuroscience Boys Town National Research Hospital, Omaha, NE, United States
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Omaha, NE, United States
| | - Tony W. Wilson
- Institute for Human Neuroscience Boys Town National Research Hospital, Omaha, NE, United States
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Omaha, NE, United States
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, United States
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Zheng Q, Yan W, Gao S, Li X. The effect of PFAS exposure on glucolipid metabolism in children and adolescents: a meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1261008. [PMID: 38425754 PMCID: PMC10902913 DOI: 10.3389/fendo.2024.1261008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024] Open
Abstract
Background Previous studies showed that per- and polyfluoroalkyl substances (PFAS), which are widely found in the environment, can disrupt endocrine homeostasis when they enter the human body. This meta-analysis aimed to evaluate current human epidemiological evidence on the relationship between PFAS exposure and glucolipid metabolism in childhood and adolescence. Methods We searched PubMed, Web of Science, Embase, and Cochrane Library databases, and identified population-based epidemiological studies related to PFAS and glucolipid metabolism indexes that were published before 30 December 2022. The heterogeneity of the included literature was assessed using the I-square (I2) test and statistics Q. Random-effects and fixed-effects models were used to combine the effect size. Subgroup analysis based on age and sex of the study participants was performed. A sensitivity analysis was used to evaluate the robustness and reliability of the combined results. Egger's and Begg's tests were used to analyze publication bias. Results A total of 12 studies were included in this analysis. There was a positive association between PFAS and TC (β = 1.110, 95% CI: 0.601, 1.610) and LDL (β = 1.900, 95% CI: 1.030, 2.770), and a negative association between PFAS and HOMA-IR in children and adolescents (β = -0.130, 95% CI: -0. 200, -0.059). PFOS was significant positive associated with TC (β = 8.22, 95% CI: 3.93, 12.51), LDL (β = (12.04, 95% CI: 5.08, 18.99), and HOMA-IR (β = -0.165, 95% CI: -0.292, -0.038). Subgroup analysis showed that exposure to PFAS in the adolescent group was positively associated with TC and LDL levels, and the relationship was stronger in females. Conclusion PFAS exposure is associated with glucolipid metabolism in children and adolescents. Among them, PFOS may play an important role. Recognition of environmental PFAS exposure is critical for stabilizing the glycolipid metabolism relationship during the growth and development of children and adolescents.
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Affiliation(s)
- Qingqing Zheng
- Department of Children Health Care, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Wu Yan
- Department of Children Health Care, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Shenghu Gao
- Department of Children Health Care, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaonan Li
- Department of Children Health Care, Children’s Hospital of Nanjing Medical University, Nanjing, China
- Institute of Pediatric Research, Nanjing Medical University, Nanjing, China
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El-Helaly S, Khashaba E, El Domiaty H, Darwish A. Parental occupational and environmental risk factors for childhood bone cancer in Mansoura oncology center: a case control study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:248-256. [PMID: 36372065 DOI: 10.1080/09603123.2022.2145271] [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: 08/12/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Cancer is the most frequently diagnosed disease-related cause of death among children and adolescents. This study was conducted to test association of occupational, environmental risk factors such as exposure to pesticides, radiations, hazardous chemicals and smoking among children with bone cancer. A retrospective case control study was conducted in Oncology center Mansoura University (OCMU). Study groups included bone cancer cases (n = 51) and an age and sex matched control group (n = 67). An interview-based questionnaire included demographic data, occupational and environmental risk factors for both children and parents. Exposure to n nitrose compounds from burning incense among children, paternal smoking and consanguinity are significantly different between cases and control. (p < 0.05). Paternal smoking and consanguinity are significant predictors for childhood bone cancer. It is recommended to add surveillance for environmental and occupational exposures to childhood bone cancer patients.
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Affiliation(s)
- S El-Helaly
- Pediatric specialist in Belkas Central Hospital, Ministry of health and population, Dakahlia, Egypt
| | - E Khashaba
- Industrial Medicine and Occupational Health Department of Public Health and Community medicine department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - H El Domiaty
- Professor of pediatric medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - A Darwish
- Pediatric Hematology/Oncology and Bone Marrow Transplantation Unit, Department of Pediatrics, Mansoura Research Center For Cord Stem Cells, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Li M, Gong J, Gao L, Zou T, Kang J, Xu H. Advanced human developmental toxicity and teratogenicity assessment using human organoid models. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 235:113429. [PMID: 35325609 DOI: 10.1016/j.ecoenv.2022.113429] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
Tremendous progress has been made in the field of toxicology leading to the advance of developmental toxicity assessment. Conventional animal models and in vitro two-dimensional models cannot accurately describe toxic effects and predict actual in vivo responses due to obvious inter-species differences between humans and animals, as well as the lack of a physiologically relevant tissue microenvironment. Human embryonic stem cell (hESC)- and induced pluripotent stem cell (iPSC)-derived three-dimensional organoids are ideal complex and multicellular organotypic models, which are indispensable in recapitulating morphogenesis, cellular interactions, and molecular processes of early human organ development. Recently, human organoids have been used for drug discovery, chemical toxicity and safety in vitro assessment. This review discusses the recent advances in the use of human organoid models, (i.e., brain, retinal, cardiac, liver, kidney, lung, and intestinal organoid models) for developmental toxicity and teratogenicity assessment of distinct tissues/organs following exposure to pharmaceutical compounds, heavy metals, persistent organic pollutants, nanomaterials, and ambient air pollutants. Combining next-generation organoid models with innovative engineering technologies generates novel and powerful tools for developmental toxicity and teratogenicity assessment, and the rapid progress in this field is expected to continue.
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Affiliation(s)
- Minghui Li
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Jing Gong
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Lixiong Gao
- Department of Ophthalmology, Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Ting Zou
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Jiahui Kang
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Haiwei Xu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China.
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Sensing Techniques for Organochlorides through Intermolecular Interaction with Bicyclic Amidines. BIOSENSORS 2021; 11:bios11110413. [PMID: 34821631 PMCID: PMC8615940 DOI: 10.3390/bios11110413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/21/2022]
Abstract
Toxic organochloride molecules are widely used in industry for various purposes. With their high volatility, the direct detection of organochlorides in environmental samples is challenging. Here, a new organochloride detection mechanism using 1,5-diazabicyclo[4.3.0]non-5-ene (DBN) is introduced to simplify a sensing method with higher detection sensitivity. Three types of organochloride compounds-trichloroethylene (TCE), dichloromethane (DCM), and dichlorodiphenyltrichloroethane (DDT)—were targeted to understand DCM conjugation chemistry by using nuclear magnetic resonance (NMR) and liquid chromatography with a mass spectrometer (LC-MS). 13C-NMR spectra and LC-MS data indicated that DBN can be labeled on these organochloride compounds by chlorine–nitrogen interaction. Furthermore, to demonstrate the organochloride sensing capability, the labeling yield and limit of detection were determined by a colorimetric assay as well as micellar electrokinetic chromatography (MEKC). The interaction with DBN was most appreciable for TCE, among other organochlorides. TCE was detected at picomolar levels, which is two orders of magnitude lower than the maximum contaminant level set by the United States Environmental Protection Agency. MEKC, in conjunction with this DBN-labeling method, enables us to develop a field-deployable sensing platform for detecting toxic organochlorides with high sensitivity.
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Liu J, Portnoy J, Um P, Cui N, Rudo-Hutt A, Yan C, Raine A, Chen A. Blood lead and mercury levels are associated with low resting heart rate in community adolescent boys. Int J Hyg Environ Health 2021; 233:113685. [PMID: 33556713 DOI: 10.1016/j.ijheh.2020.113685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 02/08/2023]
Abstract
While the neurotoxic effects of heavy metals at even low levels have been well-studied, few studies have examined the cardiovascular effects of heavy metals on resting heart rate and these have focused on adult populations. The present study aimed to examine the association between low-level environmental lead and mercury exposure and resting heart rate in community adolescents. As part of the China Jintan Cohort Study, 532 adolescents aged 12 years (SD = 0.6) were tested for blood levels of lead (BLL) and mercury (BML) and resting heart rate (RHR). Generalized linear models were conducted to test the relationship between BLL and BML and RHR, controlling for children's sex, age, and socioeconomic status. Analyses were clustered at the preschool level when the children were recruited to adjust for standard error. The mean (SD) BLL and BML were 3.14 (SD = 1.19) μg/dL and 1.26 (SD = 0.68) μg/L at age 12 years, respectively. After adjusting for confounders, we found a significant interaction between BML and BLL in predicting RHR in boys (B = -1.27, SE = 0.49, p < 0.01, n = 289). We created BLL and BML groups in boys based on median cut-offs. Boys in the High BLL/High BML group had significantly lower RHR (mean = 84.22 beats per minute [bpm], SD = 8.77, n = 61) than boys in the Low BLL/Low BML group (mean = 89.03 bpm, SD = 10.75, n = 69; p < 0.05). BML and BLL did not interact to predict RHR in girls (B = -0.18, SE = 0.88, p > 0.05, n = 242). Combined high BLL and BML were associated with low RHR in community adolescent boys. Low RHR is an indication of chronic under-arousal and has been implicated in psychopathology, particularly for externalizing behavior. Our findings may stimulate further communication and research in this area.
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Affiliation(s)
- Jianghong Liu
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
| | - Jill Portnoy
- University of Massachusetts Lowell, School of Criminology and Justice Studies, Lowell, MA, USA
| | - Phoebe Um
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Naixue Cui
- Shandong University, School of Nursing and Rehabilitation, Shandong Province, China
| | - Anna Rudo-Hutt
- University of Pennsylvania, School of Arts and Sciences, Philadelphia, PA, USA
| | - Chonghai Yan
- Shanghai Key Laboratory of Children's Environmental, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Adrian Raine
- University of Pennsylvania, Departments of Criminology, Psychiatry, and Psychology, Philadelphia, PA, USA
| | - Aimin Chen
- University of Pennsylvania, Department of Biostatistics, Epidemiology, and Informatics, Philadelphia, PA, USA
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Bijnens K, Thijs S, Leynen N, Stevens V, McAmmond B, Van Hamme J, Vangronsveld J, Artois T, Smeets K. Differential effect of silver nanoparticles on the microbiome of adult and developing planaria. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2021; 230:105672. [PMID: 33227667 DOI: 10.1016/j.aquatox.2020.105672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/04/2020] [Accepted: 10/27/2020] [Indexed: 05/23/2023]
Abstract
Silver nanoparticles (AgNPs) are widely incorporated in household, consumer and medical products. Their unintentional release via wastewaters raises concerns on their environmental impact, particularly for aquatic organisms and their associated bacterial communities. It is known that the microbiome plays an important role in its host's health and physiology, e.g. by producing essential nutrients and providing protection against pathogens. A thorough understanding of the effects of AgNPs on bacterial communities and on their interactions with the host is crucial to fully assess AgNP toxicity on aquatic organisms. Our results indicate that the microbiome of the invertebrate Schmidtea mediterranea, a freshwater planarian, is affected by AgNP exposure at the tested 10 μg/ml concentration. Using targeted amplification of the bacterial 16S rRNA gene V3-V4 region, two independent experiments on the microbiomes of adult worms revealed a consistent decrease in Betaproteobacteriales after AgNP exposure, mainly attributed to a decrease in Curvibacter and Undibacterium. Although developing tissues and organisms are known to be more sensitive to toxic compounds, three independent experiments in regenerating worms showed a less pronounced effect of AgNP exposure on the microbiome, possibly because underlying bacterial community changes during development mask the AgNP induced effect. The presence of a polyvinyl-pyrrolidone (PVP) coating did not significantly alter the outcome of the experiments compared to those with uncoated particles. The observed variation between the different experiments underlines the highly variable nature of microbiomes and emphasises the need to repeat microbiome experiments, within and between physiological states of the animal.
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Affiliation(s)
- Karolien Bijnens
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
| | - Sofie Thijs
- Centre for Environmental Sciences, Environmental Biology, Hasselt University, Hasselt, Belgium
| | - Nathalie Leynen
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
| | - Vincent Stevens
- Centre for Environmental Sciences, Environmental Biology, Hasselt University, Hasselt, Belgium
| | - Breanne McAmmond
- Department of Biological Sciences, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Jonathan Van Hamme
- Department of Biological Sciences, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Jaco Vangronsveld
- Centre for Environmental Sciences, Environmental Biology, Hasselt University, Hasselt, Belgium; Department of Plant Physiology, Faculty of Biology and Biotechnology, Maria Skłodowska-Curie University, Lublin, Poland
| | - Tom Artois
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
| | - Karen Smeets
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium.
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Gatzke-Kopp LM, Willoughby MT, Warkentien SM, O'Connor T, Granger DA, Blair C. Magnitude and Chronicity of Environmental Smoke Exposure Across Infancy and Early Childhood in a Sample of Low-Income Children. Nicotine Tob Res 2020; 21:1665-1672. [PMID: 30517756 DOI: 10.1093/ntr/nty228] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/02/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Infants and young children may be at an increased risk for second- and thirdhand exposure to tobacco smoke because of increased respiration rate and exposure to surface residue. However, relatively fewer studies have examined biomarkers of exposure (cotinine) in children under age 4 years. This study examines the magnitude and chronicity of exposure across early childhood among children from low-income families in order to better characterize contextual risk factors associated with exposure. METHODS A total of 1292 families were recruited in six nonurban counties of Pennsylvania and North Carolina. Cotinine was assayed from infant saliva at 6, 15, 24, and 48 months of age (N = 1218), and categorized as low (≤0.45 ng/mL), moderate (0.46-12 ng/mL), or high (≥12 ng/mL) at each time point. Categories were highly correlated across time. Latent class analysis was used to summarize patterns of exposure categories across time. RESULTS Magnitude of exposure in this sample was high, with approximately 12% of infants registering cotinine values at least 12 ng/mL, consistent with active smoking in adults. Greater exposure was associated with lower income, less education, more residential instability, and more instability in adult occupants in the home, whereas time spent in center-based day care was associated with lower exposure. CONCLUSIONS Young children from low-income, nonurban communities appear to bear a higher burden of secondhand smoke exposure than previous studies have reported. Results contribute to understanding populations at greater risk, as well as specific, potentially malleable, environmental factors that may be examined as direct contributors to exposure. IMPLICATIONS Results suggest that infants from low-income, nonurban families have higher risk for environmental smoke exposure than data from nationally representative samples. Predictors of exposure offer insights into specific factors that may be targeted for risk reduction efforts, specifically conditions of children's physical space. In addition to considering the increases in risk when an adult smoker lives in a child's home, families should also attend to the possible risk embedded within the home itself, such as residual smoke from previous occupants. For high-risk children, day care appears to mitigate the magnitude of exposure by providing extended time in a smoke-free environment.
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Affiliation(s)
- Lisa M Gatzke-Kopp
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA
| | - Michael T Willoughby
- Education and Workforce Development, RTI International; Research Triangle Park, NC
| | - Siri M Warkentien
- Education and Workforce Development, RTI International; Research Triangle Park, NC
| | - Thomas O'Connor
- Department of Psychiatry, University of Rochester, Rochester, NY
| | - Douglas A Granger
- Department of Psychological Science, Institute for Interdisciplinary Salivary Bioscience, University of California, Irvine, CA.,Department of Acute and Chronic Care, Johsn Hopkins University School of Nursing, Baltimore, MD.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Clancy Blair
- Department of Applied Psychology, New York University, New York, NY
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Rager JE, Bangma J, Carberry C, Chao A, Grossman J, Lu K, Manuck TA, Sobus JR, Szilagyi J, Fry RC. Review of the environmental prenatal exposome and its relationship to maternal and fetal health. Reprod Toxicol 2020; 98:1-12. [PMID: 32061676 DOI: 10.1016/j.reprotox.2020.02.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/05/2019] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Abstract
Environmental chemicals comprise a major portion of the human exposome, with some shown to impact the health of susceptible populations, including pregnant women and developing fetuses. The placenta and cord blood serve as important biological windows into the maternal and fetal environments. In this article we review how environmental chemicals (defined here to include man-made chemicals [e.g., flame retardants, pesticides/herbicides, per- and polyfluoroalkyl substances], toxins, metals, and other xenobiotic compounds) contribute to the prenatal exposome and highlight future directions to advance this research field. Our findings from a survey of recent literature indicate the need to better understand the breadth of environmental chemicals that reach the placenta and cord blood, as well as the linkages between prenatal exposures, mechanisms of toxicity, and subsequent health outcomes. Research efforts tailored towards addressing these needs will provide a more comprehensive understanding of how environmental chemicals impact maternal and fetal health.
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Affiliation(s)
- Julia E Rager
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; The Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Curriculum in Toxicology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jacqueline Bangma
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Celeste Carberry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alex Chao
- Oak Ridge Institute for Science and Education (ORISE) Participant, Research Triangle Park, NC, USA
| | | | - Kun Lu
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Curriculum in Toxicology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tracy A Manuck
- The Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jon R Sobus
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC, USA
| | - John Szilagyi
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; The Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Curriculum in Toxicology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Falck AJ, Sundararajan S, Al-Mudares F, Contag SA, Bearer CF. Fetal exposure to mercury and lead from intrauterine blood transfusions. Pediatr Res 2019; 86:510-514. [PMID: 31216568 DOI: 10.1038/s41390-019-0463-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mercury (Hg) and lead (Pb) exposure during childhood is associated with irreversible neurodevelopmental effects. Fetal exposure to Hg and Pb from intrauterine blood transfusion (IUBT) has not been reported. METHODS Fetal exposure was estimated based on transfusion volume and metal concentration in donor packed red blood cell (PRBCs). As biomarkers to quantify prenatal exposure are unknown, Hg and Pb in donor PRBCs were compared to estimated intravenous (IV) RfDs based on gastrointestinal absorption. RESULTS Three pregnant women received 8 single-donor IUBTs with volumes ranging from 19 to 120 mL/kg. Hg and Pb were present in all donor PRBC units. In all, 1/8 IUBT resulted in Hg dose five times higher than the estimated IV RfD. Median Pb dose in one fetus who received 5 single-donor IUBTs between 20-32 weeks gestation was 3.4 μg/kg (range 0.5-7.9 μg/kg). One donor unit contained 12.9 μg/dL of Pb, resulting in a fetal dose of 7.9 μg/kg, 40 times higher than the estimated IV RfD at 20 weeks gestation. CONCLUSION This is the first study documenting inadvertent exposure to Hg and Pb from IUBT and quantifying the magnitude of exposure. Screening of donor blood is warranted to prevent toxic effects from Hg and Pb to the developing fetus.
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Affiliation(s)
- Alison J Falck
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Sripriya Sundararajan
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Stephen A Contag
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA
| | - Cynthia F Bearer
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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12
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Makris G, Chrousos GP, Anesiadou S, Sabico S, Abd-Alrahman SH, Al-Daghri NM, Chouliaras G, Pervanidou P. Serum concentrations and detection rates of selected organochlorine pesticides in a sample of Greek school-aged children with neurodevelopmental disorders. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:23739-23753. [PMID: 31209749 DOI: 10.1007/s11356-019-05666-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Abstract
Prospective studies indicate that the exposure to organochlorine pesticides (OCPs) during fetal life, infancy, and early childhood may be associated with features of neurodevelopmental disorders in children. However, few studies have investigated the concentrations of serum OCPs in children with categorically diagnosed neurodevelopmental disorders. The aim of this study was to assess the concentrations and detection rates of dichlorodiphenyltrichloroethane (DDT) metabolites, hexachlorocyclohexane (HCH) isomers, cyclodienes, and methoxychlor in serum samples of children with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and specific learning disorder (SLD), all of normal intelligence, compared to typically developing controls (TD). In total, 114 schoolchildren, aged 6-13 years old, were assessed and distributed into four groups: ASD (n = 39), ADHD (n = 21), SLD (n = 32), and TD (n = 18). Each clinical group was compared to the TD group. Concentrations of serum OCPs were determined by gas chromatography and are presented as ng/g lipid. Concentrations of β-HCH, the sum of HCH isomers, and o,p'-DDD were significantly higher in ASD children: ASD vs. TD (mean ± SD): 10.5 ± 7.7 vs. 6.1 ± 4.0, (p = 0.049); 12.0 ± 10.3 vs. 6.6 ± 4.0, (p = 0.025); 7.4 ± 6.5 vs. 2.8 ± 2.3, (p = 0.0019), respectively. The detection rates of p,p'-DDT, at least one substance from DDTs detected, and the cyclodiene heptachlor epoxide, were significantly lower in the ASD group: ASD vs. TD: 12.8% vs. 38.9%, (p = 0.037); 69.2% vs. 94.4%, (p = 0.044); 10.3% vs. 38.9%, (p = 0.026), respectively. No significant differences between the ADHD or SLD groups and the TD group were observed. We demonstrated higher serum concentrations and lower detection rates of selected OCPs in ASD than TD children. Our results add to potential neurodevelopmental concerns surrounding OCPs and provide evidence of specificity in the relations between HCHs and ASD.
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Affiliation(s)
- Gerasimos Makris
- First Department of Pediatrics, School of Medicine, Unit of Developmental and Behavioral Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon & Levadias, 11527, Goudi, Athens, Greece.
| | - George P Chrousos
- First Department of Pediatrics, School of Medicine, Unit of Developmental and Behavioral Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon & Levadias, 11527, Goudi, Athens, Greece
| | - Sophia Anesiadou
- First Department of Pediatrics, School of Medicine, Unit of Developmental and Behavioral Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon & Levadias, 11527, Goudi, Athens, Greece
| | - Shaun Sabico
- Biochemistry Department, Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Sherif H Abd-Alrahman
- Biochemistry Department, Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia
- Pesticides Residues and Environmental Pollution Department, Central Agricultural Pesticide Laboratory, Agricultural Research Centre, Giza, Egypt
| | - Nasser M Al-Daghri
- Biochemistry Department, Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Giorgos Chouliaras
- First Department of Pediatrics, School of Medicine, Unit of Developmental and Behavioral Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon & Levadias, 11527, Goudi, Athens, Greece
| | - Panagiota Pervanidou
- First Department of Pediatrics, School of Medicine, Unit of Developmental and Behavioral Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon & Levadias, 11527, Goudi, Athens, Greece
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13
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Fry RC, Bangma J, Szilagyi J, Rager JE. Developing novel in vitro methods for the risk assessment of developmental and placental toxicants in the environment. Toxicol Appl Pharmacol 2019; 378:114635. [PMID: 31233757 DOI: 10.1016/j.taap.2019.114635] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 01/12/2023]
Abstract
During pregnancy, the placenta is critical for the regulation of maternal homeostasis and fetal growth and development. Exposures to environmental chemicals during pregnancy can be detrimental to the health of the placenta and therefore adversely impact maternal and fetal health. Though research on placental-derived developmental toxicity is expanding, testing is limited by the resources required for traditional test methods based on whole animal experimentation. Alternative strategies utilizing in vitro methods are well suited to contribute to more efficient screening of chemical toxicity and identification of biological mechanisms underlying toxicity outcomes. This review aims to summarize methods that can be used to evaluate toxicity resulting from exposures during the prenatal period, with a focus on newer in vitro methods centered on placental toxicity. The following key aspects are reviewed: (i) traditional test methods based on animal developmental toxicity testing, (ii) in vitro methods using monocultures and explant models, as well as more recently developed methods, including co-cultures, placenta-on-a-chip, and 3-dimensional (3D) cell models, (iii) endpoints that are commonly measured using in vitro designs, and (iv) the translation of in vitro methods into chemical evaluations and risk assessment applications. We conclude that findings from in vitro placental models can contribute to the screening of potentially hazardous chemicals, elucidation of chemical mechanism of action, incorporation into adverse outcome pathways, estimation of doses eliciting toxicity, derivation of extrapolation factors, and characterization of overall risk of adverse outcomes, representing key components of chemical regulation in the 21st century.
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Affiliation(s)
- Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; The Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Curriculum in Toxicology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jacqueline Bangma
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - John Szilagyi
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Julia E Rager
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; The Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Curriculum in Toxicology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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14
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Leynen N, Van Belleghem FG, Wouters A, Bove H, Ploem JP, Thijssen E, Langie SA, Carleer R, Ameloot M, Artois T, Smeets K. In vivo Toxicity Assessment of Silver Nanoparticles in Homeostatic versus Regenerating Planarians. Nanotoxicology 2019; 13:476-491. [DOI: 10.1080/17435390.2018.1553252] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Nathalie Leynen
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
| | - Frank G.A.J Van Belleghem
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
| | - Annelies Wouters
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
| | - Hannelore Bove
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Jan-Pieter Ploem
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
| | - Elsy Thijssen
- Applied and Analytical Chemistry, Hasselt University, Diepenbeek, Belgium
| | - Sabine A.S. Langie
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
- VITO NV, Mol, Belgium
| | - Robert Carleer
- Applied and Analytical Chemistry, Hasselt University, Diepenbeek, Belgium
| | - Marcel Ameloot
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Tom Artois
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
| | - Karen Smeets
- Centre for Environmental Sciences, Zoology, Biodiversity and Toxicology, Hasselt University, Hasselt, Belgium
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15
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Aly SM, Omran A, Abdalla MO, Gaulier JM, El-Metwally D. Lead: a hidden "untested" risk in neonatal blood transfusion. Pediatr Res 2019; 85:50-54. [PMID: 30297876 DOI: 10.1038/s41390-018-0175-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/03/2018] [Accepted: 08/24/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Neonates may be exposed to lead (Pb) through blood transfusions from donors. Pb exposure has neurological, cardiovascular, renal, and other adverse effects. The study aimed to (i) determine the blood lead levels (BLLs) in different blood product units (whole blood, packed red blood cells (pRBCs), platelets, and plasma transfused to neonates) and (ii) estimate the proportion of units with high BLLs. METHODS Residual blood from blood bank bags that were used for neonatal transfusion were collected: 25 samples from each type of blood product except for whole blood (10 samples). The Pb analysis was performed using the atomic absorption method. The study was conducted at the Suez Canal University Hospital, Egypt. RESULTS The mean of BLL in pRBCs, platelets, plasma, and whole blood were 136, 199, 108, and 130 µg/L, respectively; 60% contained Pb above 50 µg/L. The highest BLLs were in platelet units. CONCLUSIONS The present study showed for the first time that platelets and plasma in addition to whole blood and pRBCs used for neonatal transfusions are sources of Pb. Re-evaluation of the guidelines is mandatory for the safety of the neonates. Long-term neurodevelopment assessment of neonates exposed to high Pb is warranted.
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Affiliation(s)
- Sanaa Mohamed Aly
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | - Ahmed Omran
- Pediatrics and Neonatology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohamed Osama Abdalla
- Clinical Pathology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Dina El-Metwally
- Pediatrics and Neonatology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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16
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Dórea JG. Low-dose Thimerosal (ethyl-mercury) is still used in infants` vaccines: Should we be concerned with this form of exposure? J Trace Elem Med Biol 2018; 49:134-139. [PMID: 29895363 DOI: 10.1016/j.jtemb.2018.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 05/16/2018] [Indexed: 12/25/2022]
Abstract
In developing countries, Thimerosal-containing vaccines (TCV) are the main causes of organic Hg exposure for newborns, neonates, and infants immunized with TCV. This article addresses early-life exposure to this unique organic mercury compound (ethylmercury-EtHg) and the risks of its exposure. English language studies pertaining to Thimerosal/EtHg toxicity and exposure during early life were searched in PubMed; and, those publications judged to be relevant to the topic of this review were selected. The risk from the neurotoxic effects of pre- and post-natal Hg exposures depend, in part, on aggravating or attenuating environmental and/or genetic-associated factors. Health authorities in charge of controlling infectious disease dismiss the toxicology of mercury (immunological and subtle neurological effects as insignificant) related to low-dose Thimerosal. The review addresses the evidence that brings into question the safety of Thimerosal that is still present in vaccines given to pregnant women, infants, and children in developing countries, and recognizes the ethical imperative to extend the use of Thimerosal-free vaccines to developing countries, not just developed countries.
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Affiliation(s)
- José G Dórea
- Health Sciences, Universidade de Brasília, Brasília, 70919-970, DF, Brazil.
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17
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Kim S, Eom S, Kim HJ, Lee JJ, Choi G, Choi S, Kim S, Kim SY, Cho G, Kim YD, Suh E, Kim SK, Kim S, Kim GH, Moon HB, Park J, Kim S, Choi K, Eun SH. Association between maternal exposure to major phthalates, heavy metals, and persistent organic pollutants, and the neurodevelopmental performances of their children at 1 to 2years of age- CHECK cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 624:377-384. [PMID: 29258038 DOI: 10.1016/j.scitotenv.2017.12.058] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 05/25/2023]
Abstract
Exposure of the developing fetus and infants to toxic substances can cause serious lifelong health consequences. Several chemicals have been associated with adverse neurodevelopmental disorders in the early life stages of humans. However, most epidemiological studies have focused on a limited number of chemicals, and hence may exclude important chemicals from consideration or result in conclusions built on associations by chance. In the present study, we investigated the chemical exposure profile of the women, and associated these with the early neurodevelopmental performance of their offspring at 13-24months of age. The chemicals assessed include four phthalates, bisphenol A, three heavy metals, 19 polychlorinated biphenyls (PCBs), 19 organochlorine pesticides, and 19 polybrominated diphenyl ethers, which were measured from urine, whole blood, serum, and/or breastmilk of the pregnant or lactating women. For neurodevelopmental performance, the Bayley Scales of Infant Development-II (BSID-II), Social Maturity Scale (SMS), and Child Behavior Checklist (CBCL) were measured from a total of 140 toddlers. Among the measured chemicals, monoethyl phthalate (MEP) in maternal urine was significantly associated with early mental, psychomotor, and social development. In addition, breast milk di-ethylhexyl phthalate (DEHP) metabolite and blood lead concentrations were inversely associated with mental and psychomotor development indices, respectively. Maternal blood PCB153, heavy metals, and urinary MEP levels were also higher among the children with behavioral problems, as indicated by the CBCL range. Taken together, maternal exposure to several EDCs such as PCBs and DEHP was associated with adverse neurodevelopmental performances among the children aged 1-2years. Confirmation of these association in larger populations, as well as longer-term consequences of such exposure warrant further investigation.
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Affiliation(s)
- Sunmi Kim
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea
| | - Soyong Eom
- College of Medicine, Yonsei University, Seoul 26493, Republic of Korea
| | - Hai-Joong Kim
- College of Medicine, Korea University, Ansan 15355, Republic of Korea
| | - Jeong Jae Lee
- College of Medicine, Soonchunhyang University, Seoul 04401, Republic of Korea
| | - Gyuyeon Choi
- College of Medicine, Soonchunhyang University, Seoul 04401, Republic of Korea
| | - Sooran Choi
- College of Medicine, Inha University, Incheon 22332, Republic of Korea
| | - Sungjoo Kim
- College of Medicine, Hallym University, Seoul 07226, Republic of Korea
| | - Su Young Kim
- College of Medicine, Jeju National University, Jeju 63241, Republic of Korea
| | - Geumjoon Cho
- College of Medicine, Korea University, Ansan 15355, Republic of Korea
| | - Young Don Kim
- Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea
| | - Eunsook Suh
- College of Medicine, Soonchunhyang University, Seoul 04401, Republic of Korea
| | - Sung Koo Kim
- College of Medicine, Hallym University, Seoul 07226, Republic of Korea
| | - Seunghyo Kim
- College of Medicine, Jeju National University, Jeju 63241, Republic of Korea
| | - Gun-Ha Kim
- College of Medicine, Korea University, Ansan 15355, Republic of Korea
| | - Hyo-Bang Moon
- Department of Marine Sciences and Convergent Technology, Hanyang University, Ansan 15588, Republic of Korea
| | - Jeongim Park
- College of Natural Sciences, Soonchunhyang University, Asan 31538, Republic of Korea
| | - Sungkyoon Kim
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea
| | - Kyungho Choi
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea
| | - So-Hee Eun
- College of Medicine, Korea University, Ansan 15355, Republic of Korea.
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18
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Al-Saleh I, Al-Rouqi R, Elkhatib R, Abduljabbar M, Al-Rajudi T. Risk assessment of environmental exposure to heavy metals in mothers and their respective infants. Int J Hyg Environ Health 2017; 220:1252-1278. [PMID: 28869188 DOI: 10.1016/j.ijheh.2017.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 12/17/2022]
Abstract
Exposure to heavy metals can cause renal injury, which has been well documented in occupational exposure. Studies of low exposure in the general population, however, are still scarce, particularly for vulnerable populations such as mothers and young children. This study evaluated exposure to heavy metals, and biomarkers of renal function and oxidative stress in 944 lactating mothers and their infants and investigated the role of the interaction between heavy metals and oxidative stress in altering renal function. Mother and infant urine samples were analyzed to measure mercury (Hg), cadmium (Cd), and lead (Pb) concentrations for determining body-burden exposure; N-acetyl-β-d-glucosaminidase (NAG), α1-microglobulin (α1-MG), albumin (ALB), and creatinine (Cr) concentrations for determining early renal injury; and 8-hydroxy-2-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) concentrations for determining oxidative stress. The median concentrclearlyations in mothers presented as μg/g Cr (infants as μg/l) for Hg, Cd, and Pb were 0.695 (0.716), 0.322 (0.343), and 3.97 (5.306) respectively. The mothers and their infants had clearly been exposed to heavy metals and had levels higher than the reference values reported for the general populations of USA, Germany, and Canada. Multiple regression analyses clearly demonstrated associations between urinary heavy metals in quartiles and several renal and oxidative biomarkers in mothers and to a lesser extent their infants. ß coefficients for urinary excretions of MDA, 8-OHdG, ALB, α1-MG, NAG, and Cr in mothers were high in the highest quartile of Hg (1.183-51.29μg/g Cr or 1.732-106.95μg/l), Cd (0.565-765.776μg/g Cr or 0.785-1347.0μg/l), and Pb (6.606-83.937μg/g Cr or 9.459-80.826μg/l), except Pb was not associated with ALB. Infants in the highest Pb quartile (9.293-263.098μg/l) had the highest ß coefficients of urinary excretion of MDA, 8-OHdG, ALB, NAG, and Cr. Significant increasing trend in biomarkers across the quartiles of the three metals was seen in both mothers and infants (ptrend <0.001). A receiver operating characteristic analysis supported the predictive abilities of the four renal biomarkers in discriminating between low versus high metal quartiles. The interaction between heavy metals and oxidative stress contributed to the high excretions of renal biomarkers, but the mechanism remains unclear. These findings add to the limited evidence that low exposure to heavy metals in the general population is associated with alterations in renal function that could eventually progress to renal damage if exposure continues and that children are more susceptible due to the immaturity of their body organs.
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Affiliation(s)
- Iman Al-Saleh
- Environmental Health Program, Research Centre, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh 11211, Saudi Arabia.
| | - Reem Al-Rouqi
- Environmental Health Program, Research Centre, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh 11211, Saudi Arabia
| | - Rola Elkhatib
- Environmental Health Program, Research Centre, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh 11211, Saudi Arabia
| | - Mai Abduljabbar
- Environmental Health Program, Research Centre, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh 11211, Saudi Arabia
| | - Tahreer Al-Rajudi
- Environmental Health Program, Research Centre, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh 11211, Saudi Arabia
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19
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Tilley SK, Reif DM, Fry RC. Incorporating ToxCast and Tox21 datasets to rank biological activity of chemicals at Superfund sites in North Carolina. ENVIRONMENT INTERNATIONAL 2017; 101:19-26. [PMID: 28153528 PMCID: PMC5351294 DOI: 10.1016/j.envint.2016.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/09/2016] [Accepted: 10/06/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND The Superfund program of the Environmental Protection Agency (EPA) was established in 1980 to address public health concerns posed by toxic substances released into the environment in the United States. Forty-two of the 1328 hazardous waste sites that remain on the Superfund National Priority List are located in the state of North Carolina. METHODS We set out to develop a database that contained information on both the prevalence and biological activity of chemicals present at Superfund sites in North Carolina. A chemical characterization tool, the Toxicological Priority Index (ToxPi), was used to rank the biological activity of these chemicals based on their predicted bioavailability, documented associations with biological pathways, and activity in in vitro assays of the ToxCast and Tox21 programs. RESULTS The ten most prevalent chemicals found at North Carolina Superfund sites were chromium, trichloroethene, lead, tetrachloroethene, arsenic, benzene, manganese, 1,2-dichloroethane, nickel, and barium. For all chemicals found at North Carolina Superfund sites, ToxPi analysis was used to rank their biological activity. Through this data integration, residual pesticides and organic solvents were identified to be some of the most highly-ranking predicted bioactive chemicals. This study provides a novel methodology for creating state or regional databases of biological activity of contaminants at Superfund sites. CONCLUSIONS These data represent a novel integrated profile of the most prevalent chemicals at North Carolina Superfund sites. This information, and the associated methodology, is useful to toxicologists, risk assessors, and the communities living in close proximity to these sites.
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Affiliation(s)
- Sloane K Tilley
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC 27599, USA.
| | - David M Reif
- Bioinformatics Research Center, Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA.
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC 27599, USA; Curriculum in Toxicology, The University of North Carolina, Chapel Hill, NC 27599, USA.
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20
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Association of blood heavy metals with developmental delays and health status in children. Sci Rep 2017; 7:43608. [PMID: 28252669 PMCID: PMC5333623 DOI: 10.1038/srep43608] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 01/26/2017] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to evaluate the association of blood lead, mercury, and cadmium concentrations with developmental delays and to explore the association of these concentrations with the health status of children. This study recruited 89 children with developmental delays and 89 age- and sex-matched children with typical development. Their health status was evaluated using the Pediatric Quality of Life (PedsQL) Inventory for health-related quality of life (HRQOL) and the Pediatric Outcomes Data Collection Instrument for function. Family function was also evaluated. Blood lead, mercury, and cadmium concentrations were measured using inductively coupled mass spectrometry. The children with developmental delays had a considerably poorer HRQOL, lower functional performance and family function, and a higher blood lead concentration than those with typical development. The blood lead concentration had a significantly positive association with developmental delays [odds ratio (OR) = 1.54, p < 0.01] in a dose-response manner, and it negatively correlated with PedsQL scores (regression coefficient: −0. 47 to −0.53, p < 0.05) in all the children studied. The higher blood cadmium concentration showed a significantly positive association with developmental delays (OR = 2.24, for >1.0 μg/L vs. <0.6 μg/L, p < 0.05). The blood mercury concentration was not associated with developmental delays and health status.
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21
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García-Pérez J, Morales-Piga A, Gómez-Barroso D, Tamayo-Uria I, Pardo Romaguera E, López-Abente G, Ramis R. Risk of bone tumors in children and residential proximity to industrial and urban areas: New findings from a case-control study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 579:1333-1342. [PMID: 27916304 DOI: 10.1016/j.scitotenv.2016.11.131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/03/2016] [Accepted: 11/19/2016] [Indexed: 05/07/2023]
Abstract
Few epidemiologic studies have explored risk factors for bone tumors in children, and the role of environmental factors needs to be analyzed. Our objective was to ascertain the association between residential proximity to industrial plants and urban areas and risk of bone tumors in children, taking into account industrial groups and toxic pollutants released. A population-based case-control study of childhood bone cancer in Spain was carried out, covering 114 incident cases obtained from the Spanish Registry of Childhood Tumors (between 1996 and 2011), and 684 controls individually matched by sex, year of birth, and autonomous region of residence. Distances from the subject's residences to the 1271 industries and the 30 urban areas (towns) with ≥75,000 inhabitants located in the study area were computed. Unconditional logistic regression models were fitted to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance (from 1km to 3km) to industrial and urban areas, with adjustment for matching variables and sociodemographic indicators. Excess risk (OR; 95%CI) of bone tumors in children was detected for children close to industrial facilities as a whole (2.33; 1.17-4.63 at 3km) - particularly surface treatment of metals (OR=2.50; 95%CI=1.13-5.56 at 2km), production and processing of metals (OR=3.30; 95%CI=1.41-7.77 at 2.5km), urban waste-water treatment plants (OR=4.41; 95%CI=1.62-11.98 at 2km), hazardous waste (OR=4.63; 95%CI=1.37-15.61 at 2km), disposal or recycling of animal waste (OR=4.73; 95%CI=1.40-15.97 at 2km), cement and lime (OR=3.89; 95%CI=1.19-12.77 at 2.5km), and combustion installations (OR=3.85; 95%CI=1.39-10.66 at 3km)-, and urban areas (4.43; 1.80-10.92). These findings support the need for more detailed exposure assessment of certain toxics released by these facilities.
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Affiliation(s)
- Javier García-Pérez
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
| | - Antonio Morales-Piga
- Rare Disease Research Institute (IIER), Carlos III Institute of Health, Madrid, Spain; Consortium for Biomedical Research in Rare Diseases (CIBERER), Madrid, Spain.
| | - Diana Gómez-Barroso
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
| | - Ibon Tamayo-Uria
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - Elena Pardo Romaguera
- Spanish Registry of Childhood Tumors (RETI-SEHOP), University of Valencia, Valencia, Spain.
| | - Gonzalo López-Abente
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
| | - Rebeca Ramis
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
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22
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Nascimento SN, Göethel G, Baierle M, Barth A, Brucker N, Charão MF, Moro AM, Gauer B, Sauer E, Durgante J, Arbo MD, Thiesen FV, Pierre TDS, Gioda A, Moresco R, Garcia SC. Environmental exposure and effects on health of children from a tobacco-producing region. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:2851-2865. [PMID: 27838906 DOI: 10.1007/s11356-016-8071-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/07/2016] [Indexed: 06/06/2023]
Abstract
Children may be environmentally exposed to several hazards. In order to evaluate the health of children living in a tobacco-producing region, different biomarkers of exposure and effect, as well as hematological parameters, were evaluated. Biomarkers of exposure to the following xenobiotics were assessed: pesticides, nicotine, toxic elements, and organic solvents. Oxidative damage markers malondialdehyde (MDA) and protein carbonyls (PCO), vitamin C, microalbuminuria (mALB) levels, and N-acetyl-β-D-glucosaminidase (NAG) activity were also evaluated. Peripheral blood samples and urine were collected from 40 children (6-12 years), at two different crop periods: in the beginning of pesticide applications (period 1) and in the leaf harvest (period 2). The Wilcoxon signed-rank test for paired data was used to evaluate the differences between both periods. Biomarkers of exposure cotinine in urine and blood chromium (Cr) levels were increased in period 1 when compared to period 2. Moreover, a significant reduced plasmatic activity of butyrylcholinesterase (BuChE) was observed in period 2 in relation to period 1. Blood Cr levels were above the recommended by WHO in both evaluations. The biomarkers MDA and PCO as well as the kidney dysfunction biomarker, mALB, presented levels significantly increased in period 1. Additionally, decreased lymphocytes and increased basophils were also observed. Cotinine was positively associated with PCO, and Cr was positively associated with PCO and MDA. The increased Cr levels were associated with decreased lymphocytes and increased basophils. Our findings demonstrate that children environmentally exposed to xenobiotics in rural area may present early kidney dysfunction, hematological alterations, as well as lipid and protein damages, associated with co-exposure to different xenobiotics involved in tobacco cultivation.
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Affiliation(s)
- Sabrina N Nascimento
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
- Post-Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Gabriela Göethel
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
- Post-Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marília Baierle
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
| | - Anelise Barth
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
| | - Natália Brucker
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
| | - Mariele F Charão
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
- Institute of Health Sciences, Feevale University, Novo Hamburgo, RS, Brazil
| | - Angela M Moro
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
| | - Bruna Gauer
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
- Post-Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elisa Sauer
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
- Post-Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Juliano Durgante
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
| | - Marcelo D Arbo
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil
- Post-Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flavia V Thiesen
- Faculty of Pharmacy, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Tatiana D Saint' Pierre
- Department of Chemistry, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Adriana Gioda
- Department of Chemistry, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Rafael Moresco
- Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analyses, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Solange Cristina Garcia
- Laboratory of Toxicology (LATOX), Department of Analyses, Faculty of Pharmacy, Federal University of Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Santa Cecília, Porto Alegre, RS, CEP: 90610-000, Brazil.
- Post-Graduate Program in Pharmaceutical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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Hsueh YM, Chen WJ, Lee CY, Chien SN, Shiue HS, Huang SR, Lin MI, Mu SC, Hsieh RL. Association of Arsenic Methylation Capacity with Developmental Delays and Health Status in Children: A Prospective Case-Control Trial. Sci Rep 2016; 6:37287. [PMID: 27853293 PMCID: PMC5112508 DOI: 10.1038/srep37287] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/26/2016] [Indexed: 12/24/2022] Open
Abstract
This case–control study identified the association between the arsenic methylation capacity and developmental delays and explored the association of this capacity with the health status of children. We recruited 120 children with developmental delays and 120 age- and sex-matched children without developmental delays. The health status of the children was assessed using the Pediatric Quality of Life Inventory (PedsQL) and Pediatric Outcomes Data Collection Instrument (PODCI). The arsenic methylation capacity was determined by the percentages of inorganic arsenic (InAs%), monomethylarsonic acid (MMAV%), and dimethylarsinic acid (DMAV%) through liquid chromatography and hydride generation atomic absorption spectrometry. Developmental delays were significantly positively associated with the total urinary arsenic concentration, InAs%, and MMAV%, and was significantly negatively associated with DMAV% in a dose-dependent manner. MMAV% was negatively associated with the health-related quality of life (HRQOL; −1.19 to −1.46, P < 0.01) and functional performance (−0.82 to −1.14, P < 0.01), whereas DMAV% was positively associated with HRQOL (0.33–0.35, P < 0.05) and functional performance (0.21–0.39, P < 0.01–0.05) in all children and in those with developmental delays. The arsenic methylation capacity is dose-dependently associated with developmental delays and with the health status of children, particularly those with developmental delays.
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Affiliation(s)
- Yu-Mei Hsueh
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Jen Chen
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Chih-Ying Lee
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ssu-Ning Chien
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Horng-Sheng Shiue
- Department of Chinese Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shiau-Rung Huang
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Ming-I Lin
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ru-Lan Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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