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Zhang J, Fan Y, Liang H, Zhang Y. Global, regional and national temporal trends in Parkinson's disease incidence, disability-adjusted life year rates in middle-aged and older adults: a cross-national inequality analysis and Bayesian age-period-cohort analysis based on the global burden of disease 2021. Neurol Sci 2024:10.1007/s10072-024-07941-7. [PMID: 39673044 DOI: 10.1007/s10072-024-07941-7] [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: 10/24/2024] [Accepted: 12/09/2024] [Indexed: 12/15/2024]
Abstract
BACKGROUND Parkinson's disease (PD) ranks as the second most prevalent neurodegenerative disorder; however, its epidemiological characteristics among middle-aged and older adults at global, regional, and national levels remain inadequately documented. METHODS This study assessed temporal trends in PD among middle-aged and older adults by extracting incidence rates, disability-adjusted life year (DALY) rates, and corresponding age-specific rates (ASRs) from the Global Burden of Disease (GBD) database spanning 1990 to 2021. Estimated annual percentage change (EAPC) was employed to analyze trends over the past 30 years. The slope index of inequality (SII) and concentration index (CI) were utilized to evaluate disparities in the burden of PD across various countries. Additionally, Bayesian age-period-cohort (BAPC) modeling was applied to project DALY figures for the next 15 years. RESULTS In 2021, the global incidence and DALY rates for middle-aged and older adults with PD stood at 79.68 and 477.50 cases per 100,000 population, respectively. Both incidence and DALY rates have exhibited an upward trajectory over the past 32 years, with EAPCs of 1.2 (95% UI: 1.1-1.3) and 0.6 (95% UI: 0.5-0.7), respectively. Among the five sociodemographic index (SDI) regions, the high-middle SDI region reported the highest incidence and DALY rates for PD in 2021, at 93.93 and 512.29 cases per 100,000 population, respectively. A positive correlation was observed between the SDI and age-specific incidence rate (ASIR) as well as age-specific DALY rate (ASDR). Disparities in the burden of PD among middle-aged and older adults, associated with SDI, are on the rise and are primarily concentrated in high SDI countries. It is projected that the global incidence and DALY rates for middle-aged and older adults with PD will experience significant increases over the next 15 years. CONCLUSIONS The global burden of PD among middle-aged and older adults has markedly escalated over the past 32 years, particularly in high-middle SDI regions. These findings underscore the necessity for the development of effective interventions and public health policies, contributing to the attainment of the sustainable development goals established by the World Health Organization (WHO).
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510317, China
| | - Yue Fan
- Department of Obstetrics and Gynecology, Fuyang Hospital of Anhui Medical University, Fuyang, 236000, China
| | - Hao Liang
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510317, China
| | - Yong Zhang
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510317, China.
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Sellaro F, Pernetti R, Oddone E. Early biological effects in outdoor workers exposed to urban air pollution: A systematic review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 362:124985. [PMID: 39299637 DOI: 10.1016/j.envpol.2024.124985] [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: 08/31/2023] [Revised: 08/29/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024]
Abstract
Urban outdoor workers (OWs), identified as professionals spending most of their working shifts in an urban environment, are exposed for at least 8 h/day to traffic air pollution, leading to potential health risks. This paper reports the results of a systematic review aimed at identifying the potential health outcomes of exposure to air pollutants for OWs, focusing mainly on police officers, drivers and street vendors. Health outcomes were analysed in terms of early biological effects quantified with specific measured indicators. The main inclusion criterion was the assessment of at least one early biological effect (genetic and epigenetic damage/alterations, inflammation or oxidative stress indicators, or hormonal imbalance) in a population of OWs exposed to urban air pollution. By applying the PRISMA workflow, 82 papers were included in this study. The results showed that the measured pollutant concentrations were significantly below the current occupational limit values, while exceeds the indications of WHO for urban air pollution. This exposure led to significant alterations of biological markers in OWs with respect to non-exposed subjects. In particular, OWs presented an increased frequency of micronuclei and DNA adducts as the main DNA alterations, while police officers (a category of highly exposed OWs) showed hormonal alterations affecting mainly the hypothalamic-pituitary-gonadal axis. Concerning oxidative stress and inflammation, all the analysed matrices (i.e. blood, sputum, urine and lachrymal fluids) showed increased indices for OWs respect to non-exposed groups. Therefore, the evaluation of effect biomarkers to detect early alterations provides crucial information for supporting the occupational risk management of OWs and, at broader level, allows for an insight of the early-stage health outcomes due to urban air pollution.
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Affiliation(s)
- Francesca Sellaro
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; National Biodiversity Future Center, Palermo, Italy
| | - Roberta Pernetti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; National Biodiversity Future Center, Palermo, Italy.
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; Hospital Occupational Medicine Unit, ICS Maugeri IRCCS, Pavia, Italy; National Biodiversity Future Center, Palermo, Italy
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Wang VA, Delaney S, Flynn LE, Racette BA, Miller GW, Braun D, Zanobetti A, Mork D. The effect of air pollution on hospitalizations with Parkinson's disease among medicare beneficiaries nationwide. NPJ Parkinsons Dis 2024; 10:196. [PMID: 39448632 PMCID: PMC11502743 DOI: 10.1038/s41531-024-00815-x] [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: 05/29/2024] [Accepted: 10/10/2024] [Indexed: 10/26/2024] Open
Abstract
We examined the effect of annual exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3), on the rate of first hospitalization with a PD-related diagnosis (hospitalization with PD) among Medicare Fee-for-Service beneficiaries (2001-2016). Machine learning-derived annual air pollution concentrations were linked to residential ZIP codes. For each exposure, we fitted four models: 1) traditional outcome stratification, 2) marginal structural, 3) doubly robust, and 4) generalized propensity score matching Poisson regression models, adjusted for sociodemographic and meteorological confounders and long-term trends. Among 49,121,026 beneficiaries, incidence rate ratios of 1.08 (95% CI: 1.07, 1.10), 1.07 (95% CI: 1.05, 1.08), and 1.03 (95% CI: 1.02, 1.05) for an interquartile range increase in PM2.5 (3.72 µg/m3), NO2 (13.84 ppb), and O3 (10.09 ppb), respectively, were estimated from doubly robust models. Results were similar across modeling approaches. In this nationwide study, higher air pollution exposure increased the rate of hospitalizations with PD.
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Affiliation(s)
- Veronica A Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Scott Delaney
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lauren E Flynn
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Brad A Racette
- Barrow Neurological Institute, Phoenix, AZ, USA
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gary W Miller
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Data Science, Dana Farber Cancer Institute, Boston, MA, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel Mork
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Tripathi A, Pandey VK, Sharma G, Sharma AR, Taufeeq A, Jha AK, Kim JC. Genomic Insights into Dementia: Precision Medicine and the Impact of Gene-Environment Interaction. Aging Dis 2024; 15:2113-2135. [PMID: 38607741 PMCID: PMC11346410 DOI: 10.14336/ad.2024.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The diagnosis, treatment, and management of dementia provide significant challenges due to its chronic cognitive impairment. The complexity of this condition is further highlighted by the impact of gene-environment interactions. A recent strategy combines advanced genomics and precision medicine methods to explore the complex genetic foundations of dementia. Utilizing the most recent research in the field of neurogenetics, the importance of precise genetic data in explaining the variation seen in dementia patients can be investigated. Gene-environment interactions are important because they influence genetic susceptibilities and aid in the development and progression of dementia. Modified to each patient's genetic profile, precision medicine has the potential to detect groups at risk and make previously unheard-of predictions about the course of diseases. Precision medicine techniques have the potential to completely transform treatment and diagnosis methods. Targeted medications that target genetic abnormalities will probably appear, providing the possibility for more efficient and customized medical interventions. Investigating the relationship between genes and the environment may lead to preventive measures that would enable people to change their surroundings and minimize the risk of dementia, leading to the improved lifestyle of affected people. This paper provides a comprehensive overview of the genomic insights into dementia, emphasizing the pivotal role of precision medicine, and gene-environment interactions.
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Affiliation(s)
- Anjali Tripathi
- Department of Biotechnology, Sharda School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Vinay Kumar Pandey
- Division of Research & Innovation (DRI), School of Applied & Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Garima Sharma
- Department of Biomedical Science & Institute of Bioscience and Biotechnology, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Ashish Ranjan Sharma
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, 24252, Gangwon-do, Republic of Korea
| | - Anam Taufeeq
- Department of Biotechnology, Faculty of Engineering and Technology, Rama University, Kanpur, Uttar Pradesh, India
| | - Abhimanyu Kumar Jha
- Department of Biotechnology, Sharda School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Jin-Chul Kim
- Department of Biomedical Science & Institute of Bioscience and Biotechnology, Kangwon National University, Chuncheon 24341, Republic of Korea
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Negi S, Khurana N, Duggal N. The misfolding mystery: α-synuclein and the pathogenesis of Parkinson's disease. Neurochem Int 2024; 177:105760. [PMID: 38723900 DOI: 10.1016/j.neuint.2024.105760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
Neurodegenerative diseases such as Parkinson's disease (PD) are characterized by the death of neurons in specific areas of the brain. One of the proteins that is involved in the pathogenesis of PD is α-synuclein (α-syn). α-Syn is a normal protein that is found in all neurons, but in PD, it misfolds and aggregates into toxic fibrils. These fibrils can then coalesce into pathological inclusions, such as Lewy bodies and Lewy neurites. The pathogenic pathway of PD is thought to involve a number of steps, including misfolding and aggregation of α-syn, mitochondrial dysfunction, protein clearance impairment, neuroinflammation and oxidative stress. A deeper insight into the structure of α-syn and its fibrils could aid in understanding the disease's etiology. The prion-like nature of α-syn is also an important area of research. Prions are misfolded proteins that can spread from cell to cell, causing other proteins to misfold as well. It is possible that α-syn may behave in a similar way, spreading from cell to cell and causing a cascade of misfolding and aggregation. Various post-translational alterations have also been observed to play a role in the pathogenesis of PD. These alterations can involve a variety of nuclear and extranuclear activities, and they can lead to the misfolding and aggregation of α-syn. A better understanding of the pathogenic pathway of PD could lead to the development of new therapies for the treatment of this disease.
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Affiliation(s)
- Samir Negi
- School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi, G.T. Road, Phagwara, Punjab, 144411, India
| | - Navneet Khurana
- School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi, G.T. Road, Phagwara, Punjab, 144411, India
| | - Navneet Duggal
- School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi, G.T. Road, Phagwara, Punjab, 144411, India.
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Zhu J, Cui Y, Zhang J, Yan R, Su D, Zhao D, Wang A, Feng T. Temporal trends in the prevalence of Parkinson's disease from 1980 to 2023: a systematic review and meta-analysis. THE LANCET. HEALTHY LONGEVITY 2024; 5:e464-e479. [PMID: 38945129 DOI: 10.1016/s2666-7568(24)00094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Parkinson's disease is the second most common neurodegenerative disorder, exhibiting an upward trend in prevalence. We aimed to investigate the prevalence of Parkinson's disease, temporal trends between 1980 and 2023, and variations in prevalence by location, age, sex, survey period, sociodemographic index (SDI), human development index (HDI), and study characteristics (sample size, diagnostic criteria, and data source). METHODS In this systematic review and meta-analysis we searched PubMed, Cochrane, Web of Science, Embase, Scopus, and Global Health for observational studies that reported Parkinson's disease prevalence in the general population from database inception to Nov 1, 2023. We included studies if they were original observational investigations, had participants from the general population or community-based datasets, and provided numerical data on the prevalence of Parkinson's disease either with 95% CIs or with sufficient information to calculate 95% CIs. Studies were excluded if they were conducted in a specific population, had a sample size smaller than 1000, or were review articles, case reports, protocols, meeting abstracts, letters, comments, short communications, posters, and reports. The publication characteristics (first author and publication year), study location (countries, WHO regions, SDI, and HDI), survey period, study design, diagnostic criteria, data source, participant information, and prevalence data were extracted from articles using a standard form. Two authors independently evaluated eligibility, and discrepancies were resolved through discussion with the third author. We used random effect models to pool estimates with 95% CIs. Estimated annual percentage change (EAPC) was calculated to assess the temporal trend in prevalence of Parkinson's disease. The study was registered with PROSPERO, CRD42022364417. FINDINGS 83 studies from 37 countries were eligible for analysis, with 56 studies providing all-age prevalence, 53 studies reporting age-specific prevalence, and 26 studies providing both all-age and age-specific prevalence. Global pooled prevalence of Parkinson's disease was 1·51 cases per 1000 (95% CI 1·19-1·88), which was higher in males (1·54 cases per 1000 [1·17-1·96]) than in females (1·49 cases per 1000 [1·12-1·92], p=0·030). During different survey periods, the prevalence of Parkinson's disease was 0·90 cases per 1000 (0·48-1·44; 1980-89), 1·38 cases per 1000 (1·17-1·61; 1990-99), 1·18 cases per 1000 (0·77-1·67; 2000-09), and 3·81 cases per 1000 (2·67-5·14; 2010-23). The EAPC of Parkinson's disease prevalence was significantly higher in the period of 2004-23 (EAPC 16·32% [95% CI 6·07-26·58], p=0·0040) than in the period of 1980-2003 (5·30% [0·82-9·79], p=0·022). Statistically significant disparities in prevalence were observed across six WHO regions. Prevalence increased with HDI or SDI. Considerable variations were observed in the pooled prevalence of Parkinson's disease based on different sample sizes or diagnostic criteria. Prevalence also increased with age, reaching 9·34 cases per 1000 (7·26-11·67) among individuals older than 60 years. INTERPRETATION The global prevalence of Parkinson's disease has been increasing since the 1980s, with a more pronounced rise in the past two decades. The prevalence of Parkinson's disease is higher in countries with higher HDI or SDI. It is necessary to conduct more high-quality epidemiological studies on Parkinson's disease, especially in low SDI countries. FUNDING National Nature Science Foundation of China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jinqiao Zhu
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
| | - Yusha Cui
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junjiao Zhang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Yan
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dongning Su
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Anxin Wang
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
| | - Tao Feng
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Sakowski SA, Koubek EJ, Chen KS, Goutman SA, Feldman EL. Role of the Exposome in Neurodegenerative Disease: Recent Insights and Future Directions. Ann Neurol 2024; 95:635-652. [PMID: 38411261 PMCID: PMC11023772 DOI: 10.1002/ana.26897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
Neurodegenerative diseases are increasing in prevalence and place a significant burden on society. The causes are multifactorial and complex, and increasing evidence suggests a dynamic interplay between genes and the environment, emphasizing the importance of identifying and understanding the role of lifelong exposures, known as the exposome, on the nervous system. This review provides an overview of recent advances toward defining neurodegenerative disease exposomes, focusing on Parkinson's disease, amyotrophic lateral sclerosis, and Alzheimer's disease. We present the current state of the field based on emerging data, elaborate on key themes and potential mechanisms, and conclude with limitations and future directions. ANN NEUROL 2024;95:635-652.
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Affiliation(s)
- Stacey A. Sakowski
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA
| | - Emily J. Koubek
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kevin S. Chen
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stephen A. Goutman
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA
| | - Eva L. Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA
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Ning P, Guo X, Qu Q, Li R. Exploring the association between air pollution and Parkinson's disease or Alzheimer's disease: a Mendelian randomization study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:123939-123947. [PMID: 37995032 DOI: 10.1007/s11356-023-31047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
The correlation between air pollution and neurodegenerative diseases has garnered growing attention. Although observational studies have indicated a potential link between air pollution and neurodegenerative disease, establishing a causal relationship remains uncertain. To address this gap, we performed a two-sample Mendelian randomization analysis utilizing genetic instruments. This analysis aimed to investigate the causal connections between PM2.5, PM10, NO2, and NOX exposure and the occurrence of Parkinson's disease (PD) and Alzheimer's disease (AD). We implemented a series of filtering steps to identify suitable genetic instruments that demonstrated significant associations (P < 5 × 10-8) with PM2.5, PM10, NO2, and NOX. These instruments were derived from a comprehensive genome-wide association study (GWAS) encompassing up to 456,380 participants in the UK Biobank. To obtain summary statistics for PD (N = 482,730) and AD risk (N = 63,926), we utilized the most recent GWAS datasets available. For our primary analysis, we employed the inverse-variance weighted approach for two-sample MR. A multivariable MR (MVMR) was also performed to verify the impact of air pollution exposure on the risk of PD and AD. To ensure the robustness of our findings, sensitivity analyses and heterogeneity assessments were performed. In two-sample MR, by employing the inverse-variance weighted method, our result suggested that genetically NO2 exposure showed a significant association with an elevated risk of PD (OR = 4.07, 95% CI: 1.13 to 19.62, P = 0.034) and genetically PM10 exposure exhibited a significant association with a heightened risk of AD (OR = 1.93, 95% CI: 1.03-3.59, P = 0.040). Further MVMR analysis demonstrated that the causal effect between NO2 and PD disappeared (OR = 3.489, 95% CI: 0.01 to 2.1e + 03, P = 0.703), and only PM10 was associated with an increased risk of AD (OR = 6.500, 95% CI: 1.10 to 38.51, P = 0.039). Sensitivity analysis showed no detectable heterogeneity and pleiotropy (P > 0.05). Our findings demonstrate that NO2 and PM10 exposure may contribute to a risk of PD and AD, respectively. Future research is necessary to elucidate potential physiopathological mechanisms.
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Affiliation(s)
- Pingping Ning
- Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, People's Republic of China
- Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Xi'an, 710068, People's Republic of China
| | - Xingzhi Guo
- Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, People's Republic of China
- Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Xi'an, 710068, People's Republic of China
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, 710072, People's Republic of China
| | - Qiumin Qu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Rui Li
- Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, People's Republic of China.
- Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Xi'an, 710068, People's Republic of China.
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, 710072, People's Republic of China.
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Lomme J, Reedijk M, Peters S, Downward GS, Stefanopoulou M, Vermeulen R, Huss A. Traffic-related air pollution, road traffic noise, and Parkinson's disease: Evaluations in two Dutch cohort studies. Environ Epidemiol 2023; 7:e272. [PMID: 38912395 PMCID: PMC11189687 DOI: 10.1097/ee9.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/06/2023] [Indexed: 06/25/2024] Open
Abstract
Background Environmental factors such as air pollution have been associated with Parkinson's disease (PD), but findings have been inconsistent. We investigated the association between exposure to several air pollutants, road traffic noise, and PD risk in two Dutch cohorts. Methods Data from 50,087 participants from two Dutch population-based cohort studies, European Prospective Investigation into Cancer and Nutrition in the Netherlands and Arbeid, Milieu en Gezondheid Onderzoek were analyzed. In these cohorts, 235 PD cases were ascertained based on a previously validated algorithm combining self-reported information (diagnosis, medication, and symptoms) and registry data. We assigned the following traffic-related exposures to residential addresses at baseline: NO2, NOx, particulate matter (PM)2.5absorbance (as a marker for black carbon exposure), PM with aerodynamic diameter ≤2.5 µm (PM2.5), ≤10 µm (PM10), PMcoarse (size fraction 2.5-10 µm), ultrafine particles <0.1 µm (UFP), and road traffic noise (Lden). Logistic regression models were applied to investigate the associations with PD, adjusted for possible confounders. Results Both single- and two-pollutant models indicated associations between exposure to NOx, road traffic noise, and increasing odds of developing PD. Odds ratios of fully adjusted two-pollutant models in the highest compared with the lowest exposure quartile were 1.62 (95% CI = 1.02, 2.62) for NOx and 1.47 (95% CI = 0.97, 2.25) for road traffic noise, with clear trends across exposure categories. Conclusions Our findings suggest that NOx and road traffic noise are associated with an increased risk of PD. While the association with NOx has been shown before, further investigation into the possible role of environmental noise on PD is warranted.
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Affiliation(s)
- Jara Lomme
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Marije Reedijk
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - George S. Downward
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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Gong Y, Zhang X, Zhao X, Chang H, Zhang J, Gao Z, Mi Y, Chen Y, Zhang H, Huang C, Yu Z. Global ambient particulate matter pollution and neurodegenerative disorders: a systematic review of literature and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:39418-39430. [PMID: 36763275 DOI: 10.1007/s11356-023-25731-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
Previous studies on particulate matter (PM) exposure and neurodegenerative disorders showed inconsistent results, and few studies systematically examined the long-term effect of PM on neurodegenerative diseases, including all-cause dementia, Alzheimer's disease, Parkinson's disease, vascular dementia, amyotrophic lateral sclerosis, and cognitive function decline. We systematically searched for published studies in PubMed, Embase, Cochrane Library, and Web of Science up to October 31, 2022. To facilitate a comparison of effect sizes from different studies, we standardized units across studies to a 10 μg/m3 increase for PM. Heterogeneity was assessed by Cochran's Q test and I2 statistic. Publication bias was evaluated using funnel plots and Egger's tests. Subgroup analysis, meta-regression, and sensitivity analysis were performed. The protocol for this review was registered with PROSPERO (CRD42021277112). Of the 3403 originally identified studies, a meta-analysis was finally performed in 49 studies. The results showed that there was a significant positive association between long-term PM2.5 exposure and all-cause dementia, Alzheimer's disease as well as Parkinson's disease, with pooled OR of 1.30 (95%CI: 1.14, 1.47, I2 = 99.3%), 1.65 (95%CI: 1.37, 1.94, I2 = 98.2%), and 1.17 (95%CI: 1.00, 1.33, I2 = 91.8%). A positive association between PM10 and vascular dementia was observed (OR = 1.12, 95%CI: 1.04, 1.21, I2 = 0.0%). Association between PM exposure and decreased cognitive function score was found. Our results highlight the important role of PM pollution, particularly PM2.5, in the risk of age-related neurodegenerative diseases and cognitive function decline.
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Affiliation(s)
- Yuting Gong
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Chang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxi Zhang
- NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Zhan Gao
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Mi
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao Chen
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huanhuan Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China.
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zengli Yu
- School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China.,NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
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11
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Abstract
Air pollution is a complex mixture of gases and particulate matter, with adsorbed organic and inorganic contaminants, to which exposure is lifelong. Epidemiological studies increasingly associate air pollution with multiple neurodevelopmental disorders and neurodegenerative diseases, findings supported by experimental animal models. This breadth of neurotoxicity across these central nervous system diseases and disorders likely reflects shared vulnerability of their inflammatory and oxidative stress-based mechanisms and a corresponding ability to produce brain metal dyshomeo-stasis. Future research to define the responsible contaminants of air pollution underlying this neurotoxicity is critical to understanding mechanisms of these diseases and disorders and protecting public health.
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Affiliation(s)
- Deborah A Cory-Slechta
- Department of Environmental Medicine, University of Rochester School of Medicine, Rochester, New York, USA;
| | - Alyssa Merrill
- Department of Environmental Medicine, University of Rochester School of Medicine, Rochester, New York, USA;
| | - Marissa Sobolewski
- Department of Environmental Medicine, University of Rochester School of Medicine, Rochester, New York, USA;
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12
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Cole-Hunter T, Zhang J, So R, Samoli E, Liu S, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, Remfry E, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hoffmann B, Hvidtfeldt UA, Jöckel KH, Mortensen LH, Ketzel M, Yacamán Méndez D, Leander K, Ljungman P, Faure E, Lee PC, Elbaz A, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, Vermeulen RCH, Schramm S, Stafoggia M, Katsouyanni K, Brunekreef B, Hoek G, Lim YH, Andersen ZJ. Long-term air pollution exposure and Parkinson's disease mortality in a large pooled European cohort: An ELAPSE study. ENVIRONMENT INTERNATIONAL 2023; 171:107667. [PMID: 36516478 DOI: 10.1016/j.envint.2022.107667] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The link between exposure to ambient air pollution and mortality from cardiorespiratory diseases is well established, while evidence on neurodegenerative disorders including Parkinson's Disease (PD) remains limited. OBJECTIVE We examined the association between long-term exposure to ambient air pollution and PD mortality in seven European cohorts. METHODS Within the project 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from seven cohorts among six European countries. Annual mean residential concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (O3), as well as 8 PM2.5 components (copper, iron, potassium, nickel, sulphur, silicon, vanadium, zinc), for 2010 were estimated using Europe-wide hybrid land use regression models. PD mortality was defined as underlying cause of death being either PD, secondary Parkinsonism, or dementia in PD. We applied Cox proportional hazard models to investigate the associations between air pollution and PD mortality, adjusting for potential confounders. RESULTS Of 271,720 cohort participants, 381 died from PD during 19.7 years of follow-up. In single-pollutant analyses, we observed positive associations between PD mortality and PM2.5 (hazard ratio per 5 µg/m3: 1.25; 95% confidence interval: 1.01-1.55), NO2 (1.13; 0.95-1.34 per 10 µg/m3), and BC (1.12; 0.94-1.34 per 0.5 × 10-5m-1), and a negative association with O3 (0.74; 0.58-0.94 per 10 µg/m3). Associations of PM2.5, NO2, and BC with PD mortality were linear without apparent lower thresholds. In two-pollutant models, associations with PM2.5 remained robust when adjusted for NO2 (1.24; 0.95-1.62) or BC (1.28; 0.96-1.71), whereas associations with NO2 or BC attenuated to null. O3 associations remained negative, but no longer statistically significant in models with PM2.5. We detected suggestive positive associations with the potassium component of PM2.5. CONCLUSION Long-term exposure to PM2.5, at levels well below current EU air pollution limit values, may contribute to PD mortality.
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Affiliation(s)
- Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth Remfry
- Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Diego Yacamán Méndez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France
| | - Pei-Chen Lee
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France; Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Alexis Elbaz
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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13
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Castellani B, Bartington S, Wistow J, Heckels N, Ellison A, Van Tongeren M, Arnold SR, Barbrook-Johnson P, Bicket M, Pope FD, Russ TC, Clarke CL, Pirani M, Schwannauer M, Vieno M, Turnbull R, Gilbert N, Reis S. Mitigating the impact of air pollution on dementia and brain health: Setting the policy agenda. ENVIRONMENTAL RESEARCH 2022; 215:114362. [PMID: 36130664 DOI: 10.1016/j.envres.2022.114362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Emerging research suggests exposure to high levels of air pollution at critical points in the life-course is detrimental to brain health, including cognitive decline and dementia. Social determinants play a significant role, including socio-economic deprivation, environmental factors and heightened health and social inequalities. Policies have been proposed more generally, but their benefits for brain health have yet to be fully explored. OBJECTIVE AND METHODS Over the course of two years, we worked as a consortium of 20+ academics in a participatory and consensus method to develop the first policy agenda for mitigating air pollution's impact on brain health and dementia, including an umbrella review and engaging 11 stakeholder organisations. RESULTS We identified three policy domains and 14 priority areas. Research and Funding included: (1) embracing a complexities of place approach that (2) highlights vulnerable populations; (3) details the impact of ambient PM2.5 on brain health, including current and historical high-resolution exposure models; (4) emphasises the importance of indoor air pollution; (5) catalogues the multiple pathways to disease for brain health and dementia, including those most at risk; (6) embraces a life course perspective; and (7) radically rethinks funding. Education and Awareness included: (8) making this unrecognised public health issue known; (9) developing educational products; (10) attaching air pollution and brain health to existing strategies and campaigns; and (11) providing publicly available monitoring, assessment and screening tools. Policy Evaluation included: (12) conducting complex systems evaluation; (13) engaging in co-production; and (14) evaluating air quality policies for their brain health benefits. CONCLUSION Given the pressing issues of brain health, dementia and air pollution, setting a policy agenda is crucial. Policy needs to be matched by scientific evidence and appropriate guidelines, including bespoke strategies to optimise impact and mitigate unintended consequences. The agenda provided here is the first step toward such a plan.
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Affiliation(s)
- Brian Castellani
- Durham Research Methods Centre, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom; Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford, GU2 7XH, United Kingdom; Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, DH1 3LE, United Kingdom; Department of Sociology, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom.
| | - Suzanne Bartington
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Jonathan Wistow
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, DH1 3LE, United Kingdom; Department of Sociology, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom
| | - Neil Heckels
- Research and Innovation Services, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom
| | - Amanda Ellison
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, DH1 3LE, United Kingdom; Department of Psychology, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom
| | - Martie Van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Steve R Arnold
- School of Earth & Environment, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Pete Barbrook-Johnson
- Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford, GU2 7XH, United Kingdom; Environmental Change Institute, School of Geography and the Environment, University of Oxford, United Kingdom
| | - Martha Bicket
- Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
| | - Charlotte L Clarke
- Department of Sociology, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom; School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom
| | - Monica Pirani
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, W2 1PG, London, United Kingdom
| | - Matthias Schwannauer
- School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom
| | - Massimo Vieno
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB, United Kingdom
| | - Rachel Turnbull
- Academic Health Sciences Network, North East and North Cumbria, Nuns' Moor Road, Newcastle Upon Tyne NE4 5PL, United Kingdom
| | - Nigel Gilbert
- Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Stefan Reis
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB, United Kingdom; University of Exeter Medical School, European Centre for Environment and Health, Knowledge Spa, Truro, TR1 3HD, United Kingdom; The University of Edinburgh, School of Chemistry, Level 3, Murchison House, 10 Max Born Crescent, The King's Buildings, West Mains Road, Edinburgh, EH9 3BF, United Kingdom
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14
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Khreis H, Bredell C, Wai Fung K, Hong L, Szybka M, Phillips V, Abbas A, Lim YH, Jovanovic Andersen Z, Woodcock J, Brayne C. Impact of long-term air pollution exposure on incidence of neurodegenerative diseases: A protocol for a systematic review and exposure-response meta-analysis. ENVIRONMENT INTERNATIONAL 2022; 170:107596. [PMID: 36308811 DOI: 10.1016/j.envint.2022.107596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Ambient air pollution is a pervasive and ubiquitous hazard, which has been linked to premature morbidity and a growing number of morbidity endpoints. Air pollution may be linked to neurodegeneration, and via this or other pathways, to neurodegenerative diseases. Emerging evidence suggests that air pollution may contribute to neurodegenerative diseases such as dementia, Parkinson's Disease (PD), Multiple Sclerosis (MS) and Motor Neuron Diseases (MND), although this evidence remains inconsistent and very limited for MS and MND. In addition, this evidence base is rapidly emerging and would benefit from a wide and critical synthesis, including a better understanding of heterogeneity. OBJECTIVES In this paper, we present a protocol for a systematic review and meta-analysis and specify our methods a priori. The main aim of the planned systematic review is to answer the question of whether long-term exposure (>1 year) to ambient (outdoor) air pollution (exposure, compared to lower exposure) increases the risk of adult (population) incidence of neurodegenerative diseases (outcomes) in epidemiological observational studies (study design). Another aim is to meta-analyze the associations between long-term exposure to ambient air pollutants and the risk of the selected outcomes and assess the shape of exposure-response functions. To set the stage for the proposed work, we also overview the existing epidemiological evidence in this protocol, but do not critically evaluate it, as these results will be fully presented in the planned systematic review. SEARCH AND STUDY ELIGIBILITY We will search the electronic databases Medline (via Ovid), Embase (via Ovid), Cochrane Library, Cinahl (via Ebscohost), Global Health (via Ebscohost), PsycINFO (via Ebscohost), Scopus, Web of Science (Core Collection), from inception to October 2022. Eligible studies must contain primary research investigating the link between 1-year + exposure to any outdoor air pollutant, from any source, and dementia, PD, MS, and MND, or dementia subtypes: Alzheimer's Disease, vascular dementia, and mixed dementia. The search strategy and eligibility criteria are pre-determined and described in full in this protocol. STUDY APPRAISAL AND SYNTHESIS METHODS Articles will be stored and screened using Rayyan QCRI. Title and abstract screening, full text review, data extraction, risk of bias assessment and data preparation for statistical analysis will be conducted independently by two reviewers using pre-defined forms and criteria, described in this protocol. All these steps will also be piloted and the forms and/or methods adapted if issues arise. Meta-analysis and assessment of the shape of the exposure-response functions will be conducted if four independent exposure-outcomes pairs are available, and the remainder of results will be synthesized in the forms of tables and via a narrative summary. Certainty in the body of evidence will be assessed using the OHAT approach. This protocol describes the planned analysis and synthesis a priori and serves to increase transparency and impact of this systematic review and meta-analysis.
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Affiliation(s)
- Haneen Khreis
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom.
| | - Christiaan Bredell
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Kwan Wai Fung
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Lucy Hong
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Magdalena Szybka
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Veronica Phillips
- University of Cambridge Medical Library, University of Cambridge School of Clinical Medicine, Hills Rd, Cambridge CB2 0SP, United Kingdom
| | - Ali Abbas
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Youn-Hee Lim
- Section of Environmental and Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 15 Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Zorana Jovanovic Andersen
- Section of Environmental and Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 15 Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge CB2 0SR, United Kingdom
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15
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Zhang X, Xia Q, Lai Y, Wu B, Tian W, Miao W, Feng X, Xin L, Miao J, Wang N, Wu Q, Jiao M, Shan L, Du J, Li Y, Shi B. Spatial effects of air pollution on the economic burden of disease: implications of health and environment crisis in a post-COVID-19 world. Int J Equity Health 2022; 21:161. [PMCID: PMC9664438 DOI: 10.1186/s12939-022-01774-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Air pollution has been identified as related to the diseases of susceptible population, but the spatial heterogeneity of its economic burden and its determinants are rarely investigated. The issue is of great policy significance, especially after the epidemic of COVID-19, when human are facing the joint crisis of health and environment, and some areas is prone to falling into poverty.
Methods
The geographical detector was adopted to study the spatial distribution characteristics of the incidence of catastrophic health expenditure (ICHE) for older adults in 100 rural areas in China at the prefecture-city level. The health factors, sociological factors, policy factors and environmental factors and their interactions are identified.
Results
First, most health service factors had strong explanatory power for ICHE whether it interacts with air pollution. Second, 50 single-factor high-risk areas of ICHE were found in the study, but at the same time, there were 21 areas dominated by multiple factors.
Conclusion
The different contributions and synergy among the factors constitute the complex mechanism of factors and catastrophic health expenditure. Moreover, during this process, air pollution aggravates the contribution of health service factors toward ICHE. In addition, the leading factors of ICHE are different among regions. At the end, this paper also puts forward some policy suggestions from the perspective of health and environment crisis in the post-COVID-19 world: environmental protection policies should be combined with the prevention of infectious diseases; advanced health investment is the most cost-effective policy for the inverse health sequences of air pollution and infectious diseases such as coronavirus disease 2019 (COVID-19); integrating environmental protection policy into healthy development policy, different regions take targeted measures to cope with the intertwined crisis.
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16
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Markozannes G, Pantavou K, Rizos EC, Sindosi OΑ, Tagkas C, Seyfried M, Saldanha IJ, Hatzianastassiou N, Nikolopoulos GK, Ntzani E. Outdoor air quality and human health: An overview of reviews of observational studies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 306:119309. [PMID: 35469927 DOI: 10.1016/j.envpol.2022.119309] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/15/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
The epidemiological evidence supporting putative associations between air pollution and health-related outcomes continues to grow at an accelerated pace with a considerable heterogeneity and with varying consistency based on the outcomes assessed, the examined surveillance system, and the geographic region. We aimed to evaluate the strength of this evidence base, to identify robust associations as well as to evaluate effect variation. An overview of reviews (umbrella review) methodology was implemented. PubMed and Scopus were systematically screened (inception-3/2020) for systematic reviews and meta-analyses examining the association between air pollutants, including CO, NOX, NO2, O3, PM10, PM2.5, and SO2 and human health outcomes. The quality of systematic reviews was evaluated using AMSTAR. The strength of evidence was categorized as: strong, highly suggestive, suggestive, or weak. The criteria included statistical significance of the random-effects meta-analytical estimate and of the effect estimate of the largest study in a meta-analysis, heterogeneity between studies, 95% prediction intervals, and bias related to small study effects. Seventy-five systematic reviews of low to moderate methodological quality reported 548 meta-analyses on the associations between outdoor air quality and human health. Of these, 57% (N = 313) were not statistically significant. Strong evidence supported 13 associations (2%) between elevated PM2.5, PM10, NO2, and SO2 concentrations and increased risk of cardiorespiratory or pregnancy/birth-related outcomes. Twenty-three (4%) highly suggestive associations were identified on elevated PM2.5, PM10, O3, NO2, and SO2 concentrations and increased risk of cardiorespiratory, kidney, autoimmune, neurodegenerative, cancer or pregnancy/birth-related outcomes. Sixty-seven (12%), and 132 (24%) meta-analyses were graded as suggestive, and weak, respectively. Despite the abundance of research on the association between outdoor air quality and human health, the meta-analyses of epidemiological studies in the field provide evidence to support robust associations only for cardiorespiratory or pregnancy/birth-related outcomes.
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Affiliation(s)
- Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | - Evangelos C Rizos
- Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece; School of Medicine, European University Cyprus, Nicosia, Cyprus; Hellenic Open University, Patra, Greece
| | - Ourania Α Sindosi
- Laboratory of Meteorology, Department of Physics, University of Ioannina, Ioannina, Greece
| | - Christos Tagkas
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Maike Seyfried
- Faculty of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, and Department of Epidemiology, School of Public Health, Brown University, RI, USA
| | - Nikos Hatzianastassiou
- Laboratory of Meteorology, Department of Physics, University of Ioannina, Ioannina, Greece
| | | | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, and Department of Epidemiology, School of Public Health, Brown University, RI, USA.
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17
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Sun H, Shin YM, Xia M, Ke S, Wan M, Yuan L, Guo Y, Archibald AT. Spatial Resolved Surface Ozone with Urban and Rural Differentiation during 1990-2019: A Space-Time Bayesian Neural Network Downscaler. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:7337-7349. [PMID: 34751030 DOI: 10.1021/acs.est.1c04797] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Long-term exposure to ambient ozone (O3) can lead to a series of chronic diseases and associated premature deaths, and thus population-level environmental health studies hanker after the high-resolution surface O3 concentration database. In response to this demand, we innovatively construct a space-time Bayesian neural network parametric regressor to fuse TOAR historical observations, CMIP6 multimodel simulation ensemble, population distributions, land cover properties, and emission inventories altogether and downscale to 10 km × 10 km spatial resolution with high methodological reliability (R2 = 0.89-0.97, RMSE = 1.97-3.42 ppbV), fair prediction accuracy (R2 = 0.69-0.77, RMSE = 5.63-7.97 ppbV), and commendable spatiotemporal extrapolation capabilities (R2 = 0.62-0.76, RMSE = 5.38-11.7 ppbV). Based on our predictions in 8-h maximum daily average metric, the rural-site surface O3 are 15.1±7.4 ppbV higher than urban globally averaged across 30 historical years during 1990-2019, with developing countries being of the most evident differences. The globe-wide urban surface O3 are climbing by 1.9±2.3 ppbV per decade, except for the decreasing trends in eastern United States. On the other hand, the global rural surface O3 tend to be relatively stable, except for the rising tendencies in China and India. Using CMIP6 model simulations directly without urban-rural differentiation will lead to underestimations of population O3 exposure by 2.0±0.8 ppbV averaged over each historical year. Our original Bayesian neural network framework contributes to the deep-learning-driven environmental studies methodologically by providing a brand-new feasible way to realize data fusion and downscaling, which maintains high interpretability by conforming to the principles of spatial statistics without compromising the prediction accuracy. Moreover, the 30-year highly spatial resolved monthly surface O3 database with multiple metrics fills in the literature gap for long-term surface O3 exposure tracing.
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Affiliation(s)
- Haitong Sun
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K
- Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, U.K
| | - Youngsub Matthew Shin
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K
| | - Mingtao Xia
- Department of Mathematics, University of California, Los Angeles, California 90095, United States
| | - Shengxian Ke
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K
| | - Michelle Wan
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K
| | - Le Yuan
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne Victoria 3004, Australia
| | - Alexander T Archibald
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, U.K
- National Centre for Atmospheric Science, Cambridge CB2 1EW, U.K
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18
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Sun HZ, Yu P, Lan C, Wan MW, Hickman S, Murulitharan J, Shen H, Yuan L, Guo Y, Archibald AT. Cohort-based long-term ozone exposure-associated mortality risks with adjusted metrics: A systematic review and meta-analysis. Innovation (N Y) 2022; 3:100246. [PMID: 35519514 PMCID: PMC9065904 DOI: 10.1016/j.xinn.2022.100246] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/16/2022] [Indexed: 11/30/2022] Open
Abstract
Long-term ozone (O3) exposure may lead to non-communicable diseases and increase mortality risk. However, cohort-based studies are relatively rare, and inconsistent exposure metrics impair the credibility of epidemiological evidence synthetization. To provide more accurate meta-estimations, this study updates existing systematic reviews by including recent studies and summarizing the quantitative associations between O3 exposure and cause-specific mortality risks, based on unified exposure metrics. Cross-metric conversion factors were estimated linearly by decadal observations during 1990-2019. The Hunter-Schmidt random-effects estimator was applied to pool the relative risks. A total of 25 studies involving 226,453,067 participants (14 unique cohorts covering 99,855,611 participants) were included in the systematic review. After linearly unifying the inconsistent O3 exposure metrics , the pooled relative risks associated with every 10 nmol mol-1 (ppbV) incremental O3 exposure, by mean of the warm-season daily maximum 8-h average metric, were as follows: 1.014 with 95% confidence interval (CI) ranging 1.009-1.019 for all-cause mortality; 1.025 (95% CI: 1.010-1.040) for respiratory mortality; 1.056 (95% CI: 1.029-1.084) for COPD mortality; 1.019 (95% CI: 1.004-1.035) for cardiovascular mortality; and 1.074 (95% CI: 1.054-1.093) for congestive heart failure mortality. Insignificant mortality risk associations were found for ischemic heart disease, cerebrovascular diseases, and lung cancer. Adjustment for exposure metrics laid a solid foundation for multi-study meta-analysis, and widening coverage of surface O3 observations is expected to strengthen the cross-metric conversion in the future. Ever-growing numbers of epidemiological studies supported the evidence for considerable cardiopulmonary hazards and all-cause mortality risks from long-term O3 exposure. However, evidence of long-term O3 exposure-associated health effects was still scarce, so more relevant studies are needed to cover more populations with regional diversity.
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Affiliation(s)
- Haitong Zhe Sun
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
- Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK
| | - Pei Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Changxin Lan
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Michelle W.L. Wan
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
| | - Sebastian Hickman
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
| | - Jayaprakash Murulitharan
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
| | - Huizhong Shen
- School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Le Yuan
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Alexander T. Archibald
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
- National Centre for Atmospheric Science, Cambridge CB2 1EW, UK
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19
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Zang ST, Wu QJ, Li XY, Gao C, Liu YS, Jiang YT, Zhang JY, Sun H, Chang Q, Zhao YH. Long-term PM 2.5 exposure and various health outcomes: An umbrella review of systematic reviews and meta-analyses of observational studies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 812:152381. [PMID: 34914980 DOI: 10.1016/j.scitotenv.2021.152381] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Adverse effects from exposure to particulate matter <2.5 μm in diameter (PM2.5) on health-related outcomes have been found in a range of experimental and epidemiological studies. This study aimed to assess the significance, validity, and reliability of the relationship between long-term PM2.5 exposure and various health outcomes. The Embase, PubMed, Web of Science, CNKI, WANFANG, VIP, and SinoMed databases and reference lists of the retrieved review articles were searched to obtain meta-analysis and systematic reviews focusing on PM2.5-related outcomes as of August 31, 2021. Random-/fixed-effects models were applied to estimate summary effect size and 95% confidence intervals (CIs). The quality of included meta-analyses was evaluated based on the AMSTAR 2 tool. Small-study effect and excess significance bias studies were conducted to further assess the associations. Registered PROSPERO number: CRD42020200606. This included 24 articles involving 71 associations between PM2.5 exposure and the health outcomes. The evidence for the positive association of 10 μg/m3 increments of long-term exposure to PM2.5 and stroke incidence in Europe was convincing (effect size = 1.07, 95% CI: 1.05-1.10). There was evidence that was highly suggestive of a positive association between 10 μg/m3 increments of long-term exposure to PM2.5 and the following health-related outcomes: mortality of lung cancer (effect size = 1.11, 95% CI: 1.08-1.13) and Alzheimer's disease (effect size = 4.79, 95% CI: 2.79-8.21). There was highly suggestive evidence that chronic obstructive pulmonary disease risk is positively associated with higher long-term PM2.5 exposure versus lower long-term PM2.5 exposure (effect size = 2.32, 95% CI: 1.88-2.86). In conclusion, the positive association of long-term exposure to PM2.5 and stroke incidence in Europe was convincing. Given the validity of numerous associations of long-term exposure to PM2.5 and health-related outcomes is subject to biases, more robust evidence is urgently needed.
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Affiliation(s)
- Si-Tian Zang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Xin-Yu Li
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Chang Gao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ya-Shu Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yu-Ting Jiang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jia-Yu Zhang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hui Sun
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qing Chang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Yu-Hong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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20
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Jung YJ, Choi H, Oh E. Effects of particulate matter and nicotine for the MPP+-induced SH-SY5Y cells: Implication for Parkinson's disease. Neurosci Lett 2021; 765:136265. [PMID: 34563623 DOI: 10.1016/j.neulet.2021.136265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
Exposure to particulate matter (PM) has been considered a potential risk factor for various neurodegenerative diseases, whereas nicotine has protective effects on Parkinson's disease (PD). However, it is still unclear whether or how PM alone and in combination with nicotine affects the pathogenesis of PD. We investigated the potential neurotoxicity of PM and the protective properties of nicotine in an in vitro PD model. A 1-methyl-4-phenylpyridimium (MPP+)-induced neurotoxicity model was established with SH-SY5Y cells. Cell viability and apoptosis were measured using MTT and TUNEL assays, respectively. Intracellular reactive oxygen species (ROS) levels were analyzed using the cell-permeant fluorescent probe DCFH-DA. We investigated mitochondrial apoptotic markers such as Bax, Bcl2, cytochrome C, and cleaved caspase-3 and analyzed their levels by Western blotting. SH-SY5Y cells exposed to PM and MPP+ exhibited significantly increased intracellular ROS and decreased cell viability with those exposed to PM alone. PM strikingly exacerbated MPP+-induced mitochondrial dysfunction, including an increase in the Bax/Bcl2 ratio and the release of cytochrome C and cleaved caspase-3. On the other hand, pretreatment of SH-SY5Y cells with nicotine reduced the MPP+-induced loss of cell viability and levels of intracellular ROS and mitochondrial apoptotic signaling proteins. However, pretreatment with nicotine did not prevent PM-induced toxicity in MPP+-treated SHSY5Y cells. PM and MPP+ synergistically increased ROS levels and mitochondrial apoptosis, which led to SH-SY5Y cell death. The protective effect of nicotine cannot rescue PM-induced synergistic neurotoxicity in the MPP+-induced PD model. Our findings verified the opposing roles of PM and nicotine in a model of PD pathogenesis. A large number of in vivo and in vitro studies would verify the roles of PM and nicotine in the future.
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Affiliation(s)
- Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunsu Choi
- Clinical Research Institute, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
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21
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Smoking and Neuropsychiatric Disease-Associations and Underlying Mechanisms. Int J Mol Sci 2021; 22:ijms22147272. [PMID: 34298890 PMCID: PMC8304236 DOI: 10.3390/ijms22147272] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 01/02/2023] Open
Abstract
Despite extensive efforts to combat cigarette smoking/tobacco use, it still remains a leading cause of global morbidity and mortality, killing more than eight million people each year. While tobacco smoking is a major risk factor for non-communicable diseases related to the four main groups—cardiovascular disease, cancer, chronic lung disease, and diabetes—its impact on neuropsychiatric risk is rather elusive. The aim of this review article is to emphasize the importance of smoking as a potential risk factor for neuropsychiatric disease and to identify central pathophysiological mechanisms that may contribute to this relationship. There is strong evidence from epidemiological and experimental studies indicating that smoking may increase the risk of various neuropsychiatric diseases, such as dementia/cognitive decline, schizophrenia/psychosis, depression, anxiety disorder, and suicidal behavior induced by structural and functional alterations of the central nervous system, mainly centered on inflammatory and oxidative stress pathways. From a public health perspective, preventive measures and policies designed to counteract the global epidemic of smoking should necessarily include warnings and actions that address the risk of neuropsychiatric disease.
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22
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Novel Pharmacotherapies in Parkinson's Disease. Neurotox Res 2021; 39:1381-1390. [PMID: 34003454 PMCID: PMC8129607 DOI: 10.1007/s12640-021-00375-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/30/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
Parkinson’s disease (PD), an age-related progressive neurodegenerative condition, is associated with loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc), which results in motor deficits characterized by the following: akinesia, rigidity, resting tremor, and postural instability, as well as nonmotor symptoms such as emotional changes, particularly depression, cognitive impairment, gastrointestinal, and autonomic dysfunction. The most common treatment for PD is focused on dopamine (DA) replacement (e.g., levodopa = L-Dopa), which unfortunately losses its efficacy over months or years and can induce severe dyskinesia. Hence, more efficacious interventions without such adverse effects are urgently needed. In this review, following a general description of PD, potential novel therapeutic interventions for this devastating disease are examined. Specifically, the focus is on nicotine and nicotinic cholinergic system, as well as butyrate, a short chain fatty acid (SCFA), and fatty acid receptors.
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Kawada T. Letter to the Editor regarding Wang Y, Liu Y, Yan H. 2020. Effect of long-term particulate matter exposure on Parkinson's risk. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:1759-1760. [PMID: 33411167 DOI: 10.1007/s10653-020-00789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan.
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24
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Cagac A. Farming, well water consumption, rural living, and pesticide exposure in early life as the risk factors for Parkinson disease in Igdir province. ACTA ACUST UNITED AC 2021; 25:129-133. [PMID: 32351250 PMCID: PMC8015530 DOI: 10.17712/nsj.2020.2.20190104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate potential risk factors for Parkinson`s disease (PD) in elderly individuals rural living in Turkey. METHODS In total, 72 consecutive elderly Parkinson disease patients referred to the Neurology Clinic, Igdir State Hospital, Igdir, Turkey were included in the study. A structured questionnaire comprising questions on history of pastoral living, pit water consumption, and exposure to ionizing radiation and pesticides was administered to the patients. The patients were divided into 2 groups on the basis of water consumption: well water consumption group and city network consumption group. RESULTS Of 72 patients with PD, 49 (68.1%) exposed to well water while 23 (31.9%) did not exposed to well water. The average duration of well water consumption was 20 (standard deviation 6) years (p less than 0.01) in group 1. Nitrate, sulfate and heavy metal levels were significantly higher in well water than in city network water (p less than 0.05). CONCLUSION Consumption of well water containing heavy metals and nitrates in early life may contribute to the etiology of Parkinson disease in elderly individuals in Igdir province of Turkey.
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Affiliation(s)
- Aydın Cagac
- Department of Neurology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey. E-mail:
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25
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Fleury V, Himsl R, Joost S, Nicastro N, Bereau M, Guessous I, Burkhard PR. Geospatial analysis of individual-based Parkinson's disease data supports a link with air pollution: A case-control study. Parkinsonism Relat Disord 2021; 83:41-48. [PMID: 33476876 DOI: 10.1016/j.parkreldis.2020.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The etiology of Parkinson's disease (PD) remains unknown. To approach the issue of PD's risk factors from a new perspective, we hypothesized that coupling the geographic distribution of PD with spatial statistics may provide new insights into environmental epidemiology research. The aim of this case-control study was to examine the spatial dependence of PD prevalence in the Canton of Geneva, Switzerland (population = 474,211). METHODS PD cases were identified through Geneva University Hospitals, private neurologists and nursing homes medical records (n = 1115). Controls derived from a population-based study (n = 12,614) and a comprehensive population census dataset (n = 237,771). All individuals were geographically localized based on their place of residence. Spatial Getis-Ord Gi* statistics were used to identify clusters of high versus low disease prevalence. Confounder-adjustment was performed for age, sex, nationality and income. Tukey's honestly significant difference was used to determine whether nitrogen dioxide and particulate matters PM10 concentrations were different within PD hotspots, coldspots or neutral areas. RESULTS Confounder-adjustment greatly reduced greatly the spatial association. Characteristics of the geographic space influenced PD prevalence in 6% of patients. PD hotspots were concentrated in the urban centre. There was a significant difference in mean annual nitrogen dioxide and PM10 levels (+3.6 μg/m3 [p < 0.001] and +0.63 μg/m3 [p < 0.001] respectively) between PD hotspots and coldspots. CONCLUSION PD prevalence exhibited a spatial dependence for a small but significant proportion of patients. A positive association was detected between PD clusters and air pollution. Our data emphasize the multifactorial nature of PD and support a link between PD and air pollution.
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Affiliation(s)
- Vanessa Fleury
- Division of Neurology, Geneva University Hospitals, 1211, Geneva 14, Switzerland; Faculty of Medicine, University of Geneva, CMU, 1211, Geneva 4, Switzerland.
| | - Rebecca Himsl
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, 1211, Geneva 14, Switzerland; Geographic Information Research and Analysis in Population Health (GIRAPH) Group, Geneva University Hospitals, Geneva and Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland; Laboratory of Geographical Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Stéphane Joost
- Geographic Information Research and Analysis in Population Health (GIRAPH) Group, Geneva University Hospitals, Geneva and Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland; Laboratory of Geographical Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland; La Source, School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Nicolas Nicastro
- Division of Neurology, Geneva University Hospitals, 1211, Geneva 14, Switzerland; Department of Psychiatry, University of Cambridge, UK
| | - Matthieu Bereau
- Division of Neurology, Geneva University Hospitals, 1211, Geneva 14, Switzerland
| | - Idris Guessous
- Faculty of Medicine, University of Geneva, CMU, 1211, Geneva 4, Switzerland; Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, 1211, Geneva 14, Switzerland; Geographic Information Research and Analysis in Population Health (GIRAPH) Group, Geneva University Hospitals, Geneva and Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Pierre R Burkhard
- Division of Neurology, Geneva University Hospitals, 1211, Geneva 14, Switzerland; Faculty of Medicine, University of Geneva, CMU, 1211, Geneva 4, Switzerland
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Calderón-Garcidueñas L, González-Maciel A, Reynoso-Robles R, Hammond J, Kulesza R, Lachmann I, Torres-Jardón R, Mukherjee PS, Maher BA. Quadruple abnormal protein aggregates in brainstem pathology and exogenous metal-rich magnetic nanoparticles (and engineered Ti-rich nanorods). The substantia nigrae is a very early target in young urbanites and the gastrointestinal tract a key brainstem portal. ENVIRONMENTAL RESEARCH 2020; 191:110139. [PMID: 32888951 DOI: 10.1016/j.envres.2020.110139] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
Fine particulate air pollution (PM2.5) exposures are linked with Alzheimer's and Parkinson's diseases (AD,PD). AD and PD neuropathological hallmarks are documented in children and young adults exposed lifelong to Metropolitan Mexico City air pollution; together with high frontal metal concentrations (especially iron)-rich nanoparticles (NP), matching air pollution combustion- and friction-derived particles. Here, we identify aberrant hyperphosphorylated tau, ɑ synuclein and TDP-43 in the brainstem of 186 Mexico City 27.29 ± 11.8y old residents. Critically, substantia nigrae (SN) pathology seen in mitochondria, endoplasmic reticulum and neuromelanin (NM) is co-associated with the abundant presence of exogenous, Fe-, Al- and Ti-rich NPs.The SN exhibits early and progressive neurovascular unit damage and mitochondria and NM are associated with metal-rich NPs including exogenous engineered Ti-rich nanorods, also identified in neuroenteric neurons. Such reactive, cytotoxic and magnetic NPs may act as catalysts for reactive oxygen species formation, altered cell signaling, and protein misfolding, aggregation and fibril formation. Hence, pervasive, airborne and environmental, metal-rich and magnetic nanoparticles may be a common denominator for quadruple misfolded protein neurodegenerative pathologies affecting urbanites from earliest childhood. The substantia nigrae is a very early target and the gastrointestinal tract (and the neuroenteric system) key brainstem portals. The ultimate neural damage and neuropathology (Alzheimer's, Parkinson's and TDP-43 pathology included) could depend on NP characteristics and the differential access and targets achieved via their portals of entry. Thus where you live, what air pollutants you are exposed to, what you are inhaling and swallowing from the air you breathe,what you eat, how you travel, and your occupational longlife history are key. Control of NP sources becomes critical.
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Affiliation(s)
| | | | | | - Jessica Hammond
- Centre for Environmental Magnetism and Paleomagnetism, Lancaster Environment Centre, University of Lancaster, Lancaster, LA1 4YQ, UK
| | - Randy Kulesza
- Auditory Research Center, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | - Ricardo Torres-Jardón
- Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, UNAM, Mexico City, 04510, Mexico
| | | | - Barbara A Maher
- Centre for Environmental Magnetism and Paleomagnetism, Lancaster Environment Centre, University of Lancaster, Lancaster, LA1 4YQ, UK
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27
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Daiber A, Kuntic M, Hahad O, Delogu LG, Rohrbach S, Di Lisa F, Schulz R, Münzel T. Effects of air pollution particles (ultrafine and fine particulate matter) on mitochondrial function and oxidative stress - Implications for cardiovascular and neurodegenerative diseases. Arch Biochem Biophys 2020; 696:108662. [PMID: 33159890 DOI: 10.1016/j.abb.2020.108662] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
Environmental pollution is a major cause of global mortality and burden of disease. All chemical pollution forms together may be responsible for up to 12 million annual excess deaths as estimated by the Lancet Commission on pollution and health as well as the World Health Organization. Ambient air pollution by particulate matter (PM) and ozone was found to be associated with an all-cause mortality rate of up to 9 million in the year 2015, with the majority being of cerebro- and cardiovascular nature (e.g. stroke and ischemic heart disease). Recent evidence suggests that exposure to airborne particles and gases contributes to and accelerates neurodegenerative diseases. Especially, airborne toxic particles contribute to these adverse health effects. Whereas it is well established that air pollution in the form of PM may lead to dysregulation of neurohormonal stress pathways and may trigger inflammation as well as oxidative stress, leading to secondary damage of cardiovascular structures, the mechanistic impact of PM-induced mitochondrial damage and dysfunction is not well established. With the present review we will discuss similarities between mitochondrial damage and dysfunction observed in the development and progression of cardiovascular disease and neurodegeneration as well as those adverse mitochondrial pathomechanisms induced by airborne PM.
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Affiliation(s)
- Andreas Daiber
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
| | - Marin Kuntic
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Lucia G Delogu
- Department of Biomedical Sciences, University of Padova, 35131, Padova, Italy
| | - Susanne Rohrbach
- Institute of Physiology, Justus-Liebig University, Giessen, Germany
| | - Fabio Di Lisa
- Department of Biomedical Sciences, University of Padova, 35131, Padova, Italy
| | - Rainer Schulz
- Institute of Physiology, Justus-Liebig University, Giessen, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
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Nejm M, Guimarães-Marques M, Scorza CA, Victorino DB, Finsterer J, Fiorini AC, Scorza FA. Air pollution and sudden death risk in patients with Parkinson’s disease: Assessing the evidence to date. PUBLIC HEALTH IN PRACTICE 2020; 1:100008. [PMID: 36101679 PMCID: PMC9461562 DOI: 10.1016/j.puhip.2020.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 11/05/2022] Open
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Air Pollution-Related Brain Metal Dyshomeostasis as a Potential Risk Factor for Neurodevelopmental Disorders and Neurodegenerative Diseases. ATMOSPHERE 2020. [DOI: 10.3390/atmos11101098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Increasing evidence links air pollution (AP) exposure to effects on the central nervous system structure and function. Particulate matter AP, especially the ultrafine (nanoparticle) components, can carry numerous metal and trace element contaminants that can reach the brain in utero and after birth. Excess brain exposure to either essential or non-essential elements can result in brain dyshomeostasis, which has been implicated in both neurodevelopmental disorders (NDDs; autism spectrum disorder, schizophrenia, and attention deficit hyperactivity disorder) and neurodegenerative diseases (NDGDs; Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis). This review summarizes the current understanding of the extent to which the inhalational or intranasal instillation of metals reproduces in vivo the shared features of NDDs and NDGDs, including enlarged lateral ventricles, alterations in myelination, glutamatergic dysfunction, neuronal cell death, inflammation, microglial activation, oxidative stress, mitochondrial dysfunction, altered social behaviors, cognitive dysfunction, and impulsivity. Although evidence is limited to date, neuronal cell death, oxidative stress, and mitochondrial dysfunction are reproduced by numerous metals. Understanding the specific contribution of metals/trace elements to this neurotoxicity can guide the development of more realistic animal exposure models of human AP exposure and consequently lead to a more meaningful approach to mechanistic studies, potential intervention strategies, and regulatory requirements.
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Hahad O, Lelieveld J, Birklein F, Lieb K, Daiber A, Münzel T. Ambient Air Pollution Increases the Risk of Cerebrovascular and Neuropsychiatric Disorders through Induction of Inflammation and Oxidative Stress. Int J Mol Sci 2020; 21:ijms21124306. [PMID: 32560306 PMCID: PMC7352229 DOI: 10.3390/ijms21124306] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023] Open
Abstract
Exposure to ambient air pollution is a well-established determinant of health and disease. The Lancet Commission on pollution and health concludes that air pollution is the leading environmental cause of global disease and premature death. Indeed, there is a growing body of evidence that links air pollution not only to adverse cardiorespiratory effects but also to increased risk of cerebrovascular and neuropsychiatric disorders. Despite being a relatively new area of investigation, overall, there is mounting recent evidence showing that exposure to multiple air pollutants, in particular to fine particles, may affect the central nervous system (CNS) and brain health, thereby contributing to increased risk of stroke, dementia, Parkinson's disease, cognitive dysfunction, neurodevelopmental disorders, depression and other related conditions. The underlying molecular mechanisms of susceptibility and disease remain largely elusive. However, emerging evidence suggests inflammation and oxidative stress to be crucial factors in the pathogenesis of air pollution-induced disorders, driven by the enhanced production of proinflammatory mediators and reactive oxygen species in response to exposure to various air pollutants. From a public health perspective, mitigation measures are urgent to reduce the burden of disease and premature mortality from ambient air pollution.
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Affiliation(s)
- Omar Hahad
- Center for Cardiology–Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Jos Lelieveld
- Atmospheric Chemistry Department, Max Planck Institute for Chemistry, 55128 Mainz, Germany;
- Climate and Atmosphere Research Center, The Cyprus Institute, Nicosia 1645, Cyprus
| | - Frank Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- Leibniz Institute for Resilience Research, 55122 Mainz, Germany
| | - Andreas Daiber
- Center for Cardiology–Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
- Correspondence: (A.D.); (T.M.); Tel.: +49-(0)6131-176280 (A.D.); +49-(0)6131-177251 (T.M.)
| | - Thomas Münzel
- Center for Cardiology–Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
- Correspondence: (A.D.); (T.M.); Tel.: +49-(0)6131-176280 (A.D.); +49-(0)6131-177251 (T.M.)
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