Carbon monoxide exposure in the urban environment: An insidious foe for the heart?

Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation

Acute ischemic strokes (AIS) are closely linked with air pollution, and there is some evidence that traditional cardiovascular risk factors may alter the relationship between air pollution and strokes. We investigated the effect of atrial fibrillation (AF) on the association of AIS with air pollutants. This was a nationwide, population-based, case-only study that included all AIS treated in public healthcare institutions in Singapore from 2009 to 2018. Using multivariable logistic regression, adjusted for time-varying meteorological effects, we examined how AF modified the association between AIS and air pollutant exposure. A total of 51,673 episodes of AIS were included, with 10,722 (20.7%) having AF. The odds of AIS in patients with AF is higher than those without AF for every 1 µg/m³ increase in O₃ concentration (adjusted OR [aOR]: 1.005, 95% CI 1.003–1.007) and every 1 mg/m³ increase in CO concentration (aOR: 1.193, 95% CI 1.050–1.356). However, the odds of AIS in patients with AF is lower than those without AF for every 1 µg/m³ increase in SO₂ concentration (aOR: 0.993, 95% CI 0.990–0.997). Higher odds of AIS among AF patients as O₃⁻ and CO concentrations increase are also observed in patients aged ≥65 years and non-smokers. The results suggest that AF plays an important role in exacerbating the risk of AIS as the levels of O₃ and CO increase.

Haze Air Pollution Health Impacts of Breath-Borne VOCs

Here, we investigated the use of breath-borne volatile organic compounds (VOCs) for rapid monitoring of air pollution health effects on humans. Forty-seven healthy college students were recruited, and their exhaled breath samples (n = 235) were collected and analyzed for VOCs before, on, and after two separate haze pollution episodes using gas chromatography-ion mobility spectrometry (GC-IMS). Using a paired t-test and machine learning model (Gradient Boosting Machine, GBM), six exhaled VOC species including propanol and isoprene were revealed to differ significantly among pre-, on-, and post-exposure in both haze episodes, while none was found between clean control days. The GBM model was shown capable of differentiating between pre- and on-exposure to haze pollution with a precision of 90-100% for both haze episodes. However, poor performance was detected for the same model between two different clean days. In addition to gender and particular haze occurrence influences, correlation analysis revealed that NH₄⁺, NO₃^-, acetic acid, mesylate, CO, NO₂, PM_2.5, and O₃ played important roles in the changes in breath-borne VOC fingerprints following haze air pollution exposure. This work has demonstrated direct evidence of human health impacts of haze pollution while identifying potential breath-borne VOC biomarkers such as propanol and isoprene for haze air pollution exposure.

The Association of Carcinoembryonic Antigen (CEA) and Air Pollutants—A Population-Based Study

Air pollutants are substances in the air that have harmful effects on humans and the ecological environment. Although slight elevations in carcinoembryonic antigen (CEA) are commonly observed in apparently healthy persons, potential associations between CEA levels and chronic low-grade inflammation induced by air pollution have yet to be documented. We conducted a community-based cross-sectional study to estimate the association between short-term exposure to ambient air pollution and the CEA. A total of 9728 participants from health examinations were enrolled for the analysis and linked with their residential air pollutant data including ozone (O3), nitrogen dioxide (NO2), carbon monoxide (CO), sulphur dioxide (SO2), and particulate matter (PM10). The results showed that every increase of 1 ppm O3 significantly increased the mean differences of the CEA blood concentration by 0.005 ng/mL. Each increase of 1 ppm CO significantly reduced the mean differences of the CEA blood concentration by 0.455 ng/mL. Although smoking and alcohol drinking also increased the CEA levels, with adjustment of these confounders we identified a significant association between serum CEA in the general population and levels of the air pollutants O3 and CO. In conclusion, the serum CEA concentrations and short-term air pollutants O3 and CO exposure were found to have a significant relationship; however, its mechanism is still unclear. Moreover, long-term air pollution exposure and changes in CEA concentration still need to be further evaluated.

Influence of Nicotine from Diverse Delivery Tools on the Autonomic Nervous and Hormonal Systems

Background: Through measurements of the heart rate variability (HRV) accompanied by the pertinent biomarker assays, the effects of nicotine and byproducts derived from alternative nicotine delivery systems (ANDS) on the autonomic nervous system (ANS) and hormonal system have been investigated. Methods: HRV was studied in a group of volunteers (17 people), involving non-smokers, i.e., who never smoked before (11), ex-smokers (4) and active smokers (2). ANDS and smoking simulators, including regular, nicotine-free and electronic cigarettes; tobacco heating systems; chewing gums and nicotine packs of oral fixation (nic-packs), were used. Blood pressure, levels of stress hormones in saliva and catecholamines in the blood were also monitored. Results: HRV analysis showed relatively small changes in HRV and in the other studied parameters with the systemic use of nic-packs with low and moderate nicotine contents (up to 6 mg) compared to other ANDS. Conclusions: The HRV method is proven to be a promising technique for evaluation of the risks associated with smoking, dual use of various ANDS and studying the biomedical aspects of smoking cessation. Nic-packs are shown to be leaders in biological safety among the studied ANDS. A sharp surge in the activity of the sympathetic division of the ANS within the first minutes of the use of nicotine packs implies that nicotine begins to act already at very low doses (before entering the blood physically in any significant amount) through fast signal transmission to the brain from the nicotinic and taste buds located in the mouth area.

Association of air pollution with acute ischemic stroke risk in Singapore: a time-stratified case-crossover study

Background:

Air quality is an important determinant of cardiovascular health such as ischemic heart disease and acute ischemic stroke (AIS) with substantial mortality and morbidity reported across the globe. However, associations between air quality and AIS in the current literature remain inconsistent, with few studies undertaken in cosmopolitan cities located in the tropics.

Objectives:

We evaluated the associations between individual ambient air pollutants and AIS.

Methods:

We performed a nationwide, population-based, time-stratified case-crossover analysis on all AIS cases reported to the Singapore Stroke Registry from 2009 to 2018. We estimated the incidence rate ratio (IRR) of AIS across different concentrations of each pollutant by quartiles (referencing the 25th percentile), in single-pollutant conditional Poisson models adjusted for time-varying meteorological effects. We stratified our analysis by predetermined subgroups deemed at higher risk.

Results:

A total of 51,675 episodes of AIS were included. Ozone (O3) (IRR4th quartile: 1.05, 95% confidence interval (CI): 1.01–1.08) and carbon monoxide (CO) (IRR2nd quartile: 1.05, 95% CI: 1.02–1.08, IRR3rd quartile: 1.07, 95% CI: 1.04–1.10, IRR4th quartile: 1.07, 95% CI: 1.04–1.11) were positively associated with AIS incidence. The increased incidence of AIS due to O3 and CO persisted for 5 days after exposure. Those under 65 years of age were more likely to experience AIS when exposed to CO. Individuals with atrial fibrillation (AF) were more susceptible to exposure from O3, CO, and PM10. Current/ex-smokers were more vulnerable to the effect of O3.

Conclusion:

Air pollution increases the incidence of AIS, especially in those with AF and in those who are current or ex-smokers.

Seasonal variation in indoor concentrations of air pollutants in residential buildings

Indoor concentrations of PM₁₀, PM_2.5, CO, and CO₂ were measured in 25 naturally ventilated urban residences during the winter and summer seasons in Alexandria, Egypt. Ambient air samples were also collected simultaneously for comparison to indoor measurements. Furthermore, data for air exchange rates, home characteristics, and indoor activities during sampling were collected. It was found that the average indoor PM₁₀, PM_2.5, CO, and CO₂ concentrations for all homes in winter were 119.4 ± 30.9 μg/m³, 85.2 ± 25.8 μg/m³, 1.6 ± 0.8 ppm, and 692.4 ± 144.6 ppm, respectively. During summer, the average indoor levels were 98.8 ± 21.8 μg/m³, 67.8 ± 14.9 μg/m³, 0.5 ± 0.5 ppm, and 558.2 ± 66.2 ppm, respectively. The results indicate that the indoor daily averages of PM₁₀ and PM_2.5 concentrations were higher than the World Health Organization (WHO) guidelines for all selected homes in the two sampling periods. For CO and CO₂ levels, the indoor daily averages for all monitored homes were less than the WHO guideline and the American National Standards Institute/American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ANSI/ASHRAE) Standard 62.1, respectively. A strong seasonal variability was observed, with air quality being particularly poor in winter. Due to increased ventilation rates in summer, indoor levels of air pollutants were strongly dependent on ambient levels, while in winter the indoor concentrations were more strongly affected by indoor sources due to increased human activities and poor ventilation. In addition, stronger indoor/outdoor correlation of air pollutants' levels was found in summer than in winter probably due to higher ventilation and infiltration in the summer. The study also attempted to understand the potential sources and the various determinants that influence indoor PM, CO, and CO₂ concentrations in the two seasons. The findings can assist policymakers to better understand the indoor air pollution problem and to provide a sound basis for the development of proper national IAQ standards in Egypt.Implications: Personal exposure is considerably influenced by indoor air pollution which increases health risks. Assessment of indoor air quality has become a more significant issue in Egypt as people tend to spend most of their time inside buildings, especially in their homes. Currently, there is a lack of research on residential indoor air quality in Egyptian cities in terms of the spatial and temporal variation which prevents an accurate assessment of the current situation to develop effective mitigation measures and to establish national indoor air quality standards. This article is considered the first research studying the effect of seasonality on indoor concentrations of PM₁₀, PM_2.5, CO, and CO₂ in urban residences in Alexandria. It also studies the indoor/outdoor relationship of air pollutants' levels and identifies their major sources as well as the various determinants that influence their indoor concentrations.

Influence of air pollution and meteorological factors on the spread of COVID-19 in the Bangkok Metropolitan Region and air quality during the outbreak

This study investigated the effects of weather conditions, air pollutants, and the air quality index (AQI) on daily cases of COVID-19 in the Bangkok Metropolitan Region (BMR). In this research, we collected data from January 1 to March 30, 2020 (90 days). This study used secondary data of meteorological and air pollutant parameters obtained from the Pollution Control Department of the Ministry of Natural Resources and Environment as well as daily confirmed COVID-19 case data in the BMR obtained from the official webpage of the Department of Disease Control, Ministry of Public Health, Thailand. We employed descriptive statistics, and Spearman and Kendall rank correlation tests were used to investigate the associations of weather variables, air pollutants, AQI with daily confirmed COVID-19 cases. Our findings indicate that CO, NO₂, SO₂, O₃ PM₁₀, PM_2.5, AQI have a significantly negative association with daily confirmed COVID-19 cases in the BMR, whereas meteorological parameters such as temperature, relative humidity (RH), absolute humidity (AH) and wind speed (WS) showed significant positive associations with daily confirmed COVID-19 cases in the BMR. Our study is a useful supplement to encourage regulatory bodies to promote environmental strategies, as air pollution regulation could be a sustainable policy for mitigating the harmful effects of air pollutants. Furthermore, this study provides new insights into the relationship between daily meteorological factors, AQI, and air pollutants and daily confirmed COVID-19 cases in the BMR. These data may provide useful information to the public health authorities and decision makers in Thailand, as well as to the World Health Organization (WHO), in order to set proper strategic aimed at reducing the impact of the COVID-19. Future studies concerning SARS-CoV-2 and other viruses should investigate the possibility of infectious droplet dispersion in indoor and outdoor air during and after the epidemic outbreak.

Deterministic and Stochastic Cellular Mechanisms Contributing to Carbon Monoxide Induced Ventricular Arrhythmias

Chronic exposure to low levels of Carbon Monoxide is associated with an increased risk of cardiac arrhythmia. Microelectrode recordings from rat and guinea pig single isolated ventricular myocytes exposed to CO releasing molecule CORM-2 and excited at 0.2/s show repolarisation changes that develop over hundreds of seconds: action potential prolongation by delayed repolarisation, EADs, multiple EADs and oscillations around the plateau, leading to irreversible repolarisation failure. The measured direct effects of CO on currents in these cells, and ion channels expressed in mammalian systems showed an increase in prolonged late Na+, and a decrease in the maximal T- and L-type Ca++. peak and late Na+, ultra-rapid delayed, delayed rectifier, and the inward rectifier K+ currents. Incorporation of these CO induced changes in maximal currents in ventricular cell models; (Gattoni et al., J. Physiol., 2016, 594, 4193-4224) (rat) and (Luo and Rudy, Circ. Res., 1994, 74, 1071-1096) (guinea-pig) and human endo-, mid-myo- and epi-cardial (O'Hara et al., PLoS Comput. Biol., 2011, 7, e1002061) models, by changes in maximal ionic conductance reproduces these repolarisation abnormalities. Simulations of cell populations with Gaussian distributions of maximal conductance parameters predict a CO induced increase in APD and its variability. Incorporation of these predicted CO induced conductance changes in human ventricular cell electrophysiology into ventricular tissue and wall models give changes in indices for the probability of the initiation of re-entrant arrhythmia.

Long-term exposure to traffic-related air pollution and systemic lupus erythematosus in Taiwan: A cohort study

Systemic lupus erythematosus (SLE) is a multi-systemic chronic autoimmune disease, the etiology of SLE is still unclear. Only a few studies evaluated the associations between air pollution and SLE. We conducted a population-based cohort study in Taiwan to examine the associations of air pollution with SLE. A total of 682,208 individuals aged 18-70 years were retrieved from National Health Insurance Research Database. We applied 1-km resolution land use regression and satellite-based models to estimate air pollutant concentrations during 2001-2010. The mixed effect Cox models with time-dependent variables were performed to estimate the associations between air pollution and SLE, as hazard ratios (HRs) with 95% confidence interval (CI). We identified 1292 newly diagnosed SLE patients with average age of 43.26 ± 13.64 years, most of them were female. There were positive associations of SLE with exposure to a 9.76 ppb increase in nitrogen dioxide (NO₂), a 0.20 ppm increase in carbon monoxide (CO), and a 10.2 μg/m³ increase in fine particles (PM_2.5) (HR = 1.21, 95% CI: 1.08-1.36, HR = 1.44, 95% CI: 1.31-1.59, and HR = 1.12, 95% CI: 1.02-1.23, respectively). Additionally, we observed negative associations with ozone (O₃) and sulfur dioxide (SO₂). According to the exposure-response relationships, exposure to NO₂ between 28 and 38 ppb, exposure to CO above 0.6 ppm, and exposure to PM_2.5 between 18 and 46 μg/m³ were positively associated with SLE. The results suggested that long-term exposure to traffic-related gaseous air pollutants (NO₂ and CO) less than current National Ambient Air Quality Standards and PM_2.5 are significantly associated with the risk of SLE.

Cardiovascular effects of gasotransmitter donors

Gasotransmitters represent a subfamily of the endogenous gaseous signaling molecules that include nitric oxide (NO), carbon monoxide (CO), and hydrogen sulphide (H(2)S). These particular gases share many common features in their production and function, but they fulfill their physiological tasks in unique ways that differ from those of classical signaling molecules found in tissues and organs. These gasotransmitters may antagonize or potentiate each other's cellular effects at the level of their production, their downstream molecular targets and their direct interactions. All three gasotransmitters induce vasodilatation, inhibit apoptosis directly or by increasing the expression of anti-apoptotic genes, and activate antioxidants while inhibiting inflammatory actions. NO and CO may concomitantly participate in vasorelaxation, anti-inflammation and angiogenesis. NO and H(2)S collaborate in the regulation of vascular tone. Finally, H(2)S may upregulate the heme oxygenase/carbon monoxide (HO/CO) pathway during hypoxic conditions. All three gasotransmitters are produced by specific enzymes in different cell types that include cardiomyocytes, endothelial cells and smooth muscle cells. As translational research on gasotransmitters has exploded over the past years, drugs that alter the production/levels of the gasotransmitters themselves or modulate their signaling pathways are now being developed. This review is focused on the cardiovascular effects of NO, CO, and H(2)S. Moreover, their donors as drug targeting the cardiovascular system are briefly described.

Carbon monoxide pollution aggravates ischemic heart failure through oxidative stress pathway

Risk of hospital readmission and cardiac mortality increases with atmospheric pollution for patients with heart failure. The underlying mechanisms are unclear. Carbon monoxide (CO) a ubiquitous environmental pollutant could be involved. We explored the effect of daily exposure of CO relevant to urban pollution on post-myocardial infarcted animals. Rats with ischemic heart failure were exposed 4 weeks to daily peaks of CO mimicking urban exposure or to standard filtered air. CO exposure worsened cardiac contractile dysfunction evaluated by echocardiography and at the cardiomyocyte level. In line with clinical reports, the animals exposed to CO also exhibited a severe arrhythmogenic phenotype with numerous sustained ventricular tachycardias as monitored by surface telemetric electrocardiograms. CO did not affect cardiac β-adrenergic responsiveness. Instead, mitochondrial dysfunction was exacerbated leading to additional oxidative stress and Ca²⁺ cycling alterations. This was reversed following acute antioxidant treatment of cardiomyocytes with N-acetylcysteine confirming involvement of CO-induced oxidative stress. Exposure to daily peaks of CO pollution aggravated cardiac dysfunction in rats with ischemic heart failure by specifically targeting mitochondria and generating ROS-dependent alterations. This pathway may contribute to the high sensibility and vulnerability of individuals with cardiac disease to environmental outdoor air quality.

Protective effect of erythropoietin on myocardial apoptosis in rats exposed to carbon monoxide

AIMS

Cardiac complications are common in carbon monoxide (CO) poisoning and associated with high morbidity and mortality. We have previously shown that erythropoietin (EPO) could reduce CO-induced cardiac ischemia in rat. In the current study, the anti-apoptotic effect of EPO during CO cardiotoxicity was investigated in order to elucidate the mechanism of EPO anti-ischemic action.

MAIN METHODS

Wistar rats were exposed to CO (250, 1000 and 3000ppm). EPO (5000IU/kg) was administered to all groups by intraperitoneal injection at the end of CO exposure period. TUNEL and caspase-3 activity levels were assessed to investigate the effects of CO exposure and subsequent EPO administration on myocardial apoptosis. The changes of mitochondrial membrane potential (MMP) were also assessed with sensitive lipophilic dye JC-1 by flow cytometry. The roles of Bcl2 and Bax in EPO protective effect were investigated by Western blotting.

KEY FINDINGS

Myocardial apoptosis was observed following CO exposure. Moreover, mitochondrial membrane depolarization and significant reduction in Bcl2/Bax ratio were shown following CO poisoning especially at 3000ppm. On the other hand, EPO administration could effectively suppress apoptosis in myocardial cells. Also, EPO significantly prevented the CO-induced depolarization of MMP (p<0.001) and preserved Bcl2/Bax ratio (p<0.01).

SIGNIFICANCE

EPO reduces myocardial injury due to CO intoxication. Thus EPO could be suggested as a possible candidate for the management of CO cardiotoxicity with clinical applications.

Diverse mechanisms underlying the regulation of ion channels by carbon monoxide

Carbon monoxide (CO) is firmly established as an important, physiological signalling molecule as well as a potent toxin. Through its ability to bind metal-containing proteins, it is known to interfere with a number of intracellular signalling pathways, and such actions can account for its physiological and pathological effects. In particular, CO can modulate the intracellular production of reactive oxygen species, NO and cGMP levels, as well as regulate MAPK signalling. In this review, we consider ion channels as more recently discovered effectors of CO signalling. CO is now known to regulate a growing number of different ion channel types, and detailed studies of the underlying mechanisms of action are revealing unexpected findings. For example, there are clear areas of contention surrounding its ability to increase the activity of high conductance, Ca(2+) -sensitive K(+) channels. More recent studies have revealed the ability of CO to inhibit T-type Ca(2+) channels and have unveiled a novel signalling pathway underlying tonic regulation of this channel. It is clear that the investigation of ion channels as effectors of CO signalling is in its infancy, and much more work is required to fully understand both the physiological and the toxic actions of this gas. Only then can its emerging use as a therapeutic tool be fully and safely exploited.

CO and CO-releasing molecules (CO-RMs) in acute gastrointestinal inflammation

Carbon monoxide (CO) is enzymatically generated in mammalian cells alongside the liberation of iron and the production of biliverdin and bilirubin. This occurs during the degradation of haem by haem oxygenase (HO) enzymes, a class of ubiquitous proteins consisting of constitutive and inducible isoforms. The constitutive HO2 is present in the gastrointestinal tract in neurons and interstitial cells of Cajal and CO released from these cells might contribute to intestinal inhibitory neurotransmission and/or to the control of intestinal smooth muscle cell membrane potential. On the other hand, increased expression of the inducible HO1 is now recognized as a beneficial response to oxidative stress and inflammation. Among the products of haem metabolism, CO appears to contribute primarily to the antioxidant and anti-inflammatory effects of the HO1 pathway explaining the studies conducted to exploit CO as a possible therapeutic agent. This article reviews the effects and, as far as known today, the mechanism(s) of action of CO administered either as CO gas or via CO-releasing molecules in acute gastrointestinal inflammation. We provide here a comprehensive overview on the effect of CO in experimental in vivo models of post-operative ileus, intestinal injury during sepsis and necrotizing enterocolitis. In addition, we will analyse the in vitro data obtained so far on the effect of CO on intestinal epithelial cell lines exposed to cytokines, considering the important role of the intestinal mucosa in the pathology of gastrointestinal inflammation.

Resveratrol induces hepatic mitochondrial biogenesis through the sequential activation of nitric oxide and carbon monoxide production

AIMS

Nitric oxide (NO) can induce mitochondrial biogenesis in cultured cells, through increased guanosine 3',5'-monophosphate (cGMP), and activation of peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α). We sought to determine the role of NO, heme oxygenase-1 (HO-1), and its reaction product (carbon monoxide [CO]) in the induction of mitochondrial biogenesis by the natural antioxidant resveratrol.

RESULTS

S-nitroso-N-acetylpenicillamine (SNAP), an NO donor, induced mitochondrial biogenesis in HepG2 hepatoma cells, and in vivo, through stimulation of PGC-1α. NO-induced mitochondrial biogenesis required cGMP, and was mimicked by the cGMP analogue (8-bromoguanosine 3',5'-cyclic monophosphate [8-Br-cGMP]). Activation of mitochondrial biogenesis by SNAP required HO-1, as it could be reversed by genetic interference of HO-1; and by treatment with the HO inhibitor tin-protoporphyrin-IX (SnPP) in vitro and in vivo. Cobalt protoporphyrin (CoPP)-IX, an HO-1 inducing agent, stimulated mitochondrial biogenesis in HepG2 cells, which could be reversed by the CO scavenger hemoglobin. Application of CO, using the CO-releasing molecule-3 (CORM-3), stimulated mitochondrial biogenesis in HepG2 cells, in a cGMP-dependent manner. Both CoPP and CORM-3-induced mitochondrial biogenesis required NF-E2-related factor-2 (Nrf2) activation and phosphorylation of Akt. The natural antioxidant resveratrol induced mitochondrial biogenesis in HepG2 cells, in a manner dependent on NO biosynthesis, cGMP synthesis, Nrf2-dependent HO-1 activation, and endogenous CO production. Furthermore, resveratrol preserved mitochondrial biogenesis during lipopolysaccharides-induced hepatic inflammation in vivo.

INNOVATION AND CONCLUSIONS

The complex interplay between endogenous NO and CO production may underlie the mechanism by which natural antioxidants induce mitochondrial biogenesis. Strategies aimed at improving mitochondrial biogenesis may be used as therapeutics for the treatment of diseases involving mitochondrial dysfunction.

Ambient carbon monoxide associated with reduced risk of hospital admissions for respiratory tract infections

RATIONALE

Recent experimental and clinical studies suggest that exogenous carbon monoxide (CO) at lower concentrations may have beneficial effects under certain circumstances, whereas population-based epidemiologic studies of environmentally relevant CO exposure generated mixed findings.

OBJECTIVES

To examine the acute effects of ambient CO on respiratory tract infection (RTI) hospitalizations.

METHODS

A time series study was conducted. Daily emergency hospital admission and air pollution data in Hong Kong were collected from January 2001 to December 2007. Log-linear Poisson models were used to estimate the associations between daily hospital admissions for RTI and daily average concentrations of CO across three background air monitoring stations and three roadside stations, respectively, controlling for other traffic-related copollutants.

MEASUREMENTS AND MAIN RESULTS

CO concentrations were low during the study period with a daily average of 0.6 ppm in background stations and 1.0 ppm in roadside stations. Negative associations were found between ambient CO concentrations and daily hospital admissions for RTI. One ppm increase in background CO at lag 0-2 days was associated with -5.7% (95% confidence interval, -9.2 to -2.1) change in RTI admissions from the whole population according to single-pollutant model; the negative association became stronger when nitrogen dioxide or particulate matter with aerodynamic diameter less than 10 μm was adjusted for in two-pollutant models. The negative association seemed to be stronger in the adults than in the children and elderly.

CONCLUSIONS

Short-term exposure to ambient CO was associated with decreased risk of hospital admissions for RTI, suggesting some acute protective effects of low ambient CO exposure on respiratory infection.

Carbon monoxide: present and future indications for a medical gas

Gaseous molecules continue to hold new promise in molecular medicine as experimental and clinical therapeutics. The low molecular weight gas carbon monoxide (CO), and similar gaseous molecules (e.g., H2S, nitric oxide) have been implicated as potential inhalation therapies in inflammatory diseases. At high concentration, CO represents a toxic inhalation hazard, and is a common component of air pollution. CO is also produced endogenously as a product of heme degradation catalyzed by heme oxygenase enzymes. CO binds avidly to hemoglobin, causing hypoxemia and decreased oxygen delivery to tissues at high concentrations. At physiological concentrations, CO may have endogenous roles as a signal transduction molecule in the regulation of neural and vascular function and cellular homeostasis. CO has been demonstrated to act as an effective anti-inflammatory agent in preclinical animal models of inflammation, acute lung injury, sepsis, ischemia/reperfusion injury, and organ transplantation. Additional experimental indications for this gas include pulmonary fibrosis, pulmonary hypertension, metabolic diseases, and preeclampsia. The development of chemical CO releasing compounds constitutes a novel pharmaceutical approach to CO delivery with demonstrated effectiveness in sepsis models. Current and pending clinical evaluation will determine the usefulness of this gas as a therapeutic in human disease.

Temporal variation of size-fractionated particulate matter and carbon monoxide in selected microenvironments of the Milan urban area

This article focuses on air pollution in specific urban microenvironments and conditions characterized by high relative concentration levels and by possible risk to human health. For this reason, monitoring of particle number concentration (PNC) with a wide, size-resolved particle-size range, and CO (an indicator of combustion sources, e.g., traffic), was performed in a variety of microenvironments. Concentrations of ultrafine particles (UFPs), size-fractionated particulate matter (PM), and carbon monoxide (CO) were measured in the central area of Milan over three-week-long periods, one each during summer, autumn, and winter, with three monitoring sessions per day. Experimental data were collected continuously during each monitoring period along an established urban pathway. To assess the relevance of time and spatial factors affecting atmospheric concentrations of UFPs, PM, and CO data were collected while walking or moving by different private and public means of transport. Measurements were divided on the basis of different microenvironments (MEs), seasons, days of the week, and periods of the day. Data analysis shows statistically significant differences across MEs and monitoring periods. The highest measured median concentrations and data variability were observed for busy streets, walking or moving by motorized vehicle (CO, UFP) and in metro trains (PM); the lowest concentrations were observed in park areas and in indoor environments. The highest concentrations were measured during working day morning monitoring sessions. Regarding seasonal variation, UFP, PM, and CO showed different patterns: the highest median concentrations were observed in summer for CO, and in autumn and winter for the UFP and PM. Appreciable differences among all MEs and monitoring periods were observed: concentration patterns and variations appear related to typical sources of urban pollutants (traffic), proximity to sources, and time of day. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file containing Table VI: Tau b (Kendall) index for non-parametric correlation tau test.].

Carbon monoxide induces cardiac arrhythmia via induction of the late Na+ current

RATIONALE

Clinical reports describe life-threatening cardiac arrhythmias after environmental exposure to carbon monoxide (CO) or accidental CO poisoning. Numerous case studies describe disruption of repolarization and prolongation of the QT interval, yet the mechanisms underlying CO-induced arrhythmias are unknown.

OBJECTIVES

To understand the cellular basis of CO-induced arrhythmias and to identify an effective therapeutic approach.

METHODS

Patch-clamp electrophysiology and confocal Ca(2+) and nitric oxide (NO) imaging in isolated ventricular myocytes was performed together with protein S-nitrosylation to investigate the effects of CO at the cellular and molecular levels, whereas telemetry was used to investigate effects of CO on electrocardiogram recordings in vivo.

MEASUREMENTS AND MAIN RESULTS

CO increased the sustained (late) component of the inward Na(+) current, resulting in prolongation of the action potential and the associated intracellular Ca(2+) transient. In more than 50% of myocytes these changes progressed to early after-depolarization-like arrhythmias. CO elevated NO levels in myocytes and caused S-nitrosylation of the Na(+) channel, Na(v)1.5. All proarrhythmic effects of CO were abolished by the NO synthase inhibitor l-NAME, and reversed by ranolazine, an inhibitor of the late Na(+) current. Ranolazine also corrected QT variability and arrhythmias induced by CO in vivo, as monitored by telemetry.

CONCLUSIONS

Our data indicate that the proarrhythmic effects of CO arise from activation of NO synthase, leading to NO-mediated nitrosylation of Na(V)1.5 and to induction of the late Na(+) current. We also show that the antianginal drug ranolazine can abolish CO-induced early after-depolarizations, highlighting a novel approach to the treatment of CO-induced arrhythmias.