Formaldehyde and tobacco smoke as alkylating agents: the formation of N-methylenvaline in pathologists and in plastic laminate workers

Occupational Exposure to Formaldehyde and Cancer Risk Assessment in an Anatomy Laboratory

Dissecting a human cadaver is an irreplaceable practice in general training of medical students. Cadavers in anatomy laboratories are usually preserved in formalin, an embalming fluid whose basic component is formaldehyde (FA). The aim of this study is to assess the cancer risk of employees and students that are exposed to FA based on the results of three monitoring campaigns, as well as to suggest permanent solutions to the problem of FA exposure based on the results obtained. Three sampling campaigns of formaldehyde concentration in indoor environments were conducted at five different locations at the Anatomy Department of the Faculty of Medicine with the purpose of assessing permanent employees’ and medical faculty first year students’ exposure to FA. Indoor air was continuously sampled during 8 h of laboratory work and analyzed in accordance with the NIOSH Method 3500. Exceeding of the 8 h time-weighted average (8 h TWA) values recommended by Occupational Safety and Health Administration (OSHA) of 0.75 ppm was recorded in 37% of the samples during the three-month monitoring campaign. Cancer risk assessment levels for permanent employees were in the range from 6.43 × 10⁻³ to 8.77 × 10⁻⁴, while the cancer risk assessment levels for students ranged from 8.94 × 10⁻⁷ to 1.83 × 10⁻⁶. The results of the research show that cancer risk assessment for employees is several thousand times higher than the limit recommended by the EPA (10⁻⁶) and point to the importance of reducing exposure to formaldehyde through the reconstruction of the existing ventilation system, continual monitoring, the use of formaldehyde-free products, and plastination of anatomical specimens.

DNA pyrimidine bases in water: Insights into relative reactivity, byproducts formation and combined toxicity during chlorination

Soluble microbial products (SMPs), as precursors of disinfection byproducts (DBPs) in water treatment, are composed of polysaccharides, humic acid, proteins and DNA, and have caused widespread concerned. Pyrimidine bases (cytosine and thymine) are significant nitrogenous constituents of DNA, which could pose an adverse impact on water quality during chlorination. This study focused on the correlation between relative reactivity, formation of DBPs and combined toxicity in the chlorination of a binary pyrimidine base mixture. The relative reactivities of cytosine and thymine were quite different at a low disinfectant concentration; cytosine reacted more actively with chlorine than thymine did, at the chlorine/total pyrimidine bases molar ratio = 10. The chlorination of binary pyrimidine bases can produce both carbonous DBPs (C-DBPs) and nitrogenous DBPs (N-DBPs). In particular, the total yields of trichloromethane (TCM) and trichloronitromethane (TCNM) were lower than the additive yields of monadic cytosine and monadic thymine ("monadic" refers to "separate"), whereas the total yields of haloacetic acids (HAAs) and haloacetonitriles (HANs) were promoted evidently. High reactivity of cytosine with chlorine, greater potential of cytosine to produce specific DBPs and the alkylation of transformation products of thymine may synthetically account for the diversity in total DBPs yields, especially the increased formation of HAAs and HANs. In our toxicity trial, even though the antagonistic effect predominated at f_a > 0.4 (f_a refers to the affected fraction), the synergism at low concentration levels could enhance the combined toxicity by promoting the yields of N-DBPs.

Ultraperformance Liquid Chromatography Tandem Mass Spectrometry Method To Determine Formaldehyde Hemoglobin Adducts in Humans as Biomarker for Formaldehyde Exposure

Formaldehyde (FA) is an environmental chemical classified as a human carcinogen. It is highly reactive and can bind covalently with hemoglobin (Hb) to produce Hb adducts. Measurement of these Hb adducts provides valuable information about exposure to this chemical. We developed a robust, ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for quantifying FA-Hb adducts in red blood cells. The method measures the FA-VHLTPEEK peptide after trypic digestion. The peptide is a FA adduct at the N-terminus of the beta chain of human Hb. Method mean (±SD) accuracy, determined by recovery in quality control and blank material was 103.2% ± 8.11. The mean among-day and within-day coefficients of variation determined at three concentration levels (%CV) were 9.2% (range: 7.2-10.2%) and 4.9% (range 3.1-7.3%), respectively. The limit of detection was 3.4 nmol/g Hb. This method was applied to the analysis of 135 human blood samples, and FA-VHLTPEEK was detected in all study samples. FA-VHLTPEEK concentrations were not significantly different between smokers and nonsmokers. This work is the first validated UPLC-MS/MS method in which a FA peptide derived from a FA-Hb adduct could be used to monitor exposure to FA in population studies.

Is it possible to use biomonitoring for the quantitative assessment of formaldehyde occupational exposure?

The European classification, labeling and packaging classified formaldehyde as human carcinogen Group 1B and mutagen 2, fostering the re-evaluation of the exposure risk in occupational settings. Although formaldehyde exposure is traditionally measured in air, many efforts were made to identify specific exposure biomarkers: urinary formaldehyde, formic acid and DNA damage indicators. Though used in combination, none of these seems satisfactory. The influence of the metabolism on exogenous formaldehyde levels, the exposure to other xenobiotics, the difference in genetic background and metabolism efficiency, misled the relationship between genotoxicity and exposure data. Nevertheless, the limitation of adverse effects to the local contact sites hampers biomonitoring. Here we discuss the feasibility of formaldehyde biomonitoring and the use of DNA, DNA-protein cross-links and protein adducts as potential biomarkers.

Functional Toxicogenomic Profiling Expands Insight into Modulators of Formaldehyde Toxicity in Yeast

Formaldehyde (FA) is a commercially important chemical with numerous and diverse uses. Accordingly, occupational and environmental exposure to FA is prevalent worldwide. Various adverse effects, including nasopharyngeal, sinonasal, and lymphohematopoietic cancers, have been linked to FA exposure, prompting designation of FA as a human carcinogen by U.S. and international scientific entities. Although the mechanism(s) of FA toxicity have been well studied, additional insight is needed in regard to the genetic requirements for FA tolerance. In this study, a functional toxicogenomics approach was utilized in the model eukaryotic yeast Saccharomyces cerevisiae to identify genes and cellular processes modulating the cellular toxicity of FA. Our results demonstrate mutant strains deficient in multiple DNA repair pathways-including homologous recombination, single strand annealing, and postreplication repair-were sensitive to FA, indicating FA may cause various forms of DNA damage in yeast. The SKI complex and its associated factors, which regulate mRNA degradation by the exosome, were also required for FA tolerance, suggesting FA may have unappreciated effects on RNA stability. Furthermore, various strains involved in osmoregulation and stress response were sensitive to FA. Together, our results are generally consistent with FA-mediated damage to both DNA and RNA. Considering DNA repair and RNA degradation pathways are evolutionarily conserved from yeast to humans, mechanisms of FA toxicity identified in yeast may be relevant to human disease and genetic susceptibility.

Formaldehyde-induced toxicity in the nasal epithelia of workers of a plastic laminate plant

Formaldehyde is a ubiquitous volatile organic compound widely used for various industrial purposes. Formaldehyde was reclassified by the International Agency for Research on Cancer as a human carcinogen, based on sufficient evidence for a casual role for nasopharyngeal cancer. However, the mechanisms by which this compound causes nasopharyngeal cancer are not completely understood. Therefore, we have examined the formaldehyde-induced toxicity in the nasal epithelia of the workers of a plastic laminate plant in Bra, Cuneo, Piedmont region, North-Western Italy, hence in the target site for formaldehyde-related nasal carcinogenesis. We have conducted a cross-sectional study aimed at comparing the frequency of 3-(2-deoxy-β-d-erythro-pentafuranosyl)pyrimido[1,2-α]purin-10(3H)-one deoxyguanosine (M1dG) adducts, a biomarker of oxidative stress and lipid peroxidation, in 50 male exposed workers and 45 male controls using 32P-DNA post-labeling. The personal levels of formaldehyde exposure were analysed by gas-chromatography mass-spectrometry. The smoking status was estimated by measuring the concentrations of urinary cotinine by gas-chromatography mass-spectrometry. The air monitoring results showed that the exposure levels of formaldehyde were significantly greater for the plastic laminate plant workers, 211.4 ± 14.8 standard error (SE) μg m-3, than controls, 35.2 ± 3.4 (SE) μg m-3, P < 0.001. The levels of urinary cotinine were 1064 ± 118 ng ml-1 and 14.18 ± 2.5 ng ml-1 in smokers and non-smokers, respectively, P < 0.001. The M1dG adduct frequency per 108 normal nucleotides was significantly higher among the workers of the plastic laminate plant exposed to formaldehyde, 111.6 ± 14.3 (SE), compared to controls, 49.6 ± 3.4 (SE), P < 0.001. This significant association persisted also when personal dosimeters were used to measure the extent of indoor levels of formaldehyde exposure. No influences of smoking and age were observed across the study population. However, after categorization for occupational exposure, a significant effect was found in the controls, P = 0.018, where the levels of DNA damage were significantly correlated with the levels of urinary cotinine, regression coefficient (β) = 0.494 ± 0.000 (SE), P < 0.002. Our findings indicated that M1dG adducts constitute a potential mechanism of formaldehyde-induced toxicity. Persistent DNA damage contributes to the general decline of the physiological mechanisms designed to maintain cellular homeostasis.

Towards a formalin-free hospital. Levels of 15-F2t-isoprostane and malondialdehyde to monitor exposure to formaldehyde in nurses from operating theatres

Purpose: nurses are exposed to formaldehyde when managing surgical samples that are to be later transferred to histopathology. We evaluated the conditions favouring the risk of exposure to this toxic reagent and the effect of measures to prevent it. Methods: we conducted a cross-sectional study where 94 female workers were enrolled as being potentially exposed to formaldehyde. From each nurse were collected: (1) personal air-formaldehyde by a personal dosimeter (8 hours), (2) a standardized questionnaire, (3) a urine sample to test 15-F2t-isoprostane, malondialdehyde, cotinine. Results: the results indicate a marked difference related to the adoption of the under vacuum sealing procedure, as an alternative to formaldehyde for preserving tissues. Nurses using the under vacuum sealing system in the operating rooms are exposed to levels of formaldehyde 75% lower than those who do not use that system. Oxidative stress biomarkers (15-F2t-isoprostane, malondialdehyde) are significantly higher in nurses using formaldehyde (p < 0.001) and in the absence of the under vacuum sealing system (p = 0.027), in particular in those workers who use liquid formaldehyde in the operating theatre (p = 0.012). Conclusions: analysis of the biological biomarkers confirms a direct responsibility of air formaldehyde on the onset of oxidative stress while the use of the under vacuum sealing technique is associated with a significant reduction of the exposure to air-formaldehyde and redox status. Our findings can be useful to characterize the environmental health risk in operating theatres and to plan preventive measures such as the under vacuum sealing procedure.

Environmental and biological monitoring of occupational formaldehyde exposure resulting from the use of products for hair straightening

The evaluation of formaldehyde (FD) exposure in beauty salons, due to the use of hair straightening products, and its relation with genotoxicity biomarkers was performed in this study. Regardless of official recommendations, the inappropriate use of homemade hair creams has became a popular practice in Brazil, and high formaldehyde content in the "progressive straightening" creams can contain mutagens that could increase the incidence of neoplasia in those people who use them. Damage to DNA was assessed by conducting a micronuclei test (MNT) on buccal cells and the comet assay on heparinized venous blood samples. A total of 50 volunteers were recruited at six different beauty salons (labeled A to F). At two salons that used products that did not contain FD (salons D and E), environmental FD concentrations were 0.04 and 0.02 ppm. In contrast, the products used at salons A, B, C, and F contained 5.7, 2.61, 5.9, and 5.79% of FD, and these salons had environmental FD concentrations of 0.07, 0.14, 0.16, and 0.14 ppm, respectively. Comparison of the beauty salon workers from each of the six beauty salons revealed significant differences in urinary formic acid (FA) concentration before exposure (p = 0.016), urinary FA after exposure (p = 0.004), variation in FA concentration before and after exposure (p = 0.018), environmental FD concentration (p < 0.001), cytogenetic damage detected by the comet assay according to both damage index (p < 0.001) and frequency of damage (p < 0.001), and for karyorrhexis only according to the MNT (p = 0.001).

Evaluation of genotoxicity in workers exposed to low levels of formaldehyde in a furniture manufacturing facility

Formaldehyde (FA) is a chemical widely used in the furniture industry and has been classified as a potential human carcinogen. The purpose of this study was to evaluate the occupational exposure of workers to FA at a furniture manufacturing facility and the relationship between environmental concentrations of FA, formic acid concentration in urine, and DNA damage. The sample consisted of 46 workers exposed to FA and a control group of 45 individuals with no history of occupational exposure. Environmental concentrations of FA were determined by high-performance liquid chromatography. Urinary formic acid concentrations were determined by gas chromatography with flame ionization detector. DNA damage was evaluated by the micronucleus (MN) test performed in exfoliated buccal cells and comet assay with venous blood. The 8-h time-weighted average of FA environmental concentration ranged from 0.03 ppm to 0.09 ppm at the plant, and the control group was exposed to a mean concentration of 0.012 ppm. Workers exposed to higher environmental FA concentrations had urinary formic acid concentrations significantly different from those of controls (31.85 mg L(-1) vs. 19.35 mg L(-), p ≤ 0.01 Mann-Whitney test). Significant differences were found between control and exposed groups for the following parameters: damage frequency and damage index in the comet assay, frequency of binucleated cells in the MN test, and formic acid concentration in urine. The frequency of micronuclei, nuclear buds, and karyorrhexis did not differ between groups. There was a positive correlation between environmental concentrations of FA and damage frequency (Spearman's rank correlation coefficient [r s] = 0.24), damage index (r s = 0.21), binucleated cells (r s = 0.34), and urinary formic acid concentration (r s = 0.63). The results indicate that, although workers in the furniture manufacturing facility were exposed to low environmental levels of FA, this agent contributes to the observed increase in cytogenetic damage. In addition, urinary formic acid concentrations correlated strongly with occupational exposure to FA.

Inhaled formaldehyde induces DNA-protein crosslinks and oxidative stress in bone marrow and other distant organs of exposed mice

Formaldehyde (FA), a major industrial chemical and ubiquitous environmental pollutant, has been classified as a leukemogen. The causal relationship remains unclear, however, due to limited evidence that FA induces toxicity in bone marrow, the site of leukemia induction, and in other distal organs. Although induction of DNA-protein crosslinks (DPC), a hallmark of FA toxicity, was not previously detected in the bone marrow of FA-exposed rats and monkeys in studies published in the 1980s, our recent studies showed increased DPC in the bone marrow, liver, kidney, and testes of exposed Kunming mice. To confirm these preliminary results, in the current study we exposed BALB/c mice to 0, 0.5, 1.0, and 3.0 mg m(-3) FA (8 hr per day, for 7 consecutive days) by nose-only inhalation and measured DPC levels in bone marrow and other organs of exposed mice. As oxidative stress is a potential mechanism of FA toxicity, we also measured glutathione (GSH), reactive oxygen species (ROS), and malondialdehyde (MDA), in the bone marrow, peripheral blood mononuclear cells, lung, liver, spleen, and testes of exposed mice. Significant dose-dependent increases in DPC, decreases in GSH, and increases in ROS and MDA were observed in all organs examined (except for DPC in lung). Bone marrow was among the organs with the strongest effects for DPC, GSH, and ROS. In conclusion, exposure of mice to FA by inhalation induced genotoxicity and oxidative stress in bone marrow and other organs. These findings strengthen the biological plausibility of FA-induced leukemogenesis and systemic toxicity.

Oxidative stress in adolescent passive smokers living in urban and rural environments

Purpose of this study was to study the oxidative stress status through the urinary 15-F(2t)-isoprostane (15-F(2t)-isoP) among a group of 168 adolescents, differently exposed to passive tobacco smoke. Subjects were enrolled, with written informed consent, between two populations of students living and attending school in two areas with different levels of urbanization in Piedmont Region, North-Western Italy. A general linear model (GLM) analysis was performed to evaluate the role of air pollution, dependent from selected degree of urbanization and of passive exposure to tobacco smoke, quantified through cotinine, in the synthesis of 15-F(2t)-isoP, measured with ELISA technique. Formaldehyde (FA) concentration in air was also evaluated as a primary confounding factor in oxidative stress but no significant differences between the two sites were found. Conversely, direct relationship between oxidative stress status and residence of adolescents was found: oxidative stress level was 31% higher for adolescents living in Chivasso (urban site) than for those living in Casalborgone (countryside area). Furthermore, also passive tobacco smoke exposure proved to play another important direct role in the distribution of 15-F(2t)-isoP levels (p<0.0001). Lastly, an inversely proportional relationship was found between the age of adolescents and 15-F(2t)-isoP (p<0.0001). Finally, the detection of such a sensitive biological response as a consequence of limited differences of environmental pollution and exposure to tobacco smoke passively breathed could provide new and useful knowledge for the appraisal of preventive strategies, particularly for young subjects.

New results on formaldehyde: the 2nd International Formaldehyde Science Conference (Madrid, 19-20 April 2012)

The toxicology and epidemiology of formaldehyde were discussed on the 2nd International Formaldehyde Science Conference in Madrid, 19-20 April 2012. It was noted that a substantial amount of new scientific data has appeared within the last years since the 1st conference in 2007. Progress has been made in characterisation of genotoxicity, toxicokinetics, formation of exogenous and endogenous DNA adducts, controlled human studies and epidemiology. Thus, new research results are now at hand to be incorporated into existing evaluations on formaldehyde by official bodies.

Recent trend in risk assessment of formaldehyde exposures from indoor air

Studies about formaldehyde (FA) published since the guideline of 0.1 mg/m(3) by the World Health Organization (WHO) in 2010 have been evaluated; critical effects were eye and nasal (portal-of-entry) irritation. Also, it was considered to prevent long-term effects, including all types of cancer. The majority of the recent toxicokinetic studies showed no exposure-dependent FA-DNA adducts outside the portal-of-entry area and FA-DNA adducts at distant sites were due to endogenously generated FA. The no-observed-adverse-effect level for sensory irritation was 0.5 ppm and recently reconfirmed in hypo- and hypersensitive individuals. Investigation of the relationship between FA exposure and asthma or other airway effects in children showed no convincing association. In rats, repeated exposures showed no point mutation in the p53 and K-Ras genes at ≤15 ppm neither increased cell proliferation, histopathological changes and changes in gene expression at 0.7 ppm. Repeated controlled exposures (0.5 ppm with peaks at 1 ppm) did not increase micronucleus formation in human buccal cells or nasal tissue (0.7 ppm) or in vivo genotoxicity in peripheral blood lymphocytes (0.7 ppm), but higher occupational exposures were associated with genotoxicity in buccal cells and cultivated peripheral blood lymphocytes. It is still valid that exposures not inducing nasal squamous cell carcinoma in rats will not induce nasopharyngeal cancer or lymphohematopoietic malignancies in humans. Reproductive and developmental toxicity are not considered relevant in the absence of sensory irritation. In conclusion, the WHO guideline has been strengthened.

Evaluation of two commercial and three home-made fixatives for the substitution of formalin: a formaldehyde-free laboratory is possible

BACKGROUND

Formaldehyde (HCHO) is a gas (available as a 37% concentrated solution, stabilized with methanol). The 10% dilution (approximately 4% formaldehyde) has been used as a fixative since the end of the 19th century. Alternative fixatives are also commercially available or may be prepared in-house in laboratories. Statements by the IARC, along with other USA agencies (CalEPA, RoC/NTP) on the carcinogenicity of formaldehyde for humans renders its substitution in Pathology Departments necessary since the annual use of formalin may exceed 3,500 liters for a medium-large laboratory. To achieve a "formalin-free laboratory" we tested straightforward-to-make fixatives along with registered reagents offered as formalin substitutes.

METHODS

More than two hundreds specimens were fixed in parallel with in-laboratory made fixatives PAGA (Polyethylenglycol, ethyl Alcohol, Glycerol, Acetic acid), two zinc-based fixatives (ZBF, Z7), and commercially-available alternatives (RCL2 and CellBlock). Tissue micro arrays were used for morphological and immunohistochemical comparison. Extraction of RNA was carried out to evaluate preservation of nucleic acids.

RESULTS

Differences compared to formalin fixation were evident in alcohol-based fixatives, mainly restricted to higher stain affinity and considerable tissue shrinkage. Conversely, nuclear detail was superior with these alcohol-based formulas compared to formalin or glyoxale-based recipes. RNA extraction was superior for Z7, PAGA and RCL2 with regard to concentration but relatively comparable regarding quality.

CONCLUSIONS

Abolition of the human carcinogen formaldehyde from pathology laboratories is possible even in contexts whereby commercial alternatives to formalin are unavailable or are too expensive for routine use, and aspiration devices are lacking or not adequately serviced. The use of known formulations, possibly with simple and not-noxious ("alimentary grade") constituents, comparable with registered proprietary products, may expand the search for the ideal fixative combining satisfactory morphology with improved preservation of nucleic acids and proteins as well as being easy and safe to dispose of.