Chemical mixtures: evaluation of risk for child-specific exposures in a multi-stressor environment

Systems for rating bodies of evidence used in systematic reviews of air pollution exposure and reproductive and children's health: a methodological survey

BACKGROUND

Translating findings from systematic reviews assessing associations between environmental exposures and reproductive and children's health into policy recommendations requires valid and transparent evidence grading.

METHODS

We aimed to evaluate systems for grading bodies of evidence used in systematic reviews of environmental exposures and reproductive/ children's health outcomes, by conducting a methodological survey of air pollution research, comprising a comprehensive search for and assessment of all relevant systematic reviews. To evaluate the frameworks used for rating the internal validity of primary studies and for grading bodies of evidence (multiple studies), we considered whether and how specific criteria or domains were operationalized to address reproductive/children's environmental health, e.g., whether the timing of exposure assessment was evaluated with regard to vulnerable developmental stages.

RESULTS

Eighteen out of 177 (9.8%) systematic reviews used formal systems for rating the body of evidence; 15 distinct internal validity assessment tools for primary studies, and nine different grading systems for bodies of evidence were used, with multiple modifications applied to the cited approaches. The Newcastle Ottawa Scale (NOS) and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, neither developed specifically for this field, were the most commonly used approaches for rating individual studies and bodies of evidence, respectively. Overall, the identified approaches were highly heterogeneous in both their comprehensiveness and their applicability to reproductive/children's environmental health research.

CONCLUSION

Establishing the wider use of more appropriate evidence grading methods is instrumental both for strengthening systematic review methodologies, and for the effective development and implementation of environmental public health policies, particularly for protecting pregnant persons and children.

A comprehensive overview of genotoxicity and mutagenicity associated with outdoor air pollution exposure in Brazil

This review examined the mutagenicity and genotoxicity associated with exposure to outdoor air pollutants in Brazil. A search was performed on the Web of Science database using a combination of keywords that resulted in 134 articles. After applying exclusion criteria, a total of 75 articles were obtained. The articles were classified into three categories: (1) studies with plants and animals, (2) in vitro studies, and (3) human biomonitoring. The investigations were conducted in 11 of 27 Brazilian states with the highest prevalence in the southeast and south regions. Only 5 investigations focused on the effects of burning biomass on the quality of outdoor air. Plants, especially Tradescantia pallida, were the main air pollution biomonitoring tool. When available, a significant association between levels of air pollutants and genetic damage was described. Among the in vitro studies, Salmonella/microsome is the most used test to evaluate mutagenesis of outdoor air in Brazil (n = 26). Human biomonitoring studies were the least frequent category (n = 18). Most of the investigations utilized micronucleus bioassay, in oral mucosa cells (n = 15) and lymphocytes (n = 5), and the comet assay (n = 6). The analysis in this study points to the existence of gaps in genotoxicity studies and our findings indicate that future studies need to address the variety of potential sources of pollution existing in Brazil. In addition to extent of the impacts, consideration should be given to the enormous Brazilian biodiversity, as well as the determination of the role of socioeconomic inequality of the population in the observed outcomes.

Classroom Dust-Bound Polycyclic Aromatic Hydrocarbons in Jeddah Primary Schools, Saudi Arabia: Level, Characteristics and Health Risk Assessment

Data concerning polycyclic aromatic hydrocarbons (PAHs) in Jeddah's schools, Saudi Arabia, and their implications for health risks to children, is scarce. Classroom air conditioner filter dusts were collected from primary schools in urban, suburban and residential areas of Jeddah. This study aimed to assess the characteristics of classroom-dust-bound PAHs and the health risks to children of PAH exposure. Average PAH concentrations were higher in urban schools than suburban and residential schools. Benzo (b)fluoranthene (BbF), benzo(ghi)perylene (BGP), chrysene (CRY) and Dibenz[a,h]anthracene (DBA) at urban and suburban schools and BbF, BGP, fluoranthene (FLT) and indeno (1, 2, 3, -cd)pyrene (IND) at residential schools were the dominant compounds in classroom dust. PAHs with five aromatic rings were the most abundant at all schools. The relative contribution of the individual PAH compounds to total PAH concentrations in the classroom dusts of schools indicate that the study areas do share a common source, vehicle emissions. Based on diagnostic ratios of PAHs, they are emitted from local pyrogenic sources, and traffic is the significant PAH source, with more significant contributions from gasoline-fueled than from diesel cars. Based on benzo[a]pyrene equivalent (BaPequi) calculations, total carcinogenic activity (TCA) for total PAHs represent 21.59% (urban schools), 20.99% (suburban schools), and 18.88% (residential schools) of total PAH concentrations. DBA and BaP were the most dominant compounds contributing to the TCA, suggesting the importance of BaP and DBA as surrogate compounds for PAHs in this schools. Based on incremental lifetime cancer risk (ILCingestion, ILCRinhalation, ILCRdermal) and total lifetime cancer risk (TLCR)) calculations, the order of cancer risk was: urban schools > suburban schools > residential schools. Both ingestion and dermal contact are major contributors to cancer risk. Among PAHs, DBA, BaP, BbF, benzo(a)anthracene (BaA), benzo(k)fluoranthene (BkF), and IND have the highest ILCR values at all schools. LCR and TLCR values at all schools were lower than 10-6, indicating virtual safety. DBA, BaP and BbF were the predominant contributors to cancer effects in all schools.

Assessment of ultrafine particles in primary schools: Emphasis on different indoor microenvironments

Due to the negative health impacts, significant efforts have been directed towards investigating ultrafine particle (UFP) exposure in various indoor environments. As children spend approximately one third of their time in schools, educatory environments deserve particular attention; however, majority of past research has focused on UFP assessment in classrooms. Thus, this work aims to expand the characterization of UFP in primary schools by considering different indoor and outdoor school microenvironments and estimating inhalation doses for the respective students (6-11yrs old). Real-time UFP measurements were daily conducted (9:00-17:30) in 20 primary schools in Oporto (January-April 2014; October-February 2015) in classrooms, canteens, gyms, libraries, and concurrently outdoors. Overall, UFP concentrations showed large temporal and spatial variations. For classrooms (n = 73), median UFP (1.56 × 10³-16.8 × 10³ # cm^-3) were lower than the corresponding levels in ambient air of schools (1.79 × 10³-24.1 × 10³ # cm^-3). Outdoor emissions contributed to indoor UFP (indoor-to-outdoor ratios I/O of 0.0.30-0.85), but ventilation, room characteristics and its occupancy were identified as important parameters contributing to overall indoor UFP levels. Considering specific indoor school microenvironments, canteens were the microenvironment with the highest UFP levels (5.47 × 10³-36.4 × 10³ # cm^-3), cooking conducted directly on school grounds resulted in significantly elevated UFP in the respective classrooms (p < 0.05); the lowest UFP were found in libraries (4.45 × 10³-8.50 × 10³ # cm^-3) mostly due to the limited occupancies. Although students spend majority of their school time in classrooms (66-71%), classroom exposure was not consistently the predominant contributor to school total UFP inhalation dose (29-75%). Outdoor exposure contributed 23-70% of school dose (depending on UFP levels in ambient levels and/or conducted activities) whereas short periods of lunch break accounted for 8-40%. Therefore, when evaluating UFP exposure in educatory settings other microenvironments beyond classrooms should be an integral part of the study.

Windows of sensitivity to toxic chemicals in the development of reproductive effects: an analysis of ATSDR's toxicological profile database

Development of the fetus is a complex process influenced by many factors including genetics, maternal health, and environmental exposures to toxic chemicals. Adverse developmental effects on the reproductive system have the potential to harm generations beyond those directly exposed. Here, we review the available literature in Agency for Toxic Substances and Disease Registry toxicological profiles related to reproductive-developmental effects in animals following in utero exposure to chemicals. We attempt to identify windows of sensitivity. In the discussion, we correlate the findings with human development. The endpoints noted are fertility, estrus, anogenital distance, sex ratio, spermatogenesis, and mammary gland development. We identified some windows of sensitivity; however, the results were hampered by chronic-exposure studies designed to detect effects occurring throughout developmental, including multi-generational studies. This paper demonstrates the need for more acute studies in animals aimed at understanding time periods of development that are more susceptible to chemically induced adverse effects.

Polycyclic aromatic hydrocarbons in primary school environments: Levels and potential risks

Although polycyclic aromatic hydrocarbons (PAHs) are priority air pollutants that strongly affect human health, information concerning the indoor exposures is still limited. This study characterized PAH levels in primary schools and evaluated risk for the respective students (aged 8-10years) in comparison with school personnel. During January-April 2014, eighteen particulate-bound (PM_2.5) PAHs (16 USEPA priority compounds, dibenzo[a,l]pyrene, benzo[j]fluoranthene) were collected (indoors and outdoors) at ten primary urban schools in Portugal. Total mean concentrations (Σ_PAHs) ranged 2.8-54ngm^-3 in indoor air, whereas corresponding outdoor levels were 7.1-48ngm^-3. Indoor/outdoor ratios of lighter congeners (2-3 aromatic rings) demonstrated a contribution from indoor origin while heavier PAHs (4-6 aromatic rings) originated mostly from infiltration of ambient air indoors; traffic (both from diesel and gasoline fuelled vehicles) was the predominant source of indoor PAHs. Total cancer risk of 8-10years old children exceeded (up to 22 times) USEPA recommended guideline of 10^-6, and 7-87 times WHO health-based threshold of 10^-5. Risk due to indoor exposure in schools was 2-10 times higher than outdoors, mainly because of the higher amount of time that students spent indoors.

Assessment of air quality in preschool environments (3-5 years old children) with emphasis on elemental composition of PM10 and PM2.5

This study evaluated concentrations of main air pollutants in a Portuguese preschool (indoors/outdoors) environment, with emphasis on elemental characterization of different PM fractions, and estimated risks for the pupils (aged 3-5 years). With exception to total volatile organic compounds, levels of PM10, PM2.5, CO, CO2, and formaldehyde were below legislative guidelines. Calcium, sodium, aluminium, and potassium were the most abundant elements in indoor PM (82-84% of the analysed content) resulting mainly from crustal sources. Carcinogenic elements (1-2% of the indoor analysed content) were mostly PM2.5-bound (83-91%). Indoor-to-outdoor ratios of individual elements indicated contributions of indoor origin and from penetration of outdoor emissions indoors; trace metals were associated with ambient anthropogenic emissions (namely traffic). Non-carcinogenic and carcinogenic risks from overall preschool exposure were acceptable for children; for adults carcinogenic risks exceeded (4-11 times) the USEPA recommend value of 10(-6), being 8-40 times higher than for children.

Evaluation of area contaminated by wood treatment activities: Genetic markers in the environment and in the child population

Wood preservation activities and related compounds are a problem since these areas have major environmental contamination liabilities which compromise the health of the surrounding population and the integrity of ecological processes. The present study evaluated an area influenced by soil contamination arising from the activities of a deactivated wood treatment plant. The presence and effect of mutagenic compounds in environmental samples were used as markers of exposure together with the evaluation biomarkers of genetic damage in children. Organic extracts from samples of public source water and from fine atmospheric particulate matter (PM2.5) were evaluated for mutagenic potential using the Salmonella/microsome assay. Children living in the area surrounding the plant were analyzed for genetic damage assessed by the comet assay in lymphocytes and micronucleus test (MN) in lymphocytes and oral mucosa and compared to a group living in an area outside the preferential quadrant of atmospheric dispersion and in opposition to the drainage at the site. The mutagenic effect and PAHs concentrations found were similar to studies that evaluated intensely occupied urban areas and those under industrial influence. The MN frequencies in lymphocytes and binucleated cells in the oral mucosa were significantly higher in the risk group. No significant differences were observed in the other genetic damage biomarkers evaluated. The presence of pollutants with a mutagenic and carcinogenic effect on the PM2.5 and the increased in some biomarkers indicate that the population is potentially exposed to substances capable of causing adverse health effects and atmospheric airborne is a possible exposure route.

Identifying important life stages for monitoring and assessing risks from exposures to environmental contaminants: results of a World Health Organization review

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We propose a harmonized set of age bins for assessing risks from chemical exposure.

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The set of early life age groups will facilitate consistency with recent guidance.

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The age bins allow results from longitudinal birth cohort studies to be combined.

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Region-specific exposure factors and monitoring data are needed to apply the bins.

In this paper, we summarize exposure-related issues to consider in determining the most appropriate age ranges and life stages for risk assessment. We then propose a harmonized set of age bins for monitoring and assessing risks from exposures to chemicals for global use. The focus is on preconception through adolescence, though the approach should be applicable to additional life stages. A two-tiered set of early life age groups is recommended. The first tier involves the adoption of guidance similar to the childhood age groups recommended by the U.S. Environmental Protection Agency, whereas the second tier consolidates some of those age groups to reduce the burden of developing age-specific exposure factors for different regions. While there is no single “correct” means of choosing a common set of age groups to use internationally in assessing early life exposure and risk, use of a set of defined age groups is recommended to facilitate comparisons of potential exposures and risks around the globe, the collection of data and analyses of aggregate exposure and cumulative risk. Application of these age groups for robust assessment of exposure and risk for specific populations will require region-specific exposure factors as well as local environmental monitoring data.

Toxicity and elemental composition of particulate matter from outdoor and indoor air of elementary schools in Munich, Germany

Outdoor particulate matter (PM(10)) is associated with detrimental health effects. However, individual PM(10) exposure occurs mostly indoors. We therefore compared the toxic effects of classroom, outdoor, and residential PM(10). Indoor and outdoor PM(10) was collected from six schools in Munich during teaching hours and in six homes. Particles were analyzed by scanning electron microscopy and X-ray spectroscopy (EDX). Toxicity was evaluated in human primary keratinocytes, lung epithelial cells and after metabolic activation by several human cytochromes P450. We found that PM(10) concentrations during teaching hours were 5.6-times higher than outdoors (117 ± 48 μg/m(3) vs. 21 ± 15 μg/m(3), P < 0.001). Compared to outdoors, indoor PM contained more silicate (36% of particle number), organic (29%, probably originating from human skin), and Ca-carbonate particles (12%, probably originating from paper). Outdoor PM contained more Ca-sulfate particles (38%). Indoor PM at 6 μg/cm(2) (10 μg/ml) caused toxicity in keratinocytes and in cells expressing CYP2B6 and CYP3A4. Toxicity by CYP2B6 was abolished with the reactive oxygen species scavenger N-acetylcysteine. We concluded that outdoor PM(10) and indoor PM(10) from homes were devoid of toxicity. Indoor PM(10) was elevated, chemically different and toxicologically more active than outdoor PM(10). Whether the effects translate into a significant health risk needs to be determined. Until then, we suggest better ventilation as a sensible option.

PRACTICAL IMPLICATIONS

Indoor air PM(10) on an equal weight base is toxicologically more active than outdoor PM(10). In addition, indoor PM(10) concentrations are about six times higher than outdoor air. Thus, ventilation of classrooms with outdoor air will improve air quality and is likely to provide a health benefit. It is also easier than cleaning PM(10) from indoor air, which has proven to be tedious.

The impact of CYP2E1 genetic variability on risk assessment of VOC mixtures

Humans are simultaneously exposed to multiple chemicals in the environment. Many of the chemicals use the same enzymes in their metabolic pathways. Competitive inhibition may occur as one of the possible interactions between the xenobiotics in human body. For example, many volatile organic compounds (VOCs) are metabolized using P450 enzymes, specifically CYP2E1. Inheritable gene alterations may result in changes of function of the enzymes in different human subpopulations. Variations in quantity and/or quality of particular isoenzymes may cause differences in the metabolism of VOCs. These variations may cause higher sensitivity in certain populations. Using examples of three different mixtures, this review paper outlines the variances in CYP2E1 isoenzymes, effect of exposure to such mixtures on sensitive populations, and approaches to mixtures risk assessment.

Malaria control insecticide residues in breast milk: the need to consider infant health risks

BACKGROUND

In many parts of the world, deliberate indoor residual spraying (IRS) of dwellings with insecticides to control malaria transmission remains the only viable option, thereby unintentionally but inevitably also causing exposure to inhabitants. Because mothers are exposed to insecticides via various routes, accumulated residues are transferred to infants via breast milk, in some cases exceeding recommended intake levels. Except for dichlorodiphenyltrichloroethane (DDT), safety of residues of other insecticides in breast milk has not been considered during World Health Organization Pesticide Evaluation Scheme (WHOPES) evaluations. However, very little is known of the health risks posed by these chemicals to infants who, in developing countries, breast-feed for up to 2 years.

OBJECTIVE

We evaluated the need for WHOPES to include breast milk as a potentially significant route of exposure and risk to infants when evaluating the risks during evaluation of IRS insecticides.

DISCUSSION

We present evidence showing that neurologic and endocrine effects are associated with pyrethroids and DDT at levels equal or below known levels in breast milk.

CONCLUSIONS

Because millions of people in malaria control areas experience conditions of multiple sources and routes of exposure to any number of insecticides, even though lives are saved through malaria prevention, identification of potential infant health risks associated with insecticide residues in breast milk must be incorporated in WHOPES evaluations and in the development of appropriate risk assessment tools.

Binary weight-of-evidence evaluations of chemical interactions--15 years of experience

The paper reflects on the last 15years of experience in the field of mixtures risk assessment. It summarizes results found in various documents developed by the Agency for Toxic Substances and Disease Registry (ATSDR) of the weight-of-evidence (WOE) approach applied to 380 binary combinations of chemicals. Of these evaluations, 156 assessments indicated possible additivity of effects [=], 76 indicated synergism (greater-than-additive effects [>]), and 57 indicated antagonism (less-than-additive effects [<]). However, 91 combinations lacked the minimum information needed for making any assessments and, hence, were undetermined. The paper provides examples of the rationale behind some of the WOE decisions and discusses the importance of expert judgments in risk assessment evaluations. Examples are given regarding the importance of human variability in mixtures' ability to affect human health and regarding the dose versus effect relationships.