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Li J, Chen R, Liu P, Zhang X, Zhou Y, Xing Y, Xiao X, Huang Z. Association of Di(2-ethylhexyl) Terephthalate and Its Metabolites with Nonalcoholic Fatty Liver Disease: An Epidemiology and Toxicology Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:8182-8193. [PMID: 38691136 DOI: 10.1021/acs.est.3c09503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
As an alternative plasticizer to conventional phthalates, di(2-ethylhexyl) terephthalate (DEHTP) has attracted considerable concerns, given its widespread detection in the environment and humans. However, the potential toxicity, especially liver toxicity, posed by DEHTP remains unclear. In this study, based on the 2017-2018 National Health and Nutrition Examination Survey, two metabolites of DEHTP, i.e., mono(2-ethyl-5-hydroxyhexyl) terephthalate (MEHHTP) and mono(2-ethyl-5-carboxypentyl) terephthalate (MECPTP), were found to be present in the urine samples of nearly all representative U.S. adults. Moreover, a positive linear correlation was observed between the concentrations of the two metabolites and the risk of nonalcoholic fatty liver disease (NAFLD) in the population. Results of weighted quantile sum and Bayesian kernel machine regression indicated that MEHHTP contributed a greater weight to the risk of NAFLD in comparison with 12 conventional phthalate metabolites. In vitro experiments with hepatocyte HepG2 revealed that MEHHTP exposure could increase lipogenic gene programs, thereby promoting a dose-dependent hepatic lipid accumulation. Activation of liver X receptor α may be an important regulator of MEHHTP-induced hepatic lipid disorders. These findings provide new insights into the liver lipid metabolism toxicity potential of DEHTP exposure in the population.
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Affiliation(s)
- Jiaoyang Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan 430071, P.R. China
| | - Rongbin Chen
- Department of Metabolism and Endocrinology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, P.R. China
| | - Peng Liu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan 430071, P.R. China
| | - Xin Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan 430071, P.R. China
| | - Yan Zhou
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan 430071, P.R. China
| | - Yudong Xing
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan 430071, P.R. China
| | - Xinhua Xiao
- Department of Metabolism and Endocrinology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, P.R. China
| | - Zhenzhen Huang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan 430071, P.R. China
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Cambien G, Dupuis A, Guihenneuc J, Bauwens M, Belmouaz M, Ayraud-Thevenot S. Endocrine disruptors in dialysis therapies: A literature review. ENVIRONMENT INTERNATIONAL 2023; 178:108100. [PMID: 37481953 DOI: 10.1016/j.envint.2023.108100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/30/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
Endocrine disrupting chemicals (EDCs) were defined as "an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects". These compounds are mainly eliminated by the renal route. However, patients with end-stage kidney disease treated by dialysis (ESKDD) can no longer eliminate these EDCs efficiently. Furthermore, EDCs exposure could occur via leaching from medical devices used in dialysis therapy. As a result, ESKDD patients are overexposed to EDCs. The aims of this study were to summarize EDCs exposure of ESKDD patients and to evaluate the factors at the origin of this exposure. To handle these objectives, we performed a literature review. An electronic search on PubMed, Embase and Web of science databases was performed. Twenty-six studies were finally included. The EDCs reported in these studies were Bisphenol A (BPA), Bisphenol S (BPS), Bisphenol B (BPB), Nonylphenol, Di(2-ethylhexyl) phthalate (DEHP), Di-n-butyl phthalate (DBP), and Butylbenzyl phthalate (BBP). Regarding the environment of dialysis patients, BPA, BPB, BPS, DEHP, DBP and nonylphenol have been found. Environmental exposure affects EDCs blood levels in ESKDD patients who are overexposed to BPA, BPS, BPB and DEHP. For ESKDD patients, dialyzers with housing in polycarbonate and fibers in polysulfone seem to overexpose them to BPA. Regarding dialysis therapy, peritoneal dialysis seems to decrease patient exposure vs hemodialysis therapy, and hemodiafiltration therapy seems to reduce this exposure vs hemodialysis therapy. Regarding DEHP, levels tend to increase during dialysis and when DEHP plasticizer is used in PVC devices. Finally, in the European Union a regulation on medical devices was adopted on 5 April 2017 and has been applied recently. This regulation will regulate EDCs in medical devices and thereby contribute to reconsideration of their conceptions and, finally, to reduction of ESKDD patients' exposure.
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Affiliation(s)
- Guillaume Cambien
- Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France.
| | - Antoine Dupuis
- Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France.
| | - Jérémy Guihenneuc
- Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France.
| | - Marc Bauwens
- Digestiv, Urology, Nephrology, Endocrinology Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France.
| | - Mohamed Belmouaz
- Digestiv, Urology, Nephrology, Endocrinology Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France.
| | - Sarah Ayraud-Thevenot
- Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France.
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Bernard L, Bailleau M, Eljezi T, Chennell P, Souweine B, Lautrette A, Sautou V. How does continuous venovenous hemofiltration theoretically expose (ex-vivo models) inpatients to diethylhexyladipate, a plasticizer of PVC medical devices? CHEMOSPHERE 2020; 250:126241. [PMID: 32105858 DOI: 10.1016/j.chemosphere.2020.126241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
Continuous venovenous hemofiltration (CVVH) is widely used in intensive care units to treat patients with acute kidney injury requiring renal replacement therapy. The medical devices (MD) used for CVVH include a hemofilter and tubings made of plasticized PVC. Due to its known reprotoxicity, diethylhexyl phthalate (DEHP) has been replaced by alternatives such as diethylhexyladipate (DEHA) in some of these tubings. The migration of DEHA from hemofiltration systems has not been assessed and thus the level of patient exposure to this DEHP-alternative remains unknown. In this study, 2 CVVH models were used to evaluate the potential migration of DEHA from PVC tubings, allowing the determination of (Rachoin and Weisberg, 2019) the highest rates of DEHA able to migrate into a simulant flowing in a marketed adult CVVH circuit by disregarding any metabolisation and (Krieter et al., 2013) the clinical-reflecting exposure of patients to this plasticizer and its metabolites by assessing their migration into blood. In the first model, we showed that patients undergoing a CVVH procedure may be exposed to high rates of DEHA. Moreover, DEHA is continuously hydrolyzed into its primary metabolite MEHA (monoethylhexyladipate), which may reach cytotoxic level in the patients' blood. When looking from a « safer » MD perspective, DEHA might not be the best alternative plasticizer for CVVH tubings. However, to reflect clinical conditions, this study should be completed by an in-vivo evaluation (biomonitoring) of the oxidized metabolites of DEHA in urines of inpatients undergoing CVVH.
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Affiliation(s)
- Lise Bernard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, f-63000, Clermont-Ferrand, France.
| | - Mélanie Bailleau
- CHU Clermont-Ferrand, Service de Réanimation Chirurgie Cardio-vasculaire, f-63000, Clermont-Ferrand, France
| | - Teuta Eljezi
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, f-63000, Clermont-Ferrand, France
| | - Philip Chennell
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, f-63000, Clermont-Ferrand, France
| | - Bertrand Souweine
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, LMGE «Laboratoire Micro-organismes: Génome et Environnement», f-63000, Clermont-Ferrand, France
| | - Alexandre Lautrette
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, LMGE «Laboratoire Micro-organismes: Génome et Environnement», f-63000, Clermont-Ferrand, France
| | - Valérie Sautou
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, f-63000, Clermont-Ferrand, France
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Henriksen LS, Mathiesen BK, Assens M, Krause M, Skakkebæk NE, Juul A, Andersson AM, Hart RJ, Newnham JP, Keelan JA, Pennell C, Main KM, Frederiksen H. Use of stored serum in the study of time trends and geographical differences in exposure of pregnant women to phthalates. ENVIRONMENTAL RESEARCH 2020; 184:109231. [PMID: 32087443 DOI: 10.1016/j.envres.2020.109231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Exposure to some phthalate diesters has been associated with adverse reproductive health outcomes in both rodents and humans indicative of anti-androgenic effects. Exposure during sensitive periods of development, such as prenatally, is of particular concern. OBJECTIVES We wished to investigate whether phthalate metabolites measured in maternal serum samples from historical birth cohorts can be used to assess prenatal exposure. Further, we aimed to study temporal and geographical trends in phthalate exposure across three different birth cohorts. METHODS We compared phthalate metabolite levels in maternal serum samples from an Australian (1989-91) and a Danish (1997-2001) birth cohort with levels in serum and urine samples from a recent Danish birth cohort (2012-14). Samples were analysed for 32 phthalate metabolites from 15 phthalate diesters by isotope-diluted liquid chromatography-tandem mass spectrometry (LC-MS/MS). Correlations between metabolites were tested by Spearman rank correlation test, and differences between the cohorts were tested by Mann-Whitney U test. RESULTS Overall, we observed large variations in serum phthalate metabolite levels between individuals. Secondary metabolites of di-(2-ethyl-hexyl) phthalate (DEHP) and di-iso-nonyl phthalate (DiNP) in serum were weakly to moderately and positively correlated to the levels measured in urine, and secondary metabolites of DEHP were also moderately to strongly and significantly correlated in serum. Correlations with mono-(2-ethyl-hexyl) phthalate (MEHP) and mono-iso-nonyl phthalate (MiNP), the two primary metabolites of DEHP and DiNP, were inconsistent, and we found indications of sample contamination. We observed some significant differences in phthalate metabolite levels between the three cohorts with generally higher levels in the older birth cohorts. CONCLUSION Based on comparison across two older birth cohorts and a recent cohort, our results support the concept that historical biobanked serum samples may be used for assessment of prenatal exposure to phthalates when using serum levels of the monoesters of the low-molecular weight (LMW) phthalates and the secondary metabolites of the high-molecular weight (HMW) phthalates. Serum phthalate measurements are, however, not suitable for human biomonitoring and should only be used to exploit historical samples from cohorts, where urine samples were not collected. Our findings suggest that phthalate exposure may have decreased over time from the early 1990s to the 2010s.
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Affiliation(s)
- Louise S Henriksen
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Barbara K Mathiesen
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Maria Assens
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Marianna Krause
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Niels Erik Skakkebæk
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Roger J Hart
- Division of Obstetrics & Gynaecology, Faculty of Health & Medical Sciences, University of Western Australia, Perth, WA, 6008, Australia; Fertility Specialists of Western Australia, Bethesda Hospital, 25 Queenslea Drive, Claremont, WA, 6010, Australia
| | - John P Newnham
- Division of Obstetrics & Gynaecology, Faculty of Health & Medical Sciences, University of Western Australia, Perth, WA, 6008, Australia
| | - Jeffrey A Keelan
- Division of Obstetrics & Gynaecology, Faculty of Health & Medical Sciences, University of Western Australia, Perth, WA, 6008, Australia
| | - Craig Pennell
- Discipline of Obstetrics and Gynaecology, School of Medicine and Public Health, Faculty of Medicine and Health, The University of Newcastle, New South Wales, Australia
| | - Katharina M Main
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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Fernandez-Canal C, Pinta PG, Eljezi T, Larbre V, Kauffmann S, Camilleri L, Cosserant B, Bernard L, Pereira B, Constantin JM, Grimandi G, Sautou V. Patients’ exposure to PVC plasticizers from ECMO circuits. Expert Rev Med Devices 2018; 15:377-383. [DOI: 10.1080/17434440.2018.1462698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Teuta Eljezi
- CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut de Chimie de Clermont-Ferrand, Université Clermont Auvergne, Clermont–Ferrand, France
| | - Virginie Larbre
- CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut de Chimie de Clermont-Ferrand, Université Clermont Auvergne, Clermont–Ferrand, France
| | - Sophie Kauffmann
- Département de médecine périopératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lionel Camilleri
- Chirurgie cardio-vasculaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bernard Cosserant
- Département de médecine périopératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lise Bernard
- CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut de Chimie de Clermont-Ferrand, Université Clermont Auvergne, Clermont–Ferrand, France
| | - Bruno Pereira
- Direction à la recherche clinique et l’innovation, CHU Clermont-Ferrand, Clermont- Ferrand, France
| | | | - Gael Grimandi
- LIOAD INSERM UMR_S 791, Université de Nantes, Nantes, France
- Pôle Pharmacie, CHU Nantes, Nantes, France
| | - Valérie Sautou
- CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut de Chimie de Clermont-Ferrand, Université Clermont Auvergne, Clermont–Ferrand, France
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Luo H, Sun G, shi Y, Shen Y, Xu K. Evaluation of the Di(2-ethylhexyl)phthalate released from polyvinyl chloride medical devices that contact blood. SPRINGERPLUS 2014; 3:58. [PMID: 24516786 PMCID: PMC3916584 DOI: 10.1186/2193-1801-3-58] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022]
Abstract
Extraction methods that simulate those used in the clinic are recommended for obtaining extraction solutions. For polyvinyl chloride (PVC) medical devices that have contact with human blood, an alternative medium (ethanol/water mixture) is suggested as an extraction screening vehicle to evaluate the di(2-ethylhexyl)phthalate (DEHP) released. A test comparing the extraction ability between the alternative medium and whole blood from three healthy volunteers has been conducted. An experimental method is provided outlining the chemical analysis of the DEHP released from medical devices made with polyvinyl chloride (PVC). Gas chromatography-mass spectrometry (GC-MS) in the selective ion monitoring (SIM) mode was used to analyze and quantify the extracted DEHP. The linear range of the SIM method was 0.1-200 μg/mL, and the recoveries were 89.6-101.5% and 91.0-98.9% when using the ethanol/water mixture and whole blood as the extraction media, respectively. The validated method demonstrates that it is suitable for the determination of the DEHP released from PVC medical devices that have contact with blood. The results from the determination of the DEHP released will be compared with the limits derived from toxicological data for the parenteral exposure route and certain population groups, and the results will be used in the risk assessment of medical devices.
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Affiliation(s)
- Hongyu Luo
- />CFDA Jinan Quality Inspection Center for Medical Devices, 99 Tianluo Road H-T Industrial Development Zone, Jinan, 250000 China
- />Shandong Provincial Key Laboratory of Biological Evaluation of Medical Device, 99 Tianluo Road H-T Industrial Development Zone, Jinan, 250000 China
| | - Guangyu Sun
- />CFDA Jinan Quality Inspection Center for Medical Devices, 99 Tianluo Road H-T Industrial Development Zone, Jinan, 250000 China
- />Shandong Provincial Key Laboratory of Biological Evaluation of Medical Device, 99 Tianluo Road H-T Industrial Development Zone, Jinan, 250000 China
| | - Yanping shi
- />CFDA Jinan Quality Inspection Center for Medical Devices, 99 Tianluo Road H-T Industrial Development Zone, Jinan, 250000 China
- />Shandong Provincial Key Laboratory of Biological Evaluation of Medical Device, 99 Tianluo Road H-T Industrial Development Zone, Jinan, 250000 China
| | - Yong Shen
- />Shandong Hengxin Inspection Technology Development Center, 99 Tianluo Road H-T Industrial Development Zone, Jinan, 250000 China
| | - Kai Xu
- />Shandong Hengxin Inspection Technology Development Center, 99 Tianluo Road H-T Industrial Development Zone, Jinan, 250000 China
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Lyche JL, Gutleb AC, Bergman A, Eriksen GS, Murk AJ, Ropstad E, Saunders M, Skaare JU. Reproductive and developmental toxicity of phthalates. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2009; 12:225-49. [PMID: 20183522 DOI: 10.1080/10937400903094091] [Citation(s) in RCA: 386] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The purposes of this review are to (1) evaluate human and experimental evidence for adverse effects on reproduction and development in humans, produced by exposure to phthalates, and (2) identify knowledge gaps as for future studies. The widespread use of phthalates in consumer products leads to ubiquitous and constant exposure of humans to these chemicals. Phthalates were postulated to produce endocrine-disrupting effects in rodents, where fetal exposure to these compounds was found to induce developmental and reproductive toxicity. The adverse effects observed in rodent models raised concerns as to whether exposure to phthalates represents a potential health risk to humans. At present, di(2-ethylhexyl) phthalate (DEHP), di-n-butyl phthalate (DBP), and butyl benzyl phthalate (BBP) have been demonstrated to produce reproductive and developmental toxicity; thus, this review focuses on these chemicals. For the general population, DEHP exposure is predominantly via food. The average concentrations of phthalates are highest in children and decrease with age. At present, DEHP exposures in the general population appear to be close to the tolerable daily intake (TDI), suggesting that at least some individuals exceed the TDI. In addition, specific high-risk groups exist with internal levels that are several orders of magnitude above average. Urinary metabolites used as biomarkers for the internal levels provide additional means to determine more specifically phthalate exposure levels in both general and high-risk populations. However, exposure data are not consistent and there are indications that secondary metabolites may be more accurate indicators of the internal exposure compared to primary metabolites. The present human toxicity data are not sufficient for evaluating the occurrence of reproductive effects following phthalate exposure in humans, based on existing relevant animal data. This is especially the case for data on female reproductive toxicity, which are scarce. Therefore, future research needs to focus on developmental and reproductive endpoints in humans. It should be noted that phthalates occur in mixtures but most toxicological information is based on single compounds. Thus, it is concluded that it is important to improve the knowledge of toxic interactions among the different chemicals and to develop measures for combined exposure to various groups of phthalates.
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Affiliation(s)
- Jan L Lyche
- Department of Production Animal Clinical Science, Norwegian School of Veterinary Science, Oslo, Norway.
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8
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Abstract
The treatment of end-stage renal disease (ESRD) makes extensive use of presterilized disposable items which, after use, are contaminated by blood. The preferred route of disposal of such items is by incineration. Disposal costs have risen and this increase in costs has not been matched by waste management programs in renal units. Many of the waste items generated also contain polyvinyl chloride (PVC) whose incineration is environmentally sensitive. Furthermore blood tubing sets contain plasticizers such as di(2-ethylhexyl) phthalate (DEHP), which is known to pose health risks to specific groups of patients. The generation of clinical waste in a dialysis unit is analyzed, issues associated with disposal are discussed, and approaches toward a cost-effective, environmentally sustainable clinical waste management program are reviewed.
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Affiliation(s)
- Nicholas A Hoenich
- School of Clinical Medical Sciences, Medical School, University of Newcastle, Newcastle upon Tyne, United Kingdom.
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Ankersmit HJ, Wieselthaler G, Moser B, Gerlitz S, Roth G, Boltz-Nitulescu G, Wolner E. Transitory immunologic response after implantation of the DeBakey VAD continuous-axial-flow pump. J Thorac Cardiovasc Surg 2002; 123:557-61. [PMID: 11882831 DOI: 10.1067/mtc.2002.120011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The development of local and systemic infection is a significant risk factor associated with implantation of a ventricular assist device. The immunologic consequence of continuous-flow rotary blood pumps is not known. METHODS Six male adult patients (mean age 47 plus minus 10.3) with end-stage left heart failure received a DeBakey VAD axial-flow pump for use as a bridge to transplantation. (Four patients underwent transplantation after a mean 115 plus minus 14 days; 2 patients are still waiting for the allograft.) RESULTS We prospectively monitored T-cell populations and apoptosis-specific aberrant T-cell activation via CD95 triggering and annexin V binding to lymphocytes, identifying T cells undergoing early phases of apoptosis, within the first 10 weeks. Moreover, soluble death-inducing receptors soluble CD95 and soluble tumor necrosis factor-R1 were evaluated by enzyme-linked immunosorbent assay. CONCLUSION Patients bridged to transplantation by a nonpulsatile ventricular assist device demonstrated an initial pronounced apoptosis-specific immune alteration by increased annexin V binding to CD3 T cells and death-inducing receptors soluble CD95/tumor necrosis factor-R1 (all P <.001). All parameters normalized after 7 weeks to baseline. No blood-borne sepsis was detected, as defined by blood culture, within the first 10 weeks of the cohort study. These results indicate a biphasic immunologic response in patients with end-stage heart failure treated with nonpulsatile ventricular assist devices.
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Affiliation(s)
- Hendrik Jan Ankersmit
- Department of Surgery, General Hospital Vienna University, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Ankersmit HJ, Deicher R, Moser B, Teufel I, Roth G, Gerlitz S, Itescu S, Wolner E, Boltz-Nitulescu G, Kovarik J. Impaired T cell proliferation, increased soluble death-inducing receptors and activation-induced T cell death in patients undergoing haemodialysis. Clin Exp Immunol 2001; 125:142-8. [PMID: 11472437 PMCID: PMC1906103 DOI: 10.1046/j.1365-2249.2001.01590.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Haemodialysis is a widespread option for end-stage renal disease (ESRD). Long-term success of dialysis is, however, limited by a high rate of serious bacterial and viral infections. We compared T cell functions in ESRD patients undergoing haemodialysis (n = 20), or were not dialysed and received conventional medical treatment (n = 20). Healthy volunteers (n = 15) served as controls. The T cell phenotype was examined by immunofluorescence using fluorochrome-labelled monoclonal antibodies and FACS analysis. The concentration of soluble CD95/Fas and of tumour necrosis factor-alpha receptor type 1 (sTNFR1) in the sera was quantified by ELISA. Activation-induced programmed T cell death was triggered by anti-CD3/CD28 antibodies and measured by 7-AAD staining. All immunological tests were performed at least 1 month after dialysis initiation. T cell proliferation in response to phytohaemagglutinin or anti-CD3 monoclonal antibodies was moderately diminished in non-dialysed patients and markedly reduced in haemodialysis patients compared to healthy controls (P < 0.01 and P < 0.001, respectively). In a mixed lymphocyte culture the proliferative response of T cells from dialysed patients was significantly diminished (P < 0.001). T cells of both non-dialysed and dialysed patients have augmented CD95/Fas and CD45RO expression, increased sCD95/Fas and sTNFR1 release and spontaneously undergo apoptosis. Culture of T cells from haemodialysis patients with anti-CD3/CD28 antibodies increased the proportion of CD4(+) T cells committing activation-induced cell death by a mean 7.5-fold compared to T-helper cells from non-dialysed patients (P < 0.001). Renal failure and initiation of haemodialysis results in a reduced proliferative T cell response, an aberrant state of T cell activation and heightened susceptibility of CD4(+) T cells to activation-induced cell death.
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Affiliation(s)
- H J Ankersmit
- Department of Surgery, General Hospital of Vienna University, Vienna, Austria.
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