Exposure to styrene and mortality from nervous system diseases and mental disorders

Long-term air pollution and risk of amyotrophic lateral sclerosis mortality in the Women's Health Initiative cohort

BACKGROUND

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with no cure. Although the etiology of sporadic ALS is largely unknown, environmental exposures may affect ALS risk.

OBJECTIVE

We investigated relationships between exposure to long-term ambient particulate matter (PM) and gaseous air pollution (AP) and ALS mortality.

METHODS

Within the Women's Health Initiative (WHI) cohort of 161,808 postmenopausal women aged 50-79 years at baseline (1993-1998), we performed a nested case-control study of 256 ALS deaths and 2486 matched controls with emphasis on PM constituents (PM_2.5, PM₁₀, and coarse PM [PM₁₀-_2.5]) and gaseous pollutants (NO_x, NO₂, SO₂, and ozone). Time-varying AP exposures estimates were averaged 5, 7.5, and 10 years prior to ALS death using both a GIS-based spatiotemporal generalized additive mixed model and ordinary kriging (empirical and multiple imputation, MI). Conditional logistic regression was used to estimate the relative risk of ALS death.

RESULTS

In general, PM_2.5 and PM₁₀-related risks were not significantly elevated using either method. However, for PM_10-2.5, odds ratios (ORs) were >1.0 for both methods at all time periods using MI and empirical data for PM_10-2.5 (coarse) except for 5 and 7.5 years using the kriging method with covariate adjustment.

CONCLUSION

This investigation adds to the body of information on long-term ambient AP exposure and ALS mortality. Specifically, the 2019 US Environmental Protection Agency (EPA) Integrated Science Assessment summarized the neurotoxic effects of PM_2.5, PM_10, and PM₁₀-_2.5. The conclusion was that evidence of an effect of coarse PM is suggestive but the data is presently not sufficient to infer a causal relationship. Further research on AP and ALS is warranted. As time from symptom onset to death in ALS is ∼2-4 years, earlier AP measures may also be of interest to ALS development. This is the first study of ALS and AP in postmenopausal women controlling for individual-level confounders.

Air Quality Dispersion Modelling to Evaluate CIPP Installation Styrene Emissions

Cured-in-place pipe (CIPP) is one of the most popular in situ rehabilitation techniques to repair sewer and water pipes. While there are multiple approaches to curing CIPP, steam-curing of styrene-based resins has been found to be associated with air-borne chemical emissions. Health officials, utilities and industry representatives have recognized the need to know more about these emissions, especially styrene. Such concern has led to multiple studies investigating the concentrations of volatile organic compounds on CIPP installation sites. This study expands upon previous effort by modeling worst-case, steam-cured CIPP emissions over a 5-year weather record. The effort also includes calibration of the model to emissions averages over the work day rather than instantaneous field measurements. Dispersion modelling software, AERMOD, was utilized to model the styrene component of CIPP emissions on two CIPP installation sites in the US. Based on the analysis results, it was found that the styrene emitted from stacks dissipates rapidly with styrene concentrations only exceeding minimum health and safety threshold levels at distances close to the stack (2 m or less). The values predicted by the model analysis are comparable with the field measured styrene concentrations from other studies. Current safety guidelines in the US recommend a 4.6-m (15-ft) safety perimeter for stack emission points. The results of this study indicate that significant and lasting health impacts are unlikely outside recommended safety perimeter. The results also validate the importance of enforcing recommended safety guidance on steam-cured CIPP sites.

Associations of Occupational Styrene Exposure With Risk of Encephalopathy and Unspecified Dementia: A Long-Term Follow-up Study of Workers in the Reinforced Plastics Industry

Exposure to industrial solvents has been associated with encephalopathy. Styrene is a neurotoxic industrial solvent, and we investigated the long-term risk of encephalopathy and unspecified dementia following styrene exposure. We followed 72,465 workers in the reinforced plastics industry in Denmark (1977–2011) and identified incident cases of encephalopathy (n = 228) and unspecified dementia (n = 565) in national registers. Individual styrene exposure levels were modeled from information on occupation, measurements of work place styrene levels, product, process, and years of employment. Adjusted analyses were performed using a discrete survival function. A positive trend for encephalopathy (P < 0.01) and a negative trend for unspecified dementia (P = 0.03) were seen with cumulative styrene exposure accrued during the recent period of up to 15 years. For unspecified dementia and the combination of unspecified dementia and encephalopathy, a positive trend was indicated when applying a 30-year exposure lag (P = 0.13 and P = 0.07). The risk patterns seen following recent exposure probably reflect diagnostic criteria for encephalopathy requiring recent industrial solvent exposure and referral bias rather than association with styrene exposure, while the increasing risk observed for unspecified dementia and the combination of encephalopathy and unspecified dementia following distant exposure indicates an increased risk of dementia following styrene exposure with a long latency period.

Environmental styrene exposure and neurologic symptoms in U.S. Gulf coast residents

BACKGROUND

Styrene is an established neurotoxicant at occupational levels, but effects at levels relevant to the general population have not been studied. We examined the neurologic effects of environmental styrene exposure among U.S. Gulf coast residents.

METHODS

We used National Air Toxics Assessment (NATA) 2011 estimates of ambient styrene concentrations to assign exposure levels for 21,962 non-diabetic Gulf state residents, and additionally measured blood styrene concentration in a subset of participants (n = 874). Neurologic symptoms, as well as detailed covariate information, were ascertained via telephone interview. We used log-binomial regression to estimate prevalence ratios (PR) and 95% confidence intervals (95% CI) for cross-sectional associations between both ambient and blood styrene levels and self-reported neurologic symptoms. We estimated associations independently for ten unique symptoms, as well as for the presence of any neurologic, central nervous system (CNS), or peripheral nervous system (PNS) symptoms. We also examined heterogeneity of associations with estimated ambient styrene levels by race and sex.

RESULTS

One-third of participants reported at least one neurologic symptom. The highest quartile of estimated ambient styrene was associated with one or more neurologic (PR, 1.12; 95% CI: 1.07,1.18), CNS (PR, 1.17; 95% CI: 1.11,1.25), and PNS (PR, 1.16; 95% CI: 1.09,1.25) symptom. Results were less consistent for biomarker analyses, but blood styrene level was suggestively associated with nausea (PR, 1.78; 95% CI: 1.04, 3.03). In stratified analyses, we observed the strongest effects among non-White participants.

CONCLUSIONS

Increasing estimated ambient styrene concentration was consistently associated with increased prevalence of neurologic symptoms. Associations between blood styrene levels and some neurologic symptoms were suggestive. Environmental styrene exposure levels may be sufficient to elicit symptomatic neurotoxic effects.

Exposure to hazardous air pollutants and the risk of amyotrophic lateral sclerosis

BACKGROUND

Amyotrophic lateral sclerosis (ALS) is a serious and rapidly fatal neurodegenerative disorder with an annual incidence of 1-2.6/100,000 persons. Few known risk factors exist although gene-environment interaction is suspected. We investigated the relationship between suspected neurotoxicant hazardous air pollutants (HAPs) exposure and ALS.

METHODS

A case-control study involving sporadic ALS cases (n = 51) and matched controls (n = 51) was conducted from 2008 to 2011. Geocoded residential addresses were linked to U.S. EPA NATA data (1999, 2002, and 2005) by census tract. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression.

RESULTS

Residential exposure to aromatic solvents significantly elevated the risk of ALS among cases compared to controls in 2002 (OR = 5.03, 95% CI: 1.29, 19.53) and 1999 (OR = 4.27, 95% CI: 1.09, 16.79) following adjustment for education, smoking, and other exposure groups. Metals, pesticides, and other HAPs were not associated with ALS.

CONCLUSIONS

A potential relationship is suggested between residential ambient air aromatic solvent exposure and risk of ALS in this study.

"Toxic" glaucoma? A case of possible styrene-induced ocular hypertension

This case report is the first, to our knowledge, to describe ocular hypertension in a patient with occupational exposure to styrene. The intraocular pressure then returned to normal levels with removal of exposure.

Reduced production of anti-inflammatory soluble HLA-G molecules in styrene exposed workers

HLA-G antigens are non-classical HLA-class I anti-inflammatory molecules. Since styrene exposure has been suggested to induce immune alteration, we analyzed plasma levels and "in vitro" peripheral blood mononuclear cell (PBMC) production of soluble HLA-G (sHLA-G) and interleukin-10 (IL-10) molecules after lipopolysaccharide (LPS) stimulation, in styrene exposed workers and healthy subjects. Exposed workers showed reduced plasma levels of sHLA-G and IL-10 in comparison to healthy controls. Similarly, lower levels of sHLA-G and IL-10 molecules were observed in PBMC culture supernatants after LPS activation. These data propose styrene exposure as a mediator of impaired sHLA-G production.

Trends in occupational exposure to styrene in the European glass fibre-reinforced plastics industry

Aim: This study presents temporal trends of styrene exposure for workers in the European glass fibre-reinforced plastics (GRP) industry during the period 1966–2002.

Methods: Data of personal styrene exposure measurements were retrieved from reports, databases and peer-reviewed papers. Only sources with descriptive statistics of personal measurements were accepted. The styrene exposure data cover personal air samples and biological monitoring data, that is, urinary styrene metabolites (mandelic acid and/or phenylglyoxylic acid) and styrene in blood. Means of series of measurements were categorized by year, country, production process, job and sampling strategy. Linear mixed models were used to identify temporal trends and factors affecting exposure levels.

Results: Personal exposure measurements were available from 60 reports providing data on 24145 1–8-h time-weighted average shift personal air samples. Available data of biological exposure indicators included measurements of mandelic acid in post-shift urine (6361 urine samples being analysed). Trend analyses of the available styrene exposure data showed that the average styrene concentration in the breathing zone of open-mould workers in the European GRP industry has decreased on average by 5.3% per year during the period 1966–1990 and by only 0.4% annually in the period after 1990. The highest exposures were measured in Southern Europe and the lowest exposures in Northern Europe with Central Europe in between. Biological indicators of styrene (mandelic acid in post-shift urine) showed a somewhat steeper decline (8.9%), most likely because urine samples were collected in companies that showed a stronger decrease of styrene exposure in air than GRP companies where no biological measurements were carried out.

Effects of subchronic exposure to styrene on the extracellular and tissue levels of dopamine, serotonin and their metabolites in rat brain

At present, there is controversy over the neurotoxic potential of styrene. Several epidemiological and clinical studies have shown that styrene exposure causes alterations of central nervous system functions in humans. Neurotransmitters have been implicated in the pathogenesis of styrene neurotoxicity in rodents. Several studies carried out on postmortem brain tissue suggest that styrene may alter dopaminergic neurotransmission in rabbit or rat brain. Moreover, in vitro studies suggest that both styrene and styrene oxide inhibit the uptake of dopamine (DA) in purified synaptic vesicles prepared from rat brain striata. To date, biochemical studies on animals have explored global tissue levels of neurotransmitters with sub-acute exposures to styrene. However, extracellular levels of neurotransmitters are more closely related to behaviour than are global tissue levels. The present study determined changes in the extracellular concentrations of DA, serotonin (5-HT) and their acid metabolites, dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA) and 5-hydroxyindolacetic acid (5-HIAA), in striatal dialysates from freely moving adult male rats after exposure to 750 and 1,000 ppm styrene, 6 h per day, 5 days per week for 4 weeks. We also determined the concentrations of DA, 5-HT and their acid metabolites in striatum, nucleus accumbens and prefrontal cortex obtained postmortem from similarly exposed rats. Exposure to 1,000 ppm of styrene caused a significant decrease in extracellular acid metabolite concentrations. Tissue levels of acid metabolites were also decreased to a lesser extent. The effects were observed 72 h after discontinuing exposure but had vanished 17 days later. There was no change in DA or 5-HT concentrations either in the dialysates or tissues. Exposure to 750 ppm styrene caused no changes in the concentrations of DA, 5-HT and their acid metabolites either in the dialysates or tissues. The possibility that the effect of styrene is mediated by monoamine oxidase (MAO) inhibition is discussed.

Mortality patterns among workers exposed to styrene in the reinforced plastic boatbuilding industry: an update

BACKGROUND

Mortality was updated through 1998 for 5,204 workers exposed to styrene between 1959 and 1978 at two reinforced plastic boatbuilding plants. The a priori hypothesis: leukemia and lymphoma excesses would be found.

METHODS

Standardized mortality ratios (SMR) and 95% confidence intervals (CI) used Washington State and U.S. rates.

RESULTS

Overall, 860 deaths occurred (SMR 1.09, CI 1.02-1.17), with excess mortality for esophageal cancer (n = 12, SMR 2.30, CI 1.19-4.02), prostate cancer (n = 24, SMR 1.71, CI 1.09-2.54), and accidents (n = 99, SMR 1.26, CI 1.02-1.53). Among 2,062 highly exposed workers, urinary tract cancer (n = 6, SMR 3.44, CI 1.26-7.50) and respiratory disease (n = 12, SMR 2.54, CI 1.31-4.44) rates were elevated. Urinary tract cancer SMR increased with duration of employment.

CONCLUSIONS

We found no excess leukemia or lymphoma mortality. Unanticipated excess urinary tract cancer and respiratory disease mortality, possibly associated with styrene exposure, are difficult to interpret and could be chance findings.

An exploratory investigation of suicide and occupational exposure

This exploratory study evaluated the association between suicide and occupational exposure to electromagnetic fields, pesticides, and hydrocarbon solvents. The study population comprised 11,707 suicide deaths and 132,771 eligible controls identified from United States death certificate files for the years 1991 and 1992. Exposure assignment was based on job title reported on the death certificates. Exposure to electromagnetic fields and pesticides was weakly associated with suicide risk, while little evidence for an increased risk was seen for hydrocarbon solvents. The association for electromagnetic field exposure was highest for suicide between the ages 20 and 35 (odds ratio; OR = 1.5), while the highest risk of suicide for pesticide exposure was seen between the ages of 35 and 49 years (OR = 1.5). Further investigation to replicate these findings seems warranted, using higher quality occupational data.

An application of the challenge assay in boat builders exposed to low levels of styrene--a feasibility study of a possible biomarker for acquired susceptibility

Sensitivity to carcinogens and susceptibility for malignant diseases may be related to genetic predisposition, e.g. polymorphisms in toxicant-metabolizing enzymes or DNA repair deficiencies. The latter may also be acquired by exposure to substances that interfere with DNA repair processes. Application of the challenge assay to an exposed population may allow scientists to study the interference of DNA repair as an acquired susceptibility phenomenon. The assay was therefore used in a feasibility study to evaluate its application. A group of 14 workers exposed to low levels of styrene (mean < 100 mg/m3 styrene in air; 35 micrograms/l styrene in blood) and a reference of seven controls were investigated for structural chromosomal aberrations using FISH. The rate of exchange-type aberrations per 100 metaphases was 0.14 (95% CI, 0.05-0.31) in controls and 0.22 (95% CI, 0.13-0.36) in exposed workers. The difference is not statistically significant. Interaction with DNA repair was measured in the 14 workers and 2 historical controls using the challenge assay. Exchange-type aberrations per 100 metaphases after X-ray challenge of 1.66 Gy were 13.26 (10.53-16.50) and 16.19 (15.00-17.40) for the controls and exposed, respectively. The difference is statistically significant (p < 0.038). Among the exposed group, the challenge response was also significantly correlated with the cumulative lifetime exposure to styrene (R2 = 0.3996; p < 0.015) but not with the current exposure as measured in blood (R2 = 0.0226; p = 0.700). The challenge responses in the short-term and long-term exposed subgroups were 15.55 (14.23-16.96) and 17.90 (15.64-20.39), respectively, based on sample sizes of 5 and 9, respectively. The difference was not significant. Hence, data from our study are consistent with the hypothesis that long-term exposure to styrene can interfere with DNA repair activities. The lack of statistically significant differences in some of the data may be due to the small sample size and a possible confounding by age in our investigation. Additional data from our ongoing study should clarify this uncertainty.

Cumulative exposure to styrene and visual functions

BACKGROUND

Results from a 1990-1992 longitudinal study of several reinforced plastics plants showed that for those workers whose styrene exposure had decreased, color vision (CV) improved; while near visual contrast sensitivity (CS) was poorer.

METHODS

In 1999, we retested these visual functions in 18 workers with good visual acuity. A cumulative exposure index (CEI), corrected for respirator use, was calculated for each worker.

RESULTS

Intra-individual comparison of mandelic acid (MA) showed a significant decrease over time (Friedman; P = 0.015), but current values were not related to CEI. For CV, no significant difference was observed between 1992 and 1999; present results were not related to MA or CEI. The CS profile decreased over time, with significant differences at 3 cpd (Friedman; P < 0.05). CS did not vary with MA levels, but was significantly depressed at the intermediate frequencies among those in the upper CEIH category (Kruskal-Wallis; P < 0.05).

CONCLUSIONS

These findings suggest that CS loss increases with long-term cumulative exposure, reflecting chronic damage to the neuro-optic pathways.

Metabolism of styrene in the human liver in vitro: interindividual variation and enantioselectivity

1. The interindividual variation and enantioselectivity of the in vitro styrene oxidation by cytochrome P450 have been investigated in 20 human microsomal liver samples. Liver samples were genotyped for the CYP2E1*6 and CYP2E1*5B alleles. 2. Kinetic analysis indicated the presence of at least two forms of styrene-metabolizing cytochrome P450. The enzyme constants for the high-affinity component were subject to appreciable interindividual variation, i.e. Vmax1 ranged from 0.39 to 3.20 nmol mg protein(-1) min(-1) (0.96+/-0.63) and Km1 ranged from 0.005 to 0.03 mM (0.011+/-0.006). Inhibition studies with chemical inhibitors of CYP2E1, CYP1A2, CYP2C8/9 and CYP3A4 demonstrated that CYP2E1 was the primary enzyme involved in the high-affinity component of styrene oxidation. No relationship between the interindividual variation in Vmax1 and Km1 and the genetic polymorphisms of the CYP2E1 gene was found. 3. Cytochrome P450-mediated oxidation of styrene demonstrated a moderate enantioselectivity, with an enantiomeric excess (ee) of (S)-styrene oxide of 15% (range 4-27%) at low styrene concentration and an ee of (R)-styrene oxide of 7% (range -11 to +22%) at high styrene concentration. This points towards the involvement of at least two cytochrome P450, with different enantioselectivities. 4. The data indicate that cytochrome P450-mediated styrene oxidation is subject to considerable interindividual variation, but only to a moderate product enantioselectivity.

Health effects of solvent exposure among dockyard painters: mortality and neuropsychological symptoms

OBJECTIVES

To study mortality and prevalence of neuropsychological symptoms among a cohort of painters known to have been heavily exposed to organic solvents.

METHODS

A mortality study of 1292 male painters who had worked in a dockyard in Scotland for > or = 1 year between 1950 and 1992 comprised a nested cross sectional study of 953 surviving painters from the cohort and 953 male non-painters randomly selected from the local population and a case-control study of those with high symptom scores. Mortality, symptoms, and risks associated with painting, adjusting for age, education, smoking, alcohol, and personality were measured.

RESULTS

The proportional mortality ratio for all cancers was not increased significantly (110 (95% confidence interval (95% CI) 84 to 143), except for a possible excess of deaths from ischaemic heart disease (132, 105 to 164). Standardised mortality ratios were not significantly increased. Among the 260 surviving painters and 539 community controls who responded to the questionnaire there was a significant excess of symptoms among painters; adjusted relative risk (RR) increased significantly with increasing symptom score. These RRs suggested an exposure-response relation; for a high score (12-22) for all symptoms RR was 2.27 (1.20 to 4.30) for 1-4 years of exposure, 2.42 (1.18 to 4.95) for 5-9 years, 2.89 (1.42 to 5.88) for 10-14 years, and 3.41 (1.82 to 6.36) for 15-41 years, compared with controls. In multivariate analyses, painting exposure, and aging were associated with high symptom scores and there was again an increased risk relative to time worked as a painter.

CONCLUSION

This study supports the hypothesis that heavy and prolonged exposure to paint solvents leads to neuropsychological ill health.