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Vitturi BK, Montecucco A, Rahmani A, Dini G, Durando P. Occupational risk factors for multiple sclerosis: a systematic review with meta-analysis. Front Public Health 2023; 11:1285103. [PMID: 38054069 PMCID: PMC10694508 DOI: 10.3389/fpubh.2023.1285103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Objective We decided to conduct the first systematic review with meta-analysis to provide the highest level of up-to-date evidence on the occupational risk factors for Multiple Sclerosis. Methods A systematic, comprehensive literature search was performed in four electronic academic databases. We included any case-control study that enrolled working-age subjects and compared the proportion of MS cases with controls who were not exposed to an occupational risk factor. The primary outcome was the occurrence of MS. The quality assessment was performed with the Critical Appraisal Checklist for Case Control Studies, developed, and validated by the Joanna Briggs Institute. All the selection process was also carried out by two independent and previously trained researchers. Results Overall, the total sample included 19,004 people with MS and 4,164,162 controls. Agricultural workers (OR = 1.44, 95% CI 1.13-1.83), offshore workers (OR = 3.56, 95% CI 2.74-4.61), and hairdressers (OR = 8.25, 95% CI 1.02-66.52) were associated with a higher probability of being diagnosed with MS. In parallel, workers exposed to toxic fumes from oil wells (OR = 16.80, 95% CI 8.33-33.90), low-frequency magnetic fields (OR = 1.71, 95% CI 1.03-2.72), and pesticides (OR = 3.17, 95% CI = 2.53-3.99) also had an increased likelihood of having MS. Conclusion Our study has the potential to influence more assertive public policies. Nevertheless, future studies on how the occupational setting may contribute to the incidence of MS are highly recommended. Systematic review registration The protocol was registered in the international prospective register of systematic reviews (PROSPERO- CRD42023443257).
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Affiliation(s)
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Azami M, YektaKooshali MH, Shohani M, Khorshidi A, Mahmudi L. Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis. PLoS One 2019; 14:e0214738. [PMID: 30964886 PMCID: PMC6456231 DOI: 10.1371/journal.pone.0214738] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the most common neurological disorders and is one of the main causes of disability. The prevalence and incidence of MS in Iran is reported to range from 5.3 to 89/ 100,000and 7 to 148.1/ 100,000, respectively. There are no systematic and meta-analysis studies on MS in Iran. Therefore, this study was conducted to investigate the prevalence and incidence of MS in Iran using meta-analysis. METHOD A systematic review of the present study focused on MS epidemiology in Iran based on PRISMA guidelines for systematic review and meta-analysis. We searched eight international databases including Scopus, PubMed, Science Direct, Cochrane Library, Web of Science, EMBASE, PsycINFO, Google Scholar search engine and six Persian databases for peer-reviewed studies published without time limit until May 2018. Data were analyzed using Comprehensive meta-analysis ver. 2 software. The review protocol has been registered in PROSPERO with ID: CRD42018114491. RESULTS According to searching on different databases, 39 (15%) articles finalized. The prevalence of MS in Iran was estimated 29.3/ 100,000 (95%CI: 25.6-33.5) based on random effects model. The prevalence of MS in men and women was estimated to be 16.5/ 100,000 (95%CI: 13.7-23.4) and 44.8/ 100,000 (95%CI: 36.3-61.6), respectively. The incidence of MS in Iran was estimated to be 3.4/ 100,000 (95%CI: 1.8-6.2) based on random effects model. The incidence of MS in men was estimated to be 16.5/ 100,000 (95%CI: 13.7-23.4) and the incidence of MS in women was 44.8/ 100,000 (95%CI: 36.3-61.6). The meta-regression model for prevalence and incidence of MS was significantly higher in terms of year of study (p<0.001). CONCLUSIONS The results of this study can provide a general picture of MS epidemiology in Iran. The current meta-analysis showed that the prevalence and incidence of MS in Iran is high and is rising over time.
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Affiliation(s)
- Milad Azami
- Student Research Committee, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Hossein YektaKooshali
- Student Research Committee, School of Nursing, Midwifery and Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoumeh Shohani
- Department of Nursing, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Khorshidi
- Department of Epidemiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Leily Mahmudi
- Faculty of Medicine, Dezful University of Medical Sciences, Dezful, Iran
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Mar S, Liang S, Waltz M, Casper TC, Goyal M, Greenberg B, Weinstock-Guttman B, Rodriguez M, Aaen G, Belman A, Barcellos LF, Rose J, Gorman M, Benson L, Candee M, Chitnis T, Harris Y, Kahn I, Roalsted S, Hart J, Lotze T, Moodley M, Ness J, Rensel M, Rubin J, Schreiner T, Tillema JM, Waldman A, Krupp L, Graves JS, Waubant E. Several household chemical exposures are associated with pediatric-onset multiple sclerosis. Ann Clin Transl Neurol 2018; 5:1513-1521. [PMID: 30564618 PMCID: PMC6292189 DOI: 10.1002/acn3.663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022] Open
Abstract
Background There is limited information about the potential associations of multiple sclerosis (MS) and commonly used household chemicals. Methods We performed a case‐control study of exposures to common household chemicals during childhood in children with MS and healthy pediatric controls. Exposures to household products were collected from a comprehensive questionnaire (http://www.usnpmsc.org/Documents/EnvironmentalAssessment.pdf) completed by parents at the time of enrollment in the study. Cases included children diagnosed with MS or clinically isolated syndrome with at least two silent T2 bright lesions on MRI, recruited within 4 years of disease onset from 16 pediatric MS clinics in the USA. Multivariate analyses using logistic regression were adjusted for possible confounders including age, sex, race, ethnicity, mother's highest level of education, and urban versus rural living. Results Questionnaire responses to household chemicals were available for 312 eligible cases (median age 15.7 years, 63% girls) and 490 healthy controls (median age 15.0, 57% girls). Exposure to rodenticides (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.35–3.26, P ≤ 0.001), weed control agents (OR 1.99, 95% CI 1.36–2.92, P ≤ 0.001) and products for plant/tree disease control (OR 2.72, 95% CI 1.54–4.82, P ≤ 0.001) anytime during childhood were associated with an increased risk for pediatric‐onset MS in adjusted and multiple comparisons analyses. Conclusions Our findings suggest that exposure to specific household chemicals during early childhood is associated with the risk of developing pediatric‐onset MS. Future studies are needed to elucidate a causal relationship and the exact agents involved.
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Affiliation(s)
- Soe Mar
- Pediatric Multiple Sclerosis and other Demyelinating Disease Center Washington University in St. Louis St. Louis Missouri
| | - Shannon Liang
- Department of Neurology UC Davis Children's Hospital Sacramento California
| | - Michael Waltz
- Data Coordinating and Analysis Center University of Utah Salt Lake City Utah
| | - T Charles Casper
- Data Coordinating and Analysis Center University of Utah Salt Lake City Utah
| | - Manu Goyal
- Department of Radiology Washington University in St. Louis St. Louis Missouri
| | | | - Bianca Weinstock-Guttman
- Jacobs Pediatric Multiple Sclerosis Center State University of New York at Buffalo Buffalo New York
| | - Moses Rodriguez
- Mayo Clinic Pediatric Multiple Sclerosis Center Mayo Clinic Rochester Minnesota
| | - Gregory Aaen
- Pediatric Multiple Sclerosis Center Loma Linda University Children's Hospital Loma Linda California
| | - Anita Belman
- Lourie Center for Pediatric Multiple Sclerosis Stony Brook University Hospital New York New York
| | - Lisa F Barcellos
- Depatment of Epidemiology University of California Berkeley Northern California
| | - John Rose
- Department of Neurology University of Utah Salt Lake City Utah
| | - Mark Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program Boston Children's Hospital Boston Massachusetts
| | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program Boston Children's Hospital Boston Massachusetts
| | - Meghan Candee
- Primary Children's Hospital University of Utah Salt Lake City Utah
| | - Tanjua Chitnis
- Partners Pediatric Multiple Sclerosis Center Massachusetts General Hospital Boston Massachusetts
| | - Yolanda Harris
- Center for Pediatric-Onset Demyelinating Disease Children's Hospital of Alabama University of Alabama Birmingham Alabama
| | - Ilana Kahn
- Children's National Medical Center Washington DC
| | - Shelly Roalsted
- Data Coordinating and Analysis Center University of Utah Salt Lake City Utah
| | - Janace Hart
- Pediatric Multiple Sclerosis Center University of California San Francisco San Francisco California
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis Texas Children's Hospital Baylor College of Medicine Houston Texas
| | - Manikum Moodley
- Mellen Center for Multiple Sclerosis Cleveland Clinic Cleveland Ohio
| | - Jayne Ness
- Center for Pediatric-Onset Demyelinating Disease Children's Hospital of Alabama University of Alabama Birmingham Alabama
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis Cleveland Clinic Cleveland Ohio
| | | | - Teri Schreiner
- Rocky Mountain Multiple Sclerosis Center Children's Hospital Colorado University of Colorado at Denver Aurora Colorado
| | - Jan-Mendelt Tillema
- Mayo Clinic Pediatric Multiple Sclerosis Center Mayo Clinic Rochester Minnesota
| | - Amy Waldman
- Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Lauren Krupp
- Pediatric Multiple Sclerosis Center New York University New York New York
| | - Jennifer S Graves
- Pediatric Multiple Sclerosis Center University of California San Francisco San Francisco California
| | - Emmanuelle Waubant
- Pediatric Multiple Sclerosis Center University of California San Francisco San Francisco California
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Affiliation(s)
- Abhijit Chaudhuri
- Department of Neurology, Essex Centre for Regional Neurosciences, Romford RM7 0BE.
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Graves JS, Chitnis T, Weinstock-Guttman B, Rubin J, Zelikovitch AS, Nourbakhsh B, Simmons T, Waltz M, Casper TC, Waubant E. Maternal and Perinatal Exposures Are Associated With Risk for Pediatric-Onset Multiple Sclerosis. Pediatrics 2017; 139:e20162838. [PMID: 28562303 PMCID: PMC5369674 DOI: 10.1542/peds.2016-2838] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To determine if prenatal, pregnancy, or postpartum-related environmental factors are associated with multiple sclerosis (MS) risk in children. METHODS This is a case-control study of children with MS or clinically isolated syndrome and healthy controls enrolled at 16 clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire, including the capture of pregnancy and perinatal factors. Case status was confirmed by a panel of 3 pediatric MS specialists. Multivariable logistic regression analyses were used to determine association of these environmental factors with case status, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status. RESULTS Questionnaire responses were available for 265 eligible cases (median age 15.7 years, 62% girls) and 412 healthy controls (median age 14.6, 54% girls). In the primary multivariable analysis, maternal illness during pregnancy was associated with 2.3-fold increase in odds to have MS (95% confidence interval [CI] 1.20-4.21, P = .01) and cesarean delivery with 60% reduction (95% CI 0.20-0.82, P = .01). In a model adjusted for these variables, maternal age and BMI, tobacco smoke exposure, and breastfeeding were not associated with odds to have MS. In the secondary analyses, after adjustment for age, sex, race, ethnicity, and socioeconomic status, having a father who worked in a gardening-related occupation (odds ratio [OR] 2.18, 95% CI 1.14-4.16, P = .02) or any use in household of pesticide-related products (OR 1.73, 95% CI 1.06-2.81, P = .03) were both associated with increased odds to have pediatric MS. CONCLUSION Cesarean delivery and maternal health during pregnancy may influence risk for pediatric-onset MS. We report a new possible association of pesticide-related environmental exposures with pediatric MS that warrants further investigation and replication.
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Affiliation(s)
- Jennifer S Graves
- Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, California;
| | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Jennifer Rubin
- Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | | | - Bardia Nourbakhsh
- Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, California
| | - Timothy Simmons
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, Utah
| | - Michael Waltz
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, Utah
| | - T Charles Casper
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, Utah
| | - Emmanuelle Waubant
- Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, California
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Min YS, Ahn YS. Central nervous system diseases of organic solvents exposed workers based on nationwide medical surveillance-data in Korea. Am J Ind Med 2016; 59:392-8. [PMID: 26909673 DOI: 10.1002/ajim.22568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND New light is being shed on the relationship between chronic neurotoxicity of the central nervous system (CNS) and exposure to low-level organic solvents (OS). However, there are few longitudinal studies with a large sample size. METHODS A cohort of OS-exposed male workers was selected who had undergone an OS-associated specialized medical check-up at least once between 2000 and 2004 in Korea. The standardized admission ratios (SAR) for CNS diseases were calculated with reference to the Korean adult male population. Adjusted relative risks (ARR) were also estimated in comparison to noise-exposed male workers. RESULTS There were 238,574 OS-exposed workers, yielding 954,772 person-years of exposure. OS-exposed workers were at elevated risk of "other extrapyramidal and movement disorders" (G25) with a SAR = 2.95 (95% CI: 1.41-5.42) and "systemic atrophies primarily affecting the CNS" (G10-G13) SAR = 2.08 (95% CI: 1.03-3.74). There were no significant differences between the OS-exposed workers and noise-exposed workers. CONCLUSIONS A limited number of CNS diseases identified through hospital admissions data and short observation periods reduced statistical power to determine effect size. OS exposure was positively associated with "other extrapyramidal and movement disorder and systemic atrophies primarily affecting the CNS.
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Affiliation(s)
- Young-Sun Min
- Department of Occupational and Environmental Medicine; Dongguk University Gyeongju Hospital; Gyeongju-si South Korea
| | - Yeon-Soon Ahn
- Department of Occupational and Environmental Medicine; Dongguk University Ilsan Hospital; Goyang-si South Korea
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McKay KA, Jahanfar S, Duggan T, Tkachuk S, Tremlett H. Factors associated with onset, relapses or progression in multiple sclerosis: A systematic review. Neurotoxicology 2016; 61:189-212. [PMID: 27045883 DOI: 10.1016/j.neuro.2016.03.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system with an unidentified etiology. We systematically reviewed the literature on the possible risk factors associated with MS disease onset, relapses and progression from 1960 to 2012 by accessing six databases and including relevant systematic reviews, meta-analyses, case-control or cohort studies. The focus was on identifying modifiable risk factors. Fifteen systematic reviews and 169 original articles were quality assessed and integrated into a descriptive review. Best evidence, which included one or more prospective studies, suggested that lower exposure to sunlight and/or lower serum vitamin D levels were associated with an increased risk of developing MS onset and subsequent relapses, but a similar quality of evidence was lacking for disease progression. Prospective studies indicated that cigarette smoking may increase the risk of MS as well as accelerate disease progression, but whether smoking altered the risk of a relapse was largely unknown. Infections were implicated in both risk of developing MS and relapses, but data for progression were lacking. Specifically, exposure to the Epstein-Barr virus, particularly if this manifested as infectious mononucleosis during adolescence, was associated with increased MS risk. Upper respiratory tract infections were most commonly associated with an increase in relapses. Relapse rates typically dropped during pregnancy, but there was no strong evidence to suggest that pregnancy itself altered the risk of MS or affected long-term progression. Emerging research with the greatest potential to impact public health was the suggestion that obesity during adolescence may increase the risk of MS; if confirmed, this would be of major significance.
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Affiliation(s)
- Kyla A McKay
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Shayesteh Jahanfar
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tom Duggan
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Stacey Tkachuk
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Helen Tremlett
- Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.
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Kyritsis AP, Boussios S, Pavlidis N. Cancer specific risk in multiple sclerosis patients. Crit Rev Oncol Hematol 2016; 98:29-34. [DOI: 10.1016/j.critrevonc.2015.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/25/2015] [Accepted: 10/01/2015] [Indexed: 12/28/2022] Open
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Wallin MT, Kurtzke JF, Culpepper WJ, Coffman P, Maloni H, Haselkorn JK, Mahan CM. Multiple sclerosis in gulf war era veterans. 2. Military deployment and risk of multiple sclerosis in the first gulf war. Neuroepidemiology 2014; 42:226-34. [PMID: 24862835 DOI: 10.1159/000360701] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Concern has been raised that US veterans of the 1990-1991 Gulf War (GW1) may be at increased risk to develop neurologic disease. METHODS An incident cohort of multiple sclerosis (MS) and other demyelinating disease (ODD) was assembled from the US military comprising the Gulf War era (1990-2007). Cases of MS and ODD meeting standard diagnostic criteria were matched to a database of all active duty personnel from the Department of Defense. Relative risk (RR) estimates for MS and all demyelinating disease based on onset, deployment status, and exposures were calculated. RESULTS For GW1, a total of 1,841 incident cases of definite MS and ODD were identified, with 387 among 696,118 deployed and 1,454 among 1,786,215 nondeployed personnel. The RR for MS alone among those deployed compared to those nondeployed was 0.69 (confidence interval, CI: 0.61-0.78), with 0.72 (CI: 0.62-0.83) in men and 0.96 (CI: 0.75-1.22) in women. Deployment was also nonsignificant or protective as an MS risk factor across racial groups, all age groups, and each military service. RRs for MS by service were: Air Force 0.71 (CI: 0.53-0.96), Army 0.80 (CI: 0.67-0.96), Marines 0.96 (CI: 0.63-1.47), and Navy 0.56 (CI: 0.43-0.74). CONCLUSION Military deployment to GW1 was not a risk factor for developing MS.
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Affiliation(s)
- Mitchell T Wallin
- Neurology Service, Department of Veterans Affairs (VA) Medical Center, Georgetown University School of Medicine, Washington, D.C., USA
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Nicoletti A, Bruno E, Nania M, Cicero E, Messina S, Chisari C, Torrisi J, Maimone D, Marziolo R, Lo Fermo S, Patti F, Giammanco S, Zappia M. Multiple Sclerosis in the Mount Etna region: possible role of volcanogenic trace elements. PLoS One 2013; 8:e74259. [PMID: 24348986 PMCID: PMC3859652 DOI: 10.1371/journal.pone.0074259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Trace elements have been hypothesised to be involved in the pathogenesis of Multiple Sclerosis and volcanic degassing is the major natural sources of trace elements. Both incidence of Multiple Sclerosis in Catania and volcanic activity of Mount Etna have been significantly increased during the last 30 years. Due to prevailing trade winds direction, volcanic gases from Etna summit craters are mostly blown towards the eastern and southern sectors of the volcano. OBJECTIVE To evaluate the possible association between Multiple Sclerosis and exposure to volcanogenic trace elements. METHODS We evaluated prevalence and incidence of Multiple Sclerosis in four communities (47,234 inhabitants) located in the eastern flank and in two communities (52,210 inhabitants) located in the western flank of Mount Etna, respectively the most and least exposed area to crater gas emissions. RESULTS A higher prevalence was found in the population of the eastern flank compared to the population of the western one (137.6/100,000 versus 94.3/100,000; p-value 0.04). We found a borderline significantly higher incidence risk during the incidence study period (1980-2009) in the population of the eastern flank 4.6/100,000 (95% CI 3.1-5.9), compared with the western population 3.2/100,000 (95% CI 2.4-4.2) with a RR of 1.41 (95% CI 0.97-2.05; p-value 0.06). Incidence risks have increased over the time in both populations reaching a peak of 6.4/100,000 in the eastern flank and of 4.4/100.000 in the western flank during 2000-2009. CONCLUSION We found a higher prevalence and incidence of Multiple Sclerosis among populations living in the eastern flank of Mount Etna. According to our data a possible role of TE cannot be ruled out as possible co-factor in the MS pathogenesis. However larger epidemiological study are needed to confirm this hypothesis.
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Affiliation(s)
- Alessandra Nicoletti
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Elisa Bruno
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Martina Nania
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Edoardo Cicero
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Silvia Messina
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Clara Chisari
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Josita Torrisi
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | | | | | - Salvatore Lo Fermo
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Francesco Patti
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
| | - Salvatore Giammanco
- Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Etneo, Catania, Italy
| | - Mario Zappia
- Depatment G.F. Ingrassia Section of Neurosciences, University of Catania, Catania, Italy
- * E-mail:
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Celik A, Aydin N, Ozcirpici B, Saricicek E, Sezen H, Okumus M, Bozkurt S, Kilinc M. Elevated red blood cell distribution width and inflammation in printing workers. Med Sci Monit 2013; 19:1001-5. [PMID: 24231719 PMCID: PMC3843572 DOI: 10.12659/msm.889694] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/27/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to estimate the effects of exposure to chemical compounds on systemic biochemical inflammatory markers in printing industry workers. MATERIAL/METHODS Fifty-eight printing workers from 19 different small- and medium-sized enterprises in the printing sector were investigated. For comparison, 80 healthy workers not subjected to workplace chemicals served as control subjects. RESULTS No significant differences were observed between the printing workers and control subjects with respect to age, BMI, waist circumference/hip circumference ratio, smoking, and alcohol consumption. Printing workers had significantly higher serum TNF-alpha levels (11.02 ± 5.34 vs. 9.26 ± 3.87 pg/ml, p=0.039), plasma fibrinogen levels (1.74 ± 0.49 vs. 1.38 ± 0.5 mg/dl, p=0.012), and red blood cell distribution width (RDW-SD) (49.77 ± 3.09 vs. 47.3 ± 2.88 p<0.01) compared to control subjects. CONCLUSIONS Elevation of RDW, serum TNF-alpha, and plasma fibrinogen levels in printing workers may be due to systemic toxic effects of chemical compounds used in this sector. TNF-alpha is an inflammatory cytokine that has a wide spectrum of biological activities, and fibrinogen plays an important role in pathological processes. Some compounds may be carcinogenic or mutagenic. Better designed workplaces and working conditions will help to reduce the hazardous effects of chemical compounds.
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Affiliation(s)
- Ahmet Celik
- Medical Faculty, Medical Biochemistry, Sutcu Imam University, Kahramanmaras, Turkey
| | - Neriman Aydin
- Department of Public Health, Medical Faculty, Gaziantep University, Gaziantep, Turkey
| | - Birgul Ozcirpici
- Department of Public Health, Medical Faculty, Gaziantep University, Gaziantep, Turkey
| | - Edibe Saricicek
- Biochemistry Laboratory, Dr. Ersin Arslan State Hospital, Gaziantep, Turkey
| | - Hatice Sezen
- Department of Biochemistry, Medical Faculty, Harran University, Harran, Turkey
| | - Mehmet Okumus
- Department of Emergency, Sutcu Imam University, Medical Faculty, Kahramanmaras, Turkey
| | - Selim Bozkurt
- Department of Emergency, Sutcu Imam University, Medical Faculty, Kahramanmaras, Turkey
| | - Metin Kilinc
- Medical Faculty, Medical Biochemistry, Sutcu Imam University, Kahramanmaras, Turkey
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Abstract
OBJECTIVE The aim of this study was to estimate the occupational risks in relation to multiple sclerosis (MS). The immediate background for this research was our finding that there had been a high number of critical illness insurance claims by patients diagnosed with MS within the agricultural segment of a Danish pension fund. DESIGN An open insurance cohort. All payouts for the critical illness insurance from 2002 to 2011 were continuously registered. SETTINGS PensionDanmark; one of Denmark's largest pension funds. PARTICIPANTS PensionDanmark insures more than 300 000 members of the Danish Confederation of Trade Unions against critical illness. All members are insured, and all policies are identical. The total exposure is 3.3 million person-years. PRIMARY OUTCOME MEASURES The incidence of MS. RESULTS During the 10-year period, 389 persons were diagnosed with MS. The crude incidence rate for men was 10.2/100 000; the corresponding figure for women was 16.1/100 000. We found signs of an overall effect of occupation on the risk of developing MS, and the high frequency found within the agricultural segment was attributed to dairy operators, who had an incidence of MS 2.0 times higher than the rest of the study's population (95% CI=1.2 to 3.0). CONCLUSIONS Our results indicate some occupational risk factors in MS, and this should be investigated further.
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Affiliation(s)
- Henrik Horwitz
- Department of Pharmacology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Ahlgren
- Master of Science in Finance and Strategic Management, PensionDanmark, Copenhagen, Denmark
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Valery PC, Lucas RM, Williams DB, Pender MP, Chapman C, Coulthard A, Dear K, Dwyer T, Kilpatrick TJ, McMichael AJ, van der Mei I, Taylor BV, Ponsonby AL. Occupational exposure and risk of central nervous system demyelination. Am J Epidemiol 2013; 177:954-61. [PMID: 23585328 DOI: 10.1093/aje/kws361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inconsistent evidence exists regarding the association between work-related factors and risk of multiple sclerosis (MS). We examined the association between occupational exposures and risk of a first clinical diagnosis of central nervous system demyelination (FCD), which is strongly associated with progression to MS, in a matched case-control study of 276 FCD cases and 538 controls conducted in Australia (2003-2006). Using a personal residence and work calendar, information on occupational history and exposure to chemicals and animals was collected through face-to-face interviews. Few case-control differences were noted. Fewer cases had worked as professionals (≥6 years) than controls (adjusted odds ratio (AOR) = 0.60, 95% confidence interval (CI): 0.37, 0.96). After further adjustment for number of children, cases were more likely to have ever been exposed to livestock than controls (AOR = 1.54, 95% CI: 1.03, 2.29). Among women, there was an increase in FCD risk associated with 10 or more years of exposure to livestock (AOR = 2.78, 95% CI: 1.22, 6.33) or 6 or more years of farming (AOR = 2.00, 95% CI: 1.23, 3.25; also adjusted for number of children). Similar findings were not evident among men. Thus, farming and exposure to livestock may be important factors in the development of FCD among women, with this finding further revealed after the confounding effect of parity or number of children is considered.
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Barragán-Martínez C, Speck-Hernández CA, Montoya-Ortiz G, Mantilla RD, Anaya JM, Rojas-Villarraga A. Organic solvents as risk factor for autoimmune diseases: a systematic review and meta-analysis. PLoS One 2012; 7:e51506. [PMID: 23284705 PMCID: PMC3526640 DOI: 10.1371/journal.pone.0051506] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/01/2012] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Genetic and epigenetic factors interacting with the environment over time are the main causes of complex diseases such as autoimmune diseases (ADs). Among the environmental factors are organic solvents (OSs), which are chemical compounds used routinely in commercial industries. Since controversy exists over whether ADs are caused by OSs, a systematic review and meta-analysis were performed to assess the association between OSs and ADs. METHODS AND FINDINGS The systematic search was done in the PubMed, SCOPUS, SciELO and LILACS databases up to February 2012. Any type of study that used accepted classification criteria for ADs and had information about exposure to OSs was selected. Out of a total of 103 articles retrieved, 33 were finally included in the meta-analysis. The final odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by the random effect model. A sensitivity analysis confirmed results were not sensitive to restrictions on the data included. Publication bias was trivial. Exposure to OSs was associated to systemic sclerosis, primary systemic vasculitis and multiple sclerosis individually and also to all the ADs evaluated and taken together as a single trait (OR: 1.54; 95% CI: 1.25-1.92; p-value<0.001). CONCLUSION Exposure to OSs is a risk factor for developing ADs. As a corollary, individuals with non-modifiable risk factors (i.e., familial autoimmunity or carrying genetic factors) should avoid any exposure to OSs in order to avoid increasing their risk of ADs.
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Affiliation(s)
- Carolina Barragán-Martínez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Cesar A. Speck-Hernández
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Gladis Montoya-Ortiz
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Rubén D. Mantilla
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
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Koch MW, Metz LM, Agrawal SM, Yong VW. Environmental factors and their regulation of immunity in multiple sclerosis. J Neurol Sci 2012; 324:10-6. [PMID: 23154080 PMCID: PMC7127277 DOI: 10.1016/j.jns.2012.10.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/19/2012] [Accepted: 10/22/2012] [Indexed: 12/14/2022]
Abstract
Epidemiological and clinical studies have shown that environmental factors such as infections, smoking and vitamin D are associated with the risk of developing multiple sclerosis (MS). Some of these factors also play a role in the MS disease course. We are currently beginning to understand how environmental factors may impact immune function in MS on a cellular and molecular level. Here we review epidemiological, clinical and basic immunological studies on the environmental factors, viral and parasitic infections, smoking, and vitamin D and relate epidemiological findings with their likely pathophysiology in MS.
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Affiliation(s)
- Marcus W Koch
- Hotchkiss Brain Institute and the, Department of Clinical Neurosciences, University of Calgary, Canada.
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16
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Wallin MT, Culpepper WJ, Coffman P, Pulaski S, Maloni H, Mahan CM, Haselkorn JK, Kurtzke JF. The Gulf War era multiple sclerosis cohort: age and incidence rates by race, sex and service. ACTA ACUST UNITED AC 2012; 135:1778-85. [PMID: 22628389 DOI: 10.1093/brain/aws099] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We characterize here a new nationwide incident cohort of multiple sclerosis from the US military-veteran population. This cohort provides an update to the only other US nationwide incidence study of multiple sclerosis performed during the 1970s. Medical records and data from the Department of Defense and Department of Veterans Affairs for cases of multiple sclerosis who served in the military between 1990, the start of the Gulf War era, and 2007 and who were service-connected for this disorder by the Department of Veterans Affairs from 1990 on, were reviewed. A total of 2691 patients were confirmed as having multiple sclerosis: 2288 definite, 190 possible, 207 clinically isolated syndrome and six neuromyelitis optica. Overall racial categories were White, Black and other, which included all Hispanics. There were 1278 White males and 556 females; 360 Black males and 296 females; and 200 others, 153 (77%) of whom were Hispanic. Mean age at onset of 30.7 years did not differ significantly by race or sex. Age at onset was 17-50 years in 99%, the same age range as 99% of the military. Average annual age specific (age 17-50 years) incidence rates per 100 000 for the entire series were 9.6 with 95% confidence interval of 9.3-10.0. Rates for Blacks were highest at 12.1 with confidence interval 11.2-13.1, Whites were 9.3 (interval 8.9-9.8) and others 6.9 (interval 6.0-7.9). For 83 Hispanics defined for 2000-07, the rate was 8.2 (interval 6.5-10.1). Much smaller numbers gave rates of 3.3 for Asian/Pacific Islanders and 3.1 for native Americans. Rates by sex for Whites were 7.3 and 25.8 male and female, respectively, for Blacks 8.4 and 26.3, and for Hispanics 6.6 and 17.0. Rates by service were high for Air Force (10.9) and Army (10.6), medium for Navy (9.1) and Coast Guard (7.9), and low for Marines (5.3). Relative risk of multiple sclerosis was 3.39 female:male and 1.27 Black:White. These new findings indicate that females of all races now have incidence rates for multiple sclerosis some three times those of their male counterparts and that among these groups, Blacks have the highest and others (probably including Hispanics) the lowest incidence rates regardless of sex or service. The low rate for Marines is unexplained. This Gulf War era multiple sclerosis cohort provides a unique resource for further study.
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Affiliation(s)
- Mitchell T Wallin
- Neurology Service, Department of Veterans Affairs Medical Centre, Washington, DC 20422, USA.
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17
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Epidemiology of environmental exposures and human autoimmune diseases: findings from a National Institute of Environmental Health Sciences Expert Panel Workshop. J Autoimmun 2012; 39:259-71. [PMID: 22739348 DOI: 10.1016/j.jaut.2012.05.002] [Citation(s) in RCA: 241] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 05/17/2012] [Indexed: 12/17/2022]
Abstract
Autoimmune diseases (AID) are a collection of many complex disorders of unknown etiology resulting in immune responses to self-antigens and are thought to result from interactions between genetic and environmental factors. Here we review the epidemiologic evidence for the role of environmental factors in the development of human AID, the conclusions that can be drawn from the existing data, critical knowledge gaps, and research needed to fill these gaps and to resolve uncertainties. We specifically summarize the state of knowledge and our levels of confidence in the role of specific agents in the development of autoimmune diseases, and we define the areas of greatest impact for future investigations. Among our consensus findings we are confident that: 1) crystalline silica exposure can contribute to the development of several AID; 2) solvent exposure can contribute to the development of systemic sclerosis; 3) smoking can contribute to the development of seropositive rheumatoid arthritis; and 4) an inverse association exists between ultraviolet radiation exposure and the risk of development of multiple sclerosis. We suggest that more studies of phenotypes, genotypes, and multiple exposures are needed. Additional knowledge gaps needing investigation include: defining important windows in the timing of exposures and latencies relating to age, developmental state, and hormonal changes; understanding dose-response relationships; and elucidating mechanisms for disease development. Addressing these essential issues will require more resources to support research, particularly of rare AID, but knowledge of the risks conferred by environmental factors in specific genetic contexts could pave the way for prevention of AID in the future.
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18
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Hedström AK, Åkerstedt T, Hillert J, Olsson T, Alfredsson L. Shift work at young age is associated with increased risk for multiple sclerosis. Ann Neurol 2011; 70:733-41. [PMID: 22006815 DOI: 10.1002/ana.22597] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/24/2011] [Accepted: 08/05/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Environmental factors play a prominent role in multiple sclerosis (MS) etiology. The aim of this study was to investigate the potential association between shift work and MS risk, which has previously never been investigated. METHODS This report is based on 2 population-based, case-control studies, 1 with incident cases (1,343 cases, 2,900 controls) and 1 with prevalent cases (5,129 cases, 4,509 controls). Using logistic regression, the occurrence of MS among subjects who have been exposed to shift work at various ages was compared with that of those who have never been exposed by calculating the odds ratio (OR) with a 95% confidence interval (CI). RESULTS In both studies, there was a significant association between working shift at a young age and occurrence of MS (OR, 1.6; 95% CI, 1.2-2.1 in the incidence study and OR, 1.3; 95% CI, 1.0-1.6 in the prevalence study). In the incident study, the OR of developing MS was 2.0 (95% CI, 1.2-3.6) among those who had worked shifts for 3 years or longer before age 20 years, compared with those who had never worked shifts. The OR for the corresponding comparison in the prevalent study was 2.1 (95% CI, 1.3-3.4). INTERPRETATION The observed association between shift work at a young age and occurrence of MS in 2 independent studies strengthens the notion of a true relationship. Consequences of shift work such as circadian disruption and sleep restriction are associated with disturbed melatonin secretion and enhanced proinflammatory responses and may thus be part of the mechanism behind the association.
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Affiliation(s)
- Anna Karin Hedström
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
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19
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Cannon JR, Greenamyre JT. The role of environmental exposures in neurodegeneration and neurodegenerative diseases. Toxicol Sci 2011; 124:225-50. [PMID: 21914720 DOI: 10.1093/toxsci/kfr239] [Citation(s) in RCA: 260] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Neurodegeneration describes the loss of neuronal structure and function. Numerous neurodegenerative diseases are associated with neurodegeneration. Many are rare and stem from purely genetic causes. However, the prevalence of major neurodegenerative diseases is increasing with improvements in treating major diseases such as cancers and cardiovascular diseases, resulting in an aging population. The neurological consequences of neurodegeneration in patients can have devastating effects on mental and physical functioning. The causes of most cases of prevalent neurodegenerative diseases are unknown. The role of neurotoxicant exposures in neurodegenerative disease has long been suspected, with much effort devoted to identifying causative agents. However, causative factors for a significant number of cases have yet to be identified. In this review, the role of environmental neurotoxicant exposures on neurodegeneration in selected major neurodegenerative diseases is discussed. Alzheimer's disease, Parkinson's disease, multiple sclerosis, and amyotrophic lateral sclerosis were chosen because of available data on environmental influences. The special sensitivity the nervous system exhibits to toxicant exposure and unifying mechanisms of neurodegeneration are explored.
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Affiliation(s)
- Jason R Cannon
- Pittsburgh Institute for Neurodegenerative Diseases, Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
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20
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Handel AE, Giovannoni G, Ebers GC, Ramagopalan SV. Environmental factors and their timing in adult-onset multiple sclerosis. Nat Rev Neurol 2010; 6:156-66. [PMID: 20157307 DOI: 10.1038/nrneurol.2010.1] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Multiple sclerosis (MS) is a common, complex neurological disease. Epidemiological data implicate both genetic and environmental factors in the etiology of MS, with various factors interacting with one another. Environmental exposures might occur long before the disease becomes clinically evident, as suggested by the wide range in onset age. In this Review, we examine the key time periods during which the environment might contribute to MS susceptibility, as well as the potential environmental factors involved. Understanding the nature of environmental influences in MS is highly relevant to the development of public health measures that are aimed at preventing this debilitating disease.
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Affiliation(s)
- Adam E Handel
- University Department of Clinical Neurology, Level 3, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK
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21
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Ascherio A, Munger KL. Epidemiology of Multiple Sclerosis. MULTIPLE SCLEROSIS 3 2010. [PMCID: PMC7173578 DOI: 10.1016/b978-1-4160-6068-0.00004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This chapter discusses the environmental factors associated to epidemiology of multiple sclerosis. The epidemiologic evidence points to three environmental risk factors—infection with the Epstein-Barr virus (EBV), low levels of vitamin D, and cigarette smoking—whose association with multiple sclerosis (MS) seems to satisfy in varying degrees most of the criteria that support causality, including temporality, strength, consistency, biologic gradient, and plausibility. None of these associations, however, has been tested experimentally in humans and only one––vitamin D deficiency is presently amenable to experimental interventions. The evidence, albeit more sparse and inconsistent, linking other environmental factors to MS risk are summarized. Epidemiologic clues to the hypothetical role of infection in MS are complex and often seem to point in opposite directions. The ecological studies, database/linkage analyses, and longitudinal studies of sunlight exposure and vitamin D are reviewed. Biologic mechanisms for smoking and increased risk of MS could be neurotoxic, immunomodulatory, vascular, or they could involve increased frequency and duration of respiratory infections. Some other possible risk factors include––diet and hepatitis B vaccine.
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22
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Garnier R. Sclérose en plaque et exposition à des solvants organiques. ARCH MAL PROF ENVIRO 2009. [DOI: 10.1016/j.admp.2009.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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How volatile organic compounds affect free radical and antioxidant enzyme activity in textile workers. Arh Hig Rada Toksikol 2009; 59:283-7. [PMID: 19064366 DOI: 10.2478/10004-1254-59-2008-1918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Various effects of exposure to volatile organic compounds (VOC) have recently become an important issue because of their widespread use in industry. The aim of this study was to determine the effect of volatile organic solvents commonly used in textile paint industry on free radical levels and the antioxidant enzyme system in textile workers. The study included twenty exposed workers and twenty controls. Blood samples were taken after an overnight fast of 10 to 12 hours. Malondialdehyde (MDA) and total antioxidant capacity (TAC) were studied in serum while super oxide dismutase (SOD) activity was studied in erythrocytes. Statistical analysis was performed using the ANOVA and Kruskall-Wallis analysis tests. MDA and SOD were significantly higher in textile workers than in controls (p<0.01). In contrast, no significant difference was observed between them for TAC (p>0.05).Elevated MDA levels in textile workers may indicate increased lipid peroxidation as a result of long-term exposure to organic solvents, whereas elevated SOD activity suggests that the antioxidant system was activated to counter lipid peroxidation. The results suggest that textile workers occupationally exposed to volatile organic solvents make a risk group and require more frequent periodic examinations.
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Namaka M, Crook A, Doupe A, Kler K, Vasconcelos M, Klowak M, Gong Y, Wojewnik-Smith A, Melanson M. Examining the evidence: complementary adjunctive therapies for multiple sclerosis. Neurol Res 2008; 30:710-719. [DOI: 10.1179/174313208x325038] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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25
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Stokely ME, Garg P, Bhat MA, Koulen P. Transient 5-(4-phenylbutoxy)psoralen (PAP-1) treatment dissociates developing pathologies in autoimmune optic neuritis into two distinct pathology profiles. J Neurosci Res 2008; 86:2111-24. [PMID: 18335521 DOI: 10.1002/jnr.21645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Discovery of treatments to protect axonal function of neurons and prevent permanent disability associated with progressive multiple sclerosis (MS) has faced the uphill challenge of assessing relatively small changes in accumulated axon damage within a background environment that is disorganized by CNS inflammation. We hypothesized that transient immunosuppression after initiation of MS-like autoimmune mechanisms would disassociate development of MS-like myelinated axon pathology from development of CNS inflammation in a rat model of autoimmune optic neuritis (AON). A rat model of myelin oligodendrocyte glycoprotein peptide-induced AON was transiently treated (on days 3-7 after antigen exposure) with 5-(4-phenylbutoxy)psoralen (PAP-1), an immunomodulatory drug previously shown specifically to suppress proliferation of effector memory T-cells and immunoglobulin class-switched B-cells. Thirteen days after antigen exposure, optic nerves were harvested for quantitative assessment of 12 MS-associated pathologies using microfluorimetry. With one exception, the immunoreactivities (-ir) for eight markers of MS-like neuroinflammation and immune infiltration were significantly reduced (P < 0.05) by transient PAP-1 treatment, often to levels significantly below those detected in normal control rat optic nerves. With one exception, four immunoreactive markers of MS-like myelinated axon pathology were detected at levels indicating increased axon/myelin pathology compared with vehicle-treated rats with AON (P < 0.05). These data suggest the conclusion that early causative mechanisms in CNS autoimmunity initiate signaling mechanisms that diverge into two separate pathways, one that is strongly associated with inflammatory responses and one that is associated predominantly with disturbed axon-myelin interactions and impaired fast axonal transport.
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Affiliation(s)
- Martha E Stokely
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107-2699, USA
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26
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Ascherio A, Munger KL. Environmental risk factors for multiple sclerosis. Part II: Noninfectious factors. Ann Neurol 2007; 61:504-13. [PMID: 17492755 DOI: 10.1002/ana.21141] [Citation(s) in RCA: 456] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As discussed in Part I of this review, the geographic distribution of multiple sclerosis (MS) and the change in risk among migrants provide compelling evidence for the existence of strong environmental determinants of MS, where "environmental" is broadly defined to include differences in diet and other behaviors. As we did for infections, we focus here primarily on those factors that may contribute to explain the geographic variations in MS prevalence and the change in risk among migrants. Among these, sunlight exposure emerges as being the most likely candidate. Because the effects of sun exposure may be mediated by vitamin D, we also examine the evidence linking vitamin D intake or status to MS risk. Furthermore, we review the evidence on cigarette smoking, which cannot explain the geographic variations in MS risk, but may contribute to the recently reported increases in the female/male ratio in MS incidence. Other proposed risk factors for MS are mentioned only briefly; although we recognize that some of these might be genuine, evidence is usually sparse and unpersuasive.
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Affiliation(s)
- Alberto Ascherio
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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Abstract
PURPOSE OF REVIEW The cause of multiple sclerosis remains elusive. We review recent epidemiological studies of genetic and environmental factors that influence susceptibility to the disease and its clinical course. RECENT FINDINGS Genetic advances strengthen the association of multiple sclerosis with the human leukocyte antigen (HLA)-DRB1 allele and interferon-gamma polymorphisms and suggest that apolipoprotein E alleles play an important role. In the environmental realm, nested case-control studies show that prior Epstein-Barr virus exposure is overrepresented in multiple sclerosis. Smoking has been associated with both risk of multiple sclerosis and progressive disease. Vitamin D deficiency might tie together environmental clues with higher multiple sclerosis prevalence rates; dietary vitamin supplementation is also associated with reduced multiple sclerosis risk. Natural history studies demonstrated dissociation between relapses and disease progression, facilitated the ability to distinguish neuromyelitis optica and related syndromes from typical multiple sclerosis, and spawned the exploration of large datasets to model long-term disease activity. SUMMARY Our understanding of the contributions of specific genetic and environmental factors that contribute to multiple sclerosis has improved. Further refinements will eventually allow powerful longitudinal studies to assess genetic and environmental interactions with implications for prediction of individual disease susceptibility, clinical course, and response to therapy.
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Affiliation(s)
- Orhun Kantarci
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Landtblom AM, Tondel M, Hjalmarsson P, Flodin U, Axelson O. The risk for multiple sclerosis in female nurse anaesthetists: a register based study. Occup Environ Med 2006; 63:387-9. [PMID: 16709703 PMCID: PMC2078114 DOI: 10.1136/oem.2005.024604] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2005] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous studies have suggested that exposure to organic solvents, including volatile anaesthetic agents, may be a risk factor for multiple sclerosis (MS), possibly in combination with genetic and other environmental factors. AIMS To further investigate the role of volatile anaesthetic agents having similar acute toxic effects to other organic solvents. METHODS Female nurse anaesthetists, other female nurses, and female teachers from middle and upper compulsory school levels were identified and retrieved from the 1985 census, Statistics Sweden. By means of the unique personal identity number in Sweden, these individuals were linked with the disability pension registers at The National Social Insurance Board and also with data on hospital care 1985-2000 at The National Board of Health and Welfare. RESULTS The cumulative incidence rate ratio of MS was found to be increased in female nurse anaesthetists in relation to other nurses (statistically not significant) and teachers (statistically significant), respectively. CONCLUSIONS These findings give some support to previous findings of an increased risk for MS in nurse anaesthetists. This is interesting in the context of previous observations of organic solvents in general as a potential risk factor in MS.
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Affiliation(s)
- A-M Landtblom
- Department of Neuroscience and Locomotion, Division of Neurology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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29
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Affiliation(s)
- F D Dick
- Department of Environmental & Occupational Medicine, Institute of Applied Health Sciences, School of Medicine, University of Aberdeen, Liberty Safe Work Research Centre, Aberdeen, UK.
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30
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Redelings MD, McCoy L, Sorvillo F. Multiple sclerosis mortality and patterns of comorbidity in the United States from 1990 to 2001. Neuroepidemiology 2005; 26:102-7. [PMID: 16374035 DOI: 10.1159/000090444] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Multiple sclerosis (MS) is a neurodegenerative condition that can result in cognitive and physical disability and shortened life expectancy. However, population-based information is lacking regarding the mortality burden from MS in the United States. We investigated trends in MS mortality rates and examined important comorbidities in the United States from 1990 to 2001. MS deaths were matched by age, sex, and race/ethnicity with randomly selected deaths from other conditions for matched odds ratio comparisons. The overall age-adjusted mortality rate from MS was 1.44/100,000 population. MS mortality rates increased throughout the study period. MS mortality rates were higher in whites than in any other racial/ethnic group, followed by Blacks, Hispanics, American Indians/Alaska Natives, and Asians and Pacific Islanders. Observed mortality rates were more than 10 times lower in Asians and Pacific Islanders than in whites. The odds of pressure ulcers, urinary tract infections, and pneumonia/influenza being reported on the death certificate were higher in MS deaths than in matched controls.
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Affiliation(s)
- Matthew D Redelings
- Los Angeles County Department of Health Services, School of Public Health, University of California at Los Angeles, Los Angeles, CA , USA.
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31
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Affiliation(s)
- Abhijit Chaudhuri
- Department of Neurology, Essex Centre for Regional Neurosciences, Romford RM7 0BE.
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32
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Abstract
The epidemiology of multiple sclerosis (MS) has been intensively studied. It is conceptualised as a complex disease in which genetic and environmental factors act together to cause disease. There are temporal and geographic variations in disease risk, and risk of disease may be affected by migration between regions of differing risk. Numerous potential causal factors including infection, immunisations, physical and emotional stressors, climate, diet, and occupational exposures have been studied using various observational study designs. Thus far, no single environmental exposure has been consistently identified as a causal factor in MS, but sufficient data have accumulated that causal pathways should be postulated and tested. This review will focus on the environmental epidemiology of MS.
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Affiliation(s)
- Ruth Ann Marrie
- Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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33
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Weatherby SJM. Organic solvents and the risk of multiple sclerosis. Epidemiology 2003; 14:506; author reply 507. [PMID: 12843780 DOI: 10.1097/01.ede.0000071470.28125.bd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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