Air pollution exposure as a risk factor for cardiovascular disease morbidity and mortality

Indoor and outdoor air quality in street corner kiosks in a large metropolitan area

Poor air quality in workplaces constitutes a great concern on human health as a good fraction of our time is spent at work. In Greece, very unique workplaces are the street corner kiosks, which are freestanding boxes placed on sidewalks next to city streets and vehicular traffic, where one can find many consumer goods. As such, its employees are exposed to both outdoor and indoor air pollutants. Very few studies have examined the occupational exposure of kiosk workers to air pollutants, and thus the magnitude of this unique indoor and outdoor exposure remains unknown. The objective of this study is to investigate and compare the levels of indoor and outdoor particulate matter (PM10 and PM2.5), ultrafine particles (UFPs) and black carbon (BC) in different kiosks located in Athens, Greece, in urban-traffic and urban-background environments. Continuous measurements of the above-mentioned pollutants were carried out on a 24-h basis over 7 consecutive days at three kiosks from September to October 2019. Indoor PM10 concentrations in the urban kiosk ranged from 19.0 to 44.0 μg/m3, PM2.5 values ranged from 14.0 to 33.0 μg/m3, whereas BC concentrations ranged from 1.2 to 7.0 μg/m3 and UFPs from almost 9.5 to 47.0 × 103 pt/cm3. Outdoor PM10 and PM2.5 measurements ranged from 29.0 to 59.0 μg/m3 and from 22.0 to 39.0 μg/m3, respectively. BC outdoor concentrations ranged from 1.1 to 2.2 μg/m3. The mean hazard quotient (HQ) for PM10 (4.9) and PM2.5 (4.7) among all participants was >1. The health risk of exposure to PM10 and PM2.5 was found to be at moderate hazard levels, although in some cases we observed HQ values higher than 10 due to high PM10 and PM2.5 concentrations in the kiosks. Overall our study indicates that people working at kiosks can be exposed to very high concentrations on particulate pollution depending on a number of factors including the traffic that strongly depends on location and the time of the day.

Environmental Stressors and the PINE Network: Can Physical Environmental Stressors Drive Long-Term Physical and Mental Health Risks?

Both psychosocial and physical environmental stressors have been linked to chronic mental health and chronic medical conditions. The psycho-immune-neuroendocrine (PINE) network details metabolomic pathways which are responsive to varied stressors and link chronic medical conditions with mental disorders, such as major depressive disorder via a network of pathophysiological pathways. The primary objective of this review is to explore evidence of relationships between airborne particulate matter (PM, as a concrete example of a physical environmental stressor), the PINE network and chronic non-communicable diseases (NCDs), including mental health sequelae, with a view to supporting the assertion that physical environmental stressors (not only psychosocial stressors) disrupt the PINE network, leading to NCDs. Biological links have been established between PM exposure, key sub-networks of the PINE model and mental health sequelae, suggesting that in theory, long-term mental health impacts of PM exposure may exist, driven by the disruption of these biological networks. This disruption could trans-generationally influence health; however, long-term studies and information on chronic outcomes following acute exposure event are still lacking, limiting what is currently known beyond the acute exposure and all-cause mortality. More empirical evidence is needed, especially to link long-term mental health sequelae to PM exposure, arising from PINE pathophysiology. Relationships between physical and psychosocial stressors, and especially the concept of such stressors acting together to impact on PINE network function, leading to linked NCDs, evokes the concept of syndemics, and these are discussed in the context of the PINE network.

Alpha-tocopherol exerts protective function against the mucotoxicity of particulate matter in amphibian and human goblet cells

Exposure to particulate matter (PM) in ambient air is known to increase the risk of cardiovascular disorders and mortality. The cytotoxicity of PM is mainly due to the abnormal increase of reactive oxygen species (ROS), which damage cellular components such as DNA, RNA, and proteins. The correlation between PM exposure and human disorders, including mortality, is based on long-term exposure. In this study we have investigated acute responses of mucus-secreting goblet cells upon exposure to PM derived from a heavy diesel engine. To this end, we employed the mucociliary epithelium of amphibian embryos and human Calu-3 cells to examine PM mucotoxicity. Our data suggest that acute exposure to PM significantly impairs mucus secretion and results in the accumulation of mucus vesicles in the cytoplasm of goblet cells. RNA-seq analysis revealed that acute responses to PM exposure significantly altered gene expression patterns; however, known regulators of mucus production and the secretory pathway were not significantly altered. Interestingly, pretreatment with α-tocopherol nearly recovered the hyposecretion of mucus from both amphibian and human goblet cells. We believe this study demonstrates the mucotoxicity of PM and the protective function of α-tocopherol on mucotoxicity caused by acute PM exposure from heavy diesel engines.

Comparative transcriptome analysis reveals Dusp1 as a critical regulator of inflammatory response to fly ash particle exposure in mouse

Exposure to outdoor concentrations of fine particulate matter (PM2.5) is a leading global health concern. Waste incineration emission has been recognized as a potential major contributor of ambient PM2.5. Respiratory inflammation is a central feature induced by PM2.5 exposure by inhalation. However, the molecular mechanisms are not fully understood. Dual-specificity phosphatase 1 (Dusp1) plays an instrumental role in the regulation of airway inflammation. In this study, fly ash particles (20 mg/kg BW) collected from a municipal waste incinerator in China were given to BALB/c wild-type (WT) and Dusp1^-/- mice by intranasal administration daily for three consecutive days. While these particles induced mild inflammation in both genotypes, a significantly higher level of serum interleukin-6 (665 pg/ml) was measured in Dusp1^-/- mice challenged with fly ash particles than in their WT counterparts. Genome-wide transcriptome profiling of pulmonary coding genes in response to the exposure were performed in both genotypes by RNA sequencing. We identified 487 differentially-expressed genes (DEGs) in fly ash-challenged Dusp1^-/- mice versus their WT counterparts with a log₂fold-change >1.5 and p < 0.05. Functional enrichment and molecular pathway mapping of the DEGs specific to Dusp1^-/- mice exposed to the particles revealed that the top 10 perturbed molecular pathways were associated with the immune response. Our study demonstrates the anti-inflammatory role of Dusp1 in protecting the lung against insults by fly ash particles, suggesting that Dusp1 might be a therapeutic target for the treatment of PM2.5-induced respiratory diseases.

Smog and risk of overall and type-specific cardiovascular diseases: A pooled analysis of 53 cohort studies with 21.09 million participants

The reported associations of smog with the risk of cardiovascular disease (CVD) and CVD subtypes were inconsistent. We systematically searched the Pubmed (Medline) and Embase databases (from the inception to April 25, 2018) to identify the cohort studies investigating the association between smog and CVD and specific types of CVD. We conducted a meta-analysis for different types of air pollutants (PM_2.5, PM₁₀, NO₂, and O₃) in smog with the risk of specific types of CVD separately. We summarized the study-specific effect estimates using both the fixed effect model and the random effect model. The meta-analysis included 35 publications with 53 cohort studies. Overall, the associations between per 10 μg/m³ increase in PM_2.5 exposure and risk of CVD events, stroke events, ischemic heart disease(IHD) events were significant, with relative risks (RRs) of 1.11 (95% confidence interval: 1.07-1.15), 1.12 (95% CI: 1.08-1.16) and 1.14(95% CI: 1.08-1.21), respectively. PM_2.5, PM₁₀, NO₂, and O₃ exposure were associated with an increased risk of CVD mortality, with RRs of 1.11 (95% CI: 1.07-1.15), 1.09 (95% CI: 1.02-1.16), 1.23 (95% CI: 1.15-1.31) and 1.03 (95% CI: 1.02-1.05), respectively. Compared with PM₁₀, NO₂, and O₃ exposure, PM_2.5 exposure had a greater risk of stroke incidence and IHD incidence (RR 1.12, 95% CI 1.05-1.19 for stroke incidence; 1.19, 1.09-1.30 for IHD). However, no clear evidence for the associations of PM10 exposure with risk of CVD incidence, stroke incidence, and IHD incidence was observed. This meta-analysis confirms the evidence that PM_2.5 exposure was significantly associated with increased risk of CVD, stroke, and IHD. PM2.5, PM₁₀, NO₂, and O₃ exposure were separately associated with an increased risk of CVD mortality. There was a stronger association between PM_2.5 exposure and the risk of stroke and IHD incidence. It urgently needs well-designed studies to further to elaborate the biological and epidemiological mechanisms that link smog with CVD. MAIN FINDINGS: Compared with PM₁₀, NO₂, and O₃ exposures, PM_2.5 exposure was positively associated with increased risk of stroke and IHD incidence. For air pollutants and CVD events, the association of NO₂ with the risk CVD mortality is more significant.

Airborne Fine Particles Induce Hematological Effects through Regulating the Crosstalk of the Kallikrein-Kinin, Complement, and Coagulation Systems

Particulate air pollution caused by human activities has drawn global attention due to its potential health risks. Considering the inevitable contact of inhaled airborne fine particulate matter (PM) with plasma, the hematological effects of PM are worthy of study. In this study, the potential effect of PM on hematological homeostasis through triggering the crosstalk of the kallikrein-kinin system (KKS), complement, and coagulation systems in plasma was investigated. The ex vivo, in vitro, and in vivo KKS activation assays confirmed that PM samples could efficiently cause the cascade activation of key zymogens in the KKS, wherein the particles coupled with lipopolysaccharide attachment provided substantial contribution. The binding of Hageman factor XII (FXII) with PM samples and its subsequent autoactivation initiated this process. The crucial elements in the complement cascade, including complement 3 (C3) and complement 5 (C5), and coagulation system (prothrombin) were also found to be actively induced by PM exposure, which was regulated by the interplay of KKS activation. The data provided solid evidence on hematological effects of airborne PM through inducing the activation of the KKS, complement, and coagulation systems, which would be valuable in the risk assessment on air-pollution-related cardiovascular diseases.

The influence of maternal and perinatal high-fat diet on ozone-induced pulmonary responses in offspring

There is growing interest in understanding how maternal diet might affect the sensitivity of offspring to environmental exposures. Previous studies demonstrated that adult rat offspring (approximately 6-months-old) from dams given a high-fat diet (HFD) prior to, during, and after pregnancy displayed elevated pulmonary responses to an acute ozone (O3) exposure. The aim of this study was to examine the influence of maternal and perinatal HFD on pulmonary and metabolic responses to O3 in male and female young-adult offspring (approximately 3-month old). One-month-old F0 female Long-Evans rats commenced HFD (60% kcal from fat) or control diet (CD; 10.5% kcal from fat) and were bred on PND 72. Offspring were maintained on respective HFD or CD until PND 29 when all groups were switched to CD. The 3-months-old female and male offspring (n = 10/group) were exposed to air or 0.8 ppm O3 for 5hr/day for 2 consecutive days. Maternal and perinatal HFD significantly increased body weight and body fat % in offspring regardless of gender. Ozone exposure, but not maternal and perinatal diet, induced hyperglycemia and glucose intolerance in the offspring. Ozone-induced alterations in pulmonary function were exacerbated by maternal and perinatal HFD in both offspring genders. Pulmonary injury/inflammation markers in response to O3 exposure such as bronchoalveolar lavage fluid total protein, lactate dehydrogenase, total cells, and neutrophils were further augmented in offspring (males>females) from dams fed the HFD. Data suggest that maternal and perinatal HFD may enhance the susceptibility of offspring to O3-induced pulmonary injury and that these effects may be sex-specific.

Water soluble and insoluble components of PM2.5 and their functional cardiotoxicities on neonatal rat cardiomyocytes in vitro

A growing number of epidemiological surveys show that PM_2.5 is an important promoter for the cardiovascular dysfunction induced by atmospheric pollution. PM_2.5 is a complex mixture of solid and liquid airborne particles and its components determine the health risk of PM_2.5to a great extent. However, the individual cardiotoxicities of different PM_2.5 fractions are still unclear, especially in the cellular level. Here we used the neonatal rat cardiomyocytes (NRCMs) to evaluate the cardiac toxicity of PM_2.5 exposure. The cytotoxicities of Total-PM_2.5, water soluble components of PM_2.5 (WS-PM_2.5) and water insoluble components of PM_2.5 (WIS-PM_2.5), which include the cell viability, cell membrane damage, reactive oxygen species (ROS) generation, were examined with NRCMs in vitro. The results indicated that Total-PM_2.5 or WIS-PM_2.5 exposure significantly decreased the cell viability, induced the cell membrane damage and increased the ROS level in NRCMs at concentrations above 50 µg/mL. However, WS-PM_2.5 exposure could induce the cytotoxicity on NRCMs until the concentration of WS-PM_2.5 was raised to a higher concentration (75 µg/mL). Furthermore, the DNA damage was detected in NRCMs after 48 h of exposure with Total-PM_2.5, WS-PM_2.5 or WIS-PM_2.5 (75 µg/mL) and the adverse effects on mitochondrial function and action potentials of NRCMs were detected only both in the Total-PM_2.5 and WIS-PM_2.5 treatment group. In summary, our project not only estimates the risk of PM_2.5 on cardiac cells but also reveal that Total-PM_2.5 and WIS-PM_2.5 exposure were predominantly associated with the functional cardiotoxicities in NRCMs.

Characterization of a High PM2.5 Exposure Group in Seoul Using the Korea Simulation Exposure Model for PM2.5 (KoSEM-PM) Based on Time⁻Activity Patterns and Microenvironmental Measurements

The Korea Simulation Exposure Model for fine particulate matter (PM_2.5) (KoSEM-PM) was developed to estimate population PM_2.5 exposure in Korea. The data were acquired based on 59,945 min of the actual microenvironmental PM_2.5 measurements and on the time–activity patterns of 8072 residents of Seoul. The aims of the study were to estimate daily PM_2.5 exposure of Seoul population, and to determine the characteristics of a high exposure group. KoSEM-PM estimated population exposures by applying the PM_2.5 distribution to the matching time–activity patterns at 10-min intervals. The mean personal PM_2.5 exposure level of the surveyed subjects in Seoul was 26.0 ± 2.7 µg/m³ (range: 21.0–40.2 µg/m³) in summer. Factors significantly associated with high exposure included day of the week, age, industry sector, job type, and working hours. Individuals surveyed on Saturdays were more likely to be in the high exposure group than those surveyed on weekdays and Sundays. Younger, non-office-working individuals with longer working hours were more likely to be in the high exposure group. KoSEM-PM could be a useful tool to estimate population exposure levels to other region in Korea; to expand its use, microenvironmental measurements are required for other region in Korea.

Short-term transcriptome and microRNAs responses to exposure to different air pollutants in two population studies

Diesel vehicle emissions are the major source of genotoxic compounds in ambient air from urban areas. These pollutants are linked to risks of cardiovascular diseases, lung cancer, respiratory infections and adverse neurological effects. Biological events associated with exposure to some air pollutants are widely unknown but applying omics techniques may help to identify the molecular processes that link exposure to disease risk. Most data on health risks are related to long-term exposure, so the aim of this study is to investigate the impact of short-term exposure (two hours) to air pollutants on the blood transcriptome and microRNA expression levels. We analyzed transcriptomics and microRNA expression using microarray technology on blood samples from volunteers participating in studies in London, the Oxford Street cohort, and, in Barcelona, the TAPAS cohort. Personal exposure levels measurements of particulate matter (PM₁₀, PM_2.5), ultrafine particles (UFPC), nitrogen oxides (NO₂, NO and NOx), black carbon (BC) and carbon oxides (CO and CO₂) were registered for each volunteer. Associations between air pollutant levels and gene/microRNA expression were evaluated using multivariate normal models (MVN). MVN-models identified compound-specific expression of blood cell genes and microRNAs associated with air pollution despite the low exposure levels, the short exposure periods and the relatively small-sized cohorts. Hsa-miR-197-3p, hsa-miR-29a-3p, hsa-miR-15a-5p, hsa-miR-16-5p and hsa-miR-92a-3p are found significantly expressed in association with exposures. These microRNAs target also relevant transcripts, indicating their potential relevance in the research of omics-biomarkers responding to air pollution. Furthermore, these microRNAs are also known to be associated with diseases previously linked to air pollution exposure including several cancers such lung cancer and Alzheimer's disease. In conclusion, we identified in this study promising compound-specific mRNA and microRNA biomarkers after two hours of exposure to low levels of air pollutants during two hours that suggest increased cancer risks.

Implications of applying cumulative risk assessment to the workplace

Multiple changes are influencing work, workplaces and workers in the US including shifts in the main types of work and the rise of the 'gig' economy. Work and workplace changes have coincided with a decline in unions and associated advocacy for improved safety and health conditions. Risk assessment has been the primary method to inform occupational and environmental health policy and management for many types of hazards. Although often focused on one hazard at a time, risk assessment frameworks and methods have advanced toward cumulative risk assessment recognizing that exposure to a single chemical or non-chemical stressor rarely occurs in isolation. We explore how applying cumulative risk approaches may change the roles of workers and employers as they pursue improved health and safety and elucidate some of the challenges and opportunities that might arise. Application of cumulative risk assessment should result in better understanding of complex exposures and health risks with the potential to inform more effective controls and improved safety and health risk management overall. Roles and responsibilities of both employers and workers are anticipated to change with potential for a greater burden of responsibility on workers to address risk factors both inside and outside the workplace that affect health at work. A range of policies, guidance and training have helped develop cumulative risk assessment for the environmental health field and similar approaches are available to foster the practice in occupational safety and health.

Ambient and Traffic-Related Air Pollution Exposures as Novel Risk Factors for Metabolic Dysfunction and Type 2 Diabetes

PURPOSE OF REVIEW

Diabetes mellitus is a top contributor to the global burden of mortality and disability in adults. There has also been a slow, but steady rise in prediabetes and type 2 diabetes in youth. The current review summarizes recent findings regarding the impact of increased exposure to air pollutants on the type 2 diabetes epidemic.

RECENT FINDINGS

Human and animal studies provide strong evidence that exposure to ambient and traffic-related air pollutants such as particulate matter (PM), nitrogen dioxide (NO2), and nitrogen oxides (NOx) play an important role in metabolic dysfunction and type 2 diabetes etiology. This work is supported by recent findings that have observed similar effect sizes for increased exposure to air pollutants on clinical measures of risk for type 2 diabetes in children and adults. Further, studies indicate that these effects may be more pronounced among individuals with existing risk factors, including obesity and prediabetes.

SUMMARY

Current epidemiological evidence suggests that increased air pollution exposure contributes to alterations in insulin signaling, glucose metabolism, and beta (β)-cell function. Future work is needed to identify the specific detrimental pollutants that alter glucose metabolism. Additionally, advanced tools and new areas of investigation present unique opportunities to study the underlying mechanisms, including intermediate pathways, that link increased air pollution exposure with type 2 diabetes onset.

Air pollutants and asthma patient visits: Indication of source influence

BACKGROUND

Sources of air pollutants are significant factors for adverse health effect. Few current studies explored the linking of sources influence and ambient pollutants to asthma patient visits in Shanghai, China.

OBJECTIVES

This study explored the associations between short-term exposures to ambient pollutants and asthma morbidity with terrestrial and marine source influence in Shanghai.

METHODS

Generalized additive model (GAM) was used to explore the association of daily patient visits and ambient pollutants. These analyses were calculated in R statistical software in mgcv package. PSCF modeling was used to locate potential source areas contributing to the concentrations of pollutants.

RESULTS

We found that per IQR of PM_2.5, PM₁₀, NO₂, SO₂, O₃ and CO in terrestrial source were associated with an increase of 6.63% (95% CI: -0.27% to 14%), 6.48% (95% CI: 0.06% to 13.3%), 1.68% (95% CI: -2.68% to 6.24%), 2.81% (95% CI: -1.42% to 7.22%), -0.60% (95% CI: -5.94% to 5.04%) and 16.6% (95% CI: 8.68% to 25.2%), respectively in asthma patient visits. Per IQR of PM_2.5, PM₁₀, NO₂, SO₂, O₃ and CO in marine source were associated with an increase of 5.34% (95% CI: 0.42% to 10.5%), 3.84% (95% CI: 0.08% to 7.74%), 3.21% (95% CI: -0.92% to 7.52%), 2.58% (95% CI: -1.02% to 6.30%), 1.42% (95% CI: -3.10% to 6.15%) and 8.81% (95% CI: 2.56% to 15.4%). The PSCF show all of the pollutants except O₃ mainly come from terrestrial during observation. We also found that all of the pollutants except NO₂ displayed the highest effect in the spring for relative risk of asthma morbidity.

CONCLUSIONS

Ambient air pollutants that cause an increase in asthma patient visits, such as PM_2.5, PM₁₀, NO₂, SO₂ and CO are mainly produced from terrestrial sources, while O₃ is primarily from marine sources. The association of ambient pollutants and asthma patient visits is closely related with seasons, especially with spring. PM_2.5 and CO are major air pollutants increasing the relative risk of asthma patient visits in Shanghai.

Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study

BACKGROUND

Long-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.

METHODS

In this randomised, crossover study, we recruited men and women aged 60 years and older with angiographically proven stable ischaemic heart disease or stage 2 Global initiative for Obstructive Lung Disease (GOLD) COPD who had been clinically stable for 6 months, and age-matched healthy volunteers. Individuals with ischaemic heart disease or COPD were recruited from existing databases or outpatient respiratory and cardiology clinics at the Royal Brompton & Harefield NHS Foundation Trust and age-matched healthy volunteers using advertising and existing databases. All participants had abstained from smoking for at least 12 months and medications were taken as recommended by participants' doctors during the study. Participants were randomly assigned by drawing numbered disks at random from a bag to do a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park). Baseline measurements of participants were taken before the walk in the hospital laboratory. During each walk session, black carbon, particulate matter (PM) concentrations, ultrafine particles, and nitrogen dioxide (NO₂) concentrations were measured.

FINDINGS

Between October, 2012, and June, 2014, we screened 135 participants, of whom 40 healthy volunteers, 40 individuals with COPD, and 39 with ischaemic heart disease were recruited. Concentrations of black carbon, NO₂, PM₁₀, PM_2.5, and ultrafine particles were higher on Oxford Street than in Hyde Park. Participants with COPD reported more cough (odds ratio [OR] 1·95, 95% CI 0·96-3·95; p<0·1), sputum (3·15, 1·39-7·13; p<0·05), shortness of breath (1·86, 0·97-3·57; p<0·1), and wheeze (4·00, 1·52-10·50; p<0·05) after walking down Oxford Street compared with Hyde Park. In all participants, irrespective of their disease status, walking in Hyde Park led to an increase in lung function (forced expiratory volume in the first second [FEV₁] and forced vital capacity [FVC]) and a decrease in pulse wave velocity (PWV) and augmentation index up to 26 h after the walk. By contrast, these beneficial responses were attenuated after walking on Oxford Street. In participants with COPD, a reduction in FEV₁ and FVC, and an increase in R5-20 were associated with an increase in during-walk exposure to NO₂, ultrafine particles and PM_2.5, and an increase in PWV and augmentation index with NO₂ and ultrafine particles. In healthy volunteers, PWV and augmentation index were associated both with black carbon and ultrafine particles.

INTERPRETATION

Short-term exposure to traffic pollution prevents the beneficial cardiopulmonary effects of walking in people with COPD, ischaemic heart disease, and those free from chronic cardiopulmonary diseases. Medication use might reduce the adverse effects of air pollution in individuals with ischaemic heart disease. Policies should aim to control ambient levels of air pollution along busy streets in view of these negative health effects.

FUNDING

British Heart Foundation.

Air quality in the Olona Valley and in vitro human health effects

Air quality is a major point in current health policies in force globally to protect human health and ecosystems. Cardiovascular and lung diseases are the pathologies most commonly associated with air pollution and it has been estimated that exposure to particulate matters and ground-level ozone and nitric oxides caused >500.000 premature deaths in Europe. Although air quality was generally improved in the recent years, further efforts are required to reduce the impact of air pollution on humans. The present study applied a multidisciplinary approach to estimate the adverse effects on the health of the inhabitants of the Olona Valley in the north of Italy. Chemical analyses quantified the air levels of metals, dioxins, PCBs, PAHs and some macropollutants, including total, fine and coarse airborne particles. These results were used as input for the health risk assessment and in vitro bioassays were used to evaluate possible adverse effects on the respiratory tract due to the organic pollutants adsorbed on the airborne particulate matter. Critical alerts were identified from the air characterization and from the chemical-based risk assessment in view of the levels of arsenic, nickel, benzene, fine and coarse particulate matters found in the investigated zone, which can induce severe adverse effects on human health. These findings were confirmed by bioassays with A549 and BEAS-2B cells. We also used the cell transformation assay with BALB/c 3T3 cells to assess the carcinogenicity of the organic extracts of collected particles as an innovative tool to establish the possible chronic effects of inhaled pollutants. No significant changes in morphological transformation were found suggesting that, although the extracts contain compounds with proven carcinogenic potential, in our experimental conditions the levels of these pollutants were too low to induce carcinogenesis as resulted also by the chemical-based risk assessment.

Stretching the stress boundary: Linking air pollution health effects to a neurohormonal stress response

Inhaled pollutants produce effects in virtually all organ systems in our body and have been linked to chronic diseases including hypertension, atherosclerosis, Alzheimer's and diabetes. A neurohormonal stress response (referred to here as a systemic response produced by activation of the sympathetic nervous system and hypothalamus-pituitary-adrenal (HPA)-axis) has been implicated in a variety of psychological and physical stresses, which involves immune and metabolic homeostatic mechanisms affecting all organs in the body. In this review, we provide new evidence for the involvement of this well-characterized neurohormonal stress response in mediating systemic and pulmonary effects of a prototypic air pollutant - ozone. A plethora of systemic metabolic and immune effects are induced in animals exposed to inhaled pollutants, which could result from increased circulating stress hormones. The release of adrenal-derived stress hormones in response to ozone exposure not only mediates systemic immune and metabolic responses, but by doing so, also modulates pulmonary injury and inflammation. With recurring pollutant exposures, these effects can contribute to multi-organ chronic conditions associated with air pollution. This review will cover, 1) the potential mechanisms by which air pollutants can initiate the relay of signals from respiratory tract to brain through trigeminal and vagus nerves, and activate stress responsive regions including hypothalamus; and 2) the contribution of sympathetic and HPA-axis activation in mediating systemic homeostatic metabolic and immune effects of ozone in various organs. The potential contribution of chronic environmental stress in cardiovascular, neurological, reproductive and metabolic diseases, and the knowledge gaps are also discussed. This article is part of a Special Issue entitled Air Pollution, edited by Wenjun Ding, Andrew J. Ghio and Weidong Wu.

Associations of air pollution exposure with blood pressure and heart rate variability are modified by oxidative stress genes: A repeated-measures panel among elderly urban residents

BACKGROUND

Oxidative stress has been suggested as a major cause of elevated blood pressure (BP) and reduced heart rate variability (HRV) due to air pollution. We hypothesized that the associations of air pollution exposure with BP and HRV are modified by oxidative stress gene polymorphisms.

METHODS

Between 2008 and 2010, we conducted up to 5 surveys of 547 elderly participants, measured their BP and HRV, and genotyped 47 single nucleotide polymorphisms (SNPs) in 18 oxidative stress genes. Linear mixed models were constructed to evaluate the associations of particulate matter ≤10 μm, nitrogen dioxide, and sulfur dioxide with BP and HRV, as well as the modifications of these associations by the genotyped SNPs.

RESULTS

Single-SNP analyses revealed interactions between air pollution and 15 SNPs (for BP) and 33 SNPs (for HRV) (all, P for interaction < 0.05). When we generated genetic risk scores for BP and HRV, using the SNPs with interactions in the single-SNP models, we found that associations of air pollution exposure with BP and HRV were modified by the genetic risk scores (P for interaction < 0.05).

CONCLUSIONS

These results strongly suggest that the associations of air pollution with BP and HRV are mediated by oxidative stress pathways.

Upper gastrointestinal bleeding due to peptic ulcer disease is not associated with air pollution: a case-crossover study

Background

Recent studies have demonstrated an association between short-term elevations in air pollution and an increased risk of exacerbating gastrointestinal disease. The objective of the study was to evaluate if day-to-day increases in air pollution concentrations were positively associated with upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD).

Methods

A time-stratified case-crossover study design was used. Adults presenting to hospitals with their first UGIB secondary to PUD from 2004–2010 were identified using administrative databases from Calgary (n = 1374; discovery cohort) and Edmonton (n = 1159; replication cohort). Daily concentrations of ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, and particulate matter (PM₁₀ and PM_2.5) were estimated in these two cities. Conditional logistic regression models were employed, adjusting for temperature and humidity. Odds ratios (OR) with 95 % confidence intervals (CI) were expressed relative to an interquartile range increase in the concentration of each pollutant.

Results

No statistically significant associations were observed for any of the individual pollutants based on same-day, or 1-day lag effects within the Calgary discovery cohort. When the air pollution exposures were assessed as 3-, 5-, and 7-day averages, some pollutants were inversely associated with UGIB in the discovery cohort; for example, 5-day averages of nitrogen dioxide (OR = 0.68; 95 % CI: 0.53–0.88), and particulate matter <2.5 μm (OR = 0.75; 95 % CI: 0.61–0.90). However, these findings could not be reproduced in the replication cohort.

Conclusion

Our findings suggest that short-term elevations in the level of ambient air pollutants does not increase the incidence of UGIB secondary to PUD.

Electronic supplementary material

The online version of this article (doi:10.1186/s12876-015-0363-6) contains supplementary material, which is available to authorized users.

Associations between size-fractionated particulate air pollution and blood pressure in a panel of type II diabetes mellitus patients

Little is known regarding how the size distribution of particulate matter (PM) air pollution influences its effect on blood pressure (BP), especially among patients with diabetes. The objective of this study was to explore the short-term associations between size-fractionated PM and BP among diabetes patients. We scheduled 6 repeated BP examinations every 2 weeks from 13 April 2013 to 30 June 2013 in a panel of 35 type 2 diabetes mellitus patients recruited from an urban community in Shanghai, China. We measured real-time PM concentrations in the size range of 0.25 to 10 μm. We used linear mixed-effect models to examine the short-term association of size-fractionated PM and BP after controlling for individual characteristics, mean temperature, relative humidity, day of the week, years with diabetes and use of antihypertensive medication. The association with systolic BP and pulse pressure strengthened with decreasing diameter. The size fractions with the strongest associations were 0.25 to 0.40 μm for number concentrations and ≤ 2.5 μm for mass concentrations. Furthermore, these effects occurred immediately even after 0-2h and lasted for up to 48 h following exposure. An interquartile range increase in 24-h average number concentrations of PM0.25-0.40 was associated with increases of 3.61 mmHg in systolic BP and 2.96 mmHg in pulse pressure. Females, patients younger than 65 years of age and patients without antihypertensive treatment were more susceptible to these effects. Our results revealed important size and temporal patterns of PM in elevating BP among diabetes patients in China.

Promoted relationship of cardiovascular morbidity with air pollutants in a typical Chinese urban area

Background

A large number of studies about effects of air pollutants on cardiovascular mortality have been conducted; however, those investigating association between air pollutants and cardiovascular morbidity are limited, especially in developing countries.

Methods

A time-series analysis on the short-term association between outdoor air pollutants including particulate matter (PM) with diameters of 10 µm or less (PM₁₀), sulfur dioxide (SO₂) and nitrogen dioxide (NO₂) and cardiovascular morbidity was conducted in Tianjin, China based on 4 years of daily data (2008–2011). The morbidity data were stratified by sex and age. The effects of air pollutants during the warm season and the cool season were also analyzed separately.

Results

Each increase in PM₁₀, SO₂, and NO₂ by increments of 10 µg/m³ in a 2-day average concentration was associated with increases in the cardiovascular morbidity of 0.19% with 95 percent confidence interval (95% CI) of 0.08–0.31, 0.43% with 95% CI of 0.03–0.84, and 0.52% with 95% CI of −0.09–1.13, respectively. The effects of air pollutants were more evident in the cool season than those in the warm season, females and the elderly were more vulnerable to outdoor air pollution.

Conclusions

All estimated coefficients of PM₁₀, SO₂ and NO₂ are positive but only the effect of SO₂ implied statistical significance at the 5% level. Moreover, season, sex and age might modify health effects of outdoor air pollutants. This work may bring inspirations for formulating local air pollutant standards and social policy regarding cardiovascular health of residents.

An evidence-based appraisal of global association between air pollution and risk of stroke

BACKGROUND

The aim of this study was to evaluate the transient effects of air pollutants on stroke morbidity and mortality using the meta-analytic approach.

METHODS

Three databases were searched for case-crossover and time series studies assessing associations between daily increases in particles with diameter<2.5 μm (PM2.5) and diameter<10 μm (PM10), sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), ozone, and risks of stroke hospitalizations and mortality. Risk estimates were combined using random-effects model.

RESULTS

A total of 34 studies were included in the meta-analysis. Stroke hospitalizations or mortality increased 1.20% (95%CI: 0.22-2.18) per 10 μg/m3 increase in PM2.5, 0.58% (95%CI: 0.31-0.86) per 10 μg/m3 increase in PM10, 1.53% (95%CI: 0.66-2.41) per 10 parts per billion (ppb) increase in SO2, 2.96% (95%CI: 0.70-5.27) per 1 ppm increase in CO, and 2.24% (95%CI: 1.16-3.33) per 10ppb increase in NO2. These positive associations were the strongest on the same day of exposure, and appeared to be more apparent for ischemic stroke (for all 4 gaseous pollutants) and among Asian countries (for all 6 pollutants). In addition, an elevated risk (2.45% per 10 ppb; 95%CI: 0.35-4.60) of ischemic stroke associated with ozone was found, but not for hemorrhagic stroke.

CONCLUSION

Our study indicates that air pollution may transiently increase the risk of stroke hospitalizations and stroke mortality. Although with a weak association, these findings if validated may be of both clinical and public health importance given the great global burden of stroke and air pollution.