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Wu F, Malek AM, Buchanich JM, Arena VC, Rager JR, Sharma RK, Vena JE, Bear T, Talbott EO. Exposure to ambient air toxicants and the risk of amyotrophic lateral sclerosis (ALS): A matched case control study. ENVIRONMENTAL RESEARCH 2024; 242:117719. [PMID: 37993052 DOI: 10.1016/j.envres.2023.117719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with few risk factors identified and no known cure. Gene-environment interaction is hypothesized especially for sporadic ALS cases (90-95%) which are of unknown etiology. We aimed to investigate risk factors for ALS including exposure to ambient air toxics. METHODS This population-based case-control study included 267 ALS cases (from the United States [U.S.] Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry National ALS Registry and Biorepository) and 267 age, sex, and county-matched controls identified via a commercial database. Exposure assessment for 34 ambient air toxicants was performed by assigning census tract-level U.S. Environmental Protection Agency (EPA) 2011 National Air Toxics Assessment (NATA) data to participants' residential ZIP codes. Conditional logistic regression was used to compute adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for individual compounds, chemical classes, and overall exposure. Sensitivity analyses using both conditional logistic regression and Bayesian grouped weighted quartile sum (GWQS) models were performed to assess the integrity of findings. RESULTS Using the 2011 NATA, the highest exposure quartile (Q4) compared to the lowest (Q1) of vinyl chloride (aOR = 6.00, 95% CI: 1.87-19.25), 2,4-dinitrotoluene (aOR = 5.45, 95% CI: 1.53-19.36), cyanide (aOR = 4.34, 95% CI: 1.52-12.43), cadmium (aOR = 3.30, 95% CI: 1.11-9.77), and carbon disulfide (aOR = 2.98, 95% CI: 1.00-8.91) was associated with increased odds of ALS. Residential air selenium showed an inverse association with ALS (second quartile [Q2] vs. Q1: aOR = 0.38, 95% CI: 0.18-0.79). Additionally, residential exposure to organic/chlorinated solvents (Q4 vs Q1: aOR = 2.62, 95% CI: 1.003-6.85) was associated with ALS. CONCLUSIONS Our findings using the 2011 NATA linked by census tract to residential area provide evidence of increased ALS risk in cases compared to controls for 2,4-dinitrotoluene, vinyl chloride, cyanide, and the organic/chlorinated solvents class. This underscores the importance of ongoing surveillance of potential exposures for at-risk populations.
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Affiliation(s)
- Fan Wu
- Department of Environmental and Occupational Health, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Angela M Malek
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Jeanine M Buchanich
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Vincent C Arena
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Judith R Rager
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ravi K Sharma
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - John E Vena
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Todd Bear
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Evelyn O Talbott
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
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Kassahun Bekele B, Kwizera L, Abdul Razzak R, Alfadul ES, Anand A, Wojtara M, Nazir A, Uwishema O. ALS in Africa: current knowledge and exciting opportunities for future study - short communication. Ann Med Surg (Lond) 2023; 85:5827-5830. [PMID: 37915644 PMCID: PMC10617860 DOI: 10.1097/ms9.0000000000001319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/07/2023] [Indexed: 11/03/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that can present with motor and extra-motor manifestations. Its global prevalence is 4.42 per 1 000 000, and it has a high mortality rate. In sub-Saharan Africa alone, 15 per 100 000 develop ALS mainly between their 40s and 60s and only one-fourth of them have access to treatment. ALS was found to be not only affected by genetic variation but also by the patient's mood and lifestyle. In Africa, males and younger people tend to be affected with ALS and rarely present with bulbar onset. ALS diagnosis is very challenging due to the lack of ALS-specific biomarkers and the sharing of some clinical features with other syndromes. ALS treatment is mainly riluzole and supportive treatment via nasogastric tube and ventilatory support. The access to treatment in Africa is very limited, thus a very bad prognosis with a median survival time of 14 months post-diagnosis. Further research is needed to assess the real situation in Africa and to try to closely monitor patients suffering from ALS.
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Affiliation(s)
- Bezawit Kassahun Bekele
- Oli Health Magazine Organization, Research and Education
- Addis Ababa University, School of Medicine, Addis Ababa, Ethiopia
- George Washington University, Milken Institute of Public Health, Washington DC
| | - Lambert Kwizera
- Oli Health Magazine Organization, Research and Education
- AgriConsult Group Rwanda, Kigali, Rwanda
| | - Rawane Abdul Razzak
- Oli Health Magazine Organization, Research and Education
- Faculty of Medical Sciences, Lebanese University, Hadath, Beirut, Lebanon
| | - Esraa S.A. Alfadul
- Oli Health Magazine Organization, Research and Education
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ayush Anand
- Oli Health Magazine Organization, Research and Education
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Magda Wojtara
- Oli Health Magazine Organization, Research and Education
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research and Education
- Department of Medicine, King Edward Medical University, Pakistan
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research and Education
- Clinton Global Initiative University, New York, New York, USA
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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3
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Goutman SA, Boss J, Godwin C, Mukherjee B, Feldman EL, Batterman SA. Occupational history associates with ALS survival and onset segment. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:219-229. [PMID: 36193557 PMCID: PMC10067530 DOI: 10.1080/21678421.2022.2127324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To identify associations between occupational settings and self-reported occupational exposures on amyotrophic lateral sclerosis (ALS) survival and phenotypes. METHODS All patients seen in the University of Michigan Pranger ALS Clinic were invited to complete an exposure assessment querying past occupations and exposures. Standard occupational classification (SOC) codes for each job and the severity of various exposure types were derived. Cox proportional hazards models associated all-cause mortality with occupational settings and the self-reported exposures after adjusting for sex, diagnosis age, revised El Escorial criteria, onset segment, revised ALS Functional Rating Scale (ALSFRS-R), and time from symptom onset to diagnosis. Multinomial logistic regression models with three categories, adjusted for age, assessed the association between occupational settings and exposures to onset segment. RESULTS Among the 378 ALS participants (median age, 64.7 years; 54.4% male), poorer survival was associated with work in SOC code "Production Occupations" and marginally with work in "Military Occupation"; poor survival associated with self-reported occupational pesticide exposure in adjusted models. Among onset segments: cervical onset was associated with ALS participants having ever worked in "Buildings and Grounds Cleaning and Maintenance Occupations," "Construction and Extraction Occupations," and "Production Occupations"; bulbar onset with self-reported occupational exposure to radiation; and cervical onset with exposure to particulate matter, volatile organic compounds, metals, combustion and diesel exhaust, electromagnetic radiation, and radiation. CONCLUSION Occupational settings and self-reported exposures influence ALS survival and onset segment. Further studies are needed to explore and understand these relationships, most advantageously using prospective cohorts and detailed ALS registries.
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Affiliation(s)
- Stephen A Goutman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Boss
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA, and
| | - Christopher Godwin
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA, and
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Stuart A Batterman
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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Arab A, Mostafalou S. Neurotoxicity of pesticides in the context of CNS chronic diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:2718-2755. [PMID: 34663153 DOI: 10.1080/09603123.2021.1987396] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
Following the introduction and application of pesticides in human life, they have always been along with health concerns both in acute poisoning and chronic toxicities. Neurotoxicity of pesticides in chronic exposures has been known as one of the most important human health problems, as most of these chemicals act through interacting with some elements of nervous system. Pesticide-induced neurotoxicity can be defined in different categories of neurological disorders including neurodegenerative (Alzheimer, Parkinson, amyotrophic lateral sclerosis, multiple sclerosis), neurodevelopmental (attention deficit hyperactivity disorder, autism spectrum disorders, developmental delay, and intellectual disability), neurobehavioral and neuropsychiatric (depression/suicide attempt, anxiety/insomnia, and cognitive impairment) disorders some of which are among the most debilitating human health problems. In this review, neurotoxicity of pesticides in the mentioned categories and sub-categories of neurological diseases have been systematically presented in relation to different route of exposures including general, occupational, environmental, prenatal, postnatal, and paternal.
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Affiliation(s)
- Ali Arab
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sara Mostafalou
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
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Goutman SA, Boss J, Godwin C, Mukherjee B, Feldman EL, Batterman SA. Associations of self-reported occupational exposures and settings to ALS: a case-control study. Int Arch Occup Environ Health 2022; 95:1567-1586. [PMID: 35593931 PMCID: PMC9424174 DOI: 10.1007/s00420-022-01874-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Environmental exposures contribute to the pathogenesis of amyotrophic lateral sclerosis (ALS), a fatal and progressive neurological disease. Identification of these exposures is important for targeted screening and risk factor modification. OBJECTIVE To identify occupational exposures that are associated with a higher risk of ALS using both survey and standard occupational classification (SOC) coding procedures, and to highlight how exposure surveys can complement SOC coding. METHODS ALS participants and neurologically healthy controls recruited in Michigan completed a detailed exposure assessment on their four most recent and longest held occupations. Exposure scores were generated from the exposure survey, and occupations were assigned to SOC codes by experienced exposure scientists. RESULTS This study included 381 ALS and 272 control participants. ALS participants reported higher duration-adjusted occupational exposure to particulate matter (OR = 1.45, 95% CI 1.19-1.78, p < 0.001), volatile organic compounds (OR = 1.22, 95% CI 1.02-1.45, p = 0.029), metals (OR = 1.48, 95% CI 1.21-1.82, p < 0.001), and combustion and diesel exhaust pollutants (OR = 1.20, 95% CI 1.01-1.43, p = 0.041) prior to ALS diagnosis, when adjusted for sex, age, and military service compared to controls. In multivariable models, only occupational exposure to metals remained significant risk (OR = 1.56, 95% CI 1.11-2.20, p = 0.011), although in an adaptive elastic net model, particulate matter (OR = 1.203), pesticides (OR = 1.015), and metals (1.334) were all selected as risk factors. Work in SOC code "Production Occupations" was associated with a higher ALS risk. SOC codes "Building and Grounds Cleaning and Maintenance Occupations", "Construction and Extraction Occupations", "Installation, Maintenance, and Repair Occupations", and "Production Occupations" were all associated with a higher exposure to metals as determined using survey data. DISCUSSION Occupational exposure to particulate matter, volatile organic compounds, metals, pesticides, and combustion and diesel exhaust and employment in "Production Occupations" was associated with an increased ALS risk in this cohort.
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Affiliation(s)
- Stephen A Goutman
- Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109-5223, USA.
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA.
| | - Jonathan Boss
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Christopher Godwin
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109-5223, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Stuart A Batterman
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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Cunha-Oliveira T, Silva DF, Segura L, Baldeiras I, Marques R, Rosenstock T, Oliveira PJ, Silva FSG. Redox profiles of amyotrophic lateral sclerosis lymphoblasts with or without known SOD1 mutations. Eur J Clin Invest 2022; 52:e13798. [PMID: 35467758 DOI: 10.1111/eci.13798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a fatal and rapidly progressing neurodegenerative disease that affects motor neurons. This disease is associated with oxidative stress especially in mutant superoxide dismutase 1 (mutSOD1) patients. However, less is known for the most prevalent sporadic ALS form, due to a lack of disease models. Here, we studied oxidative stress profiles in lymphoblasts from ALS patients with mutSOD1 or unknown (undSOD1) mutations. METHODS mutSOD1 and undSOD1 lymphoblasts, as well as sex/age-matched controls (3/group) were obtained from Coriell and divided into 46 years-old-men (C1), 46 years-old-women (C2) or 26/27 years-old-men (C3) cohorts. Growth curves were performed, and several parameters associated with redox homeostasis were evaluated, including SOD activity and expression, general oxidative stress levels, lipid peroxidation, response to oxidative stimulus, glutathione redox cycle, catalase expression, and activity, and Nrf2 transcripts. Pooled (all cohorts) and paired (intra-cohort) statistical analyses were performed, followed by clustering and principal component analyses (PCA). RESULTS Although a high heterogeneity among lymphoblast redox profiles was found between cohorts, clustering analysis based on 7 parameters with high chi-square ranking (total SOD activity, oxidative stress levels, catalase transcripts, SOD1 protein levels, metabolic response to mM concentrations of tert-butyl hydroperoxide, glutathione reductase activity, and Nrf2 transcript levels) provided a perfect cluster segregation between samples from healthy controls and ALS (undSOD1 and mutSOD1), also visualized in the PCA. CONCLUSIONS Our results show distinct redox signatures in lymphoblasts from mutSOD1, undSOD1 and healthy controls that can be used as therapeutic targets for ALS drug development.
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Affiliation(s)
- Teresa Cunha-Oliveira
- CNC-Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Daniela Franco Silva
- CNC-Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Luis Segura
- Santa Casa de São Paulo School of Medical Science, Physiological Sciences, São Paulo, Brazil
| | - Inês Baldeiras
- CNC-Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ricardo Marques
- CNC-Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Health School of the Polytechnic Institute of Guarda, Guarda, Portugal
| | - Tatiana Rosenstock
- Department of Pharmacology, University of São Paulo, São Paulo, Brazil.,Sygnature Discovery, In vitro Neuroscience, Nottingham, UK
| | - Paulo J Oliveira
- CNC-Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Filomena S G Silva
- CNC-Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal.,Mitotag Lda, Cantanhede, Portugal
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Newell ME, Adhikari S, Halden RU. Systematic and state-of the science review of the role of environmental factors in Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's Disease. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 817:152504. [PMID: 34971691 DOI: 10.1016/j.scitotenv.2021.152504] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
The etiology of sporadic amyotrophic lateral sclerosis (ALS) is still unclear. We evaluate environmental factors suspected to be associated with ALS for their potential linkage to disease causality and to model geographic distributions of susceptible populations and expected cases worldwide. A PRISMA systematic literature review was performed 2021. Bradford Hill criteria were used to identify and rank environmental factors and a secondary review of ALS diagnoses in population studies and ALS case or cohort studies was conducted. Prevalence rate projection informed estimates of impacted regions and populations. Among 1710 papers identified, 258 met the inclusion criteria, of which 173 responded to at least one of nine Bradford Hill criteria among 83 literature-identified ALS environmental factors. Environmental determinants of ALS in order of decreasing significance were β-N-methylamino-L-alanine (BMAA), formaldehyde, selenium, and heavy metals including manganese, mercury, zinc, and copper. Murine animal models were the most common methodology for exploring environmental factors. Another line of investigation of 62 population exposure studies implicated the same group of environmental agents (mean odds ratios): BMAA (2.32), formaldehyde (1.54), heavy metals (2.99), manganese (3.85), mercury (2.74), and zinc (2.78). An age-adjusted incidence model estimated current total ALS cases globally at ~85,000 people compared to only ~1600 cases projected from the reported ALS incidence in the literature. Modeling with the prevalence microscope equation forecasted an increase in U.S. ALS cases from 16,707 confirmed in 2015 to ~22,650 projected for 2040. Two orthogonal methods employed implicate BMAA, formaldehyde, manganese, mercury, and zinc as environmental factors with strong ALS associations. ALS cases likely are significantly underreported globally, and high vulnerability exists in regions with large aging populations. Recent studies on other diseases with environmental determinants suggest the need to consider additional potential triggers and mechanisms, including exposures to microbial agents and epigenetic modifications.
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Affiliation(s)
- Melanie Engstrom Newell
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Building B, Arizona State University, 1001 S McAllister Ave, Tempe, AZ 85281-8101, USA; School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ, USA.
| | - Sangeet Adhikari
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Building B, Arizona State University, 1001 S McAllister Ave, Tempe, AZ 85281-8101, USA; School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ, USA.
| | - Rolf U Halden
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Building B, Arizona State University, 1001 S McAllister Ave, Tempe, AZ 85281-8101, USA; School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ, USA; School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ, USA; OneWaterOneHealth, Arizona State University Foundation, 1001 S. McAllister Avenue, Tempe, AZ 85287-8101, USA; Global Futures Laboratory, Arizona State University, 800 S. Cady Mall, Tempe, AZ 85281, USA.
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Andrew A, Zhou J, Gui J, Harrison A, Shi X, Li M, Guetti B, Nathan R, Tischbein M, Pioro EP, Stommel E, Bradley W. Pesticides applied to crops and amyotrophic lateral sclerosis risk in the U.S. Neurotoxicology 2021; 87:128-135. [PMID: 34562505 PMCID: PMC10756230 DOI: 10.1016/j.neuro.2021.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Environmental exposures are implicated in the etiology of amyotrophic lateral sclerosis (ALS). Application of insecticides, herbicides, and fungicides with neurotoxic properties to crops is permitted in the U.S., however reporting of the quantities is government mandated. OBJECTIVE To identify pesticides that may be associated with ALS etiology for future study. METHODS We geospatially estimated exposure to crop-applied pesticides as risk factors for ALS in a large de-identified medical claims database, the SYMPHONY Integrated Dataverse®. We extracted residence at diagnosis of ∼26,000 nationally distributed ALS patients, and matched non-ALS controls. We mapped county-level U.S. Geological Survey data on applications of 423 pesticides to estimate local residential exposure. We randomly broke the SYMPHONY dataset into two groups to form independent discovery and validation cohorts, then confirmed top hits using residential history information from a study of NH, VT, and OH. RESULTS Pesticides with the largest positive statistically significant associations in both the discovery and the validation studies and evidence of neurotoxicity in the literature were the herbicides 2,4-D (OR 1.25 95 % CI 1.17-1.34) and glyphosate (OR 1.29 95 %CI 1.19-1.39), and the insecticides carbaryl (OR 1.32 95 %CI 1.23-1.42) and chlorpyrifos (OR 1.25 95 %CI 1.17-1.33). SIGNIFICANCE Our geospatial analysis results support potential neurotoxic pesticide exposures as risk factors for sporadic ALS. Focused studies to assess these identified potential relationships are warranted.
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Affiliation(s)
- Angeline Andrew
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
| | - Jie Zhou
- Dartmouth College, Hanover, NH, United States
| | - Jiang Gui
- Dartmouth College, Hanover, NH, United States
| | | | - Xun Shi
- Dartmouth College, Hanover, NH, United States
| | - Meifang Li
- Dartmouth College, Hanover, NH, United States
| | - Bart Guetti
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | | | - Maeve Tischbein
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Erik P Pioro
- Center for ALS and Related Disorders, Cleveland Clinic, Cleveland, OH, United States
| | - Elijah Stommel
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Walter Bradley
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
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Mitsumoto H, Garofalo DC, Gilmore M, Andrews L, Santella RM, Andrews H, McElhiney M, Murphy J, Nieves JW, Rabkin J, Hupf J, Horton DK, Mehta P, Factor-Litvak P. Case-control study in ALS using the National ALS Registry: lead and agricultural chemicals are potential risk factors. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:190-202. [PMID: 34137650 DOI: 10.1080/21678421.2021.1936556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To identify occupational risk factors for ALS using well-characterized participants with ALS (P-ALS), sibling controls (S-controls), and matched population controls (P-controls) within the National ALS Registry. We also compared oxidative stress (OS) biomarkers between groups. Methods: P-ALS were recruited over 4 years. Demographic, socioeconomic, and medical data were ascertained from medical records and structured interviews. P-ALS were followed prospectively for 2 years or until death, whichever came sooner. S-controls and age-, sex-, race/ethnicity-, and residential location-matched P-controls were recruited over 3 years. Occupational exposure to lead and agricultural chemicals (ACs) were assigned by an occupational hygienist, blinded to case status. OS biomarkers in urine were measured. Results: P-ALS (mean age 62.8 years; 63% males) resided across the United States. Demographic and socioeconomic variables did not differ among P-ALS, S-controls, and P-controls. P-ALS were more likely to report occupations with exposure to lead (adjusted OR (aOR)=2.3, 95% CI 1.1, 4.6) and ACs (aOR = 2.4, 95% CI 1.2, 4.6) compared to pooled controls. Among those with occupations with exposure to both lead and ACs, aOR was 7.2 (95% CI 2.0, 26.1). Urinary 8-oxo-dG was significantly elevated among P-ALS (11.07 ± 5.42 ng/mL) compared to S-controls, P-controls, or pooled controls (pooled 7.43 ± 5.42 ng/mL; p < 0.0001) but was not associated with occupational exposure to either lead or ACs. Conclusions: Findings reveal increased risk of ALS diagnosis among those with occupational exposure to lead and ACs and increased OS biomarkers among cases compared to controls. OS may be an important pathogenic mechanism in ALS.
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Affiliation(s)
- Hiroshi Mitsumoto
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Diana C Garofalo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Madison Gilmore
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Leslie Andrews
- Department of Environmental Health, Columbia University, New York, NY, USA
| | - Regina M Santella
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Martin McElhiney
- Department of Clinical Psychology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Jennifer Murphy
- Department of Neurology, University of California, San Francisco, CA, USA, and
| | - Jeri W Nieves
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Judith Rabkin
- Department of Clinical Psychology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Jonathan Hupf
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - D Kevin Horton
- Centers for Disease Control and Prevention/Agency for Toxic Substance and Disease Registry (CDC/ATSDR), Atlanta, GA, USA
| | - Paul Mehta
- Centers for Disease Control and Prevention/Agency for Toxic Substance and Disease Registry (CDC/ATSDR), Atlanta, GA, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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10
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Jalilian H, Najafi K, Khosravi Y, Röösli M. Amyotrophic lateral sclerosis, occupational exposure to extremely low frequency magnetic fields and electric shocks: a systematic review and meta-analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2021; 36:129-142. [PMID: 32946420 DOI: 10.1515/reveh-2020-0041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Exposure to extremely low frequency magnetic fields (ELF-MF) and electric shocks occurs in many workplaces and occupations but it is unclear whether any of these exposures cause Amyotrophic lateral sclerosis (ALS). The aim of this systematic review and meta-analysis is to explore whether occupational exposure to ELF-MF and/or electric shocks are risk factor for ALS. We searched PubMed, Embase, and Web of Science databases up to the end of 2019. Pooled risk estimates were calculated using random-effects meta-analysis including exploration of the sources of heterogeneity between studies and publication bias. Twenty-seven publications fulfilled the inclusion criteria. We found a weak, significant, association between occupational exposure to ELF-MF and the risk of ALS (RRPooled estimate: 1.20; 95%CI: 1.05, 1.38) with moderate to high heterogeneity (I2=66.3%) and indication of publication bias (PEgger's test=0.03). No association was observed between occupational exposure to electric shocks and risk of ALS (RRPooled estimate: 0.97; 95%CI: 0.80, 1.17) with high heterogeneity (I2=80.5%), and little indication for publication bias (PEgger's test=0.24). The findings indicate that occupational exposure to ELF-MF, but not electric shocks, might be a risk factor for ALS. However, given the moderate to high heterogeneity and potential publication bias, the results should be interpreted with caution.
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Affiliation(s)
- Hamed Jalilian
- Department of Occupational Health and Safety Engineering, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Kamran Najafi
- Student Research Committee, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Yahya Khosravi
- Department of Occupational Health and Safety Engineering, School of Health, Research Center for Health, Safety and Environment, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Andrew AS, Bradley WG, Peipert D, Butt T, Amoako K, Pioro EP, Tandan R, Novak J, Quick A, Pugar KD, Sawlani K, Katirji B, Hayes TA, Cazzolli P, Gui J, Mehta P, Horton DK, Stommel EW. Risk factors for amyotrophic lateral sclerosis: A regional United States case-control study. Muscle Nerve 2020; 63:52-59. [PMID: 33006184 PMCID: PMC7821307 DOI: 10.1002/mus.27085] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022]
Abstract
Most amyotrophic lateral sclerosis (ALS) cases are considered sporadic, without a known genetic basis, and environmental exposures are thought to play a causal role. To learn more about sporadic ALS etiology, we recruited n = 188 ALS patients from northern New England and Ohio and matched controls 2:1 from the general population of the same regions. Questionnaires evaluated the association between a variety of lifestyle, behavioral (ie, hobbies and activities), and occupational factors and the risk of ALS, including the duration of time between exposure and ALS onset, and exposure frequency. Head trauma was associated with increased ALS risk (adjusted odds ratio [OR] 1.60 95% confidence interval [CI] 1.04‐2.45), with significantly greater effects for injuries occurring 10 or more years prior to symptom onset (P = .037). ALS risk was increased for those reporting severe electrical burns (adjusted OR 2.86, 95% CI 1.37‐6.03), with odds ratios highest for burns after age 30 (OR 3.14), and for burns 10 or more years prior to symptom onset (OR 3.09). Hobbies involving lead were the most strongly associated with ALS risk (adjusted OR 2.92, 95% CI 1.45‐5.91). Exposures to lead 20 or more years prior to diagnosis had larger effect sizes compared to those occurring more recently. Holding a job in mechanics, painting, or construction was associated with ALS. The identification of these specific environmental factors associated with ALS highlight the need for future prospective and laboratory studies to assess causality, biological mechanisms, and find prevention or treatment opportunities.
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Affiliation(s)
| | - Walter G Bradley
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel Peipert
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Tanya Butt
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kwadwo Amoako
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Erik P Pioro
- Center for ALS and Related Disorders, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rup Tandan
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - John Novak
- Ohio Health Physician Group, Westerville, Ohio, USA
| | - Adam Quick
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - K Doug Pugar
- Dayton Center for Neurological Disorders, Dayton, Ohio, USA
| | - Komal Sawlani
- Department of Neurology, University Hospital Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| | - Bashar Katirji
- Department of Neurology, University Hospital Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Jiang Gui
- Department of Biomedical Data Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Paul Mehta
- Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA
| | - D Kevin Horton
- Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA
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12
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Amyotrophic lateral sclerosis and lead: A systematic update. Neurotoxicology 2020; 81:80-88. [PMID: 32941938 DOI: 10.1016/j.neuro.2020.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
Heavy metals are considered to be among the leading environmental factors that trigger amyotrophic lateral sclerosis (ALS). However, no convincing biopathological mechanism and therapeutic clinical implication of such metals in ALS pathogenesis have been established. This is partly attributable to the technical and scientific difficulties in demonstrating a direct and causative role of heavy metals in the onset of ALS in patients. However, a body of epidemiological, clinical and experimental evidences suggest that lead (Pb), more than other metals, could actually play a major role in the onset and progression of ALS. Here, to clarify the nature of the association and the causative role of Pb in ALS, we comprehensively reviewed the scientific literature of the last decade with objective database searches and the methods typically adopted in systematic reviews, critically analysing and summarising the various scientifically sound evidence on the relationship between ALS and Pb. From these tasks, we noted a number of multidisciplinary associations between ALS and Pb, and specifically the importance of occupational exposure to Pb in ALS development and/or progression. We also report the possible involvement of TAR DNA binding protein (TDP-43)-based molecular mechanism in Pb-mediated ALS, although these data rely on a single study, which included both in vitro experiments and an animal model, and are therefore still preliminary. Finally, we briefly examined whether this knowledge could inspire new targeted therapies and policies in the fight against ALS.
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Visser AE, D'Ovidio F, Peters S, Vermeulen RC, Beghi E, Chiò A, Veldink JH, Logroscino G, Hardiman O, van den Berg LH. Multicentre, population-based, case-control study of particulates, combustion products and amyotrophic lateral sclerosis risk. J Neurol Neurosurg Psychiatry 2019; 90:854-860. [PMID: 30850472 DOI: 10.1136/jnnp-2018-319779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/01/2018] [Accepted: 01/21/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether exposure to particulates and combustion products may explain the association between certain occupations and amyotrophic lateral sclerosis (ALS) risk in a large, multicentre, population-based, case-control study, based on full job histories, using job-exposure matrices, with detailed information on possible confounders. METHODS Population-based patients with ALS and controls were recruited from five registries in the Netherlands, Ireland and Italy. Demographics and data regarding educational level, smoking, alcohol habits and lifetime occupational history were obtained using a validated questionnaire. Using job-exposure matrices, we assessed occupational exposure to silica, asbestos, organic dust, contact with animals or fresh animal products, endotoxins, polycyclic aromatic hydrocarbons and diesel motor exhaust. Multivariate logistic regression models adjusting for confounding factors were used to determine the association between these exposures and ALS risk. RESULTS We included 1557 patients and 2922 controls. Associations were positive for all seven occupational exposures (ORs ranging from 1.13 to 1.73 for high vs never exposed), and significant on the continuous scale for silica, organic dust and diesel motor exhaust (p values for trend ≤0.03). Additional analyses, adding an exposure (one at a time) to the model in the single exposure analysis, revealed a stable OR for silica. We found similar results when patients with a C9orf72 mutation were excluded. CONCLUSION In a large, multicentre study, using harmonised methodology to objectively quantify occupational exposure to particulates and combustion products, we found an association between ALS risk and exposure to silica, independent of the other occupational exposures studied.
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Affiliation(s)
- Anne E Visser
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Fabrizio D'Ovidio
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Susan Peters
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.,Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Roel Ch Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Adriano Chiò
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Jan H Veldink
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Giancarlo Logroscino
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', Pia Fondazione Cardinale G Panico, Lecce, Italy.,Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Leonard H van den Berg
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
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Lian L, Liu M, Cui L, Guan Y, Liu T, Cui B, Zhang K, Tai H, Shen D. Environmental risk factors and amyotrophic lateral sclerosis (ALS): A case-control study of ALS in China. J Clin Neurosci 2019; 66:12-18. [DOI: 10.1016/j.jocn.2019.05.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 01/08/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022]
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Zeng P, Zhou X. Causal effects of blood lipids on amyotrophic lateral sclerosis: a Mendelian randomization study. Hum Mol Genet 2019; 28:688-697. [PMID: 30445611 PMCID: PMC6360326 DOI: 10.1093/hmg/ddy384] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/03/2018] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a late-onset fatal neurodegenerative disorder that is predicted to increase across the globe by ~70% in the following decades. Understanding the disease causal mechanism underlying ALS and identifying modifiable risks factors for ALS hold the key for the development of effective preventative and treatment strategies. Here, we investigate the causal effects of four blood lipid traits that include high-density lipoprotein, low-density lipoprotein (LDL), total cholesterol and triglycerides on the risk of ALS. By leveraging instrument variables from multiple large-scale genome-wide association studies in both European and East Asian populations, we carry out one of the largest and most comprehensive Mendelian randomization analyses performed to date on the causal relationship between lipids and ALS. Among the four lipids, we found that only LDL is causally associated with ALS and that higher LDL level increases the risk of ALS in both the European and East Asian populations. Specifically, the odds ratio of ALS per 1 standard deviation (i.e. 39.0 mg/dL) increase of LDL is estimated to be 1.14 [95% confidence interval (CI), 1.05–1.24; P = 1.38E-3] in the European population and 1.06 (95% CI, 1.00–1.12; P = 0.044) in the East Asian population. The identified causal relationship between LDL and ALS is robust with respect to the choice of statistical methods and is validated through extensive sensitivity analyses that guard against various model assumption violations. Our study provides important evidence supporting the causal role of higher LDL on increasing the risk of ALS, paving ways for the development of preventative strategies for reducing the disease burden of ALS across multiple nations.
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Affiliation(s)
- Ping Zeng
- Department of Epidemiology and Biostatistics, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiang Zhou
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
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Zeng P, Yu X, Xu H. Association Between Premorbid Body Mass Index and Amyotrophic Lateral Sclerosis: Causal Inference Through Genetic Approaches. Front Neurol 2019; 10:543. [PMID: 31178821 PMCID: PMC6543002 DOI: 10.3389/fneur.2019.00543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose: Inverse association between premorbid body mass index (BMI) and amyotrophic lateral sclerosis (ALS) was implied in observational studies; however, whether this association is causal remains largely unknown. Materials and Methods: We first conducted a meta-analysis to investigate whether there exits an association between premorbid BMI and ALS. We then employed a two-sample Mendelian randomization approach to evaluate the causal relationship of genetically increased BMI with the risk of ALS. The Mendelian randomization analysis was implemented using summary statistics for independent instruments obtained from large-scale genome-wide association studies of BMI (up to ~770,000 individuals) and ALS (up to ~81,000 individuals). The causal effect of BMI on ALS was estimated using inverse-variance weighted methods and was further validated through extensive complementary and sensitivity analyses. Results: The meta-analysis showed that a unit increase of premorbid BMI can result in about 3.0% (95% CI 2.1-4.5%) risk reduction of ALS. Using 1,031 instruments that were strongly related to BMI, the causal effect of per one standard deviation increase of BMI was estimated to be 1.04 (95% CI 0.97-1.11, p = 0.275) in the European population. This null association between BMI and ALS also held in the East Asian population and was robust against various modeling assumptions and outlier biases. Additionally, the Egger-regression and MR-PRESSO ruled out the possibility of horizontal pleiotropic effects of instruments. Conclusion: Our results do not support the causal role of genetically increased or decreased BMI on the risk of ALS.
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Affiliation(s)
- Ping Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
- Center for Medical Statistics and Data Analysis, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xinghao Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Haibo Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
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Chen GX, ’t Mannetje AM, Douwes J, van den Berg L, Pearce N, Kromhout H, D’Souza W, McConnell M, Glass B, Brewer N, McLean DJ. Occupation and motor neuron disease: a New Zealand case–control study. Occup Environ Med 2019; 76:309-316. [DOI: 10.1136/oemed-2018-105605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
ObjectivesTo assess associations between occupation and motor neuron disease (MND).MethodsWe conducted a population-based case–control study with cases (n=321) recruited through the New Zealand Motor Neurone Disease Association and hospital discharge data. Controls (n=605) were recruited from the Electoral Roll. Information on personal and demographic details, lifestyle factors and a full occupational history was collected using questionnaires and interviews. Associations with ever/never employed and employment duration were estimated using logistic regression stratified by sex and adjusted for age, ethnicity, socioeconomic deprivation, education and smoking.ResultsElevated risks were observed for field crop and vegetable growers (OR 2.93, 95% CI 1.10 to 7.77); fruit growers (OR 2.03, 95% CI 1.09 to 3.78); gardeners and nursery growers (OR 1.96, 95% CI 1.01 to 3.82); crop and livestock producers (OR 3.61, 95% CI 1.44 to 9.02); fishery workers, hunters and trappers (OR 5.62, 95% CI 1.27 to 24.97); builders (OR 2.90, 95% CI 1.41 to 5.96); electricians (OR 3.61, 95% CI 1.34 to 9.74); caregivers (OR 2.65, 95% CI 1.04 to 6.79); forecourt attendants (OR 8.31, 95% CI 1.79 to 38.54); plant and machine operators and assemblers (OR 1.42, 95% CI 1.01 to 2.01); telecommunications technicians (OR 4.2, 95% CI 1.20 to 14.64); and draughting technicians (OR 3.02, 95% CI 1.07 to 8.53). Industries with increased risks were agriculture (particularly horticulture and fruit growing), construction, non-residential care services, motor vehicle retailing, and sport and recreation. Positive associations between employment duration and MND were shown for the occupations fruit growers, gardeners and nursery growers, and crop and livestock producers, and for the horticulture and fruit growing industry.ConclusionsThis study suggests associations between MND and occupations in agriculture and several other occupations.
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Gunnarsson LG, Bodin L. Amyotrophic Lateral Sclerosis and Occupational Exposures: A Systematic Literature Review and Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112371. [PMID: 30373166 PMCID: PMC6265680 DOI: 10.3390/ijerph15112371] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 11/16/2022]
Abstract
Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of occupational risk factors for amyotrophic lateral sclerosis (ALS). Methods: We identified 79 original publications on associations between work and ALS. The MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines were used to ensure high scientific quality, and reliable protocols were applied to classify the articles. Thirty-seven articles fulfilled good scientific standards, while 42 were methodologically deficient and thus were excluded from our meta-analyses. Results: The weighted relative risks for the various occupational exposures were respectively; 1.29 (95% confidence interval (CI): 0.97–1.72; six articles) for heavy physical work, 3.98 (95% CI: 2.04–7.77; three articles) for professional sports, 1.45 (95% CI: 1.07–1.96; six articles) for metals, 1.19 (95% CI: 1.07–1.33; 10 articles) for chemicals, 1.18 (95% CI: 1.07–1.31; 16 articles) for electromagnetic fields or working with electricity, and 1.18 (95% CI: 1.05–1.34; four articles) for working as a nurse or physician. Conclusions: Meta-analyses based only on epidemiologic publications of good scientific quality show that the risk of ALS is statistically significantly elevated for occupational exposures to excessive physical work, chemicals (especially pesticides), metals (especially lead), and possibly also to electromagnetic fields and health care work. These results are not explained by publication bias.
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Affiliation(s)
- Lars-Gunnar Gunnarsson
- School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.
- Department of Occupational and Environmental Medicine, Örebro University, SE 701 82 Örebro, Sweden.
| | - Lennart Bodin
- Department of Statistics, Örebro University, SE 701 82 Örebro, Sweden.
- Institute of Environmental Medicine, Karolinska Institute, SE 177 77 Stockholm, Sweden.
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Dickerson AS, Hansen J, Gredal O, Weisskopf MG. Amyotrophic Lateral Sclerosis and Exposure to Diesel Exhaust in a Danish Cohort. Am J Epidemiol 2018; 187:1613-1622. [PMID: 29590300 DOI: 10.1093/aje/kwy069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/20/2018] [Indexed: 12/12/2022] Open
Abstract
Previous studies have suggested an increased risk of amyotrophic lateral sclerosis (ALS) and other motor neuron diseases for persons in occupations commonly involving exposure to diesel exhaust (DE). In this study, we investigated the association between occupational exposure to DE and odds of ALS. ALS cases were identified from the Danish National Patient Registry (1982-2013) and individually matched to 100 controls per case on the basis of birth year and sex. Using information on occupational history from 1964 onward obtained from the Danish Pension Fund, we estimated cumulative DE exposures using a job exposure matrix. We evaluated associations using conditional logistic regression analyses and stratified the analyses by sex. Using a 10-year lag period, DE exposure was positively associated with ALS among men who had ever been exposed (adjusted odds ratio (aOR) = 1.20, 95% confidence interval (CI): 1.05, 1.38). For men with greater than 50% probability of DE exposure, we observed a positive association between ALS and highest-quartile exposure during the 5-year (aOR = 1.35, 95% CI: 1.07, 1.70) and 10-year (aOR = 1.41, 95% CI: 1.11, 1.79) lag periods. Our study suggests an association between consistently higher exposures to DE and ALS in men, but not in women. These findings support previous reports of associations between ALS and occupations commonly involving DE exposure.
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Affiliation(s)
- Aisha S Dickerson
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ole Gredal
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marc G Weisskopf
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Bello A, Woskie SR, Gore R, Sandler DP, Schmidt S, Kamel F. Retrospective Assessment of Occupational Exposures for the GENEVA Study of ALS among Military Veterans. Ann Work Expo Health 2018; 61:299-310. [PMID: 28355414 DOI: 10.1093/annweh/wxw028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/02/2016] [Indexed: 12/11/2022] Open
Abstract
Objective This paper describes the retrospective exposure assessment conducted to assess occupational exposures for the Genes and Environmental Exposures in Veterans (GENEVA) study, a case-control study investigating the joint contribution of genetics and environmental exposures to the risk of amyotrophic lateral sclerosis (ALS) among military veterans. Methods Occupational histories for 1597 study participants collected as part of the GENEVA study were the basis for this retrospective exposure assessment. The data set included 15528 jobs held from 1924 to 2010, representing 4539 unique industry and occupation (I&O) combinations. Three industrial hygiene experts were recruited to independently rate occupational exposures to specific agents previously associated with an increased risk of ALS. Utilizing information on industry, job title, tasks performed, and materials used for each job held, raters assigned exposures associated with each I&O for the 'current time' defined as the period after 1995 (post-1995). The exposure assessment targeted agents identified as potential occupational risk factors for ALS. Experts rated semi-quantitatively exposure intensity in five exposure categories (0-4) for Group A agents (lead, formaldehyde, hydrocarbon solvents, and chlorinated solvents) and qualitatively as yes/no (1/0) exposed for Group B agents (mercury, selenium, arsenic, polychlorinated biphenyls, electromagnetic field, pesticides, and viral agents). Confidence scores (0-3) were reported for every I&O rated based on raters' experience with that industry and/or job. Each I&O was assigned an average exposure score of the raters and an alternative exposure rating was developed for each I&O by excluding low confidence (<2) scores before averaging. Exposure reconstruction for jobs held pre-1995 was done by comparing exposure data extracted from the OSHA Chemical Exposure and Health Database (CEHD) during pre-1995 and post-1995. For agents with limited exposure data in the CEHD, pre-1995 exposures were determined based on raters' judgment. Results The proportion of I&O combinations determined to be 'exposed' ranged from 0.1 to 26% across different agents, with the highest values corresponding to hydrocarbon solvents and the lowest to selenium. Industries with the highest proportion of exposed records include manufacturing, utilities, healthcare, and military with non-combat jobs. Analyses for raters' reliability showed the best agreement between the raters when rating exposure to viral agents (kappa = 0.67), hydrocarbon solvents (kappa = 0.53), and lead (kappa = 0.50). The proportion of 'exposed' I&O combinations increased for hydrocarbon solvents, chlorinated solvents, and pesticides when exposure ratings were adjusted by raters' confidence. Compared to post-1995, exposures in the earlier period (pre-1995) were deemed higher or the same for most of the agents and lower for formaldehyde and electromagnetic field exposures. Conclusions Our results indicate that using raters' confidence assessment in determining exposure scores increases both the proportion of I&O combinations regarded as exposed and the intensity scores, suggesting raters tend to be conservative in their assessment when they lack detailed knowledge of an industry or job.
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Affiliation(s)
- Anila Bello
- Work Environment Department, University of Massachusetts Lowell, One University Avenue, Lowell, MA 01854, USA
| | - Susan R Woskie
- Work Environment Department, University of Massachusetts Lowell, One University Avenue, Lowell, MA 01854, USA
| | - Rebecca Gore
- Work Environment Department, University of Massachusetts Lowell, One University Avenue, Lowell, MA 01854, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Silke Schmidt
- Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
| | - Freya Kamel
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
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Stephenson J, Nutma E, van der Valk P, Amor S. Inflammation in CNS neurodegenerative diseases. Immunology 2018; 154:204-219. [PMID: 29513402 PMCID: PMC5980185 DOI: 10.1111/imm.12922] [Citation(s) in RCA: 568] [Impact Index Per Article: 94.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/22/2018] [Accepted: 02/28/2018] [Indexed: 12/11/2022] Open
Abstract
Neurodegenerative diseases, the leading cause of morbidity and disability, are gaining increased attention as they impose a considerable socioeconomic impact, due in part to the ageing community. Neuronal damage is a pathological hallmark of Alzheimer's and Parkinson's diseases, amyotrophic lateral sclerosis, Huntington's disease, spinocerebellar ataxia and multiple sclerosis, although such damage is also observed following neurotropic viral infections, stroke, genetic white matter diseases and paraneoplastic disorders. Despite the different aetiologies, for example, infections, genetic mutations, trauma and protein aggregations, neuronal damage is frequently associated with chronic activation of an innate immune response in the CNS. The growing awareness that the immune system is inextricably involved in shaping the brain during development as well as mediating damage, but also regeneration and repair, has stimulated therapeutic approaches to modulate the immune system in neurodegenerative diseases. Here, we review the current understanding of how astrocytes and microglia, as well as neurons and oligodendrocytes, shape the neuroimmune response during development, and how aberrant responses that arise due to genetic or environmental triggers may predispose the CNS to neurodegenerative diseases. We discuss the known interactions between the peripheral immune system and the brain, and review the current concepts on how immune cells enter and leave the CNS. A better understanding of neuroimmune interactions during development and disease will be key to further manipulating these responses and the development of effective therapies to improve quality of life, and reduce the impact of neuroinflammatory and degenerative diseases.
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Affiliation(s)
- Jodie Stephenson
- Centre for Neuroscience and TraumaBarts and the Blizard Institute, LondonSchool of Medicine and DentistryQueen Mary University of LondonLondonUK
- Department of PathologyVU University Medical CentreAmsterdamthe Netherlands
| | - Erik Nutma
- Department of PathologyVU University Medical CentreAmsterdamthe Netherlands
| | - Paul van der Valk
- Department of PathologyVU University Medical CentreAmsterdamthe Netherlands
| | - Sandra Amor
- Centre for Neuroscience and TraumaBarts and the Blizard Institute, LondonSchool of Medicine and DentistryQueen Mary University of LondonLondonUK
- Department of PathologyVU University Medical CentreAmsterdamthe Netherlands
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22
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Povedano M, Saez M, Martínez-Matos JA, Barceló MA. Spatial Assessment of the Association between Long-Term Exposure to Environmental Factors and the Occurrence of Amyotrophic Lateral Sclerosis in Catalonia, Spain: A Population-Based Nested Case-Control Study. Neuroepidemiology 2018; 51:33-49. [PMID: 29852480 DOI: 10.1159/000489664] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/27/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It is believed that an interaction between genetic and non-genetic factors may be involved in the development of amyotrophic lateral sclerosis (ALS). With the exception of exposure to agricultural chemicals like pesticides, evidence of an association between environmental risk factors and ALS is inconsistent. Our objective here was to investigate the association between long-term exposure to environmental factors and the occurrence of ALS in Catalonia, Spain, and to provide evidence that spatial clusters of ALS related to these environmental factors exist. METHODS We carried out a nested case-control study constructed from a retrospective population-based cohort, covering the entire region. Environmental variables were the explanatory variables of interest. We controlled for both observed and unobserved confounders. RESULTS We have found some spatial clusters of ALS. The results from the multivariate model suggest that these clusters could be related to some of the environmental variables, in particular agricultural chemicals. In addition, in high-risk clusters, besides corresponding to agricultural areas, key road infrastructures with a high density of traffic are also located. CONCLUSION Our results indicate that some environmental factors, in particular those associated with exposure to pesticides and air pollutants as a result of urban traffic, could be associated with the occurrence of ALS.
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Affiliation(s)
- Mònica Povedano
- Functional Motoneurona Unit (UFMNA), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Juan-Antonio Martínez-Matos
- Functional Motoneurona Unit (UFMNA), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Antònia Barceló
- Functional Motoneurona Unit (UFMNA), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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23
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Comfort N, Re DB. Sex-Specific Neurotoxic Effects of Organophosphate Pesticides Across the Life Course. Curr Environ Health Rep 2018; 4:392-404. [PMID: 29063415 DOI: 10.1007/s40572-017-0171-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW This review discusses the sex-specific effects of exposure to various organophosphate (OP) pesticides throughout the life course and potential reasons for the differential vulnerabilities observed across sexes. RECENT FINDINGS Sex is a crucial factor in the response to toxicants, yet the sex-specific effects of OP exposure, particularly in juveniles and adults, remain unresolved. This is largely due to study design and inconsistencies in exposure and outcome assessments. Exposure to OPs results in multiple adverse outcomes influenced by many factors including sex. Reported sex-specific effects suggest that males are more susceptible to OPs, which reflects the sex-dependent prevalence of various neurodevelopmental and neurodegenerative disorders such as autism and amyotrophic lateral sclerosis (ALS), in which males are at greater risk. Thus, this review proposes that the biological sex-specific effects elicited by OP exposure may in part underlie the dimorphic susceptibilities observed in neurological disorders. Understanding the immediate and long-term effects of OP exposure across sexes will be critical in advancing our understanding of OP-induced neurotoxicity and disease.
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Affiliation(s)
- Nicole Comfort
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA. .,NIEHS Center for Environmental Health Sciences in Northern Manhattan, Columbia University, New York, NY, 10032, USA. .,, 722 W 168th Street, 11th floor, New York, NY, 10032, USA.
| | - Diane B Re
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA. .,NIEHS Center for Environmental Health Sciences in Northern Manhattan, Columbia University, New York, NY, 10032, USA. .,Center for Motor Neuron Biology and Disease, Columbia University, New York, NY, 10032, USA. .,, 722 W 168th Street Suite 1107B, New York, NY, 10032, USA.
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24
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Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterised by a rapid loss of lower and upper motor neurons. As a complex disease, the ageing process and complicated gene-environment interactions are involved in the majority of cases. Main body Significant advances have been made in unravelling the genetic susceptibility to ALS with massively parallel sequencing technologies, while environmental insults remain a suspected but largely unexplored source of risk. Several studies applying the strategy of Mendelian randomisation have strengthened the link between environmental insults and ALS, but none so far has proved conclusive. We propose a new ALS model which links the current knowledge of genetic factors, ageing and environmental insults. This model provides a mechanism as to how ALS is initiated, with environmental insults playing a critical role. Conclusion The available evidence has suggested that inherited defect(s) could cause mitochondrial dysfunction, which would establish the primary susceptibility to ALS. Further study of the underlying mechanism may shed light on ALS pathogenesis. Environmental insults are a critical trigger for ALS, particularly in the aged individuals with other toxicant susceptible genes. The identification of ALS triggers could lead to preventive strategies for those individuals at risk.
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Affiliation(s)
- Bing Yu
- Sydney Medical School (Central), The University of Sydney, Camperdown, NSW 2006 Australia.,Department of Medical Genomics, Royal Prince Alfred Hospital and NSW Health Pathology, Camperdown, NSW 2050 Australia
| | - Roger Pamphlett
- Discipline of Pathology, Brain and Mind Centre, The University of Sydney, 94 Mallett St, Camperdown, NSW 2050 Australia.,Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
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25
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Bradley WG, Miller RX, Levine TD, Stommel EW, Cox PA. Studies of Environmental Risk Factors in Amyotrophic Lateral Sclerosis (ALS) and a Phase I Clinical Trial of l-Serine. Neurotox Res 2017; 33:192-198. [DOI: 10.1007/s12640-017-9741-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/25/2017] [Accepted: 04/21/2017] [Indexed: 12/12/2022]
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26
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Koeman T, Slottje P, Schouten LJ, Peters S, Huss A, Veldink JH, Kromhout H, van den Brandt PA, Vermeulen R. Occupational exposure and amyotrophic lateral sclerosis in a prospective cohort. Occup Environ Med 2017; 74:578-585. [DOI: 10.1136/oemed-2016-103780] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/31/2017] [Accepted: 02/10/2017] [Indexed: 12/12/2022]
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27
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Timmins HC, Saw W, Cheah BC, Lin CSY, Vucic S, Ahmed RM, Kiernan MC, Park SB. Cardiometabolic health and risk of amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:721-725. [PMID: 28029705 DOI: 10.1002/mus.25547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/14/2016] [Accepted: 12/26/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Patients diagnosed with amyotrophic lateral sclerosis (ALS) generally have a limited medical history and a normal body mass index, raising the possibility of a premorbid ALS phenotype. METHODS The prevalence of cardiometabolic factors was analyzed in 58 ALS patients via comprehensive cardiovascular assessments and compared with Australian population norms. RESULTS ALS patients had good cardiac fitness and no reported cardiovascular events. Average blood pressure, heart rate, PR interval, and corrected QT interval were in the normal range. There were significantly fewer obese women in the ALS cohort (13.6%, P < 0.05) and more men with a normal body mass index than in the general population (47.2%, P < 0.001). The percentage of individuals who had never smoked was greater for the ALS cohort (55.8%, P ≤ 0.001), and the prevalence of dyslipidemia was lower (38.7%) compared with the general population (74.4%, P < 0.001). CONCLUSION ALS patients had good cardiometabolic health, with evidence of a reduced vascular risk profile. Muscle Nerve 56: 721-725, 2017.
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Affiliation(s)
- Hannah C Timmins
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
| | - Wilfred Saw
- Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Benjamin C Cheah
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
| | - Cindy S Y Lin
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Steve Vucic
- Western Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Centre, University of Sydney, Level 4, 94 Mallett Street, Camperdown, 2050, Sydney, New South Wales, Australia
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28
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Andrew AS, Caller TA, Tandan R, Duell EJ, Henegan PL, Field NC, Bradley WG, Stommel EW. Environmental and Occupational Exposures and Amyotrophic Lateral Sclerosis in New England. NEURODEGENER DIS 2017; 17:110-116. [PMID: 28122372 DOI: 10.1159/000453359] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/10/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent data provide support for the concept that potentially modifiable exposures are responsible for sporadic amyotrophic lateral sclerosis (ALS). OBJECTIVE To evaluate environmental and occupational exposures as risk factors for sporadic ALS. METHODS We performed a case-control study of ALS among residents of New England, USA. The analysis compared questionnaire responses from 295 patients with a confirmed ALS diagnosis to those of 225 controls without neurodegenerative illness. RESULTS Self-reported job- or hobby-related exposure to one or more chemicals, such as pesticides, solvents, or heavy metals, increased the risk of ALS (adjusted OR 2.51; 95% CI 1.64-3.89). Industries with a higher toxicant exposure potential (construction, manufacturing, mechanical, military, or painting) were associated with an elevated occupational risk (adjusted OR 3.95; 95% CI 2.04-8.30). We also identified increases in the risk of ALS associated with frequent participation in water sports, particularly waterskiing (adjusted OR 3.89; 95% CI 1.97-8.44). Occupation and waterskiing both retained independent statistical significance in a composite model containing age, gender, and smoking status. CONCLUSIONS Our study contributes to a growing body of literature implicating occupational- and hobby-related toxicant exposures in ALS etiology. These epidemiologic study results also provide motivation for future evaluation of water-body-related risk factors.
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Affiliation(s)
- Angeline S Andrew
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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29
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Bozzoni V, Pansarasa O, Diamanti L, Nosari G, Cereda C, Ceroni M. Amyotrophic lateral sclerosis and environmental factors. FUNCTIONAL NEUROLOGY 2016; 31:7-19. [PMID: 27027889 DOI: 10.11138/fneur/2016.31.1.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder that affects central and peripheral motor neuron cells. Its etiology is unknown, although a relationship between genetic background and environmental factors may play a major role in triggering the neurodegeneration. In this review, we analyze the role of environmental factors in ALS: heavy metals, electromagnetic fields and electric shocks, pesticides, β-N-methylamino-L-alanine, physical activity and the controversial role of sports. The literature on the single issues is analyzed in an attempt to clarify, as clearly as possible, whether each risk factor significantly contributes to the disease pathogenesis. After summarizing conflicting observations and data, the authors provide a final synthetic statement.
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30
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Schwartz GG, Rundquist BC, Simon IJ, Swartz SE. Geographic distributions of motor neuron disease mortality and well water use in U.S. counties. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:279-283. [PMID: 28019106 DOI: 10.1080/21678421.2016.1264975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We recently reported that U.S. mortality rates for motor neuron disease (MND) at the level of the state are associated with well water use. However, data at the state level may not accurately reflect data at the individual level. We therefore examined the association between MND mortality and well water use utilizing data from smaller geographic units that may better reflect exposure and disease at the individual level. METHODS We used data on age-adjusted MND mortality rates at the level of the county, obtained from the CDC, and corresponding data on the prevalence of well water use, obtained from the U.S. Geological Survey. Data were analyzed by multivariate linear regression and by Getis-Ord Gi*, a measure of spatial clustering. RESULTS Age-adjusted mortality rates for MND in 923 U.S. counties were significantly correlated with the prevalence of well water (p < 0.0001). 'Hot spots' of MND mortality were significantly associated with 'hot spots' of well water use (p < 0.0005). CONCLUSIONS These findings support the hypothesis that an agent present in well water plays an etiologic role in ALS. Further study of water use among individuals with ALS is warranted.
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Affiliation(s)
- Gary G Schwartz
- a Department of Population Health , University of North Dakota School of Medicine & Health Sciences , Grand Forks , ND , USA and
| | - Bradley C Rundquist
- b Department of Geography , University of North Dakota College of Arts and Sciences , Grand Forks , ND , USA
| | - Isaac J Simon
- b Department of Geography , University of North Dakota College of Arts and Sciences , Grand Forks , ND , USA
| | - Sami E Swartz
- b Department of Geography , University of North Dakota College of Arts and Sciences , Grand Forks , ND , USA
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31
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Pesticides: an update of human exposure and toxicity. Arch Toxicol 2016; 91:549-599. [PMID: 27722929 DOI: 10.1007/s00204-016-1849-x] [Citation(s) in RCA: 363] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/08/2016] [Indexed: 12/12/2022]
Abstract
Pesticides are a family of compounds which have brought many benefits to mankind in the agricultural, industrial, and health areas, but their toxicities in both humans and animals have always been a concern. Regardless of acute poisonings which are common for some classes of pesticides like organophosphoruses, the association of chronic and sub-lethal exposure to pesticides with a prevalence of some persistent diseases is going to be a phenomenon to which global attention has been attracted. In this review, incidence of various malignant, neurodegenerative, respiratory, reproductive, developmental, and metabolic diseases in relation to different routes of human exposure to pesticides such as occupational, environmental, residential, parental, maternal, and paternal has been systematically criticized in different categories of pesticide toxicities like carcinogenicity, neurotoxicity, pulmonotoxicity, reproductive toxicity, developmental toxicity, and metabolic toxicity. A huge body of evidence exists on the possible role of pesticide exposures in the elevated incidence of human diseases such as cancers, Alzheimer, Parkinson, amyotrophic lateral sclerosis, asthma, bronchitis, infertility, birth defects, attention deficit hyperactivity disorder, autism, diabetes, and obesity. Most of the disorders are induced by insecticides and herbicides most notably organophosphorus, organochlorines, phenoxyacetic acids, and triazine compounds.
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32
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Schwartz GG, Klug MG. Motor neuron disease mortality rates in U.S. states are associated with well water use. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:528-534. [PMID: 27324739 PMCID: PMC5152538 DOI: 10.1080/21678421.2016.1195409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/04/2016] [Accepted: 04/25/2016] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with an unknown cause and invariably fatal outcome. We sought to evaluate a correlation between motor neuron disease (MND) mortality rates and residential radon levels that was previously reported for counties in the United Kingdom. We examined the relationships between age-adjusted MND mortality rates in U.S. states with residential radon levels, well water use, and other variables using structural equation modeling. We observed a significant correlation between MND mortality rates and radon levels. However, in structural equation models, radon did not have a significant, direct effect on MND mortality rates. Conversely, MND mortality rates were significantly and directly predicted by race and by the percentage of the population of each state using well water (p < 0.001 and p = 0.022). We observed similar, significant effects for well water use and MND mortality for males and females separately (p < 0.05). In conclusion, we hypothesize that the association of MND mortality rates with well water use reflects contamination of wells with Legionella, a bacterium common in well water that is known to cause neurologic disease. A Legionella hypothesis is a biologically plausible cause of ALS and suggests new avenues for etiologic research.
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Affiliation(s)
- Gary G. Schwartz
- Department of Population Health, University of North Dakota School of Medicine & Health Sciences,
Grand Forks,
ND,
USA
| | - Marilyn G. Klug
- Department of Population Health, University of North Dakota School of Medicine & Health Sciences,
Grand Forks,
ND,
USA
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33
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Peters TL, Kamel F, Lundholm C, Feychting M, Weibull CE, Sandler DP, Wiebert P, Sparén P, Ye W, Fang F. Occupational exposures and the risk of amyotrophic lateral sclerosis. Occup Environ Med 2016; 74:87-92. [PMID: 27418175 DOI: 10.1136/oemed-2016-103700] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/23/2016] [Accepted: 07/01/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the associations of specific occupations and occupational exposures with the risk of amyotrophic lateral sclerosis (ALS) in the Swedish population. METHODS A nested case-control study was conducted in Sweden. Patients with ALS diagnosed during 1991-2010 (n=5020) were identified from the National Patient Register and 5 controls per case (n=25 100) were randomly selected from the general Swedish population, individually matched to cases by birth year and sex. Occupational history was obtained from the Swedish censuses in 1970, 1980 and 1990. The Nordic Occupational Cancer Study Job Exposure Matrix was used to identify exposures related to individual occupations. Conditional logistic regression was used to estimate ORs and their 95% CIs. RESULTS Higher risk of ALS was associated with precision-tool manufacturing (OR 1.68, 95% CI 1.11 to 2.52) and glass, pottery and tile work (OR 1.76, 95% CI 1.03 to 3.00), whereas lower risk was associated with textile work (OR 0.44, 95% CI 0.21 to 0.91). None of the examined occupational exposures were associated with ALS risk overall. However, among individuals younger than 65 years of age, an association with a higher risk of ALS was found for formaldehyde (OR 1.29, 95% CI 1.00 to 1.65), and an association with a lower risk of ALS was found for methylene chloride (OR 0.49, 95% CI 0.26 to 0.93). CONCLUSIONS We identified several occupations and occupational exposures that may be associated with the risk of ALS in Sweden. Occupational history obtained from censuses every 10 years remains a limitation of the study.
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Affiliation(s)
- Tracy L Peters
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Freya Kamel
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Caroline E Weibull
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Pernilla Wiebert
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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34
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Su FC, Goutman SA, Chernyak S, Mukherjee B, Callaghan BC, Batterman S, Feldman EL. Association of Environmental Toxins With Amyotrophic Lateral Sclerosis. JAMA Neurol 2016; 73:803-11. [PMID: 27159543 PMCID: PMC5032145 DOI: 10.1001/jamaneurol.2016.0594] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Persistent environmental pollutants may represent a modifiable risk factor involved in the gene-time-environment hypothesis in amyotrophic lateral sclerosis (ALS). OBJECTIVE To evaluate the association of occupational exposures and environmental toxins on the odds of developing ALS in Michigan. DESIGN, SETTING, AND PARTICIPANTS Case-control study conducted between 2011 and 2014 at a tertiary referral center for ALS. Cases were patients diagnosed as having definitive, probable, probable with laboratory support, or possible ALS by revised El Escorial criteria; controls were excluded if they were diagnosed as having ALS or another neurodegenerative condition or if they had a family history of ALS in a first- or second-degree blood relative. Participants completed a survey assessing occupational and residential exposures. Blood concentrations of 122 persistent environmental pollutants, including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and brominated flame retardants (BFRs), were measured using gas chromatography-mass spectrometry. Multivariable models with self-reported occupational exposures in various exposure time windows and environmental toxin blood concentrations were separately fit by logistic regression models. Concordance between the survey data and pollutant measurements was assessed using the nonparametric Kendall τ correlation coefficient. MAIN OUTCOMES AND MEASURES Occupational and residential exposures to environmental toxins, and blood concentrations of 122 persistent environmental pollutants, including OCPs, PCBs, and BFRs. RESULTS Participants included 156 cases (mean [SD] age, 60.5 [11.1] years; 61.5% male) and 128 controls (mean [SD] age, 60.4 [9.4] years; 57.8% male); among them, 101 cases and 110 controls had complete demographic and pollutant data. Survey data revealed that reported pesticide exposure in the cumulative exposure windows was significantly associated with ALS (odds ratio [OR] = 5.09; 95% CI, 1.85-13.99; P = .002). Military service was also associated with ALS in 2 time windows (exposure ever happened in entire occupational history: OR = 2.31; 95% CI, 1.02-5.25; P = .046; exposure ever happened 10-30 years ago: OR = 2.18; 95% CI, 1.01-4.73; P = .049). A multivariable model of measured persistent environmental pollutants in the blood, representing cumulative occupational and residential exposure, showed increased odds of ALS for 2 OCPs (pentachlorobenzene: OR = 2.21; 95% CI, 1.06-4.60; P = .04; and cis-chlordane: OR = 5.74; 95% CI, 1.80-18.20; P = .005), 2 PCBs (PCB 175: OR = 1.81; 95% CI, 1.20-2.72; P = .005; and PCB 202: OR = 2.11; 95% CI, 1.36-3.27; P = .001), and 1 BFR (polybrominated diphenyl ether 47: OR = 2.69; 95% CI, 1.49-4.85; P = .001). There was modest concordance between survey data and the measurements of persistent environmental pollutants in blood; significant Kendall τ correlation coefficients ranged from -0.18 (Dacthal and "use pesticides to treat home or yard") to 0.24 (trans-nonachlor and "store lawn care products in garage"). CONCLUSIONS AND RELEVANCE In this study, persistent environmental pollutants measured in blood were significantly associated with ALS and may represent modifiable ALS disease risk factors.
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Affiliation(s)
- Feng-Chiao Su
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor
| | | | - Sergey Chernyak
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor
| | | | | | - Stuart Batterman
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor4A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor
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35
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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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36
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Coleman HG, Gray RT, Lau KW, McCaughey C, Coyle PV, Murray LJ, Johnston BT. Socio-economic status and lifestyle factors are associated with achalasia risk: A population-based case-control study. World J Gastroenterol 2016; 22:4002-8. [PMID: 27099443 PMCID: PMC4823250 DOI: 10.3748/wjg.v22.i15.4002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/14/2016] [Accepted: 01/30/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the association between various lifestyle factors and achalasia risk. METHODS A population-based case-control study was conducted in Northern Ireland, including n = 151 achalasia cases and n = 117 age- and sex-matched controls. Lifestyle factors were assessed via a face-to-face structured interview. The association between achalasia and lifestyle factors was assessed by unconditional logistic regression, to produce odds ratios (OR) and 95% confidence interval (CI). RESULTS Individuals who had low-class occupations were at the highest risk of achalasia (OR = 1.88, 95%CI: 1.02-3.45), inferring that high-class occupation holders have a reduced risk of achalasia. A history of foreign travel, a lifestyle factor linked to upper socio-economic class, was also associated with a reduced risk of achalasia (OR = 0.59, 95%CI: 0.35-0.99). Smoking and alcohol consumption carried significantly reduced risks of achalasia, even after adjustment for socio-economic status. The presence of pets in the house was associated with a two-fold increased risk of achalasia (OR = 2.00, 95%CI: 1.17-3.42). No childhood household factors were associated with achalasia risk. CONCLUSION Achalasia is a disease of inequality, and individuals from low socio-economic backgrounds are at highest risk. This does not appear to be due to corresponding alcohol and smoking behaviours. An observed positive association between pet ownership and achalasia risk suggests an interaction between endotoxin and viral infection exposure in achalasia aetiology.
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Santurtún A, Villar A, Delgado-Alvarado M, Riancho J. Trends in motor neuron disease: association with latitude and air lead levels in Spain. Neurol Sci 2016; 37:1271-5. [DOI: 10.1007/s10072-016-2581-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/11/2016] [Indexed: 12/13/2022]
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Eaglehouse YL, Talbott EO, Chang Y, Kuller LH. Participation in Physical Activity and Risk for Amyotrophic Lateral Sclerosis Mortality Among Postmenopausal Women. JAMA Neurol 2016; 73:329-36. [PMID: 26783702 PMCID: PMC6044440 DOI: 10.1001/jamaneurol.2015.4487] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Amyotrophic lateral sclerosis (ALS) is a progressive, fatal disease with no known cause. Case studies primarily of athletes and several case-control studies have suggested that high levels of strenuous physical activity (PA) may increase the risk for ALS. This relationship has yet to be evaluated among women in population-based cohort studies. OBJECTIVE To evaluate the relationship between PA and risk for ALS mortality in a large cohort of postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS The Women's Health Initiative (WHI) enrolled 161 809 postmenopausal women, aged 50 to 79 years (mean [SD] age, 63.6 [7.24] years), between 1993 and 1998 into either a clinical trial or an observational study at 40 clinical research centers across the United States. We conducted a cohort study from November 2014 to September 2015 using baseline and mortality data during an average of 9.6 years of follow-up from the entire WHI cohort, through September 1, 2013 (with 1.1% lost to follow-up), to address whether there is a relationship between PA and ALS mortality. EXPOSURES The WHI assessed frequency and duration of mild, moderate, and strenuous PA at baseline via self-administered questionnaire. MAIN OUTCOMES AND MEASURES Underlying cause of death from ALS collected from death certificates. RESULTS The WHI enrolled 161 809 women, of whom 165 died of ALS; women who died of ALS were older (median age, 66 years; interquartile range, 61-69 years) compared with the total WHI study population (median age, 63 years; interquartile range, 57-69 years). Age-adjusted ALS mortality rates varied from 7.4 (95% CI, 5.5-9.9)/100 000 person-years for no strenuous PA to 10.6 (95% CI, 5.6-20.0)/100 000 person-years for strenuous PA 3 or more days per week (P = .07). Adjusted for age and body mass index (calculated as weight in kilograms divided by height in meters squared), the odds ratio for death from ALS for participants with strenuous PA 3 or more days per week compared with no reported strenuous PA was 1.56 (95% CI, 1.02-2.37; P = .04). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first cohort study to report an increased risk for ALS mortality associated with strenuous PA in postmenopausal women. The association between strenuous PA and ALS risk observed does not compromise the overall benefit of strenuous PA for total mortality, coronary heart disease, and breast cancer reported in other WHI investigations, but it may provide an important clue to the etiology of ALS, if replicated by other studies.
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Affiliation(s)
- Yvonne L Eaglehouse
- Division of Cancer Prevention and Population Science, Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania2Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Evelyn O Talbott
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yuefang Chang
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Michael Caudle W. This can't be stressed enough: The contribution of select environmental toxicants to disruption of the stress circuitry and response. Physiol Behav 2015; 166:65-75. [PMID: 26409212 DOI: 10.1016/j.physbeh.2015.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
Integration of the hypothalamic-pituitary-adrenal (HPA) axis and the limbic system through glucocorticoid signaling is imperative in initiating and regulating a suitable stress response following real or perceived threats. Dysfunction of these circuits that results in a persistent or inhibited glucocorticoid secretion can severely affect processing of stressful experiences and lead to risk for developing further psychiatric pathology. Exposure to toxic chemicals found in our environment, including pesticides, metals, and industrial compounds, have been shown to have significant impact on neurological health and disease. Indeed, studies have begun to identify the HPA axis and limbic system as potential targets of many of these environmental chemicals, suggesting a possible environmental risk for damage to the stress circuit and response to stressful stimuli. This review will focus on our current understanding of the impact exposure to environmental toxicants, including bisphenol A and lead, has on the synaptic physiology of the HPA axis and limbic system and how this contributes to an alteration in behavior output. Further, this discussion will provide a starting point to continue to couple novel toxicological and neurological approaches to elaborate our understanding of the influence of environmental chemicals on the stress response and pathology.
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Affiliation(s)
- W Michael Caudle
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322-3090, USA; Center for Neurodegenerative Disease, School of Medicine, Emory University, Atlanta, GA 30322-3090, USA.
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Yang X, Zhao Q, An R, Zheng J, Tian S, Xu Y. Association of the functional SNP rs2275294 in ZNF512B with risk of amyotrophic lateral sclerosis and Parkinson's disease in Han Chinese. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:142-7. [DOI: 10.3109/21678421.2015.1054291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wang MD, Gomes J, Cashman NR, Little J, Krewski D. A meta-analysis of observational studies of the association between chronic occupational exposure to lead and amyotrophic lateral sclerosis. J Occup Environ Med 2015; 56:1235-42. [PMID: 25479292 PMCID: PMC4243803 DOI: 10.1097/jom.0000000000000323] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The association between occupational exposure to lead and amyotrophic lateral sclerosis (ALS) was examined through systematic review and meta-analyses of relevant epidemiological studies and reported according to PRISMA guidelines. METHODS Relevant studies were searched in multiple bibliographic databases through September 2013; additional articles were tracked through PubMed until submission. All records were screened in DistillerSR, and the data extracted from included articles were synthesized with meta-analysis. RESULTS The risk of developing ALS among individuals with a history of exposure to lead was almost doubled (odds ratio, 1.81; 95% confidence interval, 1.39 to 2.36) on the basis of nine included case-control studies with specific lead exposure information, with no apparent heterogeneity across included studies (I = 14%). The attributable risk of ALS because of exposure to lead was estimated to be 5%. CONCLUSIONS Previous exposure to lead may be a risk factor for ALS.
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Affiliation(s)
- Ming-Dong Wang
- From the Department of Epidemiology and Community Medicine (Drs Wang, Gomes, Little, and Krewski), Faculty of Medicine, University of Ottawa, Ontario; and Department of Medicine (Dr Cashman), University of British Columbia, Vancouver, British Columbia, Canada
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Yoon JH, Ahn YS. A large, nationwide, longitudinal study of central nervous system diseases among Korean workers exposed to manganese. Parkinsonism Relat Disord 2015; 21:194-8. [DOI: 10.1016/j.parkreldis.2014.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 10/09/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
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Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease. It is typically fatal within 2-5 years of symptom onset. The incidence of ALS is largely uniform across most parts of the world, but an increasing ALS incidence during the last decades has been suggested. Although recent genetic studies have substantially improved our understanding of the causes of ALS, especially familial ALS, an important role of non-genetic factors in ALS is recognized and needs further study. In this review, we briefly discuss several major genetic contributors to ALS identified to date, followed by a more focused discussion on the most commonly examined non-genetic risk factors for ALS. We first review factors related to lifestyle choices, including smoking, intake of antioxidants, physical fitness, body mass index, and physical exercise, followed by factors related to occupational and environmental exposures, including electromagnetic fields, metals, pesticides, β-methylamino-L-alanine, and viral infection. Potential links between ALS and other medical conditions, including head trauma, metabolic diseases, cancer, and inflammatory diseases, are also discussed. Finally, we outline several future directions aiming to more efficiently examine the role of non-genetic risk factors in ALS.
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Affiliation(s)
- Caroline Ingre
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per M Roos
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Freya Kamel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Malek AM, Barchowsky A, Bowser R, Heiman-Patterson T, Lacomis D, Rana S, Talbott EO. Exposure to hazardous air pollutants and the risk of amyotrophic lateral sclerosis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2015; 197:181-186. [PMID: 25544309 DOI: 10.1016/j.envpol.2014.12.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/01/2014] [Accepted: 12/06/2014] [Indexed: 05/11/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a serious and rapidly fatal neurodegenerative disorder with an annual incidence of 1-2.6/100,000 persons. Few known risk factors exist although gene-environment interaction is suspected. We investigated the relationship between suspected neurotoxicant hazardous air pollutants (HAPs) exposure and ALS. METHODS A case-control study involving sporadic ALS cases (n = 51) and matched controls (n = 51) was conducted from 2008 to 2011. Geocoded residential addresses were linked to U.S. EPA NATA data (1999, 2002, and 2005) by census tract. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. RESULTS Residential exposure to aromatic solvents significantly elevated the risk of ALS among cases compared to controls in 2002 (OR = 5.03, 95% CI: 1.29, 19.53) and 1999 (OR = 4.27, 95% CI: 1.09, 16.79) following adjustment for education, smoking, and other exposure groups. Metals, pesticides, and other HAPs were not associated with ALS. CONCLUSIONS A potential relationship is suggested between residential ambient air aromatic solvent exposure and risk of ALS in this study.
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Affiliation(s)
- Angela M Malek
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Aaron Barchowsky
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15219, USA.
| | - Robert Bowser
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA; Division of Neurobiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA.
| | - Terry Heiman-Patterson
- Department of Neurology, College of Medicine, Drexel University, Philadelphia, PA, 19107, USA.
| | - David Lacomis
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Sandeep Rana
- Department of Neurology, School of Medicine, Temple University, Philadelphia, PA, 19122, USA.
| | - Evelyn O Talbott
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
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Malek AM, Stickler DE, Antao VC, Horton DK. The National ALS Registry: a recruitment tool for research. Muscle Nerve 2014; 50:830-4. [PMID: 25111654 DOI: 10.1002/mus.24421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/11/2014] [Accepted: 08/05/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Subject recruitment is critical for understanding fatal diseases like ALS, however linking patients with researchers can be challenging. The U.S. population-based National ALS Registry allows recruitment of persons with ALS (PALS) for research opportunities. METHODS The Registry's Research Notification Mechanism was used to recruit PALS aged ≥21 years; participants completed a Web-based epidemiologic survey. PALS (n = 2,232) were sent an email describing the study, and 268 surveys were completed. RESULTS The mean age (± SD) of eligible participants was 57.7 ± 9.3 years for men and 61.5 ± 8.9 for women. Most were men (63%) and Caucasian (92%). Of 256 potentially eligible participants, 37.5% (n = 96) returned an authorization to disclose protected health information. ALS was confirmed for 94% (83/88) from physician responses. CONCLUSIONS This analysis demonstrates the National ALS Registry's usefulness in recruiting PALS for research. This recruitment source can potentially foster the discovery of better treatment options and therapies, and of prevention strategies.
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Affiliation(s)
- Angela M Malek
- Department of Neurosciences, Medical University of South Carolina, 135 Cannon Street, Room 305L, Charleston, South Carolina, 29425, USA
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Yu Y, Su FC, Callaghan BC, Goutman SA, Batterman SA, Feldman EL. Environmental risk factors and amyotrophic lateral sclerosis (ALS): a case-control study of ALS in Michigan. PLoS One 2014; 9:e101186. [PMID: 24979055 PMCID: PMC4076303 DOI: 10.1371/journal.pone.0101186] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/02/2014] [Indexed: 11/18/2022] Open
Abstract
An interim report of a case-control study was conducted to explore the role of environmental factors in the development of amyotrophic lateral sclerosis (ALS). Sixty-six cases and 66 age- and gender-matched controls were recruited. Detailed information regarding residence history, occupational history, smoking, physical activity, and other factors was obtained using questionnaires. The association of ALS with potential risk factors, including smoking, physical activity and chemical exposure, was investigated using conditional logistic regression models. As compared to controls, a greater number of our randomly selected ALS patients reported exposure to fertilizers to treat private yards and gardens and occupational exposure to pesticides in the last 30 years than our randomly selected control cases. Smoking, occupational exposures to metals, dust/fibers/fumes/gas and radiation, and physical activity were not associated with ALS when comparing the randomly selected ALS patients to the control subjects. To further explore and confirm results, exposures over several time frames, including 0-10 and 10-30 years earlier, were considered, and analyses were stratified by age and gender. Pesticide and fertilizer exposure were both significantly associated with ALS in the randomly selected ALS patients. While study results need to be interpreted cautiously given the small sample size and the lack of direct exposure measures, these results suggest that environmental and particularly residential exposure factors warrant close attention in studies examining risk factors of ALS.
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Affiliation(s)
- Yu Yu
- Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Feng-Chiao Su
- Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Brian C. Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Stephen A. Goutman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Stuart A. Batterman
- Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail: (ELF); (SAB)
| | - Eva L. Feldman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail: (ELF); (SAB)
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