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Li S, Huff RD, Rider CF, Yuen ACY, Carlsten C. Controlled human exposures to diesel exhaust or particle-depleted diesel exhaust with allergen modulates transcriptomic responses in the lung. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 945:173688. [PMID: 38851342 DOI: 10.1016/j.scitotenv.2024.173688] [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: 02/26/2024] [Revised: 05/13/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
The evidence associating traffic-related air pollution (TRAP) with allergic asthma is growing, but the underlying mechanisms for this association remain unclear. The airway epithelium is the primary tissue exposed to TRAP, hence understanding its interactions with TRAP and allergen is important. Diesel exhaust (DE), a paradigm of TRAP, consists of particulate matter (PM) and gases. Modern diesel engines often have catalytic diesel particulate filters to reduce PM output, but these may increase gaseous concentrations, and their benefits on human health cannot be assumed. We conducted a randomized, double-blinded, crossover study using our unique in vivo human exposure system to investigate the effects of DE and allergen co-exposure, with or without particle depletion as a proxy for catalytic diesel particulate filters, on the airway epithelial transcriptome. Participants were exposed for 2 h before an allergen inhalation challenge, with each receiving filtered air and saline (FA-S), filtered air and allergen (FA-A), DE and allergen (DE-A), or particle-depleted DE and allergen (PDDE-A), over four different occasions, each separated by a 4-week washout period. Endobronchial brushings were collected 48 h after each exposure, and total RNA was sequenced. Differentially expressed genes (DEGs) were identified using DESeq2, followed by GO enrichment and pathway analysis. FA-A, DE-A, and PDDE-A exposures significantly modulated genes relative to FA-S, with 462 unique DEGs identified. FA-A uniquely modulated the highest number (↑178, ↓155), followed by DE-A (↑44, ↓23), and then PDDE-A exposure (↑15, ↓2); 6 DEGs (↑4, ↓2) were modulated by all three conditions. Exposure to PDDE-A resulted in modulation of 285 DEGs compared to DE-A exposure, further revealing 26 biological process GO terms, including "cellular response to chemokine" and "inflammatory response". The transcriptional epithelial response to diesel exhaust and allergen co-exposure is enriched in inflammatory mediators, the pattern of which is altered upon particle depletion.
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Affiliation(s)
- Shijia Li
- Air Pollution Exposure Laboratory (APEL), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ryan D Huff
- Air Pollution Exposure Laboratory (APEL), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Christopher F Rider
- Air Pollution Exposure Laboratory (APEL), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Agnes C Y Yuen
- Air Pollution Exposure Laboratory (APEL), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Chris Carlsten
- Air Pollution Exposure Laboratory (APEL), Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Landwehr KR, Mead-Hunter R, O'Leary RA, Kicic A, Mullins BJ, Larcombe AN. The respiratory health effects of acute in vivo diesel and biodiesel exhaust in a mouse model. CHEMOSPHERE 2024; 362:142621. [PMID: 38880256 DOI: 10.1016/j.chemosphere.2024.142621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/28/2024] [Accepted: 06/14/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Biodiesel, a renewable diesel fuel that can be created from almost any natural fat or oil, is promoted as a greener and healthier alternative to commercial mineral diesel without the supporting experimental data to back these claims. The aim of this research was to assess the health effects of acute exposure to two types of biodiesel exhaust, or mineral diesel exhaust or air as a control in mice. Male BALB/c mice were exposed for 2-hrs to diluted exhaust obtained from a diesel engine running on mineral diesel, Tallow biodiesel or Canola biodiesel. A room air exposure group was used as a control. Twenty-four hours after exposure, a variety of respiratory related end point measurements were assessed, including lung function, responsiveness to methacholine and airway and systemic immune responses. RESULTS Tallow biodiesel exhaust exposure resulted in the greatest number of significant effects compared to Air controls, including increased airway hyperresponsiveness (178.1 ± 31.3% increase from saline for Tallow biodiesel exhaust exposed mice compared to 155.8 ± 19.1 for Air control), increased airway inflammation (63463 ± 13497 cells/mL in the bronchoalveolar lavage of Tallow biodiesel exhaust exposed mice compared to 40561 ± 11800 for Air exposed controls) and indications of immune dysregulation. In contrast, exposure to Canola biodiesel exhaust resulted in fewer significant effects compared to Air controls with a slight increase in airway resistance at functional residual capacity and indications of immune dysregulation. Exposure to mineral diesel exhaust resulted in significant effects between that of the two biodiesels with increased airway hyperresponsiveness and indications of immune dysregulation. CONCLUSION These data show that a single, brief exposure to biodiesel exhaust can result in negative health impacts in a mouse model, and that the biological effects of exposure change depending on the feedstock used to make the biodiesel.
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Affiliation(s)
- Katherine R Landwehr
- Occupation, Environment and Safety, School of Population Health, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia; Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth Children's Hospital, Nedlands, Perth, WA, 6009, Australia.
| | - Ryan Mead-Hunter
- Occupation, Environment and Safety, School of Population Health, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia
| | - Rebecca A O'Leary
- Department of Primary Industries and Regional Development, Perth, WA, 6151, Australia
| | - Anthony Kicic
- Occupation, Environment and Safety, School of Population Health, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia; Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth Children's Hospital, Nedlands, Perth, WA, 6009, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Perth, WA, 6009, Australia; Centre for Cell Therapy and Regenerative Medicine, The University of Western Australia, Perth, WA, 6009, Australia
| | - Benjamin J Mullins
- Occupation, Environment and Safety, School of Population Health, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia
| | - Alexander N Larcombe
- Occupation, Environment and Safety, School of Population Health, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia; Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth Children's Hospital, Nedlands, Perth, WA, 6009, Australia
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Robinson A, Huff RD, Ryu MH, Carlsten C. Variants in transient receptor potential channels and toll-like receptors modify airway responses to allergen and air pollution: a randomized controlled response human exposure study. Respir Res 2023; 24:218. [PMID: 37679687 PMCID: PMC10485933 DOI: 10.1186/s12931-023-02518-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Environmental co-exposure to allergen and traffic-related air pollution is common globally and contributes to the exacerbation of respiratory diseases. Individual responses to environmental insults remain variable due to gene-environment interactions. OBJECTIVE This study examined whether single nucleotide polymorphisms (SNPs) in lung cell surface receptor genes modifies lung function change and immune cell recruitment in allergen-sensitized individuals exposed to diesel exhaust (DE) and allergen. METHODS In this randomized, double-blinded, four-arm, crossover study, 13 allergen-sensitized participants underwent allergen inhalation challenge following a 2-hour exposure to DE, particle-depleted diesel exhaust (PDDE) or filtered air (FA). Lung function tests and bronchoscopic sample collection were performed up to 48 h after exposures. Transient receptor potential channel (TRPA1 and TRPV1) and toll-like receptor (TLR2 and TLR4) risk alleles were used to construct an unweighted genetic risk score (GRS). Exposure-by-GRS interactions were tested using mixed-effects models. RESULTS In participants with high GRS, allergen exposure was associated with an increase in airway hyperresponsiveness (AHR) when co-exposed to PDDE (p = 0.03) but not FA or DE. FA and PDDE also were associated with a relative increase in macrophages and decrease in lymphocytes in bronchoalveolar lavage. CONCLUSIONS TRPs and TLRs variants are associated with increased AHR and altered immune cellularity in allergen-exposed individuals. This effect is blunted by DE exposure, suggesting greater influence of unmeasured gene variants as primary meditators of a particulate-rich co-exposure. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov on December 20, 2013 (NCT02017431).
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Affiliation(s)
- Andrew Robinson
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department Medicine, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Ryan D Huff
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department Medicine, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Min Hyung Ryu
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department Medicine, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Chris Carlsten
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department Medicine, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada.
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Rodriguez-Martinez CE, Sossa-Briceño MP. Disparities in prevalence and outcomes of respiratory disease in low- and middle-income countries. Pediatr Pulmonol 2023. [PMID: 37378459 DOI: 10.1002/ppul.26573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To provide a comprehensive overview of disparities in prevalence and outcomes of respiratory diseases and notable challenges for providing optimal treatment to pediatric patients with respiratory diseases living in low- and middle-income countries (LMICs), as an input to help better understand the roots of respiratory health disparities. METHODS We conducted a narrative review of relevant literature published in electronic databases from inception to February 2023 that present data on disparities in prevalence and outcomes of respiratory disease in LMICs. Additionally, we included studies that describe and discuss challenges for providing optimal treatment to pediatric patients with respiratory diseases living in LMICs. RESULTS A number of early life exposures have been associated with adverse respiratory outcomes in later life. Several studies have shown marked geographical variations in the prevalence and burden of pediatric asthma, with consistently lower prevalence rates but significantly higher burdens and worse outcomes in LMICs. There is a wide range of challenges that adversely affect the efficient care of children with respiratory diseases that can be classified into three categories: patient-related factors, social/environmental factors, and factors related to healthcare providers or the healthcare system. CONCLUSIONS Respiratory health disparities in children living in LMICs represent a global public health issue mainly explained by an unequal distribution of preventable and modifiable risk factors for respiratory diseases across different demographic groups.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
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Bouma F, Hoek G, Koppelman GH, Vonk JM, Kerckhoffs J, Vermeulen R, Gehring U. Exposure to ambient ultrafine particles and allergic sensitization in children up to 16 years. ENVIRONMENTAL RESEARCH 2023; 219:115102. [PMID: 36565840 DOI: 10.1016/j.envres.2022.115102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/19/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Few epidemiological studies so far have investigated the role of long-term exposure to ultrafine particles (UFP) in inhalant and food allergy development. OBJECTIVES The purpose of this study was to assess the association between UFP exposure and allergic sensitization to inhalant and food allergens in children up to 16 years old in the Netherlands. METHODS 2295 participants of a prospective birth cohort with IgE measurements to common inhalant and food allergens at ages 4, 8, 12 and/or 16 were included in the study. Annual average UFP concentrations were estimated for the home addresses at birth and at the time of the IgE measurements using land-use regression models. Generalized estimating equations were used for the assessment of overall and age-specific associations between UFP exposure and allergic sensitization. Additionally, single- and two-pollutant models with NO2, PM2.5, PM2.5 absorbance and PM10 were assessed. RESULTS We found no significant associations between UFP exposure and allergic sensitization to inhalant and food allergens (OR (95% CI) ranging from 1.02 (0.95-1.10) to 1.05 (0.98-1.12), per IQR increment). NO2, PM2.5, PM2.5 absorbance and PM10 showed significant associations with sensitization to food allergens (OR (95% CI) ranging from 1.09 (1.00-1.20) to 1.23 (1.06-1.43) per IQR increment). NO2, PM2.5, PM2.5 absorbance and PM10 were not associated with sensitization to inhalant allergens. For NO2, PM2.5 and PM2.5 absorbance, the associations with sensitization to food allergens persisted in two-pollutant models with UFP. CONCLUSION This study found no association between annual average exposure to UFP and allergic sensitization in children up to 16 years of age. NO2, PM2.5, PM2.5 absorbance and PM10 were associated with sensitization to food allergens.
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Affiliation(s)
- Femke Bouma
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Judith M Vonk
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jules Kerckhoffs
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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Custovic A, Fontanella S. Evolution of Lung Function within Individuals: Clinical Insights and Data-driven Methods. Am J Respir Crit Care Med 2023; 207:379-381. [PMID: 36515972 PMCID: PMC9940144 DOI: 10.1164/rccm.202212-2226ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Adnan Custovic
- National Heart and Lung Institute Imperial College London London, United Kingdom
| | - Sara Fontanella
- National Heart and Lung Institute Imperial College London London, United Kingdom
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Hamidou Soumana I, Ryu MH, Leitao Filho FS, Yang J, Orach J, Nislow C, Leung JM, Rider CF, Carlsten C. Exposure to diesel exhaust alters the functional metagenomic composition of the airway microbiome in former smokers. ENVIRONMENTAL RESEARCH 2023; 216:114826. [PMID: 36403657 DOI: 10.1016/j.envres.2022.114826] [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: 09/06/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
The lung microbiome plays a crucial role in airway homeostasis, yet we know little about the effects of exposures such as air pollution therein. We conducted a controlled human exposure study to assess the impact of diesel exhaust (DE) on the human airway microbiome. Twenty-four participants (former smokers with mild to moderate COPD (N = 9), healthy former smokers (N = 7), and control healthy never smokers (N = 8)) were exposed to DE (300 μg/m3 PM2.5) and filtered air (FA) for 2 h in a randomized order, separated by a 4-week washout. Endobronchial brushing samples were collected 24 h post-exposure and sequenced for the 16S microbiome, which was analyzed using QIIME2 and PICRUSt2 to examine diversity and metabolic functions, respectively. DE exposure altered airway microbiome metabolic functions in spite of statistically stable microbiome diversity. Affected functions included increases in: superpathway of purine deoxyribonucleosides degradation (pathway differential abundance 743.9, CI 95% 201.2 to 1286.6), thiazole biosynthesis I (668.5, CI 95% 139.9 to 1197.06), and L-lysine biosynthesis II (666.5, CI 95% 73.3 to 1257.7). There was an exposure-by-age effect, such that menaquinone biosynthesis superpathways were the most enriched function in the microbiome of participants aged >60, irrespective of smoking or health status. Moreover, exposure-by-phenotype analysis showed metabolic alterations in former smokers after DE exposure. These observations suggest that DE exposure induced substantial changes in the metabolic functions of the airway microbiome despite the absence of diversity changes.
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Affiliation(s)
- Illiassou Hamidou Soumana
- Air Pollution Exposure Laboratory, Vancouver Coastal Health Research Institute, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Min Hyung Ryu
- Air Pollution Exposure Laboratory, Vancouver Coastal Health Research Institute, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Julia Yang
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Juma Orach
- Air Pollution Exposure Laboratory, Vancouver Coastal Health Research Institute, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Corey Nislow
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Janice M Leung
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Francis Rider
- Air Pollution Exposure Laboratory, Vancouver Coastal Health Research Institute, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Carlsten
- Air Pollution Exposure Laboratory, Vancouver Coastal Health Research Institute, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada.
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Li CH, Tsai ML, Chiou HY(C, Lin YC, Liao WT, Hung CH. Role of Macrophages in Air Pollution Exposure Related Asthma. Int J Mol Sci 2022; 23:ijms232012337. [PMID: 36293195 PMCID: PMC9603963 DOI: 10.3390/ijms232012337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/30/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Asthma is a chronic inflammatory airway disease characterized by variable airflow obstruction, bronchial hyper-responsiveness, and airway inflammation. The chronic inflammation of the airway is mediated by many cell types, cytokines, chemokines, and inflammatory mediators. Research suggests that exposure to air pollution has a negative impact on asthma outcomes in adult and pediatric populations. Air pollution is one of the greatest environmental risks to health, and it impacts the lungs' innate and adaptive defense systems. A major pollutant in the air is particulate matter (PM), a complex component composed of elemental carbon and heavy metals. According to the WHO, 99% of people live in air pollution where air quality levels are lower than the WHO air quality guidelines. This suggests that the effect of air pollution exposure on asthma is a crucial health issue worldwide. Macrophages are essential in recognizing and processing any inhaled foreign material, such as PM. Alveolar macrophages are one of the predominant cell types that process and remove inhaled PM by secreting proinflammatory mediators from the lung. This review focuses on macrophages and their role in orchestrating the inflammatory responses induced by exposure to air pollutants in asthma.
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Affiliation(s)
- Chung-Hsiang Li
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801, Taiwan
| | - Mei-Lan Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsin-Ying (Clair) Chiou
- Teaching and Research Center of Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Yi-Ching Lin
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Laboratory Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Doctoral Degree Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wei-Ting Liao
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (W.-T.L.); or (C.-H.H.); Tel.: +886-7-312-1101 (ext. 2791) (W.-T.L.); +886-7-311-5140 (C.-H.H.); Fax: +886-7-312-5339 (W.-T.L.); +886-7-321-3931 (C.-H.H.)
| | - Chih-Hsing Hung
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
- Correspondence: (W.-T.L.); or (C.-H.H.); Tel.: +886-7-312-1101 (ext. 2791) (W.-T.L.); +886-7-311-5140 (C.-H.H.); Fax: +886-7-312-5339 (W.-T.L.); +886-7-321-3931 (C.-H.H.)
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Ryu MH, Gómez C, Yuen ACY, Brook JR, Wheelock CE, Carlsten C. Urinary Eicosanoid Levels Reflect Allergen and Diesel Exhaust Coexposure and Are Linked to Impaired Lung Function. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:7107-7118. [PMID: 35044166 DOI: 10.1021/acs.est.1c07268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Eicosanoids are potent regulators of homeostasis and inflammation. Co-exposure to allergen and diesel exhaust (DE) have been shown to lead to eosinophilic inflammation, impaired airflow, and increased airway responsiveness. It is not clear whether eicosanoids mediate the mechanism by which these exposures impair lung function. We conducted a randomized, double-blinded, and four-arm crossover study. Fourteen allergen-sensitized participants were exposed to four conditions: negative control; allergen-alone exposure; DE and allergen coexposure; coexposure with particle-reducing technology applied. Quantitative metabolic profiling of urinary eicosanoids was performed using LC-MS/MS. As expected, allergen inhalation increased eicosanoids. The prostacyclin metabolite 2,3-dinor-6-keto-PGF1α (PGF1α, prostaglandin F1α) increased with coexposure, but particle depletion suppressed this pathway. Individuals with a high genetic risk score demonstrated a greater increase in isoprostane metabolites following coexposure. Causal mediation analyses showed that allergen induced airflow impairment was mediated via leukotriene E4 and tetranor-prostaglandin D metabolite. Overall, DE exposure did not augment the allergen's effect on urinary eicosanoids, except insofar as variant genotypes conferred susceptibility to the addition of DE in terms of isoprostane metabolites. These findings will add to the body of previous controlled human exposure studies and provide greater insight into how complex environmental exposures in urban air may influence individuals with sensitivity to aeroallergens.
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Affiliation(s)
- Min Hyung Ryu
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Cristina Gómez
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm SE-171 65, Sweden
- Unit of Lung and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Agnes C Y Yuen
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Jeffrey R Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 1P8, Canada
| | - Craig E Wheelock
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm SE-171 65, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm SE-171 76, Sweden
- Gunma University Initiative for Advanced Research (GIAR), Gunma University, Maebashi, Gunma 371-8511, Japan
| | - Christopher Carlsten
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
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Long E, Schwartz C, Carlsten C. Controlled human exposure to diesel exhaust: a method for understanding health effects of traffic-related air pollution. Part Fibre Toxicol 2022; 19:15. [PMID: 35216599 PMCID: PMC8876178 DOI: 10.1186/s12989-022-00454-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/03/2022] [Indexed: 12/17/2022] Open
Abstract
Diesel exhaust (DE) is a major component of air pollution in urban centers. Controlled human exposure (CHE) experiments are commonly used to investigate the acute effects of DE inhalation specifically and also as a paradigm for investigating responses to traffic-related air pollution (TRAP) more generally. Given the critical role this model plays in our understanding of TRAP’s health effects mechanistically and in support of associated policy and regulation, we review the methodology of CHE to DE (CHE–DE) in detail to distill critical elements so that the results of these studies can be understood in context. From 104 eligible publications, we identified 79 CHE–DE studies and extracted information on DE generation, exposure session characteristics, pollutant and particulate composition of exposures, and participant demographics. Virtually all studies had a crossover design, and most studies involved a single DE exposure per participant. Exposure sessions were typically 1 or 2 h in duration, with participants alternating between exercise and rest. Most CHE–DE targeted a PM concentration of 300 μg/m3. There was a wide range in commonly measured co-pollutants including nitrogen oxides, carbon monoxide, and total organic compounds. Reporting of detailed parameters of aerosol composition, including particle diameter, was inconsistent between studies, and older studies from a given lab were often cited in lieu of repeating measurements for new experiments. There was a male predominance in participants, and over half of studies involved healthy participants only. Other populations studied include those with asthma, atopy, or metabolic syndrome. Standardization in reporting exposure conditions, potentially using current versions of engines with modern emissions control technology, will allow for more valid comparisons between studies of CHE–DE, while recognizing that diesel engines in much of the world remain old and heterogeneous. Inclusion of female participants as well as populations more susceptible to TRAP will broaden the applicability of results from CHE–DE studies.
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Affiliation(s)
- Erin Long
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Carley Schwartz
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, 2775 Laurel Street 7th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Christopher Carlsten
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, 2775 Laurel Street 7th Floor, Vancouver, BC, V5Z 1M9, Canada.
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Long E, Carlsten C. Controlled human exposure to diesel exhaust: results illuminate health effects of traffic-related air pollution and inform future directions. Part Fibre Toxicol 2022; 19:11. [PMID: 35139881 PMCID: PMC8827176 DOI: 10.1186/s12989-022-00450-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/31/2022] [Indexed: 12/03/2022] Open
Abstract
Air pollution is an issue of increasing interest due to its globally relevant impacts on morbidity and mortality. Controlled human exposure (CHE) studies are often employed to investigate the impacts of pollution on human health, with diesel exhaust (DE) commonly used as a surrogate of traffic related air pollution (TRAP). This paper will review the results derived from 104 publications of CHE to DE (CHE-DE) with respect to health outcomes. CHE-DE studies have provided mechanistic evidence supporting TRAP’s detrimental effects on related to the cardiovascular system (e.g., vasomotor dysfunction, inhibition of fibrinolysis, and impaired cardiac function) and respiratory system (e.g., airway inflammation, increased airway responsiveness, and clinical symptoms of asthma). Oxidative stress is thought to be the primary mechanism of TRAP-induced effects and has been supported by several CHE-DE studies. A historical limitation of some air pollution research is consideration of TRAP (or its components) in isolation, limiting insight into the interactions between TRAP and other environmental factors often encountered in tandem. CHE-DE studies can help to shed light on complex conditions, and several have included co-exposure to common elements such as allergens, ozone, and activity level. The ability of filters to mitigate the adverse effects of DE, by limiting exposure to the particulate fraction of polluted aerosols, has also been examined. While various biomarkers of DE exposure have been evaluated in CHE-DE studies, a definitive such endpoint has yet to be identified. In spite of the above advantages, this paradigm for TRAP is constrained to acute exposures and can only be indirectly applied to chronic exposures, despite the critical real-world impact of living long-term with TRAP. Those with significant medical conditions are often excluded from CHE-DE studies and so results derived from healthy individuals may not apply to more susceptible populations whose further study is needed to avoid potentially misleading conclusions. In spite of limitations, the contributions of CHE-DE studies have greatly advanced current understanding of the health impacts associated with TRAP exposure, especially regarding mechanisms therein, with important implications for regulation and policy.
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Affiliation(s)
- Erin Long
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Christopher Carlsten
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, 2775 Laurel Street 7th Floor, Vancouver, BC, V5Z 1M9, Canada.
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12
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Gren L, Dierschke K, Mattsson F, Assarsson E, Krais AM, Kåredal M, Lovén K, Löndahl J, Pagels J, Strandberg B, Tunér M, Xu Y, Wollmer P, Albin M, Nielsen J, Gudmundsson A, Wierzbicka A. Lung function and self-rated symptoms in healthy volunteers after exposure to hydrotreated vegetable oil (HVO) exhaust with and without particles. Part Fibre Toxicol 2022; 19:9. [PMID: 35073958 PMCID: PMC8785558 DOI: 10.1186/s12989-021-00446-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background Diesel engine exhaust causes adverse health effects. Meanwhile, the impact of renewable diesel exhaust, such as hydrotreated vegetable oil (HVO), on human health is less known. Nineteen healthy volunteers were exposed to HVO exhaust for 3 h in a chamber with a double-blind, randomized setup. Exposure scenarios comprised of HVO exhaust from two modern non-road vehicles with 1) no aftertreatment system (‘HVOPM+NOx’ PM1: 93 µg m−3, EC: 54 µg m−3, NO: 3.4 ppm, NO2: 0.6 ppm), 2) an aftertreatment system containing a diesel oxidation catalyst and a diesel particulate filter (‘HVONOx’ PM1: ~ 1 µg m−3, NO: 2.0 ppm, NO2: 0.7 ppm) and 3) filtered air (FA) as control. The exposure concentrations were in line with current EU occupational exposure limits (OELs) of NO, NO2, formaldehyde, polycyclic aromatic hydrocarbons (PAHs), and the future OEL (2023) of elemental carbon (EC). The effect on nasal patency, pulmonary function, and self-rated symptoms were assessed. Calculated predicted lung deposition of HVO exhaust particles was compared to data from an earlier diesel exhaust study. Results The average total respiratory tract deposition of PM1 during HVOPM+NOx was 27 µg h−1. The estimated deposition fraction of HVO PM1 was 40–50% higher compared to diesel exhaust PM1 from an older vehicle (earlier study), due to smaller particle sizes of the HVOPM+NOx exhaust. Compared to FA, exposure to HVOPM+NOx and HVONOx caused higher incidence of self-reported symptoms (78%, 63%, respectively, vs. 28% for FA, p < 0.03). Especially, exposure to HVOPM+NOx showed 40–50% higher eye and throat irritation symptoms. Compared to FA, a decrement in nasal patency was found for the HVONOx exposures (− 18.1, 95% CI: − 27.3 to − 8.8 L min−1, p < 0.001), and for the HVOPM+NOx (− 7.4 (− 15.6 to 0.8) L min−1, p = 0.08). Overall, no clinically significant change was indicated in the pulmonary function tests (spirometry, peak expiratory flow, forced oscillation technique). Conclusion Short-term exposure to HVO exhaust concentrations corresponding to EU OELs for one workday did not cause adverse pulmonary function changes in healthy subjects. However, an increase in self-rated mild irritation symptoms, and mild decrease in nasal patency after both HVO exposures, may indicate irritative effects from exposure to HVO exhaust from modern non-road vehicles, with and without aftertreatment systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12989-021-00446-7.
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Affiliation(s)
- Louise Gren
- Ergonomics and Aerosol Technology, Lund University, 221 00, Lund, Sweden.,Lund University, NanoLund, 221 00, Lund, Sweden
| | - Katrin Dierschke
- Division of Occupational and Environmental Medicine, Lund University, 223 63, Lund, Sweden
| | - Fredrik Mattsson
- Ergonomics and Aerosol Technology, Lund University, 221 00, Lund, Sweden
| | - Eva Assarsson
- Division of Occupational and Environmental Medicine, Lund University, 223 63, Lund, Sweden
| | - Annette M Krais
- Division of Occupational and Environmental Medicine, Lund University, 223 63, Lund, Sweden
| | - Monica Kåredal
- Lund University, NanoLund, 221 00, Lund, Sweden.,Division of Occupational and Environmental Medicine, Lund University, 223 63, Lund, Sweden
| | - Karin Lovén
- Ergonomics and Aerosol Technology, Lund University, 221 00, Lund, Sweden.,Lund University, NanoLund, 221 00, Lund, Sweden
| | - Jakob Löndahl
- Ergonomics and Aerosol Technology, Lund University, 221 00, Lund, Sweden.,Lund University, NanoLund, 221 00, Lund, Sweden
| | - Joakim Pagels
- Ergonomics and Aerosol Technology, Lund University, 221 00, Lund, Sweden.,Lund University, NanoLund, 221 00, Lund, Sweden
| | - Bo Strandberg
- Division of Occupational and Environmental Medicine, Lund University, 223 63, Lund, Sweden
| | - Martin Tunér
- Division of Combustion Engines, Lund University, 221 00, Lund, Sweden
| | - Yiyi Xu
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Maria Albin
- Division of Occupational and Environmental Medicine, Lund University, 223 63, Lund, Sweden.,Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jörn Nielsen
- Division of Occupational and Environmental Medicine, Lund University, 223 63, Lund, Sweden
| | - Anders Gudmundsson
- Ergonomics and Aerosol Technology, Lund University, 221 00, Lund, Sweden.,Lund University, NanoLund, 221 00, Lund, Sweden
| | - Aneta Wierzbicka
- Ergonomics and Aerosol Technology, Lund University, 221 00, Lund, Sweden. .,Centre for Healthy Indoor Environments, Lund University, 221 00, Lund, Sweden.
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13
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Leung C, Ryu MH, Bølling AK, Maestre-Batlle D, Rider CF, Hüls A, Urtatiz O, MacIsaac JL, Lau KSK, Lin DTS, Kobor MS, Carlsten C. Peroxisome proliferator-activated receptor gamma gene variants modify human airway and systemic responses to indoor dibutyl phthalate exposure. Respir Res 2022; 23:248. [PMID: 36114491 PMCID: PMC9482266 DOI: 10.1186/s12931-022-02174-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) of peroxisome proliferator-activated receptor gamma (PPAR-γ; gene: PPARG) and oxidative stress genes are associated with asthma risk. However, whether such variants modulate responses to dibutyl phthalate (DBP), a common plasticizer associated with increased asthma development, remains unknown. The purpose of this study is to investigate how SNPs in PPARG and oxidative stress genes, as represented by two separate genetic risk scores, modify the impact of DBP exposure on lung function and the airway and systemic response after an inhaled allergen challenge. METHODS We conducted a double-blinded human crossover study with sixteen allergen-sensitized participants exposed for three hours to DBP and control air on distinct occasions separated by a 4-week washout. Each exposure was followed by an allergen inhalation challenge; subsequently, lung function was measured, and blood and bronchoalveolar lavage (BAL) were collected and analyzed for cell counts and allergen-specific immunoglobulin E (IgE). Genetic risk scores for PPAR-γ (P-GRS; weighted sum of PPARG SNPs rs10865710, rs709158, and rs3856806) and oxidative stress (OS-GRS; unweighted sum of 16 SNPs across multiple genes) were developed, and their ability to modify DBP effects were assessed using linear mixed-effects models. RESULTS P-GRS and OS-GRS modified DBP effects on allergen-specific IgE in blood at 20 h (interaction effect [95% CI]: 1.43 [1.13 to 1.80], p = 0.005) and 3 h (0.99 [0.98 to 1], p = 0.03), respectively. P-GRS also modified DBP effects on Th2 cells in blood at 3 h (- 25.2 [- 47.7 to - 2.70], p = 0.03) and 20 h (- 39.1 [- 57.9 to - 20.3], p = 0.0005), and Th2 cells in BAL at 24 h (- 4.99 [- 8.97 to - 1.01], p = 0.02). An increasing P-GRS associated with reduced DBP effect on Th2 cells. Neither GRS significantly modified DBP effects on lung function parameters. CONCLUSIONS PPAR-γ variants modulated several airway and systemic immune responses to the ubiquitous chemical plasticizer DBP. Our results suggest that PPAR-γ variants may play a greater role than those in oxidative stress-related genes in airway allergic responses to DBP. TRIAL REGISTRATION This study reports results from The Phthalate-Allergen Immune Response Study that was registered on ClinicalTrials.gov with identification NCT02688478.
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Affiliation(s)
- Clarus Leung
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, 7th Floor, 2775 Laurel St, VancouverVancouver, BC V5Z1M9 Canada
| | - Min Hyung Ryu
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, 7th Floor, 2775 Laurel St, VancouverVancouver, BC V5Z1M9 Canada
| | - Anette Kocbach Bølling
- grid.418193.60000 0001 1541 4204Department of Air Pollution and Noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Danay Maestre-Batlle
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, 7th Floor, 2775 Laurel St, VancouverVancouver, BC V5Z1M9 Canada
| | - Christopher F. Rider
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, 7th Floor, 2775 Laurel St, VancouverVancouver, BC V5Z1M9 Canada
| | - Anke Hüls
- grid.189967.80000 0001 0941 6502Department of Epidemiology and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Oscar Urtatiz
- grid.414137.40000 0001 0684 7788Department of Medical Genetics, University of British Columbia-BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Julie L. MacIsaac
- grid.414137.40000 0001 0684 7788Department of Medical Genetics, University of British Columbia-BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Kevin Soon-Keen Lau
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, 7th Floor, 2775 Laurel St, VancouverVancouver, BC V5Z1M9 Canada
| | - David Tse Shen Lin
- grid.414137.40000 0001 0684 7788Department of Medical Genetics, University of British Columbia-BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Michael S. Kobor
- grid.414137.40000 0001 0684 7788Department of Medical Genetics, University of British Columbia-BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Chris Carlsten
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, 7th Floor, 2775 Laurel St, VancouverVancouver, BC V5Z1M9 Canada
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14
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Konwar C, Asiimwe R, Inkster AM, Merrill SM, Negri GL, Aristizabal MJ, Rider CF, MacIsaac JL, Carlsten C, Kobor MS. Risk-focused differences in molecular processes implicated in SARS-CoV-2 infection: corollaries in DNA methylation and gene expression. Epigenetics Chromatin 2021; 14:54. [PMID: 34895312 PMCID: PMC8665859 DOI: 10.1186/s13072-021-00428-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Understanding the molecular basis of susceptibility factors to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a global health imperative. It is well-established that males are more likely to acquire SARS-CoV-2 infection and exhibit more severe outcomes. Similarly, exposure to air pollutants and pre-existing respiratory chronic conditions, such as asthma and chronic obstructive respiratory disease (COPD) confer an increased risk to coronavirus disease 2019 (COVID-19). METHODS We investigated molecular patterns associated with risk factors in 398 candidate genes relevant to COVID-19 biology. To accomplish this, we downloaded DNA methylation and gene expression data sets from publicly available repositories (GEO and GTEx Portal) and utilized data from an empirical controlled human exposure study conducted by our team. RESULTS First, we observed sex-biased DNA methylation patterns in autosomal immune genes, such as NLRP2, TLE1, GPX1, and ARRB2 (FDR < 0.05, magnitude of DNA methylation difference Δβ > 0.05). Second, our analysis on the X-linked genes identified sex associated DNA methylation profiles in genes, such as ACE2, CA5B, and HS6ST2 (FDR < 0.05, Δβ > 0.05). These associations were observed across multiple respiratory tissues (lung, nasal epithelia, airway epithelia, and bronchoalveolar lavage) and in whole blood. Some of these genes, such as NLRP2 and CA5B, also exhibited sex-biased gene expression patterns. In addition, we found differential DNA methylation patterns by COVID-19 status for genes, such as NLRP2 and ACE2 in an exploratory analysis of an empirical data set reporting on human COVID-9 infections. Third, we identified modest DNA methylation changes in CpGs associated with PRIM2 and TATDN1 (FDR < 0.1, Δβ > 0.05) in response to particle-depleted diesel exhaust in bronchoalveolar lavage. Finally, we captured a DNA methylation signature associated with COPD diagnosis in a gene involved in nicotine dependence (COMT) (FDR < 0.1, Δβ > 0.05). CONCLUSION Our findings on sex differences might be of clinical relevance given that they revealed molecular associations of sex-biased differences in COVID-19. Specifically, our results hinted at a potentially exaggerated immune response in males linked to autosomal genes, such as NLRP2. In contrast, our findings at X-linked loci such as ACE2 suggested a potentially distinct DNA methylation pattern in females that may interact with its mRNA expression and inactivation status. We also found tissue-specific DNA methylation differences in response to particulate exposure potentially capturing a nitrogen dioxide (NO2) effect-a contributor to COVID-19 susceptibility. While we identified a molecular signature associated with COPD, all COPD-affected individuals were smokers, which may either reflect an association with the disease, smoking, or may highlight a compounded effect of these two risk factors in COVID-19. Overall, our findings point towards a molecular basis of variation in susceptibility factors that may partly explain disparities in the risk for SARS-CoV-2 infection.
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Affiliation(s)
- Chaini Konwar
- BC Children's Hospital Research Institute (BCCHR), 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Centre for Molecular Medicine and Therapeutics, Vancouver, BC, V6H 0B3, Canada
| | - Rebecca Asiimwe
- BC Children's Hospital Research Institute (BCCHR), 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Centre for Molecular Medicine and Therapeutics, Vancouver, BC, V6H 0B3, Canada
| | - Amy M Inkster
- BC Children's Hospital Research Institute (BCCHR), 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- The Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Sarah M Merrill
- BC Children's Hospital Research Institute (BCCHR), 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Centre for Molecular Medicine and Therapeutics, Vancouver, BC, V6H 0B3, Canada
| | - Gian L Negri
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, V5Z 1L3, Canada
| | - Maria J Aristizabal
- BC Children's Hospital Research Institute (BCCHR), 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Centre for Molecular Medicine and Therapeutics, Vancouver, BC, V6H 0B3, Canada
- The Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, ON, M5S 3B2, Canada
- Department of Biology, Queen' University, Kingston, ON, K7L 3N6, Canada
- Program in Child and Brain Development, CIFAR, MaRS Centre, 661 University Ave, Toronto, ON, M5G 1M1, Canada
| | - Christopher F Rider
- The Department of Respiratory Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Julie L MacIsaac
- BC Children's Hospital Research Institute (BCCHR), 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Centre for Molecular Medicine and Therapeutics, Vancouver, BC, V6H 0B3, Canada
| | - Christopher Carlsten
- The Department of Respiratory Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Michael S Kobor
- BC Children's Hospital Research Institute (BCCHR), 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
- Centre for Molecular Medicine and Therapeutics, Vancouver, BC, V6H 0B3, Canada.
- Program in Child and Brain Development, CIFAR, MaRS Centre, 661 University Ave, Toronto, ON, M5G 1M1, Canada.
- The Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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15
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Forastiere F, Peters A. Invited Perspective: The NO2 and Mortality Dilemma Solved? Almost There! ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:121304. [PMID: 34962423 PMCID: PMC8713649 DOI: 10.1289/ehp10286] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 05/30/2023]
Affiliation(s)
- Francesco Forastiere
- Istituto per la Ricerca e l’Innovazione Biomedica Consiglio Nazionale delle Ricerche, Palermo, Italy
- Environmental Research Group, Imperial College, London, UK
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Environmental Health, Neuherberg, Germany
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16
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Abstract
Since the industrial revolution, air pollution has become a major problem causing several health problems involving the airways as well as the cardiovascular, reproductive, or neurological system. According to the WHO, about 3.6 million deaths every year are related to inhalation of polluted air, specifically due to pulmonary diseases. Polluted air first encounters the airways, which are a major human defense mechanism to reduce the risk of this aggressor. Air pollution consists of a mixture of potentially harmful compounds such as particulate matter, ozone, carbon monoxide, volatile organic compounds, and heavy metals, each having its own effects on the human body. In the last decades, a lot of research investigating the underlying risks and effects of air pollution and/or its specific compounds on the airways, has been performed, involving both in vivo and in vitro experiments. The goal of this review is to give an overview of the recent data on the effects of air pollution on healthy and diseased airways or models of airway disease, such as asthma or chronic obstructive pulmonary disease. Therefore, we focused on studies involving pollution and airway symptoms and/or damage both in mice and humans.
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17
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Jheng YT, Putri DU, Chuang HC, Lee KY, Chou HC, Wang SY, Han CL. Prolonged exposure to traffic-related particulate matter and gaseous pollutants implicate distinct molecular mechanisms of lung injury in rats. Part Fibre Toxicol 2021; 18:24. [PMID: 34172050 PMCID: PMC8235648 DOI: 10.1186/s12989-021-00417-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exposure to air pollution exerts direct effects on respiratory organs; however, molecular alterations underlying air pollution-induced pulmonary injury remain unclear. In this study, we investigated the effect of air pollution on the lung tissues of Sprague-Dawley rats with whole-body exposure to traffic-related PM1 (particulate matter < 1 μm in aerodynamic diameter) pollutants and compared it with that in rats exposed to high-efficiency particulate air-filtered gaseous pollutants and clean air controls for 3 and 6 months. Lung function and histological examinations were performed along with quantitative proteomics analysis and functional validation. RESULTS Rats in the 6-month PM1-exposed group exhibited a significant decline in lung function, as determined by decreased FEF25-75% and FEV20/FVC; however, histological analysis revealed earlier lung damage, as evidenced by increased congestion and macrophage infiltration in 3-month PM1-exposed rat lungs. The lung tissue proteomics analysis identified 2673 proteins that highlighted the differential dysregulation of proteins involved in oxidative stress, cellular metabolism, calcium signalling, inflammatory responses, and actin dynamics under exposures to PM1 and gaseous pollutants. The presence of PM1 specifically enhanced oxidative stress and inflammatory reactions under subchronic exposure to traffic-related PM1 and suppressed glucose metabolism and actin cytoskeleton signalling. These factors might lead to repair failure and thus to lung function decline after chronic exposure to traffic-related PM1. A detailed pathogenic mechanism was proposed to depict temporal and dynamic molecular regulations associated with PM1- and gaseous pollutants-induced lung injury. CONCLUSION This study explored several potential molecular features associated with early lung damage in response to traffic-related air pollution, which might be used to screen individuals more susceptible to air pollution.
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Affiliation(s)
- Yu-Teng Jheng
- Master Program in Clinical Pharmacogenomics and Pharmacoproteomics, College of Pharmacy, Taipei Medical University, Mailing address: 250 Wuxing St, Taipei, 11031, Taiwan
| | - Denise Utami Putri
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Pulmonary Research Center, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsiu-Chu Chou
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - San-Yuan Wang
- Master Program in Clinical Pharmacogenomics and Pharmacoproteomics, College of Pharmacy, Taipei Medical University, Mailing address: 250 Wuxing St, Taipei, 11031, Taiwan
| | - Chia-Li Han
- Master Program in Clinical Pharmacogenomics and Pharmacoproteomics, College of Pharmacy, Taipei Medical University, Mailing address: 250 Wuxing St, Taipei, 11031, Taiwan.
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18
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Schinko HAE, Lamprecht B, Schmidt R. Welche Veränderungen kann der Klimawandel für Pollenflug und Pollenbelastung allergener Pflanzen bringen? ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Maleki M, Anvari E, Hopke PK, Noorimotlagh Z, Mirzaee SA. An updated systematic review on the association between atmospheric particulate matter pollution and prevalence of SARS-CoV-2. ENVIRONMENTAL RESEARCH 2021; 195:110898. [PMID: 33610583 PMCID: PMC7891063 DOI: 10.1016/j.envres.2021.110898] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 05/13/2023]
Abstract
On December 31, 2019, the novel human coronavirus (COVID-19) was emerged in Wuhan city, China, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is a much controversial debate about the major pathways of transmission of the virus including airborne route. The present work is a systematic literature review (SR) aimed to assess the association of air pollution especially particulate matter pollution in the transmission and acceleration of the spread of SARS-CoV-2. The systematic literature search was performed to identify the available studies published through October 31, 2020 concerning the transmission of the disease and particulate matter air pollution in four international electronic databases. From the results of the included studies, there are suggestions that atmospheric particulate matter pollution plays a role in the SARS-CoV-2 spread, but the literature has not confirmed that it enhances the transmission although some studies have proposed that atmospheric particulate matter can operate as a virus carrier, promoting its spread. Therefore, although PM concentration alone cannot be effective in spreading the COVID-19 disease, other meteorological and environmental parameters including size of particles in ambient air, weather conditions, wind speed, relative humidity (RH) and temperature are involved. Therefore, it is necessary to consider all influencing parameters to prevent the spreading of COVID-19 disease. More studies are required to strengthen the scientific evidence and support more definitive conclusions.
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Affiliation(s)
- Maryam Maleki
- Department of Physiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
| | - Enayat Anvari
- Department of Physiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
| | - Philip K Hopke
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Clarkson University, USA.
| | - Zahra Noorimotlagh
- Biotechnology and Medical Plants Research Center, Ilam University of Medical Sciences, Ilam, Iran; Department of Environmental Health Engineering, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran.
| | - Seyyed Abbas Mirzaee
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran; Department of Environmental Health Engineering, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran.
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20
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Zhang Q, Liu C, Wang Y, Gong J, Wang G, Ge W, Chen R, Meng X, Zhao Y, Kan H. Associations of long-term exposure to ambient nitrogen dioxide with indicators of diabetes and dyslipidemia in China: A nationwide analysis. CHEMOSPHERE 2021; 269:128724. [PMID: 33162153 PMCID: PMC7904633 DOI: 10.1016/j.chemosphere.2020.128724] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND The associations between ambient NO2 and diabetes and dyslipidemia have been controversial, and data is especially lacking in developing countries. OBJECTIVE This study aimed to assess the associations of long-term exposure to NO2 with diabetes and dyslipidemia in China. METHODS We conducted a cross-sectional study including 13,013 participants from the China Health and Retirement Longitudinal Study (CHRLS). The annual average concentrations of NO2 were estimated based on the residential addresses of participants. We applied logistic regression models to evaluate the associations of NO2 with diabetes and dyslipidemia, and linear regression models to assess the associations with blood biomarkers. RESULTS A total of 1933 diabetes cases (14.85%) and 1935 (14.87%) dyslipidemia cases were identified. Significant associations were observed between NO2 and risk of diabetes and dyslipidemia independent of PM2.5 and O3. For an interquartile range (IQR) increase in NO2 (12.39 μg/m3), we observed a 13% [odds ratio (OR): 1.13; 95% confidence interval (CI): 1.01, 1.26] increased risk of diabetes, 1.48% (95%CI: 0.51%, 2.46%) increase in glucose, 0.74% (95%CI: 0.19%, 1.29%) increase in glycosylated hemoglobin (HbA1c), 17% (OR: 1.17; 95% CI: 1.05, 1.31) increased risk of dyslipidemia, 4.62% (95%CI: 2.49%, 6.79%) increase in triglyceride, and a decrease of 2.96% (95%CI: 2.13%, 3.79%) in high-density lipoprotein. The associations of NO2 with glucose disorders were stronger among smokers. CONCLUSIONS Our study indicated long-term exposure to NO2 might contribute to the development of diabetes and dyslipidemia, and the associations were potentially independent of O3 and PM2.5.
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Affiliation(s)
- Qingli Zhang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Yafeng Wang
- Institute of Social Surveys, Peking University, Beijing, China
| | - Jinquan Gong
- Institute of Social Surveys, Peking University, Beijing, China
| | - Gewei Wang
- Institute of Social Surveys, Peking University, Beijing, China
| | - Wenzhen Ge
- Regeneron Pharmaceuticals Inc., New York, 10591, USA
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China; Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, 200030, China.
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China; Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, 200030, China.
| | - Yaohui Zhao
- National School of Development, Peking University, Beijing, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
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21
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Mohammadi T, Sadatsafavi M, Carlsten C. The economics of precision health: preventing air pollution-induced exacerbation in asthma. ERJ Open Res 2021; 7:00790-2020. [PMID: 33778052 PMCID: PMC7983226 DOI: 10.1183/23120541.00790-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022] Open
Abstract
The demonstrable value of precision medicine, in the context of common environmental exposures, has scarcely been explored. This study evaluated the cost effectiveness of a preventive personalised intervention to reduce the adverse effect of air pollution in the context of asthma. A decision–analytic model was used to conduct a cost-utility analysis of prevention interventions in case of acute exposure to air pollution in mild asthma. Three different strategies, as follows, were compared: no preventive intervention; precision health strategy based on information from genotype testing, followed with treating high-risk patients; and prescribing additional medication to all mild asthmatics as a preventive intervention. The costs and quality-adjusted life years (QALYs) in the base case and alternative scenarios were obtained through probabilistic analysis. The results showed that the precision prevention intervention (anticipatory intervention for asthmatics, guided by relevant genetic abnormality, in the face of acute air pollution) is a cost-effective strategy compared with no such intervention, with an incremental cost-effectiveness ratio of CAD 49 555 per QALY. Furthermore, this strategy is a dominant strategy compared with an intervention that prescribes medication indiscriminately to all asthmatics. The incorporation of genomic testing to stratify risk of asthmatics to pollution-driven exacerbations, and then tailoring a preventive intervention accordingly, may be cost effective relative to untailored methods. These results lend plausibility to the use of precision medicine for limiting asthma exacerbation in the context of air pollution and, potentially, other exposures. Glutathione-S-transferase genotyping to determine the use of preventive asthma medication in the face of air pollution is cost effective in this model. Precision prevention in the setting of common environmental exposures may be used in other contexts.https://bit.ly/35Lab4b
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Affiliation(s)
- Tima Mohammadi
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Chris Carlsten
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
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22
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Lam HCY, Jarvis D, Fuertes E. Interactive effects of allergens and air pollution on respiratory health: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 757:143924. [PMID: 33310575 PMCID: PMC7812370 DOI: 10.1016/j.scitotenv.2020.143924] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND Studies have demonstrated an adverse role of outdoor allergens on respiratory symptoms. It is unknown whether this effect is independent or synergistic of outdoor air pollutants. METHODS We systematically reviewed all epidemiological studies that examined interaction effects between counts of outdoor airborne allergens (pollen, fungal spores) and air pollutants, on any respiratory health outcome in children and adults. We searched the MEDLINE, EMBASE and Scopus databases. Each study was summarized qualitatively and assessed for quality and risk of bias (International Prospective Register for Systematic Reviews, registration number CRD42020162571). RESULTS Thirty-five studies were identified (15 timeseries, eight case-crossovers, 11 panels and one cohort study), of which 12 reported a significant statistical interaction between an allergen and air pollutant. Eight interactions were related to asthma outcomes, including one on lung function measures and wheeze, three to medical consultations for pollinosis and one to allergic symptoms (nasal, ocular or bronchial). There was no consensus as to which allergen or air pollutant is more likely to interact. No study investigated whether interactions are stronger in atopic individuals. CONCLUSION Despite strong evidence from small experimental studies in humans, only a third of studies identified significant allergen-pollutant interactions using common epidemiological study designs. Exposure misclassification, failure to examine subgroups at risk, inadequate statistical power or absence of population-level effects are possible explanations.
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Affiliation(s)
- Holly C Y Lam
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC Centre for Environment & Health, Imperial College, London, United Kingdom.
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC Centre for Environment & Health, Imperial College, London, United Kingdom.
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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23
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Pascoe CD, Jha A, Ryu MH, Ragheb M, Vaghasiya J, Basu S, Stelmack GL, Srinathan S, Kidane B, Kindrachuk J, O'Byrne PM, Gauvreau GM, Ravandi A, Carlsten C, Halayko AJ. Allergen inhalation generates pro-inflammatory oxidised phosphatidylcholine associated with airway dysfunction. Eur Respir J 2021; 57:13993003.00839-2020. [PMID: 32883680 DOI: 10.1183/13993003.00839-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/26/2020] [Indexed: 01/14/2023]
Abstract
Oxidised phosphatidylcholines (OxPCs) are produced under conditions of elevated oxidative stress and can contribute to human disease pathobiology. However, their role in allergic asthma is unexplored. The aim of this study was to characterise the OxPC profile in the airways after allergen challenge of people with airway hyperresponsiveness (AHR) or mild asthma. The capacity of OxPCs to contribute to pathobiology associated with asthma was also to be determined.Using bronchoalveolar lavage fluid from two human cohorts, OxPC species were quantified using ultra-high performance liquid chromatography-tandem mass spectrometry. Murine thin-cut lung slices were used to measure airway narrowing caused by OxPCs. Human airway smooth muscle (HASM) cells were exposed to OxPCs to assess concentration-associated changes in inflammatory phenotype and activation of signalling networks.OxPC profiles in the airways were different between people with and without AHR and correlated with methacholine responsiveness. Exposing patients with mild asthma to allergens produced unique OxPC signatures that associated with the severity of the late asthma response. OxPCs dose-dependently induced 15% airway narrowing in murine thin-cut lung slices. In HASM cells, OxPCs dose-dependently increased the biosynthesis of cyclooxygenase-2, interleukin (IL)-6, IL-8, granulocyte-macrophage colony-stimulating factor and the production of oxylipins via protein kinase C-dependent pathways.Data from human cohorts and primary HASM cell culture show that OxPCs are present in the airways, increase after allergen challenge and correlate with metrics of airway dysfunction. Furthermore, OxPCs may contribute to asthma pathobiology by promoting airway narrowing and inducing a pro-inflammatory phenotype and contraction of airway smooth muscle. OxPCs represent a potential novel target for treating oxidative stress-associated pathobiology in asthma.
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Affiliation(s)
- Christopher D Pascoe
- Dept of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada.,Biology of Breathing Group, Children's Research Hospital of Manitoba, Winnipeg, MB, Canada.,Co-first authors
| | - Aruni Jha
- Dept of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada.,Biology of Breathing Group, Children's Research Hospital of Manitoba, Winnipeg, MB, Canada.,Co-first authors
| | - Min Hyung Ryu
- Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mirna Ragheb
- Dept of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada.,Biology of Breathing Group, Children's Research Hospital of Manitoba, Winnipeg, MB, Canada
| | - Jignesh Vaghasiya
- Dept of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada.,Biology of Breathing Group, Children's Research Hospital of Manitoba, Winnipeg, MB, Canada
| | - Sujata Basu
- Biology of Breathing Group, Children's Research Hospital of Manitoba, Winnipeg, MB, Canada
| | - Gerald L Stelmack
- Biology of Breathing Group, Children's Research Hospital of Manitoba, Winnipeg, MB, Canada
| | | | - Biniam Kidane
- Dept of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jason Kindrachuk
- Dept of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Paul M O'Byrne
- Dept of Medicine, Firestone Institute of Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Gail M Gauvreau
- Dept of Medicine, Firestone Institute of Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Amir Ravandi
- Dept of Medicine, University of Manitoba, Winnipeg, MB, Canada
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24
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Koch S, Welch JF, Tran R, Ramsook AH, Hung A, Carlsten C, Guenette JA, Koehle MS. Ventilatory responses to constant load exercise following the inhalation of a short-acting ß 2-agonist in a laboratory-controlled diesel exhaust exposure study in individuals with exercise-induced bronchoconstriction. ENVIRONMENT INTERNATIONAL 2021; 146:106182. [PMID: 33395924 DOI: 10.1016/j.envint.2020.106182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Individuals with exercise-induced bronchoconstriction (EIB) use ß2-agonists to reduce respiratory symptoms during acute exercise. The resultingbronchodilation could increase the dose of inhaled pollutants and impair respiratory function when exercise is performedin air pollution. We aimed to assess respiratory responses in individuals with EIB when completing a cycling bout while being exposed to diesel exhaust (DE) or filtered air (FA) with and without the inhalation of salbutamol (SAL), a short-acting ß2-agonist. METHODS In a double-blind, repeated-measures design, 19 participants with EIB (22-33 years of age) completed four visits: FA-placebo (FA-PLA), FA-SAL, DE-PLA, DE-SAL. After the inhalation of either 400 µg of SAL or PLA, participants sat in the exposure chamber for 60 min, breathing either FA or DE (PM2.5 = 300 μg/m3). Participants then cycled for 30 min at 50 % of peak work rate while breathing FA or DE. Respiratory responses were assessed via spirometry, work of breathing (WOB), fractional use of ventilatory capacity (V̇E/V̇E,CAP), area under the maximal expiratory flow-volume curve (MEFVAUC), and dyspnea during and following cycling. RESULTS Bronchodilation in response to SAL and acute cycling was observed, independent of FA/DE exposure. Specifically, FEV1 was increased by 7.7 % (confidence interval (CI): 7.2-8.2 %; p < 0.01) in response to SAL, and MEFVAUC was increased after cycling by 1.1 % (0.9-1.3 %; p = 0.03). Despite a significant decrease in total WOB by 6.2 J/min (4.7-7.5 J/min; p = 0.049) and a reduction in V̇E/V̇E,CAP by 5.8 % (5-6 %, p < 0.01) in the SAL exposures, no changes were observed in dyspnea. The DE exposure significantly increased V̇E/V̇E,CAP by 2.4 % (0.9-3.9 %; p < 0.01), but this did not affect dyspnea. DISCUSSION Our findings suggest that the use of SAL prior to moderate-intensity exercise when breathing high levels of DE, does not reduce respiratory function or exercise ventilatory responses for up to 60 min following exercise.
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Affiliation(s)
- Sarah Koch
- School of Kinesiology, University of British Columbia, Vancouver, Canada.
| | - Joseph F Welch
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Raymond Tran
- School of Kinesiology, University of British Columbia, Vancouver, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrew H Ramsook
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andy Hung
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Christopher Carlsten
- Faculty of Medicine, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jordan A Guenette
- School of Kinesiology, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, Vancouver, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada
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25
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Li H, Ryu MH, Rider CF, Tse W, Clifford RL, Aristizabal MJ, Wen W, Carlsten C. Predominant DNMT and TET mediate effects of allergen on the human bronchial epithelium in a controlled air pollution exposure study. J Allergy Clin Immunol 2020; 147:1671-1682. [PMID: 33069714 DOI: 10.1016/j.jaci.2020.08.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/29/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Epidemiological data show that traffic-related air pollution contributes to the increasing prevalence and severity of asthma. DNA methylation (DNAm) changes may elucidate adverse health effects of environmental exposures. OBJECTIVES We sought to assess the effects of allergen and diesel exhaust (DE) exposures on global DNAm and its regulation enzymes in human airway epithelium. METHODS A total of 11 participants, including 7 with and 4 without airway hyperresponsiveness, were recruited for a randomized, double-blind crossover study. Each participant had 3 exposures: filtered air + saline, filtered air + allergen, and DE + allergen. Forty-eight hours postexposure, endobronchial biopsies and bronchoalveolar lavages were collected. Levels of DNA methyltransferases (DNMTs) and ten-eleven translocation (TET) enzymes, 5-methylcytosine, and 5-hydroxymethylcytosine were determined by immunohistochemistry. Cytokines and chemokines in bronchoalveolar lavages were measured by electrochemiluminescence multiplex assays. RESULTS Predominant DNMT (the most abundant among DNMT1, DNMT3A, and DNMT3B) and predominant TET (the most abundant among TET1, TET2, and TET3) were participant-dependent. 5-Methylcytosine and its regulation enzymes differed between participants with and without airway hyperresponsiveness at baseline (filtered air + saline) and in response to allergen challenge (regardless of DE exposure). Predominant DNMT and predominant TET correlated with lung function. Allergen challenge effect on IL-8 in bronchoalveolar lavages was modified by TET2 baseline levels in the epithelium. CONCLUSIONS Response to allergen challenge is associated with key DNAm regulation enzymes. This relationship is generally unaltered by DE coexposure but is rather dependent on airway hyperresponsiveness status. These enzymes therefore warranted further inquiry regarding their potential in diagnosis, prognosis, and treatment of asthma.
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Affiliation(s)
- Hang Li
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Air Pollution Exposure Laboratory, Department of Medicine, Division of Respiratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Min Hyung Ryu
- Air Pollution Exposure Laboratory, Department of Medicine, Division of Respiratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher F Rider
- Air Pollution Exposure Laboratory, Department of Medicine, Division of Respiratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wayne Tse
- Air Pollution Exposure Laboratory, Department of Medicine, Division of Respiratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel L Clifford
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, Division of Respiratory Medicine, University of Nottingham, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, United Kingdom
| | - Maria J Aristizabal
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, Ontario, Canada; Child and Brain Development Program, Canadian Institute for Advanced Research (CIFAR), Toronto, Ontario, Canada
| | - Weiping Wen
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Chris Carlsten
- Air Pollution Exposure Laboratory, Department of Medicine, Division of Respiratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
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26
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Oxidation specific epitopes in asthma: New possibilities for treatment. Int J Biochem Cell Biol 2020; 129:105864. [PMID: 33069787 DOI: 10.1016/j.biocel.2020.105864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022]
Abstract
Oxidative stress is an important feature of asthma pathophysiology that is not currently targeted by any of our frontline treatments. Reactive oxygen species, generated during times of heightened oxidative stress, can damage cellular lipids causing the production of oxidation specific epitopes (OSE). OSEs are elevated in chronic inflammatory diseases and promoting their clearance by the body, through pattern recognition receptors and IgM antibodies, prevents and resolves inflammation and tissue damage in animal models. Current research on OSEs in asthma is limited. Although they are present in the lungs of people with asthma during periods of exacerbation or allergen exposure, we do not know if they are linked with disease pathobiology. This article reviews our current understanding of OSEs in asthma and explores whether targeting OSE clearance mechanisms may be a novel therapeutic intervention for asthma.
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27
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Schwartz C, Bølling AK, Carlsten C. Controlled human exposures to wood smoke: a synthesis of the evidence. Part Fibre Toxicol 2020; 17:49. [PMID: 33008417 PMCID: PMC7530963 DOI: 10.1186/s12989-020-00375-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 01/16/2023] Open
Abstract
Background Exposure to particulate matter (PM) from wood combustion represents a global health risk, encompassing diverse exposure sources; indoor exposures due to cooking in developing countries, ambient PM exposures from residential wood combustion in developed countries, and the predicted increasing number of wildfires due to global warming. Although physicochemical properties of the PM, as well as the exposure levels vary considerably between these sources, controlled human exposure studies may provide valuable insight to the harmful effects of wood smoke (WS) exposures in general. However, no previous review has focused specifically on controlled human exposure studies to WS. Results The 22 publications identified, resulting from 12 controlled human studies, applied a range of combustion conditions, exposure levels and durations, and exercise components in their WS exposure. A range of airway, cardiovascular and systemic endpoints were assessed, including lung function and heart rate measures, inflammation and oxidative stress. However, the possibility for drawing general conclusions was precluded by the large variation in study design, resulting in differences in physicochemical properties of WS, effective dose, as well as included endpoints and time-points for analysis. Overall, there was most consistency in reported effects for airways, while oxidative stress, systemic inflammation and cardiovascular physiology did not show any clear patterns. Conclusion Based on the reviewed controlled human exposure studies, conclusions regarding effects of acute WS exposure on human health are premature. Thus, more carefully conducted human studies are needed. Future studies should pay particular attention to the applied WS exposure, to assure that both exposure levels and PM properties reflect the research question.
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Affiliation(s)
- Carley Schwartz
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, P: 604-875-4729, 2775 Laurel Street 10th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Anette Kocbach Bølling
- Section of Air Pollution and Noise, Department of Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213, Oslo, Norway
| | - Christopher Carlsten
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, P: 604-875-4729, 2775 Laurel Street 10th Floor, Vancouver, BC, V5Z 1M9, Canada.
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28
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Saglani S, Wisnivesky JP, Charokopos A, Pascoe CD, Halayko AJ, Custovic A. Update in Asthma 2019. Am J Respir Crit Care Med 2020; 202:184-192. [PMID: 32338992 DOI: 10.1164/rccm.202003-0596up] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sejal Saglani
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Juan P Wisnivesky
- Division of General Internal Medicine and.,Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Antonios Charokopos
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher D Pascoe
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Manitoba, Canada; and.,Biology of Breathing Group, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew J Halayko
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Manitoba, Canada; and.,Biology of Breathing Group, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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29
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Mudway IS, Sandstrom T. Do Plasticizers within the Indoor Environment Increase Airway Allergen Responsiveness? Am J Respir Crit Care Med 2020; 202:639-640. [PMID: 32628859 PMCID: PMC7462401 DOI: 10.1164/rccm.202005-2048ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ian S Mudway
- MRC Centre for Environment and Health Kings College London London, United Kingdom and
| | - Thomas Sandstrom
- Department of Public Health and Clinical Medicine Umeå University Umeå, Sweden
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30
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Li CH, Sayeau K, Ellis AK. Air Pollution and Allergic Rhinitis: Role in Symptom Exacerbation and Strategies for Management. J Asthma Allergy 2020; 13:285-292. [PMID: 32922045 PMCID: PMC7457822 DOI: 10.2147/jaa.s237758] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/12/2020] [Indexed: 01/24/2023] Open
Abstract
This article reviews the current understanding of the role of air pollution in both the symptom exacerbation and rising prevalence of allergic rhinitis (AR) for the development of future AR therapeutics and management strategies. We discuss the epidemiological evidence for this relationship through birth cohort studies, the economic impact of AR, and the influence of air pollution through the lens of the exposome framework of allergic disease development. This is followed by a discussion on the influence of diesel exhaust and diesel exhaust particles (DEP) from motor vehicle emissions and their implication in the rising prevalence of allergic disease and allergic sensitization through triggering inflammatory signalling pathways that exacerbate AR symptoms. Finally, a summary is provided of clinical trials assessing the influence of air pollution on AR with a depiction of currently available therapies and management strategies. Future directions in the development of AR modalities given the air pollution-mediated symptom exacerbation are challenged with unfolding the complex gene–environment interaction product of heterogenous AR presentation.
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Affiliation(s)
- Carmen H Li
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Allergy Research Unit, Kingston Health Sciences Center - KGH Site, Kingston, ON, Canada
| | - Kyle Sayeau
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Allergy Research Unit, Kingston Health Sciences Center - KGH Site, Kingston, ON, Canada
| | - Anne K Ellis
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Allergy Research Unit, Kingston Health Sciences Center - KGH Site, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
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31
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Coccia M. Factors determining the diffusion of COVID-19 and suggested strategy to prevent future accelerated viral infectivity similar to COVID. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 729:138474. [PMID: 32498152 PMCID: PMC7169901 DOI: 10.1016/j.scitotenv.2020.138474] [Citation(s) in RCA: 365] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 04/13/2023]
Abstract
This study has two goals. The first is to explain the geo-environmental determinants of the accelerated diffusion of COVID-19 that is generating a high level of deaths. The second is to suggest a strategy to cope with future epidemic threats similar to COVID-19 having an accelerated viral infectivity in society. Using data on sample of N = 55 Italian province capitals, and data of infected individuals at as of April 7th, 2020, results reveal that the accelerate and vast diffusion of COVID-19 in North Italy has a high association with air pollution of cities measured with days exceeding the limits set for PM10 (particulate matter 10 μm or less in diameter) or ozone. In particular, hinterland cities with average high number of days exceeding the limits set for PM10 (and also having a low wind speed) have a very high number of infected people on 7th April 2020 (arithmetic mean is about 2200 infected individuals, with average polluted days greater than 80 days per year), whereas coastal cities also having days exceeding the limits set for PM10 or ozone but with high wind speed have about 944.70 average infected individuals, with about 60 average polluted days per year; moreover, cities having more than 100 days of air pollution (exceeding the limits set for PM10), they have a very high average number of infected people (about 3350 infected individuals, 7th April 2020), whereas cities having less than 100 days of air pollution per year, they have a lower average number of infected people (about 1014 individuals). The findings here also suggest that to minimize the impact of future epidemics similar to COVID-19, the max number of days per year that Italian provincial capitals or similar industrialized cities can exceed the limits set for PM10 or for ozone, considering their meteorological conditions, is about 48 days. Moreover, results here reveal that the explanatory variable of air pollution in cities seems to be a more important predictor in the initial phase of diffusion of viral infectivity (on 17th March 2020, b1 = 1.27, p < 0.001) than interpersonal contacts (b2 = 0.31, p < 0.05). In the second phase of maturity of the transmission dynamics of COVID-19, air pollution reduces intensity (on 7th April 2020 with b'1 = 0.81, p < 0.001) also because of the indirect effect of lockdown, whereas regression coefficient of transmission based on interpersonal contacts has a stable level (b'2 = 0.31, p < 0.01). This result reveals that accelerated transmission dynamics of COVID-19 is due to mainly to the mechanism of "air pollution-to-human transmission" (airborne viral infectivity) rather than "human-to-human transmission". Overall, then, transmission dynamics of viral infectivity, such as COVID-19, is due to systemic causes: general factors that are the same for all regions (e.g., biological characteristics of virus, incubation period, etc.) and specific factors which are different for each region and/or city (e.g., complex interaction between air pollution, meteorological conditions and biological characteristics of viral infectivity) and health level of individuals (habits, immune system, age, sex, etc.). Lessons learned for COVID-19 in the case study here suggest that a proactive strategy to cope with future epidemics is also to apply especially an environmental and sustainable policy based on reduction of levels of air pollution mainly in hinterland and polluting cities- (having low wind speed, high percentage of moisture and number of fog days) -that seem to have an environment that foster a fast transmission dynamics of viral infectivity in society. Hence, in the presence of polluting industrialization in regions that can trigger the mechanism of air pollution-to-human transmission dynamics of viral infectivity, this study must conclude that a comprehensive strategy to prevent future epidemics similar to COVID-19 has to be also designed in environmental and socioeconomic terms, that is also based on sustainability science and environmental science, and not only in terms of biology, medicine, healthcare and health sector.
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Affiliation(s)
- Mario Coccia
- CNR - National Research Council of Italy, Research Institute on Sustainable Economic Growth, Collegio Carlo Alberto, Via Real Collegio, 30-10024 Moncalieri, Torino, Italy; Yale School of Medicine, 310 Cedar Street, Lauder Hall, New Haven, CT 06510, USA.
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Gallo O, Bruno C, Locatello LG. Global lockdown, pollution, and respiratory allergic diseases: Are we in or are we out? J Allergy Clin Immunol 2020; 146:542-544. [PMID: 32605856 PMCID: PMC7306722 DOI: 10.1016/j.jaci.2020.05.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, Florence, Italy.
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, Florence, Italy
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Ryu MH, Lau KSK, Wooding DJ, Fan S, Sin DD, Carlsten C. Particle depletion of diesel exhaust restores allergen-induced lung-protective surfactant protein D in human lungs. Thorax 2020; 75:640-647. [PMID: 32467339 DOI: 10.1136/thoraxjnl-2020-214561] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
RATIONALE Exposure to air pollution is linked with increased asthma morbidity and mortality. To understand pathological processes linking air pollution and allergen exposures to asthma pathophysiology, we investigated the effect of coexposure to diesel exhaust (DE) and aeroallergen on immune regulatory proteins in human airways. METHODS Fourteen allergen-sensitised participants completed this randomised, double-blinded, cross-over, controlled exposure study. Each participant underwent four exposures (allergen-alone exposure, DE and allergen coexposure, particle-depleted DE (PDDE) and allergen coexposure, and sham exposure) on different order-randomised dates, each separated by a 4-week washout. Serum and bronchoalveolar lavage (BAL) were assayed for pattern recognition molecules, cytokines, chemokines and inflammatory mediators. RESULTS In human airways, allergen-alone exposure led to accumulation of surfactant protein D (SPD; p=0.02). Coexposure to allergen and DE did not elicit the same increase of SPD as did allergen alone; diesel particulate reduction restored allergen-induced SPD accumulation. Soluble receptor for advanced glycation end products was higher with particle reduction than without it. In the systemic circulation, there was a transient increase in SPD and club cell protein 16 (CC16) 4 hours after allergen alone. CC16 was augmented by PDDE, but not DE. % eosinophils in BAL (p<0.005), eotaxin-3 (p<0.0001), interleukin 5 (IL-5; p<0.0001) and thymus and activation regulated chemokine (p=0.0001) were each increased in BAL by allergen. IL-5, SPD and % eosinophils in BAL were correlated with decreased FEV1. CONCLUSION Short-term coexposure to aeroallergen and DE alters immune regulatory proteins in lungs; surfactant levels are dependent on particle depletion. TRIAL REGISTRATION NUMBER NCT02017431.
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Affiliation(s)
- Min Hyung Ryu
- Air Pollution Exposure Laboratory, Department of Medicine, Vancouver Coastal Health Research Institute, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Kevin Soon-Keen Lau
- Air Pollution Exposure Laboratory, Department of Medicine, Vancouver Coastal Health Research Institute, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Denise Jill Wooding
- Air Pollution Exposure Laboratory, Department of Medicine, Vancouver Coastal Health Research Institute, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Shuyu Fan
- Air Pollution Exposure Laboratory, Department of Medicine, Vancouver Coastal Health Research Institute, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Christopher Carlsten
- Air Pollution Exposure Laboratory, Department of Medicine, Vancouver Coastal Health Research Institute, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Moshammer H, Poteser M, Kundi M, Lemmerer K, Weitensfelder L, Wallner P, Hutter HP. Nitrogen-Dioxide Remains a Valid Air Quality Indicator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103733. [PMID: 32466201 PMCID: PMC7277805 DOI: 10.3390/ijerph17103733] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 01/08/2023]
Abstract
In epidemiological studies, both spatial and temporal variations in nitrogen dioxide (NO2) are a robust predictor of health risks. Compared to particulate matter, the experimental evidence for harmful effects at typical ambient concentrations is less extensive and not as clear for NO2. In the wake of the “Diesel emission scandal—Dieselgate”, the scientific basis of current limit values for ambient NO2 concentrations was attacked by industry lobbyists. It was argued that associations between NO2 levels and medical endpoints were not causal, as NO2 in older studies served as a proxy for aggressive particulate matter from incineration processes. With the introduction of particle filters in diesel cars, NO2 would have lost its meaning as a health indicator. Austria has a high percentage of diesel-powered cars (56%). If, indeed, associations between NO2 concentrations and health risks in previous studies were only due to older engines without a particle filter, we should expect a reduction in effect estimates over time as an increasing number of diesel cars on the roads were outfitted with particle filters. In previous time series studies from Vienna over shorter time intervals, we have demonstrated distributed lag effects over days up to two weeks and previous day effects of NO2 on total mortality. In a simplified model, we now assess the effect estimates for moving 5-year periods from the beginning of NO2 monitoring in Vienna (1987) until the year 2018 of same and previous day NO2 on total daily mortality. Contrary to industry claims of a spurious, no longer valid indicator function of NO2, effect estimates remained fairly stable, indicating an increase in total mortality of previous day NO2 by 0.52% (95% CI: 0.35–0.7%) per 10 µg/m3 change in NO2 concentration.
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Affiliation(s)
- Hanns Moshammer
- Department of Environmental Health, Center for Public Health, Medical University Vienna, 1090 Vienna, Austria; (M.P.); (M.K.); (K.L.); (P.W.); (L.W.); (H.-P.H.)
- Department of Hygiene, Medical University of Karakalpakstan, Uzbekistan, Nukus 230100, Uzbekistan
- Correspondence: ; Tel.: +43-1-40160-34935
| | - Michael Poteser
- Department of Environmental Health, Center for Public Health, Medical University Vienna, 1090 Vienna, Austria; (M.P.); (M.K.); (K.L.); (P.W.); (L.W.); (H.-P.H.)
| | - Michael Kundi
- Department of Environmental Health, Center for Public Health, Medical University Vienna, 1090 Vienna, Austria; (M.P.); (M.K.); (K.L.); (P.W.); (L.W.); (H.-P.H.)
| | - Kathrin Lemmerer
- Department of Environmental Health, Center for Public Health, Medical University Vienna, 1090 Vienna, Austria; (M.P.); (M.K.); (K.L.); (P.W.); (L.W.); (H.-P.H.)
| | - Lisbeth Weitensfelder
- Department of Environmental Health, Center for Public Health, Medical University Vienna, 1090 Vienna, Austria; (M.P.); (M.K.); (K.L.); (P.W.); (L.W.); (H.-P.H.)
| | - Peter Wallner
- Department of Environmental Health, Center for Public Health, Medical University Vienna, 1090 Vienna, Austria; (M.P.); (M.K.); (K.L.); (P.W.); (L.W.); (H.-P.H.)
| | - Hans-Peter Hutter
- Department of Environmental Health, Center for Public Health, Medical University Vienna, 1090 Vienna, Austria; (M.P.); (M.K.); (K.L.); (P.W.); (L.W.); (H.-P.H.)
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Glencross DA, Ho TR, Camiña N, Hawrylowicz CM, Pfeffer PE. Air pollution and its effects on the immune system. Free Radic Biol Med 2020; 151:56-68. [PMID: 32007522 DOI: 10.1016/j.freeradbiomed.2020.01.179] [Citation(s) in RCA: 269] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/22/2022]
Abstract
A well-functioning immune system is vital for a healthy body. Inadequate and excessive immune responses underlie diverse pathologies such as serious infections, metastatic malignancies and auto-immune conditions. Therefore, understanding the effects of ambient pollutants on the immune system is vital to understanding how pollution causes disease, and how that pathology could be abrogated. The immune system itself consists of multiple types of immune cell that act together to generate (or fail to generate) immune responses and in this article we review evidence of how air pollutants can affect different immune cell types such as particle-clearing macrophages, inflammatory neutrophils, dendritic cells that orchestrate adaptive immune responses and lymphocytes that enact those responses. Common themes that emerge are of the capacity of air pollutants to stimulate pro-inflammatory immune responses across multiple classes of immune cell. Air pollution can enhance T helper lymphocyte type 2 (Th2) and T helper lymphocyte type 17 (Th17) adaptive immune responses, as seen in allergy and asthma, and dysregulate anti-viral immune responses. The clinical effects of air pollution, in particular the known association between elevated ambient pollution and exacerbations of asthma and chronic obstructive pulmonary disease (COPD), are consistent with these identified immunological mechanisms. Further to this, as inhaled air pollution deposits primarily on the respiratory mucosa this review focuses on mechanisms of respiratory disease. However, as discussed in the article, air pollution also affects the wider immune system for example in the neonate and gastrointestinal tract. Whilst the many identified actions of air pollution on the immune system are notably diverse, immunological research does suggest potential strategies to ameliorate such effects, for example with vitamin D supplementation. An in-depth understanding of the immunological effects of ambient pollutants should hopefully yield new ideas on how to reduce the adverse health effects of air pollution.
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Affiliation(s)
- Drew A Glencross
- Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's Hospital, London, SE1 9RT, UK; MRC Centre for Environment and Health, King's College London, Franklin Wilkins Building, London, SE1 9NH, UK
| | - Tzer-Ren Ho
- Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's Hospital, London, SE1 9RT, UK; MRC Centre for Environment and Health, King's College London, Franklin Wilkins Building, London, SE1 9NH, UK
| | - Nuria Camiña
- MRC Centre for Environment and Health, King's College London, Franklin Wilkins Building, London, SE1 9NH, UK
| | - Catherine M Hawrylowicz
- Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's Hospital, London, SE1 9RT, UK.
| | - Paul E Pfeffer
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
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Coccia M. Two mechanisms for accelerated diffusion of COVID-19 outbreaks in regions with high intensity of population and polluting industrialization: the air pollution-to-human and human-to-human transmission dynamics (Preprint).. [DOI: 10.2196/preprints.19331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Coronavirus disease 2019 (COVID-19) is viral infection that generates a severe acute respiratory syndrome with serious pneumonia that may result in progressive respiratory failure and death.
OBJECTIVE
This study has two goals. The first is to explain the main factors determining the diffusion of COVID-19 that is generating a high level of deaths. The second is to suggest a strategy to cope with future epidemic threats with of accelerated viral infectivity in society.
METHODS
Correlation and regression analyses on on data of N=55 Italian province capitals, and data of infected individuals at as of April 2020.
RESULTS
The main results are:
o The accelerate and vast diffusion of COVID-19 in North Italy has a high association with air pollution.
o Hinterland cities have average days of exceeding the limits set for PM10 (particulate matter 10 micrometers or less in diameter) equal to 80 days, and an average number of infected more than 2,000 individuals as of April 1st, 2020, coastal cities have days of exceeding the limits set for PM10 equal to 60 days and have about 700 infected in average.
o Cities that average number of 125 days exceeding the limits set for PM10, last year, they have an average number of infected individual higher than 3,200 units, whereas cities having less than 100 days (average number of 48 days) exceeding the limits set for PM10, they have an average number of about 900 infected individuals.
o The results reveal that accelerated transmission dynamics of COVID-19 in specific environments is due to two mechanisms given by: air pollution-to-human transmission and human-to-human transmission; in particular, the mechanisms of air pollution-to-human transmission play a critical role rather than human-to-human transmission.
o The finding here suggests that to minimize future epidemic similar to COVID-19, the max number of days per year in which cities can exceed the limits set for PM10 or for ozone, considering their meteorological condition, is less than 50 days. After this critical threshold, the analytical output here suggests that environmental inconsistencies because of the combination between air pollution and meteorological conditions (with high moisture%, low wind speed and fog) trigger a take-off of viral infectivity (accelerated epidemic diffusion) with damages for health of population, economy and society.
CONCLUSIONS
Considering the complex interaction between air pollution, meteorological conditions and biological characteristics of viral infectivity, lessons learned for COVID-19 have to be applied for a proactive socioeconomic strategy to cope with future epidemics, especially an environmental policy based on reduction of air pollution mainly in hinterland zones of countries, having low wind speed, high percentage of moisture and fog that create an environment that can damage immune system of people and foster a fast transmission of viral infectivity similar to the COVID-19.
CLINICALTRIAL
not applicable
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Coccia M. Two mechanisms for accelerated diffusion of COVID-19 outbreaks in regions with high intensity of population and polluting industrialization: the air pollution-to-human and human-to-human transmission dynamics.. [DOI: 10.1101/2020.04.06.20055657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
AbstractWhat is COVID-19?Coronavirus disease 2019 (COVID-19) is viral infection that generates a severe acute respiratory syndrome with serious pneumonia that may result in progressive respiratory failure and death.What are the goals of this investigation?This study explains the geo-environmental determinants of the accelerated diffusion of COVID-19 in Italy that is generating a high level of deaths and suggests general lessons learned for a strategy to cope with future epidemics similar to COVID-19 to reduce viral infectivity and negative impacts in economic systems and society.What are the results of this study?The main results are:
The accelerate and vast diffusion of COVID-19 in North Italy has a high association with air pollution.Hinterland cities have average days of exceeding the limits set for PM10 (particulate matter 10 micrometers or less in diameter) equal to 80 days, and an average number of infected more than 2,000 individuals as of April 1st, 2020, coastal cities have days of exceeding the limits set for PM10 equal to 60 days and have about 700 infected in average.Cities that average number of 125 days exceeding the limits set for PM10, last year, they have an average number of infected individual higher than 3,200 units, whereas cities having less than 100 days (average number of 48 days) exceeding the limits set for PM10, they have an average number of about 900 infected individuals.The results reveal that accelerated transmission dynamics of COVID-19 in specific environments is due to two mechanisms given by: air pollution-to-human transmission and human-to-human transmission; in particular, the mechanisms of air pollution-to-human transmission play a critical role rather than human-to-human transmission.The finding here suggests that to minimize future epidemic similar to COVID-19, the max number of days per year in which cities can exceed the limits set for PM10 or for ozone, considering their meteorological condition, is less than 50 days. After this critical threshold, the analytical output here suggests that environmental inconsistencies because of the combination between air pollution and meteorological conditions (with high moisture%, low wind speed and fog) trigger a take-off of viral infectivity (accelerated epidemic diffusion) with damages for health of population, economy and society.What is a socioeconomic strategy to prevent future epidemics similar to COVID-19?Considering the complex interaction between air pollution, meteorological conditions and biological characteristics of viral infectivity, lessons learned for COVID-19 have to be applied for a proactive socioeconomic strategy to cope with future epidemics, especially an environmental policy based on reduction of air pollution mainly in hinterland zones of countries, having low wind speed, high percentage of moisture and fog that create an environment that can damage immune system of people and foster a fast transmission of viral infectivity similar to the COVID-19.This study must conclude that a strategy to prevent future epidemics similar to COVID 19 has also to be designed in environmental and sustainability science and not only in terms of biology.
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Permaul P, Gaffin JM, Petty CR, Baxi SN, Lai PS, Sheehan WJ, Camargo CA, Gold DR, Phipatanakul W. Obesity may enhance the adverse effects of NO 2 exposure in urban schools on asthma symptoms in children. J Allergy Clin Immunol 2020; 146:813-820.e2. [PMID: 32197971 DOI: 10.1016/j.jaci.2020.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/26/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sparse data address the effects of nitrogen dioxide (NO2) exposure in inner-city schools on obese students with asthma. OBJECTIVE We sought to evaluate relationships between classroom NO2 exposure and asthma symptoms and morbidity by body mass index (BMI) category. METHODS The School Inner-City Asthma Study enrolled students aged 4 to 13 years with asthma from 37 inner-city schools. Students had baseline determination of BMI percentile. Asthma symptoms, morbidity, pulmonary inflammation, and lung function were monitored throughout the subsequent academic year. Classroom NO2 data, linked to enrolled students, were collected twice per year. We determined the relationship between classroom NO2 levels and asthma outcomes by BMI stratification. RESULTS A total of 271 predominantly black (35%) or Hispanic students (35%) were included in analyses. Fifty percent were normal weight (5-84th BMI percentile), 15% overweight (≥85-94th BMI percentile), and 35% obese (≥95th BMI percentile). For each 10-parts per billion increase in NO2, obese students had a significant increase in the odds of having an asthma symptom day (odds ratio [OR], 1.86; 95% CI, 1.15-3.02) and in days caregiver changed plans (OR, 4.24; 95% CI, 2.33-7.70), which was significantly different than normal weight students who exhibited no relationship between NO2 exposure and symptom days (OR, 0.90; 95% CI, 0.57-1.42; pairwise interaction P = .03) and change in caregiver plans (OR, 1.37; 95% CI, 0.67-2.82; pairwise interaction P = .02). Relationships between NO2 levels and lung function and fractional exhaled nitric oxide did not differ by BMI category. If we applied a conservative Holm-Bonferroni correction for 16 comparisons (obese vs normal weight and overweight vs normal weight for 8 outcomes), these findings would not meet statistical significance (all P > .003). CONCLUSIONS Obese BMI status appears to increase susceptibility to classroom NO2 exposure effects on asthma symptoms in inner-city children. Environmental interventions targeting indoor school NO2 levels may improve asthma health for obese children. Although our findings would not remain statistically significant after adjustment for multiple comparisons, the large effect sizes warrant future study of the interaction of obesity and pollution in pediatric asthma.
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Affiliation(s)
- Perdita Permaul
- Division of Pediatric Pulmonology, Allergy and Immunology, New York-Presbyterian/Weill Cornell Medicine, New York, NY; Weill Cornell Medical College, New York, NY
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Carter R Petty
- Clinical Research Center, Boston Children's Hospital, Boston, Mass
| | - Sachin N Baxi
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Mass
| | - William J Sheehan
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; George Washington University School of Medicine, Washington, DC
| | - Carlos A Camargo
- Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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Weitekamp CA, Kerr LB, Dishaw L, Nichols J, Lein M, Stewart MJ. A systematic review of the health effects associated with the inhalation of particle-filtered and whole diesel exhaust. Inhal Toxicol 2020; 32:1-13. [PMID: 32100584 DOI: 10.1080/08958378.2020.1725187] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Diesel exhaust is a complex mixture comprised of gases and particulate matter and is a contributor to ambient air pollution. To reduce health risks, recent changes in diesel engine technology have significantly altered the composition of diesel exhaust, primarily by lowering emissions of particulate matter. However, animal toxicological studies continue to report health effects following exposure to diesel exhaust from engines employing particulate filters. The cause of these effects remains unclear.Objective and methods: To gain an understanding of the role of both particle-filtered and whole diesel exhaust on specific health outcomes, we conducted a systematic review in which we examined animal toxicological and controlled human exposure studies that included a comparison between inhalation of particle-filtered and whole diesel exhaust on any health endpoint.Results: We identified 26 studies that met both the inclusion and study evaluation criteria. For most health outcomes, the particle filtration methods employed in the included studies did not appreciably attenuate the health effects associated with exposure to whole diesel exhaust. There were also several health endpoints for which significant effects were associated with exposure to either particle-filtered or whole diesel exhaust, but not to both.Conclusions: Overall, the results from this systematic review demonstrate that exposure to different components in diesel exhaust can have distinct and independent health effects. Thus, to better inform human health risk assessments, future studies aimed at elucidating the health effects from diesel exhaust should include exposure to both particle-filtered and whole diesel exhaust.
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Affiliation(s)
- Chelsea A Weitekamp
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Durham, NC, USA
| | - Lukas B Kerr
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Durham, NC, USA.,Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Laura Dishaw
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Durham, NC, USA
| | - Jennifer Nichols
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Durham, NC, USA
| | - McKayla Lein
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Durham, NC, USA.,Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Michael J Stewart
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Durham, NC, USA
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Li Z, Ma J, Shen J, Chan MTV, Wu WKK, Wu Z. Differentially expressed circular RNAs in air pollution-exposed rat embryos. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:34421-34429. [PMID: 31637615 DOI: 10.1007/s11356-019-06489-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
Circular RNAs (circRNAs) are an important class of non-coding RNAs partly by acting as microRNA sponges. Growing evidence indicates that air pollution exposure during pregnancy could lead to congenital defects in the offspring. In this study, using circRNAs sequencing, we profiled differentially expressed circRNAs in rat embryos exposed to a high concentration (> 200 μg/m3) of fine particulate matter (PM2.5) in utero. Compared with the control embryos whose mothers were reared in clean air, 25 and 55 circRNAs were found to be downregulated and upregulated, respectively, in the air pollution-exposed group. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of circRNA-coexpressed genes indicated that segmentation, brain development, and system development together with lysine degradation, Rap1 signaling pathway, and adrenergic signaling were deregulated by in utero air pollution exposure. We also identified the central role of three circRNAs, namely circ_015003, circ_030724, and circ_127215 in the circRNA-microRNA interaction network. These data suggested that circRNA deregulation might play a crucial role in the development of air pollution-associated congenital malformations.
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Affiliation(s)
- Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianqing Ma
- Department of Orthopedic Surgery, The General Hospital of Xingtai Mining Industry Bloc., Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China
| | - Jianxiong Shen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - William K K Wu
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhanyong Wu
- Department of Orthopedic Surgery, The General Hospital of Xingtai Mining Industry Bloc., Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China.
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Bosson JA, Mudway IS, Sandström T. Traffic-related Air Pollution, Health, and Allergy: The Role of Nitrogen Dioxide. Am J Respir Crit Care Med 2019; 200:523-524. [PMID: 31059649 PMCID: PMC6727158 DOI: 10.1164/rccm.201904-0834ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jenny A Bosson
- Department of Public Health and Clinical MedicineUmeå UniversityUmeå, Swedenand
| | - Ian S Mudway
- School of Population Health and Environmental SciencesKing's College LondonLondon, United Kingdom
| | - Thomas Sandström
- Department of Public Health and Clinical MedicineUmeå UniversityUmeå, Swedenand
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