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Hubbs AF, Kreiss K, Cummings KJ, Fluharty KL, O'Connell R, Cole A, Dodd TM, Clingerman SM, Flesher JR, Lee R, Pagel S, Battelli LA, Cumpston A, Jackson M, Kashon M, Orandle MS, Fedan JS, Sriram K. Flavorings-Related Lung Disease: A Brief Review and New Mechanistic Data. Toxicol Pathol 2019; 47:1012-1026. [PMID: 31645208 DOI: 10.1177/0192623319879906] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Flavorings-related lung disease is a potentially disabling and sometimes fatal lung disease of workers making or using flavorings. First identified almost 20 years ago in microwave popcorn workers exposed to butter-flavoring vapors, flavorings-related lung disease remains a concern today. In some cases, workers develop bronchiolitis obliterans, a severe form of fixed airways disease. Affected workers have been reported in microwave popcorn, flavorings, and coffee production workplaces. Volatile α-dicarbonyl compounds, particularly diacetyl (2,3-butanedione) and 2,3-pentanedione, are implicated in the etiology. Published studies on diacetyl and 2,3-pentanedione document their ability to cause airway epithelial necrosis, damage biological molecules, and perturb protein homeostasis. With chronic exposure in rats, they produce airway fibrosis resembling bronchiolitis obliterans. To add to this knowledge, we recently evaluated airway toxicity of the 3-carbon α-dicarbonyl compound, methylglyoxal. Methylglyoxal inhalation causes epithelial necrosis at even lower concentrations than diacetyl. In addition, we investigated airway toxicity of mixtures of diacetyl, acetoin, and acetic acid, common volatiles in butter flavoring. At ratios comparable to workplace scenarios, the mixtures or diacetyl alone, but not acetic acid or acetoin, cause airway epithelial necrosis. These new findings add to existing data to implicate α-dicarbonyl compounds in airway injury and flavorings-related lung disease.
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Affiliation(s)
- Ann F Hubbs
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Kristin J Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Kara L Fluharty
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Ryan O'Connell
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Allison Cole
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Tiana M Dodd
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Sidney M Clingerman
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Jordan R Flesher
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Rebecca Lee
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Samantha Pagel
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.,West Virginia University, Morgantown, WV, USA. Cummings is now with California Department of Public Health, Richmond, CA, USA. O'Connell is now with Department of Biochemistry, West Virginia, University, Morgantown, WV, USA. Flesher is now with Department of Biology, West Virginia University, Morgantown, WV, USA. Cole is now with Department of Pediatrics-Hematology/Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Kreiss (retired) is in Sitka, AK, USA
| | - Lori A Battelli
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Amy Cumpston
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Mark Jackson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Michael Kashon
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Marlene S Orandle
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Jeffrey S Fedan
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Krishnan Sriram
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
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Hubbs AF, Fluharty KL, Edwards RJ, Barnabei JL, Grantham JT, Palmer SM, Kelly F, Sargent LM, Reynolds SH, Mercer RR, Goravanahally MP, Kashon ML, Honaker JC, Jackson MC, Cumpston AM, Goldsmith WT, McKinney W, Fedan JS, Battelli LA, Munro T, Bucklew-Moyers W, McKinstry K, Schwegler-Berry D, Friend S, Knepp AK, Smith SL, Sriram K. Accumulation of Ubiquitin and Sequestosome-1 Implicate Protein Damage in Diacetyl-Induced Cytotoxicity. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:2887-2908. [PMID: 27643531 PMCID: PMC5222965 DOI: 10.1016/j.ajpath.2016.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/09/2016] [Accepted: 07/21/2016] [Indexed: 01/12/2023]
Abstract
Inhaled diacetyl vapors are associated with flavorings-related lung disease, a potentially fatal airway disease. The reactive α-dicarbonyl group in diacetyl causes protein damage in vitro. Dicarbonyl/l-xylulose reductase (DCXR) metabolizes diacetyl into acetoin, which lacks this α-dicarbonyl group. To investigate the hypothesis that flavorings-related lung disease is caused by in vivo protein damage, we correlated diacetyl-induced airway damage in mice with immunofluorescence for markers of protein turnover and autophagy. Western immunoblots identified shifts in ubiquitin pools. Diacetyl inhalation caused dose-dependent increases in bronchial epithelial cells with puncta of both total ubiquitin and K63-ubiquitin, central mediators of protein turnover. This response was greater in Dcxr-knockout mice than in wild-type controls inhaling 200 ppm diacetyl, further implicating the α-dicarbonyl group in protein damage. Western immunoblots demonstrated decreased free ubiquitin in airway-enriched fractions. Transmission electron microscopy and colocalization of ubiquitin-positive puncta with lysosomal-associated membrane proteins 1 and 2 and with the multifunctional scaffolding protein sequestosome-1 (SQSTM1/p62) confirmed autophagy. Surprisingly, immunoreactive SQSTM1 also accumulated in the olfactory bulb of the brain. Olfactory bulb SQSTM1 often congregated in activated microglial cells that also contained olfactory marker protein, indicating neuronophagia within the olfactory bulb. This suggests the possibility that SQSTM1 or damaged proteins may be transported from the nose to the brain. Together, these findings strongly implicate widespread protein damage in the etiology of flavorings-related lung disease.
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Affiliation(s)
- Ann F Hubbs
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia.
| | - Kara L Fluharty
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Rebekah J Edwards
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; Department of Forensic and Investigative Science, West Virginia University, Morgantown, West Virginia
| | - Jamie L Barnabei
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - John T Grantham
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Scott M Palmer
- Duke University School of Medicine, Durham, North Carolina
| | - Francine Kelly
- Duke University School of Medicine, Durham, North Carolina
| | - Linda M Sargent
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Steven H Reynolds
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Robert R Mercer
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Madhusudan P Goravanahally
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; Centers for Neuroscience, West Virginia University, Morgantown, West Virginia
| | - Michael L Kashon
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - John C Honaker
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Mark C Jackson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Amy M Cumpston
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - William T Goldsmith
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Walter McKinney
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Jeffrey S Fedan
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Lori A Battelli
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Tiffany Munro
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Winnie Bucklew-Moyers
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Kimberly McKinstry
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Diane Schwegler-Berry
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Sherri Friend
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Alycia K Knepp
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; Department of Forensic and Investigative Science, West Virginia University, Morgantown, West Virginia
| | - Samantha L Smith
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia; Department of Forensic and Investigative Science, West Virginia University, Morgantown, West Virginia
| | - Krishnan Sriram
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
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Kreiss K. Recognizing occupational effects of diacetyl: What can we learn from this history? Toxicology 2016; 388:48-54. [PMID: 27326900 DOI: 10.1016/j.tox.2016.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
For half of the 30-odd years that diacetyl-exposed workers have developed disabling lung disease, obliterative bronchiolitis was unrecognized as an occupational risk. Delays in its recognition as an occupational lung disease are attributable to the absence of a work-related temporal pattern of symptoms; failure to recognize clusters of cases; complexity of exposure environments; and absence of epidemiologic characterization of workforces giving rise to case clusters. Few physicians are familiar with this rare disease, and motivation to investigate the unknown requires familiarity with what is known and what is anomalous. In pursuit of the previously undescribed risk, investigators benefited greatly from multi-disciplinary collaboration, in this case including physicians, epidemiologists, environmental scientists, toxicologists, industry representatives, and worker advocates. In the 15 years since obliterative bronchiolitis was described in microwave popcorn workers, α-dicarbonyl-related lung disease has been found in flavoring manufacturing workers, other food production workers, diacetyl manufacturing workers, and coffee production workers, alongside case reports in other industries. Within the field of occupational health, impacts include new ventures in public health surveillance, attention to spirometry quality for serial measurements, identifying other indolent causes of obliterative bronchiolitis apart from accidental over-exposures, and broadening the spectrum of diagnostic abnormalities in the disease. Within toxicology, impacts include new attention to appropriate animal models of obliterative bronchiolitis, pertinence of computational fluid dynamic-physiologically based pharmacokinetic modeling, and contributions to mechanistic understanding of respiratory epithelial necrosis, airway fibrosis, and central nervous system effects. In these continuing efforts, collaboration between laboratory scientists, clinicians, occupational public health practitioners in government and industry, and employers remains critical for improving the health of workers inhaling volatile α-dicarbonyl compounds.
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Affiliation(s)
- Kathleen Kreiss
- Division of Respiratory Health, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown WV, United States.
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