Pulmonary fibrosis in an individual occupationally exposed to inhaled indium-tin oxide

Subchronic toxicity study of indium-tin oxide nanoparticles following intratracheal administration into the lungs of rats

OBJECTIVES

We aimed to analyze the subchronic toxicity and tissue distribution of indium after the intratracheal administration of indium-tin oxide nanoparticles (ITO NPs) to the lungs of rats.

METHODS

Male Wistar rats were administered a single intratracheal dose of 10 or 20 mg In/kg body weight (BW) of ITO NPs. The control rats received only an intratracheal dose of distilled water. A subset of rats was periodically euthanized throughout the study from 1 to 20 weeks after administration. Indium concentrations in the serum, lungs, mediastinal lymph nodes, kidneys, liver, and spleen as well as pathological changes in the lungs and kidneys were determined. Additionally, the distribution of ionic indium and indium NPs in the kidneys was analyzed using laser ablation-inductively coupled plasma mass spectrometry.

RESULTS

Indium concentrations in the lungs of the 2 ITO NP groups gradually decreased over the 20-week observation period. Conversely, the indium concentrations in the mediastinal lymph nodes of the 2 ITO groups increased and were several hundred times higher than those in the kidneys, spleen, and liver. Pulmonary and renal toxicities were observed histopathologically in both the ITO groups. Both indium NPs and ionic indium were detected in the kidneys, and their distributions were similar to the strong indium signals detected at the sites of inflammatory cell infiltration and tubular epithelial cells.

CONCLUSIONS

Our results demonstrate that intratracheal administration of 10 or 20 mg In/kg BW of ITO NPs in male rats produces pulmonary and renal toxicities.

Progression of Smoking-Induced Emphysema in a Case with Indium Lung

Recently, it has become clear that inhaled indium-tin oxide causes emphysematous as well as interstitial changes in the lung. Here, we present a 59-year-old male ex-smoker, quitting smoking at the age of 55. He had been engaged in indium-tin oxide processing from 27 to 37 years of age, with 22 years having passed since the final exposure to indium. He was found to have a high serum indium concentration and Krebs von den Lungen-6 (KL-6). Furthermore, bilateral centrilobular emphysema was recognized in high-resolution computed tomography (HRCT). After transferring jobs to a non-indium-tin oxide section, KL-6 returned to a normal level within 4 years, whereas neither serum indium concentration nor emphysema had decreased to normal despite 22 years having passed since the exposure ended. At the age of 59, a thoracoscopic lung biopsy was performed to assess the contribution of smoking and that of indium to the lung destruction. The pathological findings demonstrated cholesterol granulomas with the accumulation of macrophages and multinucleated giant cells that had phagocytosed particles. Together with the typical findings of indium lung, fibrotic and emphysematous changes were observed. The elemental analysis of the biopsied specimens revealed excessive deposition of indium throughout the airways, interstitial spaces and alveoli. The pathological findings of this case may be the result of two kinds of pulmonary damage, i.e., smoking and indium. This report indicates that occupationally-inhaled indium could remain in the lung for as long as 22 years and continue to insult the lung tissue with inflammation caused by smoking.

Role of the occupational disease consultant in the multidisciplinary discussion of interstitial lung diseases

BACKGROUND

Diffuse interstitial lung diseases (ILD) constitute a heterogeneous group of conditions with complex etiological diagnoses requiring a multidisciplinary approach. Much is still unknown about them, particularly their relationship with occupational exposures. The primary objective of this study was to investigate the distribution of occupational exposures according to type of ILD. The secondary objectives were to estimate the proportion of ILDs possibly related to occupational exposure and to evaluate the added value of the participation of an occupational disease consultant in ILD multidisciplinary discussions (MDD).

METHODS

From May to December 2020, all consecutive patients with ILD whose cases were reviewed during a MDD in a referral centre for ILD were prospectively offered a consultation with an occupational disease consultant.

RESULTS

Of the 156 patients with ILD whose cases were reviewed in MDD during the study period, 141 patients attended an occupational exposure consultation. Occupational exposure was identified in 97 patients. Occupational exposure to asbestos was found in 12/31 (38.7%) patients with idiopathic pulmonary fibrosis (IPF) and in 9/18 (50.0%) patients with unclassifiable fibrosis. Occupational exposure to metal dust was found in 13/31 (41.9%) patients with IPFs and 10/18 (55.6%) patients with unclassifiable fibrosis. Silica exposure was found in 12/50 (24.0%) patients with autoimmune ILD. The link between occupational exposure and ILD was confirmed for 41 patients after the specialist occupational consultation. The occupational origin had not been considered (n = 9) or had been excluded or neglected (n = 4) by the MDD before the specialised consultation. A total of 24 (17%) patients were advised to apply for occupational disease compensation, including 22 (15.6%) following the consultation. In addition, a diagnosis different from the one proposed by the MDD was proposed for 18/141 (12.8%) patients.

CONCLUSIONS

In our study, we found a high prevalence of occupational respiratory exposure with a potential causal link in patients with ILD. We suggest that a systematic specialised consultation in occupational medicine could be beneficial in the ILD diagnostic approach.

Association between environmental toxic metals, arsenic and polycyclic aromatic hydrocarbons and chronic obstructive pulmonary disease in the US adult population

Associations between environmental metals and chemicals and adverse human health effects have emerged recently, but the links among environmental metals and respiratory diseases are less studied. The aim of this study was to assess 14 urinary metals (cadmium, barium, cobalt, molybdenum, mercury, cesium, manganese, antimony, lead, tin, strontium, tungsten, thallium, and uranium), seven species of arsenic (arsenous acid, arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid, monomethylarsonic acid, and total arsenic) and seven polycyclic aromatic hydrocarbon (PAH) (1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene, 1-hydroxyphenanthrene, 1-hydroxypyrene, 2 & 3-hydroxyphenanthrene) compounds' concentrations in urine and the correlation with chronic obstructive pulmonary disease (COPD) in the adult US population. A cross-sectional analysis using the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) dataset was conducted. Self-questionnaires related to COPD criteria were used to identify the COPD cases. The correlation between urinary metals and PAH compounds and COPD was calculated. The total study population analyzed included 2885 adults aged 20 years and older. Seven types of urinary PAHs including 1-hydroxynaphthalene [odds ratio (OR): 1.832, 95% confidence interval (CI): 1.210, 2.775], 2-hydroxynaphthalene [OR: 3.361, 95% CI: 1.519, 7.440], 3-hydroxyfluorene [OR: 2.641, 95% CI: 1.381, 5.053], 2-hydroxyfluorene [OR: 3.628, 95% CI: 1.754, 7.506], 1-hydroxyphenanthrene [OR: 2.864, 95% CI: 1.307, 6.277], 1-hydroxypyrene [OR: 4.949, 95% CI: 2.540, 9.643] and 2 & 3-hydroxyphenanthrene [OR: 3.487, 95% CI: 1.382, 8.795] were positively associated with COPD. Urinary cadmium [OR: 12.382, 95% CI: 4.459, 34.383] and tin [OR: 1.743, 95% CI: 1.189, 2.555] showed positive associations with increased odds of COPD. The other types of urinary metals were not associated with COPD. The study observed that urinary PAHs, cadmium, and tin are significantly associated with COPD.

Influence of Indium (III) Chloride on Human Dermal Fibroblast Cell Adhesion on Tantalum/Silicon Oxide Nano-Composites

Cell adhesion is an essential biological function for division, migration, signaling and tissue development. While it has been demonstrated that this cell function can be modified by using nanometer-scale surface topographic structures, it remains unknown how contaminants such as indium (III) ion might influence this specific cell behavior. Herein, the influence of indium chloride on human dermal fibroblast (GM5565) adhesion characteristics was investigated, given the frequent contact of contaminants with skin. The morphology of the adherent cells and their mitochondrial reticulum was characterized on cell culture dishes and nanopatterned surfaces by using fluorescence confocal microscopy and scanning electron microscopy. Results showed a significant proportion of cells lost their ability to align preferentially along the line axes of the nanopattern upon exposure to 3.2 mM indium chloride, with cells aligned within 10° of the pattern line axes reduced by as much as ~70%. Concurrent with the cell adhesion behaviors, the mitochondria in cells exposed to indium chloride exhibit a punctate staining that contrasts with the normal network of elongated tubular geometry seen in control cells. Our results demonstrate that exposure to indium chloride has detrimental effects on the behavior of human fibroblasts and adversely impacts their mitochondrial morphology. This shows the importance of evaluating the biological impacts of indium compounds.

Toxicokinetics and systematic responses of differently sized indium tin oxide (ITO) particles in mice via oropharyngeal aspiration exposure

Indium tin oxide (ITO) is an important semiconductor material, because of increasing commercial products consumption and potentially exposed workers worldwide. So, urgently we need to assess and manage potential health risks of ITO. Although the Occupational Exposure Limit (OEL) has been established for ITO exposure, there is still a lack of distinguishing the risks of exposure to particles of different sizes. Therefore, obtaining toxicological data of small-sized particles will help to improve its risk assessment data. Important questions raised in quantitative risk assessments for ITO particles are whether biodistribution of ITO particles is affected by particle size and to what extent systematic adverse responses is subsequently initiated. In order to determine whether this toxicological paradigm for size is relevant in ITO toxic effect, we performed comparative studies on the toxicokinetics and sub-acute toxicity test of ITO in mice. The results indicate both sized-ITO resided in the lung tissue and slowly excreted from the mice, and the smaller size of ITO being cleared more slowly. Only a little ITO was transferred to other organs, especially with higher blood flow. Two type of ITO which deposit in the lung mainly impacts respiratory system and may injure liver or kidney. After sub-acute exposure to ITO, inflammation featured by neutrophils infiltration and fibrosis with both dose and size effects have been observed. Our findings revealed toxicokinetics and dose-dependent pulmonary toxicity in mice via oropharyngeal aspiration exposure, also replenish in vivo risk assessment of ITO. Collectively, these data indicate that under the current OEL, there are potential toxic effects after exposure to the ITO particles. The observed size-dependent biodistribution patterns and toxic effect might be important for approaching the hazard potential of small-sized ITO in an occupational environment.

8-Hydroxy-2'-deoxyguanosine (8-OHdG) as a biomarker of oxidative DNA damage induced by occupational exposure to nanomaterials: a systematic review

In nuclear and mitochondrial DNA, 8-hydroxy-2'-deoxyguanosine (8-OHdG) is one of the predominant forms of reactive oxygen species (ROSs) lesions, which commonly used as a biomarker for oxidative stress. Studies showed that the different nanomaterials can induce toxicity by ROSs in human body. So, this study is going to review the studies about oxidative DNA damage caused by occupational exposure to nanomaterials, using 8-OHdG biomarker.Systematic review was managed based on Cochrane systematic review guideline. Literature search was conducted in scientific databases with the main terms of "biomarkers," "biological markers," combined with "occupational exposure" and "nanomaterials." All papers in the field of occupational exposure to nanomaterials until 2020 December were included. To evaluate the quality and bias of studies, GRADE method (Grading of Recommendations, Assessment, Development, and Evaluation) was used.Two hundred twenty-six studies were primarily achieved. By considering the inclusion criteria, overall 8 articles were selected. The majority of the studies were classified as the moderate quality studies (six studies). Also, the study-level bias was critical. This review shows that there is a significant relationship between job title and amount of produced nanomaterials and the existence of 8-OHdG. Also, the levels of 8-OHdG can be measured in urine, blood, and inhalation samples by instrumental procedures.Oxidative damages are an important threat for workers exposed to nanomaterial. Blood and EBC 8-OHdG level can be introduced as a biomarker for metal nanomaterials, but urinary 8-OHdG needs to be taken with caution. So, it is recommended that evaluation not be solely based on one biomarker.

Indium kinetics in an indium exposed worker before and after bilateral lung transplantation

Background

A male worker with indium‐tin oxide (ITO)‐induced pneumoconiosis underwent bilateral lung transplantation (LT).

Methods

Post‐LT histopathological investigations of the isolated lungs and hilar lymph nodes were performed and indium concentration in serum (In‐S) and serum Krebs von den Lungen‐6 (KL‐6) were tracked for 122 weeks.

Results

He has attained the ultimate treatment goal of > 2‐year survival. The main histopathological characteristics were pan‐lobular emphysematous change, interstitial fibrosis, and lymphocytic infiltration in the peribronchiolar/perivascular portions, and numerous cholesterol clefts and giant cells containing brown particles. These findings support the conclusion that the lung injury was caused by the inhalation of ITO. Metal element mapping and indium in the isolated lungs revealed that inhaled ITO particles in humans migrate to the lymph nodes. In‐S remained at remarkably high levels (≥30 ng/mL) and showed wide fluctuation with bimodality until 46 weeks after LT, but KL‐6 remained in the normal range for almost the entire period. The indium concentration in the donor's resection lung at 10 weeks after LT was 143.5 ng/g wet‐weight, which was only one one‐thousandth of the recipient's lung (161 µg/g wet‐weight). After 48 weeks of LT, the recipient's In‐S had gradually decreased; the biological half‐life was 1.2 years. These results clearly suggest that indium remaining in the recipient's tissues did not adversely influence the transplant donor's lungs.

Conclusions

The transplanted donor's lungs were not influenced by indium in the recipient's organs. Bilateral LT is thus an effective treatment option in severe indium lung disease cases.

Exposure profiles of workers from indium tin oxide target manufacturing and recycling factories in Taiwan

Indium tin oxide exposure poses a potential health risk, but the exposure assessment in occupational setting remains incomplete and continues to be a significant challenge. To this end, we investigated the association of work type, airborne indium concentration, respirable fraction of total indium, and cumulative indium exposure index (CEI) with the levels of plasma indium (P-In) and urinary indium (U-In) among 302 indium tin oxide target manufacturing and recycling workers in Taiwan. We observed that recycling-crushing produced the highest concentrations of total indium (area: 2084.8 μg/m³; personal: 3494.5 μg/m³) and respirable indium (area: 533.4 μg/m³; personal: 742.0 μg/m³). Powdering produced the highest respirable fraction of total indium (area: 58.6%; personal: 81.5%), where the workers had the highest levels of P-In (geometric mean: 2.0 μg/L) and U-In (1.0 μg/g creatinine). After adjusting for the confounder, the CEIs of powdering (β_PR = 0.78; β_PR = 0.44), bonding (β_PT = 0.61; β_PT = 0.37), and processing workers (β_PT = 0.43; β_PT = 0.28) showed significant associations with P-In and U-In, validating its utility in monitoring the exposure. Also, the respirable fraction of total indium significantly contributed to the increased levels of P-In and U-In among workers. The varying levels of relationship noted between indium exposure and the levels of P-In and U-In among workers with different work types suggested that setting the exposure limits among different work types is warranted.

Workers' Exposure to Indium Compounds at the Electronics Industry in Republic of Korea

Objectives

The aim of this study was to provide baseline data for the assessment of exposure to indium and to prevent adverse health effects among workers engaged in the electronics and related industries in Republic of Korea.

Methods

Total (n = 369) and respirable (n = 384) indium concentrations were monitored using personal air sampling in workers at the following 19 workplaces: six sputtering target manufacturing companies, four manufacturing companies of panel displays, two companies engaged in cleaning of sputtering components, two companies dedicated to the cleaning of sputtering target, and five indium recycling companies.

Results

The level of exposure to total indium ranged from 0.9 to 609.3 μg/m³ for the sputtering target companies; from 0.2 to 2,782.0 μg/m³ for the panel display companies and from 0.5 to 2,089.9 μg/m³ for the indium recycling companies. The level of exposure to respirable indium was in the range of 0.02 to 448.6 μg/m³ for the sputtering target companies; 0.01 to 419.5 μg/m³ for the panel display companies; and 0.5 to 436.3 μg/m³ for the indium recycling companies. The indium recycling companies had the most samples exceeding the exposure standard for indium, followed by sputtering target companies and panel display companies.

Conclusions

The main finding from this exposure assessment is that many workers who handle indium compounds in the electronics industry are exposed to indium levels that exceed the exposure standards for indium. Hence, it is necessary to continuously monitor the indium exposure of this workforce and take measures to reduce its exposure levels.

Case reports of indium lung disease in Taiwan

The production of indium-tin oxide has increased in the past decades due to the increased manufacture of liquid crystal displays (LCD). Taiwan is one of the highest indium-consuming countries worldwide. After repeated inhalation, indium oxide (In₂O₃) particles would accumulate in the lungs, resulting in severe lung effects. We report two workers of an LCD producing facility with elevated serum indium level up to 149 and 73.8 μg/L (normal value <3.5 μg/L), which was much higher than that observed in previous case reports in Taiwan. We collected their detailed working history, symptoms, pulmonary function, radiologic findings, and followed up for more than one year. We also performed workplace evaluation of the facility. We observed that sandblasters who clean components of ITO thin-film production machinery by sandblasting with aluminum oxide tend to have higher indium exposure with worse pulmonary functions and HRCT findings.

Ultrafine particles in scanning sprays: a standardized examination of five powders used for dental reconstruction

Background

Intraoral matting sprays for chairside systems can release fine or ultrafine particles or nanoparticles at dentists’ workplaces and cause work-related health problems by inhalation exposure. Until now, little is known about the magnitude of the ultrafine fraction, when using these scanning sprays. Hence, more information is needed for workplace risk assessments in dental practices.

Methods

Five commonly used dental spray-powders were examined under standardized conditions. Ingredients were taken from the respective safety data sheet. Particle number-size distributions and total number concentrations were analyzed with a fast mobility particle sizer, and reported graphically as well as mean particle fractions smaller than 100 nm. Based on these measurements, risk assessments were conducted, and particle depositions in the lung were modelled.

Results

The mean fraction of particles smaller than 100 nm varied between 9 and 93% depending on the matting agent and mode of application of the intraoral scanning spray. Propellants can represent a large fraction of these particles. Titanium dioxide, pigment-suspensions, talcum and others particles, which can pose relevant health risks, were listed as ingredients of scanning sprays in safety data sheets. Nevertheless, the deposited fraction of hazardous particles in the lung of employees in dental practices seems to be small (15%) during this dental procedure.

Conclusions

Our results suggest that dentists’ personnel can be exposed to hazardous fine and ultrafine particles. Though extensive standardized measurements and systematic evaluation of safety data sheets were used for this study, they cannot sufficiently assess and categorize potential workplace-related health risks.

The early onset and persistent worsening pulmonary alveolar proteinosis in rats by indium oxide nanoparticles

Workplace inhalation exposure to indium compounds has been reported to produce 'indium lung disease' characterized by pulmonary alveolar proteinosis (PAP), granulomas, and pulmonary fibrosis. However, there is little information about the pulmonary toxicity of nano-sized indium oxide (In₂O₃), which is widely used in various applications such as liquid crystal displays. In this study, we evaluated the time-course and dose-dependent lung injuries by In₂O₃ nanoparticles (NPs) after a single intratracheal instillation to rats. In₂O₃ NPs were instilled to female Wistar rats at 7.5, 30, and 90 cm²/rat and lung injuries were evaluated at day 1, 3, 7, 14, 30, 90, and 180 after a single intratracheal instillation. Treatment of In₂O₃ NPs induced worsening diverse pathological changes including PAP, persistent neutrophilic inflammation, type II cell hyperplasia, foamy macrophages, and granulomas in a time- and dose-dependent manner. PAP was induced from day 3 and worsened throughout the study. The concentrations of interleukin-1β, tumor necrosis factor-α, and monocyte chemoattractant protein-1 in bronchoalveolar lavage fluid (BALF) showed dose- and time-dependent increases and the levels of these inflammatory mediators are consistent with the data of inflammatory cells in BALF and progressive lung damages by In₂O₃ NPs. This study suggests that a single inhalation exposure to In₂O₃ NPs can produce worsening lung damages such as PAP, chronic active inflammation, infiltration of foamy macrophages, and granulomas. The early onset and persistent PAP even at the very low dose (7.5 cm²/rat) implies that the re-evaluation of occupational recommended exposure limit for In₂O₃ NPs is urgently needed to protect workers.

Emerging investigator series: atmospheric cycling of indium in the northeastern United States

Indium is critical to the global economy and is used in an increasing number of electronics and new energy technologies. However, little is known about its environmental behavior or impacts, including its concentrations or cycling in the atmosphere. This study determined indium concentrations in air particulate matter at five locations across the northeastern United States over the course of one year, in 1995. Historical records from a Massachusetts bog core showed that indium atmospheric concentrations in this region changed only modestly between 1995 and 2010. Atmospheric indium concentrations varied significantly both geographically and temporally, with average concentrations in PM3 of 2.1 ± 1.6 pg m-3 (1 standard deviation), and average particle-normalized concentrations of 0.2 ± 0.2 μg In per g PM3. Peaks in the particle-normalized concentrations in two New York sites were correlated with wind direction; air coming from the north contributed higher concentrations of indium than air coming from the west. This correlation, along with measurements of indium in zinc smelter emissions and coal fly ash, suggests that indium in the atmosphere in the northeastern United States comes from a relatively constant low-level input from coal combustion in the midwest, and higher but more sporadic contributions from the smelting of lead, zinc, copper, tin, and nickel north of the New York sample sites. Understanding the industrial sources of indium to the atmosphere and how they compare with natural sources can lead to a better understanding of the impact of human activities on the indium cycle, and may help to establish a baseline for monitoring future impacts as indium use grows.

Exposure Potential and Health Impacts of Indium and Gallium, Metals Critical to Emerging Electronics and Energy Technologies

The rapid growth of new electronics and energy technologies requires the use of rare elements of the periodic table. For many of these elements, little is known about their environmental behavior or human health impacts. This is true for indium and gallium, two technology critical elements. Increased environmental concentrations of both indium and gallium create the potential for increased environmental exposure, though little is known about the extent of this exposure. Evidence is mounting that indium and gallium can have substantial toxicity, including in occupational settings where indium lung disease has been recognized as a potentially fatal disease caused by the inhalation of indium particles. This paper aims to review the basic chemistry, changing environmental concentrations, potential for human exposure, and known health effects of indium and gallium.

Current and new challenges in occupational lung diseases

Occupational lung diseases are an important public health issue and are avoidable through preventive interventions in the workplace. Up-to-date knowledge about changes in exposure to occupational hazards as a result of technological and industrial developments is essential to the design and implementation of efficient and effective workplace preventive measures. New occupational agents with unknown respiratory health effects are constantly introduced to the market and require periodic health surveillance among exposed workers to detect early signs of adverse respiratory effects. In addition, the ageing workforce, many of whom have pre-existing respiratory conditions, poses new challenges in terms of the diagnosis and management of occupational lung diseases. Primary preventive interventions aimed to reduce exposure levels in the workplace remain pivotal for elimination of the occupational lung disease burden. To achieve this goal there is still a clear need for setting standard occupational exposure limits based on transparent evidence-based methodology, in particular for carcinogens and sensitising agents that expose large working populations to risk. The present overview, focused on the occupational lung disease burden in Europe, proposes directions for all parties involved in the prevention of occupational lung disease, from researchers and occupational and respiratory health professionals to workers and employers.

Dental Technicians' Pneumoconiosis

A 40-year-old female dental technician visited our hospital for the investigation of a chest X-ray abnormality. Chest computed tomography demonstrated centrilobular nodules and lung volume reduction, and her serum KL-6 level was elevated. A histological analysis of the specimens obtained on a surgical lung biopsy showed peribronchiolar fibrosis with pigmented macrophages and cholesterol clefts. An energy-dispersive X-ray analysis showed that these lung tissues contained some metals, including indium. The serum indium level was also elevated. We diagnosed this patient with pneumoconiosis caused by exposure to sandblasting certain dental metals. This is the first reported case of pneumoconiosis in a dental technician associated with exposure to indium.

Application of the ICRP respiratory tract model to estimate pulmonary retention of industrially sampled indium-containing dusts

Inhalation of indium-containing dusts is associated with the development of indium lung disease. Workers may be exposed to several different chemical forms of indium; however, their lung dosimetry is not fully understood. We characterized the physicochemical properties and measured the lung dissolution kinetics of eight indium-containing dusts. Indium dissolution rates in artificial lung fluids spanned two orders of magnitude. We used the International Commission on Radiological Protection (ICRP) human respiratory model (HRTM) to estimate pulmonary indium deposition, retention and biokinetic clearance to blood. For a two-year (median workforce tenure at facility) exposure to respirable-sized particles of the indium materials, modeled indium clearance (>99.99% removed) from the alveolar-interstitial compartment was slow for all dusts; salts would clear in 4 years, sintered indium-tin oxide (ITO) would clear in 9 years, and indium oxide would require 48 years. For this scenario, the ICRP HRTM predicted that indium translocated to blood would be present in that compartment for 3.5-18 years after cessation of exposure, depending on the chemical form. For a 40-year exposure (working lifetime), clearance from the alveolar-interstitial compartment would require 5, 10 and 60 years for indium salts, sintered ITO and indium oxide, respectively and indium would be present in blood for 5-53 years after exposure. Consideration of differences in chemical forms of indium, dissolution rates, alveolar clearance and residence time in blood should be included in exposure assessment and epidemiological studies that rely on measures of total indium in air or blood to derive risk estimates.

Particle-induced Pulmonary Alveolar Proteinosis and Subsequent Inflammation and Fibrosis: A Toxicologic and Pathologic Review

This review analyzes the published data on cases of pulmonary alveolar proteinosis (PAP) in workers inhaling crystalline aluminum, indium, silicon, and titanium particles and possible sequelae, that is, inflammation and fibrosis, and compares these findings with those from animal experiments. In inhalation studies in rodents using crystalline indium and gallium compounds, pronounced PAP followed by inflammation and fibrosis down to very low concentration ranges have been reported. Crystalline aluminum, silicon, and titanium compounds also induced comparable pulmonary changes in animals, though at higher exposure levels. Laboratory animal species appear to react to the induction of PAP with varying degrees of sensitivity. The sensitivity of humans to environmental causes of PAP seems to be relatively low. Up to now, no cases of PAP, or other pulmonary diseases in humans, have been described for gallium compounds. However, a hazard potential can be assumed based on the results of animal studies. Specific particle properties, responsible for the induction of PAP and its sequelae, have not been identified. This review provides indications that, both in animal studies and in humans, PAP is not often recognized due to the absence of properly directed investigation or is concealed behind other forms of lung pathology.

The precipitation of indium at elevated pH in a stream influenced by acid mine drainage

Indium is an increasingly important metal in semiconductors and electronics and has uses in important energy technologies such as photovoltaic cells and light-emitting diodes (LEDs). One significant flux of indium to the environment is from lead, zinc, copper, and tin mining and smelting, but little is known about its aqueous behavior after it is mobilized. In this study, we use Mineral Creek, a headwater stream in southwestern Colorado severely affected by heavy metal contamination as a result of acid mine drainage, as a natural laboratory to study the aqueous behavior of indium. At the existing pH of ~3, indium concentrations are 6-29μg/L (10,000× those found in natural rivers), and are completely filterable through a 0.45μm filter. During a pH modification experiment, the pH of the system was raised to >8, and >99% of the indium became associated with the suspended solid phase (i.e. does not pass through a 0.45μm filter). To determine the mechanism of removal of indium from the filterable and likely primarily dissolved phase, we conducted laboratory experiments to determine an upper bound for a sorption constant to iron oxides, and used this, along with other published thermodynamic constants, to model the partitioning of indium in Mineral Creek. Modeling results suggest that the removal of indium from the filterable phase is consistent with precipitation of indium hydroxide from a dissolved phase. This work demonstrates that nonferrous mining processes can be a significant source of indium to the environment, and provides critical information about the aqueous behavior of indium.

Determination of mutagenicity and genotoxicity of indium tin oxide nanoparticles using the Ames test and micronucleus assay

In this study, the mutagenicity and genotoxicity of indium tin oxide (ITO) nanomaterial were assessed using two standard genotoxicity assays, the Salmonella reverse mutation assay (Ames test) and the in vitro micronucleus (MN) assay. Seven different concentrations (12.5, 25, 50, 75, 100, 125, and 150 µg/plate) of this nanomaterial were tested using the Ames test on the TA98 and TA100 strains in the presence and absence of the S9 mixture. At all the concentrations tested, this substance did not significantly increase the number of revertant colonies compared with the control with or without S9 mixture. The genotoxic effects of ITO were investigated in human peripheral lymphocytes treated with 125, 250, 500, and 750 µg/ml concentrations of this substance for 24- and 48-h treatment periods using an MN test. Nuclear division index (NDI) was also calculated in order to determine the cytotoxicity of ITO. It was determined that ITO increased MN frequency in the 750 µg/ml concentration in 24- and 48-h treatments. In addition, ITO dose dependently decreased the NDI significantly for two treatment periods.

The toxicology of indium tin oxide

Indium tin oxide (ITO) is a technologically important semiconductor. An increasing number of cases of severe lung effects (characterized by pulmonary alveolar proteinosis and/or interstitial fibrosis) in ITO-exposed workers warrants a review of the toxicological hazards. Short- and long-term inhalation studies in rats and mice revealed persistent alveolar proteinosis, inflammation and fibrosis in the lungs down to concentrations as low as 0.01mg/m(3). In rats, the incidences of bronchiolo-alveolar adenomas and carcinomas were significantly increased at all concentrations. In mice, ITO was not carcinogenic. A few bronchiolo-alveolar adenomas occurring after repeated intratracheal instillation of ITO to hamsters have to be interpreted as treatment-related. In vitro and in vivo studies on the formation of reactive oxygen species suggest epigenetic effects as cause of the lung tumor development. Repeated intratracheal instillation of ITO to hamsters slightly affected the male sexual organs, which might be interpreted as a secondary effect of the lung damage. Epidemiological and medical surveillance studies, serum/blood indium levels in workers as well as data on the exposure to airborne indium concentrations indicate a need for measures to reduce exposure at ITO workplaces.

Effects of a powered air-purifying respirator intervention on indium exposure reduction and indium related biomarkers among ITO sputter target manufacturing workers

This study aimed to evaluate the efficacy of powered air-purifying respirators (PAPRs) worn by the workers, and to investigate the effect of this application on exposure and preclinical effects in terms of workplace measuring and biomarker monitoring in ITO sputter target manufacturing plants and workers, respectively. Fifty-four workers were recruited and investigated from 2010-2012, during which PAPRs were provided to on-site workers in September 2011. Each worker completed questionnaires and provided blood and urine samples for analysis of biomarkers of indium exposure and preclinical effects. Area and personal indium air samples were randomly collected from selected worksites and from participants. The penetration percentage of the respirator (concentration inside respirator divided by concentration outside respirator) was 6.6%. Some biomarkers, such as S-In, SOD, GPx, GST, MDA, and TMOM, reflected the decrease in exposure and showed lower levels, after implementation of PAPRs. This study is the first to investigate the efficacy of PAPRs for reducing indium exposure. The measurement results clearly showed that the implementation of PAPRs reduces levels of indium-related biomarkers. These findings have practical applications for minimizing occupational exposure to indium and for managing the health of workers exposed to indium.

Interstitial lung disorders in the indium workers of Korea: an update study for the relationship with biological exposure indices

BACKGROUND

Korea is one of the highest indium-consuming countries worldwide. The present study aims to determine the relationship between interstitial lung disorders and indium exposure in Korea.

METHODS

In 50 indium workers from seven plants, the effect of serum indium on the lungs was determined using laboratory tests, spirometry, and high-resolution computed tomography (HRCT).

RESULTS

Higher serum indium and Krebs von den Lungen-6 (KL-6) levels were associated with HRCT-detected interstitial lung changes. Workers with high serum indium levels (≥3 µg/L) had longer exposure durations and a higher prevalence of HRCT-detected interstitial lung changes. KL-6 and surfactant protein-D (SP-D) levels were significantly higher in the highest serum indium quartile than the lowest quartile. Significant dose-effect relationships existed between serum indium levels and KL-6, SP-D levels and the prevalence of HRCT-detected interstitial lung changes.

CONCLUSIONS

Workforce medical surveillance should be established to prevent indium-induced interstitial lung disease in Korea.

Genotoxicity of indium tin oxide by Allium and Comet tests

Genotoxic effects of indium tin oxide (ITO) were investigated on root cells of Allium cepa by employing both Allium and Comet assays. A. cepa roots were treated with the aqueous dispersions of ITO at 5 different concentrations (12.5, 25, 50, 75, and 100 ppm) for 4 h. Exposure of ITO significantly increased mitotic index, and total chromosomal aberrations by the Allium test. While chromosome laggards, stickiness, disturbed anaphase-telophase and anaphase bridges were observed in anaphase-telophase cells, c-metaphase and binuclear cells were observed in other cells. A significant increase in DNA damage was also observed at all concentrations of ITO by the Comet assay. These results indicate that ITO exhibits genotoxic activity in A. cepa root meristematic cells.

In vitro evaluation of the cellular effect of indium tin oxide nanoparticles using the human lung adenocarcinoma A549 cells

Indium tin oxide (ITO) nanoparticles are taken up by human lung adenocarcinoma cells and the nanoparticles induce oxidative stress and DNA damage.

Macrophage solubilization and cytotoxicity of indium-containing particles as in vitro correlates to pulmonary toxicity in vivo

Macrophage-solubilized indium-containing particles (ICPs) were previously shown in vitro to be cytotoxic. In this study, we compared macrophage solubilization and cytotoxicity of indium phosphide (InP) and indium-tin oxide (ITO) with similar particle diameters (∼ 1.5 µm) and then determined if relative differences in these in vitro parameters correlated with pulmonary toxicity in vivo. RAW 264.7 macrophages were treated with InP or ITO particles and cytotoxicity was assayed at 24 h. Ionic indium was measured in 24 h culture supernatants. Macrophage cytotoxicity and particle solubilization in vitro were much greater for InP compared with ITO. To correlate changes in vivo, B6C3F1 mice were treated with InP or ITO by oropharyngeal aspiration. On Days 14 and 28, bronchoalveolar lavage (BAL) and pleural lavage (PL) fluids were collected and assayed for total leukocytes. Cell differentials, lactate dehydrogenase activity, and protein levels were also measured in BAL. All lavage parameters were greatly increased in mice treated with InP compared with ITO. These data suggest that macrophage solubilization and cytotoxicity of some ICPs in vitro are capable of predicting pulmonary toxicity in vivo. In addition, these differences in toxicity were observed despite the two particulate compounds containing similar amounts of indium suggesting that solubilization, not total indium content, better reflects the toxic potential of some ICPs. Soluble InCl3 was shown to be more cytotoxic than InP to macrophages and lung epithelial cells in vitro further suggesting that ionic indium is the primary cytotoxic component of InP.

Indium and indium tin oxide induce endoplasmic reticulum stress and oxidative stress in zebrafish (Danio rerio)

Indium and indium tin oxide (ITO) are extensively used in electronic technologies. They may be introduced into the environment during production, use, and leaching from electronic devices at the end of their life. At present, surprisingly little is known about potential ecotoxicological implications of indium contamination. Here, molecular effects of indium nitrate (In(NO3)3) and ITO nanoparticles were investigated in vitro in zebrafish liver cells (ZFL) cells and in zebrafish embryos and novel insights into their molecular effects are provided. In(NO3)3 led to induction of endoplasmic reticulum (ER) stress response, induction of reactive oxygen species (ROS) and induction of transcripts of pro-apoptotic genes and TNF-α in vitro at a concentration of 247 μg/L. In(NO3)3 induced the ER stress key gene BiP at mRNA and protein level, as well as atf6, which ultimately led to induction of the important pro-apoptotic marker gene chop. The activity of In(NO3)3 on ER stress induction was much stronger than that of ITO, which is explained by differences in soluble free indium ion concentrations. The effect was also stronger in ZFL cells than in zebrafish embryos. Our study provides first evidence of ER stress and oxidative stress induction by In(NO3)3 and ITO indicating a critical toxicological profile that needs further investigation.

[Health effects of solar cell component material. Toxicity of indium compounds to laboratory animals determined by intratracheal instillations]

Owing to the increasing interest being paid to the issue of the global environment, the production of solar cells has increased rapidly in recent years. Copper indium gallium diselenide (CIGS) is a new efficient thin film used in some types of solar cell. Indium is a constitutive element of CIGS thin-film solar cells. It was thought that indium compounds were not harmful until the beginning of the 1990s because there was little information regarding the adverse health effects on humans or animals arising from exposure to indium compounds. After the mid-1990s, data became available indicating that indium compounds can be toxic to animals. In animal studies, it has been clearly demonstrated that indium compounds cause pulmonary toxicity and that the dissolution of indium compounds in the lungs is considerably slow, as shown by repeated intratracheal instillations in experimental animals. Thus, it is necessary to pay much greater attention to human exposure to indium compounds, and precautions against possible exposure to indium compounds are paramount with regard to health management.

Studies on the toxicity and distribution of indium compounds according to particle size in sprague-dawley rats

OBJECTIVES

The use of indium compounds, especially those of small size, for the production of semiconductors, liquid-crystal panels, etc., has increased recently. However, the role of particle size or the chemical composition of indium compounds in their toxicity and distribution in the body has not been sufficiently investigated. Therefore, the aim of this study was to examine the effects of particle size and the chemical composition of indium compounds on their toxicity and distribution.

METHODS

Male Sprague-Dawley rats were exposed to two different-sized indium oxides (average particle sizes under 4,000 nm [IO_4000] and 100 nm [IO_100]) and one nano-sized indium-tin oxide (ITO; average particle size less than 50 nm) by inhalation for 6 hr daily, 5 days per week, for 4 weeks at approximately 1 mg/m(3) of indium by mass concentration.

RESULTS

We observed differences in lung weights and histopathological findings, differential cell counts, and cell damage indicators in the bronchoalveolar lavage fluid between the normal control group and IO- or ITO-exposed groups. However, only ITO affected respiratory functions in exposed rats. Overall, the toxicity of ITO was much higher than that of IOs; the toxicity of IO_4000 was higher than that of IO_100. A 4-week recovery period was not sufficient to alleviate the toxic effects of IO and ITO exposure. Inhaled indium was mainly deposited in the lungs. ITO in the lungs was removed more slowly than IOs; IO_4000 was removed faster than IO_100. IOs were not distributed to other organs (i.e., the brain, liver, and spleen), whereas ITO was. Concentrations of indium in the blood and organ tissues were higher at 4 weeks after exposure.

CONCLUSIONS

The effect of particle size on the toxicity of indium compounds was not clear, whereas chemical composition clearly affected toxicity; ITO showed much higher toxicity than that of IO.

Subclinical interstitial lung damage in workers exposed to indium compounds

Objectives

The present study was designed to determine whether there is a relationship between indium compound exposure and interstitial lung damage in workers employed at indium tin oxide manufacturing and reclaiming factories in Korea.

Methods

In 2012, we conducted a study for the prevention of indium induced lung damage in Korea and identified 78 workers who had serum indium or Krebs von den Lungen-6 (KL-6) levels that were higher than the reference values set in Japan (3 μg/L and 500 U/mL, respectively). Thirty-four of the 78 workers underwent chest high-resolution computed tomography (HRCT), and their data were used for statistical analysis.

Results

Geometric means (geometric standard deviations) for serum indium, KL-6, and surfactant protein D (SP-D) were 10.9 (6.65) μg/L, 859.0 (1.85) U/mL, and 179.27 (1.81) ng/mL, respectively. HRCT showed intralobular interstitial thickening in 9 workers. A dose–response trend was statistically significant for blood KL-6 levels. All workers who had indium levels ≥50 μg/L had KL-6 levels that exceeded the reference values. However, dose–response trends for blood SP-D levels, KL-6 levels, SP-D levels, and interstitial changes on the HRCT scans were not significantly different.

Conclusions

Our findings suggest that interstitial lung changes could be present in workers with indium exposure. Further studies are required and health risk information regarding indium exposure should be communicated to workers and employers in industries where indium compounds are used to prevent indium induced lung damage in Korea.

Macrophage solubilization and cytotoxicity of indium-containing particles in vitro

Indium-containing particles (ICPs) are used extensively in the microelectronics industry. Pulmonary toxicity is observed after inhalation exposure to ICPs; however, the mechanism(s) of pathogenesis is unclear. ICPs are insoluble at physiological pH and are initially engulfed by alveolar macrophages (and likely airway epithelial cells). We hypothesized that uptake of ICPs by macrophages followed by phagolysosomal acidification results in the solubilization of ICPs into cytotoxic indium ions. To address this, we characterized the in vitro cytotoxicity of indium phosphide (InP) or indium tin oxide (ITO) particles with macrophages (RAW cells) and lung-derived epithelial (LA-4) cells at 24h using metabolic (3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide) and membrane integrity (lactate dehydrogenase) assays. InP and ITO were readily phagocytosed by RAW and LA-4 cells; however, the particles were much more cytotoxic to RAW cells and cytotoxicity was dose dependent. Treatment of RAW cells with cytochalasin D (CytoD) blocked particle phagocytosis and reduced cytotoxicity. Treatment of RAW cells with bafilomycin A1, a specific inhibitor of phagolysosomal acidification, also reduced cytotoxicity but did not block particle uptake. Based on direct indium measurements, the concentration of ionic indium was increased in culture medium from RAW but not LA-4 cells following 24-h treatment with particles. Ionic indium derived from RAW cells was significantly reduced by treatment with CytoD. These data implicate macrophage uptake and solubilization of InP and ITO via phagolysosomal acidification as requisite for particle-induced cytotoxicity and the release of indium ions. This may apply to other ICPs and strongly supports the notion that ICPs require solubilization in order to be toxic.

Elemental analysis of occupational and environmental lung diseases by electron probe microanalyzer with wavelength dispersive spectrometer

Occupational and environmental lung diseases are a group of pulmonary disorders caused by inhalation of harmful particles, mists, vapors or gases. Mineralogical analysis is not generally required in the diagnosis of most cases of these diseases. Apart from minerals that are encountered rarely or only in specific occupations, small quantities of mineral dusts are present in the healthy lung. As such when mineralogical analysis is required, quantitative or semi-quantitative methods must be employed. An electron probe microanalyzer with wavelength dispersive spectrometer (EPMA-WDS) enables analysis of human lung tissue for deposits of elements by both qualitative and semi-quantitative methods. Since 1993, we have analyzed 162 cases of suspected occupational and environmental lung diseases using an EPMA-WDS. Our institute has been accepting online requests for elemental analysis of lung tissue samples by EPMA-WDS since January 2011. Hard metal lung disease is an occupational interstitial lung disease that primarily affects workers exposed to the dust of tungsten carbide. The characteristic pathological findings of the disease are giant cell interstitial pneumonia (GIP) with centrilobular fibrosis, surrounded by mild alveolitis with giant cells within the alveolar space. EPMA-WDS analysis of biopsied lung tissue from patients with GIP has demonstrated that tungsten and/or cobalt is distributed in the giant cells and centrilobular fibrosing lesion in GIP. Pneumoconiosis, caused by amorphous silica, and acute interstitial pneumonia, associated with the giant tsunami, were also elementally analyzed by EPMA-WDS. The results suggest that commonly found elements, such as silicon, aluminum, and iron, may cause occupational and environmental lung diseases.

Use of and occupational exposure to indium in the United States

Indium use has increased greatly in the past decade in parallel with the growth of flat-panel displays, touchscreens, optoelectronic devices, and photovoltaic cells. Much of this growth has been in the use of indium tin oxide (ITO). This increased use has resulted in more frequent and intense exposure of workers to indium. Starting with case reports and followed by epidemiological studies, exposure to ITO has been linked to serious and sometimes fatal lung disease in workers. Much of this research was conducted in facilities that process sintered ITO, including manufacture, grinding, and indium reclamation from waste material. Little has been known about indium exposure to workers in downstream applications. In 2009-2011, the National Institute for Occupational Safety and Health (NIOSH) contacted 89 potential indium-using companies; 65 (73%) responded, and 43 of the 65 responders used an indium material. Our objective was to identify current workplace applications of indium materials, tasks with potential indium exposure, and exposure controls being used. Air sampling for indium was either conducted by NIOSH or companies provided their data for a total of 63 air samples (41 personal, 22 area) across 10 companies. Indium exposure exceeded the NIOSH recommended exposure limit (REL) of 0.1 mg/m(3) for certain methods of resurfacing ITO sputter targets, cleaning sputter chamber interiors, and in manufacturing some inorganic indium compounds. Indium air concentrations were low in sputter target bonding with indium solder, backside thinning and polishing of fabricated indium phosphide-based semiconductor devices, metal alloy production, and in making indium-based solder pastes. Exposure controls such as containment, local exhaust ventilation (LEV), and tool-mounted LEV can be effective at reducing exposure. In conclusion, occupational hygienists should be aware that the manufacture and use of indium materials can result in indium air concentrations that exceed the NIOSH REL. Given recent findings of adverse health effects in workers, research is needed to determine if the current REL sufficiently protects workers against indium-related diseases.

Organic photovoltaics: potential fate and effects in the environment

In times of dwindling fossil fuels it is particularly crucial to develop novel "green" technologies in order to cover the increasing worldwide demand for energy. Organic photovoltaic solar cells (OPVs) are promising as a renewable energy source due to low energy requirement for production, low resource extraction, and no emission of greenhouse gasses during use. In contrast to silicium-based solar cells, OPVs offer the advantages of light-weight, semi-transparency and mechanical flexibility. As to a possible forthcoming large-scale production, the environmental impact of such OPVs should be assessed and compared to currently best available technologies. For the first time, this review compiles the existing knowledge and identifies gaps regarding the environmental impact of such OPVs in a systematic manner. In this regard, we discuss the components of a typical OPV layer by layer. We discuss the probability of enhanced release of OPV-borne components into the environment during use-phase (e.g. UV- and biodegradation) and end-of-life phase (e.g. incineration and waste disposal). For this purpose, we compiled available data on bioavailability, bioaccumulation, biodegradation, and ecotoxicity. Whereas considerable research has already been carried out concerning the ecotoxicity of certain OPV components (e.g. nanoparticles and fullerenes), others have not been investigated at all so far. In conclusion, there is a general lack of information about fate, behavior as well as potential ecotoxicity of most of the main OPV components and their degradation/transformation products. So far, there is no evidence for a worrying threat coming from OPVs, but since at present, no policy and procedures regarding recycling of OPVs are in action, in particular improper disposal upon end-of-life might result in an adverse effect of OPVs in the environment when applied in large-scale.

Indium lung disease

BACKGROUND

Reports of pulmonary fibrosis, emphysema, and, more recently, pulmonary alveolar proteinosis (PAP) in indium workers suggested that workplace exposure to indium compounds caused several different lung diseases.

METHODS

To better understand the pathogenesis and natural history of indium lung disease, a detailed, systematic, multidisciplinary analysis of clinical, histopathologic, radiologic, and epidemiologic data for all reported cases and workplaces was undertaken.

RESULTS

Ten men (median age, 35 years) who produced, used, or reclaimed indium compounds were diagnosed with interstitial lung disease 4-13 years after first exposure (n = 7) or PAP 1-2 years after first exposure (n = 3). Common pulmonary histopathologic features in these patients included intraalveolar exudate typical of alveolar proteinosis (n = 9), cholesterol clefts and granulomas (n = 10), and fibrosis (n = 9). Two patients with interstitial lung disease had pneumothoraces. Lung disease progressed following cessation of exposure in most patients and was fatal in two. Radiographic data revealed that two patients with PAP subsequently developed fibrosis and one also developed emphysematous changes. Epidemiologic investigations demonstrated the potential for exposure to respirable particles and an excess of lung abnormalities among coworkers.

CONCLUSIONS

Occupational exposure to indium compounds was associated with PAP, cholesterol ester crystals and granulomas, pulmonary fibrosis, emphysema, and pneumothoraces. The available evidence suggests exposure to indium compounds causes a novel lung disease that may begin with PAP and progress to include fibrosis and emphysema, and, in some cases, premature death. Prospective studies are needed to better define the natural history and prognosis of this emerging lung disease and identify effective prevention strategies.

Occupational exposure to indium: what does biomonitoring tell us?

BACKGROUND

The industrial uses of indium, a rare metal with no known physiological role in humans, have increased dramatically over the past 15 years. The results of animal toxicity studies showing pulmonary and systemic effects as well as some reports in workers have created a growing concern about the possible occurrence of toxic effects in exposed workers. Validated biomarkers to assess exposure to indium are not available.

OBJECTIVES

This work aimed at investigating the kinetics of indium in urine (In-U) and plasma (In-Pl) in workers manufacturing In ingots and mainly exposed to hardly water-soluble In compounds. All nine workers from the In department of a large metallurgical concern participated in the study as well as 5 retired workers and 20 controls.

METHODS

Personal breathing zone air was collected throughout the work shift on Monday and Friday. Blood and urine samples were collected, before and after the shift, on the same day as the air sampling and on preshift the next Monday after a non-working week-end. Moreover, rats were given either InCl(3) by intraperitoneal injection or In(2)O(3) by pharyngeal aspiration, In was followed in plasma during 120 days and measured in tissues 120 days after exposure.

RESULTS

Higher In-Pl and In-U concentrations were found in both current (range 0.32-12.61 μg/L plasma; 0.22-3.50 μg/g creat) and former (0.03-4.38 μg/L plasma; 0.02-0.69 μg/g creat) workers compared with controls (<0.03 μg/L plasma; <0.02 μg/g creat). Both biological parameters were highly correlated but no correlation was found between In-air (10-1030 μg/m(3)) and In-Pl or In-U. Normalizing In-U by the urinary creatinine concentration reduced the inter- (from 90% to 70%) and intra-individual variability (from 54% to 35%). In-Pl remained remarkably stable along the working week (inter- and intra-individual variability: 89% and 10%, respectively). Neither In-U nor In-Pl significantly increased during the day or the week. A week-end without occupational exposure was not sufficient to reach the background In-Pl and In-U levels measured in controls. The results of the experimental investigations confirmed the hypothesis that inhalation of hardly soluble In compounds may cause accumulation of In in the body leading to a prolonged "endogenous exposure" from both a lung depot of "insoluble" particles that are progressively absorbed and from a retention depot in other internal organs.

CONCLUSION

This study shows that in workers exposed to hardly soluble In compounds, In-U and In-Pl are very sensitive to detect exposure and mainly reflect long-term exposure. In-Pl levels are particularly stable for a given individual. In-U might be more influenced than In-Pl by recent exposure. Both parameters remained high years after withdrawal from exposure, indicating a possible endogenous exposure and a prolonged risk of pulmonary and systemic diseases even after work exposure has ceased.