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Birolli WG, Lanças FM, dos Santos Neto ÁJ, Silveira HCS. Determination of pesticide residues in urine by chromatography-mass spectrometry: methods and applications. Front Public Health 2024; 12:1336014. [PMID: 38932775 PMCID: PMC11199415 DOI: 10.3389/fpubh.2024.1336014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/22/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Pollution has emerged as a significant threat to humanity, necessitating a thorough evaluation of its impacts. As a result, various methods for human biomonitoring have been proposed as vital tools for assessing, managing, and mitigating exposure risks. Among these methods, urine stands out as the most commonly analyzed biological sample and the primary matrix for biomonitoring studies. Objectives This review concentrates on exploring the literature concerning residual pesticide determination in urine, utilizing liquid and gas chromatography coupled with mass spectrometry, and its practical applications. Method The examination focused on methods developed since 2010. Additionally, applications reported between 2015 and 2022 were thoroughly reviewed, utilizing Web of Science as a primary resource. Synthesis Recent advancements in chromatography-mass spectrometry technology have significantly enhanced the development of multi-residue methods. These determinations are now capable of simultaneously detecting numerous pesticide residues from various chemical and use classes. Furthermore, these methods encompass analytes from a variety of environmental contaminants, offering a comprehensive approach to biomonitoring. These methodologies have been employed across diverse perspectives, including toxicological studies, assessing pesticide exposure in the general population, occupational exposure among farmers, pest control workers, horticulturists, and florists, as well as investigating consequences during pregnancy and childhood, neurodevelopmental impacts, and reproductive disorders. Future directions Such strategies were essential in examining the health risks associated with exposure to complex mixtures, including pesticides and other relevant compounds, thereby painting a broader and more accurate picture of human exposure. Moreover, the implementation of integrated strategies, involving international research initiatives and biomonitoring programs, is crucial to optimize resource utilization, enhancing efficiency in health risk assessment.
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Affiliation(s)
- Willian Garcia Birolli
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
- Chromatography Group, São Carlos Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | - Fernando Mauro Lanças
- Chromatography Group, São Carlos Institute of Chemistry, University of São Paulo, São Paulo, Brazil
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Balcells C, Xu Y, Gil-Solsona R, Maitre L, Gago-Ferrero P, Keun HC. Blurred lines: Crossing the boundaries between the chemical exposome and the metabolome. Curr Opin Chem Biol 2024; 78:102407. [PMID: 38086287 DOI: 10.1016/j.cbpa.2023.102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/22/2023] [Accepted: 11/09/2023] [Indexed: 02/09/2024]
Abstract
The aetiology of every human disease lies in a combination of genetic and environmental factors, each contributing in varying proportions. While genomics investigates the former, a comparable holistic paradigm was proposed for environmental exposures in 2005, marking the onset of exposome research. Since then, the exposome definition has broadened to include a wide array of physical, chemical, and psychosocial factors that interact with the human body and potentially alter the epigenome, the transcriptome, the proteome, and the metabolome. The chemical exposome, deeply intertwined with the metabolome, includes all small molecules originating from diet as well as pharmaceuticals, personal care and consumer products, or pollutants in air and water. The set of techniques to interrogate these exposures, primarily mass spectrometry and nuclear magnetic resonance spectroscopy, are also extensively used in metabolomics. Recent advances in untargeted metabolomics using high resolution mass spectrometry have paved the way for the development of methods able to provide in depth characterisation of both the internal chemical exposome and the endogenous metabolome simultaneously. Herein we review the available tools, databases, and workflows currently available for such work, and discuss how these can bridge the gap between the study of the metabolome and the exposome.
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Affiliation(s)
- Cristina Balcells
- Institute of Developmental and Reproductive Biology (IRDB), Division of Cancer, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
| | - Yitao Xu
- Institute of Developmental and Reproductive Biology (IRDB), Division of Cancer, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Rubén Gil-Solsona
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Spain
| | - Léa Maitre
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pablo Gago-Ferrero
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Spain
| | - Hector C Keun
- Institute of Developmental and Reproductive Biology (IRDB), Division of Cancer, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
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Liu Y, Sun Y, Yu J, Xia X, Ding A, Zhang D. Impacts of groundwater level fluctuation on soil microbial community, alkane degradation efficiency and alkane-degrading gene diversity in the critical zone: Evidence from an accelerated water table fluctuation simulation. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:83060-83070. [PMID: 35759097 DOI: 10.1007/s11356-022-21246-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
Petroleum hydrocarbons are hazardous to ecosystems and human health, commonly containing n-alkanes and polycyclic aromatic hydrocarbons. Previous researches have studied alkane degraders and degrading genes under aerobic or anaerobic conditions, but seldom discussed them in the intermittent saturation zone which is a connective area between the vadose zone and the groundwater aquifer with periodic alteration of oxygen and moisture. The present study investigated the difference in alkane degradation efficiency, bacterial community, and alkane degrading gene diversity in aerobic, anaerobic, and aerobic-anaerobic fluctuated treatments. All biotic treatments achieved over 90% of n-alkane removal after 120 days of incubation. The removal efficiencies of n-alkanes with a carbon chain length from 16 to 25 were much higher in anaerobic scenarios than those in aerobic scenarios, explained by different dominant microbes between aerobic and anaerobic conditions. The highest removal efficiency was found in fluctuation treatments, indicating an accelerated n-alkane biodegradation under aerobic-anaerobic alternation. In addition, the copy numbers of the 16S rRNA gene and two alkB genes (alkB-P and alkB-R) declined dramatically when switched from aerobic to anaerobic scenarios and oppositely from anaerobic to aerobic conditions. This suggested that water level fluctuation could notably change the presence of aerobic alkane degrading genes. Our results suggested that alkane degradation efficiency, soil microbial community, and alkane-degrading genes were all driven by water level fluctuation in the intermittent saturation zone, helping better understand the effects of seasonal water table fluctuation on the biodegradation of petroleum hydrocarbons in the subsurface environment.
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Affiliation(s)
- Yueqiao Liu
- Experiment and Practice Innovation Education Center, Beijing Normal University at Zhuhai, Zhuhai, 519087, China
| | - Yujiao Sun
- College of Water Sciences, Beijing Normal University, Beijing, 100875, China
| | - Jingshan Yu
- College of Water Sciences, Beijing Normal University, Beijing, 100875, China
| | - Xuefeng Xia
- College of Water Sciences, Beijing Normal University, Beijing, 100875, China
| | - Aizhong Ding
- College of Water Sciences, Beijing Normal University, Beijing, 100875, China
| | - Dayi Zhang
- College of New Energy and Environment, Jilin University, Changchun, 130021, China.
- Key Laboratory of Groundwater Resources and Environment Ministry of Education, Jilin University, Changchun, 130021, China.
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Sabbioni G, Castaño A, Esteban López M, Göen T, Mol H, Riou M, Tagne-Fotso R. Literature review and evaluation of biomarkers, matrices and analytical methods for chemicals selected in the research program Human Biomonitoring for the European Union (HBM4EU). ENVIRONMENT INTERNATIONAL 2022; 169:107458. [PMID: 36179646 DOI: 10.1016/j.envint.2022.107458] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
Humans are potentially exposed to a large amount of chemicals present in the environment and in the workplace. In the European Human Biomonitoring initiative (Human Biomonitoring for the European Union = HBM4EU), acrylamide, mycotoxins (aflatoxin B1, deoxynivalenol, fumonisin B1), diisocyanates (4,4'-methylenediphenyl diisocyanate, 2,4- and 2,6-toluene diisocyanate), and pyrethroids were included among the prioritized chemicals of concern for human health. For the present literature review, the analytical methods used in worldwide biomonitoring studies for these compounds were collected and presented in comprehensive tables, including the following parameter: determined biomarker, matrix, sample amount, work-up procedure, available laboratory quality assurance and quality assessment information, analytical techniques, and limit of detection. Based on the data presented in these tables, the most suitable methods were recommended. According to the paradigm of biomonitoring, the information about two different biomarkers of exposure was evaluated: a) internal dose = parent compounds and metabolites in urine and blood; and b) the biologically effective = dose measured as blood protein adducts. Urine was the preferred matrix used for deoxynivalenol, fumonisin B1, and pyrethroids (biomarkers of internal dose). Markers of the biological effective dose were determined as hemoglobin adducts for diisocyanates and acrylamide, and as serum-albumin-adducts of aflatoxin B1 and diisocyanates. The analyses and quantitation of the protein adducts in blood or the metabolites in urine were mostly performed with LC-MS/MS or GC-MS in the presence of isotope-labeled internal standards. This review also addresses the critical aspects of the application, use and selection of biomarkers. For future biomonitoring studies, a more comprehensive approach is discussed to broaden the selection of compounds.
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Affiliation(s)
- Gabriele Sabbioni
- Università della Svizzera Italiana (USI), Research and Transfer Service, Lugano, Switzerland; Institute of Environmental and Occupational Toxicology, Airolo, Switzerland; Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Argelia Castaño
- National Centre for Environmental Health, Instituto de Salud Carlos III (ISCIII), Majadahonda, Spain.
| | - Marta Esteban López
- National Centre for Environmental Health, Instituto de Salud Carlos III (ISCIII), Majadahonda, Spain.
| | - Thomas Göen
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander Universität Erlangen-Nürnberg (IPASUM), Erlangen, Germany.
| | - Hans Mol
- Wageningen Food Safety Research, Part of Wageningen University & Research, Wageningen, the Netherlands.
| | - Margaux Riou
- Department of Environmental and Occupational Health, Santé publique France, The National Public Health Agency, Saint-Maurice, France.
| | - Romuald Tagne-Fotso
- Department of Environmental and Occupational Health, Santé publique France, The National Public Health Agency, Saint-Maurice, France.
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Synthesis of magnetic molecular imprinted polymers for solid-phase extraction coupled with gas chromatography-mass spectrometry for the determination of type Ⅱ pyrethroid residues in human plasma. Microchem J 2021. [DOI: 10.1016/j.microc.2021.106232] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zhu H, Chinthakindi S, Kannan K. A method for the analysis of 121 multi-class environmental chemicals in urine by high-performance liquid chromatography-tandem mass spectrometry. J Chromatogr A 2021; 1646:462146. [PMID: 33895641 DOI: 10.1016/j.chroma.2021.462146] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/23/2021] [Accepted: 03/31/2021] [Indexed: 02/07/2023]
Abstract
Biomonitoring of human exposure to environmental chemicals has gained momentum in recent years. Biomonitoring methods often include analysis of a single class of chemicals with similar chemical properties. In this study, we describe a method that involves solid-phase extraction (SPE) coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) and capable of measuring 121 environmental chemicals comprising plasticizers (PMs; n = 45), environmental phenols (EPs; n = 45), and pesticides (n = 31) through a single extraction of urine. Urine samples were incubated with 20 µL of β-glucuronidase/arylsulfatase (4000 units/mL urine) (from Helix pomatia) buffered at pH 5.5 for 2 h at 37 °C for optimal deconjugation conditions. We compared two extraction methods, namely liquid-liquid extraction and SPE, and the latter with ABS Elut NEXUS® cartridges was optimized to yield best extraction efficiencies. For increased resolution and chromatographic separation, two methods involving Ultra AQ C18® and Betasil™ C18® columns were used. The MS/MS analyses were performed under both negative and positive ionization modes. The optimized method yielded excellent intra- and inter-day variabilities (relative standard deviation: 0.40-11%) and satisfactory recoveries (80-120%) for >95% of the analytes. The limits of detection were ≤ 0.1 ng/mL for 101 analytes and between 0.1 and 1.0 ng/mL for 18 analytes. The optimized SPE LC-MS/MS method was validated through the analysis of standard reference materials and proficiency test urine samples and further applied in the analysis of 21 real urine samples to demonstrate simultaneous determination of 121 environmental chemicals in urine samples.
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Affiliation(s)
- Hongkai Zhu
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, MSB 6-698, 550 1st Avenue, New York, NY 10016, United States
| | - Sridhar Chinthakindi
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, MSB 6-698, 550 1st Avenue, New York, NY 10016, United States
| | - Kurunthachalam Kannan
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, MSB 6-698, 550 1st Avenue, New York, NY 10016, United States.
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Kongtip P, Nankongnab N, Pundee R, Kallayanatham N, Pengpumkiat S, Chungcharoen J, Phommalachai C, Konthonbut P, Choochouy N, Sowanthip P, Khangkhun P, Yimsabai J, Woskie S. Acute Changes in Thyroid Hormone Levels among Thai Pesticide Sprayers. TOXICS 2021; 9:16. [PMID: 33477987 PMCID: PMC7835790 DOI: 10.3390/toxics9010016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
The objective of this study was to investigate the relationship of acute pesticide exposures and acute changes in thyroid hormones among Thai farmers. We recruited 78 farmers, who were scheduled to spray insecticides (chlorpyrifos and/or cypermethrin) or herbicides (paraquat and/or glyphosate). On the day before spraying, farmers collected their first morning void urine and went for blood collection. On the spray day, urine samples were collected at end of the spraying event and they were interviewed with questionnaires. The next morning, the first morning void urine and blood samples were collected. Blood samples were analyzed for thyroid hormones. Urine samples were analyzed for the metabolites of the pesticide sprayed. The results showed that the thyroid hormones, free triiodothyronine (FT3) and total triiodothyronine (T3) were significantly reduced as urinary chlorpyrifos metabolite increased the day after spraying. Total thyroxine (T4) significantly increased as cypermethrin metabolites increased the day after spraying. T4 significantly increased as urinary glyphosate levels increased; however, FT3 and T3 decreased significantly as urinary paraquat levels increased the day after spraying. These findings suggest that acute exposures to the pesticides chlorpyrifos, cypermethrin, paraquat and glyphosate can produce acute effects on the hypothalamic-pituitary-thyroid (HPT) axis, acutely altering thyroid hormone levels.
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Affiliation(s)
- Pornpimol Kongtip
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvidhi Road, Bangkok 10400, Thailand; (N.N.); (N.K.); (S.P.); (J.C.); (C.P.); (P.K.)
- Center of Excellence on Environmental Health and Toxicology, EHT, Bangkok 10400, Thailand;
| | - Noppanun Nankongnab
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvidhi Road, Bangkok 10400, Thailand; (N.N.); (N.K.); (S.P.); (J.C.); (C.P.); (P.K.)
- Center of Excellence on Environmental Health and Toxicology, EHT, Bangkok 10400, Thailand;
| | - Ritthirong Pundee
- Nakhonsawan Campus, Mahidol University, Nakhonsawan 60130, Thailand;
| | - Nichcha Kallayanatham
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvidhi Road, Bangkok 10400, Thailand; (N.N.); (N.K.); (S.P.); (J.C.); (C.P.); (P.K.)
| | - Sumate Pengpumkiat
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvidhi Road, Bangkok 10400, Thailand; (N.N.); (N.K.); (S.P.); (J.C.); (C.P.); (P.K.)
| | - Jutamanee Chungcharoen
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvidhi Road, Bangkok 10400, Thailand; (N.N.); (N.K.); (S.P.); (J.C.); (C.P.); (P.K.)
| | - Chavisa Phommalachai
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvidhi Road, Bangkok 10400, Thailand; (N.N.); (N.K.); (S.P.); (J.C.); (C.P.); (P.K.)
| | - Pajaree Konthonbut
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvidhi Road, Bangkok 10400, Thailand; (N.N.); (N.K.); (S.P.); (J.C.); (C.P.); (P.K.)
| | - Nattagorn Choochouy
- Faculty of Public Health, Thammasat University Lampang Campus, Lampang 52190, Thailand;
| | - Preecha Sowanthip
- Center of Excellence on Environmental Health and Toxicology, EHT, Bangkok 10400, Thailand;
| | - Phanthawee Khangkhun
- Bureau of Elderly Health, Department of Health, Ministry of Public Health, Nonthaburi 11000, Thailand;
| | - Jutharak Yimsabai
- Department of Medical Technology and Clinical Pathology, Buddhachinaraj Phitsanulok Hospital, 90 Sithamma Traipidok Road, Muang, Phitsanulok 65000, Thailand;
| | - Susan Woskie
- Department of Public Health, University of Massachusetts Lowell, One University Ave, Lowell, MA 01854-2867, USA;
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Synthesis of sheet-like polypyrrole nanowires for the microextraction of trace residues of pyrethroid pesticides in human plasma and molecular dynamics-aided study of adsorption mechanism. J Chromatogr A 2020; 1632:461609. [DOI: 10.1016/j.chroma.2020.461609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022]
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Li C, Begum A, Xue J. Analytical methods to analyze pesticides and herbicides. WATER ENVIRONMENT RESEARCH : A RESEARCH PUBLICATION OF THE WATER ENVIRONMENT FEDERATION 2020; 92:1770-1785. [PMID: 32762111 DOI: 10.1002/wer.1431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/10/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
This paper reviews studies published in 2019, in the area of analytical techniques for determination of pesticides and herbicides. It should be noted that some of the reports summarized in this review are not directly related to but could potentially be used for water environment studies. Based on different methods, the literatures are organized into six sections, namely extraction methods, electrochemical techniques, spectrophotometric techniques, chemiluminescence and fluorescence methods, chromatographic and mass spectrometric techniques, and biochemical assays. PRACTITIONER POINTS: Totally 141 research articles have been summarized. The review is divided into six parts. Chromatographic and mass spectrometric techniques are the most widely used methods.
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Affiliation(s)
- Chao Li
- College of Food and Pharmaceutical Sciences, Ningbo University, Ningbo, China
| | - Afruza Begum
- Environmental Systems Engineering, Faculty of Engineering and Applied Science, University of Regina, Regina, Canada
| | - Jinkai Xue
- Environmental Systems Engineering, Faculty of Engineering and Applied Science, University of Regina, Regina, Canada
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Simaremare SRS, Hung CC, Hsieh CJ, Yiin LM. Relationship between Organophosphate and Pyrethroid Insecticides in Blood and Their Metabolites in Urine: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010034. [PMID: 31861481 PMCID: PMC6982316 DOI: 10.3390/ijerph17010034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 01/22/2023]
Abstract
We conducted a pilot study to examine the relationship between organophosphate (OP) and pyrethroid (PYR) insecticides in blood and their metabolites in urine. A total of 30 pregnant women were enrolled in the study, and blood and urine was sampled from each subject during a regular clinic visit. Two OP and nine PYR insecticides were selected for blood sample analysis, while six OP and five PYR metabolites were analyzed for urine specimens. Both types of samples were processed and analyzed on gas chromatography-mass spectrometry. For OPs in blood, chlorpyrifos had a higher mean concentration (73.33 µg/L) than terbufos. For PYRs in blood, cypermethrin and imiprothrin were the most frequently detected species with the highest mean concentrations (151.25 and 141.25 µg/L). The concentrations of PYRs appeared to be higher than that of OPs, and the most frequently detected PYRs were commonly used in domestic products, suggesting that the exposure could mostly originate from use of domestic insecticides. The correlation between insecticides in blood and their metabolites in urine was significantly high (r = 0.795 for OPs and 0.882 for PYRs, p < 0.001), indicating routine exposure at a steady state. Residents should be cautious with domestic use of insecticide products to lower their exposure.
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Affiliation(s)
- Sailent Rizki Sari Simaremare
- Institute of Medical Sciences, Tzu Chi University, 701, Sec. 3, Zhongyang Road, Hualien City 97004, Taiwan; (S.R.S.S.); (C.-C.H.)
| | - Chien-Che Hung
- Institute of Medical Sciences, Tzu Chi University, 701, Sec. 3, Zhongyang Road, Hualien City 97004, Taiwan; (S.R.S.S.); (C.-C.H.)
| | - Chia-Jung Hsieh
- Department of Public Health, Tzu Chi University, 701, Sec. 3, Zhongyang Road, Hualien City 97004, Taiwan;
| | - Lih-Ming Yiin
- Department of Public Health, Tzu Chi University, 701, Sec. 3, Zhongyang Road, Hualien City 97004, Taiwan;
- Correspondence: ; Tel.: +886-3-856-5301 (ext. 2273)
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