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Müller A, Wouters EF, Koul P, Welte T, Harrabi I, Rashid A, Loh LC, Al Ghobain M, Elsony A, Ahmed R, Potts J, Mortimer K, Rodrigues F, Paraguas SN, Juvekar S, Agarwal D, Obaseki D, Gislason T, Seemungal T, Nafees AA, Jenkins C, Dias HB, Franssen FME, Studnicka M, Janson C, Cherkaski HH, El Biaze M, Mahesh PA, Cardoso J, Burney P, Hartl S, Janssen DJA, Amaral AFS. Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study. Pulmonology 2024:S2531-0437(24)00044-8. [PMID: 38614859 DOI: 10.1016/j.pulmoe.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function. METHODS Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. RESULTS The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC CONCLUSION The prevalence of dyspnoea varies substantially across the world and is strongly associated with lung function impairment. Using the mMRC scale in epidemiological research should be discussed.
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Affiliation(s)
- A Müller
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - E F Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P Koul
- Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - T Welte
- Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Hannover, Germany
| | - I Harrabi
- Faculté de Médecine, Sousse, Tunisia
| | - A Rashid
- RCSI and UCD Malaysia Campus, Penang, Malaysia
| | | | - M Al Ghobain
- King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - A Elsony
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | - J Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - F Rodrigues
- Pulmonology Department, Lisbon North Hospital Centre, Lisbon, Portugal; Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal
| | - S N Paraguas
- Philippine College of Chest Physicians, Manila, Philippines
| | - S Juvekar
- KEM Hospital Research Centre, Pune, India
| | - D Agarwal
- KEM Hospital Research Centre, Pune, India
| | - D Obaseki
- Department of Medicine, Obafemi Awolowo University, Nigeria; Faculty of Medicine, University of British Columbia, Canada
| | - T Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - T Seemungal
- Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago
| | | | - C Jenkins
- Woolcock Institute of Medical Research, Sydney, Australia
| | - H B Dias
- Escola Superior de Tecnologia da Saúde de Lisboa, Politecnico de Lisboa, Lisbon, Portugal
| | - F M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - M Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - C Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - H H Cherkaski
- Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria
| | - M El Biaze
- Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco
| | - P A Mahesh
- Department of Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
| | - P Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
| | - D J A Janssen
- Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
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Mak J, Feary J, Amaral AFS, Marczylo E, Cullinan P, Green DC. Occupational exposure to particulate matter and staff sickness absence on the London underground. Environ Int 2024; 185:108529. [PMID: 38484612 DOI: 10.1016/j.envint.2024.108529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/26/2024]
Abstract
The London Underground (LU) employs over 19,000 staff, some of whom are exposed to elevated concentrations of particulate matter (PM) within the network. This study quantified the occupational exposure of LU staff to subway PM and investigated the possible association with sickness absence (SA). A job exposure matrix to quantify subway PM2.5 staff exposure was developed by undertaking measurement campaigns across the LU network. The association between exposure and SA was evaluated using zero-inflated mixed-effects negative binomial models. Staff PM2.5 exposure varied by job grade and tasks undertaken. Drivers had the highest exposure over a work shift (mean: 261 µg/m3), but concentrations varied significantly by LU line and time the train spent subway. Office staff work in office buildings separate to the LU network and are unexposed to occupational subway PM2.5. They were found to have lower rates of all-cause and respiratory infection SA compared to non-office staff, those who work across the LU network and are occupational exposed to subway PM2.5. Train drivers on five out of eight lines showed higher rates of all-cause SA, but no dose-response relationship was seen. Only drivers from one line showed higher rates of SAs from respiratory infections (incidence rate ratio: 1.24, 95% confidence interval 1.10-1.39). Lower-grade customer service (CS) staff showed higher rates of all-cause and respiratory infection SA compared to higher grade CS staff. Doctor-certified chronic respiratory and cardiovascular SAs were associated with occupational PM2.5 exposure in CS staff and drivers. While some groups with higher occupational exposure to subway PM reported higher rates of SA, no evidence suggests that subway PM is the main contributing factor to SA. This is the largest subway study on health effects of occupational PM2.5 exposure and may have wider implications for subway workers, contributing to safer working environments.
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Affiliation(s)
- Justie Mak
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom; HPRU in Environmental Exposures and Health, Imperial College London, London, United Kingdom.
| | - Johanna Feary
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Department of Occupational and Environmental Medicine, Royal Brompton Hospital, London, United Kingdom
| | - André F S Amaral
- National Heart and Lung Institute, Imperial College, London, United Kingdom; NIHR Imperial Biomedical Research Centre, London, United Kingdom
| | - Emma Marczylo
- HPRU in Environmental Exposures and Health, Imperial College London, London, United Kingdom; Toxicology Department, UK Health Security Agency, Harwell Campus, Chilton, Oxfordshire, United Kingdom
| | | | - David C Green
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, London, United Kingdom; HPRU in Environmental Exposures and Health, Imperial College London, London, United Kingdom
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Lakoh S, Vamboi PL, Ouédraogo AR, Adekanmbi O, Deen GF, Russell JBW, Sankoh-Hughes A, Kamara JB, Kanu JE, Yendewa GA, Firima E, Amaral AFS. High prevalence of TB multimorbidity among adults of a tertiary hospital in Sierra Leone: a cross-sectional study. BMC Res Notes 2023; 16:337. [PMID: 37974272 PMCID: PMC10655410 DOI: 10.1186/s13104-023-06476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Tuberculosis (TB) is a leading cause of death globally, with approximately 1.5 million deaths in 2020. TB often coexists with chronic communicable and non-communicable diseases, but data to determine the extent of comorbid diseases are limited. In this study, we aimed to assess the prevalence of TB multimorbidity and its risk factors in a tertiary hospital in Sierra Leone. This is a cross-sectional study of 240 adults with microbiologically-confirmed TB at Connaught Hospital in Freetown, between March and May 2022. Logistic regression analysis was used to identify factors associated with TB multimorbidity. RESULTS The mean age of the patients was 37 years. More than two-thirds were males and about the same number had two or more chronic diseases. The most common were hypertension (47.9%) and diabetes (24.2%). Patients under 35 years of age were less likely to have TB multimorbidity (< 25 years: adjusted OR 0.07, 95%CI 0.01-0.6; 25-34 years: adjusted OR 0.2, 95%CI 0.01-0.9). We report a high prevalence of comorbid diseases among TB patients in the largest treatment center in Sierra Leone, with hypertension and diabetes being the most common. These findings support the current call for addressing comorbid non-communicable diseases in TB patients through integrated care.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
| | - Patricia Lombeh Vamboi
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdoul Risgou Ouédraogo
- Division of Pulmonology, Training and Research Unit in Health Sciences, University Joseph KI-ZEBRO, Ouagadougou, Burkina Faso
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ahmed Sankoh-Hughes
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph B Kamara
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Joseph Edwin Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
| | - André F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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Hannemann J, Thorarinnsdottir EH, Amaral AFS, Schwedhelm E, Schmidt-Hutten L, Stang H, Benediktsdottir B, Gunnarsdóttir I, Gislason T, Böger R. Biomarkers of the L-Arginine/Dimethylarginine/Nitric Oxide Pathway in People with Chronic Airflow Obstruction and Obstructive Sleep Apnoea. J Clin Med 2023; 12:5230. [PMID: 37629272 PMCID: PMC10455103 DOI: 10.3390/jcm12165230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are common chronic diseases that are associated with chronic and intermittent hypoxemia, respectively. Patients affected by the overlap of COPD and OSA have a particularly unfavourable prognosis. The L-arginine/nitric oxide (NO) pathway plays an important role in regulating pulmonary vascular function. Asymmetric (ADMA) and symmetric dimethylarginine (SDMA) interfere with NO production. METHODS We analysed the serum concentrations of ADMA, SDMA, L-arginine, L-citrulline, and L-ornithine in a large sample of the Icelandic general population together with chronic airflow obstruction (CAO), a key physiological marker of COPD that was assessed by post-bronchodilator spirometry (FEV1/FVC < LLN). OSA risk was determined by the multivariable apnoea prediction (MAP) index. RESULTS 713 individuals were analysed, of whom 78 (10.9%) showed CAO and 215 (30%) had MAP > 0.5. SDMA was significantly higher in individuals with CAO (0.518 [0.461-0.616] vs. 0.494 [0.441-0.565] µmol/L; p = 0.005), but ADMA was not. However, ADMA was significantly associated with decreasing FEV1 percent predicted among those with CAO (p = 0.002). ADMA was 0.50 (0.44-0.56) µmol/L in MAP ≤ 0.5 versus 0.52 (0.46-0.58) µmol/L in MAP > 0.5 (p = 0.008). SDMA was 0.49 (0.44-0.56) µmol/L versus 0.51 (0.46-0.60) µmol/L, respectively (p = 0.004). The highest values for ADMA and SDMA were observed in individuals with overlap of CAO and MAP > 0.5, which was accompanied by lower L-citrulline levels. CONCLUSIONS The plasma concentrations of ADMA and SDMA are elevated in COPD patients with concomitant intermittent hypoxaemia. This may account for impaired pulmonary NO production, enhanced pulmonary vasoconstriction, and disease progression.
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Affiliation(s)
- Juliane Hannemann
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
- Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and Its Health Sequelae, 20246 Hamburg, Germany
| | - Elin H. Thorarinnsdottir
- Primary Health Care of the Capital Area, 103 Reykjavik, Iceland;
- Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland; (B.B.); (T.G.)
| | - André F. S. Amaral
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK;
- NIHR Imperial Biomedical Research Centre, London W2 1NY, UK
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
| | - Lena Schmidt-Hutten
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
| | - Heike Stang
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
| | - Bryndis Benediktsdottir
- Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland; (B.B.); (T.G.)
- Sleep Department, Landspitali University Hospital of Iceland, 105 Reykjavik, Iceland
| | - Ingibjörg Gunnarsdóttir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, 102 Reykjavik, Iceland;
| | - Thórarinn Gislason
- Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland; (B.B.); (T.G.)
- Sleep Department, Landspitali University Hospital of Iceland, 105 Reykjavik, Iceland
| | - Rainer Böger
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
- Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and Its Health Sequelae, 20246 Hamburg, Germany
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Ahmed R, Osman R, Nightingale R, Nagem D, Thomson R, Malmborg R, Elmustafa M, Amaral AFS, Patel J, Burney P, El Sony A, Mortimer K. Prevalence and determinants of chronic respiratory diseases in adults in rural Sudan. Int J Tuberc Lung Dis 2023; 27:841-849. [PMID: 37880887 PMCID: PMC10599415 DOI: 10.5588/ijtld.22.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/19/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND: Chronic respiratory diseases (CRDs) greatly contribute to worldwide mortality. Despite new data emerging from Africa, prevalence estimates and determinants of CRDs in rural settings are limited. This study sought to extend the existing research conducted in urban Sudan by conducting a rural comparison.METHODS: Participants aged ≥18 years (n = 1,850), living in rural Gezira State completed pre-and post-bronchodilator spirometry and a questionnaire. Prevalence of respiratory symptoms and spirometric abnormalities were reported. Regression analyses were used to identify risk factors for CRDs.RESULTS: Prevalence of chronic airflow obstruction (CAO) was 4.1% overall and 5.5% in those aged ≥40 years. Reversibility was seen in 6.4%. Low forced vital capacity (FVC) was seen in 58.5%, and at least one respiratory symptom was present in 40.7% of the participants. CAO was more common among people aged 60-69 years (OR 2.07, 95% CI 1.13-3.82) and less common among highly educated participants (OR 0.50, 95% CI 0.27-0.93). Being underweight was associated with lower FVC (OR 3.07, 95% CI 2.24-4.20).CONCLUSIONS: A substantial burden of CRD exists among adults in rural Sudan. Investment in CRD prevention and management strategies is needed.
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Affiliation(s)
- R Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Osman
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Nightingale
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - D Nagem
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Thomson
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - M Elmustafa
- University of Gezira, Wad Medani, Wad Medani College of Medical Sciences and Technology, Wad Medani, Sudan
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London
| | - J Patel
- National Heart and Lung Institute, Imperial College London, London
| | - P Burney
- National Heart and Lung Institute, Imperial College London, London
| | - A El Sony
- The Epidemiological Laboratory, Khartoum, Sudan
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK, National Heart and Lung Institute, Imperial College London, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, University of Cambridge, Cambridge, UK, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Burney P, Knox-Brown B, Amaral AFS. Addressing the origins and health effects of small lungs - Authors' reply. Lancet Respir Med 2023:S2213-2600(23)00219-9. [PMID: 37354917 DOI: 10.1016/s2213-2600(23)00219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Peter Burney
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK.
| | - Ben Knox-Brown
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK
| | - André F S Amaral
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK; National Institute for Health Research Imperial Biomedical Research Centre, London, UK
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Ahmed R, Osman N, Noory B, Osman R, ElHassan H, Eltigani H, Nightingale R, Amaral AFS, Patel J, Burney PG, Mortimer K, El Sony A. Prevalence and determinants of chronic respiratory diseases in adults in Sudan. Int J Tuberc Lung Dis 2023; 27:373-380. [PMID: 37143219 DOI: 10.5588/ijtld.22.0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND: Chronic respiratory diseases (CRDs) are considered a significant cause of morbidity and mortality worldwide, although data from Africa are limited. This study aimed to determine the prevalence and determinants of CRDs in Khartoum, Sudan.METHODS: Data were collected from 516 participants aged ≥40 years, who had completed a questionnaire and undertook pre- and post-bronchodilator spirometry testing. Trained field workers administered the questionnaires and conducted spirometry. Survey-weighted prevalence of respiratory symptoms and spirometric abnormalities were estimated. Regression analysis models were used to identify risk factors for chronic lung diseases.RESULTS: Using the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III) reference equations, the prevalence of chronic airflow obstruction (CAO) was 10%. The main risk factor was older age, 60-69 years (OR 3.16, 95% CI 1.20-8.31). Lower education, high body mass index and a history of TB were also identified as significant risk factors. The prevalence of a low forced vital capacity (FVC) using NHANES III was 62.7% (SE 2.2) and 11.3% (SE 1.4) using locally derived values.CONCLUSION: The prevalence of spirometric abnormality, mainly low FVC, was high, suggesting that CRD is of substantial public health importance in urban Sudan. Strategies for the prevention and control of these problems are needed.
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Affiliation(s)
- R Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | - N Osman
- The Epidemiological Laboratory, Khartoum, Sudan, Federal Ministry of Health, Khartoum, Sudan
| | - B Noory
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Osman
- The Epidemiological Laboratory, Khartoum, Sudan
| | - H ElHassan
- The Epidemiological Laboratory, Khartoum, Sudan
| | - H Eltigani
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Nightingale
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College, London, UK
| | - J Patel
- National Heart and Lung Institute, Imperial College, London, UK
| | - P G Burney
- National Heart and Lung Institute, Imperial College, London, UK
| | - K Mortimer
- Liverpool University Hospitals NHS foundation Trust, Liverpool, UK, University of Cambridge, Cambridge, UK
| | - A El Sony
- The Epidemiological Laboratory, Khartoum, Sudan, Global Alliance for Respiratory Diseases, Africa
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Burney P, Knox-Brown B, Amaral AFS. Small lung syndrome: the need to reclassify chronic lung disease. The Lancet Respiratory Medicine 2023; 11:405-406. [PMID: 37003282 DOI: 10.1016/s2213-2600(23)00091-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Peter Burney
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK.
| | - Ben Knox-Brown
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK
| | - André F S Amaral
- National Heart Lung Institute, Imperial College London, London SW3 6LR, UK; National Institute for Health Research Imperial Biomedical Research Centre, London, UK
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Amaral AFS. Prevalence of chronic airflow obstruction in sub-Saharan Africa. Int J Tuberc Lung Dis 2022; 26:181-182. [PMID: 35197156 DOI: 10.5588/ijtld.21.0724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A F S Amaral
- National Heart and Lung Institute, Imperial College, London, UK
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10
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Migliori GB, Marx FM, Ambrosino N, Zampogna E, Schaaf HS, van der Zalm MM, Allwood B, Byrne AL, Mortimer K, Wallis RS, Fox GJ, Leung CC, Chakaya JM, Seaworth B, Rachow A, Marais BJ, Furin J, Akkerman OW, Al Yaquobi F, Amaral AFS, Borisov S, Caminero JA, Carvalho ACC, Chesov D, Codecasa LR, Teixeira RC, Dalcolmo MP, Datta S, Dinh-Xuan AT, Duarte R, Evans CA, García-García JM, Günther G, Hoddinott G, Huddart S, Ivanova O, Laniado-Laborín R, Manga S, Manika K, Mariandyshev A, Mello FCQ, Mpagama SG, Muñoz-Torrico M, Nahid P, Ong CWM, Palmero DJ, Piubello A, Pontali E, Silva DR, Singla R, Spanevello A, Tiberi S, Udwadia ZF, Vitacca M, Centis R, D Ambrosio L, Sotgiu G, Lange C, Visca D. Clinical standards for the assessment, management and rehabilitation of post-TB lung disease. Int J Tuberc Lung Dis 2021; 25:797-813. [PMID: 34615577 PMCID: PMC8504493 DOI: 10.5588/ijtld.21.0425] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.
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Affiliation(s)
- G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - N Ambrosino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - E Zampogna
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, South Africa
| | - A L Byrne
- Heart Lung Clinic St Vincent´s Hospital and Clinical School, University of New South Wales, Sydney, NSW, Australia, Partners In Health (Socios En Salud Sucursal), Lima, Peru
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - R S Wallis
- Aurum Institute, Johannesburg, South Africa
| | - G J Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - C C Leung
- Hong Kong Tuberculosis, Chest and Heart Diseases Association, Hong Kong
| | - J M Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - B Seaworth
- Heartland National TB Center of Excellence, San Antonio, TX, University of Texas Health Science Center, Tyler, TX, USA
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany, German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - B J Marais
- The Children´s Hospital at Westmead and the University of Sydney WHO Collaborating Center in Tuberculosis, University of Sydney, Sydney, NSW, Australia
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
| | - O W Akkerman
- University of Groningen, University Medical Center Groningen, department of Pulmonary diseases and Tuberculosis, Groningen, the Netherlands, University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, the Netherlands
| | - F Al Yaquobi
- TB and Acute Respiratory Diseases Section, Department of Communicable Diseases, Directorate General of Disease Surveillance and Control, Ministry of Health, Oman
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow Health Department, Moscow, Russian Federation
| | - J A Caminero
- Mycobacterial Unit, Pneumology Department. University General Hospital of Gran Canaria "Dr. Negrin", Las Palmas, Gran Canaria, ALOSA TB Academy, Spain
| | - A C C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - D Chesov
- Department of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - L R Codecasa
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - R C Teixeira
- National Institute of Respiratory Diseases and the Environment (INERAM), Asunción, Paraguay, Radboud University Medical Center, TB Expert Center Dekkerswald, Department of Respiratory Diseases, Nijmegen - Groesbeek, The Netherlands
| | - M P Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - S Datta
- Department of clinical sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Innovation For Health And Development (IFHAD) Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru, Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru
| | - A-T Dinh-Xuan
- Université de Paris, APHP Centre, Lung Function Unit, Department of Respiratory Diseases, Cochin Hospital, Paris, France
| | - R Duarte
- Institute of Public Health, Porto University; Medical School, Porto University; Hospital Centre of Vila Nova de Gaia/Espinho, Porto, Portugal
| | - C A Evans
- Innovation For Health And Development (IFHAD) Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru, Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru, Department of Infectious Diseases, Imperial College London, London, UK
| | | | - G Günther
- Department of Pulmonology, Inselspital Bern, University of Bern, Switzerland
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Huddart
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, UCSF Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany, German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - R Laniado-Laborín
- Clínica de Tuberculosis, Hospital General Tijuana, Universidad Autónoma De Baja California, Mexico
| | - S Manga
- Medecins Sans Frontieres (MSF), Operational Center, Paris, France
| | - K Manika
- Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - A Mariandyshev
- Northern State Medical University, Northern Arctic Federal University, Arkhangelsk, Russian Federation
| | - F C Q Mello
- Thoracic Diseases Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S G Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro, Tanzania
| | - M Muñoz-Torrico
- Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City
| | - P Nahid
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, UCSF Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - C W M Ong
- Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore
| | - D J Palmero
- Pulmonology Division, Municipal Hospital F.J. Muñiz and Instituto Vaccarezza, Buenos Aires, Argentina
| | | | - E Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - D R Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - R Singla
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
| | - S Tiberi
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK, Blizard Institute, Queen Mary University of London, London, UK
| | - Z F Udwadia
- Department of Respiratory Medicine, Hinduja Hospital & Research Center, Mumbai, India
| | - M Vitacca
- Respiratory Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane (BS), Italy
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany, Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - D Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
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11
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Burney P, Patel J, Minelli C, Gnatiuc L, Amaral AFS, Kocabaş A, Cherkaski HH, Gulsvik A, Nielsen R, Bateman E, Jithoo A, Mortimer K, Sooronbaev TM, Lawin H, Nejjari C, Elbiaze M, El Rhazi K, Zheng JP, Ran P, Welte T, Obaseki D, Erhabor G, Elsony A, Osman NB, Ahmed R, Nizankowska-Mogilnicka E, Mejza F, Mannino DM, Bárbara C, Wouters EFM, Idolor LF, Loh LC, Rashid A, Juvekar S, Gislason T, Al Ghobain M, Studnicka M, Harrabi I, Denguezli M, Koul PA, Jenkins C, Marks G, Jõgi R, Hafizi H, Janson C, Tan WC, Aquart-Stewart A, Mbatchou B, Nafees A, Gunasekera K, Seemungal T, Padukudru Anand M, Enright P, Vollmer WM, Blangiardo M, Elfadaly FG, Buist AS. Prevalence and Population Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study. Am J Respir Crit Care Med 2020; 203:1353-1365. [PMID: 33171069 DOI: 10.1164/rccm.202005-1990oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: The Global Burden of Disease programme identified smoking, and ambient and household air pollution as the main drivers of death and disability from Chronic Obstructive Pulmonary Disease (COPD). Objective: To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors. Methods: The Burden of Obstructive Lung Disease study is a cross-sectional study of adults, aged≥40, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a post-bronchodilator one-second forced expiratory volume to forced vital capacity ratio < lower limit of normal, and the relative risks associated with different risk factors. Local RR were estimated using a Bayesian hierarchical model borrowing information from across sites. From these RR and the prevalence of risk factors, we estimated local Population Attributable Risks (PAR). Measurements and Main Results: Mean prevalence of CAO was 11.2% in men and 8.6% in women. Mean PAR for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for ≥10 years, low body mass index (BMI), and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites. Conclusions: While smoking remains the most important risk factor for CAO, in some areas poor education, low BMI and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.
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Affiliation(s)
- Peter Burney
- Imperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Jaymini Patel
- Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland
| | - Cosetta Minelli
- Imperial College, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Louisa Gnatiuc
- University of Oxford, 6396, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - André F S Amaral
- Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland;
| | - Ali Kocabaş
- Cukurova Universitesi Tip Fakultesi, 63988, Pulmonary Disease, Adana, Turkey
| | | | - Amund Gulsvik
- University of Bergen, 1658, Department of Thoracic Medicine, Institute of Medicine, Bergen, Norway
| | | | | | - Anamika Jithoo
- University of Cape Town Lung Institute, 108145, Cape Town, South Africa
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine and Aintree University Hospital NHS Foundation Trust, Respiratory Medicine, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | | | - Hervé Lawin
- University of Abomey-Calavi, 107790, Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, Cotonou, Benin
| | - Chakib Nejjari
- Laboratoire d'épidémiologie, Recherche Clinique et Santé Communautaire, Fes, Morocco
| | - Mohammed Elbiaze
- Universite Sidi Mohamed Ben Abdellah Faculte de Medecine et de Pharmacie de Fes Bibliotheque, 548123, Fes, Morocco
| | - Karima El Rhazi
- Universite Sidi Mohamed Ben Abdellah Faculte de Medecine et de Pharmacie de Fes Bibliotheque, 548123, Fes, Morocco
| | - Jin-Ping Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China, Guangzhou, China
| | - Tobias Welte
- Medizinische Hochschule Hannover, Direktor der Abteilung Pneumologie, Hannover, Germany
| | | | | | | | | | | | | | - Filip Mejza
- Jagiellonian University Medical College, 49573, Krakow, Poland
| | - David M Mannino
- Medical Expert at GlaxoSmithKline, Lexington, Kentucky, United States.,University of Ketucky, Epidemiology , Lexington, Kentucky, United States
| | - Cristina Bárbara
- Hospital Pulido Valente, 70896, Unidade de Técnicas Invasivas Pneumológicas, Pneumologia II, Lisboa, Portugal.,Universidade de Lisboa Faculdade de Medicina, 37811, Instituto de Saúde Ambiental, Lisboa, Portugal
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Li-Cher Loh
- Penang Medical College, 26696, Georgetown, Malaysia
| | - Abdul Rashid
- Royal College of Surgeons of Ireland and University College Dublin, Malaysia Campus, Penang, Malaysia
| | | | | | | | | | - Imed Harrabi
- Faculty of Medicine, Sousse, Tunisia, Sousse, Tunisia
| | - Meriam Denguezli
- Universite de Sousse Faculte de Medecine de Sousse, 280226, Sousse, Tunisia
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, 29078, Internal Medicine, Srinagar, India
| | | | - Guy Marks
- Institute of Respiratory Medicine, Campertown, New South Wales, Australia
| | - Rain Jõgi
- Foundation Tartu University Clinics, Lung Clinic, Tartu, Estonia
| | | | - Christer Janson
- Uppsala Uiversity, Dep of Respiratory Medicine, Uppsala, Sweden
| | - Wan C Tan
- Univ British Columbia, icapture center, vancouver, British Columbia, Canada
| | | | | | | | | | - Terry Seemungal
- University of the West Indies, Clinical Medical Sciences, Champs Fleurs, Trinidad and Tobago
| | - Mahesh Padukudru Anand
- JSS Academy of Higher Education and Research, Department of Pulmonary Medicine, JSS Medical College, , Mysore, India
| | - Paul Enright
- University of Arizona, Medicine, Tucson, Arizona, United States
| | | | - Marta Blangiardo
- Imperial College London School of Public Health, 156430, Department of Epidemiology and Biostatistics, London, United Kingdom of Great Britain and Northern Ireland
| | - Fadlalla G Elfadaly
- The Open University, 5488, Milton Keynes, United Kingdom of Great Britain and Northern Ireland
| | - A Sonia Buist
- Oregon Health Sciences University, Medicine / Pulmonary & Critical Care, Portland, Oregon, United States
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12
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Porta M, Pumarega J, Amaral AFS, Genkinger JM, Camargo J, Mucci L, Alguacil J, Gasull M, Zhang X, Morales E, Iglesias M, Ogino S, Engel LS. Influence of KRAS mutations, persistent organic pollutants, and trace elements on survival from pancreatic ductal adenocarcinoma. Environ Res 2020; 190:109781. [PMID: 32791343 PMCID: PMC7689512 DOI: 10.1016/j.envres.2020.109781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/02/2020] [Accepted: 06/02/2020] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Reasons why pancreatic ductal adenocarcinoma (PDAC) continues to have poor survival are only partly known. No previous studies have analyzed the combined influence of KRAS mutations, persistent organic pollutants (POPs), and trace elements upon survival in PDAC or in any other human cancer. OBJECTIVE To analyze the individual and combined influence of KRAS mutations, POPs, and trace elements upon survival from PDAC. METHODS Incident cases of PDAC (n = 185) were prospectively identified in five hospitals in Eastern Spain in 1992-1995 and interviewed face-to-face during hospital admission. KRAS mutational status was determined from tumour tissue through polymerase chain reaction and artificial restriction fragment length polymorphism. Blood and toenail samples were obtained before treatment. Serum concentrations of POPs were analyzed by high-resolution gas chromatography with electron-capture detection. Concentrations of 12 trace elements were determined in toenail samples by inductively coupled plasma mass spectrometry. Multivariable Cox proportional hazards regression was used to assess prognostic associations. RESULTS Patients with a KRAS mutated tumor had a 70% higher risk of early death than patients with a KRAS wild-type PDAC (hazard ratio [HR] = 1.7, p = 0.026), adjusting for age, sex, and tumor stage. KRAS mutational status was only modestly and not statistically significantly associated with survival when further adjusting by treatment or by treatment intention. The beneficial effects of treatment remained unaltered when KRAS mutational status was taken into account, and treatment did not appear to be less effective in the subgroup of patients with a KRAS mutated tumor. POPs did not materially influence survival: the adjusted HR of the highest POP tertiles was near unity for all POPs. When considering the joint effect on survival of POPs and KRAS, patients with KRAS mutated tumors had modest and nonsignificant HRs (most HRs around 1.3 to 1.4). Higher concentrations of lead, cadmium, arsenic, vanadium, and aluminium were associated with better survival. When KRAS status, POPs, and trace elements were simultaneously considered along with treatment, only the latter was statistically significantly related to survival. CONCLUSIONS In this study based on molecular, clinical, and environmental epidemiology, KRAS mutational status, POPs, and trace elements were not adversely related to PDAC survival when treatment was simultaneously considered; only treatment was independently related to survival. The lack of adverse prognostic effects of POPs and metals measured at the time of diagnosis provide scientific and clinical reassurance on the effects of such exposures upon survival of patients with PDAC. The weak association with KRAS mutations contributes to the scant knowledge on the clinical implications of a genetic alteration highly frequent in PDAC.
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Affiliation(s)
- Miquel Porta
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain.
| | - José Pumarega
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - André F S Amaral
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jeanine M Genkinger
- Department of Epidemiology, Columbia University, New York, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA
| | - Judit Camargo
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Lorelei Mucci
- Harvard Medical School, Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, USA
| | - Juan Alguacil
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Universidad de Huelva, Huelva, Spain
| | - Magda Gasull
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Xuehong Zhang
- Harvard Medical School, Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, USA
| | - Eva Morales
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; IMIB-Arrixaca, Department of Public Health Sciences, University of Murcia
| | - Mar Iglesias
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Shuji Ogino
- Harvard Medical School, Harvard T. H. Chan School of Public Health, Brigham and Women's Hospital, Boston, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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13
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Burney P, Amaral AFS. Asthma exacerbations, air pollution, and allergens - Authors' reply. Lancet 2020; 396:753-754. [PMID: 32919503 DOI: 10.1016/s0140-6736(20)30896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/07/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Peter Burney
- National Heart and Lung Institute, Imperial College London, London SW3 6LR, UK
| | - André F S Amaral
- National Heart and Lung Institute, Imperial College London, London SW3 6LR, UK.
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14
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Allwood BW, van der Zalm MM, Amaral AFS, Byrne A, Datta S, Egere U, Evans CA, Evans D, Gray DM, Hoddinott G, Ivanova O, Jones R, Makanda G, Marx FM, Meghji J, Mpagama S, Pasipanodya JG, Rachow A, Schoeman I, Shaw J, Stek C, van Kampen S, von Delft D, Walker NF, Wallis RS, Mortimer K. Post-tuberculosis lung health: perspectives from the First International Symposium. Int J Tuberc Lung Dis 2020; 24:820-828. [PMID: 32912387 DOI: 10.5588/ijtld.20.0067] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
ALTHOUGH CURABLE, TB frequently leaves the individual with chronic physical and psycho-social impairment, but these consequences have been largely neglected. The 1st International Post-Tuberculosis Symposium (Stellenbosch, South Africa) was held to discuss priorities and gaps in addressing this issue. A barrier to progress has been the varied terminology and nomenclature, so the Delphi process was used to achieve consensus on definitions. Lack of sufficient evidence hampered definitive recommendations in most domains, including prevention and treatment of post-TB lung disease (PTLD), but the discussions clarified the research needed. A consensus was reached on a toolkit for future PTLD measurement and on PTLD patterns to be considered. The importance of extra-pulmonary consequences and progressive impairment throughout the life-course was identified, including TB recurrence and increased mortality. Patient advocates emphasised the need to address the psychological and social impacts post TB and called for clinical guidance. More generally, there is an urgent need for increased awareness and research into post-TB complications.
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Affiliation(s)
- B W Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - A Byrne
- Heart Lung Clinic, St Vincent´s Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - S Datta
- Department of Infectious Disease, Imperial College London, London, UK, Innovation For Health And Development, Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Innovacion por la Salud y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - U Egere
- IMPALA Consortium and Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - C A Evans
- Department of Infectious Disease, Imperial College London, London, UK, Innovation For Health And Development, Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Innovacion por la Salud y el Desarollo, Asociación Benéfica Prisma, Lima, Peru
| | - D Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - D M Gray
- Division of Paediatric Pulmonology, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - R Jones
- Faculty of Health, Plymouth University, Plymouth, UK
| | | | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Faculty of Science, Stellenbosch University, Johannesburg, South Africa
| | - J Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Mpagama
- Kibong´oto Infectious Diseases Hospital, Kibong´oto, Tanzania
| | - J G Pasipanodya
- Center for Infectious Diseases Research & Experimental Therapeutics, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany, German Centre for Infection Research (DFIZ), Partner Site Munich, Munich, Germany
| | | | - J Shaw
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - C Stek
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - S van Kampen
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - N F Walker
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - R S Wallis
- Aurum Institute, Johannesburg, South Africa
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK, International Union against Tuberculosis and Lung Disease, Paris, France
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Amaral AFS, Imboden M, Wielscher M, Rezwan FI, Minelli C, Garcia-Aymerich J, Peralta GP, Auvinen J, Jeong A, Schaffner E, Beckmeyer-Borowko A, Holloway JW, Jarvelin MR, Probst-Hensch NM, Jarvis DL. Role of DNA methylation in the association of lung function with body mass index: a two-step epigenetic Mendelian randomisation study. BMC Pulm Med 2020; 20:171. [PMID: 32546146 PMCID: PMC7298775 DOI: 10.1186/s12890-020-01212-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Low lung function has been associated with increased body mass index (BMI). The aim of this study was to investigate whether the effect of BMI on lung function is mediated by DNA methylation. METHODS We used individual data from 285,495 participants in four population-based cohorts: the European Community Respiratory Health Survey, the Northern Finland Birth Cohort 1966, the Swiss Study on Air Pollution and Lung Disease in Adults, and the UK Biobank. We carried out Mendelian randomisation (MR) analyses in two steps using a two-sample approach with SNPs as instrumental variables (IVs) in each step. In step 1 MR, we estimated the causal effect of BMI on peripheral blood DNA methylation (measured at genome-wide level) using 95 BMI-associated SNPs as IVs. In step 2 MR, we estimated the causal effect of DNA methylation on FEV1, FVC, and FEV1/FVC using two SNPs acting as methQTLs occurring close (in cis) to CpGs identified in the first step. These analyses were conducted after exclusion of weak IVs (F statistic < 10) and MR estimates were derived using the Wald ratio, with standard error from the delta method. Individuals whose data were used in step 1 were not included in step 2. RESULTS In step 1, we found that BMI might have a small causal effect on DNA methylation levels (less than 1% change in methylation per 1 kg/m2 increase in BMI) at two CpGs (cg09046979 and cg12580248). In step 2, we found no evidence of a causal effect of DNA methylation at cg09046979 on lung function. We could not estimate the causal effect of DNA methylation at cg12580248 on lung function as we could not find publicly available data on the association of this CpG with SNPs. CONCLUSIONS To our knowledge, this is the first paper to report the use of a two-step MR approach to assess the role of DNA methylation in mediating the effect of a non-genetic factor on lung function. Our findings do not support a mediating effect of DNA methylation in the association of lung function with BMI.
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Affiliation(s)
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthias Wielscher
- Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Faisal I. Rezwan
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gabriela P. Peralta
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Juha Auvinen
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ayoung Jeong
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Beckmeyer-Borowko
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - John W. Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marjo-Riitta Jarvelin
- Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Nicole M. Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Deborah L. Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - for the ALEC consortium
- National Heart and Lung Institute, Imperial College London, London, UK
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Faculty of Medicine, University of Oulu, Oulu, Finland
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16
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Jankowski M, Amaral AFS. ERS International Congress, Madrid, 2019: highlights from the Epidemiology and Environment Assembly. ERJ Open Res 2020; 6:00320-2019. [PMID: 32039257 PMCID: PMC6995836 DOI: 10.1183/23120541.00320-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/11/2019] [Indexed: 11/05/2022] Open
Abstract
At the European Respiratory Society's International Congress of 2019, which was held in Madrid, Spain, there were several sessions with exciting poster and oral presentations within the fields of epidemiology and tobacco control. This article is the summary of two of these sessions. One was on the use of Big Data in epidemiology and the other, on the global burden of respiratory disease and tobacco. Highlights from the Epidemiology and Environment Assembly at the #ERSCongress 2019http://bit.ly/38p6jEZ
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Affiliation(s)
- Mateusz Jankowski
- Dept of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - André F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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17
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Affiliation(s)
- Peter Burney
- National Heart and Lung Institute, Imperial College, London, UK.
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18
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Camargo J, Pumarega JA, Alguacil J, Sanz-Gallén P, Gasull M, Delclos GL, Amaral AFS, Porta M. Toenail concentrations of trace elements and occupational history in pancreatic cancer. Environ Int 2019; 127:216-225. [PMID: 30928845 DOI: 10.1016/j.envint.2019.03.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND Some occupations potentially entailing exposure to cadmium, arsenic, lead, selenium, nickel, and chromium have been associated with an increased risk of exocrine pancreatic cancer (EPC), but no studies have assessed whether body concentrations of such compounds differed among subjects occupationally exposed and unexposed. No studies which found that exposure to such metals increased the risk of EPC assessed whether past occupations were the source of exposure. OBJECTIVE The aim was to analyse the relationship between toenail concentrations of trace elements and occupational history in EPC patients. METHODS The study included 114 EPC cases personally interviewed on occupational history and lifestyle factors. Occupations were coded according to the International Standard Classification of Occupations 1988. Selected occupational exposures were assessed by two industrial hygienists and with the Finnish job-exposure matrix (Finjem). Concentrations of 12 trace elements were determined in toenail samples by inductively coupled plasma mass spectrometry. Adjusted geometric means (aGMs) and 95% confidence intervals (95% CI) were calculated. RESULTS Patients occupationally exposed to aromatic hydrocarbon solvents (AHs) had higher concentrations of cadmium, manganese, lead, iron and vanadium. The aGM of cadmium concentrations for cases exposed to any pesticide was 0.056 μg/g [95% CI: 0.029-0.108], and, for unexposed cases, 0.023 μg/g [0.017-0.031]. Patients occupationally exposed to pesticides had higher concentrations of cadmium and manganese. Higher concentrations of vanadium, lead and arsenic were related to exposure to formaldehyde. Vanadium and lead were also associated with exposure to chlorinated hydrocarbon solvents, and arsenic was related to exposure to polycyclic aromatic hydrocarbons (PAHs). CONCLUSIONS Patients occupationally exposed to AHs, pesticides, chlorinated hydrocarbon solvents, formaldehyde, volatile sulphur compounds and PAHs had higher concentrations of several metals. These elements may account for some of the occupational risks previously reported for pancreatic cancer.
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Affiliation(s)
- Judit Camargo
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - José A Pumarega
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Alguacil
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Universidad de Huelva, Huelva, Spain
| | | | - Magda Gasull
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - George L Delclos
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain; The University of Texas School of Public Health, Houston, TX, USA
| | - André F S Amaral
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Miquel Porta
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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19
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Jeong A, Imboden M, Ghantous A, Novoloaca A, Carsin AE, Kogevinas M, Schindler C, Lovison G, Herceg Z, Cuenin C, Vermeulen R, Jarvis D, Amaral AFS, Kronenberg F, Vineis P, Probst-Hensch N. DNA Methylation in Inflammatory Pathways Modifies the Association between BMI and Adult-Onset Non-Atopic Asthma. Int J Environ Res Public Health 2019; 16:E600. [PMID: 30791383 PMCID: PMC6406386 DOI: 10.3390/ijerph16040600] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 12/15/2022]
Abstract
A high body mass (BMI) index has repeatedly been associated with non-atopic asthma, but the biological mechanism linking obesity to asthma is still poorly understood. We aimed to test the hypothesis that inflammation and/or innate immunity plays a role in the obesity-asthma link. DNA methylome was measured in blood samples of 61 non-atopic participants with asthma and 146 non-atopic participants without asthma (non-smokers for at least 10 years) taking part in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) study. Modification by DNA methylation of the association of BMI or BMI change over 10 years with adult-onset asthma was examined at each CpG site and differentially methylated region. Pathway enrichment tests were conducted for genes in a priori curated inflammatory pathways and the NLRP3-IL1B-IL17 axis. The latter was chosen on the basis of previous work in mice. Inflammatory pathways including glucocorticoid/PPAR signaling (p = 0.0023), MAPK signaling (p = 0.013), NF-κB signaling (p = 0.031), and PI3K/AKT signaling (p = 0.031) were enriched for the effect modification of BMI, while NLRP3-IL1B-IL17 axis was enriched for the effect modification of BMI change over 10 years (p = 0.046). DNA methylation measured in peripheral blood is consistent with inflammation as a link between BMI and adult-onset asthma and with the NLRP3-IL1B-IL17 axis as a link between BMI change over 10 years and adult-onset asthma in non-atopic participants.
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Affiliation(s)
- Ayoung Jeong
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.
- Department of Public Health, University of Basel, 4001 Basel, Switzerland.
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.
- Department of Public Health, University of Basel, 4001 Basel, Switzerland.
| | - Akram Ghantous
- International Agency for Research on Cancer, 69372 Lyon, France.
| | - Alexei Novoloaca
- International Agency for Research on Cancer, 69372 Lyon, France.
| | - Anne-Elie Carsin
- ISGlobal, Barcelona Institute for Global Health, 08003 Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 08005 Barcelona, Spain.
| | - Manolis Kogevinas
- ISGlobal, Barcelona Institute for Global Health, 08003 Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 08005 Barcelona, Spain.
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.
- Department of Public Health, University of Basel, 4001 Basel, Switzerland.
| | - Gianfranco Lovison
- Department of Economics, Business and Statistics, University of Palermo, 90128 Palermo, Italy.
| | - Zdenko Herceg
- International Agency for Research on Cancer, 69372 Lyon, France.
| | - Cyrille Cuenin
- International Agency for Research on Cancer, 69372 Lyon, France.
| | - Roel Vermeulen
- Environmental Epidemiology Division, Utrecht University, Institute for Risk Assessment Sciences, 3584CM Utrecht, The Netherlands.
| | - Deborah Jarvis
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College, London SW3 6LR, UK.
| | - André F S Amaral
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College, London SW3 6LR, UK.
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London W2 1PG, UK.
- Italian Institute for Genomic Medicine (IIGM), 10126 Turin, Italy.
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.
- Department of Public Health, University of Basel, 4001 Basel, Switzerland.
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20
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Amaral AFS. Highlights from the European Respiratory Society 2018 Annual Congress: environment and epidemiology (assembly 6). J Thorac Dis 2018; 10:S2998-S3000. [PMID: 30310688 DOI: 10.21037/jtd.2018.08.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- André F S Amaral
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
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21
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Amaral AFS, Patel J, Kato BS, Obaseki DO, Lawin H, Tan WC, Juvekar SK, Harrabi I, Studnicka M, Wouters EFM, Loh LC, Bateman ED, Mortimer K, Buist AS, Burney PGJ. Airflow Obstruction and Use of Solid Fuels for Cooking or Heating: BOLD Results. Am J Respir Crit Care Med 2018; 197:595-610. [PMID: 28895752 PMCID: PMC6005234 DOI: 10.1164/rccm.201701-0205oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Evidence supporting the association of COPD or airflow obstruction with use of solid fuels is conflicting and inconsistent. OBJECTIVE To assess the association of airflow obstruction with self-reported use of solid fuels for cooking or heating. METHODS We analysed 18,554 adults from the BOLD study, who had provided acceptable post-bronchodilator spirometry measurements and information on use of solid fuels. The association of airflow obstruction with use of solid fuels for cooking or heating was assessed by sex, within each site, using regression analysis. Estimates were stratified by national income and meta-analysed. We carried out similar analyses for spirometric restriction, chronic cough and chronic phlegm. MEASUREMENTS AND MAIN RESULTS We found no association between airflow obstruction and use of solid fuels for cooking or heating (ORmen=1.20, 95%CI 0.94-1.53; ORwomen=0.88, 95%CI 0.67-1.15). This was true for low/middle and high income sites. Among never smokers there was also no evidence of an association of airflow obstruction with use of solid fuels (ORmen=1.00, 95%CI 0.57-1.76; ORwomen=1.00, 95%CI 0.76-1.32). Overall, we found no association of spirometric restriction, chronic cough or chronic phlegm with the use of solid fuels. However, we found that chronic phlegm was more likely to be reported among female never smokers and those who had been exposed for ≥20 years. CONCLUSION Airflow obstruction assessed from post-bronchodilator spirometry was not associated with use of solid fuels for cooking or heating.
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Affiliation(s)
- André F S Amaral
- Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland ;
| | - Jaymini Patel
- Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland ;
| | - Bernet S Kato
- Imperial College London, 4615, London, London, United Kingdom of Great Britain and Northern Ireland ;
| | | | - Hervé Lawin
- Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, University of Abomey - Calavi , Cotonou, Benin, Cotonou, Benin ;
| | - Wan C Tan
- Univ British Columbia, icapture center, Vancouver, British Columbia, Canada ;
| | - Sanjay K Juvekar
- Vadu Health and Demographic Surveillance System and Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India ;
| | - Imed Harrabi
- Faculty of Medicine, Sousse, Tunisia, Sousse, Tunisia ;
| | | | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands ;
| | - Li-Cher Loh
- Penang Medical College, 26696, Georgetown, Pulau Pinang, Malaysia ;
| | | | - Kevin Mortimer
- Liverpool School of Tropical Medicine, 9655, Liverpool, United Kingdom of Great Britain and Northern Ireland ;
| | - A Sonia Buist
- Oregon Health Sciences University, Medicine / Pulmonary & Critical Care, Portland, Oregon, United States ;
| | - Peter G J Burney
- Imperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland ;
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22
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Gagnat AA, Amaral AFS. Highlights from the European Respiratory Society 2017 annual congress: epidemiology and environment (assembly 6). J Thorac Dis 2017; 9:S1554-S1556. [PMID: 29255640 DOI: 10.21037/jtd.2017.11.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ane Aamli Gagnat
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - André F S Amaral
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
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23
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Amaral AFS, Strachan DP, Burney PGJ, Jarvis DL. Female Smokers Are at Greater Risk of Airflow Obstruction Than Male Smokers. UK Biobank. Am J Respir Crit Care Med 2017; 195:1226-1235. [PMID: 28075609 DOI: 10.1164/rccm.201608-1545oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE The prevalence of chronic obstructive pulmonary disease (COPD) is increasing faster among women than among men. OBJECTIVES To examine sex differences in the risk of airflow obstruction (a COPD hallmark) in relation to smoking history. METHODS We analyzed 149,075 women and 100,252 men taking part in the UK Biobank who had provided spirometry measurements and information on smoking. The association of airflow obstruction with smoking characteristics was assessed by sex using regression analysis. The shape of this relationship was examined using restricted cubic splines. MEASUREMENTS AND MAIN RESULTS The association of airflow obstruction with smoking status was stronger in women (odds ratio for ex-smokers [ORex], 1.44; ORcurrent, 3.45) than in men (ORex, 1.25; ORcurrent, 3.06) (P for interaction = 5.6 × 10-4). In both sexes, the association of airflow obstruction with cigarettes per day, smoking duration, and pack-years did not follow a linear pattern, with the increase in risk at lower doses being steeper among women. For equal doses of exposure, sex differences were present in both ex-smokers and current smokers for cigarettes per day (P for interactionex = 6.0 × 10-8; P for interactioncurrent = 1.1 × 10-5), smoking duration (P for interactionex = 7.9 × 10-4; P for interactioncurrent = 0.004), and pack-years (P for interactionex = 6.6 × 10-18; P for interactioncurrent = 1.3 × 10-6). Overall, those who started smoking before age 18 years were more likely to have airflow obstruction, but a sex difference in this association was not clear. For equal time since quitting, the reduction in risk among women seemed less marked than among men. CONCLUSIONS Exposed to the same dose of smoking, women showed a higher risk of airflow obstruction than men. This could partly explain the increasingly smaller sex difference in the prevalence of COPD, especially in countries where smoking patterns have become similar between women and men.
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Affiliation(s)
- André F S Amaral
- 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,2 Medical Research Council and Public Health England Centre for Environment and Health, London, United Kingdom; and
| | - David P Strachan
- 3 Population Health Research Institute, St. George's University of London, London, United Kingdom
| | - Peter G J Burney
- 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,2 Medical Research Council and Public Health England Centre for Environment and Health, London, United Kingdom; and
| | - Deborah L Jarvis
- 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,2 Medical Research Council and Public Health England Centre for Environment and Health, London, United Kingdom; and
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24
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Amaral AFS, Coton S, Kato B, Tan WC, Studnicka M, Janson C, Gislason T, Mannino D, Bateman ED, Buist S, Burney PGJ. Lung function defects in treated pulmonary tuberculosis patients. Eur Respir J 2017; 47:352-3. [PMID: 26721972 DOI: 10.1183/13993003.01366-2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- André F S Amaral
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Sonia Coton
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Bernet Kato
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Wan C Tan
- University of British Columbia Heart Lung Innovation Center, Vancouver, BC, Canada
| | - Michael Studnicka
- Dept of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Christer Janson
- Dept of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland and Landspitali University Hospital, Reykjavik, Iceland
| | - David Mannino
- Division of Pulmonary Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, USA
| | - Eric D Bateman
- Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sonia Buist
- Oregon Health and Sciences University, Portland, OR, USA
| | - Peter G J Burney
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
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Machin M, Amaral AFS, Wielscher M, Rezwan FI, Imboden M, Jarvelin MR, Adcock IM, Probst-Hensch N, Holloway JW, Jarvis DL. Systematic review of lung function and COPD with peripheral blood DNA methylation in population based studies. BMC Pulm Med 2017; 17:54. [PMID: 28320365 PMCID: PMC5360084 DOI: 10.1186/s12890-017-0397-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/16/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Epigenetic variations in peripheral blood have potential as biomarkers for disease. This systematic review assesses the association of lung function and chronic obstructive pulmonary disease (COPD) with DNA methylation profiles in peripheral blood from population-based studies. METHODS Online databases Medline, Embase, and Web of Science were searched. Google Scholar was searched to identify grey literature. After removing duplicate articles, 1155 articles were independently screened by two investigators. Peer reviewed reports on population-based studies that examined peripheral blood DNA methylation in participants with measured lung function (FEV1, FEV1/FVC ratio) or known COPD status were selected for full-text review. Six articles were suitable for inclusion. Information regarding study characteristics, designs, methodologies and conclusions was extracted. A narrative synthesis was performed based on published results. RESULTS Three of the six articles assessed the association of COPD with DNA methylation, and two of these also included associations with lung function. Overall, five reports examined the association of lung function with DNA methylation profiles. Five of the six articles reported 'significant' results. However, no consistent CpG sites were identified across studies for COPD status or lung function values. CONCLUSIONS DNA methylation patterns in peripheral blood from individuals with reduced lung function or COPD may be different to those in people with normal lung function. However, this systematic review did not find any consistent associations of lung function or COPD with differentially methylated CpG sites. Large studies with a longitudinal design to address reverse causality may prove a more fruitful area of research. TRIAL REGISTRATION PROSPERO 2016: CRD42016037352 .
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Affiliation(s)
| | - André F S Amaral
- Population Health and Occupational Disease, NHLI, Imperial College London, London, UK.
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.
| | - Matthias Wielscher
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Faisal I Rezwan
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Marjo-Riitta Jarvelin
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Ian M Adcock
- Airways Disease Section, NHLI, Imperial College London, London, UK
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Deborah L Jarvis
- Population Health and Occupational Disease, NHLI, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
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Amaral AFS, Garcia Larsen V, De Matteis S, Minelli C. Understanding the Influence of Genes, Diet, and Occupation on Respiratory Health. Am J Respir Crit Care Med 2016. [DOI: 10.1164/rccm.201604-0729rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- André F. S. Amaral
- Population Health and Occupational Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Vanessa Garcia Larsen
- Population Health and Occupational Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sara De Matteis
- Population Health and Occupational Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Cosetta Minelli
- Population Health and Occupational Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Minelli C, Dean CH, Hind M, Alves AC, Amaral AFS, Siroux V, Huikari V, Soler Artigas M, Evans DM, Loth DW, Bossé Y, Postma DS, Sin D, Thompson J, Demenais F, Henderson J, Bouzigon E, Jarvis D, Järvelin MR, Burney P. Association of Forced Vital Capacity with the Developmental Gene NCOR2. PLoS One 2016; 11:e0147388. [PMID: 26836265 PMCID: PMC4737618 DOI: 10.1371/journal.pone.0147388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/04/2016] [Indexed: 12/31/2022] Open
Abstract
Background Forced Vital Capacity (FVC) is an important predictor of all-cause mortality in the absence of chronic respiratory conditions. Epidemiological evidence highlights the role of early life factors on adult FVC, pointing to environmental exposures and genes affecting lung development as risk factors for low FVC later in life. Although highly heritable, a small number of genes have been found associated with FVC, and we aimed at identifying further genetic variants by focusing on lung development genes. Methods Per-allele effects of 24,728 SNPs in 403 genes involved in lung development were tested in 7,749 adults from three studies (NFBC1966, ECRHS, EGEA). The most significant SNP for the top 25 genes was followed-up in 46,103 adults (CHARGE and SpiroMeta consortia) and 5,062 children (ALSPAC). Associations were considered replicated if the replication p-value survived Bonferroni correction (p<0.002; 0.05/25), with a nominal p-value considered as suggestive evidence. For SNPs with evidence of replication, effects on the expression levels of nearby genes in lung tissue were tested in 1,111 lung samples (Lung eQTL consortium), with further functional investigation performed using public epigenomic profiling data (ENCODE). Results NCOR2-rs12708369 showed strong replication in children (p = 0.0002), with replication unavailable in adults due to low imputation quality. This intronic variant is in a strong transcriptional enhancer element in lung fibroblasts, but its eQTL effects could not be tested due to low imputation quality in the eQTL dataset. SERPINE2-rs6754561 replicated at nominal level in both adults (p = 0.036) and children (p = 0.045), while WNT16-rs2707469 replicated at nominal level only in adults (p = 0.026). The eQTL analyses showed association of WNT16-rs2707469 with expression levels of the nearby gene CPED1. We found no statistically significant eQTL effects for SERPINE2-rs6754561. Conclusions We have identified a new gene, NCOR2, in the retinoic acid signalling pathway pointing to a role of vitamin A metabolism in the regulation of FVC. Our findings also support SERPINE2, a COPD gene with weak previous evidence of association with FVC, and suggest WNT16 as a further promising candidate.
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Affiliation(s)
- Cosetta Minelli
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
- * E-mail:
| | - Charlotte H. Dean
- Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Mammalian Genetics Unit, MRC Harwell, Oxon, United Kingdom
| | - Matthew Hind
- Respiratory Department, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Alexessander Couto Alves
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - André F. S. Amaral
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
- MRC-PHE Centre for Environment & Health, London, United Kingdom
| | - Valerie Siroux
- Univ. Grenoble Alpes, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, F-38000, Grenoble, France
- INSERM, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, F-38000, Grenoble, France
- CHU de Grenoble, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, F-38000, Grenoble, France
| | | | - María Soler Artigas
- Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - David M. Evans
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Daan W. Loth
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yohan Bossé
- Institut universitaire de cardiologie et de pneumologie de Québec, Department of Molecular Medicine, Laval University, Québec, Canada
| | - Dirkje S. Postma
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Don Sin
- The University of British Columbia Center for Heart Lung Innovation, St-Paul’s Hospital, Vancouver, Canada
| | - John Thompson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Florence Demenais
- INSERM, UMRS-946, Genetic Variation of Human Diseases Unit, Paris, France
- Univ. Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d’Hématologie, F-75007, Paris, France
| | - John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - SpiroMeta consortium
- SpiroMeta consortium, Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - CHARGE consortium
- CHARGE consortium, Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, United States of America
| | - Emmanuelle Bouzigon
- INSERM, UMRS-946, Genetic Variation of Human Diseases Unit, Paris, France
- Univ. Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d’Hématologie, F-75007, Paris, France
| | - Deborah Jarvis
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
- MRC-PHE Centre for Environment & Health, London, United Kingdom
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- MRC-PHE Centre for Environment & Health, London, United Kingdom
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Center for Life Course Epidemiology, Faculty of Medicine, P.O. Box 5000, FI-90014 University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Kajaanintie 50, P.O. Box 20, FI-90220, Oulu, 90029 OYS, Finland
| | - Peter Burney
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
- MRC-PHE Centre for Environment & Health, London, United Kingdom
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Amaral AFS, Newson RB, Abramson MJ, Antó JM, Bono R, Corsico AG, de Marco R, Demoly P, Forsberg B, Gislason T, Heinrich J, Huerta I, Janson C, Jõgi R, Kim JL, Maldonado J, Martinez-Moratalla Rovira J, Neukirch C, Nowak D, Pin I, Probst-Hensch N, Raherison-Semjen C, Svanes C, Urrutia Landa I, van Ree R, Versteeg SA, Weyler J, Zock JP, Burney PGJ, Jarvis DL. Changes in IgE sensitization and total IgE levels over 20 years of follow-up. J Allergy Clin Immunol 2015; 137:1788-1795.e9. [PMID: 26586040 PMCID: PMC4889785 DOI: 10.1016/j.jaci.2015.09.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/21/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022]
Abstract
Background Cross-sectional studies have reported a lower prevalence of sensitization in older adults, but few longitudinal studies have examined whether this is an aging or a year-of-birth cohort effect. Objective We sought to assess changes in sensitization and total IgE levels in a cohort of European adults as they aged over a 20-year period. Methods Levels of serum specific IgE to common aeroallergens (house dust mite, cat, and grass) and total IgE levels were measured in 3206 adults from 25 centers in the European Community Respiratory Health Survey on 3 occasions over 20 years. Changes in sensitization and total IgE levels were analyzed by using regression analysis corrected for potential differences in laboratory equipment and by using inverse sampling probability weights to account for nonresponse. Results Over the 20-year follow-up, the prevalence of sensitization to at least 1 of the 3 allergens decreased from 29.4% to 24.8% (−4.6%; 95% CI, −7.0% to −2.1%). The prevalence of sensitization to house dust mite (−4.3%; 95% CI, −6.0% to −2.6%) and cat (−2.1%; 95% CI, −3.6% to −0.7%) decreased more than sensitization to grass (−0.6%; 95% CI, −2.5% to 1.3%). Age-specific prevalence of sensitization to house dust mite and cat did not differ between year-of-birth cohorts, but sensitization to grass was most prevalent in the most recent ones. Overall, total IgE levels decreased significantly (geometric mean ratio, 0.63; 95% CI, 0.58-0.68) at all ages in all year-of-birth cohorts. Conclusion Aging was associated with lower levels of sensitization, especially to house dust mite and cat, after the age of 20 years.
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Affiliation(s)
- André F S Amaral
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, United Kingdom.
| | - Roger B Newson
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, United Kingdom; Department of Primary Care and Public Health, School of Public Health, Imperial College, London, United Kingdom
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Josep M Antó
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Angelo G Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation-University of Pavia, Pavia, Italy
| | - Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Arnaud de Villeneuve Hospital, CHU Montpellier, and EPAR Team-UMR-S 1136 INSERM, Paris, France
| | - Bertil Forsberg
- Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum, Munich, Germany; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital Munich, Ludwig-Maximilians-Universität of Munich, Munich, Germany
| | - Ismael Huerta
- Epidemiological Surveillance Section, Directorate General of Public Health, Department of Health of Asturias, Oviedo, Spain
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jõgi
- Tartu University Hospital, Lung Clinic, Tartu, Estonia
| | - Jeong-Lim Kim
- Department of Publich Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - José Maldonado
- Unit of Clinical Management of Pneumology and Allergy, University Hospital of Huelva, Huelva, Spain
| | | | - Catherine Neukirch
- INSERM UMR1152, Paris, France; Université Paris Diderot Paris 7, UMR1152, Paris, France
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital Munich, Ludwig-Maximilians-Universität of Munich, and the German Center for Lung Research, Munich, Germany
| | - Isabelle Pin
- Pédiatrie, Pole Couple Enfants, CHU de Grenoble, Grenoble, France; INSERM U823, Institut Albert Bonniot, Grenoble, France; Université Joseph Fourier, Grenoble, France
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | | | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Ronald van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Serge A Versteeg
- Department of Experimental Immunology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Weyler
- Epidemiology and Social Medicine and the StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Peter G J Burney
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Deborah L Jarvis
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
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Salas LA, Villanueva CM, Tajuddin SM, Amaral AFS, Fernandez AF, Moore LE, Carrato A, Tardón A, Serra C, García-Closas R, Basagaña X, Rothman N, Silverman DT, Cantor KP, Kogevinas M, Real FX, Fraga MF, Malats N. LINE-1 methylation in granulocyte DNA and trihalomethane exposure is associated with bladder cancer risk. Epigenetics 2015; 9:1532-9. [PMID: 25482586 PMCID: PMC4622716 DOI: 10.4161/15592294.2014.983377] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
DNA methylation changes contribute to bladder carcinogenesis. Trihalomethanes (THM), a class of disinfection by-products, are associated with increased urothelial bladder cancer (UBC) risk. THM exposure in animal models produces DNA hypomethylation. We evaluated the relationship of LINE-1 5-methylcytosine levels (LINE-1%5mC) as outcome of long-term THM exposure among controls and as an effect modifier in the association between THM exposure and UBC risk. We used a case-control study of UBC conducted in Spain. We obtained personal lifetime residential THM levels and measured LINE-1%5mC by pyrosequencing in granulocyte DNA from blood samples in 548 incident cases and 559 hospital controls. Two LINE-1%5mC clusters (above and below 64%) were identified through unsupervised hierarchical cluster analysis. The association between THM levels and LINE-1%5mC was evaluated with β regression analyses and logistic regression was used to estimate odds ratios (OR) adjusting for covariables. LINE-1%5mC change between percentiles 75(th) and 25(th) of THM levels was 1.8% (95% confidence interval (CI): 0.1, 3.4%) among controls. THM levels above vs. below the median (26 μg/L) were associated with increased UBC risk, OR = 1.86 (95% CI: 1.25, 2.75), overall and among subjects with low levels of LINE-1%5mC (n = 975), OR = 2.14 (95% CI: 1.39, 3.30), but not associated with UBC risk among subjects' high levels of LINE-1%5mC (n = 162), interaction P = 0.03. Results suggest a positive association between LINE-1%5mC and THM levels among controls, and LINE-1%5mC status may modify the association between UBC risk and THM exposure. Because reverse causation and chance cannot be ruled out, confirmation studies are warranted.
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Key Words
- %5mC
- 95%, confidence intervals
- DBP, Disinfection by-products
- DNA methylation
- LINE-1
- LINE-1, Long Interspersed Element 1
- OR, Odds ratio
- Percentage of 5-methylcytosine, 95%, CI
- SBC/EPICURO, Spanish Bladder Cancer/EPICURO Study
- THM, Trihalomethanes
- UBC, Urothelial bladder cancer
- epigenetic repression
- long interspersed nucleotide elements
- trihalomethanes
- urinary bladder cancer
- y, years
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Affiliation(s)
- Lucas A Salas
- a Centre for Research in Environmental Epidemiology (CREAL) ; Barcelona , Spain
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Amaral AFS, Coton S, Kato B, Tan WC, Studnicka M, Janson C, Gislason T, Mannino D, Bateman ED, Buist S, Burney PGJ. Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. Eur Respir J 2015; 46:1104-12. [PMID: 26113680 DOI: 10.1183/13993003.02325-2014] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 05/01/2015] [Indexed: 11/05/2022]
Abstract
In small studies and cases series, a history of tuberculosis has been associated with both airflow obstruction, which is characteristic of chronic obstructive pulmonary disease, and restrictive patterns on spirometry. The objective of the present study was to assess the association between a history of tuberculosis and airflow obstruction and spirometric abnormalities in adults.The study was performed in adults, aged 40 years and above, who took part in the multicentre, cross-sectional, general population-based Burden of Obstructive Lung Disease study, and had provided acceptable post-bronchodilator spirometry measurements and information on a history of tuberculosis. The associations between a history of tuberculosis and airflow obstruction and spirometric restriction were assessed within each participating centre, and estimates combined using meta-analysis. These estimates were stratified by high- and low/middle-income countries, according to gross national income.A self-reported history of tuberculosis was associated with airflow obstruction (adjusted odds ratio 2.51, 95% CI 1.83-3.42) and spirometric restriction (adjusted odds ratio 2.13, 95% CI 1.42-3.19).A history of tuberculosis was associated with both airflow obstruction and spirometric restriction, and should be considered as a potentially important cause of obstructive disease and low lung function, particularly where tuberculosis is common.
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Affiliation(s)
- André F S Amaral
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Sonia Coton
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Bernet Kato
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Wan C Tan
- University of British Columbia Heart Lung Innovation Center, Vancouver, BC, Canada
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland and Landspitali University Hospital, Reykjavik, Iceland
| | - David Mannino
- Division of Pulmonary Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, USA
| | - Eric D Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sonia Buist
- Oregon Health & Sciences University, Portland, OR, USA
| | - Peter G J Burney
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK For a list of the BOLD collaborators see the Acknowledgements
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Amaral AFS, Ramasamy A, Castro-Giner F, Minelli C, Accordini S, Sørheim IC, Pin I, Kogevinas M, Jõgi R, Balding DJ, Norbäck D, Verlato G, Olivieri M, Probst-Hensch N, Janson C, Zock JP, Heinrich J, Jarvis DL. Interaction between gas cooking and GSTM1 null genotype in bronchial responsiveness: results from the European Community Respiratory Health Survey. Thorax 2014; 69:558-64. [PMID: 24613990 PMCID: PMC4033138 DOI: 10.1136/thoraxjnl-2013-204574] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Increased bronchial responsiveness is characteristic of asthma. Gas cooking, which is a major indoor source of the highly oxidant nitrogen dioxide, has been associated with respiratory symptoms and reduced lung function. However, little is known about the effect of gas cooking on bronchial responsiveness and on how this relationship may be modified by variants in the genes GSTM1, GSTT1 and GSTP1, which influence antioxidant defences. Methods The study was performed in subjects with forced expiratory volume in one second at least 70% of predicted who took part in the multicentre European Community Respiratory Health Survey, had bronchial responsiveness assessed by methacholine challenge and had been genotyped for GSTM1, GSTT1 and GSTP1-rs1695. Information on the use of gas for cooking was obtained from interviewer-led questionnaires. Effect modification by genotype on the association between the use of gas for cooking and bronchial responsiveness was assessed within each participating country, and estimates combined using meta-analysis. Results Overall, gas cooking, as compared with cooking with electricity, was not associated with bronchial responsiveness (β=−0.08, 95% CI −0.40 to 0.25, p=0.648). However, GSTM1 significantly modified this effect (β for interaction=−0.75, 95% CI −1.16 to −0.33, p=4×10−4), with GSTM1 null subjects showing more responsiveness if they cooked with gas. No effect modification by GSTT1 or GSTP1-rs1695 genotypes was observed. Conclusions Increased bronchial responsiveness was associated with gas cooking among subjects with the GSTM1 null genotype. This may reflect the oxidant effects on the bronchi of exposure to nitrogen dioxide.
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Affiliation(s)
- André F S Amaral
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
- MRC-PHE Centre for Environment & Health, London, UK
| | - Adaikalavan Ramasamy
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Francesc Castro-Giner
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Cosetta Minelli
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | | | - Isabelle Pin
- Pédiatrie, CHU de Grenoble, Institut Albert Bonniot, INSERM, Grenoble, France
- Université Joseph Fourier, Grenoble, France
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Rain Jõgi
- Tartu University Hospital, Lung Clinic, Tartu, Estonia
| | - David J Balding
- UCL Genetics Institute, University College London, London, UK
| | - Dan Norbäck
- Department of Medical Science, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Giuseppe Verlato
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Mario Olivieri
- Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Joachim Heinrich
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
| | - Deborah L Jarvis
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
- MRC-PHE Centre for Environment & Health, London, UK
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32
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Affiliation(s)
- André F. S. Amaral
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, London, UK
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Tajuddin SM, Amaral AFS, Fernández AF, Rodríguez-Rodero S, Rodríguez RM, Moore LE, Tardón A, Carrato A, García-Closas M, Silverman DT, Jackson BP, García-Closas R, Cook AL, Cantor KP, Chanock S, Kogevinas M, Rothman N, Real FX, Fraga MF, Malats N. Genetic and non-genetic predictors of LINE-1 methylation in leukocyte DNA. Environ Health Perspect 2013; 121:650-6. [PMID: 23552396 PMCID: PMC3672919 DOI: 10.1289/ehp.1206068] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 04/01/2013] [Indexed: 05/21/2023]
Abstract
BACKGROUND Altered DNA methylation has been associated with various diseases. OBJECTIVE We evaluated the association between levels of methylation in leukocyte DNA at long interspersed nuclear element 1 (LINE-1) and genetic and non-genetic characteristics of 892 control participants from the Spanish Bladder Cancer/EPICURO study. METHODS We determined LINE-1 methylation levels by pyrosequencing. Individual data included demographics, smoking status, nutrient intake, toenail concentrations of 12 trace elements, xenobiotic metabolism gene variants, and 515 polymorphisms among 24 genes in the one-carbon metabolism pathway. To assess the association between LINE-1 methylation levels (percentage of methylated cytosines) and potential determinants, we estimated beta coefficients (βs) by robust linear regression. RESULTS Women had lower levels of LINE-1 methylation than men (β = -0.7, p = 0.02). Persons who smoked blond tobacco showed lower methylation than nonsmokers (β = -0.7, p = 0.03). Arsenic toenail concentration was inversely associated with LINE-1 methylation (β = -3.6, p = 0.003). By contrast, iron (β = 0.002, p = 0.009) and nickel (β = 0.02, p = 0.004) were positively associated with LINE-1 methylation. Single nucleotide polymorphisms (SNPs) in DNMT3A (rs7581217-per allele, β = 0.3, p = 0.002), TCN2 (rs9606756-GG, β = 1.9, p = 0.008; rs4820887-AA, β = 4.0, p = 4.8 × 10-7; rs9621049-TT, β = 4.2, p = 4.7 × 10-9), AS3MT (rs7085104-GG, β = 0.7, p = 0.001), SLC19A1 (rs914238, TC vs. TT: β = 0.5 and CC vs. TT: β = -0.3, global p = 0.0007) and MTHFS (rs1380642, CT vs. CC: β = 0.3 and TT vs. CC; β = -0.8, global p = 0.05) were associated with LINE-1 methylation. CONCLUSIONS We identified several characteristics, environmental factors, and common genetic variants that predicted DNA methylation among study participants.
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Affiliation(s)
- Salman M Tajuddin
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre, CNIO, Madrid, Spain
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Amaral AFS, Porta M, Silverman DT, Milne RL, Kogevinas M, Rothman N, Cantor KP, Jackson BP, Pumarega JA, López T, Carrato A, Guarner L, Real FX, Malats N. Pancreatic cancer risk and levels of trace elements. Gut 2012; 61:1583-8. [PMID: 22184070 PMCID: PMC3310963 DOI: 10.1136/gutjnl-2011-301086] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Knowledge on the aetiology of exocrine pancreatic cancer (EPC) is scant. The best established risk factor for EPC is tobacco smoking. Among other carcinogens, tobacco contains cadmium, a metal previously associated with an increased risk of EPC. This study evaluated the association between concentrations of trace elements in toenails and EPC risk. METHODS The study included 118 EPC cases and 399 hospital controls from eastern Spain. Levels of 12 trace elements were determined in toenail samples by inductively coupled plasma mass spectrometry. OR and 95% CI, adjusted for potential confounders, were calculated using logistic regression. RESULTS Significantly increased risks of EPC were observed among subjects whose concentrations of cadmium (OR 3.58, 95% CI 1.86 to 6.88; p(trend)=5×10(-6)), arsenic (OR 2.02, 95% CI 1.08 to 3.78; p(trend)=0.009) and lead (OR 6.26, 95% CI 2.71 to 14.47; p(trend)=3×10(-5)) were in the highest quartile. High concentrations of selenium (OR 0.05, 95% CI 0.02 to 0.15; p(trend)=8×10(-11)) and nickel (OR 0.27, 95% CI 0.12 to 0.59; p(trend)=2×10(-4)) were inversely associated with the risk of EPC. CONCLUSION Novel associations are reported of lead, nickel and selenium toenail concentrations with pancreas cancer risk. Furthermore, the results confirm previous associations with cadmium and arsenic. These novel findings, if replicated in independent studies, would point to an important role of trace elements in pancreatic carcinogenesis.
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Affiliation(s)
- André F. S. Amaral
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Miquel Porta
- Institut Municipal d'Investigació Mèdica (IMIM), Universitat Autònoma de Barcelona, and CIBERESP, Spain
| | - Debra T. Silverman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Roger L. Milne
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Brian P. Jackson
- Trace Element Analysis Core, Department of Earth Sciences, Dartmouth College, Hanover, NH, USA
| | - José A. Pumarega
- Institut Municipal d'Investigació Mèdica (IMIM), Universitat Autònoma de Barcelona, and CIBERESP, Spain
| | - Tomàs López
- Institut Municipal d'Investigació Mèdica (IMIM), Universitat Autònoma de Barcelona, and CIBERESP, Spain
| | - Alfredo Carrato
- Hospital Ramón y Cajal, Madrid, and Hospital General de Elche, Spain
| | | | - Francisco X. Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain, and Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
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Amaral AFS, Méndez-Pertuz M, Muñoz A, Silverman DT, Allory Y, Kogevinas M, Lloreta J, Rothman N, Carrato A, Rivas del Fresno M, Real FX, Malats N. Plasma 25-hydroxyvitamin D(3) and bladder cancer risk according to tumor stage and FGFR3 status: a mechanism-based epidemiological study. J Natl Cancer Inst 2012; 104:1897-904. [PMID: 23108201 DOI: 10.1093/jnci/djs444] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous evidence suggests that 25-hydroxyvitamin D(3) [25(OH)D(3)] protects against several cancers. However, little is known regarding urothelial bladder cancer (UBC). We analyzed the association between plasma 25(OH)D(3) and overall risk of UBC, as well as according to stage and FGFR3 molecular subphenotypes. METHODS Plasma concentrations of 25(OH)D(3) in 1125 cases with UBC and 1028 control subjects were determined by a chemiluminescence immunoassay. FGFR3 mutational status and expression in tumor tissue were assessed. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by logistic regression adjusting for potential confounders. Analyses were further stratified by tumor invasiveness and grade, FGFR3 expression, and smoking status. Cell proliferation was measured in human UBC cell lines cultured with 1α,25-dihydroxyvitamin D(3). RESULTS A statistically significantly increased risk of UBC was observed among subjects presenting the lowest concentrations of 25(OH)D(3) (OR(adj) = 1.83; 95% CI = 1.19 to 2.82; P = .006), showing a dose-response effect (P (trend) = .004). The association was stronger for patients with muscle-invasive tumors, especially among low-FGFR3 expressers (OR(adj) = 5.94; 95% CI = 1.72 to 20.45; P = .005). The biological plausibility of these associations is supported by the fact that, in vitro, 1α,25-dihydroxyvitamin D(3) upregulates FGFR3 expression in UBC cell lines with low levels of wild-type FGFR3. CONCLUSION These findings support a role of vitamin D in the pathogenesis of UBC and show that 25(OH)D(3) levels are associated with FGFR3 expression in the tumor. Because FGFR3 mutation and overexpression are markers of better outcome, our findings suggest that individuals with low levels of plasma 25(OH)D(3) may be at high risk of more aggressive forms of UBC.
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Affiliation(s)
- André F S Amaral
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre, Madrid, Spain
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Czachorowski MJ, Amaral AFS, Montes-Moreno S, Lloreta J, Carrato A, Tardón A, Morente MM, Kogevinas M, Real FX, Malats N. Cyclooxygenase-2 expression in bladder cancer and patient prognosis: results from a large clinical cohort and meta-analysis. PLoS One 2012; 7:e45025. [PMID: 23028744 PMCID: PMC3441520 DOI: 10.1371/journal.pone.0045025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 08/11/2012] [Indexed: 12/02/2022] Open
Abstract
Aberrant overexpression of cyclooxygenase-2 (COX2) is observed in urothelial carcinoma of the bladder (UCB). Studies evaluating COX2 as a prognostic marker in UCB report contradictory results. We determined the prognostic potential of COX2 expression in UCB and quantitatively summarize the results with those of the literature through a meta-analysis. Newly diagnosed UCB patients recruited between 1998–2001 in 18 Spanish hospitals were prospectively included in the study and followed-up (median, 70.7 months). Diagnostic slides were reviewed and uniformly classified by expert pathologists. Clinical data was retrieved from hospital charts. Tissue microarrays containing non-muscle invasive (n = 557) and muscle invasive (n = 216) tumours were analyzed by immunohistochemistry using quantitative image analysis. Expression was evaluated in Cox regression models to assess the risk of recurrence, progression and disease-specific mortality. Meta-hazard ratios were estimated using our results and those from 11 additional evaluable studies. COX2 expression was observed in 38% (211/557) of non-muscle invasive and 63% (137/216) of muscle invasive tumors. Expression was associated with advanced pathological stage and grade (p<0.0001). In the univariable analyses, COX2 expression - as a categorical variable - was not associated with any of the outcomes analyzed. As a continuous variable, a weak association with recurrence in non-muscle invasive tumors was observed (p-value = 0.048). In the multivariable analyses, COX2 expression did not independently predict any of the considered outcomes. The meta-analysis confirmed these results. We did not find evidence that COX2 expression is an independent prognostic marker of recurrence, progression or survival in patients with UCB.
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Affiliation(s)
- Maciej J. Czachorowski
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - André F. S. Amaral
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Santiago Montes-Moreno
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Josep Lloreta
- Institut Municipal d’Investigació Mèdica – Hospital del Mar, Barcelona, Spain
- Departament de Patologia, Hospital del Mar – Parc de Salut Mar, Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Alfredo Carrato
- Hospital General Universitario de Elche, Elche, Spain
- Hospital Ramon y Cajal, Madrid, Spain
| | | | - Manuel M. Morente
- Tumor Bank Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Manolis Kogevinas
- Centre de Recerca en Epidemiologia Ambiental (CREAL), Barcelona, Spain
| | - Francisco X. Real
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- * E-mail:
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Abstract
BACKGROUND Selenium is considered to be an antioxidant, and its high levels have been inversely associated with cancer risk of several sites. This meta-analysis examined the relationship between levels of selenium measured in serum and toenails, and the risk of bladder cancer. METHODS A meta-analysis using data from seven published epidemiologic studies (three case-control, three nested case-control, one case-cohort) published before March 2010 was done to examine the association between levels of selenium and bladder cancer. Fixed and random effects analyses were done to calculate meta-odds ratio (mOR) and 95% confidence intervals (CI). Heterogeneity among studies was measured by the I(2) statistic. RESULTS Overall, the risk of bladder cancer was inversely associated with elevated levels of selenium according to a random-effects model (mOR = 0.61; 95% CI, 0.42-0.87). The mORs were 0.95 (95% CI, 0.69-1.27) and 0.55 (95% CI, 0.32-0.95) among men and women, respectively. Sex, type of sample specimen, smoking status, and study design were found to be potential sources of heterogeneity. CONCLUSIONS A significant protective effect of selenium, observed mainly among women, may result from gender-specific differences in its accumulation and excretion. The heterogeneity found among studies was mainly linked to the different biological sample specimens used to measure the selenium concentrations and the small size of the studies. Although these results suggest a protective effect of selenium for bladder cancer risk, additional large studies are warranted to support these preliminary evidence. IMPACT The present results suggest a beneficial effect of high selenium intake for bladder cancer risk.
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Affiliation(s)
- André F S Amaral
- Spanish National Cancer Research Centre, Genetic and Molecular Epidemiology Group, Madrid, Spain
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Amaral AFS, Cymbron T, Gärtner F, Lima M, Rodrigues AS. Trace metals and over-expression of metallothioneins in bladder tumoral lesions: a case-control study. BMC Vet Res 2009; 5:24. [PMID: 19615096 PMCID: PMC2725354 DOI: 10.1186/1746-6148-5-24] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 07/18/2009] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies have provided some evidence of a possible association between cancer and metallothioneins. Whether this relates to an exposure to carcinogenic metals remains unclear. METHODS In order to examine the association between the expression of metallothioneins and bladder tumors, and to compare the levels of arsenic, cadmium, chromium, lead and nickel in animals with bladder tumors and animals without bladder tumors, 37 cases of bovine bladder tumors and 17 controls were collected. The detection and quantification of metallothioneins in bladder tissue of both cases and controls was performed by immunohistochemistry. And the quantification of metals in tissue and hair was assessed by inductively coupled plasma - mass spectrometry. RESULTS Increased expression of metallothioneins was associated with bladder tumors when compared with non-tumoral bladder tissue (OR = 9.3, 95% CI: 1.0 - 480). The concentrations of cadmium, chromium, lead and nickel in hair of cases were significantly higher than those of controls. However, as for the concentration of metals in bladder tissue, the differences were not significant. CONCLUSION Though the sample size was small, the present study shows an association between bladder tumors and metallothioneins. Moreover, it shows that concentrations of metals such as cadmium, chromium, lead and nickel in hair may be used as a biomarker of exposure.
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Affiliation(s)
- André F S Amaral
- Spanish National Cancer Research Centre (CNIO), Genetic and Molecular Epidemiology Group, Madrid, Spain.
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Resendes AR, Amaral AFS, Rodrigues A, Almeria S. Prevalence of Calodium hepaticum (Syn. Capillaria hepatica) in house mice (Mus musculus) in the Azores archipelago. Vet Parasitol 2008; 160:340-3. [PMID: 19135804 DOI: 10.1016/j.vetpar.2008.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 10/23/2008] [Accepted: 11/03/2008] [Indexed: 01/25/2023]
Abstract
Calodium hepaticum (Syn. Capillaria hepatica) is a zoonotic liver nematode of mammals distributed worldwide. Rodents are believed to be the main reservoirs of this nematode. In this paper, prevalence of the parasite was analyzed in liver histological sections from 51 house mice (Mus musculus) caught in human-inhabited houses, from two localities (Furnas and Rabo de Peixe) on São Miguel island from the Azores archipelago (Portugal). Mean prevalence of infection was 19.6%, with 33.3% prevalence in Furnas and 4.1% in Rabo de Peixe (P=0.07). No significant differences were found between the prevalence of infection and the age, body weight and the sex of mice. Hepatic lesions found were either acute and/or chronic stage and consisted of moderate to severe multifocal pyogranulomatous hepatitis with encapsulated eggs with typical bipolar plugs and moderate to severe necrotizing hepatitis consistent with larva tracks. Periportal inflammatory infiltration, hepatocyte regeneration and bile duct hyperplasia were also noted. In most cases, hepatic lesions occupied more than 50% of the liver, but despite severe lesions, in some mice, no signs of hepatic failure were noticed. The high rate of infection found in the present study suggests that house mice are an important reservoir for this parasite in the Azores and could have a role in human transmission.
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Affiliation(s)
- A R Resendes
- Department of Biology, University of the Azores, Apartado 1422, 9501-855 Ponta Delgada, Portugal.
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Amaral AFS, Arruda M, Cabral S, Rodrigues AS. Essential and non-essential trace metals in scalp hair of men chronically exposed to volcanogenic metals in the Azores, Portugal. Environ Int 2008; 34:1104-8. [PMID: 18485481 DOI: 10.1016/j.envint.2008.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 03/28/2008] [Accepted: 03/31/2008] [Indexed: 05/21/2023]
Abstract
Volcanoes produce and release large amounts of toxicants, and the concentration of metals in hair can be used as a biomarker of exposure to trace metals. In order to investigate whether humans exposed to volcanic emissions demonstrate higher concentrations of essential and non-essential trace metals, scalp hair of men (3-89 years) living in two areas of the Azores, one exposed to volcanic emissions and the other not, was sampled, and their content in Cd, Cu, Pb, Rb, Se, and Zn was quantified by using High Resolution Inductively Coupled Plasma Mass Spectrometry. In average, men exposed to volcanic emissions presented higher concentrations of Cd (96.9 ppb), Cu (16.2 ppm), Pb (3417.6 ppb), Rb (216.3 ppb), and Zn (242.8 ppm), but not Se (469.6 ppb). Also, strong and significant correlations were found between Cd-Rb and Pb-Rb in the exposed men. In conclusion, humans living chronically exposed to volcanic emissions show high concentrations of essential and non-essential trace metals in scalp hair, and is suggested that this type of exposure may be as harmful as living close to industrial facilities.
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Affiliation(s)
- André F S Amaral
- CIRN, Department of Biology, University of the Azores, Ponta Delgada, Portugal.
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