Clinical effects of air pollution on the central nervous system; a review

Short-term association between outdoor air pollution and osteoporotic hip fracture

This study examines the association of the levels of different airborne pollutants on the incidence of osteoporotic hip fracture in a southern European region. Association was detected between SO₂ and NO₂ and hospital admissions due to hip fracture.

INTRODUCTION

To examine the short-term effects of outdoor air pollution on the incidence of osteoporotic hip fracture in a southern European region.

METHODS

This is an ecological retrospective cohort study based on data obtained from three databases. In a time-series analysis, we examined the association between hip fracture incidence and different outdoor air pollutants (sulfur dioxide (SO₂), monoxide (NO), nitrogen dioxide (NO₂), ozone (O₃), and particulate matter in suspension < 2.5 (PM_2.5) and < 10-μm (PM₁₀) conditions by using general additive models (Poisson distribution). The incidence rate ratio (IRR), crude and adjusted by season and different weather conditions, was estimated for all parameters. Hip incidence was later analyzed by sex and age (under or over age 75) subgroups. The main outcome measure was daily hospital admissions due to fracture.

RESULTS

Hip fracture incidence showed association with SO₂ (IRR 1.11 (95% CI 1.04-1.18)), NO (IRR 1.01 (95% CI 1.01-1.02)), and NO₂ (IRR 1.02 (95% CI 1.01-1.04)). For O₃ levels, this association was negative (IRR 0.97 (95% CI 0.95-0.99)). The association persisted for SO₂ and NO₂ when the models were adjusted by season. After adjusting by season and weather conditions, the association persisted for NO₂. When participants were stratified by age and sex, associations persisted only in women older than 75 years.

CONCLUSIONS

A short-term association was observed with several indicators of air pollution on hip fracture incidence. This is the first study that shows these associations.

Air pollution and resistance to inhaled glucocorticoids: Evidence, mechanisms and gaps to fill

Substantial evidence indicates that cigarette smoke exposure induces resistance to glucocorticoids, the primary maintenance medication in asthma treatment. Modest evidence also suggests that air pollution may reduce the effectiveness of these critical medications. Cigarette smoke, which has clear parallels with air pollution, has been shown to induce glucocorticoid resistance in asthma and it has been speculated that air pollution may have similar effects. However, the literature on an association of air pollution with glucocorticoid resistance is modest to date. In this review, we detail the evidence for, and against, the effects of air pollution on glucocorticoid effectiveness, focusing on results from epidemiology and controlled human exposure studies. Epidemiological studies indicate a correlation between increased air pollution exposure and worse asthma symptoms. But these studies also show a mix of beneficial and harmful effects of glucocorticoids on spirometry and asthma symptoms, perhaps due to confounding influences, or the induction of glucocorticoid resistance. We describe mechanisms that may contribute to reductions in glucocorticoid responsiveness following air pollution exposure, including changes to phosphorylation or oxidation of the glucocorticoid receptor, repression by cytokines, or inflammatory pathways, and epigenetic effects. Possible interactions between air pollution and respiratory infections are also briefly discussed. Finally, we detail a number of therapies that may boost glucocorticoid effectiveness or reverse resistance in the presence of air pollution, and comment on the beneficial effects of engineering controls, such as air filtration and asthma action plans. We also call attention to the benefits of improved clean air policy on asthma. This review highlights numerous gaps in our knowledge of the interactions between air pollution and glucocorticoids to encourage further research in this area with a view to reducing the harm caused to those with airways disease.

Association between air pollution and suicide: a time series analysis in four Colombian cities

BACKGROUND

Recent epidemiological studies have suggested that air pollution could be associated with suicide. However, other studies have criticized these results for being analytically weak and not taking into account potential confounding factors. As such, further studies examining the relationship under diverse contexts are necessary to help clarify this issue. This study explored the association between specific air pollutants (NO₂, SO₂, PM₁₀, PM_2.5, CO and O₃) and suicide incidence in four Colombian cities after adjusting for climatic variables and holidays.

METHODS

A time series of daily suicides among men and women living in Bogota, Medellin, Cali and Bucaramanga was generated using information from the National Administrative Department of Statistics (DANE) for the years 2011-2014. At the same time, the average daily concentration of each air pollutant for each city was obtained from monitoring stations belonging to the National Air Quality Surveillance System. Using this information together, we generated conditional Poisson models (stratified by day, month and year) for the suicide rate in men and women, with air pollutants as the principal explanatory variable. These models were adjusted for temperature, relative humidity, precipitation and holidays.

RESULTS

No association was found between any of the examined pollutants and suicide: NO₂ (IRR:0.99, 95% CI: 0.95-1.04), SO₂ (IRR:0.99, 95% CI: 0.98-1.01), PM₁₀ (IRR:0.99, 95% CI:0.95-1.03), PM_2.5 (IRR:1.01, 95% CI: 0.98-1.05), CO (IRR:1.00, 95% CI:1.00-1.00) and O₃ (IRR: 1.00, 95% CI: 0.96-1.04). In the same way, no association was found in stratified models by sex and age group neither in lagged and cumulative effects models.

CONCLUSIONS

After adjusting for major confounding factors, we found no statistically significant association between air pollution and suicide in Colombia. These "negative" results provide further insight into the current discussion regarding the existence of such a relationship.

Microglial Immune Response to Low Concentrations of Combustion-Generated Nanoparticles: An In Vitro Model of Brain Health

The brain is the central regulator for integration and control of responses to environmental cues. Previous studies suggest that air pollution may directly impact brain health by triggering the onset of chronic neuroinflammation. We hypothesize that nanoparticle components of combustion-generated air pollution may underlie these effects. To test this association, a microglial in vitro biological sensor model was used for testing neuroinflammatory response caused by low-dose nanoparticle exposure. The model was first validated using 20 nm silver nanoparticles (AgNP). Next, neuroinflammatory response was tested after exposure to size-selected 20 nm combustion-generated nanoparticles (CGNP) collected from a modern diesel engine. We show that low concentrations of CGNPs promote low-grade inflammatory response indicated by increased pro-inflammatory cytokine release (tumor necrosis factor-α), similar to that observed after AgNP exposure. We also demonstrate increased production of reactive oxygen species and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) p65 phosphorylation in microglia after CGNP stimulation. Finally, we show conditioned media from CGNP-stimulated microglia significantly reduced hypothalamic neuronal survival in vitro. To our knowledge, this data show for the first time that exposure to AgNP and CGNP elicits microglial neuroinflammatory response through the activation of NF-κB.

Insights on Localized and Systemic Delivery of Redox-Based Therapeutics

Reactive oxygen and nitrogen species are indispensable in cellular physiology and signaling. Overproduction of these reactive species or failure to maintain their levels within the physiological range results in cellular redox dysfunction, often termed cellular oxidative stress. Redox dysfunction in turn is at the molecular basis of disease etiology and progression. Accordingly, antioxidant intervention to restore redox homeostasis has been pursued as a therapeutic strategy for cardiovascular disease, cancer, and neurodegenerative disorders among many others. Despite preliminary success in cellular and animal models, redox-based interventions have virtually been ineffective in clinical trials. We propose the fundamental reason for their failure is a flawed delivery approach. Namely, systemic delivery for a geographically local disease limits the effectiveness of the antioxidant. We take a critical look at the literature and evaluate successful and unsuccessful approaches to translation of redox intervention to the clinical arena, including dose, patient selection, and delivery approach. We argue that when interpreting a failed antioxidant-based clinical trial, it is crucial to take into account these variables and importantly, whether the drug had an effect on the redox status. Finally, we propose that local and targeted delivery hold promise to translate redox-based therapies from the bench to the bedside.

A selenium species in cerebrospinal fluid predicts conversion to Alzheimer's dementia in persons with mild cognitive impairment

Background

Little is known about factors influencing progression from mild cognitive impairment to Alzheimer’s dementia. A potential role of environmental chemicals and specifically of selenium, a trace element of nutritional and toxicological relevance, has been suggested. Epidemiologic studies of selenium are lacking, however, with the exception of a recent randomized trial based on an organic selenium form.

Methods

We determined concentrations of selenium species in cerebrospinal fluid sampled at diagnosis in 56 participants with mild cognitive impairment of nonvascular origin. We then investigated the relation of these concentrations to subsequent conversion from mild cognitive impairment to Alzheimer’s dementia.

Results

Twenty-one out of the 56 subjects developed Alzheimer’s dementia during a median follow-up of 42 months; four subjects developed frontotemporal dementia and two patients Lewy body dementia. In a Cox proportional hazards model adjusting for age, sex, duration of sample storage, and education, an inorganic selenium form, selenate, showed a strong association with Alzheimer’s dementia risk, with an adjusted hazard ratio of 3.1 (95% confidence interval 1.0–9.5) in subjects having a cerebrospinal fluid content above the median level, compared with those with lower concentration. The hazard ratio of Alzheimer’s dementia showed little departure from unity for all other inorganic and organic selenium species. These associations were similar in analyses that measured exposure on a continuous scale, and also after excluding individuals who converted to Alzheimer’s dementia at the beginning of the follow-up.

Conclusions

These results indicate that higher amounts of a potentially toxic inorganic selenium form in cerebrospinal fluid may predict conversion from mild cognitive impairment to Alzheimer’s dementia.

Electronic supplementary material

The online version of this article (doi:10.1186/s13195-017-0323-1) contains supplementary material, which is available to authorized users.