Ozone inhalation induces exacerbation of eosinophilic airway inflammation and Th2-skew immune response in a rat model of AR

Short-Term Effects of Exposure to Atmospheric Ozone on the Nasal and Respiratory Symptoms in Adolescents

Information regarding the effects of exposure to relatively low ozone (O3) concentrations in daily life is limited. We evaluated the effects of daily O3 exposure on nasal and respiratory symptoms in healthy students. A panel study was conducted with students (39 people) for approximately one month. They were asked to record the presence or absence of any nasal or respiratory symptoms each day. O3 concentrations were continuously measured inside and outside the classrooms, and the maximum 1 h, maximum 8 h average, and 24 h average values were calculated for the 24 h before recording the symptoms. Additionally, personal exposure to O3 was repeatedly measured every 24 h using passive samplers. Mixed-effects models were used to evaluate the association between daily symptoms and various O3 concentrations. Increases in maximum 1 h concentrations of indoor and outdoor O3 were significantly associated with the occurrence of nasal congestion and runny nose, respectively. These associations were more pronounced in those with a history of pollinosis or allergic rhinitis. Personal O3 exposure per 24 h was also associated with sneezing, runny nose, and nasal congestion. This study showed that the assessment of the amount of personal exposure levels is desired to evaluate the health effects of O3 exposure.

Effect of ambient O3 on respiratory mortality and synergies with meteorological factors in Shenyang, China

The impact of O3 on the respiratory system is a significant global problem. Nevertheless, there is insufficient information about its impact on respiratory disorders in northeast China. In this study, we used a generalized additive model (GAM) to determine the correlation between O3 concentrations and respiratory deaths based on the daily meteorological data, pollutant concentrations, and respiratory deaths from 2014 to 2016 in Shenyang, a typical city in northeast China. Single and cumulative lag structures and seasonal modification were considered to investigate the link between O3 exposure and respiratory mortality in Shenyang, northeast China. Synergic effects of O3 and meteorological factors were also evaluated. Results indicated that there was a significant correlation between O3 and the number of deaths caused by respiratory diseases on a daily basis, regardless of the time delay between exposure and the occurrence of the deaths. A 10 µg/m3 rise in O3 concentration was associated with a 0.85% (95% CI 0.18-1.52%) increase in respiratory death at a lag of 1 day and a 1.43% (95% CI 0.40-2.48%) increase at a cumulative lag of 3 days. Stratified analyses revealed that O3 had a greater impact on health under warm conditions compared to cold settings. Additionally, O3 had a more pronounced effect on females than on males. The results for this study could provide some scientific guidance for local environment and health departments.

Can greenspace modify the combined effects of multiple air pollutants on pulmonary tuberculosis treatment outcomes? An empirical study conducted in Zhejiang Province, China

BACKGROUND

Evidence on the combined effects of air pollutants and greenspace exposure on pulmonary tuberculosis (PTB) treatment is limited, particularly in developing countries with high levels of air pollution.

OBJECTIVE

We aimed to examine the individual and combined effects of long-term exposure to air pollutants on PTB treatment outcomes while also investigating the potential modifying effect of greenspace.

METHODS

This population-based study included 82,784 PTB cases notified in Zhejiang Province, China, from 2015 to 2019. The 24-month average concentrations of particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5), ozone (O3), nitrogen dioxide (NO2), and sulfur dioxide (SO2) before PTB diagnosis were estimated using a dataset derived from satellite-based machine learning models and monitoring stations. Greenspace exposure was assessed using the annual China Land Cover Dataset. We conducted analyses using time-varying Cox proportional hazards models and cumulative risk indices.

RESULTS

In individual effect models, each 10 µg/m3 increase in PM2.5, NO2, O3, and SO2 concentrations was associated with hazard ratios for PTB treatment success of 0.95 (95% confidence interval (CI): 0.93-0.97), 0.92 (95% CI: 0.91-0.94), 0.98 (95% CI: 0.97-0.99), and 1.52 (95% CI: 1.49-1.56), respectively. In combined effect models, long-term exposure to the combination of air pollutants was negatively associated with PTB treatment success, with a joint hazard ratio (JHR) of 0.79 (95% CI: 0.63-0.96). Among the pollutants examined, O3 contributed the most to the increased risks, followed by PM2.5 and NO2. Additionally, areas with moderate levels of greenspace showed a reduced risk (JHR = 0.81, 95% CI: 0.62-0.98) compared with the estimate from the third quantile model (JHR = 0.68, 95% CI: 0.52-0.83).

CONCLUSIONS

Combined air pollutants significantly impede successful PTB treatment outcomes, with O3 and PM2.5 accounting for nearly 75% of this detrimental effect. Moderate levels of greenspace can mitigate the adverse effects associated with combined air pollutants, leading to improved treatment success for patients with PTB.

Exhalation metabolomics: A new force in revealing the impact of ozone pollution on respiratory health

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Long-term exposure to ozone and sleep disorders in children: A multicity study in China

Evidence regarding the link between long-term ambient ozone (O3) exposure and childhood sleep disorders is little. This study aims to examine the associations between long-term exposure to O3 and sleep disorders in children. We conducted a population-based cross-sectional survey, including 185,428 children aged 6-18 years in 173 schools across 14 Chinese cities during 2012 and 2018. Parents or guardians completed a checklist using Sleep Disturbance Scale for Children, and O3 exposure at residential and school addresses was estimated using a satellite-based spatiotemporal model. We used generalized linear mixed models to test the associations with adjustment for factors including socio-demographic variables, lifestyle, meteorology and multiple pollutants. Mean concentrations of O3, particulate matter with diameters ≤2.5 mm (PM2.5) and nitrogen dioxide (NO2) were 89.0 μg/m3, 42.5 μg/m3 and 34.4 μg/m3, respectively. O3 and NO2 concentrations were similar among provinces, while PM2.5 concentration varied significantly among provinces. Overall, 19.4% of children had at least one sleep disorder. Long-term exposure to O3 was positively associated with odds of sleep disorders for all subtypes. For example, each interquartile increment in home-school O3 concentrations was associated with a higher odds ratio for global sleep disorder, at 1.22 (95% confidence interval: 1.18, 1.26). Similar associations were observed for sleep disorder subtypes. The associations remained similar after adjustment for PM2.5 and NO2. Moreover, these associations were heterogeneous regionally, with more prominent associations among children residing in southeast region than in northeast and northwest regions in China. We concluded that long-term exposure to O3 is positively associated with risks of childhood sleep disorders. These associations varied by geographical region of China.

The NLRP3 inflammasome in allergic diseases: mechanisms and therapeutic implications

In recent years, there has been a global increase in the prevalence of allergic diseases, including allergic rhinitis, chronic rhinosinusitis, allergic asthma, atopic dermatitis, allergic conjunctivitis, and food allergies. Since the pathogenic mechanisms of these allergic diseases are not yet fully understood, targeted and effective therapies are lacking. The NLRP3 inflammasome, a multiprotein complex implicated in various inflammatory diseases, can be activated by diverse stimuli. It assembles into NLRP3 inflammasome complexes through conformational changes, initiating the proteolytic cleavage of dormant procaspase-1 into active caspase-1 and promoting the maturation of inflammatory cytokines, including IL-1β and IL-18. Dysfunction of the NLRP3 inflammasome may serve as a key driver of inflammatory diseases, leading to pyroptosis and amplifying the local inflammatory response. As preliminarily demonstrated, specific NLRP3 inflammatory vesicle inhibitors play refectory roles in animal models of allergic diseases, and it is believed that specific NLRP3 inflammasome inhibitors may be potential therapeutic agents for allergic diseases. This review highlights the progress of research on the NLRP3 inflammasome in allergic diseases, explores its contribution to different types of allergic diseases, and identifies promising clinical targets for intervention.

Effects of Ambient O3 on Respiratory Mortality, Especially the Combined Effects of PM2.5 and O3

BACKGROUND

In China, the increasing concentration of ozone (O3) has emerged as a significant air pollution issue, leading to adverse effects on public health, particularly the respiratory system. Despite the progress made in managing air pollution in China, it is crucial to address the problem of environmental O3 pollution at present.

METHODS

The connection between O3 exposure and respiratory mortality in Shenyang, China, from 2014 to 2018 was analyzed by a time-series generalized additive regression model (GAM) with quasi-Poisson regression. Additionally, the potential combined effects of fine particulate matter (PM2.5) and O3 were investigated using the synergy index (SI).

RESULTS

Our findings indicate that each 10 μg/m3 increase in O3 at lag 2 days was associated with a maximum relative risk (RR) of 1.0150 (95% CI: 1.0098-1.0202) for respiratory mortality in the total population. For individuals aged ≥55 years, unmarried individuals, those engaged in indoor occupations, and those with low educational attainment, each 10 μg/m3 increase in O3 at lag 07 days was linked to RR values of 1.0301 (95% CI: 1.0187-1.0417), 1.0437 (95% CI: 1.0266-1.0610), 1.0317 (95% CI: 1.0186-1.0450), and 1.0346 (95% CI: 1.0222-1.0471), respectively. Importantly, we discovered a synergistic effect of PM2.5 and O3, resulting in an SI of 2.372 on the occurrence of respiratory mortality.

CONCLUSIONS

This study confirmed a positive association between O3 exposure and respiratory mortality. Furthermore, it highlighted the interaction between O3 and PM2.5 in exacerbating respiratory deaths.

Role of NLRP3 in the exacerbation of ozone-induced allergic rhinitis

OBJECTIVE

Allergic rhinitis (AR) is an immunoglobulin E (IgE)-mediated inflammatory disorder of the nasal mucosa, and the impact of ozone on AR is gaining increasing attention. Although NOD-like receptor thermal protein domain associated protein 3 (NLRP3) plays a crucial role in the pathogenesis of AR, its regulatory mechanisms in ozone-induced exacerbation remain unclear. Therefore, we explored the impact of ozone inhalation on inflammation in AR and investigated the regulatory mechanisms involving NLRP3.

METHODS

Fifty female Sprague-Dawley rats were selected and divided into five groups: normal control (NC), normal with ozone exposure (NE), AR model, AR with ozone exposure (ARE), and ARE treated with the NLRP3 inhibitor MCC950 (ARE+MCC950). Behavioral changes were observed in the rats, and the expression of NLRP3, active-caspase 1, and GSDMD-N was detected by western blotting. The expression levels of interleukin (IL)- 4, IL-5, IL-13, IL-1β, and ovalbumin-specific IgE (OVA-sIgE) in nasal lavage fluid as well as IL-6 in the serum were measured by ELISA. The expression and distribution of NLRP3 and IL-1β in nasal mucosal tissue were detected by immunohistochemistry, and pathological changes and eosinophilic infiltration in nasal mucosal tissue were observed by hematoxylin and eosin (HE) staining. The effects of ozone exposure on inflammation in the nasal mucosal tissue of rats with AR and the relationship between NLRP3 and inflammation were analyzed.

RESULTS

Upregulation of NLRP3 was observed in the AR rat model, and ozone further aggravated the expression of NLRP3 in the nasal mucosal tissue. Compared to the AR, NC, and NE groups, NLRP3 inflammasomes were activated in the ARE group, and the expression levels of related indexes active-caspase 1 and GSDMD-N were significantly increased; the expression levels of Th2 inflammatory factors IL-4, IL-5, IL-13, and OVA-sIgE were increased, and inflammatory factors such as IL-1β and IL-6 expression was also significantly increased. HE staining revealed that ozone aggravated damage to the nasal mucosal tissue in AR. Compared with the ARE group, the expression of NLRP3 inflammasomes was downregulated, sneezing and scratching symptoms were reduced, inflammatory indicators in nasal lavage fluid were decreased, and nasal mucosal tissue damage was alleviated in rats in the ARE+MCC950 group.

CONCLUSION

Ozone exposure significantly increased the inflammatory response in an animal model of AR. MCC950 can selectively inhibit the expression of NLRP3, inhibit the activity of inflammasomes, and reduce nasal mucosal inflammation by regulating the NLRP3-caspase-1-IL-1β pathway.

Involvements of Nrf2 and oxidative stress in the ozone-elicited exacerbation in an allergic rhinitis model

OBJECTIVE AND DESIGN

An experimental rat allergic rhinitis(AR) model was made to explore the effect of different concentrations of ozone exposure and evaluate the roles of nuclear factor erythroid 2-related factor 2(Nrf2) and oxidative stress in ozone exposure.

METHOD

Sprague-Dawley rats were sensitized with ovalbumin (OVA). Three groups of AR rats were exposed respectively to different concentrations of ozone for 2 h on 6 weeks. Nasal symptoms and OVA- specific Ig E in the serum were evaluated. The pathological changes in the nasal mucosa were examined. Malondialdehyde (MDA) level and activity of superoxide dismutase(SOD) and glutathione peroxidase (GSH-Px,GPX) in the nasal mucosa tissue were measured through a spectrophotometry-based method. Nrf2、Kelch-1ike ECH- associated protein-l (Keap1) proteins was measured by western blotting. GPX1、GPX2 mRNA were detected by quantitative real time-PCR(qRT-PCR).

RESULTS

Our results showed that ozone exposure induced a significant increase of the number of sneezes, nasal rubs, amount of nasal secretion and OVA-sIgE in the serum of AR model. Ozone effected oxidative stress in different concentration. The content of MDA in AREH group was significantly higher than AR groups. The activities of SOD and GSH-Px in nasal mucosa showed different trends in different concentration groups. The activities of SOD and GSH-Px in AREL and AREM groups were higher than AR group, but decreased at AREH group. The nucleoprotein level of Nrf2 in AREL and AREM groups was higher than AR groups. However, in AREH group, it was significantly decreased, compared with AREL and AREM groups. GPX1 and GPX2 mRNA levels in nasal mucosa showed the same trend in different exposure groups.

CONCLUSIONS

Different concentrations of ozone inhalation causes changes of the expression of Nrf2 nuclear protein and its target genes in nasal mucosa of AR. High concentration ozone breaks the redox balance and aggravates oxidative damage in AR. This study suggests that inhibiting oxidative stress might be a solution for ozone-elicited detrimental effects on AR.

Chinese Guideline on Allergen Immunotherapy for Allergic Rhinitis: The 2022 Update

In the last few decades, there has been a progressive increase in the prevalence of allergic rhinitis (AR) in China, where it now affects approximately 250 million people. AR prevention and treatment include allergen avoidance, pharmacotherapy, allergen immunotherapy (AIT), and patient education, among which AIT is the only curative intervention. AIT targets the disease etiology and may potentially modify the immune system as well as induce allergen-specific immune tolerance in patients with AR. In 2017, a team of experts from the Chinese Society of Allergy (CSA) and the Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G) produced the first English version of Chinese AIT guidelines for AR. Since then, there has been considerable progress in basic research of and clinical practice for AIT, especially regarding the role of follicular regulatory T (TFR) cells in the pathogenesis of AR and the use of allergen-specific immunoglobulin E (sIgE) in nasal secretions for the diagnosis of AR. Additionally, potential biomarkers, including TFR cells, sIgG4, and sIgE, have been used to monitor the incidence and progression of AR. Moreover, there has been a novel understanding of AIT during the coronavirus disease 2019 pandemic. Hence, there was an urgent need to update the AIT guideline for AR by a team of experts from CSA and C2AR2G. This document aims to serve as professional reference material on AIT for AR treatment in China, thus improving the development of AIT across the world.

Impact of Air Pollutants and Pollen on the Severity of Nonallergic Rhinitis: A Data-Oriented Analysis

Background

Rhino-conjunctivitis symptoms are more severe in nonallergic rhinitis (NAR) patients during pollen season than in other seasons. Little is known about the role of pollen and air pollutants on the severity of NAR.

Objective

The aim of this study is to assess the cross-sectional effects of both pollen and air pollutants on NAR patients during the pollen and non-pollen seasons, and to further explore the possible relationship among these triggers.

Methods

A total of 2411 clinically diagnosed NAR outpatients from 2018 to 2019 were recruited for this study. The severity of NAR was measured using rhinoconjunctivitis symptom scores. Associations of daily exposure to pollen, PM_2.5, PM₁₀, NO₂, SO₂, CO, O₃, and rhinoconjunctivitis symptom scores were evaluated using Logistic regression models. Distributed Lag Nonlinear models were used to explore single-day and accumulative Lag effects of environmental factors mentioned above.

Results

During the pollen season, pollen concentration, higher exposure levels of PM₁₀, PM_2.5, NO₂, and SO₂ increased the severity of NAR group when compared with the low-moderate severity group. The high severity group was associated with lower exposure levels of O₃. However, during non-pollen seasons, no significant association was found in air pollutant metrics, pollen concentration, and severity of NAR. The exposure-severity effects of pollen were different when different ambient pollutants were stratified.

Conclusion

Synergistic effect of pollen and air pollutants, including PM_2.5, PM₁₀, SO₂, NO₂, and O₃, might be responsible for aggravating the symptoms of NAR patients during pollen seasons.

Emerging Insights into the Impact of Air Pollution on Immune-Mediated Asthma Pathogenesis

PURPOSE OF REVIEW

Increases in ambient levels of air pollutants have been linked to lung inflammation and remodeling, processes that lead to the development and exacerbation of allergic asthma. Conventional research has focused on the role of CD4+ T helper 2 (TH2) cells in the pathogenesis of air pollution-induced asthma. However, much work in the past decade has uncovered an array of air pollution-induced non-TH2 immune mechanisms that contribute to allergic airway inflammation and disease.

RECENT FINDINGS

In this article, we review current research demonstrating the connection between common air pollutants and their downstream effects on non-TH2 immune responses emerging as key players in asthma, including PRRs, ILCs, and non-TH2 T cell subsets. We also discuss the proposed mechanisms by which air pollution increases immune-mediated asthma risk, including pre-existing genetic risk, epigenetic alterations in immune cells, and perturbation of the composition and function of the lung and gut microbiomes. Together, these studies reveal the multifaceted impacts of various air pollutants on innate and adaptive immune functions via genetic, epigenetic, and microbiome-based mechanisms that facilitate the induction and worsening of asthma.

IL-4 plays an essential role in DnaJ-ΔA146Ply-mediated immunoprotection against Streptococcus pneumoniae in mice

The fusion protein DnaJ-ΔA146Ply is protective against pneumococcal infections in mice. However, we found that immunized IL-4-/- mice showed significant lower survival rates and higher bacterial loads than did wild-type (WT) mice after being challenged. We explored the role of IL-4 in the protective immunity conferred by DnaJ-ΔA146Ply. Our results showed that there were no significant differences in antibody titers between immunized WT mice and IL-4-/- mice. The bacterial loads of passively immunized IL-4-/- mice were significantly higher than those of WT mice, while mice immunized with anti-DnaJ-ΔA146Ply serum from WT and IL-4-/- mice showed similar capacity for bacterial clearance. DnaJ-ΔA146Ply-dependent phagocytosis of IL-4-/- neutrophils was significant decreased compared with that of WT neutrophils. The levels of Syk and phosphor-Syk in IL-4-/- neutrophils were decreased compared with those in WT neutrophils. Additionally, Splenocytes in IL-4-/- mice triggered significantly higher levels of IFN-γ and IL-17A than did splenocytes in WT mice. Taken together, our findings illustrate that IL-4 deficiency does not influence the antibody production or antibody effect, but change the cellular immune response induced by DnaJ-ΔA146Ply. Additionally, IL-4 can enhance the antibody-dependent phagocytosis of neutrophils partially by activating Syk and participate in the protective immunity induced by DnaJ-ΔA146Ply.

Relationships between Long-Term Ozone Exposure and Allergic Rhinitis and Bronchitic Symptoms in Chinese Children

Numerous studies have demonstrated that exposure to ambient ozone (O₃) could have adverse effects on children's respiratory health. However, previous studies mainly focused on asthma and wheezing. Evidence for allergic rhinitis and bronchitic symptoms (e.g., persistent cough and phlegm) associated with O₃ is limited, and results from existing studies are inconsistent. This study included a total of 59,754 children from the seven northeastern cities study (SNEC), who were aged 2 to 17 years and from 94 kindergarten, elementary and middle schools. Information on doctor-diagnosed allergic rhinitis (AR), persistent cough, and persistent phlegm was collected during 2012-2013 using a standardized questionnaire developed by the American Thoracic Society (ATS). Information for potential confounders was also collected via questionnaire. Individuals' exposure to ambient ozone (O₃) during the four years before the investigation was estimated using a satellite-based random forest model. A higher level of O₃ was significantly associated with increased risk of AR and bronchitic symptoms. After controlling for potential confounders, the OR (95% CI) were 1.13 (1.07-1.18), 1.10 (1.06-1.16), and 1.12 (1.05-1.20) for AR, persistent cough, and persistent phlegm, respectively, associated with each interquartile range (IQR) rise in O₃ concentration. Interaction analyses showed stronger adverse effects of O₃ on AR in children aged 7-17 years than those aged 2-6 years, while the adverse association of O₃ with cough was more prominent in females and children aged 7-12 years than in males and children aged 2-6 and 13-17 years. This study showed that long-term exposure to ambient O₃ was significantly associated with higher risk of AR and bronchitic symptoms in children, and the association varies across age and gender. Our findings contribute additional evidence for the importance of controlling O₃ pollution and protecting children from O₃ exposure.