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Ramar M, Wiscovitch-Russo R, Yano N, Singh H, Lamere E, Short M, Gonzalez-Juarbe N, Fedulov AV. Live bacteria in gut microbiome dictate asthma onset triggered by environmental particles via modulation of DNA methylation in dendritic cells. Cell Rep 2025; 44:115684. [PMID: 40372916 DOI: 10.1016/j.celrep.2025.115684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2025] [Revised: 03/24/2025] [Accepted: 04/18/2025] [Indexed: 05/17/2025] Open
Abstract
Despite broad knowledge of the pathogenesis, our understanding of the origin of allergy and asthma remains poor, preventing etiotropic treatments. The gut microbiome is seen to be altered in asthmatics; however, proof of causality of the microbiome alterations is lacking. We report on gut microbiome transplantation (GMT) from mice predisposed to asthma by maternal exposure to pro-allergy environmental particles into naive recipients. This GMT confers asthma predisposition, and the effect is abrogated by gamma sterilization of the transplant material or by co-administration of antibacterials, indicating that viable bacteria are mediating the effect. Metagenomics identifies key changes in the "pro-asthma" microbiome, and metabolomics links the identified species to altered production of butyrate known to act on immune cells and epigenetic mechanisms. We further show that transplant recipients develop DNA methylation alterations in dendritic cells. Finally, dendritic cells with an altered methylome present allergen to T cells, and this effect is abrogated by an epigenetically acting drug in vitro.
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Affiliation(s)
- Mohankumar Ramar
- Department of Surgery, Division of Surgical Research, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Rosana Wiscovitch-Russo
- Department of Infectious Diseases and Genomic Medicine, J. Craig Venter Institute, Rockville, MD, USA
| | - Naohiro Yano
- Department of Surgery, Division of Surgical Research, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Harinder Singh
- Department of Infectious Diseases and Genomic Medicine, J. Craig Venter Institute, Rockville, MD, USA
| | - Edward Lamere
- Department of Nuclear Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael Short
- Department of Nuclear Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Norberto Gonzalez-Juarbe
- Department of Infectious Diseases and Genomic Medicine, J. Craig Venter Institute, Rockville, MD, USA; Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD, USA.
| | - Alexey V Fedulov
- Department of Surgery, Division of Surgical Research, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
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Gładysz MZ, Ubels D, Koch M, Amirsadeghi A, Alleblas F, van Vliet S, Kamperman M, Siebring J, Nagelkerke A, Włodarczyk‐Biegun MK. Melt Electrowriting of Polyhydroxyalkanoates for Enzymatically Degradable Scaffolds. Adv Healthc Mater 2025; 14:e2401504. [PMID: 39533454 PMCID: PMC11874678 DOI: 10.1002/adhm.202401504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 10/12/2024] [Indexed: 11/16/2024]
Abstract
Melt electrowriting (MEW) enables precise scaffold fabrication for biomedical applications. With a limited number of processable materials with short and tunable degradation times, polyhydroxyalkanoates (PHAs) present an interesting option. Here, poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and a blend of PHBV and poly(3-hydroxybutyrate-co-4-hydroxybutyrate) (PHBV+P34HB) are successfully melt electrowritten into scaffolds with various architectures. PHBV+P34HB exhibits greater thermal stability, making it a superior printing material compared to PHBV in MEW. The PHBV+P34HB scaffolds subjected to enzymatic degradation show tunable degradation times, governed by enzyme dilution, incubation time, and scaffold surface area. PHBV+P34HB scaffolds seeded with human dermal fibroblasts (HDFs), demonstrate enhanced cell adherence, proliferation, and spreading. The HDFs, when exposed to the enzyme solutions and enzymatic degradation residues, show good viability and proliferation rates. Additionally, HDFs grown on enzymatically pre-incubated scaffolds do not show any difference in behavior compared those grown on control scaffolds. It is concluded that PHAs, as biobased materials with enzymatically tunable degradability rates, are an important addition to the already limited set of materials available for MEW technology.
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Affiliation(s)
- Magdalena Z. Gładysz
- Polymer ScienceZernike Institute for Advanced MaterialsUniversity of GroningenNijenborgh 4Groningen9747 AGThe Netherlands
- Pharmaceutical AnalysisGroningen Research Institute of PharmacyUniversity of GroningenP.O. Box 196, XB20Groningen9700 ADThe Netherlands
| | - Didi Ubels
- Polymer ScienceZernike Institute for Advanced MaterialsUniversity of GroningenNijenborgh 4Groningen9747 AGThe Netherlands
| | - Marcus Koch
- INM‐Leibniz Institute for New MaterialsCampus D2 266123SaarbrückenGermany
| | - Armin Amirsadeghi
- Polymer ScienceZernike Institute for Advanced MaterialsUniversity of GroningenNijenborgh 4Groningen9747 AGThe Netherlands
| | - Frederique Alleblas
- Pharmaceutical AnalysisGroningen Research Institute of PharmacyUniversity of GroningenP.O. Box 196, XB20Groningen9700 ADThe Netherlands
| | - Sander van Vliet
- Bioconversion and Fermentation TechnologyResearch Centre Biobased EconomyHanze University of Applied SciencesZernikeplein 11Groningen9747 ASThe Netherlands
| | - Marleen Kamperman
- Polymer ScienceZernike Institute for Advanced MaterialsUniversity of GroningenNijenborgh 4Groningen9747 AGThe Netherlands
| | - Jeroen Siebring
- Bioconversion and Fermentation TechnologyResearch Centre Biobased EconomyHanze University of Applied SciencesZernikeplein 11Groningen9747 ASThe Netherlands
| | - Anika Nagelkerke
- Pharmaceutical AnalysisGroningen Research Institute of PharmacyUniversity of GroningenP.O. Box 196, XB20Groningen9700 ADThe Netherlands
| | - Małgorzata K. Włodarczyk‐Biegun
- Polymer ScienceZernike Institute for Advanced MaterialsUniversity of GroningenNijenborgh 4Groningen9747 AGThe Netherlands
- Biotechnology CentreSilesian University of TechnologyKrzywoustego 8Gliwice44‐100Poland
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Prueitt RL, Drury NL, Shore RA, Boon DN, Goodman JE. Talc and human cancer: a systematic review of the experimental animal and mechanistic evidence. Crit Rev Toxicol 2024; 54:359-393. [PMID: 38979679 DOI: 10.1080/10408444.2024.2349668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/25/2024] [Indexed: 07/10/2024]
Abstract
The potential carcinogenicity of talc has been evaluated in many studies in humans and experimental animals published in the scientific literature over the last several decades, with a number of these studies reporting no associations between talc exposure and any type of cancer. In order to fully understand the current state of the science regarding the potential for talc to induce human cancers, we conducted a comprehensive and systematic review of the available experimental animal and mechanistic evidence (in conjunction with a systematic review of the epidemiology evidence in a companion analysis) to evaluate whether it supports talc as being carcinogenic to humans. We considered study quality and its impact on the interpretation of results and evaluated all types of cancer and all exposure routes. We also evaluated the evidence on the potential for talc to migrate in the body to potential tumor sites. We identified seven experimental animal carcinogenicity studies and 11 mechanistic studies of talc to systematically review. We found that several of the experimental animal carcinogenicity studies of talc have limitations that preclude their sensitivity to detect increases in tumor incidence. Regardless, the studies cover multiple exposure routes, species, and exposure durations, and none indicate that talc is a carcinogen in experimental animals except in rats under conditions of extremely high exposure that likely resulted in lung particle overload, a nonspecific effect of high exposures to poorly soluble particles, and not from any carcinogenic properties of talc. Lung particle overload leading to lung tumor formation has only been observed in rats and not in any other species, including humans. The mechanistic studies indicate that talc is not genotoxic or mutagenic, but can induce some effects that could be events on a possible pathway to carcinogenicity, mainly at high exposures or in in vitro studies with exposures of unclear relevance in vivo, but these effects are not consistent across studies and cell types. This systematic review of the experimental animal carcinogenicity and mechanistic evidence for talc indicates that an association between talc exposure and cancer is not expected in humans. Talc carcinogenicity is not plausible in any species except rats, and only when the exposure conditions are high enough to induce lung particle overload, which is not relevant to human exposures.
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Lynch HN, Lauer DJ, Leleck OM, Freid RD, Collins J, Chen K, Thompson WJ, Ierardi AM, Urban A, Boffetta P, Mundt KA. Systematic review of the association between talc and female reproductive tract cancers. FRONTIERS IN TOXICOLOGY 2023; 5:1157761. [PMID: 37608907 PMCID: PMC10442069 DOI: 10.3389/ftox.2023.1157761] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/08/2023] [Indexed: 08/24/2023] Open
Abstract
Talc is a hydrous magnesium sheet silicate used in cosmetic powders, ceramics, paints, rubber, and many other products. We conducted a systematic review of the potential carcinogenicity of genitally applied talc in humans. Our systematic review methods adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and incorporated aspects from the US Institute of Medicine (IOM, now the National Academy of Medicine) and several US EPA frameworks for systematic reviews, evaluating and integrating the epidemiological, animal, and mechanistic literature on talc and cancer. We conducted a comprehensive literature search. Detailed data abstraction and study quality evaluation, adapting the Toxic Substances Control Act (TSCA) framework, were central to our analysis. The literature search and selection process identified 40 primary studies that assessed exposure to talc and female reproductive cancer risks in humans (n = 36) and animals (n = 4). The results of our evaluation emphasize the importance of considering biological plausibility and study quality in systematic review. Integrating all streams of evidence according to the IOM framework yielded classifications of suggestive evidence of no association between perineal application of talcum powders and risk of ovarian cancer at human-relevant exposure levels. We also concluded that there is suggestive evidence of no association between genital talc application and endometrial cancer, and insufficient evidence to determine whether a causal association exists between genital talc application and cervical cancer based on a smaller but largely null body of literature.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ania Urban
- Stantec (ChemRisk), San Francisco, CA, United States
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook, NY, United States
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Ramar M, Yano N, Fedulov AV. Intra-Airway Treatment with Synthetic Lipoxin A4 and Resolvin E2 Mitigates Neonatal Asthma Triggered by Maternal Exposure to Environmental Particles. Int J Mol Sci 2023; 24:ijms24076145. [PMID: 37047118 PMCID: PMC10093944 DOI: 10.3390/ijms24076145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
Particulate matter in the air exacerbates airway inflammation (AI) in asthma; moreover, prenatal exposure to concentrated urban air particles (CAPs) and diesel exhaust particles (DEPs) predisposes the offspring to asthma and worsens the resolution of AI in response to allergens. We previously tested the hypothesis that such exposure impairs the pathways of specialized proresolving mediators that are critical for resolution and found declined Lipoxin A4 (LxA4) and Resolvin E2 (RvE2) levels in the "at-risk" pups of exposed mothers. Here, we hypothesized that supplementation with synthetic LxA4 or RvE2 via the airway can ameliorate AI after allergen exposure, which has not been tested in models with environmental toxicant triggers. BALB/c newborns with an asthma predisposition resultant from prenatal exposure to CAPs and DEPs were treated once daily for 3 days with 750 ng/mouse of LxA4 or 300 ng/mouse of RvE2 through intranasal instillation, and they were tested with the intentionally low-dose ovalbumin protocol that elicits asthma in the offspring of particle-exposed mothers but not control mothers, mimicking the enigmatic maternal transmission of asthma seen in humans. LxA4 and RvE2 ameliorated the asthma phenotype and improved AI resolution, which was seen as declining airway eosinophilia, lung tissue infiltration, and proallergic cytokine levels.
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Affiliation(s)
- Mohankumar Ramar
- Division of Surgical Research, Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Naohiro Yano
- Division of Surgical Research, Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Alexey V Fedulov
- Division of Surgical Research, Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA
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6
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Cramer DW. The association of talc use and ovarian cancer: biased or causal. Gynecol Oncol Rep 2022; 41:100896. [PMID: 35769495 PMCID: PMC9235036 DOI: 10.1016/j.gore.2021.100896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
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Kumar M, Yano N, Fedulov AV. Gestational exposure to titanium dioxide, diesel exhaust, and concentrated urban air particles affects levels of specialized pro-resolving mediators in response to allergen in asthma-susceptible neonate lungs. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2022; 85:243-261. [PMID: 34802391 PMCID: PMC8785906 DOI: 10.1080/15287394.2021.2000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Maternal gestational exposures to traffic and urban air pollutant particulates have been linked to increased risk and/or worsening asthma in children; however, mechanisms underlying this vertical transmission are not entirely understood. It was postulated that gestational particle exposure might affect the ability to elicit specialized proresolving mediator (SPM) responses upon allergen encounter in neonates. Lipidomic profiling of 50 SPMs was performed in lungs of neonates born to mice exposed to concentrated urban air particles (CAP), diesel exhaust particles (DEP), or less immunotoxic titanium dioxide particles (TiO2). While asthma-like phenotypes were induced with identical eosinophilia intensity across neonates of all particle-exposed mothers, levels of LXA4, HEPE and HETE isoforms, and HDoHe were only decreased by CAP and DEP only but not by TiO2. However, RvE2 and RvD1 were inhibited by all particles. In contrast, isomers of Maresin1 and Protectin D1 were variably elevated by CAP and DEP, whereas Protectin DX, PGE2, and TxB2 were increased in all groups. Only Protectin D1/DX, MaR1(n-3,DPA), 5(S),15(S)-DiHETE, PGE2, and RvE3 correlated with eosinophilia but the majority of other analytes, elevated or inhibited, showed no marked correlation with inflammation intensity. Evidence indicates that gestational particle exposure leads to both particle-specific and nonspecific effects on the SPM network.
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Affiliation(s)
- Mohan Kumar
- Alpert Medical School of Brown University. Department of Surgery, Rhode Island Hospital. 593 Eddy Street, Providence, RI, USA. 02903
| | - Naohiro Yano
- Alpert Medical School of Brown University. Department of Surgery, Rhode Island Hospital. 593 Eddy Street, Providence, RI, USA. 02903
| | - Alexey V. Fedulov
- Alpert Medical School of Brown University. Department of Surgery, Rhode Island Hospital. 593 Eddy Street, Providence, RI, USA. 02903
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8
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An Y, Yang Q. Tumor-associated macrophage-targeted therapeutics in ovarian cancer. Int J Cancer 2020; 149:21-30. [PMID: 33231290 DOI: 10.1002/ijc.33408] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/24/2020] [Accepted: 11/03/2020] [Indexed: 01/06/2023]
Abstract
Ovarian cancer is one of the most common gynecological malignancies. The tumor microenvironment plays an important role in regulating the progression of ovarian cancer. Macrophages, which are important immune cells in the tumor microenvironment, participate in the regulation of various biological behaviors and influence the prognosis of ovarian cancer. A large number of studies have targeted macrophages for the treatment of ovarian cancer. In addition, macrophages also play a regulatory role by interacting with other immune cells, including T cells and mesothelial cells, in the ovarian cancer microenvironment. In this review, we discuss the progress made in macrophage-targeted therapy for ovarian cancer. Although there are still several challenges in using this treatment, targeted macrophage therapy is still a promising treatment for ovarian cancer.
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Affiliation(s)
- Yuanyuan An
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qing Yang
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Emi T, Rivera LM, Tripathi VC, Yano N, Ragavendran A, Wallace J, Fedulov AV. Transcriptomic and epigenomic effects of insoluble particles on J774 macrophages. Epigenetics 2020; 16:1053-1070. [PMID: 33054565 DOI: 10.1080/15592294.2020.1834925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Here we report epigenomic and transcriptomic changes in a prototypical J774 macrophage after engulfing talc or titanium dioxide particles in presence of estrogen. Macrophages are the first immune cells to engage and clear particles of various nature. A novel paradigm is emerging, that exposure to so-called 'inert' particulates that are considered innocuous is not really free of consequences. We hypothesized that especially the insoluble, non-digestible particles that do not release a known hazardous chemical can be underappreciated agents acting to affect the regulation inside macrophages upon phagocytosis. We performed gene chip microarray profiling and found that talc alone, and especially with oestrogen, has induced a substantially more prominent gene expression change than titanium dioxide; the affected genes were involved in pathways of cell proliferation, immune response and regulation, and, unexpectedly, enzymes and proteins of epigenetic regulation. We therefore tested the DNA methylation profiles of these cells via epigenome-wide bisulphite sequencing and found vast epigenetic changes in hundreds of loci, remarkably after a very short exposure to particles; ELISA assay for methylcytosine levels determined the particles induced an overall decrease in DNA methylation. We found a few loci where both the transcriptional changes and epigenetic changes occurred in the pathways involving immune and inflammatory signalling. Some transcriptomic and epigenomic changes were shared between talc and titanium dioxide, however, it is especially interesting that each of the two particles of similar size and insoluble nature has also induced a specific pattern of gene expression and DNA methylation changes which we report here.
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Affiliation(s)
- T Emi
- Alpert Medical School of Brown University. Department of Surgery, Division of Surgical Research, Rhode Island Hospital. Providence, RI, USA
| | - L M Rivera
- Alpert Medical School of Brown University. Department of Surgery, Division of Surgical Research, Rhode Island Hospital. Providence, RI, USA.,Department of Biology, University of Puerto Rico, San Juan, Puerto Rico
| | - V C Tripathi
- Alpert Medical School of Brown University. Department of Surgery, Division of Surgical Research, Rhode Island Hospital. Providence, RI, USA
| | - N Yano
- Alpert Medical School of Brown University. Department of Surgery, Division of Surgical Research, Rhode Island Hospital. Providence, RI, USA
| | - A Ragavendran
- Computational Biology Core, COBRE Center for Computational Biology of Human Disease, Brown University, Providence, RI, USA
| | - J Wallace
- Computational Biology Core, COBRE Center for Computational Biology of Human Disease, Brown University, Providence, RI, USA
| | - Alexey V Fedulov
- Alpert Medical School of Brown University. Department of Surgery, Division of Surgical Research, Rhode Island Hospital. Providence, RI, USA
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Johnson KE, Popratiloff A, Fan Y, McDonald S, Godleski JJ. Analytic comparison of talc in commercially available baby powder and in pelvic tissues resected from ovarian carcinoma patients. Gynecol Oncol 2020; 159:527-533. [PMID: 32977988 DOI: 10.1016/j.ygyno.2020.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Measure the size and shape of talc particles in talcum powder and compare this data to the size and shape of talc particles found in surgically resected tissues from patients with ovarian carcinoma. METHODS Using polarized light microscopy (PLM) and scanning electron microscopy (SEM), we measured the size and shape of talc particles in samples of talc-containing baby powder (TCBP) and surgically resected pelvic tissues (hysterectomies) from talc-exposed patients with ovarian carcinoma. RESULTS The most frequent class of particles in TCBP can be unequivocally identified as talc, using both polarized light microscopy and scanning electron microscopy with energy dispersive X-ray analysis (SEM/EDX). The talc particles found in resected tissues from ovarian carcinoma patients are similar in size and shape to the most abundant morphological class of particles in TCBP. CONCLUSIONS This finding, combined with previous epidemiological literature and tissue-based analytical studies, provides further evidence that the small, isodiametric particles that dominate TCBP can migrate from the perineum and become lodged in distal structures in the female reproductive tract, where they may lead to an increased risk of developing ovarian carcinoma.
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Affiliation(s)
- Kurt E Johnson
- Anatomy and Cell Biology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Anastas Popratiloff
- Anatomy and Cell Biology, GW Nanofabrication and Imaging Center, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Yuwei Fan
- Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | | | - John J Godleski
- Harvard Medical School, Department of Environmental Health at Harvard TH Chan School of Public Health, 304 Central Ave., Milton, MA 02186, USA
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Goodman JE, Kerper LE, Prueitt RL, Marsh CM. A critical review of talc and ovarian cancer. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2020; 23:183-213. [PMID: 32401187 DOI: 10.1080/10937404.2020.1755402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The association between perineal talc use and ovarian cancer has been evaluated in several epidemiology studies. Some case-control studies reported weak positive associations, while other case-control and three large prospective cohort investigations found this association to be null. A weight-of-evidence evaluation was conducted of the epidemiology, toxicity, exposure, transport, in vitro, and mechanistic evidence to determine whether, collectively, these data support a causal association. Our review of the literature indicated that, while both case-control and cohort studies may be impacted by bias, the possibility of recall and other biases from the low participation rates and retrospective self-reporting of talc exposure cannot be ruled out for any of the case-control studies. The hypothesis that talc exposure induces ovarian cancer is only supported if one discounts the null results of the cohort studies and the fact that significant bias and/or confounding are likely reasons for the associations reported in some case-control investigations. In addition, one would need to ignore the evidence from animal experiments that show no marked association with cancer, in vitro and genotoxicity studies that did not indicate a carcinogenic mechanism of action for talc, and mechanistic and transport investigations that did not support the retrograde transport of talc to the ovaries. An alternative hypothesis that talc does not produce ovarian cancer, and that bias and confounding contribute the reported positive associations in case-control studies, is better supported by the evidence across all scientific disciplines. It is concluded that the evidence does not support a causal association between perineal talc use and ovarian cancer.
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Affiliation(s)
- Daniel W Cramer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
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