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Talbott EO, Malek AM, Arena VC, Wu F, Steffes K, Sharma RK, Buchanich J, Rager JR, Bear T, Hoffman CA, Lacomis D, Donnelly C, Mauna J, Vena JE. Case-control study of environmental toxins and risk of amyotrophic lateral sclerosis involving the national ALS registry. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:533-542. [PMID: 38591179 DOI: 10.1080/21678421.2024.2336108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Neurotoxic chemicals are suggested in the etiology of amyotrophic lateral sclerosis (ALS). We examined the association of environmental and occupational risk factors including persistent organochlorine pesticides (OCPs) and ALS risk among cases from the Centers for Disease Control and Prevention National ALS Registry and age, sex, and county-matched controls. METHODS Participants completed a risk factor survey and provided a blood sample for OCP measurement. ALS cases were confirmed through the Registry. Conditional logistic regression assessed associations between ALS and risk factors including OCP levels. RESULTS 243 matched case-control pairs (61.7% male, mean [SD] age = 62.9 [10.1]) were included. Fifteen of the 29 OCPs examined had sufficient detectable levels for analysis. Modest correlations of self-reported years of exposure to residential pesticide mixtures and OCP serum levels were found (p<.001). Moreover, occupational exposure to lead including soldering and welding with lead/metal dust and use of lead paint/gasoline were significantly related to ALS risk (OR = 1.77, 95% CI: 1.11-2.83). Avocational gardening was a significant risk factor for ALS (OR = 1.57, 95% CI: 1.04-2.37). ALS risk increased for each 10 ng/g of α-Endosulfan (OR = 1.42, 95% CI: 1.14-1.77) and oxychlordane (OR = 1.24, 95% CI: 1.01-1.53). Heptachlor (detectable vs. nondetectable) was also associated with ALS risk (OR = 3.57, 95% CI: 1.50-8.52). CONCLUSION This national case-control study revealed both survey and serum levels of OCPs as risk factors for ALS. Despite the United States banning many OCPs in the 1970s and 1980s, their use abroad and long half-lives continue to exert possible neurotoxic health effects.
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Affiliation(s)
- Evelyn O Talbott
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Angela M Malek
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Fan Wu
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Kristen Steffes
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Ravi K Sharma
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Jeanine Buchanich
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Judith R Rager
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Todd Bear
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Caroline A Hoffman
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - David Lacomis
- Departments of Neurology and Pathology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA, and
| | - Chris Donnelly
- Department of Neurobiology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Jocelyn Mauna
- Department of Neurobiology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - John E Vena
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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2
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Goutman SA, Boss J, Jang DG, Piecuch C, Farid H, Batra M, Mukherjee B, Feldman EL, Batterman SA. Residential exposure associations with ALS risk, survival, and phenotype: a Michigan-based case-control study. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:543-553. [PMID: 38557405 PMCID: PMC11269018 DOI: 10.1080/21678421.2024.2336110] [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: 12/21/2023] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Environmental exposures impact amyotrophic lateral sclerosis (ALS) risk and progression, a fatal and progressive neurodegenerative disease. Better characterization of these exposures is needed to decrease disease burden. OBJECTIVE To identify exposures in the residential setting that associate with ALS risk, survival, and onset segment. METHODS ALS and control participants recruited from University of Michigan completed a survey that ascertained exposure risks in the residential setting. ALS risk was assessed using logistic regression models followed by latent profile analysis to consider exposure profiles. A case-only analysis considered the contribution of the residential exposure variables via a Cox proportional hazards model for survival outcomes and multinomial logistic regression for onset segment, a polytomous outcome. RESULTS This study included 367 ALS and 255 control participants. Twelve residential variables were associated with ALS risk after correcting for multiple comparison testing, with storage in an attached garage of chemical products including gasoline or kerosene (odds ratio (OR) = 1.14, padjusted < 0.001), gasoline-powered equipment (OR = 1.16, padjusted < 0.001), and lawn care products (OR = 1.15, padjusted < 0.001) representing the top three risk factors sorted by padjusted. Latent profile analysis indicated that storage of these chemical products in both attached and detached garages increased ALS risk. Although residential variables were not associated with poorer ALS survival following multiple testing corrections, storing pesticides, lawn care products, and woodworking supplies in the home were associated with shorter ALS survival using nominal p values. No exposures were associated with ALS onset segment. CONCLUSION Residential exposures may be important modifiable components of the ALS susceptibility and prognosis exposome.
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Affiliation(s)
- Stephen A Goutman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Boss
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA, and
| | - Dae Gyu Jang
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Caroline Piecuch
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Hasan Farid
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Madeleine Batra
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA, and
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Stuart A Batterman
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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3
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Sini P, Galleri G, Ciampelli C, Galioto M, Padedda BM, Lugliè A, Iaccarino C, Crosio C. Evaluation of cyanotoxin L-BMAA effect on α-synuclein and TDP43 proteinopathy. Front Immunol 2024; 15:1360068. [PMID: 38596666 PMCID: PMC11002123 DOI: 10.3389/fimmu.2024.1360068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
The complex interplay between genetic and environmental factors is considered the cause of neurodegenerative diseases including Parkinson's disease (PD) and Amyotrophic Lateral Sclerosis (ALS). Among the environmental factors, toxins produced by cyanobacteria have received much attention due to the significant increase in cyanobacteria growth worldwide. In particular, L-BMAA toxin, produced by diverse taxa of cyanobacteria, dinoflagellates and diatoms, has been extensively correlated to neurodegeneration. The molecular mechanism of L-BMAA neurotoxicity is still cryptic and far from being understood. In this research article, we have investigated the molecular pathways altered by L-BMAA exposure in cell systems, highlighting a significant increase in specific stress pathways and an impairment in autophagic processes. Interestingly, these changes lead to the accumulation of both α-synuclein and TDP43, which are correlated with PD and ALS proteinopathy, respectively. Finally, we were able to demonstrate specific alterations of TDP43 WT or pathological mutants with respect to protein accumulation, aggregation and cytoplasmic translocation, some of the typical features of both sporadic and familial ALS.
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Affiliation(s)
- Paola Sini
- Laboratory of Molecular Biology, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Grazia Galleri
- Laboratory of Molecular Biology, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Cristina Ciampelli
- Laboratory of Molecular Biology, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Manuela Galioto
- Laboratory of Molecular Biology, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Bachisio Mario Padedda
- Laboratory of Ecology, Department of Architecture, Design and Urban Planning, University of Sassari, Sassari, Italy
| | - Antonella Lugliè
- Laboratory of Ecology, Department of Architecture, Design and Urban Planning, University of Sassari, Sassari, Italy
| | - Ciro Iaccarino
- Laboratory of Molecular Biology, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Claudia Crosio
- Laboratory of Molecular Biology, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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4
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Barney RE, Huang G, Gallagher TL, Tischbein M, DeWitt J, Martindale R, LaRochelle EMP, Tsongalis GJ, Stommel EW. Validation of a Droplet Digital PCR (ddPCR) Assay to Detect Cyanobacterial 16S rDNA in Human Lung Tissue. TOXICS 2023; 11:531. [PMID: 37368631 DOI: 10.3390/toxics11060531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Cyanobacteria produce a variety of secondary metabolites, including toxins that may contribute to the development of disease. Previous work was able to detect the presence of a cyanobacterial marker in human nasal and broncoalveolar lavage samples; however, it was not able to determine the quantification of the marker. To further research the relationship between cyanobacteria and human health, we validated a droplet digital polymerase chain reaction (ddPCR) assay to simultaneously detect the cyanobacterial 16S marker and a human housekeeping gene in human lung tissue samples. The ability to detect cyanobacteria in human samples will allow further research into the role cyanobacteria plays in human health and disease.
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Affiliation(s)
- Rachael E Barney
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Guohong Huang
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Torrey L Gallagher
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Maeve Tischbein
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - John DeWitt
- Department of Pathology, University of Vermont, Burlington, VT 05405, USA
| | - Rachel Martindale
- Department of Pathology, University of Vermont, Burlington, VT 05405, USA
| | - Ethan M P LaRochelle
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Gregory J Tsongalis
- Dartmouth-Hitchcock Medical Center, Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Elijah W Stommel
- Dartmouth-Hitchcock Medical Center, Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
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5
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Saucier D, Registe PPW, Bélanger M, O'Connell C. Urbanization, air pollution, and water pollution: Identification of potential environmental risk factors associated with amyotrophic lateral sclerosis using systematic reviews. Front Neurol 2023; 14:1108383. [PMID: 36970522 PMCID: PMC10030603 DOI: 10.3389/fneur.2023.1108383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Despite decades of research, causes of ALS remain unclear. To evaluate recent hypotheses of plausible environmental factors, the aim of this study was to synthesize and appraise literature on the potential associations between the surrounding environment, including urbanization, air pollution and water pollution, and ALS. Methods We conducted a series (n = 3) of systematic reviews in PubMed and Scopus to identify epidemiological studies assessing relationships between urbanization, air pollution and water pollution with the development of ALS. Results The combined search strategy led to the inclusion of 44 articles pertaining to at least one exposure of interest. Of the 25 included urbanization studies, four of nine studies on living in rural areas and three of seven studies on living in more highly urbanized/dense areas found positive associations to ALS. There were also three of five studies for exposure to electromagnetic fields and/or proximity to powerlines that found positive associations to ALS. Three case-control studies for each of diesel exhaust and nitrogen dioxide found positive associations with the development of ALS, with the latter showing a dose-response in one study. Three studies for each of high selenium content in drinking water and proximity to lakes prone to cyanobacterial blooms also found positive associations to ALS. Conclusion Whereas markers of air and water pollution appear as potential risk factors for ALS, results are mixed for the role of urbanization.
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Affiliation(s)
- Daniel Saucier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de formation médicale du Nouveau-Brunswick, Moncton, NB, Canada
- *Correspondence: Daniel Saucier
| | - Pierre Philippe Wilson Registe
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de formation médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Mathieu Bélanger
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de formation médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Colleen O'Connell
- Stan Cassidy Center for Rehabilitation, Fredericton, NB, Canada
- Department of Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
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6
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Residential exposure to electromagnetic fields and risk of amyotrophic lateral sclerosis: a dose-response meta-analysis. Sci Rep 2021; 11:11939. [PMID: 34099747 PMCID: PMC8185090 DOI: 10.1038/s41598-021-91349-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/25/2021] [Indexed: 11/08/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is neurodegenerative disease characterized by a fatal prognosis and still unknown etiology. Some environmental risk factors have been suggested, including exposure to magnetic fields. Studies have suggested positive associations in occupationally-exposed populations, but the link with residential exposure is still debated as is the shape of such relation. Due to recent availability of advanced biostatistical tools for dose–response meta-analysis, we carried out a systematic review in order to assess the dose–response association between ALS and residential exposure to magnetic fields. We performed an online literature searching through April 30, 2021. Studies were included if they assessed residential exposure to electromagnetic fields, based either on distance from overhead power lines or on magnetic field modelling techniques, and if they reported risk estimates for ALS. We identified six eligible studies, four using distance-based and one modelling-based exposure assessment, and one both methods. Both distance-based and particularly modelling-based exposure estimates appeared to be associated with a decreased ALS risk in the highest exposure category, although estimates were very imprecise (summary RRs 0.87, 95% CI 0.63–1.20, and 0.27, 95% CI 0.05–1.36). Dose–response meta-analysis also showed little association between distance from power lines and ALS, with no evidence of any threshold. Overall, we found scant evidence of a positive association between residential magnetic fields exposure and ALS, although the available data were too limited to conduct a dose–response analysis for the modelled magnetic field estimates or to perform stratified analyses.
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7
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Ra D, Sa B, Sl B, Js M, Sj M, DA D, Ew S, O K, Eb B, Ad C, Vx T, Gg G, Pa C, Dc M, Wg B. Is Exposure to BMAA a Risk Factor for Neurodegenerative Diseases? A Response to a Critical Review of the BMAA Hypothesis. Neurotox Res 2021; 39:81-106. [PMID: 33547590 PMCID: PMC7904546 DOI: 10.1007/s12640-020-00302-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022]
Abstract
In a literature survey, Chernoff et al. (2017) dismissed the hypothesis that chronic exposure to β-N-methylamino-L-alanine (BMAA) may be a risk factor for progressive neurodegenerative disease. They question the growing scientific literature that suggests the following: (1) BMAA exposure causes ALS/PDC among the indigenous Chamorro people of Guam; (2) Guamanian ALS/PDC shares clinical and neuropathological features with Alzheimer's disease, Parkinson's disease, and ALS; (3) one possible mechanism for protein misfolds is misincorporation of BMAA into proteins as a substitute for L-serine; and (4) chronic exposure to BMAA through diet or environmental exposures to cyanobacterial blooms can cause neurodegenerative disease. We here identify multiple errors in their critique including the following: (1) their review selectively cites the published literature; (2) the authors reported favorably on HILIC methods of BMAA detection while the literature shows significant matrix effects and peak coelution in HILIC that may prevent detection and quantification of BMAA in cyanobacteria; (3) the authors build alternative arguments to the BMAA hypothesis, rather than explain the published literature which, to date, has been unable to refute the BMAA hypothesis; and (4) the authors erroneously attribute methods to incorrect studies, indicative of a failure to carefully consider all relevant publications. The lack of attention to BMAA research begins with the review's title which incorrectly refers to BMAA as a "non-essential" amino acid. Research regarding chronic exposure to BMAA as a cause of human neurodegenerative diseases is emerging and requires additional resources, validation, and research. Here, we propose strategies for improvement in the execution and reporting of analytical methods and the need for additional and well-executed inter-lab comparisons for BMAA quantitation. We emphasize the need for optimization and validation of analytical methods to ensure that they are fit-for-purpose. Although there remain gaps in the literature, an increasingly large body of data from multiple independent labs using orthogonal methods provides increasing evidence that chronic exposure to BMAA may be a risk factor for neurological illness.
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Affiliation(s)
- Dunlop Ra
- Brain Chemistry Labs, Institute for Ethnomedicine, Jackson, WY, USA.
| | - Banack Sa
- Brain Chemistry Labs, Institute for Ethnomedicine, Jackson, WY, USA
| | - Bishop Sl
- Lewis Research Group, Faculty of Science, University of Calgary, Alberta, Canada
| | - Metcalf Js
- Brain Chemistry Labs, Institute for Ethnomedicine, Jackson, WY, USA
| | - Murch Sj
- Department of Chemistry, University of British Columbia, Kelowna, BC, Canada
| | - Davis DA
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Stommel Ew
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Karlsson O
- Department of Environmental Science, Stockholm University, Stockholm, Sweden
| | - Brittebo Eb
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | - Tan Vx
- Department of Biological Sciences, Macquarie University Centre for Motor Neuron Disease Research, Macquarie University, Ryde, Australia
| | - Guillemin Gg
- Department of Biological Sciences, Macquarie University Centre for Motor Neuron Disease Research, Macquarie University, Ryde, Australia
| | - Cox Pa
- Brain Chemistry Labs, Institute for Ethnomedicine, Jackson, WY, USA
| | - Mash Dc
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Bradley Wg
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
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8
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Filippini T, Mandrioli J, Malagoli C, Costanzini S, Cherubini A, Maffeis G, Vinceti M. Risk of Amyotrophic Lateral Sclerosis and Exposure to Particulate Matter from Vehicular Traffic: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030973. [PMID: 33499343 PMCID: PMC7908475 DOI: 10.3390/ijerph18030973] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/26/2022]
Abstract
(1) Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with still unknown etiology. Some occupational and environmental risk factors have been suggested, including long-term air pollutant exposure. We carried out a pilot case-control study in order to evaluate ALS risk due to particulate matter with a diameter of ≤10 µm (PM10) as a proxy of vehicular traffic exposure. (2) Methods: We recruited ALS patients and controls referred to the Modena Neurology ALS Care Center between 1994 and 2015. Using a geographical information system, we modeled PM10 concentrations due to traffic emissions at the geocoded residence address at the date of case diagnosis. We computed the odds ratio (OR) and 95% confidence interval (CI) of ALS according to increasing PM10 exposure, using an unconditional logistic regression model adjusted for age and sex. (3) Results: For the 132 study participants (52 cases and 80 controls), the average of annual median and maximum PM10 concentrations were 5.2 and 38.6 µg/m3, respectively. Using fixed cutpoints at 5, 10, and 20 of the annual median PM10 levels, and compared with exposure <5 µg/m3, we found no excess ALS risk at 5-10 µg/m3 (OR 0.87, 95% CI 0.39-1.96), 10-20 µg/m3 (0.94, 95% CI 0.24-3.70), and ≥20 µg/m3 (0.87, 95% CI 0.05-15.01). Based on maximum PM10 concentrations, we found a statistically unstable excess ALS risk for subjects exposed at 10-20 µg/m3 (OR 4.27, 95% CI 0.69-26.51) compared with those exposed <10 µg/m3. However, risk decreased at 20-50 µg/m3 (OR 1.49, 95% CI 0.39-5.75) and ≥50 µg/m3 (1.16, 95% CI 0.28-4.82). ALS risk in increasing tertiles of exposure showed a similar null association, while comparison between the highest and the three lowest quartiles lumped together showed little evidence for an excess risk at PM10 concentrations (OR 1.13, 95% CI 0.50-2.55). After restricting the analysis to subjects with stable residence, we found substantially similar results. (4) Conclusions: In this pilot study, we found limited evidence of an increased ALS risk due to long-term exposure at high PM10 concentration, though the high statistical imprecision of the risk estimates, due to the small sample size, particularly in some exposure categories, limited our capacity to detect small increases in risk, and further larger studies are needed to assess this relation.
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Affiliation(s)
- Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.)
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy;
| | - Carlotta Malagoli
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.)
| | - Sofia Costanzini
- DIEF Department of Engineering “Enzo Ferrari,” University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | | | | | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Correspondence:
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9
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Tesauro M, Bruschi M, Filippini T, D'Alfonso S, Mazzini L, Corrado L, Consonni M, Vinceti M, Fusi P, Urani C. Metal(loid)s role in the pathogenesis of amyotrophic lateral sclerosis: Environmental, epidemiological, and genetic data. ENVIRONMENTAL RESEARCH 2021; 192:110292. [PMID: 33027627 DOI: 10.1016/j.envres.2020.110292] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disorder of the motor system. The etiology is still unknown and the pathogenesis remains unclear. ALS is familial in the 10% of cases with a Mendelian pattern of inheritance. In the remaining sporadic cases, a multifactorial origin is supposed in which several predisposing genes interact with environmental factors. The etiological role of environmental factors, such as pesticides, exposure to electromagnetic fields, and metals has been frequently investigated, with controversial findings. Studies in the past two decades have highlighted possible roles of metals, and ionic homeostasis dysregulation has been proposed as the main trigger to motor-neuron degeneration. This study aims at evaluating the possible role of environmental factors in etiopathogenesis of ALS, with a particular attention on metal contamination, focusing on the industrial Briga area in the province of Novara (Piedmont region, North Italy), characterized by: i) a higher incidence of sporadic ALS (sALS) in comparison with the entire province, and ii) the reported environmental pollution. Environmental data from surface, ground and discharge waters, and from soils were collected and specifically analyzed for metal content. Considering the significance of genetic mechanisms in ALS, a characterization for the main ALS genes has been performed to evaluate the genetic contribution for the sALS patients living in the area of study. The main findings of this study are the demonstration that in the Briga area the most common metal contaminants are Cu, Zn, Cr, Ni (widely used in tip-plating processes), that are above law limits in surface waters, discharge waters, and soil. In addition, other metals and metalloids, such as Cd, Pb, Mn, and As show a severe contamination in the same area. Results of genetic analyses show that sALS patients in the Briga area do not carry recurrent mutations or an excess of mutations in the four main ALS causative genes (SOD1, TARDBP, FUS, C9ORF72) and for ATXN2 CAG repeat locus. This study supports the hypothesis that the higher incidence of sALS in Briga area may be related to environmental metal(loid)s contamination, along with other environmental factors. Further studies, implementing analysis of genetic polymorphisms, as well as investigation with long term follow-up, may yield to key aspects into the etiology of ALS. The interplay between different approaches (environmental, chemical, epidemiological, genetic) of our work provides new insights and methodology to the comprehension of the disease etiology.
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Affiliation(s)
- Marina Tesauro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via C. Pascal, 36, 20133, Milan, Italy.
| | - Maurizio Bruschi
- Department of Earth and Environmental Sciences, University of Milano - Bicocca, Piazza della Scienza, 1, 20133, Milan, Italy
| | - Tommaso Filippini
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi, 287, 41125, Modena, Italy
| | - Sandra D'Alfonso
- Department of Health Sciences, CAAD, UPO University, Via Solaroli, 17, 28100, Novara, Italy
| | - Letizia Mazzini
- ALS Centre Department of Neurology, Maggiore della Carità University Hospital, Corso Mazzini, 18, 28100, Novara, Italy
| | - Lucia Corrado
- Department of Health Sciences, CAAD, UPO University, Via Solaroli, 17, 28100, Novara, Italy
| | - Michela Consonni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via C. Pascal, 36, 20133, Milan, Italy
| | - Marco Vinceti
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi, 287, 41125, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, 715 Albany Street, MA 02118, USA
| | - Paola Fusi
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Piazza della Scienza, 2, 20126, Milan, Italy
| | - Chiara Urani
- Department of Earth and Environmental Sciences, University of Milano - Bicocca, Piazza della Scienza, 1, 20133, Milan, Italy.
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10
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Zuccarello P, Manganelli M, Oliveri Conti G, Copat C, Grasso A, Cristaldi A, De Angelis G, Testai E, Stefanelli M, Vichi S, Fiore M, Ferrante M. Water quality and human health: A simple monitoring model of toxic cyanobacteria growth in highly variable Mediterranean hot dry environments. ENVIRONMENTAL RESEARCH 2021; 192:110291. [PMID: 33027628 DOI: 10.1016/j.envres.2020.110291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
Due to population growth, urbanization and economic development, demand for freshwater in urban areas is increasing throughout Europe. At the same time, climate change, eutrophication and pollution are affecting the availability of water supplies. Sicily, a big island in southern Italy, suffers from an increasing drought and consequently water shortage. In the last decades, in Sicilian freshwater reservoirs several Microcystis aeruginosa and more recently Planktothrix rubescens blooms were reported. The aims of the study were: (1) identify and quantify the occurring species of cyanobacteria (CB), (2) identify which parameters, among those investigated in the waters, could favor their growth, (3) set up a model to identify reservoirs that need continuous monitoring due to the presences, current or prospected, of cyanobacterial blooms and of microcystins, relevant for environmental and, consequentially, for human health. Fifteen artificial reservoirs among the large set of Sicilian artificial water bodies were selected and examined for physicochemical and microbiological characterization. Additional parameters were assessed, including the presence, identification and count of the cyanobacterial occurring species, the measurement of microcystins (MCs) levels and the search for the genes responsible for the toxins production. Principal Component Analysis (PCA) was used to relate environmental condition to cyanobacterial growth. Water quality was poor for very few parameters, suggesting common anthropic pressures, and PCA highlighted clusters of reservoirs vulnerable to hydrological conditions, related to semi-arid Mediterranean climate and to the use of the reservoir. In summer, bloom was detected in only one reservoir and different species was highlighted among the Cyanobacteria community. The only toxins detected were microcystins, although always well below the WHO reference value for drinking waters (1.0 μg/L). However, molecular analysis could not show the presence of potential cyanotoxins producers since a few numbers of cells among total could be sufficient to produce these low MCs levels but not enough high to be proved by the traditional molecular method applied. A simple environmental risk-based model, which accounts for the high variability of both cyanobacteria growth and cyanotoxins producing, is proposed as a cost-effective tool to evaluate the need for monitoring activities in reservoirs aimed to guarantee supplying waters safety.
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Affiliation(s)
- P Zuccarello
- Environmental and Food Hygiene Laboratories, Department "G.F. Ingrassia", University of Catania, Italy
| | - M Manganelli
- Environment and Health Department, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - G Oliveri Conti
- Environmental and Food Hygiene Laboratories, Department "G.F. Ingrassia", University of Catania, Italy.
| | - C Copat
- Environmental and Food Hygiene Laboratories, Department "G.F. Ingrassia", University of Catania, Italy
| | - A Grasso
- Environmental and Food Hygiene Laboratories, Department "G.F. Ingrassia", University of Catania, Italy
| | - A Cristaldi
- Environmental and Food Hygiene Laboratories, Department "G.F. Ingrassia", University of Catania, Italy
| | - G De Angelis
- Environment and Health Department, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - E Testai
- Environment and Health Department, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - M Stefanelli
- Research Certification and Control Division, INAIL, Via Fontana Candida 1, Monteporzio Catone, Rome, Italy
| | - S Vichi
- Environment and Health Department, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - M Fiore
- Environmental and Food Hygiene Laboratories, Department "G.F. Ingrassia", University of Catania, Italy
| | - M Ferrante
- Environmental and Food Hygiene Laboratories, Department "G.F. Ingrassia", University of Catania, Italy
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11
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Filippini T, Tesauro M, Fiore M, Malagoli C, Consonni M, Violi F, Iacuzio L, Arcolin E, Oliveri Conti G, Cristaldi A, Zuccarello P, Zucchi E, Mazzini L, Pisano F, Gagliardi I, Patti F, Mandrioli J, Ferrante M, Vinceti M. Reply to Comment on "Environmental and Occupational Risk Factors of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186492. [PMID: 32906597 PMCID: PMC7559024 DOI: 10.3390/ijerph17186492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022]
Abstract
We much appreciate the positive comments and interest concerning our study on the environmental and occupational risk factors of amyotrophic lateral sclerosis (ALS) [...].
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Affiliation(s)
- Tommaso Filippini
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Correspondence:
| | - Marina Tesauro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Maria Fiore
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Carlotta Malagoli
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
| | - Michela Consonni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Federica Violi
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Laura Iacuzio
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Department of Public Health, Local Health Unit, 41121 Modena, Italy
| | - Elisa Arcolin
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
| | - Gea Oliveri Conti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Antonio Cristaldi
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Pietro Zuccarello
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Elisabetta Zucchi
- Neurology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Letizia Mazzini
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Fabrizio Pisano
- Neurological Rehabilitation Division, Policlinico San Marco di Zingonia, 24046 Zingonia (BG), Italy;
| | - Ileana Gagliardi
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Francesco Patti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy;
| | - Margherita Ferrante
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Marco Vinceti
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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12
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The cyanobacterial neurotoxin β-N-methylamino-L-alanine (BMAA) targets the olfactory bulb region. Arch Toxicol 2020; 94:2799-2808. [PMID: 32435914 PMCID: PMC7395073 DOI: 10.1007/s00204-020-02775-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022]
Abstract
Olfactory dysfunction is implicated in neurodegenerative disorders and typically manifests years before other symptoms. The cyanobacterial neurotoxin β-N-methylamino-l-alanine (BMAA) is suggested as a risk factor for neurodegenerative disease. Detection of BMAA in air filters has increased the concern that aerosolization may lead to human BMAA exposure through the air. The aim of this study was to determine if BMAA targets the olfactory system. Autoradiographic imaging showed a distinct localization of radioactivity in the right olfactory mucosa and bulb following a unilateral intranasal instillation of 3H-BMAA (0.018 µg) in mice, demonstrating a direct transfer of BMAA via the olfactory pathways to the brain circumventing the blood–brain barrier, which was confirmed by liquid scintillation. Treatment of mouse primary olfactory bulb cells with 100 µM BMAA for 24 h caused a disruption of the neurite network, formation of dendritic varicosities and reduced cell viability. The NMDA receptor antagonist MK-801 and the metabotropic glutamate receptor antagonist MCPG protected against the BMAA-induced alterations, demonstrating the importance of glutamatergic mechanisms. The ionotropic non-NMDA receptor antagonist CNQX prevented the BMAA-induced decrease of cell viability in mixed cultures containing both neuronal and glial cells, but not in cultures with neurons only, suggesting a role of neuron–glial interactions and glial AMPA receptors in the BMAA-induced toxicity. The results show that the olfactory region may be a target for BMAA following inhalation exposure. Further studies on the relations between environmental olfactory toxicants and neurodegenerative disorders are warranted.
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Filippini T, Tesauro M, Fiore M, Malagoli C, Consonni M, Violi F, Iacuzio L, Arcolin E, Oliveri Conti G, Cristaldi A, Zuccarello P, Zucchi E, Mazzini L, Pisano F, Gagliardi I, Patti F, Mandrioli J, Ferrante M, Vinceti M. Environmental and Occupational Risk Factors of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082882. [PMID: 32331298 PMCID: PMC7216189 DOI: 10.3390/ijerph17082882] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/10/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022]
Abstract
Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease with still unknown etiology. We aimed at investigating the association between environmental and occupational factors with ALS risk. Methods: We performed a population-based case-control study in four Italian provinces (Catania, Modena, Novara, and Reggio Emilia) by administration of tailored questionnaires to ALS cases (n = 95) and randomly selected population referents (n = 135). We estimated ALS risk by calculating the odds ratio (OR) with its 95% confidence interval (CI) using an unconditional logistic regression model. Results: We found a positive association with disease risk for history of occupation in the agricultural sector (OR = 2.09, 95% CI 0.79-7.54), especially for longer than 10 years (OR = 2.72, 95% 1.02-7.20). Overall occupational exposure to solvents also suggested a positive association, especially for thinners (OR = 2.27, 95% CI 1.14-4.54) and paint removers (OR = 2.01, 95% CI 0.90-4.48). Both occupational and environmental exposure to electromagnetic fields show a slightly increased risk with OR = 1.69 (95% CI 0.70-4.09) and 2.41 (95% CI 1.13-5.12), respectively. Occupational but not environmental exposure to pesticides (OR = 1.22, 95% CI 0.63-2.37), particularly fungicides, and exposure to metals (OR = 4.20, 95% CI 1.88-9.38), particularly lead, mercury, and selenium, showed an imprecise but positive association. Finally, there was an indication of increased risk for living in proximity to water bodies. Conclusions: Despite the caution that needs to be used due to some study limitations, such as the low number of exposed subjects and the possibility of recall bias, these results suggest the potential role of some environmental and occupational factors in ALS etiology.
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Affiliation(s)
- Tommaso Filippini
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Correspondence:
| | - Marina Tesauro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Maria Fiore
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Carlotta Malagoli
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
| | - Michela Consonni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (M.T.); (M.C.)
| | - Federica Violi
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Laura Iacuzio
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Department of Public Health, Local Health Unit, 41121 Modena, Italy
| | - Elisa Arcolin
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
| | - Gea Oliveri Conti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Antonio Cristaldi
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Pietro Zuccarello
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Elisabetta Zucchi
- Neurology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Letizia Mazzini
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Fabrizio Pisano
- Neurological Rehabilitation Division, Policlinico San Marco di Zingonia, 24046 Zingonia (BG), Italy;
| | - Ileana Gagliardi
- ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy; (L.M.); (I.G.)
| | - Francesco Patti
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy;
| | - Margherita Ferrante
- Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy; (M.F.); (G.O.C.); (A.C.); (P.Z.); (F.P.); (M.F.)
| | - Marco Vinceti
- CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (C.M.); (F.V.); (L.I.); (E.A.); (M.V.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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