Letter: Dimethylformamide: a cause of acute pancreatitis?

Association of urinary dimethylformamide metabolite with lung function decline: The potential mediating role of systematic inflammation estimated by C-reactive protein

Dimethylformamide (DMF) is a volatile organic compound listed as one of the four toxicants with the highest priority for human field study. However, the effect of DMF exposure on lung function and the underlying mechanisms remain unknown. We aimed to investigate the exposure-response relationship and possible mechanism between internal DMF exposure and lung function alteration. We studied 3701 Chinese adults from the Wuhan-Zhuhai cohort with a 3-year follow-up. The cross-sectional relationship between urinary biomarker of DMF exposure (N-Acetyl-S-(N-methylcarbamoyl)-L-cysteine, AMCC) and lung function, and the mediating role of plasma C-reactive protein (CRP) were assessed. We also convened a sub-cohort (N = 138) to assess the stability of AMCC in repeated urine samples collected for continuous 3 days and intervals of 1, 2 and 3 years. The longitudinal association between AMCC and lung function change in 3 years was further assessed. We found a dose-response relationship between AMCC and lung function reduction. Each 2-fold increase in AMCC was cross-sectionally associated with a 23.12-mL (95% CI: -36.68, -9.55) decrease in FVC and a 19.01-mL (95% CI: -31.08, -6.93) decrease in FEV₁. Increased CRP significantly mediated 5.39% and 5.87% of the AMCC-associated FVC and FEV₁ reductions, respectively. With 3-year follow-up, AMCC showed a fair to excellent stability (intra-class correlation coefficients were 0.88, 0.55, 0.60 and 0.50 for continuous 3 days, intervals of 1, 2 and 3 years, respectively) and was dose-dependently associated with longitudinal lung function decline. Compared with those with persistent low AMCC levels, participants with persistent high AMCC levels had a 101.09-mL/year (95% CI: -167.40, -34.77) decline in FVC and a 66.27-mL/year (95% CI: -114.14, -18.41) decline in FEV₁ in the sub-cohort. Similar results were found in the full-cohort. Our findings suggest that exposure of general population to environmental DMF may impair lung function, and systematic inflammation may be an underlying mechanism.

Occupational exposure to N,N-dimethylformamide in the summer and winter

We evaluated total body burden of N,N-dimethylformamide (DMF) taken through the lung and skin by personal exposure of workers to DMF and urinalysis of N-methylformamide (NMF) and N-acetyl-S(N-methylcarbamoyl)-cysteine (AMCC). A total of 270 workers were engaged in four different jobs in a workplace distant from main production lines emanating high levels of DMF. They were not required to wear any personal protective equipment including respirators or gloves. We found that log-transformed urinary levels of NMF and AMCC increased with an increase in log-transformed concentrations of exposure to DMF. Urinary levels of NMF and AMCC were significantly higher in the summer than the winter, although there was no significant seasonal difference in the concentrations of exposure to DMF. Our findings suggested that the increased urinary levels of NMF and AMCC in the summer resulted in increased skin absorption of DMF due to an increased amount of DMF absorbed by the moisturized skin under humid and hot conditions. Seasonal changes in the relative internal exposure index confirmed the present finding of enhanced summertime skin absorption of DMF. AMCC is thought to be a useful biomarker for assessments of cumulative exposure to DMF over a workweek and for evaluations of workers' health effects.

Seasonal difference in percutaneous absorption of N,N-dimethylformamide as determined using two urinary metabolites

OBJECTIVE

We evaluated the percutaneous absorption of N,N-dimethylformamide (DMF) in DMF-exposed workers in the summer and winter by assessing their urinary levels of DMF metabolites.

METHODS

Breathing-zone concentrations of DMF and workers' urinary levels of N-methylformamide (NMF) and N-acetyl-S-(N-methylcarbamoyl)-cysteine (AMCC) were simultaneously measured in the summer and winter in 193 male workers wearing a respirator and chemical protective gloves.

RESULTS

The mean breathing-zone concentrations of DMF in both seasons were below the occupational exposure limit of 10 ppm. Although there was no significant seasonal difference in the breathing-zone concentrations of DMF, workers' urinary levels of NMF and AMCC were significantly higher in the summer than in the winter. Log-transformed urinary levels of the metabolites were significantly correlated with log-transformed breathing-zone concentrations of DMF in the summer, whereas no significant correlation between AMCC and DMF was found in the winter. The urinary levels of AMCC were dispersed more widely than those of NMF, suggesting that urinary AMCC reflected the cumulative exposure to DMF over a workweek.

CONCLUSIONS

Percutaneous absorption was the principal route of exposure to DMF for the respirator-wearing workers. Increased urinary levels of NMF and AMCC in the summer were attributed to increased percutaneous absorption of DMF resulting from the increased amount of water-soluble DMF absorbed by sweaty skin caused by the increased summertime room temperature and humidity.

Can by-products in country-made alcohols induce acute pancreatitis?

OBJECTIVES

We previously reported a high incidence of alcohol-related acute pancreatitis (AP) in Goa, India, where country-made alcoholic products are consumed in addition to the commercially available alcoholic products. We aimed to analyze the composition of these country-made alcoholic products consumed by a population with a high incidence of alcohol-related AP.

METHODS

Three locally distilled alcoholic products (ethanol content, >20%) regularly consumed by patients developing AP, as determined by responses in a patient questionnaire, were selected. Three commercially available products with comparable ethanol content (rum, whiskey, and brandy) were used for comparison. Representative samples were analyzed using gas chromatography/mass spectrometry. Compound assignments used mass spectral searches of the NIST library (2008).

RESULTS

Commercially available rum, whiskey, and brandy used for comparison contained the 2 major constituents, ethanol and water. In addition, the country-made alcoholic products contained a higher level of by-products including long-chain alcohols (eg, butanol, propanol), aldehydes (eg, acetaldehyde), acids (eg, acetic acid), and even traces of methanol.

CONCLUSIONS

Country-made alcoholic products contain many compounds in addition to ethanol. Given the high incidence of alcohol-related AP in the population where these products are consumed, further evaluation of their constituents in relation to the induction of pancreatic damage is warranted.

N,N-Dimethylformamide modulates acid extrusion from murine hepatoma cells

N,N-Dimethylformamide (DMF) affects cellular differentiation, causes hepatotoxicity and gastric irritation, and may be carcinogenic. Since these processes involve changes in cellular pH homeostasis, we investigated the effects of DMF on H+ extrusion and cytosolic pH (pHi) of mouse hepatoma cells (Hepa 1C1C7). Extracellular pH was monitored using a silicon-based sensor system (Cytosensor microphysiometer) and pHi was monitored by fluorescence spectrophotometry. Superfusion of cells with DMF (0.25 to 0.5 M) suppressed the extracellular acidification rate (ECAR) below baseline. Following washout of DMF there was a rapid, concentration-dependent, prolonged overshoot of ECAR above baseline rates. Removal of extracellular Na+ or superfusion with amiloride abolished the overshoot in acidification rate, indicating involvement of Na+/H+ exchange. The overshoot was dependent on extracellular glucose, suggesting that it arises from an increase in metabolic acid production. Fluorescence measurements showed that DMF did not change pHi. Furthermore, DMF did not alter the rate of pHi recovery of cells acid loaded using nigericin, indicating that DMF does not directly alter Na+/H+ exchange activity in these cells. In summary, these data suggest that suppression of acidification rate by DMF is likely due to decreased metabolic acid production. Washout of DMF is then accompanied by increased glucose metabolism and H+ efflux via Na+/H+ exchange. It is possible that alterations in H+ production and transport contribute to the hepatotoxicity of DMF and its effects on cellular differentiation.

Biological monitoring of workers exposed to N-N-dimethylformamide. II. Dimethylformamide and its metabolites in urine of exposed workers

N,N-Dimethylformamide (DMF) exposure was monitored in a synthetic leather factory; at the same time, urinary dimethylformamide and its metabolites were measured in urine samples collected before and at the end of workshifts. The study was run during two different periods. During the first phase ten workers were observed for 3 days (Monday, Tuesday and Wednesday) in the same week. In the second phase 16 workers were involved in the study on a Friday and on the following Monday. Urinary DMF, as well as hydroxymethyl-N-methylformamide and hydroxymethylformamide [measured as N-methylformamide (NMF) and formamide, respectively], were measured as a "physiological" product in subjects not exposed to dimethylformamide. Environmental exposure to DMF ranged between 10 and 25 mg/m3. The unmodified solvent found in urine collected at the end of the exposure was significantly related to the environmental concentrations of DMF; its urinary concentrations were found to range between 0.1 and 1 mg/l. Higher concentrations of NMF (mean 23.3 mg/l) and formamide (24.7 mg/l) were measured in urine samples collected at the end of workshifts. The same concentrations were related to individual exposures to DMF. N-Acetyl-S-(N-methylcarbamoyl)cysteine in the urine of workers exposed to DMF showed a mean concentration of 40.4 mg/l on Friday (before and after the workshift) and a mean concentration of 10.3 mg/l on Monday. Its slow kinetic profile favours its body accumulation during the working week.(ABSTRACT TRUNCATED AT 250 WORDS)

Occupational dimethylformamide exposure. 3. Health effects of dimethylformamide after occupational exposure at low concentrations

A factory survey was conducted in a plant where N,N-dimethylformamide (DMF) was in use during the production of polyurethane plastics and related materials. In all, 318 DMF-exposed workers (195 men and 123 women) and 143 non-exposed controls (67 men and 76 women) were examined for time-weighted average exposure (to DMF and other solvents by diffusive sampling), hematology, serum biochemistry, subjective symptoms, and clinical signs. Most of the exposed workers were exposed only to DMF, whereas others were exposed to a combination of DMF and toluene. DMF exposure in the former group was up to 7.0 ppm (geometric mean on a workshop basis), whereas it was up to 2.1 ppm in combination with 4.2 ppm toluene. Both hematology and serum biochemistry, results (including aspartate and alanine aminotransferases, gamma-glutamyl transpeptidase and amylase) were essentially comparable among the 3 groups. There was, however, a dose-dependent increase in subjective symptoms, especially during work, and in digestive system-related symptoms such as nausea and abdominal pain in the past 3-month period. The prevalence rate of alcohol intolerance complaints among male (assumedly) social drinkers was also elevated in relation to DMF dose.

Clinical and pathological characteristics of hepatotoxicity associated with occupational exposure to dimethylformamide

The clinical characteristics, laboratory results, and liver biopsy findings of seven workers with toxic liver injury associated with exposure to several solvents, including substantial levels of the widely used solvent dimethylformamide, are presented. Three patients had short exposure (less than 3 months), four long exposure (greater than 1 year). Among those with brief exposure, symptoms included anorexia, abdominal pain, and disulfiram-type reaction. Aminotransferases were markedly elevated with the ratio of alanine aminotransferase to aspartate aminotransferase always greater than 1. Liver biopsy showed focal hepatocellular necrosis and microvesicular steatosis with prominence of smooth endoplasmic reticulum, complex lysosomes, and pleomorphic mitochondria with crystalline inclusions. Among workers with long exposure, symptoms were minimal and enzyme elevations modest. Biopsies showed macrovesicular steatosis, pleomorphic mitochondria without crystalloids, and prominent smooth endoplasmic reticulum, but no evidence of persisting acute injury or fibrosis. Abnormal aminotransferases in both groups may persist for months after removal from exposure, but progression to cirrhosis in continually exposed workers was not observed. We conclude that exposure of these workers to solvents, chiefly dimethylformamide, may result in two variants of toxic liver injury with subtle clinical, laboratory, and morphological features. This may be readily overlooked if occupational history and biopsy histology are not carefully evaluated.

Dimethylformamide (DMF) hepatotoxicity

Scattered case reports of accidental exposure and a few epidemiological studies have indicated that the liver is the main target organ following acute and chronic exposure to dimethylformamide (DMF). This has been confirmed in several animal species. In humans, ethanol intolerance is one of the earliest manifestations of (excessive) exposure to DMF, followed at higher exposure levels by various complaints (nausea, vomiting, abdominal pain) and the release of liver cytolytic enzymes in the plasma. The metabolic pathway of DMF has been recently clarified, but the primary cellular lesion responsible for its hepatotoxicity is still unknown.

Biological effects of acetamide, formamide, and their monomethyl and dimethyl derivatives

The industrial use of certain acetamides and formamides (particularly DMAC and DMF) for their solvent properties has resulted in rather extensive examination of their biological properties. Both DMAC and DMF are rapidly absorbed through biological membranes and are metabolized by demethylation first to monomethyl derivatives and then to the parent acetamide or formamide. Relatively high single doses to various species following oral, dermal, i.p., i.v., or inhalation exposures generally are required to produce mortality. The liver is the primary target following acute high level exposure, but massive doses can also produce damage to other organs and tissues. Repeated sublethal treatment by various routes also shows the liver to be the target organ with the degree of damage being proportional to the amount absorbed. With MMF, the potential usefulness as a cancer chemotherapeutic agent needs to be measured against the hepatotoxic effects produced in man. Acetamides and formamides are generally inactive in mutagenicity tests. Mammalian test systems do not appear to be genetically sensitive and DMF has been recommended for use as the vehicle in microbial assays designed to test for genetic activity of hard-to-dissolve chemicals. Embryotoxicity can be demonstrated at high doses; doses which generally show toxicity to the maternal animals. Structural abnormalities in sensitive species such as the rabbit are produced following exposure at near-lethal levels. The spectrum of abnormalities seen is broad and fails to show any time or site specificity in terms of developing organs/organ systems. Inhalation exposures to DMAC and DMF at levels producing some maternal toxicity in rats have produced no teratogenic response and only slight evidence of embryotoxicity. Long-term feeding of relatively high levels of acetamide produces liver cancer in rats. DMAC and DMF appear to be noncarcinogenic. The environmental toxicity of these chemicals is low. Liver damage can be produced by overexposure to these chemicals in man. Airborne concentrations need to be controlled and care should be taken to avoid excessive liquid contact as the chemicals are absorbed through the skin. A relationship exists between the amount of DMAC or DMF absorbed and the amount of MMAC or MMF excreted in the urine so that biomonitoring of the urinary metabolites can indicate situations in which total exposures, both dermal and inhalation, are excessive. An interaction between DMF and ethanol occurs such that signs, including severe facial flushing, appear when DMF-exposed individuals consume alcoholic beverages.

N,N-Dimethylformamide-induced effects on hepatic and renal xenobiotic enzymes with emphasis on aldehyde metabolism in the rat

Male Wistar rats were dosed with N,N-dimethylformamide (DMF) in drinking water at four concentration levels (0,0.1,0.5 or 1.0 g/l) for 2 or 7 weeks. Upon evaluation of the effects in the liver increased values were found for the following parameters: liver/body weight-ratio, GSH content, ethoxycoumarin O-deethylase and UDPglucuronosyltransferase activities. The GSH content, deethylase activity and, transiently, the glucuronidation activity were slightly increased also in the kidneys. Oxidative N-demethylation of DMF by hepatic microsomes in vitro was not enhanced by oral treatment. No DMF-dependent formaldehyde liberation in vitro could be detected under conditions where formaldehyde liberation from N,N-dimethylnitrosamine could be demonstrated. However, the endogenous rate of formaldehyde generation by liver microsomes isolated from DMF-treated rats was enhanced with the highest oral dose of DMF. The daily intake of DMF lowered the activities of both formaldehyde and propionaldehyde dehydrogenases in the liver soluble fraction. No inhibition of these dehydrogenases was shown in vitro by DMF (less than or equal to 10 mM) or by its main urinary metabolite N-methylformamide (less than or equal to 10 mM). The observed impairment of aldehyde oxidation in liver and kidneys of the rat after the DMF intake could explain the mechanism behind the alcohol intolerance observed in man after DMF-exposure.

Dimethylformamide and alcohol intolerance

Facial flushing and other symptoms were reported by 19 of a group of 102 men who worked with dimethylformamide (DMF). Twenty-six of the 34 episodes occurred after the workers had consumed alcoholic drinks. The metabolite N-methylformamide (MF) was detected in the urine on 45 occasions, the highest recorded concentration being 77 microliter/litre. The highest recorded concentration of DMF in air was 200 ppm. The DMF-ethanol reaction is possibly attributable to the inhibition of acetaldehyde metabolism, probably by MF.