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Kong X, Qiu Z. Correlation of exposure to volatile organic compounds with myocardial infarction: A Cross-sectional study based on NHANES 2011-2018. Sci Rep 2025; 15:17736. [PMID: 40404723 PMCID: PMC12099010 DOI: 10.1038/s41598-025-01773-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 05/08/2025] [Indexed: 05/24/2025] Open
Abstract
Myocardial infarction (MI), commonly referred to as a heart attack, ranks among the foremost causes of death worldwide. The contribution of exposure to volatile organic compounds (VOCs) to MI is still not well established. This study aims to examine how urinary metabolites of 19 volatile organic compounds (mVOCs) correlate with MI risk in the ordinary population. The data were extracted from the National Health and Nutrition Examination Survey spanning from 2011 to 2018, a nationally representative program conducted by the Centers for Disease Control and Prevention (CDC) to collect and assess the health and nutritional status of the non-institutionalized U.S. population through interviews and physical examinations. The relationship between a single mVOC and MI was analyzed by applying a logistic regression model. The nonlinear relationship between a single mVOC and MI was investigated with the help of a restricted cubic spline regression model. The overall association between mVOCs and MI was examined using a weighted quantile sum (WQS) regression model. The analysis included 5,211 participants, among whom 209 experienced MI, with mVOC levels assessed. A positive association between N-acetyl-S-(3-hydroxypropyl)-L-cysteine (3HPMA) [OR, 1.95; 95% CI, (1.06, 3.58)] and MI incidence was observed after adjustment for potential confounders. Similarly, N-acetyl-S-(2-cyanoethyl)-L-cysteine (CYMA) was also significantly associated with MI incidence [OR, 1.8; 95% CI, (1.14, 2.83)]. Each incremental unit increase in WQS was linked to a 20.4% rise in MI risk (95% CI, 1.05, 1.38). Among them, N-acetyl-S-(3,4-dihydroxybutyl)-L-cysteine (DHBMA), N-acetyl-S-(2-carboxyethyl)-L-cysteine (CEMA), CYMA, N-acetyl-S-(phenyl-2-hydroxyethyl)-L-cysteine (PHEMA), 3HPMA, and 3- and 4-methylhippuric acid (3,4MHA) were identified as key contributors, with DHBMA showing the highest weight (0.27). mVOCs are metabolic derivatives of VOC exposure, with common sources including industrial emissions, environmental pollution, and tobacco combustion. The findings revealed a significant association between urinary mVOCs and MI, implying exposure to these compounds may be linked to an increased MI risk.
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Affiliation(s)
- Xiangyu Kong
- Department of Traditional Chinese Medicine, Shanyang Town Community Health Service Center, Jinshan District, Shanghai, 201508, China.
| | - Zhao Qiu
- Department of Rehabilitation Medicine, Shanyang Town Community Health Service Center, Jinshan District, Shanghai, 201508, China
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2
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Stayner LT, Carreón-Valencia T, Demers PA, Fritz JM, Sim MR, Stewart P, Tsuda H, Cardenas A, Consonni D, Davies L, De Matteis S, Felley-Bosco E, Ghio AJ, Göen T, Grosse Y, Gualtieri AF, Josephy PD, Koutros S, Linhart I, Louro H, O'Brien KM, Panzacchi S, Peña L, Rössner P, Schildkraut JM, Stefaniak AB, Wentzensen N, Wild P, Xu Y, de Conti A, Facchin C, Wedekind R, Ahmadi A, Blanco J, Chittiboyina S, Kulasingam S, MacLehose R, Motlhale M, Shah S, Suonio E, Mattock H, Kunzmann A, Madia F, Pasqual E, Benbrahim-Tallaa L, Schubauer-Berigan MK. Carcinogenicity of talc and acrylonitrile. Lancet Oncol 2024; 25:962-963. [PMID: 38976996 DOI: 10.1016/s1470-2045(24)00384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Affiliation(s)
| | | | - Paul A Demers
- International Agency for Research on Cancer, Lyon, France
| | - Jason M Fritz
- International Agency for Research on Cancer, Lyon, France
| | - Malcolm R Sim
- International Agency for Research on Cancer, Lyon, France
| | | | - Hiroyuki Tsuda
- International Agency for Research on Cancer, Lyon, France
| | | | - Dario Consonni
- International Agency for Research on Cancer, Lyon, France
| | - Laurie Davies
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Andrew J Ghio
- International Agency for Research on Cancer, Lyon, France
| | - Thomas Göen
- International Agency for Research on Cancer, Lyon, France
| | - Yann Grosse
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Stella Koutros
- International Agency for Research on Cancer, Lyon, France
| | - Igor Linhart
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Laura Peña
- International Agency for Research on Cancer, Lyon, France
| | - Pavel Rössner
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Pascal Wild
- International Agency for Research on Cancer, Lyon, France
| | - Yuanyuan Xu
- International Agency for Research on Cancer, Lyon, France
| | - Aline de Conti
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Ayat Ahmadi
- International Agency for Research on Cancer, Lyon, France
| | - Jessica Blanco
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | | | - Sanam Shah
- International Agency for Research on Cancer, Lyon, France
| | - Eero Suonio
- International Agency for Research on Cancer, Lyon, France
| | - Heidi Mattock
- International Agency for Research on Cancer, Lyon, France
| | | | - Federica Madia
- International Agency for Research on Cancer, Lyon, France
| | - Elisa Pasqual
- International Agency for Research on Cancer, Lyon, France
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Etemadi A, Poustchi H, Chang CM, Calafat AM, Blount BC, Bhandari D, Wang L, Roshandel G, Alexandridis A, Botelho JC, Xia B, Wang Y, Sosnoff CS, Feng J, Nalini M, Khoshnia M, Pourshams A, Sotoudeh M, Gail MH, Dawsey SM, Kamangar F, Boffetta P, Brennan P, Abnet CC, Malekzadeh R, Freedman ND. Exposure to polycyclic aromatic hydrocarbons, volatile organic compounds, and tobacco-specific nitrosamines and incidence of esophageal cancer. J Natl Cancer Inst 2024; 116:379-388. [PMID: 37856326 PMCID: PMC10919344 DOI: 10.1093/jnci/djad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/18/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Studying carcinogens in tobacco and nontobacco sources may be key to understanding the pathogenesis and geographic distribution of esophageal cancer. METHODS The Golestan Cohort Study has been conducted since 2004 in a region with high rates of esophageal squamous cell carcinoma. For this nested study, the cases comprised of all incident cases by January 1, 2018; controls were matched to the case by age, sex, residence, time in cohort, and tobacco use. We measured urinary concentrations of 33 exposure biomarkers of nicotine, polycyclic aromatic hydrocarbons, volatile organic compounds, and tobacco-specific nitrosamines. We used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals for associations between the 90th vs the 10th percentiles of the biomarker concentrations and incident esophageal squamous cell carcinoma. RESULTS Among individuals who did not currently use tobacco (148 cases and 163 controls), 2 acrolein metabolites, 2 acrylonitrile metabolites, 1 propylene oxide metabolite, and one 1,3-butadiene metabolite were significantly associated with incident esophageal squamous cell carcinoma (adjusted odds ratios between 1.8 and 4.3). Among tobacco users (57 cases and 63 controls), metabolites of 2 other volatile organic compounds (styrene and xylene) were associated with esophageal squamous cell carcinoma (OR = 6.2 and 9.0, respectively). In tobacco users, 2 tobacco-specific nitrosamines (NNN and N'-Nitrosoanatabine) were also associated with esophageal squamous cell carcinoma. Suggestive associations were seen with some polycyclic aromatic hydrocarbons (especially 2-hydroxynaphthalene) in nonusers of tobacco products and other tobacco-specific nitrosamines in tobacco users. CONCLUSION These novel associations based on individual-level data and samples collected many years before cancer diagnosis, from a population without occupational exposure, have important public health implications.
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Affiliation(s)
- Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreaticobilliary Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Cindy M Chang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deepak Bhandari
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lanqing Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Julianne Cook Botelho
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Baoyun Xia
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yuesong Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Connie S Sosnoff
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jun Feng
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mahdi Nalini
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Masoud Khoshnia
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Sotoudeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitchell H Gail
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sanford M Dawsey
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Christian C Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Judice SA, Sussman HE, Walker DM, O’Neill JP, Albertini RJ, Walker VE. Clonality, trafficking, and molecular alterations among Hprt mutant T lymphocytes isolated from control mice versus mice treated with N-ethyl-N-nitrosourea. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2023; 64:432-457. [PMID: 37957787 PMCID: PMC10842105 DOI: 10.1002/em.22579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023]
Abstract
Mutations in T lymphocytes (T-cells) are informative quantitative markers for environmental mutagen exposures, but risk extrapolations from rodent models to humans also require an understanding of how T-cell development and proliferation kinetics impact mutagenic outcomes. Rodent studies have shown that patterns in chemical-induced mutations in the hypoxanthine-guanine phosphoribosyltransferase (Hprt) gene of T-cells differ between lymphoid organs. The current work was performed to obtain knowledge of the relationships between maturation events during T-cell development and changes in chemical-induced mutant frequencies over time in differing immune compartments of a mouse model. A novel reverse transcriptase-polymerase chain reaction based method was developed to determine the specific T-cell receptor beta (Tcrb) gene mRNA expressed in mouse T-cell isolates, enabling sequence analysis of the PCR product that then identifies the specific hypervariable CDR3 junctional region of the expressed Tcrb gene for individual isolates. Characterization of spontaneous Hprt mutant isolates from the thymus, spleen, and lymph nodes of control mice for their Tcrb gene expression found evidence of in vivo clonal amplifications of Hprt mutants and their trafficking between tissues in the same animal. Concurrent analyses of Hprt mutations and Tcrb gene rearrangements in different lymphoid tissues of control versus N-ethyl-N-nitrosourea-exposed mice permitted elucidation of the localization and timing of mutational events in T-cells, establishing that mutagenesis occurs primarily in the pre-rearrangement replicative period in pre-thymic/thymic populations. These findings demonstrate that chemical-induced mutagenic burden is determined by the combination of mutagenesis and T-cell clonal expansion, processes with roles in immune function and in the pathogenesis of autoimmune disease and cancer.
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Affiliation(s)
- Stephen A. Judice
- Genetic Toxicology Laboratory, University of Vermont, Burlington, Vermont
- EnviroLogix, Portland, Maine
| | - Hillary E. Sussman
- School of Public Health, University at Albany − SUNY, Albany, NY
- Wadsworth Center, New York State Department of Health, Albany, NY
- Cold Spring Harbor Laboratory Press, Cold Spring Harbor, NY
| | - Dale M. Walker
- Experimental Pathology Laboratories, Sterling, VA
- The Burlington HC Research group, Inc., Jericho, Vermont
| | - J. Patrick O’Neill
- Genetic Toxicology Laboratory, University of Vermont, Burlington, Vermont
| | - Richard J. Albertini
- Genetic Toxicology Laboratory, University of Vermont, Burlington, Vermont
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Vernon E. Walker
- Wadsworth Center, New York State Department of Health, Albany, NY
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
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5
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Douglas GR, Beevers C, Gollapudi B, Keig‐Shevlin Z, Kirkland D, O'Brien JM, van Benthem J, Yauk CL, Young RR, Marchetti F. Impact of sampling time on the detection of mutations in rapidly proliferating tissues using transgenic rodent gene mutation models: A review. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2022; 63:376-388. [PMID: 36271823 PMCID: PMC10099936 DOI: 10.1002/em.22514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
The OECD Test Guideline 488 (TG 488) for the Transgenic Rodent Gene Mutation Assay has undergone several revisions to update the recommended design for studying mutations in somatic tissues and male germ cells. The recently revised TG recommends a single sampling time of 28 days following 28 days of exposure (i.e., 28 + 28 days) for all tissues, irrespective of proliferation rates. An alternative design (i.e., 28 + 3 days) is appropriate when germ cell data is not required, nor considered. While the 28 + 28 days design is clearly preferable for slowly proliferating somatic tissues and germ cells, there is still uncertainty about the impact of extending the sampling time to 28 days for rapidly somatic tissues. Here, we searched the available literature for evidence supporting the applicability and utility of the 28 + 28 days design for rapidly proliferating tissues. A total of 79 tests were identified. When directly comparing results from both designs in the same study, there was no evidence that the 28 + 28 days regimen resulted in a qualitatively different outcome from the 28 + 3 days design. Studies with a diverse range of agents that employed only a 28 + 28 days protocol provide further evidence that this design is appropriate for rapidly proliferating tissues. Benchmark dose analyses demonstrate high quantitative concordance between the 28 + 3 and 28 + 28 days designs for rapidly proliferating tissues. Accordingly, our review confirms that the 28 + 28 days design is appropriate to assess mutagenicity in both slowly and rapidly proliferating somatic tissues, and germ cells, and provides further support for the recommended design in the recently adopted TG 488.
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Affiliation(s)
| | | | | | | | | | | | - Jan van Benthem
- National Institute for the Netherlands Public Health and the EnvironmentBilthovenThe Netherlands
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6
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Waidyanatha S, Black SR, Witt KL, Fennell TR, Swartz C, Recio L, Watson SL, Patel P, Fernando RA, Rider CV. The common indoor air pollutant α-pinene is metabolized to a genotoxic metabolite α-pinene oxide. Xenobiotica 2022; 52:301-311. [PMID: 35473450 DOI: 10.1080/00498254.2022.2070047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
1. α-Pinene caused a concentration-responsive increase in bladder hyperplasia and decrease in sperm counts in rodents following inhalation exposure. Additionally, it formed a prospective reactive metabolite, α-pinene oxide.2. To provide human relevant context for data generated in animal models and explore potential mechanism, we undertook studies to investigate the metabolism of α-pinene to α-pinene oxide and mutagenicity of α-pinene and α-pinene oxide.3. α-Pinene oxide was formed in rat and human microsomes and hepatocytes with some species differences. Based on area under the concentration versus time curves, the formation of α-pinene oxide was up to 4-fold higher in rats than in humans.4. While rat microsomes cleared α-pinene oxide faster than human microsomes, the clearance of α-pinene oxide in hepatocytes was similar between species.5. α-Pinene was not mutagenic with or without induced rat liver S9 in Salmonella typhimurium or Escherichia coli when tested up to 10,000 μg/plate while α-pinene oxide was mutagenic at ≥25 μg/plate.6. α-Pinene was metabolized to α-pinene oxide under the conditions of the bacterial mutation assay although the concentration was approximately 3-fold lower than the lowest α-pinene oxide concentration that was positive in the assay, potentially explaining the lack of mutagenicity observed with α-pinene.
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Affiliation(s)
- Suramya Waidyanatha
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | | | - Kristine L Witt
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | | | - Carol Swartz
- Integrated Laboratory Systems, Research Triangle Park, NC, USA
| | - Leslie Recio
- Integrated Laboratory Systems, Research Triangle Park, NC, USA
| | | | - Purvi Patel
- RTI International, Research Triangle Park, NC, USA
| | | | - Cynthia V Rider
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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Luo YS, He QK, Sun MX, Qiao FX, Liu YC, Xu CL, Xu ZR, Zhao SC, Wang HL, Qi ZQ, Liu Y. Acrylonitrile exposure triggers ovarian inflammation and decreases oocyte quality probably via mitochondrial dysfunction induced apoptosis in mice. Chem Biol Interact 2022; 360:109934. [DOI: 10.1016/j.cbi.2022.109934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/18/2022]
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Acrylonitrile induction of rodent neoplasia: Potential mechanism of action and relevance to humans. TOXICOLOGY RESEARCH AND APPLICATION 2022. [DOI: 10.1177/23978473211055363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acrylonitrile, an industrial chemical, is a multisite carcinogen in rats and mice, producing tumors in four tissues with barrier function, that is, brain, forestomach, Zymbal’s gland, and Harderian gland. To assess mechanism(s) of action (MoA) for induction of neoplasia and to evaluate whether the findings in rodents are indicative of human hazard, data on the potential key effects produced by acrylonitrile in the four rodent target tissues of carcinogenicity were evaluated. A notable finding was depletion of glutathione in various organs, including two target tissues, the brain, and forestomach, suggesting that this effect could be a critical initiating event. An additional combination of oxidative DNA damage and cytotoxic effects of acrylonitrile and its metabolites, cyanide, and 2-cyanoethylene oxide, could initiate pro-inflammatory signaling and sustained cell and tissue injury, leading to compensatory cell proliferation and neoplastic development. The in vivo DNA-binding and genotoxicity of acrylonitrile has been studied in several target tissues with no compelling positive results. Thus, while some mutagenic effects were reported in acrylonitrile-exposed rodents, data to determine whether this mutagenicity stems from direct DNA reactivity of acrylonitrile are insufficient. Accordingly, the induction of tumors in rodents is consistent primarily with a non-genotoxic MoA, although a contribution from weak mutagenicity cannot be ruled out. Mechanistic data to support conclusions regarding human hazard from acrylonitrile exposure is weak. Comparison of metabolism of acrylonitrile between rodents and humans provide little support for human hazard. Three of the tissues affected in bioassays (forestomach, Zymbal’s gland, and Harderian gland) are present only in rodents, while the brain is anatomically different between rodents and humans, diminishing relevance of tumor induction in these tissues to human hazard. Extensive epidemiological data has not revealed causation of human cancer by acrylonitrile.
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Waters MD, Warren S, Hughes C, Lewis P, Zhang F. Human genetic risk of treatment with antiviral nucleoside analog drugs that induce lethal mutagenesis: The special case of molnupiravir. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2022; 63:37-63. [PMID: 35023215 DOI: 10.1002/em.22471] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/28/2021] [Accepted: 01/08/2022] [Indexed: 06/14/2023]
Abstract
This review considers antiviral nucleoside analog drugs, including ribavirin, favipiravir, and molnupiravir, which induce genome error catastrophe in SARS-CoV or SARS-CoV-2 via lethal mutagenesis as a mode of action. In vitro data indicate that molnupiravir may be 100 times more potent as an antiviral agent than ribavirin or favipiravir. Molnupiravir has recently demonstrated efficacy in a phase 3 clinical trial. Because of its anticipated global use, its relative potency, and the reported in vitro "host" cell mutagenicity of its active principle, β-d-N4-hydroxycytidine, we have reviewed the development of molnupiravir and its genotoxicity safety evaluation, as well as the genotoxicity profiles of three congeners, that is, ribavirin, favipiravir, and 5-(2-chloroethyl)-2'-deoxyuridine. We consider the potential genetic risks of molnupiravir on the basis of all available information and focus on the need for additional human genotoxicity data and follow-up in patients treated with molnupiravir and similar drugs. Such human data are especially relevant for antiviral NAs that have the potential of permanently modifying the genomes of treated patients and/or causing human teratogenicity or embryotoxicity. We conclude that the results of preclinical genotoxicity studies and phase 1 human clinical safety, tolerability, and pharmacokinetics are critical components of drug safety assessments and sentinels of unanticipated adverse health effects. We provide our rationale for performing more thorough genotoxicity testing prior to and within phase 1 clinical trials, including human PIG-A and error corrected next generation sequencing (duplex sequencing) studies in DNA and mitochondrial DNA of patients treated with antiviral NAs that induce genome error catastrophe via lethal mutagenesis.
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Affiliation(s)
- Michael D Waters
- Michael Waters Consulting USA, Hillsborough, North Carolina, USA
| | | | - Claude Hughes
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Fengyu Zhang
- Global Clinical and Translational Research Institute, Bethesda, Maryland, USA
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