Air Pollution, Ultrafine Particles, and Your Brain: Are Combustion Nanoparticle Emissions and Engineered Nanoparticles Causing Preventable Fatal Neurodegenerative Diseases and Common Neuropsychiatric Outcomes?

A systematic review of air pollution exposure and brain structure and function during development

OBJECTIVES

Air pollutants are known neurotoxicants. In this updated systematic review, we evaluate new evidence since our 2019 systematic review on the effect of outdoor air pollution exposure on childhood and adolescent brain structure and function as measured by magnetic resonance imaging (MRI).

METHODS

Using PubMed, Web of Science, and Scopus we conducted an updated literature search and systematic review of articles published through January 2025, using key terms for air pollution and functional and/or structural MRI. Two raters independently screened all articles using Covidence and implemented the risk of bias instrument for systematic reviews used to inform the World Health Organization Global Air Quality Guidelines.

RESULTS

We identified 29 relevant papers, and 20 new studies met our inclusion criteria. Including six studies from our 2019 review, the 26 publications to date include study populations from the United States, Netherlands, Spain, and United Kingdom. Studies investigated exposure periods spanning pregnancy through early adolescence, and estimated air pollutant exposure levels via personal monitoring, geospatial residential estimates, or school courtyard monitors. Brain MRI occurred when children were on average 6-14.7 years old; however, one study assessed newborns. Several MRI modalities were leveraged, including structural morphology, diffusion tensor imaging, restriction spectrum imaging, arterial spin labeling, magnetic resonance spectroscopy, as well as resting-state and task-based functional MRI. Air pollutants were associated with widespread brain differences, although the magnitude and direction of findings are largely inconsistent, making it difficult to draw strong conclusions.

CONCLUSION

Prenatal and childhood exposure to outdoor air pollution is associated with structural and functional brain variations. Compared to our initial 2019 review comprised of only cross-sectional studies, the current literature now includes longitudinal studies and more advanced neuroimaging methods. Further research is needed to clarify the effects of developmental timing, along with the downstream implications of outdoor air pollution exposure on children's cognitive and mental health.

Mechanism of S-Palmitoylation in Polystyrene Nanoplastics-Induced Macrophage Cuproptosis Contributing to Emphysema through Alveolar Epithelial Cell Pyroptosis

More than microplastics, nanoplastics may pose a greater toxic effect on humans due to their unique physicochemical properties. Currently, research on lung diseases caused by respiratory exposure to nanoplastics is scarce, with epigenetic mechanisms warranting further investigation. In the present study, we exposed rats to polystyrene nanoplastics (PS-NPs) via an oral-nasal exposure system and found that PS-NPs exposure resulted in emphysema. Mechanistically, PS-NPs entered macrophages and competitively bound to sigma nonopioid intracellular receptor 1 (SIGMAR1), leading to an increase in free zDHHC palmitoyltransferase 14 (zDHHC14). This, in turn, caused elevated palmitoylation of solute carrier family 31 member 1 (SLC31A1) in macrophages, inhibiting its ubiquitination and degradation, thereby enhancing SLC31A1 expression. The increased expression of SLC31A1 promoted cuproptosis of macrophages and elevated tumor necrosis factor-α (TNF-α) secretion, which activated the NLR family pyrin domain containing 3/matrix metallopeptidase 9 (NLRP3/MMP-9) pathway in alveolar epithelial cells (AECs). This process mediated pyroptosis and degradation of extracellular matrix (ECM), resulting in the destruction of alveolar structure and development of emphysema. The findings demonstrate a previously unknown molecular mechanism by which PS-NPs induce emphysema. The findings have implications for the prevention and treatment of respiratory system damage caused by nanoparticles.

Amazon's climate crossroads: analyzing air pollution and health impacts under machine learning-based temperature increase scenarios in Northern Mato Grosso, Brazil

Air pollution has long been a public health concern in South America, now increasingly linked to climate change. In Brazil, this issue is particularly acute in smaller cities with limited monitoring infrastructure. Sinop, located in the Amazon biome of Mato Grosso, exemplifies the intersection of agricultural expansion and environmental vulnerability. This study presents a comprehensive assessment of meteorological conditions, air pollutant levels, and related health impacts in Sinop, focusing on PM2.5, PM10, and ground-level ozone (O3). Using 2022 data, we applied Health Impact Assessment (HIA) via the WHO's AirQ + tool and simulated temperature rise scenarios through a machine learning model. ur findings indicate that O3 levels are highly sensitive to meteorological variation, while PM2.5 and PM10 concentrations are projected to increase by up to 50% and 70%, respectively, under extreme warming scenarios. These changes correspond to an estimated increase in non-external mortality of over 90% for PM2.5 and more than 1000% for PM10. Seasonal simulations revealed that the dry season, marked by intense biomass burning, significantly exacerbates pollutant concentrations. These results underscore the growing burden of air pollution on public health in rapidly urbanizing regions. They also highlight the urgent need for enhanced air quality monitoring and climate-adaptive public health strategies in vulnerable areas such as the southern Amazon.

A Systematic Review Focusing on the Link between Engineered Nanoparticles and Neurodegeneration

Engineered nanoparticles (ENPs) have widely revolutionized many fields, including medicine, technology, environmental science, and industry. However, with the wide use of ENPs in everyday life, concerns are increasingly being raised about their potential neurotoxic effects on the central nervous system (CNS), particularly in relation to neurodegeneration and neuroinflammation. The present systematic review focuses on reporting the current knowledge about the neurotoxic potential of ENPs, with particular attention to their mechanism of action in neuroinflammation and neurodegeneration. This PRISMA based systematic review encompassed studies from Pubmed, Embase, and Web of Science. Eligibility criteria included focusing on engineered NPs and their impacts on neuroinflammation, neurodegeneration, and neurotoxicity. Evidence shows that ENPs easily can cross the blood-brain barrier (BBB) inducing neuronal damage and neurotoxicity due to oxidative stress, inflammation, mitochondrial dysfunction, and cell death. Inflammation plays a crucial role in activating glial cells, such as microglia and astrocytes, leading to the release of pro-inflammatory cytokines, chemokines, and reactive oxygen species (ROS). This increases the vulnerability of the brain to systemic inflammation. In conclusion, as ENP exposure continues to increase, understanding their long-term effects on the brain is fundamental to developing effective strategies to mitigate their impact on neuronal human health.

In Vitro Exposure of A549 and J774A.1 Cells to SiO2 and TiO2 Nanoforms and Related Cellular- and Molecular-Level Effects: Application of Proteomics

There is an emerging interest in incorporating proteomic data for environmental health risk assessments. Meanwhile, the production and use of engineered nanomaterials (ENMs) with attractive physicochemical properties are expanding with the potential for exposure, thus necessitating toxicity information on these materials for health risk analysis, where proteomic data can be informative. Here, cells (A549 human lung epithelial and J774A.1 mouse monocyte/macrophage cells) were exposed to ENMs (nanoforms of SiO2and TiO2) of different sizes and surface chemistries (dose: 0-100 μg/cm2, 24 h) for in vitro toxicity data. Cytotoxicity (CTB, ATP, and LDH), oxidative stress (GSH oxidation), and proteomic analysis (MS- and antibody-based) were conducted post-nanoparticle (NP) exposure to determine the relative potency and identify perturbed cellular pathways. Dose-, nanoform-, and cell type-specific cytotoxicity changes were observed upon exposure to both nanoSiO2 and nanoTiO2. Size, agglomeration, surface modification, and metal impurities appeared to be the determinants of cytotoxicity. Proteomic analysis identified some enriched mechanistic pathways and biological processes relevant to cell defense/phagocytosis, stress, metabolism, apoptosis, and inflammatory processes in J774A.1 cells exposed to these NPs. A549 cells exhibited enriched pathway/biological processes relevant to transport/endocytosis, stress, metabolism, and inflammatory processes post-NP exposures. Concordance was observed between the nanoform exposure- and cell type-related cytotoxicity responses, notably cellular ATP, which is critical for cell viability, oxidative stress, and cellular pathways/biological processes. These findings demonstrate the application of proteomics in regulatory toxicology and warrant further research in this direction.

Assessment of air quality in the Philadelphia, Pennsylvania subway

BACKGROUND

Subways are popular and efficient modes of transportation in cities. However, people are exposed to high levels of particulate matter (PM) in subways. Subway air quality in the United States has been investigated in a few cities, but data is lacking on simultaneous measurement of several pollutants, especially ultrafine particles (UFP) and black carbon (BC), in combination with different size fractions of PM.

OBJECTIVES

The goals of this study are to assess air quality in a belowground subway and compare it with outdoor ambient levels, to examine temporal variability of PM in the subway, and to analyze the correlation between PM and BC.

METHODS

Particulate matter of varying sizes (PM1, PM2.5, PM10), UFP, and BC were measured using DustTrak, nanoparticle detector, and micro aethalometer, respectively. Measurements were made at the belowground subway platform and the aboveground street level at 15th Street subway station in Philadelphia during summer 2022.

RESULTS

Belowground mean PM1, PM2.5, and PM10 were 112.2 ± 61.3 µg/m3, 120 ± 65.5 µg/m3, and 182.1 ± 132 µg/m3, respectively, which were 5.4, 5.7, and 7.6 times higher than the respective aboveground street levels. The UFP lung deposited surface area (LDSA) (59.4 ± 36.2 µm2/cm3) and BC (9.5 ± 5.4 μg/m3) belowground were 1.7 times and 10.7 times higher than the aboveground. The pollutant concentration varied from day-to-day on both the locations. A higher positive correlation was found between the belowground BC and PM2.5 (r = 0.51, p < 0.05) compared to the aboveground (r = 0.16, p < 0.05).

IMPACT

This study showed high levels of particulate matter exposure at a belowground subway station in Philadelphia. Particulate matter levels were about 5 to 8 times higher at belowground subway station than the corresponding aboveground street level. Higher levels were also observed for UFP lung deposited surface area (LDSA), while black carbon levels showed the highest concentration at the belowground level by a factor of ten compared to the aboveground level. The study shows the need for air quality management at belowground subways to reduce particulate matter exposure for the commuters.

Need for a Holistic Approach to Assessing Sustainable, Green, and Healthy Buildings

With the rising global population, economic development, and urbanization, building stock is bound to grow, warranting measures for optimizing their embodied and operational energy and resource consumption. Further, a building's indoor environment quality significantly affects occupants' health, productivity, and well-being since people spend almost 90% of their time indoors. Buildings safeguard occupant's well-being by shielding them from the outdoor air pollution and increasing climate extremes. However, buildings can also lead to acute and chronic exposure to pollutants trapped inside. The recent pandemic has demonstrated that indoor environments can prevent and promote airborne disease transmission depending on buildings' design and operation. The current segregated rating systems and regulations to gauge buildings' sustainability, health and safety, and energy efficiency have led to a fragmented approach hampering sustainable and healthy buildings' design, construction, and operations. This work discusses the environmental sustainability of buildings, their impacts on occupants' health and productivity, and if and how the existing global policies and frameworks regulate and promote the same. Developing a holistic and comprehensive framework is critical to ensure buildings' sustainability, occupants' health, and energy efficiency.

Maternal mechanisms in air pollution exposure-related adverse pregnancy outcomes: A systematic review

Air pollution exposure is linked to various adverse health effects including cardiopulmonary, neurological and reproductive outcomes. Susceptible populations such as pregnant women and infants can be affected to a greater extent compared to healthy individuals. Thus, understanding air pollutant exposure-related toxicity pathways in pregnancy can provide information on developmental origin of health and diseases in both mothers and infants. The objective of this literature review was to explore maternal mechanisms underlying the association between air pollutant exposures and adverse maternal/infant health effects. A total of 209 articles published from 1996 until November 2024 were retrieved using PubMed, Scopus and Web of Science using relevant search terms (e.g. "Air Pollution" AND "Maternal" AND "Infant" AND "Health" AND "Biomarker"). After screening and removal of articles based on exclusion criteria, 36 observational studies were included for the final analysis. There were relatively fewer articles on air pollution exposure-related adverse maternal health effects compared to air-pollution-related adverse infant health effects. Of these articles selected for the final review, 32 studies compared the effects of particulate matter (PM), PM2.5, few on other (gaseous) pollutants and one study on effects of mixtures of air pollutants. Adverse maternal health effects included hypertensive disorders, gestational diabetes mellitus (GDM) and clinically recognized early pregnancy loss, while adverse infant health effects ranged from low birth weight, preterm birth, changes in fetal heart rate, crown rump length and fetal hyperinsulinism. Moreover, oxidative stress, inflammatory responses, endothelial and metabolic dysfunction were some of the mechanisms implicated in air pollution exposure-related adverse birth outcomes. These findings warrant further validation work and identification of maternal mechanism(s) constituting the causal pathway.

Importance of sub-23 nm particles in traffic environments: Particle number emission factors and extrathoracic deposition doses

New research suggests that exposure to ultrafine particles (UFPs; particle diameter dp < 100 nm) is particularly harmful to brain health. One pathway into the body is via deposition in the respiratory system, where the smallest UFPs deposit efficiently in human extrathoracic airways. Traffic is a major source of these particles, yet sub-23 nm (dp < 23 nm) particles are currently unregulated in engine emission testing worldwide, including the stringent requirements of the European Union, nor are there requirements for ambient monitoring. In this study, we report size-resolved particle number emission factors (EFs) for traffic and estimates of extrathoracic dose rates of sub-23 nm particles. The EFs and dose rates are based on measurements conducted in different urban environments, including roads, tunnels, an airport, and a riverside, in two Central European cities (Düsseldorf and Prague) from March to April 2022. A key difference between the cities is that Düsseldorf has a low-emission zone in its central area and a newer vehicle fleet compared to Prague. Overall, traffic-influenced sites had large EFs for sub-23 nm particles. In the highway and tunnel environments, EFs of particles with dp > 2.5 nm were between 2 and 18 times greater than the EFs of particles with dp > 23 nm. Near the airport, the EF of particles with dp > 23 nm was already high, being 2-9 times higher than in other environments. The number concentrations of sub-23 nm particles varied significantly within the studied cities, and dose rates (measured in billions of particles per hour) differed by up to a factor of ten or more depending on the location.

Intranasal Zinc Oxide Nanoparticles Induce Neuronal PANoptosis via Microglial Pathway

Recent data have revealed an increased risk of respiratory exposure during the manufacturing process and application of nanomaterials, resulting in an increased incidence of neurodegenerative diseases in the general population. Zinc oxide nanoparticles (ZNPs) are among the most used nanomaterials in biomedical and manufactured consumer products. In this study, neurological dysfunction after intranasal administration of ZNPs is observed, in which the ZNPs enter the brain via the nose-to-brain pathway and accumulate in microglia but not in astrocytes or neurons. By using a coculture system of microglia and neurons, the ZNPs are found that induce microglia-derived oxidative stress injury and lead to neuronal cell PANoptosis. In this context, ZNPs induced the generation of reactive oxygen species (ROS) originating from microglial NADPH oxidase 2 (NOX2), which further induced neuronal membrane lipid peroxidation and increased Ca2+ influx and mitochondrial DNA release. The leaked mitochondrial DNA subsequently initiates PANoptosis of neurons. Importantly, inhibition of microglial NOX2 activation can significantly alleviate brain oxidative injury and rescue neuronal PANoptosis. This study can advance the understanding of the mode of neuronal cell death while underscoring the importance of the interconnections among glial cells and neurons, which is beneficial for informing effective interventions for respiratory exposure to nanoparticles.

Long-term associations between ambient air pollution and self-perceived health status: Results from the population-based KORA-Fit study

BACKGROUND

Little is known about the association between air pollution and self-perceived health (including both health-related quality of life [HRQoL] and self-rated health [SRH]). The aim of this study was therefore to explore whether long-term air pollution exposure is associated with worse self-perceived health, as measured by different tools.

METHODS

We used a land-use regression model to determine the annual average levels of particulate matter with a diameter <10 μm (PM10), coarse particles (PMcoarse), fine particles (PM2.5), fine particle absorbances (PM2.5abs), particle number concentration (PNC), ozone (O3), nitrogen dioxide (NO2), and nitrogen oxide (NOX) for geocoded residential addresses (2014-2015). Questionnaires and face-to-face interviews were used to collect HRQoL (measured using the European Quality of Life 5 Dimensions [EQ-5D] index and the European Quality of Life Visual Analogue Scale [EQ-VAS]) and SRH indicators (measured through two survey questions) (2018-2019) from participants of the Cooperative Health Research in the Region of Augsburg (KORA)-Fit study in Germany. We explored associations via generalized additive models, multinomial logistic regression, and logistic regression.

RESULTS

We included 2610 participants with a mean age of 64.0 years in this cross-sectional study, of which 1428 (54.7%) were female. Each interquartile range (IQR) increase in O3 was associated with a reduced EQ-5D index value (% change of mean points and 95% confidence interval: -0.91% [-1.76; -0.06]). The average EQ-VAS score declined between -1.57% and -0.96% with each IQR increase in PM10, PMcoarse, PM2.5abs, PNC, NO2, and NOX. These pollutants were associated with increased occurrence of poor SRH, with odds ratios ranging from 1.24 to 2.67. PM2.5abs was linked to a higher likelihood of reporting a worse comparative SRH (2.59 [1.12; 5.99]). Body mass index and self-perceived stress modified these associations.

CONCLUSIONS

Long-term air pollution exposure was associated with poor self-perceived health, presenting as lower HRQoL and higher odds of poor SRH. Single-item indicators measuring self-perceived health status may work better than multi-dimensional indicators.

Alzheimer's, Parkinson's, Frontotemporal Lobar Degeneration, and Amyotrophic Lateral Sclerosis Start in Pediatric Ages: Ultrafine Particulate Matter and Industrial Nanoparticles Are Key in the Early-Onset Neurodegeneration: Time to Invest in Preventive Medicine

Billions of people are exposed to fine particulate matter (PM2.5) levels above the USEPA's annual standard of 9 μg/m3. Common emission sources are anthropogenic, producing complex aerosolized toxins. Ultrafine particulate matter (UFPM) and industrial nanoparticles (NPs) have major detrimental effects on the brain, but the USA does not measure UFPM on a routine basis. This review focuses on the development and progression of common neurodegenerative diseases, as diagnosed through neuropathology, among young residents in Metropolitan Mexico City (MMC). MMC is one of the most polluted megacities in the world, with a population of 22 million residents, many of whom are unaware of the brain effects caused by their polluted atmosphere. Fatal neurodegenerative diseases (such as Alzheimer's and Parkinson's) that begin in childhood in populations living in air polluted environments are preventable. We conclude that UFPM/NPs are capable of disrupting neural homeostasis and give rise to relentless neurodegenerative processes throughout the entire life of the highly exposed population in MMC. The paradigm of reaching old age to have neurodegeneration is no longer supported. Neurodegenerative changes start early in pediatric ages and are irreversible. It is time to invest in preventive medicine.

Ultrafine Particulate Matter Exacerbates the Risk of Delayed Neural Differentiation: Modulation Role of METTL3-Mediated m6A Modification

Air pollution, especially from ultrafine particles (PM0.1, ≤0.1 μm), is increasingly recognized for its detrimental effects on health. The influence of PM0.1 on neurodevelopmental disorders and its underlying mechanisms remain incompletely understood but are of significant concern. Through an investigation using mouse embryonic stem cells (mESCs), our study has uncovered disruptions in cell cycle dynamics, reduced neural precursor formation, and impaired neurogenesis during mESC neural differentiation as a result of PM0.1-induced neurodevelopmental toxicity. By employing N6-methyladenosine (m6A) methylated RNA immunoprecipitation sequencing and bioinformatics, we identified Zic1 as a key target of PM0.1-induced developmental disturbances. Our mechanistic findings indicate that PM0.1 enhances m6A methylation of Zic1 by upregulating Mettl3, leading to decreased mRNA stability and expression of this gene. Furthermore, the efficacy of the METTL3 inhibitor in alleviating nerve differentiation impairments emphasizes the significance of this pathway. In addition, source analysis, molecular docking, and toxicity analyses show that PAHs with higher ring structures in PM0.1 from combustion sources competitively bind to METTL3, potentially exacerbating neurodevelopmental toxicity. This study not only underscores the severe impact of PM0.1 on neurodevelopment but also reveals the pivotal role of m6A modification in mediating these effects, providing valuable insights and potential therapeutic targets for mitigating PM0.1-related health risks.

Differential Neurotoxicity Induced in Rats by Injection of PMs from 31 Major Cities in China

The effects of particulate matter (PMs) from different cities on the nervous system remain unclear. In this study, aqueous solutions of 0.45 μm membrane-filtered PM from 31 major Chinese cities were intravenously administered to rats. Neurotoxicity and mechanisms were investigated by quantifying rat behavior, analyzing in vivo biomarkers, and examining the PM physicochemical properties. PMs from different cities had variable impacts on rat responses, as manifested by the movement speed of the right ear, particularly at 1 h and 4-6 days postexposure. Physiological mechanisms were linked to the regulation of glucocorticoids via the hypothalamic-pituitary-adrenal axis and miR-107/miR-124 expression in the blood. Additionally, PM toxicity was strongly influenced by particle morphology, size, and zeta potential, which varied greatly across cities. Using random forest and multiple linear regression, we revealed that PM particle sizes (458.67 and 531.17 nm) and PM zeta potentials (-3.78, -17.01, and -20.31 mV) had the most important impacts on rat responsiveness, which was in line with blood biomarkers levels in rats such as Glucocorticoid, IL-1β, and IFN-α. These findings indicate that PMs from 31 cities contribute to varying neurotoxicity, thus presenting a possible differential burden on Alzheimer's disease in the aging population across many different regions.

Toxicity assessment of airborne ultrafine particles: Role of transport emissions

Airborne quasi-ultrafine particle samples were collected from different outdoor sites in Barcelona (NE Spain, 35 samples) and the Valencia subway (about 400 km south of Barcelona, 3 samples). Locations and schedules were designed to cover cold and warm seasons and to represent the impact of different types of transport (cars, trains, ships, and planes). Extracts from PTFE filters (methanol:dichloromethane 1:2) were used to test toxic effects in human cell lines (Induction of reactive oxygen species, inflammatory response) and in zebrafish embryos (expression of xenobiotic response-related genes, cyp1a1, gsa1 and hao1). We observed distinct toxic effects related to different forms of oxidative stress and to inflammatory response, the two types of negative outcomes more closely related to the known epidemiological impacts of air pollution. The highest toxicity values were detected in sites receiving car and/or ship emissions, with maximums during the cold season. Chemical analysis followed by correlation and source apportionment analyses identified PAHs, combustion engines, and biomass burning emissions as the main drivers of the observed toxic effects. Therefore, traffic restrictions, car emission limits, and reduction of combustion processes are necessary to eliminate or at least to limit airborne toxicity in urban environments.

Concentrations and origins of ultrafine particles at a major European harbor

The maritime transport sector poses significant air quality concerns, particularly in nearby cities. Ultrafine particles (UFP, diameter < 100 nm) are of particular concern due to their potential health impacts. This study measured particle number concentrations (PNC), size distributions (PNSD), and other pollutants including particulate matter (PM), nitrogen oxides (NOX), black carbon (BC), sulfur dioxide (SO2) and ozone (O3), organic markers and trace elements at a major European harbor and an urban background (UB) location. The average PNC at the harbor was 1.8-fold higher than at the UB, with particularly marked differences in the Aitken mode (2.4-fold higher). NOx levels were 10.5-fold higher at the harbor, and NO2, NOX and BC concentrations were 2.0 to 2.9 times greater compared to the UB site. SO2 concentrations were also 1.7-fold higher at the harbor. Two distinct types of PNC peaks were observed: daytime peaks with high Aitken mode particles likely linked to transit ship emissions, and late afternoon/nighttime peaks with higher nucleation mode particles likely linked to thermal power plant emissions, docked cruise ships, and vehicular traffic related to ferry boarding. Source apportionment of PNC-PNSD through Positive Matrix Factorization (PMF) identified four key contributors to PNC at the harbor: Regional recirculation (9 %, modes: 100 nm and 35 nm), Nucleation (30 %, mode: 18 nm), Coastal background (22 %, mode: 75 nm), and Ship transit (33 %, mode, 35 nm). Concentrations of Ti, V, Cr, Ni, Cu, Zn, As, Sb, Pb and Na in the quasi-UFP range were more than twice at the harbor compared to the UB. This study provides insights into UFP concentrations and their sources within a major touristic and commercial harbor, highlighting the complexity of identifying specific contributions from various UFP emission sources in large harbors.

Life-course exposure to air pollution and the risk of dementia in the Lothian Birth Cohort 1936

Background

Air pollution in later life has been associated with dementia; however, limited research has investigated the association between air pollution across the life course, either at specific life periods or cumulatively. The project investigates the association of air pollution with dementia via a life-course epidemiological approach.

Methods

Participants of the Lothian Birth Cohort, born in 1936, provided lifetime residential history in 2014. Participant's air pollution exposure for time periods 1935, 1950, 1970, 1980, 1990, 2001, and 2007 was modeled using an atmospheric chemistry transport model. Lifetime cumulative exposures were calculated as time-weighted mean exposure. Of 572 participants, 67 developed all-cause dementia [35 with Alzheimer's dementia (AD)] by wave 5 (~82 years). Cox proportional hazards and competing risk models assessed the association between all-cause dementia and AD with particulate matter (diameter of ≤2.5 µm) PM2.5 and nitrogen dioxide (NO2) exposure at specific life periods and cumulatively. False discovery rate (FDR) correction was applied for multiple testing.

Results

The mean follow-up was 11.26 years. One standard deviation (SD) higher exposure to air pollution in 1935 (PM2.5 = 14.03 μg/m3, NO2 = 5.35 μg/m3) was positively linked but not statistically significant to all-cause dementia [PM2.5 hazard ratio (HR) = 1.16, 95% confidence interval (CI) = 0.90, 1.49; NO2 HR = 1.13, 95% CI = 0.88, 1.47] and AD (PM2.5 HR = 1.38, 95% CI = 1.00, 1.91; NO2 HR = 1.35, 95% CI = 0.92, 1.99). In the competing risk model, one SD elevated PM2.5 exposure (1.12 μg/m3) in 1990 was inversely associated with dementia (subdistribution HR = 0.82, 95% CI = 0.67, 0.99) at P = 0.034 but not after FDR correction (P FDR = 0.442). Higher cumulative PM2.5 per one SD was associated with an increased risk of all-cause dementia and AD for all accumulation models except for the early-life model.

Conclusion

The in-utero and early-life exposure to PM2.5 and NO2 was associated with higher AD and all-cause dementia risk, suggesting a sensitive/critical period. Cumulative exposure to PM2.5 across the life course was associated with higher dementia risk. Midlife PM2.5 exposure's negative association with all-cause dementia risk may stem from unaddressed confounders or bias.

[The effects of air pollution on health, state of epidemiological knowledge]

The health effects of air pollution have been recognized for many years. However, this area of research continues to receive increasing attention from both the scientific community and civil society. The aim of this article is to review the main epidemiological findings on the effects of outdoor air pollution. First, we will define outdoor air pollution, then describe how the exposure to different pollutants is estimated in epidemiology. Finally, we will present three examples of epidemiological studies on the effects of air pollution.

Characterization of soot and crystalline atmospheric ultrafine particles

The extraction and characterization of atmospheric ultrafine particles (UFPs) is critical to understanding environmental health and climate dynamics. This study uses an aqueous extraction method to characterize the size distribution, shape, and composition of atmospheric UFPs. We propose a combined use of techniques rarely implemented in air quality analysis, such as atomic force microscopy (AFM), with more conventional methods, such as Transmission Electron microscopy (TEM) and Dynamic Light Scattering (DLS). DLS results indicate a hydrodynamic diameter range from 117 to 1069 nm and a polydispersity index of 0.3-0.79. The high polydispersity reflects the complexity of UFPs agglomeration processes. AFM identified NPs ranging from 10 to 25 nm; topographic images show soot and crystalline structures. High-resolution TEM analysis measured the interplanar distances of crystalline UFPs, showing the presence of calcium carbonates. TEM-EDS identified soot and crystalline particles with variable composition, from Si-enriched NPs to Ca-F-Cl-Na-Si, carbonates, chlorides, and Zn-Ti-enriched nanosilica. These findings provide valuable insights into the physicochemical properties of atmospheric dust, contributing to our knowledge and the potential implications for human health and the environment.

Exposure duration and cerebral amyloidosis in the olfactory cortex of World Trade Center responders: A positron emission tomography and magnetic resonance imaging study

BACKGROUND

Amyloid-β proteins, a hallmark of Alzheimer's disease, are believed to play an adaptive role in the cerebral immune response.

OBJECTIVE

Amyloid is believed to play a role in cerebral immune response and could play a similar role in response to air pollution exposures. In the present study, we examined whether WTC exposure duration was associated with cerebral amyloidosis in WTC responders.

METHODS

WTC responders (aged 44-65 years) who varied in exposure duration but did not use personalized protective equipment were assessed using positron-emission tomography with [18F]-Florbetaben. The outcome was the cortical [18F]-Florbetaben burden, measured using regional standardized uptake value ratios (SUVRs) in 34 Desikan-Killiany regions of interest. Spearman's ρ and generalized linear models were used to estimate correlations between WTC exposure duration and cortical [18F]-Florbetaben SUVR. Cognitive and behavioral symptoms were measured. Magnetic resonance imaging was used to measure cortical thickness and diffusivity.

RESULTS

The mean age of imaged responders was 56 years old. WTC exposure duration was associated with olfactory [18F]-Florbetaben SUVR (Spearman's ρ = 0.43, p = 0.011), which was in turn associated with elevated [18F]-Florbetaben SUVR in ventral regions (ρ = 0.41, p = 0.016). Cortical [18F]-Florbetaben in ventral regions was associated with reduced response speed (ρ = -0.72, p < 0.001), was co-located with cortical diffusivity across regions in the parietal and frontal lobes and reduced cortical thickness in the isthmus cingulate (ρ = -0.53, p = 0.001).

CONCLUSIONS

Low-grade amyloidosis in the olfactory and frontal lobes was associated with WTC exposure duration. Future work should examine whether low-grade amyloidosis is correlated with the location or distribution of neurofibrillary tangles in WTC responders.

Comparative assessment of acute neurotoxicity of real-world ultra-fine black carbon emitted from residential solid fuel combustion

Incomplete combustion of residential solid fuel is one of the main anthropogenic sources for black carbon (BC). Fresh BC, mainly enriched in ultra-fine fraction of particles, can directly cross blood-brain barrier and are reported to be associated with neurodegenerative diseases. Because of the difficulties in collection and purification of BC from ambient particles, there are still significant knowledge gaps in understanding neurotoxicity caused by real-world BC. The purpose of this study is to compare the neurotoxic effects caused by BCs emitted from combustion of six residential solid fuels, and try to reveal associated biological mechanisms in SH-SY5Y cells. Two straw BC (Wheat-BC and Corn-BC) showed highest neurotoxic effects followed by wood BC (Pine-BC and Aspen-BC) and coal BC (Xvzhou and Longkou Coal), as indicated by viability, lactic dehydrogenase, malondialdehyde, adenosine triphosphate and acetylcholine levels. Coal BC caused nearly no toxicity in human neuroblastoma (SH-SY5Y) cells within highest dose of 200 μg/mL. RNA sequence and bioinformatics analysis were applied to effectively identify differential genes and signaling pathways. Based on Gene Ontology (GO) annotation, Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment, Protein Protein Interaction network (PPI network) construction, we found biomass BC affected mitochondrial function, interfered with cellular metabolic processes, disturbed redox homeostasis, and finally resulted in cellular damages. Coal-BC mainly caused cytokine/chemokine related inflammatory responses. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) and Western blotting methods were further applied to find out related signaling pathways. Biomass BC activated IL6R/JAK3/STAT3 and JAK3/STAT6 pathways leading to oxidative stress and inflammatory responses. Coal BC activated JAK3/STAT3 pathway leading to chemokine related responses. This study revealed the heterogeneity in neurotoxicity of BCs from different combustion sources and provided important data for health risk assessment. BC-related neurotoxicity should be considered when making air pollution emission control strategies, with residential biomass receiving more policy attention.

Interaction between polycyclic aromatic hydrocarbons and thymine (T)-base induces double-strand DNA distortion in different species

Polycyclic aromatic hydrocarbons (PAHs) are potent inhibitors of DNA that can induce genetic damage, abnormal gene expression, and metabolic disorders upon interfacing with biological macromolecules. However, the mechanism of their interactions with DNA remains elusive. Therefore, this study selected three representative PAHs, including phenanthrene (Phen), pyrene (Pyre), and benzo[a]pyrene (B[a]P), and explored their binding mechanisms with the double-strand DNA (dsDNA) from different species, including 1J1V (Escherichia coli), 6J5B (Arabidopsis thaliana), and 6Q1V (Homo sapiens). The results revealed that binding between PAHs and dsDNA occurred in the groove via van der Waals forces and π-π stacking, with the carboxyl oxygen atom of the thymine (T)-base within dsDNA being the key binding site. This result was further confirmed by the spectroscopic experiments, where significant changes in the peak of the T-base were observed after PAHs-dsDNA binding. More interestingly, the total binding energies of Pyre with the three dsDNA were -138.800 kJ/mol (Pyre-1J1V), -105.523 kJ/mol (Pyre-6J5B), and -127.567 kJ/mol (Pyre-6Q1V), respectively, all of which were higher than those of Phen and B[a]P. This suggests that that Pyre has the strongest dsDNA binding ability. Additionally, analysis of the thermodynamic parameters indicated that the interactions between the three PAHs and dsDNA were exothermic reactions. In contrast, the Pyre-dsDNA interaction predominantly involved van der Waals forces and hydrogen bonding due to the enthalpy change (∆H) < 0 and entropy change (∆S) < 0, while the Phen-dsDNA and B[a]P-dsDNA interactions predominantly involved hydrophobic forces due to ∆H > 0 and ∆S > 0. Furthermore, Pyre caused local distortion of dsDNA, which was more pronounced under atomic force microscopy (AFM). In summary, this study has unveiled a new phenomenon of binding between PAHs and dsDNA. This sheds light on the carcinogenic potential and environmental impacts of PAHs pollution.

Mechanistic insights regarding neuropsychiatric and neuropathologic impacts of air pollution

Air pollution is a significant environmental health risk for urban areas and developing countries. Air pollution may contribute to the incidence of cardiopulmonary and metabolic diseases. Evidence also points to the role of air pollution in worsening or developing neurological and neuropsychiatric conditions. Inhaled pollutants include compositionally differing mixtures of respirable gaseous and particulate components of varied sizes, solubilities, and chemistry. Inhalation of combustibles and volatile organic compounds (VOCs) or other irritant particulate matter (PM) may trigger lung sensory afferents which initiate a sympathetic stress response via activation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) axes. Activation of SAM and HPA axes are associated with selective inhibition of hypothalamic-pituitary-gonadal (HPG) and hypothalamic-pituitary-thyroid (HPT) axes following exposure. Regarding chronic exposure in susceptible hosts, these changes may become pathological by causing neuroinflammation, neurotransmitter, and neuroendocrine imbalances. Soluble PM, such as metals and nano-size particles may translocate across the olfactory, trigeminal, or vagal nerves through retrograde axonal transport, or through systemic circulation which may disrupt the blood-brain barrier (BBB) and deposit in neural tissue. Neuronal deposition of metallic components can have a negative impact through multiple molecular mechanisms. In addition to systemic translocation, the release of pituitary and stress hormones, altered metabolic hormonal status and resultant circulating metabolic milieu, and sympathetically and HPA-mediated changes in immune markers, may secondarily impact the brain through a variety of regulatory adrenal hormone-dependent mechanisms. Several reviews covering air pollution as a risk factor for neuropsychiatric disorders have been published, but no reviews discuss the in-depth intersection between molecular and stress-related neuroendocrine mechanisms, thereby addressing adaptation and susceptibility variations and link to peripheral tissue effects. The purpose of this review is to discuss evidence regarding neurochemical, neuroendocrine, and molecular mechanisms which may contribute to neuropathology from air pollution exposure. This review also covers bi-directional neural and systemic interactions which may raise the risk for air pollution-related systemic illness.

Perspective on using non-human primates in Exposome research

The physiological and pathological changes in the human body caused by environmental pressures are collectively referred to as the Exposome. Human society is facing escalating environmental pollution, leading to a rising prevalence of associated diseases, including respiratory diseases, cardiovascular diseases, neurological disorders, reproductive development disorders, among others. Vulnerable populations to the pathogenic effects of environmental pollution include those in the prenatal, infancy, and elderly stages of life. Conducting Exposome mechanistic research and proposing effective health interventions are urgent in addressing the current severe environmental pollution. In this review, we address the core issues and bottlenecks faced by current Exposome research, specifically focusing on the most toxic ultrafine nanoparticles. We summarize multiple research models being used in Exposome research. Especially, we discuss the limitations of rodent animal models in mimicking human physiopathological phenotypes, and prospect advantages and necessity of non-human primates in Exposome research based on their evolutionary relatedness, anatomical and physiological similarities to human. Finally, we declare the initiation of NHPE (Non-Human Primate Exposome) project for conducting Exposome research using non-human primates and provide insights into its feasibility and key areas of focus. SYNOPSIS: Non-human primate models hold unique advantages in human Exposome research.

Frontiers and hotspots evolution between air pollution and Alzheimer's disease: A bibliometric analysis from 2013 to 2023

In recent years, the study of air pollution has received increasing attention from researchers, but a summary of Alzheimer's disease (AD) and air pollution is missed. Through combing the documents in the core dataset of Web of Science, this study analyzes current research based on specific keywords. CiteSpace and VOSviewer perform statistical analysis of measurement metrics to visualize a network of relevant content elements. The research devotes discussion to the relationship between air pollution and AD. Keyword hotspots include AD, children, oxidative stress, and system inflammation. Overall, 304 documents on air pollution and AD from 2013 to 2023 were retrieved from Web of Science. One hundred twenty-two journals published relevant articles, and the number of articles has increased gradually since the past decade. Research and development in AD and air pollution are progressing rapidly, but there is still a need for more connections with multidisciplinary technologies to explore cutting-edge hotspots.

Airborne ultrafine particle concentrations and brain cancer incidence in Canada's two largest cities

BACKGROUND

Malignant brain tumours are rare, but are important to study because survival rates are low and few modifiable risk factors have been identified. Existing evidence suggests that outdoor ultrafine particles (UFPs; particulate matter < 100 nm; sometimes referred to as nanoparticles) can deposit in the brain and could encourage initiation and progression of cancerous tumours, but epidemiological data are limited.

METHODS

High-resolution estimates of outdoor UFP concentrations and size were linked to residential locations of approximately 1.5 million people in Montreal and Toronto, Canada from 2001 to 2015. Cox proportional hazards models were used to estimate associations between annual average outdoor UFPs and malignant brain tumour incidence while adjusting for potential confounding factors including other outdoor air pollutants.

FINDINGS

In total, 1365 incident brain tumour cases occurred during follow-up. Consistent positive associations were observed between long-term exposures to outdoor UFPs and brain tumour incidence with increased risk ranging from 10.5% (95% CI: -1.4, 24.0%) to 15.3% (95% CI: 0.4, 32.5%) per 10,000 particle/cm3 increase. Long-term exposures to oxidant gases, black carbon, or fine particulate matter (PM2.5) were not associated with increased brain tumour incidence.

INTERPRETATION

Our results suggest that long-term exposures to outdoor UFPs are associated with an increased risk of developing malignant brain tumours. On an absolute scale, the magnitude of this risk translates into approximately 24 additional cases per year per 10,000 particle/cm3 increase in annual average outdoor UFPs in a hypothetical city of 3-million people.

FUNDING

Canadian Institutes of Health Research (CIHR) Foundation Grant and The United States Health Effects Institute (HEI).

TFEB/LAMP2 contributes to PM0.2-induced autophagy-lysosome dysfunction and alpha-synuclein dysregulation in astrocytes

Atmospheric particulate matter (PM) exacerbates the risk factor for Alzheimer's and Parkinson's diseases (PD) by promoting the alpha-synuclein (α-syn) pathology in the brain. However, the molecular mechanisms of astrocytes involvement in α-syn pathology underlying the process remain unclear. This study investigated PM with particle size <200 nm (PM0.2) exposure-induced α-syn pathology in ICR mice and primary astrocytes, then assessed the effects of mammalian target of rapamycin inhibitor (PP242) in vitro studies. We observed the α-syn pathology in the brains of exposed mice. Meanwhile, PM0.2-exposed mice also exhibited the activation of glial cell and the inhibition of autophagy. In vitro study, PM0.2 (3, 10 and 30 µg/mL) induced inflammatory response and the disorders of α-syn degradation in primary astrocytes, and lysosomal-associated membrane protein 2 (LAMP2)-mediated autophagy underlies α-syn pathology. The abnormal function of autophagy-lysosome was specifically manifested as the expression of microtubule-associated protein light chain 3 (LC3II), cathepsin B (CTSB) and lysosomal abundance increased first and then decreased, which might both be a compensatory mechanism to toxic α-syn accumulation induced by PM0.2. Moreover, with the transcription factor EB (TFEB) subcellular localization and the increase in LC3II, LAMP2, CTSB, and cathepsin D proteins were identified, leading to the restoration of the degradation of α-syn after the intervention of PP242. Our results identified that PM0.2 exposure could promote the α-syn pathological dysregulation in astrocytes, providing mechanistic insights into how PM0.2 increases the risk of developing PD and highlighting TFEB/LAMP2 as a promising therapeutic target for antagonizing PM0.2 toxicity.

Size distribution, sources and chemistry of ultrafine particles at Barcelona-El Prat Airport, Spain

The rapid expansion of the aviation sector raises concerns about air quality impacts within and around airports. Ultrafine particles (UFP, diameter < 100 nm) are of particular concern due to their potential adverse health effects. In this study, particle number concentrations (PNC), particle number size distribution (PNSD), and other ancillary pollutants such as particulate matter (PM), nitrogen oxides (NOX), black carbon (BC), sulfur dioxide (SO2), ozone (O3), carbon monoxide (CO) and benzene, as well as organic markers and trace elements (in quasi-UFP) were measured at Barcelona-El Prat Airport (80 m and 250 m from the main taxiway and runway). Comparisons were made with an urban background (UB) location, and source apportionment of PNSD was performed using Positive Matrix Factorization (PMF). PNC inside the airport was nine-fold higher than the UB, and fifteen-fold higher when considering only nucleation mode particles (< 25 nm). Six sources contributing to PNC were identified inside the airport: Taxiing (48.7 %; mode diameter = 17 nm), Industrial/Shipping (7.4 %; mode diameter = 35 nm), Diesel (3.9 %; mode diameter = 64 nm), Regional recirculation (1.1 %; mode diameter = 100 nm), Photonucleation (16.6 %; mode diameter = 13 nm) and Takeoff (18.5 %; mode diameter = 23 nm). Due to the measurement location and prevailing wind patterns, no significant contributions from landings were detected. Chemical analysis of quasi-UFP collected on Electrical Low-Pressure Impactor (ELPI + ) filters (stages 2 to 6: 17-165 nm) revealed higher concentrations (> 2-fold) of Fe, Al, Cr, Cu, Mo, Mn, Pb, Ti, and Sb at the airport compared to the UB, with Al exhibiting the most pronounced disparity. Generally, PAH levels were low at both sites, although concentrations were higher at the airport relative to the UB. Overall, this study provides a comprehensive understanding of UFP within a major European airport, identifying the different sources contributing to PNC and PNSD.

Associations of occupational exposure to micro-LiNiCoMnO2 particles with systemic inflammation and cardiac dysfunction in cathode material production for lithium batteries

Micro-LiNiCoMnO2 (MNCM), a cathode material with highest market share, has increasing demand with the growth of lithium battery industry. However, whether MNCM exposure brings adverse effects to workers remains unclear. This study aimed to explore the association between MNCM exposure with systemic inflammation and cardiac function. A cross-sectional study of 347 workers was undertaken from the MNCM production industry in Guangdong province, China in 2020. Metals in urine were measured using ICP-MS. The associations between metals, systemic inflammation, and cardiac function were appraised using a linear or logistic regression model. Bayesian kernel machine regression (BKMR) and generalized weighted quantile sum (gWQS) models were used to explore mixed metal exposures. The analysis of interaction and mediation was adopted to assess the role of inflammation in the relation between urinary metals and cardiac function. We observed that the levels of lithium (Li) and cobalt (Co) were positively associated with systemic inflammation and heart rate. The amount of Co contributed the highest weight on the increased systemic immune-inflammation index (SII) (59.8%), the system inflammation response index (SIRI) (44.3%), and heart rate (65.0%). Based on the mediation analysis, we estimated that SII mediated 32.3% and 20.9% of the associations between Li and Co with heart rate, and SIRI mediated 44.6% and 22.2% of the associations between Li and Co with heart rate, respectively. This study demonstrated for the first time that MNCM exposure increased the risk of workers' systemic inflammation and elevated heart rate, which were contributed by the excessive Li and Co exposure. Additionally, it indicates that systemic inflammation was a major mediator of the associations of Li and Co with cardiac function in MNCM production workers.

Inflammation and olfactory loss are associated with at least 139 medical conditions

Olfactory loss accompanies at least 139 neurological, somatic, and congenital/hereditary conditions. This observation leads to the question of whether these associations are correlations or whether they are ever causal. Temporal precedence and prospective predictive power suggest that olfactory loss is causally implicated in many medical conditions. The causal relationship between olfaction with memory dysfunction deserves particular attention because this sensory system has the only direct projection to memory centers. Mechanisms that may underlie the connections between medical conditions and olfactory loss include inflammation as well as neuroanatomical and environmental factors, and all 139 of the medical conditions listed here are also associated with inflammation. Olfactory enrichment shows efficacy for both prevention and treatment, potentially mediated by decreasing inflammation.

The Toxic Effects of Petroleum Diesel, Biodiesel, and Renewable Diesel Exhaust Particles on Human Alveolar Epithelial Cells

The use of alternative diesel fuels has increased due to the demand for renewable energy sources. There is limited knowledge regarding the potential health effects caused by exhaust emissions from biodiesel- and renewable diesel-fueled engines. This study investigates the toxic effects of particulate matter (PM) emissions from a diesel engine powered by conventional petroleum diesel fuel (SD10) and two biodiesel and renewable diesel fuels in vitro. The fuels used were rapeseed methyl ester (RME), soy methyl ester (SME), and Hydrogenated Vegetable Oil (HVO), either pure or as 50% blends with SD10. Additionally, a 5% RME blend was also used. The highest concentration of polycyclic aromatic hydrocarbon emissions and elemental carbon (EC) was found in conventional diesel and the 5% RME blend. HVO PM samples also exhibited a high amount of EC. A dose-dependent genotoxic response was detected with PM from SD10, pure SME, and RME as well as their blends. Reactive oxygen species levels were several times higher in cells exposed to PM from SD10, pure HVO, and especially the 5% RME blend. Apoptotic cell death was observed in cells exposed to PM from SD10, 5% RME blend, the 50% SME blend, and HVO samples. In conclusion, all diesel PM samples, including biodiesel and renewable diesel fuels, exhibited toxicity.

A Systematic Review of Air Pollution Exposure and Brain Structure and Function during Development

Objectives

Air pollutants are known neurotoxicants. In this updated systematic review, we evaluate new evidence since our 2019 systematic review on the effect of outdoor air pollution exposure on childhood and adolescent brain structure and function as measured by magnetic resonance imaging (MRI).

Methods

Using PubMed and Web of Science, we conducted an updated literature search and systematic review of articles published through March 2024, using key terms for air pollution and functional and/or structural MRI. Two raters independently screened all articles using Covidence and implemented the risk of bias instrument for systematic reviews informing the World Health Organization Global Air Quality Guidelines.

Results

We identified 222 relevant papers, and 14 new studies met our inclusion criteria. Including six studies from our 2019 review, the 20 publications to date include study populations from the United States, Netherlands, Spain, and United Kingdom. Studies investigated exposure periods spanning pregnancy through early adolescence, and estimated air pollutant exposure levels via personal monitoring, geospatial residential estimates, or school courtyard monitors. Brain MRI occurred when children were on average 6-14.7 years old; however, one study assessed newborns. Several MRI modalities were leveraged, including structural morphology, diffusion tensor imaging, restriction spectrum imaging, arterial spin labeling, magnetic resonance spectroscopy, as well as resting-state and task-based functional MRI. Air pollutants were associated with widespread brain differences, although the magnitude and direction of findings are largely inconsistent, making it difficult to draw strong conclusions.

Conclusion

Prenatal and childhood exposure to outdoor air pollution is associated with structural and functional brain variations. Compared to our initial 2019 review, publications doubled-an increase that testifies to the importance of this public health issue. Further research is needed to clarify the effects of developmental timing, along with the downstream implications of outdoor air pollution exposure on children's cognitive and mental health.

Exposure to biodiesel exhaust is less harmful than exposure to mineral diesel exhaust on blood-brain barrier integrity in a murine model

Emerging data suggest that air pollution is a persistent source of neuroinflammation, reactive oxygen species (ROS), and neuropathology that contributes to central nervous system (CNS) disorders. Previous research using animal models has shown that exposure to diesel exhaust causes considerable disruption of the blood-brain barrier (BBB), leading to marked neuroinflammation. However, the effects of biodiesel exhaust on cerebrovascular integrity and neuroinflammation have not been explored previously. Therefore, in this study, 8-week-old BALB/c mice were exposed to biodiesel exhaust (derived from canola biodiesel or tallow biodiesel) and compared with control mice that were exposed to air or mineral diesel exhaust. Consistently with previous findings, the integrity of the BBB was significantly disrupted by exposure to mineral diesel exhaust. Tallow and canola biodiesel exhaust exposure resulted in no BBB disruption. Moreover, both tallow and canola biodiesels significantly attenuated oxidative stress in the brain. The data collectively suggest that biodiesel exhaust may exert significantly less detrimental effects on brain function, compared to mineral diesel.

Air pollution: a latent key driving force of dementia

Many researchers have studied the role of air pollutants on cognitive function, changes in brain structure, and occurrence of dementia. Due to the wide range of studies and often contradictory results, the present systematic review was conducted to try and clarify the relationship between air pollutants and dementia. To identify studies for this review, a systematic search was conducted in Scopus, PubMed, and Web of Science databases (without historical restrictions) until May 22, 2023. The PECO statement was created to clarify the research question, and articles that did not meet the criteria of this statement were excluded. In this review, animal studies, laboratory studies, books, review articles, conference papers and letters to the editors were avoided. Also, studies focused on the effect of air pollutants on cellular and biochemical changes (without investigating dementia) were also excluded. A quality assessment was done according to the type of design of each article, using the checklist developed by the Joanna Briggs Institute (JBI). Finally, selected studies were reviewed and discussed in terms of Alzheimer's dementia and non-Alzheimer's dementia. We identified 14,924 articles through a systematic search in databases, and after comprehensive reviews, 53 articles were found to be eligible for inclusion in the current systematic review. The results showed that chronic exposure to higher levels of air pollutants was associated with adverse effects on cognitive abilities and the presence of dementia. Studies strongly supported the negative effects of PM2.5 and then NO2 on the brain and the development of neurodegenerative disorders in old age. Because the onset of brain structural changes due to dementia begins decades before the onset of disease symptoms, and that exposure to air pollution is considered a modifiable risk factor, taking preventive measures to reduce air pollution and introducing behavioral interventions to reduce people's exposure to pollutants is advisable.

Traffic-related ultrafine particles impair mitochondrial functions in human olfactory mucosa cells - Implications for Alzheimer's disease

Constituents of air pollution, the ultrafine particles (UFP) with a diameter of ≤0.1 μm, are considerably related to traffic emissions. Several studies link air pollution to Alzheimer's disease (AD), yet the exact relationship between the two remains poorly understood. Mitochondria are known targets of environmental toxicants, and their dysfunction is associated with neurodegenerative diseases. The olfactory mucosa (OM), located at the rooftop of the nasal cavity, is directly exposed to the environment and in contact with the brain. Mounting evidence suggests that the UFPs can impact the brain directly through the olfactory tract. By using primary human OM cultures established from nasal biopsies of cognitively healthy controls and individuals diagnosed with AD, we aimed to decipher the effects of traffic-related UFPs on mitochondria. The UFP samples were collected from the exhausts of a modern heavy-duty diesel engine (HDE) without aftertreatment systems, run with renewable diesel (A0) and petroleum diesel (A20), and from an engine of a 2019 model diesel passenger car (DI-E6d) equipped with state-of-the-art aftertreatment devices and run with renewable diesel (Euro6). OM cells were exposed to three different UFPs for 24-h and 72-h, after which cellular processes were assessed on the functional and transcriptomic levels. Our results show that UFPs impair mitochondrial functions in primary human OM cells by hampering oxidative phosphorylation (OXPHOS) and redox balance, and the responses of AD cells differ from cognitively healthy controls. RNA-Seq and IPA® revealed inhibition of OXPHOS and mitochondrial dysfunction in response to UFPs A0 and A20. Functional validation confirmed that A0 and A20 impair cellular respiration, decrease ATP levels, and disturb redox balance by altering NAD and glutathione metabolism, leading to increased ROS and oxidative stress. RNA-Seq and functional assessment revealed the presence of AD-related alterations in human OM cells and that different fuels and engine technologies elicit differential effects.

Single-domain magnetic particles with motion behavior under electromagnetic AC and DC fields are a fatal cargo in Metropolitan Mexico City pediatric and young adult early Alzheimer, Parkinson, frontotemporal lobar degeneration and amyotrophic lateral sclerosis and in ALS patients

Metropolitan Mexico City (MMC) children and young adults exhibit overlapping Alzheimer and Parkinsons' diseases (AD, PD) and TAR DNA-binding protein 43 pathology with magnetic ultrafine particulate matter (UFPM) and industrial nanoparticles (NPs). We studied magnetophoresis, electron microscopy and energy-dispersive X-ray spectrometry in 203 brain samples from 14 children, 27 adults, and 27 ALS cases/controls. Saturation isothermal remanent magnetization (SIRM), capturing magnetically unstable FeNPs ~ 20nm, was higher in caudate, thalamus, hippocampus, putamen, and motor regions with subcortical vs. cortical higher SIRM in MMC ≤ 40y. Motion behavior was associated with magnetic exposures 25-100 mT and children exhibited IRM saturated curves at 50-300 mT associated to change in NPs position and/or orientation in situ. Targeted magnetic profiles moving under AC/AD magnetic fields could distinguish ALS vs. controls. Motor neuron magnetic NPs accumulation potentially interferes with action potentials, ion channels, nuclear pores and enhances the membrane insertion process when coated with lipopolysaccharides. TEM and EDX showed 7-20 nm NP Fe, Ti, Co, Ni, V, Hg, W, Al, Zn, Ag, Si, S, Br, Ce, La, and Pr in abnormal neural and vascular organelles. Brain accumulation of magnetic unstable particles start in childhood and cytotoxic, hyperthermia, free radical formation, and NPs motion associated to 30-50 μT (DC magnetic fields) are critical given ubiquitous electric and magnetic fields exposures could induce motion behavior and neural damage. Magnetic UFPM/NPs are a fatal brain cargo in children's brains, and a preventable AD, PD, FTLD, ALS environmental threat. Billions of people are at risk. We are clearly poisoning ourselves.

A review on micro- and nanoplastics in humans: Implication for their translocation of barriers and potential health effects

As emerging contaminants, micro- and nanoplastics (MNPs) can absorb and leach various toxic chemicals and ultimately endanger the health of the ecological environment and humans. With extensive research on MNPs, knowledge about MNPs in humans, especially their translocation of barriers and potential health effects, is of utmost importance. In this review, we collected literature published from 2000 to 2023, focusing on MNPs on their occurrence in humans, penetrating characteristics in the placental, blood-brain, and blood-testis barriers, and exposure effects on mammalian health. The characteristics and distributions of MNPs in human samples were analyzed, and the results demonstrated that MNPs were ubiquitous in most human samples, except for kidneys and cerebrospinal fluid. In addition, the phenomenon of MNPs crossing barriers and their underlying mechanisms were discussed. We also summarized the potential factors that may affect the barrier crossing and health effects of MNPs, including characteristics of MNPs, exposure doses, administration routes, exposure durations, co-exposure to other pollutants, and genetic predisposition. Exposure to MNPs may cause cytotoxicity, neurotoxicity, and developmental and reproductive toxicity in mammals. People are encouraged to reduce their exposure to MNPs to prevent these adverse health effects. Finally, we discussed the shortcomings of current research on MNPs in humans, providing a valuable reference for understanding and evaluating the potential health risks from MNP exposure in mammals, including humans.

Breathing in danger: Understanding the multifaceted impact of air pollution on health impacts

Air pollution, a pervasive environmental threat that spans urban and rural landscapes alike, poses significant risks to human health, exacerbating respiratory conditions, triggering cardiovascular problems, and contributing to a myriad of other health complications across diverse populations worldwide. This article delves into the multifarious impacts of air pollution, utilizing cutting-edge research methodologies and big data analytics to offer a comprehensive overview. It highlights the emergence of new pollutants, their sources, and characteristics, thereby broadening our understanding of contemporary air quality challenges. The detrimental health effects of air pollution are examined thoroughly, emphasizing both short-term and long-term impacts. Particularly vulnerable populations are identified, underscoring the need for targeted health risk assessments and interventions. The article presents an in-depth analysis of the global disease burden attributable to air pollution, offering a comparative perspective that illuminates the varying impacts across different regions. Furthermore, it addresses the economic ramifications of air pollution, quantifying health and economic losses, and discusses the implications for public policy and health care systems. Innovative air pollution intervention measures are explored, including case studies demonstrating their effectiveness. The paper also brings to light recent discoveries and insights in the field, setting the stage for future research directions. It calls for international cooperation in tackling air pollution and underscores the crucial role of public awareness and education in mitigating its impacts. This comprehensive exploration serves not only as a scientific discourse but also as a clarion call for action against the invisible but insidious threat of air pollution, making it a vital read for researchers, policymakers, and the general public.

Association of Exposure to Ambient Air Pollutants With Cognitive Performance and Dementia Risk and the Mediating Role of Pulmonary Function: Evidence From the UK Biobank

BACKGROUND

The pathways by which air pollution affects cognition remain to be explored. This study aimed to explore how single air pollutants [including nitrogen oxide (NOX), nitrogen dioxide (NO2), particulate matter with a diameter of 2.5 micrometers (PM2.5), PM10, and PM2.5-10], and air pollution mixture could affect cognitive function and the incidence of dementia, and determine whether pulmonary function (PF) could play a mediating role in the relationship.

METHODS

Multiple statistical methods were employed to evaluate association of 5 air pollutants (NOX, NO2, PM2.5, PM10, and PM2.5-10) with cognitive function. Bootstrap method was used to estimate mediating role of PF in the association of air pollutants with cognition or the incidence of dementia.

RESULTS

A mixture of air pollutants was associated with performance on 5 cognitive tests, and global cognition (p < .05). Significantly negative association was also identified between mixture of air pollutants and PF (β= -0.020, 95% confidence interval (CI) = -0.029 to -0.011). In addition, as PF scores increase, performance on all cognitive tests significantly improve, although the risk of dementia correspondingly decreases. It was noted that PF was shown to mediate the effects of air pollution mixtures on all cognitive tests as well as global cognition. For global cognition, PF mediated 6.08% of the association. PF was also found to have a mediating role in the association between NOX, NO2, PM2.5, and the risk of dementia.

CONCLUSIONS

Mixed air pollution may impact cognitive function, with PF potentially mediating this relationship.

Single particle mass spectral signatures from on-road and non-road vehicle exhaust particles and their application in refined source apportionment using deep learning

With advances in vehicle emission control technology, updating source profiles to meet the current requirements of source apportionment has become increasingly crucial. In this study, on-road and non-road vehicle particles were collected, and then the chemical compositions of individual particles were analyzed using single particle aerosol mass spectrometry. The data were grouped using an adaptive resonance theory neural network to identify signatures and establish a mass spectral database of mobile sources. In addition, a deep learning-based model (DeepAerosolClassifier) for classifying aerosol particles was established. The objective of this model was to accomplish source apportionment. During the training process, the model achieved an accuracy of 98.49 % for the validation set and an accuracy of 93.36 % for the testing set. Regarding the model interpretation, ideal spectra were generated using the model, verifying its accurate recognition of the characteristic patterns in the mass spectra. In a practical application, the model performed hourly source apportionment at three specific field monitoring sites. The effectiveness of the model in field measurement was validated by combining traffic flow and spatial information with the model results. Compared with other machine learning methods, our model achieved highly automated source apportionment while eliminating the need for feature selection, and it enables end-to-end operation. Thus, in the future, it can be applied in refined and online source apportionment of particulate matter.

The good, the bad, and the ugly of metals as antimicrobials

We are now moving into the antimicrobial resistance (AMR) era where more antibiotic resistant bacteria are now the majority, a problem brought on by both misuse and over use of antibiotics. Unfortunately, the antibiotic development pipeline dwindled away over the past decades as they are not very profitable compounds for companies to develop. Regardless researchers over the past decade have made strides to explore alternative options and out of this we see revisiting historical infection control agents such as toxic metals. From this we now see a field of research exploring the efficacy of metal ions and metal complexes as antimicrobials. Such antimicrobials are delivered in a variety of forms from metal salts, alloys, metal complexes, organometallic compounds, and metal based nanomaterials and gives us the broad term metalloantimicrobials. We now see many effective formulations applied for various applications using metals as antimicrobials that are effective against drug resistant strains. The purpose of the document here is to step aside and begin a conversation on the issues of use of such toxic metal compounds against microbes. This critical opinion mini-review in no way aims to be comprehensive. The goal here is to understand the benefits of metalloantimicrobials, but also to consider strongly the disadvantages of using metals, and what are the potential consequences of misuse and overuse. We need to be conscious of the issues, to see the entire system and affect through a OneHealth vision.

Particulate matter constituents trigger the formation of extracellular amyloid β and Tau -containing plaques and neurite shortening in vitro

Air pollution is an environmental factor associated with an increased risk of neurodegenerative diseases, such as Alzheimer's and Parkinson's, characterized by decreased cognitive abilities and memory. The limited models of sporadic Alzheimer's disease fail to replicate all pathological hallmarks of the disease, making it challenging to uncover potential environmental causes. Environmentally driven models of Alzheimer's disease are thus timely and necessary. We used live-cell confocal fluorescent imaging combined with high-resolution stimulated emission depletion (STED) microscopy to follow the response of retinoic acid-differentiated human neuroblastoma SH-SY5Y cells to nanomaterial exposure. Here, we report that exposure of the cells to some particulate matter constituents reproduces a neurodegenerative phenotype, including extracellular amyloid beta-containing plaques and decreased neurite length. Consistent with the existing in vivo research, we observed detrimental effects, specifically a substantial reduction in neurite length and formation of amyloid beta plaques, after exposure to iron oxide and diesel exhaust particles. Conversely, after exposure to engineered cerium oxide nanoparticles, the lengths of neurites were maintained, and almost no extracellular amyloid beta plaques were formed. Although the exact mechanism behind this effect remains to be explained, the retinoic acid differentiated SH-SY5Y cell in vitro model could serve as an alternative, environmentally driven model of neurodegenerative diseases, including Alzheimer's disease.

miR-145a-5p/SIK1/cAMP-dependent alteration of synaptic structural plasticity drives cognitive impairment induced by coke oven emissions

Exposure to fine particulate matter (PM) is associated with the neurodegenerative diseases. Coke oven emissions (COEs) in occupational environment are important sources of PM. However, its neurotoxicity is still unclear. Therefore, evaluating the toxicological effects of COE on the nervous system is necessary. In the present study, we constructed mouse models of COE exposure by tracheal instillation. Mice exposed to COE showed signs of cognitive impairment. This was accompanied by a decrease in miR-145a-5p and an increase in SIK1 expression in the hippocampus, along with synaptic structural damage. Our results demonstrated that COE-induced miR-145a-5p downregulation could increase the expression of SIK1 and phosphorylated SIK1, inhibiting the cAMP/PKA/CREB pathway by activating PDE4D, which was associated with reduced synaptic structural plasticity. Furthermore, restoring of miR-145a-5p expression based on COE exposure in HT22 cells could partially reversed the negative effects of COE exposure through the SIK1/PDE4D/cAMP axis. Collectively, our findings link epigenetic regulation with COE-induced neurotoxicity and imply that miR-145a-5p could be an early diagnostic marker for neurological diseases in patients with COE occupational exposure.

HO-1 upregulation promotes mitophagy-dependent ferroptosis in PM2.5-exposed hippocampal neurons

Fine particulate matter (PM2.5) has been extensively implicated in the pathogenesis of neurodevelopmental disorders, but the underlying mechanism remains unclear. Recent studies have revealed that PM2.5 plays a role in regulating iron metabolism and redox homeostasis in the brain, which is closely associated with ferroptosis. In this study, the role and underlying mechanism of ferroptosis in PM2.5-induced neurotoxicity were investigated in mice, primary hippocampal neurons, and HT22 cells. Our findings demonstrated that exposure to PM2.5 could induce abnormal behaviors, neuroinflammation, and neuronal loss in the hippocampus of mice. These effects may be attributed to ferroptosis induced by PM2.5 exposure in hippocampal neurons. RNA-seq analysis revealed that the upregulation of iron metabolism-related protein Heme Oxygenase 1 (HO-1) and the activation of mitophagy might play key roles in PM2.5-induced ferroptosis in HT22 cells. Subsequent in vitro experiments showed that PM2.5 exposure significantly upregulated HO-1 in primary hippocampal neurons and HT22 cells. Moreover, PM2.5 exposure activated mitophagy in HT22 cells, leading to the loss of mitochondrial membrane potential, alterations in the expression of autophagy-related proteins LC3, P62, and mTOR, as well as an increase in mitophagy-related protein PINK1 and PARKIN. As a heme-degradation enzyme, the upregulation of HO-1 promotes the release of excess iron, genetically inhibiting the upregulation of HO-1 in HT22 cells could prevent both PM2.5-induced mitophagy and ferroptosis. Furthermore, pharmacological inhibition of mitophagy in HT22 cells reduced levels of ferrous ions and lipid peroxides, thereby preventing ferroptosis. Collectively, this study demonstrates that HO-1 mediates PM2.5-induced mitophagy-dependent ferroptosis in hippocampal neurons, and inhibiting mitophagy or ferroptosis may be a key therapeutic target to ameliorate neurotoxicity following PM2.5 exposure.

Environmental pollutants and exosomes: A new paradigm in environmental health and disease

This study investigates the intricate interplay between environmental pollutants and exosomes, shedding light on a novel paradigm in environmental health and disease. Cellular stress, induced by environmental toxicants or disease, significantly impacts the production and composition of exosomes, crucial mediators of intercellular communication. The heat shock response (HSR) and unfolded protein response (UPR) pathways, activated during cellular stress, profoundly influence exosome generation, cargo sorting, and function, shaping intercellular communication and stress responses. Environmental pollutants, particularly lipophilic ones, directly interact with exosome lipid bilayers, potentially affecting membrane stability, release, and cellular uptake. The study reveals that exposure to environmental contaminants induces significant changes in exosomal proteins, miRNAs, and lipids, impacting cellular function and health. Understanding the impact of environmental pollutants on exosomal cargo holds promise for biomarkers of exposure, enabling non-invasive sample collection and real-time insights into ongoing cellular responses. This research explores the potential of exosomal biomarkers for early detection of health effects, assessing treatment efficacy, and population-wide screening. Overcoming challenges requires advanced isolation techniques, standardized protocols, and machine learning for data analysis. Integration with omics technologies enhances comprehensive molecular analysis, offering a holistic understanding of the complex regulatory network influenced by environmental pollutants. The study underscores the capability of exosomes in circulation as promising biomarkers for assessing environmental exposure and systemic health effects, contributing to advancements in environmental health research and disease prevention.

ROS-dependent degeneration of human neurons induced by environmentally relevant levels of micro- and nanoplastics of diverse shapes and forms

Our study explores the pressing issue of micro- and nanoplastics (MNPs) inhalation and their subsequent penetration into the brain, highlighting a significant environmental health concern. We demonstrate that MNPs can indeed penetrate murine brain, warranting further investigation into their neurotoxic effects in humans. We then proceed to test the impact of MNPs at environmentally relevant concentrations, with focusing on variations in size and shape. Our findings reveal that these MNPs induce oxidative stress, cytotoxicity, and neurodegeneration in human neurons, with cortical neurons being more susceptible than nociceptors. Furthermore, we examine the role of biofilms on MNPs, demonstrating that MNPs can serve as a vehicle for pathogenic biofilms that significantly exacerbate these neurotoxic effects. This sequence of investigations reveals that minimal MNPs accumulation can cause oxidative stress and neurodegeneration in human neurons, significantly risking brain health and highlights the need to understand the neurological consequences of inhaling MNPs. Overall, our developed in vitro testing battery has significance in elucidating the effects of environmental factors and their associated pathological mechanisms in human neurons.

Personal Strategies to Reduce the Cardiovascular Impacts of Environmental Exposures

Ubiquitous environmental exposures increase cardiovascular disease risk via diverse mechanisms. This review examines personal strategies to minimize this risk. With regard to fine particulate air pollution exposure, evidence exists to recommend the use of portable air cleaners and avoidance of outdoor activity during periods of poor air quality. Other evidence may support physical activity, dietary modification, omega-3 fatty acid supplementation, and indoor and in-vehicle air conditioning as viable strategies to minimize adverse health effects. There is currently insufficient data to recommend specific personal approaches to reduce the adverse cardiovascular effects of noise pollution. Public health advisories for periods of extreme heat or cold should be observed, with limited evidence supporting a warm ambient home temperature and physical activity as strategies to limit the cardiovascular harms of temperature extremes. Perfluoroalkyl and polyfluoroalkyl substance exposure can be reduced by avoiding contact with perfluoroalkyl and polyfluoroalkyl substance-containing materials; blood or plasma donation and cholestyramine may reduce total body stores of perfluoroalkyl and polyfluoroalkyl substances. However, the cardiovascular impact of these interventions has not been examined. Limited utilization of pesticides and safe handling during use should be encouraged. Finally, vasculotoxic metal exposure can be decreased by using portable air cleaners, home water filtration, and awareness of potential contaminants in ground spices. Chelation therapy reduces physiological stores of vasculotoxic metals and may be effective for the secondary prevention of cardiovascular disease.

Concordance between In Vitro and In Vivo Relative Toxic Potencies of Diesel Exhaust Particles from Different Biodiesel Blends

Diesel exhaust particles (DEPs) contribute to air pollution exposure-related adverse health impacts. Here, we examined in vitro, and in vivo toxicities of DEPs from a Caterpillar C11 heavy-duty diesel engine emissions using ultra-low-sulfur diesel (ULSD) and biodiesel blends (20% v/v) of canola (B20C), soy (B20S), or tallow-waste fry oil (B20T) in ULSD. The in vitro effects of DEPs (DEPULSD, DEPB20C, DEPB20S, and DEPB20T) in exposed mouse monocyte/macrophage cells (J774A.1) were examined by analyzing the cellular cytotoxicity endpoints (CTB, LDH, and ATP) and secreted proteins. The in vivo effects were assessed in BALB/c mice (n = 6/group) exposed to DEPs (250 µg), carbon black (CB), or saline via intratracheal instillation 24 h post-exposure. Bronchoalveolar lavage fluid (BALF) cell counts, cytokines, lung/heart mRNA, and plasma markers were examined. In vitro cytotoxic potencies (e.g., ATP) and secreted TNF-α were positively correlated (p < 0.05) with in vivo inflammatory potency (BALF cytokines, lung/heart mRNA, and plasma markers). Overall, DEPULSD and DEPB20C appeared to be more potent compared to DEPB20S and DEPB20T. These findings suggested that biodiesel blend-derived DEP potencies can be influenced by biodiesel sources, and inflammatory process- was one of the potential underlying toxicity mechanisms. These observations were consistent across in vitro and in vivo exposures, and this work adds value to the health risk analysis of cleaner fuel alternatives.

Role of the Exposome in Neurodegenerative Disease: Recent Insights and Future Directions

Neurodegenerative diseases are increasing in prevalence and place a significant burden on society. The causes are multifactorial and complex, and increasing evidence suggests a dynamic interplay between genes and the environment, emphasizing the importance of identifying and understanding the role of lifelong exposures, known as the exposome, on the nervous system. This review provides an overview of recent advances toward defining neurodegenerative disease exposomes, focusing on Parkinson's disease, amyotrophic lateral sclerosis, and Alzheimer's disease. We present the current state of the field based on emerging data, elaborate on key themes and potential mechanisms, and conclude with limitations and future directions. ANN NEUROL 2024;95:635-652.

Green and blue space exposure and non-communicable disease related hospitalizations: A systematic review

The global increase in non-communicable diseases (NCDs) presents a critical public health concern. Emerging evidence suggests that exposure to natural environments may reduce the risk of developing NCDs through multiple pathways. The present systematic review aims to synthesize and evaluate the observational evidence regarding associations between exposure to green and blue spaces and hospital admissions related to NCDs. A comprehensive literature search strategy was conducted in Embase (Ovid), PubMed, and Web of Science. The risk of bias and quality of the evidence were assessed using The Navigation Guide methodology, an approach specifically designed for environmental health research. Of 3060 search results, 17 articles were included. Notably, the majority of the studies (n = 14; 82.4%) were published from 2020 onwards. Most studies were conducted in the United States (n = 6; 35.3%) and China (n = 4; 23.5%). Exposure to green spaces was assessed through all studies, while only three included blue spaces. In terms of study design, cohort design was employed in nearly half of the studies (n = 8; 47.1%), followed by case-crossover design (n = 3, 17.6%). Over 75% of the included studies (n = 13) had a high or probably high rating in the risk of bias assessment. The studies encompassed diverse NCD outcome domains; cardiovascular diseases (CVDs) (n = 10), respiratory diseases (RSDs) (n = 2), heat-related diseases (n = 1), metabolic diseases (n = 2), cancer (n = 1), neurodegenerative diseases (NDDs) (n = 2), and mental health disorders (n = 2). The present review suggests that a clear link between blue space exposure and NCD hospital admissions is not evident. However, exposure to green spaces appears to predominantly have a protective effect, although the direction of the association varies across different outcome domains. The heterogeneity among the outcome domains together with the limited number of studies, emphasizes the need for more robust evidence.