Characterization and variability of endotoxin and 3-hydroxy fatty acids in an office building during a particle intervention study

Hydroxy fatty acids in the surface Earth system

Lipids are ubiquitous and highly abundant in a wide range of organisms and have been found in various types of environmental media. These molecules play a crucial role as organic tracers by providing a chemical perspective on viewing the material world, as well as offering a wealth of information on metabolic activities. Among the diverse lipid compounds, hydroxy fatty acids (HFAs) with one to multiple hydroxyl groups attached to the carbon chain stand out as important biomarkers for different sources of organic matter. HFAs are widespread in nature and are involved in biotransformation and oxidation processes in living organisms. The unique chemical and physical properties attributed to the hydroxyl group make HFAs ideal biomarkers in biomedicine and environmental toxicology, as well as organic geochemistry. The molecular distribution patterns of HFAs can be unique and diagnostic for a given class of organisms, including animals, plants, and microorganisms. Thus, HFAs can act as a valuable proxy for understanding the ecological relationships between different organisms and their environment. Furthermore, HFAs have numerous industrial applications due to their higher reactivity, viscosity, and solvent miscibility. This review paper integrates the latest research on the sources and chemical analyses of HFAs, as well as their applications in industrial/medicinal production and as biomarkers in environmental studies. This review article also provides insights into the biogeochemical cycles of HFAs in the surface Earth system, highlighting the importance of these compounds in understanding the complex interactions between living organisms and the environment.

Concentración y composición microbiana en el ambiente de la Biblioteca Central Jorge Palacios Preciado de la Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia

Los microorganismos, esporas, ácaros y polen son componentes naturales del aire en ambientes internos y pueden ser transportados desde el exterior por partículas aerobiológicas que pueden establecerse en el polvo y causar el biodeterioro de diversos materiales, además de representar un riesgo para la salud de las personas. Con este trabajo, se evaluó la concentración microbiana en el ambiente de la Biblioteca Central Jorge Palacios Preciado, Universidad Pedagógica y Tecnológica de Colombia. Se empleó el método de sedimentación en placa para realizar el muestreo microbiológico del ambiente, utilizando agar Sabouraud para el aislamiento de hongos y agar nutritivo para bacterias. La densidad microbiana del ambiente se encontró dentro de los límites de sanidad aceptados para ambientes de lugares públicos, y la mayor diversidad identificada estuvo representada por 34 géneros de hongos filamentosos y un grupo de hongos de la clase Phycomycetes, siendo las esporas de los géneros Cladosporium, Paecilomyces y Penicillium, las más frecuentes en la biblioteca. Las levaduras fueron las menos representativas en el ambiente con dos géneros aislados Candida y Rhodotorula. En cuanto a las bacterias, se aislaron en total 16 géneros, de los cuales Bacillus y Neisseria, fueron los más comunes. Teniendo en cuenta los géneros microbianos aislados y las investigaciones más recientes, el ambiente de la Biblioteca Central podría representar un riesgo para la salud de las personas, principalmente a nivel respiratorio, sino se adoptan algunas medidas de limpieza y de adecuación de los sistemas de ventilación.

Endotoxin markers in bronchoalveolar lavage fluid of patients with interstitial lung diseases

BACKGROUND

Exposure to inhaled endotoxins (lipopolysaccharides, LPS) of Gram-negative bacteria commonly found in indoor environments and assessed in secondary tobacco smoke, has been associated with airway inflammation and asthma exacerbation. The bronchoalveolar lavage fluid (BALf) from patients with interstitial lung diseases (sarcoidosis, lung fibrosis, smoking-related ILD, eosinophilic disorders) was analyzed for the markers of lipopolysaccharide (LPS, endotoxin).

METHODS

BALf was obtained from patients with diffuse lung diseases: idiopathic pulmonary fibrosis (n = 42), sarcoidosis (n = 22), smoking-related-ILD (n = 11) and eosinophilic disorders (n = 8). Total cell count and differential cell count were performed. In addition, samples were analyzed for 3-hydroxy fatty acids (3-OHFAs) of 10-18 carbon chain lengths, as markers of LPS, by gas chromatography-tandem mass spectrometry.

RESULTS

The highest LPS concentration was found in patients with eosinophilic disorders and the lowest in patients with sarcoidosis (p< 0.05) followed by the lung fibrosis and the sr-ILD patients. The difference between LPS in BALf with extremely high eosinophil proportion (> 25%) and those with lower proportion was also significant (p = 0.014). A significant correlation was found between LPS and eosinophils, but not between LPS and lymphocytes, neutrophils, or macrophages count.

CONCLUSIONS

A positive relationship of LPS and eosinophilic pulmonary disorders may be linked to a persistent eosinophil activation mediated by Th2 pathway: chronic endotoxin exposure would intensify Th2 pathway resulting in fibrosis and, at the same time, eosinophil stimulation, and hence in eosinophilic pulmonary disorders.

Rhinosinusitis and mold as risk factors for asthma symptoms in occupants of a water-damaged building

Mold exposure in damp buildings is associated with both nasal symptoms and asthma development, but the progression of building-related (BR) rhinosinusitis symptoms to asthma is unstudied. We examined the risk of developing BR-asthma symptoms in relation to prior BR-rhinosinusitis symptoms and microbial exposure among occupants of a damp building. We conducted four cross-sectional health and environmental surveys among occupants of a 20-story water-damaged office building. We defined BR-rhinosinusitis symptom (N=131) and comparison (N=361) groups from participants' first questionnaire responses. We compared the odds for the development of BR-asthma symptoms between these two groups over the subsequent surveys, using logistic regression models adjusted for demographics, smoking, building tenure, and first-survey exposures to fungi, endotoxin, and ergosterol. The BR-rhinosinusitis symptom group had higher odds for developing BR-asthma symptoms [odds ratio (OR)=2.2; 95% confidence interval (CI)=1.3-3.6] in any subsequent survey compared to those without BR-rhinosinusitis symptoms. The BR-rhinosinusitis symptom group with higher fungal exposure within the building had an OR of 7.4 (95% CI=2.8-19.9) for developing BR-asthma symptoms, compared to the lower fungal exposure group without BR-rhinosinusitis symptoms. Our findings suggest that rhinosinusitis associated with occupancy of water-damaged buildings may be a sentinel for increased risk for asthma onset in such buildings.

PRACTICAL IMPLICATIONS

Exposure to mold is associated with the development of asthma in damp building occupants, and rhinitis is known to be a risk factor for asthma. However, there is little information about the degree of risk for the progression of rhinosinusitis to asthma owing to mold exposures in damp buildings. Our study of damp building occupants demonstrates that building-related (BR) rhinosinusitis symptoms were a risk factor for the development of BR asthma symptoms and that exposure to mold (fungi) or other dampness-related agents augments risk for the development of BR asthma symptoms among those with BR rhinosinusitis symptoms. Our findings suggest that occurrence of BR upper respiratory illness in water-damaged buildings may presage future endemic asthma.

Characterization of endotoxin collected on California dairies using personal and area-based sampling methods

Endotoxin, found in the cell wall of gram negative bacteria, is an important contributor to the biological activity of agriculture particulate matter (PM). We analyzed endotoxin in PM collected on 13 California dairies and from the breathing zone of 226 workers during the summer months of 2008. Two particle size fractions were measured: PM(2.5) and inhalable PM. Recombinant factor C assays were used to analyze biologically active endotoxin, while gas chromatography coupled with mass spectrometry in tandem was used to quantify total lipopolysaccharide. Biologically active endotoxin concentrations in the inhalable PM size fraction from area-based samples ranged from 11-2095 EU/m(3) and from 45-2061 EU/m(3) for personal samples. Total endotoxin in the inhalable PM size fraction ranged from 75-10,166 pmol/m(3) for area-based samples and 34-11,689 pmol/m(3) for personal samples. Area-based geometric mean concentrations for biologically active endotoxin and total endotoxin in PM(2.5) and inhalable PM size fractions were 3 EU/m(3), 149 EU/m(3), 60 pmol/m(3), and 515 pmol/m(3), respectively. Personal geometric mean concentrations in the inhalable PM size fraction were 334 EU/m(3), and 1178 pmol/m(3). Biologically active and total endotoxin concentration variation was best explained by meteorological data, wind speed, relative humidity, and dairy waste management practices. Differences in endotoxin concentration and composition were found across locations on the dairy.

Muramic acid, endotoxin, 3-hydroxy fatty acids, and ergosterol content explain monocyte and epithelial cell inflammatory responses to agricultural dusts

In agricultural and other environments, inhalation of airborne microorganisms is linked to respiratory disease development. Bacterial endotoxins, peptidoglycans, and fungi are potential causative agents, but relative microbial characterization and inflammatory comparisons amongst agricultural dusts are not well described. The aim of this study was to determine the distribution of microbial endotoxin, 3-hydroxy fatty acids (3-OHFA), muramic acid, and ergosterol and evaluate inflammatory responses in human monocytes and bronchial epithelial cells with various dust samples. Settled surface dust was obtained from five environments: swine facility, dairy barn, grain elevator, domestic home (no pets), and domestic home with dog. Endotoxin concentration was determined by recombinant factor C (rFC). 3-OHFA, muramic acid, and ergosterol were measured using gas chromatography-mass spectrometry. Dust-induced inflammatory cytokine secretion in human monocytes and bronchial epithelial cells was evaluated. Endotoxin-independent dust-induced inflammatory responses were evaluated. Endotoxin and 3-OHFA levels were highest in agricultural dusts. Muramic acid, endotoxin, 3-OHFA, and ergosterol were detected in dusts samples. Muramic acid was highest in animal farming dusts. Ergosterol was most significant in grain elevator dust. Agricultural dusts induced monocyte tumor necrosis factor (TNF) alpha, interleukin (IL)-6, IL-8, and epithelial cell IL-6 and IL-8 secretion. Monocyte and epithelial IL-6 and IL-8 secretion was not dependent on endotoxin. House dust(s) induced monocyte TNFalpha, IL-6, and IL-8 secretion. Swine facility dust generally produced elevated responses compared to other dusts. Agricultural dusts are complex with significant microbial component contribution. Large animal farming dust(s)-induced inflammation is not entirely dependent on endotoxin. Addition of muramic acid to endotoxin in large animal farming environment monitoring is warranted.

Resident cleanup activities, characteristics of flood-damaged homes and airborne microbial concentrations in New Orleans, Louisiana, October 2005

BACKGROUND

Flooding in the greater New Orleans (GNO) area after the hurricanes caused extensive mold growth in homes resulting in public health concerns.

OBJECTIVES

We conducted an environmental assessment of homes to determine the extent and type of microbial growth.

METHODS

We randomly selected 112 homes, stratified by water damage, and then visually assessed mold growth. Air samples from a subset of 20 homes were analyzed for culturable fungi, fungal spores, and markers of mold ((1-->3, 1-->6)-beta-D-glucans) and bacteria (endotoxin).

RESULTS

Visible mold growth occurred in 49 (44%) homes; 18 (16%) homes had >50% mold coverage. Flood levels were >6 ft at 20 (19%), 3-6 ft at 20 (19%), and <3 ft at 28 (26%) homes out of 107; no flooding at 39 (36%) homes. The residents spent an average of 18 h (range: 1-84) doing heavy cleaning and of those, 22 (38%) reported using an N-95 or other respirator. Visible mold growth was significantly associated with flood height 3 ft and the predominant fungi indoors were Aspergillus and Penicillium species, which were in higher concentrations in homes with a flood level 3 ft. Geometric mean (GM) levels of endotoxin were as high as 40.2 EU/m(3), while GM glucan levels were as high as 3.5 microg/m(3) even when flooding was 3 ft.

CONCLUSIONS

Based on our observations of visible mold, we estimated that elevated mold growth was present in 194,000 (44%) homes in the GNO area and 70,000 (16%) homes had heavy mold growth. Concentrations of endotoxin and glucans exceeded those previously associated with health effects. With such high levels of microbial growth following flooding, potentially harmful inhalation exposures can be present for persons entering or cleaning affected homes. Persons exposed to water-damaged homes should follow the CDC recommendations developed following the 2005 hurricanes for appropriate respiratory precautions.

Particle size distributions and concentrations of airborne endotoxin using novel collection methods in homes during the winter and summer seasons

A comparison study of novel collection methods for airborne bacteria and endotoxin was performed in an environmentally controlled chamber and in pilot-field studies. Airborne particulate matter was collected in swirling liquid impingers, air-monitoring filter cassettes, and with a micro-orifice uniform deposit impactor (MOUDI) to evaluate aerodynamic particle size distributions. Environmentally controlled chamber studies showed that impingers and MOUDI recovered significantly more airborne bacteria than filter cassettes, whereas collection methods for airborne endotoxin were not significantly different. In addition, total airborne bacteria and endotoxin concentrations were measured indoors and outdoors at three homes in Boulder, CO during winter and summer seasons. Indoor concentrations collected with the three different samplers were significantly different for airborne endotoxin, but not for airborne bacteria. Total airborne bacteria indoors and outdoors significantly varied with seasons. Outdoor airborne endotoxin significantly varied with season; no seasonal variation was seen for indoor airborne endotoxin. Indoor and outdoor levels were not significantly different for both airborne bacteria and endotoxin. The largest proportion of endotoxin was associated with airborne particulate matter <1 microm.

PRACTICAL IMPLICATIONS

This study compared sampling methods for airborne endotoxin, a potent and nonspecific immune system stimulant which can induce negative health responses. The data from this study showed that swirling liquid impingers and the micro-orifice uniform deposit impactor (MOUDI) recovered significantly more airborne endotoxin than the more widely adapted method of collecting airborne endotoxin on membrane filters, when collection methods were applied in realistic settings (homes). The MOUDI measured the particle size distribution of airborne endotoxin, which can be useful for determining endotoxin respiratory toxicity and its health effects.

Fungal and endotoxin measurements in dust associated with respiratory symptoms in a water-damaged office building

We investigated the associations of fungal and endotoxin levels in office dust with respiratory health in 888 (67% participation) occupants of a water-damaged building. We analyzed floor and chair dusts from 338 workstations for culturable fungi and endotoxin. Based on averages, we ranked each floor of the building as low, medium, or high for occupants' exposure to each of these agents. Multivariate logistic regression models for building-related symptoms included this ranking of fungi and endotoxin, age, gender, race, smoking status, and duration of occupancy. Using floor dust measures, we found significantly increased odds for lower respiratory symptoms [wheeze, chest tightness, attacks of shortness of breath, and attacks of cough: odds ratios (OR) = 1.7 (95% confidence interval (CI): 1.02-2.77) to 2.4 (95% CI: 1.29-4.59)], throat irritation [OR = 1.7, (95% CI: 1.06-2.82)], and rash/itchy skin [OR = 3.0, (95% CI: 1.47-6.19)] in the highest fungal exposure group compared to the lowest, with generally linear exposure-response relationships. Nonlinear relationships were observed for many of these symptoms and endotoxin in floor dust. Interaction models showed that endotoxin modified effects of fungi on respiratory symptoms. Our findings of exposure interactions and exposure-response relationships of fungal and endotoxin with increased risk of building-related symptoms contribute to an understanding of the role of microbial agents in building-related asthma and respiratory and systemic symptoms.

PRACTICAL IMPLICATIONS

Our demonstration of exposure-response relationships between measurements of fungi and/or endotoxin in floor dusts and building-related symptoms implies that microbial agents in floor dust may be a good surrogate measure for dampness-related bioaerosol exposure, considering that measurements of microbial agents in air often fail to demonstrate the associations between exposure and health. In addition, our finding that endotoxin exposure may change the effect of fungal exposure (and vice versa) on respiratory heath suggests that exposure to both fungi and endotoxin should be assessed in epidemiological investigations examining the effect of fungal or endotoxin exposure on respiratory health in indoor environments.

Suppression of ionization and optimization of assay for 3-hydroxy fatty acids in house dust using ion-trap mass spectrometry

BACKGROUND

3-Hydroxy fatty acids (3-OHFAs), components of lipid A of gram-negative bacteria are useful chemical markers of endotoxin.

METHODS

We analyzed 3-OHFAs in house dust as trimethylsilyl (TMS) methyl ester derivatives in the electron impact ionization mode using gas chromatography ion-trap mass spectrometry. Linear calibrations with r > 0.995 were observed for all the 3-OHFA methyl ester external standards.

RESULTS

Recovery efficiency experiments with house dust demonstrated that accurate quantification requires calibration curves to be subjected to phase separation and solid phase extraction (SPE) because of differing clean-up losses according to chain length of 3-OHFAs. Recovery experiments also demonstrated interference with detection of C16:0 by the ion trap, which may be due to suppression of ionization by a constituent in house dust. Interference was overcome by injecting 1:4 dilutions of derivatized samples. The range of recoveries was 89.3%-111.5% for 3-OHFAs added to house dust. The reproducibility of injections was high (CV for C14:0 = 2.36%). The limit of detection (LOD) was 0.15 ng/mg for each 3-OHFA.

CONCLUSIONS

The modifications we made included: use of 3-hydroxy C11:0 and C13:0 methyl esters as internal standards, subjecting calibration standards to phase separation and SPE; addition of water to phase separation; addition of 1-pentadecanol as a carrier; injecting 1:4 diluted TMS derivatives of 3-OHFAs; and monitoring both m/z 131 and 133 ions to improve stability of area measurements for product ions. This method of optimization establishes an appropriate technique for quantification of 3-OHFAs in house dust.

Dust sampling methods for endotoxin - an essential, but underestimated issue

Exposure to farming environment in early life has been associated with lower risk for allergic diseases possibly caused by increased exposure to endotoxin. The aims of this study were to compare the reproducibility of different sampling methods for endotoxin, and to determine whether environmental characteristics have different effect on endotoxin levels of different sample types. The reproducibility of sampling methods (bed dust, floor dust, vacuum cleaner dust bag dust, settled dust and air samples) was studied with repeated sampling (five visits during 1 year) in five farming and five urban homes. To examine determinants of endotoxin for different types of dust sample, sampling was conducted once in 12 farming and 17 urban homes. Endotoxin was analyzed using Limulus Amebocyte Lysate assay. Bed dust samples had the best reproducibility (intraclass correlation, ICC=66%), but the difference between farming and non-farming homes was not clear with this sample type. The reproducibility of floor (ICC=52%) and settled dust (ICC=51%) was moderate. With these sample types the difference between farming and non-farming homes was clear. Settled dust had some seasonal variation. Based on this study, the best compromise for sampling for endotoxin appears to be floor dust sample followed by bed and settled dust samples. Practical Implications Endotoxins have been widely measured, even though the validity of different sample types to reflect the endotoxin exposure level of an indoor environment is poorly known. This study shows that bed dust samples have the best reproducibility, but they do not reflect the differences in exposure due to environmental factors such as farming. Floor dust samples with moderate reproducibility may be the best choice for sampling of endotoxin in large field studies.

Interlaboratory evaluation of endotoxin analyses in agricultural dusts--comparison of LAL assay and mass spectrometry

Endotoxin exposure is associated with wheeze and asthma morbidity, while early life exposure may reduce risk of allergy and asthma. Unfortunately, it is difficult to compare endotoxin results from different laboratories and environments. We undertook this study to determine if lipopolysaccharide (LPS) extraction efficiency could account for differences among laboratories. We generated and collected aerosols from chicken and swine barns, and corn processing. We randomly allocated side-by-side filter samples to five laboratories for Limulus assay of endotoxin. Lyophilized aliquots of filter extracts were analyzed for 3-hydroxy fatty acids (3-OHFAs) as a marker of LPS using gas chromatography-mass spectrometry. There were significant differences in endotoxin assay and GC-MS (LPS) results between laboratories for all dust types (p < 0.01). Patterns of differences between labs varied by dust type. Relationships between assay and GC/MS results also depended on dust type. The percentages of individual 3-OHFA chain lengths varied across labs (p < 0.0001) suggesting that each lab recovered a different fraction of the LPS available. The presence of large amounts of particle associated LPS and absence of a freezing thawing cycle were associated with lower correlations between LPS and bioactivity, consistent with an absence of Limulus response to cell-bound endotoxin. These data suggest that extraction methods affect endotoxin measurements. The LAL methods may be most suitable when comparing exposures within similar environments; GC-MS offers additional information helpful in optimizing sample treatment and extraction. GC-MS may be of use when comparing across heterogeneous environments and should be considered for inclusion in future studies of human health outcomes.

Importance of the personal endotoxin cloud in school-age children with asthma

BACKGROUND

A number of studies have observed associations between the amount of endotoxin in urban dust and chronic asthma severity, but a direct relationship between personal exposure to household endotoxin and acute asthma worsening has not yet been defined.

OBJECTIVE

We sought to investigate the relationship between day-to-day changes in personal endotoxin exposure and asthma severity.

METHODS

In the winter and spring of 1999 through 2000, endotoxin exposures were monitored in asthmatic schoolchildren by using portable, as opposed to stationary, monitors designed to measure inhalable and respirable particulate matter less than or equal to 2.5 and 10 microm in diameter. Children were followed with daily measurements of FEV(1) and asthma symptoms.

RESULTS

Over a 24-hour period, median daily personal endotoxin exposures ranged from 0.08 EU/m(3) (measured at a particulate matter size range </=2.5 microm in diameter) to 0.37 EU/m(3) (measured at a particulate matter size range </=10 microm in diameter). Personal exposures were significantly (P < .001) higher than endotoxin measurements from either indoor or outdoor stationary monitors. Moreover, individual exposures did not correlate with stationary measurements, suggesting that exposures derived from sources in close proximity to the children's personal activities might be better correlated with disease severity. Increases in personal endotoxin exposures were associated with decreased FEV(1) values and increased symptoms.

CONCLUSIONS

These findings demonstrate the importance of using personal monitoring to both measure and correlate endotoxin exposure with asthma severity.

Effects of ceiling-mounted HEPA-UV air filters on airborne bacteria concentrations in an indoor therapy pool building

The purpose of this study was to assess the effectiveness of a new generation of high-volume, ceiling-mounted high-efficiency particulate air (HEPA)-ultraviolet (UV) air filters (HUVAFs) for their ability to remove or inactivate bacterial aerosol. In an environmentally controlled full-scale laboratory chamber (87 m3), and an indoor therapy pool building, the mitigation ability of air filters was assessed by comparing concentrations of total bacteria, culturable bacteria, and airborne endotoxin with and without the air filters operating under otherwise similar conditions. Controlled chamber tests with pure cultures of aerosolized Mycobacterium parafortuitum cells showed that the HUVAF unit tested provided an equivalent air-exchange rate of 11 hr(-1). Using this equivalent air-exchange rate as a design basis, three HUVAFs were installed in an indoor therapy pool building for bioaerosol mitigation, and their effectiveness was studied over a 2-year period. The HUVAFs reduced concentrations of culturable bacteria by 69 and 80% during monitoring periods executed in respective years. The HUVAFs reduced concentrations of total bacteria by 12 and 76% during the same monitoring period, respectively. Airborne endotoxin concentrations were not affected by the HUVAF operation.

Heterogeneity in microbial exposure in schools in Sweden, Poland and Jordan revealed by analysis of chemical markers

We used gas chromatography--tandem mass spectrometry to analyze microbial components in 85 samples of airborne dust from schools in Jordan, Sweden, and Poland. To collect the samples, we allowed dust to settle on plexiglass plates hanging in the breathing zone in school buildings during both summer and winter. In each of the three countries, we conducted such sampling in two schools: one in an urban environment and the other in rural surroundings. The microbial marker profiles differed significantly between the schools and seasons. For example, samples from Jordan contained remarkably low levels of ergosterol (marker of fungal biomass) and high levels of 3-hydroxy acids (markers of lipopolysaccharide) of 10, 12, and 14 carbon chain lengths relative to such acids of 16 and 18 carbons in comparison with samples from Sweden and Poland. This dissimilarity in 3-hydroxy fatty acid distribution indicates significant differences in the populations of Gram-negative bacteria. We also noted that muramic acid (marker of bacterial biomass) exhibited the smallest variation between schools and seasons. In summary, our results demonstrate that exposure to microorganisms in indoor air in school buildings may differ markedly between countries, between seasons, and between urban and rural environments.

Metropolitan endotoxin exposure, allergy and asthma

PURPOSE OF REVIEW

To review the role of metropolitan endotoxin exposure in asthma and allergy, emphasizing recently published articles (i.e. April 2002-June 2003).

RECENT FINDINGS

In infants and toddlers in metropolitan communities, higher endotoxin levels in house dust are associated with less atopy and increased wheezing in infancy, but this increased risk may normalize by age 4 years. Increased endotoxin levels and exposure in metropolitan households with dogs and sometimes cats is intriguing in light of recent studies suggesting that animal exposure early in life is associated with less allergen sensitization and asthma. Dust endotoxin also appears to serve as a marker for other similar innate immune-stimulatory microbial components called pathogen-associated molecular patterns. Pathogen-associated molecular patterns, such as bacterial DNA, may augment and steer endotoxin-initiated immune responses in an immune-regulatory direction. These findings support the premise that the differences in health outcomes from endotoxin exposure are due to important moderating variables, such as age of exposure, timing of exposure relative to disease development, dose and frequency of exposure, co-exposures, and genetic predispositions in response to endotoxin.

SUMMARY

We will discuss (1) endotoxin's ability to exacerbate established atopic disease and asthma; (2) factors influencing endotoxin levels in metropolitan homes; (3) relationships between endotoxin, pet exposure, and atopic disease; (4) endotoxin's paradoxical potential to both abrogate as well as exacerbate asthma; and (5) endotoxin's role as a marker for other similar pathogen-associated molecular patterns.

Indoor particles and symptoms among office workers: results from a double-blind cross-over study

BACKGROUND

We studied the effects of removing small airborne particles in an office building without unusual contaminant sources or occupant complaints.

METHODS

We conducted a double-blind crossover study of enhanced particle filtration in an office building in the Midwest United States in 1993. We replaced standard particle filters, in separate ventilation systems on two floors, with highly efficient filters on alternate floors weekly over 4 weeks. Repeated-measures models were used to analyze data from weekly worker questionnaires and multiple environmental measurements.

RESULTS

Bioaerosol concentrations were low. Enhanced filtration reduced concentrations of the smallest airborne particles by 94%. This reduction was not associated with reduced symptoms among the 396 respondents, but three performance-related mental states improved; for example, the confusion scale decreased (-3.7%; 95% confidence limits (CL) = -6.5, -0.9). Most environmental dissatisfaction variables also improved; eg, "stuffy" air, -5.3% (95% CL = -10.3, -0.4). Cooler temperatures within the recommended comfort range were associated with remarkably large improvement in most outcomes; for example, chest tightness decreased -23.4% (95% CL = -38.1, -8.7) for every 1 degrees C decrease.

CONCLUSIONS

Benefits of enhanced filtration require assessment in buildings with higher particulate contaminant levels in studies controlling for temperature effects. Benefits from lower indoor temperatures need confirmation.

Endotoxin-stimulated innate immunity: A contributing factor for asthma

Exposure to airborne endotoxin in infancy may protect against asthma by promoting enhanced T(H)1 response and tolerance to allergens. On the other hand, later in life, it adversely affects patients with asthma. Endotoxin binding to receptors on macrophages and other cells generates IL-12, which inhibits IgE responses. It also generates cytokines like IL-1, TNF-alpha, and IL-8, which cause inflammation. These signal transduction pathways resemble those leading to the generation of cytokines, such as IL-4, IL-13, and IL-5, which are responsible for the inflammation of IgE-mediated allergic disease. The main difference seems to be that endotoxin recruits neutrophils, but IgE recruits eosinophils, and the details of the tissue injury from these granulocytes differ. Sources of airborne endotoxin include many agricultural dusts, aerosols from contaminated water in many industrial plants, contaminated heating and air-conditioning systems, mist-generating humidifiers, and damp or water-damaged homes. Acute inhalation of high concentrations of endotoxin can cause fever, cough, and dyspnea. Chronic inhalation of lesser amounts causes chronic bronchitis and emphysema and is associated with airway hyperresponsiveness. Airborne endotoxin adversely affects patients with asthma in 3 ways: (1) by increasing the severity of the airway inflammation; (2) by increasing the susceptibility to rhinovirus-induced colds; and (3) by causing chronic bronchitis and emphysema with development of irreversible airway obstruction after chronic exposure of adults. The most effective management is mitigating exposure. The potential of drug treatments requires further clinical investigation.