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Hao Y, Tian X, Yan F, Wang X, Huang J, Li L. Effect of MEHP on testosterone synthesis via Sirt1/Foxo1/Rab7 signaling pathway inhibition of lipophagy in TM3 cells. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 277:116394. [PMID: 38663197 DOI: 10.1016/j.ecoenv.2024.116394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/30/2024]
Abstract
Mono-2-ethylhexyl phthalic acid (MEHP) is the most toxic metabolite of the plasticizer di-2-ethylhexyl phthalic acid (DEHP), and studies have shown that MEHP causes serious reproductive effects. However, its exact mechanisms of action remain elusive. In this study, we aimed to investigate the reproductive effects of MEHP and preliminarily explore its underlying molecular mechanisms. We found that TM3 cells gradually secreted less testosterone and intracellular free cholesterol with increasing MEHP exposure. MEHP exposure inhibited lipophagy and the Sirt1/Foxo1/Rab7 signaling pathway in TM3 cells, causing aberrant accumulation of intracellular lipid droplets. Addition of the Sirt1 agonist SRT1720 and Rab7 agonist ML-098 alleviated the inhibition of lipophagy and increased free cholesterol and testosterone contents in TM3 cells. SRT1720 alleviated the inhibitory effect of MEHP on the Sirt1/Foxo1/Rab7 signaling pathway, whereas ML-098 only alleviated the inhibition of Rab7 protein expression by MEHP and had no effect on Sirt1 and Foxo1 protein expression. This suggests that MEHP inhibits lipophagy in TM3 cells by suppressing the Sirt1/Foxo1/Rab7 signaling pathway, ultimately leading to a further decrease in cellular testosterone secretion. This study improves our current understanding of the toxicity and molecular mechanisms of action of MEHP and provides new insights into the reproductive effects of phthalic acid esters.
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Affiliation(s)
- Yu Hao
- Department of Occupational and Environmental Health, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Xuan'en Tian
- Department of Pediatric Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Fengmei Yan
- Department of Occupational and Environmental Health, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Xiuqin Wang
- Ningxia Hui Autonomous Region Center for Disease Control and Prevention, Yinchuan, Ningxia 750004, China
| | - Jing Huang
- Department of Occupational and Environmental Health, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Ling Li
- Department of Occupational and Environmental Health, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health, Ningxia Medical University, Yinchuan, Ningxia 750004, China
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Zhao Y, Wang XQ, Liu RQ, Jiang FW, Wang JX, Chen MS, Zhang H, Cui JG, Chang YH, Li JL. SLC7A11 as a therapeutic target to attenuate phthalates-driven testosterone level decline in mice. J Adv Res 2024:S2090-1232(24)00216-9. [PMID: 38797476 DOI: 10.1016/j.jare.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Phthalates exposure is a major public health concern due to the accumulation in the environment and associated with levels of testosterone reduction, leading to adverse pregnancy outcomes. However, the relationship between phthalate-induced testosterone level decline and ferroptosis remains poorly defined. OBJECTIVES Herein, we aimed to explore the mechanisms of phthalates-induced testosterone synthesis disorder and its relationship to ferroptosis. METHODS We conducted validated experiments in vivo male mice model and in vitro mouse Leydig TM3 cell line, followed by RNA sequencing and metabolomic analysis. We evaluated the levels of testosterone synthesis-associated enzymes and ferroptosis-related indicators by using qRT-PCR and Western blotting. Then, we analyzed the lipid peroxidation, ROS, Fe2+ levels and glutathione system to confirm the occurrence of ferroptosis. RESULTS In the present study, we used di (2-ethylhexyl) phthalate (DEHP) to identify ferroptosis as the critical contributor to phthalate-induced testosterone level decline. It was demonstrated that DEHP caused glutathione metabolism and steroid synthesis disorders in Leydig cells. As the primary metabolite of DEHP, mono-2-ethylhexyl phthalate (MEHP) triggered testosterone synthesis disorder accompanied by a decrease in the expression of solute carri1er family 7 member 11 (SLC7A11) protein. Furthermore, MEHP synergistically induced ferroptosis with Erastin through the increase of intracellular and mitochondrial ROS, and lipid peroxidation production. Mechanistically, overexpression of SLC7A11 counteracts the synergistic effect of co-exposure to MEHP-Erastin. CONCLUSION Our research results suggest that MEHP does not induce ferroptosis but synergizes Erastin-induced ferroptosis. These findings provide evidence for the role of ferroptosis in phthalates-induced testosterone synthesis disorder and point to SLC7A11 as a potential target for male reproductive diseases. This study established a correlation between ferroptosis and phthalates cytotoxicity, providing a novel view point for mitigating the issue of male reproductive disease and "The Global Plastic Toxicity Debt".
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Affiliation(s)
- Yi Zhao
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China
| | - Xue-Qi Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China
| | - Rui-Qi Liu
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China
| | - Fu-Wei Jiang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China
| | - Jia-Xin Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China
| | - Ming-Shan Chen
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China
| | - Hao Zhang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China
| | - Jia-Gen Cui
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China
| | - Yuan-Hang Chang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China
| | - Jin-Long Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, PR China; Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, Northeast Agricultural University, Harbin 150030, PR China; Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, Northeast Agricultural University, Harbin 150030, PR China.
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Guerrelli D, Desai M, Semaan Y, Essa Y, Zurakowski D, Cendali F, Reisz J, D'Alessandro A, Luban N, Posnack NG. Prevalence and clinical implications of heightened plastic chemical exposure in pediatric patients undergoing cardiopulmonary bypass. Transfusion 2024; 64:808-823. [PMID: 38590100 DOI: 10.1111/trf.17821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/30/2024] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Phthalate chemicals are used to manufacture plastic medical products, including many components of cardiopulmonary bypass (CPB) circuits. We aimed to quantify iatrogenic phthalate exposure in pediatric patients undergoing cardiac surgery and examine the link between phthalate exposure and postoperative outcomes. STUDY DESIGN AND METHODS The study included pediatric patients undergoing (n=122) unique cardiac surgeries at Children's National Hospital. For each patient, a single plasma sample was collected preoperatively and two additional samples were collected postoperatively upon return from the operating room and the morning after surgery. Concentrations of di(2-ethylhexyl) phthalate (DEHP) and its metabolites were quantified using ultra high-pressure liquid chromatography coupled to mass spectrometry. RESULTS Patients were subdivided into three groups, according to surgical procedure: (1) cardiac surgery not requiring CPB support, (2) cardiac surgery requiring CPB with a crystalloid prime, and (3) cardiac surgery requiring CPB with red blood cells (RBCs) to prime the circuit. Phthalate metabolites were detected in all patients, and postoperative phthalate levels were highest in patients undergoing CPB with an RBC-based prime. Age-matched (<1 year) CPB patients with elevated phthalate exposure were more likely to experience postoperative complications. RBC washing was an effective strategy to reduce phthalate levels in CPB prime. DISCUSSION Pediatric cardiac surgery patients are exposed to phthalate chemicals from plastic medical products, and the degree of exposure increases in the context of CPB with an RBC-based prime. Additional studies are warranted to measure the direct effect of phthalates on patient health outcomes and investigate mitigation strategies to reduce exposure.
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Affiliation(s)
- Devon Guerrelli
- Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
- Department of Biomedical Engineering, The George Washington University School of Engineering and Applied Science, Washington, DC, USA
| | - Manan Desai
- Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA
| | - Youssef Semaan
- Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
- Department of Cardiovascular Services - Perfusion, Children's National Hospital, Washington, DC, USA
| | - Yasin Essa
- Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Francesca Cendali
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Julie Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Naomi Luban
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Hematology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
- Department of Pathology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Nikki Gillum Posnack
- Children's National Heart Institute, Children's National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Ge XR, Zhao Y, Ren HR, Jiang FW, Liu S, Lou M, Huang YF, Chen MS, Wang JX, Li JL. Phthalate drives splenic inflammatory response via activating HSP60/TLR4/NLRP3 signaling axis-dependent pyroptosis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 346:123610. [PMID: 38382728 DOI: 10.1016/j.envpol.2024.123610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/03/2024] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
As the most produced phthalate, di-(2-ethylhexyl) phthalate (DEHP) is a widely environmental pollutant primarily used as a plasticizer, which cause the harmful effects on human health. However, the impact of DEHP on spleen and its underlying mechanisms are still unclear. Pyroptosis is a novel form of cell death induced by activating NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasomes and implicated in pathogenesis of numerous inflammatory diseases. The current study aimed to explore the impact of DEHP on immune inflammatory response in mouse spleen. In this study, the male ICR mice were treated with DEHP (200 mg/kg) for 28 days. Here, DEHP exposure caused abnormal pathohistological and ultrastructural changes, accompanied by inflammatory cells infiltration in mouse spleen. DEHP exposure arouse heat shock response that involves increase of heat shock proteins 60 (HSP60) expression. DEHP also elevated the expressions of toll-like receptor 4 (TLR4) and myeloid differentiation protein 88 (MyD88) proteins, as well as the activation of NF-κB pathway. Moreover, DEHP promoted NLRP3 inflammasome activation and triggered NLRP3 inflammasome-induced pyroptosis. Mechanistically, DEHP drives splenic inflammatory response via activating HSP60/TLR4/NLRP3 signaling axis-dependent pyroptosis. Our findings reveal that targeting HSP60-mediated TLR4/NLRP3 signaling axis may be a promising strategy for inflammatory diseases treatment.
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Affiliation(s)
- Xin-Ran Ge
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Yi Zhao
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, Northeast Agricultural University, Harbin 150030, China; Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, Northeast Agricultural University, Harbin 150030, China.
| | - Hao-Ran Ren
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Fu-Wei Jiang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Shuo Liu
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Ming Lou
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Yi-Feng Huang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Ming-Shan Chen
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Jia-Xin Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Jin-Long Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, Northeast Agricultural University, Harbin 150030, China; Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, Northeast Agricultural University, Harbin 150030, China.
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Liu Y, Hamid N, Manzoor R, Zhang BF, Liao YL, Wang JX, Pei DS. PPARβ/δ-ANGPTL4 axis mediates the promotion of mono-2-ethylhexyl phthalic acid on MYCN-amplified neuroblastoma development. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:168949. [PMID: 38042186 DOI: 10.1016/j.scitotenv.2023.168949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/25/2023] [Accepted: 11/25/2023] [Indexed: 12/04/2023]
Abstract
Di-2-ethylhexyl phthalic acid (DEHP) is one of the most widely used plasticizers in the industry, which can improve the flexibility and durability of plastics. It is prone to migrate from various daily plastic products through wear and leaching into the surrounding environment and decompose into the more toxic metabolite mono-2-ethylhexyl phthalic acid (MEHP) after entering the human body. However, the impacts and mechanisms of MEHP on neuroblastoma are unclear. We exposed MYCN-amplified neuroblastoma SK-N-BE(2)C cells to an environmentally related concentration of MEHP and found that MEHP increased the proliferation and migration ability of tumor cells. The peroxisome proliferator-activated receptor (PPAR) β/δ pathway was identified as a pivotal signaling pathway in neuroblastoma, mediating the effects of MEHP through transcriptional sequencing analysis. Because MEHP can bind to the PPARβ/δ protein and initiate the expression of the downstream gene angiopoietin-like 4 (ANGPTL4), the PPARβ/δ-specific agonist GW501516 and antagonist GSK3787, the recombinant human ANGPTL4 protein, and the knockdown of gene expression confirmed the regulation of the PPARβ/δ-ANGPTL4 axis on the malignant phenotype of neuroblastoma. Based on the critical role of PPARβ/δ and ANGPTL4 in the metabolic process, a non-targeted metabolomics analysis revealed that MEHP altered multiple metabolic pathways, particularly lipid metabolites involving fatty acyls, glycerophospholipids, and sterol lipids, which may also be potential factors promoting tumor progression. We have demonstrated for the first time that MEHP can target binding to PPARβ/δ and affect the progression of neuroblastoma by activating the PPARβ/δ-ANGPTL4 axis. This mechanism confirms the health risks of plasticizers as tumor promoters and provides new data support for targeted prevention and treatment of neuroblastoma.
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Affiliation(s)
- Yiyun Liu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Naima Hamid
- Faculty of Science and Marine Environment, Ocean Pollution and Ecotoxicology (OPEC) Research Group, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
| | - Rakia Manzoor
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
| | - Bao-Fu Zhang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Yan-Ling Liao
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Jin-Xia Wang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - De-Sheng Pei
- School of Public Health, Chongqing Medical University, Chongqing 400016, China.
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Li L, Su Y, Wang S, Wang C, Ruan N, Hu Z, Cheng X, Chen J, Yuan K, Li P, Fan P. Neonatal di-(2-ethylhexyl)phthalate exposure induces permanent alterations in secretory CRH neuron characteristics in the hypothalamus paraventricular region of adult male rats. Exp Neurol 2024; 372:114616. [PMID: 38007208 DOI: 10.1016/j.expneurol.2023.114616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/31/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
Corticotrophin-releasing hormone (CRH) neurons in the hypothalamic paraventricular nucleus (PVN) play a critical role in the modulation of the hypothalamic-pituitary-adrenal (HPA) axis. Early-life exposure to di-(2-ethylhexyl) phthalate (DEHP) has been associated with an increased risk of developing psychiatric disorders in adulthood. The present work was designed to explore the impact of neonatal exposure to DEHP on adult PVN CRH neuronal activity. DEHP or vehicle was given to male rat pups from PND16 to PND22. Then, anxiety-like behaviors, serum corticosterone and testosterone, immunohistochemistry, western blotting, fluorescence in situ hybridization and acute ex vivo slice electrophysiological recordings were used to evaluate the influence of DEHP on adult PVN secretory CRH neurons. Neonatal DEHP-exposed rats exhibited enhanced anxiety-like behaviors in adults, with an increase in CORT. Secretory CRH neurons showed higher spontaneous firing activity but could be inhibited by GABAAR blockers. CRH neurons displayed fewer firing spikes, prolonged first-spike latency, depolarizing shifts in GABA reversal potential and strengthened GABAergic inputs, as indicated by increases in the frequency and amplitude of sIPSCs. Enhancement of GABAergic transmission was accompanied by upregulated expression of GAD67 and downregulated expression of GABABR1, KCC2 and GAT1. These findings suggest that neonatal exposure to DEHP permanently altered the characteristics of secretory CRH neurons in the PVN, which may contribute to the development of psychiatric disorders later in life.
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Affiliation(s)
- Li Li
- Key Laboratory of Anesthesiology of Zhejiang Province, Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Ying Su
- Key Laboratory of Anesthesiology of Zhejiang Province, Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Siyuan Wang
- Key Laboratory of Anesthesiology of Zhejiang Province, Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Brain Injury Center, Department of Neurosurgery, RenJi Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200127, China
| | - Chengyu Wang
- Key Laboratory of Anesthesiology of Zhejiang Province, Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Naqi Ruan
- Key Laboratory of Anesthesiology of Zhejiang Province, Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Zhiyan Hu
- Key Laboratory of Anesthesiology of Zhejiang Province, Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xin Cheng
- Key Laboratory of Anesthesiology of Zhejiang Province, Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Jiajia Chen
- Key Laboratory of Anesthesiology of Zhejiang Province, Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Kaiming Yuan
- Key Laboratory of Anesthesiology of Zhejiang Province, Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
| | - Peijun Li
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
| | - Pei Fan
- Zhejiang Provincial Key Laboratory of Orthopedics, Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
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Swift LM, Roberts A, Pressman J, Guerrelli D, Allen S, Haq KT, Reisz JA, D’Alessandro A, Posnack NG. Evidence for the cardiodepressive effects of the plasticizer di-2-ethylhexyl phthalate. Toxicol Sci 2023; 197:79-94. [PMID: 37812252 PMCID: PMC10734602 DOI: 10.1093/toxsci/kfad105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Di-2-ethylhexyl phthalate (DEHP) is commonly used in the manufacturing of plastic materials, including intravenous bags, blood storage bags, and medical-grade tubing. DEHP can leach from plastic medical products, which can result in inadvertent patient exposure. DEHP concentrations were measured in red blood cell units stored between 7 and 42 days (17-119 μg/ml). Using these concentrations as a guide, Langendorff-perfused rat heart preparations were acutely exposed to DEHP. Sinus activity remained stable with lower doses of DEHP (25-50 μg/ml), but sinus rate declined by 43% and sinus node recovery time (SNRT) prolonged by 56.5% following 30-min exposure to 100 μg/ml DEHP. DEHP exposure also exerted a negative dromotropic response, as indicated by a 69.4% longer PR interval, 108.5% longer Wenckebach cycle length (WBCL), and increased incidence of atrioventricular (AV) uncoupling (60-min exposure). Pretreatment with doxycycline partially rescued the effects of DEHP on sinus activity, but did not ameliorate the effects on AV conduction. DEHP exposure also prolonged the ventricular action potential and effective refractory period, but had no measurable effect on intracellular calcium transient duration. Follow-up studies using human-induced pluripotent stem cell-derived cardiomyocytes confirmed that DEHP slows electrical conduction in a time (15 min-3 h) and dose-dependent manner (10-100 μg/ml). Previous studies have suggested that phthalate toxicity is specifically attributed to metabolites of DEHP, including mono-2-ethylhexylphthalate. This study demonstrates that DEHP exposure also contributes to cardiac dysfunction in a dose- and time-dependent manner. Future work is warranted to investigate the impact of DEHP (and its metabolites) on human health, with special consideration for clinical procedures that employ plastic materials.
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Affiliation(s)
- Luther M Swift
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, District of Columbia 20010, USA
| | - Anysja Roberts
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, District of Columbia 20010, USA
| | - Jenna Pressman
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Department of Biomedical Engineering, School of Engineering and Applied Sciences, The George Washington University, Washington, District of Columbia 20037, USA
| | - Devon Guerrelli
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Department of Biomedical Engineering, School of Engineering and Applied Sciences, The George Washington University, Washington, District of Columbia 20037, USA
| | - Samuel Allen
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, District of Columbia 20010, USA
| | - Kazi T Haq
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, District of Columbia 20010, USA
| | - Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Nikki Gillum Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, District of Columbia 20010, USA
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia 20037, USA
- Department of Pharmacology & Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia 20037, USA
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8
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Emont J, Wang M, Wright K. Health system decarbonization on obstetric and newborn units. Semin Perinatol 2023; 47:151844. [PMID: 37852893 DOI: 10.1016/j.semperi.2023.151844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
The healthcare industry makes up 4.6 % of greenhouse gas (GHS) emissions worldwide. Although it is not known what proportion of GHGs come from obstetric and newborn units, newborns and pregnant individuals are likely to face some of the largest consequences from climate change. We review the literature in the areas of decarbonization on labor and delivery (L&D) and neonatal units and describe innovations from the fields of surgery and anesthesia. Best practices for L&D include refining disposable equipment packs, decreasing the use of single-use medical devices, adequately triaging waste, and decreasing the use of potent anesthetic gases such as nitrous oxide and desflurane. In neonatal settings, similarly triaging waste and decreasing the use of plastics containing endocrine disrupting chemicals can lower the carbon and environmental footprint and improve neonatal health. Additionally, avoiding unnecessary cesarean deliveries and increasing breastfeeding practices are also likely to improve the carbon footprint of L&D and neonatal units.
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Affiliation(s)
- Jordan Emont
- Department of Obstetrics and Gynecology, Columbia University Medical Center - New York Presbyterian Hospital, 622 W 168th St, New York, NY 10032, USA.
| | - Melissa Wang
- Department of Obstetrics and Gynecology, Columbia University Medical Center - New York Presbyterian Hospital, 622 W 168th St, New York, NY 10032, USA
| | - Kelly Wright
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Yang G, Gong C, Zheng X, Hu F, Liu J, Wang T, Chen X, Li M, Zhu Z, Zhang L, Li R. Early clues and molecular mechanism involved in neurodegenerative diseases induced in immature mice by combined exposure to polypropylene microplastics and DEHP. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 336:122406. [PMID: 37597731 DOI: 10.1016/j.envpol.2023.122406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
Studies have shown that exposure to either microplastics (MPs) or di-(2-ethylhexyl) phthalic acid (DEHP) alone can cause neurotoxicity in animals, but it remains uncertain whether and to what extent co-exposure to these two substances, which often occur together in reality, can also induce neurotoxicity. This study aimed to investigate the neurotoxicity and molecular mechanisms of combined exposure to DEHP and polypropylene microplastics (synthetic PP-MPs were used), the microplastics most commonly encountered by young children, in immature mice. The results showed that exposure to PP-MPs and/or DEHP did cause neurotoxic effects in immature mice, including induction of neurocognitive and memory deficits, damage to the CA3 region of the hippocampus, increased oxidative stress, and decreased AChE activity in the brain. The severity of the neurotoxicity increased with increasing concentrations of PP-MPs, combined exposure to PP-MPs and DEHP exhibited additive or synergistic effects. Transcriptomic analyses revealed that the PP-MPs and/or DEHP exposure altered the expression profiles of gene clusters involved in the stress response, and in protein processing in endoplasmic reticulum. Quantitative analyses further indicated that PP-MPs and/or DEHP exposure inhibited the activity of the heat shock response mediated by heat shock transcription factor 1, while chronically activated the unfolded protein response, consequently inducing neurotoxicity through neuronal apoptosis and neuroinflammation in the immature mice. As a pioneer study to highlight the neurotoxicity induced by combined exposure to PP-MPs and DEHP in immature mice, this research provides new insights into mitigating the health risks of PP-MPs and DEHP exposure in young children.
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Affiliation(s)
- Ge Yang
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, 430079, China
| | - Cunyi Gong
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, 430079, China
| | - Xinyue Zheng
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, 430079, China
| | - Fei Hu
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, 430079, China
| | - Jie Liu
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, 430079, China; The Primary School Attached to Central China Normal University, Wuhan, 430079, China
| | - Tian Wang
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, 430079, China; College of Civil Engineering, Huaqiao University, Xiamen, 361021, China
| | - Xinyue Chen
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, 430079, China
| | - Min Li
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, 430079, China
| | - Zhihong Zhu
- Institute of Nanoscience and Nanotechnology, College of Physical Science and Technology, Central China Normal University, Wuhan, 430079, China
| | - Ling Zhang
- School of Public Health, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Rui Li
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, 430079, China.
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Pérez PA, Toledo J, Vitellini F, Cuello VN, Cantarelli V, Ponzio M, Mukdsi JH, Gutiérrez S. Environmentally relevant DEHP exposure during gestational and lactational period inhibits filamin a testicular expression. J Mol Histol 2023; 54:509-520. [PMID: 37572267 DOI: 10.1007/s10735-023-10144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
Toxicological studies have revealed that DEHP exposure during pregnancy may induce developmental disorders, especially in male offspring, leading to morphological and functional alterations in the reproductive system by mechanisms that should be investigated. Thus, the aim of this work was to analyze the testicular toxicity induced by an environmentally relevant DEHP dose during development and its impact on FLNA, a protein that participates in the blood-testis barrier assembly. We used male Wistar rats exposed to DEHP during pregnancy and lactation. The results showed that DEHP exposure during development and lactation increased body weight, decreased gonadal weight and shortened anogenital distance. This phthalate induced morphological changes in the testis, suggestive of hypospermatogenesis. DEHP exposure decreased the number of FLNA positive cells and the expression of FLNA and claudin-1 in prepubertal testes. Furthermore, DEHP inhibited FLNA and claudin-1 protein expression in adult male rats. These results indicated that exposure to DEHP during gestation and lactation perturbed testis development and suggested that FLNA is a target protein of DEHP, possibly contributing to the phthalate-induced damage on BTB.
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Affiliation(s)
- Pablo A Pérez
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jonathan Toledo
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Facundo Vitellini
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Victoria Navall Cuello
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Verónica Cantarelli
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
- Instituto de Fisiología Humana, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marina Ponzio
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
- Instituto de Fisiología Humana, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jorge H Mukdsi
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Silvina Gutiérrez
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina.
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.
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Swift LM, Roberts A, Pressman J, Guerrelli D, Allen S, Haq KT, Reisz JA, D'Alessandro A, Posnack NG. Evidence for the cardiodepressive effects of the plasticizer di-2-ethylhexylphthalate (DEHP). BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.22.541729. [PMID: 37293060 PMCID: PMC10245927 DOI: 10.1101/2023.05.22.541729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Di-2-ethylhexylphthalate (DEHP) is commonly used in the manufacturing of plastic materials, including intravenous bags, blood storage bags, and medical-grade tubing. DEHP can leach from plastic medical products, which can result in inadvertent patient exposure. DEHP concentrations were measured in red blood cell (RBC) units stored between 7-42 days (23-119 μg/mL). Using these concentrations as a guide, Langendorff-perfused rat heart preparations were acutely exposed to DEHP. Sinus activity remained stable with lower doses of DEHP (25-50 μg/mL), but sinus rate declined by 43% and sinus node recovery time prolonged by 56.5% following 30-minute exposure to 100 μg/ml DEHP. DEHP exposure also exerted a negative dromotropic response, as indicated by a 69.4% longer PR interval, 108.5% longer Wenckebach cycle length, and increased incidence of atrioventricular uncoupling. Pretreatment with doxycycline partially rescued the effects of DEHP on sinus activity, but did not ameliorate the effects on atrioventricular conduction. DEHP exposure also prolonged the ventricular action potential and effective refractory period, but had no measurable effect on intracellular calcium transient duration. Follow-up studies using hiPSC-CM confirmed that DEHP slows electrical conduction in a time (15 min - 3 hours) and dose-dependent manner (10-100 μg/mL). Previous studies have suggested that phthalate toxicity is specifically attributed to metabolites of DEHP, including mono-2-ethylhexyl phthalate (MEHP). This study demonstrates that DEHP exposure also contributes to cardiac dysfunction in a dose- and time-dependent manner. Future work is warranted to investigate the impact of DEHP (and its metabolites) on human health, with special consideration for clinical procedures that employ plastic materials.
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Sundera Murthe S, Sreekantan S, Mydin RBSMN, Vasudevan M, Appaturi JN. Shelf-life, bioburden, water and oxygen permeability studies of laser welded SEBS/PP blended polymer. Sci Rep 2023; 13:14379. [PMID: 37658068 PMCID: PMC10474096 DOI: 10.1038/s41598-023-41477-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023] Open
Abstract
The most common material used for blood bags is PVC, which requires the addition of DEHP to increase its flexibility. DEHP is known to cross the polymer barrier and move into the stored blood and, ultimately, the patient's bloodstream. In this work, an alternative prototype composed of SEBS/PP was fabricated through blow-moulding and compared with the commercially available PVC-based blood bag which was designated as the control. The blow-moulded sample layers were welded together using CO2 lasers and optimized to obtain complete sealing of the sides. The samples' performance characteristics were analyzed using water permeability, oxygen permeability, shelf-life, and bioburden tests. The SEBS/PP sample exhibited the highest oxygen permeability rate of 1486.6 cc/m2/24 h after 40 days of ageing, indicating that the sample is conducive for red blood cell (RBC) respiration. On the other hand, the SEBS/PP sample showcased a lower water permeability rate of 0.098 g/h m2 after 40 days of aging, indicating a high-water barrier property and thus preventing water loss during storage. In comparison, the oxygen and water permeability rates of PVC-DEHP were found to be distinctly lower in performance (662.7 cc/m2/24 h and 0.221 g/h m2, respectively). In addition, shelf-life analyses revealed that after 40 days of ageing, polymer samples exhibited no visual damage or degradation. The optimal parameters to obtain adequate welding of the SEBS/PP were determined to be power of 60% (18 W), speed of 70 in/sec and 500 Pulse Per Inch (PPI). Furthermore, the bioburden estimates of SEBS/PP of 115 CFU are markedly lower compared to the bioburden estimate of PVC-DEHP of 213 CFU. The SEBS/PP prototype can potentially be an effective alternative to PVC-based blood bags, particularly for high-risk patients in order to reduce the likelihood of medical issues.
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Affiliation(s)
- Satisvar Sundera Murthe
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Engineering Campus, 14300, Nibong Tebal, Penang, Malaysia
| | - Srimala Sreekantan
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Engineering Campus, 14300, Nibong Tebal, Penang, Malaysia.
- De Eco SR Hygiene, Science and Engineering Research Centre (SERC), Engineering Campus, Universiti Sains Malaysia, 14300, Nibong Tebal, Penang, Malaysia.
| | - Rabiatul Basria S M N Mydin
- Department of Biomedical Science, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Kepala Batas, Penang, Malaysia
| | - Mugashini Vasudevan
- Department of Mechanical Engineering, Universiti Teknologi PETRONAS, 32610, Seri Iskandar, Perak Darul Ridzuan, Malaysia
| | - Jimmy Nelson Appaturi
- De Eco SR Hygiene, Science and Engineering Research Centre (SERC), Engineering Campus, Universiti Sains Malaysia, 14300, Nibong Tebal, Penang, Malaysia
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Melnyk AI, Niino C, Wright KN. Addressing Sustainability in the Operating Room. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:719-724. [PMID: 37493260 DOI: 10.1097/spv.0000000000001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
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14
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Guerrelli D, Desai M, Semaan Y, Essa Y, Zurakowski D, Cendali FI, Reisz JA, D'Alessandro A, Luban NC, Posnack NG. Prevalence and Clinical Implications of Heightened Plastic Chemical Exposure in Pediatric Patients Undergoing Cardiopulmonary Bypass. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.02.23289379. [PMID: 37205364 PMCID: PMC10187441 DOI: 10.1101/2023.05.02.23289379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Importance Phthalate chemicals are used to manufacture disposable plastic medical products, including blood storage bags and components of cardiopulmonary bypass (CPB) circuits. During cardiac surgery, patients can be inadvertently exposed to phthalate chemicals that are released from these plastic products. Objective To quantify iatrogenic phthalate chemical exposure in pediatric patients undergoing cardiac surgery, and examine the link between phthalate exposure and post-operative outcomes. Design Setting and Participants The study cohort included 122 pediatric patients undergoing cardiac surgery at Children's National Hospital. For each patient, a single plasma sample was collected pre-operatively and two additional samples were collected post-operatively upon return from the operating room (post-operative day 0) and the morning after surgery (post-operative day 1). Exposures Concentrations of di(2-ethylhexyl)phthalate (DEHP) and its metabolites were quantified using ultra high-pressure liquid chromatography coupled to mass spectrometry. Main Outcomes and Measures Plasma concentrations of phthalates, post-operative blood gas measurements, and post-operative complications. Results Study subjects were subdivided into three groups, according to surgical procedure: 1) cardiac surgery not requiring CPB support, 2) cardiac surgery requiring CPB with crystalloid prime, and 3) cardiac surgery requiring CPB with red blood cells (RBCs) to prime the circuit. Phthalate metabolites were detected in all patients, and postoperative phthalate levels were highest in patients undergoing CPB with RBC-based prime. Age-matched (<1 year) CPB patients with elevated phthalate exposure were more likely to experience post-operative complications, including arrhythmias, low cardiac output syndrome, and additional post-operative interventions. RBC washing was an effective strategy to reduce DEHP levels in CPB prime. Conclusions and Relevance Pediatric cardiac surgery patients are exposed to phthalate chemicals from plastic medical products, and the degree of exposure increases in the context of CPB with RBC-based prime. Additional studies are warranted to measure the direct effect of phthalates on patient health outcomes and investigate mitigation strategies to reduce exposure. Key Points Question: Is cardiac surgery with cardiopulmonary bypass a significant source of phthalate chemical exposure in pediatric patients?Findings: In this study of 122 pediatric cardiac surgery patients, phthalate metabolites were quantified from blood samples before and after surgery. Phthalate concentrations were highest in patients undergoing cardiopulmonary bypass with red blood cell-based prime. Heightened phthalate exposure was associated with post-operative complications.Meaning: Cardiopulmonary bypass is a significant source of phthalate chemical exposure, and patients with heightened exposure may be at greater risk for postoperative cardiovascular complications.
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Al-Saleh I, Elkhatib R, Alnuwaysir H, Aldhalaan H, Alismail E, Binmanee A, Hawari A, Alhazzani F, Jabr MB, Mohamed G. Exposure of preterm neonates receiving total parenteral nutrition to phthalates and its impact on neurodevelopment at the age of 2 months. Sci Rep 2023; 13:6969. [PMID: 37117441 PMCID: PMC10141929 DOI: 10.1038/s41598-023-33715-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
This prospective study assessed the exposure to phthalates of preterm neonates who received total parenteral nutrition (TPN) during their stay in the neonatal intensive care unit (NICU) and the risk of neurodevelopment delays at the age of 2 months. Our study recruited 33 preterm neonates who required TPN upon NICU admission. Urine samples for analyzing phthalate metabolites were obtained at admission and then daily until the last day of receiving TPN. Phthalates in the daily TPN received by the preterm neonates were analyzed. The neurodevelopment of the neonates was assessed using the Ages and Stages Questionnaire Edition 3 (ASQ-3). Diethyl phthalate and butyl benzyl phthalate were found in all TPN samples, while 27% and 83% contained dibutyl phthalate and di-(2-ethylhexyl) phthalate (DEHP), respectively. Yet, the daily dose of each phthalate that our preterm neonates received from TPN was much lower than the recommended tolerable limit. Urinary levels of monobenzyl phthalate and four metabolites of DEHP [i.e., mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP)] and the sum of four DEHP metabolites (∑4DEHP) increased significantly in preterm neonates before discharge. However, these levels were not correlated with their phthalate parent compounds in TPN, suggesting other sources of exposure in the NICU. At 2 months, we found that urinary levels of mono-iso-butyl phthalate (MiBP), MECPP, MEHP, and ∑4DEHP were inversely related to fine motor skills. After adjusting for head circumference, the inverse relationships remained significant, suggesting direct effects from phthalates. Given the extreme vulnerability of our population, it is critical to minimize exposure to phthalates during their NICU stay.
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Affiliation(s)
- Iman Al-Saleh
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia.
| | - Rola Elkhatib
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hissah Alnuwaysir
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hesham Aldhalaan
- Center for Autism Research, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Eiman Alismail
- Center for Autism Research, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Abdulaziz Binmanee
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Amal Hawari
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Fahad Alhazzani
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Mohammad Bin Jabr
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Gamal Mohamed
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
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Al-Saleh I, Elkhatib R, Alnuwaysir H, Aldhalaan H, Binmanee A, Hawari A, Alhazzani F, Jabr MB. The cumulative risk assessment of phthalates exposure in preterm neonates. Int J Hyg Environ Health 2023; 248:114112. [PMID: 36657281 DOI: 10.1016/j.ijheh.2023.114112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/11/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
Phthalates are widely used plasticizers in various consumer products and medical devices, with some reporting as having estrogenic and anti-androgenic endocrine-disrupting effects. Premature neonates may be exposed to high levels of specific phthalates during hospitalization in the neonatal intensive care unit (NICU) because of reliance on multiple medical procedures that pose a possible health risk. The present study utilized seven urinary phthalate metabolites of dibutyl phthalate isomers [(di-n-butyl phthalate (DnBP) and diisobutyl phthalate (DiBP)], butylbenzyl phthalate (BBzP), and di(2-ethylhexyl) phthalate (DEHP) that had been previously measured in 33 preterm neonates sampled at hospital admission (N = 23) and daily during their NICU stay (N = 260). We aimed to perform: (1) cumulative risk assessment (CRA) using the volume and creatinine-adjusted models; (2) examine the temporal variability of CRA from repeated measures and (3) estimate the risk of cumulative exposure to phthalates based on their anti-androgenic and/or estrogenic properties. We multiplied the relative activity of individual phthalates exhibiting estrogenic or anti-androgenic effects by daily intake. For each preterm neonate, CRA was assessed based on the hazard index (HI) metric [the sum of hazard quotients] based on three reference doses for anti-androgenicity: the tolerable daily intake (TDI) from the European Food Safety Authority, the reference dose (RfD-AA) published in 2010 and newly revised published in 2020 (NRfD-AA). The metabolites of BBzP and DEHP were 2-23 fold higher in preterm neonates during their NICU stay. Median HIs increased in the order of HINRfDAA > HIRfDAA > HITDI. In the creatinine-based model, 87% (92%), 87% (96%), and 100% (100%) of preterm neonates at admission (during NICU stay) showed HITDI, HIRfD-AA, and HINRfD-AA exceeding 1, respectively with DEHP the most prevalent. The temporal reproducibility of HI (based on three reference doses) during preterm neonate stay in the NICU was high, with intra-class correlation coefficients ranging between 0.77 and 0.97, suggesting persistent exposure to phthalates. The four phthalates that preterm neonates were exposed to in the NICU exhibited estrogenic binding and anti-androgenic effects with median values (creatinine-based) of 98.7 and 56.9 μg/kg body weight/day, respectively. This was especially true for DEHP. The results indicate that preterm neonates in this NICU setting are probably at high risk of cumulative phthalate exposure with anti-androgenic properties that may have long-term adverse reproductive and developmental effects.
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Affiliation(s)
- Iman Al-Saleh
- Environmental Health Program, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia.
| | - Rola Elkhatib
- Environmental Health Program, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hissah Alnuwaysir
- Environmental Health Program, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hesham Aldhalaan
- Center for Autism Research, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Abdulaziz Binmanee
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Amal Hawari
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Fahad Alhazzani
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Mohammad Bin Jabr
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
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Zhao Y, Zhang H, Cui JG, Wang JX, Chen MS, Wang HR, Li XN, Li JL. Ferroptosis is critical for phthalates driving the blood-testis barrier dysfunction via targeting transferrin receptor. Redox Biol 2023; 59:102584. [PMID: 36580806 DOI: 10.1016/j.redox.2022.102584] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
The global rate of human male infertility is rising at an alarming rate owing to environmental and lifestyle changes. Phthalates are the most hazardous chemical additives in plastics and have an apparently negative impact on the function of male reproductive system. Ferroptosis is a recently described form of iron-dependent cell death and has been linked to several diseases. Transferrin receptor (TfRC), a specific ferroptosis marker, is a universal iron importer for all cells using extracellular transferrin. We aim to investigate the potential involvement of ferroptosis during male reproductive toxicity, and provide means for drawing conclusions on the effect of ferroptosis in phthalates-induced male reproductive disease. In this study, we found that di (2-ethylhexyl) phthalate (DEHP) triggered blood-testis barrier (BTB) dysfunction in the mouse testicular tissues. DEHP also induced mitochondrial morphological changes and lipid peroxidation, which are manifestations of ferroptosis. As the primary metabolite of DEHP, mono-2-ethylhexyl phthalate (MEHP) induced ferroptosis by inhibiting glutathione defense network and increasing lipid peroxidation. TfRC knockdown blocked MEHP-induced ferroptosis by decreasing mitochondrial and intracellular levels of Fe2+. Our findings indicate that TfRC can regulate Sertoli cell ferroptosis and therefore is a novel therapeutic molecule for reproductive disorders in male patients with infertility.
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Affiliation(s)
- Yi Zhao
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, PR China
| | - Hao Zhang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, PR China
| | - Jia-Gen Cui
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, PR China
| | - Jia-Xin Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, PR China
| | - Ming-Shan Chen
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, PR China
| | - Hao-Ran Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, PR China
| | - Xue-Nan Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, PR China; Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, Northeast Agricultural University, Harbin, 150030, PR China; Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, Northeast Agricultural University, Harbin, 150030, PR China
| | - Jin-Long Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, PR China; Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, Northeast Agricultural University, Harbin, 150030, PR China; Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, Northeast Agricultural University, Harbin, 150030, PR China.
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Busgang SA, Spear EA, Andra SS, Narasimhan S, Bragg JB, Renzetti S, Curtin P, Bates M, Arora M, Gennings C, Stroustrup A. Application of growth modeling to assess the impact of hospital-based phthalate exposure on preterm infant growth parameters during the neonatal intensive care unit hospitalization. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 850:157830. [PMID: 35944631 PMCID: PMC10038013 DOI: 10.1016/j.scitotenv.2022.157830] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 05/29/2023]
Abstract
In this study, we use advanced growth modeling techniques and the rich biospecimen and data repositories of the NICU Hospital Exposures and Long-Term Health (NICU-HEALTH) study to assess the impact of NICU-based phthalate exposure on extrauterine growth trajectories between birth and NICU discharge. Repeated holdout weighed quantile sum (WQS) regression was used to assess the effect of phthalate mixtures on the latency to first growth spurt and on the rate of first growth spurt. Further, we assessed sex as an effect modifier of the relationship between a phthalate mixture and both outcomes. Nine phthalate metabolites, mono-ethyl phthalate (MEP), mono-benzyl phthalate (MBzP), mono-n-butyl phthalate (MBP), mono-isobutyl phthalate (MiBP), mono-(3-carboxypropyl) phthalate (MCPP), mono-2-ethylhexyl phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP) were measured in weekly urine specimens from 101 NICU-HEALTH participants between birth and the first growth spurt. Phthalate levels varied by species but not by infant sex, and decreased over the course of the NICU hospitalization as presented in detail in Stroustrup et al., 2018. There was evidence of nonlinearity when assessing the effect of phthalates on latency to first growth spurt. Above a threshold level, a higher phthalate mixture with dominant contributors MCPP, MBzP, and MEP predicted a shorter latency to the first inflection point, or an earlier growth spurt. A higher phthalate mixture with dominant contributors MECPP, MEHHP, and MEOHP was associated with an increased rate of growth. Results of both models were clearly different for boys and girls, consistent with other studies showing the sexually dimorphic impact of early life phthalate exposure. These results suggest that growth curve modeling facilitates evaluation of discrete periods of rapid growth during the NICU hospitalization and exposure to specific phthalates during the NICU hospitalization may both alter the timing of the first growth spurt and result in more rapid growth in a sexually dimorphic manner.
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Affiliation(s)
- Stefanie A Busgang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily A Spear
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Syam S Andra
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Srinivasan Narasimhan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer B Bragg
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefano Renzetti
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, Università degli Studi Di Brescia, Brescia, Italy
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mia Bates
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annemarie Stroustrup
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Neonatology, Department of Pediatrics, Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY, USA.
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Jenkins RD. Phthalates cause a low-renin phenotype commonly found in premature infants with idiopathic neonatal hypertension. Pediatr Nephrol 2022; 38:1717-1724. [PMID: 36322257 DOI: 10.1007/s00467-022-05773-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/24/2022] [Accepted: 09/24/2022] [Indexed: 03/01/2023]
Abstract
Since the 1970s, when the initial reports of neonatal hypertension related to renal artery thromboembolism were published, other secondary causes of neonatal hypertension have been reported. Those infants with no identifiable cause of hypertension were labeled with a variety of terms. Herein, we describe such infants as having idiopathic neonatal hypertension (INH). Most, but not all, of these hypertensive infants were noted to have bronchopulmonary dysplasia (BPD). More recently, reports described common clinical characteristics seen in INH patients, whether or not they had BPD. This phenotype includes low plasma renin activity, presentation near 40 weeks postmenstrual age, and a favorable response to treatment with spironolactone. A small prospective study in INH patents showed evidence of mineralocorticoid receptor activation due to inhibition of 11β-HSD2, the enzyme that converts cortisol to the less potent mineralocorticoid-cortisone. Meanwhile, phthalate metabolites have been shown to inhibit 11β-HSD2 in human microsomes. Premature infants can come in contact with exceptionally large phthalate exposures, especially those infants with BPD. This work describes a common low-renin phenotype, commonly seen in patients categorized as having INH. Further, we review the evidence that hypertension in INH patients with the low-renin phenotype may be mediated by phthalate-associated inhibition of 11β-HSD2. Lastly, we review the implications of these findings regarding identification, treatment, and prevention of the low-renin hypertension phenotype seen in premature infants categorized as having INH.
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Affiliation(s)
- Randall D Jenkins
- Oregon Health & Science University, 707 SW Gaines Rd., Mail Code CDRC-P, Portland, OR, 97239, USA.
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Tao L, Tan H, Qiao X, Li L, Yu Y, Xie J, Chen D. Emerging Plasticizers in South China House Dust and Hand Wipes: Calling for Potential Concern? ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:12190-12199. [PMID: 35975842 DOI: 10.1021/acs.est.2c02106] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following regulations on legacy plasticizers, a large variety of industrial chemicals have been employed as substitutes to manufacture consumer products. However, knowledge remains limited on their environmental distributions, fate, and human exposure risks. In the present work, we screened for a total of 34 emerging plasticizers in house dust from South China and matched hand wipes collected from volunteers (n = 49 pairs). The results revealed a frequent detection of 27 emerging plasticizers in house dust, with the total concentrations reaching a median level of 106 700 ng/g. Thirteen of them had never been investigated by any environmental studies prior to our work, which included glycerol monooleate (median: 61 600 ng/g), methyl oleate (16 400 ng/g), butyl oleate (411 ng/g), 2,2,4-trimethyl-1,3-pentanediol monoisobutyrate (341 ng/g), 2,2,4-trimethyl-1,3-pentanediol diisobutyrate (105 ng/g), isopropyl myristate (154 ng/g), di(2-ethylhexyl) sebacate (69.1 ng/g), triisononyl trimellitate (64.4 ng/g), as well as a few others. Emerging plasticizers were also frequently detected in hand wipes, with a median total level of 4680 ng, indicating potential exposure via hand-to-mouth contact. Several chemicals, including acetyl tributyl citrate, tributyl citrate, di-n-butyl maleate, isopropyl myristate, and isopropyl palmitate, exhibited significant correlations between dust and hand wipe. However, other plasticizers did not follow this pattern, and the chemical compositional profiles differed between dust and hand wipe, suggesting chemical-specific sources and exposure pathways. Although the estimation of daily intake (EDI) indicated no substantial risks through dust ingestion or hand-to-mouth transfer of emerging plasticizers, continuous monitoring is needed to explore whether some of the important plasticizers are safe replacements or regrettable substitutions of the legacy ones.
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Affiliation(s)
- Lin Tao
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China
| | - Hongli Tan
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China
| | - Xinhang Qiao
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China
| | - Liangzhong Li
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, MEE, Guangzhou 510530, China
| | - Yunjiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, MEE, Guangzhou 510530, China
| | - Jinxin Xie
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China
| | - Da Chen
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China
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Crobeddu B, Jutras-Carignan A, Kolasa É, Mounier C, Robaire B, Plante I. Gestational and lactational exposure to the emergent alternative plasticizer 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH) impairs lipid metabolism to a greater extent than the commonly used Di(2-ethylhexyl) phthalate (DEHP) in the adult rat mammary gland. Toxicol Sci 2022; 189:268-286. [PMID: 35861430 DOI: 10.1093/toxsci/kfac076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Due to their endocrine disruption properties, phthalate plasticizers such as di(2-ethylhexyl) phthalate (DEHP) can affect the hormone-dependent development of the mammary gland. Over the past few years, DEHP has been partially replaced by 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH) which also have potential endocrine disrupting properties. The goal of the present study is to understand the impact of a gestational and lactational exposure to DEHP and DINCH on mammary gland development using Sprague-Dawley rats. Both plasticizers altered the adipocytes of the mammary gland fat pad of adult progeny, as demonstrated by a decrease in their size, folding of their membrane and modulations of the lipid profiles. DEHP treatments decreased the expression of Rxrα and Scd1 at the low and high dose, respectively, but did not affect any of the other genes studied. DINCH modulation of lipid metabolism could be observed at puberty by a decreased expression of genes implicated in triglyceride synthesis, lipid transport and lipolysis, but by an increased expression of genes of the β-oxidation pathway and of genes involved in lipid storage and fatty acid synthesis at adulthood, compared to control and DEHP-treated rats. A strong upregulation of different inflammatory markers was observed following DINCH exposure only. Together, our results indicate that a gestational and lactational exposure to DINCH has earlier and more significant effects on lipid homeostasis, adipogenesis and the inflammatory state of the adult mammary gland than DEHP exposure. The long-term consequence of these effects on mammary gland health remained to be determined.
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Affiliation(s)
- Bélinda Crobeddu
- INRS-Centre Armand-Frappier Santé Biotechnologie, 531 boul. des Prairies, Laval, Québec, H7V 1B7, Canada
| | - Antoine Jutras-Carignan
- Laboratoire du métabolisme des lipides, CERMO-FC, Département des sciences biologiques, Université du Québec à Montréal, Case postale 8888, succursale Centre-Ville, Montréal, Québec, H3C 3P8, Canada
| | - Élise Kolasa
- INRS-Centre Armand-Frappier Santé Biotechnologie, 531 boul. des Prairies, Laval, Québec, H7V 1B7, Canada
| | - Catherine Mounier
- Laboratoire du métabolisme des lipides, CERMO-FC, Département des sciences biologiques, Université du Québec à Montréal, Case postale 8888, succursale Centre-Ville, Montréal, Québec, H3C 3P8, Canada
| | - Bernard Robaire
- Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, H3G 1Y6, Canada.,Department of Obstetrics & Gynecology, McGill University, Montreal, Quebec, H4A 3J1, Canada
| | - Isabelle Plante
- INRS-Centre Armand-Frappier Santé Biotechnologie, 531 boul. des Prairies, Laval, Québec, H7V 1B7, Canada
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Prasad B, Prasad KS, Dave H, Das A, Asodariya G, Talati N, Swain S, Kapse S. Cumulative human exposure and environmental occurrence of phthalate esters: A global perspective. ENVIRONMENTAL RESEARCH 2022; 210:112987. [PMID: 35219627 DOI: 10.1016/j.envres.2022.112987] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/21/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
In the current investigation, the distribution and extent of human exposure of phthalate esters (PAEs) have been reported on global extent based on computed indices. The proposed indices were calculated based on environmental concentrations, toxicity, occurrence, environmental fate, and transport of PAEs. The cumulative phthalate exposure index (PEI) based on the phthalate pollution index (PPI) was mapped on a global scale based on the existing data reported in the literature. The results revealed that the PAEs are heterogeneously distributed globally, and about 30% of total environmental PAEs are ultimately exposed to the average human being. The comparative distribution of PAEs in various environmental compartments including urban-rural, indoor-outdoor, home-dormitory-classroom, and their exposure likelihood were studied based on indices. More than 90% of total human exposure of PAEs was observed to be from indoor environmental compartments. Significantly high exposure was observed in the urban population as compared to the rural population. About 70% of the total phthalate pollution sub-index of dust was observed from home followed by a classroom of ∼15% and then a dormitory of ∼10%. In addition, the indices were equated with the current human development index (HDI), gross national income (GNI), and exposure of particulate matter of each country. Based on current findings, the population living in the areas where >20 μg/m3 of particulate matter has been reported are possibly exposed with higher PAEs. The indices were highly diversified at high HDI (0.9) values and between 40,000 and 50,000 $ per capita income due to different usage of phthalate-containing products, disposal, and extensive monitoring work carried out by the developed and developing countries.
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Affiliation(s)
- Bablu Prasad
- Department of Environmental Studies, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, India.
| | - Kumar Suranjit Prasad
- Centre of Environmental Science, Institute of Interdisciplinary Studies, University of Allahabad, Allahabad, Uttar Pradesh, India
| | - Hemen Dave
- Institute of Research and Development, Gujarat Forensic Sciences University (GFSU) Gandhinagar, Gujarat, India
| | - Aditee Das
- Department of Environmental Studies, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, India
| | - Gargi Asodariya
- Department of Environmental Studies, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, India
| | - Nisha Talati
- Department of Environmental Studies, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, India
| | - Sunita Swain
- Department of Environmental Studies, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, India
| | - Shruti Kapse
- Department of Environmental Studies, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, India
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Saab Y, Oueis E, Mehanna S, Nakad Z, Stephan R, Khnayzer RS. Risk Assessment of Phthalates and Their Metabolites in Hospitalized Patients: A Focus on Di- and Mono-(2-ethylhexyl) Phthalates Exposure from Intravenous Plastic Bags. TOXICS 2022; 10:toxics10070357. [PMID: 35878262 PMCID: PMC9324282 DOI: 10.3390/toxics10070357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023]
Abstract
Phthalate esters (PAEs) are plasticizers associated with multiple toxicities; however, no strict regulations have been implemented to restrict their use in medical applications in Lebanon. Our study aimed at assessing the potential risks correlated with phthalate exposure from IV bags manufactured in Lebanon. GC–MS analysis showed that di-(2-ethylhexyl) phthalate (DEHP) is the predominant phthalate found in almost all samples tested with values ranging from 32.8 to 39.7% w/w of plastic. DEHP concentrations in the IV solutions reached up to 148 µg/L, as measured by SPME-GC–MS/MS, thus resulting in hazard quotients greater than 1, specifically in neonates. The toxicity of DEHP is mainly attributed to its metabolites, most importantly mono-(2-ethylhexyl) phthalate (MEHP). The IV bag solution with the highest content in DEHP was therefore used to extrapolate the amounts of urinary MEHP. The highest concentrations were found in neonates having the lowest body weight, which is concerning, knowing the adverse effects of MEHP in infants. Our study suggests that the use of IV bags manufactured in Lebanon could pose a significant risk in hospitalized patients, especially infants in neonatal care. Therefore, Lebanon, as well as other countries, should start imposing laws that restrict the use of phthalates in medical IV bags and substitute them with less toxic plasticizers.
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Affiliation(s)
- Yolande Saab
- Pharmaceutical Sciences Department, School of Pharmacy, Lebanese American University, Chouran, Beirut 1102-2801, Lebanon; (E.O.); (R.S.)
- Correspondence: (Y.S.); (R.S.K.)
| | - Emilia Oueis
- Pharmaceutical Sciences Department, School of Pharmacy, Lebanese American University, Chouran, Beirut 1102-2801, Lebanon; (E.O.); (R.S.)
| | - Stephanie Mehanna
- Department of Natural Sciences, Lebanese American University, Chouran, Beirut 1102-2801, Lebanon;
| | - Zahi Nakad
- Electrical and Computer Engineering Department, School of Engineering, Lebanese American University, Chouran, Beirut 1102-2801, Lebanon;
| | - Rita Stephan
- Pharmaceutical Sciences Department, School of Pharmacy, Lebanese American University, Chouran, Beirut 1102-2801, Lebanon; (E.O.); (R.S.)
| | - Rony S. Khnayzer
- Department of Natural Sciences, Lebanese American University, Chouran, Beirut 1102-2801, Lebanon;
- Correspondence: (Y.S.); (R.S.K.)
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Phthalate Exposure: From Quantification to Risk Assessment. TOXICS 2022; 10:toxics10060330. [PMID: 35736938 PMCID: PMC9228297 DOI: 10.3390/toxics10060330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022]
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Nidens N, Vogel M, Körner A, Kiess W. Prenatal exposure to phthalate esters and its impact on child development. Best Pract Res Clin Endocrinol Metab 2021; 35:101478. [PMID: 33608224 DOI: 10.1016/j.beem.2020.101478] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Endocrine disruptive chemicals (EDCs) cause adverse health effects through interaction with endocrine systems. They are classified by chemical structure, effects on specific endocrine systems, their bioaccumulation and/or persistence in the environment, and/or clinically observable effects. In industrial nations, people are exposed to complex mixtures of many different substances all of which may have multiple and deleterious effects upon the individual. The clinical importance of epigenetic changes caused by the action of EDCs during vulnerable phases of development is currently unclear but of particular relevance. Epidemiological studies are criticized because reproducibility is not always guaranteed. Nevertheless, they remain the method of choice for the development and analysis of suitable model systems. Positive associations, despite of sometimes conflicting results, are the key in the selection of factors that can then be analyzed in model systems in an unbiased way. This article reports EDC-caused effects in the fields of growth and metabolism, neurocognitive development and sexual development and reproduction focusing mainly on phthalates and their metabolites. However, research will have to focus on the interactions of different EDCs and their consequences of prenatal and early life exposure.
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Affiliation(s)
- Nathalie Nidens
- Leipzig Research Center for Civilization Diseases (LIFE), LIFE Child, University of Leipzig, Faculty of Medicine, Philipp-Rosenthal-Straße 27, D-04103, Leipzig, Germany; Hospital for Children and Adolescents, Center for Paediatric Research, Liebigstraße 20a, D-04103, Leipzig, Germany
| | - Mandy Vogel
- Leipzig Research Center for Civilization Diseases (LIFE), LIFE Child, University of Leipzig, Faculty of Medicine, Philipp-Rosenthal-Straße 27, D-04103, Leipzig, Germany; Hospital for Children and Adolescents, Center for Paediatric Research, Liebigstraße 20a, D-04103, Leipzig, Germany
| | - Antje Körner
- Leipzig Research Center for Civilization Diseases (LIFE), LIFE Child, University of Leipzig, Faculty of Medicine, Philipp-Rosenthal-Straße 27, D-04103, Leipzig, Germany; Hospital for Children and Adolescents, Center for Paediatric Research, Liebigstraße 20a, D-04103, Leipzig, Germany
| | - Wieland Kiess
- Leipzig Research Center for Civilization Diseases (LIFE), LIFE Child, University of Leipzig, Faculty of Medicine, Philipp-Rosenthal-Straße 27, D-04103, Leipzig, Germany; Hospital for Children and Adolescents, Center for Paediatric Research, Liebigstraße 20a, D-04103, Leipzig, Germany.
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Phthalate Exposures in the Neonatal Intensive Care Unit. TOXICS 2021; 9:toxics9050090. [PMID: 33919093 PMCID: PMC8143182 DOI: 10.3390/toxics9050090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
Background: Di-2-ethylhexyl phthalate (DEHP), a phthalate compound found in medical devices, may cause toxic effects in premature infants. In this study, the objective is to quantify DEHP exposures from various intravenous and respiratory therapy devices, and to use these values to predict typical exposure for an infant in a neonatal unit. Methods: Common IV products used on infants are directed through various types of IV tubing (IVT) and analyzed for DEHP content. DEHP exposure for infants receiving respiratory therapy was determined indirectly through analysis of urine DEHP metabolites. By deriving these values for DEHP we calculated the daily exposure to DEHP from common IV fluids (IVF) and respiratory devices during hospitalization in a neonatal unit. Results: IVF labeled DEHP-positive showed very high concentrations of DEHP, but when passed through IVT, substantial amounts were adsorbed. DEHP was undetectable with all DEHP-negative IVF tests, except when passed through DEHP-positive IVT. The DEHP leached from most respiratory devices was relatively modest, except that detected from bubble CPAP. In 14 very low birthweight infants, the mean DEHP exposure was 182,369 mcg/kg over 81.2 days of the initial hospitalization. Ninety-eight percent of the exposure was from respiratory devices, with bubble CPAP accounting for 95% of the total DEHP exposure in these infants. Conclusions: The DEHP exposure in our neonatal unit can be reduced markedly by avoiding or modifying bubble CPAP equipment and avoiding IV tubing containing DEHP.
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Elimination of Intravenous Di-2-Ethylhexyl Phthalate Exposure Abrogates Most Neonatal Hypertension in Premature Infants with Bronchopulmonary Dysplasia. TOXICS 2021; 9:toxics9040075. [PMID: 33918157 PMCID: PMC8067010 DOI: 10.3390/toxics9040075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/24/2022]
Abstract
(1) Background: The incidence of hypertension in very low birthweight (VLBW) infants in a single neonatal intensive care unit (NICU) dropped markedly during a 2-year period when the IV fluid (IVF) in both the antenatal unit and the NICU temporarily changed to a di-2-ethylhexyl phthalate (DEHP)-free formulation. The objective of the current report is to document this observation and demonstrate the changes in incidence of hypertension were not associated with the variation in risk factors for hypertension; (2) Methods: The charts of all VLBW infants born in a single NICU during a 7-year span were reviewed. This time includes 32 months of baseline, 20 months of DEHP-free IVF, 20 months of IVF DEHP re-exposure, and two 4-month washout intervals. The group of interest was limited to VLBW infants with bronchopulmonary dysplasia (BPD). Chi-square analysis was used to compare incidence of hypertension among periods. Vermont Oxford NICU Registry data were examined for variation in maternal and neonatal risk factors for hypertension; Results: Incidence of hypertension in VLBW infants with BPD decreased from 7.7% (baseline) to 1.4% when IVF was DEHP-free, rising back to 10.1% when DEHP-containing IVF returned to use. Risk factors for neonatal hypertension were stable across the 3 study periods in the NICU’s group of VLBW infants; (3) Conclusions: Serendipitous removal of IVF containing DEHP resulted in near elimination of hypertension in one NICU—an effect entirely reversed after the same brand of DEHP-containing IVF returned to clinical use. These results suggest that DEHP exposure from IVF plays a major role in neonatal hypertension.
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Prasad B. Phthalate pollution: environmental fate and cumulative human exposure index using the multivariate analysis approach. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2021; 23:389-399. [PMID: 33566875 DOI: 10.1039/d0em00396d] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A comprehensive review was performed on the environmental fate, environmental occurrence, toxicity, physical-chemical properties, abiotic and biotic removal and degradation of phthalate esters (PAEs) to compute the overall phthalate exposure and their impact on human beings. The removal and degradation of these wide spread pollutants by abiotic processes such as hydrolysis and photodecomposition are very slow and insignificant. On the other hand, the breakdown of PAEs by microorganisms is considered to be one of the major routes of environmental degradation for these widespread pollutants. Numerous microbial strains have been reported to degrade these compounds under aerobic, anaerobic and facultative conditions. Concurrently, the environmental fate, transport and transformation/degradation of these compounds under natural conditions are highly dependent on their physical and chemical properties. In order to understand the relationship between the concentrations of PAEs of different environmental compartments and human exposure prospects, a novel average phthalate pollution index (PPI) and cumulative phthalate exposure index (PEI) were proposed using the multivariate analysis approach. These indices were computed on the basis of relative importance, environmental occurrence, toxicity, physical-chemical properties, abiotic and biotic removal and degradation of dimethyl phthalate (DMP), diethyl phthalate (DEP), dibutyl phthalate (DBP), butyl benzyl phthalate (BBP) and diethyl-hexyl phthalate (DEHP). At present, the average PPI and cumulative PEI of 29 countries were evaluated using the concentrations of PAEs reported in the literature. These indices signify the overall phthalate pollution, human exposure and their interrelation. According to the index, Slovakia, Canada, Taiwan, Sweden and South Africa are among the top five countries in terms of cumulative phthalate exposure as per the existing data. The exposure percentage of total PAEs significantly varies between 23 and 44% since many environmental compartments are not directly exposed to human beings and they are degraded under natural conditions.
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Affiliation(s)
- Bablu Prasad
- Department of Environmental Studies, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara 390002, India.
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Kambia N, Séverin I, Farce A, Dahbi L, Dine T, Moreau E, Sautou V, Chagnon MC. Comparative Effects of Di-(2-ethylhexyl)phthalate and Di-(2-ethylhexyl)terephthalate Metabolites on Thyroid Receptors: In Vitro and In Silico Studies. Metabolites 2021; 11:metabo11020094. [PMID: 33578748 PMCID: PMC7916494 DOI: 10.3390/metabo11020094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022] Open
Abstract
Plasticizers added to polyvinylchloride (PVC) used in medical devices can be released into patients' biological fluids. Di-(2-ethylhexyl)phthalate (DEHP), a well-known reprotoxic and endocrine disruptor, must be replaced by alternative compounds. Di-(2-ethylhexyl) terephthalate (DEHT) is an interesting candidate due to its lower migration from PVC and its lack of reprotoxicity. However, there is still a lack of data to support the safety of its human metabolites with regard to their hormonal properties in the thyroid system. The effects of DEHT metabolites on thyroid/hormone receptors (TRs) were compared in vitro and in silico to those of DEHP. The oxidized metabolites of DEHT had no effect on T3 receptors whereas 5-hydroxy-mono-(ethylhexyl)phthalate (5-OH-MEHP) appeared to be primarily an agonist for TRs above 0.2 µg/mL with a synergistic effect on T3. Monoesters (MEHP and mono-(2-ethylhexyl)terephthalate, MEHT) were also active on T3 receptors. In vitro, MEHP was a partial agonist between 10 and 20 µg/mL. MEHT was an antagonist at non-cytotoxic concentrations (2-5 µg/mL) in a concentration-dependent manner. The results obtained with docking were consistent with those of the T-screen and provide additional information on the preferential affinity of monoesters and 5-OH-MEHP for TRs. This study highlights a lack of interactions between oxidized metabolites and TRs, confirming the interest of DEHT.
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Affiliation(s)
- Nicolas Kambia
- Université de Lille, CHU Lille, ULR 7365 GRITA, F-59000 Lille, France; nicolas.kambia-kpakpaga@univ-lille (N.K.); (T.D.)
| | - Isabelle Séverin
- Université Bourgogne Franche-Comté, INSERM U1231, NUTOX, Derttech “Packtox”, 21000 Dijon, France; (I.S.); (L.D.); (M.-C.C.)
| | - Amaury Farce
- Université de Lille, CHU Lille, INSERM U1286, INFINITE, F-59000 Lille, France;
| | - Laurence Dahbi
- Université Bourgogne Franche-Comté, INSERM U1231, NUTOX, Derttech “Packtox”, 21000 Dijon, France; (I.S.); (L.D.); (M.-C.C.)
| | - Thierry Dine
- Université de Lille, CHU Lille, ULR 7365 GRITA, F-59000 Lille, France; nicolas.kambia-kpakpaga@univ-lille (N.K.); (T.D.)
| | - Emmanuel Moreau
- Université Clermont Auvergne, INSERM U1240, IMOST, 63000 Clermont-Ferrand, France;
| | - Valérie Sautou
- Université Clermont Auvergne, CHU Clermont Ferrand, CNRS, SIGMA Clermont, 63000 Clermont-Ferrand, France
- Correspondence: or ; Tel.: +33-4731-78021
| | - Marie-Christine Chagnon
- Université Bourgogne Franche-Comté, INSERM U1231, NUTOX, Derttech “Packtox”, 21000 Dijon, France; (I.S.); (L.D.); (M.-C.C.)
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Wenzel AG, Reiner JL, Kohno S, Wolf BJ, Brock JW, Cruze L, Newman RB, Kucklick JR. Biomonitoring of emerging DINCH metabolites in pregnant women in charleston, SC: 2011-2014. CHEMOSPHERE 2021; 262:128369. [PMID: 33182099 PMCID: PMC7670082 DOI: 10.1016/j.chemosphere.2020.128369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 05/14/2023]
Abstract
Due to the mounting evidence that phthalates, specifically di-2-ethylhexyl phthalate and dibutyl phthalate, produce adverse endocrine effects in humans and wildlife, the use of other chemicals as replacements has increased. One of the most commonly encountered phthalate replacements is di(isononyl)cyclohexane-1,2-dicarboxylate (DINCH). Currently, little is known about the prevalence of human exposure, bioactivity, and endocrine disrupting potential of DINCH. We sampled urine from 100 pregnant women during the second trimester of pregnancy living in Charleston, SC between 2011 and 2014 and measured the following DINCH metabolites by LC-MS/MS: cyclohexane-1,2-dicarboxylic acid-mono(hydroxy-isononyl) ester (OH-MINCH), cyclohexane-1,2-dicarboxylic acid-mono(oxo-isononyl) ester (oxo-MINCH), and cyclohexane-1,2-dicarboxylic acid-monocarboxy isooctyl ester (cx-MINCH). These metabolites were also tested on human estrogen receptor alpha and progesterone receptor beta transactivation assays in vitro. OH-MINCH was detected in 98% of urine samples. The specific gravity-adjusted median (interquartile range) OH-MINCH concentration was 0.20 (0.25) ng/mL, and concentrations were significantly higher in African American women compared to Caucasian women (p = 0.01). DINCH metabolite concentrations were consistent between years, and they did not exhibit estrogenic or progestogenic activity in vitro. Human exposure to these emerging compounds should continue to be monitored, especially in vulnerable populations, to ensure the replacement of phthalates by DINCH is not a case of regrettable substitution.
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Affiliation(s)
- Abby G Wenzel
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC, 29425, USA; National Institute of Standards and Technology, Hollings Marine Laboratory, 331 Fort Johnson Road, Charleston, SC, 29412, USA
| | - Jessica L Reiner
- National Institute of Standards and Technology, Hollings Marine Laboratory, 331 Fort Johnson Road, Charleston, SC, 29412, USA.
| | - Satomi Kohno
- Department of Biology, St. Cloud State University, 720 4thAvenue South, St. Cloud, MN, 56301, USA
| | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303, MSC 835, Charleston, SC, 29425, USA
| | - John W Brock
- Department of Chemistry, University of North Carolina Asheville, CPO #2010, One University Heights, Asheville, NC, 28804, USA
| | - Lori Cruze
- Department of Biology, Wofford College, 429 North Church Street, Spartanburg, SC, 29303, USA
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC, 29425, USA
| | - John R Kucklick
- National Institute of Standards and Technology, Hollings Marine Laboratory, 331 Fort Johnson Road, Charleston, SC, 29412, USA
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32
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Genco M, Anderson-Shaw L, Sargis RM. Unwitting Accomplices: Endocrine Disruptors Confounding Clinical Care. J Clin Endocrinol Metab 2020; 105:5862419. [PMID: 32614432 PMCID: PMC7442273 DOI: 10.1210/clinem/dgaa358] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023]
Abstract
Burgeoning evidence over the last 25 years has identified myriad synthetic chemicals with the capacity to alter various aspects of hormone synthesis and action. These endocrine-disrupting chemicals (EDCs) have been linked to various diseases, including reproductive disorders, metabolic diseases, and developmental abnormalities, among others. Exposure to EDCs arises from industrial activity, use of personal and home care products, and consumption of contaminated food and water; however, the role of healthcare in exposing individuals to EDCs is grossly underappreciated. Indeed, through the use of medications as well as medical equipment and devices, healthcare providers are unknowing mediators of exposure to EDCs, chemicals that might not only promote disease but that may also antagonize the efficacy of treatments. The ethical implications of provider-dependent exposure are profound. A failure to disclose the endocrine-disrupting properties of medical interventions violates core principles of nonmaleficence, patient autonomy, and justice as well as the practice of informed consent. Furthermore, physicians' lack of knowledge regarding EDCs in medical practice artificially skews risk-benefit calculations that are fundamental to informed medical decision-making. To combat this underappreciated ethical challenge, urgent action is required. Healthcare providers must be educated about endocrine disruption. Known EDCs, defined by endocrinologists, should be clearly labeled on all medical products, and all medication components and devices should be screened for endocrine-disrupting properties. Finally, communication strategies must be devised to empower patients with knowledge about these risks. Providing ethically competent care requires an open acknowledgment of endocrine risks imposed by the medical community that have heretofore been ignored.
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Affiliation(s)
- Matthew Genco
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, US
| | - Lisa Anderson-Shaw
- Department of Medical Education, University of Illinois at Chicago, Chicago, IL, US
| | - Robert M Sargis
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, US
- Chicago Center for Health and Environment (CACHET); University of Illinois at Chicago, Chicago, IL, US
- Correspondence and Reprint Requests: Robert M. Sargis, MD, PhD, Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, 835 S. Wolcott Suite E625; M/C 640, Chicago, IL 60612.
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33
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Ramadan M, Cooper B, Posnack NG. Bisphenols and phthalates: Plastic chemical exposures can contribute to adverse cardiovascular health outcomes. Birth Defects Res 2020; 112:1362-1385. [PMID: 32691967 DOI: 10.1002/bdr2.1752] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022]
Abstract
Phthalates and bisphenols are high production volume chemicals that are used in the manufacturing of consumer and medical products. Given the ubiquity of bisphenol and phthalate chemicals in the environment, biomonitoring studies routinely detect these chemicals in 75-90% of the general population. Accumulating evidence suggests that such chemical exposures may influence human health outcomes, including cardiovascular health. These associations are particularly worrisome for sensitive populations, including fetal, infant and pediatric groups-with underdeveloped metabolic capabilities and developing organ systems. In the presented article, we aimed to review the literature on environmental and clinical exposures to bisphenols and phthalates, highlight experimental work that suggests that these chemicals may exert a negative influence on cardiovascular health, and emphasize areas of concern that relate to vulnerable pediatric groups. Gaps in our current knowledge are also discussed, so that future endeavors may resolve the relationship between chemical exposures and the impact on pediatric cardiovascular physiology.
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Affiliation(s)
- Manelle Ramadan
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia, USA
| | - Blake Cooper
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA
| | - Nikki Gillum Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University, School of Medicine, Washington, District of Columbia, USA.,Department of Pharmacology & Physiology, George Washington University, School of Medicine, Washington, District of Columbia, USA
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34
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Camacho L, Latendresse JR, Muskhelishvili L, Law CD, Delclos KB. Effects of intravenous and oral di(2-ethylhexyl) phthalate (DEHP) and 20% Intralipid vehicle on neonatal rat testis, lung, liver, and kidney. Food Chem Toxicol 2020; 144:111497. [PMID: 32540476 DOI: 10.1016/j.fct.2020.111497] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 01/09/2023]
Abstract
The highest human exposures to the plasticizer di(2-ethylhexyl) phthalate (DEHP) occur through intravenous (iv) exposure from medical procedures. Rodent toxicity studies, mainly using oral exposures, have identified male reproductive toxicity after developmental exposure to DEHP as the primary concern. Other organs are also affected by DEHP and route may influence the degree of target organ involvement. Cammack et al. (2003) reported a critical study focused on testicular toxicity using oral and iv exposures of neonatal Sprague-Dawley rats to 60, 300, or 600 mg/kg body weight/day DEHP in Intralipid vehicle. The present study followed the same dosing paradigm and included assessment of additional organs to evaluate the potential utility of this design for DEHP alternatives. Reduction of testis weight was observed in all DEHP treatment groups and germ cell and Sertoli cell toxicity was observed at the two highest doses with both routes. Lung granulomas occurred in all iv DEHP groups, possibly related to increased fat particle size in DEHP lipid emulsions. Lung alveolar development was inhibited after both oral and iv high dose DEHP. Toxicity of oral Intralipid vehicle was observed in germ and Sertoli cells. The lack of such effects after iv vehicle exposure suggested that this may be a gut-mediated effect.
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Affiliation(s)
- Luísa Camacho
- Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR, 72079, USA
| | | | | | - Charles D Law
- Division of Neurotoxicology, National Center for Toxicological Research, Jefferson, AR, 72079, USA
| | - K Barry Delclos
- Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR, 72079, USA.
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35
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Chiang C, Flaws JA. Subchronic Exposure to Di(2-ethylhexyl) Phthalate and Diisononyl Phthalate During Adulthood Has Immediate and Long-Term Reproductive Consequences in Female Mice. Toxicol Sci 2020; 168:620-631. [PMID: 30649530 DOI: 10.1093/toxsci/kfz013] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer used in a variety of consumer products. This is concerning because DEHP is an endocrine disruptor and ovarian toxicant. Diisononyl phthalate (DiNP) is a DEHP replacement that is a rising human toxicant due to its increased use as a DEHP substitute. However, little is known about the effects of DEHP or DiNP exposure during adulthood on female reproduction. Thus, this study tested the hypothesis that DEHP or DiNP exposure during adulthood has long-term consequences for female reproduction in mice. Adult female CD-1 mice (39-40 days) were orally dosed with vehicle control (corn oil), DEHP (20 µg/kg/day-200 mg/kg/day), or DiNP (20 µg/kg/day-200 mg/kg/day) for 10 days. Females were paired with untreated male mice for breeding trials immediately post-dosing and again at 3 and 9 months post-dosing. Immediately post-dosing, DEHP and DiNP did not affect fertility. At 3 months post-dosing, DiNP (20 and 100 µg/kg/day and 200 mg/kg/day) significantly disrupted estrous cyclicity, and DiNP and DEHP (20 µg/kg/day) significantly reduced the ability of females to get pregnant. At 9 months post-dosing, DiNP significantly disrupted estrous cyclicity (100 µg/kg/day), reduced time to mating (100 µg/kg/day-200 mg/kg/day), and borderline reduced percent of females who produced offspring (20 mg/kg/day). At 9 months post-dosing, DEHP (200 µg/kg/day and 200 mg/kg/day) and DiNP (100 µg/kg/day and 20 and 200 mg/kg/day) increased numbers of male-biased litters. These data show that DEHP and DiNP exposure has long-term consequences for female reproduction, even long after cessation of exposure.
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Affiliation(s)
- Catheryne Chiang
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Jodi A Flaws
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
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36
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Stroustrup A, Bragg JB, Busgang SA, Andra SS, Curtin P, Spear EA, Just AC, Arora M, Gennings C. Sources of clinically significant neonatal intensive care unit phthalate exposure. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:137-148. [PMID: 30242269 PMCID: PMC6538481 DOI: 10.1038/s41370-018-0069-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/25/2018] [Accepted: 07/27/2018] [Indexed: 05/24/2023]
Abstract
In the United States each year, more than 300,000 infants are admitted to neonatal intensive care units (NICU) where they are exposed to a chemical-intensive hospital environment during a developmentally vulnerable period. Although multiple studies have demonstrated elevated phthalate biomarkers in NICU patients, specific sources of NICU-based phthalate exposure have not been identified.In this study, premature newborns with birth weight <1500 g were recruited to participate in a prospective environmental health cohort during the NICU hospitalization. Exposure to specific NICU equipment was recorded daily during the NICU hospitalization. One hundred forty-nine urine specimens from 71 infants were analyzed for phthalate metabolites using high-performance liquid chromatography/tandem mass spectrometry.In initial analyses, exposure to medical equipment was directly related to phthalate levels, with DEHP biomarkers 95-132% higher for infants exposed to specific medical equipment types compared to those without that equipment exposure (p < 0.001-0.023). This association was mirrored for clinically relevant phthalate mixtures whether composed of DEHP metabolites or not (p = 0.002-0.007). In models accounting for concurrent equipment use, exposure to respiratory support was associated with DEHP biomarkers 50-136% higher in exposed compared to unexposed infants (p = 0.007-0.036). Phthalate mixtures clinically relevant to neurobehavioral development were significantly associated with non-invasive respiratory support (p = 0.008-0.026). Feeding supplies and intravenous lines were not significantly associated with clinically important phthalate mixtures.Respiratory support equipment may be a significant and clinically relevant NICU source of phthalate exposure. Although manufacturers have altered feeding and intravenous supplies to reduce DEHP exposure, other sources of exposure to common and clinically impactful phthalates persist in the NICU.
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Affiliation(s)
- Annemarie Stroustrup
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jennifer B Bragg
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefanie A Busgang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Syam S Andra
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily A Spear
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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37
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The changing spectrum of hypertension in premature infants. J Perinatol 2019; 39:1528-1534. [PMID: 31388120 DOI: 10.1038/s41372-019-0457-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective is to document changes in the etiologic spectrum of hypertension in premature infants. STUDY DESIGN We reviewed all cases of systemic hypertension (HTN) in premature infants at two centers over 8 years. Infants were sorted into categorical groups as described in 2012 by Flynn. Analyses included frequency of diagnosis, timecourse of HTN, and diagnostics. Phthalate exposure via intravenous fluid and respiratory equipment was compared among groups and centers. RESULTS One hundred and twenty-nine infants having 130 episodes of HTN met the inclusion criteria. Sixty-five percent of cases were classified as pulmonary and 16% as miscellaneous. Plasma renin activity (PRA) was undetectable or <11 ng/mL/h in almost all hypertensive infants. Cases categorized as Pulmonary, medications/intoxications, and miscellaneous presented near 40 weeks postmenstrual age, with low PRA and large phthalate exposures. CONCLUSIONS High PRA HTN has been replaced by low PRA in most cases, and may be due to phthalate exposure.
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38
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Jaimes R, McCullough D, Siegel B, Swift L, McInerney D, Hiebert J, Perez-Alday EA, Trenor B, Sheng J, Saiz J, Tereshchenko LG, Posnack NG. Plasticizer Interaction With the Heart: Chemicals Used in Plastic Medical Devices Can Interfere With Cardiac Electrophysiology. Circ Arrhythm Electrophysiol 2019; 12:e007294. [PMID: 31248280 PMCID: PMC6693678 DOI: 10.1161/circep.119.007294] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Phthalates are used as plasticizers in the manufacturing of flexible, plastic medical products. Patients can be subjected to high phthalate exposure through contact with plastic medical devices. We aimed to investigate the cardiac safety and biocompatibility of mono-2-ethylhexyl phthalate (MEHP), a phthalate with documented exposure in intensive care patients. METHODS Optical mapping of transmembrane voltage and pacing studies were performed on isolated, Langendorff-perfused rat hearts to assess cardiac electrophysiology after MEHP exposure compared with controls. MEHP dose was chosen based on reported blood concentrations after an exchange transfusion procedure. RESULTS Thirty-minute exposure to MEHP increased the atrioventricular node (147 versus 107 ms) and ventricular (117 versus 77.5 ms) effective refractory periods, compared with controls. Optical mapping revealed prolonged action potential duration at slower pacing cycle lengths, akin to reverse use dependence. The plateau phase of the action potential duration restitution curve steepened and became monophasic in MEHP-exposed hearts (0.18 versus 0.06 slope). Action potential duration lengthening occurred during late-phase repolarization resulting in triangulation (70.3 versus 56.6 ms). MEHP exposure also slowed epicardial conduction velocity (35 versus 60 cm/s), which may be partly explained by inhibition of Nav1.5 (874 and 231 µmol/L half-maximal inhibitory concentration, fast and late sodium current). CONCLUSIONS This study highlights the impact of acute MEHP exposure, using a clinically relevant dose, on cardiac electrophysiology in the intact heart. Heightened clinical exposure to plasticized medical products may have cardiac safety implications-given that action potential triangulation and electrical restitution modifications are a risk factor for early after depolarizations and cardiac arrhythmias.
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Affiliation(s)
- Rafael Jaimes
- Sheikh Zayed Institute for Pediatric Surgical Innovation (R.J., D. McCullough, L.S., D. McInerney, J.H., N.G.P.), Children's National Health System, Washington DC.,Children's National Heart Institute (R.J., B.S., L.S., N.G.P.), Children's National Health System, Washington DC
| | - Damon McCullough
- Sheikh Zayed Institute for Pediatric Surgical Innovation (R.J., D. McCullough, L.S., D. McInerney, J.H., N.G.P.), Children's National Health System, Washington DC
| | - Bryan Siegel
- Children's National Heart Institute (R.J., B.S., L.S., N.G.P.), Children's National Health System, Washington DC
| | - Luther Swift
- Sheikh Zayed Institute for Pediatric Surgical Innovation (R.J., D. McCullough, L.S., D. McInerney, J.H., N.G.P.), Children's National Health System, Washington DC.,Children's National Heart Institute (R.J., B.S., L.S., N.G.P.), Children's National Health System, Washington DC
| | - Daniel McInerney
- Sheikh Zayed Institute for Pediatric Surgical Innovation (R.J., D. McCullough, L.S., D. McInerney, J.H., N.G.P.), Children's National Health System, Washington DC
| | - James Hiebert
- Sheikh Zayed Institute for Pediatric Surgical Innovation (R.J., D. McCullough, L.S., D. McInerney, J.H., N.G.P.), Children's National Health System, Washington DC
| | - Erick A Perez-Alday
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland (E.A.P.-A., L.G.T.)
| | - Beatriz Trenor
- Ci2B-Universitat Politècnica de València, Spain (B.T., F.J.S.R.)
| | | | - Javier Saiz
- Sheikh Zayed Institute for Pediatric Surgical Innovation (R.J., D. McCullough, L.S., D. McInerney, J.H., N.G.P.), Children's National Health System, Washington DC
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland (E.A.P.-A., L.G.T.)
| | - Nikki Gillum Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation (R.J., D. McCullough, L.S., D. McInerney, J.H., N.G.P.), Children's National Health System, Washington DC.,Children's National Heart Institute (R.J., B.S., L.S., N.G.P.), Children's National Health System, Washington DC.,Departments of Pediatrics and Pharmacology and Physiology, School of Medicine and Health Sciences: George Washington University, Washington DC (N.G.P.)
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39
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Kambia NK, Séverin I, Farce A, Moreau E, Dahbi L, Duval C, Dine T, Sautou V, Chagnon MC. In vitro and in silico hormonal activity studies of di-(2-ethylhexyl)terephthalate, a di-(2-ethylhexyl)phthalate substitute used in medical devices, and its metabolites. J Appl Toxicol 2019; 39:1043-1056. [PMID: 30847963 DOI: 10.1002/jat.3792] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 01/31/2023]
Abstract
Plasticizers added to polyvinylchloride used in medical devices can be released into patients' biological fluids. The substitution of di-(2-ethylhexyl)phthalate (DEHP) by alternative plasticizers is essential but their safety must be demonstrated. DEHP, di-(2-ethylhexyl)terephthalate (DEHT) and their metabolites were investigated using level 2 Organization for Economic Co-operation and Development bioassays to screen for in vitro hormonal changes. Differences between the DEHP and DEHT metabolites were observed. Albeit weak, the hormonal activities of DEHT-derived metabolites, e.g., 5-OH metabolite of mono-(ethylhexyl)terephthalate (5-OH-MEHT), were detected and the results of docking experiments performed on estrogen receptor alpha and androgen receptor agreed with the biological results. A co-stimulation of human estrogen receptor alpha and human androgen receptor was also observed. With regard to steroidogenesis, a 16-fold increase in estrogen synthesis was measured with 5-OH-MEHT. Therefore, even if DEHT remains an interesting alternative to DEHP because of its low migration from medical devices, it seems important to verify that multi-exposed patients in neonatal intensive care units do not have urinary levels of oxidized metabolites, in particular 5-OH-MEHT, suggesting a potential endocrine-disrupting effect.
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Affiliation(s)
- Nicolas K Kambia
- EA 7365, GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Université de Lille, F-59000, Lille, France.,CHU Lille, Institut de Pharmacie, F-59 000, Lille, France
| | - Isabelle Séverin
- Derttech "Packtox", NUTOX, INSERM U1231, Université Bourgogne Franche-Comté, AgroSup Dijon, 21000, Dijon, France
| | - Amaury Farce
- EA 7365, GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Université de Lille, F-59000, Lille, France.,CHU Lille, Institut de Pharmacie, F-59 000, Lille, France
| | - Emmanuel Moreau
- CHU Clermont-Ferrand, CNRS, SIGMA Clermont-Ferrand, ICCF, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Laurence Dahbi
- Derttech "Packtox", NUTOX, INSERM U1231, Université Bourgogne Franche-Comté, AgroSup Dijon, 21000, Dijon, France
| | - Claire Duval
- EA 7365, GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Université de Lille, F-59000, Lille, France.,CHU Lille, Institut de Pharmacie, F-59 000, Lille, France
| | - Thierry Dine
- EA 7365, GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Université de Lille, F-59000, Lille, France.,CHU Lille, Institut de Pharmacie, F-59 000, Lille, France
| | - Valérie Sautou
- INSERM U1240, Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, F-63000, Clermont Ferrand, France
| | - Marie-Christine Chagnon
- Derttech "Packtox", NUTOX, INSERM U1231, Université Bourgogne Franche-Comté, AgroSup Dijon, 21000, Dijon, France
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Jenkins R, Tackitt S, Gievers L, Iragorri S, Sage K, Cornwall T, O’Riordan D, Merchant J, Rozansky D. Phthalate-associated hypertension in premature infants: a prospective mechanistic cohort study. Pediatr Nephrol 2019; 34:1413-1424. [PMID: 31028470 PMCID: PMC6579777 DOI: 10.1007/s00467-019-04244-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/05/2019] [Accepted: 03/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Phthalates are associated with increased blood pressure in children. Large exposures to di-(2-ethylhexyl) phthalate (DEHP) among premature infants have been a cause for concern. METHODS We conducted a prospective observational cohort study to determine if DEHP exposures are related to systolic blood pressure (SBP) in premature infants, and if this exposure is associated with activation of the mineralocorticoid receptor (MR). Infants were monitored longitudinally for 8 months from birth. Those who developed idiopathic hypertension were compared with normotensive infants for DEHP exposures. Appearance of urinary metabolites after exposure was documented. Linear regression evaluated the relationship between DEHP exposures and SBP index and whether urinary cortisol/cortisone ratio (a surrogate marker for 11β-HSD2 activity) mediated those relationships. Urinary exosomes were quantified for sodium transporter/channel expression and interrogated against SBP index. RESULTS Eighteen patients met the study criteria, nine developed transient idiopathic hypertension at a postmenstrual age of 40.6 ± 3.4 weeks. The presence of urinary DEHP metabolites was associated with prior IV and respiratory tubing DEHP exposures (p < 0.05). Both IV and respiratory DEHP exposures were greater in hypertensive infants (p < 0.05). SBP index was related to DEHP exposure from IV fluid (p = 0.018), but not respiratory DEHP. Urinary cortisol/cortisone ratio was related to IV DEHP and SBP index (p < 0.05). Sodium transporter/channel expression was also related to SBP index (p < 0.05). CONCLUSIONS Increased blood pressure and hypertension in premature infants are associated with postnatal DEHP exposure. The mechanism of action appears to be activation of the MR through inhibition of 11β-HSD2.
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Affiliation(s)
- Randall Jenkins
- Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Road, Mail Code CDRC-P, Portland, OR, 97239, USA.
| | | | - Ladawna Gievers
- 0000 0000 9758 5690grid.5288.7Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Road, Mail Code CDRC-P, Portland, OR 97239 USA
| | - Sandra Iragorri
- 0000 0000 9758 5690grid.5288.7Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Road, Mail Code CDRC-P, Portland, OR 97239 USA
| | - Kylie Sage
- 0000 0000 9758 5690grid.5288.7Biostatistics and Design Program, School of Public Health, Oregon Health & Science University, Portland, OR USA
| | - Tonya Cornwall
- 0000 0000 9758 5690grid.5288.7Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Road, Mail Code CDRC-P, Portland, OR 97239 USA
| | - Declan O’Riordan
- 0000 0004 0448 8197grid.416857.9St. Luke’s Regional Medical Center, Boise, ID USA
| | - Jennifer Merchant
- 0000 0004 0448 8197grid.416857.9St. Luke’s Regional Medical Center, Boise, ID USA
| | - David Rozansky
- 0000 0000 9758 5690grid.5288.7Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Road, Mail Code CDRC-P, Portland, OR 97239 USA
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Perinatal exposure to di-ethyl-hexyl phthalate via parenteral route induced polycystic ovarian syndrome-like genetic and pathologic changes in F1 offspring mice. Mol Cell Toxicol 2018. [DOI: 10.1007/s13273-019-0003-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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Krassioukov A, Igawa Y, Averbeck MA, Madersbacher H, Lloyd AJ, Bøgelund M, Thiruchelvam N. Gains in health utility associated with urinary catheter innovations. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:345-351. [PMID: 30319291 PMCID: PMC6171519 DOI: 10.2147/mder.s165778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate gains in health utility for two different catheter features and a support service related to urinary catheters used for intermittent catheterization. Patients and methods Two internet-based time trade-off (TTO) surveys were undertaken to value vignettes describing two innovative catheter features and a support service. The first TTO survey “Size and Service” included catheters with compact design and the availability of a support service for users; the second TTO survey “Phthalates” included avoidance of potentially harmful phthalates in the material of the catheters. All participants were from the UK; they traded health states against a time horizon that matched their total life expectancy. Sensitivity analyses were done to estimate the impact of extreme values on disutilities. Results The participants (n=890) estimated the incremental value of 0.031 (95% CI: 0.024–0.039), 0.009 (95% CI: 0.003–0.015), and 0.037 (95% CI: 0.027–0.046), respectively, for catheters with compact design, availability of support service, and catheters not containing phthalates. Conclusions Participants valued all three improvements in catheter design. To capture the impact of such design improvements on quality of life and utilities, vignette-based approaches can be a useful supplement to the conventional, generic tools.
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Affiliation(s)
- Andrei Krassioukov
- University of British Columbia, International Collaboration On Repair Discoveries (ICORD), Vancouver, British Columbia, Canada, .,Division of Physical Medicine and Rehabilitation, Department of Medicine, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada,
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | | | | | | | | | - Nikesh Thiruchelvam
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, UK
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Perioperative Exposure to Suspect Neurotoxicants From Medical Devices in Newborns With Congenital Heart Defects. Ann Thorac Surg 2018; 107:567-572. [PMID: 30071236 DOI: 10.1016/j.athoracsur.2018.06.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Industrial chemicals are increasingly recognized as potential developmental neurotoxicants. Di(2-ethylhexyl) phthalate (DEHP), used to impart flexibility and temperature tolerance to polyvinylchloride, and bisphenol A (BPA), used to manufacture polycarbonate, are commonly present in medical devices. The magnitude of exposure in neonates during hospitalization for cardiac operations is unknown. METHODS We quantified urinary concentrations of DEHP metabolites and BPA preoperatively and postoperatively in neonates undergoing cardiac operations and their mothers. Urinary concentrations of these biomarkers reflect recent exposures (half-lives are approximately 6 to 24 hours). Biomarker concentrations in mothers' and infants' preoperative and postoperative samples were compared. RESULTS Operations were performed in 18 infants (mean age, 5 ± 4 [SD] days). The maternal sample was obtained on postpartum day 4 ± 4. The preoperative urine sample was obtained on day-of-life 4 ± 2 and the postoperative sample on day-of-life 6 ± 4. Mean maternal concentrations for DEHP metabolites and BPA were at the 50th percentile for females in the United States general population. Infant preoperative concentrations of 1 DEHP metabolite and BPA were significantly higher than maternal concentrations. Postoperative concentrations for all DEHP metabolites were significantly greater than preoperative concentrations. CONCLUSIONS There is considerable perioperative exposure to DEHP and BPA for neonates undergoing cardiac operations. Infant concentrations for both BPA and DEHP metabolites were significantly higher than maternal concentrations, consistent with the infant's exposure to medical devices. Further study is needed to determine the potential role of these suspect neurotoxicants in the etiology of neurodevelopmental disability after cardiac operations.
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Höllerer C, Becker G, Göen T, Eckert E. Human metabolism and kinetics of tri-(2-ethylhexyl) trimellitate (TEHTM) after oral administration. Arch Toxicol 2018; 92:2793-2807. [DOI: 10.1007/s00204-018-2264-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
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Stroustrup A, Bragg JB, Andra SS, Curtin PC, Spear EA, Sison DB, Just AC, Arora M, Gennings C. Neonatal intensive care unit phthalate exposure and preterm infant neurobehavioral performance. PLoS One 2018; 13:e0193835. [PMID: 29505594 PMCID: PMC5837295 DOI: 10.1371/journal.pone.0193835] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/20/2018] [Indexed: 12/22/2022] Open
Abstract
Every year in the United States, more than 300,000 infants are admitted to neonatal intensive care units (NICU) where they are exposed to a chemical-intensive hospital environment during a developmentally vulnerable period. The neurodevelopmental impact of environmental exposure to phthalates during the NICU stay is unknown. As phthalate exposure during the third trimester developmental window has been implicated in neurobehavioral deficits in term-born children that are strikingly similar to a phenotype of neurobehavioral morbidity common among children born premature, the role of early-life phthalate exposure on the neurodevelopmental trajectory of premature infants may be clinically important. In this study, premature newborns with birth weight <1500g were recruited to participate in a prospective environmental health cohort study, NICU-HEALTH (Hospital Exposures and Long-Term Health), part of the DINE (Developmental Impact of NICU Exposures) cohort of the ECHO (Environmental influences on Child Health Outcomes) program. Seventy-six percent of eligible infants enrolled in the study. Sixty-four of 81 infants survived and are included in this analysis. 164 urine specimens were analyzed for phthalate metabolites using high-performance liquid chromatography/tandem mass spectrometry. The NICU Network Neurobehavioral Scale (NNNS) was performed prior to NICU discharge. Linear and weighted quantile sum regression quantified associations between phthalate biomarkers and NNNS performance, and between phthalate biomarkers and intensity of medical intervention. The sum of di(2-ethylhexyl) phthalate metabolites (∑DEHP) was associated with improved performance on the Attention and Regulation scales. Specific mixtures of phthalate biomarkers were also associated with improved NNNS performance. More intense medical intervention was associated with higher ∑DEHP exposure. NICU-based exposure to phthalates mixtures was associated with improved attention and social response. This suggests that the impact of phthalate exposure on neurodevelopment may follow a non-linear trajectory, perhaps accelerating the development of certain neural networks. The long-term neurodevelopmental impact of NICU-based phthalate exposure needs to be evaluated.
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Affiliation(s)
- Annemarie Stroustrup
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jennifer B. Bragg
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Syam S. Andra
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Paul C. Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Emily A. Spear
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Denise B. Sison
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Allan C. Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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Di (2-Ethylhexyl) Phthalate and Its Role in Developing Cholestasis: An In Vitro Study on Different Liver Cell Types. J Pediatr Gastroenterol Nutr 2018; 66:e28-e35. [PMID: 29095348 DOI: 10.1097/mpg.0000000000001813] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer used in many polyvinylchloride medical devices and is washed out easily. Thereby critically ill infants can become exposed to DEHP concentrations significantly exceeding the recommended threshold. We suspect DEHP to play an important role in the development of intestinal failure-associated liver disease. The aim of this study was therefore to determine the direct influence of DEHP on different liver cell types. METHODS HepG2, human upcyte hepatocytes, primary murine hepatocytes, LX-2, human upcyte hepatic stellate cells, and liver organoids were cultured with DEHP (0.5-500 μmol/L) and parameters including cytotoxicity, cell-cell interactions, and expression of metabolizing enzymes were investigated. RESULTS DEHP modulated the expression of xenobiotic metabolizing enzymes, reduced the formation of bile canaliculi and cell polarity, and inhibited Cyp-activity in hepatocytes. DEHP had a toxic effect on LX-2 and induced the fibrogenic activation of hepatic stellate cells. The mode of action of DEHP was different in monolayer cultures compared to 3D-liver organoids, which were more sensitive to DEHP. CONCLUSIONS This study suggests that DEHP modulates expression and activity of drug-detoxifying liver enzymes in humans at a clinically relevant concentration. Furthermore, it may contribute to the development of cholestasis and fibrosis. These findings strongly support the opinion, that there is a significant potential for serious adverse effects of DEHP derived from medical devices on human health, especially in very young infants with immature livers.
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Jaimes R, Swiercz A, Sherman M, Muselimyan N, Marvar PJ, Posnack NG. Plastics and cardiovascular health: phthalates may disrupt heart rate variability and cardiovascular reactivity. Am J Physiol Heart Circ Physiol 2017; 313:H1044-H1053. [PMID: 28842438 PMCID: PMC5792203 DOI: 10.1152/ajpheart.00364.2017] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022]
Abstract
Plastics have revolutionized medical device technology, transformed hematological care, and facilitated modern cardiology procedures. Despite these advances, studies have shown that phthalate chemicals migrate out of plastic products and that these chemicals are bioactive. Recent epidemiological and research studies have suggested that phthalate exposure adversely affects cardiovascular function. Our objective was to assess the safety and biocompatibility of phthalate chemicals and resolve the impact on cardiovascular and autonomic physiology. Adult mice were implanted with radiofrequency transmitters to monitor heart rate variability, blood pressure, and autonomic regulation in response to di-2-ethylhexyl-phthalate (DEHP) exposure. DEHP-treated animals displayed a decrease in heart rate variability (-17% SD of normal beat-to-beat intervals and -36% high-frequency power) and an exaggerated mean arterial pressure response to ganglionic blockade (31.5% via chlorisondamine). In response to a conditioned stressor, DEHP-treated animals displayed enhanced cardiovascular reactivity (-56% SD major axis Poincarè plot) and prolonged blood pressure recovery. Alterations in cardiac gene expression of endothelin-1, angiotensin-converting enzyme, and nitric oxide synthase may partly explain these cardiovascular alterations. This is the first study to show an association between phthalate chemicals that are used in medical devices with alterations in autonomic regulation, heart rate variability, and cardiovascular reactivity. Because changes in autonomic balance often precede clinical manifestations of hypertension, atherosclerosis, and conduction abnormalities, future studies are warranted to assess the downstream impact of plastic chemical exposure on end-organ function in sensitive patient populations. This study also highlights the importance of adopting safer biomaterials, chemicals, and/or surface coatings for use in medical devices.NEW & NOTEWORTHY Phthalates are widely used in the manufacturing of consumer and medical products. In the present study, di-2-ethylhexyl-phthalate exposure was associated with alterations in heart rate variability and cardiovascular reactivity. This highlights the importance of investigating the impact of phthalates on health and identifying suitable alternatives for medical device manufacturing.
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Affiliation(s)
- Rafael Jaimes
- 1Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, District of Columbia; ,2Children’s National Heart Institute, Children’s National Health System, Washington, District of Columbia; and
| | - Adam Swiercz
- 3Department of Pharmacology and Physiology, George Washington University, Washington, District of Columbia
| | - Meredith Sherman
- 1Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, District of Columbia;
| | - Narine Muselimyan
- 3Department of Pharmacology and Physiology, George Washington University, Washington, District of Columbia
| | - Paul J. Marvar
- 3Department of Pharmacology and Physiology, George Washington University, Washington, District of Columbia
| | - Nikki Gillum Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, District of Columbia; .,Children's National Heart Institute, Children's National Health System, Washington, District of Columbia; and.,Department of Pharmacology and Physiology, George Washington University, Washington, District of Columbia
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2-Ethylhexanoic acid, found in common plasticizers, leads to an artificial increase in C8 acylcarnitine levels in two neonates treated with extracorporeal membrane oxygenation (ECMO). Clin Chim Acta 2016; 461:59-60. [PMID: 27475980 DOI: 10.1016/j.cca.2016.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022]
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Abstract
Exposure to environmental chemicals has adverse effects on the health and survival of humans. Emerging evidence supports the idea that exposure to endocrine-disrupting compounds (EDCs) can perturb an individual’s physiological set point and as a result increase his/her propensity toward several diseases. The purpose of this review is to provide an update on di-(2-ethylhexyl) phthalate, the primary plasticizer found in plastic medical devices used in neonatal intensive care units, its effects on the fetus and newborn, epidemiological studies, pharmacokinetics, toxicity and epigenetic implications. We searched the PubMed databases to identify relevant studies. Phthalates are known EDCs that primarily are used to improve the flexibility of polyvinyl chloride plastic products and are called plasticizers in lay terms. Neonates and infants are particularly vulnerable to the effects of phthalates, beginning with maternal exposure and placental transfer during gestation and during infancy following birth. In line with the developmental origins of adult disease, a focus on the effects of environmental chemicals in utero or early childhood on the genesis of adult diseases through epigenome modulation is timely and important. The epigenetic effects of phthalates have not been fully elucidated, but accumulating evidence suggests that they may be associated with adverse health effects, some of which may be heritable. Phthalate exposure during pregnancy and the perinatal period is particularly worrisome in health-care settings. Although the clinical significance of phthalate exposure has been difficult to assess with epidemiologic studies, the evidence that physiological changes occur due to exposure to phthalates is growing and points toward the need for more investigation at a molecular, specifically epigenetic level.
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Approaches to Children's Exposure Assessment: Case Study with Diethylhexylphthalate (DEHP). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070670. [PMID: 27376320 PMCID: PMC4962211 DOI: 10.3390/ijerph13070670] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/13/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022]
Abstract
Children's exposure assessment is a key input into epidemiology studies, risk assessment and source apportionment. The goals of this article are to describe a methodology for children's exposure assessment that can be used for these purposes and to apply the methodology to source apportionment for the case study chemical, diethylhexylphthalate (DEHP). A key feature is the comparison of total (aggregate) exposure calculated via a pathways approach to that derived from a biomonitoring approach. The 4-step methodology and its results for DEHP are: (1) Prioritization of life stages and exposure pathways, with pregnancy, breast-fed infants, and toddlers the focus of the case study and pathways selected that are relevant to these groups; (2) Estimation of pathway-specific exposures by life stage wherein diet was found to be the largest contributor for pregnant women, breast milk and mouthing behavior for the nursing infant and diet, house dust, and mouthing for toddlers; (3) Comparison of aggregate exposure by pathways vs biomonitoring-based approaches wherein good concordance was found for toddlers and pregnant women providing confidence in the exposure assessment; (4) Source apportionment in which DEHP presence in foods, children's products, consumer products and the built environment are discussed with respect to early life mouthing, house dust and dietary exposure. A potential fifth step of the method involves the calculation of exposure doses for risk assessment which is described but outside the scope for the current case study. In summary, the methodology has been used to synthesize the available information to identify key sources of early life exposure to DEHP.
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