Guanidine-based disinfectants, polyhexamethylene guanidine-phosphate (PHMG-P), polyhexamethylene biguanide (PHMB), and oligo(2-(2-ethoxy)ethoxyethyl guanidinium chloride (PGH) induced epithelial-mesenchymal transition in A549 alveolar epithelial cells

Zebrafish as a model for assessing biocide toxicity: A comprehensive review

The utilization of biocides in a myriad of products has become a widespread and critical practice in recent years. Among these, quaternary ammonium compounds, polyhexamethylene, parabens, and triclosan are notably prevalent across various industrial applications. However, the incorporation of these biocides raises significant concerns regarding their toxicological profile. Not only do these chemicals pose potential risks to consumers using biocide-containing products, but their environmental discharge also represents a substantial threat to the biosphere. In our meticulous review, we examined approximately 150 articles from esteemed databases including PubMed, MDPI, and Google Scholar, ultimately utilizing at least 88 of these articles to inform our analysis. Our investigation encompassed studies that probe general toxicity, behavioral toxicity, cardiovascular toxicity, and genotoxicity, among other toxicological impacts. With this comprehensive approach, we explore the zebrafish (Danio rerio) as a prominent model organism in toxicology research. This review article aims to synthesize research employing zebrafish to evaluate biocide toxicity and ascertain the suitability of this model for comprehensive analysis of biocidal agents and their associated products.

Polyhexamethylene guanidine-phosphate enhances pro-coagulant activity of human erythrocytes and venous thrombosis in rats through phosphatidylserine externalization

Polyhexamethylene guanidine-phosphate (PHMG-p) is a main compound used as a humidifier disinfectant, but the systemic health effects of PHMG-p still need to be explored. The circulatory and blood system is the organ that comes into contact with compounds absorbed into the body after inhalation exposure, resulting in various health problems, including cardiovascular diseases. This study examined the impact of PHMG-p on erythrocytes (red blood cells; RBCs), which are essential for sustaining circulatory health and are directly associated with thrombotic risks. We demonstrated that PHMG-p could enhance the thrombotic risk by promoting pro-coagulant activity and reducing erythrocyte deformability. In PHMG-p-exposed erythrocytes, phosphatidylserine externalization in the outer membrane and microvesicle generation were significantly increased under sub-hemolytic conditions, along with the morphological alterations in the erythrocytes. Exposure to PHMG-p induced erythrocyte phosphatidylserine externalization, leading to enhanced pro-coagulant activity, which was characterized by increased adhesion to vascular endothelial cells, elevated thrombin generation, and decreased deformability. Notably, calcium chelation effectively inhibited PS externalization and thrombin generation, highlighting the pivotal role of calcium influx in PHMG-p-induced thrombogenic alterations. Moreover, intratracheal instillation of PHMG-p promoted phosphatidylserine externalization and thrombin generation in rat erythrocytes, leading to a significant increase in thrombus formation, thereby corroborating the link between in vitro findings and the increased thrombotic risk observed in vivo. These findings suggest that PHMG-p may increase pro-thrombotic risk by promoting RBC pro-coagulant activity through calcium influx-driven PS externalization.

Polyhexamethylene guanidine phosphate induces epithelial-to-mesenchymal transition and cancer stem cell-like properties via Wnt/β-catenin signaling in human bronchial epithelial cells

Inhalation exposure to polyhexamethylene guanidine phosphate (PHMG-p), a primary component of humidifier disinfectants, has been linked to interstitial lung disease and potential carcinogenic effects. This study aimed to investigate epithelial cell transformation and the underlying molecular mechanisms by examining the properties of epithelial-mesenchymal transition (EMT) and cancer stem cells (CSCs) following prolonged exposure to PHMG-p. Beas-2B human bronchial epithelial cells were treated with 0.125-0.5 µg/ml PHMG-p for over 55 passages, resulting in approximately a 1.2-fold increase in proliferation and a 2-fold enhancement in wound healing, migration, and invasion. Long-term exposure induced morphological changes in Beas-2B, which adopted a spindle-shaped appearance, and displayed enhanced expression of EMT markers, including N-cadherin, Vimentin, Twist, and Snail (approximately 1.5- to 3.5-fold). Culturing these cells in a cancer stem cell medium further confirmed neoplastic transformation and the induction of CSC properties in long-term PHMG-p-treated cells. Additionally, expression levels of CSC phenotypic markers (CD44, CD133, ABCG2, and ALDH1A1) and stemness markers (SOX2, OCT4, Nanog, and KLF4) increased during PHMG-p-induced carcinogenesis. Moreover, increased reactive oxygen species (ROS) production and expression of β-catenin indicated the involvement of these signaling molecules during carcinogenesis. Collectively, our findings suggest that chronic exposure to PHMG-p, even at relatively low concentrations, can induce neoplastic transformation through the acquisition of EMT, stemness, and CSC phenotypes, potentially linked to the endogenous ROS and Wnt/β-catenin signaling pathway.

Comprehensive analysis of adverse outcome pathway, potency, human exposure supports carcinogenicity of polyhexamethylene guanidine phosphate in lung cancer

In this study, we investigated the potential mechanisms by which polyhexamethylene guanidine phosphate (PHMG-p), a known respiratory irritant, may contribute to lung cancer development. Using the adverse outcome pathway (AOP) framework, we analyzed established databases (such as AOP-Wiki) and employed AI tools (AOP-helpFinder) to identify key events (KEs) associated with lung carcinogenesis. Our analysis indicates that chronic inhalation of PHMG-p triggers a non-genotoxic pathway, characterized by cell membrane disruption, inflammation, and oxidative stress, with a point of departure (POD) of 0.0018 mg/m³, suggesting carcinogenic potential. Additionally, a human exposure assessment revealed that most claimants were exposed to PHMG-p levels exceeding the estimated inhalation reference concentration (RfC) of 0.018 µg/m³. While downstream KEs, such as DNA damage, mutation, and cell proliferation, require further investigation, our findings, supported by the AOP framework and potency and exposure assessments, strongly suggest that PHMG-p exposure could induce lung cancer in individuals affected by humidifier disinfectants. These results underscore the importance of a comprehensive risk assessment approach for evaluating the carcinogenicity of PHMG-p.

Next generation risk assessment of biocides (PHMG-p and CMIT/MIT)-induced pulmonary fibrosis using adverse outcome pathway-based transcriptome analysis

Next-generation risk assessment (NGRA) has emerged as a promising alternative to non-animal studies owing to the increasing demand for the risk assessment of inhaled toxicants. In this study, NGRA was used to assess the inhalation risks of two biocides commonly used as humidifier disinfectants: polyhexamethylene guanidine phosphate (PHMG-p) and chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT). Human bronchial epithelial cell transcriptomic data were processed based on adverse outcome pathways and used to establish transcriptome-based points of departure (tPODs) for each biocide. tPOD values were 0.00500-0.0510 μg/cm2 and 0.0342-0.0544 μg/cm2 for PHMG-p and CMIT/MIT, respectively. tPODs may provide predictive power comparable to that of traditional animal-based PODs (aPODs). The tPOD-based NGRA determined that both PHMG-p and CMIT/MIT present a high inhalation risk. Moreover, the identified PHMG-p posed a higher risk than CMIT/MIT, and children were identified as more susceptible population compared to adults. This finding is consistent with observations from actual exposure events. Our findings suggest that NGRA with transcriptomics offers a reliable approach for risk assessment of specific humidifier disinfectant biocides, while acknowledging the limitations of current models and in vitro systems, particularly regarding uncertainties in pharmacokinetics (PK) and pharmacodynamics (PD).

A systematic review and BMD modeling approach to develop an AOP for humidifier disinfectant-induced pulmonary fibrosis and cell death

Dosimetry modeling and point of departure (POD) estimation using in vitro data are essential for mechanism-based hazard identification and risk assessment. This study aimed to develop a putative adverse outcome pathway (AOP) for humidifier disinfectant (HD) substances used in South Korea through a systematic review and benchmark dose (BMD) modeling. We collected in vitro toxicological studies on HD substances, including polyhexamethylene guanidine hydrochloride (PHMG-HCl), PHMG phosphate (PHMG-p), a mixture of 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one (CMIT/MIT), CMIT, and MIT from scientific databases. A total of 193 sets of dose-response data were extracted from 34 articles reporting in vitro experimental results of HD toxicity. The risk of bias (RoB) in each study was assessed following the office of health assessment and translation (OHAT) guideline. The BMD of each HD substance at different toxicity endpoints was estimated using the US Environmental Protection Agency (EPA) BMD software (BMDS). Interspecies- or interorgan differences or most critical effects in the toxicity of the HD substances were analyzed using a 95% lower confidence limit of the BMD (BMDL). We found a critical molecular event and cells susceptible to each HD substance and constructed an AOP of PHMG-p- or CMIT/MIT-induced damage. Notably, PHMG-p induced ATP depletion at the lowest in vitro concentration, endoplasmic reticulum (ER) stress, epithelial-to-mesenchymal transition (EMT), inflammation, leading to fibrosis. CMIT/MIT enhanced mitochondrial reactive oxygen species (ROS) production, oxidative stress, mitochondrial dysfunction, resulting in cell death. Our approach will increase the current understanding of the effects of HD substances on human health and contribute to evidence-based risk assessment of these compounds.

Synergistic interaction of co-exposure to humidifier disinfectant chemicals CMIT/MIT and PHMG in lung injury

A number of biocidal disinfectant chemicals are used as household products to prevent spread of pathogens. People are commonly exposed to multiple chemicals through those disinfectants. However, effects of interactions (e.g., synergism) between disinfectants on human health outcomes have been rarely studied. In this study, we aimed to investigate associations of a mixture of chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT) and polyhexamethylene guanidine (PHMG), which had been used as humidifier disinfectants (HDs) in South Korea, with HD-associated lung injury (HDLI) in a Korean population (n = 4058) with HD exposure through use of HD products. Exposure to HD was retrospectively assessed by an interview-based standardized survey, and HDLI was determined by clinical assessment. After adjusting for covariates, PHMG-specific exposure indices (e.g., amount of use, indoor air concentration, and weekly exposure level) were dose-dependently associated with HDLI (their odds ratios for the comparison of third tertile versus first tertile were 1.95, 1.77, and 2.16, respectively). CMIT/MIT exposure was not observed to have a significant association with HDLI in a single chemical exposure model; however, associations between PHMG exposure and HDLI were strengthened by co-exposure to CMIT/MIT in combined chemical exposure models, where synergistic interactions between CMIT/MIT use and PHMG indices (amount of use and weekly exposure level) were observed (p-interaction in additive scale: 0.02 and 0.03, respectively). Our findings imply that adverse effects of PHMG exposure on lung injury among HD users might be worsened by co-exposure to CMIT/MIT. Given that plenty of household products contain disinfectants on global markets, epidemiological and toxicological investigations are warranted on interaction effects of co-exposure to disinfectants.

Predicting the occurrence of antagonism within ternary guanidine mixture pollutants based on the concentration ratio of components

The widespread prevalence and coexistence of diverse guanidine compounds pose substantial risks of potential toxicity interactions, synergism or antagonism, to environmental organisms. This complexity presents a formidable challenge in assessing the risks associated with various pollutants. Hence, a method that is both accurate and universally applicable for predicting toxicity interactions within mixtures is crucial, given the unimaginable diversity of potential combinations. A toxicity interaction prediction method (TIPM) developed in our past research was employed to predict the toxicity interaction, within guanidine compound mixtures. Here, antagonism were found in the mixtures of three guanidine compounds including chlorhexidine (CHL), metformin (MET), and chlorhexidine digluconate (CDE) by selecting Escherichia coli (E. coli) as the test organism. The antagonism in the mixture was probably due to the competitive binding of all three guanidine compounds to the anionic phosphates of E. coli cell membranes, which eventually lead to cell membrane rupture. Then, a good correlation between toxicity interactions (antagonisms) and components' concentration ratios (pis) within binary mixtures (CHL-MET, CHL-CDE, MET-CDE) was established. Based on the correlation, the TIPM was constructed and accurately predicted the antagonism in the CHL-MET-CDE ternary mixture, which once again proved the accuracy and applicability of the TIPM method. Therefore, TIPM can be suggested to identify or screen rapidly the toxicity interaction within ternary mixtures exerting potentially adverse effects on the environment.

Pulmonary Toxicity Assessment after a Single Intratracheal Inhalation of Chlorhexidine Aerosol in Mice

Guanidine disinfectants are important chemical agents with a broad spectrum of activity that are effective against most microorganisms. Chlorhexidine, one of the most used guanidine disinfectants, is added to shampoo and mouthwash and applied in medical device sterilization. During the use of chlorhexidine, aerosols with micron particle size may be formed, which may cause inhalation toxicity. To assess the toxicity of inhaled chlorhexidine aerosol, mice underwent the intratracheal instillation of different concentrations of chlorhexidine (0, 0.125%, 0.25%, 0.5%, and 1%) using a MicroSprayer Aerosolizer. The mice were exposed for eight weeks and then sacrificed to obtain lung tissue for subsequent experiments. Histopathology staining revealed damaged lung tissues and increased collagen exudation. At the same time, pulmonary function tests showed that chlorhexidine exposure could cause restrictive ventilatory dysfunction, consistent with pulmonary fibrosis. The results of transcriptome analyses suggest that chlorhexidine may trigger an inflammatory response and promote the activation of pathways related to extracellular matrix deposition. Further, we identified that chlorhexidine exposure might enhance mucus secretion by up-regulating Muc5b and Muc5ac genes, thereby inducing fibrosis-like injury. These findings underscore the need for standardized use of disinfectants and the assessment of their inhalation toxicity.

Clinical protective effects of polyhexamethylene biguanide hydrochloride (PHMB) against Vibrio parahaemolyticus causing translucent post-larvae disease (VpTPD) in Penaeus vannamei

A new emerging disease called "translucent post-larvae disease" (TPD) in Penaeus vannamei, caused by a novel type of highly lethal Vibro parahaemolyticus (VpTPD), has become an urgent threat to the shrimp farming industry in China. In order to develop an effective disinfectant for the prevention and control of the VpTPD, the clinical protective effects of polyhexamethylene biguanide hydrochloride (PHMB) against VpTPD in Penaeus vannamei were investigated by carrying out an acute toxicity test of PHMB on post-larvae of P. vannamei and its effect of treatment test on VpTPD infection. The results showed that the median lethal concentration of disinfectant (LC50) values of PHMB to post-larvae of P. vannamei after treatment for 24 h, 48 h, 72 h, 96 h were 16.13 mg/L (14.18-18.57), 10.77 mg/L (9.93-11.72), 9.68 mg/L (8.53-11.64), 9.14 mg/L (7.70-10.99), respectively. In addition, a clinical trial showed that 1 mg/L PHMB showed a strong protective effect on the post-larvae of shrimp challenged with 101-104 CFU/ml of VpTPD. The relative percentage survival (RPS) of 1 mg/L PHMB on post-larvae of P. vannamei challenged with VpTPD at 101, 102, 103 and 104 CFU/ml were 63.65 %±6.81, 62.96 %±5.56, 60.00 %±3.75 and 66.67 %±3.75 at 96 hours post infection. The results highlight the clinical protective effects of the PHMB and therefor PHMB can be used as a preventive measure to control early TPD infection in shrimp culture. This study also provides valuable information for the prevention of other bacterial diseases in shrimp culture.

Recent developments in membrane targeting antifungal agents to mitigate antifungal resistance

Fungal infections cause severe and life-threatening complications especially in immunocompromised individuals. Antifungals targeting cellular machinery and cell membranes including azoles are used in clinical practice to manage topical to systemic fungal infections. However, continuous exposure to clinically used antifungal agents in managing the fungal infections results in the development of multi-drug resistance via adapting different kinds of intrinsic and extrinsic mechanisms. The unique chemical composition of fungal membranes presents attractive targets for antifungal drug discovery as it is difficult for fungal cells to modify the membrane targets for emergence of drug resistance. Here, we discussed available antifungal drugs with their detailed mechanism of action and described different antifungal resistance mechanisms. We further emphasized structure-activity relationship studies of membrane-targeting antifungal agents, and classified membrane-targeting antifungal agents on the basis of their core scaffold with detailed pharmacological properties. This review aims to pique the interest of potential researchers who could explore this interesting and intricate fungal realm.

A multiplex inhalation platform to model in situ like aerosol delivery in a breathing lung-on-chip

Prolonged exposure to environmental respirable toxicants can lead to the development and worsening of severe respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD) and fibrosis. The limited number of FDA-approved inhaled drugs for these serious lung conditions has led to a shift from in vivo towards the use of alternative in vitro human-relevant models to better predict the toxicity of inhaled particles in preclinical research. While there are several inhalation exposure models for the upper airways, the fragile and dynamic nature of the alveolar microenvironment has limited the development of reproducible exposure models for the distal lung. Here, we present a mechanistic approach using a new generation of exposure systems, the Cloud α AX12. This novel in vitro inhalation tool consists of a cloud-based exposure chamber (VITROCELL) that integrates the breathing ^AXLung-on-chip system (AlveoliX). The ultrathin and porous membrane of the AX12 plate was used to create a complex multicellular model that enables key physiological culture conditions: the air-liquid interface (ALI) and the three-dimensional cyclic stretch (CS). Human-relevant cellular models were established for a) the distal alveolar-capillary interface using primary cell-derived immortalized alveolar epithelial cells (^AXiAECs), macrophages (THP-1) and endothelial (HLMVEC) cells, and b) the upper-airways using Calu3 cells. Primary human alveolar epithelial cells (^AXhAEpCs) were used to validate the toxicity results obtained from the immortalized cell lines. To mimic in vivo relevant aerosol exposures with the Cloud α AX12, three different models were established using: a) titanium dioxide (TiO2) and zinc oxide nanoparticles b) polyhexamethylene guanidine a toxic chemical and c) an anti-inflammatory inhaled corticosteroid, fluticasone propionate (FL). Our results suggest an important synergistic effect on the air-blood barrier sensitivity, cytotoxicity and inflammation, when air-liquid interface and cyclic stretch culture conditions are combined. To the best of our knowledge, this is the first time that an in vitro inhalation exposure system for the distal lung has been described with a breathing lung-on-chip technology. The Cloud α AX12 model thus represents a state-of-the-art pre-clinical tool to study inhalation toxicity risks, drug safety and efficacy.

Didecyldimethylammonium Chloride- and Polyhexamethylene Guanidine-Resistant Bacteria Isolated from Fecal Sludge and Their Potential Use in Biological Products for the Detoxification of Biocide-Contaminated Wastewater Prior to Conventional Biological Treatment

Simple Summary

Every year, more than a million tons of fecal sludge (FS) containing biocides based on quaternary ammonium compounds and guanidine derivatives, which are widely used for FS deodorization and control of microbial activity, are generated in the environmentally safe toilet complexes of Russian Railways trains. Higher disposal costs for such biocide-contaminated FS due to activated sludge toxicity increases pressure on sanitary equipment servicing companies («Ecotol Service» LLC) to more efficiently discharge FS to wastewater treatment plants. In this work, we have developed a new environmentally friendly approach to reducing the toxicity of FS, based on the use of biological products from biocide-resistant bacterial strains isolated from FS. Our approach has proven to be effective in a series of FS biodegradation experiments, biological oxygen demand tests, and a newly developed disk-diffusion bioassay.

Abstract

Toxic shock caused by the discharge of biocide-contaminated fecal sludge (FS) from chemical toilets to conventional wastewater treatment plants (WWTP) can be a major problem in activated sludge operation. It is necessary to develop new environmental approaches to mitigate the toxicity of biocides in order to avoid degrading the performance of WWTP. “Latrina”, a chemical toilet additive containing didecyldimethylammonium chloride and polyhexamethylene guanidine, is widely used in environmentally safe toilet complexes (ESTC) on Russian railway trains to deodorize FS and control microbial activity. In this work, seven biocide-resistant bacterial strains were isolated and identified from the FS of ESTC. The values of the minimum inhibitory and bactericidal concentrations of biocides for the isolated strains were 4.5–10 times higher than for the collection microorganisms. The bacterium Alcaligenes faecalis DOS7 was found to be particularly resistant to “Latrina”, the minimum inhibitory concentration of which was almost 30 times higher than recommended for ESTC. Biological products based on isolated bacterial strains proved to be effective for FS biodegradation under both aerobic and anaerobic conditions. The results of the biochemical oxygen demand test and the newly developed disk-diffusion bioassay confirmed that isolated strains contribute to reducing toxicity of biocidal agents in FS. Hyper-resistance, non-pathogenicity, and potential plant growth-promoting ability make A. faecalis DOS7 promising for use in various biological products for wastewater treatment and bioremediation of soils contaminated with biocides, as well as in agriculture to increase plant productivity.

Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration

BACKGROUND

It has been 10 years since the outbreak of lung disease caused by humidifier disinfectants in Korea, but the health effects have not yet been summarized. Therefore, this study aims to systematically examine the health effects of humidifier disinfectants that have been discovered so far.

METHODS

All literature with humidifier disinfectants and their representative components as the main words were collected based on the web, including PubMed, Research Information Sharing Service, and government publication reports. A total of 902 studies were searched, of which 196 were selected. They were divided into four groups: published human studies (group 1), published animal and cytotoxicology studies (group 2), technical reports (group 3), and gray literature (group 4).

RESULTS

Out of the 196 studies, 97 (49.5%) were published in peer-reviewed journals as original research. Group 1 consisted of 49 articles (50.5%), while group 2 consisted of 48 articles (49.5%). Overall, respiratory diseases such as humidifier disinfectant associated lung injury, interstitial lung disease, and asthma have a clear correlation, but other effects such as liver, heart, thymus, thyroid, fetal growth, metabolic abnormalities, and eyes are observed in toxicological experimental studies, but have not yet been identified in epidemiologic studies.

CONCLUSION

The current level of evidence does not completely rule out the effects of humidifier disinfectants on extrapulmonary disease. Based on the toxicological evidence so far, it is required to monitor the population of humidifier disinfectant exposure continuously to see if similar damage occurs.

Recent Advances in Molecular Diagnosis of Pulmonary Fibrosis for Precision Medicine

Pulmonary fibrosis is a serious, progressive lung disease characterized by scarring and stiffening lung tissues, affecting the respiratory system and leading to organ failure. It is a complex disease consisting of alveolar damage, chronic inflammation, and a varying degree of lung fibrosis. Significant challenges with pulmonary fibrosis include the lack of effective means to diagnose the disease at early stages, identify patients at higher risks of progress, and assess disease progression and treatment response. Precision medicine powered by accurate molecular profiling and phenotyping could significantly improve our understanding of the disease's heterogeneity, potential biomarkers for diagnosis and prognosis, and molecular targets for treatment development. This Review discusses various translational model systems, including organoids and lung-on-a-chip systems, biomarkers in single cells and extracellular vesicles, and functional pharmacodynamic markers. We also highlight emerging sensing technologies for molecular characterization of pulmonary fibrosis and biomarker detection.

New-Onset and Exacerbation of Lung Diseases after Short-Term Exposures to Humidifier Disinfectant during Hospitalization

(1) Background: Humidifier disinfectant (HD) is a biocidal chemical to keep the water tank inside a humidifier clean. Thousands of Koreans have experienced HD-related lung injuries. Of them, 6.9% were exposed to HD in hospitals. (2) Methods: This study investigated changes of diseases in patients (or caregivers) who experienced HD exposures during hospitalization and also investigated characteristics of hospital exposure using data from all HD-related lung injury enrollment in Korea. (3) Results: Of a total of 162 subjects, 139 subjects were hospitalized for non-lung diseases, and 23 people were hospitalized for lung diseases at the time of hospitalization. During hospital exposure, 99 (71.2%) of those hospitalized with non-lung disease experienced a new-onset of lung disease, and 15 (65.2%) of those hospitalized with lung diseases experienced exacerbation of their existing lung diseases. When we compared their exposure characteristics, those exposed in hospitals (vs. non-hospital, mostly home) were exposed for shorter periods, at closer distances, at higher HD indoor concentrations, constantly all day, and directly in the facial direction. (4) Conclusion: In conclusion, HD exposures in hospital with a high intensity even for a short term were associated with new-onset or exacerbation of lung diseases. Our findings suggest that acute exposures to HD can cause lung diseases.

Analysis of lung cancer-related genetic changes in long-term and low-dose polyhexamethylene guanidine phosphate (PHMG-p) treated human pulmonary alveolar epithelial cells

BACKGROUND

Lung injury elicited by respiratory exposure to humidifier disinfectants (HDs) is known as HD-associated lung injury (HDLI). Current elucidation of the molecular mechanisms related to HDLI is mostly restricted to fibrotic and inflammatory lung diseases. In our previous report, we found that lung tumors were caused by intratracheal instillation of polyhexamethylene guanidine phosphate (PHMG-p) in a rat model. However, the lung cancer-related genetic changes concomitant with the development of these lung tumors have not yet been fully defined. We aimed to discover the effect of long-term exposure of PHMG-p on normal human lung alveolar cells.

METHODS

We investigated whether PHMG-p could increase distorted homeostasis of oncogenes and tumor-suppressor genes, with long-term and low-dose treatment, in human pulmonary alveolar epithelial cells (HPAEpiCs). Total RNA sequencing was performed with cells continuously treated with PHMG-p and harvested after 35 days.

RESULTS

After PHMG-p treatment, genes with transcriptional expression changes of more than 2.0-fold or less than 0.5-fold were identified. Within 10 days of exposure, 2 protein-coding and 5 non-coding genes were selected, whereas in the group treated for 27-35 days, 24 protein-coding and 5 non-coding genes were identified. Furthermore, in the long-term treatment group, 11 of the 15 upregulated genes and 9 of the 14 downregulated genes were reported as oncogenes and tumor suppressor genes in lung cancer, respectively. We also found that 10 genes of the selected 24 protein-coding genes were clinically significant in lung adenocarcinoma patients.

CONCLUSIONS

Our findings demonstrate that long-term exposure of human pulmonary normal alveolar cells to low-dose PHMG-p caused genetic changes, mainly in lung cancer-associated genes, in a time-dependent manner.

Anti-COVID-19 Nanomaterials: Directions to Improve Prevention, Diagnosis, and Treatment

Following the announcement of the outbreak of COVID-19 by the World Health Organization, unprecedented efforts were made by researchers around the world to combat the disease. So far, various methods have been developed to combat this "virus" nano enemy, in close collaboration with the clinical and scientific communities. Nanotechnology based on modifiable engineering materials and useful physicochemical properties has demonstrated several methods in the fight against SARS-CoV-2. Here, based on what has been clarified so far from the life cycle of SARS-CoV-2, through an interdisciplinary perspective based on computational science, engineering, pharmacology, medicine, biology, and virology, the role of nano-tools in the trio of prevention, diagnosis, and treatment is highlighted. The special properties of different nanomaterials have led to their widespread use in the development of personal protective equipment, anti-viral nano-coats, and disinfectants in the fight against SARS-CoV-2 out-body. The development of nano-based vaccines acts as a strong shield in-body. In addition, fast detection with high efficiency of SARS-CoV-2 by nanomaterial-based point-of-care devices is another nanotechnology capability. Finally, nanotechnology can play an effective role as an agents carrier, such as agents for blocking angiotensin-converting enzyme 2 (ACE2) receptors, gene editing agents, and therapeutic agents. As a general conclusion, it can be said that nanoparticles can be widely used in disinfection applications outside in vivo. However, in in vivo applications, although it has provided promising results, it still needs to be evaluated for possible unintended immunotoxicity. Reviews like these can be important documents for future unwanted pandemics.

Antifungal Polymeric Materials and Nanocomposites

Rising global populations due to medicinal advancements increases the patient population susceptible to superficial and severe fungal infections. Fungi often implicated in these diseases includes the dermatophytes (Microsporum spp., Epidermophtyon spp., Trichophyton spp.) as well as species of the Candida spp., Aspergillosis spp. and Cryptococcus spp. genera. In addition, increasing global populations leads to increasing agricultural demands. Thus, fungal infections of preharvested crops and stored food by plant pathogens such as Magnaporthe oryzae and Fusarium oxysporum can have detrimental socioeconomic effects due to food insecurity. Current antifungal strategies are based mainly on small molecule antifungal drugs. However, these drugs are limited by poor solubility and bioavailability. Furthermore, antifungal resistance against these drugs are on the rise. Thus, antimicrobial polymers offer an alternative antifungal strategy. Antifungal polymers are characterised by cationic and hydrophobic regions where the cationic regions have been shown to interact with microbial phospholipids and membranes. These polymers can be synthetic or natural and demonstrate distinct antifungal mechanisms ranging from fungal cell membrane permeabilisation, cell membrane depolarisation or cell entry. Although the relative importance of such mechanisms is difficult to decipher. Due to the chemical properties of these polymers, they can be combined with other antimicrobial compounds including existing antifungal drugs, charcoals, lipids and metal ions to elicit synergistic effects. In some cases, antifungal polymers and nanocomposites show better antifungal effects or reduced toxicity compared to the widely used small molecule antifungal drugs. This review provides an overview of antimicrobial polymers and nanocomposites with antifungal activity and the current understanding of their antifungal mechanisms.

Polyhexamethylene guanidine phosphate increases stress granule formation in human 3D lung organoids under respiratory syncytial virus infection

Polyhexamethylene guanidine phosphate (PHMG-p), a humidifier disinfectant, is known to cause lung toxicity, including inflammation and pulmonary fibrosis. In this study, we aimed to investigate the effect of PHMG-p on human lung tissue models (2D epithelial cells and 3D organoids) under conditions of oxidative stress and viral infection. The effect of PHMG-p was studied by evaluating the formation of stress granules (SGs), which play a pivotal role in cellular adaptation to various stress conditions. Under oxidative stress and respiratory syncytial virus (RSV) infection, exposure to PHMG-p remarkably increased eIF2α phosphorylation, which is essential for SG-related signalling, and significantly increased SG formation. Furthermore, PHMG-p induced fibrotic gene expression and caused cell death due to severe DNA damage, which was further increased under oxidative stress and RSV infection, indicating that PHMG-p induces severe lung toxicity under stress conditions. Taken together, toxicity evaluation under various stressful conditions is necessary to accurately predict potential lung toxicity of chemicals affecting the respiratory tract.

Comparison of 3D airway models for the assessment of fibrogenic chemicals

Lung epithelial cells and fibroblasts play key roles in pulmonary fibrosis and are involved in fibrotic signaling and production of the extracellular matrix (ECM), respectively. Recently, 3D airway models consisting of both cell types have been developed to evaluate the fibrotic responses while facilitating cell-cell crosstalk. This study aimed to evaluate the fibrotic responses in these models using different fibrogenic agents, which are known as key events in adverse outcome pathways of pulmonary fibrosis. We quantified cell injury and several sequential steps in fibrogenesis, including inflammation, the epithelial-mesenchymal transition (EMT), fibroblast activation, and ECM accumulation, using two different 3D airway models, the EpiAirway™-full thickness (Epi/FT) and MucilAir™-human fibroblast (Mucil/HF) models. In the Epi/FT model, fibrogenic agents induced the expression of inflammation and EMT-associated markers, while in the Mucil/HF model, they induced fibroblast activation and ECM accumulation. Using this information, we conducted gene ontology term network analysis. In the Epi/FT model, the terms associated with cell migration and response to stimulus made up a large part of the network. In the Mucil/HF model, the terms associated with ECM organization and cell differentiation and proliferation constituted a great part of the network. Collectively, our data suggest that polyhexamethyleneguanidine phosphate and bleomycin induce different responses in the two 3D airway models. While Epi/FT was associated with inflammatory/EMT-associated responses, Mucil/HF was associated with fibroblast-associated responses. This study will provide an important basis for selecting proper 3D airway models and fibrogenic agents to further research or screen chemicals causing inhalation toxicity.

Humidifier Disinfectant Consumption and Humidifier Disinfectant-Associated Lung Injury in South Korea: A Nationwide Population-Based Study

Humidifier disinfectant (HD) is a household biocidal product used in humidifier water tanks to prevent the growth of microorganisms. In 2011, a series of lung injury cases of unknown causes emerged in children and pregnant women who had used HD in Korea. This study investigated changes in the nationwide number of cases of humidifier disinfectant-associated lung injury (HDLI) in concordance with nationwide HD consumption using data covering the entire Korean population. More than 25 kinds of HD products were sold between 1994 and 2011. The number of diagnosed HDLI, assessed by S27.3 (other injuries of lungs) of the Korea National Health Insurance Service (NHIS) data, sharply increased by 2005, subsequently decreased after 2005, and almost disappeared after 2011 in concordance with the annual number of HD sales. The number of self-reported HDLIs, assessed using data from all suspected HDLI cases registered in the Korea Ministry of Environment, changed with the annual number of HD sales, with a delay pattern, potentially induced by the late awareness of lung injury diseases. The present study suggests that changes in the nationwide annual consumption of HD products were consistent with changes in the annual number of HDLI cases in Korea.

Evaluation of polyhexamethylene guanidine-induced lung injuries by chest CT, pathologic examination, and RNA sequencing in a rat model

Our aim was to correlate chest CT and pathologic findings of polyhexamethylene guanidine phosphate (PHMG)-induced lung injuries in a rat model, to determine whether PHMG exposure causes lung tumors, and to explore genetic alterations according to PHMG exposure under the guidance of CT. A PHMG solution was intratracheally administrated to 40 male rats. Chest CT was carried out in all rats and both lungs were collected for histopathologic evaluation. At 4- and 8-weeks post-instillation, one lobe of the right lung from 3 rats was subjected to RNA sequencing. At least one abnormal CT finding was found in all rats at all weeks. The major CT findings were inflammation, fibrosis, and tumors in the pathologic analysis, where significant changes were observed over time. The lung lesions remained persistent after 8 weeks of PHMG exposure. In the pathologic analysis, the extent/severity of inflammation did not show statistically significant changes over time, whereas the extent/severity of fibrosis increased continuously up to 6 weeks after PHMG exposure and then decreased significantly at 8 weeks. Bronchiolar-alveolar adenomas which have malignant potential were found in 50% of rats at 6 and 8 weeks after PHMG exposure. Also, several genes associated with lung cancer, acute lung injury, and pulmonary fibrosis were detected. Our study revealed that PHMG-induced lung injury and its changes according to the number of weeks after exposure were demonstrated using chest CT and pathologic evaluation. In addition, we showed that PHMG exposure caused lung tumors and genetic alterations according to PHMG exposure under the guidance of CT.

Advancements in research and development to combat COVID-19 using nanotechnology

The whole world is currently facing a global health crisis due to the coronavirus disease (COVID-19) pandemic caused by SARS coronavirus 2, which started in Wuhan City, China, in December 2019. The pandemic has affected 235 countries, areas or territories and infected over 42 million people across the globe as per WHO update on 27 October 2020. More than 1.1 million people have died and the numbers are increasing daily. However, some drugs have been authorized for emergency treatment of patients, medication and vaccines with proven efficacy to prevent and treat the disease is still under various phases of development. The entire world is consistently making efforts to address three major challenges related to COVID-19 including prevention of its spread, prompt and early diagnosis and treatment of patients to save lives. Touted as one of the game-changing technologies of the century, nanotechnology has huge potential to develop solutions against these three major challenges of the disease. Nanotechnology comprises of multidisciplinary prospects encompassing diverse disciplines including medicine, material science, artificial intelligence, environment, virology, physical sciences, chemistry and biology. The numerous challenges can be addressed through the engineering of the various physicochemical properties of materials presents in abundance in nature. Various claims, studies and reports on research and development to combat these challenges associated with COVID-19 have been collectively discussed in this article from the perspectives of nanotechnology.

Critical window of exposure of CMIT/MIT with respect to developmental effects on zebrafish embryos: Multi-level endpoint and proteomics analysis

Systemic toxicity, particularly, developmental defects of humidifier disinfectant chemicals that have caused lung injuries in Korean children, remains to be elucidated. This study evaluated the mechanisms of the adverse effects of 5-chloro-2-methyl-4-isothiazoline-3-one/2methyl-4-isothiazolin-3-one (CMIT/MIT), one of the main biocides of the Korean tragedy, and identify the most susceptible developmental stage when exposed in early life. To this end, the study was designed to analyze several endpoints (morphology, heart rate, behavior, global DNA methylation, gene expressions of DNA methyl-transferases (dnmts) and protein profiling) in exposed zebrafish (Danio rerio) embryos at various developmental stages. The results showed that CMIT/MIT exposure causes bent tail, pericardial edema, altered heart rates, global DNA hypermethylation and significant alterations in the locomotion behavior. Consistent with the morphological and physiological endpoints, proteomics profiling with bioinformatics analysis suggested that the suppression of cardiac muscle contractions and energy metabolism (oxidative phosphorylation) were possible pivotal underlying mechanisms of the CMIT/MIT mediated adverse effects. Briefly, multi-level endpoint analysis indicated the most susceptible window of exposure to be ≤ 6 hpf followed by ≤ 48 hpf for CMIT/MIT. These results could potentially be translated to a risk assessment of the developmental exposure effects to the humidifier disinfectants.

Liposome leakage and increased cellular permeability induced by guanidine-based oligomers: effects of liposome composition on liposome leakage and human lung epithelial barrier permeability

In this study, liposome leakage using different liposome compositions and increased cellular permeability of human lung monolayer models induced by PHMG and PHMB were investigated.

Prediction of the skin sensitization potential of polyhexamethylene guanidine and triclosan and mixtures of these compounds with the excipient propylene glycol through the human Cell Line Activation Test

Household products often contain an antimicrobial agent such as biocides, polyhexamethylene guanidine (PHMG), triclosan (TCS), and propylene glycol (PG) as an excipient to dissolve the active ingredients. The skin sensitization (SS) potentials of each of these substances or mixtures of PHMG or TCS with PG have not been investigated through in vitro alternative test methods. The in vitro alternative assay called human Cell Line Activation Test (h-CLAT) served to address these issues. The h-CLAT assay was conducted in accordance with OECD TG 442E. On three independent runs, all the three substances were predicted to be sensitizers according to the SS positivity with relative fluorescence intensity of CD86 ≥ 150% and/or CD54 ≥ 200% at any tested concentrations. Mixtures of PHMG or TCS with PG at ratios of 9:1, 4:1, or 1:4 weight/volume were all positive in terms of SS potential. Since humans can be occupationally or environmentally exposed to mixtures of excipients with active ingredients of biocides, the present study may give insights into further investigations of the SS potentials of various chemical mixtures.

Mitochondria disease due to humidifier disinfectants: diagnostic criteria and its evidences

Humidifier disinfectant damages caused by the misuse of humidifier disinfects, such as polyhexamethylene guanidine (PHMG), resulted in chemical disasters in South Korea in 2011. About four million people were exposed to humidifier disinfectants (HDs) in the 17 years between 1994 and 2011. Although fatal lung damage was initially reported, investigations into the victims’ injuries revealed that the damage was not limited to the lungs, but that systemic damage was also confirmed. Considering the spread of HD from the lungs to the whole body, the toxic effects of PHMG from reactive oxygen species (ROS), NOTCH signaling pathways, and mitochondrial dysfunction resulted in endothelial damage in the lungs, blood vessels, liver, kidneys, bone marrow, nerves, and muscles. The main toxic mechanisms involved in HD damage may be the NOTCH pathway and mitochondrial damage. There are many case reports which include neurologic disorders (ADHD, depression, posttraumatic stress disorder), muscular disorder (exercise intolerance, myalgia), energy metabolism disorder (chronic fatigue syndrome), and immunologic disorder (rheumatoid arthritis) in HDs victims. These case reports involve multi-system involvement in HDs victims. Further well-designed study is needed to clarify whether mitochondrial dysfunction is associated with multi-organs involvement in HDs victims.

Effects of lipid membrane composition on the distribution of biocidal guanidine oligomer with solid supported lipid membranes

Polyhexamethylene guanidine (PHMG) is a cationic antimicrobial oligomer that has been used prevalently over the past few decades. However, due to the lack of inhalation toxicity assessment of PHMG, it has caused severe health damage, including fatal lung fibrosis, after being used as one of the major active ingredients of humidifier disinfectants in Korea. Because the first step of the entry of PHMG into airway is its association with cell membranes, the distribution of PHMG between lipid membranes and water is very important to know the depositional flux in the respiratory systems and related toxic mechanisms. We developed a quantitative method to determine the distribution constant (K_lipw) of PHMG between solid supported lipid membranes and water and evaluated the effects of lipid membrane compositions on the K_lipw of PHMG. PHMG accumulated into anionic lipid membranes rapidly compared to into cationic or zwitterionic lipid membranes, suggesting fast adsorption of PHMG onto anionic lipid head groups. K_lipw values with anionic/zwitterionic lipid mixtures were higher than K_lipw values with anionic lipids only, potentially due to the later phase separation after preferential interaction between PHMG and anionic lipids in lipid mixtures. In addition, K_lipw values increased with increasing single acyl chain lipid content in unsaturated lipids and decreasing cholesterol content. These results imply that changes in lipid spontaneous curvature and lipid bilayer packing density also affect the membrane distribution of PHMG.

This study experimentally determined the K_lipw of PHMG and assessed the effects of lipid membrane composition on K_lipw values.