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Goutman SA, Boss J, Godwin C, Mukherjee B, Feldman EL, Batterman SA. Occupational history associates with ALS survival and onset segment. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:219-229. [PMID: 36193557 PMCID: PMC10067530 DOI: 10.1080/21678421.2022.2127324] [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: 05/20/2022] [Revised: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To identify associations between occupational settings and self-reported occupational exposures on amyotrophic lateral sclerosis (ALS) survival and phenotypes. METHODS All patients seen in the University of Michigan Pranger ALS Clinic were invited to complete an exposure assessment querying past occupations and exposures. Standard occupational classification (SOC) codes for each job and the severity of various exposure types were derived. Cox proportional hazards models associated all-cause mortality with occupational settings and the self-reported exposures after adjusting for sex, diagnosis age, revised El Escorial criteria, onset segment, revised ALS Functional Rating Scale (ALSFRS-R), and time from symptom onset to diagnosis. Multinomial logistic regression models with three categories, adjusted for age, assessed the association between occupational settings and exposures to onset segment. RESULTS Among the 378 ALS participants (median age, 64.7 years; 54.4% male), poorer survival was associated with work in SOC code "Production Occupations" and marginally with work in "Military Occupation"; poor survival associated with self-reported occupational pesticide exposure in adjusted models. Among onset segments: cervical onset was associated with ALS participants having ever worked in "Buildings and Grounds Cleaning and Maintenance Occupations," "Construction and Extraction Occupations," and "Production Occupations"; bulbar onset with self-reported occupational exposure to radiation; and cervical onset with exposure to particulate matter, volatile organic compounds, metals, combustion and diesel exhaust, electromagnetic radiation, and radiation. CONCLUSION Occupational settings and self-reported exposures influence ALS survival and onset segment. Further studies are needed to explore and understand these relationships, most advantageously using prospective cohorts and detailed ALS registries.
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Affiliation(s)
- Stephen A Goutman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Boss
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA, and
| | - Christopher Godwin
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA, and
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Stuart A Batterman
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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Goutman SA, Boss J, Godwin C, Mukherjee B, Feldman EL, Batterman SA. Associations of self-reported occupational exposures and settings to ALS: a case-control study. Int Arch Occup Environ Health 2022; 95:1567-1586. [PMID: 35593931 PMCID: PMC9424174 DOI: 10.1007/s00420-022-01874-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Environmental exposures contribute to the pathogenesis of amyotrophic lateral sclerosis (ALS), a fatal and progressive neurological disease. Identification of these exposures is important for targeted screening and risk factor modification. OBJECTIVE To identify occupational exposures that are associated with a higher risk of ALS using both survey and standard occupational classification (SOC) coding procedures, and to highlight how exposure surveys can complement SOC coding. METHODS ALS participants and neurologically healthy controls recruited in Michigan completed a detailed exposure assessment on their four most recent and longest held occupations. Exposure scores were generated from the exposure survey, and occupations were assigned to SOC codes by experienced exposure scientists. RESULTS This study included 381 ALS and 272 control participants. ALS participants reported higher duration-adjusted occupational exposure to particulate matter (OR = 1.45, 95% CI 1.19-1.78, p < 0.001), volatile organic compounds (OR = 1.22, 95% CI 1.02-1.45, p = 0.029), metals (OR = 1.48, 95% CI 1.21-1.82, p < 0.001), and combustion and diesel exhaust pollutants (OR = 1.20, 95% CI 1.01-1.43, p = 0.041) prior to ALS diagnosis, when adjusted for sex, age, and military service compared to controls. In multivariable models, only occupational exposure to metals remained significant risk (OR = 1.56, 95% CI 1.11-2.20, p = 0.011), although in an adaptive elastic net model, particulate matter (OR = 1.203), pesticides (OR = 1.015), and metals (1.334) were all selected as risk factors. Work in SOC code "Production Occupations" was associated with a higher ALS risk. SOC codes "Building and Grounds Cleaning and Maintenance Occupations", "Construction and Extraction Occupations", "Installation, Maintenance, and Repair Occupations", and "Production Occupations" were all associated with a higher exposure to metals as determined using survey data. DISCUSSION Occupational exposure to particulate matter, volatile organic compounds, metals, pesticides, and combustion and diesel exhaust and employment in "Production Occupations" was associated with an increased ALS risk in this cohort.
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Affiliation(s)
- Stephen A Goutman
- Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109-5223, USA.
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA.
| | - Jonathan Boss
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Christopher Godwin
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109-5223, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Stuart A Batterman
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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Epidemiology and factors predicting survival of amyotrophic lateral sclerosis in a large Chinese cohort. Chin Med J (Engl) 2021; 134:2231-2236. [PMID: 34483254 PMCID: PMC8478368 DOI: 10.1097/cm9.0000000000001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder associated with loss of motor neurons. Our objective was to explore the epidemiology, clinical features, and survival factors of 1809 patients with ALS. METHODS We analyzed 1809 ALS patients, who were recruited from the Peking University Third Hospital from January 2005 to December 2015. Demographic data and disease-related parameters were collected. Kaplan-Meier curves were used to compare survival time. Cox proportional hazards function and the hazard ratio were used to identify adjusted prognostic predictors. RESULTS The results showed that the average annual incidence in Beijing alone was 0.38 cases/100,000 person-years and the mean age of onset was 48.88 ± 11.35 (95% confidence interval [CI]: 48.17-49.85) years. The median survival time from onset to death/tracheostomy was 58.89 ± 33.03 (95% CI: 51.46-63.84) months. In the adjusted Cox proportional hazard model, age of onset, diagnosis delay, rate of disease progression (Amyotrophic Lateral Sclerosis Functional Rating Scale Revised decline [points/month]), and body mass index all had an independent effect on survival in ALS. CONCLUSIONS Our study provides information on epidemiology, clinical features, and survival factors of patients with ALS in China. These results can be helpful in clinical practice, clinical trial design, and validation of new tools to predict disease progression.
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Jalilian H, Najafi K, Khosravi Y, Röösli M. Amyotrophic lateral sclerosis, occupational exposure to extremely low frequency magnetic fields and electric shocks: a systematic review and meta-analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2021; 36:129-142. [PMID: 32946420 DOI: 10.1515/reveh-2020-0041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Exposure to extremely low frequency magnetic fields (ELF-MF) and electric shocks occurs in many workplaces and occupations but it is unclear whether any of these exposures cause Amyotrophic lateral sclerosis (ALS). The aim of this systematic review and meta-analysis is to explore whether occupational exposure to ELF-MF and/or electric shocks are risk factor for ALS. We searched PubMed, Embase, and Web of Science databases up to the end of 2019. Pooled risk estimates were calculated using random-effects meta-analysis including exploration of the sources of heterogeneity between studies and publication bias. Twenty-seven publications fulfilled the inclusion criteria. We found a weak, significant, association between occupational exposure to ELF-MF and the risk of ALS (RRPooled estimate: 1.20; 95%CI: 1.05, 1.38) with moderate to high heterogeneity (I2=66.3%) and indication of publication bias (PEgger's test=0.03). No association was observed between occupational exposure to electric shocks and risk of ALS (RRPooled estimate: 0.97; 95%CI: 0.80, 1.17) with high heterogeneity (I2=80.5%), and little indication for publication bias (PEgger's test=0.24). The findings indicate that occupational exposure to ELF-MF, but not electric shocks, might be a risk factor for ALS. However, given the moderate to high heterogeneity and potential publication bias, the results should be interpreted with caution.
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Affiliation(s)
- Hamed Jalilian
- Department of Occupational Health and Safety Engineering, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Kamran Najafi
- Student Research Committee, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Yahya Khosravi
- Department of Occupational Health and Safety Engineering, School of Health, Research Center for Health, Safety and Environment, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Filippini T, Mandrioli J, Malagoli C, Costanzini S, Cherubini A, Maffeis G, Vinceti M. Risk of Amyotrophic Lateral Sclerosis and Exposure to Particulate Matter from Vehicular Traffic: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030973. [PMID: 33499343 PMCID: PMC7908475 DOI: 10.3390/ijerph18030973] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/26/2022]
Abstract
(1) Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with still unknown etiology. Some occupational and environmental risk factors have been suggested, including long-term air pollutant exposure. We carried out a pilot case-control study in order to evaluate ALS risk due to particulate matter with a diameter of ≤10 µm (PM10) as a proxy of vehicular traffic exposure. (2) Methods: We recruited ALS patients and controls referred to the Modena Neurology ALS Care Center between 1994 and 2015. Using a geographical information system, we modeled PM10 concentrations due to traffic emissions at the geocoded residence address at the date of case diagnosis. We computed the odds ratio (OR) and 95% confidence interval (CI) of ALS according to increasing PM10 exposure, using an unconditional logistic regression model adjusted for age and sex. (3) Results: For the 132 study participants (52 cases and 80 controls), the average of annual median and maximum PM10 concentrations were 5.2 and 38.6 µg/m3, respectively. Using fixed cutpoints at 5, 10, and 20 of the annual median PM10 levels, and compared with exposure <5 µg/m3, we found no excess ALS risk at 5-10 µg/m3 (OR 0.87, 95% CI 0.39-1.96), 10-20 µg/m3 (0.94, 95% CI 0.24-3.70), and ≥20 µg/m3 (0.87, 95% CI 0.05-15.01). Based on maximum PM10 concentrations, we found a statistically unstable excess ALS risk for subjects exposed at 10-20 µg/m3 (OR 4.27, 95% CI 0.69-26.51) compared with those exposed <10 µg/m3. However, risk decreased at 20-50 µg/m3 (OR 1.49, 95% CI 0.39-5.75) and ≥50 µg/m3 (1.16, 95% CI 0.28-4.82). ALS risk in increasing tertiles of exposure showed a similar null association, while comparison between the highest and the three lowest quartiles lumped together showed little evidence for an excess risk at PM10 concentrations (OR 1.13, 95% CI 0.50-2.55). After restricting the analysis to subjects with stable residence, we found substantially similar results. (4) Conclusions: In this pilot study, we found limited evidence of an increased ALS risk due to long-term exposure at high PM10 concentration, though the high statistical imprecision of the risk estimates, due to the small sample size, particularly in some exposure categories, limited our capacity to detect small increases in risk, and further larger studies are needed to assess this relation.
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Affiliation(s)
- Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.)
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy;
| | - Carlotta Malagoli
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.)
| | - Sofia Costanzini
- DIEF Department of Engineering “Enzo Ferrari,” University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | | | | | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, 41125 Modena, Italy; (T.F.); (C.M.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Correspondence:
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Dickerson AS, Hansen J, Gredal O, Weisskopf MG. Study of Occupational Chromium, Iron, and Nickel Exposure and Amyotrophic Lateral Sclerosis in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8086. [PMID: 33147887 PMCID: PMC7663552 DOI: 10.3390/ijerph17218086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022]
Abstract
Studies of occupational metal exposures and amyotrophic lateral sclerosis (ALS) have focused primarily on known neurotoxicants, including lead, mercury, selenium, and cadmium. However, these exposures are often co-occurring with other lesser studied metals. We conducted a population-based case-control study with the aim of assessing associations between occupational chromium, iron, and nickel exposures and risk of ALS. We identified ALS cases in Denmark from 1982 through 2013 from the Danish National Patient Registry and matched them to 100 controls based on birth year and sex. Cumulative metal exposures were estimated using job exposure matrices applied to occupational history from the Danish Pension Fund. Although mutually adjusted odds of ALS were higher in men with chromium exposures in the third quartile (aOR = 1.24; 95% CI 0.91, 1.69) and fourth quartile (aOR = 1.19; 95% CI: 0.80, 1.76) compared to those with no exposure, differences did not reach statistical significance. We also observed higher odds of ALS in women with nickel exposures in the third quartile (aOR = 2.21; 95% CI: 1.14, 4.28), but not for the fourth quartile (aOR = 0.61; 95% CI: 0.23, 1.64). Our findings do not suggest associations between occupational exposures to these metals and ALS. However, unavoidable non-differential misclassification from the use of JEMs may have masked truly increased risk.
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Affiliation(s)
- Aisha S. Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark;
| | - Ole Gredal
- National Rehabilitation Center for Neuromuscular Disorders, 8000 Copenhagen, Denmark;
| | - Marc G. Weisskopf
- Departments Epidemiology of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
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Andrew AS, Bradley WG, Peipert D, Butt T, Amoako K, Pioro EP, Tandan R, Novak J, Quick A, Pugar KD, Sawlani K, Katirji B, Hayes TA, Cazzolli P, Gui J, Mehta P, Horton DK, Stommel EW. Risk factors for amyotrophic lateral sclerosis: A regional United States case-control study. Muscle Nerve 2020; 63:52-59. [PMID: 33006184 PMCID: PMC7821307 DOI: 10.1002/mus.27085] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022]
Abstract
Most amyotrophic lateral sclerosis (ALS) cases are considered sporadic, without a known genetic basis, and environmental exposures are thought to play a causal role. To learn more about sporadic ALS etiology, we recruited n = 188 ALS patients from northern New England and Ohio and matched controls 2:1 from the general population of the same regions. Questionnaires evaluated the association between a variety of lifestyle, behavioral (ie, hobbies and activities), and occupational factors and the risk of ALS, including the duration of time between exposure and ALS onset, and exposure frequency. Head trauma was associated with increased ALS risk (adjusted odds ratio [OR] 1.60 95% confidence interval [CI] 1.04‐2.45), with significantly greater effects for injuries occurring 10 or more years prior to symptom onset (P = .037). ALS risk was increased for those reporting severe electrical burns (adjusted OR 2.86, 95% CI 1.37‐6.03), with odds ratios highest for burns after age 30 (OR 3.14), and for burns 10 or more years prior to symptom onset (OR 3.09). Hobbies involving lead were the most strongly associated with ALS risk (adjusted OR 2.92, 95% CI 1.45‐5.91). Exposures to lead 20 or more years prior to diagnosis had larger effect sizes compared to those occurring more recently. Holding a job in mechanics, painting, or construction was associated with ALS. The identification of these specific environmental factors associated with ALS highlight the need for future prospective and laboratory studies to assess causality, biological mechanisms, and find prevention or treatment opportunities.
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Affiliation(s)
| | - Walter G Bradley
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel Peipert
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Tanya Butt
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kwadwo Amoako
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Erik P Pioro
- Center for ALS and Related Disorders, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rup Tandan
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - John Novak
- Ohio Health Physician Group, Westerville, Ohio, USA
| | - Adam Quick
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - K Doug Pugar
- Dayton Center for Neurological Disorders, Dayton, Ohio, USA
| | - Komal Sawlani
- Department of Neurology, University Hospital Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| | - Bashar Katirji
- Department of Neurology, University Hospital Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Jiang Gui
- Department of Biomedical Data Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Paul Mehta
- Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA
| | - D Kevin Horton
- Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, Georgia, USA
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Abstract
Supplemental Digital Content is available in the text Objective: This study updates the mortality experience of over 25,000 workers in a large Canadian petroleum company through December 31, 2006. Methods: Standardized mortality ratios were generated for all-cause and specific cause mortality. Results: All cause and all cancer mortality were favorable compared with the general Canadian population. Cancers of previous interest were largely consistent with expectation. There is a continuing excess of mesothelioma, which is of similar magnitude as the previous update, although based on larger numbers. This excess is mostly attributable to men who died in their 50s and 60s and who worked in the refining sector. Conclusion: Most causes of death show mortality rates lower than the Canadian general population. Given the excess of mesothelioma observed, this study supports ongoing vigilance in asbestos exposure control programs, as refineries continue to remove asbestos from their facilities.
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Su L, Jin Y, Lou H, Chen G. RE: "ASSOCIATIONS OF ELECTRIC SHOCK AND EXTREMELY LOW-FREQUENCY MAGNETIC FIELD EXPOSURE WITH THE RISK OF AMYOTROPHIC LATERAL SCLEROSIS: THE EURO-MOTOR PROJECT". Am J Epidemiol 2019; 188:1753-1759. [PMID: 31150043 DOI: 10.1093/aje/kwz122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Liling Su
- Bioelectromagnetics Laboratory and Department of Reproductive Endocrinology of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Clinical Medicine, Jiangxi Medical College, Shangrao, China
| | - Yumin Jin
- Bioelectromagnetics Laboratory and Department of Reproductive Endocrinology of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Haifeng Lou
- Bioelectromagnetics Laboratory and Department of Reproductive Endocrinology of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guangdi Chen
- Bioelectromagnetics Laboratory and Department of Reproductive Endocrinology of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Visser AE, D'Ovidio F, Peters S, Vermeulen RC, Beghi E, Chiò A, Veldink JH, Logroscino G, Hardiman O, van den Berg LH. Multicentre, population-based, case-control study of particulates, combustion products and amyotrophic lateral sclerosis risk. J Neurol Neurosurg Psychiatry 2019; 90:854-860. [PMID: 30850472 DOI: 10.1136/jnnp-2018-319779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/01/2018] [Accepted: 01/21/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether exposure to particulates and combustion products may explain the association between certain occupations and amyotrophic lateral sclerosis (ALS) risk in a large, multicentre, population-based, case-control study, based on full job histories, using job-exposure matrices, with detailed information on possible confounders. METHODS Population-based patients with ALS and controls were recruited from five registries in the Netherlands, Ireland and Italy. Demographics and data regarding educational level, smoking, alcohol habits and lifetime occupational history were obtained using a validated questionnaire. Using job-exposure matrices, we assessed occupational exposure to silica, asbestos, organic dust, contact with animals or fresh animal products, endotoxins, polycyclic aromatic hydrocarbons and diesel motor exhaust. Multivariate logistic regression models adjusting for confounding factors were used to determine the association between these exposures and ALS risk. RESULTS We included 1557 patients and 2922 controls. Associations were positive for all seven occupational exposures (ORs ranging from 1.13 to 1.73 for high vs never exposed), and significant on the continuous scale for silica, organic dust and diesel motor exhaust (p values for trend ≤0.03). Additional analyses, adding an exposure (one at a time) to the model in the single exposure analysis, revealed a stable OR for silica. We found similar results when patients with a C9orf72 mutation were excluded. CONCLUSION In a large, multicentre study, using harmonised methodology to objectively quantify occupational exposure to particulates and combustion products, we found an association between ALS risk and exposure to silica, independent of the other occupational exposures studied.
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Affiliation(s)
- Anne E Visser
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Fabrizio D'Ovidio
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Susan Peters
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.,Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Roel Ch Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Adriano Chiò
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Jan H Veldink
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Giancarlo Logroscino
- Unit of Neurodegenerative Diseases, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', Pia Fondazione Cardinale G Panico, Lecce, Italy.,Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Leonard H van den Berg
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
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Risk Factors and Emerging Therapies in Amyotrophic Lateral Sclerosis. Int J Mol Sci 2019; 20:ijms20112616. [PMID: 31141951 PMCID: PMC6600314 DOI: 10.3390/ijms20112616] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal progressive neurodegenerative disease characterized by a permanent degeneration of both upper and lower motor neurons. Many different genes and pathophysiological processes contribute to this disease, however its exact cause remains unclear. Therefore, it is necessary to understand this heterogeneity to find effective treatments. In this review, we focus on selected environmental and genetic risk factors predisposing to ALS and highlight emerging treatments in ALS therapy. Of numerous defective genes associated with ALS, we focus on four principal genes that have been identified as definite causes of ALS: the SOD1 gene, C9orf72, TDP-43, as well as the recently identified TBK1. We also provide up-to-date information on selected environmental factors that have historically been considered as key players in ALS development and pathogenesis. In parallel to our survey of known risk factors, we also discuss emerging ALS stem cell therapies and experimental medicines currently undergoing phase II and III clinical trials.
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Korner S, Kammeyer J, Zapf A, Kuzma-Kozakiewicz M, Piotrkiewicz M, Kuraszkiewicz B, Goszczynska H, Gromicho M, Grosskreutz J, Andersen PM, de Carvalho M, Petri S. Influence of Environment and Lifestyle on Incidence and Progress of Amyotrophic Lateral Sclerosis in A German ALS Population. Aging Dis 2019; 10:205-216. [PMID: 31011473 PMCID: PMC6457054 DOI: 10.14336/ad.2018.0327] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease mainly affecting upper and lower motor neurons in the brain and spinal cord. Pathogenesis of ALS is still unclear, and a multifactorial etiology is presumed. The remarkable clinical heterogeneity between different phenotypes of ALS patients suggests that environmental and lifestyle factors could play a role in onset and progression of ALS. We analyzed a cohort of 117 ALS patients and 93 controls. ALS patients and controls were compared regarding physical activity, dietary habits, smoking, residential environment, potentially toxic environmental factors and profession before symptom onset and throughout the disease course. Data were collected by a personal interview. For statistical analysis descriptive statistics, statistical tests and analysis of variance were used. ALS patients and controls did not differ regarding smoking, diet and extent of physical training. No higher frequency of toxic influences could be detected in the ALS group. ALS patients lived in rural environment considerably more often than the control persons, but this was not associated with a higher percentage of occupation in agriculture. There was also a higher percentage of university graduates in the ALS group. Patients with bulbar onset were considerably more often born in an urban environment as compared to spinal onset. Apart from education and environment, ALS phenotypes did not differ in any investigated environmental or life-style factor. The rate of disease progression was not influenced by any of the investigated environmental and life-style factors. The present study could not identify any dietary habit, smoking, physical activity, occupational factor as well as toxic influences as risk factor or protective factor for onset or progression of ALS. Living in rural environment and higher education might be associated with higher incidence of ALS.
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Affiliation(s)
- Sonja Korner
- 1Department of Neurology, Hannover Medical School, Germany
| | | | - Antonia Zapf
- 2Department of Medical Statistics, University Medical Center Göttingen Germany
| | | | - Maria Piotrkiewicz
- 4Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Bożenna Kuraszkiewicz
- 4Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Hanna Goszczynska
- 4Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Marta Gromicho
- 5Institute of Physiology-Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal
| | | | - Peter M Andersen
- 7Department of Pharmacology and Clinical Neuroscience, Umea University, Sweden
| | - Mamede de Carvalho
- 5Institute of Physiology-Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal
| | - Susanne Petri
- 1Department of Neurology, Hannover Medical School, Germany.,8Center for Systems Neuroscience (ZSN), Hannover, Germany
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Chen GX, ’t Mannetje AM, Douwes J, van den Berg L, Pearce N, Kromhout H, D’Souza W, McConnell M, Glass B, Brewer N, McLean DJ. Occupation and motor neuron disease: a New Zealand case–control study. Occup Environ Med 2019; 76:309-316. [DOI: 10.1136/oemed-2018-105605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
ObjectivesTo assess associations between occupation and motor neuron disease (MND).MethodsWe conducted a population-based case–control study with cases (n=321) recruited through the New Zealand Motor Neurone Disease Association and hospital discharge data. Controls (n=605) were recruited from the Electoral Roll. Information on personal and demographic details, lifestyle factors and a full occupational history was collected using questionnaires and interviews. Associations with ever/never employed and employment duration were estimated using logistic regression stratified by sex and adjusted for age, ethnicity, socioeconomic deprivation, education and smoking.ResultsElevated risks were observed for field crop and vegetable growers (OR 2.93, 95% CI 1.10 to 7.77); fruit growers (OR 2.03, 95% CI 1.09 to 3.78); gardeners and nursery growers (OR 1.96, 95% CI 1.01 to 3.82); crop and livestock producers (OR 3.61, 95% CI 1.44 to 9.02); fishery workers, hunters and trappers (OR 5.62, 95% CI 1.27 to 24.97); builders (OR 2.90, 95% CI 1.41 to 5.96); electricians (OR 3.61, 95% CI 1.34 to 9.74); caregivers (OR 2.65, 95% CI 1.04 to 6.79); forecourt attendants (OR 8.31, 95% CI 1.79 to 38.54); plant and machine operators and assemblers (OR 1.42, 95% CI 1.01 to 2.01); telecommunications technicians (OR 4.2, 95% CI 1.20 to 14.64); and draughting technicians (OR 3.02, 95% CI 1.07 to 8.53). Industries with increased risks were agriculture (particularly horticulture and fruit growing), construction, non-residential care services, motor vehicle retailing, and sport and recreation. Positive associations between employment duration and MND were shown for the occupations fruit growers, gardeners and nursery growers, and crop and livestock producers, and for the horticulture and fruit growing industry.ConclusionsThis study suggests associations between MND and occupations in agriculture and several other occupations.
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Gunnarsson LG, Bodin L. Occupational Exposures and Neurodegenerative Diseases-A Systematic Literature Review and Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030337. [PMID: 30691095 PMCID: PMC6388365 DOI: 10.3390/ijerph16030337] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
Abstract
Objectives: To carry out an integrated and stratified meta-analysis on occupational exposure to electromagnetic fields (EMFs), metals and pesticides and its effects on amyotrophic lateral sclerosis (ALS) and Parkinson's and Alzheimer's disease, and investigate the possibility of publication bias. Methods: In the current study, we updated our recently published meta-analyses on occupational exposures in relation to ALS, Alzheimer's and Parkinson's disease. Based on 66 original publications of good scientific epidemiological standard, according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines, we analysed subgroups by carrying out stratified meta-analyses on publication year, statistical precision of the relative risk (RR) estimates, inspection of the funnel plots and test of bias. Results: Based on 19 studies the weighted RR for occupational exposure to EMFs was 1.26 (95% confidence interval (CI) 1.07⁻1.50) for ALS, 1.33 (95% CI 1.07⁻1.64) for Alzheimer's disease and 1.02 (95% CI 0.83⁻1.26) for Parkinson's disease. Thirty-one studies concerned occupational exposure to pesticides and the weighted RR was 1.35 (95% CI 1.02⁻1.79) for ALS, 1.50 (95% CI 0.98⁻2.29) for Alzheimer's disease and 1.66 (95% CI 1.42⁻1.94) for Parkinson's disease. Finally, 14 studies concerned occupational exposure to metals and only exposure to lead (five studies) involved an elevated risk for ALS or Parkinson's disease and the weighted RR was 1.57 (95% CI 1.11⁻2.20). The weighted RR for all the non-lead exposures was 0.97 (95% CI 0.88⁻1.06). Conclusions: Exposure to pesticides increased the risk of getting the mentioned neurodegenerative diseases by at least 50%. Exposure to lead was only studied for ALS and Parkinson's disease and involved 50% increased risk. Occupational exposure to EMFs seemed to involve some 10% increase in risk for ALS and Alzheimer's disease only.
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Affiliation(s)
- Lars-Gunnar Gunnarsson
- Department of Occupational and Environmental Medicine, School of Medicine, Örebro University, 701 82 Örebro, Sweden.
| | - Lennart Bodin
- Department of Statistics, Örebro University, 701 82 Örebro, Sweden.
- Institute of Environmental Medicine, Karolinska Institute, SE 177 77 Stockholm, Sweden.
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15
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Mortality by cause of death and risk behaviors in farmers versus non-farmers: the importance of avoiding the healthy worker effect. Int Arch Occup Environ Health 2019; 92:599-608. [DOI: 10.1007/s00420-018-1396-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 12/13/2018] [Indexed: 12/13/2022]
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16
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Gunnarsson LG, Bodin L. Amyotrophic Lateral Sclerosis and Occupational Exposures: A Systematic Literature Review and Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112371. [PMID: 30373166 PMCID: PMC6265680 DOI: 10.3390/ijerph15112371] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 11/16/2022]
Abstract
Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of occupational risk factors for amyotrophic lateral sclerosis (ALS). Methods: We identified 79 original publications on associations between work and ALS. The MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines were used to ensure high scientific quality, and reliable protocols were applied to classify the articles. Thirty-seven articles fulfilled good scientific standards, while 42 were methodologically deficient and thus were excluded from our meta-analyses. Results: The weighted relative risks for the various occupational exposures were respectively; 1.29 (95% confidence interval (CI): 0.97–1.72; six articles) for heavy physical work, 3.98 (95% CI: 2.04–7.77; three articles) for professional sports, 1.45 (95% CI: 1.07–1.96; six articles) for metals, 1.19 (95% CI: 1.07–1.33; 10 articles) for chemicals, 1.18 (95% CI: 1.07–1.31; 16 articles) for electromagnetic fields or working with electricity, and 1.18 (95% CI: 1.05–1.34; four articles) for working as a nurse or physician. Conclusions: Meta-analyses based only on epidemiologic publications of good scientific quality show that the risk of ALS is statistically significantly elevated for occupational exposures to excessive physical work, chemicals (especially pesticides), metals (especially lead), and possibly also to electromagnetic fields and health care work. These results are not explained by publication bias.
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Affiliation(s)
- Lars-Gunnar Gunnarsson
- School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.
- Department of Occupational and Environmental Medicine, Örebro University, SE 701 82 Örebro, Sweden.
| | - Lennart Bodin
- Department of Statistics, Örebro University, SE 701 82 Örebro, Sweden.
- Institute of Environmental Medicine, Karolinska Institute, SE 177 77 Stockholm, Sweden.
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Dickerson AS, Hansen J, Gredal O, Weisskopf MG. Amyotrophic Lateral Sclerosis and Exposure to Diesel Exhaust in a Danish Cohort. Am J Epidemiol 2018; 187:1613-1622. [PMID: 29590300 DOI: 10.1093/aje/kwy069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/20/2018] [Indexed: 12/12/2022] Open
Abstract
Previous studies have suggested an increased risk of amyotrophic lateral sclerosis (ALS) and other motor neuron diseases for persons in occupations commonly involving exposure to diesel exhaust (DE). In this study, we investigated the association between occupational exposure to DE and odds of ALS. ALS cases were identified from the Danish National Patient Registry (1982-2013) and individually matched to 100 controls per case on the basis of birth year and sex. Using information on occupational history from 1964 onward obtained from the Danish Pension Fund, we estimated cumulative DE exposures using a job exposure matrix. We evaluated associations using conditional logistic regression analyses and stratified the analyses by sex. Using a 10-year lag period, DE exposure was positively associated with ALS among men who had ever been exposed (adjusted odds ratio (aOR) = 1.20, 95% confidence interval (CI): 1.05, 1.38). For men with greater than 50% probability of DE exposure, we observed a positive association between ALS and highest-quartile exposure during the 5-year (aOR = 1.35, 95% CI: 1.07, 1.70) and 10-year (aOR = 1.41, 95% CI: 1.11, 1.79) lag periods. Our study suggests an association between consistently higher exposures to DE and ALS in men, but not in women. These findings support previous reports of associations between ALS and occupations commonly involving DE exposure.
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Affiliation(s)
- Aisha S Dickerson
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ole Gredal
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marc G Weisskopf
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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18
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Dickerson AS, Hansen J, Kioumourtzoglou MA, Specht AJ, Gredal O, Weisskopf MG. Study of occupation and amyotrophic lateral sclerosis in a Danish cohort. Occup Environ Med 2018; 75:630-638. [PMID: 29941657 DOI: 10.1136/oemed-2018-105110] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Several manuscripts have proposed associations between amyotrophic lateral sclerosis (ALS) and occupational toxicant exposures-not to mention physical activity and trauma/injury. Some have also reported associations in investigations of specific occupations. Using data from a prospective Danish cohort study, we investigated the association between employment in certain industries and ALS diagnosis. METHODS We identified 1826 ALS cases who were 25 years old or less in 1964 and diagnosed from 1982 to 2013 from the Danish National Patient Registry then matched 100 population controls to each case based on birth year and sex. Demographic data were linked to the Danish Pension Fund to determine occupation history. Conditional logistic regression models were adjusted for socioeconomic status, marital status and residential location at the index date. RESULTS There was an increase in odds of ALS among men who worked in agriculture, hunting, forestry or fishing (adjusted OR (aOR)=1.21; 95% CI 1.02 to 1.45). There was also a positive association for men employed in construction (aOR=1.21; 95% CI 1.05 to 1.39). In women, a protective association was seen with employment in the cleaning industry (aOR=0.69; 95% CI 0.52 to 0.93). CONCLUSIONS Our study shows various occupations with exposure to toxicants, such as diesel exhaust and lead, and strenuous physical activity associated with increased odds of ALS in men. Future studies should have a particular focus on gathering detailed information on physical exertion and toxicant exposures specific to certain job tasks.
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Affiliation(s)
- Aisha S Dickerson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Johnni Hansen
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | | | - Aaron J Specht
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ole Gredal
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Kab S, Moisan F, Elbaz A. Farming and incidence of motor neuron disease: French nationwide study. Eur J Neurol 2017; 24:1191-1195. [DOI: 10.1111/ene.13353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. Kab
- Santé publique France; Saint-Maurice
- Université Paris-Sud; UVSQ; CESP; INSERM, Université Paris-Saclay; Villejuif France
| | - F. Moisan
- Université Paris-Sud; UVSQ; CESP; INSERM, Université Paris-Saclay; Villejuif France
| | - A. Elbaz
- Santé publique France; Saint-Maurice
- Université Paris-Sud; UVSQ; CESP; INSERM, Université Paris-Saclay; Villejuif France
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20
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Wang MD, Little J, Gomes J, Cashman NR, Krewski D. Identification of risk factors associated with onset and progression of amyotrophic lateral sclerosis using systematic review and meta-analysis. Neurotoxicology 2017; 61:101-130. [DOI: 10.1016/j.neuro.2016.06.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
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21
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Bradley WG, Miller RX, Levine TD, Stommel EW, Cox PA. Studies of Environmental Risk Factors in Amyotrophic Lateral Sclerosis (ALS) and a Phase I Clinical Trial of l-Serine. Neurotox Res 2017; 33:192-198. [DOI: 10.1007/s12640-017-9741-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/25/2017] [Accepted: 04/21/2017] [Indexed: 12/12/2022]
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22
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D’Ovidio F, d’Errico A, Calvo A, Costa G, Chiò A. Occupations and amyotrophic lateral sclerosis: are jobs exposed to the general public at higher risk? Eur J Public Health 2017; 27:643-647. [DOI: 10.1093/eurpub/ckx006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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23
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Andrew AS, Caller TA, Tandan R, Duell EJ, Henegan PL, Field NC, Bradley WG, Stommel EW. Environmental and Occupational Exposures and Amyotrophic Lateral Sclerosis in New England. NEURODEGENER DIS 2017; 17:110-116. [PMID: 28122372 DOI: 10.1159/000453359] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/10/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent data provide support for the concept that potentially modifiable exposures are responsible for sporadic amyotrophic lateral sclerosis (ALS). OBJECTIVE To evaluate environmental and occupational exposures as risk factors for sporadic ALS. METHODS We performed a case-control study of ALS among residents of New England, USA. The analysis compared questionnaire responses from 295 patients with a confirmed ALS diagnosis to those of 225 controls without neurodegenerative illness. RESULTS Self-reported job- or hobby-related exposure to one or more chemicals, such as pesticides, solvents, or heavy metals, increased the risk of ALS (adjusted OR 2.51; 95% CI 1.64-3.89). Industries with a higher toxicant exposure potential (construction, manufacturing, mechanical, military, or painting) were associated with an elevated occupational risk (adjusted OR 3.95; 95% CI 2.04-8.30). We also identified increases in the risk of ALS associated with frequent participation in water sports, particularly waterskiing (adjusted OR 3.89; 95% CI 1.97-8.44). Occupation and waterskiing both retained independent statistical significance in a composite model containing age, gender, and smoking status. CONCLUSIONS Our study contributes to a growing body of literature implicating occupational- and hobby-related toxicant exposures in ALS etiology. These epidemiologic study results also provide motivation for future evaluation of water-body-related risk factors.
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Affiliation(s)
- Angeline S Andrew
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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24
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Roberts AL, Johnson NJ, Chen JT, Cudkowicz ME, Weisskopf MG. Race/ethnicity, socioeconomic status, and ALS mortality in the United States. Neurology 2016; 87:2300-2308. [PMID: 27742817 PMCID: PMC5135021 DOI: 10.1212/wnl.0000000000003298] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/16/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine whether race/ethnicity and socioeconomic status are associated with amyotrophic lateral sclerosis (ALS) mortality in the United States. METHODS The National Longitudinal Mortality Study (NLMS), a United States-representative, multistage sample, collected race/ethnicity and socioeconomic data prospectively. Mortality information was obtained by matching NLMS records to the National Death Index (1979-2011). More than 2 million persons (n = 1,145,368 women, n = 1,011,172 men) were included, with 33,024,881 person-years of follow-up (1,299 ALS deaths , response rate 96%). Race/ethnicity was by self-report in 4 categories. Hazard ratios (HRs) for ALS mortality were calculated for race/ethnicity and socioeconomic status separately and in mutually adjusted models. RESULTS Minority vs white race/ethnicity predicted lower ALS mortality in models adjusted for socioeconomic status, type of health insurance, and birthplace (non-Hispanic black, HR 0.61, 95% confidence interval [CI] 0.48-0.78; Hispanic, HR 0.64, 95% CI 0.46-0.88; other races, non-Hispanic, HR 0.52, 95% CI 0.31-0.86). Higher educational attainment compared with < high school was in general associated with higher rate of ALS (high school, HR 1.23, 95% CI 1.07-1.42; some college, HR 1.24, 95% CI 1.04-1.48; college, HR 1.10, 95% CI 0.90-1.36; postgraduate, HR 1.31, 95% CI 1.06-1.62). Income, household poverty, and home ownership were not associated with ALS after adjustment for race/ethnicity. Rates did not differ by sex. CONCLUSION Higher rate of ALS among whites vs non-Hispanic blacks, Hispanics, and non-Hispanic other races was not accounted for by multiple measures of socioeconomic status, birthplace, or type of health insurance. Higher rate of ALS among whites likely reflects actual higher risk of ALS rather than ascertainment bias or effects of socioeconomic status on ALS risk.
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Affiliation(s)
- Andrea L Roberts
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston.
| | - Norman J Johnson
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston
| | - Jarvis T Chen
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston
| | - Merit E Cudkowicz
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston
| | - Marc G Weisskopf
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston
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25
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Peters TL, Kamel F, Lundholm C, Feychting M, Weibull CE, Sandler DP, Wiebert P, Sparén P, Ye W, Fang F. Occupational exposures and the risk of amyotrophic lateral sclerosis. Occup Environ Med 2016; 74:87-92. [PMID: 27418175 DOI: 10.1136/oemed-2016-103700] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/23/2016] [Accepted: 07/01/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the associations of specific occupations and occupational exposures with the risk of amyotrophic lateral sclerosis (ALS) in the Swedish population. METHODS A nested case-control study was conducted in Sweden. Patients with ALS diagnosed during 1991-2010 (n=5020) were identified from the National Patient Register and 5 controls per case (n=25 100) were randomly selected from the general Swedish population, individually matched to cases by birth year and sex. Occupational history was obtained from the Swedish censuses in 1970, 1980 and 1990. The Nordic Occupational Cancer Study Job Exposure Matrix was used to identify exposures related to individual occupations. Conditional logistic regression was used to estimate ORs and their 95% CIs. RESULTS Higher risk of ALS was associated with precision-tool manufacturing (OR 1.68, 95% CI 1.11 to 2.52) and glass, pottery and tile work (OR 1.76, 95% CI 1.03 to 3.00), whereas lower risk was associated with textile work (OR 0.44, 95% CI 0.21 to 0.91). None of the examined occupational exposures were associated with ALS risk overall. However, among individuals younger than 65 years of age, an association with a higher risk of ALS was found for formaldehyde (OR 1.29, 95% CI 1.00 to 1.65), and an association with a lower risk of ALS was found for methylene chloride (OR 0.49, 95% CI 0.26 to 0.93). CONCLUSIONS We identified several occupations and occupational exposures that may be associated with the risk of ALS in Sweden. Occupational history obtained from censuses every 10 years remains a limitation of the study.
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Affiliation(s)
- Tracy L Peters
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Freya Kamel
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Caroline E Weibull
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Pernilla Wiebert
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Lacorte E, Ferrigno L, Leoncini E, Corbo M, Boccia S, Vanacore N. Physical activity, and physical activity related to sports, leisure and occupational activity as risk factors for ALS: A systematic review. Neurosci Biobehav Rev 2016; 66:61-79. [PMID: 27108217 DOI: 10.1016/j.neubiorev.2016.04.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is considered a multifactorial, multisystem neurodegenerative disease due to an interaction between environmental and genetic factors. This systematic review aims at gathering all available evidence on the association between physical activity (PA) and the risk of ALS. METHODS Relevant literature published up to January 2015 was gathered through structured searches on Medline, The Cochrane Library, and the ISI Web of Science databases. Studies considering any type of PA as the main exposure and a diagnosis of ALS or motor neuron disease were selected. Data were extracted in standardized forms, and the quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Bibliographic searches yielded 3168 records. Nineteen case control studies and 7 cohort studies met the inclusion criteria, and were included in the analysis. Evidence on cumulative measures of PA as a risk factor for ALS remain inconclusive. However, cohort studies report a significantly higher number of cases of ALS in professional soccer and American football players, and a slightly increased risk of ALS in varsity athletes.
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Affiliation(s)
- Eleonora Lacorte
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, via Giano della Bella 34, 00162 Rome, Italy.
| | - Luigina Ferrigno
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, via Giano della Bella 34, 00162 Rome, Italy.
| | - Emanuele Leoncini
- Institute of Public Health, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Via Giuseppe Dezza, 48, 20144, Milan, Italy.
| | - Stefania Boccia
- Institute of Public Health, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
| | - Nicola Vanacore
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, via Giano della Bella 34, 00162 Rome, Italy.
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Eaglehouse YL, Talbott EO, Chang Y, Kuller LH. Participation in Physical Activity and Risk for Amyotrophic Lateral Sclerosis Mortality Among Postmenopausal Women. JAMA Neurol 2016; 73:329-36. [PMID: 26783702 PMCID: PMC6044440 DOI: 10.1001/jamaneurol.2015.4487] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Amyotrophic lateral sclerosis (ALS) is a progressive, fatal disease with no known cause. Case studies primarily of athletes and several case-control studies have suggested that high levels of strenuous physical activity (PA) may increase the risk for ALS. This relationship has yet to be evaluated among women in population-based cohort studies. OBJECTIVE To evaluate the relationship between PA and risk for ALS mortality in a large cohort of postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS The Women's Health Initiative (WHI) enrolled 161 809 postmenopausal women, aged 50 to 79 years (mean [SD] age, 63.6 [7.24] years), between 1993 and 1998 into either a clinical trial or an observational study at 40 clinical research centers across the United States. We conducted a cohort study from November 2014 to September 2015 using baseline and mortality data during an average of 9.6 years of follow-up from the entire WHI cohort, through September 1, 2013 (with 1.1% lost to follow-up), to address whether there is a relationship between PA and ALS mortality. EXPOSURES The WHI assessed frequency and duration of mild, moderate, and strenuous PA at baseline via self-administered questionnaire. MAIN OUTCOMES AND MEASURES Underlying cause of death from ALS collected from death certificates. RESULTS The WHI enrolled 161 809 women, of whom 165 died of ALS; women who died of ALS were older (median age, 66 years; interquartile range, 61-69 years) compared with the total WHI study population (median age, 63 years; interquartile range, 57-69 years). Age-adjusted ALS mortality rates varied from 7.4 (95% CI, 5.5-9.9)/100 000 person-years for no strenuous PA to 10.6 (95% CI, 5.6-20.0)/100 000 person-years for strenuous PA 3 or more days per week (P = .07). Adjusted for age and body mass index (calculated as weight in kilograms divided by height in meters squared), the odds ratio for death from ALS for participants with strenuous PA 3 or more days per week compared with no reported strenuous PA was 1.56 (95% CI, 1.02-2.37; P = .04). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first cohort study to report an increased risk for ALS mortality associated with strenuous PA in postmenopausal women. The association between strenuous PA and ALS risk observed does not compromise the overall benefit of strenuous PA for total mortality, coronary heart disease, and breast cancer reported in other WHI investigations, but it may provide an important clue to the etiology of ALS, if replicated by other studies.
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Affiliation(s)
- Yvonne L Eaglehouse
- Division of Cancer Prevention and Population Science, Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania2Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Evelyn O Talbott
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yuefang Chang
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Malek AM, Barchowsky A, Bowser R, Heiman-Patterson T, Lacomis D, Rana S, Talbott EO. Exposure to hazardous air pollutants and the risk of amyotrophic lateral sclerosis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2015; 197:181-186. [PMID: 25544309 DOI: 10.1016/j.envpol.2014.12.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/01/2014] [Accepted: 12/06/2014] [Indexed: 05/11/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a serious and rapidly fatal neurodegenerative disorder with an annual incidence of 1-2.6/100,000 persons. Few known risk factors exist although gene-environment interaction is suspected. We investigated the relationship between suspected neurotoxicant hazardous air pollutants (HAPs) exposure and ALS. METHODS A case-control study involving sporadic ALS cases (n = 51) and matched controls (n = 51) was conducted from 2008 to 2011. Geocoded residential addresses were linked to U.S. EPA NATA data (1999, 2002, and 2005) by census tract. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. RESULTS Residential exposure to aromatic solvents significantly elevated the risk of ALS among cases compared to controls in 2002 (OR = 5.03, 95% CI: 1.29, 19.53) and 1999 (OR = 4.27, 95% CI: 1.09, 16.79) following adjustment for education, smoking, and other exposure groups. Metals, pesticides, and other HAPs were not associated with ALS. CONCLUSIONS A potential relationship is suggested between residential ambient air aromatic solvent exposure and risk of ALS in this study.
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Affiliation(s)
- Angela M Malek
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Aaron Barchowsky
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15219, USA.
| | - Robert Bowser
- Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA; Division of Neurobiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA.
| | - Terry Heiman-Patterson
- Department of Neurology, College of Medicine, Drexel University, Philadelphia, PA, 19107, USA.
| | - David Lacomis
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Sandeep Rana
- Department of Neurology, School of Medicine, Temple University, Philadelphia, PA, 19122, USA.
| | - Evelyn O Talbott
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
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Vergara X, Mezei G, Kheifets L. Case-control study of occupational exposure to electric shocks and magnetic fields and mortality from amyotrophic lateral sclerosis in the US, 1991-1999. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:65-71. [PMID: 24917188 DOI: 10.1038/jes.2014.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/10/2014] [Accepted: 04/15/2014] [Indexed: 06/03/2023]
Abstract
We investigated the relationship between occupational exposure to electric shocks (ES) and magnetic fields (MF) and amyotrophic lateral sclerosis (ALS) using 1991-1999 US mortality data. For each of the 5886 included ALS deaths, 10 controls-matched on sex-, age-, year- and region-were selected from among other deaths. Usual occupation as reported on death certificates was linked to job-exposure matrices for ES and MF. Education and electric occupations were associated with moderately increased ALS risks (odds ratio (OR)=1.85, 95% confidence interval (CI)=1.67, 2.04; OR=1.23, 95% CI=1.04, 1.47, respectively). For ES, ALS mortality OR were 0.73 (95% CI=0.67, 0.79) for high and 0.90 (95% CI=0.84, 0.97) for medium exposure compared with low exposure. For MF, ALS ORs were 1.09 (95% CI=1.00, 1.19) for high and 1.09 (95% CI=0.96, 1.23) for medium exposure as compared with low exposure. For electric occupations, ALS ORs were insensitive to adjustments for ES, MF or both. Consistent with previous publications, an association between electric occupations and ALS was observed. Findings do not support occupational exposure to ES or MF as an explanation.
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Affiliation(s)
- Ximena Vergara
- Department of Environment Sector, Electric Power Research Institute (EPRI), Palo Alto, California, USA
| | - Gabor Mezei
- Department of Environment Sector, Electric Power Research Institute (EPRI), Palo Alto, California, USA
| | - Leeka Kheifets
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, California, USA
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Delzor A, Couratier P, Boumédiène F, Nicol M, Druet-Cabanac M, Paraf F, Méjean A, Ploux O, Leleu JP, Brient L, Lengronne M, Pichon V, Combès A, El Abdellaoui S, Bonneterre V, Lagrange E, Besson G, Bicout DJ, Boutonnat J, Camu W, Pageot N, Juntas-Morales R, Rigau V, Masseret E, Abadie E, Preux PM, Marin B. Searching for a link between the L-BMAA neurotoxin and amyotrophic lateral sclerosis: a study protocol of the French BMAALS programme. BMJ Open 2014; 4:e005528. [PMID: 25180055 PMCID: PMC4156816 DOI: 10.1136/bmjopen-2014-005528] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is the most common motor neurone disease. It occurs in two forms: (1) familial cases, for which several genes have been identified and (2) sporadic cases, for which various hypotheses have been formulated. Notably, the β-N-methylamino-L-alanine (L-BMAA) toxin has been postulated to be involved in the occurrence of sporadic ALS. The objective of the French BMAALS programme is to study the putative link between L-BMAA and ALS. METHODS AND ANALYSIS The programme covers the period from 1 January 2003 to 31 December 2011. Using multiple sources of ascertainment, all the incident ALS cases diagnosed during this period in the area under study (10 counties spread over three French regions) were collected. First, the standardised incidence ratio will be calculated for each municipality under concern. Then, by applying spatial clustering techniques, overincidence and underincidence zones of ALS will be sought. A case-control study, in the subpopulation living in the identified areas, will gather information about patients' occupations, leisure activities and lifestyle habits in order to assess potential risk factors to which they are or have been exposed. Specimens of drinking water, food and biological material (brain tissue) will be examined to assess the presence of L-BMAA in the environment and tissues of ALS cases and controls. ETHICS AND DISSEMINATION The study has been reviewed and approved by the French ethical committee of the CPP SOOM IV (Comité de Protection des Personnes Sud-Ouest & Outre-Mer IV). The results will be published in peer-reviewed journals and presented at national and international conferences.
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Affiliation(s)
- Aurélie Delzor
- Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France
| | - Philippe Couratier
- Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France
- Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France
| | - Farid Boumédiène
- Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France
| | - Marie Nicol
- Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France
- Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France
| | - Michel Druet-Cabanac
- Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France
- Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France
| | - François Paraf
- Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France
| | - Annick Méjean
- Interdisciplinary Laboratory for Tomorrow's Energy Pack (LIED), CNRS UMR 8236, University Paris Diderot-Paris 7, Paris, France
| | - Olivier Ploux
- Interdisciplinary Laboratory for Tomorrow's Energy Pack (LIED), CNRS UMR 8236, University Paris Diderot-Paris 7, Paris, France
| | - Jean-Philippe Leleu
- Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France
| | - Luc Brient
- UMR 6553 ECOBIO, Ecosystems—Biodiversity—Evolution, University Rennes I, Rennes, France
| | - Marion Lengronne
- UMR 6553 ECOBIO, Ecosystems—Biodiversity—Evolution, University Rennes I, Rennes, France
| | - Valérie Pichon
- Department of Analytical, Bioanalytical Sciences and Miniaturization (LSABM), UMR ESPCI-ParisTech-CNRS 8231 CBI, Paris, France
- University Sorbonne, University Pierre and Marie Curie (UPMC), Paris, France
| | - Audrey Combès
- Department of Analytical, Bioanalytical Sciences and Miniaturization (LSABM), UMR ESPCI-ParisTech-CNRS 8231 CBI, Paris, France
- University Sorbonne, University Pierre and Marie Curie (UPMC), Paris, France
| | - Saïda El Abdellaoui
- Department of Analytical, Bioanalytical Sciences and Miniaturization (LSABM), UMR ESPCI-ParisTech-CNRS 8231 CBI, Paris, France
- University Sorbonne, University Pierre and Marie Curie (UPMC), Paris, France
| | - Vincent Bonneterre
- Environment and Health Prediction in Populations (EPSP), CNRS-TIMC-IMAG UMR 5525 UJF-Grenoble 1, Grenoble, France
| | - Emmeline Lagrange
- Department of Neurology, University Hospital of Grenoble, Grenoble, France
| | - Gérard Besson
- Department of Neurology, University Hospital of Grenoble, Grenoble, France
| | - Dominique J Bicout
- Environment and Health Prediction in Populations (EPSP), CNRS-TIMC-IMAG UMR 5525 UJF-Grenoble 1, Grenoble, France
- Biomathematics and Epidemiology, Environment and Health Prediction in Populations (EPSP), VetAgro Sup, Marcy-l'Etoile, France
| | - Jean Boutonnat
- Department of Neurology, University Hospital of Grenoble, Grenoble, France
| | - William Camu
- Motoneuron Diseases: Neuroinflammation and Therapy, INSERM UMR 1051, Neurosciences Institute, Montpellier, France
- Department of Neurology, ALS Center, University Hospital Gui de Chauliac, Montpellier, France
| | - Nicolas Pageot
- Motoneuron Diseases: Neuroinflammation and Therapy, INSERM UMR 1051, Neurosciences Institute, Montpellier, France
- Department of Neurology, ALS Center, University Hospital Gui de Chauliac, Montpellier, France
| | - Raul Juntas-Morales
- Motoneuron Diseases: Neuroinflammation and Therapy, INSERM UMR 1051, Neurosciences Institute, Montpellier, France
- Department of Neurology, ALS Center, University Hospital Gui de Chauliac, Montpellier, France
| | - Valérie Rigau
- Motoneuron Diseases: Neuroinflammation and Therapy, INSERM UMR 1051, Neurosciences Institute, Montpellier, France
- Department of Neurology, ALS Center, University Hospital Gui de Chauliac, Montpellier, France
| | - Estelle Masseret
- UMR 5119 ECOSYM, Ecology of Coastal Marine Systems, UM2-CNRS-IRD-Ifremer-UM1, University Montpellier II, Montpellier, France
| | - Eric Abadie
- Environment Resources Laboratory/Languedoc-Roussillon, Ifremer, Sète, France
| | - Pierre-Marie Preux
- Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France
- Department of Neurology, ALS Center, University Hospital Dupuytren, Limoges, France
| | - Benoît Marin
- Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
- University of Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France
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Hamidou B, Couratier P, Besançon C, Nicol M, Preux PM, Marin B. Epidemiological evidence that physical activity is not a risk factor for ALS. Eur J Epidemiol 2014; 29:459-75. [PMID: 24986107 DOI: 10.1007/s10654-014-9923-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/26/2014] [Indexed: 12/13/2022]
Abstract
To elucidate whether physical activity (PA) and sport increase the risk of developing amyotrophic lateral sclerosis (ALS), a literature review of epidemiological studies was conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines. Six databases (Pubmed, Scopus, ScienceDirect, IngentaConnect, Refdoc and the Cochrane database) were searched to April 2014. Experts were asked to identify studies in press. Studies of interest were examined for their level of evidence and synthetized using Armon's classification for exogenous risk factors for ALS. Of 37 epidemiological works included in the review, two (5.5%) provided class I evidence, and five (13.5%) class II. Others offered evidence of class III (n = 8, 21.6%), IV (n = 16, 43.2%) and V (n = 6, 16.2%). Results were stratified according to type of exposure: (1) PA related to sport and work (n = 14), (2) soccer and American football (n = 9), (3) occupation (n = 12), (4) proxies of PA (n = 2). Among articles which considered "PA related to sport and work", two class I studies and one class II study concluded that PA is not a risk factor for ALS. This evidence establishes (level A) that PA is not a risk factor for ALS. As regards "occupational related activity" a level of evidence of U was obtained (it is unknown whether the professional category "physical worker" is a risk factor for ALS). Football/soccer may be considered as a possible risk factor for ALS (level C) and there is a need for further research taking into account the numerous confounding factors that may arise in this field.
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Affiliation(s)
- Bello Hamidou
- INSERM UMR1094, Tropical Neuroepidemiology, Faculté de Médecine, 2 rue du Dr Marcland, 87025, Limoges Cedex, France
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Yu Y, Su FC, Callaghan BC, Goutman SA, Batterman SA, Feldman EL. Environmental risk factors and amyotrophic lateral sclerosis (ALS): a case-control study of ALS in Michigan. PLoS One 2014; 9:e101186. [PMID: 24979055 PMCID: PMC4076303 DOI: 10.1371/journal.pone.0101186] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/02/2014] [Indexed: 11/18/2022] Open
Abstract
An interim report of a case-control study was conducted to explore the role of environmental factors in the development of amyotrophic lateral sclerosis (ALS). Sixty-six cases and 66 age- and gender-matched controls were recruited. Detailed information regarding residence history, occupational history, smoking, physical activity, and other factors was obtained using questionnaires. The association of ALS with potential risk factors, including smoking, physical activity and chemical exposure, was investigated using conditional logistic regression models. As compared to controls, a greater number of our randomly selected ALS patients reported exposure to fertilizers to treat private yards and gardens and occupational exposure to pesticides in the last 30 years than our randomly selected control cases. Smoking, occupational exposures to metals, dust/fibers/fumes/gas and radiation, and physical activity were not associated with ALS when comparing the randomly selected ALS patients to the control subjects. To further explore and confirm results, exposures over several time frames, including 0-10 and 10-30 years earlier, were considered, and analyses were stratified by age and gender. Pesticide and fertilizer exposure were both significantly associated with ALS in the randomly selected ALS patients. While study results need to be interpreted cautiously given the small sample size and the lack of direct exposure measures, these results suggest that environmental and particularly residential exposure factors warrant close attention in studies examining risk factors of ALS.
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Affiliation(s)
- Yu Yu
- Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Feng-Chiao Su
- Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Brian C. Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Stephen A. Goutman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Stuart A. Batterman
- Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail: (ELF); (SAB)
| | - Eva L. Feldman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail: (ELF); (SAB)
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Malek AM, Barchowsky A, Bowser R, Heiman-Patterson T, Lacomis D, Rana S, Youk A, Stickler D, Lackland DT, Talbott EO. Environmental and occupational risk factors for amyotrophic lateral sclerosis: a case-control study. NEURODEGENER DIS 2013; 14:31-8. [PMID: 24246552 DOI: 10.1159/000355344] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 08/27/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS Environmental and occupational exposures are implicated as risk factors for amyotrophic lateral sclerosis (ALS), the etiology of which is largely unknown, although no causal relationships have been established. OBJECTIVE The aim of the study was to evaluate the associations of personal risk factors and self-reported environmental and occupational exposures with risk of ALS. METHODS The cases involved ALS patients (n = 66) identified from major neurological centers in Pittsburgh and Philadelphia, Pa., USA, from 2008 to 2010. The age-, race- and sex-matched controls included outpatient hospital and population-based controls (n = 66). A detailed questionnaire obtaining data on occupation, vocational and avocational exposure as well as personal lifestyle factors was administered. RESULTS Occupational exposure to metals (odds ratio, OR = 3.65; 95% CI: 1.15, 11.60) and pesticides (OR = 6.50; 95% CI: 1.78, 23.77) was related to increased risk of ALS after controlling for smoking and education. No associations were found for occupational exposure to organic or aromatic solvents. CONCLUSION Workers exposed to metals and pesticides may be at greater risk of ALS. Future research should involve more accurate exposure assessment through the use of job exposure matrices, confirmation of occupation and biomarkers.
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Affiliation(s)
- Angela M Malek
- Department of Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, S.C., USA
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Occupational Exposure to Extremely Low-Frequency Magnetic Fields and Neurodegenerative Disease. J Occup Environ Med 2013; 55:135-46. [DOI: 10.1097/jom.0b013e31827f37f8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bradley WG, Borenstein AR, Nelson LM, Codd GA, Rosen BH, Stommel EW, Cox PA. Is exposure to cyanobacteria an environmental risk factor for amyotrophic lateral sclerosis and other neurodegenerative diseases? Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:325-33. [PMID: 23286757 DOI: 10.3109/21678421.2012.750364] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There is a broad scientific consensus that amyotrophic lateral sclerosis (ALS) is caused by gene-environment interactions. Mutations in genes underlying familial ALS (fALS) have been discovered in only 5-10% of the total population of ALS patients. Relatively little attention has been paid to environmental and lifestyle factors that may trigger the cascade of motor neuron death leading to the syndrome of ALS, although exposure to chemicals including lead and pesticides, and to agricultural environments, smoking, certain sports, and trauma have all been identified with an increased risk of ALS. There is a need for research to quantify the relative roles of each of the identified risk factors for ALS. Recent evidence has strengthened the theory that chronic environmental exposure to the neurotoxic amino acid β-N-methylamino-L-alanine (BMAA) produced by cyanobacteria may be an environmental risk factor for ALS. Here we describe methods that may be used to assess exposure to cyanobacteria, and hence potentially to BMAA, namely an epidemiologic questionnaire and direct and indirect methods for estimating the cyanobacterial load in ecosystems. Rigorous epidemiologic studies could determine the risks associated with exposure to cyanobacteria, and if combined with genetic analysis of ALS cases and controls could reveal etiologically important gene-environment interactions in genetically vulnerable individuals.
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Affiliation(s)
- Walter G Bradley
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Zhou H, Chen G, Chen C, Yu Y, Xu Z. Association between extremely low-frequency electromagnetic fields occupations and amyotrophic lateral sclerosis: a meta-analysis. PLoS One 2012. [PMID: 23189129 PMCID: PMC3506624 DOI: 10.1371/journal.pone.0048354] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives To estimate the relationship between exposure to extremely low-frequency electromagnetic fields (ELF-EMF) and the risk of amyotrophic lateral sclerosis (ALS) by a meta-analysis. Methods Through searching PubMed databases (or manual searching) up to April 2012 using the following keywords: “occupational exposure”, “electromagnetic fields” and “amyotrophic lateral sclerosis” or “motor neuron disease”, seventeen studies were identified as eligible for this meta-analysis. The associations between ELF-EMF exposure and the ALS risk were estimated based on study design (case-control or cohort study), and ELF-EMF exposure level assessment (job title or job-exposure matrix). The heterogeneity across the studies was tested, as was publication bias. Results Occupational exposure to ELF-EMF was significantly associated with increased risk of ALS in pooled studies (RR = 1.29, 95%CI = 1.02–1.62), and case-control studies (OR = 1.39, 95%CI = 1.05–1.84), but not cohort studies (RR = 1.16, 95% CI = 0.80–1.69). In sub-analyses, similar significant associations were found when the exposure level was defined by the job title, but not the job-exposure matrix. In addition, significant associations between occupational exposure to ELF-EMF and increased risk of ALS were found in studies of subjects who were clinically diagnosed but not those based on the death certificate. Moderate heterogeneity was observed in all analyses. Conclusions Our data suggest a slight but significant ALS risk increase among those with job titles related to relatively high levels of ELF-EMF exposure. Since the magnitude of estimated RR was relatively small, we cannot deny the possibility of potential biases at work. Electrical shocks or other unidentified variables associated with electrical occupations, rather than magnetic-field exposure, may be responsible for the observed associations with ALS.
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Affiliation(s)
- Hongjie Zhou
- Bioelectromagnetics Laboratory, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Guangdi Chen
- Bioelectromagnetics Laboratory, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunjing Chen
- Bioelectromagnetics Laboratory, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunxian Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
- * E-mail: (YY); (ZX)
| | - Zhengping Xu
- Bioelectromagnetics Laboratory, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
- * E-mail: (YY); (ZX)
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Bettini M, Gargiulo-Monachelli GM, Rodríguez G, Rey RC, Peralta LM, Sica REP. Epidemiology of amyotrophic lateral sclerosis patients in a centre in Buenos Aires. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 69:867-70. [PMID: 22297869 DOI: 10.1590/s0004-282x2011000700003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 08/01/2011] [Indexed: 11/22/2022]
Abstract
UNLABELLED Sporadic amyotrophic lateral sclerosis (sALS) is considered a multifactorial disease with genetic and environmental factors causing motor neuron degeneration. OBJECTIVE To describe the epidemiological and occupational characteristics of patients with sALS who attended the Ramos Mejía Hospital at Buenos Aires, Argentina. METHOD We analyzed the medical records of sALS patients diagnosed between 2001 and 2008. All occupations were coded according to the International Standard Classification of Occupation (ISCO). RESULTS 187 patients were assessed, 38.5% were women and 61.5% men. Mean age at diagnosis was 55 years. 16% of them came from rural areas; 68% of the studied population had no health insurance. 40% were employed in elementary occupations, 19 were technicians and 8 handicraftsmen. CONCLUSION The most represented profession was elementary occupation. A large proportion of patients came from rural areas, which might suggest an increased risk of environmental exposure to an unknown agent in those regions.
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Affiliation(s)
- Mariela Bettini
- Neurology Department, J.M. Ramos Mejía Hospital, School of Medicine, University of Buenos Aires, Argentina.
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38
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Spencer P, Fry RC, Kisby GE. Unraveling 50-Year-Old Clues Linking Neurodegeneration and Cancer to Cycad Toxins: Are microRNAs Common Mediators? Front Genet 2012; 3:192. [PMID: 23060898 PMCID: PMC3460211 DOI: 10.3389/fgene.2012.00192] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/09/2012] [Indexed: 01/19/2023] Open
Abstract
Recognition of overlapping molecular signaling activated by a chemical trigger of cancer and neurodegeneration is new, but the path to this discovery has been long and potholed. Six conferences (1962–1972) examined the puzzling neurotoxic and carcinogenic properties of a then-novel toxin [cycasin: methylazoxymethanol (MAM)-β-d-glucoside] in cycad plants used traditionally for food and medicine on Guam where a complex neurodegenerative disease plagued the indigenous population. Affected families showed combinations of amyotrophic lateral sclerosis (ALS), parkinsonism (P), and/or a dementia (D) akin to Alzheimer’s disease (AD). Modernization saw declining disease rates on Guam and remarkable changes in clinical phenotype (ALS was replaced by P-D and then by D) and in two genetically distinct ALS-PDC-affected populations (Kii-Japan, West Papua-Indonesia) that used cycad seed medicinally. MAM forms DNA lesions – repaired by O6-methylguanine methyltransferase (MGMT) – that perturb mouse brain development and induce malignant tumors in peripheral organs. The brains of young adult MGMT-deficient mice given a single dose of MAM show DNA lesion-linked changes in cell-signaling pathways associated with miRNA-1, which is implicated in colon, liver, and prostate cancers, and in neurological disease, notably AD. MAM is metabolized to formaldehyde, a human carcinogen. Formaldehyde-responsive miRNAs predicted to modulate MAM-associated genes in the brains of MGMT-deficient mice include miR-17-5p and miR-18d, which regulate genes involved in tumor suppression, DNA repair, amyloid deposition, and neurotransmission. These findings marry cycad-associated ALS-PDC with colon, liver, and prostate cancer; they also add to evidence linking changes in microRNA status both to ALS, AD, and parkinsonism, and to cancer initiation and progression.
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Affiliation(s)
- Peter Spencer
- Global Health Center, Oregon Health and Science University Portland, OR, USA
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Evaluation of occupational exposure to magnetic fields and motor neuron disease mortality in a population-based cohort. J Occup Environ Med 2012; 53:1447-51. [PMID: 22076040 DOI: 10.1097/jom.0b013e318237a1d0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Epidemiologic evidence for the association between electromagnetic fields and amyotrophic lateral sclerosis, the most common form of motor neuron disease (MND), has been inconclusive. We evaluated the association between electromagnetic fields and MND among workers in occupations potentially exposed to magnetic fields METHODS MND mortality (ICD-9 335.2) was examined in the National Longitudinal Mortality Study using multivariable proportional hazards models. Occupational exposure to magnetic fields was determined on the basis of a population-based job-exposure matrix. Age at entry, education, race, sex, and income were considered for inclusion as covariates RESULTS After adjusting for age, sex, and education, there were no increased risks of MND mortality in relation to potential magnetic field exposure, with hazard ratios around the null in all magnetic field exposure quartiles CONCLUSIONS Our study does not provide evidence for an association between magnetic field exposure and MND mortality.
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Chiò A, Traynor BJ. Identifying potential risk factors for developing amyotrophic lateral sclerosis. Neurodegener Dis Manag 2011. [DOI: 10.2217/nmt.11.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
SUMMARY Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of adult life, characterized by the progressive loss of upper motor neurons in the primary motor cortex and of the spinal and bulbar lower motor neurons. The cause of sporadic cases and of the majority of hereditary cases remains elusive. So far a total of 17 genes or genetic loci of familial ALS have been identified, related to DNA/RNA processing, protein aggregation, membrane trafficking and axonal transport and mitochondrial dysfunction. A large range of environmental factors have also been studied, with inconclusive results, with the possible exception of cigarette smoking. ALS is now considered a complex multifactorial neurodegenerative disorder, but studies analyzing genetic and environmental factors together are still underway.
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Affiliation(s)
- Adriano Chiò
- ALS Center, Department of Neuroscience, University of Torino, Torino, Italy
- Azienda Ospedaliero-Universitaria, San Giovanni Battista, Torino, Italy
- Neuroscience Institute of Torino (NIT), Torino, Italy
| | - Bryan J Traynor
- Neuromuscular Diseases Research Group, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Bastos AF, Orsini M, Machado D, Mello MP, Nader S, Silva JG, da Silva Catharino AM, de Freitas MRG, Pereira A, Pessoa LL, Sztajnbok FR, Leite MA, Nascimento OJM, Bastos VH. Amyotrophic lateral sclerosis: one or multiple causes? Neurol Int 2011; 3:e4. [PMID: 21785676 PMCID: PMC3141115 DOI: 10.4081/ni.2011.e4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 04/02/2011] [Indexed: 12/11/2022] Open
Abstract
The Amyotrophic lateral sclerosis (ALS) is the most common form of motor neuron disease in the adulthood, and it is characterized by rapid and progressive compromise of the upper and lower motor neurons. The majority of the cases of ALS are classified as sporadic and, until now, a specific cause for these cases still is unknown. To present the different hypotheses on the etiology of ALS. It was carried out a search in the databases: Bireme, Scielo and Pubmed, in the period of 1987 to 2011, using the following keywords: Amyotrophic lateral sclerosis, motor neuron disease, etiology, causes and epidemiology and its similar in Portuguese and Spanish. It did not have consensus as regards the etiology of ALS. Researches demonstrates evidences as regards intoxication by heavy metals, environmental and occupational causes, genetic mutations (superoxide dismutase 1), certain viral infections and the accomplishment of vigorous physical activity for the development of the disease. There is still no consensus regarding the involved factors in the etiology of ALS. In this way, new research about these etiologies are necessary, for a better approach of the patients, promoting preventive programs for the disease and improving the quality of life of the patients.
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Sutedja NA, Fischer K, Veldink JH, van der Heijden GJMG, Kromhout H, Heederik D, Huisman MHB, Wokke JJH, van den Berg LH. What we truly know about occupation as a risk factor for ALS: a critical and systematic review. ACTA ACUST UNITED AC 2010; 10:295-301. [PMID: 19922116 DOI: 10.3109/17482960802430799] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Occupational and environmental exposures may contribute to the risk of developing sporadic amyotrophic lateral sclerosis (ALS). To summarize the available evidence, a systematic review of the literature on occupation as a potential determinant of ALS was performed according to the MOOSE guidelines. From MEDLINE, EMBASE, CINAHL, and Cochrane databases, selected studies were methodologically appraised according to Armon's classification system for ALS risk factor studies. Each occupation studied was reclassified according to the International Standard Classification of Occupations (ISCO-88). The vote-counting method was applied to summarize the data. Of 3773 potentially relevant studies, 51 were initially included. Of these, 12 studies provided risk estimates for individual occupations--one case-control, two register-based case-control, and nine register-based cohort studies. All studies fell into Armon's level of evidence class IV, indicating methodological limitations. Due to the heterogeneity of study methodology, data could not be pooled. The vote-counting method revealed several candidate occupations: veterinarians and other health workers, athletes, hairdressers, power-production plant, electrical and military workers. However, well designed studies with standardized assessment of occupation are needed to provide a more definitive answer about exogenous risk factors of ALS.
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Affiliation(s)
- Nadia A Sutedja
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, The Netherlands
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Furby A, Beauvais K, Kolev I, Rivain JG, Sébille V. Rural environment and risk factors of amyotrophic lateral sclerosis: a case–control study. J Neurol 2009; 257:792-8. [DOI: 10.1007/s00415-009-5419-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 10/21/2009] [Accepted: 11/09/2009] [Indexed: 12/14/2022]
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Godeiro-Junior C, Oliveira AS, Felicio AC, Chieia MA, Gabbai AA. Conjugal amyotrophic lateral sclerosis in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:1045-8. [DOI: 10.1590/s0004-282x2009000600015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 08/05/2009] [Indexed: 11/22/2022]
Abstract
The origin of amyotrophic lateral sclerosis (ALS) remains unknown, although it seems to be multifactorial. The role of environmental factors has been frequently investigated and suspicion of its influence can be obtained when clusters of a rare disease are described. OBJECTIVE: To describe conjugal cases of ALS in Brazil. METHOD: We describe 2 couples in which both spouses were affected by ALS. Both couples had lived in southeast Brazil and were married for at least 20 years. RESULTS: There was a great variability in clinical presentation of ALS in our patients. In both couples the interval between disease onsets was short. No precise environmental factors could be identified at the origin of these conjugal cases. CONCLUSION: The occurrence of ALS in couples living in the same area may be epidemiologically important, but we cannot exclude that cases may be due to a chance association.
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Affiliation(s)
- Clecio Godeiro-Junior
- Federal University of São Paulo, Brazil; Federal University of Rio Grande do Norte, Brazil
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45
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Harwood CA, McDermott CJ, Shaw PJ. Physical activity as an exogenous risk factor in motor neuron disease (MND): A review of the evidence. ACTA ACUST UNITED AC 2009; 10:191-204. [DOI: 10.1080/17482960802549739] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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46
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Fang F, Quinlan P, Ye W, Barber MK, Umbach DM, Sandler DP, Kamel F. Workplace exposures and the risk of amyotrophic lateral sclerosis. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:1387-92. [PMID: 19750102 PMCID: PMC2737014 DOI: 10.1289/ehp.0900580] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 05/11/2009] [Indexed: 05/11/2023]
Abstract
BACKGROUND Occupation has been suggested to play a role in amyotrophic lateral sclerosis (ALS) etiology, but detailed information on the importance of specific workplace exposures is lacking. OBJECTIVES Our aim was to assess the relationship between workplace exposures and the risk of ALS and to evaluate potential interactions between these exposures and smoking. METHODS We conducted a case-control study in New England between 1993 and 1996, comprising 109 cases and 253 controls who completed a structured interview covering occupations and workplace exposures. Unconditional logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for ALS. Analyses were conducted among the entire study population and after stratification by smoking. RESULTS We observed a higher risk of ALS for construction workers excluding supervisors (OR = 2.9; 95% CI, 1.2-7.2) and precision metal workers (OR = 3.5; 95% CI, 1.2-10.5). Self-reported exposures to paint strippers; cutting, cooling, or lubricating oils; antifreeze or coolants; mineral or white spirits; and dry cleaning agents each appeared to be associated with a 60-90% higher risk. Specific chemicals related to a > 50% increase in risk of ALS included aliphatic chlorinated hydrocarbons, glycols, glycol ethers, and hexane. Relative risks associated with these workplace exposures and chemicals were greater among nonsmokers and persisted in mutually adjusted models. CONCLUSIONS Our data suggest that certain occupations and workplace exposures may be associated with increased risk of ALS. These results need to be confirmed in independent populations.
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Affiliation(s)
- Fang Fang
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patricia Quinlan
- Department of Medicine, Division of Occupational and Environmental Medicine, University of California, San Francisco, California, USA
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - David M. Umbach
- Biostatistics Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Freya Kamel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
- Address correspondence to F. Kamel, Epidemiology Branch, National Institute of Environmental Health Sciences, P.O. Box 12233, Mail Drop A3-05, Research Triangle Park, NC 27709 USA. Telephone: (919) 541-1581. Fax: (919) 541-2511. E-mail:
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47
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Soriani MH, Desnuelle C. Épidémiologie de la SLA. Rev Neurol (Paris) 2009; 165:627-40. [DOI: 10.1016/j.neurol.2009.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 04/02/2009] [Accepted: 04/13/2009] [Indexed: 12/11/2022]
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Weisskopf MG, Morozova N, O'Reilly EJ, McCullough ML, Calle EE, Thun MJ, Ascherio A. Prospective study of chemical exposures and amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2009; 80:558-61. [PMID: 19372290 PMCID: PMC2765376 DOI: 10.1136/jnnp.2008.156976] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although environmental toxins, including pesticides, are suspected of contributing to the risk of amyotrophic lateral sclerosis (ALS), no data exist from large prospective investigations. This study assessed the association between exposure to chemicals and risk of ALS in a prospective cohort study. METHODS The relation between self-report of regular exposure to 11 different chemical classes or x rays and ALS mortality among over 1 million participants in the American Cancer Society's Cancer Prevention Study II was prospectively assessed. Follow-up from 1989 through 2004 identified 617 deaths from ALS among men and 539 among women. Adjusted rate ratios (RR) were calculated using Cox proportional hazards. RESULTS The RR for ALS mortality among individuals exposed to pesticides/herbicides compared with that among unexposed individuals was 1.07 (95% CI 0.79 to 1.44), but somewhat higher after excluding those with missing duration of pesticides exposure (RR 1.44; 95% CI 0.89 to 2.31; p = 0.14). A non-significant increase in ALS mortality was found among individuals who reported exposure to formaldehyde (RR 1.34; 95% CI 0.93 to 1.92). Excluding those with a missing duration of formaldehyde exposure, the RR was 2.47 (95% CI 1.58 to 3.86), and there was a strongly significant dose-response relation with increasing years of exposure (p trend = 0.0004). CONCLUSIONS There was little evidence for any association between pesticides/herbicide exposure and ALS. In contrast, evidence was found, suggesting an increased risk of ALS with formaldehyde exposure. Because of the longitudinal design, this result is unlikely to be due to bias, but it should nevertheless be interpreted cautiously and needs to be verified independently.
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Affiliation(s)
- M G Weisskopf
- Harvard School of Public Health, Department of Environmental Health, Boston, MA 02215, USA.
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Godeiro-Junior C, Vieira-Filho JPB, Felício AC, Oliveira ASB. Amyotrophic lateral sclerosis in a Brazilian Kayapó-Xikrin native. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:749-51. [PMID: 18949277 DOI: 10.1590/s0004-282x2008000500029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Clecio Godeiro-Junior
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, SP, Brazil.
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Zoccolella S, Masi G, Mezzapesa D, Carnicella F, Iliceto G, Lamberti P, Serlenga L. Motoneuron disease after electric injury: a case report. Neurol Sci 2008; 29:47-9. [PMID: 18379742 DOI: 10.1007/s10072-008-0860-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 01/23/2008] [Indexed: 12/14/2022]
Abstract
Several cases of motor neuron disease (MND) after electric injury have been reported in the last number of years, but the relationship between electric injury and MND remains controversial. Herein we report the case of a 60-year-old man who developed a MND following an electrical trauma. In the case presented here, the onset of disease at the site of lightning strike and the short interval of time between the electrical injury and the clinical onset of MND raise the possibility of considering electrical shock as a trigger factor for MND.
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