Diesel Engine Exhaust Exposure in Relation to Lung Cancer in Long-Haul Truck Drivers: An Eight-Step Concept Analysis

BACKGROUND

Long-haul truck drivers (LHTDs) face a number of occupational hazards. One such hazard is exposure to diesel engine exhaust (DEE). However, this concept has yet to be analyzed. To address this gap, a concept analysis was conducted to explore the effects of DEE in relation to lung cancer.

METHODS

Walker and Avant's eight-step concept analysis method was utilized: concept selection, analysis purpose, concept uses, defining attributes, model case, borderline case, antecedents and consequences, and empirical referents. PubMed, Scopus, and CINAHL databases were searched for relevant literature.

FINDINGS

Diesel engine exhaust was identified as a mixture of gases and particulates that are considered carcinogenic. Defining attributes of DEE for truckers include respiratory effects such as decreased peak flow and increased airway resistance leading to symptoms such as a phlegm-producing cough, eye and throat irritation, exacerbation of asthma symptoms, and allergic responses. The identified level of DEE exposure associated with these attributes is 75 μg EC/m3 for 1 to 2 hours daily or a long-term exposure of 10 μg EC/m3. The conceptual definition of DEE in truckers was illustrated by the attributes, antecedents, consequences, model case, and empirical referents.

CONCLUSION

Lung cancer was identified as a significant consequence of occupational DEE exposure for LHTDs. This analysis highlights the need for future research to develop interventions that will safeguard truckers from the adverse health effects of DEE exposure.

Mechanism underlying the role of integrin α3β1 in adhesive dysfunction between thyroid cells induced by diesel engine exhaust particles

The role and mechanisms of DEP exposure on thyroid injury are not yet clear. This study explores thyroid damage induced by in vivo DEP exposure using a mouse model. This study has observed alterations in thyroid follicular architecture, including rupture, colloid overflow, and the formation of voids. Additionally, there was a significant decrease in the expression levels of proteins involved in thyroid hormone synthesis, such as thyroid peroxidase and thyroglobulin, their trend of change is consistent with the damage to the thyroid structure. Serum levels of triiodothyronine and tetraiodothyronine were raise. However, the decrease in TSH expression suggests that the function of the HPT axis is unaffected. To delve deeper into the intrinsic mechanisms of thyroid injury, we performed KEGG pathway enrichment analysis, which revealed notable alterations in the cell adhesion signaling pathway. Our immunofluorescence results show that DEP exposure impairs thyroid adhesion, and integrin α3β1 plays an important role. CD151 binds to α3β1, promoting multimolecular complex formation and activating adhesion-dependent small GTPases. Our in vitro model has confirmed the pivotal role of integrin α3β1 in thyroid cell adhesion, which may be mediated by the CD151/α3β1/Rac1 pathway. In summary, exposure to DEP disrupts the structure and function of the thyroid, a process that likely involves the regulation of cell adhesion through the CD151/α3β1/Rac1 pathway, leading to glandular damage.

Effects of inhaled tier-2 diesel engine exhaust on immunotoxicity in a rat model: A hazard identification study. Part II. Immunotoxicology

Diesel exhaust (DE) is an air pollutant containing gaseous compounds and particulate matter. Diesel engines are common on gas extraction and oil sites, leading to complex DE exposure to a broad range of compounds through occupational settings. The US EPA concluded that short-term exposure to DE leads to allergic inflammatory disorders of the airways. To further evaluate the immunotoxicity of DE, the effects of whole-body inhalation of 0.2 and 1 mg/m3 DE (total carbon; 6 h/d for 4 days) were investigated 1-, 7-, and 27-days post exposure in Sprague-Dawley rats using an occupationally relevant exposure system. DE exposure of 1 mg/m3 increased total cellularity, number of CD4+ and CD8+ T-cells, and B-cells at 1 d post-exposure in the lung lymph nodes. At 7 d post-exposure to 1 mg/m3, cellularity and the number of CD4+ and CD8+ T-cells decreased in the LLNs. In the bronchoalveolar lavage, B-cell number and frequency increased at 1 d post-exposure, Natural Killer cell number and frequency decreased at 7 d post-exposure, and at 27 d post-exposure CD8+ T-cell and CD11b+ cell number and frequency decreased with 0.2 mg/m3 exposure. In the spleen, 0.2 mg/m3 increased CD4+ T-cell frequency at 1 and 7 d post-exposure and at 27 d post-exposure increased CD4+ and CD8+ T-cell number and CD8+ T-cell frequency. B-cells were the only immune cell subset altered in the three tissues (spleen, LLNs, and BALF), suggesting the induction of the adaptive immune response. The increase in lymphocytes in several different organ types also suggests an induction of a systemic inflammatory response occurring following DE exposure. These results show that DE exposure induced modifications of cellularity of phenotypic subsets that may impair immune function and contribute to airway inflammation induced by DE exposure in rats.

Global burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens in 204 countries and territories, from 1990 to 2019: results from the global burden of disease study 2019

BACKGROUND

Occupational-related cancers are a substantial global health issue. The largest proportion of occupational-related cancers is tracheal, bronchus, and lung (TBL) cancer. This study aimed to explore the geographical and temporal trends in occupational carcinogens related to TBL cancer.

METHODS

Data on TBL cancer attributable to occupational carcinogens were collected from the Global Burden of Disease Study 2019. Numbers and age-standardized rates (ASRs) of deaths, disability-adjusted life years (DALYs), and corresponding average annual percentage change (AAPC) were evaluated and stratified by geographic location, socio-demographic index (SDI) quintiles, age, and sex.

RESULTS

Globally, ASRs of deaths and DALYs in TBL cancer attributable to occupational carcinogens showed a downward trend (AAPC = - 0.69%, - 1.01%) while increases were observed in the low, low-middle, and middle SDI quintiles. Although males accounted for 82.4% and 81.5% of deaths and DALYs in 2019, respectively, it showed an upward trend of ASRs in females (AAPC = 0.33%, 0.02%). Occupational exposure to asbestos, silica and diesel engine exhaust were the top three causes of age-standardized TBL cancer deaths and DALYs. Over the past three decades, the percentage of age-standardized TBL cancer deaths and DALYs attributable to occupational asbestos and silica exposure decreased by 18.24, 6.71 and 20.52%, 4.00% globally, but increased significantly in lower SDI regions, while the burden attributable to occupational diesel engine exhaust exposure increased by 32.76, 37.23% worldwide.

CONCLUSIONS

Occupational exposure remains an important risk factor for TBL cancer. The burden of TBL cancer attributable to occupational carcinogens showed obvious heterogeneity which decreased in higher SDI but increased in lower SDI regions. The burden of males was significantly higher than females, but the females showed an increasing trend. Occupational exposure to asbestos was the main causes of the burden. Therefore, effective prevention and control measures tailored to local conditions are necessary.

CXCL17 Attenuates Diesel Exhaust Emissions Exposure-Induced Lung Damage by Regulating Macrophage Function

Exposure to diesel exhaust emissions (DEE) is strongly linked to innate immune injury and lung injury, but the role of macrophage chemoattractant CXCL17 in the lung damage caused by DEE exposure remains unclear. In this study, whole-body plethysmography (WBP), inflammatory cell differential count, and histopathological analysis were performed to assess respiratory parameters, airway inflammation, and airway injury in C57BL/6 male mice exposed to DEE for 3 months. qRT-PCR, IHC (immunohistochemistry), and ELISA were performed to measure the CXCL17 expression in airway epithelium or BALF (bronchoalveolar lavage fluid) following DEE/Diesel exhaust particle (DEP) exposure. Respiratory parameters, airway inflammation, and airway injury were assessed in CXCL17-overexpressing mice through adeno-associated virus vector Type 5 (AAV5) infection. Additionally, an in vitro THP-1 and HBE co-culture system was constructed. Transwell assay was carried out to evaluate the effect of rh-CXCL17 (recombinant human protein-CXCL17) on THP-1 cell migration. Flow cytometry and qRT-PCR were conducted to assess the impacts of rh-CXCL17 on apoptosis and inflammation/remodeling of HBE cells. We found that the mice exposed to DEE showed abnormal respiratory parameters, accompanied by airway injury and remodeling (ciliary injury in airway epithelium, airway smooth muscle hyperplasia, and increased collagen deposition). Carbon content in airway macrophages (CCAM), but not the number of macrophages in BALF, increased significantly. CXCL17 expression significantly decreased in mice airways and HBE after DEE/DEP exposure. AAV5-CXCL17 enhanced macrophage recruitment and clearance of DEE in the lungs of mice, and it improved respiratory parameters, airway injury, and airway remodeling. In the THP-1/HBE co-culture system, rh-CXCL17 increased THP-1 cell migration while attenuating HBE cell apoptosis and inflammation/remodeling. Therefore, CXCL17 might attenuate DEE-induced lung damage by recruiting and activating pulmonary macrophages, which is expected to be a novel therapeutic target for DEE-associated lung diseases.

Chemical characterization of combustion engine exhaust and assessment of helicopter deck operator occupational exposures on an offshore frigate class ship

Diesel engine exhaust (DE) consists of a complex mixture of gases and aerosols, originating from sources such as engines, turbines, and power generators. It is composed of a wide range of toxic compounds ranging from constituents that are irritating to those that are carcinogenic. The purposes of this work were to characterize DE originating from different engine types on a ship operating offshore and to quantify the potential exposure of workers on the ship's helicopter deck to select DE compounds. Sampling was conducted on a Norwegian Nansen-class frigate that included helicopter operations. Frigate engines and generators were fueled by marine diesel oil, while the helicopter engine was fueled by high flash point kerosene-type aviation fuel. Exhaust samples were collected directly from the stack of the diesel engine and one of the diesel generator exhaust stacks, inside a gas turbine exhaust stack, and at the exhaust outlet of the helicopter. To characterize the different exhaust sources, non-targeted screening of volatile and semi-volatile organic compounds was performed for multiple chemical classes. Some of the compounds detected at the sources are known irritants, such as phthalic anhydride, 2,5-dyphenyl-p-benzoquinone, styrene, cinnoline, and phenyl maleic anhydride. The exhaust from the diesel engine and diesel generator was found to contain the highest amounts of particulate matter and gaseous compounds, while the gas turbine had the lowest emissions. Personal exposure samples were collected outdoors in the breathing zone of a helicopter deck operator over nine working shifts, simultaneously with stationary measurements on the helicopter deck. Elemental carbon, nitrogen dioxide, and several volatile organic compounds are known to be present in DE, such as formaldehyde, acrolein, and phenol were specifically targeted. Measured DE exposures of the crew on the helicopter deck were variable, but less than the current European occupational exposure limits for all compounds, except elemental carbon, in which concentration varied between 0.5 and 37 µg/m³ over nine work shifts. These findings are among the first published for this type of working environment.

Numerical study on temporal and spatial distribution of particulate matter under multi-vehicle working conditions

The high growth in the use of underground diesel vehicles has led to a large number of exhaust pollutants, especially particulate matter (PM), which is a serious threat to the lives and health of underground personnel. In this paper, based on numerical simulations and field measurements, the temporal and spatial distribution of PM in the exhaust of two vehicles and the impact on the health of underground personnel was analyzed. The results showed that in both conditions, the airflow velocity between two vehicles showed a zonal distribution, and there was an airflow vortex in the chamber under the interaction of the wind. When the vehicles were running in the same direction into the wind, PM with a concentration range of 15.79-26.32 mg/m³ could reach the height of the human respiratory belt and was mainly distributed on the east side of the roadway. Therefore, underground personnel should avoid approaching the right area of the vehicle body. In addition, PM concentration around the driver position of the vehicle was still higher than the human contact limit, so the drivers of the vehicle would need personal protection. When the vehicles were running in the same direction with the wind, compared with the airflow inlet side, the amount of PM on the airflow outlet side increased more obviously with time, especially for PM with a concentration range of 21.05-31.58 mg/m³. Also, partial PM flowed into the chamber with the airflow, such that personnel should avoid being located on the downwind side of the vehicle, and personnel in the chamber should also have personal protection.

Canada Should Move Toward Adopting Harmonized Evidence-Based OELs to Consistently and Adequately Protect Workers

Due to the way occupational exposure limits (OELs) are set in Canada, workers across the country are not equally and adequately protected from harmful workplace exposures. This disparity is illustrated in the case of exposure to diesel engine exhaust (DEE). Based on the findings of a recent pan-Canadian and international scan of OELs for DEE, we recommend that Canada overcome these current disparities by moving towards harmonized, evidence-based OELs. To achieve this, Canada should adopt a centralized framework for setting OELs that considers the most recent scientific evidence as well as feasibility of implementation in the Canadian context. We assert that harmonizing OELs across Canada would allow for expertise and resources to be consolidated and is a crucial step to ensuring that all workers are consistently protected from harmful workplace exposures.

Exposure assessment of elemental carbon, polycyclic aromatic hydrocarbons and crystalline silica at the underground excavation sites for top-down construction buildings

Enclosed underground excavation worksite has an environment with poor ventilation and exposure to hazardous substances from diesel engine exhaust and construction materials. The objective of this study was to evaluate the exposure level of elemental carbon (EC), organic carbon (OC), total carbon (TC), polycyclic aromatic hydrocarbons (PAHs), dust and crystalline silica (CS) during underground excavation work for top down construction buildings. Active local air sampling for EC, OC, and TC (n = 105), PAHs (n = 50), dust (n = 34) and CS (n = 34) was conducted from inside and outside the excavator at underground excavation workshop in four different construction sites. EC, OC, TC and CS were sampled with each respirable and total particulates. EC, OC, and TC were collected on quartz-filter and analyzed using the thermal optical transmittance method. PAHs was collected on polytetrafluorethylene filter with XAD-2 and analyzed using liquid chromatography with fluorescence detector. CS and particulates were collected on poly vinyl chloride filter and analyzed using fourier-transform infrared spectroscopy. The geometric mean of respirable EC, OC, TC, total PAHs, respirable dust and respirable CS were 8.69 μg/m³, 34.32 μg/m³, 44.96 μg/m³, 6.818 μg/m³ 0.13 mg/m³ and 0.02 mg/m³ from inside the excavator and 33.20 μg/m³, 46.53 μg/m³, 78.21 μg/m³, 3.934 μg/m³, 0.9 mg/m³ and 0.08 mg/m³ from outside the excavator (underground excavation workshop), respectively. The EC and RCS concentration from outside the excavator is significantly higher than that of inside the excavator (p<0.01). The worksite with rock ground, higher vehicle density, blasting and enclosed environments had higher exposure to EC than other sites (p<0.05). There was no significant difference of EC concentration between total and respirable particulates. In top down construction sites, EC concentrations during underground excavation work exceeded recommended exposure limits as 20 μg/m³, accounted for about 50% of the total sample, and the level of concentration of RCS exceeded 1.5 times of occupational exposure limit, 0.05 mg/m³. Efforts are needed to minimize exposure to diesel engine exhaust and silica in underground excavation sites. Management of diesel engine vehicle, supply of fresh air and ventilation and introducing water facilities to create wet environment in underground worksites are strongly suggested.

Nanodomains in cardiopulmonary disorders and the impact of air pollution

Air pollution is a major environmental threat and each year about 7 million people reported to die as a result of air pollution. Consequently, exposure to air pollution is linked to increased morbidity and mortality world-wide. Diesel automotive engines are a major source of urban air pollution in the western societies encompassing particulate matter and diesel exhaust particles (DEP). Air pollution is envisioned as primary cause for cardiovascular dysfunction, such as ischemic heart disease, cardiac dysrhythmias, heart failure, cerebrovascular disease and stroke. Air pollution also causes lung dysfunction, such as chronic obstructive pulmonary disease (COPD), asthma, idiopathic pulmonary fibrosis (IPF), and specifically exacerbations of these diseases. DEP induces inflammation and reactive oxygen species production ultimately leading to mitochondrial dysfunction. DEP impair structural cell function and initiate the epithelial-to-mesenchymal transition, a process leading to dysfunction in endothelial as well as epithelial barrier, hamper tissue repair and eventually leading to fibrosis. Targeting cyclic adenosine monophosphate (cAMP) has been implicated to alleviate cardiopulmonary dysfunction, even more intriguingly cAMP seems to emerge as a potent regulator of mitochondrial metabolism. We propose that targeting of the mitochondrial cAMP nanodomain bear the therapeutic potential to diminish air pollutant — particularly DEP — induced decline in cardiopulmonary function.

Retrofitting and re-powering as a control strategies for curtailment of exposure of underground miners to diesel aerosols

A study was conducted to examine the potential of diesel emissions control strategies based on retrofitting existing power packages with exhaust aftertreatment devices and repowering with advanced power packages. The retrofit systems, a diesel oxidation catalyst (DOC) and diesel particulate filter (DPF), were evaluated individually using a US EPA tier 2 (ter 2) engine operated under four steady-state conditions and one transient cycle. The DOC effectively curtailed emissions of CO, and to some extent organic carbon (OC), elemental carbon (EC), and aerosol number concentration. The DPF system offered substantially higher reductions in OC and EC mass and aerosol number concentrations. Both, the DOC and DPF achieved reductions in the aforementioned emissions without adversely affecting emissions of NO2 and nano-sized aerosols. The strategy of repowering with an advanced system was examined using a US EPA tier 4 final (tier 4f) engine equipped with a cooled exhaust gas recirculation system and diesel exhaust fluid-based selective catalytic reduction system, but not with a DPF system. The tier 4f engine contributed substantially less than the tier 2 engine to the EC and OC mass, aerosol number, and CO, NO, and NO2 concentrations. The tier 4f engine was very effective in reducing aerosol mass, NO, and NO2 concentrations, but it was not equally effective in reducing aerosol number concentrations. The implementation of viable exhaust after treatment systems and advanced diesel power packages could be instrumental to the underground mining industry to secure a clean, economical, and dependable source of power for mobile equipment.

Air pollution and cardiovascular disease: car sick

The cardiovascular effects of inhaled particle matter (PM) are responsible for a substantial morbidity and mortality attributed to air pollution. Ultrafine particles, like those in diesel exhaust emissions, are a major source of nanoparticles in urban environments, and it is these particles that have the capacity to induce the most significant health effects. Research has shown that diesel exhaust exposure can have many detrimental effects on the cardiovascular system both acutely and chronically. This review provides an overview of the cardiovascular effects on PM in air pollution, with an emphasis on ultrafine particles in vehicle exhaust. We consider the biological mechanisms underlying these cardiovascular effects of PM and postulate that cardiovascular dysfunction may be implicated in the effects of PM in other organ systems. The employment of multiple strategies to tackle air pollution, and especially ultrafine particles from vehicles, is likely to be accompanied by improvements in cardiovascular health.

Diesel Exhaust and Lung Cancer-Aftermath of Becoming an IARC Group 1 Carcinogen

The International Agency for Research on Cancer reclassified diesel exhaust from Group 2A (probably carcinogenic to humans) to Group 1 (carcinogenic to humans) in 2012. Since then, reevaluation and reanalysis of 2 major studies (Diesel Exhaust in Miners Study and Trucking Industry Particle Study) that were influential to the International Agency for Research on Cancer evaluation have replicated the original findings and demonstrated the suitability of these epidemiologic data for the quantitative risk assessment needed to set safe exposure limits in occupational and outdoor ambient environments. The challenge now is to protect the workers and general populations in urban areas from the carcinogenicity of diesel exhaust.

Asthma trigger perceptions are associated with work disability

OBJECTIVE

To study the association between perceptions of various triggers of asthma and employment status.

METHODS

A questionnaire was administered to all those adults living in the city of Tampere, Finland, who were entitled to special reimbursement for asthma medication by the Social Insurance Institution (n = 2613). The response rate was 79%. The study population (n = 1657) consisted of individuals who worked full-time (n = 967), were unemployed (n = 197), had all-cause work disability (n = 334), or were retired due to old age (n = 159). Given a list of potential asthma triggers, the respondents were asked how often (never/sometimes/often) the trigger caused or worsened their asthma symptoms during leisure time.

RESULTS

After adjusting for background variables (age, sex, smoking, and professional status), frequency of asthma symptoms, and the use of asthma medication during the last year, any individual trigger identified as asthma-relevant was associated with having work disability (vs. working full-time). The highest odds ratio (OR) was found for vehicle exhaust (OR 5.0, CI 2.2-11.4). We found similar but less consistent associations between asthma trigger perceptions and unemployment. No elevated ORs were found regarding asthma trigger perceptions for old-age retirement.

CONCLUSIONS

Perceptions of asthma triggers are associated with all-cause work disability. Our findings suggest that asthmatics have excess trigger perceptions that are not explained by asthma alone. Asthmatics need to be informed that inaccurate trigger perceptions may develop, and how they are induced, because unnecessary trigger avoidance may interfere with work life.

DNA Damage, Mutagenesis and Cancer

A large number of chemicals and several physical agents, such as UV light and γ-radiation, have been associated with the etiology of human cancer. Generation of DNA damage (also known as DNA adducts or lesions) induced by these agents is an important first step in the process of carcinogenesis. Evolutionary processes gave rise to DNA repair tools that are efficient in repairing damaged DNA; yet replication of damaged DNA may take place prior to repair, particularly when they are induced at a high frequency. Damaged DNA replication may lead to gene mutations, which in turn may give rise to altered proteins. Mutations in an oncogene, a tumor-suppressor gene, or a gene that controls the cell cycle can generate a clonal cell population with a distinct advantage in proliferation. Many such events, broadly divided into the stages of initiation, promotion, and progression, which may occur over a long period of time and transpire in the context of chronic exposure to carcinogens, can lead to the induction of human cancer. This is exemplified in the long-term use of tobacco being responsible for an increased risk of lung cancer. This mini-review attempts to summarize this wide area that centers on DNA damage as it relates to the development of human cancer.