Epidemic outbreak of interstitial lung disease in aerographics textile workers--the "Ardystil syndrome": a first year follow up

Assessment of acute and repeated pulmonary toxicities of oligo(2-(2-ethoxy)ethoxyethyl guanidium chloride in mice

Oligo(2-(2-ethoxy)ethoxyethyl guanidinium chloride (PGH) and polyhexamethyleneguanidine phosphate (PHMG-P) are cationic biocides containing a guanidine group. Direct exposure of the lungs to PHMG-P is known to induce pulmonary inflammation and fibrotic changes. Few studies have assessed the pulmonary toxicity of PGH, another member of the guanidine family. In this study, we assessed the acute and repeated toxicity of PGH and PHMG-P to compare the pathological progression induced by both chemicals. PGH (1.5 mg/kg) or PHMG (0.6 mg/kg) was instilled intratracheally to mice once or three times every 4 days; subsequently, cytokine levels were quantified and a histopathological examination was performed. To verify the toxic mechanism of PGH, we quantified cell viability and cytokine production induced by PGH or PHMG-P in the presence or absence of anionic material in cells. Instillation of PGH and PHMG-P into the mouse lung increased cytokine production, immune cell infiltration, and pulmonary fibrotic changes. These pathological changes were exacerbated over time in the single- and the repeated-dose PHMG-P groups, but were resolved over time in the PGH groups. PGH or PHMG-P showed cytotoxic effects, IL-1β secretion, and ROS production in a dose-dependent manner in human cell lines. However, the co-treatment of anionic materials with PGH or PHMG-P significantly reduced these toxic responses, which confirmed that the cation of PGH disrupted the plasma membrane via ionic interaction, as observed for PHMG-P. In addition, we suggest the disruption of plasma membrane as a molecular initiating event of cationic chemicals-induced adverse outcomes when exposed directly to the lungs.

Occupational and environmental bronchiolar disorders

Occupational and environmental causes of bronchiolar disorders are recognized on the basis of case reports, case series, and, less commonly, epidemiologic investigations. Pathology may be limited to the bronchioles or also involve other components of the respiratory tract, including the alveoli. A range of clinical, functional, and radiographic findings, including symptomatic disease lacking abnormalities on noninvasive testing, poses a diagnostic challenge and highlights the value of surgical biopsy. Disease clusters in workplaces and communities have identified new etiologies, drawn attention to indolent disease that may otherwise have been categorized as idiopathic, and expanded the spectrum of histopathologic responses to an exposure. More sensitive noninvasive diagnostic tools, evidence-based therapies, and ongoing epidemiologic investigation of at-risk populations are needed to identify, treat, and prevent exposure-related bronchiolar disorders.

Pulmonary fibrosis in response to environmental cues and molecular targets involved in its pathogenesis

Chronic lung injury resulting from a variety of different causes is frequently associated with the develop ment of pulmonary fibrosis in humans. Although the etiology of pulmonary fibrosis is generally unknown, several sources of evidence support the hypothesis that a number of environmental and occupational agents play an etiologic role in the pathogenesis of this disease. The agents discussed in this review include beryllium, nylon flock, textile printing aerosols, polyvinyl chloride and didecyldimethylammonium chloride. The authors also describe a variety of animal models, including genetically modified mice, in order to investigate the molecular mechanism of pulmonary fibrosis, focusing on chemokine receptors, regulatory T cells and transforming growth factor-β and bone morphogenetic protein signaling. Overall, we propose the concept of toxicological pulmonary fibrosis as a lung disease induced in response to environmental cues.

Occupational interstitial lung disease

Occupational interstitial lung diseases are a diverse group of disorders of varied cause. Occupational causes account for a significant portion of all interstitial lung diseases, and new causes continue to be described. Although some are diseases of antiquity, they continue to occur in the workplace and often are misdiagnosed as "idiopathic" when physicians miss the connection to past-inhaled exposures. All of these diseases are preventable with reduction or elimination of workplace exposure. This article reviews the spectrum of diseases caused by exposure to metal dust and fumes, inorganic fibers, and nonfibrous inorganic dust. It also details an approach to the diagnosis, evaluation, and management of this group of illnesses.