Lung Pathology in U.S. Coal Workers with Rapidly Progressive Pneumoconiosis Implicates Silica and Silicates

Update on Silicosis

Although silicosis has been an established disease with a recognized cause for more than 100 years, many workers continue to be exposed to silica and new outbreaks of disease continue to occur. This article describes some of the well-established and new exposures, including denim sandblasting, artificial stone cutting, and some forms of "coal worker's pneumoconiosis." The authors review the imaging and pathology of acute silicosis (silicoproteinosis), simple silicosis, and progressive massive fibrosis and summarize known and putative associations of silica exposure, including tuberculosis, lung cancer, connective tissue disease (especially systemic sclerosis), and vasculitis.

Cuproptosis-associated hub gene identification and immune cell infiltration patterns in silicosis

Recent research has hinted at a potential connection between silicosis, a fibrotic lung disease caused by exposure to crystalline silica particles, and cuproptosis. The aim of the study was to explore how cuproptosis-related genes (CRGs) may influence the development of silicosis and elucidate the underlying mechanisms. An analysis of genes associated with both silicosis and cuproptosis was conducted. Key gene identification was achieved through the application of two machine learning techniques. Additionally, the correlation between these key genes and immune cell populations was explored and the critical pathways were discerned. To corroborate our findings, the expression of key genes was verified in both a publicly available silica-induced mouse model and our own silicosis mouse model. A total of 12 differentially expressed CRGs associated with silicosis were identified. Further analysis resulted in the identification of 6 CRGs, namely LOX, SPARC, MOXD1, ALB, MT-CO2, and AOC2. Elevated immune cell infiltration of CD8 T cells, regulatory T cells, M0 macrophages, and neutrophils in silicosis patients compared to healthy controls was indicated. Validation in a silica-induced pulmonary fibrosis mouse model supported SPARC and MT-CO2 as potential signature genes for the prediction of silicosis. These findings highlight a strong association between silicosis and cuproptosis. Among CRGs, LOX, SPARC, MOXD1, ALB, MT-CO2, and AOC2 emerged as pivotal players in the context of silicosis by modulating CD8 T cells, regulatory T cells, M0 macrophages, and neutrophils.

A cross-sectional observational study of birefringent particulates in bronchoalveolar lavage cytology in horses with equine asthma from the West v East coasts of the USA

Equine asthma (EA) is an important cause of wastage in the USA horse industry. Exposure to organic particulates, from stable dust, airborne pollen, and fungal loads, is posited to be the main cause. Dust arising from the earth's crust has been largely ignored as a contributor to EA in the veterinary literature. The objectives of this study were to investigate the occurrence of birefringent particulates in the bronchoalveolar lavage fluid (BALF) of horses with a clinical complaint of EA residing in the arid West of the USA v. the East, in an effort to determine the contribution of geolocation to geogenic dust exposure. We analyzed BALF cytology and historical data sent to our referral clinical laboratory from 148 horses from the West Coast and 233 horses from the East Coast of the USA over a 6-year period, using light microscopy to determine cell proportions and other visible elements as well as a polarizing lens to detect birefringent material. Univariate analysis showed that horses from the West coast were significantly more likely to have birefringent particulates in the BALF than horses from the East coast (40.5% v. 8.6%, p < 0.001); while horses from the East had higher BALF neutrophil proportions. Horses from the West also had lower proportions of neutrophils in the BALF than those from the East (27.1 v. 10.9, p < .001). Using historical and BAL data in a forward stepwise binary logistic regression model with presence of birefringent particulates found within alveolar macrophages as the outcome, geographical location in the West retained significance as a predictor (OR 8.0, CI [4.3-14.8], p< .001). While the birefringent particulates cannot be identified on the basis of polarizing microscopy alone, this study provides evidence that horses from the West are exposed to inorganic particulates that may contribute to signs of equine asthma.

Dose-response relationship between lung function and chest imaging response to silica exposures in artificial stone manufacturing workers

BACKGROUND

Occupational exposure to artificial stone, a popular material used for countertops, can cause accelerated silicosis, but the precise relationship between silica dose and disease development is unclear.

OBJECTIVES

This study evaluated the impact of silica exposure on lung function and chest imaging in artificial stone manufacturing workers.

METHODS

Questionnaire and spirometry assessments were administered to workers in two plants. A high-exposure subset underwent further evaluation, including chest CT and DLco. Weighting factors, assigned as proxies for silica exposure, were based on work tasks. Individual cumulative exposures were estimated using area concentration measurements and time spent in specific areas. Exposure-response associations were analyzed using linear and logistic regression models.

RESULTS

Among 65 participants, the mean cumulative silica exposure was 3.61 mg/m3-year (range 0.0001 to 44.4). Each 1 mg/m3-year increase was associated with a 0.46% reduction in FVC, a 0.45% reduction in FEV1, and increased lung function abnormality risk (aOR = 1.27, 95% CI = 1.03-1.56). Weighting factors correlated with cumulative exposures (Spearman correlation = 0.59, p < 0.0001), and weighted tenure was associated with lung function abnormalities (aOR = 1.04, 95% CI = 1.01-1.09). Of 37 high-exposure workers, 19 underwent chest CT, with 12 (63%) showing abnormal opacities. Combining respiratory symptoms, lung function, and chest X-ray achieved 91.7% sensitivity and 75% specificity for predicting chest CT abnormalities.

CONCLUSION

Lung function and chest CT abnormalities occur commonly in artificial stone workers. For high-exposure individuals, abnormalities on health screening could prompt further chest CT examination to facilitate early silicosis detection.

Characterizing Lung Particulates Using Quantitative Microscopy in Coal Miners With Severe Pneumoconiosis

CONTEXT.—

Current approaches for characterizing retained lung dust using pathologists' qualitative assessment or scanning electron microscopy with energy-dispersive spectroscopy (SEM/EDS) have limitations.

OBJECTIVE.—

To explore polarized light microscopy coupled with image-processing software, termed quantitative microscopy-particulate matter (QM-PM), as a tool to characterize in situ dust in lung tissue of US coal miners with progressive massive fibrosis.

DESIGN.—

We developed a standardized protocol using microscopy images to characterize the in situ burden of birefringent crystalline silica/silicate particles (mineral density) and carbonaceous particles (pigment fraction). Mineral density and pigment fraction were compared with pathologists' qualitative assessments and SEM/EDS analyses. Particle features were compared between historical (born before 1930) and contemporary coal miners, who likely had different exposures following changes in mining technology.

RESULTS.—

Lung tissue samples from 85 coal miners (62 historical and 23 contemporary) and 10 healthy controls were analyzed using QM-PM. Mineral density and pigment fraction measurements with QM-PM were comparable to consensus pathologists' scoring and SEM/EDS analyses. Contemporary miners had greater mineral density than historical miners (186 456 versus 63 727/mm3; P = .02) and controls (4542/mm3), consistent with higher amounts of silica/silicate dust. Contemporary and historical miners had similar particle sizes (median area, 1.00 versus 1.14 μm2; P = .46) and birefringence under polarized light (median grayscale brightness: 80.9 versus 87.6; P = .29).

CONCLUSIONS.—

QM-PM reliably characterizes in situ silica/silicate and carbonaceous particles in a reproducible, automated, accessible, and time/cost/labor-efficient manner, and shows promise as a tool for understanding occupational lung pathology and targeting exposure controls.

Accelerated silicosis in sandblasters: Pathology, mineralogy, and clinical correlates

BACKGROUND

With increasing reports of accelerated and acute silicosis, PMF, and autoimmune disease among coal miners and silica-exposed countertop workers, we present previously incompletely-described pulmonary pathology of accelerated silicosis and correlations with mineralogy, radiography, and disease progression in 46 Texas oilfield pipe sandblasters who were biopsied between 1988 and 1995.

METHODS

Worker examinations included pulmonary function tests, chest X-ray (CXR), high-resolution computed tomography (HRCT), and Gallium-67 scans. Quantitative mineralogic analysis of pulmonary parenchymal burden of silica, silicates, and metal particles used scanning electron microscopy with energy dispersive x-ray spectroscopy (SEM EDS).

RESULTS

Workers had clinical deterioration after <10 years exposure in dusty workplaces. Although initial CXR was normal in 54%, Gallium-67 scans were positive in 68% of those with normal CXR, indicating pulmonary inflammation. The histology of accelerated silicosis is diffuse interstitial infiltration of macrophages filled with weakly birefringent particles with or without silicotic nodules or alveolar proteinosis. Lung silica concentrations were among the highest in our database, showing a dose-response relationship with CXR, HRCT, and pathologic changes (macrophages, fibrosis, and silicotic nodules). Radiographic scores and diffusing capacity worsened during observation. Silica exposure was intensified, patients presented younger, with shorter exposure, more severe clinical abnormalities, higher lung particle burdens, and more rapid progression in a subset of patients exposed to recycled blasting sand.

CONCLUSIONS

Accelerated silicosis may present with a normal CXR despite significant histopathology. Multivariable analyses showed silica, and not other particles, is the driver of observed radiologic, physiologic, and histologic outcomes. Eliminating this preventable disease requires higher physician, public health, and societal awareness.

IRF4 Participates in Pulmonary Fibrosis Induced by Silica Particles through Regulating Macrophage Polarization and Fibroblast Activation

Long-term exposure to silica dust can cause silicosis, which is characterized by chronic progressive inflammatory injury, fibroblast activation, and the deposition of extracellular matrix. IRF4 is involved in immune response. However, the potential regulation of IRF4 in silicosis and pulmonary fibrosis remains largely unexplored. In this study, RNA-seq analysis identified the upregulated expression of IRF4 in fibrotic lung tissues of mice exposed to silica particles. And we verified the increased expression of IRF4 in SiO2-treated macrophages and TGF-β1-treated fibroblasts. We further found that the down-regulation of IRF4 impeded the macrophage polarization and the release of pro-fibrotic factors. Moreover, the down-regulation of IRF4 alleviated the migration, invasion, and the expression of fibrotic molecules in fibroblasts. Using ChIP-qPCR assay, we confirmed that IRF4 regulated the transcriptional activity of the IL-17A promoter, thus stimulated fibroblast activation, migration and invasion. In vivo experiment, the AAV-siIRF4 was designed to interfere with the expression of IRF4 in lung tissues of mice exposed to silica particles. Whole blood, bronchoalveolar lavage fluid and lung tissues were obtained from mice at 7, 14, 28 and 56 days after silica exposure. The results showed that the leukocyte content and inflammatory factors reached a peak at day 14 and remained peak for a long time after IRF4 knockdown. Furthermore, the fibrotic responses of mouse lung tissues were alleviated after IRF4 knockdown. Our study explored the important roles of IRF4 in inflammatory and fibrotic responses, which provided a new target for the treatment of silicosis and pulmonary fibrosis.

Occupational interstitial lung diseases

Millions of workers are exposed to substances known to cause occupational interstitial lung diseases (ILDs), particularly in developing countries. However, the burden of the disease is likely to be underestimated due to under-recognition, under-reporting or both. The diagnosis of occupational ILD requires a high level of suspicion and a thorough occupational history, as occupational and non-occupational ILDs may be clinically, functionally and radiologically indistinguishable, leading to delayed diagnosis and inappropriate management. A potential occupational aetiology should always be considered in the differential diagnosis of ILD, as removal from the workplace exposure, with or without treatment, is a key therapeutic intervention and may lead to significant improvement. In this article, we provide an overview of the 'traditional' inorganic dust-related ILDs but also address idiopathic pulmonary fibrosis and the immunologically mediated chronic beryllium disease, sarcoidosis and hypersensitivity pneumonitis, with emphasis on the importance of surveillance and prevention for reducing the burden of these conditions. To this end, health-care professionals should be specifically trained about the importance of occupational exposures as a potential cause of ILD.

Suspension characteristics of the coal-quartz dust mixture in the working environment during the fully mechanized mining process

Dust exposures during mining activity can result in lung diseases such as coal workers' pneumoconiosis (CWP) and silicosis, and it is closely related to quartz dust. In the present study, coal-quartz dust mixture were investigated considering the particle size and the specific constituents. Multiple numerical techniques, including computational fluid dynamics and discrete element method (CFD-DEM), hard sphere model, and direct Monte Carlo simulation (DSMC), were presented, and the dust diffusion processes were investigated. According to the validation of the numerical method, the suspension characteristics of the polydisperse mixed dust were analyzed in detail. The results show that PM10 responds quickly, has a large diffusion range, and is easily affected by the reflux. The particle size increases gradually from top to bottom. When the air velocity is low, the percentage of coal dust in the breathing zone tends to be 50%. The results provide theoretical guidance for the comprehensive prevention of the mixed dust in underground coal mines.

Ac-SDKP promotes KIF3A-mediated β-catenin suppression through a ciliary mechanism to constrain silica-induced epithelial-myofibroblast transition

Kinesin family member 3 A (KIF3A) decrease have been reported in silicotic patients and rats. However, the detailed mechanisms of KIF3A in silicosis remain unknown. In this study, we demonstrated that KIF3A effectively blocked the expression of β-catenin and downstream myocardin-related transcription factor (MRTF)-A/serum response factor (SRF) signaling, thus inhibiting silica-induced epithelial-myofibroblast transition (EMyT). Moreover, KIF3A was identified as a downstream mediator of an antifibrotic tetrapeptide N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP). Knockdown of KIF3A expression reactivated β-catenin/myocardin-related transcription factor (MRTF)-A/serum response factor (SRF) signaling that was attenuated by Ac-SDKP in vitro. Collectively, our findings suggest that Ac-SDKP plays its anti-fibrosis role via KIF3A-mediated β-catenin suppression, at least in part, in both in vivo model of silicosis and in vitro model of EMyT.

Historical shift in pathological type of progressive massive fibrosis among coal miners in the USA

BACKGROUND

Pneumoconiosis among coal miners in the USA has been resurgent over the past two decades, despite modern dust controls and regulatory standards. Previously published studies have suggested that respirable crystalline silica (RCS) is a contributor to this disease resurgence. However, evidence has been primarily indirect, in the form of radiographic features.

METHODS

We obtained lung tissue specimens and data from the National Coal Workers' Autopsy Study. We evaluated specimens for the presence of progressive massive fibrosis (PMF) and used histopathological classifications to type these specimens into coal-type, mixed-type and silica-type PMF. Rates of each were compared by birth cohort. Logistic regression was used to assess demographic and mining characteristics associated with silica-type PMF.

RESULTS

Of 322 cases found to have PMF, study pathologists characterised 138 (43%) as coal-type, 129 (40%) as mixed-type and 55 (17%) as silica-type PMF. Among earlier birth cohorts, coal-type and mixed-type PMF were more common than silica-type PMF, but their rates declined in later birth cohorts. In contrast, the rate of silica-type PMF did not decline in cases from more recent birth cohorts. More recent year of birth was significantly associated with silica-type PMF.

CONCLUSIONS

Our findings demonstrate a shift in PMF types among US coal miners, from a predominance of coal- and mixed-type PMF to a more commonly encountered silica-type PMF. These results are further evidence of the prominent role of RCS in the pathogenesis of pneumoconiosis among contemporary US coal miners.

Silicosis, asbestosis, and pulmonary fibrosis in Ontario, Canada from 1996 to 2019

BACKGROUND

Silicosis is a fibrotic lung disease caused by exposure to respirable crystalline silica. Historically, silicosis was common among miners and other professions in the 20th century, and in recent decades has re-emerged in coal mining and appeared in new workplaces, including the manufacture of distressed jeans and artificial stone countertops.

METHODS

Physician billing data for the province of Ontario between 1992 and 2019 were analyzed across six time-periods (1993-1995, 1996-2000, 2001-2005, 2006-2010, 2011-2015, and 2016-2019). The case definition was two or more billing records within 24 months with a silicosis diagnosis code (ICD-9 502, ICD-10 J62). Cases from 1993 to 1995 were excluded as prevalent cases. Crude incidence rates per 100,000 persons were calculated by time-period, age, sex, and region. Analyses were repeated in parallel for pulmonary fibrosis (PF) (ICD-9 515, ICD-10 J84) and asbestosis (ICD-9 501; ICD-10 J61).

RESULTS

From 1996 to 2019, 444 cases of silicosis, 2719 cases of asbestosis and 59,228 cases of PF were identified. Silicosis rates decreased from 0.42 cases per 100,000 in 1996-2000 to 0.06 per 100,000 people in 2016-2019. A similar trend was observed for asbestosis (1.66 to 0.51 per 100,000 persons) but the incidence rate of PF increased from 11.6 to 33.9 per 100,000 persons. Incidence rates for all outcomes were higher among men and older adults.

CONCLUSIONS

A decreasing incidence of silicosis was observed in this analysis. However, the incidence of PF increased, consistent with findings from other jurisdictions. While cases of silicosis have been recorded among artificial stone workers in Ontario these cases do not seem to have impacted the population rates thus far. Ongoing, periodic surveillance of occupational diseases is helpful for tracking population-level trends over time.

Imaging diagnosis of pneumoconiosis with predominant nodular pattern: HRCT and pathologic findings

The radiological patterns of known pneumoconiosis have been changing in recent years. The basic pathology in pneumoconiosis is the presence of dust macules, mixed dust fibrosis, nodules, diffuse interstitial fibrosis, and progressive massive fibrosis. These pathologic changes can coexist in dust-exposed workers. High resolution CT reflects pathological findings in pneumoconiosis and is useful for the diagnosis. Pneumoconiosis such as silicosis, coal workers' pneumoconiosis, graphite pneumoconiosis, and welder's pneumoconiosis, has predominant nodular HRCT pattern. Diffuse interstitial pulmonary fibrosis is sometimes found in the lungs of this pneumoconiosis. In the early stages of metal lung, such as aluminosis and hard metal lung, centrilobular nodules are predominant findings, and in the advanced stages, reticular opacities are predominant findings. The clinician must understand the spectrum of expected imaging patterns related to known dust exposures and novel exposures. In this article, HRCT and pathologic findings of pneumoconiosis with predominant nodular opacities are shown.

Pneumoconiosis combined with connective tissue disease in China: a cross-sectional study

OBJECTIVE

To describe the prevalence, clinical features and potential risk factors of pneumoconiosis in combination with connective tissue disease (CTD) or positive autoantibodies.

DESIGN

Cross-sectional study.

SETTING

A retrospective study of adults recruited in China between December 2016 and November 2021.

PARTICIPANTS

A total of 931 patients with pneumoconiosis at Beijing Chao-Yang Hospital were enrolled in this study; of these, 580 patients were included in the final analysis.

MAIN OUTCOME MEASURES

Pneumoconiosis combined with CTD or positive autoantibodies was a major adverse outcome.

RESULTS

In total, 13.8% (80/580) of the patients had combined pneumoconiosis with CTD, among whom the prevalence of CTD was 18.3% (46/251) in asbestosis and 11.4% (34/298) in silicosis/coal mine workers' pneumoconiosis. In comparison to the general Chinese adult population, the relative risk of various CTD in pneumoconiosis, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, primary Sjögren's syndrome, idiopathic inflammatory myopathy and antineutrophil cytoplasmic antibodies-associated vasculitis, were 11.85, 12.12, 127.40, 4.23, 9.94 and 644.66, respectively. Multivariate analysis revealed that female sex (OR 2.55, 95% CI 1.56 to 4.17) and a later stage of pneumoconiosis (OR 2.04, 95% CI 1.24 to 3.34) were the independent risk factors for CTD in patients with pneumoconiosis (all p<0.050).

CONCLUSION

CTD is highly prevalent in patients with pneumoconiosis, especially in patients of asbestosis, and silicosis/coal mine workers' pneumoconiosis. Female sex and later stages of pneumoconiosis are associated with an increased risk of combined with CTD.

Investigation of respirable coal mine dust (RCMD) and respirable crystalline silica (RCS) in the U.S. underground and surface coal mines

Dust is an inherent byproduct of mining activities that raises notable health and safety concerns. Cumulative inhalation of respirable coal mine dust (RCMD) and respirable crystalline silica (RCS) can lead to obstructive lung diseases. Despite considerable efforts to reduce dust exposure by decreasing the permissible exposure limits (PEL) and improving the monitoring techniques, the rate of mine workers with respiratory diseases is still high. The root causes of the high prevalence of respiratory diseases remain unknown. This study aimed to investigate contributing factors in RCMD and RCS dust concentrations in both surface and underground mines. To this end, a data management approach is performed on MSHA's database between 1989 and 2018 using SQL data management. In this process, all data were grouped by mine ID, and then, categories of interests were defined to conduct statistical analysis using the generalized estimating equation (GEE) model. The total number of 12,537 and 9050 observations for respirable dust concentration are included, respectively, in the U.S. underground and surface mines. Several variables were defined in four categories of interest including mine type, geographic location, mine size, and coal seam height. Hypotheses were developed for each category based on the research model and were tested using multiple linear regression analysis. The results of the analysis indicate higher RCMD concentration in underground compared to RCS concentration which is found to be relatively higher in surface coal mines. In addition, RCMD concentration is seen to be higher in the Interior region while RCS is higher in the Appalachia region. Moreover, mines of small sizes show lower RCMD and higher RCS concentrations. Finally, thin-seam coal has greater RCMD and RCS concentrations compared to thicker seams in both underground and surface mines. In the end, it is demonstrated that RCMD and RCS concentrations in both surface and underground mines have decreased. Therefore, further research is needed to investigate the efficacy of the current mass-concentration-based monitoring system.

Exosomal miRNAs contribute to coal dust particle-induced pulmonary fibrosis in rats

Coal workers' pneumoconiosis (CWP) is a fatal occupational disease caused by inhalation of coal dust particles, which leads to progressive pulmonary fibrosis. Recently, as new signal carriers for intercellular communication, exosomal miRNAs have been validated in the pathogenesis of multiple diseases. However, the research on exosomal miRNAs in CWP is still in the preliminary stage. Here, using miRNA sequencing, exosomal miRNA profiles in bronchoalveolar lavage fluid (BALF) from rats with pulmonary fibrosis induced by coal dust particles were analyzed, and the underlying biological function of putative target genes was explored by GO term analysis and KEGG pathway enrichment analysis. According to the results, intratracheal instillation of coal dust particles can alter the exosomal miRNAs expression in the BALF of rats. Further bioinformatics analysis provided some clues to reveal their function in pathological process of pneumoconiosis. More importantly, we identified 4 differentially expressed exosomal miRNAs (miRNA-21-5p, miRNA-29a-3p, miRNA-26a-5p, and miRNA-34a-5p) by qRT‑PCR and further verified the temporal changes in the expression of these exosomal miRNAs in animal models from 2 weeks to 16 weeks postexposure. In addition, we conducted a preliminary study on Smad7 as a potential target of miRNA-21-5p and found that exosomal miRNA 21-5p/Smad7 may contribute to the pulmonary fibrosis induced by coal dust particles. Our study confirmed the contribution of exosomal miRNAs to coal dust particle-induced pulmonary fibrosis and provided new insights into the pathogenesis of CWP.

Inhalational lung diseases

The term inhalational lung disease comprises a group of entities that develop secondary to the active aspiration of particles. Most are occupational lung diseases. Inhalational lung diseases are classified as occupational diseases (pneumoconiosis, chemical pneumonitis), hypersensitivity pneumonitis, and electronic-cigarette-associated lung diseases. The radiologic findings often consist of nonspecific interstitial patterns that can be difficult to interpret. Therefore, radiologists' experience and multidisciplinary teamwork are key to ensure correct evaluation. The role of the radiologist is fundamental in preventive measures as well as in diagnosis and management, having an important impact on patients' overall health. It is crucial to take into account patients' possible exposure to particles both at work and at home.

Postexposure progression of pneumoconiosis among former Appalachian coal miners

BACKGROUND

The prevalence of pneumoconiosis among working United States underground coal miners has been increasing for the past two decades, with the highest rates of disease observed among miners in the central Appalachian states of Kentucky, Virginia, and West Virginia. Surveillance for this disease in the United States focuses on working coal miners, who continue to be occupationally exposed to dust. This study examines the radiographic evidence for postexposure progression of pneumoconiosis in a population of former coal miners no longer occupationally exposed to coal mine dust who were seen at a community radiology clinic in eastern Kentucky.

METHODS

Data were obtained and analyzed from clinical records of former coal miners who had a clinic encounter during January 1, 2017-August 1, 2019, a recorded final year of employment, and ≥2 postemployment digital chest radiographs. Radiographs were classified according to the International Labour Office guidelines by at least two B Readers. A final summary pneumoconiosis severity score (range, 0-13), accounting for both small and large opacities, was assigned to each chest radiograph. Progression was defined as an increase in severity score between a miner's radiographs over time.

RESULTS

Data for 130 former coal miners were analyzed. All miners were male and most (n = 114, 88%) had worked primarily in Kentucky. Information on race/ethnicity was not available. The most common job types were roof bolters (n = 51, 39%) and continuous miner operators (n = 46, 35%). Forty-one (31.5%) miners had evidence of radiographic disease progression after leaving the workforce, with a median of 3.6 years between first and latest postretirement radiograph. A total of 80 (62%) miners had evidence of pneumoconiosis on their latest radiograph, and two-thirds (n = 53) of these were classified as progressive massive fibrosis (PMF), the most severe form of the disease.

CONCLUSIONS

Postexposure progression can occur in former coal miners, emphasizing the potential benefits of continued radiographic follow-up postemployment. In addition to participating in disease screening throughout their careers to detect pneumoconiosis early and facilitate intervention, radiographic follow-up of former coal miners can identify new or progressive radiographic findings even after workplace exposure to respirable coal mine dust ends. Identification of progressive pneumoconiosis in former miners has potential implications for clinical management and eligibility for disability compensation.

Progressive massive fibrosis: An overview of the recent literature

This review provides an overview of literature addressing progressive massive fibrosis (PMF) from September 2009 to the present. Advances are described in understanding its pathophysiology, epidemiology of the occurrence of PMF and related conditions, the impact of PMF on pulmonary function, advances in imaging of PMF, and factors affecting progression of pneumoconiosis in dust-exposed workers to PMF. Basic advances in understanding the etiology of PMF are impeded by the lack of a well-accepted animal model for human PMF. Recent studies evaluating lung tissue samples and epidemiologic investigations support an important role for the silica component of coal mine dust in causing coal workers' pneumoconiosis and PMF in contemporary coal miners in the United States and for silica in causing silicosis and PMF in artificial stone workers throughout the world. Development of PMF is associated with substantial decline in pulmonary function relative to no disease or small opacity pneumoconiosis. In recent reports, computed tomography has had greater sensitivity for detecting PMF than chest x-ray. Magnetic resonance imaging shows promise in differentiating between PMF and lung cancer. Although PMF develops in dust-exposed workers without previously identified small opacity pneumoconiosis, the presence of small opacity pneumoconiosis increases the risk for progression to PMF, as does heavier dust exposure. Recent literature does not document any effective new treatments for PMF and new therapies to prevent and treat PMF are an important need.

Thermogravimetric analysis of respirable coal mine dust for simple source apportionment

Resurgence of coal mine dust lung diseases in the central Appalachian region of the United States and elsewhere has spurred a range of efforts to better understand respirable coal mine dust (RCMD) exposures and sources. Thermogravimetric analysis (TGA) of RCMD samples can enable the dust mass to be fractionated into three main components: coal, non-carbonate minerals, and carbonates. These are expected to approximate, respectively, the three primary dust sources in many underground mines: the coal seam being mined, the surrounding rock strata (i.e., typically dominated by non-carbonate minerals) being drilled or mined along with the coal, and the rock dust products (i.e., typically made from carbonate-rich limestone or dolostone) being applied in the mine to mitigate explosibility hazards. As proof of concept, TGA was applied to respirable dust samples that were laboratory-generated from real source materials representing 15 mines. Except in the case of two mines, compositional results were generally consistent with expectations. TGA was also applied to RCMD samples collected in standard locations of 23 mines (including the 15 mines represented by the dust source materials). Results showed significantly different compositions with respect to sampling location and geographic region (i.e., within and outside of central Appalachia). To further interpret the RCMD results, a simple source apportionment model was built using the dust compositions yielded from the source materials analysis. Model results indicated that, on average, about twice as much dust was sourced from mining into rock strata than from mining the target coal seam. This finding is particularly important for mines extracting relatively large amounts of rock along with the coal or for mines that frequently encounter high-silica rock strata.

Elucidation of alveolar macrophage cell response to coal dusts: Role of ferroptosis in pathogenesis of coal workers' pneumoconiosis

Causal factors underlying coal workers' pneumoconiosis (CWP) have been variously attributed to the presence of carbon, crystalline silica and reduced iron (Fe) minerals, especially pyrite and Fe/Si-amorphous compounds. The aim of this research was to assess the role of iron in CWP and, more specifically, the cytotoxicity of coal dusts with different elemental composition towards alveolar macrophages (AMs). Survival rate of AMs, alteration in the production of pro-inflammatory cytokine TNF-α, MDA (the lipid peroxidation product) and intracellular GSH were assessed using commercial assay kits. The quantitative interaction between iron and GSH was investigated by developing a numerical model. The presence of various reduced Fe minerals (viz. pyrite and siderite) in coal dusts exhibited a consistently acute adverse impact on the viability of AMs and enhanced the production of TNF-α. The presence of the clinically available Fe chelator deferiprone (DFP) and the cytosolic antioxidant glutathione (GSH) significantly increased the viability of AMs exposed to Fe bearing coal dusts, suggesting coal dusts containing reduced Fe minerals were likely contributors to the initial stages of AM cytotoxicity via a ferroptosis related pathway. Chemical kinetic modeling indicated that these results may be attributed to an enhanced consumption of GSH as a result of Fe redox cycling. Fe^IIGSH and GS^• produced from the interaction between ferric Fe and GSH facilitated the production of O₂^•- which further oxidized GSH via a direct reaction between GSH and GS^• or GSO^•. These results suggest that coal dusts containing reduced Fe minerals and Fe compounds may elevate acute inflammation levels in AMs, indicating that crystalline silica may not be the only hazard of concern in mining environments.

Pathology and Mineralogy Demonstrate Respirable Crystalline Silica is a Major Cause of Severe Pneumoconiosis in US Coal Miners

Rationale

The reasons for resurgent coal workers’ pneumoconiosis and its most severe forms, rapidly progressive pneumoconiosis and progressive massive fibrosis (PMF), in the United States are not yet fully understood.

Objectives

To compare the pathologic and mineralogic features of contemporary coal miners with severe pneumoconiosis with those of their historical counterparts.

Methods

Lung pathology specimens from 85 coal miners with PMF were included for evaluation and analysis. We compared the proportion of cases with pathologic and mineralogic findings in miners born between 1910 and 1930 (historical) with those in miners born in or after 1930 (contemporary).

Results

We found a significantly higher proportion of silica-type PMF (57% vs. 18%; P < 0.001) among contemporary miners compared with their historical counterparts. Mineral dust alveolar proteinosis was also more common in contemporary miners compared with their historical counterparts (70% vs. 37%; P < 0.01). In situ mineralogic analysis showed that the percentage (26.1% vs. 17.8%; P < 0.01) and concentration (47.3 × 10⁸ vs. 25.8 × 10⁸ particles/cm³; P = 0.036) of silica particles were significantly greater in specimens from contemporary miners compared with their historical counterparts. The concentration of silica particles was significantly greater when silica-type PMF, mineral dust alveolar proteinosis, silicotic nodules, or immature silicotic nodules were present (P < 0.05).

Conclusions

Exposure to respirable crystalline silica appears causal in the unexpected surge of severe disease in contemporary miners. Our findings underscore the importance of controlling workplace silica exposure to prevent the disabling and untreatable adverse health effects afflicting U.S. coal miners.

Impact of reactive iron in coal mine dust on oxidant generation and epithelial lung cell viability

Coal workers' pneumoconiosis (CWP) is a preventable occupational lung disease caused by the chronic inhalation of coal mine dust. The inhalation of coal mine dusts can result in the development of a range of lung diseases termed coal mine dust lung diseases, which is not limited to CWP and includes silicosis, bronchitis, emphysema and cancer. For decades, the presence of elemental Fe, C and Si has been proposed to be the causal factors underlying CWP. The recent resurgence of CWP globally with examination of cases in the United States suggesting a potential but inconclusive role of Fe(II)-sulfide minerals. To obtain a better understanding of Australian coals, the existence and potential adverse impacts of iron minerals were examined using 24 representative Australian coal samples. The results of this work revealed that reduced iron minerals were widely distributed within samples obtained from Australian coal mines with pyrite and siderite being particularly abundant. Compared with carbon and crystalline silica, the presence of these specific iron minerals were negatively correlated to the viability of both alveolar macrophages (NR8383) and human lung epithelial cells (A549) (R² = 0.689) under scenarios reflecting biologically-relevant inflammatory response conditions. Further analysis using Welch's unpaired t-test indicated that the presence of reduced iron minerals statistically enhanced acellular oxidant production (90% CI [0.74 to 2.55]) and inflammatory response (90% CI [0.15 to 36.96]). Compared with Fe(II)-hydroxide, Fe(II)- and Fe(III)-(phyllo)silicate and Fe(II)-sulfate mineralogies, pyrite and siderite bearing dusts are likely to have greater adverse impacts on epithelial lung cells under inflammatory response conditions in view of both their iron content and reactivity.

Sarcoid-like Granulomatous Lung Disease with Subacute Progression in Silicosis

A 67-year-old man was admitted to our hospital with cough and fatigue. He had had long-term exposure to silica due to cement processing. Chest computed tomography showed bilateral centrilobular nodules, and hilar and mediastinal lymphadenopathy with calcification, suggesting chronic silicosis. Within a few months, these nodules enlarged, and bilateral patchy consolidations appeared. A lung biopsy revealed sarcoid-like granulomas with birefringent particles under polarized light without malignancy or infection. He was diagnosed with silicosis-associated sarcoid-like granulomatous lung disease, rather than sarcoidosis, according to the clinicopathological findings. His pulmonary manifestations improved after the discontinuation of silica exposure and combination therapy of corticosteroid and azathioprine.

Dusty trades and associated rheumatoid arthritis in a population-based study in the coal mining counties of Appalachia

OBJECTIVES

We previously showed increased coal mining-associated risk of rheumatoid arthritis (RA). Using additional survey data, we sought to delineate this risk further.

METHODS

We used data from two cross-sectional, random-digit-dial, population-based surveys (males;≥50 years) in selected counties in the Appalachian region of the inland, mid-Atlantic USA with elevated pneumoconiosis mortality. Surveys ascertained age, smoking, coal mining and non-coal silica exposure jobs. In a subset, we surveyed ergonomic exposures, scored by intensity. We queried diagnosis of RA, corticosteroid use, and, in a subset, use of disease modifying antirheumatic drugs (DMARDs). Multivariable logistic regression modelled RA risk (defined by glucocorticoid or DMARDs use) associated with coal mining employment, other silica exposure, smoking status, and age and ergonomic exposures.

RESULTS

We analysed data for 2981 survey respondents (mean age 66.6 years; 15% current, 44% ex-smokers). The prevalence of glucocorticoid-treated and DMARD-treated RA was 11% and 4%, respectively. Glucocorticoid-treated RA was associated with coal mining (OR 3.5; 95% CI 2.5 to 4.9) and non-coal mining silica exposure (OR 3.2; 95% CI 2.4 to 4.4). For DMARD-treated RA, the odds associated with coal mining and other silica remained elevated: OR 2.3 (95% CI 1.18, 4.5) and OR 2.7 (95% CI 1.51, 5.0), respectively. In the same model, the highest intensity ergonomic exposure also was associated with increased odds of RA (OR 4.3; 95% CI 1.96 to 9.6).

CONCLUSIONS

We observed a strong association between coal mining and other silica-exposing dusty trades and RA. Clinicians and insurers should consider occupational histories in the aetiology of RA.

Coal mine dust lung disease in miners killed in the Upper Big Branch disaster: a review of lung pathology and contemporary respirable dust levels in underground US coal mines

OBJECTIVES

In 2010, 29 coal miners died due to an explosion at the Upper Big Branch (UBB) mine in West Virginia, USA. Autopsy examinations of 24 individuals with evaluable lung tissue identified 17 considered to have coal workers' pneumoconiosis (CWP). The objectives of this study were to characterise histopathological findings of lung tissue from a sample of UBB fatalities and better understand the respirable dust concentrations experienced by these miners at UBB relative to other US coal mines.

METHODS

Occupational pulmonary pathologists evaluated lung tissue specimens from UBB fatalities for the presence of features of pneumoconiosis. Respirable dust and quartz samples submitted for regulatory compliance from all US underground coal mines prior to the disaster were analysed.

RESULTS

Families of seven UBB fatalities provided consent for the study. Histopathologic evidence of CWP was found in all seven cases. For the USA, central Appalachia and UBB, compliance dust samples showed the geometric mean for respirable dust was 0.468, 0.420 and 0.518 mg/m³, respectively, and respirable quartz concentrations were 0.030, 0.038 and 0.061 mg/m³. After adjusting for quartz concentrations, UBB exceeded the US permissible exposure limit (PEL) for respirable dust in 28% of samples.

CONCLUSIONS

Although higher than average respirable dust and quartz levels were observed at UBB, over 200 US underground coal mines had higher dust concentrations than UBB and over 100 exceeded the PEL more frequently. Together with lung histopathological findings among UBB fatalities, these data suggest exposures leading to CWP in the USA are more prevalent than previously understood.

Compositional and structural analysis of engineered stones and inorganic particles in silicotic nodules of exposed workers

Background

Engineered stone silicosis is an emerging disease in many countries worldwide produced by the inhalation of respirable dust of engineered stone. This silicosis has a high incidence among young workers, with a short latency period and greater aggressiveness than silicosis caused by natural materials. Although the silica content is very high and this is the key factor, it has been postulated that other constituents in engineered stones can influence the aggressiveness of the disease. Different samples of engineered stone countertops (fabricated by workers during the years prior to their diagnoses), as well as seven lung samples from exposed patients, were analyzed by multiple techniques.

Results

The different countertops were composed of SiO₂ in percentages between 87.9 and 99.6%, with variable relationships of quartz and cristobalite depending on the sample. The most abundant metals were Al, Na, Fe, Ca and Ti. The most frequent volatile organic compounds were styrene, toluene and m-xylene, and among the polycyclic aromatic hydrocarbons, phenanthrene and naphthalene were detected in all samples. Patients were all males, between 26 and 46 years-old (average age: 36) at the moment of the diagnosis. They were exposed to the engineered stone an average time of 14 years. At diagnosis, only one patient had progressive massive fibrosis. After a follow-up period of 8 ± 3 years, four patients presented progressive massive fibrosis. Samples obtained from lung biopsies most frequently showed well or ill-defined nodules, composed of histiocytic cells and fibroblasts without central hyalinization. All tissue samples showed high proportion of Si and Al at the center of the nodules, becoming sparser at the periphery. Al to Si content ratios turned out to be higher than 1 in two of the studied cases. Correlation between Si and Al was very high (r = 0.93).

Conclusion

Some of the volatile organic compounds, polycyclic aromatic hydrocarbons and metals detected in the studied countertop samples have been described as causative of lung inflammation and respiratory disease. Among inorganic constituents, aluminum has been a relevant component within the silicotic nodule, reaching atomic concentrations even higher than silicon in some cases. Such concentrations, both for silicon and aluminum showed a decreasing tendency from the center of the nodule towards its frontier.

Development of a new method for isolation of urban air particulates deposited in the human lung tissue

Particulate matters (PMs) are important pollutants in urban air pollution because of their variable composition. The pulmonary clearance of PMs is critical to prevent long-term immunological responses. This study established a new method for the isolation of probably deposited urban air particulates from the human lung tissue, to investigate the features of uncleared particulates. The lung samples were acellularized with SDS solution of various concentrations ranging from 1 to 10%to lyse cells and release the PMs. In addition, the extracellular matrix (ECM) that remained was digested by proteinase K enzyme. The results of this study demonstrated that an SDS solution of 4% is the optimum concentration for the isolation of settled PMs from the lung tissue. Moreover, the used enzymatic method could separate settled PMs from the lung ECM appropriately. The results exhibited that epithelial cells form 46% of the samples' weight on average, whereas just 20% of isolated PMs were found in this part of the tissue. Both groups of separated PMs tend to agglomerate, but it is significantly higher in cellular isolated PMs. The particles separated from ECM have an agglomeration tendency, which is observable only by FE-SEM imaging. Moreover, we found a major part of urban air PMs deposited in ECM. The established method in this study can be used in future investigations to isolate other types of PMs settled in the lung, such as occupationally inhaled carbonaceous particulates.

Lung Disease in Central Appalachia: It's More than Coal Dust that Drives Disparities

The population living in Central Appalachia is disproportionately impacted by lung disease. This is driven, in part, by occupational hazards and environmental exposures. However, it is more than coal dust that is driving the ongoing disparity of lung disease in the region. This review describes how the decline of the coal mine industry and subsequent rise of unemployment, poverty, and educational disparities have increased risk for worse pulmonary health outcomes in the region. Additional challenges related to healthcare access, substance use, cultural characteristics, and social capital are highlighted in their relation to pulmonary health within Central Appalachia. Lastly, the review describes strategies that hold promise to reduce regional health disparities. Several healthcare and community-centered initiatives are highlighted as successful examples of collaborative efforts working towards improving pulmonary health outcomes in the region. However, significant challenges related to social, economic, and environmental factors remain. Addressing these social determinants of health must be a paramount concern for healthcare, community and political leaders seeking to impact change and improve the health and well-being of this vulnerable population.

miR-138 inhibits epithelial-mesenchymal transition in silica-induced pulmonary fibrosis by regulating ZEB2

Silica dust is a common pollutant in the occupational environment, such as coal mines. Inhalation of silica dust can cause progressive pulmonary fibrosis and then silicosis. Silicosis is still one of the most harmful occupational diseases in the world, so the study of its pathogenesis is necessary for the treatment of silicosis. In this study, we constructed a mouse model of pulmonary fibrosis via intratracheal instillation of silica particles and identified the decreased expression of miR-138 in fibrotic lung tissues of mice. Moreover, the overexpression of miR-138 retarded the process of epithelial-mesenchymal transition (EMT) in a mouse model of silica particles exposure and epithelial cells stimulated by silica particles. Further studies showed that ZEB2 was one of the potential targets of miR-138, and the up-regulation of miR-138 reduced ZEB2 levels in mouse lung tissues and in epithelial cells. We next found that the expression levels of ɑ-SMA and Vimentin were significantly increased and E-cadherin levels were decreased after transfection with miR-138 inhibitor in epithelial cells. However, these effects were abated by the knockdown of ZEB2. Consistently, the increased migration ability of epithelial cells by miR-138 inhibitor transfection was also reversed by the knockdown of ZEB2. Collectively, we revealed that miR-138 significantly targeted ZEB2, thus inhibited the EMT process and mitigated the development of pulmonary fibrosis. miR-138 may be a potential target for the treatment of pulmonary fibrosis.

Diagnosis and Management of Fibrotic Interstitial Lung Diseases

Nonidiopathic pulmonary fibrosis (non-IPF) progressive fibrotic interstitial lung diseases (PF-ILDs) are a heterogeneous group of ILDs, often challenging to diagnose, although an accurate diagnosis has significant implications for both treatment and prognosis. A subgroup of these patients experiences progressive deterioration in lung function, physical performance, and quality of life after conventional therapy. Risk factors for ILD progression include older age, lower baseline pulmonary function, and a usual interstitial pneumonia pattern. Management of non-IPF P-ILD is both pharmacologic and nonpharmacologic. Antifibrotic drugs, originally approved for IPF, have been considered in patients with other fibrotic ILD subtypes, with favorable results in clinical trials.

Silica dust exposure induces pulmonary fibrosis through autophagy signaling

Silicosis is a well-acknowledged occupational lung disease caused by inhalation of a large amount of free silica dust during the production period and eventually a considerable negative impact on the patients' quality of life. Autophagy exerts a critical influence on immune and inflammatory responses during the pathogenesis of pulmonary fibrosis. In this study, we sought to determine whether autophagy is involved in silicosis's pathogenesis and how it may affect pulmonary cellular physiology. In the animal experiments, we found persistent activation of autophagy in the development of pulmonary fibrosis, which was also accompanied by tumor necrosis factor and transforming growth factor expression increased. Therefore, the autophagy signaling pathway may regulate the inflammatory response and affect the progression of fibrosis. Further, in vitro experiments, we used LY294002, RAPA, and N-acetylcysteine (NAC) intervened autophagy. Our results showed that PI3K/Akt/mTOR signaling pathway is involved in the autophagy changed mediated by SiO₂ exposed, and autophagy might play a protective role in the progression of pulmonary fibrosis. Additionally, NAC's effect is not apparent on SiO₂ -mediated autophagy through the PI3K/Akt/mTOR signaling pathway, but it can reduce the inflammatory response on NR8383 cells mediated by SiO2-exposed. Nevertheless, it's interesting that NAC can reduce the inflammatory response on NR8383 cells mediated by SiO₂ -exposed. Taken together, our data demonstrated that SiO₂ -exposed can induce pulmonary fibrosis along with autophagy both in vivo and in vitro, NAC could alleviate the inflammatory response NR8383 cells by SiO₂ -exposed through non PI3K/Akt/mTOR signaling pathway, and the specific mechanism of its action needs further studying.

Respirable Coal Mine Dust: A Review of Respiratory Deposition, Regulations, and Characterization

In the late 1990s, despite years of efforts to understand and reduce coal worker’s pneumoconiosis (CWP) prevalence from more than 30% in 1970 to less than 4.2%, the level of occurrence among the US coal miners increased unexpectedly. The recent resurgence of lung diseases has raised concerns in the scientific and regulatory communities. In 2014, the United States Mine Safety and Health Administration (MSHA) issued a new dust rule changing the respirable coal mine dust (RCMD) exposure limits, measurement technology, and sampling protocol. The analysis for probable causes for the substantial increase in the CWP incidence rate is rather complicated. This paper aims to conduct a review of RCMD respiratory deposition, health effects, monitoring, regulations, and particle characteristics. The primary sources of RCMD along with the health risks from potential exposure are highlighted, and the current RCMD exposure regulations of the major coal producer countries are compared. A summary of RCMD characterization studies from 1972 to the present is provided. A review of the literature revealed that numerous factors, including geological and mining parameters, advancements in mining practices, particle characteristics, and monitoring approaches are considered to contribute to the recent resurgence of RCMD lung diseases. However, the root causes of the problem are still unknown. The effectiveness of the new dust rules in the United States will probably take years to be correctly assessed. Therefore, future research is needed to understand the relationship between RCMD particle characteristics and lung deposition, and the efficacy of current monitoring practices to measure the true dose of RCMD exposure.

Educational Case: Pneumoconiosis

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.¹.

Review of Respirable Coal Mine Dust Characterization for Mass Concentration, Size Distribution and Chemical Composition

Respirable coal mine dust (RCMD) exposure is associated with black lung and silicosis diseases in underground miners. Although only RCMD mass and silica concentrations are regulated, it is possible that particle size, surface area, and other chemical constituents also contribute to its adverse health effects. This review summarizes measurement technologies for RCMD mass concentrations, morphology, size distributions, and chemical compositions, with examples from published efforts where these methods have been applied. Some state-of-the-art technologies presented in this paper have not been certified as intrinsically safe, and caution should be exerted for their use in explosive environments. RCMD mass concentrations are most often obtained by filter sampling followed by gravimetric analysis, but recent requirements for real-time monitoring by continuous personal dust monitors (CPDM) enable quicker exposure risk assessments. Emerging low-cost photometers provide an opportunity for a wider deployment of real-time exposure assessment. Particle size distributions can be determined by microscopy, cascade impactors, aerodynamic spectrometers, optical particle counters, and electrical mobility analyzers, each with unique advantages and limitations. Different filter media are required to collect integrated samples over working shifts for comprehensive chemical analysis. Teflon membrane filters are used for mass by gravimetry, elements by energy dispersive X-ray fluorescence, rare-earth elements by inductively coupled plasma-mass spectrometry and mineralogy by X-ray diffraction. Quartz fiber filters are analyzed for organic, elemental, and brown carbon by thermal/optical methods and non-polar organics by thermal desorption-gas chromatography-mass spectrometry. Polycarbonate-membrane filters are analyzed for morphology and elements by scanning electron microscopy (SEM) with energy dispersive X-ray, and quartz content by Fourier-transform infrared spectroscopy and Raman spectroscopy.

Pneumoconiosis: current status and future prospects

ABSTRACT

Pneumoconiosis refers to a spectrum of pulmonary diseases caused by inhalation of mineral dust, usually as the result of certain occupations. The main pathological features include chronic pulmonary inflammation and progressive pulmonary fibrosis, which can eventually lead to death caused by respiratory and/or heart failure. Pneumoconiosis is widespread globally, seriously threatening global public health. Its high incidence and mortality lie in improper occupational protection, and in the lack of early diagnostic methods and effective treatments. This article reviews the epidemiology, safeguard procedures, diagnosis, and treatment of pneumoconiosis, and summarizes recent research advances and future research prospects.

Imaging diagnosis of classical and new pneumoconiosis: predominant reticular HRCT pattern

Our understanding of the manifestations of pneumoconioses is evolving in recent years. Associations between novel exposures and diffuse interstitial lung disease have been newly recognized. In advanced asbestosis, two types of fibrosis are seen, probably related to dose of exposure, existence of pleural fibrosis, and the host factor status of the individual. In pneumoconiosis of predominant reticular type, nodular opacities are often seen in the early phase. The nodular pattern is centrilobular, although some in metal lung show perilymphatic distribution, mimicking sarcoidosis. High-resolution computed tomography enables a more comprehensive correlation between the pathologic findings and clinically relevant imaging findings. The clinician must understand the spectrum of characteristic imaging features related to both known dust exposures and to historically recent new dust exposures.

A novel sampling cassette for field-based analysis of respirable crystalline silica

Field-based methods for the analysis of respirable crystalline silica are now possible with the availability of portable instrumentation. Such methods also require the use of cassettes that facilitate direct-on-filter analysis of field samples. Conventional sampling cassettes can be modified such that they are amenable to direct-on-filter analysis while remaining compatible with common respirable dust samplers. The required modifications are described herein, and one version of such an analysis-ready cassette is described and evaluated in comparison to more traditional cassette designs. The novel cassette was found to result in a slightly higher mass of collected respirable material (for the same sampling duration), though this is likely due to the conductive material of the cassettes, which prevents particle wall losses in comparison to the more commonly used styrene cassette material. Both types of cassettes demonstrated comparable predictability in terms of respirable crystalline silica in a sample.

Health Disparities in Environmental and Occupational Lung Disease

Pulmonary health disparities disproportionately impact disadvantaged and vulnerable populations. This article focuses on disparities in disease prevalence, morbidity, and mortality for asthma, chronic obstructive pulmonary disease, pneumoconiosis, and lung cancer. Disparities are categorized by race, age, sex, socioeconomic status, and geographic region. Each category highlights differences in risk factors for the development and severity of lung disease. Risk factors include social, behavioral, economic, and biologic determinants of health (occupational/environmental exposures, psychosocial stressors, smoking, health literacy, health care provider bias, and health care access). Many of these risk factors are complex and inter-related; strategies proposed to decrease disparities require multilevel approaches.

Coal Workers' Pneumoconiosis and Other Mining-Related Lung Disease: New Manifestations of Illness in an Age-Old Occupation

Coal workers' pneumoconiosis (CWP) and other mining-related lung diseases are entirely preventable, yet continue to occur. While greater attention has been given to CWP and silicosis, mining exposures cause a broad spectrum of respiratory disease, including chronic bronchitis, emphysema, and pulmonary fibrosis. Physicians must obtain a detailed occupational and exposure history from miners in order to make an accurate diagnosis and determine the risk of disease progression. Mining-related lung diseases are incurable and difficult to treat. Therefore, primary prevention by limiting dust exposure and secondary prevention through chest imaging and physiologic screening should be the primary focus of disease control.

Matrix stiffness regulates α-TAT1-mediated acetylation of α-tubulin and promotes silica-induced epithelial-mesenchymal transition via DNA damage

Silicosis is characterized by silica exposure-induced lung interstitial fibrosis and formation of silicotic nodules, resulting in lung stiffening. The acetylation of microtubules mediated by α-tubulin N-acetyltransferase 1 (α-TAT1) is a posttranslational modification that promotes microtubule stability in response to mechanical stimulation. α-TAT1 and downstream acetylated α-tubulin (Ac-α-Tub) are decreased in silicosis, promoting the epithelial-mesenchymal transition (EMT); however, the underlying mechanisms are unknown. We found that silica, matrix stiffening or their combination triggered Ac-α-Tub downregulation in alveolar epithelial cells, followed by DNA damage and replication stress. α-TAT1 elevated Ac-α-Tub to limit replication stress and the EMT via trafficking of p53-binding protein 1 (53BP1, also known as TP53BP1). The results provide evidence that α-TAT1 and Ac-α-Tub inhibit the EMT and silicosis fibrosis by preventing 53BP1 mislocalization and relieving DNA damage. This study provides insight into how the cell cycle is regulated during the EMT and why the decrease in α-TAT1 and Ac-α-Tub promotes silicosis fibrosis.This article has an associated First Person interview with the first authors of the paper.

Biological effects of inhaled hydraulic fracturing sand dust. IX. Summary and significance

An investigation into the potential toxicological effects of fracking sand dust (FSD), collected from unconventional gas drilling sites, has been undertaken, along with characterization of their chemical and biophysical properties. Using intratracheal instillation of nine FSDs in rats and a whole body 4-d inhalation model for one of the FSDs, i.e., FSD 8, and related in vivo and in vitro experiments, the effects of nine FSDs on the respiratory, cardiovascular and immune systems, brain and kidney were reported in the preceding eight tandem papers. Here, a summary is given of the key observations made in the organ systems reported in the individual studies. The major finding that inhaled FSD 8 elicits responses in extra-pulmonary organ systems is unexpected, as is the observation that the pulmonary effects of inhaled FSD 8 are attenuated relative to forms of crystalline silica more frequently used in animal studies, i.e., MIN-U-SIL® 5. An attempt is made to understand the basis for the extra-pulmonary toxicity and comparatively attenuated pulmonary toxicity of FSD 8.

The impacts of coal dust on miners' health: A review

As one of the most important energy resources in the world, coal contributes a great deal to the world economy. Coal mining and processing involve multiple dust generation processes including coal cutting, transport, crushing and milling etc. Coal dust is one of the main sources of health hazard for the coal workers. Exposure of coal dusts can be prevented through administrative controls and engineering controls. Ineffective control of coal dust exposure can harm coal workers' health. Although many efforts have been made to eliminate these threats, recent years have seen an unexpected increase in coal workers' pneumoconiosis (CWP) in Appalachian basin in US. To explore the reasons for this phenomenon, in this review, we first reviewed the historical studies on coal mine dust including the regulation and engineering controls. Then, the effects of coal dust on human health was comprehensively reviewed. Next, the effects of nanoparticles on human health were reviewed, with an emphasis on toxicity of nanoparticles such as carbon nanotubes in other industries. From all this information, we hypothesize that nano-sized coal dust has contributed to the increase of CWP prevalence in recent years. As no research has been reported in this area, four directions which may need further investigation and future studies are recommended in this review. They include: 1) Systematic characterization of physicochemical properties of nano-size coal dust; 2) Toxicity and pathogenesis of nano-sized coal dust; 3) Development of real-time monitoring technology and equipment for nano-sized coal dust; 4) Development of exposure control technology and equipment. The intent of this review paper is to demonstrate the variation of coal dust properties and their impact on the mine worker's health. We suggest that the impact of nano-sized coal mine dust on miner's health has not yet been understood well and further improvements are necessary.

Respiratory surveillance for coal mine dust and artificial stone exposed workers in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand

Coal mine lung dust disease (CMDLD) and artificial stone (AS) silicosis are preventable diseases which have occurred in serious outbreaks in Australia recently. This has prompted a TSANZ review of Australia's approach to respiratory periodic health surveillance. While regulating respirable dust exposure remains the foundation of primary and secondary prevention, identification of workers with early disease assists with control of further exposure, and with the aims of preserving lung function and decreasing respiratory morbidity in those affected. Prompt detection of an abnormality also allows for ongoing respiratory specialist clinical management. This review outlines a medical framework for improvements in respiratory surveillance to detect CMDLD and AS silicosis in Australia. This includes appropriate referral, improved data collection and interpretation, enhanced surveillance, the establishment of a nationwide Occupational Lung Disease Registry and an independent advisory group. These measures are designed to improve health outcomes for workers in the coal mining, AS and other dust-exposed and mining industries.

Biological effects of inhaled hydraulic fracturing sand dust. II. Particle characterization and pulmonary effects 30 d following intratracheal instillation

Hydraulic fracturing ("fracking") is used in unconventional gas drilling to allow for the free flow of natural gas from rock. Sand in fracking fluid is pumped into the well bore under high pressure to enter and stabilize fissures in the rock. In the process of manipulating the sand on site, respirable dust (fracking sand dust, FSD) is generated. Inhalation of FSD is a potential hazard to workers inasmuch as respirable crystalline silica causes silicosis, and levels of FSD at drilling work sites have exceeded occupational exposure limits set by OSHA. In the absence of any information about its potential toxicity, a comprehensive rat animal model was designed to investigate the bioactivities of several FSDs in comparison to MIN-U-SIL® 5, a respirable α-quartz reference dust used in previous animal models of silicosis, in several organ systems (Fedan, J.S., Toxicol Appl Pharmacol. 00, 000-000, 2020). The present report, part of the larger investigation, describes: 1) a comparison of the physico-chemical properties of nine FSDs, collected at drilling sites, and MIN-U-SIL® 5, a reference silica dust, and 2) a comparison of the pulmonary inflammatory responses to intratracheal instillation of the nine FSDs and MIN-U-SIL® 5. Our findings indicate that, in many respects, the physico-chemical characteristics, and the biological effects of the FSDs and MIN-U-SIL® 5 after intratracheal instillation, have distinct differences.

Extracellular Histones Promote Pulmonary Fibrosis in Patients With Coal Workers' Pneumoconiosis

OBJECTIVE

This investigation assessed the profibrotic role that extracellular histones play in the pathogenesis of coal workers' pneumoconiosis (CWP).

METHODS

The correlation of extracellular histones with small opacity profusion (SOP) and transforming growth factor-β (TGF-β) was analyzed. The stimulating effect of extracellular histones on pulmonary fibroblast was assessed in vitro.

RESULTS

The levels of extracellular histones in plasma were positively correlated with SOP and TGF-β in the coal miners investigated. Plasma collected from patients with CWP caused apparent lung fibroblast proliferation, while anti-H4 antibody antagonized the stimulating effect of the patient plasma by blocking histone H4. In vitro experiments showed that extracellular histones directly stimulated fibroblast proliferation.

CONCLUSION

Consistent with our hypothesis, the concentrations of extracellular histones were indices of the severity of pulmonary fibrosis in simple CWP, and extracellular histones-targeted intervention could inhibit the proliferation of lung fibroblast.

A novel pathophysiological classification of silicosis models provides some new insights into the progression of the disease

Silicosis is caused by massive inhalation of silica-based particles, which leads to pulmonary inflammation, pulmonary fibrosis and lung dysfunction. Currently, the pathophysiological process of silicosis has not been well studied. Here, we defined the progression of silicosis as four stages by unsupervised clustering analysis: normal stage, inflammatory stage, progressive stage and fibrotic stage. Specifically, in normal stage, the lung function was normal, and no inflammation or fibrosis was detected in the lung tissue. Inflammatory stage showed a remarkable pulmonary inflammation but mild fibrosis and lung dysfunction. In progressive stage, significant lung dysfunction was observed, while pulmonary inflammation and fibrosis continued to deteriorate. Fibrotic stage revealed the most severe pulmonary fibrosis and lung dysfunction but no significant deterioration in inflammation. Since the common features were founded in both silicosis patients and rodents, we speculated that the pathophysiological processes of silicosis in patients might be similar to the rodents. Collectively, our new classification identified the process of silicosis, clarified the pathophysiological features of each stage, and provided some new insights for the progression of the disease.