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Blayac M, Yegen CH, Marj EA, Rodriguez JCM, Cazaunau M, Bergé A, Epaud R, Coll P, Lanone S. Acute exposure to realistic simulated urban atmospheres exacerbates pulmonary phenotype in cystic fibrosis-like mice. JOURNAL OF HAZARDOUS MATERIALS 2024; 465:133340. [PMID: 38147748 DOI: 10.1016/j.jhazmat.2023.133340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
Cystic Fibrosis (CF) is a lethal genetic disorder caused by pathogenic mutations of the CFTR gene. CF patients show a high phenotypic variability of unknown origin. In this context, the present study was therefore dedicated to investigating the effects of acute exposure to air pollution on the pulmonary morbidity of a CF-like mice model. To achieve our aim, we developed a multidisciplinary approach and designed an innovative protocol using a simulation chamber reproducing multiphasic chemical processes at the laboratory. A particular attention was paid to modulate the composition of these simulated atmospheres, in terms of concentrations of gaseous and particulate pollutants. Exposure to simulated urban atmospheres induced mucus secretion and increased inflammatory biomarkers levels, oxidative stress as well as expression of lung remodeling actors in both WT and CF-like mice. The latter were more susceptible to develop such a response. Though we could not establish direct mechanistic link between biological responses and specific components, the type of immune response induced depended on the chemical composition of the atmospheres. Overall, we demonstrated that air pollution is an important determinant of CF-like lung phenotypic variability and emphasized the added value of considering air pollution with a multi-pollutant approach.
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Affiliation(s)
- Marion Blayac
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France
| | | | - Elie Al Marj
- Université de Paris Cité and Univ Paris Est Créteil, CNRS, LISA, F-75013 Paris, France
| | | | - Mathieu Cazaunau
- Univ Paris Est Creteil and Université de Paris, CNRS, LISA, F-94010 Créteil, France
| | - Antonin Bergé
- Université de Paris Cité and Univ Paris Est Créteil, CNRS, LISA, F-75013 Paris, France
| | - Ralph Epaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France; Centre Hospitalier Intercommunal, Centre des Maladies Respiratoires Rares (RespiRare®)- CRCM, 94010 Créteil, France
| | - Patrice Coll
- Université de Paris Cité and Univ Paris Est Créteil, CNRS, LISA, F-75013 Paris, France
| | - Sophie Lanone
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France.
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2
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Morgan Bustamante BL, May L, Fejerman L, Martínez-López B. A Bayesian multilevel analysis exploring population-level effects mediating the relationship between area-level poverty and community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infection across California communities. Health Place 2023; 83:103094. [PMID: 37515963 DOI: 10.1016/j.healthplace.2023.103094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
Poverty is an often-cited driver of health disparities, and associations between poverty and community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infection are well documented. However, the pathways through which poverty influences infection have not been thoroughly examined. This project aims to identify mediating variables, or mechanisms, explaining why area-level poverty is associated with CA-MRSA infection in Californians. Bayesian multilevel models accounting for spatial confounding were developed to test whether the association between area-level poverty and CA-MRSA infection is mediated by living in a primary care shortage area (HCSA), living near an adult correctional facility, and residential environmental degradation. The association between area-level poverty and CA-MRSA infection can be partially explained by spatial autocorrelation, living in an HCSA, and environmental degradation in the neighborhood. Combined, the mediators explain approximately 6% of the odds of CA-MRSA infection for individuals living in neighborhoods with high poverty rates and 50% of the statistical association between area-level poverty and CA-MRSA infection. The statistical association between area-level poverty and infection was completely explained by the mediators for individuals living in neighborhoods with low poverty rates.
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Affiliation(s)
- Brittany L Morgan Bustamante
- Public Health Sciences, School of Medicine, University of California, Davis, CA, United States; Center for Animal Disease Modeling and Surveillance, Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, United States.
| | - Larissa May
- Department, School of Medicine, University of California, Davis, CA, United States
| | - Laura Fejerman
- Public Health Sciences, School of Medicine, University of California, Davis, CA, United States
| | - Beatriz Martínez-López
- Center for Animal Disease Modeling and Surveillance, Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, United States
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3
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Oates GR, Schechter MS. Aiming to Improve Equity in Pulmonary Health: Cystic Fibrosis. Clin Chest Med 2023; 44:555-573. [PMID: 37517835 PMCID: PMC10458995 DOI: 10.1016/j.ccm.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This review summarizes the evidence of health disparities in cystic fibrosis (CF), an autosomal recessive genetic disorder with substantial variation in disease progression and outcomes. We review disparities by race, ethnicity, socioeconomic status, geographic location, gender identity, or sexual orientation documented in the literature. We outline the mechanisms that generate and perpetuate such disparities across levels and domains of influence and assess the implications of this evidence. We then recommend strategies for improving equity in CF outcomes, drawing on recommendations for the general population and considering approaches specific to people living with CF.
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Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, VA, USA
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4
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McGarry ME, Huang CY, Ly NP. Ethnic differences in staphylococcus aureus acquisition in cystic fibrosis. J Cyst Fibros 2023; 22:909-915. [PMID: 37460380 PMCID: PMC10802839 DOI: 10.1016/j.jcf.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Hispanic people with CF (pwCF) have increased morbidity than non-Hispanic White pwCF, including increased risk of Pseudomonas aeruginosa. We aimed to determine if Staphylococcus aureus (S. aureus) acquisition varies between Hispanic and non-Hispanic White pwCF. METHODS This longitudinal cohort study of pwCF ages 0-25 years in the CF Foundation Patient Registry compared acquisition of methicillin-sensitive S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), persistent MRSA between Hispanic and non-Hispanic White pwCF. Risk of acquisition was assessed by Kaplan-Meier survival curves and its association with ethnicity was evaluated using Cox regressions. Adjusted associations were evaluated using multivariate Cox models adjusting for sex, age of entry into CFFPR, CFTR variant severity, pancreatic insufficiency, CF-related diabetes, maternal education, insurance status. RESULTS Of 10,640 pwCF, 7.5% were Hispanic and 92.5% were non-Hispanic White. Hispanic pwCF had a 19% higher risk of acquiring MSSA (HR 1.19, 95% CI 1.10-1.28, p<0.001) and 13% higher risk of acquiring MRSA (HR 1.13, 95% CI 1.02-1.26, p = 0.02) than non-Hispanic White pwCF. The difference in persistent MRSA between ethnicities did not reach statistical significance. After adjusting for confounding variables, only the risk of MSSA was significantly associated with ethnicity. Compared to non-Hispanic White pwCF, Hispanic pwCF acquired MSSA and MRSA at younger median ages (4.9 vs. 3.8 years (p<0.001), 22.4 vs. 20.8 years (p = 0.02). CONCLUSION Hispanic pwCF <25 years of age have an increased risk of acquiring MSSA and acquired MSSA and MRSA at an earlier age. Differences in S. aureus acquisition may contribute to increased morbidity in Hispanic pwCF.
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Affiliation(s)
- Meghan E McGarry
- Division of Pediatric Pulmonology, Department of Pediatrics, University of California, 550 16th Ave, Box 0632, San Francisco, CA 94158, United States.
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
| | - Ngoc P Ly
- Division of Pediatric Pulmonology, Department of Pediatrics, University of California, 550 16th Ave, Box 0632, San Francisco, CA 94158, United States
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5
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Mésinèle J, Ruffin M, Guillot L, Corvol H. Modifier Factors of Cystic Fibrosis Phenotypes: A Focus on Modifier Genes. Int J Mol Sci 2022; 23:ijms232214205. [PMID: 36430680 PMCID: PMC9698440 DOI: 10.3390/ijms232214205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Although cystic fibrosis (CF) is recognized as a monogenic disease, due to variants within the CFTR (Cystic Fibrosis Transmembrane Regulator) gene, an extreme clinical heterogeneity is described among people with CF (pwCF). Apart from the exocrine pancreatic status, most studies agree that there is little association between CFTR variants and disease phenotypes. Environmental factors have been shown to contribute to this heterogeneity, accounting for almost 50% of the variability of the lung function of pwCF. Nevertheless, pwCF with similar CFTR variants and sharing the same environment (such as in siblings) may have highly variable clinical manifestations not explained by CFTR variants, and only partly explained by environmental factors. It is recognized that genetic variants located outside the CFTR locus, named "modifier genes", influence the clinical expression of the disease. This short review discusses the latest studies that have described modifier factors associated with the various CF phenotypes as well as the response to the recent CFTR modulator therapies.
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Affiliation(s)
- Julie Mésinèle
- Sorbonne Université, Inserm U938, Centre de Recherche Saint-Antoine (CRSA), 75012 Paris, France
- Inovarion, 75005 Paris, France
| | - Manon Ruffin
- Sorbonne Université, Inserm U938, Centre de Recherche Saint-Antoine (CRSA), 75012 Paris, France
| | - Loïc Guillot
- Sorbonne Université, Inserm U938, Centre de Recherche Saint-Antoine (CRSA), 75012 Paris, France
- Correspondence: (L.G.); (H.C.)
| | - Harriet Corvol
- Sorbonne Université, Inserm U938, Centre de Recherche Saint-Antoine (CRSA), 75012 Paris, France
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Trousseau, Service de Pneumologie Pédiatrique, 75012 Paris, France
- Correspondence: (L.G.); (H.C.)
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6
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Galvani-Townsend S, Martinez I, Pandey A. Is life expectancy higher in countries and territories with publicly funded health care? Global analysis of health care access and the social determinants of health. J Glob Health 2022; 12:04091. [PMID: 36370409 PMCID: PMC9653205 DOI: 10.7189/jogh.12.04091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background To better understand factors influencing life expectancy, this paper examines how the availability of publicly funded health care in a country and multiple social determinants of health impact longevity of life. Methods In this descriptive statistical analysis, data regarding publicly funded health care, life expectancy, and social determinants of health were obtained for 196 countries and 4 territories. Social determinants included 10 indicators detailing country-level information to represent 5 key categories: economic stability, education, health & health care, neighbourhood & built environment, and social & community context. Analyses consisted of: 1) comparison of mean life expectancy among countries and territories with- and without- publicly funded health care; 2) correlations in life expectancy across social determinants by health care access and level of burden; and 3) correlations in life expectancy within social determinants for health care access by level of burden. Results Overall, life expectancy in countries and territories with- publicly funded health care (Mean (m) = 76.7 years) was significantly longer compared to countries and territories without- publicly funded health care (m = 66.8 years, P < 0.0001). For each social determinant, we observed longer life expectancy continued to be associated with publicly funded health care access across stratum (P < 0.0001), but difference in years of life expectancy existed both by burden of social determinant, as well as access to health care within quartiles of burden (Publicly funded care (yes): 68.12-80.88 years, (no): 62.39-77.33 years, all P < 0.05). Both social determinants as well as the availability of publicly funded health care were individually and simultaneously associated with mean longevity of life between countries and territories worldwide. Conclusions These findings demonstrate how, if made widely available, publicly funded health care could extend longevity of life. If combined with programs to reduce the burden of social determinants, a substantial impact can be made to promote more equitable distribution of life expectancies across the world. Ultimately, both access to publicly funded care and reducing inequalities in social determinants are needed in order to promote longer and healthier aging in populations worldwide.
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Affiliation(s)
- Sarah Galvani-Townsend
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Isabel Martinez
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
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7
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Purves J, Hussey SJK, Corscadden L, Purser L, Hall A, Misra R, Selley L, Monks PS, Ketley JM, Andrew PW, Morrissey JA. Air pollution induces Staphylococcus aureus USA300 respiratory tract colonization mediated by specific bacterial genetic responses involving the global virulence gene regulators Agr and Sae. Environ Microbiol 2022; 24:4449-4465. [PMID: 35642645 PMCID: PMC9796851 DOI: 10.1111/1462-2920.16076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
Exposure to particulate matter (PM), a major component of air pollution, is associated with exacerbation of chronic respiratory disease, and infectious diseases such as community-acquired pneumonia. Although PM can cause adverse health effects through direct damage to host cells, our previous study showed that PM can also impact bacterial behaviour by promoting in vivo colonization. In this study we describe the genetic mechanisms involved in the bacterial response to exposure to black carbon (BC), a constituent of PM found in most sources of air pollution. We show that Staphylococcus aureus strain USA300 LAC grown in BC prior to inoculation showed increased murine respiratory tract colonization and pulmonary invasion in vivo, as well as adhesion and invasion of human epithelial cells in vitro. Global transcriptional analysis showed that BC has a widespread effect on S. aureus transcriptional responses, altering the regulation of the major virulence gene regulators Sae and Agr and causing increased expression of genes encoding toxins, proteases and immune evasion factors. Together these data describe a previously unrecognized causative mechanism of air pollution-associated infection, in that exposure to BC can increase bacterial colonization and virulence factor expression by acting directly on the bacterium rather than via the host.
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Affiliation(s)
- Jo Purves
- Department of GeneticsUniversity of Leicester, University RoadLeicesterLE1 7RHUK
| | - Shane J. K. Hussey
- Department of GeneticsUniversity of Leicester, University RoadLeicesterLE1 7RHUK
| | - Louise Corscadden
- Department of GeneticsUniversity of Leicester, University RoadLeicesterLE1 7RHUK
| | - Lillie Purser
- Department of GeneticsUniversity of Leicester, University RoadLeicesterLE1 7RHUK
| | - Andie Hall
- Molecular Biology, Core Research LaboratoriesNatural History MuseumCromwell Road, LondonSW7 5BDUK
| | - Raju Misra
- Molecular Biology, Core Research LaboratoriesNatural History MuseumCromwell Road, LondonSW7 5BDUK
| | - Liza Selley
- MRC Toxicology UnitUniversity of CambridgeCambridgeCB2 1QRUK
| | - Paul S. Monks
- Department of ChemistryUniversity of LeicesterUniversity RoadLeicesterLE1 7RHUK
| | - Julian M. Ketley
- Department of GeneticsUniversity of Leicester, University RoadLeicesterLE1 7RHUK
| | - Peter W. Andrew
- Department of Respiratory SciencesUniversity of LeicesterUniversity Road, LeicesterLE1 9HNUK
| | - Julie A. Morrissey
- Department of GeneticsUniversity of Leicester, University RoadLeicesterLE1 7RHUK
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8
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Carbon nanoparticles adversely affect CFTR expression and toxicologically relevant pathways. Sci Rep 2022; 12:14255. [PMID: 35995803 PMCID: PMC9395428 DOI: 10.1038/s41598-022-18098-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/05/2022] [Indexed: 11/08/2022] Open
Abstract
Cystic fibrosis is an autosomal recessive disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) that can lead to terminal respiratory failure. Ultrafine carbonaceous particles, which are ubiquitous in ambient urban and indoor air, are increasingly considered as major contributors to the global health burden of air pollution. However, their effects on the expression of CFTR and associated genes in lung epithelial cells have not yet been investigated. We therefore evaluated the effects of carbon nanoparticles (CNP), generated by spark-ablation, on the human bronchial epithelial cell line 16HBE14o− at air–liquid interface (ALI) culture conditions. The ALI-cultured cells exhibited epithelial barrier integrity and increased CFTR expression. Following a 4-h exposure to CNP, the cells exhibited a decreased barrier integrity, as well as decreased expression of CFTR transcript and protein levels. Furthermore, transcriptomic analysis revealed that the CNP-exposed cells showed signs of oxidative stress, apoptosis and DNA damage. In conclusion, this study describes spark-ablated carbon nanoparticles in a realistic exposure of aerosols to decrease CFTR expression accompanied by transcriptomic signs of oxidative stress, apoptosis and DNA damage.
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9
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Blayac M, Coll P, Urbach V, Fanen P, Epaud R, Lanone S. The Impact of Air Pollution on the Course of Cystic Fibrosis: A Review. Front Physiol 2022; 13:908230. [PMID: 35721541 PMCID: PMC9202997 DOI: 10.3389/fphys.2022.908230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Cystic fibrosis (CF) is a lethal and widespread autosomal recessive disorder affecting over 80,000 people worldwide. It is caused by mutations of the CFTR gene, which encodes an epithelial anion channel. CF is characterized by a great phenotypic variability which is currently not fully understood. Although CF is genetically determined, the course of the disease might also depend on multiple other factors. Air pollution, whose effects on health and contribution to respiratory diseases are well established, is one environmental factor suspected to modulate the disease severity and influence the lung phenotype of CF patients. This is of particular interest as pulmonary failure is the primary cause of death in CF. The present review discusses current knowledge on the impact of air pollution on CF pathogenesis and aims to explore the underlying cellular and biological mechanisms involved in these effects.
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Affiliation(s)
- Marion Blayac
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Patrice Coll
- Université Paris Cité and Univ Paris Est Créteil, CNRS, LISA, Paris, France
| | | | - Pascale Fanen
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- AP-HP, Hopital Henri-Mondor, Service Génétique, Creteil, France
| | - Ralph Epaud
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- Centre Hospitalier Intercommunal, Centre des Maladies Respiratoires Rares (RespiRare®)-CRCM, Creteil, France
| | - Sophie Lanone
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- *Correspondence: Sophie Lanone,
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10
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Carson SW, Psoter K, Koehler K, Siklosi KR, Montemayor K, Toporek A, West NE, Lechtzin N, Hansel NN, Collaco JM, Merlo CA. Indoor air pollution exposure is associated with greater morbidity in cystic fibrosis. J Cyst Fibros 2022; 21:e129-e135. [PMID: 34531156 PMCID: PMC8918065 DOI: 10.1016/j.jcf.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exposure to higher levels of outdoor air pollution is associated with increased morbidity in individuals with cystic fibrosis. Limited information exist regarding the potential adverse effects of indoor air pollution on those with cystic fibrosis. METHODS Individuals with cystic fibrosis who were enrolled in the Twin and Sibling Study from 2000-2013, self-reported exposure to four known sources of indoor air pollution (secondhand smoke, forced hot air, wood stove and fireplace). Change in lung function, rates of hospitalizations and pulmonary exacerbations were followed over 4 years to compare outcomes in those who were exposed to those who were not exposed. RESULTS Of 1432 participants with data on secondhand smoke exposure, 362 (25.3%) were exposed. Of 765 individuals with data on forced hot air exposure, 491 (64.2%) were exposed. Of 1247 participants with data on wood stove exposure and 830 with data on fireplace exposure, 182 (14.6%) and 373 (44.9%) were exposed, respectively. In longitudinal analysis, pediatric individuals either exposed to secondhand smoke or to forced hot air had a 0.60% predicted/year decrease in FEV1% predicted (P=0.002) or a 0.46% predicted/year decrease in FEV1% predicted (P=0.048), respectively compared to individuals who were not exposed. Adults exposed to secondhand smoke had a 42% increased yearly risk of hospitalization compared to those who were not exposed (P=0.045). CONCLUSIONS Our questionnaire-based data suggest that exposure to sources of indoor air pollution increase morbidity in both the pediatric and adult cystic fibrosis populations. Future studies with quantitative indoor air quality assessments are needed.
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Affiliation(s)
- Sara W. Carson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Kevin Psoter
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Karen R. Siklosi
- Department of Pediatrics, Division of Pulmonology, Johns Hopkins University, Baltimore, MD
| | - Kristina Montemayor
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Alexandra Toporek
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Natalie E. West
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Noah Lechtzin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Nadia N. Hansel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Joseph M. Collaco
- Department of Pediatrics, Division of Pulmonology, Johns Hopkins University, Baltimore, MD
| | - Christian A Merlo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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11
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Lahiri T, Sullivan JS. Recent advances in the early treatment of cystic fibrosis: Bridging the gap to highly effective modulator therapy. Pediatr Pulmonol 2022; 57 Suppl 1:S60-S74. [PMID: 34473419 DOI: 10.1002/ppul.25660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/22/2021] [Accepted: 09/01/2021] [Indexed: 11/08/2022]
Abstract
Highly effective modulator therapy (HEMT) for cystic fibrosis (CF) has been touted as one of the greatest advances to date in CF care. As these therapies are now available for many older children and adults with CF, marked improvement of their nutritional status, pulmonary and gastrointestinal symptoms has been observed. However, most infants and younger children are not current candidates for HEMT due to age and/or cystic fibrosis transmembrane conductance regulator (CFTR) mutation. For these young children, it is essential to provide rigorous monitoring and care to avoid potential disease sequelae while awaiting HEMT availability. The following article highlights recent advances in the care of infants and young children with CF with regard to surveillance and treatment of nutritional, pulmonary, and gastrointestinal disorders. Recent clinical trials in this population are also reviewed.
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Affiliation(s)
- Thomas Lahiri
- Divisions of Pediatric Pulmonology and Gastroenterology, University of Vermont Children's Hospital, Burlington, Vermont, USA
| | - Jillian S Sullivan
- Divisions of Pediatric Pulmonology and Gastroenterology, University of Vermont Children's Hospital, Burlington, Vermont, USA
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12
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Dickinson KM, Psoter KJ, Riekert KA, Collaco JM. Association between insurance variability and early lung function in children with cystic fibrosis. J Cyst Fibros 2022; 21:104-110. [PMID: 34175244 PMCID: PMC8695631 DOI: 10.1016/j.jcf.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lower socioeconomic status (SES) has consistently been associated with poorer outcomes in individuals with cystic fibrosis (CF). Previous studies have compared outcomes for children with and without private insurance coverage, however the potential role of changes in insurance status on early health outcomes in children with CF remains unknown. OBJECTIVES To describe the variability in insurance status in early childhood and to evaluate whether insurance variability was associated with poorer outcomes at age 6. METHODS Retrospective observational study using the Cystic Fibrosis Foundation Patient Registry. Insurance status was defined as: always private (including Tricare), exclusively public, or intermittent private insurance (private insurance and exclusively public insurance in separate years) during the first 6 years of life. Outcomes at age 6 included body mass index (BMI) and FEV1 percent predicted (maxFEV1pp). RESULTS From a 2000-2011 birth cohort (n = 8,109), 42.3% always had private insurance, 30.0% had exclusively public insurance, and 27.6% had intermittent private insurance. BMI percentiles did not differ between groups; however, children with intermittent private insurance and exclusively public insurance had a 3.3% and 6.6% lower maxFEV1pp at age 6, respectively, compared to those with always private insurance. CONCLUSIONS A substantial proportion of young children in a modern CF cohort have public or intermittent private insurance coverage. While public insurance has been associated with poorer health outcomes in CF, variability in health insurance coverage may also be associated with an intermediate risk of disparities in lung function as early as age 6.
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Affiliation(s)
- Kimberly M. Dickinson
- Department of Pediatrics, Division of Pediatric Pulmonology, Johns Hopkins University, Baltimore, MD, USA
| | - Kevin J. Psoter
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin A. Riekert
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph M. Collaco
- Department of Pediatrics, Division of Pediatric Pulmonology, Johns Hopkins University, Baltimore, MD, USA
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13
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Sly PD, Vilcins D. Climate impacts on air quality and child health and wellbeing: Implications for Oceania. J Paediatr Child Health 2021; 57:1805-1810. [PMID: 34792251 DOI: 10.1111/jpc.15650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/30/2022]
Abstract
Despite the enormous gains in reducing child mortality resulting from the United Nations Millennium Development Goals, in some ways children's future wellbeing has never been under greater threat. Climate and environmental change, primarily driven by poor air quality, represents a major threat to child health and wellbeing, through both direct and indirect effects. Climate change has multiple environmental consequences impacting negatively on child health and wellbeing, including increases in ambient temperature, rising atmospheric carbon dioxide (CO2) , altered distribution of rainfall, ocean warming, rising sea level and more frequent and severe adverse weather events. Multiple pathways link these exposures to a wide variety of adverse health outcomes. Countries in Oceania are especially likely to be subjected to the effects of increases in ambient temperature, altered distribution of rainfall, ocean warming and sea level rise. These changes pose a significant risk to children and provide a moral imperative for us to act to protect child health.
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Affiliation(s)
- Peter D Sly
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Dwan Vilcins
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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14
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Nguyen JP, Huff RD, Cao QT, Tiessen N, Carlsten C, Hirota JA. Effects of environmental air pollutants on CFTR expression and function in human airway epithelial cells. Toxicol In Vitro 2021; 77:105253. [PMID: 34601066 DOI: 10.1016/j.tiv.2021.105253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022]
Abstract
The airway epithelium is exposed to a variety of air pollutants, which have been associated with the onset and worsening of respiratory diseases. These air pollutants can vary depending on their composition and associated chemicals, leading to different molecular interactions and biological effects. Mucociliary clearance is an important host defense mechanism against environmental air pollutants and this process is regulated by various ion transporters including the cystic fibrosis transmembrane conductance regulator (CFTR). With evidence suggesting that environmental air pollutants can lead to acquired CFTR dysfunction, it may be possible to leverage therapeutic approaches used in cystic fibrosis (CF) management. The aim of our study was to test whether environmental air pollutants tobacco smoke extract, urban particulate matter, and diesel exhaust particles lead to acquired CFTR dysfunction and whether it could be rescued with pharmacological interventions. Human airway epithelial cells (Calu-3) were exposed to air pollutant extracts for 24 h, with and without pharmacological interventions, with readouts of CFTR expression and function. We demonstrate that both tobacco smoke extract and diesel exhaust particles led to acquired CFTR dysfunction and that rescue of acquired CFTR dysfunction is possible with pharmacological interventions in diesel exhaust particle models. Our study emphasizes that CFTR function is not only important in the context of CF but may also play a role in other respiratory diseases impacted by environmental air pollutants. In addition, the pharmacological interventions approved for CF management may be more broadly leveraged for chronic respiratory disease management.
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Affiliation(s)
- Jenny P Nguyen
- Firestone Institute for Respiratory Health - Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON L8N 4A6, Canada
| | - Ryan D Huff
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - Quynh T Cao
- Firestone Institute for Respiratory Health - Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON L8N 4A6, Canada
| | - Nicholas Tiessen
- Firestone Institute for Respiratory Health - Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON L8N 4A6, Canada
| | - Christopher Carlsten
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - Jeremy A Hirota
- Firestone Institute for Respiratory Health - Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON L8N 4A6, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC V6H 3Z6, Canada; McMaster Immunology Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada; Department of Biology, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
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15
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Kirwa K, Eckert CM, Vedal S, Hajat A, Kaufman JD. Ambient air pollution and risk of respiratory infection among adults: evidence from the multiethnic study of atherosclerosis (MESA). BMJ Open Respir Res 2021; 8:e000866. [PMID: 33664125 PMCID: PMC7934778 DOI: 10.1136/bmjresp-2020-000866] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Air pollution may affect the risk of respiratory infection, though research has focused on uncommon infections or infections in children. Whether ambient air pollutants increase the risk of common acute respiratory infections among adults is uncertain, yet this may help understand whether pollutants influence spread of pandemic respiratory infections like COVID-19. OBJECTIVE To estimate the association between ambient air pollutant exposures and respiratory infections in adults. METHODS During five study examinations over 12 years, 6536 participants in the multiethnic study of atherosclerosis (MESA) reported upper respiratory tract infections, bronchitis, pneumonia or febrile illness in the preceding 2 weeks. Using a validated spatiotemporal model, we estimated residential concentrations of ambient PM2.5, NOx and NO2 for the 2-6 weeks (short-term) and year (long-term) prior to each examination. RESULTS In this population aged 44-84 years at baseline, 10%-32% of participants reported a recent respiratory infection, depending on month of examination and study region. PM2.5, NOx and NO2 concentrations over the prior 2-6 weeks were associated with increased reporting of recent respiratory infection, with risk ratios (95% CIs) of 1.04 (1.00 to 1.09), 1.15 (1.10 to 1.20) and 1.21 (1.10 to 1.33), respectively, per increase from 25th to 75th percentile in residential pollutant concentration. CONCLUSION Higher short-term exposure to PM2.5 and traffic-related pollutants are associated with increased risk of symptomatic acute respiratory infections among adults. These findings may provide an insight into the epidemiology of COVID-19.
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Affiliation(s)
- Kipruto Kirwa
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Carly M Eckert
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Sverre Vedal
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Joel D Kaufman
- Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
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16
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Karimi H, Nikaeen M, Gholipour S, Hatamzadeh M, Hassanzadeh A, Hajizadeh Y. PM 2.5-associated bacteria in ambient air: Is PM 2.5 exposure associated with the acquisition of community-acquired staphylococcal infections? JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2020; 18:1007-1013. [PMID: 33312619 PMCID: PMC7721920 DOI: 10.1007/s40201-020-00522-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/13/2020] [Indexed: 05/19/2023]
Abstract
Particulate matter (PM), a major component of air pollution, is an important carrier medium of various chemical and microbial compounds. Air pollution due to PM could increase the level of bacteria and associated adverse health effects. Staphylococci as important opportunistic pathogens that cause hospital- and community-acquired infections may transmit through air. This study aimed to obtain knowledge about the concentration of airborne bacteria as well as staphylococci associated with particulate matter with a diameter of less than 2.5 micrometers (PM2.5) in ambient air. The impact of meteorological factors including ultraviolet (UV) index, wind speed, temperature, and moisture on microbial concentrations was also investigated. Quartz filters were used to collect PM2.5 and associated bacteria in ambient air of a semiarid area. Airborne bacteria were quantified by culture method and Staphylococcus species identified by molecular methods. The mean (SD) concentration of PM2.5 and airborne bacteria was 64.83 (24.87) µg/m3 and 38 (36) colony forming unit (CFU)/m3, respectively. The results showed no significant correlation between the levels of PM2.5 and concentrations of bacteria (p < 0.05). Staphylococcus species were detected in 8 of 37 (22%) samples in a concentration from 3 to 213 CFU/m3. S. epidermidis was detected with the highest frequency followed by S. gallinarum and S. hominis, but S. aureus and methicillin-resistant Staphylococcus aureus (MRSA) were not detected. No significant correlation between the concentrations of bacteria with meteorological parameters was observed (p < 0.05). Our finding showed that, although the study area is sometimes subject to air pollution from PM2.5, the concentration of PM2.5- associated bacteria is relatively low. According to the results, PM2.5 may not be a source of community-associated staphylococcal infections.
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Affiliation(s)
- Hossein Karimi
- Student Research Committee and Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Nikaeen
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Gholipour
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Hatamzadeh
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hassanzadeh
- Department of Statistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yaghoub Hajizadeh
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Pompilio A, Di Bonaventura G. Ambient air pollution and respiratory bacterial infections, a troubling association: epidemiology, underlying mechanisms, and future challenges. Crit Rev Microbiol 2020; 46:600-630. [PMID: 33059504 DOI: 10.1080/1040841x.2020.1816894] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The World Health Organization attributed more than four million premature deaths to ambient air pollution in 2016. Numerous epidemiologic studies demonstrate that acute respiratory tract infections and exacerbations of pre-existing chronic airway diseases can result from exposure to ambient (outdoor) air pollution. In this context, the atmosphere contains both chemical and microbial pollutants (bioaerosols), whose impact on human health remains unclear. Therefore, this review: summarises the findings from recent studies on the association between exposure to air pollutants-especially particulate matter and ozone-and onset or exacerbation of respiratory infections (e.g. pneumonia, cystic fibrosis lung infection, and tuberculosis); discusses the mechanisms underlying the relationship between air pollution and respiratory bacterial infections, which is necessary to define prevention and treatment strategies; demonstrates the relevance of air pollution modelling in investigating and preventing the impact of exposure to air pollutants on human health; and outlines future actions required to improve air quality and reduce morbidity and mortality related to air pollution.
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Affiliation(s)
- Arianna Pompilio
- Department of Medical, Oral and Biotechnological Sciences, and Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Di Bonaventura
- Department of Medical, Oral and Biotechnological Sciences, and Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
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18
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Szczesniak R, Rice JL, Brokamp C, Ryan P, Pestian T, Ni Y, Andrinopoulou ER, Keogh RH, Gecili E, Huang R, Clancy JP, Collaco JM. Influences of environmental exposures on individuals living with cystic fibrosis. Expert Rev Respir Med 2020; 14:737-748. [PMID: 32264725 DOI: 10.1080/17476348.2020.1753507] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Natural, social, and constructed environments play a critical role in the development and exacerbation of respiratory diseases. However, less is known regarding the influence of these environmental/community risk factors on the health of individuals living with cystic fibrosis (CF), compared to other pulmonary disorders. AREAS COVERED Here, we review current knowledge of environmental exposures related to CF, which suggests that environmental/community risk factors do interact with the respiratory tract to affect outcomes. Studies discussed in this review were identified in PubMed between March 2019 and March 2020. Although the limited data available do not suggest that avoiding potentially detrimental exposures other than secondhand smoke could improve outcomes, additional research incorporating novel markers of environmental exposures and community characteristics obtained at localized levels is needed. EXPERT OPINION As we outline, some environmental exposures and community characteristics are modifiable; if not by the individual, then by policy. We recommend a variety of strategies to advance understanding of environmental influences on CF disease progression.
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Affiliation(s)
- Rhonda Szczesniak
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA
| | - Jessica L Rice
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, MD, USA
| | - Cole Brokamp
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA
| | - Patrick Ryan
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA
| | - Teresa Pestian
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA
| | - Yizhao Ni
- Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA
| | | | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine , London, UK
| | - Emrah Gecili
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA
| | - Rui Huang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA.,Department of Mathematical Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - John P Clancy
- Department of Pediatrics, University of Cincinnati , Cincinnati, OH, USA.,Department of Clinical Research, Cystic Fibrosis Foundation , Bethesda, MD, USA
| | - Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, MD, USA
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19
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Yang L, Li C, Tang X. The Impact of PM 2.5 on the Host Defense of Respiratory System. Front Cell Dev Biol 2020; 8:91. [PMID: 32195248 PMCID: PMC7064735 DOI: 10.3389/fcell.2020.00091] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
The harm of fine particulate matter (PM2.5) to public health is the focus of attention around the world. The Global Burden of Disease (GBD) Study 2015 (GBD 2015 Risk Factors Collaborators, 2016) ranked PM2.5 as the fifth leading risk factor for death, which caused 4.2 million deaths and 103.1 million disability-adjusted life-years (DALYs) loss, representing 7.6% of total global deaths and 4.2% of global DALYs. Epidemiological studies have confirmed that exposure to PM2.5 increases the incidence and mortality of respiratory infections. The host defense dysfunction caused by PM2.5 exposure may be the key to the susceptibility of respiratory system infection. Thus, this review aims to assess the impact of PM2.5 on the host defense of respiratory system. Firstly, we elaborated the epidemiological evidence that exposure to PM2.5 increases the risk of respiratory infections. Secondly, we summarized the experimental evidence that PM2.5 exposure increases the susceptibility of different pathogens (including bacteria and viruses) in respiratory system. Furthermore, here we discussed the underlying host defense mechanisms by which PM2.5 exposure increases the risk of respiratory infections as well as future perspectives.
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Affiliation(s)
- Liyao Yang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Cheng Li
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoxiao Tang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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20
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Area Deprivation as a Risk Factor for Methicillin-resistant Staphylococcus aureus Infection in Pediatric Cystic Fibrosis. Pediatr Infect Dis J 2019; 38:e285-e289. [PMID: 31568067 PMCID: PMC6802275 DOI: 10.1097/inf.0000000000002419] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In US cystic fibrosis (CF) patients, methicillin-resistant Staphylococcus aureus (MRSA) rates have tripled in the past 2 decades. Known clinical risk factors include exposure to a healthcare setting, Pseudomonas aeruginosa and CF-related diabetes. Area-level socio-environmental exposures have not been evaluated. We explored the association of area-level deprivation with MRSA prevalence in a pediatric CF Center in the Southeastern United States. METHODS Patients' residential addresses were geocoded and linked to a composite Area Deprivation Index and Rural-Urban Commuting Area scores. The association of MRSA with Area Deprivation Index and Rural-Urban Commuting Area scores was evaluated using logistic regression with robust standard errors adjusted for sociodemographic covariates (age, sex, race, mother's and father's education and household income), clinical risk factors (P. aeruginosa, CF-related diabetes, hospitalizations and number of clinic visits) and clustering. RESULTS The study included all pediatric patients (N = 231; mean age 12) at a single CF Center. MRSA was present in 44% of subjects. Higher area-level deprivation was correlated with rural residence, lack of parental college education and lower household income (P < 0.001 for each). In a multiple regression model fully adjusted for patient-level sociodemographic covariates, clinical risk factors and clustering, neighborhood deprivation was associated with more than 2-fold increase in the odds of having MRSA [OR 2.26 (1.14-4.45), P < 0.05]. CONCLUSIONS Neighborhood deprivation is a risk factor for MRSA in pediatric CF, doubling the odds of infection. Community-level socioeconomic risk factors should be considered when developing prevention strategies and treatment plans for MRSA infection in pediatric patients with CF.
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21
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Nabizadeh R, Yousefian F, Moghadam VK, Hadei M. Characteristics of cohort studies of long-term exposure to PM 2.5: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:30755-30771. [PMID: 31494855 DOI: 10.1007/s11356-019-06382-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
This study systematically reviewed all the cohort studies investigating the relationship between long-term exposure to PM2.5 and any health outcome until February 2018. We searched ISI Web of Knowledge, Pubmed, and Scopus databases for peer-reviewed journal research articles published in English. We only extracted the results of the single-pollutant main analysis of each study, excluding the effect modifications and sensitivity analyses. Out of the initial 9523 articles, 203 articles were ultimately included for analysis. Based on the different characteristics of studies such as study design, outcome, exposure assessment method, and statistical model, we calculated the number and relative frequency of analyses with statistically significant and insignificant results. Most of the studies were prospective (84.8%), assessed both genders (66.5%), and focused on a specific age range (86.8%). Most of the articles (78.1%) had used modeling techniques for exposure assessment of cohorts' participants. Among the total of 317 health outcomes, the most investigated outcomes include mortality due to cardiovascular disease (6.19%), all causes (5.48%), lung cancer (4.00%), ischemic heart disease (3.50%), and non-accidental causes (3.50%). The percentage of analyses with statistically significant results were higher among studies that used prospective design, mortality as the outcome, fixed stations as exposure assessment method, hazard ratio as risk measure, and no covariate adjustment. We can somehow conclude that the choice of right characteristics for cohort studies can make a difference in their results.
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Affiliation(s)
- Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Yousefian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Kazemi Moghadam
- Department of Environmental Health Engineering, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mostafa Hadei
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
PURPOSE OF REVIEW The cystic fibrosis (CF) lung has long been appreciated as a competitive niche for complex interactions between bacterial species. The individual relationships between effects on the host, and thereafter clinical outcomes, has been poorly understood. We aim to describe the role of Staphyloccus aureus, one of the most commonly encountered bacteria cultured from the respiratory tracts of people with CF, and it's complex interplay with other organisms, with particular attention to Pseudomonas aeruginosa. RECENT FINDINGS We describe the challenges posed in understanding the role that S. aureus plays in the CF lung, including the difficulties in interpreting culture results depending upon sampling technique, relationships with P. aeruginosa and the rest of the microbiome, as well as discussing the relative merits and potential harms of antibiotic prophylaxis. Finally, we describe the particular challenge of methicillin-resistant S. aureus. SUMMARY We describe research underway that will address the long-held contentious issues of antibiotic prophylaxis. We also describe the emerging research interest in determining whether, at differences phases in the evolution of CF airways infection, S. aureus infection can have both harmful and protective effects for the host.
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23
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Akil N, Muhlebach MS. Biology and management of methicillin resistant Staphylococcus aureus in cystic fibrosis. Pediatr Pulmonol 2018; 53:S64-S74. [PMID: 30073802 DOI: 10.1002/ppul.24139] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/20/2018] [Indexed: 02/06/2023]
Abstract
Staphylococcus aureus is one of the earliest bacteria isolated from the respiratory tract in people with cystic fibrosis (CF). Its methicillin resistant form, MRSA, has gained attention due to the rapid increase in the last decades and worse outcomes with chronic infection. In the United States, prevalence of MRSA in CF is around 27%, but is much lower (3-18%) in most other countries. Methicillin is typically genetically encoded by the mecA gene, which encodes for an alternative penicillin binding protein (PRBa). This PRBa has low affinity to β-lactams, thereby enabling growth of S. aureus in the presence of penicillinase resistant penicillins and most other β-lactams. Non-mecA positive strains of MRSA, so-called borderline resistant (BORSA) have also been described. In addition to production of toxins, the virulence of S. aureus is conferred by its adaptability allowing persistence in face of antibiotic therapies and host defense. These adaptive growth mechanisms include small colony variants, biofilms, and growth under anaerobic conditions. Several reports have described successful eradication of MRSA, yet only two randomized trials of eradication during early infection have been conducted. A list of MRSA specific antibiotics with dosing relevant to CF patients is presented here. Many of these require special dosing in people with CF. Novel antibiotics are in trials for skin and soft tissue infections and it is unclear if and when those might be available for lung infections. Thus the best strategies for MRSA would be primary prevention.
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Affiliation(s)
- Nour Akil
- Division of Pulmonology, Department of Pediatrics, University of NC at Chapel Hill, Chapel Hill, North Carolina
| | - Marianne S Muhlebach
- Division of Pulmonology, Department of Pediatrics, University of NC at Chapel Hill, Chapel Hill, North Carolina.,Marisco Lung Institute, University of NC at Chapel Hill, Chapel Hill, North Carolina
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24
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Lekkerkerk WSN, Haenen A, van der Sande MAB, Leenstra T, de Greeff S, Timen A, Tjon-a-Tsien A, Richardus JH, van de Sande-Bruinsma N, Vos MC. Newly identified risk factors for MRSA carriage in The Netherlands. PLoS One 2017; 12:e0188502. [PMID: 29190731 PMCID: PMC5708665 DOI: 10.1371/journal.pone.0188502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To elucidate new risk factors for MRSA carriers without known risk factors (MRSA of unknown origin; MUO). These MUO carriers are neither pre-emptively screened nor isolated as normally dictated by the Dutch Search & Destroy policy, thus resulting in policy failure. METHODS We performed a prospective case control study to determine risk factors for MUO acquisition/carriage (Dutch Trial Register: NTR2041). Cases were MUO carriers reported by participating medical microbiological laboratories to the RIVM from September 1st 2011 until September 1st 2013. Controls were randomly selected from the community during this period. RESULTS Significant risk factors for MUO in logistic multivariate analysis were antibiotic use in the last twelve months, aOR 8.1 (5.6-11.7), screened as contact in a contact tracing but not detected as a MRSA carrier at that time, aOR 4.3 (2.1-8.8), having at least one foreign parent, aOR 2.4 (1.4-3.9) and receiving ambulatory care, aOR 2.3 (1.4-3.7). Our found risk factors explained 83% of the MUO carriage. CONCLUSIONS Identifying new risk factors for MRSA carriers remains crucial for countries that apply a targeted screening approach as a Search and Destroy policy or as vertical infection prevention measure.
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Affiliation(s)
- W. S. N. Lekkerkerk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - A. Haenen
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - M. A. B. van der Sande
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
- UMCU, Julius Centre, Utrecht, The Netherlands
- The Institute of Tropical Medicine, Antwerp, Belgium
| | - T. Leenstra
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - S. de Greeff
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - A. Timen
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - A. Tjon-a-Tsien
- Municipal Public Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
| | - J. H. Richardus
- Municipal Public Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - M. C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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