A theoretical basis for investigating ambient air pollution and children's respiratory health

The EMPOWER program: a history and guide for increasing diversity using integrated research and education

The prevalence and pervasive nature of emerging chemicals of concern have created widespread environmental injustice apprehensions in vulnerable communities. To alleviate and address these concerns, identifying, engaging, and training a diverse environmental health research workforce will be critical and necessary steps to combat and prevent the consequences of environmental injustice. While there is an obvious need to enhance diversity in environmental health research, this process is hampered by facets of systemic racism that reduce access to educational resources needed to build interest and knowledge in students and teachers. We present here a historical perspective to offer a guide for building programs and relationships with underserved schools to help overcome limiting factors that have plagued certain public school systems. With the proper training and mentorship, the untapped workforce present within these schools will be empowered to understand and address current and emerging environmental health and safety threats. Through this transformative 8-week high school research program, we will develop well-prepared, ethical researchers committed to scientific inquiry, intensive fieldwork, and collaborative problem solving to address environmental health challenges. Following the four-step risk assessment process, students, teachers, and faculty mentors will work collaboratively to identify toxicants, potential hazards and risks, and environmental disparities in urban neighborhoods, which provides the necessary training to formulate critical thinking skills for use in academic or nonacademic careers.NEW & NOTEWORTHY The Engaging Multidisciplinary Professional Opportunities for Women in Environmental Research (EMPOWER) program is a one-of-a-kind research summer experience for minority female high school students in the state of Georgia. In addition, this program provides high school teachers with hands-on experiences that can be adapted to use in the classrooms. This combination of lab and field research immerses participants in understanding urban environmental exposures and their health effects. The EMPOWER program was established to meet the critical need for increasing diversity in science, technology, engineering, and mathematics.

Air pollution might affect the clinical course of COVID-19 in pediatric patients

Air pollution, to which children are more susceptible than adults, can promote airway inflammation, potentially exaggerating the effects of respiratory viral infection. This study examined the association between the clinical manifestation of COVID-19 in unvaccinated pediatric patients hospitalized in Poland (n = 766) and levels of particulate matter 2.5 (PM_2.5) and benzo(a)pyrene (B(a)P) within a week before hospitalization. Children aged ≤ 12 years exposed to mean and max 24 h B(a)P levels > 1 ng/m³ revealed higher odds of cough, dyspnea, fever, and increased concentrations of inflammatory markers (C-reactive protein, interleukin-6, procalcitonin, white blood cell count). In older patients (13-17 years), elevated mean 24 h B(a)P levels increased odds of dyspnea, fever, and diarrhea, and higher concentrations of C-reactive protein and procalcitonin. Exposure to max 24 h PM_2.5 levels > 20 µg/m³ was associated with higher odds of cough, increased concentrations of C-reactive protein (group ≤12 years), and increased procalcitonin concentration (groups ≤12 years and 13-17 years). In both age groups, length of stay was extended in patients exposed to elevated levels of max 24 h PM_2.5, mean and max 24 h B(a)P. This study suggests that worse air quality, particularly reflected in increased B(a)P levels, might affect the clinical course of COVID-19 in pediatric patients and adds to the disease burden during a pandemic.

Pulmonary Effects Due to Physical Exercise in Polluted Air: Evidence from Studies Conducted on Healthy Humans

Physical inactivity has caused serious effects on the health of the population, having an impact on the quality of life and the cost of healthcare for many countries. This has motivated government and private institutions to promote regular physical activity, which, paradoxically, can involve health risks when it is carried out in areas with poor air quality. This review collects information from studies conducted on healthy humans related to the pulmonary effects caused by the practice of physical activity when there is poor air quality. In addition, several challenges related to the technological and educational areas, as well as to applied and basic research, have been identified to facilitate the rational practice of exercise in poor air quality conditions.

Ambient air pollution and sickle cell disease-related emergency department visits in Atlanta, GA

BACKGROUND

Sickle cell disease (SCD) is an inherited, autosomal recessive blood disorder, among the most prevalent genetic diseases, globally. While the genetic and hemolytic dynamics of SCD have been well-characterized, the etiology of SCD-related pathophysiological processes is unclear. Although limited, observational evidence suggests that environmental factors, including urban air pollution, may play a role.

OBJECTIVES

We assessed whether daily ambient air pollution concentrations are associated with corresponding emergency department (ED) visit counts for acute SCD exacerbations in Atlanta, Georgia, during a 9-year (2005-2013) period. We also examined heterogeneity in response by age and sex.

METHODS

ED visit data were from 41 hospitals in the 20-county Atlanta, GA area. Associations between daily air pollution levels for 8 urban air pollutants and counts of SCD related ED visits were estimated using Poisson generalized linear models.

RESULTS

We observed positive associations between pollutants generally indicative of traffic emissions and corresponding SCD ED visits [e.g., rate ratio of 1.022 (95% CI: 1.002, 1.043) per interquartile range increase in carbon monoxide]. Age stratified analyses indicated stronger associations with traffic pollutants among children (0-18 years), as compared to older age strata. Associations involving other pollutants, including ozone and particulate matter and for models of individuals >18 years old, were consistent a null hypothesis of no association.

DISCUSSION

This analysis represents the first North American study to examine acute risk among individuals with SCD to urban air pollution and provide evidence of urban air pollution, especially from traffic sources, as a trigger for acute exacerbations. These findings are consistent with a hypothesis that biological pathways, including several centrally associated with oxidative stress, may contribute towards enhanced susceptibility in individuals with SCD.

Interleukin-35 reduces inflammation in acute lung injury through inhibiting TLR4/NF-κB signaling pathways

Acute lung injury (ALI) in children is a complex disease that is accompanied by an inflammatory response. The pathogenesis of ALI in children is not yet well understood. Mice with ALI exhibit inflammation of the lungs and decreased expression of interleukin (IL)-35. To investigate whether the function of IL-35 affects lipopolysaccharide (LPS)-induced ALI, IL-35 was overexpressed in cells. Enzyme-linked immunosorbent assays indicated decreased levels of IL-6 and tumor necrosis factor-α in LPS-induced and agomir-IL-35-treated murine RAW264.7 macrophages. Finally, toll-like receptor 4 (TLR4)/NF-κB signaling pathways were analyzed. The expression of TLR4, NF-κB p65 and NF-κB p50 were decreased, as was the degradation of NF-κB inhibitor-α, in LPS-induced and agomir-IL-35-treated murine RAW264.7 macrophages. The results of the present study demonstrated that IL-35 may exhibit a protective role in ALI by modulating the TLR4/NF-κB signaling pathways.

Review of the effect of air pollution exposure from industrial point sources on asthma-related effects in childhood

We reviewed epidemiologic studies of the association between exposure to air pollution from industries and asthma-related outcomes in childhood. We searched bibliographic databases and reference lists of relevant articles to identify studies examining the association between children's exposure to air pollution from industrial point-sources and asthma-related outcomes, including asthma, asthma-like symptoms, wheezing, and bronchiolitis. We extracted key characteristics of each study and when appropriate we performed a random-effects meta-analysis of results and quantified heterogeneity (I ²). Thirty-six studies were included in this review. Meta-analysis was generally not possible and limited to a few studies because of substantial variation across design characteristics and methodologies. In case-crossover studies using administrative health data, pooled odds ratio (OR) of hospitalization for asthma and bronchiolitis in children <5 years were 1.02 [95% confidence intervals (CI): 0.96, 1.08; I ² = 56%] and 1.01 (95% CI: 0.97, 1.05; I ² = 64%) per 10 ppb increase in the daily mean and hourly maximum concentration of sulfur dioxide (SO₂), respectively. For PM_2.5, pooled ORs were 1.02 (95% CI: 0.93, 1.10; I ² = 56%) and 1.01 (95% CI: 0.98, 1.03 I ² = 33%) per 10 μg/m³ increment in the daily mean and hourly maximum concentration. In cross-sectional studies using questionnaires, pooled ORs for the prevalence of asthma and wheezing in relation to residential proximity to industry were 1.98 (95% CI: 0.87, 3.09; I ² =71%) and 1.33 (95% CI: 0.86, 1.79; I ²= 65%), respectively. In conclusion, this review showed substantial heterogeneity across study designs and methods. Meta-analysis results suggested no evidence of an association for short-term asthma-related effects and an indication for long-term effects, but heterogeneity between results and limitations in terms of design and exposure assessment preclude drawing definite conclusions. Further well-conducted studies making use of a longitudinal design and of refined exposure assessment methods are needed to improve risk estimates.

Heavy Metal Mixture Exposure and Effects in Developing Nations: An Update

The drive for development and modernization has come at great cost. Various human activities in developed and developing countries, particularly in sub-Saharan Africa (SSA) have given rise to environmental safety concerns. Increased artisanal mining activities, illegal refining, use of leaded petrol, airborne dust, arbitrary discarding and burning of toxic waste, absorption of production industries in inhabited areas, inadequate environmental legislation, and weak implementation of policies, have given rise to the incomparable contamination and pollution associated with heavy metals in recent decades. This review evaluates the public health effects of heavy metals and their mixtures in SSA. This shows the extent and size of the problem posed by exposure to heavy metal mixtures in regard to public health.

Localized real-time information on outdoor air quality at kindergartens in Oslo, Norway using low-cost sensor nodes

In Norway, children in kindergartens spend significant time outdoors under all weather conditions, and there is thus a natural concern about the quality of outdoor air. It is well known that air pollution is associated with a wide variety of adverse health impacts for children, with greater impact on children with asthma. Especially during winter and spring, kindergartens in Oslo that are situated close to streets with busy traffic, or in areas where wood burning is used for house heating, can experience many days with bad air quality. During these periods, updated information on air quality levels can help the kindergarten teachers to plan appropriate outdoor activities and thus protect children's health. We have installed 17 low-cost air quality nodes in kindergartens in Oslo. These nodes are smaller, cheaper and less complex to use than traditional equipment. Performance evaluation shows that while they are less accurate and suffer from higher uncertainty than reference equipment, they still can provide reliable coarse information about local pollution. The main challenge when using this technology is that calibration parameters might change with time depending on the atmospheric conditions. Thus, even if the sensors are calibrated a priori, once deployed, and especially if they are deployed for a long time, it is not possible to determine if a node is over- or under-estimating the concentration levels. To enhance the data from the sensors, we employed a data fusion technique that allows generating a detailed air quality map merging the data from the sensors and the data from an urban model, thus being able to offer air quality information to any location within Oslo. We arranged a focus group with the participation of local administration, kindergarten staff and parents to understand their opinion and needs related to the air quality information that was provided to the participant kindergartens. They expressed concern about the data quality but agree that having updated information on the air quality in the surroundings of kindergartens can help them to reduce children's exposure to air pollution.

Proximity to two main sources of industrial outdoor air pollution and emergency department visits for childhood asthma in Edmonton, Canada

OBJECTIVE

Children are recognized to be more susceptible than healthy adults to the effects of air pollution; however, relatively few Canadian studies of children have focused on industrial emissions. We conducted a spatial cross-sectional study to explore associations between emergency department (ED) visits for childhood asthma and residential proximity to two industrial sources of air pollution (coal-fired power plant and petrochemical industry) in Edmonton, Canada.

METHODS

Using administrative health care data for Alberta between 2004 and 2010, we conducted a spatial analysis of disease clusters of count data around these two industrial sources. The distance from children's place of residence to these industrial sources was determined by using the six-character postal code from the children's ED visit. Clusters of cases were identified at the census dissemination area. Negative binomial multivariable spatial regression was used to estimate the risks of clusters in relation to the distance to these industrial sources.

RESULTS

The relative risk of ED visits for asthma, calculated using a spatial scan test for events, was 10.4 (p value &lt;0.01) within the power plant area when compared with the outside area. In addition, there was an inverse association of the distance to the power plant (coefficient = -0.01 per km) with asthma visits when multivariable models were used. No asthma clusters were identified around the petrochemical industrial area.

CONCLUSION

Our analyses revealed that there was a cluster of ED visits for asthma among children who lived near the coal-fired power plant just outside Edmonton.

Effects of air pollution on infant and children respiratory mortality in four large Latin-American cities

OBJECTIVES

Air pollution is an important public health concern especially for children who are particularly susceptible. Latin America has a large children population, is highly urbanized and levels of pollution are substantially high, making the potential health impact of air pollution quite large. We evaluated the effect of air pollution on children respiratory mortality in four large urban centers: Mexico City, Santiago, Chile, and Sao Paulo and Rio de Janeiro in Brazil.

METHODS

Generalized Additive Models in Poisson regression was used to fit daily time-series of mortality due to respiratory diseases in infants and children, and levels of PM₁₀ and O₃. Single lag and constrained polynomial distributed lag models were explored. Analyses were carried out per cause for each age group and each city. Fixed- and random-effects meta-analysis was conducted in order to combine the city-specific results in a single summary estimate.

RESULTS

These cities host nearly 43 million people and pollution levels were above the WHO guidelines. For PM₁₀ the percentage increase in risk of death due to respiratory diseases in infants in a fixed effect model was 0.47% (0.09-0.85). For respiratory deaths in children 1-5 years old, the increase in risk was 0.58% (0.08-1.08) while a higher effect was observed for lower respiratory infections (LRI) in children 1-14 years old [1.38% (0.91-1.85)]. For O₃, the only summarized estimate statistically significant was for LRI in infants. Analysis by season showed effects of O₃ in the warm season for respiratory diseases in infants, while negative effects were observed for respiratory and LRI deaths in children.

DISCUSSION

We provided comparable mortality impact estimates of air pollutants across these cities and age groups. This information is important because many public policies aimed at preventing the adverse effects of pollution on health consider children as the population group that deserves the highest protection.

Reading, Writing, and Toxics: Children's Health, Academic Performance, and Environmental Justice in Los Angeles

A significant body of previous research on environmental justice has demonstrated a disproportionate burden of environmental hazards on low-income and minority residents. In this paper we evaluate spatially indexed data on estimated respiratory and cancer risks associated with exposures to ambient air toxics to show that children of color in the Los Angeles Unified School District suffer potentially disparate health impacts, and that disparities in environmental risks may be associated with diminished school performance—even after controlling for socioeconomic and demographic covariates that generally explain much of the variation in student scores. Remediating environmental health risks in distressed neighborhoods could, therefore, improve both health and human capital.

Childhood Exposure to Ambient Air Pollutants and the Onset of Asthma: An Administrative Cohort Study in Québec

BACKGROUND

Although it is well established that air pollutants can exacerbate asthma, the link with new asthma onset in children is less clear.

OBJECTIVE

We assessed the association between the onset of childhood asthma with both time of birth and time-varying exposures to outdoor air pollutants.

METHOD

An open cohort of children born in the province of Québec, Canada, was created using linked medical-administrative databases. New cases of asthma were defined as one hospital discharge with a diagnosis of asthma or two physician claims for asthma within a 2 year period. Annual ozone (O3) levels were estimated at the child's residence for all births 1999-2010, and nitrogen dioxide (NO2) levels during 1996-2006 were estimated for births on the Montreal Island. Satellite based concentrations of fine particles (PM2.5) were estimated at a 10 km × 10 km resolution and assigned to residential postal codes throughout the province (1996-2011). Hazard ratios (HRs) were assessed with Cox models for the exposure at the birth address and for the time-dependent exposure. We performed an indirect adjustment for secondhand smoke (SHS).

RESULTS

We followed 1,183,865 children (7,752,083 person-years), of whom 162,752 became asthmatic. After controlling for sex and material and social deprivation, HRs for an interquartile range increase in exposure at the birth address to NO2 (5.45 ppb), O3 (3.22 ppb), and PM2.5 (6.50 μg/m3) were 1.04 (95% CI: 1.02, 1.05), 1.11 (95% CI: 1.10, 1.12), and 1.31 (95% CI: 1.28, 1.33), respectively. Effects of O3 and PM2.5 estimated with time-varying Cox models were similar to those estimated using exposure at birth, whereas the effect of NO2 was slightly stronger (HR = 1.07; 95% CI: 1.05, 1.09).

CONCLUSIONS

Asthma onset in children appears to be associated with residential exposure to PM2.5, O3 and NO2.

CITATION

Tétreault LF, Doucet M, Gamache P, Fournier M, Brand A, Kosatsky T, Smargiassi A. 2016. Childhood exposure to ambient air pollutants and the onset of asthma: an administrative cohort study in Québec. Environ Health Perspect 124:1276-1282; http://dx.doi.org/10.1289/ehp.1509838.

Effect of GST variants on lung function following diesel exhaust and allergen co-exposure in a controlled human crossover study

BACKGROUND

Isolated exposure to diesel exhaust (DE) or allergen can cause decrements in lung function that are impacted by the presence of genetic variants in the glutathione-S-transferase (GST) family but the effect of GST interactions with DE-allergen co-exposure on lung function is unknown. We aimed to assess the impact of DE and allergen co-exposure on lung function and the influence of GSTM1 or GSTT1 variation

METHODS

We used a blinded crossover study design with 17 atopic subjects exposed to filtered air (FA; the control for DE) or DE for 2h. One hour following each exposure to DE or FA, bronchoscopy was performed to deliver a diluent-controlled segmental allergen challenge (SAC). Methacholine challenge and forced expiratory volume in 1s (FEV1) was performed pre-exposure (baseline airway responsiveness) and 24h post-exposure (effect of co-exposure). Additionally, FEV1 was performed hourly after DE/FA exposure and protein carbonyl content was measured in plasma as an oxidative stress marker.

RESULTS

Changes in FEV1 from baseline were dependent on time following allergen exposure. DE, as opposed to FA, led to a significant change in FEV1 at 2h post-allergen exposure in GSTT1 variants only (24.5±19.6% reduction in GSTT1 null individuals vs. 9.2±7.3% reduction in GSTT1 present individuals). Moreover, plasma protein carbonyl level 4h after co-exposure was higher in the individuals who have the GSTT1 null genotype.

CONCLUSIONS

This suggests a gene-environment interaction that endangers susceptible populations co-exposed to DE and allergen.

The effects of outdoor air pollution on the respiratory health of Canadian children: A systematic review of epidemiological studies

BACKGROUND

Outdoor air pollution is a global problem with serious effects on human health, and children are considered to be highly susceptible to the effects of air pollution.

OBJECTIVE

To conduct a comprehensive and updated systematic review of the literature reporting the effects of outdoor air pollution on the respiratory health of children in Canada.

METHODS

Searches of four electronic databases between January 2004 and November 2014 were conducted to identify epidemiological studies evaluating the effect of exposure to outdoor air pollutants on respiratory symptoms, lung function measurements and the use of health services due to respiratory conditions in Canadian children. The selection process and quality assessment, using the Newcastle-Ottawa Scale, were conducted independently by two reviewers.

RESULTS

Twenty-seven studies that were heterogeneous with regard to study design, population, respiratory outcome and air pollution exposure were identified. Overall, the included studies reported adverse effects of outdoor air pollution at concentrations that were below Canadian and United States standards. Heterogeneous effects of air pollutants were reported according to city, sex, socioeconomic status and seasonality. The present review also describes trends in research related to the effect of air pollution on Canadian children over the past 25 years.

CONCLUSION

The present study reconfirms the adverse effects of outdoor air pollution on the respiratory health of children in Canada. It will help researchers, clinicians and environmental health authorities identify the available evidence of the adverse effect of outdoor air pollution, research gaps and the limitations for further research.

Contributing factors to the development of childhood asthma: working toward risk minimization

Asthma is the most common chronic disease in childhood, and considerable research has been undertaken to find ways to prevent its development and reduce its prevalence. For such interventions to be successful, risk factors for asthma emergence should be identified and clearly defined. Data are robust for some of them, including atopy, viral infections and exposure to airborne irritants, whereas it is less conclusive for others, such as aeroallergen exposure and bacterial infections. Several interventions for asthma prevention, including avoidance and pharmacotherapy, have been attempted. However, most of them have furnished equivocal results. Various issues hinder the establishment of risk factors for asthma development and reduce the effectiveness of interventions, including the complexity of the disease and the fluidity of the developing systems in childhood. In this review, we revisit the evidence on pediatric asthma risk factors and prevention and discuss issues that perplex this field.

Oxidative potential of smoke from burning wood and mixed biomass fuels

More than half the world's population still rely on burning biomass fuels to heat and light their homes and cook food. Household air pollution, a common component of which is inhalable particulate matter (PM), emitted from biomass burning is associated with increased vulnerability to respiratory infection and an enhanced risk of developing chronic obstructive pulmonary disease. In the light of an emerging hypothesis linking chronic PM exposure during childhood and increased vulnerability to respiratory diseases in adulthood, in a chain of events involving oxidative stress, reduced immunity and subsequent infection, the aim of this study was to characterise the oxidative potential (OP) of PM collected during the burning of wood and mixed biomass, whilst cooking food in the Kathmandu Valley, Nepal. Our assessments were based on the capacity of the particles to deplete the physiologically relevant antioxidants from a validated, synthetic respiratory tract lining fluid (RTLF). Incubation of mixed biomass and wood smoke particles suspensions with the synthetic RTLF for 4 h resulted in a mean loss of ascorbate of 64.76 ± 16.83% and 83.37 ± 14.12% at 50 μg/ml, respectively. Reduced glutathione was depleted by 49.29 ± 15.22% in mixed biomass and 65.33 ± 13.01% in wood smoke particles under the same conditions. Co-incubation with the transition metal chelator diethylenetriaminepentaacetate did not inhibit the rate of ascorbate oxidation, indicating a negligible contribution by redox-active metals in these samples. The capacity of biomass smoke particles to elicit oxidative stress certainly has the potential to contribute towards negative health impacts associated with traditional domestic fuels in the developing world.

Expression of glutathione S-transferase variants in human airway wall after long-term response to sulfur mustard

CONTEXT

Sulfur mustard (SM) is an alkylating agent identified as a potent chemical warfare agent. More recently, SM was used in the Iraq conflict against Iranian troops and civilians. At present, there are many people suffering from chronic obstructive pulmonary disease (COPD) due to mustard gas in Iran. SM increases the endogenous production of reactive oxygen species (ROS). The oxidant/antioxidant imbalance present in the lungs of these patients also results from the impaired capacity of the antioxidant/detoxification enzymes to detoxify the harmful reactive oxygen metabolites.

OBJECTIVE

One of the major antioxidants in human airways is glutathione S-transferase. They facilitate the detoxification of various environmental of oxidative stress. In this study, we attempted to understand the significance different in expression of GSTs in airway wall of chemical patients and control.

MATERIALS AND METHODS

Seven normal and 20 SM induced COPD individuals were studied. Bronchoscopy was performed in all subjects and two specimens were taken from the main bronchus for mRNA extraction, PCR analysis and immunohistochemistry.

RESULTS

SM-induced COPD individuals showed expression of GSTA1 2.51 ± 0.83-, GSTM1 2.84 ± 1.71- and GSTP1 5.61 ± 2.59-folds higher than those of controls that revealed. GSTP1-immunoreactivity was strongly expressed in luminal border of normal samples. SM patient samples immunoreactivity for GSTP1 in the same area were negative.

DISCUSSION AND CONCLUSION

According to these findings, we speculated that overexpression of GSTs mRNA in patients revealed that GSTs plays an important role in cellular protection against oxidative stress of MS in airway wall of patients.

A scalable, knowledge-based analysis framework for genetic association studies

BACKGROUND

Testing for marginal associations between numerous genetic variants and disease may miss complex relationships among variables (e.g., gene-gene interactions). Bayesian approaches can model multiple variables together and offer advantages over conventional model building strategies, including using existing biological evidence as modeling priors and acknowledging that many models may fit the data well. With many candidate variables, Bayesian approaches to variable selection rely on algorithms to approximate the posterior distribution of models, such as Markov-Chain Monte Carlo (MCMC). Unfortunately, MCMC is difficult to parallelize and requires many iterations to adequately sample the posterior. We introduce a scalable algorithm called PEAK that improves the efficiency of MCMC by dividing a large set of variables into related groups using a rooted graph that resembles a mountain peak. Our algorithm takes advantage of parallel computing and existing biological databases when available.

RESULTS

By using graphs to manage a model space with more than 500,000 candidate variables, we were able to improve MCMC efficiency and uncover the true simulated causal variables, including a gene-gene interaction. We applied PEAK to a case-control study of childhood asthma with 2,521 genetic variants. We used an informative graph for oxidative stress derived from Gene Ontology and identified several variants in ERBB4, OXR1, and BCL2 with strong evidence for associations with childhood asthma.

CONCLUSIONS

We introduced an extremely flexible analysis framework capable of efficiently performing Bayesian variable selection on many candidate variables. The PEAK algorithm can be provided with an informative graph, which can be advantageous when considering gene-gene interactions, or a symmetric graph, which simply divides the model space into manageable regions. The PEAK framework is compatible with various model forms, allowing for the algorithm to be configured for different study designs and applications, such as pathway or rare-variant analyses, by simple modifications to the model likelihood and proposal functions.

The influence of drinking-water pollution with heavy metal on the expression of IL-4 and IFN-γ in mice by real-time polymerase chain reaction

In recent years, water pollution has been converted to a challenging discussion in health area of human being. Heavy elements are one of the most important water pollutants and their negative adverse effects on body systems have been confirmed. In this study, investigation of effects of two heavy elements including lead (Pb) and copper (Cu) on expression of interlukin-4 (IL-4) and interferon-gamma (IFN-γ) as humoral and cellular immunity biomarkers, respectively, was aimed and PCR, real-time PCR and electrophoresis techniques were used. In this study, BALB/c mice were studied that had free access to drinking water which contained Cu or Pb salts. After 2 weeks, spleens of mice were removed, RNA extracted, and cDNA was prepared for RT-PCR. Then the expression of IL-4 and IFN-γ genes were assessed by real-time PCR. The expression of IFN-γ was up-regulated in both treated groups and the expression of IL-4 was only up-regulated in the group treated with Cu and down-regulated in the group treated with Pb. This study shows that the presence of heavy elements as drinking-water pollutants results in a disproportion of natural cytokines balances, and thus may result in a negative effect on immune system.

Expression pattern of GSTP1 and GSTA1 in the pathogenesis of asthma

Reactive oxygen species (ROS) are known aggravating factors for airway inflammation in asthma. Glutathione S-transferases (GSTs) detoxify ROS and toxic compounds in environmental exposures. However, little is known about the regulation of GST and expression of GST subtypes in asthma. The aim of this study was to evaluate how GSTs are regulated in asthma. We observed total GST activity and expression of GST subtypes in murine asthma models and GST expressions in induced sputum cells of asthmatics. Total GST activity was increased in BAL fluids of OVA-treated murine asthma model. GSTP and GSTA are highly expressed in peribronchiolar mononuclear inflammatory cells and epithelial cells in OVA-treated mice. GSTM are expressed in epithelial cells in both OVA and PBS-treated groups. GSTP1 mRNA expression was increased in the lung of OVA-treated mice compared with PBS-treated mice. GSTA1, GSTM1, and GSTT1 mRNA expressions were not different between both groups. GSTA1 mRNA expression was increased in induced sputum cells of asthmatics compared with healthy controls. GSTP1, GSTM1, and GSTT1 mRNA expressions were not different between asthmatics and healthy controls. In asthmatics, GSTP1 and GSTA1 mRNA expressions were higher in induced sputum cells of asthmatics with PC20 ≤ 4 mg/ml than those with PC20 > 4 mg/ml. GSTM1 and GSTT1 mRNA expressions were not different between two groups. These findings suggest that GSTs are upregulated in the airways of asthmatics in response to increased oxidative stress. GSTP and GSTA are thought to play an important role in protecting the airways of asthmatics compared with GSTM and GSTT.

Cardiorespiratory biomarker responses in healthy young adults to drastic air quality changes surrounding the 2008 Beijing Olympics

Associations between air pollution and cardiorespiratory mortality and morbidity have been well established, but data to support biologic mechanisms underlying these associations are limited. We designed this study to examine several prominently hypothesized mechanisms by assessing Beijing residents' biologic responses, at the biomarker level, to drastic changes in air quality brought about by unprecedented air pollution control measures implemented during the 2008 Beijing Olympics. To test the hypothesis that changes in air pollution levels are associated with changes in biomarker levels reflecting inflammation, hemostasis, oxidative stress, and autonomic tone, we recruited and retained 125 nonsmoking adults (19 to 33 years old) free of cardiorespiratory and other chronic diseases. Using the combination of a quasi-experimental design and a panel-study approach, we measured biomarkers of autonomic dysfunction (heart rate [HR*] and heart rate variability [HRV]), of systemic inflammation and oxidative stress (plasma C-reactive protein [CRP], fibrinogen, blood cell counts and differentials, and urinary 8-hydroxy-2'-deoxyguanosine [8-OHdG]), of pulmonary inflammation and oxidative stress (fractional exhaled nitric oxide [FeNO], exhaled breath condensate [EBC] pH, EBC nitrate, EBC nitrite, EBC nitrite+nitrate [sum of the concentrations of nitrite and nitrate], and EBC 8-isoprostane), of hemostasis (platelet activation [plasma sCD62P and sCD40L], platelet aggregation, and von Willebrand factor [vWF]), and of blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]). These biomarkers were measured on each subject twice before, twice during, and twice after the Beijing Olympics. For each subject, repeated measurements were separated by at least one week to avoid potential residual effects from a prior measurement. We measured a large suite of air pollutants (PM2.5 [particulate matter < or = 2.5 microm in aerodynamic diameter] and constituents, sulfur dioxide [SO2], carbon monoxide [CO], nitrogen dioxide [NO2], and ozone [O3]) throughout the study at a central Beijing site near the residences and workplaces of the subjects on a daily basis. Total particle number (TPN) was also measured at a separate site. We used a time-series analysis to assess changes in pollutant concentration by period (pre-, during-, and post-Olympics periods). We used mixed-effects models to assess changes in biomarker levels by period and to estimate changes associated with increases in pollutant concentrations, controlling for ambient temperature, relative humidity (RH), sex, and the day of the week of the biomarker measurements. We conducted sensitivity analyses to assess the impact of potential temporal confounding and exposure misclassification. We observed reductions in mean concentrations for all measured pollutants except O3 from the pre-Olympics period to the during-Olympics period. On average, elemental carbon (EC) changed by -36%, TPN by -22%, SO2 by -60%, CO by -48%, and NO2 by -43% (P < 0.05 for all these pollutants). Reductions were observed in mean concentrations of PM2.5 (by -27%), sulfate (SO4(2-)) (by -13%), and organic carbon (OC) (by -23%); however, these values were not statistically significant. Both 24-hour averages and 1-hour maximums of O3 increased (by 20% and 17%, respectively) from the pre-Olympics to the during-Olympics period. In the post-Olympics period after the pollution control measures were relaxed, mean concentrations of most pollutants (with the exception of SO4(2-) and O3) increased to levels similar to or higher than pre-Olympics levels. Concomitantly and consistent with the hypothesis, we observed, from the pre-Olympics to the during-Olympics period, statistically significant (P < or = 0.05) or marginally significant (0.05 < P < 0.1) decreases in HR (-1 bpm or -1.7% [95% CI, -3.4 to -0.1]), SBP (-1.6 mmHg or -1.8% [95% CI, -3.9 to 0.4]), 8-OHdG (-58.3% [95% CI, -72.5 to -36.7]), FeNO (-60.3% [95% CI, -66.0 to -53.6]), EBC nitrite (-30.0% [95% CI, -39.3 to -19.3]), EBC nitrate (-21.5% [95% CI, -35.5 to -4.5]), EBC nitrite+nitrate (-17.6% [95% CI, -28.4 to -5.1]), EBC hydrogen ions (-46% [calculated from EBC pH], or +3.5% in EBC pH [95% CI, 2.2 to 4.9]), sCD62P (-34% [95% CI, -38.4 to -29.2]), sCD40L (-5.7% [95% CI, -10.5 to -0.7]), and vWF (-13.1% [95% CI, -18.6 to -7.5]). Moreover, the percentages of above-detection values out of all observations were significantly lower for plasma CRP and EBC 8-isoprostane in the during-Olympics period compared with the pre-Olympics period. In the post-Olympics period, the levels of the following biomarkers reversed (increased, either with or without statistical significance) from those in the during-Olympics period: SBP (10.7% [95% CI, 2.8 to 18.6]), fibrinogen (4.3% [95% CI, -1.7 to 10.2), neutrophil count (4.7% [95% CI, -7.7 to 17.0]), 8-OHdG (315% [95% CI, 62.0 to 962]), FeNO (130% [95% CI, 62.5 to 225]), EBC nitrite (159% [95% CI, 71.8 to 292]), EBC nitrate (161% [95% CI, 48.0 to 362]), EBC nitrite+nitrate (124% [95% CI, 50.9 to 233]), EBC hydrogen ions (146% [calculated from EBC pH] or -4.8% in EBC pH [95% CI, -9.4 to -0.21), sCD62P (33.7% [95% CI, 17.7 to 51.8]), and sCD40L (9.1% [95% CI, -3.7 to 23.5]). Furthermore, these biomarkers also showed statistically significant associations with multiple pollutants across different lags after adjusting for meteorologic parameters. The associations were in the directions hypothesized and were consistent with the findings from the comparisons between periods, providing further evidence that the period effects were due to changes in air quality, independent of season and meteorologic conditions or other potential confounders. Contrary to our hypothesis, however, we observed increases in platelet aggregation, red blood cells (RBCs) and white blood cells (WBCs) associated with the during-Olympics period, as well as significant negative associations of these biomarkers with pollutant concentrations. We did not observe significant changes in any of the HRV indices and DBP by period. However, we observed associations between a few HRV indices and pollutant concentrations. Changes in air pollution levels during the Beijing Olympics were associated with acute changes in biomarkers of pulmonary and systemic inflammation, oxidative stress, and hemostasis and in measures of cardiovascular physiology (HR and SBP) in healthy, young adults. These changes support the prominently hypothesized mechanistic pathways underlying the cardiorespiratory effects of air pollution.

Joint analysis for integrating two related studies of different data types and different study designs using hierarchical modeling approaches

BACKGROUND

A chronic disease such as asthma is the result of a complex sequence of biological interactions involving multiple genes and pathways in response to a multitude of environmental exposures. However, methods to model jointly all factors are still evolving. Some of the current challenges include how to integrate knowledge from different data types and different disciplines, as well as how to utilize relevant external information such as gene annotation to identify novel disease genes and gene-environment inter-actions.

METHODS

Using a Bayesian hierarchical modeling framework, we developed two alternative methods for joint analysis of an epidemiologic study of a disease endpoint and an experimental study of intermediate phenotypes, while incorporating external information.

RESULTS

Our simulation studies demonstrated superior performance of the proposed hierarchical models compared to separate analysis with the standard single-level regression modeling approach. The combined analyses of the Southern California Children's Health Study and challenge study data suggest that these joint analytical methods detected more significant genetic main and gene-environment interaction effects than the conventional analysis.

CONCLUSION

The proposed prior framework is very flexible and can be generalized for an integrative analysis of diverse sources of relevant biological data.

GSTM1 and GSTP1 gene variants and the effect of air pollutants on lung function measures in South African children

BACKGROUND

Several genes are associated with an increased susceptibility to asthma, which may be exacerbated by ambient air pollution. These genes include GSTM1 (glutathione-S-transferase M1 gene) and GSTP1 (glutathione-S-transferase P1 gene), which may modulate the response to epithelial oxidative changes caused by air pollutant exposure. This study evaluated fluctuations in the forced expiratory volume in one second (FEV(1)) in relation to lagged daily averages of ambient air pollutants (SO(2), NO(2), NO, and PM(10)) while considering genotype as an effect modifier.

METHODS

A longitudinal cohort of 129 schoolchildren of African descent from Durban, South Africa was assessed. GSTM1 (null vs. present genotype) and GSTP1 (Ile105Val; AA → AG/GG) genotypes were determined using standard techniques. SO(2), NO(2), NO, and PM(10) were measured continuously over a year using validated methods. The outcome was intraday variability in FEV(1) . Data were collected daily over a 3-week period in each of four seasons (2004-2005).

RESULTS

Among the children tested, 27% had the GSTM1 null genotype and 81% carried the GSTP1 G allele. Approximately 26 out 104 children (25%) showed evidence of bronchial hyperreactivity, 13% reported having symptoms in keeping with persistent asthma, and a further 25% reported symptoms of mild intermittent asthma. PM(10) and SO(2) levels were moderately high relative to international guidelines. Neither GSTM1 nor GSTP1 genotypes alone were significantly associated with FEV(1) intraday variability. In models not including genotype, FEV(1) variability was statistically significantly associated only with NO(2) for 5-day lags (% change in intraday variability in FEV1 per interquartile range = 1.59, CI 0.58, 2.61). The GSTP1 genotype modified the effect of 3 days prior 24-hr average PM(10) and increased FEV(1) variability. A similar pattern was observed for lagged 3 day SO(2) exposure (P interaction < 0.05). Adverse effects of these pollutants were limited to individuals carrying the G allele for this polymorphism.

CONCLUSION

Among this indigenous South African children cohort, the GSTP1 genotype modified the effects of ambient exposures to PM(10) and SO(2) and lung function. A plausible mechanism for these observed effects is decreased capacity to mount an effective response to oxidative stress associated with the GSTP1 AG + GG genotype.

Panel studies of air pollution on children's lung function and respiratory symptoms: a literature review

OBJECTIVE

This article reviews panel studies of air pollution on children's respiratory health and proposes future research directions.

METHODS

The PubMed electronic database was used to search published original epidemiological studies in peer-reviewed journals from 2000 to November 2011. Children's age was limited to ≤18 years old. A total of 33 relevant articles were obtained, with 20 articles relating to lung function, 21 articles relating to respiratory symptoms, and 8 articles examining both.

RESULTS

Most studies suggested the adverse effects of air pollution on children's lung function and respiratory symptoms. Particles and NO(2) showed more significant results, whereas effects of SO(2) were not consistent. A few studies indicated that O(3) interacted with temperature and sometimes seemed to be a protective factor for children's respiratory health. Negative associations between air pollutants and pulmonary health were more serious in asthmatic children than in healthy subjects. However, many outcomes depended on the number of lag days. Peak expiratory flow (PEF) was the most usual measurement for children's lung function, followed by forced expiratory volume in 1 second (FEV(1)).

CONCLUSIONS

There are significant adverse effects of air pollution on children's pulmonary health, especially for asthmatics. Future studies need to examine the lag effects of air pollution on children's lung function and respiratory symptoms. Ambient temperature is predicted to change worldwide due to climate change, which will threaten population health. Further research is needed to examine the effects of ambient temperature and the interactive effects between air pollution and ambient temperature on children's lung function and respiratory symptoms.

Inflammatory and oxidative stress responses of healthy young adults to changes in air quality during the Beijing Olympics

RATIONALE

Unprecedented pollution control actions during the Beijing Olympics provided a quasi-experimental opportunity to examine biologic responses to drastic changes in air pollution levels.

OBJECTIVES

To determine whether changes in levels of biomarkers reflecting pulmonary inflammation and pulmonary and systemic oxidative stress were associated with changes in air pollution levels in healthy young adults.

METHODS

We measured fractional exhaled nitric oxide, a number of exhaled breath condensate markers (H(+), nitrite, nitrate, and 8-isoprostane), and urinary 8-hydroxy-2-deoxyguanosine in 125 participants twice in each of the pre- (high pollution), during- (low pollution), and post-Olympic (high pollution) periods. We measured concentrations of air pollutants near where the participants lived and worked. We used mixed-effects models to estimate changes in biomarker levels across the three periods and to examine whether changes in biomarker levels were associated with changes in pollutant concentrations, adjusting for meteorologic parameters.

MEASUREMENTS AND MAIN RESULTS

From the pre- to the during-Olympic period, we observed significant and often large decreases (ranging from -4.5% to -72.5%) in levels of all the biomarkers. From the during-Olympic to the post-Olympic period, we observed significant and larger increases (48-360%) in levels of these same biomarkers. Moreover, increased pollutant concentrations were consistently associated with statistically significant increases in biomarker levels.

CONCLUSIONS

These findings support the important role of oxidative stress and that of pulmonary inflammation in mediating air pollution health effects. The findings demonstrate the utility of novel and noninvasive biomarkers in the general population consisting largely of healthy individuals.

Motor vehicle air pollution and asthma in children: a meta-analysis

BACKGROUND

Asthma affects more than 17 million people in the United States;1/3 of these are children. Children are particularly vulnerable to airborne pollution because of their narrower airways and because they generally breathe more air per pound of body weight than adults, increasing their exposure to air pollutants. However, the results from previous studies on the association between motor vehicle emissions and the development of childhood wheeze and asthma are conflicting. Therefore, we conducted a meta-analysis to clarify their potential relationship.

METHODS

MEDLINE, Highwire, and The Cochrane Library databases were searched for relevant studies. Adjusted odds ratio (OR) with corresponding 95% confidence interval (CI) for the association between traffic air pollutants and wheeze or asthma were retrieved from individual studies and pooled to generate summary effect estimates (meta-OR) in STATA 11.1.

RESULTS

Nineteen studies were included in the meta-analysis. Exposure to nitrogen dioxide (meta-OR: 1.05, 95% CI: 1.00-1.11), nitrous oxide (meta-OR: 1.02, 95% CI: 1.00-1.04), and carbon monoxide (meta-OR: 1.06, 95% CI: 1.01-1.12) were positively associated with a higher prevalence of childhood asthma. Exposure to sulfur dioxide (meta-OR: 1.04, 95% CI: 1.01-1.07) was positively associated with a higher prevalence of wheeze in children. Exposure to nitrogen dioxide was positively associated with a higher incidence of childhood asthma (meta-OR: 1.14, 95% CI: 1.06-1.24), and exposures to particulate matter was positively associated with a higher incidence of wheeze in children (meta-OR: 1.05, 95% CI: 1.04-1.07).

CONCLUSIONS

Living or attending schools near high traffic density roads exposes children to higher levels of motor vehicle air pollutants, and increases the incidence and prevalence of childhood asthma and wheeze.

Reproducibility and intraindividual variation over days in buccal cell DNA methylation of two asthma genes, interferon γ (IFNγ) and inducible nitric oxide synthase (iNOS)

The biological mechanisms responsible for the onset and exacerbation of asthma symptoms in children may involve the epigenetic regulation of inflammatory genes after environmental exposures. Using buccal cells, we hypothesized that DNA methylation in promoter regions of two asthma genes, inducible nitric oxide synthase (iNOS) and interferon γ (IFNγ), can vary over several days. Repeat buccal samples were collected 4 to 7 days apart from 34 children participating in the Columbia Center for Children's Environmental Health (CCCEH) birth cohort study. Several field duplicates (sequential collection of two samples in the field) and replicates (one sample pyrosequenced twice) also were collected to ensure consistency with collection and laboratory procedures. DNA methylation was assessed by pyrosequencing a PCR of bisulfite-treated DNA. We found that replicate and field duplicate samples were correlated strongly (r = 0.86 to 0.99, P < 0.05), while repeat samples demonstrated low within-subject correlations (r = 0.19 to 0.56, P = 0.06 to 0.30). Our data reveal DNA methylation as a dynamic epigenetic mechanism that can be accessed safely and reproducibly in an inner city pediatric cohort using non-invasive buccal swabs and pyrosequencing technology.

Ambient air pollution and apnea and bradycardia in high-risk infants on home monitors

BACKGROUND

Evidence suggests that increased ambient air pollution concentrations are associated with health effects, although relatively few studies have specifically examined infants.

OBJECTIVE

We examined associations of daily ambient air pollution concentrations with central apnea (prolonged pauses in breathing) and bradycardia (low heart rate) events among infants prescribed home cardiorespiratory monitors.

METHODS

The home monitors record the electrocardiogram, heart rate, and respiratory effort for detected apnea and bradycardia events in high-risk infants [primarily premature and low birth weight (LBW) infants]. From August 1998 through December 2002, 4,277 infants had 8,960 apnea event-days and 29,450 bradycardia event-days in > 179,000 days of follow-up. We assessed the occurrence of apnea and bradycardia events in relation to speciated particulate matter and gaseous air pollution levels using a 2-day average of air pollution (same day and previous day), adjusting for temporal trends, temperature, and infant age.

RESULTS

We observed associations between bradycardia and 8-hr maximum ozone [odds ratio (OR) = 1.049 per 25-ppb increase; 95% confidence interval (CI), 1.021-1.078] and 1-hr maximum nitrogen dioxide (OR =1.025 per 20-ppb increase; 95% CI, 1.000-1.050). The association with ozone was robust to different methods of control for time trend and specified correlation structure. In secondary analyses, associations of apnea and bradycardia with pollution were generally stronger in infants who were full term and of normal birth weight than in infants who were both premature and LBW.

CONCLUSIONS

These results suggest that higher air pollution concentrations may increase the occurrence of apnea and bradycardia in high-risk infants.

An inequality study of ambient nitrogen dioxide and traffic levels near elementary schools in the Tampa area

Environmental equity has been identified as a challenge and goal of national to global air quality management. Here, relationships between traffic-related air pollution measures and the social demographics of elementary schools are investigated. Ogawa passive samplers were used to measure ambient nitrogen dioxide (NO(2)) levels near 75 randomly selected elementary schools in the county containing Tampa, FL over one week in March 2008. Concentrations were determined using colorimetric reaction using Hach nitrite reagent and photometric detection at 545 nm. NO(2) levels, two metrics of traffic (highest annual average daily traffic count within 500 m and 1000 m), and school enrollment data by demographic subgroup (racial/ethnic and socioeconomic) were then compared. Data were analyzed for distribution statistics, linear correlations, and differences in subgroup category means. Weighted average values of NO(2) and traffic count were also calculated for each subgroup. All measured NO(2) levels were low, with a mean of 2.7 ppbv and range from 0.8 to 4.7 ppbv. Values were largest at sites near downtown. Results from all analyses show comparatively higher potential exposures to measured NO(2) and traffic count for black school children, and lower values for white and Asian or Pacific Islander school children. The economically disadvantaged and Hispanic subgroups were also associated with higher levels of NO(2) and traffic counts, but the relationship was not as strong or robust. Although measured NO(2) levels were low and the differences between groups are small, results suggest disparities by racial/ethnic and economic status in children's exposures to air pollution for the Tampa area.

Polycyclic aromatic hydrocarbons impair function of β2-adrenergic receptors in airway epithelial and smooth muscle cells

Incomplete combustion produces a pollutant mixture that includes polycyclic aromatic hydrocarbons (PAHs). Previous work by the Columbia Center for Children's Environmental Health (CCCEH) and others linked exposure to PAH with symptoms of asthma and other adverse health effects in young children. Inhaled β(2)-adrenergic agonists are mainstays in the treatment of reactive airway diseases. These exogenous catecholamines engage membrane-bound β(2)-adrenergic receptors (β(2)AR) on airway epithelial and smooth muscle cells to cause airway dilation. We hypothesized that exposure to PAH might similarly interfere with the function of β(2)AR in airway epithelial or smooth muscle cells, reducing the efficacy of a medication important for the treatment of asthma symptoms. A PAH mixture was devised, based on ambient levels measured prenatally among a cohort of pregnant women participating at the CCCEH. Primary airway epithelial and smooth muscle cells were exposed to varying concentrations of the PAH mixture, and expression, function, and signaling of β(2)AR were assessed. Murine tracheal epithelial cells and human airway smooth muscle cells, after exposure to a PAH mixture, exhibited reduced expression and function of β(2)AR. These findings support our hypothesis that environmentally relevant PAHs can impede β(2)AR-mediated airway relaxation, and suggest a new paradigm where air pollutants not only contribute to the pathogenesis of childhood asthma, but also diminish responsiveness to standard therapy.

Air pollution and circulating biomarkers of oxidative stress

Chemical components of air pollutant exposures that induce oxidative stress and subsequent inflammation may be partly responsible for associations of cardiovascular morbidity and mortality with airborne particulate matter and combustion-related pollutant gasses. However, epidemiologic evidence regarding this is limited. An exposure-assessment approach is to measure the oxidative potential of particle mixtures because it is likely that hundreds of correlated chemicals are involved in overall effects of air pollution on health. Oxidative potential likely depends on particle composition and size distribution, especially ultrafine particle concentration, and on transition metals and certain semivolatile and volatile organic chemicals. For health effects, measuring systemic oxidative stress in the blood is one feasible approach, but there is no universal biomarker of oxidative stress and there are many potential target molecules (lipids, proteins, DNA, nitric oxide, etc.), which may be more or less suitable for specific study goals. Concurrent with the measurement of oxidative stress, it is important to measure gene and/or protein expression of endogenous antioxidant enzymes because they can modify relations between oxidative stress biomarkers and air pollutants. Conversely, the expression and activities of these enzymes are modified by oxidative stress. This interplay will likely determine the observed effects of air pollutants on systemic inflammatory and thrombotic mediators and related clinical outcomes. Studies are needed to assess the reliability and validity of oxidative stress biomarkers, evaluate differences in associations between oxidative stress biomarkers and various pollutant measurements (mass, chemical components, and oxidative potential), and evaluate impacts of antioxidant responses on these relations.

Microsomal epoxide hydroxylase genotypes/diplotypes, traffic air pollution, and childhood asthma

BACKGROUND

Epidemiologic studies indicate that exposure to air pollution caused by traffic may have an association with an increased risk of childhood asthma. Some studies report an association between the polymorphisms of the microsomal epoxide hydroxylase (EPHX1) gene and enzyme activity. We investigated the associations of EPHX1 Tyr113His and His139Arg polymorphisms with asthma and wheezing outcomes, and focused on the functional genetic change in different ambient nitrogen dioxide (NO₂) levels on glutathione S-transferase p1 (GSTP1) and glutathione S-transferase m1 (GSTM1) genotypes.

METHODS

A total of 3,741 children were enrolled in the Taiwan Children Health Study from 14 communities. We examined the associations of EPHX1 Tyr113His and His139Arg genotypes and diplotypes with asthma and wheezing outcomes under different ambient NO₂ exposures.

RESULTS

Children with the EPHX1 Arg/His or Arg/Arg genotypes at codon 139 were significantly associated with increased risks of lifetime asthma (adjusted OR [aOR] = 1.3; 95% CI, 1.1-1.7; and aOR = 1.5; 95% CI, 1.1-2.1, respectively). The EPHX1 diplotypes showed significant associations with lifetime asthma (global P value = .01) and early-onset asthma (global P value = .01). The risk of EPHX1 139Arg allele and 113Tyr-139Arg diplotype were of greater magnitude in higher compared with lower NO₂ communities. The increase of the effect from the EPHX1 139Arg allele with higher NO₂ exposure was most marked in the GSTP1 Val allele and GSTM1 present genotype.

CONCLUSIONS

Children with high EPHX1 activity may have increase risk of asthma and wheezing outcomes, and can be mediated through airway oxidative stress generation.

Discovery of complex pathways from observational data

Unraveling complex interactions has been a challenge in epidemiologic research. We introduce a pathway modeling framework that discovers plausible pathways from observational data, and allows estimation of both the net effect of the pathway and the types of interactions occurring among genetic or environmental risk factors. Each discovered pathway structure links combinations of observed variables through intermediate latent nodes to a final node, the outcome. Biologic knowledge can be readily applied in this framework as a prior on pathway structure to give preference to more biologically plausible models, thereby providing more precise estimation of Bayes factors for pathways of greatest interest by Markov Chain Monte Carlo (MCMC) methods.Data were simulated for binary inputs of which only a subset was involved in different pathway topologies. Our algorithm was then used to recover the pathway from the simulated data. The posterior distributions of inputs, pairwise and higher-order interactions, and topologies were obtained by MCMC methods. The evidence in favor of a particular pathway or interaction was summarized using Bayes factors. Our method can correctly identify the risk factors and interactions involved in the simulated pathway. We apply our framework to an asthma case-control data set with polymorphisms in 12 genes.

Methods for investigating gene-environment interactions in candidate pathway and genome-wide association studies

Despite the considerable enthusiasm about the yield of novel and replicated discoveries of genetic associations from the new generation of genome-wide association studies (GWAS), the proportion of the heritability of most complex diseases that have been studied to date remains small. Some of this "dark matter" could be due to gene-environment (G x E) interactions or more complex pathways involving multiple genes and exposures. We review the basic epidemiologic study design and statistical analysis approaches to studying G x E interactions individually and then consider more comprehensive approaches to studying entire pathways or GWAS data. In addition to the usual issues in genetic association studies, particular care is needed in exposure assessment, and very large sample sizes are required. Although hypothesis-driven, pathway-based and agnostic GWA study approaches are generally viewed as opposite poles, we suggest that the two can be usefully married using hierarchical modeling strategies that exploit external pathway knowledge in mining genome-wide data.

Gene--environment-wide association studies: emerging approaches

Despite the yield of recent genome-wide association (GWA) studies, the identified variants explain only a small proportion of the heritability of most complex diseases. This unexplained heritability could be partly due to gene--environment (G×E) interactions or more complex pathways involving multiple genes and exposures. This Review provides a tutorial on the available epidemiological designs and statistical analysis approaches for studying specific G×E interactions and choosing the most appropriate methods. I discuss the approaches that are being developed for studying entire pathways and available techniques for mining interactions in GWA data. I also explore methods for marrying hypothesis-driven pathway-based approaches with 'agnostic' GWA studies.

Who is affected more by air pollution-sick or healthy? Some evidence from a health survey of schoolchildren living in the vicinity of a coal-fired power plant in Northern Israel

OBJECTIVE

To evaluate the effects of exposure to air pollution by NO(x) and SO(2) on the development of pulmonary function of children, characterized by different health status.

METHODS

A cohort of 1181 schoolchildren from the 2nd to 5th grades, residing near a major coal-fired power plant in the Hadera district of Israel, were subdivided into three health status groups, according to the diagnosis given by a physician at the beginning of the study period in 1996: (a) healthy children; (b) children experiencing chest symptoms, and (c) children with asthma or spastic bronchitis. Pulmonary Function Tests (PFTs) were performed twice (in 1996 and 1999) and analyzed in conjunction with air pollution estimates at the children's places of residence and several potential confounders-height, age, gender, parental education, passive smoking, housing density, length of residence in the study area and proximity to the main road.

RESULTS

A significant negative association was found between changes in PFT results and individual exposure estimates to air pollution, controlled for socio-demographic characteristics of children and their living conditions. A sensitivity analysis revealed a decrease in the Forced Expiratory Volume during the First Second (FEV(1)) of about 19.6% for children with chest symptoms, 11.8% for healthy children, and approximately 7.9% for children diagnosed with asthma. Results of a sensitivity test for the Forced Vital Capacity (FVC) were found to be similar.

CONCLUSION

Exposure to air pollution appeared to have had the greatest effect on children with chest symptoms. This phenomenon may be explained by the fact that this untreated symptomatic group might experience the most severe insult on their respiratory system as a result of exposure to ambient air pollution, which is reflected by a considerable reduction in their FEV(1) and FVC. Since asthmatic children have lower baseline and slower growth rates, their PFT change may be affected less by exposure to air pollution, reflecting a well known relationship between pulmonary function change and height growth, according to which age-specific height is very similar for preadolescent children, but shifts upward with age during the growth spurt.

Outdoor air pollution, genetic susceptibility, and asthma management: opportunities for intervention to reduce the burden of asthma

Outdoor air pollution at levels occurring in many urban areas around the world has substantial adverse effects on health. Children in general, and children with asthma in particular, are sensitive to the adverse effects of outdoor air pollutants, including ozone, nitrogen oxides, and respirable particulate matter. A growing number of studies also show that children living in environments near traffic have increased risks of new-onset asthma, asthma symptoms, exacerbations, school absences, and asthma-related hospitalizations. The large population of children exposed to high levels of outdoor air pollutants and the substantial risks for adverse health effects present unexploited opportunities to reduce the burden of asthma. Because the evidence indicates significant adverse effects of air pollution at current levels, there is clearly a need to reduce levels of regulated pollutants such as ozone, as well as unregulated pollutants in tailpipe emissions from motor vehicles. Achieving this long-term goal requires the active involvement of physicians and medical providers to ensure that the health of children is at the top of the list of competing priorities for regulatory policy decision-making. Clinical approaches include treatment to control asthma and patient education to reduce adverse effects of the disease. Reduction in exposures also can be approached at a policy level through changes in schools and school bus operations. Beyond clinical and public health approaches to reduce exposure, another strategy to be used before clean air goals are met is to decrease the susceptibility of children to air pollution. Emerging research indicates that dietary supplementation for individuals with low antioxidant levels is one promising approach to reducing susceptibility to air pollution. A second approach involves induction of enzymatic antioxidant defenses, especially for individuals with at-risk genetic variants of key antioxidant enzymes.

Children at risk: measuring racial/ethnic disparities in potential exposure to air pollution at school and home

STUDY OBJECTIVE

This paper addresses the environmental justice implications of children's health by exploring racial/ethnic disparities in potential exposure to air pollution, based on both school and home locations of children and three different types of pollution sources, in Orange County, Florida, USA.

METHODS

Using geocoded school and residence locations of 151 709 children enrolled in the public school system, distribution functions of proximity to the nearest source are generated for each type of air pollution source in order to compare the exposure potential of white, Hispanic, and black children. Discrete buffer distances are utilised to provide quantitative comparisons for statistical testing.

MAIN RESULTS

At any given distance from each type of pollution source, the cumulative proportion of Hispanic or black children significantly exceeds the corresponding proportion of white children, for both school and home locations. Regardless of race, however, a larger proportion of children are potentially exposed to air pollution at home than at school.

CONCLUSIONS

This study addresses the growing need to consider both daytime and nighttime activity patterns in the assessment of children's exposure to environmental hazards and related health risks. The results indicate a consistent pattern of racial inequity in the spatial distribution of all types of air pollution sources examined, with black children facing the highest relative levels of potential exposure at both school and home locations.

Sample size and optimal design for logistic regression with binary interaction

There is no consensus on what test to use as the basis for sample size determination and power analysis. Some authors advocate the Wald test and some the likelihood-ratio test. We argue that the Wald test should be used because the Z-score is commonly applied for regression coefficient significance testing and therefore the same statistic should be used in the power function. We correct a widespread mistake on sample size determination when the variance of the maximum likelihood estimate (MLE) is estimated at null value. In our previous paper, we developed a correct sample size formula for logistic regression with single exposure (Statist. Med. 2007; 26(18):3385-3397). In the present paper, closed-form formulas are derived for interaction studies with binary exposure and covariate in logistic regression. The formula for the optimal control-case ratio is derived such that it maximizes the power function given other parameters. Our sample size and power calculations with interaction can be carried out online at www.dartmouth.edu/ approximately eugened.

Testing association between disease and multiple SNPs in a candidate gene

Current technology allows investigators to obtain genotypes at multiple single nucleotide polymorphism (SNPs) within a candidate locus. Many approaches have been developed for using such data in a test of association with disease, ranging from genotype-based to haplotype-based tests. We develop a new approach that involves two basic steps. In the first step, we use principal components (PCs) analysis to compute combinations of SNPs that capture the underlying correlation structure within the locus. The second step uses the PCs directly in a test of disease association. The PC approach captures linkage-disequilibrium information within a candidate region, but does not require the difficult computing implicit in a haplotype analysis. We demonstrate by simulation that the PC approach is typically as or more powerful than both genotype- and haplotype-based approaches. We also analyze association between respiratory symptoms in children and four SNPs in the Glutathione-S-Transferase P1 locus, based on data from the Children's Health Study. We observe stronger evidence of an association using the PC approach (p = 0.044) than using either a genotype-based (p = 0.13) or haplotype-based (p = 0.052) approach.

Associations of glutathione S-transferase P1, M1, and environmental tobacco smoke with wheezing illness in school children

BACKGROUND

Polymorphisms at the glutathione S-transferase (GST) were associated with asthma-related phenotypes. We hypothesized that the GSTP1 and GSTM1 genotypes could modify the effects of household environmental tobacco smoke (ETS) on childhood wheezing illness.

METHODS

We conducted a case-control study comprised of 216 lifetime wheezing children and 185 nonwheezing controls, all of whom were selected from 2524 fourth- to ninth-grade school children in southern Taiwan.

RESULTS

Homozygous GSTP1 Ile-105 was significantly associated with current wheezing (OR = 1.78, 95% CI 1.04-3.12), but insignificantly associated with ever wheezing (OR = 1.26, 95% CI 0.82-1.94). The risks of ever or current wheezing on GSTM1 null genotype were positive but not statistically significant. Although household ETS exposure was not associated with wheezing illness, after excluding subjects having in utero ETS or active smoking habits, the adverse effects of household ETS exposure differed significantly by GSTP1-105 genotypes. In children without any ETS exposure at home, GSTP1 Ile-105 homozygosity was significantly related to increased risks for both ever wheezing (OR = 2.29, 95% CI 1.17-4.49) and current wheezing (OR = 4.86, 95% CI 1.86-12.70). In children with household ETS exposure, the risks of wheezing illness did not increase for those carrying two GSTP1 Ile-105 alleles. Children carrying any GSTP1 Val-105 allele were at a significantly greater risk of both ever and current wheezing when exposed to ETS, with a clear dose-response relationship to the number of smokers at home.

CONCLUSION

Household ETS exposure is a modifiable cause of wheezing illness in a genetically susceptible subpopulation.

Ambient air pollution and children's health: A systematic review of Canadian epidemiological studies

BACKGROUND

There is growing concern about the health effects of ambient air pollution (AP) in children. The present article summarizes and compares local information regarding the adverse effects of AP on the health of Canadian children with reports from elsewhere.

METHODS

PUBMED, MEDLINE and EMBASE databases were searched for epidemiological studies, published between January 1989 and December 2004, on the adverse health effects of criteria air pollutants among Canadian children.

RESULTS

Eleven studies investigated the association between AP and various respiratory health outcomes, while one study assessed the effect of AP on sudden infant death syndrome. Another study examined the effects of AP on pregnancy outcomes. Most of the available information was from Ontario and British Columbia. Despite inconsistencies among study results and data from elsewhere, evidence from Canadian studies suggest that AP may cause adverse respiratory health effects in children and adverse pregnancy outcomes, and may contribute to infant mortality in Canada.

INTERPRETATION

AP has detrimental health effects among Canadian children. Paediatricians and other health care workers with an interest in child health should encourage parents and children to adhere to smog (AP) advisories. Existing regulatory practices should be reviewed to reduce current levels of ambient air pollutants in Canada.

Respiratory and cardiovascular functions among smoking and nonsmoking girls from two regions with different air pollution degree

AIM

The aim of the present study was to analyze the respiratory and cardiovascular functions among smoking and nonsmoking girls attending two schools situated in regions with different levels of air pollution. The characteristic of air pollution is based on the data gathered by stations 1 and 2 belonging to the Uniform National System for Monitoring the Air Pollution in Bulgaria. The participants (n=108, 16.07+/-0.80 years) were separated in two groups: smokers (S1 - from school 1, S2 - from school 2) and nonsmokers (NS1 - from school 1, NS2 - from school 2). All of them performed pulmonary function testing and .cardiopulmonary exercise testing on a treadmill using our modification of the Balke protocol (Marinov et al., 2000). Reference values for European children, previously validated for the Bulgarian population, were used.

RESULTS

There are no significant differences in mean levels of VC, IC, FEV1, MEF50 and MEF25 (as a percentage from the predicted value as well). The average level of the Tiffneau index is noticeably higher among nonsmokers from the two regions and is the lowest among smokers from the more polluted area, but a significant difference exists between S2 (88.7+/-5.9) and NS2 (92.6+/-4.7), p=0.047; T(L,CO)%pred: S1 (85.4+/-7.2) vs. S2 (86.7+/-8.2), p=0.048 and NS1 (88.3+/-8.2) vs. NS2 (92.8+/-14.5), p=0.037; V(E)%pred: S1 (127.5+/-9.6) vs. S2 (123.7+/-6.1), p=0.035; higher levels of total lung capacity (TLC%pred), S1 (107.3+/-9.2) vs. NS2 (104.3+/-9.1), p=0.009 and alveolar ventilation (VA), S1 (5.0+/-0.6) vs. NS2 (4.6+/-0.5), p=0.008.

CONCLUSIONS

1. The negative effects of the combined influence of tobacco smoking and air pollution on some respiratory and cardiovascular functions of adolescent girls are more pronounced than each influence alone. 2. The cardiopulmonary exercise test gives adequate information about the combined effect of air pollution and smoking and using it for preventive purposes is an advisable method.

Health effects of the 2003 Southern California wildfires on children

RATIONALE

In late October 2003, Southern California wildfires burned more than 3,000 km2. The wildfires produced heavy smoke that affected several communities participating in the University of Southern California Children's Health Study (CHS).

OBJECTIVES

To study the acute effects of fire smoke on the health of CHS participants.

METHODS

A questionnaire was used to assess smoke exposure and occurrence of symptoms among CHS high-school students (n = 873; age, 17-18 yr) and elementary-school children (n = 5,551; age, 6-7 yr), in a total of 16 communities. Estimates of particulate matter (PM10) concentrations during the 5 d with the highest fire activity were used to characterize community smoke level.

MAIN RESULTS

All symptoms (nose, eyes, and throat irritations; cough; bronchitis; cold; wheezing; asthma attacks), medication usage, and physician visits were associated with individually reported exposure differences within communities. Risks increased monotonically with the number of reported smoky days. For most outcomes, reporting rates between communities were also associated with the fire-related PM10 levels. Associations tended to be strongest among those without asthma. Individuals with asthma were more likely to take preventive action, such as wearing masks or staying indoors during the fire.

CONCLUSIONS

Exposure to wildfire smoke was associated with increased eye and respiratory symptoms, medication use, and physician visits.

Glutathione s-transferases M1 and P1 prevent aggravation of allergic responses by secondhand smoke

RATIONALE

Secondhand tobacco smoke (SHS) and traffic-related air pollutants are associated with asthma and allergy. Diesel exhaust particles (DEPs) and SHS can interact with allergens in exacerbating allergic airway diseases through generation of reactive oxygen species. Glutathione S-transferases (GSTs) metabolize reactive oxygen species and detoxify electrophilic xenobiotics present in SHS and DEPs.

OBJECTIVES

We tested the hypotheses that functional GSTM1-null genotype and GSTP1 codon 105 variants (Ile105 and Val105) are determinants of allergic responses to SHS, and that responses to SHS and DEPs are correlated.

METHODS AND MEASUREMENTS

In a randomized, placebo-controlled crossover trial, 19 ragweed allergen-sensitive subjects who had previously participated in a DEP trial were challenged intranasally with allergen after having been exposed to either clean air or SHS at separate visits. Nasal allergen-specific IgE, histamine, IL-4, and IFN-gamma levels were measured before and after allergen challenge.

MAIN RESULTS

Individuals with GSTM1-null or GSTP1 Ile105 genotypes showed larger nasal responses to allergens with SHS compared with clean air. GSTM1-null subjects had a larger increase in IgE than GSTM1-present subjects (median, 173.3 vs. 46.7 U/ml; p = 0.03), and the Ile105 GSTP1 genotype subjects had increased histamine (median, 10.2 vs. 4.6 nM; p = 0.01) after SHS plus allergen challenge. Responses to SHS and DEPs were correlated. Enhancement of IgE and histamine was greatest in the subjects with both the GSTM1-null and GSTP1 Ile/Ile genotypes.

CONCLUSIONS

GSTM1 and GSTP1 are important cytoprotective factors that reduce SHS and DEP exacerbation of allergic responses.

The effects of air pollution on the health of children

The present article is intended to inform paediatricians about the associations between ambient air pollution and adverse health outcomes in children within the context of current epidemiological evidence.The majority of the current literature pertains to adverse respiratory health outcomes, including asthma, other respiratory symptoms, and deficits in lung function and growth, as well as exposure to ambient levels of criteria air pollutants. In addition to the above, the present article highlights mortality, pregnancy outcomes, vitamin D deficiency and alteration in the immune system of children.Some of the data on the impact of improved air quality on children's health are provided, including the reduction of air pollution in former East Germany following the reunification of Germany, as well as the reduction in the rates of childhood asthma events during the 1996 Summer Olympics in Atlanta, Georgia, due to a reduction in local motor vehicle traffic. However, there are many other toxic air pollutants that are regularly released into the air. These pollutants, which are not regularly monitored and have not been adequately researched, are also potentially harmful to children.Significant morbidity and mortality is attributed to ambient air pollution, resulting in a significant economic cost to society. As Canada's cities grow, air pollution issues need to be a priority in order to protect the health of children and support sustainable development for future generations.

The riskscape and the color line: examining the role of segregation in environmental health disparities

Environmental health researchers, sociologists, policy-makers, and activists concerned about environmental justice argue that communities of color who are segregated in neighborhoods with high levels of poverty and material deprivation are also disproportionately exposed to physical environments that adversely affect their health and well-being. Examining these issues through the lens of racial residential segregation can offer new insights into the junctures of the political economy of social inequality with discrimination, environmental degradation, and health. More importantly, this line of inquiry may highlight whether observed pollution--health outcome relationships are modified by segregation and whether segregation patterns impact diverse communities differently. This paper examines theoretical and methodological questions related to racial residential segregation and environmental health disparities. We begin with an overview of race-based segregation in the United States and propose a framework for understanding its implications for environmental health disparities. We then discuss applications of segregation measures for assessing disparities in ambient air pollution burdens across racial groups and go on to discuss the applicability of these methods for other environmental exposures and health outcomes. We conclude with a discussion of the research and policy implications of understanding how racial residential segregation impacts environmental health disparities.