Importance of genetic polymorphisms of drug-metabolizing enzymes for the interpretation of biomarkers of exposure to styrene

The objective of this study was to test the infiuence of genetic polymorphisms for metabolic enzymes (CYP2E1, mEH, GSTM1 and GSTT1) implicated in the biotransformation of styrene in humans on the interpretation of urinary biomarkers of exposure. Thirty workers from a fibreglass-reinforced plastics factory took part in the study. Ambient styrene concentration was determined during the whole workshift by passive sampling. Urine was collected at the end of the shift for the determination of mandelic acid (MA) and phenylglyoxylic acid (PGA) (major biotransformation pathway), N-acetyl-S-(1-phenyl-2-hydroxy)ethyl-L-cysteine (M1) and N-acetyl-S-(2-phenyl-2-hydroxy)ethyl-L-cysteine (M2) (minor metabolic pathway) and creatinine. The average airborne styrene concentration of 18.2 ppm (range: 0.9-68.9 ppm) was very close to the current threshold limit value (TLV-TWA) recently adjusted by ACGIH from 50 to 20 ppm. There was a better correlation between external and internal exposure as estimated by urinary MA + PGA (r=0.92; p<0.0001) compared with urinary M1 + M2 (r=0.74; p<0.0001). To investigate to what extent genetic polymorphisms in metabolic enzymes could explain interindividual variations observed in the concentration of urinary biomarkers related to a given external exposure, two 'metabolic indexes' (derived from the ratio between the sum of urinary metabolites for a specific pathway and ambient styrene concentration) were calculated for each worker and compared for different allelic combinations. Monovariate analyses showed that GSTM1 polymorphism was clearly the most significant parameter infiuencing urinary concentrations of mercapturic acids. Based on GSTM1 allelic status, two different biological exposure indexes (BEIs) for M1 + M2 in post-shift urinary samples corresponding to a 20 ppm styrene concentration are proposed (GSTM1null: 1330 µg g(-1) creatinine, GSTM1+: 2878 µg g(-1) creatinine). Multivariate regression analyses were also performed and revealed that the presence of the rare CYP2E1*1B allele linked to TaqI polymorphism (A1/A2) was associated with increased urinary concentrations of metabolites from both pathways. Two previously described polymorphisms for the EPHX gene were also tested but seemed not really relevant for interpretation of biomarkers. In conclusion, while CYP2E1 genotyping, particularly assessment of the CYP2E1*1B allelic status, is useful for a more accurate interpretation of the concentration of urinary biomarkers, GSTM1 genotyping is absolutely necessary when considering a biological monitoring programme based on determination of urinary mercapturic acids.

1,1,1-Trichloroethane (methyl chloroform) in urine as biological index of exposure

Fifteen human volunteers were exposed to 1,1,1-trichloroethane (methyl chloroform) vapor at 72-495 mg/m3 for a period of 2 to 4 hours at rest (ten cases) and during light physical exercise (five cases). Subsequently 60 workers occupationally exposed to 1,1,1-trichloroethane in a refrigerator manufacturing plant were studied (median value: 178 mg/m3; geometrical standard deviation: 2.19 mg/m3). As expected, the relative uptake (R) of 1,1,1-trichloroethane decreased in the course of exposure at rest (R = 0.44 after 20 minutes of exposure; R = 0.26 after 240 minutes of exposure). Both in the experimentally exposed subjects and in the occupationally exposed workers, the urinary concentration of 1,1,1-trichloroethane showed a linear relationship to the corresponding environmental time-weighted average concentration. The correlation coefficients (r) were 0.95 in occupationally exposed subjects and more than 0.90 in experimentally exposed groups. A linear equation also existed between urinary concentration and amount of 1,1,1-trichloroethane absorbed (r = 0.88). The findings indicate that the urinary concentration of 1,1,1-trichloroethane can be used as an appropriate biological exposure indicator. In occupationally exposed subjects performing moderate work, the urinary 1,1,1-trichloroethane concentration corresponding to the time-weighted average of the threshold limit value was found to be 860 micrograms/L and its 95% lower confidence limit (biological threshold) 805 micrograms/L.

Saliva as an analytical tool to measure occupational exposure to toluene

OBJECTIVE

To describe a sensitive and rapid method for the determination of toluene in saliva. Biomonitoring of toluene exposure is commonly performed by determination of urinary hippuric acid, o-cresol or toluene itself. The analysis of blood toluene has been verified as another method for biomonitoring. However, drawing blood is invasive and can often not be performed at the workplace for hygienic reasons. Sampling of saliva may be non-invasive, easy to perform and a viable alternative for biomonitoring in the workplace.

METHODS

We measured the solvent concentration in saliva specimens of 5 healthy volunteers studied in the laboratory and a group of 36 workers exposed to toluene in the synthetic leather industry. Saliva was collected into Salivette (Sarstedt, Germany) devices by sterile cotton rolls placed in the mouth and then squeezed into pre-weighted vials. Environmental toluene was collected for the duration of a work-shift by Radiello (FSM, Italy) passive samplers. Toluene in urine and saliva (head space analysis) and in environmental samples was measured by GC-MS.

RESULTS

Environmental toluene levels ranged from 0.22 to 57.20 mg/m(3), while the concentrations of the solvent in saliva and urine ranged from 0.12 to 18.30 microg/L, and from 0.47 to 26.64 microg/L, respectively. The correlation coefficients (r) between biological and environmental levels of toluene were 0.77 and 0.93, respectively, for saliva and urine samples.

CONCLUSION

This preliminary study suggests that saliva may offer many advantages over 'classical' biological fluids such as blood as it is readily accessible and collectible: therefore saliva toluene may be considered as a possible biomarker of exposure to toluene.

[Characteristics, use and toxicity of fluorochemicals: review of the literature]

Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) are perfluorinated surfactants used to produce polymers and telomers whose carbon chain can be differently long. Polytetrafluoroethylene (PTFE), namely Teflon, is the chief fluoropolymer and it has been widely utilised over the last decades and all over the world. Indeed, its particular physical and chemical properties make it difficult to replace this substance in several industries (textile, paper, chemical, fire-fighting foam industry). Perfluoroalkyl-compounds may be considered ubiquitous and, in particular, it has been shown that PFOS may be concentrated in the food chain. Concerns about possible toxic effects of these chemicals date back to seventies, but only in 2000 the Environmental Protection Agency (EPA) stated PFOA and PFOS withdrawal to avoid environmental pollution. In 2002 the Organisation for Economic Co-operation and Development reported that these substances are bio-persistent, tend to accumulate in different tissues of living organisms and are toxic to mammalians. In 2006 EPA established that every PFOA emission will be eliminated not later than 2015. Actually, health effects of perfluoroalkyl-compounds on humans remain controversial, in spite of a number of experimental and epidemiological studies. Research focuses on possible endocrine disruption, thyroid and liver carcinogenicity, and development alteration. Our article reviews the main studies concerning PFOS and PFOA industrial and environmental toxicology.

[Recent prevention strategies and occupational risk analysis: Control Banding and Sobane]

Employers are responsible for the prevention of risks and must provide for the safety and health of their workers. They are obliged to apply the general principles of prevention: to avoid, where possible, any risk; to characterize and hence to estimate residual risks; to eliminate risks at the source; to adjust jobs to the needs of workers and not workers to the jobs. When we pass to the practical performance of these shared principles we introduce many problems: problems concerning terminology; problems in estimating the nature of the risks that are faced; coordination problems between the subjects that preside over prevention; problems arising from the different typology of the companies investigated In order to answer these questions the "Industrial Hygienists" have long since created various strategies for the prevention and control of risks. Among different models the methods Control Banding and Sobane-Deparis are undoubtedly the most promising. Control Banding is designed to assist especially Small and Medium Enterprises in complying with the chemical safety regulations, the scheme uses the R phrases that in Europe must be assigned to potentially harmful chemicals by the manufacturer of the chemical. R phrases describe the most important harmful effects of a chemical and have been adopted in many non European countries also. The combination of the hazard classification of the chemical and assessment of the exposure potential will allow understanding of the level of risk thus leading the person carrying out the assessment to an appropriate control method. Occupational hygienists with experience of assessing occupational exposure to chemicals agreed parameters that could be used to give reasonable indications of exposure potential. One of them is quantity being used and three categories--small, medium and large--are defined. The likelihood of the chemical becoming airborne has been addressed by defining solids according to levels of dustiness and liquids according to volatility. A simple graph that uses the boiling point of the chemical and the process operating temperature assigns the chemical a high, medium or low volatility rating. The user now has enough information to identify the control approach required to adequately reduce exposures to the chemical Occupational hygienists agreed on three broad control approaches: General Ventilation; Engineering Control; Containment. However it is recognised that in some cases specialist advice will be needed. The user takes the hazard group, quantity and level of dustiness/volatility and matches them to a control approach using a simple table. The controls are described in control guidance sheets, which comprise both general information and, for commonly performed tasks, more specific advice. The second section of the document describes a risk-prevention strategy, called SOBANE, in four levels. These four levels are: screening, where the risk factors are detected by the workers and their management, and obvious solutions are implemented; observation, where the remaining problems are studied in more detail, one by one, and the reasons and the solutions are discussed in detail; analysis, where, when necessary, an occupational health (OH) practitioner is called upon to carry out appropriate measurements to develop specific solutions; expertise, where, in very sophisticated and rare cases, the assistance of an expert is called upon to solve a particular problem. The method for the participatory screening of the risks, Deparis, is proposed for the first level screening of the SOBANE strategy. The aim of Sobane strategy is to make risk prevention faster, more cost effective, and more effective in coordinating the contributions of the workers themselves, their management, the internal and external OH practitioners and the experts.

[Indoor air quality in an Italian military submarine]

In recent years there has been increasing interest on studies concerning indoor air quality and focusing on risk factors for exposed subjects. Particularly, airborne chemicals, whose adverse effects are well known, have been identified and determined in means of transport as in other indoor places. As concerns chemical air concentrations in submarines, only a limited number of studies have been published. This paper reports measured concentration data for organic compounds (total volatile organic compounds, substances with a chemical bond S-O, nitrogen compounds, carbon monoxide, carbon dioxide, and different organic solvents) in the air sampled during an 8-h period in an Italian Military submarine, under routine operations. We observed that a periodicalfresh-air intake operation (snorkel) might cause temporary increase of contaminants levels in indoor air. Moreover, we could find that pollutants sometimes reach notable peak concentrations being potentially able to induce adverse health effects in crewmembers. Our data highlight the need to promote further investigations.

[The significance of enviromental and biological monitoring in workers employed in service stations after the elimitation of tetraethyl lead from gasoline]

The chemical risk in service stations may be due to toxic compounds present in fuel (particularly benzene and additives) and to the emission of exhausts and fine particulate from vehicles. Owing to the elimination of lead (Pb) from fuel and to the necessity of lowering CO emission, several oxygenated additives have been added to fuel, in particular methyl-tert-butyl-ether (MTBE), whose toxic properties are at present under investigation. The introduction of reformulated gasoline (RFG) and the use of catalytic converters (with possible release of platinum (Pt) in the environment) may have modified the risks for workers employed in service stations. The paper shows data collected from 26 subjects (divided into three specific tasks, namely: fuel dispenser, "self-service" attendant and controller, and cashier) to estimate the actual chemical risk and to compare it with the previous data taken from literature. For this purpose, besides performing the usual medical surveillance, we measured the environmental concentrations of benzene, MTBE and formaldehyde, the urinary levels of benzene metabolites S-phenylmercapturic acid (S-PMA) and t,t-muconic acid (MA) and of unmodified MTBE, and the blood concentrations of Pb and Pt for each subject. Mean values of these compounds were, respectively: 38.81 microg/m3; 174.04 microg/m3; 10.38 microg/m3; 2.36 microg/g creatinine; 96.57 microg/g creatinine; 1.41 microg/L; 7.00 microg/100 mL; 0.0738 ng/ml. The above values were much lower than the corresponding limit values reported by ACGIH and DFG. In particular, after the introduction of vapour recycle systems and the widespread use of "self-service" systems, airborne benzene concentration dropped from 300/400 microg/m3 to lower than 100 microg/m3, without noticeable increasing of exposure to formaldehyde. The disappearing of Pb from gasoline leads to a progressive lowering of its blood levels, while the possible risks due to the very low amounts of Pt released from catalytic converters have still to be defined exactly. Taken all in all, our results seem to indicate that, after the elimination of tetraethyl lead, the chemical risk for workers employed in service stations is now lower than in the past.

Gases and organic solvents in urine as biomarkers of occupational exposure: a review

A brief review of urine analysis in studies of occupational exposure to volatile organic compounds and gases is provided. Analysis of exhaled breath for volatile compounds does not have a long history in occupational medicine. A number of studies has been undertaken since the 1980s, and the methods are well enough accepted to be put forward as biological equivalents of threshold limit values (TLVs) for some volatile organic compounds (VOCs) such as acetone; methanol; methyl ethyl ketone (MEK); methyl isobutyl ketone (MIBK); tetrahydrofurane; dichloromethane. In the last 20 years many scientific articles have shown that the urinary concentrations of unchanged solvents are correlated with environmental exposure and could be used for biological monitoring. The use of urine analysis of unchanged solvents in occupational applications is not yet widespread. Nonetheless, in the short time since its application, a number of important discoveries has been made, and the future appears bright for this branch of analysis. In this paper, the basic concepts and methodology of urine analysis are briefly presented with a critical revision of the literature on this matter. The excretion mechanisms of organic solvents in urine are discussed, with regard to biological variability, and the future directions of research are described.

[New biomarkers of exposure]

In this paper we have defined the new biomarkers of exposure (NBE) as those biomarkers discovered in the last five years and, among previously validated biomarkers, also those applied in different ranges of doses or those determined in biological matrices which differ from matrices originally considered. We examined the results from the surveys carried out by the main Italian research units involved in biological monitoring, i.e. those from the Universities of Brescia, Milan, Naples, Padua, Parma, Pavia, Turin and Verona. The data were collected using a standardized model and included the following: type of element or organic compound, type of biomarker, analytical technique and method, their relationship with environmental monitoring data, their relationship with effect indicators or effects in general, improvement with respect to old biomarkers, reference values. Twenty two NBEs were identified: 14 elements and chemical compounds as such or as metabolites, 4 examples of mixtures, 3 of new matrices, one of speciation. Among the others, aspects such as interest in requiring NBE, quality assurance, availability, cost-benefit ratio were discussed. We conclude that development of this specific field of research appears to be a crucial point for future improvement in risk assessment and health surveillance procedures.

[Excretion kinetics of phenylhydroxyethyl mercapturic acids (PHEMAs), ethanol consumption, and chronic exposure to styrene: preliminary data on humans]

Styrene (S) is a widely used aromatic hydrocarbon, responsible for several adverse effects. In humans, the metabolism of S is well characterized: besides the major metabolites (mandelic and phenylglyoxylic acid), a minor metabolic pathway leads to phenylhydroxyethyl mercapturic acids (PHEMAs) [N-acetyl-S-(1-phenyl-2-hydroxyethyl)-L-cysteine (M1) and N-acetyl-S-(2-phenyl-2-hydroxyethyl)-L-cysteine (M2)], that are potentially useful for biomonitoring purposes. A pilot study on a volunteer exposed under controlled conditions to S, with or without ethanol administration, allowed us to characterize the excretion profile of PHEMAs and the ethanol-induced interference on PHEMAs metabolic pathway. We further considered a group of 9 workers exposed to S during the working week to determine the confounding role of chronic exposure. Our results confirm the wide interindividual variability of both the biotransformation rate of S into PHEMAs and of the excretion rate of these metabolites. Moreover, both the above parameters changed during the working week, suggesting the existence of a large intraindividual variability as a consequence of the exposure to S and to other solvents. As a practical rule, the data indicate that it is necessary to collect samples at the beginning of the working week when studies on the correlation between genotype and phenotype are carried out. Finally, the results emphasise the importance of excluding an even extemporary ethanol assumption when practicing a biological monitoring programme based on the determination of urinary PHEMAs.

[Biological monitoring of occupational exposure to desflurane]

In these last years Desflurane (D) has become used, alone or in combination with nitrous oxide, in surgical procedures. Occupational exposed groups include anesthesiologists, other physicians, (e.g. surgeons) and operating room nurses. Desflurane is a halogenated methylethylether which is administered by inhalation. Desflurane is halogenated exclusively with fluorine. The blood/gas partition coefficient of Desflurane is 0.42. Changes in the clinical effects of Desflurane rapidly follow changes in the inspired concentration. Studies in man indicate that Desflurane washes into the body rapidly. It also washes out of the body rapidly, allowing flexibility in adjustment of the depth of anaesthesia. Desflurane is eliminated via the lungs, undergoing only minimal metabolism (0.02%). In order to investigate the role of urinary D as an indicator of occupational exposure to Desflurane (CI, ppm), CI was measured in 21 members of operating room staffs. For the measurement of environmental concentration of Desflurane (CI), the ambient air was sampled using personal passive dosimeters. The analyte was desorbed by a water-methanol mixture and was analysed by means a gas chromatograph--mass spectrometer (GC-MSD) and headspace technique. The biological monitoring of exposed workers was conducted by determining the concentration of Desflurane in urine (Cu, microgram/L). Urine concentrations of Desflurane were determined by headspace analysis using GC-MSD. Significant correlations were found between the environmental Desflurane concentration and the urinary concentrations. The correlation between CI (ppm) and Cu (microgram/L) was: Log D (Cu, microgram/L) = .191 + .922 * LogCI; r = .916 On the basis of the equation it was possible to establish tentatively the biological limit values corresponding to the respective occupational exposure limit values proposed for Desflurane.

Urinary determination of N-acetyl- S-( N-methylcarbamoyl)cysteine and N-methylformamide in workers exposed to N, N-dimethylformamide

OBJECTIVES

We conducted this biomonitoring study with the aim of evaluating the correlation between the excretion of N-methylformamide (NMF) (mainly from N-hydroxy- N-methylformamide) and N-acetyl- S-( N-methylcarbamoyl)cysteine (AMCC), and levels of exposure to N, N-dimethylformamide (DMF) among occupationally exposed subjects.

METHODS

Exposure levels were determined by personal sampling: breathing zone air samples were collected by means of passive samplers. DMF collected by the charcoal in personal samplers was analysed after extraction with methanol by a gas chromatograph. For the purpose of biological monitoring the levels of NMF and AMCC were measured in pre-shift and post-shift samples. Determinations were carried out by, respectively, gas chromatography and high performance liquid chromatography (HPLC).

RESULTS AND CONCLUSIONS

The mean time-weighted average (TWA) exposure was approximately half (13.5 mg/m(3)) of the current threshold limit value, the range of the values was from 0.4 to 75.2 mg/m(3). Environmental DMF concentrations exhibited a significant correlation with the specific mercapturic acid (AMCC) collected at the end of the working week (AMCC Friday morning mg/l=1.384xDMF (mg/m(3))+8.708; r(2)=0.47; P<0.008]; hence urinary AMCC represents an index of the average exposure during several preceding working days, making it possible to calculate the approximate relationship between DMF uptake and excretion of this metabolite. A significant correlation was found also between the daily excretion of NMF and the corresponding levels of DMF in air. The equation of the regression line was: NMF (mg/g creatinine)=0.936xDMF (mg/m(3))+7.306; r(2)=0.522 ( P<0.0001).

Metabolic polymorphisms and urinary biomarkers in subjects with low benzene exposure

The effect of some common metabolic polymorphisms on the rate of trans,trans-muconic acid (TMA) and S-phenylmercapturic acid (SPMA) excretion was investigated in 169 policemen exposed to low benzene levels (<10 microg/m3) during the work shift. End-shift urinary concentrations of TMA and SPMA, normalized to unmetabolized blood benzene concentration, were used as indicators of individual metabolic capacity. CYP2E1, NQO1, GSTM1, and CSTT1 polymorphisms were analyzed in all subjects by polymerase chain reaction (PCR) restriction fragment length (RFL). The results obtained show significantly elevated levels of TMA and SPMA in urine of smokers compared to nonsmokers, whereas no correlation with environmental benzene was observed. TMA/blood benzene ratio was partially modulated by glutathione S-transferase (GST) genotypes, with significantly higher values in null individuals (GSTM1 and GSTT1 combined). However, a greater fraction of total variance of TMA/blood benzene in the study population was explained by other independent variables, that is, season of sampling, smoking habits, and gender. Variance in SPMA/blood benzene ratio was only associated with smoking and occupation, whereas no significant role was observed for the metabolic polymorphisms considered. These results suggest that in a population exposed to very low benzene concentrations, urinary TMA and SPMA levels are affected to a limited extent by metabolic polymorphisms, whereas other factors, such as gender, lifestyle, or other confounders, may account for a larger fraction of the interindividual variability of these biomarkers.

[High-pressure liquid chromatography (HPLC) with UV developer for the analysis of N-acetyl-S-(N-methylcarbomoyl)cysteine (AMCC)]

N,N-dimethylformamide (DMF) is a solvent widely used to prepare synthetic fibers. Biomonitoring of DMF is usually performed by measuring urinary N-methylformamide, which allows us to estimate exposure during the working day. An alternative biomarker is the mercapturic acid N-acetyl-S-(N-methylcarbamoyl)cysteine (AMCC) whose excretion accounts for about 13% of the absorbed DMF dose. Owing to its slow excretion (mean half-life = 23 hours) the urinary levels of AMCC at the end of a workweek reflect the cumulative dose of DMF during the whole week. Methods given in literature for measuring AMCC need the derivatization of the molecule before analysis. The paper describes a method for the determination of urinary AMCC by high-performance liquid chromatography (HPLC) with direct UV detection. Samples were purified by solid phase extraction with C18 and ENV+ cartridges, then 10 microliters were directly injected onto an Aminex HPX-87H Ion Exclusion column maintained at a temperature of 37 degrees C. Analyses were performed by isocratic run with 1 mM sulphuric acid delivered at 0.85 mL/min. The detector was set at 196 nm. Under these conditions, AMCC eluted at 11.1 min., and the detection and quantification limits were 1.32 mg/L and 3.96 mg/L, respectively. The performance of the method was evaluated on samples containing 25 mg/L and 400 mg/L of AMCC: each sample was analysed three times. The mean recovery of the extraction procedure was 88.3%. The precision (CV%) and the accuracy (Error%) ranged from 0.8% to 2.9%, and from -1.2% to +3.2%. The calibration curve was linear up to a concentration of 1000 mg/L, the coefficient of correlation was r = 0.9997. AMCC was measured in urine samples from 30 exposed and 20 unexposed (smokers and nonsmokers) subjects. Measurable amounts of AMCC were found in all of the samples from workers exposed to DMF; on the contrary, none of the samples from unexposed subjects contained this metabolite. The proposed method is sufficiently sensitive and specific for the evaluation of occupational exposure to DMF, thus it could be useful for the biological monitoring of workers exposed to this solvent.

Trichloroethylene in urine as biological exposure index

Occupational exposure to trichloroethylene (TRI) was studied by analysis of environmental air and urine from 49 workers operating in a special printing house on glass. For the measurement of environmental concentration of TRI (Cenv), the ambient air was sampled using personal passive dosimeters. The activated charcoal was desorbed with carbon disulfide and injected into a gas-cromatograph - mass spectrometer (GC-MSD). The biological monitoring of exposed workers was conducted by determining the concentration of TRI in urine (Curine) Urine concentration of TRI was determined by headspace analysis using GC-MSD. Significant correlation was found between the environmental TRI concentration and urinary TRI concentration. The use of a regression equation between Curine (microg/l) and Cenv (mg/m3) (Curine = 0.081 x Cenv + 4.27) resulted in a value of Curine corresponding to Threshold Limit Value-Time Weighted Average (TLV-TWA) exposure value (269 mg/m3) of 26.0 microg/L.

Environmental and biological monitoring of traffic wardens from the city of Rome

A molecular epidemiological study on Roman policemen is ongoing. The results of a first assessment of the occupational exposure to aromatic compounds of 66 subjects engaged in traffic control and of 33 office workers are presented in this paper. Passive personal samplers and urinary biomarkers were used to assess exposure to benzene and polycyclic hydrocarbons during work shifts. The results obtained indicate that benzene exposure in outdoor workers is about twice as high as in office workers (geometric mean 7.5 and 3.4 micrograms/m3, respectively). The distribution of individual exposure values was asymmetrical and skewed toward higher values, especially among traffic wardens. Environmental benzene levels recorded by municipal monitoring stations during work shifts (geometric mean 11.2 micrograms/m3) were in the first instance comparable to or greater than individual exposure values. However, several outlier values were observed among personal data that greatly exceeded average environmental benzene concentrations. Among the exposure biomarkers investigated, only blood benzene correlated to some extent with previous exposure to benzene, while a seasonal variation in the excretion of 1-hydroxypyrene and trans-muconic acid was observed in both study groups. In conclusion, these results suggest that outdoor work gives a greater contribution than indoor activities to benzene exposure of Roman citizens. Moreover, relatively high-level exposures can be experienced by outdoor workers, even in the absence of large-scale pollution episodes.

[Biological monitoring of occupational exposure to sevoflurane]

Sevoflurane has been used in the last few years in brief surgical operations, either alone or in combination with nitrous oxide. Occupationally exposed groups include anesthesiologists, surgeons and operating room nurses. In 1977 the National Institute for Occupational Safety and Health (NIOSH) recommended that occupational exposure to halogenated anesthetic agents (halothane, enflurane, and isoflurane), when used as the sole anesthetic, should be controlled so that no worker would be exposed to time-weighted average concentrations greater than 2 ppm during anesthetic administration. When halogenated anesthetics are associated with nitrous oxide, NIOSH recommends that the limit value should not exceed 0.5 ppm. We think these recommendations can be extended to sevoflurane. Metabolism of sevoflurane is catalyzed by cytochrome P-450; this involves oxidation of the fluoromethyl side chain of the molecule, followed by glucuronidation. Two urinary metabolites of sevoflurane have been identified: inorganic fluoride (which, however, is not specific) and a non-volatile compound that yields hexafluoroisopropanol (HFIP) when digested with the enzyme beta-glucuronidase. In order to investigate the role of urinary HFIP as an indicator of occupational exposure to sevoflurane (CI, ppm), CI was measured in 145 members of 18 operating room staffs. The measurements of the time-weighted average of CI in the breathing zone were made by means of diffusive personal samplers. Each sampler was exposed during the whole working period. Sevoflurane was desorbed with CS2 from charcoal and the concentrations were measured on a gas chromatograph (GC) equipped with a mass selective detector (MSD). The GC was equipped with a 25 meter cross-linked phenylmethylsilicon column (internal diameter 0.2 mm). GC conditions were as follows: injector column temperature = 200 degrees C; column temperature = 30 degrees C; carrier gas = helium; injection technique of samples = splitless. The analytical conditions for the MSD were the following: ion mass monitored = 131 m/e; dwell time = 50 msec; selected ion monitoring window time = 0.1 amu; electromultiplier = 400 V. Urine samples were collected near the end of the shift and were analyzed for HFIP by head-space gas chromatography after glucuronide hydrolysis. 0.5 ml of urine and 1.5 ml of 10 M sulfuric acid were added to 21.8 ml headspace vials. The vials were immediately capped, vortexed, and loaded into the headspace autosampler. Samples were maintained at 100 degrees C for 30 min, after which glucuronide hydrolysis was 99% complete. Analyses were performed on a GC equipped with a MSD. The analytical conditions for urine analysis were as follows: cross-linked 5% phenylmethylsilicon column (internal diameter 0.2 mm, length 25 m); column temperature = 35 degrees C; carrier gas = helium. The analytical conditions for the MSD were: monitored ions = 51.05 and 99; dwell time = 100 ms; selected ion monitoring window time = 0.1 amu; electromultiplier voltage = 2000 Volt. With our analytical procedure, the detection limit of HFIP in urine was 20 micrograms/L. The variation coefficient (CV) for HFIP measurement in urine was 8.7% (on 10 determinations; mean value = 1000 micrograms/L). The median value of CI was 0.77 ppm (Geometric Standard Deviation = 4.08; range = 0.05-27.9 ppm). The correlation between CI and HFIP (Cu, microgram/L) was: Log Cu (microgram/L) = 0.813 x Log CI (ppm) + 2.517 (r = 0.79, n = 145, p < 0.0001). On the basis of the equation it was possible to establish tentatively the biological limit values corresponding to the respective occupational exposure limit values proposed for sevoflurane. According to our experimental results, HFIP values of 488 micrograms/L and 160 micrograms/L correspond to airborne sevoflurane concentrations of 2 and 0.5 ppm respectively.

Exposure to benzene in urban workers: environmental and biological monitoring of traffic police in Rome

OBJECTIVES

To evaluate the contribution of traffic fumes to exposure to benzene in urban workers, an investigation on personal exposure to benzene in traffic police from the city of Rome was carried out.

METHODS

The study was performed from December 1998 to June 1999. Diffusive Radiello personal samplers were used to measure external exposures to benzene and alkyl benzenes during the workshift in 139 policemen who controlled medium to high traffic areas and in 63 office police. Moreover, as biomarkers of internal exposure to benzene, blood benzene, and urinary trans, trans-muconic and S-phenyl mercapturic acids were measured at the beginning and at the end of the workshift in 124 traffic police and 58 office police.

RESULTS

Time weighted average (TWA) exposure to benzene was consistently higher among traffic police than among indoor workers (geometric mean 6.8 and 3.5 microg/m(3), respectively). Among the traffic police, the distribution of individual exposures was highly asymmetric, skewed toward higher values. Mean ambient benzene concentrations measured by municipal air monitoring stations during workshifts of traffic police were generally higher (geometric mean 12.6 microg/m(3)) and did not correlat with personal exposure values. In particular, no association was found between highest personal exposure scores and environmental benzene concentrations. Among the exposure biomarkers investigated, only blood benzene correlated slightly with on-shift exposure to benzene, but significant increases in both urinary trans, trans-muconic and S-phenylmercapturic acids were found in active smokers compared with non-smokers, irrespective of their job.

CONCLUSION

The exposure to traffic fumes during working activities in medium to high traffic areas in Rome may give a relatively greater contribution to personal exposure to benzene than indoor sources present in confined environments. Smoking significantly contributed to internal exposure to benzene in both indoor and outdoor workers.

[The use of Internet in occupational medicine and industrial hygiene]

The internet as we know is today includes an array of tools that make information exchange easier than ever before. The best known Internet tools are the World Wide Web and the electronic mail. In the present job we identify those that are the home pages that better can help Industrial Hygienists and Doctors to acquire useful information for the profession. From the detailed examination of the possibilities offered from Internet (web documents acquisition, reading on line of scientific papers, use of mailing lists and e-mail) we can wait in future that the this new instrument will play an important role by offering extensive knowledge and information in the field of occupational and environmental health.

[Measurement of N-methylformamide in occupational exposure to N,N-dimethylformamide]

N,N-dimethylformamide (DMF) is a solvent that is widely used in industry. The major occupational sources of exposure results from production of synthetic leather. The main metabolite formed in both man and animals is N-hydroxymethyl-N-methylformamide. Demethylation leads to N-methylformamide (NMF) and formamide and also to a small extent to hydroxy-methylformamide. All the metabolites are excreted in urine, as are very small amounts of the unchanged substance. N-acetyl-S-(N-methyl-carbamoyl)-cysteine can be determined in urine as a further metabolite. We conducted this biomonitoring study with the aim of evaluating the correlation between the excretion of N-methylformamide (mainly from N-hydroxymethylformamide) and levels of exposure to N,N-dimethylformamide among occupationally exposed people. The mean time-weighted average (TWA) exposure was about half (13.5 mg/m3) of the current threshold limit value, the range of the values varying from 0.4 to 75.2 mg/m3. A linear equation existed between urinary NMF concentration and DMF concentration in the environment. The findings show that the urinary NMF concentration can be used as an appropriate biological exposure index. The authors suggest for occupationally exposed subjects, a urinary NMF concentration corresponding to the time-weighted average of the threshold limit value of 39.9 mg/l (37.2 mg/g creatinine) and a 95% lower confidence limit (biological threshold) of 23.4 mg/l (22.2 mg/g creatinine).

Evaluation of half-mask respirator protection in styrene-exposed workers

OBJECTIVE

The protection afforded by respirators to styrene (St)-exposed workers varies considerably. Our objective was to study the effective 'in the field' reduction in St exposure obtained by negative-pressure half-mask respirators worn by a group of fiberglass-reinforced plastics (FRP) workers. Protection was evaluated by measuring the reduction in urinary St (StU) excretion.

METHODS

Seven FRP workers not using respiratory protection devices were studied for a week. External exposure to St was evaluated by personal passive sampling, and the internal dose by StU measurement. Then workers were asked to use a half-mask respirator for a week for the entire morning half-shift, and St exposure and internal dose were re-assessed.

RESULTS

Mean environmental levels of St during the morning half-shift were 230-280 mg/m3, i.e., about three times the current limit proposed by ACGIH; the difference among days was not significant. Using respirators was accompanied by a large inter-individual and also intra-individual variability: the estimated reduction of StU values ranged from 30% to 90% (mean 60%). Mean StU values increased by 50% from Monday to Friday, while environmental St concentrations remained steady. Furthermore, the proportion of workers exceeding the biological equivalent exposure limit (BEEL) was 14% on Monday, double (33%) on Thursday, and triple (43%) on Friday. These data suggest a decrease of protection during the week.

CONCLUSIONS

The protection afforded by negative-pressure half-mask respirators varies widely, which stresses the need to assess the effective reduction of exposure whenever these devices are introduced for St-exposed workers. If respirators are to be re-used for several days, their performance must be evaluated during the last shift of use. Measurement of urinary excretion of unmodified St proved a useful tool for the evaluation of respirator effectiveness in exposed workers.

[Significance of urinary concentrations of S-benzyl-N-acetylcysteine (S-BMA) in subjects exposed to toluene]

Toluene is a widely diffuse solvent for oils, resins, rubber and paints, either alone or as a major component in a mixture; in the industrial environment it is currently present at concentrations of ppm. Toluene can be absorbed via the lungs or via the skin. The absorption of toluene via inhalation is related to the exposure level as well as the activities level of workers. Once absorbed into the body, toluene is metabolized in man to benzoic acid, followed by hepatic cytochrome P450 catalyzed glycine conjugation to form hippuric acid. Relatively small amounts appear in urine as o-cresol and p-cresol where they occur as glucoronide and sulfate derivate. Only a minor fraction of inhaled solvent is conjugated with glutathione with the production of S-benzyl-N-acetylcysteine (S-BMA). Several biological indicators have been proposed for evaluating toluene exposure in the workplace. These include urinary hippuric acid, toluene in blood, toluene in breath, o-cresol in urine and toluene in urine. We examined a group of 18 workers occupationally exposed to toluene, determining the concentrations of toluene in ambient air and S-BMA in urine. All urine samples were collected at the end of work shift. The renal excretion of S-BMA showed highly significant correlations with environmental data and with the other established parameters of biological monitoring of toluene. The median ambient air concentration was 15.7 ppm ranging from 2.9 to 70.3 ppm, the median concentration of S-BMA was 16.0 micrograms/g creatinine. S-BMA was detectable in urine samples of a control group of 87 subjects non occupationally exposed to toluene. Most of unexposed subjects showed S-BMA values lower than 10 micrograms/g creatinine both in smokers and in nonsmokers and no significant difference was found in samples (20) collected at three intervals during one day. Our finding further indicates that the metabolite S-BMA could be a marker of occupational toluene exposure.

[Biologic monitoring of carbon disulfide: role of glutathione]

Work goal is a critical analysis of the possibility of using TTCA as a future marker for next environmental limit values which will be probably fixed to much lower levels. Four metabolites have been identified in the urines of CS2 exposed subjects, exactly: thiocarbamide, 2-mercaptothiazolinone, 2-thiothiazolidine-4-carboxylic acid (TTCA), 2-oxothiazolidine-4-carboxylic acid. TTCA represents about the 6% of absorbed CS2 during occupational exposure. TTCA discovery in the urines of CS2 exposed workers (an heterocyclic compound which develops in vivo through direct reaction between CS2 and Glutatione) allowed a more specific approach to exposure assessment. The end-shift urine TTCA concentration seems to be in strict relationship with CS2 absorbed amount. In 1998 ACGIH maintained the 1997 limit value (TLV-TWA 10 ppm). In the 1997 DFG cut down the limit value in half (MAK 5 ppm), while, until 1996, it accepted the ACGIH value.

Determination of S-phenylmercapturic acid in urine as an indicator of exposure to benzene

S-phenylmercapturic acid (S-PMA) was measured in urine from 145 subjects exposed to low benzene concentrations in the air (C(I), benzene). The 8-h, time-weighted exposure intensity of individual workers was monitored by means of charcoal tubes and subsequent gas-chromatographic analysis after desorption with CS2. S-PMA excretion level in urine was determined by high-performance liquid chromatography with fluorescence detection. The following linear correlation was found between S-PMA concentrations in urine and benzene concentrations in the breathing zone: log(S-PMA, microg/g creatinine) = 0.712 log (C(I)-benzene, ppm) + 1.644 (n = 145, r = 0.74, P < 0.001). The geometric mean (GSD) of S-PMA concentrations in urine from 45 subjects occupationally not exposed to benzene but smoking more than 20 cigarettes/day was 7.8 microg/g creatinine (2.11), the corresponding value among non-smokers being 1.0 microg/g creatinine (2.18). It is concluded that the urinary level of S-PMA can be regarded as a useful indicator of exposure to benzene.

Genetic polymorphisms influence variability in benzene metabolism in humans

The role of genetic polymorphism in modulating urinary excretion of two benzene metabolites, i.e. trans,trans-muconic acid (t,t-MA) and S-phenylmercapturic acid (PMA), has been investigated in 59 non-smoking city bus drivers, professionally exposed to benzene via vehicle exhausts. Exposure to benzene was determined by personal passive samplers (mean +/- SD = 82.2 +/- 25.6 micrograms/m3), while internal dose and metabolic rate were evaluated by measuring urinary excretion of unmodified benzene (mean +/- SD = 361 +/- 246 ng/l), t,t-MA (mean +/- SD = 602 +/- 625 micrograms/g creatinine), and PMA (mean +/- SD = 5.88 +/- 4.76 micrograms/g creatinine). Genetic polymorphism at six loci encoding cytochrome-P450-dependent monooxygenases (CYP2E1 and CYP2D6), glutathione-S-transferases (GSTT1, GSTP1 and GSTM1) and NAD(P)H:quinone oxidoreductase (NQOR) was determined by polymerase chain reaction-based methods. No evidence emerged for a possible role of CYP2E1, GSTM1 and GSTP1 polymorphisms in determining the wide differences observed in the rate of benzene biotransformation. Conversely, a significantly higher t,t-MA urinary excretion was found to be correlated to, GSTT1 null genotype, and a significantly lower PMA excretion was detected in the subjects lacking NQOR activity and in the CYP2D6 extensive-metabolizers. Many biological (i.e. age and body burden) or lifestyle factors (i.e. rural or urban residence, use of paints and solvents, medication, alcohol and coffee intake), also taken into account as potential confounders, did not influence the correlations found. These findings suggest that CYP2D6, GSTT1 and NQOR polymorphisms contribute in explaining the metabolic variability observed in our sample. Therefore, these polymorphisms should be regarded as potential risk factors for benzene-induced adverse health effects.

Methodological issues in biomonitoring of low level exposure to benzene

Data from a pilot study on unmetabolized benzene and trans,trans muconic acid (t,t-MA) excretion in filling station attendants and unexposed controls were used to afford methodological issues in the biomonitoring of low benzene exposures (around 0.1 ppm). Urinary concentrations of benzene and t,t-MA were measured by dynamic head-space capillary GC/FID and HPLC, respectively. The accuracy of the HPLC determination of t,t-MA was assessed in terms of inter- and intra-method reliability. The adequacy of urinary t,t-MA and benzene as biological markers of low benzene exposure was evaluated by analysing the relationship between personal exposure to benzene and biomarker excretion. Filling station attendants excreted significantly higher amounts of benzene, but not of t,t-MA, than controls. Adjusting for occupational benzene exposure, smokers excreted significantly higher amounts of t,t-MA, but not of unmetabolized benzene, than nonsmokers. A comparative analysis of the present and previously published biomonitoring surveys showed a good inter-study agreement regarding the amount of t,t-MA and unmetabolized benzene excreted (about 0.1-0.2 mg/l and 1-2 micrograms/l, respectively) per unit of exposure (0.1 ppm). For each biomarker, based on the distribution of parameters observed in the pilot study, we calculated the minimum sample size required to estimate the population mean with given confidence and precision.

[The biological monitoring of occupational exposures to solvents by using their urinary concentrations]

For many years biological monitoring of occupational exposure to solvents is achieved via their specific urinary metabolites. In the last 10 years many publications have shown that the urinary concentrations of unchanged solvents are well correlated with environmental exposure and could therefore be used for biological monitoring. For acetone, methanol, methyl ethyl ketone and methyl iso butyl ketone, the American Conference of Governmental Industrial Hygienists and the Deutsche Forschungsgemeinschaft have proposed urinary concentrations of substance itself as biological exposure indices. A critical revision of the literature on this matter reveals discrepancies between the results obtained by different authors. The correlations between environmental data and respective solvents give excellent indices of correlation. However, the differences observed when comparing the regression lines obtained from different research groups are very wide. For example, for an exposure to toluene corresponding to 50 ppm, some authors found urinary concentrations equal to 35 micrograms/l, others found urinary concentration higher than 100 micrograms/l. Similarly for benzene, styrene and methyl ethyl ketone the differences were also marked. We have not identified an explanation for such different results. Biological data variability could help to explain part of these disagreements. It should also be remembered that for benzene, the analytical methodology performed in different conditions can give rise to very different results. The mechanisms of excretion of organic solvents in urine are discussed considering biological variability and analytical method problems. The current hypotheses do not allow a satisfactory interpretation of the literature results. In conclusion further experience is needed that will more clearly show which results better express the relationship between occupational exposure to organic solvents and their specific urinary concentrations.

Biological monitoring of workers exposed to carbon disulfide (CS2) in a viscose rayon fibers factory

The exposure-excretion relationship to carbon disulfide (CS2) vapor in 407 exposed workers was studied during the second half of the working week. Carbon disulfide concentrations were also determined in 50 nonexposed subjects. The geometric mean value for CS2 in urine samples from the latter was: 0.23 microgram/l (95% upper limit = 0.52 microgram/l) when log-normal distribution was assumed. Among the exposed workers, the CS2 level in urine samples collected after the first half shift exceeded the 95% upper limit of nonexposed subjects in every case. The time-weighted average intensity of exposure to CS2 vapor was measured using personal diffusive samplers (in which carbon cloth served as an adsorbent). CS2 concentrations in urine were determined in samples collected at the end of the first half shift from the 407 exposed cases as well as from 50 nonexposed controls. There was a significant correlation (p < 0.0001) between the exposure to CS2 vapor at concentrations of up to 64 mg/m3 and the levels of CS2 measured in the urine samples after four hours of exposure. The correlation indicated that a mean level of 15.5 micrograms CS2/l urine (95% confidence range, 13.8-17.1 micrograms/l) was excreted following an exposure to CS2 at 31 mg/m3 (the current occupational exposure limit).

[Technical note: proposal of a routine method of accurate measurement of urinary trans,trans-muconic acid]

A method for routine measurement of urinary trans,trans-muconic acid. A method is proposed which allows the accurate determination of urinary trans,trans-muconic acid (Ma) by HPLC with UV detection. Sample pretreatment consists of a first purification on strong anionic exchange (SAX) cartridges followed by extraction on "end capped" reversed-phase (C18-EC) ones. Purified samples are directly injected onto a chromatographic column (C18, 150 x 4.6 mm I.D., 3 microns) which is eluted with water: methanol: acetic acid (97:2:1, v/v) mixture followed by a "spike" of acetonitrile. The retention time of MA is 15 min, the coefficient of variation is lower than 3%, the limit of detection is 7 micrograms/l. The method seems suitable for accurate biological monitoring of subjects exposed to benzene.

The biological monitoring of inhalation anaesthetics

The biological monitoring of inhalation anaesthetics. Occupational exposure to inhalation anaesthetics is an undesired consequence of the work in the operating theatre. Anaesthesia is currently practised using nitrous oxide associated with one or more potent anaesthetics (halothane, enflurane, isoflurane). In the present study we evaluated the occupational exposure to inhalation anaesthetics during anaesthesia in 190 operating theatres of 41 hospitals in Italy. Nitrous oxide, halothane, enflurane, isoflurane were detected in the urine of 1521 exposed subjects (anaesthetists, surgeons and nurses). Significant correlations were found between the anaesthetic concentrations in urine produced during the shift (Cu) and anaesthetic environmental concentrations (CI). The results show that the urinary anaesthetic concentration can be used as an appropriate biological exposure index. The biological threshold values (urinary concentration values) proposed are the following: nitrous oxide, 15, 28 and 57 micrograms/L for an environmental exposure of 25, 50 and 100 ppm respectively; halothane, 97 micrograms/L (for an environmental exposure of 50 ppm), 6.1 micrograms/L (for an environmental exposure of 2 ppm) and 3.3 micrograms/L (for an environmental exposure of 0.5 ppm); enflurane, 145 micrograms/L (for an environmental exposure of 50 ppm), 22.7 micrograms/L (for an environmental exposure of 10 ppm), 3.7 micrograms/L (for an environmental exposure of 1 ppm); isoflurane, 5.3 micrograms/L (for an environmental exposure of 2 ppm) and 1.8 micrograms/L (for an environmental exposure of 0.5 ppm). These values apply to urine samples collected at the end of 4-hours' exposure to the anaesthetics.

Determination of specific mercapturic acids as an index of exposure to environmental benzene, toluene, and styrene

Methods were developed for the determination of urinary phenylmercapturic acid (PMA), a metabolite specific for benzene, benzylmercapturic acid (BMA), a metabolite of toluene and phenylhydroxyethylmercapturic acids (PHEMAs), specific for styrene, in human beings. Methods involved sample clean up followed by deacetylation and derivatization of the compounds with o-phthaldialdehyde and 2-mercaptoethanol. The fluorescent derivatives were separated on reversed-phase columns with gradient runs and detected by a fluorescence detector. The detection limits were 0.5 microgram/l for PMA and BMA, and 7 micrograms/l for PHEMAs. The background levels of PMA were higher in smokers than in nonsmokers, while no difference was found in the levels of BMA and PHEMAs. Coexposure to ethanol enanched the excretion of BMA in subjects experimentally exposed to toluene. Correlations were found between environmental benzene (r = 0.74, log transformed data), toluene (r = 0.74) or styrene (r = 0.56) and specific mercapturic acids in workers. The usefulness of PMA, BMA and PHEMAs as biomarkers is critically evaluated.

Effects of ethanol on toluene metabolism in man

The aim of this paper was to study the possible causes for metabolism changes due to ethanol and solvents interactions. In literature the effects of interaction between some solvents (toluene, xilene, TCE, etc.) and ethanol in acute experimental exposure are well known: the ingestion of a moderate amount of ethanol (0.8 gr/Kg) before inhalatory exposure to solvents causes the hematic levels of the solvent itself to increase and the urinary excretion of the main metabolites to decrease. In our study we have analyzed the possible effects of exposure to toluene vapours on elimination of toluene itself in urine, which is a useful biological index of occupational exposure to toluene. 5 healthy volunteers were exposed to toluene vapours (100 mg/m3 for 4 hours) with and without simultaneous ethanol consumption (0.5 g ethanol/Kg body weight) in an exposure chamber. The ethanol was ingested two minutes before entering the chamber and two hours after beginning of exposure in order to reach ethanol and toluene maximal concentrations in blood simultaneously. The blood and urine were collected at the beginning and at the end of exposure in order to measure toluene and ethanol. The analyses were performed by means of a Gas Chromatograph (GC) Hewlett-Packard 5880 A connected with a Mass Selective Detector (MSD). The obtained results show that ethanol causes a decrease in toluene metabolism: in fact, with constant environmental exposure, toluene concentration at the end of exposure increases in blood from 156 micrograms/L to 285 micrograms/L (+84%) in presence of ethanol; the same happens to the amount of toluene eliminated in urine (+45% in presence of ethanol), while the metabolized amount of toluene (hippuric acid in urine) was lower in presence of ethanol (1492 mg/g creatinine in comparison with 2251 mg/g creatinine; 37%). These results show that a moderate amount of ethanol changes toluene metabolism: this phenomenon may be an important source of error in the biological monitoring of solvent exposure.

Partition coefficients of methyl tert-butyl ether (MTBE)

The knowledge of the partition coefficients between the air and arterial blood and between the blood and the different physiological compartments of the body are essential to the mathematical modelling of the respiratory uptake and elimination of toxic vapours. Partition coefficients of methyl tertbutyl ether (MTBE) in saline, olive oil, urine and human blood, and various rat tissues were calculated after gas-chromatographic quantification of MTBE in the air phase. The blood/air, urine/air saline/air, fat/air and oil/air partition coefficients (lambda) are respectively: 20.0, 15.6, 15.3, 142.0 and 138.

Excretion of N-acetyl-S-(1-phenyl-2-hydroxyethyl)-cysteine and N-acetyl-S-(2-phenyl-2-hydroxyethyl)-cysteine in workers exposed to styrene

Styrene (S) has been shown to be responsible for neurotoxic effects, including behavioural changes and neuroendocrine disturbances. The initial step of S metabolism is conversion to styrene 7,8-epoxide (SO), which is present in two enantiomeric forms [(R)(+)-SO and (S)(-)-SO]; this electrophilic intermediate is considered to be directly responsible for most toxic effects of S. The major urinary metabolites derived from the biotransformation of SO in man are mandelic acid (MA) and phenylglyoxylic acid (PGA). In rats an alternative pathway has been demonstrated, which involves the conjugation of SO to glutathione (GSH), leading to the excretion of two specific mercapturic acids, N-acetyl-S-(-(1-phenyl-2-hydroxyethyl)-cysteine [M1] and N-acetyl-S-(2-phenyl-2-hydroxy-ethyl)-cysteine [M2]; a close relationship has been found between exposure to S and urinary excretion of M1 and M2 in rats. As a consequence of the chiral nature of SO, both M1 and M2 consist of two diastereoisomers (M1-'R', M1-'S', M2-'R' and M2-'S'). Early reports have shown that the conversion of S to mercapturic acids is much lower in man (below 1% of the absorbed dose) than in rats (about 10%). We propose an analytical method for the determination of urinary M1 and M2 in man, which involves a urine clean-up by a chromatographic technique with a short reversed-phase pre-column; purified samples are then deacetylated with porcine acylase and deproteinized by centrifugal ultrafiltration. A derivatization is then performed with o-phthaldialdehyde and 2-mercaptoethanol and the fluorescent derivatives are separated on a reversed-phase analytical column. The mobile phase consists of acetate buffer and methanol mixed at variable proportions, the fluorescence detector is set at 330 nm (exc.) and 440 nm (em.). M1-'S' and M1-'R' are separated (retention times = 52.8 and 73.7 min, respectively) while the diastereoisomers of M2 coelute as a single peak at 70.5 min. The detection limit is about 7 micrograms/l, the coefficients of variation are below 7% and the error percentages are less than 6%. The method was applied to 25 urine samples from workers exposed to S: significant correlations were found between mercapturic acids and MA and PGA, the best correlation being between M2 and PGA (r = 0.79). Urine samples form unexposed subjects showed no detectable amounts of the analytes. A high stereoselectivity is shown by the enzymes involved in the metabolism of S to mercapturic acids: M1-'S', which derives from (S)-SO, is excreted in much higher amounts than M1-'R', which derives from (R)-SO.

The urinary excretion of solvents and gases for the biological monitoring of occupational exposure: a review

'In the field' application of the measurement of urinary excretion of unmodified solvent for the biological monitoring of exposed workers has been investigated in many recent papers. The results obtained for several solvents are reviewed. The values of correlation coefficients (r) and regression lines obtained for benzene, toluene, xylene, styrene, n-hexane, cyclohexane, 2- and 3-methylpentane, methyl chloride, tetrachloroethylene, carbon tetrachloride, methyl chloroform, p-dichlorobenzene, nitrous oxide, halothane, isoflurane, enflurane, acetone, methyl ethyl ketone and methyl isobutyl ketone are presented. The correlations observed were generally good: r values range from 0.50-0.97, and the majority are between 0.84 and 0.90. The regression lines reported for the same solvent in different studies present some variability: this is possibly due to an inadequate control of factors influencing the relationship between external dose and absorption, such as differences in body burden, work load, individual characteristics, etc. These factors are discussed. As a whole, results reported in the literature show that measuring of urinary excretion of unmodified solvents provides a highly sensitive and specific exposure index, and can also be applied for the biological monitoring of occupational exposure to low levels of solvents or to solvent mixtures. Nevertheless, for an adequate assessment of biological limit values, further studies evaluating the reproducibility of regression lines are needed, given that the aspects influencing the correlation between external dose and urinary excretion are fully controlled. Another crucial aspect is the correlation with early effects: even though this has yet to be evaluated for several solvents, for others such as styrene and perchloroethylene a good correlation was obtained, further supporting the usefulness of the measurement of urinary excretion of solvent for the biological monitoring of occupational exposure.

Urinary excretion of specific mercapturic acids in workers exposed to styrene

Styrene is an important chemical of wide industrial use, particularly in the manufacture of polymers and reinforced plastics. Environmental and occupational exposures to styrene occur predominantly via inhalation. Styrene undergoes biotransformation mainly by side chain oxidation catalyzed by cytochrome P-450 enzymes to its reactive metabolite, styrene oxide. The (R)- and (S)-enantiomers of styrene oxide can be conjugated with glutathione to both (R)- and (S)-diastereoisomers of specific mercapturic acids, N-acetyl-S-(1-phenyl-2-hydroxyethyl)-L-cysteine (M1) and N-acetyl-S-(2-phenyl-2-hydroxyethyl)-L-cysteine (M2). We conducted this biomonitoring study with the aim of evaluating the association between excretion of specific mercapturic acids (M1 and M2) and level of exposure to styrene among occupationally exposed people. The mean time-weighted average (TWA) exposure was about one-half the current threshold limit value, the range of the values varied from 44 to 228 mg/m3. Geometric mean (GM) concentrations of 650, 1,084, and 31.8 micrograms/g creatinine were measured, respectively, for M1-S, M2, and M1-R. The environmental styrene concentration exhibited a significant correlation with total specific mercapturic acid (Mtot = sum of M1-R, M1-S, and M2), making it possible for the first time to calculate the approximate relationship between styrene uptake and excretion of these substances. The M2 mercapturic acid had a better correlation (r = 0.56) with respect to M1-R and M1-S. Significant correlations were found also between the excretion of specific mercapturic acids and biological exposure indices (i.e., mandelic and phenylglyoxylic acids and urinary styrene).

[Diffusion sampling of benzene present in the urine]

Benzene is a widely diffuse solvent; in the industrial environment benzene is currently present at concentrations of ppm. A valid method of biological monitoring that is easy to perform is need for assessing occupational and non-occupational exposures. A new method has been developed to evaluate low concentrations of benzene in urine samples by means of a diffusion sampling. The solvent is absorbed from the urine surface and concentrated on an absorbent substrate (Tenax) that is placed inside the vial. The solvent is thermically desorbed from Tenax and injected into a column (Thermal Tube Desorber-Supelco; 250 degrees C thermal flash; borosilicate capillary glass-column SPB-I 60 m length, 0.75 mm I.D., 1 micron film thickness; GC Dani 8580-FID). The method, which had not been previously employed for the determination of volatile organic substances in biological fluids, has a linear range which extends up to 40 micrograms/l, and gives results in excellent agreement with the conventional Head Space method, except in the low concentration region: the new method permits the quantitative determination of benzene quantities smaller than the detection limit of Head Space method connected with mass spectrometer (approximately 1 microgram/l). The detection limit was not exactly determined, but is estimated to be of 100 ng/l with 25 ml of urine sample.

[Environmental and biological monitoring of occupational exposure to perchloroethylene in dry cleaning shops]

Occupational exposure to perchloroethylene (PCE) was studied in a total of 106 workers in 78 dry cleaning shops in the province of Pavia, Northern, Italy. Environmental monitoring was performed by personal passive sampling. The median time weighted average (TWA) level of PCE was 57 mg/m3, i.e., about 30% of the current Threshold Limit Value (TLV) proposed by the American Conference of Governmental Industrial Hygienists (ACGIH). However, in 12 workers exposure exceeded this limit. Biological monitoring was performed via measurement of urinary trichloroacetic acid (TCA), i.e. the exposure index currently used in Italy, and urinary excretion of unmodified perchloroethylene (PCE-U) in samples collected at the end of the half-shift. Median levels of TCA and PCE were 1.03 mg/l and 17.7 micrograms/l respectively. The correlation coefficient between environmental TWA concentrations of perchloroethylene and PCE-U was 0.755 (0.809 after logarithmic transformation), compared to 0.660 for TCA values. The subjects were then classified as "low exposed" and "heavily exposed" according to whether personal exposure was lower or higher than 57 mg/m3, the median TWA value of the whole group. PCE-U levels were significantly correlated to exposure in both subgroups whereas TCA was correlated only in the "heavily exposed subjects", but not in those with lower exposure. The results of the study show that in the majority of dry cleaning shops exposure to PCE was well below the current occupational limits. Nevertheless surveillance of dry cleaners is recommended as nearly 10% of the workers exceeded the environmental and biological limits. Urinary excretion of unmodified PCE appears to be a very reliable indicator for biological monitoring of PCE exposure in dry cleaning and is also significantly correlated to exposure at low levels. The estimated biological equivalent exposure level (BEEL) for PCE-U, corresponding to the current TLV-TWA proposed by the ACGIH, is 55 micrograms/l. Urinary TCA seems to be less suitable for assessment of individual exposure to perchloroethylene in dry cleaners as it is poorly representative of exposure to low levels of the solvent, which is a very common occurrence in this occupational group nowadays.

Determination of urinary mercapturic acids of styrene in man by high-performance liquid chromatography with fluorescence detection

A method for the determination of urinary N-acetyl-S-(1-phenyl-2-hydroxyethyl)-L-cysteine (M1) and N-acetyl-S-(2-phenyl-2-hydroxyethyl)-L-cysteine (M2) in man was developed. Clean-up of urine samples was obtained by a chromatographic technique, using a short reversed-phase precolumn; purified samples were then deacetylated with porcine acylase I for 16 h at 37 degrees C and deproteinized by centrifugal ultrafiltration. Derivatization was performed with o-phthaldialdehyde and 2-mercaptoethanol and the fluorescent derivatives were separated on a reversed-phase analytical column with a gradient mobile phase consisting of 50 mM acetate buffer (pH 6.5) and methanol. The retention times of the diastereoisomers of M1 (M1-"S" and M1-"R") were 52.8 and 73.7 min, respectively: M2 diastereoisomers eluted as a single peak at 70.5 min. The fluorescence detector was set at 330 nm (excitation) and 440 nm (emission). The detection limit (at a signal-to-noise ratio of three) was about 7 micrograms/1. The method was applied to 25 urine samples from workers exposed to styrene. A relationship was found between urinary mandelic and phenylglyoxylic acids and mercapturic acids specific for styrene. Urine samples from ten non-exposed subjects showed no detectable amounts of analytes.

[Indoor pollution and biological monitoring of volatile organic compounds (VOC)]

Indoor air is a complex mixture of chemicals and airborne particles. Volatile Organic Compounds (VOC), a broad class of chemicals including diverse compounds such as Aldehydes, Terpenes, Aromatic and Aliphatic Hydrocarbons and Halogenated Volatile Organics, are an important category of indoor air pollutants. The evaluation of exposure to low doses of Chloroform and Benzene through the measurement of Chloroform and Benzene in urine was performed. Results show that biological monitoring may be helpful in indoor environmental studies in non occupational situations.

Acetone in urine as biological index of occupational exposure to isopropyl alcohol

In order to investigate a role of acetone in urine (AcU, mg/l) as an indicator of occupational exposure to isopropyl alcohol (IPA, ppm), AcU was measured in 80 male workers exposed to this substance in a plastic factory. The exposure concentration of solvent was also monitored personal diffusive sampling in the individuals during morning 4-hr shift. Urine samples were collected near the end of the shift and were analyzed for acetone by head-space gas chromatography. The correlation between airbornre concentration of IPA and its urinary metabolite acetone was significant: AcU (mg/l) = 0.031 x IPA (ppm) + 0.608, r = 0.75, n = 80, P < 0.001. We established 44 ppm as the lowest airborne concentration of IPA that caused excessive urinary excretion of acetone which could be discriminated from the endogenous production of acetone in non-exposed people. This concentration was as low as one ninth to one tenth of the current exposure limit of 400 ppm. At higher concentrations than 44 ppm, AcU was found to be a useful index for monitoring occupational exposure to IPA.

Monitoring of exposure to methylpentanes by diffusive sampling and urine analysis for alcoholic metabolites

OBJECTIVES

To investigate the possibilities of personal ambient monitoring and biological monitoring for methylpentane isomers.

METHODS

The performance of activated carbon cloth to absorb 2- and 3-methylpentane was studied by experimental vapour exposure followed by solvent extraction and gas chromatography (GC). Urine from workers and rats exposed to 2- and 3-methylpentane was analysed by GC with or without acid or enzymatic hydrolysis.

RESULTS

Carbon cloth absorbed 2- and 3-methylpentane linearly to exposures up to eight hours and to 400 ppm, and was sensitive enough to detect a 15 minute peak of exposure. The two isomers were clearly separated from hexane on a DB-1 column. For analysis of the urine, enzymatic hydrolysis was superior to acid hydrolysis. Exposure of rats to methylpentane vapours showed that 2-methyl-2-pentanol and 3-methyl-2-pentanol were excreted in urine in proportion to the dose of 2-methylpentane and 3-methylpentane, respectively. 2-Methyl derivatives of 1-, 3-, and 4-propanol, 2-methylpentane-2,4-diol, and 3-methyl-2-pentanol were minor metabolites. Analysis of urine from the exposed workers showed that 2-methyl- and 3-methyl-2-pentanol are leading urinary metabolites after exposure to the corresponding methylpentane.

CONCLUSIONS

Diffusive sampling is applicable to monitor 2- and 3-methylpentane vapours as is the case for hexane vapour. 2-Methyl-2-pentanol and 3-methyl-2-pentanol will be markers of occupational exposure to 2-methylpentane and 3-methylpentane, respectively. Also, 2-methylpentane-2,4-diol might be a marker of exposure to 2-methylpentane.

Anesthetic in urine as biological index of exposure in operating-room personnel

The aim of this study was to determine if a relationship existed between some inhalation anesthetics airborne exposure levels (Cl) and the concentration of anesthetics in samples of urine produced throughout the exposure time (Cu). The concentrations of nitrous oxide (N2O), halothane (fluothane), enflurane (ethrane), and isoflurane (forane) in the ambient atmosphere were determined in 190 operating theaters of 41 hospitals in Italy. Nitrous oxide, halothane, enflurane and isoflurane were detected in the urine of 1521 exposed subjects (anesthetists, surgeons, and nurses). The environmental measurements were performed using personal passive samplers, and the biological measurements were performed using the head space method. Significant correlations were found between the anesthetics concentration in urine produced during the shift collected after a 4-h exposure (Cu, microgram/L) and anesthetics environmental concentration (Cl, ppm). The results show that the urinary anesthetic concentration can be used as an appropriate biological exposure index. The biological values (urinary concentration values) proposed are the following: nitrous oxide, 25 micrograms/L, for an environmental value of 50 ppm; halothane, 97 micrograms/L, corresponding to 50 ppm of environmental exposure; 6.2 micrograms/L, corresponding to 2 ppm of environmental exposure; enflurane, 145 micrograms/L for an environmental exposure of 75 ppm and 5.6 micrograms/L for an environmental exposure of 2 ppm; isoflurane, 5.3 micrograms/L for an environmental exposure of 2 ppm. The values proposed are the respectively 95% lower confidence limit and therefore should be considered as a protection for the individual, especially if each biological value is corrected according to analytical variability of the measurements. In our opinion, the method of choice in the assessment of occupational exposure to inhalation anesthetics is the measurement of the urinary anesthetic concentration.

Low flow anaesthesia reduces occupational exposure to inhalation anaesthetics. Environmental and biological measurements in operating room personnel

In the present study we evaluated the occupational exposure to N2O and isoflurane during open circuit (OC) (fresh gas flow > or = minute volume) and low flow (LF) (fresh gas flow = 1.5 l/min) anaesthesia. The effects of active scavenging and of a charcoal filter positioned on the exhausting branch of the ventilator on environmental and urinary concentrations of inhalation anaesthetics were also investigated. The study was carried out in the same operating room provided with non-recirculating air changes (10 per hour). It involved anaesthetists and nurses during routine activity. N2O and isoflurane concentrations (time-weighted average) were measured after 3-hour continuous exposure: 1) in the environment at the level of the personnel's breathing zone (Ci); 2) in the environment at the ventilator zone (C); 3) in urine (Cu). During OC anaesthesia without active scavenging the breathing zone concentration of both N2O and isoflurane was very high (194.6 +/- 15.2 and 5.0 +/- 0.4 ppm, respectively). The activation of the scavenging greatly reduced the breathing zone concentration of N2O (31.6 +/- 4.1 ppm) and isoflurane (1.7 +/- 0.2 ppm). LF anaesthesia (with active scavenging) significantly reduced the environmental concentration of both anaesthetics (Ci N2O and isoflurane 22.7 +/- 1.8 and 0.6 +/- 0.04 ppm, respectively). During LF anaesthesia the breathing zone concentration of N2O remained low, even without scavenging (22.7 +/- 1.8 ppm). Similar results were obtained by measuring N2O and isoflurane concentrations at the ventilator zone and in urine.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of low levels of urinary trans,trans-muconic acid]

A method is described which allows determination of urinary t,t-muconic acid (MA) by means of HPLC with UV detection even at micrograms/l concentrations. The clean-up procedure of samples involves the use of strong anionic-exchange cartridges (SAX) for solid phase extraction (SPE). In order to improve the reproducibility of the retention time of MA (CV < 1%) and to obtain an adequate separation of MA from interferents, a high performance reverse-phase column (250 x 4.6 [I.D.] mm, 3 microns) is used and a careful control of the temperature (25 degrees C) is made. Also, a column-switching technique is applied to the chromatographic system in order to eliminate the highly retained peaks from the analytical column. The isocratic run is performed at a constant flow rate of 0.7 ml/min; the mobile phase consists of water: methanol: acetic acid (93.5:5.5: 1, v/v) and the UV detector is set at 259 nm. Under these conditions, MA elutes at 21.5 min and a single analysis takes 25 min; the detection limit (at a signal-to-noise ratio of 3) is 3 micrograms/l in urine, when a 200 microliters aliquot of the extract is injected in the analytical apparatus. The recovery of the clean-up procedure is > 90%; both the intra-assay and the inter-assay coefficients of variation are < 4%. The method has been applied to smokers and nonsmokers, subjects occupationally unexposed to benzene; the results showed a statistically significant difference between the two groups. Also, a close correlation was found between urinary excretion of MA measured with this method and environmental concentration of benzene in a population of workers occupationally exposed to low levels of this solvent.

Neurobehavioral functions in operating theatre personnel exposed to anesthetic gases

Neurobehavioral functions in paramedical operating theatre personnel were assessed in a cross-sectional survey. Sixty-two subjects (40 males and 22 females) occupationally exposed to anesthetic gases were examined and compared to 46 unexposed hospital workers (18 males and 28 females). The Simple Reaction Time (SRT) test was selected from the MANS battery (Milan Automated Neurobehavioural System). In order to evaluate acute and subacute types of effects on performance, the test was administered before and after the work shift, at the beginning and at the end of the working week. In addition, the complete battery was administered during one working day without exposure to anesthetic gases. On the last day of the working week, atmospheric nitrous oxide (N2Oa) ranged from 7 to 553 ppm (geometric mean 62.6), atmospheric ethrane (ETHa) ranged from 0.1 to 18.8 ppm (geometric mean 1.3), and urinary N2O (N2Ou) ranged from 4 to 297 micrograms/l (geometric mean 26.8). An impairment of performance on the SRT test was observed at the end of the working week in subjects exposed to anesthetic gases compared to controls. This alteration was observed also considering only the subjects exposed to less than 55 micrograms/l (which is the Italian exposure limit for N2Ou, equivalent to 100 ppm for N2Oa). No significant differences were observed for the other psychometric tests. No dose-effect relationships where found between SRT test score and the indicators of exposure (N2Oa, ETHa, N2Ou).(ABSTRACT TRUNCATED AT 250 WORDS)