An epidemiological study of the respiratory health of workers in the European refractory ceramic fibre industry.

OBJECTIVES: To investigate possible relations between respiratory health and past airborne exposure to refractory ceramic fibres (RCFs) and respirable dust in workers at six European factories, studied previously in 1987. METHODS: The target population comprised all current workers associated with RCF production, plus others who had participated in 1987 "leavers". Information was collected on personal characteristics, chest radiographs, lung function, respiratory symptoms, smoking, and full occupational history. Regression analysis was used to study relations between indices of health of individual workers and of cumulative exposure to airborne dust and fibres, and likely past exposure to asbestos. RESULTS AND DISCUSSION: 774 workers participated (90% of current workers, 37% of leavers). Profusion of small opacities in exposed workers (51% 0/1+; 8% 1/0+) was similar to that among an unexposed control group but higher than in new readings of the 1987 study films (11% 0/1+, 2% 1/0+). The large difference between 1987 and recent films may be, at least in part, a reading artefact associated with film appearance. Small opacities of International Labour Organisation (ILO) category 1/0+ were not associated with exposure. An association of borderline significance overall between 0/1+ opacities and exposure to respirable fibres was found for some exposure periods only, the time related pattern being biologically implausible. Pleural changes were related to age and exposure to asbestos, and findings were consistent with an effect of time since first exposure to RCFs. Among men, forced expired volume in 1 second (FEV(1)) and forced vital capacity (FVC) were inversely related to exposure to fibres, in current smokers only. FEV(1)/ FVC ratio and transfer factor (TL(CO)) were not related to exposures. The estimated restrictive effect was on average mild. Prevalence of respiratory symptoms was low. Chronic bronchitis and its associated symptoms (cough, phlegm) showed some association with recent exposure to respirable fibres. This could be due to an irritant effect of RCFs.

Modulation of benzo[a]pyrene diolepoxide-DNA adduct levels in human white blood cells by CYP1A1, GSTM1 and GSTT1 polymorphism.

The modulation of benzo[a]pyrene diolepoxide (BPDE)-DNA adduct levels by polymorphisms in the CYP1A1, GSTM1 and GSTT1 genes was assessed in leukocytes of Caucasian males. Eighty-nine coke oven workers (35 smokers, 36 ex-smokers and 18 non-smokers) were recruited from job categories with different exposure levels to polycyclic aromatic hydrocarbons (PAH), together with 44 power plant workers (all smokers) not exposed to PAH. BPDE-DNA adducts were detected in 69 of 133 (52%) DNA samples with a 100-fold variation (range 0.2-44 adducts/10(8) nt) and a median of 1.6 adducts/10(8) nt. All samples with the GSTM1 active genotype (n = 59) and five out of 74 samples with GSTM1*0/*0 (7%) showed non-detectable adducts (<0.2 adducts/10(8) nt) and 69 of 74 subjects with GSTM1*0/*0 (93%) had detectable adducts (>0.2 adducts/10(8) nt). The difference in adduct level between the GSTM1*0/*0 and GSTM1 active genotypes was highly significant (P < 0.0001). No significant difference in adduct level between the GSTT1*0/*0 and GSTT1 active genotypes was seen. All heterozygotes (CYP1A1*1/*2) from subjects of GSTM1 active type did not have detectable adducts. Among the GSTM1-deficient individuals (n = 69), 42 with the CYP1A1*1/*1 genotype showed a lower adduct level (median 1.3, range 0.2-4.1 adducts/10(8) nt) compared with 26 individuals with heterozygous mutated CYP1A1*1/*2 genotypes (median 2.5, range 0.4-6.1 adducts/10(8) nt, P < 0.015). One individual with low PAH exposure and the rare combination CYP1A1*2A/*2A-GSTM1*0/*0 showed an extremely high level of 44 adducts/10(8) nt. Significant differences in detectable adduct levels were found between the CYP1A1*1/*1 and CYP1A1*1/*2 genotypes in the exposed group low + medium (P = 0.01) and for all adduct levels, detectable and non-detectable (set at a fixed value), in highly exposed individuals and in ex-smokers (P = 0.03), whereas no such differences were observed in the control group. Mutated CYP1A1*1/*2 increased the adduct level in non-smokers from the exposed group (1.4 versus 2.2 adducts/10(8) nt), but had no effect on the smokers from the exposed group (2.3 versus 2.8 adducts/10(8) nt). When all variables were dichotomized, statistical evaluation showed that CYP1A1 status (P = 0.015), PAH exposure (P = 0.003) and smoking (P = 0.006) had significant effects on adduct levels which increased in the order: CYP1A1*1/*1 < CYP1A1(*1/*2 or *2A/*2A); environmental exposure < occupational exposure; non-smokers < smokers, whereby adducts increased with cigarette dose and the duration of smoking. Higher levels of BPDE-DNA adducts in individuals with the combined CYP1A1(1/*2 or *2A/*2A)-GSTM1*0/*0 genotype suggest that these genotype combinations are at increased risk for contracting lung cancer when exposed to PAH.

Relationship between blood antioxidants and occupational exposure to polycyclic aromatic hydrocarbons in coke oven workers.

BACKGROUND: We investigated if blood Cu++/Zn++ superoxide dismutase, glutathione peroxidase, and catalase activities are increased and total plasma antioxidant concentration is decreased in coke oven workers exposed to polycyclic aromatic hydrocarbons. METHODS: Ninety-six coke oven workers participated in the study. Nonexposed workers (n = 105) were randomly sampled among power plant workers in the same age range. The examination included a questionnaire on health status, occupational history, smoking, and dietary habits. Blood samples completed the examination. Coke oven workers were classified into low-, middle-, and high-exposure groups based on the benzo[a]pyrene (B[a]P) air concentrations and were further classified into the categories "topside" and "non-topside," according to their proximity to the ovens. RESULTS: Erythrocyte glutathione peroxidase activity increased with age (r = 0.18, P = 0.061) in power plant workers, whereas plasma glutathione peroxidase activity decreased with age (r = -0.18, P = 0.068) and erythrocyte glutathione peroxidase activity was inversely correlated with the number of cigarettes per day (r = -0.28, P = 0.08) in coke oven workers. Comparison of blood antioxidant enzyme activities and total plasma antioxidant concentration between coke oven and power plant workers showed that erythrocyte glutathione peroxidase activity was significantly lower in coke oven workers, even after adjustment for potential confounding factors. No differences were found either in other blood antioxidant enzyme activities or in total plasma antioxidant concentration between coke oven and power plant workers. Moreover, no trends toward decreased glutathione peroxidase activity among the three subgroups of B[a]P exposure were observed, and no differences either in blood antioxidant enzyme activities or in total plasma antioxidant concentration between the two groups of job categories were found. CONCLUSIONS: Production of reactive oxygen species seems not to be increased in coke oven workers.

Erythrocyte antioxidant enzyme activities in coal miners from three French regions.

This study investigated whether differences in the prevalence and severity of coal workers' pneumoconiosis (CWP) between three coal mines could be related to differences in oxidative stress exposure as evaluated in vivo through red-blood-cell antioxidant enzyme activities. Blood samples were obtained from 229 miners selected according to their occupation and their pneumoconiotic status. The following biomarkers were evaluated: erythrocyte catalase, Cu2+/Zn2+ superoxide dismutase (Cu2+/Zn2+ SOD), and glutathione peroxidase activities. Antioxidant enzyme activities did not differ significantly between the group of surface workers in Lorraine and the group of underground miners without CWP in Lorraine and in the other coal mines. Erythrocyte Cu2+/Zn2+ SOD activity was slightly decreased in the group of active underground miners with simple pneumoconiosis as compared with the group of miners without CWP in Nord/Pas-de-Calais. No effect was seen between retired miners at different stages of CWP. Our findings indicate that differences in the prevalence and severity of CWP do not seem to be related to various oxidative activities of coal dust particles, at least as reflected by measurements of antioxidant enzyme activities in circulating erythrocytes in this study.

High benzo[a]pyrene diol-epoxide DNA adduct levels in lung and blood cells from individuals with combined CYP1A1 MspI/Msp-GSTM1*0/*0 genotypes.

Levels of anti-benzo[a]pyrene diol-epoxide DNA adducts were analysed by high-pressure liquid chromatography/fluorimetric detection in non-tumorous lung tissues from 20 lung cancer patients and in white blood cells from 20 polycyclic aromatic hydrocarbon exposed coke oven workers. All were current tobacco smokers. CYP1A1 mutations (MspI at 6235 nt, Ile-Val462) and GSTM1 deletion polymorphisms in each individual were analysed in genomic DNA by PCR/restriction fragment length polymorphism. Independently of the CYP1A1 genotype (1) all 23 samples in the two groups with non-detectable adducts (< 0.2 per 10(8) nt) were of GSTM1 active genotype; (2) the 17 samples with detectable adducts (> or = 0.2 per 10(8) nt) in the two groups were GSTM1*0/*0. The difference in adduct levels between GSTM1*0/*0 and GSTM1 active genotype was highly significant (p < 0.00005). Among GSTM1-deficient individuals (n = 17), a subgroup of 14 individuals with CYP1A1*1/*1 (wild-type, n = 7) or heterozygous genotype (*1/*2A or *1/*2B, n = 7) showed low levels of BPDE DNA-adducts (range: 0.2-1.3 per 10(8) nt). (3) Three individuals with the rare combination CYP1A1*2A/*2A or *2A/*B and GSTM1*0/*0 showed significantly higher adduct levels (median: 17.4 adducts/10(8) nt, range 1.9-44; p = 0.017). Therefore, combination of homozygous mutated CYP1A1 and GSTM1*0/*0 genotypes lead, at a similar or even lower smoking dose, to a stronger increase of anti-benzo[a]pyrene diol-epoxide DNA adduct levels than found in individuals with CYP1A1 and GSTM1 wild-type. These data provide a mechanistic understanding of epidemiological studies that correlated these 'at risk' genotypes with increased smoking-related lung cancers.

Characterization of a soluble form of neutral endopeptidase-24.11 (EC 3.4.24.11) in human serum: enhancement of its activity in serum of underground miners exposed to coal dust particles.

A previous epidemiological study has reported the elevation of a serum metalloendopeptidase activity for underground coalminers exposed to chronic inhalation of coal mine dust particles. In this work, we have unambiguously characterized this activity as neutral endopeptidase (EC 3.4.24.11) using five different criteria. The apparent molecular weight of 100,000 g mol-1 calculated for the serum peptidase using Western blots or direct binding of the neutral endopeptidase 24.11 inhibitor [125I]-RB104 to the enzyme in acrylamide gels, suggests that the soluble form of this ectoenzyme is not generated by a post-translational cleavage of the membrane-bound form, as is the case for the closely related ectoenzyme, angiotensin-converting enzyme. The circulating endopeptidase very likely results from a shedding process. The increase in serum neutral endopeptidase 24.11 activity of underground miners compared with surface miners (5.7-fold), P < 0.01) is not correlated with systemic inflammation parameters, but seems to reflect the chronic pulmonary inflammatory state induced by coalmine dust exposure, and so may be a marker of lung injury.

Blood antioxidant enzymes as markers of exposure or effect in coal miners.

OBJECTIVE: To investigate if blood Cu++/Zn++ superoxide dismutase, glutathione peroxidase, catalase, and total plasma antioxidant activities could be markers of biological activity resulting from exposure to respirable coal mine dust in active miners, and of pneumoconiosis in retired miners. METHODS: Blood samples were randomly obtained from active surface workers (n = 30) and underground miners (n = 34), and from retired miners without (n = 21), and with (n = 33) pneumoconiosis. Antioxidant enzyme activities and total plasma antioxidants were measured in erythrocytes and plasma. Non-parametric tests were completed by analyses of covariance to compare antioxidants between groups, taking into account potential confounding factors (age, smoking history (pack-years)). RESULTS: Erythrocyte Cu++/Zn++ superoxide dismutase activity was significantly higher in the group of underground miners than the group of surface workers. The differences in total plasma antioxidants and plasma glutathione peroxidase activity between both groups were related to age. Glutathione peroxidase activity increased in the plasma of retired miners with pneumoconiosis, compared with retired miners without pneumoconiosis. No differences were found either in erythrocyte antioxidant enzyme activities or in total plasma antioxidants between the groups of retired miners without and with pneumoconiosis. CONCLUSIONS: In this study, erythrocyte Cu++/Zn++ superoxide dismutase activity may be considered as a marker of effect of respirable coal mine dust in exposed workers. This result is in agreement with the hypothesis that reactive oxygen species are involved in cell injury induced by coal mine dust, and may be predictive of the degree of inflammation and pneumoconiosis induced by coal mine dust. The increase in glutathione peroxidase activity in the plasma of retired miners with pneumoconiosis may be the result of a response to the increasing hydrogen peroxide (H2O2) production due to the disease process.

Survey of the respiratory health of the workers of a talc producing factory.

OBJECTIVES: To assess the effect of an occupational exposure to talc dust on respiratory health. METHODS: 166 talc millers from a French factory underwent spirometry and filled in a standardised respiratory questionnaire during their annual medical visit in 1989. A full sized chest radiograph taken in 1987 for the subjects hired before 1982 was also available, for the others a radiograph taken when hired was used. Radiography was repeated in 1992 for all subjects still active at this date (n = 139). The occupational exposure to talc dust was characterised for each workplace with 1440 personal samples collected since 1986 and by semiquantitative estimates of the historical exposure. RESULTS: The geometric mean (range) of estimated exposure was 1.87 (0.5 to 50) mg/m3 and the estimated cumulative exposure at the date of spirometry was > 150 y mg/m3 for 41 subjects. After adjustment for smoking in a linear model the standardised residual values of both forced vital capacity and forced expiratory volume in one second decreased significantly with increasing exposure. The prevalence of dyspnoea also increased after adjustment for smoking categories and age in a logistic regression. The prevalence of small radiological opacities was significantly related to age and to the exposure after adjustment for age and smoking categories. The incidence of new opacities between the two radiographs (11 new opacities with a profusion higher than 0/1) was significantly related to smoking (10 out of 11 are smokers) but not to the exposure. CONCLUSION: This study shows an effect of high levels of talc dust both on functional variables and on the prevalence of small radiological images, but provides no clear evidence about the possible effect of present levels of exposure.

Anti-benzo[a]pyrene diolepoxide--DNA adduct levels in peripheral mononuclear cells from coke oven workers and the enhancing effect of smoking.

The level of (+/-)-r-7,t-8-dihydroxy-t-9,10-oxy-7,8,9,10-tetrahydrobenzo[a]pyrene (anti-BPDE) bound to DNA of lymphocytes plus monocytes in 39 coke oven workers exposed to polycyclic aromatic hydrocarbons (PAH) and 39 non-exposed persons (controls) were investigated, each of the groups consisting of smokers and non-smokers. The adduct level was measured by an improved HPLC/fluorescence method (Rojas, M., Alexandrov, K., van Schooten, F. J., Hillebrand, M., Kriek, E. and Bartsch, H., Carcinogenesis, 15, 557-560, 1994) through the release of the corresponding benzo[a]pyrene (B[a]P) tetrols. The anti-BPDE-DNA adduct was detected in 51% of coke oven workers exposed to PAH and in 18% of the non-exposed (control) subjects. The mean level of anti-BPDE-DNA adducts/10(8) nucleotides in coke oven workers (15.7 +/- 37.8) was approximately 8 times higher than in non-exposed subjects (2.0 +/- 8.7). The interindividual variation of adduct levels was approximately 100-fold in coke oven workers and approximately 50-fold in controls respectively. Smokers in the exposed group had 3.5 times more DNA adducts than non-smokers. With the exception of one non-smoker with very high adduct levels (52.8 adducts/10(8)), the control subjects showed the presence of barely detectable adducts in only 16% of the samples examined. The increased in vivo formation in some smokers and high variability of anti-BPDE-DNA adducts in coke oven workers suggests variations in genetically controlled activation/inactivation reactions of PAH metabolism.

Recognition and progression of coal workers' pneumoconiosis in the collieries of northern France.

In France, both active and retired coal miners take part in medical surveillance programs. Those compensated for pneumoconiosis are registered and receive annual chest X-rays and regular lung function assessments. A longitudinal study was done among 2719 pneumoconiotics from the Nord-Pas de Calais region Compensation Register, who received first compensation between 1942 and 1987 to study progression of CSWP. Chest radiographs taken at time of compensation and in 1987 were examined by three independent readers. There was a change over time in the characteristics of pneumoconiosis at the time of first compensation toward a low profusion of irregular opacities. In the period from 1982 to 1987, 645 pneumoconiotics developed progressive massive fibrosis (PMF). The occurrence of PMF was related to the date of compensation and the profusion of small opacities at detection (after controlling for time to follow-up). Two profiles for changes in coal workers' simple pneumoconiosis (CWSP) were observed: the first in the group of subjects with mild pneumoconiosis at compensation, who did not reach category 2 at follow-up and had a low attack rate of PMF; and the second in the group of those compensated for category 1/2 pneumoconiosis or higher, who reached severe CWSP and had a twofold attack rate for PMF at follow-up. The changes observed in the characteristics of pneumoconiosis at first compensation between 1942 and 1987 suggest a lessening of disease severity.

Evaluation of tumor necrosis factor-alpha (TNF) as an exposure or risk marker in three French coal mining regions.

Several studies have shown the crucial role of the tumor necrosis factor-alpha (TNF) in the fibrosis induced by dusts containing silica and its role in the transition from simple pneumoconiosis (CWSP) to progressive massive fibrosis (PMF). To evaluate the nocivity of dust exposure among coal miners (n = 474) from different mining regions in France (e.g., Nord-Pas de Calais, Lorraine, and Provence), spontaneous and LPS or silica-induced TNF released by peripheral blood monocytes was quantified. The primary aim of this effort was to study the link between the prevalence of coal workers pneumoconiosis (CWP) and TNF release. TNF levels were significantly different between active miners from the three regions. However, after correction for age and region, TNF was found not to be related to dust exposure. Interestingly, a very low, homogeneous expression of TNF was observed in the group from Provence. These results are probably related to the absence of pneumoconiosis in this area. A positive relation between profusion and TNF release was found for all stimulants among retired miners with PMF. Although in retired miners TNF release was consistently higher, the design of the study does not allow this effect to be separated from that of age. Both silica and nonstimulated TNF release were found to increase with increasing radiological symptoms; the opposite was found for LPS-induced release.

Biological markers as indicators of exposure and pneumoconiotic risk: prospective study.

This research is designed to evaluate a number of biological markers to estimate harmful exposure on coal miners from different mining regions in France and to relate the outcome to differences in prevalence of coal worker pneumoconiosis (CWP) between these regions. Eight epidemiological groups of active and ex-miners (smokers and non-smokers) have been selected in the French collieries (North, Lorraine and Provence) according to their occupational and pneumoconiotic status. The following biomarkers have been evaluated: cellularity of sputum, elementary analysis of particles in TEM/EDAX, plasma neutral metalloendo-peptidase elastase type (NMEP), leucocyte elastase (HLE), fibronectin (FN) and elastin peptides. Pulmonary alveolitis, expressed by sputum cellularity, is different between active workers groups but not related to the general background of pneumoconiosis prevalence in the French collieries. In the plasma parameters, fibronectin, HLE and NMEP significantly increased in all groups of coal mine workers as compared to the control group, except for fibronectin parameter in Lorraine collierie. The degree of increase of these parameters allow us to discriminate the different groups and suggest that plasma FN, HLE and NMEP may be considered as biological markers of chronic inhalation of coal mine dust particles. The decrease of elastin peptides level in the Lorraine group alone suggests a specific alteration of elastin metabolism. These parameters were not related to the development of pneumoconiosis and its degree of severity.

Mortality due to respiratory cancers in the coke oven plants of the Lorraine coalmining industry (Houillères du Bassin de Lorraine).

The main activity of the Houillères du Bassin de Lorraine (Lorraine Collieries), employing 23,000 operatives and executives, is coalmining. The coke production is carried out by two coke oven plants with a workforce of respectively 747 and 552 workers. The coal coking process entails the emission of noxious products such as polycyclic aromatic hydrocarbons (PAH) from the ovens. The influence of occupational exposure on mortality due to respiratory cancers, and particularly to lung and upper respiratory and alimentary tracts cancer, was investigated among a cohort of 534 male workers from the two coke oven plants who had retired from work between 1963 and 1982. The job history of each subject has been precisely reconstructed by indicating the duration of exposure on the ovens, close to the ovens, and in maintenance occupations. The cohort mortality has been analysed according to the method of indirect standardisation with reference to the French male population and by a case-control study concerning the consumption of tobacco per cohort. The mortality due to lung cancer is 2.51 times higher than expected. This excess of mortality differs, but not significantly, between the two coke oven plants (standardised mortality ratio equals 3.05 and 1.75 respectively). It is not significantly higher among subjects exposed for more than five years, directly exposed on the ovens or working near the ovens or at maintenance occupations on the ovens (SMR = 2.78), than among those exposed for less than five years (SMR = 2.35) or those not exposed at all. Even taking into account the excess of mortality due to lung cancers in the Moselle district (1.6 time that of France), the excess of lung cancers does not seem to be explained by the regional factor, or by tobacco and alcohol consumption. Although no significant relation was offered between lung cancer and the duration of exposure to PAH, even when taking smoking habits into account, the carcinogenic role of occupational nuisances cannot be excluded.