Relationship between pleural plaques and biomarkers of cumulative asbestos dose. A necropsy study.

BACKGROUND: The relationship between pleural plaques and cumulative asbestos exposure is controversial. OBJECTIVES: To evaluate the relationship between lung asbestos bodies (AB) and fibres (AF) and plaques presence and extension. METHODS: In a necropsy series of shipyard workers with asbestos-related diseases, we measured counts (per g of dry lung tissue) of AB (thousands) and AF>1 µm (millions). Pleural plaques were classified into three extension grades. We fitted univariate and multivariable linear (dependent variables: AB and AF, log10 transformed) and multinomial (dependent variable: plaques grade) regression models. RESULTS: We analysed 124 subjects, 13 without plaques 20 with grade 1, 69 with grade 2, and 22 with grade 3 plaques. Geometric means (GM) of AB were 10.6, 23.3, 126, and 140 in the four groups respectively (P=0.0001). GMs for AF (mostly amphiboles) were 1.2, 1.4, 7.3, and 12.9 (P=0.0001). AB and AF were strongly correlated (r=0.81). The likelihood of no plaques and grade 1 plaques decreased with increasing AB and AF doses, with a corresponding increase of grade 2 and 3 plaques. Plaque presence and extension was also associated with histologically verified asbestosis (P<0.001). CONCLUSIONS: Our study showed a strong positive relationship between pleural plaque presence and extension and both lung asbestos burden and asbestosis.

Cancer-promoting role of adipocytes in asbestos-induced mesothelial carcinogenesis through dysregulated adipocytokine production.

Like many other human cancers, the development of malignant mesothelioma is closely associated with a chronic inflammatory condition. Both macrophages and mesothelial cells play crucial roles in the inflammatory response caused by asbestos exposure. Here, we show that adipocytes can also contribute to asbestos-induced inflammation through dysregulated adipocytokine production. 3T3-L1 preadipocytes were differentiated into mature adipocytes prior to use. These cells took up asbestos fibers (chrysotile, crocidolite and amosite) but were more resistant to asbestos-induced injury than macrophages and mesothelial cells. Expression microarray analysis followed by reverse transcription-PCR revealed that adipocytes respond directly to asbestos exposure with an increased production of proinflammatory adipocytokines [e.g. monocyte chemoattractant protein-1 (MCP-1)], whereas the production of anti-inflammatory adipocytokines (e.g. adiponectin) is suppressed. This was confirmed in epididymal fat pad of mice after intraperitoneal injection of asbestos fibers. Such dysregulated adipocytokine production favors the establishment of a proinflammatory environment. Furthermore, MCP-1 marginally promoted the growth of MeT-5A mesothelial cells and significantly enhanced the wound healing of Y-MESO-8A and Y-MESO-8D human mesothelioma cells. Our results suggest that increased levels of adipocytokines, such as MCP-1, can potentially contribute to the promotion of mesothelial carcinogenesis through the enhanced recruitment of inflammatory cells as well as a direct growth and migration stimulatory effect on mesothelial and mesothelioma cells. Taken together, our findings support a potential cancer-promoting role of adipocytes in asbestos-induced mesothelial carcinogenesis.

Non-neoplastic and neoplastic pleural endpoints following fiber exposure.

Exposure to asbestos fibers is associated with non-neoplastic pleural diseases including plaques, fibrosis, and benign effusions, as well as with diffuse malignant pleural mesothelioma. Translocation and retention of fibers are fundamental processes in understanding the interactions between the dose and dimensions of fibers retained at this anatomic site and the subsequent pathological reactions. The initial interaction of fibers with target cells in the pleura has been studied in cellular models in vitro and in experimental studies in vivo. The proposed biological mechanisms responsible for non-neoplastic and neoplastic pleural diseases and the physical and chemical properties of asbestos fibers relevant to these mechanisms are critically reviewed. Understanding mechanisms of asbestos fiber toxicity may help us anticipate the problems from future exposures both to asbestos and to novel fibrous materials such as nanotubes. Gaps in our understanding have been outlined as guides for future research.

Morphological and chemical mechanisms of elongated mineral particle toxicities.

Much of our understanding regarding the mechanisms for induction of disease following inhalation of respirable elongated mineral particles (REMP) is based on studies involving the biological effects of asbestos fibers. The factors governing the disease potential of an exposure include duration and frequency of exposures; tissue-specific dose over time; impacts on dose persistence from in vivo REMP dissolution, comminution, and clearance; individual susceptibility; and the mineral type and surface characteristics. The mechanisms associated with asbestos particle toxicity involve two facets for each particle's contribution: (1) the physical features of the inhaled REMP, which include width, length, aspect ratio, and effective surface area available for cell contact; and (2) the surface chemical composition and reactivity of the individual fiber/elongated particle. Studies in cell-free systems and with cultured cells suggest an important way in which REMP from asbestos damage cellular molecules or influence cellular processes. This may involve an unfortunate combination of the ability of REMP to chemically generate potentially damaging reactive oxygen species, through surface iron, and the interaction of the unique surfaces with cell membranes to trigger membrane receptor activation. Together these events appear to lead to a cascade of cellular events, including the production of damaging reactive nitrogen species, which may contribute to the disease process. Thus, there is a need to be more cognizant of the potential impact that the total surface area of REMP contributes to the generation of events resulting in pathological changes in biological systems. The information presented has applicability to inhaled dusts, in general, and specifically to respirable elongated mineral particles.

Pulmonary endpoints (lung carcinomas and asbestosis) following inhalation exposure to asbestos.

Lung carcinomas and pulmonary fibrosis (asbestosis) occur in asbestos workers. Understanding the pathogenesis of these diseases is complicated because of potential confounding factors, such as smoking, which is not a risk factor in mesothelioma. The modes of action (MOA) of various types of asbestos in the development of lung cancers, asbestosis, and mesotheliomas appear to be different. Moreover, asbestos fibers may act differentially at various stages of these diseases, and have different potencies as compared to other naturally occurring and synthetic fibers. This literature review describes patterns of deposition and retention of various types of asbestos and other fibers after inhalation, methods of translocation within the lung, and dissolution of various fiber types in lung compartments and cells in vitro. Comprehensive dose-response studies at fiber concentrations inhaled by humans as well as bivariate size distributions (lengths and widths), types, and sources of fibers are rarely defined in published studies and are needed. Species-specific responses may occur. Mechanistic studies have some of these limitations, but have suggested that changes in gene expression (either fiber-catalyzed directly or by cell elaboration of oxidants), epigenetic changes, and receptor-mediated or other intracellular signaling cascades may play roles in various stages of the development of lung cancers or asbestosis.

Asbestos, carbon nanotubes and the pleural mesothelium: a review of the hypothesis regarding the role of long fibre retention in the parietal pleura, inflammation and mesothelioma.

The unique hazard posed to the pleural mesothelium by asbestos has engendered concern in potential for a similar risk from high aspect ratio nanoparticles (HARN) such as carbon nanotubes. In the course of studying the potential impact of HARN on the pleura we have utilised the existing hypothesis regarding the role of the parietal pleura in the response to long fibres. This review seeks to synthesise our new data with multi-walled carbon nanotubes (CNT) with that hypothesis for the behaviour of long fibres in the lung and their retention in the parietal pleura leading to the initiation of inflammation and pleural pathology such as mesothelioma. We describe evidence that a fraction of all deposited particles reach the pleura and that a mechanism of particle clearance from the pleura exits, through stomata in the parietal pleura. We suggest that these stomata are the site of retention of long fibres which cannot negotiate them leading to inflammation and pleural pathology including mesothelioma. We cite thoracoscopic data to support the contention, as would be anticipated from the preceding, that the parietal pleura is the site of origin of pleural mesothelioma. This mechanism, if it finds support, has important implications for future research into the mesothelioma hazard from HARN and also for our current view of the origins of asbestos-initiated pleural mesothelioma and the common use of lung parenchymal asbestos fibre burden as a correlate of this tumour, which actually arises in the parietal pleura.

Translocation pathways for inhaled asbestos fibers.

We discuss the translocation of inhaled asbestos fibers based on pulmonary and pleuro-pulmonary interstitial fluid dynamics. Fibers can pass the alveolar barrier and reach the lung interstitium via the paracellular route down a mass water flow due to combined osmotic (active Na+ absorption) and hydraulic (interstitial pressure is subatmospheric) pressure gradient. Fibers can be dragged from the lung interstitium by pulmonary lymph flow (primary translocation) wherefrom they can reach the blood stream and subsequently distribute to the whole body (secondary translocation). Primary translocation across the visceral pleura and towards pulmonary capillaries may also occur if the asbestos-induced lung inflammation increases pulmonary interstitial pressure so as to reverse the trans-mesothelial and trans-endothelial pressure gradients. Secondary translocation to the pleural space may occur via the physiological route of pleural fluid formation across the parietal pleura; fibers accumulation in parietal pleura stomata (black spots) reflects the role of parietal lymphatics in draining pleural fluid. Asbestos fibers are found in all organs of subjects either occupationally exposed or not exposed to asbestos. Fibers concentration correlates with specific conditions of interstitial fluid dynamics, in line with the notion that in all organs microvascular filtration occurs from capillaries to the extravascular spaces. Concentration is high in the kidney (reflecting high perfusion pressure and flow) and in the liver (reflecting high microvascular permeability) while it is relatively low in the brain (due to low permeability of blood-brain barrier). Ultrafine fibers (length < 5 mum, diameter < 0.25 mum) can travel larger distances due to low steric hindrance (in mesothelioma about 90% of fibers are ultrafine). Fibers translocation is a slow process developing over decades of life: it is aided by high biopersistence, by inflammation-induced increase in permeability, by low steric hindrance and by fibers motion pattern at low Reynolds numbers; it is hindered by fibrosis that increases interstitial flow resistances.

Measurements of asbestos burden in tissues.

Asbestos inhaled into the lung is recognized as a potential causal agent for the development of diseases in man. The diseases induced by asbestos include lung cancer, fibrosis of the lung (asbestosis), and extrapulmonary tumors including mesothelioma (a tumor of the serosal membrane), as well as fibrosis and other changes in the pleura linings. The cause of these diseases can often be more specifically linked to asbestos exposure once tissue burden of asbestos is established. The asbestos burden in tissue can be defined as the number of asbestos bodies and/or the numbers and types of asbestos fibers found in the tissue. In either of these cases the quality of information is directly dependent on the preparative techniques and instrumentation used in the analysis. The present article will discuss the significance of findings of tissue burden based on both these variables.

Crocidolite asbestos fibers undergo size-dependent microtubule-mediated transport after endocytosis in vertebrate lung epithelial cells.

The large respiratory epithelial cells within primary cultures of newt (Taricha granulosa) lung are uniquely suited for high resolution video-enhanced light-microscopic studies. We show here that these cells incorporate crocidolite asbestos fibers within 18 h by endocytosis. Once inside the cell, fibers less than 5 microns in length are seen by video light microscopy to undergo saltatory transport at a maximum velocity of 1.18 microns/s. By contrast, fibers over 5 microns long rarely exhibit saltatory motion. Over time, all of the fibers become preferentially located near the nucleus. This perinuclear accumulation is largely inhibited by disassembling the cytoplasmic microtubules with nocodazole. Same cell correlative light and electron microscopy reveal that fibers exhibiting saltatory behavior are enclosed within a membrane. From these observations we conclude that, upon incorporation into epithelial cells, asbestos fibers undergo size-dependent active transport along cytoplasmic microtubules. Our data are the first to link the dimension-dependent transforming ability of asbestos fibers to a basic cellular function, i.e., the microtubule-dependent transport of cellular components.

Persistence of natural mineral fibers in human lungs: an overview.

Virtually all available data on persistence of naturally occurring mineral fibers in human lungs have been derived from studies of asbestos fiber loads. These studies indicate that, although both amphibole and chrysotile asbestos fibers are found in the lungs of the general population and exposed workers, amphibole fibers are universally present in disproportionately large and chrysotile fibers in disproportionately small amounts compared to their known abundance in the original inhaled dusts. Why this should be remains unclear. Most reports have shown that fiber accumulation is proportional to measured exposure for amphiboles, but this is not generally true for chrysotile. Very little information is available on actual fiber clearance rates from human lungs. For amosite and crocidolite, estimated clearance half-times are measured in years to decades, whereas for chrysotile the available, rather indirect, data suggest that the vast majority of fibers are cleared within months, although some fibers may be sequestered and very slowly cleared. Overall these studies suggest that the differences between amphibole and chrysotile fiber burdens in man reflect much faster clearance of chrysotile fibers, rather than a failure of chrysotile deposition. A variety of other naturally occurring fibers are commonly found in human lungs, but there are no data on their rates of accumulation or disappearance.

Biopersistence of respirable synthetic fibers and minerals: point of view of the chest physician.

Problems of diagnosis related to the presence or absence of particles in lung and pleural tissues are discussed from the clinician's viewpoint. The advantage of applying mineralogical analytical techniques is considered.

An experimental approach to the evaluation of the biopersistence of respirable synthetic fibers and minerals.

The biopersistence of fibers and minerals in the respiratory tract is an important parameter in the toxicity of those materials. The biopersistence of respirable synthetic fibers and minerals in man can be most closely evaluated in an animal model. While acellular and in vitro systems are important for initial evaluation of solubility and durability, they cannot simulate the dynamics of inhalation deposition and clearance and the subsequent systemic reaction to fibers and minerals that occurs in the animal. To evaluate the biopersistence of synthetic fibers, male rats were exposed to a well defined rat respirable aerosol of man-made vitreous fibers (MMVF), 6 hr/day for 5 days. Following exposure, subgroups were sacrificed at intervals ranging from 1 hr to 52 weeks. Following sacrifice, the lungs were removed, weighed, and immediately frozen at 20 degrees C for subsequent digestion by low temperature plasma ashing. The number, size distribution, and chemical composition of the fibers in the aerosol and lung were determined. With this animal model the role of biopersistence in altering the geometry and clearance of fibers can be systematically evaluated. The model also can be applied for the evaluation of the biopersistence of nonfibrous minerals.

Cellular and molecular mechanisms of asbestos carcinogenicity: implications for biopersistence.

Carcinogenic agents can influence the carcinogenic process either by mutating critical target genes or by increasing the number of cells at risk for mutations. Cytogenetic and molecular studies of asbestos-related cancers indicate that inactivation or loss of multiple tumor suppressor genes occurs during lung cancer development. Aneuploidy and other chromosomal changes induced by asbestos fibers may be involved in genetic alterations in asbestos-related cancers. Furthermore, asbestos fibers may influence the carcinogenic process by inducing cell proliferation, free radicals, or other promotional mechanisms. Therefore, asbestos fibers may act at multiple stages of the carcinogenic process by both genetic and epigenetic mechanisms. Biopersistence is undoubtedly important in fiber carcinogenicity. However, the time required for a fiber to remain in the lung to exert a cancer-related effect is difficult to specify.

Effect of size of man-made and natural mineral fibers on chemiluminescent response in human monocyte-derived macrophages.

Fiber size is an important factor in the tumorigenicity of various mineral fibers and asbestos fibers in animal experiments. We examined the time course of the ability to induce lucigenin-dependent chemiluminescence (CL) from human monocyte-derived macrophages exposed to Japan Fibrous Material standard reference samples (glass wool, rock wool, micro glass fiber, two types of refractory ceramic fiber, refractory mullite fiber, potassium titanium whisker, silicon carbide whisker, titanium oxide whisker, and wollastonite). We determined how fiber length or width might modify the response of cells. We found that the patterns of time-dependent increase of CL (sigmoid type) were similar for each sample except wollastonite. We observed a strong correlation between geometric-mean length and ability to induce CL in seven samples > 6 microm in length over the time course (largest r(2) = 0.9760). Although we also observed a close positive correlation between geometric-mean width and the ability to induce CL in eight samples < 1.8 microm in width at 15 min (r(2) = 0.8760), a sample of 2.4 microm in width had a low ability to induce CL. Moreover, the relationship between width and the rate of increase in ability to induce CL had a negative correlation at 30-60 min (largest r(2) = 0.7473). Our findings suggest that the release of superoxide from macrophages occurs nonspecifically for various types of mineral fibers depending on fiber length.

Intestinal transport of some macromolecules in food.

This review focuses on the intestinal transport of macromolecules in food. Although it is known that neonates have the ability to absorb proteins from the intestine as a means of passive immunization, it has generally been assumed that adults do not retain this capability. A number of studies have shown that the adult mammalian small intestine is capable of transporting a variety of macromolecules in food to a very limited extent. The evidence demonstrating the transport of test substances in the micron-size range across the adult intestinal epithelial barrier is examined for a number of food substances and environmental contaminants. It will be shown that macromolecules can be transported across this barrier by endocytosis; by uptake into the gut-associated lymphoid tissue, and possibly by uptake into the goblet cells. It is considered highly unlikely that large micron-sized particles pass between intestinal cells due to the integrity of the tight junctions between cells that exclude particles in this size range. Quantitative estimates for macromolecular uptake are included along with a discussion of the physiological parameters influencing macromolecular transport.

Asbestos and the histogenesis of lung carcinoma.

Individuals exposed to asbestos develop and die of bronchogenic carcinoma at rates well above individuals not exposed, but there is disagreement as to what factors other than the asbestos may be important in the histogenesis of the carcinoma. This report discusses the various theories as to how and why asbestos, cigarette smoke, asbestosis, and pleural disease may be involved in the development of the carcinoma. The authors conclude that other disease processes may mark individuals particularly likely to develop carcinoma of the lung, but that asbestos fibers have an independent role in the histogenesis of carcinoma of the lung.

Pathways and quantification of insoluble particles in the lung compartments of the rat.

The aim of this investigation was focused on mechanisms involved in toxicokinetics of particles and fibers within the rat lung. Biologically inert polystyrene particles or an asbestos--particle comixture were followed in their pathways of deposition and retention in the lung, particularly in the alveolar space and their accumulation in the lymph node tissue of exposed rats. One group of Wistar rats was intratracheally instilled with 0.4 ml phosphate buffered saline containing 2.4 x 10(8) inert polystyrene microspheres, a second group of animals was instilled with comixture containing 1.25 mg/ml of crocidolit asbestos fibers and previously prepared microspheres. Bronchoalveolar lavage of each lung was performed on post-instillation days 1, 7, 30, 80 and 150. Particles associated with alveolar phagocytes were counted using light microscopy. The lung and lymph node tissues were chemically dissolved and tissue aliquots passed through Nucleopor membrane filters. The number of particles in the tissue aliquot samples was determined using fluorescence microscopy. The results show that the fate of particulates in the respiratory system is highly dependent on the physical properties of the instilled material. Clearance patterns for particles and fibers are markedly different. Long-term consequences are the translocation and retention of fibrous material in the interstitum, involving the major route of clearance through the lymphatics.

Pulmonary fibre burden in sheep living in the Biancavilla area (Sicily): preliminary results.

In a national survey on mortality from malignant pleural neoplasms in Italy, aimed at detecting geographic clusters of cases of the disease, the town of Biancavilla, located in a volcanic area of Eastern Sicily, showed high risk of pleural mesothelioma in the absence of occupational asbestos exposure. An environmental survey suggested the stone quarries located in 'Monte Calvario', south-east of the town of Biancavilla, as a possible source of asbestiform fibre exposure. A subsequent crystal-chemistry investigation of the 'Monte Calvario' amphiboles identified the mineral asbestiform fibres as 'fluoro-edenite', a new end-member of the edenite ==> fluoro-edenite series. A collaborative epidemiological and environmental study was initiated to investigate the characteristics of the outbreak of malignant mesothelioma and test the hypothesis of a causal association with exposure to naturally occurring fibres. To investigate if a sheep population could be used to monitor the environmental diffusion of the fibres, we examined lung specimens from 27 culled sheep, at least 3 years old and living near Monte Calvario to check for the presence of fluoro-edenite fibres, using scanning electron microscopy (SEM) analysis and X-ray microanalysis. Fourteen mineral species have been isolated in the mineral particulate matter taken from pulmonary parenchyma, and fluoro-edenite was detected in eight sheep. These preliminary data suggest a possible bio-indicative role of sheep as sentinel animals in the evaluation of environmental fibre diffusion, which merits further investigation.

[The role of modifying factors in the carcinogenic effect of asbestos and asbestos-containing dusts]. / Rol' modifitsiruiushchikh faktorov v kantserogennom deistvii asbesta i asbestsoderzhashchikh pylei.

The modifying role of adsorption activity, fibre size, fibrogenicity, carcinogens of other classes and of some noncarcinogenic compounds in asbestos carcinogenesis have been considered. It is supposed that the modifying factors play a dominant role in asbestos blastomogenicity. The removal of these factors is an important method for tumours prophylaxis in asbestos workers.

[The influence of "rigidity" and structure of fibrous dust on their biological activity]. / Vliianie "zhestkosti" i struktury voloknistykh pylei na ikh biologicheskoe deistvie.

The authors represent experimental data on cytotoxic, fibrogenic and mutagenic effects of fibrous dusts--"soft" pulp fibers and "stiff" ones (chrysotile-asbestos, carbon, basalt and fiber glass) in comparison with the nonfibrous analogs (antigorit, quartz DQ-12 and others). Viability of peritoneal macrophages was depressed more dramatically by "stiff" fibers vs. the "soft" ones. Mutagenic activity was associated with the "stiffness" degree of the dust particles. When compared to fibrous chemical dusts, nonfibrous ones appeared inert in micronuclear test.