Interferon-epsilon is a novel regulator of NK cell responses in the uterus.

The uterus is a unique mucosal site where immune responses are balanced to be permissive of a fetus, yet protective against infections. Regulation of natural killer (NK) cell responses in the uterus during infection is critical, yet no studies have identified uterine-specific factors that control NK cell responses in this immune-privileged site. We show that the constitutive expression of IFNε in the uterus plays a crucial role in promoting the accumulation, activation, and IFNγ production of NK cells in uterine tissue during Chlamydia infection. Uterine epithelial IFNε primes NK cell responses indirectly by increasing IL-15 production by local immune cells and directly by promoting the accumulation of a pre-pro-like NK cell progenitor population and activation of NK cells in the uterus. These findings demonstrate the unique features of this uterine-specific type I IFN and the mechanisms that underpin its major role in orchestrating innate immune cell protection against uterine infection.

Retinoic Acid-Related Orphan Receptor α Is Required for Generation of Th2 Cells in Type 2 Pulmonary Inflammation.

The transcription factor retinoic acid-related orphan receptor α (RORα) is important in regulating several physiological functions, such as cellular development, circadian rhythm, metabolism, and immunity. In two in vivo animal models of type 2 lung inflammation, Nippostrongylus brasiliensis infection and house dust mite (HDM) sensitization, we show a role for Rora in Th2 cellular development during pulmonary inflammation. N. brasiliensis infection and HDM challenge induced an increase in frequency of Rora-expressing GATA3+CD4 T cells in the lung. Using staggerer mice, which have a ubiquitous deletion of functional RORα, we generated bone marrow chimera mice, and we observed a delayed worm expulsion and reduced frequency in the expansion of Th2 cells and innate lymphoid type 2 cells (ILC2s) in the lungs after N. brasiliensis infection. ILC2-deficient mouse (Rorafl/flIl7raCre) also had delayed worm expulsion with associated reduced frequency of Th2 cells and ILC2s in the lungs after N. brasiliensis infection. To further define the role for Rora-expressing Th2 cells, we used a CD4-specific Rora-deficient mouse (Rorafl/flCD4Cre), with significantly reduced frequency of lung Th2 cells, but not ILC2, after N. brasiliensis infection and HDM challenge. Interestingly, despite the reduction in pulmonary Th2 cells in Rorafl/flCD4Cre mice, this did not impact the expulsion of N. brasiliensis after primary and secondary infection, or the generation of lung inflammation after HDM challenge. This study demonstrates a role for RORα in Th2 cellular development during pulmonary inflammation that could be relevant to the range of inflammatory diseases in which RORα is implicated.

Targeting Mucin Protein Enables Rapid and Efficient Ovarian Cancer Cell Capture: Role of Nanoparticle Properties in Efficient Capture and Culture.

The development of specific and sensitive immunomagnetic cell separation nanotechnologies is central to enhancing the diagnostic relevance of circulating tumor cells (CTCs) and improving cancer patient outcomes. The limited number of specific biomarkers used to enrich a phenotypically diverse set of CTCs from liquid biopsies has limited CTC yields and purity. The ultra-high molecular weight mucin, mucin16 (MUC16) is shown to physically shield key membrane proteins responsible for activating immune responses against ovarian cancer cells and may interfere with the binding of magnetic nanoparticles to popular immunomagnetic cell capture antigens. MUC16 is expressed in ≈90% of ovarian cancers and is almost universal in High Grade Serous Epithelial Ovarian Cancer. This work demonstrates that cell bound MUC16 is an effective target for rapid immunomagnetic extraction of expressor cells with near quantitative yield, high purity and viability from serum. The results provide a mechanistic insight into the effects of nanoparticle physical properties and immunomagnetic labeling on the efficiency of immunomagnetic cell isolation. The growth of these cells has also been studied after separation, demonstrating that nanoparticle size impacts cell-particle behavior and growth rate. These results present the successful isolation of "masked" CTCs enabling new strategies for the detection of cancer recurrence and select and monitor chemotherapy.

Chlamydia muridarum infection differentially alters smooth muscle function in mouse uterine horn and cervix.

Chlamydia trachomatis infection is a primary cause of reproductive tract diseases including infertility. Previous studies showed that this infection alters physiological activities in mouse oviducts. Whether this occurs in the uterus and cervix has never been investigated. This study characterized the physiological activities of the uterine horn and the cervix in a Chlamydia muridarum (Cmu)-infected mouse model at three infection time points of 7, 14, and 21 days postinfection (dpi). Cmu infection significantly decreased contractile force of spontaneous contraction in the cervix (7 and 14 dpi; P < 0.001 and P < 0.05, respectively), but this effect was not observed in the uterine horn. The responses of the uterine horn and cervix to oxytocin were significantly altered by Cmu infection at 7 dpi (P < 0.0001), but such responses were attenuated at 14 and 21 dpi. Cmu infection increased contractile force to prostaglandin (PGF2α) by 53-83% in the uterine horn. This corresponded with the increased messenger ribonucleic acid (mRNA) expression of Ptgfr that encodes for its receptor. However, Cmu infection did not affect contractions of the uterine horn and cervix to PGE2 and histamine. The mRNA expression of Otr and Ptger4 was inversely correlated with the mRNA expression of Il1b, Il6 in the uterine horn of Cmu-inoculated mice (P < 0.01 to P < 0.001), suggesting that the changes in the Otr and Ptger4 mRNA expression might be linked to the changes in inflammatory cytokines. Lastly, this study also showed a novel physiological finding of the differential response to PGE2 in mouse uterine horn and cervix.

Endoplasmic reticulum-mediated unfolded protein response is an integral part of singlet oxygen signalling in plants.

Singlet oxygen (1 O2 ) is a by-product of photosynthesis that triggers a signalling pathway leading to stress acclimation or to cell death. By analyzing gene expressions in a 1 O2 -overproducing Arabidopsis mutant (ch1) under different light regimes, we show here that the 1 O2 signalling pathway involves the endoplasmic reticulum (ER)-mediated unfolded protein response (UPR). ch1 plants in low light exhibited a moderate activation of UPR genes, in particular bZIP60, and low concentrations of the UPR-inducer tunicamycin enhanced tolerance to photooxidative stress, together suggesting a role for UPR in plant acclimation to low 1 O2 levels. Exposure of ch1 to high light stress ultimately leading to cell death resulted in a marked upregulation of the two UPR branches (bZIP60/IRE1 and bZIP28/bZIP17). Accordingly, mutational suppression of bZIP60 and bZIP28 increased plant phototolerance, and a strong UPR activation by high tunicamycin concentrations promoted high light-induced cell death. Conversely, light acclimation of ch1 to 1 O2 stress put a limitation in the high light-induced expression of UPR genes, except for the gene encoding the BIP3 chaperone, which was selectively upregulated. BIP3 deletion enhanced Arabidopsis photosensitivity while plants treated with a chemical chaperone exhibited enhanced phototolerance. In conclusion, 1 O2 induces the ER-mediated UPR response that fulfils a dual role in high light stress: a moderate UPR, with selective induction of BIP3, is part of the acclimatory response to 1 O2 , and a strong activation of the whole UPR is associated with cell death.

OXI1 and DAD Regulate Light-Induced Cell Death Antagonistically through Jasmonate and Salicylate Levels.

Singlet oxygen produced from triplet excited chlorophylls in photosynthesis is a signal molecule that can induce programmed cell death (PCD) through the action of the OXIDATIVE STRESS INDUCIBLE 1 (OXI1) kinase. Here, we identify two negative regulators of light-induced PCD that modulate OXI1 expression: DAD1 and DAD2, homologs of the human antiapoptotic protein DEFENDER AGAINST CELL DEATH. Overexpressing OXI1 in Arabidopsis (Arabidopsis thaliana) increased plant sensitivity to high light and induced early senescence of mature leaves. Both phenomena rely on a marked accumulation of jasmonate and salicylate. DAD1 or DAD2 overexpression decreased OXI1 expression, jasmonate levels, and sensitivity to photooxidative stress. Knock-out mutants of DAD1 or DAD2 exhibited the opposite responses. Exogenous applications of jasmonate upregulated salicylate biosynthesis genes and caused leaf damage in wild-type plants but not in the salicylate biosynthesis mutant Salicylic acid induction-deficient2, indicating that salicylate plays a crucial role in PCD downstream of jasmonate. Treating plants with salicylate upregulated the DAD genes and downregulated OXI1 We conclude that OXI1 and DAD are antagonistic regulators of cell death through modulating jasmonate and salicylate levels. High light-induced PCD thus results from a tight control of the relative activities of these regulating proteins, with DAD exerting a negative feedback control on OXI1 expression.

The plastoquinone pool outside the thylakoid membrane serves in plant photoprotection as a reservoir of singlet oxygen scavengers.

The Arabidopsis vte1 mutant is devoid of tocopherol and plastochromanol (PC-8). When exposed to excess light energy, vte1 produced more singlet oxygen (1 O2 ) and suffered from extensive oxidative damage compared with the wild type. Here, we show that overexpressing the solanesyl diphosphate synthase 1 (SPS1) gene in vte1 induced a marked accumulation of total plastoquinone (PQ-9) and rendered the vte1 SPS1oex plants tolerant to photooxidative stress, indicating that PQ-9 can replace tocopherol and PC-8 in photoprotection. High total PQ-9 levels were associated with a noticeable decrease in 1 O2 production and higher levels of Hydroxyplastoquinone (PQ-C), a 1 O2 -specific PQ-9 oxidation product. The extra PQ-9 molecules in the vte1 SPS1oex plants were stored in the plastoglobules and the chloroplast envelopes, rather than in the thylakoid membranes, whereas PQ-C was found almost exclusively in the thylakoid membranes. Upon exposure of wild-type plants to high light, the thylakoid PQ-9 pool decreased, whereas the extrathylakoid pool remained unchanged. In vte1 and vte1 SPS1oex plants, the PQ-9 losses in high light were strongly amplified, affecting also the extrathylakoid pool, and PQ-C was found in high amounts in the thylakoids. We conclude that the thylakoid PQ-9 pool acts as a 1 O2 scavenger and is replenished from the extrathylakoid stock.

METHYLENE BLUE SENSITIVITY 1 (MBS1) is required for acclimation of Arabidopsis to singlet oxygen and acts downstream of ß-cyclocitral.

Singlet oxygen (1 O2 ) signalling in plants is essential to trigger both acclimatory mechanisms and programmed cell death under high light stress. However, because of its chemical features, 1 O2 requires mediators, and the players involved in this pathway are largely unknown. The ß-carotene oxidation product, ß-cyclocitral, is one such mediator. Produced in the chloroplast, ß-cyclocitral induces changes in nuclear gene expression leading to photoacclimation. Recently, the METHYLENE BLUE SENSITIVITY protein MBS has been identified as a key player in 1 O2 signalling leading to tolerance to high light. Here, we provide evidence that MBS1 is essential for acclimation to 1 O2 and cross-talks with ß-cyclocitral to mediate transfer of the 1 O2 signal to the nucleus, leading to photoacclimation. The presented results position MBS1 downstream of ß-cyclocitral in 1 O2 signalling and suggest an additional role for MBS1 in the regulation of plant growth and development under chronic 1 O2 production.

Singlet Oxygen-Induced Cell Death in Arabidopsis under High-Light Stress Is Controlled by OXI1 Kinase.

Studies of the singlet oxygen ((1)O2)-overproducing flu and chlorina1 (ch1) mutants of Arabidopsis (Arabidopsis thaliana) have shown that (1)O2-induced changes in gene expression can lead to either programmed cell death (PCD) or acclimation. A transcriptomic analysis of the ch1 mutant has allowed the identification of genes whose expression is specifically affected by each phenomenon. One such gene is OXIDATIVE SIGNAL INDUCIBLE1 (OXI1) encoding an AGC kinase that was noticeably induced by excess light energy and (1)O2 stress conditions leading to cell death. Photo-induced oxidative damage and cell death were drastically reduced in the OXI1 null mutant (oxi1) and in the double mutant ch1*oxi1 compared with the wild type and the ch1 single mutant, respectively. This occurred without any changes in the production rate of (1)O2 but was cancelled by exogenous applications of the phytohormone jasmonate. OXI1-mediated (1)O2 signaling appeared to operate through a different pathway from the previously characterized OXI1-dependent response to pathogens and H2O2 and was found to be independent of the EXECUTER proteins. In high-light-stressed plants, the oxi1 mutation was associated with reduced jasmonate levels and with the up-regulation of genes encoding negative regulators of jasmonate signaling and PCD. Our results show that OXI1 is a new regulator of (1)O2-induced PCD, likely acting upstream of jasmonate.

Plant tolerance to excess light energy and photooxidative damage relies on plastoquinone biosynthesis.

Plastoquinone-9 is known as a photosynthetic electron carrier to which has also been attributed a role in the regulation of gene expression and enzyme activities via its redox state. Here, we show that it acts also as an antioxidant in plant leaves, playing a central photoprotective role. When Arabidopsis plants were suddenly exposed to excess light energy, a rapid consumption of plastoquinone-9 occurred, followed by a progressive increase in concentration during the acclimation phase. By overexpressing the plastoquinone-9 biosynthesis gene SPS1 (solanesyl diphosphate synthase 1) in Arabidopsis, we succeeded in generating plants that specifically accumulate plastoquinone-9 and its derivative plastochromanol-8. The SPS1-overexpressing lines were much more resistant to photooxidative stress than the wild type, showing marked decreases in leaf bleaching, lipid peroxidation and PSII photoinhibition under excess light. Comparison of the SPS1 overexpressors with other prenyl quinone mutants indicated that the enhanced phototolerance of the former plants is directly related to their increased capacities for plastoquinone-9 biosynthesis.

Modulation of Zn/Cd P(1B2)-ATPase activities in Arabidopsis impacts differently on Zn and Cd contents in shoots and seeds.

Zn is an essential microelement for all living cells and Zn deficiency is widespread in world's population. At the same time, high Zn concentration and low Cd concentration are toxic to the environment. Both Zn and Cd are transported in planta via Zn/Cd HMA transporters. Engineering of HMAs expression in plants may provide a way for Zn biofortification of food as well as phytoremediation of polluted soils. In the present study we have assessed the impact of Zn/Cd HMAs invalidation/overexpression in Arabidopsis thaliana on Zn and Cd translocation from the roots to the shoots and in Zn grain filling. Overexpression of AtHMA4 had a large impact on Zn and Cd translocation and resulted in a 3-fold higher potential of Cd and Zn extraction from an industrial soil highly contaminated by Zn, Pb and Cd. Despite AtHMA4 overexpressing lines presenting a higher Zn concentration in the shoot, the Zn content in the seeds was found to be lower than in wild type plants. Our results indicate that AtHMA4 overexpression is an efficient tool to increase the root to shoot translocation of Zn and Cd in plants. Concerning biofortification of seeds, this study underlines the need for specific promoters to drive an expression pattern of the transporters in favour of Zn grain filling.

Arabidopsis lipocalins AtCHL and AtTIL have distinct but overlapping functions essential for lipid protection and seed longevity.

Lipocalins are a group of multifunctional proteins, recognized as carriers of small lipophilic molecules, which have been characterized in bacteria and animals. Two true lipocalins have been recently identified in plants, the temperature-induced lipocalin (TIL) and the chloroplastic lipocalin (CHL), the expression of which is induced by various abiotic stresses. Each lipocalin appeared to be specialized in the responses to specific stress conditions in Arabidopsis thaliana, with AtTIL and AtCHL playing a protective role against heat and high light, respectively. The double mutant AtCHL KO × AtTIL KO deficient in both lipocalins was more sensitive to temperature, drought and light stresses than the single mutants, exhibiting intense lipid peroxidation. AtCHL deficiency dramatically enhanced the photosensitivity of mutants (vte1, npq1) affected in lipid protection mechanisms (tocopherols, zeaxanthin), confirming the role of lipocalins in the prevention of lipid peroxidation. Seeds of the AtCHL KO × AtTIL KO double mutant were very sensitive to natural and artificial ageing, and again this phenomenon was associated with the oxidation of polyunsaturated lipids. The presented results show that the Arabidopsis lipocalins AtTIL and AtCHL have overlapping functions in lipid protection which are essential for stress resistance and survival.

An abscisic acid-independent oxylipin pathway controls stomatal closure and immune defense in Arabidopsis.

Plant stomata function in innate immunity against bacterial invasion and abscisic acid (ABA) has been suggested to regulate this process. Using genetic, biochemical, and pharmacological approaches, we demonstrate that (i) the Arabidopsis thaliana nine-specific-lipoxygenase encoding gene, LOX1, which is expressed in guard cells, is required to trigger stomatal closure in response to both bacteria and the pathogen-associated molecular pattern flagellin peptide flg22; (ii) LOX1 participates in stomatal defense; (iii) polyunsaturated fatty acids, the LOX substrates, trigger stomatal closure; (iv) the LOX products, fatty acid hydroperoxides, or reactive electrophile oxylipins induce stomatal closure; and (v) the flg22-mediated stomatal closure is conveyed by both LOX1 and the mitogen-activated protein kinases MPK3 and MPK6 and involves salicylic acid whereas the ABA-induced process depends on the protein kinases OST1, MPK9, or MPK12. Finally, we show that the oxylipin and the ABA pathways converge at the level of the anion channel SLAC1 to regulate stomatal closure. Collectively, our results demonstrate that early biotic signaling in guard cells is an ABA-independent process revealing a novel function of LOX1-dependent stomatal pathway in plant immunity.

Working conditions and psychosocial risk factors of employees in French electricity and gas company customer support departments.

OBJECTIVE: Little is known about the real impact of working conditions on the health of call center employees. The aim of this article is to describe the working conditions of French electricity and gas company customer service teams, especially those spending more than 75% of their working time handling calls in order to determine their subjective experience of their work and identify situations at risk of psychosocial constraints. METHODS: A cross-sectional study using a self-completion questionnaire was conducted on a representative sample of 2,000 employees working in customer service centers. The questions focused on the variety of tasks performed, the organization of working time, the physical environment of the workstation, violent situations and psychosocial factors (Job Content Questionnaire). Multivariate statistical analyses were performed to identify factors associated with the wish to leave the sector and with a high level of psychosocial constraints. RESULTS: Women made up 66% of the sample. Despite a high educational level, the average socio-professional level of the employees was relatively low. Although the vast majority of employees had chosen this career (74%), just over half would like to leave. The main factors associated with iso-strain were inadequate breaks (odds ratio (OR) = 2.0), low perceived quality of work (OR = 2.4), high proportion of working time spent handling calls (≥75% of working time: OR = 5.9, between 50 and <75%: OR = 5.2), exposure to violence either internally (often or very often: OR = 3.1) or from customers (often or very often: OR = 1.8) and an unsatisfactory workplace (OR = 2.0). CONCLUSIONS: Employees who spend more than 75% of their working time on the phone cumulate every factor linked with a high level of constraints, but all employees of the EDF and Gaz de France customer service centers are concerned. These workers share many characteristics with other call centers: predominantly female workforce; high educational level; wish to leave this sector despite the initial choice; high level of psychosocial risk factors.

Surveillance of fatal occupational injuries in France: 2002-2004.

BACKGROUND: Insufficient use is made of available information about workplace and commuting accidents covered by social insurance workers compensation funds in France. We sought to determine whether these data could be used to calculate national indicators for surveillance of fatal occupational injuries for 2002-2004. METHODS: We calculated the number of deaths, mortality rate, and years of potential life lost from workplace and commuting accidents (by sex, age, economic activity, and cause of accident) for employees by collecting data from eight social insurance funds in France. The number of deaths, the mortality rates, and the attributable fraction of accidental deaths due to work were estimated for both employees and self-employed workers. RESULTS: The mean annual number of employee deaths from workplace and commuting accidents reached 1,330 in 2002-2004. The mortality rate from workplace accidents (6.0 per 100,000) increased with age among men and was especially high in three sectors: agriculture-forestry-fishing, transportation, and construction.Overall, for employees and the self-employed combined, the mean annual number of deaths from workplace and commuting accidents was estimated at 1,557 (95% CI: 1,478-1,640). The attributable fraction of accidental deaths due to work for those aged 15-59 years was estimated at almost 20% among men. CONCLUSIONS: Despite data limitations, it was possible to calculate previously unknown national indicators of fatal workplace and commuting accidents and to compare them with other work-related health problems. These results are consistent with those observed in comparable industrialized countries.

Health professionals' attitudes and use of nipple shields for breastfeeding women.

OBJECTIVE: No professional guidelines exist regarding nipple shield use for nursing women. This study was done to determine health professionals' most common reasons for and concerns regarding the use of nipple shields for breastfeeding women. METHODS: In June and July 2009, a web-based anonymous survey was advertised via internet listservs to physicians and other allied health professionals specializing in breastfeeding management. Subjects were asked about their most common reasons for using nipple shields, their most common concerns about nipple shield use, and what they typically hear from breastfeeding women who have used nipple shields. RESULTS: Four hundred ninety participants completed the survey, with 92% having used nipple shields in their practices. Ninety-five percent of respondents who were board-certified lactation consultants used shields versus 80% of those not board-certified, although those using nipple shields used them in the same manner. The most common reason to use nipple shields among all respondents was to help the <35-week infant latch and nurse. Thirty-eight percent of respondents used nipple shields in infants >35 weeks of gestation and <3 days of age. Respondents rated "lack of follow-up by those introducing the nipple shield" as their greatest concern about nipple shields. The maternal response most frequently expressed about nipple shields was that "they are helpful." CONCLUSIONS: Nipple shield recommendation is very common among health professionals who work with nursing women, although many concerns regarding their safety exist. Guidelines should be developed to ensure that nipple shields are used in an evidence-based and safe manner.

Role of the iron mobilization and oxidative stress regulons in the genomic response of yeast to hydroxyurea.

Hydroxyurea (HU) is a specific inhibitor of ribonucleotide reductase and thus impairs dNTP synthesis and DNA replication. The long-term transcriptional response of yeast cells to hydroxyurea was investigated using DNA microarrays containing all yeast coding sequences. We show that the redox-responsive Yap regulon and the iron-mobilization Aft regulon are activated in yeast cells treated with HU. Yap1 accumulates in the nucleus in response to HU, but HU activation of the Yap regulon was only partially dependent on Yap1 and yap1Delta mutants were not hypersensitive to HU. In contrast, deletion of the AFT1 and AFT2 transcription factor genes blocked the HU activation of a subset of the Aft regulon and the aft1Delta aft2Delta double mutant was hypersensitive to HU in an iron-suppressible manner. These results highlight the importance of the redox and iron mobilization regulons in the cellular response to HU.

The protein kinase Snf1 is required for tolerance to the ribonucleotide reductase inhibitor hydroxyurea.

The Snf1/AMP-activated kinases are involved in a wide range of stress responses in eukaryotic cells. We discovered a novel role for the Snf1 kinase in the cellular response to genotoxic stress in yeast. snf1 mutants are hypersensitive to hydroxyurea (HU), methyl-methane sulfonate, and cadmium, but they are not sensitive to several other genotoxic agents. HU inhibits ribonucleotide reductase (RNR), and deletion of SNF1 also increased the growth defects of an rnr4 ribonucleotide reductase mutant. The snf1 mutant has a functional checkpoint response to HU insofar as cells arrest division normally and derepress the transcription of RNR genes. The sensitivity of snf1 to HU or to RNR4 deletion may be due to posttranscriptional defects in RNR function or to defects in the repair of, and recovery from, stalled replication forks. The Mig3 repressor was identified as one target of Snf1 in this pathway. Genetic and biochemical analyses suggest that a weak kinase activity is sufficient to confer resistance to HU, whereas a high level of kinase activity is required for optimal growth on carbon sources other than glucose. Quantitative regulation of Snf1 kinase activity may contribute to the specificity of the effector responses that it controls.

Yaf9, a novel NuA4 histone acetyltransferase subunit, is required for the cellular response to spindle stress in yeast.

Yaf9 is one of three proteins in budding yeast containing a YEATS domain. We show that Yaf9 is part of a large complex and that it coprecipitates with three known subunits of the NuA4 histone acetyltransferase. Although Esa1, the catalytic subunit of NuA4, is essential for viability, we found that yaf9 Delta mutants are viable but hypersensitive to microtubule depolymerizing agents and synthetically lethal with two different mutants of the mitotic apparatus. Microtubules depolymerized more readily in the yaf9Delta mutant compared to the wild type in the presence of nocodazole, and recovery of microtubule polymerization and cell division from limiting concentrations of nocodazole was inhibited. Two other NuA4 mutants (esa1-1851 and yng2 Delta) and nonacetylatable histone H4 mutants were also sensitive to benomyl. Furthermore, wild-type budding yeast were more resistant to benomyl when grown in the presence of trichostatin A, a histone deacetylase inhibitor. These results strongly suggest that acetylation of histone H4 by NuA4 is required for the cellular resistance to spindle stress.

Leukemia in relation to occupational exposures to benzene and other agents: a case-control study nested in a cohort of gas and electric utility workers.

BACKGROUND: Many occupational and environmental exposures have been implicated in the etiology of leukemia, but only a few, such as benzene, are well-established leukemogens. The risk of leukemia in a large cohort of gas and electricity utility workers with exposures to several suspected or confirmed carcinogens was investigated. METHODS: A case-control study nested within the cohort was conducted, with 72 leukemia cases identified among male workers, and 285 controls matched to the cases by year of birth. Only cases, and their matched controls, active in the company at the date of diagnosis were included. Exposure assessment was based on a job-exposure matrix (JEM) developed from expert judgment using a standardized procedure. RESULTS: The risk of leukemia was increased in workers with an estimated cumulative exposure to benzene > or = 16.8 ppm-years (OR = 3.6; 95% CI 1.1-11.7), and there was an indication of a dose-response relation (OR = 1.2; 95% CI 1.0-1.5 per 10 ppm-years increase in exposure). The link with benzene was more pronounced for acute leukemia than for chronic leukemia, but no association with a particular leukemia cell type was apparent. The risk of leukemia remained elevated for latency periods of 2, 5, or 10 years. CONCLUSIONS: From our evaluation, it could be estimated that the median TWA exposure to benzene among exposed workers was 0.16 ppm, i.e., within concentration ranges where an increased leukemia risk was usually not apparent in previous epidemiological studies. Although an increased leukemia risk may be real, it may also be related to other occupational factors not totally controlled for in the analysis, or to benzene exposures actually higher than expected.