Comparative health effects in mice of Libby amphibole asbestos and a fibrous amphibole from Arizona.

This project developed from studies demonstrating that Libby Amphibole Asbestos (LAA) causes a non-typical set of health outcomes not generally reported for asbestos, including systemic autoimmunity and an unusual and devastating lamellar pleural thickening that progresses to severe pulmonary dysfunction and death. Further, mineral fiber mixtures with some similarities to LAA have recently been discovered in southern Nevada and northwestern Arizona, where the material exists in extensive recreational areas and is present in yards, roads, parking lots and school yards. The objective was to compare the health outcomes in mice exposed to either LAA or the fibrous amphiboles collected in Arizona at the Lake Mead National Recreational Area at very low doses to represent environmental exposures. In this study, the fibrous amphibole asbestos sample from Arizona (AzA) is composed of winchite (69%), actinolite (22%), and non-amphibole minerals (9%) and has a mean aspect ratio of 16.7±0.9. Fibrous amphibole asbestos from Libby (LAA) is composed of winchite (70%), richterite (9%), tremolite (5%), and non-amphibole minerals (16%) with a mean aspect ratio of 8.4±0.7. C57BL/6 mice were exposed by oropharyngeal aspiration to fiber suspensions at a very low dose of 3µg/mouse. After seven months, both LAA- and AzA-exposed mice had indices of chronic immune dysfunction related to a TH17 cytokine profile, with B cell activation, autoantibody production and proteinuria, suggesting kidney involvement. In addition, both exposures led to significant lung and pleural fibrosis. These data suggest that there is risk of pulmonary disease and autoimmune outcomes with environmental exposure to amphibole asbestos, and that this is not limited to Libby, Montana.

Immunotoxicological and neurotoxicological profile of health effects following subacute exposure to geogenic dust from sand dunes at the Nellis Dunes Recreation Area, Las Vegas, NV.

Exposure to geogenic particulate matter (PM) comprised of mineral particles has been linked to human health effects. However, very little data exist on health effects associated with geogenic dust exposure in natural settings. Therefore, we characterized particulate matter size, metal chemistry, and health effects of dust collected from the Nellis Dunes Recreation Area (NDRA), a popular off-road vehicle area located near Las Vegas, NV. Adult female B6C3F1 mice were exposed to several concentrations of mineral dust collected from active and vegetated sand dunes in NDRA. Dust samples (median diameter: 4.4 µm) were suspended in phosphate-buffered saline and delivered at concentrations ranging from 0.01 to 100 mg dust/kg body weight by oropharyngeal aspiration. ICP-MS analyses of total dissolution of the dust resulted in aluminum (55,090 µg/g), vanadium (70 µg/g), chromium (33 µg/g), manganese (511 µg/g), iron (21,600 µg/g), cobalt (9.4 µg/g), copper (69 µg/g), zinc (79 µg/g), arsenic (62 µg/g), strontium (620 µg/g), cesium (13 µg/g), lead 25 µg/g) and uranium (4.7 µg/g). Arsenic was present only as As(V). Mice received four exposures, once/week over 28-days to mimic a month of weekend exposures. Descriptive and functional assays to assess immunotoxicity and neurotoxicity were performed 24 h after the final exposure. The primary observation was that 0.1 to 100 mg/kg of this sand dune derived dust dose-responsively reduced antigen-specific IgM antibody responses, suggesting that dust from this area of NDRA may present a potential health risk.

Health effects following subacute exposure to geogenic dusts from arsenic-rich sediment at the Nellis Dunes Recreation Area, Las Vegas, NV.

Geogenic dust from arid environments is a possible inhalation hazard for humans, especially when using off-road vehicles that generate significant dust. This study focused on immunotoxicological and neurotoxicological effects following subacute exposure to geogenic dust generated from sediments in the Nellis Dunes Recreation Area near Las Vegas, Nevada that are particularly high in arsenic; the naturally-occurring arsenic concentrations in these surficial sediments ranged from 4.8 to 346µg/g. Dust samples from sediments used in this study had a median diameter of 4.5µm and also were a complex mixture of naturally-occurring metals, including aluminum, vanadium, chromium, manganese, iron, cobalt, copper, zinc, strontium, cesium, lead, uranium, and arsenic. Adult female B6C3F1 mice exposed via oropharyngeal aspiration to 0.01 to 100mg dust/kg body weight, four times, a week apart, for 28days, were evaluated 24h after the last exposure. Peripheral eosinophils were increased at all concentrations, serum creatinine was dose responsively increased beginning at 1.0mg/kg/day, and blood urea nitrogen was decreased at 10 and 100mg/kg/day. Antigen-specific IgM responses and natural killer cell activity were dose-responsively suppressed at 0.1mg/kg/day and above. Splenic CD4+CD25+ T cells were decreased at 0.01, 0.1, 10, and 100mg/kg/day. Antibodies against MBP, NF-68, and GFAP were selectively reduced. A no observed adverse effect level of 0.01mg/kg/day and a lowest observed adverse effect level of 0.1mg/kg/day were determined from IgM responses and natural killer cell activity, indicating that exposure to this dust, under conditions similar to our design, could affect these responses.

Investigating palygorskite's role in the development of mesothelioma in southern Nevada: Insights into fiber-induced carcinogenicity.

Similar to asbestos fibers, nonregulated mineral fibers can cause malignant mesothelioma (MM). Recently, increased proportions of women and young individuals with MM were identified in southern Nevada, suggesting that environmental exposure to carcinogenic fibers was causing the development of MM. Palygorskite, a fibrous silicate mineral with a history of possible carcinogenicity, is abundant in southern Nevada. In this study, our aim was to determine whether palygorskite was contributing to the development of MM in southern Nevada. While palygorskite, in vitro, displayed some cytotoxicity toward primary human mesothelial (HM) cells and reduced their viability, the effects were roughly half of those observed when using similar amounts of crocidolite asbestos. No Balb/c (0/19) or MexTAg (0/18) mice injected with palygorskite developed MM, while 3/16 Balb/c and 13/14 MexTAg mice injected with crocidolite did. Lack of MM development was associated with a decreased acute inflammatory response, as injection of palygorskite resulted in lower percentages of macrophages (p = .006) and neutrophils (p = .02) in the peritoneal cavity 3 d after exposure compared to injection of crocidolite. Additionally, compared to mice injected with crocidolite, palygorskite-injected mice had lower percentages of M2 (tumor-promoting) macrophages (p = .008) in their peritoneal cavities when exposed to fiber for several weeks. Our study indicates that palygorskite found in the environment in southern Nevada does not cause MM in mice, seemingly because palygorskite, in vivo, fails to elicit inflammation that is associated with MM development. Therefore, palygorskite is not a likely contributor to the MM cases observed in southern Nevada.

Scale and the isotopic record of C4 plants in pedogenic carbonate: from the biome to the rhizosphere.

The 13C/12C ratio in pedogenic carbonate (i.e., CaCO3 formed in soil) is a significant tool for investigating C4 biomes of the past. However, the paleoecological meaning of delta13C values in pedogenic carbonate can change with the scale at which one considers the data. We describe studies of modern soils, fossil soils, and vegetation change in the Chihuahuan Desert of North America and elsewhere that reveal four scales important for paleoecologic interpretations. (1) At the broadest scale, the biome scale (hundreds to millions of km2), an isotopic record interpreted as C3 vegetation replacing C4 grasslands may indicate invading C3 woody shrubs instead of expanding C3 forests (a common interpretation). (2) At the landscape scale (several tens of m2 to hundreds of km2), the accuracy of scaling up paleoclimatic interpretations to a regional level is affected by the landform containing the isotopic record. (3) At the soil-profile scale (cm2 to m2), soil profiles with multiple generations of carbonate mixed together have a lower-resolution paleoecologic record than soil profiles repeatedly buried. (4) At the rhizosphere scale (microm2 to cm2), carbonate formed on roots lack the 14-17 per thousand enrichment observed at broader scales, revealing different fractionation processes at different scales. A multi-scale approach in dealing with delta13C in pedogenic carbonate will increase the accuracy of paleoecologic interpretations and understanding of soil-geomorphic-climatic interactions that affect boundaries between C4 and C3 vegetation.

Dust dynamics in off-road vehicle trails: Measurements on 16 arid soil types, Nevada, USA.

Soil analyses and measurements with the Portable In Situ Wind Erosion Laboratory (PI-SWERL) were conducted on 16 soil types in an area heavily affected by off-road vehicle (ORV) driving. Measurements were performed in ORV trails as well as on undisturbed terrain to investigate how ORV driving affects the vulnerability of a soil to emit PM10 (particles<10microm), during the driving as well as during episodes of wind erosion. Particular attention is paid to how the creation of a new trail affects those properties of the topsoil that determine its capability to emit PM10. Also, recommendations are given for adequate management of ORV-designed areas. The type of surface (sand, silt, gravel, drainage) is a key factor with respect to dust emission in an ORV trail. Trails in sand, defined in this study as the grain size fraction 63-2000microm, show higher deflation thresholds (the critical wind condition at which wind erosion starts) than the surrounding undisturbed soil. Trails in silt (2-63microm) and in drainages, on the other hand, have lower deflation thresholds than undisturbed soil. The increase in PM10 emission resulting from the creation of a new ORV trail is much higher for surfaces with silt than for surfaces with sand. Also, the creation of a new trail in silt decreases the supply limitation in the top layer: the capacity of the reservoir of emission-available PM10 increases. For sand the situation is reversed: the supply limitation increases, and the capacity of the PM10 reservoir decreases. Finally, ORV trails are characterized by a progressive coarsening of the top layer with time, but the speed of coarsening is much lower in trails in silt than in trails in sand or in drainages. The results of this study suggest that, to minimize emissions of PM10, new ORV fields should preferably be designed on sandy terrain rather than in silt areas or in drainages.

Nevada desert dust with heavy metals suppresses IgM antibody production.

Systemic health effects from exposure to a complex natural dust containing heavy metals from the Nellis Dunes Recreation Area (NDRA) near Las Vegas, NV, were evaluated. Several toxicological parameters were examined following lung exposure to emissive dust from three geologic sediment types heavily used for recreational off-road activities: yellow sand very rich in arsenic (termed CBN 5); a shallow cover of loose dune sand overlying a gravelly subsoil bordering dune fields (termed CBN 6); and brown claystone and siltstone (termed CBN 7). Adult female B6C3F1 mice were exposed by oropharyngeal administration to these three types of geogenic dusts at 0.01-100 mg of dust/kg of body weight, once per week for four weeks. The median grain sizes were 4.6, 3.1, and 4.4 µm, for CBN 5, 6, and 7, respectively. Each type of dust contained quantifiable amounts of aluminum, vanadium, chromium, manganese, iron, cobalt, copper, zinc, arsenic, strontium, cesium, lead, uranium, and others. Descriptive markers of immunotoxicity, neurotoxicity, hematology, and clinical chemistry parameters were assessed. Notable among all three CBN units was a systemic, dose-responsive decrease in antigen-specific IgM antibody responses. Geogenic dust from CBN 5 produced more than a 70% suppression in IgM responses, establishing a lowest adverse effect level (LOAEL) of 0.01 mg/kg. A suppression in IgM responses and a corresponding increase in serum creatinine determined a LOAEL of 0.01 mg/kg for CBN 6. The LOAEL for CBN 7 was 0.1 mg/kg and also was identified from suppression in IgM responses. These results are of concern given the frequent off-road vehicle traffic and high visitor rates at the NDRA, estimated at 300,000 each year.

Exposure to naturally occurring mineral fibers due to off-road vehicle use: A review.

BACKGROUND: The use of off-road vehicles (ORVs) is a popular source of outdoor recreation in the United States. While personal injury has been the focus of most epidemiologic investigations regarding ORV use to date, other health effects associated with ORV use have not been adequately examined. ORVs have been designed to operate in rugged, unpaved terrain, and ORVs can produce copious amounts of fugitive dust. ORV use in geographic regions with naturally occurring asbestos (NOA) and erionite (NOE) may result in the liberation of these minerals from underlying rocks and soil, which may put ORV participants at risk to potentially hazardous inhalation exposures. METHODS: A comprehensive narrative review of existing literature and reports relevant to off-road recreation and mineral fiber exposure was conducted. Manuscripts and reports included in the review were limited to those that contained quantitative data regarding concentrations of mineral fibers recorded during vehicular traffic on an unpaved road and publication in a peer-reviewed journal, official report composed by a government agency, or a report generated under the endorsement of a government agency. In addition, the potential public health impact of ORV use in regions with NOA/NOE was estimated by calculating the proximity of known mineral fiber occurrences to areas of ORV use. RESULTS: A total of 15 publications met inclusion criteria. Exposures to NOA/NOE observed from personal sampling in the included studies ranged from less than 0.01-5.6 f/cc. ORV position while riding in a group and vehicle speed were frequent determinants of measured concentrations. Multiple studies also suggest that children may experience higher exposures to mineral fibers in comparison to adult ORV riders. Information on ORV trails and 665 known occurrences of NOA/NOE was available for five states located in the western United States. Of these 665 known occurrences, approximately 80% (n=515) were located within 20 miles of an ORV trail, and nearly a third were located within one mile. CONCLUSIONS: Individuals who operate ORVs in regions where NOA/NOE is a component of the underlying soil or unpaved road may experience elevated exposures to mineral fibers. Given the prevalence of ORV trails in close proximity to these natural fiber occurrences, epidemiologic and surveillance studies of individuals who frequently engage in ORV use are recommended. Public health initiatives should concentrate on increasing awareness of these risks, allowing ORV users to make informed choices and take appropriate measures to limit these risks where possible.

Health effects following subacute exposure to geogenic dust collected from active drainage surfaces (Nellis Dunes Recreation Area, Las Vegas, NV).

The specific health effects of direct inhalation of fine minerogenic dusts generated by natural soil surfaces remain poorly known and relatively little researched. To learn more about this exposure and its contribution to human health effects, we surveyed surface sediment and characterized dust from the Nellis Dunes Recreation Area (NDRA) in Clark County, Nevada, a popular off-road vehicle (ORV) recreational site. Dry drainage systems at NDRA are commonly used as natural trail systems for ORV recreation; these surfaces also are characterized by high concentrations of heavy metals. Geogenic dust with a median diameter of 4.05 µm, collected from drainage surfaces at NDRA contained a total elemental concentration of aluminum (79,651 µg/g), vanadium (100 µg/g), chromium (54 µg/g), manganese (753 µg/g), iron (33,266 µg/g), cobalt (14 µg/g), copper (37 µg/g) zinc (135 µg/g), arsenic (71 µg/g), strontium (666 µg/g), cesium (15 µg/g), lead (34 µg/g), and uranium (54.9 µg/g). Adult female B6C3F1 mice exposed via oropharyngeal aspiration to 0.01-100 mg dust/kg body weight, four times, a week apart, for 28-days, were evaluated for immuno- and neurotoxicological outcomes 24 h after the last exposure. Antigen-specific IgM responses were dose-responsively suppressed at 0.1, 1.0, 10 and 100 mg/kg. Splenic lymphocytic subpopulations, hematological and clinical chemistry parameters were affected. In brain tissue, antibodies against NF-68, and GFAP were not affected, whereas IgM antibodies against MBP were reduced by 26.6% only in the highest dose group. A lowest observed adverse effect level (LOAEL) of 0.1 mg/kg/day and a no observed adverse effect level (NOAEL) of 0.01 mg/kg/day were derived based on the antigen primary IgM responses after subacute exposure to this geogenic dust.

Health effects from exposure to atmospheric mineral dust near Las Vegas, NV, USA.

Desert areas are usually characterized by a continuous deposition of fine airborne particles. Over time, this process results in the accumulation of silt and clay on desert surfaces. We evaluated health effects associated with regional atmospheric dust, or geogenic dust, deposited on surfaces in the Nellis Dunes Recreation Area (NDRA) in Clark County, Nevada, a popular off-road vehicle (ORV) recreational site frequented daily by riders, families, and day campers. Because of atmospheric mixing and the mostly regional origin of the accumulated particles, the re-suspended airborne dust is composed of a complex mixture of minerals and metals including aluminum, vanadium, chromium, manganese, iron, cobalt, copper, zinc, arsenic, strontium, cesium, lead, uranium, and others. Geogenic dust with a median diameter of 4.1 µm was administered via oropharyngeal aspiration to female B6C3F1 mice at doses of 0.01 to 100 mg dust/kg body weight, four times, a week apart, for 28-days. Immuno- and neurotoxicological outcomes 24 h following the last exposure were evaluated. Antigen-specific IgM responses were dose-responsively suppressed at 0.1, 1.0, 10 and 100 mg/kg/day. Splenic and thymic lymphocytic subpopulations and natural killer cell activity also were significantly reduced. Antibodies against MBP, NF-68, and GFAP were not affected, while brain CD3+ T cells were decreased in number. A lowest observed adverse effect level (LOAEL) of 0.1 mg/kg/day and a no observed adverse effect level (NOAEL) of 0.01 mg/kg/day were derived based on the antigen-specific IgM responses.

Consensus Report of the 2015 Weinman International Conference on Mesothelioma.

On November 9 and 10, 2015, the International Conference on Mesothelioma in Populations Exposed to Naturally Occurring Asbestiform Fibers was held at the University of Hawaii Cancer Center in Honolulu, Hawaii. The meeting was cosponsored by the International Association for the Study of Lung Cancer, and the agenda was designed with significant input from staff at the U.S. National Cancer Institute and National Institute of Environmental Health Sciences. A multidisciplinary group of participants presented updates reflecting a range of disciplinary perspectives, including mineralogy, geology, epidemiology, toxicology, biochemistry, molecular biology, genetics, public health, and clinical oncology. The group identified knowledge gaps that are barriers to preventing and treating malignant mesothelioma (MM) and the required next steps to address barriers. This manuscript reports the group's efforts and focus on strategies to limit risk to the population and reduce the incidence of MM. Four main topics were explored: genetic risk, environmental exposure, biomarkers, and clinical interventions. Genetics plays a critical role in MM when the disease occurs in carriers of germline BRCA1 associated protein 1 mutations. Moreover, it appears likely that, in addition to BRCA1 associated protein 1, other yet unknown genetic variants may also influence the individual risk for development of MM, especially after exposure to asbestos and related mineral fibers. MM is an almost entirely preventable malignancy as it is most often caused by exposure to commercial asbestos or mineral fibers with asbestos-like health effects, such as erionite. In the past in North America and in Europe, the most prominent source of exposure was related to occupation. Present regulations have reduced occupational exposure in these countries; however, some people continue to be exposed to previously installed asbestos in older construction and other settings. Moreover, an increasing number of people are being exposed in rural areas that contain noncommercial asbestos, erionite, and other mineral fibers in soil or rock (termed naturally occurring asbestos [NOA]) and are being developed. Public health authorities, scientists, residents, and other affected groups must work together in the areas where exposure to asbestos, including NOA, has been documented in the environment to mitigate or reduce this exposure. Although a blood biomarker validated to be effective for use in screening and identifying MM at an early stage in asbestos/NOA-exposed populations is not currently available, novel biomarkers presented at the meeting, such as high mobility group box 1 and fibulin-3, are promising. There was general agreement that current treatment for MM, which is based on surgery and standard chemotherapy, has a modest effect on the overall survival (OS), which remains dismal. Additionally, although much needed novel therapeutic approaches for MM are being developed and explored in clinical trials, there is a critical need to invest in prevention research, in which there is a great opportunity to reduce the incidence and mortality from MM.

Surface and Airborne Arsenic Concentrations in a Recreational Site near Las Vegas, Nevada, USA.

Elevated concentrations of arsenic, up to 7058 µg g(-1) in topsoil and bedrock, and more than 0.03 µg m(-3) in air on a 2-week basis, were measured in the Nellis Dunes Recreation Area (NDRA), a very popular off-road area near Las Vegas, Nevada, USA. The elevated arsenic concentrations in the topsoil and bedrock are correlated to outcrops of yellow sandstone belonging to the Muddy Creek Formation (≈ 10 to 4 Ma) and to faults crossing the area. Mineralized fluids moved to the surface through the faults and deposited the arsenic. A technique was developed to calculate airborne arsenic concentrations from the arsenic content in the topsoil. The technique was tested by comparing calculated with measured concentrations at 34 locations in the NDRA, for 3 periods of 2 weeks each. We then applied it to calculate airborne arsenic concentrations for more than 500 locations all over the NDRA. The highest airborne arsenic concentrations occur over sand dunes and other zones with a surficial layer of aeolian sand. Ironically these areas show the lowest levels of arsenic in the topsoil. However, they are highly susceptible to wind erosion and emit very large amounts of sand and dust during episodes of strong winds, thereby also emitting much arsenic. Elsewhere in the NDRA, in areas not or only very slightly affected by wind erosion, airborne arsenic levels equal the background level for airborne arsenic in the USA, approximately 0.0004 µg m(-3). The results of this study are important because the NDRA is visited by more than 300,000 people annually.

The Presence of Asbestos in the Natural Environment is Likely Related to Mesothelioma in Young Individuals and Women from Southern Nevada.

BACKGROUND: Inhalation of asbestos and other mineral fibers is known causes of malignant mesothelioma (MM) and lung cancers. In a setting of occupational exposure to asbestos, MM occurs four to eight times more frequently in men than in women, at the median age of 74 years, whereas an environmental exposure to asbestos causes the same number of MMs in men and women, at younger ages. METHODS: We studied the geology of Nevada to identify mineral fibers in the environment. We compared MM mortality in different Nevada counties, per sex and age group, for the 1999 to 2010 period. RESULTS: We identified the presence of carcinogenic minerals in Nevada, including actinolite asbestos, erionite, winchite, magnesioriebeckite, and richterite. We discovered that, compared with the United States and other Nevada counties, Clark and Nye counties, in southern Nevada, had a significantly higher proportion of MM that occurred in young individuals (<55 years) and in women. CONCLUSIONS: The elevated percentage of women and individuals younger than 55 years old, combined with a sex ratio of 1:1 in this age group and the presence of naturally occurring asbestos, suggests that environmental exposure to mineral fibers in southern Nevada may be contributing to some of these mesotheliomas. Further research to assess environmental exposures should allow the development of strategies to minimize exposure, as the development of rural areas continues in Nevada, and to prevent MM and other asbestos-related diseases.

Bariatric Surgery in the KP Northwest Region: Optimizing Outcomes by Using a Multidisciplinary Program.

Although bariatric surgery can be an appropriate treatment option for extremely obese patients, uncertainty exists as to how to optimize treatment outcomes. This article describes a coordinated multidisciplinary program designed to educate and behaviorally prepare patients for bariatric surgery and to support long-term behavioral change.Key aspects of our program include adequate preoperative obesity-related assessment, including nutritional, psychosocial, and physical assessment; emphasis on preoperative behavior change; changing the inpatient surgical treatment care path to decrease the length of hospital stay; and providing long-term management by using enhanced clinical decision support that includes Intranet-based practice resources embedded in the electronic medical record. Self-care is facilitated through group classes and support groups.A multidisciplinary bariatric program optimizes short- and long-term postoperative success and maximizes the safety and cost-effectiveness of bariatric surgery.