SlideShare ist ein Scribd-Unternehmen logo
1 von 5
Downloaden Sie, um offline zu lesen
Metals Toxicity



A Role for Associated Transition Metals in the Immunotoxicity of Inhaled
Ambient Particulate Matter
Judith T. Zelikoff, Kimberly R. Schermerhorn, Kaijie Fang, Mitchell D. Cohen, and Richard B. Schlesinger
Nelson Institute of Environmental Medicine, New York University School of Medicine, Tuxedo, New York, USA

                                                                                                         previously infected with S. pneumoniae were
                                                                                                         subsequently exposed to concentrated PM
 Epidemiologic studies demonstrate that infection, specifically pneumonia, contributes substan-
                                                                                                         with aerodynamic diameter ≤ 2.5 µm
 tially to the increased morbidity and mortality among elderly individuals following exposure to
                                                                                                         (PM2.5) (at a level at or just above the PM2.5
 ambient particulate matter (PM). This laboratory has previously demonstrated that a single
                                                                                                         National Ambient Air Quality Standard
 inhalation exposure of Streptococcus pneumoniae–infected rats to concentrated ambient PM2.5
 (particulate matter with aerodynamic diameter ≤ 2.5 µm) from New York City (NYC) air exacer-            [NAAQS]) from New York City (NYC) to
                                                                                                         determine whether acute exposure to PM
 bates the infection process and alters pulmonary and systemic immunity. Although these results
                                                                                                         induces immunologic alterations within the
 provide some basis for explaining the epidemiologic findings, the identity of specific PM con-
                                                                                                         lungs that could exacerbate an ongoing
 stituents that might have been responsible for the worsening pneumonia in exposed hosts remains
                                                                                                         S. pneumoniae infection. Results from these
 unclear. Thus, studies were performed to correlate the physicochemical attributes of ambient
                                                                                                         studies demonstrated that a single inhalation
 PM2.5 with its in vivo immunotoxicity to identify and characterize the role of constitutive transi-
                                                                                                         exposure of ambient PM2.5 worsened disease
 tion metals in exacerbating an ongoing streptococcal infection. Uninfected or previously infected
                                                                                                         outcome and compromised both local and
 rats were exposed in the laboratory to soluble divalent Fe, Mn, or Ni chloride salts. After exposure,
                                                                                                         systemic immune defense mechanisms in
 uninfected rats were sacrificed and their lungs were lavaged. Lungs from infected hosts were used
                                                                                                         exposed animals (12).
 to evaluate changes in bacterial clearance and effects of exposure on the extent/severity of infec-
                                                                                                             Studies were also performed to determine
 tion. Results demonstrated that inhalation of Fe altered innate and adaptive immunity in unin-
                                                                                                         which constituent(s) might be responsible for
 fected hosts, and both Fe and Ni reduced pulmonary bacterial clearance in previously infected rats.
                                                                                                         the observed worsening of pneumonia in
 The effects on clearance produced in infected Fe-exposed rats were similar to those seen in
                                                                                                         PM-exposed hosts. Based upon results from a
 infected rats exposed to ambient NYC PM. Taken together, these studies demonstrate that
                                                                                                         number of in vivo and in vitro investigations
 inhaled ambient PM can worsen the outcome of an ongoing pulmonary infection and that associ-
                                                                                                         demonstrating the role of particle-associated
 ated Fe may play some role in the immunotoxicity. Key words: air pollution, immunotoxicity,
                                                                                                         transition metals in mediating PM-related
 inhalation, metals, particulate matter, pulmonary immune defenses. Environ Health Perspect
                                                                                                         health effects (13–16), as well as the ability of
 110(suppl 5):871–875 (2002).
                                                                                                         some of the same metals to suppress host
 http://ehpnet1.niehs.nih.gov/docs/2002/suppl-5/871-875zppppppppppppppppppelikoff/abstract.html
                                                                                                         immunocompetence (17), experimental stud-
                                                                                                         ies were performed to characterize the role of
Epidemiologic studies have reported that             observed increase in particle-induced               constitutive transition metals in exacerbating
exposure to ambient levels of airborne particu-      mortality in elderly individuals. Studies           ongoing pneumococcal infections.
late matter with an aerodynamic diameter of          using rodent models have clearly demon-
≤ 10 µm (PM10) results in consistent increases       strated that exposure to inhaled particles          Materials and Methods
in morbidity and mortality (1–3), and that           (alone or in combination with gaseous air           Experimental Animals
elderly individuals seem to be particularly          pollutants) can compromise pulmonary host
affected (4,5). Infection, specifically pneumo-                                                           Pathogen-free male Fischer 344 rats (Harlan
                                                     resistance against microbial infections
nia, contributes substantially to the mortality                                                          Sprague Dawley, Indianapolis, IN, USA) 7–9
                                                     and/or alter specific immune mechanisms
among elderly individuals exposed to PM, and                                                             months of age were quarantined for at least
                                                     important for antibacterial defense. For
disproportionate increases in deaths due to                                                              1 week prior to use in any experiments. Rats
                                                     example, Aranyi et al. (9) demonstrated that
pneumonia have been observed immediately                                                                 were housed individually in stainless steel
                                                     intratracheal (IT) instillation of mice with
or just after even moderate episodes of particu-                                                         cages in temperature- and humidity-con-
                                                     either quartz, ferric oxide, calcium carbon-
late air pollution (6,7). These epidemiologic                                                            trolled rooms and provided food and water
                                                     ate, or sodium feldspar particles increased
findings suggest that PM may act as an                                                                   ad libitum. In addition to serology testing for
                                                     mortality from subsequent infection with S.
immunosuppressive factor that can undermine                                                              viral and bacterial pathogens, rats were exam-
                                                     pneumoniae. In other bacterial infectivity
the normal pulmonary immune response.                                                                    ined routinely during the exposure studies for
                                                     studies, instillation of aged urban air parti-
Thus, given that older individuals with chronic                                                          any gross indication of spontaneous infection
                                                     cles (0.4 µm, mass median aerodynamic
respiratory disease are not only at increased risk                                                       or for mucosal irritation due to exposure.
                                                     diameter [MMAD]) and/or coal fly ash par-
of pneumonia but also are less likely to recover     ticles (0.9 µm MMAD) reduced the resis-
from infections (8), alterations in the pul-         tance of mice to bacterial infection (10).
                                                                                                         This article is part of the monograph Molecular
monary immune system may well play a role            Moreover, studies in this laboratory demon-
                                                                                                         Mechanisms of Metal Toxicity and Carcinogenicity.
in the observed increase in mortality following      strated that inhalation of woodsmoke efflu-           Address correspondence to J.T. Zelikoff, New
PM episodes.                                         ents reduced pulmonary clearance of                 York University School of Medicine, 57 Old Forge
    Toxicologic studies demonstrating the            IT-instilled Staphylococcus aureus (11).            Rd., Tuxedo, New York 10987-5007 USA.
immunosuppressive potential of particles in              Although it has been demonstrated that          Telephone: (845) 731-3528. Fax: (845) 351-5472.
                                                                                                         E-mail: judyz@env.med.nyu.edu
the lungs strengthen the epidemiologic               the elderly with preexisting disease appear to
                                                                                                           The authors thank L. Wang for her help in initiat-
observations and support the hypothesis that         be at higher risk from the adverse effects of
                                                                                                         ing this project. This work was supported by U.S.
compromised pulmonary host immunocom-                PM than healthy individuals, considerable           Environmental Protection Agency Center grant
petence and immune defense mechanisms                uncertainty remains about specific biologic         R827351 and Health Effects Institute contract
important for resistance against Streptococcus       mechanisms that might underlie this effect.         94-03A.
pneumoniae infections contribute to the              Thus, studies were performed in which rats            Received 2 April 2002; accepted 4 June 2002.


                                                                                                                                                       871
Environmental Health Perspectives    • VOLUME 110 | SUPPLEMENT 5 | OCTOBER 2002
Metals Toxicity        Zelikoff et al.
                   •



Infected rats were maintained individually in       into fresh Todd Hewitt (TH) broth and                which were measured on a percentage scale,
HEPA filter-top cages and housed in an              maintained at 37°C in a 5% CO2 atmosphere.           the need for arcsine transformation was deter-
onsite Biosafety Level 2 facility. Animals used     The cultures were then passaged at 12-hr inter-      mined prior to analysis. Differences were
in this research have been treated humanely         vals using a protocol that maintained both the       considered significant at p < 0.05.
according to institutional guidelines.              virulence and capsulated nature of the organ-
                                                                                                         Results
                                                    ism. On the day of instillation, the bacterial
Experimental Design                                 concentration was spectrophotometrically             In studies examining the effects of concen-
Male rats previously infected by IT instillation    determined using an absorbance calibration           trated ambient PM (CAPS), previously
with 15–20 × 106 S. pneumoniae were exposed         curve prepared at 540 nm and a suspension            infected rats were sacrificed 4.5, 9, 18, 24,
for 5 hr to either ambient NYC PM2.5 (65–90         diluted with phosphate-buffered saline (PBS)         and 120 hr after exposure, and effects upon
µg/m3) or to a single PM-associated transition      to a suitable concentration for delivery of 1–2      bacterial burdens were determined (Figure 1).
                                                    × 107 organisms in a 100-µL volume.
metal (i.e., iron [Fe2+], manganese [Mn2+], or                                                           Results demonstrated that although numbers
nickel [Ni2+]) of a similar concentration and           At designated time intervals, cohorts of         of pulmonary bacteria were approximately
MMAD (i.e., 0.4 µm; Σg = 2.4 µm) and then           four rats each were sacrificed by injection of        equal in the two exposure groups at the
sacrificed at different time points postexpo-       Nembutal (sodium phenobarbital; 80                   earliest postexposure time point (i.e., 4.5 hr
sure. Effects of inhaled transition metals were     mg/kg, sc) and the lungs were removed,               postexposure), bacterial burdens in the
also determined in uninfected rats. At the          weighed, and homogenized (19). To obtain             CAPS-exposed animals were approximately
time of sacrifice, lungs were a) lavaged to pro-     estimates of total remaining viable organ-           10% above those measured in the air controls
vide fluid for evaluation of markers of lung        isms, aliquots of the homogenate were seri-          by 9 hr; by 18 hr, burdens were elevated
cell damage (i.e., lactate dehydrogenase            ally diluted and plated onto triplicate sheep        >300%. After 24 hr CAPS-exposed rats had
[LDH] and total protein) or to provide cells        blood-TH agar plates for a 24-hr incubation          substantially greater (i.e., 70% change from
for characterization; b) fixed for histopatho-      at 37°C (in 5% CO2) before enumeration.              control) bacterial burdens than infected con-
logic examination; or c) homogenized for            Both the absolute levels of bacteria and the         trol rats. At 5 days postexposure, total num-
determination of effects on pulmonary bacter-       levels of bacteria per gram lung compared            ber of bacteria per gram lung was still 30%
ial burdens. Blood taken from the portal vein       with those in three randomly infected rats           above that measured in the lungs of the
prior to sacrifice was used to determine rela-       sacrificed immediately prior to beginning            infected air-exposed controls.
tive percentages of circulating white blood         inhalation exposure were used as indices of              Uninfected rats exposed nose-only to
                                                                                                         either Fe, Mn, or Ni at 65–90 µg/m 3
cells. A total of 100 white blood cells per slide   bacterial survival.
(two slides per preparation) were counted for                                                            demonstrated significant alterations in blood
                                                    Bronchopulmonary Lavage and
differential counts.                                                                                     cell profiles (Figure 2A, B, C, respectively).
                                                    Biologic Assays                                      Although polymorphonuclear leukocyte
Exposures                                           At sacrifice, lungs from uninfected rats were        (PMN) levels significantly increased,
Ambient PM and filtered air exposures               lavaged by washing the left lung in situ
                                                    twice with Ca 2 + - and Mg 2 + -free PBS
took place in Teflon nose-only exposure                                                                   (% change compared with filtered-air control)
units (CH International, Westwood, NJ,              according to previously employed methods                                                                                     **
USA) located in a building overlooking a            (20). Spleens were also recovered and placed                                                           300
main thoroughfare in Manhattan, NYC.                in RPMI 1640 on ice until processed for
                                                                                                                  Relative bacterial burdens




Concentrated ambient PM 2.5 air was pro-            measurement of lymphoproliferative
duced using a Gerber centrifugal concentra-         responses. Aliquots of acellular lavage fluid                                                          200

tor; gaseous pollutants such as ozone, sulfur       were then used to evaluate LDH activity
dioxide, nitrogen dioxide, and ammonia              and total protein (21). Lavaged cell num-
                                                                                                                                                           100
were removed prior to exposure (18). The            bers and viability were determined by                                                                                               *
exposure atmosphere was continuously mon-           hemocytometer counting and trypan blue
itored using a condensation particle counter        exclusion, respectively. Recovered lavaged                                                               0
and real-time aerosol monitor. In addition,         cell types were subsequently characterized
filter samples were collected during exposure        morphologically by differential counting of
on Teflon membrane filters to gravimetri-           stained cells. Basal and serum-opsonized,                                                             –100
                                                                                                                                                                 0   4.5    9    18    24     120
cally measure integrated exposure mass con-         zymosan-stimulated production of super-
                                                    oxide anion (O 2 •– ) by pulmonary macro-                                                                        Time postexposure (hr)
centrations on a Cahn electrobalance.
    For the individual metal exposure studies,      phages (Mø) was assessed using a microtiter          Figure 1. A single exposure of already-infected rats
previously infected and naive rats were             plate assay based upon the reduction of fer-         to CAPS significantly increased pulmonary bacter-
exposed by inhalation (i.e., nose-only) for 5 hr    ricytochrome c (20). Proliferation of splenic        ial burdens of S. pneumoniae in a time-dependent
                                                                                                         manner (compared with the infected, air-exposed
to chloride salts of either Fe, Mn, or Ni at a      T and B lymphocytes was measured in
                                                                                                         control). Estimates of viable bacterial organisms
concentration of 65–90 µg/m3. All atmos-            response to stimulation with concanavalin
                                                                                                         were determined from colony counts on blood-TH
pheres were generated by passing freshly pre-       (Con) A and lipopolysaccharide (LPS),                agar 24 hr after plating. Both the absolute levels of
pared solutions of each metal compound              respectively (22).                                   bacteria and the levels of bacteria per gram lung
through a collision nebulizer; generated parti-                                                          compared with those in three randomly-infected
                                                    Statistical Analyses
cles were then delivered to each rat held in                                                             rats sacrificed immediately prior to beginning
                                                                                                         inhalation exposure were used as indices of bacte-
individual body tubes (CH International) on         The effects of PM exposure itself upon each
                                                                                                         rial survival. Postexposure time 0 represents those
a single-exposure tree (12).                        of the assayed parameters (i.e., exposed vs. air
                                                                                                         burdens determined immediately prior to exposure.
                                                    control), as well as those effects associated        Asterisk (*) indicates value significantly different
Pulmonary Bacterial Clearance                       with length of time post-PM exposure, were           from filtered-air control (p < 0.05). Double asterisks
Six days prior to instillation, S. pneumoniae       analyzed using a two-way analysis of variance.       (**) indicate significantly different from filtered-air
(encapsulated, type 3) was introduced               For outcomes such as bacterial clearance,            control (p < 0.01).


872                                                                                  110 | SUPPLEMENT 5 | OCTOBER 2002 • Environmental Health Perspectives
                                                                            VOLUME
Metals Toxicity                    Role of associated metals in PM immunotoxicity
                                                                                                                                                •



lymphocyte values significantly decreased at        to inhibit clearance, inhalation of Fe facili-                                                            air-exposed control animals (Table 1).
1 hr postexposure; however, by 18 hr post-          tated an increase in overall bacterial numbers.                                                           Although lung cell viability was unaffected at
exposure, leukocyte values reached control              Inhalation of Fe by infected rats also                                                                18 hr postexposure, lavageable cell numbers
levels. Acute inhalation of Mn and Fe had no        altered lavageable cell numbers and immune                                                                in the Fe-exposed infected rats decreased by
effect upon lavageable cell number or lung          cell profile compared with those of infected                                                              35% compared with levels in time-matched
histologic profile, and none of the metals
                                                                                                        PMN                            Lymphocyte                                                               Con A-stimulated             LPS-stimulated
altered cell viability or LDH activity (com-                                                                                                                                                             0.6
                                                                                  100
                                                                                                                                                        A
pared with control). In contrast, inhalation                                                                                                                                                                   Fe                                                A
                                                                                                               Air




                                                                                                                                                               Optical density
of Ni significantly reduced lavaged cell num-                                                      *
                                                                                  80                           Fe
                                                                                                                                                                                                         0.4
bers by 25% (i.e., 40 × 106 vs 30 × 106 cells
                                                                                  60
for control and Ni-exposed rats, respectively)                                                                                                                                                           0.2
and increased percent lung involvement and                                        40
                                                                                                                                                                                                                                                             *
alveolar edema/exudate 1 hr postexposure                                                                                           *
                                                                                                                                                                                                           0
                                                                                  20
(data not shown).                                                                                                                                                                                        0.6
     Metal exposure also altered certain pul-                                                                                                                                                                  Ni                                                B
                                                                                   0




                                                                                                                                                               Optical density
                                                                                              1           18         48        1          18        48
monary and systemic immune functional
                                                                                                                                                                                                         0.4
                                                                                  100
activities in uninfected animals. Inhalation                                                                                                            B
                                                                                                  *
                                                                                                               Air
exposure to Fe significantly increased (com-                                      80                           Mn                                                                                        0.2
pared with time-matched air controls) basal                                                                                                                                                                                     *
                                                    Percentage



production of O2•– by lavaged Mø 18 and 48                                        60
                                                                                                                                                                                                          0
hr postexposure (Figure 3); inhalation of Fe                                                                                                                                                                        Air   1     18    48     Air    1   18   48
                                                                                  40
had no effects on O2•– production by stimu-                                                                                        *
                                                                                                                                                                                                                              Time postexposure (hr)
lated Mø at any postexposure time point.                                          20
                                                                                                                                                              Figure 4. Inhalation of Fe (A) and Ni (B) by naive rats
Although exposure of naive rats to Mn had no                                                                                                                  alters proliferative responses of mitogen-stimulated
                                                                                   0
effect upon lymphoproliferation (data not                                                     1           18         48        1          18        48        B and T lymphocytes, respectively. Each bar (except
shown), inhalation of Fe or Ni significantly                                      100                                                                         pooled air control, which represents the mean of 12
                                                                                                                                                        C
altered the ability of splenic lymphocytes to                                                                                                                 rats) represents the mean (± SD) from four rats per
                                                                                                               Air
                                                                                                  *
                                                                                  80                           Ni                                             exposure group. Asterisk (*) indicates value signifi-
proliferate in response to mitogen stimulation
                                                                                                                                                              cantly different from individual time-matched air
(Figure 4A, B). Inhalation of Fe significantly                                     60
                                                                                                                                                              control (p < 0.05).
reduced B-lymphocyte proliferation in
                                                                                  40                                                                                                                     10
response to LPS stimulation 48 hr postexpo-                                                                                        *
                                                                                                                                                                                                                A Mn                         Initial burden
sure, but had no effect upon Con A–stimu-                                                                                                                                                                                                    Preexposure burden
                                                                                                                                                                                                         8
                                                                                  20
                                                                                                                                                                                                                                             18 hr postair
lated T-lymphocyte proliferation at any                                                                                                                                                                                                      18 hr postmetal
                                                                                                                                                                                                         6
                                                                                   0
postexposure time point (Figure 4A); at 48 hr                                                 1           18         48        1          18        48
postexposure, inhaled Fe suppressed unstimu-                                                                                                                                                             4
                                                                                                          Time postexposure (hr)
lated T-lymphocyte proliferation. On the
                                                                                                                                                                                                         2
                                                    Figure 2. Inhalation (i.e., nose-only) of Fe (A), Mn
other hand, T cells proved more sensitive to
                                                                                                                                                               Streptococcus pneumoniae levels (log10)




                                                    (B), or Ni (C) by uninfected rats alters circulating
the immunotoxic effects of inhaled Ni than                                                                                                                                                               0
                                                    blood cell profiles. Each bar represents the mean
did B lymphocytes. T-cell proliferation was                                                                                                                                                              10
                                                    (± SD) from four rats per exposure group. Asterisk                                                                                                          B Ni
significantly reduced (compared with the air         (*) indicates value significantly different from time-                                                                                                8
control) by inhaled Ni 18 hr postexposure and       matched air control (p < 0.05).
                                                                                                                                                                                                         6
returned to control levels after 48 hr; B-cell                                                                                                                                                                                                *
responses to LPS stimulation were uniformly                                             2.0                                                                                                              4
                                                                                                      Unstimulated
unaffected by Ni exposure (Figure 4B).                                                                                                              *
                                                                                                                                                                                                         2
                                                                                                         Air
     Figure 5 illustrates the effects of inhaled                                                         Fe
Mn, Ni, and Fe on pulmonary bacterial clear-
                                                    nmoles (O2 –)/105 Mø/30 min




                                                                                                                                                                                                         0
                                                                                        1.5
ance. Although a single inhalation of Mn had                                                                                                                                                             10
                                                                                                                                                                                                                                                         *
                                                                                                                                                                                                                C Fe
no significant effect upon bacterial lung bur-                                                                                      *
                                                                                                                                                                                                         8
dens (as represented as total burdens) com-
                                                                                        1.0
pared with the time-matched air controls                                                                                                                                                                 6
(Figure 5A), exposure to Ni or Fe signifi-
                                                             •




                                                                                                                                                                                                         4
cantly altered bacterial clearance (Figure 5B,
C, respectively). Although pulmonary pneu-                                                                                                                                                               2
                                                                                        0.5
mococcal levels in air-exposed infected rats                                                                                                                                                             0
dropped significantly 18 hr following expo-                                                                                                                                                                                         Total burdens
sure (compared with burdens measured in                                                                                                                       Figure 5. Burdens of S. pneumoniae in the lungs of
                                                                                         0
rats sacrificed immediately prior to exposure),                                                            1               18                   48
                                                                                                                                                              Mn- (A), Ni- (B), and Fe- (C) exposed infected rats
exposure to Ni inhibited clearance and bacte-                                                                                                                 18 hr postexposure. Estimates of viable bacterial
                                                                                                          Time postexposure (hr)
                                                                                                                                                              organisms were determined from colony counts on
rial burdens remained the same as those mea-
                                                    Figure 3. Inhalation of Fe by uninfected rats                                                             blood-TH agar 24 hr after plating. Absolute levels of
sured just prior to metal exposure (Figure
                                                    increased unstimulated O2.– production by lavaged                                                         bacteria were used as indices of bacterial survival.
5B). Conversely, inhalation of Fe increased         Mø 18 and 48 hr postexposure. Each bar repre-                                                             Each bar represents the mean (± SD) from five rats
pulmonary streptococcal levels compared             sents the mean (± SD) from four rats per exposure                                                         per exposure group. Asterisk (*) indicates value
with preexposure bacterial burdens (Figure          group. Asterisk (*) indicates value significantly dif-                                                     significantly different from time-matched air con-
                                                    ferent from time-matched air control (p < 0.05).
5C). Thus, whereas exposure to Ni appeared                                                                                                                    trol (p < 0.05).


                                                                                                                                                                                                                                                              873
Environmental Health Perspectives   • VOLUME 110 | SUPPLEMENT 5 | OCTOBER 2002
Metals Toxicity                Zelikoff et al.
                           •



Table 1. Inhalation of Fe by Streptococcus pneumoniae-infected hosts alters lavageable lung immune cell numbers and profiles.
                                                               Total cells
                                                                                                                                         Cell type (%)b
                 Hours post-          Hours post-              recovered
                  infectiona                                     (× 107)
Treatment                              exposure                                         Viability (%)               PMN                  Lymphocyte                 Macrophage
Air                   51                   3                   3.3 ± 1.0                86.0 ± 4.0               30.0 ± 14.0                9.0 ± 0.2               60.0 ± 14.0
Fe                    51                   3                   2.6 ± 1.0                84.0 ± 3.0               25.0 ± 2.0                14.0 ± 6.0               61.0 ± 4.0
Air                   66                  18                   2.6 ± 0.1                87.0 ± 2.0               26.0 ± 9.0                11.0 ± 2.0               63.0 ± 7.0
Fe                    66                  18                  *1.7 ± 0.3                83.0 ± 5.0               *8.0 ± 7.0                *4.0 ± 2.0              *88.0 ± 6.0
        were infected with 10–20 × 106 S. pneumoniae. bMean ± SD of five rats per exposure group.*Indicates significant difference (p < 0.05) from time-matched air control.
aRats


air controls. At this same time point, relative                 Decreased percentages of PMNs may have                         of alveolar Mø followed within 2 days by
percentages of lavageable PMNs and lympho-                      been due, at least in part, to the previously                  suppressed phagocytic activity and enhanced
cytes in Fe-exposed rats dropped approxi-                       observed CAPS-induced downregulation of                        lipid peroxidation (31). Similar findings
mately 3-fold, whereas Mø values increased                      tumor necrosis factor (TNF)α and/or inter-                     have also been observed in rabbits exposed
by 29%.                                                         leukin (IL)-1α production (12); both of these                  by inhalation of Ni dust for 1–6 months
                                                                cytokines are critical for the mobilization and                (32). Alveolar Mø recovered from rabbits
Discussion                                                      activation of PMNs in response to many                         exposed to NiCl2 aerosol for 1 month also
                                                                Gram-positive [G + ] microbial organisms
Studies to determine whether inhalation                                                                                        displayed suppressed phagocytic ability as
exposure to concentrated PM2.5 could exacer-                    including S. pneumoniae (27). Moreover, since                  well as decreased levels of lysozyme (used by
                                                                                                                               Mø to break down G+ bacterial cell walls)
bate an ongoing pneumococcal infection                          TNFα in conjunction with IL-12 enhances
demonstrated that a single 5-hr exposure of                     the microbicidal capacity of PMNs (28), the                    both in pulmonary phagocytes and bron-
S. pneumoniae–infected rats to CAPS (at con-                    immune cells still present in the lungs may                    chopulmonary lavage fluid. Moreover, a
centrations at or slightly greater than 65                      display reduced cytotoxic activities.                          number of studies have concluded that
µg/m3) exacerbated the infection process in a                        Inorganic constituents of airborne PM                     inhalation/instillation of certain Ni com-
time-dependent manner and altered both                          such as sulfate, nitrate, ammonium, and tran-                  pounds, including NiCl2, reduces host abil-
pulmonary and systemic immunity (12). This                      sition metals, which make up a substantial                     ity to defend against pathogenic lung
was not surprising, given that lungs contain-                   part of the mass apportionment of ambient                      infections (30). Given that lysozyme activity
ing extant pulmonary inflammation appear to                      PM, represent potential causal constituents                    has been correlated with the ability to clear
                                                                                                                               certain G + bacterial lung pathogens, and
be primed for injurious responses to air parti-                 for PM-associated health effects. Although a
cles (23). It appears from these studies that                   number of different physiochemical factors                     that the major cellular target of inhaled Ni
CAPS may be acting to alter lung antibacter-                    have been linked to PM toxicity (i.e., acid                    appears to be Mø (and other antigen pre-
ial defense mechanisms important in the han-                    aerosols, particle size, oxidative potential),                 senting cells), it is likely that Ni-induced
dling of ongoing pneumococcal infections.                       evidence is rapidly accumulating that much                     effects upon antibacterial defense may be
This scenario fits temporally with the epi-                     of the pulmonary toxicity associated with                      due, at least in part, to suppressive effects on
demiologic data that indicate that deaths                       inhaled PM is related to the types and                         this phagocyte-associated enzyme.
among exposed individuals occur relatively                      amounts of the soluble forms of transition                         Fe is a key microelement necessary to
quickly following a PM episode, and that                        metals (13,14,16).                                             maintain cellular homeostasis. Normal func-
individuals with chronic respiratory disease                         Metals are ubiquitous constituents of                     tioning of the immune system relies on trace
were less likely than healthy individuals to                    PM derived from anthropogenic and certain                      amounts of Fe to serve as a cofactor for spe-
recover from pulmonary infections following                     types of natural emissions. PM emissions                       cific metalloenzymes and for the intracellular
PM exposure (1,24, 25).                                         from oil-burning power plants and other                        formation of reactive oxygen species used for
     Although no definitive conclusions can be                   industries that contribute to air pollution                    killing phagocytosed pathogens. Both defi-
reached at this time regarding the mecha-                       contain large amounts of metals such as V,                     ciency and excessive levels of Fe can lead to
nism(s) by which inhaled concentrated PM2.5                     Fe, Ni, Zn, and Cu (15,16). Moreover,                          immune dysfunction (33). Although most
may have acted to increase pulmonary bur-                       studies from this laboratory have demon-                       studies have focused upon the immunomodu-
dens of infectious pneumococci, compromised                     strated the presence of Mn in concentrated                     lating effects associated with deficiency, Fe
pulmonary immune defense mechanisms                             NYC PM (29). Although inflammation was                         overload has been shown to suppress antibody
important for the removal/killing of S. pneu-                   not observed in this study, human exposure                     responses, T-lymphocyte functions (i.e., inter-
moniae (i.e., modified availability of PMNs)                    to airborne metals have been shown to                          feron-γ production and delayed contact
or increased bacterial survival as a result of                  induce pulmonary inflammatory responses                        hypersensitivity), and nonspecific immunity
CAPS-induced changes in the lung milieu are                     such as tracheobronchitis, asthma, chemical                    (33). For example, bactericidal activities of
two plausible hypotheses by which this may                      pneumonitis, and alveolitis. Recent studies                    Mø from patients with Fe overload and of
have occurred. In support of the former,                        have shown that acute exposure of rats to                      leukocytes treated in vitro with Fe salts were
CAPS exposure of rats with ongoing pneumo-                      mixtures of metallic compounds derived                         markedly reduced (34); inhibition of basic
nia reduced the relative percentages of lavage-                 from ambient air PM or from combustion                         cationic proteins appeared to be responsible
able PMNs 24, 48, and 72 hr postexposure                        source emissions (i.e., residual oil fly ash)                  for these reductions. In contrast, results from
compared with that observed in the air-                         can induce pronounced pulmonary inflam-                        experimental studies have suggested that Fe-
exposed infected controls (12). Given that                      mation characterized by increased permeabil-                   overloaded Mø have improved bactericidal
PMNs, in the presence of opsonizing comple-                     ity to protein and neutrophilic alveolitis (13).               ability (35). Discrepancies between the studies
ment and immunoglobulins, are the main cell                          Many transition metals associated with                    may be due to differences in host species
type responsible for the clearance of S. pneu-                  PM are potent modulators of pulmonary                          and/or the particular microorganism being
moniae from the lungs of most animal models                     and/or systemic immunocompetence (30).                         targeted by the phagocyte. More consistent
and humans (26), a PM-induced reduction                         For example, both parenteral and inhalation                    effects of Fe excess have been observed on nat-
could lead to prolongation of infection.                        exposure of soluble NiCl2 causes activation                    ural killer cell cytotoxicity and neutrophilic


874                                                                                                     110 | SUPPLEMENT 5 | OCTOBER 2002 • Environmental Health Perspectives
                                                                                             VOLUME
Metals Toxicity               Role of associated metals in PM immunotoxicity
                                                                                                              •



killing of S. pneumoniae. As has been observed       is needed to conclusively confirm or refute                            18. Gordon T, Chen LC, Fang CP, Gerber H. A centrifugal con-
                                                                                                                                centrator for use in inhalation toxicology studies. Inhal
in clinical and experimentally induced Fe defi-       the role of transition metals in PM-associated
                                                                                                                                Toxicol 11:71–87 (1999).
ciency (36), patients with clinical diseases of      immunosuppression, results contribute to a                             19. Cohen MD, Sisco M, Li Y, Zelikoff JT, Schlesinger RB.
Fe overload (i.e., thalassemia major) have           better understanding of the possible mecha-                                Immunomodulatory effects of ozone upon in situ cell-
decreased bactericidal, fungicidal, and oxida-       nism(s) by which exposure to PM2.5 may act                                 mediated responses in the lungs. Toxicol Appl Pharmacol
                                                                                                                                171:71–84 (2001).
tive burst activities (33); neutrophil-associated    to increase host mortality in exposed elderly                          20. Cohen MD, McManus TP, Yang Z, Qu Q, Schlesinger RB,
oxidative burst activity was also diminished in      individuals.                                                               Zelikoff JT. Vanadium alters macrophage interferon-γ
proportion to the degree of Fe overload.                                                                                        interactions and interferon-inducible responses. Toxicol
                                                                                                                                Appl Pharmacol 138:110–120 (1996).
                                                                       REFERENCES AND NOTES
Although inhaled Fe may have led to                                                                                         21. Zelikoff JT, Parsons E, Schlesinger RB. Immuno-
increased pulmonary burdens of S. pneumo-                                                                                       modulating activity of inhaled particulate lead oxide dis-
                                                     1.    Pope CA. Respiratory hospital admissions associated with
niae in this study by interfering with phago-                                                                                   rupts pulmonary macrophage-mediated functions
                                                           PM10 pollution in Utah, Salt Lake, and Cache Valleys. Arch           important for host defense and tumor surveillance in the
cyte-mediated killing, another possibility is              Environ Health 46:92–97 (1991).                                      lung. Environ Res 62:207–222 (1993).
that freely available inhaled Fe may have even-      2.    Seaton A, MacNee W, Donaldson K, Godden D.                       22. Schlesinger RB, Cohen MD, Gordon T, Nadziejko C,
                                                           Particulate air pollution and acute health effects. Lancet
tually overwhelmed the binding capacities of                                                                                    Zelikoff JT, Sisco M, Regal JF, Menache M. Ozone differ-
                                                           345:176–178 (1995).                                                  entially modulates airway responsiveness in atopic vs
the nascent Fe-binding proteins transferrin          3.    Thurston GD, Ito K, Kinney PL, Lippmann M. A multi-year              non-atopic guinea pigs. Inhal Toxicol 14:431–457 (2002).
and lactoferrin normally operational in lung               study of air pollution and respiratory hospital admissions       23. Imrich A, Ning YY, Kobzik L. Insoluble components of con-
fluid (37), thereby allowing bacteria that                 in three New York state metropolitan areas: results for              centrated air particles mediate alveolar macrophage
                                                           1988 and 1989 summers. J Expo Anal Environ Epidemiol                 responses in vitro. Toxicol Appl Pharmacol 167(2):140–150
require Fe as an essential nutrient (including             2:1–21 (1992).                                                       (2000).
S. pneumoniae) to freely incorporate the metal       4.    Schwartz J. Total suspended particulate matter and daily         24. Dockery DW, Schwartz J, Spengler JD. Air pollution and
and proliferate.                                           mortality in Cincinnati, Ohio. Environ Health Perspect               daily mortality: associations with particulates and acid
                                                           102:186–189 (1994).
     Mn, a dissociable cofactor for several                                                                                     aerosols. Environ Res 59:362–373 (1992).
                                                     5.    Schwartz J. Air pollution and daily mortality: a review and      25. Lebowitz MD. Epidemiological studies of the respiratory
enzymes including one of great importance in               meta-analysis. Environ Res 64:35–52 (1994).                          effects of air pollution. Eur Respir J 9:1029–1054 (1996).
the lungs, superoxide dismutase, is also             6.    Schwartz J. What are people dying of on high air pollution       26. Coonrod JD, Yoneda K. Comparative role of complement
                                                           days? Environ Res 64:26–35 (1994).
required for growth of virtually all living cells.                                                                              in pneumococcal and staphylococcal pneumonia. Infect
                                                     7.    Ware JH, Ferris BG, Dockery DW, Spengler JD, Stram DO.               Immunol 37:1270–1277 (1982).
Like Fe, shifts in Mn levels in either direction           Effects of ambient sulfur oxides and suspended particles         27. Heumann D, Barbas C, Severin A, Glauser MP, Tomasz A.
can bring about immune dysfunction.                        on respiratory health of pre-adolescent children. Am Rev             Gram-positive cell-walls stimulate synthesis of tumor
                                                           Respir Dis 133:824–842 (1986).
Inhalation of high concentrations of Mn by                                                                                      necrosis factor-α and interleukin-6 by human monocytes.
                                                     8.    Vial WC, Towes GB, Pierce AK. Early pulmonary granulo-               Infect Immunol 62:2715–2721 (1995).
occupationally exposed workers has been                    cyte recruitment in response to Streptococcus pneumo-            28. Janeway CA, Travers P, eds. Immunobiology: The Immune
shown to cause Mn pneumonitis and                          niae. Am Rev Respir Dis 129:87–91 (1984).                            System in Health and Disease. London/New York:Current
                                                     9.    Aranyi C, Graf JL, O’Shea WJ, Graham JA, Miller FF. The
croupous pneumonia. In rodents, inhalation                                                                                      Biology Ltd./Garland Publishing, 1996.
                                                           effects of intratracheally-administered coarse mode parti-       29. Zelikoff JT, Chen LC, Cohen MD, Fang K, Gordon T, Li Y et
of insoluble Mn at milligram concentrations                cles on respiratory tract infection in mice. Toxicol Lett            al. Unpublished data.
impairs pulmonary bacterial clearance and                  19:63–72 (1983).                                                 30. Cohen MD, Zelikoff JT, Schlesinger RB, eds. Pulmonary
increases bacterial-associated host mortality        10.   Hatch GE, Slade R, Boykin E, Hu PC, Miller FJ, Gardner,              Immunotoxicology. Boston:Kluwer Academic Press, 2000.
                                                           DE. Correlation of effects of inhaled versus intratra-           31. Sunderman FW Jr, Hopfer SM, Lin SM, Plowman MC,
(30). Other studies have demonstrated that                 cheally-injected metals on susceptibility to respiratory             Stojanivic T, Wong SH, Zaharia O, Ziebka L. Toxicity of
exposure of hosts already bearing a viral lung             infection in mice. Am Rev Respir Dis 124:167–173 (1985).             alveolar macrophages in rats following parenteral injec-
infection for 24 or 48 hr prior to a 3-hr expo-      11.   Zelikoff JT. Woodsmoke, kerosene heater emissions, and               tion of nickel chloride. Toxicol Appl Pharmacol
                                                           diesel exhaust. In: Pulmonary Immunotoxicology (Cohen
sure to insoluble Mn had a shorter time to                                                                                      100:107–118 (1989).
                                                           MD, Zelikoff JT, Schlesinger RB, eds). Boston:Klewar             32. Johansson A, Camner P. Effects of nickel dust on rabbit
death than their air-exposed counterparts                  Academic Press, 2000;369–386.                                        alveolar epithelium. Environ Res 22:510–516 (1980).
(38,39). Furthermore, although the effects of        12.   Zelikoff JT, Nadziejko C, Fang K, Gordon T, Premdass C,          33. Omara FO, Brousseau P, Blakley BR, Fournier M. Iron,
                                                           Cohen MD. Short-term, low-dose inhalation of ambient
soluble Mn on alveolar Mø function are still                                                                                    zinc, and copper. In: Immunotoxicology of Environmental
                                                           particulate matter exacerbates ongoing pneumococcal                  and Occupational Metals (Zelikoff JT, Thomas PT, eds).
being debated, in vitro studies have demon-                infections in Streptococcus pneumoniae-infected rats. In:            London:Taylor and Francis, 1999;231–262.
strated reductions in phagocytic activity.                 Proceedings of the Third Colloquium on Particulate Air           34. Ballart IJ, Estevez ME, Sen L, Diez RA, Giuntoli RA, de
                                                           Pollution and Human Health (Phalen R, Bell Y, eds). Irvine,
Discrepancies between these studies and those                                                                                   Miani SA, Penalver J. Progressive dysfunction of mono-
                                                           CA:University of California, Section 8, 2000;94–101.                 cytes associated with iron overload and age in patients
performed herein that demonstrated no effects        13.   Dreher KL, Jaskot RH, Lehmann JR, Richards JH, McGee                 with thalassemia major. Blood 67:105–109 (1986).
of inhaled Mn on pulmonary bacterial clear-                JK, Ghio AJ et al. Soluble transition metals mediate resid-      35. Jiang X, Baldwin CL. Iron augments macrophage-medi-
                                                           ual oil fly ash induced acute lung injury. J Toxicol Environ
ance may be due, in part, to differences in                                                                                     ated killing of Brucella abortus alone and in conjunction
                                                           Health 50:285–305 (1997).                                            with interferon-γ. Cell Immunol 148:398–407 (1993).
metal concentration and/or metal solubility.         14.   Carter JD, Ghio AJ, Samet JM, Devlin, RB. Cytokine pro-          36. Murakawa H, Bland CE, Willis WT, Dallman PR. Iron defi-
     Taken together, findings from this study               duction by human airway epithelial cells after exposure to           ciency and neutrophil function: different rates of correction
support the notion that a single exposure to               an air pollution particle is metal-dependent. Toxicol Appl           of the depressions in oxidative burst and myloperoxidase
                                                           Pharmacol 146:180–188 (1997).                                        activity after iron treatment. Blood 69:1464–1468 (1987).
concentrated ambient PM2.5, at concentra-            15.   Costa DL, Dreher KL. Bioavailable transition metals in par-      37. LaForce FM, Loose D. Release of lactoferrin by polymor-
tions equal to or just above the promulgated               ticulate matter mediates cardiopulmonary injury in healthy           phonuclear leukocytes after aerosol challenge with
24-hr NAAQS value, compromise host abil-                   and compromised animal models. Environ Health Perspect               Escherichia coli. Infect Immunol 55:2293–2295 (1987).
                                                           105:1053–1059 (1997).
ity to adequately handle an ongoing S. pneu-                                                                                38. Maigetter RZ, Ehrlich R, Fenters JD, Gardner DE.
                                                     16.   Kodavanti UP, Hauser R, Christiani DC, Meng ZH, McGee                Potentiating effects of manganese dioxide on experimen-
moniae infection. These investigations also                J, Ledbetter A, et al. Pulmonary responses to oil fly ash            tal respiratory infections. Environ Res 11:386–391 (1976).
provide biologic plausibility for the role of              particles in the rat differ by virtue of their specific soluble   39. Cohen MD. Other metals: aluminum, copper, manganese,
                                                           metals. Toxicol Sci 43:204–212 (1998).
PM-associated metals, particularly Fe and Ni,                                                                                   selenium, vanadium, and zinc. In: Pulmonary
                                                     17.   Zelikoff JT, Thomas PT, eds. Immunotoxicology of                     Immunotoxicology (Cohen MD, Zelikoff JT, Schlesinger
in exacerbating S. pneumoniae infections in                Environmental and Occupational Metals. London:Taylor                 RB, eds). Boston:Kluwer Academic Press, 2000;267–299.
CAPS-exposed hosts. Although more research                 and Francis, 1999.




                                                                                                                                                                                     875
Environmental Health Perspectives    • VOLUME 110 | SUPPLEMENT 5 | OCTOBER 2002

Weitere ähnliche Inhalte

Was ist angesagt?

Physical, Thermal and Spectroscopic Characterization of m-Toluic Acid: an Imp...
Physical, Thermal and Spectroscopic Characterization of m-Toluic Acid: an Imp...Physical, Thermal and Spectroscopic Characterization of m-Toluic Acid: an Imp...
Physical, Thermal and Spectroscopic Characterization of m-Toluic Acid: an Imp...albertdivis
 
Fenótipos e biomarcadores de exacerbação da DPOC
Fenótipos e biomarcadores de exacerbação da DPOCFenótipos e biomarcadores de exacerbação da DPOC
Fenótipos e biomarcadores de exacerbação da DPOCFlávia Salame
 
2011 effects of restraint stress on nalt structure and nasal ig a levels
2011 effects of restraint stress on nalt structure and nasal ig a levels2011 effects of restraint stress on nalt structure and nasal ig a levels
2011 effects of restraint stress on nalt structure and nasal ig a levelsLUVIA ENID SANCHEZ TORRES
 
5 antimicrobial and antistaphylococcal biofilm activity from the sea urchin p...
5 antimicrobial and antistaphylococcal biofilm activity from the sea urchin p...5 antimicrobial and antistaphylococcal biofilm activity from the sea urchin p...
5 antimicrobial and antistaphylococcal biofilm activity from the sea urchin p...Alfonso Enrique Islas Rodríguez
 
Timothy W Morris - Publications & Presentations
Timothy W Morris - Publications & PresentationsTimothy W Morris - Publications & Presentations
Timothy W Morris - Publications & PresentationsTimothy Morris
 
The influence of reduced oxygen availability on gene expression in laboratory...
The influence of reduced oxygen availability on gene expression in laboratory...The influence of reduced oxygen availability on gene expression in laboratory...
The influence of reduced oxygen availability on gene expression in laboratory...Santhi Devasundaram
 
S41421 020-0156-0
S41421 020-0156-0S41421 020-0156-0
S41421 020-0156-0gisa_legal
 
Nanotechnology based drug delivery systems for the treatment of tuberculosis
Nanotechnology based drug delivery systems for the treatment of tuberculosisNanotechnology based drug delivery systems for the treatment of tuberculosis
Nanotechnology based drug delivery systems for the treatment of tuberculosisNimitt Chokshi
 
Quorum sensing in Archaea
Quorum sensing in ArchaeaQuorum sensing in Archaea
Quorum sensing in ArchaeaZahra Naz
 
What can we learn from studying fungal microbiota
What can we learn from studying fungal microbiotaWhat can we learn from studying fungal microbiota
What can we learn from studying fungal microbiotaLaurence Delhaes
 

Was ist angesagt? (19)

Physical, Thermal and Spectroscopic Characterization of m-Toluic Acid: an Imp...
Physical, Thermal and Spectroscopic Characterization of m-Toluic Acid: an Imp...Physical, Thermal and Spectroscopic Characterization of m-Toluic Acid: an Imp...
Physical, Thermal and Spectroscopic Characterization of m-Toluic Acid: an Imp...
 
Inflammatory Lung Injury
Inflammatory Lung InjuryInflammatory Lung Injury
Inflammatory Lung Injury
 
Fenótipos e biomarcadores de exacerbação da DPOC
Fenótipos e biomarcadores de exacerbação da DPOCFenótipos e biomarcadores de exacerbação da DPOC
Fenótipos e biomarcadores de exacerbação da DPOC
 
cv-malik-2
cv-malik-2cv-malik-2
cv-malik-2
 
2011 effects of restraint stress on nalt structure and nasal ig a levels
2011 effects of restraint stress on nalt structure and nasal ig a levels2011 effects of restraint stress on nalt structure and nasal ig a levels
2011 effects of restraint stress on nalt structure and nasal ig a levels
 
5 antimicrobial and antistaphylococcal biofilm activity from the sea urchin p...
5 antimicrobial and antistaphylococcal biofilm activity from the sea urchin p...5 antimicrobial and antistaphylococcal biofilm activity from the sea urchin p...
5 antimicrobial and antistaphylococcal biofilm activity from the sea urchin p...
 
Resume - Vasu Ayyappan
Resume - Vasu AyyappanResume - Vasu Ayyappan
Resume - Vasu Ayyappan
 
KevinGorman_PL
KevinGorman_PLKevinGorman_PL
KevinGorman_PL
 
Coronavirus
Coronavirus Coronavirus
Coronavirus
 
Timothy W Morris - Publications & Presentations
Timothy W Morris - Publications & PresentationsTimothy W Morris - Publications & Presentations
Timothy W Morris - Publications & Presentations
 
Selenium Nanoparticle Enhanced Photodynamic Therapy against Biofilm forming S...
Selenium Nanoparticle Enhanced Photodynamic Therapy against Biofilm forming S...Selenium Nanoparticle Enhanced Photodynamic Therapy against Biofilm forming S...
Selenium Nanoparticle Enhanced Photodynamic Therapy against Biofilm forming S...
 
The influence of reduced oxygen availability on gene expression in laboratory...
The influence of reduced oxygen availability on gene expression in laboratory...The influence of reduced oxygen availability on gene expression in laboratory...
The influence of reduced oxygen availability on gene expression in laboratory...
 
S41421 020-0156-0
S41421 020-0156-0S41421 020-0156-0
S41421 020-0156-0
 
Bhattacharya
BhattacharyaBhattacharya
Bhattacharya
 
Nanotechnology based drug delivery systems for the treatment of tuberculosis
Nanotechnology based drug delivery systems for the treatment of tuberculosisNanotechnology based drug delivery systems for the treatment of tuberculosis
Nanotechnology based drug delivery systems for the treatment of tuberculosis
 
Quorum sensing in Archaea
Quorum sensing in ArchaeaQuorum sensing in Archaea
Quorum sensing in Archaea
 
ENMM Paper
ENMM PaperENMM Paper
ENMM Paper
 
Intro Pso
Intro PsoIntro Pso
Intro Pso
 
What can we learn from studying fungal microbiota
What can we learn from studying fungal microbiotaWhat can we learn from studying fungal microbiota
What can we learn from studying fungal microbiota
 

Andere mochten auch

Subaru09
Subaru09Subaru09
Subaru09facc8
 
Evolution
EvolutionEvolution
Evolutionklinkn
 
BCBG MAX AZRIA F09
BCBG MAX AZRIA F09BCBG MAX AZRIA F09
BCBG MAX AZRIA F09aamiri
 
Cause Marketing
Cause MarketingCause Marketing
Cause Marketingjrothman
 
Aguilares ciudad llena de comercio
Aguilares ciudad llena de comercioAguilares ciudad llena de comercio
Aguilares ciudad llena de comercioguest3d841951
 

Andere mochten auch (6)

Subaru09
Subaru09Subaru09
Subaru09
 
6172565
61725656172565
6172565
 
Evolution
EvolutionEvolution
Evolution
 
BCBG MAX AZRIA F09
BCBG MAX AZRIA F09BCBG MAX AZRIA F09
BCBG MAX AZRIA F09
 
Cause Marketing
Cause MarketingCause Marketing
Cause Marketing
 
Aguilares ciudad llena de comercio
Aguilares ciudad llena de comercioAguilares ciudad llena de comercio
Aguilares ciudad llena de comercio
 

Ähnlich wie Zelikoff Metals

Patogenesis de neumonia por neumococo
Patogenesis de neumonia por neumococoPatogenesis de neumonia por neumococo
Patogenesis de neumonia por neumococofranklinaranda
 
Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...
Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...
Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...Pırıl Erel
 
Seminario biología molecular Kevin Duque
Seminario biología molecular Kevin DuqueSeminario biología molecular Kevin Duque
Seminario biología molecular Kevin Duquekevinestebanduque
 
Ascariasis
AscariasisAscariasis
AscariasisNEB2011
 
When to Use Antibiotics for an Acute Exacerbation of COPD
When to Use Antibiotics for an Acute Exacerbation of COPDWhen to Use Antibiotics for an Acute Exacerbation of COPD
When to Use Antibiotics for an Acute Exacerbation of COPDsmanning500
 
Fenótipos e biomarcadores na exacerbação da DPOC
Fenótipos e biomarcadores na exacerbação da DPOCFenótipos e biomarcadores na exacerbação da DPOC
Fenótipos e biomarcadores na exacerbação da DPOCFlávia Salame
 
Antimicrobial peptides and innate immunity
Antimicrobial peptides and innate immunityAntimicrobial peptides and innate immunity
Antimicrobial peptides and innate immunitySpringer
 
Shouts and whispers an introduction to immunoregulation in periodontal disease
Shouts and whispers  an introduction to immunoregulation in periodontal diseaseShouts and whispers  an introduction to immunoregulation in periodontal disease
Shouts and whispers an introduction to immunoregulation in periodontal diseasedroliv
 
Microbiology of periodontal disease- part 2
Microbiology of periodontal disease- part 2Microbiology of periodontal disease- part 2
Microbiology of periodontal disease- part 2Dr.Malvika Thakur
 
Intersticial Lung Disease II.pdf
Intersticial Lung Disease II.pdfIntersticial Lung Disease II.pdf
Intersticial Lung Disease II.pdfcuencamvz24
 
Mold Toxicity - A Chronic Inflammatory Response Syndrome
Mold Toxicity - A Chronic Inflammatory Response SyndromeMold Toxicity - A Chronic Inflammatory Response Syndrome
Mold Toxicity - A Chronic Inflammatory Response SyndromeKeith Berndtson
 
Evolution in the pathogenesis of periodontal disease
Evolution in the pathogenesis of periodontal diseaseEvolution in the pathogenesis of periodontal disease
Evolution in the pathogenesis of periodontal diseaseDrAtulKoundel
 

Ähnlich wie Zelikoff Metals (20)

Patogenesis de neumonia por neumococo
Patogenesis de neumonia por neumococoPatogenesis de neumonia por neumococo
Patogenesis de neumonia por neumococo
 
Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...
Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...
Analysis in to the Epidemiology and Pathophysiology of Respiratory Syncytial ...
 
FINAL_thesis
FINAL_thesisFINAL_thesis
FINAL_thesis
 
Seminario biología molecular Kevin Duque
Seminario biología molecular Kevin DuqueSeminario biología molecular Kevin Duque
Seminario biología molecular Kevin Duque
 
Resistant Pneumococcus
Resistant PneumococcusResistant Pneumococcus
Resistant Pneumococcus
 
Indoor particles affect vascular function in the aged
Indoor particles affect vascular function in the agedIndoor particles affect vascular function in the aged
Indoor particles affect vascular function in the aged
 
Ascariasis
AscariasisAscariasis
Ascariasis
 
When to Use Antibiotics for an Acute Exacerbation of COPD
When to Use Antibiotics for an Acute Exacerbation of COPDWhen to Use Antibiotics for an Acute Exacerbation of COPD
When to Use Antibiotics for an Acute Exacerbation of COPD
 
Fenótipos e biomarcadores na exacerbação da DPOC
Fenótipos e biomarcadores na exacerbação da DPOCFenótipos e biomarcadores na exacerbação da DPOC
Fenótipos e biomarcadores na exacerbação da DPOC
 
Sensitive Subgroups
Sensitive SubgroupsSensitive Subgroups
Sensitive Subgroups
 
143399660 danf
143399660 danf143399660 danf
143399660 danf
 
Immunity to fungal infections
Immunity to fungal infectionsImmunity to fungal infections
Immunity to fungal infections
 
3 sex differences-in_bronchiolar_epithelial_injury.5[1]
3 sex differences-in_bronchiolar_epithelial_injury.5[1]3 sex differences-in_bronchiolar_epithelial_injury.5[1]
3 sex differences-in_bronchiolar_epithelial_injury.5[1]
 
Antimicrobial peptides and innate immunity
Antimicrobial peptides and innate immunityAntimicrobial peptides and innate immunity
Antimicrobial peptides and innate immunity
 
Shouts and whispers an introduction to immunoregulation in periodontal disease
Shouts and whispers  an introduction to immunoregulation in periodontal diseaseShouts and whispers  an introduction to immunoregulation in periodontal disease
Shouts and whispers an introduction to immunoregulation in periodontal disease
 
Yogev2010
Yogev2010Yogev2010
Yogev2010
 
Microbiology of periodontal disease- part 2
Microbiology of periodontal disease- part 2Microbiology of periodontal disease- part 2
Microbiology of periodontal disease- part 2
 
Intersticial Lung Disease II.pdf
Intersticial Lung Disease II.pdfIntersticial Lung Disease II.pdf
Intersticial Lung Disease II.pdf
 
Mold Toxicity - A Chronic Inflammatory Response Syndrome
Mold Toxicity - A Chronic Inflammatory Response SyndromeMold Toxicity - A Chronic Inflammatory Response Syndrome
Mold Toxicity - A Chronic Inflammatory Response Syndrome
 
Evolution in the pathogenesis of periodontal disease
Evolution in the pathogenesis of periodontal diseaseEvolution in the pathogenesis of periodontal disease
Evolution in the pathogenesis of periodontal disease
 

Mehr von הקואליציה לבריאות הציבור

תכנית לצמצום זיהום האוויר מתחבורה במטרופולין חיפה והקריות
תכנית לצמצום זיהום האוויר מתחבורה במטרופולין חיפה והקריותתכנית לצמצום זיהום האוויר מתחבורה במטרופולין חיפה והקריות
תכנית לצמצום זיהום האוויר מתחבורה במטרופולין חיפה והקריותהקואליציה לבריאות הציבור
 
נסיגה מחוק אוויר נקי? דו"ח מעקב: שנתיים לחוק אוויר נקי
נסיגה מחוק אוויר נקי?  דו"ח מעקב: שנתיים לחוק אוויר נקינסיגה מחוק אוויר נקי?  דו"ח מעקב: שנתיים לחוק אוויר נקי
נסיגה מחוק אוויר נקי? דו"ח מעקב: שנתיים לחוק אוויר נקיהקואליציה לבריאות הציבור
 
זיהום סביבתי ותחלואת נשים בלימפומה שאינה הודג'קין
זיהום סביבתי ותחלואת נשים בלימפומה שאינה הודג'קין זיהום סביבתי ותחלואת נשים בלימפומה שאינה הודג'קין
זיהום סביבתי ותחלואת נשים בלימפומה שאינה הודג'קין הקואליציה לבריאות הציבור
 
על הקשר בין זיהום סביבתי ותחלואת נשים בסרטן ריאה
על הקשר בין זיהום סביבתי ותחלואת נשים בסרטן ריאהעל הקשר בין זיהום סביבתי ותחלואת נשים בסרטן ריאה
על הקשר בין זיהום סביבתי ותחלואת נשים בסרטן ריאההקואליציה לבריאות הציבור
 
המלצות לצמצום תחלואת נשים בישראל מזיהום סביבתי
המלצות לצמצום תחלואת נשים בישראל מזיהום סביבתיהמלצות לצמצום תחלואת נשים בישראל מזיהום סביבתי
המלצות לצמצום תחלואת נשים בישראל מזיהום סביבתיהקואליציה לבריאות הציבור
 

Mehr von הקואליציה לבריאות הציבור (20)

חוות דעת על דוח איגוד ערים חיפה 2011
 חוות דעת על דוח איגוד ערים חיפה 2011 חוות דעת על דוח איגוד ערים חיפה 2011
חוות דעת על דוח איגוד ערים חיפה 2011
 
תכנית לצמצום זיהום האוויר מתחבורה במטרופולין חיפה והקריות
תכנית לצמצום זיהום האוויר מתחבורה במטרופולין חיפה והקריותתכנית לצמצום זיהום האוויר מתחבורה במטרופולין חיפה והקריות
תכנית לצמצום זיהום האוויר מתחבורה במטרופולין חיפה והקריות
 
מדריך: מרחקי הפרדה - למען בטיחות הציבור
מדריך: מרחקי הפרדה - למען בטיחות הציבורמדריך: מרחקי הפרדה - למען בטיחות הציבור
מדריך: מרחקי הפרדה - למען בטיחות הציבור
 
נסיגה מחוק אוויר נקי? דו"ח מעקב: שנתיים לחוק אוויר נקי
נסיגה מחוק אוויר נקי?  דו"ח מעקב: שנתיים לחוק אוויר נקינסיגה מחוק אוויר נקי?  דו"ח מעקב: שנתיים לחוק אוויר נקי
נסיגה מחוק אוויר נקי? דו"ח מעקב: שנתיים לחוק אוויר נקי
 
כימיקלים מסוכנים בבית
כימיקלים מסוכנים בביתכימיקלים מסוכנים בבית
כימיקלים מסוכנים בבית
 
סיכונים בריאותיים מזיהום מי תהום בישראל
סיכונים בריאותיים מזיהום מי תהום בישראלסיכונים בריאותיים מזיהום מי תהום בישראל
סיכונים בריאותיים מזיהום מי תהום בישראל
 
תסקיר השפעה על הסביבה - בז"ן
תסקיר השפעה על הסביבה - בז"ןתסקיר השפעה על הסביבה - בז"ן
תסקיר השפעה על הסביבה - בז"ן
 
עתירה לבג"צ: סגרו את חוות הגז בקריית אתא
עתירה לבג"צ: סגרו את חוות הגז בקריית אתאעתירה לבג"צ: סגרו את חוות הגז בקריית אתא
עתירה לבג"צ: סגרו את חוות הגז בקריית אתא
 
זכויות הילד: זיהום סביבתי ותחלואת ילדים
זכויות הילד: זיהום סביבתי ותחלואת ילדיםזכויות הילד: זיהום סביבתי ותחלואת ילדים
זכויות הילד: זיהום סביבתי ותחלואת ילדים
 
Biogas
BiogasBiogas
Biogas
 
צמצום זיהום אוויר מתחבורה ברשויות מקומיות
צמצום זיהום אוויר מתחבורה ברשויות מקומיותצמצום זיהום אוויר מתחבורה ברשויות מקומיות
צמצום זיהום אוויר מתחבורה ברשויות מקומיות
 
עשור של פעילות
עשור של פעילותעשור של פעילות
עשור של פעילות
 
זיהום סביבתי ותחלואת נשים בלימפומה שאינה הודג'קין
זיהום סביבתי ותחלואת נשים בלימפומה שאינה הודג'קין זיהום סביבתי ותחלואת נשים בלימפומה שאינה הודג'קין
זיהום סביבתי ותחלואת נשים בלימפומה שאינה הודג'קין
 
על הקשר בין זיהום סביבתי ותחלואת נשים בסרטן ריאה
על הקשר בין זיהום סביבתי ותחלואת נשים בסרטן ריאהעל הקשר בין זיהום סביבתי ותחלואת נשים בסרטן ריאה
על הקשר בין זיהום סביבתי ותחלואת נשים בסרטן ריאה
 
זיהום סביבתי ותחלואה במחלות לב בנשים בישראל
זיהום סביבתי ותחלואה במחלות לב בנשים בישראלזיהום סביבתי ותחלואה במחלות לב בנשים בישראל
זיהום סביבתי ותחלואה במחלות לב בנשים בישראל
 
זיהום סביבתי ותחלואת נשים בישראל בסרטן
זיהום סביבתי ותחלואת נשים בישראל בסרטן זיהום סביבתי ותחלואת נשים בישראל בסרטן
זיהום סביבתי ותחלואת נשים בישראל בסרטן
 
המלצות לצמצום תחלואת נשים בישראל מזיהום סביבתי
המלצות לצמצום תחלואת נשים בישראל מזיהום סביבתיהמלצות לצמצום תחלואת נשים בישראל מזיהום סביבתי
המלצות לצמצום תחלואת נשים בישראל מזיהום סביבתי
 
זיהום אוויר ומחלות לב בנשים
זיהום אוויר ומחלות לב בנשיםזיהום אוויר ומחלות לב בנשים
זיהום אוויר ומחלות לב בנשים
 
מה ידוע על זיהום סביבתי ותחלואת נשים?
מה ידוע על זיהום סביבתי ותחלואת נשים?מה ידוע על זיהום סביבתי ותחלואת נשים?
מה ידוע על זיהום סביבתי ותחלואת נשים?
 
איך לעזור לכנסת לעזור לך? מאיה קרבטרי
איך לעזור לכנסת לעזור לך? מאיה קרבטריאיך לעזור לכנסת לעזור לך? מאיה קרבטרי
איך לעזור לכנסת לעזור לך? מאיה קרבטרי
 

Kürzlich hochgeladen

College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceNehru place Escorts
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girlsnehamumbai
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...Miss joya
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...narwatsonia7
 
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowKolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowNehru place Escorts
 
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort ServiceCall Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Serviceparulsinha
 
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service LucknowCall Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknownarwatsonia7
 
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Servicesonalikaur4
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfMedicoseAcademics
 
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowSonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowRiya Pathan
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptxDr.Nusrat Tariq
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% SafeBangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safenarwatsonia7
 
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...narwatsonia7
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Miss joya
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformKweku Zurek
 
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...narwatsonia7
 

Kürzlich hochgeladen (20)

College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
 
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
 
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
 
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowKolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
 
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort ServiceCall Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
 
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service LucknowCall Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
 
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
 
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Servicesauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
 
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowSonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptx
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
 
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% SafeBangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
 
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy Platform
 
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
 

Zelikoff Metals

  • 1. Metals Toxicity A Role for Associated Transition Metals in the Immunotoxicity of Inhaled Ambient Particulate Matter Judith T. Zelikoff, Kimberly R. Schermerhorn, Kaijie Fang, Mitchell D. Cohen, and Richard B. Schlesinger Nelson Institute of Environmental Medicine, New York University School of Medicine, Tuxedo, New York, USA previously infected with S. pneumoniae were subsequently exposed to concentrated PM Epidemiologic studies demonstrate that infection, specifically pneumonia, contributes substan- with aerodynamic diameter ≤ 2.5 µm tially to the increased morbidity and mortality among elderly individuals following exposure to (PM2.5) (at a level at or just above the PM2.5 ambient particulate matter (PM). This laboratory has previously demonstrated that a single National Ambient Air Quality Standard inhalation exposure of Streptococcus pneumoniae–infected rats to concentrated ambient PM2.5 (particulate matter with aerodynamic diameter ≤ 2.5 µm) from New York City (NYC) air exacer- [NAAQS]) from New York City (NYC) to determine whether acute exposure to PM bates the infection process and alters pulmonary and systemic immunity. Although these results induces immunologic alterations within the provide some basis for explaining the epidemiologic findings, the identity of specific PM con- lungs that could exacerbate an ongoing stituents that might have been responsible for the worsening pneumonia in exposed hosts remains S. pneumoniae infection. Results from these unclear. Thus, studies were performed to correlate the physicochemical attributes of ambient studies demonstrated that a single inhalation PM2.5 with its in vivo immunotoxicity to identify and characterize the role of constitutive transi- exposure of ambient PM2.5 worsened disease tion metals in exacerbating an ongoing streptococcal infection. Uninfected or previously infected outcome and compromised both local and rats were exposed in the laboratory to soluble divalent Fe, Mn, or Ni chloride salts. After exposure, systemic immune defense mechanisms in uninfected rats were sacrificed and their lungs were lavaged. Lungs from infected hosts were used exposed animals (12). to evaluate changes in bacterial clearance and effects of exposure on the extent/severity of infec- Studies were also performed to determine tion. Results demonstrated that inhalation of Fe altered innate and adaptive immunity in unin- which constituent(s) might be responsible for fected hosts, and both Fe and Ni reduced pulmonary bacterial clearance in previously infected rats. the observed worsening of pneumonia in The effects on clearance produced in infected Fe-exposed rats were similar to those seen in PM-exposed hosts. Based upon results from a infected rats exposed to ambient NYC PM. Taken together, these studies demonstrate that number of in vivo and in vitro investigations inhaled ambient PM can worsen the outcome of an ongoing pulmonary infection and that associ- demonstrating the role of particle-associated ated Fe may play some role in the immunotoxicity. Key words: air pollution, immunotoxicity, transition metals in mediating PM-related inhalation, metals, particulate matter, pulmonary immune defenses. Environ Health Perspect health effects (13–16), as well as the ability of 110(suppl 5):871–875 (2002). some of the same metals to suppress host http://ehpnet1.niehs.nih.gov/docs/2002/suppl-5/871-875zppppppppppppppppppelikoff/abstract.html immunocompetence (17), experimental stud- ies were performed to characterize the role of Epidemiologic studies have reported that observed increase in particle-induced constitutive transition metals in exacerbating exposure to ambient levels of airborne particu- mortality in elderly individuals. Studies ongoing pneumococcal infections. late matter with an aerodynamic diameter of using rodent models have clearly demon- ≤ 10 µm (PM10) results in consistent increases strated that exposure to inhaled particles Materials and Methods in morbidity and mortality (1–3), and that (alone or in combination with gaseous air Experimental Animals elderly individuals seem to be particularly pollutants) can compromise pulmonary host affected (4,5). Infection, specifically pneumo- Pathogen-free male Fischer 344 rats (Harlan resistance against microbial infections nia, contributes substantially to the mortality Sprague Dawley, Indianapolis, IN, USA) 7–9 and/or alter specific immune mechanisms among elderly individuals exposed to PM, and months of age were quarantined for at least important for antibacterial defense. For disproportionate increases in deaths due to 1 week prior to use in any experiments. Rats example, Aranyi et al. (9) demonstrated that pneumonia have been observed immediately were housed individually in stainless steel intratracheal (IT) instillation of mice with or just after even moderate episodes of particu- cages in temperature- and humidity-con- either quartz, ferric oxide, calcium carbon- late air pollution (6,7). These epidemiologic trolled rooms and provided food and water ate, or sodium feldspar particles increased findings suggest that PM may act as an ad libitum. In addition to serology testing for mortality from subsequent infection with S. immunosuppressive factor that can undermine viral and bacterial pathogens, rats were exam- pneumoniae. In other bacterial infectivity the normal pulmonary immune response. ined routinely during the exposure studies for studies, instillation of aged urban air parti- Thus, given that older individuals with chronic any gross indication of spontaneous infection cles (0.4 µm, mass median aerodynamic respiratory disease are not only at increased risk or for mucosal irritation due to exposure. diameter [MMAD]) and/or coal fly ash par- of pneumonia but also are less likely to recover ticles (0.9 µm MMAD) reduced the resis- from infections (8), alterations in the pul- tance of mice to bacterial infection (10). This article is part of the monograph Molecular monary immune system may well play a role Moreover, studies in this laboratory demon- Mechanisms of Metal Toxicity and Carcinogenicity. in the observed increase in mortality following strated that inhalation of woodsmoke efflu- Address correspondence to J.T. Zelikoff, New PM episodes. ents reduced pulmonary clearance of York University School of Medicine, 57 Old Forge Toxicologic studies demonstrating the IT-instilled Staphylococcus aureus (11). Rd., Tuxedo, New York 10987-5007 USA. immunosuppressive potential of particles in Although it has been demonstrated that Telephone: (845) 731-3528. Fax: (845) 351-5472. E-mail: judyz@env.med.nyu.edu the lungs strengthen the epidemiologic the elderly with preexisting disease appear to The authors thank L. Wang for her help in initiat- observations and support the hypothesis that be at higher risk from the adverse effects of ing this project. This work was supported by U.S. compromised pulmonary host immunocom- PM than healthy individuals, considerable Environmental Protection Agency Center grant petence and immune defense mechanisms uncertainty remains about specific biologic R827351 and Health Effects Institute contract important for resistance against Streptococcus mechanisms that might underlie this effect. 94-03A. pneumoniae infections contribute to the Thus, studies were performed in which rats Received 2 April 2002; accepted 4 June 2002. 871 Environmental Health Perspectives • VOLUME 110 | SUPPLEMENT 5 | OCTOBER 2002
  • 2. Metals Toxicity Zelikoff et al. • Infected rats were maintained individually in into fresh Todd Hewitt (TH) broth and which were measured on a percentage scale, HEPA filter-top cages and housed in an maintained at 37°C in a 5% CO2 atmosphere. the need for arcsine transformation was deter- onsite Biosafety Level 2 facility. Animals used The cultures were then passaged at 12-hr inter- mined prior to analysis. Differences were in this research have been treated humanely vals using a protocol that maintained both the considered significant at p < 0.05. according to institutional guidelines. virulence and capsulated nature of the organ- Results ism. On the day of instillation, the bacterial Experimental Design concentration was spectrophotometrically In studies examining the effects of concen- Male rats previously infected by IT instillation determined using an absorbance calibration trated ambient PM (CAPS), previously with 15–20 × 106 S. pneumoniae were exposed curve prepared at 540 nm and a suspension infected rats were sacrificed 4.5, 9, 18, 24, for 5 hr to either ambient NYC PM2.5 (65–90 diluted with phosphate-buffered saline (PBS) and 120 hr after exposure, and effects upon µg/m3) or to a single PM-associated transition to a suitable concentration for delivery of 1–2 bacterial burdens were determined (Figure 1). × 107 organisms in a 100-µL volume. metal (i.e., iron [Fe2+], manganese [Mn2+], or Results demonstrated that although numbers nickel [Ni2+]) of a similar concentration and At designated time intervals, cohorts of of pulmonary bacteria were approximately MMAD (i.e., 0.4 µm; Σg = 2.4 µm) and then four rats each were sacrificed by injection of equal in the two exposure groups at the sacrificed at different time points postexpo- Nembutal (sodium phenobarbital; 80 earliest postexposure time point (i.e., 4.5 hr sure. Effects of inhaled transition metals were mg/kg, sc) and the lungs were removed, postexposure), bacterial burdens in the also determined in uninfected rats. At the weighed, and homogenized (19). To obtain CAPS-exposed animals were approximately time of sacrifice, lungs were a) lavaged to pro- estimates of total remaining viable organ- 10% above those measured in the air controls vide fluid for evaluation of markers of lung isms, aliquots of the homogenate were seri- by 9 hr; by 18 hr, burdens were elevated cell damage (i.e., lactate dehydrogenase ally diluted and plated onto triplicate sheep >300%. After 24 hr CAPS-exposed rats had [LDH] and total protein) or to provide cells blood-TH agar plates for a 24-hr incubation substantially greater (i.e., 70% change from for characterization; b) fixed for histopatho- at 37°C (in 5% CO2) before enumeration. control) bacterial burdens than infected con- logic examination; or c) homogenized for Both the absolute levels of bacteria and the trol rats. At 5 days postexposure, total num- determination of effects on pulmonary bacter- levels of bacteria per gram lung compared ber of bacteria per gram lung was still 30% ial burdens. Blood taken from the portal vein with those in three randomly infected rats above that measured in the lungs of the prior to sacrifice was used to determine rela- sacrificed immediately prior to beginning infected air-exposed controls. tive percentages of circulating white blood inhalation exposure were used as indices of Uninfected rats exposed nose-only to either Fe, Mn, or Ni at 65–90 µg/m 3 cells. A total of 100 white blood cells per slide bacterial survival. (two slides per preparation) were counted for demonstrated significant alterations in blood Bronchopulmonary Lavage and differential counts. cell profiles (Figure 2A, B, C, respectively). Biologic Assays Although polymorphonuclear leukocyte Exposures At sacrifice, lungs from uninfected rats were (PMN) levels significantly increased, Ambient PM and filtered air exposures lavaged by washing the left lung in situ twice with Ca 2 + - and Mg 2 + -free PBS took place in Teflon nose-only exposure (% change compared with filtered-air control) units (CH International, Westwood, NJ, according to previously employed methods ** USA) located in a building overlooking a (20). Spleens were also recovered and placed 300 main thoroughfare in Manhattan, NYC. in RPMI 1640 on ice until processed for Relative bacterial burdens Concentrated ambient PM 2.5 air was pro- measurement of lymphoproliferative duced using a Gerber centrifugal concentra- responses. Aliquots of acellular lavage fluid 200 tor; gaseous pollutants such as ozone, sulfur were then used to evaluate LDH activity dioxide, nitrogen dioxide, and ammonia and total protein (21). Lavaged cell num- 100 were removed prior to exposure (18). The bers and viability were determined by * exposure atmosphere was continuously mon- hemocytometer counting and trypan blue itored using a condensation particle counter exclusion, respectively. Recovered lavaged 0 and real-time aerosol monitor. In addition, cell types were subsequently characterized filter samples were collected during exposure morphologically by differential counting of on Teflon membrane filters to gravimetri- stained cells. Basal and serum-opsonized, –100 0 4.5 9 18 24 120 cally measure integrated exposure mass con- zymosan-stimulated production of super- oxide anion (O 2 •– ) by pulmonary macro- Time postexposure (hr) centrations on a Cahn electrobalance. For the individual metal exposure studies, phages (Mø) was assessed using a microtiter Figure 1. A single exposure of already-infected rats previously infected and naive rats were plate assay based upon the reduction of fer- to CAPS significantly increased pulmonary bacter- exposed by inhalation (i.e., nose-only) for 5 hr ricytochrome c (20). Proliferation of splenic ial burdens of S. pneumoniae in a time-dependent manner (compared with the infected, air-exposed to chloride salts of either Fe, Mn, or Ni at a T and B lymphocytes was measured in control). Estimates of viable bacterial organisms concentration of 65–90 µg/m3. All atmos- response to stimulation with concanavalin were determined from colony counts on blood-TH pheres were generated by passing freshly pre- (Con) A and lipopolysaccharide (LPS), agar 24 hr after plating. Both the absolute levels of pared solutions of each metal compound respectively (22). bacteria and the levels of bacteria per gram lung through a collision nebulizer; generated parti- compared with those in three randomly-infected Statistical Analyses cles were then delivered to each rat held in rats sacrificed immediately prior to beginning inhalation exposure were used as indices of bacte- individual body tubes (CH International) on The effects of PM exposure itself upon each rial survival. Postexposure time 0 represents those a single-exposure tree (12). of the assayed parameters (i.e., exposed vs. air burdens determined immediately prior to exposure. control), as well as those effects associated Asterisk (*) indicates value significantly different Pulmonary Bacterial Clearance with length of time post-PM exposure, were from filtered-air control (p < 0.05). Double asterisks Six days prior to instillation, S. pneumoniae analyzed using a two-way analysis of variance. (**) indicate significantly different from filtered-air (encapsulated, type 3) was introduced For outcomes such as bacterial clearance, control (p < 0.01). 872 110 | SUPPLEMENT 5 | OCTOBER 2002 • Environmental Health Perspectives VOLUME
  • 3. Metals Toxicity Role of associated metals in PM immunotoxicity • lymphocyte values significantly decreased at to inhibit clearance, inhalation of Fe facili- air-exposed control animals (Table 1). 1 hr postexposure; however, by 18 hr post- tated an increase in overall bacterial numbers. Although lung cell viability was unaffected at exposure, leukocyte values reached control Inhalation of Fe by infected rats also 18 hr postexposure, lavageable cell numbers levels. Acute inhalation of Mn and Fe had no altered lavageable cell numbers and immune in the Fe-exposed infected rats decreased by effect upon lavageable cell number or lung cell profile compared with those of infected 35% compared with levels in time-matched histologic profile, and none of the metals PMN Lymphocyte Con A-stimulated LPS-stimulated altered cell viability or LDH activity (com- 0.6 100 A pared with control). In contrast, inhalation Fe A Air Optical density of Ni significantly reduced lavaged cell num- * 80 Fe 0.4 bers by 25% (i.e., 40 × 106 vs 30 × 106 cells 60 for control and Ni-exposed rats, respectively) 0.2 and increased percent lung involvement and 40 * alveolar edema/exudate 1 hr postexposure * 0 20 (data not shown). 0.6 Metal exposure also altered certain pul- Ni B 0 Optical density 1 18 48 1 18 48 monary and systemic immune functional 0.4 100 activities in uninfected animals. Inhalation B * Air exposure to Fe significantly increased (com- 80 Mn 0.2 pared with time-matched air controls) basal * Percentage production of O2•– by lavaged Mø 18 and 48 60 0 hr postexposure (Figure 3); inhalation of Fe Air 1 18 48 Air 1 18 48 40 had no effects on O2•– production by stimu- * Time postexposure (hr) lated Mø at any postexposure time point. 20 Figure 4. Inhalation of Fe (A) and Ni (B) by naive rats Although exposure of naive rats to Mn had no alters proliferative responses of mitogen-stimulated 0 effect upon lymphoproliferation (data not 1 18 48 1 18 48 B and T lymphocytes, respectively. Each bar (except shown), inhalation of Fe or Ni significantly 100 pooled air control, which represents the mean of 12 C altered the ability of splenic lymphocytes to rats) represents the mean (± SD) from four rats per Air * 80 Ni exposure group. Asterisk (*) indicates value signifi- proliferate in response to mitogen stimulation cantly different from individual time-matched air (Figure 4A, B). Inhalation of Fe significantly 60 control (p < 0.05). reduced B-lymphocyte proliferation in 40 10 response to LPS stimulation 48 hr postexpo- * A Mn Initial burden sure, but had no effect upon Con A–stimu- Preexposure burden 8 20 18 hr postair lated T-lymphocyte proliferation at any 18 hr postmetal 6 0 postexposure time point (Figure 4A); at 48 hr 1 18 48 1 18 48 postexposure, inhaled Fe suppressed unstimu- 4 Time postexposure (hr) lated T-lymphocyte proliferation. On the 2 Figure 2. Inhalation (i.e., nose-only) of Fe (A), Mn other hand, T cells proved more sensitive to Streptococcus pneumoniae levels (log10) (B), or Ni (C) by uninfected rats alters circulating the immunotoxic effects of inhaled Ni than 0 blood cell profiles. Each bar represents the mean did B lymphocytes. T-cell proliferation was 10 (± SD) from four rats per exposure group. Asterisk B Ni significantly reduced (compared with the air (*) indicates value significantly different from time- 8 control) by inhaled Ni 18 hr postexposure and matched air control (p < 0.05). 6 returned to control levels after 48 hr; B-cell * responses to LPS stimulation were uniformly 2.0 4 Unstimulated unaffected by Ni exposure (Figure 4B). * 2 Air Figure 5 illustrates the effects of inhaled Fe Mn, Ni, and Fe on pulmonary bacterial clear- nmoles (O2 –)/105 Mø/30 min 0 1.5 ance. Although a single inhalation of Mn had 10 * C Fe no significant effect upon bacterial lung bur- * 8 dens (as represented as total burdens) com- 1.0 pared with the time-matched air controls 6 (Figure 5A), exposure to Ni or Fe signifi- • 4 cantly altered bacterial clearance (Figure 5B, C, respectively). Although pulmonary pneu- 2 0.5 mococcal levels in air-exposed infected rats 0 dropped significantly 18 hr following expo- Total burdens sure (compared with burdens measured in Figure 5. Burdens of S. pneumoniae in the lungs of 0 rats sacrificed immediately prior to exposure), 1 18 48 Mn- (A), Ni- (B), and Fe- (C) exposed infected rats exposure to Ni inhibited clearance and bacte- 18 hr postexposure. Estimates of viable bacterial Time postexposure (hr) organisms were determined from colony counts on rial burdens remained the same as those mea- Figure 3. Inhalation of Fe by uninfected rats blood-TH agar 24 hr after plating. Absolute levels of sured just prior to metal exposure (Figure increased unstimulated O2.– production by lavaged bacteria were used as indices of bacterial survival. 5B). Conversely, inhalation of Fe increased Mø 18 and 48 hr postexposure. Each bar repre- Each bar represents the mean (± SD) from five rats pulmonary streptococcal levels compared sents the mean (± SD) from four rats per exposure per exposure group. Asterisk (*) indicates value with preexposure bacterial burdens (Figure group. Asterisk (*) indicates value significantly dif- significantly different from time-matched air con- ferent from time-matched air control (p < 0.05). 5C). Thus, whereas exposure to Ni appeared trol (p < 0.05). 873 Environmental Health Perspectives • VOLUME 110 | SUPPLEMENT 5 | OCTOBER 2002
  • 4. Metals Toxicity Zelikoff et al. • Table 1. Inhalation of Fe by Streptococcus pneumoniae-infected hosts alters lavageable lung immune cell numbers and profiles. Total cells Cell type (%)b Hours post- Hours post- recovered infectiona (× 107) Treatment exposure Viability (%) PMN Lymphocyte Macrophage Air 51 3 3.3 ± 1.0 86.0 ± 4.0 30.0 ± 14.0 9.0 ± 0.2 60.0 ± 14.0 Fe 51 3 2.6 ± 1.0 84.0 ± 3.0 25.0 ± 2.0 14.0 ± 6.0 61.0 ± 4.0 Air 66 18 2.6 ± 0.1 87.0 ± 2.0 26.0 ± 9.0 11.0 ± 2.0 63.0 ± 7.0 Fe 66 18 *1.7 ± 0.3 83.0 ± 5.0 *8.0 ± 7.0 *4.0 ± 2.0 *88.0 ± 6.0 were infected with 10–20 × 106 S. pneumoniae. bMean ± SD of five rats per exposure group.*Indicates significant difference (p < 0.05) from time-matched air control. aRats air controls. At this same time point, relative Decreased percentages of PMNs may have of alveolar Mø followed within 2 days by percentages of lavageable PMNs and lympho- been due, at least in part, to the previously suppressed phagocytic activity and enhanced cytes in Fe-exposed rats dropped approxi- observed CAPS-induced downregulation of lipid peroxidation (31). Similar findings mately 3-fold, whereas Mø values increased tumor necrosis factor (TNF)α and/or inter- have also been observed in rabbits exposed by 29%. leukin (IL)-1α production (12); both of these by inhalation of Ni dust for 1–6 months cytokines are critical for the mobilization and (32). Alveolar Mø recovered from rabbits Discussion activation of PMNs in response to many exposed to NiCl2 aerosol for 1 month also Gram-positive [G + ] microbial organisms Studies to determine whether inhalation displayed suppressed phagocytic ability as exposure to concentrated PM2.5 could exacer- including S. pneumoniae (27). Moreover, since well as decreased levels of lysozyme (used by Mø to break down G+ bacterial cell walls) bate an ongoing pneumococcal infection TNFα in conjunction with IL-12 enhances demonstrated that a single 5-hr exposure of the microbicidal capacity of PMNs (28), the both in pulmonary phagocytes and bron- S. pneumoniae–infected rats to CAPS (at con- immune cells still present in the lungs may chopulmonary lavage fluid. Moreover, a centrations at or slightly greater than 65 display reduced cytotoxic activities. number of studies have concluded that µg/m3) exacerbated the infection process in a Inorganic constituents of airborne PM inhalation/instillation of certain Ni com- time-dependent manner and altered both such as sulfate, nitrate, ammonium, and tran- pounds, including NiCl2, reduces host abil- pulmonary and systemic immunity (12). This sition metals, which make up a substantial ity to defend against pathogenic lung was not surprising, given that lungs contain- part of the mass apportionment of ambient infections (30). Given that lysozyme activity ing extant pulmonary inflammation appear to PM, represent potential causal constituents has been correlated with the ability to clear certain G + bacterial lung pathogens, and be primed for injurious responses to air parti- for PM-associated health effects. Although a cles (23). It appears from these studies that number of different physiochemical factors that the major cellular target of inhaled Ni CAPS may be acting to alter lung antibacter- have been linked to PM toxicity (i.e., acid appears to be Mø (and other antigen pre- ial defense mechanisms important in the han- aerosols, particle size, oxidative potential), senting cells), it is likely that Ni-induced dling of ongoing pneumococcal infections. evidence is rapidly accumulating that much effects upon antibacterial defense may be This scenario fits temporally with the epi- of the pulmonary toxicity associated with due, at least in part, to suppressive effects on demiologic data that indicate that deaths inhaled PM is related to the types and this phagocyte-associated enzyme. among exposed individuals occur relatively amounts of the soluble forms of transition Fe is a key microelement necessary to quickly following a PM episode, and that metals (13,14,16). maintain cellular homeostasis. Normal func- individuals with chronic respiratory disease Metals are ubiquitous constituents of tioning of the immune system relies on trace were less likely than healthy individuals to PM derived from anthropogenic and certain amounts of Fe to serve as a cofactor for spe- recover from pulmonary infections following types of natural emissions. PM emissions cific metalloenzymes and for the intracellular PM exposure (1,24, 25). from oil-burning power plants and other formation of reactive oxygen species used for Although no definitive conclusions can be industries that contribute to air pollution killing phagocytosed pathogens. Both defi- reached at this time regarding the mecha- contain large amounts of metals such as V, ciency and excessive levels of Fe can lead to nism(s) by which inhaled concentrated PM2.5 Fe, Ni, Zn, and Cu (15,16). Moreover, immune dysfunction (33). Although most may have acted to increase pulmonary bur- studies from this laboratory have demon- studies have focused upon the immunomodu- dens of infectious pneumococci, compromised strated the presence of Mn in concentrated lating effects associated with deficiency, Fe pulmonary immune defense mechanisms NYC PM (29). Although inflammation was overload has been shown to suppress antibody important for the removal/killing of S. pneu- not observed in this study, human exposure responses, T-lymphocyte functions (i.e., inter- moniae (i.e., modified availability of PMNs) to airborne metals have been shown to feron-γ production and delayed contact or increased bacterial survival as a result of induce pulmonary inflammatory responses hypersensitivity), and nonspecific immunity CAPS-induced changes in the lung milieu are such as tracheobronchitis, asthma, chemical (33). For example, bactericidal activities of two plausible hypotheses by which this may pneumonitis, and alveolitis. Recent studies Mø from patients with Fe overload and of have occurred. In support of the former, have shown that acute exposure of rats to leukocytes treated in vitro with Fe salts were CAPS exposure of rats with ongoing pneumo- mixtures of metallic compounds derived markedly reduced (34); inhibition of basic nia reduced the relative percentages of lavage- from ambient air PM or from combustion cationic proteins appeared to be responsible able PMNs 24, 48, and 72 hr postexposure source emissions (i.e., residual oil fly ash) for these reductions. In contrast, results from compared with that observed in the air- can induce pronounced pulmonary inflam- experimental studies have suggested that Fe- exposed infected controls (12). Given that mation characterized by increased permeabil- overloaded Mø have improved bactericidal PMNs, in the presence of opsonizing comple- ity to protein and neutrophilic alveolitis (13). ability (35). Discrepancies between the studies ment and immunoglobulins, are the main cell Many transition metals associated with may be due to differences in host species type responsible for the clearance of S. pneu- PM are potent modulators of pulmonary and/or the particular microorganism being moniae from the lungs of most animal models and/or systemic immunocompetence (30). targeted by the phagocyte. More consistent and humans (26), a PM-induced reduction For example, both parenteral and inhalation effects of Fe excess have been observed on nat- could lead to prolongation of infection. exposure of soluble NiCl2 causes activation ural killer cell cytotoxicity and neutrophilic 874 110 | SUPPLEMENT 5 | OCTOBER 2002 • Environmental Health Perspectives VOLUME
  • 5. Metals Toxicity Role of associated metals in PM immunotoxicity • killing of S. pneumoniae. As has been observed is needed to conclusively confirm or refute 18. Gordon T, Chen LC, Fang CP, Gerber H. A centrifugal con- centrator for use in inhalation toxicology studies. Inhal in clinical and experimentally induced Fe defi- the role of transition metals in PM-associated Toxicol 11:71–87 (1999). ciency (36), patients with clinical diseases of immunosuppression, results contribute to a 19. Cohen MD, Sisco M, Li Y, Zelikoff JT, Schlesinger RB. Fe overload (i.e., thalassemia major) have better understanding of the possible mecha- Immunomodulatory effects of ozone upon in situ cell- decreased bactericidal, fungicidal, and oxida- nism(s) by which exposure to PM2.5 may act mediated responses in the lungs. Toxicol Appl Pharmacol 171:71–84 (2001). tive burst activities (33); neutrophil-associated to increase host mortality in exposed elderly 20. Cohen MD, McManus TP, Yang Z, Qu Q, Schlesinger RB, oxidative burst activity was also diminished in individuals. Zelikoff JT. Vanadium alters macrophage interferon-γ proportion to the degree of Fe overload. interactions and interferon-inducible responses. Toxicol Appl Pharmacol 138:110–120 (1996). REFERENCES AND NOTES Although inhaled Fe may have led to 21. Zelikoff JT, Parsons E, Schlesinger RB. Immuno- increased pulmonary burdens of S. pneumo- modulating activity of inhaled particulate lead oxide dis- 1. Pope CA. Respiratory hospital admissions associated with niae in this study by interfering with phago- rupts pulmonary macrophage-mediated functions PM10 pollution in Utah, Salt Lake, and Cache Valleys. Arch important for host defense and tumor surveillance in the cyte-mediated killing, another possibility is Environ Health 46:92–97 (1991). lung. Environ Res 62:207–222 (1993). that freely available inhaled Fe may have even- 2. Seaton A, MacNee W, Donaldson K, Godden D. 22. Schlesinger RB, Cohen MD, Gordon T, Nadziejko C, Particulate air pollution and acute health effects. Lancet tually overwhelmed the binding capacities of Zelikoff JT, Sisco M, Regal JF, Menache M. Ozone differ- 345:176–178 (1995). entially modulates airway responsiveness in atopic vs the nascent Fe-binding proteins transferrin 3. Thurston GD, Ito K, Kinney PL, Lippmann M. A multi-year non-atopic guinea pigs. Inhal Toxicol 14:431–457 (2002). and lactoferrin normally operational in lung study of air pollution and respiratory hospital admissions 23. Imrich A, Ning YY, Kobzik L. Insoluble components of con- fluid (37), thereby allowing bacteria that in three New York state metropolitan areas: results for centrated air particles mediate alveolar macrophage 1988 and 1989 summers. J Expo Anal Environ Epidemiol responses in vitro. Toxicol Appl Pharmacol 167(2):140–150 require Fe as an essential nutrient (including 2:1–21 (1992). (2000). S. pneumoniae) to freely incorporate the metal 4. Schwartz J. Total suspended particulate matter and daily 24. Dockery DW, Schwartz J, Spengler JD. Air pollution and and proliferate. mortality in Cincinnati, Ohio. Environ Health Perspect daily mortality: associations with particulates and acid 102:186–189 (1994). Mn, a dissociable cofactor for several aerosols. Environ Res 59:362–373 (1992). 5. Schwartz J. Air pollution and daily mortality: a review and 25. Lebowitz MD. Epidemiological studies of the respiratory enzymes including one of great importance in meta-analysis. Environ Res 64:35–52 (1994). effects of air pollution. Eur Respir J 9:1029–1054 (1996). the lungs, superoxide dismutase, is also 6. Schwartz J. What are people dying of on high air pollution 26. Coonrod JD, Yoneda K. Comparative role of complement days? Environ Res 64:26–35 (1994). required for growth of virtually all living cells. in pneumococcal and staphylococcal pneumonia. Infect 7. Ware JH, Ferris BG, Dockery DW, Spengler JD, Stram DO. Immunol 37:1270–1277 (1982). Like Fe, shifts in Mn levels in either direction Effects of ambient sulfur oxides and suspended particles 27. Heumann D, Barbas C, Severin A, Glauser MP, Tomasz A. can bring about immune dysfunction. on respiratory health of pre-adolescent children. Am Rev Gram-positive cell-walls stimulate synthesis of tumor Respir Dis 133:824–842 (1986). Inhalation of high concentrations of Mn by necrosis factor-α and interleukin-6 by human monocytes. 8. Vial WC, Towes GB, Pierce AK. Early pulmonary granulo- Infect Immunol 62:2715–2721 (1995). occupationally exposed workers has been cyte recruitment in response to Streptococcus pneumo- 28. Janeway CA, Travers P, eds. Immunobiology: The Immune shown to cause Mn pneumonitis and niae. Am Rev Respir Dis 129:87–91 (1984). System in Health and Disease. London/New York:Current 9. Aranyi C, Graf JL, O’Shea WJ, Graham JA, Miller FF. The croupous pneumonia. In rodents, inhalation Biology Ltd./Garland Publishing, 1996. effects of intratracheally-administered coarse mode parti- 29. Zelikoff JT, Chen LC, Cohen MD, Fang K, Gordon T, Li Y et of insoluble Mn at milligram concentrations cles on respiratory tract infection in mice. Toxicol Lett al. Unpublished data. impairs pulmonary bacterial clearance and 19:63–72 (1983). 30. Cohen MD, Zelikoff JT, Schlesinger RB, eds. Pulmonary increases bacterial-associated host mortality 10. Hatch GE, Slade R, Boykin E, Hu PC, Miller FJ, Gardner, Immunotoxicology. Boston:Kluwer Academic Press, 2000. DE. Correlation of effects of inhaled versus intratra- 31. Sunderman FW Jr, Hopfer SM, Lin SM, Plowman MC, (30). Other studies have demonstrated that cheally-injected metals on susceptibility to respiratory Stojanivic T, Wong SH, Zaharia O, Ziebka L. Toxicity of exposure of hosts already bearing a viral lung infection in mice. Am Rev Respir Dis 124:167–173 (1985). alveolar macrophages in rats following parenteral injec- infection for 24 or 48 hr prior to a 3-hr expo- 11. Zelikoff JT. Woodsmoke, kerosene heater emissions, and tion of nickel chloride. Toxicol Appl Pharmacol diesel exhaust. In: Pulmonary Immunotoxicology (Cohen sure to insoluble Mn had a shorter time to 100:107–118 (1989). MD, Zelikoff JT, Schlesinger RB, eds). Boston:Klewar 32. Johansson A, Camner P. Effects of nickel dust on rabbit death than their air-exposed counterparts Academic Press, 2000;369–386. alveolar epithelium. Environ Res 22:510–516 (1980). (38,39). Furthermore, although the effects of 12. Zelikoff JT, Nadziejko C, Fang K, Gordon T, Premdass C, 33. Omara FO, Brousseau P, Blakley BR, Fournier M. Iron, Cohen MD. Short-term, low-dose inhalation of ambient soluble Mn on alveolar Mø function are still zinc, and copper. In: Immunotoxicology of Environmental particulate matter exacerbates ongoing pneumococcal and Occupational Metals (Zelikoff JT, Thomas PT, eds). being debated, in vitro studies have demon- infections in Streptococcus pneumoniae-infected rats. In: London:Taylor and Francis, 1999;231–262. strated reductions in phagocytic activity. Proceedings of the Third Colloquium on Particulate Air 34. Ballart IJ, Estevez ME, Sen L, Diez RA, Giuntoli RA, de Pollution and Human Health (Phalen R, Bell Y, eds). Irvine, Discrepancies between these studies and those Miani SA, Penalver J. Progressive dysfunction of mono- CA:University of California, Section 8, 2000;94–101. cytes associated with iron overload and age in patients performed herein that demonstrated no effects 13. Dreher KL, Jaskot RH, Lehmann JR, Richards JH, McGee with thalassemia major. Blood 67:105–109 (1986). of inhaled Mn on pulmonary bacterial clear- JK, Ghio AJ et al. Soluble transition metals mediate resid- 35. Jiang X, Baldwin CL. Iron augments macrophage-medi- ual oil fly ash induced acute lung injury. J Toxicol Environ ance may be due, in part, to differences in ated killing of Brucella abortus alone and in conjunction Health 50:285–305 (1997). with interferon-γ. Cell Immunol 148:398–407 (1993). metal concentration and/or metal solubility. 14. Carter JD, Ghio AJ, Samet JM, Devlin, RB. Cytokine pro- 36. Murakawa H, Bland CE, Willis WT, Dallman PR. Iron defi- Taken together, findings from this study duction by human airway epithelial cells after exposure to ciency and neutrophil function: different rates of correction support the notion that a single exposure to an air pollution particle is metal-dependent. Toxicol Appl of the depressions in oxidative burst and myloperoxidase Pharmacol 146:180–188 (1997). activity after iron treatment. Blood 69:1464–1468 (1987). concentrated ambient PM2.5, at concentra- 15. Costa DL, Dreher KL. Bioavailable transition metals in par- 37. LaForce FM, Loose D. Release of lactoferrin by polymor- tions equal to or just above the promulgated ticulate matter mediates cardiopulmonary injury in healthy phonuclear leukocytes after aerosol challenge with 24-hr NAAQS value, compromise host abil- and compromised animal models. Environ Health Perspect Escherichia coli. Infect Immunol 55:2293–2295 (1987). 105:1053–1059 (1997). ity to adequately handle an ongoing S. pneu- 38. Maigetter RZ, Ehrlich R, Fenters JD, Gardner DE. 16. Kodavanti UP, Hauser R, Christiani DC, Meng ZH, McGee Potentiating effects of manganese dioxide on experimen- moniae infection. These investigations also J, Ledbetter A, et al. Pulmonary responses to oil fly ash tal respiratory infections. Environ Res 11:386–391 (1976). provide biologic plausibility for the role of particles in the rat differ by virtue of their specific soluble 39. Cohen MD. Other metals: aluminum, copper, manganese, metals. Toxicol Sci 43:204–212 (1998). PM-associated metals, particularly Fe and Ni, selenium, vanadium, and zinc. In: Pulmonary 17. Zelikoff JT, Thomas PT, eds. Immunotoxicology of Immunotoxicology (Cohen MD, Zelikoff JT, Schlesinger in exacerbating S. pneumoniae infections in Environmental and Occupational Metals. London:Taylor RB, eds). Boston:Kluwer Academic Press, 2000;267–299. CAPS-exposed hosts. Although more research and Francis, 1999. 875 Environmental Health Perspectives • VOLUME 110 | SUPPLEMENT 5 | OCTOBER 2002