Asbestos exposure and antineutrophil cytoplasmic Antibody (ANCA) positivity

Our plain-English summary of Asbestos exposure and antineutrophil cytoplasmic Antibody (ANCA) positivity, by D. Pelclová, J. Bartůnková, Z. Fenclová, et al (Archives of Environmental Health, 2003).

The study

• Authors: D. Pelclová, J. Bartůnková, Z. Fenclová, J. Lebedová, M. Hladíková, H. Benáková
• Journal: Archives of Environmental Health
• Published: 2003;58(10):662-8
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The authors used indirect immunofluorescence to examine the association of antineutrophil cytoplasmic antibodies (ANCAs) with exposure to asbestos among 61 asbestos-exposed patients (mean exposure = 24.6 yr) and 39 nonexposed controls. ANCA positivity was detected significantly more frequently (p = 0.034) in the asbestos-exposed group (21.3%) than in the control group (5.1%). ANCA-associated diseases did not occur more frequently among subjects exposed previously to asbestos than among unexposed controls. These findings confirmed that exposure to asbestos is another occupational factor, as is silica exposure, that is associated with ANCA positivity. The influence of asbestos appears stronger than that of silica because ANCA positivity was found among subjects who had histories of exposure to asbestos but who did not exhibit typical radiographic signs of asbestosis on their chest x-rays. Additional stimuli may be necessary to induce systemic vasculitis in asbestos-exposed persons.

In plain English

This Czech study compared 61 people who had worked at two asbestos-manufacturing plants in Central Bohemia with 39 former health-care office employees never exposed at work to fibrogenic dusts. Most exposed workers had made asbestos textile and insulation materials and asbestos-cement roofing. Others worked in maintenance, stock or offices. Their exposure lasted 5 to 45 years (mean 24.6). Blood was tested for antineutrophil cytoplasmic antibodies (ANCAs), which the article links to diseases such as vasculitis, an inflammation of blood vessels. ANCAs were found in 21.3% of exposed workers and 5.1% of controls (p = 0.034). Positivity was 30.4% among exposed workers whose chest X-rays showed no typical signs of asbestosis, 22.2% among those with initial signs, and 10.0% among those with asbestosis. ANCA-associated diseases were not more common in the exposed group, and no patient had vasculitis. The authors concluded that, in their opinion, asbestos is an occupational factor besides silica that induces ANCA formation. They added that further stimuli seem necessary for vasculitis. They noted the subgroups were small.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional comparison of asbestos-exposed workers and unexposed controls (blood antibody testing, examinations and questionnaire)
• Who was studied: 61 asbestos-exposed subjects (33 men, 28 women; mean age 63.2) from 2 asbestos-manufacturing plants in Central Bohemia, Czech Republic, divided by chest X-ray into H group (23, no typical signs of asbestosis), IA group (18, initial signs of asbestosis) and A group (20, developed asbestosis); 39 controls (18 men, 21 women; mean age 63.3) who had worked as office employees in the health care sector. Study dates not given.
• Exposure: Occupational asbestos exposure (fiber types not specified) in production of asbestos textile and insulation materials and asbestos-cement roofing (about 60%), maintenance (about 30%), stock work and office work; duration 5 to 45 years (mean 24.6). In the 1970s air concentrations in these plants frequently exceeded the 2 mg/m3 limit (2 to 7 mg/m3), with peaks of 50 to 540 mg/m3 measured in 1976.
• Main results:
  • ANCAs were found in 21.3% of the whole asbestos-exposed group (13 of 61) compared with 5.1% of controls (2 of 39), p = 0.034.
  • ANCA positivity by group: 30.4% in the H group (no typical radiographic signs of asbestosis), 22.2% in the IA group (initial asbestosis), 10.0% in the A group (developed asbestosis), and 5.1% in controls.
  • For the H group versus controls, the odds ratio for ANCA positivity was 8.09 (95% CI 1.51, 43.3) and the relative risk was 5.94 (95% CI 1.35, 26.2). For all exposed subjects versus controls, the odds ratio was 5.01 (95% CI 1.06, 23.60) and the relative risk was 4.16 (95% CI 1.00, 17.40). Comparisons of the IA and A groups with the H group were not significant.
  • The frequency of possible ANCA-associated diseases was comparable in exposed subjects and controls (rheumatoid arthritis in 1 exposed subject and 1 control), and no patient had vasculitis.
  • In most exposed subjects the antibody's target antigen was not identified. ELISA found BPI-ANCA in 2 exposed subjects and LTF-ANCA in 4; no PR3 or MPO ANCAs were reported.
  • Ventilatory lung function impairment was found in 70.5% of all asbestos-exposed patients and 47.4% of controls (p < 0.05).
  • Glomerular filtration (a measure of kidney function) was significantly lower in the asbestos-exposed group (p < 0.05).
  • No predictor of ANCA positivity other than asbestos exposure was found, and there was no association between Staphylococcus aureus carriage and ANCA positivity.
• The authors' conclusion: The authors concluded that, in their opinion, asbestos is an occupational factor other than silica that induces formation of ANCAs. They judged its action seemed stronger than that of silica because ANCA positivity occurred in exposed subjects without typical radiographic signs of asbestosis. They added that further stimuli seem necessary to induce systemic vasculitis, and that the findings suggest asbestos poses a health risk even at lower exposures that do not cause asbestosis.
• Limitations the authors state:
  • The numbers of ANCA-positive patients in the subgroups were small; with larger IA and A groups, the percentage of ANCA positivity in those groups might have been higher.
  • The relationship between ANCA, alpha1 antitrypsin and asbestos needs further study with more subjects than were included.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Chest X-Ray.

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