Asbestos exposure biomarkers in the follow-up of asbestos-exposed workers

Our plain-English summary of Asbestos exposure biomarkers in the follow-up of asbestos-exposed workers, by V. Paolucci, R. Romeo, A.G. Sisinni, et al (Industrial Health, 2018).

The study

• Authors: V. Paolucci, R. Romeo, A.G. Sisinni, G. Scancarello, L. Volterrani, M.A. Mazzei, L. Barabesi, P. Sartorelli
• Journal: Industrial Health
• Published: 2018;56(3):249-254
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Health surveillance of asbestos exposed workers should be stratified according to the exposure level. Unfortunately there is a lack of information regarding asbestos exposure in many working places and markers of asbestos exposure are often needed. The aim of the study was to assess the reliability of different dose and effect biomarkers in the follow up of asbestos-exposed workers. Mineralogical analysis of bronchoalveolar lavage fluid (BALF) as a biomarker of asbestos fibre burden was performed in a population of 307 male subjects occupationally exposed to asbestos. Using nonparametric statistical methods 8 variables were analyzed with respect to asbestos-related diseases and working sectors. The existence of a relationship between serum soluble mesothelin-related peptides (SMRP) and asbestos exposure levels was also investigated. Concentrations of amphiboles, chrysotile and asbestos bodies in BALF were higher in patients with asbestosis as well as in railway industry workers. A correlation between the onset of non malignant asbestos-related diseases and the levels of SMRP concentration was not found. This study confirms that fibre concentration in BALF may be considered as a reliable biomarker of previous asbestos exposure, whereas SMRP does not appear to be influenced by asbestos exposure levels.

In plain English

The authors studied 307 occupationally exposed male workers hospitalized at the University Hospital of Siena, Italy, from 2007 to 2013 for suspected asbestos-related disease. They measured chrysotile fibres, amphibole fibres and asbestos bodies in lung-wash fluid (bronchoalveolar lavage), and a blood marker, soluble mesothelin-related peptides (SMRP). A non-malignant asbestos-related disease was diagnosed in 132 workers (43%): 85 had pleural plaques, 2 had asbestosis, and 45 had both. Disease groups differed mainly in amphibole levels and time since last exposure, and less so in chrysotile and asbestos bodies. Work sectors differed mainly in the same two measures, and less so in chrysotile. Railway industry workers had the highest share of disease and the highest average fibre levels, with mean amphiboles of 863 per ml (95% confidence interval 714 to 1,046). Fibre levels were below detection in all 21 patients without occupational exposure, a group the authors said was not a true control group. SMRP did not vary significantly by disease or sector. The authors concluded that lung-fluid fibre concentration may be a reliable marker of past exposure, while SMRP did not appear to be influenced by exposure level.

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: Clinical study of hospitalized asbestos-exposed workers assessing exposure and effect biomarkers (mineral analysis of bronchoalveolar lavage fluid, serum SMRP), with CT scans reviewed retrospectively and a small non-exposed group for reference
• Who was studied: 307 male workers (mean age 57, range 41 to 81) hospitalized from 2007 to 2013 in the Occupational Medicine Unit of the University Hospital of Siena, Italy, for suspected asbestos-related diseases; plus 21 patients (17 male, 4 female) without occupational exposure who underwent bronchoscopy for non-malignant diseases in 2014 to 2015
• Exposure: Occupational asbestos exposure in 8 sectors: railway industry 20% (insulation removal and rolling stock production), shipbuilding yards 6%, building industry 13%, metal foundry 11%, engineering industry 18%, transport 8% (flight attendants, subway workers), electric energy production 19%, other industries 5%. Lung burden was measured as chrysotile fibres, amphibole fibres and asbestos bodies per ml of lavage fluid.
• Main results:
  • Of the 307 exposed workers, 132 (43%) were diagnosed with a non-malignant asbestos-related disease: 85 had pleural plaques, 2 had asbestosis, and 45 had both.
  • Between disease groups, the differences were due mainly to time since last exposure and amphibole concentration (p less than 0.001), and to a lesser extent to chrysotile (p = 0.04) and asbestos body concentration (p = 0.02).
  • Between working sectors, the differences were significant overall (p less than 0.001). They were due mainly to years since last exposure (p less than 0.001) and amphibole concentration (p less than 0.001), and to a lesser extent to chrysotile concentration (p = 0.03).
  • Railway industry workers had the highest percentage of asbestos-related diseases and the highest average fibre and asbestos body concentrations.
  • Mean amphibole concentration was 863 per ml (95% CI 714 to 1,046) in railway industry workers and 553 per ml (95% CI 452 to 689) in patients with asbestosis and pleural plaques.
  • The authors reported that transport workers, who had no asbestos diseases, had the lowest concentration of all biomarkers.
  • In the 21 patients without occupational exposure, fibre concentration was below the detection limit in all cases.
  • Serum SMRP concentration did not differ significantly between workers with asbestos-related diseases and healthy workers, or between working sectors.
• The authors' conclusion: The authors concluded that fibre concentration in lavage fluid may be considered a reliable biomarker of previous asbestos exposure, whereas SMRP does not appear to be influenced by asbestos exposure levels.
• Limitations the authors state:
  • The non-exposed group cannot be considered a statistical control group because the two populations differed markedly, so no statistical comparison with the exposed workers was made.
  • The study did not investigate whether lavage fibre concentration is useful in diagnosing malignant mesothelioma.
  • In some sectors the time since last exposure was shorter, so the authors said 10 more years of follow-up are needed to compare disease levels quantitatively.
  • Asbestos bodies as a marker have lower sensitivity and correlate poorly with chrysotile exposure.
  • A negative result of lavage or lung tissue analysis does not rule out past exposure or the chance of developing asbestos-related disease.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Biomarker, Bronchoalveolar Lavage (BAL), Soluble Mesothelin-Related Peptides (SMRP), Amphibole Group, Chrysotile, Asbestos Bodies.

Related studies

• FBLN-3 as a biomarker of pleural plaques in workers occupationally exposed to carcinogenic fibers: a pilot study — V. Rapisarda, C. Ledda, et al. (2015)
• Measurement of asbestos fibre concentrations in fluid of repeated bro-choalveolar lavages of exposed workers — P. Sartorelli, R. Romeo, et al. (2007)
• HMGB1 and Its Hyperacetylated Isoform are Sensitive and Specific Serum Biomarkers to Detect Asbestos Exposure and to Identify Mesothelioma Patients — A. Napolitano, D.J. Antoine, et al. (2016)
• Biomarkers for malignant pleural mesothelioma: current status — L. Greillier, P. Baas, et al. (2008)
• Asbestos exposure assessment by mineralogical analysis of bronchoalveolar lavage fluid — P. Sartorelli, G. Scancarello, et al. (2001)
• Plasma Biomarker Enrichment of Clinical Prognostic Indices in Malignant Pleural Mesothelioma — H.I. Pass, C. Goparaju, et al. (2016)

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