Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey

Our plain-English summary of Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey, by P. Dumortier, L. Coplü, I. Broucke, et al (Occupational and Environmental Medicine, 2001).

The study

• Authors: P. Dumortier, L. Coplü, I. Broucke, S. Emri, T. Selcuk, V. de Maertelaer, P. De Vuyst, I. Baris
• Journal: Occupational and Environmental Medicine
• Published: 2001;58(4):261-6
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: The high incidence of malignant mesothelioma in some villages of Cappadocia (Turkey) is due to environmental exposure to erionite fibres. The aim was to evaluate the fibre burden in bronchoalveolar lavage fluid (BALF) from inhabitants of an erionite village and compare it with Turkish subjects with or without environmental exposure to tremolite asbestos.

Methods: Ferruginous bodies (FBs) and fibres were measured and analyzed by light and transmission electron microscopy (TEM) in the BALF of 16 subjects originating from Tuzköy.

Results: FBs were detected in the BALF of 12 subjects, with concentrations above 1 FB/ml in seven of them. Erionite was the central fibre of 95.7% of FBs. Erionite fibres were found in the BALF of all subjects, by TEM, and these fibres were low in Mg, K, and Ca compared with erionite from Tuzköy soil. The mean concentration of erionite fibres in BALF was similar to that of tremolite fibres in Turks with environmental exposure to tremolite. The proportion of fibres longer than 8 microm in BALF represented 35.6% for erionite compared with 14.0% for tremolite. The asbestos fibre concentrations in erionite villagers was not different from that in Turks without environmental exposure to tremolite.

Conclusion: Analysis of BALF gives information about fibre retention in populations environmentally exposed to erionite for whom data on fibre burden from lung tissue samples are scarce. This may apply to exposed Turks having emigrated to other countries.

In plain English

This study measured mineral fibres in fluid washed from the lungs (bronchoalveolar lavage fluid, BALF) of 16 patients from Tuzköy, a village in Cappadocia, Turkey, where people are environmentally exposed to erionite fibres. The patients had been born there, had lived there at least 10 years, and had diagnostic bronchoscopy at Hacettepe University between 1991 and 1996. They were compared with previously reported Turkish subjects environmentally exposed to asbestos, mainly tremolite, and with Turkish controls. Coated fibres (ferruginous bodies) were found in 12 of the 16 subjects, and 95.7% of the bodies analysed were built on erionite. Electron microscopy found erionite fibres in all 16. Their concentration did not differ from tremolite concentrations in the tremolite-exposed group (p=0.82). Of the erionite fibres, 35.6% were longer than 8 µm, compared with 14.0% of tremolite fibres. Asbestos fibre levels in the villagers were similar to those in the controls. The authors concluded that BALF analysis gives information about fibre retention in erionite-exposed populations, possibly including Turkish emigrants.

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: Mineralogical analysis of lavage fluid samples from patients, examined by light and transmission electron microscopy, compared with Turkish control and tremolite-exposed groups the authors had reported earlier
• Who was studied: 16 patients from Tuzköy, Cappadocia, Turkey (11 men, 5 women, mean age 40.3 years) who had diagnostic fibreoptic bronchoscopy at Hacettepe University School of Medicine, Ankara, between September 1991 and January 1996
• Exposure: Environmental exposure to erionite, a fibrous zeolite mineral, from living in Tuzköy. Subjects were born there and lived there at least 10 years. None reported occupational asbestos exposure.
• Main results:
  • Ferruginous bodies were detected in the BALF of 12 of the 16 Tuzköy subjects (75%). Concentrations ranged from less than 0.1 to 46 bodies per ml, and exceeded 1 per ml in seven subjects.
  • The central fibre of 95 ferruginous bodies was analysed: 95.7% were built on erionite, 3.2% on tremolite and 1.1% on crocidolite.
  • Ferruginous body concentrations in the Tuzköy group were higher than asbestos body concentrations in Turkish controls (p<0.01). They were not significantly different from those in the tremolite-exposed group (p=0.09), although counts tended to be lower.
  • Electron microscopy found erionite fibres in the BALF of all 16 Tuzköy subjects. Nine had more than 300 fibres per ml; the geometric mean was 388 fibres per ml (95% CI 187 to 802).
  • Erionite fibre concentrations in the Tuzköy group did not differ from tremolite fibre concentrations in the tremolite-exposed Turkish group (p=0.82).
  • 35.6% of erionite fibres in the Tuzköy group were longer than 8 µm, compared with 14.0% of tremolite fibres in the tremolite-exposed group. Erionite fibres were significantly thicker and longer (p<0.001).
  • Concentrations of chrysotile, tremolite, titanium oxide and other non-asbestos fibres were similar in the Tuzköy group and the Turkish controls. Crocidolite was not found in the electron microscope fibre counts.
  • The ratio of uncoated fibres to coated bodies was higher for erionite in the Tuzköy group (geometric mean 611) than for tremolite in the tremolite-exposed group (geometric mean 167), p<0.02.
  • Erionite fibres recovered from BALF contained less magnesium, potassium and calcium than erionite fibres from Tuzköy soil, and had a narrower composition range.
  • In the Tuzköy group, body and fibre concentrations were not correlated with age, duration of exposure, or time since exposure ended.
• The authors' conclusion: The authors concluded that BALF analysis gives information about fibre retention in people environmentally exposed to erionite, for whom lung tissue data are scarce, and that this may also apply to exposed Turks who have emigrated. They also stated that the similar tremolite levels in villagers and controls confirm that asbestos fibres are not contributing to mesothelioma risk in the erionite villages.
• Limitations the authors state:
  • The authors noted it could be argued that BALF reflects only recent exposures and does not sample particles in the lung interstitium. They argued against this: erionite body and fibre levels did not differ between subjects still living in Tuzköy (n=7) and those who had left 8 to 36 years earlier (n=9).

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Tremolite.

Medical terms in this study, explained in our Lexicon: erionite, Bronchoalveolar Lavage (BAL), Cappadocia, Mesothelioma, Environmental Exposure, Tremolite, Ferruginous body, Transmission Electron Microscopy (TEM).

Related studies

• Assessment of environmental asbestos exposure in Turkey by bronchoalveolar lavage — P. Dumortier, L. Coplü, et al. (1998)
• The crystal structure of the killer fibre erionite from Tuzköy (Cappadocia, Turkey) — C. Giacobbe, A. Moliterni, et al. (2023)
• Fibres and asbestos bodies in bronchoalveolar lavage fluids of asbestos sprayers — T. Tuomi, P. Oksa, et al. (1992)
• Asbestos bodies in bronchoalveolar lavage fluids of brake lining and asbestos cement workers — P. Dumortier, P. De Vuyst, et al. (1990)
• Lung diseases due to environmental exposures to erionite and asbestos in Turkey — S. Emri, A. Demir, et al. (2002)
• Diagnostic value of asbestos bodies in bronchoalveolar lavage fluid — P. De Vuyst, P. Dumortier, et al. (1987)

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