Fluoro-edenitic fibres in the sputum of subjects from Biancavilla (Sicily): a pilot study

Our plain-English summary of Fluoro-edenitic fibres in the sputum of subjects from Biancavilla (Sicily): a pilot study, by M.G. Putzu, C. Bruno, A. Zona, et al (Environmental Health, 2006).

The study

• Authors: M.G. Putzu, C. Bruno, A. Zona, M. Massiccio, R. Pasetto, P.G. Piolatto, P. Comba
• Journal: Environmental Health
• Published: 2006;5:20
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: An excess of mortality for malignant neoplasms of the pleura in Biancavilla, promoted an investigation for pleural mesothelioma, disclosing 17 cases. As the absence of known sources of asbestos exposure, a local stone quarry, located near the inhabited area, used for the extraction of building materials, was investigated. Amphibolic fibres were found in the quarry and identified as fluoro-edenite "new end-member of the edenite / fluoro-edenite series" and recognized as the fluoro-edenite holotype by International Mineralogical Association--Commission on New Minerals and Mineral Names. A pilot study was performed to verify the feasibility of using spontaneous sputum as an exposure indicator for these fibres, in a context in which the use of aerosol-induced sputum technique would not be easily accepted.

Methods: Hypothesizing a behaviour of the new fibre analogous to that of asbestos, the determination of the free fibres and the ferruginous bodies in spontaneous sputum was carried out. Phase Contrast Optical Microscope and an Environmental Scanning Electron Microscope fitted with X-ray energy dispersive analysis system (micro-analysis) were used to examine the samples. The criteria for inclusion in the study were: 1) subjects hospitalized for exacerbation of chronic obstructive pulmonary disease symptoms, 2) age > or = 45 years, 3) residence in Biancavilla for at least 30 years.

Results: The preliminary findings are related to 12 subjects (7 females and 5 males). Uncoated fibres (with length > 5 microm, diameter < 3 microm, aspect ratio 3.1) and ferruginous bodies were searched. Six out of twelve subjects (4 females, 2 males) had at least one of the three samples positive for the presence of fluoro-edenite, confirmed by micro-analysis. The fibre concentration found in the sputum ranged from 0.04 to 10 fibres/g; the length from 20 to 40 microm, the diameter was < 0.5 microm. No ferruginous bodies were found in any of the samples. The four women with a positive sample were housewives. Of the two men with a positive sample, one was a farmer and the other a mason. Therefore, it may be assumed that the exposure to fluoro-edenitic fibres was mainly environmental.

Conclusion: The occurrence of the pleural mesothelioma cases and the presence of fluoro-edenitic fibres in spontaneous sputum, evidence the need to study the biological activity of fluoro-edenitic fibres and the implementation of epidemiological monitoring systems.

In plain English

This pilot study, carried out in Biancavilla, Sicily, tested whether spontaneously coughed-up sputum could show exposure to fluoro-edenite, an amphibole fibre found in a local stone quarry. The authors studied 12 people (7 women and 5 men) in hospital with worsening chronic obstructive pulmonary disease (COPD). The stated entry criteria were age 45 or older and at least 30 years living in Biancavilla, although the results table lists one woman aged 43. Three morning sputum samples per person were examined under optical and electron microscopes with chemical analysis. Six of the 12 had at least one sample containing fluoro-edenite fibres, at concentrations from 0.05 to 10 fibres per gram. Two of these six also had apatite fibres. No ferruginous bodies (coated fibres) were found in any sample. The four women with a positive sample were housewives. The two men were a farmer and a mason. From this, the authors assumed the exposure was mainly environmental. The authors concluded that the findings point to "a relatively important environmental exposure." They called for environmental clean-up, continued exposure assessment, and study of a suggested link with COPD. They noted that the group studied was 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: pilot study testing spontaneous sputum examination as an indicator of fibre exposure
• Who was studied: 12 people (7 women, 5 men) in hospital for worsening COPD in Biancavilla (Sicily). The stated inclusion criteria were age 45 or older and at least 30 years of residence in Biancavilla, but Table 1 lists one woman aged 43. Study dates are not stated.
• Exposure: fluoro-edenite, an amphibole fibre found in a local stone quarry near the town that was used for building materials; mainly environmental exposure according to the authors
• Main results:
  • 6 of the 12 people had at least one of their three sputum samples positive for fluoro-edenite, confirmed by micro-analysis
  • Fluoro-edenite fibre concentrations in sputum ranged from 0.05 to 10 fibres per gram
  • Fluoro-edenite fibres were 20 to 40 μm long and less than 0.5 μm in diameter
  • 2 of the 6 people positive for fluoro-edenite also had apatite fibres in their sputum
  • No ferruginous bodies were found in any sample
  • The four women with a positive sample were housewives. The two men were a farmer and a mason. The authors assumed the exposure was mainly environmental.
• The authors' conclusion: The authors concluded that finding fluoro-edenite fibres in 6 of 12 COPD patients points to a relatively important environmental exposure. They said further environmental clean-up, continued exposure assessment, and evaluation of the suggested relation between these fibres and COPD are warranted.
• Limitations the authors state:
  • The group studied was small
  • The absence of ferruginous bodies may reflect the small number of subjects, or properties of the fibre itself
  • Sputum examination has low sensitivity as a marker of asbestos exposure, even in people exposed at work
  • Spontaneous sputum was chosen because it was more acceptable locally, although other authors had found aerosol-induced sputum more effective for detecting ferruginous bodies

Topics

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

Medical terms in this study, explained in our Lexicon: Sputum, Biancavilla, Neoplasm, Pleura, Pleural Mesothelioma, Asbestos Exposure, fluoro-edenite, End-Member.

Related studies

• Pulmonary fibre burden in sheep living in the Biancavilla area (Sicily): preliminary results — P. DeNardo, B. Bruni, et al. (2004)
• Pleural mesothelioma cases in Biancavilla are related to a new fluoro-edenite fibrous amphibole — P. Comba, A. Gianfagna, et al. (2003)
• Adverse health effects of fluoro-edenitic fibers: epidemiological evidence and public health priorities — C. Bruno, P. Comba, et al. (2006)
• Mineral fibre toxicity: expression of retinoblastoma (Rb) and phospho-retinoblastoma (pRb) protein in alveolar epithelial and mesothelial cell lines exposed to fluoro-edenite fibres — G. Musumeci, V. Cardile, et al. (2011)
• Asbestos bodies in the sputum of asbestos workers: correlation with occupational exposure — C. Paris, F. Galateau-Salle, et al. (2002)
• The role of environmental and occupational exposures in Turkish immigrants with fibre-related disease — P. Dumortier, A. Göcmen, et al. (2001)

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