Lung diseases due to environmental exposures to erionite and asbestos in Turkey

Our plain-English summary of Lung diseases due to environmental exposures to erionite and asbestos in Turkey, by S. Emri, A. Demir, M. Dogan, et al (Toxicology Letters, 2002).

The study

• Authors: S. Emri, A. Demir, M. Dogan, H. Akay, B. Bozkurt, M. Carbone, I. Baris
• Journal: Toxicology Letters
• Published: 2002;127(1-3):251-7
• Cited by: 55 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos deposits have been used locally by the rural inhabitants of Central and Southeastern Anatolia for domestic purposes for many years. Mineralogical analysis revealed that tremolite is the most prominent asbestos type found in the region. There is in addition another mineral fiber found particularly in three villages located in the Cappadocian region of Central Anatolia (zeolite villages). This is a non-asbestos mineral, which has been identified as the fibrous zeolite, erionite. This fiber is present in the volcanic tuffs, which are used as building stone. Hence, exposure to erionite fibers is always possible in the houses, annexes, and streets of the villages. It has been demonstrated that both asbestos and erionite cause a variety of benign and malignant chest diseases. Among the diseases, calcified pleural plaques (CPP) are the most frequently seen and may be used as an indicator of mineral fiber exposure. Asbestos and erionite exposure are the main causes of malignant mesotheliomas in Turkey. In zeolite villages malignant mesothelioma is responsible for more than 50% of the total deaths. A recent study showed that simian virus 40 is not a cofactor in the pathogenesis of environmental malignant mesothelioma in Turkey. An additional recent genetic-epidemiological study showed that there are some families, which are genetically predisposed to mesothelioma.

In plain English

This article was a review. The authors discussed their group's recent findings, along with other studies, on chest diseases from environmental exposure to asbestos and erionite in rural Central and Southeastern Anatolia, Turkey. Villagers had used local asbestos deposits, mainly tremolite, for domestic purposes. Erionite, a fibrous zeolite that is not asbestos, was found in volcanic tuff used as building stone in three Cappadocian villages. A cited study found calcified pleural changes on chest X-rays in 5.4% of adults from asbestos villages and 9.3% of adults from erionite villages, compared with less than 1% in unexposed villages. In the erionite villages of Karain, Tuzköy and Sarihidir, malignant mesothelioma was described as causing more than 50% of all deaths. Among 162 emigrants from Karain living in Sweden, another study found 14 mesothelioma deaths among 18 deaths between 1965 and 1997. Cited work found no SV40 virus DNA in 29 mesothelioma specimens. The authors concluded that the principal public health aim should be preventing environmental exposure to asbestos and erionite.

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: Review of the authors' own recent findings and other published and unpublished studies
• Who was studied: Rural inhabitants of Central and Southeastern Anatolia, Turkey, including the erionite (zeolite) villages of Karain, Tuzköy and Sarihidir in Cappadocia. The authors estimated that about 16 million people in these regions had been environmentally exposed.
• Exposure: Environmental (non-occupational) exposure to asbestos used for whitewash and stucco. Tremolite was the most prominent type, with chrysotile also present and anthophyllite in certain districts (Mihalliççik and Edige). Exposure to erionite, a fibrous zeolite, came from volcanic tuffs used as building stone.
• Main results:
  • In a cited review (Karakoca et al., 1997), calcified pleural changes on chest X-ray or microfilm were found in 5.4% (range 1.3 to 42.1%) of adults from asbestos villages and 9.3% (range 1.8 to 17%) of adults from erionite villages, compared with less than 1% of adults from unexposed control villages.
  • In the zeolite villages of Karain, Tuzköy and Sarihidir, malignant mesothelioma was described as responsible for more than 50% of all deaths.
  • In a cited cohort of 162 Turkish emigrants from Karain living in Sweden (Metintas et al., 1999), there were 14 mesothelioma deaths among 18 (78%) deaths between 1965 and 1997.
  • Chest X-ray findings showed diffuse interstitial pulmonary fibrosis in 15 to 39% of the Tuzköy population over 25 years of age. The authors noted that no clinical symptoms were detected with this condition.
  • In a cited case-control study (Karakoca et al., 1998) of 31 malignant pleural mesothelioma patients, 119 Tuzköy inhabitants and 118 healthy renal donors, the HLA-B41, -B58 and -DR16 antigens were significantly more common in the mesothelioma patients than in the control groups.
  • In a cited genetic mapping study (Hammady et al., 2001), six families from one erionite village with familial clustering of malignant mesothelioma could be genetically linked to one large six-generation extended pedigree.
  • In the authors' earlier PCR study (Emri et al., 2000), none of 29 mesothelioma specimens from patients exposed to asbestos or erionite contained SV40 DNA.
  • Flow cytometric DNA analysis of 40 malignant mesothelioma patients found significantly higher aneuploidy in erionite-related cases (72.7% of 11 patients) than in asbestos-related cases (13.8% of 29 patients).
  • In survival analysis, erionite exposure was reported as a poor prognostic factor for malignant mesothelioma compared with asbestos exposure.
• The authors' conclusion: The authors concluded that the principal public health aim should be preventing environmental exposure to asbestos and erionite. They proposed educating villagers and relocating erionite villagers to an erionite-free area, and suggested that chemoprevention trials and identifying susceptibility genes may also help.

Topics

Medical terms in this study, explained in our Lexicon: Environmental Exposure, erionite, Tremolite, Mineral Fiber, Zeolite, Pleural Plaques, Malignant Mesothelioma, Mesothelioma.

Related studies

• Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey — P. Dumortier, L. Coplü, et al. (2001)
• The role of environmental and occupational exposures in Turkish immigrants with fibre-related disease — P. Dumortier, A. Göcmen, et al. (2001)
• Malignant pleural mesothelioma in Turkey, 2000-2002 — S. Emri, A.U. Demir (2004)
• Endemic malignant mesothelioma: exposure to erionite is more important than genetic factors — M. Metintas, G. Hillerdal, et al. (2010)
• High incidence of lung cancer and malignant mesothelioma linked to erionite fibre exposure in a rural community in Central Mexico — M.A. Ortega-Guerrero, G. Carrasco-Núñez, et al. (2015)
• Geological occurrence, mineralogical characterization, and risk assessment of potentially carcinogenic erionite in Italy — M. Giordani, M. Mattioli, et al. (2017)

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