Low serum IgA and airway injury in World Trade Center-exposed firefighters: a 17-year longitudinal study

Thorax ◽  
2019 ◽  
Vol 74 (12) ◽  
pp. 1182-1184
Author(s):  
Barbara Putman ◽  
Lies Lahousse ◽  
Rachel Zeig-Owens ◽  
Ankura Singh ◽  
Charles B Hall ◽  
...  
Keyword(s):  
Lung Function ◽  
Antibiotic Treatment ◽  
World Trade ◽  
World Trade Center ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Airway Injury ◽  
Serum Iga ◽  
Increased Risk ◽  
Trade Center

Serum IgA ≤70 mg/dL (low IgA) is associated with exacerbations of chronic obstructive pulmonary disease. The association of low IgA with longitudinal lung function is poorly defined. This study included 917 World Trade Center (WTC)-exposed firefighters with longitudinal spirometry measured between September 2001 and September 2018 and IgA measured between October 2001 and March 2002. Low IgA, compared with IgA >70 mg/dL, was associated with lower forced expiratory volume in 1 s (FEV1) % predicted in the year following 11 September 2001 (94.1% vs 98.6%, p<0.001), increased risk of FEV1/FVC <0.70 (HR 3.8, 95% CI 1.6 to 8.8) and increased antibiotic treatment (22.5/100 vs 11.6/100 person-years, p=0.002). Following WTC exposure, early IgA ≤70 mg/dL was associated with worse lung function and increased antibiotic treatment.

scholarly journals Metabolomics of World Trade Center-Lung Injury: a machine learning approach

2018 ◽  
Vol 5 (1) ◽  
pp. e000274 ◽  
Author(s):  
George Crowley ◽  
Sophia Kwon ◽  
Syed Hissam Haider ◽  
Erin J Caraher ◽  
Rachel Lam ◽  
...  
Keyword(s):  
Machine Learning ◽  
Lung Function ◽  
Lung Injury ◽  
World Trade ◽  
World Trade Center ◽  
Forced Expiratory Volume ◽  
Machine Learning Techniques ◽  
Maximal Class ◽  
Class Separation ◽  
Trade Center

IntroductionBiomarkers of metabolic syndrome expressed soon after World Trade Center (WTC) exposure predict development of WTC Lung Injury (WTC-LI). The metabolome remains an untapped resource with potential to comprehensively characterise many aspects of WTC-LI. This case–control study identified a clinically relevant, robust subset of metabolic contributors of WTC-LI through comprehensive high-dimensional metabolic profiling and integration of machine learning techniques.MethodsNever-smoking, male, WTC-exposed firefighters with normal pre-9/11 lung function were segregated by post-9/11 lung function. Cases of WTC-LI (forced expiratory volume in 1s <lower limit of normal, n=15) and controls (n=15) were identified from previous cohorts. The metabolome of serum drawn within 6 months of 9/11 was quantified. Machine learning was used for dimension reduction to identify metabolites associated with WTC-LI.Results580 metabolites qualified for random forests (RF) analysis to identify a refined metabolite profile that yielded maximal class separation. RF of the refined profile correctly classified subjects with a 93.3% estimated success rate. 5 clusters of metabolites emerged within the refined profile. Prominent subpathways include known mediators of lung disease such as sphingolipids (elevated in cases of WTC-LI), and branched-chain amino acids (reduced in cases of WTC-LI). Principal component analysis of the refined profile explained 68.3% of variance in five components, demonstrating class separation.ConclusionAnalysis of the metabolome of WTC-exposed 9/11 rescue workers has identified biologically plausible pathways associated with loss of lung function. Since metabolites are proximal markers of disease processes, metabolites could capture the complexity of past exposures and better inform treatment. These pathways warrant further mechanistic research.

scholarly journals Lung Function in Rescue Workers at the World Trade Center after 7 Years

2010 ◽  
Vol 362 (14) ◽  
pp. 1263-1272 ◽  
Author(s):  
Thomas K. Aldrich ◽  
Jackson Gustave ◽  
Charles B. Hall ◽  
Hillel W. Cohen ◽  
Mayris P. Webber ◽  
...  
Keyword(s):  
Lung Function ◽  
World Trade ◽  
World Trade Center ◽  
Rescue Workers ◽  
The World ◽  
Trade Center

scholarly journals COVID-19 cumulative incidence, asymptomatic infections, and fatality in Long Island, NY, January–August 2020: A cohort of World Trade Center responders

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254713
Author(s):  
Olga Morozova ◽  
Sean A. P. Clouston ◽  
Jennifer Valentine ◽  
Alexander Newman ◽  
Melissa Carr ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
World Trade ◽  
Long Island ◽  
World Trade Center ◽  
Case Fatality ◽  
Antibody Testing ◽  
Igg Antibody ◽  
Cross Sectional ◽  
Increased Risk ◽  
Trade Center

Background New York City and Long Island, NY were early foci of the COVID-19 epidemic in the US. The effects of COVID-19 on different sub-populations, and its key epidemiologic parameters remain unknown or highly uncertain. We investigated the epidemiology of COVID-19 from January to August of 2020 in an established academic monitoring cohort of N = 9,697 middle-aged World Trade Center responders residing in Long Island, NY. Methods A seroprevalence survey and a series of cross-sectional surveys were nested in a prospective cohort study. Measures included IgG antibody testing, SARS-CoV-2 polymerase chain reaction (PCR) testing, review of electronic medical records, and surveys of symptoms. Correlates of infection were analyzed with multivariable logistic regression. Results The cohort was predominantly men in their mid-fifties; 6,597 cohort members were successfully contacted (68%); 1,042 (11%) individuals participated in the seroprevalence survey; and 369 individuals (5.6% of 6,597 study participants) underwent PCR testing. The estimated standardized cumulative incidence was 21.9% (95%CI: 20.1–23.9%), the asymptomatic proportion was 16.4% (36/219; 95%CI: 11.8–22.0%), the case hospitalization ratio was 9.4% (36/385; 95%CI: 6.6–12.7%), the case fatality ratio was 1.8% (7/385; 95%CI: 0.7–3.7%), and the hospitalization fatality ratio was 8.3% (3/36; 95%CI: 1.8–22.5%). Confirmed SARS-CoV-2 infection was associated with younger age, race/ethnicity, and being currently employed. Conclusions The results of the present study suggest a high cumulative incidence of SARS-CoV-2 among WTC responders in the spring and summer of 2020 and contribute to narrowing the plausible range of the proportion of infections that exhibit no symptoms. An increased risk of infection among younger employed individuals is likely to reflect a higher probability of exposure to the virus, and the racial disparities in the infection risk warrant further investigation.

scholarly journals Bronchodilator Response Predicts Longitudinal Improvement in Small Airway Function in World Trade Center Dust Exposed Community Members

2019 ◽  
Vol 16 (8) ◽  
pp. 1421 ◽  
Author(s):  
Deepak Pradhan ◽  
Ning Xu ◽  
Joan Reibman ◽  
Roberta M. Goldring ◽  
Yongzhao Shao ◽  
...  
Keyword(s):  
World Trade ◽  
World Trade Center ◽  
Small Airway ◽  
Forced Oscillation Technique ◽  
Small Airways ◽  
Bronchodilator Response ◽  
Airway Injury ◽  
Airway Function ◽  
Trade Center ◽  
Over Time

The evolution of lung function, including assessment of small airways, was assessed in individuals enrolled in the World Trade Center Environmental Health Center (WTC-EHC). We hypothesized that a bronchodilator response at initial evaluation shown by spirometry or in small airways, as measured by forced oscillation technique (FOT), would be associated with improvement in large and small airway function over time. Standardized longitudinal assessment included pre and post bronchodilator (BD) spirometry (forced vital capacity, FVC; forced expiratory volume in 1 second, FEV1) and FOT (resistance at 5 Hz, R5; resistance at 5 minus 20 Hz, R5–20). Longitudinal changes were assessed using linear mixed-effects modelling with adjustment for potential confounders (median follow-up 2.86 years; 95% measurements within 4.9 years). Data demonstrated: (1) parallel improvement in airflow and volume measured by spirometry and small airway function (R5 and R5–20) measured by FOT; (2) the magnitude of longitudinal improvement was tightly linked to the initial BD response; and (3) longitudinal values for small airway function on FOT were similar to residual abnormality observed post BD at initial visit. These findings suggest presence of reversible and irreversible components of small airway injury that are identifiable at initial presentation. These results have implications for treatment of isolated small airway abnormalities that can be identified by non-invasive effort independent FOT particularly in symptomatic individuals with normal spirometry indices. This study underscores the need to study small airway function to understand physiologic changes over time following environmental and occupational lung injury.

scholarly journals Factors Predicting Treatment of World Trade Center-Related Lung Injury: A Longitudinal Cohort Study

2020 ◽  
Vol 17 (23) ◽  
pp. 9056
Author(s):  
Barbara Putman ◽  
Lies Lahousse ◽  
David G. Goldfarb ◽  
Rachel Zeig-Owens ◽  
Theresa Schwartz ◽  
...  
Keyword(s):  
Lung Injury ◽  
World Trade ◽  
Proportional Hazards ◽  
World Trade Center ◽  
Patient Characteristics ◽  
Forced Expiratory Volume ◽  
Cox Proportional Hazards ◽  
Beta Agonist ◽  
Cox Proportional Hazards Models ◽  
Trade Center

The factors that predict treatment of lung injury in occupational cohorts are poorly defined. We aimed to identify patient characteristics associated with initiation of treatment with inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) >2 years among World Trade Center (WTC)-exposed firefighters. The study population included 8530 WTC-exposed firefighters. Multivariable logistic regression assessed the association of patient characteristics with ICS/LABA treatment for >2 years over two-year intervals from 11 September 2001–10 September 2017. Cox proportional hazards models measured the association of high probability of ICS/LABA initiation with actual ICS/LABA initiation in subsequent intervals. Between 11 September 2001–1 July 2018, 1629/8530 (19.1%) firefighters initiated ICS/LABA treatment for >2 years. Forced Expiratory Volume in 1 s (FEV1), wheeze, and dyspnea were consistently and independently associated with ICS/LABA treatment. High-intensity WTC exposure was associated with ICS/LABA between 11 September 2001–10 September 2003. The 10th percentile of risk for ICS/LABA between 11 September 2005–10 Septmeber 2007 was associated with a 3.32-fold increased hazard of actual ICS/LABA initiation in the subsequent 4 years. In firefighters with WTC exposure, FEV1, wheeze, and dyspnea were independently associated with prolonged ICS/LABA treatment. A high risk for treatment was identifiable from routine monitoring exam results years before treatment initiation.

scholarly journals Bronchial Reactivity and Lung Function After World Trade Center Exposure

CHEST Journal ◽  
2016 ◽  
Vol 150 (6) ◽  
pp. 1333-1340 ◽  
Author(s):  
Thomas K. Aldrich ◽  
Jessica Weakley ◽  
Sean Dhar ◽  
Charles B. Hall ◽  
Tesha Crosse ◽  
...  
Keyword(s):  
Lung Function ◽  
World Trade ◽  
World Trade Center ◽  
Bronchial Reactivity ◽  
Trade Center

scholarly journals Lysophosphatidic acid and apolipoprotein A1 predict increased risk of developing World Trade Center-lung injury: a nested case-control study

Biomarkers ◽  
2014 ◽  
Vol 19 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Jun Tsukiji ◽  
Soo Jung Cho ◽  
Ghislaine C. Echevarria ◽  
Sophia Kwon ◽  
Phillip Joseph ◽  
...  
Keyword(s):  
Lysophosphatidic Acid ◽  
World Trade ◽  
Case Control Study ◽  
World Trade Center ◽  
Case Control ◽  
Apolipoprotein A1 ◽  
Increased Risk ◽  
Trade Center ◽  
Nested Case Control ◽  
Control Study

scholarly journals Cancer Incidence in World Trade Center Rescue and Recovery Workers: 14 Years of Follow-Up

2021 ◽  
Author(s):  
Jiehui Li ◽  
Janette Yung ◽  
Baozhen Qiao ◽  
Erin Takemoto ◽  
David G Goldfarb ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Cancer Incidence ◽  
World Trade ◽  
Cox Regression ◽  
World Trade Center ◽  
Cancer Registries ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Trade Center

Abstract Background Statistically significantly increased cancer incidence has been reported from 3 cohorts of World Trade Center (WTC) disaster rescue and recovery workers. We pooled data across these cohorts to address ongoing public concerns regarding cancer risk 14 years after WTC exposure. Methods From a combined deduplicated cohort of 69 102 WTC rescue and recovery workers, a sample of 57 402 workers enrolled before 2009 and followed through 2015 was studied. Invasive cancers diagnosed in 2002-2015 were identified from 13 state cancer registries. Standardized incidence ratios (SIRs) were used to assess cancer incidence. Adjusted hazard ratios (aHRs) were estimated from Cox regression to examine associations between WTC exposures and cancer risk. Results Of the 3611 incident cancers identified, 3236 were reported as first-time primary (FP) cancers, with an accumulated 649 724 and 624 620 person-years of follow-up, respectively. Incidence for combined FP cancers was below expectation (SIR = 0.96, 95% confidence interval [CI] = 0.93 to 0.99). Statistically significantly elevated SIRs were observed for melanoma-skin (SIR = 1.43, 95% CI = 1.24 to 1.64), prostate (SIR = 1.19, 95% CI = 1.11 to 1.26), thyroid (SIR = 1.81, 95% CI = 1.57 to 2.09), and tonsil (SIR = 1.40, 95% CI = 1.00 to 1.91) cancer. Those arriving on September 11 had statistically significantly higher aHRs than those arriving after September 17, 2001, for prostate (aHR = 1.61, 95% CI = 1.33 to 1.95) and thyroid (aHR = 1.77, 95% CI = 1.11 to 2.81) cancers, with a statistically significant exposure-response trend for both. Conclusions In the largest cohort of 9/11 rescue and recovery workers ever studied, overall cancer incidence was lower than expected, and intensity of WTC exposure was associated with increased risk for specific cancer sites, demonstrating the value of long-term follow-up studies after environmental disasters.

scholarly journals Case Report: A World Trade Center (WTC) responder presenting with moderate stage dementia by age 57, suggesting an extended severity of WTC-associated illness'

2021 ◽  
Author(s):  
Sam Gandy ◽  
H Allison Bender ◽  
Roberto Luccini ◽  
Theophania Ashleigh ◽  
Julie Ciardullo ◽  
...  
Keyword(s):  
World Trade ◽  
Medical Center ◽  
World Trade Center ◽  
Clinical Syndrome ◽  
Etiologic Agent ◽  
Central Feature ◽  
Ground Zero ◽  
Early Onset Dementia ◽  
Increased Risk ◽  
Trade Center

Abstract Recent evidence indicates that World Trade Center Responders (WTCRs) are apparently at increased risk for a clinical syndrome that includes PTSD (posttraumatic stress disorder) and MCI (mild cognitive impairment). The association of these behavioral and cognitive symptoms was first described by Bromet, Luft, Clouston, and colleagues. No autopsy characterization of the syndrome has yet emerged, though biofluid and neuroimaging biomarker data support features of (1) progressive behavioral and cognitive dysfunction, (2) proteinopathy involving the appearance of neurodegeneration-related molecules in the peripheral circulation, and (3) a substantial regional loss of brain volume. Inciting factors such as inhalation of neurotoxins and/or psychological stressors (or a combination of both) have been proposed as contributory to the pathogenesis, but no definitive etiologic agent has been identified. In general, the subpopulation of WTCRs who developed PTSD and MCI were those with documentable extended exposure to the central feature of “Ground Zero” known as “the pile”, and those who developed MCI were primarily a subgroup of those who had developed PTSD. Multiomic studies are underway to determine whether this subgroup might be enriched for genetic, genomic, and/or proteomic features that might have predisposed them to pathological responses to stress, environmental toxins, or both. In 2017, we had occasion to evaluate “E.T.”; at that time, a 57-year-old bilingual (English and Spanish speaking) right-handed WTCR was referred to an urban medical center dementia specialty clinic for assessment of his cognitive and behavioral functioning. While early-onset dementia can occur sporadically, the proximity of E.T. to “the pile” at “Ground Zero”, and the course of E.T.’s illness raise the possibility that WTC-related cognitive-behavioral syndromes may progress well beyond the stage of MCI to that of moderate dementia (and beyond) and that this progression may occur in the absence of full-blown PTSD.

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