In the News: Air Pollution Linked to Increased Risk of Autoimmune DiseasesAir contaminated by traffic fumes, dust, soot, and smoke may make you more likely to develop rheumatoid arthritis and other autoimmune conditions, a new study suggests.
 
By Lisa Rapaport
March 17, 2022

Car exhaust and other airborne contaminants have long been connected to heart and lung ailments, as well as rheumatoid arthritis, an immune system disorder that causes chronic swelling and joint pain.  Our own studies have shown the relationship with indicators of cognitive deficiencies in children.
In a study I reviewed, researchers from the University of Verona, Italy, reviewed medical records of over 81,000 elderly Italians treated by over 3,500 clinicians. They looked at the association between particulate of less than 2.5 micrometers in diameter that can come from burning gasoline, oil, and wood. Particulate matter (PM) is also a term used to describe dust from construction, agriculture, landfills and wildfires.
They found that 12% of the patients had an autoimmune illness during the research and that pollution exposure enhanced the likelihood of this diagnosis. Each extra 10 mcg/m3 of average PM10 was related with a 7% increased risk of autoimmune illness.
The study revealed that in the study area the average yearly PM2.5 and PM10 exposure levels were 16 and 25 mcg/m3, respectively. The WHO recommends 25 mcg/m3 for PM2.5 and 20 mcg/m3 for PM10.
The study found that those with autoimmune illnesses had a 12-13% increased chance of being diagnosed with these diseases if they were exposed to levels higher than the WHO's guidelines.
The study shows that air pollution can contribute to autoimmune illnesses, says Luz Claudio, PhD, preventive medicine and public health professor at Mount Sinai's Icahn School of Medicine.  In addition to the lungs, Dr. Claudio adds air pollution affects numerous other organs as well.
People can't escape filthy air, but they can lobby for stronger environmental standards, Claudio adds. They can also urge for greater monitoring of local air quality.
“Having a strong surveillance system in high pollution locations is quite important, especially for vulnerable individuals,” Claudio explains. “On polluted days, individuals should avoid outdoor activities.”

 In a new study we published this week in The Journal of Clinical Investigation, our multidisciplinary team of computer scientists, physicians, and epidemiologists at the Icahn School of Medicine at Mount Sinai developed a novel machine-learning algorithm. We used this new machine learning method to identify previously unknown mixtures of toxic air pollutants that appear to be linked to poor asthma outcomes in children.  
     The issue we addressed with this investigation was that most studies assess the toxicity of pollutants one at a time. But in the real world, people are exposed to mixtures of pollutants that cause different health effects. Gaurav Pandey, PhD, Assistant Professor of Genetics and Genomic Sciences and a senior author of the study, said: "Traditionally, for technical reasons, it has been difficult to study the health effects of more than one toxic at a time. We overcame this by tapping into the power of machine learning algorithms."    
     To do this, we examined early exposure to dozens of pollutants to which 151 children with mild to severe asthma were potentially exposed early in their lives, as measured by the Environmental Protection Agency's National Air Toxics Assessment resource. We developed and applied a novel algorithm, named "Data-driven ExposurE Profile (DEEP) Extraction, to determine the possible ways that each pollutant, alone or in combination with others, could explain asthma outcomes in the children. The algorithm development was led by Yan-Chak Li, MPhil, a bioinformatician, and Hsiao-Hsien Leon Hsu, ScD, Assistant Professor of Environmental Medicine and Public Health. 
     We found that some disease cases could be linked to an individual chemical. One example of an individual chemical showing an effect was the ammonia-scented waterproofing agent trimethylamine, which raised the chances that a child with asthma would spend a night in the hospital.
     Other pollutants could act alone or in mixtures. One example was acrylic acid, a chemical used in plastics, coatings, medical products, and detergents. Exposure to acrylic acid raised the chances that a child would need daily medication. Exposure to acrylic acid combined with other chemicals further increased this possibility, and in addition, it boosted the chances of emergency room visits and overnight hospitalizations among the asthmatic children who participated in the study. (See illustration)  
     In all, 34 individual chemicals were found to be linked to poor asthma outcomes. Importantly, some asthma cases appeared to be linked to mixtures of pollutants that had never been associated with asthma.   
      "As a physician who treats children with asthma, I was struck by how many potential air toxics are not on our radar," said Supinda Bunyavanich, MD, MPH, MPhil, Professor of Pediatrics, and Genetics and Genomic Sciences, and a senior author of the study. "These results changed my view of the heightened risk some children face."  
     "Our study is an example of how machine learning has the potential to alter medical research," said Dr. Pandey. "It is allowing us to understand how a wide variety of environmental factors—or the exposome—influences our health. In the future, we plan to use DEEP and other computer science techniques to tackle environmental factors associated with other complex disorders."  
     This work was supported by the Department of Genetics and Genomic Sciences at Mount Sinai, Scientific Computing at Icahn Mount Sinai, and the National Institutes of Health (AI118833, HG011407, HL147328, OD023337, and ES023515).
Article
Citation: Li, Y.C., Hsu, H.H.L., Chun Y, Chiu PH, Arditi Z, Claudio L, Pandey G, Bunyavanich S. Machine learning-driven identification of early-life air toxic combinations associated with childhood asthma outcomes. Journal of Clinical Investigation, October 5, 2021, DOI: 10.1172/JCI152088

Juan A. Ortega-Garcia, Manuel Ruiz-Marin, Alberto Carceles-Alvarez, Ferran Campillo i Lopez, Luz Claudio. Environmental Research 189 (2020) 109957.
At one point during the global novel coronavirus pandemic, Spain was the epicenter of infection.  Yet, not all regions of the country had the same rates of hospital emergency visits during this time.  The region of Murcia flattened the curve quickly while other regions of the country had overwhelmed hospital capacity. This was attributed to a robust, community-based, social media campaign promoting tele-medicine and social distancing within health care centers. 
In this rapid communication, we describe the actions taken in Murcia that may have contributed to a more favorable outcome as compared to other regions.  One important action was the coalition of activists, community leaders, physicians and researchers working as amplifiers of an educational campaign using a variety of social media and outreach strategies. 

In these infographics and accompanying article, we gathered information from primary and secondary sources to summarize the effects of the COVID-19 pandemic and quarantine on different aspects of the environment.  We found that mother nature earned some points, but lost on others.  For example, here in New York, Columbia University measured a 50% reduction in carbon monoxide emissions.  But, medical waste quadrupled due to the increased use of disposable PPE and other contaminated biomedical solid waste. 

In the article, I was cited as follows:
"One of the things that we can learn from the pandemic’s effects on the environment is that we CAN actually have an impact if there were a global effort to do so.  It is inspiring how in cities that had extreme levels of air pollution, from Los Angeles to New Delhi, people are seeing the difference that cleaner air can make to quality of life if we could reduce the number of cars and emissions from polluting industries.  Another lesson will be the realization of how productive many workers can be while working from home when they are given the proper tools. Many companies will see the value of having at least some workers work from home, reducing the need for commuting and also reducing the office space needed to conduct business." 

See the full article with the beautiful interactive infographics and the list of sources including other scientists and business leaders who contributed Here. 

ABSTRACT
Aims
In current clinical practice, prenatal alcohol exposure is usually assessed by interviewing the pregnant woman. An alternative method for detecting alcohol use is to measure the biomarker carbohydrate-deficient transferrin (CDT). However, few studies measure CDT during pregnancy. This study examines the utility of CDT biomarker in the screening of alcohol exposure during early pregnancy.
Methods
A cohort of 91, first-trimester pregnant women assigned to a public reference maternity hospital, was screened using the Green Page (GP) questionnaire, an environmental exposure tool. CDT levels and other biomarkers of alcohol use were measured and compared with questionnaire data.
Results
About 70% of the mothers in the study consumed alcohol during early pregnancy and 22% met high-risk criteria for prenatal exposure to alcohol. CDT measurement showed a statistically significant area under the receiver operating characteristic curve with a value of 0.70. For a value of 0.95% of CDT, a specificity of 93% was observed. The most significant predictors of CDT were the number of binge drinking episodes, women’s body mass index and European white race.

Conclusion
Pregnant women with a CDT value >0.95% would be good candidates for the performance of the GP questionnaire during early pregnancy in order to detect potential high-risk pregnancy due to alcohol exposure.

Mothers who use beauty products containing chemicals known as parabens during pregnancy may be more likely to have overweight daughters, a small study suggests.
Babies tended to be heavier at birth, and more likely to become overweight by age 8, when mothers used makeup, lotions and other common beauty products containing parabens while pregnant, the study found. One of these chemicals, butylparaben, was associated with excess weight only in girls.

Even so, it makes sense for pregnant women to check product labels and steer clear of beauty items containing parabens, said Luz Claudio, an environmental health researcher at the Icahn School of Medicine in New York City who wasn’t involved in the study.

“The significance of this finding cannot be underestimated because girls and women typically used more personal care products and cosmetics containing parabens than do boys and men,” Claudio said. “Thus, this effect of early exposure to parabens in females could potentially continue to increase as they grow and use even more of these products, potentially affecting the next generation of girls.”

Read the full article at: Reuters, WebMD, Medscape 
Read the original research paper from Nature

Along with greening up our living rooms and workspaces, houseplants have been shown to elevate mood, sharpen mental focus, and even boost productivity. Plants are also hyped as being all-natural indoor air purifiers, cleaning the air and sucking up airborne toxins that make us sneeze, wheeze, and develop cancer — well, that’s what an infamous 1989 NASA study led us to believe, anyway.
The reality: Potted plants don’t work like living HVAC devices, neutralizing nasty chemicals to help us breathe easy. It would be awesome if that were true, but experts today say it’s simply a myth. Despite what old research implied, houseplants have very little if any impact on indoor air quality.
According to Luz Claudio, Ph.D., an environmental medicine and public health scientist at the Icahn School of Medicine at Mount Sinai, common houseplants can indeed draw certain VOCs out of the air — but the degree to which they do so is negligible. “The amount that houseplants may reduce chemicals in a real-world environment is likely not enough to have a noticeable impact on human health,” she says.

​It seems like nowadays, whenever we hear the word "environment" in the media, it refers to the latest disaster caused by the climate crisis or the latest commonplace chemical found to cause cancer.  Children, of course, are exposed to this barrage of information and feel helpless and hopeless.  The environment is bad, and there's nothing they can do about it.
Yes.  The situation is dire.  But unless we give some sense of empowerment to children, how can we expect them to care?  Some children have turned to activism, but it is not every day that students can walk out of class in protest.  For the most part, all that children hear is the predictions of environmental doom.  And they are going to tune it off.  
With that in mind, I agreed to participate in this great new TV program called Mission Unstoppable.  With support from the Lyda Hill Philanthropies, it aims to show how STEM can be part of our everyday lives, and for at least some of us, STEM can also be at the center of our careers.  The show focuses on women doing all kinds of STEM things, because well, why not? It doesn't beat you over the head to say that "girls can do anything."  Instead, it shows you diverse girls doing everything and anything that has to do with STEM skills.  
The producers filmed 8 hours of me talking for a 4-minute feature!  That in itself was eyeopening for me.  I didn't know how much work it takes to produce TV content.  
In the interview, I tried to show that:

• The "environment" is not some amorphous faraway thing that we only interact with when we go camping.  The environment is all around us, even in the city, and it can affect our health in positive and negative ways,
• That the pollution we produce as a society doesn't disappear.  It can always come back in different forms to affect our health,
• That people, cities and even children can make a difference with the choices that they  make every day to improve the environment,
• And, of course, that a girl with an accent can be an environmental health scientist.

With the help of my student Chrystal Galan, we created an environmental scavenger hunt that children can do in their neighborhoods, homes, and schools.  It is intended to show children that the environment is everything that surrounds us and to give them some things that they can do to improve it.
As my daughter said when she saw the show: "That was really cool."  For me, to go from dork to cool, even if only for four minutes, is a step forward.

Thanks to Adina Pliskin and Robyn Ramirez from Litton TV and to interviewer Erica Hernandez. Thanks also to Mount Sinai staff and students Marlene Naanes, Lisa Cole, Chrystal Galan Rivera, and Frances Morales Ramos, for their assistance during the long hours of filming.  

Our previous research has shown that exposure to contaminants in outdoor and  indoor air can affect respiratory health, especially in children.  This is important because diseases such as asthma, bronchitis and other conditions are very common and affect many families. 

We have also previously written about how children show exposure to endocrine disrupting chemicals from personal care products and other sources.   Recently, I was interviewed by Kelly Bryant for an article in Reader's Digest.  The article lists 14 ways in which toxins "sneak" into our homes in ways that may be unexpected or surprising for many people.  I was quoted in the article as follows:
It feels good to put dry-cleaned clothing back in your closet, crisp and pressed for your next outing. But the process which made them look brand new could carry some trouble. “Perchloroethylene is a chemical used in dry cleaning,” says Luz Claudio, PhD, professor of environmental medicine at the Icahn School of Medicine in New York. “Although it’s not known how much of it may be released in the home when you bring dry-cleaned clothes in plastic bags, it may be best to open the bags and aerate them outdoors before bringing inside.”
The other 13 sneaky ways toxins may be entering your house, according to the article, are: 

• Through the floorboards in the form of radon, a gas that can lead to lung cancer after prolonged exposure.
• With new carpets that emit volatile organic compounds, especially during the first 72 hours after installation.
• Your mattresses when they are treated with toxic flame retardants.
• Air fresheners as the perfumes and scents can contain toxic chemicals.
• "Natural" products with labels that can be misleading.
• Indoor air products that are intended to perfume or mask odors in the air.
• Household dust can accumulate and concentrate many of the non-volatile toxins that exist in the home.
• Self-care products such as nail polish, shampoo, and others may release formaldehyde, which causes cancer.
• "Safe" ingredients such as polyethylene glycol are very common in cosmetics and cleaning products.  The Environmental Working Group and others question the safety of these ingredients.
• On your shoes you can bring anything that you walked on outdoors including bacteria and other organisms.
• In your walls can be lurking mold which can be an asthma trigger, especially in children.
• From the tap water in as many as 33 states have been found to have unsafe levels of several chemicals.  
• Through your air conditioner, when not well designed or maintained, can contribute to concentrating polluted indoor air. 

To read the full article, visit the Reader's Digest website.  Click below.

Our previous research has shown that exposure to contaminants in outdoor and  indoor air can affect respiratory health, especially in children.  This is important because diseases such as asthma, bronchitis and other conditions are very common and affect many families. 
We have also previously written about the discovery that houseplants could potentially improve the quality of indoor air by filtering some common pollutants.  Different kinds of plants may be able to absorb different kinds of pollutants from the air and from soil.
More recently, I was interviewed by Julia Ries for an article on Healthline.  The article is about a recent study by researchers from the University of Washington in which they show that genetically-modified pothos ivy can absorb benzene and chloroform from the air.  For the article, I was quoted as follows:
   “Air pollution is a major contributing factor in diseases, including cardiovascular disease, respiratory diseases such as asthma, and potentially brain development in children,” said Luz Claudio, PhD, a tenured professor of environmental medicine and public health at the Mount Sinai School of Medicine in New York City.
“We have better control of the environment inside our homes, so it’s worth having clean air indoors as much as possible,” Claudio said.
The original scientific article from the laboratory of Dr. Stuart E. Strand was published in the journal Environmental Science and Technology and can be found HERE.  In their study, the Strand team showed that introducing a detoxifying gene that is normally expressed in mammals (a cytochrome called P450 2e1) into pothos ivy plants not only made the plant express the gene, but also made the plant able to detoxify benzene and chloroform from the air. 
Although this type of research holds promise as a way to improve our environment, genetically-modifying plants is a controversial approach.   We don't know if adding or modifying a gene in an organism can affect other properties beyond the characteristic intended for modification.  In spite of those concerns, genetic engineering holds immense promise as part of the arsenal of approaches towards improving environmental health.