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      Association between Concentrations of Metals in Urine and Adult Asthma: A Case-Control Study in Wuhan, China

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          Abstract

          Background

          Several metals have been reported to be associated with childhood asthma. However, the results on relationships between metals and risk of childhood asthma are inconclusive, and the research on adult asthma in the Chinese general population is rare.

          Objectives

          To investigate potential associations between levels of urinary metals and adult asthma.

          Methods

          A case-control study of 551 adult asthma cases and 551 gender- and age-matched controls was conducted in Wuhan, China. Demographic information was obtained, and lung function was assessed. The urinary concentrations of 22 metals were measured by inductively coupled plasma mass spectrometry.

          Results

          After adjusting for other metalsand other covariates, urinary cadmium, molybdenum, chromium, copper, uranium and selenium were positively associated with asthma, with odds ratios (95% CI) of 1.69 (1.00, 2.85), 3.76 (2.30, 6.16), 4.89 (3.04, 7.89), 6.06 (3.27, 11.21), 6.99 (4.37, 11.19) and 9.17 (4.16, 20.21), respectively. By contrast, urinary lead, barium, iron, zinc, nickel, manganese and rubidium were negatively associated with asthma, with odds ratios (95% CI) of 0.48 (0.29, 0.80), 0.44 (0.27, 0.71), 0.41 (0.26, 0.64), 0.40 (0.24, 0.66), 0.30 (0.22, 0.41), 0.23 (0.14, 0.39) and 0.07 (0.03, 0.15), respectively. When comparing urinary metals in different subgroups of cases with those in matched controls, the associations of above 13 metals with asthma prevalence were nearly the same.

          Conclusions

          Our results suggested that asthma prevalence in the Chinese adults was positively associated with urinary chromium, chromium, selenium, molybdenum, cadmium, and uranium, and negatively associated with urinary manganese, iron, nickel, zinc, rubidium, barium and lead. Additional research with larger populations in different regions is required to support our findings.

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          Most cited references53

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          Asthma: mechanisms of disease persistence and progression.

          When asthma is diagnosed, eosinophilic inflammation and airway remodeling are established in the bronchial airways and can no longer be separated as cause and effect because both processes contribute to persistence and progression of disease, despite anti-inflammatory therapy. Th2 cells are continually active in the airways, even when disease is quiescent. IL-13 is the key effector cytokine in asthma and stimulates airway fibrosis through the action of matrix metalloproteinases on TGF-beta and promotes epithelial damage, mucus production, and eosinophilia. The production of IL-13 and other Th2 cytokines by non-T cells augments the inflammatory response. Inflammation is amplified by local responses of the epithelium, smooth muscle, and fibroblasts through the production of chemokines, cytokines, and proteases. Injured cells produce adenosine that enhances IL-13 production. We review human and animal data detailing the cellular and molecular interactions in established allergic asthma that promote persistent disease, amplify inflammation, and, in turn, cause disease progression.
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            Biomonitoring of 30 trace elements in urine of children and adults by ICP-MS.

            The paper provides physicians and clinical chemists with statistical data (concentration ranges, geometric mean values, selected percentiles, etc.) about 30 urinary trace elements in order to determine whether people have trace element deficiencies or have been exposed to higher elemental concentrations. Morning urine samples of 72 children and 87 adults from two geographical areas of Germany were collected and the elements Li, Be, V, Cr, Mn, Ni, Co, Cu, Zn, Ga, As, Se, Rb, Sr, Mo, Rh, Pd, Ag, Cd, In, Sn, Sb, Cs, Ba, Pt, Au, Pb, Tl, Bi and U were determined by inductively coupled plasma mass spectrometry (ICP-MS) with a new octopole based collision/reaction cell. The urine samples were analysed directly after a simple 1/5 (V/V) dilution with deionised water and nitric acid. Information on exposure conditions of all human subjects were collected by questionnaire-based interviews. The described concentration data down to the ng/l range are very useful for the formulation of reference values. For some elements either new data are described (e.g., for V, Ga, In, Bi, Rh, Mn) or differences to earlier studies were found (e.g., for Be, As). For other elements (e.g., Sb, Se, Mo, Ba, Cu, Zn, Li) our results are in good correlation with previous studies and also complemented with urinary trace element concentrations for children.
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              Increase in asthma: a more toxic environment or a more susceptible population?

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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 May 2016
                2016
                : 11
                : 5
                : e0155818
                Affiliations
                [1 ]Department of Occupational & Environmental Health and Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                [2 ]Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                University of Cincinnati, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: XH WC. Performed the experiments: XH XC WL. Analyzed the data: XH. Contributed reagents/materials/analysis tools: XH JX YZ XW YS JY. Wrote the paper: XH.

                Article
                PONE-D-15-44970
                10.1371/journal.pone.0155818
                4871481
                27191859
                9c9c0b29-f3a7-4542-8523-99f3d8f2e0bc
                © 2016 Huang et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 October 2015
                : 4 May 2016
                Page count
                Figures: 3, Tables: 6, Pages: 18
                Funding
                Funded by: National Basic Research Program of China
                Award ID: 2011CB503804
                Award Recipient :
                This work was supported by grants from the National Basic Research Program of China (2011CB503804). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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