ONE AIRWAY: BIOMARKERS OF PROTECTION FROM UPPER AND LOWER AIRWAY INJURY AFTER WORLD TRADE CENTER EXPOSURE
Published Date:Nov 13 2013
Source:Respir Med. 2013; 108(1):162-170.
Forced Expiratory Volume
Respiratory Tract Diseases
September 11 Terrorist Attacks
Severity Of Illness Index
Tumor Necrosis Factor-alpha
World Trade Center
Pubmed Central ID:PMC3946892
Funding:1 UL1RR029893/RR/NCRR NIH HHS/United States
AL080298A/PHS HHS/United States
HL090316/HL/NHLBI NIH HHS/United States
K23HL084191/HL/NHLBI NIH HHS/United States
K24 AI080298/AI/NIAID NIH HHS/United States
K24A1080298/PHS HHS/United States
R01HL057879/HL/NHLBI NIH HHS/United States
R01HL090316/HL/NHLBI NIH HHS/United States
T32 ES007267/ES/NIEHS NIH HHS/United States
TL1RR029892/RR/NCRR NIH HHS/United States
U01CA008617/CA/NCI NIH HHS/United States
U10- OH008243/OH/NIOSH CDC HHS/United States
U10-OH008242/OH/NIOSH CDC HHS/United States
UL1TR000038/TR/NCATS NIH HHS/United States
Firefighters exposed to World Trade Center (WTC) dust have developed chronic rhinosinusitis (CRS) and abnormal forced expiratory volume in 1 second (FEV1). Overlapping but distinct immune responses may be responsible for the clinical manifestations of upper and lower airway injury. We investigated whether a panel of inflammatory cytokines, either associated or not associated with WTC-LI, can predict future chronic rhinosinusitis disease and its severity.
Serum obtained within six months of 9/11/2001 from 179 WTC exposed firefighters presenting for subspecialty evaluation prior to 3/2008 was assayed for 39 cytokines. The main outcomes were medically managed CRS (N=62) and more severe CRS cases requiring sinus surgery (N=14). We tested biomarker-CRS severity association using ordinal logistic regression analysis.
Increasing serum IL-6, IL-8, GRO and neutrophil concentration reduced the risk of CRS progression. Conversely, increasing TNF-α increased the risk of progression. In a multivariable model adjusted for exposure intensity, increasing IL-6, TNF-α and neutrophil concentration remained significant predictors of progression. Elevated IL-6 levels and neutrophil counts also reduced the risk of abnormal FEV1 but in contrast to CRS, increased TNF-α did not increase the risk of abnormal FEV1.
Our study demonstrates both independent and overlapping biomarker associations with upper and lower respiratory injury, and suggests that the innate immune response may play a protective role against CRS and abnormal lung function in those with WTC exposure.
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