Health effects of Environmental Air Pollution Changsoo Kim, MD, PhD Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea 한국연소학회 춘계학술대회

Air pollution  The number of death cause by air pollution (WHO 2012) : from ambient air pollution 3.7 million : from household air pollution 4.3 million Percentage represents percent of total HAP or AAP burden (add up to 100%). HAP: Household air pollution; ALRI: Acute lower respiratory disease; COPD: Chronic obstructive pulmonary disease; IHD: Ischaemic heart disease. Deaths attributable to HAP (left) and AAP (right) in 2012

PM10 levels in the period (WHO 2012) PM10: Fine particulate matter of 10 microns or less; Afr: Africa; Amr: America; Emr: Eastern Mediterranean; Eur: Europe; Sear: South ‐ East Asia; Wpr: Western Pacific; LMI: Low ‐ and middle ‐ income; HI: high ‐ income.

Air pollution: basic mechanism

Health effects - inflammation Wilson MR et al. Interactions between ultrafine particles and transition metals in vivo and in vitro. Toxicol Appl Pharmacol 2002;184:172-9

Polystyrene particles of 60 nm diameter: effect on haemostasis –increase in prothrombotic tendency, resulting from platelet activation. Nemmar A, et al. Ultrafine particles affect experimental thrombosis in an in vivo hamster model. Am J Respir Crit Care Med. 2002;166:998–1004. Confocal microscopy of fixed platelet aggregates obtained after incubation with fluorescently labeled, carboxylate-modified particles (A) or amine-modified particles (B) (50 µg/ml) and ADP (1.25 µM). Effect of intratracheal instillation of 5 mg/kg of unmodified, carboxylate-modified, or amine-modified UFPs on thrombus formation. Health effects – systemic inflammation

Body distribution of particles Nemmar A, et al. Passage of intratracheally instilled ultrafine particles (< 80nm) from the lung into the systemic circulation in hamster. Am J Respir Crit Care Med 2001;164:

Carbon in Airway Macrophages and Lung Function in Children Kulkarni N. N Engl J Med 2006 jul 6;355:21-30

Oxidative stress, carcinogenesis Cancer letters 2008;266:84-97

심뇌혈관계 질환 1 1

Courtesy of K Donaldson & R Duffin, 2006 Volvo diesel engine (volvo TD45, 4 cylinders, 68 rpm)

Pope CA III et al. Cardiovascular mortality and long-term exposure to particulate air pollution: epidemioloical evidence of general pathophysiological pathways of disease. Circulation 2004;109:71-7

Peters A. Circulation 2009;120;

N Engl J Med 2009;360:

정신 / 신경계질환 2 2

Air pollution: Neuroinflammation and CNS disease Block ML, Calderon-Garciduenas. Air pollution: mechanisms of neuroinflammation and CNS disease. Trends in Neroscience 2009;32:

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Preliminary Results for depressive episode Lag0Lag1Lag2Lag0-1Lag0-2 SO (0.967, 1.046)1.042 (1.002, 1.083)1.035 (0.995, 1.077)1.030 (0.989, 1.072)1.041 (0.999, 1.085) PM (0.981, 1.050)1.021 (0.987, 1.056)1.042 (1.008, 1.077)1.022 (0.988, 1.058)1.039 (1.003, 1.075) O3O (0.991, 1.076)1.054 (1.013, 1.096)1.006 (0.968, 1.046)1.061 (1.018, 1.107)1.052 (1.009, 1.097) NO (0.974, 1.046)1.022 (0.986, 1.059)1.048 (1.012, 1.086)1.020 (0.985, 1.057)1.045 (1.008, 1.083) CO1.015 (0.977, 1.055)1.010 (0.972, 1.050)1.031 (0.991, 1.072)1.016 (0.977, 1.057)1.030 (0.989, 1.072) 24 Adjusted 1 relative risks (RR) 2 and their 95% confidence intervals (95% CI) of emergency departm ent visits for depressive episode in Seoul, Republic of Korea 1 adjusted for date of visit, day of the week, national holiday, daily mean temperature, and relative humidity. 2 per increment in 1 standard deviation of each air pollutant (SO 2, 2.44 ppb; PM 10, μg/m 3 ; O 3, ppb; NO 2, ppb; CO, 0.24 ppm). Cho et al., Journal of Affective disorder 2014

Air pollution as a risk factor for depressive episode in patients with cardiovascular disease, diabetes mellitus, or asthma Cho et al., Journal of Affective disorder 2014

Ambient ozone concentration and emergency department visits for panic attacks Cho J, et al. Journal of psychiatric research 2015

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28 Ambient particulate matter and suicide risk C Kim, et al., Ambient particulate matter as a risk factor for suicide. Am J Psychiatry 2010;167:

29 C Kim, et al., Ambient particulate matter as a risk factor for suicide. Am J Psychiatry 2010;167:

Possible mechanisms Neuroinflammation: Microglia – Resident innate immune cells in the brain – Activated in neurodegenerative diseases (AD and PD patients) Neurodegenerative disease proteins – Aβ42, α-synuclein, hyper-phosphorylated tau – DE exposed rat brain Neuropsychological effect: behavior Chemical complexity of air pollution-induced neurotoxicity 30

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