RT Journal Article
SR Electronic
T1 High plasma concentrations of organic pollutants negatively impact survival in amyotrophic lateral sclerosis
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 907
OP 912
DO 10.1136/jnnp-2018-319785
VO 90
IS 8
A1 Goutman, Stephen A
A1 Boss, Jonathan
A1 Patterson, Adam
A1 Mukherjee, Bhramar
A1 Batterman, Stuart
A1 Feldman, Eva L
YR 2019
UL http://jnnp.bmj.com/content/90/8/907.abstract
AB Objective To determine whether persistent organic pollutants (POP) affect amyotrophic lateral sclerosis (ALS) survival.Methods ALS participants seen at the University of Michigan (Ann Arbor, MI, USA) provided plasma samples for measurement of POPs. ALS disease and clinical features were collected prospectively from the medical records. Survival models used a composite summary measure of exposure due to multiple POPs (environmental risk score or ERS).Results 167 participants (40.7% female, n=68) with ALS were recruited, of which 119 died during the study period. Median diagnostic age was 60.9 years (IQR 52.7–68.2), median time from symptom onset to diagnosis was 1.01 years (IQR 0.67–1.67), bulbar onset 28.7%, cervical onset 33.5% and lumbar onset 37.7%. Participants in the highest quartile of ERS (representing highest composite exposure), adjusting for age at diagnosis, sex and other covariates had a 2.07 times greater hazards rate of mortality (p=0.018, 95% CI 1.13 to 3.80) compared with those in the lowest quartile. Pollutants with the largest contribution to the ERS were polybrominated diphenyl ethers 154 (HR 1.53, 95% CI 0.90 to 2.61), polychlorinated biphenyls (PCB) 118 (HR 1.50, 95% CI 0.95 to 2.39), PCB 138 (HR 1.69, 95% CI 0.99 to 2.90), PCB 151 (HR 1.46, 95% CI 1.01 to 2.10), PCB 175 (HR 1.53, 95% CI 0.98 to 2.40) and p,p′-DDE (HR 1.39, 95% CI 1.07 to 1.81).Conclusions Higher concentrations of POPs in plasma are associated with reduced ALS survival, independent of age, gender, segment of onset and other covariates. This study helps characterise and quantify the combined effects of POPs on ALS and supports the concept that environmental exposures play a role in disease pathogenesis.