Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room

Abstract

A growing body of evidence suggests chemicals present in air, water, soil, food, building materials and household products are toxicants that contribute to the many chronic diseases typically seen in routine medical practice. Yet, despite calls from numerous organisations to provide clinicians with more training and awareness in environmental health, there are multiple barriers to the clinical assessment of toxic environmental exposures. Recent developments in the fields of systems biology, innovative breakthroughs in biomedical research encompassing the “-omics” fields, and advances in mobile sensing, peer-to-peer networks and big data, provide tools that future clinicians can use to assess environmental chemical exposures in their patients. There is also a need for concerted action at all levels, including actions by individual patients, clinicians, medical educators, regulators, government and non-government organisations, corporations and the wider civil society, to understand the “exposome” and minimise the extent of toxic exposures on current and future generations. Clinical environmental chemical risk assessment may provide a bridge between multiple disciplines that uses new technologies to herald in a new era in personalised medicine that unites clinicians, patients and civil society in the quest to understand and master the links between the environment and human health.

<p>Comparison of cytocompatibility and anticancer properties of traditional and green chemistry-synthesized tellurium nanowires</p>

“…Chemical processes, to a certain extent, are responsible for the contamination of all the known ecosystems all over the world. [1][2][3] This is especially true for nanotechnology or nanomaterials. Nanotechnology produces materials at a small scale that have novel properties much different from those of the bulk materials.…”

Trends in the application of high-resolution mass spectrometry for human biomonitoring: An analytical primer to studying the environmental chemical space of the human exposome

“…inflammation, infection, and the microbiome) (Rappaport and Smith, 2010, Miller and Jones, 2014). The power of measuring the internal environmental chemical space of the human exposome as a tool to evaluate health risks is increasingly recognized across several scientific domains (Wild, 2005, Wild, 2012, Wild et al, 2013, Nakamura et al, 2014, Bijlsma and Cohen, 2016, Kortenkamp et al, 2007, Rappaport, 2011). The blood exposome was the first effort directed towards incorporating literature data for about 1,600 exo- and endogenous chemicals to identify associated metabolic pathways and disease etiologies (Rappaport et al, 2014).…”

The Promises and Challenges of Toxico-Epigenomics: Environmental Chemicals and Their Impacts on the Epigenome

“…A recent assessment by an expert panel convened by the World Health Organization estimated that as many as 20% of cancers, 31% of cardiovascular diseases, 42% of stroke cases, and 35% of chronic obstructive pulmonary disease cases are attributable to environmental factors (Prüss-Ustün et al 2016). Chronic illnesses that may be caused or exacerbated by environmental chemicals include asthma, obesity, Alzheimer's disease, diabetes, infertility, and ovarian dysgenesis syndrome (reviewed by Bijlsma and Cohen 2016). Taken together, it has been estimated that the health and socioeconomic costs associated with environmental chemical exposure are likely to exceed 10% of the global gross domestic product, amounting to approximately $6.23 trillion (Grandjean and Bellanger 2017).…”

“…First, toxicity studies are generally conducted with individual chemicals with the objective of providing an estimated point of departure (Goodson et al 2015). Such assessments, although undoubtedly useful, are ineffective at predicting the hazardous effects of chemicals that exhibit nonmonotonic dose responses and low dose relationships (reviewed by Vandenberg et al 2012) and fail to account for mixture effects (reviewed by Bijlsma and Cohen 2016). An additional challenge is that a subgroup of these chemicals, endocrine-disrupting chemicals (EDCs), can mimic or alter endogenous endocrine processes (Alofe et al 2019).…”

“…To date, several major classes of hazardous or potentially hazardous environmental chemicals have been identified. These include toxic elements (e.g., arsenic, cadmium, lead, mercury); naturally occurring animal, plant, and food allergens; pesticides, persistent organic pollutants (e.g., perfluorooctanoic acid, polychlorinated biphenyls); volatile organic compounds (e.g., benzene, formaldehyde, gasoline); plastic components (e.g., bisphenol A, phthalates); and air pollutants (e.g., asbestos, radon, tobacco smoke) (reviewed by Bijlsma and Cohen 2016;Sears and Genuis 2012). Biochemical effects commonly reported to be triggered by environmental toxicants include oxidative stress, endocrine disruption, genotoxicity, enzyme inhibition, epigenetic changes, and dysbiosis (reviewed by Herceg et al 2018;Sears and Genuis 2012).…”