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- Data profile Introduction to the Forensic Research via Omics Markers in Environmental Health Vulnerable Areas (FROM) study
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Jung-Yeon Kwon1
, Woo Jin Kim2
, Yong Min Cho3
, Byoung-gwon Kim1,4
, Seungho Lee1,4
, Jee Hyun Rho1
, Sang‑Yong Eom5
, Dahee Han3
, Kyung-Hwa Choi6
, Jang-Hee Lee7
, Jeeyoung Kim2
, Sungho Won8
, Hee-Gyoo Kang9
, Sora Mun9
, Hyun Ju Yoo10
, Jung-Woong Kim11
, Kwan Lee12
, Won-Ju Park13
, Seongchul Hong14
, Young-Soub Hong1,4
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Epidemiol Health 2024;e2024062
DOI: https://doi.org/10.4178/epih.e2024062 [Accepted]
Published online: July 12, 2024
2Department of Internal Medicine and Environmental Health Center, Kang-won National University, Chuncheon, Korea
3Department of Nano, Chemical & Biological Engineering, Seokyeong University, Seoul , Korea
4Environmental Health Center for Busan, Dong-A University, Busan, Korea
5Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
6Department of Preventive Medicine, College of Medicine, Dankook University , Cheonan, Korea
7SD Medical Research Institute, Yongin, Korea
8Department of Public Health Sciences, Seoul National University, Seoul , Korea
9Department of Biomedical Laboratory Science, College of Health Sciences, Eulji University, Seongnam, Korea
10Department of Convergence Medicine, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul , Korea
11Department of Life Sciences, Chung-Ang University, Seoul , Korea
12Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju, Korea
13Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
14Department of Preventive Medicine, College of Medicine, Jeju National University, Jeju, Korea
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Corresponding author:
Young-Soub Hong,
Email: yshong@dau.ac.kr
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Abstract
OBJECTIVES
Exposure to humidifier disinfectants has been linked to respiratory diseases, including interstitial lung disease, asthma, and pneumonia. Consequently, numerous toxicological studies have explored respiratory damage as both a necessary and sufficient condition for these diseases. We systematically reviewed and integrated evidence from toxicological studies by applying the evidence integration method established in previous research to confirm the biological plausibility of the association between exposure and disease.
METHODS
We conducted a literature search focusing on polyhexamethylene guanidine phosphate (PHMG) and chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT), the primary ingredients in humidifier disinfectants. We selected relevant studies based on their quality and the population, exposure, comparator, outcome (PECO) statements. These studies were categorized into 3 lines of evidence: hazard information, animal studies, and mechanistic studies. Based on a systematic review, we integrated the evidence to develop an aggregate exposure pathway–adverse outcome pathway (AEP-AOP) model for respiratory damage. The reliability and relevance of our findings were assessed by comparing them with the hypothesized pathogenic mechanisms of respiratory diseases.
RESULTS
The integration of each AEP-AOP component for PHMG and CMIT/MIT led to the development of an AEP-AOP model, wherein disinfectants released from humidifiers in aerosol or gaseous form reached target sites, causing respiratory damage through molecular initiating events and key events. The model demonstrated high reliability and relevance to the pathogenesis of respiratory diseases.
CONCLUSIONS
The AEP-AOP model developed in this study provides strong evidence that exposure to humidifier disinfectants causes respiratory diseases. This model demonstrates the pathways leading to respiratory damage, a hallmark of these conditions.
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