The relationship of polluted air and drinking water sources with the prevalence of systemic lupus erythematosus: a provincial population-based study

Jiaqi Chen,Xiang Ding,Jun Tan,Wenzhong Qu ,Lin Liu,Xuebing Feng,Linyu Geng,Zhanyun Da,Fan Wang,Wei Kong,Jiansheng Chen,Li Sun,Min Wu,Juan Tao,Meimei Wang,Qiming Xian ,Wei Pan ,Fuwan Ding,Jun Liang,Hua Wei,Ying Zou ,Miaojia Zhang,Huaixia Hu,Jing Li,Jian Wu,Lingyun Sun

doi:10.1038/s41598-021-98111-8

Abstract

Environmental exposures interact with genetic factors has been thought to influence susceptibility of systemic lupus erythematosus (SLE) development. To evaluate the effects of environmental exposures on SLE, we conducted a population-based cohort study across Jiangsu Province, China, to examine the associations between the living environment including air and water pollution, population density, economic income level, etc. and the prevalence and mortality of hospitalized SLE (h-SLE) patients. A total of 2231 h-SLE patients were retrieved from a longitudinal SLE database collected by the Jiangsu Lupus Collaborative Group from 1999 to 2009. The results showed that: It existed regional differences on the prevalence of h-SLE patients in 96 administrative districts; The distribution of NO2 air concentration monitored by atmospheric remote sensors showed that three of the ultra-high-prevalence districts were located in the concentrated chemical industry emission area; h-SLE patient prevalence was positively correlated with the excessive levels of nitrogen in drinking water; The positive ratio of pericarditis and proteinuria was positively correlated with the prevalence of h-SLE patients and pollution not only induced a high h-SLE patient prevalence but also a higher mortality rate, which might be attributed to NOx pollution in the air and drinking water. In summary, our data suggested that NOx in air and drinking water may be one of the important predispositions of SLE, especially for patients with renal involvement.

Highlights

Environmental exposures interact with genetic factors has been thought to influence susceptibility of systemic lupus erythematosus (SLE) development
To evaluate the population density of each administrative district and the distribution of hospitalized SLE (h-SLE) patients, we analyzed the density of 2231 individuals in 96 administrative districts of Jiangsu Province (Fig. 1A) and significant difference analysis of the h-SLE patient prevalence of population density group indicated that there was no significant difference in h-SLE patient prevalence among different groups (Fig. 1B)
To reveal the relationships of environmental exposures and h-SLE incidence, we conducted a normalized analysis between the cases and the h-SLE patient prevalence in 96 administrative districts of Jiangsu Province (R2 = 0.62, Fig. 1C). 45 of the 96 districts fell outside the 0.2 × 0.2 area, supporting that the onset of lupus may be triggered by exposure to environmental factors

Summary

Introduction

Environmental exposures interact with genetic factors has been thought to influence susceptibility of systemic lupus erythematosus (SLE) development. Environmental agents that inhibit ERK signaling, its upstream regulator protein kinase C delta (PKC-d), or other conditions such as diet and aging, that impact DNMT1 activity may increase methylation-sensitive gene expression through epigenetic mechanisms to cause a lupus-like disease in genetically predisposed individuals[24,25]. All of these data support that environmental pollutants have proinflammatory effects and are contributing to the generation of inflammation and autoimmunity. Our data showed NOx in air and drinking water may be one of the important predispositions of SLE, especially for patients with renal involvement, while the economic and living standards had no effect on h-SLE patient prevalence distribution

Methods

Results

Conclusion