Aerotoxic Syndrome Research Articles

Inhibition kinetics of acetylcholinesterase and butyrylcholinesterase from various species by 2-(2-cresyl)-4H-1,3,2-benzodioxaphosphorin-2-oxide (CBDP)

The aerotoxic syndrome has been associated with exposure to tricresyl phosphate (TCP), which is used as additive in hydraulic fluids and engine lubricants. The toxic metabolite 2-(2-cresyl)-4H-1,3,2-benzodioxaphosphorin-2-oxide (CBDP) is formed from the TCP isomer tri-ortho-cresyl phosphate (TOCP) in vivo and is known to react with the active site serine in acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) resulting in the inhibition of the enzymes. Previous in vitro studies showed pronounced species differences in the inhibition kinetics of cholinesterases by organophosphorus compounds (OP), which must be considered in the development of relevant animal models for the investigation of OP poisoning and the aerotoxic syndrome. The present study was designed to investigate the inhibition kinetics of human, Cynomolgus monkey, pig, mini pig, guinea pig, mouse, and rat AChE as well as BChE by CBDP under standardized conditions. There were similar rate constants for the inhibition (ki) of human, Cynomolgus monkey and mouse AChE by CBDP. In contrast, the ki values obtained for guinea pig, mini pig, pig, and rat AChE were 2.8- to 5.9-fold lower than that of human AChE. The results of the present study confirmed CBDP as one of the most potent inhibitors of human BChE, indicating a ki value of 3.24 ± 0.33 ×108M−1min−1, which was about 1,140-fold higher than that of human AChE. Accordingly, a markedly more pronounced inhibition rate of BChE from the species guinea pig, mini pig, pig, rat, Cynomolgus monkey, and mouse by CBDP was found as compared to those of AChE from the respective sources, indicating 2.0- to 89.6-fold higher ki values.

Burden of Proof: The Debate Surrounding Aerotoxic Syndrome.

Since the 1980s, some commercial airline pilots and flight crews in the United States, United Kingdom and Australia began to report an illness they believed was caused by exposure to contaminated cabin air. Despite a body of scientific research and health activism calling for this condition, termed Aerotoxic Syndrome (AS), to be classified an occupational illness, it has not been accepted as a clinical entity because its causation remains contested. This article contends that debates over the recognition of AS have been shaped by the politics of science and what can be considered evidence of a causal link; the burden of proof lay with survivors and their allies rather than with airlines and manufacturers. The history of AS shows the challenges of reacting to health risks in a global industry that provides an important form of transportation, and enjoys considerable political and economic influence. It also reveals that at the heart of commercial jet air travel remains an unresolved public health issue, and those who claim to be suffering from AS expected prompt recognition, reform and assistance in light of scientific research and personal testimony, as well as a range of chemical, medical, legal and air safety reports.

Inappropriate Use of Risk Assessment in Addressing Health Hazards Posed by Civil Aircraft Cabin Air

Toxicological reviews of data on Aerotoxic Syndrome that have been widely referenced by the airline industry tend to use a toxicological endpoint, Organo-Phosphate Induced Neuropathy (OPIDN), that is acknowledged to be the result of a very high dose of organophosphate exposure. Additionally, the reviews tend to only address one chemical, Tri-Ortho Cresyl Phosphate (TOCP), ignoring the presence of other toxic compounds in a complex mixture. In using this to justify the safety of the continued use of unfiltered engine bleed air to ventilate civil aircraft cabins, this represents a misuse of toxicological risk assessment. The approach totally ignores the scientific literature on repeated low-dose exposure to OPs over extended periods, the constant presence of a complex mixture of OPs in engine bleed air and their overall toxicity and the variable susceptibility of individuals to toxicological damage. This paper lists the above-mentioned studies and reviews a sub-set. We present the scientific literature that should be considered to make a realistic risk assessment of the hazards of aircraft engine bleed air.

Association and Causation: Bradford Hill Approach to Aerotoxic Syndrome

Association and Causation: Bradford Hill Approach to Aerotoxic Syndrome

Aerotoxic syndrome, discussion of possible diagnostic criteria

Introduction: The term aerotoxic syndrome (ATS) was proposed 20 years ago to describe a constellation of symptoms reported by pilots and cabin crew following exposure to hydraulic fluids, engine oil, and pyrolysis products during flight. Hydraulic fluids and engine oil contain a large number of potentially toxic chemicals, including various organophosphate compounds (OPCs). However, ATS is not yet recognised as a valid diagnosis in aviation or general medicine, because the incidence and aetiology continues to be debated.Discussion: Early studies report findings from symptom surveys or cognitive assessments of small samples of self-selected aircrew, but objective measures of exposure were lacking. Over the last decade, researchers have used more sophisticated techniques to measure exposure, such as on board monitoring studies and biomarkers of exposure (e.g., reduced levels of serum butyrylcholinesterases [BChE]) and more sophisticated techniques to detect nervous system injuries such as fMRI and autoantibody testing. Consideration has also been given to inter-individual differences in the ability to metabolise certain chemical compounds as a result of genetic polymorphisms and exclusion of other potential causes of ill health.Conclusions: We discuss factors which suggest a diagnosis of probable ATS; recommend an assessment protocol which incorporates the aforementioned techniques; and propose diagnostic criteria for probable ATS, based on our previously reported findings in aircrew and the results of recent studies.

Three patients with probable aerotoxic syndrome

Introduction: “Aerotoxic syndrome” is a debated entity. Regulatory authorities consider long-term health effects to be an unlikely consequence of exposure to contaminated air because several air quality monitoring studies report low concentrations of toxic chemicals in cabin air. We describe two pilots and one flight attendant, who developed ill health during their flying career which improved after cessation of flying.Case details: The most frequently reported symptoms were headache, balance problems, fatigue, gastro-intestinal complaints and cognitive impairment. One of these patients had reduced levels of butyrylcholinesterase after a flight suggesting exposure to organophosphate compounds had occurred. All three were found to have elevated neuronal and glial auto-antibodies, biomarkers of central nervous system injury, and all three had genetic polymorphisms of paraoxonase (PON-1) and two of cytochrome P450, leading to a reduced ability to metabolize organophosphate compound (OPs).Discussion: A similar constellation of symptoms has been described in other studies of aircrew, although objective evidence of exposure is lacking in most of these studies. Reduced levels of butyrylcholinesterases in one of our cases is suggestive of causation and elevated neuronal and glial autoantibodies provide objective evidence of damage to the central nervous system. We consider further research is warranted.

Contaminated Air: Is the ‘But For’ Test Saving Air Carriers?

Cases concerning victims of presumed air cabin contamination are receiving ever more media attention. Meanwhile, experts are still trying to demonstrate that the so called ‘fume events’ might have consequences on human health. A recent study published in 2017 demonstrates a ‘clear cause and effect relationship has been identified linking the symptoms, diagnoses and findings to the occupational environment.’ (Susan Michaelis et al., Aerotoxic Syndrome: A New Occupational Disease?, 3 Pub.c Health Panorama 198 (2017)) If other studies corroborate such findings, then carriers might face large amounts of litigation from former crew members who are suffering from chronic illnesses. Although the problem has been known for over a decade, only a few cases have been successful, mainly because the victims used specific health-related legislation rather than general tort law. Basing itself predominantly on the Richard Westgate case, this article concludes that the famous English ‘but for’ test is preventing claimants from demonstrating any causal link between their illnesses and the fume events.

Investigating the potential for transisomerisation of trycresyl phosphate with a palladium catalyst and its implications for aircraft cabin air quality

The quality of aircraft cabin air has been an area of concern for several decades. Many investigations have linked the presence of organophosphates in air to Aerotoxic Syndrome with adverse symptoms reported by thousands of aircraft crew across the globe. Currently the source of organophosphates has been under debate, with studies pointing towards tricresylphosphates (TCP) in aircraft oil as the main source due to leaks in engine seals resulting in fumes entering the cabin. However, comparisons of oil and cabin samples have shown that the cabin samples contain a much higher proportion of ortho-substituted TCP than is commonly detected in oil. The aim of this experiment was to investigate the potential for palladium catalysts (present in aircraft air conditioning systems) to convert meta- and para-substituted TCP to produce ortho-substituted TCP through transisomerisation. This experiment was performed in a controlled laboratory setting aimed to represent the conditions likely to be experienced in aircraft. Samples were introduced to a stainless steel micro reactor tube containing the pelletized palladium catalyst using a HPLC pump with a 0.2 ml/min feed flow rate. The temperature maintained at 400 °C over a period of 1 h and samples collected using a condensing vesicle. These were then diluted and transferred to a 2 mL vial for analysis by gas chromatography mass spectrometry. No evidence supporting the transisomerisation of tricresylphosphate was obtained. This indicates that more emphasis should be placed on identifying other potential sources of ortho substituted TCP.

Neurotoxicity in acute and repeated organophosphate exposure

The term organophosphate (OP) refers to a diverse group of chemicals that are found in hundreds of products worldwide. As pesticides, their most common use, OPs are clearly beneficial for agricultural productivity and the control of deadly vector-borne illnesses. However, as a consequence of their widespread use, OPs are now among the most common synthetic chemicals detected in the environment as well as in animal and human tissues. This is an increasing environmental concern because many OPs are highly toxic and both accidental and intentional exposures to OPs resulting in deleterious health effects have been documented for decades. Some of these deleterious health effects include a variety of long-term neurological and psychiatric disturbances including impairments in attention, memory, and other domains of cognition. Moreover, some chronic illnesses that manifest these symptoms such as Gulf War Illness and Aerotoxic Syndrome have (at least in part) been attributed to OP exposure. In addition to acute acetylcholinesterase inhibition, OPs may affect a number of additional targets that lead to oxidative stress, axonal transport deficits, neuroinflammation, and autoimmunity. Some of these targets could be exploited for therapeutic purposes. The purpose of this review is thus to: 1) describe the important uses of organophosphate (OP)-based compounds worldwide, 2) provide an overview of the various risks and toxicology associated with OP exposure, particularly long-term neurologic and psychiatric symptoms, 3) discuss mechanisms of OP toxicity beyond cholinesterase inhibition, 4) review potential therapeutic strategies to reverse the acute toxicity and long term deleterious effects of OPs.

Chemically Enhanced Polymer-Coated Carbon Nanotube Electronic Gas Sensor for Isopropyl Alcohol Detection.

Breathing-air quality within commercial airline cabins has come under increased scrutiny because of the identification of volatile organic compounds (VOCs) from the engine bleed air used to provide oxygen to cabins. Ideally, a sensor would be placed within the bleed air pipe itself, enabling detection before it permeated through and contaminated the entire cabin. Current gas-phase sensors suffer from issues with selectivity, do not have the appropriate form factor, or are too complex for commercial deployment. Here, we chose isopropyl alcohol (IPA), a main component of de-icer spray used in the aerospace community, as a target analyte: IPA exposure has been hypothesized to be a key component of aerotoxic syndrome in pre, during, and postflight. IPAs proposed mechanism of action is that of an anesthetic and central nervous system depressant. In this work, we describe IPA sensor development by showing (1) the integration of a polymer as an IPA capture matrix, (2) the adoption of a redox chemical additives as an IPA oxidizer, and (3) the application of carbon nanotubes as an electronic sensing conduit. We demonstrate the ability to not only detect IPA at 100–10 000 ppm in unfiltered, laboratory air but also discriminate among IPA, isoprene, and acetone, especially in comparison to a typical photoionization detector. Overall, we show an electronic device that operates at room temperature and responds preferentially to IPA, where the increase in the resistance corresponds directly to the concentration of IPA. Ultimately, this study opens up the pathway to selective electronic sensors that can enable real-time monitoring in a variety of environments for the force health prevention and protection, and the potential through future work to enable low parts-per-million and possibly high parts-per-billion selective detection of gas-phase VOCs of interest.

Organophosphorus Compounds at 80: Some Old and New Issues.

One of the major classes of pesticides is that of the organophosphates (OPs). Initial developments date back almost 2 centuries but it was only in the mid-1940s that OPs reached a prominent status as insecticides, a status that, albeit declining, is still ongoing. OPs are highly toxic to nontarget species including humans, the primary effects being an acute cholinergic toxicity (responsible for thousands of poisoning each year) and a delayed polyneuropathy. Several issues of current debate and investigation on the toxicology of OPs are discussed in this brief review. These include (1) possible additional targets of OPs, (2) OPs as developmental neurotoxicants, (3) OPs and neurodegenerative diseases, (4) OPs and the "aerotoxic syndrome," (5) OPs and the microbiome, and (6) OPs and cancer. Some of these issues have been debated and studied for some time, while others are newer, suggesting that the study of the toxicology of OPs will remain an important scientific and public health issue for years to come.

The Aetiology of 'Aerotoxic Syndrome'- A Toxico- Pathological Viewpoint

The Aetiology of 'Aerotoxic Syndrome'- A Toxico- Pathological Viewpoint

Acetylcholinesterase and neuropathy target esterase activities in 11 cases of symptomatic flight crew members after fume events

ABSTRACTIn modern aviation, so-called fume events such as exposure to an unknown mixture of chemicals introduced into the aircraft cabin with bleed air drawn off at the engines may occur. Human exposure may result in (neuro)toxic symptoms described as so-called “aerotoxic syndrome.” Currently, among other agents organophosphates (OP) are regarded as a likely cause of the observed adverse effects. After fume events 11 flight crew members (9 female/2 male; ages 23–58 yr) were admitted for a medical examination within 5 d post exposure. Individual acetylcholinesterase (AChE) and neuropathy target esterase (NTE) activities were determined. Anamnesis and clinical findings confirmed prominent symptoms of an intoxication, including headache, cognitive difficulties, and neurological disorders, among others. Patient AChE activities ranged from 37 to 50 U/g hemoglobin (reference values: 26.7–50.9 U/g hemoglobin). Ten individuals showed NTE activities ranging from 3.14 to 6.3 nmol phenyl valerate/(min × mg protein) (reference values: 3.01–24), with one patient exhibiting low NTE activity of 1.4. Biochemical effect monitoring was applied to encompass a broad range of AChE-inhibiting compounds such as OP, carbamates, and isocyanates, or to detect inhibition of NTE. The measured AChE activities indicated a subordinate contribution of OP or related compounds to the observed symptoms. All noted NTE activities were clustered at low levels. Our data suggest a likely inhibition of NTE activities in patients after fume events, which warrants further investigation. The observed symptoms may be linked to known chemical compounds in fume events, and it is not possible to infer a direct correlation between manifestations and AChE -inhibiting compounds at this time.

Aircraft cabin air contamination and aerotoxic syndrome—a review of the evidence

Aircraft cabin air contamination and aerotoxic syndrome—a review of the evidence

Aircraft cabin air contamination and aerotoxic syndrome—a review of the evidence

Aircraft cabin air contamination and aerotoxic syndrome—a review of the evidence

A comparison of fresh and used aircraft oil for the identification of toxic substances linked to aerotoxic syndrome

Fresh and used aircraft engine lubricants (Mobil Jet Oil II) were analysed using a Fourier Transform Ion Cyclotron Resonance Mass Spectrometer (FTICRMS) and comprehensive two dimensional gas chromatography with high resolution time of flight mass spectrometry (GCxGC-HRTOFMS). The composition of the fresh oil was established, with special focus to its tricresyl phosphate (TCP) content as this has formed the focus for most investigations into aerotoxic syndrome. The results showed that only four TCP isomers were present at detectable levels in the fresh oil: mmm-TCP, mmp-TCP, ppm-TCP and ppp-TCP. The results indicate that the formulation of Mobile Jet Oil II does not contain the more toxic ortho substituted TCP isomers at concentrations above 0.0005%. The temperatures of jet engines during operation are greater than 200 °C which creates the potential to alter the composition of the original oil and create other toxic compounds. The results show there may be a significant risk from alkylated cresyl phosphates, which were identified in the used oils at concentrations calculated in the range of 0.13–0.69%. w/w. Several xylenyl and ethylphenyl phosphates have been shown to exhibit a similar toxicity to ortho substituted TCP isomers which makes there discovery in used oil significant. These compounds should be included in future aircraft air quality studies and when assessing the risks and causes of aerotoxic syndrome.

In vitro neurotoxic hazard characterization of different tricresyl phosphate (TCP) isomers and mixtures

Exposure to tricresyl phosphates (TCPs), via for example contaminated cabin air, has been associated with health effects including the so-called aerotoxic syndrome. While TCP neurotoxicity is mainly attributed to ortho-isomers like tri-ortho-cresyl phosphate (ToCP), recent exposure and risk assessments indicate that ToCP levels in cabin air are very low. However, the neurotoxic potential of non-ortho TCP isomers and TCP mixtures is largely unknown. We therefore measured effects of exposure (up to 48h) to different TCP isomers, mixtures and the metabolite of ToCP (CBDP: cresyl saligenin phosphate) on cell viability and mitochondrial activity, spontaneous neuronal electrical activity, and neurite outgrowth in primary rat cortical neurons.The results demonstrate that exposure to TCPs (24–48h, up to 10μM) increases mitochondrial activity, without affecting cell viability. Effects of acute TCP exposure (30min) on neuronal electrical activity are limited. However, electrical activity is markedly decreased for the majority of TCPs (10μM) following 48h exposure. Additional preliminary data indicate that exposure to TCPs (48h, 10μM) did not affect the number of neurites per cell or average neurite length, except for TmCP and the analytical TCP mixture (Sigma) that induced a reduction of average neurite length.The combined neurotoxicity data demonstrate that the different TCPs, including ToCP, are roughly equipotent and a clear structure-activity relation is not apparent for the studied endpoints. The no-observed-effect-concentrations (1μM) are well above current exposure levels indicating limited neurotoxic health risk, although exposures may have been higher in the past. Moreover, prolonged and/or repeated exposure to TCPs may exacerbate the observed neurotoxic effects, which argues for additional research.

Aerotoxic syndrome as a Mirce mechanics phenomenon

Aerotoxic syndrome is a somewhat controversial condition that could be triggered by the air compression systems in commercial planes. Some of the air that is compressed and recirculated throughout the cabins originates in jet engines; when excess oil molecules enter that air supply, it can result in what is called a 'fume event' Thus, the main objective of this paper is to address the aerotoxic phenomenon as one possible mechanism of the motion in Mirce Mechanic and examine how some of the existing Mirce Mechanics method could be applied to calculate reduction in the probability of inhaling aerotoxic, by the crew and frequent flyers ,through the application of some of the options available to the designers and operators presented in the paper.

The aerotoxic syndrome: Is there a new low-level neurotoxic syndrome in the air?

The aerotoxic syndrome: Is there a new low-level neurotoxic syndrome in the air?

Towards a clinical diagnosis of the aerotoxic syndrome, possible methods and challenges

Towards a clinical diagnosis of the aerotoxic syndrome, possible methods and challenges