1 4686 167 NEW THERAPEUTIC TARGETS IN TRANSFUSION-DEPENDENT AND -INDEPENDENT THALASSEMIA. BETA-THALASSEMIAS ARE CHARACTERIZED BY REDUCED PRODUCTION OF BETA-GLOBIN CHAIN, RESULTING IN ALPHA/BETA-CHAIN UNBALANCE AND PRECIPITATION OF ALPHA-GLOBIN-HEME COMPLEXES AND DETERMINING INEFFECTIVE ERYTHROPOIESIS. INEFFECTIVE ERYTHROPOIESIS, CHRONIC HEMOLYTIC ANEMIA, AND COMPENSATORY HEMATOPOIETIC EXPANSION ARE THE DISEASE HALLMARKS, AND THEY ARE RELATED TO THE SEVERITY OF THE CHAIN UNBALANCE. SEVERAL CLINICAL FORMS OF BETA-THALASSEMIA, INCLUDING THE COINHERITANCE OF BETA-THALASSEMIA WITH HEMOGLOBIN E RESULTING IN HEMOGLOBIN E/BETA-THALASSEMIA, HAVE BEEN DESCRIBED. CLINICALLY, BETA-THALASSEMIAS CAN BE CLASSIFIED AS TRANSFUSION-DEPENDENT THALASSEMIA (TDT) AND NON-TRANSFUSION-DEPENDENT THALASSEMIA (NTDT) ACCORDING TO THE SEVERITY OF THE PHENOTYPE, WHICH IS CAUSED BY A WIDE SPECTRUM OF MUTATIONS IN A HOMOZYGOUS OR COMPOUND HETEROZYGOUS STATE. CURRENT TREATMENT OF TDT CONSISTS OF REGULAR TRANSFUSIONS THAT LEAD TO IRON OVERLOAD, REQUIRING IRON CHELATION TO PREVENT IRON-RELATED ORGAN TOXICITY. NTDT PATIENTS DO NOT REQUIRE TRANSFUSIONS OR ONLY OCCASIONALLY REQUIRE THEM; HOWEVER, THEY DEVELOP IRON OVERLOAD AS WELL BECAUSE OF INCREASED INTESTINAL IRON ABSORPTION CAUSED BY CHRONIC ANEMIA. HEMATOPOIETIC STEM CELL ALLOGENIC TRANSPLANT IS THE ONLY APPROVED CURE FOR BETA-THALASSEMIA; HOWEVER, IT IS STILL LIMITED BY CLINICAL CONDITIONS AND THE AVAILABILITY OF MATCHED DONORS AS WELL AS BY POTENTIAL GRAFT-VERSUS-HOST DISEASE (GVHD). GENE THERAPY COULD AVOID THE GVHD RISK, ALTHOUGH HEMATOPOIETIC STEM CELLS MUST BE GENETICALLY MODIFIED EX VIVO. EPIGENETIC MANIPULATION AND GENOMIC EDITING ARE NOVEL EXPERIMENTAL APPROACHES. AN INCREASED UNDERSTANDING OF THE PATHOPHYSIOLOGY THAT CONTROLS THE DISEASE PROCESS PROMPTED US TO EXPLORE ALTERNATIVE THERAPEUTIC APPROACHES THAT ADDRESS THE UNDERLYING CHAIN UNBALANCE, INEFFECTIVE ERYTHROPOIESIS, AND IRON DYSREGULATION. MOLECULES, SUCH AS JAK2 INHIBITORS AND THE ACTIVIN-RECEPTOR LIGAND TRAP THAT TARGET INEFFECTIVE ERYTHROPOIESIS, ARE ALREADY IN CLINICAL TRIALS WITH PROMISING RESULTS. OTHER AGENTS AIMED TO GENERATE IRON-RESTRICTED ERYTHROPOIESIS ARE ALSO UNDER EXPERIMENTAL EVALUATION. 2017 2 1157 29 CONTAMINANT METALS AS CARDIOVASCULAR RISK FACTORS: A SCIENTIFIC STATEMENT FROM THE AMERICAN HEART ASSOCIATION. EXPOSURE TO ENVIRONMENTAL POLLUTANTS IS LINKED TO INCREASED RISK OF CARDIOVASCULAR DISEASE. BEYOND THE EXTENSIVE EVIDENCE FOR PARTICULATE AIR POLLUTION, ACCUMULATING EVIDENCE SUPPORTS THAT EXPOSURE TO NONESSENTIAL METALS SUCH AS LEAD, CADMIUM, AND ARSENIC IS A SIGNIFICANT CONTRIBUTOR TO CARDIOVASCULAR DISEASE WORLDWIDE. HUMANS ARE EXPOSED TO METALS THROUGH AIR, WATER, SOIL, AND FOOD AND EXTENSIVE INDUSTRIAL AND PUBLIC USE. CONTAMINANT METALS INTERFERE WITH CRITICAL INTRACELLULAR REACTIONS AND FUNCTIONS LEADING TO OXIDATIVE STRESS AND CHRONIC INFLAMMATION THAT RESULT IN ENDOTHELIAL DYSFUNCTION, HYPERTENSION, EPIGENETIC DYSREGULATION, DYSLIPIDEMIA, AND CHANGES IN MYOCARDIAL EXCITATION AND CONTRACTILE FUNCTION. LEAD, CADMIUM, AND ARSENIC HAVE BEEN LINKED TO SUBCLINICAL ATHEROSCLEROSIS, CORONARY ARTERY STENOSIS, AND CALCIFICATION AS WELL AS TO INCREASED RISK OF ISCHEMIC HEART DISEASE AND STROKE, LEFT VENTRICULAR HYPERTROPHY AND HEART FAILURE, AND PERIPHERAL ARTERY DISEASE. EPIDEMIOLOGICAL STUDIES SHOW THAT EXPOSURE TO LEAD, CADMIUM, OR ARSENIC IS ASSOCIATED WITH CARDIOVASCULAR DEATH MOSTLY ATTRIBUTABLE TO ISCHEMIC HEART DISEASE. PUBLIC HEALTH MEASURES REDUCING METAL EXPOSURE ARE ASSOCIATED WITH REDUCTIONS IN CARDIOVASCULAR DISEASE DEATH. POPULATIONS OF COLOR AND LOW SOCIOECONOMIC MEANS ARE MORE COMMONLY EXPOSED TO METALS AND THEREFORE AT GREATER RISK OF METAL-INDUCED CARDIOVASCULAR DISEASE. TOGETHER WITH STRENGTHENING PUBLIC HEALTH MEASURES TO PREVENT METAL EXPOSURES, DEVELOPMENT OF MORE SENSITIVE AND SELECTIVE MEASUREMENT MODALITIES, CLINICAL MONITORING OF METAL EXPOSURES, AND THE DEVELOPMENT OF METAL CHELATION THERAPIES COULD FURTHER DIMINISH THE BURDEN OF CARDIOVASCULAR DISEASE ATTRIBUTABLE TO METAL EXPOSURE. 2023 3 759 32 CASE REPORT OF CUTANEOUS SQUAMOUS CELL CARCINOMA AT THE WRIST JOINT AND THE PUBLIC HEALTH CRISIS OF ARSENICOSIS. CONTEXT: ARSENICOSIS IS CAUSED BY LONG TERM (6 MONTHS PLUS) INGESTION OF ARSENIC ABOVE A SAFE DOSE, CHARACTERIZED BY SKIN LESIONS AND POSSIBLE INVOLVEMENT OF INTERNAL ORGANS. ARSENICOSIS IS COMMON IN INDIA AND BANGLADESH WHERE NATURALLY OCCURRING HIGH CONCENTRATIONS OF ARSENIC IN THE EARTH'S CRUST CONTAMINATE GROUND WATER, CAUSING ADVERSE HEALTH EFFECTS. CASE PRESENTATION: WE REPORT A CASE OF A 55-YEAR-OLD INDIAN MALE, RESIDENT OF A KNOWN ARSENIC ENDEMIC REGION OF UTTAR PRADESH WHO SUFFERED FROM CHARACTERISTIC PULMONARY AND CUTANEOUS FEATURES OF CHRONIC ARSENIC TOXICITY WHICH INCLUDED RADIOLOGICAL FINDINGS OF INTERSTITIAL LUNG DISEASE, HYPERKERATOTIC LESIONS OVER THE PALMS AND SOLES, RAIN DROP LIKE PIGMENTATION OVER THE TRUNK, AND CARCINOMATOUS CHANGES AT THE WRIST JOINT. THE PATIENT WAS STARTED ON CHELATING AGENTS (D-PENICILLAMINE) AND ORAL RETINOIDS (ISOTRETINOIN) FOLLOWED BY THE SURGICAL EXCISION OF THE CARCINOMA. DISCUSSION: ENVIRONMENTAL CONTAMINATION WITH ARSENIC IS A WELL-KNOWN HEALTH HAZARD IN SOUTH ASIAN COUNTRIES. THE MAIN SOURCE IS CONSUMPTION OF CONTAMINATED GROUND WATER FOR DOMESTIC PURPOSES. CUTANEOUS LESIONS, INTERNAL ORGAN INVOLVEMENT INCLUDING INTERSTITIAL LUNG DISEASE AND CARCINOMAS AS OBSERVED IN OUR PATIENT HAVE BEEN REPORTED IN THE LITERATURE. VARIOUS MECHANISMS LIKE EPIGENETIC CHANGES AND ARSENIC-INDUCED IMMUNE SUPPRESSION HAVE BEEN PROPOSED FOR THE DEVELOPMENT OF CUTANEOUS CARCINOMAS WITH PROLONGED EXPOSURE TO ARSENIC. RELEVANCE TO CLINICAL PRACTICE: AMONG THE VARIOUS CAUSES OF PALMO-PLANTAR HYPERKERATOSIS, ARSENICOSIS SHOULD BE KEPT IN MIND WHEN PRESENTING IN COMBINATION WITH PIGMENTARY CHANGES AND CARCINOMATOUS GROWTH FROM AN ARSENIC-ENDEMIC REGION. CONCLUSIONS: PEOPLE RESIDING IN ARSENIC-ENDEMIC REGIONS SHOULD BE MADE AWARE OF ARSENIC-RELATED HEALTH HAZARDS. RAINWATER HARVESTING AND GOOD NUTRITION ARE THE SIMPLEST MEASURES WHICH COULD BE ADOPTED BY THE EXPOSED POPULATION IN AFFECTED AREAS. SEVERAL METHODS HAVE ALSO BEEN EMPLOYED BY GOVERNMENTAL AND NON-GOVERNMENT ORGANIZATIONS TO SEPARATE ARSENIC FROM CONTAMINATED WATER TO COMBAT ARSENIC-RELATED DISEASES AND CARCINOMAS. COMPETING INTERESTS: THE AUTHORS DECLARE NO COMPETING FINANCIAL INTERESTS. 2021 4 12 68 2017 CLINICAL TRIALS UPDATE IN NEW TREATMENTS OF BETA-THALASSEMIA. THE UNDERLYING BASIS OF BETA-THALASSEMIA PATHOLOGY IS THE DIMINISHED BETA-GLOBIN SYNTHESIS LEADING TO ALPHA-GLOBIN ACCUMULATION AND PREMATURE APOPTOTIC DESTRUCTION OF ERYTHROBLASTS, CAUSING OXIDATIVE STRESS-INDUCED INEFFECTIVE ERYTHROPOIESIS, BONE MARROW HYPERPLASIA, SPLENOMEGALY, AND INCREASED INTESTINAL IRON ABSORPTION WITH PROGRESSIVE IRON OVERLOAD. BETTER UNDERSTANDING OF THE MOLECULAR MECHANISMS UNDERLYING THIS DISEASE LED TO THE RECOGNITION OF NEW TARGETS WITH POTENTIAL THERAPEUTIC UTILITY. AGENTS SUCH AS JAK2 INHIBITORS AND TGF-BETA LIGAND TRAPS THAT REDUCE THE INEFFECTIVE ERYTHROPOIESIS PROCESS ARE ALREADY BEING TESTED IN CLINICAL TRIALS WITH PROMISING RESULTS. OTHER AGENTS THAT AIM TO REDUCE OXIDATIVE STRESS (ACTIVATORS OF FOXO3, HRI-EIF2AP, PRX2, HSP70, AND PK ANTI-OXIDANT SYSTEMS AND INHIBITORS OF HO-1) AND TO DECREASE IRON OVERLOAD (HEPCIDIN AGONISTS, ERYTHROFERRONE INHIBITORS AND EXOGENOUS TRANSFERRIN) ARE ALSO UNDER EXPERIMENTAL INVESTIGATION. SIGNIFICANT PROGRESS HAS ALSO BEEN MADE IN THE AREA OF ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION WITH SEVERAL ONGOING CLINICAL TRIALS EXAMINING NEW CONDITION REGIMENS AS WELL AS DIFFERENT DONOR SELECTION AND STEM CELL SOURCE OPTIONS. GENE THERAPY HAS REACHED A CRITICAL POINT AND PHASE 1 CLINICAL TRIALS HAVE RECENTLY BEEN LAUNCHED TO EXAMINE THE EFFECTIVENESS AND ESPECIALLY LONG TERM SAFETY. EPIGENETIC MANIPULATION AND GENOMIC EDITING OF THE GAMMA- OR BETA-GLOBIN GENE ARE NOVEL AND PROMISING EXPERIMENTAL GENE THERAPY APPROACHES FOR BETA-THALASSEMIA GIVING HOPE FOR CURE FOR THIS CHRONIC DISEASE. THIS REVIEW OUTLINES THE KEY POINTS OF THE MOLECULAR MECHANISMS UNDERLYING BETA-THALASSEMIA IN RELATION TO THE DEVELOPMENT OF NEW THERAPIES AND AN UPDATE IS GIVEN BOTH AT THE PRE-CLINICAL AND CLINICAL LEVEL. AM. J. HEMATOL. 91:1135-1145, 2016. (C) 2016 WILEY PERIODICALS, INC. 2016 5 2569 26 EPIGENETICS OF ANKYLOSING SPONDYLITIS: RECENT DEVELOPMENTS. ANKYLOSING SPONDYLITIS (AS) IS A CHRONIC INFLAMMATORY AUTOIMMUNE DISEASE WHICH MAINLY AFFECTS THE SPINE, SACROILIAC JOINT AND PERIPHERAL JOINTS. TO DATE, THE EXACT CAUSES AND PATHOGENESIS OF AS STILL REMAIN UNKNOWN. IT IS CONSIDERED THAT THE PATHOGENESIS OF AS IS ASSOCIATED WITH GENETIC, INFECTION, ENVIRONMENT, IMMUNITY AND OTHER FACTORS. AMONG THEM, THE ROLE OF GENETIC FACTORS IN THE PATHOGENESIS OF AS HAS BEEN STUDIED MOST DEEPLY. HOWEVER, OVER THE PAST FEW YEARS, THE FUNCTION OF ENVIRONMENTAL PREDISPOSITION AND EPIGENETIC MODIFICATION IN THE PATHOGENESIS OF AS HAS RECEIVED EXTENSIVE ATTENTION. THIS PAPER SUMMARIZES THE RECENT PROGRESS IN THE EPIGENETICS OF AS, INCLUDING ABNORMAL EPIGENETIC MODIFICATIONS AT AS-ASSOCIATED GENOMIC LOCI, SUCH AS DNA METHYLATION, HISTONE MODIFICATION, MICRORNA, AND SO ON. IN SUMMARY, THE FINDINGS OF THIS REVIEW ATTEMPT TO EXPLAIN THE ROLE OF EPIGENETIC MODIFICATION IN THE OCCURRENCE AND DEVELOPMENT OF AS. NEVERTHELESS, THERE ARE STILL UNKNOWN AND COMPLICATED ASPECTS WORTH EXPLORING TO DEEPEN OUR UNDERSTANDING OF THE PATHOGENESIS OF AS. 2021 6 4753 70 NOVEL THERAPEUTIC ADVANCES IN BETA-THALASSEMIA. THE MAIN CHARACTERISTIC OF THE PATHOPHYSIOLOGY OF BETA-THALASSEMIA IS REDUCED BETA-GLOBIN CHAIN PRODUCTION. THE INEVITABLE IMBALANCE IN THE ALPHA/BETA-GLOBIN RATIO AND ALPHA-GLOBIN ACCUMULATION LEAD TO OXIDATIVE STRESS IN THE ERYTHROID LINEAGE, APOPTOSIS, AND INEFFECTIVE ERYTHROPOIESIS. THE RESULT IS COMPENSATORY HEMATOPOIETIC EXPANSION AND IMPAIRED HEPCIDIN PRODUCTION THAT CAUSES INCREASED INTESTINAL IRON ABSORPTION AND PROGRESSIVE IRON OVERLOAD. CHRONIC HEMOLYSIS AND RED BLOOD CELL TRANSFUSIONS ALSO CONTRIBUTE TO IRON TISSUE DEPOSITION. A BETTER UNDERSTANDING OF THE UNDERLYING MECHANISMS LED TO THE DETECTION OF NEW CURATIVE OR "DISEASE-MODIFYING" THERAPEUTIC OPTIONS. SUBSTANTIAL EVOLVEMENT HAS BEEN MADE IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION WITH CURRENT CLINICAL TRIALS INVESTIGATING NEW CONDITION REGIMENS AS WELL AS DIFFERENT DONORS AND STEM CELL SOURCE OPTIONS. GENE THERAPY HAS ALSO MOVED FORWARD, AND PHASE 2 CLINICAL TRIALS WITH THE USE OF BETA-GLOBIN INSERTION TECHNIQUES HAVE RECENTLY BEEN SUCCESSFULLY COMPLETED LEADING TO APPROVAL FOR USE IN TRANSFUSION-DEPENDENT PATIENTS. GENETIC AND EPIGENETIC MANIPULATION OF THE GAMMA- OR BETA-GLOBIN GENE HAVE ENTERED THE CLINICAL TRIAL SETTING. AGENTS SUCH AS TGF-BETA LIGAND TRAPS AND PYRUVATE KINASE ACTIVATORS, WHICH REDUCE THE INEFFECTIVE ERYTHROPOIESIS, HAVE BEEN TESTED IN CLINICAL TRIALS WITH FAVORABLE RESULTS. ONE TGF-BETA LIGAND TRAP, LUSPATERCEPT, HAS BEEN APPROVED FOR USE IN ADULTS WITH TRANSFUSION-DEPENDENT BETA-THALASSEMIA. THE INDUCTION OF HBF WITH THE PHOSPHODIESTERASE 9 INHIBITOR IMR-687, WHICH INCREASE CYCLIC GUANOSINE MONOPHOSPHATE, IS CURRENTLY BEING TESTED. ANOTHER THERAPEUTIC APPROACH IS TO TARGET THE DYSREGULATION OF IRON HOMEOSTASIS, USING, FOR EXAMPLE, HEPCIDIN AGONISTS (INHIBITORS OF TMPRSS6 AND MINIHEPCIDINS) OR FERROPORTIN INHIBITORS (VIT-2763). THIS REVIEW PROVIDES AN UPDATE ON THE NOVEL THERAPEUTIC OPTIONS THAT ARE PRESENTLY IN DEVELOPMENT AT THE CLINICAL LEVEL IN BETA-THALASSEMIA. 2021 7 363 32 AMBIENT AIR POLLUTION: HEALTH HAZARDS TO CHILDREN. AMBIENT AIR POLLUTION IS PRODUCED BY SOURCES INCLUDING VEHICULAR TRAFFIC, COAL-FIRED POWER PLANTS, HYDRAULIC FRACTURING, AGRICULTURAL PRODUCTION, AND FOREST FIRES. IT CONSISTS OF PRIMARY POLLUTANTS GENERATED BY COMBUSTION AND SECONDARY POLLUTANTS FORMED IN THE ATMOSPHERE FROM PRECURSOR GASES. AIR POLLUTION CAUSES AND EXACERBATES CLIMATE CHANGE, AND CLIMATE CHANGE WORSENS HEALTH EFFECTS OF AIR POLLUTION. INFANTS AND CHILDREN ARE UNIQUELY SENSITIVE TO AIR POLLUTION, BECAUSE THEIR ORGANS ARE DEVELOPING AND THEY HAVE HIGHER AIR PER BODY WEIGHT INTAKE. HEALTH EFFECTS LINKED TO AIR POLLUTION INCLUDE NOT ONLY EXACERBATIONS OF RESPIRATORY DISEASES BUT ALSO REDUCED LUNG FUNCTION DEVELOPMENT AND INCREASED ASTHMA INCIDENCE. ADDITIONAL OUTCOMES OF CONCERN INCLUDE PRETERM BIRTH, LOW BIRTH WEIGHT, NEURODEVELOPMENTAL DISORDERS, IQ LOSS, PEDIATRIC CANCERS, AND INCREASED RISKS FOR ADULT CHRONIC DISEASES. THESE EFFECTS ARE MEDIATED BY OXIDATIVE STRESS, CHRONIC INFLAMMATION, ENDOCRINE DISRUPTION, AND GENETIC AND EPIGENETIC MECHANISMS ACROSS THE LIFE SPAN. NATURAL EXPERIMENTS DEMONSTRATE THAT WITH INITIATIVES SUCH AS INCREASED USE OF PUBLIC TRANSPORTATION, BOTH AIR QUALITY AND COMMUNITY HEALTH IMPROVE. SIMILARLY, THE CLEAN AIR ACT HAS IMPROVED AIR QUALITY, ALTHOUGH EXPOSURE INEQUITIES PERSIST. OTHER EFFECTIVE STRATEGIES FOR REDUCING AIR POLLUTION INCLUDE ENDING RELIANCE ON COAL, OIL, AND GAS; REGULATING INDUSTRIAL EMISSIONS; REDUCING EXPOSURE WITH ATTENTION TO PROXIMITY OF RESIDENCES, SCHOOLS, AND CHILD CARE FACILITIES TO TRAFFIC; AND A GREATER AWARENESS OF THE AIR QUALITY INDEX. THIS POLICY REVIEWS BOTH SHORT- AND LONG-TERM HEALTH CONSEQUENCES OF AMBIENT AIR POLLUTION, ESPECIALLY IN RELATION TO DEVELOPMENTAL EXPOSURES. IT EXAMINES INDIVIDUAL, COMMUNITY, AND LEGISLATIVE STRATEGIES TO MITIGATE AIR POLLUTION. 2021 8 360 18 AMBIENT AIR POLLUTION AND BIOMARKERS OF HEALTH EFFECT. RECENTLY, THE AIR POLLUTION SITUATION OF OUR COUNTRY IS VERY SERIOUS ALONG WITH THE DEVELOPMENT OF URBANIZATION AND INDUSTRIALIZATION. STUDIES INDICATE THAT THE EXPOSURE OF AIR POLLUTION CAN CAUSE A RISE OF INCIDENCE AND MORTALITY OF MANY DISEASES, SUCH AS CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), ASTHMA, MYOCARDIAL INFARCTION, AND SO ON. HOWEVER, THERE IS NOW GROWING EVIDENCE SHOWING THAT SIGNIFICANT AIR POLLUTION EXPOSURES ARE ASSOCIATED WITH EARLY BIOMARKERS IN VARIOUS SYSTEMS OF THE BODY. IN ORDER TO BETTER PREVENT AND CONTROL THE DAMAGE EFFECT OF AIR POLLUTION, THIS ARTICLE SUMMARIZES COMPREHENSIVELY EPIDEMIOLOGICAL STUDIES ABOUT THE BAD EFFECTS ON THE BIOMARKERS OF RESPIRATORY SYSTEM, CARDIOVASCULAR SYSTEM, AND GENETIC AND EPIGENETIC SYSTEM EXPOSURE TO AMBIENT AIR POLLUTION. 2017 9 1223 27 CRITICAL REVIEW ON EMERGING HEALTH EFFECTS ASSOCIATED WITH THE INDOOR AIR QUALITY AND ITS SUSTAINABLE MANAGEMENT. INDOOR AIR QUALITY (IAQ) IS ONE OF THE FUNDAMENTAL ELEMENTS AFFECTING PEOPLE'S HEALTH AND WELL-BEING. CURRENTLY, THERE IS A LACK OF AWARENESS AMONG PEOPLE ABOUT THE QUANTIFICATION, IDENTIFICATION, AND POSSIBLE HEALTH EFFECTS OF IAQ. AIRBORNE POLLUTANTS SUCH AS VOLATILE ORGANIC COMPOUNDS (VOCS), PARTICULATE MATTER (PM), SULFUR DIOXIDE (SO2), CARBON MONOXIDE (CO), NITROUS OXIDE (NO), POLYCYCLIC AROMATIC HYDROCARBONS (PAHS) MICROBIAL SPORES, POLLEN, ALLERGENS, ETC. PRIMARILY CONTRIBUTE TO IAQ DETERIORATION. THIS REVIEW DISCUSSES THE SOURCES OF MAJOR INDOOR AIR POLLUTANTS, MOLECULAR TOXICITY MECHANISMS, AND THEIR EFFECTS ON CARDIOVASCULAR, OCULAR, NEUROLOGICAL, WOMEN, AND FOETAL HEALTH. ADDITIONALLY, CONTEMPORARY STRATEGIES AND SUSTAINABLE METHODS FOR REGULATING AND REDUCING POLLUTANT CONCENTRATIONS ARE EMPHASIZED, AND CURRENT INITIATIVES TO ADDRESS AND ENHANCE IAQ ARE EXPLORED, ALONG WITH THEIR UNIQUE ADVANTAGES AND POTENTIALS. DUE TO THEIR LONGER EXPOSURE TIMES AND PARTICULAR PHYSICAL CHARACTERISTICS, WOMEN AND CHILDREN ARE MORE AT RISK FOR POOR INDOOR AIR QUALITY. BY TRIGGERING MANY TOXICITY MECHANISMS, INCLUDING OXIDATIVE STRESS, DNA METHYLATION, EPIGENETIC MODIFICATIONS, AND GENE ACTIVATION, INDOOR AIR POLLUTION CAN CAUSE A RANGE OF HEALTH ISSUES. LOW BIRTH WEIGHT, ACUTE LOWER RESPIRATORY TRACT INFECTIONS, SICK BUILDING SYNDROMES (SBS), AND EARLY DEATH ARE MORE PREVALENT IN EXPOSED RESIDENTS. ON THE OTHER HAND, THE MAIN CAUSES OF INCAPACITY AND EARLY MORTALITY ARE LUNG CANCER, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, AND CARDIOVASCULAR DISORDERS. IT'S CRUCIAL TO ACKNOWLEDGE ANTICIPATED RESEARCH NEEDS AND IMPLEMENTED EFFICIENT INTERVENTIONS AND POLICIES TO LOWER HEALTH HAZARDS. 2023 10 6876 37 [PROLONGED EXPOSURE TO ATMOSPHERIC AIR POLLUTION AND MORTALITY FROM RESPIRATORY CAUSES]. DIFFERENT DESIGNS CAN BE USED TO ANALYZE THE RELATIONSHIPS BETWEEN RESPIRATORY MORTALITY AND LONG TERM EXPOSURE TO ATMOSPHERIC POLLUTION: EPIDEMIOLOGICAL STUDIES (COHORT, PREVALENCE STUDY) DEMONSTRATE THE REALITY OF THE RELATIONSHIP AND TOXICOLOGICAL STUDIES EXPLAIN IT. COHORT STUDIES HAVE THE ADVANTAGE OF BEING ABLE TO TAKE INTO ACCOUNT MANY CONFOUNDING FACTORS AND THUS AVOID BIASES (WHICH IS NOT THE CASE WITH PREVALENCE STUDIES), BUT REQUIRE SIGNIFICANT HUMAN AND FINANCIAL RESOURCES. THEY WERE FIRST ADOPTED IN THE US, BUT ARE NOW MORE OFTEN APPLIED IN EUROPE. THE RESULTS ARE RELATIVELY CONSISTENT, AS THEY ALL SHOW A STATISTICALLY SIGNIFICANT ASSOCIATION BETWEEN AN INCREASE IN PARTICULATE POLLUTION AND CARDIOPULMONARY MORTALITY. MORTALITY FROM LUNG CANCER IS ALSO ASSOCIATED WITH LONG TERM EXPOSITION TO PARTICLES AND SOMETIMES TO OZONE OR NITROGEN OXIDES. CEREBROVASCULAR DISEASES AND SUDDEN DEATH OF YOUNG CHILDREN HAVE ALSO BEEN ASSOCIATED WITH PARTICULATE POLLUTION. THE RELATIONSHIPS ARE MORE POWERFUL FOR LONG TERM THAN SHORT TERM EXPOSURE BUT ARE ALSO LINEAR AND WITHOUT THRESHOLD. IN ORDER TO EXPLAIN THESE EFFECTS (TODAY THE CAUSALITY OF THE RELATIONSHIP IS CERTAIN) THERE ARE MANY POSSIBLE FACTORS, PARTICULARLY REGARDING PARTICULATE EXPOSURES: AN INCREASE IN CARDIOVASCULAR RISK BIOMARKERS (FIBRINOGEN, WHITE BLOOD CELLS, AND PLATELETS), ATHEROSCLEROSIS, CHRONIC INFLAMMATION OF LUNG TISSUES INCREASED BY ACUTE EXPOSURE, ETC. MORE AND MORE STUDIES ADDRESS THE INTERACTION BETWEEN GENE AND ENVIRONMENT AND EVEN EPIGENETIC PHENOMENA WHICH COULD BE RESPONSIBLE OF THESE EFFECTS. PUBLIC HEALTH IMPACT COULD BE QUANTIFIED. THE EUROPEAN E&H SURVEILLANCE PROGRAM APHEIS, FOR EXAMPLE, ESTIMATED THAT IF PM2.5 LEVELS REMAINED BELOW 15 MICROG/M(3), A 30 YEAR OLD PERSON COULD SEE HIS LIFE EXPECTANCY INCREASED BY 1 MONTH TO 2 YEARS, DEPENDING ON THE STUDIED CITY. FINALLY, MORTALITY IS NOT THE ONLY RELEVANT INDICATOR FOR HEALTH EFFECTS OF AIR POLLUTION. ISAAC STUDIES ADDRESS ASTHMA, ALLERGIC RHINITIS AND ECZEMA AMONG CHILDREN. 2009 11 4881 22 OVERVIEW OF THE CARDIOVASCULAR EFFECTS OF ENVIRONMENTAL METALS: NEW PRECLINICAL AND CLINICAL INSIGHTS. ENVIRONMENTAL CAUSES OF CARDIOVASCULAR DISEASES (CVDS) ARE GLOBAL HEALTH ISSUES. IN PARTICULAR, AN ASSOCIATION BETWEEN METAL EXPOSURE AND CVDS HAS BECOME EVIDENT BUT CAUSAL EVIDENCE STILL LACKS. THEREFORE, THIS SYMPOSIUM AT THE SOCIETY OF TOXICOLOGY 2022 ANNUAL MEETING ADDRESSED EPIDEMIOLOGICAL, CLINICAL, PRE-CLINICAL ANIMAL MODEL-DERIVED AND MECHANISM-BASED EVIDENCE BY FIVE PRESENTATIONS: 1) AN EPIDEMIOLOGIC STUDY ON POTENTIAL CVD RISKS OF INDIVIDUALS EXPOSED OCCUPATIONALLY AND ENVIRONMENTALLY TO HEAVY METALS; 2) BOTH PRESENTATIONS OF THE SECOND AND THIRD WERE CLINICAL STUDIES FOCUSING ON THE POTENTIAL LINK BETWEEN HEAVY METALS AND PULMONARY ARTERIAL HYPERTENSION (PAH), BY PRESENTING ALTERED BLOOD METAL CONCENTRATIONS OF BOTH NON-ESSENTIAL AND ESSENTIAL METALS IN THE PATIENTS WITH PAH AND POTENTIAL THERAPEUTIC APPROACHES; 3) ARSENIC-INDUCED ATHEROSCLEROSIS VIA INFLAMMATORY CELLS IN MOUSE MODEL; 4) PATHOGENIC EFFECTS ON THE HEART BY ADULT CHRONIC EXPOSURE TO VERY LOW-DOSE CADMIUM VIA EPIGENETIC MECHANISMS AND WHOLE LIFE EXPOSURE TO LOW DOSE CADMIUM VIA EXACERBATING HIGH-FAT-DIET-LIPOTOXICITY. THIS SYMPOSIUM HAS BROUGHT EPIDEMIOLOGISTS, THERAPEUTIC INDUSTRY, PHYSICIANS, AND TRANSLATIONAL SCIENTISTS TOGETHER TO DISCUSS THE HEALTH RISKS OF OCCUPATIONAL AND ENVIRONMENTAL EXPOSURE TO HEAVY METALS THROUGH DIRECT CARDIOTOXICITY AND INDIRECT DISRUPTION OF HOMEOSTATIC MECHANISMS REGULATING ESSENTIAL METALS, AS WELL AS LIPID LEVELS. THE DATA SUMMARIZED BY THE PRESENTERS INFERS A POTENTIAL CAUSAL LINK BETWEEN MULTIPLE METALS AND CVDS AND DEFINES DIFFERENCES AND COMMONALITIES. THEREFORE, SUMMARY OF THESE PRESENTATIONS MAY ACCELERATE THE DEVELOPMENT OF EFFICIENT PREVENTIVE AND THERAPEUTIC STRATEGIES BY FACILITATING COLLABORATIONS AMONG MULTIDISCIPLINARY INVESTIGATORS. 2022 12 300 26 AIR POLLUTION AND INDOOR SETTINGS. INDOOR ENVIRONMENTS CONTRIBUTE SIGNIFICANTLY TO TOTAL HUMAN EXPOSURE TO AIR POLLUTANTS, AS PEOPLE SPEND MOST OF THEIR TIME INDOORS. HOUSEHOLD AIR POLLUTION (HAP) RESULTING FROM COOKING WITH POLLUTING ("DIRTY") FUELS, WHICH INCLUDE COAL, KEROSENE, AND BIOMASS (WOOD, CHARCOAL, CROP RESIDUES, AND ANIMAL MANURE) IS A GLOBAL ENVIRONMENTAL HEALTH PROBLEM. INDOOR POLLUTANTS ARE GASES, PARTICULATES, TOXINS, AND MICROORGANISMS AMONG OTHERS, THAT CAN HAVE AN IMPACT ESPECIALLY ON THE HEALTH OF CHILDREN AND ADULTS THROUGH A COMBINATION OF DIFFERENT MECHANISMS ON OXIDATIVE STRESS AND GENE ACTIVATION, EPIGENETIC, CELLULAR, AND IMMUNOLOGICAL SYSTEMS. AIR POLLUTION IS A MAJOR RISK FACTOR AND CONTRIBUTOR TO MORBIDITY AND MORTALITY FROM MAJOR CHRONIC DISEASES. CHILDREN ARE SIGNIFICANTLY AFFECTED BY THE IMPACT OF THE ENVIRONMENT DUE TO BIOLOGICAL IMMATURITY, PRENATAL AND POSTNATAL LUNG DEVELOPMENT. POOR AIR QUALITY HAS BEEN RELATED TO AN INCREASED PREVALENCE OF CLINICAL MANIFESTATIONS OF ALLERGIC ASTHMA AND RHINITIS. HEALTH PROFESSIONALS SHOULD INCREASE THEIR ROLE IN MANAGING THE EXPOSURE OF CHILDREN AND ADULTS TO AIR POLLUTION WITH BETTER METHODS OF CARE, PREVENTION, AND COLLECTIVE ACTION. INTERVENTIONS TO REDUCE HOUSEHOLD POLLUTANTS MAY PROMOTE HEALTH AND CAN BE ACHIEVED WITH EDUCATION, COMMUNITY, AND HEALTH PROFESSIONAL INVOLVEMENT. 2021 13 529 21 ASTHMA IN URBAN CHILDREN: EPIDEMIOLOGY, ENVIRONMENTAL RISK FACTORS, AND THE PUBLIC HEALTH DOMAIN. ASTHMA IS THE MOST COMMONLY REPORTED CHRONIC CONDITION OF CHILDHOOD IN DEVELOPED COUNTRIES, WITH 6.5 MILLION CHILDREN AFFECTED IN THE USA. A DISPARATE BURDEN OF CHILDHOOD ASTHMA IS SEEN AMONG SOCIOECONOMICALLY DISADVANTAGED YOUTH, OFTEN CONCENTRATED IN URBAN AREAS WITH HIGH POVERTY RATES. HOST FACTORS THAT PREDISPOSE A CHILD TO ASTHMA INCLUDE ATOPY, MALE GENDER, PARENTAL HISTORY OF ASTHMA, AND ALSO RACE, ETHNICITY, AND GENETIC AND EPIGENETIC SUSCEPTIBILITIES. ENVIRONMENTAL FACTORS, SUCH AS IMPROVED HYGIENE, AMBIENT AIR POLLUTION, AND EARLY LIFE EXPOSURES TO MICROBES AND AEROALLERGENS, ALSO INFLUENCE THE DEVELOPMENT OF ASTHMA. WITH GREATER THAN 90% OF TIME SPENT INDOORS, HOME EXPOSURES (SUCH AS COCKROACH, RODENT, AND INDOOR AIR POLLUTION) ARE HIGHLY RELEVANT FOR URBAN ASTHMA. MORBIDITY REDUCTION MAY REQUIRE FOCUSED PUBLIC HEALTH INITIATIVES FOR ENVIRONMENTAL INTERVENTION IN HIGH PRIORITY RISK GROUPS AND THE ADDITION OF IMMUNE MODULATORY AGENTS IN CHILDREN WITH POORLY CONTROLLED DISEASE. 2016 14 4182 31 MESOAMERICAN NEPHROPATHY (MEN): WHAT WE KNOW SO FAR. IN 2002, A REPORT FROM EL SALVADOR DESCRIBED A HIGH INCIDENCE OF CHRONIC KIDNEY DISEASE (CKD) OF UNKNOWN CAUSE, MOSTLY IN YOUNG MALES FROM SPECIFIC COASTAL AREAS. SIMILAR SITUATIONS WERE OBSERVED ALONG THE PACIFIC OCEAN COASTLINE OF OTHER CENTRAL AMERICAN COUNTRIES AND SOUTHERN MEXICO (MESOAMERICA). THIS NEW FORM OF CKD HAS BEEN DENOMINATED MESOAMERICAN ENDEMIC NEPHROPATHY (MEN). THE TYPICAL PRESENTATION OF MEN IS A YOUNG MALE FROM AN ENDEMIC AREA WITH A FAMILY HISTORY OF CKD, LOW EGFR, HIGH SERUM CREATININE, LOW LEVEL OF ALBUMINURIA, HYPOKALEMIA, HYPERURICEMIA, AND URINE URATE CRYSTALS. KIDNEY BIOPSY DEMONSTRATING TUBULOINTERSTITIAL NEPHRITIS REMAINS THE GOLD STANDARD FOR DIAGNOSIS BUT IS AVAILABLE ONLY FOR A MINORITY. COMMONLY PROPOSED CAUSES INCLUDE THERMAL STRESS/DEHYDRATION AND/OR EXPOSURE TO ENVIRONMENTAL POLLUTANTS. HOWEVER, LIKELY, A THIRD FACTOR, WHICH COULD BE GENETIC OR EPIGENETIC, COULD CONTRIBUTE TO THE CAUSE AND DEVELOPMENT OF THE DISEASE, ALONG WITH SOCIAL DETERMINANTS. CURRENTLY, PREVENTIVE MEASURES FOCUS ON MINIMIZING WORKERS EXPOSURE TO THERMAL STRESS/DEHYDRATION. THERE ARE MANY RESEARCH OPPORTUNITIES AND PRIORITIES SHOULD INCLUDE CLINICAL TRIALS TO EVALUATE THE EFFICACY AND SAFETY OF THE CURRENT TREATMENT PROTOCOLS, ALONG WITH ETIOLOGICAL AND GENETIC STUDIES, AND THE DEVELOPMENT OF KIDNEY DISEASE DATA SYSTEMS. ALTHOUGH THERE IS SCANT AND CONTROVERSIAL LITERATURE WITH REGARD S TO THE ETIOLOGY, DIAGNOSIS AND MANAGEMENT OF THE DISEASE, OUR AIM IS TO PROVIDE THE READER A VISION OF THE DISEASE BASED ON OUR EXPERIENCE. 2020 15 298 36 AIR POLLUTION AND AIRWAY DISEASE. EPIDEMIOLOGICAL AND TOXICOLOGICAL RESEARCH CONTINUES TO SUPPORT A LINK BETWEEN URBAN AIR POLLUTION AND AN INCREASED INCIDENCE AND/OR SEVERITY OF AIRWAY DISEASE. DETRIMENTAL EFFECTS OF OZONE (O(3)), NITROGEN DIOXIDE (NO(2)) AND PARTICULATE MATTER (PM), AS WELL AS TRAFFIC-RELATED POLLUTION AS A WHOLE, ON RESPIRATORY SYMPTOMS AND FUNCTION ARE WELL DOCUMENTED. NOT ONLY DO WE HAVE STRONG EPIDEMIOLOGICAL EVIDENCE OF A RELATIONSHIP BETWEEN AIR POLLUTION AND EXACERBATION OF ASTHMA AND RESPIRATORY MORBIDITY AND MORTALITY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), BUT RECENT STUDIES, PARTICULARLY IN URBAN AREAS, HAVE SUGGESTED A ROLE FOR POLLUTANTS IN THE DEVELOPMENT OF BOTH ASTHMA AND COPD. SIMILARLY, WHILE PREVALENCE AND SEVERITY OF ATOPIC CONDITIONS APPEAR TO BE MORE COMMON IN URBAN COMPARED WITH RURAL COMMUNITIES, EVIDENCE IS EMERGING THAT TRAFFIC-RELATED POLLUTANTS MAY CONTRIBUTE TO THE DEVELOPMENT OF ALLERGY. FURTHERMORE, NUMEROUS EPIDEMIOLOGICAL AND EXPERIMENTAL STUDIES SUGGEST AN ASSOCIATION BETWEEN EXPOSURE TO NO(2) , O(3) , PM AND COMBUSTION PRODUCTS OF BIOMASS FUELS AND AN INCREASED SUSCEPTIBILITY TO AND MORBIDITY FROM RESPIRATORY INFECTION. GIVEN THE CONSIDERABLE CONTRIBUTION THAT TRAFFIC EMISSIONS MAKE TO URBAN AIR POLLUTION RESEARCHERS HAVE SOUGHT TO CHARACTERIZE THE RELATIVE TOXICITY OF TRAFFIC-RELATED PM POLLUTANTS. RECENT ADVANCES IN MECHANISMS IMPLICATED IN THE ASSOCIATION OF AIR POLLUTANTS AND AIRWAY DISEASE INCLUDE EPIGENETIC ALTERATION OF GENES BY COMBUSTION-RELATED POLLUTANTS AND HOW POLYMORPHISMS IN GENES INVOLVED IN ANTIOXIDANT PATHWAYS AND AIRWAY INFLAMMATION CAN MODIFY RESPONSES TO AIR POLLUTION EXPOSURES. OTHER INTERESTING EPIDEMIOLOGICAL OBSERVATIONS RELATED TO INCREASED HOST SUSCEPTIBILITY INCLUDE A POSSIBLE LINK BETWEEN CHRONIC PM EXPOSURE DURING CHILDHOOD AND VULNERABILITY TO COPD IN ADULTHOOD, AND THAT INFANTS SUBJECTED TO HIGHER PRENATAL LEVELS OF AIR POLLUTION MAY BE AT GREATER RISK OF DEVELOPING RESPIRATORY CONDITIONS. WHILE THE CHARACTERIZATION OF POLLUTANT COMPONENTS AND SOURCES PROMISE TO GUIDE POLLUTION CONTROL STRATEGIES, THE IDENTIFICATION OF SUSCEPTIBLE SUBPOPULATIONS WILL BE NECESSARY IF TARGETED THERAPY/PREVENTION OF POLLUTION-INDUCED RESPIRATORY DISEASES IS TO BE DEVELOPED. 2011 16 1397 25 DIET PHYTOCHEMICALS AND CUTANEOUS CARCINOMA CHEMOPREVENTION: A REVIEW. CUTANEOUS CARCINOMA, WHICH HAS OCCUPIED A PECULIAR PLACE AMONG WORLDWIDE POPULATIONS, IS COMMONLY RESPONSIBLE FOR THE CONSIDERABLY INCREASING MORBIDITY AND MORTALITY RATES. CURRENTLY AVAILABLE MEDICAL PROCEDURES FAIL TO COMPLETELY AVOID CUTANEOUS CARCINOMA DEVELOPMENT OR TO PREVENT MORTALITY. CANCER CHEMOPREVENTION, AS AN ALTERNATIVE STRATEGY, IS BEING CONSIDERED TO REDUCE THE INCIDENCE AND BURDEN OF CANCERS THROUGH CHEMICAL AGENTS. DERIVED FROM DIETARY FOODS, PHYTOCHEMICALS HAVE BECOME SAFE AND RELIABLE COMPOUNDS FOR THE CHEMOPREVENTION OF CUTANEOUS CARCINOMA BY RELIEVING MULTIPLE PATHOLOGICAL PROCESSES, INCLUDING OXIDATIVE DAMAGE, EPIGENETIC ALTERATION, CHRONIC INFLAMMATION, ANGIOGENESIS, ETC. IN THIS REVIEW, WE PRESENTED COMPREHENSIVE KNOWLEDGES, MAIN MOLECULAR MECHANISMS FOR THE INITIATION AND DEVELOPMENT OF CUTANEOUS CARCINOMA AS WELL AS EFFECTS OF VARIOUS DIET PHYTOCHEMICALS ON CHEMOPREVENTION. 2017 17 3775 25 INTERACTIONS BETWEEN ARSENIC-INDUCED TOXICITY AND NUTRITION IN EARLY LIFE. EXPOSURE TO ARSENIC THROUGH DRINKING WATER IS A MAJOR PUBLIC HEALTH PROBLEM AFFECTING MOST COUNTRIES, ALTHOUGH THE SITUATION IS PARTICULARLY SEVERE IN LOW-INCOME NATIONS. THE HEALTH CONSEQUENCES OF CHRONIC ARSENIC EXPOSURE INCLUDE INCREASED RISK FOR VARIOUS FORMS OF CANCER AND NUMEROUS NONCANCER EFFECTS, INCLUDING DIABETES, SKIN DISEASES, CHRONIC COUGH, AND TOXIC EFFECTS ON LIVER, KIDNEY, CARDIOVASCULAR SYSTEM, AND PERIPHERAL AND CENTRAL NERVOUS SYSTEMS. IN RECENT YEARS INCREASING REPORTS OF EFFECTS ON FETAL AND CHILD DEVELOPMENT HAVE APPEARED. THERE SEEMS TO BE A WIDE VARIATION IN SUSCEPTIBILITY TO ARSENIC TOXICITY, WHICH IS LIKELY TO BE RELATED TO FACTORS SUCH AS VARIATION IN ARSENIC METABOLISM, NUTRITION, HOST-RELATED DEFENSE MECHANISMS, AND GENETIC PREDISPOSITION. THE MAIN MECHANISMS OF ARSENIC-NUTRITION INTERACTIONS INCLUDE ARSENIC-INDUCED OXIDATIVE STRESS, WHICH REQUIRES NUTRIENT-DEPENDENT DEFENSE SYSTEMS, AND ARSENIC METABOLISM (METHYLATION) VIA 1-CARBON METABOLISM, WHICH REQUIRES METHYL GROUPS, FOLIC ACID, VITAMIN B-12, AND BETAINE FOR THE REMETHYLATION OF HOMOCYSTEINE TO METHIONINE. AN EFFICIENT FIRST METHYLATION STEP IN COMBINATION WITH A SLOW SECOND METHYLATION STEP SEEMS TO BE MOST CRITICAL FROM A TOXICOLOGICAL POINT OF VIEW. A THIRD MODE OF ARSENIC-NUTRITION INTERACTION INVOLVES EPIGENETIC EFFECTS AND FETAL PROGRAMMING VIA DNA METHYLATION. 2007 18 3566 33 IMPACT OF HEAVY METALS ON THE FEMALE REPRODUCTIVE SYSTEM. INTRODUCTION: IT HAS BEEN RECOGNIZED THAT ENVIRONMENTAL POLLUTION CAN AFFECT THE QUALITY OF HEALTH OF THE HUMAN POPULATION. HEAVY METALS ARE AMONG THE GROUP OF HIGHLY EMITTED CONTAMINANTS AND THEIR ADVERSE EFFECT OF LIVING ORGANISMS HAS BEEN WIDELY STUDIED IN RECENT DECADES. LIFESTYLE AND QUALITY OF THE AMBIENT ENVIRONMENT ARE AMONG THESE FACTORS WHICH CAN MAINLY CONTRIBUTE TO THE HEAVY METALS EXPOSURE IN HUMANS. OBJECTIVE: A REVIEW OF LITERATURE LINKING HEAVY METALS AND THE FEMALE REPRODUCTIVE SYSTEM AND DESCRIPTION OF THE POSSIBLE ASSOCIATIONS WITH EMISSION AND EXPOSURE OF HEAVY METALS AND IMPAIRMENTS OF FEMALE REPRODUCTIVE SYSTEM ACCORDING TO CURRENT KNOWLEDGE. RESULTS: THE POTENTIAL HEALTH DISORDERS CAUSED BY CHRONIC OR ACUTE HEAVY METALS TOXICITY INCLUDE IMMUNODEFICIENCY, OSTEOPOROSIS, NEURODEGENERATION AND ORGAN FAILURES. POTENTIAL LINKAGES OF HEAVY METALS CONCENTRATION FOUND IN DIFFERENT HUMAN ORGANS AND BLOOD WITH OESTROGEN-DEPENDENT DISEASES SUCH AS BREAST CANCER, ENDOMETRIAL CANCER, ENDOMETRIOSIS AND SPONTANEOUS ABORTIONS, AS WELL AS PRE-TERM DELIVERIES, STILLBIRTHS AND HYPOTROPHY, HAVE ALSO BEEN REPORTED. CONCLUSIONS: ENVIRONMENTAL DETERIORATION CAN LEAD TO THE ELEVATED RISK OF HUMAN EXPOSURE TO HEAVY METALS, AND CONSEQUENTLY, HEALTH IMPLICATIONS INCLUDING DISTURBANCES IN REPRODUCTION. IT IS THEREFORE IMPORTANT TO CONTINUE THE INVESTIGATIONS ON METAL-INDUCED MECHANISMS OF FERTILITY IMPAIRMENT ON THE GENETIC, EPIGENETIC AND BIOCHEMICAL LEVEL. 2015 19 1915 28 ENVIRONMENTAL AND OCCUPATIONAL EXPOSURE OF METALS AND FEMALE REPRODUCTIVE HEALTH. UNTAINTED ENVIRONMENT PROMOTES HEALTH, BUT THE LAST FEW DECADES EXPERIENCED STEEP UPSURGE IN ENVIRONMENTAL CONTAMINANTS POSING DETRIMENTAL PHYSIOLOGICAL IMPACT. THE RESPONSIBLE FACTORS MAINLY INCLUDE THE EXPONENTIAL GROWTH OF HUMAN POPULATION, HAVOC RISE IN INDUSTRIALIZATION, POORLY PLANNED URBANIZATION, AND SLAPDASH ENVIRONMENT MANAGEMENT. ENVIRONMENTAL DEGRADATION CAN INCREASE THE LIKELIHOOD OF HUMAN EXPOSURE TO HEAVY METALS, RESULTING IN HEALTH CONSEQUENCES SUCH AS REPRODUCTIVE PROBLEMS. AS A RESULT, RESEARCH INTO METAL-INDUCED CAUSES OF REPRODUCTIVE IMPAIRMENT AT THE GENETIC, EPIGENETIC, AND BIOCHEMICAL LEVELS MUST BE STRENGTHENED FURTHER. THESE METALS IMPACT UPON THE FEMALE REPRODUCTION AT ALL STRATA OF ITS REGULATION AND FUNCTIONS, BE IT DEVELOPMENT, MATURATION, OR ENDOCRINE FUNCTIONS, AND ARE LINKED TO AN INCREASE IN THE CAUSES OF INFERTILITY IN WOMEN. CHRONIC EXPOSURES TO THE HEAVY METALS MAY LEAD TO BREAST CANCER, ENDOMETRIOSIS, ENDOMETRIAL CANCER, MENSTRUAL DISORDERS, AND SPONTANEOUS ABORTIONS, AS WELL AS PRE-TERM DELIVERIES, STILLBIRTHS. FOR EXAMPLE, ENDOMETRIOSIS, ENDOMETRIAL CANCER, AND SPONTANEOUS ABORTIONS ARE ALL CAUSED BY THE METALLOESTROGEN CADMIUM (CD); LEAD (PB) LEVELS OVER A CERTAIN THRESHOLD CAN CAUSE SPONTANEOUS ABORTION AND HAVE A TERATOGENIC IMPACT; TOXIC AMOUNTS OF MERCURY (HG) HAVE AN INFLUENCE ON THE MENSTRUAL CYCLE, WHICH CAN LEAD TO INFERTILITY. IMPACT OF ENVIRONMENTAL EXPOSURE TO HEAVY METALS ON FEMALE FERTILITY IS THEREFORE A WELL-KNOWN FACT. THUS, THE UNDERLYING MECHANISMS MUST BE EXPLAINED AND PERIODICALLY UPDATED, GIVEN THE GROWING EVIDENCE ON THE INFLUENCE OF INCREASING ENVIRONMENTAL HEAVY METAL LOAD ON FEMALE FERTILITY. THE PURPOSE OF THIS REVIEW IS TO GIVE A CONCISE OVERVIEW OF HOW HEAVY METAL AFFECTS FEMALE REPRODUCTIVE HEALTH. 2022 20 6030 35 THE BURGEONING CARDIOVASCULAR DISEASE EPIDEMIC IN INDIANS - PERSPECTIVES ON CONTEXTUAL FACTORS AND POTENTIAL SOLUTIONS. CARDIOVASCULAR DISEASES (CVD) ARE THE LEADING CAUSE OF DEATH AND DISABILITY IN INDIA. THE CVD EPIDEMIC IN INDIANS IS CHARACTERIZED BY A HIGHER RELATIVE RISK BURDEN, AN EARLIER AGE OF ONSET, HIGHER CASE FATALITY AND HIGHER PREMATURE DEATHS. FOR DECADES, RESEARCHERS HAVE BEEN TRYING TO UNDERSTAND THE REASON FOR THIS INCREASED BURDEN AND PROPENSITY OF CVD AMONG INDIANS. IT CAN PARTLY BE EXPLAINED BY POPULATION-LEVEL CHANGES AND THE REMAINING BY INCREASED INHERENT BIOLOGICAL RISK. WHILE INCREASED BIOLOGICAL RISK CAN BE ATTRIBUTED TO PHENOTYPIC CHANGES CAUSED BY EARLY LIFE INFLUENCES, SIX MAJOR TRANSITIONS CAN BE CONSIDERED LARGELY RESPONSIBLE FOR THE POPULATION-LEVEL CHANGES IN INDIA-EPIDEMIOLOGICAL, DEMOGRAPHIC, NUTRITIONAL, ENVIRONMENTAL, SOCIAL-CULTURAL AND ECONOMIC. ALTHOUGH CONVENTIONAL RISK FACTORS EXPLAIN SUBSTANTIAL POPULATION ATTRIBUTABLE RISK, THE THRESHOLDS AT WHICH THESE RISK FACTORS OPERATE ARE DIFFERENT AMONG INDIANS COMPARED WITH OTHER POPULATIONS. THEREFORE, ALTERNATE EXPLANATIONS FOR THESE ECOLOGICAL DIFFERENCES HAVE BEEN SOUGHT AND MULTIPLE HYPOTHESES HAVE BEEN PROPOSED OVER THE YEARS. PRENATAL FACTORS THAT INCLUDE MATERNAL AND PATERNAL INFLUENCES ON THE OFFSPRING, AND POSTNATAL FACTORS, RANGING FROM BIRTH THROUGH CHILDHOOD, ADOLESCENCE AND YOUNG ADULTHOOD, AS WELL AS INTER-GENERATIONAL INFLUENCES HAVE BEEN EXPLORED USING THE LIFE COURSE APPROACH TO CHRONIC DISEASE. IN ADDITION TO THIS, RECENT RESEARCH HAS ILLUSTRATED THE IMPORTANCE OF THE ROLE OF INHERENT BIOLOGICAL DIFFERENCES IN LIPID METABOLISM, GLUCOSE METABOLISM, INFLAMMATORY STATES, GENETIC PREDISPOSITIONS AND EPIGENETIC INFLUENCES FOR THE INCREASED RISK. A MULTIFACETED AND HOLISTIC APPROACH TO CVD PREVENTION THAT TAKES INTO CONSIDERATION POPULATION-LEVEL AS WELL AS BIOLOGICAL RISK FACTORS WOULD BE NEEDED TO CONTROL THE BURGEONING CVD EPIDEMIC AMONG INDIANS. 2023