Assessment of the Feasibility of a Future Integrated Larger-Scale Epidemiological Study to Evaluate Health Risks of Air Pollution Episodes in Children

Abstract

Air pollution exposure can lead to exacerbation of respiratory disorders in children. Using sensitive biomarkers helps to assess the impact of air pollution on children’s respiratory health and combining protein, genetic and epigenetic biomarkers gives insights on their interrelatedness. Most studies do not contain such an integrated approach and investigate these biomarkers individually in blood, although its collection in children is challenging. Our study aimed at assessing the feasibility of conducting future integrated larger-scale studies evaluating respiratory health risks of air pollution episodes in children, based on a qualitative analysis of the technical and logistic aspects of a small-scale field study involving 42 children. This included the preparation, collection and storage of non-invasive samples (urine, saliva), the measurement of general and respiratory health parameters and the measurement of specific biomarkers (genetic, protein, epigenetic) of respiratory health and air pollution exposure. Bottlenecks were identified and modifications were proposed to expand this integrated study to a higher number of children, time points and locations. This would allow for non-invasive assessment of the impact of air pollution exposure on the respiratory health of children in future larger-scale studies, which is critical for the development of policies or measures at the population level.

Noninvasive integrative approach applied to children in the context of recent air pollution exposure demonstrates association between fractional exhaled nitric oxide (FeNO) and urinary CC16

“…To our knowledge this is the first study conducted in children, in the context of short-term exposure to PM, where FeNO and U-CC16 were measured, where their mutual association was investigated, and where specific consideration was taken for the genetic background and renal handling adjustment when using U-CC16 as a biomarker. Although our study involved only a limited number of participants, as it was initially conceived as a feasibility study (Nauwelaerts et al, 2022a), relevant and statistically significant associations were obtained.…”

“…On the first time point of the study, a saliva sample was collected to investigate the CC16 SNP G38A genotype. More details on the complete set-up of the field study, on the measurements and sampling have been described elsewhere, where we have reported on the set-up and logistic bottlenecks for this type of studies (Nauwelaerts et al, 2022a).…”

“…Information on the air pollution exposure was obtained from measurements conducted in the context of this small scale field study, described into detail elsewhere (Nauwelaerts et al, 2022a). Briefly, air pollutant levels were obtained from air quality measurement campaigns of two stationary measuring stations.…”

“…However, cautious interpretation is needed as there are a number of confounding factors to take into account, such as exercise, exposure to smoke, viral infections or certain food intakes (Bjermer et al, 2014). Moreover, in the context of large scale studies, conducted in multiple locations and at several time points, it can be time consuming and logistically challenging to measure FeNO, as it necessitates trained staff and multiple instruments, increasing the costs (Nauwelaerts et al, 2022a). Furthermore, in the case a set-up with self-sampling is envisaged to facilitate larger-scale studies, the measurement of FeNO is not feasible anymore and other alternatives for monitoring the respiratory health are needed (Nauwelaerts et al, 2022b).…”

“…None investigated their mutual association in that context, neither used an integrated approach by including the genetic background of the child into the analysis. Previously, we conducted a small scale field study, in view of future larger scale studies, that envisaged the collection of samples for the measurement of U-CC16 as well as FeNO at two time points in a small group of school children exposed to air pollution (Nauwelaerts et al, 2022a) at two different locations. Although this was a small scale field study, aimed at providing insight at the logistic and technical level for future large-scale studies (Nauwelaerts et al, 2022a), we used the collected samples and FeNO measurement data in our current integrated study to assess if U-CC16, a potential biomarker of lung epithelial injury, is associated with FeNO in children recently exposed to different levels of air pollution.…”