Rapid progression of pleural disease due to exposure to Libby amphibole: “Not your grandfather's asbestos related disease”

Abstract

LA exposure can cause a non-malignant pleural disease that is more rapidly progressive and more severe than the usual asbestos-related disease.

Mesothelial cell autoantibodies upregulate transcription factors associated with fibrosis

“…We recently demonstrated that the LA-induced autoantibodies alone, in the absence of asbestos, could contribute to the fibrotic process in mice (Gilmer et al 2016). The public health significance of this result is further highlighted by evidence that the LA non-malignant pleural disease is more severe and progressive than what is classically described for general occupational (chrysotile) asbestos exposures, and that the radiographic lesions were clearly associated with pulmonary function decline (Black et al 2014, Larson et al 2012, Whitehouse 2004). …”

“…Vermiculite is a mineral well known for its ability to resist changes in temperature and degradation, making this silicate mineral desirable for use in many products. Unfortunately, the vermiculite ore bed was contaminated with a unique type of amphibole asbestos now referred to as Libby Amphibole (LA) (Black et al 2014). Many public structures in Libby were conditioned with this mineral, including homes, playgrounds, and the track and baseball field.…”

“…Many public structures in Libby were conditioned with this mineral, including homes, playgrounds, and the track and baseball field. Moreover, children would sometimes play in the piles of vermiculite, and families would use it in their gardens (Black et al 2014). In 2002, the mine and the surrounding community were designated as a Superfund site by the U.S. Environmental Protection Agency (EPA) because of considerable health complications associated with LA exposure, now known to include reduced pulmonary function, enhanced autoimmune responses, pleural and interstitial fibrosis, and substantially increased mortality from lung cancer and malignant mesothelioma (Antao et al 2012, Peipins et al 2003, Pfau et al 2005, Whitehouse et al 2008).…”

“…Pleural disease, however, is the most prevalent pulmonary outcome in Libby, causing significant morbidity and mortality (Peipins et al 2003), with an atypical clinical presentation including severe chest pain and rapid progression (Black et al 2014). Moreover, an increase in the risk for systemic autoimmune diseases, specifically Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), and Systemic Sclerosis (SSc), has also been reported (Noonan et al 2006, Pfau et al 2014).…”

“Not your grandfather's pleural disease”: Rapid progression, ventilatory impairment, and chronic pleuritic pain from Libby vermiculite/amphibole

“…Findings have included the associations between X-ray and spirometry [Larson et al, 2012], low-level exposure and PT [Rohs et al, 2008;Christensen et al, 2013], exposure severity and PT [Rohs et al, 2008] and exposure and asbestos-related mortality, including mesothelioma [Sullivan, 2007;Whitehouse et al, 2008]. Informative as these reports are, they reflect our grandparental knowledge of ARD and not the unique features described by Black et al [2014] in this issue of the AJIM. Among 353 patients with X-rays indeterminate for PT, 98 (28%) were noted to have PT on HRCT [Muravov et al, 2005].…”