Immune cells and cardiovascular health in premenopausal women of rural India chronically exposed to biomass smoke during daily household cooking
Highlights
► Effect of chronic biomass smoke exposure on immunological profile was investigated. ► Marked suppression in the total number of T-helper (CD4+) cells and B (CD19+) cells was observed. ► Appreciable rise was documented in the number of CD8+ T-cytotoxic cells, Treg cells and CD16+CD56+ natural killer (NK) cells. ► Immunological profile changed with the type of biomass fuel used for the cooking and with kitchen location.
Introduction
Cooking and wood burning are significant sources of indoor air pollution (IAP) in developing nations like India. IAP from biomass smoke is a complex mixture of fine and ultrafine particles, carbon monoxide (CO), oxides of nitrogen and sulfur, transitional metals, polycyclic aromatic hydrocarbons, volatile organic compounds and bioaerosols (Smith, 2000). These particles are capable not only of activating endogenous sources of local inflammation (Chang et al., 1990, Mukae et al., 2001) and oxidative stress within pulmonary tissue (e.g. immune cells; Brook, 2008), but also of stimulating production and release of polymorphonuclear leukocytes (PMN) and monocytes from the bone marrow (Goto et al., 2004, Swiston et al., 2008), which are key players in executing the immune functions.
Reports have shown that inhalation of toxic particles and gasses induces lung epithelial cells and alveolar macrophages to generate a rich milieu of inflammatory mediators, which in turn produce an integrated local lung and systemic inflammatory immune response (Hogg and van Eeden, 2009, Vardavas et al., 2010). These complex inflammatory processes and changes in the immune system are crucial in the pathogenesis of disorders like chronic obstructive lung disease (COPD), lung cancer, and atherosclerosis (Domagala-Kulawik, 2008).
We have previously shown that women chronically exposed to biomass smoke have greater prevalence of hypertension, increased platelet activity, elevated levels of oxidized low-density lipoprotein and anti-cardiolipin antibodies and hence, they are predisposed to increased risk of cardiovascular disease development (Dutta et al., 2011). Atherosclerosis is an inflammatory and thrombotic disease. A crosstalk between platelets and lymphocytes, and a role of platelets in enhancing development of T-effector cell have been mentioned by Gerdes et al. (2011). In addition, immune-alteration that may occur from exposure to cooking smoke may lead to greater susceptibility to infection with elevated titer of immunoglobulin E (IgE; Mishra et al., 1999). Changes in cells of the immune system are important indicators of systemic response of the body to air pollution. Against this backdrop, we attempt to investigate, in this study, the immunological changes in rural women who have been cooking exclusively with biomass for the past 5 years or more. The findings were compared with that of age-matched women from same locality who cooked exclusively with liquefied petroleum gas (LPG). To the best of our knowledge, this study on immune-toxicity due to cumulative exposure to biomass smoke is the first of its kind in India.
Section snippets
Study design
We conducted a cross-sectional analysis of the associations between indices of indoor air pollution (IAP) and a set of immune assays. All women gave informed consent before participation in this study.
Study population
Women were recruited from rural villages of four districts (Hooghly, Burdwan, Nadia and Birbhum) of West Bengal, an eastern state in India. A total of 819 apparently healthy, never-smoking premenopausal married women with regular menstrual cycle (28 ± 2 days) were enrolled. Among the participants,
Demographic characteristics of the participants
Demographic and socio-economic characteristics of biomass- and LPG-using women are compared in Table 1. It is apparent that the two groups were well-matched with respect to age, body mass index (BMI), years and hours of cooking, passive smoking due to presence of smokers in the family, food habit, and number of family members. However, they differed significantly (p < 0.05) with respect to education, family income and presence of separate kitchen. Compared with controls, biomass users were less
Discussion
This study has shown that women who cooked exclusively with biomass fuel had alterations in immune defense compared with their neighbors who cooked with LPG. Biomass users illustrated marked suppression in the total number of T-helper (CD4+) cells and B (CD19+) cells while appreciable rise was documented in the number of CD8+ T-cytotoxic cells and CD16+CD56+ natural killer (NK) cells. Chronic exposures to biomass smoke were perhaps responsible for these alterations. This hypothesis is supported
Conclusions
This study has shown that indoor air pollution from biomass fuel use is a serious health hazard for rural people in eastern India. Women who cook with these fuels are the worst hit. This is a neglected area of public health that affects the majority of nation's population. In view of the enormity of the problem, the issue of indoor air pollution should be dealt seriously. Efforts should be made by all concerned to understand the problem better and to formulate strategies to reduce emission and
Acknowledgment
The study was funded by the Council of Scientific and Industrial Research, India and the Central Pollution Control Board, Delhi under the Ministry of Environment and Forests, Government of India.
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