Occupational perchloroethylene exposure in dry-cleaning workers: Oxidative stress and hepatorenal biomarkers
Abstract
Introduction: Perchloroethylene (PCE) is widely used in dry cleaning and has been linked to hepatorenal toxicity. We aimed to assess the relationship between occupational PCE exposure, oxidative stress, and biomarkers of liver and kidney function.
Materials and methods: We conducted a cross-sectional study of 30 male Iranian dry-cleaning workers and 30 frequency-matched controls. Personal full-shift air samples were collected for PCE. Serum biomarkers of oxidative stress ; Malondialdehyde (MDA), Superoxide Dismutase (SOD) and Catalase (CAT); and organ function; Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Alkaline Phosphatase (ALP), bilirubin, creatinine, urea; were measured.
Results: Exposed workers had a mean Time-Weighted Average (TWA) of 29 ppm, exceeding the 25-ppm Occupational Exposure Limit (OEL). Compared with controls, Malondialdehyde (MDA), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and creatinine were higher (p<0.05), while SOD and CAT were lower
(p<0.05); ALP and bilirubin did not differ. Within the exposed group, longer employment was associated with worsening oxidative and hepatorenal markers. Multivariate regression analysis confirmed that PCE exposure
remained a significant independent predictor of oxidative stress (MDA, SOD, CAT) even after adjusting for age and smoking.
Conclusion: Findings indicate oxidative stress accompanies subclinical liver injury and early renal impact at prevailing occupational exposures. Reducing PCE through engineering controls and safer technologies should
be prioritized
1. Petrucci E, Scarsella M, De Filippis P, Di Palma L. Tetrachloroethene recovery and hazard reduction of spent powders from dry cleaning process. Waste Management & Research. 2015;33(4):339-44.
2. Anbhazhagan S, Winkins SS. A biochemical study on variability of Superoxide dismutase, Catalase and Glutathione peroxidase in dry cleaners. Indian Journal of Clinical Biochemistry. 2008;23(2):198-9.
3. Lynge E, Tinnerberg H, Rylander L, Romundstad P, Johansen K, Lindbohm M-L, et al. Exposure to tetrachloroethylene in dry cleaning shops in the Nordic countries. Annals of occupational hygiene. 2011;55(4):387-96.
4. Lucas D, Hervé A, Lucas R, Cabioch C, Capellmann P, Nicolas A, et al. Assessment of Exposure to perchloroethylene and its clinical repercussions for 50 dry-cleaning employees. Journal of Occupational and Environmental Hygiene. 2015;12(11):767-73.
5. Modenese A, Gioia TC, Chiesi A, Abbacchini C, Borsari L, Ferrari D, et al. Evaluation of occupational exposure to perchlorethylene in a group of Italian dry cleaners using noninvasive exposure indices. International Journal of Environmental Research and Public Health. 2019;16(16):2832.
6. Guyton KZ, Hogan KA, Scott CS, Cooper GS, Bale AS, Kopylev L, et al. Human health effects of tetrachloroethylene: key findings and scientific issues. Environmental Health Perspectives. 2014;122(4):325-34.
7. Callahan CL, Stewart PA, Blair A, Purdue MP. Extended mortality follow-up of a cohort of dry cleaners. Epidemiology. 2019;30(2):285-90.
8. Ruder AM, Ward EM, Brown DP. Mortality in dry‐cleaning workers: An update. American journal of industrial medicine. 2001;39(2):121-32.
9. Vlaanderen J, Straif K, Ruder A, Blair A, Hansen J, Lynge E, et al. Tetrachloroethylene exposure and bladder cancer risk: a meta-analysis of dry-cleaning-worker studies. Environmental Health Perspectives. 2014;122(7):661-6.
10. Shen C, Zhao C-Y, Liu F, Wang Y-D, Wang W. Acute liver failure associated with occupational exposure to tetrachloroethylene. J Korean Med Sci. 2011;26(1):138-42.
11. Trevisan A, Maccà I, Rui F, Carrieri M, Bartolucci GB, Manno M. Kidney and liver biomarkers in female dry-cleaning workers exposed to perchloroethylene. Biomarkers. 2000;5(6):399-409.
12. Labbafinejad Y, Mohammadi S, Mirzamohammadi E, Ghaffari M, Attarchi M, Amiri A. Assessment of neuro behavioral disorders in workers exposed to organic solvents in a publication house. Medical journal of the Islamic Republic of Iran. 2014;28:3.
13. Everatt R, Slapšytė G, Mierauskienė J, Dedonytė V, Bakienė L. Biomonitoring study of dry cleaning workers using cytogenetic tests and the comet assay. Journal of occupational and environmental hygiene. 2013;10(11):609-21.
14. Azimi M, Bahrami MR, Hachesu VR, Reza JZ, Mihanpour H, Sakhvidi MJZ, et al. Primary DNA damage in dry cleaners with perchlorethylene exposure. The international journal of occupational and environmental medicine. 2017;8(4):224.
15. Gromadzinska J, Wasowicz W. Oxidative stress-inducing workplace agents. Comments on Toxicology. 2003;9(1):23-37.
16. Soleimani E, Moghadam RH, Ranjbar A. Occupational exposure to chemicals and oxidative toxic stress. Toxicology and Environmental Health Sciences. 2015;7(1):1-24.
17. Koretsi V, Kirschneck C, Proff P, Römer P. Expression of glutathione peroxidase 1 in the spheno-occipital synchondrosis and its role in ROS-induced apoptosis. European journal of orthodontics. 2015;37(3):308-13.
18. Zhu Q-X, Shen T, Ding R, Liang Z-Z, Zhang X-J. Cytotoxicity of trichloroethylene and perchloroethylene on normal human epidermal keratinocytes and protective role of vitamin E. Toxicology. 2005;209(1):55-67.
19. Wang G, Wang J, Ansari GS, Khan MF. Autoimmune potential of perchloroethylene: Role of lipid-derived aldehydes. Toxicology and applied pharmacology. 2017;333:76-83.
20. Ghahri A, Dehghan MH, Seydi P, Mashayekhi S, Naderi Y, Seydi E. The perchloroethylene‐induced toxicity in dry cleaning workers lymphocytes through induction of oxidative stress. Journal of Biochemical and Molecular Toxicology. 2022;36(4):e23000.
21. Tucker JD, Sorensen KJ, Ruder AM, McKernan LT, Forrester CL, Butler MA. Cytogenetic analysis of an exposed-referent study: perchloroethylene-exposed dry cleaners compared to unexposed laundry workers. Environmental Health. 2011;10(1):16.
22. McKernan LT, Ruder AM, Petersen MR, Hein MJ, Forrester CL, Sanderson WT, et al. Biological exposure assessment to tetrachloroethylene for workers in the dry cleaning industry. Environmental Health. 2008;7(1):12.
23. Maccà I, Carrieri M, Scapellato ML, Scopa P, Trevisan A, Bartolucci GB. Biological monitoring of exposure to perchloroethylene in dry cleaning workers. La Medicina del lavoro. 2012;103:382-93.
24. Li C, Li X, Zhang Z. Oxidative stress and pro-inflammatory cytokines following perchloroethylene exposure in young female dry-cleaning workers. Work. 2024;77(3):975-9.
25. Abell MT, Agrawal A, Andrews RN, Arnold JE, Ashley KE, Baron PA, et al. NIOSH Manual of Analytical Methods (NMAM), [print edition]. 2020.
26. Hosseinzadeh M, Hemmatjo R, Moutab Sahihazar Z, Galvani S, Hajaghazadeh M. Probabilistic health risk assessment of occupational exposure to BTEX in a paint manufacturing plant using Monte-Carlo simulation. Human and Ecological Risk Assessment: An International Journal. 2023;29(3-4):859-80.
27. Earnest GS, Ewers LM, Ruder AM, Petersen MR, Kovein RJ. An evaluation of retrofit engineering control interventions to reduce perchloroethylene exposures in commercial dry-cleaning shops. Applied occupational and environmental hygiene. 2002;17(2):104-11.
28. Ewers LM, Ruder AM, Petersen MR, Earnest GS, Goldenhar LM. Effects of retrofit emission controls and work practices on perchloroethylene exposures in small dry-cleaning shops. Applied occupational and environmental hygiene. 2002;17(2):112-20.
29. Habib S, Ahmed HO, Al-Muhairi N, Ziad R. Preliminary Study: Environmental Assessment of Perchloroethylene in Dry‐Cleaning Facilities in the UAE. Journal of Environmental and Public Health. 2018;2018(1):1732906.
30. Luo JCJ, Shih TS, Chang CP, Huang CC. Blood oxidative stress in Taiwan workers exposed to carbon disulfide. American journal of industrial medicine. 2011;54(8):637-45.
31. Zepeda‐Arce R, Rojas‐García AE, Benitez‐Trinidad A, Herrera‐Moreno JF, Medina‐Díaz IM, Barrón‐Vivanco BS, et al. Oxidative stress and genetic damage among workers exposed primarily to organophosphate and pyrethroid pesticides. Environmental toxicology. 2017;32(6):1754-64.
32. Hesari N, Francis CM, Halden RU. Evaluation of glycol ether as an alternative to perchloroethylene in dry cleaning. Toxics. 2014;2(2):115-33.
33. Ceballos DM, Fellows KM, Evans AE, Janulewicz PA, Lee EG, Whittaker SG. Perchloroethylene and dry cleaning: It's time to move the industry to safer alternatives. Frontiers in Public Health. 2021;9:638082.
2. Anbhazhagan S, Winkins SS. A biochemical study on variability of Superoxide dismutase, Catalase and Glutathione peroxidase in dry cleaners. Indian Journal of Clinical Biochemistry. 2008;23(2):198-9.
3. Lynge E, Tinnerberg H, Rylander L, Romundstad P, Johansen K, Lindbohm M-L, et al. Exposure to tetrachloroethylene in dry cleaning shops in the Nordic countries. Annals of occupational hygiene. 2011;55(4):387-96.
4. Lucas D, Hervé A, Lucas R, Cabioch C, Capellmann P, Nicolas A, et al. Assessment of Exposure to perchloroethylene and its clinical repercussions for 50 dry-cleaning employees. Journal of Occupational and Environmental Hygiene. 2015;12(11):767-73.
5. Modenese A, Gioia TC, Chiesi A, Abbacchini C, Borsari L, Ferrari D, et al. Evaluation of occupational exposure to perchlorethylene in a group of Italian dry cleaners using noninvasive exposure indices. International Journal of Environmental Research and Public Health. 2019;16(16):2832.
6. Guyton KZ, Hogan KA, Scott CS, Cooper GS, Bale AS, Kopylev L, et al. Human health effects of tetrachloroethylene: key findings and scientific issues. Environmental Health Perspectives. 2014;122(4):325-34.
7. Callahan CL, Stewart PA, Blair A, Purdue MP. Extended mortality follow-up of a cohort of dry cleaners. Epidemiology. 2019;30(2):285-90.
8. Ruder AM, Ward EM, Brown DP. Mortality in dry‐cleaning workers: An update. American journal of industrial medicine. 2001;39(2):121-32.
9. Vlaanderen J, Straif K, Ruder A, Blair A, Hansen J, Lynge E, et al. Tetrachloroethylene exposure and bladder cancer risk: a meta-analysis of dry-cleaning-worker studies. Environmental Health Perspectives. 2014;122(7):661-6.
10. Shen C, Zhao C-Y, Liu F, Wang Y-D, Wang W. Acute liver failure associated with occupational exposure to tetrachloroethylene. J Korean Med Sci. 2011;26(1):138-42.
11. Trevisan A, Maccà I, Rui F, Carrieri M, Bartolucci GB, Manno M. Kidney and liver biomarkers in female dry-cleaning workers exposed to perchloroethylene. Biomarkers. 2000;5(6):399-409.
12. Labbafinejad Y, Mohammadi S, Mirzamohammadi E, Ghaffari M, Attarchi M, Amiri A. Assessment of neuro behavioral disorders in workers exposed to organic solvents in a publication house. Medical journal of the Islamic Republic of Iran. 2014;28:3.
13. Everatt R, Slapšytė G, Mierauskienė J, Dedonytė V, Bakienė L. Biomonitoring study of dry cleaning workers using cytogenetic tests and the comet assay. Journal of occupational and environmental hygiene. 2013;10(11):609-21.
14. Azimi M, Bahrami MR, Hachesu VR, Reza JZ, Mihanpour H, Sakhvidi MJZ, et al. Primary DNA damage in dry cleaners with perchlorethylene exposure. The international journal of occupational and environmental medicine. 2017;8(4):224.
15. Gromadzinska J, Wasowicz W. Oxidative stress-inducing workplace agents. Comments on Toxicology. 2003;9(1):23-37.
16. Soleimani E, Moghadam RH, Ranjbar A. Occupational exposure to chemicals and oxidative toxic stress. Toxicology and Environmental Health Sciences. 2015;7(1):1-24.
17. Koretsi V, Kirschneck C, Proff P, Römer P. Expression of glutathione peroxidase 1 in the spheno-occipital synchondrosis and its role in ROS-induced apoptosis. European journal of orthodontics. 2015;37(3):308-13.
18. Zhu Q-X, Shen T, Ding R, Liang Z-Z, Zhang X-J. Cytotoxicity of trichloroethylene and perchloroethylene on normal human epidermal keratinocytes and protective role of vitamin E. Toxicology. 2005;209(1):55-67.
19. Wang G, Wang J, Ansari GS, Khan MF. Autoimmune potential of perchloroethylene: Role of lipid-derived aldehydes. Toxicology and applied pharmacology. 2017;333:76-83.
20. Ghahri A, Dehghan MH, Seydi P, Mashayekhi S, Naderi Y, Seydi E. The perchloroethylene‐induced toxicity in dry cleaning workers lymphocytes through induction of oxidative stress. Journal of Biochemical and Molecular Toxicology. 2022;36(4):e23000.
21. Tucker JD, Sorensen KJ, Ruder AM, McKernan LT, Forrester CL, Butler MA. Cytogenetic analysis of an exposed-referent study: perchloroethylene-exposed dry cleaners compared to unexposed laundry workers. Environmental Health. 2011;10(1):16.
22. McKernan LT, Ruder AM, Petersen MR, Hein MJ, Forrester CL, Sanderson WT, et al. Biological exposure assessment to tetrachloroethylene for workers in the dry cleaning industry. Environmental Health. 2008;7(1):12.
23. Maccà I, Carrieri M, Scapellato ML, Scopa P, Trevisan A, Bartolucci GB. Biological monitoring of exposure to perchloroethylene in dry cleaning workers. La Medicina del lavoro. 2012;103:382-93.
24. Li C, Li X, Zhang Z. Oxidative stress and pro-inflammatory cytokines following perchloroethylene exposure in young female dry-cleaning workers. Work. 2024;77(3):975-9.
25. Abell MT, Agrawal A, Andrews RN, Arnold JE, Ashley KE, Baron PA, et al. NIOSH Manual of Analytical Methods (NMAM), [print edition]. 2020.
26. Hosseinzadeh M, Hemmatjo R, Moutab Sahihazar Z, Galvani S, Hajaghazadeh M. Probabilistic health risk assessment of occupational exposure to BTEX in a paint manufacturing plant using Monte-Carlo simulation. Human and Ecological Risk Assessment: An International Journal. 2023;29(3-4):859-80.
27. Earnest GS, Ewers LM, Ruder AM, Petersen MR, Kovein RJ. An evaluation of retrofit engineering control interventions to reduce perchloroethylene exposures in commercial dry-cleaning shops. Applied occupational and environmental hygiene. 2002;17(2):104-11.
28. Ewers LM, Ruder AM, Petersen MR, Earnest GS, Goldenhar LM. Effects of retrofit emission controls and work practices on perchloroethylene exposures in small dry-cleaning shops. Applied occupational and environmental hygiene. 2002;17(2):112-20.
29. Habib S, Ahmed HO, Al-Muhairi N, Ziad R. Preliminary Study: Environmental Assessment of Perchloroethylene in Dry‐Cleaning Facilities in the UAE. Journal of Environmental and Public Health. 2018;2018(1):1732906.
30. Luo JCJ, Shih TS, Chang CP, Huang CC. Blood oxidative stress in Taiwan workers exposed to carbon disulfide. American journal of industrial medicine. 2011;54(8):637-45.
31. Zepeda‐Arce R, Rojas‐García AE, Benitez‐Trinidad A, Herrera‐Moreno JF, Medina‐Díaz IM, Barrón‐Vivanco BS, et al. Oxidative stress and genetic damage among workers exposed primarily to organophosphate and pyrethroid pesticides. Environmental toxicology. 2017;32(6):1754-64.
32. Hesari N, Francis CM, Halden RU. Evaluation of glycol ether as an alternative to perchloroethylene in dry cleaning. Toxics. 2014;2(2):115-33.
33. Ceballos DM, Fellows KM, Evans AE, Janulewicz PA, Lee EG, Whittaker SG. Perchloroethylene and dry cleaning: It's time to move the industry to safer alternatives. Frontiers in Public Health. 2021;9:638082.
| Files | ||
| Issue | Vol 10 No 4 (2025): Autumn 2025 | |
| Section | Original Research | |
| DOI | https://doi.org/10.18502/japh.v10i4.20618 | |
| Keywords | ||
| Perchloroethylene; Occupational exposure; Oxidative stress; Biomarkers; Liver injury | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Jafari A, Karimi S, Esmaeilzadeh Z, Hajaghazadeh M. Occupational perchloroethylene exposure in dry-cleaning workers: Oxidative stress and hepatorenal biomarkers. JAPH. 2025;10(4):543-558.
