Relationship between occupational exposure to respirable crystalline silica and serum CC16 level as a potential biomarker for preventing silicosis: A systematic review and meta-analysis study
Abstract
In this present study, the association between occupational exposure to Respirable Crystalline Silica (RCS) and serum level of Clara Cell Protein (CC16) was investigated in the form of a systematic review and meta-analysis. Various databases including PubMed, Scopus, and Web of Sciences were searched until August 2022 based on Medical subject headings (MeSH) such as "CC10 protein, human" OR "Clara-cell specific 10-kD protein "OR "Clara cell phospholipid-binding protein human" AND Silicosis. Standardized Mean Difference (SMD) was used to compare the mean difference in CC16 serum levels between the silicotic and non-silicotic groups. During the initial database search until August 2022, 18 articles were found. By excluding duplicates and final screening in terms of compliance with the title and objectives, eight articles were included in our analysis. The overall effect estimate demonstrated that silicosis patients had lower serum level of CC16 (SMD:-3.58; 95% CI, from -5.14 to-2.3; I2 = 94.4% P-value<0.001) than that of the control group. Moreover, silicosis patients and exposed
individuals had lower serum level of CC16 (SMD:-3.32; 95% CI, from -4.19 to -2.45; I2 = 88.6% P-value<0.001) compared to the control group. The silica exposure had a lower CC16 level (SMD:-1.92; 95% CI, from -4.22 to 0.39; I2= 97.5% P-value<0.001) than the non-silicosis groups. The results demonstrated that occupational exposure to RCS is associated with the reduction of serum CC16 level. Therefore, the reduced serum level
of CC16 protein can be used to monitor the maximum exposure level of workers to RCS in related workplaces.
1. Mossman BT, Glenn RE. Bioreactivity of the crystalline silica polymorphs, quartz and cristobalite, and implications for occupational exposure limits (OELs). Critical reviews in toxicology. 2013;43(8):632-60.
2. Naha N, Muhamed JCJ, Pagdhune A, Sarkar B, Sarkar K. Club cell protein 16 as a biomarker for early detection of silicosis. Indian J Med Res. 2020;151(4):319-25.
3. Pollard KM. Silica, silicosis, and autoimmunity. Frontiers in immunology. 2016;7:97.
4. Boudigaard SH, Schlünssen V, Vestergaard JM, Søndergaard K, Torén K, Peters S, et al. Occupational exposure to respirable crystalline silica and risk of autoimmune rheumatic diseases: a nationwide cohort study. International Journal of Epidemiology. 2021;50(4):1213-26.
5. McLean D, Glass B, Mannetje A, Douwes J. Exposure to respirable crystalline silica in the construction industry we have a problem? The New Zealand Medical Journal (Online). 2017;130(1466):78-82.
6. Baron PA, Rice FL, Key-Schwartz R, Bartley D, Schlecht P. Health effects of occupational exposure to respirable crystalline silica. 2002.
7. Leso V, Fontana L, Romano R, Gervetti P, Iavicoli I. Artificial stone associated silicosis: a systematic review. International journal of environmental research and public health. 2019;16(4):568.
8. Thongtip S, Siviroj P, Prapamontol T, Deesomchok A, Wisetborisut A, Nangola S, et al. A suitable biomarker of effect, club cell protein 16, from crystalline silica exposure among Thai stone-carving workers. Toxicology and Industrial Health. 2020;36(4):287-96.
9. Zhang S, Jia Q, Song J, Tan Q, Yu G, Guo X, et al. Clinical significance of CC16 and IL-12 in bronchoalveolar lavage fluid of various stages of silicosis. Ann Palliat Med. 2020;9(6):3848-56.
10. Castranova V, Vallyathan V. Silicosis and coal workers' pneumoconiosis. Environmental health perspectives. 2000;108(suppl 4):675-84.
11. Leung CC, Yu ITS, Chen W. Silicosis. The Lancet. 2012;379(9830):2008-18.
12. Wang SX, Liu P, Wei MT, Chen L, Guo Y, Wang RY, et al. Roles of serum Clara cell protein 16 and surfactant protein-D in the early diagnosis and progression of silicosis. J Occup Environ Med. 2007;49(8):834-9.
13. Yassin A, Yebesi F, Tingle R. Occupational exposure to crystalline silica dust in the United States, 1988–2003. Environmental health perspectives. 2005;113(3):255-60.
14. Álvarez RF, González CM, Martínez AQ, Pérez JJB, Fernández LC, Fernández AP. Guidelines for the diagnosis and monitoring of silicosis. Archivos de Bronconeumología (English Edition). 2015;51(2):86-93.
15. Liu J, Song HY, Zhu BL, Pan LP, Qian XL. The Effect of Silica Dust Exposure on the Serum Clara Cell Protein 16 Levels in Chinese Workers. Biomed Environ Sci. 2019;32(1):47-50.
16. Lock-Johansson S, Vestbo J, Sorensen GL. Surfactant protein D, Club cell protein 16, Pulmonary and activation-regulated chemokine, C-reactive protein, and Fibrinogen biomarker variation in chronic obstructive lung disease. Respiratory research. 2014;15(1):1-10.
17. Pandey JK, Agarwal D. Biomarkers: A potential prognostic tool for silicosis. Indian journal of occupational and environmental medicine. 2012 Sep 1;16(3):101-7.
18. Nandi SS, Lambe UP, Sarkar K, Sawant S, Deshpande J. A rapid point-of-care CC16 kit for screening of occupational silica dust-exposed workers for early detection of silicosis/silico-tuberculosis. Sci Rep. 2021;11(1):23485.
19. Petrek M, Hermans C, Kolek V, Fialová J, Bernard A. Clara cell protein (CC16) in serum and bronchoalveolar lavage fluid of subjects exposed to asbestos. Biomarkers. 2002;7(1):58-67.
20. Doyle IR, Hermans C, Bernard A, Nicholas TE, Bersten AD. Clearance of Clara cell secretory protein 16 (CC16) and surfactant proteins A and B from blood in acute respiratory failure. American journal of respiratory and critical care medicine. 1998;158(5):1528-35.
21. Bernard A, Hermans C. Biomonitoring of early effects on the kidney or the lung. Science of the total environment. 1997;199(1-2):205-11.
22. Bernard AM, Gonzalez-Lorenzo JM, Siles E, Trujillo G, Lauwerys R. Early decrease of serum Clara cell protein in silica-exposed workers. Eur Respir J. 1994;7(11):1932-7.
23. Sharma N, Kundu D, Dhaked S, Das A. Silicosis and silicotuberculosis in India. Bulletin of the World Health Organization. 2016;94(10):777.
24. Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement (Chinese edition). Journal of Chinese Integrative Medicine. 2009;7(9):889-96.
25. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European journal of epidemiology. 2010;25(9):603-5.
26. Sarkar K, Dhatrak S, Sarkar B, Ojha UC, Raghav P, Pagdhune A. Secondary prevention of silicosis and silico-tuberculosis by periodic screening of silica dust exposed workers using serum club cell protein 16 as a proxy marker. Health Science Reports. 2021;4(3).
27. Albrecht C, Adolf B, Weishaupt C, Höhr D, Zeitträger I, Friemann J, et al. Clara-cell hyperplasia after quartz and coal-dust instillation in rat lung. Inhalation Toxicology. 2001;13(3):191-205.
28. Gulumian M, Borm PJA, Vallyathan V, Castranova V, Donaldson K, Nelson G, et al. Mechanistically Identified Suitable Biomarkers of Exposure, Effect, and Susceptibility for Silicosis and Coal-Worker'S Pneumoconiosis: A Comprehensive Review. Journal of Toxicology and Environmental Health, Part B. 2006;9(5):357-95.
29. Almuntashiri S, Zhu Y, Han Y, Wang X, Somanath PR, Zhang D. Club cell secreted protein CC16: potential applications in prognosis and therapy for pulmonary diseases. Journal of Clinical Medicine. 2020;9(12):4039.
30. McAuley DF, Matthay MA. Clara cell protein CC16: a new lung epithelial biomarker for acute lung injury. Chest. 2009;135(6):1408-10.
31. Hermans C, Bernard A. Clara cell protein (CC16): characteristics and potential applications as biomarker of lung toxicity. Biomarkers. 1996;1(1):3-8.
32. Peri A, Cordella-Miele E, Miele L, Mukherjee AB. Tissue-specific expression of the gene coding for human Clara cell 10-kD protein, a phospholipase A2-inhibitory protein. The Journal of Clinical Investigation. 1993;92(5):2099-109.
2. Naha N, Muhamed JCJ, Pagdhune A, Sarkar B, Sarkar K. Club cell protein 16 as a biomarker for early detection of silicosis. Indian J Med Res. 2020;151(4):319-25.
3. Pollard KM. Silica, silicosis, and autoimmunity. Frontiers in immunology. 2016;7:97.
4. Boudigaard SH, Schlünssen V, Vestergaard JM, Søndergaard K, Torén K, Peters S, et al. Occupational exposure to respirable crystalline silica and risk of autoimmune rheumatic diseases: a nationwide cohort study. International Journal of Epidemiology. 2021;50(4):1213-26.
5. McLean D, Glass B, Mannetje A, Douwes J. Exposure to respirable crystalline silica in the construction industry we have a problem? The New Zealand Medical Journal (Online). 2017;130(1466):78-82.
6. Baron PA, Rice FL, Key-Schwartz R, Bartley D, Schlecht P. Health effects of occupational exposure to respirable crystalline silica. 2002.
7. Leso V, Fontana L, Romano R, Gervetti P, Iavicoli I. Artificial stone associated silicosis: a systematic review. International journal of environmental research and public health. 2019;16(4):568.
8. Thongtip S, Siviroj P, Prapamontol T, Deesomchok A, Wisetborisut A, Nangola S, et al. A suitable biomarker of effect, club cell protein 16, from crystalline silica exposure among Thai stone-carving workers. Toxicology and Industrial Health. 2020;36(4):287-96.
9. Zhang S, Jia Q, Song J, Tan Q, Yu G, Guo X, et al. Clinical significance of CC16 and IL-12 in bronchoalveolar lavage fluid of various stages of silicosis. Ann Palliat Med. 2020;9(6):3848-56.
10. Castranova V, Vallyathan V. Silicosis and coal workers' pneumoconiosis. Environmental health perspectives. 2000;108(suppl 4):675-84.
11. Leung CC, Yu ITS, Chen W. Silicosis. The Lancet. 2012;379(9830):2008-18.
12. Wang SX, Liu P, Wei MT, Chen L, Guo Y, Wang RY, et al. Roles of serum Clara cell protein 16 and surfactant protein-D in the early diagnosis and progression of silicosis. J Occup Environ Med. 2007;49(8):834-9.
13. Yassin A, Yebesi F, Tingle R. Occupational exposure to crystalline silica dust in the United States, 1988–2003. Environmental health perspectives. 2005;113(3):255-60.
14. Álvarez RF, González CM, Martínez AQ, Pérez JJB, Fernández LC, Fernández AP. Guidelines for the diagnosis and monitoring of silicosis. Archivos de Bronconeumología (English Edition). 2015;51(2):86-93.
15. Liu J, Song HY, Zhu BL, Pan LP, Qian XL. The Effect of Silica Dust Exposure on the Serum Clara Cell Protein 16 Levels in Chinese Workers. Biomed Environ Sci. 2019;32(1):47-50.
16. Lock-Johansson S, Vestbo J, Sorensen GL. Surfactant protein D, Club cell protein 16, Pulmonary and activation-regulated chemokine, C-reactive protein, and Fibrinogen biomarker variation in chronic obstructive lung disease. Respiratory research. 2014;15(1):1-10.
17. Pandey JK, Agarwal D. Biomarkers: A potential prognostic tool for silicosis. Indian journal of occupational and environmental medicine. 2012 Sep 1;16(3):101-7.
18. Nandi SS, Lambe UP, Sarkar K, Sawant S, Deshpande J. A rapid point-of-care CC16 kit for screening of occupational silica dust-exposed workers for early detection of silicosis/silico-tuberculosis. Sci Rep. 2021;11(1):23485.
19. Petrek M, Hermans C, Kolek V, Fialová J, Bernard A. Clara cell protein (CC16) in serum and bronchoalveolar lavage fluid of subjects exposed to asbestos. Biomarkers. 2002;7(1):58-67.
20. Doyle IR, Hermans C, Bernard A, Nicholas TE, Bersten AD. Clearance of Clara cell secretory protein 16 (CC16) and surfactant proteins A and B from blood in acute respiratory failure. American journal of respiratory and critical care medicine. 1998;158(5):1528-35.
21. Bernard A, Hermans C. Biomonitoring of early effects on the kidney or the lung. Science of the total environment. 1997;199(1-2):205-11.
22. Bernard AM, Gonzalez-Lorenzo JM, Siles E, Trujillo G, Lauwerys R. Early decrease of serum Clara cell protein in silica-exposed workers. Eur Respir J. 1994;7(11):1932-7.
23. Sharma N, Kundu D, Dhaked S, Das A. Silicosis and silicotuberculosis in India. Bulletin of the World Health Organization. 2016;94(10):777.
24. Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement (Chinese edition). Journal of Chinese Integrative Medicine. 2009;7(9):889-96.
25. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European journal of epidemiology. 2010;25(9):603-5.
26. Sarkar K, Dhatrak S, Sarkar B, Ojha UC, Raghav P, Pagdhune A. Secondary prevention of silicosis and silico-tuberculosis by periodic screening of silica dust exposed workers using serum club cell protein 16 as a proxy marker. Health Science Reports. 2021;4(3).
27. Albrecht C, Adolf B, Weishaupt C, Höhr D, Zeitträger I, Friemann J, et al. Clara-cell hyperplasia after quartz and coal-dust instillation in rat lung. Inhalation Toxicology. 2001;13(3):191-205.
28. Gulumian M, Borm PJA, Vallyathan V, Castranova V, Donaldson K, Nelson G, et al. Mechanistically Identified Suitable Biomarkers of Exposure, Effect, and Susceptibility for Silicosis and Coal-Worker'S Pneumoconiosis: A Comprehensive Review. Journal of Toxicology and Environmental Health, Part B. 2006;9(5):357-95.
29. Almuntashiri S, Zhu Y, Han Y, Wang X, Somanath PR, Zhang D. Club cell secreted protein CC16: potential applications in prognosis and therapy for pulmonary diseases. Journal of Clinical Medicine. 2020;9(12):4039.
30. McAuley DF, Matthay MA. Clara cell protein CC16: a new lung epithelial biomarker for acute lung injury. Chest. 2009;135(6):1408-10.
31. Hermans C, Bernard A. Clara cell protein (CC16): characteristics and potential applications as biomarker of lung toxicity. Biomarkers. 1996;1(1):3-8.
32. Peri A, Cordella-Miele E, Miele L, Mukherjee AB. Tissue-specific expression of the gene coding for human Clara cell 10-kD protein, a phospholipase A2-inhibitory protein. The Journal of Clinical Investigation. 1993;92(5):2099-109.
| Files | ||
| Issue | Vol 9 No 2 (2024): Spring 2024 | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/japh.v9i2.15926 | |
| Keywords | ||
| Silica Biomarker Clara-cell specific 10- kD protein Silicosis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Arabzadeh H, Poormohammadi A, Khazaei S, Fattahi Darghlou M. Relationship between occupational exposure to respirable crystalline silica and serum CC16 level as a potential biomarker for preventing silicosis: A systematic review and meta-analysis study. JAPH. 2024;9(2):225-234.
