Barts and The London School of Medicine, Queen Mary University of London and Royal London Hospital, London, UK.
Institute of Neuroscience, University of Lisbon, Lisbon, Portugal.
Muscle Nerve. 2020 Aug;62(2):187-191. doi: 10.1002/mus.26855. Epub 2020 Mar 16.
Genetic, epigenetic, and environmental factors are relevant in the causation of amyotrophic lateral sclerosis (ALS) in a multistep cascade. We suggest that exposure to environmental pollutants in early life is one such factor. ALS was first described in the 19th century in the context of the Industrial Revolution that began more than 50 years earlier. The rising incidence of ALS thereafter correlates with increasing longevity, but this is an incomplete association. We suggest that increasing exposure to environmental pollutants due to industrial activity, acting over a lifetime, is also important. The combination of genetic mutations and pollutant exposure, with increased life expectancy, may account for the apparent variations in incidence of the disease in different countries and continents and even regionally within a given country. This hypothesis is testable by focused epidemiological studies, evaluating early and lifelong industrial pollutant exposure of differing types, within the Bradford Hill framework.
遗传、表观遗传和环境因素在肌萎缩侧索硬化症（ALS）的多步骤级联反应中起重要作用。我们认为，早年暴露于环境污染物是其中一个因素。ALS 于 19 世纪在更早开始的工业革命背景下首次被描述。此后，ALS 的发病率上升与寿命延长相关，但这只是一种不完全的关联。我们认为，由于工业活动导致的环境污染物暴露的增加，在一生中持续作用，也很重要。遗传突变和污染物暴露的结合，加上预期寿命的延长，可能解释了不同国家和大洲，甚至在一个给定国家的不同地区，疾病发病率的明显差异。这一假设可以通过在布拉德福德·希尔框架内进行有针对性的流行病学研究来检验，评估不同类型的早期和终生工业污染物暴露。
