Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
Environ Health Perspect. 2020 Apr;128(4):47010. doi: 10.1289/EHP5751. Epub 2020 Apr 29.
Biomarkers of exposure, susceptibility, and effect are fundamental for understanding environmental exposures, mechanistic pathways of effect, and monitoring early adverse outcomes. To date, no study has comprehensively evaluated a large suite and variety of biomarkers in household air pollution (HAP) studies in concert with exposure and outcome data. The Household Air Pollution Intervention Network (HAPIN) trial is a liquified petroleum gas (LPG) fuel/stove randomized intervention trial enrolling 800 pregnant women in each of four countries (i.e., Peru, Guatemala, Rwanda, and India). Their offspring will be followed from birth through 12 months of age to evaluate the role of pre- and postnatal exposure to HAP from biomass burning cookstoves in the control arm and LPG stoves in the intervention arm on growth and respiratory outcomes. In addition, up to 200 older adult women per site are being recruited in the same households to evaluate indicators of cardiopulmonary, metabolic, and cancer outcomes.
Here we describe the rationale and ultimate design of a comprehensive biomarker plan to enable us to explore more fully how exposure is related to disease outcome.
HAPIN enrollment and data collection began in May 2018 and will continue through August 2021. As a part of data collection, dried blood spot (DBS) and urine samples are being collected three times during pregnancy in pregnant women and older adult women. DBS are collected at birth for the child. DBS and urine samples are being collected from the older adult women and children three times throughout the child's first year of life. Exposure biomarkers that will be longitudinally measured in all participants include urinary hydroxy-polycyclic aromatic hydrocarbons, volatile organic chemical metabolites, metals/metalloids, levoglucosan, and cotinine. Biomarkers of effect, including inflammation, endothelial and oxidative stress biomarkers, lung cancer markers, and other clinically relevant measures will be analyzed in urine, DBS, or blood products from the older adult women. Similarly, genomic/epigenetic markers, microbiome, and metabolomics will be measured in older adult women samples.
Our study design will yield a wealth of biomarker data to evaluate, in great detail, the link between exposures and health outcomes. In addition, our design is comprehensive and innovative by including cutting-edge measures such as metabolomics and epigenetics. https://doi.org/10.1289/EHP5751.
生物标志物的暴露、易感性和效应是理解环境暴露、作用机制途径和监测早期不良结局的基础。迄今为止，尚无研究综合评估大量不同的生物标志物与暴露和结局数据在家庭空气污染 (HAP) 研究中的相关性。家庭空气污染干预网络 (HAPIN) 试验是一项液化石油气 (LPG) 燃料/炉灶随机干预试验，在四个国家（秘鲁、危地马拉、卢旺达和印度）各招募 800 名孕妇。他们的后代将从出生到 12 个月大进行随访，以评估在控制组中使用生物量燃烧炉灶和干预组中使用 LPG 炉灶的产前和产后 HAP 暴露对生长和呼吸结局的影响。此外，每个地点还招募了多达 200 名成年妇女，以评估心肺、代谢和癌症结局的指标。
本研究旨在描述一项全面生物标志物计划的基本原理和最终设计，以更全面地探索暴露与疾病结局的关系。
HAPIN 的入组和数据收集于 2018 年 5 月开始，将持续到 2021 年 8 月。作为数据收集的一部分，孕妇和成年妇女在怀孕期间三次采集干血斑 (DBS) 和尿液样本。在孩子出生时为孩子采集 DBS。在孩子一岁之前的整个过程中，成年妇女和儿童三次采集 DBS 和尿液样本。将在所有参与者中进行纵向测量的暴露生物标志物包括尿液羟基多环芳烃、挥发性有机化学代谢物、金属/类金属、左旋葡聚糖和可替宁。将在成年妇女的尿液、DBS 或血液制品中分析生物效应标志物，包括炎症、内皮和氧化应激生物标志物、肺癌标志物和其他临床相关指标。同样，将在成年妇女样本中测量基因组/表观遗传标志物、微生物组和代谢组学。
我们的研究设计将产生大量的生物标志物数据，以详细评估暴露与健康结局之间的联系。此外，我们的设计全面且具有创新性，包括代谢组学和表观遗传学等前沿措施。https://doi.org/10.1289/EHP5751.
