title: Using biomarkers to inform cumulative risk assessment.
abstract: BACKGROUND
  Biomarkers are considered the method of choice for determining exposure to environmental contaminants and relating such exposures to health outcomes. However, the association between many biomarkers and outcome is not direct because of variability in sensitivity and susceptibility in the individual.
  
  
  OBJECTIVE
  We explore the relationship between environmental exposures and health outcomes as mitigated by differential susceptibility in individuals or populations and address the question "Can biomarkers enable us to understand and quantify better the population burden of disease and health effects attributable to environmental exposures?"
  
  
  METHODS
  We use a case-study approach to develop the thesis that biomarkers offer a pathway to disaggregation of health effects into specific, if multiple, risk factors. We offer the point of view that a series or array of biomarkers, including biomarkers of exposure, biomarkers of susceptibility, and biomarkers of effect, used in concert offer the best means by which to effect this disaggregation. We commence our discussion by developing the characteristics of an ideal biomarker, then give some examples of commonly used biomarkers to show the strengths and weaknesses of current usage. We follow this by more detailed case-study assessment outlining the state-of-the-science in specific cases. We complete our work with recommendations regarding the future use of biomarkers and areas for continued development.
  
  
  CONCLUSIONS
  The case studies provide examples of when and how biomarkers can be used to infer the source and magnitude of exposure among a set of competing sources and pathways. The answer to this question is chemical specific and relates to how well the biomarker matches the characteristics of an "ideal" biomarker-in particular ease of collection and persistence. The use of biomarkers in combination provides a better opportunity to disaggregate both source and pathway contributions.
authors.affiliation: Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. bryan@sph.emory.edu
authors.forename: P Barry
authors.initials: PB
authors.lastname: Ryan
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Burke
authors.forename: Elaine A
authors.initials: EA
authors.lastname: Cohen Hubal
authors.forename: Jerome J
authors.initials: JJ
authors.lastname: Cura
authors.forename: Thomas E
authors.initials: TE
authors.lastname: McKone
mesh_terms: D015415:Biomarkers; D004198:Disease Susceptibility; D004777:Environment; D004781:Environmental Exposure; D004785:Environmental Pollutants / Q000633:toxicity*; D033161:Government Regulation; D006801:Humans; D011634:Public Health; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D004785:Environmental Pollutants