title: One airway: Biomarkers of protection from upper and lower airway injury after World Trade Center exposure.
abstract: BACKGROUND
  Firefighters exposed to World Trade Center (WTC) dust have developed chronic rhinosinusitis (CRS) and abnormal forced expiratory volume in 1 s (FEV1). Overlapping but distinct immune responses may be responsible for the clinical manifestations of upper and lower airway injury. We investigated whether a panel of inflammatory cytokines, either associated or not associated with WTC-LI, can predict future chronic rhinosinusitis disease and its severity.
  
  
  METHODS
  Serum obtained within six months of 9/11/2001 from 179 WTC exposed firefighters presenting for subspecialty evaluation prior to 3/2008 was assayed for 39 cytokines. The main outcomes were medically managed CRS (N = 62) and more severe CRS cases requiring sinus surgery (N = 14). We tested biomarker-CRS severity association using ordinal logistic regression analysis.
  
  
  RESULTS
  Increasing serum IL-6, IL-8, GRO and neutrophil concentration reduced the risk of CRS progression. Conversely, increasing TNF-α increased the risk of progression. In a multivariable model adjusted for exposure intensity, increasing IL-6, TNF-α and neutrophil concentration remained significant predictors of progression. Elevated IL-6 levels and neutrophil counts also reduced the risk of abnormal FEV1 but in contrast to CRS, increased TNF-α did not increase the risk of abnormal FEV1.
  
  
  CONCLUSIONS
  Our study demonstrates both independent and overlapping biomarker associations with upper and lower respiratory injury, and suggests that the innate immune response may play a protective role against CRS and abnormal lung function in those with WTC exposure.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine New York, NY, USA.
authors.forename: Soo Jung
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; New York University, School of Medicine, Department of Medicine, New York, NY, USA.
authors.forename: Ghislaine C
authors.initials: GC
authors.lastname: Echevarria
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine New York, NY, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Kwon
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine New York, NY, USA.
authors.forename: Bushra
authors.initials: B
authors.lastname: Naveed
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine New York, NY, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Schenck
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine New York, NY, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Tsukiji
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine New York, NY, USA; New York University, School of Medicine, Department of Environmental Medicine, Tuxedo Park, NY, USA.
authors.forename: William N
authors.initials: WN
authors.lastname: Rom
authors.affiliation: Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY, USA; Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine New York, NY, USA; New York University, School of Medicine, Department of Environmental Medicine, Tuxedo Park, NY, USA; Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Nolan
authors.affiliation: Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine New York, NY, USA; New York University, School of Medicine, Department of Environmental Medicine, Tuxedo Park, NY, USA; Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY, USA. Electronic address: michael.weiden@med.nyu.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Weiden
mesh_terms: D015415:Biomarkers / Q000097:blood; D004391:Dust; D061388:Firefighters; D005541:Forced Expiratory Volume; D006801:Humans; D007249:Inflammation / Q000175:diagnosis; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D055370:Lung Injury / Q000175:diagnosis / Q000209:etiology; D008297:Male; D009504:Neutrophils / Q000166:cytology; D009518:New York; D016273:Occupational Exposure / Q000009:adverse effects*; D012140:Respiratory Tract Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D012220:Rhinitis / Q000175:diagnosis / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D047851:September 11 Terrorist Attacks; D012720:Severity of Illness Index; D012852:Sinusitis / Q000175:diagnosis / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D004391:Dust; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha
keywords: Chronic rhinosinusitis; Innate immunity; One airway; World Trade Center