title: Association of Environmental Toxins With Amyotrophic Lateral Sclerosis.
abstract: Persistent environmental pollutants may represent a modifiable risk factor involved in the gene-time-environment hypothesis in amyotrophic lateral sclerosis (ALS).
  
  
  
  To evaluate the association of occupational exposures and environmental toxins on the odds of developing ALS in Michigan.
  
  
  
  Case-control study conducted between 2011 and 2014 at a tertiary referral center for ALS. Cases were patients diagnosed as having definitive, probable, probable with laboratory support, or possible ALS by revised El Escorial criteria; controls were excluded if they were diagnosed as having ALS or another neurodegenerative condition or if they had a family history of ALS in a first- or second-degree blood relative. Participants completed a survey assessing occupational and residential exposures. Blood concentrations of 122 persistent environmental pollutants, including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and brominated flame retardants (BFRs), were measured using gas chromatography-mass spectrometry. Multivariable models with self-reported occupational exposures in various exposure time windows and environmental toxin blood concentrations were separately fit by logistic regression models. Concordance between the survey data and pollutant measurements was assessed using the nonparametric Kendall τ correlation coefficient.
  
  
  
  Occupational and residential exposures to environmental toxins, and blood concentrations of 122 persistent environmental pollutants, including OCPs, PCBs, and BFRs.
  
  
  
  Participants included 156 cases (mean [SD] age, 60.5 [11.1] years; 61.5% male) and 128 controls (mean [SD] age, 60.4 [9.4] years; 57.8% male); among them, 101 cases and 110 controls had complete demographic and pollutant data. Survey data revealed that reported pesticide exposure in the cumulative exposure windows was significantly associated with ALS (odds ratio [OR] = 5.09; 95% CI, 1.85-13.99; P = .002). Military service was also associated with ALS in 2 time windows (exposure ever happened in entire occupational history: OR = 2.31; 95% CI, 1.02-5.25; P = .046; exposure ever happened 10-30 years ago: OR = 2.18; 95% CI, 1.01-4.73; P = .049). A multivariable model of measured persistent environmental pollutants in the blood, representing cumulative occupational and residential exposure, showed increased odds of ALS for 2 OCPs (pentachlorobenzene: OR = 2.21; 95% CI, 1.06-4.60; P = .04; and cis-chlordane: OR = 5.74; 95% CI, 1.80-18.20; P = .005), 2 PCBs (PCB 175: OR = 1.81; 95% CI, 1.20-2.72; P = .005; and PCB 202: OR = 2.11; 95% CI, 1.36-3.27; P = .001), and 1 BFR (polybrominated diphenyl ether 47: OR = 2.69; 95% CI, 1.49-4.85; P = .001). There was modest concordance between survey data and the measurements of persistent environmental pollutants in blood; significant Kendall τ correlation coefficients ranged from -0.18 (Dacthal and "use pesticides to treat home or yard") to 0.24 (trans-nonachlor and "store lawn care products in garage").
  
  
  
  In this study, persistent environmental pollutants measured in blood were significantly associated with ALS and may represent modifiable ALS disease risk factors.
authors.affiliation: Department of Environmental Health Sciences, University of Michigan, Ann Arbor.
authors.forename: Feng-Chiao
authors.initials: FC
authors.lastname: Su
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Goutman
authors.affiliation: Department of Environmental Health Sciences, University of Michigan, Ann Arbor.
authors.forename: Sergey
authors.initials: S
authors.lastname: Chernyak
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor.
authors.forename: Bhramar
authors.initials: B
authors.lastname: Mukherjee
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Callaghan
authors.affiliation: Department of Environmental Health Sciences, University of Michigan, Ann Arbor.
authors.forename: Stuart
authors.initials: S
authors.lastname: Batterman
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor4A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor.
authors.forename: Eva L
authors.initials: EL
authors.lastname: Feldman
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000097:blood* / Q000453:epidemiology*; D016022:Case-Control Studies; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D004785:Environmental Pollutants / Q000097:blood*; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016273:Occupational Exposure / Q000706:statistics & numerical data; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D004785:Environmental Pollutants