Abstract
Nasosinusal polyposis (NSP) is a chronic inflammatory disease of the nasal mucosa. Although the pathophysiology underlying NSP formation is not fully understood, environmental factors appear to be contributed the development of this disease. A case–control study of Tunisian patients was examined to assess the levels of cadmium (Cd) and nickel (Ni) in blood and reparse the association between the exposure to these metals and the risk of nasosinusal polyposis disease. Mean blood levels of Cd in patients (2.2 ± 12.8 μg/L) were significantly higher than those of controls (0.5 ± 0.7 μg/L). Levels of blood Cd were positively correlated with tobacco smoking and chewing among controls. The Cd and Ni concentrations among control (p = 0.001) and patient (p = 0.018) tobacco consumers (smoking, chewing, and shisha) were significantly higher than those nonconsumers. Additionally, Ni blood levels of patient and control smokers were significantly higher than those of nonsmokers. Cd levels in blood samples of NSP patients occupationally exposed for more than 14 years were eight times higher than that of nonexposed. Drinking water was also found to be incriminated as exposure sources. Among risk factors, shisha consumption, environmental exposure, and occupational exposure presented the most significant association with NSP disease (odds ratio (OR) = 14.1, 10.1, and 1.7, respectively). High levels of blood Cd (OR = 3.5) were strongly associated with NSP disease (p = 0.027). Ni blood levels were shown to be associated with the four stages of polyps in both nasal cavities (right and left) (p < 0.05). This investigation suggested a potential role of toxic metals in the mechanism of NSP disease development. Exposure assessment investigations encompassing a wider population are needed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Afridi HI, Kazi TG, Kazi NG, Jamali MK et al (2010) Evaluation of cadmium, lead, nickel and zinc status in biological samples of smokers and nonsmokers hypertensive patients. J Hum Hypertens 24(1):34–43
Alaya-Ltifi L, Chokri MA, Selmi S (2012) Breeding performance of passerines in a polluted oasis habitat in southern Tunisia. Ecotoxicol Environ Saf 79:170–175
Alexiou A, Sourtzi P, Dimakopoulou K, Manolis E, Velonakis E (2011) Nasal polyps: heredity, allergies, and environmental and occupational exposure. J Otolaryngol Head Neck Surg 40(1):58–63
Ashraf MW (2012) Levels of heavy metals in popular cigarette brands and exposure to these metals via smoking. Sci World J. 729430. doi:10.1100/2012/729430
Barbieri PG, Tomenzoli D, Morassi L, Festa R, Fernicola C (2005) Sino-nasal-inverted papillomas and occupational etiology. G Ital Med Lav Ergon 27(4):422–426
Belaid N, Neel C, Lenainc JF, Buzierc R, Kallel M, Ayoub T et al (2012) Assessment of metal accumulation in calcareous soil and forage crops subjected to long-term irrigation using treated wastewater: case of El Hajeb-Sfax, Tunisia. Agric Ecosyst Environ 158:83–93
Caciari T, Capozzella A, Tomei F, Nieto HA et al (2012) Arsenic and peripheral blood count in workers exposed to urban stressors. Clin Ter 163(5):293–302
Chaaban MR, Walsh EM, Woodworth BA (2013) Epidemiology and differential diagnosis of nasal polyps. Am J Rhinol Allergy 27:473–487
Choi YH, Kim K (2014) Noise-induced hearing loss in Korean workers: co-exposure to organic solvents and heavy metals in nationwide industries. PLoS ONE 9(5):e97538
Collins MM, Pang Y-T, Loughanz S, Wilson JA (2002) Environmental risk factors and gender in nasal polyposis. Clin Otolaryngol 27:314–317
d’Errico A, Pasian S, Baratti A, Zanelli R, Alfonzo S, Gilardi L, Beatrice F, Bena A, Costa G (2009) A case-control study on occupational risk factors for sino-nasal cancer. Occup Environ Med 66(7):448–455
Doll R, Morgan LG, Speizer FE (1970) Cancers of the lung and nasal sinuses in nickel workers. Br J Cancer 24:623–632
Eccles R (1995) Rhinitis as a mechanism of respiratory defence. Eur Arch Otorhinolaryngol (Suppl 1):S2–S7
Feki-Tounsi M, Olmedo P, Gil F, Khlifi R, Mhiri MN, Rebai A, Hamza-Chaffai A (2013a) Low-level arsenic exposure is associated with bladder cancer risk and cigarette smoking: a case–control study among men in Tunisia. Environ Sci Pollut Res Int 20:3923–3931
Feki-Tounsi M, Olmedo P, Gil F, Khlifi R, Mhiri MN, Rebai A, Hamza-Chaffai A (2013b) Cadmium in blood of Tunisian men and risk of bladder cancer: interactions with arsenic exposure and smoking. Environ Sci Pollut Res Int 20:7204–7213
Frączek M, Rostkowska-Nadolska B, Kapral M, Szota J, Kręcicki T, Mazurek U (2013) Microarray analysis of NF-κB-dependent genes in chronic rhinosinusitis with nasal polyps. Adv Clin Exp Med 22(2):209–217
Fundová P, Funda DP, Kovář D, Holý R, Navara M, Tlaskalová-Hogenová H (2013) Increased expression of chemokine receptors CCR1 and CCR3 in nasal polyps: molecular basis for recruitment of the granulocyte infiltrate. Folia Microbiol (Praha) 58(3):219–224
Garnit H, Bouhlel S, Barca D, Chtara C (2012) Application of LA-ICP-MS to sedimentary phosphatic particles from Tunisian phosphorite deposits: insights from trace elements and REE into paleo-depositional environments. Chem Erde 72:127–139
Gil F, Capitán-Vallvey LF, De Santiago E, Ballesta J, Pla A, Hernández AF, Gutiérrez-Bedmar M, Fernández-Crehuet J, Gómez J, López-Guarnido O, Rodrigo L, Villanueva E (2006) Heavy metal concentrations in the general population of Andalusia, South of Spain: a comparison with the population within the area of influence of Aznalcóllar mine spill SW Spain. Sci Total Environ 372:49–57
Gil F, Hernández AF, Márquez C, Femia P, Olmedo P, López-Guarnido O et al (2011) Biomonitorization of cadmium, chromium, manganese, nickel and lead in whole blood, urine, axillary hair and saliva in an occupationally exposed population. Sci Total Environ 409:1172–1180
Hodnett D, Wood DM, Raja K, Dargan PI, Shah AD (2012) A healthy volunteer study to investigate trace element contamination of blood samples by stainless steel venipuncture needles. Clin Toxicol (Philadelphia, Pa) 50(2):99–107
Homma H, Kamiya K, Kusunoki T, Ikeda K (2013) Multiplex analyses of cytokine and chemokine release from the cultured fibroblast of nasal polyps: the effect of IL-17A. Acta Otolaryngol 133(10):1065–1072
IARC (1990) International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Chromium, nickel and welding. Lyon, France: IARC, 49
Ivanenko NB, Solovyev ND, Ivanenko AA, Ganeev AA (2012) Application of Zeeman graphite furnace atomic absorption spectrometry with high-frequency modulation polarization for the direct determination of aluminum, beryllium, cadmium, chromium, mercury, manganese, nickel, lead, and thallium in human blood. Arch Environ Contam Toxicol 63(3):299–308
Khlifi R, Olmedo P, Gil F, Feki-Tounsi M, Chakroun A, Rebai A, Hamza- Chaffai A (2013) Blood nickel and chromium levels in association with smoking and occupational exposure among head and neck cancer patients in Tunisia. Environ Sci Pollut Res 20:8282–8294
Khlifi R, Olmedo P, Gil F, Feki-Tounsi M, Hammami B, Rebai A, Hamza-Chaffai A (2014a) Risk of laryngeal and nasopharyngeal cancer associated with arsenic and cadmium in the Tunisian population. Environ Sci Pollut Res Int 21:2032–2042
Khlifi R, Olmedo P, Gil F, Feki-Tounsi M, Hammami B, Rebai A, Hamza-Chaffai A (2014b) Biomonitoring of cadmium, chromium, nickel and arsenic in general population living near mining and active industrial areas in Southern Tunisia. Environ Monit Assess 186(2):761–779
Kule ZG1, Habesoglu TE, Somay A, Deveci HS, Kule M, Gursel AO (2014) Histopathological characteristics of nasal polyps in smokers and non-smokers. J Craniofac Surg 25(3):946–949
Luukkainen A, Karjalainen J, Hurme M, Paavonen T, Huhtala H, Toppila-Salmi S (2014) Relationships of indoleamine 2,3-dioxygenase activity and cofactors with asthma and nasal polyps. Am J Rhinol Allergy 28(1):e5–e10
Marsh GM, Youk AO, Buchanich JM, Erdal S, Esmen NA (2007) Work in the metal industry and nasopharyngeal cancer mortality among formaldehyde-exposed workers. Regul Toxicol Pharm 48:308–319
Meltzer EO, Hamilos DL, Hadley JA et al (2006) Rhinosinusitis: developing guidance for clinical trials. Otolaryngol Head Neck Surg 135(5 Suppl):S31–S80
Ojo JO, Oketayo OO, Adesanmi CA, Horvat M, Mazej D, Tratnik J (2014) Influence of nutritional status on some toxic and essential elements in the blood of women exposed to vehicular pollution in Ile-Ife, Nigeria. Environ Sci Pollut Res Int 21(2):1124–1132
Olmedo P, Pla A, Hernández AF, López-Guarnido O, Rodrigo L, Gil F (2010) Validation of a method to quantify chromium, cadmium, manganese, nickel and lead in human whole blood, urine, saliva and hair samples by electrothermal atomic absorption spectrometry. Anal Chim Acta 659:60–67
Paget-Bailly S, Guida F, Carton M, Menvielle G, Radoï L, Cyr D, Schmaus A et al (2013) Occupation and head and neck cancer risk in men: results from the ICARE study, a French population-based case–control study. J Occup Environ Med 55(9):1065–1073
Sciskalska M, Zalewska M, Grzelak A, Milnerowicz H (2014) The influence of the occupational exposure to heavy metals and tobacco smoke on the selected oxidative stress markers in smelters. Biol Trace Elem Res. (in press)
Shatkin JS, Delsupehe KG, Thisted RA, Corey JP (1994) Mucosal allergy in the absence of systemic allergy in nasal polyposis and rhinitis: a meta-analysis. Otolaryngol Head Neck Surg 111(5):553–556
Valera FC, Umezawa K, Brassesco MS, Castro-Gamero AM, Queiroz RG, Scrideli CA, Tone LG, Anselmo-Lima WT (2012) Suppression of inflammatory cytokine secretion by an NF-ĸB inhibitor DHMEQ in nasal polyps fibroblasts. Cell Physiol Biochem 30(1):13–22
Viana GF, Garcia KS, Menezes-Filho JA (2011) Assessment of carcinogenic heavy metal levels in Brazilian cigarettes. Environ Monit Assess 181(1–4):255–265. doi:10.1007/s10661-010-1827-3
Voegels RL, Santoro P, Butugan O et al (2001) Nasal polyposis and allergy: is there a correlation? Am J Rhinol 15(1):9–14
Wadhwa SK, Kazi TG, Afridi HI, Kazi N et al (2010) Evaluation of cadmium and zinc in biological samples of tobacco and alcohol user male mouth cancer patients. Hum Exp Toxicol 29(3):221–230
Wilson KF, McMains KC, Orlandi RR (2014) The association between allergy and chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations. Int Forum Allergy Rhinol. doi:10.1002/alr.21258
Wu AW, Ting JY, Platt MP, Tierney HT, Metson R (2013) Factors affecting time to revision sinus surgery for nasal polyps: a 25-year experience. Laryngoscope 124(1):29–33
Yang Y, Liu H, Xiang XH, Liu FY (2013) Outline of occupational chromium poisoning in China. Bull Environ Contam Toxicol 90(6):742–749
Yuan TH, Lian IB, Tsai KY, Chang TK, Chiang CT, Su CC, Hwang YH (2011) Possible association between nickel and chromium and oral cancer: a case–control study in central Taiwan. Science of the Total Environment 409:1046–1052
Acknowledgments
This study was supported by the Ministry of Higher Education, Scientific Research, and Technology. We thank all members of the Department of ORL, Habib Borguiba Hospital, Sfax, Tunisia, and especially Dr. Adel Chakroun and Dr Amine Chakroun for their efforts and assistance in recruiting patients.
Conflict of interest
The authors declare that they have no competing interests.
Author information
Authors and Affiliations
Corresponding author
Additional information
Responsible editor: Philippe Garrigues
Rights and permissions
About this article
Cite this article
Khlifi, R., Olmedo, P., Gil, F. et al. Cadmium and nickel in blood of Tunisian population and risk of nasosinusal polyposis disease. Environ Sci Pollut Res 22, 3586–3593 (2015). https://doi.org/10.1007/s11356-014-3619-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11356-014-3619-8