CARD Clinic study: asbestos exposure linked to autoimmune diseases

During the last 15 years, substantial evidence has shown a strong link between Libby amphibole asbestos and higher risks of autoimmune diseases and disorders, the Center for Asbestos Related Disease announced on Aug. 15.

The CARD clinic completed the six-year-long Libby Epidemiology Research Program study on the effects of asbestos on the immune system in the fall of 2015 and recently released preliminary data from that study.

As part of the three-fold project, research scientists from Idaho State University, Icahn School of Medicine at Mount Sinai and University of Montana, along with the CARD clinic, studied the effects of asbestos on the immune system, lung development and lung-scarring, and whether or not these health complications overlap.

According to Dusti Thompson, the CARD clinic outreach specialist, based on the preliminary results of the studied 950 self-reported autoimmune diagnoses, there may be as much as a 10-fold increase in risk for lupus, scleroderma, and rheumatoid arthritis in people exposed to amphibole asbestos.

“The immune system is supposed to attack foreign things like germs but sometimes it makes a mistake and starts attacking the body’s tissue,” Dr. Jean Pfau, the lead researcher on the autoimmune project, said. Pfau is a research scientist at the Idaho State University Department of Microbiology and Immunology who has been studying the effects of inhaled dusts on the immune system for 15 years. According to Pfau, Libby amphibole asbestos exposure has a stronger link to autoimmune disorders than other types of asbestos exposure.

Pfau said that autoimmune diseases and disorders can be really frustrating for patients and doctors because they are especially difficult to diagnose, and are often misdiagnosed as other diseases.

“You have a community where people are obviously getting sick,” Pfau said. “You have a huge amount of stress. You have a lot of people that are suffering and they don’t know why. They are really just struggling.”

There’s a long list of autoimmune diseases, but the most common caused by amphibole asbestos are lupus, scleroderma, and rheumatoid arthritis among much more, rarer autoimmune disorders, which are not classified as of yet. These diseases do tend to run in families, as a gene-environment interaction. Pfau noted that while susceptibility would probably continue through genes, she suspects that since the asbestos exposure isn’t there, it might not happen.

Unlike other autoimmune diseases like type I diabetes or thyroid diseases, Pfau said the autoimmune diseases caused by amphibole asbestos don’t attack specific parts of the body. The earliest symptoms of autoimmune diseases are severe fatigue, inflammatory symptoms and sore joints.

To find out if a patient has an autoimmune disease or disorder, a rheumatologist would take an Antinuclear Antibody test. Pfau noted that the patient is diagnosed if they need to test positive in the Antinuclear Antibody test, on top of having a set of symptoms.

According to Thompson, during the research, they found that residents of the Libby area exposed to amphibole asbestos are significantly more likely to have a positive Antinuclear Autoantibody test, a blood test used to evaluate a person for autoimmune disorders.

A positive test result means an increased risk of systemic autoimmune diseases such as lupus, scleroderma and rheumatoid arthritis. Thompson noted that it’s important to remember that these autoimmune diseases remain very rare, even in Libby. The preliminary data presented also does not indicate that everyone exposed to the amphibole asbestos will get one of these diseases.

This all began when the Agency for Toxic Substances and Disease Registry awarded a $5 million grant to the Icahn School of Medicine at Mount Sinai in 2009, in partnership with researchers at ISU and MSU, to create the Libby Epidemiology Research Program, which had the mission of furthering research in long-term health effects of amphibole asbestos in Libby and the surrounding community. Pfau said the researchers began by gathering subjects to collect samples and data from patients diagnosed with autoimmune diseases, abiding by research rules and regulations. After the data was collected, the researchers performed data analysis.

Also in their testing, researchers found that autoantibodies caused by amphibole asbestos may increase the risk of worsening the scarring in the lining of the lung. According to Pfau, the overall mission was to build a database and see how these health conditions overlap.

“[The data] becomes a great resource for the future,” Pfau said. “We have shown we think that the autoimmune component is making the pleural lung disease worse. We now kind of know some of the pathway components and what’s happening in the body. That means we (can) begin to have ways to explore therapy.”

Pfau also said that the research from Libby will bring about change that will help a lot of people in areas throughout the U.S. that experience similar issues with certain dust.

“We just look forward to being able to further our research and go down other trails in addition to what we’ve already done,” Thompson said.

Since the early 2000s, the CARD Clinic, in partnership with numerous organizations and universities, have been studying the health complications of amphibole asbestos. The current preliminary results add to the Agency for Toxic Substances & Disease Registry’s data presented in a 2000-2001 extensive screening program in Libby. In that study, more than 7,000 residents were questioned and 6.7 percent of the population reported having lupus, rheumatoid arthritis or systemic sclerosis, which is proportionally higher than the less-than one percent of the U.S. population who have ever suffered from these conditions, they noted. In addition, they also found that 18 percent of 6,668 had abnormalities in the lining of their lungs, with the average rate of the U.S. being 0.2 to 0.3 percent.

A 2014 journal article publication, written by Pfau and Kinta M. Serve of the Center for Environmental Health Sciences at the University of Montana also added to the body of work associating autoimmune disorders with amphibole asbestos. According to the 2014 publication, the difficulty of linking asbestos to specific autoimmune disorders comes from a lack of statistics, exposure misclassifications, mixed exposures to different fibers and the time interval between exposure and appearance of clinical disease. On top of those reasons, some people with these diseases do not present definite or readily observable symptoms. For these reasons, some of the data found cannot be proven as completely accurate.

While preliminary results are not conclusive, there is certainly substantial evidence gathered through the past 16 years that contributes to the association between autoimmune disorders and asbestos exposure.

Thompson and Pfau hope that the autoimmune study final results will be ready by the end of this year. The pleural lining lung study is currently on hold until further notice and data from the study on lung development of children exposed to asbestos will be released by the end of the month.

Reporter Bethany Rolfson may be reached at 293-4124 or by email at Reporter@TheWesternNews.com.