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Utility of urinary Clara cell protein (CC16) to demonstrate increased lung epithelial permeability in non-smokers exposed to outdoor secondhand smoke

Abstract

The objective of this study was to assess the utility of urinary Clara cell protein (CC16) as a biomarker of increased lung epithelial permeability in non-smokers exposed to outdoor secondhand smoke. Twenty-eight healthy non-smoking adults visited outdoor patios of a restaurant and a bar where non-participants smoked and an open-air control with no smokers on three weekend days in a crossover study; subjects visited each site once for 3 h. Urine samples were collected at baseline, immediately post exposure and next morning, and analyzed for CC16. Changes in CC16 across location types or with cigarette count were analyzed using mixed-effect models, which included all subjects and stratified by gender. Urinary CC16 was higher in males (n=9) compared with females (n=18) at all measurement occasions (P<0.002), possibly reflecting prostatic contamination. Urinary CC16 from pre-exposure to post-exposure was higher following visits to restaurant and bar sites compared with the control among females but this increase did not reach statistical significance. Post-exposure to pre-exposure urinary CC16 ratios among females increased with cigarette count (P=0.048). Exposure-related increases in urinary CC16 were not seen among males. In conclusion, urinary CC16 may be a useful biomarker of increased lung epithelial permeability among female non-smokers; further work will be required to evaluate its applicability to males.

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Acknowledgements

We thank the 28 study participants as well as Anderson Morris who served as a technician and driver. Thanks also to Pam Olive, Cindy Phan and Veronica Dave for help with analysis of CC16 and urinary creatinine. We further acknowledge Connie Sosnoff and Yang Xia for salivary cotinine and urinary NNAL analyses. This study was funded by the National Institutes of Environmental Health Science, project number 1R21ES017845-01A1. Dr. John Balmes is funded in part by the Flight Attendant Medical Research Institute (FAMRI). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Correspondence to Luke P Naeher.

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JRB was funded in part through a grant from the Flight Attendant Medical Research Institute (FAMRI) that awards competitive grants through requests for proposals, which can be initiated by the board of trustees of FAMRI. Once funded, FAMRI has no role in the design, conduct, interpretation, or publication of the research. The organization does not gain or lose financially through publication of any article. The other authors declare no conflict of interest.

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St Helen, G., Holland, N., Balmes, J. et al. Utility of urinary Clara cell protein (CC16) to demonstrate increased lung epithelial permeability in non-smokers exposed to outdoor secondhand smoke. J Expo Sci Environ Epidemiol 23, 183–189 (2013). https://doi.org/10.1038/jes.2012.68

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