Cover Image

Fine Particulate Matter (PM2.5) and Health Effects: An Unbridle Problem in Iran

Maryam Baghbeheshti, Mohammad Zolfaghari, Regina Rückerl

Particulate matter (PM) is a complex mixture of solid and liquid particles from various sources. Fine PM or PM2.5 is defined as a mass with a size of less than 2.5 μm in aerodynamic diameter and has a large contribution to the world increasing annually. Iran is a developing country set in the Middle East that is not secured from this pollutant mainly due to its industries, desert dust and the travel of dust from the neighboring countries. Poor air quality caused by PM2.5 can induce multiorgan dysfunction including cardiovascular disease, respiratory impairment, and other adverse effects that lead to morbidity and even death. Since PM2.5 is a risk factor for health problems, the comprehension of the detailed molecular mechanisms of PM2.5 including oxidative stress and inflammation would be beneficial. The aim of this review is gathering information from epidemiological studies about the health effects of this pollutant in Iran for the sake of a healthy environment and proposing solutions which can be applied to every country that is concerned about the air quality. [GMJ.2017;6(2):81-94]

Particulate Matters; Air Pollution; Health Effects

Wegesser TC, Pinkerton KE, Last JA. California wildfires of 2008: coarse and fine particulate matter toxicity. Environ Health Perspect. 2009;117(6):893-7

Kim KH, Kabir E, Kabir S. A review on the human health impact of airborne particulate matter. Environ Int. 2015;74:136-43.

Giannadaki D, Lelieveld J, Pozzer A. Implementing the US air quality standard for PM 2.5 worldwide can prevent millions of premature deaths per year. Environ Health. 2016;15(1):88.

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2224-60.

Rückerl R, Schneider A, Breitner S, Cyrys J, Peters A. Health effects of particulate air pollution: a review of epidemiological evidence. Inhal Toxicol. 2011;23(10):555-92.

Maté T, Guaita R, Pichiule M, Linares C, Díaz J. Short-term effect of fine particulate matter (PM 2.5) on daily mortality due to diseases of the circulatory system in Madrid (Spain). Sci Total Environ. 2010; 408(23):5750-7.

World Health Organization. Health effects of particulate matter. Policy implications for countries in Eastern Europe. Caucasus and central Asia. World Health Organization Regional Office for Europe, Copenhagen. 2013. (Accessed 2013, at http://www.euro.who.int/en/health-topics/environment-and-health/air-quality/publications/2013/health-effects-of-particulate-matter.-policy-implications-for-countries-in-eastern-europe,-caucasus-and-central-asia-2013)

Shi L, Zanobetti A, Kloog I, Coull BA, Koutrakis P, Melly SJ, et al. Low-concentration PM 2.5 and mortality: estimating acute and chronic effects in a population-based study. Environ Health Perspect. 2016; 124(1):46-52.

Pinault L, Tjepkema M, Crouse DL, Weichenthal S, van Donkelaar A, Martin RV, et al. Risk estimates of mortality attributed to low concentrations of ambient fine particulate matter in the Canadian community health survey cohort. Environ Health. 2016 ;15:18.

Givehchi R, Arhami M, Tajrishy M. Contribution of the Middle Eastern dust source areas to PM 10 levels in urban receptors: case study of Tehran, Iran. Atmos Environ. 2013;75:287-95.

United States Census Bureau. World population. 2009 (Accessed Aug 16, 2013, at http://www. census.gov/population/international/data/worldpop/table_ population.php.)

Hamedian AA, Javid A, Zarandi SM, Rashidi Y, Majlesi M. Air Quality Analysis by Using Fuzzy Inference System and Fuzzy C-mean Clustering in Tehran, Iran from 2009–2013. Iran J Public Health. 2016; 45(7):917-25.

Arfaeinia H, Kermani M, Aghaei M, Asl FB, Karimzadeh S. Comparative investigation of health quality of air in Tehran, Isfahan and Shiraz metropolises in 2011-2012. Journal of Health in the Field. 2017;1(4): 37-44.

Sanobari F, Banisaeid S. Determination of atmospheric particulate matter and heavy metals in air of Tabriz City, Iran. Asian J Chem. 2007;19(6):4143-50.

Gholampour A, Nabizadeh R, Naseri S, Yunesian M, Taghipour H, Rastkari N, et al. Exposure and health impacts of outdoor particulate matter in two urban and industrialized area of Tabriz, Iran. J Environ Health Sci Eng. 2014;12(1):27.

Esposito K, Petrizzo M, Maiorino MI, Bellastella G, Giugliano D. Particulate matter pollutants and risk of type 2 diabetes: a time for concern? Endocrine. 2016;51(1):32-7.

Bravo MA, Ebisu K, Dominici F, Wang Y, Peng RD, Bell ML. Airborne fine particles and risk of hospital admissions for understudied populations: effects by urbanicity and short-term cumulative exposures in 708 US counties. Environ Health Perspect. 2017; 125(4): 594–601.

Atkinson RW, Kang S, Anderson HR, Mills IC, Walton HA. Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis. Thorax. 2014;69(7):660-5.

Ostro B, Lipsett M, Reynolds P, Goldberg D, Hertz A, Garcia C, et al. Long-term exposure to constituents of fine particulate air pollution and mortality: results from the California Teachers Study. Environmental Health Perspectives. Environ Health Perspect. 2010;118(3):363-9.

Lepeule J, Laden F, Dockery D, Schwartz J. Chronic exposure to fine particles and mortality: an extended follow-up of the Harvard Six Cities study from 1974 to 2009. Environ Health Perspect. 2012;120(7):965-70.

Cesaroni G, Badaloni C, Gariazzo C, Stafoggia M, Sozzi R, Davoli M, et al. Long-term exposure to urban air pollution and mortality in a cohort of more than a million adults in Rome. Environ Health Perspect. 2013;121(3):324-31.

Garcia CA, Yap PS, Park HY, Weller BL. Association of long-term PM2.5 exposure with mortality using different air pollution exposure models: impacts in rural and urban California. Int J Environ Health Res. 2016;26(2):145-57.

Miri M, Derakhshan Z, Allahabadi A, Ahmadi E, Conti GO, Ferrante M, et al. Mortality and morbidity due to exposure to outdoor air pollution in Mashhad metropolis, Iran. The AirQ model approach. Environ Res. 2016;151:451-57.

Masoumi A, Khalesifard HR, Bayat A, Moradhaseli R. Retrieval of aerosol optical and physical properties from ground-based measurements for Zanjan, a city in Northwest Iran. Atmos Res. 2013;120:343-55.

Alessandrini ER, Stafoggia M, Faustini A, Gobbi GP, Forastiere F. Saharan dust and the association between particulate matter and daily hospitalisations in Rome, Italy. Occup Environ Med. 2013;70(6):432-4.

Mallone S, Stafoggia M, Faustini A, Gobbi GP, Marconi A, Forastiere F. Saharan dust and associations between particulate matter and daily mortality in Rome, Italy. Environ Health Perspect. 2011;119(10):1409-14.

Stafoggia M, Zauli-Sajani S, Pey J, Samoli E, Alessandrini E, Basagaña X, et al. Desert dust outbreaks in Southern Europe: contribution to daily PM10 concentrations and short-term associations with mortality and hospital admissions. Environ Health Perspect. 2016;124(4):413-9.

Hojati S, Khademi H, Cano AF, Landi A. Characteristics of dust deposited along a transect between central Iran and the Zagros Mountains. Catena. 2012;88(1):27-36.

Mohammadyan M, Shabankhani B. Indoor PM 1, PM 2.5, PM 10 and outdoor PM 2.5 concentrations in primary schools in Sari, Iran. Arh Hig Rada Toksikol. 2013;64(3):371-7.

Gholampour A, Nabizadeh R, Yunesian M, Naseri S, Taghipour H, Rastkari N, et al. Physicochemical characterization of ambient air particulate matter in Tabriz, Iran. Bull Environ Contam Toxicol. 2014;92(6):738-44.

de Paula Ribeiro J, Kalb AC, Campos PP, De La Cruz AR, Martinez PE, Gioda A, et al. Toxicological effects of particulate matter (PM 2.5) on rats: Bioaccumulation, antioxidant alterations, lipid damage, and ABC transporter activity. Chemosphere. 2016;163:569-77.

Shahsavani A, Naddafi K, Haghighifard NJ, Mesdaghinia A, Yunesian M, Nabizadeh R, et al. The evaluation of PM 10, PM 2.5, and PM 1 concentrations during the Middle Eastern Dust (MED) events in Ahvaz, Iran, from April through September 2010. J Arid Environ. 2012;77:72-83.

Gholampour A, Nabizadeh R, Hassanvand MS, Taghipour H, Nazmara S, Mahvi AH. Characterization of saline dust emission resulted from Urmia Lake drying. J Environ Health Sci Eng. 2015;13:82.

Rashki A, Eriksson PG, Rautenbach CD, Kaskaoutis DG, Grote W, Dykstra J. Assessment of chemical and mineralogical characteristics of airborne dust in the Sistan region, Iran. Chemosphere. 2013;90(2):227-36.

Zarasvandi A, Carranza EJ, Moore F, Rastmanesh F. Spatio-temporal occurrences and mineralogical–geochemical characteristics of airborne dusts in Khuzestan Province (southwestern Iran). J GEOCHEM EXPLOR. 2011;111(3):138-51.

Saniei R, Zangiabadi A, Sharifikia M, Ghavidel Y. Air quality classification and its temporal trend in Tehran, Iran, 2002-2012. Geospat Health. 2016 ;11(2):442.

Deng X, Rui W, Zhang F, Ding W. PM2.5 induces Nrf2-mediated defense mechanisms against oxidative stress by activating PIK3/AKT signaling pathway in human lung alveolar epithelial A549 cells. Cell Biol Toxicol. 2013;29(3):143-57.

Donaldson K, Stone V, Borm PJ, Jimenez LA, Gilmour PS, Schins RP, et al. Oxidative stress and calcium signaling in the adverse effects of environmental particles (PM 10). Free Radic Biol Med. 2003;34(11):1369-82.

Huang Q, Zhang J, Peng S, Tian M, Chen J, Shen H. Effects of water soluble PM 2.5 extracts exposure on human lung epithelial cells (A549): a proteomic study. J Appl Toxicol. 2014;34(6):675-87.

Maciejczyk P, Zhong M, Lippmann M, Chen LC. Oxidant generation capacity of source-apportioned PM2.5. Inhal Toxicol. 2010;22 Suppl 2:29-36.

Méndez-Armenta M, Nava-Ruiz C, Fernández-Valverde F, Sánchez-García A, Rios C. Histochemical changes in muscle of rats exposed subchronically to low doses of heavy metals. Environ Toxicol Pharmacol. 2011;32(1):107-12.

Chen HM, Lee YH, Wang YJ. ROS-triggered signaling pathways involved in the cytotoxicity and tumor promotion effects of pentachlorophenol and tetrachlorohydroquinone. Chem Res Toxicol. 2015;28(3):339-50.

Ghio AJ, Carraway MS, Madden MC. Composition of air pollution particles and oxidative stress in cells, tissues, and living systems. J Toxicol Environ Health B Crit Rev. 2012;15(1):1-21.

Xu X, Wang H, Liu S, Xing C, Liu Y, Aodengqimuge, et al. TP53-dependent autophagy links the ATR-CHEK1 axis activation to proinflammatory VEGFA production in human bronchial epithelial cells exposed to fine particulate matter (PM2.5). Autophagy. 2016;12(10):1832-1848.

Mitkus RJ, Powell JL, Zeisler R, Squibb KS. Comparative physicochemical and biological characterization of NIST interim reference material PM 2.5 and SRM 1648 in human A549 and mouse RAW264. 7 cells. Toxicol In Vitro. 2013;27(8):2289-98.

Dieme D, Cabral-Ndior M, Garçon G, Verdin A, Billet S, Cazier F, et al. Relationship between physicochemical characterization and toxicity of fine particulate matter (PM 2.5) collected in Dakar city (Senegal). Environ Res. 2012;113:1-13.

Martinelli N, Olivieri O, Girelli D. Air particulate matter and cardiovascular disease: a narrative review. Eur J Intern Med. 2013;24(4):295-302.

Westberg H, Elihn K, Andersson E, Persson B, Andersson L, Bryngelsson L, et al. Inflammatory markers and exposure to airborne particles among workers in a Swedish pulp and paper mill. Int Arch Occup Environ Health. 2016;89(5):813-22.

Wang Y, Lin Z, Huang H, He H, Yang L, Chen T, et al. AMPK is required for PM2.5-induced autophagy in human lung epithelial A549 cells. Int J Clin Exp Med. 2015;8(1):58-72.

Yan Z, Wang J, Li J, Jiang N, Zhang R, Yang W, et al. Oxidative stress and endocytosis are involved in upregulation of interleukin‐8 expression in airway cells exposed to PM2.5. Environ Toxicol. 2015;31(12):1869-78.

Haberzettl P, McCracken JP, Bhatnagar A, Conklin DJ. Insulin sensitizers prevent fine particulate matter-induced vascular insulin resistance and changes in endothelial progenitor cell homeostasis. Am J Physiol Heart Circ Physiol. 2016;310(11):H1423-38.

Jin XT, Chen ML, Li RJ, An Q, Song L, Zhao Y, et al. Progression and inflammation of human myeloid leukemia induced by ambient PM2.5. Arch Toxicol. 2016;90(8):1929-38.

Rui W, Guan L, Zhang F, Zhang W, Ding W. PM2.5-induced oxidative stress increases adhesion molecules expression in human endothelial cells through the ERK/AKT/NF-κB-dependent pathway. J Appl Toxicol. 2016;36(1):48-59.

Cao J, Qin G, Shi R, Bai F, Yang G, Zhang M, et al. Overproduction of reactive oxygen species and activation of MAPKs are involved in apoptosis induced by PM2.5 in rat cardiac H9c2 cells. J Appl Toxicol. 2016;36(4):609-17.

Jin Y, Wu Z, Wang N, Duan S, Wu Y, Wang J, et al. Association of EGF Receptor and NLRs signaling with Cardiac Inflammation and Fibrosis in Mice Exposed to Fine Particulate Matter. J Biochem Mol Toxicol. 2016;30(9):429-37.

Xie Y, Gong C, Bo L, Jiang S, Kan H, Song W, et al. Treg responses are associated with PM2.5-induced exacerbation of viral myocarditis. Inhal Toxicol. 2015;27(6):281-6.

Líbalová H, Krčková S, Uhlířová K, Kléma J, Ciganek M, Rössner P, et al. Analysis of gene expression changes in A549 cells induced by organic compounds from respirable air particles. Mutat Res. 2014;770:94-105.

Franchini M, Mannucci PM. Air pollution and cardiovascular disease. Thromb Res. 2012;129(3):230-4.

Lai CY, Lai CH, Chuang HC, Pan CH, Yen CC, Lin WY, et al. Physicochemistry and cardiovascular toxicity of metal fume PM2.5: a study of human coronary artery endothelial cells and welding workers. Sci Rep. 2016 ;6:33515.

Hampel R, Breitner S, Schneider A, Zareba W, Kraus U, Cyrys J, et al. Acute air pollution effects on heart rate variability are modified by SNPs involved in cardiac rhythm in individuals with diabetes or impaired glucose tolerance. Environ Res. 2012;112:177-85.

Schneider A, Hampel R, Ibald-Mulli A, Zareba W, Schmidt G, Schneider R, et al. Changes in deceleration capacity of heart rate and heart rate variability induced by ambient air pollution in individuals with coronary artery disease. Part Fibre Toxicol. 2010 ;7:29.

O'Neal WT, Soliman EZ, Efird JT, Judd SE, Howard VJ, Howard G, et al. Fine particulate air pollution and premature atrial contractions: The Reasons for Geographic and Racial Differences in Stroke study. J Expo Sci Environ Epidemiol. 2017;27(3):271-275.

Xie Y, Bo L, Jiang S, Tian Z, Kan H, Li Y, et al. Individual PM2.5 exposure is associated with the impairment of cardiac autonomic modulation in general residents. Environ Sci Pollut Res Int. 2016 ;23(10):10255-61.

Schwartz J, Park SK, O'neill MS, Vokonas PS, Sparrow D, Weiss S, et al. Glutathione-S-transferase M1, obesity, statins, and autonomic effects of particles: gene-by-drug-by-environment interaction. Am J Respir Crit Care Med. 2005;172(12):1529-33.

Weichenthal SA, Pollitt KG, Villeneuve PJ. PM 2.5, oxidant defence and cardiorespiratory health: a review. Environ Health. 2013;12(1):40.

Reardon M, Malik M. Changes in heart rate variability with age. Pace. 1996 ;19(11):1863-6.

Carney RM, Freedland KE. Depression and heart rate variability in patients with coronary heart disease. Cleve Clin J Med. 2009; 76(Suppl 2): S13–S17.

Haikerwal A, Akram M, Del Monaco A, Smith K, Sim MR, Meyer M, et al. Impact of fine particulate matter (PM2.5) exposure during wildfires on cardiovascular health outcomes. J Am Heart Assoc. 2015 ;4(7):e001653.

Marchini T, Wolf D, Michel NA, Mauler M, Dufner B, Hoppe N, et al. Acute exposure to air pollution particulate matter aggravates experimental myocardial infarction in mice by potentiating cytokine secretion from lung macrophages. Basic Res Cardiol. 2016;111(4):44.

Pei Y, Jiang R, Zou Y, Wang Y, Zhang S, Wang G, et al. Effects of fine particulate matter (PM2.5) on systemic oxidative stress and cardiac function in ApoE−/− mice. Int J Environ Res Public Health. 2016 ;13(5):484.

Ostro B, Malig B, Broadwin R, Basu R, Gold EB, Bromberger JT, et al. Chronic PM2.5 exposure and inflammation: determining sensitive subgroups in mid-life women. Environ Res. 2014 ;132:168-75.

Dabass A, Talbott EO, Venkat A, Rager J, Marsh GM, Sharma RK, et al. Association of exposure to particulate matter (PM 2.5) air pollution and biomarkers of cardiovascular disease risk in adult NHANES participants (2001–2008). Int J Hyg Environ Health. 2016;219(3):301-10.

Bonzini M, Tripodi A, Artoni A, Tarantini L, Marinelli B, Bertazzi PA, et al. Effects of inhalable particulate matter on blood coagulation. J Thromb Haemost. 2010;8(4):662-8.

Mutlu GM, Green D, Bellmeyer A, Baker CM, Burgess Z, Rajamannan N, et al. Ambient particulate matter accelerates coagulation via an IL-6–dependent pathway. J Clin Invest. 2007;117(10):2952-61.

Laurent PA, Séverin S, Hechler B, Vanhaesebroeck B, Payrastre B, Gratacap MP. Platelet PI3Kβ and GSK3 regulate thrombus stability at a high shear rate. Blood. 2015;125(5):881-8.

Niu J, Liberda EN, Qu S, Guo X, Li X, Zhang J, et al. The role of metal components in the cardiovascular effects of PM 2.5. PloS one. 2013;8(12):e83782.

Giorgini P, Di Giosia P, Grassi D, Rubenfire M, D Brook R, Ferri C. Air pollution exposure and blood pressure: an updated review of the literature. Curr Pharm Des. 2016;22(1):28-51.

Meng X, Zhang Y, Yang KQ, Yang YK, Zhou XL. Potential Harmful Effects of PM2.5 on Occurrence and Progression of Acute Coronary Syndrome: Epidemiology, Mechanisms, and Prevention Measures. Int J Environ Res Public Health. 2016;13(8):748.

Ying Z, Xu X, Chen M, Liu D, Zhong M, Chen LC, et al. A synergistic vascular effect of airborne particulate matter and nickel in a mouse model. Toxicol Sci. 2013;135(1):72-80.

Davoodi G, Sharif AY, Kazemisaeid A, Sadeghian S, Farahani AV, Sheikhvatan M, et al. Comparison of heart rate variability and cardiac arrhythmias in polluted and clean air episodes in healthy individuals. Environ Health Prev Med. 2010;15(4):217-21.

Naddafi K, Hassanvand MS, Yunesian M, Momeniha F, Nabizadeh R, Faridi S, et al. Health impact assessment of air pollution in megacity of Tehran, Iran. Iranian J Environ Health Sci Eng. 2012;9(1):28.

Nasser Z, Salameh P, Nasser W, Abou Abbas L, Elias E, Leveque A. Outdoor particulate matter (PM) and associated cardiovascular diseases in the Middle East. Int J Occup Med Environ Health. 2015;28(4):641-61.

Ediagbonya TF, Tobin AE. Air pollution and respiratory morbidity in an urban area of Nigeria. Greener J Environ Manag Pub Saf. 2013;2(1):9-15.

Poursafa P, Kelishadi R. Air pollution, platelet activation and atherosclerosis. Inflamm Allergy Drug Targets. 2010;9(5):387-92.

Pope CA, Dockery DW. Health effects of fine particulate air pollution: lines that connect. Journal of the air & waste management association. J Air Waste Manag Assoc 2006;56(6):709-42.

Lv H, Yue J, Chen Z, Chai S, Cao X, Zhan J, et al. Effect of transient receptor potential vanilloid-1 on cough hypersensitivity induced by particulate matter 2.5. Life Sci. 2016;151:157-66.

Ogino K, Nagaoka K, Okuda T, Oka A, Kubo M, Eguchi E, et al. PM2.5-induced airway inflammation and hyperresponsiveness in NC/Nga mice. Environ Toxicol. 2017;32(3):1047-54.

Jhun I, Gaffin JM, Coull BA, Huffaker MF, Petty CR, Sheehan WJ, et al. School Environmental Intervention to Reduce Particulate Pollutant Exposures for Children with Asthma. J Allergy Clin Immunol Pract. 2017;5(1):154-159.e3.

Fu J, Jiang D, Lin G, Liu K, Wang Q. An ecological analysis of PM2. 5 concentrations and lung cancer mortality rates in China. BMJ Open. 2015;5(11):e009452.

Ferecatu I, Borot MC, Bossard C, Leroux M, Boggetto N, Marano F, et al. Polycyclic aromatic hydrocarbon components contribute to the mitochondria-antiapoptotic effect of fine particulate matter on human bronchial epithelial cells via the aryl hydrocarbon receptor. Part Fibre Toxicol. 2010;7:18.

Hassanvand MS, Naddafi K, Faridi S, Nabizadeh R, Sowlat MH, Momeniha F, et al. Characterization of PAHs and metals in indoor/outdoor PM 10/PM 2.5/PM 1 in a retirement home and a school dormitory. Sci Total Environ. 2015;527-528:100-10.

Ni L, Chuang CC, Zuo L. Fine particulate matter in acute exacerbation of COPD. Front Physiol. 2015;6:294.

Li R, Kou X, Xie L, Cheng F, Geng H. Effects of ambient PM2. 5 on pathological injury, inflammation, oxidative stress, metabolic enzyme activity, and expression of c-fos and c-jun in lungs of rats. Environmental Science and Pollution Research. Environ Sci Pollut Res Int. 2015;22(24):20167-76.

Ren J, Li B, Yu D, Liu J, Ma Z. Approaches to prevent the patients with chronic airway diseases from exacerbation in the haze weather. J Thorac Dis. 2016;8(1):E1-7

Olujimi OO, Ana GR, Ogunseye OO, Fabunmi VT. Air quality index from charcoal production sites, carboxyheamoglobin and lung function among occupationally exposed charcoal workers in South Western Nigeria. Springerplus. 2016;5(1):1546.

Shahi AM, Omraninava A, Goli M, Soheilarezoomand HR, Mirzaei N. The effects of air pollution on cardiovascular and respiratory causes of emergency admission. Emerg (Tehran). 2014;2(3):107-14.

Hawkes CH, Del Tredici K, Braak H. Parkinson's disease: the dual hit theory revisited. Ann N Y Acad Sci. 2009;1170:615-22.

Andican G, Konukoglu D, Bozluolcay M, Bayülkem K, Firtiına S, Burcak G. Plasma oxidative and inflammatory markers in patients with idiopathic Parkinson’s disease. Acta Neurol Belg. 2012;112(2):155-9.

Palacios N, Fitzgerald KC, Hart JE, Weisskopf MG, Schwarzschild MA, Ascherio A, et al. Particulate matter and risk of Parkinson disease in a large prospective study of women. Environ Health. 2014;13:80.

Calderón-Garcidueñas L, Leray E, Heydarpour P, Torres-Jardón R, Reis J. Air pollution, a rising environmental risk factor for cognition, neuroinflammation and neurodegeneration: The clinical impact on children and beyond. Rev Neurol (Paris). 2016;172(1):69-80.

Liu R, Young MT, Chen JC, Kaufman JD, Chen H. Ambient air pollution exposures and risk of Parkinson disease. Environ Health Perspect 2016;124(11):1759-1765.

Block ML, Elder A, Auten RL, Bilbo SD, Chen H, Chen JC, et al. The outdoor air pollution and brain health workshop. Neurotoxicology. 2012;33(5):972-84.

Calderón-Garcidueñas L, Franco-Lira M, D'angiulli A, Rodríguez-Díaz J, Blaurock-Busch E, Busch Y, et al. Mexico City normal weight children exposed to high concentrations of ambient PM 2.5 show high blood leptin and endothelin-1, vitamin D deficiency, and food reward hormone dysregulation versus low pollution controls. Relevance for obesity and Alzheimer disease. Environ Res. 2015;140:579-92.

Bhatt DP, Puig KL, Gorr MW, Wold LE, Combs CK. A pilot study to assess effects of long-term inhalation of airborne particulate matter on early Alzheimer-like changes in the mouse brain. PLoS One. 2015;10(5):e0127102

Foroughan M, Farahani ZG, Shariatpanahi M, Vaezinejad M, Kamerani A, Ali A, et al. Risk factors of Alzheimer's disease among Iranian population. Curr Alzheimer Res. 2008;5(1):70-2.

Alimohammadi H, Fakhri S, Derakhshanfar H, Hosseini-Zijoud SM, Safari S, Hatamabadi HR. The effects of air pollution on ischemic stroke admission rate. Chonnam Med J. 2016;52(1):53-8.

Haghdoost AA, Rezazadeh-Kermani M, Sadghirad B, Baradaran HR. Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis. East Mediterr Health J. 2009;15(3):591-9.

Liu C, Bai Y, Xu X, Sun L, Wang A, Wang TY, et al. Exaggerated effects of particulate matter air pollution in genetic type II diabetes mellitus. Part Fibre Toxicol. 2014;11:27.

Yan C, Cao XN, Shen LJ, Liu DY, Peng JP, Chen JJ, et al. Long-term exposure to PM2. 5 from automobile exhaust results in reproductive dysfunction in male rats. Zhonghua Nan Ke Xue. 2016;22(2):104-9.

Cavallini A, Lippolis C, Vacca M, Nardelli C, Castegna A, Arnesano F, et al. The Effects of Chronic Lifelong Activation of the AHR Pathway by Industrial Chemical Pollutants on Female Human Reproduction. PLoS One. 2016;11(3):e0152181.

Feng S, Gao D, Liao F, Zhou F, Wang X. The health effects of ambient PM 2.5 and potential mechanisms. Ecotoxicol Environ Saf. 2016;128:67-74.

Kumar N. The Exposure Uncertainty Analysis: The Association between Birth Weight and Trimester Specific Exposure to Particulate Matter (PM2. 5 vs. PM10). Int J Environ Res Public Health. 2016;13(9).

Gandhi R, Kumar D, Burns EJ, Nadeau M, Dake B, Laroni A, et al. Activation of the aryl hydrocarbon receptor induces human type 1 regulatory T cell–like and Foxp3+ regulatory T cells. Nat Immunol. 2010;11(9):846-53.

Sancini G, Farina F, Battaglia C, Cifola I, Mangano E, Mantecca P, et al. Health risk assessment for air pollutants: alterations in lung and cardiac gene expression in mice exposed to Milano winter fine particulate matter (PM2.5). PLoS One. 2014;9(10):e109685.

Wong CM, Tsang H, Lai HK, Thach TQ, Thomas GN, Chan KP, et al. STROBE-Long-Term Exposure to Ambient Fine Particulate Air Pollution and Hospitalization Due to Peptic Ulcers. Medicine (Baltimore). 2016;95(18):e3543.

Mukaddes E. Oxidative stress and benefits of antioxidant agents in acute and chronic hepatitis. Hepat Mon. 2012;12(3):160-7.

Tong H. Dietary and pharmacological intervention to mitigate the cardiopulmonary effects of air pollution toxicity. Biochim Biophys Acta. 2016;1860(12):2891-8.

Romieu I, Garcia-Esteban R, Sunyer J, Rios C, Alcaraz-Zubeldia M, Velasco SR, et al. The Effect of Supplementation with Omega-3 Polyunsaturated Fatty Acids on Markers of Oxidative Stress in Elderly Exposed to PM 2.5. Environ Health Perspect. 2008;116(9):1237-42.

de Hartog JJ, Lanki T, Timonen KL, Hoek G, Janssen NA, Ibald-Mulli A, et al. Associations between PM 2.5 and Heart Rate Variability Are Modified by Particle Composition and Beta-Blocker Use in Patients with Coronary Heart Disease. Environ Health Perspect. 2009;117(1):105-11.

Kamani H, Hoseini M, Seyedsalehi M, Mahdavi Y, Jaafari J, Safari GH. Concentration and characterization of airborne particles in Tehran’s subway system. Environ Sci Pollut Res Int. 2014;21(12):7319-28.

Bonyadi Z, Ehrampoush MH, Ghaneian MT, Mokhtari M, Sadeghi A. Cardiovascular, respiratory, and total mortality attributed to PM2. 5 in Mashhad, Iran. Environ Monit Assess. 2016;188(10):570.

Wang C, Tu Y, Yu Z, Lu R. PM2. 5 and cardiovascular diseases in the elderly: An overview. Int J Environ Res Public Health. 2015;12(7):8187-97.

Masri S, Garshick E, Coull BA, Koutrakis P. A novel calibration approach using satellite and visibility observations to estimate fine particulate matter exposures in Southwest Asia and Afghanistan. J Air Waste Manag Assoc. 2017;67(1):86-95.

Habil M, Massey DD, Taneja A. Personal and ambient PM 2.5 exposure assessment in the city of Agra. Data Brief. 2016;6:495-502.

Refbacks