Component-Specific Air pollutant Drivers of Disease Risk in Early to Midlife: a pathway approach. (DREaM)
Lead Research Organisation:
Imperial College London
Department Name: School of Public Health
Abstract
Air pollution remains the major environmental cause of premature death globally, with long-term exposures to elevated concentrations of microscopic airborne particles and pollutant gases associated with both increased cardiovascular and respiratory hospital admissions and deaths. These adverse effects of living for long periods in areas of elevated pollutant concentrations are much greater than the those associated with short-term exposures, such as those associated with an air pollution episode, which has led to the hypothesis that air pollution not only aggravates disease symptoms in vulnerable groups, such as individuals with pre-existing chronic disease but may also contribute to their development. Consistent with this view, air pollution exposures have been shown to be associated with early signs of cardiovascular and respiratory disease, such as hypertension, high cholesterol, inflammation, and poor lung function in otherwise healthy individuals. This has significant policy implications as it implies reducing air pollution exposures in early to midlife has the potential to provide benefits far into the future, reducing age-related disease and their associated health costs. This expands our understanding of the vulnerability of the population to air pollution, emphasizing how important early life exposures are to health in later life. There are however considerable gaps in our knowledge of how air pollution exposures in childhood to mid-life can promote these adverse responses. Part of the problem here is that our understanding of how air pollution causes harm to the human body is largely based on studies that examine short-term responses to pollutants. We know very well that air pollution causes damaging oxidation reactions in the body and elicits inflammation, both in the lung and circulation, but what is less clear is how these responses relate to the effects of long-term, low-level cumulative exposures. Compounding this is the absence of clear biological indicators of long term exposures.
Recently it has become apparent that under a range of environmental stresses, DNA can undergo structural changes modifying the way in which genes are switched on and off. While some of these changes occur very rapidly, before resolving, others appear stable over time and potentially even inheritable across generations. As these alterations can occur in genes with functional roles in the regulation of inflammation, or the detoxification of particle components, identifying these DNA changes has the potential to provide insights into the underlying mechanisms contributing to the long-term effects of air pollution. This is the central aim of this study; to identify DNA modifications in genes in both children and adults that are associated with air pollution exposures, are stable across time and can be related to the early life risk factors for cardiovascular disease. To achieve this, we will estimate the exposures of children and adults in three large population cohorts using state of the art modeling that will allow us to consider the impacts of a broad range of chemical components within the air we breathe. This approach has the potential not only to improve our understanding of the components within the air pollution mix that increase our vulnerability to pollution but also to drill down into the underlying causal mechanisms. This will have significant policy impacts, both in terms of the development of targeted pollutant mitigation actions and communication strategies explaining the risks of air pollution to the 'healthy' general public before clinical symptoms become apparent in later life.
Recently it has become apparent that under a range of environmental stresses, DNA can undergo structural changes modifying the way in which genes are switched on and off. While some of these changes occur very rapidly, before resolving, others appear stable over time and potentially even inheritable across generations. As these alterations can occur in genes with functional roles in the regulation of inflammation, or the detoxification of particle components, identifying these DNA changes has the potential to provide insights into the underlying mechanisms contributing to the long-term effects of air pollution. This is the central aim of this study; to identify DNA modifications in genes in both children and adults that are associated with air pollution exposures, are stable across time and can be related to the early life risk factors for cardiovascular disease. To achieve this, we will estimate the exposures of children and adults in three large population cohorts using state of the art modeling that will allow us to consider the impacts of a broad range of chemical components within the air we breathe. This approach has the potential not only to improve our understanding of the components within the air pollution mix that increase our vulnerability to pollution but also to drill down into the underlying causal mechanisms. This will have significant policy impacts, both in terms of the development of targeted pollutant mitigation actions and communication strategies explaining the risks of air pollution to the 'healthy' general public before clinical symptoms become apparent in later life.
Planned Impact
The overall aim of this study, in terms of impacts beyond its academic objectives, is to provide an evidential base that supports air pollution mitigation to improve public health and reduce the personal and societal costs associated with NCD.
This project has many potential beneficiaries and its outputs are likely to act across a range of scales from local to international: (1) the most immediate impact will be to the public, particularly to those within the CHILL study areas in London and Luton, and the police within the occupational AIRWAVE cohort, who will kept informed of the research findings arising from this work throughout the course of the study. The study will highlight the early origins of disease and the role that air pollution can play in these processes by impairing lung growth or promoting increases in known risk factor for the development of CVD.(2) The second major group will be policy makers, who will need to respond to these findings to develop new abatement strategies, or mechanisms to reduce exposures in vulnerable groups. The increased focus on PM components, as opposed to simply particle mass has the potential to identify particularly harmful sources, which may aid in the development of more tailored solutions to the current challenges of urban air quality. (3) Relevant professional bodies working in health care (NHS), occupational health, transport or involved in the development of disease prevention strategies at local and national government level. (4) Third sector organisations, especially those involved in health advocacy and efforts to improve urban environments. (5) Industry, especially firms involved in the development of low cost air quality sensors, portable health technologies and air filtration systems for work places in schools. The findings may also influence major car manufacturers, to accelerate the development of low pollution vehicles. (6) Academic and research communities (as described in the academic beneficiaries section).
Dissemination to these wider stakeholder groups will be coordinated via the MRC-PHE Centre for Environment & Health's Community Advisory Board (Chaired by the study PI), comprising NGOs, politicians, patient groups, public health professional and representatives from press and industry. All members of the study team will be encouraged to present to this forum, with a focus on the development of ethical amendments, participant engagement in the CHILL and AIRWAVE cohorts, and effective communication of study findings. Because of the latency period between early to midlife exposures and the emergence of NCDs later in life there are significant challenges in communicating health risks, particularly during middle age, and we will work with closely with PPI/E professionals within our organisations to ensure we address this challenge. The vulnerable, are not only those with pre-existing disease, but those on the pathway to sub-optimal health in later life. More detail on our strategies to ensure effective engagement with the stakeholder communities outline above is included in our Pathways to Impact statement.
This project has many potential beneficiaries and its outputs are likely to act across a range of scales from local to international: (1) the most immediate impact will be to the public, particularly to those within the CHILL study areas in London and Luton, and the police within the occupational AIRWAVE cohort, who will kept informed of the research findings arising from this work throughout the course of the study. The study will highlight the early origins of disease and the role that air pollution can play in these processes by impairing lung growth or promoting increases in known risk factor for the development of CVD.(2) The second major group will be policy makers, who will need to respond to these findings to develop new abatement strategies, or mechanisms to reduce exposures in vulnerable groups. The increased focus on PM components, as opposed to simply particle mass has the potential to identify particularly harmful sources, which may aid in the development of more tailored solutions to the current challenges of urban air quality. (3) Relevant professional bodies working in health care (NHS), occupational health, transport or involved in the development of disease prevention strategies at local and national government level. (4) Third sector organisations, especially those involved in health advocacy and efforts to improve urban environments. (5) Industry, especially firms involved in the development of low cost air quality sensors, portable health technologies and air filtration systems for work places in schools. The findings may also influence major car manufacturers, to accelerate the development of low pollution vehicles. (6) Academic and research communities (as described in the academic beneficiaries section).
Dissemination to these wider stakeholder groups will be coordinated via the MRC-PHE Centre for Environment & Health's Community Advisory Board (Chaired by the study PI), comprising NGOs, politicians, patient groups, public health professional and representatives from press and industry. All members of the study team will be encouraged to present to this forum, with a focus on the development of ethical amendments, participant engagement in the CHILL and AIRWAVE cohorts, and effective communication of study findings. Because of the latency period between early to midlife exposures and the emergence of NCDs later in life there are significant challenges in communicating health risks, particularly during middle age, and we will work with closely with PPI/E professionals within our organisations to ensure we address this challenge. The vulnerable, are not only those with pre-existing disease, but those on the pathway to sub-optimal health in later life. More detail on our strategies to ensure effective engagement with the stakeholder communities outline above is included in our Pathways to Impact statement.
Organisations
Publications

Arias De La Torre J
(2023)
The relationship between air pollution and multimorbidity: Can two birds be killed with the same stone?
in European journal of epidemiology

Bakolis I
(2021)
Mental health consequences of urban air pollution: prospective population-based longitudinal survey.
in Social psychiatry and psychiatric epidemiology

Enlo-Scott Z
(2021)
Drug metabolism in the lungs: opportunities for optimising inhaled medicines.
in Expert opinion on drug metabolism & toxicology

Faherty T
(2024)
HIPTox-Hazard Identification Platform to Assess the Health Impacts from Indoor and Outdoor Air Pollutant Exposures, through Mechanistic Toxicology: A Single-Centre Double-Blind Human Exposure Trial Protocol
in International Journal of Environmental Research and Public Health

Fussell JC
(2022)
A Review of Road Traffic-Derived Non-Exhaust Particles: Emissions, Physicochemical Characteristics, Health Risks, and Mitigation Measures.
in Environmental science & technology

Hajmohammadi H
(2024)
Long-term air pollution exposure and risk of SARS-CoV-2 infection: A UK-wide cohort study.
in Respiratory medicine

Karamanos A
(2023)
Associations between air pollutants and blood pressure in an ethnically diverse cohort of adolescents in London, England.
in PloS one

Kelly FJ
(2021)
Air Pollution and Asthma: Critical Targets for Effective Action.
in Pulmonary therapy

Kumar P
(2023)
Characteristics of fine and ultrafine aerosols in the London underground.
in The Science of the total environment

Lim S
(2021)
Characterising professional drivers' exposure to traffic-related air pollution: Evidence for reduction strategies from in-vehicle personal exposure monitoring.
in Environment international
Related Projects
Project Reference | Relationship | Related To | Start | End | Award Value |
---|---|---|---|---|---|
NE/T001895/1 | 13/02/2019 | 29/06/2020 | £1,285,073 | ||
NE/T001895/2 | Transfer | NE/T001895/1 | 30/06/2020 | 31/10/2023 | £1,165,125 |
Description | This study will deliver its key scientific finding over the next 12-month, due to delays related to COVID and importantly for this study school closures. We have however been able to produce enhanced air pollution models for the UK and to increase the general public's understanding of the need for long term biomarkers of response and exposures. We have also been able to add cognitive function as an additional endpoint through leveraged funding from the Bart's Charity. We have also been active in engaging with policy makers to emphasize the need to focus on the communication of the long-term impacts of air pollution on health, and particularly its contribution to the development of chronic disease. We have also been able to deliver enhance science education to the theme covered in DREaM to over 6,000 children, including over the school closure period, to improve general understanding of this research area. |
First Year Of Impact | 2021 |
Sector | Government, Democracy and Justice,Culture, Heritage, Museums and Collections |
Impact Types | Cultural Societal Policy & public services |
Description | 'Health Effects of Air Pollution on Children' - a presentation given to Clean Air Bayswater group |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Talk on the impact of air pollution on children's health |
Year(s) Of Engagement Activity | 2023 |
Description | BBC news story - focsuing on the impact of air pollution on the brain |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | News story on emerging evidence and work ongoing on the health impacts of air pollution on the brain. |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.bbc.co.uk/news/science-environment-67031322 |
Description | Bloomsbury Festival, London (21-22 October 2022) |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Two day event focusing on the impact of air pollution on children's health. Used to highlight progress in the CHILL, CHILL Cog and DREaM projects. |
Year(s) Of Engagement Activity | 2022 |
Description | Breathe 2022 - a collaboration with the artist Dryden Goodwin and Invisible Dust, with support from The Wellcome Trust, Arts Council, Lewisham council and the Bloomsbury Festival. |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | A year long public art science collaboration to highlight the impact of air pollution on lung health. Launched on the 18th of May, but with public events and panels held throughout the year. Included public art displayed throughout London, leading up to a unveiling of a public/artist animation in Catford on the 30th November, which was also used as a launch event for the announcement of the extension of London's ULEZ, attended by the London Mayor. The animation was also the center piece of the events to mark the 10th year anniversary of the death of Ella Adoo Kissi Debrah (15th Fen 2023). |
Year(s) Of Engagement Activity | 2022,2023 |
URL | https://invisibledust.com/projects/breathe-2022/ |
Description | ERG 30th Anniversary meeting on air pollution and brain health: How does Air Pollution affect the brain |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | A half day meeting on air pollution and brain health, including discussions of exposure and response biomarkers |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.youtube.com/watch?v=5ZNTZutUhUY |
Description | Environmental Research Group - 30th Anniversary Meeting: From Correlation to Causation |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | A presentation on the integration of toxicology into the decision making process focused on identifying the harmful components of particulate matter. |
Year(s) Of Engagement Activity | 2024 |
URL | https://www.youtube.com/watch?v=7XqGYaQ-AFA |
Description | Great Exhibition Road festival, Imperial College London - Paint Lab collaboration with Lucille Clerc |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | In Small Changes/Big Impact, Lucille Clerc creates a participatory installation that involves each visitor. She hopes to highlight the gradual, unseen build-up of pollutants in our respiratory system and how small, incremental changes to improve air quality may counter its effects. Dr Ian Mudway researches the impacts of air pollution on human health and develops tests to quantify the toxicity of the chemical cocktails that pollute the air we breathe |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.greatexhibitionroadfestival.co.uk/about-us/explore/paint-lab/ |
Description | Gresham College Lecture - Biological Interfaces with the Outside World |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Gresham lecture focused on how pollutants interact with the mucosal surfaces of the lung, Delivered in my role of Gresham Professor of Environmental Health. |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.youtube.com/watch?v=6fAqr8tYDnk |
Description | Gresham College Lecture - Living with the Forever Chemicals |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Exploring the evidence for the health impacts of PFAS within the environment |
Year(s) Of Engagement Activity | 2024 |
URL | https://www.youtube.com/watch?v=JhsVv1nTfnI |
Description | Gresham College Lecture - Microplastics, Public Health Myth or Menace |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | A lecture on the emerging field of microplastics research. Focusing on facts versus perceived views in the media |
Year(s) Of Engagement Activity | 2024 |
URL | https://www.youtube.com/watch?v=vocvz6N6faI |
Description | Gresham College Lecture - School Engagement: Air Pollution and the Brain |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Schools |
Results and Impact | Gresham college school outreach lecture delivered at the Mullberry School for Girls in Tower Hamlets, but live streamed to schools nationally, |
Year(s) Of Engagement Activity | 2024 |
Description | Gresham College Public Lecture on the Exposome (27th October 2022) |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Gresham public lecture introducing the exposome concept and it's role in public health. Large audience reached through digital platform. |
Year(s) Of Engagement Activity | 2022 |
URL | https://www.gresham.ac.uk/watch-now/exposome |
Description | Gresham College Public Lecture to mark the 70th anniversary of the London Smog (5th November 2022) |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Lecture to mark the 70th anniversary of the London Smog, reached a large online audience. |
Year(s) Of Engagement Activity | 2022 |
URL | https://www.gresham.ac.uk/watch-now/londons-air |
Description | New Scientist Live - London (7-9th October 2022) |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Three day event held in London. We had a stand highlighting the work of the MRC Centre for Environment and Health and the associated NIHR HPRUs. The event was used to showcase progress in ongoing projects including DREaM, HIP-Tox, CHILL, CHILL Cog and Wellhome. Two days for the general public and one school day. |
Year(s) Of Engagement Activity | 2023 |
Description | New Scientist Live - Manchester (11th-13th March 2022) |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | Three day New Scientist Live Event in Manchester to highlight the work of the MRC Centre in Environment and Health and the associated HPRUs. Also used to highlight ongoing research projects including DREaM, CHILL, HIP-Tox and Wellhome. |
Year(s) Of Engagement Activity | 2022 |
Description | Royal Society of Chemistry - Toxicology Group meeting on Environmental Toxic Tort - current perspectives and recent cases |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Other audiences |
Results and Impact | This was a meeting convened by the Royal Society of Chemistry to update environmental lawyers in the UK about the evidence available to be used in legal cases based on tort. |
Year(s) Of Engagement Activity | 2024 |
URL | https://www.google.com/search?sca_esv=1d9669fa733ed905&q=%22mudway%22+royal+society+of+chemistry+tor... |