Dépistage, prise en charge et suivi des personnes potentiellement surexposées à l’arsenic inorganique du fait de leur lieu de résidence

International audienceBackground and objectives. - The French national authority for health (Haute Autorite de sante: HAS) and the French clinical toxicology society (Societe de toxicologie clinique: STC) received a formal request from the French ministry for heath to elaborate recommendations for the screening of environmental overexposure to inorganic arsenic (iAs), for the medical management of overexposed patients and for the medical surveillance of exposed population.Methods. - The method used for the elaboration was the Clinical practice guidelines method recommended by HAS in this situation (HAS, 2010).Results. - The recommendations are presented in the present article. They concern: a) identification of those sites with a high risk of iAs overexposure for the residents (using bioaccessible concentrations in soils); the target population for Asi overexposure screening and screening modalities (using measurement of iAs and its metabolites in urine); b) the biomonitoring indications and modalities for overexposed individuals; c) the fraction of the population with iAs environmental exposure which should be the target for the detection and the diagnosis of complications, and the modalities of these operations; d) the treatment and prevention of iAs environmental overexposure. (C) 2020 Elsevier Masson SAS. All rights reserved.RésuméContexte et objectifsÀ la demande de la Direction générale de la santé, la Haute Autorité de santé (HAS), en partenariat avec la Société de toxicologie clinique (STC) et avec la collaboration de la Société française de médecine du travail (SFMT), la Société française de santé publique (SFSP), la Société française de toxicologie analytique (SFTA) et la Société francophone de santé-environnement (SFSE) a élaboré des recommandations pour le dépistage des surexpositions environnementales à l’arsenic inorganique (Asi) et la prise en charge des populations concernées.MéthodeLa méthode d’élaboration utilisée est celle des Recommandations pour la pratique clinique (RPC) de la HAS (HAS, 2010).RésultatsLes recommandations élaborées identifient : les sites susceptibles d’entraîner des surexpositions environnementales, à partir de la concentration d’Asi dans leur sol ; la fraction des résidents qui constitue la population cible du dépistage ; les modalités de ce dépistage qui utilise le dosage de l’Asi et de ses métabolites dans les urines. En fonction des résultats du primo-dépistage, elles précisent les indications et le déroulement de la surveillance biométrologique. Elles indiquent la fraction de la population exposée qui constitue la cible de la recherche de complications de la surexposition environnementale à l’Asi. Elles précisent les modalités de cette recherche. Enfin, elles proposent des mesures pour le traitement et la prévention des contaminations par l’Asi de l’environnement

Dioxin-induced changes in epididymal sperm count and spermatogenesis Mudanças induzidas por dioxina na contagem epididimal de esperma e espermatogênese

A single in utero exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on gestation day 15 decreased epididymal sperm count in adult rats and thus was used to establish a tolerable daily intake for TCDD. However, several laboratories have been unable to replicate these findings. Moreover, conflicting reports of TCDD effects on daily sperm production suggest that spermatogenesis may not be as sensitive to the adverse effects of TCDD as previously thought. We performed a PubMed search using relevant search terms linking dioxin exposure with adverse effects on reproduction and spermatogenesis. Developmental exposure to TCDD is consistently linked with decreased cauda epididymal sperm counts in animal studies, although at higher dose levels than those used in some earlier studies. However, the evidence linking in utero TCDD exposure and spermatogenesis is not convincing. Animal studies provide clear evidence of an adverse effect of in utero TCDD exposure on epididymal sperm count but do not support the conclusion that spermatogenesis is adversely affected. The mechanisms underlying decreased epididymal sperm count are unknown; however, we postulate that epididymal function is the key target for the adverse effects of TCDD.<br>Uma única exposição in utero a 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) no 15º dia de gestação diminuiu a contagem de esperma epididimal em ratos adultos e por isso foi utilizada para estabelecer uma dosagem diária tolerável para TCDD. No entanto, diversos laboratórios não conseguiram reproduzir esses resultados. Além disso, relatórios conflitantes dos efeitos de TCDD na produção diária de esperma sugere que espermatogênese pode não ser tão sensível aos efeitos adversos do TCDD como antes se pensava. Foi feita uma pesquisa no PubMed usando termos de pesquisa relevantes, relacionados à exposição à dioxina com efeitos adversos na reprodução e na espermatogênese. Exposição em desenvolvimento ao TCDD é consistentemente relacionada à diminuição da contagem da cauda epididimal de esperma, mas não apoia a conclusão de que a espermatogênese é afetada. Os mecanismos por trás da diminuição da contagem de esperma epididimal são desconhecidos; no entanto, contestamos que a função epididimal é a chave para efeitos adversos do TCDD