The International Tissue and Tumor Repository for Chronic Arseniasis at the Armed Forces Institute of Pathology. (Correspondence).

The public health concern for environmental exposure to arsenic has been widely recognized for decades. However, recent human activities have resulted in even greater arsenic exposures and the potential increase for chronic arsenic poisoning on a worldwide basis. This is especially the case in China, Taiwan, Thailand, Mexico, Chile, India, and Bangladesh. The sources of arsenic exposure vary from burning arsenic-rich coal (China) (1) and mining activities (Malaysia, Japan) to the ingestion of arsenic-contaminated drinking water (Taiwan, Inner Mongolia, China) (2). The groundwater arsenic contamination in Bangladesh and the West Bengal Delta of India has received the greatest international attention due to the large number of people exposed and the high prevalence of arsenic-induced diseases (3). Recent estimates suggest that in West Bengal as many as 20-30 million people are at risk from drinking arsenic-contaminated water obtained from thousands of tube wells that appear to be contaminated with naturally occurring arsenic.

Although the health effects associated with chronic arsenic exposure have been reasonably well characterized in those areas around the world with high arsenic levels in their drinking water, the association of adverse health effects with arsenic exposure in the United States is less clear. This is primarily due to the lower exposure levels in the great majority of U.S. drinking water supplies and the lack of research studies that look for health effects in arsenic-exposed persons.

Cancer is a well-established arsenic-related disease, although the cancer risk at low level exposure is unclear. Equally unclear is whether low-level arsenic exposures may play a role in the incidence in non-cancer heath problems in the United States such as immune suppression and cardiovascular disease. This uncertainty in dose effects at low levels has resulted in hotly debated differences in opinion as to the need for stricter government regulation of arsenic in drinking water. Recently, the National Research Council studied the issue and determined that the current drinking water standard for arsenic is too high and recommended that it be lowered (4). The U.S. Environmental Protection Agency (U.S. EPA), in fact, has proposed lowering the allowable drinking water standard from 50 [micro]g/L to 10 [micro]g/L. The drinking water industry, however, opposes changing the standard on the basis that more information is needed as to how arsenic causes cancer and other health effects, and whether these mechanisms operating at high dose levels also operate at low levels as well.

It is true that the mechanisms by which arsenic may induce adverse health effects are largely unknown. There are two major reasons for this. One is that the sophisticated molecular probes needed to study cellular and biochemical mechanisms have only recently become available, whereas most of the toxicity studies with arsenic were conducted many years before their availability. A second, equally important reason is that properly fixed human tissues from arsenic-exposed persons are not available for such sophisticated research studies. The dilemma we face is that now we have the research tools (with even more sophisticated methods on the horizon), but we do not have the human tissues to study.

The Armed Forces Institute of Pathology (AFIP) is participating in an international research effort aimed at the development of an International Tissue and Tumor Repository for Chronic Arseniasis in Humans (ITTRCA). This effort is supported by four other federal agencies, including the U.S. EPA, the National Cancer Institute, the National Institute of Environmental Health Sciences, and the U.S. Geological Survey. The main objective of the ITTRCA is to obtain and archive tissues from persons known to or suspected of having been exposed to arsenic (environmental or occupational) and exhibiting adverse health effects. A component of this repository is to provide a mechanism by which the underlying pathology and morphology of arsenic-induced lesions can be described (5). The major thrust of the ITTRCA is to facilitate the formulation of a standardized system of nomenclature for the study of skin lesions and other arsenic-induced changes in tissues, to foster the use of archival materials for the development of international collaborative projects on arsenic health effects, to facilitate the use and accessibility of archival materials associated with arsenic exposure, and to develop interlaboratory trials for the analysis and speciation of arsenic in biological tissues. Another unique component of the ITTRCA is the link to a repository of sources (coal, ores, soil, water) for arsenic exposures organized and maintained by the U.S. Geological Survey.

We request that pathologists, clinicians, epidemiologists, toxicologists, and public health professionals in the United States and throughout the world participate in this exciting international project. Please contact us for further information about the ITTRCA and the methods for collection and shipment of tissues.

REFERENCES AND NOTES

(1.) Finkelman RB, Belkin HE, Zheng BS. Health impacts of domestic coal use in China. Proc Natl Acad Sci USA 96:3272-3431 (1999).

(2.) Chen CJ, Hsu LI, Tseng CH, Hsueh YM, Chiou HY. Emerging epidemics of arseniasis in Asia. In: Arsenic Exposure and Health Effects (Chappell WR, Abernathy CO, Calderon RL, eds). New York Elsevier Science Ltd, 1999;113--121.

(3.) Guha Mazumder DN, De BK, Santra A, Dasgusta J, Ghosh N, Roy BK, Ghoshal UC, Saha J, Chartterjee A, Dutta S, et al. Chronic arsenic toxicity: epidemiology, natural history and treatment. In: Arsenic Exposure and Health Effects (Chappell WR, Abernathy CO, Calderon RL, eds). New York Elsevier Science Ltd, 1999;335-347.

(4.) National Research Council. Arsenic in Drinking Water. Washington DC:National Academic Press, 1999.

(5.) Centeno JA, Martinez L, Ladich ER, Page NP, Mullick FG, Ishak KO, Zheng BS, Gibb H, Thompson C, Longfellow D. Arsenic-Induced Lesions. Washington, DC:Armed Forces Institute of Pathology, 2000.

Jose A. Centeno
Florabel G. Mullick
U.S. Armed Forces Institute of Pathology
Washington, D.C.
E-mail: [e-mail]
Telephone: [phone]

Herman Gibb
U.S. EPA, National Center for
Environmental Assessment
Washington, D.C.

David Longfellow
National Cancer Institute
Bethesda, Maryland

Claudia Thompson
National Institute of Environmental
Health Sciences
Research Triangle Park, North Carolina