Parkinsonism (PS) is a debilitating neurodegenerative disorder that affects millions of people worldwide. The causes of primary (idiopathic) PS are largely unknown, although there is growing experimental and epidemiologic evidence that environmental toxicants play important etiologic roles. Endotoxin (lipopolysaccharide) is a component of the outer membranes of Gram-negative bacteria cell walls that is released when bacteria lyse. Human exposure to endotoxin occurs in numerous environmental settings, with especially high levels found in cotton textile manufacturing, which is the focus of this proposed research. It is noteworthy that endotoxin has been established as a model experimental agent that induces selective death of dopaminergic neurons in vitro and in vivo. Despite convincing experimental support for a plausible pathogenic role of endotoxin in PS, there have been no previous epidemiologic studies that have explicitly tested this association. Accordingly, we are proposing to conduct an epidemiological study of PS among a well- characterized cohort of women textile workers in Shanghai, China that we have studied previously for cancer risk factors. Our previous research has generated quantitative estimates of cumulative doses of endotoxin. We will conduct standardized neurological examinations to determine the prevalence and severity of the cardinal signs and symptoms of parkinsonism among 600 retired women previously employed in cotton textile factories who were exposed to endotoxin and an age-matched non-exposed group composed of 300 retired women textile workers who had never worked in cotton factories or in jobs with potential endotoxin exposure. We will also perform a 3-year clinical follow-up among PS cases identified in years 1 and 2 of the project to determine disease progression. Our analyses will generate quantitative dose-response trends for relations of endotoxin exposure with PS risk, severity, and progression that are adjusted for potential confounding by age, smoking, reproductive history, and other occupational exposures. The findings from this project have great promise to clarify further the role of neuroinflammation in the pathogenesis of human parkinsonism, which will ultimately be important for prevention of this disorder. This new application is for an epidemiological study of the risks, severity, and progression of clinical parkinsonism (PS) among women textile workers in Shanghai in relation to occupational endotoxin exposure. Endotoxin, which has been shown to induce PS in animals, is a widespread environmental exposure. Thus, the results of the research could have important disease prevention implications.

Public Health Relevance

This new application is for an epidemiological study of the risks, severity, and progression of clinical parkinsonism (PS) among women textile workers in Shanghai. The primary hypothesis to be tested is that endotoxin exposure from cotton dust is a risk factor for PS. The study will compare 600 workers exposed to cotton dust with 300 textile workers who never worked with cotton dust.

National Institute of Health (NIH)
National Institute of Environmental Health Sciences (NIEHS)
Research Project (R01)
Project #
Application #
Study Section
Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Lawler, Cindy P
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Washington
Schools of Public Health
United States
Zip Code
Nakamura, Tomohiro; Lipton, Stuart A (2016) Nitrosative Stress in the Nervous System: Guidelines for Designing Experimental Strategies to Study Protein S-Nitrosylation. Neurochem Res 41:510-4
Zhang, Dongxian; Lee, Brian; Nutter, Anthony et al. (2015) Protection from cyanide-induced brain injury by the Nrf2 transcriptional activator carnosic acid. J Neurochem 133:898-908
Nakamura, Tomohiro; Prikhodko, Olga A; Pirie, Elaine et al. (2015) Aberrant protein S-nitrosylation contributes to the pathophysiology of neurodegenerative diseases. Neurobiol Dis 84:99-108
Okamoto, Shu-ichi; Lipton, Stuart A (2015) S-Nitrosylation in neurogenesis and neuronal development. Biochim Biophys Acta 1850:1588-93
Costa-Mallen, Paola; Zabetian, Cyrus P; Agarwal, Pinky et al. (2015) Haptoglobin phenotype modifies serum iron levels and the effect of smoking on Parkinson disease risk. Parkinsonism Relat Disord 21:1087-92
Mata, Ignacio F; Leverenz, James B; Weintraub, Daniel et al. (2014) APOE, MAPT, and SNCA genes and cognitive performance in Parkinson disease. JAMA Neurol 71:1405-12