Exploring Environmental Health: Insights from the Yale Superfund Research Center on the Emerging Contaminant-Induced Cancers
November 13, 2023Yale Cancer Center Grand Rounds | November 10, 2023
Presented by: Dr. Vasilis Vasiliou
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Transcript
- 00:00I'm Melinda Irwin.
- 00:01I'm a professor in the School of
- 00:04Public Health with Vasilis and also
- 00:06deputy Director for the Cancer Center,
- 00:09overseeing population sciences research,
- 00:12which focuses on lifestyle,
- 00:14genetic and environmental risk factors
- 00:17for cancer etiology and outcomes.
- 00:20So we're delighted today to have
- 00:23the Yale and National International
- 00:25expert in environmental carcinogens
- 00:28and cancer speak to us.
- 00:30Doctor Vasilis Vasilu,
- 00:31who is also he's the Susan Dwight
- 00:34Bliss Professor of Environmental
- 00:35Health Sciences as well as Chair of
- 00:38our Department of Environmental Health
- 00:40Sciences in the Yale School of Public Health.
- 00:43He received his PhD in Biochemical
- 00:46Pharmacology from the University
- 00:48of Ion Ionina in Greece.
- 00:51He then trained in gene
- 00:53environment interactions,
- 00:55molecular toxicology and pharmacogenetics
- 00:58at the Department of Environmental
- 01:00Health and the College of Medicine
- 01:03at University of Cincinnati.
- 01:04He joined Yale 10 almost 10 years
- 01:07ago in 2014 from the University
- 01:09of Colorado School of Pharmacy,
- 01:12where he rose to the ranks to
- 01:14become professor and director of the
- 01:16toxicology graduate program and was
- 01:18professor also of ophthalmology.
- 01:20He's established an internationally
- 01:23recognized research program that's been
- 01:26continuously funded by NIH since 1997,
- 01:28and his research interests include
- 01:31the etiology and molecular mechanisms
- 01:33of environmentally induced human
- 01:35disease such as liver disease,
- 01:37obesity and diabetes, cancer,
- 01:40and neurodegenerative diseases.
- 01:43Vasilis is the director of the N i.e.
- 01:46HS funded P 42,
- 01:48Yale Superfund Research Center
- 01:50and also the director of the NI
- 01:53AAA funded R24 Resource Center for
- 01:55Mouse Models and Metabolomics tools
- 01:58to investigate alcohol metabolism
- 02:01and tissue injury.
- 02:03This is really does translational
- 02:05research from preclinical work
- 02:07to clinical to community engaged
- 02:09research focusing on environmental
- 02:11risk factors in cancer.
- 02:13Thank you.
- 02:14Thank
- 02:16you very much, Melinda.
- 02:17Thank you for the invitation.
- 02:18And Melinda, thank you very much
- 02:20for the impressive introduction.
- 02:21I don't know if I
- 02:26anyway, so I wish.
- 02:32Let me start.
- 02:33Actually the talk of today's lecture
- 02:36is exploring environmental health,
- 02:39the insights through our P42
- 02:43Centre Research Centre on emerging
- 02:46contaminants and their their,
- 02:48their effects on cancer.
- 02:52So one of the concerns that we have is,
- 02:55you know that 50% or maybe more than
- 03:01more than 50% of the cancers might
- 03:04not be due to the genetic effects,
- 03:06might not be to mutations,
- 03:08might not be to polymorphisms
- 03:10or things like that.
- 03:11So they have an environmental impact.
- 03:13One of the things that has triggered
- 03:16my attention the last five or you know
- 03:206-7 years is the early onsets of cancer,
- 03:24which actually there was a very
- 03:27nice review in Natural Nature
- 03:30Reviews in clinical oncology,
- 03:33which posed the question if the early onset
- 03:36of cancer is an emerging global epidemic.
- 03:39And it has.
- 03:40As you can see, the incidence of of
- 03:43cancers in various organs in ages less
- 03:47than 50 and actually less than 40,
- 03:50has been rising in many parts
- 03:52of the world since the 80s.
- 03:54The evidence suggests an ideological risk
- 03:57of risk factor exposures in early life.
- 04:00Young, under hood,
- 04:01and all those specific individual
- 04:04exposures remain to be largely unknown.
- 04:06So this is what my interests are,
- 04:09how this environmental exposures
- 04:11could lead not only to cancers but
- 04:14also to early onsets of cancers.
- 04:16And we can go from liver cancer
- 04:19to colorectal cancer with
- 04:21associations to alcohol,
- 04:22which I could give you
- 04:24another lecture on that.
- 04:25But anyway,
- 04:25the early onset cancer epidemic
- 04:27might be 1 manifestation of
- 04:29increasing the trends of the in the
- 04:31development of many chronic disease
- 04:33in the young and future generation.
- 04:35So what we come here is the
- 04:39early life exposure,
- 04:40it's the exposures of the of the mother.
- 04:44And actually now it's also exposure
- 04:47preconceptionally for both mother
- 04:49and father what they have been
- 04:51into it and how this would affect
- 04:53the development of the embryon,
- 04:55the later studies.
- 04:56So the exposome includes
- 04:58environmental exposure,
- 04:59Melinda talked about diet,
- 05:01lifestyle,
- 05:01obesity and microbiome and this
- 05:04this exposome has changed completely
- 05:07in the last 40 or 50 years.
- 05:10So a lot of people looking into how this
- 05:13Eddy life exposures could have an effect.
- 05:16Of course we should not ignore the
- 05:18exposure we have on daily basis and
- 05:21talking about that one of the most
- 05:24important thing is drinking water.
- 05:26You drink your water and in most
- 05:28of the cases especially when you
- 05:30come to emerging contaminants,
- 05:32you don't you have no idea what
- 05:34what the water contains.
- 05:36So it's it's a lot of aspects in here.
- 05:39So talking about drinking water
- 05:42and protecting the environment.
- 05:44So the federal government has the
- 05:46Superfund Act and what that is refers
- 05:49to a comprehensive environmental response.
- 05:52Compensation and liability are
- 05:54known as CLEFCLA since the 80s.
- 05:56So what the federal government did
- 05:59is they put a law that provides a
- 06:02legal framework for clean up sites of
- 06:04contaminate and hazardous substances.
- 06:07Especially,
- 06:07you know there are some states,
- 06:09Connecticut is a heavily industrialized,
- 06:14actually it's a retired,
- 06:16it's a retired state of heavily
- 06:20industrialized area.
- 06:21If I'll show you the sites of superfunds,
- 06:26either federal or local,
- 06:28we might walk away and go and
- 06:29look for a job or another state.
- 06:31It's everywhere and I will
- 06:33explain you why in I'll
- 06:34give you some of these examples.
- 06:36Again, we have to be taking
- 06:39everything into consideration.
- 06:40So there is the federal law,
- 06:42if there is a company that has a spill out,
- 06:45so they're getting a fine and that could
- 06:47be hundreds of millions of dollars.
- 06:50So this amount of money,
- 06:52some of this amount of money they
- 06:53go to the EPA and some of them
- 06:56they go to National Institute of
- 06:57Environmental Health Sciences and what
- 06:59the environmental Health Sciences does
- 07:01takes this money and creates a centers.
- 07:04So you have we have here the Cancer
- 07:07Center at the same time we have
- 07:09the the Superfund research centers
- 07:11through around the the United States.
- 07:14And essentially the centers focus on
- 07:17the understanding of health effects of
- 07:19the exposures to hazardous substances,
- 07:21developing innovative technologies
- 07:24to mitigate essentially size,
- 07:27clean up and engaging communities
- 07:30affected by this environmental issues.
- 07:32So their research contributes to the
- 07:36overall goal of safeguarding the public
- 07:38health and environmental in areas
- 07:40of hazard or waste contamination.
- 07:42So this is what are the centers and
- 07:44this is as I said this is where the
- 07:47federal money from penalties from
- 07:49those cleanups go and they're coming.
- 07:51So how many centers that exist?
- 07:53We have 23 funded centers in the in
- 07:57the United States and as you can see
- 08:00on the top left is our Connecticut,
- 08:02it's a Yale Superfund Reset centre.
- 08:04This is the first ever centre we've
- 08:07got in Connecticut and the focus of as
- 08:11I said the focus of our the focus of
- 08:15our centre is on emerging contaminants.
- 08:18So what are water contaminants of
- 08:21emerging concern now these are chemicals
- 08:23that they're detected in trace amount
- 08:26in our drinking water within global
- 08:30drinking supplies that their risk on
- 08:34human health is not fully understand
- 08:37or even not been evaluated at all.
- 08:40OK.
- 08:41And what are these emerging
- 08:43concerns include that including
- 08:45industrial chemicals such as P Fas.
- 08:48Everybody has heard about the P Fas.
- 08:50Everybody you know today at least you
- 08:54will get educated on on 1.4 dioxane on
- 08:57some volatile solvents that they exist.
- 08:59But in addition to that we have
- 09:01a lot of pharmaceuticals,
- 09:03personal care products and actually
- 09:06yesterday NIHS had a webinar about the
- 09:09Expos on on personal care products.
- 09:12You'll be surprised how much they
- 09:14go down the drain and how much they
- 09:16end up in your drinking water.
- 09:17It's truly amazing.
- 09:19And of course you have pesticides
- 09:21and herbicides that come from
- 09:23the agriculture that eventually,
- 09:25you know they're going to end up into
- 09:28the water table and they're going
- 09:30to add up to our drinking water.
- 09:32So the overall objective of our Yale
- 09:36Superfund Research Center is to improve
- 09:39public health from the emerging water
- 09:41contaminants in the drinking waters.
- 09:44And what we're trying to do with
- 09:46trying to develop not innovative
- 09:48research in terms of the mechanisms
- 09:51of toxicities that they this
- 09:54emerging contaminants 'cause and
- 09:55also look at the ways that we can
- 09:59mitigate that we can detect and
- 10:01mitigate that and also
- 10:04inform the communities,
- 10:05talk with the communities, listen to
- 10:07their needs and talk to us about it.
- 10:10Our center has been focused on 1.4 dioxane.
- 10:14We and also it's what we call,
- 10:17I'm sorry walking around,
- 10:20I'm Greg, I'm sorry that's it's
- 10:23in my sense this is in my genes,
- 10:26it's not environmental.
- 10:28So it's 1.4 dioxin and what we call
- 10:32its Co contaminants which is 1,
- 10:35it's the dichloroethane,
- 10:37trichloroethane and also trichloroethylene.
- 10:40Those are volatile solvents that
- 10:42they exist and I will explain you
- 10:44why and how this has come up with.
- 10:46But essentially,
- 10:47this is what our center is doing
- 10:48and this is what we're focusing now.
- 10:50You can say why did you focus on that?
- 10:53So when I came here, it was 2014.
- 10:56I immediately went on,
- 10:59I think the next year immediately
- 11:01I met with the state authorities,
- 11:03the Department of Public Health
- 11:06and the Department of Energy
- 11:07and Environmental Protection.
- 11:08And I said I'd like to develop
- 11:11a Superfund research program
- 11:13for the state of Connecticut.
- 11:15What is the issue that you have?
- 11:18At that time?
- 11:19PFS were not that hot and
- 11:21actually thank God because we
- 11:23took the direction of 1.4 dioxin.
- 11:25Had they know anything about 1.4 dioxin?
- 11:27No.
- 11:28But they told me that this was the
- 11:30major issue and the major issue was
- 11:33because of this solvents on this
- 11:35multiple sites in the state of Connecticut.
- 11:37And the problem with 1.4 dioxin
- 11:40is they could not filter it.
- 11:43It would go through every aspect.
- 11:47And even in public water,
- 11:48they cannot filter it If if
- 11:50the source is contaminated,
- 11:52it will end up in your drinking water.
- 11:54So that was a major issue and This is
- 11:57why we chose to go with 1.4 dioxane.
- 12:00So the superfan center.
- 12:01And actually I'm really proud
- 12:03not because I got the grant,
- 12:05I'm really proud because I brought
- 12:07the four schools together and that
- 12:08is our school of public health,
- 12:10the School of Medicine,
- 12:11the engineering and the environment.
- 12:13And we developed this program.
- 12:14This program consists of,
- 12:16as you can see,
- 12:18four research projects and four course.
- 12:21We have the administrative core,
- 12:22we have the training core,
- 12:25the DMAC which plays the it's the
- 12:29data management and analytics.
- 12:31We also have the community engagement
- 12:33and of course we have the training,
- 12:36the training core that you're going.
- 12:37I'll go in a little bit more details
- 12:40when we move forward on this.
- 12:42So again,
- 12:4311 more time it was the concern
- 12:46of the public,
- 12:47of the public institutions was on
- 12:501.4 dioxin for a particular reason.
- 12:52Because it is a possible human carcinogen.
- 12:57It has been found that it causes
- 13:00cancer in animals,
- 13:02but now there is no epidemiological
- 13:05studies yet in humans.
- 13:07This is why it's emerging contaminants
- 13:10and it's found with the other Co
- 13:12contaminants and has been prioritized
- 13:15by US Environmental Protection
- 13:17Agency on the on the 3rd Unregulated
- 13:21Monitoring role for testing in
- 13:242013 and 2015 and you will see
- 13:26the map. It is spread
- 13:29throughout United States.
- 13:31So it's been also characterized
- 13:34as forever chemical just like the
- 13:37PFS because it cannot be filtered.
- 13:39It's very, it's difficult to be,
- 13:42you know metabolized by bacterial
- 13:45species and so on and it goes there.
- 13:49This is from the chemical Environmental
- 13:51news saying that this is really so when
- 13:54I put the team together, I put them,
- 13:57we wrote a big grant that we can
- 14:00we oversee what it was available,
- 14:02what was the scientific evidence,
- 14:04what was the demological studies,
- 14:07what are the strategies to mitigate that.
- 14:10And we we had that on a very
- 14:13nice review that actually helped
- 14:15us to get the team together.
- 14:18So 1.4 dioxane of course in three isomers,
- 14:211.41 point 2 and 1.3,
- 14:24but the concern and the most most
- 14:27prevalent is the 1.4 dioxane.
- 14:30Is it a new chemical?
- 14:31No, it's not.
- 14:32I'm just not going to go in
- 14:34all details of this because we
- 14:36can talk about for a long time,
- 14:38but it was first synthesized in 1863 and
- 14:42initially it was used as a stabilizer.
- 14:45It was used as a stabilizer for the
- 14:50for the solvents, the DCATCE and DCA,
- 14:55and what happens is this,
- 14:57this solvents, they were covered on.
- 15:02They were.
- 15:03They were transferred on aluminium
- 15:06containers and the aluminum containers,
- 15:08you know,
- 15:08they have a cover inside which
- 15:10is aluminum and they protect from
- 15:13being interacting with the metal.
- 15:16So what happened is after a certain
- 15:18period of time these solvents
- 15:20interact with the metal and they
- 15:23create even toxic products.
- 15:24So what they did is they found
- 15:27out 1.4 dioxane,
- 15:28it could block the catalysis
- 15:31of this reaction.
- 15:32So they were using 1.4 dioxane as
- 15:35a stabilizer of those chemicals not
- 15:37only to protect the toxicity but
- 15:40stabilize the solvents for their use.
- 15:43And what we're using this everything
- 15:45that you can imagine, I'll show you.
- 15:47So it was used as a stabilizer to begin with,
- 15:50but later as you can see from this,
- 15:52it has been used in many in many areas.
- 15:55So this is the uses,
- 15:57I'm not going to go in great details
- 15:59but includes from the stabilizing to medical,
- 16:02pharmaceutical, rubber and plastic industry,
- 16:06printing in and paints,
- 16:07adhesives, brake fluids,
- 16:09brake cleaning fluids and also rust
- 16:13remover and also antifreeze and deicing.
- 16:17The stuff that you they throwing on
- 16:20the airplanes before we take off on
- 16:22this it has 1.4 dioxide quite a bit
- 16:24and what we end up with on the ground.
- 16:28OK so pesticides and some of the
- 16:31pesticides they have up to 50% of
- 16:351.4 dioxide 50% anyway and also
- 16:39the consumer products we talked
- 16:41about before what is environmental
- 16:43concerns first of all ground water
- 16:46contamination resistance it's as I
- 16:48told you it's it's there it cannot be
- 16:51really degraded easily and can travel.
- 16:54It can travel everywhere toxicity.
- 16:56It's been classified,
- 16:57as I told you,
- 16:58as a possible human carcinogen by
- 17:01both the USEPA and the National
- 17:03engine for Recession.
- 17:04Cancer. Regulatory concerns
- 17:06are plenty of concerns.
- 17:08There is no federal regulation.
- 17:09Well, we don't have federal
- 17:10regulation yet, even for PFAS.
- 17:12And I don't know if you
- 17:15watch the movie Dark Waters,
- 17:17which I recommend that you do,
- 17:19you realize what what I'm talking about?
- 17:21About PFAS and regulatory issues.
- 17:24So as I told you before,
- 17:27what do you find, 1.4 Dioxane.
- 17:29You find all the other
- 17:31solvents or vice versa.
- 17:32It has happened in play many
- 17:34places in the United States
- 17:36around the Air Force or you know,
- 17:39army bases and everywhere.
- 17:40And it's not only in the United States,
- 17:43even in German Japan,
- 17:45China they have found whatever you find
- 17:49DC or DCA you will find 1.4 dioxin.
- 17:53So you expect to have it also in the rivers,
- 17:57in fish and in the drinking water.
- 18:00Here is the map from the you CMR 3
- 18:03and you can see there are white dots,
- 18:08I mean dots,
- 18:09Gray dots and red dots and
- 18:12essentially this is above,
- 18:14below and or around the
- 18:17recommendation concentration which
- 18:19is .36 micro grams per liter.
- 18:22This is a reference dose that
- 18:24this is the dose that it can
- 18:26cause one cancer per million.
- 18:28OK.
- 18:28And again this is advisory
- 18:31nothing regulatory.
- 18:32The areas we have chosen as it was here,
- 18:35you cannot believe if
- 18:37you live in Long Island,
- 18:39public water from Long Island
- 18:41comes from well water.
- 18:43And most of these areas,
- 18:44they're really high levels of 1.4 dioxide.
- 18:47And what happened on that?
- 18:48Actually Governor Cuomo was very
- 18:51strong and put the legislation and
- 18:54there is a law in New York now
- 18:57that prohibits the manufacturers
- 19:00to put 1.4 dioxane in detergents
- 19:03and household items.
- 19:05Now there is a lawsuit from the
- 19:07industry against the government,
- 19:08but you know,
- 19:08at least they put that and they
- 19:10recognize that because everything,
- 19:12and I don't have time to go through that,
- 19:15your tide, your your shampoo,
- 19:17your everything,
- 19:17it has 1.4 dioxane and everything is
- 19:20going to go down to the water table.
- 19:22And especially in Long Island,
- 19:25the public water comes from well water.
- 19:28So it's a major concern.
- 19:29Another area,
- 19:31which was one of the reasons that
- 19:35NIH had a very strong also thing
- 19:37is NIHS locates in North Carolina,
- 19:40major, major contamination.
- 19:41Also in North Carolina in the Cape
- 19:45Fear River is fully contaminated
- 19:47and you know it's still getting
- 19:49a lot of discharges in there.
- 19:52Is it only there?
- 19:53No, we have the case of Michigan,
- 19:55which I'll explain you later.
- 19:57We're working on that.
- 19:58Ann Arbor has a major plan of
- 20:011.4 dioxane sitting right there
- 20:02and there's a lot of concern.
- 20:05New Jersey found out last couple of
- 20:08years that the public water had 1.4 dioxane.
- 20:13And what happened there is a lawsuit.
- 20:14I haven't followed up the details,
- 20:16but in March 23 of 2023.
- 20:20The water companies shoot the
- 20:22manufacturers for putting 1.4
- 20:24dioxin into the river,
- 20:25which eventually ended up into
- 20:27the drinking water.
- 20:28So there's a lot of things going on and this
- 20:31is happening just right now.
- 20:33That was again in a different area in
- 20:35North Carolina where they found again
- 20:401.4 dioxin 1300 times higher
- 20:42compared to the reference level.
- 20:45So what I'm saying is there is a lot of
- 20:49issues in there simply because was not
- 20:52nobody was paying attention before and
- 20:54this is this is something that due to
- 20:57the difficulties in determining that
- 20:59and having the assays but eventually
- 21:02right now there is a major concern.
- 21:05So in terms of toxicity in general
- 21:08most of the toxicity what we know
- 21:10or what we knew and what we're going
- 21:13to do is from liver and kidney OK.
- 21:16But however they have been found that
- 21:18there is some effects also in nasal
- 21:21and eye liver toxist is dose dependent
- 21:25characterized by cell degeneration,
- 21:27preneoplastic lesion development,
- 21:30acid lobular swelling, necrosis,
- 21:33increased DNA synthesis,
- 21:35all the prenea plastic damages that
- 21:38you can see in chromosomal damage
- 21:41and and and enzyme leakage.
- 21:43The kidney toxicity manifests as a
- 21:46generation of the cortical tube cells,
- 21:48tubular tubular neclosis and
- 21:52chloro nephritis.
- 21:54So the other thing that we have
- 21:56discovered in our and which I think
- 21:59it could be very disturbing but is
- 22:01that we found out that there is
- 22:03a potential disruption of glucose
- 22:06homeostasis at least in our mice.
- 22:09But again, it's not published.
- 22:11We have it here.
- 22:14So the studies and I'm not going to go,
- 22:16I can bypass because time is running.
- 22:19There are a lot of,
- 22:20a lot of experiments both in mice
- 22:23and rats in over the two years that
- 22:26it is a proven liver carcinogen.
- 22:28And you know it has been shown
- 22:32that you know it is occurring in
- 22:35various labs throughout the year,
- 22:37throughout the globe and they
- 22:39found the same thing.
- 22:40So one of the thing though that it was
- 22:43a little bit puzzling is when they took,
- 22:46they did the genotoxicity.
- 22:47In other words they did the aims test
- 22:50or sister comma the exchange test.
- 22:52They couldn't find any genotoxicity
- 22:55for this 1.4 dioxin.
- 22:56So they said well it's not the mutagen,
- 22:58maybe it's a promoter.
- 22:59As you can see on the 4th bullet,
- 23:02well,
- 23:02there is a published study published
- 23:05last year by a Japanese group
- 23:07that indicates that 1.4 dioxin can
- 23:10induce DNA adducts as well.
- 23:13OK, and they're going on that.
- 23:16But what really triggered my interest
- 23:18and this is what really reflects
- 23:21essentially the mode of action of
- 23:241.4 dioxane is what they did is
- 23:28they took genotoxic carcinogens
- 23:31not genotoxic carcinogens in 1.4
- 23:34dioxane and they did the studies
- 23:36in both mice and rats.
- 23:37They measured the RNA sick and
- 23:40they try to make sense if 1.4
- 23:43dioxin belongs to one or the other
- 23:46group based on gene expression.
- 23:49And what they found as you can
- 23:50see from the from the slides
- 23:521.4 dioxin is a distinct form.
- 23:55So in other words it's it's does not
- 23:58belong to any of these two models
- 24:00which I thought it was very interesting
- 24:03and it was worth of exploring.
- 24:05So let's go and see what we're doing.
- 24:09So our Project 1 briefly goes
- 24:11on liver cancer and biomarkers.
- 24:14So essentially we're trying to use mouse
- 24:18models, human cells and organization,
- 24:21also zebra fish to dissect the
- 24:25molecular mechanisms of causing cancer.
- 24:27That's what the Project one does.
- 24:30The project Two, as I told you,
- 24:32there is no epidemiological study on,
- 24:35you know, on on 1.4 dioxin.
- 24:38And this was the major obstacle
- 24:40that I had to go through for the
- 24:43resubmission because everybody,
- 24:44when I was putting the stuff about
- 24:47carcinogenist, they said, well,
- 24:48we don't have epidemiological status.
- 24:50Well, somebody has to do it anyway.
- 24:53To make a Long story short,
- 24:54the budget of this project, it's not huge.
- 24:57So we did not have money to do
- 25:00the epidemiological studies.
- 25:02However, the NIHS said we do want
- 25:04you to do something about it.
- 25:06So what we decided was exposure assessment.
- 25:10So in other words epidemiological
- 25:13studies in much less number of samples.
- 25:17So the Project 3 is something
- 25:19that we're trying to detect the
- 25:221.4 dioxin and Co contaminants
- 25:24in areas that they're there.
- 25:26My whole idea in here is can we
- 25:29develop a system that it can be
- 25:32online that you can monitor the area,
- 25:35do the bio monitoring from your computer
- 25:38or the EPA can you know get the information.
- 25:42It's a difficult task.
- 25:45Many eliminated Jordan patio
- 25:46that when I talked to them about
- 25:48they said I cannot be done.
- 25:50Anyway, to make a Long story short,
- 25:52I'll show you what we're doing
- 25:53and we're trying to develop that,
- 25:54but the the idea of having those
- 25:57sensors is really hot right now in
- 26:00all the aspects that you can do.
- 26:02Finally, the project for as I told you,
- 26:04and this is another very important project,
- 26:07is how we can degrade.
- 26:10So you're well watered,
- 26:12most likely might have 1.4 dioxide.
- 26:15I'm not saying it does,
- 26:16but if it does, how you can purify it?
- 26:19Well, you can purify it with reverse osmosis,
- 26:22but do you have $15,000 to?
- 26:24So it's just for reduce versus
- 26:26Moses on your water.
- 26:28And some people may afford it,
- 26:30but how about the people that they cannot?
- 26:31We're talking about environmental
- 26:33justice as well.
- 26:34So there's a lot of issues that
- 26:36need to be discussing there.
- 26:37So that's Project 4.
- 26:40And the Project 4,
- 26:42essentially what it tries to
- 26:43do is trying to use what we
- 26:46call advanced oxidation,
- 26:47which is essentially oxidative stress.
- 26:49And I have more slides to show you,
- 26:51but I want to give you the big picture.
- 26:53So you try to utilize hydrogen peroxide,
- 26:56you break the hydrogen peroxide,
- 26:58you create reactive oxygen species
- 27:00and then the reactive oxygen species
- 27:03that can degrade your chemical.
- 27:05And this is also we're trying to do
- 27:08something similar with PFS as well.
- 27:10But anyway, this is of the record.
- 27:11Let's go for
- 27:15project One.
- 27:15This is the theme that we have.
- 27:17Essentially Yin Chen leads that I'm
- 27:20a Co leader, but I'm following her.
- 27:23That's her project.
- 27:25And we have of course Georgia from
- 27:27from and other people in the lab.
- 27:30And this is in collaboration
- 27:31with the National Toxicology
- 27:33Program with Stephen Ferguson,
- 27:35who is doing the human
- 27:38Hepatocytes and also the human,
- 27:41the 3D structures of the of
- 27:43the of the human cells that we
- 27:45can do the organoids and we
- 27:47can test 1.4 dioxin in there.
- 27:49So what we do here at the
- 27:51Yale and I'll show you is,
- 27:53is we're doing the mouse work.
- 27:55So NTP,
- 27:56National Toxicology Program is helping
- 27:58us with determining the effects on cells.
- 28:02And Robin Tanway from Ohio State University,
- 28:05which I was there 10 days ago,
- 28:07they're evaluating our 1.4 dioxin but
- 28:11most importantly the mixtures with the
- 28:14other Co contaminants on zebrafish.
- 28:16Why we do that because to do that
- 28:19in mice you need you know about
- 28:2320 fold budget and much more
- 28:27time to evaluate that in mice.
- 28:30So zebrafish in an is an amazing
- 28:33tool and actually his here facility
- 28:37up in Oregon State for the zebra
- 28:39fish screening and especially the
- 28:41exposomic studies is truly amazing.
- 28:43So we take advantage of that and
- 28:46actually we're not restricting the
- 28:48science only to carcinogenicity,
- 28:50but we're also doing a lot of stuff
- 28:53for behavioral stuff and also
- 28:55for that could have an effect on
- 28:58mental issues of this compound.
- 29:00So what we really know again
- 29:03this is I'm going to pass,
- 29:05I have covered that quite a bit.
- 29:07We know that causes cancer.
- 29:08We don't know the mechanism 1.4
- 29:11dioxin is a carcinogen in mice.
- 29:14We don't know what what is
- 29:16doing and what is going on.
- 29:17So what we're doing,
- 29:19so we're doing animal study,
- 29:21we're not just repeating what
- 29:23it has been done before,
- 29:25but we're trying to use knockout animal
- 29:27models that will have an effect on on this.
- 29:31So we're using models on oxidative stress
- 29:35and I will give you the examples in here.
- 29:37But essentially the first part is we're
- 29:40using mice and we do high dose and low dose.
- 29:44For the high dose is to get the effect,
- 29:46low dose is to mimic the human exposures.
- 29:49And from there we're doing the
- 29:52Omics based system approach,
- 29:53we're doing the RNA transcriptome,
- 29:56the metabolomics and also the
- 29:58phenotyping of this mice and we
- 30:01have quite a bit of data so far.
- 30:03So then we'll combine this on using
- 30:06deep learning, doing the RNA 6,
- 30:09the metabolomics and you know
- 30:11also the clinical,
- 30:12the not clinical,
- 30:13the phenotyping things and we're trying
- 30:15to determine the mode of action,
- 30:17the MOA and also the exposure and
- 30:20toxicity biomarkers which we're
- 30:21going to feed the project to when
- 30:23they do the exposure analysis.
- 30:25I told you before that we also
- 30:28using the the HEPA RG cells with
- 30:32NTP and the zebra fish for the AM 3.
- 30:36Here is a little bit of
- 30:38of the what we know and what
- 30:41we're currently know regarding the
- 30:43the metabolism of 1.4 dioxane.
- 30:45One of the thing I want to take your
- 30:48I want to have your attention to it.
- 30:50It is metabolized by cytochrome P452U1.
- 30:53Why this is important?
- 30:55Because cytochrome P452U1 is the
- 30:59activator of many carcinogens,
- 31:01many what we call precarcinogens to
- 31:06very active intermediates that they can
- 31:08cause cancer that can interact with DNA.
- 31:10So as you can see on the right
- 31:12hand side you can see also you
- 31:15have the TCe and the PCE which have
- 31:17the solvents which can also be
- 31:20metabolized by cytochrome P452.
- 31:21I want you to keep that in mind
- 31:24because what we have found,
- 31:26it's something that I think we have
- 31:28explained some of these effects.
- 31:30So we've we've already
- 31:31published quite a few papers.
- 31:33In terms of the mechanism,
- 31:35I wish I had too much time to show you,
- 31:37but one of the major findings that
- 31:39we did and nobody has shown that
- 31:43before is we found that 1.4 dioxane
- 31:46induced the cytochrome P452E1.
- 31:50And why this is important?
- 31:52Because if you have a Co exposure of
- 31:56cytochrome P452E1 and trichloroethylene
- 31:58or diethyl nitrozamine in your
- 32:01cigarette smoke or in, you know,
- 32:03in the smoke food that you eat,
- 32:05then you have higher chances of
- 32:07metabolizing the procarcinosis to
- 32:09carcinosis and they can cause liver cancer.
- 32:12So in other words,
- 32:13it can act as a promoter by
- 32:16inducing the cytochrome P452E1 in
- 32:19addition to the cytochrome P452E1.
- 32:21And you can see it in your left.
- 32:23We find that there is increased
- 32:25oxidative stress as indicated with
- 32:27four hydroxynone anal and also with the
- 32:30increase of the quinone oxidoridactase,
- 32:32which is a gene involved in
- 32:35the antioxidant response.
- 32:39So I apologize this happens again.
- 32:43You know the the image becomes a little
- 32:46bit but what the highlights of our
- 32:49research are this and this happens to me.
- 32:51I don't know why this but I have
- 32:54another one that I can show you.
- 32:56But we have find out so far that there
- 32:58is a direct xenotoxic effect for
- 33:01dioxin that includes oxidative stress.
- 33:03We already published that in 2022.
- 33:05There is a dominant role of two one
- 33:08in the metabolism as we have found by
- 33:11metabolomics and also for the liver toxicity.
- 33:15But also we have not only
- 33:20the induction of 2 E one,
- 33:22we have found the 2nd mechanism which is
- 33:26completely independent of Cytochrome B452E1.
- 33:28How do we do that?
- 33:30We're using knockouts that they have not
- 33:33Cytochrome B451 and we determined that.
- 33:36So this is what we're doing.
- 33:38Specific aim one and specific aim 2
- 33:41is we're using knockout mice and again
- 33:45remember we have the metabolism here.
- 33:47As you can see Cytochrome B450 is
- 33:50metabolized the first two animal models,
- 33:53the GCLM knockout is a model of
- 33:57mice that has low glutathione
- 33:59levels so that animal model,
- 34:02it has low antioxidant capacity.
- 34:04Nerf 2 knockout model is the Nerf two
- 34:07is a transcription factor involved
- 34:10in all the genes involving
- 34:12done dioxidant response.
- 34:13So if the nerve 2 gets activated,
- 34:16your cell becomes really active.
- 34:20Against the insults and we try we
- 34:22you we're currently using that,
- 34:24we're doing the experiments and to do that.
- 34:27So we're also using the cytochrome P4
- 34:30phase E2E1 As I said we completed those
- 34:33studies actually and we're using the NQ
- 34:36one and also the aldehydehydrogenase 2.
- 34:38As you can see the Ald H2 could
- 34:41be involved in the last steps
- 34:43of the metabolism of that.
- 34:44And you know the Ald H2 is a gene that
- 34:48has it's highly polymorphic in a lot
- 34:51of individuals especially those in from
- 34:56the from Asian population quite a bit.
- 35:00So Project 2 is the exposure
- 35:03assessment team led by Co led by
- 35:06Nicole Diesel and Brian Litter.
- 35:09And we have also most of our people from
- 35:11our department in exposures Crystal,
- 35:13Pollet, Zhai and Lu.
- 35:15And also we have collaborators
- 35:17in North Carolina State,
- 35:19Joe Hoppin and and death of Nappy.
- 35:22And this as I told you is going
- 35:26to be an exposure model,
- 35:27exposure assessment model here
- 35:29in Long Island and we have
- 35:32already going through that.
- 35:34So the aims again is you go you
- 35:36collect the water you collect the
- 35:38blood from these people and then
- 35:41you're trying to also make much the
- 35:45the medical records and you're trying
- 35:47to do the exposure assessment and
- 35:49we're trying to interact all this this
- 35:52project as I told you as we're using
- 35:54metabolomics in this in this project
- 35:56and the metabolomics here will be
- 35:59coordinated with a metabolomics for
- 36:01the first program which is on the
- 36:041st specific aim which is in mice.
- 36:06The third project is led by many
- 36:11Elimelech from the school of the the
- 36:15Department of Chemical Environmental
- 36:17Engineering and also you know is Jordan
- 36:20Petia and true Gender are from this,
- 36:23from this group.
- 36:24And again what we're they're
- 36:26trying to do is they're trying to
- 36:28develop this kind of molecules,
- 36:30the eptomers or all this idea that it
- 36:33can bind to that and then it can be
- 36:37detected and then they can transmit that.
- 36:40It's stuff we're not going to
- 36:41accomplish in the first five years,
- 36:43but at least we can develop the sensors
- 36:46to develop and then we can try to find
- 36:48out how we can develop the network.
- 36:514th project,
- 36:51and I apologize,
- 36:52I'm trying to give to finish so we
- 36:54can have some time for discussion.
- 36:564th project is by Jai Hong Kim
- 36:58and John Faulkner.
- 36:59And as I told you this is relating
- 37:02to develop small devices that
- 37:04you can use in your house to get
- 37:07rid of 1.4 dioxide and they're
- 37:09using the advanced oxidation.
- 37:11It will take me about a lecture to
- 37:13explain you that but essentially I think
- 37:16I told you the principle is hydrogen
- 37:18peroxide generate hydroxy radical and
- 37:20this hydroxy radical will hit that.
- 37:22They are using actually two kind
- 37:24of approaches in there and I think
- 37:26I have they they are developing
- 37:29some nice some nice things and
- 37:32I'm going to tell put there share
- 37:34some that you can that
- 37:35we have made.
- 37:37We successfully synthesized the catalyst,
- 37:40the boron doped carbon catalyst
- 37:42shown here and fabricated
- 37:44hydrogen peroxide synthesis cell.
- 37:47We quickly discover that maintaining
- 37:49the performance in the real water
- 37:52metrics would be the key for success
- 37:54of this research to provide a
- 37:57system that can perform for a long
- 37:59period for a household application.
- 38:01We therefore developed a framework on
- 38:04how to optimize post electrolysis to
- 38:07enhance catalytic tolerance against
- 38:10impurities present in water and in to
- 38:13improve overall lifetime of the cell.
- 38:16We discovered that optimized pulsing
- 38:19sequence enabled improved long term
- 38:22hydrogen peroxide performance to
- 38:24nearly 300 hours and 35 times better
- 38:27than conventional electrolysis even
- 38:29in the presence of most detrimental
- 38:32impurities such as nickel and zinc.
- 38:35These findings make this cell closer
- 38:38to real world implementation for
- 38:41prolonged hydrogen peroxide synthesis and
- 38:44subsequent one for dioxane destruction.
- 38:48Let me share some recent progress.
- 38:50This is the second we have made
- 38:51we successfully synthesized the
- 38:56I'm sorry it was I thought it was
- 38:59as an. This is the second method
- 39:01destroy one for dioxane in specific
- 39:04aim too we explore the use of
- 39:07engineered gas phase nano bubbles.
- 39:10We perform extensive characterization
- 39:12of nano bubbles in solution with a
- 39:15focus on hydro thoradical generation
- 39:18and by performing a number of different
- 39:22characterization using degradation of hydro
- 39:24thoradical specific target compounds,
- 39:26electron paramagnetic resonance spectroscopy
- 39:29and a fluorescence based indicator.
- 39:32Through this phase of research we
- 39:35concluded that nano bubble induced or hydro
- 39:38thoradical generation is minimal if not all.
- 39:41But we will continue to study if there
- 39:43is an alternative way to enhance the
- 39:46non local enabled advanced workstation.
- 39:50So I alternative technology
- 39:52I wouldn't be able to tell you that. So
- 39:57that's why I sent my daughter my
- 39:59daughter's first year in governmental
- 40:01engineering in Boulder, Co.
- 40:03So the next is our the next is
- 40:05our community engagement core,
- 40:07which will have Iris,
- 40:09Kaminski and Andrea and Esposito.
- 40:11Call it Derry Woods,
- 40:13executive director of the Citizens
- 40:14Campaign of the Environment.
- 40:16And we, you know, she's very big,
- 40:19big in terms of community
- 40:21engagement and we're doing quite
- 40:23a bit in in community engagement.
- 40:25We're ready and we utilize community
- 40:28engagement actually to recruit
- 40:30people for the project too.
- 40:32This has been fascinating so far,
- 40:35but we're not staying only in
- 40:37Log Island or even Vermont.
- 40:40We're expanding in other areas too.
- 40:42So the other areas that I'm working
- 40:44right now and I will tell you is
- 40:46the New Hampshire in North Carolina,
- 40:48Michigan,
- 40:49and recently I have been engaged by Florida.
- 40:53Believe it or not,
- 40:55there is an area over there,
- 40:56Lake Mary,
- 40:57that has even 30,000 times higher
- 41:01levels of 1.4 dioxin in their surface water.
- 41:06Anyway,
- 41:06this is some of the stuff that
- 41:09we've already done and the publicity
- 41:11that the centre is getting and
- 41:12I have more and more,
- 41:14but I'm just leaving you that we're
- 41:16using that as a tool and we communicate,
- 41:18you know, people calling me in the office,
- 41:21they said we want to register
- 41:22for this study and you,
- 41:24they need more information.
- 41:25And this has not been studying
- 41:27only in Long Island.
- 41:29And you know, newspapers have taken
- 41:31the centre because of the importance,
- 41:33as I told you,
- 41:34of 1.4 dioxin discovered in many states.
- 41:37So we're getting a lot training component.
- 41:39I think I was smart on that.
- 41:41I took our Jordan,
- 41:44I mean I took Chris Judy.
- 41:46Chris,
- 41:47Judy is our esteemed director of
- 41:49a graduate program at way SPH.
- 41:51And also we have the engineer,
- 41:53a graduate program.
- 41:54And this too made a dream team
- 41:57and you know it had actually the
- 41:59best one of the best scores on the
- 42:02components they had almost 1012 on
- 42:05their application and Yin Chen is
- 42:08also part Co investigator on that.
- 42:11So the way building up training
- 42:14education capacity going from even
- 42:18under graduates with an R-25 that
- 42:21they have on training undergraduate
- 42:24students to MPH students and also
- 42:27PhD students and post doctoral.
- 42:29This is classic regular the schedule
- 42:33we're doing for the training of our PhD.
- 42:37Last but not least and I kept the
- 42:39picture in here of Peter Petuzzi,
- 42:42although he retired and he
- 42:43just stepped down right now,
- 42:45but I love Peter and that was another
- 42:48another dream team here of Hong Yu
- 42:51Zhao and Peter Petuzzi that they
- 42:53that they do the data management and
- 42:56analysis core team which essentially
- 42:58bring all the projects together.
- 43:00And I'm not going to go to all specific aims,
- 43:03but essentially it's coordination
- 43:05between projects and cores, fostering,
- 43:08data sharing and interoperability.
- 43:12So we're trying to develop all this
- 43:14cloud systems and finally and most
- 43:17importantly is data quality assurance,
- 43:21quality control and data integration.
- 43:23So this is huge and we get really good.
- 43:27So I am almost at my 45 minute mark and
- 43:33essentially what I would like to say,
- 43:36the establishment of our Yale Superfan
- 43:39Centre marks a significant milestone of
- 43:42our departmental commitment to addressing
- 43:45emerging contaminants linked to cancer.
- 43:48Our strategic plan includes the development
- 43:51of peripheral research project.
- 43:53We get the budget cut of almost 50%
- 43:55of our initial budget, not only us,
- 43:58everybody did because they withdrew some
- 44:00money from that project to support the
- 44:03climate change in a number of institutes.
- 44:06So what we're trying to do is we're
- 44:08trying to develop peripheral research
- 44:10projects for exposure assessment and
- 44:12various locations across United States,
- 44:15fostering international collaboration
- 44:16and broadening the impact of our work.
- 44:20We aim to strengthen the partnerships
- 44:23of course with Cancer Center,
- 44:25with the liver center, with diabetes Center,
- 44:28leveraging their expertise and
- 44:30resources for more comprehensive
- 44:33approach to our research in vendors.
- 44:37And as we advance,
- 44:38our focus will extend beyond the scope of of
- 44:43the 1.4 dioxin and the volatile compounds.
- 44:46And we try,
- 44:47I'm going to try to get more emerging
- 44:50contaminant with particular emphasis to PFAS.
- 44:54And actually PFAS is, you know,
- 44:59because of their ability
- 45:02to be endocrine disruptors,
- 45:04they have been linked now
- 45:07to obesity and diabetes.
- 45:09And as I told you before,
- 45:10we find something similar and
- 45:11there are a lot of interaction.
- 45:13Another thing about PFAS
- 45:15induces kidney cancer, OK,
- 45:17it's the major cancer that
- 45:19induces is kidney cancer.
- 45:21So what is the,
- 45:22you know,
- 45:22the interaction of this between them?
- 45:24This is something that we need to explore.
- 45:26So this expansion will involve in depth
- 45:29exploration between links and the PFAS
- 45:32especially as I told you kidney cancer
- 45:34and and and obesity bringing virus
- 45:37insight to the scientific community.
- 45:39I'm going to stop with that and I'm
- 45:41going to take questions and we're
- 45:43happy to discuss anything you wish.
- 45:51Yes, great. Thank you.
- 45:53I the whole project began
- 45:58with the involvement of the
- 46:00community alerting you to 1 dioxide.
- 46:02So at the Cancer Center,
- 46:05liver cancer is a priority.
- 46:06Cancer that is in the strategic
- 46:09plan given its increased rates in
- 46:11Connecticut as well as nationally.
- 46:14So I'd love to think about
- 46:16collaborations to how we can
- 46:18do more on the epidemiologic or
- 46:20clinical aspect and and link it,
- 46:22you know with patients coming in
- 46:24newly diagnosed with liver cancer.
- 46:26Could there be a case control study
- 46:28where water is collected from their
- 46:31home blood questionnaires and
- 46:32then have a a controlled sample.
- 46:34So there's so much opportunity.
- 46:36I think here
- 46:37that's what David said. That's why
- 46:39he invited me to give the talk here.
- 46:41We need to get this, Melinda,
- 46:42this is a very good point.
- 46:44If we can get more and actually, you know,
- 46:47we can explore the possibilities and
- 46:48if we have more blood samples of that,
- 46:51we can do much better, much, much more.
- 46:54And that's a very good point. Yes.
- 46:58Going to Long Island for Thanksgiving,
- 47:01get your water with you. Is
- 47:04there a safe like what do you recommend?
- 47:07What is there a brand of like bottled
- 47:09water that doesn't that's guaranteed to
- 47:11not be contaminated? Depends.
- 47:13Now listen, I mean there are
- 47:15there are areas in Long Island,
- 47:16there is this interactive map that you can
- 47:19find which areas they have high levels.
- 47:21But to be on the safe side, you know,
- 47:24I was going to say use public water,
- 47:27but this public water over
- 47:29there comes from well water.
- 47:30I don't know how the late status is,
- 47:33but it might not be a bad idea
- 47:34to use some bottled water.
- 47:39First of all, I want to echo on you
- 47:41and Melinda set because there are
- 47:44tremendous opportunities here that
- 47:45are aligned in many ways with the
- 47:48forthcoming Cancer Center strategic plan.
- 47:51I'd like to add to that education because
- 47:54you have cancer education programs running
- 47:58that are cancer connected education
- 48:00programs running that are complementary
- 48:03to our other training programs.
- 48:05The question for you though is you began with
- 48:09a a challenge from the state of Connecticut,
- 48:11but I noticed all the
- 48:12collaborations are out of state.
- 48:14Can you tell us more about how
- 48:16this work might impact our state
- 48:19and our catchment community?
- 48:23It's the same thing.
- 48:26There are
- 48:27certain areas that they have 1.4
- 48:29dioxane in the state of Connecticut.
- 48:32However, the state of Connecticut has
- 48:34taken very good care of the public water
- 48:38and their public water is pretty safe.
- 48:40You are as long as you are in public water,
- 48:43they're taking good care how it's
- 48:45going to have a major impact.
- 48:46It's going to have a major
- 48:48impact on on liver cancer.
- 48:50But you know the problem,
- 48:52it might not be completely here,
- 48:54but it has several aspects of you know,
- 49:00getting engaged with
- 49:04agencies, the state agencies addressing that.
- 49:07And as Melita said, there is an
- 49:09increased rate of of liver cancer,
- 49:11which brings the other point
- 49:12you were talking about.
- 49:13I also have AT32 program with the
- 49:17livers with psychiatry essentially.
- 49:20But it's my point of view is my other
- 49:23lab that I have is alcohol and cancer and
- 49:26I actually organized the International
- 49:29Conference on Alcohol and Cancer.
- 49:31So this is another area that I think
- 49:34the increased levels of alcohol
- 49:35consumption is a very good contributor
- 49:38and that along with obesity.
- 49:40So if you add another factor which is
- 49:431.4 dioxin even if it's in low levels
- 49:46for for example in the state of Connecticut,
- 49:49what we saw in here there is an
- 49:51increase of the Cytochrome P CN¥452.00.
- 49:54So if you get get that in combination
- 49:58with smoking nitrozamines or other
- 50:01exposures you can increase the rate
- 50:04of you know of of cancer in the area,
- 50:10right. Yes,
- 50:15well that's a good point.
- 50:18Listen, we have done a lot of risk evaluation
- 50:23risk for water sources in on wells water.
- 50:27I wouldn't say that 1.4 dioxin is
- 50:30that major concern because we know
- 50:31what the were the areas of 1.4 dioxin.
- 50:35My concern would have been more on the PFAS.
- 50:39So my recommendation is test
- 50:41your well water for PFAS,
- 50:44that's the only suggestion.
- 50:47I don't think in Connecticut we
- 50:49have that major issue of 1.4 dioxin.
- 50:59Well, if you test, that's a very good point.
- 51:01If you test it, if you test your well
- 51:04and it's positive for 1.4 dioxin,
- 51:06you don't have to wait for for
- 51:09Jihong Kim to develop these devices.
- 51:12What you do is you use plastic water,
- 51:14I mean plastic water from,
- 51:16you know, from bottles.
- 51:17Of course you can have some things
- 51:19from there, but it's at least safer.
- 51:22If you find that there is P fast,
- 51:24the P fast, you can filter them
- 51:26with charcoal and stuff like that.
- 51:28So there are devices that
- 51:30they're relatively cheap.
- 51:32But one of the things that I want to tell
- 51:34you is the importance of drinking water.
- 51:36Because you're going to drink,
- 51:38you may avoid drinking alcohol,
- 51:40you may avoid smoking cigarettes,
- 51:43but you're going to drink your water.
- 51:44Yes,
- 51:48you're safe,
- 51:51you're safe,
- 51:55You cover both of them.
- 51:59Well, the other thing is
- 52:01you know in terms of the,
- 52:03the Cancer Center is the liver
- 52:06center and also there is a high
- 52:09incidence of alcohol induced liver
- 52:11cancers and not only the liver
- 52:13cancer but also colorectal cancers.
- 52:15And the incidence of colorectal cancers
- 52:17are really high as well throughout
- 52:19not only the nation internationally
- 52:22and especially the early onsets.
- 52:32Yes,
- 52:34I think so. Yes.
- 52:37So thank you for the question.
- 52:39Usually the stages are, you know,
- 52:41you start from steatosis,
- 52:43you go to fibrosis,
- 52:44you go to cirrhosis and then
- 52:46some cases you know you go to
- 52:49a pater cellular carcinoma.
- 52:51It is possible that you can
- 52:53go without cirrhosis.
- 52:54Yes, I mean in animal models
- 52:58they go without any any
- 52:59signs of cirrhosis at all.
- 53:06But one of the problems, well,
- 53:07talking about the animals and
- 53:08humans and stuff like that,
- 53:10you know that alcohol,
- 53:12it is well known that causes
- 53:15liver cirrhosis, right?
- 53:16If you try to do the same thing in mice,
- 53:20there is no way you can do it.
- 53:21But you can take a mouse and you can
- 53:24put carbon to trichlorate for 3-4 weeks,
- 53:27you'll get cirrhosis 100%.
- 53:29So that's that's the the challenges
- 53:32that you have between animal models
- 53:34and human thing and that's what we're
- 53:36trying to to do the organoids as a
- 53:39complementary to to the mouse studies.
- 53:46All right. Thank you very much.