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Glinda S. Cooper,¹ Susan L. Makris,¹ Paul J. Nietert,² and Jennifer Jinot¹

¹National Center for Environmental Assessment, U.S. Environmental Protection Agency, Washington, DC, USA; ²Medical University of South Carolina, Charleston, South Carolina, USA

Abstract
Objective: Our objective was to examine experimental and epidemiologic studies pertaining to immune-related, and specifically autoimmune-related, effects of trichloroethylene (TCE) .

Data sources and extraction: We performed a literature search of PubMed and reviewed bibliographies in identified articles. We then systematically reviewed immune-related data, focusing on clinical and immunologic features and mechanistic studies.

Data synthesis: Studies conducted in MRL^+/+ lupus mice report an accelerated autoimmune response in relation to exposure to TCE or some metabolites. Effects have been reported after 4 weeks of exposure to TCE at doses as low as 0.1 mg/kg/day in drinking water and have included increased antinuclear antibodies and interferon-γ (IFN-γ) and decreased secretion of interleukin-4 (IL-4) , consistent with an inflammatory response. Autoimmune hepatitis, inflammatory skin lesions, and alopecia have been found after exposures of 32–48 weeks. Recent mechanistic experiments in mice examined oxidative stress and, specifically, effects on lipid-peroxidation–derived aldehydes in TCE-induced autoimmune disease. Two studies in humans reported an increase in IL-2 or IFN-γ and a decrease in IL-4 in relation to occupational or environmental TCE exposure. Occupational exposure to TCE has also been associated with a severe, generalized hypersensitivity skin disorder accompanied by systemic effects, including hepatitis. In three case–control studies of scleroderma with a measure of occupational TCE exposure, the combined odds ratio was 2.5 [95% confidence interval (CI) , 1.1–5.4] in men and 1.2 (95% CI, 0.58–2.6) in women.

Conclusion: The consistency among the studies and the concordance between the studies in mice and humans support an etiologic role of TCE in autoimmune disease. Multisite collaborations and studies of preclinical immune markers are needed to further develop this field of research.

Key words: autoimmune liver disease, solvents, systemic sclerosis, trichloroethylene. Environ Health Perspect 117:696–702 (2009) . doi:10.1289/ehp.11782 available via http://dx.doi.org/ [Online 9 January 2009]

Address correspondence to G.S. Cooper, National Center for Environmental Assessment (8601-P) , U.S. Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, DC 20460 USA. Telephone: (703) 347-8636. Fax: (703) 347-8689. E-mail: cooper.glinda@epa.gov

The views expressed are those of the authors and do not necessarily reflect the views or policies of the U.S. Environmental Protection Agency.

The authors declare they have no competing financial interests.

Received 10 June 2008 ; accepted 9 January 2009.