9/11 first responders with highest exposure to toxic dust at risk of liver disease

NEW YORK — Twenty years after the devastating attacks on September 11, doctors are still uncovering the fallout from the destruction of the World Trade Center. In a new study, researchers at Mount Sinai Hospital in New York have discovered a link between the toxic dust coming from Ground Zero and liver damage. Their findings show that the earliest first responders on the scene have an even higher risk of fatty liver disease than others in the area after the terror attacks.

The report is the first to connect higher odds of liver disease to time spent near the rubble in 2001. Study authors find that emergency personnel at Ground Zero within the first two weeks of the attack encountered the highest concentrations of toxic materials. These individuals are now showing greater signs of decreasing density in their livers — a key measure of liver disease due to chemical exposure (or hepatic steatosis).

What makes toxic chemicals so harmful to the liver?

Ground Zero 9/11
Mount Sinai researchers find that the earliest first responders on the scene of the 9/11 terror attack in New York City have an even higher risk of fatty liver disease than others in the area.

The liver plays a major role in detoxifying foreign substances in the body. When harmful toxins enter the body, it can disrupt this process. Steatosis means that the liver is developing unusually high levels of fat.

On the day of the September 11 attacks and in the days and weeks after, over 20,000 first responders came into contact with poisonous dust, airborne particulates, and other chemicals that doctors now know increase toxicity in the liver. All of this increases their risk for toxicant-associated steatohepatitis, the most serious form of toxicant-associated fatty liver disease. This illness can eventually lead to liver cancer and liver failure.

“Our study showed that continued monitoring for liver disease is warranted in World Trade Center responders—such as law enforcement, fire, and recovery workers in any field at the site—particularly those who arrived at or shortly after the attacks and had a higher exposure to the toxic dust,” says the study’s senior author Claudia Henschke, MD, PhD, Professor of Diagnostic, Molecular and Interventional Radiology at the Icahn School of Medicine at Mount Sinai, in a media release. “At the moment, there are no protocols to monitor responders for liver disease, so this study points to the need to further study this issue in this at-risk population.”

9/11 toxic dust impacting multiple organs

Researchers analyzed the lung scans of nearly 1,800 World Trade Center first responders during this study. All of these individuals are part of Mount Sinai’s World Trade Center Health Program Clinical Center of Excellence.

Although healthcare programs which monitor 9/11 first responders typically look out for lung trouble, study authors developed an algorithm to find evidence of liver damage which is still visible in a lung scan.

That algorithm discovered signs of lower density livers, a sign of hepatic steatosis, in more than 14 percent of patients. A closer look at this connection revealed that patients at Ground Zero within the first two weeks of the terror attack had the highest exposure to toxins coming from the destroyed buildings. With these results in hand, emergency workers with a particularly low liver density are now heading to liver specialists for diagnosis and treatment.

“Our previous work found evidence of liver disease was three times higher in the lung scans of World Trade Center responders compared to other patients’ lung scans, so this new study suggests that responders who arrived at Ground Zero earlier should receive enhanced monitoring for liver disease,” concludes the study’s first author, Artit Jirapatnakul, PhD, Assistant Professor of Diagnostic, Molecular and Interventional Radiology at Icahn Mount Sinai. “Now that we have this link, the next step is to understand why or how the toxic dust actually causes liver damage.”

The study appears in the American Journal of Industrial Medicine.