Orem, and 9 co-authors, reported in 2007 that coal contains myriad organic compounds, some known to be toxic and others that are potentially toxic. Toxic organic compounds found in coal of particular interest include:
i) condensed aromatic structures (e.g., polycyclic aromatic hydrocarbons), which can act as mutagens, cancer promoters, and endocrine disrupters;
ii) aromatic amines, which have probable nephrotoxic activity; and
iii) heterocyclic compounds, which may be carcinogenic and nephrotoxic.
Toxic organic compounds can be leached from coal into water supplies, and long -term human exposure to these compounds may lead to disease occurrence, including cancer and renal disease. Despite these potential hazards, little is known about the impact and toxicity of organic substances derived from coal in water supplies. One example of a disease hypothesized to be linked to coal-derived toxic organic compounds in water supplies is Balkan endemic nephropathy (BEN).
In this paper, The authors summarized results from our studies linking BEN to the leaching of toxic organic compounds from low rank (lignite) Pliocene coal deposits into water supplies (well and spring water) of the rural villages where the disease occurs. The authors also introduced the idea of pandemic nephropathy (PEN) for BEN-like diseases that are linked to coal-derived toxic organic compounds in water supplies, but that occur outside the Balkans. Preliminary results supporting the PEN hypothesis are presented, with results from proposed PEN areas in Wyoming (WY) and Louisiana (LA). Results of toxicological studies of the effects of organic compounds isolated from water supplies in BEN and PEN areas on human cell cultures are also discussed. China, India, Turkey, and Portugal represent other areas where BEN-like diseases may occur, as a result of the presence of extensive low rank coal deposits and rural populations using untreated water in contact with coal in these nations.
The hypothesis implicating coal-derived toxic organic compounds in the etiology of BEN has been tested, and results support the hypothesis. This hypothesis accounts for both the Figure 1: Coal map of the United States showing states with the highest incidence and number of deaths from renal/pelvic cancers (similar to the uroepithelial cancers associated with BEN). All of these states have large rural populations that use well water, and extensive low rank coal deposits (similar to the Pliocene lignites linked to BEN).
The hypothesis implicating coal-derived toxic organic compounds in the etiology of BEN has been tested, and results support the hypothesis. This hypothesis accounts for both the geographic restriction of BEN, and many of its medical features. Well water from BEN villages contain higher numbers and concentrations of potentially toxic extractable and HMW organic compounds compared with controls. Study results do not support involvement of inorganic substances (except for the possible involvement of nitrate as a cofactor) in water supplies in BEN etiology. The concept of PEN or BEN-like diseases (especially RPC) that occur outside of the Balkans is supported by preliminary geochemical results from the United States in states with high rates of RPC and low rank coal deposits (LA and WY). Renal disease may also be linked to lignite-containing areas in northern Portugal (Deolinda Flores, Universidade do Porto, Portugal, personal communication).
Preliminary toxicology studies exposing different types of human cell cultures (including kidney cells) to TFU concentrates from BEN wells/springs, and from areas of high RPC in the United States (LA and WY), showed a range of effects, including excessive cell proliferation at lower doses, and cell necrosis at higher doses, relative to controls. These results are consistent with both the cell necrosis associated with BEN, and the occurrence of RPC in BEN and PEN. Tangential flow ultrafiltration concentrates also induced changes in cell morphology, especially the development of large vacuoles within the cells. Additional cell line toxicology studies and animal experiments (rats) with TFU concentrates, and studies of the effects of organic compounds in TFU concentrates on lecithin : cholesterol acyltransferase activity, which is low in BEN patients (29) are currently under way.
Diseases that are like BEN (kidney nephropathy and RPC) linked to toxic organic compounds derived from coal in drinking water supplies may be widespread. This may also include toxic organic compounds in peat water used as water supplies. Ongoing work is exploring the occurrence and etiology of PEN as a global issue in medical geology, focusing on areas where low rank coals and populations using untreated well water occur (e.g. India, Turkey, China, Portugal).
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