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Abstract: PO1421

Drilling into a Potential Correlation Between ANCA-Associated Vasculitis and Natural Gas Wells

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Makati, Devan, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Akers, James Lewis, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Shawwa, Khaled, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Schmidt, Rebecca J., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Kannabhiran, Dinesh, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
Background

ANCA-associated vasculitis (AAV), a systemic necrotizing disease affecting small and medium blood vessels, is caused by antineutrophil cytoplasmic autoantibodies which target intracellular proteinase 3 (PR3) or myeloperoxidase (MPO). The incidences of PR3-AAV and MPO-AAV vary geographically with PR3-AAV most commonly reported in the United Kingdom and MPO-AAV the predominant type seen in Japan. Environmental exposure has been implicated in the pathophysiology of MPO-AAV. The aim of this study is to evaluate a potential relationship between AAV and environmental factors in north central West Virginia.

Methods

This is a retrospective cohort study of 212 patients diagnosed with AAV at West Virginia University and its affiliated hospitals from January 1, 1990 to December 31, 2019. Patients were mapped by zip code and prevalence of AAV assessed over time.

Results

The proportion of MPO-ANCA cases increased (37.5% before 2010 vs 71.7% after 2016 (p=0.008)) with a resultant increase in the prevalence of AAV overall after 2010 (Table). During this time, the production of natural gas through fracking increased with barrel production rising more than 5-fold after 2010. Regional heat mapping reveals that the increase in cases of AAV occurred in areas of increased fracking activity (Figure)

Conclusion

The increase in prevalence of MPO-ANCA AAV correlates temporally and geographically with escalations in fracking activity. These findings suggest that exposure to toxins from fracking could be operative in the pathophysiology of AAV and the increase in case numbers seen in north central West Virginia.

Prevalence of ANCA before and after 2010
Prevalence per 100,000Before 2010After 2010p- value
Overall4.84 (N=24)11.73 (N=61)<0.001
PR3-ANCA3.25 (N= 16)4.42 (N=21)0.41
MPO-ANCA2.24 (N=8)7.66 (N=40)<0.001

Pictured on the left is a map of all the gas fracking wells (pictured in red) and gas and oil fracking wells (pictured in yellow) (WVGES Maps and GIS Data Menu [wvnet.edu]). Pictured on the right is a map of the ANCA cases diagnosed after 2010.