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A newly released study suggests that exposure to a chemical commonly used in dry cleaning and consumer products has been linked to three times the risk of a dangerous liver disease. The study, published in the journal Liver International, found that tetrachloroethylene, also called perchloroethylene (PCE), was associated with triple the odds of "significant liver fibrosis" in U.S. adults. PCE is a human-made, colorless liquid used in dry cleaning, household goods and industrial settings to remove grease, among other purposes. PCE is also used in some adhesives, spot cleaners and stainless steel polish. The study cited research conducted by the Keck School of Medicine of the University of Southern California. Liver fibrosis is an excessive amount of scar tissue in the liver that can lead to liver cancer, liver failure or death, a news release from the school explains. "This study, the first to examine the association between PCE levels in humans and significant liver fibrosis, underscores the underreported role environmental factors may play in liver health,” said Brian P. Lee, MD, MAS. Lee is a hepatologist and liver transplant specialist with Keck Medicine and the lead author of the study. The findings suggest that exposure to PCE may be the reason why one person develops liver disease while someone with the exact same health and demographic profile does not." The school said people are typically exposed to PCE through the air and can be present in drinking water from contaminated sites due to spills or improper disposal of PCE. The International Agency for Research on Cancer has classified PCE as a probable carcinogen and linked it to bladder cancer, multiple myeloma and non-Hodgkin lymphoma," the release notes. Lee said other studies showed PCE exposure increased the risk of liver cancer, said Lee. The United States Environmental Protection Agency has launched a 10-year phaseout of PCE use in dry cleaning and has banned or put workplace controls on other PCE uses. To make the findings, Lee and researchers at Keck used National Health and Nutrition Examination Survey (NHANES) data. The researchers tracked PCE exposure through the concentration of PCE in individuals' blood in people 20 or older from 2017 through 2020. Lee said that of this data, which is the most recent years available, around 7% of the population had "detectable PCE." The team then examined individuals with PCE in their blood who also had "significant liver fibrosis" and found that those exposed to the chemical were three times more likely to have significant liver fibrosis than those unexposed. The results remained steady independent of factors like age, sex, race, ethnicity and education level. However, the study did reveal that those most at risk of PCE exposure were from higher-income homes. Lee said people with higher incomes may be more likely to use dry cleaning services, which would increase the exposure to PCE over time. "However, people who work in dry cleaning facilities may also face elevated risk due to prolonged, direct exposure to PCE at work," Lee said. Researchers found that for every one nanogram per milliliter increase in PCE concentration in the blood, the person's odds of having significant liver fibrosis increased fivefold. Lee said alcohol use and fat buildup in the liver, linked to obesity and other health factors, did not appear to play a role in significant liver fibrosis when PCE was present. Patients will ask, how can I have liver disease if I don’t drink and I don’t have any of the health conditions typically associated with liver disease, and the answer may be PCE exposure," Lee said. Lee said he would like to see more research in the environmental toxins field and how they affect liver disease, noting he feels there is "no doubt" other toxins exist that are dangerous to the liver. "We hope our research will help both the public and physicians understand the connection between PCE exposure and significant liver fibrosis,” he said. “If more people with PCE exposure are screened for liver fibrosis, the disease can be caught earlier and patients may have a better chance of recovering their liver function," Lee said.
