{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:42:22Z","timestamp":1786632142863,"version":"build-2736575974"},"reference-count":30,"publisher":"American Chemical Society (ACS)","issue":"1","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":4119,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Leber hereditary optic neuropathy (LHON) is a maternally inherited loss of central vision related to pathogenic mutations in the mitochondrial genome, which are a necessary but not sufficient condition to develop the disease. Investigation of precipitating environmental\/occupational (and additional genetic) factors could be relevant for prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>After a 6-month period of occupational exposure to n-hexane and other organic solvents, a 27-year-old man (a moderate smoker) developed an optic neuropathy. The patient had a full ophthalmologic and neurologic investigation, including standardized cycloergometer test for serum lactic acid levels and a skeletal muscle biopsy. His exposure history was also detailed, and he underwent genetic testing for LHON mitochondrial DNA mutations. The patient suffered a sequential optic neuropathy with the hallmarks of LHON and tested positive for the homoplasmic 11778G \u2192 A\/ND4 mutation. Routine laboratory monitoring revealed increased concentrations of urinary 2.5 hexandione (n-hexane metabolite) and hippuric acid (toluene metabolite) in the period immediately preceding the visual loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In a subject carrying an LHON mutation, the strict temporal sequence of prolonged appreciable occupational exposure followed by sudden onset of visual loss must raise a suspicion of causality (with a possible further interaction with tobacco smoke).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance<\/jats:title>\n                    <jats:p>In this article, we add to the candidate occupational\/environmental triggers of LHON and highlight the need for appropriate case\u2013control (and laboratory) studies to validate the causal effect of mixed toxic exposures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1289\/ehp.9245","type":"journal-article","created":{"date-parts":[[2006,9,19]],"date-time":"2006-09-19T15:49:36Z","timestamp":1158680976000},"page":"113-115","source":"Crossref","is-referenced-by-count":51,"title":["Grand Rounds: Could Occupational Exposure to\n                    <i>n<\/i>\n                    -Hexane and Other Solvents Precipitate Visual Failure in Leber Hereditary Optic Neuropathy?"],"prefix":"10.1021","volume":"115","author":[{"given":"Valerio","family":"Carelli","sequence":"first","affiliation":[{"name":"Dipartimento di Scienze Neurologiche, Alma Mater Studiorum\u2014University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Franceschini","sequence":"additional","affiliation":[{"name":"Dipartimento di Sanit\u00e0 Pubblica, Azienda USL Bologna, San Giorgio di Piano, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Venturi","sequence":"additional","affiliation":[{"name":"U.O. Medicina del Lavoro, Policlinico S.Orsola-Malpighi, Alma Mater Studiorum\u2014University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Barboni","sequence":"additional","affiliation":[{"name":"Centro di Oftalmologia Salus, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Savini","sequence":"additional","affiliation":[{"name":"Centro di Oftalmologia Salus, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Barbieri","sequence":"additional","affiliation":[{"name":"Dipartimento di Sanit\u00e0 Pubblica, Azienda USL Bologna, San Giorgio di Piano, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ettore","family":"Pirro","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Neurologiche, Alma Mater Studiorum\u2014University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"La Morgia","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Neurologiche, Alma Mater Studiorum\u2014University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria L.","family":"Valentino","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Neurologiche, Alma Mater Studiorum\u2014University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Zanardi","sequence":"additional","affiliation":[{"name":"U.O. 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