Exogenous antioxidant and antigenotoxic agents against asbestos-induced toxicity: A systematic review with implications for post-earthquake exposure scenarios.

Earthquakes can release asbestos fibers from damaged building materials, creating a potentially high-exposure scenario for residents and debris workers. Asbestos induces oxidative stress, DNA damage, cell cycle disruptions, and, over time, chronic inflammation and cancer. This systematic review (PRISMA 2020; Web of Science, Scopus, and PubMed; 2000-2026) examined whether exogenous, nonenzymatic antioxidant or antigenotoxic agents reduce asbestos-induced toxicity. Twenty studies were included and graded using a six-level hierarchy of evidence. In 16 studies, some phytochemicals, thiols, and other agents showed favorable effects on redox, inflammatory, immune, or genotoxicity endpoints; only 5 assessed genotoxicity, and all were in vitro or short-term animal models. All four studies with a disease/tumor endpoint or a randomized human design were null. Therefore, the evidence demonstrates only biological plausibility under experimental conditions. There is no evidence that dietary or supplemental antioxidant intake reduces asbestos-related toxicity. Consequently, exposure control remains the only evidence-based preventive strategy.