[Anemia and neutropenia due to copper deficiency during long-term total parenteral nutrition]

A 33 year-old man with undiagnosed neuropathy showing mental retardation and involuntary movements has been nourished for a long period by total parenteral nutrition (TPN) because of frequent vomiting and repeated aspiration pneumonitis. After ten months' TPN, macrocytic anemia and neutropenia developed and iron preparation was administered without hematological improvement. Bone marrow examination revealed normocellular marrow without features of megaloblastosis and dysplasia. In some erythroblasts and immature myeloid cells, vacuoles were observed and mature granulocytes were reduced in the bone marrow. Both serum copper and ceruloplasmin were very low (12 micrograms/dl and 7mg/dl, respectively). Thus, oral administration of copper sulfate resulted in marked increase of reticulocytes and subsequent improvement of anemia and neutropenia within two months. Copper deficiency is a rare condition, but during an unusual nutrition such as TNP, hematological abnormality due to copper deficiency must be noticed to occur.

Recent developments in Menkes disease

Recent studies on Menkes disease are reviewed, focusing especially on copper transport in the cells. A large amount of copper accumulated in the organelle-free cytoplasm, whereas mitochondria were in a state of copper deficiency, indicating that Menkes mutation probably affects copper transport from the cytosol to the organelles in the cells. Microscopic observation of the brain of the macular mouse showed that copper accumulates in the blood vessels. Observation of the brain tissue of the macular mouse after intraventricular administration of copper revealed that copper accumulates in the glia as well as the blood vessels. Copper accumulation was also observed in cultured astrocytes, a type of glial cell, indicating that the affected astrocytes accumulate blood-borne copper and release little of it in the patients with Menkes disease. Thus the effective treatment of Menkes disease could possibly be to release trapped copper from the blood vessels and glia into the neurons.

Antimicrobial strategies in the prevention of dental caries

Antimicrobial agents, applied either professionally or delivered from dentifrices or mouthwashes, could reduce caries by controlling plaque formation, suppressing cariogenic species, or by inhibiting bacterial metabolism. Chlorhexidine has proven anticaries activity; other agents might also prevent caries by means of their antiplaque properties. Sugar substitutes stabilize the microflora by reducing the number of acid challenges to plaque and stimulating saliva flow; some also have antimicrobial properties, especially against mutans streptococci. Vaccines have been prepared from purified antigens of mutans streptococci. These vaccines confer protection in non-human primates, but have yet to be tested in a human clinical trial.

Solcoderm as alternative conservative treatment for acute anal fissure: a controlled clinical study

Acute anal fissure is a common malady that results in morbidity. If a patient is not responsive to conservative treatment, the current recommended treatments are either anal dilatation or lateral internal sphincterotomy. Both operations promise relatively good results, but the recurrence rates are about 16 per cent and 7 per cent, respectively. This fact, together with possible postoperative complications and costs, justifies trying conservative treatment before referring patients for surgery. The authors treated a study group of 25 patients with a topical application of Solcoderm. Another group of 25 patients concurrently treated with the usual conservative treatment served as the control group. Analysis of the early and late results proved Solcoderm to be simple to use, safe, without systemic side effects, cost-effective, and with statistically significant better outcome. Consequently, the authors believe that this method of treatment is justified in cases of acute and fissure and should be attempted before operation.

Essential metalloelement metabolism and radiation protection and recovery

Understanding the metabolism of essential metalloelements and their role in tissue maintenance and function as well as the roles of essential metalloelement-dependent enzymes in responding to injury offers a new approach to preventing and/or treating radiation injury. This review presents the roles of some essential metalloelement-dependent enzymes in the maintenance and function of tissues and their responses to radiation injury and gives an account of the observed effects of nontoxic doses of essential metalloelement compounds on protection against radiation damage and its recovery. The radiolysis of chemical bonds and free radicals derived from oxygen accounts for the acute and chronic aspects of radiation injury. The recognized biochemical roles of essential metalloelements and their observed pharmacological effects predict the therapeutic usefulness of essential metalloelement complexes in the prevention and/or treatment of radiation injury. Copper complexes have radiation protection and radiation recovery activities and cause rapid recovery of immunocompetence and radiation-induced damage to cells and tissues. Recently, iron, manganese, and zinc complexes have also been found to prevent death in lethally irradiated mice. These pharmacological effects of essential metalloelement complexes can be understood to be due to facilitation of de novo synthesis of essential metalloelement-dependent enzymes which have roles in preventing the accumulation of pathological concentrations of oxygen radicals or repairing damage caused by radiation-induced bond homolysis. Essential metalloelement complexes offer a physiological approach to prevention and/or treatment of radiation injury.

Experimental photodynamic therapy with a copper metal vapor laser in colorectal cancer

In an attempt to define the best conditions for an adjunctive treatment of residual colonic microtumors by photodynamic therapy (PDT), an experimental model has been defined. S.c. HT29 colonic-cancer-cell tumors grown in nude mice were used and, 48 hr after i.p. administration of 30 mg/kg Photofrin (PH), laser illumination was performed with 75 or 150 Joules/cm2. The efficiencies of 2 lasers, the classically used rhodamine laser (RL) and a copper metal vapor laser (CMVL), were compared. The effects of PDT were assessed by histological and immunocytochemical (detection of a digestive enzyme, dipeptidyl-peptidase IV, as a marker of cell viability) follow-up and by the growth curve of the tumors after illumination. We conclude that, although the depth of necrosis resulting from PDT was nearly 3 mm at 75 J/cm2 and nearly 4-5 mm at 150 J/cm2 with both lasers, complete necrosis was obtained only with the CMVL at 150 J/cm2 (in 50% of the tumors). Under the other conditions, a layer of unaffected cells persisted at the pole opposite to laser illumination, resulting in growth curves lower than but parallel to those of the controls. Analysis of drug concentrations in the tumors and various organs, 48 hr after injection, i.e., at the time of laser illumination, revealed the presence of 21 micrograms/g dry weight PH in the tumors. The tumor vs. host-organ ratios were equal to or higher than 1 for the small bowel, colon, stomach, lung, skin and muscle. In contrast, the ratios were below 1 for the spleen, pancreas, kidney and liver.

Ataxia and head tremor in an alpaca (Lama pacos)

An 18-month-old alpaca developed nervous signs, including swaying of the head and neck, a wide-based stance and hind-limb ataxia. No certain diagnosis was made but the animal recovered after successive treatment with amoxycillin, vitamin B1, ivermectin and copper oxide, followed by vitamin E and selenium. The differential diagnosis rationale of treatment is described.

Zinc-induced copper deficiency in an infant

OBJECTIVE

To describe the case of a 13-month-old girl who developed copper deficiency as a result of excessive zinc gluconate ingestion.

SETTING

Tertiary care hospital in Syracuse, NY.

INTERVENTIONS

Cessation of zinc ingestion followed by intravenous and oral copper chloride therapy.

MEASUREMENTS/MAIN RESULTS

Ingestion of zinc gluconate, 120 mg/d for 6 months, and thereafter 180 mg/d for 1 month, preceded the clinical presentation of listlessness, anemia, neutropenia, poor weight gain, abnormal sparse hair, and scorbuticlike bone changes. Findings on a bone marrow examination included ring sideroblasts and suggested copper deficiency. Plasma zinc level was 36.7 mumol/L, serum ceruloplasmin level was 20 mg/L, and serum copper level was undetectable. Clinical and laboratory abnormalities resolved shortly after initiation of copper therapy.

CONCLUSIONS

This case demonstrates the reciprocal relationship of copper and zinc metabolism and exemplifies the important interrelationships of dietary trace minerals.

A multivariate study of protective effects of Zn and Cu against nephrotoxicity induced by cadmium metallothionein in rats

Factorial experimental design was used to study the protective effects of Zn and Cu on cadmium-metallothionein(CdMT)-induced nephrotoxicity in male Wistar rats. In the factorial design two levels of Zn (0 and 25 mg/kg body weight), two levels of Cu (0 and 12.5 mg/kg), and two levels of CdMT (0.1 and 0.4 mg of Cd/kg) were used as varied factors. The factorial design was complemented with a center point with all three variables at an intermediate setting, i.e., Zn at 12.5 mg/kg, Cu at 6.25 mg/kg, and CdMT at 0.25 mg Cd/kg. Each of the nine combinations of settings was administered to one of nine groups with six rats in each. Zn and Cu were injected sc 24 hr prior to the injection of CdMT. The concentrations of protein and Ca in urine and Ca in renal cortex were used as effects. The relationship between the experimental design settings and the effects were modeled with multiple regression. The multiple regression analysis revealed that for the high dose of CdMT (i) the enhanced values of protein in urine caused by CdMT injection could be more efficiently reduced by Zn than by Cu, and (ii) excessive Ca in urine and renal cortex could be more efficiently reduced by Cu than by Zn. No significant synergism or antagonism between Cu and Zn was found. These models can be used to estimate the dose levels of Zn and Cu which will reduce the toxic effects of CdMT. The treatment of 20.4 mg/kg Zn, for example, will reduce the effects of 0.4 mg Cd/kg as CdMT on protein in urine, and 2.8 mg/kg Cu will reduce the Ca in urine to the levels of those caused by 0.25 mg Cd/kg (no Zn and Cu). Similarly, the effect of 0.4 mg Cd/kg on Ca level in renal cortex can be reduced to that of 0.28 mg Cd/kg as CdMT by 7.98 mg Cu/kg, which is three times as efficient as Zn. The obtained results might be of importance in understanding the mechanism of cadmium toxicity and the potential risk to the health of the population exposed to cadmium occupationally or environmentally.

Effects of copper supplementation on ceruloplasmin and copper-zinc superoxide dismutase in free-living rheumatoid arthritis patients

Inflammation, an acute phase stress, alters copper (Cu) metabolism, but effects on human Cu requirements are unknown. Cu supplementation (2 mg/day, 4 weeks) increased erythrocyte Cu-zinc (Zn) superoxide dismutase (SOD) activity levels in 18 of 23 rheumatoid arthritis (RA) patients receiving gold or methotrexate (mean increase 21%). SOD values were significantly lower in RA patients than in 47 age- and sex-matched controls before, but not after supplementation. Supplementation did not significantly affect ceruloplasmin (Cp) activity or protein concentrations in either group. However, RA subjects showed significantly lower Cp activity to protein ratios compared to controls, before and after supplementation. Cu supplementation did not affect acute phase status of RA patients as evidenced by unchanged serum alpha-1-acid glycoprotein levels. In conclusion, the effects of Cu supplementation on erythrocyte SOD activities suggested a trend toward marginal Cu status in RA patients.

Menkes' disease: report of a case and determination of eumelanin and pheomelanin in hypopigmented hair

We report a male infant with Menkes' disease who showed, at the age of 3 months, slow growth, hair abnormalities such as pili torti and white hair, and low levels of serum copper and ceruloplasmin. The exceptionally bright portions of his hair contained eumelanin and pheomelanin at levels only half those of normal Japanese controls. After subcutaneous administration of copper-histidinate for 2 months, his scalp hair changed to dark brown.

Ascorbic acid with cupric ions as a chemotherapy for human lung tumor xenografts implanted beneath the renal capsule of immunocompetent mice

The growth of human lung carcinoma xenografts implanted beneath the renal capsule of immunocompetent mice was investigated (the six-day subrenal capsule assay) by using combinations of ascorbic acid and cupric ions. A maximum suppression of growth of this human lung tumor, LX-1, was observed at an estimated consumption level by the mice of 6 to 8 g ascorbic acid and 2 to 5 mg cupric ions per day per kg body weight. The data suggest that more than one oxidative or degradative product of ascorbic acid or of some copper compounds may be responsible for the observed antitumor activities, and that the chemotherapeutic effect is being produced at some stoichiometric ratios of ascorbic acid to cupric ions. When such a combination of the two substances was consumed by the mice, optimal therapeutic effect was exerted on the implanted xenografts.

[A clinical evaluation of an improved copper amalgam]

The author presents the results of physicochemical trials and preliminary clinical assessment of modified copper amalgam, carried out to master the optimal method for its preparation. The optimal conditions for the preparation of a filling from modified copper amalgam consist in mixing 0.42 +/- 0.02 g of the alloy powder and 0.3 g of mercury within 25-35 sec. Clinical trials have demonstrated the advantages of this modification vs. the filling manufactured in this country previously, this recommending it for practical pedodontics.

Non-Menkes-type copper deficiency with regression, lactic acidosis, and granulocytopenia

A 2-year-old girl with granulocytopenia developed fever followed by truncal ataxia and progressive neurologic regression. CT demonstrated symmetric low-density areas in the cerebral white matter. Sural nerve biopsy revealed axonal degeneration. Blood lactate levels were high, and serum levels of copper and ceruloplasmin and urinary excretion of copper were low. Cultured skin fibroblasts showed normal copper uptake. Treatment with oral copper administration normalized serum copper and ceruloplasmin levels, blood lactate levels, and granulocyte count. However, copper levels in the CSF were still low, and the patient showed no clinical improvement. We speculated that copper transport across the intestinal wall and across the blood-brain barrier was impaired.

The phosphorous burn--a preliminary comparative experimental study of various forms of treatment

White phosphorous burns were inflicted on 44 Wistar (CR) rats. All animals of the control (C1) group (untreated white phosphorous burns) died within 48 h while those of the control (C2) group (wound only, no white phosphorous burns) survived at least 6 days. Copper sulphate, either as a solution or as an emulsion, proved lethal even without white phosphorous burns. Water irrigation alone proved to be a life-saving procedure for the white phosphorous burned rats.

[Experimental studies on the effect of various cleaning fluids in phosphorus burns]

Male Wistar rats were divided into three groups. Group 1 consisted of uninjured normal rats. Animals in groups 2 and 3 were inflicted with 20-30% third degree phosphorus burn. Group 2 served as control without cleansing, and group 3 animals were washed with various fluids postburn. There were five subgroups in group 3: Subgroup I, the wound was washed with water (fluid I); Subgroup II. 1% detergent solution was used (fluid II); Subgroup III, 5% NaHCO3 was applied after being washed with 2% CuSO4 (fluid III); Subgroup IV, 2% CuSO4 was used only (fluid IV); Subgroup V, water was used after the application of 2% CuSO4. The results showed: 1. The tissue phosphorus and serum BuN values were decreased markedly immediately and 6 h postburn when fluid II was used. It was demonstrated that the detergent was more effective than fluids I and III. Therefore we proposed that a detergent should be used to wash off phosphorus from the wound. 2. The serum copper value increased immediately after the application of 2% CuSO4. However, the serum copper value decreased significantly after the use of NaHCO3. The results suggest that copper poisoning can possibly occur when CuSO4 is used alone, and NaHCO3 solution is effective to wash off CuSO4.

Treatment of Trichophyton mentagrophytes infection in rabbits

Copper sulfate and a metastabilized chlorous acid/chlorine dioxide (MECA) compound were evaluated for efficacy in treating Trichophyton mentagrophytes infection in rabbits. Forty rabbits naturally infected with T mentagrophytes were allotted to 5 treatment groups: nontreated control, sham dip, 1% copper sulfate dip, MECA dip, and MECA spray. Results of lesion culture, regression of gross lesions, and histopathologic findings were documented. Copper sulfate and MECA were effective in treating clinical dermatophytosis and in decreasing T mentagrophytes carrier status in rabbits.

A comparison of phenotype and copper distribution in blotchy and brindled mutant mice and in nutritionally copper deficient controls

The murine mottled mutants brindled, Mo br, and blotchy, Mo blo, are valuable animal models for the study of mammalian copper metabolism. In this paper, we present data showing that a nutritionally copper deficient suckling mouse, Cu-, with strong phenotypic similarities to the brindled mutant can be produced by feeding genetically normal dams a copper deficient diet (0.1-0.4 ppm Cu2+) from the day of mating. Comparisons of copper distribution between the Cu- mice and brindled mutants indicate that when a small dose of copper (0.5-0.9 micrograms Cu2+) was administered by intracardiac injection, the copper was abnormally distributed, and that the pattern of tissue distribution was very similar in Cu- mice and brindled mutants 24 h after injection. When, however, a treatment dose (50 micrograms Cu2+) was injected subcutaneously, and tissues assayed 3 d after injection, copper distribution in Cu- mice and brindled mutants was clearly different. Copper deficiency in Cu- suckling mice is entirely derived from maternal effects. Evidence that maternal effects may also influence the survival and phenotype of the brindled and blotchy mutants was obtained by comparing the viability of mutants born to dams carrying mottled mutations on one or both X chromosomes.

Possible mechanism of the gastroprotective activity elicited by some copper(II) complexes

The gastroprotective activity of some copper(II) complexes has been previously described. Since mucus secretion may be a factor responsible for their gastroprotective activity, this study was designed to determine the influence of these compounds on mucous secretion in rat. The copper complexes assayed at a dose of 25 mg/kg significantly increased mucous secretion. Pre-treatment with indometacin, a cyclooxygenase inhibitor, does not influence the mucostimulant properties of these compounds. However, the effect on mucus secretion was significantly decreased by pre-treatment with a depletor of endogenous thiols, n-ethylmaleimide. These results suggest the additional role of sulfhydryl groups in the mucosal gastroprotective effect of copper(II) complexes.

[Polymer-metal complexes of the Mycobacterium protein antigen prevent the dissemination of postvaccinal infection in the T-deficiency state]

Primary obtained triple highly immunogenetic complex consists of nonimmunogenic protein antigen, isolated from the BCG, nontoxic polyelectrolyte and bivalent cuprum ions. Immunization with this complex provides high immunoprotection in the experimented B mice (T-deficit mice) from lethal dissemination BCG. Inoculation of single components of the complex has no protection. Result of these experiments suggest that antigen-polyelectrolyte complexes obtained on the basis of nonimmunogenic protein fraction of the tuberculosis bacilli show the properties of a thymus-independent immunization preparations, and provide immune defense in the T-cell deficit of the immune system.

A study of adjunctive copper sulphate treatment in patients with rheumatoid arthritis who have relapsed while taking D-penicillamine

Formation of a D-penicillamine-copper complex may be necessary for the anti-rheumatic effect of D-penicillamine. Thus, depletion of copper stores by D-penicillamine may eventually lead to relapse in D-penicillamine treated patients. Twenty-one patients who relapsed on D-penicillamine were randomised to copper sulphate 20 mg daily (n = 13) or matched placebo (n = 8) in addition to penicillamine daily for 16 weeks. Urinary copper was increased in the copper treated patients but no statistically significant or clinically important improvement occurred in either group.

The effects of copper supplementation on the prevalence of cartilage lesions in foals

The potential role of dietary copper in the development of cartilage defects in foals was investigated. Twenty-one mares were fed rations containing 13 ppm copper (CuC, control) or 32 ppm copper (CuS, supplemented) during the last three to six months of gestation and first three months of lactation. Their foals were fed pelleted concentrate containing 15 or 55 ppm Cu and were destroyed at 90 (5 CuC and 5 CuS foals) or 180 (6 CuC and 5 CuS foals) days. Focal cartilage lesions were found at multiple sites on necropsy. In foals killed at 90 days, there were over twice (9 versus 4) as many lesions of osteochondrosis and more than four times (9 versus 2) as many articular lesions of osteophyte formation or thinning in CuC foals compared with CuS foals. These differences were due predominantly to a higher number of lesions in one CuC foal. Two 90-day CuC foals had osteochondrosis of articular-epiphyseal (A-E) complex, one with thickenings and separation from subchondral bone and one with subchondral fibrosis. One 90-day CuS foal had a cartilage thickening of the A-E complex in the tibiotarsal joint with separation from subchondral bone. In foals killed at 180 days, there were seven times more articular lesions (21 versus 3) of osteophyte formation or thinning, nearly twice as many lesions of osteochondrosis (13 versus 8) [corrected] in the physis and over five times as many involving the A-E complex (11 versus 2) in six CuC foals compared with five CuS foals.(ABSTRACT TRUNCATED AT 250 WORDS)