Alteration of peripheral markers of copper homeostasis in Alzheimer's disease patients: implications in aetiology and therapy

Alzheimer's disease represents a growing health problem because of the ongoing increase in life expectancy. Therefore understanding the molecular alterations responsible for neurodegeneration has become imperative in order to develop efficient strategies for the therapy. Mounting evidence suggests that the essential metal ion copper is intriguingly connected with the established molecular markers of Alzheimer's disease and that copper homeostasis is disturbed in affected individuals, leading to oxidative stress and neurodegeneration. This review summarizes the mechanisms of copper trafficking in cells and describes the relationship between copper, the amyloid precursor protein and beta-amyloid. Since one of the main goals of the research on Alzheimer's disease is the identification of blood markers to aid diagnosis and monitor the effects of therapeutic approaches, the results obtained in a series of studies on copper in the blood of Alzheimer's disease patients recently carried out in our laboratories are described.

Co-treatment with copper compounds dramatically decreases toxicities observed with cisplatin cancer therapy and the anticancer efficacy of some copper chelates supports the conclusion that copper chelate therapy may be markedly more effective and less toxic than cisplatin therapy

Co-Administration of Cu(II) chelates are reported to decrease life threatening Cisplatin [Pt(II) (NH3)2(CL)2]-induced acute degenerative renal, gastrointestinal, thymic, and bone marrow states consistent with serious necrotizing and immune-mediated inflammatory disease. Initially it was found that copper sulfate treatment completely prevented lethality as well as gastric and nephrotoxicity without compromising Pt(II) (NH3)2(CL) 2 antineoplastic activity, which led to suggestions that prior Cu(II)-treatment be used clinically to prevent serious side effects of Pt(II) (NH3)2(CL)2-treatment. In the course of these studies it was discovered that Cu(II)-treatments alone inhibited neoplastic growth and increased survival of rat and mouse models of cancer. Subsequently it was discovered that a stable non-toxic and non-polar lipophilic chelate, Copper(II)2(3,5-diisopropylsalicylate)4, caused redifferentiation of cultured neuroblastoma and mouse muscle-implanted mammary adenocarcinoma without neoplastic cell killing. Another stable non-toxic and non-polar lipophilic chelate, Copper(II)2(3,5-ditertiarybutylsalicylate)4, was found to prevent Bax-initiated and caspases-3-activation mediated apoptosis. These remarkable observations are concluded to be due to enzyme-mimetic or modulating reactivities of Cu(II) chelates and/or facilitation of Cu(II or I)-dependent enzyme syntheses required to overcome inflammatory-neoplastic disease states. Further, approaches to treating neoplastic diseases by removal of Cu from tissues with ammonium tetrathiomolybdate in an anticopper approach to therapy are not well founded based upon existing scientific literature.

Could chronic wounds not heal due to too low local copper levels?

Copper is an essential trace element involved in numerous human physiological and metabolic processes. It plays a key role in many of the processes that together comprise wound healing, including induction of endothelial growth factor, angiogenesis and expression and stabilization of extracellular skin proteins. We hypothesize that in individuals with diabetic ulcers, decubitus, peripheral vascular, or other wounds which might have compromised circulation to the wound site, that part of the incapacity of the wounds to heal is due to low local copper levels. Contamination of wounds is also an important factor causing impaired wound healing. Importantly, copper has potent broad biocidal properties. In contrast, the risk of adverse skin reactions due to exposure to copper is extremely low. We thus hypothesize that introducing copper into wound dressings would not only reduce the risk of wound and dressing contamination, as silver does but, more importantly, would stimulate faster wound repair directly. This would be done by the release of copper from the wound dressings directly into the wound site inducing angiogenesis and skin regeneration.

Historical review of Svarna Măksika

The old age Ayurvedic claim about the therapeutic importance of metals and mineral bhasmas are time tasted. To make available the evidence for use of metals and minerals in therapeutics and to provide the knowledge of processing techniques in ancient India it is very much necessary to look over the history. Rasa săstra is the branch of Ayurvedic science which deals with the pharmaceutical processings of the metals and minerals. Svarna Măksika is one of the most important materials described in various Rasa literatures as well as in Sarmhităs and in other Ayurvedic texts. Going through the different literatures its different features, geological distributions and various processing techniques like sŏdhana, mărana are found. In Samhită period only the features were described but during 7th Cen. AD & onwards its processings were found. Now a day Svarrna Măksika is correlated with chalcopyrite by modern metallurgists. The features of chalcopyrite are also given to assist the more study in this regard. In the current paper it is tried to collect and compile all the related area about Svarna Măksika from all possible ancient literary resources as well as from possible modern texts, to facilitate further research.

Use of copper oxide wire particles to control gastrointestinal nematodes in goats

The objectives of these experiments were to determine the optimal dose of copper oxide wire particles (COWP) necessary to reduce gastrointestinal nematode (GIN) infection in young and mature goats naturally infected with Haemonchus contortus or a mixed infection and to determine whether the effectiveness could be enhanced through feeding management. Two experiments were conducted during cooler months in Georgia, and 4 experiments were conducted during warmer spring or summer months in Arkansas. Meat goats received 0 up to 10 g of COWP under a variety of management conditions. In all experiments, blood and feces were collected every 3 or 7 d from 6 to 42 d to determine blood packed cell volume (PCV) and fecal egg counts (FEC) to estimate the degree of GIN infection. In mature goats grazing fall pasture, mean FEC of 0 g of COWP-treated goats increased, and those of 4 g of COWP-treated goats remained low on d 0, 7, and 14 (COWP x d, P < 0.03), and FEC decreased on these days (P < 0.001). In 5 and 10 g of COWP-treated goats, PCV increased (P < 0.001), but FEC and PCV remained unchanged over time in control goats. Fecal egg counts were similar among all low doses (0.5, 1, 2, 4 g) of COWP administered to weaned kids for all dates examined (P > 0.10), which were lower on d 7 through 21 (COWP x date, P < 0.05) but similar by d 28, compared with FEC of 0 g of COWP-treated kids. Packed cell volume was lower in 0 g compared with all COWP-treated kids by d 14 (COWP x date, P < 0.05). Feeding management in combination with COWP for GIN control had little effect compared with COWP alone for these short-term studies. In conclusion, a dose of COWP as low as 0.5 g, which was considered optimal to reduce the risk of copper toxicity, was effective in reducing FEC in young goats, and 5 g of COWP was effective in older goats. Copper oxide does not appear to be effective in controlling newly acquired L4 stage (preadult) larvae, which also feed on blood, leading to decreased PCV in newly infected goats.

Trace element supplementation after major burns modulates antioxidant status and clinical course by way of increased tissue trace element concentrations

BACKGROUND

After major burns, patients can develop nutritional deficiencies including trace element (TE) deficiencies. Various complications, such as infections and delayed wound healing, influence the clinical course of such patients.

OBJECTIVES

We aimed to investigate the effects of large, intravenous doses of TE supplements on circulating and cutaneous TE tissue concentrations, on antioxidant status, and on clinical outcome after major burns.

DESIGN

This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 +/- 11 y (x +/- SD) with burns on 45 +/- 21% of their body surface area. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. Blood and urine samples were collected until day 20, and skin biopsy specimens were collected on days 3, 10, and 20.

RESULTS

The age of the patients and the severity of their burns did not differ significantly between the groups. Plasma TE concentrations were significantly higher in the TE group. In burned areas, skin contents of both selenium (P=0.05) and zinc (P=0.04) increased significantly by day 20. Plasma and tissue antioxidant status was improved by supplementation. The number of infections in the first 30 d was significantly lower in the TE group (P=0.015), with a median number of 2 versus 4 infections per patient in the TE and V groups, respectively, as a result of a reduction in pulmonary infections (P=0.03). Wound healing was improved in the TE group, with lower requirements for regrafting (P=0.02).

CONCLUSIONS

TE supplementation was associated with higher circulating plasma and skin tissue contents of selenium and zinc and improved antioxidant status. These changes were associated with improved clinical outcome, including fewer pulmonary infections and better wound healing.

A novel therapeutic drug (copper nicotinic acid complex) for non-alcoholic fatty liver

BACKGROUND

Fatty liver is the accumulation of fat in liver cells, which leads to disruption of the normal liver structure and function.

METHODS

A non-alcoholic fatty liver rat model received copper (Cu) (I)-nicotinate complex [CuCl(HNA)2] for 4 weeks.

RESULTS

Clinical signs and histopathological examinations showed obvious improvements in rats that received Cu complex who were continuously on an (HCFF) diet than those returned to standard diet with Cu complex. The improvement was matched in total lipids in sera and hepatic tissue, with disappearance of fat droplets from liver sections. Furthermore, the gain in body weight and the corresponding decrease in liver weight, decreased liver transaminases and alkaline phosphatase were prominent. The oxidative stress markers such as nitric oxide, lipid peroxides, glutathione and superoxide dismutase were obviously changed to healthy normal levels.

CONCLUSION

The Cu complex may serve as a novel chemical restoring agent in fatty degenerated liver cells and for renewal of their structure and functions. However, clinical trials are required for more evaluation of the Cu complex in humans.

Trace element supplementation after major burns increases burned skin trace element concentrations and modulates local protein metabolism but not whole-body substrate metabolism

BACKGROUND

After major burns, patients exhibit an intense catabolism, and the wounds require surgery and grafting for closure. Complications, such as weight loss and delayed wound healing, are worsened by trace element (TE) deficiencies.

OBJECTIVE

We aimed to assess the effects of TE supplements on systemic substrate turnover and local protein metabolism during wound healing after major burns.

DESIGN

This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 +/- 11 y with burns on 45 +/- 16% of their body surface area; 12 had skin biopsies performed on days 3, 10, and 20, and 10 patients underwent a stable-isotope investigation on day 10. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. On day 10, [(13)C]phenylalanine (600-microg/kg bolus followed by 12 microg x kg(-1) x min(-1)) plus 6-[(2)H(2)]glucose and [(2)H(5)]glycerol were infused for 6 h to determine skin protein turnover. Biopsies were performed 1 and 6 h after the start of infusion to determine [(13)C]phenylalanine enrichment.

RESULTS

The patients' mean age and burn severity did not differ significantly between the groups nor between the skin investigations subgroups. Plasma TE concentrations were significantly higher in the TE group. In the burned areas, the skin contents of selenium (P=0.02) and zinc (P=0.03) increased by day 20. The supernatant-to-plasma (13)C enrichment ratio in burned skin was 0.363 +/- 0.094 (TE group) and 0.286 +/- 0.130 (V group) after 1 h (NS) and 0.592 +/- 0.153 (TE group) and 0.262 +/- 0.171 (V group) after 6 h, which reflected lower catabolism in the TE group (P=0.03). No significant differences in whole-body substrate turnover were found between the groups.

CONCLUSION

TE supplementation was associated with an increased skin tissue content of selenium and zinc and with a reduction in skin protein catabolism.

Control of gastrointestinal nematodes with copper oxide wire particles in a flock of lactating Polypay ewes and offspring in Iowa, USA

Copper oxide wire particles (COWP) have been used to reduce infection of Haemonchus contortus in hair breed lambs in southeastern USA without signs of copper toxicity. However, copper sensitivity among breeds and regions varies. The objective was to determine the effectiveness and safety of COWP in lactating Polypay ewes and their offspring grazing alfalfa/bluegrass pasture in a rotational grazing system. Mature Polypay ewes were administered 0, 0.5, 1, or 2 g (n=8 or 9/dose) COWP approximately 60 days after lambing in mid-July 2005. Their offspring were administered 0 (n=6), 0.5 or 0.75 g (n=9), 1 or 2 g (n=6) COWP 2 weeks later in late July. The primary gastrointestinal nematode was H. contortus (70%). Between Days 7 and 35, FEC were greater in 0 and 0.5 g COWP groups compared with ewes administered 2 g COWP (COWP x day, P<0.004). PCV decreased in all groups of ewes between Days 0 and 21 (day, P<0.001). Aspartate aminotransferase (AST) activity, a measure of liver copper levels, and body weight was similar among groups of ewes. FEC decreased within 7 days in COWP-treated compared with untreated lambs and remained low throughout experiment (COWP x day, P<0.05). PCV increased in COWP-treated lambs between Days 7 and 35 and decreased in untreated lambs between Days 0 and 21 (COWP x day, P<0.009). AST activity was similar among groups of lambs. Administration of 2 g COWP to ewes prevented a rise in FEC, but a dose of 0.5 g was ineffective as an anthelmintic. Administration of all doses of COWP to lambs decreased FEC and increased PCV compared to untreated lambs. There were no signs of copper toxicity in ewes or lambs. Alternative suppression of H. contortus infections may be necessary in ewes, but COWP was effective in H. contortus management for lambs.

Combining the effects of supplementary feeding and copper oxide needles for the control of gastrointestinal nematodes in browsing goats

The aim was to assess the benefits obtained from combining supplementary feeding and copper needles (COWP), compared to the use of both approaches independently, for the control of gastrointestinal nematode (GIN) infections in browsing kids. Forty-four nematode free Criollo kids were exposed to natural parasite infection. The kids were divided into six experimental groups: not treated, supplemented (NT-S), not treated, not supplemented (NT-NS), moxidectin treated, supplemented (M-S), moxidectin treated not supplemented (M-NS), copper treated, supplemented (COWP-S) and copper treated, non-supplemented (COWP-NS). Copper treated groups received Copinox (2 g capsules) on day 0 and on day 60 of the trial. Moxidectin treated groups received Cydectin (0.2 mg/kg of body weight s.c.) every 28 days. Three of the groups received individual supplementation (100 g of feed/day fresh basis; 74% sorghum: 26% soybean meal; NT-S, M-S and COWP-S) and the other three groups were not supplemented (NT-NS, M-NS and COWP-NS). Animals browsed native vegetation (6.5 h/day) during the wet season (154 days). Kids were weighed every 14 days to determine live weight gain (LWG) and blood and faecal samples were obtained to determine packed cell volume (PCV), haemoglobin (Hb), peripheral eosinophil counts (PEC) and faecal egg counts (FEC). At the end of the trial, four kids of each group were euthanatized (six kids in each COWP treated group). Worm burdens, female worm lengths and prolificacy were determined. Liver samples were used to determine copper concentration and were stained with haematoxylin-eosin to determine microscopic lesions. Animals receiving the combination of supplementary feeding and COWP improved their LWG, PCV and Hb to similar levels of animals with suppressive AH treatment. This was not the case when COWP was used without supplementation. Liver copper concentration in COWP treated groups increased significantly especially in the COWP-NS kids but this was not associated with liver lesions or clinical signs. Post-mortem Haemonchus contortus and Trichostrongylus colubriformis worm counts had a tendency to be reduced in the different groups (66-35% reduction) compared to NT-NS group at the end of the trial (P>0.05). Also, COWP treatment and/or supplementation reduced female worm length of T. colubriformis and prolificacy of H. contortus and T. colubriformis. This study, confirmed the value of nutritional supplementation in the control of GIN in growing kids. The use of COWP in addition to supplementation had a limited contribution on the kids' resilience against GIN. This may be due to the reduced infection of H. contortus during this trial.

Dietary copper supplementation reverses hypertrophic cardiomyopathy induced by chronic pressure overload in mice

Sustained pressure overload causes cardiac hypertrophy and the transition to heart failure. We show here that dietary supplementation with physiologically relevant levels of copper (Cu) reverses preestablished hypertrophic cardiomyopathy caused by pressure overload induced by ascending aortic constriction in a mouse model. The reversal occurs in the continued presence of pressure overload. Sustained pressure overload leads to decreases in cardiac Cu and vascular endothelial growth factor (VEGF) levels along with suppression of myocardial angiogenesis. Cu supplementation replenishes cardiac Cu, increases VEGF, and promotes angiogenesis. Systemic administration of anti-VEGF antibody blunts Cu regression of hypertrophic cardiomyopathy. In cultured human cardiomyocytes, Cu chelation blocks insulin-like growth factor (IGF)-1- or Cu-stimulated VEGF expression, which is relieved by addition of excess Cu. Both IGF-1 and Cu activate hypoxia-inducible factor (HIF)-1alpha and HIF-1alpha gene silencing blocks IGF-1- or Cu-stimulated VEGF expression. HIF-1alpha coimmunoprecipitates with a Cu chaperone for superoxide dismutase-1 (CCS), and gene silencing of CCS, but not superoxide dismutase-1, prevents IGF-1- or Cu-induced HIF-1alpha activation and VEGF expression. Therefore, dietary Cu supplementation improves the condition of hypertrophic cardiomyopathy at least in part through CCS-mediated HIF-1alpha activation of VEGF expression and angiogenesis.

[Copper deficiency with pancytopenia, bradycardia and neurologic symptoms]

A 48-year-old man was referred to our hospital in December, 2005 because of general fatigue, gait disturbance and bradycardia. He had a history of polysurgery due to recurrent ileus and had been treated with home total parenteral nutrition for the short-bowel syndrome since 2003. Clinical findings on admission included marked emaciation and severe weakness of the extremities. Pancytopenia was noted in the peripheral blood. The serum levels of copper and ceruloplasmin were 3 microg/dl and 3 mg/dl, respectively, while Vit. B12 and folate were within the normal range. The bone marrow demonstrated cytoplasmic vacuolation in the myeloid and megakaryocytic series, and sideroblastic changes. No evidence of hematologic malignancies was presented. The diagnosis was copper deficiency and the patient was treated with copper supplementation. Four weeks after copper therapy, the serum level of copper rose to 50 microg/dl and ceruloplasmin to 14 mg/dl. Significant improvements in the hematologic profile, ECG findings and weakness of extremities were noted. Although bicytopenia (anemia and neutropenia) is considered to be a feature of hematologic disorders caused by copper deficiency, the present case showed pancytopenia. The exact mechanism of the unusual association of thrombocytopenia and other abnormalities with copper deficiency remains to be elucidated.

Marginal adaptation and micro-porosity of class II restorations of a high copper amalgam and a palladium-free gallium-based alloy

The aim of the current investigation was to compare the marginal adaptation and internal porosity of a gallium (Ga)-based alloy (Galloy) with a high copper amalgam (Permite C DP) when used in moderately sized conventional class II cavities. Ten dentists placed two restorations of each material in standardized class II cavities in typodont teeth set in a phantom head. The proximal surfaces of the restored teeth were subsequently examined using an optical microscope and colour photographs were taken. The teeth were then serially sectioned before being re-examined microscopically and re-photographed. Three dentists rated the photographs of the restorations on two occasions, 2 weeks apart, for marginal adaptation and internal porosity using a six and five point scoring criteria, respectively. Inter- and intra-examiner agreements were assessed with weighted kappa statistics. The Ga-based alloy exhibited inferior marginal adaptation and a significantly higher level of porosity and internal defects compared with the dental amalgam. Marginal defects were mainly concentrated at the gingival third of the proximal boxes for both alloys. The poor marginal adaptation and extensive internal porosity detected for the Ga-based alloy was attributed to the difficulty in the alloy condensation related mainly to the 'stickiness' of the alloy to the condensers and to the rapid change in the plasticity of the alloy during condensation. This could possibly be a factor in the post-operative complications reported with the clinical use of this alloy.

Copper deficiency myeloneuropathy resembling B12 deficiency: partial resolution of MR imaging findings with copper supplementation

Copper deficiency has been associated with a clinical syndrome, myeloneuropathy. Radiographic changes resembling B(12) deficiency in the cervical spinal cord have been described. We present a case of copper deficiency myeloneuropathy, with cervical MR imaging findings resembling B(12) deficiency, which partially reversed following copper supplementation. This is, to our knowledge, the first described case of radiographic improvement with copper supplementation.

Lessons learned from Art Pardee in cell cycle, science, and life

This essay is written to honor Dr Art Pardee's 85th birthday (July 13, 2006). In this essay, I have summarized the lessons I learned from Art and the cell-cycle research I performed in Art's laboratory during my postdoctoral training period. I have also summarized some research from my own laboratory that has been inspired by the lessons I learned from Art, including the interactions between cell cycle and cell death regulators and discovery of novel polyphenol- and copper-based proteasome inhibitors. Finally, I have discussed the potential use of these proteasome inhibitors in cancer prevention and treatment.

Controlling thermal damage of incisions using diamond, copper, and sapphire heat-conducting templates with and without cooling

INTRODUCTION

We investigated the reduction of thermal damage to the surrounding tissue when laser incisions were made with and without using thermal conducting templates at room temperature and cooled to 5 degrees C.

STUDY DESIGN/MATERIALS AND METHODS

We used the Vanderbilt free-electron laser (FEL) at 5.4, 6.1, 6.45, and 7.7 microns. We also used a conventional continuous wave (CW) carbon dioxide laser at 10.6 microns. Incisions were made on 5x10 mm pieces of human breast skin (in vitro) and analyzed with histology. Computer morphometrics were used to measure the amount of thermal damage.

RESULTS

All templates produced a statistically significant reduction in the thermal damage. Additionally, we showed that cooling the templates made a statistically significant greater reduction in the thermal damage. The cooled diamond template reduced the thermal damage from the FEL to 28% of the damage observed without a template. The same cooled template reduced the thermal damage from the CO(2) laser to 56% of the damage observed without a template. Lesser reductions were observed with the copper template and even less with the sapphire template. The sapphire template reduced the thermal damage to 39 and 67% of the damage observed without a template for the FEL and the CO(2) laser, respectively.

CONCLUSION

These results indicate that unwanted lateral thermal damage from laser incisions can be reduced with cooled thermally conductive templates with the best results obtained with the diamond template, which is also the best thermal conductor.

[Suckling calves with symptoms of swayback]

Within a 1-year period, three calves from the same herd developed ataxia of the hind limbs and urinary incontinence at about 6 months of age. Signs progressed and the calves were slaughtered 1-8 months after the onset of signs. The calves belonged to a suckling beef herd of 35 cattle. Blood samples from 11 cattle of different ages were collected and glutathione peroxidase and copper levels were measured. Glutathione peroxidase levels were below the normal range in all cattle and copper levels were below the normal range in 7 of ll cattle. Pathological examination of an affected calf revealed a Wallerian type of degeneration of myelinated nerve fibres in the lateral and ventral spinal cord tracts. In addition, the hepatic copper content was very low. Copper deficiency is a well-known cause of swayback in young sheep and goats. To our knowledge, this is the first report of a possible association between a swayback-like syndrome and copper deficiency in calves.

Relapsing hypocupraemic myelopathy requiring high-dose oral copper replacement

Adult-onset copper deficiency with neurological manifestations is a newly recognised syndrome. Long-term oral copper replacement therapy has been the mainstay of treatment in the literature. A case of relapsing hypocupraemic myelopathy responsive to increased doses of copper replacement is reported. Standard doses of copper may not be sufficient for all patients.

Effects of Topical Copper Tripeptide Complex on CO2 Laser–Resurfaced Skin

OBJECTIVE

To evaluate the role of skin care products that contain a copper tripeptide complex, glycyl-l-histidyl-l-lysine-Cu(2+) (GHK-Cu), in treating carbon dioxide (CO(2)) laser-resurfaced skin.

METHODS

Patients meeting the inclusion criteria underwent circumoral skin resurfacing using a CO(2) laser at standard settings. Patients were then randomized to receive posttreatment skin regimens with or without GHK-Cu. Evaluations for erythema throughout the posttreatment period were performed using computer software and blinded evaluators. In addition, overall improvement in wrinkles and overall improvement in skin appearance 12 weeks after treatment were assessed. Patients completed a validated questionnaire before and 12 weeks after treatment.

RESULTS

Thirteen patients completed the study. Computer analysis and blinded evaluators found no statistically significant differences between groups for earlier resolution of erythema. All the patients experienced significant improvement in wrinkles and overall skin quality, but no differences were found between groups. The results of the questionnaire indicated a significant difference in the posttreatment improvement of overall skin quality for patients using GHK-Cu (P = .04).

CONCLUSIONS

Copper tripeptide complex (GHK-Cu) skin care products placed on CO(2) laser-resurfaced skin offered no significant reduction or resolution of posttreatment erythema. Objective evaluation found no significant improvement in wrinkles or overall skin quality. However, patient satisfaction was significantly higher for those who used GHK-Cu skin care products after CO(2) laser skin resurfacing.

Urological complications and copper replacement therapy in childhood Menkes syndrome

BACKGROUND

Urological complications are frequent in Menkes syndrome, a very rare X-linked recessive disorder of copper (Cu) metabolism.

AIM

To evaluate the role of Cu therapy in preventing the progression of urological complications.

SUBJECTS AND METHODS

We retrospectively enrolled 57 patients with Menkes syndrome (55 published case reports and two of our own unpublished cases) and investigated the reported urological complications, distinguishing the patients with or without Cu replacement therapy and evaluating the efficacy of this therapy in the prevention of urological complications.

RESULTS

The most frequent urological complication was bladder diverticulum (38.6% of the total patients); obstruction bladder outflow and rupture of the kidney were less frequent (both 1.8% of the total). The number of congenital urological complications increased progressively by age category; in fact, 77.8% of patients did not report urological complications at the age of 0.4+/-0.2 y, and 28.6% of them displayed > or = two congenital urological complications at the age of 9.3+/-2.6 y. The percentage of urological complications found in younger patients not on Cu therapy did not differ from that of older patients treated with Cu therapy. A comparison between patients of the same age interval, who were or were not treated with Cu, showed that treated children had fewer urological complications than untreated children.

CONCLUSION

Our investigation suggests that Cu therapy in patients with Menkes syndrome does not prevent the progression of urological complications; however, it might delay their worsening.

Evaluation of multiple low doses of copper oxide wire particles compared with levamisole for control of Haemonchus contortus in lambs

High levels of anthelmintic resistance in gastrointestinal nematodes (GIN) of small ruminants have created the need for alternative approaches to parasite control. Copper oxide wire particles (COWP; 2g) have proven effective in decreasing GIN infection in lambs. However, the risk of copper toxicity has limited the usefulness of this approach. Recently, smaller doses (0.5 and 1g) have proven effective in GIN control, reducing the risk of toxicity. The objective of this study was to examine the effectiveness and risk of toxicity using multiple small doses of COWP for GIN control in lambs between weaning and market weight. Dorper crossbred ram lambs were orally administered levamisole (Levasol, 8.0mg/kg; n=8), 0.5g (n=9), or 1g COWP (n=9) at weaning (Day 0; 118+/-2 days of age; late May 2005) and again at 6-week intervals for a total of four treatments. A pooled fecal culture determined that Haemonchus contortus was the predominant gastrointestinal parasite at weaning. Lambs grazed bermudagrass pastures and were supplemented with up to 500g corn/soybean meal and free choice trace mineralized salt. Fecal egg counts (FEC), packed cell volume (PCV), and plasma aspartate aminotransferase (AST) activity were determined every 14 days and lambs weighed every 28 days. GIN infection reached a peak at Day 42 (high FEC, low PCV). COWP effectively reduced FEC on Days 0 and 42 compared with the previous week, but did not reduce FEC on Days 84 and 126 (treatment by time interaction, P<0.005). Plasma AST activity and weight gains were similar among treatment groups throughout the study period. Concentrations of copper in the liver on Day 155 were greater in COWP-treated lambs (P<0.001), but all concentrations were normal. Multiple doses of COWP were as effective as levamisole for control of H. contortus without risk of copper toxicity.

Copper modulates non-enzymatic antioxidants in the freshwater fish Channa punctata (Bloch) exposed to deltamethrin

The assessment of the ecotoxicological risks caused by pesticides to ecosystems are based on data on the toxicity and effects of pesticide preparations to non-target organisms like fish. Deltamethrin is a widely used pesticide based on pyrethroids, which is reported to be extremely toxic to fish species. Modulatory effect of copper pre-exposure (10 ppb) on deltamethrin (0.75 microg l-1)-induced oxidative stress was investigated in freshwater fish Channa punctata (Bloch). Non-enzymatic antioxidants were studied as biomarkers of exposure to deltamethrin and possible protection afforded by copper pre-exposure. Glutathione levels were reduced significantly (P<0.05) in liver of copper-acclimatized deltamethrin-exposed group when compared with deltamethrin-exposed groups. The total thiol levels of copper-acclimatized deltamethrin-exposed group was significantly lowered (P<0.01) in liver when compared with deltamethrin-exposed group, while non-protein thiol levels recorded a significant (P<0.01) increase in liver of copper-acclimatized deltamethrin-exposed group when compared with deltamethrin-exposed group. The lipid peroxidation levels of copper-acclimatized deltamethrin-exposed groups were significantly lowered (P<0.01) in liver when compared with deltamethrin-exposed group. Deltamethrin is known to induce toxic responses by generating reactive oxygen species and to neutralize its toxic effect various non-enzymatic antioxidants were found to be modulated thus implicating their role as biomarkers in pollution control programmes.

Recovery and Maintenance of Copper Levels in Geriatric Patients on Enteral Feeding for a Prolonged Period

Latent copper deficiency develops after 3 mo in patients receiving enteral feeding solutions with low copper levels. We examined whether a copper-rich enteral solution restores and maintains the level of copper in serum for a prolonged period. The study group consisted of 13 patients (eight males and five females). Commercial preparations, F2alpha and Lifelon-PZ, for enteral administration were used. F2alpha and Lifelon-PZ contain 1.6 and 0.13 mg/L, respectively, of copper. Serum copper levels were monitored in patients before and after administration of F2alpha, a copper-rich enteral solution, at the neurological ward of Nagoya Daini Red Cross Hospital. Four of the 13 patients received Liflon-PZ, a copper-poor enteral solution, before this trial. Blood samples were taken every month. The daily average copper dosage with F2alpha was 1.8 +/- 0.4 mg/d (1.0-2.4 mg/d). The copper level in the four patients who received Liflon-PZ was 10.5 +/- 5.5 micromol/L before this trial. The level rose to 18.9 +/- 3.6)mol/L 1 mo after the change to the copper-rich, F2alpha. The average serum copper level in the other patients before the start of enteral feeding was 15.3 +/- 5.0 micromol/L. The proper copper level was maintained with F2alpha in the long term. A copper-rich enteral preparation could easily restore and maintain serum copper levels for a prolonged period. A dose of 1.8 +/- 0.4 mg copper/d (1.0-2.4 mg/d) was sufficient for our patients.

Copper-replacement treatment for symptomatic Menkes disease: ethical considerations

We describe a child with classical Menkes disease with a novel ATP7A mutation, intractable seizures, severe hypotonia and developmental delay, hypopigmentation of the skin and hair, and failure to thrive, who was treated with daily subcutaneous copper histidine injections for 2(1/2) years, beginning at 15 months of age. He became seizure-free and pigmentation of his skin and hair darkened, but he continued to have severe developmental delays. His condition remains stable 8 months after stopping treatment. We review the ethical aspects of offering copper treatment for Menkes disease infants diagnosed after neurological symptoms become manifest. These include (1) the prospect for any benefits, (2) the potential risks and discomforts, (3) the parents' wishes with respect to treatment, (4) the family's understanding of the treatment's potential futility, (5) the family's understanding of the investigational nature of this treatment, (6) the potential for treatment to have an adverse impact on unaffected family members, (7) whether the ultimate decision regarding treatment should rest with health care providers or with the patient's parents, and (8) the duration of treatment. The ethical issues encountered in providing possibly futile treatment in this difficult disorder seem relevant to other pediatric medical conditions as well.

Impact of antioxidants, zinc, and copper on cognition in the elderly: a randomized, controlled trial

Participants in the Age-Related Eye Disease Study were randomly assigned to receive daily antioxidants (vitamin C, 500 mg; vitamin E, 400 IU; beta carotene, 15 mg), zinc and copper (zinc, 80 mg; cupric oxide, 2 mg), antioxidants plus zinc and copper, or placebo. A cognitive battery was administered to 2,166 elderly persons after a median of 6.9 years of treatment. Treatment groups did not differ on any of the six cognitive tests (p > 0.05 for all). These results do not support a beneficial or harmful effect of antioxidants or zinc and copper on cognition in older adults.

[The role of copper and magnesium in the pathogenesis and treatment of affective disorders]

Magnesium and copper are important modulators of NMDA-receptor activity. Recent data indicate that disturbances of glutamatergic transmission (especially via NMDA-receptor) are involved in pathogenesis of mood disorders. Magnesium deficiency, the same as disturbances in turn over of copper, are related to a variety of psychological symptoms especially depression. There are many reports indicating significant changes in blood levels of magnesium or copper during a depressive episode. Moreover magnesium exhibits antidepressant-like and anxiolytic-like effects in animal models of depression, in rodents. This article reviews the alterations in central and peripheral magnesium and copper homeostasis in relation to pathophysiology and treatment of depression.

Acquired copper deficiency following prolonged jejunostomy feeds

A 19-year-old man who developed extensive oesophageal lye (Alkali) stricture and received long-term enteral nutrition (eight months) with a jejunostomy tube developed macrocytic anaemia (Hb: 41 g/L) with leucopenia (white blood cell [WBC]: 3.0 x 10(9)/L). The patient's serum vitamin B12, folate, iron and liver function tests were normal. Bone marrow examination revealed gross erythroid hyperplasia and cytoplasmic vacuolization of erythroid and myeloid elements. Further investigations revealed low serum copper (0.3 micromol/L) and ceruloplasmin concentrations (<30 mg/L) with marginally low normal serum concentration of red cell peroxidase (13 U/gHb), establishing the diagnosis of copper deficiency anaemia. The anaemia and leucopenia responded intermittently to intravenous copper therapy, but the serum copper concentration dropped when intravenous copper therapy was withdrawn. Enteral jejunostomy copper supplementation failed to maintain adequate serum copper concentrations. After stabilizing the general condition of the patient, a pharyngo-gastric anastamosis was performed and normal oral diet commenced, which restored normal serum copper concentration. This case report suggests that copper supplements in the form of copper sulphate are not adequately absorbed when administered through a jejunostomy tube.

The effectiveness of copper oxide wire particles as an anthelmintic in pregnant ewes and safety to offspring

The objective of the experiment was to determine the effectiveness of copper oxide wire particles (COWP) in pregnant ewes and safety to lambs. COWP have been used recently as an anthelmintic in small ruminants to overcome problems associated with nematode resistance to chemical dewormers. Doses of COWP (<or=4 g) have been used in lambs without clinical signs of copper toxicity. Use in pregnant ewes has not been examined. Mature Katahdin ewes were administered 0 (n=14), 2 (n=15), or 4 (n=15)g of COWP 33+/-1.6 days before lambing in late March 2004. Fecal egg counts (FEC) and blood packed cell volume (PCV) were determined between Days 0 (day of COWP administration) and 35. Lambs were weighed within 24h after birth, at 30 and 60 days of age, and in mid-September ( approximately 120 days of age). Blood was collected from lambs within 24h after birth and at 30 days of age for determination of the activity of the liver enzyme, aspartate aminotransferase (AST) in plasma. Within 7 days after COWP administration, FEC decreased by 1308 and 511 eggs/g (epg) in the 2 and 4 g groups, respectively, compared with an increase of 996 epg in the control group (P<0.02). PCV was similar among groups between Days 0 and 35. Lamb plasma AST activity at birth increased with increasing dose of COWP in dams (P<0.001). Plasma AST activity at 30 days of age was similar for lambs from ewes treated with 0 and 2g COWP, but was slightly greater in lambs from ewes treated with 4 g COWP (P<0.02). Birth weights decreased with increasing COWP (P<0.003). By 30 (COWPxbirth type, P<0.02) and 60 (COWPxbirth type, P<0.02) days of age, weight of multiple-born lambs decreased with increasing COWP, while weight of single-born lambs was similar among treatments. In mid-September ( approximately 120 days of age) weights of multiple-born lambs from ewes treated with 4 g COWP tended to be lightest compared with lambs from ewes treated with 0 or 2g COWP or single-born lambs (P<0.09). Lamb survival to 30, 60, or 120 days of age was not affected by COWP treatment to ewes. Administration of 4 g COWP to late pregnant ewes may negatively impact multiple-born offspring, but the 2g appears to be safe for production.

Copper deficiency myeloneuropathy and pancytopenia secondary to overuse of zinc supplementation

The haematological complications of acquired copper deficiency have been well documented, but the neurological complications have only recently been reported. An illustrative case of copper deficiency myeloneuropathy with pancytopenia is presented and the potential aetiologies and neurological manifestations of this deficiency state discussed.

[Manufacturing and stability of copper-histidine solution for treatment of Menkes' Kinky Hair Syndrome]

Menkes' Kinky Hair Syndrom is a rare, X-linked recessive multisystemic lethal disorder of copper metabolism. Male infants who are affected usually die at the age of 2-3 years. If the disease is diagnosed early, patients profit from subcutaneously administered copper salts. We describe the preparation and stability of a copper-histidin solution. This solution has some advantages in terms of stability over the solutions described in earlier publications. This is a great advantage for the patients and their parents, because an ambulatory care or a home care of this patients is possible now.

The Neurotoxicity of Iminodipropionitrile (IDPN) is Ameliorated by Copper

Iminodipropionitrile (IDPN) was given to rats on diets with normal copper levels, 5 ppm, and to rats on diets with high copper levels, 100 ppm. The former developed neurological symptoms, namely choreoathetoid head movements, circling and retropulsion, while the latter only showed vague incoordination. Since rats, raised on a copper deficient diet alone, i.e. 0.9 ppm develop the same symptoms, we assume that IDPN chelates copper. The axons of the motor nerve cells show metachromatic degeneration in the rats given IDPN on a diet with normal copper level, but not in the rats on a high copper level.

[Low zinc and high copper levels in mothers of children with isolated cleft lip and palate]

Changes in orofacial development have been reported in offspring of animals treated with copper injections or low zinc diet during pregnancy. The aim of our study was to determine serum levels of zinc and copper in mothers of children with non-syndromic orofacial clefts and in women who gave birth to healthy children. Ninety six healthy women participated in the study: 35 mothers of children with cleft lip and cleft palate (CLP), 30 mothers of children with cleft palate (CP) and 31 control mothers of healthy children. Serum zinc and copper concentrations were determined by the use of inductively coupled plasma-mass spectrometry (ICP-MS).

RESULTS

Between CLP and controls there were significant differences in mean zinc levels (511 +/- 121 microg/L vs 572 +/- 76 microg/L, p = 0.012) and copper levels (991 +/- 388 microg/L vs 810 +/- 201 microg/L, p = 0.02). In CP mean serum zinc and copper levels were 540 +/- 130 microg/L and 846 +/- 291 microg/L. The ratio of serum zinc to copper levels was significantly lower in CLP comparing to CP and controls (0.57 +/- 0.19 vs 0.67 +/- 0.18 and 0.74 +/- 0.19, p = 0.003).

CONCLUSION

Our results suggest that trace elements may play a role in facial clefting in humans.

Effect of copper and diethyldithiocarbamate combination therapy on the macular mouse, an animal model of Menkes disease

Menkes disease (MD) is a neurodegenerative disorder characterized by a copper deficiency in the brain. It is caused by the defective intestinal absorption of copper resulting from a deficiency of a copper-transporting ATPase, ATP7A. This gives rise to an accumulation of copper in the intestine. The copper deficiency in the brain of MD patients cannot be improved by copper injections, because the administered copper accumulates at the blood-brain barrier and is not transported across to the neurons. To resolve this problem, we investigated the effect of a combination therapy of copper and sodium diethyldithiocarbamate (DEDTC), a lypophilic chelator, in an animal model of MD, the macular mouse. Four-week-old macular mice treated with 50 mug of CuCl2 on the 7th day after birth were used. Experimental mice were given a subcutaneous injection of CuCl2 (4 microg) and an intraperitoneal injection of DEDTC (0.2 mg/g body weight) twice a week for 4 weeks and then sacrificed. Copper concentrations and cytochrome-c oxidase activity in the brains of treated mice were higher than those of control macular mice, which received only copper or saline. The ratios of brain noradrenaline to dopamine and of adrenaline to dopamine were also increased by the treatment, suggesting that the activity of dopamine beta-hydroxylase, a copper-dependent enzyme, was improved by the treatment. Liver and renal function tests showed no abnormalities in the treated mice, although copper concentrations in the kidneys of treated mice were higher than those of control macular mice. These results suggest that DEDTC facilitates the passage of copper across the blood-brain barrier and that the combination therapy of copper and DEDTC may be an effective treatment for the neurological disturbances suffered by patients with MD.

Copper deficiency myelopathy produces a clinical picture like subacute combined degeneration

BACKGROUND

Copper deficiency in ruminants is known to cause an ataxic myelopathy. Copper deficiency as a cause of progressive myelopathy in adults is underrecognized.

OBJECTIVE

To describe the clinical, biochemical, electrophysiologic, and imaging characteristics in 13 patients with myelopathy associated with copper deficiency.

METHODS

The records of patients with a copper deficiency-associated myelopathy were reviewed. Clinical characteristics, laboratory investigations, and responses to therapeutic intervention were summarized.

RESULTS

Thirteen such patients were found, 11 of them in a 15-month period. All patients presented with prominent gait difficulty, reflecting a sensory ataxia due to dorsal column dysfunction and lower limb spasticity. All patients had polyneuropathy. A high or high-normal serum zinc level was seen in 7 of the 11 patients for whom this information was available. Somatosensory evoked potential studies done in eight patients showed impaired conduction in central proprioceptive pathways. Dorsal column signal change on spine MRI was present in three patients. An initial clue to the diagnosis was a very low ceruloplasmin level; further tests of copper metabolism excluded Wilson disease. The cause remained unexplained in most patients. Oral copper supplementation restored normal or near-normal copper levels in 7 of the 12 patients in whom adequate follow-up data were available; parenteral supplementation restored normal level in 3 further patients. Copper supplementation prevented further neurologic deterioration, but the degree of actual improvement was variable.

CONCLUSIONS

Unrecognized copper deficiency appears to be a common cause of idiopathic myelopathy in adults. The clinical picture bears striking similarities to the syndrome of subacute combined degeneration associated with vitamin B12 deficiency. Early recognition and copper supplementation may prevent neurologic deterioration.

Prevalence of multiple micronutrient deficiencies amongst pregnant women in a rural area of Haryana

Deficiencies of micronutrients (zinc, iron, folic acid and iodine) during pregnancy are known causes of Low Birth Weight (LBW). Studies have documented status of one or two micronutrients amongst pregnant women (PW). However, no attempt has been made to concurrently assess the prevalence of multiple micronutrient deficiencies and the factors associated with them amongst PW.

OBJECTIVE

The present study was undertaken to assess the prevalence of multiple micronutrient deficiencies amongst PW in a rural area.

METHODS

A community based cross sectional survey was conducted in six villages of a rural area of district Faridabad in Haryana state, India during November 2000 and October 2001. All PW aged 18 years or more, with pregnancy duration of more than 28 weeks were enrolled. Data were collected on socio-economic status and other demographic parameters. Serum zinc, copper and magnesium levels were estimated by utilizing the Atomic absorption spectrophotometry (AAS); serum ferritin and folate was estimated by Enzyme Linked Immuno Sorbent Assay (ELISA) method and the Radio-Immuno Assay (RIA) method, respectively and serum thyroid stimulating hormone (TSH) level was estimated by the Abbot AxSYM System. Serum zinc, copper, magnesium, ferritin, and folate levels less than 70.0 microg/dl, 80.0 microg/dl, 1.80 mg/dl, 15 ng/ml, and 3 ng/ml, respectively were considered as indicative of deficiency for respective micronutrients. The TSH levels of 4.670 and more indicated iodine deficiency status. Dietary intake of micronutrients was assessed utilizing 1-day 24-hour dietary recall methodology. Food consumption pattern was assessed utilizing the food frequency questionnaire methodology.

RESULTS

Nearly 73.5, 2.7, 43.6, 73.4, 26.3, and 6.4 percent PW were deficient in zinc, copper, magnesium, iron, folic acid and iodine, respectively. The highest concurrent prevalence of two, three, four and five micronutrient deficiency was of zinc and iron (54.9%); zinc, magnesium and iron (25.6%); zinc, magnesium, iron and folic acid (9.3%) and zinc, magnesium, iron, folic acid and iodine (0.8%), respectively. No pregnant woman was found to have concomitant deficiencies of all the six micronutrients. Dietary intake data revealed an inadequate nutrient intake. Over 19% PW were consuming less than 50% of the recommended calories. Similarly, 99, 86.2, 75.4, 23.6, 3.9 percent of the PW were consuming less than 50% of the recommended folic acid, zinc, iron, copper, and magnesium. The consumption of food groups rich in micronutrients (pulses, vegetables, fruits, nuts and oil seeds, animal foods) was infrequent. Univariate and Multivariate logistic regression analysis revealed that low dietary intake of nutrients, low frequency of consumption of food groups rich in micronutrients and increased reproductive cycles with short interpregnancy intervals were important factors leading to micronutrient deficiencies.

CONCLUSION

There was a high prevalence of micronutrient deficiencies amongst the PW of the area, possibly due to the poor dietary intake of food and low frequency of consumption of food groups rich in micronutrients. The concurrent prevalence of two, three, four and five micronutrient deficiencies were common.

Role of trace elements zinc, copper and magnesium during pregnancy and its outcome

Trace element deficiencies have been documented to play an important role in determination of the fetal outcome. Pregnant women in developing countries have been reported to consume diets with a lower density of minerals and vitamins. Deficiencies of trace elements like zinc, copper and magnesium have been implicated in various reproductive events like infertility, pregnancy wastage, congenital anomalies, pregnancy induced hypertension, placental abruption, premature rupture of membranes, still births and low birth weight. The present review article highlights the important of role played by zinc, copper and magnesium during pregnancy and its outcome. The role of individual trace elements and in combination with other trace elements has not been completely documented. There is a need to undertake further studies in this field.

[Use of copper oxide wire particles (Copinox) for the prevention of congenital copper deficiency in a herd of German Improved Fawn breed of goat]

In a herd of German Improved Fawn breed of goat in the year 2000 neonatal kid losses due to congenital copper deficiencies were observed. To clarify the problems and to prevent losses in the next breeding season serum copper levels of 10 dams and four control Boer goats were investigated at four time points during one year. Additionally ten kids of the following year were sampled and the serum copper levels were studied. Immediatly after parturition and 8 weeks later the dams showed low serum copper levels (10.4 +/- 11.1 micromol/l, 5.7 +/- 2.9 micromol/l resp.). At the end of the pasture season an increase of serum copper could be measured (19.3 +/- 16.0 micromol/l). To prevent enzootic ataxia due to congenital copper deficiency, the dams were treated with copper oxide wire particles in the next late gestation. At this time point serum copper concentrations started to decrease (18.5 +/- 8.4 micromol/l). The re-examination 3 month later demonstrated an increase of the serum mean copper concentrations up to 23.4 micromol/l in the dams and to 16.2 micromol/l in the kids. The serum copper levels were significantly higher compared to the levels the year before. Big variation of the serum copper levels in the control Boer goats occurred during the year, but no clinical symptoms of copper deficiency could be observed. The copper levels in the grass and soil samples were 6.8 mg/kg and 0.2 mg/kg dry substance, respectively. A secondary copper deficiency based on cadmium could be excluded through the low levels of soil samples. The contents of sulphur and molybdenum were not determined. The results indicate that the German Improved Fawn breed of goats suffered from a primary copper deficiency due to the inefficient mineral supplementation. The administration of Copinox in the last third of the gestation leads to a continious raising of the copper concentrations in the serum and is suited to prevent ataxia due to congential copper deficiency in neonatal kids.

Mitochondrial decay, a major cause of aging, can be delayed

Mitochondrial decay due to oxidant byproducts is a principal underlying contributor to aging, including the degenerative diseases of aging such as brain degeneration [15,23,32]. The energy for basic metabolic processes comes from mitochondria, and their decay with age impairs cellular metabolism and leads to cellular decline. Our progress over the last decade in delaying the mitochondrial decay of aging is briefly reviewed.

Abnormal motor function persists following recovery from perinatal copper deficiency in rats

What are the biochemical and behavioral consequences of perinatal copper deficiency? Pregnant Holtzman rats were fed a modified AIN-76A diet low in copper (0.34 mg Cu/kg and 42 mg Fe/kg) starting on gestation d 7. Seven rats received copper in their drinking water (20 mg Cu/L) (+Cu) and 7 drank deionized water (-Cu). Treatments did not affect litter size or pregnancy outcome. Compared with +Cu dams and a sample of +Cu male weanling [postnatal day (P)21] offspring, -Cu rats exhibited signs consistent with copper deficiency. P21 males were switched to a nonpurified copper-adequate diet and sampled biochemically after 3 mo and behaviorally after 3 and 6 mo of repletion (CuR). Compared with controls, CuR rats had lower brain copper and iron levels 3 and 6 mo after repletion; other biochemical differences were not detected. Behavioral assessments after 5 mo of repletion indicated a persistent impairment in motor function of CuR compared with control rats as evaluated by the accelerating rotorod procedure. These results suggest that permanent impairment to motor function can persist after long-term recovery from perinatal copper deficiency.

The clinical effect of dietary supplementation with omega-3 fish oils and/or copper in systemic lupus erythematosus

OBJECTIVE

To determine the effect of dietary supplementation with omega-3 fish oils with or without copper on disease activity in systemic lupus erythematosus (SLE). Fish oil supplementation has a beneficial effect on murine models of SLE, while exogenous copper can decrease the formation of lupus erythematosus cells in rats with a hydralazine-induced collagen disease.

METHODS

A double blind, double placebo controlled factorial trial was performed on 52 patients with SLE. Patients were randomly assigned to 4 treatment groups. Physiological doses of omega-3 fish oils and copper readily obtainable by dietary means were used. One group received 3 g MaxEPA and 3 mg copper, another 3 g MaxEPA and placebo copper, another 3 mg copper and placebo fish oil, and the fourth group received both placebo capsules. Serial measurements of disease activity using the revised Systemic Lupus Activity Measure (SLAM-R) and peripheral blood samples for routine hematological, biochemical, and immunological indices were taken at baseline, 6, 12, and 24 weeks.

RESULTS

There was a significant decline in SLAM-R score from 6.12 to 4.69 (p < 0.05) in those subjects taking fish oil compared to placebo. No significant effect on SLAM-R was observed in subjects taking copper. Laboratory variables were unaffected by either intervention.

CONCLUSION

In the management of SLE, dietary supplementation with fish oil may be beneficial in modifying symptomatic disease activity.

Use of Theraflex-TMJ topical cream for the treatment of temporomandibular joint and muscle pain

This randomized, double-blind study was designed to evaluate the effectiveness of the topical cream Theraflex-TMJ (NaBob/Rx, San Mateo, CA) in patients with masseter muscle pain and temporomandibular joint (TMJ) pain. Fifty-two subjects (5 males and 47 females) were instructed to apply a cream over the afflicted masseter muscle(s) or over the jaw joint(s) twice daily for two weeks. Theraflex-TMJ cream was used by the experimental group, while a placebo cream was used by the control group. The means of pain ratings were calculated prior to the application of the cream (baseline), after ten days of tx (period 1), and 15 days of tx (period 2) days of treatment and five days after stopping the treatment (follow-up). There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 (p < 0.01), period 2 (p < 0.001), and follow-up (p < 0.01). For the control group, no significant differences were found between the different time periods (p > 0.05). There was evidence of minor side effects such as skin irritation and/or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups. The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporomandibular joint.

Myeloneuropathy and anemia due to copper malabsorption

Dietary deficiency of copper results in a progressive ataxic myelopathy in ruminants called swayback. Menkes disease is a human disease due to an inherited defect in copper absorption; survival into adulthood is typically not known to occur. We report a 63-year-old woman who was evaluated by us for a myeloneuropathy that occurred in the setting of copper malabsorption. Her neurological deterioration stopped with copper supplementation. The limited literature on neurological manifestations of acquired copper deficiency suggests that the clinical presentation resembles the myeloneuropathy seen with vitamin B12 deficiency.

A combination therapy with copper nicotinate complex reduces the adverse effects of 5-fluorouracil on patients with hepatocellular carcinoma

5-Fluorouracil (5-FU) as chemotherapy in cases of hepatocellular carcinoma (HCC), was found to initiate hepatotoxic injuries, ascites, leucopenia, thrombocytopenia and myelosupression that limit its use. Therefore, this work was conducted to investigate whether the combination of copper (I)-nicotinate complex [CuCl (HNA)2] with 5-FU may overcome such a drug resistance. Forty-eight patients with HCC were therapy-naïve and treated with 5-FU (12 mg/kg/day) for 5 days in 2 cycles with 4 weeks in between. Twenty-four of them were simultaneously given oral doses of copper (I)-nicotinate complex (0.8 mg/kg/day) started with the 5-FU treatment. The combined therapy of CuCl (HNA)2 with 5-FU could improve the prognosis of HCC-patients. Improvement of liver function was presented by significant reduction of serum bilirubin (p<0.001), transaminases and alkaline phoshatase (p<0.05). The copper complex prevented hypoproteinaemic and hypoalbuminaemic effects of 5-FU and rendered the prothrombin time to its normal value (p<0.001). Superoxide dismutase, ceruloplasmin and immunoglobulins IgG showed significant increases (p<0.001), while serum copper and lipid peroxides were reduced (p<0.001). Thrombocytopenia, leucopenia and other myelosuppressive effects of 5-FU were reduced by the co-administration of CuCl (HNA)2. In conclusion the combination with CuCl (HNA)2 given in such a dosage schedule mitigated the most frequent toxicities associating 5-FU administration and enhanced defense mechanisms against oxidative stress.