Neurobehavioral functioning after cessation of manganese exposure: a follow-up after 14 years

Manganese neurotoxicity: lessons learned from longitudinal studies in nonhuman primates

BACKGROUND

Exposure to excess levels of the essential trace element manganese produces cognitive, psychiatric, and motor abnormalities. The understanding of Mn neurotoxicology is heavily governed by pathologic and neurochemical observations derived from rodent studies that often employ acute Mn exposures. The comparatively sparse studies incorporating in vivo neuroimaging in nonhuman primates provide invaluable insights on the effects of Mn on brain chemistry.

OBJECTIVES

The purpose of this review is to discuss important aspects of Mn neurotoxicology and to synthesize recent findings from one of the largest cohorts of nonhuman primates used to study the neurologic effects of chronic Mn exposure.

DISCUSSION

We reviewed our recent in vivo and ex vivo studies that have significantly advanced the understanding of Mn-induced neurotoxicity. In those studies, we administered weekly doses of 3.3-5.0 (n=4), 5.0-6.7 (n=5), or 8.3-10.0 mg Mn/kg (n=3) for 7-59 weeks to cynomolgus macaque monkeys. Animals expressed subtle deficits in cognition and motor function and decreases in the N-acetylaspartate-to-creatine ratio in the parietal cortex measured by magnetic resonance spectroscopy reflective of neuronal dysfunction. Impaired striatal dopamine release measured by positron emission tomography was observed in the absence of changes in markers of dopamine neuron degeneration. Neuropathology indicated decreased glutamine synthetase expression in the globus pallidus with otherwise normal markers of glutamatergic and GABAergic neurotransmission. Increased amyloid beta (A4) precursor-like protein 1 gene expression with multiple markers of neurodegeneration and glial cell activation was observed in the frontal cortex.

CONCLUSIONS

These findings provide new information on mechanisms by which Mn affects behavior, neurotransmitter function, and neuropathology in nonhuman primates.

Manganese exposure among smelting workers: relationship between blood manganese-iron ratio and early onset neurobehavioral alterations

A biomarker for detection of early onset neurobehavioral alterations in manganism remains unknown. The purpose of this study was to use a neurobehavioral test battery to identify subtle changes in Mn-induced motor and memory dysfunction and to relate the quantifiable neurological dysfunction to an established Mn-exposure index such as blood manganese-iron ratio (MIR). A total of 323 subjects were recruited to control (n=106), low-exposure (122), and high-exposure (95) groups. The test battery consisted of standard testing procedures including the nine-hole and groove-type steadiness tester, Benton visual retention test, and Purdue pegboard coordination test. No significant health problems or clinically diagnosed neurological dysfunctions were observed. Benton test did not reveal any abnormal memory deficits among Mn-exposed smelters, nor did the groove and nine-hole tests detect any abnormality in dynamic and static steadiness in tested subjects. Purdue pegboard test showed a remarkable age-related decline in fine movement coordination among all study participants regardless of the Mn-exposure condition. Mn exposure significantly exacerbated this age-related deterioration. Statistical modeling revealed that the plasma and erythrocyte MIR (i.e., pMIR and eMIR, respectively) were associated with Purdue pegboard scores. Among all subjects whose MIR were above the cut-off value (COV), pMIR was significantly correlated with pegboard scores (r=-0.261, p=0.002), whereas for those subjects over the age of 40, the eMIR, but not pMIR, was associated with declined pegboard performance (r=-0.219, p=0.069). When both factors were taken into account (i.e., age>40 and MIR>the COV), only pMIR was inversely associated with pegboard scores. Combining their usefulness in Mn-exposure assessment, we recommend that the blood Mn-Fe ratio may serve as a reasonable biomarker not only for assessment of Mn exposure but also for health risk assessment.

Manganese and its role in Parkinson's disease: from transport to neuropathology

The purpose of this review is to highlight recent advances in the neuropathology associated with Mn exposures. We commence with a discussion on occupational manganism and clinical aspects of the disorder. This is followed by novel considerations on Mn transport (see also chapter by Yokel, this volume), advancing new hypotheses on the involvement of several transporters in Mn entry into the brain. This is followed by a brief description of the effects of Mn on neurotransmitter systems that are putative modulators of dopamine (DA) biology (the primary target of Mn neurotoxicity), as well as its effects on mitochondrial dysfunction and disruption of cellular energy metabolism. Next, we discuss inflammatory activation of glia in neuronal injury and how disruption of synaptic transmission and glial-neuronal communication may serve as underlying mechanisms of Mn-induced neurodegeneration commensurate with the cross-talk between glia and neurons. We conclude with a discussion on therapeutic aspects of Mn exposure. Emphasis is directed at treatment modalities and the utility of chelators in attenuating the neurodegenerative sequelae of exposure to Mn. For additional reading on several topics inherent to this review as well as others, the reader may wish to consult Aschner and Dorman (Toxicological Review 25:147-154, 2007) and Bowman et al. (Metals and neurodegeneration, 2009).

Past occupational exposure to airborne manganese in a manganese alloy plant

A retrospective exposure assessment of a group of manganese (Mn) alloy workers was performed in conjunction with a 2004 follow-up study, 14 years after cessation of exposure, to evaluate the long-term effects of occupational Mn exposure on neurobehavioral functions. The ferro- and silico-Mn alloy plant opened in 1973 and closed in 1991. The airborne total Mn (TMn) exposures for job groupings were established using personal sampling data from a 1991 industrial hygiene survey. Historical short-term total dust (TDust) data were used to estimate past TDust exposure for job groupings and plant areas. Relationships between Mn content and TDust from the 1991 survey, supported by sparse historical data, were used to estimate TMn content in the historical TDust data. Results showed past personal TDust exposure levels much higher than those found in 1991. Changes in TDust levels and corresponding TMn levels were a function of changes in ventilation, work practices, and operations, not of product (ferro- or silico-Mn). Relationships between TMn and respirable Mn (RMn) from area sampling in 1991 were used to estimate RMn exposure for the job groups. Work histories for 112 workers were developed from payroll records, questionnaires, and interviews and combined with Mn exposure estimates to develop cumulative exposure indices (CEIs). The TMn CEI ranged from 0.27 mg/m(3)x years to 100.24 mg/m(3)x years, with an AM of 24.40 mg/m(3)x years and a GM of 14.06 mg/m(3)x years. The RMn CEI had an AM of 2.95 mg/m(3)x years and a GM of 1.78 mg/m(3)x years with a range of 0.05-12.03 mg/m(3)x years. Overall average TMn exposure intensity, the TMn CEI divided by time worked in years for each worker, had an AM of 1.6 mg Mn/m(3), a GM of 1.0 mg Mn/m(3), range 0.02-6.2 6 mg Mn/m(3). The results of the 2004 follow-up study showed several concentration-response relationships between TMn CEI and neurobehavioral outcomes, which suggest that increase in cumulative TMn exposure level has long-term consequences on the nervous system.

Manganese cumulative exposure and symptoms: a follow-up study of alloy workers

Long-term exposure to manganese (Mn) particulates through inhalation can be neurotoxic, with deficits in neuromotor and cognitive domains. Mn-exposed individuals also report symptoms, including fatigue, mood changes, irritability, concentration difficulties, and sweating in the absence of physical effort. The long-term course of Mn-related symptoms after cessation of exposure has never been examined. Male workers from a Mn-alloy production plant participated in a study on nervous system functions (initial examination), and were followed-up 14 years after plant closure. The relation between self-reported symptoms and Mn cumulative exposure index (CEI) was examined among 71 Mn-alloy workers and 71 referents. Symptoms from the questionnaire were grouped into categories, and the reported frequency was compared between referents and Mn-alloy workers in each Mn CEI tertile using General Linear Models, controlling for age, education, and alcohol consumption. A gradual increase in symptoms frequency was observed for complaints related to hearing and movement control both at initial and follow-up examination, and fatigue and autonomic nervous system only at initial examination. In addition, an exposure-effect relation was apparent for symptoms related to memory, concentration and balance reported at both examinations, with Mn-workers in the highest CEI tertile reporting the highest level of symptomatology. Sleeping complaints were not associated with exposure to Mn, while musculoskeletal pain and muscular weakness were reported more often by Mn-workers than referents but were not clearly related to CEI. The findings suggest that former Mn-alloy workers continue to perceive symptoms many years after cessation of exposure. Despite the limitations of self-reported symptoms, subjective complaints are an important part of a health assessment since they relate directly to perceived health status and day-to-day functioning.

Increased APLP1 expression and neurodegeneration in the frontal cortex of manganese-exposed non-human primates

Chronic manganese (Mn) exposure produces a neurological syndrome with psychiatric, cognitive, and parkinsonian features. Gene expression profiling in the frontal cortex of Cynomologous macaques receiving 3.3-5.0 mg Mn/kg weekly for 10 months showed that 61 genes were increased and four genes were decreased relative to controls from a total of 6766 genes. Gene changes were associated with cell cycle regulation, DNA repair, apoptosis, ubiquitin-proteasome system, protein folding, cholesterol homeostasis, axonal/vesicular transport, and inflammation. Amyloid-beta (Abeta) precursor-like protein 1, a member of the amyloid precursor protein family, was the most highly up-regulated gene. Immunohistochemistry confirmed increased amyloid precursor-like protein 1 protein expression and revealed the presence of diffuse Abeta plaques in Mn-exposed frontal cortex. Cortical neurons and white matter fibers from Mn-exposed animals accumulated silver grains indicative of on-going degeneration. Cortical neurons also exhibited nuclear hypertrophy, intracytoplasmic vacuoles, and apoptosis stigmata. p53 immunolabeling was increased in the cytoplasm of neurons and in the nucleus and processes of glial cells in Mn-exposed tissue. In summary, chronic Mn exposure produces a cellular stress response leading to neurodegenerative changes and diffuse Abeta plaques in the frontal cortex. These changes may explain the subtle cognitive deficits previously demonstrated in these same animals.