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Rossi KA, Almenara CCP, Simões RP, Mulher LCCS, Krause M, Carneiro MTWD, Padilha AS. Short-term Effects of Cadmium Exposure on Blood Pressure and Vascular Function in Wistar Rats. Biol Trace Elem Res 2024; 202:2645-2656. [PMID: 37697136 DOI: 10.1007/s12011-023-03851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
Chronic cadmium exposure is known to be associated with vascular changes and increased blood pressure, but its short-term effects on the cardiovascular system remain poorly understood. This study aimed to investigate the pressoric and vascular effects of a 7-day exposure to CdCl2 in Wistar rats. The rats were divided in control group (Ct), which received tap water, and the Cd group, which received a 100 mg/L CdCl2 solution via drinking water for 7 days. We analyzed body weight, plasma Cadmium concentration, systolic blood pressure (SBP), and vascular responses. Despite relatively low plasma Cadmium concentration, the Cd group exhibited elevated SBP and increased contractile response to phenylephrine. Endothelium removal and NOS inhibition increased contractions in both groups. In the Cd group's aorta, we observed enhanced levels of phospho-eNOS (Ser1177) and basal NO release. Cd group showed reduced Catalase expression and increased basal release of H2O2, with catalase reducing the contractile response. In arteries pre-contracted with phenylephrine, Cd group showed impaired endothelium-dependent (Acetylcholine) and independent (sodium nitroprussiate-SNP) relaxation responses. However, responses to SNP were similar after pre-contraction with KCl in both groups. These data suggest early effects of Cadmium on blood pressure and aortic function, indicating impaired H2O2-scavenging by catalase. Increased H2O2 due to Cadmium exposure might explain heightened responses to phenylephrine and weakened relaxation responses mediated by the NO-K+-channels pathway. Our findings shed light on Cadmium's short-term impact on the cardiovascular system, providing insights into potential mechanisms underlying its effects on blood pressure regulation and vascular function.
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Affiliation(s)
- Karoline Alves Rossi
- Physiological Sciences Post-Graduation Program, Federal University of Espírito Santo, Vitoria, ES, Brazil
| | | | - Rakel Passos Simões
- Physiological Sciences Post-Graduation Program, Federal University of Espírito Santo, Vitoria, ES, Brazil
| | | | - Maiara Krause
- Department of Chemistry, Federal University of Espírito Santo, Vitoria, ES, Brazil
| | | | - Alessandra Simão Padilha
- Physiological Sciences Post-Graduation Program, Federal University of Espírito Santo, Vitoria, ES, Brazil.
- Programa de Pós-Graduação Em Ciências Fisiológicas, CCS/UFES, Av. Marechal Campos, MaruípeVitoria, ES, 146829043-900, Brazil.
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Sepulchro Mulher LCC, Simões RP, Rossi KA, Schereider IRG, Silva Nascimento CLD, Ávila RA, Padilha AS. In vitro cadmium exposure induces structural damage and endothelial dysfunction in female rat aorta. Biometals 2023; 36:1405-1420. [PMID: 37651061 DOI: 10.1007/s10534-023-00526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
Cadmium is a heavy metal that is widespread in the environment and has been described as a metalloestrogen and a cardiovascular risk factor. Experimental studies conducted in male animals have shown that cadmium exposure induces vascular dysfunction, which could lead to vasculopathies caused by this metal. However, it is necessary to investigate the vascular effects of cadmium in female rats to understand its potential sex-dependent impact on the cardiovascular system. While its effects on male rats have been studied, cadmium may act differently in females due to its potential as a metalloestrogen. In vitro studies conducted in a controlled environment allow for a direct assessment of cadmium's impact on vascular function, and the use of female rats ensures that sex-dependent effects are evaluated. Therefore, the aim of this study was to investigate the in vitro effects of Cadmium Chloride (CdCl2, 5 µM) exposure on vascular reactivity in the isolated aorta of female Wistar rats. Exposure to CdCl2 damaged the architecture of the vascular endothelium. CdCl2 incubation increased the production and release of O2•-, reduced the participation of potassium (K+) channels, and increased the participation of the angiotensin II pathway in response to phenylephrine. Moreover, estrogen receptors alpha (Erα) modulated vascular reactivity to phenylephrine in the presence of cadmium, supporting the hypothesis that cadmium could act as a metalloestrogen. Our results demonstrated that in vitro cadmium exposure induces damage to endothelial architecture and an increase in oxidative stress in the isolated aorta of female rats, which could precipitate vasculopathies. Graphical Abstract. Own source from Canva and Servier Medical Art servers.
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Affiliation(s)
- Lorraine Christiny Costa Sepulchro Mulher
- Physiological Sciences Post-Graduation Program, CCS/UFES, Federal University of Espírito Santo, Av. Marechal Campos, 1468, 26 Maruípe, Vitoria, ES, 29043-900, Brazil
| | - Rakel Passos Simões
- Physiological Sciences Post-Graduation Program, CCS/UFES, Federal University of Espírito Santo, Av. Marechal Campos, 1468, 26 Maruípe, Vitoria, ES, 29043-900, Brazil
| | - Karoline Alves Rossi
- Physiological Sciences Post-Graduation Program, CCS/UFES, Federal University of Espírito Santo, Av. Marechal Campos, 1468, 26 Maruípe, Vitoria, ES, 29043-900, Brazil
| | - Ingridy Reinholz Grafites Schereider
- Physiological Sciences Post-Graduation Program, CCS/UFES, Federal University of Espírito Santo, Av. Marechal Campos, 1468, 26 Maruípe, Vitoria, ES, 29043-900, Brazil
| | - Camilla Lóren da Silva Nascimento
- Physiological Sciences Post-Graduation Program, CCS/UFES, Federal University of Espírito Santo, Av. Marechal Campos, 1468, 26 Maruípe, Vitoria, ES, 29043-900, Brazil
| | - Renata Andrade Ávila
- Physiological Sciences Post-Graduation Program, CCS/UFES, Federal University of Espírito Santo, Av. Marechal Campos, 1468, 26 Maruípe, Vitoria, ES, 29043-900, Brazil
| | - Alessandra Simão Padilha
- Physiological Sciences Post-Graduation Program, CCS/UFES, Federal University of Espírito Santo, Av. Marechal Campos, 1468, 26 Maruípe, Vitoria, ES, 29043-900, Brazil.
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Gao L, Li X. Protective Effect of Tubotaiwine on Cadmium-Induced Hypertension in Rats through Reduction in Arterial Stiffness and Vascular Remodeling. DOKL BIOCHEM BIOPHYS 2021; 500:368-375. [PMID: 34697745 DOI: 10.1134/s1607672921050136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 11/22/2022]
Abstract
Humans are adversely affected by exposure to cadmium (Cd) as it induces oxidative stress which damages kidneys, bones pulmonary tissues, liver, cardiovascular, immune, reproductive systems and influences endocrine secretions. In the present study tubotaiwine treatment regulated systolic, diastolic and mean arterial blood pressure of the Cd exposed rats. Tubotaiwine significantly promoted vascular responsiveness to Phe, ACh and SNP and reversed Cd mediated decrease in eNOS and increase in iNOS expression. Treatment of the Cd exposed rats with tubotaiwine reduced number of smooth muscle cells, decreased collagen content and promoted content of elastin in aortic artery walls. Tubotaiwine treatment significantly suppressed Cd-induced increase in MMP-2 and MMP-9 in rat aortic artery tissues. Increase in O2-, urinary nitrate/nitrite, MDA, carbonyl level and decrease in GSH production in rat blood and thoracic aorta tissues were effectively reversed by tubotaiwine treatment. Tubotaiwine treatment of the rats significantly reduced Cd-induced increase in blood, liver, heart and kidney tissue Cd content in dose dependent manner. Thus, tubotaiwine suppresses Cd induced hypertension in rats by reducing arterial stiffness, inhibition of oxidative stress and increasing vascular remodeling. Therefore, tubotaiwine has beneficial effect on Cd induced hypertension in rats and may be developed as a potential candidate for treatment of hypertension.
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Affiliation(s)
- Liwei Gao
- Department of Cardiovascular Medicine, Danyang People's Hospital of Jiangsu Province, 212300, Danyang, Jiangsu, China
| | - Xiaolin Li
- Department of Radiology, the First People's Hospital of Jingmen City, 448000, Jingmen City, Hubei Province, China.
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Martins AC, Santos AAD, Lopes ACBA, Skalny AV, Aschner M, Tinkov AA, Paoliello MMB. Endothelial Dysfunction Induced by Cadmium and Mercury and its Relationship to Hypertension. Curr Hypertens Rev 2021; 17:14-26. [PMID: 33475076 DOI: 10.2174/1573402117666210121102405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Hypertension is an important public health concern that affects millions globally, leading to a large number of morbidities and fatalities. The etiology of hypertension is complex and multifactorial, and it involves environmental factors, including heavy metals. Cadmium and mercury are toxic elements commonly found in the environment, contributing to hypertension. We aimed to assess the role of cadmium and mercury-induced endothelial dysfunction in the development of hypertension. A narrative review was carried out through database searches. In this review, we discussed the critical roles of cadmium and mercury in the etiology of hypertension and provided new insights into potential mechanisms of their effect, focusing primarily on endothelial dysfunction. Although the mechanisms by which cadmium and mercury induce hypertension have yet to be completely elucidated, evidence for both implicates impaired nitric oxide signaling in their hypertensive etiology.
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Affiliation(s)
- Airton C Martins
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Alessanda A D Santos
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Ana C B A Lopes
- Graduate Program in Public Health, Center of Health Sciences, State University of Londrina, Londrina, Brazil
| | - Anatoly V Skalny
- Medical Elementology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Alexey A Tinkov
- Medical Elementology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Monica M B Paoliello
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, United States
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Adefegha SA, Oboh G, Iyoha AE, Oyagbemi AA. Comparative effects of horseradish (Moringa oleifera) leaves and seeds on blood pressure and crucial enzymes relevant to hypertension in rat. PHARMANUTRITION 2019. [DOI: 10.1016/j.phanu.2019.100152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Tetrahydrocurcumin protects against cadmium-induced hypertension, raised arterial stiffness and vascular remodeling in mice. PLoS One 2014; 9:e114908. [PMID: 25502771 PMCID: PMC4263715 DOI: 10.1371/journal.pone.0114908] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/14/2014] [Indexed: 12/15/2022] Open
Abstract
Background Cadmium (Cd) is a nonessential heavy metal, causing oxidative damage to various tissues and associated with hypertension. Tetrahydrocurcumin (THU), a major metabolite of curcumin, has been demonstrated to be an antioxidant, anti-diabetic, anti-hypertensive and anti-inflammatory agent. In this study, we investigated the protective effect of THU against Cd-induced hypertension, raised arterial stiffness and vascular remodeling in mice. Methods Male ICR mice received CdCl2 (100 mg/l) via drinking water for 8 weeks. THU was administered intragastrically at dose of 50 or 100 mg/kg/day concurrently with Cd treatment. Results Administration of CdCl2 significantly increased arterial blood pressure, blunted vascular responses to vasoactive agents, increased aortic stiffness, and induced hypertrophic aortic wall remodeling by increasing number of smooth muscle cells and collagen deposition, decreasing elastin, and increasing matrix metalloproteinase (MMP)-2 and MMP-9 levels in the aortic medial wall. Supplementation with THU significantly decreased blood pressure, improved vascular responsiveness, and reversed the structural and mechanical alterations of the aortas, including collagen and elastin deposition. The reduction on the adverse response of Cd treatment was associated with upregulated eNOS and downregulated iNOS protein expressions, increased nitrate/nitrite level, alleviated oxidative stress and enhanced antioxidant glutathione. Moreover, THU also reduced the accumulation of Cd in the blood and tissues. Conclusions Our results suggest that THU ameliorates cadmium-induced hypertension, vascular dysfunction, and arterial stiffness in mice through enhancing NO bioavailability, attenuating oxidative stress, improving vascular remodeling and decreasing Cd accumulation in other tissues. THU has a beneficial effect in moderating the vascular alterations associated with Cd exposure.
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Abstract
Dose-finding studies enable the successful conduct of peripheral nerve blocks by ensuring the administration of appropriate doses of local anesthetic. However, the optimal dose-finding methodology remains ambiguous. In this research methodology article, we set out to review the basic aspects pertaining to dose-response curves (graded vs quantal), the pharmacodynamic indices required by dose-finding studies, the properties of different dose-finding methods (sigmoidal dose-response curve analysis, Dixon-Mood method, Biased Coin Design, and Bayesian analysis), as well as strategies and recommendations for future research.
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Angeli JK, Cruz Pereira CA, de Oliveira Faria T, Stefanon I, Padilha AS, Vassallo DV. Cadmium exposure induces vascular injury due to endothelial oxidative stress: the role of local angiotensin II and COX-2. Free Radic Biol Med 2013; 65:838-848. [PMID: 23973752 DOI: 10.1016/j.freeradbiomed.2013.08.167] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/05/2013] [Accepted: 08/15/2013] [Indexed: 12/18/2022]
Abstract
Cadmium is an environmental pollutant that is closely linked with cardiovascular diseases, such as atherosclerosis and hypertension. Moreover, cadmium can induce an increase in oxidative stress. One of the main sites affected by oxidative stress is the aorta, which consequently develops atherosclerosis. However, there are few reports demonstrating aortic effects induced by small concentrations of cadmium that are similar to those found in the blood resulting from occupational exposure. Furthermore, several studies have reported on chronic cadmium exposure, and the results of these studies may have been influenced by the secondary effects induced by this metal, such as hypertension. Therefore, we investigated the effects of acute cadmium exposure on the vascular reactivity to phenylephrine of aortic rings isolated from male Wistar rats. Cadmium increased phenylephrine reactivity without changing the vasorelaxation induced by acetylcholine and sodium nitroprusside. Endothelial damage or incubation with L-NAME shifted the phenylephrine concentration-response curves leftward in arteries incubated with or without cadmium, but the curves were shifted to a lesser degree after cadmium incubation. Enalapril, losartan, the nonselective COX inhibitor indomethacin, the TXA(2) synthase inhibitor furegrelate, the selective COX-2 inhibitor NS 398, the TP receptor antagonist SQ 29.548, the EP1 receptor antagonist SC 19.220, superoxide dismutase, and the NADPH oxidase inhibitor apocynin partially reverted the cadmium-induced effects on the reactivity to phenylephrine. Cadmium exposure increased vasoconstrictor activity by reducing NO bioavailability owing to the increased production of ROS by NADPH oxidase. The results of the tested cadmium concentration, which is below the reference values, suggest that acute cadmium exposure may induce vascular injury through endothelial oxidative stress. These data contribute to the evidence indicating that cadmium is a high risk to public health.
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Affiliation(s)
- Jhuli Keli Angeli
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, 29040-091 Vitória, ES, Brazil.
| | | | - Thaís de Oliveira Faria
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, 29040-091 Vitória, ES, Brazil
| | - Ivanita Stefanon
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, 29040-091 Vitória, ES, Brazil
| | - Alessandra Simão Padilha
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, 29040-091 Vitória, ES, Brazil
| | - Dalton Valentim Vassallo
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, 29040-091 Vitória, ES, Brazil; Escola de Ensino Superior da Santa Casa de Misericórdia de Vitória, EMESCAM, Vitória, ES, Brazil
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Chronic cadmium treatment promotes oxidative stress and endothelial damage in isolated rat aorta. PLoS One 2013; 8:e68418. [PMID: 23874620 PMCID: PMC3709967 DOI: 10.1371/journal.pone.0068418] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/29/2013] [Indexed: 01/21/2023] Open
Abstract
Cadmium is a highly toxic metal that is present in phosphate fertilizers, and the incidence of cadmium poisoning in the general population has increased, mainly due to cigarette smoking. Once absorbed, cadmium accumulates in the tissues, causing harmful effects including high blood pressure, endothelial damage and oxidative stress. Oxidative stress is known to efficiently produce oxidized low-density lipoprotein and consequently atherosclerosis, mainly in the aorta. However, the mechanisms through which endothelial damage is induced by cadmium have not been elucidated. Thus, the aim of this study was to investigate the effects of this metal in the isolated aorta and the possible role of oxidative stress. Rats received 100 mg.L(-1) cadmium chloride (CdCl2) in the drinking water or distilled water alone for four weeks. The pressor effect of cadmium was followed throughout the exposure period by tail plethysmography. At the end of the fourth week, the blood cadmium content was established, and the vascular reactivity of the isolated aorta to phenylephrine, acetylcholine and sodium nitroprusside was analyzed in the context of endothelium denudation and incubation with L-NAME, apocynin, losartan, enalapril, superoxide dismutase (SOD) or catalase. We observed an increased response to phenylephrine in cadmium-treated rats. This increase was abolished by catalase and SOD incubation. Apocynin treatment reduced the phenylephrine response in both treatment groups, but its effect was greater in cadmium-treated rats, and NOX2 expression was greater in the cadmium group. These results suggested that cadmium in blood concentrations similar to those found in occupationally exposed populations is able to stimulate NOX2 expression, contributing to oxidative stress and reducing NO bioavailability, despite enhanced eNOS expression. These findings suggest that cadmium exposure promotes endothelial damage that might contribute to inflammation, vascular injury and the development of atherosclerosis.
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Leite RP, Predes FS, Monteiro JC, Freitas KM, Wada RS, Dolder H. Advantage of Guaraná (Paullinia cupana Mart.) supplementation on cadmium-induced damages in testis of adult Wistar rats. Toxicol Pathol 2012; 41:73-9. [PMID: 22659242 DOI: 10.1177/0192623312447541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Paullinia cupana is an Amazonian bush whose seeds have long been used in folk medicine. However, most of the therapeutic properties attributed to this plant are broad and nonspecific, although an antioxidant activity has been reported. On the other hand, cadmium is a heavy metal known for increasing free radicals, hence resulting in cellular oxidative damages. This study was designed to evaluate whether Paullinia cupana is able to reduce cadmium-induced morphological impairment in Wistar rat testis. Adult male Wistar rats 110 days old were ip injected with cadmium (1.15 mg/kg BW [body weight]) and subsequently treated with P. cupana during 56 days. Furthermore, groups receiving either P. cupana extract or cadmium are mentioned. After the treatment period, testis samples were subjected to histological and stereological analyses. Moderate to severe testicular impairments were shown by the animals exposed to cadmium. However, the animals supplemented with P. cupana after cadmium exposure showed a significant decrease in the proportion of damaged seminiferous tubules. Also, P. cupana supplementation was effective in maintaining the number of Leydig cells per testis in the animals exposed to cadmium. In conclusion, P. cupana supplementation was partially efficient in preventing cadmium from damaging the testis of adult Wistar rats.
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Affiliation(s)
- Rodrigo P Leite
- Department of Cell Biology, Institute of Biology, UNICAMP, São Paulo, Brazil
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Leite RP, Wada RS, Monteiro JC, Predes FS, Dolder H. Protective effect of Guaraná (Paullinia cupana var. sorbilis) pre-treatment on cadmium-induced damages in adult Wistar testis. Biol Trace Elem Res 2011; 141:262-74. [PMID: 20495888 DOI: 10.1007/s12011-010-8729-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 05/05/2010] [Indexed: 11/30/2022]
Abstract
Guaraná (Paullinia cupana) is an Amazonian plant. Its antioxidant potential was demonstrated to be due to the high polyphenol concentration. On the other hand, one of the mechanisms underlying cadmium-induced cellular damage is free radical mediated, resulting in increased oxidative processes. This study investigated P. cupana's potential to attenuate cadmium-induced damages in Wistar rat testis. Adult male Wistar rats were either pre-treated with 2 mg/g body weight (BW) of powdered P. cupana seed during 56 days and/or injected with cadmium chloride at a dose of 1.15 mg/kg BW. After cadmium exposition (48 h), testes samples were evaluated by histological and stereological analyses. Both groups exposed to cadmium presented evident morphological alterations relative to control animals. A few rodents showed massive cell death in the seminiferous epithelium and intertubular space, indicating that some animals are more sensitive to cadmium. Despite the alterations observed in both groups, pre-treatment with P. cupana was effective in attenuating morphological changes in Leydig cells, as well as reducing inflammatory response, relative to animals exclusively exposed to the metal. Animals treated only with P. cupana presented a significant increase in plasma testosterone levels and a significant increase in volumetric proportions of seminiferous tubules, which are indicative of spermatogenic stimulation.
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Affiliation(s)
- Rodrigo Paula Leite
- Department of Anatomy, Cell Biology, Physiology and Biophysical, Institute of Biology, UNICAMP, P. O. Box 6109, Campinas, São Paulo, 13083-863, Brazil
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Ronco AM, Montenegro M, Castillo P, Urrutia M, Saez D, Hirsch S, Zepeda R, Llanos MN. Maternal exposure to cadmium during gestation perturbs the vascular system of the adult rat offspring. Toxicol Appl Pharmacol 2011; 251:137-45. [DOI: 10.1016/j.taap.2011.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 12/30/2010] [Accepted: 01/04/2011] [Indexed: 01/21/2023]
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