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Geng J, Wei D, Wang L, Xu Q, Wang J, Shi J, Ma C, Zhao M, Huo W, Jing T, Wang C, Mao Z. The association of isocarbophos and isofenphos with different types of glucose metabolism: The role of inflammatory cells. J Environ Sci (China) 2025; 147:322-331. [PMID: 39003050 DOI: 10.1016/j.jes.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 07/15/2024]
Abstract
To investigate the associations between isocarbophos and isofenphos with impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM), and to assess the mediation roles of inflammation cells. There were 2701 participants in the case-control study, including 896 patients with T2DM, 900 patients with IFG, 905 subjects with NGT. Plasma isocarbophos and isofenphos concentrations were measured using gas chromatography and triple quadrupole tandem mass spectrometry. Generalized linear models were used to calculate the relationships between plasma isofenphos and isocarbophos levels with inflammatory factor levels and T2DM. Inflammatory cell was used as mediators to estimate the mediating effects on the above associations. Isocarbophos and isofenphos were positively related with T2DM after adjusting for other factors. The odds ratio (95% confidence interval) (OR (95%CI)) for T2DM was 1.041 (1.015, 1.068) and for IFG was 1.066 (1.009, 1.127) per unit rise in ln-isocarbophos. The prevalence of T2DM increased by 6.4% for every 1 unit more of ln-isofenphos (OR (95% CI): 1.064 (1.041, 1.087)). Additionally, a 100% rise in ln-isocarbophos was linked to 3.3% higher ln-HOMA2IR and a 0.029 mmol/L higher glycosylated hemoglobin (HbA1c) (95% CI: 0.007, 0.051). While a 100% rise in ln-isofenphos was linked to increase in ln-HOMA2 and ln-HOMA2IR of 5.8% and 3.4%, respectively. Furthermore, white blood cell (WBC) and neutrophilic (NE) were found to be mediators in the relationship between isocarbophos and T2DM, and the corresponding proportions were 17.12% and 17.67%, respectively. Isofenphos and isocarbophos are associated with IFG and T2DM in the rural Chinese population, WBC and NE have a significant role in this relationship.
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Affiliation(s)
- Jintian Geng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Dandan Wei
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Lulu Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Qingqing Xu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Juan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Jiayu Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Cuicui Ma
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Mengzhen Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Wenqian Huo
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Tao Jing
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
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Martins JRN, Lopes S, Hurtado HN, da Silva FN, Villard DR, Taboga SR, Souza KLA, Quesada I, Soriano S, Rafacho A. Acute and chronic effects of the organophosphate malathion on the pancreatic α and β cell viability, cell structure, and voltage-gated K + currents. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2023; 98:104046. [PMID: 36587778 DOI: 10.1016/j.etap.2022.104046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/09/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Studies indicate that the pesticide malathion may have a role in diabetes. Herein, we determined the effects of different concentrations of malathion on survival, ultrastructure, and electrophysiologic islet cell parameters. Acutely, high concentrations of malathion (0.5 or 1 mM) increased cell death in rat islet cells, while low concentrations (0.1 mM) caused signs of cell damage in pancreatic α and β cells. Exposure of RINm5F cells to malathion for 24 or 48 h confirmed the reduction in β-cell viability at lower concentrations (0.001-100 µM). Chronic exposure of mouse pancreatic α and β cells to 3 nM of malathion led to increased voltage-gated K+ (Kv) currents in α-cells. Our findings show a time and concentration dependency for the malathion effect on the reduction of islet cell viability and indicate that pancreatic α cells are more sensitive to malathion effects on Kv currents and cell death.
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Affiliation(s)
- J R N Martins
- Laboratory of Investigation in Chronic Diseases LIDoC, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina UFSC, Florianópolis, Brazil; Graduate Program in Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina UFSC, Florianópolis, Brazil
| | - S Lopes
- Central Laboratory of Electron Microscopy LCME, PROPESQ, Federal University of Santa Catarina UFSC, Florianópolis, Brazil
| | - H N Hurtado
- Department of Physiology, Genetics, and Microbiology, University of Alicante, Alicante, Spain
| | - F N da Silva
- Laboratory of Investigation in Chronic Diseases LIDoC, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina UFSC, Florianópolis, Brazil; Graduate Program in Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina UFSC, Florianópolis, Brazil
| | - D R Villard
- NUMPEX-BIO, Campus Duque de Caxias, Universidade Federal do Rio de Janeiro (UFRJ), Campus UFRJ Duque de Caxias Prof. Geraldo Cidade, Duque de Caxias 25245-390, Brazil
| | - S R Taboga
- Department of Biological Sciences, Laboratory of Microscopy and Microanalysis, Universidade Estadual Paulista-UNESP, São Paulo, Brazil
| | - K L A Souza
- NUMPEX-BIO, Campus Duque de Caxias, Universidade Federal do Rio de Janeiro (UFRJ), Campus UFRJ Duque de Caxias Prof. Geraldo Cidade, Duque de Caxias 25245-390, Brazil
| | - I Quesada
- Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universidad Miguel Hernández, Elche, Spain; Biomedical Research Center in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - S Soriano
- Department of Physiology, Genetics, and Microbiology, University of Alicante, Alicante, Spain; Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universidad Miguel Hernández, Elche, Spain
| | - A Rafacho
- Laboratory of Investigation in Chronic Diseases LIDoC, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina UFSC, Florianópolis, Brazil; Graduate Program in Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina UFSC, Florianópolis, Brazil.
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Bruxel MA, da Silva FN, da Silva RA, Zimath PL, Rojas A, Moreira ELG, Quesada I, Rafacho A. Preconception exposure to malathion and glucose homeostasis in rats: Effects on dams during pregnancy and post-term periods, and on their progeny. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 316:120633. [PMID: 36370973 DOI: 10.1016/j.envpol.2022.120633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Understanding the individual and global impact of pesticides on human physiology and the different stages of life is still a challenge in environmental health. We analyzed here whether administration of the organophosphate insecticide malathion before pregnancy could affect glucose homeostasis during pregnancy and, in addition, generate possible later consequences in mothers and offspring. For this, adult Wistar rats were allocated into two groups and were treated daily (intragastric) with malathion (14 or 140 mg/kg, body mass (bm)) for 21-25 days. Corn oil was used as vehicle in the Control group. Subgroups were defined based on the absence (nulliparous) or presence (pregnant) of a copulatory plug. Pregnant rats were followed by an additional period of 2 months after the term (post-term), without continuing malathion treatment. Fetuses and adult offspring of males and females were also evaluated. We ran an additional experimental design with rats exposed to malathion before pregnancy at a dose of 0.1 mg/kg bm. Malathion exposure resulted in glucose intolerance in the mothers during pregnancy and post-term period, regardless of the exposure dose. This was accompanied by increased visceral adipose tissue mass, dyslipidemia, unchanged pancreatic β-cell mass, and varying insulin responses to glucose in vivo. The number of total newborns and birthweight was not affected by malathion exposure. Adult offspring from both sexes also became glucose-intolerant, regardless of the pesticide dose their dams were exposed to. This alteration could be associated with changes at the epigenomic level, as reduced hepatic mRNA content of DNA methylases and demethylases was found. We demonstrated that periconceptional exposure to malathion with doses aiming to mimic from work environment to indirect contamination predisposes progenitors and offspring rats to glucose intolerance. Thus, we conclude that subchronic exposure to malathion is a risk factor for gestational diabetes and prediabetes later in life.
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Affiliation(s)
- Maciel Alencar Bruxel
- Laboratory of Investigation in Chronic Diseases - LIDoC, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil; Multicenter Graduate Program in Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil
| | - Flávia Natividade da Silva
- Laboratory of Investigation in Chronic Diseases - LIDoC, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil; Graduate Program in Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil
| | - Rodrigo Augusto da Silva
- Center of Epigenetic Study and Gene Regulation - CEEpiRG, Program in Environmental and Experimental Pathology, Paulista University - UNIP, São Paulo, Brazil
| | - Priscila Laiz Zimath
- Laboratory of Investigation in Chronic Diseases - LIDoC, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil; Graduate Program in Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil
| | - Anabel Rojas
- Centro Andaluz de Biología Molecular y Medicina Regenerativa-CABIMER, Universidad Pablo de Olavide, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas (CSIC), Seville, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Eduardo Luis Gasnhar Moreira
- Laboratory of Investigation in Chronic Diseases - LIDoC, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil; Multicenter Graduate Program in Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil
| | - Ivan Quesada
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain; Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universidad Miguel Hernández, Elche, Spain
| | - Alex Rafacho
- Laboratory of Investigation in Chronic Diseases - LIDoC, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil; Multicenter Graduate Program in Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil; Graduate Program in Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil.
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Djekkoun N, Depeint F, Guibourdenche M, El Khayat El Sabbouri H, Corona A, Rhazi L, Gay-Queheillard J, Rouabah L, Hamdad F, Bach V, Benkhalifa M, Khorsi-Cauet H. Chronic Perigestational Exposure to Chlorpyrifos Induces Perturbations in Gut Bacteria and Glucose and Lipid Markers in Female Rats and Their Offspring. TOXICS 2022; 10:toxics10030138. [PMID: 35324763 PMCID: PMC8949051 DOI: 10.3390/toxics10030138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022]
Abstract
An increasing burden of evidence is pointing toward pesticides as risk factors for chronic disorders such as obesity and type 2 diabetes, leading to metabolic syndrome. Our objective was to assess the impact of chlorpyrifos (CPF) on metabolic and bacteriologic markers. Female rats were exposed before and during gestation and during lactation to CPF (1 mg/kg/day). Outcomes such as weight, glucose and lipid profiles, as well as disturbances in selected gut bacterial levels, were measured in both the dams (at the end of the lactation period) and in their female offspring at early adulthood (60 days of age). The results show that the weight of CPF dams were lower compared to the other groups, accompanied by an imbalance in blood glucose and lipid markers, and selected gut bacteria. Intra-uterine growth retardation, as well as metabolic disturbances and perturbation of selected gut bacteria, were also observed in their offspring, indicating both a direct effect on the dams and an indirect effect of CPF on the female offspring. Co-treatment with inulin (a prebiotic) prevented some of the outcomes of the pesticide. Further investigations could help better understand if those perturbations mimic or potentiate nutritional risk factors for metabolic syndrome through high fat diet.
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Affiliation(s)
- Narimane Djekkoun
- PeriTox UMR_I 01 Laboratory, University Center for Health Research, CURS-UPJV, Picardy Jules Verne University, CEDEX 1, 80054 Amiens, France; (N.D.); (M.G.); (H.E.K.E.S.); (A.C.); (J.G.-Q.); (V.B.); (M.B.)
- Laboratory of Cellular and Molecular Biology, University of the Brothers Mentouri Constantine 1, Constantine 2500, Algeria;
| | - Flore Depeint
- Transformations & Agro-Ressources ULR7519, Institut Polytechnique UniLaSalle—Université d’Artois, 60026 Beauvais, France; (F.D.); (L.R.)
| | - Marion Guibourdenche
- PeriTox UMR_I 01 Laboratory, University Center for Health Research, CURS-UPJV, Picardy Jules Verne University, CEDEX 1, 80054 Amiens, France; (N.D.); (M.G.); (H.E.K.E.S.); (A.C.); (J.G.-Q.); (V.B.); (M.B.)
| | - Hiba El Khayat El Sabbouri
- PeriTox UMR_I 01 Laboratory, University Center for Health Research, CURS-UPJV, Picardy Jules Verne University, CEDEX 1, 80054 Amiens, France; (N.D.); (M.G.); (H.E.K.E.S.); (A.C.); (J.G.-Q.); (V.B.); (M.B.)
| | - Aurélie Corona
- PeriTox UMR_I 01 Laboratory, University Center for Health Research, CURS-UPJV, Picardy Jules Verne University, CEDEX 1, 80054 Amiens, France; (N.D.); (M.G.); (H.E.K.E.S.); (A.C.); (J.G.-Q.); (V.B.); (M.B.)
| | - Larbi Rhazi
- Transformations & Agro-Ressources ULR7519, Institut Polytechnique UniLaSalle—Université d’Artois, 60026 Beauvais, France; (F.D.); (L.R.)
| | - Jerome Gay-Queheillard
- PeriTox UMR_I 01 Laboratory, University Center for Health Research, CURS-UPJV, Picardy Jules Verne University, CEDEX 1, 80054 Amiens, France; (N.D.); (M.G.); (H.E.K.E.S.); (A.C.); (J.G.-Q.); (V.B.); (M.B.)
| | - Leila Rouabah
- Laboratory of Cellular and Molecular Biology, University of the Brothers Mentouri Constantine 1, Constantine 2500, Algeria;
| | - Farida Hamdad
- Center for Human Biology, CHU Amiens-Picardie, 80000 Amiens, France;
| | - Véronique Bach
- PeriTox UMR_I 01 Laboratory, University Center for Health Research, CURS-UPJV, Picardy Jules Verne University, CEDEX 1, 80054 Amiens, France; (N.D.); (M.G.); (H.E.K.E.S.); (A.C.); (J.G.-Q.); (V.B.); (M.B.)
| | - Moncef Benkhalifa
- PeriTox UMR_I 01 Laboratory, University Center for Health Research, CURS-UPJV, Picardy Jules Verne University, CEDEX 1, 80054 Amiens, France; (N.D.); (M.G.); (H.E.K.E.S.); (A.C.); (J.G.-Q.); (V.B.); (M.B.)
- Center for Human Biology, CHU Amiens-Picardie, 80000 Amiens, France;
| | - Hafida Khorsi-Cauet
- PeriTox UMR_I 01 Laboratory, University Center for Health Research, CURS-UPJV, Picardy Jules Verne University, CEDEX 1, 80054 Amiens, France; (N.D.); (M.G.); (H.E.K.E.S.); (A.C.); (J.G.-Q.); (V.B.); (M.B.)
- Correspondence: ; Tel.: +33-322-827-896
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Cobilinschi C, Ţincu RC, Cobilinschi CO, Neagu TP, Becheanu G, Sinescu RD, Checheriţă IA, Grinţescu IM, Lascăr I. Histopathological features of low-dose organophosphate exposure. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:423-432. [PMID: 33544793 PMCID: PMC7864311 DOI: 10.47162/rjme.61.2.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Organophosphate (OP) use remains largely available worldwide despite more strict regulatory measures, in agriculture, parks or households, leading to a daily low-dose exposure. The systemic dysfunction appears partly due to acetylcholinesterase inhibition, exhibiting a primary toxic effect on the endocrine system but also on the liver and kidneys, which are responsible for products metabolization and elimination. Prolonged OP exposure can be responsible for histopathological (HP) changes that can either evolve or worsen pre-existing conditions. We conducted an experimental study including six male Wistar rats divided into two groups (four rats in the study group and two in the control group). The subjects in the first group were administered 100 mg/kg Chlorpyrifos half median lethal dose (LD50) at baseline and at 48 hours, under general anesthesia. Organ harvesting was achieved after one week. HP modifications were discovered in all kidney samples, with dystrophic changes and vacuolization of mesangial cells, dilation of renal tubules and epithelial atrophy. Congestion of vascular structures also occurred. The liver samples showed severe alteration in both vessels and hepatocytes. Adrenal gland impairment was confirmed through an increase in vacuole number in all areas, while a decrease in colloid content was noted in the thyroid gland simultaneously with a modified foamy aspect. This study is the first to certify the extent of organ injury induced by OP exposure, describing both glomerular and tubular involvement in the kidneys, liver necrosis and endocrine disturbances.
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Affiliation(s)
- Cristian Cobilinschi
- Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, Romania; ; Clinical Department No. 3, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania;
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El-Nahhal Y, El-Nahhal I. Cardiotoxicity among Children Accidentally Exposed to Organophosphate Insecticides Coupled with Scorpion Bites in Gaza. Health (London) 2021. [DOI: 10.4236/health.2021.139078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Farkhondeh T, Aschner M, Sadeghi M, Mehrpour O, Naseri K, Amirabadizadeh A, Roshanravan B, Aramjoo H, Samarghandian S. The effect of diazinon on blood glucose homeostasis: a systematic and meta-analysis study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:4007-4018. [PMID: 33175357 DOI: 10.1007/s11356-020-11364-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
Though evidence exists on the association between diazinon (DZN), an organophosphate pesticide, with hyperglycemia, contrasting reports also exist. Herein, we performed a systematic and meta-analysis study to address this issue. A systematic search was conducted in PubMed, Ovid Medline, Google Scholar, Scopus, and Web of Science up to April 5, 2020, searching for animal studies (rodents and fish) that assessed the impact of DZN on blood glucose concentration. The risk of bias was assessed by the SYRCLE's RoB scale. Once each article's quality was assessed, a random-effects meta-regression was used to pool the data into a meta-analysis. Heterogeneity between the studies was evaluated with the I square and Q test. Random-effect meta-analysis of 19 studies (I2 = 90.5%, p < 0.001) indicated low heterogeneity between the studies. DZN significantly increased blood glucose levels in the exposed versus control groups (95% CI: 2.46-4.94; Z = 5.86; p < 0.001). Subgroup analysis indicated that the effect of high-dose (3.40 (95% CI: 2.03-4.76)) DZN on changes in blood glucose was more pronounced than in the low dose (4.83 (95% CI: 1.56-8.11)). It was also ascertained that the blood glucose level was significantly higher in females (3.55 (95% CI: 2.21-4.89)) versus males (4.87 (95% CI: 0.20-9.55)) exposed to DZN. No publication bias was observed. Sensitivity analysis showed the robustness of the (standardized mean differences: 3.26-4.03). Our findings establish an association between DZN exposure and hyperglycemia in rodents and fish, which is both dose- and gender-dependent.
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Affiliation(s)
- Tahereh Farkhondeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
- Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, USA
| | - Mahmood Sadeghi
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Omid Mehrpour
- Arizona Poison & Drug Information Center, the University of Arizona, college of pharmacy and university of Arizona, Tucson, Arizona, USA
- Scientific unlimited horizon, Tucson, Arizona, USA
| | - Kobra Naseri
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
- Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Amirabadizadeh
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Hamed Aramjoo
- Student Research Committee, BSc Student in Medical LaboratoryScience, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeed Samarghandian
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Aramjoo H, Farkhondeh T, Aschner M, Naseri K, Mehrpour O, Sadighara P, Roshanravan B, Samarghandian S. The association between diazinon exposure and dyslipidemia occurrence: a systematic and meta-analysis study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:3994-4006. [PMID: 33159230 DOI: 10.1007/s11356-020-11363-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
The effects of diazinon (DZN), an organophosphate pesticide, on lipid profiles have been extensively reported. However, controversy on this issue persists. Here, we performed a systematic and meta-analysis study to investigate the association between DZN exposure and dyslipidemia in rodents and fish species. This systematic review was prepared according to the PRISMA guidelines. Main databases, including Google Scholar, Scopus, PubMed, Ovid MEDLINE, and Web of Science, were systematically searched through March 4, 2020. The risk of bias was evaluated with the SYRCLE's RoB tool. Once all articles were assessed for scientific quality, a random-effects model was applied to perform a pooled analysis. I2 and Q test were used to assess the heterogeneity between articles, and Forest plots, indicating point and pooled estimates, were drawn. Twenty-eight articles were included; between them, 13 publications were selected for meta-analysis. Random-effects meta-analysis showed low heterogeneity between the articles. A pooled analysis indicated that DZN significantly increased total cholesterol levels (95% CI: 0.86-3.79; Z = 3.10; p = 0.002), triglyceride (95% CI: 0.38-3.22; Z = 2.48; p = 0.09), low-density lipoprotein cholesterol (95% CI: 0.25-2.85; Z = 2.34; p = 0.7) in the DZN vs. control groups. In addition, DZN significantly decreased high-density lipoprotein cholesterol (95% CI: - 2.92, - 0.42; Z = 2.62; p = 0.07) in the DZN vs. control groups. No publication bias was observed. Our findings suggest that DZN induces dyslipidemia in rodents and fish species in a dose-dependent manner.
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Affiliation(s)
- Hamed Aramjoo
- Student Research Committee, BSc Student in Medical Laboratory Science, Birjand University of Medical Sciences, Birjand, Iran
| | - Tahereh Farkhondeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
- Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Micheal Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209 1300 Morris Park Avenue, Bronx, NY, USA
| | - Kobra Naseri
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
- Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- Arizona Poison & Drug Information Center, the University of Arizona, College of Pharmacy and University of Arizona, Tucson, AZ, USA
- Scientific Unlimited Horizon, Tucson, AZ, USA
| | - Parisa Sadighara
- Department of Environmental Health Engineering, Food Safety Division, School of Public Health and Center for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeed Samarghandian
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Yousefizadeh S, Farkhondeh T, Samarghandian S. Age-Related Diazinon Toxicity Impact on Blood Glucose, Lipid Profile and Selected Biochemical Indices in Male Rats. Curr Aging Sci 2020; 12:49-54. [PMID: 31038084 PMCID: PMC6971895 DOI: 10.2174/1874609812666190416160918] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/24/2019] [Accepted: 04/05/2019] [Indexed: 12/20/2022]
Abstract
Background: Diabetes and its complications are age-related diseases. Low-grade inflammation plays the main role in the aging processes. Diazinon (DZN), an organophosphate pesticide, has been found to induce metabolic disturbances. Objective: The present study was designed to investigate the impact of DZN on age-related changes on inflammatory cells, blood glucose concentration, lipid profile, and liver and kidney function indices in adult and aged rats. Methods: Male rats (2 and 16 month old) were orally administrated with DZN (15 mg/kg) for 4 weeks. Then the blood was obtained for measuring inflammatory cells, lipid profile, glucose and serum biochemical indices such as liver enzymes, albumin, total protein, creatinine (Cr), urea, and uric acid in the serum of adult and aged male rats. Results: DZN increased the blood levels of glucose and the percentage of lymphocytes and also serum levels of TChol, TG, LDL-c, AST, ALT, ALP, LDH, Cr, urea, and uric acid in the adult and aged rats versus the aged matched control rats (p< 0.001). A marked reduction in HDL-c levels, total protein, albumin, and in the percentage of neutrophils were seen in the adult and aged animals exposed to DZN versus the aged matched control rats. DZN also increased the levels of LDL-c and ALT in the aged rats versus adult animals. Conclusion: The present study indicated that DZN can cause metabolic disturbance. However, the age-dependent effects of DZN on metabolic indices were not be confirmed by the present data.
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Affiliation(s)
- Shahnaz Yousefizadeh
- Department of Laboratory and Clinical Sciences, Faculty of Para-Veterinary, Ilam University, Ilam, Iran
| | - Tahereh Farkhondeh
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeed Samarghandian
- Department of Basic Medical Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
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10
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Artificial Pancreas Control Strategies Used for Type 1 Diabetes Control and Treatment: A Comprehensive Analysis. APPLIED SYSTEM INNOVATION 2020. [DOI: 10.3390/asi3030031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This paper presents a comprehensive survey about the fundamental components of the artificial pancreas (AP) system including insulin administration and delivery, glucose measurement (GM), and control strategies/algorithms used for type 1 diabetes mellitus (T1DM) treatment and control. Our main focus is on the T1DM that emerges due to pancreas’s failure to produce sufficient insulin due to the loss of beta cells (β-cells). We discuss various insulin administration and delivery methods including physiological methods, open-loop, and closed-loop schemes. Furthermore, we report several factors such as hyperglycemia, hypoglycemia, and many other physical factors that need to be considered while infusing insulin in human body via AP systems. We discuss three prominent control algorithms including proportional-integral- derivative (PID), fuzzy logic, and model predictive, which have been clinically evaluated and have all shown promising results. In addition, linear and non-linear insulin infusion control schemes have been formally discussed. To the best of our knowledge, this is the first work which systematically covers recent developments in the AP components with a solid foundation for future studies in the T1DM field.
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11
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Badr AM. Organophosphate toxicity: updates of malathion potential toxic effects in mammals and potential treatments. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:26036-26057. [PMID: 32399888 DOI: 10.1007/s11356-020-08937-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
Organophosphorus insecticides toxicity is still considered a major global health problem. Malathion is one of the most commonly used organophosphates nowadays, as being considered to possess relatively low toxicity compared with other organophosphates. However, widespread use may lead to excessive exposure from multiple sources. Mechanisms of MAL toxicity include inhibition of acetylcholinesterase enzyme, change of oxidants/antioxidants balance, DNA damage, and facilitation of apoptotic cell damage. Exposure to malathion has been associated with different toxicities that nearly affect every single organ in our bodies, with CNS toxicity being the most well documented. Malathion toxic effects on liver, kidney, testis, ovaries, lung, pancreas, and blood were also reported. Moreover, malathion was considered as a genotoxic and carcinogenic chemical compound. Evidence exists for adverse effects associated with prenatal and postnatal exposure in both animals and humans. This review summarizes the toxic data available about malathion in mammals and discusses new potential therapeutic modalities, with the aim to highlight the importance of increasing awareness about its potential risk and reevaluation of the allowed daily exposure level.
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Affiliation(s)
- Amira M Badr
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 22452, Riyadh, 11459, Saudi Arabia.
- Department of Pharmacology and Toxicology, College of Pharmacy, Ain Shams University, Heliopolis, Cairo, Egypt.
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12
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Samarghandian S, Foadoddin M, Zardast M, Mehrpour O, Sadighara P, Roshanravan B, Farkhondeh T. The impact of age-related sub-chronic exposure to chlorpyrifos on metabolic indexes in male rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:22390-22399. [PMID: 32314281 DOI: 10.1007/s11356-020-08814-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
Chlorpyrifos (CPF), an organophosphorus pesticide (OP), has been implicated in metabolic diseases; however, the data are controversial. Rising age has been found as a main risk factor for metabolic diseases, and it has been proposed that advanced age increases susceptibility to the toxic effects of OPs. Therefore, this investigation aimed to evaluate the impact of CPF on hyperglycemia, hypercholesterolemia, and inflammation in animals with different ages. CPF (5 mg/kg) for 45 consecutive days was administered orally to male Wistar rats with different ages including 2-, 10-, and 20-month-old. The results indicated an increase in glucose and inflammatory indices, and also lipid profile was changed in the serum of aged animals in comparison with the 2-month-old animals. CPF administration amplified these parameters in the 20-month-old rats in comparison with that of aged-matched controls. The histopathological examination also indicated that CPF caused slight to moderate changes in the liver of 2-, 10-, and 20-month-old animals. Cholestasis was also observed in the CPF-administrated 20-month-old rats. In conclusion, aging may increase the susceptibility to CPF-induced metabolic disturbances in the animal models. It is proposed that advancing in age elevates the susceptibility to the metabolic effects of CPF.
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Affiliation(s)
- Saeed Samarghandian
- Healthy Ageing Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Moshen Foadoddin
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahmoud Zardast
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
- Rocky Mountain Poison and Drug Safety, Denver Health, Denver, CO, USA
| | - Parisa Sadighara
- Department of Environmental Health Engineering, Food Safety Division, School of Public Health and Center for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Tahereh Farkhondeh
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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13
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Farkhondeh T, Amirabadizadeh A, Samarghandian S, Mehrpour O. Impact of chlorpyrifos on blood glucose concentration in an animal model: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:2474-2481. [PMID: 31848960 DOI: 10.1007/s11356-019-07229-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
Chlorpyrifos, an organophosphate insecticide, disturbs blood glucose hemostasis in experimental models and causes metabolic disorders. However, there are controversial findings of its impact on the BS level. The present meta-analysis aimed to investigate blood gluocse levels in rats exposed to chlorpyrifos. Present systematic review and meta-analysis study was done by searching in the online databases, including Google Scholar, Web of Science, PubMed, and Scopus. Data were analyzed by performing "random effects meta-regression." Findings were expressed as standardized mean value and 95% confidence interval (CI). Heterogeneity between studies was assessed using I-square and Q test. Meta-analysis of 7 animal studies indicated the dose-dependence manner of chlorpyrifos exposure on the blood glucose levels. The subgroup analysis indicated that exposure to low doses of chlorpyrifos significantly increased the blood glucose levels in exposed animals versus the nonexposed (0.11; 95% CI: - 1.14, 1.36, z = 2.25, p = 0.03, I2 = 90.1%, p < 0.001) and high doses markedly decreased blood glucose levels in exposed rats versus the nonexposed (7.34; 95%CI: - 9.35, - 5.32, z = 6.41, p < 0.001, I2 = 96.9%, p < 0.001). The random effects and pooled analysis indicated that the blood glucose levels were 4.22-fold lower in exposed animals versus the nonexposed ones (95% CI: - 5.59,- 2.85; Z = 3.97; p < 0.001); therefore, heterogeneity was significant (I2 = 96.5%, p < 0.001). The present finding indicated the association between chlorpyrifos exposure and a decrease in blood glucose levels. However, more studies should be designed to clarify this effect of chlorpyrifos exposure on blood glucose levels and involved mechanisms.
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Affiliation(s)
- Tahereh Farkhondeh
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Saeed Samarghandian
- Department of Basic Medical Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Omid Mehrpour
- Rocky Mountain Poison and Drug Safety, Denver Health, Denver, CO, USA.
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da Luz Abreu E, Savall ASP, Boneberg AA, Martins BB, Gervini VC, Sampaio TB, Fajardo AR, Paroul N, Roos DH, Pinton S. (3Z)-5-Chloro-3-(Hydroxyimino)indolin-2-one attenuates hyperglycemia, increased hepatic glycogen content and hepatic damage induced by malathion acute exposure in rats. Nutr Metab (Lond) 2019; 16:61. [PMID: 31516541 PMCID: PMC6727524 DOI: 10.1186/s12986-019-0374-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Organophosphorus pesticides (OP's) are heavily constituted in agriculture, gardens, home and veterinary and although it is useful, there are concerns about the environment, safety and health of human and animals. In this study, we investigated the effects of a new oxime, (3Z)-5-Chloro-3-(Hydroxyimino)indolin-2-one (OXIME) against the alterations induced by malathion, an OP insecticide, acute exposure on markers of hepatic damage, glucose homeostasis, oxidative stress in rats cholinesterase (ChE) activity in rats. METHODS Adult male Wistar rats were divided into four groups: Control; Malathion; OXIME; and Malathion+OXIME. Twelve hours after co-treatment with malathion (250 mg/kg, i.p.) and/or OXIME (50 mg/kg, i.g.), the plasma and liver samples were collected for biochemical analyses. RESULTS The OXIME blocked the increase of plasma markers of hepatic function (AST and ALP) and the enzymatic inhibition of catalase and glutathione reductase in the liver of malathion-treated rats. Moreover, the hepatic cholinesterases inhibition induced by malathion acute exposure was suppressed by OXIME treatment. As assessed, a single dose of OXIME lowered the glycemia levels and hepatic glycogen content enhanced by malathion. CONCLUSIONS This study suggests promise effects of (3Z)-5-Chloro-3-(Hydroxyimino) indolin-2-one against the hyperglycemia and the hepatic damage induced by malathion acute exposure, as well as its use as a ChE activity reactivator.
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Affiliation(s)
- Edina da Luz Abreu
- Universidade Federal do Pampa (UNIPAMPA) Campus Uruguaiana, Uruguaiana, RS CEP 97500-970 Brazil
| | - Anne Suély Pinto Savall
- Universidade Federal do Pampa (UNIPAMPA) Campus Uruguaiana, Uruguaiana, RS CEP 97500-970 Brazil
| | - Allyson Ardais Boneberg
- Universidade Federal do Pampa (UNIPAMPA) Campus Uruguaiana, Uruguaiana, RS CEP 97500-970 Brazil
| | - Bianca Barreto Martins
- Universidade Federal do Rio Grande - Campus Carreiros, Rio Grande, RS CEP 96201-900 Brazil
| | | | - Tuane Bazanella Sampaio
- Instituto Federal de Educação, Ciência e Tecnologia Farroupilha – Campus Santo Ângelo, Santo Ângelo, RS CEP 98806-700 Brazil
| | - André Ricardo Fajardo
- Universidade Federal de Pelotas (UFPel) - Campus Capão do Leão s/n, Pelotas, RS CEP 96010-900 Brazil
| | - Natália Paroul
- Universidade Regional Integrada (URI), Campus Erechim, Erechim, RS CEP 99709-910 Brazil
| | - Daniel Henrique Roos
- Universidade Federal do Pampa (UNIPAMPA) Campus Uruguaiana, Uruguaiana, RS CEP 97500-970 Brazil
| | - Simone Pinton
- Universidade Federal do Pampa (UNIPAMPA) Campus Uruguaiana, Uruguaiana, RS CEP 97500-970 Brazil
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15
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Gifford RM, Chathuranga U, Lamb T, Verma V, Sattar MA, Thompson A, Siribaddana S, Ghose A, Forbes S, Reynolds RM, Eddleston M. Short-term glucose dysregulation following acute poisoning with organophosphorus insecticides but not herbicides, carbamate or pyrethroid insecticides in South Asia. Clin Toxicol (Phila) 2018; 57:254-264. [PMID: 30306807 DOI: 10.1080/15563650.2018.1515438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ingestion of organophosphorus (OP) insecticides is associated with acute hyperglycaemia. We conducted a prospective study to determine whether glucose dysregulation on admission associated with ingestion of OP insecticides or other pesticides is sustained to hospital discharge or to 3-12 months later. METHODS We recruited participants to two similar studies performed in parallel in Anuradhapura, Sri Lanka, and Chittagong, Bangladesh, following hospitalisation for OP insecticide, herbicide or other pesticide self-poisoning. Two-hour 75 g oral glucose tolerance testing (OGTT) was performed after recovery from the acute poisoning, at around the time of discharge. In Sri Lanka, a four time-point OGTT for area-under-the-curve (AUC), C-peptide and homeostatic modelling of insulin resistance (HOMA-IR) was undertaken, repeated after 1 year. In Bangladesh, a 2-h OGTT for glucose was undertaken and repeated after 3 months in participants with initial elevated 2-h glucose. We compared glucose homeostasis by poison group and adjusted findings for age, BMI and sex. FINDINGS Seventy-three Sri Lankan and 151 Bangladeshi participants were recruited. We observed higher mean [SD] fasting (4.91 [0.74] vs. 4.66 [0.46] mmol/L, p = .003) and 2-h glucose (7.94 [2.54] vs. 6.71 [1.90] mmol/L, p < .0001) in OP-poisoned groups than pyrethroid, carbamate, herbicide or 'other poison' groups at discharge from hospital. In Sri Lanka, HOMA-IR, glucose and C-peptide AUC were higher in OP than carbamate or herbicide groups. Adjusted analyses remained significant except for fasting glucose. Follow-up analysis included 92 participants. There was no significant difference in OGTT results between OP-poisoned and other participants at follow-up (mean [SD] 2-h fasting glucose 4.67 [0.92] vs. 4.82 [0.62], p = .352; 2-h glucose 6.96 [2.31] mmol/L vs. 6.27 [1.86] mmol/L, p = .225). CONCLUSION We found in this small prospective study that acute OP insecticide poisoning caused acute glucose dysregulation that was sustained to hospital discharge but had recovered by 3-12 months. Acute glucose dysregulation was related to defects in insulin action and secretion. This study did not address long-term risk of diabetes following acute OP insecticide poisoning, but could provide the data for a power calculation for such a study.
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Affiliation(s)
- Robert M Gifford
- a University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK.,b South Asian Clinical Toxicology Research Collaboration , Faculty of Medicine , University of Peradeniya , Sri Lanka
| | - Umesh Chathuranga
- b South Asian Clinical Toxicology Research Collaboration , Faculty of Medicine , University of Peradeniya , Sri Lanka
| | - Thomas Lamb
- b South Asian Clinical Toxicology Research Collaboration , Faculty of Medicine , University of Peradeniya , Sri Lanka
| | - Vasundhara Verma
- b South Asian Clinical Toxicology Research Collaboration , Faculty of Medicine , University of Peradeniya , Sri Lanka
| | - Md Abdus Sattar
- c Department of Medicine, Faculty of Medicine , Chittagong Medical College , Chittagong , Bangladesh
| | - Adrian Thompson
- a University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | - Sisira Siribaddana
- d Department of Medicine, Faculty of Medicine , Rajarata University of Sri Lanka , Saliyapura , Sri Lanka
| | - Aniruddha Ghose
- c Department of Medicine, Faculty of Medicine , Chittagong Medical College , Chittagong , Bangladesh
| | - Shareen Forbes
- a University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | - Rebecca M Reynolds
- a University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
| | - Michael Eddleston
- a University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK.,b South Asian Clinical Toxicology Research Collaboration , Faculty of Medicine , University of Peradeniya , Sri Lanka.,e Centre for Pesticide Suicide Prevention , University of Edinburgh , Edinburgh , UK
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