Supplementation of Calcium and Fluoride-Free Water Mitigates Skeletal Fluorosis in Fluoride-Intoxicated Rats

Correlations between bone metabolism biomarkers and fluoride exposure in adults and children

Increased exposure to fluoride, which notably affects bone metabolism, is a global concern. However, the correlations and sensitivity of bone metabolism to fluoride remain controversial. In this cross-sectional study, 549 children (aged 7-12 years) and 504 adults (≥ 18 years old) were recruited in the high-fluoride areas of the Henan Province. Urinary fluoride (UF) level was determined using a fluoride electrode. Fasting venous blood serum was collected to measure bone metabolism biomarkers. The selected bone metabolism biomarkers for children included bone alkaline phosphatase (BALP), serum alkaline phosphatase (ALP), osteocalcin (OCN), calcitonin (CT), parathyroid hormone (PTH), phosphorus (P5+), and calcium (Ca2+). For adults, the biomarkers included ALP, CT, PTH, β-CrossLaps (β-CTX), P5+, and Ca2+. The correlations between UF and bone metabolism biomarkers were analyzed using binary logistic regression, a trend test, a generalized additive model, and threshold effect analysis. Regression analysis indicated a significant correlation between serum OCN, PTH, and UF levels in children aged 7-9 years. Serum OCN, PTH, and BALP contents were significantly correlated with UF in boys (P < 0.05). Furthermore, the interaction between age and UF affected serum P5+ and PTH (P < 0.05). The generalized additive model revealed nonlinear dose-response relationships between P5+, BALP, and UF contents in children (P < 0.05). Serum OCN level was linearly correlated with the UF concentration (P < 0.05). Similarly, a significant correlation was observed between β-CTX and UF levels in adults. In addition, significant correlations were observed between UF-age and serum Ca2+, β-CTX, and PTH contents. There was a non-linear correlation between serum Ca2+, P5+, and β- CTX and UF levels (P < 0.05). Overall, serum OCN, BALP, and P5+ levels can serve as sensitive bone metabolism biomarkers in children, while β-CTX, P5+, and Ca2+ can be considered fluoride-sensitive bone metabolism biomarkers in adults.

Calcium supplementation attenuates fluoride-induced bone injury via PINK1/Parkin-mediated mitophagy and mitochondrial apoptosis in mice

Excessive consumption of fluoride can cause skeletal fluorosis. Mitophagy has been identified as a novel target for bone disorders. Meanwhile, calcium supplementation has shown great potential for mitigating fluoride-related bone damage. Hence, this study aimed to elucidate the association between mitophagy and skeletal fluorosis and the precise mechanisms through which calcium alleviates these injuries. A 100 mg/L sodium fluoride (NaF) exposure model in Parkin knockout (Parkin-/-) mice and a 100 mg/L NaF exposure mouse model with 1% calcium carbonate (CaCO3) intervention were established in the current study. Fluoride exposure caused the impairment of mitochondria and activation of PTEN-induced putative kinase1 (PINK1)/E3 ubiquitin ligase Park2 (Parkin)-mediated mitophagy and mitochondrial apoptosis in the bones, which were restored after blocking Parkin. Additionally, the intervention model showed fluoride-exposed mice exhibited abnormal bone trabecula and mechanical properties. Still, these bone injuries could be effectively attenuated by adding 1% calcium to their diet, which reversed fluoride-activated mitophagy and apoptosis. To summarize, fluoride can activate bone mitophagy through the PINK1/Parkin pathway and mitochondrial apoptosis. Parkin-/- and 1% calcium provide protection against fluoride-induced bone damage. Notably, this study provides theoretical bases for the prevention and therapy of animal and human health and safety caused by environmental fluoride contamination.

In Silico Analysis of Ferroptosis-Related Genes and Its Implication in Drug Prediction against Fluorosis

Fluorosis is a serious global public health problem. Interestingly, so far, there is no specific drug treatment for the treatment of fluorosis. In this paper, the potential mechanisms of 35 ferroptosis-related genes in U87 glial cells exposed to fluoride were explored by bioinformatics methods. Significantly, these genes are involved in oxidative stress, ferroptosis, and decanoate CoA ligase activity. Ten pivotal genes were found by the Maximal Clique Centrality (MCC) algorithm. Furthermore, according to the Connectivity Map (CMap) and the Comparative Toxicogenomics Database (CTD), 10 possible drugs for fluorosis were predicted and screened, and a drug target ferroptosis-related gene network was constructed. Molecular docking was used to study the interaction between small molecule compounds and target proteins. Molecular dynamics (MD) simulation results show that the structure of the Celestrol-HMOX1 composite is stable and the docking effect is the best. In general, Celastrol and LDN-193189 may target ferroptosis-related genes to alleviate the symptoms of fluorosis, which may be effective candidate drugs for the treatment of fluorosis.

Fluoride exposure induces lysosomal dysfunction unveiled by an integrated transcriptomic and metabolomic study in bone marrow mesenchymal stem cells

Fluoride has received much attention for its predominant bone toxicity in the human body. However, the toxic mechanism of bone injury caused by fluoride exposure remains largely unclear. Bone marrow mesenchymal stem cells (BMSCs) are widely used as model cells for evaluating bone toxicity after environmental toxicant exposure. In this study, BMSCs were exposed to fluoride at 1, 2, and 4 mM for 24 h, and fluoride significantly inhibited cell viability at 2 and 4 mM. A multiomics analysis combining transcriptomics with metabolomics was employed to detect alterations in genes and metabolites in BMSCs treated with 2 mM fluoride. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of transcriptomics profiles identified "lysosomes" as the top enriched pathway, which was severely damaged by fluoride exposure. Lysosomal damage was indicated by decreases in the expression of lysosomal associated membrane protein 2 (LAMP 2) and cathepsin B (CTSB) as well as an increase in pH. Upregulation of the lysosome-related genes Atp6v0b and Gla was observed, which may be attributed to a compensatory lysosomal biogenesis transcriptional response. Interestingly, inhibition of glutathione metabolism was observed in fluoride-treated BMSCs at the metabolomic level. Moreover, an integrative analysis between altered genes, metabolites and lysosome signaling pathways was conducted. Palmitic acid, prostaglandin C2, and prostaglandin B2 metabolites were positively associated with Atp6v0b, a lysosome-related gene. Overall, our results provide novel insights into the mechanism responsible for fluoride-induced bone toxicity.

Challenges of fluoride pollution in environment: Mechanisms and pathological significance of toxicity - A review

Fluoride is an important trace element in the living body. A suitable amount of fluoride has a beneficial effect on the body, but disproportionate fluoride entering the body will affect various organs and systems, especially the liver, kidneys, nervous system, endocrine system, reproductive system, bone, and intestinal system. In recent years, with the rapid development of agriculture and industry, fluoride pollution has become one of the important factors of environmental pollution, and fluoride pollution in any form is becoming a serious problem. Although countries around the world have made great breakthroughs in controlling fluoride pollution, however fluorosis still exists. A large amount of fluoride accumulated in animals will not only produce the toxic effects, but it also causes cell damage and affect the normal physiological activities of the body. There is no systematic description of the damage mechanism of fluoride. Therefore, the study on the toxicity mechanism of fluoride is still in progress. This review summarizes the existing information of several molecular mechanisms of the fluoride toxicity comprehensively, aiming to clarify the toxic mechanism of fluoride on various body systems. We have also summerized the pathological changes of those organ systems after fluoride poisoning in order to provide some ideas and solutions to the reader for the prevention and control of modern fluoride pollution.

Borassus flabellifer Linn haustorium methanol extract mitigates fluoride-induced apoptosis by enhancing Nrf2/Haeme oxygenase 1 -dependent glutathione metabolism in intestinal epithelial cells

Fluoride is the most common cause of drinking water-associated toxicity and is known to induce various metabolic imbalances and dental/skeletal fluorosis. The present study analyzed the protective effect of Borassus flabellifer Linn. haustorium extract (BHE) against fluoride-induced intestinal redox metabolism and apoptosis. The total polyphenols and total flavonoids present in BHE were estimated to be 39.67 ± 5.14 mg gallic acid equivalent/g extract and 8.59 ± 0.74 mg quercetin equivalent. In cultured intestinal epithelial cells (IEC-6), sodium fluoride exposure-induced apoptosis mediated through antioxidant enzyme inhibition and subsequent oxidative damages. Further, there observed an increased expression of caspase-3, caspase-7, and apoptotic protease activating factor-1 (apaf-1) genes, increased cytochrome C release, and caspase 3/7 activity indicating the apoptosis- mediated cell death (p < 0.05). Upon pretreatment with BHE, the cytotoxic effect of fluoride was reduced by decreasing the expression of apoptotic genes and increased the cytochrome release as well as caspase 3/7 activity (p < 0.01). Providing the mechanistic basis, the expression of nuclear factor erythroid 2-related factor-2 (Nrf2)/haeme oxygenase-1 (HO1) gene was increased in the BHE pretreated cells; corroborating to these, there observed increased activity of glutathione biosynthetic enzymes (p < 0.05) and glutathione reductase. Hence, the protective effect of BHE may be mediated through Nrf2-mediated glutathione biosynthesis, the subsequent establishment of redox balance, and inhibition of apoptosis in intestinal epithelial cells.