Mutagenicity, carcinogenicity and teratogenicity of lithium compounds

A Review on the Recent Advancements on Therapeutic Effects of Ions in the Physiological Environments

This review focuses on the therapeutic effects of ions when released in physiological environments. Recent studies have shown that metallic ions like Ag+, Sr2+, Mg2+, Mn2+, Cu2+, Ca2+, P+5, etc., have shown promising results in drug delivery systems and regenerative medicine. These metallic ions can be loaded in nanoparticles, mesoporous bioactive glass nanoparticles (MBGNs), hydroxyapatite (HA), calcium phosphates, polymeric coatings, and salt solutions. The metallic ions can exhibit different functions in the physiological environment such as antibacterial, antiviral, anticancer, bioactive, biocompatible, and angiogenic effects. Furthermore, the metals/metalloid ions can be loaded into scaffolds to improve osteoblast proliferation, differentiation, bone development, fibroblast growth, and improved wound healing efficacy. Moreover, different ions possess different therapeutic limits. Therefore, further mechanisms need to be developed for the highly controlled and sustained release of these ions. This review paper summarizes the recent progress in the use of metallic/metalloid ions in regenerative medicine and encourages further study of ions as a solution to cure diseases.

Lithium carbonate: Updated reproductive and developmental toxicity assessment using scientific literature and guideline compliant studies

The current publication describes most recent so far unpublished (key) guideline and GLP compliant reproductive and developmental toxicity studies of lithium carbonate in rats, including their interpretation and conclusions in terms of human hazard assessment when compared to existing literature. Particular attention was paid to the target organs and dose response of lithium ion related effects to differentiate between a primary (pharmacokinetic/pharmacodynamic) action and secondary effects as a result of systemic and target organ toxicity. In the key two-generation reproduction toxicity (OECD TG 416) study in rats, doses of 5, 15 and 45 mg/kg bw/d (0.95, 2.9 and 8.6 mg Li⁺/kg bw/d) were given by oral gavage, resulting in clear NOAELs of 15 mg/kg bw/d (2.9 mg Li⁺/kg bw/d) for systemic parental toxicity and 45 mg/kg bw/d (8.6 mg Li⁺/kg bw/d) for reproductive toxicity and fetal toxicity. Target organ changes were consistently observed in liver (cytoplasmic rarefaction) and kidney (dilated tubuli). In the key developmental toxicity (OECD TG 414) study in rats, doses given by oral gavage were 10, 30 and 90 mg/kg bw/d (1.9, 5.7 and 17.1 mg Li⁺/kg bw/d) was investigated resulting in NO(A)ELs of 30 mg/kg bw/d (5.7 mg Li⁺/kg bw/d) (maternal toxicity) and 90 mg/kg bw/d (17 mg Li⁺/kg bw/d) (fetal toxicity and teratogenicity). The highest dose of 90 mg/kg bw/day resulted in clear signs of toxicity and peak plasma concentrations at the toxic range (>1.0 mEq lithium/L). Toxic effects of lithium carbonate were not seen in the reproductive and developmental organs. No adverse effects on sperm (total motility, progressive motility and morphology of testicular and cauda epididymal sperm) were observed in the two-generation rat reproduction toxicity study. There was also no impact on fertility indices or on litter sizes in this study, nor were there any fetal effects in the two-generation reproduction toxicity and developmental toxicity study at doses causing already systemic toxicity in the dams. Secondary effects such as decreased weight (gain) and food consumption were reported in the developmental toxicity study. The absence of any reproductive/developmental findings at dose levels causing clear systemic toxicity in the test animals in these key mammalian studies, does not suggest an immediate concern for possible human reproductive or developmental toxicity effects from exposure to lithium during drug use.

Changes in Lithium Levels in Bees and Their Products Following Anti-Varroa Treatment

Simple Summary

Varroosis caused by the ectoparasitic mite Varroa destructor has been the biggest threat to managed bee colonies over recent decades. Chemicals available to treat the disease imply problems of resistance, inconsistent efficacy, and residues in bee products. Recently, alongside novel compounds to defeat the pest, lithium chloride has been found to be effective. In this study, we found that lithium treatments leave beeswax residue-free. The possibility of decontamination in adult bees, bee bread, and uncapped honey was revealed. On the other hand, ripe honey was found to be affected by lithium administered via feeding. Case studies are necessary to uncover the level of exposition in harvested honey to estimate its potential risk once it becomes a registered veterinary medicine.

Abstract

The biggest threat to beekeeping is varroosis caused by the mite Varroa destructor. Chemicals available to treat this fatal disease may present problems of resistance or inconsistent efficacy. Recently, lithium chloride has appeared as a potential alternative. To date, the amount of residue lithium treatments may leave in honeybee products is poorly understood. Honeybees were fed with 25 mM lithiated sugar syrup, which was used in earlier studies. The accumulation and elimination of the lithium were monitored in bees and their products for 22 days. Lithium concentration increased in the entire body of the bees to day 4 post-treatment and then recovered rapidly to the control level. Lithium exposure was found to affect uncapped honey in the short term (<16 days), but ripe (capped) honey measured at the end of the trial remained affected. On the other hand, lithium treatment left beeswax lithium-free. Based on these data, we propose that comprehensive research on harvested honey is needed to decide on the veterinary use of lithium.

A Genome-Wide Screen in Saccharomyces cerevisiae Reveals a Critical Role for Oxidative Phosphorylation in Cellular Tolerance to Lithium Hexafluorophosphate

Lithium hexafluorophosphate (LiPF₆) is one of the leading electrolytes in lithium-ion batteries, and its usage has increased tremendously in the past few years. Little is known, however, about its potential environmental and biological impacts. In order to improve our understanding of the cytotoxicity of LiPF₆ and the specific cellular response mechanisms to it, we performed a genome-wide screen using a yeast (Saccharomyces cerevisiae) deletion mutant collection and identified 75 gene deletion mutants that showed LiPF₆ sensitivity. Among these, genes associated with mitochondria showed the most enrichment. We also found that LiPF₆ is more toxic to yeast than lithium chloride (LiCl) or sodium hexafluorophosphate (NaPF₆). Physiological analysis showed that a high concentration of LiPF₆ caused mitochondrial damage, reactive oxygen species (ROS) accumulation, and ATP content changes. Compared with the results of previous genome-wide screening for LiCl-sensitive mutants, we found that oxidative phosphorylation-related mutants were specifically hypersensitive to LiPF₆. In these deletion mutants, LiPF₆ treatment resulted in higher ROS production and reduced ATP levels, suggesting that oxidative phosphorylation-related genes were important for counteracting LiPF₆-induced toxicity. Taken together, our results identified genes specifically involved in LiPF₆-modulated toxicity, and demonstrated that oxidative stress and ATP imbalance maybe the driving factors in governing LiPF₆-induced toxicity.

[Lithium in the psychopharmacology of affective disorders and mechanisms of its effects on cellular physiology]

However, despite successful use of lithium in the treatment of affective disorders for almost 40 years, the mechanisms of its therapeutic action are still poorly understood. This review presents and summarizes the current literature about the use of lithium in treatment of affective disorders, as well as its effects on cellular physiology, with a separate description of the effect of this ion on the functioning of nerve tissue and ion-molecular mechanisms.

Derivation of whole blood biomonitoring equivalents for lithium for the interpretation of biomonitoring data

INTRODUCTION

Lithium salts have numerous industrial uses and are also used in the treatment of bipolar disorders. The main source of lithium exposure to the general population is drinking water and foods. Lithium is nephrotoxic at higher doses. Thus, oral exposure guidelines for lithium have been derived, including ICH's permitted daily exposure (PDE = 0.008 mg lithium/kg-bw/day) adopted by Health Canada and the United States Environmental Protection Agency's (U.S. EPA) provisional peer reviewed toxicity value (PPRTV = 0.002 mg lithium/kg-bw/day), both based on human data.

OBJECTIVE

To derive whole blood biomonitoring equivalents (BEs) associated with PDE and PPRTV to interpret population-level biomonitoring data in health risk context.

METHOD

A simple kinetic relationship based on plasma clearance value (0.5 L/kg-bw/day) and the oral absorption fraction (100%) was used to derive blood BEs for PDE and PPRTV.

RESULTS

This analysis resulted in BE values in plasma and whole blood of 16 and 10 μg/L, respectively, based on the PDE values developed by the Health Canada and of 4.2 and 2.7 μg/L, respectively, based on the PPRTV developed by U.S. EPA.

CONCLUSION

The derived BE values can be used to interpret population-level biomonitoring data.

Phycoremediation of lithium ions from aqueous solutions using free and immobilized freshwater green alga Oocystis solitaria: mathematical modeling for bioprocess optimization

Lithium is registered as a serious pollutant that causes environmental damage to an irrigation water supply. Freshwater green alga (Oocystis solitaria) was studied for its potential to remove lithium ions from aqueous solutions. The Plackett-Burman design was applied for initial screening of six factors for their significances for the removal of lithium from aqueous solutions using Oocystis solitaria cells. Among the variables screened, pH, lithium concentration, and temperature were the most significant factors affecting lithium removal. Hence, the levels of these significant variables were further investigated for their interaction effects on lithium removal using the Box-Behnken statistical design. The optimum conditions for maximum lithium removal from aqueous solutions by Oocystis solitaria were the initial lithium concentration of 200 mg/L, contact time of 60 min, temperature of 30 °C, pH 5, and biomass of Oocystis solitaria cells of 1 g/L with agitation condition. Under the optimized conditions, the percentage of maximum lithium removal was 99.95% which is larger than the percentage of lithium removal recorded before applying the Plackett-Burman design (40.07%) by 2.49 times. The different properties of Oocystis solitaria, as an adsorbent, were explored with SEM and via FTIR analysis. The spectrum of FTIR analysis for samples of Oocystis solitaria cells before lithium biosorption showed different absorption peaks at 3394 cm^-1, 2068 cm^-1, 1638 cm^-1, 1398 cm^-1, 1071 cm^-1, and 649 cm^-1 which has been shifted to 3446 cm^-1, 2924 cm^-1, 1638 cm^-1, 1384 cm^-1, 1032 cm^-1, and 613 cm^-1, respectively, after lithium biosorption by the alga. The treatment of aqueous solution containing lithium with Oocystis solitaria cells immobilized in alginate beads removed 98.71% of lithium at an initial concentration of 200 mg/L after 5 h. Therefore, Oocystis solitaria may be considered as an alternative for sorption and removal of lithium ions from wastewaters.

Genotoxic and mutagenic studies of teratogens in developing rat and mouse

In this review, genotoxic and mutagenic effects of teratogenic chemical agents in both rat and mouse have been reviewed. Of these chemicals, 97 are drugs and 33 are pesticides or belong to other groups. Large literature searches were conducted to determine the effects of chemicals on chromosome abnormalities, sister chromatid exchanges, and micronucleus formation in experimental animals such as rats and mice. In addition, studies that include unscheduled DNA synthesis, DNA adduct formations, and gene mutations, which help to determine the genotoxicity or mutagenicity of chemicals, have been reviewed. It has been estimated that 46.87% of teratogenic drugs and 48.48% of teratogenic pesticides are positive in all tests. So, all of the teratogens involved in this group have genotoxic and mutagenic effects. On the other hand, 36.45% of the drugs and 21.21% of the pesticides have been found to give negative results in at least one test, with the majority of the tests giving positive results. However, only 4.16% of the drugs and 18.18% of the pesticides were determined to give negative results in the majority of the tests. Among tests with major negative results, 12.50% of the teratogenic drugs and 12.12% of the teratogenic pesticides were negative in all conducted tests.

Lithium promotes the production of reactive oxygen species via GSK-3β/TSC2/TOR signaling in the gill of zebrafish (Danio rerio)

In this study, the mechanism that lithium (Li) promotes the production of reactive oxygen species (ROS) via the glycogen synthase kinase-3β (GSK-3β)/tuberous sclerosis complex 2 (TSC2)/target of rapamycin (TOR) signaling was investigated in the gill of zebrafish (Danio rerio). After the zebrafish were treated by 25 and 50 mg/L Li+, the mRNA expression of GSK-3β and TSC2 was inhibited, but the expression of TOR was induced in the gill of zebrafish. The levels of hydrogen peroxide (H2O2), superoxide anion (O2·-), and hydroxy radical (·OH) as well as the activity of superoxide dismutase (SOD) were increased, while the activities of catalase (CAT), glutathione peroxidase (GSH-PX), and peroxidase (POD) were decreased by 25 and 50 mg/L Li+ treatments. In the ZF4 cells, the mRNA expression of GSK-3β and TSC2 was inhibited, but TOR expression was induced by 1, 5, and 10 mmol/L Li+ treatments. To further confirm that lithium promoted ROS production via GSK-3β inhibition, GSK-3β RNA was interfered. It was found that the interference of GSK-3β RNA induced the TSC2/TOR signaling. The levels of H2O2, O2·-, and ·OH were increased, but the activities of CAT, GSH-PX, and POD were decreased by GSK-3β RNA interference. In addition, lithium decreased the mitochondrial membrane potential (MMP) with Rhodamine-123 assay, but increased the levels of ROS by 2',7'-dichlorofluorescein diacetate (DCFH-DA) assay. The present results indicated that lithium promoted the ROS production through the GSK-3β/TSC2/TOR signaling in the gill of zebrafish.

Is lithium biologically an important or toxic element to living organisms? An overview

Industrialized world is exposing living organisms to different chemicals and metals such as lithium (Li). Due to their use in common household items to industrial applications, it is imperative to examine their bioavailability. Lithium belongs to the group IA and also has wider uses such as in batteries, air conditioners to atomic reactors. Lithium occurs naturally in soil and water, mostly at low concentrations, and enters the food chain. It is not one of the essential minerals though various studies indicate that low levels of Li have beneficial effects on living organisms, whereas high levels expose them to toxicity and related detrimental effects. This review suggests that Li could be biologically important to living organism depending upon its concentration/exposure. Little is known about its biological importance and molecular understanding of its accumulation and mode of action, which might have future implications for Li's long-term effects on living organisms.

The occurrence of lithium in the environment of the Jordan Valley and its transfer into the food chain

Lithium is found in trace amounts in all soils. It is also found in plants and in nearly all the organs of the human body. Low Li intake can cause behavioral defects. Thus, this study was conducted to investigate the concentration and distribution of water-soluble Li in soils of the Jordan Valley and its concentration in citrus trees and some important food crops in view of the significant implications of Li for human health. The concentration of soluble Li was measured in 180 soil samples collected at two depths (0-20 and 20-40 cm) whereas its content was determined in fully expanded leaves collected from citrus and different vegetable crops. Concentrations of soluble Li in soils vary from 0.95 to 1.04 mg l(-1) in topsoil and from 1.06 to 2.68 mg l(-1) in subsoil, while Li concentration in leaves ranged from 2 to 27 mg kg(-1) DM. Lithium concentrations in leaves of crops of the same family or different families vary with location in the valley; i.e., they decreased from north to south. It is concluded that soluble Li in soils and the plant family did not solely affect Li transfer in the food chain. In addition, soil EC, Ca, Mg, and Cl, which increased from north to south, might adversely affect plant Li uptake. The current study also showed that consuming 250-300 g FW of spinach day(-1) per person is recommended to provide consumers with their daily Li requirement necessary for significant health and societal benefits.

Genotoxicity evaluation of locally produced dental porcelain--an in vitro study using the Ames and Comet assays

The aim of this study was to determine the genotoxicity of a locally produced dental porcelain (Universiti Sains Malaysia, Malaysia) using the Ames and Comet assays. In the Ames assay, four genotypic variants of the Salmonella strains (TA98, TA100, TA1537 and TA1535) carrying mutations in several genes were used. The dental porcelain was incubated with these four strains in five different doses both in the presence and absence of metabolic activation (S9) and the result was assessed based on the number of revertant colonies. Concurrently, appropriate positive controls were used so as to validate the test. The average number of revertant colonies per plate treated with locally produced dental porcelain was less than double as compared to that of negative control. In the Comet assay, L929 (CCL-1 ATCC, USA) mouse fibroblast cells were treated with the dental porcelain in three different concentrations along with concurrent negative and positive controls. The tail moment which was used as a measurement of DNA damage was almost equal to that of the negative control, suggesting that the locally produced dental porcelain did not induce any DNA damage. The results indicated that the locally produced dental porcelain is non-genotoxic under the present test conditions.

Toxicity of lithium to humans and the environment--a literature review

Lithium concentrations in the surface and underground waters may be higher than general environment in places where lithium-rich brines and minerals occur, and in places where lithium batteries are disposed of. This review has indicated that lithium is not expected to bioaccumulate and its human and environmental toxicity are low. Lithium is not a dietary mineral for plants but it does stimulate plant growth. Large doses of lithium (up to 10 mg/L in serum) are given to patients with bipolar disorder. At 10 mg/L of blood, a person is mildly lithium poisoned. At 15 mg/L they experience confusion and speech impairment, and at 20 mg/L Li there is a risk of death. A provisional recommended daily intake of 14.3 microg/kg body weight lithium for an adult has been suggested.

Inhibition of GSK-3 beta activity attenuates proliferation of human colon cancer cells in rodents

The authors' recent discovery that glycogen synthase kinase-3beta (GSK-3beta) participates in colon cancer cells' survival and proliferation prompted us to investigate whether GSK-3beta inhibition alters proliferation of colon cancer cells in vivo. Groups of four or five athymic mice (Balb/c, nu/nu) with subcutaneous xenografts of SW480 human colon cancer cells were treated with dimethyl sulfoxide (DMSO) or different doses (1, 2 and 5 mg/kg body weight) of either small-molecule GSK-3beta inhibitor (SB-216763 and AR-A014418) by intraperitoneal injection three times per week for 5 weeks. Compared with DMSO (a diluent of the GSK-3beta inhibitors) as a control, either GSK-3beta inhibitor significantly inhibited proliferation of cancer cell xenografts in the rodents in a dose-dependent manner. Histochemical and immunohistochemical analysis of tumor xenografts demonstrated a significant, dose-dependent decrease in fractions of proliferating cells and an increase in the incidence of apoptosis of cancer cells in mice treated with either GSK-3beta inhibitor. No adverse events or effects were observed in the rodents during the course of treatment, except for rare lethal accidents due to intraperitoneal injection. Morphological examination showed no apparent pathologic changes in major organs including the lungs, liver, pancreas, kidneys, spleen and large bowel of rodents treated with DMSO and the GSK-3beta inhibitors. The results indicate that the GSK-3beta inhibitors would be a novel class of therapeutic agent for colon cancer.

Lithium-associated hypothyroidism and thyroid papillary carcinoma: a case report

Ionizing radiation, some hereditary factors, and chronic thyroid-stimulating hormone elevation increases the risk of differentiated thyroid carcinoma. Lithium salts are used in the treatment of affective (mood) disorders as well as a variety of other psychiatric conditions. There have been occasional reports of hematologic and solid neoplasms associated with lithium use. We report a patient who developed hypothyroidism and subsequently, thyroid papillary carcinoma while on lithium treatment for bipolar affective disorder.

The effects of lithium, valproic acid, and carbamazepine during pregnancy and lactation

The chronic, complex, and episodic course of bipolar mood disorder presents a particularly formidable challenge to the clinician making a treatment plan for the onset or recurrence of the illness during pregnancy and lactation. Women treated with anti-manic drugs who become pregnant are commonly considered to be at high risk for fetal complications during the pregnancy or during lactation. The risks of antimanic drug use during pregnancy include teratogenic effects, direct neonatal toxicity, and the potential for longer-term neurobehavioral sequela. The use of medications during pregnancy and lactation requires critical attention to the timing of exposure, dosage, duration of use, and fetal susceptibility. The postnatal period is a time of increased onset and relapse of mental illness. No antimanic drug can be proven completely safe. Prescribing antimanic medications with a long safety record, avoiding exposure in the first trimester; avoiding multidrug regimens, and prescribing the lowest dose for the shortest duration will minimize the fetal risk. This review considers treatment with lithium, valproic acid, and carbamazepine. It assesses the risk to the fetus, the perinatal risks for the infant, the risks associated with treatment during the puerperium and breast-feeding, and the risks to the later development of the child.

Maternal issues affecting the fetus

Maternal disorders and exposures that affect fetal cardiac structure and function are reviewed, emphasizing fetal echocardiographic diagnosis and monitoring, and approaches for in utero therapy. Maternal diabetes, hyperthyroidism, lupus erythematosis, epilepsy, congenital heart disease, infections, and drug exposures are considered.

Increased sister chromatid exchange and chromosomal aberration frequencies in psychiatric patients receiving psychopharmacological therapy

Combinations of various psychotropic drugs are often used, sometimes for long periods, in the treatment of various forms of psychiatric disorders. This paper evaluates the cytogenetic consequences of daily exposure to polytherapy with antianxiety, antipsychotic and antimaniacal drugs by determining chromosomal aberrations (CA) and sister chromatid exchange (SCE) in peripheral blood samples. The study was performed with a group of 36 psychiatric patients: 18 receiving long-term treatment with lithium carbonate, combined with benzodiazepines (BD) and antipsychotic agents (Group A) and 18 treated with BD and antipsychotics (Group B). Among the latter, 7 patients had only been treated for 1 month (Group B1). The results reveal a significant increase (p<0.01) in cells with aberrations in the two groups of patients (A,B) compared to controls. Moreover, complex aberrations (dicentrics, rearrangements, chromatid exchanges) had a frequency of 0.63% in patients receiving long-term treatment compared to 0.11% in controls, corresponding to the general spontaneous rate. The mean frequency of SCE/cell and the percentage of cells with a high frequency of exchanges (HFC) also showed a highly significant difference compared to controls in both Group A and Group B. Group B1 (patients who only commenced treatment 1 month earlier) did not differ from the control group with regard to the frequency and type of chromosomal aberration or in relation to the mean frequency of SCE/cell. No significant differences were detected between Groups A and B both of which showed similar frequencies of cells with aberrations, SCE/cell and HFC. No correlations were observed in Group A between lithemia and the biological markers studied.

Genetic toxicities of human teratogens

Birth defects cause a myriad of societal problems and place tremendous anguish on the affected individual and his or her family. Current estimates categorize about 3% of all newborn infants as having some form of birth defect or congenital anomaly. As more precise means of detecting subtle anomalies become available this estimate, no doubt, will increase. Even though birth defects have been observed in newborns throughout history, our knowledge about the causes and mechanisms through which these defects are manifested is limited. For example, it has been estimated that around 20% of all birth defects are due to gene mutations, 5-10% to chromosomal abnormalities, and another 5-10% to exposure to a known teratogenic agent or maternal factor [D.A. Beckman, R.L. Brent, Mechanisms of teratogenesis. Ann. Rev. Pharmacol. Toxicol. 24 (1984) 483-500; K. Nelson, L.B. Holmes Malformations due to presumed spontaneous mutations in newborn infants, N. Engl. J. Med. 320 (1989) 19-23.]. Together, these percentages account for only 30-40%, leaving the etiology of more than half of all human birth defects unexplained. It has been speculated that environmental factors account for no more than one-tenth of all congenital anomalies [D.A. Beckman, R.L. Brent, Mechanisms of teratogenesis, Ann. Rev. Pharmacol. Toxicol. 24 (1984) 483-500]. Furthermore, since there is no evidence in humans that the exposure of an individual to any mutagen measurably increases the risk of congenital anomalies in his or her offspring' [J.F. Crow, C. Denniston, Mutation in human populations, Adv. Human Genet. 14 (1985) 59-121; J.M. Friedman, J.E. Polifka, Teratogenic Effects of Drugs: A Resource for Clinicians (TERIS). The John Hopkins University Press, Baltimore, 1994], the mutagenic activity of environmental agents and drugs as a factor in teratogenesis has been given very little attention. Epigenetic activity has also been given only limited consideration as a mechanism for teratogenesis. As new molecular methods are developed for assessing processes associated with teratogenesis, especially those with a genetic or an epigenetic basis, additional environmental factors may be identified. These are especially important because they are potentially preventable. This paper examines the relationships between chemicals identified as human teratogens (agents that cause birth defects) and their mutagenic activity as evaluated in one or more of the established short-term bioassays currently used to measure such damage. Those agents lacking mutagenic activity but with published evidence that they may otherwise alter the expressions or regulate interactions of the genetic material, i.e. exhibit epigenetic activity, have likewise been identified. The information used in making these comparisons comes from the published literature as well as from unpublished data of the U.S. National Toxicology Program (NTP).