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Ajibo DN, Orish CN, Ruggieri F, Bocca B, Battistini B, Frazzoli C, Orish FC, Orisakwe OE. An Update Overview on Mechanistic Data and Biomarker Levels in Cobalt and Chromium-Induced Neurodegenerative Diseases. Biol Trace Elem Res 2024; 202:3538-3564. [PMID: 38017235 DOI: 10.1007/s12011-023-03965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
There is increasing evidence that the imbalance of metals as cobalt (Co) and chromium (Cr) may increase the risk of development and progression of neurodegenerative diseases (NDDs). The human exposure to Co and Cr is derived mostly from industry, orthopedic implants, and polluted environments. Neurological effects of Co and Cr include memory deficit, olfactory dysfunction, spatial disorientation, motor neuron disease, and brain cancer. Mechanisms of Co and Cr neurotoxicity included DNA damage and genomic instability, epigenetic changes, mitochondrial disturbance, lipid peroxidation, oxidative stress, inflammation, and apoptosis. This paper seeks to overview the Co and Cr sources, the mechanisms by which these metals induce NDDs, and their levels in fluids of the general population and patients affected by NDDs. To this end, evidence of Co and Cr unbalance in the human body, mechanistic data, and neurological symptoms were collected using in vivo mammalian studies and human samples.
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Affiliation(s)
- Doris Nnena Ajibo
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria
| | - Chinna Nneka Orish
- Department of Anatomy, College of Health Sciences University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria
| | - Flavia Ruggieri
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Beatrice Bocca
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Beatrice Battistini
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Chiara Frazzoli
- Department for Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore Di Sanità, Rome Viale Regina Elena, 29900161, Rome, Italy
| | | | - Orish E Orisakwe
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria.
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria.
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Stojsavljević A, Jagodić J, Perović T, Manojlović D, Pavlović S. Changes of Target Essential Trace Elements in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Biomedicines 2024; 12:1589. [PMID: 39062163 PMCID: PMC11274787 DOI: 10.3390/biomedicines12071589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Multiple sclerosis (MS) is a chronic, complex, and demyelinating disease closely associated with altered levels of trace elements. Although the first studies into the role of trace elements in MS were published in the 1970s, for five decades it has remained unknown whether trace elements can be part of this heterogeneous neurological disease. (2) Materials and methods: To drive toward at a potential solution, we conducted a systematic review and meta-analysis to elucidate whether there were differences in circulating levels of neurologically important essential trace elements (Zn, Fe, Co, Cu, Mn, and Se) between MS cases and controls. (3) Results: This study revealed significantly lower serum/plasma Zn and Fe levels and higher Cu levels in MS-affected individuals compared to controls. At the same time, no significant differences were found between the MS cases and controls regarding their serum/plasma levels of Co, Mn, or Se. Thus, the loss of Fe and Zn should be considered in supplementation/nutrition strategies for MS patients. On the other hand, since high serum Cu levels indicate a burden on the bloodstreams of MS patients, Cu should be excluded from mineral supplement strategies. Furthermore, all three trace elements (Fe, Zn, and Cu) should be considered from an etiological point of view, and, most importantly, their levels in the bloodstreams of MS patients should be monitored. (4) Conclusions: This study highlights the way for personalized and targeted strategies in the management of MS.
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Affiliation(s)
- Aleksandar Stojsavljević
- Innovation Center, Faculty of Chemistry, University of Belgrade, Studentski Trg 12-16, 11000 Belgrade, Serbia
| | - Jovana Jagodić
- Faculty of Chemistry, University of Belgrade, 11000 Belgrade, Serbia; (J.J.); (D.M.)
| | - Tatjana Perović
- Psychiatric Hospital, University Medical Center Zvezdara, 11000 Belgrade, Serbia;
- Serbian RE&CBT Centre, 11000 Belgrade, Serbia
| | - Dragan Manojlović
- Faculty of Chemistry, University of Belgrade, 11000 Belgrade, Serbia; (J.J.); (D.M.)
| | - Slađan Pavlović
- Institute for Biological Research “Siniša Stanković”-National Institute of the Republic of Serbia, University of Belgrade, 11108 Belgrade, Serbia;
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Serdysnki KC, Kaplan S, Oraham A, Mirgati S, Akili F, Allam E. Trunnionosis in total hip arthroplasty with accompanying amyloidosis and calcium pyrophosphate deposition disease. Radiol Case Rep 2024; 19:186-189. [PMID: 38028302 PMCID: PMC10630768 DOI: 10.1016/j.radcr.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
Metal-on-polyethylene (MoP) is a common type of total hip arthroplasty. Trunnionosis is a rare but concerning complication of this type of implant. Trunnionosis involves wear and corrosion at the femoral component's head-neck interface and may cause a local inflammatory response referred to as an adverse reaction to metal debris (ARMD). We present a rare case of trunnionosis with concurrent calcium pyrophosphate deposition disease (CPPD) and amyloidosis in a MoP implant. ARMD can be linked to crystalline arthropathy and amyloidosis, possibly due to metal ion-induced acidosis. Clinicians should consider trunnionosis in patients with persistent post-surgical hip pain, and order metal ion tests and synovial fluid analysis to aid in the diagnosis of this condition if suspected. Timely recognition enables appropriate surgical revision.
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Affiliation(s)
| | - Sam Kaplan
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Aaron Oraham
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Sidney Mirgati
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Fatima Akili
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
| | - Emad Allam
- Loyola University Medical Center and Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153 USA
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Blackmon J, Blackmon L, Goode C, Douthit N. Systemic Cobalt Toxicity Secondary to Metal-on-Metal Prosthetic Hip Replacement: a Case Report. J Gen Intern Med 2024; 39:133-137. [PMID: 37914907 PMCID: PMC10817879 DOI: 10.1007/s11606-023-08490-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Jonathan Blackmon
- East Alabama Health Internal Medicine Residency, 2000 Pepperell Pkwy, Opelika, AL, 36801, USA.
| | - Lindsey Blackmon
- East Alabama Health Internal Medicine Residency, 2000 Pepperell Pkwy, Opelika, AL, 36801, USA
| | - Claire Goode
- Auburn VCOM, 910 South Donahue Drive, Auburn, AL, 36832, USA
| | - Nathan Douthit
- East Alabama Health Internal Medicine Residency, 2000 Pepperell Pkwy, Opelika, AL, 36801, USA
- Auburn VCOM, 910 South Donahue Drive, Auburn, AL, 36832, USA
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Tower SS, Gessner BD, Cho CS, Bridges RL. The association of cobalturia with cobaltism symptoms a prospective blinded study of 229 post-arthroplasty patients. PLoS One 2023; 18:e0295203. [PMID: 38127904 PMCID: PMC10734948 DOI: 10.1371/journal.pone.0295203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Cobalt is a mitochondrial toxin, clinical cobaltism manifests with constitutional, neurologic, and cardiovascular symptomatology. Cobalt's severe toxidrome is known through case reports from extreme wear or corrosion of cobalt-chromium arthroplasty components. However, the spectrum and epidemiology of orthopedic-implant cobaltism and its relationship to duration and degree of cobalt exposure are not well defined. METHODS The relationship of urine-cobalt concentration and duration of exposure to cobalt-chromium joint implants and cobaltism symptomatology were prospectively studied in 229 patients. Subjects received a Cobaltism-Symptom-Inventory-Score (CSIS) based on a protocolized interview and examination followed by a spot urine-cobalt measurement. RESULTS 129 (56%) subjects were cobalturic (urine-cobalt ≥1.0 ppb). 122 (53%) subjects had a CSIS of >2, this status significantly associates with cobalturia. Median [IQR] urine-cobalt in the subjects with a CSIS >2 was 4.1[1.1-17.0] ppb compared to 0.5[0.5-1.4] ppb in subjects with CSIS ≤ 2. Cobalturia has a sensitivity of 0.69, a specificity of 0.77, and a positive predictive value of 0.74 for a CSIS of >2. The product of years-exposed to a cobalt-chromium implant and urine-cobalt by quartiles significantly positively associates with the Cobaltism-Symptom-Inventory-Score. CONCLUSION A urine-cobalt of ≥1 ppb likely indicates adverse systemic exposure to orthopedic-implant generated cobalt. Cobaltism severity as quantified by the CSIS significantly correlates with the product of spot urine-cobalt concentration and years-exposed to a cobalt-chromium orthopedic-implant indicating a dose-response relationship. Medical provider and public awareness of orthopedic-implant cobaltism is vital because tens-of-millions are at-risk and early cobaltism is reversible. Further use of cobalt-chromium orthopedic-implants should be questioned given cobaltism becomes clinically apparent at a spot urine-cobalt of 1 ppb or greater. Monitoring of patients with high-risk cobalt-chromium orthopedic-implants appears to be indicated.
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Affiliation(s)
- Stephen S. Tower
- University of Alaska, Medical School, Anchorage, Alaska, United States of America
| | | | - Christina S. Cho
- University of Alaska, Medical School, Anchorage, Alaska, United States of America
| | - Robert L. Bridges
- Aegis Imaging Consultants, Girdwood, Alaska, United States of America
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