Association between lead and cadmium co-exposure and systemic immune inflammation in residents living near a mining and smelting area in NW China

Relationships between blood chromium exposure and liver injury: Exploring the mediating role of systemic inflammation in a chromate-exposed population

Hexavalent chromium and its compounds are prevalent pollutants, especially in the work environment, pose a significant risk for multisystem toxicity and cancers. While it is known that chromium accumulation in the liver can cause damage, the dose-response relationship between blood chromium (Cr) and liver injury, as well as the possible potential toxic mechanisms involved, remains poorly understood. To address this, we conducted a follow-up study of 590 visits from 305 participants to investigate the associations of blood Cr with biomarkers for liver injury, including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and direct bilirubin (DBIL), and to evaluate the mediating effects of systemic inflammation. Platelet (PLT) and the platelet-to-lymphocyte ratio (PLR) were utilized as biomarkers of systemic inflammation. In the linear mixed-effects analyses, each 1-unit increase in blood Cr level was associated with estimated effect percentage increases of 0.82% (0.11%, 1.53%) in TBIL, 1.67% (0.06%, 3.28%) in DBIL, 0.73% (0.04%, 1.43%) in ALT and 2.08% (0.29%, 3.87%) in AST, respectively. Furthermore, PLT mediated 10.04%, 11.35%, and 10.77% increases in TBIL, DBIL, and ALT levels induced by chromate, respectively. In addition, PLR mediated 8.26% and 15.58% of the association between blood Cr and TBIL or ALT. These findings shed light on the mechanisms underlying blood Cr-induced liver injury, which is partly due to worsening systemic inflammation.

Selenium restored mitophagic flux to alleviate cadmium-induced hepatotoxicity by inhibiting excessive GPER1-mediated mitophagy activation

Cadmium (Cd) is a common environmental pollutant, while selenium (Se) can ameliorate heavy metal toxicity. Consequently, this study aimed to investigate the protective effects of Se against Cd-induced hepatocyte injury and its underlying mechanisms. To achieve this, we utilized the Dongdagou-Xinglong cohort, BRL3A cell models, and a rat model exposed to Cd and/or Se. The results showed that Se counteracted liver function injury and the decrease in GPER1 levels caused by environmental Cd exposure, and various methods confirmed that Se could protect against Cd-induced hepatotoxicity both in vivo and in vitro. Mechanistically, Cd caused excessive mitophagy activation, evidenced by the colocalization of LC3B, PINK1, Parkin, P62, and TOMM20. Transfection of BRL3A cells with mt-keima adenovirus indicated that Cd inhibited autophagosome-lysosome fusion, thereby impeding mitophagic flux. Importantly, G1, a specific agonist of GPER1, mitigated Cd-induced mitophagy overactivation and hepatocyte toxicity, whereas G15 exacerbates these effects. Notably, Se supplementation attenuated Cd-induced GPER1 protein reduction and excessive mitophagy activation while facilitating autophagosome-lysosome fusion, thereby restoring mitophagic flux. In conclusion, this study proposed a novel mechanism whereby Se alleviated GPER1-mediated mitophagy and promoted autophagosome-lysosome fusion, thus restoring Cd-induced mitophagic flux damage, and preventing hepatocyte injury.

Association between heavy metals exposure and persistent infections: the mediating role of immune function

Introduction

Persistent infections caused by certain viruses and parasites have been associated with multiple diseases and substantial mortality. Heavy metals are ubiquitous environmental pollutants with immunosuppressive properties. This study aimed to determine whether heavy metals exposure suppress the immune system, thereby increasing the susceptibility to persistent infections.

Methods

Using data from NHANES 1999-2016, we explored the associations between heavy metals exposure and persistent infections: Cytomegalovirus (CMV), Epstein-Barr Virus (EBV), Hepatitis C Virus (HCV), Herpes Simplex Virus Type-1 (HSV-1), Toxoplasma gondii (T. gondii), and Toxocara canis and Toxocara cati (Toxocara spp.) by performing logistic regression, weighted quantile sum (WQS) and Bayesian kernel machine regression (BKMR) models. Mediation analysis was used to determine the mediating role of host immune function in these associations.

Results

Logistic regression analysis revealed positive associations between multiple heavy metals and the increased risk of persistent infections. In WQS models, the heavy metals mixture was associated with increased risks of several persistent infections: CMV (OR: 1.58; 95% CI: 1.17, 2.14), HCV (OR: 2.94; 95% CI: 1.68, 5.16), HSV-1 (OR: 1.25; 95% CI: 1.11, 1.42), T. gondii (OR: 1.97; 95% CI: 1.41, 2.76), and Toxocara spp. (OR: 1.76; 95% CI: 1.16, 2.66). BKMR models further confirmed the combined effects of heavy metals mixture and also identified the individual effect of arsenic, cadmium, and lead. On mediation analysis, the systemic immune inflammation index, which reflects the host's immune status, mediated 12.14% of the association of mixed heavy metals exposure with HSV-1 infection.

Discussion

The findings of this study revealed that heavy metals exposure may increase susceptibility to persistent infections, with the host's immune status potentially mediating this relationship. Reducing exposure to heavy metals may have preventive implications for persistent infections, and further prospective studies are needed to confirm these findings.

Prenatal and childhood air pollution exposure, cellular immune biomarkers, and brain connectivity in early adolescents

Introduction

Ambient air pollution is a neurotoxicant with hypothesized immune-related mechanisms. Adolescent brain structural and functional connectivity may be especially vulnerable to ambient pollution due to the refinement of large-scale brain networks during this period, which vary by sex and have important implications for cognitive, behavioral, and emotional functioning. In the current study we explored associations between air pollutants, immune markers, and structural and functional connectivity in early adolescence by leveraging cross-sectional sex-stratified data from the Adolescent Brain Cognitive Development℠ Study®.

Methods

Pollutant concentrations of fine particulate matter, nitrogen dioxide, and ozone were assigned to each child's primary residential address during the prenatal period and childhood (9-10 years-old) using an ensemble-based modeling approach. Data collected at 11-13 years-old included resting-state functional connectivity of the default mode, frontoparietal, and salience networks and limbic regions of interest, intracellular directional and isotropic diffusion of available white matter tracts, and markers of cellular immune activation. Using partial least squares correlation, a multivariate data-driven method that identifies important variables within latent dimensions, we investigated associations between 1) pollutants and structural and functional connectivity, 2) pollutants and immune markers, and 3) immune markers and structural and functional connectivity, in each sex separately.

Results

Air pollution exposure was related to white matter intracellular directional and isotropic diffusion at ages 11-13 years, but the direction of associations varied by sex. There were no associations between pollutants and resting-state functional connectivity at ages 11-13 years. Childhood exposure to nitrogen dioxide was negatively correlated with white blood cell count in males. Immune biomarkers were positively correlated with white matter intracellular directional diffusion in females and both white matter intracellular directional and isotropic diffusion in males. Lastly, there was a reliable negative correlation between lymphocyte-to-monocyte ratio and default mode network resting-state functional connectivity in females, as well as a compromised immune marker profile associated with lower resting-state functional connectivity between the salience network and the left hippocampus in males. In post-hoc exploratory analyses, we found that the PLSC-identified white matter tracts and resting-state networks related to processing speed and cognitive control performance from the NIH Toolbox.

Conclusions

We identified novel links between childhood nitrogen dioxide and cellular immune activation in males, and brain network connectivity and immune markers in both sexes. Future research should explore the potentially mediating role of immune activity in how pollutants affect neurological outcomes as well as the potential consequences of immune-related patterns of brain connectivity in service of improved brain health for all.

The mediation effect of Systemic Immunity Inflammation Index between urinary metals and TOFAT among adults in the NHANES dataset

Systemic Immune Inflammatory Index (SII) is a novel indicator of inflammation. However, no studies have reported the effect of SII on the association between metals and total fat (TOFAT). We aim to investigate the mediated effect of SII on the relationship between urinary metals and TOFAT in a US adult population. This cross-sectional study was conducted among adults with complete information on SII, urine metal concentrations, and TOFAT from the 2011-2018 National Health and Nutrition Examination Survey (NHANES). Multifactorial logistic regression and restricted cubic splines were used to explore the association between urine metal levels and TOFAT. Furthermore, serial mediation analyses were used to investigate the mediating effect of SII on metals and TOFAT. A total of 3324 subjects were included in this study. After adjusting for confounders, arsenic (As), cadmium (Cd), cobalt (Co), cesium (Cs), inorganic mercury (Hg), molybdenum (Mo), manganese (Mn), lead (Pb), antimony (Sb), and thallium(Tl) had negative decreased trends of odds ratios for TOFAT (all P for trend < 0.05). In the total population, we found that Cd, Co, and Tu were positively associated with SII (β = 29.70, 79.37, and 31.08), whereas As and Hg had a negative association with SII. The mediation analysis showed that SII mediated the association of Co with TOFAT, with the β of the mediating effect being 0.9% (95%CI: 0.3%, 1.6%). Our findings suggested that exposure to As, Cd, and Hg would directly decrease the level of TOFAT. However, Co would increase TOFAT, completely mediated by SII, mainly exerted in females rather than males.

Effects of Cadmium and Lead Co-exposure on Sleep Status in Rural Areas Northwestern China

In this study, we explored how cadmium and lead co-exposure affects sleep status among residents of a polluted area and nature reserve in rural northwestern China. Cadmium and lead levels were measured using blood samples, and sleep status was evaluated using sleep questionnaires, with the main sleep indicators including sleep duration, sleep quality, bedtime, and staying up. Furthermore, cadmium-lead co-exposure levels were divided into three groups: high exposure, medium exposure, and low exposure. Subjects in the contaminated area had significantly higher exposure levels (p < 0.001) and more negative sleep indicators (p < 0.01). Significant differences were found for all four sleep indicators in the high exposure group compared to the low exposure group (p < 0.01). Moreover, the overall evaluation of sleep status with high cadmium-lead co-exposure had a negative impact. Our data suggest that cadmium-lead co-exposure has a negative effect on sleep status and may have a synergistic effect on sleep.

Association of blood cadmium levels and all-cause mortality among adults with rheumatoid arthritis: The NHANES cohort study

BACKGROUND

The potential impact of environmental cadmium exposure on the prognosis of patients with rheumatoid arthritis (RA) remains unclear, despite its known association with various adverse health outcomes.

METHODS

In this study, a total of 1285 RA patients were included in the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2016. The Cox regression model was employed to investigate the relationship between blood cadmium levels and the risk of all-cause mortality in RA patients.

RESULTS

During a mean follow-up duration of 105.9 months, 341 patient deaths were recorded. After adjusting for multiple factors, elevated blood cadmium was strongly correlated with an increased risk of all-cause mortality in patients with RA. With one unit rise in natural logarithm-transformed blood cadmium concentrations, the risk of patient death increased by 107%. The adjusted hazard ratios for each quartile of blood cadmium demonstrated a significant upward trend (P < 0.001). A linear dose-response relationship of blood cadmium concentrations with all-cause mortality was also distinctive (P < 0.001). Consistent findings were ascertained when conducting stratified analyses by age, gender, race, education level, body mass index, smoking status, and drinking status.

CONCLUSIONS

Elevated blood cadmium levels may serve as a risk factor for increased death risk in RA patients.

Association between multiple-heavy-metal exposures and systemic immune inflammation in a middle-aged and elderly Chinese general population

BACKGROUND

Exposure to heavy metals alone or in combination can promote systemic inflammation. The aim of this study was to investigate potential associations between multiple plasma heavy metals and markers of systemic immune inflammation.

METHODS

Using a cross-sectional study, routine blood tests were performed on 3355 participants in Guangxi, China. Eight heavy metal elements in plasma were determined by inductively coupled plasma mass spectrometry. Immunoinflammatory markers were calculated based on peripheral blood WBC and its subtype counts. A generalised linear regression model was used to analyse the association of each metal with the immunoinflammatory markers, and the association of the metal mixtures with the immunoinflammatory markers was further assessed using weighted quantile sum (WQS) regression.

RESULTS

In the single-metal model, plasma metal Fe (log10) was significantly negatively correlated with the levels of immune-inflammatory markers SII, NLR and PLR, and plasma metal Cu (log10) was significantly positively correlated with the levels of immune-inflammatory markers SII and PLR. In addition, plasma metal Mn (log10 conversion) was positively correlated with the levels of immune inflammatory markers NLR and PLR. The above associations remained after multiple corrections. In the mixed-metal model, after WQS regression analysis, plasma metal Cu was found to have the greatest weight in the positive effects of metal mixtures on SII and PLR, while plasma metals Mn and Fe had the greatest weight in the positive effects of metal mixtures on NLR and LMR, respectively. In addition, blood Fe had the greatest weight in the negative effects of the metal mixtures for SII, PLR and NLR.

CONCLUSION

Plasma metals Cu and Mn were positively correlated with immunoinflammatory markers SII, NLR and PLR. While plasma metal Fe was negatively correlated with immunoinflammatory markers SII, NLR, and PLR.

Association and mediation analyses among multiple metal exposure, mineralocorticoid levels, and serum ion balance in residents of northwest China

Toxic metals are vital risk factors affecting serum ion balance; however, the effect of their co-exposure on serum ions and the underlying mechanism remain unclear. We assessed the correlations of single metal and mixed metals with serum ion levels, and the mediating effects of mineralocorticoids by investigating toxic metal concentrations in the blood, as well as the levels of representative mineralocorticoids, such as deoxycorticosterone (DOC), and serum ions in 471 participants from the Dongdagou-Xinglong cohort. In the single-exposure model, sodium and chloride levels were positively correlated with arsenic, selenium, cadmium, and lead levels and negatively correlated with zinc levels, whereas potassium and iron levels and the anion gap were positively correlated with zinc levels and negatively correlated with selenium, cadmium and lead levels (all P < 0.05). Similar results were obtained in the mixed exposure models considering all metals, and the major contributions of cadmium, lead, arsenic, and selenium were highlighted. Significant dose-response relationships were detected between levels of serum DOC and toxic metals and serum ions. Mediation analysis showed that serum DOC partially mediated the relationship of metals (especially mixed metals) with serum iron and anion gap by 8.3% and 8.6%, respectively. These findings suggest that single and mixed metal exposure interferes with the homeostasis of serum mineralocorticoids, which is also related to altered serum ion levels. Furthermore, serum DOC may remarkably affect toxic metal-related serum ion disturbances, providing clues for further study of health risks associated with these toxic metals.

Cross-sectional and Longitudinal Associations Between Metal Mixtures and Serum C3, C4: Result from the Manganese‑exposed Workers Healthy Cohort

Exposure to metal mixtures compromises the immune system, with the complement system connecting innate and adaptive immunity. Herein, we sought to explore the relationships between blood cell metal mixtures and the third and fourth components of serum complement (C3, C4). A total of 538 participants were recruited in November 2017, and 289 participants were followed up in November 2021. We conducted a cross-sectional analysis at baseline and a longitudinal analysis over 4 years. Least Absolute Shrinkage and Selection Operator (LASSO) was employed to identify the primary metals related to serum C3, C4; generalized linear model (GLM) was further used to evaluate the cross-sectional associations of the selected metals and serum C3, C4. Furthermore, participants were categorized into three groups according to the percentage change in metal concentrations over 4 years. GLM was performed to assess the associations between changes in metal concentrations and changes in serum C3, C4 levels. At baseline, each 1-unit increase in log10-transformed in magnesium, manganese, copper, rubidium, and lead was significantly associated with a change in serum C3 of 0.226 (95% CI: 0.146, 0.307), 0.055 (95% CI: 0.022, 0.088), 0.113 (95% CI: 0.019, 0.206), - 0.173 (95% CI: - 0.262, - 0.083), and - 0.020 (95% CI: - 0.039, - 0.001), respectively. Longitudinally, decreased copper concentrations were negatively associated with an increment in serum C3 levels, while decreased lead concentrations were positively associated with an increment in serum C3 levels. However, no metal was found to be primarily associated with serum C4 in LASSO, so we did not further explore the relationship between them. Our research indicates that copper and lead may affect complement system homeostasis by influencing serum C3 levels. Further investigation is necessary to elucidate the underlying mechanisms.

The role of ZEB1 in regulating tight junctions in antrochoanal polyp

Background

Antrochoanal polyp (ACP) is a benign nasal mass of unknown etiology. Tight junctions (TJs) are essential to the epithelial barrier that protects the body from external damage. However, the phenotype of tight junction in ACP is currently unclear.

Methods

The samples were collected from 20 controls, 37 patients with ACP and 45 patients with chronic rhinosinusitis with nasal polyp (CRSwNP). Quantitative Real-Time PCR (qRT-PCR) and immunofluorescence staining (IF) were performed to analyze the expressions of TJs markers (ZO-1, claudin-3 and occludin) and ZEB1. hNEpCs were transfected with ZEB1 small interfering RNA (si-ZEB1) or ZEB1 over-expression plasmid (OE-ZEB1). qRT-PCR and Western blotting were used to determine the levels of TJs-related markers. Primary human nasal epithelial cells (hNECs) were stimulated with IL-17A and si-ZEB1, and the expression of epithelial barrier markers were measured by qRT-PCR and Western blotting.

Results

Compared to the control group, ACP group showed a significant downregulation in both mRNA and protein levels of ZO-1, occludin, and claudin-3. Furthermore, disease severity correlates positively with the degree of disruption of tight junctions. In addition, higher expression levels of ZEB1, IL-17A, and IFN-γ were observed in the ACP group compared to controls. Overexpression of ZEB1 in hNEpCs led to impairments in the levels of ZO-1, occludin, and claudin-3, while silencing of ZEB1 expression was found to enhance the barrier function of epithelial cells. Finally, IL-17 stimulation of hNECs impaired the expression of TJs-associated molecules (ZO-1, occludin, and claudin-3), which was effectively reversed by the IL-17A + si-ZEB1 group.

Conclusions

The tight junctions in ACP were extremely damaged and were correlated with the severity of the disease. ZEB1 was involved in the pathogenesis of ACP mediated by IL-17A through regulating tight junctions.

The single and mixed impacts of cadmium, cobalt, lead, and PAHs on systemic immunity inflammation index in male and female

Background

Studies on the association between mixed exposure to common pollutants such as cadmium (Cd), cobalt (Co), lead (Pb), and polycyclic aromatic hydrocarbons (PAHs) with Systemic Immune Inflammatory Index (SII), a novel hemocyte-based inflammatory marker, have not been reported. This study explored the relationship between co-exposure to Cd, Co, Pb, PAHs, and SII.

Methods

In this study, we used data from the National Health and Nutrition Examination Survey and enrolled adults with complete information on Cd, Co, Pb, PAHs, and SII. The linear regression was used to analyze the association of single pollutants with SII. Furthermore, a Bayesian Kernel Machine Regression analysis and a generalized weighted quantile sum regression analysis were used to analyze the association between mixed exposure to Cd, Co, Pb, and six PAHs and SII. We also separated males and females and analyzed the different effects of pollutants on SII, respectively.

Results

5,176 participants were included in the study. After adjusting for age, gender, race, education, smoking, drinking, physical activity, and sedentary, Cd, Co, 1-OHN, 2-OHN and 2-OHF were positive with SII in the total population. Compared with the 50th percentile, the joint effect of pollutants on SII was positive. In the total population, males, and females, the top contaminant with the highest effect weights on SII were Co, Cd, and 1-OHN, respectively. The result of interaction analysis showed that the low concentrations of Cd had an elevation effect on SII in males.

Conclusion

This study found a positive association of mixed exposure to Cd, Co, Pb, and six PAHs with SII, which occurred mainly in females.

Serum albumin mediates the associations between heavy metals and two novel systemic inflammation indexes among U.S. adults

BACKGROUND

The effects of heavy metal exposure on immunological function have sparked widespread concern, but unequivocal evidence on the association between mixed metal exposure and novel systemic inflammatory indexes remains scarce.

OBJECTIVES

This study aimed to analyze the associations of heavy metals with two novel systemic inflammation indexes and the mediated effects of serum albumin.

METHODS

Nineteen metals were detected among 4082 U.S. adults based on the NHANES. A linear regression, restricted cubic splines (RCS) regression, weighted quantile sum (WQS), Quantile-based Gcomputation (qgcomp), and Bayesian kernel machine regression (BKMR) were conducted to evaluate the associations of single metal and mixed metals with systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) levels, respectively. A series of subgroup analyses were used to identify potentially vulnerable populations. Furthermore, we conducted mediation analyses to investigate the mediated effects of serum albumin on the associations of metals with SII and SIRI.

RESULTS

In the single-exposure model, exposure to various metals such as urinary Co, As, and serum Zn, Cu was associated with SII and SIRI (PFDR<0.05). Simultaneously, the above metals were linear positively correlated with SII and SIRI. Mixed-exposure analyses consistently showed that overall mixed urinary metal levels were positively pertinent for SII and SIRI levels, and the metal Co played a significant role in the urinary metal mixtures. Subgroup analyses showed that exposure to urinary Cd in men and elderly people increased SII and SIRI levels. The results of mediation analyses suggested the association of urinary metal mixture with SII and SIRI was mediated by albumin, and the proportion of mediation was 14.45% and 9.49%, respectively.

CONCLUSIONS

Our findings suggested that metal exposure is strongly associated with the levels of system inflammation indexes and that serum albumin is, in part, a mediator of this association.

Moderate selenium mitigates hand grip strength impairment associated with elevated blood cadmium and lead levels in middle-aged and elderly individuals: insights from NHANES 2011-2014

Background: Selenium (Se) has been reported to have an antagonistic effect on heavy metals in animals. Nevertheless, there is a lack of epidemiological research examining whether Se can mitigate the adverse effects of cadmium (Cd) and lead (Pb) on hand grip strength (HGS) in middle-aged and elderly individuals. Methods: This study used data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). HGS measurements were conducted by trained examiners with a dynamometer. Concentrations of Se, Cd, and Pb in blood were determined via inductively coupled plasma mass spectrometry. We employed linear regression, restricted cubic splines, and quantile g-computation (qgcomp) to assess individual and combined associations between heavy metals and HGS. The study also explored the potential influence of Se on these associations. Results: In both individual metal and multi-metal models adjusted for confounders, general linear regression showed Se's positive association with HGS, while Cd and Pb inversely related to it. At varying Se-Cd and Se-Pb concentrations, high Se relative to low Se can attenuate Cd and Pb's HGS impact. An inverted U-shaped correlation exists between Se and both maximum and combined HGS, with Se's benefit plateauing beyond approximately 200 μg/L. Stratified analysis by Se quartiles reveals Cd and Pb's adverse HGS effects diminishing as Se levels increase. Qgcomp regression analysis detected Se alleviating HGS damage from combined Cd and Pb exposure. Subsequent subgroup analyses identified the sensitivity of women, the elderly, and those at risk of diabetes to HGS impairment caused by heavy metals, with moderate Se supplementation beneficial in mitigating this effect. In the population at risk for diabetes, the protective role of Se against heavy metal toxicity-induced HGS reduction is inhibited, suggesting that diabetic individuals should particularly avoid heavy metal-induced handgrip impairment. Conclusion: Blood Cd and Pb levels are negatively correlated with HGS. Se can mitigate this negative impact, but its effectiveness plateaus beyond 200 μg/L. Women, the elderly, and those at risk of diabetes are more vulnerable to HGS damage from heavy metals. While Se supplementation can help, its protective effect is limited in high diabetes risk groups.

Association of urinary heavy metal combined exposure with periodontitis among US adults from NHANES 2011-2014

Some heavy metals are associated with periodontitis; whereas most of these associations have focused on individual metal, there are no specific studies on the effects of combined heavy metal exposure on periodontitis. We conducted an analysis on the association between urinary heavy metal exposure and periodontitis in participants aged 30 years and older using multiple logistic regression and Bayesian kernel machine regression (BKMR). This analysis was performed on data from the National Health and Nutrition Examination Survey from 2011 to 2014. The study found that using logistic regression, the 4th quartile of urinary lead and molybdenum and the 3rd quartile of urinary strontium were positively associated with periodontitis compared to the reference quartile after adjusting for covariates. Odds ratio (OR) with 95% confidence interval (CI) was 1.738 (1.069-2.826), 1.515 (1.025-2.239), and 1.498 (1.010-2.222), respectively. The 3rd and 4th quartiles of urinary cobalt were negatively associated with periodontitis, and their ORs and 95% CIs were 0.639 (0.438-0.934) and 0.571 (0.377-0.964), respectively. The BKMR model showed that urinary barium, lead, and molybdenum were positively associated with periodontitis in a range of concentrations and urinary cobalt, manganese, tin, and strontium were negatively correlated with periodontitis. Furthermore, the overall association between urinary heavy metals and periodontitis was positive. Our study provides evidence for an association between exposure to multiple urinary heavy metals and periodontitis. However, further longitudinal studies are needed to explore the specific mechanisms involved.

The relationship between cadmium exposure and hepatitis B susceptibility and the establishment of its prediction model

Cadmium, a common metal, is an environmental contaminant that is hepatotoxic and immunotoxic. Cadmium exposure may affect hepatitis B immunity. The purpose of this study was to assess the association between cadmium exposure and hepatitis B serology in the US population and to develop a model to predict susceptibility of hepatitis B. The study included 50,588 individuals in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. Univariate and multivariate logistic regression and dose-response curves were used to evaluate the relationship between cadmium exposure and hepatitis B serology. Through multivariate logistic regression results, a predictive model was established, and relevant indicators were used to verify the clinical value of the model and evaluate prognostic value of serum cadmium concentration in patients with hepatitis B. We selected 5989 (≥ 6 years old) participants. Univariate logistic regression analysis showed that gender (aOR = 0.7192, 95% CI = 0.6492-0.7968), age (aOR = 1.030, 95% CI = 1.026-1.033), race (aOR = 0.8974, 95% CI = 0.8591-0.9374), poverty ratio (aOR = 1.042, 95% CI = 0.9872-1.101), body mass index (BMI) (aOR = 1.052, 95% CI = 1.044-1.061), hypertension (aOR = 2.017, 95% CI = 1.763-2.306), diabetes (aOR = 2.673, 95% CI = 2.119-3.370), vigorous recreational activities (aOR = 0.6369, 95% CI = 0.5725-0.7085), moderate recreational activity (aOR = 0.7681, 95% CI = 0.6935-0.8574) and cadmium (aOR = 1.295, 95% CI = 1.168-1.436) were closely related to hepatitis B virus (HBV) susceptibility. After adjusting for these confounding factors, multivariate logistic regression analysis showed that the odds ratio of HBV susceptibility was positively correlated with the level of cadmium in serum. The effectiveness of the model was then evaluated by establishing a nomogram, and by calibration curves, ROC curves, and clinical decision curves. Our study shows that cadmium exposure is positively associated with HBV susceptibility risk in the US population, and the constructed model has clinical significance.

Independent and Combined Associations of Blood Manganese, Cadmium and Lead Exposures with the Systemic Immune-Inflammation Index in Adults

Manganese (Mn), cadmium (Cd) and lead (Pb) have toxic effects on the immune system. However, their independent and combined effects on immune-inflammation responses are unclear. In recent years, the systemic immune-inflammation index (SII) has been developed as an integrated and novel inflammatory indicator. A retrospective cross-sectional study of 2174 adults ≥20 years old from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 was conducted. Generalized linear models were used to evaluate the independent and combined associations of SII with blood Mn, Cd and Pb levels. As continuous variables, both blood Cd and Mn showed dose-dependent relationships with the SII before and after adjusting for all potential confounding factors. Metal concentrations were then converted into categorical variables. Compared with the adults in the lowest Cd or Mn tertile, those in the highest tertile had higher risks of elevated SII. Furthermore, co-exposure to Mn and Cd also showed a positive relationship with the SII after adjusting for all confounding factors. However, the single effect of Pb exposure and the joint effect of Pb and other metal exposures on the SII were not observed. This study provides important epidemiological evidence of the associations of SII with single and co-exposure effects of blood Mn, Cd, and Pb.

The association between multi-heavy metals exposure and lung function in a typical rural population of Northwest China

BACKGROUND

Heavy metal exposure is acknowledged to be associated with decrease of lung function, but the relationship between metals co-exposure and lung function in rural areas of Northwest China remains unclear, particularly in an area famous for heavy metal pollution and solid fuel use. Therefore, the purpose of this study is to explore the effects of heavy metal exposure on lung function and the potential impacts of living habit in a rural cohort of Northwest China.

METHODS

The study area included five villages of two regions in Northwestern China-Gansu province. All participants were recruited from the Dongdagou-Xinglong (DDG-XL) rural cohort in the study area. Urine levels of 10 common and representative heavy metals were detected by ICP-MS, including Cobalt (Co), Nickel (Ni), Molybdenum (Mo), Cadmium (Cd), Stibium (Sb), Copper (Cu), Zinc (Zn), Mercury (Hg), Lead (Pb), and Manganese (Mn). The lung function was detected by measuring percentages of predicted forced vital capacity (FVC%) and predicted forced expiratory volume in one second (FEV1%) as well as the ratio of FEV1/FVC. We also analyzed the association between heavy metals and pulmonary ventilation dysfunction (PVD). Restricted cubic spline, logistic regression, linear regression, and bayesian kernel machine regression (BKMR) model were used to analyze the relationship between heavy metal exposure and lung function.

RESULTS

Finally, a total of 382 participants were included in this study with an average age of 56.69 ± 7.32 years, and 82.46% of them used solid fuels for heating and cooking. Single metal exposure analysis showed that the higher concentration of Hg, Mn, Sb, and lower Mo may be risk factors for PVD. We also found that FEV1% and FVC% were negatively correlated with Sb, Hg, and Mn, but positively correlated with Mo. The effect of mixed heavy metals exposure could be observed through BKMR model, through which we found the lung function decreased with the increase of heavy metal concentration. Furthermore, the males, BMI ≥ 24 kg/m2 and who used solid fuels showed a higher risk of PVD when exposed to Co, Zn, and Hg.

CONCLUSIONS

Our results suggested that heavy metal exposure was associated with decrease of lung function regardless of single exposure or mixed exposure, particularly for Sb, Hg, Mn and those who use solid fuels.

The Effect of Smoking Habits on Blood Cadmium and Lead Levels in Residents Living Near a Mining and Smelting Area in Northwest China: a Cross-Sectional Study

Few studies have focused on environmental cadmium (Cd) and lead (Pb) exposure while exploring the effect of smoking on blood Cd (BCd) and blood Pb (BPb) levels. Moreover, essential trace elements affect the absorption, accumulation, and toxicity of Cd and Pb. To investigate the effect of smoking on BCd and BPb levels under high Cd and Pb exposure and the influence of essential trace elements on the effect, 301 residents living near a mining and smelting area in Northwest China were included in our study. After collecting health information and measuring BCd, BPb, serum iron, magnesium, and total calcium levels, we analyzed the association between smoking and BCd and BPb levels and the influence of the essential trace elements on the association. The results showed that BCd and BPb levels in smokers were significantly higher than those in non-smokers. There was a dose-response association between pack-years and the odds ratios (ORs) of high BCd and BPb levels in all participants compared with non-smokers. Serum iron, magnesium, and calcium had a negative effect on the elevations of the ORs of high BCd and BPb levels. In addition, smoking-related elevations of BCd and BPb levels vary by sex, age, BMI, and age of smoking initiation. Our findings present evidence for the effect of smoking on BCd and BPb levels under high Cd and Pb exposure and may provide guidance for the prevention and control of BCd and BPb elevations in residents living in Cd- and Pb-polluted areas.

Mixed heavy metals exposure affects the renal function mediated by 8-OHG: A cross-sectional study in rural residents of China

Heavy metals are important risk factors for kidney, but their co-exposure effect on kidney and related mechanism remain unclear. This study evaluated the relationship between heavy metals and renal function, and the feasible mediation effect of oxidative stress. Based on the Dongdagou-Xinglong cohort, participants were recruited and their information were collected through questionnaires and physical examinations. The urine concentration of heavy metals like Cobalt, Nickel, Molybdenum, Cadmium, Antimony, Copper, Zinc, Mercury, Lead, Manganese, and renal injury biomarkers like β2-microglobulin, β-N-Acetylglucosaminidase, retinol-binding protein, 8-hydroxyguanine (8-OHG) were measured and corrected by creatinine. Linear regression was conducted to analyze the relationship between metals and renal biomarkers. Bayesian kernel machine regression, weighted quantile sum and quantile-based g-computation were applied to analyze the association between metal mixtures and renal biomarkers. Finally, the mediating effect of 8-OHG was analyzed through the mediation model. We found that these metals were positively related with renal biomarkers, where copper showed the strongest relationship. The co-exposure models showed that renal biomarkers increased with the concentration of mixtures, particularly for cadmium, copper, mercury, manganese. In addition, the proportion of 8-OHG in mediating effect of metals on renal function ranged from 2.6% to 86.9%. Accordingly, the renal function damage is positively associated with metals, and 8-OHG may play an important mediating role.

Associations of long-term cadmium exposure with peripheral white blood cell subtype counts and indices in residents of cadmium-polluted areas

BACKGROUND

Experimental evidence suggests that exposure to cadmium (Cd) could affect immune cells in vivo and in vitro. However, the associations of long-term Cd exposure with white blood cell (WBC) subtype counts and hemogram-derived indices have been rarely investigated. Therefore, we evaluated these relationships in residents of cadmium-polluted areas.

METHODS

This cross-sectional study included 431 participants aged 45-75 years without occupational exposure histories from Cd-contaminated areas of southern China. We detected WBC, neutrophil, lymphocyte, and monocyte counts using routine blood tests and calculated neutrophil-lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and lymphocyte-monocyte ratio (LMR). Urinary Cd (U-Cd) was measured with inductively coupled plasma mass spectrometry and adjusted for creatinine. To evaluate the associations of U-Cd with peripheral WBC subtype counts and indices, we performed multivariate linear regression, logistic regression and subgroup analyses using U-Cd categorized into quartiles.

RESULTS

In models adjusted for all potential confounders, U-Cd was negatively associated with WBC, neutrophil, and monocyte counts in Q2, compared with Q1 of U-Cd (p < 0.05). A similar relationship was observed between U-Cd and NLR and SIRI, whereas the corresponding association for LMR was positive (p < 0.05). In subgroup analyses, U-Cd was negatively associated with neutrophil count, except for never smokers, after full adjustment.

CONCLUSIONS

U-Cd was negatively associated with WBC count, neutrophil count, monocyte count, NLR, and SIRI, and positively associated with LMR. Therefore, neutrophil count could be a potential indicator of long-term Cd exposure-associated immunosuppressive effect.

Effects of lead and cadmium co-exposure on liver function in residents near a mining and smelting area in northwestern China

Chronic exposure to environmental cadmium (Cd) and lead (Pb) may have adverse effects on the human health. In this study, we aimed to determine the primary and interactive effects of Cd and Pb exposure on liver function in residents near a mining and smelting area in northwestern China. A total of 451 subjects were recruited, from which blood samples were collected to determine the levels of Cd, Pb, and liver function indices. Additionally, the association between the levels of exposure markers and liver function indices was analysed. Cd and Pb levels were significantly higher in subjects living in the polluted area than in those living in the non-polluted reference area. The liver function levels of subjects in the polluted area were poor compared with those in the reference area. In addition, Cd and Pb levels in the blood were positively associated with gamma glutamyl transpeptidase (GGT) levels and negatively associated with direct bilirubin (DBil) levels. Cd and Pb may be risk factors for abnormal liver function. The risk of abnormal liver function was higher in subjects with moderate Cd and Pb levels, high Cd levels, high Pb levels, and high Cd and Pb levels than in those with low Cd and Pb levels. Our data show that exposure to Cd and/or Pb can cause abnormal liver function. Cd and Pb may have an antagonistic effect on liver function, and high Cd exposure alone has a more profound effect on abnormal liver function compared with co-exposure to Pb and Cd.

Lead exposure is non-linearly associated with subclinical myocardial injury in the general population without cardiovascular disease

Background and aims

Growing studies have focused on the effect of lead exposure on human circulatory system, while the relationship between lead exposure and subclinical myocardial injury (SC-MI) is still poorly known. Therefore, this study was to explore the effect of lead exposure on SC-MI.

Methods

The study included 6,272 individuals aged 40 and older without cardiovascular disease (CVD) from the third National Health and Nutrition Examination Survey. Blood lead was used as an alternative marker of lead exposure. Multivariable logistic regression models, restricted cubic spline and threshold effect analyses were performed to investigate the effect of blood lead on SC-MI.

Results

After adjusting for age, sex, race, diabetes, hypertension, systolic blood pressure, body mass index, waist-to-hip ratio, triglycerides, total cholesterol, creatinine, fasting plasma glucose and hemoglobin Alc, higher blood lead level was independently related to higher risk of SC-MI (OR 1.047, 95% CI [1.018, 1.077]; P = 0.003). Restricted cubic spline curve showed that there was a non-linear correlation between blood lead and SC-MI. Threshold effect analysis determined that the inflection point of blood lead was 3.8 ug/dl. When the blood lead level was higher than 3.8 ug/dl, there was an independent positive correlation between blood lead level and the risk of SC-MI (OR 1.031, 95% CI [1.009, 1.053]; P < 0.01). And similar associations were also observed among subgroups of male, ≤60 years, >60 years, never smoker, non-Hispanic White, non-Hispanic Black or without hypertension and diabetes.

Conclusions

Blood lead was non-linearly related to SC-MI in population free from CVD.

Association among Helicobacter pylori Infection, Tooth Loss, and Heavy Medal Exposure in a Chinese Rural Population

Previous research suggests that heavy metals may be associated with increased susceptibility to Helicobacter pylori infection. This study investigated the effect of heavy metal exposure (Pb and Cd) on tooth loss and H. pylori infection in a Chinese rural population, who live near a mining and smelting area. Blood samples were collected from the study participants to estimate the lead (Pb) and cadmium (Cd) exposure levels. H. pylori infection was analyzed using the 14C-urea breath test, and the number of missing teeth (MT), filled teeth (FT), and missing or filled teeth (MFT) were counted by conducting a physical examination. Regression analysis was used to assess the difference between H. pylori-positive and -negative individuals in the MT, FT, and MFT groups, adjusting for confounders. The H. pylori infection prevalence was higher in individuals in the high Cd or high Pb groups than that in the low Cd or low Pb groups (p < 0.05). In addition, greater numbers of FT and MFT were observed in individuals in the high Pb group than those in the low Pb group (p < 0.05). We further found 8.7% (95% CI, 2.8−23.8%, p = 0.017) of the effect of the high BPb level on H. pylori infection risk could be statistically explained by FT using amediation analyses in adjusted models, and 6.8% (95% CI, 1.6−24.8%, p = 0.066) by MFT. Furthermore, FT and MFT were significantly associated with increased risk for H. pylori infection (odds ratio (OR) = 4.938, 95% confidence interval (CI): 1.125−21.671; OR = 3.602, 95% CI: 1.218−10.648, respectively). Pb and Cd exposure may be associated with tooth loss and increased susceptibility to H. pylori infection, and tooth loss may be an independent risk factor for H. pylori infection.

Heavy metals exposure is associated with early liver dysfunction among rural residents aged 40-75 years in southwest China

Heavy metals exposure has been associated with liver dysfunction in recent reports, while the hepatoxicity of lead (Pb) and cadmium (Cd) has been well established. However, the combined effects of multi-metal in real-world scenario on liver dysfunction are still unclear. This cross-sectional study examined associations between 10 biomarkers of early liver injury and multiple heavy metals levels. The levels of heavy metals/metalloid (magnesium [Mg], calcium [Ca], iron [Fe], zinc [Zn], arsenic [As], Cd, copper [Cu], and Pb) were measured in blood and urinary sample collected from 725 participants in a Cd-polluted area and an unpolluted area in southwest China. The early liver dysfunction biomarkers included the liver enzymes (ALT, ALP, AST, and GGT), proteins (TP, ALB, and GLO), and bilirubin (TBIL, DBIL, and IBIL). Confounder-adjusted beta coefficients were determined using multiple linear regression model analysis for the group-classified and gender-classified samples. Our results showed that blood Fe, Cd, and Cu levels were found to be positively related to elevated ALT levels and blood Cu was positively associated with AST levels in the Cd-polluted area, while the highest blood Zn quartile in the polluted area and blood Mg quartile in the unpolluted area were associated with lower ALT levels. Our finding implies that industrial pollution results in heavy metals of Cd and Pb exposure and effects of Fe, Cd, Cu, and Pb in the Cd-polluted area may be the main contributors to increase the risk of liver dysfunction while Zn in the Cd-polluted area and Mg in the unpolluted area may be the protective factors.