Neurobehavioral effects of arsenic exposure among secondary school children in the Kandal Province, Cambodia

Inflammation in Metal-Induced Neurological Disorders and Neurodegenerative Diseases

Essential metals play critical roles in maintaining human health as they participate in various physiological activities. Nonetheless, both excessive accumulation and deficiency of these metals may result in neurotoxicity secondary to neuroinflammation and the activation of microglia and astrocytes. Activation of these cells can promote the release of pro-inflammatory cytokines. It is well known that neuroinflammation plays a critical role in metal-induced neurotoxicity as well as the development of neurological disorders, such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). Initially seen as a defense mechanism, persistent inflammatory responses are now considered harmful. Astrocytes and microglia are key regulators of neuroinflammation in the central nervous system, and their excessive activation may induce sustained neuroinflammation. Therefore, in this review, we aim to emphasize the important role and molecular mechanisms underlying metal-induced neurotoxicity. Our objective is to raise the awareness on metal-induced neuroinflammation in neurological disorders. However, it is not only just neuroinflammation that different metals could induce; they can also cause harm to the nervous system through oxidative stress, apoptosis, and autophagy, to name a few. The primary pathophysiological mechanism by which these metals induce neurological disorders remains to be determined. In addition, given the various pathways through which individuals are exposed to metals, it is necessary to also consider the effects of co-exposure to multiple metals on neurological disorders.

Early postnatal and concurrent exposure to metals and neurobehavioral outcomes at 5 years: Associations with individual environmental exposures and mixtures

BACKGROUND

Little is known about the effect of postnatal exposure to heavy metals on children's behavior problems. This study aimed to investigate the association between metal exposure during different stages of postnatal life and neurobehavioral outcomes in preschool children.

METHODS

Urinary concentrations of six metals (arsenic, cadmium, chromium, lead, manganese, and vanadium) were measured using inductively coupled plasma mass spectrometry in 220 participants at two time points: before 1 year and at 5 years of age. Mothers completed the Child Behavior Checklist when the children were 5 years old. Multivariable linear and logistic regression analyses were used to evaluate the association between metal concentrations and behavioral outcomes. We employed Bayesian kernel machine regression (BKMR) to assess possible joint effects and potential interactions between metal mixtures and behavioral outcomes.

RESULTS

Concentrations of urinary arsenic (As) in infants were associated with higher scores for anxious/shy behavior problems (β ranging from 0.03 to 0.23). Further analyses showed that As exposure increased the odds of scores falling into the borderline or clinical range on anxious/depressed, affective, and pervasive developmental problems (ORs: 2.45-3.40). Stratification by sex indicated significance in girls but not in boys. BKMR analysis showed that, among the metal mixtures, As displayed a major effect on behavior scores. Concentrations of urinary cadmium in infants were also associated with higher behavioral scores but did not increase the risk of clinical problems. A cross-sectional survey in 5-year-olds did not show a significant association between concurrent metal exposure and behavioral outcome.

CONCLUSION

Our results showed that exposure to As and Cd during infancy was associated with emotional problems in children. The effect of arsenic exposure was more pronounced among female infants. We suggest reducing exposure to toxic metals during early postnatal life to prevent behavioral problems in children."

Child and Adolescent Manganese Biomarkers and Adolescent Postural Balance in Marietta CARES Cohort Participants

BACKGROUND

Manganese (Mn) plays a significant role in both human health and global industries. Epidemiological studies of exposed populations demonstrate a dose-dependent association between Mn and neuromotor effects ranging from subclinical effects to a clinically defined syndrome. However, little is known about the relationship between early life Mn biomarkers and adolescent postural balance.

OBJECTIVES

This study investigated the associations between childhood and adolescent Mn biomarkers and adolescent postural balance in participants from the longitudinal Marietta Communities Actively Researching Exposures Study (CARES) cohort.

METHODS

Participants were recruited into CARES when they were 7-9 y old, and reenrolled at 13-18 years of age. At both time points, participants provided samples of blood, hair, and toenails that were analyzed for blood Mn and lead (Pb), serum cotinine, hair Mn, and toenail Mn. In adolescence, participants completed a postural balance assessment. Greater sway indicates postural instability (harmful effect), whereas lesser sway indicates postural stability (beneficial effect). Multivariable linear regression models were conducted to investigate the associations between childhood and adolescent Mn biomarkers and adolescent postural balance adjusted for age, sex, height-weight ratio, parent/caregiver intelligence quotient, socioeconomic status, blood Pb, and serum cotinine.

RESULTS

CARES participants who completed the adolescent postural balance assessment (n = 123 ) were 98% White and 54% female and had a mean age of 16 y (range: 13-18 y). In both childhood and adolescence, higher Mn biomarker concentrations were significantly associated with greater adolescent sway measures. Supplemental analyses revealed sex-specific associations; higher childhood Mn biomarker concentrations were significantly associated with greater sway in females compared with males.

DISCUSSION

This study found childhood and adolescent Mn biomarkers were associated with subclinical neuromotor effects in adolescence. This study demonstrates postural balance as a sensitive measure to assess the association between Mn biomarkers and neuromotor function. https://doi.org/10.1289/EHP13381.

Effects of sodium arsenite exposure on behavior, ultrastructure and gene expression of brain in adult zebrafish (Danio rerio)

Arsenic, a common metal-like substance, has been demonstrated to pose potential health hazards and induce behavioral changes in humans and rodents. However, the chronic neurotoxic effects of arsenic on aquatic animals are still not fully understood. This study aimed to investigate the effects of arsenic exposure on adult zebrafish by subjecting 3-month-old zebrafish to three different sodium arsenite water concentrations: 0 μg/L (control group), 50 μg/L, and 500 μg/L, over a period of 30 days. To assess the risk associated with arsenic exposure in the aquatic environment, behavior analysis, transmission electron microscopy techniques, and quantitative real-time PCR were employed. The behavior of adult zebrafish was evaluated using six distinct tests: the mirror biting test, shoaling test, novel tank test, social preference test, social recognition test, and T maze. Following the behavioral tests, the brains of zebrafish were dissected and collected for ultrastructural examination and gene expression analysis. The results revealed that sodium arsenite exposure led to a significant reduction in aggression, cohesion, social ability, social cognition ability, learning, and memory capacity of zebrafish. Furthermore, ultrastructure and genes regulating behavior in the zebrafish brain were adversely affected by sodium arsenite exposure.

Update of the risk assessment of inorganic arsenic in food

The European Commission asked EFSA to update its 2009 risk assessment on arsenic in food carrying out a hazard assessment of inorganic arsenic (iAs) and using the revised exposure assessment issued by EFSA in 2021. Epidemiological studies show that the chronic intake of iAs via diet and/or drinking water is associated with increased risk of several adverse outcomes including cancers of the skin, bladder and lung. The CONTAM Panel used the benchmark dose lower confidence limit based on a benchmark response (BMR) of 5% (relative increase of the background incidence after adjustment for confounders, BMDL05) of 0.06 μg iAs/kg bw per day obtained from a study on skin cancer as a Reference Point (RP). Inorganic As is a genotoxic carcinogen with additional epigenetic effects and the CONTAM Panel applied a margin of exposure (MOE) approach for the risk characterisation. In adults, the MOEs are low (range between 2 and 0.4 for mean consumers and between 0.9 and 0.2 at the 95th percentile exposure, respectively) and as such raise a health concern despite the uncertainties.

Neurocognitive Analysis of Low-level Arsenic Exposure and Executive Function Mediated by Brain Anomalies Among Children, Adolescents, and Young Adults in India

Importance

Arsenic, a contaminant of groundwater and irrigated crops, is a global public health hazard. Exposure to low levels of arsenic through food extends well beyond the areas with high arsenic content in water.

Objective

To identify cognitive impairments following commonly prevalent low-level arsenic exposure and characterize their underlying brain mechanisms.

Design, Setting, and Participants

This multicenter population-based cohort study analyzed cross-sectional data of the Indian Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA) cohort, recruited between November 4, 2016, and May 4, 2019. Participants aged 6 to 23 years were characterized using deep phenotyping measures of behavior, neuropsychology, psychopathology, brain neuroimaging, and exposure to developmental adversities and environmental neurotoxins. All analyses were performed between June 1, 2020, and December 31, 2021.

Exposure

Arsenic levels were measured in urine as an index of exposure.

Main Outcomes and Measures

Executive function measured using the cVEDA neuropsychological battery, gray matter volume (GMV) from T1-weighted magnetic resonance imaging, and functional network connectivity measures from resting state functional magnetic resonance imaging.

Results

A total of 1014 participants aged 6 to 23 years (589 male [58.1%]; mean [SD] age, 14.86 [4.79] years) were included from 5 geographic locations. Sparse-partial least squares analysis was used to describe a negative association of arsenic exposure with executive function (r = -0.12 [P = 5.4 × 10-4]), brain structure (r = -0.20 [P = 1.8 × 10-8]), and functional connectivity (within network, r = -0.12 [P = 7.5 × 10-4]; between network, r = -0.23 [P = 1.8 × 10-10]). Alterations in executive function were partially mediated by GMV (b = -0.004 [95% CI, -0.007 to -0.002]) and within-network functional connectivity (b = -0.004 [95% CI, -0.008 to -0.002]). Socioeconomic status and body mass index moderated the association between arsenic and GMV, such that the association was strongest in participants with lower socioeconomic status and body mass index.

Conclusions and Relevance

The findings of this cross-sectional study suggest that low-level arsenic exposure was associated with alterations in executive functioning and underlying brain correlates. These results indicate potential detrimental consequences of arsenic exposure that are below the currently recommended guidelines and may extend beyond endemic risk areas. Precision medicine approaches to study global mental health vulnerabilities highlight widespread but potentially modifiable risk factors and a mechanistic understanding of the impact of low-level arsenic exposure on brain development.

Inorganic arsenic alters the development of dopaminergic neurons but not serotonergic neurons and induces motor neuron development via Sonic hedgehog pathway in zebrafish

The mechanism of inorganic arsenic-induced neurotoxicity at the cellular level is not known. In zebrafish, teratological effects of inorganic arsenic have been shown at various concentrations. Here, we used similar concentrations of inorganic arsenic to evaluate the effects on specific neuron types. Exposure of zebrafish embryos at 5 h post fertilization (hpf) to sodium arsenite induced developmental toxicity (reduced body length) in 72 hpf larvae, beginning at a concentration of 300 mg/L concentration. Mortality or overt morphological deformity was detected at 500 mg/L sodium arsenite. While 200 mg/L sodium arsenite induced development of tyrosine hydroxylase-positive (dopaminergic) neurons, there was no significant effect on the development of 5-hydroxytryptamine (serotonergic) neurons. Sodium arsenite reduced acetylcholinesterase activity. In the hb9-GFP transgenic larvae, both 200 and 400 mg/L sodium arsenite produced supernumerary motor neurons in the spinal cord. Inhibition of the Sonic hedgehog (Shh) pathway that is essential for motor neuron development, by Gant61, prevented sodium arsenite-induced supernumerary motor neuron development. Inductively coupled plasma mass spectrometry (ICP-MS) revealed that with 200 mg/L and 400 mg/L sodium arsenite treatment, each larva had an average of 387.8 pg and 847.5 pg arsenic, respectively. The data show for the first time that inorganic arsenic alters the development of dopaminergic and motor neurons in the zebrafish larvae and the latter occurs through the Shh pathway. These results may help understand why arsenic-exposed populations suffer from psychiatric disorders and motor neuron disease and Shh may, potentially, serve as a plasma biomarker of arsenic toxicity.

Arsenic in drinking water, hair, and prevalence of arsenicosis in Perak, Malaysia

Arsenic is a carcinogen element that occurs naturally in our environment. Humans can be exposed to arsenic through ingestion, inhalation, and dermal absorption. However, the most significant exposure pathway is via oral ingestion. Therefore, a comparative cross-sectional study was conducted to determine the local arsenic concentration in drinking water and hair. Then, the prevalence of arsenicosis was evaluated to assess the presence of the disease in the community. The study was conducted in two villages, namely Village AG and Village P, in Perak, Malaysia. Socio-demographic data, water consumption patterns, medical history, and signs and symptoms of arsenic poisoning were obtained using questionnaires. In addition, physical examinations by medical doctors were performed to confirm the signs reported by the respondents. A total of 395 drinking water samples and 639 hair samples were collected from both villages. The samples were analyzed using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) to determine arsenic concentration. The results showed that 41% of water samples from Village AG contained arsenic concentrations of more than 0.01 mg/L. In contrast, none of the water samples from Village P exceeded this level. Whilst, for hair samples, 85 (13.5%) of total respondents had arsenic levels above 1 μg/g. A total of 18 respondents in Village AG had at least one sign of arsenicosis and hair arsenic levels of more than 1 μg/g. Factors significantly associated with increased arsenic levels in hair were female, increasing age, living in Village AG and smoking. The prevalence of arsenicosis in the exposed village indicates chronic arsenic exposure, and immediate mitigation action needs to be taken to ensure the wellbeing of the residents in the exposed village.

Neuropsychological effects and cognitive deficits associated with exposure to mercury and arsenic in children and adolescents of the Mojana region, Colombia

The present study aims to explore the neuropsychological performance and exposure to mercury (Hg) and arsenic (As) in Colombian children and adolescents considering biomarkers in hair and blood. The total sample consisted of 70 participants from the Mojana region, Colombia. A neuropsychological evaluation protocol was used, consisting of 11 internationally recognized tests, with evidence of national validation and use for measurement in neurotoxicology contexts. A 57.1% of the sample presented levels above the reference value according to the USEPA, the WHO, and the ATSDR for total mercury in hair (HgH), blood mercury (HgB), and/or blood arsenic (AsB). The mean values reported for HgH were 1.76 ± 3.1 μg/g (95% CI 1.02-2.50) with ranges between 0.23 and 17.20; for HgB: 4.11 ± 5.93 μg/l (CI 2.69-5.52), ranging between 0.25 and 25.80, and for AsB: 1.96 ± 2.73 (CI 1.31-2.61) ranging between 0.50 and 15.50. In the comparison of groups in relation to the level of exposure, a significant difference was found (p < 0.05) for the subtest The Boston Naming Test (BNT). Correlation analyses found, on the one hand, significant negative relationships in tests integrated within the verbal (CVB) and executive function (EF) components as well as evidence of positive relationships in the manifestation of errors in their performance with the levels of Hg and/or As transformed by biomarker (Log10). In the linear regression analyses it was found that for each increase in the concentration of HgH, HgB, and AsB it is estimated that, both for the models with and without data adjustment, there is a loss of scores in integrated measures within the CVB and EF for the transformed levels of HgH, HgB, and AsB; and an increase in the reported errors in their processing within these functions. According to these results, exposure to mercury and/or arsenic is related with performance in verbal neuropsychological skills and executive functioning.

Pollution characteristics and health risk assessment of PM2.5-bound arsenic: a 7-year observation in the urban area of Jinan, China

The aim of the study was to analyze the temporal trends, pollution sources, and carcinogenic health risks associated with PM_2.5-bound arsenic (As). A total of 588 PM_2.5 samples were collected in Jinan during January 2014-December 2020. The content and distribution characteristics were determined for As and Al in PM_2.5, and the pollution sources were identified based on enrichment factors (EFs). The health risk of inhalation exposure to As was estimated using the risk assessment methods recommended by the United States Environmental Protection Agency (US EPA). The annual average concentration of As in PM_2.5 was 4.5-17.5 ng m^-3, which was 0.8-2.9 times higher than the limit ruled by the European Union and China's Ambient Air Quality Standards (6 ng m^-3). From 2014 to 2020, the As concentration gradually decreased from 17.5 to 4.9 ng m^-3. After 2017, the concentration was close to the level required by the atmospheric quality standard (6 ng m^-3). The PM_2.5 and arsenic concentrations in the heating season were significantly higher than those in the non-heating season. The EF of As ranged from 144 to 607, which was higher than 10. The cancer risk of As in PM_2.5 decreased to the lowest values (heating season 1.0 × 10^-5 and non-heating season 7.1 × 10^-6, respectively) in 2019. As in Jinan mainly came from anthropogenic pollution. The level of As pollution has been significantly reduced in recent years, but there is still a high risk of carcinogenesis. Air pollution control strategies and guidelines need to be implemented in urban areas, especially during the heating season in winter and spring.

Residence in an Area with Environmental Exposure to Heavy Metals and Neurobehavioral Performance in Children 9-11 Years Old: An Explorative Study

We explored the association between residence in an area polluted with metals and neurobehavioral performance in children aged 9 to 11. A cross-sectional study was conducted with thirty boys and thirty girls aged 9 to 11 from public schools in a heavily industrialized area, matched by age (±4 months) and gender with 15 boys and 15 girls from public schools in cities without relevant industrial activity. Neurobehavioral performance was assessed with the Behavioral Assessment and Research System. Linear regression models were used, adjusting for age, sex, social class and multimedia activities to predict each of the neurobehavioral outcome variables. No differences in neurobehavioral performance were found when all children with residence in areas with environmental exposure to metals were classified as exposed and the children from the other provinces as unexposed. However, when we compared children living <1 km from an industrial area with respect to those living more than 1 km away, significant differences were found. Children living <1 km away had lower scores on Finger Tapping (p = 0.03), Symbol-Digit (p = 0.07) and Continuous Performance (p = 0.02) than those living farther away. Our results support the hypothesis that residing close to an area with industrial activity (<1 km) is associated with deficits in neurobehavioral performance among children aged 9 to 11.

The Role of Micronutrients and Toxic Metals in the Management of Epidemics in Cambodia

The illegal trade of wildlife in SE Asia has been identified as the likely cause of the COVID-19 pandemic. We reviewed 198 papers on the current COVID pandemic in Cambodia, diseases such as avian influenza and Nipah virus, most likely to develop into a new pandemic in Cambodia, and common features of disease that require mitigation. Artisanal goldmining uses pure mercury in the areas where wildlife is smuggled to China. Moreover, 30-40% of Cambodians are zinc deficient. High levels of arsenic in irrigation water (>1000 µg/L) are associated with very low levels of zinc in rice (5 µg/g) and rice is the primary staple food for the region. Brown rice from nine of 15 paddy fields in the arsenic zone of Cambodia had double the new guidelines of 100 µg/kg inorganic arsenic for children's food in the EU and USA. The combination of deficiencies of essential micronutrients like zinc and pervasive presence of arsenic and mercury has the potential to compromise the immunity of many Cambodians. Innovative solutions are suggested to improve micronutrient nutrition. Toxins that suppress the immune system must be better managed to reduce the virulence of pathogens. Cambodia was not likely the source of the COVID-19 but does have problems that could result in a new pandemic.

Nutrition, one-carbon metabolism and arsenic methylation

Exposure to arsenic (As) is a major public health concern globally. Inorganic As (InAs) undergoes hepatic methylation to form monomethyl (MMAs)- and dimethyl (DMAs)-arsenical species, facilitating urinary As elimination. MMAsIII is considerably more toxic than either InAsIII or DMAsV, and a higher proportion of MMAs in urine has been associated with risk for a wide range of adverse health outcomes. Efficiency of As methylation differs substantially between species, between individuals, and across populations. One-carbon metabolism (OCM) is a biochemical pathway that provides methyl groups for the methylation of As, and is influenced by folate and other micronutrients, such as vitamin B12, choline, betaine and creatine. A growing body of evidence has demonstrated that OCM-related micronutrients play a critical role in As methylation. This review will summarize observational epidemiological studies, interventions, and relevant experimental evidence examining the role that OCM-related micronutrients have on As methylation, toxicity of As, and risk for associated adverse health-related outcomes. There is fairly robust evidence supporting the impact of folate on As methylation, and some evidence from case-control studies indicating that folate nutritional status influences risk for As-induced skin lesions and bladder cancer. However, the potential for folate to be protective for other As-related health outcomes, and the potential beneficial effects of other OCM-related micronutrients on As methylation and risk for health outcomes are less well studied and warrant additional research.

Carcinogenic and non-carcinogenic health risk of arsenic ingestion via drinking water in Langat River Basin, Malaysia

The prolonged persistence of toxic arsenic (As) in environment is due to its non-biodegradable characteristic. Meanwhile, several studies have reported higher concentrations of As in Langat River. However, it is the first study in Langat River Basin, Malaysia, that As concentrations in drinking water supply chain were determined simultaneously to predict the health risks of As ingestion. Water samples collected in 2015 from the four stages of drinking water supply chain were analysed for As concentration by inductively coupled plasma mass spectrometry. Determined As concentrations along with the time series data (2004-2015) were significantly within the maximum limit 0.01 mg/L of drinking water quality standard set by World Health Organization. The predicted As concentration by auto-regression moving average was 3.45E-03 mg/L in 2020 at 95% level based on time series data including climatic control variables. Long-term As ingestion via household filtration water at Langat Basin showed no potential lifetime cancer risk (LCR) 9.7E-06 (t = 6.68; p = 3.37E-08) as well as non-carcinogenic hazard quotient (HQ) 4.8E-02 (t = 6.68; p = 3.37E-08) risk at 95% level. However, the changing landscape, ex-mining ponds and extensive use of pesticides for palm oil plantation at Langat Basin are considered as the major sources of increased As concentration in Langat River. Therefore, a two-layer water filtration system at Langat Basin should be introduced to accelerate the achievement of sustainable development goal of getting safe drinking water supply.

Gut microbiota perturbations and neurodevelopmental impacts in offspring rats concurrently exposure to inorganic arsenic and fluoride

Many "hot spot" geographic areas across the world with drinking water co-contaminated with inorganic arsenic (iAs) and fluoride (F^-), two of the most common natural contaminants in drinking water. Both iAs and F^- are known neurotoxins and affect neurodevelopment of children. However, very few studies have investigated the neurodevelopmental effects of concurrent exposure to iAs and F^-, which could potentially pose a greater risk than iAs or F^- exposure alone. Further, perturbations of gut microbiota, which plays a regulatory role in neurodevelopment, resulting from iAs and F^- exposure has been reported in numerous studies. There is lacking of information regarding to the relationship among concurrent iAs and F^- exposure, microbiome disruption, and neurodevelopmental impacts. To fill these gaps, we treated offspring rats to iAs (50 mg/L NaAsO₂) and F^- (100 mg/L NaF), alone or combined from early life (in utero and childhood) to puberty. We applied Morris water maze test to assess spatial learning and memory of these rats and generated gut microbiome profiles using 16S rRNA gene sequencing. We showed that concurrent iAs and F^- exposure caused more prominent neurodevelopmental effects in rats than either iAs or F^- exposure alone. Moreover, Unsupervised Principal Coordinates Analysis (PCoA) and Linear Discriminant Analysis Effect Size (LEfSe) analysis of gut microbiome sequencing results separated concurrent exposure group from others, indicating a more sophisticated change of gut microbial communities occurred under the concurrent exposure condition. Further, a correlation analysis between indices of the water maze test and microbial composition at the genus level identified featured genera that were clearly associated with neurobehavioral performance of rats. 75% (9 out of 12) genera, which had a remarkable difference in relative abundance between the control and combined iAs and F^- exposure groups, showed significantly strong correlations (r = 0.70-0.90) with the water maze performance indicators. Collectively, these results suggest that concurrent iAs and F^- exposure led to more prominent effects on neurodevelopment and gut microbiome composition structures in rats, and the strong correlation between them indicates a high potential for the development of novel microbiome-based biomarkers of iAs and/or F^- associated neurodevelopmental deficits.

Pollution characteristics and chronic health risk assessment of metals and metalloids in ambient PM2.5 in Licheng District, Jinan, China

PM_2.5 samples were collected at the Wangsheren primary school site in Licheng District of Jinan, China, during 2016. Eleven metals and metalloids including Al, As, Be, Cd, Cr, Hg, Mn, Ni, Pb, Sb and Se in PM_2.5 were measured by inductively coupled plasma-mass spectroscopy. The annual average mass concentration of PM_2.5 was found to be 88.7 μg m^-3. The highest PM_2.5 concentrations were obtained during the heating seasons of winter and spring. The concentrations of metals and metalloids in PM_2.5 were in a descending order of Al, Pb, Mn, As, Se, Cr, Sb, Ni, Cd, Hg and Be. The enrichment factors showed that Pb, Mn, As, Se, Cr, Sb, Ni, Cd, Hg originated from anthropogenic sources. Factor analysis indicated that the main sources of the metals were coal combustion dust, soil dust, metallurgical industry, brake abrasion of vehicles and other mixed sources. Coal combustion dust was the primary source of metal pollution in PM_2.5. Non-carcinogenic risks associated with exposure through the respiratory system were between 6.30 × 10^-4 and 7.62 × 10^-1, which were lower than the safe limit (1). The carcinogenic risks of Cr, As and Cd were 3.17 × 10^-5, 1.52 × 10^-5, 2.22 × 10^-6, respectively, which were higher than the precautionary criterion (10^-6/year). This study indicates that the air pollution of PM_2.5 is of public health concern in Licheng District of Jinan, particularly related to potential carcinogenic metals of As, Cr and Cd. Intervention action is needed to reduce the emission sources of these elements, especially coal combustion in winter heating season.

Interactions of Dimethylarsinic Acid, Total Arsenic and Zinc Affecting Rice Crop Management and Human Health in Cambodia

BACKGROUND

In parts of Cambodia and in many other parts of the world, irrigation of rice with groundwater results in arsenic (As) accumulation in soil and rice, leading to health concerns associated with rice consumption. At times, some As is present as relatively nontoxic, non-regulated, dimethylarsinic acid (DMA). Low levels of zinc (Zn) have been found in rice from Bangladesh, Cambodia, and China where As levels in rice are high. Furthermore, there have been claims that Zn deficiency is responsible for stunting the growth of children in Cambodia and elsewhere, however in rural Asia, rice is the major source of Zn. Current data are inadequate for both Zn and DMA in Cambodian rice.

OBJECTIVES

The present study aimed to provide a preliminary evaluation of the relationship between the content of Zn and DMA in rice grain in Preak Russey, an area with elevated levels of As in groundwater and to improve the management of Zn deficiency in rice.

METHODS

Rice agriculture was evaluated along the Mekong River in Cambodia. Analyses for metals, total As, and As species in rice and water were conducted by inductively coupled plasma mass spectrometry. Analysis of total Zn and As in soils and total Zn in rice were analyzed using X-ray fluorescence (XRF) spectrometry.

RESULTS

Rice in Preak Russey had Zn concentrations less than a third the level recommended by the United Nations World Food Programme. There was a significant (p < 0.05) negative correlation between the Zn content of rice and DMA in rice with the lowest Zn and highest DMA levels occurring near irrigation wells, the source of As.

CONCLUSIONS

The highest levels of DMA in rice were associated with Zn deficiency in rice.

COMPETING INTERESTS

The authors declare no competing financial interests.

Exposure to Inorganic Arsenic and Lead and Autism Spectrum Disorder in Children: A Systematic Review and Meta-Analysis

Inorganic arsenic (iAs) and lead (Pb) rank first and second on the U.S. Environmental Protection Agency's priority list of hazardous substances. Both are known neurotoxic metals that cause detrimental effects on brain development and lead to deficits in cognitive function and behavioral performance in children. Studies have indicated a potential link between iAs and Pb exposure and a higher risk for autism spectrum disorder (ASD). To provide further insight into whether developmental exposure to iAs or Pb is associated with ASD, we conducted a systematic review and combined data into a meta-analysis to evaluate the available human evidence on the relationships. We systematically reviewed relevant studies published through December 30, 2018 and identified 14 studies on iAs and 37 studies on Pb exposure and their respective associations with ASD. Among them, 8 (53.3%) and 19 (51.3%) studies reported a positive association for iAs and Pb, respectively, and none reported a sole inverse association. In the following meta-analysis, we found statistically significant higher iAs concentrations, in hair and in blood, for children diagnosed with ASD compared with controls across studies. However, the findings on Pb exposure were inconsistent, with a significant association for hair Pb, no association for urinary Pb, and an inverse association for blood Pb. After considering strengths and limitations of the body of research, we concluded that there is consistent evidence supporting a positive association between early life iAs exposure and diagnosis of ASD and inconsistent evidence for Pb exposure and ASD risk. We believe it is in the best interest of policy makers and the public to reduce exposures to iAs and Pb among pregnant women and children. Further, our research supports the need for large perspective human studies with accurate measurement and determination of the long-term body burden of iAs and Pb exposures to assess the impact of iAs and Pb exposures on ASD risk.

Arsenic Neurotoxicity in Humans

Arsenic (As) contamination affects hundreds of millions of people globally. Although the number of patients with chronic As exposure is large, the symptoms and long-term clinical courses of the patients remain unclear. In addition to reviewing the literature on As contamination and toxicity, we provide useful clinical information on medical care for As-exposed patients. Further, As metabolite pathways, toxicity, speculated toxicity mechanisms, and clinical neurological symptoms are documented. Several mechanisms that seem to play key roles in As-induced neurotoxicity, including oxidative stress, apoptosis, thiamine deficiency, and decreased acetyl cholinesterase activity, are described. The observed neurotoxicity predominantly affects peripheral nerves in sensory fibers, with a lesser effect on motor fibers. A sural nerve biopsy showed the axonal degeneration of peripheral nerves mainly in small myelinated and unmyelinated fibers. Exposure to high concentrations of As causes severe central nervous system impairment in infants, but no or minimal impairment in adults. The exposure dose-response relationship was observed in various organs including neurological systems. The symptoms caused by heavy metal pollution (including As) are often nonspecific. Therefore, in order to recognize patients experiencing health problems caused by As, a multifaceted approach is needed, including not only clinicians, but also specialists from multiple fields.

Environmental and Health Implications of the Correlation Between Arsenic and Zinc Levels in Rice from an Arsenic-Rich Zone in Cambodia

BACKGROUND

In parts of Cambodia, irrigation of rice with groundwater results in arsenic accumulation in soils and rice, leading to health concerns associated with rice consumption. In Bangladesh and China, low zinc levels in rice have been found in regions where arsenic levels in rice are high. Furthermore, there have been claims that zinc deficiency is responsible for stunting of children in Cambodia. There are limited data on zinc in Cambodian rice, but in rural Asia, rice is the major source of zinc.

OBJECTIVES

To provide a preliminary evaluation of the zinc content in rice grain in Preak Russey, an area with elevated levels of arsenic. The importance of zinc in rice for infants was also assessed.

METHODS

Rice cultivation was evaluated in sixty farms along the Mekong River in Cambodia. Analyses for metals, total arsenic, and arsenic species in the water and rice were conducted at the University of Ottawa, Canada by inductively coupled plasma - mass spectrometry. Analysis of total zinc and arsenic in soils were analyzed in Phnom Penh using X-ray fluorescence spectrometry (XRF). Total zinc in rice was also measured by XRF analysis.

RESULTS

Rice in the Preak Russey area contained zinc with ½ to ¼ of the 1987 Codex standard for rice in Infant Formula. Moreover, our average zinc concentration in rice samples was less than a third that recommended for zinc fortification in rice by the United Nations World Food Programme. There was a significant (α=0.05) negative correlation between the arsenic and zinc content of rice with the lowest zinc levels occurring near the irrigation wells, the source of arsenic. There was a significantly higher content of zinc in rice from farms that fertilized with cow manure.

CONCLUSIONS

Handheld XRF spectrometers are useful tools for detection of zinc levels in rice. The potential for zinc deficiency in farmers in areas of Cambodia with arsenic toxicity is high.

COMPETING INTERESTS

The authors declare no competing financial interests.

Peripheral neuropathy induced by drinking water contaminated with low-dose arsenic in Myanmar

Background

More than 140 million people drink arsenic-contaminated groundwater. It is unknown how much arsenic exposure is necessary to cause neurological impairment. Here, we evaluate the relationship between neurological impairments and the arsenic concentration in drinking water (ACDW).

Participants and methods

A cross-sectional study design was employed. We performed medical examinations of 1867 residents in seven villages in the Thabaung township in Myanmar. Medical examinations consisted of interviews regarding subjective neurological symptoms and objective neurological examinations of sensory disturbances. For subjective neurological symptoms, we ascertained the presence or absence of defects in smell, vision, taste, and hearing; the feeling of weakness; and chronic numbness or pain. For objective sensory disturbances, we examined defects in pain sensation, vibration sensation, and two-point discrimination. We analyzed the relationship between the subjective symptoms, objective sensory disturbances, and ACDW.

Results

Residents with ACDW ≥ 10 parts per billion (ppb) had experienced a “feeling of weakness” and “chronic numbness or pain” significantly more often than those with ACDW < 10 ppb. Residents with ACDW ≥ 50 ppb had three types of sensory disturbances significantly more often than those with ACDW < 50 ppb. In children, there was no significant association between symptoms or signs and ACDW.

Conclusion

Subjective symptoms, probably due to peripheral neuropathy, occurred at very low ACDW (around 10 ppb). Objective peripheral nerve disturbances of both small and large fibers occurred at low ACDW (> 50 ppb). These data suggest a threshold for the occurrence of peripheral neuropathy due to arsenic exposure, and indicate that the arsenic concentration in drinking water should be less than 10 ppb to ensure human health.

A systematic literature review of epidemiologic studies of developmental manganese exposure and neurodevelopmental outcomes

BACKGROUND

Neurotoxic effects of high-level occupational exposure to manganese (Mn) are well established; however, whether lower-level environmental exposure to Mn in early life causes neurodevelopmental toxicity in children is unclear.

METHODS

A systematic literature review was conducted to identify and evaluate epidemiologic studies of specific Mn biomarkers assessed during gestation, childhood, or adolescence in association with neurodevelopmental outcomes, focusing on quantitative exposure-response estimates with specific endpoints that were assessed in multiple independent study populations. Study quality was evaluated using the revised RTI item bank and the Cochrane Risk of Bias tool, and the overall weight of epidemiologic evidence for causality was evaluated according to the Bradford Hill considerations.

RESULTS

Twenty-two epidemiologic studies were identified that estimated associations between early-life Mn biomarkers and neurodevelopmental outcomes. Seven of these studies provided adjusted estimates for the association with child intelligence assessed using versions of the Wechsler Intelligence Scales for Children; no other specific neurodevelopmental endpoints were assessed in more than three independent study populations each. Among the studies of child intelligence, five studies in four independent populations measured blood Mn, three studies measured hair Mn, and one measured dentin Mn. Overall, cross-sectional associations between Mn biomarkers and measures of child intelligence were mostly statistically nonsignificant but in a negative direction; however, the lone prospective cohort study found mostly null results, with some positive (favorable) associations between dentin Mn and child intelligence. Studies were methodologically limited by their cross-sectional design and potential for confounding and selection bias, as well as unaddressed questions on exposure assessment validity and biological plausibility.

CONCLUSIONS

The statistical associations reported in the few studies of specific Mn biomarkers and specific neurodevelopmental endpoints do not establish causal effects based on the Bradford Hill considerations. Additional prospective cohort studies of Mn biomarkers and validated neurodevelopmental outcomes, and a better understanding of the etiologic relevance of Mn biomarkers, are needed to shed light on whether environmental exposure to Mn causes adverse neurodevelopmental effects in children.

Prenatal exposure to arsenic and neurobehavioral development of newborns in China

The link between arsenic exposure and deficits in children's neurodevelopment has been suggested, but it remains unclear regarding the arsenic-related effects on the developing brain in early life. To investigate the associations of in utero arsenic exposure with neonatal neurobehavioral development, we conducted a cross-sectional study of 892 mother-infant pairs from 10 hospitals of different levels in Shanghai, China. The concentrations of arsenic were determined in cord blood samples. Neurobehavioral measures were administered at 3 days postpartum in full-term newborns using the neonatal behavioral neurological assessment (NBNA). Logistic regression models were used to estimate odds ratios for dichotomous NBNA outcomes. After adjusting for potential confounders, a natural log unit (ln-unit) increase in cord blood arsenic was associated with 90% increased odds of low NBNA score (95% confidence interval [CI]: 1.62, 2.23). As for clusters, each ln-unit arsenic increase was associated with 47% increased odds of low score for behavior (95% CI: 1.31, 1.66) and 36% increased odds of low score for passive muscle tone (95% CI: 1.23, 1.51). Odds ratios comparing extreme tertiles were 8.62 (95% CI: 4.19, 17.8) for total scale, 3.69 (95% CI: 2.35, 5.82) for behavior, and 3.32 (95% CI: 2.21, 4.97) for passive tone (all p-trend < 0.001). Stratified analyses showed that these associations were strengthened in newborns of mothers over 29 years of age. Our results provide evidence for an inverse association between low-level prenatal arsenic exposure and neurobehavioral performance of newborns, particularly among those born to older mothers. Further studies are warranted to confirm these findings and to determine whether such decrements in early neurodevelopment persist in later childhood.

Arsenic induces autophagy in developmental mouse cerebral cortex and hippocampus by inhibiting PI3K/Akt/mTOR signaling pathway: involvement of blood-brain barrier's tight junction proteins

For the past decade, there has been an increased concern about the health risks from arsenic (As) exposure, because of its neurotoxic effects on the developing brain. The exact mechanism underlying As-induced neurotoxicity during sensitive periods of brain development remains unclear, especially the role of blood-brain barrier's (BBB) tight junction (TJ) proteins during As-induced neurotoxicity. Here, we highlight the involvement of TJ proteins in As-induced autophagy in cerebral cortex and hippocampus during developmental periods [postnatal day (PND) 21, 28, 35 and 42]. Here, the administration of arsenic trioxide (As₂O₃) at doses of 0.15 mg or 1.5 mg or 15 mg As₂O₃/L in drinking water from gestational to lactational and continued to the pups till PND42 resulted in a significant decrease in the mRNA expression levels of TJ proteins (Occludin, Claudin, ZO-1 and ZO-2) and Occludin protein expression level. In addition, As exposure significantly decreased PI3K, Akt, mTOR, and p62 with a concomitant increase in Beclin1, LC3I, LC3II, Atg5 and Atg12. Moreover, As exposure also significantly downregulated the protein expression levels of mTOR with a concomitant upregulation of Beclin 1, LC3 and Atg12 in all the developmental age points. However, no significant alterations were observed in low and medium dose-exposed groups of PND42. Histopathological analysis in As-exposed mice revealed decreased number of pyramidal neurons in hippocampus; and neurons with degenerating axons, shrinkage of cells, remarkable vacuolar degeneration in cytoplasm, karyolysis and pyknosis in cerebral cortex. Ultrastructural analysis by transmission electron microscopy revealed the occurrence of autophagosomes and vacuolated axons in the cerebral cortex and hippocampus of the mice exposed to high dose As at PND21 and 42. The severities of changes were found to more persist in the cerebral cortex than in the hippocampus of As-exposed mice. Finally, we conclude that the leaky BBB in cerebral cortex and hippocampus may facilitate the transfer of As and induces autophagy by inhibiting PI3K/Akt/mTOR signaling pathway in an age-dependent manner, i.e., among the four different developmental age points, PND21 animals were found to be more vulnerable to the As-induced neurotoxicity than the other three age points.

Groundwater Irrigation and Arsenic Speciation in Rice in Cambodia

BACKGROUND

Arsenic bioaccumulation in rice is a global concern affecting food security and public health.

OBJECTIVE

The present study examined arsenic species in rice in Cambodia to characterize health risks with rice consumption and to clarify uncertainties with Codex guidelines.

METHODS

The present study collected 61 well water samples, 105 rice samples, 70 soil samples, and conducted interviews with 44 families in Preak Russey near the Bassac River and Kandal Province along the Mekong River in Cambodia. Analyses of metals, total arsenic and arsenic species were conducted in laboratories in Canada, Cambodia and Singapore.

RESULTS

Unlike in Bangladesh, rice with the highest total arsenic concentrations in Cambodia contains mostly organic arsenic, dimethylarsinic acid (DMA), which is unregulated and much less toxic than inorganic arsenic. The present study found that storing surface runoff in ditches prior to irrigation can significantly reduce the arsenic concentration in rice. It is possible to remove > 95% of arsenic from groundwater prior to irrigation with natural reactions.

CONCLUSIONS

The provision of high quality drinking water in 2015 to Preak Russey removed about 95% of the dietary inorganic arsenic exposure. The extremes in arsenic toxicity that are still obvious in these farmers should become less common. Rice from the site with the highest documented levels of arsenic in soils and water in Cambodia passes current Codex guidelines for arsenic.

INFORMED CONSENT

Obtained.

COMPETING INTERESTS

The authors declare no competing financial interests.

Co-exposure to methylmercury and inorganic arsenic in baby rice cereals and rice-containing teething biscuits

BACKGROUND

Rice is an important dietary source for methylmercury (MeHg), a potent neurotoxin, and inorganic arsenic (As), a human carcinogen. Rice baby cereals are a dietary source of inorganic As; however, less is known concerning MeHg concentrations in rice baby cereals and rice teething biscuits.

METHODS

MeHg concentrations were measured in 36 rice baby cereals, eight rice teething biscuits, and four baby cereals manufactured with oats/wheat (n = 48 total). Arsenic (As) species, including inorganic As, were determined in rice baby cereals and rice teething biscuits (n = 44/48), while total As was determined in all products (n = 48).

RESULTS

Rice baby cereals and rice teething biscuits were on average 61 and 92 times higher in MeHg, respectively, and 9.4 and 4.7 times higher in total As, respectively, compared to wheat/oat baby cereals. For a 15-g serving of rice baby cereal, average MeHg intake was 0.0092μgday-1 (range: 0.0013-0.034μgday-1), while average inorganic As intake was 1.3μgday-1 (range: 0.37-2.3μgday-1). Inorganic As concentrations in two brands of rice baby cereal (n = 12/36 boxes of rice cereal) exceeded 100ng/g, the proposed action level from the U.S. Food and Drug Administration. Log10 MeHg and inorganic As concentrations in rice baby cereals were strongly, positively correlated (Pearson's rho = 0.60, p < 0.001, n = 36).

CONCLUSIONS

Rice-containing baby cereals and teething biscuits were a dietary source of both MeHg and inorganic As. Studies concerning the cumulative impacts of MeHg and inorganic As on offspring development are warranted.

Major Limitations in Using Element Concentrations in Hair as Biomarkers of Exposure to Toxic and Essential Trace Elements in Children

BACKGROUND

Hair is a commonly used exposure biomarker for metals and other trace elements, but concern has been raised regarding its appropriateness for assessing the internal dose.

OBJECTIVES

The aim of the present study was to evaluate children's hair as biomarker of internal dose for toxic (As, Mn, Cd, Pb) and essential elements (Mg, Ca, Fe, Co, Cu, Zn, Se, Mo).

METHODS

In 207 children (9-10 years of age), originating from a population-based cohort in rural Bangladesh, we measured concentrations of the selected elements in hair ( closest to the scalp) using ICP-MS. We compared these with previously measured concentrations in erythrocytes, urine, and water. For a subset of children (n=19), we analyzed four consecutive 2 cm pieces of hair.

RESULTS

There were strong associations between hair As and the other biomarkers (erythrocytes: r_s=0.73, p<0.001; urine: r_S=0.66, p<0.001); and water (r_s=0.60, p<0.001); and there were significant correlations between Se in hair and erythrocytes (overall r_s=0.38, p<0.001), and urine (r_s=0.29, p<0.001). Hair Co and Mo showed weak correlations with concentrations in erythrocytes. Hair Mn was not associated with Mn in erythrocytes, urine, or water, and the geometric mean concentration increased almost five times from the 2 cm closest to the head to the 7th–8th cm (p<0.001). Also Mg, Ca, Co, Cd, and Pb increased from the scalp outward (>50% higher in 7th–8th cm compared with 1st–2nd cm, p<0.001).

CONCLUSIONS

Hair was found to be a useful exposure biomarker of absorbed As and Se only. Of all measured elements, hair Mn seemed the least reflective of internal dose. https://doi.org/10.1289/EHP1239.

Effects of manganese exposure on visuoperception and visual memory in schoolchildren

BACKGROUND

Manganese (Mn) is an essential metal involved in multiple physiological functions. Environmental exposure to airborne Mn is associated with neurocognitive deficits in humans. Children, whose nervous system is in development, are particularly susceptible to Mn neurotoxicity.

OBJECTIVE

The objective of this study was to assess the association between Mn environmental exposure, and effects on visuoperception and visual memory in schoolchildren.

METHODS

We assessed schoolchildren between 7 and 11 years old, with similar socioeconomic status, from the mining district of Molango (n=148) and Agua Blanca (n=119, non-mining area) in Hidalgo state, Mexico. The Rey-Osterrieth Complex Figure (ROCF) test was used to assess visuoperception and short-term visual memory. Hair manganese (MnH) concentrations were determined. Linear regression models were constructed to estimate the associations between MnH and ROCF scores, adjusted for potential confounders.

RESULTS

The geometric mean MnH was nine times higher in schoolchildren from the Mn mining area (5.25μg/g) than in schoolchildren from the non-mining area (0.55μg/g). For the ROCF Copy trial, MnH was significantly associated with an increase in distortion errors (tangency, closure), angle errors, overtracing (partial overtracing). In the Immediate Recall trial, MnH was significantly associated with increased overtracing (partial overtracing) and omissions, and negatively associated with the number of perceptual drawn units, total score and percentage immediate recall.

CONCLUSIONS

MnH is associated with alterations in visuoperception and short-term visual memory in schoolchildren exposed to airborne Mn.

Chronic Exposure to Arsenic in Drinking Water Causes Alterations in Locomotor Activity and Decreases Striatal mRNA for the D2 Dopamine Receptor in CD1 Male Mice

Arsenic exposure has been associated with sensory, motor, memory, and learning alterations in humans and alterations in locomotor activity, behavioral tasks, and neurotransmitters systems in rodents. In this study, CD1 mice were exposed to 0.5 or 5.0 mg As/L of drinking water for 6 months. Locomotor activity, aggression, interspecific behavior and physical appearance, monoamines levels, and expression of the messenger for dopamine receptors D1 and D2 were assessed. Arsenic exposure produced hypoactivity at six months and other behaviors such as rearing and on-wall rearing and barbering showed both increases and decreases. No alterations on aggressive behavior or monoamines levels in striatum or frontal cortex were observed. A significant decrease in the expression of mRNA for D2 receptors was found in striatum of mice exposed to 5.0 mg As/L. This study provides evidence for the use of dopamine receptor D2 as potential target of arsenic toxicity in the dopaminergic system.

Neurodevelopmental outcomes among 2- to 3-year-old children in Bangladesh with elevated blood lead and exposure to arsenic and manganese in drinking water

BACKGROUND

The people of Bangladesh are currently exposed to high concentrations of arsenic and manganese in drinking water, as well as elevated lead in many regions. The objective of this study was to investigate associations between environmental exposure to these contaminants and neurodevelopmental outcomes among Bangladeshi children.

METHODS

We evaluated data from 524 children, members of an ongoing prospective birth cohort established to study the effects of prenatal and early childhood arsenic exposure in the Sirajdikhan and Pabna Districts of Bangladesh. Water was collected from the family's primary drinking source during the first trimester of pregnancy and at ages 1, 12 and 20-40 months. At age 20-40 months, blood lead was measured and neurodevelopmental outcomes were assessed using a translated, culturally-adapted version of the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III).

RESULTS

Median blood lead concentrations were higher in Sirajdikhan than Pabna (7.6 vs. <LODμg/dL, p <0.0001) and water arsenic concentrations were lower (1.5 vs 25.7 μg/L, p <0.0001). Increased blood lead was associated with decreased cognitive scores in Sirajdikhan (β = -0.17, SE = 0.09, p = 0.05), whereas increased water arsenic was associated with decreased cognitive scores in Pabna (β = -0.06, SE = 0.03, p = 0.05). Water manganese was associated with fine motor scores in an inverse-U relationship in Pabna.

CONCLUSION

Where blood lead levels are high, lead is associated with decreased cognitive scores on the BSID-III, and effects of other metals are not detected. In the setting of lower lead levels, the adverse effects of arsenic and manganese on neurodevelopment are observed.

Neurological and neuropsychological functions in adults with a history of developmental arsenic poisoning from contaminated milk powder

During the summer of 1955, mass arsenic poisoning of bottle-fed infants occurred in the western part of Japan due to contaminated milk powder, and more than 100 died; some childhood victims were later found to suffer from neurological sequelae in adolescence. This unique incident enabled us to explore infancy as a critical period of arsenic exposure in regard to developmental neurotoxicity and its possible persistence through adulthood. The purpose of this work is to evaluate the association between developmental arsenic exposure and the neurological outcomes more than 50 years later. We conducted a retrospective cohort study during the period from April 2012 to February 2013 in two hospitals in Okayama Prefecture, Japan. The study sample consisted of 50 individuals: 27 known poisoning victims from Okayama Prefecture, and 23 non-exposed local controls of similar age. In addition to neurological examination, we adapted a battery of neurophysiological and neuropsychological tests to identify the types of brain functions affected by early-life arsenic exposure. While limited abnormalities were found in the neurophysiological tests, neuropsychological deficits were observed. Except for Finger tapping, all test scores in the exposed group--Vocabulary and Block Design from Wechsler Adults Intelligent Scale III, Design memory subtest from Wide Range Assessment of Memory and Learning 2, and Grooved pegboard test--were substantially below those obtained by the unexposed. The exposed group showed average performance at least 1.2 standard deviations below the average for the controls. Exposed participants performed less well than controls, even after exclusion of subjects with recognized disabilities or those with a high level of education. Adults who had suffered arsenic poisoning during infancy revealed neuropsychological dysfunctions, even among those subjects not recognized as having disabilities. Developmental neurotoxicity due to arsenic likely results in permanent changes in brain functions.

Low-level arsenic exposure and developmental neurotoxicity in children: A systematic review and risk assessment

Risk assessments of arsenic have focused on skin, bladder, and lung cancers and skin lesions as the sensitive cancer and non-cancer health endpoints, respectively; however, an increasing number of epidemiologic studies that can inform risk assessment have examined neurodevelopmental effects in children. We conducted a systematic review and risk assessment based on the epidemiologic literature on possible neurodevelopmental effects at lower arsenic exposures. Twenty-four cross-sectional, case-control, and cohort studies were identified that report on the association between low-level arsenic exposure (i.e., largely <100 μg/L of arsenic in drinking water) and neurological outcomes in children. Although the overall evidence does not consistently show a causal dose-response relationship at low doses, the most rigorously conducted studies from Bangladesh indicate possible inverse associations with cognitive function, predominantly involving concurrent arsenic exposure as measured by biomarkers (i.e., arsenic in urine or blood) and raw verbal test scores at ages 5-11 years. Issues such as non-comparability of outcome measures across studies; inaccuracies of biomarkers and other measures of inorganic arsenic exposure; potential effect modification by cultural practices; insufficient adjustment for nutritional deficiencies, maternal IQ, and other important confounders; and presence of other neurotoxicants in foreign populations limit generalizability to U.S.

POPULATIONS

Of the few U.S. studies available, the most rigorously conducted study did not find a consistent dose-response relationship between arsenic concentrations in tap water or toenails and decrements in IQ scores. Assuming that the strongest dose-response relationship from the most rigorous evidence from Bangladesh is generalizable to U.S. populations, possible reference doses were estimated in the range of 0.0004-0.001 mg/kg-day. These doses are higher than the U.S. Environmental Protection Agency reference dose for chronic lifetime exposure, thus indicating protectiveness of the existing value for potential neurotoxicity in children. This reference dose is undergoing revision as EPA considers various health endpoints in the reassessment of inorganic arsenic health risks.