Application of pharmacokinetic data to the risk assessment of inhaled manganese

Manganese Encephalopathy Caused by Homemade Methcathinone (Ephedrone) Prevalence in Poland

Manganese encephalopathy is a known disorder in occupational medicine. A serious phenomenon has been the emergence of manganese encephalopathy in intravenous users of homemade methcathinone (ephedrone). A short survey was developed for clinical environments dealing with people who use psychoactive substances. The data were obtained from 72 rehabilitation therapy centers. Surveys carried out in about a third of Polish centers dealing with providing medical assistance to people addicted to substances other than alcohol and tobacco have shown that over 4% of people treated there had symptoms of manganese encephalopathy, of which more than half are people in whom the probability of a clinical diagnosis of this disorder is significant. It has been shown that knowledge of manganese encephalopathy is none or minimal in more than 70% of the surveyed institutions. An urgent need for personnel training in this field was pointed out. Attention was paid to the importance of disseminating good review articles on new and dynamically developing problem phenomena.

Evaluate the adverse impact of metal oxide on workers of different age groups that engage with gas metal arc welding process: health risk assessment

Immense epidemiological studies have been indicated about adverse effects of the welding fumes on the health of the welders, especially respiratory problems and other physiological disorders. The different types of welding mechanisms produce aerosols/fumes that contain different metals including chromium (Cr) and manganese (Mn). In the present study, the welders of two age groups (adolescents and adults) were selected; simultaneously the age-matched adolescents and adults belong to nonindustrial area as referents/control subjects. Biological samples (scalp hair) were collected from welders and referents, along with analyzed for Cr and Mn by electrothermal atomic absorption spectrometer, prior to acid digestion. To evaluate the occupational exposure on the health of the workers, the clinical features and biochemical parameters of selected population (exposed and non-exposed age-matched groups) were also carried out. The resulted data indicated that the concentrations of Mn and Cr were significantly higher in scalp hair samples of welders as compared to referent subjects (p < 0.01), verifying the absorption/exposure of both metals produced in welding fumes. The high prevalence of anemia and stomach disorder was observed in adolescent than adult welding workers. The incidence of asthma and related symptoms was elevated in adult welders than in younger boys. The neurological problems were particularly observed in aged welders > 50 years, might be due to long time exposure of welding fumes contains different toxicant especially Mn in ill ventilation system of workshops.

The effects of manganese overexposure on brain health

Manganese (Mn) is the twelfth most abundant element on the earth and an essential metal to human health. Mn is present at low concentrations in a variety of dietary sources, which provides adequate Mn content to sustain support various physiological processes in the human body. However, with the rise of Mn utility in a variety of industries, there is an increased risk of overexposure to this transition metal, which can have neurotoxic consequences. This risk includes occupational exposure of Mn to workers as well as overall increased Mn pollution affecting the general public. Here, we review exposure due to air pollution and inhalation in industrial settings; we also delve into the toxic effects of manganese on the brain such as oxidative stress, inflammatory response and transporter dysregulation. Additionally, we summarize current understandings underlying the mechanisms of Mn toxicity.

Chemical and Colloidal Dynamics of MnO2 Nanosheets in Biological Media Relevant for Nanosafety Assessment

Many layered crystal phases can be exfoliated or assembled into ultrathin 2D nanosheets with novel properties not achievable by particulate or fibrous nanoforms. Among these 2D materials are manganese dioxide (MnO2 ) nanosheets, which have applications in batteries, catalysts, and biomedical probes. A novel feature of MnO2 is its sensitivity to chemical reduction leading to dissolution and Mn2+ release. Biodissolution is critical for nanosafety assessment of 2D materials, but the timing and location of MnO2 biodissolution in environmental or occupational exposure scenarios are poorly understood. This work investigates the chemical and colloidal dynamics of MnO2 nanosheets in biological media for environmental and human health risk assessment. MnO2 nanosheets are insoluble in most aqueous phases, but react with strong and weak reducing agents in biological fluid environments. In vitro, reductive dissolution can be slow enough in cell culture media for MnO2 internalization by cells in the form of intact nanosheets, which localize in vacuoles, react to deplete intracellular glutathione, and induce cytotoxicity that is likely mediated by intracellular Mn2+ release. The results are used to classify MnO2 nanosheets within a new hazard screening framework for 2D materials, and the implications of MnO2 transformations for nanotoxicity testing and nanosafety assessment are discussed.

Elemental analysis in living human subjects using biomedical devices

Today, patients undergoing dialysis are at low risk for aluminum-induced dementia. Workers are unlikely to experience cadmium-induced emphysema and the public's exposure to lead is an order of magnitude lower than in 1970. The research field of in vivo elemental analysis has played a role in these occupational and environmental health improvements by allowing the effects of people's chronic exposure to elements to be studied using non-invasive, painless, and relatively low-cost technology. From the early 1960s to the present day, researchers have developed radiation-based systems to measure the elemental content of organs at risk or storage organs. This reduces the need for (sometimes painful) biopsy and the risk of infection. Research and development has been undertaken on forty-nine in vivo measurement system designs. Twenty-nine different in vivo elemental analysis systems, measuring 22 different elements, have been successfully taken from design and testing through to human measurement. The majority of these systems employ either neutron activation analysis or x-ray fluorescence analysis as the basis of the measurement. In this review, we discuss eight of the successful systems, explaining the rationale behind their development, the methodology, the health data that has resulted from application of these tools, and provide our opinion on potential future technical developments of these systems. We close by discussing four technologies that may lead to new directions and advances in the whole field.

Methylcyclopentadienyl manganese tricarbonyl increases cell vulnerability to oxidative stress on rat thymocytes

Methylcyclopentadienyl manganese tricarbonyl (MMT) is used as a gasoline antiknock additive. However, the toxic effect of MMT is currently not well understood. In this study, we investigated the toxic effect of MMT on rat thymocytes using a flow cytometer and fluorescent probes. MMT at 100-300 µM significantly increased the population of cells exhibiting propidium fluorescence, i.e., the population of dead cells. The intensity of BES-So-AM fluorescence significantly increased when using 100 µM MMT. In addition, the intensity of oxonol fluorescence in rat thymocytes increased with the treatment with MMT in a concentration-dependent manner (10-100 µM). The toxic effect of MMT was inhibited by quercetin, antioxidant flavonoid. Moreover, co-treatment with 30-100 µM MMT and 100 µM H₂O₂ increased the cell lethality further. These results indicate that MMT increases cell vulnerability to oxidative stress on rat thymocytes. This study provides insight into the toxic effect of MMT on the immune system.

para-Aminosalicylic acid in the treatment of manganese toxicity. Complexation of Mn2+ with 4-amino-2-hydroxybenzoic acid and its N-acetylated metabolite

Manganese excess can induce in humans neurological disorders known as manganism.

Estimation of students' exposure to metal concentrations from river-dust episodes during 1994-2012

Two elementary schools (Shiuguang and Fongrong) from Yulin County in Taiwan, near a main area of potential exposure to Aeolian river-dust, were selected to collect outdoor and indoor PM₁₀ aerosols and to measure five metals in PM₁₀ (As, Ni, Cr, Cd, and Mn). Significant relationships (p < 0.01) were found between outdoor PM₁₀ concentrations at Lunbei's air quality monitoring station and the two elementary schools. The outdoor PM₁₀ concentrations at the monitoring station and the schools' indoor PM₁₀ concentrations also showed significant correlations. This study also established a relationship between the outdoor and indoor concentrations of PM₁₀ and metals in the schools. Estimations were made regarding students' 8 h of exposure to metal concentrations from river-dust episodes during 1994-2012, based on correlation equations that were shown to be statistically significant.

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.

Associations among environmental exposure to manganese, neuropsychological performance, oxidative damage and kidney biomarkers in children

Environmental exposure to manganese (Mn) results in several toxic effects, mainly neurotoxicity. This study investigated associations among Mn exposure, neuropsychological performance, biomarkers of oxidative damage and early kidney dysfunction in children aged 6-12 years old. Sixty-three children were enrolled in this study, being 43 from a rural area and 20 from an urban area. Manganese was quantified in blood (B-Mn), hair (H-Mn) and drinking water using inductively coupled plasma mass spectrometry (ICP-MS). The neuropsychological functions assessed were attention, perception, working memory, phonological awareness and executive functions - inhibition. The Intelligence quotient (IQ) was also evaluated. The biomarkers malondialdehyde (MDA), protein carbonyls (PCO), δ-aminolevulinate dehydratase (ALA-D), reactivation indexes with dithiothreitol (ALA-RE/DTT) and ZnCl2 (ALA-RE/ZnCl2), non-protein thiol groups, as well as microalbuminuria (mALB) level and N-acetyl-β-D-glucosaminidase (NAG) activity were assessed. The results demonstrated that Mn levels in blood, hair and drinking water were higher in rural children than in urban children (p<0.01). Adjusted for potential confounding factors, IQ, age, gender and parents' education, significant associations were observed mainly between B-Mn and visual attention (β=0.649; p<0.001). Moreover, B-Mn was negatively associated with visual perception and phonological awareness. H-Mn was inversely associated with working memory, and Mn levels from drinking water with written language and executive functions - inhibition. Rural children showed a significant increase in oxidative damage to proteins and lipids, as well as alteration in kidney function biomarkers (p<0.05). Moreover, significant associations were found between B-Mn, H-Mn and Mn levels in drinking water and biomarkers of oxidative damage and kidney function, besides between some oxidative stress biomarkers and neuropsychological tasks (p<0.05). The findings of this study suggest an important association between environmental exposure to Mn and toxic effects on neuropsychological function, oxidative damage and kidney function in children.

Manganese Is Essential for Neuronal Health

The understanding of manganese (Mn) biology, in particular its cellular regulation and role in neurological disease, is an area of expanding interest. Mn is an essential micronutrient that is required for the activity of a diverse set of enzymatic proteins (e.g., arginase and glutamine synthase). Although necessary for life, Mn is toxic in excess. Thus, maintaining appropriate levels of intracellular Mn is critical. Unlike other essential metals, cell-level homeostatic mechanisms of Mn have not been identified. In this review, we discuss common forms of Mn exposure, absorption, and transport via regulated uptake/exchange at the gut and blood-brain barrier and via biliary excretion. We present the current understanding of cellular uptake and efflux as well as subcellular storage and transport of Mn. In addition, we highlight the Mn-dependent and Mn-responsive pathways implicated in the growing evidence of its role in Parkinson's disease and Huntington's disease. We conclude with suggestions for future focuses of Mn health-related research.

Cognitive deficits and ALA-D-inhibition in children exposed to multiple metals

Children are especially vulnerable to adverse effects of multiple metals exposure. The aim of this study was to assess some metals concentrations such as lead (Pb), arsenic (As), chromium (Cr), manganese (Mn) and iron (Fe) in whole blood, serum, hair and drinking water samples using inductively coupled plasma-mass spectrometry (ICP-MS) in rural and urban children. In addition, evaluate the adverse effects of multiple metals exposure on cognitive function and δ-aminolevulinate dehydratase (ALA-D) activity. The cognitive ability assessment was performed by the Raven's Colored Progressive Matrices (RCPM) test. The ALA-D activity and ALA-D reactivation index (ALA-RE) activity with DTT and ZnCl2 also were determined. Forty-six rural children and 23 urban children were enrolled in this study. Rural children showed percentile IQ scores in the RCPM test significantly decreased in relation to urban children. According to multiple linear regression analysis, the Mn and Fe in hair may account for the cognitive deficits of children. Manganese and Fe in hair also were positively correlated with Mn and Fe in drinking water, respectively. These results suggest that drinking water is possibly a source of metals exposure in children. ALA-D activity was decreased and ALA-RE with DTT and ZnCl2 was increased in rural children in comparison to urban children. Moreover, ALA-D inhibition was correlated with Cr blood levels and ALA-RE/DDT and ALA-RE/ZnCl2 were correlated with levels of Cr and Hg in blood. Thus, our results indicated some adverse effects of children's exposure to multiple metals, such as cognitive deficits and ALA-D inhibition, mainly associated to Mn, Fe, Cr and Hg.

Association of hair manganese level with symptoms in attention-deficit/hyperactivity disorder

OBJECTIVE

The study examined the association between hair manganese level and symptoms of attention-deficit/hyperactivity disorder (ADHD) in Korean children.

METHODS

Forty clinic-referred children with ADHD and 43 normal control children participated in this study. The participants were 6-15 years old and were mainly from the urban area of Seoul, Korea. ADHD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition and Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version. The severity and symptoms of ADHD was evaluated according to the ADHD Diagnostic System, and parent's Korean ADHD Rating Scale (K-ARS). All participants completed intelligence test and hair mineral analysis. We divided the data of hair Mn into two groups to determine whether a deficit or excess of Mn are associated with ADHD. Multiple logistic regression analyses were performed to identify hair manganese levels associated with ADHD, controlling for age, sex, and full scale intelligence quotient (IQ).

RESULTS

The proportion of abnormal range Mn group was significantly high in ADHD compared to controls. However, after statistical control for covariates including age and sex, abnormal range Mn group was significantly associated with ADHD (OR=6.40, 95% CI=1.39-29.41, p=0.017).

CONCLUSION

The result of this study suggests that excess exposure or deficiency of Mn were associated with ADHD among children in Korea. Further investigation is needed to evaluate the effects of hair manganese levels on symptoms in ADHD.

Biopersistence of silver nanoparticles in tissues from Sprague-Dawley rats

Silver nanoparticles are known to be distributed in many tissues after oral or inhalation exposure. Thus, understanding the tissue clearance of such distributed nanoparticles is very important to understand the behavior of silver nanoparticles in vivo. For risk assessment purposes, easy clearance indicates a lower overall cumulative toxicity. Accordingly, to investigate the clearance of tissue silver concentrations following oral silver nanoparticle exposure, Sprague–Dawley rats were assigned to 3 groups: control, low dose (100 mg/kg body weight), and high dose (500 mg/kg body weight), and exposed to two different sizes of silver nanoparticles (average diameter 10 and 25 nm) over 28 days. Thereafter, the rats were allowed to recover for 4 months. Regardless of the silver nanoparticle size, the silver content in most tissues gradually decreased during the 4-month recovery period, indicating tissue clearance of the accumulated silver. The exceptions were the silver concentrations in the brain and testes, which did not clear well, even after the 4-month recovery period, indicating an obstruction in transporting the accumulated silver out of these tissues. Therefore, the results showed that the size of the silver nanoparticles did not affect their tissue distribution. Furthermore, biological barriers, such as the blood–brain barrier and blood-testis barrier, seemed to play an important role in the silver clearance from these tissues.

Update on a Pharmacokinetic-Centric Alternative Tier II Program for MMT-Part II: Physiologically Based Pharmacokinetic Modeling and Manganese Risk Assessment

Recently, a variety of physiologically based pharmacokinetic (PBPK) models have been developed for the essential element manganese. This paper reviews the development of PBPK models (e.g., adult, pregnant, lactating, and neonatal rats, nonhuman primates, and adult, pregnant, lactating, and neonatal humans) and relevant risk assessment applications. Each PBPK model incorporates critical features including dose-dependent saturable tissue capacities and asymmetrical diffusional flux of manganese into brain and other tissues. Varied influx and efflux diffusion rate and binding constants for different brain regions account for the differential increases in regional brain manganese concentrations observed experimentally. We also present novel PBPK simulations to predict manganese tissue concentrations in fetal, neonatal, pregnant, or aged individuals, as well as individuals with liver disease or chronic manganese inhalation. The results of these simulations could help guide risk assessors in the application of uncertainty factors as they establish exposure guidelines for the general public or workers.

Blood manganese levels in patients with hepatic encephalopathy

PROJECT

Hepatic encephalopathy is an increasingly common disease. Identification of prognosis risk factors in patients with liver damage may lead to preventive actions, towards decreasing its mortality. Manganese (Mn) levels are increased in basal ganglia of patients with hepatic encephalopathy as well as in cases of cirrhotic and liver failure patients. The present is a clinical, prospective, prolective and observational study developed at the Internal Medicine Service from "Dr. Darío Fernández Fierro" General Hospital, ISSSTE, Mexico City. The objective of this work was to report whole blood Mn levels and mortality in encephalopathic patients.

PROCEDURE

Consecutive patients over 18 years of age, diagnosed with hepatic encephalopathy were recruited at the emergency room service. An informed consent, signed by their families was collected. Patients' clinical characteristics, biochemical tests of renal function, hemoglobin, glucose, bilirubins and albumin levels were obtained along with a blood sample to analyze Mn. Patients evolution was followed up for 6 months.

RESULTS

Blood Mn in patients [median, (range)] [20.5, (10.5-39.5) μg/L] were higher than blood levels from a group of healthy volunteers [7.5, (6.1-12.8) μg/L] (P<0.001). Among 9 patients studied four died, 2 women and 2 men, those patients showed higher (P=0.032) Mn levels [28, (17-39.5) μg/L] than those alive [13.5, (10.5-32) μg/L] after the follow up period.

CONCLUSIONS

In this pilot study, Mn blood levels were higher in hepatic encephalopathy that died as consequence of the disease that those that survived in a 6 month follow up period. Blood Mn could be a potential prognosis factor for death in patients with hepatic encephalopathy.

Protective effects of antioxidants and anti-inflammatory agents against manganese-induced oxidative damage and neuronal injury

Exposure to excessive manganese (Mn) levels leads to neurotoxicity, referred to as manganism, which resembles Parkinson's disease (PD). Manganism is caused by neuronal injury in both cortical and subcortical regions, particularly in the basal ganglia. The basis for the selective neurotoxicity of Mn is not yet fully understood. However, several studies suggest that oxidative damage and inflammatory processes play prominent roles in the degeneration of dopamine-containing neurons. In the present study, we assessed the effects of Mn on reactive oxygen species (ROS) formation, changes in high-energy phosphates and associated neuronal dysfunctions both in vitro and in vivo. Results from our in vitro study showed a significant (p<0.01) increase in biomarkers of oxidative damage, F(2)-isoprostanes (F(2)-IsoPs), as well as the depletion of ATP in primary rat cortical neurons following exposure to Mn (500 μM) for 2h. These effects were protected when neurons were pretreated for 30 min with 100 of an antioxidant, the hydrophilic vitamin E analog, trolox (6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid), or an anti-inflammatory agent, indomethacin. Results from our in vivo study confirmed a significant increase in F(2)-IsoPs levels in conjunction with the progressive spine degeneration and dendritic damage of the striatal medium spiny neurons (MSNs) of mice exposed to Mn (100mg/kg, s.c.) 24h. Additionally, pretreatment with vitamin E (100mg/kg, i.p.) or ibuprofen (140 μg/ml in the drinking water for two weeks) attenuated the Mn-induced increase in cerebral F(2)-IsoPs? and protected the MSNs from dendritic atrophy and dendritic spine loss. Our findings suggest that the mediation of oxidative stress/mitochondrial dysfunction and the control of alterations in biomarkers of oxidative injury, neuroinflammation and synaptodendritic degeneration may provide an effective, multi-pronged therapeutic strategy for protecting dysfunctional dopaminergic transmission and slowing of the progression of Mn-induced neurodegenerative processes.

Prolactin is a peripheral marker of manganese neurotoxicity

Excessive exposure to Mn induces neurotoxicity, referred to as manganism. Exposure assessment relies on Mn blood and urine analyses, both of which show poor correlation to exposure. Accordingly, there is a critical need for better surrogate biomarkers of Mn exposure. The aim of this study was to examine the relationship between Mn exposure and early indicators of neurotoxicity, with particular emphasis on peripheral biomarkers. Male Wistar rats (180-200g) were injected intraperitoneally with 4 or 8 doses of Mn (10mg/kg). Mn exposure was evaluated by analysis of Mn levels in brain and blood along with biochemical end-points (see below).

RESULTS

Brain Mn levels were significantly increased both after 4 and 8 doses of Mn compared with controls (p<0.001). Blood levels failed to reflect a dose-dependent increase in brain Mn, with only the 8-dose-treated group showing significant differences (p<0.001). Brain glutathione (GSH) levels were significantly decreased in the 8-dose-treated animals (p<0.001). A significant and dose-dependent increase in prolactin levels was found for both treated groups (p<0.001) compared to controls. In addition, a decrease in motor activity was observed in the 8-dose-treated group compared to controls.

CONCLUSIONS

(1) The present study demonstrates that peripheral blood level is a poor indicator of Mn brain accumulation and exposure; (2) Mn reduces GSH brain levels, likely reflecting oxidative stress; (3) Mn increases blood prolactin levels, indicating changes in the integrity of the dopaminergic system. Taken together these results suggest that peripheral prolactin levels may serve as reliable predictive biomarkers of Mn neurotoxicity.

Neuropsychological effects of low-level manganese exposure in welders

While the neuropsychological effects of high manganese (Mn) exposure in occupational settings are well known, the effects of lower levels of exposure are less understood. In this study, we investigated the neuropsychological effects of lower level occupational Mn exposure in 46 male welders (mean age=37.4, S.D.=11.7 years). Each welders' cumulative Mn exposure indices (Mn-CEI) for the past 12 months and total work history Mn exposure were constructed based on air Mn measurements and work histories. The association between these exposure indices and performance on cognitive, motor control, and psychological tests was examined. In addition, among a subset of welders (n=24) who completed the tests both before and after a work shift, we examined the association between cross-shift Mn exposure assessed from personal monitoring and acute changes in test scores. Mn exposures in this study (median=12.9 μg/m³) were much lower, as compared to those observed in other similar studies. Increasing total Mn-CEI was significantly associated with slower reaction time on the continuous performance test (CPT; p<0.01), as well as worse mood for several scales on the Profile of Mood States (POMS; confused, tired, and a composite of tired and energetic, all p ≤ 0.03). Increasing Mn-CEI over the previous 12 months was significantly associated with worse mood on the sad, tense, and confused POMS scales (all p ≤ 0.03) and the association with worse CPT performance approached significance (p=0.10). Higher Mn exposure over the course of a workday was associated with worse performance on the CPT test across the day (p=0.06) as well as declines in fine motor control over the work-shift (p=0.04), adjusting for age and time between the 2 tests. Our study suggests that even at relatively low Mn exposure levels neuropsychological effects may manifest particularly with respect to attention, mood, and fine motor control.

Manganese inhalation as a Parkinson disease model

The present study examines the effects of divalent and trivalent Manganese (Mn²⁺/Mn³⁺) mixture inhalation on mice to obtain a novel animal model of Parkinson disease (PD) inducing bilateral and progressive dopaminergic cell death, correlate those alterations with motor disturbances, and determine whether L-DOPA treatment improves the behavior, to ensure that the alterations are of dopaminergic origin. CD-1 male mice inhaled a mixture of Manganese chloride and Manganese acetate, one hour twice a week for five months. Before Mn exposure, animals were trained to perform motor function tests and were evaluated each week after the exposure. By the end of Mn exposure, 10 mice were orally treated with 7.5 mg/kg L-DOPA. After 5 months of Mn mixture inhalation, striatal dopamine content decreased 71%, the SNc showed important reduction in the number of TH-immunopositive neurons, mice developed akinesia, postural instability, and action tremor; these motor alterations were reverted with L-DOPA treatment. Our data provide evidence that Mn²⁺/Mn³⁺ mixture inhalation produces similar morphological, neurochemical, and behavioral alterations to those observed in PD providing a useful experimental model for the study of this neurodegenerative disease.

Intellectual function in Mexican children living in a mining area and environmentally exposed to manganese

BACKGROUND

Excessive exposure to manganese (Mn), an essential trace element, has been shown to be neurotoxic, especially when inhaled. Few studies have examined potential effects of Mn on cognitive functions of environmentally exposed children.

OBJECTIVE

This study was intended to estimate environmental exposure to Mn resulting from mining and processing and to explore its association with intellectual function of school-age children.

METHODS

Children between 7 and 11 years of age from the Molango mining district in central Mexico (n = 79) and communities with similar socioeconomic conditions that were outside the mining district (n = 93) participated in the cross-sectional evaluation. The revised version of the Wechsler Intelligence Scale for Children adapted for the Mexican population was applied. Concentrations of Mn in blood (MnB) and hair (MnH) were used as biomarkers of exposure.

RESULTS

Exposed children had significantly higher median values for MnH (12.6 μg/g) and MnB (9.5 μg/L) than did nonexposed children (0.6 μg/g and 8.0 μg/L, respectively). MnH was inversely associated with Verbal IQ [β = -0.29; 95% confidence interval (CI), -0.51 to -0.08], Performance IQ (β = -0.08; 95% CI, -0.32 to 0.16), and Total Scale IQ (β = -0.20; 95% CI, -0.42 to 0.02). MnB was inversely but nonsignificantly associated with Total and Verbal IQ score. Age and sex significantly modified associations of MnH, with the strongest inverse associations in young girls and little evidence of associations in boys at any age. Associations with MnB did not appear to be modified by sex but appeared to be limited to younger study participants.

CONCLUSIONS

The findings from this study suggest that airborne Mn environmental exposure is inversely associated with intellectual function in young school-age children.

Risk assessment of an essential element: manganese

Manganese (Mn) is an essential element for humans, animals, and plants and is required for growth, development, and maintenance of health. Mn is present in most tissues of all living organisms and is present naturally in rocks, soil, water, and food. High-dose oral, parenteral, or inhalation exposures are associated with increased tissue Mn levels that may lead to development of adverse neurological, reproductive, or respiratory effects. Manganese-induced clinical neurotoxicity is associated with a motor dysfunction syndrome commonly referred to as manganism. Because Mn is an essential element and absorption and excretion are homeostatically regulated, a reasonable hypothesis is that there should be no adverse effects at low exposures. Therefore, there should be a threshold for exposure, below which adverse effects may occur only rarely, if at all, and the frequency of occurrence of adverse effects may increase with higher exposures above that threshold. Lowest-observed-adverse-effect levels (LOAELs), no-observed-adverse-effect levels (NOAELs), and benchmark dose levels (BMDs) have been derived from studies that were conducted to evaluate subclinical neurotoxicity in human occupational cohorts exposed to Mn. Although there is some uncertainty about the predictive value of the subclinical neuromotor or neurobehavioral effects that were observed in these occupational cohort studies, results of the neurological tests were used in risk assessments to establish guidelines and regulations for ambient air levels of Mn in the environment. A discussion of the uncertainties associated with these tests is provided in this review. The application of safety and uncertainty factors result in guidelines for ambient air levels that are lower than the LOAELs, NOAELs, or BMDs from occupational exposure studies by an order of magnitude, or more. Specific early biomarkers of effect, such as subclinical neurobehavioral or neurological changes or magnetic resonance imaging (MRI) changes, have not been established or validated for Mn, although some studies attempted to correlate certain biomarkers with neurological effects. Pharmacokinetic studies with rodents and monkeys provide valuable information about the absorption, bioavailability, and tissue distribution of various Mn compounds with different solubilities and oxidation states in different age groups. These pharmacokinetic studies showed that rodents and primates maintain stable tissue Mn levels as a result of homeostatic mechanisms that tightly regulate absorption and excretion of ingested Mn and limit tissue uptake at low to moderate levels of inhalation exposure. In addition, physiologically based pharmacokinetic (PBPK) models are being developed to provide for the ability to conduct route-to-route extrapolations, evaluate nasal uptake to the central nervous system (CNS), and determine life-stage differences in Mn pharmacokinetics. Such models will facilitate more rigorous quantitative analysis of the available human pharmacokinetic data for Mn and will be used to identify situations that may lead to increased brain accumulation related to altered Mn kinetics in different human populations, and to develop quantitatively accurate predictions of elevated Mn levels that may serve as a basis of dosimetry-based risk assessments. Such dosimetry-based risk assessments will permit for the development of more scientifically refined and robust recommendations, guidelines, and regulations for Mn levels in the ambient environment and occupational settings.

Essentiality, toxicity, and uncertainty in the risk assessment of manganese

Risk assessments of manganese by inhalation or oral routes of exposure typically acknowledge the duality of manganese as an essential element at low doses and a toxic metal at high doses. Previously, however, risk assessors were unable to describe manganese pharmacokinetics quantitatively across dose levels and routes of exposure, to account for mass balance, and to incorporate this information into a quantitative risk assessment. In addition, the prior risk assessment of inhaled manganese conducted by the U.S. Environmental Protection Agency (EPA) identified a number of specific factors that contributed to uncertainty in the risk assessment. In response to a petition regarding the use of a fuel additive containing manganese, methylcyclopentadienyl manganese tricarbonyl (MMT), the U.S. EPA developed a test rule under the U.S. Clean Air Act that required, among other things, the generation of pharmacokinetic information. This information was intended not only to aid in the design of health outcome studies, but also to help address uncertainties in the risk assessment of manganese. To date, the work conducted in response to the test rule has yielded substantial pharmacokinetic data. This information will enable the generation of physiologically based pharmacokinetic (PBPK) models capable of making quantitative predictions of tissue manganese concentrations following inhalation and oral exposure, across dose levels, and accounting for factors such as duration of exposure, different species of manganese, and changes of age, gender, and reproductive status. The work accomplished in response to the test rule, in combination with other scientific evidence, will enable future manganese risk assessments to consider tissue dosimetry more comprehensively than was previously possible.

Multi-dose-route, multi-species pharmacokinetic models for manganese and their use in risk assessment

Manganese (Mn) is an essential element that may be toxic in conditions of overexposure. Nearly 10 years ago, some of the authors of this article published a proposed methodology to perform a tissue-dose-based risk assessment and a detailed list of data needs necessary to perform the assessment. Since that time, a substantial body of Mn pharmacokinetic (PK) data has been generated in rats and nonhuman primates, allowing for the construction of physiologically based pharmacokinetic (PBPK) models for Mn. This study reviews the development of the Mn PBPK models, reassesses the previously identified data needs, and details potential uses of these models in risk assessment of Mn. Based upon numerous animal experiments, pharmacokinetic (PK) models have effectively simulated tissue kinetics of Mn from both inhaled and oral Mn intake. PK models achieve this by incorporating homeostatic control processes, saturable tissue binding capacities, and preferential fluxes in various tissue regions. While minor data gaps still exist, the models captured the main dose-dependent characteristics of Mn disposition in rodents and monkeys and provide a structure to parameterize an equivalent PK description in humans. These models are organized to contribute to a tissue-dose based risk assessment of Mn that simultaneously considers ingestion and inhalation kinetics of Mn along with homeostatic control of Mn.

Cognitive impairment in an adult Mexican population non-occupationally exposed to manganese

We examined the association between non-occupational exposure to Mn and cognitive functions. The study was carried out in a mining district located in Hidalgo State, Mexico, with 288 adults. Air and blood Mn concentrations were determined, and neuropsychological tests were administered to explore cognitive functions and depression. Blood Mn mean was 9.5 ± 4.14 μg/L. A total of 73% of the study group were in contact with air Mn levels that surpassed the EPA recommended guideline level for non-occupational environments (0.05 μg/m(3)). Air Mn concentration was associated as a risk factor for attention impairment (OR=1.75, 95% CI: 1.01-3.06). Blood Mn levels were not associated to any of the measured outcomes. The main finding of this study is the presence of attention impairments associated to high levels of air Mn exposure. These results confirm previous studies, in which cognitive impairment is reported for exposed population.

Proposal for a revised Reference Concentration (RfC) for manganese based on recent epidemiological studies

In 1993, based on observations of subclinical neurological effects in workers, the United States Environmental Protection Agency (US EPA) published a Reference Concentration (RfC) of 0.05 microg/m(3) for manganese (Mn). The geometric mean exposure concentration, 150 microg/m(3) respirable Mn, was considered the lowest observable adverse effect level (LOAEL), and uncertainty factors (UFs) were applied to account for sensitive populations, database limitations, a LOAEL, subchronic exposure, and potential differences in toxicity of different forms of Mn. Based on a review of more recent literature, we propose two alternate Mn RfCs. Of 12 more recent occupational studies of eight cohorts with chronic exposure durations, examining subclinical neurobehavioral effects, predominantly on the motor system, three were considered appropriate for development of an RfC. All three studies yielded no observable adverse effect levels (NOAELs) of approximately 60 microg/m(3) respirable Mn. Converting the occupational NOAEL to a human equivalent concentration (HEC) of 21microg/m(3) (for continuous exposure) and applying a UF of 10 to account for intraspecies variability yielded an RfC of 2microg/m(3). We also derived a similar RfC (7 microg/m(3)) using an Mn benchmark dose (BMD) as the point of departure. Overall confidence in both RfCs is medium.

Oxidative damage and neurodegeneration in manganese-induced neurotoxicity

Exposure to excessive manganese (Mn) levels results in neurotoxicity to the extrapyramidal system and the development of Parkinson's disease (PD)-like movement disorder, referred to as manganism. Although the mechanisms by which Mn induces neuronal damage are not well defined, its neurotoxicity appears to be regulated by a number of factors, including oxidative injury, mitochondrial dysfunction and neuroinflammation. To investigate the mechanisms underlying Mn neurotoxicity, we studied the effects of Mn on reactive oxygen species (ROS) formation, changes in high-energy phosphates (HEP), neuroinflammation mediators and associated neuronal dysfunctions both in vitro and in vivo. Primary cortical neuronal cultures showed concentration-dependent alterations in biomarkers of oxidative damage, F2-isoprostanes (F2-IsoPs) and mitochondrial dysfunction (ATP), as early as 2 h following Mn exposure. Treatment of neurons with 500 microM Mn also resulted in time-dependent increases in the levels of the inflammatory biomarker, prostaglandin E2 (PGE2). In vivo analyses corroborated these findings, establishing that either a single or three (100 mg/kg, s.c.) Mn injections (days 1, 4 and 7) induced significant increases in F2-IsoPs and PGE2 in adult mouse brain 24 h following the last injection. Quantitative morphometric analyses of Golgi-impregnated striatal sections from mice exposed to single or three Mn injections revealed progressive spine degeneration and dendritic damage of medium spiny neurons (MSNs). These findings suggest that oxidative stress, mitochondrial dysfunction and neuroinflammation are underlying mechanisms in Mn-induced neurodegeneration.

Recovery from welding-fume-exposure-induced MRI T1 signal intensities after cessation of welding-fume exposure in brains of cynomolgus monkeys

The shortening of the MRI T1 relaxation time, indicative of a high signal intensity in a T1-weighted MRI, is known as a useful biomarker for Mn exposure after short-term welding-fume exposure. A previous monkey experimental study found that the T1 relaxation times decreased time-dependently after exposure, and a visually detectable high signal intensity appeared after 150 days of exposure. The nadir for the shortening of the T1 relaxation time was also previously found to correspond well with the blood Mn concentration in welders, suggesting a correlation between a prolonged high blood Mn concentration and shortened T1 relaxation time. Accordingly, to clarify the clearance of the brain Mn concentration after the cessation of welding-fume exposure, cynomolgus monkeys were assigned to 3 groups-unexposed, low dose (31 mg/m(3) total suspended particulate (TSP), 0.9 mg Mn/m(3)), and high dose (62 mg/m(3) TSP, 1.95 mg Mn/m(3))-and exposed to manual metal-arc stainless steel (MMA-SS) welding fumes for 2 h per day for 8 mo in an inhalation chamber system equipped with an automatic fume generator. After reaching the peak MRI T1 signal intensity (shortest T1 relaxation time), the monkeys were allowed to recover by ceasing the welding-fume exposure. Within 2 mo, the MRI T1 signal intensities for the exposed monkeys returned to nearly the same level as those for the unexposed monkeys, indicating the potential for recovery from a high MRI T1 signal intensity induced by welding-fume exposure, even after prolonged exposure. Clearance of the Mn tissue concentration was also demonstrated in the globus pallidus, plus other tissues from the brain, liver, spleen, and blood. In contrast, there was no clearance of the lung concentrations of Mn, indicating that a soluble form of Mn was transported to the blood and brain. Therefore, the solubility of Mn in welding fumes would appear to be an important determinant as regards the retention of blood Mn levels and brain tissue Mn concentrations in welders.

JEM spotlight: metal speciation related to neurotoxicity in humans

Improved living conditions have led to a steady increase in the life expectancy of humans in most countries. However, this is accompanied by an increased probability of suffering from neurodegenerative diseases like Alzheimer's disease or Parkinson's disease. Unfortunately, the therapeutic possibilities for curing these diseases are very limited up to now. Many studies indicate that a variety of environmental factors contribute to the initiation and promotion of neurodegenerative diseases. For example, the role of metal exposure and disturbance of metal homeostasis in the brain is discussed in this respect. However, most studies focus on the neurological and toxicological aspects but not on a detailed characterisation of the species of the involved metals. Therefore, this review summarizes the neurotoxic effects of selected metals on humans and focuses on contributions from trace element speciation analysis with relevance to neuroscientific research. In spite of the advance in instrumentation and methodology of speciation analysis there are few applications for matrices like cerebrospinal fluid which is due to limited access to these samples and analytical challenges caused by matrix interferences, low concentrations and limited stability of many trace element species of interest. The most relevant neurotoxic metals aluminium, lead, manganese and mercury are reviewed in detail while further metals like cadmium, arsenic, bismuth and tin are briefly discussed. Current results indicate that knowledge on trace element speciation can contribute to a better understanding of the transport of metals across the neural barriers and potentially of their role in diseased human brains.

Prolonged manganese exposure induces severe deficits in lifespan, development and reproduction possibly by altering oxidative stress response in Caenorhabditis elegans

We examined the possible multiple defects induced by acute and prolonged exposure to high levels of manganese (Mn) solution by monitoring the endpoints of lifespan, development, reproduction, and stress response. Our data suggest that acute exposure (6 h) to Mn did not cause severe defects of life span, development, and reproduction, similarly, no significant defect could be found in animals exposed to a low concentration of Mn (2.5 micromol/L) for 48 h. In contrast, prolonged exposure (48 h) to high Mn concentrations (75 and 200 micromol/L) resulted in significant defects of life span, development, and reproduction, as well as the increase of the percentage of population with hsp-16.2::gfp expression indicating the obvious induction of stress responses in exposed animals. Moreover, prolonged exposure (48 h) to high concentrations (75 and 200 micromol/L) of Mn decreased the expression levels of antioxidant genes of sod-1, sod-2, sod-3, and sod-4 compared to control. Therefore, prolonged exposure to high concentrations of Mn will induce the severe defects of life span, development, and reproduction in nematodes possibly by affecting the stress response and expression of antioxidant genes in Caenorhabditis elegans.

Effect of chronic low level manganese exposure on postural balance: a pilot study of residents in southern Ohio

OBJECTIVE

The objective of this study was to determine the effect of non-occupational exposure to manganese (Mn) on postural balance.

METHODS

Residents living near a ferromanganese refinery provided hair and blood samples after postural balance testing. The relationship between hair Mn and postural balance was analyzed with logistic regression. Following covariate adjustment, postural balance was compared with control data by analysis of covariance.

RESULTS

Mean hair Mn was 4.4 microg/g. A significantly positive association was found between hair Mn and sway area (eyes open on the platform, P = 0.05; eyes closed on the platform, P = 0.04) and sway length (eyes open on the platform, P = 0.05; eyes closed on the platform, P = 0.04). Postural balance of residents was significantly larger than controls in 5 out of 8 postural balance outcomes.

CONCLUSION

Preliminary findings suggest subclinical impairment in postural balance among residents chronically exposed to ambient Mn. A prospective study with a larger sample size is warranted.

The neurotoxic effects of manganese on the dopaminergic innervation of the gill of the bivalve mollusc, Crassostrea virginica

We examined effects of manganese on the nervous system and innervation of lateral cilia of Crassostrea virginica. While essential in trace amounts, tissue manganese accumulation is neurotoxic, inducing Manganism, a Parkinson's-like disease in humans. Lateral cilia of the gill of C. virginica are controlled by a reciprocal serotonergic-dopaminergic innervation from their ganglia. Oysters were incubated 3 days in the presence of up to 1 mM manganese, followed by superfusion of the cerebral ganglia, visceral ganglia or gill with dopamine or serotonin. Beating rates of cilia were measured by stroboscopic microscopy of isolated gill preparations or gill preparations with the ipsilateral cerebral and/or visceral ganglia attached. Acute manganese treatments impaired the dopaminergic, cilio-inhibitory system, while having no effect on the serotonergic, cilio-excitatory system, which is in agreement with the proposed mechanism of manganese toxicity in humans. Manganese treatments also decreased endogenous dopamine levels in the cerebral and visceral ganglia, and gills, but not serotonin levels. We demonstrated that manganese disrupts the animal's dopaminergic system, and also that this preparation can be used to investigate mechanisms that underlie manganese neurotoxicity. It also may serve as a model in pharmacological studies of drugs to treat or prevent Manganism and other dopaminergic cell disorders.

Pharmacokinetic modeling of manganese in the rat IV: Assessing factors that contribute to brain accumulation during inhalation exposure

A recently published physiologically based pharmacokinetic (PBPK) model successfully accounted for steady-state tissue manganese (Mn) concentration seen with normal dietary intakes and for biphasic, whole-body time-course profiles observed with tracer (54Mn) dosing. In this present study, PBPK modeling was used to evaluate Mn kinetics and brain concentrations in rats exposed to Mn both in their diet and by inhalation. Three published studies were used: (1) rats fed on diets ranging from 2 to 100 ppm, (2) rats on 125 ppm in diet and exposed via inhalation at 0.0 to 3.00 mg Mn/m3 each day for 14 d, and (3) rats to 0.1 or 0.5 mg Mn/m3 for 6 h/d, 5 d/wk over a 90-d period. The original model structure with well-mixed and "deep" compartments for each tissue could not describe rapid increases in tissue concentrations and rapid declines seen in high concentration inhalation studies. A second structure was developed that included (1) saturable, high-affinity binding of Mn in all tissues and (2) asymmetric diffusion from blood into brain (i.e., transport into and out of specific brain regions such as the striatum was described with different diffusion constants). This second model was consistent with liver and striatum experimental data. Preferential increases in some brain regions were predicted for exposures above 0.2 mg/m3 and had a rapid (i.e., 1 or 2 wk) return to steady-state levels. Multi-dose-route PBPK models for Mn based on this alternative model structure can be readily scaled to evaluate tissue Mn kinetics in other species and for human populations. Once validated across test animals, these PBPK models will be useful in tissue-dose based risk assessment with manganese.

Time to re-evaluate the guideline value for manganese in drinking water?

OBJECTIVE

We reviewed the scientific background for the current health-based World Health Organization (WHO) guideline value for manganese in drinking water.

DATA SOURCES AND EXTRACTION

The initial starting point was the background document for the development of the WHO's guideline value for manganese in drinking water as well as other regulations and recommendations on manganese intake levels. Data referred to in these documents were traced back to the original research papers. In addition, we searched for scientific reports on manganese exposure and health effects.

DATA SYNTHESIS

The current health-based guideline value for manganese in drinking water is based partly on debatable assumptions, where information from previous reports has been used without revisiting original scientific articles. Presently, preparation of common infant formulas with water containing manganese concentrations equivalent to the WHO guideline value will result in exceeding the maximum manganese concentration for infant formula. However, there are uncertainties about how this maximum value was derived. Concurrently, there is increasing evidence of negative neurologic effects in children from excessive manganese exposure.

CONCLUSIONS

The increasing number of studies reporting associations between neurologic symptoms and manganese exposure in infants and children, in combination with the questionable scientific background data used in setting the manganese guideline value for drinking water, certainly warrant a re-evaluation of the guideline value. Further research is needed to understand the causal relationship between manganese exposure and children's health, and to enable an improved risk assessment.

Mitochondrial-mediated apoptosis in neural stem cells exposed to manganese

Manganese is an essential nutrient for humans that has to be maintained at proper levels for normal brain functioning. However, manganese also acts as a toxicant to the brain, and several studies have linked exposure to excessive manganese to neurotoxicity in adults. A recent report has suggested that ingesting high doses of manganese via drinking water can impede intellectual functions in children. It is known that during development, the nervous system is particularly vulnerable to different types of injuries and toxicants. Neural stem cells (NSCs) play an essential role in both the developing nervous system and the adult brain where the capacity for self-renewal may be important. In the present study, we have used NSCs to investigate the molecular mechanisms involved in manganese developmental neurotoxicity. The results show that primary cultures of rat embryonic cortical NSCs as well as the murine-derived multipotent NSC line C17.2 undergo apoptotic cell death via a mitochondrial-mediated pathway in response to manganese. Exposed cells exhibit typical apoptotic features, such as chromatin condensation and cell shrinkage, mitochondrial cytochrome c release, activation of caspase-3, and caspase-specific cleavage of the endogenous substrate poly (ADP-ribose) polymerase. In addition, our data also show that reactive oxygen species formation plays a role in the onset of manganese toxicity in NSCs.

Speciation and toxicological relevance of manganese in humans

Although manganese is an essential trace element, concerns are rising about the Mn exposure of humans being related to neurotoxic effects. This review summarizes several aspects of this topic to provide updated information on Mn related investigations, including chemical speciation of Mn-compounds. The paper starts with some chemical aspects of Mn and its compounds, enlightening oxidation states in general and in biological matrices. This is followed by considerations on natural sources of human exposure, on occupational sources and on anthropogenically caused environmental sources, for example from the use of methylcyclopentadienyl manganese tricarbonyl (MMT). Next, the paper deals with Mn levels in the human organism, showing normal Mn concentrations in various tissues or body fluids, and continues with the toxicology of Mn, i.e. absorption, distribution and excretion. Of specific concern is the transfer of Mn to the brain which is the relevant neurotoxic target. In this context, parallels and differences between primary and Mn-dependent Parkinsonism are discussed, concluding with a risk assessment and a consideration of susceptible groups. The main part of this review focuses on recent investigations on Mn speciation. Analytical problems and their solutions are also described for correct identification of relevant Mn-compounds in matrices of human origin. Finally, future needs are discussed, such as further investigations on those Mn-species which may overcome neural barrier control, on disease-modulated barrier control, on susceptibility to certain Mn-species, and on the interaction of Mn with Fe-homeostasis in the brain.