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Halabicky OM, Pinto-Martin JA, Compton P, Liu J. Low level lead exposure in early childhood and parental education on adolescent IQ and working memory: a cohort study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:168-176. [PMID: 35750750 PMCID: PMC9789207 DOI: 10.1038/s41370-022-00450-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/21/2022] [Accepted: 05/31/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The independent effect of lead exposure and parental education on children's neurocognition is well-documented. However, few studies have examined the combined effect of childhood lead exposure and parental education on adolescent neurocognition, especially in China. OBJECTIVE Examine both the combined and interactive effect of childhood blood lead levels (BLLs) and parental education on early adolescent neurocognition. METHODS 417 children from a longitudinal cohort study in Jintan, China had BLLs measured at 3-5 years and 12 years, parental education levels assessed at 3-5 years, and neurocognitive outcomes tested at 12 years. RESULTS BLLs at 3-5 years were inversely associated with adolescent IQ (β -0.55 95% CI: -0.97, -0.13) but not working memory (β -0.06 95% CI: -0.23, 0.11) and parental education was positively associated with adolescent IQ (β 0.68 95% CI: 0.19, 1.17) and working memory (β 0.24 95% CI: 0.04, 0.44). BLLs and parental education evidenced combined effects on neurocognition, where children with higher BLLs and lower fathers' education had mean IQ scores 7.84 (95% CI: -13.15, -2.53) points lower than children with lower BLLs and higher fathers' education. There were significant associations between parental education and working memory, however, not with BLLs. The interaction between mother and father high school education and BLLs was insignificant for effects on IQ and working memory. SIGNIFICANCE Childhood lead exposure and parental education levels have a combined and long-term impact on IQ, evidence that may partially explain disparities in lead exposure associated outcomes and highlight those children at greatest risk for neurocognitive deficits. IMPACT STATEMENT Children continue to be exposed to low-levels of environmental lead in China and globally, warranting examination of the impact of such exposures. This paper demonstrates that even relatively low-level lead exposure in early childhood significantly influences adolescent neurocognitive functioning. Furthermore, co-existing social determinant of health-related variables, measured here as parental education, have a combined impact on neurocognition. These results highlight children at greater risk for neurocognitive deficits and demonstrate the need to examine the influence of lead exposure within the broader socio- ecological environment, as these factors work in tandem to influence longer-term neurocognitive outcomes.
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Affiliation(s)
- Olivia M Halabicky
- School of Nursing, University of Pennsylvania, 418 Curie Blvd. Claire M. Fagin Hall, Philadelphia, PA, USA
- School of Public, Health University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Jennifer A Pinto-Martin
- School of Nursing, University of Pennsylvania, 418 Curie Blvd. Claire M. Fagin Hall, Philadelphia, PA, USA
| | - Peggy Compton
- School of Nursing, University of Pennsylvania, 418 Curie Blvd. Claire M. Fagin Hall, Philadelphia, PA, USA
| | - Jianghong Liu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd. Claire M. Fagin Hall, Philadelphia, PA, USA.
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Ergen FB, Cosan DT, Kandemir T, Dag İ, Mutlu F, Cosan TE. An Enriched Environment Leads to Increased Synaptic Plasticity-Associated miRNA Levels after Experimental Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2021; 30:105766. [PMID: 33866227 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/26/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE In subarachnoid hemorrhage (SAH), impairments in motor and cognitive functions may occur and continue in later periods. MicroRNAs (miRNAs) are small non-coding RNAs that can directly or indirectly affect synaptic reconstruction. mir-132, mir-134, and mir-138 are the leading miRNAs that can be effective on some neurological functions through its effects on synaptic plasticity in the relevant brain areas. In our study, it was aimed to determine the levels of miRNAs in the hippocampus and frontal lobe of rats exposed to different environmental conditions after the experimental SAH. METHODS SAH was created using the cisterna magna double blood-injection method. Brain tissues were collected at different times after the last blood injection. Rats were grouped according to the different environmental conditions in which they were kept. Expression levels of miRNAs were performed by qPCR and ultrastructural changes in samples were determined by transmission electron microscopy (TEM). RESULTS After SAH, miR-132, miR-134, and miR-138 expressions in the frontal lobes of rats increased in impoverished environment on the 7th day and in the enriched environment on the 14th day. It was observed that the myelin and microtubule structures in the axons that were disrupted after SAH were more organized and stable in the enriched environment. CONCLUSIONS After SAH, different environmental conditions may affect the miRNA levels associated with synaptic plasticity and microtubule organization in the frontal lobe, and this might have some effects especially on cognitive and motor functions related to this brain area.
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Affiliation(s)
- Fulya Buge Ergen
- Department of Interdisciplinary Neuroscience, Health Science Institute, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Didem Turgut Cosan
- Department of Interdisciplinary Neuroscience, Health Science Institute, Eskisehir Osmangazi University, Eskisehir, Turkey; Department of Medical Biology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Turan Kandemir
- Department of Neurosurgery, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - İlknur Dag
- Central Research Laboratory Application and Research Center, Eskisehir Osmangazi University, Eskisehir, Turkey; Vocational Health Services High School, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Fezan Mutlu
- Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tevfik Erhan Cosan
- Department of Interdisciplinary Neuroscience, Health Science Institute, Eskisehir Osmangazi University, Eskisehir, Turkey; Department of Neurosurgery, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Dórea JG. Neurodevelopment and exposure to neurotoxic metal(loid)s in environments polluted by mining, metal scrapping and smelters, and e-waste recycling in low and middle-income countries. ENVIRONMENTAL RESEARCH 2021; 197:111124. [PMID: 33861977 DOI: 10.1016/j.envres.2021.111124] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
This review covers a wide body of literature to gain an understanding of the impacts of informal activities related to metal extraction (primary mining and recycling) on early life exposure to neurotoxicants and on neurodevelopment. In primary mining, gold extraction with Hg amalgamation is the main environmental cause of Hg pollution in most artisanal small-scale gold mining (ASGM) activities around the world. Nevertheless, in Sub-Saharan Africa (SSA), Pb disrupted from gold-related ores, mining, and artisanal cookware production are an important neurotoxicant that seriously contaminates the affected population, with devastating effects on children. In e-waste recycling settings, the range of neurotoxic substances that contaminate mothers and children is wider than in primary mining environments. Thus, Hg and Pb are major pre- and postnatal neurotoxicants affecting children in the informal metal extraction activities and SSA countries show the highest record of human contamination and of neurotoxic effects on children. There are additional sources of neurotoxic contamination from mining and metal processing activities (cyanide tailing in South America and SSA) and/or co-exposure to Hg-containing products such as cosmetics (soaps and Hg-based skin lightning creams in Africa) and pediatric Thimerosal-containing vaccines (TCVs, that breaks down to ethyl-mercury) in current use in middle and low income countries. However, the action of these neurotoxicants (per se or in combination) on children needs more attention and research. Studies show a negative association between biomarkers of all environmental metal(loid)s (As, Cd, Hg, Mn, and Pb) studied and neurodevelopment in young children. Sadly, in many unregulated activities, child labor is widely employed, thus presenting an additional occupational exposure. Children living in polluted environments related to metal processing are disproportionately exposed to a wide range of co-occurring neurotoxic substances. The review showed compelling evidence from highly representative parts of the world (Africa, Asia, and Latin America) that the studied neurotoxic substances negatively affected areas of the brain associated with language, memory and executive function, as well as psychosocial behavior. Protecting the environment and children from unregulated and highly polluting metal extraction and processing are inextricably intertwined and deserve urgent attention.
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Affiliation(s)
- José G Dórea
- Universidade de Brasília, Brasília, 70919-970, DF, Brazil.
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Cognitive Impairment Induced by Lead Exposure during Lifespan: Mechanisms of Lead Neurotoxicity. TOXICS 2021; 9:toxics9020023. [PMID: 33525464 PMCID: PMC7912619 DOI: 10.3390/toxics9020023] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
Lead (Pb) is considered a strong environmental toxin with human health repercussions. Due to its widespread use and the number of people potentially exposed to different sources of this heavy metal, Pb intoxication is recognized as a public health problem in many countries. Exposure to Pb can occur through ingestion, inhalation, dermal, and transplacental routes. The magnitude of its effects depends on several toxicity conditions: lead speciation, doses, time, and age of exposure, among others. It has been demonstrated that Pb exposure induces stronger effects during early life. The central nervous system is especially vulnerable to Pb toxicity; Pb exposure is linked to cognitive impairment, executive function alterations, abnormal social behavior, and fine motor control perturbations. This review aims to provide a general view of the cognitive consequences associated with Pb exposure during early life as well as during adulthood. Additionally, it describes the neurotoxic mechanisms associated with cognitive impairment induced by Pb, which include neurochemical, molecular, and morphological changes that jointly could have a synergic effect on the cognitive performance.
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(Ascorb)ing Pb Neurotoxicity in the Developing Brain. Antioxidants (Basel) 2020; 9:antiox9121311. [PMID: 33371438 PMCID: PMC7767447 DOI: 10.3390/antiox9121311] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/21/2022] Open
Abstract
Lead (Pb) neurotoxicity is a major concern, particularly in children. Developmental exposure to Pb can alter neurodevelopmental trajectory and has permanent neuropathological consequences, including an increased vulnerability to further stressors. Ascorbic acid is among most researched antioxidant nutrients and has a special role in maintaining redox homeostasis in physiological and physio-pathological brain states. Furthermore, because of its capacity to chelate metal ions, ascorbic acid may particularly serve as a potent therapeutic agent in Pb poisoning. The present review first discusses the major consequences of Pb exposure in children and then proceeds to present evidence from human and animal studies for ascorbic acid as an efficient ameliorative supplemental nutrient in Pb poisoning, with a particular focus on developmental Pb neurotoxicity. In doing so, it is hoped that there is a revitalization for further research on understanding the brain functions of this essential, safe, and readily available vitamin in physiological states, as well to justify and establish it as an effective neuroprotective and modulatory factor in the pathologies of the nervous system, including developmental neuropathologies.
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Frndak S, Barg G, Canfield RL, Quierolo EI, Mañay N, Kordas K. Latent subgroups of cognitive performance in lead- and manganese-exposed Uruguayan children: Examining behavioral signatures. Neurotoxicology 2019; 73:188-198. [PMID: 30978412 DOI: 10.1016/j.neuro.2019.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Lead (Pb) and manganese (Mn) are confirmed neurotoxins but it is unclear to what extent low-level exposure produces a unique behavioral signature. The objective of this study was to investigate latent cognitive profiles among children (6-8 years) from Montevideo, Uruguay co-exposed to these metals. METHOD Among 345 children, blood Pb and hair Mn were measured using atomic absorption spectroscopy and ICP-MS, respectively. Sixteen measures, reflecting multiple domains of cognitive functioning were gathered: (1) three tests from Cambridge Neuropsychological Test Automated Battery (CANTAB): Intra-Extra Dimensional Shift (IED), Spatial Span (SSP) and Stockings of Cambridge (SOC), (2) ten tasks from Woodcock-Muñoz Achievement Battery, Revised (WM): Visual-Motor Integration, Verbal Comprehension (Vocabulary, Synonyms, Antonyms, Analogies), Visual-Auditory Comprehension, Concept Formation, Visual Spatial Thinking, Number Inversion and Spatial Relations, (3) Bender Gestalt task, and (4) Weschler block design task. Scores were modeled using latent profile analysis (LPA). Association between blood Pb and hair Mn on performance profiles was assessed using ordinal regression, controlling for confounders. An interaction between Pb and Mn was tested. RESULTS Mean ± SD of blood Pb was 4.1 ± 2.1 μg/dL and 35% of children had blood Pb ≥ 5 μg/dL. Median [5%, 95%] hair Mn level was 0.8 [0.3, 4.1] ppb. Three latent cognitive performance profiles were identified: high (n = 46, 13%), average (n = 209, 61%) and low (n = 90, 26%). Each one-unit increase in blood Pb was associated with a 28% greater likelihood of belonging to a poorer-performing profile. The association was non-linear, with the effect of Pb on profile membership strongest at lower levels of exposure. There was no meaningful interaction between Pb and Mn. CONCLUSIONS A behavioral signature for low-level Pb & Mn exposure was not identified, but the likelihood of membership in low-performing profile was higher at lowest levels of blood Pb. There was no effect measure modification between Pb and Mn. Future research should address how complex environments created by chemical exposures and the social context relate to cognitive performance in young children.
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Affiliation(s)
- Seth Frndak
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, USA.
| | - Gabriel Barg
- Department of Neurocognition, Catholic University of Uruguay, Montevideo, Uruguay
| | | | - Elena I Quierolo
- Center for Research, Catholic University of Uruguay, Montevideo, Uruguay
| | - Nelly Mañay
- Faculty of Chemistry, University of the Republic of Uruguay, Montevideo, Uruguay
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, USA
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Jaffee SR. Lead exposure and child maltreatment as models for how to conceptualize early-in-life risk factors for violence. Infant Ment Health J 2019; 40:23-38. [DOI: 10.1002/imhj.21756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Schmidt CW. After the Screening: What Happens Next for Children with Elevated Blood Lead? ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:102001. [PMID: 29068317 PMCID: PMC5933304 DOI: 10.1289/ehp2482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 06/07/2023]
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Prenatal maternal stress in relation to the effects of prenatal lead exposure on toddler cognitive development. Neurotoxicology 2017; 59:71-78. [DOI: 10.1016/j.neuro.2017.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 12/21/2022]
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Campbell C, Greenberg R, Mankikar D, Ross RD. A Case Study of Environmental Injustice: The Failure in Flint. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E951. [PMID: 27690065 PMCID: PMC5086690 DOI: 10.3390/ijerph13100951] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
Abstract
The failure by the city of Flint, Michigan to properly treat its municipal water system after a change in the source of water, has resulted in elevated lead levels in the city's water and an increase in city children's blood lead levels. Lead exposure in young children can lead to decrements in intelligence, development, behavior, attention and other neurological functions. This lack of ability to provide safe drinking water represents a failure to protect the public's health at various governmental levels. This article describes how the tragedy happened, how low-income and minority populations are at particularly high risk for lead exposure and environmental injustice, and ways that we can move forward to prevent childhood lead exposure and lead poisoning, as well as prevent future Flint-like exposure events from occurring. Control of the manufacture and use of toxic chemicals to prevent adverse exposure to these substances is also discussed. Environmental injustice occurred throughout the Flint water contamination incident and there are lessons we can all learn from this debacle to move forward in promoting environmental justice.
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Affiliation(s)
- Carla Campbell
- Department of Public Health Sciences, Room 408, College of Health Sciences, University of Texas at El Paso, 500 W. University Ave, El Paso, TX 79968, USA.
| | - Rachael Greenberg
- National Nurse-led Care Consortium (NNCC), Philadelphia, PA 19102, USA.
| | - Deepa Mankikar
- Research and Evaluation Group, Public Health Management Corporation, Philadelphia, PA 19102, USA.
| | - Ronald D Ross
- Occupational and Environmental Medicine Consultant, Las Cruces, NM 88001, USA.
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Bellinger DC, Matthews-Bellinger JA, Kordas K. A developmental perspective on early-life exposure to neurotoxicants. ENVIRONMENT INTERNATIONAL 2016; 94:103-112. [PMID: 27235688 DOI: 10.1016/j.envint.2016.05.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/14/2016] [Accepted: 05/14/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND Studies of early-life neurotoxicant exposure have not been designed, analyzed, or interpreted in the context of a fully developmental perspective. OBJECTIVES The goal of this paper is to describe the key principles of a developmental perspective and to use examples from the literature to illustrate the relevance of these principles to early-life neurotoxicant exposures. METHODS Four principles are discussed: 1) the effects of early-life neurotoxicant exposure depend on a child's developmental context; 2) deficits caused by early-life exposure initiate developmental cascades that can lead to pathologies that differ from those observed initially; 3) early-life neurotoxicant exposure has intra-familial and intergenerational impacts; 4) the impacts of early-life neurotoxicant exposure influence a child's ability to respond to future insults. The first principle is supported by considerable evidence, but the other three have received much less attention. DISCUSSION Incorporating a developmental perspective in studies of early-life neurotoxicant exposures requires prospective collection of data on a larger array of covariates than usually considered, using analytical approaches that acknowledge the transactional processes between a child and the environment and the phenomenon of developmental cascades. CONCLUSION Consideration of early-life neurotoxicant exposure within a developmental perspective reveals that many issues remain to be explicated if we are to achieve a deep understanding of the societal health burden associated with early-life neurotoxicant exposures.
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Affiliation(s)
- David C Bellinger
- Department of Neurology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02112, USA; Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Julia A Matthews-Bellinger
- Department of Psychiatry, University of Massachusetts Medical School, Boston Psychoanalytic Society and Institute, 19 Fair Oaks Park, Needham, MA 02492, USA.
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, 270 Farber Hall, Buffalo, NY 14214, USA.
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Chan YH, Gao M, Wu W. Are newborn rat-derived neural stem cells more sensitive to lead neurotoxicity? Neural Regen Res 2013; 8:581-92. [PMID: 25206702 PMCID: PMC4145982 DOI: 10.3969/j.issn.1673-5374.2013.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 01/05/2013] [Indexed: 01/01/2023] Open
Abstract
Lead ion (Pb2+) has been proven to be a neurotoxin due to its neurotoxicity on mammalian nervous system, especially for the developing brains of juveniles. However, many reported studies involved the negative effects of Pb2+ on adult neural cells of humans or other mammals, only few of which have examined the effects of Pb2+ on neural stem cells. The purpose of this study was to reveal the biological effects of Pb2+ from lead acetate [Pb (CH3COO)2] on viability, proliferation and differentiation of neural stem cells derived from the hippocampus of newborn rats aged 7 days and adult rats aged 90 days, respectively. This study was carried out in three parts. In the first part, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay (MTT viability assay) was used to detect the effects of Pb2+ on the cell viability of passage 2 hippocampal neural stem cells after 48-hour exposure to 0–200 μM Pb2+. In the second part, 10 μM bromodeoxyuridine was added into the culture medium of passage 2 hippocampal neural stem cells after 48-hour exposure to 0–200 μM Pb2+, followed by immunocytochemical staining with anti-bromodeoxyuridine to demonstrate the effects of Pb2+ on cell proliferation. In the last part, passage 2 hippocampal neural stem cells were allowed to grow in the differentiation medium with 0–200 μM Pb2+. Immunocytochemical staining with anti-microtubule-associated protein 2 (a neuron marker), anti-glial fibrillary acidic protein (an astrocyte marker), and anti-RIP (an oligodendrocyte marker) was performed to detect the differentiation commitment of affected neural stem cells after 6 days. The data showed that Pb2+ inhibited not only the viability and proliferation of rat hippocampal neural stem cells, but also their neuronal and oligodendrocyte differentiation in vitro. Moreover, increased activity of astrocyte differentiation of hippocampal neural stem cells from both newborn and adult rats was observed after exposure to high concentration of lead ion in vitro. These findings suggest that hippocampal neural stem cells of newborn rats were more sensitive than those from adult rats to Pb2+ cytotoxicity.
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Affiliation(s)
- Yan Ho Chan
- Department of Anatomy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Mingyong Gao
- Department of Anatomy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR, China ; Department of Spine Surgery, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei Province, China
| | - Wutian Wu
- Department of Anatomy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong SAR, China ; State Key Laboratory of Brain and Cognitive Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China ; Research Center of Reproduction, Development and Growth, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China ; GHM Institute of Central Nervous System Regeneration, Jinan University, Guangzhou 510630, Guangdong Province, China
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