Status of children's blood lead levels in Pakistan: implications for research and policy

Lead acetate induces hippocampal pyramidal neuron degeneration in mice via up-regulation of executioner caspase-3, oxido-inflammatory stress expression and decreased BDNF and cholinergic activity: Reversal effects of Gingko biloba supplement

PURPOSE

It has been hypothesized that compounds with strong anti-oxidant activity might mitigate lead-induced neurotoxicity that resulted to neuronal degeneration.Ginkgo biloba supplement (GB-S) is a neuroactive supplement which has been reported to demonstrate neuroprotective effects. In this study, we investigated the reversal effect and the underlying mechanism of GB-S following lead-induced neurotoxicity in mice.

METHODS

Male Swiss mice (n = 8) were pre-treated with lead acetate (100 mg/kg) for 30 min before GB-S (10 mg/kg and 20 mg/kg) or Ethylenediaminetetraacetic acid (EDTA) (50 mg/kg) intraperitoneally for 14 consecutive days. Memory impairment symptoms were evaluated on day 13 and 14 using Y-maze and Novel object recognition test (NORT) respectively. Thereafter, spectrophotometry, ELISA, immunohistochemistry and histomorphormetry were used to estimate the degree and expression of biomarkers of neuronal inflammation: oxido-inflammatory stress, apoptosis and degeneration in the hippocampus (HC).

RESULTS

Lead acetate treatment significantly (p < 0.05) induced neurobehavioral impairment which was reversed by GB-S as evident in increased percentage alternation and discrimination index. GB-S significantly (p < 0.05) reduced lipid peroxidation and nitrite level, inhibited TNF-α and acetylcholinesterase activity and improved glutathione, catalase and superoxide dismutase activity in the HC. Moreover, GB-S inhibited hippocampal apoptosis via elevated expression of caspase-3 with marked increase level of brain derived neurotrophic factor (BDNF). Also, the histomorphormetric study showed that GB-S rescued death of pyramidal neurons (CA3) in the HC.

CONCLUSION

Our findings however suggest that GB-S decreased memory impairment progression induced by lead acetate via mechanisms connected to inhibition of oxido-inflammatory stress mediators, restrained acetylcholinesterase activity, up-regulated BDNF/Caspase-3 expression and suppression of hippocampal pyramidal neuron degeneration in mice.

Concentrations of Lead, Mercury, Arsenic, Cadmium, Manganese, and Aluminum in the Blood of Pakistani Children with and without Autism Spectrum Disorder and Their Associated Factors

BACKGROUND

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with early onset in utero or childhood. Environmental exposure to six metals (Pb, Hg, As, Cd, Mn, Al) is believed to be associated with ASD directly or interactively with genes. Objective: To assess the association of ASD among Pakistani children with the six metals and genotype frequencies of three GST genes (GSTP1, GSTM1, GSTT1).

METHODS

We enrolled 30 ASD cases, age 2-12 years old, and 30 age- and sex-matched typically developing (TD) controls in Karachi, Pakistan. We assessed associations of ASD status with various factors using Conditional Logistic Regression models. We also used General Linear Models to assess possible interaction of blood Mn and Pb concentrations with the three GST genes in relation to ASD status.

RESULTS

The unadjusted difference between ASD and TD groups in terms of geometric mean blood Pb concentrations was marginally significant (p = 0.05), but for Al concentrations, the adjusted difference was marginally significant (p = 0.06).

CONCLUSIONS

This is the first study reporting six blood metal concentrations of Pakistani children with ASD. Estimates provided for possible interactions of GST genes with Mn and Pb in relation to ASD status are valuable for designing future similar studies.

Contribution of house dust contamination towards lead exposure among children in Karachi, Pakistan

Lead exposure is associated with impaired neurodevelopment among children. House dust is recognized as one of the important secondary sources of lead exposure in children. We assessed the relationship between lead contamination in house dust and blood lead level in Pakistani children. We investigated lead contamination in house dust samples collected from 59 houses in Karachi, Pakistan. The lead content of house dust in Pakistan was relatively higher than that reported in previous studies. Weekly lead intakes from house dust were considerably higher among Pakistani children. In Pakistani children, 12% (7 of 58) showed lead intake values greater than the previous Provisional Tolerable Weekly Intake of lead. A correlation (Pearson's correlation = 0.37) was found between weekly lead intake from house dust and blood lead level in Pakistani children. In addition, blood lead levels were significantly higher in children with high lead intakes than in children with low and medium lead intakes. Thus, house dust is an important source of lead exposure in Pakistani children.

Evaluation of inorganic contaminants emitted from automobiles and dynamics in soil, dust, and vegetations from major highways in Pakistan

The deposition of toxic metals in the ecosystem contributes to the exposure and bioaccumulation of metals in the food chain, thus affecting human health. This study aimed to access the distribution of metal pollution emitted from automobiles in the dust, soil, and plant samples collected from the roadsides of national highways. Furthermore, metals were also determined in fuels and vehicular emissions. High contents of Pb, Cd, Cr, Cu, Fe, Mn, and Zn were found in roadsides as compared to control (35 km away from roads). The comparison among plants indicated that Calotropis procera and Rumex dentatus contained significantly higher metals than other plants. The concentrations of Pb, Cd, Cr, and Fe in plants were above the safe limits of the WHO/FAO. Significant and positive correlations were found between Cr, Cu, Fe, Pb, and Zn in the dust and soil samples and Cd and Cr in dust and plants. According to the results of the PCA analysis, all metals formed the first two components explaining 89.5% of the total variance. The source of these metals was attributed to automobile exhaust and dust depositions. The findings of the present study suggest that roadside plants are heavily infested with heavy metals due to vehicular smoke pollution, so the consumption of vegetation facing vehicular pollution may lead to certain physiological disorders and diseases. Graphical abstract.

Assessment of lead exposure among automobile technicians in Khyber Pakhtunkhwa, Pakistan

Exposure to Pb among automobile technicians in selected towns of Khyber Pakhtunkhwa Province, Pakistan, was studied using a questionnaire, biological sampling (blood, hair, nails), and analysis of Pb biomonitoring data across various subgroups of occupation, age, and years of exposure. The study population included exposed automobile technicians (n=50) and a control group (n=50). The automobile technicians were further stratified into 4 groups: mechanics, auto-body technicians, electricians, and painters. Mean Pb levels in biological samples of the automobile technicians were significantly higher than in the control group (P<0.01). The Pb concentrations (mean±standard deviation) in whole blood, hair, and nails of automobile technicians were 65.3±41.9μgdL^-1, 23.6±11.2mgkg^-1 and 29.7±14.5mgkg^-1, respectively, whereas concentrations in the control group were 21.7±17.6μgdL^-1, 4.8±3.4mgkg^-1 and 7.2±3.9mgkg^-1. Fifty two percent of the automobile technicians had blood levels >50μgdL^-1, but only 14% of the control group exceeded this level. Considering that Pb blood levels of 50μgdL^-1 exceed maximum concentrations recommended by leading public health organizations, appropriate measures should be taken to protect the welfare of the exposed automobile technicians and their families.

Lead Exposure and Associated Risk Factors among New Migrant Children Arriving in Greece

Background: This study aims to assess lead exposure and associated risk factors among newly arrived migrant (M) (immigrant and refugees) children in Greece and a matched control of native (N) children. Methods: A prospective, cross-sectional study was performed in an outpatient clinic of a tertiary children’s hospital. Results: From 2010 to 2014, 598 children (M/N: 349/249) with a mean age of 6.96 years old (range 1–14, SD 3.76) were enrolled. Blood lead levels (BLLs) ranged from 0.7 to 21 μg/dL in migrant and from 0.4 to 10 μg/dL in native Greek children. Elevated BLLs ≥ 5 μg/dL were detected in 27.7% of migrants and 1.2% of natives (p < 0.001). A significant association was found between EBLLs and childrens’ age (≤5 years) (OR: 1.8, p-value 0.02) and EBLLs with Asian origin (OR: 3.63, p-value 0.023). Conclusion: New migrant children presented with increased BLLs when compared to their age- and sex-matched controls. Younger age and Asian origin were significant risk factors associated with elevated BLLs among children. Early screening, secondary prevention, and regular follow-up could prove useful in this vulnerable population.

LncRNA Uc.173 is a key molecule for the regulation of lead-induced renal tubular epithelial cell apoptosis

Transcribed ultra-conserved region (T-UCR) transcripts are a novel class of long non-coding RNAs (lncRNAs) transcribed from ultra-conserved region which is highly conserved in human, rat, and mouse genome. LncRNA UC.173 has been found significantly down-regulated in lead-exposed population and lead-exposed animal mode, and had an inhibitory effect on lead-induced nerve cell apoptosis. We supposed that lncRNA UC.173 had an inhibitory effect on lead-induced renal tubular epithelial cell apoptosis. Thus, the aim of our study was to explore the function of lncRNA UC.173 in lead-exposed renal tubular epithelial cells. In our results, lead exposure inhibited renal tubular epithelial cells viability and promoted cell apoptosis and apoptosis-associated genes expression, but no effect on cell-cycle distribution. Lead exposure inhibited the expression of lncRNA UC.173 in renal tubular epithelial cells, and the inhibition effect was time-dependent and concentration-dependent. Up-regulation of lncRNA UC.173 had no effect on renal tubular epithelial cell viability, cell cycle and apoptosis, but significantly rescued lead-induced inhibition of renal tubular epithelial cell viability and suppressed lead-induced cell apoptosis. In summary, our experiments suggest that lncRNA UC.173 is certainly involved in the regulation of lead-induced renal tubular epithelial cell apoptosis, which may supply a new strategy to minimize lead-induced nephrotoxicity.

Lead Exposure Assessment among Pregnant Women, Newborns, and Children: Case Study from Karachi, Pakistan

Lead (Pb) in petrol has been banned in developed countries. Despite the control of Pb in petrol since 2001, high levels were reported in the blood of pregnant women and children in Pakistan. However, the identification of sources of Pb has been elusive due to its pervasiveness. In this study, we assessed the lead intake of pregnant women and one- to three-year-old children from food, water, house dust, respirable dust, and soil. In addition, we completed the fingerprinting of the Pb isotopic ratios (LIR) of petrol and secondary sources (food, house-dust, respirable dust, soil, surma (eye cosmetics)) of exposure within the blood of pregnant women, newborns, and children. Eight families, with high (~50 μg/dL), medium (~20 μg/dL), and low blood levels (~10 μg/dL), were selected from 60 families. The main sources of exposure to lead for children were food and house-dust, and those for pregnant women were soil, respirable dust, and food. LIR was determined by inductively coupled plasma quadrupole mass spectrometry (ICP-QMS) with a two sigma uncertainty of ±0.03%. The LIR of mothers and newborns was similar. In contrast, surma, and to a larger extent petrol, exhibited a negligible contribution to both the child’s and mother’s blood Pb. Household wet-mopping could be effective in reducing Pb exposure. This intake assessment could be replicated for other developing countries to identify sources of lead and the burden of lead exposure in the population.

Epidemiologic Characteristics of Children with Blood Lead Levels ≥45 μg/dL

OBJECTIVES

To identify risk factors and describe outcomes for children newly identified with blood lead levels (BLLs) ≥45 µg/dL in New York City (NYC) during 2004-2010 to promote timely identification as well as inform clinical practice and public health policy.

STUDY DESIGN

Inclusion criteria were residence in NYC and an elevated confirmatory venous test within 2 weeks of the initial BLL ≥45 µg/dL. Data collected during case coordination of these children were linked with blood testing data and home inspection reports. Children with BLLs ≥45 µg/dL also were compared with the general population of children younger than 18 years of age in NYC.

RESULTS

A total of 145 children <18 years of age were newly identified with BLLs ≥45 µg/dL. The mean age was 3.83 years, and the median time for BLL to decline below 10 µg/dL was 3.26 years. Major reported risk factors were eating paint (36%), spending time outside the US (34%), having a developmental delay (27%), using imported products (26%), being foreign born (14%), being of Pakistani descent (12%), eating soil (5%), and having sickle cell disease (4%). Compared with the age-standardized NYC population, cases were more likely to be Asian or black and live in housing built before 1940.

CONCLUSIONS

Although the incidence of lead poisoning has declined in the US, severe cases still occur. Physicians should be especially vigilant in certain at-risk populations including children who eat paint chips or soil, spend time outside the US (particularly in Pakistan), use imported products, or have developmental delays or sickle cell disease.

External lead contamination of women's nails by surma in Pakistan: Is the biomarker reliable?

Adverse health effects of heavy metals are a public health concern, especially lead may cause negative health impacts to human fetal and infantile development. The lead concentrations in Pakistani pregnant women's nails, used as a biomarker, were measured to estimate the lead exposure. Thirteen nail samples out of 84 nails analyzed contained lead higher than the concentration (13.6 μg/g) of the fatal lead poisoning case, raising the possibility of an external contamination. Eye cosmetics such as surma are recognized as one of the important sources of lead exposure in Pakistan. We collected in Pakistan 30 eye cosmetics made in Pakistan, Saudi Arabia and western countries. As the metal composition analysis by energy dispersive X-ray fluorescence spectrometry revealed that some surma samples contained lead more than 96%, the surma might contaminate the nail specimen. Scanning electron microscopy observations showed that lead-containing surma consists of fine particle of galena (ore of lead sulfide) in respirable dust range (less than 10 μm). In addition, relative in vitro bioavailability of lead in the surma was determined as 5.2%. Thus, lead-containing surma consists of inhalable and bioavailable particles, and it contributes an increased risk of lead exposure. Moreover, the relationship between the surma and the lead-contaminated nails by lead isotope ratios analysis indicated the potential of lead contamination in nails by surma. These results suggest that lead in the nails was derived both from body burden of lead and external contamination by lead-containing surma. Therefore, nail is not suited as a biomarker for lead exposure in the countries where surma used, because we may overestimate lead exposure by surface lead contamination in the nail by surma.

Identifying the Gaps in Practice for Combating Lead in Drinking Water in Hong Kong

Excessive lead has been found in drinking water in Hong Kong in tests carried out in 2015. Investigations have identified that the problem in public rental housing estates was caused by the problematic solders used in the plumbing, and recommendations on enhancing the quality control system and strengthening the relevant water quality standards have been proposed. The cause for the same problem happening in other premises where soldering has not been adopted for water pipe connections is left unidentified. Considering the unidentified cause and the recommendations made, this study aims to identify the gaps in practice followed in Hong Kong for safeguarding the water quality of new installations. A holistic review of governing ordinances and regulations, products and materials used and the testing and commissioning requirements adopted in Hong Kong and elsewhere in the world were conducted. Based on international practices and parametric analysis, it was found that there are gaps in practices followed in Hong Kong, which are directly and indirectly leading to the lead-in-water crisis. Recommendations for improvement in the quality control system, and the water quality standards including the allowable lead content and leaching limit for products and materials and the testing and commissioning requirements on plumbing installations have been made. The review and the identified gaps would become useful reference for countries in strengthening their relevant water quality standards.

Exposure assessment of lead from food and airborne dusts and biomonitoring in pregnant mothers, their fetus and siblings in Karachi, Pakistan and Shimotsuke, Japan

AIM

Exposure assessment of lead (Pb) and Arsenic (As) from food, water, and house dust intake were assessed among pregnant women, their children and fetuses in Pakistan and Japan, as well as their body burden of the metals in their blood.

METHOD

Fifty families which included a pregnant woman, a fetus and the 1-3-year-old siblings were recruited in Karachi and Khairpur in Pakistan, and Shimotsuke and Asahikawa in Japan, respectively. Their dietary exposure to Pb and As was measured in 3-day food duplicates and drinking water by ICP-MP. Pb in house dust and respirable dust was evaluated with an energy dispersive X-ray fluorescence spectrometry. Non-radioactive isotope Pb profiles of blood specimens will be compared with those of the exposure origins, such as food duplicates, respirable house dust, the soils nearby, and gasoline.

RESULTS

Judging from the data collected and analyzed so far, contribution from dietary intake is highly correlated to higher body burden of Pb among Pakistani mothers. Additional data analyses will reveal the status of Pb and As body burden in Pakistani mothers, fetuses and their siblings, and causal sources of high body burden is delineated by Pb isotope profile analysis of different sources of Pb exposure.

Redistribution of subcellular calcium and its effect on apoptosis in primary cultures of rat proximal tubular cells exposed to lead

Previous studies have shown that cytosolic Ca(2+) ([Ca(2+)]c) overload was involved in Pb-induced apoptosis in primary cultures of rat proximal tubular (rPT) cells, but the source of elevated Ca(2+) and the effect of potential subcellular Ca(2+) redistribution on apoptosis are still unknown. In this study, variations of [Ca(2+)]c in two culture media (Ca(2+)-containing and Ca(2+)- free) were analyzed, indicating that Pb-induced elevation of [Ca(2+)]c was primarily generated intracellularly. Fluo-4-AM, dihydro-Rhod-2-AM and Mag-Fluo-4-AM was loaded to Pb-exposed rPT cells to monitor the imaging of Ca(2+) concentrations in the cytoplasm ([Ca(2+)]c), mitochondria ([Ca(2+)]mit) and endoplasmic reticulum (ER) ([Ca(2+)]ER), respectively, under the confocal microscope. Data indicate that elevations of [Ca(2+)]c and [Ca(2+)]mit with depletion of [Ca(2+)]ER were revealed in Pb-treated rPT cells, but this subcellular Ca(2+) redistribution could be significantly suppressed by 2-APB, a specific inhibitor of inositol 1,4,5-trisphosphate receptor (IP3R) that functions to release Ca(2+) from ER stores. Simultaneously, Pb-mediated mitochondrial Ca(2+) overload can be partially suppressed by the cytosolic Ca(2+) chelator BAPTA-AM, suggesting that Ca(2+) uptake into mitochondria occurs via diverse pathways and ER Ca(2+) storage was the chief source. Furthermore, Pb-induced apoptosis was markedly inhibited by 2-APB and BAPTA-AM, respectively. Additionally, elevated IP3 levels with up-regulated IP3R-1 and IP3R-2 (mRNA and protein) levels were revealed in Pb-exposed rPT cells. In summary, IP3R-mediated ER Ca(2+) release promoted the elevations of [Ca(2+)]c and [Ca(2+)]mit in Pb-exposed rPT cells, which played a chief role in apoptosis induced by impaired calcium homeostasis.

Determination of lead, cations, and anions concentration in indoor and outdoor air at the primary schools in Kuala Lumpur

This study was carried out to determine the concentration of lead (Pb), anions, and cations at six primary schools located around Kuala Lumpur. Low volume sampler (MiniVol PM₁₀) was used to collect the suspended particulates in indoor and outdoor air. Results showed that the concentration of Pb in indoor air was in the range of 5.18 ± 1.08 μg/g–7.01 ± 0.08 μg/g. All the concentrations of Pb in indoor air were higher than in outdoor air at all sampling stations. The concentrations of cations and anions were higher in outdoor air than in indoor air. The concentration of Ca²⁺ (39.51 ± 5.01 mg/g–65.13 ± 9.42 mg/g) was the highest because the cation existed naturally in soil dusts, while the concentrations of NO₃⁻ and SO₄²⁻ were higher in outdoor air because there were more sources of exposure for anions in outdoor air, such as highly congested traffic and motor vehicles emissions. In comparison, the concentration of NO₃⁻ (29.72 ± 0.31 μg/g–32.00 ± 0.75 μg/g) was slightly higher than SO₄²⁻. The concentrations of most of the parameters in this study, such as Mg²⁺, Ca²⁺, NO₃⁻, SO₄²⁻, and Pb²⁺, were higher in outdoor air than in indoor air at all sampling stations.

Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan - a community based cross-sectional study

BACKGROUND

Chronic kidney disease (CKD) is increasing being recognized as a global public health problem. However, there is dearth of information on the prevalence, determinants, and management of CKD from low- and middle-income countries. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications.

METHODS

We conducted a cross-sectional study on 2873 participants aged ≥ 40 years in 12 representative communities in Karachi, Pakistan. The primary outcome was clinically significant CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 estimated by CKD-EPI (CKD Epidemiology Collaboration) Pakistan equation (0.686 × CKD-EPI1.059) or urinary albumin to creatinine ratio ≥ 3 mg/mmol (i.e. KDOQI CKD stage G3, A2 or worse).

RESULTS

The overall prevalence (95% CI) of CKD was 12.5% (11.4 - 13.8%). The factors independently associated with CKD were older age, hypertension, diabetes, elevated systolic blood pressure, raised fasting plasma glucose, raised triglycerides, and history of stroke (p<0.05 for each). About 267 (74.4%, 69.5 - 78.8%) adults with CKD had concomitant hypertension. Of these, 130 (48.7%, 42.6 - 54.9%) were on antihypertensive medications, and less than 20% had their BP controlled to conventional target of ≤ 140/90 mm Hg, and only 16.9% (12.6 - 21.9%) were on blockers of renin-angiotensin system alone or in combination with other drugs.

CONCLUSIONS

Clinically significant CKD is common among Pakistani adults. The conventional risk factors for CKD and poor control of blood pressure among patients with CKD highlight the need to integrate CKD prevention and management in the primary care infrastructure in Pakistan, and possibly neighbouring countries.

Puerarin protects against lead-induced cytotoxicity in cultured primary rat proximal tubular cells

Puerarin, a potent free radicals scavenger, has been demonstrated to have protective efficacy in oxidative damage induced by nephrotoxins. In the present study, the attenuating effect of puerarin (PU) on lead (Pb)-induced apoptosis and oxidative stress was investigated in cultured primary rat proximal tubular (rPT) cells. Results showed that exposure to 0.5 µM Pb induced a decrease in cell viability accompanied with obvious cellular morphological alterations and caused an increase in apoptotic rate and apoptotic morphological changes. Simultaneously, depletion of mitochondrial membrane potential (ΔΨ) and intracellular glutathione (GSH); elevation of caspase-3 activity, intracellular reactive oxygen species, and malondialdehyde levels; and inhibition of GSH peroxidase (GSH-Px) activity were revealed in the cells exposed to Pb alone. However, simultaneous supplementation with PU (50 and 100 µM) protected rPT cells from Pb-induced cytotoxicity through inhibiting apoptosis, attenuating lipid peroxidation, renewing mitochondrial function, and elevating the intracellular antioxidants (nonenzymatic and enzymic) levels. In conclusion, these findings suggested that PU, as a widely distributed dietary antioxidant, contributes potentially to inhibition of Pb-induced cytotoxicity in rPT cells.

Blood and hair lead in children with different extents of iron deficiency in Karachi

Childhood iron deficiency has a high incidence in Pakistan. Some but not all studies have shown that dietary iron deficiency may cause increased absorption of lead as both compete for the same transporters in the small intestine. Therefore, children in Pakistan, residing in heavily polluted cities like Karachi may be prone to lead poisoning. This hypothesis was tested by investigating blood and hair lead concentrations in children from Karachi who were divided into four groups of iron status; normal, borderline iron deficiency, iron deficiency and iron deficiency anaemia. A prospective observational study was conducted where 269 children were categorized into four groups of iron status using the World Health Organization criteria and one based on soluble transferrin receptor measurements. Blood iron status was determined using a full blood count, serum iron, ferritin, transferrin saturation and soluble transferrin receptor measurements. Blood lead was determined by graphite atomic absorption spectroscopy, whereas hair lead was assessed using an inductively coupled plasma atomic emission spectroscopy technique. Blood lead concentrations were significantly higher in children with iron deficiency anaemia (mean [95% confidence intervals] were 24.9 [22.6-27.2] μg/dL) compared to those with normal iron status (19.1 [16.8-21.4] μg/dL) using WHO criteria. In contrast, hair lead content was not significantly different in children of different iron status. Our findings reinforce the importance of not only reducing environmental lead pollution but also the development of national health strategies to reduce childhood iron deficiency in Pakistan.

Isotopic signatures for natural versus anthropogenic Pb in high-altitude Mt. Everest ice cores during the past 800 years

A long-term record, extending back 800 years (1205 to 2002 AD), of the Pb isotopic composition ((206)Pb/(207)Pb and (208)Pb/(207)Pb) as well as Pb concentrations from high altitude Mt. Everest ice cores has the potential to identify sources and source regions affecting natural and anthropogenic Pb deposition in central Asia. The results show that the regional natural background Pb isotope signature (~1.20 for (206)Pb/(207)Pb and ~2.50 for (208)Pb/(207)Pb) in the central Himalayas was dominated by mineral dust over the last ~750 years from 1205 to 1960s, mostly originating from local sources with occasional contributions of long-range transported dust probably from Sahara desert and northwestern India. Since the 1970s, the Pb isotope ratios are characterized by a continuous decline toward less radiogenic ratios with the least mean ratios of 1.178 for (206)Pb/(207)Pb and 2.471 for (208)Pb/(207)Pb in the period 1990-1996. The depression of the (206)Pb/(207)Pb and (208)Pb/(207)Pb values during the corresponding periods is most likely due to an increasing influence of less radiogenic Pb of anthropogenic origin mainly from leaded gasoline used in South Asia (India as well as possibly Bangladesh and Nepal). From 1997 to 2002, isotopic composition tends to show a shift to slightly more radiogenic signature. This is likely attributed to reducing Pb emissions from leaded gasoline in source regions, coinciding with the nationwide reduction of Pb in gasoline and subsequent phase-out of leaded gasoline in South Asia since 1997. An interesting feature is the relatively high levels of Pb concentrations and enrichment factors (EF) between 1997 and 2002. Although the reason for this feature remains uncertain, it would be probably linked with an increasing influence of anthropogenic Pb emitted from other sources such as fossil fuel combustion and non-ferrous metal production.

Effect of lead ion on the function of the human ether-à-go-go-related gene K+ channel

Lead (Pb) is a trace metal element in the human body. In order to understand the hazard mechanism of the elevated blood lead level on the human body, the effect of Pb(2+) on the human ether-à-go-go-related gene (hERG) K(+) channel in the HEK 293 cell was investigated for the first time using whole-cell patch clamp technique, molecular dynamics simulation, and quantum chemistry calculation methods. We found that Pb(2+) obviously inhibits the current of the hERG K(+) channel, and delays the "activation" and "deactivation" of the hERG K(+) channel, indicating that Pb(2+) evidently decreases the function of the K(+) channel in the cell. The effect is increased with increasing the concentration of Pb(2+). When the concentration of Pb(2+) is 400 μg L(-1), the function of the K(+) channel is entirely lost. The results from the molecular dynamics simulation and quantum chemistry calculation indicated that Pb(2+) can coordinate with the oxygen/sulfur atoms in the K(+) channel protein, leading to the decrease in the function of the K(+) channel. According to the experimental results, we suggested that once the K(+) channel in the human body was irreversibly inactivated by Pb(2+), it would affect the treatment and prognosis of Pb(2+) intoxication.

Synergistic effects of iron deficiency and lead exposure on blood lead levels in children

BACKGROUND

Lead poisoning is a well recognized environmental health problem in children. Independent association of iron deficiency and lead exposure with elevated blood lead level (BLL) has been reported. Whether iron deficiency in combination with chronic lead exposure increases BLL and susceptibility to its harmful effects in children needs to be elucidated.

METHODS

In this case-control study, 246 children were randomly recruited. They comprised 123 children of lead smelters/battery recycle plant workers living close to the industries at Wah/Gujranwala, Pakistan (lead exposed group) and 123 children living 30 km away from the industrial area (controls). Blood lead analysis was carried out on the anodic stripping voltammeter lead analyzer 3010B. Blood counting was done on a Sysmex hematological analyzer and serum ferritin was determined by kit method on Immulite-1000.

RESULTS

Of the 123 children in each group, 42 (34%) were iron deficient in the exposed group while 35 (28%) in the controls. The children's median age was 4 years (69 males and 54 females in each group). Lead exposed iron deficient children had significantly higher BLL median (quartile) 13.1 μg/dL (10.1-16.8) as compared with 9.6 μg/dL (7.6-10.3) in the iron deficient controls (P<0.05). Elevated BLL level was found in 31% of the lead exposed children and in 11% of the controls. Lead exposed children revealed a stronger negative correlation (r= -0.54; P=0.001) between BLL and serum ferritin than the controls (r=-0.36; P=0.01).

CONCLUSION

Iron deficiency in combination with lead exposure synergistically elevates blood lead levels and susceptibility to its harmful effects in children.

Lead exposure and its adverse health effects among occupational worker’s children

Lead exposure is an important environmental health problem particularly affecting the children of occupational workers living in the lead-contaminated environment. The objectives of the study were to find out the frequency, potential sources and adverse health effects of elevated blood lead level (BLL) in the children of lead-related occupational workers. It was a comparative cross-sectional study. A total of two hundred forty six children aged 1—6 years, comprising an equal number (n = 123) from lead smelters/battery recycle plant workers living close to the industries at Wah/Gujranwala, Pakistan (lead-exposed group) and those living 30 km away from the industrial area (controls) were included. Demographic and clinical data of each subject was collected. Blood lead analysis was carried out by using kits on the lead analyzer (3010 B ESA, USA). Biochemical tests of renal and hepatic profile were analyzed on Selectra E auto analyzer. The median age of children was 4 years; comprising of 69 boys and 54 girls. The lead-exposed children had significantly high BLLs median (range) 8.1 (1—20.9) μg/dL as compared to controls 6.7 (1—13.3) μg/dL (p ≤ 0.01). The children of occupational workers had elevated BLL (>10 μg/dL) in 38 (31%) as compared with 14 (11%) in controls. Hematopoietic, renal, and hepatic functions were significantly impaired in the lead-exposed children. In conclusion, the children of lead-related occupational workers have significantly increased frequency (31%) of lead poisoning. The potential source of lead overexposure in these children may be indirect through father’s clothes and contaminated environment at home. Increased lead accumulation adversely affects health of these children.

Toxic metals in the atmosphere in Lahore, Pakistan

Aerosol mass (PM(10) and PM(2.5)) and detailed elemental composition were measured in monthly composites during the calendar year of 2007 at a site in Lahore, Pakistan. Elemental analysis revealed extremely high concentrations of Pb (4.4microg m(-3)), Zn (12microg m(-3)), Cd (0.077microg m(-3)), and several other toxic metals. A significant fraction of the concentration of Pb (84%), Zn (98%), and Cd (90%) was contained in the fine particulate fraction (PM(2.5) and smaller); in addition, Zn and Cd were largely (>or=60%) water soluble. The 2007 annual average PM(10) mass concentration was 340microg m(-3), which is well above the WHO guideline of 20microg m(-3). Dust sources were found to contribute on average (maximum) 41% (70%) of PM(10) mass and 14% (29%) of PM(2.5) mass on a monthly basis. Seasonally, concentrations were found to be lowest during the monsoon season (July-September). Principle component analysis identified seven factors, which combined explained 91% of the variance of the measured components of PM(10). These factors included three industrial sources, re-suspended soil, mobile sources, and two regional secondary aerosol sources likely from coal and/or biomass burning. The majority of the Pb was found to be associated with one industrial source, along with a number of other toxic metals including As and Cr. Cadmium, another toxic metal, was found at concentrations 16 times higher than the maximum exposure level recommended by the World Health Organization, and was concentrated in one industrial source that was also associated with Zn. These results highlight the importance of focusing control strategies not only on reducing PM mass concentration, but also on the reduction of toxic components of the PM as well, to most effectively protect human health and the environment.

Lead and cadmium accumulation in medicinal plants collected from environmentally different sites

Though use of herbal medicine is increasing dramatically worldwide, environmental pollution especially with heavy metals poses serious problem on quality of medicinal plants and their products. In Ethiopia, where more than 85% of the population relies on traditional medicine, data on heavy metals level of plants is unavailable. The purpose of this study was to assess Pb and Cd in plants grown in different parts of Ethiopia. Out of 26 samples analyzed, four for lead (15.4%; 11.56 +/- 1.07 to 98.19 +/- 1.05 mg/kg) and seventeen for cadmium (65.4%; 0.38 to 1.83 +/- 0.06 mg/kg) were found to contain concentrations above WHO limits (10 mg/kg and 0.3 mg/kg respectively).

The state of ambient air quality in Pakistan--a review

BACKGROUND AND PURPOSE

Pakistan, during the last decade, has seen an extensive escalation in population growth, urbanization, and industrialization, together with a great increase in motorization and energy use. As a result, a substantial rise has taken place in the types and number of emission sources of various air pollutants. However, due to the lack of air quality management capabilities, the country is suffering from deterioration of air quality. Evidence from various governmental organizations and international bodies has indicated that air pollution is a significant risk to the environment, quality of life, and health of the population. The Government has taken positive steps toward air quality management in the form of the Pakistan Clean Air Program and has recently established a small number of continuous monitoring stations. However, ambient air quality standards have not yet been established. This paper reviews the data being available on the criteria air pollutants: particulate matter (PM), sulfur dioxide, ozone, carbon monoxide, nitrogen dioxide, and lead.

METHODS

Air pollution studies in Pakistan published in both scientific journals and by the Government have been reviewed and the reported concentrations of PM, SO(2), O(3), CO, NO(2), and Pb collated. A comparison of the levels of these air pollutants with the World Health Organization air quality guidelines was carried out.

RESULTS

Particulate matter was the most serious air pollutant in the country. NO(2) has emerged as the second high-risk pollutant. The reported levels of PM, SO(2), CO, NO(2), and Pb were many times higher than the World Health Organization air quality guidelines. Only O(3) concentrations were below the guidelines.

CONCLUSIONS

The current state of air quality calls for immediate action to tackle the poor air quality. The establishment of ambient air quality standards, an extension of the continuous monitoring sites, and the development of emission control strategies are essential.

Determination of toxic and essential elements in children's blood with inductively coupled plasma-mass spectrometry

Recent studies have suggested that low blood lead level, less than 50 microg L(-1), can influence the neurobehavioral performance of children. In addition, nutritional deficiencies in some essential elements may increase the toxicity of lead, and some essential elements may influence the blood concentrations of lead and other toxic metals. These findings, coupled with the scarcity of available data on some elements in children's blood and the introduction of methylcyclopentadienyl manganese tricarbonyl (MMT) to gasoline, accentuate the need to monitor the concentrations of lead, manganese, and other heavy metals and essential elements in children's blood. This study reports on the multi-element analysis of blood of South African school children using inductively coupled plasma-mass spectrometry (ICP-MS). The sample preparation consisted of a nitric acid/hydrogen peroxide open digestion and subsequent dilution with MilliQ water. The accuracy and precision were evaluated from quintuplet analyses of Seronorm trace elements whole blood reference material and human blood samples. Concentrations of lead, arsenic, manganese, copper, zinc, selenium, cobalt, and chromium in the blood of South African school children were determined. The average values were: lead 56.4 microg L(-1), arsenic 1.53 microg L(-1), manganese 8.48 microg L(-1), copper 1195 microg L(-1), zinc 3431 microg L(-1), selenium 176 microg L(-1), cobalt 0.80 microg L(-1), and chromium 1.25 microg L(-1). The level of lead was in line with some reported lower concentrations. The concentrations of arsenic and manganese were generally lower than those found in the literature. The concentrations of cobalt, copper, selenium, and chromium were higher than those found in other studies, whereas that of zinc was lower.

Oxidative stress and apoptotic changes in primary cultures of rat proximal tubular cells exposed to lead

Lead is a known nephrotoxic element. In this study, primary cultures of rat proximal tubular (rPT) cells were treated with different concentrations of lead acetate (0.25, 0.5 and 1 microM) to investigate its cytotoxic mechanism. A progressive loss in cell viability together with a significant increase in the number of apoptotic and necrotic cells and lactate dehydrogenase release were seen in the experiment. Simultaneously, elevation of reactive oxygen species levels and intracellular [Ca(2+)]i, depletion of mitochondrial membrane potential and intracellular glutathione were revealed during the lead exposure. In addition, apoptotic morphological changes induced by lead exposure in rPT cells were demonstrated by Hoechst 33258 staining. The apoptosis was markedly prevented by N-acetyl-L-cysteine, while the necrosis was not affected. Moreover, catalase and superoxide dismutase activities in the living cells rose significantly. In conclusion, exposure of rPT cells to low-concentration lead led to cell death, mediated by an apoptotic and a necrotic mechanism. The apoptotic death induced by oxidative stress was the chief mechanism. Meanwhile, a group of cells survived lead action, mediated by their ability to activate antioxidant defense systems.

Maternal nutritional status during pregnancy and surma use determine cord lead levels in Karachi, Pakistan

OBJECTIVES

To estimate the umbilical cord blood lead levels (BLLs) of Pakistani neonates and to identify determinants for umbilical BLLs.

METHODS

We conducted a cross-sectional study of mothers and infants at one of the two obstetric units of two tertiary care hospitals in Karachi during January-August 2005. Information from 540 mothers selected randomly from those registered for delivery was obtained about their pregnancy, diet, and current and past lead exposures. We collected umbilical cord blood for lead levels analyzed using graphite furnace atomic absorption spectrophotometry. We computed geometric and arithmetic means. We performed multiple linear regression analysis to identify factors associated with log-transformed umbilical cord BLLs. We also performed logistic regression analysis to identify determinants of high lead cord BLLs (10 microg/dl).

RESULTS

The geometric mean cord BLL of the neonates was 9.6 microg/dl; arithmetic mean (S.D.) was 10.8 microg/dl (5.7) with a median of 9.7 microg/dl and a range of 1.8-48.9 microg/dl. Women who reported intake of less than 58.5mg of elemental iron supplement per day during pregnancy had cord BLL of 10.0 microg/dl; in comparison those women who had higher iron intake had lower cord BLL (8.4 microg/dl). Those who used surma (an eye cosmetic) daily had higher cord BLL (11.5 microg/dl) as compared to those who used it less frequently (9.4 microg/dl). In multivariable linear regression model, higher iron intake, owning a car, and being in 2nd quartile of mid-arm circumference were associated with low lead levels while father's occupation in lead-based industry was associated with significantly higher umbilical cord BLLs. There was interaction of daily surma use and ethnicity. Geometric mean BLLs were varied among surma users by ethnicity.

CONCLUSIONS

Umbilical cord BLLs are high in Karachi, Pakistan, in comparison to those in developed countries such as United States. Measures are needed to reduce fetal lead exposure to prevent adverse affect on neurocognitive development. Association of low iron (below RDA of 60 mg per day) with high umbilical cord has implications for strengthening iron supplement intake during pregnancy. Umbilical cord BLLs differed among surma users by ethnicity.