The reactions of gold(0) with amino acids and the significance of these reactions in the biochemistry of gold

What do we know about dermal bioaccessibility of metals coated on antibacterial films?

Antibacterial films have gained attention since the outbreak of the COVID-19 pandemic; however, the impact of metals contained in antibacterial films on human safety have not been sufficiently investigated. This study reports on the important features that must be considered when assessing the bioaccessibility of Ag, Cu, and Zn in antibacterial films. Specifically, the effects of the artificial sweat component (i.e., amino acid and pH), surface weathering of antibacterial films, wipe sampling, and sebum were carefully examined. Our findings suggest that amino acids greatly affect bioaccessibility as amino acids act as ligands to facilitate metal ion leaching. In addition, constant exposure to ultraviolet C causes the film surface to oxidize, which significantly increases metal bioaccessibility due to the electrostatic repulsion between metal oxides and organic substrates. The presence of sebum in artificial sweat and physical damage to the film surface had no significant effects. Furthermore, the wipe sampling used to mimic the realistic dermal contact suggests the feasibility of applying this method for the assessment of bioaccessibility of metals in antibacterial films. The method offers significant advantages for evaluating the human safety aspects of skin contact with consumer products in future research.

Concomitant Sub-Chronic Administration of Small-Size Gold Nanoparticles Aggravates Doxorubicin-Induced Liver Oxidative and Inflammatory Damage, Hyperlipidemia, and Hepatic Steatosis

This study examined the effect of gold nanoparticles (AuNPs) on doxorubicin (DOX)-induced liver damage and steatosis in rats and tested its effect mechanism. Wistar male rats were divided into four groups (each of eight rats) as control, AuNPs (50 µL of 10 nm), DOX (15 mg/kg; 3 mg/kg/week), and DOX + AuNPs-treated rats. DOX is known to induce fasting hyperglycemia and hyperinsulinemia in treated rats. Individual treatment of both DOX and AuNPs also promoted liver damage, increased circulatory levels of ALT and AST, and stimulated serum and liver levels of TGs, CHOL, LDL-c, and FFAs. They also stimulated MDA, TNF-α, and IL-6, reduced GSH, SOD, HO-1, and CAT, upregulated mRNA levels of Bax and caspases-3 and -8 and downregulated mRNA levels of Bcl2 in the livers of rats. However, while DOX alone reduced hepatic levels of PPARα, both AuNPs and DOX stimulated mRNA levels of SREBP1, reduced the mRNA, cytoplasmic and nuclear levels of Nrf2, and increased mRNA, cytoplasmic, and nuclear levels of NF-κB. The liver damage and the alterations in all these parameters were significantly more profound when both AuNPs and DOX were administered together. In conclusion, AuNPs exaggerate liver damage, hyperlipidemia, and hepatic steatosis in DOX-treated rats by activating SREBP1 and NF-κB and suppressing the Nrf2/antioxidant axis.

Gold Nanoparticles Dissolve Extracellularly in the Presence of Human Macrophages

INTRODUCTION

Gold nanoparticles (AuNPs) have the potential to be used in various biomedical applications, partly due to the inertness and stability of gold. Upon intravenous injection, the NPs interact with the mononuclear phagocyte system, first with monocytes in the blood and then with macrophages in tissue. The NP-macrophage interaction will likely affect the stability of the AuNPs, but this is seldom analyzed. This study aimed to elucidate the role of macrophages in the biodissolution of AuNPs and underlying mechanisms.

METHODS

With an in vitro dissolution assay, we used inductively coupled plasma mass spectrometry to quantitatively compare the dissolution of 5 and 20 nm AuNPs coated with citrate or PEG in cell medium alone or in the presence of THP1-derived macrophages at 24 hours. In addition, we analyzed the cell dose, compared extra- and intracellular dissolution, and explored the possible role of reactive nitrogen species.

RESULTS

The results showed a higher cellular dose of the citrate-coated AuNPs, but dissolution was mainly evident for those sized 5 nm, irrespective of coating. The macrophages clearly assisted the dissolution, which was approximately fivefold higher in the presence of macrophages. The dissolution, however, appeared to take place mainly extracellularly. Acellular experiments demonstrated that peroxynitrite can initiate oxidation of gold, but a ligand is required to keep the gold ions in solution.

CONCLUSION

This study suggests extracellular dissolution of AuNPs in the presence of macrophages, likely with the contribution of the release of reactive nitrogen species, and provides new insight into the fate of AuNPs in the body.

Bioleaching of Gold from Silicate Ore by Macrococcus caseolyticus and Acinetobacter calcoaceticus: Effect of Medium, Amino Acids and Growth Supernatant

The aims of this work were to study the gold leaching by the isolated bacteria from silicate ore. Three strains were isolated and identified as Macrococcus caseolyticus, Acinetobacter calcoaceticus, and Bacillus sp. MBEA40. However, only M. caseolyticus and A. calcoaceticus were capable of gold bioleaching. In order to examine only the effect of microorganisms involved in the gold bioleaching process, minimal medium and ethanol mineral salt medium without amino acids were used for culturing M. caseolyticus and A. calcoaceticus, respectively. The result showed that the growth supernatant (in the absence of microorganisms) of both strains might be more suitable to leaching gold from ore than leaching by microorganisms (in the presence of microorganisms) directly. This might be due to the fact that there is no interference of gold absorption and metal toxicity in microorganisms in the long-term operation. The result also confirmed that amino acids/peptides/proteins produced by microorganisms might be involved in gold bioleaching, as shown in the high-performance liquid chromatography (HPLC) results. The Fourier transform infrared spectroscopy (FTIR) study also found that amine groups and carboxylic groups played important roles in gold bioleaching by M. caseolyticus and A. calcoaceticus. In addition, the bioleaching process had significantly higher gold leaching than mixed pure amino acids due to the growth supernatant containing mixed amino acids/peptides/proteins and other compounds. Therefore, the growth supernatant of M. caseolyticus and A. calcoaceticus can be applied in gold bioleaching under neutral pH conditions, which is considered to be a safe, not corrosive, and environmentally friendly leaching process. This study is also needed further study in order to increase the percentage of gold bioleaching and decrease times.

Comparison of five artificial skin surface film liquids for assessing dermal bioaccessibility of metals in certified reference soils

Dermal exposure to metals has previously received less attention than oral/inhalation exposure. Nonetheless, human health risk is significant for certain contaminants and exposure scenarios. The present study aims to (1) characterize two certified reference soils (SQC001, BGS 102); and (2) assess Cr, Ni, Pb, and Zn dermal bioaccessibility via in vitro assays using three synthetic sweat formulations (EN 1811, pH 6.5 (Sweat A), NIHS 96-10, pH 4.7 (Sweat B), and a more complex pH 5.5 formulation containing amino acids (Sweat C)) and two sebum formulations. Metals bioaccessibility in sweat followed Sweat B > Sweat C > Sweat A, attributed to sweat B lower pH. Dermal bioaccessibility in both sebum formulations was lower than 1% for Ni and Pb and below 9% for Cr and Zn, possibly due to low affinity of metals for non-polar lipids. It must be noted that bioaccessible Zn in BGS 102 was higher when extracted with synthetic sebum compared to any of the synthetic sweat formulations. Metal bioaccessibility in sweat was considerably higher for SQC001 (up to 76.6% for Zn using Sweat B) than for BGS 102 (ranging between 0.02 and 1.3% for all elements and all sweat formulations), attributed to higher pH, higher organic carbon, and higher cation exchange capacity of reference soil BGS 102. Sebum formulations spiked with metals generally entailed low metal recovery (except for Zn), which may explain overall low bioaccessibility values for sebum. Sebum and sweat formulation, and soil properties seem to control in vitro dermal bioaccessibility of metals.

Advanced fabrication of biosensor on detection of Glypican-1 using S-Acetylmercaptosuccinic anhydride (SAMSA) modification of antibody

Glypican-1 (GPC-1) has been recognized as biomarker of pancreatic cancer. Quantification of GPC-1 level is also pivotal to breast cancer and prostate cancer’s patients. We hereby report the first biosensor for GPC-1 detection. Instead of using crosslinking technique and surface immobilization of antibody, we applied a novel method for biosensor fabrication, using S-Acetylmercaptosuccinic anhydride (SAMSA) to modify the Anti-GPC-1 producing a thiol-linked Anti-GPC-1. The thiol-linked Anti-GPC-1 was then directly formed a single-layer antibody layer on the gold biosensor, minimizing the biosensor preparation steps significantly. Time of Flight Secondary Ions Mass Spectroscopy (TOF-SIMS) characterization verified the thiol-linked antibody layer and demonstrated a unique perspective for surface protein characterization. Differential pulse voltammetry (DPV) was applied to quantify GPC-1 antigen in undiluted human serum with a concentration range of 5,000 pg/µL to 100 pg/µL. The performance of this newly designed biosensor was also compared with modified self-assembled monolayer system fabricated biosensor, demonstrating the high-sensitivity and high-reproducibility of the SAMSA modified antibody based biosensor. This simple fabrication method can also expand to detection of other biomolecules. The simplified operation process shows great potential in clinical application development.

International guidelines for the in vivo assessment of skin properties in non-clinical settings: part 1. pH

Background

Skin surface pH is known to influence the dissolution and partitioning of chemicals and may influence exposures that lead to skin diseases. Non-clinical environments (e.g. workplaces) are highly variable, thereby presenting unique measurement challenges that are not typically encountered in clinical settings. Hence, guidelines are needed for consistent measurement of skin surface pH in environments that are difficult to control.

Methods

An expert workshop was convened at the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals to review available data on factors that could influence the determination of skin surface pH in non-clinical settings with emphasis on the workplace as a worst case scenario.

Results

The key elements of the guidelines are: (i) minimize, to the extent feasible, the influences of relevant endogenous (anatomical position, skin health, time of day), exogenous (hand washing, barrier creams, soaps and detergents, occlusion), environmental (seasonality), and measurement (atmospheric conditions) factors; (ii) report pH measurements results as a difference or percent change (not absolute values) using a measure of central tendency and variability; and (iii) report notable deviations from these guidelines and other relevant factors that may influence measurements.

Conclusion

Guidelines on the measurement and reporting of skin surface pH in non-clinical settings should promote consistency in data reporting, facilitate inter-comparison of study results, and aid in understanding and preventing occupational skin diseases.

Gold nanoparticles: a revival in precious metal administration to patients

Gold has been used as a therapeutic agent to treat a wide variety of rheumatic diseases including psoriatic arthritis, juvenile arthritis, and discoid lupus erythematosus. Although the use of gold has been largely superseded by newer drugs, gold nanoparticles are being used effectively in laboratory based clinical diagnostic methods while concurrently showing great promise in vivo either as a diagnostic imaging agent or a therapeutic agent. For these reasons, gold nanoparticles are therefore well placed to enter mainstream clinical practice in the near future. Hence, the present review summarizes the chemistry, pharmacokinetics, biodistribution, metabolism, and toxicity of bulk gold in humans based on decades of clinical observation and experiments in which gold was used to treat patients with rheumatoid arthritis. The beneficial attributes of gold nanoparticles, such as their ease of synthesis, functionalization, and shape control are also highlighted demonstrating why gold nanoparticles are an attractive target for further development and optimization. The importance of controlling the size and shape of gold nanoparticles to minimize any potential toxic side effects is also discussed.

Subchronic inhalation toxicity of gold nanoparticles

Background

Gold nanoparticles are widely used in consumer products, including cosmetics, food packaging, beverages, toothpaste, automobiles, and lubricants. With this increase in consumer products containing gold nanoparticles, the potential for worker exposure to gold nanoparticles will also increase. Only a few studies have produced data on the in vivo toxicology of gold nanoparticles, meaning that the absorption, distribution, metabolism, and excretion (ADME) of gold nanoparticles remain unclear.

Results

The toxicity of gold nanoparticles was studied in Sprague Dawley rats by inhalation. Seven-week-old rats, weighing approximately 200 g (males) and 145 g (females), were divided into 4 groups (10 rats in each group): fresh-air control, low-dose (2.36 × 10⁴ particle/cm³, 0.04 μg/m³), middle-dose (2.36 × 10⁵ particle/cm³, 0.38 μg/m³), and high-dose (1.85 × 10⁶ particle/cm³, 20.02 μg/m³). The animals were exposed to gold nanoparticles (average diameter 4-5 nm) for 6 hours/day, 5 days/week, for 90-days in a whole-body inhalation chamber. In addition to mortality and clinical observations, body weight, food consumption, and lung function were recorded weekly. At the end of the study, the rats were subjected to a full necropsy, blood samples were collected for hematology and clinical chemistry tests, and organ weights were measured. Cellular differential counts and cytotoxicity measurements, such as albumin, lactate dehydrogenase (LDH), and total protein were also monitored in a cellular bronchoalveolar lavage (BAL) fluid. Among lung function test measurements, tidal volume and minute volume showed a tendency to decrease comparing control and dose groups during the 90-days of exposure. Although no statistically significant differences were found in cellular differential counts, histopathologic examination showed minimal alveoli, an inflammatory infiltrate with a mixed cell type, and increased macrophages in the high-dose rats. Tissue distribution of gold nanoparticles showed a dose-dependent accumulation of gold in only lungs and kidneys with a gender-related difference in gold nanoparticles content in kidneys.

Conclusions

Lungs were the only organ in which there were dose-related changes in both male and female rats. Changes observed in lung histopathology and function in high-dose animals indicate that the highest concentration (20 μg/m³) is a LOAEL and the middle concentration (0.38 μg/m³) is a NOAEL for this study.

Formulation and stability of a novel artificial human sweat under conditions of storage and use

A limitation of most artificial sweat formulations used for in vitro assessment of chemical release from materials in contact with skin have little biological relevance to human sweat. The purposes of this paper are to provide guidance for preparation of a novel artificial sweat with chemical constituents at concentrations that match human sweat and to characterize chemical stability. The artificial sweat was characterized under conditions of use (with and without sebum at 36 degrees C) and storage (without sebum at -4, 4, and 23 degrees C) over 28 days by gas chromatography-mass spectroscopy, high-performance liquid chromatography, enzymatic assay kits, and ion-selective electrodes. Seven indicator constituents were tracked: sodium, chloride, glucose, lactic acid, urea, pantothenic acid, and alanine. With or without sebum at 36 degrees C, the sweat solvent was chemically stable for 14 days. Storage by refrigeration at 4 degrees C retained the chemical integrity of the solvent longest. Based on these results, the solvent should be used within 14 days of preparation. The artificial sweat model presented herein is most similar to human sweat and has applications as a dissolution solvent, donor solution in diffusion cells, or vehicle for patch testing. This sweat model may aid researchers in understanding potential release and percutaneous absorption of chemicals in contact with human skin surface liquids.

Levels of gold in plasma after dental gold inlay insertion

OBJECTIVE

Several studies have reported increased levels of gold (Au) in the blood of patients with dental gold restorations. This study analyzed gold levels in blood plasma before dental gold inlay insertion, 0-12 months after, and 15 years after.

MATERIAL AND METHODS

Plasma samples from 9 patients were taken before and 0-10 months after gold inlay insertion. Fifteen years after gold inlay insertion, further blood samples taken from 8 of these patients were analyzed for gold using inductively coupled plasma mass spectrometry. An oral examination was also carried out before and 15 years after gold inlay insertion.

RESULTS

Gold levels in plasma were significantly higher 0-12 months after gold inlay insertion than before treatment (p=0.008). No significant difference in gold plasma levels was found between 0-12 months after and 15 years after insertion (p=0.109), although there was a significant correlation between the number of gold alloy surfaces and the amount of gold in plasma 15 years after insertion (p=0.028).

CONCLUSIONS

This study supports a dose-related release of gold into plasma from dental gold restorations, a release that appears to be stable over time.

Dissolution of materials in artificial skin surface film liquids

The dissolution of chemical constituents from jewelry, textiles, cosmetics, drugs, industrial chemicals, and particles in direct and prolonged contact with human skin is often assessed in vitro using artificial skin surface film liquids (SSFL). To provide meaningful results, the composition of artificial SSFL should accurately mimic human sweat and sebum, and the conditions of the in vitro test system should accurately reflect in vivo skin conditions. We summarized the reported composition of human SSFL and compared it to 45 different formulations of artificial sweat and 18 formulations of artificial sebum (studies published from 1940 to 2005). Conditions of in vitro dissolution test systems were reviewed and compared to in vivo skin conditions. The concentrations of individual constituents and pH of artificial sweat and concentrations of artificial sebum constituents are not always within ranges reported for human SSFL. Nearly all artificial SSFL lack many of the constituents in human SSFL. To develop a comprehensive model SSFL, we propose a standard SSFL, modified from the two best published sweat and sebum formulations. Little is known concerning the influence of test system conditions on dissolution, including SSFL temperature, container material composition, agitation, and physicochemical properties of the test article on dissolution. Thus, both a need and an opportunity exist for standardizing the composition of artificial SSFL and in vitro dissolution test methodologies. To standardize in vitro dissolution test systems, we recommend: maintaining artificial SSFL at a biologically relevant temperature appropriate to the human activity being modeled, carefully selecting test and sample storage containers to avoid bias in dissolution measurements, accounting for friction between a test article and skin in a biologically plausible manner, and physicochemical characterization of the test article or material to better understand mechanisms of dissolution and potential mechanisms of toxic action of dissolved material. More accurate modeling and better understanding of chemical dissolution from articles in contact with the skin will ultimately improve risk decision making, thereby protecting even the most susceptible persons from adverse health effects resulting from skin exposure.

Type IV hypersensitivity reactions to upper lid gold weight implants-is patch testing necessary?

AIMS

To report two cases of allergic reaction to upper lid gold weight implants in patients with facial nerve palsy and to identify the use of pre-implantation patch testing in predicting gold hypersensitivity.

METHODS

One patient who had a positive family history of gold allergy and had undergone previous gold dental restoration underwent patch testing with gold sodium thiosulphate. The gold weight from the same patient was analysed using scanning electron microscopy and energy dispersive X-ray analysis, which can detect surface impurities. Tissue obtained during surgery to remove the gold weight from the second patient was examined histologically.

RESULTS

Patch testing in the first patient gave a positive result. Analysis of the gold weight removed from the same patient confirmed 99.99% purity, and hence sensitivity to the gold itself was considered to be the cause of the inflammatory reaction. Histology of tissue taken from the eyelid of the second patient was consistent with type IV hypersensitivity.

CONCLUSION

A personal and family history of gold allergy should be looked for before upper eyelid gold weight implantation. Patch testing should be performed for patients where there is doubt about whether gold has been the specific cause of previous allergic reactions, for patients who have undergone previous dental restoration involving gold, or if there is a positive family history of gold allergy.

Differences in dissolution behavior in a phagolysosomal simulant fluid for single-constituent and multi-constituent materials associated with beryllium sensitization and chronic beryllium disease

Particle dissolution within macrophage phagolysosomes is hypothesized to be an important source of dissolved beryllium for input to the cell-mediated immune reaction associated with development of beryllium sensitization and chronic beryllium disease (CBD). To better understand the dissolution of beryllium materials associated with elevated prevalence of sensitization and CBD, single-constituent (beryllium oxide (BeO) particles sampled from a screener operation, finished product BeO powder, finish product beryllium metal powder) and multi-constituent (particles sampled from an arc furnace during processing of copper-beryllium alloy) aerosol materials were studied. Dissolution rates were measured using phagolysosomal simulant fluid (PSF) in a static dissolution technique and then normalized to measured values of specific surface area to calculate a chemical dissolution rate constant (k) for each material. Values of k, in g/(cm2 day), for screener BeO particles (1.3 +/- 1.9 x 10(-8)) and for BeO powder (1.1 +/- 0.5 x 10(-8)) were similar (p = 0.45). The value of k observed for beryllium metal powder (1.1 +/- 1.4 x 10(-7)) was significantly greater than observed for the BeO materials (p < 0.0003). For arc furnace particles, k (1.6 +/- 0.6 x 10(-7)) was significantly greater than observed for the BeO materials (p < 0.00001), despite the fact that the chemical form of beryllium in the aerosol was BeO. These results suggest that dissolution of beryllium differs among physicochemical forms of beryllium and direct measurement of dissolution is needed for multi-constituent aerosol. Additional studies of the dissolution behavior of beryllium materials in a variety of mixture configurations will aid in developing exposure-response models to improve understanding of the risk of beryllium sensitization and CBD.

Percutaneous absorption of gold sodium thiosulfate used for patch testing

Contact allergy to gold has been shown to be correlated to wearing of golden jewellery as well as to the presence of dental gold. The prerequisite for sensitization and elicitation of an allergic contact dermatitis to gold is ionization and percutaneous absorption of the allergen. The present study was undertaken with the aim to demonstrate gold in blood after an occlusive patch testing with gold sodium thiosulfate (GSTS). Patients were patch tested with GSTS 0.5, 2.0 and 5.0% in petrolatum. Venous blood was sampled before testing as well as on day 3 (D3) or day 7 (D7). Blood gold levels were analysed by inductively coupled plasma mass spectrometry. In all 66 patients, the blood level of gold was significantly higher in the 2nd blood sample than in the 1st (median 0.34 versus 0.03 micro g/l). The increase was similar in patients allergic and not allergic to gold. There was no difference between gold levels on D3 and on D7 after epicutaneous application. Presumably, other allergens may also be taken up in blood during patch testing.

Contact orofacial granulomatosis caused by delayed hypersensitivity to gold and mercury

Orofacial granulomatosis, an entity with characteristic clinicopathologic features, is thought to be a reactive process. The authors describe orofacial granulomatosis associated with contact allergy to gold in dental crowns in one patient and a possible allergic contact reaction to mercury from dental fillings in another one. Thus allergic contact dermatitis to the metals gold and mercury should be considered as a possible etiologic agent of orofacial granulomatosis.

Sensitization potential of gold sodium thiosulfate in mice and guinea pigs

Since gold sodium thiosulfate (GST) has been included in a standard patch test series for diagnosis of allergic contact dermatitis from gold, the incidence of patients showing positive reactions to gold is increasing. However, there were little reports on induction of gold sensitization in animals. In this study, we have examined the sensitization potential of GST using mice and guinea pigs. In the guinea pig maximization test, 2 or 6 out of 10 animals showed positive skin responses, mainly edema, by challenge with 2% or 5% GST in 50% ethanol solution, respectively. In the mouse ear swelling test, positive ear swelling (20% greater increase in ear thickness) after challenge with GST was shown in 2 out of 6 mice those previously treated with GST. Topical exposure of mice to GST in 70% dimethylsulfoxide solution induced small increases in the lymph node weight and the lymph node cell (LNC) number in the murine local lymph node assay (LLNA). A greater degree of LNC responses were observed in the sensitive mouse lymph node assay (SLNA) compared with the LLNA, but the stimulation index of total lymph node response by GST was not so high. From these results, GST was identified as a contact allergen, but the sensitization potential was not so strong. In the mouse IgE test, treatment of mice with GST resulted in a statistically significant increase in the serum IgE antibody concentration that associated with immediate-type hypersensitivity reaction. It may suggest that the sensitization responses from gold would appear not only at the contact site but also systematically.

Gold concentration in blood in relation to the number of gold restorations and contact allergy to gold

Previous studies have demonstrated an association between gold allergy and the presence of dental gold restorations. The aim of the present study was to investigate the relationship between the concentration of gold in blood (B-Au) and the number of tooth surfaces with gold alloys in subjects with and without contact allergy to gold. In 80 patients referred for patch testing because of eczematous disease, blood samples were taken and analyzed for B-Au using inductively coupled plasma mass spectrometry. The detection limit for the Au determination was 0.04 microg/L. In addition, a dentist made a clinical and radiological examination of the patients and registered the number of dental gold surfaces. Patients with dental gold restorations had a statistically significantly higher B-Au in Mann-Whitney U test (P = 0.025), (range < 0.04-1.07 microg/L) than patients without (range < 0.04-0.15 microg/L). Furthermore, a positive correlation was found between B-Au and the number of dental gold surfaces (P < 0.01). There was no statistically significant difference in B-Au between persons with and without contact allergy to gold. The study thus indicates that gold is released from dental restorations and taken tip into the circulation.

Dental gold alloys and contact allergy

Contact allergy to gold as demonstrated by patch testing is very common among patients with eczematous disease and seems to be even more frequent among patients with complaints from the oral cavity. There is a positive correlation between gold allergy and the presence of dental gold. Gold allergy is often found in patients with non-specific stomatitides as well as in those with lichenoid reactions or with only subjective symptoms from the oral cavity. The therapeutic effect of substituting other dental materials for gold alloys is conspicuous in casuistic reports but less impressive in larger patient materials. The amount of dental gold is correlated qualitatively and quantitatively to the blood level of gold and the effects if any of circulating blood gold are unknown. There is clearly a need for prospective studies in the field and gold sodium thiosulfate is considered an important item in the dental series for patch testing.

In vitro lymphocyte reactivity to gold compounds in the diagnosis of contact hypersensitivity

The use of the lymphocyte transformation test (LTT) in the diagnosis of contact hypersensitivity to gold was studied in 8 patients who had positive patch tests to gold salts, and in 8 control subjects who were negative to such patch tests. Gold sodium thiosulfate and gold chloride were added to cultures of lymphocytes, which were labeled by 3H-thymidine after 96 h. The lymphocyte stimulation index was calculated as the beta-counts in stimulated cultures divided by those in control cultures. The index was statistically significantly higher for the patient group (p=0.005-0.04) than for the control group. Levels of interferon-gamma (IFN-gamma) were determined for the supernatants of the lymphocyte cultures. An index IFN-gamma, which is defined as the level of IFN-gamma in stimulated cultures divided by that in control cultures, was statistically significantly higher for the patient group (p=0.01-0.006). The LTT stimulation index showed specificity and sensitivity between 67 and 80%, the respective values for Index IFN-gamma being between 73 and 100% when the patch test was used as a reference method. Evaluation of lymphocyte reactivity might be of future interest in the diagnosis of allergic reactions to gold if the sensitivity and specificity can be improved.

Gold--a controversial sensitizer. European Environmental and Contact Dermatitis Research Group

Until recently, gold allergy was considered to be extremely rare. Gold has been used and worshipped for thousands of years without any obvious complaints of skin problems, either in those participating in mining and other ways of prospecting, or in those wearing jewellery. When studies on contact allergy to gold sodium thiosulfate were published at the beginning of the 1990s, the allergic nature of the reported positive patch test reactions to gold was questioned. The major argument for such questioning was the lack of demonstrable clinical relevance in most positive reactors. A major reason for the questioning may have been confusion in differentiating between contact allergy and allergic contact dermatitis. To arrive at a diagnosis of allergic contact dermatitis, 3 steps have, in principle, to be fulfilled: (i) establishment of contact allergy; (ii) demonstration of present exposure; (iii) assessment of clinical relevance, i.e., causing or aggravating a contact dermatitis. In this paper, these steps are discussed with regard to gold. With our present knowledge of contact allergy-allergic contact dermatitis, we do not recommend including gold sodium thiosulfate in the standard series. It should be applied for scientific purposes and when allergic contact dermatitis from gold is suspected.

A metallurgical approach to metal contact dermatitis

It is well-known that some metals/alloys are sensitizing on skin contact, but it is not so well appreciated that sensitization is dependent on the reaction of the metal/alloy with sweat. The first step in skin sensitization by metals/alloys is a corrosion process and the formation of soluble metal ions. The nature of this process has implications with respect to occurrence of metal contact dermatitis, to testing techniques and to classification of metals/alloys as skin sensitizers.

Gold: an allergen of growing significance

Gold moved into the limelight of medical literature thanks to the anti-inflammatory activity and effectiveness of gold compounds in the treatment of rheumatoid arthritis, but more recently also because of the growing incidence of hypersensitivity induced by it which is expressed in cutaneous and mucosal reactions. This review discusses dermatotoxicity associated with gold. In some countries gold has moved into second place as allergen, following nickel. Such recognition is mainly due to improved diagnostic methods and to its inclusion in routine dermal patch testing. Some unconventional manifestations of hypersensitivity are associated with use patterns which involve intimate contact with the metal as a component of jewelry. In-depth analysis of the growing number of cases of allergy has revealed various immunological idiosyncrasies as being characteristic of this metal. These include late reactions to challenge, extraordinary persistence of clinical effects, formation of intracutaneous nodules and immunogenic granuloma unresponsive to conventional steroid therapy, the occurrence of eczema at sites distant from the site of contact, and flare-ups of eczema upon systemic provocation with allergen which are characteristic of drug induced allergy. These manifestations demand investigations at the molecular level of the unusual mechanisms of action involved.

Contact allergy to gold sodium thiosulfate

100 consecutive patients routinely attending the contact dermatitis clinic were patched tested to gold sodium thiosulfate (GST). 13 patients had a positive patch test to GST, 11 of whom were female, and 12 had pierced ears. There was no correlation with any other substance in the European standard series, although there was a high incidence of nickel sensitivity in all patients (33%). Eczema on the ring fingers and neck was significantly more common in the group positive to GST. 1/2 of the patients with a positive response to GST had symptoms that they felt could be attributed to gold allergy.

Contact allergy to gold sodium thiosulfate

278 consecutive patients with suspected contact dermatitis were patch tested with the European standard series and gold sodium thiosulfate (0.5% pet.): 13 patients (4.6%) had a positive allergic response to gold sodium thiosulfate (GST). All of these patients were female, with a mean age of 37 years. The most frequent site of eczema in these patients was the head and neck (62%). A seborrhoeic distribution of eczema was common. 46% had involvement of the limbs, 15% had a perianal or perivulval rash. The mean duration of eczema in this group of patients was 15.8 months. 54% of patients allergic to gold were also allergic to nickel. Biopsy of positive patch test reactions to GST were consistent with allergic contact dermatitis.

High frequency of contact allergy to gold sodium thiosulfate. An indication of gold allergy?

When gold sodium thiosulfate was added to the patch test standard series, positive reactions were obtained in 8.6% of 823 consecutive patients with suspect contact allergy. The test reactions were clinically of an allergic type and, in several cases, long-lasting. There was no correlation with other allergens in the standard series. In a special study on 38 patients with contact allergy to gold sodium thiosulfate, the following principal findings were obtained: positive patch tests to the compound itself in dilute concentration; positive patch tests to potassium dicyanoaurate; negative patch tests to gold sodium thiomalate, sodium thiosulfate, and metallic gold; positive intradermal tests to gold sodium thiosulfate. Our findings make gold sodium thiosulfate the 2nd most common contact allergen after nickel sulfate. It is suggested that a positive skin test to gold sodium thiosulfate represents gold allergy.

Dental amalgam and mercury

This paper looks at the issues of the current amalgam controversy: the daily dose of mercury from amalgam, hypersensitivity to mercury, claims of adverse effects from amalgam mercury and alleged overnight "cures." In addition, the toxicity and allergenicity of the proposed alternative materials are examined with the same kind of scrutiny applied by the anti-amalgam group to dental amalgam.

Control of oxidative damage in rheumatoid arthritis by gold(I)-thiolate drugs

The roles of anti-arthritic gold(I)-thiolate drugs such as disodium aurothiomalate ('Myocrisin') in the modulation or promotion of oxygen radical-mediated oxidative damage in vivo are reviewed. In particular, the precise molecular mechanisms by which these novel second-line agents exert their therapeutic effects are discussed in terms of (i) the direct and indirect control of enzymes involved in the generation or scavenging of reactive oxygen species (ROS) such as superoxide ion, hydrogen peroxide and hydroxyl radical, (ii) the protection of proteins and relevant enzyme systems against attack by ROS and (iii) their direct involvement in the production (at appropriate 'target' sites) or scavenging of ROS in vivo. In addition, the role of the orally-effective gold(I)-phosphine complex auranofin in the control of oxidative damage in rheumatoid arthritis is also discussed.

Contact allergy to gold after systemic administration of gold for rheumatoid arthritis

A patient with seropositive, nodular rheumatoid arthritis (RA) developed contact allergy to gold jewellery following a severe skin rash which occurred after 13 weeks of treatment with sodium aurothiomalate. Patch testing confirmed that the contact allergy was due to gold. This is the first proved case of contact allergy to gold or any other compound initiated by systemic administration of the allergen.

Skin contact with gold and gold alloys

3 types of reaction to gold merit discussion. First, there is the effect known as black dermographism, in which stroking with certain metals immediately produces well-defined black lines on the skin. Some gold alloys are amongst such metals. The evidence indicates that the effect is the result of impregnation of the skin with black metallic particles generated by mechanical abrasion of the metal by contaminants of the skin. There is no positive and unequivocal evidence of the ability of metals to mark uncontaminated skin so rapidly that it is possible to write upon it. Secondly there are the 2 related phenomena of the wear of gold jewelry, and the susceptibility to certain individuals to blackening of the skin where it is in contact with such jewelry. The occurrence of smudge, as it is often called, is not very common, but is brought to the attention of most jewelers from time to time. In extreme cases it may make it embarrassing for the person concerned to wear metallic jewelry. It would appear as if gold smudge also results mainly from mechanical abrasion of jewelry, though this may be aided and/or supplemented in some instances by corrosion of gold or gold alloy induced by certain components of the sweat. Finally, there is the question of true allergic responses to contact of the skin with gold and its alloys. Judging from the very few cases which have been recorded, such responses are extremely rare. Some recent observations on the reactions of metallic gold with amino acids and of reaction to contact of the skin with gold on the part of rheumatoid arthritis patients undergoing gold therapy, are, however, relevant in this connection.