Exposure to Aluminum, Cadmium, and Mercury and Autism Spectrum Disorder in Children: A Systematic Review and Meta-Analysis

Investigating the role of food pollutants in autism spectrum disorder: a comprehensive analysis of heavy metals, pesticides, and mycotoxins

Food pollutants, including heavy metals, pesticides, and mycotoxins, have been proposed as potential risk factors for autism spectrum disorder (ASD) during pregnancy and early childhood. This paper examines the impact of food pollutants on ASD risk. A systematic search through PubMed, Google Scholar, and Sciverse yielded studies from 1990 to present. Research indicates elevated levels of heavy metals in children with ASD, linking pesticides and toxins to brain development disruptions. Mycotoxins, specifically, show a correlation with ASD and can contaminate food, posing a threat to neurodevelopment. Strategies like choosing organic foods and reducing exposure to toxins may benefit individuals with ASD and those vulnerable to the disorder. Further research is essential to comprehend the food pollutant-ASD relationship and devise effective exposure reduction strategies.

Health risk assessment for human mercury exposure from Cinnabaris-containing Baizi Yangxin Pills in healthy volunteers Po administration

BACKGROUND

Cinnabaris (α-HgS), a mineral traditional Chinese material medica, has been used in combination with other herbs manifesting some definite therapeutic effects for thousands of years. But the currently reported mercury poisoning incidents raised the doubts about the safety of Cinnabaris-containing traditional Chinese medicines (TCMs). Baizi Yangxin Pills (BZYXP) is a Cinnabaris-containing TCM widely used in clinical practice. This study evaluated the health risk of mercury exposure from BZYXP in healthy volunteers based on the total mercury and mercury species analysis of blood and urine after single and multiple doses of BZYXP.

METHODS

Blood pharmacokinetics and urinary excretion studies of mercury were compared between single (9 g, once daily) and multiple doses (9 g, twice daily, continued for 7 days) of BZYXP. The whole blood and urine samples were collected at the specific points or periods after the administration of BZYXP. The total mercury and mercury species in blood and urine samples were determined by cold vapor-atomic fluorescence spectrometry (CV-AFS) and HPLC-CV-AFS, respectively.

RESULTS

The mercury was excreted slowly and accumulated obviously after continuous exposure of BZYXP. Moreover, the well-known neurotoxin methylmercury (MeHg) was detected in blood samples after 7 days' administration of BZYXP. In the urine samples, only Hg(II) was detected. Therefore, long-term use of BZYXP will cause mercury poisoning due to mercury's high accumulative properties and MeHg formation.

CONCLUSION

Cinnabaris-containing TCMs such as BZYXP should be restricted to cases in which alternatives are available, and the blood mercury species profile should be monitored during the long-term clinical medication.

Autism spectrum disorder: Cadmium and mercury concentrations in different biological samples, a systematic literature review and meta-analysis of human studies

The present study was conducted to investigate the differences in cadmium (Cd) and mercury (Hg) concentrations between children with autism spectrum disorder (ASD) and controls. In this systematic review and meta-analysis study, three thousand one hundred forty-five studies were collected from scientific databases including Web of Science, Scopus, PubMed, and Google Scholar from January 2000 to October 2022 and were investigated for eligibility. As a result, 37 studies published in the period from 2003 to 2022 met our inclusion criteria and were considered in the meta-analysis. The heterogeneity assumption was evaluated using the Chi-squared-based Q-test and I-squared (I2) statistics. The pooled estimates were shown in the forest plots with Hedges' g (95% confidence interval) values. The random effects model demonstrated that there is no significant difference in the blood (Hedges' g: 0.14, 95% CI: 0.45, 0.72, p > 0.05), hair (Hedges' g: 0.12, 95% CI: 0.26, 0.50, p > 0.05), and urinary (Hedges' g: 0.05, 95% CI: 0.86, 0.76, p > 0.05) Cd levels of the case group versus control subjects. Moreover, the pooled findings of studies showed no significant difference in the blood (Hedges' g: 1.69, 95% CI: 0.09, 3.48, p > 0.05), hair (Hedges' g: 3.42, 95% CI: 1.96, 8.80, p > 0.05), and urinary (Hedges' g: 0.49, 95% CI: 1.29 - 0.30, p > 0.05) Hg concentrations. The results demonstrated no significant differences in Hg and Cd concentrations in different biological samples of children with ASD compared to control subjects.

More about making profits or providing safe drinking water? A state-of-the-art review on sachet water contamination in Nigeria

Public health concerns on surface and groundwater contamination worldwide have increased. Sachet water contamination has also raised serious concerns across many developing countries. While previous studies attempted to address this issue, this review takes a different approach by utilizing a comprehensive analysis of physicochemical parameters, heavy metals, and microbial loads tested in sachet water across Nigeria's six geopolitical zones, within the period of 2020-2023. In this review study, over 50 articles were carefully analyzed. Collected data unveiled regional variations in the quality of sachet water across Nigeria. Noteworthy concerns revolve around levels of pH, total hardness, magnesium, calcium, nickel, iron, lead, mercury, arsenic, and cadmium. Fecal contamination was also identified as a significant issue, with the prevalence of several pathogens like Escherichia coli, Salmonella typhi, Enterobacter cloacae, Staphylococcus aureus, and Enterococcus faecalis. The manufacturing, delivery, storage, and final sale of sachet water, as well as poor environmental hygiene, were identified as potential contamination sources. The intake of contaminated sachet water exposes the citizens to waterborne and carcinogenic diseases. While the sachet water industry keeps growing and making profits, it is apparent that improvement calls made by previous studies, regarding the quality of water produced, have not been paid serious attention.

Environmental Risk Factors in Autism Spectrum Disorder: A Narrative Review

Existing evidence indicates that environmental factors might contribute up to 50% of the variance in autism spectrum disorder (ASD) risk. This structured narrative review offers a comprehensive synthesis of current knowledge on environmental risk factors in ASD, including evaluation of conflicting evidence, exploration of underlying mechanisms, and suggestions for future research directions. Analysis of diverse epidemiological investigations indicates that certain environmental factors, including advanced parental age, preterm birth, delivery complications, and exposure to toxic metals, drugs, air pollutants, and endocrine-disrupting chemicals, are linked to an increased ASD risk through various mechanisms such as oxidative stress, inflammation, hypoxia, and its consequences, changes in neurotransmitters, disruption of signaling pathways and some others. On the other hand, pregnancy-related factors such as maternal diabetes, maternal obesity, and caesarian section show a weaker association with ASD risk. At the same time, other environmental factors, such as vaccination, maternal smoking, or alcohol consumption, are not linked to the risk of ASD. Regarding nutritional elements data are inconclusive. These findings highlight the significance of environmental factors in ASD etiology and emphasize that more focused research is needed to target the risk factors of ASD. Environmental interventions targeting modifiable risk factors might offer promising avenues for ASD prevention and treatment.

Machine Learning Assisted Discovery of Interactions between Pesticides, Phthalates, Phenols, and Trace Elements in Child Neurodevelopment

A growing body of literature suggests that developmental exposure to individual or mixtures of environmental chemicals (ECs) is associated with autism spectrum disorder (ASD). However, investigating the effect of interactions among these ECs can be challenging. We introduced a combination of the classical exposure-mixture Weighted Quantile Sum (WQS) regression and a machine-learning method termed Signed iterative Random Forest (SiRF) to discover synergistic interactions between ECs that are (1) associated with higher odds of ASD diagnosis, (2) mimic toxicological interactions, and (3) are present only in a subset of the sample whose chemical concentrations are higher than certain thresholds. In a case-control Childhood Autism Risks from Genetics and Environment (CHARGE) study, we evaluated multiordered synergistic interactions among 62 ECs measured in the urine samples of 479 children in association with increased odds for ASD diagnosis (yes vs no). WQS-SiRF identified two synergistic two-ordered interactions between (1) trace-element cadmium (Cd) and the organophosphate pesticide metabolite diethyl-phosphate (DEP); and (2) 2,4,6-trichlorophenol (TCP-246) and DEP. Both interactions were suggestively associated with increased odds of ASD diagnosis in the subset of children with urinary concentrations of Cd, DEP, and TCP-246 above the 75th percentile. This study demonstrates a novel method that combines the inferential power of WQS and the predictive accuracy of machine-learning algorithms to discover potentially biologically relevant chemical-chemical interactions associated with ASD.

Prenatal and postnatal exposure to heavy metals in PM2.5 and autism spectrum disorder

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders, and its incidence is increasing over time. Although several environmental factors have been suspected to be risk factors for ASD, studies on the effects of airborne heavy metals on newly developed ASD are still limited. We conducted a large birth cohort study of 168,062 live term births in Taichung during 2004-2011 to assess the association of heavy metals in particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) with ASD, and identify sensitive time windows during prenatal and postnatal periods. Heavy metals, including arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) in PM2.5, were estimated using the Weather Research and Forecasting/Chem (WRF/Chem), inserted from the top 75 emission sources for the module. The association between childhood ASD and 4 metals were analyzed from pregnancy to 9 months after birth. The Cox proportional hazard model with a distributed lag nonlinear model (DLNM) was used to estimate the association between heavy metals in PM2.5 and ASD. We identified 666 incident ASD cases in 168,062 participants. A positive association between Hg and ASD was found at 9 months after birth (Hazard Ratio: 1.63; 95% CI: 1.13-2.36). According to the DLNM, there was an increased risk of exposure to Hg during 10-25 weeks after birth, and decreased risk of exposure to Hg during gestational weeks 4-6. Exposure to As and Hg on the risk of ASD were significantly stronger in low birth weight infants (<2500 g) than in those of birth weight ≥2500 g during postnatal period. Postnatal exposure to Hg in PM2.5 may associate with increased ASD incidence. Infants with low birth weight and exposure to As and Hg in PM2.5 are more likely to develop ASD.

Thioredoxin 1 and Thioredoxin Reductase 1 Redox System Is Dysregulated in Neutrophils of Subjects with Autism: In Vitro Effects of Environmental Toxicant, Methylmercury

Autism spectrum disorder (ASD) is a complex developmental disorder in children that results in abnormal communicative and verbal behaviors. Exposure to heavy metals plays a significant role in the pathogenesis or progression of ASD. Mercury compounds pose significant risk for the development of ASD as children are more exposed to environmental toxicants. Increased concentration of mercury compounds has been detected in different body fluids/tissues in ASD children, which suggests an association between mercury exposure and ASD. Thioredoxin1 (Trx1) and thioredoxin reductase1 (TrxR1) redox system plays a crucial role in detoxification of oxidants generated in different immune cells. However, the effect of methylmercury and the Nrf2 activator sulforaphane on the Trx1/TrxR1 antioxidant system in neutrophils of ASD subjects has not been studied previously. Therefore, this study examined the effect of methylmercury on Trx1/TrxR1 expression, TrxR activity, nitrotyrosine, and ROS in neutrophils of ASD and TDC subjects. Our study shows that Trx1/TrxR1 protein expression is dysregulated in ASD subjects as compared to the TDC group. Further, methylmercury treatment significantly inhibits the activity of TrxR in both ASD and TDC groups. Inhibition of TrxR by mercury is associated with upregulation of the Trx1 protein in TDC neutrophils but not in ASD neutrophils. Furthermore, ASD neutrophils have exaggerated ROS production after exposure to methylmercury, which is much greater in magnitude than TDC neutrophils. Sulforaphane reversed methylmercury-induced effects on neutrophils through Nrf2-mediated induction of the Trx1/TrxR1 system. These observations suggest that exposure to the environmental toxicant methylmercury may elevate systemic oxidative inflammation due to a dysregulated Trx1/TrxR1 redox system in the neutrophils of ASD subjects, which may play a role in the progression of ASD.

Association between heavy metals exposure (cadmium, lead, arsenic, mercury) and child autistic disorder: a systematic review and meta-analysis

Background

Studies have found that toxic heavy metals exposure could induce the generation of reactive oxygen species (ROS), and is of epigenetic effect, which might be associated with the occurrence of Autistic Disorder (ASD). This systematic review and meta-analysis aims to elucidate the association between exposure to 4 heavy metals, cadmium (Cd), lead (Pb), arsenic(As), and mercury (Hg), and the occurrence of ASD in children.

Methods

We searched PubMed, Web of Science, Embase, and Cochrane Library, from their inception to October 2022, for epidemiological investigations that explore the association between exposure to Cd, Pb, As, or Hg and the occurrence of child ASD.

Results

A total of 53 studies were included, involving 5,054 individuals aged less than 18 (2,533 ASD patients and 2,521 healthy controls). Compared with the healthy controls, in hair and blood tests, concentrations of the 4 heavy metals were significantly higher in the ASD group than in the healthy control group, and the differences in Pb, arsenic and Hg were statistically significant (P < 0.05). In the urine test, concentrations of arsenic and Hg were significantly higher in the ASD group than in the healthy control group (P < 0.05), while the results of Cd and Pb were opposite to those of arsenic and Hg (P > 0.05). Subgroup analysis for geographic regions showed that ASD patients in Asia and Europe had higher concentrations of the 4 heavy metals, compared with the healthy controls, in which the differences in Pb, arsenic, and Hg were statistically significant (P < 0.05), while in North America, the healthy controls had higher Cd, arsenic, and Hg concentrations (P > 0.05).

Conclusion

Compared with the healthy control group, the ASD group had higher concentrations of Cd, Pb, arsenic, and Hg. These 4 heavy metals play different roles in the occurrence and progression of ASD. Moreover, there is significant heterogeneity among the included studies due to controversies about the study results among different countries and regions and different sources of detection materials. The results of this study firmly support the policies to limit heavy metals exposure, especially among pregnant women and young children, so as to help reduce the incidence of ASD.

Comparison between pollutants found in breast milk and infant formula in the last decade: A review

Since ancient times, breastfeeding has been the fundamental way of nurturing the newborn. The benefits of breast milk are widely known, as it is a source of essential nutrients and provides immunological protection, as well as developmental benefits, among others. However, when breastfeeding is not possible, infant formula is the most appropriate alternative. Its composition meets the nutritional requirements of the infant, and its quality is subject to strict control by the authorities. Nonetheless, the presence of different pollutants has been detected in both matrices. Thus, the aim of the present review is to make a comparison between the findings in both breast milk and infant formula in terms of contaminants in the last decade, in order to choose the most convenient option depending on the environmental conditions. For that, the emerging pollutants including metals, chemical compounds derived from heat treatment, pharmaceutical drugs, mycotoxins, pesticides, packaging materials, and other contaminants were described. While in breast milk the most concerning contaminants found were metals and pesticides, in infant formula pollutants such as metals, mycotoxins, and packaging materials were the most outstanding. In conclusion, the convenience of using a feeding diet based on breast milk or either infant formula depends on the maternal environmental circumstances. However, it is important to take into account the immunological benefits of the breast milk compared to the infant formula, and the possibility of using breast milk in combination with infant formula when the nutritional requirements are not fulfilled only with the intake of breast milk. Therefore, more attention should be paid in terms of analyzing these conditions in each case to be able to make a proper decision, as it will vary depending on the maternal and newborn environment.

Aluminium in the Human Brain: Routes of Penetration, Toxicity, and Resulting Complications

Aluminium (Al) is the most ubiquitous metal in the Earth's crust. Even though its toxicity is well-documented, the role of Al in the pathogenesis of several neurological diseases remains debatable. To establish the basic framework for future studies, we review literature reports on Al toxicokinetics and its role in Alzheimer's disease (AD), autism spectrum disorder (ASD), alcohol use disorder (AUD), multiple sclerosis (MS), Parkinson's disease (PD), and dialysis encephalopathy (DE) from 1976 to 2022. Despite poor absorption via mucosa, the biggest amount of Al comes with food, drinking water, and inhalation. Vaccines introduce negligible amounts of Al, while the data on skin absorption (which might be linked with carcinogenesis) is limited and requires further investigation. In the above-mentioned diseases, the literature shows excessive Al accumulation in the central nervous system (AD, AUD, MS, PD, DE) and epidemiological links between greater Al exposition and their increased prevalence (AD, PD, DE). Moreover, the literature suggests that Al has the potential as a marker of disease (AD, PD) and beneficial results of Al chelator use (such as cognitive improvement in AD, AUD, MS, and DE cases).

The role of environmental trace element toxicants on autism: A medical biogeochemistry perspective

Since genetic factors alone cannot explain most cases of Autism, the environmental factors are worth investigating as they play an essential role in the development of some cases of Autism. This research is a review paper that aims to clarify the role of the macro elements (MEs), Trace elements (TEs) and ultra-trace elements (UTEs) on human health if they are greater or less than the normal range. Aluminium (Al), cadmium Cd), lead (Pb), chromium (Cr), zinc (Zn), copper (Cu), nickel (Ni), arsenic (As), mercury (Hg), manganese (Mn), and iron (Fe) have been reviewed. Exposure to toxicants has a chemical effect that may ultimately lead to autism spectrum disorder (ASD). The Cr, As and Al are found in high concentrations in the blood of an autistic child when compared to normal child reference values. The toxic metals, particularly aluminium, are primarily responsible for difficulties in socialization and language skills disabilities. Zinc and copper are important elements in regulating the gene expression of metallothioneins (MTs), and zinc deficiency may be a risk factor for ASD pathogenesis. Autistics frequently have zinc deficiency combined with copper excess; as part of the treatment protocol, it is critical to monitor zinc and copper levels in autistic people, particularly those with zinc deficiency. Zinc deficiency is linked to epileptic seizures, which are common in autistic patients. Higher serum manganese and copper significantly characterize people who have ASD. Autistic children have significantly decreased lead and cadmium in urine, whereas they have significantly higher urine Cr. A higher level of As and Hg was found in the ASD individual's blood.

Phenotypic aging mediates the association between blood cadmium and depression: a population-based study

Depression is a serious public health problem today, especially in middle-aged and older adults. Although the etiology of the disease has not been fully elucidated, environmental factors are increasingly not negligible. Cadmium is widely used in industrial production. The general population may be chronically exposed to low doses of cadmium. This study aimed to investigate the association between blood cadmium and depression and to explore the mediating role of aging indicators in this process. We conducted a cross-sectional study on blood cadmium (N = 7195, age ≥ 20 years) using data from the 2007-2010 National Health and Nutrition Examination Survey (NHANES). Aging indicators (biological and phenotypic age) are calculated by combining multiple biochemical and/or functional indicators. To determine the relationship between blood cadmium concentrations and depressive symptoms, we used weighted multivariate logistic regression and restricted cubic spline functions and employed mediation analysis to explore the possible mediating effects of aging indicators in the process. We found a significant positive association between blood cadmium and depression with an odds ratio (OR) and 95% confidence interval (CI): 1.22 (1.04,1.43). Restricted cubic spline analysis found a linear positive association between blood cadmium and depression. In the fully covariate-adjusted model, we found a positive association between blood cadmium and biological age and phenotypic age with β and 95% CI: 1.02 (0.65, 1.39) and 2.35 (1.70, 3.01), respectively. In the mediation analysis, we found that phenotypic age mediated 21.32% of the association between blood cadmium and depression. These results suggest that even exposure to low doses of cadmium can increase the risk of depression and that this process may be mediated by phenotypic aging.

A systematic literature review on the association between exposures to toxic elements and an autism spectrum disorder

BACKGROUND AND AIM

Autism spectrum disorder (ASD) is a neurodevelopmental illness characterized by difficulties in social communication and repetitive behaviors. There have been many previous studies of toxic metals in ASD. Therefore, the priority of this study is to review the relationships between exposure to toxic metals and ASD.

MATERIALS & METHODS

This study was based on a comprehensive search of international databases, such as Web of Science, Science Direct, Scopus, PubMed, and Google Scholar, for all works related to the subject under discussion from 1982 to 2022. We further summarize published data linked to this topic and discuss with clarifying evidence that agrees and conflicts with the association between exposure to toxic metals, including mercury (Hg), lead (Pb), cadmium (Cd), arsenic (As), and aluminum (Al) and ASD.

RESULTS

40 out of 63 papers met the requirements for meta-analysis. Blood Pb levels (standardized mean difference (SMD) = 0.81; 95 % confidence interval (CI): 0.36-1.25), blood Hg (SMD = 0.90; CI: 0.30-1.49), hair Pb (SMD = 1.47; CI: 0.03-2.92), urine As (SMD = 0.65; CI: 0.22-1.09), and urine Al levels (SMD = 0.85; CI: 0.40-1.29) in autistic individuals were significantly higher than those of healthy control (HC). Whereas, blood As levels (SMD = 1.33; CI: -1.32-3.97), hair As (SMD = 0.55; CI: -0.14-1.24), hair Cd (SMD = 0.60; CI: -0.31-1.51), hair Hg (SMD = 0.41; CI: -0.30-1.12), hair Al (SMD = 0.87; CI: -0.02-1.77), urine Pb (SMD = -0.68; CI: -2.55-1.20), urine Cd (SMD = -0.26; CI: -0.94-0.41), and urine Hg levels (SMD = 0.47; CI: -0.09-1.04) in autistic individuals were significantly lower than those of HC.

CONCLUSION

Toxic metal content significantly differed between individuals with ASD and HC in the current meta-analysis. The results assist in clarifying the significance of toxic metals as environmental factors in the development of ASD.

Metal Profiles in Autism Spectrum Disorders: A Crosstalk between Toxic and Essential Metals

Since hundreds of years ago, metals have been recognized as impacting our body's physiology. As a result, they have been studied as a potential cure for many ailments as well as a cause of acute or chronic poisoning. However, the link between aberrant metal levels and neuropsychiatric illnesses such as schizophrenia and neurodevelopmental disorders, such as autism spectrum disorders (ASDs), is a relatively new finding, despite some evident ASD-related consequences of shortage or excess of specific metals. In this review, we will summarize past and current results explaining the pathomechanisms of toxic metals at the cellular and molecular levels that are still not fully understood. While toxic metals may interfere with dozens of physiological processes concurrently, we will focus on ASD-relevant activity such as inflammation/immune activation, mitochondrial malfunction, increased oxidative stress, impairment of axonal myelination, and synapse formation and function. In particular, we will highlight the competition with essential metals that may explain why both the presence of certain toxic metals and the absence of certain essential metals have emerged as risk factors for ASD. Although often investigated separately, through the agonistic and antagonistic effects of metals, a common metal imbalance may result in relation to ASD.

Inductively coupled plasma mass spectrometry based urine metallome to construct clinical decision models for autism spectrum disorder

BACKGROUND

The global prevalence of autism spectrum disorder (ASD) is on the rise, and high levels of exposure to toxic heavy metals may be associated with this increase. Urine analysis is a noninvasive method for investigating the accumulation and excretion of heavy metals. The aim of this study was to identify ASD-associated urinary metal markers.

METHODS

Overall, 70 children with ASD and 71 children with typical development (TD) were enrolled in this retrospective case-control study. In this metallomics investigation, inductively coupled plasma mass spectrometry was performed to obtain the urine profile of 27 metals.

RESULTS

Children with ASD could be distinguished from children with TD based on the urine metal profile, with ASD children showing an increased urine metal Shannon diversity. A metallome-wide association analysis was used to identify seven ASD-related metals in urine, with cobalt, aluminum, selenium, and lithium significantly higher, and manganese, mercury, and titanium significantly lower in the urine of children with ASD than in children with TD. The least absolute shrinkage and selection operator (LASSO) machine learning method was used to rank the seven urine metals in terms of their effect on ASD. On the basis of these seven urine metals, we constructed a LASSO regression model for ASD classification and found an area under the receiver operating characteristic curve of 0.913. We also constructed a clinical prediction model for ASD based on the seven metals that were different in the urine of children with ASD and found that the model would be useful for the clinical prediction of ASD risk.

CONCLUSIONS

The study findings suggest that altered urine metal concentrations may be an important risk factor for ASD, and we recommend further exploration of the mechanisms and clinical treatment measures for such alterations.

Systemic maternal inflammation promotes ASD via IL-6 and IFN-γ

Autism spectrum disorder (ASD) is a neurological disorder that manifests during early development, impacting individuals through their ways of communicating, social behaviors, and their ability to perform day-to-day activities. There have been different proposed mechanisms on how ASD precipitates within a patient, one of which being the impact cytokines have on fetal development once a mother's immune system has been activated (referred to as maternal immune activation, MIA). The occurrence of ASD has long been associated with elevated levels of several cytokines, including interleukin-6 (IL-6) and interferon gamma (IFN-γ). These proinflammatory cytokines can achieve high systemic levels in response to immune activating pathogens from various extrinsic sources. Transfer of cytokines such as IL-6 across the placental barrier allows accumulation in the fetus, potentially inducing neuroinflammation and consequently altering neurodevelopmental processes. Individuals who have been later diagnosed with ASD have been observed to have elevated levels of IL-6 and other proinflammatory cytokines during gestation. Moreover, the outcome of MIA has been associated with neurological effects such as impaired social interaction and an increase in repetitive behavior in animal models, supporting a mechanistic link between gestational inflammation and development of ASD-like characteristics. The present review attempts to provide a concise overview of the available preclinical and clinical data that suggest cross-talk between IL-6 and IFN-γ through both extrinsic and intrinsic factors as a central mechanism of MIA that may promote the development of ASD.

Neurotoxic effects of environmental contaminants-measurements, mechanistic insight, and environmental relevance

Pollution is a significant and growing concern for any population regardless of age because these environmental contaminants exhibit different neurodegenerative effects on persons of different ages. These environmental contaminants are the products of human welfare projects like industry, automobile exhaust, clinical and research laboratory extrudes, and agricultural chemicals. These contaminants are found in various forms in environmental matrices like nanoparticles, particulate matter, lipophilic vaporized toxicants, and ultrafine particulate matter. Because of their small size, they can easily cross blood-brain barriers or use different cellular mechanisms for assistance. Other than this, these contaminants cause an innate immune response in different cells of the central nervous system and cause neurotoxicity. Considering the above critiques and current needs, this review summarizes different protective strategies based on bioactive compounds present in plants. Various bioactive compounds from medicinal plants with neuroprotective capacities are discussed with relevant examples. Many in vitro studies on clinical trials have shown promising outcomes using plant-based bioactive compounds against neurological disorders.

Toxic metal exposures from infant diets: Risk prevention strategies for caregivers and health care professionals

Concerns are growing regarding the presence of toxic elements such as arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) in the ingredients and prepared foods for infants and young children. There are few clear, evidence-based, guidelines on the maximum tolerable limits of toxicants in foods and little understanding of toxicant exposure or adverse health effects attributable to dietary exposure. Caregivers are faced with the burden of making decisions about which foods to select, how often to feed them to their children, and what foods to limit. This article reviews the current literature and existing recommendations on dietary exposure to toxic elements in children under 2 years of age, and their health effects in early childhood-focusing on growth, neurodevelopment, and immune function. The article also outlines best practices for healthcare providers to address the concerns of toxic element exposure through the diet in young children. Several foods consistently appear in the literature as potential sources of toxic element exposure. Contaminated drinking and cooking water, including water used to prepare infant formula, could also be a major exposure source. In the absence of stronger evidence on effects of dietary modification, exclusive breastfeeding until six months of age, followed by a diverse diet are some strategies to reduce dietary toxic element exposure while ensuring an adequate and balanced nutrient intake. Healthcare providers can support families by sharing information and encouraging blood Pb testing, the only element for which such testing is currently recommended.

The combined effect between BDNF genetic polymorphisms and exposure to metals on the risk of Chinese dyslexia

BDNF gene has been implicated in the development of cognition and language. Meanwhile, exposure to metals might interact with BDNF gene to increase the risk of neurodevelopmental disorders. The present study aimed to explore the association between BDNF genetic polymorphisms and dyslexic risk and examine whether BDNF polymorphisms would interact with metal exposures, jointly contributing to dyslexia. Among a case-control study composed of 238 children with dyslexia and 228 healthy controls, the BDNF genetic polymorphisms were genotyped by the Sequenom MassARRAY system, and the exposure to eight metals, such as lead (Pb), mercury (Hg) and copper (Cu), were measured using an inductively coupled plasma-mass spectrometer (ICP-MS). Multivariable logistic regression models were used to assess the adjusted odds ratios (ORs) and 95% confidence interval (CI) of dyslexia. After multivariate adjustment, significant associations of dyslexic risk with rs6265 polymorphisms of the BDNF gene were observed (OR = 1.99; 95% CI: 1.15-3.44). Furthermore, exposure to Cu could interact with rs6265 to increase the risk of dyslexia (P interaction = 0.045). High-Cu children with the rs6265 TT genotype were more likely to have dyslexia compared with low-Cu children carrying CC + CT genotypes (OR = 3.19; 95% CI: 1.38-7.39). The findings of this study suggested that the polymorphism of rs6265 in BDNF gene could interact with Cu exposure to increase the occurrence of dyslexia.

A Mini-Review Regarding the Modalities to Study Neurodevelopmental Disorders-Like Impairments in Zebrafish—Focussing on Neurobehavioural and Psychological Responses

Neurodevelopmental disorders (NDDs) are complex disorders which can be associated with many comorbidities and exhibit multifactorial-dependent phenotypes. An important characteristic is represented by the early onset of the symptoms, during childhood or young adulthood, with a great impact on the socio-cognitive functioning of the affected individuals. Thus, the aim of our review is to describe and to argue the necessity of early developmental stages zebrafish models, focusing on NDDs, especially autism spectrum disorders (ASD) and also on schizophrenia. The utility of the animal models in NDDs or schizophrenia research remains quite controversial. Relevant discussions can be opened regarding the specific characteristics of the animal models and the relationship with the etiologies, physiopathology, and development of these disorders. The zebrafish models behaviors displayed as early as during the pre-hatching embryo stage (locomotor activity prone to repetitive behavior), and post-hatching embryo stage, such as memory, perception, affective-like, and social behaviors can be relevant in ASD and schizophrenia research. The neurophysiological processes impaired in both ASD and schizophrenia are generally highly conserved across all vertebrates. However, the relatively late individual development and conscious social behavior exhibited later in the larval stage are some of the most important limitations of these model animal species.

A case-control study on the relationship between urine trace element levels and autism spectrum disorder among Iranian children

Autism spectrum disorder (ASD) is a type of neurodevelopmental disorder characterized mainly by qualitative deficiencies in social communication skills, accompanied by repetitive and restricted behavior patterns. This study was conducted to investigate the associations between the risk of ASD development in children and exposure to trace elements (arsenic (As), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), lead (Pb), nickel (Ni), and zinc (Zn)). Two groups of children, including 44 ASD and 35 typically developing (TD) children, were selected, and their fasting urine samples were obtained. The concentration levels of trace elements were assayed using ICP-MS. The results showed that as compared to the TD group, the concentration levels of As (p = 0.002) and Pb (p < 0.001) and also Cr (p < 0.001), Cu (p = 0.001), and Ni (p < 0.001) were significantly higher among ASD children. In terms of gender, boys with ASD showed elevated levels of Cr, Cu, Ni, and Pb, whereas the urine levels of As, Cr, Cu, Ni, and Pb were markedly higher among girls when compared to the non-ASD children. Under the logistic regression model, the risk difference for As, Co, Cr, Cu, Ni, Pb, and Zn remained significant when adjustment was applied for age and gender confounders.

Outdoor light at night and autism spectrum disorder in Shanghai, China: A matched case-control study

BACKGROUND

Several environmental factors have been identified to be associated with autism spectrum disorder (ASD) over the past decades. However, evidence is limited for the effect of exposure to outdoor light at night (LAN) on ASD in China and even elsewhere in the world.

METHODS

Participants in this study were from a multi-stage sampling survey on ASD conducted between June 2014 and October 2014 among children aged 3-12 years in Shanghai, China. All participants underwent a two-stage screening of ASD via questionnaire, and then, suspected cases were finally diagnosed by clinical examination. For data analyses, each ASD case was randomly matched with 10 healthy controls by age and sex. The LAN data were extracted from the stable lights product of the US Defense Meteorological Satellite Program's Operational Linescan System (DMSP-OLS) according to geolocation information of residential addresses. Mean levels of exposure to LAN during the 3 years after birth and 1 year before birth were calculated. We used conditional logistic regression models to examine the association between LAN and ASD.

RESULTS

We investigated 84,934 children from 96 kindergartens, 55 primary schools, and 28 special education schools, and 203 children were diagnosed as ASD cases. A total of 1727 children (157 ASD cases and 1570 healthy controls) were included in the final analyses. Brighter LAN exposures after and before birth were significantly associated with higher risk of ASD. After adjusting for potential covariates, adjusted odd ratios and 95% confidence intervals associated with per unit increase in LAN were 1.066 (1.027, 1.107) during the 3 years after birth and 1.046 (1.018, 1.075) during the 1 year before birth.

CONCLUSIONS

Results of our study concluded brighter LAN exposure was significantly associated with higher risk of ASD among Chinese children, which suggested that outdoor LAN could be a potential risk factor of ASD.

The myth of vaccination and autism spectrum

BACKGROUND

Among all of the studied potential causes of autism, vaccines have received some of the most scrutiny and have been the topic of many evidence-based studies. These efforts have led the great majority of scientists, physicians, and public health researchers to refute causation between vaccines and autism.

RATIONALE

This presumed association and concern has been a major contributor to parents' refusal to immunize their children and has become a major threat to public health in secluded populations over the last two decades, even prior to the COVID-19 pandemic. With the emergence of COVID-19 immunizations, sentiments towards this topic were addressed as a public health concern that may influence the ability to overcome the Corona virus worldwide.

SCIENTIFIC REVIEW OF DATA

Despite the overwhelming data demonstrating that there is no link between vaccines and autism, many parents are hesitant to immunize their children because of the alleged association. Other contributing factors to the myths and conspiracy theories surrounding the association between vaccines and autism include the fact that the diagnosis of autism is typically made after the age of receiving the main childhood immunizations, as well as the occasional occurrence of regression after the age of first year vaccinations. In spite of vast evidence that the main contribution to the increase in incidence is from improvement of the diagnostic process, this rapid and publicized rise in autism diagnoses feeds parental concerns regarding any medical intervention that may be associated with the health of their children.

RECOMMENDATIONS

It is plausible that with more evidence-based studies linking autism to specific etiologies the myth will diminish and disappear eventually. In an era where conspiracy theories are prevalent on social media, it is critical that evidence-based studies relating autism to specific etiologies be made public, and that information concerning autism diagnosis and causes be made more readily available through social media and parental organizations.

Preconcentration and determination of trace Hg(ii) using ultrasound-assisted dispersive solid phase microextraction

Defect rich molybdenum disulfide (MoS₂) nanosheets were hydrothermally synthesized and their potential for ultrasound assisted dispersive solid phase microextraction of trace Hg(ii) ions was assessed. Ultrasonic dispersion allows the MoS₂ nanosheets to chelate rapidly and evenly with Hg(ii) ions and results in improving the precision and minimizing the extraction time. The multiple defect rich surface was characterized by X-ray diffraction and high-resolution transmission electron microscopy. The surface charge of intrinsically sulfur rich MoS₂ nanosheets and their elemental composition was characterized by zeta potential measurements, energy dispersive spectroscopy, and X-ray photoelectron spectroscopy. The cracks and holes on the basal planes of MoS₂ led to diffusion of the Hg(ii) ions into the interior channels. Inner-sphere chelation along with outer-sphere electrostatic interaction were the proposed mechanism for the Hg(ii) adsorption onto the MoS₂ surface. The experimental data showed good selectivity of MoS₂ nanosheets towards Hg(ii) adsorption. The systematic and constant errors of the proposed method were ruled out by the analysis of the Standard Reference Material (>95% recovery with <5% RSD). The Student's t-test values for the analyzed Standard Reference Material were found to be less than the critical Student's t value at 95% confidence level. The limit of detection (3S) was found to be 0.01 ng mL⁻¹. The MoS₂ nanosheets were successfully employed for the analysis of Hg(ii) in environmental water samples.

Hg(ii) ion adsorption onto an MoS₂ surface.

Neuroprotective effect of Bryophyllum pinnatum flavonoids against aluminum chloride-induced neurotoxicity in rats

Toxic metals such as aluminum accumulation in the brain have been associated with the pathophysiology of several neurodegenerative disorders. Bryophyllum pinnatum leaves contain a vast array of polyphenols, particularly flavonoids, that may play a role in the prevention of toxic and degenerative effects in the brain. This study assessed the neuro-restorative potential of leaves of B. pinnatum enriched flavonoid fraction (BPFRF) in aluminum-induced neurotoxicity in rats. Neurotoxicity was induced in male Wistar rats by oral administration of 150 mg/kg body weight of aluminum chloride (AlCl₃) for 21 days. Rats were grouped into five (n = 6); Control (untreated), Rivastigmine group, AlCl₃ group and BPFRF group (50 and 100 mg/kg b.wt.) for 21 days. Neuronal changes in the hippocampus and cortex were biochemically and histologically evaluated. Expression patterns of acetylcholinesterase (AChE) mRNA were assessed using semi-quantitative reverse-transcription-polymerase chain reaction protocols. Molecular interactions of BPFRF compounds were investigated in silico. The results revealed that oral administration of BPFRF ameliorated oxidative imbalance by augmenting antioxidant systems and decreasing lipid peroxidation caused by AlCl₃. BPFRF administration also contributed to the down-regulation of AChE mRNA transcripts and improved histological features in the hippocampus and cortex. Molecular docking studies revealed strong molecular interactions between BPFRF compounds, catalase, superoxide dismutase and glutathione peroxidase Overall, these findings suggest the neuroprotective effect of Bryophyllum pinnatum against aluminum-induced neurotoxicity.

Evaluation of the Relationship Between Environmental Factors, Nutrition, and Metabolic Changes in Children Diagnosed With Autism in North Cyprus: A Case-Control Study

Introduction

Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by deficits in social behaviors and nonverbal interactions. The disorder is believed to be multifactorial regarding etiopathology. This study aimed to investigate the possible risk factors associated with the development of autism in the prenatal and postnatal periods.

Methods

We conducted an unmatched case-control study composed of 56 autistic cases and 85 control children in North Cyprus. Cases recruited were previously diagnosed by a pediatric psychiatrist as being on the autistic spectrum. Parental questionnaires were distributed, and the collected data were analysed using Statistical Package for the Social Sciences (SPSS) version 24 (IBM Corp, Armonk, NY). Binary logistic regression was used to compute the adjusted odds ratios (aOR), adjusted for possible confounders.

Results

Our results showed increased odds of developing ASD in mothers with mental disorders such as depression and anxiety (aOR 6.99; 95% CI 1.94 - 25.24), mothers with medical conditions such as Hashimoto’s thyroiditis (aOR 2.68; 95% CI 1.06 - 6.78), mothers using aluminum-containing anti-acids (aOR 2.34; 95% CI 1.012 - 5.39), mothers exposed to loud noises during pregnancy (aOR 2.66; 95% CI 1.005 - 7.034), mothers with ≥ two previous miscarriages (aOR 4.19; 95% CI 1.17 -14.97), neonates with birth weight <2500 grams (aOR 4.19; 95% CI 1.16 - 14.84), male gender neonates (aOR 3.26; 95% CI 1.31 - 8.90), and neonates exposed to MRI or CT scan during the first year of life (aOR 6.94; 95% CI 1.15 - 42.07). Decreased odds of ASD development were observed in mothers using multivitamins during pregnancy (aOR 0.35; 95% CI 0.13 - 0.97), mothers consuming slight amounts of baking powder during pregnancy (aOR 0.235; 95% CI 0.09 - 0.60), mothers with threatened abortion (aOR 0.35; 95% CI 0.12 - 0.98), and neonates taking iron supplementation during the first six months of life (aOR 0.38; 95% 0.16 - 0.91).

Conclusion

There were various maternal and neonatal factors associated with ASD development in North Cyprus. Although there is some evidence to suggest that exposure to specific factors during prenatal or postnatal periods may increase the risk of ASD, there is insufficient evidence that implicates a specific factor for autism etiology. Future studies are recommended to be performed on larger scales to support further the factors associated with ASD development.

Mechanisms of Metal-Induced Mitochondrial Dysfunction in Neurological Disorders

Metals are actively involved in multiple catalytic physiological activities. However, metal overload may result in neurotoxicity as it increases formation of reactive oxygen species (ROS) and elevates oxidative stress in the nervous system. Mitochondria are a key target of metal-induced toxicity, given their role in energy production. As the brain consumes a large amount of energy, mitochondrial dysfunction and the subsequent decrease in levels of ATP may significantly disrupt brain function, resulting in neuronal cell death and ensuing neurological disorders. Here, we address contemporary studies on metal-induced mitochondrial dysfunction and its impact on the nervous system.

Perturbed MAPK signaling in ASD: Impact of metal neurotoxicity

The mitogen-activated protein kinase (MAPK) pathways are intracellular signaling pathways necessary for regulating various physiological processes, including neurodevelopment. The developing brain is vulnerable to toxic substances, and metals, such as lead, mercury, nickel, manganese, and others, have been proven to induce disturbances in the MAPK signaling pathway. Since a well-regulated MAPK is necessary for normal neurodevelopment, perturbation of the MAPK pathway results in neurodevelopmental disorders, including autism spectrum disorder (ASD). ASD affects brain parts responsible for communication, cognition, social interaction, and other patterned behaviors. Several studies have addressed the role of metals in the etiopathogenesis of ASD. Here, we briefly review the MAPK signaling pathway and its role in neurodevelopment. Furthermore, we highlight the role of metal toxicity in the development of ASD and how perturbed MAPK signaling may result in ASD.

Sulfur amino acid metabolism and related metabotypes of autism spectrum disorder: A review of biochemical evidence for a hypothesis

There are multiple lines of evidence for an impaired sulfur amino acid (SAA) metabolism in autism spectrum disorder (ASD). For instance, the concentrations of methionine, cysteine and S-adenosylmethionine (SAM) in body fluids of individuals with ASD is significantly lower while the concentration of S-adenosylhomocysteine (SAH) is significantly higher as compared to healthy individuals. Reduced methionine and SAM may reflect impaired remethylation pathway whereas increased SAH may reflect reduced S-adenosylhomocysteine hydrolase activity in the catabolic direction. Reduced SAM/SAH ratio reflects an impaired methylation capacity. We hypothesize multiple mechanisms to explain how the interplay of oxidative stress, neuroinflammation, mercury exposure, maternal use of valproate, altered gut microbiome and certain genetic variants may lead to these SAA metabotypes. Furthermore, we also propose a number of mechanisms to explain the metabolic consequences of abnormal SAA metabotypes. For instance in the brain, reduced SAM/SAH ratio will result in melatonin deficiency and hypomethylation of a number of biomolecules such as DNA, RNA and histones. In addition to previously proposed mechanisms, we propose that impaired activity of "radical SAM" enzymes will result in reduced endogenous lipoic acid synthesis, reduced molybdenum cofactor synthesis and impaired porphyrin metabolism leading to mitochondrial dysfunction, porphyrinuria and impaired sulfation capacity. Furthermore depletion of SAM may also lead to the disturbed mTOR signaling pathway in a subgroup of ASD. The proposed "SAM-depletion hypothesis" is an inclusive model to explain the relationship between heterogeneous risk factors and metabotypes observed in a subset of children with ASD.