Effect of acute copper exposure on gastrointestinal permeability in healthy volunteers

Lustrous White Erosions Surrounded by an Erythematous Mucosa: A Novel Endoscopic Finding of Gastric Lesions in Patients with Wilson Disease

Wilson disease is an inherited copper metabolism disorder. We herein report a novel endoscopic finding in three men with Wilson disease. These patients underwent upper endoscopy due to gastrointestinal symptoms or during follow-up. In each case, endoscopy revealed lustrous white erosions surrounded by an erythematous mucosa in the greater curvature of the gastric body. A biopsy of the lesions showed orcein-positive tissue, indicating copper deposition, in the interstitial stroma and fundic glands of the mucosa. All patients had been receiving treatment with zinc acetate. These endoscopic findings might have been related to the cytotoxicity of the accumulated copper and zinc acetate.

Evaluating tissue levels of the eight trace elements and heavy metals among esophagus and gastric cancer patients: A comparison between cancerous and non-cancerous tissues

BACKGROUND

Considering the affecting role of environmental factors including trace elements and heavy metals on the upper gastrointestinal (GI) cancers, there is paucity of empirical research in tissue evaluations.

OBJECTIVES

The present study aimed to measure the tissue content of some trace elements and heavy metals such as zinc (Zn), chromium (Cr), manganese (Mn), tin (Sn), copper (Cu), aluminum (Al), lead (Pb), and iron (Fe) in esophagus and gastric cancerous tissues compared to the adjacent healthy tissues.

METHODS

In a cross-sectional study, the aforementioned trace elements and heavy metals were evaluated among patients with esophagus and gastric cancers. During endoscopy, multiple samples were taken from cancerous lesions and the adjacent healthy tissues. The classic flame atomic absorption spectroscopy (FAAS) method was employed as the study framework.

RESULTS

Fifty patients with the mean age of 53.92 ± 8.73 were enrolled in the current study. Thirteen patients suffered from esophageal cancer and thirty-seven patients were afflicted with gastric cancer. The results revealed significant differences in the median concentrations of Zn, Cr, Sn and, Cu (P < 0.05) between the two groups. Although there were no significant changes in the tissue content in the esophageal samples, in the median concentrations of Zn, Cr and, Sn (P < 0.05) in gastric tissues, significant differences were observed. Further, the results indicated that gender enacted an affecting role in the level of some trace elements and heavy metals.

CONCLUSION

The tissue contents of some elements were altered in gastric and esophageal cancers; this difference may reflect the underlying mechanism of cellular changing during the tumorigenesis or direct exposure of these elements. It seems that under the shade of other coexisting risk factors, larger cohort studies are suggested to be conducted to investigate other probable aspects in this area of interest.

Pb, Cd, and Cu Play a Major Role in Health Risk from Contamination in Duck Meat and Offal for Food Production in Thailand

Zinc, Pb, Cd, Mn, Fe, Cr, and Cu levels in duck meat from large-scale farms have been found to be significantly higher than those from free-grazing duck farms. Zinc, Co, Mn, Cr, and Cu contamination levels in duck liver from large-scale farms were significantly higher than those from free-grazing farms; only Cd in duck liver from free-grazing farms was higher than in liver samples from large-scale farms at P < 0.05. Lead, Cd, Fe, and Cr levels in duck intestine samples from free-grazing farms were higher than large-scale farms at P < 0.001. Moreover, the average concentrations of Pb in duck meat and liver samples from large-scale farms and Cd levels in duck liver samples from free-grazing farm also exceeded the FAO/WHO and Codex Alimentarius limits by 100% (55/55), 100% (54/54), and 67.6% (23/34), respectively. PCA analysis showed a strong positive relationship between the eight metals in meat, liver, and intestine was > 0.69, > 0.69, and > 0.72, in order. The relationship of the liver combined with the intestine was > 0.65. This study indicated that consumers may incur health risks from long-term consumption of duck due to high Pb and Cd concentrations from both types of farms, particularly from large-scale duck farms.

Advances in the mechanism of high copper diets in restraining pigs growth

High copper feed has been widely used as an inexpensive and highly effective feed additive to promote growth performance of pigs. However, long-term feeding of high copper feed may reduce the growth-promoting effects of copper, time-dependent accumulation of copper in animal tissues and organs, and copper toxicity thereby reducing the growth performance of pigs. Due to the widespread effects of high copper supplementation in animals' diets, the benefits and drawbacks of high copper feeding in pigs have been reported in several studies. Meanwhile, few of these studies have systematically described the mechanism by which high copper diets restrain pig growth. Therefore, to address the concerns and give a better understanding of the mechanism of high copper diet in restraining pig growth in different systems, this paper reviews the research progress of long-term supplementation of high copper on the growth of pigs and provides some suggestions and further research directions.

Health Risk Contamination of Heavy Metals in Yolk and Albumen of Duck Eggs Collected in Central and Western Thailand

Two hundred duck egg samples were collected from 20 farms in Central and Western Thailand. The levels of Zn, Co, Mn, Fe, and Cr in yolks were found significantly higher than in albumen, whereas the levels of Cd and Cu contaminations in egg albumen were significantly higher than in yolks. The mean level of Pb contamination in whole eggs was 4.06 ± 2.70 mg kg^-1 dry weight. This level was higher than the Thai agricultural standard no. 6703-2005 for duck eggs set at 0.1 ppm for the magnitude of 40.6 times. In addition, 98% (196/200) of duck egg samples had Pb levels higher than the standard limit. However, the calculation of daily intakes of Pb, Cd, and Cu contamination in the current study of duck eggs shows that these metals were lower than the World Health Organization and the Food and Agriculture Organization provisional tolerated daily intake. These levels may, however, present a health risk resulting from a long-term exposure. It can be concluded that consumers may be at risk of Pb, Cd, and Cu contamination if they consume contaminated duck eggs. In addition, long-term monitoring of the health risks of heavy metals contamination should be conducted concerning the duck egg production system in Thailand.

A carbon-dot-based dual-emission probe for ultrasensitive visual detection of copper ions

In this work, we successfully developed an ultrasensitive dual-emission fluorescent sensor (CRB) for instant visual determination of Cu²⁺ by modifying a Cu-sensitive rhodamine B derivative (RB) onto photostable carboxyl modified carbon dots (CDs).

Copper Corrosion and Biocorrosion Events in Premise Plumbing

Corrosion of copper pipes may release high amounts of copper into the water, exceeding the maximum concentration of copper for drinking water standards. Typically, the events with the highest release of copper into drinking water are related to the presence of biofilms. This article reviews this phenomenon, focusing on copper ingestion and its health impacts, the physicochemical mechanisms and the microbial involvement on copper release, the techniques used to describe and understand this phenomenon, and the hydrodynamic effects. A conceptual model is proposed and the mathematical models are reviewed.

Impact of copper oxide nanomaterials on differentiated and undifferentiated Caco-2 intestinal epithelial cells; assessment of cytotoxicity, barrier integrity, cytokine production and nanomaterial penetration

BACKGROUND

Copper oxide nanomaterials (CuO NMs) are exploited in a diverse array of products including antimicrobials, inks, cosmetics, textiles and food contact materials. There is therefore a need to assess the toxicity of CuO NMs to the gastrointestinal (GI) tract since exposure could occur via direct oral ingestion, mucocillary clearance (following inhalation) or hand to mouth contact.

METHODS

Undifferentiated Caco-2 intestinal cells were exposed to CuO NMs (10 nm) at concentrations ranging from 0.37 to 78.13 μg/cm2 Cu (equivalent to 1.95 to 250 μg/ml) and cell viability assessed 24 h post exposure using the alamar blue assay. The benchmark dose (BMD 20), determined using PROAST software, was identified as 4.44 μg/cm2 for CuO NMs, and 4.25 μg/cm2 for copper sulphate (CuSO4), which informed the selection of concentrations for further studies. The differentiation status of cells and the impact of CuO NMs and CuSO4 on the integrity of the differentiated Caco-2 cell monolayer were assessed by measurement of trans-epithelial electrical resistance (TEER), staining for Zonula occludens-1 (ZO-1) and imaging of cell morphology using scanning electron microscopy (SEM). The impact of CuO NMs and CuSO4 on the viability of differentiated cells was performed via assessment of cell number (DAPI staining), and visualisation of cell morphology (light microscopy). Interleukin-8 (IL-8) production by undifferentiated and differentiated Caco-2 cells following exposure to CuO NMs and CuSO4 was determined using an ELISA. The copper concentration in the cell lysate, apical and basolateral compartments were measured with Inductive Coupled Plasma Optical Emission Spectrometry (ICP-OES) and used to calculate the apparent permeability coefficient (Papp); a measure of barrier permeability to CuO NMs. For all experiments, CuSO4 was used as an ionic control.

RESULTS

CuO NMs and CuSO4 caused a concentration dependent decrease in cell viability in undifferentiated cells. CuO NMs and CuSO4 translocated across the differentiated Caco-2 cell monolayer. CuO NM mediated IL-8 production was over 2-fold higher in undifferentiated cells. A reduction in cell viability in differentiated cells was not responsible for the lower level of cytokine production observed. Both CuO NMs and CuSO4 decreased TEER values to a similar extent, and caused tight junction dysfunction (ZO-1 staining), suggesting that barrier integrity was disrupted.

CONCLUSIONS

CuO NMs and CuSO4 stimulated IL-8 production by Caco-2 cells, decreased barrier integrity and thereby increased the Papp and translocation of Cu. There was no significant enhancement in potency of the CuO NMs compared to CuSO4. Differentiated Caco-2 cells were identified as a powerful model to assess the impacts of ingested NMs on the GI tract.

Impact of Dietary Lipids on Colonic Function and Microbiota: An Experimental Approach Involving Orlistat-Induced Fat Malabsorption in Human Volunteers

OBJECTIVES:

High-fat diets alter gut microbiota and barrier function, inducing metabolic endotoxemia and low-grade inflammation. Whether these effects are due to the high dietary lipid content or to the concomitant decrease of carbohydrate intake is unclear. The aim of this study was to determine whether higher amounts of dietary fat reaching the colon (through orlistat administration) affect the colonic ecosystem in healthy volunteers and the effect of the prebiotic oligofructose (OF) in this model.

METHODS:

Forty-one healthy young subjects were distributed among four groups: Control (C), Prebiotic (P), Orlistat (O), and Orlistat/Prebiotic (OP). They consumed a fat-standardized diet (60 g/day) during Week-1 (baseline) and after 1 week of washout, Week-3. During Week-3, they also received their respective treatment (Orlistat: 2 × 120 mg/day, OF: 16 g/day, and maltodextrin as placebo). A 72-h stool collection was carried out at the end of Week-1 (T0) and Week-3 (T1). Fecal fat, calprotectin, and short-chain fatty acids (SCFAs) as well as the antioxidant activity of fecal waters (ferric-reducing antioxidant power), fecal microbiota composition (by deep sequencing), and gut permeability (Sucralose/Lactulose/Mannitol test) were determined at these times.

RESULTS:

Fecal fat excretion was higher in the O (P=0.0050) and OP (P=0.0069) groups. This event was accompanied, in the O group, by an increased calprotectin content (P=0.047) and a decreased fecal antioxidant activity (P=0.047). However, these alterations did not alter gut barrier function and the changes observed in the composition of the fecal microbiota only affected bacterial populations with low relative abundance (<0.01%); in consequences, fecal SCFA remained mainly unchanged. Part of the colonic alterations induced by orlistat were prevented by OF administration.

CONCLUSIONS:

In the context of an equilibrated diet, the acute exposition of the colonic ecosystem to high amounts of dietary lipids is associated with an incremented excretion of fecal calprotectin and pro-oxidant activity of the colonic content, in the absence of significant changes in the microbiota.

Label-free detection of Cu(ii) in a human serum sample by using a prion protein-immobilized FET sensor

We report a simple and label-free detection of Cu²⁺utilizing prion proteins as the recognition molecules, which can provide highly sensitive and selective performance at the nanomolar level in a human serum sample.

Nutrients affecting gastric barrier

The gastric barrier could be considered an active tissue involved in many synthetic and metabolic functions, as the immunological defense, by activating mucosal immune system. Barrier integrity results from a balance between protective and aggressive endogenous factors and from their interaction with exogenous factors (steroidal or nonsteroidal anti-inflammatory drugs, dietary nitrates, nitrites and/or NaCl, stress, Helicobacter pylori infection, food allergens and contaminants, metals, chemicals, radiation, smoking and alcohol intake). Nutrients represent the most important exogenous factors affecting gastric barrier because of the impact on people's everyday life. We report evidence from the literature about nutrients affecting gastric barrier and we investigate the possible effect that nutrients can play to determining or maintaining a gastric barrier dysfunction.

Human health effects of residual carbon nanotubes and traditional water treatment chemicals in drinking water

The volume of industrial and domestic wastewater is increasing significantly year by year with the change in the lifestyle based on mass consumption and mass disposal brought about by the dramatic development of economies and industries. Therefore, effective advanced wastewater treatment is required because wastewater contains a variety of constituents such as particles, organic materials, and emulsion depending on the resource. However, residual chemicals that remain during the treatment of wastewaters form a variety of known and unknown by-products through reactions between the chemicals and some pollutants. Chronic exposure to these by-products or residual chemicals through the ingestion of drinking water, inhalation and dermal contact during regular indoor activities (e.g., showering, bathing, cooking) may pose cancer and non-cancer risks to human health. For example, residual aluminium salts in treated water may cause Alzheimer's disease (AD). As for carbon nanotubes (CNTs), despite their potential impacts on human health and the environment having been receiving more and more attention in the recent past, existing information on the toxicity of CNTs in drinking water is limited with many open questions. Furthermore, though general topics on the human health impacts of traditional water treatment chemicals have been studied, no comparative analysis has been done. Therefore, a qualitative comparison of the human health effects of both residual CNTs and traditional water treatment chemicals is given in this paper. In addition, it is also important to cover and compare the human health effects of CNTs to those of traditional water treatment chemicals together in one review because they are both used for water treatment and purification.

The release of zinc, copper, lead, and cadmium from the mineral tissue of teeth under the influence of soft drinks and sour-tasting food

This study was carried out with the aim of identifying the effects of consuming sour-tasting food and refreshing drinks on the bone tissue of teeth among teenagers. The cumulative effect of a year-long exposure of teeth to the erosive effects of a model system of acidic media (citric acid, lactic acid, acetic acid, apple vinegar, lemonade, the soft drink Sprite, mineral water) was studied. The effects were registered based on the amount of released biometal ions, of zinc and copper, and toxic lead, during a period of 24 hr at room temperature, using the potentiometric stripping analysis. In the given time span, amounts ranging from 75 to 750 ppm of zinc, from 0.1 to 1.0 ppm of copper, and up to 1.5 ppm of lead were released from the dental matrix, while the release of cadmium was below the level of detection. The changes to the mineral structure of the bone tissue were monitored by the Fourier's transformation infrared spectroscopy and scanning electron microscopy technique. These studies have shown that under the influence of an acidic medium significant erosion to the tooth enamel ensues and that the eroded surfaces had a radius of 1-5 μm.

Effects of maternal protein nutrition and subsequent grazing on chicory (Cichorium intybus) on parasitism and performance of lambs

Forty-eight 4- to 5-yr-old Blackface x Bluefaced Leicester (Mule) ewes and their 24-d-old twin lambs were used to assess the effects of maternal protein nutrition and subsequent grazing on chicory (Cichorium intybus) on performance and parasitism. The experiment consisted of 2 grazing periods: safe pasture period and experimental pasture period. During an adaptation period of 66 d, ewes were infected through oral dosing with Teladorsagia circumcincta infective larvae (3 d per wk) and were supplemented with protein (HP) or not (LP) for the last 45 d of this period. At the end of this period, ewes and their lambs were turned out onto a parasitologically safe pasture; all ewes continued to be dosed with parasite (once a week), and HP ewes received protein supplementation for the first 35 d. Ewes and lambs grazed the safe pasture for an additional 43 d after termination of protein supplementation and of oral dosing with parasites. Ewes and their lambs were then moved onto newly established experimental pastures sown with chicory or grass/clover (Lolium perenne/Trifolium repens). During the safe pasture period, HP ewes had decreased fecal egg counts (FEC) compared with LP ewes, whereas HP lambs had temporarily less (P < 0.05) FEC, decreased (P < 0.001) plasma pepsinogen concentrations, and grew faster (P = 0.028) than LP lambs. Lambs grazing chicory had consistently less (P < 0.001) FEC and grew faster (P = 0.013) than lambs grazing grass/clover but had greater (P < 0.001) concentrations of pepsinogen. Pasture larvae counts were decreased (P = 0.07) for the chicory compared with the grass/clover plots. There were no interactions (P > 0.10) between maternal nutrition and grazed forage type on performance or parasitological measurements. Our results suggest that increased maternal protein nutrition and subsequent grazing of chicory independently improve lamb performance and reduce lamb parasitism.

Evaluation of powdered infant formula milk as chelating agent for copper under simulated gastric conditions of a baby's stomach

The objective of this study was to determine the complexing capacity of four types of powdered commercial milks with copper(II) using square wave adsorptive stripping voltammetry. Two were types of cow milk adapted for babies under one year (A and B), one was soymilk (C) and the other was normal milk (D). Milk solutions were prepared following the instructions shown on the milk container, and they were mixed with a pepsin solution simulating a baby's stomach conditions (pepsin and salts concentration, pH and temperature). Complexing capacity was determined by titrating milk samples with aliquots of a standard copper solution until the peak current due to solvated or free copper ions was increasing. Assuming a 1:1 copper-milk complex, the apparent stability constant was found using the pseudopolarogram method. The log K'(Cu-milk) values were 4.9, 5.0, 3.0 and 5.1 for A, B, C and D types of milk, respectively. Voltammograms of the milk solution as a function of copper added show that the binding properties of the four types of powdered milk studied were different and that saturation of the four types, occurs at different copper concentrations. Concentrations obtained were: 4.9, 5.8, 1.1 and 10.1 mM for A, B, C and D types, respectively. The best complexing agent was the solution prepared with powdered milk D and the worst was that of C. This is important for the bioavailability of this element as a micronutrient.

Is a leaky gut involved in the pathogenesis of intrahepatic cholestasis of pregnancy?

Increased gastrointestinal permeability has been demonstrated in several liver diseases. It may facilitate the absorption of gut-derived endotoxin-stimulating Kupffer cells to release proinflammatory cytokines or other potentially hepatotoxic compounds. We examined gastrointestinal permeability, plasma levels of anti-lipopolysacharides (anti-LPS), and four proinflammatory cytokines in 20 patients with intrahepatic cholestasis of pregnancy (ICP) compared with 22 normal pregnant and 29 non-pregnant women. Urinary excretion of sucrose and the urinary lactulose/mannitol (L/M) ratio after a standard oral load were used to assess gastrointestinal permeability. Anti-LPS (IgA, IgM, and IgG) were measured in peripheral blood by Human EndoCAb test kit; TNF-alpha, IL-1beta, IL-6, and IL-10 by Quantikine HS human immunoassays. Sucrose urinary excretion was similar in the three groups, indicating normal gastric permeability. The urinary L/M ratio was significantly higher in ICP than in the other groups [median (interquartile range): 0.018% (0.011-0.023) in ICP, 0.012% (0.009-0.016) in normal pregnancies, and 0.009% (0.008-0.012) in non-pregnant women, P < .01]. No significant differences were found in anti-LPS or cytokines plasma levels except slightly higher levels of IL-6 in ICP patients than in non-pregnant women (P < .05). Four of five women with abnormal urinary L/M ratio during ICP continued to show abnormalities in tests up to 2 years after delivery. In conclusion, an increased intestinal permeability was detected in ICP patients during and after pregnancy. A "leaky gut" may participate in the pathogenesis of ICP by enhancing the absorption of bacterial endotoxin and the enterohepatic circulation of cholestatic metabolites of sex hormones and bile salts.

Prebiotic ingestion does not improve gastrointestinal barrier function in burn patients

Prebiotics increase intestinal levels of health-promoting bacteria implicated in decreasing pathogen colonization, stimulating immune functions and stabilizing gut barrier functions, parameters which are altered in burn patients. We propose that regular intake of a prebiotic, oligofructose (OF), might help to improve the altered gastrointestinal (GI) permeability observed in burn patients. A randomized, double-blind, controlled clinical trial was carried out in 41 burn patients (mean burn surface area=17.1+/-8.2%) who ingested daily 6 g of oligofructose (OF group) or sucrose as placebo (Control group) during 15 days. Gastrointestinal permeability to sucrose and lactulose/mannitol (L/M) was evaluated on days 1 (before treatment) 3, 7, 14 and 21. A permeability test was also performed in 18 healthy subjects as controls. Thirty-one patients completed the protocol (dropout rate=24.4%). Healthy subjects had a basal sucrose excretion of 21.3 mg (14.0-32.5 mg) and a basal L/M ratio of 0.017% (0.009-0.022%). Sucrose excretion increased 5-fold and L/M ratio 4.4-fold in burn patients on day 1 and these high levels of marker excretion decreased significantly throughout the study (p=0.016 and 0.000001, respectively). No differences between the OF and Control groups were observed for sucrose excretion or L/M ratio. In conclusion, the normalization of gastrointestinal permeability is not accelerated by prebiotic intake.

Toxicity of copper intake: lipid profile, oxidative stress and susceptibility to renal dysfunction

The present study was carried out to investigate the effects of copper (Cu) intake on lipid profile, oxidative stress and tissue damage in normal and in diabetic condition. Since diabetes mellitus is a situation of high-risk susceptibility to toxic compounds, we examined potential early markers of Cu excess in diabetic animals. Male Wistar rats, at 60-days-old were divided into six groups of eight rats each. The control(C) received saline from gastric tube, the no-diabetic(Cu-10), treated with 10 mg/kg of Cu(Cu(++)-CuSO4, gastric tube), no-diabetic with Cu-60 mg/kg(Cu-60), diabetic(D), diabetic low-Cu(DCu-10) and diabetic high-Cu(DCu-60). Diabetes was induced by an ip injection of streptozotocin (60 mg/kg). After 30 days of treatments, no changes were observed in serum lactate dehydrogenase, alanine transaminase and alkaline phosphatase, indicating no adverse effects on cardiac and hepatic tissues. D-rats had glucose intolerance and dyslipidemic profile. Cholesterol and LDL-cholesterol were higher in Cu-60 and DCu-60 than in C, Cu-10 and D and DCu-10 groups respectively. Cu-60 rats had higher lipid hydroperoxide (HP) and lower superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) serum activities than C and Cu-10 rats. LH was increased and GSH-Px was decreased, while no alterations were observed in SOD and catalase in serum of DCu-60 animals. DCu-60 rats had increased urinary glucose, creatinine and albumin. In conclusion, Cu intake at high concentration induced adverse effects on lipid profile, associated with oxidative stress and diminished activities of antioxidant enzymes. Diabetic animals were more susceptible to copper toxicity. High Cu intake induced dyslipidemic profile, oxidative stress and kidney dysfunction in diabetic condition. Copper renal toxicity was associated with oxidative stress and reduction at least, one of the antioxidant enzymes.

Community-based randomized double-blind study of gastrointestinal effects and copper exposure in drinking water

We assessed gastrointestinal effects in 1,365 adults exposed to either < 0.01 (controls), 2, 4, or 6 mg copper/L of drinking water for 2 months in a randomized, double-blind community-based study. The risk of symptoms increased with increasing Cu exposure and decreased with time. The best model by counting-process analysis included Cu concentration and sex. The risk of symptoms remained significantly higher in women than in men during weeks 1-4 for all concentrations tested; at week 1 comparison with the < 0.01-mg/L group showed that differences became significant in women at 4 mg/L [relative risk (RR) = 1.53; 95% confidence interval (CI), 1.02-2.05), and in men at 6 mg/L (RR = 1.9; 95% CI, 1.02-2.79). At week 2 for men and week 4 in women, the Cu concentration required to obtain significant differences on symptom report was > 6 mg Cu/L. We conclude that exposure to Cu in drinking water results in gastrointestinal symptoms, which are modulated by Cu concentration, time, and sex.

Confirmation of an acute no-observed-adverse-effect and low-observed-adverse-effect level for copper in bottled drinking water in a multi-site international study

In a double blind, 3x3 factorial (volumexdose) study, 70 adult females (18-60 years of age) at four different international sites (total pooled n=269) were given 100, 150, or 200ml of bottled drinking water with 0.4, 0.8, or 1.2mg of copper (Cu) as the sulfate salt once each week. Two additional doses (0 and 1.6mg Cu) were added at the 200ml volume to determine a dose-response relationship and corroborate previously reported results. All subjects completed a questionnaire at 0, 0.25, and 1h post-dosing that screened for positive gastrointestinal (GI) effects (nausea, vomiting, abdominal pain, and diarrhea). Nausea was the most prevalent symptom reported and was generally reported within the first 15min (water volume, p<0.032; copper dose, p<0.0001; and water volumexcopper interaction, p<0.97). As volume increased, the effect of Cu-induced nausea decreased; as Cu dose increased, the incidence of nausea increased. At 200ml, a significant increase in reported incidence of nausea at 0.25h occurred at 1.2 mg Cu (6mg Cu/L), indicating a NOAEL of 0.8mg Cu (4mg Cu/L) for adult females. These data confirm a previously determined human acute NOAEL for Cu added to distilled water, and provide additional, controlled human data for determining safe concentrations of Cu in drinking water.

Copper deficiency and excess in infancy: developing a research agenda

Copper deficiency and excess have been recognized as potential health problems for infants and children worldwide. Clinical manifestations of copper deficiency and excess are well characterized but the precise sequence by which high copper intake interacts with genetic control systems, leading to liver damage in infants, is unknown. The possibility that genetic mutations or epigenetic factors related to the functional development of copper homeostasis, could make otherwise normal infants on normal copper intake more susceptible to copper toxicity has been an issue of concern. In January 2001 a group of pediatricians and researchers interested in this area met at Tegernsee, Bavaria, Germany, to reviewing the state of knowledge on the topic. They addressed six main issues: 1) The relevance of copper deficit and excess as health problems. 2) The appropriate biomarkers to identify and characterize copper status 3) The genetic variability in copper metabolism 4) The mechanisms of whole body copper homeostasis in early life and their changes with age 5) The development of experimental and animal models to address research questions on copper homeostasis in infants. 6) The safe upper and lower limits of copper intake/exposure from water and food. We present here the highlights of the discussions and the main conclusions of the meeting.

Gastrointestinal symptoms and blood indicators of copper load in apparently healthy adults undergoing controlled copper exposure

BACKGROUND

Mild and moderate effects of marginally low and marginally high copper exposure are poorly understood in humans.

OBJECTIVE

The objective was to assess acute gastrointestinal effects and blood markers of copper status in apparently healthy adults who underwent controlled copper exposure for 2 mo.

DESIGN

This was a 2-mo, randomized, controlled, double-blind study of 1365 apparently healthy adults in whom acute gastrointestinal symptoms (nausea, vomiting, diarrhea, and abdominal pain) were assessed as responses to copper exposure (<0.01, 2, 4, or 6 mg/L water). Blood markers were measured in 240 participants at the end of the survey. Subjects with anemia, inflammation, or infection were excluded. Serum and erythrocyte copper, peripheral mononuclear cell copper, serum ceruloplasmin, the nonceruloplasmin bound copper fraction, superoxide dismutase activity, hemoglobin, mean corpuscular volume, serum ferritin, and liver enzyme activities were measured.

RESULTS

The percentage of subjects reporting gastrointestinal symptoms was higher in the 6-mg Cu group than in the <0.01-mg Cu group (P < 0.02). One hundred ninety-five subjects fulfilled the inclusion criteria for the blood studies. Although a significant relation between copper intake and total gastrointestinal symptoms was observed, no relation was found between copper intake or reported symptoms and copper-load variables.

CONCLUSIONS

Gastrointestinal symptoms increased significantly in response to 6 mg Cu/L water. No detectable changes were observed in indicators of copper status, which suggests competent homeostatic regulation. The results of liver function tests remained normal in all subjects. The lack of change in superoxide dismutase activity supports the Food and Nutrition Board's latest recommendation of 0.9 mg Cu/d for adults.

Gastric response to acute copper exposure

Early effects of acute copper exposure consist mainly of nausea and altered gastric permeability. To assess copper effects on gastric response 30 apparently healthy volunteers underwent two controlled trials receiving a solution with (10 mg Cu/l) and without (<0.01 mg Cu/l) copper sulfate after overnight fasting, in random order. Ultrasonography was chosen to follow indirectly the gastric emptying pattern for 120 min. Measurements were expressed as z scores [z=(mean-Xi)/S.D.]. Results showed that nobody presented symptoms after drinking water without added copper while 9 subjects presented nausea after receiving the 10 mg Cu/l solution. The group receiving drinking water with 10 mg Cu/l presented greater antral areas during the first 60 min of observation. Individual and mean fitted curves for antral area, calculated and compared using the linear mixed-effects model fit by REML, showed a group effect of copper on antral area over time (L. Ratio=23.98, P<0.0001); the effect was due to delay in decreasing antral area in the copper treated group during the first hour after ingestion. No differences were found by gender or nausea. Results show a copper effect on gastric response suggesting that acute exposure to copper in water modify the first phase of gastric emptying.

Effect of acute cigarette smoking, alone or with alcohol, on gastric barrier function in healthy volunteers

BACKGROUND

Smoking is a risk factor for gastroduodenal ulcer and gastric adenocarcinoma. However, the pathophysiological mechanisms induced by acute cigarette smoking in the human gastric mucosa are poorly understood.

AIM

To evaluate the effect of acute cigarette smoking, alone or with alcohol, on the gastric permeability to sucrose, a specific marker of mucosal damage in the stomach.

SUBJECTS AND METHODS

Twenty healthy volunteers (8 smokers/12 non-smokers) were studied. Each fasted subject ingested 500 ml of a 20% sucrose solution and the amount of sucrose excreted in a 5-hour urine collection was measured by gas chromatography Four sucrose permeability tests were carried out: 1. basal, 2. while smoking 5 cigarettes, 3. after drinking 50 ml of a 40 degrees alcoholic beverage, 4. a combination of 2+3.

RESULTS

Sucrose excretion increased after alcohol ingestion (40.5 +/- 6.0 mg vs 143.1 +/- 28.9 mg, p = 0.002), but was not modified by acute cigarette smoking (34.4 +/- 5.9 mg). When alcohol and cigarettes were simultaneously consumed, the increase in alcohol-induced sucrose excretion was significantly reduced (73.1 +/- 16.6 mg, p = 0.03). Basal sucrose excretion was similar in smokers and non-smokers. However, in acute cigarette smoking, a decrease in sucrose excretion was observed in smokers (p = 0.02) but not in non-smokers.

CONCLUSIONS

These results indicate that acute cigarette smoking may tighten the gastric mucosa in habitual smokers and this is associated with a smaller increase of gastric permeability induced by alcohol.