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Stojsavljević A, Lakićević N, Pavlović S. Mercury and Autism Spectrum Disorder: Exploring the Link through Comprehensive Review and Meta-Analysis. Biomedicines 2023; 11:3344. [PMID: 38137565 PMCID: PMC10741416 DOI: 10.3390/biomedicines11123344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Mercury (Hg) is a non-essential trace metal with unique neurochemical properties and harmful effects on the central nervous system. In this study, we present a comprehensive review and meta-analysis of peer-reviewed research encompassing five crucial clinical matrices: hair, whole blood, plasma, red blood cells (RBCs), and urine. We assess the disparities in Hg levels between gender- and age-matched neurotypical children (controls) and children diagnosed with autism spectrum disorder (ASD) (cases). After applying rigorous selection criteria, we incorporated a total of 60 case-control studies into our meta-analysis. These studies comprised 25 investigations of Hg levels in hair (controls/cases: 1134/1361), 15 in whole blood (controls/cases: 1019/1345), 6 in plasma (controls/cases: 224/263), 5 in RBCs (controls/cases: 215/293), and 9 in urine (controls/cases: 399/623). This meta-analysis did not include the data of ASD children who received chelation therapy. Our meta-analysis revealed no statistically significant differences in Hg levels in hair and urine between ASD cases and controls. In whole blood, plasma, and RBCs, Hg levels were significantly higher in ASD cases compared to their neurotypical counterparts. This indicates that ASD children could exhibit reduced detoxification capacity for Hg and impaired mechanisms for Hg excretion from their bodies. This underscores the detrimental role of Hg in ASD and underscores the critical importance of monitoring Hg levels in ASD children, particularly in early childhood. These findings emphasize the pressing need for global initiatives aimed at minimizing Hg exposure, thus highlighting the critical intersection of human-environment interaction and neurodevelopment health.
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Affiliation(s)
- Aleksandar Stojsavljević
- Innovative Centre, Faculty of Chemistry, University of Belgrade, Studentski Trg 12–16, 11000 Belgrade, Serbia
| | - Novak Lakićević
- Clinical Centre of Montenegro, Clinic for Neurosurgery, Ljubljanska bb, 81000 Podgorica, Montenegro;
| | - Slađan Pavlović
- Institute for Biological Research “Siniša Stanković”—National Institute of the Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11060 Belgrade, Serbia;
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Shiani A, Sharafi K, Omer AK, Kiani A, Karamimatin B, Massahi T, Ebrahimzadeh G. A systematic literature review on the association between exposures to toxic elements and an autism spectrum disorder. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 857:159246. [PMID: 36220469 DOI: 10.1016/j.scitotenv.2022.159246] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 05/16/2023]
Abstract
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.
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Affiliation(s)
- Amir Shiani
- Department of Speech Therapy, School of Rehabilitation Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran; Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kiomars Sharafi
- Research Center for Environmental Determinants of Health (RCEDH), Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Environmental Health Engineering, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Abdullah Khalid Omer
- Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran; Razga Company, Kurdistan Region, Iraq.
| | - Amir Kiani
- Regenerative Medicine Research Center (RMRC), Kermanshah University of Medical Sciences, Kermanshah, Iran; Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Karamimatin
- Research Center for Environmental Determinants of Health (RCEDH), Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Tooraj Massahi
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Gholamreza Ebrahimzadeh
- Department of Environmental Health Engineering, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
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Rahbar MH, Ibrahim SH, Azam SI, Hessabi M, Karim F, Kim S, Zhang J, Gulzar Ali N, Loveland KA. Concentrations of Lead, Mercury, Arsenic, Cadmium, Manganese, and Aluminum in the Blood of Pakistani Children with and without Autism Spectrum Disorder and Their Associated Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8625. [PMID: 34444373 PMCID: PMC8392432 DOI: 10.3390/ijerph18168625] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with early onset in utero or childhood. Environmental exposure to six metals (Pb, Hg, As, Cd, Mn, Al) is believed to be associated with ASD directly or interactively with genes. Objective: To assess the association of ASD among Pakistani children with the six metals and genotype frequencies of three GST genes (GSTP1, GSTM1, GSTT1). METHODS We enrolled 30 ASD cases, age 2-12 years old, and 30 age- and sex-matched typically developing (TD) controls in Karachi, Pakistan. We assessed associations of ASD status with various factors using Conditional Logistic Regression models. We also used General Linear Models to assess possible interaction of blood Mn and Pb concentrations with the three GST genes in relation to ASD status. RESULTS The unadjusted difference between ASD and TD groups in terms of geometric mean blood Pb concentrations was marginally significant (p = 0.05), but for Al concentrations, the adjusted difference was marginally significant (p = 0.06). CONCLUSIONS This is the first study reporting six blood metal concentrations of Pakistani children with ASD. Estimates provided for possible interactions of GST genes with Mn and Pb in relation to ASD status are valuable for designing future similar studies.
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Affiliation(s)
- Mohammad H. Rahbar
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.H.); (S.K.); (J.Z.)
| | - Shahnaz H. Ibrahim
- Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan; (S.H.I.); (N.G.A.)
- Child Development and Rehabilitation Centre, Aga Khan University, Karachi 74800, Pakistan
| | - Syed Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan; (S.I.A.); (F.K.)
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.H.); (S.K.); (J.Z.)
| | - Fatima Karim
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan; (S.I.A.); (F.K.)
| | - Sori Kim
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.H.); (S.K.); (J.Z.)
- Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jing Zhang
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.H.); (S.K.); (J.Z.)
- Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Nasreen Gulzar Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan; (S.H.I.); (N.G.A.)
| | - Katherine A. Loveland
- Louis A Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA;
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Baj J, Flieger W, Flieger M, Forma A, Sitarz E, Skórzyńska-Dziduszko K, Grochowski C, Maciejewski R, Karakuła-Juchnowicz H. Autism spectrum disorder: Trace elements imbalances and the pathogenesis and severity of autistic symptoms. Neurosci Biobehav Rev 2021; 129:117-132. [PMID: 34339708 DOI: 10.1016/j.neubiorev.2021.07.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023]
Abstract
The identification of biomarkers as diagnostic tools and predictors of response to treatment of neurological developmental disorders (NDD) such as schizophrenia (SZ), attention deficit hyperactivity disorder (ADHD), or autism spectrum disorder (ASD), still remains an important challenge for clinical medicine. Metallomic profiles of ASD patients cover, besides essential elements such as cobalt, chromium, copper, iron, manganese, molybdenum, zinc, selenium, also toxic metals burden of: aluminum, arsenic, mercury, lead, beryllium, nickel, cadmium. Performed studies indicate that children with ASD present a reduced ability of eliminating toxic metals, which leads to these metals' accumulation and aggravation of autistic symptoms. Extensive metallomic studies allow a better understanding of the importance of trace elements as environmental factors in the pathogenesis of ASD. Even though a mineral imbalance is a fact in ASD, we are still expecting relevant tests and the elaboration of reference levels of trace elements as potential biomarkers useful in diagnosis, prevention, and treatment of ASD.
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Affiliation(s)
- Jacek Baj
- Department of Anatomy, Medical University of Lublin, Jaczewskiego Street 8b, 20-400, Lublin, Poland.
| | - Wojciech Flieger
- Faculty of Medicine, Medical University of Lublin, Aleje Racławickie 1, 20-059, Lublin, Poland
| | - Michał Flieger
- Faculty of Medicine, Medical University of Lublin, Aleje Racławickie 1, 20-059, Lublin, Poland
| | - Alicja Forma
- Chair and Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego Street 8b, 20-090, Lublin, Poland
| | - Elżbieta Sitarz
- Chair and 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Gluska Street 1, 20-439, Lublin, Poland
| | - Katarzyna Skórzyńska-Dziduszko
- Chair and Department of Human Physiology, Medical University of Lublin, Radziwillowska Street 11, Lublin, 20-080, Poland
| | - Cezary Grochowski
- Laboratory of Virtual Man, Chair of Anatomy, Medical University of Lublin, Jaczewskiego Street 8b, 20-400, Lublin, Poland
| | - Ryszard Maciejewski
- Department of Anatomy, Medical University of Lublin, Jaczewskiego Street 8b, 20-400, Lublin, Poland
| | - Hanna Karakuła-Juchnowicz
- Chair and 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Gluska Street 1, 20-439, Lublin, Poland; Department of Clinical Neuropsychiatry, Medical University of Lublin, Gluska Street 1, 20-439, Lublin, Poland
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Associations of Metabolic Genes ( GSTT1, GSTP1, GSTM1) and Blood Mercury Concentrations Differ in Jamaican Children with and without Autism Spectrum Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041377. [PMID: 33546147 PMCID: PMC7913200 DOI: 10.3390/ijerph18041377] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 12/12/2022]
Abstract
We investigated interactive roles of three metabolic glutathione S-transferase (GST) genes (GSTP1, GSTT1, and GSTM1) and autism spectrum disorder (ASD) status in relation to blood Hg concentrations (BHC) of Jamaican children. We used data from 266 children (2-8 years) with ASD and their 1:1 age- and sex-matched typically developing (TD) controls. After adjusting General Linear Models for child’s age, socioeconomic status, consumption of leafy vegetables, fried plantain, canned fish, and the interaction between GSTP1 and GSTT1, we found significant interactions between GSTP1 and ASD status in relation to BHC either in a co-dominant or dominant genetic model for GSTP1(P < 0.001, P = 0.007, respectively). In the co-dominant model for the Ile105Val GSTP1 polymorphism, geometric mean (GM) BHC in ASD cases with genotype Ile/Ile were significantly higher than in cases with the Ile/Val genotype (0.73 vs. 0.48 µg/L, P = 0.01). In contrast, in TD controls with the Ile/Val genotype GM BHC were significantly higher than in those with the Ile/Ile genotype (0.72 vs. 0.49 µg/L, P = 0.03) or the Val/Val genotype (0.72 vs. 0.51 µg/L, P = 0.04). Although our findings are consistent with the role of GSTP1 in detoxification of Hg, replication in other populations is warranted.
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Rahbar MH, Samms-Vaughan M, Lee M, Zhang J, Hessabi M, Bressler J, Bach MA, Grove ML, Shakespeare-Pellington S, Beecher C, McLaughlin W, Loveland KA. Interaction between a Mixture of Heavy Metals (Lead, Mercury, Arsenic, Cadmium, Manganese, Aluminum) and GSTP1, GSTT1, and GSTM1 in Relation to Autism Spectrum Disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2020; 79:101681. [PMID: 33193808 PMCID: PMC7664834 DOI: 10.1016/j.rasd.2020.101681] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Exposure to many environmental chemicals, including metals, often does not occur in isolation, hence requires assessment of the associations between exposure to mixtures of chemicals and human health. OBJECTIVES To investigate associations of a metal mixture of lead (Pb), mercury (Hg), arsenic (As), cadmium (Cd), manganese (Mn), and aluminum (Al) in children with autism spectrum disorder (ASD), additively or interactively with each of three glutathione S-transferase (GST) genes (GSTP1, GSTT1, and GSTM1). METHOD Using data from 266 case-control pairs of Jamaican children (2-8 years old), we fitted negative and positive generalized weighted quantile sum (gWQS) regression models to assess the aforementioned associations. RESULTS Based on additive and interactive negative gWQS models adjusted for maternal age, parental education, child's parish, and seafood consumption, we found inverse associations of the overall mixture score with ASD [MOR (95% CI): 0.70 (0.49, 0.99); P < 0.05) and [MOR (95%CI): 0.46 (0.25, 0.84); P = 0.01], respectively. In an unadjusted negative gWQS model, we found a marginally significant interaction between GSTP1 and a mixture of three metals (Pb, Hg, and Mn) (P = 0.07) while the association was no longer significant after adjustment for the same covariates (P = 0.24). CONCLUSIONS Differences in diet between ASD and control groups may play a role in the inverse associations we found. The possible interactive association between Mn and GSTP1 in ASD based on gWQS is consistent with our previous reports. However, possible interaction of GSTP1 with Pb and Hg in ASD requires further investigation and replication.
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Affiliation(s)
- Mohammad H. Rahbar
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Maureen Samms-Vaughan
- Department of Child & Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston, Jamaica
| | - MinJae Lee
- Division of Biostatistics, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Jing Zhang
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jan Bressler
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - MacKinsey A. Bach
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Megan L. Grove
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | | | - Compton Beecher
- Department of Basic Medical Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Wayne McLaughlin
- Department of Basic Medical Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
- Caribbean Genetics (CARIGEN), The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Katherine A. Loveland
- Louis A Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA
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Hessabi M, Rahbar MH, Dobrescu I, Bach MA, Kobylinska L, Bressler J, Grove ML, Loveland KA, Mihailescu I, Nedelcu MC, Moisescu MG, Matei BM, Matei CO, Rad F. Concentrations of Lead, Mercury, Arsenic, Cadmium, Manganese, and Aluminum in Blood of Romanian Children Suspected of Having Autism Spectrum Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2303. [PMID: 31261817 PMCID: PMC6651707 DOI: 10.3390/ijerph16132303] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022]
Abstract
Environmental exposure to lead (Pb), mercury (Hg), arsenic (As), cadmium (Cd), manganese (Mn), and aluminum (Al) has been associated with neurodevelopmental disorders including autism spectrum disorder (ASD). We conducted a pilot study during May 2015-May 2107 to estimate blood concentrations of six metals (Pb, Hg, As, Cd, Mn, and Al) and identify their associated factors for children with ASD or suspected of having ASD in Romania. Sixty children, age 2-8 years, were administered versions of ADOS or ADI-R translated from English to Romanian. After assessment, 2-3 mL of blood was obtained and analyzed for the concentrations of the six metals. The mean age of children was 51.9 months and about 90% were male. More than half (65%) of the children were born in Bucharest. Over 90% of concentrations of As and Cd were below limits of detection. Geometric mean concentrations of Pb, Mn, Al, and Hg were 1.14 μg/dL, 10.84 μg/L, 14.44 μg/L, and 0.35 μg/L, respectively. Multivariable linear regression analysis revealed that children who were female, had less educated parents, exhibited pica, and ate cold breakfast (e.g., cereal), watermelon, and lamb had significantly higher concentrations of Pb compared to their respective referent categories (all p < 0.05 except for eating lamb, which was marginally significant, p = 0.053). Although this is the first study that provides data on concentrations of the six metals for Romanian children with ASD, the findings from this study could be useful for designing future epidemiologic studies for investigating the role of these six metals in ASD in Romanian children.
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Affiliation(s)
- Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Mohammad H Rahbar
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Iuliana Dobrescu
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy of Carol Davila, Psychiatry Clinical Hospital Alexandru Obregia, Bucharest, sector 4, 041914, Romania
| | - MacKinsey A Bach
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Liana Kobylinska
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy of Carol Davila, Psychiatry Clinical Hospital Alexandru Obregia, Bucharest, sector 4, 041914, Romania
| | - Jan Bressler
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Megan L Grove
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Katherine A Loveland
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA
| | - Ilinca Mihailescu
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy of Carol Davila, Psychiatry Clinical Hospital Alexandru Obregia, Bucharest, sector 4, 041914, Romania
| | - Maria Cristina Nedelcu
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy of Carol Davila, Psychiatry Clinical Hospital Alexandru Obregia, Bucharest, sector 4, 041914, Romania
| | - Mihaela Georgeta Moisescu
- Department of Biophysics and Cellular Biotechnology, University of Medicine and Pharmacy of Carol Davila, Bucharest, sector 5, 050747, Romania
| | - Bogdan Mircea Matei
- Department of Biophysics and Cellular Biotechnology, University of Medicine and Pharmacy of Carol Davila, Bucharest, sector 5, 050747, Romania
| | - Christien Oktaviani Matei
- Department of Biophysics and Cellular Biotechnology, University of Medicine and Pharmacy of Carol Davila, Bucharest, sector 5, 050747, Romania
| | - Florina Rad
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy of Carol Davila, Psychiatry Clinical Hospital Alexandru Obregia, Bucharest, sector 4, 041914, Romania.
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Lee M, Rahbar MH, Samms-Vaughan M, Bressler J, Bach MA, Hessabi M, Grove ML, Shakespeare-Pellington S, Coore Desai C, Reece JA, Loveland KA, Boerwinkle E. A generalized weighted quantile sum approach for analyzing correlated data in the presence of interactions. Biom J 2019; 61:934-954. [PMID: 31058353 DOI: 10.1002/bimj.201800259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/26/2019] [Accepted: 03/13/2019] [Indexed: 12/23/2022]
Abstract
A weighted quantile sum (WQS) regression has been used to assess the associations between environmental exposures and health outcomes. However, the currently available WQS approach, which is based on additive effects, does not allow exploring for potential interactions of exposures with other covariates in relation to a health outcome. In addition, the current WQS cannot account for clustering, thus it may not be valid for analysis of clustered data. We propose a generalized WQS approach that can assess interactions by estimating stratum-specific weights of exposures in a mixture, while accounting for potential clustering effect of matched pairs of cases and controls as well as censored exposure data due to being below the limits of detection. The performance of the proposed method in identifying interactions is evaluated through simulations based on various scenarios of correlation structures among the exposures and with an outcome. We also assess how well the proposed method performs in the presence of the varying levels of censoring in exposures. Our findings from the simulation study show that the proposed method outperforms the traditional WQS, as indicated by higher power of detecting interactions. We also find no strong evidence that the proposed method falsely identifies interactions when there are no true interactive effects. We demonstrate application of the proposed method to real data from the Epidemiological Research on Autism Spectrum Disorder (ASD) in Jamaica (ERAJ) by examining interactions between exposure to manganese and glutathione S-transferase family gene, GSTP1 in relation to ASD.
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Affiliation(s)
- MinJae Lee
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mohammad H Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Jan Bressler
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - MacKinsey A Bach
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Manouchehr Hessabi
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Megan L Grove
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | - Jody-Ann Reece
- The University of the West Indies (UWI), Mona Campus, Kingston, Jamaica
| | | | - Eric Boerwinkle
- The University of Texas Health Science Center at Houston, Houston, TX, USA
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Jones SL, Campbell B, Hart T. Laboratory tests commonly used in complementary and alternative medicine: a review of the evidence. Ann Clin Biochem 2019; 56:310-325. [PMID: 30813740 DOI: 10.1177/0004563218824622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
It is increasingly easy for the general public to access a wide range of laboratory tests. Tests can be ordered online with little or no input from a health professional. The complementary and alternative medicine (CAM) community promote and sell a wide range of tests, many of which are of dubious clinical significance. Many have little or no clinical utility and have been widely discredited, whilst others are established tests that are used for unvalidated purposes. They range from the highly complex, employing state of the art technology, e.g. heavy metal analysis using inductively coupled plasma-mass spectrometry, to the rudimentary, e.g. live blood cell analysis. Results of 'CAM tests' are often accompanied by extensive clinical interpretations which may recommend, or be used to justify, unnecessary or harmful treatments. There are now a small number of laboratories across the globe that specialize in CAM testing. Some CAM laboratories operate completely outside of any accreditation programme whilst others are fully accredited to the standard of established clinical laboratories. In this review, we explore CAM testing in the United States, the United Kingdom and Australia with a focus on the common tests on offer, how they are reported, the evidence base for their clinical application and the regulations governing their use. We will also review proposed changed to in-vitro diagnostic device regulations and how these might impact on CAM testing.
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Affiliation(s)
- Stuart L Jones
- 1 Department of Clinical Biochemistry, King George's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | | | - Tanya Hart
- 3 Department of Clinical Biochemistry, Poole Hospital NHS Foundation Trust, UK
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Rahbar MH, Samms-Vaughan M, Lee M, Christian MA, Bressler J, Hessabi M, Grove ML, Shakespeare-Pellington S, Desai CC, Reece JA, Loveland KA, Beecher C, McLaughlin W, Boerwinkle E. Interaction between manganese and GSTP1 in relation to autism spectrum disorder while controlling for exposure to mixture of lead, mercury, arsenic, and cadmium. RESEARCH IN AUTISM SPECTRUM DISORDERS 2018; 55:50-63. [PMID: 30930959 PMCID: PMC6434704 DOI: 10.1016/j.rasd.2018.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND We previously reported a significant interactive association between polymorphisms of GSTP1 and blood manganese concentrations (BMC) with autism spectrum disorder (ASD) in Jamaican children. In this paper, we investigate the same interactive association with ASD while adjusting for the mixture of four metals (lead, mercury, cadmium, and arsenic). METHOD We used data from 163 case-control pairs of children 2-8 years of age from our autism project in Jamaica, in which we collected blood for heavy metals analysis at enrollment. To minimize potential multicollinearity between concentrations of the four metals, we generated a mixture index using generalized weighted quantile sum regression, which was used in conditional logistic regression models to control for the four metals while assessing the interactive association between GSTP1 and BMC with ASD. RESULTS Similar to the findings we reported previously, we found that in co-dominant and dominant models for GSTP1, among children with the Ile/Ile genotype, those with BMC > 12μg/L had 4.6 and 4.27 times higher odds of ASD compared to those with BMC < 12μg/L (adjusted Matched Odds Ratio (MOR) = 4.6, 95% CI: 1.21 - 17.42 and adjusted MOR = 4.27, 95% CI: 1.15 - 15.85, respectively). In the co-dominant model, for children with the Ile/Val and Val/Val genotypes, the adjusted MORs were 1.26 (95% CI: 0.32, 5.01) and 0.26 (95% CI: 0.05, 1.42), respectively. CONCLUSIONS After adjusting for the mixture of four metals, the interactive association of BMC and GSTP1 with ASD remained significant with similar magnitude of associations. Results should be interpreted cautiously.
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Affiliation(s)
- Mohammad H. Rahbar
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The
University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School,
The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences
(CCTS), The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Maureen Samms-Vaughan
- Department of Child & Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston,
Jamaica
| | - MinJae Lee
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School,
The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences
(CCTS), The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - MacKinsey A. Christian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The
University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences
(CCTS), The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Jan Bressler
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The
University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of
Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences
(CCTS), The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Megan L. Grove
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The
University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of
Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | | | - Charlene Coore Desai
- Department of Child & Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston,
Jamaica
| | - Jody-Ann Reece
- Department of Child & Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston,
Jamaica
| | - Katherine A. Loveland
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health
Science Center at Houston, Houston, Texas 77054, USA
| | - Compton Beecher
- Department of Basic Medical Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Wayne McLaughlin
- Department of Basic Medical Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
- Caribbean Genetics (CARIGEN),The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The
University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of
Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
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Skalny AV, Simashkova NV, Skalnaya MG, Klyushnik TP, Chernova LN, Tinkov AA. Mercury and autism spectrum disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:75-79. [DOI: 10.17116/jnevro20181185275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Kern JK, Geier DA, Deth RC, Sykes LK, Hooker BS, Love JM, Bjørklund G, Chaigneau CG, Haley BE, Geier MR. RETRACTED ARTICLE: Systematic Assessment of Research on Autism Spectrum Disorder and Mercury Reveals Conflicts of Interest and the Need for Transparency in Autism Research. SCIENCE AND ENGINEERING ETHICS 2017; 23:1689-1690. [PMID: 26507205 PMCID: PMC5705728 DOI: 10.1007/s11948-015-9713-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Janet K. Kern
- Institute of Chronic Illnesses, Inc., 14 Redgate Court, Silver Spring, MD 20905 USA
| | - David A. Geier
- Institute of Chronic Illnesses, Inc., 14 Redgate Court, Silver Spring, MD 20905 USA
| | | | | | | | | | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
| | | | | | - Mark R. Geier
- Institute of Chronic Illnesses, Inc., 14 Redgate Court, Silver Spring, MD 20905 USA
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Kern JK, Geier DA, Deth RC, Sykes LK, Hooker BS, Love JM, Bjørklund G, Chaigneau CG, Haley BE, Geier MR. Systematic Assessment of Research on Autism Spectrum Disorder (ASD) and Mercury Reveals Conflicts of Interest and the Need for Transparency in Autism Research. SCIENCE AND ENGINEERING ETHICS 2017; 23:1691-1718. [PMID: 29119411 PMCID: PMC5705731 DOI: 10.1007/s11948-017-9983-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Historically, entities with a vested interest in a product that critics have suggested is harmful have consistently used research to back their claims that the product is safe. Prominent examples are: tobacco, lead, bisphenol A, and atrazine. Research literature indicates that about 80-90% of studies with industry affiliation found no harm from the product, while only about 10-20% of studies without industry affiliation found no harm. In parallel to other historical debates, recent studies examining a possible relationship between mercury (Hg) exposure and autism spectrum disorder (ASD) show a similar dichotomy. Studies sponsored and supported by industry or entities with an apparent conflict of interest have most often shown no evidence of harm or no "consistent" evidence of harm, while studies without such affiliations report positive evidence of a Hg/autism association. The potentially causal relationship between Hg exposure and ASD differs from other toxic products since there is a broad coalition of entities for whom a conflict of interest arises. These include influential governmental public health entities, the pharmaceutical industry, and even the coal burning industry. This review includes a systematic literature search of original studies on the potential relationship between Hg and ASD from 1999 to August 2015, finding that of the studies with public health and/or industry affiliation, 86% reported no relationship between Hg and ASD. However, among studies without public health and/or industry affiliation, only 21% find no relationship between Hg and ASD. The discrepancy in these results suggests a bias indicative of a conflict of interest.
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Affiliation(s)
- Janet K. Kern
- Institute of Chronic Illnesses, Inc, 14 Redgate Court, Silver Spring, MD 20905 USA
| | - David A. Geier
- Institute of Chronic Illnesses, Inc, 14 Redgate Court, Silver Spring, MD 20905 USA
| | | | | | | | | | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
| | | | | | - Mark R. Geier
- Institute of Chronic Illnesses, Inc, 14 Redgate Court, Silver Spring, MD 20905 USA
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Saghazadeh A, Ahangari N, Hendi K, Saleh F, Rezaei N. Status of essential elements in autism spectrum disorder: systematic review and meta-analysis. Rev Neurosci 2017; 28:783-809. [DOI: 10.1515/revneuro-2017-0015] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/16/2017] [Indexed: 12/15/2022]
Abstract
AbstractAutism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder that imposes heavy financial burden on governments and families of affected children. It is considered a multifactorial condition, where trace elements are among environmental factors that may contribute to ASD. Meanwhile, the between-study variance is high. The present systematic review was designed to investigate the difference in trace element measures between patients with ASD and control subjects. Meta-analyses showed that the hair concentrations of chromium (p=0.024), cobalt (p=0.012), iodine (p=0.000), iron (p=0.017), and magnesium (p=0.007) in ASD patients were significantly lower than those of control subjects, while there were higher magnesium levels in the hair of ASD patients compared to that of controls (p=0.010). Patients with ASD had higher blood levels of copper (p=0.000) and lower levels of zinc compared to controls (p=0.021). Further urinary iodine levels in patients with ASD were decreased in comparison with controls (p=0.026). Sensitivity analyses showed that ASD patients in non-Asian but not in Asian countries had lower hair concentrations of chromium compared to controls. Also, such analyses indicated that ASD patients in Asian countries had lower hair zinc concentrations, whereas ASD patients in non-Asian countries had higher hair zinc concentrations in comparison with control subjects. This study found significant differences in the content of trace elements between patients with ASD compared to controls. The findings help highlighting the role of trace elements as environmental factors in the etiology of ASD.
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Affiliation(s)
- Amene Saghazadeh
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd., Tehran 14194, Iran
- MetaCognition Interest Group (MCIG), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran
| | - Narges Ahangari
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran
| | - Kasra Hendi
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran
| | - Fatemeh Saleh
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd., Tehran 14194, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 14194, Iran
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Boston, MA, USA
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15
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Saghazadeh A, Rezaei N. Systematic review and meta-analysis links autism and toxic metals and highlights the impact of country development status: Higher blood and erythrocyte levels for mercury and lead, and higher hair antimony, cadmium, lead, and mercury. Prog Neuropsychopharmacol Biol Psychiatry 2017; 79:340-368. [PMID: 28716727 DOI: 10.1016/j.pnpbp.2017.07.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder that affects cognitive and higher cognitive functions. Increasing prevalence of ASD and high rates of related comorbidities has caused serious health loss and placed an onerous burden on the supporting families, caregivers, and health care services. Heavy metals are among environmental factors that may contribute to ASD. However, due to inconsistencies across studies, it is still hard to explain the association between ASD and toxic metals. Therefore the objective of this study was to investigate the difference in heavy metal measures between patients with ASD and control subjects. METHODS We included observational studies that measured levels of toxic metals (antimony, arsenic, cadmium, lead, manganese, mercury, nickel, silver, and thallium) in different specimens (whole blood, plasma, serum, red cells, hair and urine) for patients with ASD and for controls. The main electronic medical database (PubMed and Scopus) were searched from inception through October 2016. RESULTS 52 studies were eligible to be included in the present systematic review, of which 48 studies were included in the meta-analyses. The hair concentrations of antimony (standardized mean difference (SMD)=0.24; 95% confidence interval (CI): 0.03 to 0.45) and lead (SMD=0.60; 95% confidence interval (CI): 0.17 to 1.03) in ASD patients were significantly higher than those of control subjects. ASD patients had higher erythrocyte levels of lead (SMD=1.55, CI: 0.2 to 2.89) and mercury (SMD=1.56, CI: 0.42 to 2.70). There were significantly higher blood lead levels in ASD patients (SMD=0.43, CI: 0.02 to 0.85). Sensitivity analyses showed that ASD patients in developed but not in developing countries have lower hair concentrations of cadmium (SMD=-0.29, CI: -0.46 to -0.12). Also, such analyses indicated that ASD patients in developing but not in developed lands have higher hair concentrations of lead (SMD=1.58, CI: 0.80 to 2.36) and mercury (SMD=0.77, CI: 0.31 to 1.23). These findings were confirmed by meta-regression analyses indicating that development status of countries significantly influences the overall effect size of mean difference for hair arsenic, cadmium, lead, and mercury between patients with ASD and controls. CONCLUSION The findings help highlighting the role of toxic metals as environmental factors in the etiology of ASD, especially in developing lands. While there are environmental factors other than toxic metals that greatly contribute to the etiology of ASD in developed lands. It would be, thus, expected that classification of ASD includes etiological entities of ASD on the basis of implication of industrial pollutants (developed vs. developing ASD).
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Affiliation(s)
- Amene Saghazadeh
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; MetaCognition Interest Group (MCIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Boston, MA, USA.
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16
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Quantitative analysis of organophosphate insecticide metabolites in urine extracted from disposable diapers of toddlers in Japan. Int J Hyg Environ Health 2017; 220:209-216. [DOI: 10.1016/j.ijheh.2016.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/19/2022]
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17
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Sivanesan S, Tan A, Jeyaraj R, Lam J, Gole M, Hardan A, Ashkan K, Rajadas J. Pharmaceuticals and Stem Cells in Autism Spectrum Disorders: Wishful Thinking? World Neurosurg 2017; 98:659-672. [DOI: 10.1016/j.wneu.2016.09.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022]
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18
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Kern JK, Geier DA, Sykes LK, Haley BE, Geier MR. The relationship between mercury and autism: A comprehensive review and discussion. J Trace Elem Med Biol 2016; 37:8-24. [PMID: 27473827 DOI: 10.1016/j.jtemb.2016.06.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/17/2016] [Accepted: 06/01/2016] [Indexed: 12/28/2022]
Abstract
The brain pathology in autism spectrum disorders (ASD) indicates marked and ongoing inflammatory reactivity with concomitant neuronal damage. These findings are suggestive of neuronal insult as a result of external factors, rather than some type of developmental mishap. Various xenobiotics have been suggested as possible causes of this pathology. In a recent review, the top ten environmental compounds suspected of causing autism and learning disabilities were listed and they included: lead, methyl-mercury, polychorinated biphenyls, organophosphate pesticides, organochlorine pesticides, endocrine disruptors, automotive exhaust, polycyclic aromatic hydrocarbons, polybrominated diphenyl ethers, and perfluorinated compounds. This current review, however, will focus specifically on mercury exposure and ASD by conducting a comprehensive literature search of original studies in humans that examine the potential relationship between mercury and ASD, categorizing, summarizing, and discussing the published research that addresses this topic. This review found 91 studies that examine the potential relationship between mercury and ASD from 1999 to February 2016. Of these studies, the vast majority (74%) suggest that mercury is a risk factor for ASD, revealing both direct and indirect effects. The preponderance of the evidence indicates that mercury exposure is causal and/or contributory in ASD.
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Affiliation(s)
- Janet K Kern
- Institute of Chronic Illnesses, Inc., 14 Redgate Court, Silver Spring, MD, 20905 USA; Council for Nutritional and Environmental Medicine, Mo i Rana, Norway; CoMeD, Inc., 14 Redgate Court, Silver Spring, MD, 20905 USA.
| | - David A Geier
- Institute of Chronic Illnesses, Inc., 14 Redgate Court, Silver Spring, MD, 20905 USA; CoMeD, Inc., 14 Redgate Court, Silver Spring, MD, 20905 USA
| | - Lisa K Sykes
- CoMeD, Inc., 14 Redgate Court, Silver Spring, MD, 20905 USA
| | - Boyd E Haley
- University of Kentucky, 410 Administration Drive, Lexington, KY, 40506 USA
| | - Mark R Geier
- Institute of Chronic Illnesses, Inc., 14 Redgate Court, Silver Spring, MD, 20905 USA; CoMeD, Inc., 14 Redgate Court, Silver Spring, MD, 20905 USA
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Lee YJ, Oh SH, Park C, Hong M, Lee AR, Yoo HJ, Shin CY, Cheon KA, Bahn GH. Advanced pharmacotherapy evidenced by pathogenesis of autism spectrum disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2014; 12:19-30. [PMID: 24851117 PMCID: PMC4022762 DOI: 10.9758/cpn.2014.12.1.19] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/17/2014] [Accepted: 03/20/2014] [Indexed: 01/08/2023]
Abstract
In clinical practice, pharmacological treatment is mostly focused on behavioral symptoms in everyday life. Nevertheless, persistent effort continues to develop medication for causal treatment. Recent changes in diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) to DSM-5 would affect not only diagnosing approaches, but also therapeutic approaches. Because previous pervasive developmental disorders have been integrated into a single entity, the autism spectrum disorder (ASD), we have to prepare for what medications are valuable for the ASD. In this article, we reviewed the following etiological treatment: acetylcholine and glutamate related medicine; amino acid medicine such as secretin, endogenous opioid, and oxytocin; complementary and alternative medicine such as chelating agents, vitamins, and omega-3; promising drugs related to the scope of pharmacogenetics currently under study.
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Affiliation(s)
- Yeon Jung Lee
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soo Hyun Oh
- Department of Life Sciences, Ewha Womans University, Seoul, Korea
| | - Chanmin Park
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Minha Hong
- Department of Psychiatry, Dankook University Medical College, Chungnam, Korea
| | - Ah Rah Lee
- Kyung Hee University School of Medicine, Seoul, Korea
| | - Hee Jeong Yoo
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chan Young Shin
- Department of Pharmacology, Konkuk University School of Medicine, Seoul, Korea
| | - Keun-Ah Cheon
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
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Rossignol DA, Genuis SJ, Frye RE. Environmental toxicants and autism spectrum disorders: a systematic review. Transl Psychiatry 2014; 4:e360. [PMID: 24518398 PMCID: PMC3944636 DOI: 10.1038/tp.2014.4] [Citation(s) in RCA: 302] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/15/2013] [Accepted: 01/06/2014] [Indexed: 11/21/2022] Open
Abstract
Although the involvement of genetic abnormalities in autism spectrum disorders (ASD) is well-accepted, recent studies point to an equal contribution by environmental factors, particularly environmental toxicants. However, these toxicant-related studies in ASD have not been systematically reviewed to date. Therefore, we compiled publications investigating potential associations between environmental toxicants and ASD and arranged these publications into the following three categories: (a) studies examining estimated toxicant exposures in the environment during the preconceptional, gestational and early childhood periods; (b) studies investigating biomarkers of toxicants; and (c) studies examining potential genetic susceptibilities to toxicants. A literature search of nine electronic scientific databases through November 2013 was performed. In the first category examining ASD risk and estimated toxicant exposures in the environment, the majority of studies (34/37; 92%) reported an association. Most of these studies were retrospective case-control, ecological or prospective cohort studies, although a few had weaker study designs (for example, case reports or series). Toxicants implicated in ASD included pesticides, phthalates, polychlorinated biphenyls (PCBs), solvents, toxic waste sites, air pollutants and heavy metals, with the strongest evidence found for air pollutants and pesticides. Gestational exposure to methylmercury (through fish exposure, one study) and childhood exposure to pollutants in water supplies (two studies) were not found to be associated with ASD risk. In the second category of studies investigating biomarkers of toxicants and ASD, a large number was dedicated to examining heavy metals. Such studies demonstrated mixed findings, with only 19 of 40 (47%) case-control studies reporting higher concentrations of heavy metals in blood, urine, hair, brain or teeth of children with ASD compared with controls. Other biomarker studies reported that solvent, phthalate and pesticide levels were associated with ASD, whereas PCB studies were mixed. Seven studies reported a relationship between autism severity and heavy metal biomarkers, suggesting evidence of a dose-effect relationship. Overall, the evidence linking biomarkers of toxicants with ASD (the second category) was weaker compared with the evidence associating estimated exposures to toxicants in the environment and ASD risk (the first category) because many of the biomarker studies contained small sample sizes and the relationships between biomarkers and ASD were inconsistent across studies. Regarding the third category of studies investigating potential genetic susceptibilities to toxicants, 10 unique studies examined polymorphisms in genes associated with increased susceptibilities to toxicants, with 8 studies reporting that such polymorphisms were more common in ASD individuals (or their mothers, 1 study) compared with controls (one study examined multiple polymorphisms). Genes implicated in these studies included paraoxonase (PON1, three of five studies), glutathione S-transferase (GSTM1 and GSTP1, three of four studies), δ-aminolevulinic acid dehydratase (one study), SLC11A3 (one study) and the metal regulatory transcription factor 1 (one of two studies). Notably, many of the reviewed studies had significant limitations, including lack of replication, limited sample sizes, retrospective design, recall and publication biases, inadequate matching of cases and controls, and the use of nonstandard tools to diagnose ASD. The findings of this review suggest that the etiology of ASD may involve, at least in a subset of children, complex interactions between genetic factors and certain environmental toxicants that may act synergistically or in parallel during critical periods of neurodevelopment, in a manner that increases the likelihood of developing ASD. Because of the limitations of many of the reviewed studies, additional high-quality epidemiological studies concerning environmental toxicants and ASD are warranted to confirm and clarify many of these findings.
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Affiliation(s)
- D A Rossignol
- Family Medicine, Rossignol Medical Center, Irvine, CA, USA
| | - S J Genuis
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R E Frye
- Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Mass spectrometry for the study of autism and neurodevelopmental disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 806:525-44. [PMID: 24952201 DOI: 10.1007/978-3-319-06068-2_26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mass spectrometry (MS) has been increasingly used to study central nervous system disorders, including autism spectrum disorders (ASDs). The first studies of ASD using MS focused on the identification of external toxins, but current research is more directed at understanding endogenous protein changes that occur in ASD (ASD proteomics). This chapter focuses on how MS has been used to study ASDs, with particular focus on proteomic analysis. Other neurodevelopmental disorders have been investigated using this technique, including genetic syndromes associated with autism such as fragile X syndrome and Smith-Lemli-Opitz syndrome.
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Woods AG, Ngounou Wetie AG, Sokolowska I, Russell S, Ryan JP, Michel TM, Thome J, Darie CC. Mass spectrometry as a tool for studying autism spectrum disorder. J Mol Psychiatry 2013; 1:6. [PMID: 25408899 PMCID: PMC4223881 DOI: 10.1186/2049-9256-1-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/13/2012] [Indexed: 12/04/2022] Open
Abstract
Autism spectrum disorders (ASDs) are increasing in incidence but have an incompletely understood etiology. Tools for uncovering clues to the cause of ASDs and means for diagnoses are valuable to the field. Mass Spectrometry (MS) has been a useful method for evaluating differences between individuals with ASDs versus matched controls. Different biological substances can be evaluated using MS, including urine, blood, saliva, and hair. This technique has been used to evaluate relatively unsupported hypotheses based on introduction of exogenous factors, such as opiate and heavy metal excretion theories of ASDs. MS has also been used to support disturbances in serotonin-related molecules, which have been more consistently observed in ASDs. Serotonergic system markers, markers for oxidative stress, cholesterol system disturbances, peptide hypo-phosphorylation and methylation have been measured using MS in ASDs, although further analyses with larger numbers of subjects are needed (as well as consideration of behavioral data). Refinements in MS and data analysis are ongoing, allowing for the possibility that future studies examining body fluids and specimens from ASD subjects could continue to yield novel insights. This review summarizes MS investigations that have been conducted to study ASD to date and provides insight into future promising applications for this technique, with focus on proteomic studies.
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Affiliation(s)
- Alisa G Woods
- Biochemistry and Proteomics Group Department of Chemistry and Biomolecular Science, Clarkson University, 8 Clarkson Avenue, Potsdam, NY 13699-5810 USA
| | - Armand G Ngounou Wetie
- Biochemistry and Proteomics Group Department of Chemistry and Biomolecular Science, Clarkson University, 8 Clarkson Avenue, Potsdam, NY 13699-5810 USA
| | - Izabela Sokolowska
- Biochemistry and Proteomics Group Department of Chemistry and Biomolecular Science, Clarkson University, 8 Clarkson Avenue, Potsdam, NY 13699-5810 USA
| | - Stefanie Russell
- Department of Psychology, State University of New York at Plattsburgh, 101 Broad Street, Plattsburgh, NY 12901 USA
| | - Jeanne P Ryan
- Department of Psychology, State University of New York at Plattsburgh, 101 Broad Street, Plattsburgh, NY 12901 USA
| | - Tanja Maria Michel
- Department of Psychiatry, University of Rostock, Gehlsheimer Straße 20, D-18147 Rostock, Germany
| | - Johannes Thome
- Department of Psychiatry, University of Rostock, Gehlsheimer Straße 20, D-18147 Rostock, Germany ; College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Costel C Darie
- Biochemistry and Proteomics Group Department of Chemistry and Biomolecular Science, Clarkson University, 8 Clarkson Avenue, Potsdam, NY 13699-5810 USA
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Al-Farsi YM, Waly MI, Al-Sharbati MM, Al-Shafaee MA, Al-Farsi OA, Al-Khaduri MM, Gupta I, Ouhtit A, Al-Adawi S, Al-Said MF, Deth RC. Levels of heavy metals and essential minerals in hair samples of children with autism in Oman: a case-control study. Biol Trace Elem Res 2013. [PMID: 23188679 DOI: 10.1007/s12011-012-9553-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Toxic levels of heavy metals and low levels of essential minerals have been suggested to play a critical role in the pathogenesis of autism spectrum disorders (ASD). This study documents the levels of heavy metals and essential minerals in hair samples of children with ASD in Muscat, the urbanized capital of Oman, Muscat. The study included 27 children with ASD and 27 matched non-ASD controls. Parental interviews were held and dietary intake questionnaires completed in conjunction with the collection of hair samples. Analysis of heavy metals and essential minerals was carried out by inductively coupled plasma mass spectrometry. Chi-square analysis and non-parametric Fisher's exact tests were used to assess statistical significance. Children with ASD had significantly higher levels of all 11 analyzed heavy metals in their hair samples (P < 0.05), ranging from 150 to 365 % of control levels. ASD children also had significantly higher levels of essential minerals sulfur, sodium, magnesium, potassium, zinc, and iron, but lower levels of calcium and copper in their hair samples. This study corroborates data from previous studies in different parts of the world indicating the presence of elevated levels of heavy metals and selective depletion of essential minerals in the hair of children with ASD.
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Affiliation(s)
- Yahya M Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khoudh, Oman.
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Adams JB, Audhya T, McDonough-Means S, Rubin RA, Quig D, Geis E, Gehn E, Loresto M, Mitchell J, Atwood S, Barnhouse S, Lee W. Toxicological status of children with autism vs. neurotypical children and the association with autism severity. Biol Trace Elem Res 2013. [PMID: 23192845 DOI: 10.1007/s12011-012-9551-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study investigates both the level of toxic metals in children with autism and the possible association of those toxic metals with autism severity. This study involved 55 children with autism ages 5-16 years compared to 44 controls with similar age and gender. The study included measurements of toxic metals in whole blood, red blood cells (RBC), and urine. The autism group had higher levels of lead in RBC (+41 %, p = 0.002) and higher urinary levels of lead (+74 %, p = 0.02), thallium (+77 %, p = 0.0001), tin (+115 %, p = 0.01), and tungsten (+44 %, p = 0.00005). However, the autism group had slightly lower levels of cadmium in whole blood (-19 %, p = 0.003). A stepwise, multiple linear regression analysis found a strong association of levels of toxic metals with variation in the degree of severity of autism for all the severity scales (adjusted R(2) of 0.38-0.47, p < 0.0003). Cadmium (whole blood) and mercury (whole blood and RBC) were the most consistently significant variables. Overall, children with autism have higher average levels of several toxic metals, and levels of several toxic metals are strongly associated with variations in the severity of autism for all three of the autism severity scales investigated.
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Affiliation(s)
- James B Adams
- Arizona State University, Tempe, AZ 85287-6006, USA.
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Wang L, Angley MT, Gerber JP, Sorich MJ. A review of candidate urinary biomarkers for autism spectrum disorder. Biomarkers 2012; 16:537-52. [PMID: 22022826 DOI: 10.3109/1354750x.2011.598564] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Autism is a complex, heterogeneous neurodevelopmental condition with a strong genetic component potentially impacted by various environmental factors influencing susceptibility. There are no reliable laboratory tests available to confirm an autism diagnosis. OBJECTIVE To examine the published literature and identify putative urinary biomarkers of autism. METHODS A comprehensive literature search was conducted using electronic bibliographic databases. RESULTS Putative autism biomarkers were identified that could be categorized according to the key theories that exist regarding the etiology of autism: gastrointestinal factors, immune dysregulation, heavy metal toxicity, neurotransmitter abnormalities, and oxidative stress. CONCLUSION There is scope for specific urinary biomarkers to be useful for identification of autistic metabolic phenotypes.
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Affiliation(s)
- Lv Wang
- Sansom Institute for Health Research, University of South Australia, Adelaide
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26
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Wright B, Pearce H, Allgar V, Miles J, Whitton C, Leon I, Jardine J, McCaffrey N, Smith R, Holbrook I, Lewis J, Goodall D, Alderson-Day B. A comparison of urinary mercury between children with autism spectrum disorders and control children. PLoS One 2012; 7:e29547. [PMID: 22355303 PMCID: PMC3280241 DOI: 10.1371/journal.pone.0029547] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 11/30/2011] [Indexed: 11/22/2022] Open
Abstract
Background Urinary mercury concentrations are used in research exploring mercury exposure. Some theorists have proposed that autism is caused by mercury toxicity. We set out to test whether mercury concentrations in the urine of children with autism were significantly increased or decreased compared to controls or siblings. Methods Blinded cohort analyses were carried out on the urine of 56 children with autism spectrum disorders (ASD) compared to their siblings (n = 42) and a control sample of children without ASD in mainstream (n = 121) and special schools (n = 34). Results There were no statistically significant differences in creatinine levels, in uncorrected urinary mercury levels or in levels of mercury corrected for creatinine, whether or not the analysis is controlled for age, gender and amalgam fillings. Conclusions This study lends no support for the hypothesis of differences in urinary mercury excretion in children with autism compared to other groups. Some of the results, however, do suggest further research in the area may be warranted to replicate this in a larger group and with clear measurement of potential confounding factors.
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Affiliation(s)
- Barry Wright
- North Yorkshire and York Primary Care Trust, York, United Kingdom.
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27
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Heavy Metal in Children’s Tooth Enamel: Related to Autism and Disruptive Behaviors? J Autism Dev Disord 2011; 42:929-36. [DOI: 10.1007/s10803-011-1318-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Metals such as iron and copper are critical to living organisms, whereas other metals such as lead and arsenic have no known biologic role. Any metals in large amounts may cause toxicity. Many metals cause pervasive systemic effects involving the nervous system, which can be subtle in some cases. Although challenging, the diagnosis and treatment of metal poisoning can be made based on history, physical examination, and the proper use of metal testing. This article focuses on the use, and misuse, of chelation in the diagnosis and management of metal intoxication.
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Kern JK, Geier DA, Adams JB, Mehta JA, Grannemann BD, Geier MR. Toxicity biomarkers in autism spectrum disorder: a blinded study of urinary porphyrins. Pediatr Int 2011; 53:147-53. [PMID: 20626635 DOI: 10.1111/j.1442-200x.2010.03196.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent studies suggest that children diagnosed with an autism spectrum disorder (ASD) have significantly increased levels of urinary porphyrins associated with mercury (Hg) toxicity, including pentacarboxyporphyrin (5cxP), precoproporphyrin (prcP), and coproporphyrin (cP), compared to typically developing controls. However, these initial studies were criticized because the controls were not age- and gender-matched to the children diagnosed with an ASD. METHODS Urinary porphyrin biomarkers in a group of children (2-13 years of age) diagnosed with an ASD (n= 20) were compared to matched (age, gender, race, location, and year tested) group of typically developing controls (n= 20). RESULTS Participants diagnosed with an ASD had significantly increased levels of 5cxP, prcP, and cP in comparison to controls. No significant differences were found in non-Hg associated urinary porphyrins (uroporphyrins, hexacarboxyporphyrin, and heptacarboxyporphyrin). There was a significantly increased odds ratio for an ASD diagnosis relative to controls among study participants with precoproporphyrin (odds ratio = 15.5, P < 0.01) and coproporphyrin (odds ratio = 15.5, P < 0.01) levels in the second through fourth quartiles in comparison to the first quartile. CONCLUSION These results suggest that the levels of Hg-toxicity-associated porphyrins are higher in children with an ASD diagnosis than controls. Although the pattern seen (increased 5cxP, prcP, and cP) is characteristic of Hg toxicity, the influence of other factors, such as genetics and other metals cannot be completely ruled out.
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Affiliation(s)
- Janet K Kern
- Research Department, Genetics Consultants of Dallas/ASD Centers, LLC., 408 N. Allen Dr, Allen, TX 75013, USA.
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Yorbik O, Kurt I, Haşimi A, Oztürk O. Chromium, cadmium, and lead levels in urine of children with autism and typically developing controls. Biol Trace Elem Res 2010; 135:10-5. [PMID: 19688188 DOI: 10.1007/s12011-009-8494-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 07/30/2009] [Indexed: 10/20/2022]
Abstract
Although potentially harmful effects of heavy metals are well known, limited numbers of studies exist regarding their relationship with autism. The aim of this study was to investigate urine levels of some heavy metals such as of chromium (Cr), cadmium (Cd), and lead (Pb) in children with autism and healthy subjects. Urine levels of Cr, Cd, and Pb were measured by atomic absorption spectrometry in 30 children with autism and compared with 20 healthy controls. Urine Cd and Pb levels were found as significantly decreased in children with autism compared to healthy subjects (p < 0.05). On the other hand, urine Cr levels were significantly higher in children with autism than healthy subjects (p < 0.05). This study suggested that autism may be associated with significant decrease in excretion rate of Cd and Pb and a significant increase excretion rate in the levels of Cr in the urine. These results have indicated that further studies are warranted for investigation of possible roles of heavy metals in autism.
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Affiliation(s)
- Ozgür Yorbik
- Child Psychiatry Department, Gülhane Military Medical Faculty, Etlik 06018, Ankara, Turkey.
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31
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Curtis JT, Hood AN, Chen Y, Cobb GP, Wallace DR. Chronic metals ingestion by prairie voles produces sex-specific deficits in social behavior: an animal model of autism. Behav Brain Res 2010; 213:42-9. [PMID: 20433873 DOI: 10.1016/j.bbr.2010.04.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 04/13/2010] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
Abstract
We examined the effects of chronic metals ingestion on social behavior in the normally highly social prairie vole to test the hypothesis that metals may interact with central dopamine systems to produce the social withdrawal characteristic of autism. Relative to water-treated controls, 10 weeks of chronic ingestion of either Hg(++) or Cd(++) via drinking water significantly reduced social contact by male voles when they were given a choice between isolation or contact with an unfamiliar same-sex conspecific. The effects of metals ingestion were specific to males: no effects of metals exposure were seen in females. Metals ingestion did not alter behavior of males allowed to choose between isolation or their familiar cage-mates, rather than strangers. We also examined the possibility that metals ingestion affects central dopamine functioning by testing the voles' locomotor responses to peripheral administration of amphetamine. As with the social behavior, we found a sex-specific effect of metals on amphetamine responses. Males that consumed Hg(++) did not increase their locomotor activity in response to amphetamine, whereas similarly treated females and males that ingested only water significantly increased their locomotor activities. Thus, an ecologically relevant stimulus, metals ingestion, produced two of the hallmark characteristics of autism - social avoidance and a male-oriented bias. These results suggest that metals exposure may contribute to the development of autism, possibly by interacting with central dopamine function, and support the use of prairie voles as a model organism in which to study autism.
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Affiliation(s)
- J Thomas Curtis
- Department of Pharmacology & Physiology, Oklahoma State University Center for Health Sciences, 1111 W 17th Street, Tulsa, OK 74107, USA.
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32
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DeSoto MC. A reply to Soden et al.: your data shows autistic children have higher levels of heavy metals. Clin Toxicol (Phila) 2010; 46:1098; author reply 1098. [DOI: 10.1080/15563650802314368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Early biomarkers of cadmium exposure and nephrotoxicity. Biometals 2010; 23:793-809. [PMID: 20107869 DOI: 10.1007/s10534-010-9288-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 01/08/2010] [Indexed: 01/27/2023]
Abstract
As the risks of cadmium (Cd)-induced kidney disease have become increasingly apparent, much attention has been focused on the development and use of sensitive biomarkers of Cd nephrotoxicity. The purpose of this review is to briefly summarize the current state of Cd biomarker research. The review includes overviews of the toxicokinetics of Cd, the mechanisms of Cd-induced proximal tubule injury, and mechanistic summaries of some of the biomarkers (N-acetyl-β-D-glucosamidase; β(2)-microglubulin, metallothionein, etc.) that have been most widely used in monitoring of human populations for Cd exposure and nephrotoxicity. In addition, several novel biomarkers (kidney injury molecule-1, α-glutathione-S-transferase and insulin) that offer the potential for improved biomonitoring of Cd-exposed populations are discussed.
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Lee EJ, Arbuckle TE. Urine-sampling methods for environmental chemicals in infants and young children. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2009; 19:625-33. [PMID: 19550439 DOI: 10.1038/jes.2009.36] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 05/19/2009] [Accepted: 05/26/2009] [Indexed: 05/23/2023]
Abstract
This review paper examines and evaluates urine-sampling methodologies in infants and young children, to determine which methods are suitable for use in large biomonitoring surveys or studies of environmental chemicals in children younger than 6 years. Methods for non-toilet-trained children include the use of urine bags, collection pads (e.g., cotton or gauze inserts), disposable diapers, cotton diapers, and the clean catch method. In toilet-trained children, collection methods include use of a commode insert pan as well as specimen collection cups. The advantages and disadvantages of these various methods need to be evaluated with respect to the target population, timing and frequency of collection, minimum sample volume required, method of urine extraction, potential for contamination of the sample, stability of the analyte of interest, and burden on participants and research team. Collection methods must not introduce contamination or affect the integrity of the sample, should be logistically practical, and should minimize discomfort experienced by the child. Although collection of urine samples from children who are not toilet-trained is more challenging than collection from older toilet-trained children, the vulnerability of younger children to the exposure to and health effects of environmental chemicals makes finding suitable methods a priority.
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Affiliation(s)
- Ellen J Lee
- Chemicals Surveillance Division, Risk Management Bureau, Health Canada, Ottawa, ON, Canada
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DeSoto MC. Ockham's Razor and autism: the case for developmental neurotoxins contributing to a disease of neurodevelopment. Neurotoxicology 2009; 30:331-7. [PMID: 19442816 DOI: 10.1016/j.neuro.2009.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 03/04/2009] [Accepted: 03/07/2009] [Indexed: 12/12/2022]
Abstract
Much professional awareness regarding environmental triggers for ASD has been narrowly focused on a single possible exposure pathway (vaccines). Meanwhile, empirical support for environmental toxins as a broad class has been quietly accumulating. Recent research has shown that persons with ASD have comparatively higher levels of various toxins and are more likely to have reduced detoxifying ability, and, that rates of ASD may be higher in areas with greater pollution. This report documents that within the state with the highest rate of ASD, the rate is higher for schools near EPA Superfund sites, t (332)=3.84, p=.0001. The reasons for the rise in diagnoses likely involve genetically predisposed individuals being exposed to various environmental triggers at higher rates than in past generations.
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Affiliation(s)
- M Catherine DeSoto
- Department of Psychology, University of Northern Iowa, Baker Hall, Cedar Falls, IA 50614-0505, United States.
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Hughes JR. A review of recent reports on autism: 1000 studies published in 2007. Epilepsy Behav 2008; 13:425-37. [PMID: 18627794 DOI: 10.1016/j.yebeh.2008.06.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 06/24/2008] [Accepted: 06/27/2008] [Indexed: 01/28/2023]
Abstract
From 1000 studies published in 2007 on all aspects of autism, those that reached clear conclusions or included quantitative data were selected for this review. Possible etiologies include elemental metals, especially the inconsistent evidence regarding mercury from the vaccine preservative thimerosal, not used after 2001, and chromosomes and genes with the conclusion that autism has a complex genetic architecture. Also, various parental conditions are considered, as are many different abnormalities in the central nervous system, especially underconnectivity within the cortex. Furthermore, deficiencies in mirror neurons have been proposed, leading to the "theory of mind" explanation that autistic children tend to disregard others. In addition, various global deficiencies, like an increase in inhibitory synaptic transmission, are proposed. Characteristics of these children include selective (inward) attention; underresponsiveness; stereotyped repetitive motor behavior; increased head size, weight, and height; various cognitive and communicative disorders; and also epilepsy. Therapy has emphasized risperidone, but some atypical antipsychotic medications have been helpful, as have robotic aids, massage, hyperbaric oxygen, and music. Nearly every conceivable problem that a child could have can be observed in these unfortunate children.
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Affiliation(s)
- John R Hughes
- Department of Neurology, University of Illinois Medical Center (M/C 796), 912 South Wood Street, Chicago, IL 60612, USA
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Van der Linde AAA, Pillen S, Gerrits GPJM, Bouwes Bavinck JN. Stevens-Johnson syndrome in a child with chronic mercury exposure and 2,3-dimercaptopropane-1-sulfonate (DMPS) therapy. Clin Toxicol (Phila) 2008; 46:479-81. [PMID: 18568806 DOI: 10.1080/15563650701779687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Stevens-Johnson syndrome (SJS) is an uncommon and potentially serious mucocutaneous disease. The most important step in the management of SJS is early recognition and immediate withdrawal of the causative agent. We present a patient with SJS associated with dimercaptopropane-1-sulfonate (DMPS) therapy. CASE REPORT An asymptomatic 11-year old boy who had been exposed chronically to mercury vapour had a 24-hour urine mercury concentration of 37 microgram/L (reference value <10 microgram/L). Exposure to the mercury vapour was stopped and treatment with oral DMPS was begun. After two weeks of therapy, he developed a disseminated cutaneous eruption of red pruritic macules on his chest and back, which three days later had spread all over his body with the discrete maculae becoming confluent; erosions and crusts developed on his lips and he had blisters in his mouth. The diagnosis of SJS was made, the DMPS was stopped, and the SJS resolved gradually. DISCUSSION Chelation agents like DMPS or DMSA are increasingly used and are available over the counter in some countries. These drugs are used in patients with complaints that are attributed to mercury-containing dental amalgams and in children with autism. CONCLUSION The reported association suggests that SJS may be a potential complication of DMPS therapy, and this should be considered in the risk-benefit analysis of chelation. The reported association suggests that SJS may be a potential complication of DMPS therapy, and this should be considered in the risk-benefit analysis of chelation.
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38
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Curtis LT, Patel K. Nutritional and environmental approaches to preventing and treating autism and attention deficit hyperactivity disorder (ADHD): a review. J Altern Complement Med 2008; 14:79-85. [PMID: 18199019 DOI: 10.1089/acm.2007.0610] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The purpose of this study was to concisely review the available literature of nutritional and environmental factors on autistic spectrum and attention deficit hyperactivity disorder (ADHD). DESIGN AND METHODS Review of journal articles found on the PubMed database and from information from several conference proceedings. RESULTS Many, but not all, studies link exposure to toxins such as mercury, lead, pesticides, and in utero smoking exposure to higher levels of autism and/or ADHD. Some studies have reported many nutritional deficiencies in autism/ADHD patients. Numerous studies have reported that supplemental nutrients such as omega-3 fatty acids, vitamins, zinc, magnesium, and phytochemicals may provide moderate benefits to autism/ADHD patients. Avoidance of food allergens, food chemicals, and chelation therapy may also provide some relief to autism/ADHD patients. CONCLUSIONS Autistic spectrum disorders and ADHD are complicated conditions in which nutritional and environmental factors play major roles. Larger studies are needed to determine optimum multifactorial treatment plans involving nutrition, environmental control,medication, and behavioral/education/speech/physical therapies.
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