Studies on variations in serum copper and serum copper oxidase activity, together with studies on the copper content of the cerebrospinal fluid, with particular reference to the variations in multiple sclerosis

Copper concentration in multiple sclerosis: a systematic review and meta-analysis

BACKGROUND

A wide range of risk factors, from genetic to environmental, have been identified to play role in the etiology of multiple sclerosis. However, the role of trace element remains mostly unknown. We sought to combine all available evidence to assess the association between copper concentration and multiple sclerosis.

METHODS

This systematic review and meta-analysis was conducted based on PRISMA guidelines. PubMed, Scopus, Embase, and Web of Science were searched since inception till July 2020. Observational studies that assessed copper as exposure in serum, plasma, whole blood, and cerebrospinal fluid were included. Standardized mean differences (SMD), comparing the mean of copper concentration in multiple sclerosis patients versus healthy controls, were considered as the measure of association. The fixed-effect model with inverse variance weighting was used to combine the findings.

RESULTS

Twenty studies inclusive of 797 multiple sclerosis cases and 875 healthy controls were included in the meta-analysis (all case-control studies). The combined SMDs were 1.25 (95% confidence interval [CI] 0.95 to 1.55, number of included studies [n]=4) in plasma, 0.45 (CI 0.22 to 0.68, n=4) in whole blood, 0.19 (CI 0.06 to 0.33, n=12) in blood serum and 1.23 (CI 0.83 to 1.64, n=4) in cerebrospinal fluid.

CONCLUSIONS

We found a higher concentration of copper in multiple sclerosis patients than healthy controls. The possible causal nature of the observed associations warrants further investigation with prospective data.

Variations in Serum Copper and Ceruloplasmin Levels in Advanced Gastrointestinal Cancer Treated with Polychemotherapy

Serum copper and ceruloplasmin levels (SCL, SCeL) in 57 patients with advanced cancer of the stomach (35 cases) or large intestine (22 cases) treated with polychemotherapy were studies. In gastroenteric cancer, SCL, which are already high in untreated patients, have a tendency to increase further in cases of progression of the disease, while they seem to significantly decrease in cases of remission. SCeL during the trial appeared to be correlated to the clinical evolution of the disease only in the case of stomach cancer. In large intestine cancer, SCeL did not show any significant variation in relation to the normal range. These observations, in particular on the behavior of SCL in the neoplasms of the digestive tract, are in accordance with the results of other studies. The authors are inclined to attach a diagnostic and prognostic value to the variation in SCL and SCeL in gastrointestinal cancer.

Redox metals homeostasis in multiple sclerosis and amyotrophic lateral sclerosis: a review

The effect of redox metals such as iron and copper on multiple sclerosis and amyotrophic lateral sclerosis has been intensively studied. However, the origin of these disorders remains uncertain. This review article critically describes the physiology of redox metals that produce oxidative stress, which in turn leads to cascades of immunomodulatory alteration of neurons in multiple sclerosis and amyotrophic lateral sclerosis. Iron and copper overload has been well established in motor neurons of these diseases’ lesions. On the other hand, the role of other metals like cadmium participating indirectly in the redox cascade of neurobiological mechanism is less studied. In the second part of this review, we focus on this less conspicuous correlation between cadmium as an inactive-redox metal and multiple sclerosis and amyotrophic lateral sclerosis, providing novel treatment modalities and approaches as future prospects.

Phenytoin-mediated oxidative stress in serum of female epileptics: a possible pathogenesis in the fetal hydantoin syndrome

1. The concentration of serum malondialdehyde (MDA) was measured as the index of lipid peroxidation in female epileptics with phenytoin (PHT) monotherapy. Sera from 20 female epileptics with PHT monotherapy, 12 female epileptics without anticonvulsant therapy and 20 female healthy controls were sampled. The levels of serum copper (S-Cu), serum zinc (S-Zn), copper/zinc superoxide dismutase (CuZn-SOD), and reduced glutathione (GSH) were analyzed as interactive factors of the oxidative stress. 2. For the female epileptics with PHT monotherapy, serum MDA concentration (2.6 +/- 0.7 microM vs control 1.8 +/- 0.6 microM, P < 0.05), CuZn-SOD activity (178.2 +/- 63.5 U/dL vs control 97/1 +/- 36.4 U/dL, P < 0.01), and S-Cu content (126.2 +/- 36.1 micrograms/dL vs control 98.4 +/- 16.7 micrograms/dL, P < 0.05) were significantly increased, but GSH level (27.5 +/- 6.8 microM vs control 32.2 +/- 5.7 microM, P < 0.05) was significantly decreased. The level of serum MDA was associated with the elevation of CuZn-SOD activity (r = 0.54, P < 0.05) and S-Cu content (r = 0.44, P < 0.05) in all the samples collected from epileptics and controls. However, there were no significant differences in all the above parameters between the female epileptics without anticonvulsant therapy and healthy controls. 3. These results indicated that oxidative stress was enhanced in the female epileptics with PHT-monotherapy. Apart from the reactive PHT intermediate, the abnormal metabolism of S-Cu, CuZn-SOD, and GSH was highly involved in the PHT-mediated toxicity. Supplement of GSH, modification of CuZn-SOD enzyme activity and reduction of the absorption of copper may prevent the incidence of fetal hydantoin syndrome during pregnancy.

Geology, trace elements and health

Both animal and vegetable life depend for their existence on appropriate amounts of various trace elements, albeit in very small amounts. This paper lists some of these trace elements and the ailments in which they play an important role. The elements discussed are gold, platinum, copper, lead, zinc, aluminium, silica, mercury, cadmium, selenium, arsenic, and iodine. The diseases involved range from multiple sclerosis, various cancers, arthritis, goitre, Down's Syndrome, and mental retardation. Less well known are Keshan, Alzheimer's, Itai-Itai, and Minamata diseases. Of particular interest in the latter part of the twentieth century is the discovery that serious deficiencies of either copper or zinc in the diet of animals may break down their immune defence mechanisms. The ability of certain plants selectively to concentrate particular heavy metals in their tissues and pollen is discussed.

The effects of phenytoin on serum and organ concentrations of zinc and copper in cat

The effects of phenytoin (PHT) on zinc (Zn) and copper (Cu) concentrations in serum and different organs have been studied in cats. Five cats were treated with PHT 5 mg/kg body weight each day. Increased serum concentrations of Zn and Cu were found after 12 weeks of treatment. Increased Zn concentrations were found in the kidney and increased Cu concentrations in the liver and kidney. There wee signs of fatty degeneration of the liver. It is postulated that the drug acts as a chelator of the minerals and enhances their absorption from the intestine. A Cu accumulation may occur during PHT treatment.

Hypercupraemia induced by antiepileptic drugs

Serum copper and zinc levels were measured in 84 treated male epileptics, aged between 6 and 18 years, by an atomic absorption spectroscopic method. These patients were selected randomly from a residential special school. Twenty drug-free healthy but educationally subnormal (ESN) male subjects of similar age group from the same school acted as controls. No abnormality in serum zinc level was observed. In nineteen (22.6%) epileptics, copper levels were above the upper level of normal range (20.5 mumol/l), whereas this was only marginally elevated (20.8 mumol/l) in one (5%) ESN subject. The mean copper level in all epileptics was higher than the controls (P less than 0.01), but there was no difference between the epileptics treated with sodium valproate alone and the ESN group. The patients who were receiving carbamazepine either as monotherapy or in combination with other drugs except phenytoin, had higher mean copper levels than the controls (P less than 0.01). A similar observation was made in relation with phenytoin polytherapy (but excluding carbamazepine). There also appeared to be an association between the high serum copper levels and diffuse/generalized electroencephalographic changes (P less than 0.001). Some antiepileptic drugs, particularly carbamazepine, can produce such electroencephalographic abnormalities. It is concluded that hypercupraemia observed in these treated epileptics were related to the induction of caeruloplasmin synthesis by phenytoin and carbamazepine.

Zinc and copper in multiple sclerosis

The serum concentrations of zinc and copper were measured in 50 patients with multiple sclerosis. Lower serum zinc levels were found compared to age- and sex-matched controls. In younger patients low serum copper concentrations were noted. Zinc concentrations in CSF were unchanged. The possibility that malabsorption of the metals causes the low serum concentrations is discussed.

Metabolismo do cobre nas epilepsias

Partindo do fato de que o metabolismo do cobre está alterado nas epilepsias, o autor estudou sob que forma essa alteração se manifesta e, mediante o uso de curare em pacientes mentais submetidos ao eletrochoque, a influência da hiperatividade muscular própria da crise convulsiva sobre o metabolismo do cobre. Além disso, o autor estudou as correlações entre sexo e idade dos pacientes epilépticos, de um lado, e cupremia e cuprorraquia, do outro, e fez a correlação entre os níveis de cobre do soro e do LCR desses pacientes. Nos pacientes epilépticos (84) foram colhidas amostras de sangue (81 casos) e de LCR (66 casos) em período intercrítico para dosagem do cobre total. Nos pacientes mentais (32) foram colhidas amostras de sangue antes e imediatamente após crise convulsiva determinada pelo eletrochoque simples (22 casos) para dosagem de ceruloplasmina, e imediatamente após eletrochoque sob ação de curare (10 casos) para dosagem do cobre total. Os resultados foram submetidos a análise estatística, tendo o autor chegado às seguintes conclusões: 1) o nível de cobre do sangue e do LCR dos pacientes epilépticos não depende do sexo nem da idade; 2) o teor de cobre do LCR está correlacionado com o do sangue nos pacientes epilépticos; 3) a supressão, mediante o uso de substância curarizante, das manifestações musculares da crise produzida pelo eletrochoque acarreta queda não significativa do nível de cobre do sangue; 4) a queda do nível de cobre do sangue após convulsões determinadas pelo eletrochoque depende da hiperatividade muscular que caracteriza a crise convulsiva; 5) a queda do nível de cobre do sangue após convulsões determinadas pelo eletrochoque depende principalmente do cobre de reação direta; 6) a queda dos níveis de cobre do sangue após convulsões determinadas pelo eletrochoque é devida à pas* sagem desse elemento para os espaços intracelulares.