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Ajibo DN, Orish CN, Ruggieri F, Bocca B, Battistini B, Frazzoli C, Orish FC, Orisakwe OE. An Update Overview on Mechanistic Data and Biomarker Levels in Cobalt and Chromium-Induced Neurodegenerative Diseases. Biol Trace Elem Res 2024; 202:3538-3564. [PMID: 38017235 DOI: 10.1007/s12011-023-03965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
There is increasing evidence that the imbalance of metals as cobalt (Co) and chromium (Cr) may increase the risk of development and progression of neurodegenerative diseases (NDDs). The human exposure to Co and Cr is derived mostly from industry, orthopedic implants, and polluted environments. Neurological effects of Co and Cr include memory deficit, olfactory dysfunction, spatial disorientation, motor neuron disease, and brain cancer. Mechanisms of Co and Cr neurotoxicity included DNA damage and genomic instability, epigenetic changes, mitochondrial disturbance, lipid peroxidation, oxidative stress, inflammation, and apoptosis. This paper seeks to overview the Co and Cr sources, the mechanisms by which these metals induce NDDs, and their levels in fluids of the general population and patients affected by NDDs. To this end, evidence of Co and Cr unbalance in the human body, mechanistic data, and neurological symptoms were collected using in vivo mammalian studies and human samples.
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Affiliation(s)
- Doris Nnena Ajibo
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria
| | - Chinna Nneka Orish
- Department of Anatomy, College of Health Sciences University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria
| | - Flavia Ruggieri
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Beatrice Bocca
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Beatrice Battistini
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Chiara Frazzoli
- Department for Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore Di Sanità, Rome Viale Regina Elena, 29900161, Rome, Italy
| | | | - Orish E Orisakwe
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria.
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria.
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2
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Samargandi R, Le Nail LR, Hetaimish B, Saad M. Cobalt-chromium toxicity following revision of total hip replacement. Saudi Med J 2024; 45:194-198. [PMID: 38309739 PMCID: PMC11115421 DOI: 10.15537/smj.2024.45.2.20230334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/14/2023] [Indexed: 02/05/2024] Open
Abstract
Systemic cobalt-chromium (Co-Cr) toxicity following a total hip replacement is a rare complication that may sometimes lead to fatal consequences. We report a case of a 64-year-old woman, who presented with Co-Cr toxicity after revision of fractured ceramic components with metal-on-polyethylene. Systemic toxicity occurred a year after surgery and was expressed brutally with mostly central neurological symptoms. Revision surgery allowed rapid regression of all symptoms. Prosthetic revision with a metal bearing surface after a history of fracture of the ceramic bearing component should be avoided. Orthopedic surgeons and the different medical actors should be aware of this rare but serious complication to allow earlier management. Above all, multidisciplinary management is primordial to allow correct diagnosis and appropriate treatment.
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Affiliation(s)
- Ramy Samargandi
- From the Department of Orthopedic Surgery and Traumatology (Samargandi, Le Nail, Saad), The Regional University Hospital Centre of Tours, Tours, France, and from the Department of Orthopedic Surgery (Samargandi, Hetaimish), College of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia.
| | - Louis-Romée Le Nail
- From the Department of Orthopedic Surgery and Traumatology (Samargandi, Le Nail, Saad), The Regional University Hospital Centre of Tours, Tours, France, and from the Department of Orthopedic Surgery (Samargandi, Hetaimish), College of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia.
| | - Bandar Hetaimish
- From the Department of Orthopedic Surgery and Traumatology (Samargandi, Le Nail, Saad), The Regional University Hospital Centre of Tours, Tours, France, and from the Department of Orthopedic Surgery (Samargandi, Hetaimish), College of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia.
| | - Maxime Saad
- From the Department of Orthopedic Surgery and Traumatology (Samargandi, Le Nail, Saad), The Regional University Hospital Centre of Tours, Tours, France, and from the Department of Orthopedic Surgery (Samargandi, Hetaimish), College of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia.
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Lukas S, Martinot P, Putman S, Lons A, Drumez E, Migaud H, Girard J. Metal ion release after hip resurfacing arthroplasty and knee arthroplasty: a retrospective study of one hundred ninety-five cases. INTERNATIONAL ORTHOPAEDICS 2024; 48:119-126. [PMID: 37650937 DOI: 10.1007/s00264-023-05915-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Hip arthroplasty with metal-on-metal bearings like hip resurfacing results in the release of metallic ions. In parallel, like every metallic implant, knee arthroplasty implants undergo passive corrosion. We analyzed blood levels of cobalt and chromium ions in patients who have a hip resurfacing arthroplasty and compared them to patients who have undergone knee arthroplasty at a minimum follow-up of one year. The hypothesis was that there is no difference in the ion release between hip resurfacing and knee arthroplasty. METHODS Sixty-three patients who underwent knee arthroplasty were compared to a cohort of 132 patients who underwent hip resurfacing. The blood levels of cobalt and chromium ions were determined preoperatively and at six and 12 months postoperatively and then compared between groups. We analyzed the relationship between ion release and the change in clinical outcome scores (Harris Hip score, Oxford Hip score, Merle D'Aubigné Postel score, Oxford Knee score, International Knee Society score), the BMI, sex, physical activity, implant size and inclination of the acetabular implant (hip resurfacing patients only). Mixed linear models were used to assess the changes in ion blood levels over time. RESULTS The cobalt blood levels were higher in the first 6 months in the resurfacing group (0.87 ug/L vs 0.67 ug/L; p = 0.011), while it was higher in the knee arthroplasty group at 12 months (1.20 ug/L vs 1.41 ug/L; p = 0.0008). There were no significant differences in chromium levels during the follow-up period. CONCLUSION The increase in metal ion release after knee arthroplasty is as high as after hip resurfacing at the one year follow-up. The monitoring of this parameter probably should not be recommended in case of good clinicals outcomes.
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Affiliation(s)
- S Lukas
- Univ. Lille, CHU Lille, ULR 4490-PMOI, F-59000, Lille, France.
- Service d'Orthopédie, Hôpital Salengro, Place de Verdun, CHU Lille, F-59000, Lille, France.
| | - P Martinot
- Département de Chirurgie Orthopédique, Hôpital Saint Philibert, Université Catholique de Lille, Lomme, France
| | - S Putman
- Univ. Lille, CHU Lille, ULR 4490-PMOI, F-59000, Lille, France
- Service d'Orthopédie, Hôpital Salengro, Place de Verdun, CHU Lille, F-59000, Lille, France
| | - A Lons
- Département de Chirurgie Orthopédique, Hôpital Saint Philibert, Université Catholique de Lille, Lomme, France
| | - E Drumez
- Unité de Biostatistiques, Université Lille, Centre Hospitalier Universitaire Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, F-59000, Lille, France
| | - H Migaud
- Univ. Lille, CHU Lille, ULR 4490-PMOI, F-59000, Lille, France
- Service d'Orthopédie, Hôpital Salengro, Place de Verdun, CHU Lille, F-59000, Lille, France
| | - J Girard
- Univ. Lille, CHU Lille, ULR 4490-PMOI, F-59000, Lille, France
- Service d'Orthopédie, Hôpital Salengro, Place de Verdun, CHU Lille, F-59000, Lille, France
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, EA 7369-URePSS-Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000, Lille, France
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Ahmed A, Grabie Y, Loeffler J, Buchen Y, Acharya S. Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica. Cureus 2023; 15:e47322. [PMID: 38022109 PMCID: PMC10657017 DOI: 10.7759/cureus.47322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Total hip arthroplasty (THA) is the preferred treatment for patients with hip joint disorders refractory to conservative management. While original implants were designed to articulate a metallic femoral head onto a polyethylene liner, the popularity of "metal-on-metal" (MoM) hip implants surged in the early 21st century due to their perceived superior long-term durability and lower revision rates. However, subsequent follow-up studies showed high failure rates due to inflammatory responses to periprosthetic metallic debris leading to lymphocytic proliferation, soft tissue necrosis or fibrosis, systemic metal toxicity, and/or the development of cystic pseudotumors. Although these discoveries resulted in a significant decrease in MoM THA and revision procedures, the majority of MoM hip implants persist in the adult population. In this case report and review, we report the presentation, diagnostic work-up, and management of an 84-year-old status-post MoM THA who presented with unilateral leg tenderness and poor ambulation secondary to pseudotumor-induced sciatica.
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Affiliation(s)
- Adham Ahmed
- Internal Medicine, City University of New York School of Medicine, New York, USA
| | - Yisroel Grabie
- Internal Medicine, Staten Island University Hospital-Northwell Health, New York, USA
| | - Jeffrey Loeffler
- Internal Medicine, Staten Island University Hospital-Northwell Health, New York, USA
| | - Yosef Buchen
- Internal Medicine, Staten Island University Hospital-Northwell Health, New York, USA
| | - Sudeep Acharya
- Pulmonary and Critical Care Medicine, Staten Island University Hospital-Northwell Health, New York, USA
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Crutsen JRW, Koper MC, Jelsma J, Heymans M, Heyligers IC, Grimm B, Mathijssen NMC, Schotanus MGM. Prosthetic hip-associated cobalt toxicity: a systematic review of case series and case reports. EFORT Open Rev 2022; 7:188-199. [PMID: 35298414 PMCID: PMC8965198 DOI: 10.1530/eor-21-0098] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Prosthetic hip-associated cobalt toxicity (PHACT) is caused by elevated blood cobalt concentrations after hip arthroplasty. The aim of this study is to determine which symptoms are reported most frequently and in what type of bearing. We also try to determine the blood level of cobalt concentrations associated with toxicological symptoms. A systematic review was conducted on the 10th of July according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A methodological quality assessment (risk of bias (RoB)) was performed. Primary outcomes were the reported symptoms of cobalt toxicity and the level of cobalt concentrations in blood. These levels were associated with toxicological symptoms. A total of 7645 references were found of which 67 relevant reports describing 79 patients. The two most used bearings in which PHACT was described were metal-on-metal (MoM) bearings (38 cases) and revised (fractured) ceramic-on-ceramic (CoC) bearings where the former ceramic head was replaced by a metal head (32 cases). Of all reported symptoms, most were seen in the neurological system, of which 24% were in the sensory system and 19.3% were in central/peripheral system, followed by the cardiovascular (22.1%) system. The mean cobalt concentration for MoM-bearings was 123.7 ± 96.8 ppb and 1078.2 ± 1267.5 ppb for the revised fractured CoC-bearings. We recommend not to use a metal-based articulation in the revision of a fractured CoC bearing and suggest close follow-up with yearly blood cobalt concentration controls in patients with a MoM bearing or a revised fractured CoC bearing. Level of Evidence: Level V, systematic review.
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Affiliation(s)
- J R W Crutsen
- Department of Orthopaedic Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - M C Koper
- Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Zoetermeer, the Netherlands
| | - J Jelsma
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands
| | - M Heymans
- Zuyderland Academy, Centre of Knowledge and Information (KIC), Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - I C Heyligers
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands
| | - B Grimm
- Luxembourg Institute Health, Human Motion, Orthopaedics, Sports Medicine, Digital Methods (HOSD), Luxembourg, Luxembourg
| | - N M C Mathijssen
- Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Zoetermeer, the Netherlands
| | - M G M Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands
- School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Wise JP, Young JL, Cai J, Cai L. Current understanding of hexavalent chromium [Cr(VI)] neurotoxicity and new perspectives. ENVIRONMENT INTERNATIONAL 2022; 158:106877. [PMID: 34547640 PMCID: PMC8694118 DOI: 10.1016/j.envint.2021.106877] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 05/21/2023]
Abstract
Hexavalent chromium [Cr(VI)] is a global environmental pollutant that increases risk for several types of cancers and is increasingly being recognized as a neurotoxicant. Traditionally, the brain has been viewed as a largely post-mitotic organ due to its specialized composition of neurons, and consequently, clastogenic effects were not considered in neurotoxicology. Today, we understand the brain is composed of at least eight distinct cell types - most of which continue mitotic activity throughout lifespan. We have learned these dividing cells play essential roles in brain and body health. This review focuses on Cr(VI), a potent clastogen and known human carcinogen, as a potentially neurotoxic agent targeting mitotic cells of the brain. Despite its well-established role as a human carcinogen, Cr(VI) neurotoxicity studies have failed to find a significant link to brain cancers. In the few studies that did find a link, Cr(VI) was identified as a risk for gliomas. Instead, in the human brain, Cr(VI) appears to have more subtle deleterious effects that can impair childhood learning and attention development, olfactory function, social memory, and may contribute to motor neuron diseases. Studies of Cr(VI) neurotoxicity with animal and cell culture models have demonstrated elevated markers of oxidative damage and redox stress, with widespread neurodegeneration. One study showed mice exposed to Cr(VI)-laden tannery effluent exhibited longer periods of aggressive behavior toward an "intruder" mouse and took longer to recognize mice previously encountered, recapitulating the social memory deficits observed in humans. Here we conducted a critical review of the available literature on Cr(VI) neurotoxicity and synthesize the collective observations to thoroughly evaluate Cr(VI) neurotoxicity - much remains to be understood and recognized.
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Affiliation(s)
- John P Wise
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA.
| | - Jamie L Young
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Jun Cai
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Lu Cai
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
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