Detection and monitoring of disorders of essential trace elements

Specific of accumulation of manganese in organs and tissues of Hereford cattle

The elemental status of cattle is one of the important factors, which determine its growth, fertility, fetal development, meat and dairy production, etc. Therefore, the study of content of different elements in cattle organs and tissues and its correlation with cattle characteristics and diet is urgent task. It is also important to develop intravital and low-invasive methods to analyze element content in cattle to regulate its diet during lifetime. In the present work, we have studied the content and distribution of manganese in Hereford cattle from an ecologically clean zone of Western Siberia (Russia). 252 samples were taken from 31 bulls aged 15-18 months. They were collected from various livestock farms in the region and analyzed using atomic absorption spectrophotometry (organs and muscle tissue) and inductively coupled plasma atomic emission spectrometry (hair). The median values of manganese concentration obtained in natural moisture for hair, heart, kidneys, liver, lungs, muscles, spleen, testes, and brain were 25, 0.37, 1.0, 2.6, 0.4, 0.2, 0.4, 0.5, and 0.5 ppm. Accordingly, the concentration of manganese differs significantly in the organs and tissues of animals (H = 188.6, df = 8, p <0.0001). Statistically significant associations of manganese were revealed in pairs: liver-testis, hair-testis, spleen-testis, and heart-brain. The classification of organs and tissues of animals according to the level of content and variability of manganese is carried out. The concentration of manganese in the body is not uniform, most of all it is deposited in the hair and excretory organs of the liver and kidneys. In other organs and muscle tissues, the distribution of manganese is more even and is in the range of 0.2-0.5 ppm. The resulting ranges can be used as a guideline for Hereford cattle bred in Western Siberia.

Metal mixtures associate with higher amyotrophic lateral sclerosis risk and mortality independent of genetic risk and correlate to self-reported exposures: a case-control study

Background

The pathogenesis of amyotrophic lateral sclerosis (ALS) involves both genetic and environmental factors. This study investigates associations between metal measures in plasma and urine, ALS risk and survival, and exposure sources.

Methods

Participants with and without ALS from Michigan provided plasma and urine samples for metal measurement via inductively coupled plasma mass spectrometry. Odds and hazard ratios for each metal were computed using risk and survival models. Environmental risk scores (ERS) were created to evaluate the association between exposure mixtures and ALS risk and survival and exposure source. ALS (ALS-PGS) and metal (metal-PGS) polygenic risk scores were constructed from an independent genome-wide association study and relevant literature-selected SNPs.

Results

Plasma and urine samples from 454 ALS and 294 control participants were analyzed. Elevated levels of individual metals, including copper, selenium, and zinc, significantly associated with ALS risk and survival. ERS representing metal mixtures strongly associated with ALS risk (plasma, OR=2.95, CI=2.38-3.62, p<0.001; urine, OR=3.10, CI=2.43-3.97, p<0.001) and poorer ALS survival (plasma, HR=1.42, CI=1.24-1.63, p<0.001; urine, HR=1.52, CI=1.31-1.76, p<0.001). Addition of the ALS-PGS or metal-PGS did not alter the significance of metals with ALS risk and survival. Occupations with high potential of metal exposure associated with elevated ERS. Additionally, occupational and non-occupational metal exposures associated with measured plasma and urine metals.

Conclusion

Metals in plasma and urine associated with increased ALS risk and reduced survival, independent of genetic risk, and correlated with occupational and non-occupational metal exposures. These data underscore the significance of metal exposure in ALS risk and progression.

A comprehensive landscape of the zinc-regulated human proteome

Zinc is an essential micronutrient that regulates a wide range of physiological processes, principally through Zn 2+ binding to protein cysteine residues. Despite being critical for modulation of protein function, for the vast majority of the human proteome the cysteine sites subject to regulation by Zn 2+ binding remain undefined. Here we develop ZnCPT, a comprehensive and quantitative mapping of the zinc-regulated cysteine proteome. We define 4807 zinc-regulated protein cysteines, uncovering protein families across major domains of biology that are subject to either constitutive or inducible modification by zinc. ZnCPT enables systematic discovery of zinc-regulated structural, enzymatic, and allosteric functional domains. On this basis, we identify 52 cancer genetic dependencies subject to zinc regulation, and nominate malignancies sensitive to zinc-induced cytotoxicity. In doing so, we discover a mechanism of zinc regulation over Glutathione Reductase (GSR) that drives cell death in GSR-dependent lung cancers. We provide ZnCPT as a resource for understanding mechanisms of zinc regulation over protein function.

A State-of-the-Science Review on Metal Biomarkers

PURPOSE OF REVIEW

Biomarkers are commonly used in epidemiological studies to assess metals and metalloid exposure and estimate internal dose, as they integrate multiple sources and routes of exposure. Researchers are increasingly using multi-metal panels and innovative statistical methods to understand how exposure to real-world metal mixtures affects human health. Metals have both common and unique sources and routes of exposure, as well as biotransformation and elimination pathways. The development of multi-element analytical technology allows researchers to examine a broad spectrum of metals in their studies; however, their interpretation is complex as they can reflect different windows of exposure and several biomarkers have critical limitations. This review elaborates on more than 500 scientific publications to discuss major sources of exposure, biotransformation and elimination, and biomarkers of exposure and internal dose for 12 metals/metalloids, including 8 non-essential elements (arsenic, barium, cadmium, lead, mercury, nickel, tin, uranium) and 4 essential elements (manganese, molybdenum, selenium, and zinc) commonly used in multi-element analyses.

RECENT FINDINGS

We conclude that not all metal biomarkers are adequate measures of exposure and that understanding the metabolic biotransformation and elimination of metals is key to metal biomarker interpretation. For example, whole blood is a good biomarker of exposure to arsenic, cadmium, lead, mercury, and tin, but it is not a good indicator for barium, nickel, and uranium. For some essential metals, the interpretation of whole blood biomarkers is unclear. Urine is the most commonly used biomarker of exposure across metals but it should not be used to assess lead exposure. Essential metals such as zinc and manganese are tightly regulated by homeostatic processes; thus, elevated levels in urine may reflect body loss and metabolic processes rather than excess exposure. Total urinary arsenic may reflect exposure to both organic and inorganic arsenic, thus, arsenic speciation and adjustment for arsebonetaine are needed in populations with dietary seafood consumption. Hair and nails primarily reflect exposure to organic mercury, except in populations exposed to high levels of inorganic mercury such as in occupational and environmental settings. When selecting biomarkers, it is also critical to consider the exposure window of interest. Most populations are chronically exposed to metals in the low-to-moderate range, yet many biomarkers reflect recent exposures. Toenails are emerging biomarkers in this regard. They are reliable biomarkers of long-term exposure for arsenic, mercury, manganese, and selenium. However, more research is needed to understand the role of nails as a biomarker of exposure to other metals. Similarly, teeth are increasingly used to assess lifelong exposures to several essential and non-essential metals such as lead, including during the prenatal window. As metals epidemiology moves towards embracing a multi-metal/mixtures approach and expanding metal panels to include less commonly studied metals, it is important for researchers to have a strong knowledge base about the metal biomarkers included in their research. This review aims to aid metals researchers in their analysis planning, facilitate sound analytical decision-making, as well as appropriate understanding and interpretation of results.

Investigations on Zinc Isotope Fractionation in Breast Cancer Tissue Using in vitro Cell Culture Uptake-Efflux Experiments

Zinc (Zn) accumulates in breast cancer tumors compared to adjacent healthy tissue. Clinical samples of breast cancer tissue show light Zn isotopic compositions (δ66Zn) relative to healthy tissue. The underlying mechanisms causing such effects are unknown. To investigate if the isotopic discrimination observed for in vivo breast cancer tissue samples can be reproduced in vitro, we report isotopic data for Zn uptake-efflux experiments using a human breast cancer cell line. MDA-MB-231 cell line was used as a model for triple receptor negative breast cancer. We determined Zn isotope fractionation for Zn cell uptake (Δ66Znuptake) and cell efflux (Δ66Znefflux) using a drip-flow reactor to enable comparison with the in vivo environment. The MDA-MB-231 cell line analyses show Zn isotopic fractionations in an opposite direction to those observed for in vivo breast cancer tissue. Uptake of isotopically heavy Zn (Δ66Znuptake = +0.23 ± 0.05‰) is consistent with transport via Zn transporters (ZIPs), which have histidine-rich binding sites. Zinc excreted during efflux is isotopically lighter than Zn taken up by the cells (Δ66Znefflux = -0.35 ± 0.06‰). The difference in Zn isotope fractionation observed between in vitro MDA-MB-231 cell line experiments and in vivo breast tissues might be due to differences in Zn transporter levels or intercellular Zn storage (endoplasmic reticulum and/or Zn specific vesicles); stromal cells, such as fibroblasts and immune cells. Although, additional experiments using other human breast cancer cell lines (e.g., MCF-7, BT-20) with varying Zn protein characteristics are required, the results highlight differences between in vitro and in vivo Zn isotope fractionation.

Zinc as a Neuroprotective Nutrient for COVID-19-Related Neuropsychiatric Manifestations: A Literature Review

The outbreak of the pandemic associated with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) led researchers to find new potential treatments, including nonpharmacological molecules such as zinc (Zn2+). Specifically, the use of Zn2+ as a therapy for SARS-CoV-2 infection is based on several findings: 1) the possible role of the anti-inflammatory activity of Zn2+ on the aberrant inflammatory response triggered by COronaVIrus Disease 19 (COVID-19), 2) properties of Zn2+ in modulating the competitive balance between the host and the invading pathogens, and 3) the antiviral activity of Zn2+ on a number of pathogens, including coronaviruses. Furthermore, Zn2+ has been found to play a central role in regulating brain functioning and many disorders have been associated with Zn2+ deficiency, including neurodegenerative diseases, psychiatric disorders, and brain injuries. Within this context, we carried out a narrative review to provide an overview of the evidence relating to the effects of Zn2+ on the immune and nervous systems, and the therapeutic use of such micronutrients in both neurological and infective disorders, with the final goal of elucidating the possible use of Zn2+ as a preventive or therapeutic intervention in COVID-19. Overall, the results from the available evidence showed that, owing to its neuroprotective properties, Zn2+ supplementation could be effective not only on COVID-19-related symptoms but also on virus replication, as well as on COVID-19-related inflammation and neurological damage. However, further clinical trials evaluating the efficacy of Zn2+ as a nonpharmacological treatment of COVID-19 are required to achieve an overall improvement in outcome and prognosis.

Reference intervals for trace elements in the general Danish population and their dependence on serum proteins

Reference intervals that indicate the anticipated results of clinical chemistry parameters in a healthy background population are essential for the proper interpretation of laboratory data. In the present study, we analysed major trace elements in blood samples from 400 randomly selected members of the general Danish population. Reference intervals were established for trace elements in both whole blood and serum, and associations with major plasma transport proteins were investigated. In the case of a statistically significant correlation, a corresponding protein-adjusted reference interval was established for comparison with the unadjusted interval. While several trace elements correlated with albumin, ferritin and transferrin, the overall impact of transport proteins was minor and resulted in only marginal changes in the reference intervals. In conclusion, the updated reference intervals for trace elements can be employed without adjusting for plasma protein concentrations.

Impact of nationwide essential trace element shortages: A before-after, single-center analysis of hospitalized adults receiving home parenteral nutrition therapy

BACKGROUND

Recent data on the prevalence of essential trace element (ETE) deficiencies in home parenteral nutrition (HPN) patients are scarce. We investigated whether ETE deficiencies are still an important issue for HPN patients and whether the prevalence of such deficiencies may be influenced by nationwide drug shortages.

METHODS

We conducted a single-institution, retrospective analysis from 2006 to 2015 of hospitalized HPN patients who continued PN during and in between hospitalizations. In subgroup analysis, patients were dichotomized as those with HPN duration <1 vs ≥1 year. Zinc (Zn), copper (Cu), and selenium (Se) levels were abstracted for patients over the study period. Prevalence of ETE deficiency was compared using chi-squared test for patients hospitalized during nonshortage vs shortage (2011-2014) periods.

RESULTS

Ninety-six patients were included in the analysis. Prevalence of ETE deficiency during nonshortage vs shortage periods was 48% vs 54% (Zn), 15% vs 21% (Cu), and 24% vs 48% (Se; P = .01), respectively. When comparing patients who received HPN <1 year vs ≥1 year, the prevalence of Se deficiency doubled during shortage in both subgroups (24% to 42% vs 26% to 49%); and Cu deficiency tripled during shortage period in the group receiving HPN ≥1 year (5% to 16%).

CONCLUSION

ETE deficiency is prevalent in hospitalized HPN patients and was exacerbated during nationwide shortages of parenteral supplements. Statistical significance may be limited by small sample size. Future studies are needed to determine optimal ETE supplementation strategies for minimizing the impacts of nationwide drug shortages on HPN patients.

MrpH, a new class of metal-binding adhesin, requires zinc to mediate biofilm formation

Proteus mirabilis, a Gram-negative uropathogen, is a major causative agent in catheter-associated urinary tract infections (CAUTI). Mannose-resistant Proteus-like fimbriae (MR/P) are crucially important for P. mirabilis infectivity and are required for biofilm formation and auto-aggregation, as well as for bladder and kidney colonization. Here, the X-ray crystal structure of the MR/P tip adhesin, MrpH, is reported. The structure has a fold not previously described and contains a transition metal center with Zn²⁺ coordinated by three conserved histidine residues and a ligand. Using biofilm assays, chelation, metal complementation, and site-directed mutagenesis of the three histidines, we show that an intact metal binding site occupied by zinc is essential for MR/P fimbria-mediated biofilm formation, and furthermore, that P. mirabilis biofilm formation is reversible in a zinc-dependent manner. Zinc is also required for MR/P-dependent agglutination of erythrocytes, and mutation of the metal binding site renders P. mirabilis unfit in a mouse model of UTI. The studies presented here provide important clues as to the mechanism of MR/P-mediated biofilm formation and serve as a starting point for identifying the physiological MR/P fimbrial receptor.

Many bacteria use fimbriae to adhere to surfaces, and this function is often essential for pathogens to gain a foothold in the host. In this study, we examine the major virulence-associated fimbrial protein, MrpH, of the bacterial urinary tract pathogen Proteus mirabilis. This species is particularly known for causing catheter-associated urinary tract infections, in which it forms damaging urinary stones and crystalline biofilms that can block the flow of urine through indwelling catheters. MrpH resides at the tip of mannose-resistant Proteus-like (MR/P) fimbriae and is required for MR/P-dependent adherence to surfaces. Although MR/P belongs to a well-known class of adhesive fimbriae encoded by the chaperone-usher pathway, we found that MrpH has a dramatically different structure compared with other tip-located adhesins in this family. Unexpectedly, MrpH was found to bind a zinc cation, which we show is essential for MR/P-mediated biofilm formation and adherence to red blood cells. Furthermore, MR/P-mediated adherence can be modified by controlling zinc levels. These findings have the potential to aid development of better anti-biofilm urinary catheters or other methods to prevent P. mirabilis infection of the urinary tract.

Association Between Trace Element Status and Depression in HTLV-1-Infected Patients: a Retrospective Cohort Study

Depression and Anxiety are two important public health problems that are known to be associated with viral infections. The association between the intake of nutrients such as zinc and copper with symptoms of depression has been studied previously. The aim of the current study was to investigate the association between depression with human T cell lymphotropic virus type 1 (HTLV-1) infection and serum content of zinc and copper in a large Iranian population cohort. The study population consisted of 279 HTLV-1-positive patients who were identified after recruitment as part of a large cohort study: the Mashhad Stroke and Heart Association Disorder (MASHAD) study. They were divided into two groups of diagnosed with or without depression based on their symptoms. Serum zinc and copper levels of all subjects were measured using the flame atomic absorption spectrometry. The population sample comprised of 279 individuals infected with HTLV-1 of whom 192 (68.8%) were women. The mean serum zinc in the group with and without depression was 78.69 ± 13.79 μg/dl and 86.87 ± 19.44 μg/dl, respectively (p < 0.001). Also, the serum copper level was higher in the depressive group (116.75 ± 39.56) than in the non-depressive group (104.76 ± 30.77) (p 0.004). The association between serum zinc and copper with depression in HTLV-1-infected patients which was shown in this study could be considered in the treatment strategies in these patients.

Zinc and skin: an update

The essential trace element zinc (Zn) plays a key role in the development, differentiation and growth of various human tissues. Zinc homeostasis is primarily regulated by two zinc transporter families (solute-linked carrier families, SLC). Disturbances in zinc metabolism may give rise to disorders that typically manifest themselves on the skin. An autosomal recessive zinc deficiency disorder, acrodermatitis enteropathica is caused by a mutation in the gene coding for the ZIP4 transporter. Due to intestinal malabsorption, affected infants develop clinical signs and symptoms shortly after weaning. Acquired zinc deficiency is a rare but underdiagnosed disorder associated with various etiologies and variable clinical manifestations. Depending on the patient's age, a multitude of causes have to be considered. Given the characteristic periorificial and acral lesions, the clinical diagnosis is usually made by dermatologists. Laboratory confirmation includes measurement of plasma zinc levels and - as a supplementary measure - zinc-dependent enzymes such as alkaline phosphatase. Oral zinc replacement therapy frequently leads to clinical remission within a few days. Depending on the cause, disease management should include cooperation with pediatricians and gastroenterologists in order to guarantee optimal patient care.

Zinc: physiology, deficiency, and parenteral nutrition

The essential trace element zinc (Zn) has a large number of physiologic roles, in particular being required for growth and functioning of the immune system. Adaptive mechanisms enable the body to maintain normal total body Zn status over a wide range of intakes, but deficiency can occur because of reduced absorption or increased gastrointestinal losses. Deficiency impairs physiologic processes, leading to clinical consequences that include failure to thrive, skin rash, and impaired wound healing. Mild deficiency that is not clinically overt may still cause nonspecific consequences, such as susceptibility to infection and poor growth. The plasma Zn concentration has poor sensitivity and specificity as a test of deficiency. Consequently, diagnosis of deficiency requires a combination of clinical assessment and biochemical tests. Patients receiving parenteral nutrition (PN) are susceptible to Zn deficiency and its consequences. Nutrition support teams should have a strategy for assessing Zn status and optimizing this by appropriate supplementation. Nutrition guidelines recommend generous Zn provision from the start of PN. This review covers the physiology of Zn, the consequences of its deficiency, and the assessment of its status, before discussing its role in PN.

Removal of the gadolinium interference from the measurement of selenium in human serum by use of collision cell quadrupole inductively coupled plasma mass spectrometry (Q-ICP-MS)

BACKGROUND

Measurement of selenium in serum is an important clinical biomarker of nutritional status. The presence of gadolinium (Gd) in samples following administration of the contrast agents used for magnetic resonance imaging (MRI) results in a significant positive bias when using quadrupole inductively coupled plasma mass spectrometry (Q-ICP-MS).

METHODS

Three instrumental set-ups were assessed: standard mode with no collision gas and collision cell mode with either a hydrogen:helium mixture or hydrogen. The effect of Gd on the selenium (Se) signal was assessed using external quality assurance (EQA) specimens and internal quality control (IQC) materials, both unspiked and spiked with Gd. Serum previously shown to contain high concentrations of Gd-containing contrast agents were also analysed.

RESULTS

Recoveries of Se in the spiked compared to the unspiked samples were: between 500% and 1300% using standard mode; 100% and 29,000% using collision cell mode with hydrogen:helium mixture; and between 99% and 103% using hydrogen. The use of H2 in the collision cell provided accurate results, indicating that the charge exchange reaction (CER) of Gd(2+) with H2 removes this interference. Analysis of patient serum known to contain the Gd contrast agent using the method gave results within the selenium reference range (adults 0.89-1.65 µmol/L). The presence of Gd, as low as 0.2 mg/L, in serum samples causes a positive interference on the measurement of Se by ICP-MS.

CONCLUSIONS

Using a CER mode with pure H2 in the collision cell it was possible to fully remove the interference due to Gd(2+) from the signal for Se.

High blood manganese in iron-deficient children in Karachi

Objective

Dietary Fe deficiency has a high incidence in Pakistani children and may be associated with increased gastrointestinal absorption of trace metals such as Mn. Therefore, children residing in heavily polluted cities like Karachi may be prone to Mn toxicity. The present study investigated blood Mn concentrations in Karachi children of different Fe statuses.

Design

A prospective observational study was conducted where children were classified into different categories of Fe status – normal Fe, borderline Fe deficiency, Fe deficiency and Fe-deficiency anaemia – using WHO criteria supported by measurements of soluble transferrin receptors. Blood Mn was determined for children in each category using graphite atomic absorption spectroscopy.

Setting

Three hospital outpatient departments in Karachi, Pakistan.

Subjects

A total of 269 children (156 males, 113 females) aged 6–60 months from low-income families of Karachi.

Results

Blood Mn concentrations were significantly higher in children with Fe-deficiency anaemia and Fe deficiency compared with those of normal Fe status (both P < 0·01). Blood concentrations of soluble transferrin receptors were higher in children with Fe-deficiency anaemia compared with those of borderline or normal Fe status (both P < 0·05).

Conclusions

These findings report for the first time high blood Mn concentrations in Fe-deficient children of this age group. There is therefore an urgent need to identify and remove environmental exposure to Mn in combination with health strategies aimed at eradicating childhood Fe deficiency.

Dietary copper: a novel predisposing factor for oral submucous fibrosis?

Oral submucous fibrosis (OSMF) is known devastating disorder commonly seen in South Asian developing countries. It is directly linked to areca nut chewing and the contents of areca are subjected to multitude of investigations. Among all the contents of areca nut, the copper element has been extensively studied. Most of the published studies have validated its association with OSMF because of its local action. In this paper we postulate a novel biological pathway through which copper is thought to predispose oral mucosa to OSMF. The hypothesis is instructive in explaining various unexplored aspects of the disease.

Panmasala chewing induces deterioration in oral health and its implications in carcinogenesis

ABSTRACT Panmasala containing tobacco was introduced in the Indian market during the 1970s. Panmasala consists of areca nut (betel nut), catechu, lime, cardamom, spices, and unspecified flavoring agents, etc., with tobacco locally known as gutkha or without tobacco (Plain or sada), and consumed abundantly in India and also other parts of the world, predominantly in South East Asian countries. Available studies demonstrate that the habits of chewing panmasala gutkha or plain by students and adolesescents are on the increase, which may lead to deterioration of oral health and other organ systems. Based on the experimental as well as clinical studies available on panmasala as well as on different components of panmasala, this review suggests that it has the potential in causation of various oral diseases such as Oral Sub Mucosis Fibrosis (OSMF) and leucoplakia which may lead to oral cancer. Studies reviewed on these chewing mixtures also reveal that it is likely to be carcinogenic, as tobacco and areca nut have carcinogenic potential and both have encompassing addictive potential leading to dependence on chewing mixture containing areca nut and tobacco. These mixtures might not only lead to cancer but may also affect other organs of the body, including oral hard tissues in the form of dental attrition and sensitivity. There is a need to consider the potential health hazards associated with the habits of these products, especially oral cancer. More research is needed to find out early changes which could be reversible and also intervention measures through education to desist people in indulging in such habits.

Prediction of type-2 diabetes based on several element levels in blood and chemometrics

The present study was designed to evaluate the levels of eight elements including lithium, zinc, chromium, copper, iron, manganese, nickel and vanadium in whole blood of type-2 diabetes patients, to compare them with age-matched healthy controls and to investigate the feasibility of combining them with an ensemble model for diagnosing purpose. A dataset involving 158 samples, among which 105 were taken from healthy adults and the remaining 53 from patients with type-2 diabetes, was collected. All samples were split into the training set and the test set with the equal size. Based on a simple variable selection, two elements, i.e., chromium and iron, are also picked out as the most important elements. Three kinds of algorithms, i.e., fisher linear discriminate analysis (FLDA), support vector machine (SVM) and decision tree (DT), were used for constructing member models. The best ensemble classifiers constructed on the training set were validated on the independent test set, and the prediction results were compared with those from clinical diagnostics on the same subjects. The results reveal that almost all ensemble classifiers exhibit similar performance, implying that these elements coupled with an appropriate ensemble classifier can serve as a valuable tool of diagnosing diabetes type-2.

Interference of gadolinium on the measurement of selenium in human serum by inductively coupled plasma-quadrupole mass spectrometry

Selenium is an important clinical biomarker of nutritional status; however, the occurrence of gadolinium in a patient's serum as a result of the contrast agents used during magnetic resonance imaging investigations, results in a significant positive bias in its measurement by inductively coupled plasma-quadrupole mass spectrometry.

Bioaccumulation of metals in human blood in industrially contaminated area

Heavy metals were analyzed in different foods crops, milk, meat and blood samples collected from different age group subjects such as children (1-12 years), adolescent (12-18 years), adults (18-45 years) and old age (above 45 and 55 years for males and females, respectively) from polluted and relatively less polluted areas. The results revealed that the consumption of contaminated food crops, meat and milk have significantly increased the concentrations of selected metals in the human blood. Cu, Zn and Mn concentrations were significantly higher (p < 0.05) in the blood samples collected from the polluted area as compared to control area. Old people had accumulated high concentrations of metals as compared to the younger ones within the same area. Males accumulated higher concentrations of metals as compared to females.

Levels of As, Cd, Pb, Cu, Se and Zn in bovine kidneys and livers in Jamaica

Paired liver and kidney samples from 100 free-range cattle in different parts of Jamaica were analyzed for essential and non-essential trace elements. We found significant enrichment of elements in the kidney (K) compared to the liver (L) with the K/L concentration ratios being 5.2 for Cd, 4.1 for Pb, 3.5 for Se and 2.1 for As, but the Cu contents of the kidney were significantly higher with the K/L ratio of 0.45. A large number of kidney and liver samples showed Cu concentrations in the ranges that were associated with deficiency effects in mammals. About 15% of the hepatic samples had Zn concentrations below 20 microg/g, suggesting that there might be zinc insufficiency in some of the animals. Positive associations were found between the metals in both the kidney and liver. On average, the intake of Cd from consumption of both bovine kidney and liver from the island was estimated to be 5.2 microg/day, equivalent to about 7% of the provisional tolerable daily intake (PTDI), although anyone who habitually consumed the few kidneys or livers with >40 microg/g cadmium may be at some risk of exceeding the PTDI. The consumption of offal from local animals did not appear to be an important dietary source of any of the essential microelements.

The prediction of cardiovascular disease based on trace element contents in hair and a classifier of boosting decision stumps

The early discovery of cardiovascular disease (CVD) is crucial for performing successful treatments. This study aims at exploring the feasibility of Adaboost (ensemble from machining learning) using decision stumps as weak classifier, combined with trace element analysis of hair, for accurately predicting early CVD. A total of 124 hair samples composed of two groups of samples (one is healthy group from 100 healthy persons aged 24-72 while the other is patient group from 24 cardiovascular disease patients aged 36-81) were used. Nine kinds of trace elements, i.e., chromium (Cr), manganese (Mn), cadmium (Cd), copper (Cu), zinc (Zn), selenium (Se), iron (Fe), aluminum (Al), and nickel (Ni), were selected. In a preliminary analysis, no obvious linear correlations between elements can be observed and the concentration of Cr, Fe, Al, Cd, Ni, or Se for healthy group is higher than that for patient group while the opposite is true for Mn, Cu, or Zn, indicating that both low Se/Fe and high Mn/Cu can be identified as major risk factors. Based on the proposed approach, the final ensemble classifier, constructed on the training set and contained only four decision stumps, achieved an overall identification accuracy of 95.2%, a sensitivity of 100% and a specificity of 94% on the independent test set. The results suggested that integrating Adaboost and trace element analysis of hair sample can serve as a useful tool of diagnosing CVD in clinical practice.

Quality specifications for the determination of copper, zinc, and selenium in human serum or plasma: evaluation of an approach based on biological and analytical variation

BACKGROUND

Trace element external quality assessment schemes monitor laboratory performance and provide a stimulus for improvement in accuracy. However, monitoring of participant performance varies according to the scheme and can lead to conflicting conclusions.

METHODS

Quality specifications based on biological intra- and interindividual variability were calculated and compared to those currently used by various trace element external quality assessment schemes for plasma or serum copper, zinc, and selenium concentrations. For this purpose, we evaluated results reported by participating laboratories in different schemes, at key concentrations, using z scores.

RESULTS

Minimal quality specifications developed from the biological intra- and interindividual variability were, for Cu, +/-0.84 micromol/L or 12% of the assigned target concentration, whichever is greater; for Zn, +/-1.20 micromol/L or 15% of the assigned target concentration, whichever is greater; and for Se, +/-0.072 micromol/L or 12% of the assigned target concentration, whichever is greater. Reported performance of the participating laboratories depended on analyte, concentration, and the selected quality specification. In addition, the most commonly used methods for the determination of Cu, Zn, and Se may give different results.

CONCLUSIONS

The proposed minimal quality specifications based on biological variation are generally slightly less stringent than those currently in use, although they do not drastically change the performance evaluation in the different schemes. These specifications are a first step in the harmonization of practices among the schemes and remain to be evaluated.

Trace elements in human milk: correlation with blood levels, inter-element correlations and changes in concentration during the first month of lactation

Using inductively coupled plasma mass spectrometry (ICP-MS) based analytical procedures, the concentration of several trace elements (Mn, As, Pb, Co, Ni, Cu, Zn and Se) was determined in human milk samples collected from a group of healthy lactating Portuguese women (n=44), both on the 2nd day postpartum (i.e., colostrum; n=34) and at 1 month postpartum (i.e., mature milk; n=19). Blood samples (n=44), collected on the 2nd day after parturition, were also analyzed for the same trace elements. No major correlations were observed between the levels of the analyzed trace elements in blood and colostrum samples. All the studied elements, except for Co, Pb and Ni, showed a significant trend for a decrease in concentration in milk during the first month of lactation. This trend was more pronounced for Zn and Se, whose levels decreased to approximately 23% and 44% of their initial mean concentration, respectively. With the exception of Co (r=0.607) and Zn (r=0.487), no significant correlations were observed when comparing the levels of each trace element between samples of colostrum and mature milk. Several inter-element correlations were found within each type of milk sample. The most significant were: (i) Se vs Cu (r=0.828) and Se vs Co (r=0.605) in colostrum samples and (ii) Ni vs Pb (r=0.756), Ni vs Mn (r=0.743) and Se vs Co (r=0.714) in mature milk samples. An inverse correlation between Zn and Se was also found in both types of milk sample; however, it only reached statistical significance for mature milk (r=-0.624).

Zinc, copper, selenium and manganese blood levels in preterm infants

OBJECTIVE

To measure the zinc, copper, selenium and manganese blood levels in a cohort of 68 preterm infants, and to establish any associations with growth and/or dietary intake.

DESIGN

Blood samples were collected at an infant's expected date of delivery (term) and 6 months later. Serum zinc, plasma copper and whole blood manganese were analysed by atomic absorption spectrometry, plasma and red cell selenium were determined by mass spectrometry. Growth and dietary intake determinations have been previously published.

SETTING

Hampshire, England.

RESULTS

Mean (SD) birth weight of the infants was 1.47 (0.434) kg and mean gestation was 31.4 (2.9) weeks. Mean blood levels at term and 6 months were: serum zinc 12.0 (2.6) micromol/l and 13.8 (2.5) micromol/l; plasma copper 10.1 (2.6) micromol/l and 19.2 (3.6) micromol/l; plasma selenium 0.49 (0.15) micromol/l and 0.72 (0.14) micromol/l; red blood cell selenium 1.68 (0.40) micromol/l and 1.33 (0.19) micromol/l; and blood manganese 320 (189) nmol/l and 211 (68) nmol/l, respectively. There were no significant associations between levels of zinc and copper and dietary intakes of those nutrients at either age (dietary intakes of selenium and manganese were not determined). Only copper levels at term were significantly associated (r = 0.31; p = 0.05) with a growth parameter (head circumference).

CONCLUSION

These results provide new information about trace element status in this vulnerable population.

Evaluation of methods for trace-element determination with emphasis on their usability in the clinical routine laboratory

Commonly used techniques for trace-element analysis in human biological material are flame atomic absorption spectrometry (FAAS), graphite furnace atomic absorption spectrometry (GFAAS), inductively coupled plasma atomic emission spectrometry (ICP-AES) and inductively coupled plasma mass spectrometry (ICP-MS). Elements that form volatile hydrides, first of all mercury, are analysed by hydride generation techniques. In the absorption techniques the samples are vaporized into free, neutral atoms and illuminated by a light source that emits the atomic spectrum of the element under analysis. The absorbance gives a quantitative measure of the concentration of the element. ICP-AES and ICP-MS are multi-element techniques. In ICP-AES the atoms of the sample are excited by, for example, argon plasma at very high temperatures. The emitted light is directed to a detector, and the optical signals are processed to values for the concentrations of the elements. In ICP-MS a mass spectrometer separates and detects ions produced by the ICP, according to their mass-to-charge ratio. Dilution of biological fluids is commonly needed to reduce the effect of the matrix. Digestion using acids and microwave energy in closed vessels at elevated pressure is often used. Matrix and spectral interferences may cause problems. Precautions should be taken against trace-element contamination during collection, storage and processing of samples. For clinical problems requiring the analysis of only one or a few elements, the use of FAAS may be sufficient, unless the higher sensitivity of GFAAS is required. For screening of multiple elements, however, the ICP techniques are preferable.

Native state of metals in non-digested tissues by partial least squares regression analysis of visible and near-infrared spectra

A procedure has been used for the classification and quantification of metals on the basis of a chemometric analysis of visible and near-infrared (Vis-NIR) spectra of metals such as Cu, Mn and Fe in the brain, liver, kidney and testis of mice without digestion. Transmittance spectra in the 600- to 1000-nm region subjected to partial least-squares (PLS) regression analysis and leave-out cross-validation facilitated development of chemometrics models for predicting metal concentration. From the models, Cu, Mn and Fe yielded the coefficients of determination in cross-validation (R(2)(VAL)) as 0.8013, 0.9021 and 0.8295 with standard errors of cross-validation (SECV) of 3.399, 0.8237 and 76.512 microg per g tissue, respectively. The respective detection limits of Cu, Mn and Fe were 12.19, 2.616 and 266.32 microg per g tissue. Furthermore, the regression coefficients of the models showed specific patterns for the respective metals. These results suggest that Vis-NIR spectroscopy may have a great potential for analysis of native state of metals in tissues.

Effect of zinc replacement on lipids and lipoproteins in type 2-diabetic patients

Abnormal zinc and lipid plasma levels occur more frequently in metabolically uncontrolled diabetic patients. These lipid alterations are key factors in the emergence of microvascular complications, which lead to death in those patients. Yet, zinc sulfate supplementation may be a therapeutical resource to recover some functioning and improve life span. This article reports the assessment of lipid profile from type 2-diabetes mellitus patients treated with hypoglycemic therapy drugs, who additionally presented zinc levels lower than average in Mexican reference. The patients received a 100 mg zinc sulfate treatment in a crossover double-blind design of clinically controlled study with starch as placebo. The diabetic patients had changes in their lipid profile after a 12-week zinc treatment as compared with placebo treatment. The 100 mg zinc sulfate treatment was well tolerated, significantly reduced total cholesterol and triglyceride concentrations, and increased those corresponding to zinc as well as HDL cholesterol in the bloodstream. Thus, using this treatment the cardiovascular involvement is expected to decrease in the type 2-diabetes mellitus patients, especially those with myocardial infarction and stroke, which are the main death causes in Mexico.

The role of metals in neurodegenerative processes: aluminum, manganese, and zinc

Until the last decade, little attention was given by the neuroscience community to the neurometabolism of metals. However, the neurobiology of heavy metals is now receiving growing interest, since it has been linked to major neurodegenerative diseases. In the present review some metals that could possibly be involved in neurodegeneration are discussed. Two of them, manganese and zinc, are essential metals while aluminum is non-essential. Aluminum has long been known as a neurotoxic agent. It is an etiopathogenic factor in diseases related to long-term dialysis treatment, and it has been controversially invoked as an aggravating factor or cofactor in Alzheimer's disease as well as in other neurodegenerative diseases. Manganese exposure can play an important role in causing Parkinsonian disturbances, possibly enhancing physiological aging of the brain in conjunction with genetic predisposition. An increased environmental burden of manganese may have deleterious effects on more sensitive subgroups of the population, with sub-threshold neurodegeneration in the basal ganglia, generating a pre-Parkinsonian condition. In the case of zinc, there has as yet been no evidence that it is involved in the etiology of neurodegenerative diseases in humans. Zinc is redox-inactive and, as a result of efficient homeostatic control, does not accumulate in excess. However, adverse symptoms in humans are observed on inhalation of zinc fumes, or accidental ingestion of unusually large amounts of zinc. Also, high concentrations of zinc have been found to kill bacteria, viruses, and cultured cells. Some of the possible mechanisms for cell death are reviewed.

Serum microminerals and the indices of lipid metabolism in an apparently healthy population

Serum copper and zinc concentrations were measured in 560 apparently healthy Kuwaitis (238 males and 322 females) aged 15-80 years to assess micromineral effect on the indices of lipid metabolism. Following the recommended guidelines of the European Atherosclerosis Society (EAS) and the National Cholesterol Education Program Expert Panel (NCEPEP), the incidence of dyslipidemia was assessed from enzymatic assay data of triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) concentrations. Males had significantly lower TC (P=0.029) and HDL-C (P<0.0001) levels than females, while TG were significantly (P=0.023) lower in females. The prevalence of hypercholesterolemia, hypertriglyceridemia, elevated LDL-C, and low HDL-C levels were 35, 30, 22, and 13%, respectively. Copper did not correlate with zinc (r = -0.067, P = 0.135) but was positively associated with TC (r=0.196, P<0.0001), LDL-C (r=0.134, P = 0.003), TG (r = 0.092, P=0.039), and age (r=0.281, P<0.0001). It is concluded that unlike in animal studies, copper excess in humans is associated with hyperlipidemia and therefore will predispose to atherosclerosis.

Selenium concentrations in serum of individuals with liver diseases (cirrhosis or hepatitis): relationship with some nutritional and biochemical markers

Serum concentrations were measured in individuals (n = 50) with liver diseases (cirrhosis and hepatitis) by hydride generation atomic absorption spectrometry in a cross-sectional study. Mean serum selenium levels determined in patients with cirrhosis (n = 12) or with hepatitis (n = 38) were significantly lower (P<0.01) than those measured in control groups mainly due to a decreased liver function. Mean serum selenium concentrations were significantly lower in cirrhotic individuals when compared with patients with hepatitis (P<0.05). Therefore, the severity of the live injury is a factor conditioning the impairment in the selenium body status observed in individuals with hepatopathies. In hepatic patients serum total cholesterol levels showed a significant correlation with serum selenium concentrations (r=0.912, P<0.05) demonstrating the important role of selenium as an antioxidant agent; similarly, gamma-glutamic-transferase levels were significantly correlated with the serum selenium levels (r=-0.803, P<0.05) indicating that when the intensity of the hepatic injury increases (enhancement in serum GGT levels) concomitantly the serum selenium levels decrease significantly. No significant relationships between serum selenium levels and sex or age of patients were observed.

Multi-element analysis of trace element levels in human autopsy tissues by using inductively coupled atomic emission spectrometry technique (ICP-AES)

Autopsy tissue samples from the brain front lobe, cerebellum, heart, kidney (cortex and medulla), liver, pancreas, spleen and ovary were analysed for AL, B, Ba, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Se, Sr and Zn in 30 (17 women and 13 men) subjects ranging in age from 17 to 96 years at Haukeland University Hospital in Norway. The tissues were selected from macroscopically normal organs and samples were handled according to guidelines recommended to avoid contamination in the pre-analytical phase. Concentration of the trace elements were determined by the inductively coupled plasma atomic emission spectrometry technique (ICP-AES). In most tissues the concentrations of the essential trace elements followed the order Fe> Zn> Cu> Mn> Se> Cr> Co except in the ovary where Se was higher than Mn. The liver was the major site of deposition for Co, Cu and Mn as well as the spleen for Co, brain front lobe for Cu and pancreas for Mn. Ba, Sr and Ni built up in the ovary foLLowed by the kidney. Older subjects accumulated Ba and Sr in most tissues, whereas Al accumulated in the kidney cortex and Cd in the brain cerebellum. Generally males had higher concentrations of trace elements in the different tissue sampLes than females with the exception of Mn in the brain front lobe and heart and Sr in the liver. ICP-AES is a useful method to assess the concentration and the profiLe of trace elements in human autopsy tissues.

Determination of trace elements (Cu, Zn, Mn, Pb) and magnesium by atomical absorption in patients receiving total parenteral nutrition

OBJECTIVE

We measured the serum levels of four trace elements (Cu, Zn, Mn, Pb) and Mg in surgical patients receiving total parenteral nutrition (TPN). The clinical implications and the results are discussed.

METHODS

Two groups of patients were studied: the first group (n = 40) was our study group and the second (n = 40) was the control group. Four measurements of each trace element (TE) in blood serum were carried out: one before initiating TPN, one 24 h after, one 3 d later, and the last one immediately after discontinuing TPN. Each measurement was repeated twice. The Perkin-Elmer atomic absorption spectrophotometer (model 2380) with furnace graphite HGA-300 was used to measure the TE levels and an acetylene flame was used to measure the Mg levels.

RESULTS

Levels of all the TEs, except Pb, were lower before the administration of TPN compared with the control group (P < 0.05). The levels of TEs during and immediately after TPN were generally lower in comparison with the initial measurement before the administration of TPN.

CONCLUSION

The results of this study suggest that it may be necessary to 1) add Cu, Zn, Mn, and Mg to the parenteral nutritional solution and 2) follow the fluctuations in serum levels during the administration of TPN.

Trace element reference values in serum determined by inductively coupled plasma atomic emission spectrometry

Serum reference values for Ba, B, Cd, Cu, Fe, Mn, Li, Se, Sr, and Zn in 141 healthy Norwegians were determined. The trace element concentrations were determined by the inductively coupled plasma atomic emission spectrometry technique that we have recently validated. The reference intervals were established according to the recommendations of the International Federation of Clinical Chemistry and Laboratory Medicine. Also coverage intervals with coverage uncertainties were calculated according to the International Union of Pure and Applied Chemistry. The population studied consisted of 69 men and 72 women of the ages 21-87 years. The effects of gender, age, smoking, and oral contraceptives on serum levels of trace elements were investigated. Median concentrations of the different trace elements in (micromol/l) were as follows: Ba (0.44), B (1.50), Cd (0.004), Cu (17.1), Fe (21.4), Li (0.06), Mn (0.003), Se (1.26), Sr (0.17), and Zn (13.3). An increase in serum Ba and Sr was detected with age. These metals and Se were also significantly higher in women over 50 years of age in comparison to younger women. Women had higher serum Cu than men and those on oral contraceptives had higher serum Cu and Fe. Serum B tended to increase with age, while it was significantly reduced with smoking.

Hypermanganesemia in long-term intravenous nutrition and chronic liver disease

BACKGROUND

Hypermanganesemia and cholestatic liver disease are both recognized complications of long-term IV nutrition. Manganese is primarily excreted in bile, and recent studies have indicated that manganese toxicity may play a role in the pathogenesis of IV nutrition-associated cholestasis.

METHODS

Whole blood and plasma manganese concentrations were measured in patients receiving long-term home IV nutrition (HIN, n = 30). Whole blood manganese concentrations also were measured in patients with chronic liver disease (CLD, n = 10) and control subjects (n = 10).

RESULTS

Whole blood manganese concentrations of all CLD patients were within the reference interval (73 to 210 nmol/L) and were not different from those of the control group (151 +/- 44 nmol/L, CLD vs 155 +/- 35 nmol/L, control; not significant), despite the presence of cholestasis. In contrast, whole blood manganese concentration was increased (>210 nmol/L) in 26 patients, and plasma manganese concentration increased (>23 nmol/L) in 23 of the patients receiving HIN. None of the patients exhibited neurologic signs of manganese toxicity. There was no correlation between whole blood manganese concentrations and markers of cholestasis, IV manganese intake, or duration of HIN. However, plasma manganese concentration correlated both with average weekly IV manganese intake (r = .44, p = .02) and with gamma-glutamyl transferase (r = .43, p = .02) and alkaline phosphatase activities (r = .55, p = .003).

CONCLUSIONS

Cholestatic liver disease does not appear to contribute to increased whole blood manganese concentrations in patients not receiving HIN. Plasma manganese concentrations in patients receiving HIN reflect recent manganese exposure and impaired excretion where cholestasis is present. The lack of relationship between plasma and whole blood manganese concentrations suggests that factors other than manganese intake and excretion affect intracellular concentrations.

Manganese

Manganese is a very hard, brittle metal, which is used to increase the strength of steel alloys. Absorption from the gastrointestinal tract occurs in the divalent and tetravalent forms. Permanganates, which are strong oxidizing agents, have a +7 valence. The principal organomanganese compound is the anti-knock additive, methylcyclopentadienyl manganese tricarbonyl. Manganese is a ubiquitous constituent of the environment comprising about 0.1% of the earth's crust. For the general population, food is the most important source of manganese with daily intake ranging from 2-9 mg Mn. Combustion of gasoline containing methylcyclopentadienyl manganese tricarbonyl releases submicron particles of Mn3O4 that are potentially respirable. Biomagnification of manganese in the food chain probably does not occur. The lungs and gastrointestinal tract absorb some manganese, but the relative amounts absorbed from each site are not known. Homeostatic mechanisms limit the absorption of manganese from the gastrointestinal tract. Elimination of manganese occurs primarily by excretion into the bile. Animal studies indicate that manganese is an essential co-factor for enzymes, such as hexokinase, superoxide dismutase, and xanthine oxidase. However, no case of manganese deficiency in humans has been identified. Manganism is a central nervous system disease first described in the 1800s following exposure to high concentrations of manganese oxides. Manganese madness was the term used to describe the initial psychiatric syndrome (compulsive behavior, emotional lability, hallucinations). More commonly, these workers developed a Parkinson's-like syndrome. Currently, the risks of exposure to low concentrations of manganese in the industrial and in the environmental settings (e.g., methylcyclopentadienyl manganese tricarbonyl in gasoline) are being evaluated with regards to the development of subclinical neuropsychological changes. The American Conference of Governmental and Industrial Hygienists recently lowered the TLV-TWA for manganese compounds and inorganic manganese compounds to 0.2 mg Mn/m3.

Assessment of status

Laboratory methods for the measurement of micronutrients are usually based upon determinations in the peripheral blood. Most are relatively insensitive, but can screen for impending acute deficiency or toxicity. The metabolic responses to disease, injury and infection may alter the laboratory findings independently of dietary supply. Methods based upon the intra-cellular biochemical function of individual micronutrients are becoming available and can detect more marginal deficiencies. The investigation of general populations for micronutrient depletions largely relies upon clinical and epidemiological evaluation of responses to controlled trials of supplementation.