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

Effect of lactic acid bacteria by different concentrations of copper based on non-target metabolomic analysis

Copper (Cu) is an essential element for mammals, but excess intake can have detrimental health consequences. However, Cu is no longer present in the "Limit of Contaminants in Foods" promulgated in 2022. The potential impact of different Cu (II) concentrations on human health remains unclear. In this study, a strain of lactic acid bacteria (LAB), namely, Lactiplantibacillus plantarum CICC 23121 (L23121), was selected as a prebiotic indicator strain to indirectly assess the effects of food-limited Cu (II) concentrations (issued by Tolerance limit of copper in foods in 1994) on the functions of intestinal microbes. We used non-target metabolomics, automatic growth curve detector, scanning electron microscopy (SEM), and Fourier transform infrared spectroscopy (FTIR) to investigate the effects of Cu (II) on L23121. The study revealed shows that the 50% minimum inhibitory concentration (MIC50) of Cu (II) for most lactic acid bacteria was 4 mg/L. At low Cu (II) concentrations (≤ 4 mg/L), the pentose phosphate pathway and pyrimidine metabolism of the lactic acid bacteria were affected, resulting in a decrease in the content of beneficial secondary metabolites and a significant decrease in the cell activity. As Cu (II) concentrations increase (≥ 6 mg/L), the key amino acid and lipid metabolisms were affected, leading to the inhibition of growth and primary metabolite production of the bacteria. Under high concentration of Cu (II) (6 mg/L), the surface adhesion of the bacteria was distorted and covered with significantly large particles, and the functional groups of the cells were significantly shifted. As a probiotic, the abundance of lactic acid bacteria in the intestine is significantly reduced, which will inevitably seriously damage intestinal homeostasis. Thus, to protect human intestinal microbes' health, it is recommended to limit the concentration of Cu in food to less than 4 mg/L.

Synthesis and characterization of cylindrical electrode with sucrose binder as advanced electrode materials for copper 3D-electro-oxidation

This study produced a biomass-based cylindrical electrode containing sucrose (an organic binder). The Cu2+ removal performance of the synthesized sucrose-bonded cylindrical electrode was evaluated in a 3-phase 3-dimensional electro-oxidation reactor (3D-EO) and the classical electro-oxidation method (2D-EO). Sodium Dodecyl Sulfate (SDs) was grafted onto activated carbon and used as microelectrode in 3D-EO reactors. SDs grafting resulted in a 57% reduction in the micropores of activated carbon. Therefore, the surface area of carbon after grafting decreased from 1328 m2/g to 580 m2/g. The sucrose-bonded cylindrical electrode has a rich carbon structure and consists of 84.04 wt% C, 12.10 wt% O and 3.20 wt%Si. According to CV measurement, the sucrose-bonded cylindrical electrode gives a surface reaction against Cu2+ at voltages lower than -0.62 V. Increasing the potential difference from 1V to 3V in 2D-EO and 3D-EO processes led to the removal of Cu2+ from the solution. The 3D-EO reactor achieved a removal rate of 87.12% at 3V. The 100 ppm solution was treated with a 3D-EO reactor containing 6 g/L of PC/SDs400Ws for 60 min, successfully removing 91.22% of Cu2+.

Latent Benefits and Toxicity Risks Transmission Chain of High Dietary Copper along the Livestock-Environment-Plant-Human Health Axis and Microbial Homeostasis: A Review

The extensive use of high-concentration copper (Cu) in feed additives, fertilizers, pesticides, and nanoparticles (NPs) inevitably causes significant pollution in the ecological environment. This type of chain pollution begins with animal husbandry: first, Cu accumulation in animals poisons them; second, high Cu enters the soil and water sources with the feces and urine to cause toxicity, which may further lead to crop and plant pollution; third, this process ultimately endangers human health through consumption of livestock products, aquatic foods, plants, and even drinking water. High Cu potentially alters the antibiotic resistance of soil and water sources and further aggravates human disease risks. Thus, it is necessary to formulate reasonable Cu emission regulations because the benefits of Cu for livestock and plants cannot be ignored. The present review evaluates the potential hazards and benefits of high Cu in livestock, the environment, the plant industry, and human health. We also discuss aspects related to bacterial and fungal resistance and homeostasis and perspectives on the application of Cu-NPs and microbial high-Cu removal technology to reduce the spread of toxicity risks to humans.

Investigating electrochemical deposition of gold on commercial off-the-shelf 3-D printing materials towards developing sensing applications†

The COVID-19 pandemic highlighted the inaccessibility of quick and affordable clinical diagnostics. This led to increased interest in creating low-cost portable electrochemical (EC) devices for environmental monitoring and clinical diagnostics. One important perspective is to develop new fabrication methods for functional and low-cost electrode chips. Techniques, such as electron beam and photolithography, allow precise and high-resolution electrode fabrication; however, they are costly and can be time-consuming. More recently, fused deposition modeling three-dimensional (3-D) printing is being used as an alternative fabrication technique due to the low-cost of the printer and rapid prototyping capability. In this study, we explore enhancing the conductivity of 3-D printed working electrodes with EC gold deposition. Two commercial conductive filament brands were used and investigated to fabricate electrode chips. Furthermore, strategies to apply epoxy glue and conductive silver paint were investigated to control the electrode surface area and ensure good electrical connection. This device enables detection at drinking water concentration thresholds. The practical application of the fabricated electrodes is demonstrated by detecting Cu²⁺ using anodic stripping voltammetry.

Customized electrodes were made with 3-D printing and gold electrochemical reduction towards analytical applications.

Mechanisms of Cd and Cu induced toxicity in human gastric epithelial cells: Oxidative stress, cell cycle arrest and apoptosis

Cadmium (Cd) and copper (Cu) are widely present in foods. However, their adverse effects on human gastric epithelium are not fully understood. Here, human gastric epithelial cells (SGC-7901) were employed to study the toxicity and associated mechanisms of Cd + Cu co-exposure. Their effects on cell viability, morphology, oxidative damage, cell cycle, apoptosis, and the mRNA levels of antioxidases and cell cycle regulatory genes were investigated. Co-exposure to Cd (5 μM)/Cu (10 μM) induced >40% cell viability loss, whereas little effect on cell viability at <10 μM Cd or 40 μM Cu. Compared to individual exposure, co-exposure induced greater oxidative damage by elevating ROS (3.5 folds), malondialdehyde (2.3 folds) and expression of SOD1 and HO-1 besides inhibiting CAT, GPX1 and Nrf2. A marked S cell-cycle arrest was observed in co-exposure, evidenced by more cells staying in the S phase (36%), up-regulation of cyclins-dependent kinase (CDK4) and CDKs inhibitor (p21) and down-regulation of CDK2, CDK6 and p27. Furthermore, higher apoptosis (22%) with floated and round cells occurred in co-exposure group. Our data implicate the cytotoxicity of Cd + Cu co-exposure was higher than individual exposure, and individual assessment would underestimate their potential health risk. Oxidative stress and cell cycle arrest possibly played a role in Cd + Cu induced toxicity and apoptosis in SGC-7901 cells. Our data suggest the importance to reduce Cd in foods to decrease its adverse impacts on human digestive system.

Legionellosis and Recent Advances in Technologies for Legionella Control in Premise Plumbing Systems: A Review

This review discusses Legionella, among the most prolific and publicly well-known waterborne pathogens, and advances in potential treatment technologies. The number of cases associated with Legionella continues to rise, as does its public awareness. Currently, cases associated with premise plumbing account for the largest number of legionellosis cases in the United States. So, while it is important to understand Legionella as such, it is also important to investigate how to treat drinking water in premise plumbing for Legionella and other waterborne pathogens. While there are currently several methods recognized as potential means of inactivating waterborne pathogens, several shortcomings continue to plague its implementation. These methods are generally of two types. Firstly, there are chemical treatments such as chlorine, chlorine dioxide, monochloramine, ozone, and copper-silver ionization. Secondly, there are physical treatments such as thermal inactivation and media filtration. Their shortcomings range from being labor-intensive and costly to having negative health effects if not properly operated. Recently developed technologies including ultraviolet (UV) irradiation using light emitting diodes (LEDs) and innovative carbon nanotube (CNT) filters can better control waterborne pathogens by allowing for the simultaneous use of different treatment measures in plumbing systems.

In-situ synthesis of reduced graphene oxide/gold nanoparticles modified electrode for speciation analysis of copper in seawater

In this paper, reduced graphene oxide/gold nanoparticle/Nafion (rGO/AuNP/Nafion) modified electrode was fabricated through in-situ synthesis and used for determination of copper ions in strong salt electrolyte (0.5M NaCl) by differential pulse anodic stripping voltammetry (DPASV). This in-situ synthesis procedure was based on the ion-exchange and electrochemical reduction. The use of rGO provided a larger electrode surface and the presence of more active sites, while electron transfer was accelerated by incorporating AuNPs. Nafion was utilized as a cation exchange polymer in which rGO and AuNPs could be tightly attached to the electrode surface. The physical and electrochemical characterizations of the as-prepared modified electrode were studied by transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS) and cyclic voltammetry. AuNPs with diameter of 5-10nm on rGO decorated in the gold electrode surface were observed. Under the optimal conditions, the rGO/AuNP/Nafion electrode had a linear response to copper ions in the concentrations range from 20nM to 1μM (R² = 0.998), with the lowest detectable concentration of 8nM and the detection limit of 4nM (S/N = 3). Additionally, this electrode was successfully applied to the speciation analysis of copper (free, dissolved and total) in seawater.

Copper Corrosion and Biocorrosion Events in Premise Plumbing

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

Eco-Health linkages: assessing the role of ecosystem goods and services on human health using causal criteria analysis

OBJECTIVES

In the last decade, we saw an upsurge of studies evaluating the role of ecosystem goods and services (EGS) on human health (Eco-Health). Most of this work consists of observational research of intermediate processes and few address the full pathways from ecosystem to EGS to human health, limiting our ability to assess causality.

METHODS

We conducted a causal criteria analysis of Eco-Health literature using Eco-Evidence, a software tool that helps evaluate evidence of cause-effect relationships. We focus on the context of green spaces providing "buffering" EGS that may influence disease.

RESULTS

We found support for a causal linkage between green spaces and all of the EGS tested, and sufficient evidence linking EGS to gastro intestinal disease and heat morbidities. Inconsistencies were found when assessing the link between EGS to cardiovascular and respiratory diseases. Few studies directly link green spaces to health. Those that do, support a connection to cardiovascular disease, and heat morbidities, but provide inconsistent evidence regarding respiratory illness.

CONCLUSIONS

Our results help establish an agenda to shape future Eco-Health research and define priorities for managing green spaces to provide human health benefits.

Selective adsorption and recycle of Cu2+ from aqueous solution by modified sugarcane bagasse under dynamic condition

Tetraethylenepentamine modified sugarcane bagasse was prepared and applied to test its feasibility in removing and recovering Cu²⁺ from wastewater under dynamic condition. Results showed that the Cu²⁺ could be selectively absorbed from wastewater by the modified SCB fixed bed column. To understand the adsorption mechanism, Cd²⁺ had been selected as the model interfering ion to investigate how co-ions influence the adsorption of Cu²⁺ on the sorbent. It was observed that the adsorption capacity of the sorbent for Cu²⁺ (0.26 mmol g^-1) was significantly higher than that of Cd²⁺ (0.03 mmol g^-1), even when the Cd²⁺ initial concentration was 100 times higher than that of Cu²⁺ in the binary system. This finding indicated that the presence of Cd²⁺ in the solution exerted negligible influence on the adsorption of Cu²⁺ on the modified SCB. The selectivity of the modified sorbent was further confirmed in the Cu/Cd/Mg/Pb/K quinary system. Further analysis to dynamic adsorption experiment illustrated that, due to the presence of amine groups, the modified SCB showed strong coordination ability to Cu²⁺, which allowed the other adsorbed ions (e.g., Cd²⁺) desorbed. This high adsorption selectivity toward Cu²⁺ suggested that this prepared sorbent would be a promising candidate for removing and recovering Cu²⁺ from wastewater.

Urinary Metal Levels in a Chilean Community 31 Years After the Dumping of Mine Tailings

BACKGROUND

Between 1938 and 1975, the city of Chañaral, located in the north of Chile, received 200 megatons of unregulated mining waste, which created an artificial beach 10 kilometers long and covering an area larger than 4 km2. In 1983, this deposit was classified as a serious case of marine pollution in the Pacific Ocean, according to the Organization for Economic Cooperation and Development. In 1989, dumping ceased due to a judicial order. Until now, the effects of this pollution on the population living around these mine tailings has been unknown.

OBJECTIVE

To determine the prevalence of exposure to metals by dust from mine tailings in Chañaral, a city located in the northern mining area of Chile.

METHODS

The level of urinary metals in a representative sample of adults from Chanaral was determined.

RESULTS

Urinary levels of total arsenic (44.6 μg/L), inorganic arsenic (17.0 μg/L) and nickel (2.8 μg/L) were higher than in other areas of Chile. Levels of copper (17.9 μg/L), mercury (1.6 μg/L) and lead (0.9 μg/L) exceeded international values. Of the total subjects, 67.5%, 30.4%, 29.4%, 16.9%, 13.2 and 9.3% presented with high levels of copper, nickel, total arsenic, inorganic arsenic, mercury and lead, respectively.

CONCLUSION

Thirty-one years after suspension of the discharge of mining waste, the local population in this area remains exposed to metals from the mine tailings. Surveillance and remedial actions addressing the Chañaral mine tailings are needed.

Removal of Cu (II) and Pb (II) from Aqueous Solution using engineered Iron Oxide Nanoparticles

Nano-sized Fe₃O₄ and Fe₂O₃ were synthesized using a precipitation method. The nanomaterials were tested as adsorbents for the removal of both Cu²⁺ and Pb²⁺ ions. The nanomaterials were characterized using X-ray powder diffraction to determine both the phase and the average grain size of the synthesized nanomaterials. Batch pH studies were performed to determine the optimum binding pH for both the Cu²⁺ and Pb²⁺ to the synthesized nanomaterials. The optimum binding was observed to occur at pH 4 and above. Time dependency studies for Cu²⁺ and Pb²⁺ showed the binding occurred within the first five minutes of contact and remained constant up to 2 hours of contact. Isotherm studies were utilized to determine the binding capacity of each of the nanomaterials for Cu²⁺ and Pb²⁺. The binding capacity of Fe₃O₄ with Cu²⁺ and Pb²⁺ were 37.04 mg/g and 166.67 mg/g, respectively. The binding capacities of the Fe₂O₃ nanomaterials with Cu²⁺ and Pb²⁺ were determined to be 19.61 mg/g and 47.62 mg/g, respectively. In addition, interference studies showed no significant reduction in the binding of either Cu²⁺ or Pb²⁺ to the Fe₃O₄ or Fe₂O₃ nanomaterials in the presence of solutions containing the individual ions Na⁺, K⁺, Mg²⁺ and Ca²⁺ or a solution consisting of a combination of all the aforementioned cations in one solution.

Parasitological, Hematological and Biochemical Characteristics of a Model of Hyper-microfilariaemic Loiasis (Loa loa) in the Baboon (Papio anubis)

Background

Loiasis, a filarial infection caused by Loa loa usually thought to cause relatively minor morbidity, can cause serious and often fatal reactions in patients carrying very high levels of circulating Loa loa microfilariae (mf) following administration of microfilaricidal drugs. An experimental model of this condition would greatly aid the definition of the optimal management of this important clinical presentation.

Methodology/Principle Findings

Fifteen baboons (Papio anubis) were infected with 600 infective larvae (L3) isolated from Chrysops vector flies. Animals were observed for any clinical changes; blood samples were collected every 1–2 months for 22 months, and analysed for parasitological, hematological and biochemical profiles using standard techniques. All animals became patent but remained clinically normal throughout the study. The parasitological pre-patent period was between 4–8 months, with a majority (60%) of animals becoming patent by 5 months post infection (MPI); all animals were patent by 8 MPI. Microfilarial loads increased steadily in all animals and reached a peak at 18 MPI. By 10 MPI >70% of animals had mf >8,000 mf/mL, and at 18 MPI >70% of animals had mf >30,000mf/mL with 50% of these animals with mf >50,000mf/mL. Absolute eosinophil, creatinine, Ca²⁺ and K⁺ levels were generally above normal values (NV). Positive associations were seen between microfilariaemia and eosinophilia, Hb, Ca²⁺, and gamma-GT values, whilst significant negative associations were seen between microfilariaemia and potassium, glucose and mononuclear leukocyte levels.

Conclusions

Infection of splenectomised baboons with L. loa can induce levels of circulating microfilariae, and corresponding haematological profiles, which parallel those seen in those humans in danger of the severe post-microfilariacide clinical responses. Utilization of this experimental model could contribute to the improved management of the loiasis related adverse responses in humans.

Loiasis is a filarial infection of humans that, in addition to causing severe direct clinical effects, is of concern to the global community’s efforts to eliminate the important filarial diseases, onchocerciasis and lymphatic filariasis, through causing interruption to mass drug distribution activities. Hyper-microfilariaemia has been seen to be the characteristic parameter in patients suffering from post ivermectin encephalopathy, a condition which sometimes leads to death. Understanding and developing appropriate approaches to the treatment and prevention of these severe adverse reactions has been difficult due to the lack of suitable models. As primates can be infected with human L. loa, and can develop hyper-microfilariaemia, it is likely that they therefore can serve as suitable models for the investigation of this syndrome in humans. This current study shows that following splenectomy the circulating microfilarial loads are similar to those seen in humans, and that the clinical pathology profile following infection also appears to be similar. The consistent ability to induce microfilariae levels of above 30,000 mf/ml in more than 70% of the tested animals suggests that this is indeed a practical model for investigating the adverse events occurring in hyper-loiasis.

Fabrication of fluorescent SiO2@zeolitic imidazolate framework-8 nanosensor for Cu2+ detection

The formation of core–shell SiO₂@ZIF-8 nanostructures for Cu²⁺ detection is reported here.

Storing drinking-water in copper pots kills contaminating diarrhoeagenic bacteria

Microbially-unsafe water is still a major concern in most developing countries. Although many water-purification methods exist, these are expensive and beyond the reach of many people, especially in rural areas. Ayurveda recommends the use of copper for storing drinking-water. Therefore, the objective of this study was to evaluate the effect of copper pot on microbially-contaminated drinking-water. The antibacterial effect of copper pot against important diarrhoeagenic bacteria, including Vibrio cholerae O1, Shigella flexneri 2a, enterotoxigenic Escherichia coli, enteropathogenic E. coli, Salmonella enterica Typhi, and Salmonella Paratyphi is reported. When drinking-water (pH 7.83 +/- 0.4; source: ground) was contaminated with 500 CFU/mL of the above bacteria and stored in copper pots for 16 hours at room temperature, no bacteria could be recovered on the culture medium. Recovery failed even after resuscitation in enrichment broth, followed by plating on selective media, indicating loss of culturability. This is the first report on the effect of copper on S. flexneri 2a, enteropathogenic E. coli, and Salmonella Paratyphi. After 16 hours, there was a slight increase in the pH of water from 7.83 to 7.93 in the copper pots while the other physicochemical parameters remained unchanged. Copper content (177 +/- 16 ppb) in water stored in copper pots was well within the permissible limits of the World Health Organization. Copper holds promise as a point-of-use solution for microbial purification of drinking-water, especially in developing countries.

Administration of high doses of copper to capuchin monkeys does not cause liver damage but induces transcriptional activation of hepatic proliferative responses

Liver cells respond to copper loading upregulating protective mechanisms. However, to date, except for liver content, there are no good indicators that identify individuals with excess liver copper. We hypothesized that administering high doses of copper to young (5.5 mg Cu · kg⁻¹ . d⁻¹) and adult (7.5 mg Cu · kg⁻¹ . d⁻¹) capuchin monkeys would induce detectable liver damage. Study groups included adult monkeys (2 females, 2 males) 3-3.5 y old at enrollment treated with copper for 36 mo (ACu); age-matched controls (1 female, 3 males) that did not receive additional copper (AC); young monkeys (2 female, 2 males) treated from birth with copper for 36 mo (YCu); and young age-matched controls (2 female, 2 males) that did not receive additional copper (YC). We periodically assessed clinical, blood biochemical, and liver histological indicators and at 36 mo the hepatic mRNA abundance of MT2a, APP, DMT1, CTR1, HGF, TGFβ, and NFκΒ only in adult monkeys. After 36 mo, the liver copper concentration was 4-5 times greater in treated monkeys relative to controls. All monkeys remained healthy with normal routine serum biochemical indices and there was no evidence of liver tissue damage. Relative mRNA abundance of HGF, TGFβ and NFκB was significantly greater in ACu than in AC monkeys. In conclusion, capuchin monkeys exposed to copper at doses up to 50 times the current upper level enhanced expression of genes related to inflammation and injury without clinical, blood biochemical, or histological evidence of liver damage.

Risks and benefits of copper in light of new insights of copper homeostasis

Copper is an essential micronutrient involved in a variety of biological processes indispensable to sustain life. At the same time, it can be toxic when present in excess, the most noticeable chronic effect being liver damage. Potent, efficient regulatory mechanisms control copper absorption in the digestive tract and copper biliary excretion; absorption ranges between 12 and 60% in humans, depending on Cu intake, presence of other factors in the diet that may promote or inhibit its absorption and on the copper status of the individual. Current evidence suggests that copper deficiency may be more prevalent than previously thought, while copper toxicity is uncommon under customary daily life conditions. Menkes syndrome and Wilson disease are genetic conditions associated with severe copper deficiency and severe copper toxicity, respectively. Effects of milder degrees of copper deficiency and excess copper exposure are not well described, mainly due to lack of sensitive and specific indicators; serum copper concentration and ceruloplasmin are the most frequently used indicators, but they only detect rather intense changes of copper status. Of the many proteins assessed as potential markers of copper status the chaperone of Zn-Cu superoxide dismutase (CCS1) has yielded promising results; data on its performance under different conditions are needed to confirm its use as an indicator of early copper deficiency. Defining copper requirements and upper safe limits of consumption (UL) is a complex process since there are adverse health consequences from both copper deficiency and copper excess (U shape curve). The regulatory framework for risk assessment of essential trace elements introduced by the International Programme on Chemical Safety (IPCS) has proposed a homeostatic model to determine the Adequate Range of Oral Intake (AROI) of essential trace elements; the nadir of the resulting U shape curve serves to define the AROI. At this range of intake physiological mechanisms allow for normal homeostasis and basically, there are no detectable adverse effects. At present, Recommended Dietary Intakes (DRIs) and Adequate Intakes (AIs) are used to recommend copper intakes at different ages and life situations. Evidence obtained in humans and non-human primates presented here suggest that current copper UL should be re evaluated. Developing the scientific basis for a copper UL and evaluating the relevance of copper deficiency globally are future key challenges for copper researchers.

An exposure-response curve for copper excess and deficiency

There is a need to define exposure-response curves for both Cu excess and deficiency to assist in determining the acceptable range of oral intake. A comprehensive database has been developed where different health outcomes from elevated and deficient Cu intakes were assigned ordinal severity scores to create common measures of response. A generalized linear model for ordinal data was used to estimate the probability of response associated with dose, duration and severity. The model can account for differences in animal species, the exposure medium (drinking water and feed), age, sex, and solubility. Using this model, an optimal intake level of 2.6 mg Cu/d was determined. This value is higher than the current U.S. recommended dietary intake (RDI; 0.9 mg/d) that protects against toxicity from Cu deficiency. It is also lower than the current tolerable upper intake level (UL; 10 mg/d) that protects against toxicity from Cu excess. Compared to traditional risk assessment approaches, categorical regression can provide risk managers with more information, including a range of intake levels associated with different levels of severity and probability of response. To weigh the relative harms of deficiency and excess, it is important that the results be interpreted along with the available information on the nature of the responses that were assigned to each severity score.

Influence of estrogens on copper indicators: in vivo and in vitro studies

Classic copper indicators are not sensitive and specific for detecting excess copper exposure when this is higher than customary but not markedly elevated. Serum copper and ceruloplasmin (Cp) are the most commonly used indicators to assess nutritional status of copper. The objective of this paper was to study the influence of estrogens on these indicators and others used to assess early effects of excess copper exposure in humans and the expression of a set of copper related proteins in a hepatic cellular model. For the studies in humans, 107 healthy participants (18-50 years) were allocated as follows: group 1 (n = 39), women assessed on day 7 of their hormonal cycle; group 2 (n = 34), women assessed on day 21 of their hormonal cycle, and group 3 (n = 34, comparison group), healthy men. Participants received 8 mg Cu/day (as copper sulfate) during 6 months. Serum Cp and Cu, Cu-Zn-superoxide dismutase activity, liver function indicators [aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyltransferase (GGT)], and serum Fe and Zn concentrations were measured monthly. In addition, the influence of estradiol on intracellular total copper content, hctr1, dmt1 and shbg mRNA abundance and hCTR1, and DMT1 expression was measured in HepG2 cells. Serum Cu, Fe, and Zn and liver aminotransferases but not Cu-Zn-superoxide dismutase varied depending on sex. Fe nutrition indicators, GGT, and ALT activities showed significant differences between the hormonal phases. Cellular experiments showed that estradiol increased cellular Cu concentration and hCTR1 and DMT1 mRNA expression and changed these proteins expression patterns. Estradiols significantly influence the responses to copper at the whole body and the cellular levels, suggesting that they help maintaining copper availability for metabolic needs.

Essentiality and toxicity in copper health risk assessment: overview, update and regulatory considerations

Copper (Cu), an essential element required as a cofactor and/or structural component of numerous metalloenzymes, is uniquely positioned as a case study for issues associated with the essential metals health risk assessment, because of its extensive database. Essential elements pose distinct challenges when establishing regulatory guidelines because too little as well as too much intake can produce adverse health consequences and the dose-response curve is roughly U-shaped. Thus, conventional health risk assessment paradigms do not apply to essential elements; the dose-response assessment needs to define an acceptable range of oral intake (AROI) which prevents deficiency by meeting nutritional requirements while avoiding toxicity due to high intakes. The conceptual framework for this type of risk assessment includes consideration of biological processes that are unique to essential elements-homeostasis, basal and normative nutritional requirements, bioavailability, and nutrient-nutrient interactions. In this paper, the Cu database on physiology, deficiency, and excess is briefly reviewed in order to establish the range of potential health hazards associated with varying levels of intake. Issues discussed include the (1) development of suitable dose-response methodologies, including appropriate dose and response metrics, for Cu; (2) categorization of severity of response and functional significance; (3) use of endpoints of similar severity and functionality for deficiency and excess in dose-response assessment; (4) development of valid biomarkers for subclinical effects, exposures and susceptibilities. Guideline values for Cu intake have been established by nutritional and toxicologic regulatory or advisory boards. Although regulators are more concerned with the potential human toxicity arising from excessive Cu intake, the preponderance of evidence suggests that deficiency is more of a public health concern than excess.

Acute copper sulphate poisoning: a case report and literature review

Voluntary copper poisoning is a rare mode of suicide. We report a case of copper sulphate poisoning in a patient presenting delusions with mystic demands for purification. The initial gastrointestinal symptoms were followed by intravascular haemolysis and renal failure. The course was favourable after symptomatic treatment and specific copper chelation therapy. However, the pathogenesis is not fully understood and with the present state of knowledge, no one treatment can be said to be superior to another. The authors discuss the various treatments of this rare poisoning through a review of the available literature.

Copper and liver function indicators vary depending on the female hormonal cycle and serum hormone binding globulin (SHBG) concentration in healthy women

Previous studies showed that responses to chronic administration of copper were significantly associated with gender, raising the need to better characterize the relation between the effects observed and stradiols. The objective of this study was to measure copper and liver function indicators and the sex hormone binding globulin (SHBG) serum concentrations in healthy adults exposed to copper, grouped by sex and phase of the female hormonal cycle. Healthy females on day 7 (follicular phase, Group 1, n = 39), on day 21 (secretory phase, Group 2, n = 34) and males (comparison group, Group 3, n = 34) received 8 mg Cu/day (as copper sulfate), orally, for 6 months. On days 0, 30, 60, 120, and 180, the serum concentration of copper, ceruloplasmin, liver aminotransferases, and SHBG were measured. Analysis of results included analysis of variance (ANOVA; repeated measures) and the post hoc Bonferroni correction. Participants remained healthy throughout the study period, including aminotransferases below the cut off in all measures. GGT, AST, and ALT activities were significantly different by group and by time (ANOVA repeated measures P < 0.05). Six-month curves of serum copper and ceruloplasmin concentrations were different by group, by time and interaction group x time (all P < 0.001). SHBG curves were different by group and time (P < 0.01), and interaction group x time (P < 0.009). Serum copper, ceruloplasmin, and liver aminotranferases are influenced by estrogens/progesterone, something that should be considered when these indicators are used as outcomes of effects. Time of sampling was also significantly associated with the indicators and deserves further study.

CCS and SOD1 mRNA are reduced after copper supplementation in peripheral mononuclear cells of individuals with high serum ceruloplasmin concentration

The limits of copper homeostatic regulation in humans are not known, making it difficult to define the milder effects of early copper excess. Furthermore, a robust assay to facilitate the detection of early stages of copper excess is needed. To address these issues, we assessed changes in relative mRNA abundance of methallothionein 2A (MT2A), prion (PrP), amyloid precursor-like protein 2 (APLP2), Cu/Zn superoxide dismutase (SOD1) and its copper chaperone (CCS) in peripheral mononuclear cells (PMNCs) from healthy adults representing the 5% highest and lowest extremes in the distribution curve of serum ceruloplasmin (Cp) concentrations of 800 individuals. The intracellular Cu content was also determined. PMNCs were isolated from individuals before and after exposure to a single daily dose of 10 mg Cu (as CuSO(4)) for 2 months. Results showed that although there were fluctuations in serum Cp values of the samples assessed before copper exposure, no significant differences were observed in cell copper content or in the relative abundance of MT2A, PrP and APLP2 transcripts in PMNCs. Also, these values were not modified after copper supplementation. However, CCS and SOD1 mRNA levels were reduced in PMNCs after copper supplementation in the individuals with the high Cp values, suggesting that they should be further explored as biomarkers of moderate copper overload in humans.

Case study of complaints on drinking water quality: relationship to copper content?

Several families of Talca city, Chile complained to health authorities for what they attributed to consumption of copper (Cu)-contaminated drinking water. We assessed the situation 6-12 mo after the initiation of complaints by characterizing the symptoms reported, the chemistry of drinking water, and the Cu concentration in stagnant drinking water. After completing a census, 1778 households accepted participation and were categorized as follows: category 1, Cu plumbing for tap water and dwellers reporting health complaints (HC); category 2, Cu plumbing for tap water and dwellers reporting no HC; category 3, plastic plumbing for tap water and dwellers reporting no HC. Questionnaires recorded characteristics of households and symptoms presented by each member of the family in the last 3 mo. The Cu concentration in drinking water was measured in a subsample of 80 homes with Cu pipes. In category 1, participants presented significantly more abdominal pain, diarrhea, and/or vomiting (gastrointestinal [GI] symptoms) in comparison to category 3 and to categories 2 plus 3. The stagnant Cu concentrations measured in drinking water in all houses studied were below the US Environmental Protection Agency guideline value (<1.3 mg Cu/L). In summary, data obtained by interviews suggested that individuals in some areas of Talca city were suffering more GI symptoms potentially related to Cu excess, but measurement of Cu concentration in stagnant tap waters ruled out the association between Cu exposure and GI symptom reports at the time of this study. The dose-response curves for GI symptoms and Cu exposure now available were crucial in the analyses of results.

Dietary zinc, copper and selenium, and risk of lung cancer

Zinc, copper and selenium are important cofactors for several enzymes that play a role in maintaining DNA integrity. However, limited epidemiologic research on these dietary trace metals and lung cancer risk is available. In an ongoing study of 1,676 incident lung cancer cases and 1,676 matched healthy controls, we studied the associations between dietary zinc, copper and selenium and lung cancer risk. Using multiple logistic regression analysis, the odds ratios (OR) and 95% confidence intervals (CI) of lung cancer for all subjects by increasing quartiles of dietary zinc intake were 1.0, 0.80 (0.65-0.99), 0.64 (0.51-0.81), 0.57 (0.42-0.75), respectively (p trend = 0.0004); similar results were found for men. For dietary copper, the ORs and 95% CI for all subjects were 1.0, 0.59 (0.49-0.73), 0.51 (0.41-0.64), 0.34 (0.26-0.45), respectively (p trend < 0.0001); similar reductions in risk and trend were observed by gender. Dietary selenium intake was not associated with risk, except for a significant inverse trend (p = 0.04) in men. Protective trends (p < 0.05) against lung cancer with increased dietary zinc intake were also found for all ages, BMI > 25, current smokers, pack-years < or =30, light drinkers and participants without emphysema. Increased dietary copper intake was associated with protective trends (p < 0.05) across all ages, BMI, smoking and vitamin/mineral supplement categories, pack-years < or =30 and 30.1-51.75 and participants without emphysema. Our results suggest that dietary zinc and copper intakes are associated with reduced risk of lung cancer. Given the known limitations of case-control studies, these findings must be interpreted with caution and warrant further investigation.

A Series of Patients in the Emergency Department Diagnosed with Copper Poisoning: Recognition Equals Treatment

Only scarce data are available on chronic copper poisoning in general toxicology literature. This paper reports four patients with chronic copper poisoning and one patient with acute poisoning. The cases with chronic poisoning in our study consisted of four members of a farmer family presenting to the emergency department (ED) with malaise, weakness, abdominal pain, headache, dizziness, tightness in the chest, leg and back pain, accompanied by significant anemia (hemoglobin [Hb]: 8.7 - 9.5 g/dl). They were hospitalized and investigated thoroughly, although there were no other findings or clues enlightening the etiology of anemia. The anemia was attributed to chronic copper exposure acquired from vegetables containing copper. The diagnosis was established by ruling out other possible etiologies and history coupled with laboratory findings. The patients were discharged with the recommendation on diet to avoid consumption of pesticide-treated vegetables. Their Hb values were between 10 and 11.4 g/dl on the 15th day, and between 12 and 14 g/dl after two months. Their symptoms had also resolved completely in two months. The patient with acute intoxication (5th case) had ingested copper oxychloride with suicidal intent. He was admitted with anuria and hemolytic anemia. After being hospitalized for fifteen days, he was diagnosed with chronic renal failure and was scheduled for a dialysis program. Acute poisoning is more deliberate, while chronic exposure may result in atypical findings. In conclusion, physicians working in primary care and EDs should consider copper poisoning in patients presenting with anemia, abdominal pain, headache, tightness in the chest, and leg and back pain.

Copper, oxidative stress, and human health

Copper (Cu), a redox active metal, is an essential nutrient for all species studied to date. During the past decade, there has been increasing interest in the concept that marginal deficits of this element can contribute to the development and progression of a number of disease states including cardiovascular disease and diabetes. Deficits of this nutrient during pregnancy can result in gross structural malformations in the conceptus, and persistent neurological and immunological abnormalities in the offspring. Excessive amounts of Cu in the body can also pose a risk. Acute Cu toxicity can result in a number of pathologies, and in severe cases, death. Chronic Cu toxicity can result in liver disease and severe neurological defects. The concept that elevated ceruloplasmin is a risk factor for certain diseases is discussed. In this paper, we will review recent literature on the potential causes of Cu deficiency and Cu toxicity, and the pathological consequences associated with the above. Finally, we will review some of the potential biochemical lesions that might underlie these pathologies. Given that oxidative stress is a characteristic of Cu deficiency, the role of Cu in the oxidative defense system will receive special attention. The concept that excess Cu may be a precipitating factor in Alzheimer's disease is discussed.

Supplementing copper at the upper level of the adult dietary recommended intake induces detectable but transient changes in healthy adults

The health consequences of mild copper excess in humans are unknown. In a previous study, 2 mo of supplementation with up to 6 mg Cu/L in drinking water did not induce detectable changes. Here we assessed a copper supplement at the upper level of dietary recommendations for "healthy" adults. The study was a prospective controlled trial; participants (women and men, 18-50 y old), represented the upper and lower 5% of the ceruloplasmin distribution curve obtained from a community-based sample of 800 healthy adults (n = 41/group, each approximately 50% men). Individuals received a single daily dose of 10 mg Cu for 60 d. Before and after supplementation, blood [copper, ceruloplasmin protein, homocysteine, liver aminotranferases, Cu-Zn -superoxide dismutase activity in erythrocytes (eSOD), and glutathione in peripheral mononuclear cells] and urine [copper excretion after a 5-h administration of a chelator 2,3-dimercapto-1-propano-sodium sulfonate (DMPS)] analyses were performed. After 2 mo, liver enzyme activities remained below the clinical cutoff value used to diagnose liver dysfunction, but had increased significantly in both groups and genders. These increases were no longer present 12 mo after the copper loading period was completed. Glutathione in mononuclear cells (mmol/g of protein) also increased after the 2-mo copper loading in both groups and in both genders (P = 0.01). eSOD activity, serum homocysteine concentration, and urinary copper excretion 5 h after DMPS administration were not affected. We conclude that copper administered as described induced a transient, mild, but significant elevation of aminotransferases.

Sex and ceruloplasmin modulate the response to copper exposure in healthy individuals

Previous studies indicated that sex might influence the response to copper exposure. Ceruloplasmin (Cp) is an indicator of Cu status, but it is not clear whether and how it reflects changes of Cu status among healthy individuals. In this study, 82 apparently healthy women and men were chosen from 800 individuals because their Cp values belonged to the higher and lower 10% of the group Cp distribution curve. Before and after receiving a supplement of 10mg Cu/day (upper limit of daily intake) for 2 months, we performed blood and urinary biochemical measurement of potential Cu markers. We used principal component analysis and linear discriminant analysis to identify blood and/or urinary Cu indicators that showed a differential response to copper. Results showed that Cp values in serum represent a reliable indicator to differentiate subgroups within the normal population in their response to Cu exposure. The response depends on Cp values and on sex, such that women with higher and men with lower Cp values exhibit the greatest response.