Potential for Manganese-Induced Neurologic Harm to Formula-Fed Infants: A Risk Assessment of Total Oral Exposure

Manganese in residential drinking water from a community-initiated case study in Massachusetts

BACKGROUND

Manganese (Mn) is a metal commonly found in drinking water, but the level that is safe for consumption is unknown. In the United States (U.S.), Mn is not regulated in drinking water and data on water Mn concentrations are temporally and spatially sparse.

OBJECTIVE

Examine temporal and spatial variability of Mn concentrations in repeated tap water samples in a case study of Holliston, Massachusetts (MA), U.S., where drinking water is pumped from shallow aquifers that are vulnerable to Mn contamination.

METHODS

We collected 79 residential tap water samples from 21 households between September 2018 and December 2019. Mn concentrations were measured using inductively coupled plasma mass spectrometry. We calculated descriptive statistics and percent of samples exceeding aesthetic (secondary maximum containment level; SMCL) and lifetime health advisory (LHA) guidelines of 50 µg/L and 300 µg/L, respectively. We compared these concentrations to concurrent and historic water Mn concentrations from publicly available data across MA.

RESULTS

The median Mn concentration in Holliston residential tap water was 2.3 µg/L and levels were highly variable (range: 0.03-5,301.8 µg/L). Mn concentrations exceeded the SMCL and LHA in 14% and 12% of samples, respectively. Based on publicly available data across MA from 1994-2022, median Mn concentration was 17.0 µg/L (N = 37,210; range: 1-159,000 µg/L). On average 40% of samples each year exceeded the SMCL and 9% exceeded the LHA. Samples from publicly available data were not evenly distributed between MA towns or across sampling years.

IMPACT STATEMENT

This study is one of the first to examine Mn concentrations in drinking water both spatially and temporally in the U.S. Findings suggest that concentrations of Mn in drinking water frequently exceed current guidelines and occur at concentrations shown to be associated with adverse health outcomes, especially for vulnerable and susceptible subpopulations like children. Future studies that comprehensively examine exposure to Mn in drinking water and its associations with children's health are needed to protect public health.

Metals in Cow Milk and Soy Beverages: Is There a Concern?

Nowadays, there is an increased consumption of plant-based protein beverages like soy beverages (SBs) as substitutes for cow milk (CM). Both accumulate toxic metals like lead (Pb), cadmium (Cd), and manganese (Mn), which, although essential, are neurotoxic at high levels. Metals can also perturb the normal development of children. This work aimed to evaluate these metal concentrations in CM and SB purchased on the Portuguese market. After validation of the method, linearity of calibration curves, work range, detection and quantification limits, and selectivity, metals were determined in 14 CM and 14 SB brands using atomic absorption spectrometry. The values were compared between CM and SB and with permissible limit values. Soy beverages had significantly (p < 0.05) higher concentrations of Cd (5.6 ± 4.2 µg/L) and Mn (117.4 ± 30.3) µg/L) than CM (2.15 ± 1.84 µg/L and 5.93 ± 1.21 µg/L, respectively); the Pb concentrations in CM (19.3 ± 12.1 µg/L) were not significantly (p > 0.05) higher than in SB (13.4 ± 9.6 µg/L). These values were similar to other studies and close to but under permissible limit values. Nevertheless, due to the toxicity and bioaccumulation of metals, the fact that these foods are routinely ingested by all ages, mainly children, and represent key ingredients in many processed foods, including baby foods, we suggest strict surveying of metal levels in CM and SBs.

Levels of organic pollutants and metals/metalloids in infant formula marketed in Brazil: Risks to early-life health

Infant formula intake is recommended to ensure comprehensive nutritional and caloric fulfillment when exclusive breastfeeding is not possible. However, similarly to breast milk, infant formulas may also contain pollutants capable of inducing endocrine-disrupting and neurotoxic effects. Thus, considering the sensitivity of their developing physiological systems and that infants have heightened susceptibility to environmental influences, this study was aimed at assessing the contents of essential elements, and inorganic and organic pollutants in infant formulas marketed in Brazil. Additionally, health risk assessments for selected contaminants were also performed. Measured contents of essential elements (Ca, Fe, Mg, Mn, Cu, Se, and Zn) were congruent with label information. Nevertheless, some toxic elements (Pb, Cd, As, Ni, and Al) were also detected. Notably, in the upper-bound scenario, Pb and Cd surpassed established threshold values when comparing the estimated daily intake (EDI) and tolerable daily intake (TDI - 3.57 and 0.36 μg/kg bw, respectively). Bisphenol P (BPP) and benzyl butyl phthalate (BBP) were frequently detected (84 % detection rate both) with elevated contents (BPP median = 4.28 ng/g and BBP median = 0.24 ng/g). Furthermore, a positive correlation (0.41) was observed between BPP and BBP, implying a potential co-occurrence within packaging materials. Methyl-paraben also correlated positively with BBP (0.57), showing a detection rate of 53 %. The cumulative PBDE contents ranged from 0.33 to 1.62 ng/g, with BDE-154 and BDE-47 the dominant congeners. When comparing EDI values with TDIs, all organic pollutants remained below the thresholds across all exposure scenarios. Moreover, non-carcinogenic risks were below the threshold (HQ > 1) when dividing the EDIs by the respective reference doses for chronic exposure. While the current findings may suggest that infant formula intake poses no immediate risk in terms of the evaluated chemicals, it remains imperative to conduct further research to safeguard the health of infants considering other chemicals, as well as their potential cumulative effects.

A comprehensive survey and analysis of international drinking water regulations for inorganic chemicals with comparisons to the World Health Organization's drinking-water guidelines

BACKGROUND

The World Health Organization (WHO) has published criteria for determining the quality of drinking water since 1958. Since 1984, these criteria were termed "guidelines" to emphasize that they are not national standards, but rather guidelines for nations to develop their own national standards, which may take into account local environmental, social, economic, and cultural conditions. When calculating guideline values (GVs), the WHO reviews the toxicological literature, calculates a health-based value (HBV), and determines whether the HBV should be adopted as a GV. The WHO also considers aesthetic aspects of drinking water quality, such as taste and the staining of plumbing fixtures, and additionally supplies aesthetic values (AVs) for certain drinking water contaminants. There is no central registry for national drinking water standards, so the degree of variation of national drinking water standards is not known.

METHODS

We examined standards, guidelines, and background documents for all inorganic contaminants published by the WHO from 1958-2022. We also searched for national drinking water standards for all independent countries.

RESULTS

We found the WHO currently has 16 GVs, six HBVs without GVs, and six AVs without HBVs or GVs for inorganic drinking water contaminants, excluding disinfection agents and their byproducts. More than half of the point of departure studies used to support these values were published in 2005 or earlier. Ninety-eight percent of the world's population lives in jurisdictions with drinking water standards, and 14 countries directly link their national standards to the current WHO's drinking water guidelines. Lack of transparency (standards available only through purchase) and typographical errors are common problems, especially for resource-limited countries.

CONCLUSIONS

The WHO drinking water guidelines are crucially important for drinking water safety; they are used for guidance or as official standards throughout the world. It is crucial that they be based on the best available science.

Animal Models of Childhood Exposure to Lead or Manganese: Evidence for Impaired Attention, Impulse Control, and Affect Regulation and Assessment of Potential Therapies

Behavioral disorders involving attention and impulse control dysfunction, such as ADHD, are among the most prevalent disorders in children and adolescents, with significant impact on their lives. The etiology of these disorders is not well understood, but is recognized to be multifactorial, with studies reporting associations with polygenic and environmental risk factors, including toxicant exposure. Environmental epidemiological studies, while good at establishing associations with a variety of environmental and genetic risk factors, cannot establish causality. Animal models of behavioral disorders, when properly designed, can play an essential role in establishing causal relationships between environmental risk factors and a disorder, as well as provide model systems for elucidating underlying neural mechanisms and testing therapies. Here, we review how animal model studies of developmental lead or manganese exposure have been pivotal in (1) establishing a causal relationship between developmental exposure and lasting dysfunction in the domains of attention, impulse control, and affect regulation, and (2) testing the efficacy of specific therapeutic approaches for alleviating the lasting deficits. The lead and manganese case studies illustrate how animal models can advance knowledge in ways that are not possible in human studies. For example, in contrast to the Treatment of Lead Poisoned Children (TLC) human clinical trial evaluating succimer chelation efficacy to improve cognitive functioning in lead-exposed children, our developmental lead exposure animal model showed that succimer chelation can produce lasting cognitive benefits if chelation sufficiently reduces brain lead levels. In addition, this study revealed that succimer treatment in the absence of lead exposure produces lasting cognitive dysfunction, highlighting potential risks of chelation in off-label uses, such as the treatment of autistic children without a history of lead exposure. Our animal model of developmental manganese exposure has demonstrated that manganese can cause lasting attentional and sensorimotor deficits, akin to an ADHD-inattentive behavioral phenotype, thereby providing insights into the role of environmental exposures as contributors to ADHD. These studies have also shown that oral methylphenidate (Ritalin) can fully alleviate the deficits produced by early developmental Mn exposure. Future work should continue to focus on the development and use of animal models that appropriately recapitulate the complex behavioral phenotypes of behavioral disorders, in order to determine the mechanistic basis for the behavioral deficits caused by developmental exposure to environmental toxicants, and the efficacy of existing and emerging therapies.

The Body Status of Manganese and Activity of This Element-Dependent Mitochondrial Superoxide Dismutase in a Rat Model of Human Exposure to Cadmium and Co-Administration of Aronia melanocarpa L. Extract

The impact of a polyphenol-rich 0.1% aqueous extract from Aronia melanocarpa L. berries (AE) on the body status of manganese (Mn) and the activity of this essential element-dependent mitochondrial superoxide dismutase (MnSOD) during treatment with cadmium (Cd) was investigated in a rat model of low-level and moderate environmental human exposure to this xenobiotic (1 and 5 mg Cd/kg diet, respectively, for 3-24 months). The exposure to Cd, dose- and duration-dependently, affected the body status of Mn (apparent absorption, body retention, serum and tissue concentrations, content in some organs and total Mn body burden, and urinary and faecal excretion) and the activity of MnSOD in the mitochondria of the liver, kidney, and brain. The administration of AE during the exposure to Cd prevented or at least partially protected the animals from the perturbation of the metabolism of Mn, as well as ameliorated changes in the activity of MnSOD and the concentration of Mn and protected from Cd accumulation in the mitochondria. In conclusion, AE may protect from disorders in the body status of Mn and influence the antioxidative capacity of cells under chronic exposure to Cd. The findings confirm the protective impact of aronia berries products against Cd toxicity.

Manganese-Induced Toxicity in C. elegans: What Can We Learn from the Transcriptome?

Manganese (Mn) is an essential ubiquitous transition metal and, when occupationally or environmentally overexposed, a well-known risk factor for several neurological pathologies. However, the molecular mechanisms underlying Mn-induced neurotoxicity are largely unknown. In this study, addressing RNA-Seq analysis, bioavailability and survival assays, key pathways of transcriptional responses to Mn overexposure were investigated in the model organism Caenorhabditis elegans (C. elegans), providing insights into the Mn-induced cellular stress and damage response. Comparative transcriptome analyses identified a large number of differentially expressed genes (DEGs) in nematodes exposed to MnCl₂, and functional annotation suggested oxidative nucleotide damage, unfolded protein response and innate immunity as major damage response pathways. Additionally, a time-dependent increase in the transcriptional response after MnCl₂ exposure was identified by means of increased numbers of DEGs, indicating a time-dependent response and activation of the stress responses in Mn neurotoxicity. The data provided here represent a powerful transcriptomic resource in the field of Mn toxicity, and therefore, this study provides a useful basis for further planning of targeted mechanistic studies of Mn-induced neurotoxicity that are urgently needed in the face of increasing industrially caused environmental pollution with Mn.

Mutagens in raw ewe milk in Orava region, northern Slovakia: metals

The aim of this work was to determine the concentrations of selected mutagenic elements (As, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Se) in raw ewe milk from undisturbed environment in Orava region, northern Slovakia. There are possible sources of some of the analyzed metals which may be distributed from the metallurgical plants located in the Ostrava region, Czech Republic, and Katowice, Poland. In total, forty milk samples were analyzed in June and August using an inductively coupled plasma optical emission spectrometry. The differences in elements concentrations between the seasonal periods were not significant except of iron (p < 0.0001). The concentrations of most of the metals in ewe milk were low and under the permissible or recommended limits. However, arsenic and selenium concentrations were elevated and could pose a risk of the mutagenic effect, particularly in children. The frequency of element occurrence in June was as follows: Se > Fe > As > Cu > Mn > Ni > Co > Pb > Cr > Cd, and in August: Se > Fe = As > Cu > Mn > Pb > Co > Ni > Cr > Cd. The correlation analysis revealed very strong positive correlation between Cu:Pb (p < 0.05), very strong negative correlation between Fe:Se (p < 0.05). The strong correlations were also found between other elements. The present study showed that milk produced in the relatively undisturbed environment might contain various mutagenic elements. The relationships between the elements might result in the additive or synergistic effects of elements and increase the risk of their mutagenic effects even in low concentrations. Therefore, attention must be paid to the monitoring of metals in the areas where food sources destined especially for child nutrition are produced.

Drinking Water Quality and Public Health in the Kathmandu Valley, Nepal: Coliform Bacteria, Chemical Contaminants, and Health Status of Consumers

Residents of Nepal’s Kathmandu Valley draw drinking water from tube wells, dug wells, and stone spouts, all of which have been reported to have serious water quality issues. In this study, we analyzed drinking water samples from 35 tube wells, dug wells, stone spouts, and municipal tap water for bacterial and chemical contaminants, including total and fecal coliform, aluminum, arsenic, barium, beryllium, boron, cadmium, cobalt, chromium, copper, fluoride, iron, mercury, manganese, molybdenum, nickel, lead, antimony, selenium, thallium, uranium, vanadium, and zinc. We also asked a sampling of households who used these specific water sources to rate the taste of their water, list any waterborne diseases they were aware of, and share basic health information about household members. This survey provided us with information from 146 households and 603 individuals. We found widespread bacterial contamination of water sources, with 94% of sources having detectable total or fecal coliform. Nepal Drinking Water Quality Standards and World Health Organization (WHO) Drinking-Water Guidelines or health-based values were exceeded for aluminum (max = 0.53 mg/L), arsenic (max = 0.071 mg/L), iron (max = 7.22 mg/L), and manganese (max = 3.229 mg/L). The distribution of water sources with high arsenic, iron, and manganese appeared to be associated with floodplain deposits. Mixed effects logistic regression models were used to examine the interactions between social factors and water contaminants and their effects on household members’ health. Consumers of water sources with both high and low concentrations of manganese were less likely to have a positive attitude towards school than those whose water sources had moderate concentrations of manganese. Social factors, especially education, played a large role in predicting individual health outcomes. Household taste ratings of drinking water were not correlated with iron or manganese concentrations, suggesting that WHO’s reliance on aesthetic criteria for these contaminants instead of formal drinking-water guidelines may not be sufficient to protect public health.

Risks to children from inhalation of aerosolized aqueous manganese emitted from ultrasonic humidifiers can be greater than for corresponding ingestion

The essential trace element manganese (Mn) can cause neurotoxicity with inhalation acknowledged as a more severe health and cognition threat than ingestion.

METHODS

Over a range of aqueous Mn concentrations present in tap water, this research characterizes exposures and risks for adults and 0.25, 1, 2.5, and 6 yr old children who ingest the water and inhale respirable particles produced by a room-sized ultrasonic humidifier filled with the same water. Aqueous Mn concentrations evaluated included 50 µg/L USEPA esthetic guideline, 80 µg/L WHO infant guideline, and 120 µg/L Canadian regulatory level. Airborne-particle-bound Mn concentrations were generated for water filling an ultrasonic humidifier under four realistic room conditions (33 m³ small or 72 m³ large) with varying ventilation rates from 0.2/h -1.5/h. Average daily doses (ADD) and reference intake doses were calculated for ingestion and 8-h inhalation of humidified air. Hazard quotients (HQ) compared the intake doses and reference doses. Multi-path particle dosimetry (MPPD) model quantified the particle deposition and deposited dose in children's and adults' respiratory tracts.

RESULTS

At only 11 µg/L Mn, the resulting humidified air Mn exceeds USEPA's reference concentration of 0.05 µg/m³ Mn in small room with low, energy-efficient ventilation. Inhalation ADD are 2 magnitudes lower than ingestion ADD for identical water Mn concentrations and daily exposure frequency. Even so, ingestion HQs are approximately 0.2 but inhalation risk is significant (HQ>1) for children and adults when breathing Mn-humidified air under most small room conditions at 50, 80 or 120 µg/L Mn. MPPD model indicates inhaled Mn deposits in head and pulmonary regions, with greater Mn dose deposits in children than adults.

CONCLUSION

Inhalation of Mn-particles produced from ultrasonic humidifiers can pose greater risks than ingestion at the same water concentration, especially for children. Aqueous Mn concentration and room size influence risks. Limiting manganese exposures and setting regulations requires consideration of both ingestion and inhalation of water.

Effects of Manganese on Genomic Integrity in the Multicellular Model Organism Caenorhabditis elegans

Although manganese (Mn) is an essential trace element, overexposure is associated with Mn-induced toxicity and neurological dysfunction. Even though Mn-induced oxidative stress is discussed extensively, neither the underlying mechanisms of the potential consequences of Mn-induced oxidative stress on DNA damage and DNA repair, nor the possibly resulting toxicity are characterized yet. In this study, we use the model organism Caenorhabditis elegans to investigate the mode of action of Mn toxicity, focusing on genomic integrity by means of DNA damage and DNA damage response. Experiments were conducted to analyze Mn bioavailability, lethality, and induction of DNA damage. Different deletion mutant strains were then used to investigate the role of base excision repair (BER) and dePARylation (DNA damage response) proteins in Mn-induced toxicity. The results indicate a dose- and time-dependent uptake of Mn, resulting in increased lethality. Excessive exposure to Mn decreases genomic integrity and activates BER. Altogether, this study characterizes the consequences of Mn exposure on genomic integrity and therefore broadens the molecular understanding of pathways underlying Mn-induced toxicity. Additionally, studying the basal poly(ADP-ribosylation) (PARylation) of worms lacking poly(ADP-ribose) glycohydrolase (PARG) parg-1 or parg-2 (two orthologue of PARG), indicates that parg-1 accounts for most of the glycohydrolase activity in worms.