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Marques MR, de Assis PHG, Azeredo PS, Fleury JA, Costa JR, Gomes LS, Lima DS, Ribeiro NCDS, Biancardi MF, Dos Santos FCA. Aluminum intake in the neonatal phase disrupts endochondral ossification in rodents. J Trace Elem Med Biol 2022; 72:126962. [PMID: 35358782 DOI: 10.1016/j.jtemb.2022.126962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 01/29/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated the effects of aluminum (Al) intake on endochondral ossification during the neonatal phase. METHOD Twelve male newborn Gerbils (Meriones unguiculatus) were randomly divided into control (C) and aluminum (Al) groups (n = 6 animals/group). From the 1st to 15th day of life, gerbils received an AlCl3 solution (10 mg/kg/day) via gavage. The control group received only the saline solution. On the 16th day, their tibias were processed for paraffin embedding and were submitted to histomorphometric, histochemical, and immunohistochemical analyses. RESULTS In the epiphyseal cartilage Al did not affect the proteoglycan content or cell proliferation; however, it increased matrix metalloprotease-2 (MMP-2) immunostaining and the hypertrophic layer thickness. In bone, Al decreased trabeculae number, trabecular width, cortical bone width, and proliferation. Furthermore, the relative frequency of bone matrix and fibrillar collagen decreased 3.9% and 16.2%, respectively. The number of osteoclasts and osteocalcin digital optical density (D.O.D) remained the same. CONCLUSION The results suggest that Al intake during the neonatal period impairs endochondral ossification by affecting epiphyseal cartilage and bone architecture.
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Affiliation(s)
- Mara Rubia Marques
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil.
| | - Pedro Henrique Graciano de Assis
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil
| | - Patrícia Santos Azeredo
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil
| | - Jaqueline Aguiar Fleury
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil
| | - Janaina Ribeiro Costa
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil
| | - Liana Silva Gomes
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil
| | - Danilo Silva Lima
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil
| | - Naiara Cristina de Souza Ribeiro
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil
| | - Manoel Francisco Biancardi
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil
| | - Fernanda Cristina Alcântara Dos Santos
- Laboratório de Microscopia Aplicada à Reprodução - (LaMARe) - Instituto de Ciências Biológicas, Universidade Federal de Goiás, Avenida Esperança, s/n, Câmpus Samambaia, CEP 74690-900 Goiânia, Goiás, Brazil
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Röllin HB, Channa K, Olutola B, Nogueira C, Odland JØ. In Utero Exposure to Aluminium and Other Neurotoxic Elements in Urban Coastal South African Women at Delivery: An Emerging Concern. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051724. [PMID: 32155754 PMCID: PMC7084550 DOI: 10.3390/ijerph17051724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Abstract
Aluminium (Al) is a non-essential neurotoxicant and there is limited information regarding exposure to Al in utero. This study sought to evaluate the in utero exposure to Al in urban South African women, its effects on birth outcomes and possible synergistic effects between Al, essential and neurotoxic elements such as lead (Pb), mercury (Hg) and arsenic (As), as well as a a potential sex-dependent response to these elements in neonates. This study has found elevated levels of Al in urban women at delivery. The Spearman’s rank correlation coefficients (p-value) of the association between maternal serum Al and birth outcomes (gestational age and parity), and between maternal serum Al and Cu, Zn and Se, were statistically significant. However, in the general and the stratified models, no association was found between any of the birth outcomes and maternal serum Al. The association between maternal serum Al and neurotoxic elements at delivery showed a significant positive correlation for Pb only (rho = 0.361; p < 0.001) which was found to be sex-dependent in neonates (males, rho = 0.285; p < 0.004 and females, rho = 0.444, p < 0.001). Our preliminary findings indicate that in utero exposure to Al is an emerging concern requiring further research and directives from public health authorities.
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Affiliation(s)
- Halina B. Röllin
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (B.O.); (C.N.); (J.Ø.O.)
- Environment and Health Research Unit, Medical Research Council, Johannesburg 2094, South Africa
- Correspondence: ; Tel.: +27-12-356-3261
| | - Kalavati Channa
- Lancet Laboratories, Department of Analytical Chemistry, Johannesburg 2090, South Africa;
| | - Bukola Olutola
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (B.O.); (C.N.); (J.Ø.O.)
| | - Claudina Nogueira
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (B.O.); (C.N.); (J.Ø.O.)
| | - Jon Ø. Odland
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (B.O.); (C.N.); (J.Ø.O.)
- Department of Community Medicine and Nursing, Faculty of Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
- Higher School of Economics, National Research University, 107078 Moscow, Russia
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Röllin HB, Nogueira C, Olutola B, Channa K, Odland JØ. Prenatal Exposure to Aluminum and Status of Selected Essential Trace Elements in Rural South African Women at Delivery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1494. [PMID: 30011954 PMCID: PMC6068832 DOI: 10.3390/ijerph15071494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/01/2018] [Accepted: 07/12/2018] [Indexed: 11/16/2022]
Abstract
This study sought to evaluate the in utero exposure to aluminum and status of selected trace elements in South African women at delivery since aluminum is known to be toxic in all developmental stages even at low concentrations. Serum aluminum was negatively correlated with aluminum in urine, both uncorrected and corrected for creatinine, which suggests the retention of aluminum in body stores. Serum copper and zinc levels were found to be high in this study population. Serum copper levels were negatively correlated with aluminum in serum (β = -0.095; p = 0.05). There was a marginal negative correlation between aluminum levels in serum and manganese levels in whole blood (β = -0.087; p = 0.08). Copper levels in maternal serum were negatively correlated with birth weight and the length of neonates. There were a number of positive correlations between maternal characteristics and birth outcomes. Mothers who consumed root vegetables frequently appeared to be protected from aluminum retention and increased body burden since their serum aluminum levels were found to be significantly lower. The findings of the current study can be used as a baseline for further research on aluminum exposure and its associated interactions and outcomes in vulnerable populations.
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Affiliation(s)
- Halina B Röllin
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria 0001, South Africa.
- Environment and Health Research Unit, Medical Research Council, Johannesburg, 2193, South Africa.
| | - Claudina Nogueira
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria 0001, South Africa.
| | - Bukola Olutola
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria 0001, South Africa.
| | - Kalavati Channa
- Lancet Laboratories, Department of Analytical Chemistry, Johannesburg 2092, South Africa.
- Department of Biomedical Technology, School of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa.
| | - Jon Ø Odland
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria 0001, South Africa.
- Institute of Community Medicine, University of Tromsø, Tromsø 9019, Norway.
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Aluminum and Phthalates in Calcium Gluconate: Contribution From Glass and Plastic Packaging. J Pediatr Gastroenterol Nutr 2017; 64:109-114. [PMID: 27111341 DOI: 10.1097/mpg.0000000000001243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Aluminum contamination of parenteral nutrition solutions has been documented for 3 decades. It can result in elevated blood, bone, and whole body aluminum levels associated with neurotoxicity, reduced bone mass and mineral content, and perhaps hepatotoxicity. The primary aluminum source among parenteral nutrition components is glass-packaged calcium gluconate, in which aluminum concentration in the past 3 decades has averaged approximately 4000 μg/L, compared with <200 μg/L in plastic container-packaged calcium gluconate. A concern about plastic packaging is leaching of plasticizers, including phthalates, which have the potential to cause endocrine (male reproductive system) disruption and neurotoxicity. METHODS Aluminum was quantified in samples collected periodically for more than 2 years from 3 calcium gluconate sources used to prepare parenteral nutrition solutions; 2 packaged in glass (from France and the United States) and 1 in plastic (from Germany); in a recently released plastic-packaged solution (from the United States); and in the 2 glass containers. Phthalate concentration was determined in selected samples of each product and leachate of the plastic containers. RESULTS The initial aluminum concentration was approximately 5000 μg/L in the 2 glass-packaged products and approximately 20 μg/L in the plastic-packaged product, and increased approximately 30%, 50%, and 100% in 2 years, respectively. The aluminum concentration in a recently released Calcium Gluconate Injection USP was approximately 320 μg/L. Phthalates were not detected in any calcium gluconate solutions or leachates. CONCLUSIONS Plastic packaging greatly reduces the contribution of aluminum to parenteral nutrition solutions from calcium gluconate compared with the glass-packaged product.
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Anderson C, MacKay M. Physical Compatibility of Calcium Chloride and Sodium Glycerophosphate in Pediatric Parenteral Nutrition Solutions. JPEN J Parenter Enteral Nutr 2016; 40:1166-1169. [DOI: 10.1177/0148607115592673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/01/2015] [Indexed: 01/15/2023]
Affiliation(s)
| | - Mark MacKay
- Primary Children’s Hospital, Salt Lake City, Utah
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Yokel RA, Harris WR, Spilling CD, Abramov VP, Lone JM, Kuhn RJ. A Filtration System That Greatly Reduces Aluminum in Calcium Gluconate Injection, USP Used to Prepare Parenteral Nutrition Solutions. J Pediatr Pharmacol Ther 2014; 19:189-95. [PMID: 25309149 DOI: 10.5863/1551-6776-19.3.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study objective was to reduce aluminum (Al) in Calcium Gluconate Injection, US Pharmacopeia (USP) used in the preparation of parenteral nutrition (PN) solutions. METHODS A flow-through filter containing an immobilized chelator that complexes Al from Calcium Gluconate Injection, USP as it flows through the filter was designed, refined by design modifications, and extensively tested. When a small-volume parenteral vial containing 100 mL of Calcium Gluconate Injection, USP is connected on the inlet side of the filter, and the outlet side is connected to an evacuated receiving vial, the filtered solution is drawn into the receiving vial. This constitutes a complete system to remove Al from Calcium Gluconate Injection, USP. RESULTS The extent of Al removal is flow rate dependent. At a flow rate of 1 mL/min approximately 85% of the Al was removed from calcium gluconate solution. PN solutions have been reported to deliver 15 to 23 mcg/kg/day Al to neonates. Given that Calcium Gluconate Injection, USP provides 85% of the Al in neonatal PN solutions, removal of 85% of the Al from this source was calculated to reduce Al delivered to most neonates to <5 mcg/kg/day. CONCLUSIONS A point-of-use, self-contained, single-use, disposable, Al-complexing filter has been created. It was calculated to reduce Al delivered in PN solutions by 72%, resulting in daily Al delivery below the level that results in Al accumulation associated with central nervous system and bone toxicity to all but the smallest (<1 kg) infants.
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Affiliation(s)
- Robert A Yokel
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky ; ALKYMOS Inc, Lexington, Kentucky
| | - Wesley R Harris
- ALKYMOS Inc, Lexington, Kentucky ; Department of Chemistry and Biochemistry, University of Missouri, St Louis, Missouri
| | - Christopher D Spilling
- ALKYMOS Inc, Lexington, Kentucky ; Department of Chemistry and Biochemistry, University of Missouri, St Louis, Missouri
| | | | | | - Robert J Kuhn
- ALKYMOS Inc, Lexington, Kentucky ; Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
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Willhite CC, Karyakina NA, Yokel RA, Yenugadhati N, Wisniewski TM, Arnold IMF, Momoli F, Krewski D. Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts. Crit Rev Toxicol 2014; 44 Suppl 4:1-80. [PMID: 25233067 PMCID: PMC4997813 DOI: 10.3109/10408444.2014.934439] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007) . Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of "total Al"assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al(+3) to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)(+2) and Al(H2O)6 (+3)] that after complexation with O2(•-), generate Al superoxides [Al(O2(•))](H2O5)](+2). Semireduced AlO2(•) radicals deplete mitochondrial Fe and promote generation of H2O2, O2 (•-) and OH(•). Thus, it is the Al(+3)-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates. Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer's disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants. The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances.
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Affiliation(s)
- Calvin C. Willhite
- Risk Sciences International, Ottawa, ON, Canada
- McLaughlin Centre for Population Health Risk Assessment, Ottawa, ON, Canada
| | | | - Robert A. Yokel
- Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | | | - Thomas M. Wisniewski
- Departments of Neurology, Psychiatry and Pathology, New York University School of Medicine, New York City, New York, USA
| | - Ian M. F. Arnold
- Occupational Health Program, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franco Momoli
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Daniel Krewski
- Risk Sciences International, Ottawa, ON, Canada
- McLaughlin Centre for Population Health Risk Assessment, Ottawa, ON, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Abstract
A recent review of macronutrients in parenteral nutrition (PN) in the NICU population summarized the carbohydrate, protein, and fat nutrients in PN.1 The purpose of this article is to review the other nutrients in PN that are important for growth and homeostasis including minerals or electrolytes, vitamins, and trace elements. Although the macronutrients contribute more dramatically to adequate nutrition and growth, the other components in PN have significant impact on use of macronutrients as well as targeted organ and cellular function.
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Fanni D, Ambu R, Gerosa C, Nemolato S, Iacovidou N, Van Eyken P, Fanos V, Zaffanello M, Faa G. Aluminum exposure and toxicity in neonates: a practical guide to halt aluminum overload in the prenatal and perinatal periods. World J Pediatr 2014; 10:101-7. [PMID: 24801228 DOI: 10.1007/s12519-014-0477-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND During the last years, human newborns have been overexposed to biologically reactive aluminum, with possible relevant consequences on their future health and on their susceptibility to a variety of diseases. Children, newborns and particularly preterm neonates are at an increased risk of aluminum toxicity because of their relative immaturity. DATA SOURCES Based on recent original publications and classical data of the literatures, we reviewed the aluminum content in mother's food during the intrauterine life as well as in breast milk and infant formula during lactation. We also determined the possible role of aluminum in parenteral nutrition solutions, in adjuvants of vaccines and in pharmaceutical products. A special focus is placed on the relationship between aluminum overexposure and the insurgence of bone diseases. RESULTS Practical points of management and prevention are suggested. Aluminum sources that infants may receive during the first 6 months of life are presented. In the context of prevention of possible adverse effects of aluminum overload in fetal tissues during development, simple suggestions to pregnant women are described. Finally, practical points of management and prevention are suggested. CONCLUSIONS Pediatricians and neonatologists must be more concerned about aluminum content in all products our newborns are exposed to, starting from monitoring aluminum concentrations in milk- and soy-based formulas in which, on the basis of recent studies, there is still too much aluminum.
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Affiliation(s)
- Daniela Fanni
- Department of Pathology, University Hospital San Giovanni di Dio, AOU Cagliari and University of Cagliari, Cagliari, Italy
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Courtney-Martin G, Kosar C, Campbell A, Avitzur Y, Wales PW, Steinberg K, Harrison D, Chambers K. Plasma Aluminum Concentrations in Pediatric Patients Receiving Long-Term Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2014; 39:578-85. [PMID: 24743391 DOI: 10.1177/0148607114531046] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/17/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients receiving long-term parenteral nutrition (PN) are at increased risk of aluminium (Al) toxicity because of bypass of the gastrointestinal tract during PN infusion. Complications of Al toxicity include metabolic bone disease (MBD), Al-associated encephalopathy in adults, and impaired neurological development in preterm infants. Unlike the United States, there are no regulations regarding Al content of large- and small-volume parenterals in Canada. We, therefore, aimed to present our data on plasma Al concentration and Al intake from our cohort of pediatric patients receiving long-term PN. METHODS Plasma Al concentration was retrospectively gathered from the patient charts of all 27 patients with intestinal failure (IF) receiving long-term PN at The Hospital for Sick Children, Toronto, Canada, and compared with age- and sex-matched controls recruited for comparison. In addition, Al concentration was measured in PN samples collected from 10 randomly selected patients with IF and used to determine their Al intake. RESULTS The plasma Al concentration of patients with IF receiving long-term PN was significantly higher than that of control participants (1195 ± 710 vs 142 ± 63 nmol/L; P < .0001). In the subgroup of 10 patients for whom Al intake from their PN solution was determined, mean ± SD Al intake from PN was 15.4 ± 15 µg/kg, 3 times the Food and Drug Administration upper recommended intake level, and Al intake was significantly related to plasma Al concentration (P = .02, r (2) = 0.52). CONCLUSION Pediatric patients receiving long-term PN for IF in Canada are at risk for Al toxicity.
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Affiliation(s)
- Glenda Courtney-Martin
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Christina Kosar
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Alison Campbell
- Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Yaron Avitzur
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada The Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Paul W Wales
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada The Department of Surgery, University of Toronto, Toronto, Canada
| | - Karen Steinberg
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Debra Harrison
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Kathryn Chambers
- Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada
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Abstract
These proceedings will review the role of chelation in five metals-aluminum, cadmium, chromium, cobalt, and uranium-in order to illustrate various chelation concepts. The process of "chelation" can often be oversimplified, leading to incorrect assumptions and risking patient harm. For chelation to be effective, two critical assumptions must be fulfilled: the presumed "metal toxicity" must correlate with a given body or a particular compartment burden, and reducing this compartmental or the body burden (through chelation) attenuates toxicity. Fulfilling these assumptions requires an established dose-response relationship, a validated, reproducible means of toxicity assessment (clinical, biochemical, or radiographical), and an appropriate assessment mechanisms of body or compartment burden. While a metal might "technically" be capable of chelation (and readily demonstrable in urine or feces), this is an insufficient endpoint. Clinical relevance must be affirmed. Deferoxamine is an accepted chelator for appropriately documented aluminum toxicity. There is a very minimal treatment window in order to address chelation in cadmium toxicity. In acute toxicity, while no definitive chelation benefit is described, succimer (DMSA), diethylenetriaminepentaacetate (DTPA), and potentially ethylenediaminetetraacetic acid (EDTA) have been considered. In chronic toxicity, chelation is unsupported. There is little evidence to suggest that currently available chromium chelators are efficacious. Similarly, scant human evidence exists with which to provide recommendation for cobalt chelation. DTPA has been recommended for cobalt radionuclide chelation, although DMSA, EDTA, and N-acetylcysteine have also been suggested. DTPA is unsupported for uranium chelation. Sodium bicarbonate is currently recommended, although animal evidence is conflicting.
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Affiliation(s)
- Silas W Smith
- Department of Emergency Medicine, Division of Medical Toxicology, New York University School of Medicine, New York, NY, USA,
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