Genotoxicity of chromium (III) and cobalt (II) and interactions between them

Metallosis-Induced Warm Antibody Auto-Immune Hemolytic Anemia After Bilateral, Large-Diameter Metal-on-Metal Total Hip Arthroplasty With Complete Remission After Revision

The use of metal-on-metal bearing couples in total hip arthroplasty can lead to an increased release of metal ions, particularly cobalt and chromium over time. This can lead to local and systemic metallosis, which has cytotoxic, genotoxic, and immunotoxic effects and can cause a host of secondary disorders. We describe the case of a 37-year-old female patient that was diagnosed with warm-antibody autoimmune hemolytic anemia (WAIHA) one and a half years after bilateral large-diameter head metal-on-metal total hip arthroplasty. For 11 years, it was refractory to all therapy, including splenectomy and rituximab, requiring long-term oral prednisone for disease control. Ultimately, systemic metallosis and periprosthetic joint infection were diagnosed, requiring explantation of the prostheses. By the sixth week postoperatively, she experienced complete spontaneous remission of her WAIHA. In conclusion, WAIHA can be associated with systemic metallosis in patients with metal-on-metal prosthetic joint replacements. Both hematologists and orthopedic surgeons should be aware of this.

Genotoxicity of chromium (III) and cobalt (II) and interactions between them

Introduction. Chromium and cobalt are essential trace elements that are required only in a small amount, otherwise their excess can cause toxic effects.

Aim. The aim of this study was to determine the effects of chromium (III) and cobalt (II) and their combinations on genotoxicity in human fibroblasts cells (BJ).

Material and methods. In this work, comet and micronucleus assays were used. The BJ cells were exposed to chromium chloride and cobalt chloride at concentration ranges from 100 to 1400 µM. Mixtures of these elements were prepared so as to examine interactions between them.

Results. The present study shows the genotoxic effects of chromium (III) and cobalt (II) and their mixtures on BJ cells. In the comet assay, no comets were observed at the lowest concentrations; in the higher, a significant increase in their percentage was observed. In the other assay (formation of micronuclei), a statistically significant increase in the number of cells with micronuclei was observed in the BJ cells spiked with cobalt chloride and chromium chloride. In the case of simultaneous incubation of chromium chloride at 200 µM and cobalt chloride at 1000 µM in the BJ line, antagonism was observed. However, the interaction of chromium chloride at the 1000 µM and cobalt chloride at 200 µM leads to synergism between the studied elements.

Conclusions. Cobalt (II) and chromium (III) show genotoxic properties, they induce breaks in double and single-stranded DNA and they cause formation of AP-sites that do not have purine or pyrimidine bases.