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Vielee ST, Isibor J, Buchanan WJ, Roof SH, Patel M, Meaza I, Williams A, Toyoda JH, Lu H, Wise SS, Kouokam JC, Young Wise J, Abouiessa AM, Cai J, Cai L, Wise JP. Employing a Toxic Aging Coin approach to assess hexavalent chromium (Cr[VI])-induced neurotoxic effects on behavior: Heads for age differences. Toxicol Appl Pharmacol 2024; 489:117007. [PMID: 38901695 PMCID: PMC11342792 DOI: 10.1016/j.taap.2024.117007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024]
Abstract
We are facing a rapidly growing geriatric population (65+) that will live for multiple decades and are challenged with environmental pollution far exceeding that of previous generations. Consequently, we currently have a poor understanding of how environmental pollution will impact geriatric health distinctly from younger populations. Few toxicology studies have considered age differences with geriatric individuals. Critically, all top ten most prevalent age-related diseases are linked to metal exposures. Hexavalent chromium [Cr(VI)] is a metal of major environmental health concern that can induce aging phenotypes and neurotoxicity. However, there are many knowledge gaps for Cr(VI) neurotoxicity, including how Cr(VI) impacts behavior. To address this, we exposed male rats across three ages (3-, 7-, and 18-months old) to Cr(VI) in drinking water (0, 0.05, 0.1 mg/L) for 90 days. These levels reflect the maximum contaminant levels determined by the World Health Organization (WHO) and the U.S. Environmental Protection Agency (US EPA). Here, we report how these Cr(VI) drinking water levels impacted rat behaviors using a battery of behavior tests, including grip strength, open field assay, elevated plus maze, Y-maze, and 3-chamber assay. We observed adult rats were the most affected age group and memory assays (spatial and social) exhibited the most significant effects. Critically, the significant effects were surprising as rats should be particularly resistant to these Cr(VI) drinking water levels due to the adjustments applied in risk assessment from rodent studies to human safety, and because rats endogenously synthesize vitamin C in their livers (vitamin C is a primary reducer of Cr[VI] to Cr[III]). Our results emphasize the need to broaden the scope of toxicology research to consider multiple life stages and suggest the current regulations for Cr(VI) in drinking water need to be revisited.
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Affiliation(s)
- Samuel T Vielee
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Jessica Isibor
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - William J Buchanan
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Spencer H Roof
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Maitri Patel
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Idoia Meaza
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Aggie Williams
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Jennifer H Toyoda
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Haiyan Lu
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Sandra S Wise
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - J Calvin Kouokam
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Jamie Young Wise
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | | | - Jun Cai
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Lu Cai
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - John P Wise
- Pediatric Research Institute, the Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA.
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Ajibo DN, Orish CN, Ruggieri F, Bocca B, Battistini B, Frazzoli C, Orish FC, Orisakwe OE. An Update Overview on Mechanistic Data and Biomarker Levels in Cobalt and Chromium-Induced Neurodegenerative Diseases. Biol Trace Elem Res 2024; 202:3538-3564. [PMID: 38017235 DOI: 10.1007/s12011-023-03965-w] [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: 07/06/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
There is increasing evidence that the imbalance of metals as cobalt (Co) and chromium (Cr) may increase the risk of development and progression of neurodegenerative diseases (NDDs). The human exposure to Co and Cr is derived mostly from industry, orthopedic implants, and polluted environments. Neurological effects of Co and Cr include memory deficit, olfactory dysfunction, spatial disorientation, motor neuron disease, and brain cancer. Mechanisms of Co and Cr neurotoxicity included DNA damage and genomic instability, epigenetic changes, mitochondrial disturbance, lipid peroxidation, oxidative stress, inflammation, and apoptosis. This paper seeks to overview the Co and Cr sources, the mechanisms by which these metals induce NDDs, and their levels in fluids of the general population and patients affected by NDDs. To this end, evidence of Co and Cr unbalance in the human body, mechanistic data, and neurological symptoms were collected using in vivo mammalian studies and human samples.
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Affiliation(s)
- Doris Nnena Ajibo
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria
| | - Chinna Nneka Orish
- Department of Anatomy, College of Health Sciences University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria
| | - Flavia Ruggieri
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Beatrice Bocca
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Beatrice Battistini
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Chiara Frazzoli
- Department for Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore Di Sanità, Rome Viale Regina Elena, 29900161, Rome, Italy
| | | | - Orish E Orisakwe
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria.
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, 5323, Port Harcourt, Rivers State, Nigeria.
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Ouisselsat M, El Maouaki A, Maidoumi S, François Y, Pineau A, Sedki A. Assessment of Essential and Toxic Element Levels in the Toenails of Children with Autism Spectrum Disorder. Biol Trace Elem Res 2024:10.1007/s12011-024-04319-w. [PMID: 39042314 DOI: 10.1007/s12011-024-04319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/15/2024] [Indexed: 07/24/2024]
Abstract
Autism spectrum disorder (ASD) has become a global public health concern, impacting the quality of life. The question of gene-environment interaction in the emergence of ASD remains a subject of ongoing debate, and exploring its pathophysiology is thoroughly related to metals as a risk factor. Therefore, this study aims to assess the levels of toxic (Al, Cd, Hg, and Pb) and essential (Cr, Mn, Fe, Ni, Cu, Zn, and Se) elements in toenail samples collected in children with ASD and neurotypical children, by ICP-MS. Parallelly, we will discuss the use of toenails as an exposure indicator. The study involved 208 children aged 3 to 14 from Marrakech, Morocco. One hundred two were diagnosed with ASD and 106 were neurotypical children. Significant statistical differences in the concentration of Cr, Mn, and Fe were documented between the two groups. Higher levels of Pb in toenails compared to reference values have been reported. No association was established between concentrations of elements and age. Spearman correlation coefficients revealed a significantly different pattern of mutual dependence for toxic and essential elements between the two groups. The strongest positive correlations were found in the neurotypical group (Fe-Mn (ρ = 0.750), and Se-Zn (ρ = 0.800)). These results provide additional, although inconclusive, evidence on the probable role of element disturbance in the pathogenesis of ASD. Further studies should be performed to explore other nutritional, cultural, sociodemographic, environmental, and methodological factors that may impact the levels of these elements in the nails and their possible correlation with the incidence of ASD.
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Affiliation(s)
- Mariam Ouisselsat
- Laboratory of Water, Biodiversity and Climate Change, Department of Biology, Faculty of Sciences - Semlalia, Cadi Ayyad University, Bd Moulay Abdellah BP, 2390-40001, Marrakech, Morocco.
| | - Amal El Maouaki
- Laboratory of Clinical, Experimental and Environmental Neurosciences, Faculty of Medicine and Pharmacy, Cadi Ayyad University, 274, 40000, Marrakech, Morocco
| | - Sana Maidoumi
- Laboratory of Water, Biodiversity and Climate Change, Department of Biology, Faculty of Sciences - Semlalia, Cadi Ayyad University, Bd Moulay Abdellah BP, 2390-40001, Marrakech, Morocco
- Higher Institute of Nursing Professions and Health Techniques, Rue Abdelouahab Derraq, 40000, Marrakech, Morocco
| | - Yannick François
- Mineral Element Dosing Centre, UFR of Pharmaceutical and Biological Sciences, University of Nantes, 9, Rue Bias, 44035 - 44000, Nantes Cedex 1, France
| | - Alain Pineau
- Mineral Element Dosing Centre, UFR of Pharmaceutical and Biological Sciences, University of Nantes, 9, Rue Bias, 44035 - 44000, Nantes Cedex 1, France
| | - Azeddine Sedki
- Laboratory of Water, Biodiversity and Climate Change, Department of Biology, Faculty of Sciences - Semlalia, Cadi Ayyad University, Bd Moulay Abdellah BP, 2390-40001, Marrakech, Morocco
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Taleb S, Varela-Mattatall G, Allen A, Haast R, Khan AR, Kalia V, Howard JL, MacDonald SJ, Menon RS, Lanting BA, Teeter MG. Assessing brain integrity in patients with long-term and well-functioning metal-based hip implants. J Orthop Res 2024; 42:1292-1302. [PMID: 38235918 DOI: 10.1002/jor.25785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
Production of metal debris from implant wear and corrosion processes is now a well understood occurrence following hip arthroplasty. Evidence has shown that metal ions can enter the bloodstream and travel to distant organs including the brain, and in extreme cases, can induce sensorial and neurological diseases. Our objective was tosimultaneously analyze brain anatomy and physiology in patients with long-term and well-functioning implants. Included were subjects who had received total hip or hip resurfacing arthroplastywith an implantation time of a minimum of 7 years (n = 28) and age- and sex-matched controls (n = 32). Blood samples were obtained to measure ion concentrations of cobalt and chromium, and the Montreal Cognitive Assessment was performed. 3T MRI brain scans were completed with an MPRAGE sequence for ROI segmentation and multiecho gradient echo sequences to generate QSM and R2* maps. Mean QSM and R2* values were recorded for five deep brain and four middle and cortical brain structures on both hemispheres: pallidum, putamen, caudate, amygdala, hippocampus, anterior cingulate, inferior temporal, and cerebellum. No differences in QSM or R2* or cognition scores were found between both groups (p > 0.6654). No correlation was found between susceptibility and blood ion levels for cobalt or chromium in any region of the brain. No correlation was found between blood ion levels and cognition scores. Clinical significance: Results suggest that metal ions released by long-term and well-functioning implants do not affect brain integrity.
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Affiliation(s)
- Shahnaz Taleb
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Gabriel Varela-Mattatall
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Abbigail Allen
- Department of Surgery, London Health Sciences Centre, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Roy Haast
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Ali R Khan
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Vishal Kalia
- Department of Medical Imaging, Schulich School of Medicine & Dentistry, Division of Musculoskeletal Imaging, Western University, London, Ontario, Canada
| | - James L Howard
- Department of Surgery, London Health Sciences Centre, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Steven J MacDonald
- Department of Surgery, London Health Sciences Centre, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Ravi S Menon
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Brent A Lanting
- Department of Surgery, London Health Sciences Centre, Division of Orthopaedic Surgery, London, Ontario, Canada
| | - Matthew G Teeter
- Schulich School of Medicine & Dentistry, Imaging Group, Robarts Research Institute, Western University, London, Ontario, Canada
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Tower SS, Gessner BD, Cho CS, Bridges RL. The association of cobalturia with cobaltism symptoms a prospective blinded study of 229 post-arthroplasty patients. PLoS One 2023; 18:e0295203. [PMID: 38127904 PMCID: PMC10734948 DOI: 10.1371/journal.pone.0295203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Cobalt is a mitochondrial toxin, clinical cobaltism manifests with constitutional, neurologic, and cardiovascular symptomatology. Cobalt's severe toxidrome is known through case reports from extreme wear or corrosion of cobalt-chromium arthroplasty components. However, the spectrum and epidemiology of orthopedic-implant cobaltism and its relationship to duration and degree of cobalt exposure are not well defined. METHODS The relationship of urine-cobalt concentration and duration of exposure to cobalt-chromium joint implants and cobaltism symptomatology were prospectively studied in 229 patients. Subjects received a Cobaltism-Symptom-Inventory-Score (CSIS) based on a protocolized interview and examination followed by a spot urine-cobalt measurement. RESULTS 129 (56%) subjects were cobalturic (urine-cobalt ≥1.0 ppb). 122 (53%) subjects had a CSIS of >2, this status significantly associates with cobalturia. Median [IQR] urine-cobalt in the subjects with a CSIS >2 was 4.1[1.1-17.0] ppb compared to 0.5[0.5-1.4] ppb in subjects with CSIS ≤ 2. Cobalturia has a sensitivity of 0.69, a specificity of 0.77, and a positive predictive value of 0.74 for a CSIS of >2. The product of years-exposed to a cobalt-chromium implant and urine-cobalt by quartiles significantly positively associates with the Cobaltism-Symptom-Inventory-Score. CONCLUSION A urine-cobalt of ≥1 ppb likely indicates adverse systemic exposure to orthopedic-implant generated cobalt. Cobaltism severity as quantified by the CSIS significantly correlates with the product of spot urine-cobalt concentration and years-exposed to a cobalt-chromium orthopedic-implant indicating a dose-response relationship. Medical provider and public awareness of orthopedic-implant cobaltism is vital because tens-of-millions are at-risk and early cobaltism is reversible. Further use of cobalt-chromium orthopedic-implants should be questioned given cobaltism becomes clinically apparent at a spot urine-cobalt of 1 ppb or greater. Monitoring of patients with high-risk cobalt-chromium orthopedic-implants appears to be indicated.
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Affiliation(s)
- Stephen S. Tower
- University of Alaska, Medical School, Anchorage, Alaska, United States of America
| | | | - Christina S. Cho
- University of Alaska, Medical School, Anchorage, Alaska, United States of America
| | - Robert L. Bridges
- Aegis Imaging Consultants, Girdwood, Alaska, United States of America
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Beba A, Peterson SM, Brennan PC, O’Byrne J, Machulda MM, Jannetto PI, Vemuri P, Lewallen DG, Kremers HM, Vassilaki M. Correlation of Blood Metal Concentrations with Cognitive Scores and Neuroimaging Findings in Patients with Total Joint Arthroplasty. J Alzheimers Dis 2023; 94:1335-1342. [PMID: 37393495 PMCID: PMC10481381 DOI: 10.3233/jad-221182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
Total joint arthroplasty (TJA) implants are composed of metals, ceramics, and/or polyethylene. Studies suggest that the debris released from metal implants may possess neurotoxic properties with reports of neuropsychiatric symptoms and memory deficits, which could be relevant to Alzheimer's disease and related dementias. This exploratory study examined the cross-sectional correlation of blood metal concentrations with cognitive performance and neuroimaging findings in a convenience sample of 113 TJA patients with history of elevated blood metal concentrations of either titanium, cobalt and/or chromium. Associations with neuroimaging measures were observed but not with cognitive scores. Larger studies with longitudinal follow-up are warranted.
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Affiliation(s)
- Alican Beba
- George Washington University, Columbian College of Arts and Sciences, Washington, DC, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Peter C. Brennan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jamie O’Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Paul I. Jannetto
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Zhang J, Lin J, Zhao X, Yao F, Feng C, He Z, Cao X, Gao Y, Khan NU, Chen M, Luo P, Shen L. Trace Element Changes in the Plasma of Autism Spectrum Disorder Children and the Positive Correlation Between Chromium and Vanadium. Biol Trace Elem Res 2022; 200:4924-4935. [PMID: 35006555 DOI: 10.1007/s12011-021-03082-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/21/2021] [Indexed: 12/27/2022]
Abstract
Existing data demonstrate a significant correlation between autism spectrum disorder (ASD) and the status of biologically essential and toxic trace elements. However, there is still a lack of data on the steady state of trace elements in ASD. We performed a case-control study to explore the association between the risk of ASD and 23 trace elements in plasma. The results showed that children with ASD had considerably decreased lithium (Li), manganese (Mn), selenium (Se), barium (Ba), mercury (Hg), and tin (Sn) levels when compared to their age- and sex-matched controls. Meanwhile, children with ASD had considerably increased plasma chromium (Cr) and vanadium (V) concentrations. We also divided each group into subgroups based on age and gender and created element-related networks for each subgroup. We detected significant element correlations within or between subgroups, as well as changes in correlations that included all elements examined. Finally, more element correlations were observed among males, which may open a new avenue for understanding the complicated process behind the sex ratio of children with ASD. Overall, our data revealed a novel relationship between elements and ASD, which may extend current understanding about ASD.
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Affiliation(s)
- Jun Zhang
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
- School of Public Health, Key Laboratory of Environmental Pollution Monitoring Control Ministry of Education, Guizhou Medical University, Guiyang, 550025, People's Republic of China
| | - Jing Lin
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, People's Republic of China
| | - Xiying Zhao
- Shenzhen Academy of Metrology and Quality Inspection, Shenzhen, 518055, People's Republic of China
| | - Fang Yao
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
- Brain Disease and Big Data Research Institute, Shenzhen University, Shenzhen, 518071, People's Republic of China
| | - Chengyun Feng
- Maternal and Child Health Hospital of Baoan, Shenzhen, 518100, People's Republic of China
| | - Zhijun He
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
- Shenzhen Key Laboratory of Marine Biotechnology and Ecology, Shenzhen, 518071, People's Republic of China
| | - Xueshan Cao
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
| | - Yan Gao
- Maternal and Child Health Hospital of Baoan, Shenzhen, 518100, People's Republic of China
| | - Naseer Ullah Khan
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China
| | - Margy Chen
- Department of Psychology, Emory University, Atlanta, GA, 30322, USA
| | - Peng Luo
- School of Public Health, Key Laboratory of Environmental Pollution Monitoring Control Ministry of Education, Guizhou Medical University, Guiyang, 550025, People's Republic of China
| | - Liming Shen
- College of Life Science and Oceanography, Shenzhen University, Shenzhen, 518071, People's Republic of China.
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Vassilaki M, Kremers WK, Machulda MM, Knopman DS, Petersen RC, Laporta ML, Berry DJ, Lewallen DG, Maradit Kremers H. Long-term Cognitive Trajectory After Total Joint Arthroplasty. JAMA Netw Open 2022; 5:e2241807. [PMID: 36374499 PMCID: PMC9664257 DOI: 10.1001/jamanetworkopen.2022.41807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Individuals with total joint arthroplasty (TJA) have long-term exposure to metal-containing implants; however, whether long-term exposure to artificial implants is associated with cognitive function is unknown. OBJECTIVE To compare long-term cognitive trajectories in individuals with and without TJA. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study assessed serial cognitive evaluations of 5550 participants (≥50 years of age) from the Mayo Clinic Study of Aging between November 1, 2004, and December 31, 2020. EXPOSURES Total joint arthroplasty of the hip or the knee. MAIN OUTCOMES AND MEASURES Linear mixed-effects models were used to compare the annualized rate of change in global and domain-specific cognitive scores in participants with and without TJA, adjusting for age, sex, educational level, apolipoprotein E ε4 carrier status, and cognitive test practice effects. RESULTS A total of 5550 participants (mean [SD] age at baseline, 73.04 [10.02] years; 2830 [51.0%] male) were evaluated. A total of 952 participants had undergone at least 1 TJA of the hip (THA, n = 430) or the knee (TKA, n = 626) before or after entry into the cohort. Participants with TJA were older, more likely to be female, and had a higher body mass index than participants without TJA. No difference was observed in the rate of cognitive decline in participants with and without TJA until 80 years of age. A slightly faster cognitive decline at 80 years or older and more than 8 years from surgery was observed (b = -0.03; 95% CI, -0.04 to -0.02). In stratified analyses by surgery type, the faster decline was observed primarily among older participants with TKA (b = -0.04; 95% CI, -0.06 to -0.02). CONCLUSIONS AND RELEVANCE In this cohort study, long-term cognitive trajectories in individuals with and without TJA were largely similar except for a slightly faster decline among the oldest patients with TKA; however, the magnitude of difference was small and of unknown clinical significance.
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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | | | - Ronald C Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Abdel Hamid OI, Attia ME, Hirshon JM, El-Shinawi M, El-Hussaini M, El-Setouhy M. Psychiatric Disorders and Genotoxicity Following Primary Metal on Polyethylene Total Hip Arthroplasty and Their Correlation to Cobalt/Chromium Levels. Drug Healthc Patient Saf 2022; 14:97-111. [PMID: 35880007 PMCID: PMC9308046 DOI: 10.2147/dhps.s360643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hip arthroplasty (HA) using implantable metal components is among the commonest orthopedic interventions. However, it can be followed by several complications following corrosion and the release of metal ions. Several studies proved that damaged genomic DNA may contribute to the pathophysiology of mental disorders. Aim The current work aims to evaluate the psychiatric disorders in metal on polyethylene hip arthroplasty (MOP-HA) patients and its correlation to cobalt/chromium (Co/Cr) levels and genotoxicity. Methods The work was a longitudinal follow-up study including 34 adults with unilateral primary MOP-HA meeting the inclusion and exclusion criteria. Preoperatively, 6, 12-months-postoperatively, patients were examined for cognitive impairment using mini-mental-state-examination (MMSE), depression using major-depressive-inventory (MDI), and blood samples were collected for estimation of Co/Cr, detection of genotoxicity by single-cell-gel-electrophoresis (comet assay) and serum 8-hydroxy-2'-deoxyguanosine (8-OHdG). Results Cognitive impairment was reported in 18.5% and 14.8% at 6-months, and 12-months postoperative, respectively. Depressive disorder was recorded in 22.2% at 6-months and 14.8% at 12-months postoperative. The marginal homogeneity tests proved a non-significant difference. There was a non-significant difference in preoperative, 6-months, 12-months postoperative MMSE, and MDI scores. There were significantly increased Co/Cr levels at 6-months postoperative. The levels decreased at 12-months postoperative, however, still significantly higher than preoperative values. There was a significant increase in serum 8-OHdG and the levels were positively correlated to cobalt levels at both 6 and 12-months-postoperative. There was a non-significant difference among preoperative, 6-months, and 12-months postoperative comet assay measurements. Conclusion From previous findings, we can conclude that will-functioning MOP hip arthroplasty can induce increased ion levels and positively correlated increase in biochemical markers of genotoxicity (8-OHdG).
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Affiliation(s)
- Omaima I Abdel Hamid
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed E Attia
- Orthopedics Departments, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Jon M Hirshon
- Department of Emergency Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Galala University, Galala City, Suez, Egypt
| | - Moustafa El-Hussaini
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maged El-Setouhy
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Family and Community Medicine, Faculty of Medince, Jazan University, Jazan, Kingdom of Saudi Arabia
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10
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Islam GMR, Rahman MM, Hasan MI, Tadesse AW, Hamadani JD, Hamer DH. Hair, serum and urine chromium levels in children with cognitive defects: A systematic review and meta-analysis of case control studies. CHEMOSPHERE 2022; 291:133017. [PMID: 34813844 PMCID: PMC8792285 DOI: 10.1016/j.chemosphere.2021.133017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/11/2021] [Accepted: 11/19/2021] [Indexed: 05/02/2023]
Abstract
Environmental chromium exposure may cause impaired development of children. We conducted a systematic review and meta-analysis. Electronic databases including PubMed, Embase, Web of Science and CINAHL were searched to identify case-control studies that reported childhood Cr exposure and cognitive development. The Newcastle-Ottawa Scale (NOS) was used to ensure the quality of the included studies. Cr levels were compared in cases and controls, and a random effect meta-analysis was performed using Stata version 16. Twelve of 61 studies identified in the literature search were eligible for this analysis. Hair, serum and urine Cr measurements were reported by seven, two and one studies, respectively. In addition, one study reported both serum and hair Cr exposure and another reported urine and hair Cr exposure. The pooled standard mean differences (SMD) showed that hair Cr levels were non-significantly lower among children with cognitive defects (-0.01 μg/g, 95% CI: -0.04, 00, p = 0.27). In serum and urine, the pooled SMD was higher in children with cognitive deficits compared with healthy control children (0.32 μg/g, 95% CI: -0.78, 1.42, p = 0.56 and 0.64 μg/g, CI: -0.07,1.36, p = 0.08; respectively). In summary, this systematic review found no significant differences in hair, serum and urine Cr levels between children with cognitive deficits and healthy control children when all study data were pooled in the meta-analysis. Larger studies using standardized criteria and longitudinal assessment of cognitive development are needed to determine whether there is a dose response effect of childhood Cr exposure on cognitive development of children.
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Affiliation(s)
- G M Rabiul Islam
- Harvard T.H. Chan School of Public Health, Harvard University, USA; Department of Food Engineering and Tea Technology, Shahjalal University of Science and Technology, Bangladesh.
| | | | - Mohammed Imrul Hasan
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Amare Worku Tadesse
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, SOAS University of London, UK
| | - Jena Derakhshani Hamadani
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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11
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Wise JP, Young JL, Cai J, Cai L. Current understanding of hexavalent chromium [Cr(VI)] neurotoxicity and new perspectives. ENVIRONMENT INTERNATIONAL 2022; 158:106877. [PMID: 34547640 PMCID: PMC8694118 DOI: 10.1016/j.envint.2021.106877] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 05/21/2023]
Abstract
Hexavalent chromium [Cr(VI)] is a global environmental pollutant that increases risk for several types of cancers and is increasingly being recognized as a neurotoxicant. Traditionally, the brain has been viewed as a largely post-mitotic organ due to its specialized composition of neurons, and consequently, clastogenic effects were not considered in neurotoxicology. Today, we understand the brain is composed of at least eight distinct cell types - most of which continue mitotic activity throughout lifespan. We have learned these dividing cells play essential roles in brain and body health. This review focuses on Cr(VI), a potent clastogen and known human carcinogen, as a potentially neurotoxic agent targeting mitotic cells of the brain. Despite its well-established role as a human carcinogen, Cr(VI) neurotoxicity studies have failed to find a significant link to brain cancers. In the few studies that did find a link, Cr(VI) was identified as a risk for gliomas. Instead, in the human brain, Cr(VI) appears to have more subtle deleterious effects that can impair childhood learning and attention development, olfactory function, social memory, and may contribute to motor neuron diseases. Studies of Cr(VI) neurotoxicity with animal and cell culture models have demonstrated elevated markers of oxidative damage and redox stress, with widespread neurodegeneration. One study showed mice exposed to Cr(VI)-laden tannery effluent exhibited longer periods of aggressive behavior toward an "intruder" mouse and took longer to recognize mice previously encountered, recapitulating the social memory deficits observed in humans. Here we conducted a critical review of the available literature on Cr(VI) neurotoxicity and synthesize the collective observations to thoroughly evaluate Cr(VI) neurotoxicity - much remains to be understood and recognized.
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Affiliation(s)
- John P Wise
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA.
| | - Jamie L Young
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Jun Cai
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Lu Cai
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Research Institute, The Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40292, USA
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12
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Swiatkowska I, Henckel J, Sabah SA, Hart AJ. Self-Reported Neurotoxic Symptoms in Hip Arthroplasty Patients With Highly Elevated Blood Cobalt: A Case-Control Study. J Patient Saf 2022; 18:e10-e17. [PMID: 32209948 DOI: 10.1097/pts.0000000000000687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence of self-reported neurotoxicity and cognitive defects in hip replacement patients with markedly raised blood cobalt. METHODS Case group comprised 53 patients with metal-on-metal (MoM) implants and a history of blood Co ≥20 μg/L for a median of 3 years (interquartile range, 2-5 years). The control group comprised 53 patients with ceramic-on-ceramic prostheses and blood Co <1 μg/L. Median age was 67 years (interquartile range, 60-74 years). The participants completed the Neurotoxic Symptom Checklist-60, Diabetic Neuropathy Score, Douleur Neuropathique-10, and Systemic Symptom Checklist, and underwent the Mini-Mental State Examination. RESULTS The MoM and ceramic-on-ceramic groups were compared, the results were as follows: Neurotoxic Symptom Checklist-60 (median): cognitive defects (2.0 versus 1.9; P = 0.002), chest complaints (1.3 versus 1.3; P = 0.042), balance disturbances (1.3 versus 1.0; P < 0.001), sleep disturbances (2.7 versus 2.0; P = 0.004), mood disorders (2.0 versus 1.5; P = 0.001), sensorimotor disorders (1.6 versus 1.2; P < 0.001), physical complaints (2.0 versus 1.4; P = 0.009), fatigue (2.0 versus 1.6; P = 0.001), and total score (108 versus 90; P < 0.001); abnormal Diabetic Neuropathy Score/Douleur Neuropathique-10 (%): 60.3/13.2 versus 24.5/1.9 (P < 0.001/P = 0.028). Systemic Symptom Checklist (in percent): feeling cold (37.7 versus 17; P = 0.01), weight gain (18.9 versus 1.9; P = 0.008), metallic taste (26.4 versus 3.8; P = 0.002), worsening eyesight (37.7 versus 15.1; P = 0.008) and hearing (24.5 versus 7.5; 0.032), ankle swelling (32.1 versus 7.5; P = 0.002), shortness of breath on exertion (9.4 versus 5.7; P = 0.015), and generalized rash (28.3 versus 7.5; P = 0.01); and Mini-Mental State Examination (median): 29 versus 30 (P = 0.017). Patients in the MoM group were aware of their high cobalt levels and displayed a higher tendency to overreport symptoms (P < 0.001), which could have contributed to the higher scores. CONCLUSIONS Frequency of reporting a number of symptoms was markedly higher in MoM patients, but clinically significant neurotoxicity was not observed (possibly due to the short exposure to elevated cobalt). Patients with repeated blood Co ≥20 μg/L measurements should be questioned about possible systemic health complaints at follow-up.
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Affiliation(s)
- Ilona Swiatkowska
- From the Institute of Orthopaedics and Musculoskeletal Science, University College London
| | - Johann Henckel
- Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Shiraz A Sabah
- Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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13
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Lee C, Hu M. Parkinsonism in a Patient With Metal on Metal Total Hip Replacement Related Elevated Serum Heavy Metal Levels. Cureus 2021; 13:e17791. [PMID: 34522559 PMCID: PMC8425495 DOI: 10.7759/cureus.17791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Abstract
Heavy metal toxicity accounts for a rare minority of parkinsonian presentations. It is established that metal on metal total hip replacements can elevate serum cobalt and chromium levels. Here, we present an atypical parkinsonism presentation in a patient with metal on metal total hip replacement related heavy metal exposure, a picture complicated by a previous cerebral vascular accident involving the right lentiform nucleus. Initial work-up included MRI brain and dopamine transporter uptake imaging. A follow-up consultation revealed progressing parkinsonism. This case presentation reports the first parkinsonism presentation associated with metal on metal total hip replacement related heavy metal toxicity.
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Affiliation(s)
- Charlotte Lee
- Oxford University Medical School, Medical Sciences Division, University of Oxford, Oxford, GBR
| | - Michele Hu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, GBR.,Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, GBR
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14
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Abstract
This cohort study examines the association of cobalt-chrome arthroprosthetic components with adverse reactions to metallic debris, such as cobaltism.
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Affiliation(s)
- Stephen S. Tower
- University of Alaska, Anchorage
- WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) program, University of Washington School of Medicine, Anchorage, Alaska
- Tower Orthopedic and Joint Replacement Clinic, Anchorage, Alaska
| | - Christina S. Cho
- WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) program, University of Washington School of Medicine, Anchorage, Alaska
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15
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Perino G, De Martino I, Zhang L, Xia Z, Gallo J, Natu S, Langton D, Huber M, Rakow A, Schoon J, Gomez-Barrena E, Krenn V. The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty. EFORT Open Rev 2021; 6:399-419. [PMID: 34267931 PMCID: PMC8246109 DOI: 10.1302/2058-5241.6.210013] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The histopathological examination of the periprosthetic soft tissue and bone has contributed to the identification and description of the morphological features of adverse local tissue reactions (ALTR)/adverse reactions to metallic debris (ARMD). The need of a uniform vocabulary for all disciplines involved in the diagnosis and management of ALTR/ARMD and of clarification of the parameters used in the semi-quantitative scoring systems for their classification has been considered a pre-requisite for a meaningful interdisciplinary evaluation. This review of key terms used for ALTR/ARMD has resulted in the following outcomes: (a) pseudotumor is a descriptive term for ALTR/ARMD, classifiable in two main types according to its cellular composition defining its clinical course; (b) the substitution of the term metallosis with presence of metallic wear debris, since it cannot be used as a category of implant failure or histological diagnosis; (c) the term aseptic lymphocytic-dominated vasculitis- associated lesion (ALVAL) should be replaced due to the absence of a vasculitis with ALLTR/ALRMD for lymphocytic-predominant and AMLTR/AMRMD for macrophage-predominant reaction. This review of the histopathological classifications of ALTR/ARMD has resulted in the following outcomes: (a) distinction between cell death and tissue necrosis; (b) the association of corrosion metallic debris with adverse local lymphocytic reaction and tissue necrosis; (c) the importance of cell and particle debris for the viscosity and density of the lubricating synovial fluid; (d) a consensus classification of lymphocytic infiltrate in soft tissue and bone marrow; (e) evaluation of the macrophage infiltrate in soft tissues and bone marrow; (f) classification of macrophage induced osteolysis/aseptic loosening as a delayed type of ALTR/ARMD; (g) macrophage motility and migration as possible driving factor for osteolysis; (h) usefulness of the histopathological examination for the natural history of the adverse reactions, radiological correlation, post-marketing surveillance, and implant registries. The review of key terms used for the description and histopathological classification of ALTR/ARMD has resulted in a comprehensive, new standard for all disciplines involved in their diagnosis, clinical management, and long-term clinical follow-up.
Cite this article: EFORT Open Rev 2021;6:399-419. DOI: 10.1302/2058-5241.6.210013
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Affiliation(s)
- Giorgio Perino
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lingxin Zhang
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Canada
| | - Zhidao Xia
- Centre for Nanohealth, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Czech Republic
| | - Shonali Natu
- Department of Pathology, University Hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - David Langton
- Orthopaedic Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Monika Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria
| | - Anastasia Rakow
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Janosch Schoon
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Enrique Gomez-Barrena
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik-GmbH, Trier, Germany
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16
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Hoffman JF, Vergara VB, Kalinich JF. Brain region- and metal-specific effects of embedded metals in a shrapnel wound model in the rat. Neurotoxicology 2021; 83:116-128. [PMID: 33453298 DOI: 10.1016/j.neuro.2021.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/03/2021] [Accepted: 01/03/2021] [Indexed: 02/07/2023]
Abstract
The health effects of prolonged exposure to embedded metal fragments, such as those found in shrapnel wounds sustained by an increasing number of military personnel, are not well known. As part of a large collaborative effort to expand this knowledge, we use an animal model of shrapnel wounds originally developed to investigate effects of embedded depleted uranium to investigate effects of military-relevant metals tungsten, nickel, cobalt, iron, copper, aluminum, lead, and depleted uranium compared to an inert control, tantalum. Rats are surgically implanted with pellets of one of the metals of interest in the gastrocnemius (leg) muscle and tracked until 1 month, 3 months, 6 months, or 12 months from the time of implant, at which point they are euthanized and multiple organs and tissue samples are collected for inspection. Here we focus on four regions of the brain: frontal cortex, hippocampus, amygdala, and cerebellum. We examined changes in accumulated metal concentration in each region as well as changes in expression of proteins related to blood brain barrier tight junction formation, occludin and ZO-1, and synapse function, PSD95, spinophilin, and synaptotagmin. We report few changes in metal accumulation or blood brain barrier protein expression, but a large number of synapse proteins have reduced expression levels, particularly within the first 6 months of exposure, but there are regional and metal-specific differences in effects.
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Affiliation(s)
- Jessica F Hoffman
- Internal Contamination and Metal Toxicity Program, Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD, USA
| | - Vernieda B Vergara
- Internal Contamination and Metal Toxicity Program, Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD, USA
| | - John F Kalinich
- Internal Contamination and Metal Toxicity Program, Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD, USA.
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17
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Implant-derived CoCrMo alloy nanoparticle disrupts DNA replication dynamics in neuronal cells. Cell Biol Toxicol 2021; 37:833-847. [PMID: 33415469 DOI: 10.1007/s10565-020-09577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
The complexity of cobalt-chromium-molybdenum (CoCrMo) nanoparticles generated from the hip modular taper interfaces resulted in inconclusive outcomes on the level of toxicity in orthopedic patients. We used a hip simulator to generate physiologically relevant CoCrMo degradation products (DPs) to demonstrate the variation in the level of toxicity in neurons in comparison to processed degradation products (PDPs). The study outcomes indicate that DP induces a higher level of DNA damage in the form of double- and single-stranded DNA breaks and alkaline labile DNA adducts versus PDPs. The scientific advancements of this study are the following: (i) how DPs mimic more closely to the implant debris from hip implants in terms of bioactivity, (ii) how hip implant debris causes local and systemic issues, and (iii) methods to augment the biologic impact of implant debris. We discovered that DP is bioactive compared with PDP, and this should be considered in the toxicity evaluation related to implants. • The physicochemical characteristics of the CoCrMo is a major factor to consider for implant-related cytotoxicity or genotoxicity experimental design. • Elevated levels of intracellular ROS induced by the physiologically relevant wear particle are detrimental to the neuronal cells. • The DP can induce variation in DNA replication dynamics compared to PDP.
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18
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Tower SS, Medlin DJ, Bridges RL, Cho CS. Corrosion of Polished Cobalt-Chrome Stems Presenting as Cobalt Encephalopathy. Arthroplast Today 2020; 6:1022-1027. [PMID: 33385045 PMCID: PMC7772456 DOI: 10.1016/j.artd.2020.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022] Open
Abstract
Adverse reactions to metallic debris from corrosion of polished cobalt-chromium–cemented femoral stems are reported. Cobaltism (systemic cobalt poisoning) has not been reported from this phenomenon. Three patients presented to their surgeon for ongoing care 10-20 years after primary metal-on-plastic hip arthroplasty with the same polished cobalt-chromium–cemented femoral stems (Heritage, Zimmer). Urine cobalt was elevated, and the patients had symptoms consistent with cobaltism. Quantitative-F16DG-PET-CT brain imaging was performed showing generalized and focal brain hypometabolism consistent with cobalt encephalopathy. At revision, all stems were well fixed and grossly corroded. At 1 year after revision, cobalturia and cognitive symptoms were resolved or improved. Mechanically assisted crevice corrosion at the polymethylmethacrylate interface is a complication of polished cobalt-chromium–cemented stems that can result in systemic cobalt exposure and toxic encephalopathy. Our cases had only minor periprosthetic symptoms. Patients implanted with polished cobalt-chromium–cemented stems warrant monitoring with urine cobalt. Patients with cobaltemia warrant an evaluation for toxic encephalopathy.
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Affiliation(s)
- Stephen S Tower
- Affiliated Professor Alaska's Medical School, Tower Orthopedic and Joint Replacement Clinic, Anchorage, AK, USA
| | | | | | - Christina S Cho
- Tower Orthopedic and Joint Replacement Clinic, Anchorage, AK, USA
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19
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Rakow A, Schoon J. Systemic Effects of Metals Released from Arthroplasty Implants – a Brief Summary. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 158:501-507. [DOI: 10.1055/a-1187-1751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AbstractIn recent years, increasing concern has been raised regarding potential systemic toxicity of metals released from arthroplasty implants. A lack of valid metal thresholds for human (organ) toxicity and the prospect of multi-decade survival of modern hip and knee replacements pose special challenges. Indeed, evidence of systemic effects of metals released from such implants is largely missing. Systemic cobalt exposure has repeatedly been associated with cardiotoxic and neurotoxic effects, and also with thyroid dysfunction. The toxic potential of chromium is considered less pronounced. Yet, in arthroplasty there is usually a co-exposure to chromium and cobalt which complicates evaluation of element-specific effects. Toxicity of titanium dioxide nanoparticles has been subject to debate among international regulatory authorities. Their wide use in a variety of products in everyday life, such as toothpaste, cosmetics and food colorants, hampers the assessment of an
arthroplasty-induced systemic titanium exposure. To date there is no clear evidence for systemic complications due to titanium dioxide released from arthroplasty implants. Release of further metals such as tantalum, niobium, nickel, vanadium and zirconium from hip and knee replacement implants has been described occasionally, but systemic effects of respective long-term exposure scenarios are unknown. Generally, the characterization of all released metals regarding their chemical and physical specifications is critical for the evaluation of potential systemic risks. Systematic studies investigating the accumulation of metals relevant in arthroplasty in different organs/organ systems and the biological consequences of such accumulations are urgently needed.
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Affiliation(s)
- Anastasia Rakow
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Janosch Schoon
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Universitätsmedizin Greifswald, Germany
- Julius Wolff Institute, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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20
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Zheng F, Gonçalves FM, Abiko Y, Li H, Kumagai Y, Aschner M. Redox toxicology of environmental chemicals causing oxidative stress. Redox Biol 2020; 34:101475. [PMID: 32336668 PMCID: PMC7327986 DOI: 10.1016/j.redox.2020.101475] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022] Open
Abstract
Living organisms are surrounded with heavy metals such as methylmercury, manganese, cobalt, cadmium, arsenic, as well as pesticides such as deltamethrin and paraquat, or atmospheric pollutants such as quinone. Extensive studies have demonstrated a strong link between environmental pollutants and human health. Redox toxicity is proposed as one of the main mechanisms of chemical-induced pathology in humans. Acting as both a sensor of oxidative stress and a positive regulator of antioxidants, the nuclear factor erythroid 2-related factor 2 (NRF2) has attracted recent attention. However, the role NRF2 plays in environmental pollutant-induced toxicity has not been systematically addressed. Here, we characterize NRF2 function in response to various pollutants, such as metals, pesticides and atmospheric quinones. NRF2 related signaling pathways and epigenetic regulations are also reviewed.
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Affiliation(s)
- Fuli Zheng
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, China; Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, 10461, United States.
| | - Filipe Marques Gonçalves
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, 10461, United States
| | - Yumi Abiko
- Environmental Biology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, China.
| | - Yoshito Kumagai
- Environmental Biology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan.
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, 10461, United States.
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21
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Bridges RL, Cho CS, Beck MR, Gessner BD, Tower SS. F-18 FDG PET brain imaging in symptomatic arthroprosthetic cobaltism. Eur J Nucl Med Mol Imaging 2020; 47:1961-1970. [PMID: 31863138 PMCID: PMC7299907 DOI: 10.1007/s00259-019-04648-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/05/2019] [Indexed: 10/28/2022]
Abstract
PURPOSE Imaging studies of cobalt toxicity from cobalt-chromium alloy arthroprosthetics have focused on the local intra-articular and peri-articular presentation from failing joint replacements. Most studies investigating neurological findings have been small case series focused on the clinical findings of memory loss, diminished executive function, tremor, hearing and vision loss, depression, and emotional lability. This study utilizes software-based quantitative analysis of brain metabolism to assess the degree of hypometabolism and areas of susceptibility, determine if a pattern of involvement exists, and measure reversibility of findings after prosthetic revision to cobalt-free appliances. METHODS Over 48 months, 247 consecutive patients presenting to an orthopedic clinic with an arthroprosthetic joint containing any cobalt-chromium part were screened with whole blood and urine cobalt levels. A clinically validated inventory of 10 symptoms was obtained. Symptomatic patients with a blood cobalt level above 0.4 mcg/L or urine cobalt greater than 1 mcg/L underwent F-18 FDG PET brain imaging. Analysis was performed with FDA-approved quantitative brain analysis software with the pons as the reference region. Control group was the normal brain atlas within the software. RESULTS Of the 247 consecutively screened patients, 123 had blood and urine cobalt levels above the threshold. The 69 scanned patients had statistically significant regional hypometabolism and higher symptoms inventory. Fifty-seven patients were retained in the study. Distribution of hypometabolism was in descending order: temporal, frontal, Broca's areas, anterior cingulate, parietal, posterior cingulate, visual, sensorimotor, thalamic, and lastly caudate. Metal-on-metal (MoM) and metal-on-plastic (MoP) joint replacements produced similar patterns of hypometabolism. Of 15 patients with necessary revision surgery, 8 demonstrated improved metabolism when later re-scanned. CONCLUSION All scanned patients had regions of significant hypometabolism. Neurological toxicity from elevated systemic cobalt levels following arthroprosthetic joint replacement has a pattern of regional susceptibility similar to heavy metals and solvents, differing from classical dementias and may occur at blood and urine cobalt levels as low as 0.4 mcg/L and 1 mcg/L, respectively. Presently accepted thresholds for cobalt exposure and monitoring may need revision. Quantitative F-18 FDG PET brain imaging may aid in the decision process for treatment options and timing of possible medical versus surgical intervention.
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Affiliation(s)
- Robert L Bridges
- Aegis Imaging Consultants, LLC, P.O. Box 751, 170 Cervin Circle, Girdwood, AK, 99587, USA.
| | - Christina S Cho
- Aegis Imaging Consultants, LLC, P.O. Box 751, 170 Cervin Circle, Girdwood, AK, 99587, USA
- Tower Joint Replacement Clinic, Inc., Anchorage, AK, USA
| | - Marc R Beck
- Aegis Imaging Consultants, LLC, P.O. Box 751, 170 Cervin Circle, Girdwood, AK, 99587, USA
- Turnagain Radiology Associates, LLC, Anchorage, AK, USA
| | - Bradford D Gessner
- Aegis Imaging Consultants, LLC, P.O. Box 751, 170 Cervin Circle, Girdwood, AK, 99587, USA
- EpiVac Consulting Services, Anchorage, AK, USA
| | - Stephen S Tower
- Aegis Imaging Consultants, LLC, P.O. Box 751, 170 Cervin Circle, Girdwood, AK, 99587, USA
- Tower Joint Replacement Clinic, Inc., Anchorage, AK, USA
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22
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Self-reported systemic complaints in patients with metal-on-metal hip arthroplasty. J Orthop 2020; 18:213-217. [PMID: 32071507 DOI: 10.1016/j.jor.2020.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/24/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction An increase in blood serum metal ion levels is seen after implantation of all metal-on-metal (MoM) hip prosthesis. Systemic complaints contributed to raised cobalt ion concentrations in patients with MoM arthroplasty may lead to a variety of symptoms. The aim of this study is to investigate self-reported systemic complaints in association with cobalt ion concentrations in patients with any type of MoM hip prosthesis. Methods A cohort study was conducted. Patients with both unilateral and bilateral, resurfacing and large head metal on metal total hip arthroplasties (LHMoM THA) were included. Cobalt ion concentrations were measured by inductively coupled plasma mass spectrometry. Based on the known cobalt toxicity symptoms of case-reports and toxicology reports a new non-validated questionnaire was developed. Analysis was performed on two groups; a low cobalt ion concentration group and a high cobalt ion concentration group. Results A total of 62 patients were included with a mean age at surgery of 60.8 ± 9.3 years and a mean follow up of 6.3 ± 1.4 years. Mean cobalt ion concentrations were 104 ± 141 nmol/L (9-833). Based on the different thresholds (120-170 or 220 nmol/L) the low cobalt ion concentration group consisted of 44 (71%), 51 (82%) or 55 (89%) subjects respectively. In the 120 nmol/L and 170 nmol/L thresholds a significant difference in age was found. The composite score for OVS increased from 54% to 57%-68% with rising threshold value, a hint at the correlation between ion concentration and symptom prevalence. Discussion Ocular-vestibular symptoms were more common in high cobalt ion concentration groups for the three threshold levels tested and with increasing prevalence for higher threshold values. With regards to proactively inquired, self-reported symptoms the threshold where effects may be present could be lower than values currently applied in clinical follow-up.
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Simultaneous adsorptive study of toxic metal ions in quaternary system from aqueous solution using low cost black cumin seeds (Nigella sativa) adsorbents. SOUTH AFRICAN JOURNAL OF CHEMICAL ENGINEERING 2019. [DOI: 10.1016/j.sajce.2019.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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24
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Caparros-Gonzalez RA, Giménez-Asensio MJ, González-Alzaga B, Aguilar-Garduño C, Lorca-Marín JA, Alguacil J, Gómez-Becerra I, Gómez-Ariza JL, García-Barrera T, Hernandez AF, López-Flores I, Rohlman DS, Romero-Molina D, Ruiz-Pérez I, Lacasaña M. Childhood chromium exposure and neuropsychological development in children living in two polluted areas in southern Spain. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 252:1550-1560. [PMID: 31277024 DOI: 10.1016/j.envpol.2019.06.084] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 05/28/2023]
Abstract
This study aimed to assess the association between exposure to chromium and neuropsychological development among children. A cross-sectional study was conducted with 393 children aged 6-11 years old randomly selected from State-funded schools in two provinces in Southern Spain (Almeria and Huelva), in 2010 and 2012. Chromium levels in urine and hair samples were analyzed by inductively coupled plasma mass spectrometry with an octopole reaction system. Neuropsychological development was evaluated using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and three computerized tests from the Behavioural Assessment and Research System (BARS): Reaction Time Test (RTT), Continuous Performance Test (CPT) and Selective Attention Test (SAT). Multivariable linear regression models adjusted for potential confounders, including heavy metals, were applied to examine the association between chromium levels and neuropsychological outcomes. A 10-fold increase in urine chromium levels was associated with a decrease of 5.99 points on the WISC-IV Full-Scale IQ (95% CI: 11.98 to -0.02). Likewise, a 10-fold increase in urine chromium levels in boys was associated with a decrease of 0.03 points in the percentage of omissions (95% CI: 0.0 to 0.05) in the SAT, with an increase of 68.35 points in latency (95% CI: 6.60 to 130.12) in the RTT, and with an increase in the number of trials with latencies > 1000 ms (β = 37.92; 95% CI: 2.73 to 73.12) in the RTT. An inverse significant association was detected between chromium levels in hair and latency in the SAT in boys (β = -50.53; 95% CI: 86.86 to -14.22) and girls (β = -55.95; 95% CI: 78.93 to -32.97). Excluding trials with latencies >1000 ms in the RTT increased latency scores by 29.36 points in boys (95% CI: 0.17 to 58.57), and 39.91 points in girls (95% CI: 21.25 to 58.59). This study is the first to show the detrimental effects of postnatal chromium exposure on neuropsychological development in school-aged children.
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Affiliation(s)
- Rafael A Caparros-Gonzalez
- Mind, Brain and Behaviour Research Center (CIMCYC), Faculty of Psychology, University of Granada, Granada, Spain; Department of Nursing, Faculty of Health Sciences, University of Jaen, Jaen, Spain
| | | | - Beatriz González-Alzaga
- Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
| | | | - J Andrés Lorca-Marín
- Department of Clinical, Experimental and Social Psychology, University of Huelva, Huelva, Spain; Natural Resources, Health, and Environment Research Centre (RENSMA), University of Huelva, Huelva, Spain
| | - Juan Alguacil
- Natural Resources, Health, and Environment Research Centre (RENSMA), University of Huelva, Huelva, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - José L Gómez-Ariza
- Professor José Carlos Vílchez Martín, Department of Chemistry, University of Huelva, Huelva, Spain; Natural Resources, Health, and Environment Research Centre (RENSMA), University of Huelva, Huelva, Spain
| | - Tamara García-Barrera
- Professor José Carlos Vílchez Martín, Department of Chemistry, University of Huelva, Huelva, Spain; Natural Resources, Health, and Environment Research Centre (RENSMA), University of Huelva, Huelva, Spain
| | - Antonio F Hernandez
- Department of Legal Medicine, Toxicology and Physical Anthropology, University of Granada, Granada, Spain
| | - Inmaculada López-Flores
- Department of Genetics, Faculty of Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
| | - Diane S Rohlman
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, USA
| | - Desiree Romero-Molina
- Department of Statistics and Operational Research, Faculty of Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
| | - Isabel Ruiz-Pérez
- Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marina Lacasaña
- Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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25
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Pijls BG, Meessen JMTA, Tucker K, Stea S, Steenbergen L, Marie Fenstad A, Mäkelä K, Cristian Stoica I, Goncharov M, Overgaard S, de la Torre JA, Lübbeke A, Rolfson O, Nelissen RGHH. MoM total hip replacements in Europe: a NORE report. EFORT Open Rev 2019; 4:423-429. [PMID: 31210979 PMCID: PMC6549109 DOI: 10.1302/2058-5241.4.180078] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of this paper is to determine the prevalence of metal-on-metal (MoM) total hip replacement (THR) in European registries, to assess the incidence of revision surgery and to describe the national follow-up guidelines for patients with MoM THR including resurfacings. Eleven registries of the Network of Orthopaedic Registries of Europe (NORE) participated totalling 54 434 resurfacings and 58 498 large stemmed MoM THRs. The resurfacings and stemmed large head MoM had higher pooled revision rates at five years than the standard total hip arthroplasties (THA): 6.0%, 95% confidence interval (CI) 5.3 to 6.8 for resurfacings; 6.9%, 95% CI 4.4 to 9.4 for stemmed large head MoM; and 3.0%, 95% CI 2.5 to 3.6 for conventional THA. The resurfacings and stemmed large head MoM had higher pooled revision rates at ten years than the standard THAs: 12.1%, 95% CI 11.0 to 13.3 for resurfacings; 15.5%, 95% CI 9.0 to 22 for stemmed large head MoM; and 5.1%, 95% CI 3.8 to 6.4 for conventional THA. Although every national registry reports slightly different protocols for follow-up, these mostly consist of annual assessments of cobalt and chromium levels in blood and MRI (MARS) imaging.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180078
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Affiliation(s)
- Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Keith Tucker
- Implant Performance Committee, England and Wales National Joint Registry, ODEP, Beyond Compliance and MHRA Expert Advisory Group for MoM Prostheses, London, UK
| | | | - Liza Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten, LROI), 's- Hertogenbosch, The Netherlands
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | | | - Maxim Goncharov
- VJRR, Russian Scientific Research Institute of Traumatology and Orthopedics, St Petersburg, Russia
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Jorge Arias de la Torre
- Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Biomedicina (IBIOMED). Universidad de León, León, Spain
| | - Anne Lübbeke
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals, Geneva, Switzerland.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Postoperative Depression Following Spinal Fusion Surgery; Is There a Role for Elevated Serum Levels of Cobalt and Chromium? World Neurosurg 2017; 105:1026. [PMID: 28847129 DOI: 10.1016/j.wneu.2017.06.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 11/22/2022]
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27
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Mansour TR, Alnemari A, Krafcik B, Gaudin D. In Reply to "Postoperative Depression Following Spinal Fusion Surgery; Is There a Role for Elevated Serum Levels of Cobalt and Chromium?". World Neurosurg 2017; 105:1027. [PMID: 28847130 DOI: 10.1016/j.wneu.2017.06.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Tarek R Mansour
- Division of Neurological Surgery, Department of Surgery, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Ahmed Alnemari
- Division of Neurological Surgery, Department of Surgery, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Brianna Krafcik
- Division of Neurological Surgery, Department of Surgery, The University of Toledo Medical Center, Toledo, Ohio, USA
| | - Daniel Gaudin
- Division of Neurological Surgery, Department of Surgery, The University of Toledo Medical Center, Toledo, Ohio, USA.
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Remy LL, Byers V, Clay T. Reproductive outcomes after non-occupational exposure to hexavalent chromium, Willits California, 1983-2014. Environ Health 2017; 16:18. [PMID: 28264679 PMCID: PMC5340004 DOI: 10.1186/s12940-017-0222-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/18/2017] [Indexed: 05/18/2023]
Abstract
BACKGROUND From 1963-1995, a factory in Willits, Mendocino County, CA used toxic hexavalent chromium (Cr(VI)) without adequate measures to protect the population. We use longitudinal hospital data to compare reproductive outcomes for two generations in Willits and two generations in the Rest of County (ROC). This is the first study to quantify the reproductive impact of Cr(VI) in a non-occupational population. METHODS We searched California hospital discharge data (1983-2014) to find Mendocino County residents born 1950 or later. ZIP-code 95490 identifies Willits residents, with all others living in ROC. We used the Multi-Level Clinical Classification Software (CCS) to classify health outcomes. First, we calculated the crude birth rate using an external census denominator. The next two models used self-contained denominators to assess health of infants and two generations of pregnant women. Finally, we focused on non-pregnant females and, for comparison, males. Here we added admissions for people who moved, linked and summarized admissions to the person level, and calculated rates per census population. RESULTS We found 29311 newborn records in ROC and 5036 from Willits. At start of period, Willits birth rate was low and did not recover until 12 years after Plant closure. While the Plant was open, respiratory conditions, perinatal jaundice, and birth defect rates were higher for Willits infants compared to ROC, but improved post-closure. Risk for abnormal birthweight and term was high and remained high over the study period. During the period under study, we identified 31444 admissions of pregnant ROC women and 5558 from Willits. Willits women had significantly higher risk of pregnancy loss compared to ROC, whether stratified by generation, age group, or pre- and post-closure. Regardless of when exposed, Willits women continued to have significantly higher rates of in-hospital terminations, as animal studies of Cr(VI) exposure predict. In life course models, non-pregnant Willits women have significantly higher risk of reproductive organ conditions and neoplasms compared to ROC. CONCLUSIONS Adverse reproductive outcomes are elevated and consistent with animal studies. General health outcomes reflect the same broad effect reported for occupationally exposed workers. For the first time, the detrimental reproductive effects of non-occupational Cr(VI) exposure in human females and their infants is reported.
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Affiliation(s)
- Linda L Remy
- Family Health Outcomes Project, Family and Community Medicine, School of Medicine, University of California San Francisco, 500 Parnassus Ave. Room MU-337, San Francisco, CA 94143-0900 USA
| | - Vera Byers
- Immunology Inc, PO Box 4703, Incline Village, NV 89450 USA
| | - Ted Clay
- Family Health Outcomes Project, Family and Community Medicine, School of Medicine, University of California San Francisco, 500 Parnassus Ave. Room MU-337, San Francisco, CA 94143-0900 USA
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29
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Green B, Griffiths E, Almond S. Neuropsychiatric symptoms following metal-on-metal implant failure with cobalt and chromium toxicity. BMC Psychiatry 2017; 17:33. [PMID: 28114963 PMCID: PMC5259873 DOI: 10.1186/s12888-016-1174-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There were at least 31,171 metal-on-metal (MoM) hip implants in the UK between 2003 and 2011. Some of these were subject to failure and widescale recalls and revisions followed. METHOD This is a presentation of ten cases (mean age 60 years) where we evaluated neuropsychiatric morbidity following metal-on-metal hip implant failure and revision. Implants were ASR total hip replacement (acetabular implant, taper sleeve adaptor and unipolar femoral implants) performed between 2005 and 2009. This case series describes, for the first time, neuropsychiatric complications after revision where there has been cobalt and chromium toxicity. RESULTS Pre-revision surgery, nine patients had toxic levels of chromium and cobalt (mean level chromium 338 nmol/l, mean cobalt 669.4 nmol/l). Depression assessment showed 9 of 9 respondents fulfilled the BDI criteria for depression and 3 of these were being treated. 7 of 9 patients showing short term memory deficit with mean mini mental state examination score of 24.2. The normal population mean MMSE for this group would be expected to be 28 with <25 indicating possible dementia. CONCLUSIONS We found neurocognitive and depressive deficits after cobalt and chromium metallosis following MoM implant failure. Larger studies of neurocognitive effects are indicated in this group. There may be implications for public health.
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Affiliation(s)
- Ben Green
- The Institute of Medicine, University of Chester and University Centre Shrewsbury, Bache Hall, Countess Way, Chester, Cheshire, CH2 1JR, UK.
| | - Emily Griffiths
- 0000 0000 9421 9783grid.271308.fPublic Health England, 5 Old Fulwood Road, Sheffield, S10 3TG UK
| | - Solomon Almond
- 0000 0001 0683 9016grid.43710.31The Institute of Medicine, University of Chester and University Centre Shrewsbury, Bache Hall, Countess Way, Chester, Cheshire CH2 1JR UK
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Pijls BG, Meessen JMTA, Schoones JW, Fiocco M, van der Heide HJL, Sedrakyan A, Nelissen RGHH. Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0156051. [PMID: 27295038 PMCID: PMC4905643 DOI: 10.1371/journal.pone.0156051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE There are concerns about increased mortality in patients with metal-on-metal bearings in total hip arthroplasty (THA). OBJECTIVE To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthroplasty. DATA SOURCES Search of PubMed, MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, AcademicSearchPremier, ScienceDirect, Wiley and clinical trial registers through March 2015, augmented by a hand search of references from the included articles. No language restrictions were applied. STUDY SELECTION Two reviewers screened and identified randomised controlled trials and observational studies of primary total hip arthroplasty comparing MOM THA with non-MOM THA. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted study data and assessed risk of bias. Risk differences (RD) were calculated with random effect models. Meta-regression was used to explore modifying factors. MAIN OUTCOMES AND MEASURES Difference in mortality and difference in morbidity expressed as revisions and medical complications between patients with MOM THA and non-MOM THA. RESULTS Forty-seven studies were included, comprising 4,000 THA in randomised trials and over 500,000 THA in observational studies. For mortality, random effects analysis revealed a higher pooled RD of 0.7%, 95%, confidence interval (CI) [0.0%, 2.3%], I-square 42%; the heterogeneity was explained by differences in follow-up. When restricted to studies with long term follow-up (i.e. 10 years or more), the RD for mortality was 8.5%, 95%, CI [5.8%, 11.2%]; number needed to treat was 12. Further subgroup analyses and meta-regression random effects models revealed no evidence for other moderator variables (study level covariates, e.g. resurfacing vs. non-resurfacing MOM) than follow-up duration. The quality of the evidence presented in this meta-analysis was characterized as moderate according to the CLEAR-NPT (for non-pharmacological trials) and Cochrane risk of bias Table. CONCLUSIONS AND RELEVANCE Meta-analysis suggests there may be an increased long-term risk of mortality and revision surgery for patients with MOM THA compared to patients with non-MOM THA. REGISTRATION PROSPERO 2014:CRD42014007417.
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Affiliation(s)
- B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - J M T A Meessen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Fiocco
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - H J L van der Heide
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Sedrakyan
- FDA Medical Device Epidemiology (MDEpiNet) Science and Infrastructure Center, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States of America
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Singh P, Chowdhuri DK. Environmental Presence of Hexavalent but Not Trivalent Chromium Causes Neurotoxicity in Exposed Drosophila melanogaster. Mol Neurobiol 2016; 54:3368-3387. [DOI: 10.1007/s12035-016-9909-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/03/2016] [Indexed: 02/06/2023]
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In Vitro Analyses of the Toxicity, Immunological, and Gene Expression Effects of Cobalt-Chromium Alloy Wear Debris and Co Ions Derived from Metal-on-Metal Hip Implants. LUBRICANTS 2015. [DOI: 10.3390/lubricants3030539] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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