Heavy Metals, Cardiovascular Disease, and the Unexpected Benefits of Chelation Therapy

This review summarizes evidence from 2 lines of research previously thought to be unrelated: the unexpectedly positive results of TACT (Trial to Assess Chelation Therapy), and a body of epidemiological data showing that accumulation of biologically active metals, such as lead and cadmium, is an important risk factor for cardiovascular disease. Considering these 2 areas of work together may lead to the identification of new, modifiable risk factors for atherosclerotic cardiovascular disease. We examine the history of chelation up through the report of TACT. We then describe work connecting higher metal levels in the body with the future risk of cardiovascular disease. We conclude by presenting a brief overview of a newly planned National Institutes of Health trial, TACT2, in which we will attempt to replicate the findings of TACT and to establish that removal of toxic metal stores from the body is a plausible mechanistic explanation for the benefits of edetate disodium treatment.

Zinc excess increases cellular demand for iron and decreases tolerance to copper in Escherichia coli

Transition metals serve as an important class of micronutrients that are indispensable for bacterial physiology but are cytotoxic when they are in excess. Bacteria have developed exquisite homeostatic systems to control the uptake, storage, and efflux of each of biological metals and maintain a thermodynamically balanced metal quota. However, whether the pathways that control the homeostasis of different biological metals cross-talk and render cross-resistance or sensitivity in the host-pathogen interface remains largely unknown. Here, we report that zinc (Zn) excess perturbs iron (Fe) and copper (Cu) homeostasis in Escherichia coli, resulting in increased Fe and decreased Cu levels in the cell. Gene expression analysis revealed that Zn excess transiently up-regulates Fe-uptake genes and down-regulates Fe-storage genes and thereby increases the cellular Fe quota. In vitro and in vivo protein-DNA binding assays revealed that the elevated intracellular Fe poisons the primary Cu detoxification transcription regulator CueR, resulting in dysregulation of its target genes copA and cueO and activation of the secondary Cu detoxification system CusSR-cusCFBA Supplementation with the Fe chelator 2,2'-dipyridyl (DIP) or with the reducing agent GSH abolished the induction of cusCFBA during Zn excess. Consistent with the importance of this metal homeostatic network in cell physiology, combined metal treatment, including simultaneously overloading cells with both Zn (0.25 mm) and Cu (0.25 mm) and sequestering Fe with DIP (50 μm), substantially inhibited E. coli growth. These results advance our understanding of bacterial metallobiology and may inform the development of metal-based antimicrobial regimens to manage infectious diseases.

Long-Term Accumulation of Metals in the Skeleton as Related to Osteoporotic Derangements

The concentrations of metals in the environment are still not within the recommended limits as set by the regulatory authorities in various countries because of human activities. They can enter the food chain and bioaccumulate in soft and hard tissues/organs, often with a long half-life of the metal in the body. Metal exposure has a negative impact on bone health and may result in osteoporosis and increased fracture risk depending on concentration and duration of metal exposure and metal species. Bones are a long-term repository for lead and some other metals, and may approximately contain 90% of the total body burden in birds and mammals. The present review focuses on the most common metals found in contaminated areas (mercury, cadmium, lead, nickel, chromium, iron, and aluminum) and their effects on bone tissue, considering the possibility of the long-term bone accumulation, and also some differences that might exist between different age groups in the whole population.

Acclimation to Nutritional Immunity and Metal Intoxication Requires Zinc, Manganese, and Copper Homeostasis in the Pathogenic Neisseriae

Neisseria gonorrhoeae and Neisseria meningitidis are human-specific pathogens in the Neisseriaceae family that can cause devastating diseases. Although both species inhabit mucosal surfaces, they cause dramatically different diseases. Despite this, they have evolved similar mechanisms to survive and thrive in a metal-restricted host. The human host restricts, or overloads, the bacterial metal nutrient supply within host cell niches to limit pathogenesis and disease progression. Thus, the pathogenic Neisseria require appropriate metal homeostasis mechanisms to acclimate to such a hostile and ever-changing host environment. This review discusses the mechanisms by which the host allocates and alters zinc, manganese, and copper levels and the ability of the pathogenic Neisseria to sense and respond to such alterations. This review will also discuss integrated metal homeostasis in N. gonorrhoeae and the significance of investigating metal interplay.

Host-Mediated Copper Stress Is Not Protective against Streptococcus pneumoniae D39 Infection

Metal ions are required by all organisms for the chemical processes that support life. However, in excess they can also exert toxicity within biological systems. During infection, bacterial pathogens such as Streptococcus pneumoniae are exposed to host-imposed metal intoxication, where the toxic properties of metals, such as copper, are exploited to aid in microbial clearance. However, previous studies investigating the antimicrobial efficacy of copper in vivo have reported variable findings. Here, we use a highly copper-sensitive strain of S. pneumoniae, lacking both copper efflux and intracellular copper buffering by glutathione, to investigate how copper stress is managed and where it is encountered during infection. We show that this strain exhibits highly dysregulated copper homeostasis, leading to the attenuation of growth and hyperaccumulation of copper in vitro. In a murine infection model, whole-tissue copper quantitation and elemental bioimaging of the murine lung revealed that infection with S. pneumoniae resulted in increased copper abundance in specific tissues, with the formation of spatially discrete copper hot spots throughout the lung. While the increased copper was able to reduce the viability of the highly copper-sensitive strain in a pneumonia model, copper levels in professional phagocytes and in a bacteremic model were insufficient to prosecute bacterial clearance. Collectively, this study reveals that host copper is redistributed to sites of infection and can impact bacterial viability in a hypersusceptible strain. However, in wild-type S. pneumoniae, the concerted actions of the copper homeostatic mechanisms are sufficient to facilitate continued viability and virulence of the pathogen. IMPORTANCE Streptococcus pneumoniae (the pneumococcus) is one of the world's foremost bacterial pathogens. Treatment of both localized and systemic pneumococcal infection is becoming complicated by increasing rates of multidrug resistance globally. Copper is a potent antimicrobial agent used by the mammalian immune system in the defense against bacterial pathogens. However, unlike other bacterial species, this copper stress is unable to prosecute pneumococcal clearance. This study determines how the mammalian host inflicts copper stress on S. pneumoniae and the bacterial copper tolerance mechanisms that contribute to maintenance of viability and virulence in vitro and in vivo. This work has provided insight into the chemical biology of the host-pneumococcal interaction and identified a potential avenue for novel antimicrobial development.

Reduction of Lead Levels in Patients Following a Long-Term, Intermittent Calcium Ethylenediaminetetraacetic Acid (EDTA)-Based Intravenous Chelation Infusions: A Prospective Experimental Cohort

Chronic exposure to and the accumulation of lead has been associated with cardiovascular and all-cause morbidity and mortality. It has also been associated with accelerated declines in cognitive function and has been theorized as a contributor to essential hypertension. This study demonstrates the capacity of intermittent infusions of calcium ethylenediaminetetraacetic acid (EDTA) to reduce the amount of lead measured by provocative urinary testing, which is considered a marker for total body lead stores. Since lead is a known toxic substance with no safe levels, reducing the amount of accumulated lead in an individual has the possibility of decreasing the risk of heart disease, dementia, and other chronic illnesses associated with lead exposure. This study population was 15 healthy, asymptomatic patients who were evaluated for accumulated total body lead stores as part of a routine health screening. Total body lead was estimated by measuring urinary output after the patients had received intravenous (IV) calcium EDTA as a chelating agent. After establishing their baseline stored lead levels, patients received a series of intravenous chelation infusions to reduce body lead. The average number of infusions given was 14, over an average period of 24 months. After the series of chelations, there was an average reduction in the lead of 39.16% (range of 16% to 40%). All 15 subjects had a reduction in the amount of excreted lead after the series of chelation infusions.

Chinese Herbal Medicines - Manufacturing Flaws and Misuse

Chinese herbal medicines are mixtures of botanical, mineral, and/or animal products. The medicines are either prepared by a herbalist for a specific patient or available over the counter in ready to use or decoct formulations. The number of literature references with regard to adverse effects from Chinese herbal medicines has grown dramatically in the last decade along with the increased use of these treatments. These adverse effects can be attributed to a variety of reasons. Intentional adulteration of herbal medicines with pharmaceuticals to substantiate medicinal claims has resulted in a number of serious adverse effects, including some fatal cases. Cases of metal intoxication have been reported from their use as active ingredients or their presence as contaminants. Substituting a more toxic herb for a benign one, either by misidentification or for economic gain, can also result in adverse effects. Variability in the natural products from differences in growing, harvesting, and storage conditions affects the concentration of active components. Changes in these concentrations make consistent dosing a problem, especially for those herbs with a low therapeutic index. Because the causes of adverse effects from Chinese herbal medicines are varied, each incident must be thoroughly investigated to determine the causes, the potential public health risks, and the ways to avoid similar incidences in the future.