DMSA administration to patients with alleged mercury poisoning from dental amalgams: a placebo-controlled study

The present investigation was performed to determine the effect of 14-day oral administration of meso-2.3-dimercaptosuccinic acid (DMSA) on the urinary mercury excretion and the potential reduction of blood and plasma mercury concentrations, and also to relate these effects to possible decrease of symptoms, allegedly associated with amalgam fillings. Twenty subjects, relating their symptoms to mercury from amalgam fillings, received 20 mg/kg DMSA or placebo for 14 days. Their symptoms and mood states were recorded during the study and at a check-up 3 months later. Interpretation was based on intra-individual differences. DMSA-treatment resulted in an average increase in urinary mercury excretion by 65% and a decrease in blood mercury levels of 0.04 microgram/L/day. At the check-up after 3 months, urinary mercury excretion had returned to the pre-treatment level. No treatment effect of DMSA was apparent on subjective symptoms and mood state. One statistically significant treatment effect was noted-a decrease in fatigue-inertia in the DMSA-group-but there was no demonstrable correlation with increased urinary excretion or decreased blood concentration of mercury. Three subjects showed hypersensitive reactions, probably DMSA-specific, at the end of the treatment period. This placebo-controlled study provides no scientific support for diagnostic or therapeutic administration of DMSA for symptoms allegedly associated with chronic mercury exposition from dental amalgam fillings.

A short history of electrophoretic methods

High resolution separation of proteins, based on charge differences, is possible with disc electrophoresis, displacement electrophoresis (isotachophoresis) and notably isoelectric focusing (IEF). Size separation is obtained in sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The combination of gel IEF, followed by SDS-PAGE in a second-dimensional slab gel, i.e. two-dimensional gel electrophoresis, affords the highest resolution with up to several thousand spots per gel. Staining of proteins gives high resolution patterns which can be scanned and stored in comprehensive databases. Over the last 10 years the electrophoretic separation in gels and subsequent visualization of nucleic acids (DNA, RNA) and even genes as well as nucleotides have been much improved, making possible efficient mapping of the genes in humans and all other organisms. This has led to the biggest concerted endeavor in the history of science, i.e. the mapping of the human genome, which will be of importance as long as mankind exists. In the last years electrophoresis in capillaries has attracted much interest because for numerous substances, such as proteins nucleic acids, pharmaceuticals, metabolites, and peptides, it offers high resolution on the analytical scale with over 1 million theoretical plates. Electrophoretic methods have unprecedented impact on life sciences, providing a basis for unique advances in biochemistry, molecular biology, genetics, gene technology and medicine.

Electrophoretic analysis of stimulated cat parotid saliva

The proteins of parasympathetically stimulated cat parotid saliva were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and high resolution two-dimensional electrophoresis (2-DE). SDS-PAGE revealed up to 30 polypeptide bands in microliter volumes of unconcentrated saliva. The patterns were highly reproducible and characterized by prominent bands of M(r) 57,000, M(r) 30,000 and M(r) 15,000. The major protein (M(r) 30,000) appeared as a dimer (M(r) 60,000) when electrophoresed under non-reducing conditions but dissociated into its monomeric form when the SDS concentration of the denatured samples was increased from 1 to 5%. This indicates a noncovalent association. The protein patterns of saliva from different cats differed slightly but sequential samples from the same cat (collected during 90 min of stimulation) showed little change in protein pattern apart from a fall in total protein content. Following 2-DE, the major protein (M(r) 30,000) appeared as a complex array of at least eight spots in two tiers (pI 5.2-6.2; M(r) 28,000 and 32,000). The characteristics of this protein are discussed with reference to allergy to cats.

Apolipoprotein D and alpha 1-microglobulin in human urine: effect of cadmium exposure

Apolipoprotein D is a previously unrecognized urinary protein of unknown function which we have tested as a potential marker for kidney malfunction. This protein and alpha 1-microglobulin have been quantified by zone immunoelectrophoresis assay in urine samples from a group of eight men occupationally exposed to cadmium-containing welding fumes for many years. All these workers had highly elevated concentrations of urinary cadmium and indications of tubular proteinuria, as compared to a group of 50 apparently healthy normal men analyzed in parallel. The cadmium-exposed workers demonstrated three- and 15-fold average increases in apolipoprotein D and alpha 1-microglobulin, respectively, over normal values in urine, estimated both as excretion rates and as milligrams of protein per mmol of creatinine. All these increments were highly significantly different (P < 0.001) from the corresponding values of the reference group. Essentially the same results were obtained for each of the proteins from two independent consecutive samplings of the workers' urine. There were good linear (R = 0.70, 0.80) and logarithmic (R = 0.84, 0.81) correlations between the urinary concentrations of alpha 1-microglobulin and apolipoprotein D for both the reference and the study group. Although not as sensitive an indicator for tubular proteinuria as alpha 1-microglobulin, apolipoprotein D, being a storage-stable urinary protein, seems a valuable complement for the diagnosis of tubular malfunction.

Renal and immunological effects of occupational exposure to inorganic mercury

Seven parameters of renal dysfunction (urinary excretion of albumin, orosomucoid, beta 2-microglobulin, N-acetyl-beta-glucosaminidase (NAG), and copper; serum creatinine concentration, and relative clearance of beta 2-microglobulin) were examined in a group of chloralkali workers exposed to mercury vapour (n = 89) and in an unexposed control group (n = 75). Serum concentrations of immunoglobulins (IgA, IgG, IgM) and auto-antibodies towards glomeruli and other tissues were also determined. The parameters examined were compared between the two groups and related to different exposure parameters. In the chloralkali group median blood mercury concentration (B-Hg) was 55 nmol/l, serum mercury (S-Hg) 45 nmol/l, and urine mercury concentration (U-Hg) 14.3 nmol/mmol creatinine (25.4 micrograms/g creatinine). Corresponding concentrations for the control group were 15 nmol/l, 4 nmol/l, and 1.1 nmol/mmol creatinine (1.9 micrograms/g creatinine) respectively. None of the parameters of renal dysfunction differed significantly between the two groups, but there was a tendency to increased excretion of NAG in the exposed group compared with the controls. Also, a statistically significant relation existed between U-Hg and U-NAG (p less than 0.001). Serum immunoglobulin concentrations did not differ between the groups, and serum titres of autoantibodies (including antiglomerular basement membrane and antilaminin antibodies) were low in both groups. Thus the results gave no evidence of glomerular damage or of a tubular reabsorption defect at the current relatively low exposures. The findings still indicate slight, dose related tubular cell damage in the mercury exposed group. There were no signs of a mercury induced effect on the immune system.

Kidney effects in long term exposed lead smelter workers

Occupational exposure to lead may cause kidney damage. This study was carried out on a cohort of 70 active and 30 retired long term exposed lead smelter workers. Their kidney function was compared with 31 active and 10 retired truck assembly workers who had no occupational exposure to lead. The lead workers had been regularly followed up with measurements of lead concentration in blood since 1950. Previous exposure to lead was calculated as a time integrated blood lead index for each worker. Blood and urine samples were obtained from all subjects. The concentration of lead in blood (B-Pb) and urine (U-Pb) was analysed. The urinary concentrations of several sensitive indicators of early tubular (U-beta 2-microglobulin (U-beta 2-m); U-N-acetyl-beta-glucosaminidase (U-NAG)) and glomerular kidney damage (U-albumin) were determined. The B-Pb and U-Pb values were significantly higher among active and retired lead workers compared with their corresponding control groups. The highest concentrations were found among the active lead workers. The concentrations of the parameters of kidney function investigated were of the same magnitude for exposed workers and controls. No clinical signs of renal impairment were found among the workers. No correlations of clinical importance existed between concentrations of U-albumin, U-beta 2-m, and U-NAG activity on the one hand and the concentrations of B-Pb, cumulative blood lead index, U-Pb, and lead concentrations in the calcaneus and tibia on the other, among lead workers and controls. Despite many years of moderate to heavy exposure to lead, particularly for the retired lead workers, no signs of adverse effects on the kidney such as early tubular or glomerular malfunction were found. Reversible changes in kidney function during the 1950s and 1960s could not be excluded, however, due to a greater exposure to lead during that time.

Quantification of apolipoprotein D in human urine by zone immunoelectrophoresis assay: a methodological and clinical study

A zone immunoelectrophoresis assay (ZIA) has been developed for the quantification of apolipoprotein D (apo D) in unconcentrated native human urine. A standard curve, linear between 1 and 8 mg apo D/l was obtained with ZIA. The relative coefficients of variation for this method were 5-9% (n = 15 x 6) with a mean +/- SD of 7 +/- 1.4% and below 11% (n = 6 x 15) for within-run and between-run reproducibility, respectively. Equal amounts of apo D in unconcentrated and diluted urines, in serum and of the purified protein produced the same zone migration distances indicating parallelism between the immunologic reactions of apo D in different sample matrixes. Storage experiments with normal urines demonstrated good stability of apo D in both acidic and alkalinized urine over at least 2 days at +5 degrees C and during several days at -20 degrees C to -40 degrees C. Using ZIA, urine samples from 50 normal healthy men aged 23-65 years were analyzed for apo D. Mean and SD were: 2.8 +/- 2.1 mg/l, 2.6 +/- 1.8 micrograms/min and 0.24 +/- 0.13 mg/mmol for concentration, rate of excretion and mass/creatinine concentration, respectively.

Automatic method for quantitation of mercury in blood, plasma and urine

Here we report our experience of quantification of mercury in blood, plasma and urine by using modifications of a procedure for cold vapour atomic absorption. We have tried: (1) modifications of the instrumentation including the tower, the cell and apparatus for measurement; (2) to increase the volume of sample, avoiding problems caused by foaming and background to arrive at a reliable method with low detection limit. Blood and plasma samples were digested overnight in a mixture of nitric acid and perchloric acid (1:5). Recovery of known additions of mercury was close to 100%. Coefficients of variation (CV) within runs and between runs was for B-Hg 4.7 and 9.5, respectively at 20 nmol/l, and for U-Hg 1.8 and 5.2, respectively at 57 nmol/l. The same detection limit of 5 nmol/l was obtained with blood, plasma and urine. This is in the lower range of non-occupationally exposed normal subjects. The results, including those obtained in sample exchange with other laboratories and with reference materials, indicate that the accuracy of this method for quantification of mercury is good.

Biological monitoring of environmental and occupational exposure to mercury

Biological monitoring was used to assess mercury exposure from occupational and environmental sources in a group of chloralkali workers (n = 89) and in a control group (n = 75). In the control group, the median value for blood mercury (B-Hg) was 15 nmol/l, that for serum mercury (S-Hg) was 4 nmol/l and that for urinary mercury (U-Hg) was 1.1 nmol/mmol creatinine. Corresponding levels in the chloralkali group were 55 nmol/l, 45 nmol/l and 14.3 nmol/mmol creatinine, respectively. In the control group, there were statistically significant relationships between fish consumption and both B-Hg and S-Hg values (P less than 0.001), whereas U-Hg correlated best with the individual amalgam burden (P less than 0.01). In the chloralkali group, the mercury levels in blood and urine were significantly related to the type of work (P less than 0.001) but not to the length of employment, to fish consumption or to the quantity of dental amalgam fillings. In both groups there were poor correlations between smoking or alcohol intake and the mercury levels in blood and urine. The results strongly suggest that fish is an important source of methylmercury exposure and that amalgam fillings are probably the most important source of inorganic mercury exposure among occupationally unexposed individuals. In the chloralkali group, mercury exposure from fish and amalgam was overshadowed by occupational exposure to inorganic mercury.

Haematological changes in house painters using epoxy paints

Haematological parameters, iso-transferrin ratio in plasma and serotonin uptake in platelets were studied in 10 men (age range 21-54 years) with occupational long-term, low level exposure to vapours from epoxy paints. The control group consisted of 10 healthy men (age range 20-48 years) not occupationally exposed to chemicals or organic solvents. The mean cellular volume of erythrocytes was significantly higher for the house painters than the controls (p less than 0.05). The plasma concentration of iso-transferrin with isoelectric point 5.7 (Tf5.7) and the ratio between Tf5.7 and total transferrin (Tftot) were significantly higher in the exposed group (p less than 0.05). The uptake of serotonin in platelets (Vmax) from the exposed workers was significantly lower than the values for the controls (p less than 0.01). The results indicate an association between the observed biological effects and the chemical exposure, and we speculate that this is caused by changes in structure and function of the cell membranes.

On the possibility of differential diagnosis at elevated erythrocyte sedimentation rate by analysis of the concentrations of blood plasma proteins--a model study

An elevated erythrocyte sedimentation rate is generally regarded as an unspecific and mostly pathological indicator of inflammation or tumour. However, we have determined the concentrations of plasma/serum proteins that influence the erythrocyte sedimentation rate in numerous samples from several groups of patients with different diseases, including 2 forms of cancer. Equations have been developed by which the 1 h value of erythrocyte sedimentation rate can be expressed as the sum of disease-specific coefficients for each protein multiplied by the measured concentrations of the respective proteins. These equations are shown to be disease-specific with 64-93% probability. Such equations may thus form the basis for differential diagnosis.

Increased isotransferrin ratio and reduced erythrocyte and platelet volumes in blood from thermoplastic industry workers

Ten women (aged 31-61 years) and five men (aged 20-59 years) occupationally exposed to welding fumes of polyacetate containing diethylphthalate in a thermoplastic industry were studied. They had been employed 1-33 years (median: 11 years). Seven women (aged 35-55) and eight men (aged 26-73) acted as unexposed controls. The exposed persons showed increased isotransferrin ratio in blood serum and reduced volumes of erythrocytes and platelets in blood.

High performance concentration and gel filtration of rat urinary protein allergens

Allergies to laboratory animals, notably rats, have become an increasingly recognized occupational problem. Identification and isolation of the individual proteins causing allergic reactions, could form the basis for early recognition of sensitivity, diagnosis, control of degree of pollution of the environment and desensibilization treatments. Frequently, allergens originate from dried rat urine. Because earlier published methods were found unsatisfactory we have developed a new strategy for isolation of rat urinary proteins including a high performance technique for their mild concentration on hydroxyapatite. The concentrated allergens have been fractionated according to molecular size by high performance gel filtration and according to carbohydrate content by wheat germ lectin-Sepharose 6 MB affinity chromatography. The obtained fractions have been examined by denaturing and non-denaturing polyacrylamide gradient gel electrophoresis followed by sensitive staining procedures, and tested with respect to allergenicity by skin tests on allergic patients.

History of electrophoretic methods

Electrophoresis is the migration of electrically charged particles or ions in solutions due to an applied electric field. The ability to separate very similar substances including different proteins for analytical and preparative purposes has increased, especially since 1950, owing to the introduction of zone electrophoresis in paper and later in gels of polyacrylamide or agarose. After 1960, disc and displacement electrophoresis (isotachophoresis) and isoelectric focusing offered much increased resolution. Electrophoretic methods nowadays promote advances in biochemistry and molecular biology and will continue to be very important in science and for numerous applications in genetics, gene technology, sequencing of nucleic acids and proteins, studies of diseases and malfunctions including cancer, and in the identification of species and individuals, e.g., in forensic medicine.

Separation of different forms of transferrin by isoelectric focusing to detect effects on the liver caused by xenobiotics

Several genetic variants and also isoforms of transferrin differing in carbohydrate structure can be separated by polyacrylamide or agarose gel isoelectric focusing. Numerous blood plasma or serum samples can be analyzed in parallel in each gel. Studies of the heterogeneity of transferrin have already revealed many results of importance to different fields of human medicine. Gene typing can give important and useful information for paternity determination and in forensic medicine. The gene type C 2 seems to have increased frequency in certain malfunctions. Futhermore, functional abnormalities of liver cells can be revealed by determination of the concentrations of transferrin isoforms differing mainly in their carbohydrate parts. The isoforms can be quantified with zone immunoelectrophoresis assay. Thus valuable information can be obtained about important modulated regulations of cell and membrane functions, even when these are disturbed by disease and xenobiotics. The information may be useful e.g. in the detection of individuals suffering from toxic effects, to identify toxic agents and exposure conditions. Studies of house painters revealed that exposure to different types of paints had an effect on transferrin. Determination of the concentration of the isotransferrin with pI 5.7 in blood samples from alcoholics can be used as a marker for the detection of liver dysfunction and for the monitoring of therapy treatments. In addition, by analyzing the isotransferrins a rare genetic abnormality can be detected.

The N-acetylneuraminic acid content of five forms of human transferrin

Five isoforms of human serum transferrin were separated by isoelectric focusing and their N-acetylneuraminic acid content was determined. The forms differed in isoelectric point by about 0.1 of a pH unit with the structural differences situated in the carbohydrate parts. Each form had one sialic acid molecule (NANA) less than the next most acidic form. GLC-MS showed that the most abundant form with isoelectric point 5.5 had two two-branched carbohydrate chains, each having the galactoses covered by terminal sialic acid. The form with isoelectric point 5.4 had one three-branched and one two-branched carbohydrate chain, and all branches terminated with a sialic acid residue. The form with isoelectric point 5.6 had a terminal galactose on one of its two two-branched carbohydrate chains. Comparison of the sialic acid content of the five transferrin forms and their carbohydrate structures showed that some of the forms expose terminal galactose without attracting the asialoglycoprotein receptors on hepatocytes.

Urinary excretion of chromium in chromeplaters after discontinued exposure

In a previous study [Lindberg and Vesterberg, 1983a], excretion of chromium in urine (U-Cr) in chromeplaters was proposed for biological monitoring of ongoing exposure. Published reports were found about the decline of U-Cr after discontinued exposure in welders working in chromium-alloyed stainless steel, but not in chromeplaters. In this study, half-times (t1/2) were calculated for ten chromeplaters over a weekend, and for 23 chromeplaters over 31 days vacation. The results suggest that the excretion of chromium can be approximated to a two-compartment model. Estimated from the median values, an initial rapid phase with an assumed t1/2 of 2-3 days is followed by a phase with a t1/2 of approximately a month. Differences between the decline of U-Cr in chromeplaters and welders are discussed.

Concentration differences in isoforms of transferrin in blood from alcoholics during abuse and abstinence

At least five different forms of iron-saturated transferrin (Tf) from blood plasma can be separated by isoelectric focusing. These transferrin forms differ in the carbohydrate parts, especially the amount of sialic acid. The increased relative concentration of the form with isoelectric point 5.7 (Tf5.7) has been shown to be a good indicator for liver effects caused by alcohol abuse. However, in alcoholics during abstinence the newly formed transferrin has a higher sialic acid content than most of the transferrin already present in the blood. This indicates that the elevated concentration of Tf5.7 with a low sialic acid content, found in alcoholics is not due to a defect at sialylation, but most probably caused by an impaired uptake of sialic acid-deficient transferrin by the hepatocytes due to membrane dysfunction.

Biological exposure limits estimated from relations between occupational styrene exposure during a workweek and excretion of mandelic and phenylglyoxylic acids in urine

Styrene exposure of 18 workers in fiberglass reinforced plastic industries was measured for 30-min periods throughout each workday for a week. The styrene uptake was estimated using pulmonary ventilation measurements. All urine voidings were collected separately and the styrene metabolites, mandelic acid (MA) and phenylglyoxylic acid (PGA) were determined. The relationship between both exposure and uptake versus excretion of these metabolites was studied. Styrene metabolite concentrations and excretion rates (with 95% tolerance limits) were calculated to correspond to a constant 8-h exposure at the Swedish exposure limit level (25 ppm) or an uptake of an exposure limit related styrene dose (6.3 mmol). The tightest tolerance limits were obtained for excretion rate of MA + PGA per 24 h. The calculated biological exposure limit was 3.4 (+/- 0.7) mmol MA + PGA/24h for a dose of 6.3 mmol styrene.