Diabetes mellitus associated with arsenic exposure in Bangladesh

Protective effect of Piper betle leaf extract against cadmium-induced oxidative stress and hepatic dysfunction in rats

The present study was undertaken to examine the attenuative effect of Piper betle leaf extract (PBE) against cadmium (Cd) induced oxidative hepatic dysfunction in the liver of rats. Pre-oral supplementation of PBE (200 mg/kg BW) treated rats showed the protective efficacy against Cd induced hepatic oxidative stress. Oral administration of Cd (5 mg/kg BW) for four weeks to rats significantly (P > 0.05) elevated the level of serum hepatic markers such as serum aspartate transaminase (AST), serum alanine transaminase (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), gamma-glutamyl transpeptidase (GGT), bilirubin (TBRNs), oxidative stress markers viz., thiobarbituric acid reactive substances (TBARS), lipid hydroperoxides (LOOH), protein carbonyls (PC) and conjugated dienes (CD) and significantly (P > 0.05) reduced the enzymatic antioxidants viz., superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione S-transferase (GST), glutathione reductase (GR) and glucose-6-phosphate dehydrogenase (G6PD) and non-enzymatic antioxidants Viz., reduced glutathione (GSH), total sulfhydryls (TSH), vitamin C and vitamin E in the liver. Pre-oral supplementation of PBE (200 mg/kg BW) in Cd intoxicated rats, the altered biochemical indices and pathological changes were recovered significantly (P > 0.05) which showed ameliorative effect of PBE against Cd induced hepatic oxidative stress. From the above findings, we suggested that the pre-administration of P. betle leaf extract exhibited remarkable protective effects against cadmium-induced oxidative hepatic injury in rats.

Adjusting for Urinary Creatinine Overestimates Arsenic Concentrations in Diabetics

BACKGROUND/AIMS: Arsenic (As) is linked to insulin resistance in animal studies, but the effect of low-level As exposure on the prevalence of diabetes in humans is uncertain. An optimal method to report inorganic As in humans has not been established. Measurements of As in spot urine are usually adjusted to creatinine (Cr). However, urinary Cr is an independent variable in diabetes. Our aims are to optimize reporting of urinary As in the setting of diabetes and insulin resistance. METHODS: Urinary inorganic As was measured in 24-hour or first-void spot urine from diabetic (n = 31) and non-diabetic (n = 12) subjects and normalized to Cr or specific gravity (SG). The relation of normalized urinary inorganic As to glycemia and surrogate measures of insulin resistance was investigated. Blood pressure, waist circumference, and glycated hemoglobin were also assessed. Homeostasis model assessment was used to determine insulin resistance. RESULTS: A strong correlation was found between spot urinary As adjusted to Cr (R(2) = 0.82) or SG (R(2) = 0.61) to 24-hour urinary As (p < 0.001), while non-adjusted urinary As did not correlate well (R(2) = 0.03, p = 0.46). Adjusting for Cr revealed significant differences in total 24-hour urinary As when comparing diabetic to normal subjects. In contrast, no differences were found when As was adjusted to SG using either 24-hour or spot urine. Moreover, adjusted urinary spot or 24-hour As measures did not correlate with measures of glycemia or insulin resistance. Conclusions: Urinary Cr is an independent variable in diabetes, therefore adjusting spot As for SG is preferred.

Acute exposure of arsenic tri-oxide produces hyperglycemia in both sexes of an Indian teleost, Clarias batrachus (Linn.)

The present investigation has been conducted to study of the effect of acute exposure of sublethal doses of arsenic tri-oxide (As(2)O(3)) on blood glucose level in an Indian teleost, Clarias batrachus, during their post-breeding season (October to January). The effect was correlated with the sex and doses used with time. Acute exposure of As(2)O(3) of 5, 10 and 15 mg/l for six consecutive days (i.e., 144 h) has been conducted on both sexes of C. batrachus. During the present investigation, it was noticed that the females were more reactive to arsenic in producing hyperglycemia compared to their male counterparts. The difference between males and females to produce hyperglycemia on exposure to arsenic appears to be dose dependent, as lower doses of 5 and 10 mg/l exhibit less difference between the two sexes compared to the highest dose order of 15 mg/l. After 96 h of treatment, a normoglycemic condition was observed in both sexes. However, no significant differences in average normal blood glucose levels were noticed in male and female C. batrachus during the post-breeding season.

Association between urinary arsenic and diabetes mellitus in the Korean general population according to KNHANES 2008

INTRODUCTION

We present data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008 on the associations between urinary arsenic and diabetes mellitus in a representative sample of the adult Korean population.

METHODS

This study was based on data obtained in KNHANES 2008, which was conducted for three years (2007-2009) using a rolling sampling design involving a complex, stratified, multistage, probability-cluster survey of a representative sample of the noninstitutionalized civilian population of South Korea.

RESULTS

Geometric means of total urinary arsenic concentration in females and total participants with diabetes mellitus were significantly higher than in participants without diabetes mellitus after adjustment for covariates, including age, seafood consumption, body mass index (BMI), hypertension, area of residence, regional area, education level, and smoking and drinking status. Multiple regression analysis after similar adjustment showed that total urinary arsenic concentration was associated with diabetes status in the females and total participants. In addition, after similar adjustment, the odds ratios (ORs) for diabetes mellitus in female participants and all participants were 1.502 (95% CI, 1.038-2.171) and 1.312 (95% CI, 1.040-1.655), respectively, for doubling of the level of urinary total arsenic concentration.

CONCLUSION

This study showed an association between total urinary arsenic concentration and the prevalence of diabetes mellitus in a representative sample of the adult population, especially women, with environmental arsenic exposure after adjustment for seafood intake and relevant diabetes risk factors.

Chronic arsenic toxicity: studies in West Bengal, India

Chronic arsenic toxicity (arsenicosis) as a result of drinking arsenic-contaminated groundwater is a major environmental health hazard throughout the world, including India. A lot of research on health effects, including genotoxic effect of chronic arsenic toxicity in humans, have been carried out in West Bengal during the last 2 decades. A review of literature including information available from West Bengal has been made to characterize the problem. Scientific journals, monographs, and proceedings of conferences with regard to human health effects, including genotoxicity, of chronic arsenic toxicity have been reviewed. Pigmentation and keratosis are the specific skin diseases characteristic of chronic arsenic toxicity. However, in West Bengal, it was found to produce various systemic manifestations, such as chronic lung disease, characterized by chronic bronchitis, chronic obstructive and/or restrictive pulmonary disease, and bronchiectasis; liver diseases, such as non cirrhotic portal fibrosis; polyneuropathy; peripheral vascular disease; hypertension; nonpitting edema of feet/hands; conjunctival congestion; weakness; and anemia. High concentrations of arsenic, greater than or equal to 200 μg/L, during pregnancy were found to be associated with a sixfold increased risk for stillbirth. Cancers of skin, lung, and urinary bladder are the important cancers associated with this toxicity. Of the various genotoxic effects of arsenic in humans, chromosomal aberration and increased frequency of micronuclei in different cell types have been found to be significant. Various probable mechanisms have been incriminated to cause DNA damage because of chronic arsenic toxicity. The results of the study in West Bengal suggest that deficiency in DNA repair capacity, perturbation of methylation of promoter region of p53 and p16 genes, and genomic methylation alteration may be involved in arsenic-induced disease manifestation in humans. P53 polymorphism has been found to be associated with increased occurrence of arsenic-induced keratosis. Of the various genes involved in the regulation of arsenic metabolism, single-nucleotide polymorphisms of purine nucleoside phosphorylase, in one study, showed increased occurrence of arsenicosis.

Arsenic-induced oxidative stress and its reversibility

This review summarizes the literature describing the molecular mechanisms of arsenic-induced oxidative stress, its relevant biomarkers, and its relation to various diseases, including preventive and therapeutic strategies. Arsenic alters multiple cellular pathways including expression of growth factors, suppression of cell cycle checkpoint proteins, promotion of and resistance to apoptosis, inhibition of DNA repair, alterations in DNA methylation, decreased immunosurveillance, and increased oxidative stress, by disturbing the pro/antioxidant balance. These alterations play prominent roles in disease manifestation, such as carcinogenicity, genotoxicity, diabetes, cardiovascular and nervous systems disorders. The exact molecular and cellular mechanisms involved in arsenic toxicity are rather unrevealed. Arsenic alters cellular glutathione levels either by utilizing this electron donor for the conversion of pentavalent to trivalent arsenicals or directly binding with it or by oxidizing glutathione via arsenic-induced free radical generation. Arsenic forms oxygen-based radicals (OH(•), O(2)(•-)) under physiological conditions by directly binding with critical thiols. As a carcinogen, it acts through epigenetic mechanisms rather than as a classical mutagen. The carcinogenic potential of arsenic may be attributed to activation of redox-sensitive transcription factors and other signaling pathways involving nuclear factor κB, activator protein-1, and p53. Modulation of cellular thiols for protection against reactive oxygen species has been used as a therapeutic strategy against arsenic. N-acetylcysteine, α-lipoic acid, vitamin E, quercetin, and a few herbal extracts show prophylactic activity against the majority of arsenic-mediated injuries in both in vitro and in vivo models. This review also updates the reader on recent advances in chelation therapy and newer therapeutic strategies suggested to treat arsenic-induced oxidative damage.

Trace and toxic element patterns in nonsmoker patients with noninsulin-dependent diabetes mellitus, impaired glucose tolerance, and fasting glucose

PROJECT:

Noninsulin dependent diabetes mellitus is supposed to be associated with fluctuations in the plasma levels of several trace elements. There is accumulating evidence that the metabolism of several trace elements is altered in patients with noninsulin dependent diabetes mellitus and that these nutrients might have specific roles in the pathogenesis and progression of this disorder.

PROCEDURE:

The aim of the present study is to compare the levels of essential trace and toxic elements including lead (Pb), arsenic (As), cadmium (Cd), chromium (Cr), aluminium (Al), nickel (Ni), cobalt (Co), iron (Fe), copper (Cu), selenium (Se), zinc (Zn), vanadium (V), manganese (Mn), barium (Ba), silver (Ag), and mercury (Hg) in patients with noninsulin dependent diabetes mellitus (n = 31), impaired glucose tolerance (n = 20), impaired fasting glucose (n = 14), and healthy controls (n = 22). Plasma concentrations of the elements were measured by using inductively coupled plasma mass spectrometry.

RESULTS:

The results indicated that values of lead, nickel, aluminium, copper, and chromium were significantly higher, but not above toxic levels, in the plasma of nonsmoker patients with noninsulin dependent diabetes mellitus (P < 0.05). The values for these elements were found to be significantly higher (P < 0.05) in patients with impaired fasting glucose than in controls. Moreover, a statistically significant correlation was found between plasma levels of glycated hemoglobin and of some trace elements like lead, nickel, aluminium, copper, chromium, cadmium, and mercury.

CONCLUSIONS

Thus, it was concluded that chronic complications of glucose metabolism disorders might be associated with alterations in the levels of some trace elements. Nevertheless, some more timely and extensive studies are required to clarify the exact mechanisms of each of these changes.

Arsenic and diabetes: current perspectives

Arsenic is a naturally occurring toxic metalloid of global concern. Many studies have indicated a dose-response relationship between accumulative arsenic exposure and the prevalence of diabetes mellitus (DM) in arseniasis-endemic areas in Taiwan and Bangladesh, where arsenic exposure occurs through drinking water. Epidemiological researches have suggested that the characteristics of arsenic-induced DM observed in arseniasis-endemic areas in Taiwan and Mexico are similar to those of non-insulin-dependent DM (Type 2 DM). These studies analyzed the association between high and chronic exposure to inorganic arsenic in drinking water and the development of DM, but the effect of exposure to low to moderate levels of inorganic arsenic on the risk of DM is unclear. Navas-Acien et al. recently proposed that a positive association existed between total urine arsenic and the prevalence of Type 2 DM in people exposed to low to moderate levels of arsenic. However, the diabetogenic role played by arsenic is still debated upon. An increase in the prevalence of DM has been observed among residents of highly arsenic-contaminated areas, whereas the findings from community-based and occupational studies in low-arsenic-exposure areas have been inconsistent. Recently, a population-based cross-sectional study showed that the current findings did not support an association between arsenic exposure from drinking water at levels less than 300 μg/L and a significantly increased risk of DM. Moreover, although the precise mechanisms for the arsenic-induced diabetogenic effect are still largely undefined, recent in vitro experimental studies indicated that inorganic arsenic or its metabolites impair insulin-dependent glucose uptake or glucose-stimulated insulin secretion. Nevertheless, the dose, the form of arsenic used, and the experimental duration in the in vivo studies varied greatly, leading to conflicting results and ambiguous interpretation of these data with respect to human exposure to arsenic in the environment. Moreover, the experimental studies were limited to the use of arsenic concentrations much higher than those relevant to human exposure. Further prospective epidemiological studies might help to clarify this controversy. The issues about environmental exposure assessment and appropriate biomarkers should also be considered. Here, we focus on the review of mechanism studies and discuss the currently available evidence and conditions for the association between environmental arsenic exposure and the development of DM.

Oxidative stress and hepatic stellate cell activation are key events in arsenic induced liver fibrosis in mice

Arsenic is an environmental toxicant and carcinogen. Exposure to arsenic is associated with development of liver fibrosis and portal hypertension through ill defined mechanisms. We evaluated hepatic fibrogenesis after long term arsenic exposure in a murine model. BALB/c mice were exposed to arsenic by daily gavages of 6 μg/gm body weight for 1 year and were evaluated for markers of hepatic oxidative stress and fibrosis, as well as pro-inflammatory, pro-apoptotic and pro-fibrogenic factors at 9 and 12 months. Hepatic NADPH oxidase activity progressively increased in arsenic exposure with concomitant development of hepatic oxidative stress. Hepatic steatosis with occasional collection of mononuclear inflammatory cells and mild portal fibrosis were the predominant liver lesion observed after 9 months of arsenic exposure, while at 12 months, the changes included mild hepatic steatosis, inflammation, necrosis and significant fibrosis in periportal areas. The pathologic changes in the liver were associated with markers of hepatic stellate cells (HSCs) activation, matrix reorganization and fibrosis including α-smooth muscle actin, transforming growth factor-β1, PDGF-Rβ, pro-inflammatory cytokines and enhanced expression of tissue inhibitor of metalloproteinase-1 and pro(α) collagen type I. Moreover, pro-apoptotic protein Bax was dominantly expressed and Bcl-2 was down-regulated along with increased number of TUNEL positive hepatocytes in liver of arsenic exposed mice. Furthermore, HSCs activation due to increased hepatic oxidative stress observed after in vivo arsenic exposure was recapitulated in co-culture model of isolated HSCs and hepatocytes exposed to arsenic. These findings have implications not only for the understanding of the pathology of arsenic related liver fibrosis but also for the design of preventive strategies in chronic arsenicosis.

The association between arsenic exposure from drinking water and cerebrovascular disease mortality in Taiwan

BACKGROUND

Chronic arsenic exposure is associated with a variety of diseases, including cancer, peripheral vascular disease, and diabetes. However, its association with cerebrovascular diseases (CVD) has not yet been resolved. The aim of this study is to explore this association in Taiwan using nation-wide data.

MATERIALS AND METHODS

We analyzed mortality data in Taiwan from 1971 to 2005 and choose two geographic areas with populations suffering from chronic exposure to arsenic in drinking water for study, the blackfoot disease endemic area (BFDEA) in the southwest and Lan-Yang Basin (LYB) in the northeast parts of Taiwan. The Chia-Yi and Tainan Counties, which surround the BFDEA, and the nation of Taiwan as a whole were used as reference populations. Direct standardized mortality rates and gender-specific indirect standardized mortality ratios (SMRs) were calculated for the four populations.

RESULTS

The direct standardized mortality rate for CVD in Taiwan decreased from 2.46/10(3) person-year in 1971 to 0.63/10(3) person-year in 2005, and women had significantly lower mortality than men (SMR = 0.80; p < 0.05). The CVD mortality rates of populations with chronic arsenic exposure were significantly higher than the reference populations (SMR ranging from 1.06 to 1.09 in men and 1.12 to 1.14 in women; p < 0.05). The BFDEA had higher CVD mortality rates than the LYB, with SMR = 1.05 (p < 0.05) in men and SMR = 1.04 (p = 0.05) in women.

CONCLUSION

In Taiwan, while CVD mortality decreased in both genders between 1971 and 2005, chronic arsenic exposure from drinking water was associated with increased risks of CVD.

Arsenic inhibits myogenic differentiation and muscle regeneration

BACKGROUND

The incidence of low birth weights is increased in offspring of women who are exposed to high concentrations of arsenic in drinking water compared with other women. We hypothesized that effects of arsenic on birth weight may be related to effects on myogenic differentiation.

OBJECTIVE

We investigated the effects of arsenic trioxide (As2O3) on the myogenic differentiation of myoblasts in vitro and muscle regeneration in vivo.

METHODS

C2C12 myoblasts and primary mouse and human myoblasts were cultured in differentiation media with or without As2O3 (0.1-0.5 microM) for 4 days. Myogenic differentiation was assessed by myogenin and myosin heavy chain expression and multinucleated myotube formation in vitro; skeletal muscle regeneration was tested using an in vivo mouse model with experimental glycerol myopathy.

RESULTS

A submicromolar concentration of As2O3 dose-dependently inhibited myogenic differentiation without apparent effects on cell viability. As2O3 significantly and dose-dependently decreased phosphorylation of Akt and p70s6k proteins during myogenic differentiation. As2O3-induced inhibition in myotube formation and muscle-specific protein expression was reversed by transfection with the constitutively active form of Akt. Sections of soleus muscles stained with hematoxylin and eosin showed typical changes of injury and regeneration after local glycerol injection in mice. Regeneration of glycerol-injured soleus muscles, myogenin expression, and Akt phosphorylation were suppressed in muscles isolated from As2O3-treated mice compared with untreated mice.

CONCLUSION

Our results suggest that As2O3 inhibits myogenic differentiation by inhibiting Akt-regulated signaling.

Association between chronic arsenic exposure and nutritional status among the women of child bearing age: a case-control study in Bangladesh

The role of nutritional factors in arsenic metabolism and toxicity is yet to be fully elucidated. A low protein diet results in decreased excretion of DMA and increased tissue retention of arsenic in experimental studies. Malnourished women carry a higher risk of adverse pregnancy outcomes. Chronic exposure to high arsenic (>50 microg/L) through drinking water also increases the risk of adverse pregnancy outcomes. The synergistic effects (if any) of malnutrition and chronic arsenic exposure may worsen the adverse pregnancy outcomes. This population based case control study reports the association between chronic arsenic exposure and nutritional status among the rural women in Bangladesh. 348 cases (BMI < 18.5) and 360 controls (BMI 18.5-24.99) were recruited from a baseline survey conducted among 2,341 women. An excess risk for malnutrition was observed among the participants chronically exposed to higher concentrations of arsenic in drinking water after adjusting for potential confounders such as participant's age, religion, education, monthly household income and history of oral contraceptive pills. Women exposed to arsenic >50 microg/L were at 1.9 times (Odds Ratio = 1.9, 95% CI = 1.1-3.6) increased risk of malnutrition compared to unexposed. The findings of this study suggest that chronic arsenic exposure is likely to contribute to poor nutritional status among women of 20-45 years.

Arsenic in public water supplies and cardiovascular mortality in Spain

BACKGROUND

High-chronic arsenic exposure in drinking water is associated with increased cardiovascular disease risk. At low-chronic levels, as those present in Spain, evidence is scarce. In this ecological study, we evaluated the association of municipal drinking water arsenic concentrations during the period 1998-2002 with cardiovascular mortality in the population of Spain.

METHODS

Arsenic concentrations in drinking water were available for 1721 municipalities, covering 24.8 million people. Standardized mortality ratios (SMRs) for cardiovascular (361,750 deaths), coronary (113,000 deaths), and cerebrovascular (103,590 deaths) disease were analyzed for the period 1999-2003. Two-level hierarchical Poisson models were used to evaluate the association of municipal drinking water arsenic concentrations with mortality adjusting for social determinants, cardiovascular risk factors, diet, and water characteristics at municipal or provincial level in 651 municipalities (200,376 cardiovascular deaths) with complete covariate information.

RESULTS

Mean municipal drinking water arsenic concentrations ranged from <1 to 118 microg/L. Compared to the overall Spanish population, sex- and age-adjusted mortality rates for cardiovascular (SMR 1.10), coronary (SMR 1.18), and cerebrovascular (SMR 1.04) disease were increased in municipalities with arsenic concentrations in drinking water > 10 microg/L. Compared to municipalities with arsenic concentrations < 1 microg/L, fully adjusted cardiovascular mortality rates were increased by 2.2% (-0.9% to 5.5%) and 2.6% (-2.0% to 7.5%) in municipalities with arsenic concentrations between 1-10 and >10 microg/L, respectively (P-value for trend 0.032). The corresponding figures were 5.2% (0.8% to 9.8%) and 1.5% (-4.5% to 7.9%) for coronary heart disease mortality, and 0.3% (-4.1% to 4.9%) and 1.7% (-4.9% to 8.8%) for cerebrovascular disease mortality.

CONCLUSIONS

In this ecological study, elevated low-to-moderate arsenic concentrations in drinking water were associated with increased cardiovascular mortality at the municipal level. Prospective cohort studies with individual measures of arsenic exposure, standardized cardiovascular outcomes, and adequate adjustment for confounders are needed to confirm these ecological findings. Our study, however, reinforces the need to implement arsenic remediation treatments in water supply systems above the World Health Organization safety standard of 10 microg/L.

Dietary B vitamin intakes and urinary total arsenic concentration in the Health Effects of Arsenic Longitudinal Study (HEALS) cohort, Bangladesh

PURPOSE

The objective of this analysis was to evaluate the effects of dietary B vitamin intakes on creatinine-adjusted urinary total arsenic concentration among individuals participating in the Health Effects of Arsenic Longitudinal Study (HEALS) cohort in Araihazar, Bangladesh. Arsenic exposure is a major public health problem in Bangladesh, where nearly 77 million people have been chronically exposed to arsenic through the consumption of naturally contaminated groundwater. Dietary factors influencing the metabolism of ingested arsenic may potentially be important modifiers of the health effects of arsenic in this population.

METHODS

Daily average B vitamin intakes from a validated food frequency questionnaire and laboratory data on drinking water and urinary arsenic concentrations among 9,833 HEALS cohort participants were utilized. Statistical analyses were conducted using generalized estimating equations incorporating knotted spline linear regression.

RESULTS

Increasing dietary intakes of thiamin, niacin, pantothenic acid, and pyridoxine were found to significantly increase urinary total arsenic excretion, adjusted for daily arsenic intake from drinking water and other potential confounders.

CONCLUSIONS

These results suggest that higher intakes of certain B vitamins may enhance the excretion of arsenic from the body. This study offers new insights into modifiable dietary factors that relate to arsenic excretion and thus provides potential avenues for the prevention of arsenic-related health effects.

Environmental toxins, a potential risk factor for diabetes among Canadian Aboriginals

OBJECTIVES

To review the current literature to determine if there is a case for examining the presence of toxins in traditional foods and the environment as a possible risk factor for type 2 diabetes in Canadian Aboriginal populations.

STUDY DESIGN

Literature review. METHODS. The scientific literature on possible causes of type 2 diabetes in Aboriginal populations in Canada was reviewed. Potential exposure through food and water to environmental toxins such as methylmercury, arsenic, persistent organic pollutants (POPs), including bisphenol A and phthalates, as well as Aboriginal lifestyle and composition of the traditional diet is discussed. RESULTS. There is growing evidence to suggest that environmental toxins may be associated with noninsulin-dependent diabetes mellitus (type 2 diabetes), which many consider to be endemic worldwide. In Canada, diabetes has reached epidemic proportions, especially among Aboriginal populations. Based on both molecular and pathological findings, some toxins found in the environment interfere with the functioning of the pancreas' islets of Langerhans cells, and consequently they affect insulin production. In addition, there is new evidence suggesting that obesity may be linked to endocrine disruptors, thus increasing the likelihood that obesity in itself may not be a chief risk factor for diabetes.

CONCLUSIONS

Diabetes prevalence rates among First Nations, Inuit and Métis populations are 3-5 times higher than the general population. Accepted risk factors such as diet, lifestyle and genetics do not fully explain this phenomenon. However, as many environmental toxins bioaccumulate in the food chain and are found in wild game and fish traditionally harvested and consumed by Aboriginal peoples, these chemicals could present health risks not yet fully explored. As there is not enough evidence to rule out this possibility, further studies are suggested. If correct, such environmental risk factors, especially if they are encountered early in life, would have implications on Aboriginal public health.

Effect of insulin on arsenic toxicity in diabetic rats—liver function studies

Arsenic (iAs)-induced diabetic mellitus has been debated by several workers. However, role of insulin in iAs-induced diabetes is yet to be investigated. Present report suggests that iAs promotes insulin secretion in diabetic rats and inhibits hyperglycemia. Whereas, reverse effects were recorded after insulin treatment to diabetic and iAs-treated rats. These conditions affect accumulation of iAs in liver. It decreased in diabetic and iAs-treated rats but increased after insulin treatment. Reciprocal effects were observed on serum transaminases and total bilirubin. Nevertheless, activity of glucose-6-phosphatase in the liver was stimulated by insulin treatment to diabetic and arsenic-fed rats. These results suggest that manifestations of arsenic-induced diabetes mellitus are not modulated or reversed by insulin. Observations on liver function further suggest that iAs is less toxic in diabetic rats. This protective effect has been attributed to noninsulin-dependent carbohydrate regulatory mechanisms. Diabetes certainly alters the pharmacodynamics and pharmacokinetics of iAs in rat.

A study of factors influencing urinary arsenic excretion in exposed workers

This study was designed to evaluate the influence of occupational and non-occupational factors on urinary arsenic excretion in workers exposed to iAs (inorganic arsenic) in the dismantlement of a factory which once produced fertilisers. We measured iAs and its methylated metabolites in 108 urinary samples of workers exposed to iAs in July 2006. A total of 13.9% of the samples showed levels higher than the Biological Exposure Index (BEI) of 35 microg/l (mean value 23.9 microg/l). After the improvement of working conditions, in August-October 2006 we collected urinary samples from each of the 108 workers enrolled. We also administrated a questionnaire, in order to investigate the influence of occupational and non-occupational factors on the urinary arsenic excretion. A significant difference was observed in relation with seafood consumption and age stratification. We have found a significant reduction of urinary arsenic excretion between the two phases of biological monitoring, probably due to appropriate hygiene work-related interventions.

Mortality patterns among workers exposed to arsenic, cadmium, and other substances in a copper smelter

OBJECTIVE

To evaluate the long-term mortality experience of workers exposed to arsenic, cadmium, and other substances at a copper mine and smelter in Copperhill, Tennessee studied earlier as part of an industry-wide study.

METHODS

Subjects were 2,422 male workers employed three or more years in the smelter or mill between 1/1/46 until the plant strike and scale-down of operations in April 1996. Vital status was determined through 2000 for 99.4% of subjects and cause of death for 91.3% of 878 deaths. Historical exposures were estimated for lead, SO(2), arsenic, cadmium, dust, and cobalt. We computed standardized mortality ratios (SMRs) based on U.S. and local county rates and modeled internal relative risks (RRs).

RESULTS

We observed overall deficits in deaths based on national and local county comparisons from all causes, all cancers and most of the cause of death categories examined. We found limited evidence of increasing mortality risks from cerebrovascular disease with increasing duration and cumulative arsenic exposure, but no evidence of an exposure-response relationship for cadmium exposure and bronchitis.

CONCLUSIONS

Our limited evidence of an association between inhaled arsenic exposure and CVD is an exploratory finding not observed in other epidemiology studies of more highly exposed occupational populations. Possible alternative explanations include chance alone and uncontrolled confounding or effect modification by co-exposures or other factors correlated with arsenic exposure and unique to the Copperhill facility.

Arsenate-induced maternal glucose intolerance and neural tube defects in a mouse model

BACKGROUND

Epidemiological studies have linked environmental arsenic (As) exposure to increased type 2 diabetes risk. Periconceptional hyperglycemia is a significant risk factor for neural tube defects (NTDs), the second most common structural birth defect. A suspected teratogen, arsenic (As) induces NTDs in laboratory animals.

OBJECTIVES

We investigated whether maternal glucose homeostasis disruption was responsible for arsenate-induced NTDs in a well-established dosing regimen used in studies of arsenic's teratogenicity in early neurodevelopment.

METHODS

We evaluated maternal intraperitoneal (IP) exposure to As 9.6 mg/kg (as sodium arsenate) in LM/Bc/Fnn mice for teratogenicity and disruption of maternal plasma glucose and insulin levels. Selected compounds (insulin pellet, sodium selenate (SS), N-acetyl cysteine (NAC), l-methionine (L-Met), N-tert-Butyl-alpha-phenylnitrone (PBN)) were investigated for their potential to mitigate arsenate's effects.

RESULTS

Arsenate caused significant glucose elevation during an IP glucose tolerance test (IPGTT). Insulin levels were not different between arsenate and control dams before (arsenate, 0.55 ng/dl; control, 0.48 ng/dl) or after glucose challenge (arsenate, 1.09 ng/dl; control, 0.81 ng/dl). HOMA-IR index was higher for arsenate (3.9) vs control (2.5) dams (p=0.0260). Arsenate caused NTDs (100%, p<0.0001). Insulin pellet and NAC were the most successful rescue agents, reducing NTD rates to 45% and 35%.

CONCLUSIONS

IPGTT, insulin assay, and HOMA-IR results suggest a modest failure of glucose stimulated insulin secretion and insulin resistance characteristic of glucose intolerance. Insulin's success in preventing arsenate-induced NTDs provides evidence that these arsenate-induced NTDs are secondary to elevated maternal glucose. The NAC rescue, which did not restore maternal glucose or insulin levels, suggests oxidative disruption plays a role.

Arsenic contamination in groundwater in the Southeast Asia region

The adverse impact of groundwater contaminated with arsenic (As) on humans has been reported worldwide, particularly in Asian countries. In this study, we present an overview of the As crisis in the Southeast Asian region where groundwater is contaminated with naturally occurring As and where contamination has become more widespread in recent years. In this region more than 100 million people are estimated to be at risk from groundwater As contamination, and some 700,000 people are known so far to have been affected by As-related diseases. Despite investments exceeding many millions of dollars, there are still substantial knowledge gaps about the prevalence and impact of As, notably in its epidemiology, temporal variations, social factors, patient identification, treatment, etc. Arsenic-affected people in the affected regions also face serious social problems. Of major concern is the fact that many researchers from different countries have been conducting research in SE Asia region but with a lack of coordination, thus duplicating their work. There is an urgent need to coordinate these various studies to ensure better delivery of research outcomes. Further research is needed to improve field testing and monitoring of drinking water sources, and to develop new treatments for chronic As toxicity and new sources of safe drinking water.

Chronic exposure of arsenic via drinking water and its adverse health impacts on humans

Worldwide chronic arsenic (As) toxicity has become a human health threat. Arsenic exposure to humans mainly occurs from the ingestion of As contaminated water and food. This communication presents a review of current research conducted on the adverse health effects on humans exposed to As-contaminated water. Chronic exposure of As via drinking water causes various types of skin lesions such as melanosis, leucomelanosis, and keratosis. Other manifestations include neurological effects, obstetric problems, high blood pressure, diabetes mellitus, diseases of the respiratory system and of blood vessels including cardiovascular, and cancers typically involving the skin, lung, and bladder. The skin seems to be quite susceptible to the effects of As. Arsenic-induced skin lesions seem to be the most common and initial symptoms of arsenicosis. More systematic studies are needed to determine the link between As exposure and its related cancer and noncancer end points.

Association of arsenic and kidney dysfunction in people with diabetes and validation of its effects in rats

We studied villagers with and without diabetes from arsenic-endemic areas and a nearby control site in Xinjiang Autonomous Region, PR China. Water and urinary arsenic were assayed for exposure measurement. Urinary NAG (N-acetyl-beta-glucosaminidase), a kidney function test, blood glucose, triglyceride, cholesterol, high density lipid and low density lipid were measured. Villagers from endemic areas were found to have higher urinary arsenic concentrations. The NAG results also suggest that chronic arsenic exposure presents a significant adverse impact on the kidney function of villagers in the endemic areas. However, blood glucose levels of diabetes individuals were lower than those from the control site. These observations were validated in rats which were chronically exposed to arsenic in drinking water. The distinct relationship between chronic arsenic exposure and diabetes mellitus requires further investigation. A rodent model is a useful tool for study of this type.

Arsenic exposure at low-to-moderate levels and skin lesions, arsenic metabolism, neurological functions, and biomarkers for respiratory and cardiovascular diseases: review of recent findings from the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh

The contamination of groundwater by arsenic in Bangladesh is a major public health concern affecting 35-75 million people. Although it is evident that high levels (>300 microg/L) of arsenic exposure from drinking water are related to adverse health outcomes, health effects of arsenic exposure at low-to-moderate levels (10-300 microg/L) are not well understood. We established the Health Effects of Arsenic Longitudinal Study (HEALS) with more than 20,000 men and women in Araihazar, Bangladesh, to prospectively investigate the health effects of arsenic predominantly at low-to-moderate levels (0.1 to 864 microg/L, mean 99 microg/L) of arsenic exposure. Findings to date suggest adverse effects of low-to-moderate levels of arsenic exposure on the risk of pre-malignant skin lesions, high blood pressure, neurological dysfunctions, and all-cause and chronic disease mortality. In addition, the data also indicate that the risk of skin lesion due to arsenic exposure is modifiable by nutritional factors, such as folate and selenium status, lifestyle factors, including cigarette smoking and body mass index, and genetic polymorphisms in genes related to arsenic metabolism. The analyses of biomarkers for respiratory and cardiovascular functions support that there may be adverse effects of arsenic on these outcomes and call for confirmation in large studies. A unique strength of the HEALS is the availability of outcome data collected prospectively and data on detailed individual-level arsenic exposure estimated using water, blood and repeated urine samples. Future prospective analyses of clinical endpoints and related host susceptibility will enhance our knowledge on the health effects of low-to-moderate levels of arsenic exposure, elucidate disease mechanisms, and give directions for prevention.

Chronic low-level arsenic exposure causes gender-specific alterations in locomotor activity, dopaminergic systems, and thioredoxin expression in mice

Arsenic (As) is a toxic metalloid widely present in the environment. Human exposure to As has been associated with the development of skin and internal organ cancers and cardiovascular disorders, among other diseases. A few studies report decreases in intelligence quotient (IQ), and sensory and motor alterations after chronic As exposure in humans. On the other hand, studies of rodents exposed to high doses of As have found alterations in locomotor activity, brain neurochemistry, behavioral tasks, and oxidative stress. In the present study both male and female C57Bl/6J mice were exposed to environmentally relevant doses of As such as 0.05, 0.5, 5.0, or 50 mg As/L of drinking water for 4 months, and locomotor activity was assessed every month. Male mice presented hyperactivity in the group exposed to 0.5 mg As/L and hypoactivity in the group exposed to 50 mg As/L after 4 months of As exposure, whereas female mice exposed to 0.05, 0.5, and 5.0 mg As/L exhibited hyperactivity in every monthly test during As exposure. Furthermore, striatal and hypothalamic dopamine content was decreased only in female mice. Also decreases in tyrosine hydroxylase (TH) and cytosolic thioredoxin (Trx-1) mRNA expression in striatum and nucleus accumbens were observed in male and female mice, respectively. These results indicate that chronic As exposure leads to gender-dependent alterations in dopaminergic markers and spontaneous locomotor activity, and down-regulation of the antioxidant capacity of the brain.

Ameliorating effect of curcumin on sodium arsenite-induced oxidative damage and lipid peroxidation in different rat organs

The present study was conducted to investigate the antioxidative effect of curcumin against sodium arsenite-induced oxidative damage in rat. Animals were divided into four groups, the first group was used as control. Groups 2, 3 and 4 were orally treated with curcumin (15 mg/kg BW), sodium arsenite (Sa, 5 mg/kg BW) and sodium arsenite plus curcumin, respectively. Rats were orally administered their respective doses daily for 30 days. Results showed that Sa increased thiobarbituric acid-reactive substances (TBARS) in plasma, liver, kidney, lung, testes and brain. While, the activities of glutathione S-transferase, superoxide dismutase and catalase and the content of sulfhydryl groups (SH-groups) were significantly decreased in plasma and tissues compared to control. Treatment with curcumin alone reduced the levels of TBARS, while induced the activities of the antioxidant enzymes, and the levels of SH-groups. The presence of curcumin with Sa reduced the induction in the levels of TBARS and induced the decrease in the activities of antioxidant enzymes and the levels of SH-groups. Results indicated that treatment with Sa decreased body weight and increased liver weight compared to control. The presence of curcumin with Sa alleviated its toxic effects. It can be concluded that curcumin has beneficial influences and could be able to antagonize Sa toxicity.

Evaluation of biochemical changes in chronic arsenic poisoning among Bangladeshi patients

An estimated 40 million people in Bangladesh have been suffering from arsenic toxicity-related diseases because of drinking water contamination with high levels of naturally occurring arsenic. To evaluate the biochemical changes in chronic arsenic exposure, a total of 115 exposed subjects diagnosed as arsenicosis patients were examined and interviewed, and 120 unexposed volunteers were enrolled in this study. Drinking water, urine and peripheral blood samples were collected from all participants and analyzed. The average levels of arsenic in the drinking water and spot urine samples of the arsenicosis patients were 218.1 microg/L and 234.6 microg/L, respectively, and duration of exposure was 7.6 +/- 5.2 yrs that ranged from 1-25 yrs. Prevalence of diabetes mellitus among chronic arsenic-exposed subjects was about 2.8 times higher than the unexposed subjects. The activities of alkaline phosphatase were significantly elevated in the patients, 197 U/L compared to 149 U/L in the controls, but alanine transaminase and aspartate transaminase were mostly normal. The patients had significantly lower levels of serum creatinine, 0.97 mg/dL compared to 1.15 mg/dL in the controls; but had significantly elevated levels of total protein, 84 g/L and 77 g/L respectively. The mean level of inorganic phosphate in the serum of arsenicosis patients was 6.4 mg/dL compared to 4.6 mg/dL in the unexposed subjects and the level was significantly higher, indicating substitution of the pentavalent arsenate for the phosphate ion causing underutilization of the latter. Evaluation of the lipid profiles showed while the levels of triacylglycerol were not much different, the patients had significantly lower levels of cholesterol, HDL-cholesterol and LDL-cholesterol compared to the unexposed subjects. These findings suggest significant changes in biochemical parameters in human arsenic toxicity.

Evaluation of status of toxic metals in biological samples of diabetes mellitus patients

There is accumulating evidence that the metabolism of several trace elements is altered in diabetes mellitus and that these nutrients might have specific roles in the pathogenesis and progress of this disease. The aim of present study was to compare the level of toxic elements, lead (Pb), cadmium (Cd), and arsenic (As) in biological samples (whole blood, urine, and scalp hair) of patients having diabetes mellitus type-2 age ranged (31-60) (n=238), with those of age matched non-diabetics (ND) as control subjects (n=196), of both genders. The concentrations of elements were measured by means of an atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy was checked by conventional wet acid digestion method and using certified reference materials. The overall recoveries of all elements were found in the range of 98.1-99.4% of certified values. The results of this study showed that the mean values of Pb, Cd and, As were significantly higher in scalp hair samples of smoker and non-smoker diabetic patients as compared to control subjects (p<0.001). The concentration of understudy toxic metals was also high in blood and urine samples of DM patient but difference was more significant in smoker DM patients. These results are consistent with those obtained in other studies, confirming that toxic metals may play a role in the development of diabetes mellitus.

Validity of spatial models of arsenic concentrations in private well water

OBJECTIVE

Arsenic is a pervasive contaminant in underground aquifers worldwide, yet documentation of health effects associated with low-to-moderate concentrations (<100microg/L) has been stymied by uncertainties in assessing long-term exposure. A critical component of assessing exposure to arsenic in drinking water is the development of models for predicting arsenic concentrations in private well water in the past; however, these models are seldom validated. The objective of this paper is to validate alternative spatial models of arsenic concentrations in private well water in southeastern Michigan.

METHODS

From 1993 to 2002, the Michigan Department of Environmental Quality analyzed arsenic concentrations in water from 6050 private wells. This dataset was used to develop several spatial models of arsenic concentrations in well water: proxy wells based on nearest-neighbor relationships, averages across geographic regions, and geostatistically derived estimates based on spatial correlation and geologic factors. Output from these models was validated using arsenic concentrations measured in 371 private wells from 2003 to 2006.

RESULTS

The geostatisical model and nearest-neighbor approach outperformed the models based on geographic averages. The geostatistical model produced the highest degree of correlation using continuous data (Pearson's r=0.61; Spearman's rank rho=0.46) while the nearest-neighbor approach produced the strongest correlation (kappa(weighted)=0.58) using an a priori categorization of arsenic concentrations (<5, 5-9.99, 10-19.99, > or = 20microg/L). When the maximum contaminant level was used as a cut-off in a two-category classification (<10, > or =10microg/L), the nearest-neighbor approach and geostatistical model had similar values for sensitivity (0.62-0.63), specificity (0.80), negative predictive value (0.85), positive predictive value (0.53), and percent agreement (75%).

DISCUSSION

This validation study reveals that geostatistical modeling and nearest-neighbor approaches are effective spatial models for predicting arsenic concentrations in private well water. Further validation analyses in other regions are necessary to indicate how widely these findings may be generalized.

Sociocultural aspects of arsenicosis in Bangladesh: community perspective

This was a cross-sectional study under taken to explore the socioeconomic perspective of the arsenicosis problem, carried out in arsenic contaminated Upazillas where at least 100 arsenicosis patients had been identified. Two of the Upazillas with significant arsenic mitigation intervention and three of the Upazillas with limited interventions were selected for the study. Seven hundred fifty respondents were included in the study from 25 villages of the 5 Upazillas. Arsenicosis became a serious problem for the affected communities. Majority (71.31%) of respondents obtained their drinking water from tubewells, almost one third (29%) of the respondents still knowingly using arsenic contaminated water. Primary reason identified for this practice was distance of safe water source. Majority (58.6%) of the respondents said to face economic and 17.9% said to face social problem of varied range. Patients of lower income group were particularly more likely to face economic problems (P< .001) as well as social problem (P< .01). About half (50.7%) of the arsenicosis patients faced difficulty whilst receiving treatment, particularly female patients were more likely to face problem than male (P< .05). Several concerns also were surfaced regarding the heath care service provider particularly to the women patients, some of which are: long waiting time for receiving treatment (15%), discrimination in service delivery (10.7%) and inadequate separate facility for female patients (14.3%). Moreover the issues of financial burden raised by the respondents seem to have emerged as significant in terms of health care access. Access to Health service was particularly difficult for poor patients, as they often had to face problems associated with accessing service like, non availability of medicines in the hospitals (50.7%), traveling long distance (26.7%), purchasing medicine in most cases (32.4%) etc. Their dissatisfaction was compounded by negligent behavior of health care staff and nature of treatment provided. Furthermore length of time needed for reversal of symptoms led to loosing faith on efficacy of treatment, which cascades to negligence of patient's part in seeking health care. Women are less likely to get treatment for arsenicosis than men (P< .01). As there appear to be specific difficulties for women particularly for poor women in accessing health care, social and cultural values make it difficult for them to attend to their own health needs and to travel to service providers. Study findings suggest that a significant proportion (79.9%) of arsenicosis patient was found to access alternative health care. This includes; Homeopath, village doctors, Kabiraj and local pharmacists. Respondents in high intervention Upazillas were significantly more likely to get treatment (P< .05), to face fewer problems and to be satisfied with the facility (P< .001). Provision of safe water options, periodic screening of water source for arsenic, availability of trained doctor, regular availability of medicine, doorstep treatment, follow up on severe patients were the suggestions came from community for improvement.

Arsenic and diabetes and hypertension in human populations: A review

Long-term exposure to ingested arsenic from drinking water has been well documented to be associated with an increased risk of diabetes mellitus and hypertension in a dose-response relationship among residents of arseniasis-endemic areas in southwestern Taiwan and Bangladesh. An increased risk of self-reported hypertension but not diabetes was reported in a community-based study of residents who consumed drinking water with a low level of arsenic. Increased glycosylated hemoglobin level and systolic blood pressure were observed in workers occupationally exposed to arsenic. Inconsistent findings of arsenic and diabetes in occupational studies may result from the healthy worker effect and the variation in exposure measurement, age composition, number of patients, accuracy in diagnosis and classification of underlying causes of death, competing causes of death, and method to detect diabetes. The dose-response relationship and toxicological mechanisms of arsenic-induced diabetes and hypertension need further elucidation.

Examination of the effects of arsenic on glucose homeostasis in cell culture and animal studies: development of a mouse model for arsenic-induced diabetes

Previous epidemiologic studies found increased prevalences of type 2 diabetes mellitus in populations exposed to high levels of inorganic arsenic (iAs) in drinking water. Although results of epidemiologic studies in low-exposure areas or occupational settings have been inconclusive, laboratory research has shown that exposures to iAs can produce effects that are consistent with type 2 diabetes. The current paper reviews the results of laboratory studies that examined the effects of iAs on glucose metabolism and describes new experiments in which the diabetogenic effects of iAs exposure were reproduced in a mouse model. Here, weanling male C57BL/6 mice drank deionized water with or without the addition of arsenite (25 or 50 ppm As) for 8 weeks. Intraperitoneal glucose tolerance tests revealed impaired glucose tolerance in mice exposed to 50 ppm As, but not to 25 ppm As. Exposure to 25 and 50 ppm As in drinking-water resulted in proportional increases in the concentration of iAs and its metabolites in the liver and in organs targeted by type 2 diabetes, including pancreas, skeletal muscle and adipose tissue. Dimethylarsenic was the predominant form of As in the tissues of mice in both 25 and 50 ppm groups. Notably, the average concentration of total speciated arsenic in livers from mice in the 50 ppm group was comparable to the highest concentration of total arsenic reported in the livers of Bangladeshi residents who had consumed water with an order of magnitude lower level of iAs. These data suggest that mice are less susceptible than humans to the diabetogenic effects of chronic exposure to iAs due to a more efficient clearance of iAs or its metabolites from target tissues.

Inorganic arsenic exposure and type 2 diabetes mellitus in Mexico

Inorganic arsenic exposure in drinking water has been recently related to diabetes mellitus. To evaluate this relationship the authors conducted in 2003, a case-control study in an arseniasis-endemic region from Coahuila, a northern state of Mexico with a high incidence of diabetes. The present analysis includes 200 cases and 200 controls. Cases were obtained from a previous cross-sectional study conducted in that region. Diagnosis of diabetes was established following the American Diabetes Association criteria, with two fasting glucose values > or = 126 mg/100 ml (> or = 7.0 mmol/l) or a history of diabetes treated with insulin or oral hypoglycemic agents. The next subject studied, subsequent to the identification of a case in the cross-sectional study was taken as control. Inorganic arsenic exposure was measured through total arsenic concentrations in urine, measured by hydride-generation atomic absorption spectrophotometry. Subjects with intermediate total arsenic concentration in urine (63.5-104 microg/g creatinine) had two-fold higher risk of having diabetes (odds ratio=2.16; 95% confidence interval: 1.23, 3.79), but the risk was almost three times greater in subjects with higher concentrations of total arsenic in urine (odds ratio=2.84; 95% confidence interval: 1.64, 4.92). This data provides additional evidence that inorganic arsenic exposure may be diabetogenic.

Molecular mechanisms of the diabetogenic effects of arsenic: inhibition of insulin signaling by arsenite and methylarsonous acid

BACKGROUND

Increased prevalences of diabetes mellitus have been reported among individuals chronically exposed to inorganic arsenic (iAs). However, the mechanisms underlying the diabetogenic effects of iAs have not been characterized. We have previously shown that trivalent metabolites of iAs, arsenite (iAs(III)) and methylarsonous acid (MAs(III)) inhibit insulin-stimulated glucose uptake (ISGU) in 3T3-L1 adipocytes by suppressing the insulin-dependent phosphorylation of protein kinase B (PKB/Akt).

OBJECTIVES

Our goal was to identify the molecular mechanisms responsible for the suppression of PKB/Akt phosphorylation by iAs(III) and MAs(III).

METHODS

The effects of iAs(III) and MAs(III) on components of the insulin-activated signal transduction pathway that regulate PKB/Akt phosphorylation were examined in 3T3-L1 adipocytes.

RESULTS

Subtoxic concentrations of iAs(III) or MAs(III) had little or no effect on the activity of phosphatidylinositol 3-kinase (PI-3K), which synthesizes phosphatidylinositol-3,4,5-triphosphate (PIP(3)), or on phosphorylation of PTEN (phosphatase and tensin homolog deleted on chromosome ten), a PIP(3) phosphatase. Neither iAs(III) nor MAs(III) interfered with the phosphorylation of 3-phosphoinositide-dependent kinase-1 (PDK-1) located downstream from PI-3K. However, PDK-1 activity was inhibited by both iAs(III) and MAs(III). Consistent with these findings, PDK-1-catalyzed phosphorylation of PKB/Akt(Thr308) and PKB/Akt activity were suppressed in exposed cells. In addition, PKB/Akt(Ser473) phosphorylation, which is catalyzed by a putative PDK-2, was also suppressed. Notably, expression of constitutively active PKB/Akt restored the normal ISGU pattern in adipocytes treated with either iAs(III) or MAs(III).

CONCLUSIONS

These results suggest that inhibition of the PDK-1/PKB/Akt-mediated transduction step is the key mechanism for the inhibition of ISGU in adipocytes exposed to iAs(III) or MAs(III), and possibly for impaired glucose tolerance associated with human exposures to iAs.

Detecting arsenic-related skin lesions: experiences from a large community-based survey in Bangladesh

A cross-sectional survey was conducted in Matlab, Bangladesh, to determine the prevalence of skin lesions (a three-step procedure) associated with arsenic exposure and discuss validity and feasibility in relation to recommended screening algorithms. Cases with skin lesions were identified by screening above 4 years of age (n = 166,934). Trained field teams conducted a careful house-to-house screening and identified 1682 individuals with skin lesions, who were referred to physicians for confirmation. Physicians diagnosed 579 cases as probable and documented all these with digital photographs. Two experts inspected all photographs for consensus agreement that was reached for 504 cases. Using the experts' opinions as reference, the positive predictive value of the physicians' diagnosis was 87% (male = 82% vs. female = 94%; p < 0.01). The physicians had difficulties in separating arsenic-induced keratosis from differential diagnoses, while probability for correct diagnosis was high for arsenic-related pigmentation changes. Including information on current arsenic concentration in drinking water (which was masked at time of skin examination) or urine in the diagnostic algorithm should have increased the number of false negative cases. In the present transition of drinking water sources these markers of current exposure levels provide no information on past exposure. A 2-3 step procedure with house-to-house screening and clinic-based confirmation of arsenic-induced skin lesions is a feasible approach. Information on arsenic concentration in current water sources or in urine should not have improved the precision in the diagnosis. These results may have policy implications for community screening of arsenic-related skin lesions in Bangladesh and elsewhere.

Arsenic methylation, GSTT1, GSTM1, GSTP1 polymorphisms, and skin lesions

OBJECTIVE

We investigated whether primary and secondary arsenic methylation ratios were associated with skin lesions and whether GSTT1, GSTP1, and GSTM1 polymorphisms modify these relationships.

METHODS

A case-control study of 600 cases and 600 controls that were frequency matched on age and sex was conducted in Pabna, Bangladesh, in 2001-2002. Individual well water, urine, and blood samples were collected. Water arsenic concentration was determined using inductively coupled plasma mass spectrometry (ICP-MS). Urinary arsenic speciation was determined using high performance liquid chromatography hydride with generator atomic absorption spectrometry and ICP-MS. Genotyping was conducted using multiplex polymerase chain reaction and TaqMan.

RESULTS

A 10-fold increase in primary methylation ratio [monomethylarsonic acid (MMA)/(arsenite + arsenate] was associated with a 1.50-fold increased risk of skin lesions (multivariate odds ratio = 1.50; 95% confidence interval, 1.00-2.26). We observed significant interaction on the multiplicative scale between GSTT1 wildtype and secondary methylation ratio [dimethylarsinic acid/MMA; likelihood ratio test (LRT), p = 0.01]. No significant interactions were observed for GSTM1 or GSTP1 or for primary methylation ratios.

CONCLUSION

Our findings suggest that increasing primary methylation ratios are associated with an increase in risk of arsenic-related skin lesions. The interaction between GSTT1 wildtype and secondary methylation ratio modifies risk of skin lesions among arsenic-exposed individuals.

Arsenic in drinking water and cerebrovascular disease, diabetes mellitus, and kidney disease in Michigan: a standardized mortality ratio analysis

BACKGROUND

Exposure to arsenic concentrations in drinking water in excess of 300 microg/L is associated with diseases of the circulatory and respiratory system, several types of cancer, and diabetes; however, little is known about the health consequences of exposure to low-to-moderate levels of arsenic (10-100 microg/L).

METHODS

A standardized mortality ratio (SMR) analysis was conducted in a contiguous six county study area of southeastern Michigan to investigate the relationship between moderate arsenic levels and twenty-three selected disease outcomes. Disease outcomes included several types of cancer, diseases of the circulatory and respiratory system, diabetes mellitus, and kidney and liver diseases. Arsenic data were compiled from 9251 well water samples tested by the Michigan Department of Environmental Quality from 1983 through 2002. Michigan Resident Death Files data were amassed for 1979 through 1997 and sex-specific SMR analyses were conducted with indirect adjustment for age and race; 99% confidence intervals (CI) were reported.

RESULTS

The six county study area had a population-weighted mean arsenic concentration of 11.00 microg/L and a population-weighted median of 7.58 microg/L. SMR analyses were conducted for the entire six county study area, for only Genesee County (the most populous and urban county), and for the five counties besides Genesee. Concordance of results across analyses is used to interpret the findings. Elevated mortality rates were observed for both males (M) and females (F) for all diseases of the circulatory system (M SMR, 1.11; CI, 1.09-1.13; F SMR, 1.15; CI, 1.13,-1.17), cerebrovascular diseases (M SMR, 1.19; CI, 1.14-1.25; F SMR, 1.19; CI, 1.15-1.23), diabetes mellitus (M SMR, 1.28; CI, 1.18-1.37; F SMR, 1.27; CI, 1.19-1.35), and kidney diseases (M SMR, 1.28; CI, 1.15-1.42; F SMR, 1.38; CI, 1.25-1.52).

CONCLUSION

This is some of the first evidence to suggest that exposure to low-to-moderate levels of arsenic in drinking water may be associated with several of the leading causes of mortality, although further epidemiologic studies are required to confirm the results suggested by this ecologic SMR analysis.

Gene expression profiles in peripheral lymphocytes by arsenic exposure and skin lesion status in a Bangladeshi population

Millions of individuals worldwide are chronically exposed to arsenic through their drinking water. In this study, the effect of arsenic exposure and arsenical skin lesion status on genome-wide gene expression patterns was evaluated using RNA from peripheral blood lymphocytes of individuals selected from the Health Effects of Arsenic Longitudinal Study. Affymetrix HG-U133A GeneChip (Affymetrix, Santa Clara, CA) arrays were used to measure the expression of approximately 22,000 transcripts. Our primary statistical analysis involved identifying differentially expressed genes between participants with and without arsenical skin lesions based on the significance analysis of microarrays statistic with an a priori defined 1% false discovery rate to minimize false positives. To better characterize differential expression, we also conducted Gene Ontology and pathway comparisons in addition to the gene-specific analyses. Four-hundred sixty-eight genes were differentially expressed between these two groups, from which 312 differentially expressed genes were identified by restricting the analysis to female never-smokers. We also explored possible differential gene expression by arsenic exposure levels among individuals without manifest arsenical skin lesions; however, no differentially expressed genes could be identified from this comparison. Our findings show that microarray-based gene expression analysis is a powerful method to characterize the molecular profile of arsenic exposure and arsenic-induced diseases. Genes identified from this analysis may provide insights into the underlying processes of arsenic-induced disease and represent potential targets for chemoprevention studies to reduce arsenic-induced skin cancer in this population.

Association between arsenic exposure from drinking water and anemia during pregnancy

OBJECTIVE

Arsenic is associated with numerous health effects. We investigated the association between arsenic exposure from drinking water and anemia during pregnancy.

METHODS

We conducted a prospective cohort pregnancy study in two Chilean cities with contrasting drinking water arsenic levels: 40 microg/L versus <1 microg/L. This analysis included 810 women who gave birth to live, singleton infants and had at least one hemoglobin determination during pregnancy.

RESULTS

Arsenic exposed women were more likely to be anemic during pregnancy after adjusting for other factors. Furthermore, as pregnancy progressed, the prevalence of anemia rose more sharply among those in the exposed versus unexposed city: 49% versus 17%.

CONCLUSION

This study suggests an association between moderate arsenic in drinking water and anemia during pregnancy. Further research is needed to identify the specific types of anemia underlying the association.

Assessment of arsenic contamination of groundwater and health problems in Bangladesh

Excessive amounts of arsenic (As) in the groundwater in Bangladesh and neighboring states in India are a major public health problem. About 30% of the private wells in Bangladesh exhibit high concentrations of arsenic. Over half the country, 269 out of 464 administrative units, is affected. Similar problems exist in many other parts of the world, including the Unites States. This paper presents an assessment of the health hazards caused by arsenic contamination in the drinking water in Bangladesh. Four competing hypotheses, each addressing the sources, reaction mechanisms, pathways, and sinks of arsenic in groundwater, were analyzed in the context of the geologic history and land-use practices in the Bengal Basin. None of the hypotheses alone can explain the observed variability in arsenic concentration in time and space; each appears to have some validity on a local scale. Thus, it is likely that several bio-geochemical processes are active among the region’s various geologic environments, and that each contributes to the mobilization and release of arsenic. Additional research efforts will be needed to understand the relationships between underlying biogeochemical factors and the mechanisms for arsenic release in various geologic settings.