The Case For Cadmium and Lead Heavy Metal Screening

Early economic evaluation of chelation therapy in kidney transplant recipients with high-normal lead

BACKGROUND

Kidney transplant recipients (KTR) with high-normal lead have a higher risk of graft failure (GF). Clinically, chelation therapy using meso-2,3-dimercaptosuccinic acid (DMSA) removes lead. Despite the proposal that chelation therapy can prevent GF through lead removal, evidence is lacking. To guide research efforts, we conducted an early economic evaluation, aiming to explore the economic feasibility of screening for and implementing chelation therapy with oral DMSA for high-normal plasma lead concentrations in KTR (i.e., the intervention) compared to standard of care.

METHODS

A Markov model simulated the life course of 10,000 KTR in the Netherlands from a societal perspective. Transition probabilities were estimated using the data from TransplantLines Food and Nutrition Biobank and Cohort study. Costs and utilities were sourced from publications and public data. Model robustness was investigated through deterministic and probabilistic sensitivity analyses. Various administration strategies were tested. Five-year costs were calculated from a healthcare payer's perspective. Value of information was assessed.

RESULTS

The intervention was cost-saving and improved health, leading to a dominant incremental cost-effectiveness ratio. The result was most sensitive to transition probabilities (led by GF, followed by death with functioning graft and after graft failure). The probability of the intervention being cost-effective was 60%. Chelation strategies did not affect the result. The intervention applied to the Dutch KTR population could save €27 million in the initial five years. Further research is desirable if the cost of obtaining perfect information on GF survival is approximately below €4,000/KTR (all uncertainties under €5,000/KTR).

CONCLUSION

The cost-effectiveness of the intervention is robust in KTR, except when considering the uncertainties around (graft) survival probabilities. Applying chelation therapy in the new setting we studied holds significant potential. However, trials that systematically assess the efficacy, administration strategies, and impacts on survival are crucial in updating the current evaluation and informing policies.

Chelation Therapy in Coronary Artery Disease: Fact or Fiction?

Coronary artery disease (CAD) is responsible for 690,000 deaths a year, a leading cause of mortality worldwide. CAD results from cholesterol plaque buildup in arteries. Chelation therapy, which uses ethylenediaminetetraacetic acid to remove toxic metals from the bloodstream, has been explored as an alternative treatment for atherosclerotic CAD. While the 2013 Trial to Assess Chelation Therapy (TACT) trial showed modest cardiovascular benefits, particularly in patients with diabetes, subsequent studies such as TACT2 did not confirm its efficacy in reducing cardiovascular events in patients with diabetes. Adverse effects of chelation therapy could include renal dysfunction, electrolyte imbalances, and potential complications from heavy metal mobilization that could be fatal. Still, none of these were seen in TACT or TACT2.

Plastic-related endocrine disrupting chemicals significantly related to the increased risk of estrogen-dependent diseases in women

OBJECTIVE

To evaluate the association between exposure to plastic-related endocrine-disrupting chemicals (EDCs), specifically Bisphenol A (BPA), Phthalates, Cadmium, and Lead, and the risk of estrogen-dependent diseases (EDDs) such as polycystic ovary syndrome (PCOS), endometriosis, or endometrial cancer by conducting a meta-analysis of relevant studies.

METHODS

PubMed, Web of Science, and Cochrane Library databases were used for literature retrieval of articles published until the 21st of April 2023. Literature that evaluated the association between BPA, phthalates, cadmium, and/or lead exposure and the risk of PCOS, endometriosis, or endometrial cancer development or exacerbation were included in our analysis. STATA/MP 17.0 was used for all statistical analyses.

RESULTS

Overall, 22 articles were included in our meta-analysis with a total of 83,641 subjects all of whom were females aged between 18 and 83 years old. The overall effect size of each study was as follows: endometriosis risk in relation to BPA exposure ES 1.82 (95% CI; 1.50, 2.20). BPA and PCOS risk ES 1.61 (95% CI; 1.39, 1.85). Phthalate metabolites and endometriosis risk; MBP ES 1.07 (95% CI; 0.86, 1.33), MEP ES 1.05 (95% CI; 0.87, 1.28), MEHP ES 1.15 (95% CI; 0.67, 1.98), MBzP ES 0.97 (95% CI; 0.63, 1.49), MEOHP ES 1.87 (95% CI; 1.21, 2.87), and MEHHP ES 1.98 (95% CI; 1.32, 2.98). Cadmium exposure and endometrial cancer risk ES 1.14 (95% CI; 0.92, 1.41). Cadmium exposure and the risk of endometriosis ES 2.54 (95% CI; 1.71, 3.77). Lead exposure and the risk of endometriosis ES 1.74 (95% CI; 1.13, 2.69).

CONCLUSION

Increased serum, urinary, or dietary concentration of MBzP and MEHP in women is significantly associated with endometriosis risk. Increased cadmium concentration is associated with endometrial cancer risk.

Associations between patterns of blood heavy metal exposure and health outcomes: insights from NHANES 2011-2016

BACKGROUND

Extensive research has explored the association between heavy metal exposure and various health outcomes, including malignant neoplasms, hypertension, diabetes, and heart diseases. This study aimed to investigate the relationship between patterns of exposure to a mixture of seven heavy metals and these health outcomes.

METHODS

Blood samples from 7,236 adults in the NHANES 2011-2016 studies were analyzed for levels of cadmium, manganese, lead, mercury, selenium, copper, and zinc. Cluster analysis and logistic regression identified three distinct patterns of mixed heavy metal exposure, and their associations with health outcomes were evaluated.

RESULTS

Pattern 1 exhibited higher odds ratios (ORs) for malignancy during NHANES 2011-2012 (OR = 1.33) and 2015-2016 (OR = 1.29) compared to pattern 2. Pattern 3 showed a lower OR for malignancy during NHANES 2013-2014 (OR = 0.62). For hypertension, pattern 1 displayed higher ORs than pattern 2 for NHANES 2011-2012 (OR = 1.26), 2013-2014 (OR = 1.31), and 2015-2016 (OR = 1.41). Pattern 3 had lower ORs for hypertension during NHANES 2013-2014 (OR = 0.72) and 2015-2016 (OR = 0.67). In terms of heart diseases, pattern 1 exhibited higher ORs than pattern 2 for NHANES 2011-2012 (OR = 1.34), 2013-2014 (OR = 1.76), and 2015-2016 (OR = 1.68). Pattern 3 had lower ORs for heart diseases during NHANES 2013-2014 (OR = 0.59) and 2015-2016 (OR = 0.52). However, no significant trend was observed for diabetes. All three patterns showed the strongest association with hypertension among the health outcomes studied.

CONCLUSIONS

The identified patterns of seven-metal mixtures in NHANES 2011-2016 were robust. Pattern 1 exhibited higher correlations with hypertension, heart disease, and malignancy compared to pattern 2, suggesting an interaction between these metals. Particularly, the identified patterns could offer valuable insights into the management of hypertension in healthy populations.

Protective Effect of Astragaloside IV against Cadmium-Induced Damage on Mouse Renal Podocytes (MPC5)

In this study, we investigated the protective effect of Astragaloside IV (Ast) on mouse podocytes and its possible mechanism of action by constructing a cadmium-induced mouse renal podocytes model. We investigated the effects of cadmium (Cd) toxicity on cell number, morphology, the mitochondrial status of subcellular organelles, protein and gene levels, and the protective effects of Ast by constructing a model of Cd-induced damage to mouse renal podocytes (MPC5) and giving Ast protection at the same time. The results showed that exposure of MPC5 cells to CdCl₂ culture medium containing 6.25 μM concentration acted with low cell mortality, but the mortality of MPC5 cells increased with the prolongation of cadmium exposure time. Given Ast, the death rate in the low dose group (12.5 μM) was significantly reduced, while the death rate in the medium dose group (25 μM) was extremely significantly reduced. In comparison to the control group, the Cd-exposed group exhibited a significant increase of 166.7% in malondialdehyde (MDA) content and a significant decrease of 17.1% in SOD activity. The mitochondrial membrane potential was also reduced to varying degrees. However, in the Ast-protected group compared to the Cd-exposed group, the MDA content significantly decreased by 20.8%, the SOD activity decreased by 7.14%, and the mitochondrial membrane potential showed a significant increase. Fluorescence staining of mitochondrial membrane potential indicated that Cd exposure caused mitochondrial apoptosis. In the 12-h cadmium-exposed group, the protein expression of Nephrin in mice significantly decreased by 33.4%. However, the expression of the Desmin protein significantly increased by 67.8%, and the expression of the autophagy protein LC3-II significantly increased by 55.5%. Meanwhile, the expression of PINK1, a mitochondrial autophagy pathway protein, was significantly increased in the 12 h and 24 h cadmium exposure groups. The mRNA level of PINK1 was significantly increased, and that of Parkin was decreased in the 48 h cadmium exposure group. Compared to the Cd-exposed group, the Ast group showed more significant improvements in the expression of podocyte structure, functional proteins, and mitochondrial autophagy pathway proteins. The immunological assay of mitochondrial autophagic pathway proteins further indicated that Cd-induced damage to MPC5 cells might be associated with the dysregulation of mitochondrial autophagy.

Where do you live and what do you do? Two questions that might impact your kidney health

In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.

Recognition of Heavy Metals by Using Resorcin[4]arenes Soluble in Water

The complexing properties of two water-soluble resorcin[4]arenes (tetrasodium 5,11,17,23-tetrakissulfonatemethylen 2,8,14,20-tetra(butyl)resorcin[4]arene, Na₄BRA, and tetrasodium 5,11,17,23-tetrakissulfonatemethylen-2,8,14,20-tetra(2-(methylthio)ethyl)resorcin[4]arene, Na₄SRA) with polluting heavy metals such as Cu²⁺, Pb²⁺, Cd²⁺ and Hg²⁺ were studied by conductivity, and the findings were confirmed by using other techniques to try to apply this knowledge to removing them. The results indicate that Na₄BRA is able to complex Cu²⁺ in a 1:1 ratio and Pb²⁺ in a 1:2 ratio, while Na₄SRA complexes Hg²⁺ in a 1:1 ratio. On the contrary, no indications have been observed that either of the resorcin[4]arenes studied complexes the Cd²⁺ ions. The results suggest that the bonds established between the sulfur atoms located at the lower edge of the SRA^4- and the solvent hydrogens could prevent the entry of the guest into the host cavity. However, in the case of Hg²⁺ ions, the entry is favoured by the interactions between the sulfur donor atoms present on the lower edge of Na₄SRA and the Hg²⁺ ions. Therefore, it can be said that Na₄BRA is selective for Cu²⁺ and Pb²⁺ ions and Na₄SRA is selective for Hg²⁺ ions.