Total mercury concentration in placental tissue, a good biomarker of prenatal mercury exposure, is associated with risk for neural tube defects in offspring

Fundamental origins of neural tube defects with a basis in genetics and nutrition

Neural tube defects (NTDs) are leading congenital malformations. Its global prevalence is one in 1000 pregnancies and it has high morbidity and mortality. It has multiple risk factors like genetic errors and environmental stressors like maternal malnutrition and in utero exposure to pollutants like chemicals. The genetic program determines neural tube development based on timely expression of many genes involved in developmental signaling pathways like BMP, PCP and SHH. BMP expression defines ectoderm. SOX represses BMP in ectoderm and convertes to the neuroectoderm. Subsequently, PCP molecules define the tissue patterning for convergent-extension, a critical step in neural tube genesis. Further, SHH sets spatial patterning of the neural tube. Nutrients are the essential major environmental input for embryogenesis. But it may also carry risk factors. Malnutrition, especially folate deficiency, during embryogenesis is a major cause for NTDs. Folate is integral in the One Carbon metabolic pathway. Its deficiency and error in the pathway are implicated in NTDs. Folate supplementation alone is insufficient to prevent NTDs. Thus, a comprehensive understanding of the various risk factors is necessary to strategize reduction of NTDs. We review the current knowledge of various risk factors, like genetic, metabolic, nutritional, and drugs causing NTDs and discuss the steps required to identify them in the early embryogenesis to avoid NTDs.

Interplay Between Vitamin D Levels and Heavy Metals Exposure in Pregnancy and Childbirth: A Systematic Review

BACKGROUND/OBJECTIVES

Vitamin D (VD) deficiency has been associated with increased risk of gestational disorders affecting the endocrine system, immune system, and neurodevelopment in offspring. Recent studies have focused on the interaction between toxic elements and micronutrients during pregnancy. This review analyzes the potential relationships between VD levels and heavy metals in pregnant women and their offspring.

METHODS

A systematic review was conducted according to PRISMA 2020 guidelines, using databases such as PubMed, ScienceDirect, Cochrane Library, and Google Scholar. Boolean operators 'AND' and 'OR' were applied with terms like 'pregnancy', 'vitamin D', 'heavy metals', and 'newborns'.

RESULTS

From 4688 articles, 14 studies were selected based on relevance and quality. These studies measured the levels of metals like lead (Pb), cadmium (Cd), mercury (Hg), and arsenic (As), in biological samples including maternal blood, umbilical cord blood, placenta tissue, and meconium during different stages of pregnancy, showing an inverse relationship between VD deficiency and heavy metal concentrations, which could be related to the incidence of preterm birth.

CONCLUSIONS

The review highlights the importance of maintaining adequate VD levels during pregnancy, suggesting that sufficient VD may mitigate the adverse effects of heavy metal exposure, potentially reducing pregnancy-related complications.

Interplay and long-lasting effects of maternal low-level Pb, Hg, and Cd exposures on offspring cognition

Lead (Pb), mercury (Hg), and cadmium (Cd) are prevalent and persistent environmental contaminants, causing detrimental effects on millions of individuals worldwide. Our previous research demonstrated that early-life exposure to low-level Pb, Hg, and Cd mixtures may lead to cognitive impairments. However, the association and interaction among low levels of Pb, Hg, or Cd exposure remains unclear. In this study, a two-level full factorial design (5.481, 0.036, and 2.132 mg/L for Pb, Hg, and Cd respectively) was conducted to assess the interplay among maternal Pb, Hg, and Cd exposure on offspring cognition. Following exposure during pregnancy and lactation, a competitive absorption among Pb, Hg, and Cd was observed. Maternal exposure to each metal alone resulted in higher blood and brain concentrations of Pb, Hg, and Cd in offspring compared to co-exposure at equivalent levels. However, behavioral experiments conducted in the Morris water maze and novel object recognition test revealed maternal Pb, Hg, and Cd exposure synergistically impaired offspring's spatial cognition and recognition memory. Importantly, this dysfunction persisted into middle age even without exposure after adulthood. Moreover, the open field test and elevated plus maze indicated maternal low-level Pb, Hg, and Cd co-exposure triggered risk-taking behavior in weaning offspring, with a significant main effect for Pb exposure. No long-lasting effect on risk-taking behavior was detected in middle-aged offspring. Further investigation into molecular mechanisms showed that the dysregulation of corticosterone reaction and immune response might be the potential mechanism underlying Pb, Hg, and Cd co-exposure-induced cognitive impairments. Our study highlights the synergistic and long-lasting effects of multiple heavy metal exposures,underscoring the urgency to prevent exposure to metal mixtures among children and women of childbearing age.

Mercury exposure in ringed seals (Pusa hispida saimensis) in Lake Saimaa, Finland, and the placenta as a possible non-invasive biomonitoring tool

The Saimaa ringed seal (Pusa hispida saimensis) is a subspecies of ringed seal, landlocked in Lake Saimaa, Finland. The small population of less than 500 seals is facing many human-induced threats, including chemical contaminants. Mercury, in particular, has previously been suggested to be one of the chemicals affecting the viability of this endangered population. We analysed mercury concentrations from placentas and lanugo pup tissues (blubber, brain, kidney, liver, and muscle) to determine current prenatal exposure levels. These pups were found dead in or near birth lairs and were less than 3 months old. Additionally, we used threshold values available in the literature to estimate the potential mercury toxicity to the Saimaa ringed seal. We also determined selenium concentrations for its potential to alleviate the adverse effects of mercury. We further supplemented our study with brain samples collected from various seal age classes. These seals were found dead by either natural causes or by being caught in gillnets. The analysed chemicals were present in all tissues. For lanugo pups, mercury concentrations were the highest in the kidney and liver, whereas the highest selenium to mercury molar ratio was observed in placentas. The toxicity evaluation suggested that, in severe cases, mercury may cause adverse effects in lanugo and older pups. In these cases, the selenium concentrations were low and selenium to mercury ratio was below 1:1 threshold ratio and thus unlikely to provide adequate protection from the adverse effects of mercury. Furthermore, adverse effects are more likely to occur in adult seals, as mercury bioaccumulates, leading to higher concentrations in older individuals. Placental mercury concentrations correlated to those in the livers and muscle tissues of lanugo pups. This, together with the fact that placentas can be collected non-invasively and in good condition, provides a potential novel method for biomonitoring mercury exposure in Saimaa ringed seals.

N-acetylcysteine protects against neurodevelopmental injuries induced by methylmercury exposure during pregnancy and lactation

As an extremely dangerous environmental contaminant, methylmercury (MeHg) results in detrimental health effects in human brain nervous system, one of its main targets. However, as a developmental toxicant, the brain of offspring is vulnerable to MeHg during pregnancy and lactation exposure. Unfortunately, mechanisms of neurodevelopmental injuries induced by MeHg have not been fully elucidated. N-acetylcysteine (NAC) has been used for several decades as an antioxidant to antagonize oxidative stress. However, the molecular mechanisms of NAC alleviating MeHg-induced neurodevelopmental toxicity are not clear. Here, for evaluation of the dose-dependent effects of MeHg exposure on neurodevelopmental injuries of offspring, and the possible protective effects of NAC, the pregnant female mice were exposed to MeHg (4, 8, 12 mg/L, respectively) and NAC (50, 100, 150 mg/kg, respectively) from gestational day 1 (GD1) to postnatal day 21 (PND21). Our results indicated that administering MeHg caused behavioral impairment and neuronal injuries in the cerebral cortex of newborn mice. MeHg dose-dependently caused reactive oxygen species (ROS) overproduction and oxidative stress aggravation, together with expression of Nrf2, HO-1, Notch1, and p21 up-regulation, and CDK2 inhibition. NAC treatment dose-dependently antagonized MeHg-induced oxidative stress that may contribute to alleviating neurobehavioral and neurodevelopmental impairments. These results give insight into that NAC can protect against MeHg-induced neurodevelopmental toxicity by its antioxidation capacity.

Exencephaly-Anencephaly Sequence Associated with Maxillary Brachygnathia, Spinal Defects, and Palatoschisis in a Male Domestic Cat

Anencephaly, a severe neural tube defect characterized by the absence of major parts of the brain and skull, is a rare congenital disorder that has been observed in various species, including cats. Considering the uncommon appearance of anencephaly, this paper aims to present anencephaly in a stillborn male kitten from an accidental inbreeding using various paraclinical methods. Histological examination of tissue samples from the cranial region, where parts of the skull were absent, revealed the presence of atypical nerve tissue with neurons and glial cells organized in clusters, surrounded by an extracellular matrix and with an abundance of blood vessels, which are large, dilated, and filled with blood, not characteristic of nerve tissue structure. In CT scans, the caudal part of the frontal bone, the fronto-temporal limits, and the parietal bone were observed to be missing. CT also revealed that the dorsal tubercle of the atlas, the dorsal neural arch, and the spinal process of the C2-C7 bones were missing. In conclusion, the kitten was affected by multiple congenital malformations, a combination of exencephaly-anencephaly, maxillary brachygnathism, closed cranial spina bifida at the level of cervical vertebrae, kyphoscoliosis, palatoschisis, and partial intestinal atresia. The importance of employing imaging techniques cannot be overstated when it comes to the accurate diagnosis of neural tube defects.

Prenatal Exposure to Toxic Metals and Neural Tube Defects: A Systematic Review of the Epidemiologic Evidence

BACKGROUND

Neural tube defects (NTDs) affect > 300,000 pregnancies worldwide annually. Few nongenetic factors, other than folate deficiency, have been identified that may provide intervenable solutions to reduce the burden of NTDs. Prenatal exposure to toxic metals [arsenic (As), cadmium (Cd), mercury (Hg), manganese (Mn) and lead (Pb)] may increase the risk of NTDs. Although a growing epidemiologic literature has examined associations, to our knowledge no systematic review has been conducted to date.

OBJECTIVE

Through adaptation of the Navigation Guide systematic review methodology, we aimed to answer the question "does exposure to As, Cd, Hg, Mn, or Pb during gestation increase the risk of NTDs?" and to assess challenges to evaluating this question given the current evidence.

METHODS

We selected available evidence on prenatal As, Cd, Hg, Mn, or Pb exposure and risk of specific NTDs (e.g., spina bifida, anencephaly) or all NTDs via a comprehensive search across MEDLINE, Embase, Web of Science, and TOXLINE databases and applied inclusion/exclusion criteria. We rated the quality and strength of the evidence for each metal. We applied a customized risk of bias protocol and evaluated the sufficiency of evidence of an effect of each metal on NTDs.

RESULTS

We identified 30 studies that met our criteria. Risk of bias for confounding and selection was high in most studies, but low for missing data. We determined that, although the evidence was limited, the literature supported an association between prenatal exposure to Hg or Mn and increased risk of NTDs. For the remaining metals, the evidence was inadequate to establish or rule out an effect.

CONCLUSION

The role of gestational As, Cd, or Pb exposure in the etiology of NTDs remains unclear and warrants further investigation in high-quality studies, with a particular focus on controlling confounding, mitigating selection bias, and improving exposure assessment. https://doi.org/10.1289/EHP11872.

Neurotransmitter disturbances caused by methylmercury exposure: Microbiota-gut-brain interaction

The fetal and early postnatal stages are periods of rapid brain development, during which, methylmercury (MeHg) exposure can cause lasting cognitive impairments. MeHg exposure disrupts neurotransmitter metabolites, which increased susceptibility to neurological responses. However, the neurotoxic mechanism underlying the MeHg-induced disruption of neurotransmitter metabolism requires further exploration. To this end, female Sprague-Dawley (SD) rats were administered NaCl (control group) or MeHg (0.6 mg/kg, 1.2 mg/kg and 2.4 mg/ kg body weight (bw), where the body weight refers to the dams) during the perinatal period, and then changes in neurotransmitter profiles and the gut microbiota of offspring were detected. The results showed that tryptophan (Trp) and tyrosine (Tyr) pathway neurotransmitter metabolites, including serotonin (5-HT), 5-hydroxy indole acetic acid (5-HIAA), N-acetyl-5-hydroxytryptamin (NAS), Tyr, dopamine (DA) and epinephrine (E), were significantly changed, and the Kynurenine/Tryptophan (Kyn/Trp) ratio was increased in the MeHg-treated groups. Meanwhile, acetylcholine (ACh) and neurotransmitters involved in the amino acid pathway were significantly reduced. Notably, MeHg treatment induced a significant reduction in tight junctions in the colon and hippocampal tissue. Furthermore, fecal microbiota analysis indicated that the diversity and composition characteristics were significantly altered by MeHg exposure. Mediation analysis showed that the gut microbiota mediated the effect of MeHg treatment on the neurotransmitter expression profiles. The present findings shed light on the regulatory role of the gut microbiota in MeHg-disrupted neurotransmitter metabolic pathways and the potential impact of perinatal MeHg treatment on the "cross-talk" between the gut and brain.

Embryonic mercury exposure in zebrafish: Alteration of metabolites and gene expression, related to visual and behavioral impairments

The widespread presence of mercury, a heavy metal found in the environment and used in numerous industries and domestic, raises concerns about its potential impact on human health. Nevertheless, the adverse effects of this environmental toxicant at low concentrations are often underestimated. There are emerging studies showing that accumulation of mercury in the eye may contribute to visual impairment and a comorbidity between autism spectrum disorders (ASD) trait and visual impairment. However, the underlying mechanism of visual impairment in humans and rodents is challenging. In response to this issue, zebrafish larvae with a cone-dominated retinal visual system were exposed to 100 nM mercury chloride (HgCl₂), according to our previous study, followed by light-dark stimulation, a social assay, and color preference to examine the functionality of the visual system in relation to ASD-like behavior. Exposure of embryos to HgCl₂ from gastrulation to hatching increased locomotor activity in the dark, reduced shoaling and exploratory behavior, and impaired color preference. Defects in microridges as the first barrier may serve as primary tools for HgCl₂ toxicity affecting vision. Depletion of polyunsaturated fatty acids (PUFAs), linoleic acid, arachidonic acid (ARA), alpha-linoleic acid, docosahexaenoic acid (DHA), stearic acid, L-phenylalanine, isoleucine, L-lysine, and N-acetylputrescine, along with the increase of gamma-aminobutyric acid (GABA), sphingosine-1-phosphate, and citrulline assayed by liquid chromatography-mass spectrometry (LC-MS) suggest that these metabolites serve as biomarkers of retinal impairments that affect vision and behavior. Although suppression of adsl, shank3a, tsc1b, and nrxn1a gene expression was observed, among these tsc1b showed more positive correlation with ASD. Collectively, these results contribute new insights into the possible mechanism of mercury toxicity give rise to visual, cognitive, and social deficits in zebrafish.

Impact of prenatal exposure to metallic elements on neural tube defects: Insights from human investigations

Metallic elements play a pivotal role in maternal and fetal health. Metals can cross the placental barrier and be absorbed by fetuses, where they may affect closure of the neural tube during embryonic development. Neural tube defects (NTDs), which result from aberrant closure of the neural tube three to four weeks post-conception, have a multifactorial and complex etiology that combines genetic variants and environmental exposure. Recent advances in population-level association studies have investigated the link between maternal environmental exposure and NTDs, particularly the influence of metals on the incidence of NTDs. Herein, we present a broad and qualitative review of current literature on the association between maternal and prenatal metal exposure via the maternal peripheral blood, amniotic fluid, placenta, umbilical cord, and maternal hair, and the risk of developing NTDs. Specifically, we identify the various aggravating or attenuating effects of metallic exposure on the risk of NTD formation. This review provides novel insights into the association between environmental metals and NTDs and has important applications for NTD prevention and mitigating environmental exposure to metals.

Prenatal Mercury Exposure and Infant Weight Trajectories in a UK Observational Birth Cohort

Mercury is highly toxic metal found in trace quantities in common foods. There is concern that exposure during pregnancy could impair infant development. Epidemiological evidence is mixed, but few studies have examined postnatal growth. Differences in nutrition, exposures, and the living environment after birth may make it easier to detect a negative impact from mercury toxicity on infant growth. This study includes 544 mother-child pairs from the Avon Longitudinal Study of Parents and Children. Blood mercury was measured in early pregnancy and infant weight at 10 intervals between 4 and 61 months. Mixed-effect models were used to estimate the change in infant weight associated with prenatal mercury exposure. The estimated difference in monthly weight gain was -0.02 kg per 1 standard deviation increase in Hg (95% confidence intervals: -0.10 to 0.06 kg). When restricted to the 10th decile of Hg, the association with weight at each age level was consistently negative but with wide confidence intervals. The lack of evidence for an association may indicate that at Hg levels in this cohort (median 1.9 µg/L) there is minimal biological impact, and the effect is too small to be either clinically relevant or detectable.

Detection of Relevant Heavy Metal Concentrations in Human Placental Tissue: Relationship between the Concentrations of Hg, As, Pb and Cd and the Diet of the Pregnant Woman

Heavy metals can cross the placental barrier and reach the fetal compartment, threatening fetal development. Pregnant women can acquire these through food, drinking water, toxic habits or simply by breathing polluted air. The placenta has been described as a biomarker of maternal and fetal exposure to different toxic elements.

OBJECTIVES

The main objective of this study was to test the possible existence of heavy metal deposits (Pb, As, Cd and Hg) in the placentas of women who gave birth at term in our setting, analyzing the influence of daily life and dietary habits.

METHODS

We studied 103 placentas, obtained by consecutive sampling, of women that delivered in the Regional Maternity Hospital of Malaga between March and June, 2021. As, Cd and Pb concentrations were analyzed using mass spectrometry techniques. Hg concentration was studied according to US EPA method 7473. Women also answered a questionnaire with epidemiological variables.

RESULTS

Detectable concentrations were found in 14.56% [As], 44.6% [Cd], 81.5% [Pb] and 100% [Hg]. [Pb] and [As] correlated significantly (Spearman's Rho of 0.91 and <0.001), as did [Hg] and [Cd] (Spearman's Rho 0.256, p < 0.004). The [Pb] and [AS] concentrations were significantly higher in cases of tap water consumption. [Hg] concentrations predicted the birth weight of female newborns.

Carcinogenic effects of heavy metals by inducing dysregulation of microRNAs: A review

Heavy metal exposure has soared due to the twentieth century's industrial activity. The most common heavy metals that lead to human poisoning are mercury, cadmium, and arsenic. Acute or chronic poisoning may develop following exposure to water, air, or food, so the bioaccumulation of these heavy metals causes harmful consequences in various human tissues and organs. Heavy metals interfere with biological functions such as growth, proliferation, differentiation, damage repair, and apoptosis. The mechanisms of action for these metals to cause toxicity are similar, including forming reactive oxygen species (ROS), weakening antioxidant defenses, enzyme inactivation, and oxidative stress. Heavy metal exposure is mainly associated with skin, liver, prostate, lung, urinary bladder, thyroid, and kidney cancers, as well as causing gastrointestinal malignancies. Several microRNAs (miRNAs or miRs) have been involved in various human cancers due to the dysregulation of miRNA function. Recent investigations have confirmed that microRNA dysregulation plays a role in the carcinogenesis of many tissues. This review presents the data concerning arsenic, cadmium, and mercury metals and their contamination sources, human exposure, toxicity, and inducing malignant transformations such as carcinogenicity in in-vitro or in-vivo specimens or dysregulated expression of microRNAs.

Mercury in the brain (tumor tissues) and in markers (hair and blood) of exposure in Western Amazonia patients

BACKGROUND

Central nervous system tumors (CNSTs) represent the second most frequent form of malignant tumors in childhood and the second leading cause of death associated with neurological diseases, affecting individuals of all age groups. In adults, CNSTs are the sixth most common cause of death in patients with malignant tumors. Additionally, the brain is the most sensitive and studied organ for mercury (Hg) toxicity.

METHOD

We studied total Hg (THg) in tissue samples (of benign and malignant CNSTs) and explored its associations with THg in exposure markers (hair and blood) from 65 patients (40 females and 25 males) who underwent surgical treatment.

RESULTS

No statistically significant differences were found in THg concentrations in brain tumors or in blood and hair from these patients (classified as malignant/benign or glioma/non-glioma); also, there were no statistically significant differences between males and females. However, statistically significant correlations were found between THg in CNSTs and in hair (r_s = 0.4967; p = 0.0001) and in blood (r_s = 0.4702; p = 0.0058); but no significant correlations were found between THg in hair and blood (r_s = 0.1229; p = 0.5332). In the Western Amazon, with endemic exposure to fish-methylmercury, these urban patients were low to moderate fish consumers; THg concentrations in blood (median: 0.645 µg.L^-1; range: 8.01-21.02 µg.L^-1; n = 56) and hair (median: 0.686 µg.g-¹; range: 0.01-10.02 µg.g^-1; n = 65) were relatively low, whereas THg levels in brain tumors (median: 8.194 ng.g^-1; range: <0.10-69.16 ng.g^-1; n = 65) were within range of published studies in brain autopsies. Additionally, no statistically significant correlations (p = 0.4828) were observed between frequency of fish consumption and THg in the brain.

CONCLUSION

Although no significant THg concentrations in the type of brain tumors (benign versus malignant) were found, the significantly positive correlation between markers of THg exposure (hair and blood) and THg in the brain tissues indicates its usefulness as a marker/proxy for brain-THg load. These findings confirm the value of using hair and blood as constructs of THg in the brain of exposed populations.

Contamination of breast milk with lead, mercury, arsenic, and cadmium in Iran: a systematic review and meta-analysis

Breast milk is a complete food for the development of the newborn, but it can also be an important route for environmental pollutants transmission to the infants. This study was aimed to evaluate the status of heavy metals including lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As) in the breast milk of Iranian mothers. The international databases including Scopus, PubMed, Web of Science and the Persian electronic databases including Scientific Information Database, IranMedex and Magiran were examined to find relevant articles published until July 2021. A total of 23 studies examined the levels of toxic metals in Iranian breast milk samples. According to the findings, the pooled average concentrations (µg/L) of Pb, Cd, Hg and As were 25.61, 2.40, 1.29 and 1.16, respectively. The concentration of Hg and Pb in colostrum milk was more than twice of mature milk. The Hg mean concentration in the breast milk of mothers with at least one amalgam-filled tooth was approximately three times that of mothers without amalgam-filled teeth. Risk assessment analysis indicated that the intake of Pb and Hg by infants through breastfeeding can be considered a health concern in Iran. It seems necessary to reduce the Pb exposure of pregnant and lactating women in Iran. However, more extensive studies are needed to clarify the toxic metals' exposure status of infants through breast milk in other parts of the country.

Prenatal Mercury Exposure and Neurodevelopment up to the Age of 5 Years: A Systematic Review

Neurodevelopmental delays can interfere with children’s engagement with the world and further development, and may have negative consequences into adulthood. Mercury is highly toxic and may negatively influence neurodevelopment because it can freely cross the placenta and accumulate in the fetal brain. We searched four publication databases (Embase, PsycINFO, PubMed/MEDLINE, Scopus) for studies examining the relationship between early life mercury exposure and scores on neurodevelopmental performance measures in children aged 0 to 5 years old. Study quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Thirty-two prospective studies were included in the review. Neurodevelopmental performance was measured using 23 different scales, most commonly the Bayley Scales of Infant and Toddler Development (BSID). In most cases, the evidence for an association between mercury and neurodevelopment was weak. There did not appear to be exceptions for particular childhood ages, outcome scales, or mercury levels. The small number of results to the contrary were more likely to be studies which did not meet our high-quality criteria, and could be a consequence of multiple testing, selection bias, or incomplete confounder adjustment. Based on current evidence, dietary mercury exposure during pregnancy is unlikely to be a risk factor for low neurodevelopmental functioning in early childhood.

Mercury and Prenatal Growth: A Systematic Review

The intrauterine environment is critical for healthy prenatal growth and affects neonatal survival and later health. Mercury is a toxic metal which can freely cross the placenta and disrupt a wide range of cellular processes. Many observational studies have investigated mercury exposure and prenatal growth, but no prior review has synthesised this evidence. Four relevant publication databases (Embase, MEDLINE/PubMed, PsycINFO, and Scopus) were systematically searched to identify studies of prenatal mercury exposure and birth weight, birth length, or head circumference. Study quality was assessed using the NIH Quality Assessment Tool, and results synthesised in a narrative review. Twenty-seven studies met the review criteria, these were in 17 countries and used 8 types of mercury biomarker. Studies of birth weight (total = 27) involving populations with high levels of mercury exposure, non-linear methods, or identified as high quality were more likely to report an association with mercury, but overall results were inconsistent. Most studies reported no strong evidence of association between mercury and birth length (n = 14) or head circumference (n = 14). Overall, our review did not identify strong evidence that mercury exposure leads to impaired prenatal growth, although there was some evidence of a negative association of mercury with birth weight.