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Vázquez-Lorente H, Dundjerović DM, Tatić SB, Rodríguez-Menéndez S, González-Iglesias H, Gomes CM, Paunović IR, Dragutinović VV. Relationship between Trace Elements and Matrix Metalloproteinases 2 and 9 and their Tissue Inhibitors in Medullary Thyroid Carcinoma. Biol Trace Elem Res 2022; 201:3225-3232. [PMID: 36156766 PMCID: PMC10160158 DOI: 10.1007/s12011-022-03431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/19/2022] [Indexed: 11/02/2022]
Abstract
Medullary Thyroid Carcinoma (MTC) constitutes around 5% of all thyroid cancers. Trace elements assessment has emerged as a useful strategy in the diagnostics of MTC combined with Matrix Metalloproteinases (MMPs) and Tissue Inhibitors of Matrix Metalloproteinases (TIMPs) analysis. The aim of this study was to compare the presence and content of trace elements (i.e., Copper (Cu), Zinc (Zn), Iron (Fe), and Manganese (Mn)) in MTC with respect to control samples and their potential relationship with markers of MTC in tissues. The study included 26 patients who had undergone thyroidectomy, due to the diagnosis of MTC and 17 patients as control. We combined tumour pathology and staging, immunohistochemical analysis of calcitonin, MMPs, and TIMPs, with analytical biochemistry using Inductively Coupled Plasma - Mass Spectrometry (ICP-MS) to determine the levels of trace elements. No differences by MTC type for MMPs and their TIPMs, although strong TIMP-1 and TIMP-2 immunohistochemical expression of MTC were unveiled. Additionally, Zn, Fe, and Mn tended to be decreased, and Cu to be increased in samples presenting MTC with respect to controls. Moreover, Zn was the unique trace element which seemed to be correlated with MMPs and TIMPs. Trace elements such as Zn, Fe, and Mn are decreased in tissues affected by MTC. In addition, Zn may be the trace element which saves more relationship with the proportion and intensity of MMPs, being considered altogether useful biomarkers of MTC. We therefore suggest the analysis of novel and traditional markers of MTC as a novel approach in this pathology.
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Affiliation(s)
| | - Duško M Dundjerović
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetislav B Tatić
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sara Rodríguez-Menéndez
- Instituto Universitario Fernández-Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo), Oviedo, Spain
| | - Héctor González-Iglesias
- Instituto Universitario Fernández-Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo), Oviedo, Spain
- Instituto de Productos Lácteos de Asturias, Consejo Superior de Investigaciones Científicas (IPLA-CSIC), Villaviciosa, Spain
| | - Cláudio M Gomes
- Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- Departamento de Química E Bioquímica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Ivan R Paunović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Vesna V Dragutinović
- Institute of Chemistry in Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Sumaily KM. The Roles and Pathogenesis Mechanisms of a Number of Micronutrients in the Prevention and/or Treatment of Chronic Hepatitis, COVID-19 and Type-2 Diabetes Mellitus. Nutrients 2022; 14:2632. [PMID: 35807813 PMCID: PMC9268086 DOI: 10.3390/nu14132632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 02/06/2023] Open
Abstract
A trace element is a chemical element with a concentration (or other measures of an amount) that is very low. The essential TEs, such as copper (Cu), selenium (Se), zinc (Zn), iron (Fe) and the electrolyte magnesium (Mg) are among the most commonly studied micronutrients. Each element has been shown to play a distinctive role in human health, and TEs, such as iron (Fe), zinc (Zn) and copper (Cu), are among the essential elements required for the organisms' well-being as they play crucial roles in several metabolic pathways where they act as enzyme co-factors, anti-inflammatory and antioxidant agents. Epidemics of infectious diseases are becoming more frequent and spread at a faster pace around the world, which has resulted in major impacts on the economy and health systems. Different trace elements have been reported to have substantial roles in the pathogenesis of viral infections. Micronutrients have been proposed in various studies as determinants of liver disorders, COVID-19 and T2DM risks. This review article sheds light on the roles and mechanisms of micronutrients in the pathogenesis and prevention of chronic hepatitis B, C and E, as well as Coronavirus-19 infection and type-2 diabetes mellitus. An update on the status of the aforementioned micronutrients in pre-clinical and clinical settings is also briefly summarized.
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Affiliation(s)
- Khalid M Sumaily
- Clinical Biochemistry Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh P.O. Box 145111, Saudi Arabia
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Planeta K, Kubala-Kukus A, Drozdz A, Matusiak K, Setkowicz Z, Chwiej J. The assessment of the usability of selected instrumental techniques for the elemental analysis of biomedical samples. Sci Rep 2021; 11:3704. [PMID: 33580127 PMCID: PMC7881205 DOI: 10.1038/s41598-021-82179-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
The fundamental role of major, minor and trace elements in different physiological and pathological processes occurring in living organism makes that elemental analysis of biomedical samples becomes more and more popular issue. The most often used tools for analysis of the elemental composition of biological samples include Flame and Graphite Furnace Atomic Absorption Spectroscopy (F-AAS and GF-AAS), Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) and Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Each of these techniques has many advantages and limitations that should be considered in the first stage of planning the measurement procedure. Their reliability can be checked in the validation process and the precision, trueness and detection limits of elements belong to the most frequently determined validation parameters. The main purpose of this paper was the discussion of selected instrumental techniques (F-AAS, GF-AAS, ICP-OES and ICP-MS) in term of the achieved validation parameters and the usefulness in the analysis of biological samples. The focus in the detailed literature studies was also put on the methods of preparation of the biomedical samples. What is more based on the own data the usefulness of the total reflection X-ray fluorescence spectroscopy for the elemental analysis of animal tissues was examined. The detection limits of elements, precision and trueness for the technique were determined and compared with the literature data concerning other of the discussed techniques of elemental analysis. Reassuming, the following paper is to serve as a guide and comprehensive source of information concerning the validation parameters achievable in different instrumental techniques used for the elemental analysis of biomedical samples.
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Affiliation(s)
- Karolina Planeta
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, Krakow, Poland
| | - Aldona Kubala-Kukus
- Institute of Physics, Jan Kochanowski University, Kielce, Poland
- Holly Cross Cancer Centre, Kielce, Poland
| | - Agnieszka Drozdz
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, Krakow, Poland
| | - Katarzyna Matusiak
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, Krakow, Poland
| | - Zuzanna Setkowicz
- Institute of Zoology and Biomedical Research, Jagiellonian University, Krakow, Poland
| | - Joanna Chwiej
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, Krakow, Poland.
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Cirrhotic Liver of Liver Transplant Recipients Accumulate Silver and Co-Accumulate Copper. Int J Mol Sci 2021; 22:ijms22041782. [PMID: 33670100 PMCID: PMC7916850 DOI: 10.3390/ijms22041782] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/13/2022] Open
Abstract
Silver-based materials are widely used in clinical medicine. Furthermore, the usage of silver containing materials and devices is widely recommended and clinically approved. The impact on human health of the increasing use of silver nanoparticles in medical devices remains understudied, even though Ag-containing dressings are known to release silver into the bloodstream. In this study, we detected a widespread and sometimes significant silver accumulation both in healthy and sick liver biopsies, levels being statistically higher in patients with various hepatic pathologies. 28 healthy and 44 cirrhotic liver samples were investigated. The median amount of 0.049 ppm Ag in livers was measured in cirrhotic livers while the median was 0.0016 ppm for healthy livers (a more than 30-fold difference). The mean tissue concentrations of essential metals, Fe and Zn in cirrhotic livers did not differ substantially from healthy livers, while Cu was positively correlated with Ag. The serum levels of gamma-glutamyl transpeptidase (GGTP) was also positively correlated with Ag in cirrhotic livers. The increased Ag accumulation in cirrhotic livers could be a side effect of wide application of silver in clinical settings. As recent studies indicated a significant toxicity of silver nanoparticles for human cells, the above observation could be of high importance for the public health.
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Chung SM, Moon JS, Yoon JS, Won KC, Lee HW. The sex-specific effects of blood lead, mercury, and cadmium levels on hepatic steatosis and fibrosis: Korean nationwide cross-sectional study. J Trace Elem Med Biol 2020; 62:126601. [PMID: 32634767 DOI: 10.1016/j.jtemb.2020.126601] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/02/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022]
Abstract
AIM The potential effects of heavy metals on non-alcoholic fatty liver disease (NAFLD) remain unknown. We investigated the sex-specific relationships of blood lead (BPb), mercury (BHg), and cadmium (BCd) levels with hepatic steatosis (HS) and fibrosis (HF). METHOD We included 4420 participants from the 2016-2017 Korea National Health and Nutrition Examination Survey. High-risk alcoholics and patients with chronic hepatitis B or C infections or liver cirrhosis were excluded. We calculated the hepatic steatosis index (HSI) and fibrosis-4 index (FIB-4) values; we defined the presence of HS and HF as an HSI ≥ 36 and FIB-4 score >2.67, respectively. We adjusted for age, smoking and alcohol consumption statuses, hypertension, obesity, diabetes, hypertriglyceridemia, and BPb, BHg, and BCd levels. RESULT In males (n = 1860), the HSI was correlated negatively with the BPb level and positively with the BHg level (both p < 0.01). The FIB-4 score was correlated positively with the BPb and BCd levels (both p < 0.01). In females (n = 2560), the HSI and FIB-4 score were correlated positively with the BPb, BHg, and BCd levels (all p < 0.01). After adjustments, the BHg level increased the risk of HS in both males (OR = 1.065, p = 0.003) and females (OR = 1.061, p = 0.048), and the BCd level increased the risk of HF in females (OR = 1.668, p = 0.012). CONCLUSION Blood heavy metal levels were generally correlated positively with the HSI and FIB4 score, more so in females than males. The BHg level was associated with HS in males and females, and the BCd level was associated with HF in females. Further studies on NAFLD progression according to heavy metal status and sex are warranted.
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Affiliation(s)
- Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
| | - Ji Sung Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
| | - Kyu Chang Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
| | - Hyoung Woo Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam College of Medicine, Daegu, Republic of Korea.
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Advances in the Study of the Potential Hepatotoxic Components and Mechanism of Polygonum multiflorum. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:6489648. [PMID: 33062019 PMCID: PMC7545463 DOI: 10.1155/2020/6489648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/26/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022]
Abstract
The roots of Polygonum multiflorum (PM) (He Shou Wu in Chinese) are one of the most commonly used tonic traditional Chinese medicines (TCMs) in China. PM is traditionally valued for its antiaging, liver- and kidney-tonifying, and hair-blackening effects. However, an increasing number of hepatotoxicity cases induced by PM attract the attention of scholars worldwide. Thus far, the potential liver injury compounds and the mechanism are still uncertain. The aim of this review is to provide comprehensive information on the potential hepatotoxic components and mechanism of PM based on the scientific literature. Moreover, perspectives for future investigations of hepatotoxic components are discussed. This study will build a new foundation for further study on the hepatotoxic components and mechanism of PM.
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Gruber A, Müller R, Wagner A, Colucci S, Spasić MV, Leopold K. Total reflection X-ray fluorescence spectrometry for trace determination of iron and some additional elements in biological samples. Anal Bioanal Chem 2020; 412:6419-6429. [PMID: 32337622 PMCID: PMC7442763 DOI: 10.1007/s00216-020-02614-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
Trace elements are essential for life and their concentration in cells and tissues must be tightly maintained and controlled to avoid pathological conditions. Established methods to measure the concentration of trace elements in biological matrices often provide only single element information, are time-consuming, and require special sample preparation. Therefore, the development of straightforward and rapid analytical methods for enhanced, multi-trace element determination in biological samples is an important and raising field of trace element analysis. Herein, we report on the development and validation of a reliable method based on total reflection X-ray fluorescence (TXRF) analysis to precisely quantify iron and other trace metals in a variety of biological samples, such as the liver, parenchymal and non-parenchymal liver cells, and bone marrow–derived macrophages. We show that TXRF allows fast and simple one-point calibration by addition of an internal standard and has the potential of multi-element analysis in minute sample amounts. The method was validated for iron by recovery experiments in homogenates in a wide concentration range from 1 to 1600 μg/L applying well-established graphite furnace atomic absorption spectrometry (GFAAS) as a reference method. The recovery rate of 99.93 ± 0.14% reveals the absence of systematic errors. Furthermore, the standard reference material “bovine liver” (SRM 1577c, NIST) was investigated in order to validate the method for further biometals. Quantitative recoveries (92–106%) of copper, iron, zinc, and manganese prove the suitability of the developed method. The limits of detection for the minute sample amounts are in the low picogram range. Graphical abstract ![]()
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Affiliation(s)
- Andreas Gruber
- Institute of Analytical and Bioanalytical Chemistry, Ulm University, 89081, Ulm, Germany
| | - Riccarda Müller
- Institute of Analytical and Bioanalytical Chemistry, Ulm University, 89081, Ulm, Germany
| | - Alessa Wagner
- Institute of Comparative Molecular Endocrinology, Ulm University, 89081, Ulm, Germany
| | - Silvia Colucci
- Department of Pediatric Hematology, Oncology and Immunology, University of Heidelberg, 69120, Heidelberg, Germany.,Molecular Medicine Partnership Unit, 69120, Heidelberg, Germany
| | - Maja Vujić Spasić
- Institute of Comparative Molecular Endocrinology, Ulm University, 89081, Ulm, Germany
| | - Kerstin Leopold
- Institute of Analytical and Bioanalytical Chemistry, Ulm University, 89081, Ulm, Germany.
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Chiba R, Morikawa N, Sera K, Ishida K, Nagashima H, Shigeeda W, Deguchi H, Tomoyasu M, Hosokawa T, Saito H, Sugai T, Yamauchi K, Maemondo M. Elemental and mutational analysis of lung tissue in lung adenocarcinoma patients. Transl Lung Cancer Res 2019; 8:S224-S234. [PMID: 31857947 DOI: 10.21037/tlcr.2019.08.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background This study aimed to observe the association between trace element concentrations in lung tissue from lung adenocarcinoma cancer (LADC) patients and mutations in the epidermal growth factor receptor (EGFR) and KRAS genes. Methods LADC patients who had undergone lung resection were included in this study. Furthermore, twenty patients without lung cancer were included in this study as the control group. Samples were separately collected from both tumor and peritumor tissues. The mutational status was assessed for EGFR mutations, ALK rearrangements and KRAS mutations. Based on these analyses, patients were grouped into three groups: EGFR mutation, KRAS mutation and wild-type groups. The concentrations of various trace elements in the lung tissues were measured by a particle-induced X-ray emission (PIXE) system, and the results were analyzed for statistical significance. Results A total of 110 LADC patients were included in this study. The median age was 70 years, and 60% of the participants were female. Moreover, 18% and 20% of patients were EGFR- and KRAS-positive, respectively. Thirty-two trace elements were measured, and 18 trace elements were detectable. The concentrations of Fe, Co, Ni, Cu, Zn and Br were significantly higher in the KRAS mutation and wild-type groups than in the control group regardless of whether the samples were from tumor or peritumor tissues. For these 6 trace elements, the concentrations were significantly higher in smokers than in non-smokers. Considering the effect of smoking, differences in the trace element concentrations between each mutational group remained. Conclusions Trace elements in the lung may play a role in development of LADC in both smokers and never-smokers. However, prospective studies with larger sample sizes are needed to support this hypothesis.
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Affiliation(s)
- Ryosuke Chiba
- Department of Internal Medicine, Division of Pulmonary Medicine, Allergy, and Rheumatology, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Naoto Morikawa
- Department of Internal Medicine, Division of Pulmonary Medicine, Allergy, and Rheumatology, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Koichiro Sera
- Cyclotron Research Center, Iwate Medical University School of Medicine Takizawa, Iwate, Japan
| | - Kazuyuki Ishida
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Hiromi Nagashima
- Department of Internal Medicine, Division of Pulmonary Medicine, Allergy, and Rheumatology, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Wataru Shigeeda
- Department of Thoracic Surgery, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Hiroyuki Deguchi
- Department of Thoracic Surgery, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Makoto Tomoyasu
- Department of Thoracic Surgery, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Takako Hosokawa
- Takizawa Laboratory, Japan Radioisotope Association, Takizawa, Iwate, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Kohei Yamauchi
- Department of Internal Medicine, Division of Pulmonary Medicine, Allergy, and Rheumatology, Iwate Medical University School of Medicine Morioka, Iwate, Japan
| | - Makoto Maemondo
- Department of Internal Medicine, Division of Pulmonary Medicine, Allergy, and Rheumatology, Iwate Medical University School of Medicine Morioka, Iwate, Japan
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Osterode W, Falkenberg G, Ferenci P, Wrba F. Quantitative trace element mapping in liver tissue from patients with Wilson`s disease determined by micro X-ray fluorescence. J Trace Elem Med Biol 2019; 51:42-49. [PMID: 30466937 DOI: 10.1016/j.jtemb.2018.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 08/25/2018] [Accepted: 09/20/2018] [Indexed: 01/25/2023]
Abstract
AIMS of this investigation were to quantify copper (Cu), iron (Fe) and zinc (Zn) along with sulphur (S) and phosphorus (P) in hepatocytes and connective tissue in liver section from patients with Wilson´s disease (WD) by micro Synchrotron X-ray fluorescence (μ-SRXRF). Secondly to establish two-dimensional μ-SRXRF element mappings for comparison with histologically prepared slices, and thirdly to assess whether elemental distributions are associated. METHODS Archival liver tissues from twelve patients with end-stage cirrhosis or fulminant WD were investigated. Mutations in ATP7B have been classified before. For control seven archived normal liver tissues were investigated. μ-SRXRF measurements were performed at the DORIS III storage ring at HASYLAB/DESY (Hamburg, Germany). Two-dimensional element distribution were compared with histologically prepared slices about 20-30 μm apart from those investigated by μ-SRXRF. RESULTS Elementary copper (Cu) could be demonstrated in all investigated liver sections simultaneously with Fe, Zn, P and S. In WD mean Cu was 20 fold increased in hepatocytes and threefold in fibrotic areas in comparison with controls. In regeneration nodules Cu was strikingly inhomogeneous distributed. Cu concentrations measured by μ-SRXRF correlated with those measured by atom absorption spectroscopy. Strong associations in their regional distribution existed between Zn and Cu or Fe and S. Moreover, differences in Cu/S were found between hepatocytes and fibrotic areas. An increase of Fe could only be documented in hepatocytes compared to fibrotic areas. With a beam size of 15 x 15 μm two-dimensional distributions of these elements are morphologically comparable with histological section with a magnification of about 25x optic microscope. CONCLUSIONS μ-SRXRF investigations are a valuable tool for quantifying element concentrations in biological tissues and further provide 2-dimensional information of element distribution and elemental association in a biological tissues, thus speeding up basic knowledge in a synopsis with biological and clinical data.
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Affiliation(s)
- W Osterode
- Medizinische Universität Wien, Univ. Klinik für Innere Medizin II, Institut für Arbeitsmedizin, Austria.
| | - G Falkenberg
- Deutsches Elektronen-Synchrotron (DESY), Photon Science, Germany
| | - P Ferenci
- Medizinische Universität Wien, Univ. Klinik für Innere Medizin III, Klinisches Abteilung für Gastroenterologie und Hepatologie, Austria
| | - F Wrba
- Medizinische Universität Wien, Klinisches Institut für Klinische Pathologie, Austria
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