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Liu J, Wang L, Li S, Lin Z, Yang G, Miao Z. Association of urine glyphosate levels with renal injury biomarkers in children living close to major vegetable-producing regions in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:168677. [PMID: 38007119 DOI: 10.1016/j.scitotenv.2023.168677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
Glyphosate (GLY)-based herbicides exposure contributes to renal dysfunction in experimental conditions, but the effects on humans are rarely reported. Biomonitoring is practically relevant for evaluating the association of urine GLY levels and renal damage in children living close to vegetable-cultivating regions. In this study, we collected the first-morning void urine samples of 239 healthy children (aged 3-12, 48.12 % boys) living near major vegetable-producing regions in March-May and August 2023 in Shandong Province, China. Urine levels of GLY and kidney injury-associated biomarkers were determined using ELISA kits to assess their correlation. GLY was detected in 92.05 % of urine samples (220 out of 239 participants) and the geometric concentration (GM) was 7.429 μg/L (range: 0.625 to 38.267 μg/L). Binary logistic regression and multivariate regression analysis revealed GLY detectability and levels positively correlated with home ventilation and self-producing vegetable intake of the subjects, as well as sampling periods. Moreover, a statistically significant concentration association with urine GLY was found for kidney injury-associated biomarkers (NGAL and KIM-1) (R2 = 0.923 and 0.855, respectively). Additionally, risk assessment revealed that the maximum value of probable daily intake was 0.150 mg/kg bw/day, accounting for 30.1 % of the established Acceptable Daily Intake of GLY. This study unveils a positive correlation between continuous GLY-based herbicide exposure and renal injury biomarkers of children. A large-scale epidemiological study is warranted for comprehensively assessing the effects of GLY-based herbicides on kidney function of the entire public.
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Affiliation(s)
- Jingbo Liu
- College of Biological and Brewing Engineering, Taishan University, Tai'an City, China.
| | - Lei Wang
- The Second Children & Women's Healthcare of Ji'nan City, Laiwu City, China
| | - Song Li
- College of Basic Medicine, Shandong First Medical University, Ji'nan City, China
| | - Zhenxian Lin
- College of Biological and Brewing Engineering, Taishan University, Tai'an City, China
| | - Guangcheng Yang
- College of Biological and Brewing Engineering, Taishan University, Tai'an City, China
| | - Zengmin Miao
- College of Life Sciences, Shandong First Medical University, Tai'an City, China.
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Perananthan V, Wijerathna T, Mohamed F, Gawarammana IB, Dawson A, Buckley NA. Measurement of an intestinal biomarker during poisonings from select toxicants and toxins. Clin Toxicol (Phila) 2023; 61:693-696. [PMID: 37831053 DOI: 10.1080/15563650.2023.2265051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Intestinal toxicity can occur following ingestion of various drugs, chemicals, and toxins. Intestinal fatty acid binding protein is a cytosolic protein specific to intestinal epithelial cells released into the systemic circulation following intestinal injury. Understanding intestinal toxicity in poisoning has the potential to explain mechanisms of toxicity and gastrointestinal symptoms. METHODS Plasma samples were retrospectively analysed for intestinal fatty acid binding protein in 25 healthy controls and in those poisoned with Gloriosa superba (n = 18), Thevetia peruviana (n = 26), organophosphates (in various solvents) (n = 17), paracetamol (n = 14), glyphosate (n = 20), 2-methyl-4-chlorophenoxyacetic acid (n = 18) and propanil (n = 19). RESULTS Median peak plasma intestinal fatty acid binding protein concentrations were significantly higher in patients poisoned with Gloriosa superba (2,994.1 µg/L; interquartile range 600.0-5,158.2, P < 0.001), Thevetia peruviana (1,292.5 µg/L; interquartile range 760.3 - 2,076.2; P < 0.001), glyphosate (1,803.6 µg/L; interquartile range 225.7-8,927.7; P < 0.001), 2-methyl-4-chlorophenoxyacetic acid (1,236.2 µg/L; interquartile range 192.6 - 1,709.7; P = 0.010), paracetamol (1,066.5 µg/L; interquartile range 512.9 - 1,336.9; P = 0.035), and organophosphate poisoning (729.8 µg/L; interquartile range 431.5 - 1,588.2; P = 0.046) than in healthy controls (221.6 µg/L; interquartile range 134.8 - 460.1). Median intestinal fatty acid binding protein was not statistically significantly increased compared to controls after propanil poisoning (630.0 µg/L; interquartile range 23.5 - 1,390.3; P = 0.423). CONCLUSIONS Our pilot study describes intestinal injury assessed by elevated plasma intestinal fatty acid binding protein concentrations following the ingestion of several poisons. This serves as a foundation for further exploration into enterocyte damage in toxicology.
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Affiliation(s)
- Varan Perananthan
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Wijerathna
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Biosystems Technology, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Sydney Pharmacy School, University of Sydney, Camperdown, NSW, Australia Pharmacology
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Bandara Gawarammana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Dawson
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas A Buckley
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
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Rapid determination of polyethoxylated tallow amine surfactants in human plasma by LC-MSMS. Talanta 2023; 254:124115. [PMID: 36481395 DOI: 10.1016/j.talanta.2022.124115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/20/2022]
Abstract
The potential exposure to the widely used glyphosate-based herbicides, including attempted suicide by ingestion, is of world-wide concern. Whilst the major focus to date has been on managing exposure to the active ingredient glyphosate, it is now recognised that a common major 'inert' surfactant ingredient, polyethoxylated tallow amine (POEA) and related compounds, may be more toxic. However, the information on the toxicokinetics of POEA surfactants after exposure is limited, in part, due to the lack of suitable methods for their analysis in biological matrices. We therefore developed and validated a robust LC-MSMS method that allowed, for the first time, a rapid analysis of 11 POEA homologues in human plasma. Chromatographic separation was achieved on a Kinetex EVO C18 column under a 5 min gradient elution with mobile phase A containing water/acetonitrile/formic acid (95:5:0.1, v/v/v) and mobile phase B containing acetonitrile/water/formic acid (95:5:0.1, v/v/v). Amlodipine was chosen as the internal standard (IS) for this assay. Amlodipine-d4 would be an ideal alternative IS to expand the applicability of the established method especially in antihypertensive patients. Multiple reaction monitoring (MRM) methods were optimized for 11 POEA homologues and the IS. Sample pre-treatment was performed using simple protein precipitation with methanol at a ratio of 4:1, requiring only 20 μL plasma. The validated method showed good specificity, accuracy and precision with lower limits of quantification (LLOQ) ranging from 0.35 to 10.8 ng mL-1 for all selected POEA homologues. The method was then used to measure concentrations of the various POEA surfactants in more than 600 human plasma samples from 151 patients admitted to hospital with acute glyphosate intoxication. The highest concentrations ranged from 1.07 ng mL-1 for C18u(EO)4-362.70 ng mL-1 for C16s(EO)2. The analysis of POEA surfactants plasma concentrations as described here underpins the assessment of POEA internal exposure and the relationships between POEA related glyphosate toxicity and the extent of poisoning.
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Rodrigues CE, Endre ZH. Definitions, phenotypes, and subphenotypes in acute kidney injury-Moving towards precision medicine. Nephrology (Carlton) 2023; 28:83-96. [PMID: 36370326 PMCID: PMC10100386 DOI: 10.1111/nep.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/23/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
The current definition of acute kidney injury (AKI) is generic and, based only on markers of function, is unsuitable for guiding individualized treatment. AKI is a complex syndrome with multiple presentations and causes. Targeted AKI management will only be possible if different phenotypes and subphenotypes of AKI are recognised, based on causation and related pathophysiology. Molecular signatures to identify subphenotypes are being recognised, as specific biomarkers reveal activated pathways. Assessment of individual clinical risk needs wider dissemination to allow identification of patients at high risk of AKI. New and more timely markers for glomerular filtration rate (GFR) are available. However, AKI diagnosis and classification should not be limited to GFR, but include tubular function and damage. Combining damage and stress biomarkers with functional markers enhances risk prediction, and identifies a population enriched for clinical trials targeting AKI. We review novel developments and aim to encourage implementation of these new techniques into clinical practice as a strategy for individualizing AKI treatment akin to a precision medicine-based approach.
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Affiliation(s)
- Camila Eleuterio Rodrigues
- Nephrology Department, Prince of Wales Clinical School - UNSW Medicine, Sydney, New South Wales, Australia.,Nephrology Department, Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - Zoltán H Endre
- Nephrology Department, Prince of Wales Clinical School - UNSW Medicine, Sydney, New South Wales, Australia
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The Significance of Estimated Glomerular Filtration Rate for Predicting Mortality in Glyphosate Herbicide-Intoxicated Patients: A Single-Center, Retrospective Observational Study. J Clin Med 2022; 11:jcm11164824. [PMID: 36013063 PMCID: PMC9409664 DOI: 10.3390/jcm11164824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Glyphosate herbicide (GH) is widely used worldwide. It has a higher fatality rate than expected. GH-poisoned cases are increasingly reported. Acute kidney injury in poisoned patients is one of several predictors of GH mortality. The aim of this study was to determine whether estimated glomerular filtration rate (eGFR) could predict kidney injury in GH intoxication. Methods: This was a retrospective study conducted at the emergency department (ED) of a single hospital between January 2004 and December 2021. A total of 434 patients presented with GH intoxication via oral ingestion, and 424 were enrolled. Their demographic characteristics, laboratory variables, complications, and mortality were analyzed to determine clinical predictors associated with GH-induced mortality using a logistic regression analysis. The relationship between GH intoxication and eGFR was determined based on the results of dominance analysis. Additionally, the comparison of creatinine and eGFR was performed through receiver operating characteristic (ROC) curves. Results: A total of 424 GH-poisoned patients were enrolled. Of them, 43 (10.1%) died. In the multivariable analysis, initial GCS (OR: 0.874; 95% CI: 0.765−0.998, p = 0.047), albumin (OR: 0.874; 95% CI: 0.765−0.998, p = 0.027), pH (OR: 0.002; 95% CI: 0.000−0.037, p < 0.001), QTc interval (OR: 1.018; 95% CI: 1.007−1.029, p = 0.001), and eGFR (OR: 0.969; 95% CI: 0.95−0.989, p = 0.003) were independent factors for predicting in-hospital mortality. In the dominance analysis of the relative importance of the predictive factors, pH accounted for the largest proportion at 35.8%, followed by QTc (20.0%), GCS (17.3%), eGFR (17.0%), and albumin (9.9%). Additionally, eGFR had a larger area under the ROC curve (0.846; 95% CI, 0.809−0.879) than that of creatinine (0.811; 95% CI, 0.771−0.848, p = 0.033). Conclusion: In sum, eGFR, considered a surrogate of renal function, was a useful prognostic factor for mortality in glyphosate herbicide-poisoned patients.
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Cellier M, Anthony N, Bruneau C, Descatha A. Determination of Glyphosate and AMPA in Blood Can Predict the Severity of Acute Glyphosate Herbicide Poisoning. Lab Med 2022; 53:394-398. [PMID: 35150270 DOI: 10.1093/labmed/lmac002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To evaluate a potential association between blood and urine concentration of glyphosate and its metabolite, aminomethylphosphonic acid (AMPA), with severity of acute glyphosate (herbicide) poisoning. METHODS In our retrospective study of acute glyphosate poisoning, we examined records from the French National Database of Poisonings, dated between January 1, 2004, and December 31, 2016. We compared the severity of poisoning among case individuals using the Fisher exact test and Wilcoxon test. Also, we calculated ROC curves to determine the cutoff for blood and urine concentration. RESULTS A total of 17 plasma glyphosate, 11 urine glyphosate, 13 plasma AMPA, and 10 urine AMPA specimens were included in our study, with collection dates ranging from January 1, 2004, through December 31, 2016. CONCLUSION The optimal cutoff we discovered for blood concentration of AMPA was 0.88 mg/L; for glyphosate, it was 600 mg/L. The cutoff plasma concentration of AMPA has never been described in the literature, to our knowledge.
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Affiliation(s)
- M Cellier
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - N Anthony
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - C Bruneau
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - A Descatha
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
- UNIV Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Angers, France
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Upamalika SWAM, Wannige CT, Vidanagamachchi SM, Gunasekara SC, Kolli RT, De Silva PMCS, Kulasiri D, Jayasundara N. A review of molecular mechanisms linked to potential renal injury agents in tropical rural farming communities. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2022; 92:103850. [PMID: 35301132 DOI: 10.1016/j.etap.2022.103850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
The chronic kidney disease of unknown etiology (CKDu) is a global health concern primarily impacting tropical farming communities. Although the precise etiology is debated, CKDu is associated with environmental exposures including heat stress and chemical contaminants such as fluoride, heavy metals, and herbicide glyphosate. However, a comprehensive synthesis is lacking on molecular networks underpinning renal damage induced by these factors. Addressing this gap, here we present key molecular events associated with heat and chemical exposures. We identified that caspase activation and lipid peroxidation are common endpoints of glyphosate exposure, while vasopressin and polyol pathways are associated with heat stress and dehydration. Heavy metal exposure is shown to induce lipid peroxidation and endoplasmic reticulum stress from ROS activated MAPK, NFĸB, and caspase. Collectively, we identify that environmental exposure induced increased cellular oxidative stress as a common mechanism mediating renal cell inflammation, apoptosis, and necrosis, likely contributing to CKDu initiation and progression.
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Affiliation(s)
| | | | | | | | - Ramya Tulasi Kolli
- Nicholas School of the Environment, Duke University, NC 27708, United States.
| | | | - Don Kulasiri
- Department of Molecular Biosciences, and Centre for Advanced Computational Solutions (C-fACS), Lincoln University, New Zealand.
| | - Nishad Jayasundara
- Nicholas School of the Environment, Duke University, NC 27708, United States.
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Perananthan V, Wijerathna T, Mohamed F, Gawarammana IB, Dawson AH, Buckley NA. Circulating intestinal fatty acid binding protein and intestinal toxicity in Russell's viper envenomation. Clin Toxicol (Phila) 2022; 60:311-318. [PMID: 34378471 DOI: 10.1080/15563650.2021.1965160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/24/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Abdominal pain is known to be an early clinical predictor of severe systemic Russell's viper (RV) envenomation and is often associated with the later development of coagulopathy and neurotoxicity. The mechanism of abdominal pain is unknown, but we postulated it might be due to intestinal microvascular endothelial gut damage. Gut-toxicity can be detected using the novel biomarker Intestinal Fatty Acid Binding Protein (IFABP). We also wanted to explore the mechanisms and consequences of this toxicity by measuring procalcitonin as a specific marker of sepsis triggered by bacterial endotoxin, and serum cystatin-C (CysC) as a measure of acute kidney injury. We hypothesised that severe gut-injury might lead to gut-barrier failure, translocation of gastrointestinal microorganisms, associated sepsis and systemic inflammatory response syndrome (SIRS), with a possible exacerbation of snake-bite severity, including acute kidney injury that was previously attributed to direct venom effects. METHODS Serial plasma samples previously collected from 16 RV envenomations with abdominal pain, 15 RV envenomations without abdominal pain and 25 healthy controls were assayed for IFABP. A subgroup of these RV envenomations were assayed for procalcitonin (n = 24) and serum CysC (n = 11). RESULTS The median peak IFABP for RV envenomations was much higher than healthy controls [3703.0 pg/mL (IQR 2250.1-13702.0 pg/mL) vs. 270.1 pg/mL (IQR 153.5-558.0 pg/mL) (p < 0.001)]. There was no difference in those with and without abdominal pain [3801.4 pg/mL (IQR 2080.5-22446.3 pg/mL) vs. 3696.6 pg/mL (IQR 2280.3-4664.7 pg/mL) (p = 1.0)]. Peak procalcitonin levels were elevated in envenomed patients 30.1 ng/ml (IQR: 13.1-59.7 ng/ml) with a level >2ng/mL indicative of severe sepsis] and also correlated with peak IFABP (r = 0.55, p = 0.006, n = 24). Peak serum CysC was also elevated and also correlated with IFABP (r = 0.71, p = 0.037, n = 9). CONCLUSION IFABP is significantly elevated indicating enterocyte damage occurs in RV envenomation. IFABP correlated with markers of sepsis (procalcitonin) and acute kidney injury (serum CysC) suggesting that enterocyte damage resulting in translocation of microbial associated molecular patterns (MAMPs) contributes to RV envenomation associated SIRS and sepsis.
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Affiliation(s)
- Varan Perananthan
- Edith Collins Research Institute, Royal Prince Alfred Hospital, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Disciplines of Pharmacology/Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thilini Wijerathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Disciplines of Pharmacology/Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya
- Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Indika B Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew H Dawson
- Edith Collins Research Institute, Royal Prince Alfred Hospital, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Disciplines of Pharmacology/Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nicholas A Buckley
- Edith Collins Research Institute, Royal Prince Alfred Hospital, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Disciplines of Pharmacology/Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
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Chemical toxicity assessment and Physiological investigation in rats exposed to pyrethroid insecticide type 1 and possible mitigation of propolis. THE EUROBIOTECH JOURNAL 2022. [DOI: 10.2478/ebtj-2022-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The current investigation aims to study the potential protective effects of propolis methanolic extract (100 mg/kg BW) on the systemic toxic effects after dietary exposure concentration (1/100 LD50 for 30 days) of permethrin (PM) administered in experimental rats. In this experiment, we added propolis four weeks after PM -administration to examining the medicinal effects. Therapeutic use of propolis mitigated PM -induced deterioration of liver and kidney functions and myocardial damage measured by cardiac enzymes lactate dehydrogenase (LDH) and creatine kinase MB (CK-MB) in serum. In addition, propolis treatment (prophylactic and therapeutic) prevented PM-induced apoptosis index, including B-cell lymphoma protein 2 (BCL-2)-associated X (BAX) protein activates, and lipid peroxide (LP). The results showed propolis induced a significant decrease in serum levels of thyroid hormones (T3 and T4), proinflammatory cytokines tumor necrosis factor-alpha (TNF-α), interferon-gamma (INF-γ), interleukin one beta (IL-1β), interleukin 12 (IL-12), and interleukin 6 (IL-6). Besides, nuclear factor-kappa B (NF-kB), acetylcholine esterase (AChE), and hematological constituents. Cardiac biomarkers, liver, and kidney functions were substantially lower in propolis treatment. High-performance liquid chromatography (HPLC) and Gas chromatography–mass spectrometry (GC- MS) of the propolis-MeOH extract showed valuable antioxidant phenolics and flavonoids capable of alleviating oxidative stress through the free-radical scavenging efficacy and regulating signaling pathways of proinflammatory cytokines.
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Wijewickrama ES, Mohamed F, Gawarammana IB, Endre ZH, Buckley NA, Isbister GK. Serum and urinary biomarkers for early detection of acute kidney injury following Hypnale spp. envenoming. PLoS Negl Trop Dis 2021; 15:e0010011. [PMID: 34871314 PMCID: PMC8675918 DOI: 10.1371/journal.pntd.0010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/16/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Hump-nosed pit viper (HNV; Hypnale spp.) bites account for most venomous snakebites in Sri Lanka. Acute kidney injury (AKI) is the most serious systemic manifestation (1–10%) following HNV envenoming. We aimed to identify the value of functional and injury biomarkers in predicting the development of AKI early following HNV bites. Methods We conducted a prospective cohort study of patients with confirmed HNV envenoming presenting to two large tertiary care hospitals in Sri Lanka. Demographics, bite details, clinical effects, complications and treatment data were collected prospectively. Blood and urine samples were collected from patients for coagulation and renal biomarker assays on admission, at 0-4h, 4-8h, 8-16h and 16-24h post-bite and daily until discharge. Follow-up samples were obtained 1 and 3 months post-discharge. Creatinine (sCr) and Cystatin C (sCysC) were measured in serum and kidney injury molecule-1 (uKIM-1), clusterin (uClu), albumin (uAlb), β2-microglobulin (uβ2M), cystatin C (uCysC), neutrophil gelatinase associated lipocalin (uNGAL), osteopontin (uOPN) and trefoil factor-3 (uTFF-3) were measured in urine. Definite HNV bites were based on serum venom specific enzyme immunoassay. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to stage AKI. Two patients had chronic kidney disease at 3 month follow-up, both with pre-existing abnormal sCr, and one developed AKI following HNV envenoming. Results There were 52 patients with confirmed HNV envenoming; median age 48y (Interquartile range [IQR]:40-59y) and 29 (56%) were male. Median time to admission was 1.87h (IQR:1–2.75h). Twelve patients (23%) developed AKI (AKI stage 1 = 7, AKI stage 2 = 1, AKI stage 3 = 4). Levels of five novel biomarkers, the functional marker serum Cystatin C and the damage markers urinary NGAL, cystatin C, β2-microglobulin and clusterin, were elevated in patients who developed moderate/severe acute kidney injury. sCysC performed the best at 0–4 h post-bite in predicting moderate to severe AKI (AUC-ROC 0.95;95%CI:0.85–1.0) and no biomarker performed better than sCr at later time points. Conclusions sCysC appears to be a better marker than sCr for early prediction of moderate to severe AKI following HNV envenoming. Snakebite is a major public health problem associated with considerable morbidity and mortality worldwide. Acute kidney injury is one of the major systemic complications of snakebites. Its pathophysiology is poorly understood and the diagnosis is often delayed due to lack of sensitive biomarkers. We aimed to investigate the value of selected biomarkers in the early diagnosis of acute kidney injury following hump-nosed pit viper (Hypnale spp.) envenoming. In a group of 52 patients with confirmed hump-nosed pit viper envenoming acute kidney injury was found to be common and was associated with severe disease in some. Levels of five novel biomarkers, the functional marker serum Cystatin C and the damage markers urinary NGAL, cystatin C, β2-microglobulin and clusterin, were elevated in patients who developed moderate/ severe acute kidney injury. Serum Cystatin C performed better than serum creatinine in early prediction of moderate/severe acute kidney injury. Serum Cystatin C appears to be a promising novel biomarker in diagnosing acute kidney injury in the setting of hump-nosed pit viper envenoming.
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Affiliation(s)
- Eranga Sanjeewa Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- * E-mail:
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- The University of Sydney, Faculty of Medicine and Health, Biomedical informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, Sydney, NSW, Australia
- Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Indika B. Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Zoltan H. Endre
- Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Nicholas A. Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- The University of Sydney, Faculty of Medicine and Health, Biomedical informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, Sydney, NSW, Australia
| | - Geoffrey K. Isbister
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
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Vodovar D, Peyre H, Mégarbane B. Relationship between acute kidney injury and mortality in poisoning - a systematic review and metanalysis. Clin Toxicol (Phila) 2021; 59:771-779. [PMID: 34080503 DOI: 10.1080/15563650.2021.1928161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
RATIONALE Three consensus classifications of acute kidney injury have been published. These are RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease published by the Acute Dialysis Quality Initiative workgroup), AKIN (published by the Acute Kidney Injury Network) and KDIGO (published by the Kidney Disease Improving Global Outcome workgroup). Acute kidney injury has been reported consistently as associated with worsened outcomes. However, toxicant-related acute kidney injury has been excluded from the studies used to validate the classifications of acute kidney injury. OBJECTIVE To study whether poisoned patients who develop acute kidney injury, as defined by consensus definitions/classifications, have higher mortality compared to those who did not. METHODS Databases were searched from 2004 to 2019 using the following keywords (KDIGO OR "Kidney Disease: Improving Global Outcomes" OR "Kidney Disease Improving Global Outcomes" OR AKIN OR "AKI network" OR "Acute kidney Injury Network" OR ADQI OR RIFLE OR "Acute dialysis quality initiative") AND (intoxication OR poisoning OR overdose OR ingestion) AND (AKI OR kidney OR renal OR ARF). If data were available, we used a random-effects meta-analysis model and Fisher's exact test to compare mortality in patients according to kidney function definitions (acute kidney injury vs not) and stages (stages vs no acute kidney injury), respectively. If data were available, we assessed the correlation between mortality and renal function (no acute kidney injury, risk/stage 1, injury/stage 2 and failure/stage 3) using the Spearman correlation. If available, we collected the results of statistical analyses in studies that have used acute kidney injury to predict mortality. RESULTS Study selection. Thirty-three relevant studies were found, 22/33 retrospective studies (67%) and 11/33 prospective studies (33%). Paraquat was the most frequent toxicant involved (13/33, 39%). We found a disparity between studies regarding the timeframe during which mortality was assessed, the temporality of the renal function considered to predict mortality (initial/worst) and the criteria used to define/grade acute kidney injury across studies. Univariate association between acute kidney injury definitions/stages and mortality. Consensus definitions/staging of acute kidney injury were associated with higher mortality, using univariate analyses, in twenty-eight (RIFLE = 7; AKIN = 12; KDIGO = 9) studies included but not in five (AKIN = 4, KDIGO = 1). When available data were pooled, RIFLE (5 studies), AKIN (16 studies) and KDIGO definitions (8 studies) of acute kidney injury were associated with a higher mortality (Log unadjusted Odds ratios [95%-confidence interval], 2.60 [2.23; 2.97], 2.02 [1.48; 2,52] and 3.22 [2,65; 3.78], respectively). However, we found high heterogeneity (I2=54,7%) and publication bias among studies using AKIN. In ten studies with available data, the correlation between renal function (no acute kidney injury, risk/stage 1, injury/stage 2, failure/stage 3) and mortality was significant in 5 studies (RIFLE = 2; AKIN = 3), but not in five studies (RIFLE = 1; AKIN = 3; KDIGO = 1).Multivariate association between acute kidney injury definitions/stages and mortality. The definitions of acute kidney injury were associated with higher mortality in two studies (RIFLE = 2), but not in four studies (AKIN = 1 and KDIGO = 3. The stages of acute kidney injury (including one or more stages) were associated with higher mortality in four (RIFLE = 1, AKIN = 1 and KDIGO = 2). CONCLUSIONS All three consensus definitions/classifications were associated independently with increased mortality in poisoning but with disparity between studies reporting acute kidney injury.
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Affiliation(s)
- Dominique Vodovar
- Paris Poison Control Centre, Federation of Toxicology APHP, Fernand Widal Hospital, Paris, France.,University of Paris, Inserm UMRS 1144, Paris, France.,University of Paris, Medical school, Paris, France
| | - Hugo Peyre
- University of Paris, Medical school, Paris, France.,Neurodiderot. INSERM UMR 1141, Paris Diderot University, Paris, France.,Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
| | - Bruno Mégarbane
- University of Paris, Inserm UMRS 1144, Paris, France.,University of Paris, Medical school, Paris, France.,Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, Paris, France
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12
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Shihana F, Wong WKM, Joglekar MV, Mohamed F, Gawarammana IB, Isbister GK, Hardikar AA, Seth D, Buckley NA. Urinary microRNAs as non-invasive biomarkers for toxic acute kidney injury in humans. Sci Rep 2021; 11:9165. [PMID: 33911095 PMCID: PMC8080685 DOI: 10.1038/s41598-021-87918-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
MicroRNAs in biofluids are potential biomarkers for detecting kidney and other organ injuries. We profiled microRNAs in urine samples from patients with Russell's viper envenoming or acute self-poisoning following paraquat, glyphosate, or oxalic acid [with and without acute kidney injury (AKI)] and on healthy controls. Discovery analysis profiled for 754 microRNAs using TaqMan OpenArray qPCR with three patients per group (12 samples in each toxic agent). From these, 53 microRNAs were selected and validated in a larger cohort of patients (Russell's viper envenoming = 53, paraquat = 51, glyphosate = 51, oxalic acid = 40) and 27 healthy controls. Urinary microRNAs had significantly higher expression in patients poisoned/envenomed by different nephrotoxic agents in both discovery and validation cohorts. Seven microRNAs discriminated severe AKI patients from no AKI for all four nephrotoxic agents. Four microRNAs (miR-30a-3p, miR-30a-5p, miR-92a, and miR-204) had > 17 fold change (p < 0.0001) and receiver operator characteristics area-under-curve (ROC-AUC) > 0.72. Pathway analysis of target mRNAs of these differentially expressed microRNAs showed association with the regulation of different nephrotoxic signaling pathways. In conclusion, human urinary microRNAs could identify toxic AKI early after acute injury. These urinary microRNAs have potential clinical application as early non-invasive diagnostic AKI biomarkers.
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Affiliation(s)
- Fathima Shihana
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
- Centenary Institute of Cancer Medicine and Cell Biology, The University of Sydney, Sydney, NSW, Australia.
| | - Wilson K M Wong
- Diabetes and Islet Biology Group, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Mugdha V Joglekar
- Diabetes and Islet Biology Group, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Fahim Mohamed
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Allied Health Sciences, Department of Pharmacy, University of Peradeniya, Peradeniya, Sri Lanka
- Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Indika B Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia
| | - Anandwardhan A Hardikar
- Diabetes and Islet Biology Group, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Devanshi Seth
- Centenary Institute of Cancer Medicine and Cell Biology, The University of Sydney, Sydney, NSW, Australia
- Discipline of Clinical Medicine and Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicholas A Buckley
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Abstract
Evolutionary processes, including mutation, migration and natural selection, have influenced the prevalence and distribution of various disorders in humans. However, despite a few well-known examples, such as the APOL1 variants - which have undergone positive genetic selection for their ability to confer resistance to Trypanosoma brucei infection but confer a higher risk of chronic kidney disease - little is known about the effects of evolutionary processes that have shaped genetic variation on kidney disease. An understanding of basic concepts in evolutionary genetics provides an opportunity to consider how findings from ancient and archaic genomes could inform our knowledge of evolution and provide insights into how population migration and genetic admixture have shaped the current distribution and landscape of human kidney-associated diseases. Differences in exposures to infectious agents, environmental toxins, dietary components and climate also have the potential to influence the evolutionary genetics of kidneys. Of note, selective pressure on loci associated with kidney disease is often from non-kidney diseases, and thus it is important to understand how the link between genome-wide selected loci and kidney disease occurs in relation to secondary nephropathies.
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14
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Wang R, Chen J, Ding F, Zhang L, Wu X, Wan Y, Hu J, Zhang X, Wu Q. Renal tubular injury induced by glyphosate combined with hard water: the role of cytosolic phospholipase A2. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:130. [PMID: 33569432 PMCID: PMC7867956 DOI: 10.21037/atm-20-7739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The combined effects of glyphosate and hard water on chronic kidney disease of unknown etiology (CDKu) have attracted much interest, but the mechanisms remain unknown. Cytoplasmic phospholipase A2 (cPLA2) plays a key role in the acute and chronic inflammatory reactions. This study explored the effect of glyphosate combined with hard water on renal tubules and the possible targets and mechanisms involved. Methods In vivo experiments were conducted to investigate the synergistic effects and potential mechanisms of glyphosate and hard water on renal tubular injury in mice. Results Administration of glyphosate in mice resulted in elevated levels of β2-microglobulin (β2-MG), albumin (ALB), and serum creatinine (SCr) compared to control mice. This increase was more pronounce when glyphosate was combined with hard water. In the glyphosate-treated mice, small areas of the kidney revealed fibroblast proliferation and vacuolar degeneration, particularly at the higher dose of 400 mg/kg glyphosate. However, the combination of glyphosate and hard water induced an even greater degree of pathological changes in the kidney. Immunofluorescence and western blot analyses showed that glyphosate and hard water had a coordinated effect on calcium ions (Ca2+)-activated phospholipase A2 and the activation may play a key role in inflammation and renal tubular injury. Exposure to glyphosate alone or glyphosate plus hard water increased the levels of oxidative stress markers and inflammatory biomarkers, namely, thromboxane A2 (TX-A2), leukotriene B4 (LTB4), prostaglandin E2 (PGE2), nitric oxide synthase (NOS), and nitric oxide (NO). Parameters of oxidative stress, including the levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were decreased. Further analysis showed that the levels of these biomarkers were significantly different between the mice treated with glyphosate plus hard water and the mice treated with glyphosate alone. Conclusions These findings suggested that hard water combined with glyphosate can induce renal tubular injury in mice, and this may involve mitogen-activated protein kinases (MAPK)/cytosolic phospholipase A2 (cPLA2)/arachidonic acid (AA) and its downstream factors.
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Affiliation(s)
- Ruojing Wang
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Jing Chen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fan Ding
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Lin Zhang
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Xuan Wu
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Yi Wan
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Jianying Hu
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Xiaoyan Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing Wu
- School of Public Health and Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
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15
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Wijerathna TM, Mohamed F, Gawarammana IB, Wunnapuk K, Dissanayake DM, Shihana F, Buckley NA. Cellular injury leading to oxidative stress in acute poisoning with potassium permanganate/oxalic acid, paraquat, and glyphosate surfactant herbicide. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2020; 80:103510. [PMID: 33031936 DOI: 10.1016/j.etap.2020.103510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 06/11/2023]
Abstract
Previous studies on human acute kidney injury (AKI) following poisoning with potassium permanganate/oxalic acid (KMnO4/H2C2O4), paraquat, and glyphosate surfactant herbicide (GPSH) have shown rapid and large increases in serum creatinine (sCr) that cannot be entirely explained by direct nephrotoxicity. One plausible mechanism for a rapid increase in sCr is oxidative stress. Thus, we aimed to explore biomarkers of oxidative stress, cellular injury, and their relationship with sCr, after acute KMnO4/H2C2O4, paraquat, and GPSH poisonings. Serum biomarkers [sCr, creatine (sCn), cystatin C (sCysC)] and urinary biomarkers [cytochrome C (CytoC), 8-isoprostane (8-IsoPs)] were evaluated in 105 patients [H2C2O4/KMnO4 (N = 57), paraquat, (N = 21), GPSH (N = 27)] recruited to a multicenter cohort study. We used area under the receiver operating characteristics curve (AUC-ROC) to quantify the extent of prediction of moderate to severe AKI (acute kidney injury network stage 2/3 (AKIN2/3)). Patients with AKIN2/3 showed increased levels of CytoC. Early high CytoC predicted AKIN2/3 in poisoning with KMnO4/H2C2O4 (AUC-ROC4-8h: 0.81), paraquat (AUC-ROC4-8h: 1.00), and GPSH (AUC-ROC4-8h: 0.91). 8-Isoprostane levels were not significantly elevated. Reduced sCn and increased sCr/sCn ratios were observed for 48 h post KMnO4/H2C2O4 ingestion. Paraquat exhibited a similar pattern (N = 11), however only 3 were included in our study. Increased CytoC suggests there is mitochondrial injury coupled with energy depletion. The increased sCr within 24 h could be due to increased conversion of cellular creatine to creatinine during the process of adenosine triphosphate (ATP) generation and then efflux from cells. Later increases of sCr are more likely to represent a true decrease in kidney function.
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Affiliation(s)
- Thilini Madushanka Wijerathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka; Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia; The University of Sydney, Faculty of Medicine and Health, Discipline of Biomedical Informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, Sydney, 2006 NSW, Australia
| | - Indika Bandara Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Klintean Wunnapuk
- Toxicology Division, Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Fathima Shihana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; The University of Sydney, Faculty of Medicine and Health, Discipline of Biomedical Informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, Sydney, 2006 NSW, Australia
| | - Nicholas Allan Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; The University of Sydney, Faculty of Medicine and Health, Discipline of Biomedical Informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, Sydney, 2006 NSW, Australia
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16
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Trasande L, Aldana SI, Trachtman H, Kannan K, Morrison D, Christakis DA, Whitlock K, Messito MJ, Gross RS, Karthikraj R, Sathyanarayana S. Glyphosate exposures and kidney injury biomarkers in infants and young children. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 256:113334. [PMID: 31677874 PMCID: PMC7307380 DOI: 10.1016/j.envpol.2019.113334] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/14/2019] [Accepted: 09/30/2019] [Indexed: 05/20/2023]
Abstract
The goal of this study was to assess biomarkers of exposure to glyphosate and assess potential associations with renal function in children. Glyphosate is used ubiquitously in agriculture worldwide. While previous studies have indicated that glyphosate may have nephrotoxic effects, few have examined potential effects on kidney function in children. We leveraged three cohorts across different phases of child development and measured urinary levels of glyphosate. We evaluated associations of glyphosate with three biomarkers of kidney injury: albuminuria (ACR), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury marker 1 (KIM-1). Multivariable regression analyses examined associations of glyphosate with kidney injury biomarkers controlling for covariates. We identified glyphosate in 11.1% of the total participants. The herbicide was detected more frequently in the neonate population (30%). Multivariable regression models failed to identify significant associations of log-transformed glyphosate with any of the kidney injury biomarkers, controlling for covariates age, sex, and maternal education. While we confirm detectability of glyphosate in children's urine at various ages and stages of life, there is no evidence in this study for renal injury in children exposed to low levels of glyphosate. Further studies of larger sample size are indicated to better understand putative deleterious effects of the herbicide after different levels of exposure.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA
| | - Sandra India Aldana
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Howard Trachtman
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA.
| | | | - Deborah Morrison
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | | | | | - Mary Jo Messito
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Rachel S Gross
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | | | - Sheela Sathyanarayana
- Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
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Barnett LMA, Cummings BS. Nephrotoxicity and Renal Pathophysiology: A Contemporary Perspective. Toxicol Sci 2019; 164:379-390. [PMID: 29939355 DOI: 10.1093/toxsci/kfy159] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The kidney consists of numerous cell types organized into the nephron, which is the basic functional unit of the kidney. Any stimuli that induce loss of these cells can induce kidney damage and renal failure. The cause of renal failure can be intrinsic or extrinsic. Extrinsic causes include cardiovascular disease, obesity, diabetes, sepsis, and lung and liver failure. Intrinsic causes include glomerular nephritis, polycystic kidney disease, renal fibrosis, tubular cell death, and stones. The kidney plays a prominent role in mediating the toxicity of numerous drugs, environmental pollutants and natural substances. Drugs known to be nephrotoxic include several cancer therapeutics, drugs of abuse, antibiotics, and radiocontrast agents. Environmental pollutants known to target the kidney include cadmium, mercury, arsenic, lead, trichloroethylene, bromate, brominated-flame retardants, diglycolic acid, and ethylene glycol. Natural nephrotoxicants include aristolochic acids and mycotoxins such as ochratoxin, fumonisin B1, and citrinin. There are several common characteristics between mechanisms of renal failure induced by nephrotoxicants and extrinsic causes. This common ground exists primarily due to similarities in the molecular mechanisms mediating renal cell death. This review summarizes the current state of the field of nephrotoxicity. It emphasizes integrating our understanding of nephrotoxicity with pathological-induced renal failure. Such approaches are needed to address major questions in the field, which include the diagnosis, prognosis and treatment of both acute and chronic renal failure, and the progression of acute kidney injury to chronic kidney disease.
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Affiliation(s)
| | - Brian S Cummings
- Interdisciplinary Toxicology Program.,Pharmaceutical and Biomedical Sciences, University of Georgia, Athens, Georgia 30602
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18
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Ratnayake I, Mohamed F, Buckley NA, Gawarammana IB, Dissanayake DM, Chathuranga U, Munasinghe M, Maduwage K, Jayamanne S, Endre ZH, Isbister GK. Early identification of acute kidney injury in Russell's viper (Daboia russelii) envenoming using renal biomarkers. PLoS Negl Trop Dis 2019; 13:e0007486. [PMID: 31260445 PMCID: PMC6625728 DOI: 10.1371/journal.pntd.0007486] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 07/12/2019] [Accepted: 05/23/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a major complication of snake envenoming, but early diagnosis remains problematic. We aimed to investigate the time course of novel renal biomarkers in AKI following Russell's viper (Daboia russelii) bites. METHODOLOGY/PRINCIPAL FINDINGS We recruited a cohort of patients with definite Russell's viper envenoming and collected serial blood and urine samples on admission (<4h post-bite), 4-8h, 8-16h, 16-24h, 1 month and 3 months post-bite. AKI stage (1-3) was defined using the Acute Kidney Injury Network criteria. AKI stages (1-3) were defined by the Acute Kidney Injury Network (AKIN) criteria. There were 65 Russell's viper envenomings and 49 developed AKI: 24 AKIN stage 1, 13 stage 2 and 12 stage 3. There was a significant correlation between venom concentrations and AKI stage (p = 0.007), and between AKI stage and six peak biomarker concentrations. Although most biomarker concentrations were elevated within 8h, no biomarker performed well in diagnosing AKI <4h post-bite. Three biomarkers were superior to serum creatinine (sCr) in predicting AKI (stage 2/3) 4-8h post-bite: serum cystatin C (sCysC) with an area under the receiver operating curve (AUC-ROC), 0.78 (95%CI:0.64-0.93), urine neutrophil gelatinase-associated lipocalin (uNGAL), 0.74 (95%CI:0.59-0.87) and urine clusterin (uClu), 0.81 (95%CI:0.69-0.93). No biomarker was better than sCr after 8h. Six other urine biomarkers urine albumin, urine beta2-microglobulin, urine kidney injury molecule-1, urine cystatin C, urine trefoil factor-3 and urine osteopontin either had minimal elevation, and/or minimal prediction for AKI stage 2/3 (AUC-ROC<0.7). CONCLUSIONS/SIGNIFICANCE AKI was common and sometimes severe following Russell's viper bites. Three biomarkers uClu, uNGAL and sCysC, appeared to become abnormal in AKI earlier than sCr, and may be useful in early identification of envenoming.
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Affiliation(s)
- Indira Ratnayake
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- TACT, Department of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Pharmacy, Faculty of Allied Health Science, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Nicholas A. Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- TACT, Department of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Indika B. Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Dhammika M. Dissanayake
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Umesh Chathuranga
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Mahesh Munasinghe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kalana Maduwage
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Zoltan H. Endre
- Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Geoffrey K. Isbister
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia
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20
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Wijerathna TM, Gawarammana IB, Mohamed F, Dissanayaka DM, Dargan PI, Chathuranga U, Jayathilaka C, Buckley NA. Epidemiology, toxicokinetics and biomarkers after self-poisoning with Gloriosa superba. Clin Toxicol (Phila) 2019; 57:1080-1086. [DOI: 10.1080/15563650.2019.1581939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Thilini Madushanka Wijerathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Bandara Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Pharmacy, Faculty of Allied Health Science, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Paul I Dargan
- Clinical Toxicology, Guy’s and St Thomas’, NHS Foundation Trust and Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Umesh Chathuranga
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chamila Jayathilaka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas Alan Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
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Prasadi GAM, Mohamed F, Senarathna L, Cairns R, Pushpakumara PHGJ, Dawson AH. Paediatric poisoning in rural Sri Lanka: an epidemiological study. BMC Public Health 2018; 18:1349. [PMID: 30522467 PMCID: PMC6282383 DOI: 10.1186/s12889-018-6259-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute paediatric poisoning is a common public health concern for both developed and developing countries. The type of agent and underlying cause differ depending on the social, cultural, economic and educational background. The objectives of this study were to identify the incidence and pattern of paediatric poisoning in a rural district in Sri Lanka and establish whether tertiary referral hospital data are a useful surrogate for estimating district level epidemiology of paediatric poisoning. METHODS A subset of epidemiological data were obtained from March 2011 to February 2013 from a randomized controlled trial (SLCTR/2010/008) conducted in 45 hospitals in Kurunegala district. RESULTS The age adjusted annual incidence of all cause of acute poisoning in children aged 1 to 12 years in the study area was 60.4 per 100,000. The incidence of poisoning of younger age group (1 to 6 years; 76 per 100,000) was significantly higher than older age group (7 to 12 years; 41 per 100,000) (p = 0.0001) in Kurunegala district. The annual incidence rate of paediatric admissions due to deliberate self-poisoning is 18 per 100,000 population. This study also established that admission data from primary hospitals provided the most accurate epidemiological information on paediatric poisoning. CONCLUSIONS In rural districts of Sri Lanka, acute paediatric poisoning cases were less frequent and less severe compared to adult poisoning cases (426-446 per 100,000 population). The incidence of poisoning was significantly higher among young children with compared to old children. In this study, deliberate self-poisoning among older children was more frequently seen than in other comparable countries. Because most of the admissions are directed to and managed by primary hospitals, data from referral hospitals alone cannot be used to represent the true incidence of acute poisoning within a district. The data set from all the primary hospitals (n = 44) yielded more accurate poisoning incidence amongst a paediatric population.
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Affiliation(s)
| | - Fahim Mohamed
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,TACT, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lalith Senarathna
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rose Cairns
- Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Sydney, Australia.,New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | | | - Andrew Hamilton Dawson
- SACTRC, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Central Clinical School, University of Sydney, Sydney, Australia
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22
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Wijerathna TM, Mohamed F, Dissanayaka D, Gawarammana I, Palangasinghe C, Shihana F, Endre Z, Shahmy S, Buckley NA. Albuminuria and other renal damage biomarkers detect acute kidney injury soon after acute ingestion of oxalic acid and potassium permanganate. Toxicol Lett 2018; 299:182-190. [PMID: 30300734 DOI: 10.1016/j.toxlet.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/14/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Deliberate self-poisoning with a combination washing powder containing oxalic acid (H2C2O4) and potassium permanganate (KMnO4) is a significant medical problem in the Southern Province of Sri Lanka. Acute kidney injury (AKI) is a frequent consequence. Biomarkers for early diagnosis of nephrotoxicity could guide appropriate supportive therapies. METHODS We investigated the performance of three serum biomarkers and nine urinary biomarkers in 85 patients in an ongoing multicenter prospective cohort study in Sri Lanka exploring AKI following poisoning. RESULTS Sixty two (62/85, 73%) patients developed AKI (acute kidney injury network, AKIN, criteria). Early and rapid increases in serum creatinine (sCr) peaking on day 3 were observed in AKIN stage 2 and 3 patients. In these patients, serum cystatin C (sCysC) rose more gradually but also peaked on day 3. Biomarker concentrations (normalized to urinary creatinine) of urinary albumin (uAlbumin), clusterin (uClusterin), beta-2-microglobulin (uB2M), osteopontin (uOPN), neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (uKIM-1) in the AKIN2/3 group increased above the 95th centile concentration of the healthy population. Within 8 h of ingestion, the normalized uAlbumin and sCysC predicted AKIN2/3 with respective area under receiver operating characteristic curve, AUC-ROC values, of 0.94 (95% CI 0.86-1.00) and 0.85 (95% CI 0.76-0.95). CONCLUSIONS Urinary albumin was the best performing AKI biomarker following ingestion of H2C2O4/KMnO4. This may reflect glomerular injury and/or proximal tubular injury. The urinary albumin concentrations observed in this study could generally be detected using albumin specific dipstick methods, easily available even in resource poor settings.
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Affiliation(s)
- Thilini M Wijerathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Pharmacy, Faculty of Allied Health Science, University of Peradeniya, Peradeniya, Sri Lanka; Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney Australia; Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Dhammika Dissanayaka
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chathura Palangasinghe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fathima Shihana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Zoltan Endre
- Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney Australia
| | - Seyed Shahmy
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
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23
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García-Espiñeira M, Tejeda-Benitez L, Olivero-Verbel J. Toxicity of atrazine- and glyphosate-based formulations on Caenorhabditis elegans. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2018; 156:216-222. [PMID: 29550685 DOI: 10.1016/j.ecoenv.2018.02.075] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/04/2018] [Accepted: 02/28/2018] [Indexed: 06/08/2023]
Abstract
Atrazine and Glyphosate are herbicides massively used in agriculture for crop protection. Upon application, they are available to the biota in different ecosystems. The aim of this research was to evaluate the toxicity of Glyphosate and Atrazine based formulations (GBF and ABF, respectively). Caenorhabditis elegans was exposed to different concentrations of each single formulation, and to the mixture. Lethality, locomotion, growth, and fertility were measured as endpoints. Effects on gene expression were monitored utilizing green fluorescence protein transgenic strains. ABF caused lethality of 12%, 15%, and 18% for 6, 60, and 600 μM, respectively, displaying a dose dependence trend. GBF produced lethality of 20%, 50%, and 100% at 0.01, 10, and 100 μM, respectively. Locomotion inhibition ranged from 21% to 89% at the lowest and maximum tested concentrations for Atrazine; whereas for Glyphosate, exposure to 10 μM inhibited 87%. Brood size was decreased by 67% and 93% after treatment to 0.06 and 6 μM Atrazine, respectively; and by 23% and 93% after exposure to 0.01 and 10 μM Glyphosate, respectively. There were no significant differences in growth. Changes in gene expression occurred in all genes, highlighting the expression of sod-1, sod-4, and gpx-4 that increased more than two-fold after exposure to 600 μM ABF and 10 μM GBF. The effects observed for the mixture of these formulations were additive for lethality, locomotion and fertility. In short, GBF, ABF, and their mixture induced several toxic responses related to oxidative stress on C. elegans.
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Affiliation(s)
- María García-Espiñeira
- Environmental and Computational Chemistry Group, Zaragocilla Campus. School of Pharmaceutical Sciences. University of Cartagena, Cartagena 130015, Colombia.
| | - Lesly Tejeda-Benitez
- Development and Use of Biomass Research Group, Piedra de Bolivar Campus, School of Engineering, Universidad de Cartagena, Cartagena, 130015, Colombia.
| | - Jesus Olivero-Verbel
- Environmental and Computational Chemistry Group, Zaragocilla Campus. School of Pharmaceutical Sciences. University of Cartagena, Cartagena 130015, Colombia.
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Abstract
The burden of disease and death attributable to environmental pollution is becoming a public health challenge worldwide, especially in developing countries. The kidney is vulnerable to environmental pollutants because most environmental toxins are concentrated by the kidney during filtration. Given the high mortality and morbidity of kidney disease, environmental risk factors and their effect on kidney disease need to be identified. In this Review, we highlight epidemiological evidence for the association between kidney disease and environmental pollutants, including air pollution, heavy metal pollution and other environmental risk factors. We discuss the potential biological mechanisms that link exposure to environmental pollutants to kidney damage and emphasize the contribution of environmental pollution to kidney disease. Regulatory efforts should be made to control environmental pollution and limit individual exposure to preventable or avoidable environmental risk. Population studies with accurate quantification of environmental exposure in polluted regions, particularly in developing countries, might aid our understanding of the dose-response relationship between pollutants and kidney diseases.
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Affiliation(s)
- Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China
| | - Sheng Nie
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China
| | - Hanying Ding
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China
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25
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Valcke M, Levasseur ME, Soares da Silva A, Wesseling C. Pesticide exposures and chronic kidney disease of unknown etiology: an epidemiologic review. Environ Health 2017; 16:49. [PMID: 28535811 PMCID: PMC5442867 DOI: 10.1186/s12940-017-0254-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 05/08/2017] [Indexed: 05/20/2023]
Abstract
The main causes of chronic kidney disease (CKD) globally are diabetes and hypertension but epidemics of chronic kidney disease of unknown etiology (CKDu) occur in Central America, Sri Lanka, India and beyond. Althoug also being observed in women, CKDu concentrates among men in agricultural sectors. Therefore, suspicions fell initially on pesticide exposure, but currently chronic heat stress and dehydration are considered key etiologic factors. Responding to persistent community and scientific concerns about the role of pesticides, we performed a systematic review of epidemiologic studies that addressed associations between any indicator of pesticide exposure and any outcome measure of CKD. Of the 21 analytical studies we identified, seven were categorized as with low, ten with medium and four with relatively high explanation value. Thirteen (62%) studies reported one or more positive associations, but four had a low explanation value and three presented equivocal results. The main limitations of both positive and negative studies were unspecific and unquantified exposure measurement ('pesticides'), the cross-sectional nature of most studies, confounding and selection bias. The four studies with stronger designs and better exposure assessment (from Sri Lanka, India and USA) all showed exposure-responses or clear associations, but for different pesticides in each study, and three of these studies were conducted in areas without CKDu epidemics. No study investigated interactions between pesticides and other concommittant exposures in agricultural occupations, in particular heat stress and dehydration. In conclusion, existing studies provide scarce evidence for an association between pesticides and regional CKDu epidemics but, given the poor pesticide exposure assessment in the majority, a role of nephrotoxic agrochemicals cannot be conclusively discarded. Future research should procure assessment of lifetime exposures to relevant specific pesticides and enough power to look into interactions with other major risk factors, in particular heat stress.
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Affiliation(s)
- Mathieu Valcke
- WHO-PAHO Collaborating Centre on Environmental and Occupational Health Impact Assessment and Surveillance INSPQ-CHUQ-DSPQ, 945, Avenue Wolfe, Québec, G1V 5B3 Canada
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, C.P. 6128 Succursale Centre-Ville, Montreal, H3C 3J7 Canada
| | - Marie-Eve Levasseur
- WHO-PAHO Collaborating Centre on Environmental and Occupational Health Impact Assessment and Surveillance INSPQ-CHUQ-DSPQ, 945, Avenue Wolfe, Québec, G1V 5B3 Canada
| | - Agnes Soares da Silva
- Pan American Health Organization (PAHO), 525 Twenty-third Street, N.W, Washington DC, 20037 USA
| | - Catharina Wesseling
- Department of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, 171 77 Stockholm, SE Sweden
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Gifford FJ, Gifford RM, Eddleston M, Dhaun N. Endemic Nephropathy Around the World. Kidney Int Rep 2017; 2:282-292. [PMID: 28367535 PMCID: PMC5362147 DOI: 10.1016/j.ekir.2016.11.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/02/2016] [Accepted: 11/06/2016] [Indexed: 11/18/2022] Open
Abstract
There have been several global epidemics of chronic kidney disease of unknown etiology (CKDu). Some, such as Itai-Itai disease in Japan and Balkan endemic nephropathy, have been explained, whereas the etiology of others remains unclear. In countries such as Sri Lanka, El Salvador, Nicaragua, and India, CKDu is a major public health problem and causes significant morbidity and mortality. Despite their geographical separation, however, there are striking similarities between these endemic nephropathies. Young male agricultural workers who perform strenuous labor in extreme conditions are the worst affected. Patients remain asymptomatic until end-stage renal failure. Biomarkers of tubular injury are raised, and kidney biopsy shows chronic interstitial nephritis with associated tubular atrophy. In many of these places access to dialysis and transplantation is limited, leaving few treatment options. In this review we briefly describe the major historic endemic nephropathies. We then summarize the epidemiology, clinical features, histology and clinical course of CKDu in Mesoamerica, Sri Lanka, India, Egypt, and Tunisia. We draw comparisons between the proposed etiologies and supporting research. Recognition of the similarities may reinforce the international drive to establish causality and to effect prevention.
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Affiliation(s)
- Fiona J. Gifford
- Pharmacology, Toxicology & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Robert M. Gifford
- Pharmacology, Toxicology & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Michael Eddleston
- Pharmacology, Toxicology & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- South Asian Clinical Toxicology Research Collaboration (SACTRC), University of Peradeniya, Peradeniya, Sri Lanka
| | - Neeraj Dhaun
- Pharmacology, Toxicology & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
- Correspondence: Neeraj Dhaun, The Queen’s Medical Research Institute, 3 Floor Centre, Room C3.27, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.The Queen’s Medical Research Institute3 Floor Centre, Room C3.27, 47 Little France CrescentEdinburgh EH16 4TJUK
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