Mercury and Movement Disorders: The Toxic Legacy Continues

Evaluation of mass mercury poisoning cases occurring in a center in Türkiye: symptomatology, treatment methods, and follow-up processes

Mercury (Hg) is a toxic heavy metal with extensive applications. In children, mercury exposure often occurs inadvertently through laboratories, thermometers, or fluorescent lamps. Inhalation of elemental mercury can affect the central nervous system and urinary system. Early diagnosis and treatment are crucial to prevent severe complications. A retrospective evaluation was conducted on 82 pediatric cases of mercury poisoning who presented to Bingöl State Hospital on January 15, 2020. Blood and urine mercury levels were measured. Patients with mercury levels > 10 μg/L received intravenous treatment with 2,3-dimercaptopropane sulfonic acid (DMPS) for 5 days. Plasma and urine mercury levels were analyzed before and after treatment. Adverse effects of treatment and follow-up processes were also examined. Of the patients, 43.9% were female, and 56.1% were male, with a mean age of 9.4 ± 3.2 years. A total of 42.7% of cases were symptomatic, with headache being the most common symptom (26.8%). Significant reductions in blood and urine mercury levels were observed after treatment (p < 0.001). Adverse effects of the drug were reported in 43.9% of cases, with nausea (50%) and itching (25%) being the most frequent.Conclusion: Chelation therapy was effective in significantly reducing mercury levels in cases of mercury poisoning. Adverse effects must be carefully managed, and long-term follow-up is essential. This study provides significant contributions to the literature on mass mercury poisoning cases.

A Fast-Forward Dilute-and-Shoot Multielement Method for Analysis of 33 Elements in Human Whole Blood, Serum, and Urine by Inductively Coupled Plasma Mass Spectrometry: A Streamlined Approach for Clinical Diagnostic and Biomonitoring

The analysis of toxic and essential elements in human matrices is used in clinical diagnostics and for biomonitoring of different populations to study related health outcomes. This work aimed to develop fast and reliable methods for the analysis of a broad range of elements in liquid human matrices, such as whole blood, serum, and urine, with a similar setup for the three matrices and different analysis needs. An easy and fast-forward dilute-and-shoot method for 33 elements (i.e., Ag, Al, As, B, Ba, Be, Bi, Cd, Ce, Co, Cr, Cu, Hg, I, Li, Mn, Mo, Ni, Pb, Pd, Pt, Sb, Se, Sn, Sr, Te, Th, Tl, U, V, W, Zn, and Zr) was developed. 200 µL of either sample material was diluted with an alkaline reagent to a volume of 4 mL in total. Sample dilution and preparation of matrix-matched calibration standards were performed in 48-well plates by an automated liquid handler. Diluted samples were analyzed by inductively coupled plasma mass spectrometry on a Perkin Elmer NexIon 300D ICP-MS instrument equipped with an ESI-FAST SC2DX autosampler in kinetic energy discrimination mode with helium as cell gas at either 4.8 mL or 5.7 mL and 1600 W RF generator power. The method validation results showed good accuracy for fresh human samples from an external quality assessment scheme with measured concentrations within the assigned concentration ranges. Good precision and reproducibility for most elements were demonstrated with variation coefficients below or far below 8% and 15% for whole blood, 8% and 10% for serum, and 10% and 10% for urine, respectively. The developed reagent and instrumental setup were applicable to all three matrices. This minimizes the risk of human errors when switching between analyses of the different sample matrices and allows a rapid and easy analysis of whole blood, serum, and urine within one day if needed. The method demonstrated robustness over time, withstanding minor changes in the preparation of working solutions and samples, instrumental analysis, and setup. Analysis of human real samples showed the method's applicability for 33 toxic and essential elements in whole blood, serum, and urine and at concentrations relevant to clinical diagnostics as well as biomonitoring.

Acute onset parkinsonism after consumption of traditional Chinese medicine: A cause for vigilance

Mercury poisoning is a rare yet critical toxicological emergency, typically associated with chronic exposure. This case report details the unusual presentation of acute parkinsonism in a 66-year-old woman who had been ingesting black pills, an unidentified kind of traditional Chinese medicine, obtained from a pirate radio source. The patient displayed symptoms such as acute onset frequent falls, unsteady gait, and slow movements, prompting a detailed medical examination. The patient's neurological assessment revealed classic parkinsonian features, including mask face, cogwheel rigidity, and bradykinesia. Subsequent laboratory investigations disclosed an elevated blood mercury level (47 μg/L), and imaging studies, including 99mTc-TRODAT-1 SPECT, confirmed bilateral putamina dysfunction consistent with secondary parkinsonism. Traditional medications of Parkinsonism provided minimal relief, leading to the introduction of chelation therapy with dimercaptosuccinic acid (DMSA), resulting in a significant improvement in symptoms following a 20-day course. The discussion emphasizes the distinctive clinical manifestations of organic and inorganic mercury poisoning, underscoring the delayed onset and central nervous system involvement in organic mercury toxicity. The unidentified black pills, known to exceed mercury standards, were identified as the likely source of mercury poisoning in this case. This report acknowledges the potential reversibility of certain causes of acute parkinsonism and highlights the importance of a thorough drug history and toxicology assessment in patients presenting with acute parkinsonism. This report also contributes to the existing understanding of mercury-induced parkinsonism and emphasizes the significance of timely intervention in managing similar cases.

Health risk assessment for human mercury exposure from Cinnabaris-containing Baizi Yangxin Pills in healthy volunteers Po administration

BACKGROUND

Cinnabaris (α-HgS), a mineral traditional Chinese material medica, has been used in combination with other herbs manifesting some definite therapeutic effects for thousands of years. But the currently reported mercury poisoning incidents raised the doubts about the safety of Cinnabaris-containing traditional Chinese medicines (TCMs). Baizi Yangxin Pills (BZYXP) is a Cinnabaris-containing TCM widely used in clinical practice. This study evaluated the health risk of mercury exposure from BZYXP in healthy volunteers based on the total mercury and mercury species analysis of blood and urine after single and multiple doses of BZYXP.

METHODS

Blood pharmacokinetics and urinary excretion studies of mercury were compared between single (9 g, once daily) and multiple doses (9 g, twice daily, continued for 7 days) of BZYXP. The whole blood and urine samples were collected at the specific points or periods after the administration of BZYXP. The total mercury and mercury species in blood and urine samples were determined by cold vapor-atomic fluorescence spectrometry (CV-AFS) and HPLC-CV-AFS, respectively.

RESULTS

The mercury was excreted slowly and accumulated obviously after continuous exposure of BZYXP. Moreover, the well-known neurotoxin methylmercury (MeHg) was detected in blood samples after 7 days' administration of BZYXP. In the urine samples, only Hg(II) was detected. Therefore, long-term use of BZYXP will cause mercury poisoning due to mercury's high accumulative properties and MeHg formation.

CONCLUSION

Cinnabaris-containing TCMs such as BZYXP should be restricted to cases in which alternatives are available, and the blood mercury species profile should be monitored during the long-term clinical medication.

Developmental exposure to methylmercury alters GAD67 immunoreactivity and morphology of endothelial cells and capillaries of midbrain and hindbrain regions of adult rat offspring

INTRODUCTION

Methylmercury (MeHg) is an environmental contaminant that is of particular concern in Northern Arctic Canadian populations. Specifically, organic mercury compounds such as MeHg are potent toxicants that affect multiple bodily systems including the nervous system. Developmental exposure to MeHg is a major concern, as the developing fetus and neonate are thought to be especially vulnerable to the toxic effects of MeHg. The objective of this study was to examine developmental exposure to low doses of MeHg and effects upon the adult central nervous system (CNS). The doses of MeHg chosen were scaled to be proportional to the concentrations of MeHg that have been reported in human maternal blood samples in Northern Arctic Canadian populations.

METHOD

Offspring were exposed to MeHg maternally where pregnant Sprague Dawley rats were fed cookies that contained MeHg or vehicle (vehicle corn oil; MeHg 0.02 mg/kg/body weight or 2.0 mg/kg/body weight) daily, throughout gestation (21 days) and lactation (21 days). Offspring were not exposed to MeHg after the lactation period and were euthanized on postnatal day 450. Brains were extracted, fixed, frozen, and sectioned for immunohistochemical analysis. A battery of markers of brain structure and function were selected including neuronal GABAergic enzymatic marker glutamic acid decarboxylase-67 (GAD67), apoptotic/necrotic marker cleaved caspase-3 (CC3), catecholamine marker tyrosine hydroxylase (TH), immune inflammatory marker microglia (Cd11b), endothelial cell marker rat endothelial cell antigen-1 (RECA-1), doublecortin (DCX), Bergmann glia (glial fibrillary acidic protein (GFAP)), and general nucleic acid and cellular stains Hoechst, and cresyl violet, respectively. Oxidative stress marker lipofuscin (autofluorescence) was also assessed. Both male and female offspring were included in analysis. Two-way analysis of variance (ANOVA) was utilized where sex and treatment were considered as between-subject factors (p* <0.05). ImageJ was used to assess immunohistochemical results.

RESULTS

In comparison with controls, adult rat offspring exposed to both doses of MeHg were observed to have (1) increased GAD67 in the cerebellum; (2) decreased lipofuscin in the locus coeruleus; and (3) decreased GAD67 in the anterior CA1 region. Furthermore, in the substantia nigra and periaqueductal gray, adult male offspring consistently had a larger endothelial cell and capillary perimeter in comparison to females. The maternal high dose of MeHg influenced RECA-1 immunoreactivity in both the substantia nigra and periaqueductal gray of adult rat offspring, where the latter neuronal region also showed statistically significant decreases in RECA-1 immunoreactivity at the maternal low dose exposure level. Lastly, males exposed to high doses of MeHg during development exhibited a statistically significant increase in the perimeter of endothelial cells and capillaries (RECA-1) in the cerebellum, in comparison to male controls.

CONCLUSION

Findings suggest that in utero and early postnatal exposure to MeHg at environmentally relevant doses leads to long-lasting and selective changes in the CNS. Exposure to MeHg at low doses may affect GABAergic homeostasis and vascular integrity of the CNS. Such changes may contribute to neurological disturbances in learning, cognition, and memory that have been reported in epidemiological studies.

Should ebselen be considered for the treatment of mercury intoxication? A minireview

Mercury is a ubiquitous environmental contaminant and can be found in inorganic (Hg0, Hg+ and Hg2+) and organic forms (chiefly CH3Hg+ or MeHg+). The main route of human, mammals and bird exposure occurs via predatory fish ingestion. Occupational exposure to Hg0 (and Hg2+) can also occur; furthermore, in gold mining areas the exposure to inorganic Hg can also be high. The toxicity of electrophilic forms of Hg (E+Hg) is mediated by disruption of thiol (-SH)- or selenol (-SeH)-containing proteins. The therapeutic approaches to treat methylmercury (MeHg+), Hg0 and Hg2+ are limited. Here we discuss the potential use of ebselen as a potential therapeutic agent to lower the body burden of Hg in man. Ebselen is a safe drug for humans and has been tested in clinical trials (for instance, brain ischemia, noise-induce hearing loss, diabetes complications, bipolar disorders) at doses varying from 400 to 3600 mg per day. Two clinical trials with ebselen in moderate and severe COVID are also approved. Ebselen can be metabolized to an intermediate with -SeH (selenol) functional group, which has a greater affinity to electrophilic Hg (E+Hg) forms than the available thiol-containing therapeutic agents. Accordingly, as observed in vitro and rodent models in vivo, Ebselen exhibited protective effects against MeHg+, indicating its potential as a therapeutic agent to treat MeHg+ overexposure. The combined use of ebselen with thiol-containing molecules (e.g. N-acetylcysteine and enaramide)) is also commented, because they can have synergistic protective effects against MeHg+.

Effect of methylmercury on fetal neurobehavioral development: an overview of the possible mechanisms of toxicity and the neuroprotective effect of phytochemicals

Methylmercury (MeHg) is a global environmental pollutant with neurotoxic effects. Exposure to MeHg via consumption of seafood and fish can severely impact fetal neurobehavioral development even when MeHg levels in maternal blood are as low as about 5 μg/L, which the mother tolerates well. Persistent motor dysfunctions and cognitive deficits may result from trans-placental exposure. The present review summarizes current knowledge on the mechanisms of MeHg toxicity during the period of nervous system development. Although cerebellar Purkinje cells are MeHg targets, the actions of MeHg on thiol components in the neuronal cytoskeleton as well as on mitochondrial enzymes and induction of disturbances of glutamate signaling can impair extra-cerebellar functions, also at levels well tolerated by adult individuals. Numerous herbal substances possess neuroprotective effects, predominantly represented by natural polyphenolic molecules that might be utilized to develop natural drugs to alleviate neurotoxicity symptoms caused by MeHg or other Hg compounds.

Effects of Removal Conditions on Mercury Amount Remaining in the Oral Cavity and inside Drainage System after Removing Dental Amalgams

Mercury is produced and drained into the environment by removing dental amalgams, which may cause mercury pollution. This study aimed to clarify the mercury amount remaining in the oral cavity and inside the drain system after removal. The effects of the removal conditions and differences in drainage systems were also investigated. Dental amalgams filled in the tooth and placed in a phantom head were removed using an air turbine under several conditions (two removal methods, absence of cooling water, and intraoral suction). Then, the oral cavity was rinsed with 100 mL of water (oral rinse water), and 500 mL of water was suctioned to wash the inside of the drainage system (system rinse water). Both water samples were collected in two ways (amalgam separator and gas-liquid separator), and their mercury amounts were measured. It was found that the amount of mercury left in the oral cavity and drainage system after dental amalgams removal could be reduced when the amalgams were removed by being cut into fragments as well as using cooling water and intraoral suction. In addition, using amalgam separators can significantly reduce the amount of mercury in the discharge water and prevent the draining of mercury into the environment.