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Unuma K, Wen S, Sugahara S, Nagano S, Aki T, Ogawa T, Takeda-Homma S, Oikawa M, Tojo A. Thallium reabsorption via NKCC2 causes severe acute kidney injury with outer medulla-specific calcium crystal casts in rats. Arch Toxicol 2024; 98:3973-3986. [PMID: 39361050 PMCID: PMC11496332 DOI: 10.1007/s00204-024-03868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 09/10/2024] [Indexed: 10/23/2024]
Abstract
Thallium (Tl) is one of the most toxic heavy metals, associated with accidental poisoning and homicide. It causes acute and chronic systemic diseases, including gastrointestinal and cardiovascular diseases and kidney failure. However, few studies have investigated the mechanism by which Tl induces acute kidney injury (AKI). This study investigated the toxic effects of Tl on the histology and function of rat kidneys using biochemical and histopathological assays after intraperitoneal thallium sulfate administration (30 mg/kg). Five days post-administration, rats exhibited severely compromised kidney function. Low-vacuum scanning electron microscopy revealed excessive calcium (Ca) deposition in the outer medulla of Tl-loaded rats, particularly in the medullary thick ascending limb (mTAL) of the loop of Henle. Tl accumulated in the mTAL, accompanied by mitochondrial dysfunction in this segment. Tl-loaded rats showed reduced expression of kidney transporters and channels responsible for Ca2+ reabsorption in the mTAL. Pre-administration of the Na-K-Cl cotransporter 2 (NKCC2) inhibitor furosemide alleviated Tl accumulation and mitochondrial abnormalities in the mTAL. These findings suggest that Tl nephrotoxicity is associated with preferential Tl reabsorption in the mTAL via NKCC2, leading to mTAL mitochondrial dysfunction and disrupted Ca2+ reabsorption, culminating in mTAL-predominant Ca crystal deposition and AKI. These findings on the mechanism of Tl nephrotoxicity may contribute to the development of novel therapeutic approaches to counter Tl poisoning. Moreover, the observation of characteristic Ca crystal deposition in the outer medulla provides new insights into diagnostic challenges in Tl intoxication.
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Affiliation(s)
- Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Shuheng Wen
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Sho Sugahara
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shutaro Nagano
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshihiko Aki
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tadayuki Ogawa
- Comprehensive Research Facilities for Advanced Medical Science, Dokkyo Medical University, Tochigi, Japan
| | - Shino Takeda-Homma
- National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Masakazu Oikawa
- National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Akihiro Tojo
- Department of Nephrology and Hypertension, Dokkyo Medical University, Tochigi, Japan
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Fujihara J, Nishimoto N. Thallium - poisoner's poison: An overview and review of current knowledge on the toxicological effects and mechanisms. Curr Res Toxicol 2024; 6:100157. [PMID: 38420185 PMCID: PMC10899033 DOI: 10.1016/j.crtox.2024.100157] [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: 10/30/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
Thallium (Tl) is one of the most toxic metals and its historic use in homicides has led it to be known as "the poisoner's poison." This review summarizes the methods for identifying Tl and determining its concentrations in biological samples in recently reported poisoning cases, as well as the toxicokinetics, toxicological effects, toxicity mechanisms, and detoxication methods of Tl. Recent findings regarding Tl neurotoxicological pathways and toxicological effects of Tl during pregnancy are also presented. Confirmation of elevated Tl concentrations in blood, urine, or hair is indispensable for diagnosing Tl poisoning. The kidneys show the highest Tl concentration within 24 h after ingestion, while the brain shows the highest concentration thereafter. Tl has a very slow excretion rate due to its large distribution volume. Following acute exposure, gastrointestinal symptoms are observed at an early stage, and neurological dysfunction is observed later: Tl causes the most severe damage in the central nervous system. Alopecia and Mees' lines in the nails are observed within 1 month after Tl poisoning. The toxicological mechanism of Tl is considered to be interference of vital potassium-dependent processes with Tl+ because its ionic radius is similar to that of K+, as well as inhibition of enzyme reactions by the binding of Tl to -SH groups, which disturbs vital metabolic processes. Tl toxicity is also related to reactive oxygen species generation and mitochondrial dysfunction. Prussian blue is the most effective antidote, and metallothionein alone or in combination with Prussian blue was recently reported to have cytoprotective effects after Tl exposure. Because Tl poisoning cases are still reported, early determination of Tl in biological samples and treatment with an antidote are essential.
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Affiliation(s)
- Junko Fujihara
- Department of Legal Medicine, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane 693-8501, Japan
| | - Naoki Nishimoto
- Shimane Institute for Industrial Technology, 1 Hokuryo, Matsue, Shimane 690-0816, Japan
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Abd Elnabi MK, Elkaliny NE, Elyazied MM, Azab SH, Elkhalifa SA, Elmasry S, Mouhamed MS, Shalamesh EM, Alhorieny NA, Abd Elaty AE, Elgendy IM, Etman AE, Saad KE, Tsigkou K, Ali SS, Kornaros M, Mahmoud YAG. Toxicity of Heavy Metals and Recent Advances in Their Removal: A Review. TOXICS 2023; 11:580. [PMID: 37505546 PMCID: PMC10384455 DOI: 10.3390/toxics11070580] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/29/2023]
Abstract
Natural and anthropogenic sources of metals in the ecosystem are perpetually increasing; consequently, heavy metal (HM) accumulation has become a major environmental concern. Human exposure to HMs has increased dramatically due to the industrial activities of the 20th century. Mercury, arsenic lead, chrome, and cadmium have been the most prevalent HMs that have caused human toxicity. Poisonings can be acute or chronic following exposure via water, air, or food. The bioaccumulation of these HMs results in a variety of toxic effects on various tissues and organs. Comparing the mechanisms of action reveals that these metals induce toxicity via similar pathways, including the production of reactive oxygen species, the inactivation of enzymes, and oxidative stress. The conventional techniques employed for the elimination of HMs are deemed inadequate when the HM concentration is less than 100 mg/L. In addition, these methods exhibit certain limitations, including the production of secondary pollutants, a high demand for energy and chemicals, and reduced cost-effectiveness. As a result, the employment of microbial bioremediation for the purpose of HM detoxification has emerged as a viable solution, given that microorganisms, including fungi and bacteria, exhibit superior biosorption and bio-accumulation capabilities. This review deals with HM uptake and toxicity mechanisms associated with HMs, and will increase our knowledge on their toxic effects on the body organs, leading to better management of metal poisoning. This review aims to enhance comprehension and offer sources for the judicious selection of microbial remediation technology for the detoxification of HMs. Microbial-based solutions that are sustainable could potentially offer crucial and cost-effective methods for reducing the toxicity of HMs.
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Affiliation(s)
- Manar K. Abd Elnabi
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
- Biotechnology Program, Institute of Basic and Applied Science (BAS), Egypt-Japan University of Science and Technology, New Borg El-Arab City 21934, Egypt
| | - Nehal E. Elkaliny
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Maha M. Elyazied
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Shimaa H. Azab
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Shawky A. Elkhalifa
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Sohaila Elmasry
- Microbiology Department, Faculty of science, Damanhour University, Behaira 22514, Egypt;
| | - Moustafa S. Mouhamed
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Ebrahim M. Shalamesh
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Naira A. Alhorieny
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Abeer E. Abd Elaty
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Ibrahim M. Elgendy
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Alaa E. Etman
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Kholod E. Saad
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
| | - Konstantina Tsigkou
- Department of Chemical Engineering, University of Patras, 1 Karatheodori str, 26504 Patras, Greece;
| | - Sameh S. Ali
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
- Biofuels Institute, School of the Environment and Safety Engineering, Jiangsu University, Zhenjiang 212013, China
| | - Michael Kornaros
- Department of Chemical Engineering, University of Patras, 1 Karatheodori str, 26504 Patras, Greece;
| | - Yehia A.-G. Mahmoud
- Botany Department, Faculty of Science, Tanta University, Tanta 31527, Egypt; (M.K.A.E.); (N.E.E.); (M.M.E.); (S.H.A.); (S.A.E.); (M.S.M.); (E.M.S.); (N.A.A.); (A.E.A.E.); (I.M.E.); (A.E.E.); (K.E.S.); (Y.A.-G.M.)
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Pragst F, Hartwig S. Repeated poisoning of the life partner by thallium - a case of questionable Munchausen by adult proxy syndrome with ensuing attempted murder. Int J Legal Med 2022; 136:695-704. [PMID: 35190879 DOI: 10.1007/s00414-022-02791-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
Abstract
After the use of thallium as rat poison was banned, the knowledge about the severe and treacherous course of poisonings with this toxic metal has widely been lost. In the present case, the male victim sustained two insidious poisoning attacks in 2017 and 2020 by the perpetrator, his female life partner. In the first poisoning episode, he suffered from increasing heavy pain of the abdomen, stinging pain of both legs, persistent obstipation, hyperesthesia, and, after about 2 weeks, tuft-wise loss of hair as typical symptoms of the thallium poisoning. Within 7 weeks, he was successively examined in six hospitals with a wide variety of diagnostic methods, but a conclusive explanation of the complaints was not found. The possibility of a metal intoxication was then suggested by the perpetrator who privately arranged the analysis of a blood sample with the result of 175 µg/l thallium. Although a criminal poisoning was assumed, the perpetrator was not identified. After the victim left the perpetrator, she subtly executed a second poisoning attack with thallium sulfate (blood level 1230 µg/l after 1 day, urine level 4760 µg/l after 10 days, and hair concentrations 3.26-0.49 from proximal to distal in 9 segments). The perpetrator was sentenced to 10.5 years imprisonment for grievous bodily harm and attempted murder. Because of the behavior of the perpetrator, a Munchausen by proxy syndrome was discussed as a motivation of the first poisoning but was excluded by the psychiatric expert because of a missing antisocial personality disorder.
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Affiliation(s)
- Fritz Pragst
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Forensic Medicine, Turmstraße 21 (Haus N), 10559, Berlin, Germany
| | - Sven Hartwig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Forensic Medicine, Turmstraße 21 (Haus N), 10559, Berlin, Germany
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Wang TT, Wen B, Yu XN, Ji ZG, Sun YY, Li Y, Zhu SL, Cao YL, Wang M, Jian XD, Wang T. Early diagnosis, treatment, and outcomes of five patients with acute thallium poisoning. World J Clin Cases 2021; 9:5082-5091. [PMID: 34307559 PMCID: PMC8283604 DOI: 10.12998/wjcc.v9.i19.5082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/27/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thallium poisoning is rare and difficult to recognize. Early diagnosis and treatment of thallium-poisoned patients are essential to prevent morbidity and mortality.
AIM To evaluate the efficacy of treatments and outcomes of five patients with early diagnosis of acute thallium poisoning.
METHODS Five patients who consumed a thallium-contaminated meal were hospitalized in succession, and underwent clinical examinations such as blood tests and electromyography tests. Urine and blood tests confirmed the diagnosis of thallotoxicosis, revealing the occurrence of food poisoning. All patients underwent detoxification treatment, including hemoperfusion (HP) and treatment with Prussian blue (PB). A 24-mo follow-up was performed to evaluate the long-term outcomes on the patients after discharge.
RESULTS Initially, the patients presented with symptoms of acute thallium poisoning including hyperalgesia of the limbs and abdominalgia, which may differ from common peripheral neuropathy. Accompanying symptoms such as hepatic damage and alopecia were observed in all the patients, which further confirmed the diagnosis of poisoning. Treatment with chelating agents was ineffective, while HP and treatment with PB drastically decreased the thallium concentration in the urine and blood. With early diagnosis and intervention, four patients had a good prognosis and no permanent sequelae. One patient developed blindness and disability during the 24-mo follow-up period.
CONCLUSION Identification of incident cluster and characteristic symptoms is extremely important for early diagnosis of acute thallium poisoning. HP plus PB is essential to improve the prognosis of thallium-poisoned patients.
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Affiliation(s)
- Ting-Ting Wang
- Department of Neurology, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
| | - Bing Wen
- Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Xiu-Nan Yu
- Department of Neurology, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
| | - Zhang-Ge Ji
- Department of Neurology, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
| | - Yi-Yong Sun
- Department of Neurology, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
| | - Ying Li
- Department of Neurology, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
| | - Shou-Lian Zhu
- Department of Neurology, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
| | - Yong-Liang Cao
- Department of Neurology, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
| | - Mei Wang
- Department of Neurology, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
| | - Xiang-Dong Jian
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Tan Wang
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
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Concurrent Heavy Metal Exposures and Idiopathic Dilated Cardiomyopathy: A Case-Control Study from the Katanga Mining Area of the Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094956. [PMID: 34066615 PMCID: PMC8124897 DOI: 10.3390/ijerph18094956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023]
Abstract
Blood and/or urine levels of 27 heavy metals were determined by ICPMS in 41 patients with dilated cardiomyopathy (DCM) and 29 presumably healthy subjects from the Katanga Copperbelt (KC), in the Democratic Republic of Congo (DRC). After adjusting for age, gender, education level, and renal function, DCM probability was almost maximal for blood concentrations above 0.75 and 150 µg/dL for arsenic and copper, respectively. Urinary concentrations above 1 for chromium, 20 for copper, 600 for zinc, 30 for selenium, 2 for cadmium, 0.2 for antimony, 0.5 for thallium, and 0.05 for uranium, all in μg/g of creatinine, were also associated with increased DCM probability. Concurrent and multiple exposures to heavy metals, well beyond permissible levels, are associated with increased probability for DCM. Study findings warrant screening for metal toxicity in case of DCM and prompt public health measures to reduce exposures in the KC, DRC.
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