Effects of aluminium, lead and zinc on delta-aminolaevulinic acid dehydratase

Lead, Mercury and Cadmium in Fish and Shellfish from the Indian Ocean and Red Sea (African Countries): Public Health Challenges

The main aim of this review was to assess the incidence of Pb, Hg and Cd in seafood from African countries on the Indian and the Red Sea coasts and the level of their monitoring and control, where the direct consumption of seafood without quality control are frequently due to the poverty in many African countries. Some seafood from African Indian and the Red Sea coasts such as mollusks and fishes have presented Cd, Pb and Hg concentrations higher than permitted limit by FAOUN/EU regulations, indicating a possible threat to public health. Thus, the operationalization of the heavy metals (HM) monitoring and control is strongly recommended since these countries have laboratories with minimal conditions for HM analysis.

Hypothesis: Metabolic targeting of 5-aminolevulinate synthase by tryptophan and inhibitors of heme utilisation by tryptophan 2,3-dioxygenase as potential therapies of acute hepatic porphyrias

Metabolic targeting of liver 5-aminolevulinate synthase (5-ALAS) by inhibition of heme utilisation by tryptophan (Trp) 2,3-dioxygenase (TDO) or the use of tryptophan is proposed as a therapy of acute hepatic porphyrias. 5-ALAS, the rate-limiting enzyme of heme biosynthesis, is under negative feedback control by a small regulatory heme pool in the hepatic cytosol. Acute porphyric attacks, precipitated by fasting, certain hormones and some drugs, involve induction of 5-ALAS secondarily to depletion of the above pool, and the resultant elevation of 5-ALA levels initiates the abdominal and neurological symptoms of attacks. By utilising the regulatory heme, cytosolic TDO undermines the feedback control, thus allowing 5-ALAS induction to occur, e.g. upon glucocorticoid induction of TDO during fasting (starvation) and exogenous glucocorticoid administration. Currently, glucose therapy is the preferred strategy for reversing moderate attacks induced by fasting (calorie restriction), with more severe attacks being treated by intravenous heme preparations. Reversal of fasting-induced attacks by glucose is explained by the previously demonstrated reversal of increased heme utilisation by TDO. Inhibitors of this utilisation are therefore potential therapeutic targets in acute attacks and also for maintenance of a symptomless state. Existing TDO inhibitors other than glucose include allopurinol, nicotinamide and recently developed potent inhibitors such as LM10 used in cancer therapy. Based on studies in rats, the hypothesis predicts that the safety or otherwise of drugs in the hepatic porphyrias is determined by their ability to inhibit TDO utilisation of heme under basal conditions or after glucocorticoid induction or heme activation of TDO, in parallel with reciprocal changes in 5-ALAS induction. Tryptophan is also proposed as a potential therapy of acute attacks either alone or as an adjunct to the recently proposed 5-ALAS1 gene silencing. Trp increases heme biosynthesis by enhancing 5-ALA dehydratase activity and, based on a Trp-5-ALA model presented herein, Trp offers several advantages over heme therapy, namely rapid conversion of 5-ALA into heme, a greatly enhanced heme availability, a near complete inhibition of 5-ALAS induction, assumed rapid clearance of 5-ALA and hence accelerated resolution of symptoms of attacks, and finally provision of the neuroprotective metabolite kynurenic acid to neutralise the neurological symptoms. The hypothesis also addresses heme regulation in species lacking the TDO free apoenzyme and its glucocorticoid induction mechanism and proposes detailed assessment of heme biosynthesis in these species. Detailed proposals for testing the hypothesis are presented.

8-Hydroxyquinolines: a review of their metal chelating properties and medicinal applications

Metal ions play an important role in biological processes and in metal homeostasis. Metal imbalance is the leading cause for many neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis. 8-Hydroxyquinoline (8HQ) is a small planar molecule with a lipophilic effect and a metal chelating ability. As a result, 8HQ and its derivatives hold medicinal properties such as antineurodegenerative, anticancer, antioxidant, antimicrobial, anti-inflammatory, and antidiabetic activities. Herein, diverse bioactivities of 8HQ and newly synthesized 8HQ-based compounds are discussed together with their mechanisms of actions and structure–activity relationships.

Pyrithione and 8-hydroxyquinolines transport lead across erythrocyte membranes

Acute and chronic lead poisoning remains a significant health problem. Although chelating agents can bind to plasma lead, they cannot cross cell membranes where the total body lead burden resides, and are thus inefficient at reducing the total body lead burden. Recently, calcium and sodium ionophores have been shown to transport lead across cell membranes providing a novel method for reducing total body lead stores. We recently found that clioquinol, an 8-hydroxyquinoline derivative, can act as a zinc ionophore. We postulated that zinc ionophores might also be able to transport lead across biological membranes. To study this, we loaded lead in vitro into human erythrocytes and then studied the ability of zinc ionophores to transport lead into the extracellular space, where it was trapped with a lead chelator. Using inductively coupled plasma mass spectrometry (ICP-MS), we found that several 8-hydroxyquinoline derivatives, as well as the zinc and sodium salts of pyrithione (N-hydroxypyridine-2-thione), reduced erythrocyte lead content. The water-soluble compound, sodium pyrithione, was able to reduce lead in citrated whole blood, without partitioning into the erythrocytes. These results indicate that two classes of zinc ionophores can transport lead across a biological membrane, and they confirm that these ionophores are not cation-specific. Lead ionophores may prove useful in mobilizing lead into the extracellular space, thereby improving the efficacy of chelation therapy, in vivo or ex vivo.

Serum Clara Cell Protein as an Indicator of Pulmonary Impairment in Occupational Exposure at Aluminum Foundry

OBJECTIVES

Although some of the exposures in aluminum (Al) smelting have been well characterized, and respiratory disorders in aluminum production workers are well known, the relationship between internal aluminum loads and appropriate lung biomarkers have not been elucidated. The aim of our work was to carry out a comprehensive investigation in workers employed in the Aluminum Foundry Casting Department with special reference to currently existing hygiene standards, known as threshold limit values (TLV) based on aluminum effects on the respiratory system. The measurement of serum anti-inflammatory Clara cell protein (CC16) was employed as a peripheral marker of the lung epithelium function.

MATERIALS AND METHODS

A group of 50 casting smelters, 5 locksmiths, 11 sawyers and auxiliary workers exposed to dust containing 14% of aluminum, and a group of 42 controls were examined. Respiratory function tests were performed and forced volume capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory volume in the first percent (FEV1%), forced expiratory flows in 50% VC (FEV50), and markers of foundry workers' exposure and body burden, Al concentration in the breathing zone, blood and urine, biomarkers of the effects of exposure, concentration of CC16 and hyaluronic acid (HA) in serum were determined in all examined workers. Additional measurements comprised determinations of serum iron (Fe) levels, myeloperoxidase (MPO), eosinophil cationic protein (ECP), immunoglobulin E (IgE), glutathione S-transferase (GST), and superoxide dismutase (SOD) activity in erythrocytes.

RESULTS

The group of casting smelters was characterized by the highest levels of aluminum in urine (Al-U) (43.7 microg L(-1)), high levels of MPO, ECP and IgE, high SOD activity, low CC16 levels, and low activity of GST. Lower Al-U excretion was observed in locksmiths (35.2 microg L(-1)) and sawyers (21.7 microg L(-1)). Serum CC16 proved to be the most sensitive biomarker, showing high inverse relationship with serum Al (Al-S) concentrations in casting smelters (p = 0.006).

CONCLUSIONS

The study showed that in conditions of occupational exposure, dusts containing Al2O3 < 1 mg m(-3) cause changes in the respiratory system and biomarkers in serum, especially in CC16, connected with altered functioning of this system. Changes in concentrations of the examined biomarkers and also in respiratory parameters of the study subjects were observed when Al-U concentration was > 40 microg L (-1).

Inorganics and hormesis

The article is a comprehensive review of the occurrence of hormetic dose-response relationships induced by inorganic agents, including toxic agents, of significant environmental and public health interest (e.g., arsenic, cadmium, lead, mercury, selenium, and zinc). Hormetic responses occurred in a wide range of biological models (i.e., plants, invertebrate and vertebrate animals) for a large and diverse array of endpoints. Particular attention was given to providing an assessment of the quantitative features of the dose-response relationships and underlying mechanisms that could account for the biphasic nature of the hormetic response. These findings indicate that hormetic responses commonly occur in appropriately designed experiments and are highly generalizeable with respect to biological model responses. The hormetic dose response should be seen as a reliable feature of the dose response for inorganic agents and will have an important impact on the estimated effects of such agents on environmental and human receptors.

Effect of aluminum on delta-aminolevulinic acid dehydratase from mouse blood

The objective of this study was to investigate aluminum deposition in whole blood and plasma of mice and the activity of blood delta-aminolevulinic acid dehydratase (ALA-D) after in vitro and in vivo exposure to this element. In vitro experiments showed activation and inhibition of the enzyme activity when 0.01-5.0 mM of aluminum sulphate were used (IC(50): 1.31 mM). Treatment with citrate and aluminum plus citrate increased ALA-D activity in vivo and the increase in enzyme activity was parallel to the increase in aluminum content in blood and plasma. These results show that aluminum has a distinct effect on ALA-D activity: first, at relatively lower concentrations it activated, and at high concentration it inhibited, blood ALA-D in vitro; second, it activated the enzyme when administered to drinking water. One important toxicological finding of the present report is that the apparent irrelevant addition of citrate to the drinking water significantly increased the level of aluminum in blood and plasma. Thus, in order to predict more accurately the extent of human exposure to aluminum it would be advantageous to consider the level of citrate ingestion and not exclusively the aluminum level in water or food.

Interaction of aluminum with exogenous and endogenous iron in the organism of rats

The aim of these experiments was to find changes in free erythrocyte protoporphyrins (FEP) and in the concentration of endogenous iron in the blood, erythrocytes, serum, liver, kidneys, and spleen of rats, as well as in the dynamics of aluminum concentrations in the serum of rats after oral application of aluminum chloride (AlCl(3)) separately or with ferrum chloride (FeCl(2)), depending on the time and doses administered. The experiments were carried out on female Wistar rats which received (p.o.) 100 mg Al/kg separately or with iron (4 mg Fe/kg) daily for 35 days. The effects of aluminum administration were noticed after the second week. The experiments demonstrated that the increase in the level of free erythrocyte protoporphyrins in the blood is the most sensitive indicator of exposure to AlCl(3). A decrease in iron concentration in erythrocytes, blood, and spleen was also noticed. The response and the sequence of the investigated effects were recorded according to aluminum and iron concentration in the serum. Joint administration of iron and aluminum decreases concentration of aluminum in serum and prevents changes in the investigated indicators in rats exposed to aluminum chloride.

Kinetics of aluminum-induced inhibition of delta-aminolevulinic acid dehydratase in vitro

Anemia, one consequence of aluminum toxicity, may be due to inhibition of enzymes in the heme biosynthetic pathway. In this study, the in vitro effect of aluminum on rat liver and erythrocyte delta-aminolevulinic acid dehydratase (delta-ALA dehydratase), an enzyme that is sensitive to a number of metal ions, was investigated. The presence of 1-10 microM AlCl3 caused a concentration-dependent inhibition of liver delta-ALA dehydratase activity. The Ki for AlCl3-induced inhibition of delta-ALA dehydratase was 4.1 microM, and 10 microM AlCl3 virtually abolished delta-ALA dehydratase activity (99% inhibition). Erythrocyte delta-ALA dehydratase was also inhibited by similar concentrations of AlCl3 and displayed a Ki of 1.1 microM. AlCl3 (5 microM) decreased the Vmax by 50% but did not change the Km, suggestive of reversible, noncompetitive inhibition. Sodium citrate (50 microM) when added with AlCl3 completely restored delta-ALA dehydratase activity to basal levels. Thus, disruption of delta-ALA dehydratase occurred at low micromolar levels of AlCl3 in vitro, which may help to explain abnormalities in the heme pathway in cases of aluminum poisoning.

Physiological and toxicological changes in the skin resulting from the action and interaction of metal ions

The human environment contains more than 50 metal or metalloid elements. At least 15 are recognized as trace elements, with zinc, calcium, copper, magnesium, and iron having specific roles in skin morphogenesis and function. The present review focuses on the presumed role of metal ions in the skin, their competition for carrier proteins, and membrane receptors. Evidence presented shows that the balance of trace metal ions is critical for normal skin and repair mechanisms following injury. Xenobiotic ions can impair this balance, leading to pathological change. The skin acts as an organ of elimination of excess trace metals and xenobiotic ions from the body, but mechanisms of voidance vary for different metals. Metal ions are an important cause of allergies, and evidence is presented to show that the majority of metals or metal compounds can induce allergic changes. Except for chromium and nickel, which are among the most common human allergens, animal models have provided little information. At least cadmium, thorium, lead, chromium, nickel, beryllium, and arsenic and proven or putative carcinogens in animals or humans on the basis of cytological or epidemiological evidence. However, only arsenic exhibits a clear predilection for the skin. Other metals such as gold can induce subcutaneous sarcoma following injection, but the relevance of this observation in terms of human occupational risk is discounted.

The effect of aluminum chloride on some steps of heme biosynthesis in rats after oral exposure

Certain disturbances in heme biosynthesis induced by aluminum chloride were examined. The experiment was performed on female rats that received AlCl3 orally at the dose 100 mg Al/kg daily for 21 d. The effects of aluminum on the activity of delta-aminolevulinic acid synthetase (ALA-S), dehydratase (ALA-D), and heme oxygenase (O.H.) were observed on 3, 7, 14, and 21 d in liver and kidneys of rats. Also the activity of ALA-D in blood and the concentration of delta-aminolevulinic acid (ALA-U) in urine were observed. Orally administered aluminum caused increase in the activity of ALA-D in the liver and blood, and parallel decrease of ALA-U in urine (r = -0.85) of rats. Aluminum chloride also induced an increase of ALA-S and O.H. in the liver but not in the kidneys. The changes of the enzymes activity participating in heme biosynthesis after administration of aluminum may be correlated with anemia and iron metabolism in rats.

Hematological effects of aluminum on living organisms

1. Aluminum has been of great interest for many researchers over a number of years; its biochemical and physiological role is not yet fully clear. There are few papers describing the hematological consequences of its excess in living organisms and most of their data are cited in this paper. 2. Aluminum reduced the deformability of erythrocytes, and such cells are rather frequently retained in the reticuloendothelial system of the spleen and eliminated faster from the blood stream. 3. Aluminum produces peroxidative changes in the erythrocytes membrane, leading to hemolysis. Therefore, the depressed erythrocyte count in animals intoxicated with aluminum may be the consequence of both the hemolytic action of aluminum and the shortened time of survival of erythrocytes. 4. It was demonstrated that aluminum inhibits heme biosynthesis in vitro. This problem requires, however, further studies and observation. 5. Changes occurring under the influence of Al3+ on the leukocyte system of animals suggest the influence of this element on the resistance of the organism, but the mechanism of the action of Al3+ still requires elucidation. 6. Cell metabolism including blood cells may be affected by aluminum in many ways, the more so as the element may combine in vitro with amino acids, peptides, proteins, enzymes, substrates, cofactors, nucleotides and carbohydrates. Aluminum stimulates NADPH oxidation and takes part in the process of free radical formation.

Effect of aluminum mobilization on hemoglobin during the first six months after transplantation

We prospectively monitored 38 patients for the first six months following successful renal cadaver allograft transplantation. Hemoglobin increased from a mean of 8.2 +/- 0.3 g/dl to 13.4 +/- 0.3 g/dl (SEM), P < 0.001, plasma aluminum decreased from 1.3 +/- 0.2 mumol/liter to 0.46 +/- 0.04 mumol/liter, P < 0.001, and urinary aluminum excretion which peaked at one week post-transplant, 5.5 +/- 1.3 mumol/24 hr decreased to 1.8 +/- 0.3 mumol/24 hr, P < 0.001. Prior to transplantation 22 patients had been prescribed aluminum-containing phosphate binders. Following transplantation this group had persistently greater plasma aluminum and urinary aluminum concentrations which were sustained throughout the study period, compared with those not given aluminum containing medicaments. Hemoglobin and iron status were similar in the two groups prior to transplantation, although red blood cell volume was smaller in those given aluminum-containing phosphate binders, 89 +/- 0.9 fl (fentoliters) versus 95 +/- 1.6 fl, P < 0.05. However, the percentage increase in hemoglobin following transplantation was greater in the group not given aluminum preparations, 34 +/- 4% versus 7 +/- 5% at one month, 69 +/- 7% versus 37 +/- 7% at three months, and 80 +/- 8% versus 56 +/- 8% at six months respectively, all P < 0.05. This study suggests that aluminum mobilization following successful renal transplantation may reduce the rate of hemopoiesis.

Resistance to recombinant human erythropoietin due to aluminium overload and its reversal by low dose desferrioxamine therapy

Seventeen severely anaemic and transfusion-dependent haemodialysis patients with a haemoglobin less than 7 g/dl were treated with recombinant human erythropoietin (r-Hu-EPO). Aluminium toxicity was diagnosed by a positive desferrioxamine (DFO) test and bone biopsy. Seven out of eight patients without aluminium toxicity responded to r-Hu-EPO therapy. Similarly all patients with aluminium toxicity (n = 4) but pre-treated with standard dose of DFO prior to r-Hu-EPO therapy responded but none of the patients with untreated aluminium toxicity (n = 5) responded to r-Hu-EPO therapy. In order to achieve adequate response in these patients, r-Hu-EPO and DFO had to be given in combination. The dose of desferrioxamine used to reverse r-Hu-EPO resistance was less and also used for a short time. We therefore confirm r-Hu-EPO resistance owing to aluminium overload and report its successful and safe reversal with low dose DFO therapy.

Chemistry and biology of heme. Effect of metal salts, organometals, and metalloporphyrins on heme synthesis and catabolism, with special reference to clinical implications and interactions with cytochrome P-450

Although free porphyrins occur in nature in small quantities, no known function has been assigned to them. In contrast, heme and cobalamin, which are Fe and Co chelates of porphyrins or porphyrin derivatives, respectively, carry out crucial biological functions. Heme is the prosthetic group for a number of hemoproteins. These include myoglobin and hemoglobin, which carry out oxygen binding or transport; mitochondrial cytochromes aa3, b, c, and c3, which are important in transferring electrons; microsomal cytochrome P-450, which catalyzes mixed-function oxidations; catalase, which decomposes H2O2; peroxidase, which activates H2O2; and tryptophan pyrrolase, which catalyzes the oxidation of tryptophan. Recently, heme has also been shown to be the prosthetic group of prostaglandin and peroxide synthetase and indoleamine dioxygenase. The elegant studies of the biochemical pathway for the formation of heme demonstrated the arrangement in the porphyrin macrocycle of the carbon and nitrogen atoms originating from the eight glycine and the succinic acid molecule that are the precursors of porphyrins. There are eight enzymes involved in the synthesis of heme. The first and last three of these enzymes are localized in mitochondria, while the intermediate enzymes are localized in cytosol. The catalytic site of HMOX recognizes metalloporphyrins with central metal atoms other than iron; it favors some of these metalloporphyrins over heme as a potential substrate, sometimes by a large factor, permitting the synthetic heme analogue to serve as a potent competitive inhibitor of HMOX reaction. Since these synthetic metalloporphyrins do not bind molecular oxygen, they are not metabolically degraded by ring rupture and do not add to the body pool of bile pigment. One possible consequence of this competitive inhibition of heme degradation is suppression of bile pigment formation to such a degree that excessive plasma levels of bilirubin may be diminished. The studies of Drummond and Kappas (1981) and later studies in rats, mice, monkeys, and man, and also our studies have proved the latter phenomenon. The compound does not appear to affect the metabolic disposition of preformed bilirubin but inhibits biliary bilirubin excretion derived from the metabolism of endogenous or exogenous heme. Whether some of the effect of Sn-PP on naturally occurring or experimentally induced jaundice in animals reflects diversion of heme to nonheme to oxygenase-dependent pathways of heme metabolism, or whether a pathway which is normally latent becomes activated concurrent with HMOX inhibition is not known.(ABSTRACT TRUNCATED AT 400 WORDS)

Tissue distribution and urinary excretion of essential elements in rats orally exposed to aluminum chloride

The purpose of this study was to determine disorders in the metabolism of the essential elements (Ca, Fe, Cu, and Zn) in some tissues of rats, as well as to detect the dynamics of urinary excretion of these metals after oral administration of 20 mgAl/kg every day for 8 wk. The elements were determined in brain, kidneys, blood, and urine of the animals in 1st, 2nd, 3rd, 4th, and 8th wk after the exposure to AlCl3. After the 1st wk of aluminium administration, we observed increase of Ca and a decrease of Fe in blood. In brain Ca, Fe, and Cu concentrations were significantly higher in Al-treated rats than in controls after 8-wk exposure. The concentration changes of the essential metals in the tissue were accompanied by increase of the Ca, Fe, and Zn urinary excretion. We assume that the increase in urinary excretion of Ca and the decrease of Fe in the blood may be sensitive indicators of oral aluminium administration.

Aluminum induced anemia: pathogenesis and treatment in patients on chronic hemodialysis

The baseline hematologic status of 27 patients with modest degrees of aluminum overload was examined. In addition, hematologic data were evaluated in 19 of these patients during and after treatment with DFO. Although neither severe anemia nor microcytosis was observed pretreatment, there was a significant correlation between hemoglobin level and degree of aluminum burden as determined by bone surface aluminum staining (r = -0.58; P less than 0.007). Following treatment with DFO, hemoglobin concentration increased dramatically by 1.3 to 4.4 g/dl in eight patients but did not change in the remaining eleven. Responders and nonresponders were similar with regard to the degree of aluminum overload both before and after chelation therapy but differed with regard to baseline levels of erythropoietin (higher in responders) and degree of iron overload (greater in nonresponders). Pretherapy levels of red cell ALA dehydratase were depressed in all patients (32 +/- 4 vs. 56 +/- 5 U/g Hb in normals) but did not correlate with the degree of aluminum overload and did not change with chelation therapy. Pretherapy levels of red cell protoporphyrin were elevated in 15 of 24 patients (62%) and were higher in responders than in nonresponders. Following DFO therapy, levels fell by 25 to 50% in 7 of 8 patients with elevated pretherapy values, despite the tendency in several patients to develop iron deficiency with treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of aluminum in the pathogenesis of anemia in an outpatient hemodialysis population

Anemia is a well-defined complication of aluminum overload in chronic dialysis patients which may be present before other manifestations of aluminum toxicity are obvious. Causes of anemia in chronic renal failure are multiple, and at the present time there is no marker for aluminum-induced anemia. Deferoxamine (DFO) treatment can correct aluminum-related anemia and microcytosis, but may be associated with side effects. Because of the possible role of aluminum in red blood cells in causing the anemia associated with aluminum overload, we attempted to test red blood cell (RBC) aluminum as a marker for aluminum-associated anemia and to assess the prevalence of aluminum-associated anemia in an outpatient dialysis population. Both random plasma aluminum and RBC aluminum correlated well with the increase in plasma aluminum seen following DFO challenge. However, RBC aluminum was affected less by changes in oral aluminum intake than plasma aluminum. There were strong correlations of RBC and plasma aluminum to corpuscular volume (MCV) in our patients. Moreover, patients within the highest quartile of RBC aluminum had a lower mean MCV (82.1 +/- 1.7 vs 89.6 +/- 1.7, p less than .01) and hematocrit (HCT) (24.3 +/- 4 vs 28.2 +/- 1.5, p less than .05) than those within the lowest quartile. These data suggest that aluminum toxicity is an important cause of microcytic anemia in outpatient hemodialysis patients. Prospective long-term studies are needed to further define the usefulness of RBC aluminum in diagnosing and following hemodialysis patients with aluminum-induced anemia.

Aluminum inhibits erythropoiesis in vitro

Anemia has been associated with aluminum intoxication in patients on chronic dialysis and in animals. In studies presented here, in vitro human erythroid culture was used to delineate the effects of aluminum on normal hematopoiesis. Aluminum by itself in routine culture, even at very high levels (1,035 ng/ml), did not significantly affect erythroid colony growth. The addition of human transferrin to the culture, however, resulted in a marked dose-dependent inhibition of erythroid, but not myeloid colony growth. At all doses, CFU-E progenitors showed greater inhibition than burst-forming units (BFU-E). Aluminum inhibition was not overcome by increasing the dose of erythropoietin or adding additional burst-promoting activity to the culture. Inhibition by aluminum was directly related to the number of binding sites on transferrin in the culture, and was not observed in the presence of fully iron-saturated transferrin.

Aluminium chelation therapy in dialysis patients: evidence for inhibition of haemoglobin synthesis by low levels of aluminium

To investigate the possibility that aluminium may exacerbate anaemia in dialysis patients with only modest aluminium accumulation, 15 patients whose exposure to aluminium had been low were treated for three months with the aluminium chelating agent desferrioxamine, 30 mg/kg intravenously at the end of each dialysis session. Serum aluminium concentrations before treatment were 5-125 micrograms/ml. After one month of desferrioxamine, serum aluminium (including the chelate) had risen from 54.6 (SEM 11.2) to 167.0 (27.5) micrograms/l; and after three months haemoglobin had risen from 8.46 (0.70) to 10.43 (0.80) g/l. Mean cell volume and mean cell haemoglobin concentration also increased significantly. The maximum rise in haemoglobin correlated with the patients' aluminium burden as estimated by the mean serum aluminium concentration after one month of desferrioxamine therapy (r = 0.85). The greatest response to desferrioxamine occurred in patients with a baseline serum aluminium of 15-75 micrograms/l (mean increase in haemoglobin 38%). The results indicate that even the modest aluminium accumulation found in most dialysis patients has a pronounced inhibitory effect on haemoglobin synthesis. The possible toxic effect of aluminium should be considered in all anaemic dialysis patients.

Metal-induced alterations of delta-aminolevulinic acid dehydratase

ALAD is a cytoplasmic enzyme that catalyzes the second step of the heme biosynthesis pathway, that is, the condensation of two molecules of delta-aminolevulinic acid into porphobilinogen. ALAD is a zinc-dependent enzyme; thiol groups are essential for its activity; and in vitro experiments show that ALAD can be activated or inhibited by several metal ions including A;3+, Pb2+, Cd2+, Hg2+, Ag2+, and Cu2+. To explain these effects, it has been postulated that metals bind to thiol groups of allosteric sites and, according to their structure, provoke allosteric transitions to the active or inactive form of the enzyme. Under current environmental and occupational exposure levels, lead is practically the only metal that can affect ALAD activity. Erythrocyte ALAD is the most sensitive indicator of lead exposure: effects of exposure are detectable even when blood lead levels are within the "normal" range. Zinc protects ALAD in vitro and in vivo from the inhibitory effect of lead. There is also some suggestion that aluminum could be responsible for the decreased erythrocyte ALAD activity observed in patients on chronic hemodialysis.

Microcytic anemia in dialysis patients: reversible marker of aluminum toxicity

Improvement of microcytic anemia after deferoxamine treatment is described in eight long-term dialysis patients with high serum aluminum concentration and other clinical signs of aluminum toxicity. Hematocrit increase of 3 to 19 vol% was associated with correction of microcytosis, significant reduction in abnormal levels of free erythrocyte protoporphyrins, and amelioration of the bone-related symptoms and neurologic signs of aluminum intoxication. Increase in hematocrit, reversal of microcytosis, and reduction in protoporphyrin levels all correlated with the aluminum burden as indicated by the pretreatment serum aluminum levels and by the peak serum aluminum levels during mobilization with deferoxamine. Furthermore, deferoxamine resulted in marked improvement in anemia despite significant reduction in serum ferritin levels. This reversal of microcytosis with deferoxamine provides objective evidence verifying the toxicity of aluminum, and suggests that microcytosis may be an easily detected marker for both clinical diagnosis as well as response to treatment in some cases of aluminum intoxication.

Delta aminolevulinic acid dehydratase amounts in lead-exposed subjects: description of a method correlated with the immunoturbidimetric assay

The measurement of delta-aminolevulinic acid dehydratase (ALA.D) activity is a good index of lead exposure. Recently, we proposed an immunoturbidimetric assay which allows determination of the amount of the enzyme. This last test is particularly interesting for workers presenting high blood-lead levels. We then studied the effects of different agents (dithiothreitol, heat and zinc ions) in restoring the activity of lead-inhibited ALA.D. The individual or combined effects of these three agents showed an additive restoration of activity. The combination of zinc ions with heat and/or DTT gave the best activations, which correlated perfectly with ALA.D amounts. Consequently, the catalytic assay using zinc ions and DTT may be used in routine testing as an indirect measurement of ALA.D amount.

Purification and properties of 5-aminolaevulinate dehydratase from human erythrocytes

A new procedure for the isolation of homogeneous human 5-aminolaevulinate dehydratase (porphobilinogen synthase, EC 4.2.1.24) is described in which the enzyme is purified 35000-fold and in 65-74% yield. The specific activity of the purified enzyme, 24 units/mg, is the highest yet reported. An efficient stage for the removal of haemoglobin is incorporated in the method, which has general application to the purification of other erythrocyte enzymes. The erythrocyte dehydratase (Mr 285 000) is made up of eight apparently identical subunits of Mr 35 000. The enzyme is sensitive to oxygen, and its activity is maintained by the presence of thiols such as dithioerythritol. Zn2+ is obligatory for enzyme activity, the apoenzyme being essentially inactive (approximately equal to 12% of control) when assayed in buffers devoid of Zn2+. Addition of Zn2+ to the apoenzyme restores activity as long as the sensitive thiol groups are fully reduced; optimal stimulation occurs between 100 and 300 microM-Zn2+. The human enzyme is inhibited by Pb2+ in a non-competitive fashion [KiI (dissociation constant for E X S X Pb2+ complex) = 25.3 +/- 3.0 microM; KiS (dissociation constant for E X Pb2+ complex) = 9.0 +/- 2.0 microM]. Modification of thiol groups, inactivation by oxidation, alkylation or reaction with thiophilic reagents demonstrates the importance of sensitive thiol groups for full enzymic activity.

Aluminium toxicity in chronic renal insufficiency

Aluminium is a ubiquitous element in the environment and has been demonstrated to be toxic, especially in individuals with impaired renal function. Not much is known about the biochemistry of aluminium and the mechanisms of its toxic effects. Most of the interest in aluminium has been in the clinical setting of the haemodialysis unit. Here aluminium toxicity occurs due to contamination of dialysis solutions, and treatment of the patients with aluminium-containing phosphate binding gels. Aluminium has been shown to be the major contributor to the dialysis encephalopathy syndrome and an osteomalacic component of dialysis osteodystrophy. Other clinical disturbances associated with aluminium toxicity are a microcytic anaemia and metastatic extraskeletal calcification. Aluminium overload can be treated effectively by chelation therapy with desferrioxamine and haemodialysis. Aluminium is readily transferred from the dialysate to the patient's bloodstream during haemodialysis. Once transferred, the aluminium is tightly bound to non-dialysable plasma constituents. Very low concentrations of dialysate aluminium in the range of 10-15 micrograms/l are recommended to guard against toxic effects. Very few studies have been directed towards the separation of the various plasma species which bind aluminium. Gel filtration chromatography has been used to identify five major fractions, one of which is of low molecular weight and the others appear to be protein-aluminium complexes. Recommendations on aluminium monitoring have been published and provide 'safe' and toxic concentrations. Also, the frequency of monitoring has been addressed. Major problems exist with the analytical methods for measuring aluminium which result from inaccurate techniques and contamination difficulties. The most widely used analytical technique is electrothermal atomic absorption spectrometry which can provide reliable measurements in the hands of a careful analyst.

The effects of lead on the renin-angiotensin system

Acute lead treatment of rabbits resulted in significant increases in both plasma renin activity and aldosterone concentration. No significant changes were observed in blood pressure, heart rate and plasma angiotensin-converting enzyme activity. The calcium channel-blocking drug verapamil attenuated the renin and aldosterone response in vivo. Lead increased renin release in a dose-dependent manner in a renal cortex slice preparation. Both verapamil and diltiazem attenuated the lead-induced renin release in vitro, but only with diltiazem did this attain statistical significance.

Immunological and enzymatic studies of erythrocytic delta-aminolevulinate dehydratase. Comparison of results obtained in normal and lead-exposed subjects

The delta-aminolevulinate dehydratase (ALA.D) quantitative assay on a centrifugal fast analyser showed that subjects whose blood-lead level varies between 30 and 75 micrograms/100 ml (1.5 to 3.75 microM/l) react to blood intoxication by synthesizing de novo an amount of enzyme correlating to blood-lead levels. At higher concentrations, the reactional synthesis occurs very rarely. These results suggest that enzyme is constitutive, but also inductible as soon as its substrate accumulates; this last ability may disappear at high blood-lead levels: a hypothesis is proposed thereafter.

The effects of environmental lead exposure and in vitro zinc on tissue delta-aminolevulinic acid dehydratase in urban pigeons

1. Elevated lead burdens in three urban pigeon populations caused ALAD inhibition, in blood, kidney and liver, the degree of inhibition generally corresponding to the lead content of each tissue. The values obtained are compared with those given by studies of lead exposure in mammals. 2. The usefulness of blood ALAD as an index of lead exposure is discussed. 3. The pH activity profile of ALAD in blood and kidney of urban pigeons was also changed. 4. In vitro zinc additions partially restored lead-inhibited ALAD. 5. These findings are discussed in terms of the possible manner in which lead inhibits ALAD.

Zinc, copper and delta-aminolaevulinic acid dehydratase in vitro and in vivo

The effects of zinc and copper on delta-aminolaevulinic acid dehydratase were studied in vitro and in vivo. The in vitro addition of zinc alone to whole blood resulted in a highly significant increase in enzyme activity. The addition of copper alone had the opposite effect with a significant decrease in enzyme activity. When both elements were added to whole blood the inhibitory effect of copper was reduced. In in vivo studies of plasma zinc, plasma copper and whole blood delta-aminolaevulinic acid dehydratase, a positive correlation was found between plasma zinc and whole blood delta-aminolaevulinic acid dehydratase and a negative correlation was found between plasma copper and enzyme activity.

Metal ion interactions in the control of haem oxygenase induction in liver and kidney

Mn2+ and Zn2+ exhibit a striking ability to block the induction by Sn2+ and Ni2+ of haem oxygenase (EC 1.14.99.3) in kidney. The blocking effects of Mn2+ and Zn2+ were found to be greatest on simultaneous administration, time-dependent when administered up to 8 h before the inducing metal ions, and ineffective when administered as little as 10 min after the inducing metal ions. The decreases in cytochrome P-450 and haem contents and the sequential changes in delta-aminolaevulinate synthase (EC 2.3.1.37) activity that occur concomitant with haem oxygenase induction were largely eliminated with simultaneous or prior treatment with Mn2+ or Zn2+, but not when Mn2+ or Zn2+ was administered after Sn2+ or Ni2+. Mn2+ and Zn2+ did not increase the catabolism of the enzyme in vivo. Zn2+ on simultaneous administration was also able substantially to block the induction of haem oxygenase by Co2+, Cd2+ and Ni2+ in liver. The Zn2+ blockade of Cd2+ induction was examined in detail, and prior or simultaneous administration of Zn2+ was found to be effective in blocking the induction of haem oxygenase and the concomitant decreases in cytochrome P-450 and haem contents, ethylmorphine demethylase activity and the sequential changes in delta-aminolaevulinate synthase activity. Zn2+ administration 10 min or more after Cd2+ was ineffective in preventing the occurrence of these perturbations in haem metabolism. These findings describe a new and striking biological property of Mn2+ and Zn2+, and indicate the existence of significant metal ion interactions in the control of haem metabolism.

Acute lead poisoning: an unusual cause of hepatitis

Four patients, aged 17 to 25 years, obtained lead and opium pills which had been stolen from retail pharmacists. They crushed them, suspended them in water an injected them intravenously. They developed general malaise, vomiting and constipation, and blood tests several weeks after injection of the pills showed raised alkaline phosphatase and aspartate transaminases. All four patients had negative tests for the hepatitis B surface antigen. Liver biopsy specimens showed persistent hepatitis in one and resolving hepatitis in the remaining three. Liver lead levels were grossly elevated in every case. The liver lead levels found it the patients described here were up to 35 times greater than levels which have been reported in industrial lead poisoning. It is postulated that the livers of patients with chronic lead poisoning are able to withstand this insult whereas in the cases described the overwhelming dose of lead was sufficient to cause hepatic damage.

Effect of oral zinc intake on delta-aminolaevulinic acid dehydratase in red blood cells

Earlier results regarding the in vitro and in vivo effects of zinc on delta-aminolaevulinic acid dehydratase (ALAD) activity in red blood cells were confirmed in healthy human subjects after oral intake of zinc for 12 weeks. In one group of seven healthy adults, oral intake of zinc for 12 weeks. In one group of seven healthy adults, oral intake of zinc, as the sulphate salt (2.07 mmol zinc/day) for 6 weeks, resulted in a 44% increase in the activity of ALAD in erythrocytes. Plasma zinc levels also increased during the experimental period and reached a maximum of 29 mumol after 6 weeks and remained constant thereafter. In another group, the intake of zinc in a lower dose, (0.69 mmol zinc/day) for 12 weeks, showed a similar tendency, although the increase in the enzyme activity, as well as the plasma zinc levels, was relatively much less. The plasma copper levels decreased significantly in the second group after the zinc intake and reached a low value of 11 mumol at the end of the experimental period. The Cu:Zn ratio also decreased considerably towore valuable indicator of zinc status than plasma zinc levels alone.

Haem biosynthesis in rheumatoid disease

The activities in blood of six enzymes of the haem biosynthetic pathway have been determined in 12 patients with rheumatoid disease, six of whom were anaemic. The porphyrin and porphyrin-precursor intermediary products of haem biosynthesis were also determined in blood, urine and faeces. No significant differences were found between anaemic and non-anaemic subjects. Failure of delta-amino-laevulinate synthase activity to increase in response to anaemia may be the nature of the marrow unresponsiveness suggested as one factor in the causation of the anaemia. Normal ferrochelatase activity and normal concentrations of free protoporphyrin support the view that iron is effectively unavailable although present in normal amounts. Coproporphyrinogen oxidase activity was significantly depressed.