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Donzelli G, Sera F, Morales MA, Vozzi F, Roos T, Schaffert A, Paparella M, Murugadoss S, Mertens B, Gehring R, Linzalone N. A systematic review and meta-analysis of human population studies on the association between exposure to toxic environmental chemicals and left ventricular dysfunction (LVD). ENVIRONMENTAL RESEARCH 2024; 249:118429. [PMID: 38354889 DOI: 10.1016/j.envres.2024.118429] [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: 08/24/2023] [Revised: 11/08/2023] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Exposure to environmental chemicals has been associated with an elevated risk of heart failure (HF). However, the impact on early markers of HF, such as left ventricular dysfunction (LVD), remains limited. OBJECTIVE To establish a foundation of evidence regarding early HF markers and their association with environmental pollutants, a systematic review and meta-analysis was conducted. METHODS The search, conducted on October 13th, 2023, encompassed PubMed, Embase, and Web of Science without filters, focusing on observational studies reporting myocardial geometrical, structural, or functional alterations in individuals without a history of heart disease. This included the general adult population, workers, young people, and the elderly. The risk of bias was assessed using the ROBINS-I tool at both study and item levels. RESULTS The systematic review included 17 studies involving 43.358 individuals exposed to air pollution and 2038 exposed to heavy metals. Approximately 41% of the effect measures of associations reported significant abnormalities in myocardial structure or function. The metanalyses by pollutants categories indicated positive associations between LV systolic and diastolic abnormalities and exposure to PM2.5 [-0.069 (-0.104, -0.033); -0.044 (-0.062, -0.025)] and PM10 [-0.055 (-0.087, -0.022); -0.030 (-0.050, -0.010)] and NO2 [-0.042 (-0.071, -0.013); -0.021 (-0.037, -0.004)], as well as positive associations between lead exposure and LV systolic abnormalities [-0.033 (-0.051, -0.016)]. CONCLUSIONS Existing evidence shows that specific early markers of HF may be associated with exposure to chemical pollutants. It is recommended to include such endpoints in new longitudinal and case-control studies to confirm further risk associations. These studies should consider co-exposures, account for vulnerable groups, and identify cardiotoxic compounds that may require regulation. When examining the link between myocardial abnormalities and environmental exposure, it is also advisable to explore the supportive use of Adverse Outcome Pathway (AOP) approaches to confirm a causal relationship.
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Affiliation(s)
- G Donzelli
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), Pisa, Italy.
| | - F Sera
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy.
| | - M A Morales
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), Pisa, Italy.
| | - F Vozzi
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), Pisa, Italy.
| | - T Roos
- Department of Population Health Sciences, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
| | - A Schaffert
- Institute of Medical Biochemistry, Medical University Innsbruck, Innsbruck, Austria.
| | - M Paparella
- Institute of Medical Biochemistry, Medical University Innsbruck, Innsbruck, Austria.
| | - S Murugadoss
- Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium.
| | - B Mertens
- Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium.
| | - R Gehring
- Department of Population Health Sciences, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
| | - N Linzalone
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), Pisa, Italy.
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Ma Y, Huang H, Qian H, Wu Y, Gao Z. Association of urinary bisphenol A levels with heart failure risk in U.S. adults from the NHANES (2003-2016). Front Cardiovasc Med 2024; 11:1329586. [PMID: 38766304 PMCID: PMC11099872 DOI: 10.3389/fcvm.2024.1329586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Although heart failure (HF) has been linked to bisphenol A (BPA), few studies have investigated the cut-off values for the effects of urinary BPA levels on heart failure risk. The association between urinary BPA levels and HF prognosis has not been investigated. Methods This study included 11,849 adults over 20 years old using information from the National Health and Nutrition Examination Survey (NHANES), which was conducted from 2003 to 2016. The relationship between urinary BPA levels and the risk of HF was determined via a multivariable logistic regression model, and restricted cubic spline (RCS) methods were used to determine the cut-off for the effect of BPA levels on HF risk. Based on the available NT-proBNP concentration data from the NHANES (2003-2004), multivariable linear regression was applied to determine the linear association between the NT-proBNP concentration and urinary BPA concentration. Results The results revealed a positive correlation between a urinary BPA concentration in the fourth quartile and the occurrence of heart failure [OR 1.49, 95% CI (1.09, 2.04), p = 0.012]. A one-unit increase (1 ng/mg creatinine) in the ln-transformed BPA concentration was linked to a 15% increase in the incidence of HF [OR 1.15, 95% CI (1.03, 1.29), p = 0.014]. The cut-off urinary BPA concentration for HF risk was 1.51 ng/mg creatinine. There was a positive correlation between urinary BPA and NT-proBNP concentrations [β = 0.093, 95% CI (0.014, 0.171), p = 0.02] in males, but there was no linear association [β = 0.040, 95% CI (-0.033, 0.113), p = 0.283] in females. Discussion Increased urinary BPA levels are linked to an increased risk of heart failure and poor prognosis. There is a significant increase in the risk of heart failure if the urinary concentration of BPA exceeds 1.51 ng/mg creatinine.
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Affiliation(s)
- Yuanyuan Ma
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Haobin Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Haiyun Qian
- Department of Cardiothoracic Surgery, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | - Yanhu Wu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhe Gao
- Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Lieberman‐Cribbin W, Li Z, Lewin M, Ruiz P, Jarrett JM, Cole SA, Kupsco A, O'Leary M, Pichler G, Shimbo D, Devereux RB, Umans JG, Navas‐Acien A, Nigra AE. The Contribution of Declines in Blood Lead Levels to Reductions in Blood Pressure Levels: Longitudinal Evidence in the Strong Heart Family Study. J Am Heart Assoc 2024; 13:e031256. [PMID: 38205795 PMCID: PMC10926826 DOI: 10.1161/jaha.123.031256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Chronic lead exposure is associated with both subclinical and clinical cardiovascular disease. We evaluated whether declines in blood lead were associated with changes in systolic and diastolic blood pressure in adult American Indian participants from the SHFS (Strong Heart Family Study). METHODS AND RESULTS Lead in whole blood was measured in 285 SHFS participants in 1997 to 1999 and 2006 to 2009. Blood pressure and measures of cardiac geometry and function were obtained in 2001 to 2003 and 2006 to 2009. We used generalized estimating equations to evaluate the association of declines in blood lead with changes in blood pressure; cardiac function and geometry measures were considered secondary. Mean blood lead was 2.04 μg/dL at baseline. After ≈10 years, mean decline in blood lead was 0.67 μg/dL. In fully adjusted models, the mean difference in systolic blood pressure comparing the highest to lowest tertile of decline (>0.91 versus <0.27 μg/dL) in blood lead was -7.08 mm Hg (95% CI, -13.16 to -1.00). A significant nonlinear association between declines in blood lead and declines in systolic blood pressure was detected, with significant linear associations where blood lead decline was 0.1 μg/dL or higher. Declines in blood lead were nonsignificantly associated with declines in diastolic blood pressure and significantly associated with declines in interventricular septum thickness. CONCLUSIONS Declines in blood lead levels in American Indian adults, even when small (0.1-1.0 μg/dL), were associated with reductions in systolic blood pressure. These findings suggest the need to further study the cardiovascular impacts of reducing lead exposures and the importance of lead exposure prevention.
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Affiliation(s)
- Wil Lieberman‐Cribbin
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Zheng Li
- Office of Capacity Development and Applied Prevention Science, Agency for Toxic Substances and Disease RegistryAtlantaGAUSA
| | - Michael Lewin
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease RegistryAtlantaGAUSA
| | - Patricia Ruiz
- Office of Innovation and Analytics, Agency for Toxic Substances and Disease RegistryAtlantaGAUSA
| | - Jeffery M. Jarrett
- Division for Laboratory SciencesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Shelley A. Cole
- Population Health ProgramTexas Biomedical Research InstituteSan AntonioTXUSA
| | - Allison Kupsco
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Marcia O'Leary
- Missouri Breaks Research Industries Research, Inc.Eagle ButteSDUSA
| | - Gernot Pichler
- Department of CardiologyKarl Landsteiner Institute for Cardiovascular and Critical Care Research, Clinic FloridsdorfViennaAustria
| | - Daichi Shimbo
- Division of CardiologyColumbia University Irving Medical CenterNew YorkNYUSA
| | | | - Jason G. Umans
- MedStar Health Research InstituteHyattsvilleMDUSA
- Georgetown‐Howard Universities Center for Clinical and Translational ScienceWashingtonDCUSA
| | - Ana Navas‐Acien
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - Anne E. Nigra
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
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4
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Fitch ML, Kabir R, Ebenebe OV, Taube N, Garbus H, Sinha P, Wang N, Mishra S, Lin BL, Muller GK, Kohr MJ. Cadmium exposure induces a sex-dependent decline in left ventricular cardiac function. Life Sci 2023; 324:121712. [PMID: 37100378 PMCID: PMC10246466 DOI: 10.1016/j.lfs.2023.121712] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
AIMS Cadmium exposure is a worldwide problem that has been linked to the development of cardiovascular disease. This study aimed to elucidate mechanistic details of chronic cadmium exposure on the structure and function of the heart. MAIN METHODS Male and female mice were exposed to cadmium chloride (CdCl2) via drinking water for eight weeks. Serial echocardiography and blood pressure measurements were performed. Markers of hypertrophy and fibrosis were assessed, along with molecular targets of Ca2+-handling. KEY FINDINGS Males exhibited a significant reduction in left ventricular ejection fraction and fractional shortening with CdCl2 exposure, along with increased ventricular volume at end-systole, and decreased interventricular septal thickness at end-systole. Interestingly, no changes were detected in females. Experiments in isolated cardiomyocytes revealed that CdCl2-induced contractile dysfunction was also present at the cellular level, showing decreased Ca2+ transient and sarcomere shortening amplitude with CdCl2 exposure. Further mechanistic investigation uncovered a decrease in sarco/endoplasmic reticulum Ca2+-ATPase 2a (SERCA2a) protein expression and phosphorylated phospholamban levels in male hearts with CdCl2 exposure. SIGNIFICANCE The findings of our novel study provide important insight into how cadmium exposure may act as a sex-specific driver of cardiovascular disease, and further underscore the importance of reducing human exposure to cadmium.
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Affiliation(s)
- Michael L Fitch
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Raihan Kabir
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Obialunanma V Ebenebe
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Nicole Taube
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Haley Garbus
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Prithvi Sinha
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Nadan Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Sumita Mishra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Brian L Lin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Grace K Muller
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Department of Cell and Molecular Physiology, Loyola University Stritch School of Medicine, Maywood, IL, United States of America.
| | - Mark J Kohr
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
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5
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Gerzen OP, Votinova VO, Potoskueva IK, Tzybina AE, Nikitina LV. Direct Effects of Toxic Divalent Cations on Contractile Proteins with Implications for the Heart: Unraveling Mechanisms of Dysfunction. Int J Mol Sci 2023; 24:10579. [PMID: 37445756 DOI: 10.3390/ijms241310579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
The binding of calcium and magnesium ions to proteins is crucial for regulating heart contraction. However, other divalent cations, including xenobiotics, can accumulate in the myocardium and enter cardiomyocytes, where they can bind to proteins. In this article, we summarized the impact of these cations on myosin ATPase activity and EF-hand proteins, with special attention given to toxic cations. Optimal binding to EF-hand proteins occurs at an ionic radius close to that of Mg2+ and Ca2+. In skeletal Troponin C, Cd2+, Sr2+, Pb2+, Mn2+, Co2+, Ni2+, Ba2+, Mg2+, Zn2+, and trivalent lanthanides can substitute for Ca2+. As myosin ATPase is not a specific MgATPase, Ca2+, Fe2+, Mn2+, Ni2+, and Sr2+ could support myosin ATPase activity. On the other hand, Zn2+ and Cu2 significantly inhibit ATPase activity. The affinity to various divalent cations depends on certain proteins or their isoforms and can alter with amino acid substitution and post-translational modification. Cardiac EF-hand proteins and the myosin ATP-binding pocket are potential molecular targets for toxic cations, which could significantly alter the mechanical characteristics of the heart muscle at the molecular level.
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Affiliation(s)
- Oksana P Gerzen
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Ekaterinburg, Russia
| | - Veronika O Votinova
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Ekaterinburg, Russia
| | - Iulia K Potoskueva
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Ekaterinburg, Russia
| | - Alyona E Tzybina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Ekaterinburg, Russia
| | - Larisa V Nikitina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Ekaterinburg, Russia
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Zhao L, Cheng J, Liu D, Gong H, Bai D, Sun W. Potentilla anserina polysaccharide alleviates cadmium-induced oxidative stress and apoptosis of H9c2 cells by regulating the MG53-mediated RISK pathway. Chin J Nat Med 2023; 21:279-291. [PMID: 37120246 DOI: 10.1016/s1875-5364(23)60436-4] [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: 09/23/2022] [Indexed: 05/01/2023]
Abstract
Oxidative stress plays a crucial role in cadmium (Cd)-induced myocardial injury. Mitsugumin 53 (MG53) and its mediated reperfusion injury salvage kinase (RISK) pathway have been demonstrated to be closely related to myocardial oxidative damage. Potentilla anserina L. polysaccharide (PAP) is a polysaccharide with antioxidant capacity, which exerts protective effect on Cd-induced damage. However, it remains unknown whether PAP can prevent and treat Cd-induced cardiomyocyte damages. The present study was desgined to explore the effect of PAP on Cd-induced damage in H9c2 cells based on MG53 and the mediated RISK pathway. For in vitro evaluation, cell viability and apoptosis rate were analyzed by CCK-8 assay and flow cytometry, respectively. Furthermore, oxidative stress was assessed by 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) staining and using superoxide dismutase (SOD), catalase (CAT), and glutathione/oxidized glutathione (GSH/GSSG) kits. The mitochondrial function was measured by JC-10 staining and ATP detection assay. Western blot was performed to detect the expression of proteins related to MG53, the RISK pathway, and apoptosis. The results indicated that Cd increased the levels of reactive oxygen species (ROS) in H9c2 cells. Cd decreased the activities of SOD and CAT and the ratio of GSH/GSSG, resulting in decreases in cell viability and increases in apoptosis. Interestingly, PAP reversed Cd-induced oxidative stress and cell apoptosis. Meanwhile, Cd reduced the expression of MG53 in H9c2 cells and inhibited the RISK pathway, which was mediated by decreasing the ratio of p-AktSer473/Akt, p-GSK3βSer9/GSK3β and p-ERK1/2/ERK1/2. In addition, Cd impaired mitochondrial function, which involved a reduction in ATP content and mitochondrial membrane potential (MMP), and an increase in the ratio of Bax/Bcl-2, cytoplasmic cytochrome c/mitochondrial cytochrome c, and Cleaved-Caspase 3/Pro-Caspase 3. Importantly, PAP alleviated Cd-induced MG53 reduction, activated the RISK pathway, and reduced mitochondrial damage. Interestingly, knockdown of MG53 or inhibition of the RISK pathway attenuated the protective effect of PAP in Cd-induced H9c2 cells. In sum, PAP reduces Cd-induced damage in H9c2 cells, which is mediated by increasing MG53 expression and activating the RISK pathway.
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Affiliation(s)
- Lixia Zhao
- Institute of Integrated Traditional Chinese and Western Medicine, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; School of Nursing, Gansu University of Chinese Medicine, Lanzhou 730000, China; Key Laboratory of Dunhuang Medicine, Ministry of Education, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Ju Cheng
- Institute of Genetics, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Di Liu
- Key laboratory of Evidence Science Techniques Research and Application of Gansu Province, Gansu University of Political Science and Law, Lanzhou 730000, China
| | - Hongxia Gong
- School of Basic Medical Sciences, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Decheng Bai
- Institute of Integrated Traditional Chinese and Western Medicine, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Wei Sun
- Department of Cardiac Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China.
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Yu YL, Yang WY, Hara A, Asayama K, Roels HA, Nawrot TS, Staessen JA. Public and occupational health risks related to lead exposure updated according to present-day blood lead levels. Hypertens Res 2023; 46:395-407. [PMID: 36257978 PMCID: PMC9899691 DOI: 10.1038/s41440-022-01069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 02/07/2023]
Abstract
Lead is an environmental hazard that should be addressed worldwide. Over time, human lead exposure in the western world has decreased drastically to levels comparable to those among humans living in the preindustrial era, who were mainly exposed to natural sources of lead. To re-evaluate the potential health risks associated with present-day lead exposure, a two-pronged approach was applied. First, recently published population metrics describing the adverse health effects associated with lead exposure at the population level were critically assessed. Next, the key results of the Study for Promotion of Health in Recycling Lead (SPHERL; NCT02243904) were summarized and put in perspective with those of the published population metrics. To our knowledge, SPHERL is the first prospective study that accounted for interindividual variability between people with respect to their vulnerability to the toxic effects of lead exposure by assessing the participants' health status before and after occupational lead exposure. The overall conclusion of this comprehensive review is that mainstream ideas about the public and occupational health risks related to lead exposure urgently need to be updated because a large portion of the available literature became obsolete given the sharp decrease in exposure levels over the past 40 years.
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Affiliation(s)
- Yu-Ling Yu
- grid.5596.f0000 0001 0668 7884Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- grid.16821.3c0000 0004 0368 8293Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Azusa Hara
- grid.26091.3c0000 0004 1936 9959Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Kei Asayama
- grid.264706.10000 0000 9239 9995Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan ,grid.5596.f0000 0001 0668 7884Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium ,Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Harry A. Roels
- grid.12155.320000 0001 0604 5662Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tim S. Nawrot
- grid.5596.f0000 0001 0668 7884Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium ,grid.12155.320000 0001 0604 5662Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jan A. Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium ,grid.5596.f0000 0001 0668 7884Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
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8
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Zhou N, Huang Y, Li M, Zhou L, Jin H. Trends in global burden of diseases attributable to lead exposure in 204 countries and territories from 1990 to 2019. Front Public Health 2022; 10:1036398. [PMID: 36504990 PMCID: PMC9727290 DOI: 10.3389/fpubh.2022.1036398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Lead hazards are ubiquitous in the environment, and lead exposure has been proved to damage human health. Nevertheless, there is limited data on the global burden of diseases attributable to lead exposure. In this study, we evaluated the temporal-spatial trend of disease burden caused by lead exposure in 204 countries and territories from 1990 to 2019. Methods Based on Global Burden of Disease (GBD) Study 2019, deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR) and DALYs rate (ASDR) were estimated by region, country, sex and age. The estimated annual percentage change (EAPC) was calculated to assess the temporal trends of ASMR and ASDR between 1990 and 2019. Results Global deaths increased from 0.53 (95% UI: 0.31, 0.77) to 0.90 (95% UI: 0.55, 1.29) million, and the number of DALYs increased from 16.02 (95% UI: 10.32, 22.17) to 21.68 (95% UI: 13.81, 30.30) million between 1990 and 2019. China, India and Bangladesh were top three countries with the largest number of deaths and DALYs in 2019. The ASMR (per 100,000 population) decreased from 14.47 (95% UI: 8.40, 21.43) to 11.48 (95% UI: 7.00, 16.49) with EAPC of -0.75 (95% UI: -0.87, -0.64), and the ASDR (per 100,000 population) decreased from 378.01 (95% UI: 240.55, 524.18) to 267.52 (95% UI: 170.57, 373.44) with EAPC of -1.19 (95% UI: -1.32, -1.07). Most of disease burden of lead exposure occurred in the men and elderly population. Stroke and ischemic heart disease were two key sources of disease burden of lead exposure. Also, a negative association between sociodemographic index (SDI) and disease burden of lead exposure was observed. Conclusions Lead exposure poses a significant disease burden globally, and is still a great threat to public health. Primary prevention measures of reducing lead exposure in the environment are essential.
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Affiliation(s)
- Nan Zhou
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yue Huang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Mingma Li
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Lu Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hui Jin
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Statistics, School of Public Health, Southeast University, Nanjing, China,*Correspondence: Hui Jin
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9
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Xing X, Xu M, Yang L, Shao C, Wang Y, Qi M, Niu X, Gao D. Association of selenium and cadmium with heart failure and mortality based on the National Health and Nutrition Examination Survey. J Hum Nutr Diet 2022. [DOI: 10.1111/jhn.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Xin Xing
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Min Xu
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Lijun Yang
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Congcong Shao
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Yuan Wang
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Mengyao Qi
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Xiaolin Niu
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
- Department of Cardiology, Meishan Brach of the Third Affiliated Hospital Yanan University School of Medical Meishan Sichuan China
| | - Dengfeng Gao
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
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10
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Gerzen OP, Nabiev SR, Klinova SV, Minigalieva IA, Sutunkova MP, Katsnelson BA, Nikitina LV. Molecular mechanisms of mechanical function changes of the rat myocardium under subchronic lead exposure. Food Chem Toxicol 2022; 169:113444. [PMID: 36179994 DOI: 10.1016/j.fct.2022.113444] [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: 05/25/2022] [Revised: 09/10/2022] [Accepted: 09/21/2022] [Indexed: 11/26/2022]
Abstract
A moderate degree of lead intoxication was observed in male rats after repeated intraperitoneal injections with two doses of lead acetate three times a week during 5 (12.5 mg of Pb per kg body mass) and 6 (6.01 mg of Pb per kg body mass) weeks. Using an in vitro motility assay, we investigated the impact of this intoxication on the characteristics of actin-myosin interaction and its regulation in the atria, right, and left ventricles. Both lead doses exposure decreased the maximum sliding velocity of reconstituted thin filaments over myosin and fraction of motile filaments in all heart chambers, caused the myosin isoforms shift towards slower β-myosin heavy chains in ventricles and decreased regulatory light chain phosphorylation in atria. No statistically significant difference was found in force and calcium regulation of actin-myosin interaction. A dose-dependent effect of lead on myosin functional characteristics was found in all heart chambers, but the degree of this effect varied depending on the heart chamber.
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Affiliation(s)
- Oksana P Gerzen
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia.
| | - Salavat R Nabiev
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Svetlana V Klinova
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Ilzira A Minigalieva
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Marina P Sutunkova
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Boris A Katsnelson
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Larisa V Nikitina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
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11
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Liu J, Li Y, Li D, Wang Y, Wei S. The burden of coronary heart disease and stroke attributable to dietary cadmium exposure in Chinese adults, 2017. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 825:153997. [PMID: 35202702 DOI: 10.1016/j.scitotenv.2022.153997] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
Cadmium (Cd) is a metal with a long biological half-life that could cause health issues, such as coronary heart disease (CHD), stroke, and other cardiovascular diseases (CVD). Recent studies showed an ascending trend in the dietary Cd intake in the Chinese population. The contribution of dietary Cd intake to CHD and stroke burden, on the other hand, remains to be established. To calculate the disease burden for CHD and stroke attributable to dietary Cd, we estimated dietary Cd intake by associating the Cd concentration in food with consumption frequency. The toxicokinetic (TK) model and dietary Cd consumption were used to simulate urinary cadmium (U-Cd) concentrations. The population attributable fraction (PAF) can be derived for the computation of the attributable disease burden expressed as Disability-Adjusted Life Years (DALYs) in provinces, genders, and age groups by combining the relative risk (RR) with the population distribution of U-Cd. The mean of dietary Cd consumption and the geometric mean of U-Cd in the Chinese adult population are 0.684 μg/kg bw/day and 0.88 μg/g creatinine. The CHD burden attributable to dietary Cd was 3.26 million DALYs, with a 9.69% proportion of the total CHD burden. The DALYs for stroke attributable to Cd in food was approximately 3.64 million, accounting for 8.22% of the overall stroke burden. Furthermore, the attributable disease burden of CHD and stroke are higher in the south, women, and middle-aged and older adults. Our study suggested that foodborne Cd exposure contributes a considerable proportion of the CHD and stroke burden. More attention is needed to control Cd in food in order to reduce the burden of CHD and stroke in the Chinese population.
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Affiliation(s)
- Jialin Liu
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Yiling Li
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Dong Li
- Center for Statistical Science, Department of Industrial Engineering, Tsinghua University, Beijing 100084, PR China
| | - Yibaina Wang
- National Food Safety Risk Assessment Center, Key Laboratory of Food Safety Risk Assessment, Ministry of Health, Beijing 10022, PR China
| | - Sheng Wei
- MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China.
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12
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Yalçin SS, Erdal İ, Oğuz B, Duzova A. Associations between toxic elements and blood pressure parameters in adolescents. J Trace Elem Med Biol 2022; 71:126949. [PMID: 35193093 DOI: 10.1016/j.jtemb.2022.126949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/20/2021] [Accepted: 02/10/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Both exposure to toxic elements and hypertension (HT) are a global health problem. We planned to examine the associations between some toxic elements in urine, and blood pressure (BP) and its diurnal changes in adolescents. METHODS In this cross-sectional study, 48 adolescents who were newly diagnosed with HT and 38 adolescents with age-appropriate BP and normal physical examination were included. Anthropometric measurements, urinary toxic elements, carotid intima media thickness (cIMT), and office and 24-hour ambulatory BP measurements (ABPM) of participants were taken. Urinary elements levels were studied with ICP-MS. Elements were grouped in tertiles according to urinary levels. Logistic regression analyses were performed to show the interactions. RESULTS Urinary cadmium, mercury, lead, and arsenic were found to be at detectable level in 90.7%, 69.8%, 91.9% and 100% of the participants, respectively. Univariate analyses showed that elevated daytime systolic and/or diastolic BP was associated with urinary cadmium and mercury. No association between urinary toxic elements and nighttime BP was found. When height and body mass index z-scores adjusted for, age, gender, and all four urinary creatinine-corrected toxic elements analyzed, multiple logistic regression revealed that there was an association between mercury (high vs. low; AOR:3.85) and office HT, and mercury (high vs. low; AOR:6.18) and cadmium (middle vs. low; AOR: 13.38) were associated with "elevated 24-hour systolic BP and/or diastolic BP", and "elevated 24-hour mean arterial BP" in ABPM. CONCLUSION There are complex relationships between toxic elements and BP parameters in adolescents, and more studies are needed to define the evolution of these relations.
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Affiliation(s)
- Siddika Songül Yalçin
- Division of Social Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - İzzet Erdal
- Division of Social Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Berna Oğuz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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13
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Klinova SV, Minigalieva IA, Protsenko YL, Sutunkova MP, Gurvich VB, Ryabova JV, Valamina IE, Gerzen OP, Nabiev SR, Balakin AA, Lookin ON, Lisin RV, Kuznetsov DA, Privalova LI, Panov VG, Katsnelson LB, Nikitina LV, Katsnelson BA. Changes in the Cardiotoxic Effects of Lead Intoxication in Rats Induced by Muscular Exercise. Int J Mol Sci 2022; 23:ijms23084417. [PMID: 35457235 PMCID: PMC9029617 DOI: 10.3390/ijms23084417] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Exposure to lead is associated with an increased risk of cardiovascular diseases. Outbred white male rats were injected with lead acetate intraperitoneally three times a week and/or were forced to run at a speed of 25 m/min for 10 min 5 days a week. We performed noninvasive recording of arterial pressure, electrocardiogram and breathing parameters, and assessed some biochemical characteristics. Electrophoresis in polyacrylamide gel was used to determine the ratio of myosin heavy chains. An in vitro motility assay was employed to measure the sliding velocity of regulated thin filaments on myosin. Isolated multicellular preparations of the right ventricle myocardium were used to study contractility in isometric and physiological modes of contraction. Exercise under lead intoxication normalized the level of calcium and activity of the angiotensin-converting enzyme in the blood serum, normalized the isoelectric line voltage and T-wave amplitude on the electrocardiogram, increased the level of creatine kinase-MB and reduced the inspiratory rate. Additionally, the maximum sliding velocity and the myosin heavy chain ratio were partly normalized. The effect of exercise under lead intoxication on myocardial contractility was found to be variable. In toto, muscular loading was found to attenuate the effects of lead intoxication, as judged by the indicators of the cardiovascular system.
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Affiliation(s)
- Svetlana V. Klinova
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 620014 Yekaterinburg, Russia; (S.V.K.); (I.A.M.); (M.P.S.); (V.B.G.); (J.V.R.); (I.E.V.); (L.I.P.); (V.G.P.)
| | - Ilzira A. Minigalieva
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 620014 Yekaterinburg, Russia; (S.V.K.); (I.A.M.); (M.P.S.); (V.B.G.); (J.V.R.); (I.E.V.); (L.I.P.); (V.G.P.)
| | - Yuri L. Protsenko
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (Y.L.P.); (O.P.G.); (S.R.N.); (A.A.B.); (O.N.L.); (R.V.L.); (D.A.K.); (L.B.K.); (L.V.N.)
| | - Marina P. Sutunkova
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 620014 Yekaterinburg, Russia; (S.V.K.); (I.A.M.); (M.P.S.); (V.B.G.); (J.V.R.); (I.E.V.); (L.I.P.); (V.G.P.)
| | - Vladimir B. Gurvich
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 620014 Yekaterinburg, Russia; (S.V.K.); (I.A.M.); (M.P.S.); (V.B.G.); (J.V.R.); (I.E.V.); (L.I.P.); (V.G.P.)
| | - Julia V. Ryabova
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 620014 Yekaterinburg, Russia; (S.V.K.); (I.A.M.); (M.P.S.); (V.B.G.); (J.V.R.); (I.E.V.); (L.I.P.); (V.G.P.)
| | - Irene E. Valamina
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 620014 Yekaterinburg, Russia; (S.V.K.); (I.A.M.); (M.P.S.); (V.B.G.); (J.V.R.); (I.E.V.); (L.I.P.); (V.G.P.)
| | - Oksana P. Gerzen
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (Y.L.P.); (O.P.G.); (S.R.N.); (A.A.B.); (O.N.L.); (R.V.L.); (D.A.K.); (L.B.K.); (L.V.N.)
| | - Salavat R. Nabiev
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (Y.L.P.); (O.P.G.); (S.R.N.); (A.A.B.); (O.N.L.); (R.V.L.); (D.A.K.); (L.B.K.); (L.V.N.)
| | - Alexander A. Balakin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (Y.L.P.); (O.P.G.); (S.R.N.); (A.A.B.); (O.N.L.); (R.V.L.); (D.A.K.); (L.B.K.); (L.V.N.)
| | - Oleg N. Lookin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (Y.L.P.); (O.P.G.); (S.R.N.); (A.A.B.); (O.N.L.); (R.V.L.); (D.A.K.); (L.B.K.); (L.V.N.)
| | - Ruslan V. Lisin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (Y.L.P.); (O.P.G.); (S.R.N.); (A.A.B.); (O.N.L.); (R.V.L.); (D.A.K.); (L.B.K.); (L.V.N.)
| | - Daniil A. Kuznetsov
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (Y.L.P.); (O.P.G.); (S.R.N.); (A.A.B.); (O.N.L.); (R.V.L.); (D.A.K.); (L.B.K.); (L.V.N.)
| | - Larisa I. Privalova
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 620014 Yekaterinburg, Russia; (S.V.K.); (I.A.M.); (M.P.S.); (V.B.G.); (J.V.R.); (I.E.V.); (L.I.P.); (V.G.P.)
| | - Vladimir G. Panov
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 620014 Yekaterinburg, Russia; (S.V.K.); (I.A.M.); (M.P.S.); (V.B.G.); (J.V.R.); (I.E.V.); (L.I.P.); (V.G.P.)
- Institute of Industrial Ecology, The Urals Branch of the Russian Academy of Sciences, 620049 Ekaterinburg, Russia
| | - Leonid B. Katsnelson
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (Y.L.P.); (O.P.G.); (S.R.N.); (A.A.B.); (O.N.L.); (R.V.L.); (D.A.K.); (L.B.K.); (L.V.N.)
| | - Larisa V. Nikitina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (Y.L.P.); (O.P.G.); (S.R.N.); (A.A.B.); (O.N.L.); (R.V.L.); (D.A.K.); (L.B.K.); (L.V.N.)
| | - Boris A. Katsnelson
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 620014 Yekaterinburg, Russia; (S.V.K.); (I.A.M.); (M.P.S.); (V.B.G.); (J.V.R.); (I.E.V.); (L.I.P.); (V.G.P.)
- Correspondence: ; Tel.: +7-343-253-04-21 or +7-922-126-30-90; Fax: +7-343-3717-740
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14
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García-Esquinas E, Ortolá R, Buño A, Olmedo P, Gil F, Banegas JR, Pérez-Gómez B, Navas-Acién A, Rodríguez-Artalejo F. Cadmium exposure and growth differentiation factor-15 (GDF-15) levels in non-smoking older adults. ENVIRONMENTAL RESEARCH 2022; 206:112250. [PMID: 34695433 DOI: 10.1016/j.envres.2021.112250] [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: 09/08/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cadmium (Cd) exposure is a risk factor for cardiovascular disease (CVD); however, understanding the effects of Cd at the cellular level remains incomplete. Since growth differentiation factor-15 (GDF-15) is a cytokine produced in many cell types in response to tissue injury and inflammation that may capture several pathways between Cd and CVD, this study examined the relationship between blood Cd levels and serum GDF-15 concentrations in community-dwelling older adults. METHODS Cd and GDF-15 were measured in 1942 non-smoking individuals aged 65+ with no previous history of CVD. The association of Cd with GDF-15 was evaluated in linear regression models that adjusted for sociodemographic, lifestyle and biological risk factors, inflammatory biomarkers (IL-6, C-reactive protein and neutrophil to lymphocyte ratio), and markers of vascular damage (NTproBNP and cTnT-hs). RESULTS Geometric mean Cd exposure was 0.11 μg/L (0.09 in never- and 0.15 in former-smokers) and geometric mean GDF-15 was 1186.21 pg/mL (1182.67 in never- and 1191.66 in former-smokers). In multivariable analyses, we found a dose-response association between Cd levels and GDF-15: adjusted mean percentage differences in GDF-15 (95% confidence interval) per 2-fold increase in Cd concentrations in the overall non-smoking population and in never smokers were, respectively, 2.54% (1.01, 4.06) and 2.50% (0.47, 4.54). In spline regression, the dose-response relationship was progressive over the range of Cd concentrations with no significant departures from linearity. CONCLUSIONS Cd exposure may be related to enhanced GDF-15 expression. Future studies with repeated GDF-15 measurements should confirm the present findings to better understand the biological mechanisms underlying this association.
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Affiliation(s)
- Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Antonio Buño
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Department of Laboratory Medicine, La Paz University Hospital, Madrid, Spain
| | - Pablo Olmedo
- Department of Legal Medicine, Toxicology, and Physical Anthropology, School of Medicine, University of Granada, Granada, Spain
| | - Fernando Gil
- Department of Legal Medicine, Toxicology, and Physical Anthropology, School of Medicine, University of Granada, Granada, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Beatriz Pérez-Gómez
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Navas-Acién
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
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15
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Sears CG, Eliot M, Raaschou-Nielsen O, Poulsen AH, Harrington JM, Howe CJ, James KA, Roswall N, Overvad K, Tjønneland A, Meliker J, Wellenius GA. Urinary Cadmium and Incident Heart Failure: A Case-Cohort Analysis Among Never-Smokers in Denmark. Epidemiology 2022; 33:185-192. [PMID: 34860726 PMCID: PMC8810592 DOI: 10.1097/ede.0000000000001446] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Epidemiologic studies suggest cadmium exposure is associated with cardiovascular disease risk, including heart failure. However, prior findings may be influenced by tobacco smoking, a dominant source of cadmium exposure and risk factor for heart failure. The present study leverages up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to examine the relationship between urinary cadmium and incident heart failure among people who never smoked. METHODS Between 1993 and 1997, 19,394 never-smoking participants (ages 50-64 years) enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 men and 600 women and identified 958 incident heart failure cases occurring between baseline and 2015. Using a case-cohort approach, we estimated adjusted hazard ratios (aHR) for heart failure in Cox proportional hazards models with age as the time scale. RESULTS Participants had relatively low concentrations of urinary cadmium, as expected for never smokers (median = 0.20; 25th, 75th = 0.13, 0.32 μg cadmium/g creatinine). In adjusted models, we found that higher urinary cadmium was associated with a higher rate of incident heart failure overall (aHR = 1.1 per interquartile range difference [95% CI = 1.0, 1.2). In sex-stratified analyses, the association seemed restricted to men (aHR = 1.5 [95% CI = 1.2, 1.9]). CONCLUSIONS In this cohort of people who never smoked tobacco, environmental cadmium was positively associated with incident heart failure, especially among men.
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Affiliation(s)
- Clara G. Sears
- Department of Epidemiology, Brown University School of
Public Health, Providence, RI, USA
- Christina Lee Brown Envirome Institute, Division of
Environmental Medicine, Department of Medicine, University of Louisville,
Louisville, KY, USA
| | - Melissa Eliot
- Department of Epidemiology, Brown University School of
Public Health, Providence, RI, USA
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen,
Denmark
- Department of Environmental Science, Aarhus University,
Roskilde, Denmark
| | | | - James M. Harrington
- Center for Analytical Science, Research Triangle Institute,
Research Triangle Park, NC, USA
| | - Chanelle J. Howe
- Department of Epidemiology, Brown University School of
Public Health, Providence, RI, USA
| | - Katherine A. James
- Department of Family Medicine, University of Colorado
Denver, Denver, CO, USA
| | - Nina Roswall
- Danish Cancer Society Research Center, Copenhagen,
Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus,
Denmark
- Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen,
Denmark
- Department of Public Health, University of Copenhagen,
Copenhagen, Denmark
| | - Jaymie Meliker
- Program in Public Health, Department of Family,
Population, & Preventive Medicine, Stony Brook University, NY, USA
| | - Gregory A. Wellenius
- Department of Epidemiology, Brown University School of
Public Health, Providence, RI, USA
- Department of Environmental Health, Boston University,
Boston, MA, USA
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16
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Ferreira G, Santander A, Chavarría L, Cardozo R, Savio F, Sobrevia L, Nicolson GL. Functional consequences of lead and mercury exposomes in the heart. Mol Aspects Med 2021; 87:101048. [PMID: 34785060 DOI: 10.1016/j.mam.2021.101048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/20/2022]
Abstract
Lead and mercury are heavy metals that are highly toxic to life forms. There are no known physiological processes that require them, and they do not have a particular threshold concentration to produce biologic damage. They are non-biodegradable, and they slowly accumulate in the environment in a dynamic equilibrium between air, water, soil, food, and living organisms. Their accumulation in the environment has been increasing over time, because they were not banned from use in anthropogenic industrial production. In their +2 cationic state they are powerful oxidizing agents with the ability to interfere significantly with processes that require specific divalent cations. Acute or chronic exposure to lead and mercury can produce multisystemic damage, especially in the developing nervous systems of children and fetuses, resulting in variety of neurological consequences. They can also affect the cardiovascular system and especially the heart, either directly through their action on cardiomyocytes or indirectly through their effects on innervation, humoral responses or blood vessel alterations. For example, heart function modified by these heavy metals are heart rate, contraction, excitability, and rhythm. Some cardiac molecular targets have been identified and characterized. The direct mechanisms of damage of these heavy metals on heart function are discussed. We conclude that exposome to these heavy metals, should be considered as a major relevant risk factor for cardiac diseases.
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Affiliation(s)
- Gonzalo Ferreira
- Laboratory of Ion Channels, Biological Membranes and Cell Signaling. Department of Biophysics, Faculty of Medicine, Universidad de la República, Gral. Flores, 2125, CP 11800, Montevideo, Uruguay.
| | - Axel Santander
- Laboratory of Ion Channels, Biological Membranes and Cell Signaling. Department of Biophysics, Faculty of Medicine, Universidad de la República, Gral. Flores, 2125, CP 11800, Montevideo, Uruguay
| | - Luisina Chavarría
- Laboratory of Ion Channels, Biological Membranes and Cell Signaling. Department of Biophysics, Faculty of Medicine, Universidad de la República, Gral. Flores, 2125, CP 11800, Montevideo, Uruguay
| | - Romina Cardozo
- Laboratory of Ion Channels, Biological Membranes and Cell Signaling. Department of Biophysics, Faculty of Medicine, Universidad de la República, Gral. Flores, 2125, CP 11800, Montevideo, Uruguay
| | - Florencia Savio
- Laboratory of Ion Channels, Biological Membranes and Cell Signaling. Department of Biophysics, Faculty of Medicine, Universidad de la República, Gral. Flores, 2125, CP 11800, Montevideo, Uruguay
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, Universidad Católica de Chile, Santiago, 8330024, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville, E-41012, Spain; Medical School (Faculty of Medicine), São Paulo State University (UNESP), Brazil; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Queensland, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, 9713GZ, Groningen, the Netherlands
| | - Garth L Nicolson
- Department of Molecular Pathology, The Institute for Molecular Medicine, 16731 Gothard St. Huntington Beach, California, 92647, USA
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17
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Chen Z, Huo X, Chen G, Luo X, Xu X. Lead (Pb) exposure and heart failure risk. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:28833-28847. [PMID: 33840028 DOI: 10.1007/s11356-021-13725-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 02/08/2023]
Abstract
Lead (Pb) is a heavy metal with widespread industrial use, but it is also a widespread environmental contaminant with serious toxicological consequences to many species. Pb exposure adversely impacts the cardiovascular system in humans, leading to cardiac dysfunction, but its effects on heart failure risk remain poorly elucidated. To better understand the pathophysiological effects of Pb, we review potential mechanisms by which Pb exposure leads to cardiac dysfunction. Adverse effects of Pb exposure on cardiac function include heart failure risk, pressure overload, arrhythmia, myocardial ischemia, and cardiotoxicity. The data reviewed clearly establish that Pb exposure can play an important role in the occurrence and development of heart failure. Future epidemiological and mechanistic studies should be developed to better understand the involvement of Pb exposure in heart failure.
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Affiliation(s)
- Zihan Chen
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, 22 Xinling Rd, Shantou, 515041, Guangdong, China
| | - Xia Huo
- Laboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou, 511443, Guangdong, China
| | - Guangcan Chen
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, 22 Xinling Rd, Shantou, 515041, Guangdong, China
| | - Xiuli Luo
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, 22 Xinling Rd, Shantou, 515041, Guangdong, China
| | - Xijin Xu
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, 22 Xinling Rd, Shantou, 515041, Guangdong, China.
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, 515041, Guangdong, China.
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18
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Lamas GA, Ujueta F, Navas-Acien A. Lead and Cadmium as Cardiovascular Risk Factors: The Burden of Proof Has Been Met. J Am Heart Assoc 2021; 10:e018692. [PMID: 33942628 PMCID: PMC8200701 DOI: 10.1161/jaha.120.018692] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gervasio A Lamas
- Department of Medicine Mount Sinai Medical Center Miami Beach FL.,Columbia University Division of Cardiology Mount Sinai Medical CenterMiami Beach FL
| | - Francisco Ujueta
- Department of Medicine Mount Sinai Medical Center Miami Beach FL
| | - Ana Navas-Acien
- Department of Environmental Health Sciences Columbia University Mailman School of Public Health New York NY
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19
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Narita K, Amiya E. Social and environmental risks as contributors to the clinical course of heart failure. Heart Fail Rev 2021; 27:1001-1016. [PMID: 33945055 DOI: 10.1007/s10741-021-10116-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.
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Affiliation(s)
- Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan. .,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan.
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20
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McCarty MF. Nutraceutical, Dietary, and Lifestyle Options for Prevention and Treatment of Ventricular Hypertrophy and Heart Failure. Int J Mol Sci 2021; 22:ijms22073321. [PMID: 33805039 PMCID: PMC8037104 DOI: 10.3390/ijms22073321] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022] Open
Abstract
Although well documented drug therapies are available for the management of ventricular hypertrophy (VH) and heart failure (HF), most patients nonetheless experience a downhill course, and further therapeutic measures are needed. Nutraceutical, dietary, and lifestyle measures may have particular merit in this regard, as they are currently available, relatively safe and inexpensive, and can lend themselves to primary prevention as well. A consideration of the pathogenic mechanisms underlying the VH/HF syndrome suggests that measures which control oxidative and endoplasmic reticulum (ER) stress, that support effective nitric oxide and hydrogen sulfide bioactivity, that prevent a reduction in cardiomyocyte pH, and that boost the production of protective hormones, such as fibroblast growth factor 21 (FGF21), while suppressing fibroblast growth factor 23 (FGF23) and marinobufagenin, may have utility for preventing and controlling this syndrome. Agents considered in this essay include phycocyanobilin, N-acetylcysteine, lipoic acid, ferulic acid, zinc, selenium, ubiquinol, astaxanthin, melatonin, tauroursodeoxycholic acid, berberine, citrulline, high-dose folate, cocoa flavanols, hawthorn extract, dietary nitrate, high-dose biotin, soy isoflavones, taurine, carnitine, magnesium orotate, EPA-rich fish oil, glycine, and copper. The potential advantages of whole-food plant-based diets, moderation in salt intake, avoidance of phosphate additives, and regular exercise training and sauna sessions are also discussed. There should be considerable scope for the development of functional foods and supplements which make it more convenient and affordable for patients to consume complementary combinations of the agents discussed here. Research Strategy: Key word searching of PubMed was employed to locate the research papers whose findings are cited in this essay.
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Affiliation(s)
- Mark F McCarty
- Catalytic Longevity Foundation, 811 B Nahant Ct., San Diego, CA 92109, USA
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21
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Zhou L, Wang S, Cao L, Ren X, Li Y, Shao J, Xu L. Lead acetate induces apoptosis in Leydig cells by activating PPARγ/caspase-3/PARP pathway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:34-44. [PMID: 31145012 DOI: 10.1080/09603123.2019.1625034] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Abstract
This study was designed to investigate the cytotoxicity of lead acetate (Pb(AC)2, a representative air pollutant) by focusing on PPARγ/caspase-3/PARP apoptotic signaling pathway and to explore the inhibitory effect of PPARγ antagonist on apoptosis of TM3 Leydig cells. MTT assay was utilized to examine cell viability. Cell apoptosis was analyzed using a flow cytometry by staining with Annexin V-PE/7AAD staining and a fluorescence microscope by staining with Hoechst 33,258. The levels of apoptosis-related proteins were examined using western blot. From the results, Pb reduced significantly TM3 cell proliferation in concentration- and time-dependent manner. It increased significantly apoptosis; increased the PPARγ, Bax, procaspase-3, cleaved caspase-3, proPARP, cleaved PARP levels; and decreased Bcl-2 level in Pb-treated TM3 cells as compared to control cells. Furthermore, pretreatment with PPARγ antagonist significantly attenuated the apoptosis and cleavage of caspase-3 and PARP induced by Pb. Our results suggested that Pb induced cytotoxicity on TM3 Leydig cells, at least in part, by increasing PPARγ expression, stimulating cleavage of caspase-3 and PARP, and then induced cell apoptosis.
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Affiliation(s)
- Li Zhou
- Department of Nutrition, School of Public Health, Xuzhou Medical University , Xuzhou, China
| | - Susu Wang
- Department of Nutrition, School of Public Health, Xuzhou Medical University , Xuzhou, China
| | - Lina Cao
- Department of Nutrition, School of Public Health, Xuzhou Medical University , Xuzhou, China
| | - Xiangmei Ren
- Department of Nutrition, School of Public Health, Xuzhou Medical University , Xuzhou, China
| | - Yuanhong Li
- Department of Nutrition, School of Public Health, Xuzhou Medical University , Xuzhou, China
| | - Jihong Shao
- Department of Nutrition, School of Public Health, Xuzhou Medical University , Xuzhou, China
| | - Lichun Xu
- Department of Hygiene,School of Public Health, Xuzhou Medical University , China
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22
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Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP, Lancellotti P, Melenovsky V, Morris DA, Nagel E, Pieske-Kraigher E, Ponikowski P, Solomon SD, Vasan RS, Rutten FH, Voors AA, Ruschitzka F, Paulus WJ, Seferovic P, Filippatos G. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2020; 40:3297-3317. [PMID: 31504452 DOI: 10.1093/eurheartj/ehz641] [Citation(s) in RCA: 760] [Impact Index Per Article: 190.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/30/2018] [Accepted: 08/26/2019] [Indexed: 02/07/2023] Open
Abstract
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for HF symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), left ventricular (LV) filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
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Affiliation(s)
- Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany
| | - Rudolf A de Boer
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Stefan D Anker
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany
| | - Erwan Donal
- Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy.,Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy
| | - Carolyn S P Lam
- National Heart Centre, Singapore & Duke-National University of Singapore.,University Medical Centre Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt.,German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Adriaan A Voors
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Switzerland
| | - Walter J Paulus
- Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands
| | - Petar Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital "Attikon", Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
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23
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Katsnelson BA, Klinova SV, Gerzen OP, Balakin AA, Lookin ON, Lisin RV, Nabiev SR, Privalova LI, Minigalieva IA, Panov VG, Katsnelson LB, Nikitina LV, Kuznetsov DA, Protsenko YL. Force-velocity characteristics of isolated myocardium preparations from rats exposed to subchronic intoxication with lead and cadmium acting separately or in combination. Food Chem Toxicol 2020; 144:111641. [PMID: 32758638 DOI: 10.1016/j.fct.2020.111641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 01/28/2023]
Abstract
This investigation continues our study of the effects of Pb-Cd poisoning on the heart, extending the enquiry from isometric to auxotonic contractions, thereby examining the effect on the ability of myocardial tissues to perform mechanical work. Different shifts were revealed in myocardial force-velocity relations following subchronic exposure of rats to lead acetate and cadmium chloride acting separately, in combination, or in combination with a bioprotective complex (BPC). The experiments were conducted on isolated preparations of trabecules and papillary muscles of the right ventricle in physiological loading conditions and on isolated heart muscle contractile proteins examined by the in vitro motility assay. The results of the latter correlate with the shifts in the ratio of cardiac myosin isoforms. The amount of work performed by the myocardium was calculated on the basis of the tension-shortening loop area and was found to be similar in the preparations from all experimental groups. This fact presumably reflects adaptive capacity of the myocardial function even when contractility is damaged due to the metallic intoxication of a moderate severity. Some characteristics of rat myocardium altered by the impact of lead-cadmium intoxication became fully or partly normalized if intoxication developed against background administration of a bioprotective complex (BPC). Together with previously reported results obtained in the isometric mode of contractility, all these results strengthen the scientific foundations of risk assessment and risk management projects in the occupational and environmental conditions characterized by human exposure to lead and/or cadmium.
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Affiliation(s)
- Boris A Katsnelson
- The Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russia.
| | - Svetlana V Klinova
- The Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russia
| | - Oksana P Gerzen
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Alexander A Balakin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Oleg N Lookin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Ruslan V Lisin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Salavat R Nabiev
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Larisa I Privalova
- The Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russia
| | - Ilzira A Minigalieva
- The Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russia
| | - Vladimir G Panov
- The Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russia; The Institute of Industrial Ecology, The Urals Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Leonid B Katsnelson
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Larisa V Nikitina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Daniil A Kuznetsov
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Yuri L Protsenko
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
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24
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Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP, Lancellotti P, Melenovsky V, Morris DA, Nagel E, Pieske-Kraigher E, Ponikowski P, Solomon SD, Vasan RS, Rutten FH, Voors AA, Ruschitzka F, Paulus WJ, Seferovic P, Filippatos G. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2020; 22:391-412. [PMID: 32133741 DOI: 10.1002/ejhf.1741] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/30/2018] [Accepted: 08/26/2019] [Indexed: 12/11/2022] Open
Abstract
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), LV filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1 : Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2 : Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
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Affiliation(s)
- Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany
| | - Rudolf A de Boer
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Stefan D Anker
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany
| | - Erwan Donal
- Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy.,Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy
| | - Carolyn S P Lam
- National Heart Centre, Singapore & Duke-National University of Singapore.,University Medical Centre Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt.,German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Adriaan A Voors
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Switzerland
| | - Walter J Paulus
- Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands
| | - Petar Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital "Attikon", Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
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25
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Protsenko YL, Klinova SV, Gerzen OP, Privalova LI, Minigalieva IA, Balakin AA, Lookin ON, Lisin RV, Butova KA, Nabiev SR, Katsnelson LB, Nikitina LV, Katsnelson BA. Changes in rat myocardium contractility under subchronic intoxication with lead and cadmium salts administered alone or in combination. Toxicol Rep 2020; 7:433-442. [PMID: 32181144 PMCID: PMC7063142 DOI: 10.1016/j.toxrep.2020.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 12/13/2022] Open
Abstract
Subchronic intoxications induced in male rats by repeated intraperitoneal injections of lead acetate and cadmium chloride, administered either alone or in combination, are shown to affect the biochemical, cytological and morphometric parameters of blood, liver, heart and kidneys. The single twitch parameters of myocardial trabecular and papillary muscle preparations were measured in the isometric regime to identify changes in the heterometric (length-force) and chronoinotropic (frequency-force) contractility regulation systems. Differences in the responses of these systems in trabecules and papillary muscles to the above intoxications are shown. A number of myocardium mechanical characteristics changing in rats under the effect of a combined lead-cadmium intoxication and increased proportion of α-myosin heavy chains were observed to normalize fully or partially if such intoxication was induced against background administration of a proposed bioprotective complex. Based on the experimental results and literature data, some assumptions are suggested concerning the mechanisms of the cardiotoxic effects produced by lead and cadmium.
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Affiliation(s)
- Yuri L Protsenko
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Svetlana V Klinova
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russia
| | - Oksana P Gerzen
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Larisa I Privalova
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russia
| | - Ilzira A Minigalieva
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russia
| | - Alexander A Balakin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Oleg N Lookin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.,Ural Federal University, Yekaterinburg, Russia
| | - Ruslan V Lisin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Ksenya A Butova
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Salavat R Nabiev
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Leonid B Katsnelson
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.,Ural Federal University, Yekaterinburg, Russia
| | - Larisa V Nikitina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Boris A Katsnelson
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russia
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Staessen JA, Thijs L, Yang WY, Yu CG, Wei FF, Roels HA, Nawrot TS, Zhang ZY. Interpretation of Population Health Metrics: Environmental Lead Exposure as Exemplary Case. Hypertension 2020; 75:603-614. [PMID: 32008462 PMCID: PMC8032208 DOI: 10.1161/hypertensionaha.119.14217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Our objective was to gain insight in the calculation and interpretation of population health metrics that inform disease prevention. Using as model environmental exposure to lead (ELE), a global pollutant, we assessed population health metrics derived from the Third National Health and Nutrition Examination Survey (1988 to 1994), the GBD (Global Burden of Disease Study 2010), and the Organization for Economic Co-operation and Development. In the National Health and Nutrition Examination Survey, the hazard ratio relating mortality over 19.3 years of follow-up to a blood lead increase at baseline from 1.0 to 6.7 µg/dL (10th–90th percentile interval) was 1.37 (95% CI, 1.17–1.60). The population-attributable fraction of blood lead was 18.0% (10.9%–26.1%). The number of preventable ELE-related deaths in the United States would be 412 000 per year (250 000–598 000). In GBD 2010, deaths and disability-adjusted life-years globally lost due to ELE were 0.67 million (0.58–0.78 million) and 0.56% (0.47%–0.66%), respectively. According to the 2017 Organization for Economic Co-operation and Development statistics, ELE-related welfare costs were $1 676 224 million worldwide. Extrapolations from the foregoing metrics assumed causality and reversibility of the association between mortality and blood lead, which at present-day ELE levels in developed nations is not established. Other issues limiting the interpretation of ELE-related population health metrics are the inflation of relative risk based on outdated blood lead levels, not differentiating relative from absolute risk, clustering of risk factors and exposures within individuals, residual confounding, and disregarding noncardiovascular disease and immigration in national ELE-associated welfare estimates. In conclusion, this review highlights the importance of critical thinking in translating population health metrics into cost-effective preventive strategies.
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Affiliation(s)
- Jan A Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.).,Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands (J.A.S.).,NPA Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (J.A.S.)
| | - Lutgarde Thijs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.)
| | - Wen-Yi Yang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.).,Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China (W.-Y.Y.)
| | - Cai-Guo Yu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.).,Department of Endocrinology, Beijing Lu He Hospital and Key Laboratory of Diabetes Prevention and Research, Capital Medical University, China (C.-G.Y.)
| | - Fang-Fei Wei
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.)
| | - Harry A Roels
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (H.A.R., T.S.N.)
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (H.A.R., T.S.N.)
| | - Zhen-Yu Zhang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.)
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27
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Dolan LC, Flannery BM, Hoffman-Pennesi D, Gavelek A, Jones OE, Kanwal R, Wolpert B, Gensheimer K, Dennis S, Fitzpatrick S. A review of the evidence to support interim reference level for dietary lead exposure in adults. Regul Toxicol Pharmacol 2020; 111:104579. [PMID: 31945454 DOI: 10.1016/j.yrtph.2020.104579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/13/2022]
Abstract
FDA developed the interim reference level (IRL) for lead of 3 μg/day in children and 12.5 μg/day in women of childbearing age (WOCBA) to better protect the fetus from lead toxicity. These IRLs correspond to a blood lead level (BLL) of 0.5 μg/dL in both populations. The current investigation was performed to determine if the IRL for WOCBA should apply to the general population of adults. A literature review of epidemiological studies was conducted to determine whether a BLL of 0.5 μg/dL is associated with adverse effects in adults. Some studies reported adverse effects over a wide range of BLLs that included 0.5 μg/dL adding uncertainty to conclusions about effects at 0.5 μg/dL; however, no studies clearly identified this BLL as an adverse effect level. Results also showed that the previously developed PTTDI for adults of 75 μg/day lead may not be health protective, supporting use of a lower reference value for lead toxicity in this population group. Use of the 12.5 μg/day IRL as a benchmark for dietary lead intake is one way FDA will ensure that dietary lead intake in adults is reduced.
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Affiliation(s)
- Laurie C Dolan
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Brenna M Flannery
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA.
| | - Dana Hoffman-Pennesi
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Alexandra Gavelek
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Olivia E Jones
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Richard Kanwal
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Beverly Wolpert
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Kathleen Gensheimer
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Sherri Dennis
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Suzanne Fitzpatrick
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
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28
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Chen J, He W, Zhu X, Yang S, Yu T, Ma W. Epidemiological study of kidney health in an area with high levels of soil cadmium and selenium: Does selenium protect against cadmium-induced kidney injury? THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 698:134106. [PMID: 31505350 DOI: 10.1016/j.scitotenv.2019.134106] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 08/01/2019] [Accepted: 08/24/2019] [Indexed: 06/10/2023]
Abstract
Chronic exposure to cadmium (Cd) can cause renal dysfunction. Studies of animals, cell cultures, and plants have found that selenium (Se) can effectively alleviate the hazard generated by Cd, but there has been little study of this in general human populations. This study recruited 313 subjects from China's Hubei Province, including 160 living in areas with high soil Cd and Se (exposure group) and 153 living in clean areas (control group). The levels of the following were detected: Cd and Se in blood (B-Cd and B-Se), urine (U-Cd and U-Se), and hair (H-Cd and H-Se); N-acetyl-β-D-glucosaminidase (U-NAG), β2-microglobulin (U-β2-MG), and albumin (U-ALB) in urine; and malondialdehyde (S-MDA), superoxide dismutase (S-SOD), and glutathione peroxidase (S-GSH-Px) in serum. In addition, the interactions between Cd and Se were assessed. The median levels of B-Cd, B-Se, U-Cd, U-Se, H-Cd, H-Se, S-MDA, and S-GSH-Px of exposure group (2.60 ng/mL, 238.90 ng/mL, 3.13 μg/g Cr, 45.43 μg/g Cr, 0.06 μg/g, 0.70 μg/g, 5.22 nmol/mL, and 308.89 U, respectively) were significantly higher than of controls (0.95 ng/mL, 130.50 ng/mL, 1.08 μg/g Cr, 30.51 μg/g Cr, 0.04 μg/g, 0.49 μg/g, 4.71 nmol/mL, and 267.54 U, respectively), but there were no significant differences in U-NAG, U-β2-MG, U-ALB, or S-SOD between the two groups. U-NAG levels were significantly negatively associated with the interaction between Cd and Se (B: -0.511, 95% CI: -0.886, -0.136). Additionally, changes in the direction of the estimated regression coefficient in the low and high H-Se groups were observed for U-Cd and S-MDA (from 0.018 to -0.090), U-Cd and S-GSH-Px (from -0.039 to 0.101). This study found that populations living in areas with high levels of soil Cd and Se did not show greater Cd-induced renal tubular and glomerular injuries than the control population, which could attribute to the protective effects of Se. The protective effects may be related to the peculiar function of Se that Se can combine with free Cd to activate the antioxidant enzyme system.
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Affiliation(s)
- Juan Chen
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, PR China
| | - Wei He
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, PR China
| | - Xiaojun Zhu
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing 100050, PR China
| | - Siwen Yang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, PR China
| | - Tao Yu
- School of Earth Sciences and Resources, China University of Geosciences, Beijing 100083, PR China
| | - Wenjun Ma
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, PR China.
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29
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Klinova SV, Minigalieva IA, Privalova LI, Valamina IE, Makeyev OH, Shuman EA, Korotkov AA, Panov VG, Sutunkova MP, Ryabova JV, Bushueva TV, Shtin TN, Gurvich VB, Katsnelson BA. Further verification of some postulates of the combined toxicity theory: New animal experimental data on separate and joint adverse effects of lead and cadmium. Food Chem Toxicol 2019; 136:110971. [PMID: 31751644 DOI: 10.1016/j.fct.2019.110971] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 01/10/2023]
Abstract
Outbred male rats were repeatedly injected intraperitoneally two-level sub-lethal doses of lead acetate and/or cadmium chloride solutions 3 times a week during 6 weeks. The animals developed explicit, even if moderate, subchronic intoxication characterized by a large number of indices, both common to both metals (including increased DNA fragmentation coefficient) and lead-specific. Special attention was paid to hemodynamic and electrocardiographic effects. The combined action of lead and cadmium was modeled with the help of the Response Surface Methodology to obtain additional support for the previously substantiated postulates of combined toxicity's typological ambiguity. This is dependent on which particular effect comes under consideration, on its level, and on the acting dose ratio. For one and the same toxic combination, the type of combined toxic action can vary from synergistic to contra-directional. In particular, the actions of lead and cadmium on blood pressure were found to be opposite in direction. Furthermore, it is shown once again that the systemic toxic effects of a metal combination, its in vivo genotoxicity included, can be more or less attenuated by background administration of a theoretically justified composition of biologically active agents.
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Affiliation(s)
- Svetlana V Klinova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 30 Popov Str, Ekaterinburg, 620014, Russia
| | - Ilzira A Minigalieva
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 30 Popov Str, Ekaterinburg, 620014, Russia
| | - Larisa I Privalova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 30 Popov Str, Ekaterinburg, 620014, Russia
| | - Irene E Valamina
- The Central Research Laboratory, The Ural State Medical University, 17 Klyuchevskaya Str, Ekaterinburg, 620109, Russia
| | - Oleg H Makeyev
- The Ural Federal University Named After the First President of Russia B.N. Yeltsin, 19 Mira Str, Ekaterinburg, 620002, Russia
| | - Eugene A Shuman
- The Ural Federal University Named After the First President of Russia B.N. Yeltsin, 19 Mira Str, Ekaterinburg, 620002, Russia
| | - Artem A Korotkov
- The Ural Federal University Named After the First President of Russia B.N. Yeltsin, 19 Mira Str, Ekaterinburg, 620002, Russia
| | - Vladimir G Panov
- Institute of Industrial Ecology, The Urals Branch of the Russian Academy of Sciences, 20 Sofia Kovalevskaya Str, Ekaterinburg, 620990, Russia
| | - Marina P Sutunkova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 30 Popov Str, Ekaterinburg, 620014, Russia
| | - Julia V Ryabova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 30 Popov Str, Ekaterinburg, 620014, Russia
| | - Tatiana V Bushueva
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 30 Popov Str, Ekaterinburg, 620014, Russia
| | - Tatiana N Shtin
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 30 Popov Str, Ekaterinburg, 620014, Russia
| | - Vladimir B Gurvich
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 30 Popov Str, Ekaterinburg, 620014, Russia
| | - Boris A Katsnelson
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, 30 Popov Str, Ekaterinburg, 620014, Russia.
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30
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Yu CG, Wei FF, Yang WY, Zhang ZY, Mujaj B, Thijs L, Feng YM, Boggia J, Nawrot TS, Struijker-Boudier HAJ, Staessen JA. Central hemodynamics in relation to blood lead in young men prior to chronic occupational exposure. Blood Press 2019; 28:279-290. [DOI: 10.1080/08037051.2019.1610654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Cai-Guo Yu
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Endocrinology, Beijing Luhe Hospital and Key Laboratory of Diabetes Prevention and Research, Capital Medical University, Beijing, China
| | - Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Blerim Mujaj
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Ying-Mei Feng
- Department of Endocrinology, Beijing Luhe Hospital and Key Laboratory of Diabetes Prevention and Research, Capital Medical University, Beijing, China
| | - José Boggia
- Unidad de Hipertensión Arterial, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Tim S. Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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31
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Affiliation(s)
- Rajiv Chowdhury
- From the Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Kim van Daalen
- From the Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
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32
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Protsenko YL, Katsnelson BA, Klinova SV, Lookin ON, Balakin AA, Nikitina LV, Gerzen OP, Nabiev SR, Minigalieva IA, Privalova LI, Gurvich VB, Sutunkova MP, Katsnelson LB. Further analysis of rat myocardium contractility changes associated with a subchronic lead intoxication. Food Chem Toxicol 2019; 125:233-241. [PMID: 30634013 DOI: 10.1016/j.fct.2018.12.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/06/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
A moderate subchronic lead intoxication was observed in male rats after repeated intraperitoneal injections of lead acetate. Right ventricular trabeculae and papillary muscles were isolated for in vitro studying of the contraction-relaxation cycle under isotonic and physiological loading. The contractile function of the myocardium was also assessed by measuring the velocity of thin filament movement over myosin. Lead intoxication led in papillary muscles to a decrease in the maximal rate of isotonic shortening for all afterloads and a decrease in the thin filament sliding velocity. Papillary muscles from lead-exposed rats displayed marked changes in most of the main characteristics of afterload contraction-relaxation cycles, but in trabeculae these changes were less pronounced. The reported changes were attenuated to some extent in rats treated with a Ca-containing bioprotector. The amount of work produced by both types of heart muscle preparations was not changed by lead. Only in papillary muscles the load-dependent relaxation index was significantly increased in the lead-treated groups. Thus subchronic lead intoxication affects the peak rate of force development and relaxation properties of cardiac muscle contracting in isotonic/physiological regimes rather than the total amount of mechanical work, which may reflect adaptive changes in the myocardial function under decreased contractility.
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Affiliation(s)
- Yuri L Protsenko
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Boris A Katsnelson
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia.
| | - Svetlana V Klinova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Oleg N Lookin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia; Ural Federal University, Ekaterinburg, Russia
| | - Alexander A Balakin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Larisa V Nikitina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Oksana P Gerzen
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Salavat R Nabiev
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Ilzira A Minigalieva
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Larisa I Privalova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Vladimir B Gurvich
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Marina P Sutunkova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Leonid B Katsnelson
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia; Ural Federal University, Ekaterinburg, Russia
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33
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Protsenko YL, Katsnelson BA, Klinova SV, Lookin ON, Balakin AA, Nikitina LV, Gerzen OP, Minigalieva IA, Privalova LI, Gurvich VB, Sutunkova MP, Katsnelson LB. Effects of subchronic lead intoxication of rats on the myocardium contractility. Food Chem Toxicol 2018; 120:378-389. [PMID: 30036551 DOI: 10.1016/j.fct.2018.07.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/02/2018] [Accepted: 07/19/2018] [Indexed: 01/21/2023]
Abstract
Outbred male rats were repeatedly injected IP with sub-lethal doses of lead acetate 3 times a week during 5 weeks. They developed an explicit, even if moderate, lead intoxication characterized by typical hematological and some other features. The next day after the last injection the heart of each animal was excised, and the trabecules and papillary muscles from the right ventricle were used for modeling in vitro isometric (with varying starting length of the preparation) regimes of the contraction-relaxation cycle with different preloads. Several well-established parameters of this model were found changed compared with the preparations taken from the hearts of healthy control rats. Background in vivo calcium treatment attenuated both systemic and cardiotoxic effects of lead to an extent. We show for the first time that subchronic intoxication with lead caused myocardial preparations in a wide range of lengths to respond by a decrease in the time and speed parameters of the isometric contraction while maintaining its amplitude and by a decrease in the passive stiffness of trabecules. The responses of the various heart structures are outlined, and the isomyosin ratio is shown to have shifted towards the slow isoform. Mechanistic and toxicological inferences from the results are discussed.
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Affiliation(s)
- Yuri L Protsenko
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Boris A Katsnelson
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia.
| | - Svetlana V Klinova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Oleg N Lookin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Alexander A Balakin
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Larisa V Nikitina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Oksana P Gerzen
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Ilzira A Minigalieva
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Larisa I Privalova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Vladimir B Gurvich
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Marina P Sutunkova
- The Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Ekaterinburg, Russia
| | - Leonid B Katsnelson
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
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34
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Yang WY, Zhang ZY, Thijs L, Bijnens EM, Janssen BG, Vanpoucke C, Lefebvre W, Cauwenberghs N, Wei FF, Luttun A, Verhamme P, Van Hecke E, Kuznetsova T, D'hooge J, Nawrot TS, Staessen JA. Left ventricular function in relation to chronic residential air pollution in a general population. Eur J Prev Cardiol 2017; 24:1416-1428. [PMID: 28617090 PMCID: PMC5574492 DOI: 10.1177/2047487317715109] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background In view of the increasing heart failure epidemic and awareness of the adverse impact of environmental pollution on human health, we investigated the association of left ventricular structure and function with air pollutants in a general population. Methods In 671 randomly recruited Flemish (51.7% women; mean age, 50.4 years) we echocardiographically assessed left ventricular systolic strain and strain rate and the early and late peak velocities of transmitral blood flow and mitral annular movement (2005−2009). Using subject-level data, left ventricular function was cross-sectionally correlated with residential long-term exposure to air pollutants, including black carbon, PM2.5, PM10 (particulate matter) and nitrogen dioxide (NO2), while accounting for clustering by residential address and confounders. Results Annual exposures to black carbon, PM2.5, PM10 and NO2 averaged 1.19, 13.0, 17.7, and 16.8 µg/m3. Systolic left ventricular function was worse (p ≤ 0.027) with higher black carbon, PM2.5, PM10 and NO2 with association sizes per interquartile interval increment ranging from −0.339 to −0.458% for longitudinal strain and from −0.033 to −0.049 s−1 for longitudinal strain rate. Mitral E and a′ peak velocities were lower (p ≤ 0.021) with higher black carbon, PM2.5 and PM10 with association sizes ranging from −1.727 to −1.947 cm/s and from −0.175 to −0.235 cm/s, respectively. In the geographic analysis, the systolic longitudinal strain sided with gradients in air pollution. The path analysis identified systemic inflammation as a possible mediator of associations with black carbon. Conclusions Long-term low-level air pollution is associated with subclinical impairment of left ventricular performance and might be a risk factor for heart failure.
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Affiliation(s)
- Wen-Yi Yang
- 1 Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium
| | - Zhen-Yu Zhang
- 1 Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium
| | - Lutgarde Thijs
- 1 Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium
| | - Esmée M Bijnens
- 2 Centre for Environmental Sciences, Hasselt University, Belgium
| | - Bram G Janssen
- 2 Centre for Environmental Sciences, Hasselt University, Belgium
| | | | - Wouter Lefebvre
- 4 Flemish Institute for Technological Research, Mol, Belgium
| | - Nicholas Cauwenberghs
- 1 Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium
| | - Fang-Fei Wei
- 1 Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium
| | - Aernout Luttun
- 5 Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium
| | - Peter Verhamme
- 5 Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium
| | - Etienne Van Hecke
- 6 Division of Geography and Tourism, Faculty of Science, University of Leuven, Belgium
| | - Tatiana Kuznetsova
- 1 Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium
| | - Jan D'hooge
- 7 Laboratory on Cardiovascular Imaging and Dynamics, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium
| | - Tim S Nawrot
- 2 Centre for Environmental Sciences, Hasselt University, Belgium
| | - Jan A Staessen
- 1 Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Faculty of Medicine, University of Leuven, Belgium.,8 R&D Group VitaK, Maastricht University, The Netherlands
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