[Anemia induced by cadmium intoxication]

A suspected case of "itai-itai disease" in a cadmium-polluted area in Akita prefecture, Japan

BACKGROUND

Itai-itai disease is the most severe case of chronic cadmium (Cd) toxicity, which was endemic in Cd-polluted areas in the Jinzu River basin in Toyama prefecture, Japan. Akita prefecture also has Cd-polluted areas, but there have been no cases of "itai-itai disease".

CASE PRESENTATION

An elderly female farmer with Cd nephropathy residing in a Cd-polluted area in the northern part of the Akita prefecture was identified through hospital-based screening at Akita Rosai Hospital in Odate city. She had chronic renal failure with a high Cd exposure level and advanced renal tubular dysfunction. The shortening of height, bone deformities and fractures, abnormal bone metabolism suggesting osteomalacia, and renal anemia were also noted. Therefore, "itai-itai disease", similar to cases in the Jinzu River basin, was suspected.

CONCLUSION

This is the first case of "itai-itai disease" in a Cd-polluted area in Akita prefecture.

Blocked erythroid differentiation and delayed enucleation of erythroblasts may contribute to murine embryonic toxicity upon exposure to low dose of cadmium

Epidemiological and experimental studies have demonstrated the association of spontaneous abortion or embryonic atrophy with heavy metals, including some well-known anemia inducers, such as cadmium (Cd). However, the direct adverse effect of Cd on embryos without inducing maternal anemia remains unclear. In this study, we treated mice with a low dose of Cd before and after mating to minimize Cd-induced maternal anemia. Although most embryos developed normally, embryonic atrophy was still observed in a small percentage of embryos from Cd-exposed pregnant mice. Compared to the embryos from the control pregnant mice, a complete blockage of erythroid differentiation was observed in the atrophic embryos but no obvious alteration of erythroid differentiation in the non-atrophic embryos, respectively. Moreover, our results suggested delayed enucleation of erythroblasts in these non-atrophic embryos. Mechanically, the inhibited iron transport from the placenta to the fetus together with the increased iron export in the fetal livers might contribute to embryonic atrophy and delayed enucleation of erythroblasts upon Cd exposure. Our data may provide new insights into the embryonic toxicity of low-dose Cd.

Cadmium chloride generates cytotoxic reactive species that cause oxidative damage and morphological changes in human erythrocytes

Cadmium chloride (CdCl₂₎ is a widely used industrial compound that exhibits multiple organ toxicity. Cadmium is transported through blood where erythrocytes are exposed to its action. Here the effect of CdCl₂ on human erythrocytes was examined under in vitro conditions. Human erythrocytes were treated with 0.01-0.5 mM CdCl₂ for 24 h at 37 °C. Lysates were made from CdCl₂ treated and untreated (control) cells and used for further analysis. CdCl₂ treatment resulted in marked hemolysis of erythrocytes and oxidation of hemoglobin to methemoglobin. This will result in anemia and also reduce the oxygen carrying ability of erythrocytes. Hemoglobin oxidation was accompanied by degradation of heme and release of free ferrous iron moiety. Further analysis showed elevated lipid hydroperoxides and formation of advanced oxidation protein products along with reduction in total sulfhydryl content, indicating the generation of oxidative stress condition in the cell. Incubation of erythrocytes with CdCl₂ enhanced generation of reactive oxygen and nitrogen species, decreased the antioxidant power and inhibited pathways of glucose metabolism. Plasma membrane was damaged as indicated by enhanced osmotic fragility and inhibition of membrane bound enzymes. This was confirmed by electron microscopy which showed formation of echinocytes. These results show that CdCl₂ generates reactive species which impair the antioxidant system resulting in oxidative damage to erythrocytes.

The association between hemoglobin level and osteoporosis in a Chinese population with environmental lead and cadmium exposure

Low hemoglobin (Hb) level or anemia is associated with osteoporosis and bone fracture. Cadmium (Cd) and lead (Pb) exposure are also risk factors of osteoporosis and anemia. However, the role of anemia in Cd/Pb related bone loss remains unclear. The aim of present study was to investigate the association between Hb level and bone loss in a population with environmental lead and cadmium exposure. One hundred and ninety-four women and 108 men with different levels of Cd/Pb exposure were included in our study. The Cd/Pb exposure was determined using graphite-furnace atomic absorption spectrometry. Forearm bone mineral density (BMD) was determined by peripheral dual-energy X-ray absortiometry. Hb concentration was determined using an automatic blood cellcounter. A logistic model was established to predict the risk of osteoporosis. The BMDs of women that had the highest quartile BCd and BPb were markedly lower than that with the lowest quartile (p < 0.05). The BMD and the prevalence of osteoporosis in men with anemia were lower and higher than that with normal Hb (p < 0.05), respectively. In men, age, BPb and anemia were independent risk factors for osteoporosis. The odds ratio (OR) of men with anemia was 11.28 (95%confidence interval (CI):1.94-65.54) and 19.56 (95%CI: 2.98-128.78) compared to those with normal Hb after adjusting for potential cofounders. No such association was found in women. The area under the curve was 0.88 (95%CI: 0.82-0.96) in predicting osteoporosis using the logistic model in men. Linear discriminant analysis also showed that 90.7% of osteoporosis was correctly classified. Our data show that anemia is associated with incident of osteoporosis in men but not in women that environmentally exposed to Pb and Cd.

Partial protective effects of melatonin on cadmium-induced changes in hematological characteristics in rats

We investigated the effects of melatonin (Mlt) on hematological characteristics to determine the percentage of alpha-naphthyl acetate esterase (ANAE) positive lymphocytes in rats chronically exposed to cadmium (Cd). We used four groups of male rats: control (C), melatonin (Mlt), cadmium (Cd) and Cd + Mlt (CdMlt). Blood samples were obtained to assess the erythrocytes (RBC), leukocytes (WBC), platelets (PLT), hemoglobin (HGB), hematocrit (HCT), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV) as well as alpha-naphthyl acetate esterase (ANAE) positive lymphocytes. We found that the number of WBC increased in the Cd group compared to the other three experimental groups. Low MCV and MCHC values caused by Cd were ameliorated by Mlt treatment in the CdMlt group. We found no significant change in the RBC, HGB, MCH, PLT and HCT values among the experimental groups. Mlt treatment also increased the percentage of ANAE positive lymphocytes. Mlt partially protects some hematological characteristics in cases of chronic Cd toxicity.

Relationship between osteoid formation and iron deposition induced by chronic cadmium exposure in ovariectomized rats

Itai-itai (Japanese, "It hurts! It hurts!") disease (IID), a form of osteomalacia, can be induced in ovariectomized rats by long-term administration of cadmium (Cd). This IID rat model shows severe anemia, severe nephropathy, and osteomalacia accompanied by iron (Fe) deposition at the mineralization front. We characterized the pathogenesis of Cd-induced bone lesions by investigating the relationship between Fe deposition and osteoid tissue formation in ovariectomized rats. The rats were injected with CdCl₂ (0.5 mg/kg) for 70 weeks, with or without co-injection of erythropoietin (EPO) for varying lengths of time to elucidate whether EPO prevents and/or cures anemia, and, with the restoration from anemia, lessens the osteoid tissue formation. Necropsies were performed at 25, 50, or 70 weeks. Fe deposition at the mineralization front of bone was found at 50 weeks and increased thereafter. Animals injected with EPO showed decreased Fe deposition, although there was no relation between EPO administration and osteoid formation in the femur. Because the increase in bone lesion severity was independent of the amount of Fe deposition, we suggest that Fe deposition is not involved in the etiology of Cd-induced femoral bone lesions.

Adverse Impact of Heavy Metals on Bone Cells and Bone Metabolism Dependently and Independently through Anemia

Mounting evidence is revealing that heavy metals can incur disordered bone homeostasis, leading to the development of degenerative bone diseases, including osteoporosis, osteoarthritis, degenerative disk disease, and osteomalacia. Meanwhile, heavy metal-induced anemia has been found to be intertwined with degenerative bone diseases. However, the relationship and interplay among these adverse outcomes remain elusive. Thus, it is of importance to shed light on the modes of action (MOAs) and adverse outcome pathways (AOPs) responsible for degenerative bone diseases and anemia under exposure to heavy metals. In the current Review, the epidemiological and experimental findings are recapitulated to interrogate the contributions of heavy metals to degenerative bone disease development which may be attributable dependently and independently to anemia. A few likely mechanisms are postulated for anemia-independent degenerative bone diseases, including dysregulated osteogenesis and osteoblastogenesis, imbalanced bone formation and resorption, and disturbed homeostasis of essential trace elements. By contrast, remodeled bone microarchitecture, inhibited erythropoietin production, and disordered iron homeostasis are speculated to account for anemia-associated degenerative bone disorders upon heavy metal exposure. Together, this Review aims to elaborate available literature to fill in the knowledge gaps in understanding the detrimental effects of heavy metals on bone cells and bone homeostasis through different perspectives.

Cadmium induces iron deficiency anemia through the suppression of iron transport in the duodenum

Cadmium (Cd) is an environmental contaminant that triggers toxic effects in various tissues such as the kidney, liver, and lung. Cd can also cause abnormal iron metabolism, leading to anemia. Iron homeostasis is regulated by intestinal absorption. However, whether Cd affects the iron absorption pathway is unclear. We aimed to elucidate the relationship between the intestinal iron transporter system and Cd-induced iron deficiency anemia. C57BL/6J female and male mice, 129/Sv female mice, and DBA/2 female mice were given a single oral dose of CdCl₂ by gavage. After 3 or 24 h, Cd decreased serum iron concentrations and inhibited the expression of iron transport-related genes in the duodenum. In particular, Cd decreased the levels of divalent metal transporter 1 and ferroportin 1 in the duodenum. In addition, human colon carcinoma Caco-2 cells were treated with CdCl₂. After 72 h, Cd decreased the expression of iron transport-related factors in Caco-2 cells with a pattern similar to that seen in the murine duodenum. These findings suggest that Cd inhibits iron absorption through direct suppression of iron transport in duodenal enterocytes and contributes to abnormal iron metabolism.

Coexistence of diverse heavy metal pollution magnitudes: Health risk assessment of affected cattle and human population in some rural regions, Qena, Egypt

Objective:

The purpose of this study was to measure the mean concentrations of heavy metals including aluminum (Al), arsenic, nickel (Ni), mercury, lead (Pb), and cadmium (Cd) and to assess the health hazards due to the exposure of cattle/human population to a distinct or the mixture of heavy metals through various sources.

Materials and methods:

A total of 180 samples including water sources, animal feed, and raw cows’ milk from rural regions in Qena, Egypt, were examined using the inductively coupled plasma emission spectrometer (ICP; iCAP 6200).

Results:

The data highlighted heavy metal pollution with variable concentrations among most of the investigated regions. All concentrations of Al, Ni, and Cd detected in the feeding stuff showed a strong correlation to their respective levels in milk rather than those detected in water (R²= 0.072 vs. 0.039, 0.13 vs. 0.10, and 0.46 vs. 0.014, respectively) (p < 0.05). Anisocytosis and poikilocytosis with a tendency to rouleaux formation were evident, and basophilic stippling was a pathognomic indicator for heavy metal toxicity, especially Pb. Leukopenia and macrocytic anemia were shown in 50% and 65% of examined cattle, respectively. The target hazard quotients values were more than one (>1) for all heavy metals from water intake for both children and adults and Al and Cd in milk for children, and the hazard index values were indicated higher for noncarcinogenic health hazards. The target cancer risk values predispose people in the surveyed villages to higher cancerous risks due to exposures to the mixture of heavy metal through the consumption of water and milk.

Conclusion:

The bioaccumulation and transmission of heavy metal mixtures from water sources and feeding material have detrimental influences on milk pollution and cattle health which seem to be a serious issue affecting public health in those rural communities.

Disruption of iron homeostasis and resultant health effects upon exposure to various environmental pollutants: A critical review

Environmental pollution has become one of the greatest problems in the world, and the concerns about environmental pollutants released by human activities from agriculture and industrial production have been continuously increasing. Although intense efforts have been made to understand the health effects of environmental pollutants, most studies have only focused on direct toxic effects and failed to simultaneously evaluate the long-term adaptive, compensatory and secondary impacts on health. Burgeoning evidence suggests that environmental pollutants may directly or indirectly give rise to disordered element homeostasis, such as for iron. It is crucially important to maintain concerted cellular and systemic iron metabolism. Otherwise, disordered iron metabolism would lead to cytotoxicity and increased risk for various diseases, including cancers. Thus, study on the effects of environmental pollutants upon iron homeostasis is urgently needed. In this review, we recapitulate the available findings on the direct or indirect impacts of environmental pollutants, including persistent organic pollutants (POPs), heavy metals and pesticides, on iron homeostasis and associated adverse health problems. In view of the unanswered questions, more efforts are warranted to investigate the disruptive effects of environmental pollutants on iron homeostasis and consequent toxicities.

New insights into disruption of iron homeostasis by environmental pollutants

Among the numerous health conditions environmental pollutants can cause, chronic exposure to pollutants including persistent organic pollutants (POPs) and heavy metals has been shown to disturb a specific biological homeostatic process, the iron metabolism in human body. Disorders of iron metabolism are among the common diseases of humans and encompass a broad spectrum of diseases with different clinical manifestations, ranging from anemia to iron overload, and possibly to neurodegenerative diseases and cancer. Hepcidin-ferroportin (FPN) signaling is one of the key mechanisms responsible for iron supply, utilization, recycling, and storage, and recent studies demonstrated that exposure to environmental pollutants including POPs and heavy metals could lead to disruption of the hepcidin-FPN axis along with disordered systemic iron homeostasis and diseases. This article introduces and highlights the accompanying review article by Drs. Xu and Liu in this journal, which elaborates in detail the adverse effects of environmental pollutants on iron metabolism, and the mechanisms responsible for these toxicological outcomes. It also points out the knowledge gaps still existing in this subject matter. Research that will fill these gaps will improve our understanding of the issue and provide useful information to prevent or treat diseases induced by environmental pollutants.

Effects of lead and cadmium co-exposure on hemoglobin in a Chinese population

Cadmium (Cd) and lead (Pb) show adverse effects on hemoglobin. But most studies are focussed on one single agent. In this study, we observed the main and interactive effects of Cd and Pb on the hemoglobin level in a Chinese population. A total of 308 persons (202 women and 106 men), living in controlled and polluted areas, were included in this study. Blood and urine were collected to determine the levels of hemoglobin (Hb), Cd, Pb, and urinary N-acetyl-β-D-glucosaminidase (UNAG). The Cd and Pb level of subjects living in the polluted area were significantly higher compared to those living in the control area (p<0.05). The level of hemoglobin was declined with the increasing BPb (p<0.05) and BCd in women. The Hb of women and men with the highest level of BCd and BPb were decreased by 8.3g/L and 10.7 g/L compared to those with the lowest level of BCd and BPb, respectively. The Hb level of those women and men with the highest level of UNAG decreased by 4.2g/L and 17.2g/L compared with those with low level of UNAG, respectively. Hb was negatively associated with BPb, BCd, and UNAG. This study evidenced that Cd and Pb can influence Hb level. In addition, our study shows that Cd and Pb may have interactive effects on Hb and Hb level was correlated with tubular dysfunction caused by Cd and Pb exposure.

Correlation between cadmium and blood counts in workers exposed to urban stressor

The objective of this study was to assess the exposures to cadmium (Cd) in urban workers and the association between Cd exposure and values of blood counts. Urinary Cd, blood Cd, and blood counts were obtained from 355 outdoor workers; a subgroup of 99 subjects were monitored to evaluate personal exposure to airborne Cd. The mean value of personal exposure to Cd was 1.5 ng/m3 for traffic assistants and 1.2 ng/m3 for drivers. Urinary and blood Cd were correlated to the airborne Cd (respectively r=3 and r=4). The multiple linear regression models showed the associations among white blood cell, the percentage of neutrophils (NEU%), the percentage of lymphocytes (LYM%), and the concentrations of blood Cd (respectively R2=27, R2=37, R2=581). The subjects with blood Cd values higher than 1.2 μg/L showed an increase of LYM% mean values and a decrease of NEU% mean values with respect to the group with blood Cd values lower than 1.1 μg/L.

Cadmium depletes cellular iron availability through enhancing ferroportin translation via iron responsive element

Cadmium (Cd) is a heavy metal that has detrimental effects on various organs. The widespread contamination of Cd in the environment, crops and food sources poses a severe threat to human health. Acute toxicities of Cd have been extensively investigated; however, the health impact of chronic low‑dose exposure to Cd, particularly exposure under non‑toxic concentrations, has yet to be elucidated. Furthermore, the toxic threshold of Cd is currently unknown. Ferroportin is the only known iron exporter in vertebrate cells, and it has an essential role in controlling iron egress from cells. To the best of our knowledge, the present study is the first to verify the regulation of ferroportin by Cd. Treatment with low‑dose Cd (i.e. at sublethal concentrations, without undermining cell viability) increased the protein expression of ferroportin in macrophages, and this was associated with depleted cellular iron levels. Mechanistic investigations revealed that Cd modulated the ferroportin concentration at the translational level, via the iron responsive element located at the 5'‑untranslated region of ferroportin. In conclusion, these data provide evidence for the molecular basis by which Cd alters cellular iron availability through elevating concentrations of ferroportin.

The tetraethylammonium salt of monensic acid-An antidote for subacute cadmium intoxication: a study using an ICR mouse model

In this study, the ability of the chelating agent monensic acid (administered as the tetraethylammonium salt) to reduce the cadmium (Cd) concentration in the kidneys, liver, heart, lungs, spleen and testes of Cd-intoxicated mice was investigated. Chelation therapy with the tetraethylammonium salt of monensic acid led to a significant decrease of the Cd concentration in all of the organs of the Cd-treated mice. This effect varied from 50% in the kidneys to 90% in the hearts of the sacrificed animals (compared to the Cd-treated controls). No redistribution of the toxic metal ions to the brain of the animals as a result of the detoxification with the chelating agent was observed. The detoxification of the animals with the antibiotic salt did not perturb the endogenous levels of copper (Cu) or zinc (Zn). The tetraethylammonium salt of monensic acid significantly ameliorated the Cd-induced total iron (Fe) depletion in the liver and spleen of Cd-treated mice. It also restored to control levels the values of transferrin-bound Fe and the total iron binding capacity (TIBC) of the plasma. These results imply that the tetraethylammonium salt of monensic acid could be an efficient antidote in cases of Cd-intoxication.

Natural antioxidants protect against cadmium-induced damage during pregnancy and lactation in rats' pups

Free-radicals production is involved in the toxicity of cadmium. The aim of this study was to determine whether biochemical changes occurred in the liver and kidney of cadmium exposed pups during gestation and lactation, and additionally to investigate the potential beneficial role of the administration of certain antioxidants against cadmium exposure damage. Pregnant Wistar rats received the following treatments as drinking water: (1) Distilled water; (2) Cadmium (10 mg/L); (3) Cadmium + Zinc (20 mg/L) + vitamins A (50000 U/L), C (2 g/L), E (500 mg/L), and B(6) (500 mg/L); (4) Vitamins + Zinc solution. We found an increase in hemolysis and in the aminolevulinic acid dehydratase (delta-ALAD) activity in the erythrocytes among both cadmium-exposed groups. Cadmium exposure increased the production of thiobarbituric acid reactive substances (TBARS), catalase, and alkaline and acid phosphatase activity in both the organs studied. The effect on the enzymatic activity was reduced by the coadministration of vitamins and zinc. Our findings suggest that administration of antioxidants during gestation and lactation could prevent some of the negative effects of cadmium.

Cadmium increases ferroportin-1 gene expression in J774 macrophage cells via the production of reactive oxygen species

Cadmium intoxication has been associated with the dysregulation of iron homeostasis. In the present study, we investigated the effect of cadmium on the expression of ferroportin 1 (FPN1), an important iron transporter protein that is involved in iron release from macrophages. When we incubated cadmium with J774 mouse macrophage cells, FPN1 mRNA levels were significantly increased in a dose- and time-dependent manner. Furthermore, the cadmium-induced FPN1 mRNA expression was associated with increased levels of FPN1 protein. On the other hand, cadmium-mediated FPN1 mRNA induction in J774 cells was completely blocked when cells were co-treated with a transcription inhibitor, acitomycin D. Also, cadmium directly stimulated the activity of the FPN1-promoter driven luciferase reporter, suggesting that the cadmium up-regulates FPN1 gene expression in a transcription-dependent manner. Finally, cadmium exposure to J774 macrophages increased intracellular reactive oxygen species (ROS) levels by ~ 2-fold, compared to untreated controls. When J774 cells were co-treated with antioxidant N-acetylcystein, the cadmium-induced FPN1 mRNA induction was significantly attenuated. In summary, the results of this study clearly demonstrated that cadmium increased FPN1 expression in macrophages through a mechanism that involves ROS production, and suggests another important interaction between iron and cadmium metabolism.