1
|
Saleh SM, El-Tawil OS, Mahmoud MB, Abd El-Rahman SS, El-Saied EM, Noshy PA. Do Nanoparticles of Calcium Disodium EDTA Minimize the Toxic Effects of Cadmium in Female Rats? Biol Trace Elem Res 2024; 202:2228-2240. [PMID: 37721680 PMCID: PMC10955038 DOI: 10.1007/s12011-023-03842-6] [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: 05/26/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
The present study aims to investigate the ability of CaNa2EDTA (ethylenediaminetetraacetic acid) macroparticles and nanoparticles to treat cadmium-induced toxicity in female rats and to compare their efficacies. Forty rats were divided into 4 equal groups: control, cadmium, cadmium + CaNa2EDTA macroparticles and Cd + CaNa2EDTA nanoparticles. Cadmium was added to the drinking water in a concentration of 30 ppm for 10 weeks. CaNa2EDTA macroparticles and nanoparticles (50 mg/kg) were intraperitoneally injected during the last 4 weeks of the exposure period. Every two weeks, blood and urine samples were collected for determination of urea, creatinine, metallothionein and cadmium concentrations. At the end of the experiment, the skeleton of rats was examined by X-ray and tissue samples from the kidney and femur bone were collected and subjected to histopathological examination. Exposure to cadmium increased the concentrations of urea and creatinine in the serum and the concentrations of metallothionein and cadmium in serum and urine of rats. A decrease in bone mineralization by X-ray examination in addition to various histopathological alterations in the kidney and femur bone of Cd-intoxicated rats were also observed. Treatment with both CaNa2EDTA macroparticles and nanoparticles ameliorated the toxic effects induced by cadmium on the kidney and bone. However, CaNa2EDTA nanoparticles showed a superior efficacy compared to the macroparticles and therefore can be used as an effective chelating antidote for treatment of cadmium toxicity.
Collapse
Affiliation(s)
- Safa M Saleh
- Department of Toxicology, Forensic Medicine and Veterinary Regulations, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Osama S El-Tawil
- Department of Toxicology, Forensic Medicine and Veterinary Regulations, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Manal B Mahmoud
- Immune Section, Research Institute for Animal Reproduction, Giza, Egypt
| | - Sahar S Abd El-Rahman
- Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Eiman M El-Saied
- Department of Toxicology, Forensic Medicine and Veterinary Regulations, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Peter A Noshy
- Department of Toxicology, Forensic Medicine and Veterinary Regulations, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt.
| |
Collapse
|
2
|
Abstract
Heavy metals are harmful environmental pollutants that have attracted widespread attention due to their health hazards to human cardiovascular disease. Heavy metals, including lead, cadmium, mercury, arsenic, and chromium, are found in various sources such as air, water, soil, food, and industrial products. Recent research strongly suggests a connection between cardiovascular disease and exposure to toxic heavy metals. Epidemiological, basic, and clinical studies have revealed that heavy metals can promote the production of reactive oxygen species, which can then exacerbate reactive oxygen species generation and induce inflammation, resulting in endothelial dysfunction, lipid metabolism distribution, disruption of ion homeostasis, and epigenetic changes. Over time, heavy metal exposure eventually results in an increased risk of hypertension, arrhythmia, and atherosclerosis. Strengthening public health prevention and the application of chelation or antioxidants, such as vitamins and beta-carotene, along with minerals, such as selenium and zinc, can diminish the burden of cardiovascular disease attributable to metal exposure.
Collapse
Affiliation(s)
- Ziwei Pan
- Key Laboratory of Combined Multi Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Z.P., P.L.)
- Institute of Translational Medicine, Zhejiang University, Hangzhou, China (Z.P., P.L.)
| | - Tingyu Gong
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China (T.G.)
| | - Ping Liang
- Key Laboratory of Combined Multi Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Z.P., P.L.)
- Institute of Translational Medicine, Zhejiang University, Hangzhou, China (Z.P., P.L.)
| |
Collapse
|
3
|
Kawai K, Madra A, Kawakami R, Sato Y, Konishi T, Shiraki T, Sekimoto T, Tanaka T, Virmani R, Finn AV. Effect of EDTA with porous balloon on calcified lesion: An atherosclerotic cadaver study. Catheter Cardiovasc Interv 2024. [PMID: 38606477 DOI: 10.1002/ccd.31052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Ethylene diamine tetra-acetic acid (EDTA) is a chelating agent used to dissolve calcium deposits but evidence in decalcifying atherosclerotic lesions is limited. AIMS We assessed the feasibility and efficacy of EDTA delivered via porous balloon to target calcified lesions in cadaveric below-the-knee (BTK) arteries. METHODS Using porcine carotid arteries, EDTA concentration was measured in the arterial wall and outside the artery at the 0-, 0.5-, 4-, and 24-h circulation after the injection through a porous balloon. In cadaver BTK samples, the proximal and distal anterior tibial artery (ATA) and distal posterior tibial artery (PTA) were studied. EDTA-2Na/H2O or EDTA-3Na/H2O were administrated using a porous balloon, then circulated for 6 h for EDTA-3Na/H2O and 24 h for EDTA-2Na/H2O and EDTA-3Na/H2O. Micro-CT imaging of the artery segments before and after the circulation and cross-sectional analyses were performed to evaluate calcium burden. RESULTS In the porcine carotid study, EDTA was delivered through a porous balloon present in the arterial wall and was retained there for 24 h. In BTK arteries, cross-sectional analyses of micro-CT revealed a significant decrease in the calcium area in the distal ATA segment under 24-h circulation with EDTA-2Na/H2O and in the distal ATA segment under 24-h circulation with EDTA-3Na/H2O. The proximal ATA segment under 6-h circulation with EDTA-3Na/H2O showed no significant change in any parameters of calcium CONCLUSION: EDTA-3Na/H2O or EDTA-2Na/H2O with longer circulation times resulted in greater calcium reduction in atherosclerotic lesion. EDTA may have a potential therapeutic option for the treatment of atherosclerotic calcified lesions.
Collapse
Affiliation(s)
| | | | | | - Yu Sato
- CVPath Institute, Gaithersburg, MD, USA
| | | | | | | | | | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
4
|
Anwar A, De Ayreflor Reyes SR, John AA, Breiling E, O’Connor AM, Reis S, Shim JH, Shah AA, Srinivasan J, Farny NG. Nucleic Acid Aptamers Protect Against Lead (Pb(II)) Toxicity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.28.587288. [PMID: 38585880 PMCID: PMC10996642 DOI: 10.1101/2024.03.28.587288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Lead (Pb(II)) is a pervasive heavy metal toxin with many well-established negative effects on human health. Lead toxicity arises from cumulative, repeated environmental exposures. Thus, prophylactic strategies to protect against the bioaccumulation of lead could reduce lead-associated human pathologies. Here we show that DNA and RNA aptamers protect C. elegans from toxic phenotypes caused by lead. Reproductive toxicity, as measured by brood size assays, is prevented by co-feeding of animals with DNA or RNA aptamers. Similarly, lead-induced behavioral anomalies are also normalized by aptamer feeding. Further, cultured human HEK293 and primary murine osteoblasts are protected from lead toxicity by transfection with DNA aptamers. The osteogenic development, which is decreased by lead exposure, is maintained by prior transfection of lead-binding DNA aptamers. Aptamers may be an effective strategy for the protection of human health in the face of increasing environmental toxicants.
Collapse
Affiliation(s)
- Afreen Anwar
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
- Department of Biotechnology, Baba Ghulam Shah Badshah University, Rajouri (J&K), India
| | | | - Aijaz Ahmad John
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Erik Breiling
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Abigail M. O’Connor
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Stephanie Reis
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Jae-Hyuck Shim
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Li Weibo Institute for Rare Diseases Research, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ali Asghar Shah
- Department of Biotechnology, Baba Ghulam Shah Badshah University, Rajouri (J&K), India
| | - Jagan Srinivasan
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
- Program in Bioinformatics and Computational Biology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
- Program in Neuroscience, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Natalie G. Farny
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
- Program in Bioinformatics and Computational Biology, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
- Program in Neuroscience, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| |
Collapse
|
5
|
Lo CC, Yeh TH, Jao YH, Wang TH, Lo HR. Efficacy of outer membrane permeabilization in promoting aromatic isothiocyanates-mediated eradication of multidrug resistant Gram-negative bacteria and bacterial persisters. Folia Microbiol (Praha) 2024:10.1007/s12223-024-01143-6. [PMID: 38319459 DOI: 10.1007/s12223-024-01143-6] [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: 08/16/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
Multidrug resistant (MDR) bacteria are recognized to be one of the most important problems in public health. The outer membrane permeability is a critical intrinsic mechanism of bacterial resistance. In addition, bacteria produce a small number of dormant persister cells causing multidrug tolerance that reduces antimicrobial efficacy. This study aimed to evaluate the inhibitory effects of the combination of aromatic isothiocyanates (ITCs) with membrane-active agents on bacterial persisters and MDR Gram-negative bacteria. Our study demonstrated that membrane-active agents, particularly ethylenediaminetetraacetic acid (EDTA) synergistically enhanced the inhibitory activity of aromatic benzyl ITC and phenethyl ITC against most Gram-negative bacteria strains with fractional inhibitory concentration index values ranging from 0.18 to 0.5 and 0.16 to 0.5, respectively, and contributed to an 8- to 64-fold minimal inhibitory concentration reduction compared with those of aromatic ITCs alone. The EDTA-aromatic ITCs combination effectively reduced the survival rates of tested bacteria and significantly eradicated bacterial persisters (p = 0.033 and 0.037, respectively). The growth kinetics analysis also supported the enhanced inhibitory effect of EDTA-aromatic ITCs combination against tested bacteria. Our results suggested an alternate treatment strategy against Gram-negative bacteria, promoting the entry of aromatic ITCs into bacterial cytoplasm to facilitate bacterial clearance and thus preventing the development of bacterial resistance.
Collapse
Affiliation(s)
- Chung-Cheng Lo
- Department of Internal Medicine, Pingtung Veterans General Hospital Longquan Branch, Pingtung, 912012, Taiwan
| | - Tzu-Hui Yeh
- Department of Pathology and Laboratory Medicine, Pingtung Veterans General Hospital, Pingtung, 900053, Taiwan
| | - Ya-Hsuan Jao
- Department of Clinical Laboratory, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, 802511, Taiwan
| | - Tzu-Hui Wang
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 813414, Taiwan
| | - Horng-Ren Lo
- Department of Medical Laboratory Science and Biotechnology, Fooyin University, Kaohsiung, 831301, Taiwan.
| |
Collapse
|
6
|
Aaseth JO, Alehagen U, Opstad TB, Alexander J. Vitamin K and Calcium Chelation in Vascular Health. Biomedicines 2023; 11:3154. [PMID: 38137375 PMCID: PMC10740993 DOI: 10.3390/biomedicines11123154] [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: 10/10/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
The observation that the extent of artery calcification correlates with the degree of atherosclerosis was the background for the alternative treatment of cardiovascular disease with chelator ethylenediamine tetraacetate (EDTA). Recent studies have indicated that such chelation treatment has only marginal impact on the course of vascular disease. In contrast, endogenous calcium chelation with removal of calcium from the cardiovascular system paralleled by improved bone mineralization exerted, i.e., by matrix Gla protein (MGP) and osteocalcin, appears to significantly delay the development of cardiovascular diseases. After post-translational vitamin-K-dependent carboxylation of glutamic acid residues, MGP and other vitamin-K-dependent proteins (VKDPs) can chelate calcium through vicinal carboxyl groups. Dietary vitamin K is mainly provided in the form of phylloquinone from green leafy vegetables and as menaquinones from fermented foods. Here, we provide a review of clinical studies, addressing the role of vitamin K in cardiovascular diseases, and an overview of vitamin K kinetics and biological actions, including vitamin-K-dependent carboxylation and calcium chelation, as compared with the action of the exogenous (therapeutic) chelator EDTA. Consumption of vitamin-K-rich foods and/or use of vitamin K supplements appear to be a better preventive strategy than EDTA chelation for maintaining vascular health.
Collapse
Affiliation(s)
- Jan O. Aaseth
- Research Department, Innlandet Hospital Trust, P.O. Box 104, N-2381 Brumunddal, Norway
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, N-2418 Elverum, Norway
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden;
| | - Trine Baur Opstad
- Oslo Centre for Clinical Heart Research Laboratory, Department of Cardiology, Oslo University Hospital Ullevål, P.O. Box 4950, Nydalen, N-0424 Oslo, Norway;
- Faculty of Medicine, University of Oslo, N-0370 Oslo, Norway
| | - Jan Alexander
- Norwegian Institute of Public Health, P.O. Box 222, N-0213 Oslo, Norway;
| |
Collapse
|
7
|
Arruebarrena MA, Hawe CT, Lee YM, Branco RC. Mechanisms of Cadmium Neurotoxicity. Int J Mol Sci 2023; 24:16558. [PMID: 38068881 PMCID: PMC10706630 DOI: 10.3390/ijms242316558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Cadmium is a heavy metal that increasingly contaminates food and drink products. Once ingested, cadmium exerts toxic effects that pose a significant threat to human health. The nervous system is particularly vulnerable to prolonged, low-dose cadmium exposure. This review article provides an overview of cadmium's primary mechanisms of neurotoxicity. Cadmium gains entry into the nervous system via zinc and calcium transporters, altering the homeostasis for these metal ions. Once within the nervous system, cadmium disrupts mitochondrial respiration by decreasing ATP synthesis and increasing the production of reactive oxygen species. Cadmium also impairs normal neurotransmission by increasing neurotransmitter release asynchronicity and disrupting neurotransmitter signaling proteins. Cadmium furthermore impairs the blood-brain barrier and alters the regulation of glycogen metabolism. Together, these mechanisms represent multiple sites of biochemical perturbation that result in cumulative nervous system damage which can increase the risk for neurological and neurodegenerative disorders. Understanding the way by which cadmium exerts its effects is critical for developing effective treatment and prevention strategies against cadmium-induced neurotoxic insult.
Collapse
Affiliation(s)
- Madelyn A. Arruebarrena
- Neuroscience and Behavior Program, University of Notre Dame, Notre Dame, IN 46556, USA; (M.A.A.); (Y.M.L.)
| | - Calvin T. Hawe
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA;
| | - Young Min Lee
- Neuroscience and Behavior Program, University of Notre Dame, Notre Dame, IN 46556, USA; (M.A.A.); (Y.M.L.)
| | - Rachel C. Branco
- Neuroscience and Behavior Program, University of Notre Dame, Notre Dame, IN 46556, USA; (M.A.A.); (Y.M.L.)
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA;
| |
Collapse
|
8
|
Wang TP, Yeh TH, Lo CC, Lin KH, Huang MH, Lo HR. Synergistic action of indole-3-carbinol with membrane-active agents against multidrug-resistant Gram-negative bacteria. Lett Appl Microbiol 2023; 76:ovad093. [PMID: 37580156 DOI: 10.1093/lambio/ovad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 07/12/2023] [Accepted: 08/12/2023] [Indexed: 08/16/2023]
Abstract
The purpose of this study was to evaluate the antimicrobial activity of indole-3-carbinol (I3C) with membrane-active agents, namely carbonyl cyanide 3-chlorophenylhydrazone (CCCP) and ethylenediaminetetraacetic acid (EDTA) against multidrug-resistant (MDR) Gram-negative bacteria and bacterial persisters. The determination of minimal inhibitory concentration (MIC) showed that I3C was effective against Acinetobacter baumannii (3.13‒6.25 × 10-3 mol l-1), Klebsiella pneumoniae (8 × 10-3 mol l-1), Pseudomonas aeruginosa (6.25‒12.5 × 10-3 mol l-1), and Escherichia coli (6.25‒12.5 × 10-3 mol l-1). Our study demonstrated that EDTA synergistically enhanced the bactericidal activity of I3C against most MDR Gram-negative bacteria isolates and contributed to an 8- to 64-fold MIC reduction compared with that of I3C alone, yet CCCP only displayed synergy with I3C against P. aeruginosa and A. baumannii. The EDTA-I3C combination also significantly reduced the viable number of testing bacteria (P = 7.2E-05), effectively reduced bacterial persisters, and repressed bacterial growth compared with that the use of I3C alone. Our data demonstrate that use of EDTA as adjuvant molecules can effectively improve the antibacterial activity of I3C and may help to reduce the development of antimicrobial resistance.
Collapse
Affiliation(s)
- Tso-Ping Wang
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Tzu-Hui Yeh
- Department of Pathology and Laboratory Medicine, Pingtung Veterans General Hospital, Pingtung 900053, Taiwan
| | - Chung-Cheng Lo
- Department of Internal Medicine, Pingtung Veterans General Hospital Longquan Branch, Pingtung 91245, Taiwan
| | - Kuan-Hua Lin
- Department of Medical Laboratory Science and Biotechnology, Fooyin University, Kaohsiung 83102, Taiwan
| | - Mei-Han Huang
- Department of Medical Laboratory Science and Biotechnology, Fooyin University, Kaohsiung 83102, Taiwan
| | - Horng-Ren Lo
- Department of Medical Laboratory Science and Biotechnology, Fooyin University, Kaohsiung 83102, Taiwan
| |
Collapse
|
9
|
Dorward AM, Stewart AJ, Pitt SJ. The role of Zn2+ in shaping intracellular Ca2+ dynamics in the heart. J Gen Physiol 2023; 155:e202213206. [PMID: 37326614 PMCID: PMC10276528 DOI: 10.1085/jgp.202213206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/18/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Increasing evidence suggests that Zn2+ acts as a second messenger capable of transducing extracellular stimuli into intracellular signaling events. The importance of Zn2+ as a signaling molecule in cardiovascular functioning is gaining traction. In the heart, Zn2+ plays important roles in excitation-contraction (EC) coupling, excitation-transcription coupling, and cardiac ventricular morphogenesis. Zn2+ homeostasis in cardiac tissue is tightly regulated through the action of a combination of transporters, buffers, and sensors. Zn2+ mishandling is a common feature of various cardiovascular diseases. However, the precise mechanisms controlling the intracellular distribution of Zn2+ and its variations during normal cardiac function and during pathological conditions are not fully understood. In this review, we consider the major pathways by which the concentration of intracellular Zn2+ is regulated in the heart, the role of Zn2+ in EC coupling, and discuss how Zn2+ dyshomeostasis resulting from altered expression levels and efficacy of Zn2+ regulatory proteins are key drivers in the progression of cardiac dysfunction.
Collapse
Affiliation(s)
- Amy M. Dorward
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Alan J. Stewart
- School of Medicine, University of St Andrews, St Andrews, UK
| | | |
Collapse
|
10
|
Lamas GA, Anstrom KJ, Navas-Acien A, Boineau R, Kim H, Rosenberg Y, Stylianou M, Jones TLZ, Joubert BR, Santella RM, Escolar E, Aude YW, Fonseca V, Elliott T, Lewis EF, Farkouh ME, Nathan DM, Mon AC, Gosnell L, Newman JD, Mark DB. The trial to assess chelation therapy 2 (TACT2): Rationale and design. Am Heart J 2022; 252:1-11. [PMID: 35598636 PMCID: PMC9434822 DOI: 10.1016/j.ahj.2022.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Intravenous edetate disodium-based infusions reduced cardiovascular events in a prior clinical trial. The Trial to Assess Chelation Therapy 2 (TACT2) will replicate the initial study design. METHODS TACT2 is an NIH-sponsored, randomized, 2x2 factorial, double masked, placebo-controlled, multicenter clinical trial testing 40 weekly infusions of a multi-component edetate disodium (disodium ethylenediamine tetra-acetic acid, or Na2EDTA)-based chelation solution and twice daily oral, high-dose multivitamin and mineral supplements in patients with diabetes and a prior myocardial infarction (MI). TACT2 completed enrollment of 1000 subjects in December 2020, and infusions in December 2021. Subjects are followed for 2.5 to 5 years. The primary endpoint is time to first occurrence of all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for unstable angina. The trial has >;85% power to detect a 30% relative reduction in the primary endpoint. TACT2 also includes a Trace Metals and Biorepository Core Lab, to test whether benefits of treatment, if present, are due to chelation of lead and cadmium from patients. Design features of TACT2 were chosen to replicate selected features of the first TACT, which demonstrated a significant reduction in cardiovascular outcomes in the EDTA chelation arm compared with placebo among patients with a prior MI, with the largest effect in patients with diabetes. RESULTS Results are expected in 2024. CONCLUSION TACT2 may provide definitive evidence of the benefit of edetate disodiumbased chelation on cardiovascular outcomes, as well as the clinical importance of longitudinal changes in toxic metal levels of participants.
Collapse
Affiliation(s)
- Gervasio A Lamas
- Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
| | - Kevin J Anstrom
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ana Navas-Acien
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Robin Boineau
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Hwasoon Kim
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Yves Rosenberg
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mario Stylianou
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Teresa L Z Jones
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Bonnie R Joubert
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | - Regina M Santella
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Esteban Escolar
- Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Y Wady Aude
- Heart and Vascular Specialists of South Texas, McAllen, TX, USA
| | - Vivian Fonseca
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Eldrin F Lewis
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - David M Nathan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana C Mon
- Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Leigh Gosnell
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| |
Collapse
|
11
|
Maikawa CL, Nguyen LT, Mann JL, Appel EA. Formulation Excipients and Their Role in Insulin Stability and Association State in Formulation. Pharm Res 2022; 39:2721-2728. [PMID: 35978148 PMCID: PMC9633423 DOI: 10.1007/s11095-022-03367-y] [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: 06/16/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
While excipients are often overlooked as the "inactive" ingredients in pharmaceutical formulations, they often play a critical role in protein stability and absorption kinetics. Recent work has identified an ultrafast absorbing insulin formulation that is the result of excipient modifications. Specifically, the insulin monomer can be isolated by replacing zinc and the phenolic preservative metacresol with phenoxyethanol as an antimicrobial agent and an amphiphilic acrylamide copolymer excipient for stability. A greater understanding is needed of the interplay between excipients, insulin association state, and stability in order to optimize this formulation. Here, we formulated insulin with different preservatives and stabilizing excipient concentrations using both insulin lispro and regular human insulin and assessed the insulin association states using analytical ultracentrifugation as well as formulation stability. We determined that phenoxyethanol is required to eliminate hexamers and promote a high monomer content even in a zinc-free lispro formulation. There is also a concentration dependent relationship between the concentration of polyacrylamide-based copolymer excipient and insulin stability, where a concentration greater than 0.1 g/mL copolymer is required for a mostly monomeric zinc-free lispro formulation to achieve stability exceeding that of Humalog in a stressed aging assay. Further, we determined that under the formulation conditions tested zinc-free regular human insulin remains primarily hexameric and is not at this time a promising candidate for rapid-acting formulations.
Collapse
Affiliation(s)
- Caitlin L Maikawa
- Department of Bioengineering, Stanford University, Stanford, 94305, USA
| | - Leslee T Nguyen
- Department of Biochemistry, Stanford University, Stanford, 94305, USA
| | - Joseph L Mann
- Department of Materials Science & Engineering, Stanford University, Stanford, 94305, USA
| | - Eric A Appel
- Department of Bioengineering, Stanford University, Stanford, 94305, USA. .,Department of Materials Science & Engineering, Stanford University, Stanford, 94305, USA. .,Department of Pediatrics (Endocrinology), Stanford University, Stanford, 94305, USA. .,ChEM-H Institute, Stanford University, Stanford, CA, 94305, USA. .,Woods Institute for the Environment, Stanford University, Stanford, CA, 94305, USA.
| |
Collapse
|
12
|
Ravalli F, Vela Parada X, Ujueta F, Pinotti R, Anstrom KJ, Lamas GA, Navas‐Acien A. Chelation Therapy in Patients With Cardiovascular Disease: A Systematic Review. J Am Heart Assoc 2022; 11:e024648. [PMID: 35229619 PMCID: PMC9075296 DOI: 10.1161/jaha.121.024648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
Background EDTA is an intravenous chelating agent with high affinity to divalent cations (lead, cadmium, and calcium) that may be beneficial in the treatment of cardiovascular disease (CVD). Although a large randomized clinical trial showed benefit, smaller studies were inconsistent. We conducted a systematic review of published studies to examine the effect of repeated EDTA on clinical outcomes in adults with CVD. Methods and Results We searched 3 databases (MEDLINE, Embase, and Cochrane) from database inception to October 2021 to identify all studies involving EDTA treatment in patients with CVD. Predetermined outcomes included mortality, disease severity, plasma biomarkers of disease chronicity, and quality of life. Twenty-four studies (4 randomized clinical trials, 15 prospective before/after studies, and 5 retrospective case series) assessed the use of repeated EDTA chelation treatment in patients with preexistent CVD. Of these, 17 studies (1 randomized clinical trial) found improvement in their respective outcomes following EDTA treatment. The largest improvements were observed in studies with high prevalence of participants with diabetes and/or severe occlusive arterial disease. A meta-analysis conducted with 4 studies reporting ankle-brachial index indicated an improvement of 0.08 (95% CI, 0.06-0.09) from baseline. Conclusions Overall, 17 studies suggested improved outcomes, 5 reported no statistically significant effect of treatment, and 2 reported no qualitative benefit. Repeated EDTA for CVD treatment may provide more benefit to patients with diabetes and severe peripheral arterial disease. Differences across infusion regimens, including dosage, solution components, and number of infusions, limit comparisons across studies. Additional research is necessary to confirm these findings and to evaluate the potential mediating role of metals. Registration URL: https://www.crd.york.ac.uk/; Unique identifier: CRD42020166505.
Collapse
Affiliation(s)
- Filippo Ravalli
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNY
| | | | - Francisco Ujueta
- Department of Medicine at Mount Sinai Medical CenterMiami BeachFL
| | - Rachel Pinotti
- Levy LibraryIcahn School of Medicine at Mount SinaiNew YorkNY
| | | | - Gervasio A. Lamas
- Department of Medicine at Mount Sinai Medical CenterMiami BeachFL
- Columbia University Division of Cardiology at Mount Sinai Medical CenterMiami BeachFL
| | - Ana Navas‐Acien
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNY
| |
Collapse
|
13
|
Maikawa CL, Chen PC, Vuong ET, Nguyen LT, Mann JL, d'Aquino AI, Lal RA, Maahs DM, Buckingham BA, Appel EA. Ultra-Fast Insulin-Pramlintide Co-Formulation for Improved Glucose Management in Diabetic Rats. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2101575. [PMID: 34499434 PMCID: PMC8564421 DOI: 10.1002/advs.202101575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/07/2021] [Indexed: 05/04/2023]
Abstract
Dual-hormone replacement therapy with insulin and amylin in patients with type 1 diabetes has the potential to improve glucose management. Unfortunately, currently available formulations require burdensome separate injections at mealtimes and have disparate pharmacokinetics that do not mimic endogenous co-secretion. Here, amphiphilic acrylamide copolymers are used to create a stable co-formulation of monomeric insulin and amylin analogues (lispro and pramlintide) with synchronous pharmacokinetics and ultra-rapid action. The co-formulation is stable for over 16 h under stressed aging conditions, whereas commercial insulin lispro (Humalog) aggregates in 8 h. The faster pharmacokinetics of monomeric insulin in this co-formulation result in increased insulin-pramlintide overlap of 75 ± 6% compared to only 47 ± 7% for separate injections. The co-formulation results in similar delay in gastric emptying compared to pramlintide delivered separately. In a glucose challenge, in rats, the co-formulation reduces deviation from baseline glucose compared to insulin only, or separate insulin and pramlintide administrations. Further, comparison of interspecies pharmacokinetics of monomeric pramlintide suggests that pharmacokinetics observed for the co-formulation will be well preserved in future translation to humans. Together these results suggest that the co-formulation has the potential to improve mealtime glucose management and reduce patient burden in the treatment of diabetes.
Collapse
Affiliation(s)
- Caitlin L Maikawa
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Peyton C Chen
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Eric T Vuong
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Leslee T Nguyen
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Joseph L Mann
- Department of Materials Science & Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Andrea I d'Aquino
- Department of Materials Science & Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Rayhan A Lal
- Department of Medicine (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Diabetes Research Center, Stanford University, Stanford, CA, 94305, USA
| | - David M Maahs
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Diabetes Research Center, Stanford University, Stanford, CA, 94305, USA
| | - Bruce A Buckingham
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Diabetes Research Center, Stanford University, Stanford, CA, 94305, USA
| | - Eric A Appel
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
- Department of Materials Science & Engineering, Stanford University, Stanford, CA, 94305, USA
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, 94305, USA
- Diabetes Research Center, Stanford University, Stanford, CA, 94305, USA
- ChEM-H Institute, Stanford University, Stanford, CA, 94305, USA
| |
Collapse
|
14
|
Bao Y, Ge X, Li L, He J, Huang S, Luo X, Chen X, Chen P, Yang X. The impacts of different anticoagulants and long-term frozen storage on multiple metal concentrations in peripheral blood: a comparative study. Biometals 2021; 34:1191-1205. [PMID: 34365581 DOI: 10.1007/s10534-021-00336-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
It is important but remains unclear whether ethylenediaminetetraacetic acid (EDTA) and sodium heparin anticoagulants have different impacts on the levels of various metals in peripheral blood after long-term frozen storage. The concentrations of 22 metals (Al, As, Ba, Ca, Cd, Cr, Co, Cu, Mn, Mg, Mo, Ni, Fe, Pb, Rb, Se, Sn, Sb, Sr, Ti, V, Zn) in whole blood, blood cells and plasma from 22 healthy participants were determined twice, 18 months apart, using inductively coupled plasma mass spectrometry (ICP-MS). The mean percentage error (MPE) and intraclass correlation coefficient (ICC) were calculated to evaluate the impact of the anticoagulants and long-term frozen storage on metal concentrations, respectively. The concentrations of Sb and Ba in whole blood, blood cells and plasma were significantly altered by EDTA and sodium heparin at two measurement timepoints (P < 0.05 and MPE > 80%). In EDTA tubes, the Ti and Ni concentrations in blood cells were changed significantly; and in heparin tubes, the concentrations of Ni and Mo in blood cells and Sb in plasma were also altered (P < 0.05 and MPE > 80%). The ICCs of 11 metals in whole blood, 15 metals in blood cells and 16 metals in plasma remained unchanged in EDTA tubes, and 16 metals in whole blood, 15 metals in blood cells and 17 metals in plasma remained unchanged in heparin tubes (ICC > 0.40). Our study suggested the use of EDTA tubes to determine Sb concentrations in peripheral blood and heparin tubes to determine Ba concentrations. Additionally, heparin tubes may be more suited for determining multiple metal concentrations in whole blood, whereas for blood cells and plasma either EDTA or heparin tubes could be used.
Collapse
Affiliation(s)
- Yu Bao
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China
| | - Xiaoting Ge
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China
| | - Longman Li
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China
| | - Junxiu He
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China
| | - Sifang Huang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China
| | - Xiaoyu Luo
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China
| | - Xing Chen
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Pan Chen
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xiaobo Yang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China. .,Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China. .,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China. .,Department of Public Health, School of Medicine, Guangxi University of Science and Technology, Liuzhou, Guangxi, China.
| |
Collapse
|
15
|
Heavy Metal Toxicity in Chronic Renal Failure and Cardiovascular Disease: Possible Role for Chelation Therapy. Cardiol Rev 2021; 28:312-318. [PMID: 32040019 DOI: 10.1097/crd.0000000000000304] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Exposure to heavy metals is common. This exposure is related to environmental contamination of air, water and soil, occupational exposure, accumulation in food, tobacco, and other factors. Cadmium and lead are notable for their widespread contamination, long-lasting effects in the body, and renal as well as cardiovascular toxicity. Acute toxicity due to high-level exposure, as well as chronic low-level exposure are now well-established pathogenic entities. Both chronic renal failure and ischemic heart disease patients have been treated separately in recent studies with ethylenediaminetetraacetic acid (EDTA) chelation therapy. In patients with chronic kidney disease (serum creatinine: 1.5-4.0 mg/dL) and increased body lead burden, weekly low-dose chelation with calcium EDTA slowed the rate of decline in renal function in patients with diabetes and in non-diabetic patients. In patients with a history of myocardial infarction, the Trial to Assess Chelation Therapy study showed that EDTA chelation decreased the likelihood of cardiovascular events, particularly in patients with diabetes. However, heavy metal levels were not measured in this study. It is clear that more research is needed in this area. There is also a need to more frequently consider and test for the possibility of cadmium and lead toxicity in patients with increased risk, such as those with hypertension, diabetes mellitus, and chronic renal disease.
Collapse
|
16
|
Glicklich D, Frishman WH. The Case For Cadmium and Lead Heavy Metal Screening. Am J Med Sci 2021; 362:344-354. [PMID: 34048724 DOI: 10.1016/j.amjms.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 01/24/2023]
Abstract
Exposure to cadmium and lead is widespread, and is related to environmental contamination, occupational sources, food, tobacco and other consumer products. Lower socioeconomic status increases the risk of heavy metal exposure and the diseases associated with cadmium and lead toxicity. Concurrent toxicity with both cadmium and lead is likely but has not often been assessed. There is now substantial evidence linking cadmium and lead to many diseases including hypertension, diabetes mellitus, obesity, cancer, coronary artery disease, chronic kidney disease (CKD) and lung disease. Both chronic renal failure and ischemic heart disease patients have been treated separately in recent studies with calcium disodium ethylenediaminetetraacetic acid (Ca EDTA) chelation therapy. In patients with CKD, serum creatinine 1.5-4.0 mg/dL, and increased body lead burden, weekly low dose chelation with Ca EDTA slowed the rate of decline in renal function in diabetics and non-diabetics. In patients with a history of myocardial infarction, the Trial to Assess Chelation Therapy (TACT) study showed that Ca EDTA chelation decreased the likelihood of cardiovascular events, particularly in diabetics. Ca EDTA chelation administered carefully at lower dosage (<50 mg/kg per week) is generally safe. In the past, acute renal failure associated with much higher dosage was reported. We suggest that the preponderance of the evidence favors a more activist approach towards diagnosis and possible intervention in heavy metal toxicity.
Collapse
Affiliation(s)
- Daniel Glicklich
- Kidney Transplant Division, New York Medical College/Westchester Medical Center, Valhalla, NY, USA.
| | - William H Frishman
- Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY, USA
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Cadmium has been recognized as a potential risk factor for cardiovascular disease (CVD). We present a review of cadmium toxicity, its effect on cellular activities, and a summary of reported association between environmental cadmium exposure and CVD. We also discuss the possible therapeutic benefit of cadmium chelation. RECENT FINDINGS Experimental data suggest that cadmium affects several signaling pathways which may lead to endothelial dysfunction and vascular tissue damage, promoting atherosclerosis. This is further supported by epidemiological studies that have shown an association of even low-level cadmium exposure with an increased risk of clinical cardiovascular events. The Trial to Assess Chelation Therapy (TACT) provided inferential evidence for the cardiovascular benefit of treating toxic metal burden. However, at the present time, there is no direct evidence, but suggestive findings from clinical trials indicating that removal of cadmium from body stores may be associated with improved cardiovascular outcomes. An evolving body of evidence supports environmental cadmium exposure as a pro-atherosclerosis risk factor in CVD; however, the mechanisms for the proatherogenic effect of cadmium are still not completely understood. Further studies in translational toxicology are needed to fill the knowledge gaps regarding the molecular mechanisms of cadmium toxicity and the promotion of atherosclerosis.
Collapse
|
18
|
Lemmens E, Waterschoot J, Smolders E, Delcour JA. Impact of Mineral Ions and Their Concentrations on Pasting and Gelation of Potato, Rice, and Maize Starches and Blends Thereof. STARCH-STARKE 2021. [DOI: 10.1002/star.202000110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Elien Lemmens
- Laboratory of Food Chemistry and Biochemistry, and Leuven Food Science and Nutrition Research Centre (LFoRCe) KU Leuven Kasteelpark Arenberg 20 Leuven B‐3001 Belgium
| | - Jasmien Waterschoot
- Laboratory of Food Chemistry and Biochemistry, and Leuven Food Science and Nutrition Research Centre (LFoRCe) KU Leuven Kasteelpark Arenberg 20 Leuven B‐3001 Belgium
| | - Erik Smolders
- Division of Soil and Water Management KU Leuven Kasteelpark Arenberg 20 Leuven B‐3001 Belgium
| | - Jan A. Delcour
- Laboratory of Food Chemistry and Biochemistry, and Leuven Food Science and Nutrition Research Centre (LFoRCe) KU Leuven Kasteelpark Arenberg 20 Leuven B‐3001 Belgium
| |
Collapse
|
19
|
Robotti E, Quasso F, Manfredi M, Gosetti F, Mazzucco E, Isidoro C, Marengo E. Determination by ICP-MS and multivariate data analysis of elemental urine excretion profile during the EDTA chelation therapy: A case study. J Trace Elem Med Biol 2020; 62:126608. [PMID: 32853885 DOI: 10.1016/j.jtemb.2020.126608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 06/04/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Based on the medical history and laboratory analytical tests, a patient presenting symptoms compatible with Chronic Fatigue Syndrome was suspected of metal intoxication; therefore, a chelating therapy was attempted. In parallel, the profile of elemental excretion in urine was determined. METHODS Chelation therapy by CaNa2EDTA was administered every two weeks and urine samples were routinely collected for 17 months. The samples were mineralized with HNO3 69 % and analyzed by Inductively-Coupled Plasma - Mass Spectrometry. Data were processed by multivariate statistical methods. RESULTS Most of the toxic elements showed a peak of excretion in 12-24 h after EDTA administration, which returned to basal level by 24-36 h after the treatment. Yet, the excretion of some trace elements persisted in the urine collected 26 h after the treatment. CONCLUSIONS The analysis of excreted metals following the CaNa2EDTA infusion allowed to monitor dynamically the chelation therapy. The chelation therapy was effective in mobilizing and eliminating the principal heavy metals present from the body. However, since such clearance almost vanished 24 h after the treatment, a protocol with more frequent and low-dose administrations is advisable to improve the metal excretion.
Collapse
Affiliation(s)
- Elisa Robotti
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Michel 11, 15121, Alessandria, Italy.
| | - Fabio Quasso
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Michel 11, 15121, Alessandria, Italy.
| | - Marcello Manfredi
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy; Isalit srl, c/o IPAZIA, Corso Trieste 15/A, 28100 Novara, Italy.
| | - Fabio Gosetti
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Piazza Della Scienza 1, 20126, Milano, Italy.
| | | | - Ciro Isidoro
- Department of Health Sciences, University of Piemonte Orientale, Via P. Solaroli 17, 28100, Novara, Italy.
| | - Emilio Marengo
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Viale Michel 11, 15121, Alessandria, Italy.
| |
Collapse
|
20
|
Maikawa CL, Smith AAA, Zou L, Roth GA, Gale EC, Stapleton LM, Baker SW, Mann JL, Yu AC, Correa S, Grosskopf AK, Liong CS, Meis CM, Chan D, Troxell M, Maahs DM, Buckingham BA, Webber MJ, Appel EA. A co-formulation of supramolecularly stabilized insulin and pramlintide enhances mealtime glucagon suppression in diabetic pigs. Nat Biomed Eng 2020; 4:507-517. [PMID: 32393892 PMCID: PMC7274092 DOI: 10.1038/s41551-020-0555-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/03/2020] [Indexed: 02/06/2023]
Abstract
Treatment of patients with diabetes with insulin and pramlintide (an amylin analogue) is more effective than treatment with insulin only. However, because mixtures of insulin and pramlintide are unstable and have to be injected separately, amylin analogues are only used by 1.5% of people with diabetes needing rapid-acting insulin. Here, we show that the supramolecular modification of insulin and pramlintide with cucurbit[7]uril-conjugated polyethylene glycol improves the pharmacokinetics of the dual-hormone therapy and enhances postprandial glucagon suppression in diabetic pigs. The co-formulation is stable for over 100 h at 37 °C under continuous agitation, whereas commercial formulations of insulin analogues aggregate after 10 h under similar conditions. In diabetic rats, the administration of the stabilized co-formulation increased the area-of-overlap ratio of the pharmacokinetic curves of pramlintide and insulin from 0.4 ± 0.2 to 0.7 ± 0.1 (mean ± s.d.) for the separate administration of the hormones. The co-administration of supramolecularly stabilized insulin and pramlintide better mimics the endogenous kinetics of co-secreted insulin and amylin, and holds promise as a dual-hormone replacement therapy.
Collapse
Affiliation(s)
- Caitlin L Maikawa
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Anton A A Smith
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
- Department of Science and Technology, Aarhus University, Aarhus, Denmark
| | - Lei Zou
- Department of Chemical and Biomolecular Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - Gillie A Roth
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Emily C Gale
- Department of Biochemistry, Stanford University, Stanford, CA, USA
| | | | - Sam W Baker
- Department of Comparative Medicine, Stanford University, Stanford, CA, USA
| | - Joseph L Mann
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Anthony C Yu
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Santiago Correa
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | | | - Celine S Liong
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Catherine M Meis
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Doreen Chan
- Department of Chemistry, Stanford University, Stanford, CA, USA
| | - Megan Troxell
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - David M Maahs
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, USA
- Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - Bruce A Buckingham
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, USA
- Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - Matthew J Webber
- Department of Chemical and Biomolecular Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - Eric A Appel
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA.
- Department of Pediatrics (Endocrinology), Stanford University, Stanford, CA, USA.
- Diabetes Research Center, Stanford University, Stanford, CA, USA.
| |
Collapse
|
21
|
Maikawa CL, Smith AAA, Zou L, Meis CM, Mann JL, Webber MJ, Appel EA. Stable Monomeric Insulin Formulations Enabled by Supramolecular PEGylation of Insulin Analogues. ADVANCED THERAPEUTICS 2020; 3:1900094. [PMID: 32190729 PMCID: PMC7079736 DOI: 10.1002/adtp.201900094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Indexed: 12/17/2022]
Abstract
Current "fast-acting" insulin analogues contain amino acid modifications meant to inhibit dimer formation and shift the equilibrium of association states toward the monomeric state. However, the insulin monomer is highly unstable and current formulation techniques require insulin to primarily exist as hexamers to prevent aggregation into inactive and immunogenic amyloids. Insulin formulation excipients have thus been traditionally selected to promote insulin association into the hexameric form to enhance formulation stability. This study exploits a novel excipient for the supramolecular PEGylation of insulin analogues, including aspart and lispro, to enhance the stability and maximize the prevalence of insulin monomers in formulation. Using multiple techniques, it is demonstrated that judicious choice of formulation excipients (tonicity agents and parenteral preservatives) enables insulin analogue formulations with 70-80% monomer and supramolecular PEGylation imbued stability under stressed aging for over 100 h without altering the insulin association state. Comparatively, commercial "fast-acting" formulations contain less than 1% monomer and remain stable for only 10 h under the same stressed aging conditions. This simple and effective formulation approach shows promise for next-generation ultrafast insulin formulations with a short duration of action that can reduce the risk of post-prandial hypoglycemia in the treatment of diabetes.
Collapse
Affiliation(s)
- Caitlin L Maikawa
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Anton A A Smith
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
| | - Lei Zou
- Department of Chemical and Biomolecular Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Catherine M Meis
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
| | - Joseph L Mann
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
| | - Matthew J Webber
- Department of Chemical and Biomolecular Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Eric A Appel
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| |
Collapse
|
22
|
Abstract
Background To evaluate whether blood markers of lead, cadmium, and mercury can improve prediction for cardiovascular disease (CVD) mortality when added individually, jointly, or as an integrative index/Environmental Risk Score (ERS), in a model with established risk factors. Methods and Results Our study sample comprised 16 028 adults aged ≥40 years who were enrolled in the National Health and Nutrition Examination Survey 1999–2012 and followed up through December 31, 2015. The study sample was randomly split into training for the ERS construction (n=8043) and testing for the evaluation of prediction performance (n=7985). ERS was computed using elastic‐net penalized Cox's model based on the selected metal predictors predicting CVD mortality. During median follow‐up of 7.2 years, 517 died from CVD. In the training set, linear terms of cadmium and mercury, squared terms of lead and mercury, and all 3 pairwise interactions were selected by elastic‐net for ERS construction. In the testing set, the C‐statistic increased from 0.845 when only established CVD risk factors were in the model to 0.854 when the ERS was additionally added to the model. Addition of all linear, squared, and pairwise interaction terms of blood metals to the Cox's models improved C‐statistic from 0.845 to 0.857. The improvement remained significant when it was assessed by net reclassification improvement and integrated discrimination improvement. Conclusions Our findings suggest that blood markers of toxic metals can improve CVD risk prediction over the established risk factors and highlight their potential utility for CVD risk assessment, prevention, and precision health.
Collapse
Affiliation(s)
- Xin Wang
- Department of Epidemiology School of Public Health University of Michigan Ann Arbor MI
| | - Bhramar Mukherjee
- Department of Biostatistics School of Public Health University of Michigan Ann Arbor MI
| | - Sung Kyun Park
- Department of Epidemiology School of Public Health University of Michigan Ann Arbor MI.,Department of Environmental Health Sciences School of Public Health University of Michigan Ann Arbor MI
| |
Collapse
|
23
|
Ru X, Guo Y, Bai Z, Xie X, Ma X, Zhu L, Wang K, Wang F, Yang L, Lu J. Synthesis of calcium carbonate nanoparticles in erythrocytes enables efficient removal of extracellular lead ions. Commun Chem 2019. [DOI: 10.1038/s42004-019-0199-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
24
|
Calderon Moreno R, Navas-Acien A, Escolar E, Nathan DM, Newman J, Schmedtje JF, Diaz D, Lamas GA, Fonseca V. Potential Role of Metal Chelation to Prevent the Cardiovascular Complications of Diabetes. J Clin Endocrinol Metab 2019; 104:2931-2941. [PMID: 30869793 PMCID: PMC9136707 DOI: 10.1210/jc.2018-01484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/07/2019] [Indexed: 02/12/2023]
Abstract
CONTEXT For decades, there has been epidemiologic evidence linking chronic toxic metal exposure with cardiovascular disease, suggesting a therapeutic role for metal chelation. Given the lack of compelling scientific evidence, however, the indications for metal chelation were never clearly defined. To determine the safety and efficacy of chelation therapy, the National Institutes of Health funded the Trial to Assess Chelation Therapy (TACT). TACT was the first double-blind, randomized, controlled trial to demonstrate an improvement in cardiovascular outcomes with edetate disodium therapy in patients with prior myocardial infarction. The therapeutic benefit was striking among the prespecified subgroup of patients with diabetes. DESIGN We review the published literature focusing on the atherogenic nature of diabetes, as well as available evidence from clinical trials, complete and in progress, of metal chelation with edetate disodium therapy in patients with diabetes. RESULTS The TACT results support the concept that ubiquitous toxic metals such as lead and cadmium may be modifiable risk factors for cardiovascular disease, particularly in patients with diabetes. CONCLUSIONS The purpose of this review is to discuss the potential mechanisms unifying the pathogenesis of atherogenic factors in diabetes with toxic metal exposure, and the potential role of metal chelation.
Collapse
Affiliation(s)
| | - Ana Navas-Acien
- Columbia University Mailman School of Public Health, New York, New York
| | - Esteban Escolar
- Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida
| | - David M Nathan
- Diabetes Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jonathan Newman
- Department of Medicine, New York University School of Medicine, New York, New York
| | | | - Denisse Diaz
- Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida
- Correspondence and Reprint Requests: Denisse Diaz, MD, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, Florida 33140. E-mail:
| | - Gervasio A Lamas
- Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida
| | - Vivian Fonseca
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| |
Collapse
|
25
|
Keshavarz B, Jiang X, Hsieh YHP, Rao Q. Matrix effect on food allergen detection – A case study of fish parvalbumin. Food Chem 2019; 274:526-534. [DOI: 10.1016/j.foodchem.2018.08.138] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 11/24/2022]
|
26
|
Zhai H, Wang Y, Wang M, Liu S, Yu F, Gao C, Li G, Wu Q. Construction of a Glutathione-Responsive and Silica-Based Nanocomposite for Controlled Release of Chelator Dimercaptosuccinic Acid. Int J Mol Sci 2018; 19:E3790. [PMID: 30487433 PMCID: PMC6321213 DOI: 10.3390/ijms19123790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/24/2018] [Accepted: 11/25/2018] [Indexed: 11/16/2022] Open
Abstract
Dimercaptosuccinic acid (DMSA) is an oral heavy metal chelator. Although DMSA is the most acceptable chelator in the urinary excretion of toxic elements from children and adults, its defects in plasma binding and the membrane permeability limit its interaction with intracellular elements and affect its efficacy in chelation therapy. Herein, a novel nanocomposite composed of mesoporous silica nanoparticles (MSNs), disulfide bond, and DMSA was synthesized and characterized with a scanning/transmission electron microscope, IR and Raman spectra, and TGA analysis. The in vitro interactions with glutathione (GSH) and cellular uptake assays showed that it was able to be stable in extracellular environments such as in blood, be internalized by cells, and release DMSA inside via GSH-triggered disulfide cleavage reaction. The in vitro adsorption assays showed that MSNs-SH as its intracellular metabolite had strong adsorbability for models of Hg2+ or Pb2+. The hemolysis and cell viability assays showed that it was compatible with blood and cells even at a concentration of 1000 μg·mL-1. All above could not only enable it to be a GSH-responsive drug delivery system (DDS) for DMSA delivery but also to be a solution for its defects and efficacy. Thus, introduction of intelligent DDS might open a new avenue for DMSA-based chelation therapy.
Collapse
Affiliation(s)
- Hongqiang Zhai
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China.
- Institute of Medicinal Biotechnology of Medical Science & Peking Union Medical College, Beijing 100850, China.
| | - Yuli Wang
- State key laboratory of toxicology and medical countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China.
| | - Menghua Wang
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China.
| | - Shuai Liu
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China.
| | - Feifei Yu
- Institute of Medicinal Biotechnology of Medical Science & Peking Union Medical College, Beijing 100850, China.
| | - Chunsheng Gao
- State key laboratory of toxicology and medical countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China.
| | - Guiling Li
- Institute of Medicinal Biotechnology of Medical Science & Peking Union Medical College, Beijing 100850, China.
| | - Qiang Wu
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China.
| |
Collapse
|
27
|
Diaz D, Fonseca V, Aude YW, Lamas GA. Chelation therapy to prevent diabetes-associated cardiovascular events. Curr Opin Endocrinol Diabetes Obes 2018; 25:258-266. [PMID: 29846236 PMCID: PMC6058685 DOI: 10.1097/med.0000000000000419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW For over 60 years, chelation therapy with disodium ethylene diamine tetraacetic acid (EDTA, edetate) had been used for the treatment of cardiovascular disease (CVD) despite lack of scientific evidence for efficacy and safety. The Trial to Assess Chelation Therapy (TACT) was developed and received funding from the National Institutes of Health (NIH) to ascertain the safety and efficacy of chelation therapy in patients with CVD. RECENT FINDINGS This pivotal trial demonstrated an improvement in outcomes in postmyocardial infarction (MI) patients. Interestingly, it also showed a particularly large reduction in CVD events and all-cause mortality in the prespecified subgroup of patients with diabetes. The TACT results may support the concept of metal chelation to reduce metal-catalyzed oxidation reactions that promote the formation of advanced glycation end products, a precursor of diabetic atherosclerosis. SUMMARY In this review, we summarize the epidemiological and basic evidence linking toxic metal accumulation and diabetes-related CVD, supported by the salutary effects of chelation in TACT. If the ongoing NIH-funded TACT2, in diabetic post-MI patients, proves positive, this unique therapy will enter the armamentarium of endocrinologists and cardiologists seeking to reduce the atherosclerotic risk of their diabetic patients.
Collapse
Affiliation(s)
- Denisse Diaz
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach FL
| | - Vivian Fonseca
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Yamil W. Aude
- University of Texas Rio Grande Valley Doctors Hospital at Renaissance, Edinburg, Texas, USA
| | - Gervasio A. Lamas
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach FL
| |
Collapse
|
28
|
|
29
|
Raghuvanshi R, Chaudhari A, Kumar GN. 2-Ketogluconic acid and pyrroloquinoline quinone secreting probiotic Escherichia coli Nissle 1917 as a dietary strategy against heavy metal induced damage in rats. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
30
|
Arenas IA, Navas-Acien A, Ergui I, Lamas GA. Enhanced vasculotoxic metal excretion in post-myocardial infarction patients following a single edetate disodium-based infusion. ENVIRONMENTAL RESEARCH 2017; 158:443-449. [PMID: 28689036 DOI: 10.1016/j.envres.2017.06.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 05/10/2023]
Abstract
UNLABELLED Toxic metals have been associated with cardiovascular mortality and morbidity. We have hypothesized that enhanced excretion of vasculotoxic metals might explain the positive results of the Trial to Assess Chelation Therapy (TACT). The purpose of this study was to determine whether a single infusion of the edetate disodium- based infusion used in TACT led to enhanced excretion of toxic metals known to be associated with cardiovascular events. METHODS Twenty six patients (post-MI, age > 50 years, serum creatinine ≤ 2.0mg/dL) were enrolled in this open-label study. Urinary levels of 20 toxic metals normalized to urinary creatinine concentrations were measured at baseline in overnight urine collections, for 6h following a placebo infusion of 500mL normal saline and 1.2% dextrose, and for 6h following a 3g edetate disodium-based infusion. Self-reported metal exposure, smoking status, food frequency, occupational history, drinking water source, housing and hobbies were collected at baseline by a metal exposure questionnaire. RESULTS The mean age was 65 years (range 51-81 years). All patients were male. 50% had diabetes mellitus and 58% were former smokers. Mean (SD) serum creatinine was 0.95 (0.31) mg/dL. Toxic metals were detected in the baseline urine of >80% of patients. After placebo infusion there were no significant changes in total urinary metal levels. After edetate infusion, total urinary metal level increased by 71% compared to baseline (1500 vs. 2580µg/g creatinine; P<0.0001). The effect of edetate was particularly large for lead (3835% increase) and cadmium (633% increase). CONCLUSIONS Edetate disodium-based infusions markedly enhanced the urinary excretion of lead and cadmium, toxic metals with established epidemiologic evidence and mechanisms linking them to coronary and vascular events.
Collapse
Affiliation(s)
- Ivan A Arenas
- The Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ana Navas-Acien
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ian Ergui
- The Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Gervasio A Lamas
- The Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL, USA.
| |
Collapse
|
31
|
Aneni EC, Escolar E, Lamas GA. Chronic Toxic Metal Exposure and Cardiovascular Disease: Mechanisms of Risk and Emerging Role of Chelation Therapy. Curr Atheroscler Rep 2017; 18:81. [PMID: 27822681 DOI: 10.1007/s11883-016-0631-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the last few decades, there has been a growing body of epidemiologic evidence linking chronic toxic metal exposure to cardiovascular disease-related morbidity and mortality. The recent and unexpectedly positive findings from a randomized, double-blind, multicenter trial of metal chelation for the secondary prevention of atherosclerotic cardiovascular disease (Trial to Assess Chelation Therapy (TACT)) have focused the discussion on the role of chronic exposure to toxic metals in the development and propagation of cardiovascular disease and the role of toxic metal chelation therapy in the secondary prevention of cardiovascular disease. This review summarizes the most recent evidence linking chronic toxic metal exposure to cardiovascular disease and examines the findings of TACT.
Collapse
Affiliation(s)
- Ehimen C Aneni
- Department of Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, USA
| | - Esteban Escolar
- Columbia University Division of Cardiology, Mount Sinai Medical Center, 4300 Alton Road, Suite # 2070A, Miami Beach, FL, 33140, USA
| | - Gervasio A Lamas
- Department of Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, USA.
- Columbia University Division of Cardiology, Mount Sinai Medical Center, 4300 Alton Road, Suite # 2070A, Miami Beach, FL, 33140, USA.
| |
Collapse
|
32
|
Sultan S, Murarka S, Jahangir A, Mookadam F, Tajik AJ, Jahangir A. Chelation therapy in cardiovascular disease: an update. Expert Rev Clin Pharmacol 2017; 10:843-854. [DOI: 10.1080/17512433.2017.1339601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sulaiman Sultan
- Center for Integrative Research on Cardiovascular Aging and Aurora Cardiovascular Services, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - Shishir Murarka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Ahad Jahangir
- Department of Materials Science and Engineering, University of Wisconsin–Madison, Madison, WI, USA
| | - Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - A. Jamil Tajik
- Center for Integrative Research on Cardiovascular Aging and Aurora Cardiovascular Services, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - Arshad Jahangir
- Center for Integrative Research on Cardiovascular Aging and Aurora Cardiovascular Services, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| |
Collapse
|
33
|
Eom SY, Yim DH, Hong SM, Kim YD, Kim H, Choi BS, Park JD, Park CH, Kim GB, Yu SD. Changes in blood and urinary cadmium levels and bone mineral density according to osteoporosis medication in individuals with an increased cadmium body burden. Hum Exp Toxicol 2017; 37:350-357. [DOI: 10.1177/0960327117705425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- S-Y Eom
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - D-H Yim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - S-M Hong
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Y-D Kim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - H Kim
- Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - B-S Choi
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - J-D Park
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - C-H Park
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - G-B Kim
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| | - S-D Yu
- Environmental Health Research Division, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
| |
Collapse
|
34
|
Lamas GA, Issa OM. Edetate Disodium-Based Treatment for Secondary Prevention in Post-Myocardial Infarction Patients. Curr Cardiol Rep 2016; 18:20. [PMID: 26797807 DOI: 10.1007/s11886-015-0690-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An abundance of data, known for decades, is available linking metals, such as lead and cadmium, with cardiovascular disease. However, the idea that these toxic metals could be a modifiable risk factor for atherosclerosis did not become apparent clinically until the completion of the Trial to Assess Chelation Therapy in 2012. This pivotal study was the first double-blind, randomized, controlled trial of its kind to demonstrate a clear improvement in cardiovascular outcomes with edetate disodium therapy in a secondary prevention, post-myocardial infarction population. This effect size was most striking in diabetic patients, where the efficacy of edetate disodium was comparable, if not superior, to that of current guideline-based therapies. Given the economic burden of diabetes and cardiovascular disease, the potential impact of this therapy could be enormous if the results of this study are replicated.
Collapse
Affiliation(s)
- Gervasio A Lamas
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach FL, 4300 Alton Road, Miami Beach, FL, 33140, USA.
| | - Omar M Issa
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach FL, 4300 Alton Road, Miami Beach, FL, 33140, USA
| |
Collapse
|
35
|
Lamas GA, Ergui I. Chelation therapy to treat atherosclerosis, particularly in diabetes: is it time to reconsider? Expert Rev Cardiovasc Ther 2016; 14:927-38. [PMID: 27149141 PMCID: PMC5105603 DOI: 10.1080/14779072.2016.1180977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Case reports and case series have suggested a possible beneficial effect of chelation therapy in patients with atherosclerotic disease. Small randomized trials conducted in patients with angina or peripheral artery disease, however, were not sufficiently powered to provide conclusive evidence on clinical outcomes. AREAS COVERED The Trial to Assess Chelation Therapy (TACT) was the first randomized trial adequately powered to detect the effects of chelation therapy on clinical endpoints. We discuss results and future research. Expert commentary: Chelation reduced adverse cardiovascular events in a post myocardial infarction (MI) population. Patients with diabetes demonstrated even greater benefit, with a number needed to treat of 6.5 patients to prevent a cardiac event over 5 years, with a 41% relative reduction in risk of a cardiac event (p = 0.0002). These results led to the revision of the ACC/AHA guideline recommendations for chelation therapy, changing its classification from class III to class IIb. TACT2, a replicative trial, will assess the effects of chelation therapy on cardiovascular outcomes in diabetic patients with a prior myocardial infarction. We are seeking participating sites for TACT2.
Collapse
Affiliation(s)
- Gervasio A Lamas
- a The Columbia University Division of Cardiology at Mount Sinai Medical Center , Miami Beach , FL , USA
| | - Ian Ergui
- a The Columbia University Division of Cardiology at Mount Sinai Medical Center , Miami Beach , FL , USA
| |
Collapse
|
36
|
Abstract
The Trial to Assess Chelation Therapy (TACT) was a randomized double-blind placebo-controlled trial enrolling patients age ≥50 years with prior myocardial infarction. TACT used a 2 × 2 factorial design to study ethylene diamine tetraacetic acid (EDTA) chelation and high-dose vitamin supplementation. Chelation provided a modest but significant reduction in cardiovascular endpoints. The benefit was stronger and significant among participants with diabetes but absent in those without diabetes. Mechanisms by which chelation might reduce cardiovascular risk in persons with diabetes include the effects of EDTA chelation on transition and toxic metals. Transition metals, particularly copper and iron, play important roles in oxidative stress pathways. Toxic metals, in particular cadmium and lead, are toxic for the cardiovascular system. This review discusses the epidemiologic evidence and animal and human studies supporting the role of these metals in the development of diabetes and ischemic heart disease and potential ways by which EDTA chelation could confer cardiovascular benefit.
Collapse
|
37
|
Lamas GA, Navas-Acien A, Mark DB, Lee KL. Heavy Metals, Cardiovascular Disease, and the Unexpected Benefits of Chelation Therapy. J Am Coll Cardiol 2016; 67:2411-2418. [PMID: 27199065 PMCID: PMC4876980 DOI: 10.1016/j.jacc.2016.02.066] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 12/21/2022]
Abstract
This review summarizes evidence from 2 lines of research previously thought to be unrelated: the unexpectedly positive results of TACT (Trial to Assess Chelation Therapy), and a body of epidemiological data showing that accumulation of biologically active metals, such as lead and cadmium, is an important risk factor for cardiovascular disease. Considering these 2 areas of work together may lead to the identification of new, modifiable risk factors for atherosclerotic cardiovascular disease. We examine the history of chelation up through the report of TACT. We then describe work connecting higher metal levels in the body with the future risk of cardiovascular disease. We conclude by presenting a brief overview of a newly planned National Institutes of Health trial, TACT2, in which we will attempt to replicate the findings of TACT and to establish that removal of toxic metal stores from the body is a plausible mechanistic explanation for the benefits of edetate disodium treatment.
Collapse
Affiliation(s)
- Gervasio A Lamas
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida.
| | - Ana Navas-Acien
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel B Mark
- Duke Clinical Research Institute, Durham, North Carolina
| | - Kerry L Lee
- Duke Clinical Research Institute, Durham, North Carolina
| |
Collapse
|
38
|
Kukongviriyapan U, Apaijit K, Kukongviriyapan V. Oxidative Stress and Cardiovascular Dysfunction Associated with Cadmium Exposure: Beneficial Effects of Curcumin and Tetrahydrocurcumin. TOHOKU J EXP MED 2016; 239:25-38. [PMID: 27151191 DOI: 10.1620/tjem.239.25] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cadmium (Cd) is a non-essential heavy metal with high toxicity potential. Humans are exposed to Cd present in diet, polluted air, and cigarette smoke. Cd exposure has been associated with increased risk of chronic diseases, including hypertension, atherosclerosis, diabetes, and nephropathy, all of which could be attributable to dysfunctional endothelial and smooth muscle cells. Cd toxicity is correlated with increased reactive oxygen formation and depletion of antioxidants, resulting in an oxidative stress. Chelation of Cd has proved useful in the removal of the Cd burden. However, several chelating agents cause side effects in clinical usage. Recent studies have shown that the antioxidant compounds curcumin and tetrahydrocurcumin can alleviate vascular dysfunction and high blood pressure caused by Cd toxicity. In chronic Cd exposure, these antioxidants protect vascular endothelium by increasing nitric oxide (NO•) bioavailability and improving vascular function. Antioxidant activity against Cd intoxication results directly and/or indirectly through free radical scavenging, metal chelation, enhanced expression of the antioxidant defense system, regulation of inflammatory enzymes, increase in NO• bioavailability, and reduction of gastrointestinal absorption and tissue Cd accumulation. This review summarizes current knowledge of Cd-induced oxidative stress and cardiovascular dysfunction and a possible protective effect conferred by the antioxidants curcumin and tetrahydrocurcumin.
Collapse
|
39
|
He B, Yuan L, Dai W, Gao W, Zhang H, Wang X, Fang W, Zhang Q. Dynamic bio-adhesion of polymer nanoparticles on MDCK epithelial cells and its impact on bio-membranes, endocytosis and paracytosis. NANOSCALE 2016; 8:6129-45. [PMID: 26932537 DOI: 10.1039/c5nr08858e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Nowadays, concern about the use of nanotechnology for biomedical application is unprecedentedly increasing. In fact, nanosystems applied for various potential clinical uses always have to cross the primary biological barrier consisting of epithelial cells. However, little is really known currently in terms of the influence of the dynamic bio-adhesion of nanosystems on bio-membranes as well as on endocytosis and transcytosis. This was investigated here using polymer nanoparticles (PNs) and MDCK epithelial cells as the models. Firstly, the adhesion of PNs on cell membranes was found to be time-dependent with a shift of both location and dispersion pattern, from the lateral adhesion of mainly mono-dispersed PNs initially to the apical coverage of the PN aggregate later. Then, it was interesting to observe in this study that the dynamic bio-adhesion of PNs only affected their endocytosis but not their transcytosis. It was important to find that the endocytosis of PNs was not a constant process. A GM1 dependent CDE (caveolae dependent endocytosis) pathway was dominant in the preliminary stage, followed by the co-existence of a CME (clathrin-mediated endocytosis) pathway for the PN aggregate at a later stage, in accordance with the adhesion features of PNs, suggesting the modification of PN adhesion patterns on the endocytosis pathways. Next, the PN adhesion was noticed to affect the structure of cell junctions, via altering the extra- and intra-cellular calcium levels, leading to the enhanced paracellular transport of small molecules, but not favorably enough for the obviously increased passing of PNs themselves. Finally, FRAP and other techniques all demonstrated the obvious impact of PN adhesion on the membrane confirmation, independent of the adhesion location and time, which might lower the threshold for the internalization of PNs, even their aggregates. Generally, these findings confirm that the transport pathway mechanism of PNs through epithelial cells is rather dynamic, and is remarkably affected by the adhesion patterns of PNs on the cell membrane.
Collapse
Affiliation(s)
- Bing He
- Department of Pathology, School of Basic Medical Sciences, Peking University, Beijing 100191, China. and Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
| | - Lan Yuan
- Medical and Healthy Analytical Center, Peking University, Beijing 100191, China
| | - Wenbing Dai
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
| | - Wei Gao
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics (Theranostics), School of Pharmacy, Tianjin Medical University, Tianjin 300070, China
| | - Hua Zhang
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
| | - Xueqing Wang
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
| | - Weigang Fang
- Department of Pathology, School of Basic Medical Sciences, Peking University, Beijing 100191, China.
| | - Qiang Zhang
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100191, China.
| |
Collapse
|
40
|
Zhang S, Zhang R, Ma B, Qiu J, Li J, Sang Y, Liu W, Liu H. Specific detection of potassium ion in serum by a modified G-quadruplex method. RSC Adv 2016. [DOI: 10.1039/c6ra04046b] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A modified dual-labelled G-quadruplex method is successfully designed to rapidly detect K+ in complex matrix of real serum.
Collapse
Affiliation(s)
- Shan Zhang
- State Key Laboratory of Crystal Materials
- Shandong University
- Jinan
- China
| | - Ruibin Zhang
- Blood Purification Center
- Jinan Central Hospital
- Jinan
- China
| | - Baojin Ma
- State Key Laboratory of Crystal Materials
- Shandong University
- Jinan
- China
| | - Jichuan Qiu
- State Key Laboratory of Crystal Materials
- Shandong University
- Jinan
- China
| | - Jianhua Li
- State Key Laboratory of Crystal Materials
- Shandong University
- Jinan
- China
| | - Yuanhua Sang
- State Key Laboratory of Crystal Materials
- Shandong University
- Jinan
- China
| | - Wei Liu
- State Key Laboratory of Crystal Materials
- Shandong University
- Jinan
- China
| | - Hong Liu
- State Key Laboratory of Crystal Materials
- Shandong University
- Jinan
- China
| |
Collapse
|
41
|
Song Y, Huang Z, Song Y, Tian Q, Liu X, She Z, Jiao J, Lu E, Deng Y. The application of EDTA in drug delivery systems: doxorubicin liposomes loaded via NH4EDTA gradient. Int J Nanomedicine 2014; 9:3611-21. [PMID: 25120359 PMCID: PMC4128794 DOI: 10.2147/ijn.s64602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The applications of ethylenediaminetetraacetic acid (EDTA) have been expanded from the treatment of heavy metal poisoning to chelation therapies for atherosclerosis, heart disease, and cancers, in which EDTA reduces morbidity and mortality by chelating toxic metal ions. In this study, EDTA was used in a drug delivery system by adopting an NH4EDTA gradient method to load doxorubicin into liposomes with the goal of increasing therapeutic effects and decreasing drug-related cytotoxicity. The particle size of the optimum NH4EDTA gradient liposomes was 79.4±1.87 nm, and the entrapment efficiency was 95.54%±0.59%. In vitro studies revealed that liposomes prepared using an NH4EDTA gradient possessed long-term stability and delayed drug release. The in vivo studies also showed the superiority of the new doxorubicin formulation. Compared with an equivalent drug dose (5 mg/kg) prepared by (NH4)2SO4 gradient, NH4EDTA gradient liposomes showed no significant differences in tumor inhibition ratio, but cardiotoxicity and liposome-related immune organ damage were lower, and no drug-related deaths were observed. These results show that use of the NH4EDTA gradient method to load doxorubicin into liposomes could significantly reduce drug toxicity without influencing antitumor activity.
Collapse
Affiliation(s)
- Yanzhi Song
- College of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Zhenjun Huang
- College of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Yang Song
- Jiangsu Hansoh Pharmaceutical Co., Ltd., Lianyungang, People's Republic of China
| | - Qingjing Tian
- College of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Xinrong Liu
- College of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Zhennan She
- College of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Jiao Jiao
- College of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Eliza Lu
- Livzon Mabpharm Inc., Zhuhai, People's Republic of China
| | - Yihui Deng
- College of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| |
Collapse
|
42
|
Chelation therapy and cardiovascular disease: connecting scientific silos to benefit cardiac patients. Trends Cardiovasc Med 2014; 24:232-40. [PMID: 25106084 DOI: 10.1016/j.tcm.2014.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 12/25/2022]
Abstract
Medical practitioners have treated atherosclerotic disease with chelation therapy for over 50 years. Lack of strong of evidence led conventional practitioners to abandon its use in the 1960s and 1970s. This relegated chelation therapy to complementary and alternative medicine practitioners, who reported good anecdotal results. Concurrently, the epidemiologic evidence linking xenobiotic metals with cardiovascular disease and mortality gradually accumulated, suggesting a plausible role for chelation therapy. On the basis of the continued use of chelation therapy without an evidence base, the National Institutes of Health released a Request for Applications for a definitive trial of chelation therapy. The Trial to Assess Chelation Therapy (TACT) was formulated as a 2 × 2 factorial randomized controlled trial of intravenous EDTA-based chelation vs. placebo and high-dose oral multivitamins and multiminerals vs. oral placebo. The composite primary endpoint was death, reinfarction, stroke, coronary revascularization, or hospitalization for angina. A total of 1708 post-MI patients who were 50 years or older with a creatinine of 2.0 or less were enrolled and received 55,222 infusions of disodium EDTA or placebo with a median follow-up of 55 months. Patients were on evidence-based post-MI medications including statins. EDTA proved to be safe. EDTA chelation therapy reduced cardiovascular events by 18%, with a 5-year number needed to treat (NNT) of 18. Prespecified subgroup analysis revealed a robust benefit in patients with diabetes mellitus with a 41% reduction in the primary endpoint (5-year NNT = 6.5), and a 43% 5-year relative risk reduction in all-cause mortality (5-year NNT = 12). The magnitude of benefit is such that it suggests urgency in replication and implementation, which could, due to the excellent safety record, occur simultaneously.
Collapse
|
43
|
Abstract
These proceedings will review the role of chelation in five metals-aluminum, cadmium, chromium, cobalt, and uranium-in order to illustrate various chelation concepts. The process of "chelation" can often be oversimplified, leading to incorrect assumptions and risking patient harm. For chelation to be effective, two critical assumptions must be fulfilled: the presumed "metal toxicity" must correlate with a given body or a particular compartment burden, and reducing this compartmental or the body burden (through chelation) attenuates toxicity. Fulfilling these assumptions requires an established dose-response relationship, a validated, reproducible means of toxicity assessment (clinical, biochemical, or radiographical), and an appropriate assessment mechanisms of body or compartment burden. While a metal might "technically" be capable of chelation (and readily demonstrable in urine or feces), this is an insufficient endpoint. Clinical relevance must be affirmed. Deferoxamine is an accepted chelator for appropriately documented aluminum toxicity. There is a very minimal treatment window in order to address chelation in cadmium toxicity. In acute toxicity, while no definitive chelation benefit is described, succimer (DMSA), diethylenetriaminepentaacetate (DTPA), and potentially ethylenediaminetetraacetic acid (EDTA) have been considered. In chronic toxicity, chelation is unsupported. There is little evidence to suggest that currently available chromium chelators are efficacious. Similarly, scant human evidence exists with which to provide recommendation for cobalt chelation. DTPA has been recommended for cobalt radionuclide chelation, although DMSA, EDTA, and N-acetylcysteine have also been suggested. DTPA is unsupported for uranium chelation. Sodium bicarbonate is currently recommended, although animal evidence is conflicting.
Collapse
Affiliation(s)
- Silas W Smith
- Department of Emergency Medicine, Division of Medical Toxicology, New York University School of Medicine, New York, NY, USA,
| |
Collapse
|
44
|
Escolar E, Lamas GA, Mark DB, Boineau R, Goertz C, Rosenberg Y, Nahin RL, Ouyang P, Rozema T, Magaziner A, Nahas R, Lewis EF, Lindblad L, Lee KL. The effect of an EDTA-based chelation regimen on patients with diabetes mellitus and prior myocardial infarction in the Trial to Assess Chelation Therapy (TACT). Circ Cardiovasc Qual Outcomes 2013; 7:15-24. [PMID: 24254885 DOI: 10.1161/circoutcomes.113.000663] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The Trial to Assess Chelation Therapy (TACT) showed clinical benefit of an EDTA-based infusion regimen in patients aged ≥50 years with prior myocardial infarction. Diabetes mellitus before enrollment was a prespecified subgroup. METHODS AND RESULTS Patients received 40 infusions of EDTA chelation or placebo. A total of 633 (37%) patients had diabetes mellitus (322 EDTA and 311 placebo). EDTA reduced the primary end point (death, reinfarction, stroke, coronary revascularization, or hospitalization for angina; 25% versus 38%; hazard ratio, 0.59; 95% confidence interval [CI], 0.44-0.79; P<0.001) over 5 years. The result remained significant after Bonferroni adjustment for multiple subgroups (99.4% CI, 0.39-0.88; adjusted P=0.002). All-cause mortality was reduced by EDTA chelation (10% versus 16%; hazard ratio, 0.57; 95% CI, 0.36-0.88; P=0.011), as was the secondary end point (cardiovascular death, reinfarction, or stroke; 11% versus 17%; hazard ratio, 0.60; 95% CI, 0.39-0.91; P=0.017). However, after adjusting for multiple subgroups, those results were no longer significant. The number needed to treat to reduce 1 primary end point over 5 years was 6.5 (95% CI, 4.4-12.7). There was no reduction in events in non-diabetes mellitus (n=1075; P=0.877), resulting in a treatment by diabetes mellitus interaction (P=0.004). CONCLUSIONS Post-myocardial infarction patients with diabetes mellitus aged ≥50 demonstrated a marked reduction in cardiovascular events with EDTA chelation. These findings support efforts to replicate these findings and define the mechanisms of benefit. However, they do not constitute sufficient evidence to indicate the routine use of chelation therapy for all post-myocardial infarction patients with diabetes mellitus. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00044213.
Collapse
Affiliation(s)
- Esteban Escolar
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Elastin-specific medial vascular calcification, termed "Monckeberg's sclerosis," has been recognized as a major risk factor for various cardiovascular events. We hypothesize that chelating agents, such as disodium ethylenediaminetetraacetic acid (EDTA), diethylenetriaminepentaacetic acid (DTPA), and sodium thiosulfate (STS) might reverse elastin calcification by directly removing calcium from calcified tissues into soluble calcium complexes. We assessed the chelating ability of EDTA, DTPA, and STS on removal of calcium from hydroxyapatite (HA) powder, calcified porcine aortic elastin, and calcified human aorta in vitro. We show that both EDTA and DTPA could effectively remove calcium from HA and calcified tissues, while STS was not effective. The tissue architecture was not altered during chelation. In the animal model of aortic elastin-specific calcification, we further show that local periadventitial delivery of EDTA loaded in to poly(lactic-co-glycolic acid) nanoparticles regressed elastin-specific calcification in the aorta. Collectively, the data indicate that elastin-specific medial vascular calcification could be reversed by chelating agents.
Collapse
Affiliation(s)
| | | | - Naren Vyavahare
- Corresponding author: Naren Vyavahare, PhD, Department of Bioengineering, Clemson University, 501 Rhodes Engineering Research Center, Clemson, South Carolina, 29634; Phone: 864 656 5558; Fax: 864 656 4466,
| |
Collapse
|
46
|
Chakraborty S, Dutta AR, Sural S, Gupta D, Sen S. Ailing bones and failing kidneys: a case of chronic cadmium toxicity. Ann Clin Biochem 2013; 50:492-5. [PMID: 23800513 DOI: 10.1177/0004563213481207] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heavy metal toxicity is often caused by occupational exposure. Chronic cadmium toxicity is a significant health concern among workers engaged in zinc smelting, battery production and silver jewellery industries, particularly in developing countries. We report the case of a 48-year-old man who presented with severe osteoporosis, impaired renal function and acquired Fanconi syndrome. He was finally diagnosed with chronic cadmium toxicity resulting from long-term occupational exposure. Cadmium has a long biological half-life and there is no effective treatment for people who are exposed to it. Therefore, an early diagnosis and prevention of further exposure are important.
Collapse
Affiliation(s)
- Sutirtha Chakraborty
- Department of Biochemistry, Peerless Hospital and BK Roy Research Center, Kolkata, India.
| | | | | | | | | |
Collapse
|
47
|
Bernhoft RA. Cadmium toxicity and treatment. ScientificWorldJournal 2013; 2013:394652. [PMID: 23844395 PMCID: PMC3686085 DOI: 10.1155/2013/394652] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/28/2013] [Indexed: 02/06/2023] Open
Abstract
Cadmium is a heavy metal of considerable toxicity with destructive impact on most organ systems. It is widely distributed in humans, the chief sources of contamination being cigarette smoke, welding, and contaminated food and beverages. Toxic impacts are discussed and appear to be proportional to body burden of cadmium. Detoxification of cadmium with EDTA and other chelators is possible and has been shown to be therapeutically beneficial in humans and animals when done using established protocols.
Collapse
Affiliation(s)
- Robin A Bernhoft
- Bernhoft Centers for Advanced Medicine, 11677 San Vicente Blvd, Suite 208/211, Los Angeles, CA 93023, USA.
| |
Collapse
|
48
|
Inbaraj BS, Chen BH. In vitro removal of toxic heavy metals by poly(γ-glutamic acid)-coated superparamagnetic nanoparticles. Int J Nanomedicine 2012; 7:4419-32. [PMID: 22927758 PMCID: PMC3420602 DOI: 10.2147/ijn.s34396] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Indexed: 11/26/2022] Open
Abstract
Background: Chelation therapy involving organic chelators for treatment of heavy metal intoxication can cause cardiac arrest, kidney overload, mineral deficiency, and anemia. Methods: In this study, superparamagnetic iron oxide nanoparticles (SPIONs) modified with an edible biopolymer poly(γ-glutamic acid) (PGA) were synthesized by coprecipitation method, characterized and evaluated for their removal efficiency of heavy metals from a metal solution, and simulated gastrointestinal fluid (SGIF). Results: Instrumental characterization of bare- and PGA-SPIONs revealed 7% coating of PGA on SPIONs with a spherical shape and an iron oxide spinel structure belonging to magnetite. The particle sizes as determined from transmission electron microscopy images were 8.5 and 11.7 nm for bare- and PGA-SPIONs, respectively, while the magnetization values were 70.3 and 61.5 emu/g. Upon coating with PGA, the zeta potentials were shifted from positive to negative at most of the environmental pH (3–8) and biological pH (1–8), implying good dispersion in aqueous suspension and favorable conditions for heavy metal removal. Batch studies showed rapid removal of lead and cadmium with the kinetic rates estimated by pseudo-second-order model being 0.212 and 0.424 g/mg·min, respectively. A maximum removal occurred in the pH range 4–8 in deionized water and 5–8 in SGIF corresponding to most gastrointestinal pH except for the stomach. Addition of different ionic strengths (0.001–1 M sodium acetate) and essential metals (Cu, Fe, Zn, Mg, Ca, and K) did not show any marked influence on lead removal by PGA-SPIONs, but significantly reduced the binding of cadmium. Compared to deionized water, the lead removal from SGIF was high at all pH with the Langmuir monolayer removal capacity being 98.70 mg/g for the former and 147.71 mg/g for the latter. However, a lower cadmium removal capacity was shown for SGIF (23.15 mg/g) than for deionized water (31.13 mg/g). Conclusion: These results suggest that PGA-SPIONs could be used as a metal chelator for clinical treatment of metal poisoning.
Collapse
|
49
|
Wang MW. A microfluidic device for separating erythrocytes polluted by lead (II) from a continuous bloodstream flow. Electrophoresis 2012; 33:780-7. [DOI: 10.1002/elps.201100354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
50
|
Yantasee W, Rutledge RD, Chouyyok W, Sukwarotwat V, Orr G, Warner CL, Warner MG, Fryxell GE, Wiacek RJ, Timchalk C, Addleman RS. Functionalized nanoporous silica for the removal of heavy metals from biological systems: adsorption and application. ACS APPLIED MATERIALS & INTERFACES 2010; 2:2749-58. [PMID: 20939537 PMCID: PMC3429124 DOI: 10.1021/am100616b] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Surface-functionalized nanoporous silica, often referred to as self-assembled monolayers on mesoporous supports (SAMMS), has previously demonstrated the ability to serve as very effective heavy metal sorbents in a range of aquatic and environmental systems, suggesting that they may be advantageously utilized for biomedical applications such as chelation therapy. Herein we evaluate surface chemistries for heavy metal capture from biological fluids, various facets of the materials' biocompatibility, and the suitability of these materials as potential therapeutics. Of the materials tested, thiol-functionalized SAMMS proved most capable of removing selected heavy metals from biological solutions (i.e., blood, urine, etc.) Consequentially, thiol-functionalized SAMMS was further analyzed to assess the material's performance under a number of different biologically relevant conditions (i.e., variable pH and ionic strength) to gauge any potentially negative effects resulting from interaction with the sorbent, such as cellular toxicity or the removal of essential minerals. Additionally, cellular uptake studies demonstrated no cell membrane permeation by the silica-based materials generally highlighting their ability to remain cellularly inert and thus nontoxic. The results show that organic ligand functionalized nanoporous silica could be a valuable material for a range of detoxification therapies and potentially other biomedical applications.
Collapse
|