[15N]methacetin urine test: a method to study the development of hepatic detoxification capacity

Bio-effect monitoring using a [(15)N]methacetin test as diagnostic tool to monitor remediation effects in an industrially polluted region

The classical way to demonstrate the efficiency of remediation is measuring the reduction of toxic compounds in the environment. Nevertheless, more important is the risk reduction in human health. To determine changing health effects, exposure and bio-effects have to be monitored at time of and during remediation. Kindergarten children from a heavily polluted industrial (n=23) and a control area (n=12) were investigated. The region-specific outdoor and indoor exposure [27 volatile organic compounds (VOC), emphasis on tri- and tetrachloroethylene (TRI, TETRA)], the internal load [(trichloroacetic acid-TCA-as urine metabolites of TRI and TETRA and S-phenyl- and S-benzylmercapturic acid (SPMA and SBMA) as metabolites of benzene and toluene], and biological effect assessment ([(15)N]methacetin test-a non-invasive stable isotope test to determine the unspecific liver detoxification capacity of an individual) were measured twice a year during 2 years of remediation (1997/1998). It could be shown that in- and outdoor levels of TRI and TETRA decreased by 47% in the heavily polluted village, Greppin, while the levels remained much the same in the control village, Roitzsch. This trend was reflected in the decreasing elimination of TCA in the urine (41%) by the Greppin children, with no differences in the TCA elimination in Roitzsch probands. As the remediation efforts decreased the burden of exposure, the children's liver detoxification capacity improved as well. Combining different methods, such as exposure-effect (external and internal loads) and bio-effect monitoring, proved to be useful to assess remediation successes including the improvement in human health.

Noninvasive assessment of liver detoxification capacity of children, observed in children from heavily polluted industrial and clean control areas, together with assessments of air pollution and chloro-organic body burden

The liver is an important target organ in exposure to foreign substances or their metabolites. Early changes in the metabolic capacity of the liver may be a first sign of the effect of an exposure and an indication of an early (pre)pathological process. For the noninvasive testing of this metabolic capacity, a special diagnostic tool has been developed and demonstrated under real exposure conditions. The main questions investigated were (1) whether the liver detoxification capacity of children is affected by long-term low exposure in a highly polluted area and (2) to what extent redevelopment in once heavily polluted industrial areas contributes to improvement in the health measured in the children from the changed detoxification capacity. Kindergarten children from a heavily polluted industrial area and a control area were observed over a prolonged period during redevelopment of the industrial area. The liver's detoxification capacity was assessed with a stable-isotope-based diagnostic test, the [(15)N]methacetin test. In addition, the region-specific external exposure (indicator components were chlorinated compounds) and internal load were measured. The difference in the children's internal load between the exposed and control groups reflected the differences in exposure (exposed children had an internal load 2.3 times greater than that of the control children). The exposed children showed a 6% lower liver detoxification capacity. A reduction in pollution by about 70% as a result of remediation was reflected in improved liver detoxification capacity, and the difference between the polluted and control areas was no longer significant. Prolonged exposure to low concentrations of xenobiotics can disturb hepatic functioning. The proposed test can be used as a tool to determine the effects of multicomponent exposure and is well suited for bioeffect monitoring.

Detecting exposure-dependent changes of liver detoxification capacity of children in a formerly high-loaded industrial area with a 15N-labelled diagnostic tool

The effect of remediation activities in formerly high-loaded industrial areas is measured conventionally in terms of decreased toxic loads. It is more difficult to investigate the effect on physiological parameters of the people living there. A non-invasive 15N-based organ function test, the [15N]methacetin urine test, was adapted to environmental-medical purposes for the detection of small deviations from the norm-range hepatic detoxification capacity. Parallel to the measurement of region-specific external exposure (especially by tri- and tetrachloro ethylene) and of the corresponding internal load (urinary trichloro acetic acid), the hepatic mono oxygenation capacity was determined. The study cohort consisted of 35 kindergarten children who were 3.3+/-0.5 years old at the beginning of the study. They lived in a high-polluted industrial village (n = 23) and in a non-polluted control village close by (n = 12), respectively. Children living in the polluted area were exposed a 2.3 times higher load and showed detoxification capacities 6% lower than the children in the control area. Improvement of the environmental situation led to exposure data decreasing by 70%, which is also reflected in smaller internal load and improved liver detoxification of the children in the polluted area. Then, between loaded and control area the mean hepatic detoxification was no longer significantly different (0.6%). The study shows that chronic low-dose exposure can disturb a hepatic function and that thereafter the capacity is recovered quickly in children. The stable isotope-based test is suited to characterize a health effect of multicomponent exposure by bioeffect monitoring within the framework of screening and testing the remediation efficiency.

The [15N]methacetin liver function test characterizes multicomponent exposure of children in industrially polluted regions

The [15N]methacetin urine test for assessing disturbances of the cytochrome P450-aided oxygenation of xenobiotics in the human liver has been approved in several environmental health studies. A recent longitudinal study of kindergarten children near chemical and mining companies undergoing fundamental restructuring showed high, seasonally fluctuating SO2 burden which was well correlated with alterations in the mean liver states of the children. At one point the correlation disappeared, together with indications of large amounts of chlorinated compounds overflowing locally at nighttime. This was finally proven by analyzing urine samples from the children for trichloroacetic acid (TCA). Chlorinated ethanes and ethenes-the precursors of TCA-seemed to dominate the air pollution and to affect the hepatic detoxification capacity. We concluded that the methacetin liver function test reflects multicomponent exposure, including acute monopolization by a dominant pollutant for a time.

In vivo research with stable isotopes in biochemistry, nutrition and clinical medicine: an overview

Tracers and kinetic modelling provide the opportunity to follow the movement and to quantify the metabolic fates of biological compounds in vivo. For studies in children and for repeated studies in adults, the use of stable isotopically labelled substrates are preferable and safe. Measurement of isotopic enrichment in biological molecules is highly specific and can be extremely precise. This allows the development of models of biological system dynamics in cells and organs that are otherwise inaccessible for sampling. Applications in biochemistry, nutrition and clinical medicine show the potential of stable isotopes in vivo. Methodology is of paramount importance and includes the choice of bolus studies, (primed) continuous infusions, use of multiple tracers and use of isotopomer information and intrinsic labels. There is no limit to the number and kind of compounds that can be traced. Topics include intermediate metabolism (lipids, proteins and carbohydrates) using hydrogen, carbon and nitrogen labels. In clinical medicine, 13C-breath tests are available for detection of Helicobacter pylori ([13C]urea breath test), and for assessment of a variety of gastro-intestinal and hepatic functions (e.g. [13C]octanoate and mixed [13C]triglyceride breath tests for studies of gastric emptying and fat absorption, respectively). Because theoretical, methodological, physiological and practical aspects are intertwined, in vivo research with stable isotopes demands close collaboration between the clinical researcher and the chemist responsible for the mass spectrometry.