Clinical and biochemical abnormalities in coppersmiths exposed to cadmium

TGF-β1 Potentiates the Cytotoxicity of Cadmium by Induction of a Metal Transporter, ZIP8, Mediated by the ALK5-Smad2/3 and ALK5-Smad3-p38 MAPK Signal Pathways in Cultured Vascular Endothelial Cells

Vascular endothelial cells cover the luminal surface of blood vessels in a monolayer and play a role in the regulation of vascular functions, such as the blood coagulation-fibrinolytic system. When the monolayer is severely or repeatedly injured, platelets aggregate at the damaged site and release transforming growth factor (TGF)-β₁ in large quantities from their α-granules. Cadmium is a heavy metal that is toxic to various organs, including the kidneys, bones, liver, and blood vessels. Our previous study showed that the expression level of Zrt/Irt-related protein 8 (ZIP8), a metal transporter that transports cadmium from the extracellular fluid into the cytosol, is a crucial factor in determining the sensitivity of vascular endothelial cells to cadmium cytotoxicity. In the present study, TGF-β₁ was discovered to potentiate cadmium-induced cytotoxicity by increasing the intracellular accumulation of cadmium in cells. Additionally, TGF-β₁ induced the expression of ZIP8 via the activin receptor-like kinase 5-Smad2/3 signaling pathways; Smad3-mediated induction of ZIP8 was associated with or without p38 mitogen-activated protein kinase (MAPK). These results suggest that the cytotoxicity of cadmium to vascular endothelial cells increases when damaged endothelial monolayers that are highly exposed to TGF-β₁ are repaired.

Does Cadmium Contribute to the Development of Renal Parenchymal Hypertension?

In our study we investigated 36 out-patients with renal disease, 22 of whom were hypertensive. In all patients proteinuria was present (4.30 ± 5.05 g protein/day) and kidney diseases were verified by renal biopsy. Blood cadmium in non-smokers was significantly (p< 0.05) lower than in smokers. We found a positive correlation between cadmium-concentration of blood and urine (p<0.01, R = 0.44) and between cadmium-concentration of blood and blood uric acid (p< 0.01, R = 0.44). Proteinuria was weakly correlated with cadmium concentration of urine (p<0.05, R = 0.35). Patients with renal hypertension showed a significantly higher (p< 0.05) urine cadmium excretion per day (1.60 ± 1.12 μg/day) compared to normotensives with a disease of the kidney (1.14 ± 1.47 μg/day). Our results indicate that cadmium may be involved in the development of hypertension in patients with renal disease.

Mouse kidney expresses mRNA of four highly related sodium-glucose cotransporters: regulation by cadmium

BACKGROUND

To study the molecular mechanism responsible for cadmium-induced Fanconi syndrome, an in vitro mouse model has been used. We have previously shown that exposure of primary cultures of kidney cortical cells to micromolar concentrations of cadmium inhibited uptake of the glucose analog, [14C] methyl alpha-d-glucopyranoside (AMG) (261 mCi/mmol, NEN), and decreased mRNA levels of two kidney sodium-glucose cotransporters (SGLTs), SGLT1 and SGLT2. We also isolated partial cDNA of another member of the SGLT family, SGLT3-b, from cultured kidney cells and observed that cadmium exposure increased the abundance of its mRNA. In this study, we investigated the effect of cadmium on the second mouse kidney SGLT3 isoform, SGLT3-a. We also examined which SGLTs were transcribed in vivo.

METHODS

Cadmium was added to the confluent primary cultures of kidney cortical cells at concentrations of 5, 7.5, and 10 micromol/L. After 24 hours, uptake of [14C]AMG was measured and total RNA was extracted for semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) of SGLT3-a. Also, cDNA from whole kidneys of mice was used in PCR with primers specific for each SGLT. A partial cDNA sequence of SGLT3-a and the full-length cDNA sequence of SGLT3-b were obtained from their respective PCR clones.

RESULTS

Exposure of cortical cells to 5 micromol/L cadmium increased SGLT3-a mRNA level 3.4- +/- 0.78-fold (mean +/- SEM, P < 0.03, N = 5). mRNAs of SGLT1, SGLT2, SGLT3-a, and SGLT3-b were simultaneously present in cDNA samples from whole kidneys of mice. SGLT3-b cDNA sequence was revised from its predicted sequence to encode a 660 amino acid protein.

CONCLUSION

Reabsorption of glucose in mouse kidney may involve four SGLTs. Cadmium affects mRNA expression of all four SGLTs in vitro.

Avaliação audiométrica de trabalhadores ocupacionalmente expostos a ruído e cádmio

Introdução: O ruído é caracterizado como o fator mais prevalente na origem de doenças ocupacionais. Também é o agente físico nocivo à saúde mais comum nos ambientes de trabalho, causando perda auditiva. Além do ruído, agentes químicos presentes no meio ocupacional, como solventes e metais pesados, são descritos como causadores de alteração auditiva. Objetivo: Avaliar dois grupos de indivíduos expostos à mesma intensidade de ruído industrial, sendo um desses grupos exposto ao cádmio e outro não, e verificar se a exposição aos dois agentes poluentes é mais prejudicial do que a exposição ao ruído isoladamente. Forma de estudo: Clínico prospectivo. Material e Método: Foi realizado estudo audiométrico de 36 trabalhadores de indústria metalúrgica, expostos a ruído e fumos de cádmio em seu ambiente de trabalho, no período de 1994 a 1998. Os resultados obtidos nesse grupo foram comparados aos de um grupo controle composto de 36 trabalhadores dos mesmos setores da empresa, porém expostos somente ao ruído. Resultados: Observou-se uma perda auditiva concentrada principalmente nas freqüências de 4000 e 6000 Hz, mais acentuada no grupo exposto ao ruído e cádmio. Conclusão: Os dados indicaram uma provável ação ototóxica do metal cádmio quando associado à exposição ao ruído.

Differential regulation of mouse kidney sodium-dependent transporters mRNA by cadmium

Chronic exposure to cadmium can result in renal glycosuria. Previously, we reported that cadmium reduced the relative abundance of the sodium-glucose cotransporter mRNA (Blumenthal et al., Toxicol. Appl. Pharmacol.149, 49-54, 1998). To investigate this phenomenon further, we isolated full-length cDNA clones encoding both high- and low-affinity sodium-dependent glucose transporters SGLT1 and SGLT2, respectively, from cultured mouse kidney cortical cells. We also amplified a fragment of another putative sodium-glucose cotransporter with homology to the known SAAT1/pSGLT2 or SGLT3 from our cultured cells and named it SGLT3. In order to examine the effect of cadmium on these transporters, primary cultures of mouse kidney cortical cells were exposed to micromolar concentrations of cadmium for 24 h and levels of SGLT1, SGLT2, and SGLT3 mRNA were determined by semiquantitative RT-PCR. Five to 10 microM of cadmium inhibited sodium-dependent uptake of the glucose analog, alpha-methyl D-glucopyranoside and progressively reduced the level of SGLT1. Cadmium also inhibited SGLT2 mRNA by 37%, but no further decline was observed at concentrations of cadmium greater than 5 microM. While cadmium inhibited SGLT1 and SGLT2, it significantly stimulated the expression of SGLT3 by fivefold. These results imply that individual sodium-glucose cotransporter mRNA species are not regulated in a similar fashion. In addition, the isolation of three separate SGLT species from these cultures suggests that, in addition to SGLT1 and SGLT2, glucose reabsorption by renal epithelial cells might involve additional glucose transporters such as SGLT3.

Cadmium inhibits vacuolar H(+)-ATPase and endocytosis in rat kidney cortex

The mechanism of cadmium (Cd)-induced damage in the mammalian proximal tubule that is manifested by defects in reabsorption of various compounds, is poorly understood. A vacuolar H(+)-ATPase (V-ATPase) in proximal tubule (PT) brush border and intracellular vesicles may be affected by Cd, and this may influence intracellular vesicle trafficking and reabsorption of the filtered proteins. We studied the effects of Cd on V-ATPase and endocytosis in rat renal PT in vivo and on acidification mechanisms in isolated renal cortical organelles in vitro. The V-ATPase activity in brush border membrane (BBM) from Cd-intoxicated rats was 40% lower compared to that in control animals. Immunofluorescence studies in cortical tissue sections and Western blot studies in BBM from Cd-treated rats showed a strongly decreased abundance of the 31 kDa and 70 kDa V-ATPase subunits. Functional studies in vivo showed a dramatically diminished endocytosis of fluorescein-labeled dextran in PT cells from Cd-treated animals, whereas morphological studies revealed a loss of endocytic invaginations and subapical vesicles in the same cells. In studies in vitro, Cd inhibited V-ATPase activity in a concentration- and time-dependent manner in both BBM and endocytic vesicles, whereas in endocytic vesicles, Cd inhibited ATP-driven intravesicular acidification and accelerated the dissipation of transmembrane pH gradients. We conclude that Cd may impair acidification in cell organelles by (a) causing a loss of V-ATPase protein in their limiting membranes, (b) inhibiting the intrinsic V-ATPase activity, and (c) dissipating the transmembrane pH gradient. This may inhibit endocytosis of filtered proteins and impair vesicle-mediated recycling of some membrane transporters, thus contributing to the loss of reabsorptive capacity of the PT.

Renal type II Na/Pi-cotransporter is strongly impaired whereas the Na/sulphate-cotransporter and aquaporin 1 are unchanged in cadmium-treated rats

The cellular mechanisms of cadmium (Cd) nephrotoxicity are poorly understood. In this study we investigated the cellular causes of the Cd-induced phosphaturia in the rat. Compared to controls, Cd-treated rats (2 mg Cd/kg body weight, s.c. for 14 days) showed a marked polyuria, proteinuria and phosphaturia. As studied by the rapid filtration technique in isolated cortical brush-border membrane vesicles (BBMV), Na+-gradient-driven uptake of phosphate ([32Pi]) and of [3H] glucose were markedly decreased in Cd-treated rats, whereas uptake of sulphate ([35S]) remained unchanged. By Western blotting of BBMV proteins and by indirect immunocytochemistry in 4-micron thick frozen fixed kidney sections, using an antibody against the type II Na/Pi-cotransporter (NaPi-2), we found a diminished expression of this protein in the brush-border membrane from Cd-treated rats. How ever, the expression of the water channel aquaporin 1, estimated from the specific antibody staining in brush-border membranes, remained unchanged by Cd. Northern blot analysis showed a strong reduction of 2.7 kb NaPi-2-related mRNA in Cd-affected kidneys. Our data indicate that: (1) Cd may reduce reabsorption of Pi in proximal tubules by affecting the expression of the functional Na/Pi-cotransporters in the luminal membrane, and (2) Cd effects on brush-border transporters are selective.

High frequency of metalworkers among patients with seminomatous tumors of the testis: a case-control study

Occupational analyses were conducted between 1971 and 1978 comparing 165 cases of testicular cancer in the Hannover region of Germany with 187 controls without neoplastic diseases admitted to the Hannover University Medical School during the same period. The results showed a significantly higher risk of metal workers developing seminomas and mixed seminomatous tumors compared to the controls (odds ratio 2.05; 1.17-3.58). There was a lack of risk for the nonseminomatous tumors as a whole group, and cases with a history of metal work may have a decreased risk for embryonal carcinomas. No definite single noxious substance responsible for the development of testicular tumors could be detected. In view of the results in animal experiments, cadmium and zinc are especially considered in the discussion.

The renal handling of calcium and phosphorus in environmental cadmium-exposed subjects with renal dysfunction

Clearance methods were used to clarify the renal handling of calcium (Ca) and phosphorus (P) in a population with renal dysfunction induced by exposure to environmental cadmium (Cd). Seventy-six Cd-exposed subjects (32 men and 44 women) and 36 non-exposed subjects (18 men and 18 women) took part in this study. Fractional excretion of P was higher in the Cd-exposed subjects than in the non-exposed subjects, while that of Ca was equal to that of the non-exposed subjects. The urinary excretion rates of Ca and P tended to be lower in the Cd-exposed subjects than in the non-exposed subjects. The urinary excretion rate of Ca was closely related to creatinine clearance, while that of P was related to creatinine clearance and the percentage tubular reabsorption of phosphorus. It is thought that in Cd-induced renal dysfunction the urinary excretion of Ca depends on glomerular function, and no increased excretion of urinary Ca was observed by these clearance methods. It is also clarified that the parallelism in the urinary excretion of Ca and Na persists in Cd-exposed subjects with renal dysfunction.

Human and experimental studies on renal eicosanoid response to long-term cadmium exposure

In order to assess the effects of long-term exposure to cadmium (Cd) on the renal metabolism of eicosanoids, the urinary excretion of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), prostaglandin E2 (PGE2), prostaglandin F2 alpha (PGF2 alpha), and thromboxane B2 (TXB2) was determined in 37 workers exposed to Cd and in female Sprague-Dawley rats given 100 ppm Cd in drinking water for 10 months. Urinary output of sodium and calcium was also determined. The Cd-exposed workers showed an increased urinary concentration of 6-keto-PGF1 alpha, PGE2, sodium, and calcium. The rise of 6-keto-PGF1 alpha was related to Cd levels in blood and weakly correlated with urinary sodium. Calcium in urine was not related to the concentration of the metal in blood and urine. A slight elevation in urinary TXB2 was also observed in workers with blood Cd higher than 5 micrograms/liter. After 10 months of exposure to Cd, female Sprague-Dawley rats presented an enhanced urinary excretion of albumin, transferrin, beta 2-microglobulin, sodium, and PGE2 in urine. The latter was significantly correlated with albuminuria and transferrinuria. In conclusion the results show that chronic exposure to Cd induces changes in the urinary excretion of some eicosanoids. The possible relation of these changes to Cd-induced kidney dysfunction are discussed.

Changes in renal function in cadmium-intoxicated rats

Changes in renal function, Na+-K+-ATPase activity and PAH transport system in kidney cortex were studied in rats treated with cadmium. Subcutaneous injections of CdCl2 (2 mg Cd/kg.day) for 16 days induced a marked polyuria and a hyposthenuria. These changes were accompanied by increase in urinary protein, glucose, urea, calcium, phosphate, chloride and potassium excretions. The change in urine flow was proportional to the change in total osmotic solute excretion. Creatinine excretion and TcH2O remained unchanged. Na+ excretion was not increased, but the Na+-K+-ATPase of renal cortex was significantly inhibited. PAH uptake by renal cortical slices was markedly attenuated in Cd-treated rats. The Vmax for active PAH influx was drastically reduced, but the Km was not changed. The passive influx and efflux of PAH across the basolateral membrane and the renal tissue oxygen consumption were not apparently altered in Cd-treated animals. These results indicate that 1) the nature of Cd-induced polyuria and hyposthenuria is an osmotic diuresis induced by proximal tubular rejection of various substances, and 2) the mechanism of impaired renal PAH excretion in Cd-treated animals is a loss of organic anion carriers in proximal tubular basolateral membranes.

Cadmium-metallothionein nephrotoxicity in the rat: transient calcuria and proteinuria

After a s.c. injection of 0.4 mg Cd/kg as cadmium-metallothionein (CdMT) in rats, a marked increase in urinary protein concentration appeared at 16-40 h. There was a peak of urinary Cd content during the first 4 h after the treatment. Urinary Ca was increased at 8 h after the CdMT injection and returned to normal level at 32 h. Luminal and basolateral renal membrane vesicles were isolated from both control group and CdMT (0.4 mg Cd/kg) group at 24 h after the injection. Calcium uptake and binding of both fractions were decreased in the group treated with CdMT. Cd, Zn and MT concentrations in the kidney cortex were increased, but Ca concentration was not significantly changed. Since injected CdMT is probably only partly reabsorbed by tubular cells at the dose level of 0.4 mg Cd/kg as CdMT, excessive plasma CdMT is rapidly excreted in urine, explaining the increased Cd excretion during the first few hours observed in the present experiment. Decreased Ca binding in the luminal membranes as observed in vitro could be one of the mechanisms of production of calcuria if occurring in vivo. Another possible explanation of calcuria is that Cd ions released from CdMT into the cytoplasm of the tubular cell, may exert ionic interference with Ca transport across the luminal membranes and produce decreased Ca reabsorption. It is known that a disturbance of Ca metabolism could influence the membrane stability and such a change may contribute to explaining the proteinuria characteristic of CdMT nephrotoxicity. The reversibility of the proteinuria observed after a single dose of CdMT may be related to the induction of metallothionein synthesis in the renal cells.

Cadmium concentrations in human kidneys from the UK

The concentration of cadmium in the cortex and medulla of nearly 1000 kidneys obtained at autopsy was determined by atomic absorption spectrophotometry. Particular care was taken over the analytical procedures to ensure the accuracy and precision of the results; intrakidney variability was examined and found to be small. The frequency distributions of cadmium concentrations were approximately lognormal. There was much variability in cadmium concentrations between individuals, with geometric coefficients of variation for both cortex and medulla of around 100%. Cadmium concentrations varied with age and smoking habits, but not sex. Values were successively higher than those in the previous age-group up to 50-59 years (geometric mean 19 micrograms/g), after which they were successively lower; on average, heavy smokers had cadmium concentrations some 15-20% higher than those in light smokers who in turn had values some 15-20% higher than those in non-smokers. No definite conclusions could be reached on the variation of cadmium concentrations with either cause of death or location, or over time. The present study, the first of its kind in the UK, has provided benchmark data; its results are broadly in line with those from previous but smaller studies in other countries.

Prevalence of calcified upper urinary tract stone disease in a random population survey. Report of a combined study of general practitioners and hospital staff

There are few randomised studies specifically designed to establish the prevalence of upper urinary tract stone disease. The present random study sampled a population of 7000 in the central belt of Scotland. Three thousand three hundred and ninety-eight subjects were X-rayed and possible calcified upper tract stones were further investigated, revealing a prevalence rate of 3.5% of the total surveyed population. Socio-economic characteristics of the population were determined, such as occupation, history of previous infection, stone disease and backache. Simple urine and blood analyses were undertaken. There was no difference in stone prevalence between males and females (1.03:1) as distinct from treated stone patients. There were no differences between the sexes with respect to family history of stone disease but females have a greater chance of having had previous urinary tract infection.

Occupation and urinary tract stone disease

Certain occupations have a high incidence of urinary tract stone disease and in view of the potential nephrotoxic effects of metals and the heavy industry in the Glasgow area, a review of occupations of patients attending our stone clinic was done to discover if patients had been exposed to hot-metal processes. Sixty-three per cent of male patients had been exposed to hot-metal fumes for periods ranging from one to fifty years. A random population of asymptomatic stone formers discovered on epidemiologic screening showed that only 26 per cent of these patients could have had exposure to hot metals. Certain epidemiologic aspects of stone disease are reviewed. Little work has been done on occupational aspects of stone disease, and there is scope for further investigation in this area.

The importance of cadmium as a factor in calcified upper urinary tract stone disease--a prospective 7-year study

The non-essential trace metal cadmium may cause major pathological effects on the kidneys. A group of coppersmiths who have been chronically exposed to cadmium poisoning was systematically studied over a 6-year period. The stone prevalence in the group is now just under 40% as compared with 3.5% in a general population. The blood cadmium levels have remained persistently elevated despite removal of the cadmium source. The measurement of cadmium as a means of monitoring chronic poisoning has been undertaken in terms of the prospective study in the coppersmiths and also in its relationship to other trace metals, namely serum zinc and copper. Urologists should be aware of the possibility of cadmium poisoning.

Whole body calcium deficit in cadmium-exposed workers with hypercalciuria

Whole body elemental composition of 15 men occupationally exposed to cadmium was determined by total body in vivo neutron activation analysis and whole body counting. A significant deficit (P less than 0.01) in calcium was observed, compared with two groups of control subjects. The deficit increased with length of time exposed to cadmium.

Evidence of cadmium toxicity in a population living in a zinc-mining area. Pilot survey of Shipham residents

22 of 31 residents of a Somerset village where soil levels of cadmium were high had raised blood-cadmium levels, and some had clinical and biochemical findings (including hypertension and biochemical evidence of renal tubular damage) indicating toxic effects which could be attributed to the metal. It is suggested that more detailed studies should be carried out as a matter of urgency and that advice on avoiding local garden produce and not smoking should be emphasised. Probably more serious, however, is the summation effect with industrial exposure.

A rapid direct determination of cadmium in blood by anodic stripping voltammetry

This paper describes a rapid, sensitive anodic stripping voltammetry (ASV) method for measuring quantities of cadmium in blood. An advantage of this method is the minimal sample preparation required, using a metal-exchange reagent. A sensitivity of 4 nmol/l can be obtained. The results correlate with those obtained by atomic absorption spectroscopy. Within-run, the coefficient of variation (CV) was 8.9% at a cadmium concentration of 32 nmol/l. Between run CV was 5.4% at 37 nmol/l. The reference interval for blood cadmium concentration was 5-60 nmol/l for non-smokers and 5-85 nmol/l for cigarette-smokers. This method of cadmium analysis shows that ASV is a rapid, sensitive method for determination of blood cadmium in the normal range.

Hypercalciuria related to cadmium exposure

A work force has been investigated for possible cadmium intoxication. One group who are coppersmiths have an 18.5 per cent prevalence of upper urinary tract stone disease associated with a statistically highly significant hypercalciuria and reduced serum inorganic phosphate. Proof of exposure to cadmium has been confirmed in all workers. The trace element cadmium should be kept in mind when investigating stone formers who exhibit an unexplained hypercalciuria.

The prevalence of calcified upper urinary tract stone disease in a random population--Cumbernauld Health Survey

It is difficult to obtain the true prevalence of stone disease in community. A proper random sample of a population has been studied and a figure of 3.83% of calcified stones have been found in 2,000 subjects. The significance of biochemical, bacteriological, skeletal and other surgical abnormalities is discussed. It is now possible to study individual groups within the population with respect to stone disease.