Effects of cerium oxide nanoparticles on adenine-induced chronic kidney disease model rats

AIM

Cerium oxide, particularly in nanoparticle form (nanoceria), has been investigated for biomedical applications as a promising new agent for treating several pathologies. The aim of the present study was to characterize the pharmacologic effects of nanoceria in an animal model of chronic kidney disease.

METHODS

We created the chronic kidney disease animal model by feeding rats a 0.25% adenine diet. Male Wistar rats were divided into five groups: normal diet, 0.25% adenine diet, or adenine diet containing three different doses or durations of nanoceria treatment. Blood was collected weekly from the tail veins of each rat and analyzed for renal function markers. After 5 weeks, various biochemical markers in serum, plasma, and urine were also analyzed.

RESULTS

In the adenine-treated group, body weight was significantly decreased, and the kidneys lost much of their healthy reddish color and became lumpy and white in appearance. In addition, levels of serum creatinine, blood urea nitrogen, and plasma uremic toxins were significantly increased in adenine-treated rats compared with controls. Renal functional and structural damage in adenine diet model rats tended to be ameliorated by nanoceria ingestion. The high-dose cerium-treated group maintained reddish areas in the kidneys, and the increases in biomarker levels of creatinine, blood urea nitrogen, and inorganic phosphorus were markedly reduced, regardless of treatment duration.

CONCLUSIONS

Ingestion of nanoceria may be effective for improving or preventing renal damage caused by adenine. Geriatr Gerontol Int 2024; 24: 88-95.

Combinatory Effects of Cerium Dioxide Nanoparticles and Acetaminophen on the Liver-A Case Study of Low-Dose Interactions in Human HuH-7 Cells

The interactions between pharmaceuticals and nanomaterials and its potentially resulting toxicological effects in living systems are only insufficiently investigated. In this study, two model compounds, acetaminophen, a pharmaceutical, and cerium dioxide, a manufactured nanomaterial, were investigated in combination and individually. Upon inhalation, cerium dioxide nanomaterials were shown to systemically translocate into other organs, such as the liver. Therefore we picked the human liver cell line HuH-7 cells as an in vitro system to investigate liver toxicity. Possible synergistic or antagonistic metabolic changes after co-exposure scenarios were investigated. Toxicological data of the water soluble tetrazolium (WST-1) assay for cell proliferation and genotoxicity assessment using the Comet assay were combined with an untargeted as well as a targeted lipidomics approach. We found an attenuated cytotoxicity and an altered metabolic profile in co-exposure experiments with cerium dioxide, indicating an interaction of both compounds at these endpoints. Single exposure against cerium dioxide showed a genotoxic effect in the Comet assay. Conversely, acetaminophen exhibited no genotoxic effect. Comet assay data do not indicate an enhancement of genotoxicity after co-exposure. The results obtained in this study highlight the advantage of investigating co-exposure scenarios, especially for bioactive substances.

Metal Homeostasis and Gas Exchange Dynamics in Pisum sativum L. Exposed to Cerium Oxide Nanoparticles

Cerium dioxide nanoparticles are pollutants of emerging concern. They are rarely immobilized in the environment. This study extends our work on Pisum sativum L. as a model plant, cultivated worldwide, and is well suited for investigating additive interactions induced by nanoceria. Hydroponic cultivation, which prompts accurate plant growth control and three levels of CeO2 supplementation, were applied, namely, 100, 200, and 500 mg (Ce)/L. Phytotoxicity was estimated by fresh weights and photosynthesis parameters. Additionally, Ce, Cu, Zn, Mn, Fe, Ca, and Mg contents were analyzed by high-resolution continuum source atomic absorption and inductively coupled plasma optical emission techniques. Analysis of variance has proved that CeO2 nanoparticles affected metals uptake. In the roots, it decreased for Cu, Zn, Mn, Fe, and Mg, while a reversed process was observed for Ca. The latter is absorbed more intensively, but translocation to above-ground parts is hampered. At the same time, nanoparticulate CeO2 reduced Cu, Zn, Mn, Fe, and Ca accumulation in pea shoots. The lowest Ce concentration boosted the photosynthesis rate, while the remaining treatments did not induce significant changes. Plant growth stimulation was observed only for the 100 mg/L. To our knowledge, this is the first study that demonstrates the effect of nanoceria on photosynthesis-related parameters in peas.

In vivo-induced size transformation of cerium oxide nanoparticles in both lung and liver does not affect long-term hepatic accumulation following pulmonary exposure

Recent findings show that cerium oxide (CeO2) nanoparticles may undergo in vivo-induced size transformation with the formation of smaller particles that could result in a higher translocation following pulmonary exposure compared to virtually insoluble particles, like titanium dioxide (TiO2). Therefore, we compared liver deposition of CeO2 and TiO2 nanoparticles of similar primary sizes 1, 28 or 180 days after intratracheal instillation of 162 μg of NPs in female C57BL/6 mice. Mice exposed to 162 μg CeO2 or TiO2 nanoparticles by intravenous injection or oral gavage were included as reference groups to assess the amount of NPs that reach the liver bypassing the lungs and the translocation of NPs from the gastrointestinal tract to the liver, respectively. Pulmonary deposited CeO2 nanoparticles were detected in the liver 28 and 180 days post-exposure and TiO2 nanoparticles 180 days post-exposure as determined by darkfield imaging and by the quantification of Ce and Ti mass concentration by inductively coupled plasma-mass spectrometry (ICP-MS). Ce and Ti concentrations increased over time and 180 days post-exposure the translocation to the liver was 2.87 ± 3.37% and 1.24 ± 1.98% of the initial pulmonary dose, respectively. Single particle ICP-MS showed that the size of CeO2 nanoparticles in both lung and liver tissue decreased over time. No nanoparticles were detected in the liver following oral gavage. Our results suggest that pulmonary deposited CeO2 and TiO2 nanoparticles translocate to the liver with similar calculated translocation rates despite their different chemical composition and shape. The observed particle size distributions of CeO2 nanoparticles indicate in vivo processing over time both in lung and liver. The fact that no particles were detected in the liver following oral exposure showed that direct translocation of nanoparticles from lung to the systemic circulation was the most important route of translocation for pulmonary deposited particles.

Dermal transfer and environmental release of CeO2 nanoparticles used as UV inhibitors on outdoor surfaces: Implications for human and environmental health

A major area of growth for "nano-enabled" consumer products have been surface coatings, including paints stains and sealants. Ceria (CeO₂) nanoparticles (NPs) are of interest as they have been used as additives in these these products to increase UV resistance. Currently, there is a lack of detailed information on the potential release, and speciation (i.e., ion vs. particle) of CeO₂ NPs used in consumer-available surface coatings during intended use scenarios. In this study, both Micronized-Copper Azole pressure-treated lumber (MCA), and a commercially available composite decking were coated with CeO₂ NPs dispersed in Milli-Q water or wood stain. Coated surfaces were divided into two groups. The first was placed outdoors to undergo environmental weathering, while the second was placed indoors to act as experimental controls. Both weathered surfaces and controls were sampled over a period of 6months via simulated dermal contact using methods developed by the Consumer Product Safety Commission (CPSC). The size and speciation of material released was determined through sequential filtration, total metals analysis, X-Ray Absorption Fine Structure Spectroscopy, and electron microscopy. The total ceria release from MCA coated surfaces was found to be dependent on dispersion matrix with aqueous applications releasing greater quantities of CeO₂ than stain based applications, 66±12mg/m² and 36±7mg/m², respectively. Additionally, a substantial quantity of CeO₂ was reduced to Ce(III), present as Ce(III)-organic complexes, over the 6-month experimental period in aqueous based applications.

Synergistic role of nanoceria on the ability of tobacco smoke to induce carcinogenic hallmarks in lung epithelial cells

AIM

Since controversial results have been obtained in studies dealing with nanoceria usefulness in biomedical applications, the transforming effects of long-term exposure to nanoceria in lung epithelial cells, alone or together with cigarette smoke condensate (CSC), were evaluated.

MATERIALS & METHODS

In vitro cell transformation techniques were used to study several hallmarks of carcinogenesis. Morphology, cell proliferation, gene expression, cell migration, anchorage-independent cell growth and cell secretome were analyzed.

RESULTS & CONCLUSION

Data evidence no transforming ability of nanoceria, but support a synergistic role on CSC's transforming ability. A more noticeable spindle-like phenotype, increased proliferation rate, higher degree of differentiation status dysregulation, higher migration capacity, increased anchorage-independent cell growth and higher levels of MMP-9 and cell growth promoting capability, were observed. In addition, nanoceria co-exposure exacerbates the expression of FRA-1.

The impact of cerium oxide nanoparticles on the salt stress responses of Brassica napus L

Dwindling high quality water resources and growing population are forcing growers to irrigate crops with water of high salinity. It is well recognized that salinity negatively affects plant physiology and biochemistry, and represents one of the most serious threats to crop production and food security. Meanwhile, engineered nanoparticles (ENPs) are increasingly detected in irrigation water and agricultural soils due to the rapid advancement of nanotechnology. Previous research has demonstrated that ENPs such as cerium oxide nanoparticles (CeO₂-NPs) exert significant impact on plant growth and production. However, almost all previous studies were conducted in well controlled environment. Knowledge on how ENPs affect plant development in a stressed condition is almost empty. The goal of the present study was to understand the physiological and biochemical changes in Brassica napus L. (canola) cv. 'Dwarf Essex' under synergistic salt stress and CeO₂-NPs effects. Two salinity levels: 0 (control) and 100 mM NaCl, and three CeO₂-NPs concentrations: 0 (control), 200 and 1000 mg kg^-1 dry sand and clay mixture, were employed. As expected, 100 mM of NaCl significantly hindered plant growth and negatively affected the physiological processes of canola. Plants treated with CeO₂-NPs had higher plant biomass, exhibited higher efficiency of the photosynthetic apparatus and less stress in both fresh water and saline water irrigation conditions Overall, our results demonstrated that CeO₂-NPs led to changes in canola growth and physiology which improved the plant salt stress response but did not completely alleviate the salt stress of canola.

Soil organic matter influences cerium translocation and physiological processes in kidney bean plants exposed to cerium oxide nanoparticles

Soil organic matter plays a major role in determining the fate of the engineered nanomaterials (ENMs) in the soil matrix and effects on the residing plants. In this study, kidney bean plants were grown in soils varying in organic matter content and amended with 0-500mg/kg cerium oxide nanoparticles (nano-CeO2) under greenhouse condition. After 52days of exposure, cerium accumulation in tissues, plant growth and physiological parameters including photosynthetic pigments (chlorophylls and carotenoids), net photosynthesis rate, transpiration rate, and stomatal conductance were recorded. Additionally, catalase and ascorbate peroxidase activities were measured to evaluate oxidative stress in the tissues. The translocation factor of cerium in the nano-CeO2 exposed plants grown in organic matter enriched soil (OMES) was twice as the plants grown in low organic matter soil (LOMS). Although the leaf cover area increased by 65-111% with increasing nano-CeO2 concentration in LOMS, the effect on the physiological processes were inconsequential. In OMES leaves, exposure to 62.5-250mg/kg nano-CeO2 led to an enhancement in the transpiration rate and stomatal conductance, but to a simultaneous decrease in carotenoid contents by 25-28%. Chlorophyll a in the OMES leaves also decreased by 27 and 18% on exposure to 125 and 250mg/kg nano-CeO2. In addition, catalase activity increased in LOMS stems, and ascorbate peroxidase increased in OMES leaves of nano-CeO2 exposed plants, with respect to control. Thus, this study provides clear evidence that the properties of the complex soil matrix play decisive roles in determining the fate, bioavailability, and biological transport of ENMs in the environment.

Foliar applied nanoscale and microscale CeO2 and CuO alter cucumber (Cucumis sativus) fruit quality

There is lack of information about the effects of foliar applied nanoparticles on fruit quality. In this study, three week-old soil grown cucumber seedlings were foliar-exposed to nCeO2, nCuO, and corresponding bulk counterparts at 50, 100, and 200mg/L. Respective suspensions/solutions were sprayed to experimental units in a volume of 250ml. Net photosynthesis rate (Pn), stomatal conductance (Gs), and transpiration rate (E) were measured 15days after treatment application and in 74day-old plants. Yield, fruit characteristics (size, weight, and firmness), Ce, Cu, and nutritional elements were also measured. Results showed a nano-specific decrement on Pn (22% and 30%) and E (11% and 17%) in seedling leaves exposed to nCeO2 and nCuO at 200mg/L, respectively, compared with control. nCeO2 at 50mg/L, bCeO2 at 200mg/L, and all Cu treatments, except nCuO at 100mg/L, significantly reduced fruit firmness (p≤0.05), compared with control. However, nCuO at 200mg/L and bCuO at 50mg/L significantly increased fruit fresh weight (p≤0.05). At 200mg/L, nCeO2 and bCeO2 reduced fruit Zn by 25%, while nCuO and bCuO reduced fruit Mo by 51% and 44%, respectively, compared with control. This study has shown that when the route of exposure is the foliage, differences in particle size are less significant, compared to root-based exposure. To the authors' knowledge, this is the first report on the effect of foliar application of nCeO2 and nCuO upon yield and nutritional quality of cucumber.

Living target of Ce(III) action on horseradish cells: proteins on/in cell membrane

Positive and negative effects of rare earth elements (REEs) in life have been reported in many papers, but the cellular mechanisms have not been answered, especially the action sites of REEs on plasma membrane are unknown. Proteins on/in the plasma membrane perform main functions of the plasma membrane. Cerium (Ce) is the richest REEs in crust. Thus, the interaction between Ce(III) and the proteins on/in the plasma membrane, the morphology of protoplast, and the contents of nutrient elements in protoplast of horseradish were investigated using the optimized combination of the fluorescence microscopy, fluorescence spectroscopy, circular dichroism, scanning electron microscopy, and X-ray energy dispersive spectroscopy. It was found that Ce(III) at the low concentrations (10, 30 μM) could interact with proteins on/in the plasma membrane of horseradish, leading to the improvement in the structure of membrane proteins and the plasma membrane, which accelerated the intra-/extra-cellular substance exchange and further promoted the development of cells. When horseradish was treated with Ce(III) at the high concentrations (60, 80 μM), Ce(III) also could interact with the proteins on/in the plasma membrane of horseradish, leading to the destruction in the structure of membrane proteins and the plasma membrane. These effects decelerated the intra-/extra-cellular substance exchange and further inhibited the development of cells. Thus, the interaction between Ce(III) and proteins on/in the plasma membrane in plants was an important reason of the positive and negative effects of Ce(III) on plants. The results would provide some references for understanding the cellular effect mechanisms of REEs on plants.

[Nanocrystaline ceria based materials--perspectives for biomedical application]

Nanocrystalline ceria possesses a unique complex of physical and chemical properties making it highly bioactive material. In this review, modern data on the action of nanocrystalline ceria on cells, micro- and macroorganisms are analyzed. Special attention is paid to the analysis of the factors affecting protective properties of CeO2 with respect to the living systems.

Uptake and inflammatory effects of nanoparticles in a human vascular endothelial cell line

The mechanisms governing the correlation between exposure to nanoparticles and the increased incidence of cardiovascular disease remain unknown. Nanoparticles appear to cross the pulmonary epithelial barrier into the bloodstream, raising the possibility of direct contact with the vascular endothelium. Because endothelial inflammation is critical for the development of cardiovascular pathology, we hypothesized that direct exposure of human aortic endothelial cells (HAECs*) to nanoparticles induces an inflammatory response and that this response depends on the composition of the particles. To test this hypothesis, we incubated HAECs for 1 to 8 hours with different concentrations (0.001-50 microg/mL) of iron oxide (Fe2O3), yttrium oxide (Y2O3), cerium oxide (CeO2), and zinc oxide (ZnO) nanoparticles. Using real-time reverse transcriptase-polymerase chain reaction (RT-PCR), we subsequently measured messenger RNA (mRNA) levels of three markers of inflammation: intercellular cell adhesion molecule-1 (ICAM-1), interleukin-8 (IL-8), and monocyte chemotactic protein-1 (MCP-1). The particles were well characterized in terms of size, surface area, composition, and crystal structure. To determine the interactions of nanoparticles with HAECs, we used inductively coupled plasma-mass spectrometry (ICP-MS) to measure the concentration of internalized particles. Our data indicate that the delivery of nanoparticles to the HAEC surface and their uptake within the cells correlate directly with the concentration of particles in the cell culture medium. Transmission electron microscopy (TEM) revealed that the Fe2O3, Y2O3, and ZnO nanoparticles are internalized by HAECs and are often found within intracellular vesicles (the CeO2 particles were not imaged). Fe2O3 nanoparticles did not provoke an inflammatory response in HAECs at any of the concentrations tested, CeO2 particles elicited no response at low concentrations and a weak response above 10 microg/mL, and Y2O3 and ZnO nanoparticles elicited a pronounced inflammatory response above a threshold concentration of 10 microg/mL. We used fluorescent markers to identify the production of reactive oxygen species (ROS) in cells; the results showed that Y2O3 and ZnO particles at the highest concentrations may lead to the production of ROS. At the highest concentration, ZnO nanoparticles caused significant loss of cell adherence. These results demonstrate that inflammation in HAECs after acute exposure to metal oxide nanoparticles depends on the concentration and composition of the particles.

[Cerium-induced granulomatous dermatitis]

BACKGROUND

The presence of inorganic foreign bodies in granulomatous cutaneous lesions is not infrequent. In this paper, we describe the first case of cerium-induced cutaneous granulomatous dermatitis.

CASE REPORT

A 57-year-old woman seriously burned four years ago presented with papulonodular lesions affecting only the burned areas treated with topical cerium nitrate-silver sulfadiazine cream (Flammacérium). Biopsies revealed sarcoidal granuloma associated with exogenous particles. Electron probe X-ray microanalysis demonstrated a high cerium content. Screening for systemic sarcoidosis was negative. The patient was treated with hydroxychloroquine. After four months of follow-up, clinical and histological evidence of decreased infiltrate was noted.

DISCUSSION

Cerium nitrate-silver sulfadiazine cream (Flammacérium) is widely used for the topical treatment of burns. The main effect of cerium is to create superficial calcification, which decreases wound colonization and prevents the formation of granulation tissue (no hypertrophic scar formation) in burns. Prior to our case, no cutaneous side-effects of cerium had been encountered. Inoculation of foreign matter may or may not induce granuloma formation or sarcoidosis in different subjects, according to their immunologic status. The favorable outcome in this case could in fact be due to a change in the pattern of cytokinin production (TH1=> TH2) rather than the effects of hydroxychloroquine therapy.

Bioaccumulation of lanthanum and cerium and their effects on the growth of wheat (Triticum aestivum L.) seedlings

Through short-term exposure (7-d exposure), long-term exposure (16-d exposure) and exposure-recovery (7-d exposure + 9-d recovery), the bioaccumulation and distribution of La and Ce and their effects on growth of wheat seedlings were studied. Addition of La (0.5-25 mg/l) and Ce (0.5-25 mg/l) to the culture medium individually and in combination inhibited primary root elongation, reduced the dry weight of roots and shoots and the content of mineral elements (Ca, Mg, K, Cu, Zn). The damage increased with an increase in the concentrations of La and Ce in culture medium. Relative damage ratio increased with an increase in concentrations of La and Ce in the culture medium and with exposure time. Comparing exposure-recovery groups with long-term exposure groups, primary root lengths, dry weight of roots and shoots and the content of five mineral elements were higher. The accumulation of La and Ce in the seedlings was positively correlated with the concentrations of La and Ce in the culture medium and with exposure time. Bioaccumulation factors of La and Ce in roots were much higher than those of shoots. The uptake rates of La and Ce by the plants were much higher than the translocation rates from roots to shoots. The accumulation and distribution of La and Ce in the seedlings in exposure-recovery groups showed that there was very little excretion through metabolism during the recovery period, but redistribution occurred throughout the whole plant. No apparent selective uptake was found between La and Ce by the plants when they were applied in combination.

Geographical distribution of endomyocardial fibrosis in south Kerala

BACKGROUND

Endomyocardial fibrosis (EMF) is a chronic heart disease confined to a few geographically specific locations within 15 degrees of the equator. Several aetiological hypotheses exist, among them filarial infection, eosinophilia, and toxic effect of the monazite element cerium from the soil. This study attempts to find out whether the pattern of distribution of EMF in south Kerala in India is consistent with the geochemical hypothesis.

METHODS

From hospital records we identified all patients from south Kerala who had a confirmed diagnosis of EMF during the period 1978-1994. Our controls were patients from the southern districts diagnosed to have rheumatic heart disease (RHD) during the same period. We traced their residence address to the administrative subunit of taluk, and plotted the distribution of patients with EMF and RHD for each taluk in south Kerala. The taluks were then grouped into areas of high (> 4/100,000), medium (2.01-4/100,000), and low (< or = 2/100,000) density in each case.

RESULTS

We identified an area of high density of EMF comprising four taluks near the coastline situated within the districts of Alapuzha, Kollam, and Pathanamthitta. Two coastal taluks in Kollam and Alapuzha districts are known areas of deposits of monazite elements in the state. Geographical distribution is not related to prevalence of filariasis and eosinophilia.

CONCLUSION

Coexistence of high density of occurrence of EMF and deposits of monazite elements support the geochemical hypothesis.

Rare earth (cerium oxide) pneumoconiosis: analytical scanning electron microscopy and literature review

Rare earth pneumoconiosis is an uncommonly reported disease caused by the inhalation of dust containing lanthanides, also known as rare earth metals, which are common industrial materials. The pathologic manifestations and natural history of this disorder are incompletely understood. We describe a male patient with a 35-year history of optical lens grinding, an occupation associated with exposure to cerium oxide, a rare earth metal-containing compound. The patient presented with progressive dyspnea and an interstitial pattern on chest X-ray; open lung biopsy showed interstitial fibrosis histologically indistinguishable from usual interstitial pneumonitis. However, scanning electron microscopy with energy-dispersive X-ray analysis demonstrated numerous particulate deposits in the lung, of which the majority contained the rare earth metal cerium alone or in combination with other elements. Our case is one of the first to describe rare earth pneumoconiosis associated with pulmonary fibrosis in the occupational setting of optical lens manufacture. Besides reinforcing the contention that rare earth metals are potentially harmful, our case suggests that such agents may be causally related to the development of pulmonary fibrosis.

A geochemical basis for endomyocardial fibrosis

Analysis of hearts of patients dying from endomyocardial fibrosis showed a significantly greater concentration of cerium, a lanthanide present in leafy vegetables and root tubers, than in control hearts. This may be important in the pathogenesis of the disease and provides a geographical basis for the prevalence of the disease in the tropics.

[Pneumoconiosis caused by "rare earths" (cer-pneumoconiosis)]

Slowly progressive restriction in respiratory function was observed in five reproduction photographers who had been exposed to fumes of carbon arc lamps for more than a decade. In all cases interstitial lung fibrosis had developed and accumulations of fine granular dust particles were found in the tissue. Combined analyses including X-ray diffraction, infrared spectroscopy, plasma analysis, X-ray microanalysis and electron diffraction revealed the presence of rare earth minerals (mainly cerium compounds) in all lungs. The rare earth minerals originating from the core of the burned carbon rods used in the arc lamps represent the etiological factors responsible for the development of so-called "cerium pneumoconiosis".

Rare-earth pneumoconiosis: a new case

A new case of rare-earth (RE) pneumoconiosis is described. The subject had worked as a photoengraver for 13 years and had not been exposed for 17 years. Chest X-ray showed a diffuse nodular pattern (q 2/3-ILO/1980). The patient was asymptomatic despite a restrictive spirometric impairment. The diagnosis derived from the finding, in the bronchoalveolar lavage fluid, of abnormal levels of La, Ce, Nd, Sm, Tb, Yb, and Lu. The presence of these elements was demonstrated by two methods: the neutron activation analysis and (as regards Ce alone) the X-ray energy spectrometry of mineral particles observed with electron microscope. Abnormal levels of rare earths were demonstrated also in the nails, suggesting an absorption of the RE from the lung.

Topical chemotherapy for burns using cerium salts and silver sulfadiazine

These experimental data indicate that cerium compounds exert a measurable antimicrobial action in vitro. In vivo the simultaneous use of cerium sulfadiazine and silver sulfadiazine was more effective than silver sulfadiazine alone or the combination of cerous nitrate and silver sulfadiazine. When cerous nitrate was used clically, gram-positive bacteria predominated. In contrast, wounds exposed to silver salts alone harbor a predominately gram-negative flora. The combination of cerous nitrate and silver sulfadiazine appears to provide a broad spectrum inhibitory to both types of organisms. It is apparent that a sampling problem exists in any attempt to monitor wounds that may exceed a square meter in extent. These bacteriologic data pertain only to the surface flora. The need to culture tissue samples of burn wounds has been emphasized. Our experience, however, is that invasion of deep tissue without dense surface colonization, greater than 10(5), is infrequent. Furthermore, fragments of eschar were submitted regularly for culture; those results confirmed the surface culture findins. The characteristic yellow-green color of cerium nitrate treated eschars may results from oxidation of trivalent cerium to yellow ceric ions. Free silver and sulfadiazine ions are available also in small amounts because of limited ionization of the highly insoluble silver sulfadiazine. This might promote the in vivo formation of cerous sulfadiazine and would provide a continuous source of ionic cerium for microbial inhibition. The modification of silver sulfadiazine cream by incorporating cerous nitrate into it strikingly enhances its topical antiseptic effect in burn wounds without increasing toxicity.

Cerium nitrate: a new topical antiseptic for extensive burns

The wounds of 60 burned patients were treated topically with cerium nitrate, which was applied either as a cream or in aqueous solution. Cerium nitrate has a potent antiseptic effect in human burn wounds, especially against gram negative bacteria and fungi. Pseudomonas aeruginosa was recovered from the wounds infrequently and never predominated. Fungi were practically never found. No patient treated with cerium developed a necrotizing wound infection. Analysis of the detailed bacteriological data indicated that, in contrast to previous results with use of the nitrate or sulfadiazine salts of silver, when gram negative species predominated, the flora tended to be predominantly gram positive when cerium was used. Therefore, some patients were treated simultaneously with cerium nitrate and silver sulfadiazine; this resulted in an even more efficient suppression of the wound flora than was observed previously with either cerium alone or silver salts alone; results with the simultaneous topical therapy in patients with injuries that previously were uniformly lethal were excellent. No toxicity attributable to the use of cerium was observed, although one instance of methemoglobinemia due to nitrate was documented. The adsorption of topically applied cerium essentially is nil. The use of cerium nitrate was associated with a nearly 50 percent reduction in the anticipated death rate. Cerium nitrate is a promising new topical antiseptic agent for the treatment of burns, particularly when it is used in combination with silver sulfadiazine.