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Mercury exposure and serum ceruloplasmin
S110
Abstracts / Toxicology Letters 258S (2016) S62–S324
Conclusions: Preoperative MetHb recognition is essential in order to deliver safe anesthesia. Physicians should always consider a MetHb rebound after methylene blue therapy, especially in dapsone induced MetHb. http://dx.doi.org/10.1016/j.toxlet.2016.06.1455
P04-032 Mercury exposure and serum ceruloplasmin G. Guzzi 1 , A. Ronchi 2 , M. Barbaro 3,∗ , L. Brambilla 4 , S. Ferrucci 4 , P.D. Pigatto 5 1
P04-031 Metamyelocytes associated with mercury exposure C. Bargiggia 1 , A. Ronchi 2 , A. Soldarini 3 , M. Barbaro 3,∗ , P.D. Pigatto 4 , G. Guzzi 5 1 Operative Unit of Immunohematology and Transfusional Medicine, “San Raffaele” Hospital Scientific Institute, Milan, Italy 2 Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia, Italy 3 Laboratory Medicine, “San Raffaele” Hospital Scientific Institute, Milano, Italy 4 Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy 5 Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy
Question: Hematological toxicity of mercury is well-known in toxicology. Exposure to mercury is able to induce adverse reaction as follows: leucopenia, leukocytosis, hypereosinophilia, high serum beta2-microglobulin, and blood dyscrasias-induced by mercury. It is also vasculotoxic. Methods: In 2016, a 47-year-old male was evaluated for potential adverse health effects of dental alloys. He had one mercury-containing amalgam tooth filling on upper right second molar and one gold-based onlay on upper left first molar. Patient was evaluated for hematological, immunological, and toxicological assessment of mercury burden. Results: At presentation, review of the Giemsa-stained blood smear revealed characteristic abnormal metamyelocytes 0.1 (109 /L; 1.0%). Concentrations of mercury in saliva sample after post-provocative chewing-gum test were 1.4 g/l (threshold limit, <2.7). Intraoral mercury vapor was 0.3 g/cm3 (threshold limit, <3.0). Blood mercury concentrations were 8.6 g/l (threshold limit, <2), whereas urinary mercury levels were 2.9 g/l (threshold limit, ≤1). Serum soluble interleukin-2 receptor levels was elevated 4470 pg/mL (600–2000) and he had high total serum IgE, 2262 UI/mL (0–100). He had low levels of complement component C3, 0.80 g/L (0.90–1.80). 41 days after treatment with mercury amalgam removal – as well as gold-based onlay – metamyelocytes were not found in the patient’s peripheral-blood smear. IgE immunoglobulins were significantly decreased at 1724 UI/mL (0–100). Levels of soluble interleukin-2 receptor (sIL2R) had fallen at 2290 pg/mL (range, 600–2000). Conclusions: Total removal of mercury-containing dental amalgam tooth filling was found to reverse abnormal metamyelocytes in the peripheral blood. http://dx.doi.org/10.1016/j.toxlet.2016.06.1456
Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy 2 Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia, Italy 3 Laboratory Medicine, “San Raffaele” Hospital Scientific Institute, Milano, Italy 4 Operative Unit of Dermatology, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milano, Italy 5 Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy Question: Mercury might be involved in hepatic metabolism of copper and ceruloplasmin. The mercury–copper antagonism has never been studied clinically in humans. Methods: In 52 patients with long-term exposure to mercury amalgam, we measured panel of markers indicating hepatic copper metabolism and mercury levels in whole-blood and urine. In 2 patients in whom low level of serum ceruloplasmin developed, these biomarkers were measured again in as many as possible of the 2 patients in whom the mercury amalgam-removal treatment was received by the patients. Results: Of the 1086 screened patients with adverse events to mercury amalgam, 52 patients (4.79%) underwent serum ceruloplasmin determination. Mean age was 50 ± 13.3. The mean (SD±) level of serum ceruloplasmin was 0.28 ± 0.08 g/L, ranging from 0.13 to 0.49 in 34 women. The average (SD±) level of serum ceruloplasmin was 0.24 ± 0.05 g/L, ranging from 0.16 to 0.39 in 18 men. Of serum ceruloplasmin, below the lower limit of normal, the mean (SD±) level of serum ceruloplasmin did not differ significantly between the two groups (0.21 ± 0.02 g/L in 11 men of 18, 61.11%) versus 0.20 ± 0.04 g/L (10 of 34, 29.41%) women. Our results show that serum levels of ceruloplasmin increased from their pretreatment values within a few months (Patient 1, within 4 months; Patients 2, within 6 months) after the completion of mercury amalgam-removal treatment in each patient and remained stable within the normal range (from 0.25 to 0.62 g/L) for up to 6 months. Conclusions: Mercury alters the regulation of copper metabolism in humans. http://dx.doi.org/10.1016/j.toxlet.2016.06.1457
Abstracts / Toxicology Letters 258S (2016) S62–S324
Conclusions: Preoperative MetHb recognition is essential in order to deliver safe anesthesia. Physicians should always consider a MetHb rebound after methylene blue therapy, especially in dapsone induced MetHb. http://dx.doi.org/10.1016/j.toxlet.2016.06.1455
P04-032 Mercury exposure and serum ceruloplasmin G. Guzzi 1 , A. Ronchi 2 , M. Barbaro 3,∗ , L. Brambilla 4 , S. Ferrucci 4 , P.D. Pigatto 5 1
P04-031 Metamyelocytes associated with mercury exposure C. Bargiggia 1 , A. Ronchi 2 , A. Soldarini 3 , M. Barbaro 3,∗ , P.D. Pigatto 4 , G. Guzzi 5 1 Operative Unit of Immunohematology and Transfusional Medicine, “San Raffaele” Hospital Scientific Institute, Milan, Italy 2 Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia, Italy 3 Laboratory Medicine, “San Raffaele” Hospital Scientific Institute, Milano, Italy 4 Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy 5 Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy
Question: Hematological toxicity of mercury is well-known in toxicology. Exposure to mercury is able to induce adverse reaction as follows: leucopenia, leukocytosis, hypereosinophilia, high serum beta2-microglobulin, and blood dyscrasias-induced by mercury. It is also vasculotoxic. Methods: In 2016, a 47-year-old male was evaluated for potential adverse health effects of dental alloys. He had one mercury-containing amalgam tooth filling on upper right second molar and one gold-based onlay on upper left first molar. Patient was evaluated for hematological, immunological, and toxicological assessment of mercury burden. Results: At presentation, review of the Giemsa-stained blood smear revealed characteristic abnormal metamyelocytes 0.1 (109 /L; 1.0%). Concentrations of mercury in saliva sample after post-provocative chewing-gum test were 1.4 g/l (threshold limit, <2.7). Intraoral mercury vapor was 0.3 g/cm3 (threshold limit, <3.0). Blood mercury concentrations were 8.6 g/l (threshold limit, <2), whereas urinary mercury levels were 2.9 g/l (threshold limit, ≤1). Serum soluble interleukin-2 receptor levels was elevated 4470 pg/mL (600–2000) and he had high total serum IgE, 2262 UI/mL (0–100). He had low levels of complement component C3, 0.80 g/L (0.90–1.80). 41 days after treatment with mercury amalgam removal – as well as gold-based onlay – metamyelocytes were not found in the patient’s peripheral-blood smear. IgE immunoglobulins were significantly decreased at 1724 UI/mL (0–100). Levels of soluble interleukin-2 receptor (sIL2R) had fallen at 2290 pg/mL (range, 600–2000). Conclusions: Total removal of mercury-containing dental amalgam tooth filling was found to reverse abnormal metamyelocytes in the peripheral blood. http://dx.doi.org/10.1016/j.toxlet.2016.06.1456
Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy 2 Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia, Italy 3 Laboratory Medicine, “San Raffaele” Hospital Scientific Institute, Milano, Italy 4 Operative Unit of Dermatology, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milano, Italy 5 Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy Question: Mercury might be involved in hepatic metabolism of copper and ceruloplasmin. The mercury–copper antagonism has never been studied clinically in humans. Methods: In 52 patients with long-term exposure to mercury amalgam, we measured panel of markers indicating hepatic copper metabolism and mercury levels in whole-blood and urine. In 2 patients in whom low level of serum ceruloplasmin developed, these biomarkers were measured again in as many as possible of the 2 patients in whom the mercury amalgam-removal treatment was received by the patients. Results: Of the 1086 screened patients with adverse events to mercury amalgam, 52 patients (4.79%) underwent serum ceruloplasmin determination. Mean age was 50 ± 13.3. The mean (SD±) level of serum ceruloplasmin was 0.28 ± 0.08 g/L, ranging from 0.13 to 0.49 in 34 women. The average (SD±) level of serum ceruloplasmin was 0.24 ± 0.05 g/L, ranging from 0.16 to 0.39 in 18 men. Of serum ceruloplasmin, below the lower limit of normal, the mean (SD±) level of serum ceruloplasmin did not differ significantly between the two groups (0.21 ± 0.02 g/L in 11 men of 18, 61.11%) versus 0.20 ± 0.04 g/L (10 of 34, 29.41%) women. Our results show that serum levels of ceruloplasmin increased from their pretreatment values within a few months (Patient 1, within 4 months; Patients 2, within 6 months) after the completion of mercury amalgam-removal treatment in each patient and remained stable within the normal range (from 0.25 to 0.62 g/L) for up to 6 months. Conclusions: Mercury alters the regulation of copper metabolism in humans. http://dx.doi.org/10.1016/j.toxlet.2016.06.1457