Blood Lead, Manganese, and Aluminum Levels in a Regional Italian Cohort of ALS Patients

Garzillo, Elpidio Maria; Lamberti, Monica; Genovese, Giuliana; Pedata, Paola; Feola, Daniela; Sannolo, Nicola; Daniele, Luca; Trojsi, Francesca; Monsurrò, Maria Rosaria; Miraglia, Nadia

doi:10.1097/jom.0000000000000266

Cited by 30 publications

(22 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One study found that, compared to controls, Mn levels were elevated in serum but not CSF of ALS patients (Kapaki et al, 1997), while another found the reverse – an elevation among patients compared to controls in CSF but not plasma (Roos et al, 2013). Another study found no difference in Mn levels in serum of ALS patients and controls (Garzillo et al, 2014). One study reported an inverse association of ALS with Mn levels in blood cells (Nagata et al, 1985), while others found null associations in several blood compartments (Pamphlett et al, 2001) and in toenails (Bergomi et al, 2002).…”

Section: Discussionmentioning

confidence: 96%

“…Previous studies comparing trace metal levels in ALS patients and controls have reported inconsistent results, possibly because of variations in study design and small size, with 17 to 40 patients and 9 to 40 controls in each study (Bergomi et al, 2002; Garzillo et al, 2014; Kapaki et al, 1997; Nagata et al, 1985; Pamphlett et al, 2001; Roos et al, 2013; Supplemental Table 1). These studies measured metals in various biological samples, including cerebrospinal fluid (CSF), whole blood, blood cells, serum or plasma, and toenails.…”

Section: Discussionmentioning

confidence: 98%

“…Lead (Pb), the metal most often studied using measured levels, is generally positively associated with ALS risk (Fang et al, 2010; Kamel et al, 2005). Studies of other metals, including selenium (Se), zinc (Zn), copper (Cu), and manganese (Mn), have primarily evaluated the presumed toxic effects of high exposures (Bergomi et al, 2002; Garzillo et al, 2014; Kapaki et al, 1997; Nagata et al, 1985; Pamphlett et al, 2001; Roos et al, 2013; see Supplemental Table 1). Metal deficiencies could also plausibly increase ALS risk because metals are essential trace elements and play a role in mitigating oxidative stress as well as other critical cell processes (Jellinger, 2013).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Blood levels of trace metals and amyotrophic lateral sclerosis

et al. 2016

View full text Add to dashboard Cite

Some trace metals may increase risk of amyotrophic lateral sclerosis (ALS), whereas others may be beneficial. Our goal was to examine associations of ALS with blood levels of selenium (Se), zinc (Zn), copper (Cu), and manganese (Mn). We conducted a case-control study of 163 neurologist confirmed patients from the National Registry of Veterans with ALS and 229 frequency-matched veteran controls. We measured metal levels in blood using inductively coupled plasma mass spectrometry and estimated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between ALS and a doubling of metal levels using unconditional logistic regression, adjusting for age, gender, and race/ethnicity. ALS was inversely associated with both Se (OR=0.4, 95% CI: 0.2–0.8) and Zn (OR=0.4, 95% CI: 0.2–0.8). Inverse associations with Se were stronger in patients with bulbar compared to spinal onset, worse function, longer diagnostic delay, and longer collection delay; inverse associations with Zn were stronger for those with worse function and longer collection delay. In contrast, ALS was positively associated with Cu (OR=3.4, 95% CI: 1.5–7.9). For Mn, no linear trend was evident (OR=0.9, 95% CI: 0.6–1.3, Ptrend=0.51). Associations of Se, Zn, Cu, and Mn with ALS were independent of one another. Adjustment for lead levels attenuated the positive association of ALS with Cu but did not change associations with Se, Zn, or Mn. In conclusion, Se and Zn were inversely associated with ALS, particularly among those with worse function, suggesting that supplementation with these metals may benefit such patients, while Cu was positively associated with ALS. Deficiencies of Se and Zn and excess Cu may have a role in ALS etiology.

show abstract

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Blood levels of trace metals and amyotrophic lateral sclerosis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In comparison, there is a study of the levels of lead in the blood of patients with ALS in an Italian agricultural area [104]. This study was not included in our meta-analysis since data on exposure were missing.…”

Section: Discussionmentioning

confidence: 99%

Amyotrophic Lateral Sclerosis and Occupational Exposures: A Systematic Literature Review and Meta-Analyses

Gunnarsson

Bodin

2018

IJERPH

View full text Add to dashboard Cite

Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of occupational risk factors for amyotrophic lateral sclerosis (ALS). Methods: We identified 79 original publications on associations between work and ALS. The MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines were used to ensure high scientific quality, and reliable protocols were applied to classify the articles. Thirty-seven articles fulfilled good scientific standards, while 42 were methodologically deficient and thus were excluded from our meta-analyses. Results: The weighted relative risks for the various occupational exposures were respectively; 1.29 (95% confidence interval (CI): 0.97–1.72; six articles) for heavy physical work, 3.98 (95% CI: 2.04–7.77; three articles) for professional sports, 1.45 (95% CI: 1.07–1.96; six articles) for metals, 1.19 (95% CI: 1.07–1.33; 10 articles) for chemicals, 1.18 (95% CI: 1.07–1.31; 16 articles) for electromagnetic fields or working with electricity, and 1.18 (95% CI: 1.05–1.34; four articles) for working as a nurse or physician. Conclusions: Meta-analyses based only on epidemiologic publications of good scientific quality show that the risk of ALS is statistically significantly elevated for occupational exposures to excessive physical work, chemicals (especially pesticides), metals (especially lead), and possibly also to electromagnetic fields and health care work. These results are not explained by publication bias.

show abstract

“…Also for aluminum, it was initially assumed a role in Amyotrophic Lateral Sclerosis, but has not been confirmed in more recent studies (44). Studies about other metals, including selenium (Se), zinc (Zn), copper (Cu) and manganese (Mn), have predominantly evaluated by high exposures toxic effects (45)(46)(47). Kapaki et al (48) found in Amyotrophic Lateral Sclerosis patients a significant reduction of copper in serum and CSF levels compared to the control group (20.25 ± 7.09 vs 30.86 ± 16.02 SD micrograms/l, and 913.21 ± 165.55 against 1020.17 ± 197.76 micrograms/l), and an increase in serum levels of manganese (3.59 ± 0.89 SD micrograms/l vs 3:03 ± 1:23 SD micrograms/l) supposing an imbalance in the homeostasis of essential trace elements in ALS patients.…”

Section: Introductionmentioning

confidence: 99%

Occupational physician and amyotrophic lateral sclerosis: needs and training and information tools

Tomei¹

2017

PER

View full text Add to dashboard Cite

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease. The etiology and pathogenesis of ALS are currently largely unknown and the correlation between occupational and environmental exposures and ALS is not clear. The aim of this article is to create an information/training tools not only for workers but also for employers and occupational physicians. Materials and methods: within the project "Amyotrophic Lateral Sclerosis: contributory causes of occupational origin, risk assessment, early diagnosis and information-education" funded by IN-AIL, starting from the first year of the research, in parallel with the acquisition of the literature related to the research performed on Amyotrophic Lateral Sclerosis, contributing factors regarding work origin, it was decided to search for informative-educational material produced by the main international agencies and the main associations national and international patients members of the International Alliance ALS/MND Associations. All work tools are designed using the power point without animations for argument gravity. Results: brochures for occupational physician, employers and workers are created in order to understand the problems of the person with ALS and to maximize the potential workforce. Discussion: occupational physicians have to know all aspects of ALS in order to improve make a judgment of suitability appropriate for the employee/patient. Employers must know the aspects of the disease, especially from the organizational point of view in order to be prepared in this situation. Workers, intended as patients, have to know the disease and know how to deal with it in all possible situations. The psychological aspect has great importance and affects anyone who happens to live new and difficult situations such as ALS.

show abstract

Blood Lead, Manganese, and Aluminum Levels in a Regional Italian Cohort of ALS Patients

Abstract: Results confirmed the association between high Pb blood levels and ALS; on the contrary, Al and Mn did not differ significantly in patients and controls, suggesting that Mn and especially Al may play a less important role in the ALS pathogenesis.

Cited by 30 publications

References 19 publications

Blood levels of trace metals and amyotrophic lateral sclerosis

Blood levels of trace metals and amyotrophic lateral sclerosis

Amyotrophic Lateral Sclerosis and Occupational Exposures: A Systematic Literature Review and Meta-Analyses

Occupational physician and amyotrophic lateral sclerosis: needs and training and information tools

Contact Info

Product

Resources

About