Manganese Deposition in Basal Ganglia due to Perioperative Parenteral Nutrition following Gastrointestinal Surgeries

Abstract

Background/Aims: Serial changes in blood manganese (Mn) levels and brain MRI examinations following perioperative parenteral nutrition (PN) were investigated. Methods: Six cases undergoing pancreatoduodenectomy (PD), 4 cases undergoing thoracic esophagectomy (TE), 18 cases undergoing total gastrectomy (TG) and 20 cases undergoing colorectal surgeries (CR) with daily administration of 20 µmol of Mn per day were studied. Cases undergoing PD, TE, TG or CR without Mn administration served as controls. Results: Hyperintense lesions in the basal ganglia on T1-weighted MRI and elevated blood Mn levels were recognized after PN in 4 of 6 cases in the PD group, in 3 of 4 cases in the TE group, in 1 of 18 cases in the TG group and in 2 of 20 cases in the CR group. No abnormalities were recognized in the control groups. Conclusion: The possible Mn deposition in the basal ganglia caused by perioperative PN should be especially noted in cases undergoing PD or TE.

Brain manganese and the balance between essential roles and neurotoxicity

“…As these brain regions are particularly sensitive to oxidative injury, a supported mechanism for Mn neurotoxicity, it is thought that this combination explains the relative involvement of these brain structures in Mn neurotoxicity (117,(217)(218)(219)(220). The accumulation of Mn in basal ganglia occurs across multiple routes of exposure and genetic bases for elevated systemic Mn levels: including chronic oral exposure from contaminated water (218), inhalation Mn particulates from ferromanganese plants (28) patients receiving parenteral nutrition (221,222), or direct intravenous delivery (i.e. ephedrone users), as well as genetic alterations in the Mn efflux transporters as described earlier in this review (219,(223)(224)(225)(226).…”

Manganese-Induced Dopaminergic Neurodegeneration: Insights into Mechanisms and Genetics Shared with Parkinson’s Disease

“…Many metabolically active cell types, particularly tonically active motor neurons in the substantia nigra (SN), require high levels of ATP for optimal function and survival . Mn accumulates in the SN, globus pallidus (GP), and striatum (STR), where it interferes with ATP synthesis, in a similar fashion to mitochondrial inhibitors or experimentally induced ischemia. − The accumulation of Mn in these brain regions corresponds to highly dense expression of the divalent metal transporter 1 (DMT1), − which has been found to be responsible for dietary , as well as olfactory Mn uptake . Both for PD and Mn-induced neurodegeneration, the dopaminergic (DAergic) neurotransmitter system is primarily affected in human, ,− nonhuman primates, , and rodents, − as well as in C. elegans (unpublished data).…”

Intestinal failure: A new era in clinical management

“…Excess manganese has been reported in patients with intestinal failure receiving long‐term PN therapy. This has been associated with abnormal liver function and manganese deposition in the basal ganglia 37 …”

“…This has been associated with abnormal liver function and manganese deposition in the basal ganglia. 37 The enteral route is the preferred route of nutritional support in patients with intestinal failure. Enteral nutrition is safer, cheaper, and easier to administer, as well as having physiologic and metabolic advantages.…”