Catherine Nisse

Renal and Neurologic Effects of Cadmium, Lead, Mercury, and Arsenic in Children: Evidence of Early Effects and Multiple Interactions at Environmental Exposure Levels

Lead, cadmium, mercury, and arsenic are common environmental pollutants in industrialized countries, but their combined impact on children’s health is little known. We studied their effects on two main targets, the renal and dopaminergic systems, in > 800 children during a cross-sectional European survey. Control and exposed children were recruited from those living around historical nonferrous smelters in France, the Czech Republic, and Poland. Children provided blood and urine samples for the determination of the metals and sensitive renal or neurologic biomarkers. Serum concentrations of creatinine, cystatin C, and β2-microglobulin were negatively correlated with blood lead levels (PbB), suggesting an early renal hyperfiltration that averaged 7% in the upper quartile of PbB levels (> 55 μg/L; mean, 78.4 μg/L). The urinary excretion of retinol-binding protein, Clara cell protein, and N-acetyl-β-d-glucosaminidase was associated mainly with cadmium levels in blood or urine and with urinary mercury. All four metals influenced the dopaminergic markers serum prolactin and urinary homovanillic acid, with complex interactions brought to light. Heavy metals polluting the environment can cause subtle effects on children’s renal and dopaminergic systems without clear evidence of a threshold, which reinforces the need to control and regulate potential sources of contamination by heavy metals.

Biomarkers of Renal Effects in Children and Adults with Low Environmental Exposure to Heavy Metals

The health effects of chronic exposure to heavy metals such as lead, cadmium, and mercury are widely documented, yet few data exist about the renal impact of low environmental exposure to these metals, particularly in children. The aim of this study was to assess renal parameters in children and adults living in an environment known for its past heavy metal contamination around two nonferrous smelters in northern France (Noyelles-Godault and Auby) and to compare their results with age and gender-matched controls living in neighboring municipalities with unpolluted soil (total: 400 children, 600 adults, sex ratio = 1). The integrity of renal function was assessed by measuring the urinary excretion levels of total protein, albumin, transferrin, g 2 -microglobulin, retinol-binding protein, brush border antigen, and the enzyme N-acetyl- g -D-glucosaminidase (NAG). The mean blood concentrations of lead (Pb-B, children h 42.2 w /L, adults h 71.3. w /L) and of cadmium (Cd-B, children h 0.52 w g/L, adults 0.86 w g/L) were all relatively low, indicating a low uptake of these heavy metals from the environment despite relatively high levels in soil (between 100 and 1700 ppm for lead and 0.7 to 233 ppm for cadmium). Pb-B levels were, however, significantly increased in boys, girls, and women--but not men--living in the polluted area. Boys, men, and women living in the polluted area had also on average higher Cd-B levels. The concentrations of mercury in urine (Hg-U) were by contrast similar in control and exposed groups. None of the renal parameters studied showed a significant difference between control and exposed groups. The influence of heavy metals on renal parameters was further assessed by stepwise multiple regression, testing Pb-B, Cd-B, Hg-U, age, gender, body mass index (BMI), urinary creatinine levels, and area of residence as predictors in both children and adults, including first-order metal interaction terms, smoking habits, and alcohol consumption in adults. The only positive correlation was found between the urinary excretion of NAG activity (standardized for BMI and urinary creatinine) and Cd-B levels when taking the whole children population, indicating that even low cadmium burdens may produce subtle effects on the proximal tubule in children, although deleterious consequences are unlikely should exposure not increase. However, in the absence of other positive findings even after studying the smaller subgroups with higher levels of heavy metals, these results are clearly indicative of the minimal renal impact of living around nonferrous smelters that are currently complying with pollution regulations, even when soil contamination is still high.

Bioaccessibility of trace elements as affected by soil parameters in smelter-contaminated agricultural soils : a statistical modeling approach

An investigation was undertaken to identify the most significant soil parameters that can be used to predict Cd, Pb, and Zn bioaccessibility in smelter-contaminated agricultural soils. A robust model was established from an extended database of soils by using: (i) a training set of 280 samples to select the main soil parameters, to define the best population to be taken into account for the model elaboration, and to construct multivariate regression models, and (ii) a test set of 110 samples to validate the ability of the regression models. Total carbonate, organic matter, sand, P(2)O(5), free Fe-Mn oxide, and pseudototal Al and trace element (TE) contents appeared as the main variables governing TE bioaccessibility. The statistical modeling approach was reasonably successful, indicating that the main soil factors influencing the bioaccessibility of TEs were taken into account and the predictions could be applicable for further risk evaluation in the studied area.

Environmental lead exposure in a population of children in northern France: Factors affecting lead burden

BACKGROUND This study is part of the assessment of a site in northern France polluted by lead from industrial emissions. Our objectives were to look for the factors that influence lead burden in children aged 8-11 years. METHODS A cross-sectional population-based study took place in 1996-97 and included 400 children (200 of whom lived on the metal-polluted site). RESULTS The geometric mean of the blood-lead levels of children living on the polluted site was 39.5 microg/l (95% CI = 36.3-43.1); that of the non-exposed children was 30.6 microg/l (95% CI = 27.8-33.6) (P < 0.0001). Analysis of the variations in the mean blood-lead levels showed associations with: distance from the smelting plants (mean blood-lead level fell by a factor of 1/1.3 (95% CI = 1/1.2-1/1.4) for each km from the smelter over the range of 1-3 km and was constant thereafter) and consumption of tap water (when the water pipes were made of lead, the mean blood-lead level of children who drank tap water was twice as high (95% CI = 1.2-3.4) as that of children who did not). CONCLUSIONS The childrens blood-lead levels were essentially linked to two factors: proximity to the smelters and drinking tap rather than bottled water.

Blood and urinary levels of metals and metalloids in the general adult population of Northern France: The IMEPOGE study, 2008–2010

BACKGROUND The assessment of human chemical risks related to occupational or environmental exposure to pollutants requires the use of both accurate exposure indicators and reference values. The objective of this study was to evaluate the blood and urinary levels of various metals and metalloids in a sample of adults aged 20-59 years of the general population of Northern France, a formerly heavily industrialised area that retains some industrial activity. METHODS A cross-sectional study was conducted between 2008 and 2010, enrolling 2000 residents of Northern France. The quota method was used to guarantee the representativeness of the participants on a sex, age, social category and smoking status basis, according to the census done by the French National Institute of Statistics and Economic Studies. The levels of 14 metals: aluminium (Al), antimony (Sb), total arsenic (As), beryllium (Be), cadmium (Cd), cobalt (Co), chromium (Cr), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), thallium (Tl), vanadium (V) and zinc (Zn) were quantified by ICP-MS in urine and blood samples. RESULTS A total of 982 men and 1018 women participated, allowing the analysis of 1992 blood and 1910 urine samples. Some metal(loid)s were detected in over 99% of the blood (Cd, Co, Mn, Ni, Pb) and urine (As, Co, Pb, Zn) samples and the remaining metals in 84-99% of the samples, with the exception of blood V (19%), blood Be (57%) and urine Be (58%). Mean blood levels of Pb and Zn were significantly higher in men, and Mn, Co and Cr in women. In urine, mean Pb, Tl and Sb concentrations were significantly higher in men, and Al and Co in women. Current smokers had significantly higher mean levels of blood Cd and Pb and lower blood Co, Mn and Hg. In urine (adjusted on urinary creatinine), the smokers had higher mean levels of Cd, Pb, V and Zn and lower mean levels of As, Co, and Hg. Overall, the mean urinary levels of most metal(loid)s found in the general population of Northern France were higher than those found in the French national survey for the same period except for urinary V. Mean blood lead level was markedly less than that of the French national population. CONCLUSION This first biomonitoring survey of a large number of metal(loid)s in the general population of Northern France provides useful information on exposure levels to toxic elements and highlights the specificity of the regional environment. These data could be used, in complement to the national human biomonitoring reference values, for the interpretation of biomonitoring results.

Environmental exposure to lead in a population of adults living in northern France: lead burden levels and their determinants

As part of the assessment of a site in northern France polluted by metals from two smelters (in particular, lead, cadmium and mercury), a cross-sectional study was carried out which intended to estimate the levels of the lead burden of the adult population living on the site and the factors associated with these levels. The exposed zone included 10 municipalities in the Nord-Pas de Calais region, located in the vicinity of two non-ferrous metal smelters. The soils in these municipalities contained between 100 and 1700 ppm of lead. The non-polluted zone contained 20 municipalities from the same region, drawn randomly from those in the region of comparable size but free from any industrial lead exposure. The adult study population (301 men and 300 women) was stratified according to age, sex, employment status and exposure level. The inclusion criteria required subjects who were aged between 20 and 50 years and had been living in the exposed zone for at least 8 years; the exclusion criteria were pregnancy, cancer, kidney disease and diabetes. No more than 10% of the subjects participating could work at one of the two smelters. Data collection took place at home; visiting nurses interviewed subjects to complete a questionnaire and also took blood samples. The lead assay was performed by atomic absorption spectrometry. The geometric mean of the blood-lead levels was 74 microg/l, 95% CI = 69-80 among men and 49 microg/l, 95% CI = 46-53 among women. Blood-lead levels exceeding 100 microg/l were found among 30% of men and 12% of women. Several factors were associated with variation of the mean blood-lead level: the blood-lead level was significantly higher among the men for subjects living less than 1 km from the smelters (geometric mean x 1.3, 95% CI = 1.1-1.6), for those who drink alcoholic beverages (x 1.1, 95% CI = 1.0-1.2 for consumption of 30 g/day), those who smoke (x 1.2, 95% CI = 1.0-1.3 for 20 cigarettes/day), and for subjects with occupational exposure; among the women, for subjects living less than 1 km from the smelters (geometric mean x 1.5, 95% CI = 1.2-1.7), for those who drink alcohol (x 1.1, 95% CI = 1.1-1.2 for a daily consumption of 10 g), and for women living in a building constructed before 1948 (x 1.2, 95% CI = 1.0-1.4).

Current sources of lead exposure and their relative contributions to the blood lead levels in the general adult population of northern France: the IMEPOGE Study, 2008-2010.

ABSTRACT There is justification for limiting lead (Pb) exposure as much as possible, given its impact on health at low concentrations. Consequently, the aim of this study was to measure blood lead levels (BLL) and examine exposure factors related to BLL variations in the general adult population of northern France, a current and past industrial area. Two thousand inhabitants of northern France, aged between 20 and 59 years, were recruited using the quota method with caution. Blood lead levels were quantified by inductively coupled plasma–mass spectroscopy (ICP-MS), and variation factors were studied separately in men and women using multivariate stepwise linear and logistic regression models. The geometric mean of the BLL was 18.8 μg/L (95% confidence interval [CI]: 18.3–19.3). Occupational factors affected BLL only in men and represented 14% of total explained variance of BLL. External occupational factors significantly increasing mean levels of BLL were tobacco, consumption of some beverages (wine, coffee, tea, and/or tap water), raw vegetables, housing characteristics (built prior to 1948, Pb piping in the home) and do-it-yourself or leisure activities (paint stripping or rifle shooting). Consumption habits accounted together for 25% and 18% of the total explained variance, respectively, in men and women. Industrial environment did not significantly contribute to BLL variations. Blood lead levels observed in the general population of this industrial part of France did not appear to be excessively elevated compared to values found internationally. Nonetheless, these BLL remain a public health issue in regard to nonthreshold toxicity attributed to Pb.

Dose-dependent elimination kinetics for mercury in urine: observations in subjects with brief but high-level exposure

AbstractObjectives—To study the elimination kinetics for mercury in urine (U-Hg) after brief but high-level exposure. Methods—U-Hg was examined in 11 workers after 2–10 days of exposure to inorganic Hg and after symptoms and signs of Hg intoxication had appeared. Initial U-Hg excretion varied between 60 and 2360 μg/g creatinine. The subjects were followed up for 1–11 months. In each subject, one- and two-compartment models were fitted to the U-Hg values, assuming an exponential decrease, by weighted non-linear least-squares regression (weight = 1/U-Hg). Results—The data indicated two elimination phases in subjects with initial U-Hg above 600 μg/g. In the two-compartment models, there was a fast phase with a half-time of 2–16 days, and a slow phase with a halftime of more than a month. The fast phase contributed 70–90% to the sum of the Y intercepts. Conclusions—The kinetics of U-Hg excretion after cessation of exposure seems to be dose-dependent and, at least in certain cases, to have two phases. The explanation for the fast phase may be that the capacity of certain binding sites in the kidney was exceeded.

Urinary homovanillic acid and serum prolactin levels in children with low environmental exposure to lead

Current evidence suggests that the neurotoxic effects of lead may partially be mediated through interference with the dopaminergic system. The aim of this study was to assess the levels of two peripheral dopaminergic markers- serum prolactin (Pro-S) and urinary homovanillic acid (HVA-U) - in children living around two lead smelters, who are presumed to be exposed to high environmental lead pollution (n = 200), and compare their results with 200 age- and sex-matched controls living in an area unpolluted by heavy metals, giving a total of 400 children (200 boys and 200 girls). The influence of lead exposure on HVA-U and Pro-S was assessed by stepwise multiple regression, testing lead concentrations in blood (Pb-B), age, sex and area of residence as predictors. Though lead levels were significantly higher in boys and in the lead-polluted environment, mean Pb-B values were relatively low, indicating a low uptake of lead in the contaminated environment (39.5 μg l-1, range 4.6-165μgl-1, n = 200), and no significant correlation could be found with either Pro-S or HVA-U. However, when the subgroup of 121 children with Pb-B levels above 50 μg l-1 were considered, a weak positive correlation was found between Pb-B and HVA-U (r2 = 0.04, p = 0.03), whilst in the even smaller subgroup of 15 children with Pb-B levels above 100 μg l-1, Pro-S appeared to be positively correlated with Pb-B, though the numbers of children were too small for the correlation to reach statistical significance (p = 0.095). These weak associations, probably not important in biological terms, indicate that Pro-S and HVA-U are not useful biomarkers at present exposure levels to lead in the environment. Nevertheless, the finding of subtle biochemical alterations in the dopaminergic system at Pb-B levels of around 100μgl-1 supports the recommended setting of the action level at this value.

Influence Of Delta-Aminolevulinic Acid Dehydratase Gene Polymorphism on Selected Lead Exposure Biomarkers in a Cohort of Ex-Smelter Workers

Lead (Pb) body burden and toxicity may be influenced by genetic polymorphisms. The aim of this study was to investigate the influence of G177C delta-aminolevulinic acid dehydratase (ALAD) polymorphism (rs1800435) on selected Pb exposure biomarkers in a population of workers highly exposed to this metal in the past. A cross-sectional survey was conducted between 2007 and 2009 within the cohort of ex-employees of a smelter in the north of France that closed down in 2003. A questionnaire was completed by each participant and blood samples enabled determination of Pb levels and ALAD polymorphism. Five parameters estimating the Pb body burden and its variations were studied: last blood lead level (BLL) during activity, cumulative blood Pb index, BLL at the time of the study, and absolute and percent changes in BLL after cessation of metal exposure. Multiple regression models were used to evaluate links between ALAD polymorphism and the selected Pb exposure biomarkers. Two hundred and four men were included. At the time of inclusion, the median age was 53.5 yr. The median duration of Pb exposure was 25 yr and the median latency since end of exposure was 5.6 yr. The frequency of ALAD-2 allele was 9.3%, with 34 subjects being heterozygous (ALAD1-2) and 2 homozygous (ALAD2-2). According to genotype, there was no significant difference for any of the five selected Pb exposure biomarkers. These results lend support to the notion that ALAD polymorphism exerts no marked impact on Pb body burden.