Níveis de metais pesados em amostras biológicas e sua importância em saúde

Universidad de Cartagena
Odontóloga, Inverstigador del grupo de Salud Pública De la Facultad de Odontología de la Universidad de Cartagena (GISPOUC).
email: lesbiarosa_tiradoamador@hotmail.com

Universidad de Cartagena
Facultad de Odontología
email: lesbiarosa_tiradoamador@hotmail.com

Universidad de Cartagena
Facultad de Odontología
email: lesbiarosa_tiradoamador@hotmail.com

Universidad de Cartagena
Facultad de Odontología
email: lesbiarosa_tiradoamador@hotmail.com

Universidad de Cartagena
Facultad de Odontología
email: lesbiarosa_tiradoamador@hotmail.com
Na sociedade do século xxi —focada no desenvolvimento socioeconómico—, a continua industrialização, a prática da mineração e de atividades produtivas como a agricultura, são opções atraentes; no entanto, no desenvolvimento destas atividades é frequente o uso e a emissão de alguns químicos para o meio ambiente, dentro dos quais estão os metais pesados. No organismo dos seres vivos estão presentes pequenas quantidades de alguns metais pesados que podem intervir em reações bioquímicas; porém, outros metais não representam utilidade biológica. Por isso, a exposição ocupacional e a exposição passiva a metais pesados presentes no ambiente ou que provem da dieta deve ser regulada, porque em quantidades superiores às consideradas normais podem ocasionar algumas doenças. O controle da exposição a metais pesados inclui monitorar os níveis presentes em diferentes matrizes biológicas como o sangue, a urina, a saliva o cabelo e as unhas. Cada uma destas matrizes estará indicada de acordo com o tipo de exposição que tenha experimentado o indivíduo; além disso irá oferecer algumas vantagens e limitações. É por isso que esta revisão procura informar sobre os efeitos ocasionados no organismo por níveis excessivos de alguns metais pesados e a utilidade oferecida pelas matrizes biológicas na determinação de tais níveis.
Tabak LA. A revolution in biomedical assessment: the development of salivary diagnostics. J Dent Educ. 2001; 65: 1335-9.
Vardanyan LG, Ingole BS. Studies on heavy metal accumulation in aquatic macrophytes from Sevan (Armenia) and Carambolim (India) lake systems. Environ Int. 2006; 32(2):208-18.
Ybañez N, Montoro R. Trace element food toxicology: an old and ever-growing discipline. Crit Rev Food Sci Nutr. 1996;36(4):299-320.
Behne D, Hammel C, Pfeifer H, Röthlein D, Gessner H, Kyriakopoulos A. Speciation of selenium in the mammalian organism. Analyst. 1998 May;123(5):871-3.
Barregård L, Svalander C, Schütz A, Westberg G, Sällsten G, Blohmé I. Cadmium, mercury, and lead in kidney cortex of the general Swedish population: a study of biopsies from living kidney donors. Environ Health Perspect. 1999 Nov;107(11):867-71.
Navarro J, Aguilar I, López J. Aspectos bioquímicos y genéticos de la tolerancia y acumulación de metales pesados en plantas. Ecosistemas. 2007; 16 (2): 10-25.
Järup L. Hazards of heavy metal contamination. Br Med Bull. 2003; 68:167-82.
Nriagu JO. History of global metal pollution. Science. 1996; 272: 223–4.
Delgadillo A, González C, Priego F, Villagómez J, & Acevedo O. Fitorremediación, una alternativa para eliminar la contaminación. Trop. subtrop. agroecosyt. 2011; 14 (2): 597–612. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1870-04622011000200002&lng=es.
Stern BR, Solioz M, Krewski D, Aggett P, Aw TC, Baker S et al. Copper and human health: biochemistry, genetics, and strategies for modeling dose-response relationships. J Toxicol Environ Health B Crit Rev. 2007; 10(3):157-222.
Georgopoulos PG1, Roy A, Yonone-Lioy MJ, Opiekun RE, Lioy PJ.Environmental copper: its dynamics and human exposure issues. J. Toxicol. Environ. Health B.2001; 4(4):341–394.
Medeiros DM, Jennings D. Role of copper in mitochondrial biogenesis via interaction with ATP synthase and cytochrome c oxidase. J Bioenerg Biomembr. 2002; 34(5):389-95.
Keen CL, Clegg MS, Hanna LA, Lanoue L, Rogers JM, Daston GP. The plausibility of micronutrient deficiencies being a significant contributing factor to the occurrence of pregnancy complications. J Nutr. 2003;133(5 Suppl
:1597S-1605S.
Saari JT. Copper deficiency and cardiovascular disease: role of peroxidation, glycation, and nitration. Can J Physiol Pharmacol. 2000; 78(10):848-55.
Uauy R, Olivares M, González M. Essentiality of copper in humans. Am J Clin Nutr 1998; 67(5 suppl):952S–959S.
Aydin A, Orhan H, Sayal A, Ozata M, Sahin G, Işimer A. Oxidative stress and nitric oxide related parameters in type II diabetes mellitus: effects of glycemic control. Clin Biochem. 2001;34(1):65-70.
Flores L1, Rodela S, Abian J, Clària J, Esmatjes E. F2 isoprostane is already increased at the onset of type 1 diabetes mellitus: effect of glycemic control. Metabolism. 2004; 53(9):1118-20.
Xu X, Pin S, Gathinji M, Fuchs R, Harris ZL. Aceruloplasminemia: an inherited neurodegenerative disease with impairment of iron homeostasis. Ann N Y Acad Sci. 2004; 1012:299-305.
Gaetke LM, Chow CK. Copper toxicity, oxidative stress, and antioxidant nutrients. Toxicology. 2003; 189(1-2):147-63.
Hostynek JJ, Maibach HI. Copper hypersensitivity: dermatologic aspects--an overview. Rev Environ Health. 2003; 18(3):153-83.
Watanabe K, Tanaka T, Shigemi T, Hayashida Y, Maki K. Mn and Cu concentrations in mixed saliva of elementary school children in relation to sex, age, and dental caries. J Trace Elem Med Biol. 2009; 23(2):93-9.
Kao RT, Dault S, Pichay T. Understanding the mercury reduction issue: the impact of mercury on the environment and human health. J Calif Dent Assoc. 2004; 32(7):574-9.
Wolfe M, Schwarzbach S, Sulaiman R. Effects of mercury on wildlife: A comprehensive review. Environ Toxicol Chem. 1998; 17 (2): 146–160.
McDowell MA, Dillon CF, Osterloh J, Bolger PM, Pellizzari E, Fernando R. Hair mercury levels in U.S. children and women of childbearing age: reference range data from NHANES 1999-2000. Environ Health Perspect. 2004;
(11):1165-71.
Bates MN. Mercury amalgam dental fillings: an epidemiologic assessment. Int J Hyg Environ Health. 2006; 209(4):309-16.
Hightower JM, Moore D. Mercury levels in high-end consumers of fish. Environ Health Perspect. 2003; 111(4):604-8.
Homme KG1, Kern JK, Haley BE, Geier DA, King PG, Sykes LK, Geier MR. New science challenges old notion that mercury dental amalgam is safe. Biometals. 2014; 27(1):19-24.
Florea D, Molina J, Millán E, Sáez L, Pérez de la Cruz A, Planells P.Nosotros y el cinc. Nutr Hosp. 2012; 27(3):691-700.
Torres R, Bahr P. El Zinc: La chispa de la vida. Rev Cubana Pediatr. 2004; 76 (4). Disponible en: http://bvs.sld.cu/revistas/ped/vol76_4_04/ped08404.htm
Hernández Fernández CM, Izquierdo Estévez A. Función del Cinc en la recuperación inmunonutricional de lactantes malnutridos. Rev Cubana Aliment Nutr 2000; 14(1):65-70.
Salguerio M, Weill R, Hernández M, Zubillaga M, Lysionek A, Caro R. Deficiencia de zinc en relación con el desarrollo intelectual y sexual. Rev. cub. Salud pública. 2004; 30(2). Disponible en: http://www.redalyc.org/pdf/214/21430207.pdf
Roney N, Osier M, Paikoff SJ, Smith CV, Williams M, De Rosa CT; Agency for Toxic Substances and Disease Registry. ATSDR evaluation of potential for human exposure to zinc. Toxicol Ind Health. 2007; 23(5-6):247-308.
Prasad AS. Recognition of Zinz-Deficiency Síndrome. Nutrition. 2001;17:67-69.
Prasad AS. Clinical manifestations of zinc deficiency. Annu Rev Nutr. 1985; 5:341-63.
Téllez J, Bautista F. Exposición ocupacional a plomo: aspectos toxicológicos. Avances en enfermería. 2005; XXIII (1).
Peña C, Dean C, Ayala F. Toxicología ambiental: evaluación de riesgo y restauración ambiental, 2001, The University of Arizona, pp.48-60.
Fontana D, Lascano V, Solá N, Martinez S, Virgolini M, Mazzieri M. Intoxicación por plomo y su tratamiento farmacológico. Rev. salud pública. 2013;(XVII) 1:49-59.
Téllez J. Metales pesados: mercurio, plomo y cromo¨ en aspectos toxicológicos de plaguicidas y metales pesados, Gutierrez, Téllez, Patiño. Memorias, Departamento de toxicología, facultad de medicina, Universidad Nacional de Colombia, 2003.
Lanphear BP, Hornung R, Khoury J, et al. Low-Level Environmental Lead Exposure and Children’s Intellectual Function: An International Pooled Analysis. Environ Health Perspect. 2005; 113(7):894-899. doi:10.1289/ehp.7688.
Bernhoft R. Cadmium Toxicity and Treatment. The ScientificWorldJournal. 2013; 2013. Disponible en: http://www.hindawi.com/journals/tswj/2013/394652/cta/
Talio MC, Luconi MO, Masi AN, Fernández LP. Cadmium monitoring in saliva and urine as indicator of smoking addiction. Sci Total Environ. 2010; 408(16):3125-32.
Lafuente A. The hypothalamic-pituitary-gonadal axis is target of cadmium toxicity. An update of recentstudies and potential therapeutic approaches. Food Chem Toxicol. 2013; 59: 395-404.
Whanger PD. Cadmium effects in rats on tissue iron, selenium, and blood pressure; blood and hair cadmium in some oregon residents. Environ Health Perspect. 1979; 28:115-21.
Amerongen AV, Veerman EC. Saliva--the defender of the oral cavity. Oral Dis. 2002; 8(1):12-22.
Lawrence HP. Salivary markers of systemic disease: noninvasive diagnosis of disease and monitoring of general health. J Can Dent Assoc. 2002; 68(3):170-4.
Chiappin S, Antonelli G, Gatti R, De Palo EF. Saliva specimen: a new laboratory tool for diagnostic and basic investigation. Clin Chim Acta. 2007; 383(1-2):30-40.
Lima DP, Diniz DG, Moimaz SA, Sumida DH, Okamoto AC. Saliva: reflection of the body. Int J Infect Dis. 2010; 14(3):e184-8.
Ben-Aryeh H, Sela J, Peled M. [Salivary tests as a diagnostic tool in oral disease management]. Refuat Hapeh Vehashinayim. 2002; 19(3):51-6, 90.
Barbosa F Jr, Corrêa Rodrigues MH, Buzalaf MR, Krug FJ, Gerlach RF, Tanus-Santos JE. Evaluation of the use of salivary lead levels as a surrogate of blood lead or plasma lead levels in lead exposed subjects. Arch Toxicol. 2006
Oct; 80(10):633-7. Epub 2006 Apr 14.
Drummer OH. Drug testing in oral fluid. Clin Biochem Rev. 2006; 27 (3): 147-159.
Bosker WM, Huestis MA. Oral fluid testing for drugs of abuse. Clin Chem 2009; 55 (11): 1910-1931.
Olmedo P, Pla A, Hernández AF, López-Guarnido O, Rodrigo L, Gil F. Validation of a method to quantify chromium, cadmium, manganese, nickel and lead in human whole blood, urine, saliva and hair samples by electrothermal atomic absorption spectrometry. Anal Chim Acta. 2010; 659(1-2):60-7.
Esteban M, Castaño A. Non-invasive matrices in human biomonitoring: a review. Environ Int 2009; 35(2):438–49.
Pigatto P D, Arancio L, Guzzi G. et al Metals from amalgam in saliva: association with lichenoid lesions, leukoplakia, burning mouth syndrome. Toxicol Letters 2005. 158SS169–S170.
West C, Hardcastle J, Compton R. Sono-Electroanalytical Determination of Lead in Saliva. Electroanalysis 2002;14 (21):1470–1478.
Zimmer H, Ludwig H, Bader M, Bailer J, Eickholz P, Staehle HJ, Triebig G. Determination of mercury in blood, urine and saliva for the biological monitoring of an exposure from amalgam fillings in a group with self-reported adverse health effects. Int J Hyg Environ Health. 2002; 205(3):205-11.
Langel K, Engblom C, Pehrsson A, Gunnar T, Ariniemi K, Lillsunde P. Drug testing in oral fluid-evaluation of sample collection devices. J Anal Toxicol. 2008; 32(6):393-401.
Gjerde H, Øiestad E, Christophersen A. Using biological samples in epidemiological research on drugs of abuse. Norsk Epidemiologi 2011; 21 (1): 5-14.
Varrica D, Tamburo E, Dongarrà G, Sposito F. Trace elements in scalp hair of children chronically exposed to volcanic activity (Mt. Etna, Italy). Sci Total Environ. 2014; 470-471:117-26.
Cairns T, Hill V, Schaffer M, Thistle W. Removing and identifying drug contamination in the analysis of human hair. Forensic Sci Int. 2004; 145(2-3):97-108.
Cirimele V, Kintz P, Dumestre V, Goullé JP, Ludes B. Identification of ten corticosteroids in human hair by liquid chromatography-ionspray mass spectrometry. Forensic Sci Int. 2000; 107(1-3):381-8.
Chittleborough G, Steel BJ. Is human hair a dosimeter for endogenous zinc and other trace elements? Sci Total Environ. 1980; 15(1):25-35.
Gil F, Hernández AF, Márquez C Et al. Biomonitorization of cadmium, chromium, manganese, nickel and lead in whole blood, urine, axillary hair and saliva in an occupationally exposed population. Sci Total Environ. 2011; 409(6):1172-80. doi: 10.1016/j.scitotenv.2010.11.033. Epub 2011 Jan 6.
Barbosa Jr F, Tanus-Santos JE, Gerlach RF, Parsons PJ. A critical review of biomarkers used for monitoring human exposure to lead: advantages, limitations and future needs. Environ Health Perspect 2005; 113 (12):1669–74.
Blaurock-Busch E, Amin OR, Rabah T. Heavy metals and trace elements in hair and urine of a sample of arab children with autistic spectrum disorder. Maedica (Buchar). 2011; 6(4):247-57.
Mehra R, Juneja M. Elements in scalp hair and nail indicating metal body burden in polluted environment. JSIR. 2005; 64 (2):119-124.
NNorom IC, Igwe JC, Ejimone JC. Multielement analyses of human scalp hair samples from three distant towns in southeastern Nigeria. Afr J Biotechnol. 2005; 4 (10): 1124-1127.
Carrillo J, Amador M. Maduración de las células sanguíneas. Editorial Cybercell. 2007.
Mussali P, Tovar E, Valverde M, Rojas E. Biomarkers of exposure for assessing environmental metal pollution: from molecules to ecosystems. Rev. Int. Contam. Ambie.2013; 29 (1) 117-140.
Kamal A, Qayyum M, Cheema I, Rashid A. Biological Monitoring of Blood aphthalene Levels as a Marker of Occupational Exposure to PAHs among Auto-Mechanics and Spray Painters in Rawalpindi. BMC Public Health
; 11: 467. Disponible en: http://www.biomedcentral.com/content/pdf/1471-2458-11-467.pdf
García E, Pérez B, Fernández P, Fernández MA, de Paz C, Pérez AM et al. Lead, mercury and cadmium in umbilical cord blood and its association with parental epidemiological variables and birth factors. BMC Public Health. 2013; 13: 841. Disponible en: http://www.biomedcentral.com/1471-2458/13/841
Moreiras Tuni O, Cuadrado Vives C. Ingesta de contaminantes (metales pesados) vía dieta total del Conjunto Nacional y Comunidades Autónomas: nuevo enfoque. Rev Clin Esp 1993;193:76-81.
King S, Schaub M. Análisis de Orina y de los Líquidos Corporales. 5a ed. Ed. Madrid: Médica Panamericana; 2010.
Castaño A, Sánchez-Rodríguez JE, Cañas A, Esteban M, Navarro C, Rodríguez-García AC. Mercury, lead and cadmium levels in the urine of 170 Spanish adults: a pilot human biomonitoring study. Int J Hyg Environ Health. 2012; 215(2):191-5.
Schrier R. Diagnostic Value of Urinary Sodium, Chloride, Urea, and Flow. J Am Soc Nephrol. 2011; 22(9): 1610–1613.
Rahmoune H, Thompson PW, Ward JM, Smith CD, Hong G, Brown J. Glucose transporters in human renal proximal tubular cells isolated from the urine of Patients with non-insulin-dependent diabetes. Diabetes.2005; 54(12):3427-34.
Aguilera I, Daponte A, Gil F, Hernández AF, Godoy P, Pla A, et al. Urinary levels of arsenic and heavy metals in children and adolescents living in the industrialised area of Ria of Huelva (SW Spain). Environ Int. 2010;36(6):563-
Batista BL, Rodrigues JL, Nunes JA, Tormen L, Curtius AJ, Barbosa F Jr. Simultaneous determination of Cd, Cu, Mn, Ni, Pb and Zn in nail samples by inductively coupled plasma mass spectrometry (ICP-MS) after tetramethylammonium hydroxide solubilization at room temperature: comparison with ETAAS. Talanta. 2008; 76(3):575-9.
Mortada WI, Sobh MA, el-Defrawy MM, Farahat SE. Reference intervals of cadmium, lead, and mercury in blood, urine, hair, and nails among residents in Mansoura city, Nile delta, Egypt. Environ Res. 2002; 90(2):104-10.
Bales CW1, Freeland-Graves JH, Askey S, Behmardi F, Pobocik RS, Fickel JJ et al. Zinc, magnesium, copper, and protein concentrations in human saliva: age- and sex-related differences. Am J Clin Nutr. 1990; 51(3):462-9.
Kuyumcu ME, Yesil Y, Ozturk ZA, Cankurtaran M, Ulger Z, Halil M et al. An alternative way for the evaluation of zinc status in the elderly; nail zinc levels and relationship with Alzheimer's disease. Eur Rev Med Pharmacol Sci. 2013; 17(11):1467-71.
Yousef S, Eapen V, Zoubeidi T, Kosanovic M, Mabrouk AA, Adem A. Learning disorder and blood concentration of heavy metals in the United Arab Emirates. Asian J Psychiatr. 2013; 6(5):394-400.
Lakshmi Priya MD, Geetha A. Level of trace elements (copper, zinc, magnesium and selenium) and toxic elements (lead and mercury) in the hair and nail of children with autism. Biol Trace Elem Res. 2011; 142(2):148-58.
Adams SV, Newcomb PA, Shafer MM, Atkinson C, Bowles EJ, Newton KM et al. Urinary cadmium and mammographic density in premenopausal women. Breast Cancer Res Treat. 2011; 128(3):837-44.
Sponder M1, Fritzer-Szekeres M2, Marculescu R2, Mittlböck M3, Uhl M4, Köhler-Vallant B5, Strametz-Juranek J1. Blood and urine levels of heavy metal pollutants in female and male patients with coronary artery disease. Vasc Health Risk Manag. 2014 May 13;10:311-7. doi: 10.2147/VHRM.S61510. eCollection 2014.
Wang D, Du X, Zheng W. Alteration of saliva and serum concentrations of manganese, copper, zinc, cadmium and lead among career welders. Toxicol Lett. 2008; 176(1):40-7.
Banderas-Tarabay JA, Zacarías-D'Oleire IG, Garduño-Estrada R, Aceves-Luna E, González-Begné M. Electrophoretic analysis of whole saliva and prevalence of dental caries. A study in Mexican dental students. Arch Med Res. 2002; 33(5):499-505.
Arai F, Yamamura Y, Yoshida M, Kishimoto T. Blood and urinary levels of metals (Pb, Cr, Cd, Mn, Sb, Co and Cu) in cloisonne workers. Ind Health. 1994;32(2):67-78.
Basta N, Gradwohl R. Estimation of Cd, Pb, and Zn bioavailability in smelter- contaminated soils by a sequential extraction procedure. Journal of Soil Contamination. 2000; 9(2): 149-164.
Jurczak A1, Brodowski J, Grochans E, Karakiewicz B, Szkup-Jabłońska M, Wieder-Huszla S et al. Effect of menopausal hormone therapy on the levels of magnesium, zinc, lead and cadmium in post-menopausal women. Ann Agric Environ Med. 2013; 20(1):147-51.
Parajuli RP, Fujiwara T, Umezaki M, Watanabe C. Association of cord blood levels of lead, arsenic, and zinc with neurodevelopmental indicators in newborns: a birth cohort study in Chitwan Valley, Nepal. Environ Res. 2013; 121:45-51.
Bjermo H, Sand S, Nälsén C, Lundh T, Enghardt Barbieri H, Pearson M. Lead, mercury, and cadmium in blood and their relation to diet among Swedish adults. Food Chem Toxicol. 2013; 57:161-9.
Elhamri H, Idrissi L, Coquery M, Azemard S, El Abidi A, Benlemlih M et al. Hair mercury levels in relation to fish consumption in a community of the Moroccan Mediterranean coast. Food Addit Contam. 2007; 24(11):1236-46.
Díez S1, Delgado S, Aguilera I, Astray J, Pérez-Gómez B, Torrent M et al. Prenatal and early childhood exposure to mercury and methylmercury in Spain, a high-fish-consumer country. Arch Environ Contam Toxicol. 2009; 56(3):615-22.
Kaniewski A, Takagi Y, Marcinkowski JT. Concentrations of 21 elements in hair of people living in Poznań. Probl. Med. Społ 1997; 32: 391.
Wang D, Du X, Zheng W. Alteration of saliva and serum concentrations of manganese, copper, zinc, cadmium and lead among career welders. Toxicology Letters.2008; 176 (1): 40–47.
Ireneusz Całkosiński, Andrzej Gamian, Joanna Kobierska−Brzoza, Katarzyna Fita, Agnieszka Czajczyńska−Waszkiewicz, Jacek Majda. The influence of variable environmental factors on human’s organism adaptive ability. Adv Clin Exp Med. 2009; 18 (5): 519–527.
Sukumar A, Subramanian R. Relative element levels in the paired samples of scalp hair and fingernails of patients from New Delhi. Sci Total Environ. 2007; 372 (2-3):474-9.
Radomska K, Graczyk A, Konarski J, Adamowicz B. Evaluation of macro- and micro element content in the human body determined by hair analysis. Pol. Tyg. Lek. 1991; 46: 24.
Aguilera I, Daponte A, Gil F, Hernández AF, Godoy P, Pla A, Ramos JL; DASAHU group. Urinary levels of arsenic and heavy metals in children and adolescents living in the industrialised area of Ria of Huelva (SW Spain). Environ Int. 2010; 36(6):563-9.
Cañas AI, Cervantes-Amat M, Esteban M, Ruiz-Moraga M, Pérez-Gómez B, Mayor J et al. Blood lead levels in a representative sample of the Spanish adult population: The BIOAMBIENT.ES project. Int J Hyg Environ Health. 2014; 217(4-5):452-9.
Sepúlveda L, Agudelo L, Arengas A. El mercurio, sus implicaciones en la salud y en el ambiente. Revista Luna Azul. 1997; 4. [Citado 20 de marzo de 2014] Disponible en: http://lunazul.ucaldas.edu.co/downloads/e4822404Revista4_8.pdf
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