Cadmium, lead, mercury, and aluminum are toxic metals that may interact metabolically with nutritionally essential metals. Iron deficiency increases absorption of cadmium, lead, and aluminum. Lead interacts with calcium in the nervous system to impair cognitive development. Cadmium and aluminum interact with calcium in the skeletal system to produce osteodystrophies. Lead replaces zinc on heme enzymes and cadmium replaces zinc on metallothionein. Selenium protects from mercury and methylmercury toxicity. Aluminum interacts with calcium in bone and kidneys, resulting in aluminum osteodystrophy. Calcium deficiency along with low dietary magnesium may contribute to aluminum-induced degenerative nervous disease.

Toxic and essential metal interactions

The brain is a highly compartmentalized organ exceptionally susceptible to accumulation of metabolic errors. Alzheimer's disease (AD) is the most prevalent neurodegenerative disease of the elderly and is characterized by regional specificity of neural aberrations associated with higher cognitive functions. Aluminum (Al) is the most abundant neurotoxic metal on earth, widely bioavailable to humans and repeatedly shown to accumulate in AD-susceptible neuronal foci. In spite of this, the role of Al in AD has been heavily disputed based on the following claims: 1) bioavailable Al cannot enter the brain in sufficient amounts to cause damage, 2) excess Al is efficiently excreted from the body, and 3) Al accumulation in neurons is a consequence rather than a cause of neuronal loss. Research, however, reveals that: 1) very small amounts of Al are needed to produce neurotoxicity and this criterion is satisfied through dietary Al intake, 2) Al sequesters different transport mechanisms to actively traverse brain barriers, 3) incremental acquisition of small amounts of Al over a lifetime favors its selective accumulation in brain tissues, and 4) since 1911, experimental evidence has repeatedly demonstrated that chronic Al intoxication reproduces neuropathological hallmarks of AD. Misconceptions about Al bioavailability may have misled scientists regarding the significance of Al in the pathogenesis of AD. The hypothesis that Al significantly contributes to AD is built upon very solid experimental evidence and should not be dismissed. Immediate steps should be taken to lessen human exposure to Al, which may be the single most aggravating and avoidable factor related to AD.

Aluminum and Alzheimer's Disease: After a Century of Controversy, Is there a Plausible Link?

Aluminium is the most widely distributed metal in the environment and is extensively used in daily life that provides easy exposure to human beings. The exposure to this toxic metal occurs through air, food and water. However, there is no known physiological role for aluminium within the body and hence this metal may produce adverse physiological effects. Chronic exposure of animals to aluminium is associated with behavioural, neuropathological and neurochemical changes. Among them, deficits of learning and behavioural functions are most evident. Some epidemiological studies have shown poor performance in cognitive tests and a higher abundance of neurological symptoms for workers occupationally exposed to aluminium. However, in contrast to well established neurotoxic effects, neurobehavioural studies of aluminium in rodents have generally not produced consistent results. Current researches show that any impairment in mitochondrial functions may play a major role in many human disorders including neurodegenerative disorders. Being involved in the production of reactive oxygen species, aluminium may cause impairments in mitochondrial bioenergetics and may lead to the generation of oxidative stress which may lead to a gradual accumulation of oxidatively modified cellular proteins. In this review, the neuropathologies associated with aluminium exposure in terms of neurobehavioural changes have been discussed. In addition, the impact of aluminium on the mitochondrial functions has also been highlighted.

Aluminium neurotoxicity: neurobehavioural and oxidative aspects.

Background
Aluminum is regularly taken up with the daily diet. It is also used in antiperspirants, as an adjuvant for vaccination, and in desensitization procedures. In this review, we present the scientifically documented harmful effects of aluminum on health and the threshold values associated with them.

The Health Effects of Aluminum Exposure.

The strength of the evidence implicating aluminium as an important factor in the dementia of Alzheimer's disease (AD) is reviewed. We submit that the weight of the epidemiological and biological arguments is considerable. While a complete understanding has not been achieved, we recommend lowering aluminium exposure in municipal drinking water to below 50 μg/l in at least the province of Ontario. The Ministry of Energy and the Environment of Ontario maintains a drinking water surveillance programme which has provided a database for more than 10 years. This database has permitted assessment of the relative risk for AD using four independent measures of disease prevalence: 1. weighted residential history as a measure of exposure in autopsy-verified AD cases and controls; 2. first admission hospital discharge diagnoses of AD and controls; 3. death certificate rates for AD and presenile dementia; 4. impairments in cognitive function in elderly males. Taken together, many of the criticisms applied to epidemiological studies conducted elsewhere and reaching similar conclusions have been met. A vast experimental database on aluminium neurotoxicity, rapid advances in the understanding of the molecular basis of AD, and comparison studies between human brains exposed to chronic low dose aluminium exposure secondary to renal failure and AD, lend strong biological support to the conclusions reached by the epidemiological studies. The factors initiating AD, how aluminium gains access to the brain in AD, and the relative contributions of food, pharmaceuticals and skin absorption, remain unknown. While a full understanding is not in hand, the devastating nature of the disease, the lack of an effective treatment or prevention and the high cost to the health care system, together with the human costs, weighed against the relative cost of moderately reducing drinking water aluminium concentration to reduce exposure indicate that action is both reasonable and timely.

Aluminium and the risk for alzheimer's disease

Animal model systems are used extensively for experimental in vivo studies. When biochemical and hematological measurements are made, reference intervals for the animal species must be determined. Here, the subjects for our study were young adult male New Zealand White rabbits. Blood was sampled from 110 normal healthy rabbits. Biochemical and hematological blood variables were measured by methods available in our routine service laboratory, and we report the ranges.

Normal biochemical and hematological values in New Zealand white rabbits.

Aspects of aluminum toxicity.

The antigenicity of neuronal cytoskeletal lesions was studied immunohistochemically in adult New Zealand white rabbits after intraventricular (subacute) and intravenous (chronic) administration of a water-soluble aluminium compound, aluminium (Al) maltol. After short-term intraventricular administration, rabbits developed widespread neurofibrillary degeneration (NFD) involving pyramidal neurons of the isocortex and allocortex, projection neurons of the diencephalon, and nerve cells of the brain stem and spinal cord. There was a predilection for motor neuron involvement and for the infratentorial portions of the neuraxis. Perikarya and proximal neurites were especially affected. Bundles of 10 nm filaments were frequently present. Three of the animals treated intravenously for 12 weeks or longer displayed NFD in the oculomotor complex and in the pyramidal neurons of the occipital isocortex. Following either mode of administration, the affected neurons exhibited immunostaining with a panel of monoclonal antibodies (MAbs) against phosphorylated (SMI-31), non-phosphorylated/phosphatase-sensitive (SMI-32), and dephosphorylation-independent (SMI-33) epitopes of high and middle molecular weight neurofilament (NF) protein subunits. They were non-reactive with MAbs to microtubule-associated protein 2 and the class III neuron-associated beta-tubulin isotype. Our findings indicate that intraventricular Al maltol produces similar, but more widespread degeneration of projection-type neurons than the less water-soluble Al compounds as reported by others. The NFD lesions are compared with those of senile dementia of the Alzheimer type (SDAT) and motor neuron disease.

Neuronal cytoskeletal lesions induced in the CNS by intraventricular and intravenous aluminium maltol in rabbits.

Long-term aluminum (Al) administration was studied in rabbits using intravenous (I.V.) injections of aluminum maltol or oral aluminum citrate in drinking water along with calcium. In the intravenous study, renal and liver tissue Al levels increased and were associated with proximal renal tubular pathology and with hepatic periportal Al-positive multinucleated cells. After oral Al, renal Al levels were increased in the Al-hard water group, while hepatic Al levels were not significantly increased over controls. However, cirrhosis was found in five orally-loaded animals which received Al and/or low dietary calcium or soft water. Collectively, these findings suggest that renal accumulation of Al is causally related to nephrotoxicity; that the lack of renal changes after oral loading is due to low absorption from normal adult gastrointestinal tract and normal functioning of mature kidneys; and that the elevated liver Al levels, achieved after I.V. administration, are related to the presence of hepatic Al-containing giant cells.

Long-term oral or intravenous aluminum administration in rabbits. I. Renal and hepatic changes.

We report two methods for determining aluminum concentrations in blood. Method 1, proposed for routine monitoring of patients with chronic renal failure, includes a collection procedure that can be adopted by any renal dialysis unit, with a minimum of sample contamination. Plasma samples are diluted fourfold with HNO3/Triton X-100 matrix modifier. Method 2 is proposed for determining aluminum concentrations in patients with normal renal function, e.g., in drug studies and environmental monitoring. Samples are diluted with an equal volume of Mg(NO3)2 matrix modifier and atomized from a L'vov platform. By either method, analytical recovery of aluminum added to serum ranged between 92% and 105% throughout the linear calibration range. The reference interval (mean +/- SD) for aluminum in 22 healthy subjects by method 2 was 0.044 +/- 0.030 mumol/L.

C. D. Hewitt

Papers

Normal biochemical and hematological values in New Zealand white rabbits.

Aspects of aluminum toxicity.

Neuronal cytoskeletal lesions induced in the CNS by intraventricular and intravenous aluminium maltol in rabbits.

Long-term oral or intravenous aluminum administration in rabbits. I. Renal and hepatic changes.

Critical Appraisal of Two Methods for Determining Aluminum in Blood Samples