| Phlebotomy Increases Cadmium Uptake in Hemochromatosis Agneta Åkesson,1 Per Stål,2 and Marie Vahter1 1Institute of Environmental Medicine, Division of Metals and Health, Karolinska Institutet, Stockholm, Sweden
2Department of Gastroenterology and Hepatology, Huddinge University Hospital, Karolinska Institutet, Huddinge, Sweden Abstract
The intestinal absorption of the nephrotoxic environmental pollutant cadmium increases markedly when iron stores are depleted. This may be mediated by an up regulation of the recently identified mucosal transporter DMT1 (Nramp2 or DCT1) for divalent cations. We tested whether the highly increased iron absorption in hereditary hemochromatosis (HH) was accompanied by an enhanced absorption of cadmium and lead. Cadmium and lead in blood and iron status markers were determined in 21 nonsmoking subjects with HH genetically tested for the HFE mutations and in 21 nonsmoking controls matched for age and sex. In subjects with HH on maintenance phlebotomy treatment, blood concentrations of cadmium, but not lead, were significantly higher than in paired controls. There was a strong age-independent positive association between blood cadmium and the number of years of phlebotomy treatment. Blood lead showed a similar but less pronounced consequence of treatment. All HH subjects with lower blood cadmium than the corresponding controls had either no mutation in the HFE gene, were not phlebotomized, or were phlebotomized for only a limited time. Our findings indicate that the treatment rather than the disease increased the cadmium uptake in homozygous HH. Further studies are needed to confirm whether the disease decreased cadmium absorption and whether the absorption was dependent on the genotype. Key words: absorption, cadmium, DCT1, DMT1, hemochromatosis, HFE, human, iron, lead, Nramp2. Environ Health Perspect 108:289-291 (2000) . [Online 15 February 2000] http://ehpnet1.niehs.nih.gov/docs/2000/108p289-291akesson/ abstract.html Address correspondence to A. Åkesson, Institute of Environmental Medicine, Division of Metals and Health, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden. Telephone: 46 8 728 75 42. Fax: 46 8 33 70 39. E-mail: Agneta.Akesson@imm.ki.se We thank A. Hagberg and C. Järlemark for blood sampling and B. Lind and B. Palm for metal analyses. This study was supported by a grant from the Swedish Society of Medicine. Received 30 August 1999 ; accepted 13 October 1999.
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