Examination of the relationship between the degree of stenosis of the anterior descending branch of the left coronary artery and the concentrations of metals and metalloids in the myocardial tissue of the left ventricle

[A. Ćirović]

36 listova

Medicina - Zapaljenje i autoimunost / Medicine - Inflamation and autoimmunity

Uvod: Po broju novoobolelih, kako u svetu, tako i u Srbiji, kardiovaskularna oboljenja zauzimaju centralno mesto. Veza između ekspozicije različitim metalima i metaloidima iz okruženja i nastanka različitih kardioloških oboljenja je neosporna, ali nedovoljno istražena. U današnje vreme čovek je izložen različitim metalima i metaloidima tokom svakodnevnih aktivnosti; sve vrste namirnica koje se koriste u ishrani, zatim duvan, kozmetika i aerozagađenje, sadrže u različitim koncentracijama mnoge metale i metaloide, posebno uključujući teške metale. Dosadašnje znanje bazirano na rezultatima in vivo studija ukazuje da su neki teški metali, poput arsena, kadmijuma i olova izuzetno kardiotoksični. Važno je istaći da je stepen toksičnog dejstva ovih teških metala u direktnoj korelaciji sa dužinom ekspozicije, kao i sa koncentracijama navedenih metala kojima je čovek izložen. Takođe je pokazano da neki teški metali mogu da se nađu u povišenim koncentracijama u krvi i/ili urinu kod osoba sa određenim kardiološkim oboljenjima poput ishemijske bolesti srca ili nekih tipova kardiomiopatije. Većina metala i metaloida se deponuje u miokardu u određenom obimu; međutim, mehanizmi koji utiču na pojačano nakupljanje istih nisu dovoljno istraženi. Takođe je malo poznato da li se različiti metali i metaloidi nakupljaju u tkivu miokarda homogeno ili su neki delovi tkiva podložniji nakupljanju. Disproporcija u snabdevanju kiseonikom kod ishemijske bolesti srca koja se javlja u miokardu distalno od stenoze u odnosu na tkivo miokarda proksimalno od stenoze može da rezultuje hipoksijom miokarda. Hipoksija dovodi do pojačane ekspresije transferinskog receptora 1 (transferrin receptor 1; TfR1), kao i proteina koji se naziva divalentni metalni transporter-1 (divalent metal transporter-1), koji mogu da doprinesu ubrzanom nakupljanju teških metala distalno od stenoze. Ciljevi teze: Cilj ovog istraživanja bio je da se ispita da li se kadmijum, olovo, arsen, živa, nikl, bakar, gvožđe, mangan, cink, kalcijum i magnezijum nakupljaju homogeno u tkivu miokarda leve komore. Zatim smo želeli da ispitamo da li se navedeni metali i metaloidi nakupljaju u većem obimu distalno od stenoze prednje međukomorne grane (prednje nishodne grane) leve koronarne arterije, koja je procenjivana makroskopski; takođe smo hteli da ispitamo da li povišene vrednosti pojedinih pokazatelja zapaljenskog procesa u organizmu, kao što su C-reaktivni protein (CRP) i ukupan broj leukocita, koreliraju sa koncentracijama metala distalno od stenoze. Na kraju, hteli smo da ispitamo da li osobe kod kojih su dijagnostikovana određena oboljenja, poput koronarne bolesti srca, kardiomiopatije, srčane insuficijencije ili hronične bubrežne insuficijencije, imaju povećane/snižene vrednosti pojedinih metala u miokardu leve komore. Materijal i metode: Naša studija je organizovana po tipu studije preseka. Prikupili smo 90 uzoraka tkiva miokarda leve komore [od 62 osobe oba pola (35 muškaraca i 27 žena), starijih od 30 godina] na Institutu za anatomiju i Institutu za patologiju Medicinskog fakulteta u Beogradu. Prvi deo eksperimenta je rađen na uzorcima prikupljenim na Institutu za anatomiju (n=20; od deset osoba) i podrazumevao je ispitivanje homogenosti taloženja metala unutar tkiva miokarda leve komore. Debljina međukomorske pregrade merena je kaliperom na Institutu za anatomiju. Drugi deo eksperimenta je rađen na uzorcima prikupljenim na Institutu za patologiju (n=36; od 18 osoba), gde smo utvrđivali da li stenoza koronarne arterije utiče na pojačano nakupljanje metala i metaloida distalno od stenoze...

Introduction: Both globally and in Serbia, cardiovascular diseases occupy a central place in terms of the number of newly affected individuals. The connection between exposure to various metals and metalloids, which are constantly present in the environment and the development of various cardiovascular diseases, is undeniable but not thoroughly researched. In today's world, humans are exposed to various metals and metalloids during daily activities. All types of food used in nutrition, tobacco, cosmetics, and air pollution contain different concentrations of various metals and metalloids, including heavy metals. On the other hand, it is well-known from in vivo studies that some heavy metals, such as arsenic, cadmium, and lead, are extremely cardiotoxic, and the extent of their toxic effects correlates with the duration of exposure and the concentrations to which individuals are exposed. It has also been shown that some heavy metals can be found in elevated concentrations in the blood and/or urine of individuals with certain cardiovascular diseases, such as ischemic heart disease or cardiomyopathies. Most metals and metalloids are deposited in the myocardium to a greater or lesser extent, but the mechanisms influencing increased metal and metalloid accumulation are not sufficiently researched. It is also not well-known whether different metals and metalloids accumulate homogeneously in the myocardium or if some areas are more susceptible to accumulation than others. The disproportion that occurs in the myocardium distal to a stenosis in ischemic heart disease can result in myocardial hypoxia distal to the stenosis. Hypoxia leads to increased expression of transferrin receptor 1 (TfR1) as well as a protein called divalent metal transporter-1, which can contribute to the accelerated accumulation of heavy metals distal to the stenosis. Thesis Objectives: The aim of this research was to investigate whether cadmium, lead, arsenic, mercury, nickel, copper, iron, manganese, zinc, calcium, and magnesium accumulate homogeneously in the left ventricular myocardium. We also wanted to examine whether the mentioned metals and metalloids accumulate to a greater extent distal to the stenosis of the anterior interventricular artery, which was assessed macroscopically. We also aimed to determine whether the concentrations of certain inflammatory factors, such as C-reactive protein (CRP) and total leukocyte count, correlate with the metal concentrations distal to the stenosis. Finally, we wanted to investigate whether individuals diagnosed with certain diseases, such as coronary heart disease, cardiomyopathies, heart failure, and chronic kidney disease, have increased or decreased levels of certain metals in the left ventricular myocardium. Materials and Methods: Our study was organized as a cross-sectional study. We collected 90 left ventricular samples [from 62 individuals of both genders (35 man and 27 women), aged over 30 years] at the Institute of Anatomy and the Institute of Pathology of the Faculty of Medicine in Belgrade. The first part of the experiment was conducted on samples collected at the Institute of Anatomy (n=20; from ten individuals) and involved the investigation of metal deposition homogeneity within the left ventricular myocardium...

miokard; leva komora; olovo; arsen; metali; metaloidi; cink; kardiomiopatija; srčana insuficijencija; ishemijska bolest srca

Myocardium; left ventricle; lead; arsenic; metals; metalloids; zinc; cardiomyopathy; cardiac insufficiency; ischemic heart disease

616.12-008(043.3)

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