Health Effects In Population Exposed To Arsenic Through Drinking Water

Health Effects in Population Exposed to Arsenic Through Drinking Water Dr. Apurba Kumar Bandyopadhyay K. P. C. Medical College and Hospital & Indian Institute of Chemical Biology, Kolkata

ARSENIC POISONING IN WEST BENGAL

 9 out of 18 districts affected covering 38,865 sq. km. Over 6 million exposed to arsenic.

people

 More than 300,000 people with arsenical skin lesions, more sub-clinically affected. About 15-20% individuals show arsenic induced skin lesions. One of the greatest arsenic calamities in the world.

OBJECTIVES OF THE STUDY 1.Assessment of health effects through epidemiological studies 3.Haematological studies arsenic-exposed individuals.

on

5. Evaluation of the effect of chronic arsenic exposure on immune system.

EPIDEMIOLOGICAL SURVEY

EPIDEMIOLOGICAL SURVEY

Criteria for selecting different clinical symptoms: Raindrop pigmentation Cutaneous

Hyperkeratosis Pigmentation Peripheral Neuropathy

Respiratory symptoms Eye

Pain, paresthesia, numbness, muscle cramp, Anaesthesia or hypothesia to touch, pain, temperature, pressure and vibration. Calf tenderness, deep tendon reflex, muscle wasting, nerve thickening. Cough, shortness of breath, breath sounds Conjunctivitis, irritation, watering, burning sensation

PHOTOGRAPHS OF DIFFERENT SKIN LESIONS OBSERVED IN ARSENIC EXPOSED STUDY SUBJECTS

a (a) Hyperpigmentation

b

c

d

(b,c, d) Raindrop pigmentation

e (e,f) Palmar & Planter hyperkeratosis

f

g (g,h) Plantar hyperkeratosis

h

ARSENIC CONTENT IN WATER & BIO-SAMPLES

Variables Unexposed (N = 389) Exposed Individuals (Arsenic in) ( Mean ± S.D.) Without skin lesion With skin lesion (N = 352) ( Mean ± S.D.) (N = 373) Water(µg/l) 6.97 ± 2.10 186.89 ± 124.67a 200.83 ± 145.83a Nail (µg/g) ± 4.27 a,b

0.55 ± 0.39

2.89 ± 2.19a

4.41

Hair(µg/g) ± 2.33 a,b

0.33 ± 0.25

1.93 ± 1.52a

2.67

Urine(µg/l) 27.69 ± 20.96 175.25±114.04 a,b

238.21 ± 246.79a

Journal of Exposure Sciences and Environmental ------------------------------------------------------------------------------------Epidemiology (2007) 17(3):215-223 ------------------

PERCENTAGES OF NEUROPATHY, RESPIRATORY AND EYE DISEASES IN THE THREE STUDY POPULATIONS Unexposed(N = 389) a,b

45

Exposed group without arsenicinduced skin lesion (N = 352)

Percentage of Occurance (%)

40

a,b

35

Exposed group with arsenic-induced skin lesion (N = 373)

a,b

30 25 20 15 10

a a

a

5 0

a b

PN

Resp

Eye

p<0.01, when compared to unexposed group

p<0.01, when compared to exposed group without arsenicinduced skin lesion

Journal of Exposure Science and Environmental Epidemiology, 2007:17(3):215-223

HAEMATOLOGICAL STUDY

EXPLAINING ANAEMIA IN ARSENIC EXPOSED INVIDUALS Formation of Sphaeroechinocytes

Correlation between Hemolysis and Hemoglobin Concentration 80

14

70

12 Haemoglobin (gm%)

% of Sphaeroechinocytes

16

60 50 40

10 8 6

30

4

20

2

10

0

0

0

<7gm%

8 - 10gm%

>11gm%

Hemoglobin Content

Relationship of % of Sphaeroechinocytes with different degrees of anemia.

10

20

30

40

50

60

70

80

% Haemolysis

The line represents regression analysis of samples obtained from arsenic exposed population with different degrees of anemia.

EXPLAINING ANAEMIA IN ARSENIC EXPOSED INVIDUALS GSH Content of Erythrocytes in Arsenic Exposed Population

Protein Carbonyl Content of Erythrocyte Membrane in Arsenic Exposed Population

0.6

µ M/mg

35

0.4 0.3 0.2 0.1 0

30 25

Protein carbonyl Concentration ( of protein)

GSH Content ( µ g/mg of protein)

0.5

Control

Group A

Group B

Group C

20 15 10 5 0

Control

Group A

Group B

Group C

Groups A, B and C represent arsenic exposed population with different degrees of anemia. Hemoglobin ranges in different groups are : Control – 12.0 to 15.0 gm%, Group A – 13.0 to 14.6 gm%, Group B – 10.0 to 12.8 gm% and Group C – 7.0 to 9.8 gm%.

IMMUNOLOGICAL STUDY

ARSENIC EXPOSURE DECREASES CD4/ CD8 RATIO CD4/CD8 Ratio Unexpos ed Expos ed

CD4/CD8 Ratio

1.4 1.2 1 0.8 0.6 0.4 0.2 0

* p< 0.01

*

ARSENIC EXPOSURE REDUCES in vitro CELL ADHESION AND NITRIC OXIDE PRODUCTION BY MACROPHAGES Nitric Oxide Production by Macrophages

In vitro Cell Adhesion of Macrophages

Unexposed

0.2

Exposed 1.5

0.18

* Unexposed

0.1

**

0.08

*

0.06 0.04

Exposed

0.5

0.12

1

0.14 Absorbance at 635 nm

0.02 0

30 min

60 min

*p<0.01. **p<0.05

0

Absorbance at 635 nm

0.16

ARSENIC EXPOSURE ALTERS INFLAMMATORY CYTOKINE EXPRESSON PATTERNS

*

5000

Concentration (pg/ml)

4500

Unexposed Exposed

4000 3500 3000

*

2500

*

2000

*

*

1500 1000 500 0

TNF-a

IL1b

IL6 Cytokines

*p<0.

IL8

IL10

ARSENIC EXPOSURE IMPAIRS PHAGOCYTIC CAPACITY OF MACROPHAGES ΔMFI= MFI(37ºC) MFI(4ºC)

Unexposed 173103.3* Exposed *p<0.001

6733.34

SUMMARY 1.Results of epidemiological studies indicate that individuals not manifesting arsenic induced skin lesion are also susceptible to arsenic induced genotoxicity. 3.Hematological studies indicate that arsenic can induce anemia in exposed individuals. 5.Immunological Studies arsenic exposure

prove leads

that to