Tissue Mineral Levels in Victims of Sudden Infant Death Syndrome 11
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784 ERICKSON ET AL. 27. Underwood, E. J.: Trace elements in human and animal nutrition. 4th ed. p. 410. 30. Requests for reprints should be addressed to: Dr. Marilyn M. Erickson, Depart- (Academic Press, New York, 1977). ment of Pediatrics, St. Louis Children's Hospital, P.O. Box 14871, St. Louis, 28. Ziegler, E. E., Edwards, B. B., Jensen, R. L., Mahaffey, K. R., and Foman, S. J.: MO 63178 Absorption and retention of lead by infants. Pediatr. Res., 12: 29 (1978). 31. This research was supported in part by NIH grant No. 5T32 AM07033. 29. This work is taken in part from a dissertation submitted to the Graduate School, 32. This research was supported in part by NIH grant No. HD-09998-04. St. Louis University by M. M. Erickson in partial fulfillment ofthe requirement 33. Received for publication June 22, 1982. for the Ph.D. degree in Pathology. 34. Accepted for publication March 15, 1983. 003 I-3998/83/ 17 10-0784$02.00/0 PEDIATRIC RESEARCH Vol. 17, No. 10, 1983 Copyright O 1983 International Pediatric Research Foundation, Inc. Printed in (I.S.A. Tissue Mineral Levels in Victims of Sudden Infant Death Syndrome 11. Essential Minerals: Copper, Zinc, Calcium, and Magnesium(45) MARILYN M. ERICKSON,'~~~~~)ALPHONSE POKLIS, GEORGE E. GANTNER, ALLAN W. DICKINSON, AND LAURA S. HILL MAN'^" The Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine; the Division of Neonatology; St. Louis Children's Hospital; the Division of Bone and Mineral Metabolism, the Jewish Hospital of St. Louis; the Management Information and Systems Department, Monsanto Company; the Department of Pathology, St. Louis University School of Medicine; and the Offices of the Medical Examiner, St. Louis City and St. Louis County, MO USA Summary however, because different deficiencies are manifest in different tissues and because some tissue concentrations vary with age, Deficiencies of various vitamin and minerals per se have been mineral deficiencies were not totally excluded. suggested as possible causes of sudden infant death syndrome Mineral interactions are known to occur both among the essen- (SIDS). Further, a deficiency of essential minerals may lead to tial elements and between toxic and essential elements (20,35,42). enhanced toxicity of toxic elements, in particular, lead and cad- Copper and zinc are antagonistic to each other (lo), while normal mium. To explore the possibility of mineral deficiencies or inter- calcium metabolism, in some instances, depends on the presence actions with the toxic metals, lead and cadmium, lung, liver, of normal amounts of magnesium (1). A deficiency of copper or kidney, and rib specimens were obtained at autopsy from 66 SIDS zinc will lead to enhanced toxicity of lead or cadmium whereas an infants and 23 infants who died suddenly from other causes. Tissue excessive dietary intake of the essential minerals will be protective copper, zinc, calcium, and magnesium were measured by atomic (9, 23, 35). Tissue lead concentrations are greatly elevated when absorption spectroscopy. No differences were found between SIDS dietary calcium is low (27, 28, 36). Magnesium supplementation and non-SIDS for any element in any tissue except for more has been shown to effect increased excretion of lead in rats (41). magnesium in the liver (P < 0.0001) and less copper in the lungs The determination of copper, zinc, calcium, and magnesium (P 0.02) in the SIDS group. Only sporadic interactions between < concentrations in tissues of SIDS victims was undertaken to see if toxic and essential elements could be found. We found no evidence any relationships existed between these elements and the cadmium of any essential mineral deficiencies per se or significant interac- and lead levels previously reported (14) and at the same time with tions of essential and toxic minerals that might potentiate the a larger number of cases and with appropriately age-matched effects of toxic metals. The physiologic significance, if any, of the controls to further examine the possibility of the presence of higher liver magnesium and lower lung copper found in SIDS is deficiencies or excesses of these elements in multiple tissues. unclear. Abbreviations MATERIALS AND METHODS AAS, atomic absorption spectrophotometry Fresh lung, liver, right kidney, and right 5th rib specimens were CaBP, calcium-binding protein obtained from infants autopsied at the St. Louis City and County SIDS, sudden infant death syndrome Medical Examiners' Offlces. The ages at death ranged from 4-26 wk. There were 66 SIDS and 23 non-SIDS infants. Each tissue was packaged separately in plastic bags and stored at -20°C until Because of their wide ranging effects, deficiencies of various the analyses were run. The tissues were processed as previously vitamins and minerals have been suggested as a possible cause of described. (14). The tissue acid digests were analyzed for copper SIDS including biotin (22), thiamine (11, 37), vitamin D (21) using electrothermal AAS and for zinc, calcium, and magnesium vitamin E and/or selenium (29, 38), and magnesium (5). Lapin, et using air-acetylene flame AAS. A Varian Model 1200 AAS was al. (25) measured selenium, magnesium, copper, and zinc concen- used for rib zinc measurements and a Perkin-Elmer Model 403 trations in liver samples from 13 SIDS cases ranging from 1-10 equipped with an HGA 2200 graphite furnace was used for all months of age and 14 non-SIDS cases, age 5 days to 13 years. other mineral measurements. Deuterium background correction They found no significant differences between the two groups; was used for copper and zinc. Lanthanum was used to suppress ESSENTIAL MINERALS 785 phosphate interference in the calcium analyses. National Bureau mineral concentrations, all values were corrected to the age of 13 of Standards SRM 1577 bovine liver was used as a tissue reference. wk. The age-corrected values in the two groups then were com- The results are reported in micrograms per gram of dried tissue. pared. Tissue mineral levels that were more than four standard Log transformations of the raw data were used to calculate deviations from the mean were eliminated from the subsequent Pearson's correlation wefficients (r). Significance levels (P) were calculations. taken from a table (12) using r values and degrees of freedom. To avoid the possibility of errors resulting from changes with age in RESULTS The mean and standard deviation of the mineral concentrations Table 1. Tissue mineral concentrations' for each of the four tissues are shown in Table 1. No differences SIDS~ non-SIDS2 were found except for significantly more magnesium in the liver Mineral/ (P < 0.0001) and less copper in the lungs (P < 0.02) in the SIDS tissue n Mean f S.D. n Mean f S.D. group than was found in the non-SIDS group. Age correction did Copper not produce any significant changes in mean & S.D. mineral Lung concentrations and thus only non-age-corrected means are shown Liver in the Table. Kidney4 The only mineral concentration changes with age: a decrease in Rib liver copper in both the SIDS and non-SIDS (P < 0.0001), a zinc decrease in liver calcium in SIDS (P < 0.0005) but not in non- SIDS, a decrease in lung magnesium (P 0.0005), lung zinc (P Lung < Liver < 0.05), and rib zinc (P < 0.005) in non-SIDS but not in SIDS. Kidney4 Only the slopes of liver calcium versus age were different between SIDS and non-SIDS (P 0.01). The intercept for lung magnesium Rib < Calcium was lower (P < 0.01) in SIDS and the intercepts for liver magne- Lung sium (P< 0.05) and liver calcium (P < 0.01) were higher in SIDS. Liver Correlation between essential elements and rib or same tissue Kidney4 lead and kidney or same tissue cadmium (14) can be seen in Table Rib1 2. There was no signif3cant differences in mineral levels between Magnesium black and white infants or between males and females. Lung Liver DISCUSSION Kidney4 A search of the literature has revealed no previous studies of Rib tissue minerals in infants as a distinct group. In some studies ' Mineral concentrations are expressed in pg/g dry weight except rib infants were grouped with older children and even with adults; calcium which is expressed in mg/g dry weight. however, our findings are all within expected ranges. Mean SIDS age = 11.9 wk, mean non-SIDS age = 13.4 wk. Copper. Copper is an element essential for bone growth and Significant diffference, lung Cu P < 0.02, liver Mg P < 0.0001. maintenance, for hematopoiesis and as a wmponent of several Cortex. key metalloenzymes including lysyl oxidase, tyrosinase, superox- Table 2. Tissue mineral correlations (r) Lead Cadmium SIDS non-SIDS SIDS non-SIDS Rib Same tissue Rib Same tissue Kidney Same tissue Kidney Same tissue Copper Lung 0.1054 0.0804 -0.2223 -0.1447 0.1040 0.2419 0.3954 0.5220' Liver -0.2406 -0.2371 -0.3063 -0.3084 -0.45373 -0.0543 -0.429 1' -0.0520 Kidney -0.2344 -0.0120 -0.3081 0.05 1 1 -0.0452 0.0452 0.0543 0.0543 Rib -0.0580 -0.0580 0.25 17 0.25 17 -0.3604' 0.1010 -0.4843' -0.0563 zinc . Lung -0.0019 -0.2322 0.0028 -0.3369 -0.2200 -0.0698 -0.2646 -0.1999 Liver -0.0260 0.2066 -0.1216 0.3366 0.0246 -0.0073 0.053 1 -0.0754 Kidney 0.0272 0.1461 0.075 1 -0.0850 -0.0794 -0.0794 -0.3264 -0.3264 Rib 0.0124 0.0124 0.1902 0.1902 -0.2865' 0.045 1 -0.4569' 0.1677 Calcium Lung -0.0993 0.1629 0.1255 0.056 1 -0.0182 -0.0359 -0.1447 0.0584 Liver -0.0914 -0.2036 -0.2032 -0.0353 -0.40093 -0.1830 0.2442 0.2918 Kidney 0.0337 -0.3023 -0.1046 -0.2994 -0.1527 -0.1527 -0.3552 -0.3552 Rib -0.073 1 -0.0731 -0.1304 -0.1304 0.2946' -0.0372 0.2042 0.0829 Magnesium Lung 0.0361 -0.3219' -0.3004 -0.4742' -0.1706 -0.0877 -0.4937' -0.0277 Liver 0.1 169 -0.0079 -0.3599 0.2536 0.0469 0.2509' 0.2321 0.0476' Kidney -0.0150 0.0281 -0.2569 -0.2159 -0.2538' -0.2538' -0.0745 -0.0745 Rib -0.0383 -0.0383 -0.3366 -0.3366 -0.0365 -0.0564 -0.0406 0.0149 ' P < 0.05.