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Neurofibrillary tangles of Alzheimer's disease contain predominantly tau protein and to a lesser degree amyloid precursor protein (APP), A beta protein, alpha 1-antichymotrypsin (ACT) and ubiquitin. Previously we have demonstrated the presence of phosphorylated tau and neurofilament proteins in neurofibrillary degeneration (NFD) induced by aluminum (Al) maltolate in rabbits [Savory et al., Brain Res. 669 (1995) 325-329; Savory et al., Brain Res. 707 (1996) 272-281]. Using the same animal system we have now detected APP, A beta, ACT and ubiquitin-like immunoreactivities in NFD-bearing neurons, often colocalizing in the NFD. Diffuse cytoplasmic staining for APP, A beta and ubiquitin was also present in neurons without NFD from Al maltolate-treated rabbits. This study provides additional support for immunochemical similarities between Al-induced NFD in rabbits and the neurofibrillary tangles in human subjects with Alzheimer's disease.

Iatrogenic aluminium toxicity is reported in a patient who underwent an orthotopic liver transplant and who had concomitant renal failure requiring hemodialysis. Following transplantation the patient developed a metabolic encephalopathy with only mildly elevated blood ammonia concentrations. During the period following transplantation the patient received massive infusions of albumin and was on oral feeding (vivonexten), both of which contained aluminium, as did the dialysis fluid. Hyperaluminemia and profoundly elevated liver tissue aluminium concentrations were observed. Treatment with desferrioxamine, a trivalent ion chelator, decreased the plasma aluminium concentrations with an improvement in the patient's mental status.

The intracisternal administration of aluminum maltolate to New Zealand white rabbits produces a reproducible neurofibrillary degeneration which is significantly reversed by desferrioxamine treatment. Quantitative analysis of brain and spinal cord tissue demonstrates that the aluminum deposition is higher close to the injection site than at locations further removed from the point of administration. Most importantly, treatment with desferrioxamine removes most of the aluminum from the brain and spinal cord, even from the sites of highest concentration. The ability to manipulate this system in the formation and degradation of NFD and in removal of aluminum may shed light on mechanisms of NFD formation and have implications for therapeutic advances in the treatment of certain human neurodegenerative diseases.

Intracisternal administration of aluminum maltolate to rabbits produces a marked argyrophilic neurofibrillary degeneration (NFD) which is also immunoreactive for both phosphorylated and non-phosphorylated microtubule associated protein tau. Using tissue fixation in PBF, the monoclonal antibodies Tau-2 and AT8 stain the NFD. Dephosphorylation markedly reduces the positivity of AT8. Using PLP-fixed tissue, monoclonal antibody Tau-1 also immunostains aluminum-induced NFD.

Neurotoxic effects of aluminum (Al) were recognized > 100 years ago, but have only recently been studied in detail. By far, the most dramatic effect of Al is that of producing intraneuronal perikaryal neurofilamentous aggregates, which consist of phosphorylated neurofilaments. Several species have been used to demonstrate this effect, rabbit being most common; the effect also is seen in in vitro systems. Besides its role in producing neurofibrillary pathology, Al appears to modify the blood-brain barrier and exert cholinergic and noradrenergic effects. Possible mechanisms of Al neurotoxicity could be related to cell damage via free radical production, impairment of glucose metabolism, and effects on signal transduction.

The deposition of aluminum (Al) in the brain and spinal cord of adult male New Zealand white rabbits was monitored following the intraventricular administration of Al maltolate. Although decreasing concentrations of Al were observed from the injection site (approximately 10 micrograms/g dry tissue) to the lumbar cord (2.1 micrograms/g), argyrophilic tangles were present in the perikarya and proximal neurites of neurons as far distal as the lumbar and sacral cord areas. Quantitative immunoblot studies of the three neurofilament protein isoforms failed to detect changes resulting from Al maltolate treatment. Similarly no significant alterations in the total phosphate content of these cytoskeletal proteins were observed. Lastly, on Northern blots, the expression of genes encoding for the 200 kDa and 68 kDa neurofilament proteins also was unaffected by Al maltolate treatment.

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.

Aluminum (Al) was given orally as a citrate salt in either hard or soft water in combination with low or normal dietary calcium intake over the duration of 12 months using 60 healthy, young adult male New Zealand white rabbits, age four to seven months, divided into six groups. Although decreased weight gain was noted, no significant histological changes were found in the central or peripheral nervous system or in multiple other organs except for liver, nor were tissue levels of Al elevated in brain or liver. However, Al in renal tissue was increased after 52 weeks of treatment in Group 1 (which received Al and a low calcium diet), in spleen in Groups 1 and 2 (on Al and a low calcium diet), and in bone in Group 1. Thus, although the mature intestine acts as a relatively impermeable barrier, some Al is, in fact, absorbed and deposited.

The effects of long-term aluminum exposure on erythroid parameters were investigated in a rabbit system. Healthy young adult male rabbits were maintained on drinking water containing five mg per L of aluminum citrate; others were treated with an intravenous solution of aluminum maltol, 0.225 mmol of aluminum per week. In the oral study, decreases in the hematocrit, hemoglobin, and red cell count were observed over a 12-month period in those animals on soft water with a low calcium content and containing aluminum citrate; however, no changes were seen in those on hard water containing aluminum citrate nor in rabbits maintained on a normal diet. Small amounts of aluminum were observed in bone marrow macrophages, usually accompanied by iron, in both the orally- and intravenously-treated animals. There was poor correlation between bone marrow aluminum content and length of exposure.

We have developed a neuronal culture system to evaluate the neurotoxic effects of aluminium maltol on fetal rabbit midbrain sections containing the oculomotor nucleus. Cultures were treated with 5, 7, 9, 11, 13 and 15 mumol/l aluminium maltol or 39 and 45 mumol/l maltol (molal equivalents to 13 and 15 mumol/l aluminium maltol). Control cultures were maintained in nutrient medium alone. Silver-positive neuritic swellings and occasional perikaryal neurofibrillary tangles were observed in cultures treated with 11, 13 and 15 mumol/l aluminium maltol. The number of tangles (involved neurons) produced in aluminium maltol treated cultures were counted and compared to (untreated) controls. We observed a total of 3, 7 and 7% of involved neurons following treatment with 11, 13 and 15 mumol/l aluminium maltol respectively, and none in the control group. By immunohistochemistry, neurofibrillary tangles were immunoreactive with MAbs to phosphorylated (SMI-31), non-phosphorylated, phosphorylation dependent (SMI-32) and phosphorylation independent (SMI-33) epitopes of the high (-H) and middle (-M) molecular weight neurofilament subunits (NF-H/M). By contrast these lesions were nonreactive with MAbs recognizing tau, MAP2 or different beta-tubulin isotypes. The perikaryal tangles consisted of focal accumulations of 10 nm straight filaments by electron microscopy. These findings are in agreement with previous data from rabbit in vivo studies after the administration of aluminium maltol intravenously (Bertholf et al., 1989) or intraventricularly (Katsetos et al., 1990). Using this in vitro system, aluminium-induced neurofibrillary tangles can be consistently produced, and changes in the distribution of neurofilament proteins evaluated. These studies may aid in the assessment of the possible role of aluminium in the aetiology of human neurodegenerative disorders.

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.

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.

Aluminum is the most abundant metal in the earth's crust. The widespread occurrence of aluminum, both in the environment and in foodstuffs, makes it virtually impossible for man to avoid exposure to this metal ion. Attention was first drawn to the potential role of aluminum as a toxic metal over 50 years ago, but was dismissed as a toxic agent as recently as 15 years ago. The accumulation of aluminum, in some patients with chronic renal failure, is associated with the development of toxic phenomena; dialysis encephalopathy, osteomalacic dialysis osteodystrophy, and an anemia. Aluminum accumulation also occurs in patients who are not on dialysis, predominantly infants and children with immature or impaired renal function. Aluminum has also been implicated as a toxic agent in the etiology of Alzheimer's disease, Guamiam amyotrophic lateral sclerosis, and parkinsonism-dementia.

The multiple features of the syndrome of uremia are a result of the retention of a wide variety of metabolic end products. Although a number of metabolites have been incriminated as "the uremic toxin," none of them accounts for all aspects of uremia. It is likely that the uremic syndrome is a result of the pathological effects of many retained substances. Of major current interest is the development of toxicity in brain, bone and other tissues due to accumulation of aluminum. The recognition of aluminum toxicity may have implications not only in patients with impaired renal function but also in other disease states.

This method for determining aluminum in human serum involves electrothermal atomic absorption spectrophotometry. A longer drying time allows less pre-dilution of the sample, and the method also includes a flush cycle after atomization. Standard-addition methodology is used to eliminate matrix effects and the need for a standard curve. We used this method on serum from 50 normal persons and from 34 patients with chronic renal failure who were on long-term intermittent hemodialysis. The mean normal serum aluminum concentration was 6.1 micrograms/L (CV 2.7%), and values for the patients ranged from 13 to 475 micrograms/L.

In order to study the effects of vitamin D on aluminium balance when different forms of vitamin D and phosphate binders are used simultaneously for therapeutic purposes, 30 Sprague-Dawley weanling rats, weighing 44-66 g, were randomly assigned to 5 groups: (A) control, (B) aluminum hydroxide, (C) dihydrotachysterol at 16 micrograms/kg/day, (D) 1,25-dihydroxyvitamin D at 16 ng/kg/day and (E) vitamin D at 2,000 IU/kg/day. Aluminum hydroxide (60 mg/kg/day) in the feed was provided to all except the control group. The vitamin D or metabolites were fed by stomach tube daily for a period of 10 days. At the end of the study, the mean (+/- SEM) serum aluminum concentration, as determined by flameless atomic absorption spectrophotometry, was 5.0 +/- 2.4 micrograms/l; there were no significant differences in these results between groups. During the last three days of the study, 24-hour urine and stool collections were made with the usual precautions against trace mineral contamination. The means (+/- SEM) of aluminum balances for groups A, B, C, D and E were -388 +/- 261, 1,121 +/- 331; 2,316 +/- 304; 2,387 +/- 245, and 1,968 +/- 337 micrograms/day, respectively. We conclude that at therapeutic doses of aluminum hydroxide and vitamin D or its metabolites, hyperaluminemia was not observed. However, the positive aluminum balances imply retention, and the use of vitamin D, especially its potent metabolites dihydrotachysterol and 1,25-dihydroxyvitamin D, intensified this risk.

In the presence of normal renal function, a high concentration of aluminum in drinking water has been implicated as a factor in the etiology of a neurological syndrome in one specific geographical area. The role of aluminum as a toxic agent in other neurological disorders, where renal function is normal, is controversial. Aluminum is absorbed from the gastrointestinal tract and is normally excreted by the kidneys in the urine. In patients with chronic renal failure, aluminum appears to be of proven toxicological importance. In these patients the accumulation of aluminum in tissues causes an encephalopathy (dialysis encephalopathy or dialysis dementia), a specific form of metabolic bone disease (osteomalacic dialysis osteodystrophy), and an anemia and also plays an etiological role in some of the other complications associated with end-stage chronic renal disease. A failure in the normal renal excretory mechanism accounts for the tissue accumulation in chronic renal failure. The majority of chronic renal failure patients who develop aluminum toxicity are on long-term treatment with either hemo- or peritoneal dialysis; some patients develop toxicity who are only on treatment with aluminum-containing phosphate-binding agents. Aluminum in the dialysate appears to be the major source of the metal in chronic renal failure patients who develop aluminum toxicity. The aluminum content of the dialysate depends primarily on the content of the water with which it is prepared; there may be some contribution from the chemicals used in the concentrate which is added to the water. Some domestic tap-water supplies contain aluminum in high concentration, either naturally or because aluminum has been added as a flocculant in the purification process.(ABSTRACT TRUNCATED AT 250 WORDS)

An understanding of Al3+-induced diseases requires identification of the blood carrier of Al3+ to the tissues where Al3+ exerts a toxic action. Quantitative studies demonstrate that the protein transferrin (iron-free) is the strongest Al3+ binder in blood plasma. Under plasma conditions of pH 7.4 and [HCO3-]27 mmol/L, the successive stability constant values for Al3+ binding to transferrin are log K1 = 12.9 and log K2 = 12.3. When the concentration of total Al3+ in plasma is 1 mumol/L, the free Al3+ concentration permitted by transferrin is 10(-14.6) mol/L, less than that allowed by insoluble Al(OH)3, by Al(OH)2H2PO4, or by complexing with citrate. Thus transferrin is the ultimate carrier of Al3+ in the blood. We also used intensity changes produced by metal ion binding to determine the stability constants for Fe3+ binding to transferrin: log K1 = 22.7 and log K2 = 22.1. These constants agree closely with a revision of the reported values obtained by equilibrium dialysis. By comparison with Fe3+ binding, the Al3+ stability constants are weaker than expected; this suggests that the significantly smaller Al3+ ions cannot coordinate to all the transferrin donor atoms available to Fe3+.

The absorption of aluminum was studied in twelve healthy male volunteers over a period of fourteen days in a placebo-controlled, double blind study. All subjects were institutionalized during the study. Eight subjects (treated group) received ascending doses of aceglutamide aluminum (N-acetyl-L-glutamine aluminum complex) administered in multiple daily doses. The remaining four subjects (untreated group) received placebo. Systemic absorption and excretion of aluminum were evaluated by measuring aluminum concentrations in serum, urine and fecal samples. Aluminum concentrations were determined by electrothermal atomic absorption spectrometry. All serum aluminum concentrations were less than 16 micrograms/L for both groups. The mean urinary and fecal aluminum concentrations in the aluminum-treated group were significantly higher than in the untreated group during the study days the drug was administered. The total amount of aluminum (as aceglutamide aluminum) given to each treated subject during the 14 day study period as 3290 mg. The mean total fecal aluminum concentration was 3318 mg for the treated group and 269 mg for the untreated group during the study period. These findings are consistent with the view that some aluminum absorption from the gastrointestinal tract occurred following the administration of the drug. The absorbed aluminum appears to have been rapidly excreted in the urine and the feces.

Aluminum related osteodystrophy is the most important manifestation of trace metal toxicity related to degenerative diseases of the skeleton. Aluminum overload occurs in chronic renal failure patients on hemodialysis treatment and results from transfer from dialysis solutions and from oral intake of aluminum containing phosphate binding gels. Laboratory diagnosis involves serum and bone analysis and bone staining for aluminum. A challenge test with desferrioxamine also aids in the diagnosis. Electrothermal atomic absorption spectrometry is widely used for aluminum detection. Guidelines for toxic concentrations of aluminum have been established.

Simultaneous administration of 1,25-dihydroxyvitamin-D3, citrate, and aluminum-containing phosphate binders is frequently used in patients with chronic renal failure. In order to investigate whether citrate may represent a risk factor of aluminum intoxication, 16 Sprague-Dawley weanling rats were randomly assigned to four groups: 1,25-dihydroxyvitamin-D3 at 16 ng/kg/day was given to all groups except the control; in addition, two groups received either aluminum hydroxide at 160 mg elemental aluminum/kg/day, or aluminum citrate at 160 mg elemental aluminum/kg/day, respectively. The control group received only the vehicle. Extremely high aluminum concentrations were detected in the hippocampus of rats receiving aluminum compounds. This content of aluminum (microgram/g dry weight) was far higher than that found in other brain areas of the same animals (146.40 +/- 51.23 versus 4.49 +/- 0.62, P less than 0.001) as well as that detected in the hippocampus of the control animals (2.73 +/- 0.40). Thus, in non-uremic, weanling rats supplemented with 1,25-dihydroxyvitamin-D3, the administration of aluminum favors selective accumulation in the hippocampus. No differences between aluminum hydroxide and aluminum citrate administration were observed.

We have studied the electrothermal atomic absorption measurement of aluminum in serum samples by direct analysis with standard additions and the use of a matrix modifier. We have also measured aluminum by analysis of the supernate after pretreatment of serum with concentrated nitric acid to precipitate proteins, and have compared the results obtained by these two techniques. Both appear to eliminate interferences arising from the serum matrix. We quantified the aluminum by utilizing a stabilized temperature (L'vov) platform. Within-run precision (CV) for the standard-additions method was 16.6% (means = 6.5 micrograms/L) and 6.0% (means = 86.8 micrograms/L) and for the protein precipitation method was 10.1% (means = 10.9 micrograms/L) and 4.2% (means = 88.5 micrograms/L). Linearity of the standard curve extended from 0 to 120 micrograms/L for the standard-additions method and from 0 to 100 micrograms/L for the protein precipitation method. Samples from 38 patients were analyzed by both techniques, and linear regression analysis yielded the equation y (protein precipitation) = 1.02 X (standard additions) + 2.04.

By means of laser microprobe mass analysis (LAMMA), we have studied the ultrastructural localization of aluminium in livers of aluminium maltol-treated rabbits. This animal model was developed to study long-term aluminium toxicity using systemic (intravenous) administration of aluminium. We could only detect aluminium in electron-dense inclusion bodies found in large, sometimes multinucleated cells. These results prove that the actual observation of aluminium deposits in liver with LAMMA gives more information than bulk analysis and can be very useful to explore mechanisms of toxicity.

The binding of aluminum in the serum of a normal male volunteer was examined using gel filtration chromatography and flameless atomic absorption spectrometry. The elution profile obtained with Sephacryl S-200 gel separated the aluminum into four major peaks. These peaks appear to be associated with a high molecular weight protein(s), albumin, and possibly some low molecular weight protein(s) and/or some inorganic anions. The elution profile for a renal dialysis patient gave similar results.

Normal and uremic serum samples were chromatographed on a gel filtration column and fractions were analyzed for protein and aluminum content. Whereas much of the aluminum in the serum samples eluted with protein, a significant fraction appeared to be associated with low molecular weight species. Analysis of column fractions for aluminum binding by a competitive binding assay indicated no aluminum-binding serum constituents in these later eluting fractions. Uremic serum appeared, however, to contain aluminum-binding constituents of a lower molecular weight than in normal serum.

Aluminum is a toxic metal and has been implicated as the causative agent in the dialysis encephalopathy syndrome. In the study reported here, the transfer of aluminum to the blood from dialysis fluid during hemodialysis was demonstrated even when deionized water was used in the preparation of the dialysate. Studies were carried out on the binding of aluminum to serum proteins and other constituents in patients on long-term hemodialysis. Five major aluminum peaks were observed on chromatographic separation; four were associated with proteins and one large peak was probably associated with a low molecular weight species. The size of the latter peak was enhanced by increasing the aluminum content of the eluting buffer. It is postulated that this low molecular weight species might be the neurotoxic form of aluminum.

Aluminum toxicity in patients with chronic renal failure has been related to renal osteodystrophy and dialysis encephalopathy (DES). The toxicity is associated with renal osteodystrophy in two ways. One association is the iatrogenic effect of excessive use of aluminum hydroxide gels resulting in hypophosphatemia which interferes with bone mineralization. The second association may involve deposition of aluminum in bone owing to aluminum being absorbed during hemodialysis. Evidence for this second association has been gathered from epidemiological studies of hemodialysis centers and their practices of using either tap water high in aluminum in the dialysate, or aluminum-free deionized water. In patients with DES, aluminum accumulation in the brain has been clearly shown to come from either the ingestion of aluminum containing phosphate-binding gels, aluminum in the dialysate, or a combination of the two. The outbreak of the DES also has been well-correlated with the sudden elevation of aluminum in tap water owing to the use of large amounts of aluminum in water treatment plants. Whether aluminum itself or a combination of aluminum and other factors causes DES is not understood at this time.

The methods for aluminum analysis vary from the simple and often nonspecific chemical and physical procedures to the highly sophisticated types such as neutron activation and atomic absorption spectrometry. Atomic absorption procedures are the techniques of choice for most routine hospital laboratories. The wide distribution of aluminum in nature can create severe contamination problems in aluminum analysis. Procedures to avoid contamination are discussed. In recent years aluminum has been implicated as a possible etiological agent in DES and in Alzheimer's Disease. A common finding in these two conditions is an elevated brain aluminum content. The patients with Alzheimer's Disease develop characteristic neurofibrillary tangles which lead to the degeneration of the affected neurons. Similar tangles can be induced in laboratory animals injected intracerebrally with aluminum salts. Even though the laboratory animals develop tangles resembling those seen in patients with Alzheimer's Disease, no evidence has been published to show that the tangles seen in Alzheimer's Disease are induced by the elevated brain aluminum content. Although there are some similar clinical symptoms in both Alzheimer's Disease and DES, the hemodialysis patients with DES do not develop neurofibrillary tangles despite an elevated brain aluminum content. The significance of this difference is not understood. The sources of the increase in tissue aluminum levels found in hemodialysis patients are from the gastrointestinal absorption of aluminum in aluminum containing phosphate-binding gels and by transfer from the dialyzate to the blood during the hemodialysis procedure. Plasma aluminum values may be reduced by the administration of a minimum dosage of phosphate-binding gels and by the use of purified water to make up the dialysate. The incidence of DES is reduced by the use of these procedures to maintain the hemodialysis patients' plasma aluminum at a low concentration. The increased brain aluminum content of patients with Alzheimer's Disease is derived from the environment. Because of the ubiquitous occurrence of aluminum, we are exposed to it daily in our food, water, and in the air. The low levels of aluminum absorbed from the environment may explain why susceptible patients do not develop Alzheimer's Disease until after many years of exposure, if indeed aluminum is the etiological agent in Alzheimer's Disease. The many papers that have been published concerning aluminum, DES, and Alzheimer's Disease make a strong case for linking elevated tissue aluminum content with these conditions. However, conclusive evidence to support this theory has not been published. Until the effect of aluminum on cellular chemistry is more fully understood, the possibility that DES and Alzheimer's Disease may result from other causes or from aluminum and another agent acting concomitantly must be considered.

Aluminium is a ubiquitous element in the environment and has been demonstrated to be toxic, especially in individuals with impaired renal function. Not much is known about the biochemistry of aluminium and the mechanisms of its toxic effects. Most of the interest in aluminium has been in the clinical setting of the haemodialysis unit. Here aluminium toxicity occurs due to contamination of dialysis solutions, and treatment of the patients with aluminium-containing phosphate binding gels. Aluminium has been shown to be the major contributor to the dialysis encephalopathy syndrome and an osteomalacic component of dialysis osteodystrophy. Other clinical disturbances associated with aluminium toxicity are a microcytic anaemia and metastatic extraskeletal calcification. Aluminium overload can be treated effectively by chelation therapy with desferrioxamine and haemodialysis. Aluminium is readily transferred from the dialysate to the patient's bloodstream during haemodialysis. Once transferred, the aluminium is tightly bound to non-dialysable plasma constituents. Very low concentrations of dialysate aluminium in the range of 10-15 micrograms/l are recommended to guard against toxic effects. Very few studies have been directed towards the separation of the various plasma species which bind aluminium. Gel filtration chromatography has been used to identify five major fractions, one of which is of low molecular weight and the others appear to be protein-aluminium complexes. Recommendations on aluminium monitoring have been published and provide 'safe' and toxic concentrations. Also, the frequency of monitoring has been addressed. Major problems exist with the analytical methods for measuring aluminium which result from inaccurate techniques and contamination difficulties. The most widely used analytical technique is electrothermal atomic absorption spectrometry which can provide reliable measurements in the hands of a careful analyst.

In the past decade, aluminum has been recognized as a toxic metal in patients with chronic renal failure. It is, however, possible that other trace metals, such as nickel, may also have toxic actions in these patients. The plasma concentration of a metal, such as aluminum or nickel, may not provide a valid index of either tissue content or total body burden. In the study reported here, the aluminum and nickel content of lymphocytes was measured and compared with plasma concentrations in normal controls and patients with chronic renal failure. The findings suggest that lymphocytes may be of value as a nucleated 'tissue' for the assessment of trace metal status.

A method was developed for measuring the concentration of lipid peroxidation products in rabbit brain, heart, lung, liver, and kidney tissue. Specimens were homogenized in cold buffer, acidified, and heated to near boiling in the presence of thiobarbituric acid in order to form the malondialdehyde-thiobarbiturate adduct. After centrifugation, the supernatant was injected onto a reversed-phase high pressure liquid chromatography (HPLC) column, and the effluent was monitored for absorbance at 532 nm. Absorbances were compared to a standard curve constructed from absorbance data for tetraethoxypropane standards, which yield stoichiometric amounts of the malondialdehyde-thiobarbiturate adduct. Results were expressed as nmol of adduct per gram (dry weight) of tissue. Hippocampus had significantly greater concentrations of lipid peroxidation products (79.0 +/- 15.7 nmol per g) than did brainstem (52.1 +/- 13.8 nmol per g), but there was no significant increase in lipid peroxidation in aluminum treated rabbit brains when compared with controls. Aluminum intoxication appeared, however, to stimulate lipid peroxidation in heart, lung, liver, and kidney. Aluminum accumulation in brain and organ tissue of treated rabbits was confirmed by atomic absorption spectrophotometry of an acid digest of the homogenate. These results are in contrast to previous studies which demonstrated an increase in lipid peroxidation products in rat brains following oral administration of aluminum hydroxide.

We studied the toxicity of an intravenously injected, water-soluble aluminum complex (aluminum maltol) in 20 young adult male New Zealand white rabbits over a period of 8 to 30 weeks. Sixteen rabbits injected with aluminum-free maltol and 15 untreated rabbits served as controls. Rabbits were injected three times per week with 75 mumol of aluminum maltol per injection, or a molar equivalent amount of maltol alone, through an indwelling jugular catheter. Liver contained the highest concentrations of aluminum among the aluminum maltol-treated rabbits, and aluminum accumulation was correlated with the appearance of periportal multinucleated giant cells in 13 of 20 rabbits. These cells stained positively for aluminum when a fluorescent (Morin) stain was applied to tissue from rabbits with a high concentration of aluminum in the liver. Proximal renal tubular necrosis or atrophy was found in 15 of 20 aluminum maltol-treated rabbits but not in maltol-treated and untreated controls. Renal tubules in rabbits with acute proximal renal necrosis stained positively for aluminum. Neurofibrillary tangles, immunoreactive with a monoclonal antibody to the 200-kDa subunit of neurofibrillary protein, were observed in the oculomotor nucleus of 3 aluminum maltol-treated rabbits (treated for 12, 20, and 29 weeks), but in none of the two groups of controls. These tangles were present in 3 of 10 aluminum-treated rabbits in which the nucleus was located. None of the 17 animals in both control groups in which the nucleus was found demonstrated tangles. A slight increase in brain tissue aluminum concentration was confirmed by an electrothermal atomic absorption spectrophotometric method. There were no specific findings in heart or lung tissue from aluminum-treated rabbits, although the aluminum content of these tissues was 10 to 20 times greater than control values. This model should be useful for investigating the effects of systemic exposure to high concentrations of solubilized aluminum.

Binding of aluminum to human serum albumin and transferrin was investigated using a competitive binding assay incorporating a cation exchange resin, chelex. Both albumin and transferrin were found to produce linear Scatchard plots of aluminum binding data over the aluminum and protein concentration ranges found in humans. Binding constants measured for albumin and transferrin were 1.96 and 0.515 microM, respectively.

In normal subjects the gastrointestinal tract is a relatively impermeable barrier to aluminum with a low fractional absorption rate for this metal ion. Aluminum absorbed from the gastrointestinal tract is normally excreted by the kidneys; in the presence of impaired renal function aluminum is retained and accumulates in body tissues. Aluminum-containing medications are given, by mouth, to patients with chronic renal failure as phosphate-binding agents for the therapeutic control of hyperphosphatemia. Patients with chronic renal failure are also exposed to aluminum in domestic tap-water supplies used either for drinking or, in those on dialysis treatment, in the preparation of their dialysate. In patients with end-stage chronic renal failure, particularly in those on treatment by hemodialysis, the accumulation of aluminum in bone, brain, and other tissues is associated with toxic sequelae. An increased brain content of aluminum appears to be the major etiological factor in the development of a neurological syndrome called either "dialysis encephalopathy" or "dialysis dementia"; an increased bone content causes a specific form of osteomalacia. An excess of aluminum also appears to be an etiological factor in a microcytic, hypochromic anemia that occurs in some patients with chronic renal failure on long-term treatment with hemodialysis. The various mechanisms involved in the toxic phenomena associated with the accumulation of aluminum in body tissues have not been clearly defined but are the subject of extensive investigations.