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 people

exposed to arsenic.

 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 on
arsenic-exposed individuals.

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 Pain, paresthesia, numbness, muscle cramp,

Neuropathy Anaesthesia or hypothesia to touch, pain,
temperature, pressure and vibration. Calf
tenderness, deep tendon reflex, muscle
wasting, nerve thickening.

Respiratory
symptoms Cough, shortness of breath,
breath sounds
Eye Conjunctivitis, irritation, watering, burning
sensation
 PHOTOGRAPHS OF DIFFERENT SKIN LESIONS
OBSERVED IN ARSENIC EXPOSED STUDY SUBJECTS

a b c d
(a) Hyperpigmentation (b,c, d) Raindrop pigmentation

e f g h
(e,f) Palmar & Planter (g,h) Plantar
hyperkeratosis hyperkeratosis
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) 0.55 ± 0.39 2.89 ± 2.19a 4.41

± 4.27 a,b

Hair(µg/g) 0.33 ± 0.25 1.93 ± 1.52a 2.67

± 2.33 a,b

Urine(µg/l) 27.69 ± 20.96 238.21 ± 246.79a

175.25±114.04 a,b
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)
45 a,b
Exposed group without arsenic-
40 (N = 352)
induced skin lesion

a,b Exposed group with arsenic-induced

Percentage of Occurance (%)

35
a,b (N = 373)
skin lesion
30

25

20

15
a
a a
10

0
PN Resp Eye

a
p<0.01, when compared to unexposed group
b
p<0.01, when compared to exposed group without arsenic-
induced 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
16

80 14

70 12

Haemoglobin (gm%)
% of Sphaeroechinocytes

60 10

50 8

40 6

30 4

20 2

10 0
0 10 20 30 40 50 60 70 80
0
<7gm% 8 - 10gm% >11gm% % Haemolysis
Hemoglobin Content

Relationship of % of The line represents regression analysis of

Sphaeroechinocytes with different samples obtained from arsenic exposed
degrees of anemia. 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
35

µ M/mg
0.5
30
GSH Content ( µ g/mg of protein)

0.4 25

Protein carbonyl Concentration (

20

of protein)
0.3

15
0.2
10
0.1
5

0 0
Control Group A Group B Group C 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

1.4
*
CD4/CD8 Ratio

1.2

0.8

0.6

0.4

0.2

* p< 0.01
 ARSENIC EXPOSURE REDUCES in vitro CELL
ADHESION AND NITRIC OXIDE PRODUCTION BY
MACROPHAGES

In vitro Cell Adhesion of Macrophages Nitric Oxide Production by Macrophages

Unexposed
0.2 Exposed
0.18

1.5
0.16
0.14 *
Absorbance at 635 nm

0.12

Absorbance at 635 nm
Unexposed

1
0.1
Exposed
0.08 ** *
0.06

0.5
0.04
0.02
0
30 min 60 min 0

*p<0.01. **p<0.05
ARSENIC EXPOSURE ALTERS INFLAMMATORY
CYTOKINE EXPRESSON PATTERNS

5000 *
Unexposed
4500
Exposed
4000
Concentration (pg/ml)

3500
3000
*
2500
2000 * *
*
1500
1000

500
0
TNF-a IL1b IL6 IL8 IL10
Cytokines

*p<0.
 ARSENIC EXPOSURE IMPAIRS
PHAGOCYTIC CAPACITY OF
MACROPHAGES

ΔMFI= MFI(37ºC) -
MFI(4ºC)
Unexposed
173103.3*
Exposed 6733.34

*p<0.001
 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 prove that

arsenic exposure leads to