Monoclonal antibodies to salmonid immunoglobulin: characterization and applicability in immunoassays.

Monoclonal antibodies to rainbow trout (Oncorhynchus mykiss) IgM were prepared and characterized for use in immunoassays. Antibodies produced by the five clones reacted with the heavy chain of the immunoglobulin. No indication of different heavy chain isotype specificity was observed for the MAbs. One clone discerned IgM from rainbow trout while the other four clones cross-reacted with IgM from Atlantic salmon (Salmo salar) and from brown trout (Salmo trutta). The monoclonal antibodies identified a B-cell like lymphocyte population that contributed to approximately 45% of the blood leucocytes in rainbow trout but was absent in the thymus. The proportion of Ig+ cells was higher in blood lymphocyte cultures stimulated with lipopolysaccharide than in nonstimulated cultures or in cultures stimulated with Concanavalin A. Applied in an ELISA for measuring humoral antibodies to Vibrio anguillarum in trout, the monoclonal anti-rainbow trout IgM antibodies discriminated seropositive fish from control fish more efficiently than did polyclonal rabbit antitrout IgM antibodies.

Immunomodulating effects after perinatal exposure to methylmercury in mice.

The influence of methylmercury on the developing immune system was studied in offspring from Balb/c mice exposed to 0, 0.5 or 5 mg Hg/kg as methylmercury in the diet. Dams were exposed for 10 weeks prior to mating, during gestation and lactation. Pups were exposed to mercury until day 15 of lactation, thereafter the pups were given control milk and control diet. Samples for mercury analysis were collected from the pups on days 22 and 50, and for immunological studies on days 10, 22 and 50. The exposure resulted in significantly increased total Hg concentrations in whole blood on day 22 and 50 in offspring from the 5 mg Hg/kg group, and in offspring from the 0.5 mg Hg/kg group on day 22. On day 50, blood mercury levels had decreased to background levels in the 0.5 mg Hg/kg group. Increased numbers of splenocytes and thymocytes were found in offspring from the 0.5 mg Hg/kg group. Flow cytometry analysis of thymocytes revealed increased numbers and altered proportions of lymphocyte subpopulations within the thymus in offspring from both of the exposed groups. The proliferative response of splenocytes to the B-cell mitogen LPS was increased in offspring from dams exposed to 5 mg Hg/kg, and the primary antibody response to a viral antigen was stimulated in pups from dams exposed to 0.5 mg Hg/kg. The present results indicate that placental and lactational transfer of mercury affects thymocyte development and stimulates certain mitogen- or antigen-induced lymphocyte activities in mice.

Lack of effects of some individual polybrominated diphenyl ether (PBDE) and polychlorinated biphenyl (PCB) congeners on human lymphocyte functions in vitro.

The structural similarities between polybrominated diphenyl ethers and immunotoxic halogenated aromatic compounds suggest that the polybrominated diphenyl ethers might affect the immune system. The present study was undertaken to investigate the immunological effects of some purified PBDE-congeners on human lymphocyte function in vitro. Polychlorinated biphenyl congeners were also included in the study. Mitogen-induced DNA synthesis and immunoglobulin synthesis by lymphocytes from blood donors were examined following polybrominated diphenyl ether or polychlorinated biphenyl exposure in vitro in order to determine the immunotoxic potential of these substances. No effects on mitogen-induced proliferation or immunoglobulin synthesis were observed after exposure of cells to concentrations up to 10(-5) M. The negative findings in this study indicate that certain functions of human peripheral lymphocytes, i.e. proliferation and immunoglobulin synthesis, are insensitive to the direct action of polybrominated diphenyl ethers and polychlorinated biphenyls. Our results are in accordance with other recent studies in which no effects on immunological parameters were demonstrated by exposure of lymphocytes to polyhalogenated aromatic hydrocarbons in vitro.

Effects of subchronic exposure to Caramel Colour III on the immune system in mice.

Administration of Caramel Colour III is associated with lymphopenia in laboratory animals, especially if the animals are fed a vitamin B6-deficient diet. Recently, functional immunological alterations in rats exposed to Caramel Colour III have been reported. The component of Caramel Colour III that is responsible for the immunological effects has been shown to be 2-acetyl-4-tetrahydroxybutyl imidazole (THI). In the present study, female Balb/c mice fed a diet with a relatively high vitamin B6 content were exposed to 2 or 10% of a commercial Caramel Colour III preparation with a low THI content (less than 25 ppm) in the drinking water for 9 wk. Although this treatment did not induce a lymphopenia in the exposed mice, flow cytometric analysis of lymphocyte subpopulations demonstrated reductions in the CD4+ and CD8+ cell populations. In addition, the proliferative response of spleen cells to B and T cell mitogens was significantly reduced in the mice exposed to 2% Caramel Colour III. No changes were observed in natural killer cell activity or in the humoral antibody response to a viral antigen. The results indicate that Caramel Colour III that meets the specified limit of less than 25 mg THI/kg may, nevertheless, interfere with the lymphoid system in mice with an adequate vitamin B6 status.

In vitro exposure of human lymphocytes to trichothecenes: individual variation in sensitivity and effects of combined exposure on lymphocyte function.

The trichothecenes are mycotoxins produced by fungi of the genus Fusarium, which are commonly present in foods and feed of cereal origin. Owing to the lack of sufficient toxicological data for most of the trichothecenes, in vitro studies may contribute to risk assessments of these toxins. In the present report, human lymphocyte cultures were used to study the individual variation in sensitivity among humans and the effects on in vitro Ig production. Furthermore, proliferative responses of cells exposed to combinations of two of the toxins were studied. Four toxins, T-2 toxin, diacetoxyscirpenol (DAS), nivalenol (NIV) and deoxynivalenol (DON) were included in the study. All four of the tested trichothecenes effectively inhibited mitogen-induced lymphocyte proliferation. There were no statistically significant differences in sensitivity to the toxins between lymphocytes from female and male blood donors. The individual variation in sensitivity, evaluated as the range of IC50 values, was rather limited (within a factor of 3 to 4). Immunoglobulin production by pokeweed-stimulated human lymphocytes was also effectively inhibited with IC50 values similar to the IC50 values in the proliferation tests for DON and NIV. However, IC50 values for Ig synthesis in cultures exposed to T2 were approximately two to three times higher than the corresponding IC50 values found in the proliferation tests. At low levels of exposure, elevated Ig production was observed in lymphocyte cultures from four out of the five blood donors tested. This effect was most pronounced on IgA synthesis. Combinations of NIV with T2, DAS or DON resulted in additive toxicity in the lymphocyte proliferation test, while combinations of DON with T2 or DAS resulted in an inhibition that was slightly lower than what could have been expected from the inhibition produced by the individual toxins. In conclusion, the tested trichothecenes inhibited both proliferation and Ig production in human lymphocytes in a dose-dependent manner with limited variation in sensitivity between individuals. Enhanced Ig production was observed in cell cultures exposed to the lower doses of the toxins. Combined exposure to two of the toxins resulted mainly in additive or antagonistic effects, although synergistic effects cannot be excluded and should be further investigated. These findings indicate that the total intake of type A and B trichothecenes should be taken into account in risk assessments.

Effects of ochratoxin A on the mouse immune system after subchronic exposure.

The effects on the immune system of oral, subchronic exposure to ochratoxin A (OA) at 6, 250 or 2600 micrograms/kg diet were studied in female Balb/c mice. After 28 days of exposure, antibody production plague-forming cells/spleen, was suppressed in a dose-dependent manner which was significant in the two highest exposure groups. In addition, a decrease in thymocyte cell counts was seen in the 250-micrograms/kg group. After 90 days exposure, flow cytometry analysis of thymic lymphocyte subpopulations revealed a decreased proportion of mature (CD4+ or CD8+) cells. Furthermore, the mitogenic responsiveness of thymocytes and splenocytes to concanavalin A (Con A) was significantly decreased. This effect was observed in all three treatment groups. Interleukin-2 production of Con A-stimulated lymphocytes, natural killer cell activity, and humoral antibody titres to a viral antigen were not affected by OA treatment. The present results indicate that subchronic, oral exposure to OA affects certain immune functions in mice at exposure levels that may be found in contaminated food products.

Prenatal exposure of Balb/c mice to ochratoxin A: effects on the immune system in the offspring.

Effects of prenatal exposure to the mycotoxin ochratoxin A (OA) on the immune system were evaluated in Balb/c mice. Dams were exposed to OA in their diet at doses of 0.18 (control), 30 or 200 micrograms/kg before and during gestation. At birth, pups were cross-fostered to non-exposed dams. OA exposure of the dams did not influence reproductive outcome, that is, the numbers of litters, litter sizes and body weight of the pups. Flow cytomety analysis of T-lymphocyte subpopulations on days 14 and 28 postpartum revealed a decrease in the percentages of splenic CD4+ and CD8+ cells in offspring from the high-dose group (200 micrograms/kg diet), but no significant alterations in absolute numbers of these cell populations nor in the total numbers of splenocytes were observed. In the thymus, a relative as well as an absolute increase in the CD4+ subpopulation was seen in exposed pups on day 14. On day 28, the absolute numbers of CD4+, CD8+ and CD4+CD8+ (double positive) cells were increased, reflecting an elevated number of thymocytes in the high-dose group. No significant differences were found in the proliferative responses of splenic or thymic lymphocytes to mitogens, or in the production of interleukin-2 in concanavalin A-stimulated cell cultures. Further, the plaque-forming cell response to sheep red blood cells and the humoral antibody response to the viral antigen PR8 were not affected by prenatal exposure to OA. No significant differences in natural killer cell activity were observed. The results indicate that exposure of dams to relatively low levels of dietary OA alters absolute and relative numbers of lymphocyte subpopulations in lymphoid organs, but does not suppress immune functions in the offspring.

Levels of ochratoxin A in blood from Norwegian and Swedish blood donors and their possible correlation with food consumption.

Blood levels of ochratoxin A were determined in 406 Scandinavian blood donors (206 from Oslo, Norway, and 200 from Visby on the island of Gotland, Sweden), using an HPLC method. In connection with the blood collection, the subjects were asked to fill in a food questionnaire to obtain individual dietary information relevant to ochratoxin A exposure. The mean plasma level of ochratoxin A was 0.18 ng/ml in Oslo and slightly higher, 0.21 ng/ml (P=0.046) in Visby. There was no correlation between plasma levels of ochratoxin A and the estimated total dietary intake of ochratoxin A based on consumption data and levels in food (retrieved from the literature), neither was the plasma level of ochratoxin A correlated with the total amount of food consumed. However, consumption of several foods, including cereal products, wine, beer and pork, were to some minor degree related to high plasma levels of ochratoxin A. The strongest correlations (correlation coefficient r>0.4; P<0.001) were observed for women in relation to the consumption of beer or medium brown bread. Correlation analysis of combinations of two or more food categories did not result in any statistically significant correlation.

Toxicological evaluation of myristicin.

Myristicin, or methoxysafrole, is the principal aromatic constituent of the volatile oil of nutmeg, the dried ripe seed of Myristica fragrans. Myristicin is also found in several members of the carrot family (Umbelliferae). Several intoxications have been reported after an ingestion of approximately 5 g of nutmeg, corresponding to 1-2 mg myristicin/kg body weight (b.w.). Although these intoxications may be ascribed to the actions of myristicin, it is likely that other components of nutmeg may also be involved. The metabolism of myristicin resembles that of safrole. No information is available, however, concerning the quantitative importance of the different metabolic pathways. The acute toxicity of myristicin appears to be low. No toxic effects were observed in rats administered myristicin perorally at a dose of 10 mg/kg b.w., while 6-7 mg/kg b.w. may be enough to cause psychopharmacological effects in man. A weak DNA-binding capacity has been demonstrated, but there are no indications that myristicin exerts carcinogenic activity in short-term assays using mice. Intake estimations indicate that nonalcoholic drinks may be the most important single source of myristicin intake. Based on available data, it seems unlikely that the intake of myristicin from essential oils and spices in food, estimated to a few mg per person and day in this report, would cause adverse effects in humans. It is, however, at present not possible to make a complete risk assessment, as studies regarding genotoxicity and chronic toxicity, including reproductive toxicity and carcinogenicity, are still lacking.

Activation markers and cell proliferation as indicators of toxicity: a flow cytometric approach.

Cell proliferation is an attractive endpoint in in vitro toxicity assays, since nearly any kind of damage in a cell may result in altered cell proliferation. In toxicological applications, liquid scintillation counting, measuring radioactivity from tritiated thymidine, has been the traditional way to estimate cell proliferation. An alternative approach is the measurement of BrdU incorporation by flow cytometry. Before the actual DNA synthesis starts, several proteins are expressed on the cell surface, as well as intracellularly. Among the markers on the cell surface CD69, CD25, and CD71 are sequentially expressed on human lymphocytes after a mitogenic stimulation. The aim of this study was to evaluate information obtained by analysis of expression of activation markers on cell surfaces in lymphocyte subsets and to compare it with data from cell proliferation studies performed by liquid scintillation counting and BrdU flow cytometry. The experiments were performed with phytohemagglutinin-stimulated human lymphocytes exposed to ochratoxin A and cyclosporin A. While ochratoxin A-treated cultures showed a steep inhibition with increasing concentration, the cyclosporin A treatment gave an inhibition curve with a less steep slope. Activation marker studies showed that the effect of treatment with both of the toxins was more pronounced on the late markers CD25 and CD71, while CD69 had the advantage that significant effects could be detected as early as 6 h after ochratoxin A treatment. Cyclosporin A treatment induced only minor alterations in CD69 expression. Certain differences in expression of activation markers between CD4+ and CD8+ subsets were found both in ochratoxin A- and cyclosporin A-treated cultures. A stimulating effect was found in cell cultures exposed to the lowest concentration of ochratoxin A on CD69 and CD25 expression. Signs of an increase in frequencies of proliferating cells measured with the BrdU flow cytometry method were also seen. This increase could not be detected with liquid scintillation counting. No other differences between the liquid scintillation counting and BrdU flow cytometry measurements of proliferation were obtained. We conclude that studies of activation marker expression by the flow cytometric approach used in this report are useful complements to traditional measurements of cell proliferation as they yield subset-specific information about cellular processes which precede proliferation of lymphocytes.

Influence of perinatal ochratoxin A exposure on the immune system in mice.

The mycotoxin ochratoxin A (OA) is a well-documented immunotoxic agent which affects both cellular and humoral immunity. In the present study, the effects of maternal exposure to single doses of OA during gestation or lactation were studied in Balb/c offspring. A single dose exposure of the dams to OA (500 micrograms/kg body weight) on day 16 of gestation resulted in decreased proliferation of splenic and thymic lymphocytes in response to mitogens in the pups at 15 days of age. Flow cytometry analysis of thymocyte subpopulations revealed lower percentages of mature CD4+ cells and higher percentages of immature, double-positive (CD4+CD8+) cells in the exposed pups. In contrast, a single exposure of the dams of OA on day 10 postpartum significantly increased the proliferative responsiveness of lymphocytes in the offspring when stimulated with B or T cell mitogens 3 days after the exposure. This effect was most prominent in the highest dose group (500 micrograms/kg body weight). The present results are in accordance with previous observations in rats, and show that the time of exposure significantly influences the immunotoxic effects of OA on the developing immune system in rodents.

Lymphocyte expression in transgenic trout by mouse immunoglobulin promoter/enhancer.

Two groups of transgenic rainbow trout (Oncorhynchus mykiss, Walbaum) have been produced and compared. One group harbored the reporter gene of chloramphenicol acetyltransferase (CAT) associated with mouse immunoglobulin (Ig) promoter/enhancer (pUCL-CAT-E). The other group carried the same reporter gene under the control of the cytomegalovirus promoter/enhancer (pCMV-CAT). Slot blot analysis of DNA from blood cells and other tissues from pUCL-CAT-E fish showed variation of copy number between the major tissues but not between red and white blood cells. Southern blot analysis indicated that multiple copies organized in concatemers were incorporated into the genome. The pCMV-CAT fish had a pronounced expression of CAT in both white and red blood cells. In contrast, activity of CAT was found in the white blood cells of all pUCL-CAT-E fish but not in their red blood cells. Expression in white blood cells was found preferentially in sIg+ cells, indicating that B cells are the major expressors. High expression was also found in spleen and kidney, but the activity found in thymocytes was equal to the background level. Analysis of some major tissues showed high white blood cell expression associated with low tissue expression, except that liver (known to contain lymphoid tissue in fish) was higher. Thus the regulatory elements of the Ig gene from mouse induce a tissue-specific expression in fish.

Influence of dietary nivalenol exposure on gross pathology and selected immunological parameters in young pigs.

Young pigs were fed diets to which 0, 2.5, or 5 mg/kg of purified nivalenol (NIV) had been added. The exposure continued for 3 weeks without any signs of feed refusal, vomiting, or change in clinical appearance, and there were no changes in body or organ weights due to the exposure. However, the concluding macroscopic examination revealed gastrointestinal erosions and signs of nephropathy in most of the exposed pigs. There were no differences in total or differential blood leukocyte counts between control and exposed pigs in blood samples collected after 0, 1, or 3 weeks, nor in the number of thymocytes at the end of the trial. Spleen cell numbers showed a dose-dependent decrease after 3 weeks of exposure that was statistically different from controls in pigs exposed to 5 mg NIV/kg. Flow cytometric analysis of lymphocytes revealed decreased numbers of both the CD4+ and the CD8+ subpopulations in the spleen at this point in time, reflecting the lower numbers of splenocytes; but no proportional changes were seen. In blood, exposure to NIV caused a transient decrease in the proportion of CD4+ cells after 1 week of exposure. Analysis of IgG and IgA in plasma showed a time-dependent tendency of increasing plasma concentrations of IgA and decreasing concentrations of IgG in the 2.5 mg/kg group, but differences in Ig levels between experimental groups and controls were not observed at any time. No differences were seen in the mitogen-induced proliferation by lymphocytes from blood, spleen, or thymus. In conclusion, exposure of young pigs to NIV in the diet caused pathological alterations in the kidneys and gastrointestinal tract and reduced the number of splenocytes. The results also indicated that exposure to NIV caused a time-dependent increase in IgA production in the 2.5 mg/kg group.

Effects of ochratoxin A on the rat immune system after perinatal exposure.

Effects on the immune system after perinatal exposure to ochratoxin A (OA) were studied in Sprague-Dawley rats after single or repeated exposure of the dams. In a short-term study, dams with litters were given a single dose of OA (0, 10, 50 or 250 micrograms/kg body weight) on day 11 of lactation. The effects on cell numbers in spleen and thymus añd on the mitogen responses of lymphocytes were evaluated in the suckling pups on day 14 of lactation. The proliferative response of splenocytes to the T-cell mitogen Concanavalin A (Con A) was significantly stimulated in pups from dams given 10 or 50 micrograms OA/kg body weight as compared to control pups. In addition, proliferation of thymocytes in response to Con A was stimulated in pups from dams exposed to 50 micrograms OA/kg body weight. In a long-term, cross-fostering study comparing pre- and postnatal exposure, half of the dams received 50 micrograms OA/kg body weight 5 days a week by gastric intubation 2 weeks before mating, during gestation and then 7 days a week until weaning. Effects on immune parameters were studied in the pups on day 14 of lactation and at 13 weeks of age. Suppressed mitogenic responses were seen to both lipopolysaccharide (LPS) and Con A in prenatally exposed pups sampled on day 14 of lactation. At 13 weeks the response of splenocytes to LPS was still impaired. The primary antibody response to a viral antigen was also lower in the prenatally exposed pups than in the control pups. These effects on the immune response were not seen in the groups of pups exposed postnatally or both pre- and postnatally, although blood concentrations of OA were higher in these groups at the time of the first sampling. This indicates that the decrease in proliferation and antibody production resulted from prenatal modulation of the immune system. The results show that prenatal exposure to relatively low doses of OA may induce immunosuppression. In contrast, short-term exposure of suckling pups to OA via the milk stimulates the proliferative responses of lymphocytes to polyclonal activation.

Dietary intake of some important mycotoxins by the Swedish population.

To estimate the intake of some mycotoxins from food in Sweden, approximately 600 samples were collected and analysed for aflatoxins, ochratoxin A, patulin and trichothecenes. Intakes were calculated for average and high consumers among adults and children and compared with the tolerable daily intake (TDI) of the respective toxin. Mycotoxin levels in the food samples were generally below the European/national maximum limits. However, high levels of aflatoxins were found in some samples of Brazil nuts and pistachios. The intake of ochratoxin A, patulin and trichothecenes was found to be below the temporary, TDI values (tTDI) proposed for these toxins by international expert groups, although the intake of trichothecenes (expressed as T-2 toxin equivalents) in children with a high consumption of cereals was close to the tTDI for T-2 toxin. Since there is to date no established numerical tTDI for aflatoxins, such a value was estimated for use within the project. The calculated intake of aflatoxins in high consumers exceeded this tTDI by a factor of two. In conclusion, the exposure to mycotoxins in Sweden did not generally, give rise to any major health concerns in the present study. However, the high levels of aflatoxins in certain commodities emphasize the need for preventive measures and improved control of toxin levels in these food items. Furthermore, the need for regulatory levels for trichothecenes in cereal products should be evaluated.

Does aluminium stimulate the immune system in male rats after oral exposure?

The influence of oral aluminium exposure on the immune system was studied in rats. Male rats were exposed to soluble and labile Al in acidic drinking water (0-500 mg Al/l) for 7-9 weeks. The concentration of Al in femur bone was higher in rats exposed to 50 and 500 mg Al/l (mean concentration 277 and 599 ng Al/g) than in control rats (150 ng Al/g). The Al concentration in blood plasma could only be quantified in the 500 mg/l group (mean 2.7 ng/ml), whereas the concentrations in the control and 50 mg/l groups were low (< 2 ng Al/ml). Exposure of 4-13-weeks-old rats to the highest Al concentration caused an increased number of splenocytes, whereas exposure of 9-16-weeks-old rats to 500 mg Al/l caused an increased number of thymocytes. Moreover, the proliferative response of splenocytes to the mitogen Con A (2 micrograms/ml) was increased by exposure of the 9-16-weeks-old rats to 500 mg Al/l as compared with the controls. The results indicate that oral Al exposure caused a slight stimulation of some immune functions in the rat at Al plasma concentrations normally found in the human population (< 10 ng Al/ml).

Effects of four trichothecene mycotoxins on activation marker expression and cell proliferation of human lymphocytes in culture.

Four trichothecene mycotoxins--the type A trichothecenes T2-toxin and diacetoxyscirpenol and the type B trichothecenes nivalenol and deoxynivalenol--were studied. The effects of these mycotoxins on the expression of the sequentially expressed activation markers CD69, CD25, and CD71 and on proliferation of human lymphocytes were studied in culture with a duration of up to 72 h. All the examined toxins affected activation marker expression in a similar way. After 6 h, the CD69 expression was lower in exposed cultures compared to controls. After 24 and 48 h of exposure, an increased frequency of cells expressing CD69 was found in exposed cultures, indicating a delay in downregulation of CD69 expression. Stimulation of CD25 expression was observed for doses below the IC50 value, while suppression was found for higher doses. The pattern was different from that detected for CD69 expression, in that an increased expression of CD25 never occurred after exposure to the highest concentration of the toxin, and in that no stimulatory effects were found after 48 h of exposure, indicating that the response was inhibited and not delayed. The effects of toxin exposure on CD71 expression were in many respects similar to the effects on CD25 expression. We conclude that the trichothecene mycotoxins investigated in this study inhibited the cell cycle in a similar way and exert their main antiproliferative action rather early in the cell cycle, before or in conjunction with CD25 expression.

Influence of aluminium on the immune system--an experimental study on volunteers.

The purpose of this study was to examine whether oral exposure to aluminum (Al) can affect the human immune system. Eighteen healthy volunteers (mean age 42, 28-57 yr) were divided into a test group (9 females, 4 males) and a referent group (3 females, 2 males). Over 6 weeks, the test subjects ingested 10 ml of antacid (aluminum hydroxide, 59 mg Al/ml) three times daily. Aluminum was analyzed in urine before and during the exposure period (ICP-MS). Blood samples were used for analysis of lymphocyte subpopulations, mitogen-induced lymphocyte proliferation and in vitro production and circulating plasma concentrations of immunoglobulin (Ig) A, IgG, IgM, interleukin (IL) -2 and IL-4. Urinary Al concentration in the test subjects was approximately 10- to 20-fold higher than in the referent group during exposure. This indicates that ingestion of an Al-containing antacid is associated with an Al absorption far above that originating from food and drinking water. In both referents and test subjects the lymphocyte subpopulations, lymphocyte proliferation and the in vitro Ig and IL production showed similar, time-dependent changes before as well as during the exposure period. No major differences were seen between the referent and test groups regarding the immune parameters, except for a slightly smaller CD8+CD45R0+ population (primed cytotoxic T-cells), in the exposed individuals as compared to the referents. The results also show that subjects on antacid therapy may constitute a suitable population for studying biological effects of high-dose oral exposure to Al.