Hair multi-bioelement profile of Kashin-Beck disease in the endemic regions of China

Background: Kashin-Beck disease (KBD) is a serious chronic osteochondral disease that is endemic in humans. Selenium (Se) has been considered in hypotheses of the aetiology of KBD, but few studies have explored the relationship between other elements and KBD. Objective: This study explored the relationship between 39 elements and KBD. Methods: In this retrospective study, 150 boys aged 6 to 14 years were randomly selected from a total population of 1,214 children. Subjects from endemic areas were divided into five groups: (KBD -Bin, N = 30; KBD + Se-Yongshou, N = 30; Control -Bin, N = 30; Control + Se -Yongshou, N = 30; and Control External -Chang'an, N = 30). Samples of occipital hair were collected from each subject, and thirty-nine elements, including 15 toxic elements, 19 nutrient elements, and 5 other elements were assayed by inductively coupled plasma mass spectrometry (ICP-MS). Correlation analysis of the elements in each group was performed by ggcorrplot (visualization of a correlation matrix using 'ggplot2') and PerformanceAnalytics packages in the program R Project. Results: Among the 15 toxic elements, the levels of aluminum (Al) and bismuth (Bi) in the KBD -Bin were significantly higher than in the other groups, and the levels of silver (Ag), beryllium (Be), platinum (Pt), antimony (Sb), tin (Sn) and lead (Pb) in the KBD -Bin were significantly lower than in the other groups. Among the 19 nutrient elements, the levels of selenium (Se), iodine (I), sulfur (S), and boron (B) in the KBD -Bin were significantly lower than in the other groups. The levels of calcium (Ca), iron (Fe), manganese (Mn), chromium (Cr), strontium (Sr) and phosphorus (P) in the KBD -Bin were significantly higher than in the other groups. Correlations between various elements were remarkably different among the groups. There were positive correlations between As and Pb, Cd and Sb, Pb and Sb, Sb and U in the Control External -Chang'an, between Al and Ni, Cd and Pb, TI and Ni, Ti and U in the Se-S KBD, and between B and I, B and Mo, Mn and V in the Control External -Chang'an. Conclusions: These findings indicate that the interactions between elements do not represent a simple reciprocal relationship in the occurrence of KBD. In fact, KBD was associated with an imbalance in multiple elements that play a dynamic and interactive role in the development of the disease.