Aluminum Exposure from Parenteral Nutrition: Early Bile Canaliculus Changes of the Hepatocyte with A 2021 Update on the 2019 Technical Report of the American Academy of Pediatrics on Aluminum Effects in Infants and Children

Long-term parenteral nutrition (PN) can cause parenteral nutrition-associated liver disease in newborns (PNALD). Aluminum (Al) is a recognised contaminant in infant PN, and we believe it plays a significant role in PNALD. The aim of this analysis is to see how Al affects hepatocytes in a piglet model.

We used a Yucatan piglet PN model to perform a randomised control study. Piglets between the ages of 3 and 6 days were divided into two classes. PN with 63 g/kg/day of Al was given to the high Al group (n=8), while PN with 24 g/kg/day of Al was given to the low Al group (n=7). Over the course of two weeks, serum samples for total bile acids (TBA) were collected, and liver tissue was obtained at the conclusion of the study. Transmission electron microscopy (TEM) and Image-J software analysis were used to investigate the morphometry of the bile canaliculus. The American Academy of Pediatrics published a primary technical study on Al effects in infants and children in December 2019. This chapter contains revisions and comments on the report.

The canalicular space was smaller in the high Al group, and the microvilli were shorter than in the low Al group. The TBA did not vary between the two parties.

Conclusions: Despite unaltered serum bile acids, Al induces structural changes in hepatocytes. Short microvilli are associated with high Al in PN, which can reduce the functional excretion area of hepatocytes and inhibit bile flow. The US Food and Drug Administration (FDA) made the decision to enforce new rules based on long-term toxicity studies of Al content in PN components. Large-volume ingredients must minimise the Al concentration, and all small-volume components must be labelled with the Al concentration explicitly. Despite these guidelines, the total Al concentration from some components remains higher than the recommended final concentration, according to both the US FDA and us. The United States Food and Drug Administration (US FDA) and our concerns about the toxicity of Al in infant PN formulas are well-founded, necessitating additional testing.

Author (s) Details

Amanda R. Hall
Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada

Ha Le
Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada

Chris Arnold
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada

Janet Brunton
Department of Biochemistry, Memorial University of Newfoundland, St. John’s, NL, Canada

Robert Bertolo
Department of Biochemistry, Memorial University of Newfoundland, St. John’s, NL, Canada

Grant G. Miller
Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada

Gordon A. Zello
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada

Consolato Sergi
Department of Lab. Medicine and Pathology, University of Alberta, Edmonton, AB, Canada and Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada

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