This is the first report to our knowledge showing that inorganic mercury in concentrations as low as 0.1 μM can induce VEGF and IL-6 release from human cultured mast cells. We also report for the first time that mercury has a significant synergistic effect with SP (0.1 μM) on VEGF release; this amount of VEGF release is higher than what has previously been reported for hCBMCs [
19]. One paper has reported that HgCl
2 can induce release of histamine from primary lung and human leukemic mast cells (HMC-1 cells), but only at toxic levels of 0.33 mM [
20]. Here we show that HgCl
2 induces β-hexosaminidase release, but only at a concentration of 10 μM. Mercury (10 μM) has previously been shown to induce release of β-hexosaminidase, IL-4 and TNF-α from a murine mast cell line and from mouse bone marrow-derived cultured mast cells; the secretion of cytokines mediated by HgCl
2 is additive to that which follows FcepsilonRI-induced mast cell activation [
11]. In contrast, HgCl
2 does not have an effect on its own on release of histamine and IL-4 from human basophil, but only enhances allergic release at concentrations of 1 and 10 μM [
12]. This is also true for IL-4 release from rat mast cells [
21]. Clinical symptoms of mercury poisoning may be expected at blood levels of 1 μM [
12]. However, brain mast cells may react to lower mercury concentrations, especially in vulnerable patient subpopulations.
Mast cells, by virtue of their location in the skin, respiratory tract, and gastrointestinal system are potential targets for environmental agents with immunotoxic effects [
22]. Mast cells are critical not only for allergic reactions, but also important in both innate and acquired immunity [
23], as well as in inflammation [
24]. In view of the fact that a subgroup of ASD patients have allergy symptoms that do not appear to be triggered by IgE, it is noteworthy that mast cells can be stimulated by non-allergic triggers originating in the gut or the brain [
24], especially neuropeptides such as SP [
25] and neurotensin (NT) [
26]. Once activated, mast cells secrete numerous vasoactive, neurosensitizing and proinflammatory molecules that are relevant to ASD; these include histamine, proteases, VEGF, prostaglandin D
2, as well as cytokines such as IL-6 [
24]. In particular, mast cells can secrete VEGF [
27,
28], an isoform of which is vasodilatory [
29] and is over expressed in delayed hypersensitivity reactions [
30]. In fact, mast cells can release VEGF [
31], IL-6 [
32] and other mediators "selectively" without degranulation [
33]. Such mediators could disrupt the gut-blood and blood-brain barriers (BBB) permitting brain inflammation [
34]. It is important to note that mercury can cross the BBB through a transport mechanism that can lead to significant brain concentrations, and that can persist for prolonged periods of time [
2,
35]. Activated brain mast cells can disrupt the BBB [
36,
37] and further increase brain mercury levels.
The mechanisms of heavy metal neurotoxicity are not fully understood. Mercury increases cytosolic calcium levels in PC12 cells [
38], and thimerosal does so in thymus lymphocytes [
39]. Mercury may also increase cellular oxidative stress since neurons are highly susceptible to reactive oxygen species (ROS) and neuronal mitochondria are especially vulnerable to oxidative damage [
40]. In fact, the primary dietary source of neurotoxic mercury compounds is via the ingestion of methylmercury from fish, which has been previously linked to neurological damage [
41].
Mercury's activation of mast cell inflammatory mediator release may enhance allergic reactions in atopic individuals and exacerbate IgE-dependent diseases [
12]. Allergic symptomatology is often present in ASD patients [
34], and a survey of children with ASD in Italy reported that the strongest association was with a history of allergies [
42]. Moreover, a recent study reported increased atopic diseases, as well as elevated serum IgE and eosinophils in Asperger patients [
43]. In a National Survey of Children's Health, parents of autistic children reported symptoms of allergies more often than other children, with food allergies showing the greatest difference [
44]. A case series study also reported higher rate of food allergies in ASD children [
45]. In one study, 30% of autistic children (n = 30) had a history of atopy as compared to 2.5% of age-matched "neurologic controls" (n = 30), but there was no difference in serum IgE or in skin prick tests to 12 common antigens [
46], implicating triggers other than IgE. In another study, ASD patients did not have increased incidence of allergic asthma or allergic dermatitis [
42], but this study included only ASD patients that were positive to RAST/skin testing. Finally, a preliminary report indicated that the prevalence of ASD may be 10-fold higher [
47] than the general population (1/100 children) in mastocytosis patients [
48], characterized by increased number of hyperactive mast cells in many tissues, with symptoms that include allergies, food intolerances and "brain fog" [
49,
50].
Some epidemiological studies have failed to find a significant relationship between mercury exposure from vaccines and autism [
3-
7]. Nevertheless, 87% of children included in the US Vaccine Adverse Event Reporting System (VAERS) have ASD [
8]. Moreover, a paper based on computerized medical records in the Vaccine Safety Datalink concluded there was "significantly increased rate ratios for ASD with mercury exposure from Thimerosal-containing vaccines" [
9]. Also, there are a series of epidemiological studies conducted in the USA that have found significant associations between environmental sources of mercury exposure and ASDs [
51]. In addition, patients with severe ASD have evidence of significantly increased urinary porphyrins consistent with mercury intoxication [
52-
55]. Mercury toxicity may also affect critical methylation pathways in vulnerable cells [
56].
ASD are a group of pervasive developmental disorders that include autistic disorder, Asperger's disorder, and atypical autism - also known as pervasive developmental disorder-not otherwise specified (PDD-NOS). These are neurodevelopmental disorders diagnosed in early childhood [
57]. They are characterized by various degrees of dysfunctional communication and social skills, repetitive and stereotypic behaviors, as well as attention, cognitive, learning and sensory defects [
57,
58]. ASD cases have increased more than 10-fold during the last decade to a prevalence of 1/100 children [
44,
57,
59]. However, there is no known distinct pathogenesis, there are no biomarkers, and there is no effective treatment [
60].
ASD may result from a combination of genetic/biochemical susceptibility and epigenetic exposure to environmental factors, including reduced ability to excrete mercury and/or exposure to mercury at critical developmental periods [
2,
56]. A number of papers have suggested that ASD may be associated with immune dysfunction [
61], while a recent review made the case that ASD may be a neuroimmune disorder involving mast cell activation [
34].