SEQC Spanish Society of Laboratory Medicine

- Festem 2022

• The Congress of the Federation of European Societies on Trace Elements and Minerals (FESTEM) addressed environmental exposure to toxic substances, presented epidemiological studies on trace elements and cardiovascular risk, their relationship with metabolic syndrome, as well as studies on bioavailability, innovations in analysis of these elements, and clinical cases, among others

• Introduced by Dr. Montserrat González, president of FESTEM and Head of the Clinical Biochemistry Service of the Hospital General Universitario Gregorio Marañón (HGUGM), Dr. Antonio Buño, president of the SEQC^ML, Dr. Muriel Bost, president of the Institute of Trace Elements of UNESCO, and Dr. Beatriz García Fidalgo, deputy medical director of the HGUGM

Madrid, September 29, 2022 – The Spanish Society of Laboratory Medicine (SEQC^ML) has organized, in collaboration with the Hospital General Universitario Gregorio Marañón (HGUGM), the eighth edition of the Congress of the Federation of European Societies on Trace Elements and Minerals ( FESTEM), with a more clinical and patient-oriented approach than in previous editions. From September 28 to October 1, a group of experts meeting in Madrid addressed different issues related to trace elements. Specifically, they called for advances in the study of the effects of trace elements, both in vulnerable groups (pregnant women and children), and in occupationally exposed groups. Epidemiological studies on trace elements and cardiovascular risk, neurodegenerative diseases and anemia,innovations in the analysis of these elements, and clinical cases, among others, were also presented.

The inauguration of the FESTEM Congress was attended by Dr. Montserrat González, president of FESTEM and Head of the Clinical Biochemistry Service of the Hospital General Universitario Gregorio Marañón (HGUGM), Dr. Antonio Buño, president of the SEQC^ML, Dr. Muriel Bost, president of the UNESCO Institute of Trace Elements, and Dr. Beatriz García Fidalgo, deputy medical director of the HGUGM.

Trace elements are those elements that are present in our body and constitute less than 0.01% of body weight. Despite this, some such as copper (Cu), iodine (I), iron (Fe) and selenium (Se) are essential because they are part of metalloenzymes, proteins, hormones or vitamins, and their deficiency causes disease and death. Theirpresence in the diet is necessary, without forgetting that the optimal concentration range is very narrow, so an excess of these essential elements can also be toxic.

The president of the UNESCO Institute for Trace Elements, Dr. Muriel Bost, addressed this issue in her presentation “Essentiality and toxicity of trace elements and minerals”. According to Dr. Bost, the lack of these essential elements is frequent in emerging countries, but also in our countries, particularly in vulnerable populations such as young children, pregnant women, obese patients, especially after bariatric surgery, or older people. As she indicated “any adverse nutritional alteration will have a significant impact on health, not only immediate but also in the long term. The current COVID-19 pandemic may have a significant impact on micronutrient status, especially essential trace elements.”

In addition to the essential ones, there are trace elements, such as lead (Pb), aluminum (Al), or mercury (Hg), which are toxic to the body. According to Dr. Bost, the increase in pollution, technological developments, and certain natural catastrophes "are responsible for deleterious toxic effects, often associated with oxidative stress and an inflammatory syndrome that facilitates the appearance of chronic diseases in the general population. The increasing use of metal nanoparticles and metal prostheses may also be responsible for chronic poisoning." In the field of ecotoxicology, the expert noted that metals usually end up in aquatic systems, "where they can be transferred, bioaccumulate, and in some cases bioaccumulate along food chains and, ultimately, induce toxicity".

The president of the UNESCO Institute for Trace Elements pointed out that the lack of understanding of the complex links between the environment and human well-being has led to trying to treat the symptoms of a disease instead of getting to the root causes, in particular, human activities. "Therefore, it is important to diagnose a deficiency or overload of these elements, but also acute metal intoxication," she stressed.

Trace elements and cardiovascular risk

The experts gathered at the FESTEM Congress also addressed trace elements as emerging cardiovascular risk factors that can have a major impact on the world population. Thus, in the panel discussion "Trace Elements and Cardiovascular Diseases", the president of FESTEM and of the SEQC^ML Trace Elements Commission, Dr. Montserrat González, pointed out that epidemiological studies would be presented explaining that these elements can produce effects from atherosclerosis to clinical symptomatology due to microvascular and macrovascular disease, emphasizing the need to "have an integrated view of the molecular mechanisms and biological pathways by which these environmental metals influence health, in order to contribute effectively to public health and prevention in precision medicine and to improve cardiovascular health.

The great technological advances of recent years have meant a great boost in the knowledge of trace elements. According to the director of the Defense Institute ofToxicology (ITOXDEF), Mª Teresa Llorente, "cutting-edge technology such as ICP-MS (inductively coupled plasma mass spectrometry) techniques that were exclusive to research laboratories, are being introduced in a gradual and generalized way in large clinical laboratories, facilitating awareness and bringing the scientific community closer to an understanding of these elements and their impact on our organism”.

According to Dr. Montserrat González, the lower cost of this equipment, together with the development of methods that do not require as much experience as in the past, is leading toan important role for Laboratory Medicine in this field. “The knowledge that Laboratory Medicine professionals have of the preanalytical conditions for the correct analysis of trace elements, their clinical application, quality assurance, and how to inform requesting doctors, among other things, has also led to greater knowledge among other specialists and a boom in the clinical application of these elements”, noted the expert.

Regarding the main challenges and lines of research, the president of the UNESCO Institute for Trace Elements, Dr. Muriel Bost, indicated that "the lack of adequate biomarkers greatly limits our ability to assess the relationship between exposure to trace elements in diet and health”. Likewise, she noted the need for more multidisciplinary studies with public participation. For her part, Dr. Montserrat González emphasized the need to establish the requirements, which depend on genetic and non-genetic factors such as sex or age, to prevent diseases such as cancer, osteoporosis,and cardiovascular or neurodegenerative diseases. In addition, she considers it essential to study trace elements together with molecular data from metabolomics, proteomics, or genomics "that allow us to move forward and clarify whether these elements are the cause of the disease or rather their alteration is simply a nutritional or functional consequence of another disorder".

Spanish Society of Laboratory Medicine (SEQC^ML)

The Spanish Society of Laboratory Medicine (SEQC^ML) —founded in 1976— is an active member of the international and European Clinical Laboratory Federations IFCC and EFLM. It currently encompasses almost 3,000 professionals and its main objective is to bring together all scientists interested in the Clinical Laboratory field, promote the dissemination of scientific and technical publications, organize national and international meetings, courses, and congresses, and cooperate with other scientific societies. Likewise, the Society aims to contribute to studying and recommending standardized methods and establishing guidelines and recommendations for training in the field of Laboratory Medicine. For more information: www.seqc.es