Highest Brain Bismuth Levels and Neuropathology Are Adjacent to Fenestrated Blood Vessels in Mouse Brain after Intraperitoneal Dosing of Bismuth Subnitrate

A small fraction of humans ingesting bismuth (Bi)-containing medications develops neurotoxicity in which neuropsychiatric signs precede motor dysfunction. Large ip doses of Bi subnitrate (BSN) produce similar signs in mice, but little is known about the pathogenesis of neurotoxicity in either species. Adult female Swiss-Webster mice received a neurotoxic dose (2500 mg/kg ip) of BSN. Bi distribution and neuropathology were determined as follows: (1) Regions of central and peripheral nervous system were assayed for Bi by atomic absorption spectrometry (AAS) 28 days after dosing, (2) regional brain Bi distribution was demonstrated in histologic sections by autometallography 28 days after dosing, and (3) blood/brain barrier status and neuropathologic effects were evaluated by light and electron microscopic techniques 1, 3, and 7 days and 2, 3, 4, and 5 weeks after dosing. By AAS, Bi levels were highest in olfactory bulb (∼7 ppm), hypothalamus (∼7 ppm), septum (∼3 ppm), and brain stem (∼3 ppm). Striatum and cerebral cortex had the least Bi (∼1 ppm). Regional distribution by autometallography showed that high Bi levels were associated with diffusion of Bi from fenestrated blood vessels of circumventricular organs and olfactory epithelium. All treated mice had hydrocephalus, but no other pathology was demonstrable by light microscopy. By electron microscopy, dramatic expansion of the extracellular space between choroid plexus epithelial cells was observed. Dendrites in the neuropil of the hypothalamus and septum exhibited vacuoles and membranous debris. Based on the Bi distribution and lesions, we propose that diffusion of Bi from fenestrated blood vessels contributes to pathogenesis of neurotoxicity in mice. This proposal is consistent with the clinical features of Bi-related neurotoxicity in humans.