Environmental pollutants as vascular poisons: rethinking mesenteric ischemia through the lens of heavy metal toxicity

Mesenteric ischemia is a potentially deadly condition that occurs due to the lack of blood supply to the intestine. There is also emerging evidence that the mesenteric circulation may result in vascular dysfunction and ischemic damage caused by environmental contaminants especially heavy metals such as lead and mercury. Persistent exposure leads to endothelial dysfunction through the generation of oxidative stress, nitric oxide depletion, mitochondrial dysfunction and inflammatory signaling pathways. This hypothesis-generating narrative review integrates toxicological and vascular evidence to propose that chronic low-level exposure to these metals could represent an underrecognized etiological factor in mesenteric ischemia. The main molecular mechanisms, including oxidative stress, endothelial dysfunction, mitochondrial dysfunction, and vascular remodeling, are discussed, and the potential synergistic toxicity of the combined exposure to metals is considered. Additionally, several crucial diagnostic biomarkers are mentioned, such as intestinal fatty acid-binding protein (I-FABP), alpha-glutathione S-transferase (α-GST), C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and malondialdehyde (MDA). A knowledge of the connection between mesenteric vascular injury and exposure to heavy metals may aid in the development of improved methods of diagnosis and treatment.