Aluminum toxicity: a comprehensive narrative review

Aluminum (Al) is a widely accessible environmental and industrial element that finds routes of exposure through inhalation of airborne particles, ingestion of contaminated food and water, dermal and medical applications. Chronic and acute exposure lead to systemic accumulation of Al that induce aluminum toxicity. Exposure to Al exerts diverse toxicological effects, including oxidative stress, immune dysregulation, genotoxicity, pro-inflammatory activity, protein misfolding, enzymatic inhibition, metabolic imbalance, membrane dysfunction and induction of apoptosis and necrosis. The Al toxicity is associated with a wide range of pathologies such as respiratory diseases, cardiovascular complications, gastrointestinal disorders, inflammation, hematologic, hepato-renal and neurodegenerative diseases and reproductive and developmental disorders, genotoxicity as well as endocrine and pancreatic necrosis. This comprehensive review narrates multifactorial nature of Al toxicity emphasizing role of reactive oxygen species in pathogenesis and significances of Al exposure in high-risk populations.