Evaluation of the potential role of chelation therapy in treatment of low to moderate lead exposures

Journal Article · Thu Nov 01 00:00:00 EST 1990 · Environmental Health Perspectives; (USA)

DOI:https://doi.org/10.1289/ehp.908967· OSTI ID:5718299

Chisolm, Jr, J J ^[1]

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1. Johns Hopkins School of Medicine, Baltimore, MD (USA)

In the overall long-term management of lead poisoning, chelation therapy can have short-term benefits; however, these benefits must be accompanied by drastic reduction in environmental exposure to lead if therapy is to have any long-term benefit. This discussion is limited to calcium disodium ethylenediaminetetraacetate (CaNa{sub 2}EDTA), the chelating agent that has been the mainstay of treatment of lead poisoning for the past 38 years, and to meso-2,3-dimercaptosuccinic acid (DMSA), a new and promising oral chelating agent, which is an orphan drug and is currently classified as an investigational new drug by the US Food and Drug Administration. With both drugs, multiple courses of treatment will be needed if any substantial reduction in body lead burden is to be achieved. A major limitation of CaNa{sub 2}EDTA is the enormous diuresis of zinc that it produces. DMSA produces a comparable diuresis of lead, a greater decrease in blood lead, and has negligible influence on the urinary losses of zinc, copper, iron, and calcium. Limited experience to date in man has revealed no significant adverse side effects of DMSA. In animals, DMSA will promptly reduce the concentration of lead in brain and kidney, in particular. By contrast, similar 5-day courses of CaNa{sub 2}EDTA do not produce any net reduction in brain lead. This is important, as the brain is the critical organ of the adverse effects of lead in children. If the efficacy of DMSA is to be comprehensively evaluated ethically in children, new and more sensitive neurochemical, electrophysiologic, or other markers must be developed.

• OSTI ID: 5718299
• Journal Information: Environmental Health Perspectives; (USA), Vol. 89; ISSN 0091-6765
• Country of Publication: United States
• Language: English

Related Subjects

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
CHELATING AGENTS
BIOLOGICAL EFFECTS
LEAD COMPOUNDS
BLOOD CHEMISTRY
BRAIN
CHEMOTHERAPY
EDTA
KIDNEYS
POISONING
RESEARCH PROGRAMS
SUCCINIC ACID
AMINO ACIDS
BODY
CARBOXYLIC ACIDS
CENTRAL NERVOUS SYSTEM
DICARBOXYLIC ACIDS
NERVOUS SYSTEM
ORGANIC ACIDS
ORGANIC COMPOUNDS
ORGANS
THERAPY
560300* - Chemicals Metabolism & Toxicology