Effectiveness of DTPA treatments following the injection of particulate plutonium

Chelating decorporation agents for internal contamination by actinides: Designs, mechanisms, and advances

During the wide utilization of the actinides in medicine, energy, military, and other fields, internal contaminations can profoundly endanger human health and public security. Chelating decorporation agents are the most effective therapies to reduce internal contamination that includes radiological and chemical toxicities. This review introduces the structures of chelating decorporation agents including inorganic salts, polyaminocarboxylic acids, peptides, polyphosphonates, siderophores, calixarenes, polyethylenimines, and fullerenes, and highlights ongoing advances in their designs and mechanisms. However, there are still numerous challenges that block their applications including coordination properties, pharmacokinetic properties, oral bioavailability, limited timing of administration, and toxicity. Therefore, additional efforts are needed to push novel decorporation agents with high efficiency and low toxicity for the treatment of internal contamination by actinides.

Effects of the chelating agent DTPA on naturally accumulating metals in the body

Diethylenetriaminepentaacetate (DTPA) is the most widely used chelating agent for Pu and Am. Volunteers were assigned to receive intravenous injections or aerosol inhalations of 1 g of DTPA on days 1-4; volunteers received once daily injections of CaDTPA or ZnDTPA, CaDTPA inhalation as an aerosol, or CaDTPA injection on day 1 and ZnDTPA on days 2-4. CaDTPA injection or inhalation increased the excretion rates of Zn in urine with concomitantly reduced levels of serum Zn. Injection of CaDTPA reduced activities of serum alkaline phosphatase (AP) in parallel with the kinetics of Zn, whereas CaDTPA and ZnDTPA injection reduced activities of lactate dehydrogenase (LDH), and reduced activities of creatinine kinase (CK) were observed upon CaDTPA injection and its inhalation. Intravenous administration of CaDTPA and ZnDTPA enhanced excretion rates of Mn in urine, whereas transient reduction of Mn levels in serum was detected only via CaDTPA injection. Both CaDTPA and ZnDTPA transiently reduced levels of Mg in serum without affecting the excretion rates. On the other hand, both DTPAs increased excretion rates of toxic metals such as Pb and Cd, and CaDTPA also increased the rates of Hg. These results suggest that DTPA, and especially CaDTPA, removes essential metals and that the activities of these metalloenzymes are good indicators for the imbalance of essential metals during the DTPA administration. Our results also show that CaDTPA injection is more potent for removing these metals than ZnDTPA and inhalation of CaDTPA, and DTPA may be useful for the treatment of acute heavy metal poisoning with Pb, Cd, or Hg.

Saving normal tissues - a goal for the ages

Almost since the earliest utilization of ionizing radiation, many within the radiation community have worked toward either preventing (i.e. protecting) normal tissues from unwanted radiation injury or rescuing them from the downstream consequences of exposure. However, despite over a century of such investigations, only incremental gains have been made toward this goal and, with certainty, no outright panacea having been found. In celebration of the 60th anniversary of the International Journal of Radiation Biology and to chronicle the efforts that have been made to date, we undertook a non-rigorous survey of the articles published by normal tissue researchers in this area, using those that have appeared in the aforementioned journal as a road map. Three 'snapshots' of publications on normal tissue countermeasures were taken: the earliest (1959-1963) and most recent (2013-2018) 5-year of issues, as well as a 5-year intermediate span (1987-1991). Limiting the survey solely to articles appearing within International Journal of Radiation Biology likely reduced the number of translational studies interrogated given the basic science tenor of this particular publication. In addition, by taking 'snapshots' rather than considering the entire breadth of the journal's history in this field, important papers that were published during the interim periods were omitted, for which we apologize. Nonetheless, since the journal's inception, we observed that, during the chosen periods, the majority of studies undertaken in the field of normal tissue countermeasures, whether investigating radiation protectants, mitigators or treatments, have focused on agents that interfere with the physical, chemical and/or biological effects known to occur during the acute period following whole body/high single dose exposures. This relatively narrow approach to the reduction of normal tissue effects, especially those that can take months, if not years, to develop, seems to contradict our growing understanding of the progressive complexities of the microenvironmental disruption that follows the initial radiation injury. Given the analytical tools now at our disposal and the enormous benefits that may be reaped in terms of improving patient outcomes, as well as the potential for offering countermeasures to those affected by accidental or mass casualty exposures, it appears time to broaden our approaches to developing normal tissue countermeasures. We have no doubt that the contributors and readership of the International Journal of Radiation Biology will continue to contribute to this effort for the foreseeable future.

Final Report on the Safety Assessment of Pentasodium Pentetate and Pentetic Acid as Used in Cosmetics

Pentasodium Pentetate and Pentetic Acid function as chelating agents in cosmetics. Pentasodium Pentetate is readily soluble in water, but the corresponding free acid is not. Pentasodium Pentetate is used in almost 400 cosmetic products over a wide range of product categories, although it is mostly used in hair dyes and colors at use concentrations of 0.1% to 1.0%. Pentetic Acid is used in 150 cosmetic products, mostly in hair dyes and colors. Chelating agents are used in cosmetics to remove calcium and magnesium cations, which impede foaming and cleansing performance and which can cause a haze in clear liquids. The acute oral LD50 of Pentasodium Pentetate in rats was >5 g/kg. The acute dermal LD50 of Pentapotassium Pentetate using rats was reported to be >2 g/kg. The intraperitonal LD50 of Pentetic Acid was reported to be 585 mg/kg. Short-term studies of the calcium and sodium salts of Pentetic Acid in male mice demonstrated no dose-related toxicity over the dose range of 10, 100, and 250 mg/kg. In a 4-week dermal toxicity study, daily topical application of 0.05% Pentasodium Pentetate to shaved and abraded rabbit skin produced moderate erythema after the first week and throughout the study, but no systemic tox-icity. Pentasodium Pentetate or Pentapotassium Pentetate applied to intact albino rabbit skin were not irritating. A 40% solution of Pentapotassium Pentetate was not sensitizing in a guinea pig maximization test. The no observed adverse effect level (NOAEL) for rats given 40% Pentapotassium Pentetate by oral gavage was reported to be 83 mg/kg day-1. Subchronic inhalation evaluation of a bath freshener containing 0.05% or 0.09% Pentasodium Pentetate using albino rats determined that there was no cumulative systemic toxicity attributable to the ingredient at either concentration. The no observed effect level (NOEL) for maternal toxicity in pregnant rats was 400 mg/kg body weight and for fetal toxicity was 100 mg/kg body weight. Another reproductive toxicity study evaluated Pentetic Acid–Zn with and without sodium chloride in pregnant C57/B1 Dougherty mice. No toxicity was found without added sodium chloride. Pentapotassium Pentetate was not muta-genic in an Ames test, with or without metabolic activation. The same material tested in Chinese hamster ovary cells was not clas-togenic. Calcium Pentetate at 1.351 µg/ml produced a statistically significant increase in the number of sister-chromatid exchanges. Pentasodium Pentetate is nonirritating to moderately irritating, but not a sensitizer in clinical tests. A human comedogenicity (acne promotion) test using Pentasodium Pentetate found no effect. Although data are lacking on the dermal penetration of these two ingredients, other chelating agents such as EDTA do not penetrate the skin, so it is likely that Pentasodium Pentetate and Pentetic Acid also would not penetrate. The high water solubility of Pentasodium Pentetate and the low water solubility of Pentetic Acid also support that their dermal penetration will be low. Other chelating agents, including EDTA and its salts, have been determined to be safe in the current practices of use in cosmetics. Meta-, Tri-, and Hexam-etaphosphate salts are chelating agents determined to be safe in the current practices of use in cosmetics. Metasilicate salts were found to be safe as chelating agents in cosmetics when formulated to avoid irritation. Overall, these data were considered sufficient to support the safety of Pentesodium Pentetate and Pentetic Acid as used in cosmetics.

Efforts to control the errant products of a targeted in vivo generator

Alpha-particle immunotherapy by targeted alpha-emitters or alpha-emitting isotope generators is a novel form of extraordinarily potent cancer therapy. A major impediment to the clinical use of targeted actinium-225 (225Ac) in vivo generators may be the radiotoxicity of the systemically released daughter radionuclides. The daughters, especially bismuth-213 (213Bi), tend to accumulate in the kidneys. We tested the efficacy of various pharmacologic agents and the effect of tumor burden in altering the pharmacokinetics of the 225Ac daughters to modify their renal uptake. Pharmacologic treatments in animals were started before i.v. administration of the HuM195-225Ac generator. 225Ac, francium-221 (221Fr), and 213Bi biodistributions were calculated in each animal at different time points after 225Ac generator injection. Oral metal chelation with 2,3-dimercapto-1-propanesulfonic acid (DMPS) or meso-2,3-dimercaptosuccinic acid (DMSA) caused a significant reduction (P < 0.0001) in the renal 213Bi uptake; however, DMPS was more effective than DMSA (P < 0.001). The results with DMPS were also confirmed in a monkey model. The renal 213Bi and 221Fr activities were significantly reduced by furosemide and chlorothiazide treatment (P < 0.0001). The effect on renal 213Bi activity was further enhanced by the combination of DMPS with either chlorothiazide or furosemide (P < 0.0001). Competitive antagonism by bismuth subnitrate moderately reduced the renal uptake of 213Bi. The presence of a higher target-tumor burden significantly prevented the renal 213Bi accumulation (P = 0.003), which was further reduced by DMPS treatment (P < 0.0001). Metal chelation, diuresis with furosemide or chlorothiazide, and competitive metal blockade may be used as adjuvant therapies to modify the renal accumulation of 225Ac daughters.

Review of 239Pu and 226Ra effects in beagles

A long term biological study has been completed that was designed to assess the predicted effects in humans of internally deposited 239Pu by comparison with 226Ra in beagles. Herein we summarize for the first time results of several previous reports about the effects of these two radionuclides in our beagles in an attempt to elucidate what has been learned since the beginning of the study in the early 1950's. Perhaps the most important finding was that bone surface-seeking plutonium is more toxic at equal mean skeletal radiation doses (<3 Gy for 239Pu, <20 Gy for 226Ra) than bone volume-seeking radium for the induction of skeletal malignancy by about a factor of 16 for a single intravenous injection of monomeric 239Pu. In addition, ancillary studies have shown that when plutonium transfers continuously onto bone surfaces from a depot of particulate 239Pu in phagocytic cells, its relative toxicity per Gy average skeletal dose is enhanced by about a factor of 2. Juvenile animals or dogs injected as mature adults were only about half as sensitive for equal mean skeletal doses as dogs injected as young adults. Male and female dogs were about equally sensitive to radiation of the skeleton by either radionuclide. Findings about radiation-induced fractures are summarized as well as data on the induction of soft-tissue malignancies by 239Pu or 226Ra. Natural survival was not affected at the lower dosage levels of either 226Ra or 239Pu as compared with control dogs given no radioactivity, but the survival of animals at higher levels was reduced. No additional life-shortening effects beyond those attributable to occurrence of radiation-induced malignancies or other radiation-induced effects were suggested by analysis of data for low dosage levels.

Bone cancers in Mayak workers

Bone cancer mortality risks were evaluated in 11,000 workers who started working at the "Mayak" Production Association in 1948-1958 and who were exposed to both internally deposited plutonium and external gamma radiation. Comparisons with Russian and U.S. general population rates indicate excess mortality, especially among females, plutonium plant workers, and workers with external doses exceeding 1 Sv. Comparisons within the Mayak worker cohort, which evaluate the role of plutonium body burden with adjustment for cumulative external dose, indicate excess mortality among workers with burdens estimated to exceed 7.4 kBq (relative risk = 7.9; 95% CI = 1.6-32) and among workers in the plutonium plant who did not have routine plutonium monitoring data based on urine measurements (relative risk = 4.1; 95% CI = 1.2-14). In addition, analyses treating the estimated plutonium body burden as a continuous variable indicate increasing risk with increasing burden (P < 0.001). Because of limitations in current plutonium dosimetry, no attempt was made to quantify bone cancer risks from plutonium in terms of organ dose, and risk from external dose could not be reliably evaluated.