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Bjørklund G, Crisponi G, Nurchi VM, Cappai R, Buha Djordjevic A, Aaseth J. A Review on Coordination Properties of Thiol-Containing Chelating Agents Towards Mercury, Cadmium, and Lead. Molecules 2019; 24:E3247. [PMID: 31489907 PMCID: PMC6767255 DOI: 10.3390/molecules24183247] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/26/2019] [Accepted: 08/31/2019] [Indexed: 11/17/2022] Open
Abstract
The present article reviews the clinical use of thiol-based metal chelators in intoxications and overexposure with mercury (Hg), cadmium (Cd), and lead (Pb). Currently, very few commercially available pharmaceuticals can successfully reduce or prevent the toxicity of these metals. The metal chelator meso-2,3-dimercaptosuccinic acid (DMSA) is considerably less toxic than the classical agent British anti-Lewisite (BAL, 2,3-dimercaptopropanol) and is the recommended agent in poisonings with Pb and organic Hg. Its toxicity is also lower than that of DMPS (dimercaptopropane sulfonate), although DMPS is the recommended agent in acute poisonings with Hg salts. It is suggested that intracellular Cd deposits and cerebral deposits of inorganic Hg, to some extent, can be mobilized by a combination of antidotes, but clinical experience with such combinations are lacking. Alpha-lipoic acid (α-LA) has been suggested for toxic metal detoxification but is not considered a drug of choice in clinical practice. The molecular mechanisms and chemical equilibria of complex formation of the chelators with the metal ions Hg2+, Cd2+, and Pb2+ are reviewed since insight into these reactions can provide a basis for further development of therapeutics.
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Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine, N-8610 Mo i Rana, Norway.
| | - Guido Crisponi
- Cittadella Universitaria, University of Cagliari, 09042 Cagliari, Italy.
| | - Valeria Marina Nurchi
- Department of Life and Environmental Sciences, University of Cagliari, 09042 Cagliari, Italy.
| | - Rosita Cappai
- Department of Life and Environmental Sciences, University of Cagliari, 09042 Cagliari, Italy.
| | - Aleksandra Buha Djordjevic
- Department of Toxicology "Akademik Danilo Soldatović", Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia.
| | - Jan Aaseth
- Research Department, Innlandet Hospital, N-2380 Brumunddal, Norway.
- Inland Norway University of Applied Sciences, N-2411 Elverum, Norway.
- IM Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow, Russia.
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Cappelletti S, Piacentino D, Fineschi V, Frati P, D'Errico S, Aromatario M. Mercuric chloride poisoning: symptoms, analysis, therapies, and autoptic findings. A review of the literature. Crit Rev Toxicol 2019; 49:329-341. [PMID: 31433682 DOI: 10.1080/10408444.2019.1621262] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Among mercury-related intoxications, the re-emerging of mercuric chloride poisoning has been recently described in literature. Only sparse data, reporting the clinical symptoms, the anatomo-pathological findings, the analytical procedures or the treatment have been published and no exhaustive analysis of all these factors exists in literature. The classic symptoms associated with toxicity of mercuric chloride is a combination of renal, gastrointestinal (GI) and central nervous system (CNS) damages, eventually leading to death. Fatalities related to exposure to mercuric chloride have been reported since the nineteenth century. To date, there have been 45 published cases in the medical literature in which the intoxication or the death is attributed to mercuric chloride. In this review, we will describe the modern medical treatments, with particular attenztion to the developments of the lasts two decades, in order to provide an exhaustive description of the clinical symptoms, the post-mortem findings, and the analytical procedures to act out when mercuric chloride intoxication occurs. The analysis of the data obtained permitted us to accurately describe all the organs and apparatus involved in mercuric chloride intoxication. The target organs were the kidneys, the GI tract and the CNS. A description of the analytical procedures for the determination of mercuric chloride in biological materials, to carry out in vivo and in post-mortem samples has also been described.
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Affiliation(s)
- Simone Cappelletti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy.,State Police Health Service Department, Ministry of Interior , Rome , Italy
| | - Daria Piacentino
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse (NIDA) Intramural Research Program, National Institutes of Health , Bethesda , MD , USA
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy
| | - Stefano D'Errico
- Legal Medicine Unit, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy.,Legal Medicine Unit, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
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Zhai H, Wang Y, Wang M, Liu S, Yu F, Gao C, Li G, Wu Q. Construction of a Glutathione-Responsive and Silica-Based Nanocomposite for Controlled Release of Chelator Dimercaptosuccinic Acid. Int J Mol Sci 2018; 19:E3790. [PMID: 30487433 PMCID: PMC6321213 DOI: 10.3390/ijms19123790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/24/2018] [Accepted: 11/25/2018] [Indexed: 11/16/2022] Open
Abstract
Dimercaptosuccinic acid (DMSA) is an oral heavy metal chelator. Although DMSA is the most acceptable chelator in the urinary excretion of toxic elements from children and adults, its defects in plasma binding and the membrane permeability limit its interaction with intracellular elements and affect its efficacy in chelation therapy. Herein, a novel nanocomposite composed of mesoporous silica nanoparticles (MSNs), disulfide bond, and DMSA was synthesized and characterized with a scanning/transmission electron microscope, IR and Raman spectra, and TGA analysis. The in vitro interactions with glutathione (GSH) and cellular uptake assays showed that it was able to be stable in extracellular environments such as in blood, be internalized by cells, and release DMSA inside via GSH-triggered disulfide cleavage reaction. The in vitro adsorption assays showed that MSNs-SH as its intracellular metabolite had strong adsorbability for models of Hg2+ or Pb2+. The hemolysis and cell viability assays showed that it was compatible with blood and cells even at a concentration of 1000 μg·mL-1. All above could not only enable it to be a GSH-responsive drug delivery system (DDS) for DMSA delivery but also to be a solution for its defects and efficacy. Thus, introduction of intelligent DDS might open a new avenue for DMSA-based chelation therapy.
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Affiliation(s)
- Hongqiang Zhai
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China.
- Institute of Medicinal Biotechnology of Medical Science & Peking Union Medical College, Beijing 100850, China.
| | - Yuli Wang
- State key laboratory of toxicology and medical countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China.
| | - Menghua Wang
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China.
| | - Shuai Liu
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China.
| | - Feifei Yu
- Institute of Medicinal Biotechnology of Medical Science & Peking Union Medical College, Beijing 100850, China.
| | - Chunsheng Gao
- State key laboratory of toxicology and medical countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China.
| | - Guiling Li
- Institute of Medicinal Biotechnology of Medical Science & Peking Union Medical College, Beijing 100850, China.
| | - Qiang Wu
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China.
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van Eijkeren JCH, Olie JDN, Bradberry SM, Vale JA, de Vries I, Clewell HJ, Meulenbelt J, Hunault CC. Modeling the effect of succimer (DMSA; dimercaptosuccinic acid) chelation therapy in patients poisoned by lead. Clin Toxicol (Phila) 2016; 55:133-141. [DOI: 10.1080/15563650.2016.1263855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - J. Daniël N. Olie
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pharmacology and Toxicology, University of Nijmegen, Nijmegen, The Netherlands
| | - Sally M. Bradberry
- City Hospital, National Poisons Information Service (Birmingham Unit), Birmingham, UK
- School of Biosciences, University of Birmingham, Birmingham, UK
| | - J. Allister Vale
- City Hospital, National Poisons Information Service (Birmingham Unit), Birmingham, UK
- School of Biosciences, University of Birmingham, Birmingham, UK
| | - Irma de Vries
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jan Meulenbelt
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Claudine C. Hunault
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
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van Eijkeren JCH, Olie JDN, Bradberry SM, Vale JA, de Vries I, Meulenbelt J, Hunault CC. Modelling dimercaptosuccinic acid (DMSA) plasma kinetics in humans. Clin Toxicol (Phila) 2016; 54:833-839. [DOI: 10.1080/15563650.2016.1221508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - J. Daniël N. Olie
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pharmacology and Toxicology, University of Nijmegen, Nijmegen, The Netherlands
| | - Sally M. Bradberry
- National Poisons Information Service (Birmingham Unit), City Hospital, Birmingham, UK
- School of Biosciences, University of Birmingham, Birmingham, UK
| | - J. Allister Vale
- National Poisons Information Service (Birmingham Unit), City Hospital, Birmingham, UK
- School of Biosciences, University of Birmingham, Birmingham, UK
| | - Irma de Vries
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Meulenbelt
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Claudine C. Hunault
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Shukla J, Mittal BR. Dimercaptosuccinic acid: A multifunctional cost effective agent for imaging and therapy. Indian J Nucl Med 2015; 30:295-302. [PMID: 26430311 PMCID: PMC4579612 DOI: 10.4103/0972-3919.164015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dimercaptosuccinic acid (DMSA) is an analog of dimercaprol used as metal chelating moiety in variety of conditions. In nuclear medicine itself two types of Tc-99m DMSA complexes are used, trivalent and pentavalent forms. In this review, we have discussed the mechanism of uptake of both complexes as well as diagnostic and therapeutic application in a clinical scenario.
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Affiliation(s)
- Jaya Shukla
- Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Thurtle N, Greig J, Cooney L, Amitai Y, Ariti C, Brown MJ, Kosnett MJ, Moussally K, Sani-Gwarzo N, Akpan H, Shanks L, Dargan PI. Description of 3,180 courses of chelation with dimercaptosuccinic acid in children ≤ 5 y with severe lead poisoning in Zamfara, Northern Nigeria: a retrospective analysis of programme data. PLoS Med 2014; 11:e1001739. [PMID: 25291378 PMCID: PMC4188566 DOI: 10.1371/journal.pmed.1001739] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 08/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2010, Médecins Sans Frontières (MSF) discovered extensive lead poisoning impacting several thousand children in rural northern Nigeria. An estimated 400 fatalities had occurred over 3 mo. The US Centers for Disease Control and Prevention (CDC) confirmed widespread contamination from lead-rich ore being processed for gold, and environmental management was begun. MSF commenced a medical management programme that included treatment with the oral chelating agent 2,3-dimercaptosuccinic acid (DMSA, succimer). Here we describe and evaluate the changes in venous blood lead level (VBLL) associated with DMSA treatment in the largest cohort of children ≤ 5 y of age with severe paediatric lead intoxication reported to date to our knowledge. METHODS AND FINDINGS In a retrospective analysis of programme data, we describe change in VBLL after DMSA treatment courses in a cohort of 1,156 children ≤ 5 y of age who underwent between one and 15 courses of chelation treatment. Courses of DMSA of 19 or 28 d duration administered to children with VBLL ≥ 45 µg/dl were included. Impact of DMSA was calculated as end-course VBLL as a percentage of pre-course VBLL (ECP). Mixed model regression with nested random effects was used to evaluate the relative associations of covariates with ECP. Of 3,180 treatment courses administered, 36% and 6% of courses commenced with VBLL ≥ 80 µg/dl and ≥ 120 µg/dl, respectively. Overall mean ECP was 74.5% (95% CI 69.7%-79.7%); among 159 inpatient courses, ECP was 47.7% (95% CI 39.7%-57.3%). ECP after 19-d courses (n = 2,262) was lower in older children, first-ever courses, courses with a longer interval since a previous course, courses with more directly observed doses, and courses with higher pre-course VBLLs. Low haemoglobin was associated with higher ECP. Twenty children aged ≤ 5 y who commenced chelation died during the period studied, with lead poisoning a primary factor in six deaths. Monitoring of alanine transaminase (ALT), creatinine, and full blood count revealed moderate ALT elevation in <2.5% of courses. No clinically severe adverse drug effects were observed, and no laboratory findings required discontinuation of treatment. Limitations include that this was a retrospective analysis of clinical data, and unmeasured variables related to environmental exposures could not be accounted for. CONCLUSIONS Oral DMSA was a pharmacodynamically effective chelating agent for the treatment of severe childhood lead poisoning in a resource-limited setting. Re-exposure to lead, despite efforts to remediate the environment, and non-adherence may have influenced the impact of outpatient treatment. Please see later in the article for the Editors' Summary.
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Affiliation(s)
| | - Jane Greig
- Médecins Sans Frontières, London, United Kingdom
| | | | - Yona Amitai
- Department of Management, Bar Ilan University, Ramat Gan, Israel
| | - Cono Ariti
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mary Jean Brown
- Healthy Homes/Lead Poisoning Prevention Program, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Michael J. Kosnett
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, United States of America
| | | | - Nasir Sani-Gwarzo
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Henry Akpan
- Federal Ministry of Health, Abuja, Nigeria
- Federal Ministry of Communication Technology, Abuja, Nigeria
| | | | - Paul I. Dargan
- Médecins Sans Frontières, Amsterdam, Holland
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Smith D, Strupp BJ. The scientific basis for chelation: animal studies and lead chelation. J Med Toxicol 2014; 9:326-38. [PMID: 24113857 DOI: 10.1007/s13181-013-0339-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This presentation summarizes several of the rodent and non-human studies that we have conducted to help inform the efficacy and clinical utility of succimer (meso-2,3-dimercaptosuccincinic acid) chelation treatment. We address the following questions: (1) What is the extent of body lead, and in particular brain lead reduction with chelation, and do reductions in blood lead accurately reflect reductions in brain lead? (2) Can succimer treatment alleviate the neurobehavioral impacts of lead poisoning? And (3) does succimer treatment, in the absence of lead poisoning, produce neurobehavioral deficits? Results from our studies in juvenile primates show that succimer treatment is effective at accelerating the elimination of lead from the body, but chelation was only marginally better than the complete cessation of lead exposure alone. Studies in lead-exposed adult primates treated with a single 19-day course of succimer showed that chelation did not measurably reduce brain lead levels compared to vehicle-treated controls. A follow-up study in rodents that underwent one or two 21-day courses of succimer treatment showed that chelation significantly reduced brain lead levels, and that two courses of succimer were significantly more efficacious at reducing brain lead levels than one. In both the primate and rodent studies, reductions in blood lead levels were a relatively poor predictor of reductions in brain lead levels. Our studies in rodents demonstrated that it is possible for succimer chelation therapy to alleviate certain types of lead-induced behavioral/cognitive dysfunction, suggesting that if a succimer treatment protocol that produced a substantial reduction of brain lead levels could be identified for humans, a functional benefit might be derived. Finally, we also found that succimer treatment produced lasting adverse neurobehavioral effects when administered to non-lead-exposed rodents, highlighting the potential risks of administering succimer or other metal-chelating agents to children who do not have elevated tissue lead levels. It is of significant concern that this type of therapy has been advocated for treating autism.
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Affiliation(s)
- Donald Smith
- Microbiology and Environmental Toxicology, University of California Santa Cruz, Santa Cruz, CA, USA,
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Sears ME. Chelation: harnessing and enhancing heavy metal detoxification--a review. ScientificWorldJournal 2013; 2013:219840. [PMID: 23690738 PMCID: PMC3654245 DOI: 10.1155/2013/219840] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/14/2013] [Indexed: 01/21/2023] Open
Abstract
Toxic metals such as arsenic, cadmium, lead, and mercury are ubiquitous, have no beneficial role in human homeostasis, and contribute to noncommunicable chronic diseases. While novel drug targets for chronic disease are eagerly sought, potentially helpful agents that aid in detoxification of toxic elements, chelators, have largely been restricted to overt acute poisoning. Chelation, that is multiple coordination bonds between organic molecules and metals, is very common in the body and at the heart of enzymes with a metal cofactor such as copper or zinc. Peptides glutathione and metallothionein chelate both essential and toxic elements as they are sequestered, transported, and excreted. Enhancing natural chelation detoxification pathways, as well as use of pharmaceutical chelators against heavy metals are reviewed. Historical adverse outcomes with chelators, lessons learned in the art of using them, and successes using chelation to ameliorate renal, cardiovascular, and neurological conditions highlight the need for renewed attention to simple, safe, inexpensive interventions that offer potential to stem the tide of debilitating, expensive chronic disease.
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Affiliation(s)
- Margaret E Sears
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, Canada.
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Flora SJS, Bhadauria S, Pachauri V, Yadav A. Monoisoamyl 2, 3-dimercaptosuccinic acid (MiADMSA) demonstrates higher efficacy by oral route in reversing arsenic toxicity: a pharmacokinetic approach. Basic Clin Pharmacol Toxicol 2011; 110:449-59. [PMID: 22117535 DOI: 10.1111/j.1742-7843.2011.00836.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Monoisoamyl DMSA (MiADMSA), a lipophilic chelating agent has emerged as a promising drug for the treatment of arsenic. The present study aimed at exploring the optimum dose and route of administration for achieving maximum arsenic elimination with minimal side effects. We also carried out a pharmacokinetic analysis of this drug to support arsenic chelation. Rats were exposed to arsenic (25 ppm) for 6 months and later received MiADMSA (50 or 100 mg/kg) orally and via i.p. route for 5 days. Oxidative stress parameters and arsenic levels in soft tissues, liver function test and histopathology of liver and kidney were performed. Plasma kinetic of MiADMSA (plasma-free drug and total drug) at 50 and 100 mg/kg p.o. was carried out. Arsenic exposure resulted in significant oxidative stress and hepatotoxicity. MiADMSA at 50 mg/kg dose administered orally provided about 45% and 75% protection against oxidative stress and in lowering body arsenic burden, respectively, against 25% and 40% via i.p. route. Pharmacokinetic analysis supported prolonged availability of the drug through oral administration. Collectively, these findings led us to conclude that oral administration of MiADMSA was more effective than intraperitoneal administration and that the minimum effective dose with least side effects was 50 mg/kg.
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Affiliation(s)
- Swaran J S Flora
- Division of Pharmacology and Toxicology, Defence Research and Development Establishment, Gwalior, India.
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Bradberry S, Vale A. A comparison of sodium calcium edetate (edetate calcium disodium) and succimer (DMSA) in the treatment of inorganic lead poisoning. Clin Toxicol (Phila) 2009; 47:841-58. [DOI: 10.3109/15563650903321064] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bradberry S, Vale A. Dimercaptosuccinic acid (succimer; DMSA) in inorganic lead poisoning. Clin Toxicol (Phila) 2009; 47:617-31. [DOI: 10.1080/15563650903174828] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hoet P, Buchet JP, Decerf L, Lavalleye B, Haufroid V, Lison D. Clinical evaluation of a lead mobilization test using the chelating agent dimercaptosuccinic acid. Clin Chem 2005; 52:88-96. [PMID: 16239340 DOI: 10.1373/clinchem.2005.051128] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The lead mobilization test reflects the mobilizable and likely toxicologically active fraction of the lead body burden. We propose a safe and convenient protocol for this test, to assess concomitant copper and zinc excretion and to determine the size of the chelatable lead pool in nonoccupationally exposed adults. METHODS The study population included 80 white adults: 40 controls [median blood lead concentration (PbB), 25 microg/L] and 40 lead-exposed individuals (315 microg/L). After collection of 4- and 24-h baseline urine specimens and a blood sample, dimercaptosuccinic acid (DMSA) was administered orally (1 g), and additional 4- and 24-h urine specimens were obtained. Determinants of the chelatable urinary lead (DMSA-PbU) were traced by linear regression analysis. RESULTS Urinary DMSA and lead excretion peaked within 2-3 h after DMSA administration. The amounts of DMSA, lead, copper, and zinc recovered in the 4-h urinary collections were highly correlated with those in 24-h collections (r = 0.857, 0.859, 0.958, and 0.757, respectively). At PbB concentrations >300 microg/L, the relationship between DMSA-PbU and PbB showed a steep increase and a widespread dispersion of DMSA-PbU around the regression line. After DMSA, copper and zinc excretion rates were increased up to 91- and 33-fold, respectively. No side effects were reported after DMSA. CONCLUSIONS Determination of DMSA-PbU in a 4-h collection after DMSA is convenient, apparently safe, and inexpensive. An upper reference limit value of 22 microg/4 h is proposed for Belgian reference individuals. The diagnostic value of DMSA-PbU is likely to be contributive for PbB >300 microg/L.
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Affiliation(s)
- Perrine Hoet
- Unit of Industrial Toxicology and Occupational Medicine, Faculty of Medicine, Catholic University of Louvain, Brussels, Belgium.
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Rademacher DJ, Steinpreis RE, Weber DN. Short-term exposure to dietary Pb and/or DMSA affects dopamine and dopamine metabolite levels in the medulla, optic tectum, and cerebellum of rainbow trout (Oncorhynchus mykiss). Pharmacol Biochem Behav 2001; 70:199-207. [PMID: 11701189 DOI: 10.1016/s0091-3057(01)00597-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rainbow trout (Oncorhynchus mykiss) were randomly assigned to one of the following dietary exposure conditions: lead (Pb) solvent (2% nitric acid), meso-2,3-dimercaptosuccinic acid (DMSA) solvent (0.1 N NaOH), Pb, DMSA, Pb followed by Pb solvent, or Pb followed by DMSA. Medulla, cerebellum, and optic tectum homogenates were analyzed for dopamine (DA), homovanillic acid (HVA), and 3,4-dihydroxyphenylacetic acid (DOPAC). DA levels in all brain regions tended to be highest for trout exposed to dietary Pb followed by dietary DMSA. DA levels were elevated for trout exposed to dietary DMSA and Pb followed by Pb solvent. DA levels were below control levels for trout exposed to Pb only. HVA levels varied across brain regions. However, HVA levels in all brain regions tended to be elevated for trout exposed to dietary DMSA and Pb followed by Pb solvent. DOPAC levels across all brain regions were below control levels for trout dietary exposed to DMSA, Pb only, Pb followed by Pb solvent, and Pb followed by DMSA. These data indicate that Pb and/or DMSA have the potential of altering DA, HVA, and DOPAC levels in the medulla, cerebellum, and optic tectum. The animal model of short-term dietary exposure to Pb and DMSA, both alone and sequentially, to mimic dietary exposure to Pb and the oral delivery of DMSA, that our laboratory has developed, may be useful in future studies aimed at characterizing the neurobiological mechanisms by which Pb and/or DMSA alter neurotransmitter levels and behavior.
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Affiliation(s)
- D J Rademacher
- Department of Psychology, University of Wisconsin-Milwaukee, 224 Garland Hall, 2441 East Hartford Avenue, Milwaukee, WI 53211, USA
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Chisolm JJ. Safety and efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) in children with elevated blood lead concentrations. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 2000; 38:365-75. [PMID: 10930052 DOI: 10.1081/clt-100100945] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of meso-2,3-dimercaptosuccinic acid in the treatment of children with lead toxicity. DESIGN This was an open-label study in 59 children 12-65-months old, with pretreatment whole-blood lead levels of 25-66 microg/dL, who received 116, 26-28 day courses of oral dimer-captosuccinic acid, while residing either in the Pediatric Clinical Research Unit of the Johns Hopkins Hospital or in lead-safe housing during the outpatient portion of the study. RESULTS All, who completed the study, showed sharp decreases in blood lead concentration during therapy, but 2-3 weeks following completion of drug therapy, blood lead concentration rebounded to an average of 58% (23 microg Pb/dL of whole blood) of their average pretreatment blood lead concentration (40 microg Pb/dL of whole blood). There were no adverse reactions attributable to dimercaptosuccinic acid; however, 2 of the 59 patients were reexposed to defective lead paint and experienced sharp increases in blood lead concentration while on therapy. In one instance, the child's blood lead concentration increased from 20 to 90 microg Pb/dL whole blood in 1 week. Other unexpected events were discussed in the text. CONCLUSIONS Dimercaptosuccinic acid is apparently safe and does mobilize lead into the urine, but not the essential metals, zinc and copper. Reexposure is always a danger; therefore, all children, while on therapy, should be monitored for their blood lead concentration at weekly intervals during and immediately after therapy. No conclusions can be drawn from this study regarding long-term beneficial effects, if any, of this drug on late neurocognitive outcome.
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Affiliation(s)
- J J Chisolm
- Lead Poisoning Program, The Kennedy Krieger Institute, Baltimore, Maryland 21205, USA
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16
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Pokorski PL, McCabe MJ, Pounds JG. Meso-2,3-dimercaptosuccinic acid induces calcium transients in cultured rhesus monkey kidney cells. Toxicology 1999; 138:81-91. [PMID: 10576585 DOI: 10.1016/s0300-483x(99)00092-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The maintenance of intracellular Ca2+ homeostasis is critical to many cellular functions that rely on the calcium ion as a messenger. While attempting to characterize the effects of lead on intracellular calcium levels ([Ca2+]i) in LLC-MK2 Rhesus Monkey kidney cells, we observed that treatment with the metal chelating drug, meso-2,3-dimer-captosuccinic acid (DMSA) evoked transient increases in [Ca2+]i. Changes in [Ca2+]i were monitored using the Ca2+ indicator dye Fura-2 and a dual wavelength fluorescence imaging system. In the presence of 2 mM extracellular Ca2+, DMSA treatment caused a concentration-dependent (15-500 microM) transient increase in [Ca2+]i returning to baseline levels within 30-60 s. Pharmacologic concentrations of DMSA (30 microM) stimulated a three-fold increase in [Ca2+]i, which was spatiotemporally comparable to Ca2+ transients induced by other calcium agonists. Depletion of inositol trisphosphate (IP3)-sensitive [Ca2+]i stores with the smooth endoplasmic reticulum calcium-ATPase (SERCA) inhibitor thapsigargin did not prevent DMSA-elicited increases in [Ca2+]i, suggesting that Ca2+ mobilized by DMSA was either extracellular or from an non-IP3 releasable Ca2+ pool. Treatment with glutathione, cysteine, or 2-mercaptoethanol caused similar but not identical calcium transients. Adenosine-5'-trisphosphate (ATP) also elicited transient increases in [Ca2+]i similar to those of DMSA. No transient increases in [Ca2+]i were elicited by DMSA or ATP in the absence of extracellular calcium. These data indicate that DMSA and other sulfhydryl compounds trigger an influx of extracellular calcium, suggesting a previously unobserved and unanticipated interaction between DMSA and the Ca2+ messenger system.
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Affiliation(s)
- P L Pokorski
- Department of Pharmaceutical Sciences, Institute of Chemical Toxicology, Wayne State University, Detroit, MI 48201, USA
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Abstract
Chelation therapy is the basis for the treatment of metal poisoning. A number of chelating agents have been widely used since the 1950s. Since these agents can be potentially given to a metal-intoxicated pregnant woman, their intrinsic developmental toxicities are a matter of concern. While the embryo/fetal toxic effects of some chelators have been reported to occur at doses higher than those currently given in the medical treatment of metal poisoning, according to experimental data the potential use of other metal antidotes is controversial. In those cases, the benefits and risks of usage should be carefully weighed. The developmental toxicity of known chelators of clinical interest is presented here. Chelating agents were divided according to the following structurally related categories: polyaminocarboxylic acids, chelators with vicinal -SH groups, beta-mercapto-alpha-aminoacids, hydroxamic acids, ortho-hydroxycarboxylic acids, and miscellaneous agents. Since it has been demonstrated that the teratogenic potential of most chelators is, at least in part, due to induced trace element deficiencies, the advisability of mineral supplements during chelation treatment is also discussed.
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Affiliation(s)
- J L Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, Rovira i Virgili University, Reus, Spain
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