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.
Similar content being viewed by others
References
Graziano JH, Siris ES, LoIacono N, Silverberg SJ, Turgeon L (1985) 2,3-Dimercaptosuccinic acid as an antidote for lead intoxication. Clin Pharmacol Ther 37:431–438
Graziano JH (1986) Role of 2,3-dimercaptosuccinic acid in the treatment of heavy metal poisoning. Med Toxicol 1:155–162
Graziano JH, Lolacono NJ, Meyer P (1988) Dose–response study of oral 2,3-dimercaptosuccinic acid in children with elevated blood lead concentrations. J Pediatr 113(4):751–757
Graziano JH, Lolacono NJ, Moulton T, Mitchell ME, Slavkovich V, Zarate C (1992) Controlled study of meso-2,3-dimercaptosuccinic acid for the management of childhood lead intoxication. J Pediatr 120(1):133–139
Aposhian HV, Maiorino RM, Dart RC, Perry DF (1989) Urinary excretion of meso-2,3-dimercaptosuccinic acid in human subjects. Clin Pharmacol Ther 45:520–526
Aposhian HV, Aposhian MM (1990) Meso-2,3-dimercaptosuccinic acid: chemical, pharmacological and toxicological properties of an orally effective metal chelating agent. Annu Rev Pharmacol Toxicol 30:279–306
Rivera M, Zheng W, Aposhian HV, Fernando Q (1989) Determination and metabolism of dithiol chelating agents VIII. Metal complexes of meso-dimercaptosuccinic acid. Toxicol Appl Pharmacol 100:96–106
Maiorino RM, Akins JM, Blaha K, Carter DE, Aposhian HV (1990) Determination and metabolism of dithiol chelating agents: X. In humans, meso-2,3-dimercaptosuccinic acid is bound to plasma proteins via mixed disulfide formation. J Pharmacol Exp Ther 254(2):570–577
Dart RC, Hurlbut KM, Maiorino RM, Mayersohn M, Aposhian HV, Hassen LV (1994) Pharmacokinetics of meso-2,3-dimercaptosuccinic acid in patients with lead poisoning and in healthy adults. J Pediatr 125:309–316
Asiedu P, Moulton T, Blum CB, Roldan E, Lolacono NJ, Graziano JH (1995) Metabolism of meso-2,3-dimercaptosuccinic acid in lead-poisoned children and normal adults. Environ Health Perspect 103(7–8):734–739
Smith DR, Woolard D, Luck M, Laughlin N (2000) Succimer and the reduction of tissue lead in juvenile monkeys. Toxicol Appl Pharmacol 166:230–240
Cremin J, Luck M, Laughlin N, Smith DR (2001) Oral succimer decreases the gastrointestinal absorption of lead in juvenile monkeys. Environ Health Perspect 109:613–620
Cremin J, Luck M, Laughlin N, Smith DR (1999) Efficacy of succimer chelation for reducing brain lead in a primate model of human lead exposure. Toxicol Appl Pharmacol 161:283–293
Stangle D, Strawderman M, Smith D, Kuypers M, Strupp B (2004) Reductions in blood lead overestimate reductions in brain lead after repeated succimer regimens in a rodent model of childhood lead exposure. Environ Health Perspect 112:302–308
Needleman HL, Riess JA, Tobin MJ, Biesecker GE, Greenhouse JB (1996) Bone lead levels and delinquent behavior. JAMA 275:363–369
ACCLPP, Report of the Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control and Prevention. “Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention”, January 4, 2012. http://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_030712.pdf .
CDC, Response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations in “Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention”. June 7, 2012. http://www.cdc.gov/nceh/lead/ACCLPP/CDC_Response_Lead_Exposure_Recs.pdf .
Rogan WJ, Dietrich KN, Ware JH, Dockery DW, Salganik M, Radcliffe J et al (2001) The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. N Engl J Med 344:1421–1426
Dietrich KN, Ware JH, Salganik M, Radcliffe J, Rogan WJ, Rhoads GG et al (2004) Treatment of lead-exposed children clinical trial group: effect of chelation therapy on the neuropsychological and behavioral development of lead exposed children after school entry. Pediatrics 114:19–26
Stangle D, Smith DR, Beaudin S, Strawderman M, Levitsky D, Strupp B (2007) Succimer chelation improves learning, attention and arousal regulation in lead-exposed rats but produces lasting cognitive impairment in the absence of lead exposure. Env Health Perspect 115(2):201–209
Beaudin S, Stangle D, Smith DR, Levitsky D, Strupp B (2007) Succimer chelation normalizes reactivity to reward omission and errors in lead-exposed rats. Neurotoxicol Teratol 29:188–202
Smith DR, Bayer LE, Strupp BJ (1998) Efficacy of succimer chelation for reducing brain Pb in rodents. Env Res 78:168–176
Acknowledgments
We are grateful to the many individuals who contributed to the research that provided the foundation for much of what we know about the efficacy and underlying mechanisms of lead chelation therapy in humans and animals models. In particular, we thank L. Bayer, S. Beaudin, J. Cremin, M. Kuypers, N. Laughlin, M. Luck, D. Stangle, M. Strawderman, and D. Woolard for their significant contributions to the studies presented here. Funding for the original studies presented here was provided by the National Institutes of Health (R01 ES06918, ES07535, ES07457, ES07457, ES05950, and DK0715827, and F32 ES05870).
ATSDR Disclaimer
This publication was supported by the cooperative agreement award number 1U61TS000117-04 from the Agency for Toxic Substances and Disease Registry (ATSDR). Its contents are the responsibility of the authors and do not necessarily represent the official views of the Agency for Toxic Substances and Disease Registry (ATSDR).
Sources of funding for project
n/a.
Conflict delineations
For the work under consideration for publication, Dr. Smith received an honorarium and reimbursement for travel through the ACMT/ATSDR Cooperative Agreement. Dr. Strupp has no conflicts.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Smith, D., Strupp, B.J. The Scientific Basis for Chelation: Animal Studies and Lead Chelation. J. Med. Toxicol. 9, 326–338 (2013). https://doi.org/10.1007/s13181-013-0339-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13181-013-0339-2