Chelation in Metal Intoxication
Abstract
:1. Introduction
2. Chelation: Concept and Chemistry
3. Common Chelating Agents: Pharmacology and Toxicology
3.1. Calcium Disodium Ethylenediamine Tetraacetic Acid (CaNa2EDTA)
Pharmacological Profile
3.2. Calcium Trisodium DTPA
Pharmacological Profile
3.3. D-Penicillamine
Pharmacological Profile
3.4. British Anti Lewisite (BAL)
Pharmacological Profile
- Low therapeutic index (small margin of safety)
- Tendency to redistribute arsenic to brain and testes
- Need for (painful) intramuscular injection
- Unpleasant odor (rotten eggs)
3.5. Meso-2,3-Dimercaptosuccinic Acid (DMSA)
Pharmacological Profile
3.6. Sodium 2,3 Dimercaptopropane-l-Sulphonate (DMPS)
Pharmacological Profile
3.7. New DMSA Analogues
3.7.1. Monoisoamyl DMSA (MiADMSA)
Pharmacological Profile
3.7.2. Monomethyl DMSA (MmDMSA) and Monocyclohexyl DMSA (MchDMSA)
3.8. Deferoxamine (DFO)
Pharmacological Profile
3.9. Deferiprone (L1)
Pharmacological Profile
3.10. TETA
Pharmacological Profile
3.11. Nitrilotriacetic Acid (NTA)
4. Limitations of Current Chelation Therapy
5. Newer Strategies: Combination Therapy
6. Oxidative Stress in Metal Toxicity and the Role of Antioxidants
7. Therapeutic Recommendations for Heavy Metal Poisoning
- Prevention of further metal absorption into the system
- Elimination of metal from the circulation
- Inactivation of metal bioavailable in the system
7.1. Prevention of Further Metal Absorption into the System
7.2. Elimination of Metal from the Circulation
7.3. Inactivation of Metal Bioavailability in the System
7.3.1. Lead
7.3.2. Arsenic
7.3.4. Cadmium
7.3.5. Mercury
7.3.6. Iron
8. Role of Antioxidants during Chelation
9. Conclusions
Acknowledgments
References
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Metal | Na | Li | Ba | Sr | Mg | Ca | Mn | Fe | Co | Zn | Cd | Pb | Ni |
K (log) | 1.7 | 2.8 | 7.8 | 8.6 | 8.7 | 10.6 | 13.4 | 14.4 | 16.1 | 16.1 | 16.4 | 18.3 | 18.4 |
Therapeutic Strategy | Examples | Refs. | Benefits |
---|---|---|---|
Development of newer chelating, agents | MiADMSA MmDMSA MchDMSA | [86] |
|
Combination therapy with two chelating agents | DMSA+ MiADMSA MiADMSA+CaNa2EDTA | [52,87,89] [85] |
|
Chelating agent + Antioxidants | DMSA/MiADMSA + NAC DMSA/MiADMSA + LA MiADMSA+ Quercetin DMSA/MiADMSA + Taurine DMSA/MiADMSA+ Vitamin | [115,207] [109] [132] [112,113] [205,108,120] |
|
Chelating agent + Micronutrients | DMSA+Zn CaNa2EDTA+Zn Fe DMSA+Cu | [16,122,121] [111] [208] [121] |
|
Chelating agent + Herbal extract. | Centella asiatica Moringa Oleifera Garlic | [209] [210] [211] |
|
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Flora, S.J.S.; Pachauri, V. Chelation in Metal Intoxication. Int. J. Environ. Res. Public Health 2010, 7, 2745-2788. https://doi.org/10.3390/ijerph7072745
Flora SJS, Pachauri V. Chelation in Metal Intoxication. International Journal of Environmental Research and Public Health. 2010; 7(7):2745-2788. https://doi.org/10.3390/ijerph7072745
Chicago/Turabian StyleFlora, Swaran J.S., and Vidhu Pachauri. 2010. "Chelation in Metal Intoxication" International Journal of Environmental Research and Public Health 7, no. 7: 2745-2788. https://doi.org/10.3390/ijerph7072745