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Cadmium-induced apoptosis in the urogenital organs of the male rat and its suppression by chelation.

Cadmium-induced apoptosis is shown to occur, in vivo, in several organs of the male Wistar rat urogenital system, 48 h after cadmium administration i.p. at a dose of 0.03 mmol/kg. Characteristic DNA fragmentation (as measured by an enzyme-linked immunosorbent-assay, ELISA) and histopathologically observed changes characteristic of apoptosis are found in the kidney, prostate, seminal vesicles, testes, and epididymis. TUNEL assay also demonstrates the apoptosis. Such changes are absent from bladder and vas deferens tissue. Timely administration of an appropriate chelating agent capable of reaching intracellular cadmium binding sites can suppress the processes leading to apoptosis. Administration of monoisomyl meso-2,3-dimercaptosuccinate (Mi-ADMS, 0.5 mmol/kg i.p.) to cadmium-treated rats is effective in greatly reducing typical histopathologic signs of apoptosis and the associated chromatin DNA fragmentation as revealed by ELISA when the antagonist is administered 1 h after cadmium. Administration of the chelating agent at law times results in greater degradation of DNA into oligonucleotides and more prominent histopathological evidence of apoptotic changes in the affected organs of the rat urogenital system. There is also a progressive increase in apoptotic changes indicated by TUNEL assay, as the antagonist is administered at progressively greater intervals after cadmium.

Animals↗

Acute and chronic neuropsychological consequences of mercury vapor poisoning in two early adolescents.

Mercury is an extremely toxic heavy metal that can devastate the central nervous system. The neuropsychological consequences of mercury vapor intoxication have been studied primarily in adults. We present two adolescent half-siblings, ages 13 and 15, who were unintentionally exposed to concentrated mercury vapor for 3 months. Both children participated in neuropsychological evaluations shortly after being diagnosed with mercury toxicity, and again 1 year later. Results from the initial assessments documented functional deficits consistent with diffuse encephalopathy. Upon follow-up, neuropsychological functioning had improved, but deficits remained in visuoperceptual and constructional skills, nonverbal memory, and conceptual abstraction. The deficits persisted despite removal from exposure, return of urinary and blood mercury to acceptable levels, and resolution of neuropsychiatric symptoms. The deficits were similar to, but more severe than, those found in adults suffering from mercury vapor intoxication. The results suggest that the developing brain may be especially vulnerable to mercury vapor toxicity.

Adolescent↗

Mobilization and detoxification of polonium-210 in rats by 2,3-dimercaptosuccinic acid and its derivatives.

PURPOSE: To reduce retention and toxicity of the alpha particle emitter polonium-210 in rats by newly developed chelating agents. MATERIALS AND METHODS: Repeated subcutaneous chelation was conducted after intravenous injection of 210Po nitrate. For reduction of 210Po retention the treatment with vicinal dithiols meso-and rac-2,3-dimercaptosuccinic acid (DMSA), mono-i-amylmeso-2,3-dimercapto succinate (Mi-ADMS) and mono-N-(i-butyl)-meso-2,3-dimercapto succinamide (Mi-BDMA) were used. For the reduction of toxic effects of 210Po, treatment effectiveness of Mi-BDMA was compared with that of N,N'-di(2-hydroxyethyl)ethylenediamine-N,N'-biscarbodithioate (HOEtTTC, reference compound). RESULTS: Treatment with meso-DMSA and rac-DMSA altered the main excretion route of 210Po, reduced its contents in the liver but increased its deposition in the kidneys. Treatment with Mi-ADMS or Mi-BDMA increased total excretion of 210Po, mainly via the faeces. Only Mi-BDMA decreased 210Po levels in the kidneys. The effectiveness of all chelators decreased with delay in the start of treatment. In a survival study, the lives of rats treated early with Mi-BDMA or delayed with HOEtTTC were prolonged three-fold when compared with rats receiving a lethal amount of 210Po only. CONCLUSIONS: Of the vicinal dithiols examined, Mi-BDMA was the best mobilizing chelating agent for 210Po and it reduced 210Po toxicity when the treatment started immediately. However, the detoxification efficacy of the immediate treatment with HOEtTTC, observed in our previous study, was superior to that of the present result with Mi-BDMA.

Animals↗

Methylmercury removal in the dog during infusion of 2,3-dimercaptosuccinic acid (DMSA).

2,3-Dimercaptosuccinic acid (DMSA) has been utilized in chelation therapy and in extracorporal complexing hemodialysis therapy for experimental methylmercury intoxication. In the latter application, substantial excretion of methylmercury occurred by the urinary route. This prompted the current study of the effects of continuous intravenous DMSA infusion therapy on methylmercury kinetics in the dog. Animals previously dosed with 203Hg-labeled methylmercury at 2.5 mg Hg/kg received a priming dose of DMSA, followed by a continuous iv infusion at dose rates that resulted in DMSA concentrations in plasma similar to those observed during DMSA complexing hemodialysis therapy. The kinetics of 203Hg removal in DMSA-infused dogs was compared with both saline-infused controls and DMSA complexing hemodialysis treated dogs. DMSA infusion therapy resulted in a shift in 203Hg binding within systemic blood from the red-cell fraction into plasma. This was consistent with an observed association of DMSA with the plasma fraction. The shift in 203Hg from red cells into plasma was paralleled by an increase in urinary clearance of 203Hg during the DMSA infusion period. In four dogs treated in this fashion, an average of 6.5 micrograms of mercury was removed by the urinary route over the 5-h treatment period, compared to 0.007 micrograms in the saline-infused dogs. Although a similar magnitude of mercury output into urine was observed during DMSA complexing hemodialysis, an additional 5 micrograms was removed by the dialyzer, making that technique 1.5 times as effective as infusion therapy. Comparing 203Hg tissue concentration after DMSA infusion therapy with the saline-treated controls revealed a 6.5-fold decrease in liver, a 3-fold reduction in kidney, and a 27% reduction in cerebrum. No significant differences were observed in medulla or cerebellum. Histopathology revealed no consistent differences between DMSA-treated and saline-treated animals. The DMSA infusion therapy was effective in causing a rapid removal of 203Hg from animals previously dosed with 203Hg-labeled methylmercury. DMSA infusion therapy may provide a useful therapeutic alternative for methylmercury poisoning when rapid removal of the intoxicant is desired and hemodialysis equipment and expertise are not readily available.

Animals↗

In vivo screening of potential antidotes for chronic cadmium intoxication.

Nineteen chelating agents have been screened under identical conditions of metal loading in an attempt to establish their relative ability to mobilize cadmium from the liver and kidney in mice with chronic cadmium intoxication. The compounds investigated were divided into five groups: polyaminocarboxylic acids, monothiols, dithiols, macrocycles, and a miscellaneous category. Only 2,3-dimercaptopropanol (BAL) and sodium diethyldithiocarbamate (NaDDTC) were able to produce a statistically significant (at the 95% level) reduction in the cadmium content of the kidney. The closely related dithiols sodium 2,3-dimercaptopropane-1-sulfonate and 2,3-dimercaptosuccinic acid produced statistically significant increases in the liver cadmium contents, as did N-(2-mercaptopropionyl)-glycine. The reduction in kidney cadmium levels produced by both BAL and NaDDTC was just under 40%.

Animals↗

Antagonists for acute oral cadmium chloride intoxication.

An examination has been carried out on the relative efficacy of a number of chelating agents when acting as antagonists for oral cadmium chloride intoxication in mice. The compounds were administered orally after the oral administration of cadmium chloride at 1 mmol/kg. Of the compounds examined, several were useful in terms of enhancing survival, but by far the most effective in both enhancing survival and leaving minimal residual levels of cadmium in the liver and the kidney, was meso-2,3-dimercaptosuccinic acid (DMSA). Several polyaminocarboxylic acids also enhanced survival. The most effective of these in reducing liver and kidney levels of cadmium were diethylenetriaminepentaacetic acid (DTPA), trans-1,2-diaminocyclohexane-N,N,N'N'-tetraacetic acid (CDTA), and triethylenetetraminehexaacetic acid (TTHA). D-Penicillamine (DPA) was found to promote survival but also led to kidney cadmium levels higher than those found in the controls. Sodium 2,3-dimercaptopropane-1-sulfonate (DMPS) was as effective in promoting survival as DMSA but left levels of cadmium in the kidney and liver that were approximately four times greater than those found with DMSA.

Administration, Oral↗

Mobilization of lead by esters of meso-2,3-dimercaptosuccinic acid.

An examination was made of the relative efficacies of 2,3-dimercapto-1-propanol (BAL) and three diesters ( [CH(SH)COOR]2; DMDMS, R = CH3; DEDMS, R = C2H5; and Di-PDMS, R = CH(CH3)2] of meso-2,3-dimercaptosuccinic acid (DMSA) in mobilizing freshly injected lead from mice. These diesters, like BAL, reduced the lead levels resulting from freshly injected lead in both the soft tissues (liver, kidneys, spleen, and brain) and the bone (tibia). After treatment with the dimethyl (DMDMS), the diethyl (DEDMS), and the diisopropyl (Di-PDMS) esters the lead content of each of the organs was significantly less than that present in the untreated controls. Each of the diesters reduced lead levels in the kidneys, liver, and spleen significantly below those levels found after BAL treatment. The action of the diesters in reducing brain lead levels was comparable to that of BAL. Di-PDMS was the most effective of these compounds and was significantly superior to BAL. Each of the esters was also significantly more effective than BAL in reducing the whole body level of lead.

Animals↗

Oral meso-2,3-dimercaptosuccinic acid in pregnant Sprague-Dawley rats: teratogenicity and alterations in mineral metabolism. I. Teratological evaluation.

meso-2,3-Dimercaptosuccinic acid (DMSA), an effective antagonist for the treatment of lead, arsenic, mercury, and cadmium poisoning, was evaluated for developmental toxicity in pregnant Sprague-Dawley rats. DMSA was administered by gavage on d 6-15 of gestation at doses of 0, 100, 300, or 1000 mg DMSA/kg/d. At termination on d 20 of gestation, fetuses were examined for external, visceral, and skeletal malformations and variations. Maternal toxicity was observed at all doses, as evidenced by a significant decrease in body weight gain. There were no effects with respect to hematology or clinical chemistry. Increased early resorptions, increased percentage postimplantation loss, and reduced fetal body weight per litter were observed at 100, 300, and 1000 mg/kg/d. Examination of fetuses for gross external abnormalities, visceral and skeletal malformations, or ossification variations revealed that DMSA did not produce teratogenicity at any dosage level. However, significant fetotoxicity was observed at 100, 300, and 1000 mg/kg/d. The no-observable-effect level (NOEL) for maternal and developmental toxicity was less than 100 mg DMSA/kg/d.

Administration, Oral↗

Oral meso-2,3-dimercaptosuccinic acid in pregnant Sprague-Dawley rats: teratogenicity and alterations in mineral metabolism. II. Effect on mineral metabolism.

The effect of meso-2,3-dimercaptosuccinic acid (DMSA) on mineral metabolism was investigated in pregnant Sprague-Dawley rats. Animals were given by gavage doses of 0, 100, 300, or 1000 mg DMSA/kg/d on gestational d 6-15. On d 20 of gestation dams were killed and fetuses were removed from the uterus. The levels of calcium, magnesium, zinc, copper, and iron were measured in maternal liver, kidney, and intestine, as well as in whole fetus and in fetal liver. Mineral analysis of maternal and fetal tissues revealed pronounced effects of DMSA on mineral metabolism. The results of this investigation indicate a strong possibility that the negative effects of the drug on pregnancy are due in part to the changes in mineral metabolism.

Administration, Oral↗

Developmental toxicity evaluation of monoisoamyl meso-2,3-dimercaptosuccinate in mice.

Monoisoamyl meso-2,3-dimercaptosuccinate (Mi-ADMS), a new dimercaptosuccinic acid (DMSA) analog with enhanced lipophilic properties, was evaluated for potential developmental toxicity. Intraperitoneal injections of Mi-ADMS were given to female Swiss mice (0, 47.5, 95, and 190 mg/kg) on gestational d 6-15. The maternal clinical status was monitored daily during treatment. At termination (gestational d 18), dams were evaluated for clinical status and gestational outcome. Each live fetus was weighed and examined for external, visceral, and skeletal abnormalities. Although no maternal mortality was observed, treatment with 95 and 190 mg/kg resulted in maternal toxicity, manifested as reduced body weight gain during treatment and increased relative liver weight. Embryo/fetal toxicity, consisting of a significant increase in the number of late resorptions as well as in the percentage of postimplantation loss, reduced (nonsignificant) fetal body weight, and an increase in the incidence of skeletal defects, was also observed at 190 mg/kg/d. However, no treatment-related external or soft-tissue malformations or developmental variations were found in any group. The no-observed-adverse-effect level (NOAEL) for maternal toxicity was 47.5 mg/kg/d, whereas the NOAEL for developmental toxicity was 95 mg/kg/d. These results indicate that Mi-ADMS did not produce developmental toxicity in mice in the absence of maternal toxicity.

Abnormalities, Drug-Induced↗

Effect of monoisoamyl meso-2,3-dimercaptosuccinate on the pathology of acute cadmium intoxication.

The ability of monoisoamyl meso-2,3-dimercaptosuccinate (Mi-ADMS) to offset the characteristic organ pathology of intraperitoneally administered cadmium chloride (CdCl2) and that of the cadmium-cysteine complex has been examined in male Wistar rats. The tissues examined for damage were the testes, kidney, liver, pancreas, and bone marrow. At a high dose of CdCl2 (0.03 mmol/kg, ip) testicular damage was completely prevented by Mi-ADMS (0.50 mmol/kg, ip) given immediately. A decrease in the protective ability of the antagonist was observed following delayed administration of Mi-ADMS given at 1, 2, 4, and 24 h post CdCl2. At a lower dose of CdCl2 (0.006 mmol/kg, ip), Mi-ADMS furnished essentially full protection from testicular damage when given (0.50 mmol/kg, sc) at 0 and 1 h after CdCl2. The administration of cadmium-cysteine complex (0.01 mmol/kg, ip) induced notable renal tubular damage, which was antagonized by the administration of Mi-ADMS (0.50 mmol/kg, ip) as late as 4 h after the complex. At a 24-h delay, extensive tubular necrosis was found on sacrifice after 4 d. The administration of cadmium-cysteine complex ip reduced, but did not eliminate, the characteristic damage of the seminiferous tubules found for cadmium alone. There is a progressive reduction of testicular weight as the interval between cadmium and antagonist administration increases. The average kidney weights of the animals given CdCl2-cysteine complex were increased in comparison to normal controls. The antagonistic effects of Mi-ADMS treatment on cadmium intoxication in the kidneys and the testes of rats is very similar to that found for effective dithiocarbamate antagonists. In order to obtain complete protection of the testes from the deteterious effects of cadmium, such antagonists must be administered no later than about 1 h after the cadmium.

Acute Disease↗

Neither DMPS nor DMSA is effective in quantitative elimination of elemental mercury after intentional IV injection.

BACKGROUND: Intravenous injection of elemental mercury (Hg) is rare and considered relatively harmless. Treatment recommendations vary and the effectiveness of chelation therapy is controversial. CASE REPORT: A 27-year-old man intravenously injected 1.5 mL of elemental Hg. Within 12 hours he became febrile, tachycardic and dyspneic. Physical examination was unremarkable. X-rays showed scattered radiodense deposits in the lung, heart, intestinal wall, liver and kidney. The serum Hg level on admission was 172 microg/L and peaked on day 6 at 274 microg/L. Cumulative renal elimination during a five day oral treatment period with 2,3-dimercaptopropane-1-sulfonate (DMPS) and meso-2,3-dimercaptosuccinic acid (DMSA) was 8 mg and 3 mg, respectively. CONCLUSION: Although urinary excretion could be enhanced during chelation therapy, Hg deposits in organs resulted in negligible elimination of mercury compared to the exposed dose.

Adult↗

Safety and efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) in children with elevated blood lead concentrations.

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.

Administration, Oral↗

Acute elevation of blood lead levels within hours of ingestion of large quantities of lead shot.

BACKGROUND: Ingestion of elemental lead foreign bodies is felt to have a low risk of clinically significant lead absorption unless gastrointestinal pathology and/or prolonged transit time are present. We present a case of ingestion of a large quantity of small diameter lead shot accompanied by rapid elevation of blood lead levels. CASE REPORT: A 5 1/2-year-old previously healthy girl was found eating the pellets from an ankle weight. She vomited and complained of abdominal pain. In the emergency department, she had no complaints and normal vital signs. An abdominal X-ray showed thousands of small, round, metallic density objects in the stomach. Her white blood cell count was 14,700/mm3, and the hemoglobin, mean corpuscular volume, free erythrocyte protoporphyrin, zinc protoporphyrin, biochemistry panel 21, and urinalysis were normal. She had no prior lead level for comparison. Whole-bowel irrigation was begun and she passed over 11 stools with pellets as well as other foreign bodies (erasers, bead, etc.) in the first 24 hours. Pellets were still seen on X-ray the following day so she received a high-fiber diet and bisacodyl tablets 10 mg/d. On hospital day 2, her admission blood lead (drawn 13 hours after ingestion) was reported as 57 microg/dL (2.7 microm/L) and chelation was begun with oral 2,3-dimercaptosuccinic acid 10 mg/kg 3x/d for 5 days, then 2x/d for 14 days. Her peak measured lead level was 79 microg/dL approximately 36 hours after ingestion. She excreted 2,273 microg lead in the urine during her first 24 hours of chelation. Her blood lead dropped to 14.3 microg/dL by the end of chelation. She did not develop any apparent signs of lead poisoning. CONCLUSION: Acute elevations of blood lead concentrations may occur rapidly after ingestion of multiple small elemental lead objects.

Antidotes↗

Intravenous mercury injection and ingestion: clinical manifestations and management.

BACKGROUND: Mercury is a complex toxin with clinical manifestations determined by the chemical form, route, dose, and acuity of the exposure. Parenteral injection of elemental mercury remains uncommon. CASE REPORT: A 40-year-old male injected 3 mL of elemental mercury intravenously and ingested 3 mL as a suicide attempt. Within 24 hours, he became dyspneic, febrile, tachycardic, and voiced mild gastrointestinal complaints. Chest X-ray revealed scattered pulmonary infiltrates and embolized mercury bilaterally. A ventilation/perfusion scan demonstrated ventilation/ perfusion deficits. Additionally, his renal function declined, as manifest by minor elevations in blood urea nitrogen and creatinine and decreased urine output. Pulmonary therapy, intravenous hydration, and chelation using 2,3-dimercaptoscuccinic acid (DMSA/Succimer) were started. Over the next 36 hours, the patient's pulmonary and renal functions improved. Temperature and heart rate subsequently normalized, and symptoms at discharge were mild exertional dyspnea. DISCUSSION: Liquid mercury injected intravenously embolizes to the pulmonary vasculature and perhaps vessels in other organs such as heart and kidney. In-situ oxidation to inorganic mercury, which is directly toxic to a variety of tissues, may help explain the multisystem involvement. CONCLUSION: Significant pulmonary dysfunction accompanied by radiographically demonstrated mercury emboli and temporary abnormalities in several organs improved shortly after initiation of chelation. The impact of chelation on long-term outcome of parenteral mercury exposure remains uncharacterized.

Administration, Oral↗