Clinical Chemistry
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Clinical Chemistry 52: 88-96, 2006. First published October 20, 2005; 10.1373/clinchem.2005.051128
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(Clinical Chemistry. 2006;52:88-96.)
© 2006 American Association for Clinical Chemistry, Inc.

Drug Monitoring and Toxicology

Clinical Evaluation of a Lead Mobilization Test Using the Chelating Agent Dimercaptosuccinic Acid

Perrine Hoeta, Jean-Pierre Buchet, Laurence Decerf, Benoît Lavalleye, Vincent Haufroid and Dominique Lison

Unit of Industrial Toxicology and Occupational Medicine, Faculty of Medicine, Catholic University of Louvain, Brussels, Belgium.

aAddress correspondence to this author at: Unit of Industrial Toxicology and Occupational Medicine, Faculty of Medicine, Catholic University of Louvain, Clos Chapelle-aux-Champs 30-54, 1200 Brussels, Belgium. E-mail hoet{at}toxi.ucl.ac.be.

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 µg/L] and 40 lead-exposed individuals (315 µg/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 µg/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 µg/4 h is proposed for Belgian reference individuals. The diagnostic value of DMSA-PbU is likely to be contributive for PbB >300 µg/L.






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