Succimer chelation does not produce lasting reductions of blood lead levels in a rodent model of retained lead fragments

• Published in: Environmental toxicology and pharmacology 2023-11, Vol.104, p.104283-104283, Article 104283
• Main Authors: Twardy, Shannon M., Hanson, Sarah M., Jursa, Thomas, Gaitens, Joanna M., Kalinich, John M., McDiarmid, Melissa A., Smith, Don R.
• Format: Article
• Language: English
• Subjects: Animals; CaNa2EDTA; Chelating Agents - pharmacology; Chelating Agents - therapeutic use; Chelation; Edetic Acid - pharmacology; Edetic Acid - therapeutic use; Firearms; Humans; Lead - toxicity; Lead exposure; Lead Poisoning - drug therapy; Lead Poisoning - metabolism; Retained fragments; Rodentia; Succimer; Wounds, Gunshot
• ISSN: 1382-6689; 1872-7077
• DOI: 10.1016/j.etap.2023.104283

Retained lead fragments from nonfatal firearm injuries pose a risk of lead poisoning. While chelation is well-established as a lead poisoning treatment, it remains unclear whether chelation mobilizes lead from embedded lead fragments. Here, we tested whether 1) DMSA/succimer or CaNa2EDTA increases mobilization of lead from fragments in vitro, and 2) succimer is efficacious in chelating fragment lead in vivo, using stable lead isotope tracer methods in a rodent model of embedded fragments. DMSA was > 10-times more effective than CaNa2EDTA in mobilizing fragment lead in vitro. In the rodent model, succimer chelation on day 1 produced the greatest blood lead reductions, and fragment lead was not mobilized into blood. However, with continued chelation and over 3-weeks post-chelation, blood lead levels rebounded with mobilization of lead from the fragments. These findings suggest prolonged chelation will increase fragment lead mobilization post-chelation, supporting the need for long-term surveillance in patients with retained fragments. •Lead poisoning from retained lead fragments is a poorly recognized health threat.•It is unclear if chelation is effective for lead poisoning from retained fragments.•Succimer chelation mobilizes lead from embedded fragments into blood and tissues.•Succimer chelation may not be efficacious for reducing longer-term risk of lead poisoning from embedded lead fragments.