Syllabus METAL ION EXCESS TOXICITY

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Syllabus Metalionexcesstoxicity-Feexcesstoxicity-Africansiderosis,hemosiderosis, hemochromatosis(bronzediabetes)anddetoxification.Cuexcesstoxicity:Wilson’sdisease andtreatment. Heavymetaliontoxicity:Hg,Pb,Cd,Astoxiceffects–mechanismoftoxiceffects.Heavy metaltoxicitytreatment-chelationtherapy:chelatingagentsforHg,Pb,Cd,Astoxicity. Metalcomplexesasdrugs:cis-plainasanticanceragent:mechanismofactionandside effects;goldcomplexesasantiarthriticdrugs-chrysotherapy.Metalcomplexesindiagnosis- Gdcomplexesinmagneticresonanceimaging(MRI). METALIONEXCESSTOXICITY Ironexcesstoxicity ü ItisduetoaccidentalintakeofFeSO4tabletscausingerosionofthegastrointestinal tract. ü Hemochomatosisisageneticdisorder,depositionofironoccursinvitalorganslike liver,spleen,pancreas,skinetc.Itleadstobronzepigmentationontheskiniscalled bronzediabetes. ü Siderosis(depositionofFeOdustinthelungs)isassociatedwithexcessofiron. ü AfricansiderosisisanironoverloaddisorderfirstobservedamongpeopleofSouthern AfricaandCentralAfrica.Dietaryironoverloadistheconsumptionoflargeamount ofhome-brewedbeerwithhighamountofironcontentinit. Detoxification : Siderophore desferrioxamine is a chelating antidote used for Fe removal Coppertoxicity Copper is a principal component of several metalloproteins and some naturally occurring pigments.Ahealthyadultpossessescopperbetween200to300mgandthehighestamountis concentratedin the locus of brain. Wilson’sdiseaseand Menkes’ kinky hair syndromeare associatedwithageneticdisorderinthemetabolismofcopper. Wilson’sdisease ü In Wilson'sdisease,the copper-content is morethan hundred timesgreaterthanthe normal content. The clinical symptoms of Wilson's disease include hepatic cirrhosis(liverdisease),neurologicaldamage,brownorgreenringsinthecorneaofthe eyes,lackofcoordinationetc.Theexcesscopperisdepositedfirstintheliverandthen inthecentralnervoussystem. ü InWilson'sdisease,thepatientsarefoundtohavethelowlevelsofapoceruloplasmin which is responsible for copper transport. Thus this disease is associated with the geneticfailuretosynthesiseapoceruloplasmin. ü In this disease,there isa large amount of copper in blood stream and it causesthe damage of erythrocyte membrane(hemolyticanemia). Copper is finally deposited in liverandbraindevelopingthehepaticandneurologicsymptoms. Treatment: Toreducethecopperoverload,thechelatingdugslikeNa2Ca(EDTA),D-penicillamine, 2,3-dimercaptopropan-1-olareclinicallyrecommended. Zn-saltsarenowrecommendedforthetreatmentofWilsondisease.Probably,theZn-salts involvetheinductionofthioneinproteinintheintestinalcells.Thethioneinproteintightly bindsthecopper.Thusitinhibitstheintestinaluptakeofcopper.ThemajoradvantageofZn- therapyisitslowtoxicity. .

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Chelation Therapy
Corporate Medical Policy Chelation Therapy File Name: chelation_therapy Origination: 12/1995 Last CAP Review: 2/2021 Next CAP Review: 2/2022 Last Review: 2/2021 Description of Procedure or Service Chelation therapy is an established treatment for the removal of metal toxins by converting them to a chemically inert form that can be excreted in the urine. Chelation therapy comprises intravenous or oral administration of chelating agents that remove metal ions such as lead, aluminum, mercury, arsenic, zinc, iron, copper, and calcium from the body. Specific chelating agents are used for particular heavy metal toxicities. For example, desferroxamine (not Food and Drug Administration [FDA] approved) is used for patients with iron toxicity, and calcium-ethylenediaminetetraacetic acid (EDTA) is used for patients with lead poisoning. Note that disodium-EDTA is not recommended for acute lead poisoning due to the increased risk of death from hypocalcemia. Another class of chelating agents, called metal protein attenuating compounds (MPACs), is under investigation for the treatment of Alzheimer’s disease, which is associated with the disequilibrium of cerebral metals. Unlike traditional systemic chelators that bind and remove metals from tissues systemically, MPACs have subtle effects on metal homeostasis and abnormal metal interactions. In animal models of Alzheimer’s disease, they promote the solubilization and clearance of β-amyloid protein by binding to its metal-ion complex and also inhibit redox reactions that generate neurotoxic free radicals. MPACs therefore interrupt two putative pathogenic processes of Alzheimer’s disease. However, no MPACs have received FDA approval for treating Alzheimer’s disease. Chelation therapy has also been investigated as a treatment for other indications including atherosclerosis and autism spectrum disorder.
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