ON MEDICINE: Treating Chronic Lead Toxicity?

Genesee County Medical Society

As we enter the holiday season and ponder how 2017 has quickly flown past, many of us wonder if there is anything more we could medically do to assist the Flint residents who drank leaded water. We could easily argue that more should have been done to prevent this disaster by those responsible for monitoring the quality of the city’s water. Fortunately, a lot of good, caring people in this world have stepped up to provide aid. Several foundations, as well as the state and the federal government have granted monies for services to improve education, research, epidemiological needs and water line repair. On the periphery, it would seem everything is being taken care of as much as it can be. The true situation is…not really. There is still more, possibly a lot more. The GCMS Community and Environmental Health Committee have been researching this subject since the end of 2015. As a result, it has thoroughly evaluated several potential treatments and may have some answers. It seems there is very little information in the literature on the effects of low-level chronic lead ingestion and accumulation within a population. The FDA had long approved both oral DMSA and intravenous Calcium EDTA for lead toxicity, but it was only used for only acute lead toxicity with blood lead levels that reached 45 ppm and above. Despite that recommendation researchers along with the Centers for Disease Control felt that neurologic damage would occur with levels even as low as 5 ppm. With hypertension, cardiovascular, kidney, renal, neurological and other end-organ damage through long-term exposure being reported in the literature, it became necessary for the committee to determine if treatment seemed feasible. Extensive harm follows long-term lead storage in organs such as the nervous, cardiovascular, and urologic systems. Because of this, it was decided to press for an adult study that treated lead with both DMSA and EDTA.

Dr. Gervasio Lamas, Cardiologist, and Professor of Medicine at Mt Sinai and Chairman of Cardiology at Columbia University caught wind of the Committee’s work and has taken a keen interest in the idea. He has aligned himself and his support team with this effort. He too believes, as a result of his own past research (including TACT 1), that a study has real merit. It potentially could show improvement in long-term health parameters such as reducing cardiovascular events, decreasing blood pressure, improving creatinine and GFR, normalizing uric acid levels, and improving neurologic function ( such as emotional lability, memory loss, attention deficit, and peripheral nerve disorders).

From this was created the Flint Adult Chelation Trial (FACT) descriptor that will be presented to potential donors and others who require better understanding of its purpose:

Flint Adult Chelation Trial (FACT) Descriptor
In response to the exposure of all Flint water consumers to lead, the Genesee County Medical Society is planning to initiate a 5-year study with Dr. Gervasio Lamas and his NIH funded team to determine the effectiveness of oral and intravenous chelating medicines in reducing the body burden of stored/sequestered lead in bones.

The goal of this study is to reduce the incidence of heart attacks, brain damage, strokes, gout, hypertension, and kidney disease due to the release of trapped lead over the years from bones. Lead is a known toxic metal that replaces calcium in living cells and disrupts normal function, contributing to the cause of these chronic conditions. The problems may not be evident until years after the exposure to lead in water, dust, soil, paint or other sources.

Chelating (toxic metal binding) agents have been used safely for decades to treat high-level lead exposure in children and adults. These chelators bind the lead- and other harmful metals—in the blood so more lead can be drawn out from bone storage to be bound and eliminated by the kidneys and gut. These medicines have been given intravenously by trained physicians and can also be taken by mouth.
Biweekly doses of oral chelating medicines or weekly intravenous treatments will be administered to clear lead from the body. Participants will be followed to see if there are fewer health and brain function problems.

Participants should be over 18 years of age at the time of recruitment and have consumed Flint water at any time from April 2014 until present. Follow-up will be performed by Genesee County Medical Society members or at the Emergency Medical Center of Flint. NIH, state and other funding is essential to carrying out this work. There have been recent studies published in the Journal of the American Medical Association (JAMA) and other peer-reviewed journals which demonstrate a reduction in cardiovascular morbidity and mortality in patients who have undergone chelation therapy. Considering the number of people who have been exposed to lead via water and a lifetime of exposure, action must be taken. The information gained from this study may also benefit children of women who may have been exposed while pregnant and other exposed populations. There are many other communities which will benefit from the results of this study.

Dr. Gervasio Lamas and his team were sought out by the Medical Society because of their ongoing work that demonstrated a significant reduction in repeat heart attacks for adult patients. We also have a small group of trained environmental health physicians who have helped patients with chelating medicines for other conditions.

The study will require a baseline check of mental and physical function, and various organ tests to estimate how much lead can be eliminated. The homes of participants and their work/exposure history will also be studied to eliminate continued exposure to lead from various sources.

Should the study be performed as expected it will provide information that will prove vital to many communities not only in Michigan but elsewhere within this country and world where chronic elevations of lead are feared to cause future disease. This is only part of what the Genesee County Medical Society does to support its mission, helping its members and improving the health of the citizens of this county.