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24-hour provoked urine excretion test for heavy metals in children with autism and typically developing controls, a
Sarah E Soden1, Jennifer A Lowry, Carol B Garrison
1Section of Behavioral and Developmental Sciences, Children's Mercy Hospital and Assistant Professor of Pediatrics, University of Missouri - Kansas City School of Medicine. Kansas City, Missouri. USA. ssoden@cmh.edu
Insights
This pilot study found no evidence of excess chelatable heavy metals in children with autism using meso-2,3-dimercaptosuccinic acid (DMSA) provocation. Further research is needed to confirm these findings on heavy metal body burden in autism.
Area of Science:
- Environmental Toxicology
- Developmental Pediatrics
- Biochemistry
Background:
- Complementary and alternative medicine often uses chelators for autism, based on the unproven premise of heavy metal toxicity.
- Meso-2,3-dimercaptosuccinic acid (DMSA) can diagnose chelatable heavy metal body burden by mobilizing metals.
Purpose of the Study:
- To investigate the prevalence of excess chelatable heavy metal body burden in children with autism.
- To assess if children with autism have a higher risk of heavy metal accumulation compared to typically developing children.
Main Methods:
- A pilot study involving 17 children with autism and 5 controls.
- Evaluated Arsenic (As), Cadmium (Cd), Lead (Pb), and Mercury (Hg) using baseline and DMSA-provoked urine collections.
- Quantification by Inductively Coupled Plasma-Mass Spectrometry with interpretation against unprovoked reference ranges.
Main Results:
- Three of 15 autistic children showed slightly elevated metal excretion, with two near detection limits.
- One child's mercury excretion normalized after dietary changes (fish removal).
- No autistic participants demonstrated a clear excess chelatable body burden of As, Cd, Pb, or Hg.
Conclusions:
- The study found no evidence supporting the hypothesis of increased chelatable heavy metal burden in children with autism.
- The proportion of autistic participants with excess chelatable body burden was estimated at 0% (95% CI: 0-22%).
- Further investigation is warranted to definitively rule out heavy metal involvement in autism.
Introduction:
The complementary and alternative medicine practice of prescribing chelators to children with autism is based on the premise that the chronic symptoms of autism can be ameliorated by reducing heavy metal body burden. However, there has not been definitive evidence, published to date, to support the assertion that children with autism are at increased risk of an excess chelatable body burden of heavy metals. The oral chelator meso-2,3-dimercaptosuccinic acid (DMSA) can be used diagnostically to mobilize heavy metals from extravascular pools, enhancing the identification of individuals who have a chelatable body burden.
Methods:
Seventeen children with autism and five typically developing children were enrolled in a pilot study to test for chelatable body burden of Arsenic (As), Cadmium (Cd), Lead (Pb), and Mercury (Hg). Evaluation included a questionnaire regarding potential exposure to heavy metals, diet restrictions, a baseline 24-hour urine collection, and a DMSA-provoked urine collection. Urine collections were sent for As, Cd, Pb, and Hg quantification by Inductively Coupled Plasma-Mass Spectrometry. Unprovoked reference ranges were used in the interpretation of all collections.
Results:
Fifteen autistic children and four typically developing children completed the study. Three autistic subjects excreted one metal in greater quantity during the provoked excretion than baseline. Two of these were very close to the limit of detection. In the third case, the provoked excretion of mercury was between the upper limit of normal and lower limit of the potentially toxic reference range. Fish was removed from this child's diet for greater than one month, and the provoked excretion test repeated. The repeat excretion of mercury was within the normal range.
Conclusion:
In the absence a proven novel mode of heavy metal toxicity, the proportion of autistic participants in this study whose DMSA provoked excretion results demonstrate an excess chelatable body burden of As, Cd, Pb, or Hg is zero. The confidence interval for this proportion is 0-22%.