Chelation Therapy for Rare Earth Element Toxicity: Current Evidence, Challenges and Future Directions.

Area of Science:

• Environmental Science
• Toxicology
• Materials Science

Background:

• Increasing use of rare earth elements (REEs) in technology raises concerns about human exposure and toxicity.
• Existing research on REE toxicity is fragmented across different exposure routes and biological systems.

Purpose of the Study:

• To synthesize current evidence on REE toxicity across various exposure pathways (inhalation, ingestion, occupational).
• To critically evaluate REE-specific toxicity mechanisms and their clinical manifestations.
• To identify the therapeutic gap in managing REE exposure, particularly the lack of effective chelation therapy.

Main Methods:

• Comprehensive literature review integrating human clinical data, animal models, and in vitro studies.
• Critical appraisal of REE-specific toxicological mechanisms (e.g., oxidative stress, mitochondrial dysfunction).
• Analysis of current chelation therapies and their efficacy for REE exposure.

Main Results:

• REEs induce multiorgan effects through distinct mechanisms, differing from conventional heavy metals.
• A significant therapeutic gap exists, with current chelators like DTPA showing limited efficacy for REEs such as gadolinium and cerium.
• Clinical manifestations of REE toxicity require early recognition and tailored supportive care.

Conclusions:

• There is an urgent need for the development and validation of REE-specific chelating agents.
• Clinicians must be aware of REE toxicity risks, emphasizing early detection and management.
• Future research should focus on novel chelation strategies and international guidance harmonization to protect public health.