Therapeutic approaches for chlordecone poisoning in humans

Due to lack of adequate industrial safety measures, workers in a small factory that manufactured the organochlorine pesticide chlordecone were exposed to large amounts of this toxic material for many months. High concentrations of chlordecone were present in samples of blood, liver, and fat from these workers. Toxic manifestations prominently involved the nervous system, liver and testes. Although a plasmaphoresis experiment indicated that chlordecone is rapidly transferred from tissues to blood, attempts to employ hemoperfusion as a means for removing chlordecone from the body were unsuccessful because chlordecone is avidly bound by plasma proteins and was not extracted by the hemoperfusion sorbents. An alternative approach to therapy was based on the observations that stool contains only a small fraction of the substantial amounts of chlordecone excreted in bile. Oral administration of cholestyramine, a nonabsorbable resin that binds chlordecone in vitro, increased fecal excretion of chlordecone and accelerated its disappearance from the body. This treatment was accompanied by amelioration of the clinical manifestations of toxicity, indicating that the subacute toxic effects of chlordecone are reversible. Studies of chlordecone excretion in one patient with a surgically created bile fistula disclosed the existence of the novel, nonbiliary mechanism for excretion of chlordecone in the stool. Further physiological studies are needed to explore the possible role of the gut in the excretion of many kinds of slowly eliminated lipophilic toxins.