Clinical Toxicology (2014), 52, 444 Copyright © 2014 Informa Healthcare USA, Inc. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.3109/15563650.2014.897353
LETTER TO THE EDITOR
Paolo D. Pigatto
NSE as a biomarker of mercury exposure
Department of Bioscience for Health, Dermatological Clinic, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy Dear Editor,
Anna Ronchi Pavia Poison Control Center and National Toxicology Information Centre, Department of Toxicology, IRCCS Maugeri Foundation and University of Pavia, Italy
In their impressive and timely study, Yilmaz et al. (2014) found that circulating biomarkers – neuron-specific enolase (NSE), glutamate receptor (GRIA 1) and S100B were associated – at least in part – with overexposure to metallic mercury vapor (Hg0) among children and adolescent.1 We welcome and support the article by Yilmaz et al. (2014) but we would like to raise one point.1 In the Materials and Methods section, they state that “The children who have a blood mercury level higher than 10 micrograms per liter had a chelation therapy with dimercaptosuccinic acid”.1 Therefore, some patients in the study received doses of water-soluble sodium salt of 2,3-dimercapto-1-propane sulfonic acid (DMPS) to diminish the density of blood mercury concentrations.1 Generally speaking, chelating agents – as DMPS – are medications that have been shown to reduce heavy metals in case of metals overexposure in humans.2 Given that we have previously noted a potential association between serum NSE levels and whole-blood levels of mercury related to the toxic effects induced by mercury vapors (Hg0),3 it would have been valuable to consider the use of chelation therapy as potential confounding variable. If so, mercury biomarker levels NSE associated with mercury overexposure would have been higher than they reported in their outcome.1 This is a possible explanation of the little correlation that they found between the clinical use of serum NSE and recent exposure to mercury vapor.1 Could the authors help us – and the Journal’s readers – understand this issue?
Gianpaolo Guzzi Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy
Declaration of interest The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Yilmaz FM, Yilmaz H, Tutkun E, Uysal S, Carman KB, Dilber C, Ercan M. Serum biochemical markers of central nerve system damage in children with acute elemental mercury intoxication. Clin Toxicol (Phila) 2014; 52:32–38. 2. Aposhian HV, Bruce DC, Alter W, Dart RC, Hurlbut KM, Aposhian MM. Urinary mercury after administration of 2,3-dimercaptopropane1-sulfonic acid: correlation with dental amalgam score. FASEB J 1992; 6:2472–2476. 3. Costa A, Branca V, Pigatto PD, Guzzi G. Pediatric mercury poisoning, brain MRI, and white matter hyperintensities. Eur J Pediatr 2011; 170:677.
Received 11 February 2014; accepted 19 February 2014. Address correspondence to Dr. Gianpaolo Guzzi, Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B. (not-for-profit organization), Via A. Banfi, 4, 20122 Milan, Italy. Tel. ⫹ 11-39-02-782-561. Fax. ⫹ 11-39-02-367-355-40. E-mail: [email protected]
444
Copyright of Clinical Toxicology (15563650) is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
LETTER TO THE EDITOR
Paolo D. Pigatto
NSE as a biomarker of mercury exposure
Department of Bioscience for Health, Dermatological Clinic, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy Dear Editor,
Anna Ronchi Pavia Poison Control Center and National Toxicology Information Centre, Department of Toxicology, IRCCS Maugeri Foundation and University of Pavia, Italy
In their impressive and timely study, Yilmaz et al. (2014) found that circulating biomarkers – neuron-specific enolase (NSE), glutamate receptor (GRIA 1) and S100B were associated – at least in part – with overexposure to metallic mercury vapor (Hg0) among children and adolescent.1 We welcome and support the article by Yilmaz et al. (2014) but we would like to raise one point.1 In the Materials and Methods section, they state that “The children who have a blood mercury level higher than 10 micrograms per liter had a chelation therapy with dimercaptosuccinic acid”.1 Therefore, some patients in the study received doses of water-soluble sodium salt of 2,3-dimercapto-1-propane sulfonic acid (DMPS) to diminish the density of blood mercury concentrations.1 Generally speaking, chelating agents – as DMPS – are medications that have been shown to reduce heavy metals in case of metals overexposure in humans.2 Given that we have previously noted a potential association between serum NSE levels and whole-blood levels of mercury related to the toxic effects induced by mercury vapors (Hg0),3 it would have been valuable to consider the use of chelation therapy as potential confounding variable. If so, mercury biomarker levels NSE associated with mercury overexposure would have been higher than they reported in their outcome.1 This is a possible explanation of the little correlation that they found between the clinical use of serum NSE and recent exposure to mercury vapor.1 Could the authors help us – and the Journal’s readers – understand this issue?
Gianpaolo Guzzi Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy
Declaration of interest The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Yilmaz FM, Yilmaz H, Tutkun E, Uysal S, Carman KB, Dilber C, Ercan M. Serum biochemical markers of central nerve system damage in children with acute elemental mercury intoxication. Clin Toxicol (Phila) 2014; 52:32–38. 2. Aposhian HV, Bruce DC, Alter W, Dart RC, Hurlbut KM, Aposhian MM. Urinary mercury after administration of 2,3-dimercaptopropane1-sulfonic acid: correlation with dental amalgam score. FASEB J 1992; 6:2472–2476. 3. Costa A, Branca V, Pigatto PD, Guzzi G. Pediatric mercury poisoning, brain MRI, and white matter hyperintensities. Eur J Pediatr 2011; 170:677.
Received 11 February 2014; accepted 19 February 2014. Address correspondence to Dr. Gianpaolo Guzzi, Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B. (not-for-profit organization), Via A. Banfi, 4, 20122 Milan, Italy. Tel. ⫹ 11-39-02-782-561. Fax. ⫹ 11-39-02-367-355-40. E-mail: [email protected]
444
Copyright of Clinical Toxicology (15563650) is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
