Chelation: DMSA, Lipoic Acid, Clay Baths, and Natural Chelating Agents
Since up to one-third of children with autism may present with regression in milestones in the second year of life, families and professionals might suggest association of symptoms of autism with environmental events that are temporally related. With the increase in reported prevalence of ASD over the past 15 years [Barbaresi et al., 2005], associations with environmental exposures that have systematically changed have been proposed. One such association is with thimerosal, which is an ethylmercury derivative used to stabilize killed virus vaccinations packaged in multidose vials. It is reported that mercury exposure shifts cytokine production from Th1 to Th2, which may decrease T cell and natural killer cell activity. Some strains of mice have enhanced genetic susceptibility to the effects of mercury [Hornig et al., 2004]. Live virus vaccines like the trivalent measles–mumps–rubella vaccine do not contain thimerosal. Thimerosal is no longer present in childhood vaccines except for DT and influenza vaccine.
Several studies have examined the relationship of thimerosal-containing vaccines and ASD. Thimerosal was removed from childhood vaccines in Denmark in 1992. This allowed Madsen et al. [2003] to examine the rate of reported autism before and after this change in practice. The rate of diagnosis of autism increased prior to the removal of thimerosal and continued at that trajectory after its removal. Verstraeten et al. [2004] used the Vaccine Safety Datalink to investigate any relationship of thimerosal exposure based on number of immunizations and body weight with developmental disabilities. No consistent associations were identified. Causality could not be implied. Geier and Geier [2002] reported an analysis of the Vaccine Adverse Events Reporting System database set that suggested an increased rate of reported speech delay, mental retardation, and autism after thimerosal-containing vaccine. This type of study does not determine causality. The Institute of Medicine review in 2001 [Stratton et al., 2001] did not endorse an association of thimerosal and autism based on the evidence available. There is genetic variation in the capacity to detoxify mercury as evidenced by data from different strains of mice [Hornig et al., 2004].
Dimercaptosuccinic acid (DMSA) is a commonly used agent in clinical practice for chelation of lead and other heavy metals. Although effective at removing lead from the bloodstream and periphery, follow up studies do not demonstrate resolution of neurodevelopmental sequelae [Dietrich et al., 2004]. By extension, chelating agents like DSMA are used in an attempt to remove mercury that is believed to be sequestered in the tissue after early childhood vaccination in children with autism. There are no peer-reviewed publications regarding efficacy of chelation agents for the treatment of autism that have yet come to press. Natural chelation using mud baths or dietary fiber supplements and augmentation of chelation with antioxidants have not been evaluated in the peer reviewed literature.
Renal and hepatic toxicity must be monitored with DMSA chelation. In the absence of documented elevation of heavy metal burden, there is no rationale for chelation therapy outside of controlled clinical trials. By extrapolation from the data related to lead poisoning, neurological damage should not be affected by chelation at a later date [Dietrich et al., 2004].