title: 24-hour provoked urine excretion test for heavy metals in children with autism and typically developing controls, a pilot study.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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%.
authors.affiliation: Section 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
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Soden
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Lowry
authors.forename: Carol B
authors.initials: CB
authors.lastname: Garrison
authors.forename: Gary S
authors.initials: GS
authors.lastname: Wasserman
mesh_terms: D001151:Arsenic / Q000652:urine; D001321:Autistic Disorder / Q000628:therapy / Q000652:urine*; D002614:Chelating Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D019216:Metals, Heavy / Q000652:urine*; D010865:Pilot Projects; D004113:Succimer / Q000494:pharmacology*; D016482:Urinalysis / Q000379:methods
chemical_list: D002614:Chelating Agents; D019216:Metals, Heavy; D004113:Succimer; D001151:Arsenic