Arsenic, a metalloid, is known to cause deleterious effects
in
various body organs, particularly the liver, urinary bladder, and
brain, and these effects are primarily mediated through oxidative
stress. Chelation therapy has been considered one of the promising
medical treatments for arsenic poisoning. Meso 2,3- dimercaptosuccinic
acid (DMSA) has been recognized as one of the most effective chelating
drugs to treat arsenic poisoning. However, the drug is compromised
with a number of shortcomings, including the inability to treat chronic
arsenic poisoning due to its extracellular distribution. Monoisoamyl
2,3-dimercaptosuccinic acid, one of the analogues of meso 2,3-dimeraptosuccinic
acid (DMSA), is a lipophilic chelator and has shown promise to be
considered as a potential future chelating agent/antidote not only
for arsenic but also for a few other heavy metals like lead, mercury,
cadmium, and gallium arsenide. The results from numerous studies carried
out in the recent past, mainly from our group, strongly support the
clinical application of MiADMSA. This review paper summarizes most
of the scientific details including the chemistry, pharmacology, and
safety profile of MiADMSA. The efficacy of MiADMSA mainly against
arsenic toxicity but also a few other heavy metals was also discussed.
We also reviewed a few other strategies in order to achieve the optimum
effects of MiADMSA, like combination therapy using two chelating agents
or coadministration of a natural and synthetic antioxidant (including
phytomedicine) along with MiADMSA for treatment of metal/metalloid
poisoning. We also briefly discussed the use of nanotechnology (nano
form of MiADMSA i.e. nano-MiADMSA) and compared it with bulk MiADMSA.
All these strategies have been shown to be beneficial in getting more
pronounced therapeutic efficacy of MiADMSA, as an adjuvant or as a
complementary agent, by significantly increasing the chelating efficacy
of MiADMSA.