N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases

Abstract

Systemic toxicity associated with cobalt (Co) and chromium (Cr) containing metal hip alloy may result in neuropathy, cardiomyopathy, and hypothyroidism. However clinical management concerning chelating therapy is still debated in literature. Here are described two metal-on-metal hip-implanted patients in which N-acetyl-cysteine decreased elevated blood metal levels. A 67-year-old male who underwent Co/Cr hip implant in September 2009 referred to our Poison Control Centre for persisting elevated Co/Cr blood levels (from March 2012 to November 2014). After receiving oral high-dose N-acetyl-cysteine, Co/Cr blood concentrations dropped by 86% and 87% of the prechelation levels, respectively, and persisted at these latter concentrations during the following 6 months of follow-up. An 81-year-old female who underwent Co/Cr hip implant in January 2007 referred to our Centre for detection of high Co and Cr blood levels in June 2012. No hip revision was indicated. After a therapy with oral high-dose N-acetyl-cysteine Co/Cr blood concentrations decreased of 45% and 24% of the prechelation levels. Chelating agents reported in hip-implanted patients (EDTA, DMPS, and BAL) are described in few cases. N-acetyl-cysteine may provide chelating sites for metals and in our cases reduced Co and Cr blood levels and resulted well tolerable.

F-18 FDG PET brain imaging in symptomatic arthroprosthetic cobaltism

“…At the time of revision, patient was placed on oral N-acetyl-Cysteine (NAC) to further reduce cobalt burden. [35] At 13 months post-revision, repeat scan had 87 hypometabolic regions with score of − 229.6 and 18 hypometabolic clusters. Blood cobalt was 0.2 mcg/L and urine cobalt 0.4 mcg/L.…”

In vitro assessment of cobalt oxide particle dissolution in simulated lung fluids for identification of new decorporating agents

“…of Co 2+ resulting from leaching of Co-containing prostheses. Administration of N-acetyl-cysteine significantly decreased Co 2+ concentration in blood (Giampreti et al, 2016) whereas EDTA had only at transient efficacy (Pazzaglia et al, 2011). Following inhalation of 60 Co3O4P, the most likely scenario at the work place, chelation by DTPA is expected to concern mainly the ionized form of cobalt, Co 2+ , suggesting that DTPA treatment would have limited efficacy.…”

“…these ligands to increase Co3O4P dissolution in the lung fluids surrogates Gamble's and ALF, as well as in HEPES. The efficacy of the different drugs N-acetyl-L-cysteine (NAC), EDTA, L-cysteine (L-cys), glutathione (GSH), N,N-bis (2-aminoethyl) -1,2-ethanediamine dihydrochloride (Trien) and Dpenicillamine (D-PEN) was assessed and compared to that of DTPA, as DTPA is currently the recommended treatment in case of accidental internal contamination with Co3O4P(ASN, 2008;Giampreti et al, 2016).…”

<p>Neuroprotective effect of <em>N</em>-acetylcysteine against cisplatin-induced toxicity in rat brain by modulation of oxidative stress and inflammation</p>

“…N -acetylcysteine (NAC) is thiolic amino acid that has been reported to scavenge free radicals, replenish reduced glutathione (GSH) and prevent its depletion, and inhibit lipid peroxidation (LPO) 13. It can also restore the deterioration in the pro-oxidant/antioxidant balance via its metal-chelation activity 14. NAC possesses neurovascular-protective actions and shows a positive effect in the treatment of neurological disorders through its ability to downregulate inflammation and oxidative stress 15,16.…”