Autism Clinical Trial
Official title:
An Investigation of the Efficacy of Mercury Chelation as a Treatment for Autism Spectrum Disorder
This study will examine whether DMSA, an oral chelating agent that removes mercury and other
metals from the body, is beneficial for children with autism. DMSA is commonly used to treat
autism, although it has never been tested in a controlled study and there is no proof that
it helps children with the disorder. Support for its use is based on single-case reports of
benefits of chelation with DMSA. This study will help determine whether or not DMSA is
useful for treating autism.
Children between 4 and 10 years of age with autism spectrum disorder who weigh at least 33
pounds, who have detectable, but not toxic, levels of mercury or lead in the blood, and who
have not previously received chelation therapy may be eligible for this study.
Participants complete a medical history, behavioral and psychological assessment and
physical examination. Blood, hair, urine and stool samples are collected for testing.
Because DMSA can remove minerals the body needs, such as zinc and iron, as well as the toxic
lead and mercury, participants take a daily multivitamin supplement starting 1 month before
beginning chelation therapy and continuing for the duration of treatment. After 1 month of
the supplementation regimen, the children are assigned to receive DMSA or placebo for 12
weeks, divided into six 2-week cycles. They take the assigned drug 3 times a day on days 1,
2 and 3 of each cycle and continue the multivitamin every day.
The children are seen in the clinic immediately before and after the first, third and sixth
cycles. At each checkup, the parent or guardian answers a set of questions about the child's
autism symptoms, physical health and medication side effects. Blood, urine and stool samples
are collected for laboratory testing.
Chelation of metals is widely used in the community to treat individuals with Autism
Spectrum Disorder (ASD), with some surveys estimating that 1 in 12 children with autism have
undergone chelation. This widespread use reflects the hypothesis that many cases of ASD are
caused by exposure to thimerosal, an ethylmercury-based compound used previously in the US
as a vaccine preservative for routine childhood immunizations. The prevalent use of
chelation therapy stands in stark contrast with the lack of scientific or clinical evidence
of efficacy, and creates a public health imperative for empiric data. Thus we propose a
controlled trial of the effects of chelation on the core behavioral symptoms and overall
functioning of children with ASD. The present investigation is a double-blind, randomized
placebo-controlled study of the oral chelating agent meso-2,3-dimercaptosuccinic acid (DMSA;
succimer) among 120 children, ages four to ten years, who meet criteria for ASD. Pre- and
post-treatment behavioral ratings will be used to evaluate the efficacy of chelation. In
addition, children will undergo comprehensive medical history, physical examination and
laboratory analyses.
Our objective is to quantify differences in behavioral functioning between the chelation
treatment group and the placebo control group. Analysis of mercury levels before and during
the course of treatment will be used to confirm the expected DMSA-induced excretion of
mercury and to identify differences among children in the extent of excretion. Our primary
hypothesis is that, on average and relative to the control group, children with ASD who
undergo chelation with DMSA will show greater improvements in communication and social
behavior.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double-Blind, Primary Purpose: Treatment
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