Chelation therapy is a form of medical treatment in which a chelating ligand is used to selectively remove a metal from the body. When the metal exists as a divalent ion, such as with lead, Pb or mercury, Hg selectivity against calcium, Ca and magnesium, Mg, is essential in order that the treatment does not remove essential metals.
Selectivity is determined by various factors. In the case of iron overload, which may occur in individuals with β-thalessemia who have received blood transfusions, the target metal ion is in the +3 oxidation state and so forms stronger complexes than the divalent ions. It also forms stronger complexes with oxygen-donor ligands than with nitrogen-donor ligands. deferoxamine, a naturally occurring siderophore produced by the actinobacter Streptomyces pilosus and was used initially as a chelation therapy agent. Synthetic siderophores such as deferiprone and deferasirox have been developed, using the known structure of deferoxamine as a starting point. Chelation occurs with the two oxygen atoms.
Wilson's disease is caused by a defect in copper metabolism which results in accumulation of copper metal in various organs of the body. The target ion in this case is divalent, Cu. This ion is classified as borderline in the scheme of Ahrland, Chatt and Davies. This means that it forms roughly equally strong complexes with ligands whose donor atoms are N, O or F as with ligands whose donor atoms are P, S or Cl. Penicillamine, which contains nitrogen and sulphur donor atoms, is used as this type of ligand binds more strongly to copper ions than to calcium and magnesium ions.
Treatment of poisoning by heavy metals such as lead and mercury is more problematical, because the ligands used do not have high specificity relative to calcium. For example, EDTA may be administered as a calcium salt to reduce the removal of calcium from bone together with the heavy metal. Factors determining selectivity for lead against zinc, cadmium and calcium have been reviewed,