Trace metals clinical significance

The editors concept of clinical chemistry, as stated in previous volumes of this serial publication, encompasses a wide field of subjects— from the mechanism of blood coagulation to the microbiological assay of vitamins, and from the significance of trace metals in health and disease to the therapeutic application of increased gas pressure. The natural history of clinical conditions and their comparison with normal controls share one common feature, namely, the central position of some species of molecules, be they small or large, all of them the natural subject of chemical research. Hence, practical methods develop, either manual or mechanized, the results of which become increasingly more useful for the clinician in diagnosis, therapy, and prognosis. 

It is clearly understood that severe acute clinical situations like severe infections, thermal injury, shock, postsurgical stages, polytrauma, etc., affect trace metal metabolism in an extremely intense way. Each of the known trace metals may be implicated. Primarily losses of trace metals or a shift from one compartment to another caused by acute phase proteins are of prominent clinical significance [58]. For this reason in infusion therapy in intensive care the solutions should contain a sufflcient amount of trace metals for substitution to promote recovery. 

As a gerontologist I am particularly worried with the extent of mental failure among the old and the increase in intellectually impaired and demented people that must take place in the next few decades. In a recent overview it is stated that around the year 2020 approximately 20% of the population of the USA will be over 65, of whom 10% will have clinically significant mental impairment, half of them sufficiently affected to be labeled demented. The possibility that inadequate zinc or other trace metals may play a part in the breakdown of neuronal integrity is not yet excluded and represents one of the important areas needing further researeh in the field of the neurobiology of trace metals. 

This was significant in the preparation of l,2-dimethyl-3-hydroxy-4-pyridone, employed clinically as an iron chelating agent. The aminoreductone is obtained by reaction of methylamine with maltol. Traces of metal within the system readily form highly colored complexes with reactant or product and these are difficult to remove. With the CMR, the preparation was achieved in 65 % yield without the need for decolorizing charcoal and the product was crystallized by collecting the effluent in acetone (Scheme 2.10) [22]. 

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