Department of Pathology and Genomic Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Environ Health Perspect. 2023 Aug;131(8):85002. doi: 10.1289/EHP12371. Epub 2023 Aug 28.
Childhood lead poisoning remains an important public health issue in the United States, as well as elsewhere in the world. Although primary prevention is a major goal and it is critically important to keep children from getting poisoned, it is also important to explore ways to reduce the neurotoxic effects of lead in those children already poisoned. Whether lead-induced neurotoxicity and its related adverse outcomes are viewed as "permanent" or "persistent" may influence the way in which potential remediation efforts are considered for improving outcomes from childhood lead poisoning.
The objective of this commentary was to discuss the ideas of permanence and persistence in relation to the direct neurotoxic effects of lead on the brain and the resulting adverse outcomes from these effects. Recent new insights regarding potential mitigation of lead-induced neurotoxic effects on brain and behavior are considered along with clinical information on neurorehabilitation to suggest potential strategies for improving cognitive/behavioral outcomes in lead-poisoned children.
The distinction between permanent and persistent in regard to lead-induced neurotoxicity and its resulting outcomes may have broad implications for public health policies in response to the problem of childhood lead exposure. The term permanent implies that the damage is irreversible with little chance of improvement. However, there is evidence that at least some of the adverse cognitive/behavioral outcomes from lead exposure are persistent rather than permanent and potentially amenable, under the appropriate circumstances, to some level of mitigation. This author recommends that clinical, interventional research efforts be devoted to exploring optimal neurorehabilitative and enrichment conditions to stimulate plasticity and enhance functioning to determine the extent to which promising results from preclinical studies of lead-induced brain damage and the mitigation of these effects can be successfully translated to humans. https://doi.org/10.1289/EHP12371.
儿童铅中毒仍然是美国乃至世界其他国家的一个重要公共卫生问题。虽然主要目标是初级预防，防止儿童中毒至关重要，但探索减少已中毒儿童铅的神经毒性影响的方法也很重要。铅诱导的神经毒性及其相关不良后果是否被视为“永久性”或“持续性”，可能会影响人们对潜在补救措施的看法，以改善儿童铅中毒的后果。
本评论旨在讨论永久性和持续性的概念与铅对大脑的直接神经毒性作用以及由此产生的不良后果之间的关系。考虑到关于减轻铅诱导的神经毒性对大脑和行为的潜在影响的最新新见解，以及关于神经康复的临床信息，提出了改善铅中毒儿童认知/行为结果的潜在策略。
永久性和持续性之间的区别铅诱导的神经毒性及其由此产生的后果可能对针对儿童铅暴露问题的公共卫生政策产生广泛影响。“永久性”一词意味着损害是不可逆转的，几乎没有改善的机会。然而，有证据表明，至少一些铅暴露的不良认知/行为后果是持续性的而不是永久性的，在适当的情况下，有可能在一定程度上减轻。作者建议将临床、干预性研究工作致力于探索最佳的神经康复和丰富条件，以刺激可塑性并增强功能，以确定从铅诱导的脑损伤的临床前研究和减轻这些影响的有希望的结果在多大程度上可以成功转化为人类。https://doi.org/10.1289/EHP12371。
