Is Lanthanum Carbonate the missing link in NSF/GISF?

There are two recent papers in the chemistry literature discussing metals in the Lanthanide family, which includes Gadolinium and Lanthanum. One describes the toxicites that the different members cause. Interestingly defect in protein folding is one of the dysfunctions. Proteins need to be folded correctly in order to function. This will be the subject of another blog. One paper mentioned the concept of multimetal toxicity, which is something that I have blogged on regarding GDD and probably also causing additive Lead Deposition Disease (and other metals, in combination).

But in seeing the paper on toxicities of Lanthanide metals, I was reminded of Lanthanum carbonate. Lanthanide carbonate is used in renal dialysis patients as a phosphate binder. Could Gd and Lanthanum be acting in concert to cause NSF/GISF? (GISF= Gad Induced Systemic Fibrosis = NSF)

I had to start in a reflection of one of the dark humor issues I have in the thinking of conventional radiologists and physicians. All so ready to accept NSF, and yet dispute that GDD could exist... which is nonsensical, and I will explain why (again), and tangentially very accepting of the name NSF and disputing naming GDD, GDD. NSF?GISF is activation of CD34+ bone marrow cell infiltrates, the most recognized, but not only one, circulating fibrocytes. Activation of bone marrow immune cells is the last battalion of the immune system to fight an offender, after starting with more advanced troops: Mast cells, neutrophils, T cells, if they all fail, the bone marrow cells step in to wall things off with fibrosis, because they could not otherwise figure out how to kill it (a la Edgar Allen Poe novel). This happens with Tb for example... So why does in renal failure the immune system start with the last battalion. The other very important uncertainty, if the reason for NSF/GISF is prolonged presence of Gd in the body, many people have longer retention, and this is excluding the fact that everyone retains Gd. So I have been thinking (and others) is it something about renal failure: acidosis, phosphatemia, something else. Then I thought of Lanthanum carbonate, prompted by these recent articles.

Patients on dialysis receive Lanthanum carbonate as a phosphate binder. So if Gd is retained in the body, ofcourse it stands to reason the closely related metal Lanthanum must also be retained in the body. If people are getting weekly dialysis and weekly Lanthanum, they must have an enormous amount of Lanthanum stored in their body. And then there is this: Lanthanum presence in the body is essentially never tested. Lanthanum is not one of the 20 toxic heavy metals tested for by Doctors Data, nor tested by Genova... So we have no idea how much Lanthanum is retained in renal dialysis patients. Now Lanthanum can be tested for, just like the famous 20, but it has to be by special request.

So is NSF/GISF a bimetal deposition disease of Lanthanum and Gd... my opinion it may well be, and maybe it is likely. But one could say, but Dr Semelka, what about NSF/GISF in patients who are not on dialysis. I consider two possibilities: 1. in subjects with normal kidneys, then they are in the group of GDD-NSF. GDD is a Tcell disease (my opinion) so why wouldn't some people have a bone marrow cell infiltrate involvement as well? Exactly, why wouldn't some people have that. Infact the combination of Mast-Cell acute hypersensitivity reaction (AHR), and Tcell GDD is very common, maybe 1/4 to 1/3 of GDD subjects have this combination. 2. in virtually all diseases there are examples that do not fit the mold for perhaps a huge variety of reasons: individuals getting pure NSF/GISF who are not on renal dialysis, but do have moderate renal failure, and maybe in them some other phenomenon is occurring not due to Lanthanum.

Should we be testing for Lanthanum in renal dialysis patients? Probably. In NSF/GISF patients? yes.

Does DTPA remove Lanthanum? Almost certainly yes due to its similarity to Gd.

I have to repeat the quick aside since I brought it up: the name NSF doesn't tell you what caused the disease or really what the disease is. GDD tells you what caused it and what it is due to: G is for Gd, DD tells you it is a result of the metal remaining retained in the body. Basically it is a persistent immune reaction to retained Gd. There could not possibly be a better name. Also GDD is the umbrella term for the entire spectrum of persistent Gd symptoms/ organ dysfunctions, that are not a 'pure' NSF/GISF, nor a 'pure' AHR. GDD is primarily pro-inflammatory in nature > for everything. NSF/GISF in pure state is a pro-fibrotic condition.

Lanthanum and Gd a bimetal toxicity in NSF/GISF? My opinion there is a good likelihood it is, as it could account for its unusual immune response it generates. Lanthanum has preceded the presence of Gd and has been churning along activating the immune system. Then Gd shows up.

Richard Semelka, MD