Urinary 5-aminolevulinic acid in lead-exposed children

Lead intoxication can interfere with haem synthesis and alter the concentration of haem precursors, such as the neurotoxin 5-aminolevulinic acid, in plasma and urine. The relationship between blood lead concentration (PbB), a biomarker of lead exposure, and 5-aminolevulinic acid concentration in urine (ALAU), a biomarker of the early biological effect of lead, was examined in lead-exposed children. ALAU was assayed by chemical derivatization and high performance liquid chromatography with fluorescence detection. The study subjects were 79 children with moderate to high lead exposure recruited from a lead-poisoning prevention clinic. Their urine had been previously analysed for creatinine (CR) concentration and the benzene metabolite trans,trans-muconic acid, and their blood had been analysed for lead. We found that ALAU was not correlated with PbB (Spearman r = 0.088, p = 0.44), but the ratio ALAU/CR was correlated with PbB (Spearman r = 0.22, p = 0.054). Creatinine and ALAU concentrations were higher in urine samples collected in the afternoon than those collected in the morning, a finding that is consistent with known diurnal variation. However the ratio ALAU/CR was not different in morning and afternoon urines, supporting the use of creatinine adjustment of ALAU analysis of spot urine samples. In view of the neurotoxic properties of ALA, future validation studies of biomarkers of lead exposure and effect in children should include ALAU or ALAU/CR as potential markers of lead effect.