Clioquinol-Zinc Chelate: A Candidate Causative Agent of Subacute Myelo-Optic Neuropathy
Open accessAbstract
Background 5-chloro-7-iodo-8-hydroxyquinoline (clioquinol) was used clinically three decades ago as an oral antiparasitic agent and to increase intestinal absorption of zinc in patients with acrodermatitis enteropathica, a genetic disorder of zinc absorption. Use of clioquinol was epidemiologically linked to subacute myelo-optic neuropathy (SMON), characterized by peripheral neuropathy and blindness, which affected 10,000 patients in Japan. Discontinuation of oral clioquinol use led to elimination of SMON, however, the mechanism of how clioquinol induces neurotoxicity is unclear.Materials and methods We tested the effect of clioquinol-metal chelates on neural crest-derived melanoma cells. The effect of clioquinol chelates on cells was further studied by electron microscopy and by a mitochondrial potential-sensitive fluorescent dye.Results Of the ions tested, only clioquinol-zinc chelate demonstrated cytotoxicity. The cytotoxicity of clioquinol-zinc chelate was extremely rapid, suggesting that its primary effect was on the mitochondria. Electron microscopic analysis demonstrated that clioquinol-zinc chelate caused mitochondrial damage. This finding was further confirmed by the observation that clioquinol-zinc chelate caused a decrease in mitochondrial membrane potential.Conclusions We demonstrate that clioquinol, in the presence of zinc, is converted to a potent mitochondrial toxin. The phenomenon of clioquinol mediated toxicity appears to be specific to zinc and is not seen with other metals tested. Since clioquinol has been shown to cause increased systemic absorption of zinc in humans, it is likely that clioquinol-zinc chelate was present in appreciable levels in patients with SMON and may be the ultimate causative toxin of SMON.
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Use of non-specific chelators (i.e., CQ) that do not interact selectively with the Aβ-metal species exhibit adverse side effects that will likely limit their long term clinical use.
“However, use of non-specific chelators (i.e., CQ) that do not interact selectively with the Aβ–metal species exhibit adverse side effects that will likely limit their long term clinical use.3,28,29,31,44,46–48”
From Bifunctional Compounds for Controlling Metal-Mediated Aggregation of the Aβ<sub>42</sub>Peptide (2012) · cites this paper as [47]
The Introduction and Discussion (page not supplied) link oral clioquinol to subacute myelo-optic neuropathy and say its oral use was discontinued or diminished. The Results show that clioquinol forms chelates with several metals. The paper does not assess selectivity for Aβ–metal species or establish that this lack of selectivity is why long-term clinical use would be limited. (LLM, conf=0.86)
Experimental — accuracy not yet measuredClioquinol toxicity has been reported if used over an extended period, and this may be due to formation of a Zn-clioquinol chelate.
“However, clioquinol toxicity has been reported if it is used over an extended period [1712] and this may be due to the formation of a Zn-clioquinol chelate [1713].”
From Iron behaving badly: inappropriate iron chelation as a major contributor to the aetiology of vascular and other progressive inflammatory and degenerative diseases (2009) · cites this paper as [1713]
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- Authors
- Arbiser, J. L., Kraeft, S.-K., van Leeuwen, R., Hurwitz, S. J., Selig, M., Dickersin, G. R., Flint, A., Byers, H. R., & Chen, L. B.
- Affiliations
- Emory University (US)
- Dana-Farber Cancer Institute (US)
- Harvard University (US)
- Boston Children's Hospital (US)
- Boston University (US)
- Corresponding author
- Arbiser, Jack L.
- Venue
- Molecular Medicine
- Published
- 1998-10
- Volume
- 4
- Issue
- 10
- Pages
- 665-670
- ISSN
- 1076-1551 (ISSN-L)
- 1528-3658
- PMC
- PMC2230249
- OpenAlex
- W1595180425
- Cited by
- 85
- References
- 16
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2022: 3 · 2021: 4 · 2020: 7 · 2019: 3 · 2018: 8 · 2017: 2 · 2016: 4 · 2015: 7 · 2014: 5 · 2013: 3 · 2012: 4
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Molecular Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kao Corporation
- National Institutes of Health (5r03ar044947-04)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R03 AR44947)
- Topics
- Health Sciences › Medicine › Ophthalmology › Drug-Induced Ocular Toxicity
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Heavy Metal Exposure and Toxicity
- Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
- Keywords
- clioquinol, subacute myelo-optic neuropathy, zinc chelate, neurotoxicity, mitochondrial toxicity, mitochondrial membrane potential, melanoma cells, acrodermatitis enteropathica, metal chelates, cytotoxicity
- MeSH terms
- Chelating Agents, Humans, Clioquinol, Membrane Potentials, Mitochondria, Myelitis, Optic Neuritis, Syndrome, Tumor Cells, Cultured, Zinc
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