PubMed · 74015
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J M Peters. 1978-02-02. The Kepone episode: another warning.. https://doi.org/10.1056/nejm197802022980511
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An unresolved question is whether humans exposed to comparatively low doses of persistent environmental chemicals such as polyhalogenated biphenyls or organochlorine pesticides are at risk for injury to the liver. Cross-sectional epidemiologic studies suggest that these chemicals may produce statistically significant but clinically mild abnormalities in the commonly employed chemical tests of liver function. The few reports of human liver morphology reveal nonspecific changes reflecting effects of lipophilic chemicals. There is evidence that chemicals of this category in at least some doses cause induction of liver microsomal enzymes involved in biotransformation of foreign substances. This finding has been documented by measurements of the clearance of model drugs or the appearance in the urine of steroid metabolites or glucaric acid. Although a positive statistical correlation between the concentrations of these chemicals in serum and the serum gamma-glutamyltranspeptidase activity has been reported, the non-specificity of the latter enzyme precludes conclusion that this change is indicative of induction of liver microsomal enzymes. Although the effects of this type of environmental chemical are not indicative of progressive liver disease, only prospective clinical trials can resolve the issue of the risk for future development of liver malignancy.
Chlordecone is an organochlorine insecticide which intoxicated a number of workers in 1975 because of excessive exposure in the industrial plant. The major manifestations were tremor, opsoclonus, arthralgias, pleural pain, and reduced sperm count. The half-life in blood was determined to be 165 days, but treatment with cholestyramine reduced this to 80 days. Despite initial high blood levels of chlordecone, follow up at six years indicated that in the workers reevaluated the chlordecone had been cleared completely from blood, with very low levels remaining in fat. As the chlordecone was cleared, the clinical manifestations abated, and many of the patients returned to work. Appropriate industrial hygienic and medical management would probably have quickly aborted the epidemic.