Case in point, the prevailing model for how gadolinium ends up in the skin involves a hypothetical process called "transmetallation," in which other metals, such as iron or calcium present in the tissue, knock the gadolinium off the chelator to which it is normally bound.
"Transmetallation is just a theory at this point. It hasn't yet been irrefutably proven to occur in the body. Electron microscopy cannot detect what a metal is bound to, but a special kind of subatomic particle accelerator can."
To that end, Dr. High will soon be the first dermatopathologist to gain access to such an instrument. By the time this article is published, he will have been engaged in particle accelerator experiments designed to prove whether gadolinium in tissue is no longer bound to its chelators, as the transmetallation theory suggests. "There will likely be other information coming out to show that other metals may contribute to gadolinium deposition and perhaps to NSF itself," he said.
Even if gadolinium is not the only cause of NSF, it certainly appears a strong trigger in susceptible individuals. Estimates indicate that 3%-5% of patients with ESRD may be at risk for NSF. It appears that, in addition to ESRD, predisposition to thrombosis and inflammation may be involved. The risk is also likely proportional to the number of scans a person receives during renal failure.
For those who develop the disorder, there's little physicians can do. "I see about 10-12 patients with NSF at the University of Colorado. We've tried everythingphotopheresis, plasmapheresis, renal transplant. No single treatment works uniformly well for all patients. And there are no formal studies comparing modalities."
Dr. High predicted that the current controversy about gadolinium will prompt a surge of interest in "medical geology" and the study of how elemental metals affect human health. Currently, Dr. High is working on a rapid, noninvasive screening device to detect metals such as gadolinium in human tissue.
Gadolinium conglomerations in a fibrohistiocytic cell from the skin of an NSF patient are shown above. Courtesy Dr. Whitney A. High