Effects of environmental and occupational lead toxicity and its association with iron metabolism

Toxicol Appl Pharmacol. 2022 Jan 1:434:115794. doi: 10.1016/j.taap.2021.115794. Epub 2021 Nov 13.


Background: Discrepancies are present in the findings from clinical trials evaluating a physiological role of iron status in the lead-exposed population.

Objective: The purpose of this article was to summarize the current understanding of cellular mechanisms of lead toxicity and present a comprehensive review of existing clinical trials related to associations of lead poisoning and iron status. Although an association of iron metabolism pathways that are affected by lead intoxication has been studied, there are still aspects that remain to be elucidated. The existence of additional Pb uptake pathways besides DMT1 transporter-mediated is postulated to non-specifically regulate lead absorption.

Methods: Authors performed a systematic search of PubMed, EMBASE® and Web of Science databases to identify studies that reported an association between health risks of non-organic lead that are associated with iron status markers as possible effect modifier.

Results: There were 58 studies that met the pre-defined inclusion criteria for the systematic review. There is a strong body of evidence supporting the hypothesis that alleviated blood lead level can be correlated with a reduced body iron store and increasing the risk of anemia. This association is of a high significance in cases of a young adolescent, weaker in groups of older children and often without a statistical significance in adults.

Discussion: Discrepancies in the observations may result from different specificities of lead absorption pathways in children and adults, as well as the power of the statistical tests in varying population sizes. It may be assumed that the extent of iron deficits coupled together with source, timing, and severity of lead exposure, significantly influence the correlation between these factors. Some of the intervention programs of counteracting lead poisoning by iron supplementation proved to be effective and may be a promising prevention strategy for the exposed population.

Keywords: Iron metabolism; Lead; iron; lead poisoning; lead toxicity.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Drug Interactions
  • Environmental Exposure
  • Environmental Pollutants / toxicity*
  • Humans
  • Iron / metabolism*
  • Iron / pharmacokinetics
  • Lead / pharmacokinetics
  • Lead / toxicity*
  • Occupational Exposure


  • Environmental Pollutants
  • Lead
  • Iron