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Association of renal function and δ-aminolevulinic acid dehydratase polymorphism among Vietnamese and Singapore workers exposed to inorganic lead
  1. S-E Chia1,
  2. H J Zhou2,
  3. E Yap3,
  4. M T Tham1,
  5. N-V Dong2,
  6. N T Hong Tu3,
  7. K-S Chia1
  1. 1Department of Community, Occupational & Family Medicine, National University of Singapore, Singapore
  2. 2Center of Occupational Health & Environment, Ministry of Industry, Vietnam
  3. 3General Department of Preventive Medicine and Control of HIV/AIDS Control, Ministry of Health, Vietnam
  1. Correspondence to:
 Prof. S-E Chia
 Department of Community, Occupational & Family Medicine (MD3), Yong Loo Lin School of Medicine, National University of Singapore, 16 Medical Drive, Singapore 117597, Republic of Singapore; cofcse{at}


Objectives: To investigate the effect of δ-aminolevulinic acid dehydratase (ALAD) polymorphisms on the association between blood lead and renal function among Vietnamese and Singaporean workers who were exposed to low to medium levels of inorganic lead, and to study the distribution of ALAD polymorphism among Vietnamese, Chinese, Malays and Indians.

Methods: A total of 459 male and female workers were studied. Blood and urine were collected for each worker in order to determine ALAD genotype, blood lead, and urinary δ-aminolevulinic acid (ALAU). Renal function tests included urine albumin (Ualb), urine β2 microglobulin (Uβ2m), urinary α1 microglobulin (Uα1m), N-acetyl-glucosaminidas (NAG), and urine retinol blinding protein (RBP). A multiple regression model with interaction term was applied to fit the entire data and to explore the modifying effect of ALAD polymorphism on the relation of blood lead to each renal function parameter.

Results: ALAD1-1 was the predominant genotype for all the ethnic groups while ALAD2-2 was the rarest. The frequency of ALAD2 allele was higher among Malays (8.8%) and Indians (10.6%) compared to the Chinese (5.0%) and Vietnamese (4.3%). The geometric mean of blood lead for all workers was 19.0 μg/dl. The models for Uβ2m, Uα1m, and NAG showed that the ALAD1-2/2-2 group had higher β coefficients than the ALAD1-1 group. Corresponding to 10 μg/dl blood lead, ALAD1-1 homozygotes had an increment of 1.288 μg/g Cr, 1.175 mg/g Cr, and 1.995 U/g Cr for Uβ2m, Uα1m, and NAG, respectively. ALAD1-2/2-2 subjects had higher increments of 3.802 μg/g Cr, 2.138 mg/g Cr, and 3.89 U/g Cr for Uβ2m, Uα1m, and NAG, respectively.

Conclusion: The frequency of the ALAD2 allele is as low in Vietnamese workers as in Chinese. Workers with the ALAD2 allele appeared more susceptible to the effects of lead (especially at higher levels) on renal function.

  • ALAD, δ-aminolevulinic acid dehydratase
  • ALAU, urinary δ-aminolevulinic acid
  • NAG, N-acetyl-beta-glucosaminidase
  • RBP, retinol binding protein
  • Ualb, urinary albumin
  • Uα1m, urine α1 microglobulin
  • Uβ2m, urine β2 microglobulin
  • URBP, urine retinol binding protein
  • UNAG, urinary N-acetyl-beta-glucosaminidase
  • ALAD polymorphism
  • blood lead
  • renal function
  • urinary β2 microglobulin
  • urinary α1 microglobulin
  • N-acetyl-glucosaminidase

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  • Funding: this study was supported by research grant no. 01/1/21/19/186 from the Agency for Science, Technology and Research, Biomedical Research Council (BMRC), Singapore

  • Competing interests: none declared