There are reports of alterations in the number and functions of the cells of the immune system in patients with metal-on-metal (MOM) orthopaedic implants. These effects have been correlated with elevated chromium levels in the patients' blood. We have investigated the interactions of clinically relevant concentrations of Cr VI with macrophages in vitro, and the mechanisms responsible for its toxicity. Cr VI causes a concentration dependent decrease in macrophage viability above 1 microM as measured by the MTT and Neutral Red assays. This falls well within the range of circulating chromium serum concentrations measured in patients with MOM. Intracellular reduced glutathione (GSH) levels fall as a result, and most of the loss (86%) is account...