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Wunnapuk K, Mohammed F, Gawarammana I, Liu X, Verbeeck RK, Buckley NA, Roberts MS, Musuamba FT. Prediction of paraquat exposure and toxicity in clinically ill poisoned patients: a model based approach. Br J Clin Pharmacol 2015; 78:855-66. [PMID: 24697850 DOI: 10.1111/bcp.12389] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/25/2014] [Indexed: 11/28/2022] Open
Abstract
AIMS Paraquat poisoning is a medical problem in many parts of Asia and the Pacific. The mortality rate is extremely high as there is no effective treatment. We analyzed data collected during an ongoing cohort study on self-poisoning and from a randomized controlled trial assessing the efficacy of immunosuppressive therapy in hospitalized paraquat-intoxicated patients. The aim of this analysis was to characterize the toxicokinetics and toxicodynamics of paraquat in this population. METHODS A non-linear mixed effects approach was used to perform a toxicokinetic/toxicodynamic population analysis in a cohort of 78 patients. RESULTS The paraquat plasma concentrations were best fitted by a two compartment toxicokinetic structural model with first order absorption and first order elimination. Changes in renal function were used for the assessment of paraquat toxicodynamics. The estimates of toxicokinetic parameters for the apparent clearance, the apparent volume of distribution and elimination half-life were 1.17 l h(-1) , 2.4 l kg(-1) and 87 h, respectively. Renal function, namely creatinine clearance, was the most significant covariate to explain between patient variability in paraquat clearance.This model suggested that a reduction in paraquat clearance occurred within 24 to 48 h after poison ingestion, and afterwards the clearance was constant over time. The model estimated that a paraquat concentration of 429 μg l(-1) caused 50% of maximum renal toxicity. The immunosuppressive therapy tested during this study was associated with only 8% improvement of renal function. CONCLUSION The developed models may be useful as prognostic tools to predict patient outcome based on patient characteristics on admission and to assess drug effectiveness during antidote drug development.
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Affiliation(s)
- Klintean Wunnapuk
- Therapeutics Research Centre, School of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Protective effects of thalidomide on pulmonary injuries in a rat model of paraquat intoxication. JOURNAL OF INFLAMMATION-LONDON 2015. [PMID: 26221080 PMCID: PMC4517355 DOI: 10.1186/s12950-015-0093-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background This study was designed to evaluate the protective effects of thalidomide on paraquat (PQ)-induced lung injuries in a rat model and to explore the underlying mechanisms. Methods Rats were exposed to 50 mg/kg PQ by oral gavage, and treated with thalidomide through oral administration at 60 mg/kg once a day, 6 days/week for 2 weeks. Serum levels of IL-6, TNF-alpha, TGFbeta1 and COL1A1 were detected at different time points after paraquat exposure. At the end of the study, lung tissues were collected for pathological inspection as well as analyses of water content and expression levels of IL-6, TNF-alpha, TGFbeta1 and COL1A1 mRNA. Results The results showed that thalidomide treatment could significantly alleviate PQ-induced pathological changes in lung tissue and severity of lung edema. Thalidomide treatment after PQ exposure resulted in significantly reduced serum levels of IL-6, TNF-alpha, TGF-beta1 and COL1A1, as compared to PQ group. PCR analysis demonstrated that expression levels of IL-6, TNF-alpha, TGF-beta1 and COL1A1 in lung tissue were significantly increased after PQ exposure but reduced by thalidomide, which were confirmed by immunohistochemistry staining. Conclusions Our results indicated that inflammatory factors played important roles in PQ-induced lung injuries and thalidomide could protect rats from PQ-induced lung injuries by inhibiting the upregulation of inflammatory factors.
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Chao LK, Fang TC. Dialysis catheter-related pulmonary embolism in a patient with paraquat intoxication. Tzu Chi Med J 2015; 28:166-169. [PMID: 28757750 PMCID: PMC5442902 DOI: 10.1016/j.tcmj.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/06/2015] [Accepted: 04/29/2015] [Indexed: 11/26/2022] Open
Abstract
A 30-year-old woman was sent to the emergency room after alcohol and paraquat ingestion. After three sessions of hemoperfusion via the indwelling double-lumen catheter, the patient could tolerate ambient air and her urine output was good. However, on the 10th day of hospitalization, she had a sudden onset of dyspnea and hypoxia. Pulmonary embolism was diagnosed by a computed tomography pulmonary angiogram. The patient recovered after anticoagulation therapy. We could find no reports of dyspnea caused by pulmonary embolism in patients with paraquat intoxication. Here, we present this rare case; the indwelling double-lumen catheter might have been a cause of the pulmonary embolism.
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Affiliation(s)
- Li-Keng Chao
- Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Te-Chao Fang
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Zhou CY, Kang X, Li CB, Li XH, Liu Y, Wang Z, Wang L, Wu T, Mohan C, Hu DY, Peng A. Pneumomediastinum predicts early mortality in acute paraquat poisoning. Clin Toxicol (Phila) 2015; 53:551-6. [PMID: 26072933 DOI: 10.3109/15563650.2015.1046183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT In paraquat (PQ) poisoning, death often occurs after the appearance of pneumomediastinum (PM). However, the clinical features and eventual outcome of PM in PQ intoxication remains unclear. OBJECTIVE We aimed to characterize PM following PQ poisoning and its prognostic value for predicting mortality. MATERIALS AND METHODS Enrolled PQ-poisoned patients (n = 75) were divided into two groups according to whether PM could be detected by chest computed tomography or not. The study outcomes included 5- and 90-day death after intoxication. Survival curves were derived using the Kaplan-Meier method, and mortality risk factors were analyzed by forward stepwise Cox regression analysis. RESULTS PM was documented in 21.3% of the patients (16/75); in 13 of them PM set in within 3 days of PQ ingestion. 15 patients died within 3 days of appearance of PM. Compared with patients without PM, those with PM were younger (P = 0.011), and had higher scores of Acute Physiology and Chronic Health Evaluation (P < 0.001) and Sequential Organ Failure Assessment (P = 0.003). In addition, patients with PM had a higher incidence of acute renal failure (P = 0.001), toxic hepatitis (P = 0.008), and respiratory insufficiency (P = 0.003). PM predicted an increased risk of 90-day death (93.8% of patients with PM vs. 40.7% among those without PM; hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0-5.6; P = 0.045), and increased risk of 5-day death (81.3% vs. 27.1%; HR, 3.2; 95% CI, 1.2-8.1; P = 0.017). DISCUSSION AND CONCLUSION Early PM, occurring within 8 days, is a specific predictor of mortality in PQ poisoning.
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Affiliation(s)
- Chun-Yu Zhou
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine , Shanghai , PR China
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Dinis-Oliveira RJ, Carvalho F, Moreira R, Proença JB, Santos A, Duarte JA, Bastos MDL, Magalhães T. Clinical and forensic signs related to chemical burns: A mechanistic approach. Burns 2015; 41:658-79. [PMID: 25280586 DOI: 10.1016/j.burns.2014.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 09/04/2014] [Accepted: 09/08/2014] [Indexed: 12/14/2022]
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Mohamed F, Endre ZH, Buckley NA. Role of biomarkers of nephrotoxic acute kidney injury in deliberate poisoning and envenomation in less developed countries. Br J Clin Pharmacol 2015; 80:3-19. [PMID: 26099916 DOI: 10.1111/bcp.12601] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/17/2014] [Accepted: 01/29/2015] [Indexed: 12/20/2022] Open
Abstract
Acute kidney injury (AKI) has diverse causes and is associated with increased mortality and morbidity. In less developed countries (LDC), nephrotoxic AKI (ToxAKI) is common and mainly due to deliberate ingestion of nephrotoxic pesticides, toxic plants or to snake envenomation. ToxAKI shares some pathophysiological pathways with the much more intensively studied ischaemic AKI, but in contrast to ischaemic AKI, most victims are young, previously healthy adults. Diagnosis of AKI is currently based on a rise in serum creatinine. However this may delay diagnosis because of the kinetics of creatinine. Baseline creatinine values are also rarely available in LDC. Novel renal injury biomarkers offer a way forward because they usually increase more rapidly in AKI and are normally regarded as absent or very low in concentration, thereby reducing the need for a baseline estimate. This should increase sensitivity and speed of diagnosis. Specificity should also be increased for urine biomarkers since many originate from the renal tubular epithelium. Earlier diagnosis of ToxAKI should allow earlier initiation of appropriate therapy. However, translation of novel biomarkers of ToxAKI into clinical practice requires better understanding of non-renal factors in poisoning that alter biomarkers and the influence of dose of nephrotoxin on biomarker performance. Further issues are establishing LDC population-based normal ranges and assessing sampling and analytical parameters for low resource settings. The potential role of renal biomarkers in exploring ToxAKI aetiologies for chronic kidney disease of unknown origin (CKDu) is a high research priority in LDC. Therefore, developing more sensitive biomarkers for early diagnosis of nephrotoxicity is a critical step to making progress against AKI and CKDu in the developing world.
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Affiliation(s)
- Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.,Clinical Pharmacology and Toxicology Group, Professorial Medicine Unit, The Prince of Wales Clinical School, University of New South Wales, NSW, Australia.,Department of Pharmacy, Faculty of Allied Health Science, University of Peradeniya, Sri Lanka
| | - Zoltan H Endre
- Department of Nephrology, Prince Of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Nicholas A Buckley
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.,Clinical Pharmacology and Toxicology Group, Professorial Medicine Unit, The Prince of Wales Clinical School, University of New South Wales, NSW, Australia.,Pharmacology, SOMS, Sydney Medical School, University of Sydney, NSW, Australia
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258
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Gong P, Lu Z, Xing J, Wang N, Zhang Y. Traditional chinese medicine Xuebijing treatment is associated with decreased mortality risk of patients with moderate paraquat poisoning. PLoS One 2015; 10:e0123504. [PMID: 25923333 PMCID: PMC4414552 DOI: 10.1371/journal.pone.0123504] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/23/2015] [Indexed: 12/13/2022] Open
Abstract
Paraquat poisoning causes multiple organ injury and high mortality due to severe toxicity and lack of effective treatment. Xuebijing (XBJ) injection, a traditional Chinese medicine preparation of five Chinese herbs (Radix Salviae Miltiorrhiae, Rhizoma Chuanxiong, Flos Carthami, Angelica Sinensis and Radix Paeoniae Rubra), has an anti-inflammatory effect and is widely used in the treatment of sepsis. This retrospective study was designed to evaluate the effects of XBJ combined with conventional therapy on mortality risk of patients with acute paraquat poisoning. Out of 68 patients, 27 were treated with conventional therapy (control group) and 41 were treated with intravenous administration of XBJ (100 ml, twice a day, up to 7 days) plus conventional therapy (XBJ group). Vital organ function, survival time within 28 days and adverse events during the treatment were reviewed. Results indicated that XBJ treatment significantly increased median survival time among patients ingesting 10-30 ml of paraquat (P=0.02) compared with the control group. After adjustment for covariates, XBJ treatment was associated significantly with a lower mortality risk (adjusted HR 0.242, 95% CI 0.113 to 0.516, P=0.001) compared with the control group. Additionally, compared with Day 1, on Day 3 the value of PaO2/FiO2 was significantly decreased, and the values of serum alanine aminotransferase, creatinine and troponin T were significantly increased in the control group (all P<0.05), but these values were significant improved in the XBJ group (all P<0.05). Only one patient had skin rash with itch within 30 minutes after injection and no severe adverse events were found in the XBJ group. In conclusion, XBJ treatment is associated with decreased mortality risk of patients with moderate paraquat poisoning, which may be attributed to improved function of vital organs with no severe adverse events.
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Affiliation(s)
- Ping Gong
- Emergency Department, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning province, People’s Republic of China
| | - Zhidan Lu
- Emergency Department, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning province, People’s Republic of China
| | - Jing Xing
- Emergency Department, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning province, People’s Republic of China
| | - Na Wang
- Emergency Department, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning province, People’s Republic of China
| | - Yu Zhang
- Emergency Department, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning province, People’s Republic of China
- * E-mail:
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259
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He F, Xu P, Zhang J, Zhang Q, Gu S, Liu Y, Wang J. Efficacy and safety of pulse immunosuppressive therapy with glucocorticoid and cyclophosphamide in patients with paraquat poisoning: A meta-analysis. Int Immunopharmacol 2015; 27:1-7. [PMID: 25921027 DOI: 10.1016/j.intimp.2015.04.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/20/2015] [Accepted: 04/14/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Paraquat (PQ) is widely used in developing countries. Accidental or suicidal PQ poisoning is a public health concern due to lack of effective treatment. Because the role of pulse immunosuppressive therapy with glucocorticoid and cyclophosphamide for PQ poisoning is uncertain, we performed a meta-analysis to investigate the efficacy and safety of the therapy. METHOD A systematic literature search for randomized controlled trials (RCTs) and other clinical studies was performed in Pub Med, Embase, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature and Retrieval System, and Chinese Medical Current Contents. We estimated pooled relative risk ratios (RRs) and 95% confidence intervals (CIs) using a fixed effect model or random effect model. Outcomes included mortality, incidence of acute renal failure (ARF) and hypoxia, and leucopenia. RESULTS Five studies (three RCTs) involving 332 PQ poisoning patients met the criteria. The mortality of moderate to fulminant poisoning patients receiving the pulse therapy was lower than that of the controls (60.4% vs. 85.3%; RR 0.71, 95% CI: 0.59, 0.86, P=0.0004). The therapy also reduced the mortality of patients with moderate to severe PQ poisoning (45.1% vs. 79.1%, RR 0.45; 95% CI: 0.28, 0.75, P=0.002). However, the therapy did not decrease the incidence of ARF and hypoxia. In addition, the pulse therapy caused more leucopenia than the controls (36.9% vs. 2.6%; RR: 9.12; 95% CI: 3.65, 22.81, P<0.00001). CONCLUSION Pulse immunosuppressive therapy with glucocorticoid and cyclophosphamide may reduce the mortality of PQ poisoning patients, although the therapy may cause leucopenia.
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Affiliation(s)
- Fei He
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Peng Xu
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Jun Zhang
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Qiuling Zhang
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Shuangshuang Gu
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Yao Liu
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China
| | - Jun Wang
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China.
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The volume ratio of ground glass opacity in early lung CT predicts mortality in acute paraquat poisoning. PLoS One 2015; 10:e0121691. [PMID: 25830638 PMCID: PMC4382148 DOI: 10.1371/journal.pone.0121691] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/14/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pulmonary injury is the main cause of death in acute paraquat (PQ) poisoning. However, whether quantitative lung computed tomography (CT) can be useful in predicting the outcome of PQ poisoning remains unknown. We aimed to identify early findings of quantitative lung CT as predictors of outcome in acute PQ poisoning. METHODS Lung CT scanning (64-slide) and quantitative CT lesions were prospectively measured for patients after PQ intoxication within 5 days. The study outcome was mortality during 90 days follow-up. Survival curves were derived by the Kaplan-Meier method, and mortality risk factors were analyzed by the forward stepwise Cox regression analysis. RESULTS Of 97 patients, 41 (42.3%) died. Among the eight different types of lung CT findings which appeared in the first 5-day of PQ intoxication, four ones discriminated between survivors and non-survivors including ground glass opacity (GGO), consolidation, pneumomediastinum and "no obvious lesion". With a cutoff value of 10.8%, sensitivity of 85.4% and specificity of 89.3%, GGO volume ratio is better than adopted outcome indicators in predicting mortality, such as estimated amount of PQ ingestion, plasma or urine PQ concentration, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores. GGO volume ratios above 10.8% were associated with increased mortality (hazard ratio, 5.82; 95% confidence interval, 4.77-7.09; P < 0.001). CONCLUSIONS The volume ratio of GGO exceeding 10.8% is a novel, reliable and independent predictors of outcome in acute PQ poisoning.
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261
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Mohamed F, Endre Z, Jayamanne S, Pianta T, Peake P, Palangasinghe C, Chathuranga U, Jayasekera K, Wunnapuk K, Shihana F, Shahmy S, Buckley N. Mechanisms underlying early rapid increases in creatinine in paraquat poisoning. PLoS One 2015; 10:e0122357. [PMID: 25815837 PMCID: PMC4376530 DOI: 10.1371/journal.pone.0122357] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 02/18/2015] [Indexed: 01/17/2023] Open
Abstract
Background Acute kidney injury (AKI) is common after severe paraquat poisoning and usually heralds a fatal outcome. The rapid large increases in serum creatinine (Cr) exceed that which can be explained by creatinine kinetics based on loss of glomerular filtration rate (GFR). Methods and Findings This prospective multi-centre study compared the kinetics of two surrogate markers of GFR, serum creatinine and serum cystatin C (CysC), following paraquat poisoning to understand and assess renal functional loss after paraquat poisoning. Sixty-six acute paraquat poisoning patients admitted to medical units of five hospitals were included. Relative changes in creatinine and CysC were monitored in serial blood and urine samples, and influences of non-renal factors were also studied. Results Forty-eight of 66 patients developed AKI (AKIN criteria), with 37 (56%) developing moderate to severe AKI (AKIN stage 2 or 3). The 37 patients showed rapid increases in creatinine of >100% within 24 hours, >200% within 48 hours and >300% by 72 hours and 17 of the 37 died. CysC concentration increased by 50% at 24 hours in the same 37 patients and then remained constant. The creatinine/CysC ratio increased 8 fold over 72 hours. There was a modest fall in urinary creatinine and serum/urine creatinine ratios and a moderate increase in urinary paraquat during first three days. Conclusion Loss of renal function contributes modestly to the large increases in creatinine following paraquat poisoning. The rapid rise in serum creatinine most probably represents increased production of creatine and creatinine to meet the energy demand following severe oxidative stress. Minor contributions include increased cyclisation of creatine to creatinine because of acidosis and competitive or non-competitive inhibition of creatinine secretion. Creatinine is not a good marker of renal functional loss after paraquat poisoning and renal injury should be evaluated using more specific biomarkers of renal injury.
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Affiliation(s)
- Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Pharmacology and Toxicology Group, Professorial Medicine Unit, The Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Nephrology, Prince Of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Zoltan Endre
- Department of Nephrology, Prince Of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Timothy Pianta
- Department of Nephrology, Prince Of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Philip Peake
- Department of Nephrology, Prince Of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Chathura Palangasinghe
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Umesh Chathuranga
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kithsiri Jayasekera
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Klintean Wunnapuk
- Therapeutics Research Centre, School of Medicine, University of Queensland, Brisbane, Australia
| | - Fathima Shihana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Seyed Shahmy
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nicholas Buckley
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Pharmacology and Toxicology Group, Professorial Medicine Unit, The Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- Department of Pharmacology, School of Medical Sciences, Sydney Medical School, University of Sydney, Sydney, Australia
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Paraquat induces epithelial-mesenchymal transition-like cellular response resulting in fibrogenesis and the prevention of apoptosis in human pulmonary epithelial cells. PLoS One 2015; 10:e0120192. [PMID: 25799450 PMCID: PMC4370722 DOI: 10.1371/journal.pone.0120192] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 02/04/2015] [Indexed: 01/31/2023] Open
Abstract
The aim of this study is to investigate the molecular mechanisms underlying delayed progressive pulmonary fibrosis, a characteristic of subacute paraquat (PQ) poisoning. Epithelial-mesenchymal transition (EMT) has been proposed as a cause of organ fibrosis, and transforming growth factor-β (TGF-β) is suggested to be a powerful mediator of EMT. We thus examined the possibility that EMT is involved in pulmonary fibrosis during PQ poisoning using A549 human alveolar epithelial cells in vitro. The cells were treated with various concentrations of PQ (0–500 μM) for 2–12 days. Short-term (2 days) high-dose (>100 μM) treatments with PQ induced cell death accompanied by the activation of caspase9 as well as a decrease in E-cadherin (an epithelial cell marker), suggesting apoptotic cell death with the features of anoikis (cell death due to the loss of cell-cell adhesion). In contrast, long-term (6–12 days) low-dose (30 μM) treatments with PQ resulted in a transformation into spindle-shaped mesenchymal-like cells with a decrease of E-cadherin as well as an increase of α-smooth muscle actin (α-SMA). The mesenchymal-like cells also secreted the extracellular matrix (ECM) protein fibronectin into the culture medium. The administration of a TGF-β1 receptor antagonist, SB431542, almost completely attenuated the mesenchymal transformation as well as fibronectin secretion, suggesting a crucial role of TGF-β1 in EMT-like cellular response and subsequent fibrogenesis. It is noteworthy that despite the suppression of EMT-fibrogenesis, apoptotic death was observed in cells treated with PQ+SB431542. EMT-like cellular response and subsequent fibrogenesis were also observed in normal human bronchial epithelial (NHBE) cells exposed to PQ in a TGF-β1-dependent manner. Taken together, our experimental model reflects well the etiology of PQ poisoning in human and shows the involvement of EMT-like cellular response in both fibrogenesis and resistance to cell death during subacute PQ poisoning of pulmonary epithelial cells.
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Natural antioxidant betanin protects rats from paraquat-induced acute lung injury interstitial pneumonia. BIOMED RESEARCH INTERNATIONAL 2015; 2015:608174. [PMID: 25861636 PMCID: PMC4377444 DOI: 10.1155/2015/608174] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/16/2015] [Indexed: 12/16/2022]
Abstract
The effect of betanin on a rat paraquat-induced acute lung injury (ALI) model was investigated. Paraquat was injected intraperitoneally at a single dose of 20 mg/kg body weight, and betanin (25 and 100 mg/kg/d) was orally administered 3 days before and 2 days after paraquat administration. Rats were sacrificed 24 hours after the last betanin dosage, and lung tissue and bronchoalveolar lavage fluid (BALF) were collected. In rats treated only with paraquat, extensive lung injury characteristic of ALI was observed, including histological changes, elevation of lung : body weight ratio, increased lung permeability, increased lung neutrophilia infiltration, increased malondialdehyde (MDA) and myeloperoxidase (MPO) activity, reduced superoxide dismutase (SOD) activity, reduced claudin-4 and zonula occluden-1 protein levels, increased BALF interleukin (IL-1) and tumor necrosis factor (TNF)-α levels, reduced BALF IL-10 levels, and increased lung nuclear factor kappa (NF-κB) activity. In rats treated with betanin, paraquat-induced ALI was attenuated in a dose-dependent manner. In conclusion, our results indicate that betanin attenuates paraquat-induced ALI possibly via antioxidant and anti-inflammatory mechanisms. Thus, the potential for using betanin as an auxilliary therapy for ALI should be explored further.
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Liu XW, Ma T, Qu B, Liu Z. Effects of noninvasive positive pressure ventilation on oxygenation status and prognosis in patients with acute paraquat-induced lung injury. Clin Ther 2015; 37:654-9. [PMID: 25655533 DOI: 10.1016/j.clinthera.2014.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 12/08/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of noninvasive positive pressure ventilation (NIPPV) on oxygenation status and prognosis in patients with acute lung injury induced by paraquat (PQ) poisoning. METHODS Patients with acute PQ-induced lung injury treated with NIPPV were admitted to an emergency intensive care unit. Changes in oxygenation status (respiratory rate and the partial pressure of alveolar O2 and CO2 [PaO2 and PaCO2, respectively]) after initial NIPPV were observed. Differences in inspiratory pressure (PI) between nonsurvivors and survivors were compared. The relationship between PI and the prognosis of patients with acute PQ-induced lung injury was evaluated. FINDINGS A total of 86 patients (47 women, 39 men; mean age, 33.5 [24.5] years [range, 22-61 years]) were included. There were significant differences in respiratory rate, PaO2, and PaCO2 from before to after initial NIPPV (respiratory rate, 35 [14] vs 26 [16] min(-1) [P = 0.037]; PaO2, 61.8 [19.6] vs 73.5 [26.8] mm Hg [P = 0.046]; and PaCO2, 27.7 [16.4] vs 34.6 [19.2] mm Hg [P = 0.039]). The overall mortality rate was 75.6% (65/86) during a 28-day follow-up period. We observed a significant difference in initial PI (PIinit) between nonsurvivors and survivors (8.2 [4.3] vs 6.6 [3.8] cm H2O; P = 0.043). Furthermore, nonsurvivors had a greater maximal PI (PImax) than did survivors (21.6 [9.8] vs 15.4 [8.5] cm H2O; P = 0.022). Correlation analysis revealed that both PIinit and PImax were associated with a poor prognosis in patients with acute PQ-induced lung injury (PIinit, r = -0.29 [P = 0.038]; PImax, r = -0.31 [P = 0.042]). IMPLICATIONS NIPPV may effectively improve oxygenation status in patients with acute PQ-induced lung injury, thereby relieving dyspnea and promoting the recovery of pulmonary function. PIinit and PImax may be important determinants of prognosis in acute PQ-induced lung injury. These findings need further verification in a large-scale, multicenter, randomized controlled study that combines other factors with a relatively long-term follow-up.
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Affiliation(s)
- Xiao-Wei Liu
- Department of Emergency, First Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Tao Ma
- Department of Emergency, First Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Bo Qu
- Department of Biostatistics, School of Public Health, China Medical University, Liaoning, People's Republic of China
| | - Zhi Liu
- Department of Emergency, First Affiliated Hospital, China Medical University, Liaoning, People's Republic of China.
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265
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Jayasumana C, Paranagama P, Agampodi S, Wijewardane C, Gunatilake S, Siribaddana S. Drinking well water and occupational exposure to Herbicides is associated with chronic kidney disease, in Padavi-Sripura, Sri Lanka. Environ Health 2015; 14:6. [PMID: 25596925 PMCID: PMC4417209 DOI: 10.1186/1476-069x-14-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 01/13/2015] [Indexed: 05/02/2023]
Abstract
BACKGROUND The chronic kidney disease of unknown etiology (CKDu) among paddy farmers in was first reported in 1994 and has now become most important public health issue in dry zone of Sri Lanka. The objective was to identify risk factors associated with the epidemic in an area with high prevalence. METHODS A case control study was carried out in Padavi-Sripura hospital in Trincomalee district. CKDu patients were defined using health ministry criteria. All confirmed cases (N = 125) fulfilling the entry criteria were recruited to the study. Control selection (N = 180) was done from people visiting the hospital for CKDu screening. Socio-demographic and data related to usage of applying pesticides and fertilizers were studied. Drinking water was also analyzed using ICP-MS and ELISA to determine the levels of metals and glyphosate. RESULTS Majority of patients were farmers (N = 107, 85.6%) and were educated up to 'Ordinary Level' (N = 92, 73.6%). We specifically analyzed for the effect modification of, farming by sex, which showed a significantly higher risk for male farmers with OR 4.69 (95% CI 1.06-20.69) in comparison to their female counterparts. In the multivariable analysis the highest risk for CKDu was observed among participants who drank well water (OR 2.52, 95% CI 1.12-5.70) and had history of drinking water from an abandoned well (OR 5.43, 95% CI 2.88-10.26) and spray glyphosate (OR 5.12, 95% CI 2.33-11.26) as a pesticide. Water analysis showed significantly higher amount of hardness, electrical conductivity and glyphosate levels in abandoned wells. In addition Ca, Mg, Ba, Sr, Fe, Ti, V and Sr were high in abandoned wells. Surface water from reservoirs in the endemic area also showed contamination with glyphosate but at a much lower level. Glyphosate was not seen in water samples in the Colombo district. CONCLUSION The current study strongly favors the hypothesis that CKDu epidemic among farmers in dry zone of Sri Lanka is associated with, history of drinking water from a well that was abandoned. In addition, it is associated with spraying glyphosate and other pesticides in paddy fields. Farmers do not use personnel protective equipments and wears scanty clothing due to heat when spraying pesticides.
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Affiliation(s)
- Channa Jayasumana
- />Department of Pharmacology, Faculty of Medicine, Rajarata University of Sri Lanka, Anuradhapura, 50008 Sri Lanka
| | - Priyani Paranagama
- />Department of Chemistry, Faculty of Science, University of Kelaniya, Colombo, Sri Lanka
| | - Suneth Agampodi
- />Department of Community Medicine, Faculty of Medicine, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | | | - Sarath Gunatilake
- />Department of Health Science, California State University Long Beach, Long Beach, CA USA
| | - Sisira Siribaddana
- />Department of Medicine, Faculty of Medicine, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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266
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Affiliation(s)
- Sohyung Park
- Forensic Medical Center, National Forensic Service, Wonju, Korea
| | - Sujin Jeong
- Narcotics, Forensic Toxicology & Chemistry Division, Seoul Institute, National Forensic Service, Seoul, Korea
| | - Han Young Lee
- Forensic Medical Center, National Forensic Service, Wonju, Korea
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267
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Tang J, Liu Z, Zhang Y, Wang L, Li D, Ding J, Jiang X. Fluorofenidone-loaded PLGA microspheres for targeted treatment of paraquat-induced acute lung injury in rats. RSC Adv 2015. [DOI: 10.1039/c5ra00656b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lung-targeting fluorofenidone (AKF) loaded PLGA microspheres (AKF-MS) for the treatment of paraquat (PQ)-induced acute lung injury in rats, were constructed by a solvent evaporation method.
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Affiliation(s)
- Jing Tang
- Key Laboratory of Drug Targeting and Drug Delivery System
- West China School of Pharmacy
- Sichuan University
- Chengdu 610041
- PR China
| | - Zhenbao Liu
- School of Pharmaceutical Sciences
- Central South University
- Changsha 410013
- PR China
| | - Yue Zhang
- School of Pharmaceutical Sciences
- Central South University
- Changsha 410013
- PR China
| | - Ling Wang
- Key Laboratory of Drug Targeting and Drug Delivery System
- West China School of Pharmacy
- Sichuan University
- Chengdu 610041
- PR China
| | - Dai Li
- Xiangya Hospital
- Central South University
- Changsha 410008
- PR China
| | - Jinsong Ding
- School of Pharmaceutical Sciences
- Central South University
- Changsha 410013
- PR China
| | - Xuehua Jiang
- Key Laboratory of Drug Targeting and Drug Delivery System
- West China School of Pharmacy
- Sichuan University
- Chengdu 610041
- PR China
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268
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Wang Z, Ma J, Zhang M, Wen C, Huang X, Sun F, Wang S, Hu L, Lin G, Wang X. Serum Metabolomics in Rats after Acute Paraquat Poisoning. Biol Pharm Bull 2015; 38:1049-53. [DOI: 10.1248/bpb.b15-00147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Zhiyi Wang
- The Second Affiliated Hospital & Yuying Children’s Hospital, Wenzhou Medical University
| | - Jianshe Ma
- Function Experiment Teaching Center, Wenzhou Medical University
| | - Meiling Zhang
- Analytical and Testing Center, Wenzhou Medical University
| | - Congcong Wen
- Analytical and Testing Center, Wenzhou Medical University
| | - Xueli Huang
- Analytical and Testing Center, Wenzhou Medical University
| | - Fa Sun
- Analytical and Testing Center, Wenzhou Medical University
| | - Shuanghu Wang
- The Laboratory of Clinical Pharmacy, People’s Hospital of Lishui City
| | - Lufeng Hu
- Department of Clinical Pharmacy, The First Affiliated Hospital of Wenzhou Medical University
| | - Guanyang Lin
- Department of Clinical Pharmacy, The First Affiliated Hospital of Wenzhou Medical University
| | - Xianqin Wang
- Analytical and Testing Center, Wenzhou Medical University
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269
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Tao Z, Gao J, Zhang G, Xue M, Yang W, Tong C, Yuan Y. Shufeng Jiedu Capsule protect against acute lung injury by suppressing the MAPK/NF-κB pathway. Biosci Trends 2014; 8:45-51. [PMID: 24647112 DOI: 10.5582/bst.8.45] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study sought to investigate the protective effect of an alternative medicine, Shufeng Jiedu Capsule, in acute lung injury and inflammation signaling pathways related to that action. Hematoxylin and eosin (HE) staining was used to observe pathological changes in rat lung tissue, arterial blood was subjected to blood gas analysis and lactic acid levels were determined, immunofluorescent staining for interleukin-1β (IL-1β) was performed, enzyme linked immunosorbent assay (ELISA) was used to detect biomarkers of the nuclear factor-κB (NF-κB) inflammation pathway including IL-1β and tumor necrosis factor α (TNF-α), biomarkers of the mitogen-activated protein kinase (MAPK) signal pathway including P-selectin, transforming growth factor β (TGF-β), keratinocyte-derived chemokine (KC), and C-Jun/AP-1 were measured, and real-time PCR was used to detect NF-κB mRNA. Results in rats with lipopolysaccharide-induced acute lung injury suggested that Shufeng Jiedu Capsule may increase the partial pressure of oxygen in lung tissue, decrease lactic acid levels, inhibit inflammatory factors such as IL-1β and TNF-α, and suppress the levels of P-selectin, TGF-β, KC, C-Jun/AP-1, and NF-κB mRNA. Thus, Shufeng Jiedu Capsule is a traditional medicine that may alleviate acute lung injury by suppressing the MAPK/NF-κB signaling pathway.
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Affiliation(s)
- Zhengang Tao
- Emergency Department, Zhongshan Hospital, Fudan University
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270
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Gao Y, Zhang X, Yang Y, Li W. Early haemoperfusion with continuous venovenous haemofiltration improves survival of acute paraquat-poisoned patients. J Int Med Res 2014; 43:26-32. [PMID: 25391306 DOI: 10.1177/0300060514549782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To determine whether haemoperfusion (HP) with continuous venovenous haemofiltration (CVVH) improves the survival of patients with acute paraquat poisoning, compared with those treated using HP alone. Methods Medical records of patients with acute paraquat poisoning were analysed. Patients were randomised to undergo HP or HP + CVVH within 24 h of paraquat ingestion. Mortality rate, survival duration and cause of death were recorded. Results There were no significant differences in mortality rate between the HP group ( n = 458) and the HP + CVVH group ( n = 226) (57.4% and 58.4%, respectively). The mean survival duration was significantly longer in the HP + CVVH group than the HP group (8.6 ± 3.1 and 5.1 ± 2.3 days, respectively). Early circulatory collapse was a major cause of death in the HP group. The major cause of death in the HP + CVVH group was late respiratory failure. Conclusion Combined therapy with HP and CVVH can prevent early death and prolong survival duration following acute paraquat poisoning, providing the opportunity for further treatment.
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Affiliation(s)
- Yanxia Gao
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaofan Zhang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanjie Yang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenlu Li
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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271
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Lin C, Yen TH, Juang YY, Lin JL, Lee SH. Psychiatric comorbidity and its impact on mortality in patients who attempted suicide by paraquat poisoning during 2000-2010. PLoS One 2014; 9:e112160. [PMID: 25386676 PMCID: PMC4227688 DOI: 10.1371/journal.pone.0112160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/13/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Paraquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated. METHODS We included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates. RESULTS The consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13-27.69; p < 0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure. CONCLUSIONS Awareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung branch, Keelung, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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272
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Mahat NA, Yin CL, Jayaprakash PT. Influence of paraquat on Chrysomya megacephala (Fabricius) (Diptera: Calliphoridae) infesting minced-beef substrates in Kelantan, Malaysia. J Forensic Sci 2014; 59:529-32. [PMID: 24745083 DOI: 10.1111/1556-4029.12355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study investigated the influence of paraquat, a prevalent poison used by suicides, on initial oviposition and development of Chrysomya megacephala (Fabricius) using minced-beef substrates. Paraquat in lethal dose for human (40 mg/kg), two times the lethal dose (80 mg/kg) and five times the lethal dose (200 mg/kg) were mixed thoroughly with respective minced-beef substrates (1 kg each) that were decomposed in a shaded habitat fully protected from rain. Results of four replications of the above experiment revealed that the presence of paraquat neither delayed initial oviposition nor prolonged the developmental stages of C. megacephala. Therefore, estimation of postmortem interval (PMI) based on empirical baseline data obtained using animal models devoid of any poisons would still be appropriate for estimating PMI in paraquat-related deaths.
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273
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Madhan B, Arunprasad G, Krishnan B. Paraquat tongue. BMJ Case Rep 2014; 2014:bcr-2014-206581. [PMID: 25336555 DOI: 10.1136/bcr-2014-206581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Balasubramanian Madhan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gnanasekaran Arunprasad
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balasubramanian Krishnan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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274
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Wen X, Gibson CJ, Yang I, Buckley B, Goedken MJ, Richardson JR, Aleksunes LM. MDR1 transporter protects against paraquat-induced toxicity in human and mouse proximal tubule cells. Toxicol Sci 2014; 141:475-83. [PMID: 25015657 PMCID: PMC4271045 DOI: 10.1093/toxsci/kfu141] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/01/2014] [Indexed: 12/12/2022] Open
Abstract
Paraquat is a herbicide that is highly toxic to the lungs and kidneys following acute exposures. Prior studies have demonstrated that the organic cation transporter 2 and multidrug and toxin extrusion protein 1 contribute to the urinary secretion of paraquat in the kidneys. The purpose of this study was to determine whether the multidrug resistance protein 1 (MDR1/Mdr1, ABCB1, or P-glycoprotein) also participates in the removal of paraquat from the kidneys and protects against renal injury. Paraquat transport and toxicity were quantified in human renal proximal tubule epithelial cells (RPTEC) that endogenously express MDR1, HEK293 cells overexpressing MDR1, and Mdr1a/1b knockout mice. In RPTEC cells, reduction of MDR1 activity using the antagonist PSC833 or siRNA transfection increased the cellular accumulation of paraquat by 50%. Reduced efflux of paraquat corresponded with enhanced cytotoxicity in PSC833-treated cells. Likewise, stable overexpression of the human MDR1 gene in HEK293 cells reduced intracellular levels of paraquat by 50%. In vivo studies assessed the renal accumulation and subsequent nephrotoxicity of paraquat (10 or 30 mg/kg ip) in wild-type and Mdr1a/1b knockout mice. At 4 h after paraquat treatment, renal concentrations of paraquat in the kidneys of Mdr1a/1b knockout mice were 750% higher than wild-type mice. By 72 h, paraquat-treated Mdr1a/1b knockout mice had more extensive tubular degeneration and significantly greater mRNA expression of kidney injury-responsive genes, including kidney injury molecule-1, lipocalin-2, and NAD(P)H quinone oxidoreductase 1, compared with wild-type mice. In conclusion, MDR1/Mdr1 participates in the elimination of paraquat from the kidneys and protects against subsequent toxicity.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B/deficiency
- ATP Binding Cassette Transporter, Subfamily B/genetics
- ATP Binding Cassette Transporter, Subfamily B/metabolism
- Animals
- Cyclosporins/pharmacology
- Disease Models, Animal
- Gene Expression Regulation/drug effects
- HEK293 Cells
- Herbicides/metabolism
- Humans
- Kidney Diseases/chemically induced
- Kidney Diseases/genetics
- Kidney Diseases/metabolism
- Kidney Diseases/pathology
- Kidney Diseases/prevention & control
- Kidney Tubules, Proximal/drug effects
- Kidney Tubules, Proximal/metabolism
- Kidney Tubules, Proximal/pathology
- Mice, Inbred C57BL
- Mice, Knockout
- Paraquat/metabolism
- RNA Interference
- RNA, Messenger/metabolism
- Renal Elimination/drug effects
- Time Factors
- Transfection
- ATP-Binding Cassette Sub-Family B Member 4
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Affiliation(s)
- Xia Wen
- Department of Pharmacology and Toxicology, Rutgers University Ernest Mario School of Pharmacy, Piscataway, New Jersey 08854
| | - Christopher J Gibson
- Department of Pharmacology and Toxicology, Rutgers University Ernest Mario School of Pharmacy, Piscataway, New Jersey 08854 Joint Graduate Program in Toxicology, Rutgers University, Piscataway, New Jersey 08854
| | - Ill Yang
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854
| | - Brian Buckley
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854
| | - Michael J Goedken
- Office of Translational Science, Rutgers University, Piscataway, New Jersey 08854
| | - Jason R Richardson
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854 Department of Environmental and Occupational Medicine, Rutgers University Robert Wood Johnson Medical School, Piscataway, New Jersey 08854
| | - Lauren M Aleksunes
- Department of Pharmacology and Toxicology, Rutgers University Ernest Mario School of Pharmacy, Piscataway, New Jersey 08854 Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854
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275
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Cherukuri H, Pramoda K, Rohini D, Thunga G, Vijaynarayana K, Sreedharan N, Varma M, Pandit V. Demographics, clinical characteristics and management of herbicide poisoning in tertiary care hospital. Toxicol Int 2014; 21:209-13. [PMID: 25253933 PMCID: PMC4170565 DOI: 10.4103/0971-6580.139813] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Herbicide poisoning is most common method of suicide in India and it is associated with high morbidity and mortality. Among different herbicidal poisonings the most predominantly found poisonings are paraquat and glyphosate. These compounds are highly toxic and their poisonings require proper management techniques. High fatality is seen in these cases which are mainly due to its inherent toxicity and lack of effective treatment. Common symptoms of these poisonings includes gastrointestinal corrosive effects with mouth and throat, epigastric pain and dysphagia, acid-base imbalance, pulmonary edema, shock and arrhythmia. Long term health effects include pulmonary fibrosis, renal failure, hepatic failure, heart failure, multi-organ failure or death. No proven antidote exists for these poisonings. So the treatment is mainly supportive. Initially gastric lavage or whole-gut irrigation using adsorbents such as Fuller's earth, bentonite or activated charcoal is recommended. In case of renal failure hemodialysis or hemoperfusion may be considered. However novel approaches like treatment with N-acetylcysteine, vitamin C, vitamin E, cyclophosphamide may also be helpful.
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Affiliation(s)
- Harika Cherukuri
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India
| | - K Pramoda
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India
| | - D Rohini
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India
| | - K Vijaynarayana
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India
| | - N Sreedharan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India
| | - Muralidhar Varma
- Department of Medicine, Kasturba Hospital, Manipal University, Manipal, Karnataka, India
| | - Vinay Pandit
- Department of Medicine, Kasturba Hospital, Manipal University, Manipal, Karnataka, India
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276
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Zou T, He P, Cao J, Li Z. Determination of Paraquat in Vegetables Using HPLC-MS-MS. J Chromatogr Sci 2014; 53:204-9. [DOI: 10.1093/chromsci/bmu041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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277
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Toygar M, Aydin I, Agilli M, Aydin FN, Oztosun M, Gul H, Macit E, Karslioglu Y, Topal T, Uysal B, Honca M. The relation between oxidative stress, inflammation, and neopterin in the paraquat-induced lung toxicity. Hum Exp Toxicol 2014; 34:198-204. [PMID: 24818613 DOI: 10.1177/0960327114533808] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Paraquat (PQ) is a well-known quaternary nitrogen herbicide. The major target organ in PQ poisoning is the lung. Reactive oxygen species (ROS) and inflammation play a crucial role in the development of PQ-induced pulmonary injury. Neopterin is synthesized in macrophage by interferon γ and other cytokines. We aimed to evaluate the utility of neopterin as a diagnostic marker in PQ-induced lung toxicity. Sprague Dawley rats were randomly divided into two groups (sham and PQ), administered intraperitoneally 1 mL saline and PQ (15 mg/kg/mL) respectively. Blood samples and lungs were collected for analyses. Lung injury and fibrosis were seen in the PQ group. Serum total antioxidant capacity, lactate dehydrogenase (LDH), and lung transforming growth factor-1β (TGF-1β) levels were significantly higher than the sham group (in all, p < 0.001). In addition, in the PQ group, serum neopterin and lung malondialdehyde (MDA) levels were also significantly higher than the sham group (in all, p = 0.001). Serum neopterin levels were correlated with LDH activities, lung MDA, lung TGF-1β levels, and the degree of lung injury. These findings demonstrated that oxidative stress, reduction of antioxidant capacity, and inflammation play a crucial role in the PQ-induced lung injury. Elevated serum neopterin levels may be a prognostic parameter to determine extends of PQ-induced lung toxicity. Further studies may be performed to clarify the role of neopterin by different doses of PQ.
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Affiliation(s)
- M Toygar
- Department of ForensicMedicine, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - I Aydin
- Department of Clinical Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey
| | - M Agilli
- Department of Clinical Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey
| | - F N Aydin
- Department of Clinical Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey
| | - M Oztosun
- Turkish Armed Forces, Health Services Command, Ankara, Turkey
| | - H Gul
- Department of Toxicology, Gulhane Military Medical Academy, Ankara, Turkey
| | - E Macit
- Department of Toxicology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Y Karslioglu
- Department of Pathology, Gulhane Military Medical Academy, Ankara, Turkey
| | - T Topal
- Department of Physiology, Gulhane Military Medical Academy, Ankara, Turkey
| | - B Uysal
- Department of Physiology, Gulhane Military Medical Academy, Ankara, Turkey
| | - M Honca
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
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278
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Amirshahrokhi K, Bohlooli S. Effect of methylsulfonylmethane on paraquat-induced acute lung and liver injury in mice. Inflammation 2014; 36:1111-21. [PMID: 23595869 DOI: 10.1007/s10753-013-9645-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Methylsulfonylmethane (MSM) is a natural organosulfur compound that exhibits antioxidative and anti-inflammatory effects. This study was carried out to investigate the effect of MSM on paraquat (PQ)-induced acute lung and liver injury in mice. A single dose of PQ (50 mg/kg, i.p.) induced acute lung and liver toxicity. Mice were treated with MSM (500 mg/kg/day, i.p.) for 5 days. At the end of the experiment, animals were euthanized, and lung and liver tissues were collected for histological and biochemical analysis. Tissue samples were used to determine malondialdehyde (MDA), myeloperoxidase (MPO), catalase (CAT), superoxide dismutase (SOD), glutathione (GSH), and tumor necrosis factor-α (TNF-α) levels. Blood samples were used to measure plasma alanine transaminase (ALT), γ-glutamyl transferase (GGT), and alkaline phosphatase (ALP). Histological examination indicated that MSM decreased lung and liver damage caused by PQ. Biochemical results showed that MSM treatment significantly reduced tissue levels of MDA, MPO, and TNF-α, while increased the levels of SOD, CAT, and GSH compared with PQ group. MSM treatment also significantly reduced plasma levels of ALT, GGT, and ALP. These findings suggest that MSM as a natural product attenuates PQ-induced pulmonary and hepatic oxidative injury.
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Affiliation(s)
- Keyvan Amirshahrokhi
- Department of Pharmacology, School of Medicine, Ardabil University of Medical Sciences, P.O. Box 5618953141, Ardabil, Iran,
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279
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Chowdhary S, Bhattacharyya R, Banerjee D. Acute organophosphorus poisoning. Clin Chim Acta 2014; 431:66-76. [DOI: 10.1016/j.cca.2014.01.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/15/2014] [Accepted: 01/18/2014] [Indexed: 11/25/2022]
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280
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Zhang N, Xie YP, Pang L, Zang XX, Wang J, Shi D, Wu Y, Liu XL, Wang GH. Paraquat increases connective tissue growth factor expression and impairs lung fibroblast proliferation and viscoelasticity. Hum Exp Toxicol 2014; 33:1232-40. [PMID: 24556028 DOI: 10.1177/0960327114524239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This in vitro study was designed to investigate the molecular mechanisms of paraquat-induced damage using cultured human fetal lung fibroblasts (MRC-5 cells), in order to promote the development of improved therapies for paraquat poisoning. Paraquat’s effects on proliferation were examined by flow cytometry, on viscoelasticity by the micropipette aspiration technique, and on connective tissue growth factor (CTGF) expression by real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Paraquat was found to significantly reduce the proliferation index of MRC-5 cells in a concentration-dependent manner ( p < 0.05) and to significantly impair the viscoelastic properties in a time-independent manner ( p < 0.05). Exposure to paraquat led to a significant and time-dependent increase in CTGF expression ( p < 0.05) and induced changes in the morphology and biomechanical characteristics of the MRC-5 cells. These findings not only provide novel insights into the mechanisms of paraquat-induced lung fibrosis but may represent useful targets of improved molecular-based therapies for paraquat poisoning.
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Affiliation(s)
- N Zhang
- Department of Emergency Medicine, The First Hospital of Jilin University, China
| | - Y-P Xie
- Department of Emergency Medicine, Lianyungang Hospital Affiliated to Xuzhou Medical College, China
| | - L Pang
- Department of Emergency Medicine, The First Hospital of Jilin University, China
| | - X-X Zang
- Department of Emergency Medicine, The First Hospital of Jilin University, China
| | - J Wang
- Department of Gastrointestinal Medicine, The First Hospital of Jilin University, China
| | - D Shi
- Department of Emergency Medicine, Jilin Traditional Chinese Medical College, China
| | - Y Wu
- Department of Emergency Medicine, The First Hospital of Jilin University, China
| | - X-L Liu
- Department of Emergency Medicine, The First Hospital of Jilin University, China
| | - G-H Wang
- Pharmacy and Biological Science College, Weifang Medical University, China
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281
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282
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Sun S, Li F, Liu F, Wang J, Peng X. Fluorescence detecting of paraquat using host-guest chemistry with cucurbit[8]uril. Sci Rep 2014; 4:3570. [PMID: 24389647 PMCID: PMC3880963 DOI: 10.1038/srep03570] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/25/2013] [Indexed: 01/04/2023] Open
Abstract
Paraquat (PQ) is one of the most widely used herbicides in the world, which has a good occupational safety record when used properly. While, it presents high mortality index after intentional exposure. Accidental deaths and suicides from PQ ingestion are relatively common in developing countries with an estimated 300,000 deaths occurring in the Asia–Pacific region alone each year, and there are no specific antidotes. Good predictors of outcome and prognosis may be plasma and urine testing within the first 24 h of intoxication. A fluorescence enhancement of approximately 30 times was seen following addition of PQ to a solution of the supramolecular compound 2MB@CB[8], which comprised two methylene blue (MB) molecules within one cucurbit[8]uril (CB[8]) host molecule. The fluorescence intensity was linearly proportional to the amount of PQ added over the concentration range 2.4 × 10−10 M–2.5 × 10−4 M. The reaction also occurred in living cells and within live mice.
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Affiliation(s)
- Shiguo Sun
- 1] State Key Laboratory of Fine Chemicals, Dalian University of Technology, E 224 West Campus, No. 2, Linggonglu, 116024, Dalian, China [2]
| | - Fusheng Li
- 1] State Key Laboratory of Fine Chemicals, Dalian University of Technology, E 224 West Campus, No. 2, Linggonglu, 116024, Dalian, China [2]
| | - Fengyu Liu
- 1] School of Chemistry, Dalian University of Technology, No. 2, Linggonglu, 116024, Dalian, China [2]
| | - Jitao Wang
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, E 224 West Campus, No. 2, Linggonglu, 116024, Dalian, China
| | - Xiaojun Peng
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, E 224 West Campus, No. 2, Linggonglu, 116024, Dalian, China
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283
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Baltazar MT, Dinis-Oliveira RJ, Bastos MDL, Duarte JA, Carvalho F. Lysine acetylsalicylate improves the safety of paraquat formulation in rats by increasing its elimination and preventing lung and kidney injury. Toxicol Res (Camb) 2014; 3:266. [DOI: 10.1039/c3tx50102g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
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284
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Kervégant M, Merigot L, Glaizal M, Schmitt C, Tichadou L, de Haro L. Paraquat poisonings in France during the European ban: experience of the Poison Control Center in Marseille. J Med Toxicol 2013; 9:144-7. [PMID: 23435962 DOI: 10.1007/s13181-012-0283-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Paraquat, a widely used herbicide in the world, has caused severe and fatal poisonings. Because of its high toxicity, the European Union withdrew paraquat from its market in July 2007. The purpose of this report is to describe cases of paraquat poisoning recorded at the Poison Control Center in Marseille over the 9-year period starting and ending 4.5 years before and after the paraquat ban. Data analysis showed that the most severe exposures were linked to ingestion. The fatality rate of deliberate consumption was near 50 % (34 suicide attempts and 15 deaths). Our data showed a marginal decline in total number of poisonings observed after the paraquat ban (38 vs 33 after the ban) mostly due to a decrease in the number of unintentional exposure (21 vs 16 after the ban). However, there was no apparent change in the number suicidal attempts using paraquat. Regarding geographical distribution, data showed that most poisonings in mainland France were unintentional, while poisonings in overseas French territories were mostly voluntary. Despite the European ban and the preventive measures, paraquat continues to contribute to severe and life-threatening poisonings in Southeastern and overseas France.
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Affiliation(s)
- Morgane Kervégant
- Poison Control Center, Hospital Sainte Marguerite, 270 Boulevard Sainte Marguerite, 13009, Marseille, France
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285
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Wang Z, Ge Y, Bao H, Dworkin L, Peng A, Gong R. Redox-sensitive glycogen synthase kinase 3β-directed control of mitochondrial permeability transition: rheostatic regulation of acute kidney injury. Free Radic Biol Med 2013; 65:849-858. [PMID: 23973862 PMCID: PMC3859848 DOI: 10.1016/j.freeradbiomed.2013.08.169] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 07/31/2013] [Accepted: 08/16/2013] [Indexed: 01/29/2023]
Abstract
Mitochondrial dysfunction plays a pivotal role in necroapoptotic cell death and in the development of acute kidney injury (AKI). Evidence suggests that glycogen synthase kinase (GSK) 3β resides at the nexus of multiple signaling pathways implicated in the regulation of mitochondrial permeability transition (MPT). In cultured renal tubular epithelial cells, a discrete pool of GSK3β was detected in mitochondria. Coimmunoprecipitation assay confirmed that GSK3β physically interacts with cyclophilin F and voltage-dependent anion channel (VDAC), key MPT regulators that possess multiple GSK3β phosphorylation consensus motifs, suggesting that GSK3β has a direct control of MPT. Upon a strong burst of reactive oxygen species elicited by the pro-oxidant herbicide paraquat, the activity of the redox-sensitive GSK3β was drastically enhanced. This was accompanied by augmented phosphorylation of cyclophilin F and VDAC, associated with MPT and cell death. Inhibition of GSK3β by either the selective inhibitor 4-Benzyl-2-methyl-1,2,4-thiadiazolidine-3,5-dione (TDZD-8) or forced expression of a kinase-dead mutant obliterated paraquat-induced phosphorylation of cyclophilin F and VDAC, prevented MPT, and improved cellular viability. Conversely, ectopic expression of a constitutively active GSK3β amplified the effect of paraquat on cyclophilin F and VDAC phosphorylation and sensitized cells to paraquat-induced MPT and death. In vivo, paraquat injection elicited marked oxidant stress in the kidney and resulted in acute kidney dysfunction and massive tubular apoptosis and necrosis. Consistent with in vitro findings, the activity of GSK3β was augmented in the kidney after paraquat injury, associated with increased phosphorylation of cyclophilin F and VDAC and sensitized MPT. TDZD-8 blocked GSK3β activity in the kidney, intercepted cyclophilin F and VDAC phosphorylation, prevented MPT, attenuated tubular cell death, and ameliorated paraquat-induced AKI. Our data suggest that the redox-sensitive GSK3β regulates renal tubular injury in AKI by controlling the activity of MPT regulators.
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Affiliation(s)
- Zhen Wang
- Department of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China; Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, RI 02903, USA
| | - Yan Ge
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, RI 02903, USA
| | - Hui Bao
- Department of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China; Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, RI 02903, USA
| | - Lance Dworkin
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, RI 02903, USA
| | - Ai Peng
- Department of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Rujun Gong
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, RI 02903, USA.
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286
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Nagami H, Maejima F, Nishigaki Y, Natsukawa S. Trends in paraquat poisoning in Japan - viewed from surveys on clinical cases. J Rural Med 2013; 8:228-32. [PMID: 25648748 PMCID: PMC4309333 DOI: 10.2185/jrm.2873] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/28/2013] [Indexed: 11/27/2022] Open
Abstract
Objective: Paraquat poisoning occurs worldwide, and both the fatality rate
and the number of deaths are out of the ordinary. Japan is one of the few countries in the
world that have replaced 24% products with 5% products. This report is an attempt to
introduce information about paraquat poisoning in Japan. Methods: The Japanese Association of Rural Medicine has carried out
extensive surveys on clinical cases of pesticide poisoning at its 122 member installations
since 2007. Of all the findings, we have picked out and evaluated those concerned with
paraquat poisoning. Findings: Twenty-two out of 28 persons who attempted to commit suicide with
paraquat died in 2007–2011. The rate of deaths from suicide attempts with paraquat stands
at somewhere near 80% or so even with 5% products, so it appears that the attempts to
reduce the death rate did not have the intended effect even with products having a lower
concentration. Conclusion: The “outcome prediction line” propounded in 1979 still stands
today, while a wide variety of therapies have been studied. It seems that paraquat should
at least be classified into Class Ib (highly hazardous) given that the mortality remains
high and efficacious therapies remain elusive.
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Affiliation(s)
| | - Fumio Maejima
- Division of Health Care, Saku Central Hospital, Japan
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287
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Jang HN, Bae EJ, Hwang K, Kang Y, Yun S, Cho HS, Chang SH, Park DJ. Hemolytic uremic syndrome associated with paraquat intoxication. J Clin Apher 2013; 29:183-6. [PMID: 24989018 DOI: 10.1002/jca.21310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 10/29/2013] [Accepted: 11/07/2013] [Indexed: 11/08/2022]
Abstract
We report a case of a 66-year-old patient with paraquat intoxication resulting in the requirement for hemoperfusion, hemodialysis, and plasma exchange. His initial serum paraquat level was 0.24 µg/mL (0.0-0.1 µg/mL). Activated charcoal (50 g) was administered orally, and high-dose N-acetylcysteine (150 mg/kg) was administered intravenously. In addition, immediate 4 h hemoperfusion was also performed for three consecutive days after admission. Hemodialysis was started on the 4th day after admission because of uremia. On the 9th day after admission, laboratory findings demonstrated hemolytic uremic syndrome (HUS): microangiopathic hemolytic anemia (MAHA), thrombocytopenia, elevated reticulocyte count, and lactate dehydrogenase (LDH). Plasma exchange was performed three times consecutively. Anemia and thrombocytopenia were improved, and LDH was normalized after plasma exchange. Urine output increased to 2240 mL/day on the 18th day after admission, and hemodialysis was discontinued. He is currently being observed at our follow-up clinic without renal impairment or pulmonary dysfunction for 1.5 years since discharge. We should suspect paraquat-associated HUS when thrombocytopenia and anemia are maintained for a long time after paraquat intoxication.
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Affiliation(s)
- Ha Nee Jang
- Department of Internal Medicine, School of Medicine Gyeongsang University, Jinju, South Korea
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288
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Anti-inflammatory effect of thalidomide in paraquat-induced pulmonary injury in mice. Int Immunopharmacol 2013; 17:210-5. [DOI: 10.1016/j.intimp.2013.06.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/23/2013] [Accepted: 06/03/2013] [Indexed: 11/22/2022]
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289
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Bertram A, Haenel SS, Hadem J, Hoeper MM, Gottlieb J, Warnecke G, Kaschinski S, Hafer C, Kühn-Velten WN, Günther D, Kielstein JT. Tissue concentration of paraquat on day 32 after intoxication and failed bridge to transplantation by extracorporeal membrane oxygenation therapy. BMC Pharmacol Toxicol 2013; 14:45. [PMID: 24010554 PMCID: PMC3847611 DOI: 10.1186/2050-6511-14-45] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/15/2013] [Indexed: 12/18/2022] Open
Abstract
Background Paraquat is a highly toxic herbicide, which not only leads to acute organ damage, but also to pulmonary fibrosis. There are only anecdotal reports of rescue lung transplantation, as paraquat is stored and only slowly released from different tissues. Bridging the time to complete depletion of paraquat from the body could render this exceptional therapy strategy possible, but not much is known on the time interval after which transplantation can safely be performed. Case presentation We report on a case of accidental paraquat poisoning in a 23 years old Caucasian man, who developed respiratory failure due to pulmonary fibrosis. The patient was listed for high urgency lung transplantion, and extracorporeal membrane oxygenation was implemented to bridge the time to transplantation. The patient died 32 days after paraquat ingestion, before a suitable donor organ was found. In postmortem tissue specimen, no paraquat was detectable anymore. Conclusion This case report indicates that complete elimination of paraquat after oral ingestion of a lethal dose is achievable. The determined time frame for this complete elimination might be relevant for patients, in which lung transplantation is considered.
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Affiliation(s)
- Anna Bertram
- Department of Nephrology, Hannover Medical School, Carl Neuberg Street 1, Hannover 30625, Germany.
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290
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de Lorenzo-Pinto A, García Sánchez R, Lobato Matilla E, Herranz Alonso A. La tierra de Fuller, «desterrada» en las intoxicaciones por herbicidas. Med Clin (Barc) 2013; 141:231. [DOI: 10.1016/j.medcli.2013.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 01/24/2013] [Indexed: 11/16/2022]
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291
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Tsai HL, Chang JW, Yang HW, Chen CW, Yang CC, Yang AH, Liu CS, Chin TW, Wei CF, Lee OK. Amelioration of Paraquat-Induced Pulmonary Injury by Mesenchymal Stem Cells. Cell Transplant 2013; 22:1667-81. [DOI: 10.3727/096368912x657765] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Acute paraquat (PQ) poisoning induces redox cycle and leads to fatal injury of lung. Clinical management is supportive in nature due to lack of effective antidote, and the mortality is very high. Mesenchymal stem cells (MSCs) process the properties of immunomodulation, anti-inflammatory, and antifibrotic effects and oxidative stress resistance. MSC transplantation may theoretically serve as an antidote in PQ intoxication. In this study, we examined the potential therapeutic effects of MSCs in PQ-induced lung injury. The degree of PQ toxicity in the rat type II pneumocyte cell line, L2, and MSCs was evaluated by examining cell viability, ultrastructural changes, and gene expression. L2 cells treated with 0.5 mM PQ were cocultured in the absence or presence of MSCs. For the in vivo study, adult male SD rats were administered an intraperitoneal injection of PQ (24 mg/kg body weight) and were divided into three groups: group I, control; group II, cyclophosphamide and methylprednisolone; group III, MSC transplantation 6 h after PQ exposure. MSCs were relatively resistant to PQ toxicity. Coculture with MSCs significantly inhibited PQ accumulation in L2 cells and upregulated the expression of antioxidative heme oxygenase 1 and metallothionein 1a genes, reversed epithelial-to-mesenchymal transition, and increased the viability of PQ-exposed L2 cells. Treatment with MSCs resulted in a significant reduction in severity of liver and renal function deterioration, alleviated lung injury, and prolonged the life span of rats. Altogether, our results suggest that MSCs possess antidote-like effect through multifactorial protection mechanism. The results of this preclinical study demonstrate that transplantation of MSCs may be a promising therapy and should be further validated clinically.
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Affiliation(s)
- Hsin-Lin Tsai
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jei-Wen Chang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Wen Yang
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chang-Wei Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Chang Yang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An-Hang Yang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Ultrastructural and Molecular Pathology, Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Su Liu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tai-Wai Chin
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chou-Fu Wei
- Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Oscar K. Lee
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan
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292
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Wunnapuk K, Liu X, Peake P, Gobe G, Endre Z, Grice JE, Roberts MS, Buckley NA. Renal biomarkers predict nephrotoxicity after paraquat. Toxicol Lett 2013; 222:280-8. [PMID: 23954200 DOI: 10.1016/j.toxlet.2013.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/31/2013] [Accepted: 08/06/2013] [Indexed: 12/11/2022]
Abstract
Paraquat is a widely used herbicide which has been involved in many accidental and intentional deaths. Nephrotoxicity is common in severe acute paraquat poisoning. We examined seven renal injury biomarkers, including cystatin-C, kidney injury molecule-1, β2-microglobulin, clusterin, albumin, neutrophil gelatinase-associated lipocalin and osteopontin, to develop a non-invasive method to detect early renal damage and dysfunction and to compare with the conventional endogenous marker creatinine. Male Wistar rats were dosed orally with four different doses of paraquat, and the biomarker patterns in urine and plasma were investigated at 8, 24 and 48h after paraquat exposure. By Receiver Operating Characteristic analysis, urinary kidney injury molecule-1 was the best marker at predicting histological changes, with areas under the Receiver Operating Characteristic curve of 0.81 and 0.98 at 8 and 24h (best cut-off value>0.000326μg/ml), respectively. Urinary kidney injury molecule-1, urinary albumin and urinary Cystatin-C elevations correlated with the degree of renal damage and injury development. Further study is required to compare biomarkers changes in rats with those seen in human poisoning.
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Affiliation(s)
- Klintean Wunnapuk
- Therapeutics Research Centre, School of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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293
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Abstract
BACKGROUND At present, there is a lack of effective treatments for paraquat poisoning. Xuebijing injection is a complex traditional Chinese prescription consisting of Flos Carthami, Radix Paeoniae Rubra, Rhizoma Chuanxiong, Radix Salviae Miltiorrhizae and Radix Angelicae Sinensis. Although clinical experience suggests that Xuebijing injection might have potential in the management of paraquat poisoning, there is no conclusion on the effectiveness of this treatment. OBJECTIVES To assess the effects of Xuebijing injection in patients with paraquat poisoning. SEARCH METHODS We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EBSCO), ISI Web of Science: Science Citation Index Expanded, ISI Web of Science: Conference Proceedings Citation Index-Science, Chinese bio-medical literature and retrieval system (CBM), China National Knowledge Infrastructure Database (CNKI), and the Traditional Chinese Medicine Database. The search was run on the 29th May 2013. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing Xuebijing injection combined with conventional care against conventional care alone. DATA COLLECTION AND ANALYSIS Two or three authors independently selected studies, assessed study quality and extracted data. We calculated the mortality risk ratio (RR) and 95% confidence interval (CI). Data on all-cause mortality at the end of follow-up were summarised in a meta-analysis. MAIN RESULTS We identified two trials including 84 people. Although there were fewer deaths in people treated with Xuebijing injection, meta-analysis showed that it did not provide a statistically significant benefit in reducing all-cause mortality in people with paraquat poisoning as compared to control (RR 0.71; 95% CI 0.48 to 1.04; P = 0.08). AUTHORS' CONCLUSIONS Based on the findings of two small RCTs, Xuebijing injection did not have a statistically significant benefit on reducing all-cause mortality in people with paraquat poisoning. However, both included studies involved small numbers of participants and were considered to be of poor methodological quality. The results are imprecise and easily compatible with the play of chance. Xuebijing injection may be effective for people with paraquat poisoning; however, this needs to be proven by further high-quality evidence.
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Affiliation(s)
- Jin Deng
- Department of Nephrology, The First Affiliated Hospital of Nanhua University, Hengyang, China
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294
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Sun IO, Lee KY. Cyclophosphamide dose: how much is needed to win the war against paraquat poisoning? Korean J Intern Med 2013; 28:410-2. [PMID: 23864798 PMCID: PMC3712148 DOI: 10.3904/kjim.2013.28.4.410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/09/2013] [Indexed: 01/20/2023] Open
Affiliation(s)
- In O Sun
- Division of Nephrology and Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Kwang Young Lee
- Division of Nephrology and Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
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295
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Okumura T, Seto Y, Fuse A. Countermeasures against chemical terrorism in Japan. Forensic Sci Int 2013; 227:2-6. [DOI: 10.1016/j.forsciint.2012.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/03/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
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296
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Fahim MA, Shehab S, Nemmar A, Adem A, Dhanasekaran S, Hasan MY. Daily subacute paraquat exposure decreases muscle function and substantia nigra dopamine level. Physiol Res 2013; 62:313-21. [PMID: 23489189 DOI: 10.33549/physiolres.932386] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The use of the herbicide paraquat (1,1'-dimethyl-4,4'-bipyridylium dichloride; PQ) which is widely used in agriculture is known to cause dopaminergic neurotoxicity. However, the mechanisms underlying this effect are not fully understood. This present study investigated the behavioral manifestations, motor coordination, and dopaminergic neurodegeneration following exposure to PQ. Male rats were injected with PQ (10 mg/kg i.p.) daily for three weeks. Rotarod systems were used for measuring locomotor activity and motor coordination. The effects of PQ on dorsiflexor, electrophysiologically-induced muscle contraction were studied. Dopamine concentrations in the ventral mesencephalon were measured by high performance liquid chromatography and the number of dopaminergic neurons in substantia nigra pars compacta was estimated by tyrosine hydroxylase immunohistochemistry. PQ induced difficulty in movement and significant reduction in motor activity and twitch tension at the dorsiflexor skeletal muscle. The number of tyrosine hydroxylase positive neurons was significantly less in the substantia nigra pars compacta and nigral dopamine level was significantly reduced in PQ treated animals (20.4+/-3.4 pg/mg) when compared with control animals (55.0+/-2.4 pg/mg wet tissue). Daily treatment of PQ for three weeks induces selective dopaminergic neuronal loss in the substantia nigra and significant behavioral and peripheral motor deficit effects.
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Affiliation(s)
- M A Fahim
- Faculty of Medicine, UAE University, Al Ain, United Arab Emirates.
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297
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Liu HL, Chen WL, Yang MC, Lin HM, Chou CC, Chang CF, Lin TJ, Liu KT, Lin YR. Prediction of early mortality in patients with paraquat intoxication. J Acute Med 2013. [DOI: 10.1016/j.jacme.2013.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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298
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Wu B, Song B, Yang H, Huang B, Chi B, Guo Y, Liu H. Central nervous system damage due to acute paraquat poisoning: An experimental study with rat model. Neurotoxicology 2013; 35:62-70. [DOI: 10.1016/j.neuro.2012.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 12/08/2012] [Accepted: 12/08/2012] [Indexed: 12/17/2022]
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299
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Chien WC, Chung CH, Jaakkola JJK, Chu CM, Kao S, Su SL, Lai CH. Risk and prognostic factors of inpatient mortality associated with unintentional insecticide and herbicide poisonings: a retrospective cohort study. PLoS One 2012; 7:e45627. [PMID: 23029146 PMCID: PMC3448651 DOI: 10.1371/journal.pone.0045627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/21/2012] [Indexed: 11/28/2022] Open
Abstract
Introduction Pesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings. Methods We performed a retrospective cohort study of 3,986 inpatients recruited at hospitalization between 1999 and 2008 in Taiwan. We used the International Classification of Disease, 9th ed., Clinical Modification external causes of injury codes to classify poisoning agents into accidental poisoning by insecticides and herbicides. Comparisons in mortality rates were made between insecticide poisoning patients and herbicide poisoning patients by using the Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs). Results There were 168 deaths during 21,583 person-days of follow-up evaluation (7.8 per 1,000 person-days). The major causes of mortality for insecticide poisonings were the toxic effect of organophosphate and coma, and the major causes of mortality for herbicide poisonings were the toxic effect of other pesticides and the toxic effect of organophosphate. The mortality for herbicide exposure was fourfold higher than that for insecticide exposure. The factors associated with inpatient mortality were herbicide poisonings (HR = 4.58, 95% CI 3.29 to 6.37) and receiving mechanical ventilation treatment (HR = 3.85, 95% CI 2.73 to 5.42). Conclusions We demonstrated that herbicides stand out as the dominant agent for poisoning-related fatalities. The control of and limiting access to herbicide agents and developing appropriate therapeutic regimens, including emergency care, should be priorities.
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Affiliation(s)
- Wu-Chien Chien
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Jouni J. K. Jaakkola
- Center for Environmental and Respiratory Health Research, Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Chi-Ming Chu
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Senyeong Kao
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Sui-Lung Su
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
| | - Ching-Huang Lai
- Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China
- * E-mail:
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300
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Kim YS, Jung H, Gil HW, Hong SY, Song HY. Proteomic analysis of changes in protein expression in serum from animals exposed to paraquat. Int J Mol Med 2012; 30:1521-7. [PMID: 23023206 DOI: 10.3892/ijmm.2012.1143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/13/2012] [Indexed: 11/06/2022] Open
Abstract
Paraquat (PQ) poisoning remains a major public health concern in many countries. Extensive research has focused on finding early diagnostic biomarkers of acute PQ poisoning. In order to investigate the characterization of diagnostic biomarkers in PQ poisoning, we utilized proteomic analysis using serum from rats exposed to PQ, and we identified 8 differentially expressed proteins from over 500 protein spots. The expression of apolipoprotein E (ApoE), preprohaptoglobin (Pphg), a precursor of haptoglobin (Hp), and complement component 3 (C3) proteins was greatly induced by PQ exposure while the expression of fibrinogen γ-chain (FGG) and Ac-158 was dramatically reduced. To further investigate the possibility of ApoE, Pphg and FGG as useful diagnostic biomarkers of PQ poisoning, western blot and qRT-PCR analyses were conducted using cell lines as well as rat and human sera. The expression levels of ApoE, Hp and FGG were significantly altered in the presence of PQ in both rat and human serum suggesting that these proteins may be appropriate candidate molecular biomarkers for the early diagnosis of acute PQ intoxication.
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Affiliation(s)
- Yong-Sik Kim
- Department of Microbiology, College of Medicine, Soon Chun Hyang University, Cheonan, Chungnam 330-090, Republic of Korea
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