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Chen Q, Wang Y, Sheng L, Huang Y. Metformin suppresses proliferation and differentiation induced by BMP9 via AMPK signaling in human fetal lung fibroblast-1. Front Pharmacol 2022; 13:984730. [PMID: 36091775 PMCID: PMC9448853 DOI: 10.3389/fphar.2022.984730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Adenosine monophosphosphate-activated protein kinase (AMPK) and its activator metformin were found to be involved in the regulation of fibroblast activation and pulmonary fibrosis. However, the regulatory mechanism has been undetermined. Recently, AMPK has been reported to exert its effect through inhibiting bone morphogenetic protein (BMP) pathway. In this study, human fetal lung fibroblast (HFL-1) cells were treated with metformin or specific AMPKα1 mutants, including constitutively activated mutant (AMPK-CA) and dominant negative mutant (AMPK-DN), combined with BMP9, and then the absorbance of these cells was measured by cell counting kit (CCK)-8 assay. The colony number of HFL-1 cells stimulated by metformin with or without BMP9 was examined by colony formation assay. The protein expressions of differentiated markers (α-smooth muscle actin, collagen I and collagen III) and the key molecules of BMP9 signaling, including activin receptor-like kinase (ALK) one and phosphorylated small mother against decapentaplegic (p-Smad)1/5, were also evaluated by western blot. Data revealed that BMP9 induced the proliferation and differentiation of HFL-1 cells which was suppressed by metformin or AMPK-CA. Meanwhile, the effect of metformin on BMP9-induced activation was counteracted by AMPK-DN. In addition, we found that the expressions of ALK1 and p-Smad1/5 induced by BMP9 were attenuated by metformin and AMPK-CA, whereas the inhibitory responses of metformin to the increased ALK1 and p-Smad1/5 were reduced by AMPK-DN. Accordingly, these results suggested that metformin mitigated BMP9-induced proliferation and differentiation of HFL-1 cells, which was achieved partly through the activation of AMPK and inhibition of ALK1/Smad1/5 signaling.
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Affiliation(s)
- Qiongfeng Chen
- Department of Pathophysiology, Basic Medical College of Nanchang University, Nanchang, China
- Department of Pathology, Basic Medical College of Nanchang University, Nanchang, China
| | - Yaqun Wang
- Department of Pathophysiology, Basic Medical College of Nanchang University, Nanchang, China
| | - Linna Sheng
- Department of Pathophysiology, Basic Medical College of Nanchang University, Nanchang, China
| | - Yonghong Huang
- Department of Pathophysiology, Basic Medical College of Nanchang University, Nanchang, China
- *Correspondence: Yonghong Huang,
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Zhang Y, Yuan D, Li Y, Yang F, Hou L, Yu Y, Sun C, Duan G, Meng C, Yan H, Li D, Gao Y, Sun T, Zhu C. Paraquat promotes acute lung injury in rats by regulating alveolar macrophage polarization through glycolysis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 223:112571. [PMID: 34352584 DOI: 10.1016/j.ecoenv.2021.112571] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 05/02/2023]
Abstract
The present study investigates whether paraquat (PQ) regulates polarization of alveolar macrophages through glycolysis and promotes the occurrence of acute lung injury in rats. In vivo, the PQ intraperitoneal injection was used to construct a model of acute lung injury in rats. In vitro, the study measured the effect of different concentrations of PQ on the viability of the alveolar macrophages, and explored the polarization and glycolysis metabolism of alveolar macrophages at different time points after PQ intervention. Compared with the normal control (NC) group, the lung pathological damage in rats increased gradually after PQ poisoning, reaching a significant degree at 48 h after poisoning. The PQ-poisoned rat serum showed increased expressions of interleukin-6 (IL-6), tumor necrosis factor- α (TNF-α), and M1 macrophage marker, iNOS, while the expression of interleukin-10 (IL-10) and M2 macrophage marker, Arg1, decreased. The toxic effect of PQ on alveolar macrophages was dose- and time-dependent. Compared with the NC group, IL-6 and TNF-α in the cell supernatant gradually increased after PQ intervention, while the IL-10 content gradually decreased. The PQ intervention in alveolar macrophages increased the expression of intracellular glycolysis rate-limiting enzyme pyruvate kinase isozymes M1/M2 (PKM1/M2), lactate, lactate/pyruvate ratio, and the polarization of alveolar macrophage towards M1. Inhibition of cellular glycolysis significantly reduced the PQ-induced alveolar macrophage polarization to M1 type. Thus, PQ induced increased polarization of lung macrophages toward M1 and decreased polarization toward M2, promoting acute lung injury. Therefore, it can be concluded that PQ regulates the polarization of alveolar macrophages through glycolysis.
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Affiliation(s)
- Yan Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Ding Yuan
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Yi Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fang Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Linlin Hou
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Yanwu Yu
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Changhua Sun
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Guoyu Duan
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Cuicui Meng
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Hongyi Yan
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Dongxu Li
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China
| | - Yanxia Gao
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China.
| | - Tongwen Sun
- General ICU, the First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou 450052, China.
| | - Changju Zhu
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450000, China.
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Anthrahydroquinone-2-6-disulfonate is a novel, powerful antidote for paraquat poisoning. Sci Rep 2021; 11:20159. [PMID: 34635711 PMCID: PMC8505516 DOI: 10.1038/s41598-021-99591-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
Paraquat (PQ) is a widely used fast-acting pyridine herbicide. Accidental ingestion or self-administration via various routes can cause severe organ damage. Currently, no effective antidote is available commercially, and the mortality rate of poisoned patients is exceptionally high. Here, the efficacy of anthrahydroquinone-2-6-disulfonate (AH2QDS) was observed in treating PQ poisoning by constructing in vivo and ex vivo models. We then explored the detoxification mechanism of AH2QDS. We demonstrated that, in a rat model, the PQ concentration in the PQ + AH2QDS group significantly decreased compared to the PQ only group. Additionally, AH2QDS protected the mitochondria of rats and A549 cells and decreased oxidative stress damage, thus improving animal survival and cell viability. Finally, the differentially expressed genes were analysed in the PQ + AH2QDS group and the PQ group by NextGen sequencing, and we verified that Nrf2's expression in the PQ + AH2QDS group was significantly higher than that in the PQ group. Our work identified that AH2QDS can detoxify PQ by reducing PQ uptake and protecting mitochondria while enhancing the body's antioxidant activity.
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Li LR, Chaudhary B, You C, Dennis JA, Wakeford H. Glucocorticoid with cyclophosphamide for oral paraquat poisoning. Cochrane Database Syst Rev 2021; 6:CD008084. [PMID: 34190331 PMCID: PMC8243635 DOI: 10.1002/14651858.cd008084.pub5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This an update of a Cochrane Review. Paraquat is a widely used herbicide, but is also a lethal poison. In some low- and middle-income countries (LMICs) paraquat is commonly available and inexpensive, making poisoning prevention difficult. Most of the people poisoned by paraquat have taken it as a means of self-poisoning. Standard treatment for paraquat poisoning prevents further absorption and reduces the load of paraquat in the blood through haemoperfusion or haemodialysis. The effectiveness of standard treatments is extremely limited. The immune system plays an important role in exacerbating paraquat-induced lung fibrosis. Immunosuppressive treatment using glucocorticoid and cyclophosphamide in combination has been developed and studied as an intervention for paraquat poisoning. OBJECTIVES To assess the effects of glucocorticoid with cyclophosphamide for moderate to severe oral paraquat poisoning. SEARCH METHODS The most recent searches were run in September 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Injuries Trials Register), Ovid MEDLINE(R), Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid OLDMEDLINE, Embase Classic + Embase (Ovid), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S, and CPSI-SSH), and trials registries. We also searched the following three resources: China National Knowledge Infrastructure database (CNKI ); Wanfang Data (); and VIP () on 12 November 2020. We examined the reference lists of included studies and review papers. SELECTION CRITERIA We included randomised controlled trials (RCTs). For this update, in accordance with Cochrane Injuries' Group policy (2015), we included only prospectively registered RCTs for trials published after 2010. We included trials which assessed the effects of glucocorticoid with cyclophosphamide delivered in combination. Eligible comparators were standard care (with or without a placebo), or any other therapy in addition to standard care. Outcomes of interest included mortality and infections. DATA COLLECTION AND ANALYSIS We calculated the mortality risk ratio (RR) and 95% confidence interval (CI). Where possible, we summarised data for all-cause mortality at relevant time periods (from hospital discharge to three months after discharge) in meta-analysis, using a fixed-effect model. We conducted sensitivity analyses based on factors including whether participants were assessed at baseline for plasma paraquat levels. We also reported data on infections within one week after initiation of treatment. MAIN RESULTS We included four trials with a total of 463 participants. The included studies were conducted in Taiwan (Republic of China), Iran, and Sri Lanka. Most participants were male. The mean age of participants was 28 years. We judged two of the four included studies, including the largest and most recently conducted study (n = 299), to be at low risk of bias for key domains including sequence generation. We assessed one study to be at high risk of selection bias and another at unclear risk, since allocation concealment was either not mentioned in the trial report or explicitly not undertaken. We assessed three of the four studies to be at unclear risk of selective reporting, as no protocols could be identified. An important source of heterogeneity amongst the included studies was the method of assessment of participants' baseline severity using analysis of plasma levels (two studies employed this method, whilst the other two did not). No studies assessed the outcome of mortality at 30 days following ingestion of paraquat. Low-certainty evidence from two studies indicates that glucocorticoids with cyclophosphamide in addition to standard care may slightly reduce the risk of death in hospital compared to standard care alone ((RR 0.82, 95% CI 0.68 to 0.99; participants = 322); results come from sensitivity analysis excluding studies not assessing plasma at baseline). However, we have limited confidence in this finding as heterogeneity was high (I2 = 77%) and studies varied in terms of size and comparators. A single large study provided data showing that there may be little or no effect of treatment at three months post discharge from hospital (RR 0.98, 95% CI 0.85 to 1.13; 1 study, 293 participants; low-certainty evidence); however, analysis of long-term results amongst participants whose injuries arose from self-poisoning must be interpreted with caution. We remain uncertain of the effect of glucocorticoids with cyclophosphamide on infection within one week after initiation of the treatment; this outcome was assessed by two small studies only (31 participants, very low-certainty evidence) that considered leukopenia as a proxy or risk factor for infection. Neither study reported infections in any participants. AUTHORS' CONCLUSIONS Low-certainly evidence suggests that glucocorticoids with cyclophosphamide in addition to standard care may slightly reduce mortality in hospitalised people with oral paraquat poisoning. However, we have limited confidence in this finding because of substantial heterogeneity and concerns about imprecision. Glucocorticoids with cyclophosphamide in addition to standard care may have little or no effect on mortality at three months after hospital discharge. We are uncertain whether glucocorticoid with cyclophosphamide puts patients at an increased risk of infection due to the limited evidence available for this outcome. Future research should be prospectively registered and CONSORT-compliant. Investigators should attempt to ensure an adequate sample size, screen participants for inclusion rigorously, and seek long-term follow-up of participants. Investigators may wish to research the effects of glucocorticoid in combination with other treatments.
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Affiliation(s)
- Luying Ryan Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | | | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jane A Dennis
- Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Wakeford
- Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, London, UK
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Lin CC, Hsu KH, Shih CP, Chang GJ. Hemodynamic and electromechanical effects of paraquat in rat heart. PLoS One 2021; 16:e0234591. [PMID: 33793552 PMCID: PMC8016255 DOI: 10.1371/journal.pone.0234591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/18/2021] [Indexed: 01/04/2023] Open
Abstract
Paraquat (PQ) is a highly lethal herbicide. Ingestion of large quantities of PQ usually results in cardiovascular collapse and eventual mortality. Recent pieces of evidence indicate possible involvement of oxidative stress- and inflammation-related factors in PQ-induced cardiac toxicity. However, little information exists on the relationship between hemodynamic and cardiac electromechanical effects involved in acute PQ poisoning. The present study investigated the effects of acute PQ exposure on hemodynamics and electrocardiogram (ECG) in vivo, left ventricular (LV) pressure in isolated hearts, as well as contractile and intracellular Ca2+ properties and ionic currents in ventricular myocytes in a rat model. In anesthetized rats, intravenous PQ administration (100 or 180 mg/kg) induced dose-dependent decreases in heart rate, blood pressure, and cardiac contractility (LV +dP/dtmax). Furthermore, PQ administration prolonged the PR, QRS, QT, and rate-corrected QT (QTc) intervals. In Langendorff-perfused isolated hearts, PQ (33 or 60 μM) decreased LV pressure and contractility (LV +dP/dtmax). PQ (10-60 μM) reduced the amplitudes of Ca2+ transients and fractional cell shortening in a concentration-dependent manner in isolated ventricular myocytes. Moreover, whole-cell patch-clamp experiments demonstrated that PQ decreased the current amplitude and availability of the transient outward K+ channel (Ito) and altered its gating kinetics. These results suggest that PQ-induced cardiotoxicity results mainly from diminished Ca2+ transients and inhibited K+ channels in cardiomyocytes, which lead to LV contractile force suppression and QTc interval prolongation. These findings should provide novel cues to understand PQ-induced cardiac suppression and electrical disturbances and may aid in the development of new treatment modalities.
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Affiliation(s)
- Chih-Chuan Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Kuang-Hung Hsu
- Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Pang Shih
- Department of Nursing, Yuanpei University of Medical Technology, Hsin-Chu, Taiwan
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medicinal Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Cardiovascular Division of Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
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Zheng F, Zhu J, Zhang W, Fu Y, Lin Z. Thal protects against paraquat-induced lung injury through a microRNA-141/HDAC6/IκBα-NF-κB axis in rat and cell models. Basic Clin Pharmacol Toxicol 2021; 128:334-347. [PMID: 33015978 PMCID: PMC7894280 DOI: 10.1111/bcpt.13505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/18/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022]
Abstract
The protective functions of thalidomide in paraquat (PQ)-induced injury have been reported. But the mechanisms remain largely unknown. In this research, a PQ-treated rat model was established and further treated with thalidomide. Oedema and pathological changes, oxidative stress, inflammation, fibrosis and cell apoptosis in rat lungs were detected. A PQ-treated RLE-6TN cell model was constructed, and the viability and apoptosis rate of cells were measured. Differentially expressed microRNAs (miRNAs) after thalidomide administration were screened out. Binding relationship between miR-141 and histone deacetylase 6 (HDAC6) was validated. Altered expression of miR-141 and HDAC6 was introduced to identify their involvements in thalidomide-mediated events. Consequently, thalidomide administration alone exerted no damage to rat lungs; in addition it reduced PQ-induced oedema. The oxidative stress, inflammation and cell apoptosis in rat lungs were reduced by thalidomide. In RLE-6TN cells, thalidomide increased cell viability and decreased apoptosis. miR-141 was responsible for thalidomide-mediated protective events by targeting HDAC6. Overexpression of HDAC6 blocked the protection of thalidomide against PQ-induced injury via activating the IkBα-NF-κB signalling pathway. Collectively, this study evidenced that thalidomide protects lung tissues from PQ-induced injury through a miR-141/HDAC6/IkBα-NF-κB axis.
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Affiliation(s)
- Fenshuang Zheng
- Department of Emergency MedicineSecond People's Hospital of Yunnan ProvinceKunmingChina
| | - Junbo Zhu
- Department of Emergency MedicineSecond People's Hospital of Yunnan ProvinceKunmingChina
| | - Wei Zhang
- Department of Emergency MedicineSecond People's Hospital of Yunnan ProvinceKunmingChina
| | - Yangshan Fu
- Department of Emergency MedicineSecond People's Hospital of Yunnan ProvinceKunmingChina
| | - Zhaoheng Lin
- Department of Critical Care MedicinePeople's Hospital of Xishuangbanna Dai Nationality Autonomous PrefecturePingpongChina
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Gao YX, Wang YB, Wan YD, Sun TW, Li Y, Hou LL, Sun P, Yuan D, Duan GY, Sun CH, Che L, Zhang Y. Immunosuppressive drugs to reduce the mortality rate in patients with moderate to severe paraquat poisoning: A Meta-analysis. J Toxicol Sci 2020; 45:163-175. [PMID: 32147639 DOI: 10.2131/jts.45.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The benefits and adverse effects of immunosuppressive drugs (ISDs) in patients with paraquat (PQ) poisoning have not been thoroughly assessed. This meta-analysis study aims to evaluate the effect of ISDs in patients with moderate to severe PQ poisoning. We searched PubMed, Embase, Cochrane Library, Ovid Medline, CNKI and Wanfang Data from inception to January 2019. The Mantel-Haenszel method with a random-effects model was used to calculate the pooled relative risks (RRs) and 95% Confidence Intervals (CIs) as described by DerSimonian and Laird. An L'Abbé plot was drawn to explore the relationship between the degree of poisoning and mortality. Four randomized controlled trials, two prospective and seven retrospective studies were identified. ISDs were significantly associated with reduced mortality (RR 0.76; 95% CI, 0.58-0.99) and the incidence rate of multiple-organ dysfunction syndrome (MODS) (RR 0.63; 95% CI, 0.48-0.83) in patients with moderate to severe PQ poisoning. They were not associated with an increased incidence rate of hepatitis and reduced incidence rate of acute renal failure and hypoxia. The L'Abbé plot results showed a slight increase in mortality rate in the ISD group with increased mortality in the placebo group. This indicates a possible advantage of ISDs in most of the patients with severe PQ poisoning. These findings suggest that ISDs may reduce the mortality and incidence rate of MODS in moderate to severe PQ poisoning patients, and severe PQ poisoning patients might benefit more from ISDs.
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Affiliation(s)
- Yan-Xia Gao
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
| | - Yi-Bo Wang
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
| | - You-Dong Wan
- Emergency ICU, Affiliated Hospital of Qingdao University, China
| | - Tong-Wen Sun
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
| | - Yi Li
- Emergency Department, Peking Union Medical College Hospital, China
| | - Lin-Lin Hou
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
| | - Pei Sun
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
| | - Ding Yuan
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
| | - Guo-Yu Duan
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
| | - Chang-Hua Sun
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
| | - Lu Che
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
| | - Yan Zhang
- Emergency Department, The First Affiliated hospital of Zhengzhou University, China
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Osteonecrosis of Femoral Head, An Overlooked Long-Term Complication after Paraquat Intoxication: A Retrospective Cohort Study. Sci Rep 2020; 10:8827. [PMID: 32483235 PMCID: PMC7264308 DOI: 10.1038/s41598-020-65756-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/29/2020] [Indexed: 01/04/2023] Open
Abstract
With increasing numbers of patients surviving acute intoxication phase, long-term complication after paraquat intoxication is a topic worth exploring, such as osteonecrosis (ON) of femoral head. We reviewed 86 paraquat-intoxicated survivors between 2000 and 2012 in Chang Gung Memorial Hospital, a 3700-bed tertiary hospital in Taiwan. With all the patients underwent same detoxification protocol in the acute stage, 17.4% of paraquat poisoning survivors developed ON of femoral head requiring surgery during follow up. Most of ON episodes occurred within 2 to 4 years after paraquat intoxication and then plateau after 6 years. ON patients exhibited higher SOFA scores than non-ON patients (2.80 ± 2.14 vs. 1.76 ± 1.52, p = 0.028). Furthermore, AKIN scores are also higher in the ON patients than non-ON patients (0.87 ± 1.13 vs. 0.38 ± 0.74, p = 0.040). Multivariate logistic regression showed higher AKIN score and higher partial pressure of carbon dioxide in the blood 48 hours after admission significantly predicted ON of femoral head after paraquat intoxication (p = 0.002 and p = 0.006 respectively). Larger studies with longer follow-up durations are warranted to confirm our finding.
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Wan XL, Zhou ZL, Wang P, Zhou XM, Xie MY, Mei J, Weng J, Xi HT, Chen C, Wang ZY, Wang ZB. Small molecule proteomics quantifies differences between normal and fibrotic pulmonary extracellular matrices. Chin Med J (Engl) 2020; 133:1192-1202. [PMID: 32433051 PMCID: PMC7249707 DOI: 10.1097/cm9.0000000000000754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pulmonary fibrosis is a respiratory disease caused by the proliferation of fibroblasts and accumulation of the extracellular matrix (ECM). It is known that the lung ECM is mainly composed of a three-dimensional fiber mesh filled with various high-molecular-weight proteins. However, the small-molecular-weight proteins in the lung ECM and their differences between normal and fibrotic lung ECM are largely unknown. METHODS Healthy adult male Sprague-Dawley rats (Rattus norvegicus) weighing about 150 to 200 g were randomly divided into three groups using random number table: A, B, and C and each group contained five rats. The rats in Group A were administered a single intragastric (i.g.) dose of 500 μL of saline as control, and those in Groups B and C were administered a single i.g. dose of paraquat (PQ) dissolved in 500 μL of saline (20 mg/kg). After 2 weeks, the lungs of rats in Group B were harvested for histological observation, preparation of de-cellularized lung scaffolds, and proteomic analysis for small-molecular-weight proteins, and similar procedures were performed on Group C and A after 4 weeks. The differentially expressed small-molecular-weight proteins (DESMPs) between different groups and the subcellular locations were analyzed. RESULTS Of the 1626 small-molecular-weight proteins identified, 1047 were quantifiable. There were 97 up-regulated and 45 down-regulated proteins in B vs. A, 274 up-regulated and 31 down-regulated proteins in C vs. A, and 237 up-regulated and 28 down-regulated proteins identified in C vs. B. Both the up-regulated and down-regulated proteins in the three comparisons were mainly distributed in single-organism processes and cellular processes within biological process, cell and organelle within cellular component, and binding within molecular function. Further, more up-regulated than down-regulated proteins were identified in most sub-cellular locations. The interactions of DESMPs identified in extracellular location in all comparisons showed that serum albumin (Alb) harbored the highest degree of node (25), followed by prolyl 4-hydroxylase beta polypeptide (12), integrin β1 (10), apolipoprotein A1 (9), and fibrinogen gamma chain (9). CONCLUSIONS Numerous PQ-induced DESMPs were identified in de-cellularized lungs of rats by high throughput proteomics analysis. The DESMPs between the control and treatment groups showed diversity in molecular functions, biological processes, and pathways. In addition, the interactions of extracellular DESMPs suggested that the extracellular proteins Alb, Itgb1, Apoa1, P4hb, and Fgg in ECM could be potentially used as biomarker candidates for pulmonary fibrosis. These results provided useful information and new insights regarding pulmonary fibrosis.
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Affiliation(s)
- Xin-Long Wan
- Platform for Radiation Protection and Emergency Preparedness of Southern Zhejiang, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
- Center for Health Assessment, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Zhi-Liang Zhou
- Department of Emergency Medicine and General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Peng Wang
- Department of Emergency Medicine and General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xiao-Ming Zhou
- Department of Emergency Medicine and General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Meng-Ying Xie
- Department of Geriatric Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jin Mei
- Institute of Bioscaffold Transplantation and Immunology, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Jie Weng
- Department of Emergency Medicine and General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Hai-Tao Xi
- Institute of Bioscaffold Transplantation and Immunology, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Chan Chen
- Department of Geriatric Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Zhi-Yi Wang
- Center for Health Assessment, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
- Department of Emergency Medicine and General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- Institute of Bioscaffold Transplantation and Immunology, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Zhi-Bin Wang
- Institute of Bioscaffold Transplantation and Immunology, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
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Metabolitic profiling of amino acids in paraquat-induced acute kidney injury. Clin Exp Nephrol 2019; 23:474-483. [PMID: 30859350 DOI: 10.1007/s10157-019-01702-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/19/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The herbicide paraquat (1, 1'-dimethyl-4, 4'-bipyridylium dichloride; PQ) is a poison well-known to cause delayed mortality due to acute kidney injuries (AKI). This study examines the changes in serum amino acids (AAs) metabolite profiles as surrogate markers of renal cell metabolism and function after paraquat poisoning. METHODS To identify the metabolic profiling of free serum AAs and its metabolites, serum from 40 paraquat-poisoned patients with or without AKI is collected. LC-MS/GC-MS is performed to analyze AA molecules. A Cox proportional hazard model was used to assess for incidence of AKI. Receiver operating characteristic (ROC) curve is applied to evaluate AKI occurrence and prognosis. RESULTS A total of 102 serum AAs and its metabolites were identified. Compared with non-AKI patients, 37 varied significantly in AKI patients. The univariate Cox proportional hazard model analysis revealed that the estimated PQ amount, plasma PQ concentration, urine PQ concentration, APACHE, SOFA scores and 16 amino acids correlated with the incidence of AKI. Further analyses revealed that 3-methylglutarylcarnitine, 1-methylimidazoleacetate, and urea showed higher cumulative hazard ratios for the occurrence of AKI during follow-up (P < 0.05). The area under the curve (AUC) of 3-methylglutarylcarnitine, 1-methylimidazoleacetate and urea were 0.917, 0.857, 0.872, respectively. CONCLUSION 3-methylglutarylcarnitine, 1-methylimidazoleacetate and urea were associated with AKI in patients with paraquat intoxication.
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Wang Z, Gu D, Sheng L, Cai J. Protective Effect of Anthocyanin on Paraquat-Induced Apoptosis and Epithelial-Mesenchymal Transition in Alveolar Type II Cells. Med Sci Monit 2018; 24:7980-7987. [PMID: 30403199 PMCID: PMC6234756 DOI: 10.12659/msm.910730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Paraquat (PQ) can over-accumulate in alveolar epithelial cells. Anthocyanin (An) can exert anti-oxidative properties. The role of An in PQ-induced toxicity is unclear, so we aimed to explore whether An could inhibit epithelial mesenchymal transition (EMT) induced by PQ in alveolar cells. MATERIAL AND METHODS lveolar epithelial cells were treated with PQ and An with concentration gradient for 12, 24, and 48 h. The cell viability, ROS level, and apoptosis rate were determined using the Cell Counting Kit-8 (CCK-8) and flow cytometry, respectively. The lactate dehydrogenase (LDH) leakage, methane dicarboxylic aldehyde (MDA) level, glutathione peroxidase (GPx), and superoxide dismutase (SOD) activities were determined by spectrophotometric method. The mRNA and protein expressions were detected using quantitative real-time PCR (qPCR) and Western blot, respectively. RESULTS An reduced the PQ-induced apoptosis in a dose-dependent manner. Moreover, An reduced the ratio of Bax/Bcl-2 to ROS level. We found that An suppressed the activity of LDH and MDA and improved SOD and GPX levels. Additionally, the level of PQ-induced E-cadherin was decreased by An while the expressions of vimentin, α-smooth muscle actin (α-SMA), and collagens type I (col-I) were increased. Furthermore, An inhibited the levels of transforming growth factor β1 (TGF-β1) and activin receptor-like kinase 5 (ALK5) and reduced the phosphorylation of smad2. CONCLUSIONS Our study shows newly discovered effects of anthocyanidins on EMT and supports their chemopreventive effects in paraquat-induced apoptosis in alveolar type II cells.
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Affiliation(s)
- Zhihua Wang
- Emergency Department of Traumatology, Shanghai Pudong Hospital, Shanghai, China (mainland)
| | - Dongming Gu
- Emergency Department of Traumatology, Shanghai Pudong Hospital, Shanghai, China (mainland)
| | - Lezhi Sheng
- Emergency Department of Traumatology, Shanghai Pudong Hospital, Shanghai, China (mainland)
| | - Jinfang Cai
- Emergency Department of Traumatology, Shanghai Pudong Hospital, Shanghai, China (mainland)
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Chen CW, Wu YH, Chien SC, Lin JC. A survival case of intravenous paraquat intoxication: A case report. Medicine (Baltimore) 2018; 97:e11669. [PMID: 30045322 PMCID: PMC6078682 DOI: 10.1097/md.0000000000011669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Paraquat, an agent highly toxic to humans and animals, is a widely used herbicide and also commonly used for suicide attempts in Taiwan. The most common route of intoxication is oral ingestion, and parenteral poisoning is respectively rare. PATIENT CONCERNS A 39-year-old illicit abuser of heroin and amphetamine injected 0.5 mL of 24% paraquat directly into his right cephalic vein due to hallucination. The patient was brought to our emergency department for management 4 hours after injection. He was fully conscious and had normal vital signs. Systemic review showed mild dyspnea, abdominal pain and right wrist pain over the injection site. The only abnormal physical finding was erythema over the injection site and epigastric tenderness. DIAGNOSIS Laboratory investigations, including complete blood count, liver and renal function, and electrolytes initially yielded normal results. Urinalysis showed normal findings except a positive urine paraquat test (4+). The initial plasma paraquat concentration was 0.51 μg/mL. INTERVENTIONS He was admitted to the intensive care unit and underwent one session of charcoal hemoperfusion therapy. Acute kidney injury developed on the fourth day after intoxication, with the level of serum creatinine rising rapidly from 0.96 to 4.57 mg/dL and the daily urine output decreased noticeably from > 2000 to 900 mL. The serum creatinine level improved gradually with adequate fluid supplementation. OUTCOMES The patient was discharged 13 days later in a stable condition. LESSONS Intravenous paraquat intoxication is rare. Patients who suffer from intravenous intoxication may not directly suffer from mucosal irritation, but the clinical onset of systemic effects is more immediate and lethal. The prognosis of paraquat poisoning is determined by the time of poisoning and the plasma paraquat concentration before treatment. Proudfoot's curve provides a simple method of predicting the survival rate. The most effective mode of management is extracorporeal therapy, and immunosuppressive or antioxidant therapies have shown insufficient evidence of benefit.
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Affiliation(s)
- Chi-Wei Chen
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - Yen-Hung Wu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shun-Ching Chien
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - Jhong-Ching Lin
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
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Abstract
N, N'-dimethyl-4, 4'-bipyridinium dichloride (paraquat) is a widely used synthetic, nonselective contact herbicide. Ingestion of toxic doses of paraquat can be fatal with life-threatening effects on the lungs, gastrointestinal (GI) tract, kidney, liver, heart, and other organs. Till date, there are no specific antidotes and none of the current treatments have proven efficacious. The prognosis is uniformly poor worldwide, including those who treat aggressively with multimodal therapies. Long-term survivors are few, and have GI and pulmonary complications. Hence, prevention needs to be the utmost priority, and on exposure, aggressive decontamination should be initiated. Although it is a very common herbicide, there are very few cases reported from India and awareness among people needs to be widened.
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Affiliation(s)
- M Asisha Janeela
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajoy Oommen
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajay Kumar Misra
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - I Ramya
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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14
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Wei TY, Yen TH, Cheng CM. Point-of-care testing in the early diagnosis of acute pesticide intoxication: The example of paraquat. BIOMICROFLUIDICS 2018; 12:011501. [PMID: 29430271 PMCID: PMC5775096 DOI: 10.1063/1.5003848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/04/2018] [Indexed: 05/09/2023]
Abstract
Acute pesticide intoxication is a common method of suicide globally. This article reviews current diagnostic methods and makes suggestions for future development. In the case of paraquat intoxication, it is characterized by multi-organ failure, causing substantial mortality and morbidity. Early diagnosis may save the life of a paraquat intoxication patient. Conventional paraquat intoxication diagnostic methods, such as symptom review and urine sodium dithionite assay, are time-consuming and impractical in resource-scarce areas where most intoxication cases occur. Several experimental and clinical studies have shown the potential of portable Surface Enhanced Raman Scattering (SERS), paper-based devices, and machine learning for paraquat intoxication diagnosis. Portable SERS and new SERS substrates maintain the sensitivity of SERS while being less costly and more convenient than conventional SERS. Paper-based devices provide the advantages of price and portability. Machine learning algorithms can be implemented as a mobile phone application and facilitate diagnosis in resource-limited areas. Although these methods have not yet met all features of an ideal diagnostic method, the combination and development of these methods offer much promise.
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Affiliation(s)
- Ting-Yen Wei
- Interdisciplinary Program of Life Science, National Tsing Hua University, Hsinchu 300, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and Chang Gung University, Linkou 333, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan
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Zhao X, Xiao Y, Zhu J, Xu Z, Liu L, Zhang J. Prognostic comparison of goal-oriented hemoperfusion and routine hemoperfusion combined with continuous venovenous hemofiltration for paraquat poisoning. J Int Med Res 2017; 46:1091-1102. [PMID: 29082819 PMCID: PMC5972246 DOI: 10.1177/0300060517734917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective To investigate the impact of goal-oriented hemoperfusion (HP) with monitoring of the paraquat concentration on the prognosis of patients with acute paraquat poisoning. Methods This prospective observational study involved patients with acute paraquat poisoning admitted from March 2012 to September 2015. The patients received either goal-oriented or routine HP. All other treatments were the same between the two groups. The primary endpoint was 28-day mortality after poisoning. The secondary endpoints were the incidence of organ dysfunction within 7 days and 7-day mortality. Results Eighty-four patients were enrolled (49 in the control group and 35 in the goal-oriented group). The two groups were similar in terms of clinical characteristics. There was no significant difference in the incidence of organ dysfunction between the two groups within 1 week of admission. Mortality on day 7 was significantly lower in the goal-oriented than control group, but there was no difference on day 28. However, 28-day mortality was significantly lower in the goal-oriented group among patients with an oral dose of ≤50 ml. Conclusions HP with monitoring of the urine paraquat concentration as goal-oriented therapy can reduce the early mortality of paraquat poisoning.
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Affiliation(s)
- Xuming Zhao
- 1 Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Xiao
- 1 Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianliang Zhu
- 1 Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhiping Xu
- 1 Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lijun Liu
- 1 Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinsong Zhang
- 2 Department of Emergency Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Gao J, Feng S, Wang J, Yang S, Li Y. Prolonged methylprednisolone therapy after the pulse treatment for patients with moderate-to-severe paraquat poisoning: A retrospective analysis. Medicine (Baltimore) 2017; 96:e7244. [PMID: 28640126 PMCID: PMC5484234 DOI: 10.1097/md.0000000000007244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This retrospective study aims to evaluate the effect of prolonged methylprednisolone (MP) therapy on the mortality of patients with moderate-to-severe paraquat (PQ) poisoning after the pulse treatment.We performed a retrospective analysis of patients with acute moderate-to-severe PQ poisoning that were admitted to the emergency department from May 2012 to August 2016. Out of 138 patients, 60 were treated with pulse treatment (15 mg kg day MP for 3 days) and 78 were treated with prolonged MP therapy after pulse treatment (15 mg kg day MP for 3 days; afterward, the dosage was reduced in half every 2 days, and the MP therapy was terminated until 0.47 mg kg day). Kaplan-Meier method was used to compare the mortality between the 2 groups. Cox proportional hazard models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI).The mortality of the prolonged MP therapy after pulse treatment group was lower than that of the pulse group (47.4% vs 63.3%; log-rank tests, P = .003). According to the multivariate Cox analysis, the prolonged MP therapy after pulse treatment was significantly associated with a lower mortality risk (HR: 0.31, 95% CI: 0.19-0.52, P < .001) compared with the pulse group. In addition, the prolonged MP therapy after pulse treatment caused more incidences of leucopenia than the pulse treatment alone (25.6% vs 11.7%, P = .04).The prolonged MP therapy after pulse treatment can reduce the mortality of moderate-to-severe PQ poisoning patients.
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Affiliation(s)
- Jie Gao
- Emergency Department, Cangzhou Central Hospital, Cangzhou City
| | - ShunYi Feng
- Emergency Department, Cangzhou Central Hospital, Cangzhou City
| | - Jian Wang
- Emergency Department, Cangzhou Central Hospital, Cangzhou City
| | - SiYuan Yang
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou City, China
| | - Yong Li
- Emergency Department, Cangzhou Central Hospital, Cangzhou City
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17
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Chen CY, Weng YM, Chen JC. Pneumocystis Pneumonia Infection in a Survivor of Paraquat Intoxication. J Acute Med 2017; 7:75-78. [PMID: 32995175 PMCID: PMC7517916 DOI: 10.6705/j.jacme.2017.0702.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 09/12/2016] [Accepted: 10/03/2016] [Indexed: 06/11/2023]
Abstract
Patients who survived recent paraquat intoxication might be treated with glucocorticoid andcyclophosphamide to avoid further lung fi brosis. Such patients might be susceptible to opportunistic infections. Pneumocystis pneumonia (PCP) is an important opportunistic lung infection in hematologic malignancy patients on chemotherapy. We report a patient who recently survived paraquat intoxication and presented with acute respiratory insuffi ciency post glucocorticoid and cyclosporine treatment. A fulminant clinical course, and a clear medical history of immunocompromised state draw physician's attention to the possible opportunistic lung infection. PCP infection was confi rmed by a PCP deoxyribonucleic acid test. The symptoms improved markedly after appropriate antibiotics treatment. This report suggests that clinicians should consider PCP infection in patients who develop secondary pneumonia after paraquat intoxication. PCP treatment as part of empirical antibiotics should be added, especially in such patients presented with rapidly progressive course.
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Affiliation(s)
- Chih-Yu Chen
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Emergency Medicine Linko Taiwan
| | - Yi-Ming Weng
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Emergency Medicine Linko Taiwan
| | - Jih-Chang Chen
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Emergency Medicine Linko Taiwan
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18
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Weng CH, Chen HH, Hu CC, Huang WH, Hsu CW, Fu JF, Lin WR, Wang IK, Yen TH. Predictors of acute kidney injury after paraquat intoxication. Oncotarget 2017; 8:51345-51354. [PMID: 28881652 PMCID: PMC5584253 DOI: 10.18632/oncotarget.17975] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/07/2017] [Indexed: 12/17/2022] Open
Abstract
Paraquat intoxication is characterized by multi-organ failure, causing substantial mortality and morbidity. Many paraquat patients experience acute kidney injury (AKI), sometimes requiring hemodialysis. We observed 222 paraquat-intoxicated patients between 2000 and 2012, and divided them into AKI (n = 103) and non-AKI (n = 119) groups. The mortality rate was higher for AKI than non-AKI patients (70.1% vs. 40.0%, P < 0.001). Patients with AKI had a longer time to hospital arrival (P = 0.003), lower PaO2 (P = 0.006) and higher alveolar-arterial O2 difference (P < 0.001) 48 h after admission, higher sequential organ failure assessment 48-h score (P < 0.001), higher severity index of paraquat poisoning (SIPP) score (P = 0.016), lower PaCO2 at admission (P = 0.031), higher PaO2 at admission (P = 0.015), lower nadir PaCO2 (P = 0.001) and lower nadir HCO3 (P = 0.004) than non-AKI patients. Multivariate logistic regression indicated that acute hepatitis (P < 0.001), a longer time to hospital arrival (P < 0.001), higher SIPP score (P = 0.026) and higher PaO2 at admission (P = 0.014) were predictors of AKI. The area under the receiver operating characteristic curve confirmed that an Acute Kidney Injury Network 48-hour score ≥ 2 predicted AKI necessitating hemodialysis with a sensitivity of 0.6 and specificity of 0.832. AKI is common (46.4%) following paraquat ingestion, and acute hepatitis, the time to hospital arrival, SIPP score and PaO2 at admission were powerful predictors of AKI. Larger studies with longer follow-up durations are warranted.
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Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Hui-Hsiang Chen
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Ching-Chih Hu
- Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Jen-Fen Fu
- Department of Medical Research, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wey-Ran Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - I-Kwan Wang
- Department of Nephrology, Chang Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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19
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Veríssimo G, Bast A, Weseler AR. Paraquat disrupts the anti-inflammatory action of cortisol in human macrophages in vitro: therapeutic implications for paraquat intoxications. Toxicol Res (Camb) 2017; 6:232-241. [PMID: 30090494 DOI: 10.1039/c6tx00406g] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/01/2017] [Indexed: 12/19/2022] Open
Abstract
The herbicide paraquat (1,1'-dimethyl-4,4'-bipyridinium dichloride) has been banned in Europe since 2007 due to its high toxicity in humans. However, it is still widely used in Middle/South America and in Asia where it is annually associated with a high incidence of unintentional and intentional poisoning. Human macrophage-like cell lines were used to shed more light on the inflammatory response elicited by paraquat. Paraquat (3-1000 μM) reduced cell viability in a dose- and time-dependent manner. Exposure to 50 or 200 μM paraquat for 24 h elevated the release of interleukin 8 and gene expression of tumor necrosis factor-α. Expression of the 11β-hydroxysteroid dehydrogenase 1 gene tended to increase, while cellular glutathione concentrations decreased. The anti-inflammatory effect of cortisol was significantly disrupted. The paraquat-induced cortisol resistance could not be prevented by N-acetyl-l-cysteine. However, a polyphenolic extract of grape seeds consisting of monomeric and oligomeric flavan-3-ols (MOF) reduced paraquat-induced inflammation in the presence of cortisol to baseline. In conclusion, the results suggest that an impaired cortisol response may contribute to paraquat-mediated inflammation. Agents with pleiotropic cellular and subcellular effects on redox regulation and inflammation, such as plant-derived polyphenols, may be an effective add-on to the therapy of paraquat intoxications with glucocorticoids.
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Affiliation(s)
- Gesiele Veríssimo
- Institute for Studies in Collective Health , Federal University of Rio de Janeiro , Praça Jorge Machado Moreira 100 , Cidade Universitária , Rio de Janeiro 21941-598 , Brazil.,Department of Pharmacology and Toxicology , Maastricht University , PO Box 616 , 6200 MD Maastricht , The Netherlands . ; ;
| | - Aalt Bast
- Department of Pharmacology and Toxicology , Maastricht University , PO Box 616 , 6200 MD Maastricht , The Netherlands . ; ;
| | - Antje R Weseler
- Department of Pharmacology and Toxicology , Maastricht University , PO Box 616 , 6200 MD Maastricht , The Netherlands . ; ;
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Prognostic value of hematological parameters in patients with paraquat poisoning. Sci Rep 2016; 6:36235. [PMID: 27824090 PMCID: PMC5099941 DOI: 10.1038/srep36235] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/12/2016] [Indexed: 12/27/2022] Open
Abstract
Paraquat (PQ) is a non-selective contact herbicide, and acute PQ poisoning has a high mortality. The aim of the present study is to evaluate the prognostic value of hematological parameters in patients with acute PQ poisoning. We retrospectively reviewed the records of patients with acute PQ poisoning from January 2010 to December 2015 at the First Affiliated Hospital, Anhui Medical University (Hefei, China). A total of 202 patients were included in the study, and the 30-day mortality was 51.98%. Leukocyte, neutrophil counts and neutrophil-lymphocyte ratio (NLR) were significantly higher in non-survivors than in survivors. In the receiver operating characteristic (ROC) curve analysis, the NLR had an area of 0.916(95%CI, 0.877–0.954) and the optimal cut-off value was 10.57 (sensitivity, 86.70%; specificity, 83.51%; Youden’s index, 0.702). The leukocyte counts had an area of 0.849(95%CI, 0.796–0.902) and the optimal cut-off value was 13.15 × 103/mm3 (sensitivity, 77.10%; specificity, 83.50%; Youden’s index, 0.606). The neutrophil counts had an area of 0.878(95%CI, 0.830–0.925) and the optimal cut-off value was 10.10 × 103/mm3 (sensitivity, 83.80%; specificity, 79.38%; Youden’s index, 0.632). NLR, leukocyte and neutrophil counts are associated with the 30-day mortality, which may be useful and simple parameters in predicting the prognosis of PQ poisoning.
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Shao X, Li M, Luo C, Wang YY, Lu YY, Feng S, Li H, Lang XB, Wang YC, Lin C, Shen XJ, Zhou Q, Jiang H, Chen JH. Effects of rapamycin against paraquat-induced pulmonary fibrosis in mice. J Zhejiang Univ Sci B 2015; 16:52-61. [PMID: 25559956 DOI: 10.1631/jzus.b1400229] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND AIMS Ingestion of paraquat (PQ), a widely used herbicide, can cause severe toxicity in humans, leading to a poor survival rate and prognosis. One of the main causes of death by PQ is PQ-induced pulmonary fibrosis, for which there are no effective therapies. The aim of this study was to evaluate the effects of rapamycin (RAPA) on inhibiting PQ-induced pulmonary fibrosis in mice and to explore its possible mechanisms. METHODS Male C57BL/6J mice were exposed to either saline (control group) or PQ (10 mg/kg body weight, intraperitoneally; test group). The test group was divided into four subgroups: a PQ group (PQ-exposed, non-treated), a PQ+RAPA group (PQ-exposed, treated with RAPA at 1 mg/kg intragastrically), a PQ+MP group (PQ-exposed, treated with methylprednisolone (MP) at 30 mg/kg intraperitoneally), and a PQ+MP+RAPA group (PQ-exposed, treated with MP at 30 mg/kg intraperitoneally and with RAPA at 1 mg/kg intragastrically). The survival rate and body weight of all the mice were recorded every day. Three mice in each group were sacrificed at 14 d and the rest at 28 d after intoxication. Lung tissues were excised and stained with hematoxylin-eosin (H&E) and Masson's trichrome stain for histopathological analysis. The hydroxyproline (HYP) content in lung tissues was detected using an enzyme-linked immunosorbent assay (ELISA) kit. The expression of transforming growth factor-β1 (TGF-β1) and α-smooth muscle actin (α-SMA) in lung tissues was detected by immunohistochemical staining and Western blotting. RESULTS A mice model of PQ-induced pulmonary fibrosis was established. Histological examination of lung tissues showed that RAPA treatment moderated the pathological changes of pulmonary fibrosis, including alveolar collapse and interstitial collagen deposition. HYP content in lung tissues increased soon after PQ intoxication but had decreased significantly by the 28th day after RAPA treatment. Immunohistochemical staining and Western blotting showed that RAPA treatment significantly down-regulated the enhanced levels of TGF-β1 and α-SMA in lung tissues caused by PQ exposure. However, RAPA treatment alone could not significantly ameliorate the lower survival rate and weight loss of treated mice. MP treatment enhanced the survival rate, but had no significant effects on attenuating PQ-induced pulmonary fibrosis or reducing the expression of TGF-β1 and α-SMA. CONCLUSIONS This study demonstrates that RAPA treatment effectively suppresses PQ-induced alveolar collapse and collagen deposition in lung tissues through reducing the expression of TGF-β1 and α-SMA. Thus, RAPA has potential value in the treatment of PQ-induced pulmonary fibrosis.
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Affiliation(s)
- Xue Shao
- Kidney Disease Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Muthu V, Das A, Bal A, Agarwal R. Severe cholestasis and hepatic dysfunction in a case of fatal paraquat poisoning. Clin Res Hepatol Gastroenterol 2015; 39:e7-9. [PMID: 25193237 DOI: 10.1016/j.clinre.2014.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 07/18/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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