Early diagnosis of n-hexane-caused neuropathy

Acceptable Limits for n-Hexane in Spacecraft Atmospheres

INTRODUCTION:The Spacecraft Maximum Allowable Concentrations (SMACs) for C2-C9 alkanes set by NASA in 2008 under the guidance and approval of the National Research Council specifically excluded SMACs for n-hexane. Unlike other C2-C9 alkanes, n-hexane can cause polyneuropathy after metabolism in humans or rodents and so requires more stringent SMACs than the other members of this group do. This document reviews the relevant published studies of n-hexane toxicity to develop exposure duration-specific SMACs for n-hexane of 200 ppm for 1 hour, 30 ppm for 24 hours, and 2.4 ppm for 7 days, 30 days, 180 days, and 1000 days.Garcia HD. Acceptable limits for n-hexane in spacecraft atmospheres. Aerosp Med Hum Perform. 2021; 92(12):956-961.

Electrophysiological follow-up of patients with chronic peripheral neuropathy induced by occupational intoxication with n-hexane

The aim of this study is to characterize and dynamically monitor the progress of peripheral neuropathy induced by n-hexane by electromyography and nerve conduction velocity (NCV-EMG). Twenty-five patients with n-hexane poisoning from an electronic company were investigated in the year 2009. The occupational history of these workers was collected, and toxic substance exposure was identified. Neurologic inspection and regular NCV-EMG inspection were performed for all patients upon hospital admission and after 3, 6, and 12 months of treatment. NCV-EMG results shown that patients with n-hexane poisoning have simultaneous damage on motor and sensory nerves, of which sensory nerve damage was more severe. Motor nerves of the lower limbs were severe damaged than those of the upper limbs; whereas injury of sensory nerve in the upper limbs was more severe than that of the lower limbs. After treatment, clinical signs and symptoms of the patients were significantly improved. NCV-EMG result showed a delayed worsening at 3 months then gradually recovered after 12 months. Recovery of the motor nerve was better compared with sensory nerve, with upper limbs faster than that of the lower limbs.

Urinary 2,5-hexanedione excretion in cryptogenic polyneuropathy compared to the general Swedish population

Background

2,5-hexanedione (2,5-HD) is the main neurotoxic metabolite of methyl-n-butyl ketone (MBK) and n-hexane, and known to cause polyneuropathy. The aim of our study was to compare the urinary levels of 2,5-HD between cases with cryptogenic polyneuropathy and the general Swedish population, and to elucidate the role of certain external factors.

Methods

Morning urine samples were collected from 114 cases with cryptogenic polyneuropathy (77 men and 37 women) and 227 referents (110 men and 117 women) randomly selected from the population registry. None had any current occupational exposure to n-hexane or MBK. The urine samples were analysed by a gas chromatographic method based on acidic hydrolysis.

Results

Cases had statistically higher urinary levels of 2,5-HD (0.48 mg/L) than the general population (0.41 mg/L) and men higher excretion than women (0.48 mg/L and 0.38 mg/L, respectively). There was no difference in 2,5-HD levels between current smokers and non-smokers. Occupational exposure to xylene, alcohol consumption and ever exposed to general anaesthesia were associated with lower excretion in men while for occupational exposure to nitrous oxide in women higher excretion was seen. Higher excretion of 2,5 HD was inversely related to increasing age.

Conclusions

Significantly higher levels of urinary 2,5-HD were seen in men and cryptogenic polyneuropathy cases seemingly unexposed to n-hexane. Hypothetically, this might be due to either differences in metabolic patterns or some concealed exposure. The difference in means between cases and the general population is small and can therefore not allow any firm conclusions of the causality, however.

Activation of soluble guanylate cyclase by nitric oxide is increased in lymphocytes from both rats chronically exposed to 2,5-hexanedione and workers chronically exposed to n-hexane

Although occupational exposure to n-hexane induces neurotoxic effects in the central and peripheral nervous systems, the mechanisms of its neurotoxicity remain unclear. n-Hexane is metabolized to 2,5-hexanedione (2,5-HD), which is the neurotoxic agent and the indicator chosen for the biological monitoring of exposed workers. It has been previously reported that chronic exposure to 2,5-HD impairs the glutamate-nitric oxide-cyclic GMP pathway at the level of activation of soluble guanylate cyclase (sGC) enzyme by nitric oxide (NO), both in cultured neurons and in the cerebellum of rats in vivo. The aim of this study was to assess whether the activation of sGC by NO is also altered in lymphocytes from rats treated with 2,5-HD and/or workers chronically exposed to n-hexane. Lymphocytes were isolated from male Wistar rats treated with 2,5-HD in drinking water, and from blood samples from shoe-factory workers environmentally and chronically exposed to n-hexane. Urine samples were also collected from workers at the end of the shift in order to measure the urinary levels of 2,5-HD. Activation of sGC by NO was significantly higher (p<0.05) in lymphocytes from rats treated with 2,5-HD than in control rats. In isolated lymphocytes from exposed workers the activation of sGC by NO also increases (p<0.05) in contrast to the controls. The results presented here indicate that the activation of lymphocytes could be an indicator of the toxicity produced by being exposed to n-hexane, since the effects observed in workers chronically exposed to n-hexane are similar to those found in rats chronically treated with 2,5-HD in drinking water.

Toxic neuropathies

Many substances, organic and manufactured, may induce peripheral nerve damage when exposed to them. The expected clinical phenotype is of a distal, sensory or sensorimotor polyneuropathy, often painful, with axonal characteristics on electrodiagnostic and histopathologic analysis. Treatment is limited; often, the only effective management is supportive care and avoidance from or removal of the offending toxin. Fortunately, the majority of toxic neuropathies are self-limited and improves gradually after toxin elimination.

Occupational exposure to mixtures of organic solvents increases the risk of neurological symptoms among printing workers in Hong Kong

LEARNING OBJECTIVES

Summarize the nature and extent of exposure to organic solvents to which printing workers in this study were subjected. Compare the numbers of neurological symptoms in exposed and non-exposed workers and how they related to level of exposure, as defined by specific job title or by air sampling. Clarify the relationship between exposure to organic solvents and individual psychoneurological and other symptoms.

ABSTRACT

The health effects of low-dose occupational exposure to organic solvents remains unclear. A cross-sectional survey was conducted among 762 male printing workers to assess the impacts of exposure to mixtures of n-hexane, toluene, isopropyl alcohol, and benzene on neurological and other symptoms. After controlling for age, smoking, alcohol drinking, past exposure history, working hours and shift work, current exposure to solvent mixtures was significantly associated with the total number of neurological symptoms and with the prevalence of specific symptoms of the nervous system and mucous membrane irritation. The adjusted odds ratio of neurovegetative lability (1.7-5.9), abnormal or reduced smell (1.6-4.1), memory loss (1.8), and mucous membrane irritation symptoms (1.5-4.6) significantly increased in the exposed group, especially when the summation index of exposure exceeded one.

Free and total 2,5-hexanedione in biological monitoring of workers exposed to n-hexane in the shoe industry

OBJECTIVES

To analyse the role of total 2,5-hexanedione (2,5-HD) compared with free 2,5-HD as a biological indicator of exposure to n-hexane at work.

METHODS

One-hundred and thirty two workers in contact with this solvent during their occupation in the shoe industry in the province of Alicante (Spain) were studied. Environmental and biological tests were carried out analysing variations of the concentration of the metabolite in urine corresponding to different working conditions. Environmental exposure was evaluated in each work place using active personal monitors and measured by gas chromatography (GC). Dichloromethane extracts of the urine samples collected at the end of the working shifts were analysed, before (determining free 2,5-HD, the toxic metabolite) and after acid hydrolysis (pH 0.1) (yielding the total 2,5-HD) and also by GC. The concentration of conjugated metabolite 4,5-dihydroxy-2-hexanone was calculated from the difference between total and free 2,5-HD.

RESULTS

Free 2,5-HD represented an average of 14.2% of the total 2,5-HD determined in urine, and this percentage increased significantly (P<0.01) with higher environmental levels of acetone. Other factors, such as absorption through the skin (depending on the use of gloves) and the day on which samples were taken also significantly affected the relation between the two indicators and their respective relationships with environmental concentrations of n-hexane.

CONCLUSION

Although analyses of the relationship between the levels of atmospheric n-hexane and those of metabolites in urine show a greater correlation for total 2,5-HD than for free 2,5-HD, our results suggest that free 2,5-HD could be a better indicator in evaluating risk of exposure to n-hexane, since the concentration is directly related to the neurotoxic effect.

Partial conduction blocks in N-hexane neuropathy

Nerve conduction blocks, defined by a significant reduction in amplitude or area of the compound muscle action potential at proximal compared with distal sites of stimulation, have been described in glue-sniffers and in workers with industrial exposure at an early stage of n-hexane neuropathy. The frequency with which this focal conduction anomaly appears is described and discussed in the case of a very homogeneous group of 10 young workers diagnosed with n-hexane polyneuropathy. Partial conduction blocks occurred in only two workers and may have been related to the intensity and duration of toxic exposure.

A comparison of electrophysiological tests for the early diagnosis of diabetic neuropathy

Clinical criteria and several electrophysiological parameters for detecting nerve damage were compared in 99 patients with diabetes mellitus type 1 and type 2. Abnormal results were found in sural/radial amplitude ratio (51%), minimal F-wave latency of the tibial nerve (36.4%), sensory conduction velocity of the sural nerve (29.8%), and sural sensory nerve action potential amplitude (29.3%) when pooling data from all patients and comparing them to age- and height-matched normal control subjects. Analysis of all the parameters revealed large differences between the diabetes mellitus type 1 and type 2 groups, suggesting that the type of diabetes must be taken into account when comparing the sensitivity of nerve conduction tests. In diabetes mellitus type 1, the sural/radial ratio had the clearest correlation with course of illness and was the first parameter to show a significant reduction. We conclude that the simple ratio between sural and radial amplitudes is a very sensitive parameter and abnormalities in this ratio provide the means for earliest detection of neuropathy in diabetes mellitus type 1.

Relationship between 2,5-hexanedione concentrations in nerve, serum, and urine alone or under co-treatment with different doses of methyl ethyl ketone, acetone, and toluene

To ascertain the relationship among 2,5-hexanedione (2,5-HD) concentrations in nerve, serum and urine, rats were injected subcutaneously with 2.6 mmol/kg 2,5-HD alone, or together with 2.6 or 13.0 mmol/kg of methyl ethyl ketone, acetone and toluene. 2,5-HD concentrations in sciatic nerve (NC), serum (SC) and urine (UC) were determined, and the linear regression between each two of NC, SC, and UC were calculated. There was good correlation between NC and SC, SC and UC in the 2,5-HD alone group, and good correlation between NC and SC in the co-treated groups. Co-treatment solvent had little effect on the relationship between SC and NC. 13.0 mmol/kg co-treated solvent tended to decrease the regression coefficients compared with 2.6 mmol/kg co-treated solvent. These results show that SC can be used in estimating NC in the 2,5-HD alone or co-treated groups, and UC can be used in estimating SC in the 2,5-HD alone group.

n-Hexane neuropathy due to rubber cement sniffing

n-Hexane neuropathy has been described after glue sniffing and industrial exposure. Onset may be subacute and reminiscent of Guillain-Barré syndrome. Although the primary pathology is axonal, electrophysiologic evaluation is frequently most remarkable for conduction slowing. We describe a patient with a severe subacute neuropathy following n-hexane exposure via glue sniffing. Although symptoms worsened after termination of exposure ("coasting"), strength gradually improved to near normal. Sources of toxic exposure should be sought in all patients with subacute demyelinating neuropathies.

Solvents and neurotoxicity

We describe the clinical evaluation of the nervous-system effects of solvent exposure. We review the current evidence in the epidemiological literature on neurotoxicological effects of solvents, and outline methods and issues to be taken into account in assessment of the patient whose symptoms may be related to solvent toxicity. Primary prevention of these disorders is essential, because treatment options are limited.

The nature of uncoupling by n-hexane, 1-hexanethiol and 1-hexanol in rat liver mitochondria

We have analyzed the effects of n-hexane, 1-hexanethiol, and 1-hexanol on the coupled respiration of rat liver mitochondria. Incubation of mitochondria with n-hexane, 1-hexanethiol and 1-hexanol resulted in a stimulation, at low concentrations, and an inhibition, at high concentrations, of the state 4 mitochondrial respiration. Three criteria, all based on the comparison with the effect of DNP, have been used to establish whether the stimulation of respiration, at low concentrations of n-hexane, 1-hexanethiol, and 1-hexanol, depends on protonophoric mechanisms. First, the quantitative relationship between the extents of respiratory stimulation and membrane potential depression: a strong decrease of membrane potential was induced by increasing concentrations of DNP and a negligible depression by increasing concentrations of n-hexane or 1-hexanethiol. Only a slight decrease was induced by 1-hexanol. Second, the quantitative relationship between the extents of respiratory stimulation and of proton conductance increase: at equivalent rates of respiration, the enhancement of the proton conductance induced by DNP was very marked, by n-hexane and 1-hexanethiol practically negligible, and by 1-hexanol much smaller than that induced by DNP. Third, in titrations with redox inhibitors of the proton pumps, the pattern of the relationship between proton pump conductance and membrane potential was markedly different from protonophoric and non-protonophoric uncouplers: almost linear in the case of DNP, highly non-linear in the case of n-hexane, 1-hexanethiol and 1-hexanol. These three criteria support the view that n-hexane, 1-hexanethiol, and partially 1-hexanol, uncouple mitochondrial respiration by a non-protonophoric mechanism.

Behaviour of urinary 2,5-hexanedione in occupational co-exposure to n-hexane and acetone

We analysed the relationship between free 2,5-hexanedione (2,5-HD) and total 2,5-HD in the urine of 87 workers exposed to n-hexane and other solvents (hexane isomers, acetone and toluene), in relation to different working conditions. The concentration of free 2,5-HD in urine of workers exposed to n-hexane was about 12% of total urinary 2,5-HD. The most significant correlation (r = 0.936) was that of total 2,5-HD in urine with environmental n-hexane and exhaled air. With equal exposure to n-hexane, the concentrations in urine of free and total 2,5-HD increased when cutaneous absorption was involved (gloves not used), during the working week and with co-exposure to acetone. An analysis of the relationship between combined exposure to acetone and urinary concentrations of the various forms of 2,5-HD suggests that acetone might influence the toxicokinetics of n-hexane, increasing the proportion of free 2,5-HD.