Case files of the University of Cincinnati fellowship in medical toxicology: two patients with acute lethal occupational exposure to hydrogen sulfide

Stable Eu3+/Cu2+-Functionalized Supramolecular Zinc(II) Complexes as Fluorescent Probes for Turn-On and Ratiometric Detection of Hydrogen Sulfide

Fabrication of dual-emitting materials for H₂S sensing under environmental and biological conditions is currently of great interest. In this work, a new chemically stable metal supramolecular complex [Zn₂(pda)₂(H₂O)₃]·(H₂O)_0.5 (Znpda, pda = 1,10-phenanthroline-2,9-dicarboxylic acid), with accessible uncoordinated carboxylic oxygen sites, is solvothermally synthesized. It can serve as a host in luminescent hybrid composites. By incorporating Eu³⁺ and Cu²⁺ in the supramolecular coordination network, we obtained the dual-emitting hybrid material Eu³⁺/Cu²⁺@Znpda, which simultaneously shows intense ligand and weak Eu³⁺ emissions in HEPES buffer solution. Since H₂S can easily chelate with Cu²⁺ and recover the blocked "antenna effect" between the ligand and Eu³⁺, Eu³⁺/Cu²⁺@Znpda possesses both the turn-on and ratiomectric fluorescence response to H₂S. Accordingly, we designed an IMPLICATION logic gate for H₂S recognition by employing the fluorescence intensity ratio between the ligand and Eu³⁺ as the output signal. In addition, Eu³⁺/Cu²⁺@Znpda shows a fast response (<1 min) and high sensitivity (1.45 μM) to H₂S over other interfering species in the HEPES buffer solution, highlighting its potential use for H₂S sensing under environmental and biological conditions.

Engineering of bioactive metal sulfide nanomaterials for cancer therapy

Metal sulfide nanomaterials (MeSNs) are a novel class of metal-containing nanomaterials composed of metal ions and sulfur compounds. During the past decade, scientists found that the MeSNs engineered by specific approaches not only had high biocompatibility but also exhibited unique physicochemical properties for cancer therapy, such as Fenton catalysis, light conversion, radiation enhancement, and immune activation. To clarify the development and promote the clinical transformation of MeSNs, the first section of this paper describes the appropriate fabrication approaches of MeSNs for medical science and analyzes the features and limitations of each approach. Secondly, we sort out the mechanisms of functional MeSNs in cancer therapy, including drug delivery, phototherapy, radiotherapy, chemodynamic therapy, gas therapy, and immunotherapy. It is worth noting that the intact MeSNs and the degradation products of MeSNs can exert different types of anti-tumor activities. Thus, MeSNs usually exhibit synergistic antitumor properties. Finally, future expectations and challenges of MeSNs in the research of translational medicine are spotlighted.

Rapid and simple colorimetric detection of hydrogen sulfide using an etching-resistant effect on silver nanoprisms

A fast and sensitive colorimetric paper sensor has been developed using silver nanoprisms (Ag NPRs) with an edge length of ~50 nm for the detection of free H₂S gas. We prepared two types of Ag NPRs-coated H₂S sensing papers: a multi-zone patterned paper for passive (diffusion mode), and a single-zone patterned paper for pumped mode of H₂S gas. The change in color intensity was quantitatively analyzed of Ag NPRs-coated paper after KCl treatment depending on the concentration of H₂S gas, from yellow to purplish brown. As a result, Ag NPRs-coated H₂S sensing paper showed good sensitivity with a linear range of 1.03 to 32.9 μM H₂S, high selectivity, and good reproducibility and stability, together with a fast response time of 1 min. The developed H₂S sensing paper was applied to detect the free H₂S gas released from three types of garlic including crushed, peeled, and fresh garlic. Therefore, it can be utilized as a simple, fast, and reliable tool for on-site colorimetric detection of free H₂S gas for quality control of dietary supplements and exhaled breath analysis.Graphical abstract.

Proteomics analysis of lung reveals inflammation and cell death induced by atmospheric H2S exposure in pig

Hydrogen sulfide (H₂S) is a popular toxic environmental gas and industrial pollutant, which can be harmful to multiple organ systems of both human and livestock, especially to the respiratory system. However, the injury mechanism of H₂S exposure to lung remains poorly understood. In this study, pig lung was selected as a H₂S exposure model for the first time. We first examined the histological damage and the mRNA expression of pro-inflammatory genes of lung in pigs exposed to H₂S. Histopathology change and increased mRNA level of pro-inflammatory cytokines demonstrated that H₂S exposure indeed induced inflammatory injury in the porcine lung. We then performed TMT-based quantitative proteomics analysis to probe the injury molecular mechanism. The proteomics results showed that 526 proteins have significant changes in abundance between control and H₂S treated swine. Further validation analysis of some H₂S responsive proteins using both Real-time quantitative PCR and western blotting demonstrated that proteomics data are reliable. KEGG pathway analysis revealed that these proteins were involved in antigen processing and presentation, complement and coagulation cascade, IL-17 signaling pathway, ferroptosis and necroptosis. Our data suggest that H₂S exposure induced immune suppression, inflammatory response and cell death. These findings provide a new insight into the complexity mechanisms of H₂S induced lung injury, and offer therapeutic potential as drug targets with a view towards curing the intoxication caused by H₂S.

Smart H2S-Triggered/Therapeutic System (SHTS)-Based Nanomedicine

Hydrogen sulfide (H2S) is of vital importance in several biological and physical processes. The significance of H2S-specific detection and monitoring is emphasized by its elevated levels in various diseases such as cancer. Nanotechnology enhances the performance of chemical sensing nanoprobes due to the enhanced efficiency and sensitivity. Recently, extensive research efforts have been dedicated to developing novel smart H2S-triggered/therapeutic system (SHTS) nanoplatforms for H2S-activated sensing, imaging, and therapy. Herein, the latest SHTS-based nanomaterials are summarized and discussed in detail. In addition, therapeutic strategies mediated by endogenous H2S as a trigger or exogenous H2S delivery are also included. A comprehensive understanding of the current status of SHTS-based strategies will greatly facilitate innovation in this field. Lastly, the challenges and key issues related to the design and development of SHTS-based nanomaterials (e.g., morphology, surface modification, therapeutic strategies, appropriate application, and selection of nanomaterials) are outlined.

Hydrogen sulfide exposure induces jejunum injury via CYP450s/ROS pathway in broilers

Hydrogen sulfide (H₂S) is generally recognized as a highly poisonous environmental and industrial pollutant. Previous toxicological studies of H₂S are mainly focused on the nervous and cardiovascular system. There are few reports on the H₂S toxicity effects on jejunum to our knowledge. Our study examined the morphological changes and antioxidant functions of broiler jejunum after the 42-day exposure to H₂S. Effects of H₂S on morphological damage and immune function in the broiler jejunum were analyzed from the perspective of CYP450s and oxidative stress via transcriptomics and quantitative real-time PCR (qRT-PCR). It was found that the activities of GPx, CAT, SOD, and T-AOC and the level of GSH were observably decreased (P < 0.05), while the contents of MDA and H₂O₂ were remarkably increased (P < 0.05) in the jejunums of broilers exposed to H₂S, which undergone a process of oxidative stress, and typical inflammatory changes and apoptosis could be observed. Transcriptional profiling results showed that 208 genes were significantly up-regulated while 295 genes were remarkably down-regulated in H₂S group. The expression of CYP450s, inflammation and apoptosis-related genes were also significantly increased. In conclusion, H₂S led to the redox homeostasis disorder through CYP450s differential expression in broiler jejunum. The jejunal inflammatory response, apoptosis along with the immune dysfunction were subsequently observed, which eventually caused jejunal morphology and functional damage. The present study further enriches and perfects the mechanism theory of H₂S toxicity on broilers, which may be valuable for the risk assessment of H₂S and human health protection.

A Case of Survival: Myocardial Infarction and Ventricular Arrhythmia Induced by Severe Hydrogen Sulfide Poisoning

Most cases of acute hydrogen sulfide (H2S) poisoning in China are caused by sewage processing. With the rapid development of urbanization in China, H2S poisoning is showing an increasing trend. Here, we report a case of survival from severe H2S poisoning. A 40-year-old worker was found in the underground sewer lines. He was unresponsive with bilaterally dilated pupils and had poor oxygen saturation. After intubation, he was transferred to the intensive care unit. He developed respiratory failure, acute myocardial infarction, ventricular arrhythmia and left ventricular function impairment, requiring artificial ventilation with highly concentrated oxygen, hyperbaric oxygen treatment and drug therapy. Consequently, he completely recovered from the respiratory and cardiac failure. Cases of survival after severe H2S intoxication have been rarely reported. Such exposures may bring about severe myocardial impairment, which is most likely to benefit from angiotensin-converting enzyme inhibition and β-blocker.

A gas chromatography-mass spectrometry based study on serum metabolomics in rats chronically poisoned with hydrogen sulfide

Hydrogen sulfide poisoning is a common occupational hazard, whose mortality and incidence rates are first and second, respectively, among occupational poisoning incidents in China. The main target organs of its toxicity are in the central nervous system and respiratory system. However, there are currently no specific direct tests that can be used to diagnose poisoned patients. In this study, we developed a serum metabonomic method using orthogonal partial least squares-discriminate analysis (OPLS-DA), based on gas chromatography-mass spectrometry (GC/MS) to evaluate the effect of chronic poisoning by hydrogen sulfide in rats. The OPLS-DA data demonstrated that the model group (n = 60) differed significantly from the control group (n = 30), suggesting that the metabolic profiles of the two groups are markedly different. Alterations in the levels of some metabolites such as citrate, galactose, lactate, mannose, inositol, urea, phosphate, alanine and valine were detected by OPLS-DA analysis. We observed changes in metabolic pathways including lipid metabolism, energy metabolism and amino metabolism in the model group. Our results indicate that GC/MS-based metabonomic methods may provide novel detection means for chronic hydrogen sulfide poisoning.

Hydrogen sulfide intoxication

Hydrogen sulfide (H2S) is a hazard primarily in the oil and gas industry, agriculture, sewage and animal waste handling, construction (asphalt operations and disturbing marshy terrain), and other settings where organic material decomposes under reducing conditions, and in geothermal operations. It is an insoluble gas, heavier than air, with a very low odor threshold and high toxicity, driven by concentration more than duration of exposure. Toxicity presents in a unique, reliable, and characteristic toxidrome consisting, in ascending order of exposure, of mucosal irritation, especially of the eye ("gas eye"), olfactory paralysis (not to be confused with olfactory fatigue), sudden but reversible loss of consciousness ("knockdown"), pulmonary edema (with an unusually favorable prognosis), and death (probably with apnea contributing). The risk of chronic neurcognitive changes is controversial, with the best evidence at high exposure levels and after knockdowns, which are frequently accompanied by head injury or oxygen deprivation. Treatment cannot be initiated promptly in the prehospital phase, and currently rests primarily on supportive care, hyperbaric oxygen, and nitrite administration. The mechanism of action for sublethal neurotoxicity and knockdown is clearly not inhibition of cytochrome oxidase c, as generally assumed, although this may play a role in overwhelming exposures. High levels of endogenous sulfide are found in the brain, presumably relating to the function of hydrogen sulfide as a gaseous neurotransmitter and immunomodulator. Prevention requires control of exposure and rigorous training to stop doomed rescue attempts attempted without self-contained breathing apparatus, especially in confined spaces, and in sudden release in the oil and gas sector, which result in multiple avoidable deaths.

Suicide fads: frequency and characteristics of hydrogen sulfide suicides in the United States

OBJECTIVE

To assess the frequency of hydrogen sulfide (H(2)S) suicides and describe the characteristics of victims in the United States (U.S.) since the technique became common in Japan in 2007.

METHODS

To ascertain the frequency of intentional H(2)S related deaths in the U.S. prior to the start of the Japanese trend in 2007, we searched the multiple-cause-of-death data from the National Vital Statistics System. To collect as much information about the victims as possible, we sent an email to the National Association of Medical Examiners (NAME) listserv asking for their cooperation in identifying cases of H(2)S suicide. To identify cases that were not voluntarily reported by medical examiners but were reported by the media, we conducted Google searches using the search terms: "hydrogen sulfide suicide," "H(2)S suicide," "detergent suicide," "chemical suicide," and "suicide fad." We obtained all available autopsy reports and abstracted information, including the site of the incident, the presence of a note warning others about the toxic gas and the demographic characteristics of the victims. We contacted medical examiners who potentially had custody of the cases that were identified through media reports and requested autopsies of these victims. When unable to obtain the autopsies, we gathered information from the media reports.

RESULTS

Forty-five deaths from H(2)S exposure occurred in the U.S. from 1999 to 2007, all unintentional. Responses from the NAME listserv yielded autopsy reports for 11 victims, and Google searches revealed an additional 19 H(2)S suicides in the U.S. since 2008. Overall (n=30), two cases were identified during 2008, 10 in 2009, and 18 in 2010. The majority of victims were white males, less than 30-years-old, left a warning note, and were found in cars. There were five reports of injuries to first responders, but no secondary fatalities.

CONCLUSION

H(2)S suicides are increasing in the U.S., and their incidence is probably underestimated by public health officials and physicians. First responders are at risk when assessing these victims due to the severe toxicity of the gas. Emergency providers must be aware of H(2)S suicides to educate others and care for the rare survivor.

Hydrogen Sulfide

Hydrogen sulfide is a relatively common, frequently lethal, and unique occupational hazard for which research since 1990 has uncovered many anomalies and subtleties and a previously unsuspected physiological role for the endogenous agent. The result has been uncertainty and misunderstanding, particularly for persons new to the literature. This review addresses evidence that settles past controversies, guides practical issues in evaluating human toxicity, addresses unresolved issues involving chronic exposure, and points the way to a deeper understanding of the agent and its effects.

Hydrogen sulfide exposure in an adult male

Hydrogen sulfide (H(2)S) is responsible for many incidents of occupational toxic exposure, especially in the petroleum industry. The clinical effects of H(2)S depend on its concentration and the duration of exposure. H(2)S is immediately fatal when concentrations are over 500-1000 parts per million (ppm) but exposure to lower concentrations, such as 10-500 ppm, can cause various respiratory symptoms that range from rhinitis to acute respiratory failure. H(2)S may also affect multiple organs, causing temporary or permanent derangements in the nervous, cardiovascular, renal, hepatic, and hematological systems. We present a case of occupational exposure to H(2)S leading to multi-organ involvement, acute respiratory failure, organizing pneumonia, and shock resembling acute sepsis. The patient also developed mild obstructive and restrictive pulmonary disease and peripheral neuropathy.