Comparison of the ultrastructural myopathy induced by anticholinesterase agents at the end plates of rat soleus and extensor muscles

Donepezil inhibits neuromuscular junctional acetylcholinesterase and enhances synaptic transmission and function in isolated skeletal muscle

BACKGROUND AND PURPOSE

Donepezil, a piperidine inhibitor of acetylcholinesterase (AChE) prescribed for treatment of Alzheimer's disease, has adverse neuromuscular effects in humans, including requirement for higher concentrations of non-depolarising neuromuscular blockers during surgery. Here, we examined the effects of donepezil on synaptic transmission at neuromuscular junctions (NMJs) in isolated nerve-muscle preparations from mice.

EXPERIMENTAL APPROACH

We measured effects of therapeutic concentrations of donepezil (10 nM to 1 μM) on AChE enzymic activity, muscle force responses to repetitive stimulation, and spontaneous and evoked endplate potentials (EPPs) recorded intracellularly from flexor digitorum brevis muscles from CD01 or C57BlWldS mice.

KEY RESULTS

Donepezil inhibited muscle AChE with an approximate IC50 of 30 nM. Tetanic stimulation in sub-micromolar concentrations of donepezil prolonged post-tetanic muscle contractions. Preliminary Fluo4-imaging indicated an association of these contractions with an increase and slow decay of intracellular Ca2+ transients at motor endplates. Donepezil prolonged spontaneous miniature EPP (MEPP) decay time constants by about 65% and extended evoked EPP duration almost threefold. The mean frequency of spontaneous MEPPs was unaffected but the incidence of 'giant' MEPPs (gMEPPs), some exceeding 10 mV in amplitude, was increased. Neither mean MEPP amplitude (excluding gMEPPs), mean EPP amplitude, quantal content or synaptic depression during repetitive stimulation were significantly altered by concentrations of donepezil up to 1 μM.

CONCLUSION AND IMPLICATIONS

Adverse neuromuscular signs associated with donepezil therapy, including relative insensitivity to neuromuscular blockers, are probably due to inhibition of AChE at NMJs, prolonging the action of ACh on postsynaptic nicotinic acetylcholine receptors but without substantively impairing evoked ACh release.

"Calcium bombs" as harbingers of synaptic pathology and their mitigation by magnesium at murine neuromuscular junctions

Excitotoxicity is thought to be an important factor in the onset and progression of amyotrophic lateral sclerosis (ALS). Evidence from human and animal studies also indicates that early signs of ALS include degeneration of motor nerve terminals at neuromuscular junctions (NMJs), before degeneration of motor neuron cell bodies. Here we used a model of excitotoxicity at NMJs in isolated mouse muscle, utilizing the organophosphorus (OP) compound omethoate, which inhibits acetylcholinesterase activity. Acute exposure to omethoate (100 μM) induced prolonged motor endplate contractures in response to brief tetanic nerve stimulation at 20-50 Hz. In some muscle fibers, Fluo-4 fluorescence showed association of these contractures with explosive increases in Ca²⁺ ("calcium bombs") localized to motor endplates. Calcium bombs were strongly and selectively mitigated by increasing Mg²⁺ concentration in the bathing medium from 1 to 5 mM. Overnight culture of nerve-muscle preparations from Wld^S mice in omethoate or other OP insecticide components and their metabolites (dimethoate, cyclohexanone, and cyclohexanol) induced degeneration of NMJs. This degeneration was also strongly mitigated by increasing [Mg²⁺] from 1 to 5 mM. Thus, equivalent increases in extracellular [Mg²⁺] mitigated both post-synaptic calcium bombs and degeneration of NMJs. The data support a link between Ca²⁺ and excitotoxicity at NMJs and suggest that elevating extracellular [Mg²⁺] could be an effective intervention in treatment of synaptic pathology induced by excitotoxic triggers.

Antagonistic postsynaptic and presynaptic actions of cyclohexanol on neuromuscular synaptic transmission and function

Intentional ingestion of agricultural organophosphorus insecticides is a significant public health issue in rural Asia, causing thousands of deaths annually. Some survivors develop a severe, acute or delayed myasthenic syndrome. In animal models, similar myasthenia has been associated with increasing plasma concentration of one insecticide solvent metabolite, cyclohexanol. We investigated possible mechanisms using voltage and current recordings from mouse neuromuscular junctions (NMJs) and transfected human cell lines. Cyclohexanol (10-25 mM) reduced endplate potential (EPP) amplitudes by 10-40% and enhanced depression during repetitive (2-20 Hz) stimulation by up to 60%. EPP decay was prolonged more than twofold. Miniature EPPs were attenuated by more than 50%. Cyclohexanol inhibited whole-cell currents recorded from CN21 cells expressing human postjunctional acetylcholine receptors (hnAChR) with an IC₅₀ of 3.74 mM. Cyclohexanol (10-20 mM) also caused prolonged episodes of reduced-current, multi-channel bursting in outside-out patch recordings from hnAChRs expressed in transfected HEK293T cells, reducing charge transfer by more than 50%. Molecular modelling indicated cyclohexanol binding (-6 kcal/mol) to a previously identified alcohol binding site on nicotinic AChR α-subunits. Cyclohexanol also increased quantal content of evoked transmitter release by ∼50%. In perineurial recordings, cyclohexanol selectively inhibited presynaptic K⁺ currents. Modelling indicated cyclohexanol binding (-3.8 kcal/mol) to voltage-sensitive K⁺ channels at the same site as tetraethylammonium (TEA). TEA (10 mM) blocked K⁺ channels more effectively than cyclohexanol but EPPs were more prolonged in 20 mM cyclohexanol. The results explain the pattern of neuromuscular dysfunction following ingestion of organophosphorus insecticides containing cyclohexanol precursors and suggest that cyclohexanol may facilitate investigation of mechanisms regulating synaptic strength at NMJs. KEY POINTS: Intentional ingestion of agricultural organophosphorus insecticides is a significant public health issue in rural Asia, causing thousands of deaths annually. Survivors may develop a severe myasthenic syndrome or paralysis, associated with increased plasma levels of cyclohexanol, an insecticide solvent metabolite. Analysis of synaptic transmission at neuromuscular junctions in isolated mouse skeletal muscle, using isometric tension recording and microelectrode recording of endplate voltages and currents, showed that cyclohexanol reduced postsynaptic sensitivity to acetylcholine neurotransmitter (reduced quantal size) while simultaneously enhancing evoked transmitter release (increased quantal content). Patch recording from transfected cell lines, together with molecular modelling, indicated that cyclohexanol causes selective, allosteric antagonism of postsynaptic nicotinic acetylcholine receptors and block of presynaptic K⁺ -channel function. The data provide insight into the cellular and molecular mechanisms of neuromuscular weakness following intentional ingestion of agricultural organophosphorus insecticides. Our findings also extend understanding of the effects of alcohols on synaptic transmission and homeostatic synaptic function.

Impaired neuromuscular function by conjoint actions of organophosphorus insecticide metabolites omethoate and cyclohexanol with implications for treatment of respiratory failure

BACKGROUND

Ingestion of agricultural organophosphorus insecticides is a significant cause of death in rural Asia. Patients often show acute respiratory failure and/or delayed, unexplained signs of neuromuscular paralysis, sometimes diagnosed as "Intermediate Syndrome". We tested the hypothesis that omethoate and cyclohexanol, circulating metabolites of one agricultural formulation, cause muscle weakness and paralysis.

METHODS

Acetylcholinesterase activity of insecticide components and metabolites was measured using purified enzyme from eel electroplaque or muscle homogenates. Mechanomyographic recording of pelvic limb responses to nerve stimulation was made in anaesthetized pigs and isometric force was recorded from isolated nerve-muscle preparations from mice. Omethoate and cyclohexanol were administered intravenously or added to physiological saline bathing isolated muscle. We also assessed the effect of MgSO₄ and cooling on neuromuscular function.

RESULTS

Omethoate caused tetanic fade in pig muscles and long-lasting contractions of the motor innervation zone in mouse muscle. Both effects were mitigated, either by i.v. administration of MgSO₄ in vivo or by adding 5 mM Mg²⁺ to the medium bathing isolated preparations. Combination of omethoate and cyclohexanol initially potentiated muscle contractions but then rapidly blocked them. Cyclohexanol alone caused fade and block of muscle contractions in pigs and in isolated preparations. Similar effects were observed ex vivo with cyclohexanone and xylene. Cyclohexanol-induced neuromuscular block was temperature-sensitive and rapidly reversible.

CONCLUSIONS

The data indicate a crucial role for organophosphorus and solvent metabolites in muscle weakness following ingestion of agricultural OP insecticide formulations. The metabolites omethoate and cyclohexanol acted conjointly to impair neuromuscular function but their effects were mitigated by elevating extracellular Mg²⁺ and decreasing core temperature, respectively. Clinical studies of MgSO₄ therapy and targeted temperature management in insecticide-poisoned patients are required to determine whether they may be effective adjuncts to treatment.

Creatine phosphate kinase elevations signaling muscle damage following exposures to anticholinesterases: 2 sentinel patients

In this study, the authors describe 2 patients who experienced confirmed exposures to anticholinesterases that commenced in the 1970s. Subsequently, elevations in creatine phosphate kinase (CPK) were initially detected more than a decade following the first acute exposure. Beginning in the early 1980s, the patients suffered from progressive generalized muscle weakness, chronic fatigue, myopathy, neuropathy, and severe neurobehavioral impairments. Previous occupational exposures included pyridostigmine, as well as isopropyl methylphosphonofluoridate (percutaneous lethal dose [LD50] < 28 mg/kg body weight), and 1 patient had exposure to agricultural organophosphates. The authors hypothesize that the workers' CPK elevations, first detected more than a decade following acute exposures to anticholinesterases, were sentinel events for impending muscle damage and necrosis. Many Gulf War veterans with Gulf War disease who reported exposures to anticholinesterases 1 decade earlier currently suffer from vague neuromuscular and cognitive impairments. Therefore, medical programs for Gulf War veterans with Gulf War Syndrome should include surveillance for elevated CPK, abnormalities of neuromuscular conduction, and genetic susceptibility, and they should promote therapeutic trials for palliation.

The effects of toxins on muscle

Substances known to be myotoxic are reviewed, including descriptions of the resultant clinical syndromes and the mechanisms important in their development. Certain host characteristics such as altered immune and metabolic regulation are known to modulate the effects of individual myotoxins, producing varied clinical syndromes. Evaluation procedures important in identifying a toxin-induced myopathy are described.

Effects of exposure to low-dose pyridostigmine on neuromuscular junctions in vitro

During the Persian Gulf War, pyridostigmine bromide (PB), a reversible inhibitor of acetylcholinesterase, was used as prophylaxis against exposure to nerve gas. Exposure to PB has been suggested as a potential cause of the persistent fatigue reported among Gulf War veterans. The aim of this study was to evaluate the effects of acute and continuous exposure to low doses of PB on the neuromuscular junction. Organotypic spinal cord-muscle cocultures were used to examine in vitro the effects of PB under controlled conditions. Acute exposure to PB potentiated neuromuscular activity. Continuous exposure to PB produced a progressive decrease in the contractile activity of muscle fibers. Ultrastructural examination by electron microscopy revealed no abnormalities in the neuromuscular junctions after 1 week of exposure. Nerve terminal degeneration and atrophy of the postjunctional folds were evident after 2-week exposure to low-dose PB. The effects of PB were reversible following withdrawal. The reversibility of the PB-induced changes in vitro suggests that such changes are causally unrelated to the fatigue reported by Persian Gulf War veterans years after exposure to PB.

Neuromuscular responses to pyridostigmine bromide in organotypic spinal cord-muscle culture

Pyridostigmine bromide (PB) promotes and then silences cholinergic muscle activity, and disrupts the junctional regions of muscle fibers and associated nerve terminals, in organotypic mouse spinal cord-muscle cultures continuously treated with low concentrations of the drug for up to 14 days. Spontaneous muscle activity is restored within 1 week of drug removal.

Toxic myopathies

Toxic myopathies may occur with a variety of prescribed medications, illicit drug abuse, or other toxins. The article discusses an overview of some of the compounds that may cause myopathy, the clinical and laboratory features, histology, mechanisms of action, and potential risk factors of myopathy. The ability to recognize these syndromes is essential to avoid unnecessary tests and to avoid delay in treatment, especially in critically ill patients or patients with other neuromuscular diseases.

Effects of myotoxins on skeletal muscle fibers

This review highlights various aspects of a number of experimental myological alterations, induced by different chemical toxicants, including anticholinesterase, colchicine, vincristine, chloroquine, tetanus toxin, botulinum toxin, reserpine and emetine. Despite their chemical diversity and mechanism(s) of action, it is evident from the data discussed here that remarkably different toxic agents exert quite similar effects and induce toxic myopathies. The latter include preferential involvement of slow-twitch red muscle, mitochondrial derangement, denervation-like alterations, formation of membranous whorls, tubular aggregates, autophagic vacuoles and axonal sprouts. The non-invasive experimental models discussed here are valuable in studying various aspects of myopathology in the absence of any mechanical damage to the innervating elements from neurons to axonal terminals.

Role of muscle fasciculations in the generation of myopathies in mammalian skeletal muscle

The myotoxicity of pyridostigmine bromide was investigated on rat diaphragm nerve-muscle preparations in vitro. Within 2 h of exposure to pyridostigmine (2 microM), diaphragm muscles exhibited ultrastructural alterations characterized by swelling of subjunctional mitochondria and disorganization of contractile proteins. These alterations developed both in the absence and presence of electrical stimulation of the phrenic nerve, and were accompanied by continuous muscle fasciculations. Pretreatment by tetrodotoxin suppressed both the muscle fasciculations and the appearance of myopathies. These findings suggest that fasciculations may be an important contributing factor in the development of anti-cholinesterase-induced myopathies.

Origin and significance of acetylcholine and choline in plasma and serum from normal and paretic cows

Before the onset of bovine paresis a stage of hyperactivity and hypersensitivity was observed in clinical as well as in immunologically provoked cases. By gas chromatographic analysis of choline (Ch) in plasma and serum from four immunologically provoked cows this stage was verified to be an initial immuno-cholinergic hyperactivation. In the first hour after antigen challenge with 0.5 mg nematode AChE there was a very sharp rise in Ch mainly from agonist-stimulated and phospholipase mediated phosphatidylcholine (PC) breakdown. A secondary massive influx of Ca into cells was mirrored in a 1 mmol/l depression of serum-Ca values during the first hours. The hyperagonism mediated Ca-translocation brought water into cells, resulting in reduced plasma volume. The generally supposed mechanism of secondary, Ca-mediated cell damage and cell death was initiated and sometimes resulted in "Downers" with persisting paralysis. All acetylcholine (ACh)-stimulated parts from CNS to the periphery are irregularly involved explaining the very varied clinical appearance of bovine paresis, and the influence on for instance the autonomous nerve system, adrenals and pancreas. In the experimental group, ACh in plasma showed a sharp fall within the first hour, while there were fairly constant values of serum-ACh in the first four hours, possibly indicating some antibody protection. When paresis was established between 15-28 hours after challenge the general anergetic state was characterised by low ACh-levels. Also in a larger field group ACh-levels were significantly depressed in paretic compared to healthy cows. The unexpected finding in this group was considerably higher levels of ACh and especially Ch in serum compared to plasma. The origin of ACh and Ch had to be blood cells. Preliminary gas chromatographic analysis has confirmed ACh-synthesis by leucocytes and an integrated immuno-cholinergic system of great importance can be anticipated. The general feature of bovine paresis is updated by immune-etiological, pathophysiological, blood chemical, clinical-experimental and nomenclature considerations. The exact mechanism of pathogenesis is not revealed in this investigation, though many circumstances favour an anti-Id mediated hyperagonism. Other types of investigations and above all more basic knowledge of distribution and functional character of cholinergic components on immune cells are required.

Morphological and electrophysiological study of distal motor nerve fiber degeneration and sprouting after irreversible cholinesterase inhibition

A single subcutaneous injection of a sublethal dose of the irreversible organophosphate sarin (0.08 mg/kg) in rats induced a non-Wallerian-type axonal degeneration of the neuromuscular synapse in the slow twitch, soleus muscle. These alterations of the endplate region were more obvious in the soleus than in the fast extensor digitorum longus muscle and were slowly reversible, complete recovery requiring about 10 days. Silver-cholinesterase staining and electrophysiological techniques were used to define the spatiotemporal evolution of prejunctional abnormalities. The non-Wallerian-type axonal degeneration of the neuromuscular synapse was characterized by bead or balloon-like varicosities of the focal, distal, and terminal nerve fibers and a retraction of terminal axons. Axonal degeneration was accompanied by junctional and extrajunctional membrane depolarization and was followed by nerve sprouting at focal, distal, and terminal nerve fibers. Transients similar to miniature endplate potentials were recorded along the muscle fiber at distances of 800-2500 microns away from the parent endplate. New ectopic endings, originating from the same endplate, were discovered adjacent to the terminal axon and also distant from the parent endplate. Very elaborate terminal arborization and occasional multibranching arose from a progressive growth sprout. The new sprouting may have served to compensate for the loss of synaptic contact caused by sarin. Thus the present study demonstrates a direct cytotoxic effect of sarin and indicates that this organophosphate agent may be an important neurotoxicological tool to understand the mechanisms involved in nerve sprouting.

Myopathic alterations in extraocular muscle of rats subchronically fed pyridostigmine bromide

To determine if alterations in extraocular muscle morphology occur after subchronic oral administration of pyridostigmine bromide, rats were continuously fed 90 mg/kg in meal and examined at 1, 2, 4, 7, and 15 days. Within the first day, blood acetylcholinesterase activity was reduced by 87% and remained inhibited by 74-91% during the study. Light microscopy demonstrated that by day 1 approximately 3% of the extraocular myofibers were shrunken and invaded by inflammatory cells. The most severe degenerative changes consisting of vacuoles and inflammatory cell infiltration occurred at day 1 with progressively less severe changes at days 2 and 4. At days 7 and 15, 1.3-4.5% of the myofibers still exhibited damage. Ultrastructurally, all presynaptic areas were normal but the postsynaptic areas of affected myofibers at days 1, 2, and 4 showed myofilament and Z-band dissolution, mitochondrial inclusions, subneural fold and T-tubule/sarcoplasmic reticulum vacuolization and subneural fold depth reduction. By days 7 and 15, these changes were diminished in some cases and in others alterations appeared similar to day 1. We conclude that subchronic feeding of pyridostigmine bromide induces myopathic rather than neurogenic changes in rat extraocular muscle and that the myopathy is different in these muscles than in the diaphragm from the the same rats.

Calcium channel blocker influences the density of alpha-actinin labeling at the rat neuromuscular junction

Alpha-actinin is a muscle protein located along the Z-disc. Incubation of frog muscle with the calcium ionophore, A23187, can decrease the immunogold labelling of alpha-actinin. Pyridostigmine (PYR) is an inhibitor of acetylcholinesterase, which causes disruption of Z-discs only in the region of the motor endplate. This is probably due to excess influx of calcium ions, leading to activation of proteases. Pretreating animals with the calcium channel blocker diltiazem can significantly reduce damage to the Z-discs at the motor endplate caused by PYR. It was of interest to determine whether the distribution of alpha-actinin had been altered following PYR administration and whether diltiazem could prevent those changes. There was less alpha-actinin labelling at the motor endplate compared to away from this region for all treatment groups. Animals administered diltiazem showed less labelling compared to PYR, but with no disruption of Z-discs at the motor endplate following diltiazem. Pretreatment with diltiazem reduced the incidence of Z-disc damage, but the degree of alpha-actinin labeling at the endplate was less than that seen with diltiazem alone. The greater effect seen at the endplate implies that neuromuscular activity is an important factor. The drugs may be causing a reduction in alpha-actinin labelling by different mechanisms.

Calcium channel blocker reverses anticholinesterase-induced myopathy

Inhibition of the enzyme, acetylcholinesterase (AChE), at the neuromuscular junction by pyridostigmine (PYR) results in breakdown of the postjunctional folds and dissolution of the Z-discs. It is hypothesized that excess activation of the acetylcholine (ACh) receptors by unhydrolyzed ACh results in a large influx of calcium ions. This could possibly lead to the activation of calcium-dependent proteases, resulting in the observed myopathy. Pretreatment with the calcium channel blocker, diltiazem, followed by administration of both PYR and the calcium blocker resulted in a significant reduction in the extent of muscle damage due to PYR alone. In order to ascertain whether the calcium blocker could reverse the myopathy previously induced by PYR, the AChE inhibitor was administered first, resulting in significant muscle damage, followed the next day by diltiazem. After 7 days of diltiazem treatment, with continued administration of PYR, the calcium blocker significantly reduced the myopathy at the neuromuscular junction. The results are discussed in terms of possible clinical application of diltiazem in neuromuscular diseases (i.e. muscular dystrophy).

The reversible carbamate, (-)physostigmine, reduces the size of synaptic end plate lesions induced by sarin, an irreversible organophosphate

Pretreatment of rats with atropine and the reversible esterase inhibitor physostigmine [-)PHY), prior to injection of a lethal dose of the irreversible organophosphate sarin (0.13 mg/kg), protects 100% of the animals from lethality. We have used quantitative light and qualitative electron microscopy to show that damage to the end plate region of voluntary muscles is also strikingly limited by the same pretreatment. Drug effects on soleus motor end plates detectable 1 hr after treatment were (1) a single sublethal dose of sarin (0.08 mg/kg) produced large, blistered, and severely disrupted subjucntional regions. Damage extended from the end plate, in the form of myofiber necrosis and subsequent phagocytosis; (2) (-)PHY (0.1 mg/kg) itself had a selective effect in inducing irregularities of the subjunctional sarcomere band without any gross vacuolization; (3) the morphometric analysis done with light microscopy indicated that the combination of atropine (0.5 mg/kg) and (-)PHY (0.1 mg/kg) prior to a lethal dose of sarin (0.13 mg/kg) offered 86% reduction in the average area of the lesions, relative to the dimensions of damage induced by atropine/sarin alone. In most lesions induced by (-)PHY, recognizable changes were markedly less severe in degree and extent than those seen in sarin myopathy; there were few instances of extensive muscle damage and myofiber necrosis. The relationship of the (-)PHY dose to the level of protection against sarin suggested that (-)PHY pretreatment almost completely prevents the characteristic sarin-induced myopathy and, instead, imposes the characteristic PHY-induced subjunctional swelling. In all three experimental groups examined, the myopathic changes located extrajuctionally were reversible. The mechanism by which (-)PHY acts as a protective agent is discussed.

Fine structural localization of Ca2+-ATPase activity at the frog neuromuscular junction

Ca2+-ATPase activity has been shown to be associated with the nerve terminal plasma membrane at the frog neuromuscular junction. Using a modification of the Wachstein-Meisel procedure for localization of phosphatases, a dense reaction product forms at the neuronal plasma membrane/Schwann cell interface. It has been determined that this reaction product is associated with the plasma membrane of the nerve terminal and not the plasma membrane of the Schwann cell. No ATPase activity is demonstrated at the presynaptic portion of the plasma membrane facing the synaptic gap. When a preparation is denervated, a Schwann cell process moves into the space previously occupied by the nerve. There is no ATPase activity associated with the Schwann cell plasma membrane. Conversely, when the Schwann cell is selectively injured, dense reaction product continues to be associated with the nerve terminal plasma membrane. There is some indication that this ATPase activity is dependent on the presence of Ca2+ and Mg2+. Incubation in the calmodulin inhibitor, R24571, shows little inhibition of labelling.

Enantiomer (+)physostigmine prevents organophosphate-induced subjunctional damage at the neuromuscular synapse by a mechanism not related to cholinesterase carbamylation

The natural alkaloid (-)PHY is a reversible anticholinesterase carbamate, but in contrast, its optical isomer (+)PHY, is a very weak anticholinesterase. We have shown that treatment of rats with atropine and (-)PHY prior to injections of a lethal dose of the irreversible organophosphate sarin (0.13 mg/kg) not only protected 100% of the animals from lethality but also reduced the size of the subneural lesions of the nicotinic synapses of skeletal muscle. Similar protection against lethality is provided by pretreatment with (+)PHY. At the concentration used (0.3 mg/kg), there was no detectable inhibition of AChE activity. We have examined the protection afforded by (+)PHY or (-)PHY against lethality and myopathy due to organophosphate agents such as sarin. The major alterations in the soleus motor endplates 1 hr after drug treatment were as follows: (1) A single sublethal dose of sarin (0.08 mg/kg) produced enlarged, blistered, and severely disrupted subjunctional regions, with muscle damage extending beyond the endplate to include myofiber necrosis and subsequent phagocytosis; (2) (+)PHY (0.3 mg/kg) produced no obvious damage in the postjunctional region; (3) (-)PHY (0.1 mg/kg) had a selective effect in inducing irregularities of the subjunctional sarcomere band patterns without any gross vacuolization; (4) light microscopic data indicated that the combination of atropine and (+)PHY, or of atropine and (-)PHY (0.1 mg/kg), 30 min prior to a lethal dose of sarin, offered dramatic reduction in the average dimension of lesions. Lesions were detectable in most endplates but recognizable changes were markedly less severe than those seen in sarin myopathy. Few instances of extensive muscle damage and myofiber necrosis were visible.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of diisopropylfluorophosphate and soman on rat skeletal muscle contracture during tetanic stimulation

A number of reports have documented the myopathy that accompanies exposure to irreversible acetylcholinesterase inhibitors. However, less information is available on the functional consequences of the myopathy. The purpose of this study was to examine the effects of diisopropylfluorophosphate (DFP) and soman on skeletal muscle contracture. Rats were given daily doses of DFP or soman, and the tetanic contracture of the triceps surae muscles was recorded at various exposure periods up to 20 d. DFP decreased tetanic contracture during 5-Hz stimulation. Increased stimulation up to 50 Hz did not enhance the effect. The muscles showed the greatest deficit on d 5. Continued dosing produced a slightly attenuated effect. Soman produced a frequency-dependent increase in muscle contracture. The increase was greatest on d 2 and 4, but remained elevated over the 20-d study. These results show that two drugs that presumably both raised levels of transmitter in the synaptic cleft as a result of esterase inhibition can produce either enhanced or decreased muscle contraction.

Acute tabun toxicity; biochemical and histochemical consequences in brain and skeletal muscles of rat

Male Sprague-Dawley rats injected s.c. with an acute non-lethal dose (200 micrograms/kg) of ethyl N,N-dimethylphosphoramidocyanidate (tabun) showed onset of hypercholinergic activity within 10-15 min. The maximal severity of toxicity signs was evident within 0.5-1 h and persisted for 6 h. Except for mild tremors no overt toxicity signs were evident after 24 h. Within 1 h a dramatic decline of acetylcholinesterase (AChE) activity occurred in all the brain structures (less than 3%) and skeletal muscles (less than 10% in soleus and hemi-diaphragm; and 32% in extensor digitorum longus (EDL)). No significant recovery was seen up to 48-72 h. Within 7 days rats became free of toxicity signs and AChE activity had recovered to about 40% in brain structures (except cortex, 14%) and 65-70% in skeletal muscles. Within 1 h the 16 S molecular form of AChE located at the neuromuscular junction was most severely inhibited in soleus, followed by hemi-diaphragm and least in the EDL, and had fully recovered in all the muscles when examined after day 7. Muscle fiber necrosis developed within 1-3 h in soleus and hemi-diaphragm and after a delay of 24 h in EDL. The highest number of necrotic lesions in all muscles was seen at 72 h with the hemi-diaphragm maximally affected and EDL the least. To determine detoxification of tabun by non-specific binding, the activity of butyrylcholinesterase (BuChE) and carboxylesterase (CarbE) was measured. The inhibition and recovery pattern of BuChE activity was quite similar to that of AChE, except that the rate of recovery was more rapid. Within 1 h the remaining activity of CarbE was 10% in plasma, about 30% in brain structures, and 79% in liver; recovery was complete within 7 days. The inhibition of BuChE and CarbE can serve as a protective mechanism against tabun toxicity by reducing the amount available for AChE inhibition. The prolonged AChE inhibition in muscle and brain may indicate storage of tabun and delayed release from non-enzymic sites. Since tabun is a cyanophosphorus compound, the toxic effects from the released cyanide (CN) could be another reason for the delayed recovery after tabun.

Biochemical and histochemical alterations following acute soman intoxication in the rat

Rats injected with a nonlethal acute dose (100 micrograms/kg, sc) of soman (pinacolyl methylphosphonofluoridate) exhibited signs of anticholinesterase toxicity beginning at 5-15 min with increasing severity and lasting for 4-6 hr. Generalized tremors and seizure activity indicated comparatively greater involvement of the central cholinergic system than peripheral neuromuscular effects. During peak toxicity, all the brain regions tested showed more than 95% inhibition of acetylcholinesterase (AChE) activity. The cortex area was maximally affected (99% inhibition). Among skeletal muscles, soleus AChE was most severely affected (94%) and extensor digitorum longus (EDL) the least (72%). Inhibition of EDL AChE occurred at a much slower rate than in brain and other muscles. Significant recovery of AChE activity was seen by 48-72 hr after soman treatment in both brain and skeletal muscles. By Day 7, recovery was virtually complete in skeletal muscles but not in brain, although significant recovery had occurred by this time. Muscle fiber necrosis developed within 6 hr in the soleus and diaphragm, while no necrotic fibers were found in the EDL. The 16 S AChE molecular form showed the fastest recovery of the AChE isozymes in all three muscles. Full recovery was seen after 7 days in soleus and was increased to greater than control activity in diaphragm and EDL. The inhibition pattern of butyrylcholinesterase (BuChE) activity was similar to that described for AChE activity, but the recovery was comparatively faster. Carboxylesterase activity in plasma was decreased to less than 10% of control within 1 hr and recovered to 53% of control within 24 hr. No significant inhibition was seen in hepatic carboxylesterase activity. It can be concluded that soman-induced acute toxicity is directly related to the rate and degree of AChE inhibition. A significant amount of soman binds to non-AChE enzymes with serine sites such as BuChE and carboxylesterases.