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Ruben DR, Benhassine M, Michel D, Filip VU, Erwin D, Ives H. Optimizing Medical Care during a Nerve Agent Mass Casualty Incident Using Computer Simulation. J Med Syst 2024; 48:82. [PMID: 39235718 DOI: 10.1007/s10916-024-02094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 07/23/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Chemical mass casualty incidents (MCIs) pose a substantial threat to public health and safety, with the capacity to overwhelm healthcare infrastructure and create societal disorder. Computer simulation systems are becoming an established mechanism to validate these plans due to their versatility, cost-effectiveness and lower susceptibility to ethical problems. METHODS We created a computer simulation model of an urban subway sarin attack analogous to the 1995 Tokyo sarin incident. We created and combined evacuation, dispersion and victim models with the SIMEDIS computer simulator. We analyzed the effect of several possible approaches such as evacuation policy ('Scoop and Run' vs. 'Stay and Play'), three strategies (on-site decontamination and stabilization, off-site decontamination and stabilization, and on-site stabilization with off-site decontamination), preliminary triage, victim distribution methods, transport supervision skill level, and the effect of search and rescue capacity. RESULTS Only evacuation policy, strategy and preliminary triage show significant effects on mortality. The total average mortality ranges from 14.7 deaths in the combination of off-site decontamination and Scoop and Run policy with pretriage, to 24 in the combination of onsite decontamination with the Stay and Play and no pretriage. CONCLUSION Our findings suggest that in a simulated urban chemical MCI, a Stay and Play approach with on-site decontamination will lead to worse outcomes than a Scoop and Run approach with hospital-based decontamination. Quick transport of victims in combination with on-site antidote administration has the potential to save the most lives, due to faster hospital arrival for definitive care.
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Affiliation(s)
- De Rouck Ruben
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090, Belgium.
| | - Mehdi Benhassine
- Simulation, Modelling, and Analysis of Complex Systems, Department of Mathematics, Royal Military Academy, Renaissancelaan 30, Brussels, 1000, Belgium
| | - Debacker Michel
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090, Belgium
| | - Van Utterbeeck Filip
- Simulation, Modelling, and Analysis of Complex Systems, Department of Mathematics, Royal Military Academy, Renaissancelaan 30, Brussels, 1000, Belgium
| | - Dhondt Erwin
- Royal Higher Institute for Defence, Renaissancelaan 30, Brussels, 1000, Belgium
| | - Hubloue Ives
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090, Belgium
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Amend N, Timperley CM, Bird M, Green AC, Worek F, Seeger T. The use of bispyridinium non-oxime analogues for the restoration of nerve agent impaired neuromuscular transmission in rat hemidiaphragms - Structure optimization. Toxicol Lett 2024; 397:42-47. [PMID: 38723915 DOI: 10.1016/j.toxlet.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/21/2024] [Accepted: 04/29/2024] [Indexed: 06/16/2024]
Abstract
Organophosphate pesticide poisoning challenges health care systems worldwide. Furthermore, nerve agents remain a continuous threat. The treatment options for organophosphate poisoning have virtually been unchanged for decades, relying on symptomatic treatment and the use of oximes to indirectly restore neuromuscular function. Hence, compounds targeting directly nicotinic acetylcholine receptors (nAChRs) might substantially improve treatment options. The current study investigated a series of bispyridinium analogues with a trimethylene or 2,2'-diethyloxy linker in a rat hemidiaphragm model, using indirect field stimulation. Methyl- and ethyl-substituted bispyridinium analogues restored neuromuscular function up to 37 ± 17% (MB419, a 3-methyl analogue) at a stimulation frequency of 20 Hz. The bispyridinium analogues with a 2- or 3-methyl group, or a 2- or 3-ethyl group, tended towards a higher restoration of neuromuscular function than those with a 4-methyl or 4-ethyl group, respectively. The current data can be used for future studies to optimize structure-based molecular modeling of compounds targeting the nAChR.
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Affiliation(s)
- Niko Amend
- Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstrasse 11, Munich 80937, Germany; Walther-Straub-Institute of Pharmacology and Toxicology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Goethestr. 33, Munich 80336, Germany.
| | - Christopher M Timperley
- Chemical, Biological and Radiological (CBR) Division, Defence Science and Technology Laboratory (Dstl), Porton Down, Salisbury, Wiltshire SP4 0JQ, UK
| | - Mike Bird
- Chemical, Biological and Radiological (CBR) Division, Defence Science and Technology Laboratory (Dstl), Porton Down, Salisbury, Wiltshire SP4 0JQ, UK
| | - A Christopher Green
- Chemical, Biological and Radiological (CBR) Division, Defence Science and Technology Laboratory (Dstl), Porton Down, Salisbury, Wiltshire SP4 0JQ, UK
| | - Franz Worek
- Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstrasse 11, Munich 80937, Germany
| | - Thomas Seeger
- Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstrasse 11, Munich 80937, Germany
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Voros C, Dias J, Timperley CM, Nachon F, Brown RCD, Baati R. The risk associated with organophosphorus nerve agents: from their discovery to their unavoidable threat, current medical countermeasures and perspectives. Chem Biol Interact 2024; 395:110973. [PMID: 38574837 DOI: 10.1016/j.cbi.2024.110973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
The first organophosphorus nerve agent was discovered accidently during the development of pesticides, shortly after the first use of chemical weapons (chlorine, phosgene) on the battlefield during World War I. Despite the Chemical Weapons Convention banning these substances, they have still been employed in wars, terrorist attacks or political assassinations. Characterised by their high lethality, they target the nervous system by inhibiting the acetylcholinesterase (AChE) enzyme, preventing neurotransmission, which, if not treated rapidly, inevitably leads to serious injury or the death of the person intoxicated. The limited efficacy of current antidotes, known as AChE reactivators, pushes research towards new treatments. Numerous paths have been explored, from modifying the original pyridinium oximes to developing hybrid reactivators seeking a better affinity for the inhibited AChE. Another crucial approach resides in molecules more prone to cross the blood-brain barrier: uncharged compounds, bio-conjugated reactivators or innovative formulations. Our aim is to raise awareness on the threat and toxicity of organophosphorus nerve agents and to present the main synthetic efforts deployed since the first AChE reactivator, to tackle the task of efficiently treating victims of these chemical warfare agents.
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Affiliation(s)
- Camille Voros
- Ecole de Chimie Polymère et Matériaux ECPM, Université de Strasbourg, ICPEES UMR CNRS 7515, 25 rue Becquerel, F-67087, Strasbourg, France.
| | - José Dias
- Département de Toxicologie et Risques Chimiques, Institut de Recherche Biomédicale des Armées, F-91220 Brétigny-sur-Orge, France
| | - Christopher M Timperley
- Chemical, Biological and Radiological (CBR) Division, Dstl, Porton Down, Salisbury, Wiltshire, SP4 0JQ, UK.
| | - Florian Nachon
- Département de Toxicologie et Risques Chimiques, Institut de Recherche Biomédicale des Armées, F-91220 Brétigny-sur-Orge, France
| | - Richard C D Brown
- Department of Chemistry, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - Rachid Baati
- Ecole de Chimie Polymère et Matériaux ECPM, Université de Strasbourg, ICPEES UMR CNRS 7515, 25 rue Becquerel, F-67087, Strasbourg, France; OPGS Pharmaceuticals, Paris BioTech Santé, 24 rue du Faubourg Saint-Jacques, F-75014, Paris, France.
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Cornelissen AS, van den Berg RM, Langenberg JP, van Grol M, Bross R, Pittman J, Cochrane L, Savransky V. Effective skin decontamination with RSDL® (reactive skin decontamination lotion kit) following dermal exposure to a Novichok class nerve agent. Chem Biol Interact 2024; 395:111001. [PMID: 38641146 DOI: 10.1016/j.cbi.2024.111001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/21/2024]
Abstract
In recent years, various poisoning incidents have been reported, involving the alleged use of the so-called Novichok agents, resulting in their addition to the Schedule I list of the Organisation for the Prohibition of Chemical Warfare (OPCW). As the physicochemical properties of these agents are different from the 'classical' nerve agents, such as VX, research is needed to evaluate whether and to what extent existing countermeasures are effective. Here, we evaluated the therapeutic potential of RSDL® (Reactive Skin Decontamination Lotion Kit) for the neutralization of percutaneous toxicity caused by Novichok agents, both in vitro and in vivo. Experiments showed the three selected Novichok agents (A230, A232, A234) could be degraded by RSDL lotion, but at a different rate. The half-life of A234, in the presence of an excess of RSDL lotion, was 36 min, as compared to A230 (<5 min) and A232 (18 min). Following dermal exposure of guinea pigs to A234, application of the RSDL kit was highly effective in preventing intoxication, even when applied up until 30 min following exposure. Delayed use of the RSDL kit until the appearance of clinical signs of intoxication (3-4 h) was not able to prevent intoxication progression and deaths. This study determines RSDL decontamination as an effective treatment strategy for dermal exposure to the Novichok agent A234 and underscores the importance of early, forward use of skin decontamination, as rapidly as possible.
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Affiliation(s)
- Alex S Cornelissen
- TNO Defence, Safety and Security, CBRN Protection, Rijswijk, the Netherlands
| | | | - Jan P Langenberg
- TNO Defence, Safety and Security, CBRN Protection, Rijswijk, the Netherlands
| | - Marco van Grol
- TNO Defence, Safety and Security, CBRN Protection, Rijswijk, the Netherlands
| | - Rowdy Bross
- TNO Defence, Safety and Security, CBRN Protection, Rijswijk, the Netherlands
| | - John Pittman
- Emergent BioSolutions Inc., Gaithersburg, MD, USA
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Blom TL, Wingelaar TT. Current Perspectives on the Management of Patients Poisoned With Novichok: A Scoping Review. Mil Med 2024; 189:e1381-e1389. [PMID: 38035754 DOI: 10.1093/milmed/usad464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/01/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Nerve agents have emerged as a global threat since their discovery in the 1930s, posing severe risks due to their inhibition of acetylcholinesterase and the subsequent accumulation of acetylcholine in nerve synapses. Despite the enforcement of the Chemical Weapon Convention to control chemical weapons, including nerve agents, recent events, such as the Novichok attacks on Sergei Skripal and Alexei Navalny, have highlighted the persistent threat. Novichok, a distinct class of nerve agents, raises specific concerns regarding its management due to limited understanding. This article aims to comprehensively analyze existing literature. MATERIALS AND METHODS A scoping review was employed to comprehensively assess the current state of knowledge on managing patients poisoned with Novichok. Following the PRISMA-ScR guidelines, relevant literature was identified in peer-reviewed journals covering symptoms, diagnosis, treatment, decontamination, and long-term effects. Searches were conducted on February 1, 2023, across four electronic databases (PubMed, EMBASE, MEDLINE, and Web of Science) using "Novichok" as a keyword. No restrictions were applied, and additional studies were sought from the references of identified papers. Eligible papers included discussions on Novichok or its specific properties impacting management, regardless of study type, language, or publication date, while those unrelated to the study's conceptual framework were excluded. RESULTS A total of 170 records were identified from the initial database search, with 86 studies screened after removing duplicates. Among these, 28 publications met the eligibility criteria and were included in the analysis. An additional relevant study was identified from the citation lists of included studies, bringing the total to 29. The review encompasses studies published from 2018 onwards, indicating the growing interest in this topic. While most studies are reviews on Novichok or nerve agents in general, several theoretical and experimental investigations were also found. CONCLUSION This review highlights the significant uncertainties and knowledge gaps surrounding the management of patients poisoned with Novichok. While some aspects align with other nerve agents, limited research likely due to safety and ethical challenges leads to assumptions and uncertainties in patient care. The review identifies areas with ongoing research, such as decontamination and biomarker recognition, while other aspects remain understudied. The possible inefficacy of current treatment options and the need for further research on oximes, bioscavengers, and long-term effects emphasize the necessity for increased research to optimize patient outcomes. More studies are essential to clarify the actual threat and toxicity of Novichok. Moreover, raising awareness among medical staff is crucial for early diagnosis, prompt treatment, and safety. This review offers valuable insights into managing Novichok-poisoned patients and calls for increased research and awareness in this critical area.
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Affiliation(s)
- Tess L Blom
- Diving and Submarine Medical Center, Royal Netherlands Navy, Den Helder, CA 1780, the Netherlands
| | - Thijs T Wingelaar
- Diving and Submarine Medical Center, Royal Netherlands Navy, Den Helder, CA 1780, the Netherlands
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Saya L, Ratandeep, Arya B, Rastogi K, Verma M, Rani S, Sahu PK, Singh MR, Singh WR, Hooda S. Recent advances in sensing toxic nerve agents through DMMP model simulant using diverse nanomaterials-based chemical sensors. Talanta 2024; 272:125785. [PMID: 38394750 DOI: 10.1016/j.talanta.2024.125785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
Recent terrorist assaults have demonstrated the need for the exploration and design of sustainable and stable chemical sensors with quick reaction times combined with great sensitivity. Among several classes of chemical warfare agents, nerve agents have been proven to be the most hazardous. Even short-term exposure to them can result in severe toxic effects. Human beings inadvertently face the after-effects of these chemicals even several years after these chemicals were used. Due to the extreme toxicity and difficulty in handling, dimethyl methylphosphonate (DMMP), a simulant of nerve agents with much lesser toxicity, is frequently used in laboratories as a substitute. Having a chemical structure almost identical to those of nerve agents, DMMP can mimic the properties of nerve agents. Through this paper, authors have attempted to introduce the evolution of several chemical sensors used to detect DMMP in recent years, including field-effect transistors, chemicapacitors, chemiresistors, and mass-sensitive sensors. A detailed discussion of the role of nanomaterials as chemical sensors in the detection of DMMP has been the main focus of the work through a comprehensive overview of the research on gas sensors that have been reported making use of the properties of a wide range of nanomaterials.
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Affiliation(s)
- Laishram Saya
- Department of Chemistry, Sri Venkateswara College (University of Delhi), Dhaula Kuan, New Delhi 110021, India; Department of Chemistry, Manipur University, Canchipur, Imphal 795003, Manipur, India; Polymer Research Laboratory, Department of Chemistry, Acharya Narendra Dev College (University of Delhi), Govindpuri, Kalkaji, New Delhi, 110019, India.
| | - Ratandeep
- School of Chemical Sciences and Advanced Materials Research Center, Indian Institute of Technology Mandi, Kamand, Mandi 175075, Himachal Pradesh, India
| | - Bipasa Arya
- Polymer Research Laboratory, Department of Chemistry, Acharya Narendra Dev College (University of Delhi), Govindpuri, Kalkaji, New Delhi, 110019, India
| | - Kanjika Rastogi
- Polymer Research Laboratory, Department of Chemistry, Acharya Narendra Dev College (University of Delhi), Govindpuri, Kalkaji, New Delhi, 110019, India
| | - Manisha Verma
- Department of Physics, Acharya Narendra Dev College, (University of Delhi), Govindpuri, Kalkaji, New Delhi, 110019, India
| | - Sanjeeta Rani
- Department of Physics, Acharya Narendra Dev College, (University of Delhi), Govindpuri, Kalkaji, New Delhi, 110019, India
| | - Prasanta Kumar Sahu
- Department of Chemistry, Shivaji College, (University of Delhi), Raja Garden, New Delhi, 110027, India
| | - M Ramananda Singh
- Department of Chemistry, Kirorimal College, (University of Delhi), Delhi, 110007, India
| | - W Rameshwor Singh
- Department of Chemistry, Manipur University, Canchipur, Imphal 795003, Manipur, India.
| | - Sunita Hooda
- Polymer Research Laboratory, Department of Chemistry, Acharya Narendra Dev College (University of Delhi), Govindpuri, Kalkaji, New Delhi, 110019, India.
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Xia JD, Wang H, Hua LW, Xu M, Zheng X, Zhang K. Comparative analysis of organophosphorus versus carbamate pesticide poisoning: a case study. Arh Hig Rada Toksikol 2024; 75:81-84. [PMID: 38548379 PMCID: PMC10978098 DOI: 10.2478/aiht-2024-75-3781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/01/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
Organophosphorus poisoning is a critical condition that can cause central nervous system depression, respiratory failure, and death early on. As its clinical manifestations closely resemble those of carbamate pesticide poisoning, the aim of this case study is to present a case of misdiagnosis, initially identifying carbofuran poisoning as organophosphate in a patient suspect of a heatstroke. We also present a case of intentional self-poisoning with organophosphate dichlorvos to underline the likelihood of pesticide poisoning in patients exhibiting acute cholinergic symptoms when the ingested substance is not known. In such cases, empirical treatment with atropine and oxime can be started pending timely differential diagnosis to adjust treatment as necessary.
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Affiliation(s)
- Jia-ding Xia
- Affiliated Hospital of Chengde Medical University, Intensive Care Unit, Chengde, China
| | - Hui Wang
- Affiliated Hospital of Chengde Medical University, Intensive Care Unit, Chengde, China
| | - Li-wei Hua
- Affiliated Hospital of Chengde Medical University, Intensive Care Unit, Chengde, China
| | - Min Xu
- Affiliated Hospital of Chengde Medical University, Intensive Care Unit, Chengde, China
| | - Xin Zheng
- Affiliated Hospital of Chengde Medical University, Intensive Care Unit, Chengde, China
| | - Kun Zhang
- Affiliated Hospital of Chengde Medical University, Intensive Care Unit, Chengde, China
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Corby G. Pralidoxime Is no Longer Fit for Purpose as an Antidote to Organophosphate Poisoning in the United Kingdom. Disaster Med Public Health Prep 2024; 18:e32. [PMID: 38384185 DOI: 10.1017/dmp.2024.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Pralidoxime is the only oxime antidote to organophosphate poisoning stocked in the United Kingdom, produced by rational drug design in the 1950s. Typically, it is used alongside atropine, to reverse the effects of acetylcholinesterase inhibition. However, its efficacy has been questioned by recent meta-analyses of use treating attempted suicides in less economically developed countries, where organophosphate poisoning is more common. This policy analysis assesses the likely efficacy of pralidoxime in the United Kingdom, in scenarios largely different from those evaluated in meta-analyses. In all scenarios, the UK delay in antidote administration poses a major problem, as pralidoxime acts in a time-critical reactivation mechanism before "ageing" of acetylcholinesterase occurs. Additionally, changes in the organophosphates used today versus those pralidoxime was rationally designed to reverse, have reduced efficacy since the 1950s. Finally, the current dosage regimen may be insufficient. Therefore, one must re-evaluate our preparedness and approach to organophosphate poisoning in the United Kingdom.
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Affiliation(s)
- George Corby
- St John's College, University of Oxford, Oxford, UK
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Reddy DS. Neurosteroids as Novel Anticonvulsants for Refractory Status Epilepticus and Medical Countermeasures for Nerve Agents: A 15-Year Journey to Bring Ganaxolone from Bench to Clinic. J Pharmacol Exp Ther 2024; 388:273-300. [PMID: 37977814 PMCID: PMC10801762 DOI: 10.1124/jpet.123.001816] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023] Open
Abstract
This article describes recent advances in the use of neurosteroids as novel anticonvulsants for refractory status epilepticus (RSE) and as medical countermeasures (MCs) for organophosphates and chemical nerve agents (OPNAs). We highlight a comprehensive 15-year journey to bring the synthetic neurosteroid ganaxolone (GX) from bench to clinic. RSE, including when caused by nerve agents, is associated with devastating morbidity and permanent long-term neurologic dysfunction. Although recent approval of benzodiazepines such as intranasal midazolam and intranasal midazolam offers improved control of acute seizures, novel anticonvulsants are needed to suppress RSE and improve neurologic function outcomes. Currently, few anticonvulsant MCs exist for victims of OPNA exposure and RSE. Standard-of-care MCs for postexposure treatment include benzodiazepines, which do not effectively prevent or mitigate seizures resulting from nerve agent intoxication, leaving an urgent unmet medical need for new anticonvulsants for RSE. Recently, we pioneered neurosteroids as next-generation anticonvulsants that are superior to benzodiazepines for treatment of OPNA intoxication and RSE. Because GX and related neurosteroids that activate extrasynaptic GABA-A receptors rapidly control seizures and offer robust neuroprotection by reducing neuronal damage and neuroinflammation, they effectively improve neurologic outcomes after acute OPNA exposure and RSE. GX has been selected for advanced, Biomedical Advanced Research and Development Authority-supported phase 3 trials of RSE and nerve agent seizures. In addition, in mechanistic studies of neurosteroids at extrasynaptic receptors, we identified novel synthetic analogs with features that are superior to GX for current medical needs. Development of new MCs for RSE is complex, tedious, and uncertain due to scientific and regulatory challenges. Thus, further research will be critical to fill key gaps in evaluating RSE and anticonvulsants in vulnerable (pediatric and geriatric) populations and military persons. SIGNIFICANCE STATEMENT: Following organophosphate and nerve agent intoxication, refractory status epilepticus (RSE) occurs despite benzodiazepine treatment. RSE occurs in 40% of status epilepticus patients, with a 35% mortality rate and significant neurological morbidity in survivors. To treat RSE, neurosteroids are better anticonvulsants than benzodiazepines. Our pioneering use of neurosteroids for RSE and nerve agents led us to develop ganaxolone as a novel anticonvulsant and neuroprotectant with significantly improved neurological outcomes. This article describes the bench-to-bedside journey of bringing neurosteroid therapy to patients, with ganaxolone leading the way.
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Affiliation(s)
- Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Bryan, Texas and Institute of Pharmacology and Neurotherapeutics, Texas A&M University Health Science Center, Bryan, Texas
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Shen L, Zhang Y, Cai Q, Yang J, Wang Y, Quan D. HI-6-loaded PEGylated liposomes: an on-site first-aid strategy for acute organophosphorus agent poisoning. Drug Deliv 2023; 30:20-27. [DOI: 10.1080/10717544.2022.2152132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Liao Shen
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yadan Zhang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Qimei Cai
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Jun Yang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yongan Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Dongqin Quan
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
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Aracava Y, Albuquerque EX, Pereira EFR. (R,S)-trihexyphenidyl, acting via a muscarinic receptor-independent mechanism, inhibits hippocampal glutamatergic and GABAergic synaptic transmissions: Potential relevance for treatment of organophosphorus intoxication. Neuropharmacology 2023; 239:109684. [PMID: 37549771 PMCID: PMC10590273 DOI: 10.1016/j.neuropharm.2023.109684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
Preclinical studies have reported that, compared to the muscarinic receptor (mAChR) antagonist atropine, (R,S)-trihexyphenidyl (THP) more effectively counters the cholinergic crisis, seizures, and neuropathology triggered by organophosphorus (OP)-induced acetylcholinesterase (AChE) inhibition. The greater effectiveness of THP was attributed to its ability to block mAChRs and N-methyl-d-aspartate-type glutamatergic receptors (NMDARs) in the brain. However, THP also inhibits α7 nicotinic receptors (nAChRs). The present study examined whether THP-induced inhibition of mAChRs, α7 nAChRs, and NMDARs is required to suppress glutamatergic synaptic transmission, whose overstimulation sustains OP-induced seizures. In primary hippocampal cultures, THP (1-30 μM) suppressed the frequency of excitatory and inhibitory postsynaptic currents (EPSCs and IPSCs, respectively) recorded from neurons in nominally Mg2+-free solution. A single sigmoidal function adequately fit the overlapping concentration-response relationships for THP-induced suppression of IPSC and EPSC frequencies yielding an IC50 of 6.3 ± 1.3 μM. Atropine (1 μM), the NMDAR antagonist d,l-2-amino-5-phosphonopentanoic acid (D,L-AP5, 50 μM), and the α7 nAChR antagonist methyllycaconitine (MLA, 10 nM) did not prevent THP-induced inhibition of synaptic transmission. THP (10 μM) did not affect the probability of transmitter release because it had no effect on the frequency of miniature IPSCs and EPSCs recorded in the presence of tetrodotoxin. Additionally, THP had no effect on the amplitudes and decay-time constants of miniature IPSCs and EPSCs; therefore, it did not affect the activity of postsynaptic GABAA and glutamate receptors. This study provides the first demonstration that THP can suppress action potential-dependent synaptic transmission via a mechanism independent of NMDAR, mAChR, and α7 nAChR inhibition.
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Affiliation(s)
- Yasco Aracava
- Division of Translational Toxicology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edson X Albuquerque
- Division of Translational Toxicology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edna F R Pereira
- Division of Translational Toxicology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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Amend N, Koller M, Schmitt C, Worek F, Wille T. The suitability of a polydimethylsiloxane-based (PDMS) microfluidic two compartment system for the toxicokinetic analysis of organophosphorus compounds. Toxicol Lett 2023; 388:24-29. [PMID: 37827339 DOI: 10.1016/j.toxlet.2023.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
Organ-on-a-chip platforms are an emerging technology in experimental and regulatory toxicology (species-specific differences, ethical considerations). They address gaps between in vivo and in vitro models. However, there are still certain limitations considering material, setup and applicability. The current study examined the suitability of a commercially available polydimethylsiloxane-based (PDMS) organ-chip for the toxicokinetic characterization of the highly toxic nerve agent VX and the organophosphate pesticide parathion. The respective concentrations of 1000 µmol/L and 100 µmol/L VX and parathion were chosen deliberately high in order to study concentrations even if high compound absorption by PDMS might occur. Neuronal and liver spheroids, totaling 2 × 106 cells were used to study concentration changes of VX and parathion. In addition, VX enantiomers were quantified. The current study suggests a significant absorption of VX, respectively parathion by PDMS. This might require future investigation of alternative materials or coatings to limit absorption for organophosphorus compounds in toxicokinetic studies.
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Affiliation(s)
- Niko Amend
- Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstrasse 11, 80937 Munich, Germany.
| | - Marianne Koller
- Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstrasse 11, 80937 Munich, Germany
| | - Christian Schmitt
- Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstrasse 11, 80937 Munich, Germany
| | - Franz Worek
- Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstrasse 11, 80937 Munich, Germany
| | - Timo Wille
- Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstrasse 11, 80937 Munich, Germany; Department F, Medical CBRN Defence, Bundeswehr Medical Academy, Ingolstädter Str 240, Munich 80939, Germany
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13
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Liu S, Ling L, Ma J, Yuan H, Guo Z, Feng Q, Xia X. Trends and profiles of acute poisoning cases: a retrospective analysis. Front Public Health 2023; 11:1235304. [PMID: 37732094 PMCID: PMC10507702 DOI: 10.3389/fpubh.2023.1235304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Abstract
Acute poisoning is a significant public health concern. This retrospective study investigates trends in acute poisoning cases and explores the clinical and sociodemographic profiles associated with this condition. Medical data from 859 hospitalized patients diagnosed with acute poisoning between January 2017 and December 2022 were comprehensively analyzed. The descriptive statistical analysis revealed that 360 patients had underlying diseases, with depression being the most prevalent among them. Furthermore, urban areas accounted for 87.2% of the acute poisoning cases, indicating a higher incidence compared to rural areas. The substances implicated in acute poisoning incidents varied, with drugs of abuse being the most common (53.2%), followed by pesticides (22.2%), carbon monoxide (11.8%), and alcohol (5.4%). Suicide attempt/suicide emerged as the leading cause of acute poisoning incidents, accounting for 75.9% of cases, while poisoning accidents predominantly occurred within the home setting. Through chi-square tests, it was determined that risk factors for suicide attempt/suicide included female gender and underlying medical conditions. Temporal analysis showed that the total number of acute poisoning cases increased from 2017 to 2019 and decreased from 2019 to 2022. Notably, suicide-related cases exhibited an upward trend, with suicide attempt/suicide accounting for over 80% of all acute poisoning cases after 2020. This study contributes valuable insights into the trends, profiles, and risk factors associated with acute poisoning cases.
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Affiliation(s)
| | | | | | | | | | | | - Xiaohua Xia
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China
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Ke P, Stidham RA, Forbes AM, Castaneto MS, Wegner MD, Mont SL. A Hidden Gem: Highlighting the Indispensable Capabilities and History of the DoD Cholinesterase Monitoring Program and DoD Cholinesterase Reference Laboratory. Mil Med 2023; 188:220-222. [PMID: 36929418 DOI: 10.1093/milmed/usad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/13/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
The DoD Cholinesterase Monitoring Program and Cholinesterase Reference Laboratory have safeguarded U.S. government employees in chemical defense for over five decades. Considering Russia's potential deployment of chemical warfare nerve agents in Ukraine, it is critical to maintain a robust cholinesterase testing program and its efficiency presently and in future.
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Affiliation(s)
- Pucheng Ke
- DoD Cholinesterase Reference Laboratory, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Ralph A Stidham
- Division of Epidemiology and Disease Surveillance, U.S. Army Public Health Command-Central, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Adrienne M Forbes
- DoD Cholinesterase Reference Laboratory, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Marisol S Castaneto
- DoD Food Analysis and Diagnostic Laboratory, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Matthew D Wegner
- DoD Food Analysis and Diagnostic Laboratory, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Stephanie L Mont
- U.S. Army Public Health Command-Central, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
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15
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Vasanthi SS, Rao NS, Samidurai M, Massey N, Meyer C, Gage M, Kharate M, Almanza A, Wachter L, Mafuta C, Trevino L, Carlo AM, Bryant E, Corson BE, Wohlgemuth M, Ostrander M, Showman L, Wang C, Thippeswamy T. Disease-modifying effects of a glial-targeted inducible nitric oxide synthase inhibitor (1400W) in mixed-sex cohorts of a rat soman (GD) model of epilepsy. J Neuroinflammation 2023; 20:163. [PMID: 37438764 PMCID: PMC10337207 DOI: 10.1186/s12974-023-02847-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Acute exposure to seizurogenic organophosphate (OP) nerve agents (OPNA) such as diisopropylfluorophosphate (DFP) or soman (GD), at high concentrations, induce immediate status epilepticus (SE), reactive gliosis, neurodegeneration, and epileptogenesis as a consequence. Medical countermeasures (MCMs-atropine, oximes, benzodiazepines), if administered in < 20 min of OPNA exposure, can control acute symptoms and mortality. However, MCMs alone are inadequate to prevent OPNA-induced brain injury and behavioral dysfunction in survivors. We have previously shown that OPNA exposure-induced SE increases the production of inducible nitric oxide synthase (iNOS) in glial cells in both short- and long- terms. Treating with a water soluble and highly selective iNOS inhibitor, 1400W, for 3 days significantly reduced OPNA-induced brain changes in those animals that had mild-moderate SE in the rat DFP model. However, such mitigating effects and the mechanisms of 1400W are unknown in a highly volatile nerve agent GD exposure. METHODS Mixed-sex cohort of adult Sprague Dawley rats were exposed to GD (132 μg/kg, s.c.) and immediately treated with atropine (2 mg/kg, i.m) and HI-6 (125 mg/kg, i.m.). Severity of seizures were quantified for an hour and treated with midazolam (3 mg/kg, i.m.). An hour post-midazolam, 1400W (20 mg/kg, i.m.) or vehicle was administered daily for 2 weeks. After behavioral testing and EEG acquisition, animals were euthanized at 3.5 months post-GD. Brains were processed for neuroinflammatory and neurodegeneration markers. Serum and CSF were used for nitrooxidative and proinflammatory cytokines assays. RESULTS We demonstrate a significant long-term (3.5 months post-soman) disease-modifying effect of 1400W in animals that had severe SE for > 20 min of continuous convulsive seizures. 1400W significantly reduced GD-induced motor and cognitive dysfunction; nitrooxidative stress (nitrite, ROS; increased GSH: GSSG); proinflammatory cytokines in the serum and some in the cerebrospinal fluid (CSF); epileptiform spikes and spontaneously recurring seizures (SRS) in males; reactive gliosis (GFAP + C3 and IBA1 + CD68-positive glia) as a measure of neuroinflammation, and neurodegeneration (especially parvalbumin-positive neurons) in some brain regions. CONCLUSION These findings demonstrate the long-term disease-modifying effects of a glial-targeted iNOS inhibitor, 1400W, in a rat GD model by modulating reactive gliosis, neurodegeneration (parvalbumin-positive neurons), and neuronal hyperexcitability.
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Affiliation(s)
- Suraj S. Vasanthi
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Nikhil S. Rao
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Manikandan Samidurai
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Nyzil Massey
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Christina Meyer
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Meghan Gage
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Mihir Kharate
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Aida Almanza
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Logan Wachter
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Candide Mafuta
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Lily Trevino
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Adriana M. Carlo
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Elijah Bryant
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Brooke E. Corson
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Morgan Wohlgemuth
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Morgan Ostrander
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Lucas Showman
- W.M. Keck Metabolomics Research Laboratory, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Chong Wang
- Department of Veterinary Diagnostic and Production Animal Medicine and Statistics, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
| | - Thimmasettappa Thippeswamy
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, 50011 USA
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16
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Vasanthi SS, Rao NS, Samidurai M, Massey N, Meyer C, Gage M, Kharate M, Almanza A, Wachter L, Mafuta C, Trevino L, Carlo AM, Bryant E, Corson BE, Wohlgemuth M, Ostrander M, Wang C, Thippeswamy T. Disease-Modifying Effects of a Glial-targeted Inducible Nitric Oxide Synthase Inhibitor (1400W) in Mixed-sex Cohorts of a Rat Soman (GD) Model of Epilepsy. RESEARCH SQUARE 2023:rs.3.rs-2883247. [PMID: 37214912 PMCID: PMC10197763 DOI: 10.21203/rs.3.rs-2883247/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background Acute exposure to seizurogenic organophosphate (OP) nerve agents (OPNA) such as diisopropylfluorophosphate (DFP) or soman (GD), at high concentrations, induce immediate status epilepticus (SE), reactive gliosis, neurodegeneration, and epileptogenesis as a consequence. Medical countermeasures (MCMs- atropine, oximes, benzodiazepines), if administered in < 20 minutes of OPNA exposure, can control acute symptoms and mortality. However, MCMs alone are inadequate to prevent OPNA-induced brain injury and behavioral dysfunction in survivors. We have previously shown that OPNA exposure-induced SE increases the production of inducible nitric oxide synthase (iNOS) in glial cells in both short- and long- terms. Treating with a water soluble and highly selective iNOS inhibitor, 1400W, for three days significantly reduced OPNA-induced brain changes in those animals that had mild-moderate SE in the rat DFP model. However, such mitigating effects and the mechanisms of 1400W are unknown in a highly volatile nerve agent GD exposure. Methods Mixed-sex cohort of adult Sprague Dawley rats were exposed to GD (132µg/kg, s.c.) and immediately treated with atropine (2mg/kg, i.m) and HI-6 (125mg/kg, i.m.). Severity of seizures were quantified for an hour and treated with midazolam (3mg/kg, i.m.). An hour post-midazolam, 1400W (20mg/kg, i.m.) or vehicle was administered daily for two weeks. After behavioral testing and EEG acquisition, animals were euthanized at 3.5 months post-GD. Brains were processed for neuroinflammatory and neurodegeneration markers. Serum and CSF were used for nitrooxidative and proinflammatory cytokines assays. Results We demonstrate a significant long-term (3.5 months post-soman) disease-modifying effect of 1400W in animals that had severe SE for > 20min of continuous convulsive seizures. 1400W significantly reduced GD-induced motor and cognitive dysfunction; nitrooxidative stress (nitrite, ROS; increased GSH: GSSG); proinflammatory cytokines in the serum and some in the cerebrospinal fluid (CSF); epileptiform spikes and spontaneously recurring seizures (SRS) in males; reactive gliosis (GFAP + C3 and IBA1 + CD68 positive glia) as a measure of neuroinflammation, and neurodegeneration (including parvalbumin positive neurons) in some brain regions. Conclusion These findings demonstrate the long-term disease-modifying effects of a glial-targeted iNOS inhibitor, 1400W, in a rat GD model by modulating reactive gliosis, neurodegeneration, and neuronal hyperexcitability.
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17
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Niquet J, Nguyen D, de Araujo Furtado M, Lumley L. Treatment of cholinergic-induced status epilepticus with polytherapy targeting GABA and glutamate receptors. Epilepsia Open 2023; 8 Suppl 1:S117-S140. [PMID: 36807554 PMCID: PMC10173853 DOI: 10.1002/epi4.12713] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
Despite new antiseizure medications, the development of cholinergic-induced refractory status epilepticus (RSE) continues to be a therapeutic challenge as pharmacoresistance to benzodiazepines and other antiseizure medications quickly develops. Studies conducted by Epilepsia. 2005;46:142 demonstrated that the initiation and maintenance of cholinergic-induced RSE are associated with trafficking and inactivation of gamma-aminobutyric acid A receptors (GABAA R) thought to contribute to the development of benzodiazepine pharmacoresistance. In addition, Dr. Wasterlain's laboratory reported that increased N-methyl-d-aspartate receptors (NMDAR) and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPAR) contribute to enhanced glutamatergic excitation (Neurobiol Dis. 2013;54:225; Epilepsia. 2013;54:78). Thus, Dr. Wasterlain postulated that targeting both maladaptive responses of reduced inhibition and increased excitation that is associated with cholinergic-induced RSE should improve therapeutic outcome. We currently review studies in several animal models of cholinergic-induced RSE that demonstrate that benzodiazepine monotherapy has reduced efficacy when treatment is delayed and that polytherapy with drugs that include a benzodiazepine (eg midazolam and diazepam) to counter loss of inhibition, concurrent with an NMDA antagonist (eg ketamine) to reduce excitation provide improved efficacy. Improved efficacy with polytherapy against cholinergic-induced seizure is demonstrated by reduction in (1) seizure severity, (2) epileptogenesis, and (3) neurodegeneration compared with monotherapy. Animal models reviewed include pilocarpine-induced seizure in rats, organophosphorus nerve agent (OPNA)-induced seizure in rats, and OPNA-induced seizure in two mouse models: (1) carboxylesterase knockout (Es1-/- ) mice which, similarly to humans, lack plasma carboxylesterase and (2) human acetylcholinesterase knock-in carboxylesterase knockout (KIKO) mice. We also review studies showing that supplementing midazolam and ketamine with a third antiseizure medication (valproate or phenobarbital) that targets a nonbenzodiazepine site rapidly terminates RSE and provides further protection against cholinergic-induced SE. Finally, we review studies on the benefits of simultaneous compared with sequential drug treatments and the clinical implications that lead us to predict improved efficacy of early combination drug therapies. The data generated from seminal rodent studies of efficacious treatment of cholinergic-induced RSE conducted under Dr. Wasterlain's guidance suggest that future clinical trials should treat the inadequate inhibition and temper the excess excitation that characterize RSE and that early combination therapies may provide improved outcome over benzodiazepine monotherapy.
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Affiliation(s)
- Jerome Niquet
- Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
- Epilepsy Research LaboratoryVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Donna Nguyen
- Neuroscience DepartmentU.S. Army Medical Research Institute of Chemical Defense (USAMRICD)Aberdeen Proving GroundMarylandUSA
| | | | - Lucille Lumley
- Neuroscience DepartmentU.S. Army Medical Research Institute of Chemical Defense (USAMRICD)Aberdeen Proving GroundMarylandUSA
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18
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Ramadori GP. Organophosphorus Poisoning: Acute Respiratory Distress Syndrome (ARDS) and Cardiac Failure as Cause of Death in Hospitalized Patients. Int J Mol Sci 2023; 24:ijms24076658. [PMID: 37047631 PMCID: PMC10094912 DOI: 10.3390/ijms24076658] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Industrial production of food for animals and humans needs increasing amounts of pesticides, especially of organophosphates, which are now easily available worldwide. More than 3 million cases of acute severe poisoning are estimated to occur worldwide every year, and even more cases remain unreported, while 200,000–350,000 incidentally or intentionally poisoned people die every year. Diagnostic and therapeutic procedures in organophosphate poisoning have, however, remained unchanged. In addition to several neurologic symptoms (miosis, fasciculations), hypersecretion of salivary, bronchial, and sweat glands, vomiting, diarrhea, and loss of urine rapidly induce dehydration, hypovolemia, loss of conscience and respiratory distress. Within hours, signs of acidosis due to systemic hypoxia can be observed at first laboratory investigation after hospitalization. While determination of serum-cholinesterase does not have any diagnostic value, it has been established that hypoalbuminemia alone or accompanied by an increase in creatinine, lactate, or C-reactive protein serum levels has negative prognostic value. Increased serum levels of C-reactive protein are a sign of systemic ischemia. Protective mechanical ventilation should be avoided, if possible. In fact, acute respiratory distress syndrome characterized by congestion and increased weight of the lung, accompanied by heart failure, may become the cause of death. As the excess of acetylcholine at the neuronal level can persist for weeks until enough newly, locally synthesized acetylcholinesterase becomes available (the value of oximes in reducing this time is still under debate), after atropine administration, intravenous albumin and fluid infusion should be the first therapeutic interventions to reestablish normal blood volume and normal tissue oxygenation, avoiding death by cardiac arrest.
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19
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Chen J, Guo Z, Xin Y, Gu Z, Zhang L, Guo X. Effective remediation and decontamination of organophosphorus compounds using enzymes: From rational design to potential applications. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 867:161510. [PMID: 36632903 DOI: 10.1016/j.scitotenv.2023.161510] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Organophosphorus compounds (OPs) have been widely used in agriculture for decades because of their high insecticidal efficiency, which maintains and increases crop yields worldwide. More importantly, OPs, as typical chemical warfare agents, are a serious concern and significant danger for military and civilian personnel. The widespread use of OPs, superfluous and unreasonable use, has caused great harm to the environment and food chain. Developing efficient and environmentally friendly solutions for the decontamination of OPs is a long-term challenge. Microbial enzymes show potential application as natural and green biocatalysts. Thus, utilizing OP-degrading enzymes for environmental decontamination presents significant advantages, as these enzymes can rapidly hydrolyze OPs; are environmentally friendly, nonflammable, and noncorrosive; and can be discarded safely and easily. Here, the properties, structure and catalytic mechanism of various typical OP-degrading enzymes are reviewed. The methods and effects utilized to improve the expression level, catalytic performance and stability of OP-degrading enzymes were systematically summarized. In addition, the immobilization of OP-degrading enzymes was explicated emphatically, and the latest progress of cascade reactions based on immobilized enzymes was discussed. Finally, the latest applications of OP-degrading enzymes were summarized, including biosensors, nanozyme mimics and medical detoxification. This review provides guidance for the future development of OP-degrading enzymes and promotes their application in the field of environmental bioremediation and medicine.
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Affiliation(s)
- Jianxiong Chen
- National Engineering Research Center of Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Research Center for Bioactive Product Processing Technology, Jiangnan University, Wuxi 214122, China
| | - Zitao Guo
- National Engineering Research Center of Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Research Center for Bioactive Product Processing Technology, Jiangnan University, Wuxi 214122, China
| | - Yu Xin
- National Engineering Research Center of Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Research Center for Bioactive Product Processing Technology, Jiangnan University, Wuxi 214122, China
| | - Zhenghua Gu
- National Engineering Research Center of Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Research Center for Bioactive Product Processing Technology, Jiangnan University, Wuxi 214122, China
| | - Liang Zhang
- National Engineering Research Center of Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Research Center for Bioactive Product Processing Technology, Jiangnan University, Wuxi 214122, China.
| | - Xuan Guo
- State Key Laboratory of NBC Protection for Civilian, Research Institute of Chemical Defense, Academy of Military Science, Beijing 102205, China; CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China.
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20
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Li Y, Huang L, Zhang Z, Huang J, Xing H, Wang L, Sui X, Luo Y, Wang Y, Yang J. An in vitro nerve agent brain poisoning transwell model for convenient and accurate antidote evaluation. Toxicol In Vitro 2023; 88:105541. [PMID: 36572320 DOI: 10.1016/j.tiv.2022.105541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/01/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
Nerve agent (NA) can inhibit acetylcholinesterase (AChE) causing seriously injury at extremely low doses. However, the cruel reality is that the lack of effective cerebral antidotes for treatment of NA poisoning. There is an urgent requirement for the large-scale evaluation and screening of antidotes. An effective NA antidote should include two characteristics: a) to permeate the blood-brain barrier (BBB); 2) to reactivate the inhibited AChE in brain. Existing methods for evaluating reactivators in vitro can only examine the reactivation effect, while the current Transwell model can only evaluate the drug penetration performance for crossing the barrier. In this work, brain microvascular endothelial cells (RBMECs) were inoculated to establish a Transwell model. AChE, NAs and antidotes of reactivators were added into the different chambers to simulate central poisoning and peripheral drug administration. This method can evaluate the reactivation ability and brain penetration ability of compounds at same time, which is a rapidly and accurately way for drug preliminary screening. In addition to small-molecule drugs, a liposomal nanoantidote loaded with the reactivator Asoxime chloride (HI-6)was prepared. This nanoantidote show high reactivation rate against the NA (sarin), evaluated by both this modified model in vitro and animal test, gaining the consistence results.
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Affiliation(s)
- Yao Li
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China; Quality-control department, Military Hospital of 78 Group of PLA, Mudanjiang 157000, China
| | - Lijuan Huang
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China
| | - Zinan Zhang
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China
| | - Jingyi Huang
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China
| | - Huanchun Xing
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China
| | - Lin Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China
| | - Xin Sui
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China
| | - Yuan Luo
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China
| | - Yongan Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China.
| | - Jun Yang
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China.
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21
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Review of Possible Therapies in Treatment of Novichoks Poisoning and HAZMAT/CBRNE Approaches: State of the Art. J Clin Med 2023; 12:jcm12062221. [PMID: 36983219 PMCID: PMC10054273 DOI: 10.3390/jcm12062221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/02/2023] [Accepted: 03/11/2023] [Indexed: 03/16/2023] Open
Abstract
Novichoks-organophosphorus compounds belong to the nerve agents group, constituting the fourth generation of chemical warfare agents. The tremendous toxicity of Novichoks is assumed to be several times greater than that of VX, whereas no published experimental research supports this. They were surreptitiously created during the Cold War by the Soviet Union. Novichok’s toxic action mechanism consists of the inhibition of acetylcholinesterase activity. The review includes data on treating poisoning caused by OPs which could be used as guidelines for the therapy in case of Novichok exposure and HAZMAT/CBRNE approaches. Novichoks pose a severe threat due to their toxicity; however, there is insufficient information about the identity of A-series nerve agents. Filling in the missing data gaps will accelerate progress in improving protection against Novichoks and developing optimal therapy for treating poisoning casualties. Furthermore, introducing solutions to protect medical personnel in contact with a hazardous substance increases the chances of saving casualties of HAZMAT/CBRNE incidents.
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22
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Elhaj R, Reynolds JM. Chemical exposures and suspected impact on Gulf War Veterans. Mil Med Res 2023; 10:11. [PMID: 36882803 PMCID: PMC9993698 DOI: 10.1186/s40779-023-00449-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/24/2023] [Indexed: 03/09/2023] Open
Abstract
Gulf War Illness (GWI) encompass a spectrum of maladies specific to troops deployed during the Persian Gulf War (1990-1991). There are several hypothesized factors believed to contribute to GWI, including (but not limited to) exposures to chemical agents and a foreign environment (e.g., dust, pollens, insects, and microbes). Moreover, the inherent stress associated with deployment and combat has been associated with GWI. While the etiology of GWI remains uncertain, several studies have provided strong evidence that chemical exposures, especially neurotoxicants, may be underlying factors for the development of GWI. This mini style perspective article will focus on some of the major evidence linking chemical exposures to GWI development and persistence decades after exposure.
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Affiliation(s)
- Rami Elhaj
- Center for Cancer Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA
| | - Joseph M Reynolds
- Center for Cancer Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA.
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23
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Sepahi S, Gerayli S, Delirrad M, Taghavizadeh Yazdi ME, Zare-Zardini H, Bushehri B, Ghorani-Azam A. Biochemical responses as early and reliable biomarkers of organophosphate and carbamate pesticides intoxication: A systematic literature review. J Biochem Mol Toxicol 2023; 37:e23285. [PMID: 36524544 DOI: 10.1002/jbt.23285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/03/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Inhibition of cholinesterase (ChE) activity has been long considered as the main diagnostic method of organophosphate (OP) and carbamate pesticides poisoning; however, it has been shown that ChE activity may also be altered due to exposure to other non-organophosphorus toxicants and variety of different medical conditions. Hence, to avoid misdiagnosis, we aimed to systematically review available documents to look for additional biomarkers of OP and carbamate poisoning. The electronic databases in addition to Google scholar were searched for eligible articles on March 2022 using "organophosphate," "carbamate," and "biomarker" including all their similar terms. After collecting the relevant documents, the data were extracted and described qualitatively. In total, data of 66 articles from 51 human and 15 animal studies were extracted. Findings demonstrated that enzymes such as β-glucuronidase, neuropathy target esterase, amylase, and lipase, in addition to hematological indicators such as CBC, CRP, lactate dehydrogenase, and CPK have high sensitivity and accuracy in the diagnosis of OP poisoning. Findings suggest that using various markers for diagnosis of OP intoxication is helpful for appropriate management, and early identifying the patients at risk of death. The suggested biomarkers also help to avoid misdiagnosis of OP poisoning with other similar conditions.
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Affiliation(s)
- Samaneh Sepahi
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Sina Gerayli
- Division of Inflammation and inflammatory Diseases, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Delirrad
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Forensic Medicine and Toxicology, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Hadi Zare-Zardini
- Hematology and Oncology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Sciences, Farhangian University, Isfahan, Iran
| | - Behzad Bushehri
- Department of Forensic Medicine and Toxicology, Urmia University of Medical Sciences, Urmia, Iran
| | - Adel Ghorani-Azam
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Forensic Medicine and Toxicology, Urmia University of Medical Sciences, Urmia, Iran
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24
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Wen L, Wang J, Liu Z, Tao CA, Rao J, Hang J, Li Y. A portable acetylcholinesterase-based electrochemical sensor for field detection of organophosphorus. RSC Adv 2023; 13:6389-6395. [PMID: 36874943 PMCID: PMC9982831 DOI: 10.1039/d2ra05383g] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 01/23/2023] [Indexed: 03/06/2023] Open
Abstract
A portable acetylcholinesterase (AChE)-based electrochemical sensor based on a screen-printed carbon electrode (SPCE) and a miniature potentiostat was constructed for the rapid field detection of organophosphorus pesticides (OPs). Graphene (GR) and gold nanoparticles (AuNPs) were successively introduced onto SPCE for surface modification. Due to the synergistic effect of the two nanomaterials, the signal of the sensor has a significant enhancement. Take isocarbophos (ICP) as a model for chemical warfare agents (CAWs) and Ops; the SPCE/GR/AuNPs/AChE/Nafion sensor shows a wider linear range (0.1-2000 μg L-1), and a lower limit of detection (0.012 μg L-1) than SPCE/AChE/Nafion and SPCE/GR/AChE/Nafion sensors. Tests in actual fruit and tap water samples also yielded satisfactory results. Therefore, the proposed method can be used as a simple and cost-effective strategy for construction of portable electrochemical sensors for OP field detection.
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Affiliation(s)
- Long Wen
- College of Science, National University of Defense Technology Changsha 410073 P. R. China
| | - Jianfang Wang
- College of Science, National University of Defense Technology Changsha 410073 P. R. China
| | - Zhuoliang Liu
- College of Science, National University of Defense Technology Changsha 410073 P. R. China
| | - Cheng-An Tao
- College of Science, National University of Defense Technology Changsha 410073 P. R. China
| | - Jialing Rao
- College of Science, National University of Defense Technology Changsha 410073 P. R. China
| | - Jian Hang
- College of Science, National University of Defense Technology Changsha 410073 P. R. China
| | - Yujiao Li
- College of Science, National University of Defense Technology Changsha 410073 P. R. China
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25
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Meng WQ, Sedgwick AC, Kwon N, Sun M, Xiao K, He XP, Anslyn EV, James TD, Yoon J. Fluorescent probes for the detection of chemical warfare agents. Chem Soc Rev 2023; 52:601-662. [PMID: 36149439 DOI: 10.1039/d2cs00650b] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chemical warfare agents (CWAs) are toxic chemicals that have been intentionally developed for targeted and deadly use on humans. Although intended for military targets, the use of CWAs more often than not results in mass civilian casualties. To prevent further atrocities from occurring during conflicts, a global ban was implemented through the chemical weapons convention, with the aim of eliminating the development, stockpiling, and use of CWAs. Unfortunately, because of their relatively low cost, ease of manufacture and effectiveness on mass populations, CWAs still exist in today's world. CWAs have been used in several recent terrorist-related incidents and conflicts (e.g., Syria). Therefore, they continue to remain serious threats to public health and safety and to global peace and stability. Analytical methods that can accurately detect CWAs are essential to global security measures and for forensic analysis. Small molecule fluorescent probes have emerged as attractive chemical tools for CWA detection, due to their simplicity, ease of use, excellent selectivity and high sensitivity, as well as their ability to be translated into handheld devices. This includes the ability to non-invasively image CWA distribution within living systems (in vitro and in vivo) to permit in-depth evaluation of their biological interactions and allow potential identification of therapeutic countermeasures. In this review, we provide an overview of the various reported fluorescent probes that have been designed for the detection of CWAs. The mechanism for CWA detection, change in optical output and application for each fluorescent probe are described in detail. The limitations and challenges of currently developed fluorescent probes are discussed providing insight into the future development of this research area. We hope the information provided in this review will give readers a clear understanding of how to design a fluorescent probe for the detection of a specific CWA. We anticipate that this will advance our security systems and provide new tools for environmental and toxicology monitoring.
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Affiliation(s)
- Wen-Qi Meng
- Department of Protective Medicine Against Chemical Agents, Faculty of Naval Medicine, Naval Medical University, 800 Xiangying Rd., Shanghai 200433, China.
| | - Adam C Sedgwick
- Chemistry Research Laboratory, University of Oxford, Mansfield Road, OX1 3TA, UK
| | - Nahyun Kwon
- Department of Chemistry and Nanoscience, Ewha Womans University, Seoul 120-750, Korea.
| | - Mingxue Sun
- Department of Protective Medicine Against Chemical Agents, Faculty of Naval Medicine, Naval Medical University, 800 Xiangying Rd., Shanghai 200433, China.
| | - Kai Xiao
- Department of Protective Medicine Against Chemical Agents, Faculty of Naval Medicine, Naval Medical University, 800 Xiangying Rd., Shanghai 200433, China.
| | - Xiao-Peng He
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Feringa Nobel Prize Scientist Joint Research Center, Frontiers Center for Materiobiology and Dynamic Chemistry, School of Chemistry and Molecular Engineering, East China University of Science and Technology, 130 Meilong Rd., Shanghai 200237, China. .,The International Cooperation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China.,National Center for Liver Cancer, Shanghai 200438, China
| | - Eric V Anslyn
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78712-1224, USA.
| | - Tony D James
- Department of Chemistry, University of Bath, Bath, BA2 7AY, UK. .,School of Chemistry and Chemical Engineering, Henan Normal University, Xinxiang 453007, China
| | - Juyoung Yoon
- Department of Chemistry and Nanoscience, Ewha Womans University, Seoul 120-750, Korea.
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26
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Charejoo A, Arabfard M, Jafari A, Nourian YH. A complete, evidence-based review on novichok poisoning based on epidemiological aspects and clinical management. FRONTIERS IN TOXICOLOGY 2023; 4:1004705. [PMID: 36762227 PMCID: PMC9905702 DOI: 10.3389/ftox.2022.1004705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023] Open
Abstract
Background: The whole world has learned about the existence of a highly toxic neuro-paralytic substance called Novichok. A wide range of neuro-paralytic toxins were used during the wars of decades ago, which also had harmful and irreversible effects. Fortunately, the establishment of conventions prohibiting the use of these weapons prevented the adverse clinical consequences of these compounds. What we did in the present study was to evaluate the clinical features of Novichok, how to manage exposure to it, and to evaluate the prognostic aspects associated with this poisoning agent. Methods: The manuscript especial databases including Medline, Web of knowledge, Google scholar, and Scopus were deeply searched by the two blinded investigators for all eligible studies based on the considered keywords. Initially 98 articles were initially collected by database searching that considering eligibility criteria, 83 articles were finally eligible for the final assessment. There is a lack of clinical trials and case-cohort studies on general population about treatment and side effects when it comes to human nerve agents and most of the data in our search is based on animal studies. Results: In evaluating various clinical, auto physiological and prognostic aspects of exposure to these substances, special attention was necessary to the following points. First, Novichok agents are considered more potent than other toxic agents. Pathophysiologically, these agents irreversibly bind acetylcholinesterase and produce a rapid cholinergic toxidrome which is responsible for the clinical manifestations as well as the potential dangerous and life threatening side effects caused by these agents. Uniquely, these agents are thought to also target every neuron in the central and peripheral nervous system. As a managerial and therapeutic approach, early and timely treatment of its related complication along with prevents massive exposure and decontamination in addition to rapid resuscitation can prohibit debilitating neuropathy and death due to facing it. Conclusion: The present review highlights the importance of recognizing the potential acute toxic effects of Novichok agents, diagnostic and therapeutic approaches (life-saving antidotal therapy) to complications and ultimately the application of guidelines to improve the prognosis of exposure to these agents for both victims and medical community.
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27
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Muacevic A, Adler JR, Kakkar R, Aravindakshan R, Tripathi M, Ayyanar R, V M. Mysterious Outbreak of Acute Neurological Syndrome in Eluru, Andhra Pradesh, India: A Post-outbreak Geo-Spatial Analysis. Cureus 2022; 14:e31801. [PMID: 36569687 PMCID: PMC9780085 DOI: 10.7759/cureus.31801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND An outbreak characterized by sudden-onset seizures, loss of consciousness, and complete recovery within a few hours was reported from Eluru town in Andhra Pradesh on December 6, 2020. This study was conducted to assess the environmental correlates of the outbreak using geo-mapping tools. METHODS A post-outbreak survey was conducted among affected cases in January-February, 2021. A house-to-house survey tool collected information on demographics, clinical profile, and environmental and psychological aspects (Impact of Event Scale). Geo-mapping and news media content analyses were done using QGIS and Atlas.ti software, respectively. RESULTS A total of 394 cases were studied. The median (interquartile range [IQR]) age of the participants was 27 (17-39) years and comprised mostly male students. There was no clustering of cases within 48 hours of illness onset in the spatial analysis. Loss of consciousness was the first (50.7%) and the most common symptom. All cases were taken to a health facility and were discharged after a median duration of 48 minutes. COVID-19-related and environmental practices were not associated with the clinical manifestations. Awareness about pesticides was low. The outbreak reportedly had a psychological impact on 24.4% of the participants. The most common co-occurring themes in the news media analysis were water contamination and pesticides. CONCLUSION The geo-spatial analysis did not find case clustering or points of convergence during the incubation period. The geo-locations did not distribute around water bodies or suspected landmarks although news media projected water contamination and pesticides as probable causes of the outbreak.
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28
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Sarailoo M, Afshari S, Asghariazar V, Safarzadeh E, Dadkhah M. Cognitive Impairment and Neurodegenerative Diseases Development Associated with Organophosphate Pesticides Exposure: a Review Study. Neurotox Res 2022; 40:1624-1643. [PMID: 36066747 DOI: 10.1007/s12640-022-00552-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 10/14/2022]
Abstract
A significant body of literature emphasizes the role of insecticide, particularly organophosphates (OPs), as the major environmental factor in the etiology of neurodegenerative diseases. This review aims to study the relationship between OP insecticide exposure, cognitive impairment, and neurodegenerative disease development. Human populations, especially in developing countries, are frequently exposed to OPs due to their extensive applications. The involvement of various signaling pathways in OP neurotoxicity are reported, but the OP-induced cognitive impairment and link between OP exposure and the pathophysiology of neurodegenerative diseases are not clearly understood. In the present review, we have therefore aimed to come to new conclusions which may help to find protective and preventive strategies against OP neurotoxicity and may establish a possible link between organophosphate exposure, cognitive impairment, and OP-induced neurotoxicity. Moreover, we discuss the findings obtained from animal and human research providing some support for OP-induced cognitive impairment and neurodegenerative disorders.
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Affiliation(s)
- Mehdi Sarailoo
- Students Research Committee, School of Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Salva Afshari
- Students Research Committee, Pharmacy School, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Vahid Asghariazar
- Deputy of Research & Technology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Elham Safarzadeh
- Department of Microbiology, Parasitology, and Immunology, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Masoomeh Dadkhah
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran.
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29
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Zhang L, Chen J, Zhang X, Wang Y, Cen J, Shi G, Sun M, Wang X, Meng W, Xiao K. Rapid detection of nerve agents in environmental and biological samples using a fluorescent probe. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 275:121171. [PMID: 35325854 DOI: 10.1016/j.saa.2022.121171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
Nerve agents are highly toxic chemical warfare agents that are easy to synthesize and have recently been applied many times in local wars and terrorist attacks. Fluorescent probes have been widely used in life science and medical research due to their features of short reaction time, high sensitivity and good selectivity. Herein, two fluorescent compounds, NMU-1 and NMU-2, were synthesized for the selective detection of nerve agents. NMU-1 exhibited good detection performance for nerve agents. With increasing nerve agent concentration, the fluorescence signal of NMU-1 at 498 nm gradually decreased with an excellent linear relationship. NMU-1 exhibited a low LOD (4.6 μM for DCP and 8.41 μM for soman), a rapid response (less than 3 min) and a large Stokes shift (98 nm) along with obvious color changes. Due to its high sensitivity and good selectivity, NMU-1 was successfully applied to image nerve agents in living PC12 cells. Furthermore, NMU-1 was used as a key element to develop chemical warfare agent test paper, which exhibited significant fluorescent changes under hand-held 365-nm UV light upon contact with nerve agents.
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Affiliation(s)
- Ling Zhang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou 221002, China.
| | - Jiasheng Chen
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou 221002, China
| | - Xinyue Zhang
- School of Pharmacy, Henan University, Kaifeng, 475004, China
| | - Yurun Wang
- Department of Protective Medicine Against Chemical Agents, Faculty of Naval Medicine, Naval Medical University, Shanghai, 200433, China
| | - Jinfeng Cen
- Department of Protective Medicine Against Chemical Agents, Faculty of Naval Medicine, Naval Medical University, Shanghai, 200433, China
| | - Guiyan Shi
- Department of Protective Medicine Against Chemical Agents, Faculty of Naval Medicine, Naval Medical University, Shanghai, 200433, China
| | - Mingxue Sun
- Department of Protective Medicine Against Chemical Agents, Faculty of Naval Medicine, Naval Medical University, Shanghai, 200433, China
| | - Xianyou Wang
- School of Pharmacy, Henan University, Kaifeng, 475004, China
| | - Wenqi Meng
- Department of Protective Medicine Against Chemical Agents, Faculty of Naval Medicine, Naval Medical University, Shanghai, 200433, China.
| | - Kai Xiao
- Department of Protective Medicine Against Chemical Agents, Faculty of Naval Medicine, Naval Medical University, Shanghai, 200433, China.
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30
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Karasova JZ, Kassa J, Hepnarova V, Pejchal J, Junova L, Andrys R, Malinak D, Bzonek P, Kohoutova Z, Musilek K. Toxicity, pharmacokinetics, and effectiveness of the ortho-chlorinated bispyridinium oxime, K870. Food Chem Toxicol 2022; 167:113236. [PMID: 35738326 DOI: 10.1016/j.fct.2022.113236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022]
Abstract
Oxime reactivators are causal antidotes for organophosphate intoxication. Herein, the toxicity, pharmacokinetics, and reactivation effectiveness of o-chlorinated bispyridinium oxime K870 are reported. Oxime K870 was found to have a safe profile at a dose of 30 mg/kg in rats. It exhibited rapid absorption and renal clearance similar to those of other charged oximes after intramuscular administration. Its isoxazole-pyridinium degradation product was identified in vivo. Although it showed some improvement in brain targeting, it was nevertheless rapidly effluxed from the central nervous system. Its reactivation effectiveness was evaluated in rats and mice intoxicated with sarin, tabun, VX, and paraoxon and compared with pralidoxime and asoxime. K870 was found to be less effective in reversing tabun poisoning compared to its parent unchlorinated oxime K203. However, K870 efficiently reactivated blood acetylcholinesterase for all tested organophosphates in rats. In addition, K870 significantly protected against intoxication by all tested organophosphates in mice. For these reasons, oxime K870 seems to have a broader reactivation spectrum against multiple organophosphates. It seems important to properly modulate the oximate forming properties (pKa) to obtain more versatile oxime reactivators.
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Affiliation(s)
- Jana Zdarova Karasova
- Department of Toxicology and Military Pharmacy, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic; Biomedical Research Center, University Hospital, Hradec Kralove, Czech Republic.
| | - Jiri Kassa
- Department of Toxicology and Military Pharmacy, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Vendula Hepnarova
- Department of Toxicology and Military Pharmacy, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Jaroslav Pejchal
- Department of Toxicology and Military Pharmacy, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Lucie Junova
- Department of Toxicology and Military Pharmacy, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Rudolf Andrys
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - David Malinak
- Biomedical Research Center, University Hospital, Hradec Kralove, Czech Republic; Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petr Bzonek
- Department of Toxicology and Military Pharmacy, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic; Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Zuzana Kohoutova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kamil Musilek
- Biomedical Research Center, University Hospital, Hradec Kralove, Czech Republic; Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic.
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31
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Allard JL, Shields KA, Munro T, Lua LHL. Design and production strategies for developing a recombinant butyrylcholinesterase medical countermeasure for Organophosphorus poisoning. Chem Biol Interact 2022; 363:109996. [PMID: 35654125 DOI: 10.1016/j.cbi.2022.109996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/06/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
Abstract
Organophosphorus nerve agents represent a serious chemical threat due to their ease of production and scale of impact. The recent use of the nerve agent Novichok has re-emphasised the need for broad-spectrum medical countermeasures (MCMs) to these agents. However, current MCMs are limited. Plasma derived human butyrylcholinesterase (huBChE) is a promising novel bioscavenger MCM strategy, but is prohibitively expensive to isolate from human plasma at scale. Efforts to produce recombinant huBChE (rBChE) in various protein expression platforms have failed to achieve key critical attributes of huBChE such as circulatory half-life. These proteins often lack critical features such as tetrameric structure and requisite post-translational modifications. This review evaluates previous attempts to generate rBChE and assesses recent advances in mammalian cell expression and protein engineering strategies that could be deployed to achieve the required half-life and yield for a viable rBChE MCM. This includes the addition of a proline-rich attachment domain, fusion proteins, post translational modifications, expression system selection and optimised downstream processes. Whilst challenges remain, a combinatorial approach of these strategies demonstrates potential as a technically feasible approach to achieving a bioactive and cost effective bioscavenger MCM.
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Affiliation(s)
- Joanne L Allard
- Defence Science and Technology Group, Fishermans Bend, Victoria, 3207, Australia; The University of Queensland, Brisbane, Queensland, 4072, Australia.
| | - Katherine A Shields
- Defence Science and Technology Group, Fishermans Bend, Victoria, 3207, Australia
| | - TrentP Munro
- The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Linda H L Lua
- The University of Queensland, Brisbane, Queensland, 4072, Australia
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32
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Bugay V, Gregory SR, Belanger-Coast MG, Zhao R, Brenner R. Effects of Sublethal Organophosphate Toxicity and Anti-cholinergics on Electroencephalogram and Respiratory Mechanics in Mice. Front Neurosci 2022; 16:866899. [PMID: 35585917 PMCID: PMC9108673 DOI: 10.3389/fnins.2022.866899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Organophosphates are used in agriculture as insecticides but are potentially toxic to humans when exposed at high concentrations. The mechanism of toxicity is through antagonism of acetylcholinesterase, which secondarily causes excess activation of cholinergic receptors leading to seizures, tremors, respiratory depression, and other physiological consequences. Here we investigated two of the major pathophysiological effects, seizures and respiratory depression, using subcutaneous injection into mice of the organophosphate diisopropylfluorophosphate (DFP) at sublethal concentrations (2.1 mg/Kg) alone and co-injected with current therapeutics atropine (50 mg/Kg) or acetylcholinesterase reactivator HI6 (3 mg/Kg). We also tested a non-specific cholinergic antagonist dequalinium chloride (2 mg/Kg) as a novel treatment for organophosphate toxicity. Electroencephalogram (EEG) recordings revealed that DFP causes focal delta frequency (average 1.4 Hz) tonic spikes in the parietal region that occur transiently (lasting an average of 171 ± 33 min) and a more sustained generalized theta frequency depression in both parietal and frontal electrode that did not recover the following 24 h. DFP also caused behavioral tremors that partially recovered the following 24 h. Using whole body plethysmography, DFP revealed acute respiratory depression, including reduced breathing rates and tidal volumes, that partially recover the following day. Among therapeutic treatments, dequalinium chloride had the most potent effect on all physiological parameters by reducing acute EEG abnormalities and promoting a full recovery after 24 h from tremors and respiratory depression. Atropine and HI6 had distinct effects on EEGs. Co-treatment with atropine converted the acute 1.4 Hz tonic spikes to 3 Hz tonic spikes in the parietal electrode and promoted a partial recovery after 24 h from theta frequency and respiratory depression. HI6 fully removed the parietal delta spike increase and promoted a full recovery in theta frequency and respiratory depression. In summary, while all anticholinergic treatments promoted survival and moderated symptoms of DFP toxicity, the non-selective anti-cholinergic dequalinium chloride had the most potent therapeutic effects in reducing EEG abnormalities, moderating tremors and reducing respiratory depression.
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33
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Countermeasures in organophosphorus intoxication: pitfalls and prospects. Trends Pharmacol Sci 2022; 43:593-606. [DOI: 10.1016/j.tips.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 11/24/2022]
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34
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Rapid Onset of Neuromuscular Paralysis or Weakness. Crit Care Clin 2022; 38:413-428. [DOI: 10.1016/j.ccc.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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35
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36
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Goonasekera C, Karalliedde L. Laryngeal Dysfunction and Acute Organophosphorus Poisoning. Indian J Crit Care Med 2022; 26:155-156. [PMID: 35712734 PMCID: PMC8857723 DOI: 10.5005/jp-journals-10071-24107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Goonasekera C, Karalliedde L. Laryngeal Dysfunction and Acute Organophosphorus Poisoning. Indian J Crit Care Med 2022;26(2):155-156.
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Affiliation(s)
- Chulananda Goonasekera
- Department of Anaesthetics, King's College Hospital NHS Foundation Trust, Institute of Childhealth, University College London, London, England, United Kingdom
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37
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Lv Q, Yu HL, Yang Y, Meng FH, Dai XD, Jiang PY, Liu CC. Screening of monoclonal antibodies against specific phosphonylation sites and analysis of serum samples exposed to soman and VX using an indirect competitive enzyme-linked immunosorbent assay. Anal Bioanal Chem 2022; 414:2713-2724. [PMID: 35083511 DOI: 10.1007/s00216-022-03914-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/13/2022]
Abstract
Organophosphorus nerve agents (OPNAs) covalently bind to tyrosine 411 of human serum albumin (HSA) and the formed adducts are stable biomarkers of OPNA exposure. The detection of these adducts has been limited to mass spectrometry techniques combined with protein digestion. Here, we developed indirect competitive ELISA (icELISA) methods to verify OPNA exposure by the detection of OPNA-phosphonylated adducts at tyrosine 411 residue (OPNA-HSA adducts), in which monoclonal antibodies (mAbs) against phosphonylation sites at tyrosine 411 were introduced. The two mAbs were prepared by the fourth generation of rabbit mAb technology using the phosphonylated peptides of LVRY(GD or VX)TKKVPQC as the haptens. These mAbs were screened using our developed competitive ELISA method and then selected based on their individual affinity and selectivity. As a result, we obtained two mAbs that recognized the HSA Tyr 411 adduct of GD (mAb-5G2) or VX (mAb-12B9), respectively. They shared the highest affinity exhibiting a Kd value of about 10-6 mol/L of the OPNA exposure concentration. They also had remarkable selectivity, which could especially recognize their individual OPNA-HSA adducts in a native state but did not recognize other OPNA-HSAs and unadducted HSAs. Especially for mAb-12B9, it could clearly distinguish VX-HSA and GB-HSA between which there was only one alkyl difference in their phosphonyl portion of the adducted sites. The two mAbs were then used to build the icELISA method for analysis of the serum samples exposed to OPNA. It was found that the detectable lowest GD- and VX-exposed concentrations in serum samples were respectively 1.0 × 10-6 mol/L and 10.0 × 10-6 mol/L. This study provides one novel approach and strategy for the retrospective detection of OPNA exposure, and the two mAbs have great potential to be extended for point-of-care testing of OPNA intoxication.
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Affiliation(s)
- Qiao Lv
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, China
- Laboratory of Analytical Chemistry, Research Institute of Chemical Defence, Beijing, 102205, China
| | - Hui-Lan Yu
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, China.
- Laboratory of Analytical Chemistry, Research Institute of Chemical Defence, Beijing, 102205, China.
| | - Yang Yang
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, China
- Laboratory of Analytical Chemistry, Research Institute of Chemical Defence, Beijing, 102205, China
| | - Fan-Hua Meng
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, China
| | - Xian-Dong Dai
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, China
| | - Pei-Yu Jiang
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, China
- Laboratory of Analytical Chemistry, Research Institute of Chemical Defence, Beijing, 102205, China
| | - Chang-Cai Liu
- State Key Laboratory of NBC Protection for Civilian, Beijing, 102205, China.
- Laboratory of Analytical Chemistry, Research Institute of Chemical Defence, Beijing, 102205, China.
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Zhao D, Liu J, Zhang L, Zhou Y, Zhong Y, Yang Y, Huang C, Wang Y. Loading and Sustained Release of Pralidoxime Chloride from Swellable MIL-88B(Fe) and Its Therapeutic Performance on Mice Poisoned by Neurotoxic Agents. Inorg Chem 2021; 61:1512-1520. [PMID: 34969248 DOI: 10.1021/acs.inorgchem.1c03227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Maintaining a long-term continuous and stable reactivator blood concentration to treat organophosphorus nerve agent poisoning using acetylcholinesterase (AChE) reactivator pralidoxime chloride (2-PAM) is very important yet difficult. Because the flexible framework of MIL-88B(Fe) nanoparticles (NPs) can swell in polar solvents, pralidoxime chloride (2-PAM) was loaded in MIL-88B(Fe) NPs (size: ca. 500 nm) by stirring and incubation in deionized water to obtain 2-PAM@MIL-88B(Fe), which had a maximum drug loading capacity of 12.6 wt %. The as-prepared composite was characterized by IR, powder X-ray diffraction (P-XRD), scanning electron microscopy (SEM), ζ-potential, Brunauer-Emmett-Teller (BET), and thermogravimetry/differential thermal analysis (TG/DTA). The results showed that under constant conditions, the maximum drug release rates of 2-PAM@MIL-88B(Fe) in absolute ethanol, phosphate-buffered saline (PBS) solution (pH = 7.4), and PBS solution (pH = 4) at 150 h were 51.7, 80.6, and 67.1%, respectively. This was because the composite showed different swelling behaviors in different solvents. In PBS solution with pH = 2, the 2-PAM@MIL-88B(Fe) framework collapsed after 53 h and released 100% of 2-PAM. For mice after intragastric poisoning with sarin (a neurotoxic agent), an atropine-assisted 2-PAM@MIL-88B(Fe) treatment experiment revealed that 2-PAM@MIL-88B(Fe) continuously released 2-PAM for more than 72 h so that poisoned AChE was continuously and steadily reactivated. The reactivation rate of AChE was 56.7% after 72 h. This composite is expected to provide a prolonged, stable therapeutic drug for the mid- and late-stage treatment of neurotoxic agent poisoning.
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Affiliation(s)
- Dianfa Zhao
- State Key Laboratory of Chemical Resource Engineering, Institute of Chemistry, Beijing University of Chemical Technology, Beijing 100029, P. R. China
| | - Jie Liu
- State Key Laboratory of Chemical Resource Engineering, Institute of Chemistry, Beijing University of Chemical Technology, Beijing 100029, P. R. China
| | - Lijuan Zhang
- State Key Laboratory of Chemical Resource Engineering, Institute of Chemistry, Beijing University of Chemical Technology, Beijing 100029, P. R. China
| | - Yunshan Zhou
- State Key Laboratory of Chemical Resource Engineering, Institute of Chemistry, Beijing University of Chemical Technology, Beijing 100029, P. R. China
| | - Yuxu Zhong
- Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Sciences PLA China, Beijing 100850, P. R. China
| | - Yang Yang
- State Key Laboratory of Chemical Resource Engineering, Institute of Chemistry, Beijing University of Chemical Technology, Beijing 100029, P. R. China
| | - Chengcheng Huang
- State Key Laboratory of Chemical Resource Engineering, Institute of Chemistry, Beijing University of Chemical Technology, Beijing 100029, P. R. China
| | - Yong'an Wang
- Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Sciences PLA China, Beijing 100850, P. R. China
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Chemical, biological, radiological, and nuclear mass casualty medicine: a review of lessons from the Salisbury and Amesbury Novichok nerve agent incidents. Br J Anaesth 2021; 128:e200-e205. [PMID: 34794766 DOI: 10.1016/j.bja.2021.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022] Open
Abstract
On March 4, 2018, two casualties collapsed on a park bench in Salisbury, Wiltshire, UK. They were later discovered to have been the victims of an attempted murder using the Soviet-era Novichok class of nerve agent. The casualties, along with three further critically ill patients, were cared for in Salisbury District Hospital's Intensive Care Unit. Before the COVID-19 pandemic, the Salisbury and Amesbury incidents were the longest-running major incidents in the history of the UK National Health Service. This narrative review seeks to reflect on the lessons learned from these chemical incidents, with a particular focus on hospital and local organisational responses.
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Finnegan TJ, Gunawardana VWL, Badjić JD. Molecular Recognition of Nerve Agents and Their Organophosphorus Surrogates: Toward Supramolecular Scavengers and Catalysts. Chemistry 2021; 27:13280-13305. [PMID: 34185362 PMCID: PMC8453132 DOI: 10.1002/chem.202101532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Indexed: 12/19/2022]
Abstract
Nerve agents are tetrahedral organophosphorus compounds (OPs) that were developed in the last century to irreversibly inhibit acetylcholinesterase (AChE) and therefore impede neurological signaling in living organisms. Exposure to OPs leads to a rapid development of symptoms from excessive salivation, nasal congestion and chest pain to convulsion and asphyxiation which if left untreated may lead to death. These potent toxins are prepared on a large scale from inexpensive staring materials, making it feasible for terrorist groups or states to use them against military and civilians. The existing antidotes provide limited protection and are difficult to apply to a large number of affected individuals. While new prophylactics are currently being developed, there is still need for therapeutics capable of both preventing and reversing the effects of OP poisoning. In this review, we describe how the science of molecular recognition can expand the pallet of tools for rapid and safe sequestration of nerve agents.
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Affiliation(s)
- Tyler J Finnegan
- Department of Chemistry and Biochemistry, The Ohio State University, 100 West 18th Avenue, Columbus, OH, USA
| | | | - Jovica D Badjić
- Department of Chemistry and Biochemistry, The Ohio State University, 100 West 18th Avenue, Columbus, OH, USA
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41
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Biçer E. A review on C-P bonding reactions assisted by manganese(III) acetate. PHOSPHORUS SULFUR 2021. [DOI: 10.1080/10426507.2021.1945062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Emre Biçer
- Faculty of Engineering and Natural Sciences, Sivas University of Science and Technology, Sivas, Turkey
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42
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Singh AP, Balayan S, Gupta S, Jain U, Sarin R, Chauhan N. Detection of pesticide residues utilizing enzyme-electrode interface via nano-patterning of TiO2 nanoparticles and molybdenum disulfide (MoS2) nanosheets. Process Biochem 2021. [DOI: 10.1016/j.procbio.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Zandona A, Maraković N, Mišetić P, Madunić J, Miš K, Padovan J, Pirkmajer S, Katalinić M. Activation of (un)regulated cell death as a new perspective for bispyridinium and imidazolium oximes. Arch Toxicol 2021; 95:2737-2754. [PMID: 34173857 DOI: 10.1007/s00204-021-03098-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022]
Abstract
Oximes, investigated as antidotes against organophosphates (OP) poisoning, are known to display toxic effects on a cellular level, which could be explained beyond action on acetylcholinesterase as their main target. To investigate this further, we performed an in vitro cell-based evaluation of effects of two structurally diverse oxime groups at concentrations of up to 800 μM, on several cell models: skeletal muscle, kidney, liver, and neural cells. As indicated by our results, compounds with an imidazolium core induced necrosis, unregulated cell death characterized by a cell burst, increased formation of reactive oxygen species, and activation of antioxidant scavenging. On the other hand, oximes with a pyridinium core activated apoptosis through specific caspases 3, 8, and/or 9. Interestingly, some of the compounds exhibited a synergistic effect. Moreover, we generated a pharmacophore model for each oxime series and identified ligands from public databases that map to generated pharmacophores. Several interesting hits were obtained including chemotherapeutics and specific inhibitors. We were able to define the possible structural features of tested oximes triggering toxic effects: chlorine atoms in combination with but-2(E)-en-1,4-diyl linker and adding a second benzene ring with substituents such as chlorine and/or methyl on the imidazolium core. Such oximes could not be used in further OP antidote development research, but could be introduced in other research studies on new specific targets. This could undoubtedly result in an overall improved wider use of unexplored oxime database created so far in OP antidotes field of research in a completely new perspective.
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Affiliation(s)
- Antonio Zandona
- Institute for Medical Research and Occupational Health, POB 291, 10001, Zagreb, Croatia
| | - Nikola Maraković
- Institute for Medical Research and Occupational Health, POB 291, 10001, Zagreb, Croatia
| | | | - Josip Madunić
- Institute for Medical Research and Occupational Health, POB 291, 10001, Zagreb, Croatia
| | - Katarina Miš
- Faculty of Medicine, Institute of Pathophysiology, University of Ljubljana, Ljubljana, Slovenia
| | | | - Sergej Pirkmajer
- Faculty of Medicine, Institute of Pathophysiology, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Katalinić
- Institute for Medical Research and Occupational Health, POB 291, 10001, Zagreb, Croatia.
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Cole SD, Elliott ER, Rankin SC. SODAPOP: A Metacognitive Mnemonic Framework to Teach Antimicrobial Selection. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:263-266. [PMID: 32412374 DOI: 10.3138/jvme.2019-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Mnemonics are used widely throughout medical education to help manage large amounts of information and to promote a systematic approach to complex problems. SODAPOP is a metacognitive mnemonic that offers learners a framework for veterinary clinical decision making to support optimal antimicrobial selection. SODAPOP has students consider the source and organism before they decide to treat; then they consider the antimicrobials to which the organism is susceptible with regard to contraindications in the patient; and, ultimately, the options are weighed and a plan is formulated. A preliminary study showed that students' perception of SODAPOP was favorable and that exposure to SODAPOP improved student confidence levels. Further research is needed to determine whether SODAPOP improves students' optimal antimicrobial selection. SODAPOP could be a potentially helpful teaching tool because it can be mapped to the Association of American Veterinary Medical Colleges competency-based veterinary education framework under subcompetencies 1.3 and 4.2. A mnemonic such as SODAPOP could be integrated throughout the veterinary curriculum both in basic science courses (microbiology) and with real cases during clinical rotations.
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[Accidental injection of an unknown emergency antidote for acetylcholinesterase activation]. Unfallchirurg 2021; 125:91-93. [PMID: 34032886 PMCID: PMC8763776 DOI: 10.1007/s00113-021-01010-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/03/2022]
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Dong N, Wang S, Li X, Li W, Gao N, Pang L, Xing J. Prognostic nomogram for the severity of acute organophosphate insecticide self-poisoning: a retrospective observational cohort study. BMJ Open 2021; 11:e042765. [PMID: 34031108 PMCID: PMC8149305 DOI: 10.1136/bmjopen-2020-042765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop a convenient nomogram for the bedside evaluation of patients with acute organophosphorus poisoning (AOPP). DESIGN This was a retrospective study. SETTING Two independent hospitals in northern China, the First Hospital of Jilin University and the Lequn Hospital of the First Hospital of Jilin University. PARTICIPANTS A total of 1657 consecutive patients admitted for the deliberate oral intake of AOPP within 24 hours from exposure and aged >18 years were enrolled between 1 January 2013 and 31 December 2018. The exclusion criteria were: normal range of plasma cholinesterase, exposure to any other type of poisonous drug(s), severe chronic comorbidities including symptomatic heart failure (New York Heart Association III or IV) or any other kidney, liver and pulmonary diseases. Eight hundred and thirty-four patients were included. PRIMARY OUTCOME MEASURE The existence of severely poisoned cases, defined as patients with any of the following complications: cardiac arrest, respiratory failure requiring ventilator support, hypotension or in-hospital death. RESULTS 440 patients from one hospital were included in the study to develop a nomogram of severe AOPP, whereas 394 patients from the other hospital were used for the validation. Associated risk factors were identified by multivariate logistic regression. The nomogram was validated by the area under the receiver operating characteristic curve (AUC). A nomogram was developed with age, white cells, albumin, cholinesterase, blood pH and lactic acid levels. The AUC was 0.875 (95% CI 0.837 to 0.913) and 0.855 (95% CI 0.81 to 0.9) in the derivation and validation cohorts, respectively. The calibration plot for the probability of severe AOPP showed an optimal agreement between the prediction by nomogram and actual observation in both derivation and validation cohorts. CONCLUSION A convenient severity evaluation nomogram for patients with AOPP was developed, which could be used by physicians in making clinical decisions and predicting patients' prognosis.
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Affiliation(s)
- Ning Dong
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Shaokun Wang
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Xingliang Li
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Wei Li
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Nan Gao
- Third Clinical Hospital of Changchun Traditional Chinese Medicine University, Changchun, Jilin, China
| | - Li Pang
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
| | - Jihong Xing
- Department of Emergency, Jilin University First Hospital, Changchun, Jilin, China
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Meng W, Pei Z, Wang Y, Sun M, Xu Q, Cen J, Guo K, Xiao K, Li Z. Two birds with one stone: The detection of nerve agents and AChE activity with an ICT-ESIPT-based fluorescence sensor. JOURNAL OF HAZARDOUS MATERIALS 2021; 410:124811. [PMID: 33450470 DOI: 10.1016/j.jhazmat.2020.124811] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/20/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
Nerve agents are among the world's deadliest poisons, and the target enzyme is acetylcholinesterase (AChE). To better diagnosis nerve agent poisonings, a reliable diagnostic method for both nerve agents and AChE is desirable. Herein, we synthesized a series of fluorescent sensors for both real nerve agents and acetylcholinesterase activity detection. Among these sensors, HBQ-AE exhibited a fast response rate (within 10 s for nerve agent and 8 min for AChE), good sensitivity (the limit of detection is 6 nM and 0.2 U/mL) and a high off/on contrast. To the best of our knowledge, HBQ-AE is the first fluorescence sensor for nerve agents and AChE activity detection. The fluorescent change of HBQ-AE from nonfluorescence to blue fluorescence (nerve agent) or orange fluorescence (AChE) by excitation at 365 nm can be easily observed with the naked eye. HBQ-AE was successfully applied to image nerve agents and AChE activity in living cells. Moreover, HBQ-AE is the vital member to construct a test paper that can be employed to detect and diagnose chemical warfare agents.
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Affiliation(s)
- Wenqi Meng
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, Nanjing, China; Lab of Toxicology & Pharmacology, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Zhipeng Pei
- Lab of Toxicology & Pharmacology, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Yurun Wang
- Lab of Toxicology & Pharmacology, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Mingxue Sun
- Lab of Toxicology & Pharmacology, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Qingqiang Xu
- Lab of Toxicology & Pharmacology, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Jinfeng Cen
- Lab of Toxicology & Pharmacology, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Kai Guo
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, Nanjing, China
| | - Kai Xiao
- Lab of Toxicology & Pharmacology, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China.
| | - Zhenjiang Li
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, Nanjing, China.
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A Smartphone Camera Colorimetric Assay of Acetylcholinesterase and Butyrylcholinesterase Activity. SENSORS 2021; 21:s21051796. [PMID: 33807562 PMCID: PMC7961819 DOI: 10.3390/s21051796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) can serve as biochemical markers of various pathologies like liver disfunction and poisonings by nerve agents. Ellman’s assay is the standard spectrophotometric method to measure cholinesterase activity in clinical laboratories. The authors present a new colorimetric test to assess AChE and BChE activity in biological samples using chromogenic reagents, treated 3D-printed measuring pads and a smartphone camera as a signal detector. Multiwell pads treated with reagent substrates 2,6-dichlorophenolindophenyl acetate, indoxylacetate, ethoxyresorufin and methoxyresorufin were prepared and tested for AChE and BChE. In the experiments, 3D-printed pads containing indoxylacetate as a chromogenic substrate were optimal for analytical purposes. The best results were achieved using the red (R) channel, where the limit of detection was 4.05 µkat/mL for BChE and 4.38 µkat/mL for AChE using a 40 µL sample and a 60 min assay. The major advantage of this method is its overall simplicity, as samples are applied directly without any specific treatment or added reagents. The assay was also validated to the standard Ellman’s assay using human plasma samples. In conclusion, this smartphone camera-based colorimetric assay appears to have practical applicability and to be a suitable method for point-of-care testing because it does not require specific manipulation, additional education of staff or use of sophisticated analytical instruments.
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Ribchester RR, Mehta AR. Neuromuscular junctions: mind meeting matter. Lancet Neurol 2021; 20:93. [PMID: 33484653 DOI: 10.1016/s1474-4422(20)30486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Steindl D, Boehmerle W, Körner R, Praeger D, Haug M, Nee J, Schreiber A, Scheibe F, Demin K, Jacoby P, Tauber R, Hartwig S, Endres M, Eckardt KU. Novichok nerve agent poisoning. Lancet 2021; 397:249-252. [PMID: 33357496 DOI: 10.1016/s0140-6736(20)32644-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 11/21/2022]
Affiliation(s)
- David Steindl
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Boehmerle
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Körner
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Damaris Praeger
- Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marcel Haug
- Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Nee
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Adrian Schreiber
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Scheibe
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Demin
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Rudolf Tauber
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Berlin, Germany; Labor Berlin Charité Vivantes GmbH, Berlin, Germany
| | - Sven Hartwig
- Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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