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Quiroga-Garza ME, Ruiz-Lozano RE, Azar NS, Mousa HM, Komai S, Sevilla-Llorca JL, Perez VL. Noxious effects of riot control agents on the ocular surface: Pathogenic mechanisms and management. FRONTIERS IN TOXICOLOGY 2023; 5:1118731. [PMID: 36733462 PMCID: PMC9887149 DOI: 10.3389/ftox.2023.1118731] [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: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Riot Control Agents (RCAs) are chemical compounds used by law enforcement agencies to quell violent demonstrations as an alternative to lethal force and as part of police/military training. They are also known as tear gases because of the hallmark ocular irritation and lacrimation they cause. The most common RCAs include oleoresin capsicum (contained in Mace and pepper spray), chlorobenzylidene malononitrile, dibenzoxazepine, and chloroacetophenone (previously the main content of Mace); some of which have been in use for decades. Their immediate incapacitating effects are mediated through polymodal afferent fibers innervating the corneal surface, inducing the release of peptides that cause neurogenic inflammation. Although previously thought to have only transient effects on exposed patients more severe complications such as corneal stromal opacities, corneal neovascularization, neurotrophic keratopathy, conjunctival necrosis, and pseudopterygium can occur. Concerningly, the lack of research and specific therapies restrict the current management to decontamination and symptom-tailored support. This manuscript will provide an overview of the toxic mechanisms of RCAs, their clinical manifestations, and current therapy after exposure to tear gases.
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Affiliation(s)
- Manuel E. Quiroga-Garza
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Nadim S. Azar
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Hazem M. Mousa
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Seitaro Komai
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Jose L. Sevilla-Llorca
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Victor L. Perez
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States,*Correspondence: Victor L. Perez,
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Toy HI, Yildiz AB, Tasdemir Kahraman D, Ilhan S, Dikensoy O, Bayram H. Capsaicin suppresses ciliary function, while inducing permeability in bronchial epithelial cell cultures of COPD patients. Front Pharmacol 2022; 13:996046. [PMID: 36278231 PMCID: PMC9582664 DOI: 10.3389/fphar.2022.996046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022] Open
Abstract
Take Home Message: Capsaicin modified inflammatory response and caused toxicity in bronchial epithelial cultures from patients with COPD. More importantly, capsaicin decreased ciliary beat frequency and induced epithelial permeability and these effects were partially prevented by formoterol and roflumilast. Tear gas is widely used to halt mass demonstrations. Studies have reported its adverse effects on multiple organ systems; however, its effect on individuals with chronic respiratory diseases and the underlying mechanisms of these effects are unclear. For the first time in the literature, we investigated the effects of capsaicin, the active ingredient of tear gas, on bronchial epithelial cell (BEC) cultures obtained from well-characterized groups of nonsmokers, smokers, and patients with chronic obstructive pulmonary disease (COPD). BEC cultures were incubated with 50-500 μM capsaicin in the absence and presence of formoterol (1μM) and roflumilast (0.1 μM) for 24 h. Ciliary beat frequency (CBF) and transepithelial electrical resistance (TEER) were assessed at T1/4, T1/2, T1, T2, T4, T6, and T24 h, whereas the release of granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL)-8, and lactate dehydrogenase (LDH) was measured at T24 h. Capsaicin (250 µM) significantly decreased CBF of all BEC cultures from T1/4 h to T24 h (p<0.05). Formoterol significantly prevented decreases in CBF induced by capsaicin. Higher concentrations of capsaicin (250-500 μM) significantly reduced TEER of BECs from nonsmokers (T2-T24 h), smokers (T24 h) and COPD patients (T2 and T24 h), which was partially prevented by roflumilast. Capsaicin (500 μM) decreased release of IL-8 (p<0.0001) and GM-CSF (p<0.05) while inducing release of LDH in BECs (p<0.05), and this was more prominent in BEC from patients with COPD. In conclusion, our findings demonstrate that capsaicin can suppress ciliary activity and cytokine release from BECs, induce BEC culture permeability and cellular toxicity and that these effects can be partially prevented by formoterol and roflumilast.
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Affiliation(s)
- Halil Ibrahim Toy
- Gaziantep University School of Medicine, Respiratory Research Laboratory, Gaziantep, Türkiye
- Izmir Biomedicine and Genome Center, Izmir, Türkiye
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Türkiye
- Department of Epidemiology and Cancer Control, St. Jude Childrens Research Hospital, Memphis, TN, United States
| | | | - Demet Tasdemir Kahraman
- Gaziantep University School of Medicine, Respiratory Research Laboratory, Gaziantep, Türkiye
- Gaziantep University, Faculty of Medicine, Department of Medical Biochemistry, Gaziantep, Türkiye
| | - Sedat Ilhan
- Gaziantep University School of Medicine, Respiratory Research Laboratory, Gaziantep, Türkiye
- Gaziantep University, Institute of Health Sciences, Department of Respiratory Biology, Gaziantep, Türkiye
| | - Oner Dikensoy
- Department of Chest Diseases, Gaziantep University School of Medicine, Gaziantep, Türkiye
| | - Hasan Bayram
- Gaziantep University School of Medicine, Respiratory Research Laboratory, Gaziantep, Türkiye
- Department of Chest Diseases, Gaziantep University School of Medicine, Gaziantep, Türkiye
- Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Türkiye
- Koc University Research Centre for Translational Medicine (KUTTAM), Koç University, Istanbul, Türkiye
- *Correspondence: Hasan Bayram,
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Chemical Agents Encountered in Protests. Emerg Med Clin North Am 2022; 40:365-379. [DOI: 10.1016/j.emc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brown JL, Lyons CE, Toddes C, Monko T, Tyshynsky R. Reevaluating tear gas toxicity and safety. Inhal Toxicol 2021; 33:205-220. [PMID: 34511005 DOI: 10.1080/08958378.2021.1963887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tear gases, or chemical demonstration control agents (DCA), were originally created as weapons that could severely disable or kill enemy troops. Though banned in war, these chemicals are still used in domestic policing. Here we review the available scientific literature on tear gas, summarizing findings from animal and environmental studies as well describing data from new human studies. We find a lack of scientific evidence supporting the safety of tear gas, especially regarding its long-term impacts on human health and the environment. Many of the available studies were published decades ago, and do not parse data by variables such as chemical type and exposure time, nor do they account for the diversity of individuals who are exposed to tear gas in real-life situations. Due to the dearth of scientific research and the misinterpretation of some of the available studies, we conclude that a serious reevaluation of chemical DCA safety and more comprehensive exposure follow-up studies are necessary.
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Affiliation(s)
- Jennifer L Brown
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Carey E Lyons
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Carlee Toddes
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Timothy Monko
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Roman Tyshynsky
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
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Patowary P, Pathak MP, Kishor S, Roy PK, Das S, Chattopadhyay P, Zaman K. Cardiopulmonary function and dysregulated cardiopulmonary reflexes following acute oleoresin capsicum exposure in rats. Toxicol Appl Pharmacol 2020; 405:115188. [PMID: 32805267 DOI: 10.1016/j.taap.2020.115188] [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: 05/28/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
Cardiopulmonary functions such as respiratory depression, severe irritation, inflamed respiratory tract, hyperventilation and, tachycardia are the most affected ones when it comes to the riot control agent oleoresin capsicum (OC) exposure. However, no studies have been done to elucidate the mechanism underlying deterioration of the combined cardiopulmonary functions. Parameters such as acute respiratory, cardiac, parameters and ultrasonography (USG) measurements were investigated in an in vivo setup using Wistar rats at 1 h and 24 h post inhalation exposure to 2%, 6% and 10% OC, whereas, cell migration in rat peritoneal mast cells (RPMCs), metabolomics and eosinophil peroxidase (EPO) activity in bronchoalveolar lavage fluid (BALF) were investigated in an in vitro setup. Results obtained from electrophysiological recording indicated that OC exposure produces apnea and decrease in mean arterial pressure (MAP) was obtained from hemodynamic parameters whereas cardiac parameters assessment revealed increase in the level of cardiac output (CO) and decrease in stroke volume (SV) with recovery towards the post-exposure period. A decrease in the percentage area of certain fatty acid pathway metabolites in BALF appropriately linked the lung injury following OC exposure which was further cemented by increasing concentration of EPO. Histopathology and SEM also proved to be favorable techniques for the detection of OC induced physiological cardiac and pulmonary modifications respectively. Furthermore, Boyden chamber experiment established the chemoattractant property of OC. It may be concluded from the above studies that these newly reported facets may be utilized pharmacologically to mitigate cardiopulmonary adverse effects owing to OC exposure.
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Affiliation(s)
- Pompy Patowary
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur 784 001, Assam, India; Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh 786 004, Assam, India
| | - Manash Pratim Pathak
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur 784 001, Assam, India; Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh 786 004, Assam, India
| | - Sumit Kishor
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur 784 001, Assam, India
| | - Probin Kumar Roy
- Department of Pharmaceutics, Regional Institute of Paramedical and Nursing Sciences, Aizawl, Mizoram, India
| | - Sanghita Das
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur 784 001, Assam, India
| | - Pronobesh Chattopadhyay
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur 784 001, Assam, India.
| | - Kamaruz Zaman
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh 786 004, Assam, India
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Ilgaz A, Uyanusta FÇK, Arbak P, Müezzinoğlu A, Çiftçi TU, Akpınar S, Fırat H, Güven SF, Çiftçi B, Karaoğlanoğlu S, Dağlı E, Erkan F. Extensive Exposure to Tear Gases in Ankara. Turk Thorac J 2019; 20:108-113. [PMID: 30958982 DOI: 10.5152/turkthoracj.2018.18096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The most common chemical substances used as mass control agents are chloroacetophenone, chlorobenzylidene malononitrile, and oleoresin capsicum. These agents not only have local and rapid effects but also have systemic and long-term effects. The aim of the present study was to discuss the patterns of tear gas exposure and to investigate its effects on respiratory functions. MATERIALS AND METHODS A face-to-face survey was conducted in 86 individuals who had been exposed to tear gas indoor and outdoor during the public protests in June 2013. RESULTS The most frequently reported respiratory complaints included cough, dyspnea, phlegm, and chest pain. Spirometry measurements including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were also performed. Indoor exposers have lower mean % predicted FVC and FEV1 values than outdoor exposers. All complaints and signs were more common in indoor exposure to tear gas than in outdoor exposure. CONCLUSION Safety of the chemicals used as mass control agents during protests is doubtful as these agents are associated with several health risks.
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Affiliation(s)
- Aslıhan Ilgaz
- Clinic of Pulmonary Diseases, Middle East Technical University, Medical Center, Ankara, Turkey
| | | | - Peri Arbak
- Department of Chest Diseases, Düzce University School of Medicine, Düzce, Turkey
| | - Arif Müezzinoğlu
- Ankara Chamber of Medical Doctors, Commission of Workers' Health and Occupational Physicians, Ankara, Turkey
| | - Tansu Ulukavak Çiftçi
- Department of Pulmonary Diseases, Gazi University School of Medicine, Ankara, Turkey
| | - Serdar Akpınar
- Clinic of Chest Diseases, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Hikmet Fırat
- Clinic of Chest Diseases, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Selma Fırat Güven
- Sleep Disorders Center, Atatürk Chest Diseases, Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Bülent Çiftçi
- Department of Pulmonary Diseases, Bozok University School of Medicine, Yozgat, Turkey
| | - Selen Karaoğlanoğlu
- Department of Pulmonary Diseases, Ordu University School of Medicine, Ordu, Turkey
| | - Elif Dağlı
- Clinic of Child Chest Diseases, Acıbadem Fulya Hospital, İstanbul, Turkey
| | - Feyza Erkan
- Department of Pulmonary Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Menezes RG, Hussain SA, Rameez MAM, Kharoshah MA, Madadin M, Anwar N, Senthilkumaran S. Chemical crowd control agents. Med Leg J 2015; 84:22-5. [PMID: 26658556 DOI: 10.1177/0025817215622314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chemical crowd control agents are also referred to as riot control agents and are mainly used by civil authorities and government agencies to curtail civil disobedience gatherings or processions by large crowds. Common riot control agents used to disperse large numbers of individuals into smaller, less destructive, and more easily controllable numbers include chloroacetophenone, chlorobenzylidenemalononitrile, dibenzoxazepine, diphenylaminearsine, and oleoresin capsicum. In this paper, we discuss the emergency medical care needed by sufferers of acute chemical agent contamination and raise important issues concerning toxicology, safety and health.
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Affiliation(s)
- Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| | - Syed Ather Hussain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Mohammed Madadin
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| | - Naureen Anwar
- Department of Biochemistry, Srinivas Institute of Medical Sciences and Research Centre, Mangalore, India
| | - Subramanian Senthilkumaran
- Department of Emergency and Critical Care Medicine, Sri Gokulam Hospital and Research Institute, Salem, India
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