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Panda B, Momin A, Devabattula G, Doneti R, Khandwaye A, Godugu C. A review on mechanistic aspects of litchi fruit induced acute encephalopathy. Toxicon 2024; 248:108052. [PMID: 39074693 DOI: 10.1016/j.toxicon.2024.108052] [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: 04/23/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 07/31/2024]
Abstract
Litchi (Litchi sinensis), a fruit with a sweet and white aril, cultivated mainly in Southeast Asia and possesses anticancer, antibacterial, antioxidant, and other therapeutic properties. It is a delicacy among children. However, an outbreak of acute encephalopathy syndrome (AES) in litchi growing regions during the seasons of litchi ripening and harvesting (May-June) resulted in symptoms of lethargy, weakness, fever, vomiting, seizures, and coma that was most common among malnourished children below 15 years. Upon successful epidemiological studies, it was confirmed that the non-protein amino acids such as hypoglycine A (HGA) and methylenecyclopropylglycine (MCPG) are responsible for the AES outbreak. Most of the underprivileged and malnourished kids with an empty stomach venture into the litchi orchards to savor the fruit during the litchi harvesting season. Their fasting condition results in decreased glucose levels in the blood. The decreased glucose levels trigger glycogenolysis. However, gluconeogenesis takes over glycogenolysis to replenish the glucose levels due to fewer glycogen stores in malnourished children. The toxins are involved in fatty acid oxidation and gluconeogenesis pathways, by blocking several steps in the former process. Depleted glycogen stores and suppression of gluconeogenesis synergistically cause hypoglycemia and accumulation of toxic intermediates from the metabolic pathway leading to metabolic failure. The incidence of AES can be prevented by creating proper awareness among the farmers, vendors and consumers on the importance of adverse effects of litchi fruit when consumed on empty stomach or fasting state. Further, elucidating detailed biochemical pathway of HGA and MCPG toxicity, improving agricultural and public health practices, keeping glucose stores and glucose banks in the areas which are highly prone to litchi induced toxicity are some of the therapeutic measures. This review highlights and discusses the AES incidences, mechanistic pathways involved in litchi fruit toxicity, and corresponding risk factors involved and possible treatment and preventive approaches.
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Affiliation(s)
- Biswajit Panda
- Department of Biological Sciences (Regulatory Toxicology), National Institute of Pharmaceutical Education and Research (NIPER), Balanagar, Hyderabad, Telangana, 500037, India
| | - Alfiya Momin
- Department of Biological Sciences (Regulatory Toxicology), National Institute of Pharmaceutical Education and Research (NIPER), Balanagar, Hyderabad, Telangana, 500037, India
| | - Geetanjali Devabattula
- Department of Biological Sciences (Regulatory Toxicology), National Institute of Pharmaceutical Education and Research (NIPER), Balanagar, Hyderabad, Telangana, 500037, India
| | - Ravinder Doneti
- Department of Biological Sciences (Regulatory Toxicology), National Institute of Pharmaceutical Education and Research (NIPER), Balanagar, Hyderabad, Telangana, 500037, India
| | - Aarti Khandwaye
- Department of Biological Sciences (Regulatory Toxicology), National Institute of Pharmaceutical Education and Research (NIPER), Balanagar, Hyderabad, Telangana, 500037, India
| | - Chandraiah Godugu
- Department of Biological Sciences (Regulatory Toxicology), National Institute of Pharmaceutical Education and Research (NIPER), Balanagar, Hyderabad, Telangana, 500037, India.
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Watson CJ, Edlow JA. Managing Adults With Hypoglycemia. Ann Emerg Med 2023; 82:705-712. [PMID: 37632497 DOI: 10.1016/j.annemergmed.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Christopher James Watson
- Tufts University School of Medicine, Boston, MA; Division of Medical Toxicology, Department of Emergency Medicine, Maine Medical Center, Portland, ME
| | - Jonathan A Edlow
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
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Singh AK, Shahi SK, Kumar B, Das MK. Is Ambient Weather a Risk Factor for Acute Encephalopathy Outbreaks in Children in Muzaffarpur, Bihar, India? Insight from a 9-Year Analysis. J Trop Pediatr 2022; 68:6500066. [PMID: 35015895 DOI: 10.1093/tropej/fmab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Despite periodic outbreaks, the causes and risk factors of acute encephalitis syndrome (AES) in children of Muzaffarpur, Bihar, India, remain unknown. We explored the correlation between AES caseload and the climate parameters. METHODS Data for 1318 hospitalized children with AES during 2012-20 were used. The correlation between AES cases and daily climate parameters (temperature, sunshine, rainfall, humidity and wind speed) for the previous 24, 48 and 72 h were examined using Pearson's and Spearman's rank-order correlation and Poisson regression or negative binomial regression analyses. RESULTS Most (91.8%) of the AES cases occurred during the summer season (May-July months), especially June month. Pearson's and Spearman's rank-order correlation analyses revealed that AES caseload had positive correlations with maximum (r = 0.275, ρ = 0.293) and minimum (r = 0.306, ρ = 0.306) temperatures during past 24 h and heat index (r = 0.325, ρ = 0.325) and negative correlation with humidity (r = -0.222, ρ = -0.222) and rainfall (r = -0.183, ρ = -0.183) (all p < 0.05). The correlation was consistent for the climate parameters for the past 24, 48 and 72 h. Regression analysis also documented a significant association of AES cases with daily maximum (β: 0.32-0.36) and minimum (β: 0.53-0.62) temperatures and heat index (β: 0.92-1.03) over past 24, 48 and 72 h (all p < 0.01). The number of AES cases exponentially increased when the daily maximum and minimum temperatures crossed 40°C and 31°C, respectively. CONCLUSIONS The climate parameters, especially temperature appears to be a risk factor for AES in children. The definite aetiological role of heat for AES in children needs further exploration.
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Affiliation(s)
- Arun K Singh
- Rastriya Bal Swasthya Karyakram, Ministry of Health, Government of India, NIHFW Campus, Munirka, New Delhi 110067, India.,Department of Neonatology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
| | - Sunil Kumar Shahi
- Department of Medical Administration, Sri Krishna Medical College Hospital, Muzaffarpur, Bihar 842001, India
| | - Bhartendu Kumar
- Department of Surgery, Sri Krishna Medical College Hospital, Muzaffarpur, Bihar 842001, India
| | - Manoja Kumar Das
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi 110020, India
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González-Medina S, Bevin W, Alzola-Domingo R, Chang YM, Piercy RJ. Hypoglycin A absorption in sheep without concurrent clinical or biochemical evidence of disease. J Vet Intern Med 2021; 35:1170-1176. [PMID: 33675130 PMCID: PMC7995363 DOI: 10.1111/jvim.16077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hypoglycin A (HGA) intoxication after ingestion of Acer spp. tree material has never been confirmed in domesticated ruminants despite their similar grazing habitats. OBJECTIVES To investigate whether sheep have low HGA bioavailability caused by rumen HGA breakdown. ANIMALS Stomach and rumen fluid samples from 5 adult horses and 5 adult sheep respectively. Residual serum samples from 30 ewes and lambs. METHODS Experimental and retrospective cohort study. Hypoglycin A concentration was quantified in horse gastric and sheep ruminal samples after in vitro incubation with Acer pseudoplatanus seeds. Serum samples from grazing sheep (n = 20) and nursing lambs (n = 10) obtained before and after their release onto pastures with and without Sycamore seedlings were analyzed for HGA and methylenecyclopropyl-acetic acid carnitine, and serum biochemistry. RESULTS Neither ovine rumen nor equine gastric fluid affected HGA content in samples incubated for up to 2 hours. Despite HGA's detection in serum from sheep (n = 13/15; median, 23.71 ng/mL; range, 5.62-126.4 ng/mL) grazing contaminated pastures and in their nursing lambs (n = 2/5; median, 12.5 ng/mL; range, 8.82-15.67 ng/mL), there was no apparent clinical or subclinical disease. CONCLUSIONS AND CLINICAL IMPORTANCE Any reduced sensitivity to HGA intoxication in sheep seems unrelated to ruminal degradation. Serum HGA concentrations in sheep were similar to those of subclinically affected atypical myopathy horses. Any reduced sensitivity of sheep to HGA might be related to greater metabolic resistance rather than selective grazing habits or lower bioavailability. Hypoglycin A was found in nursing lambs, suggesting that HGA is excreted in milk.
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Affiliation(s)
- Sonia González-Medina
- Comparative Neuromuscular Diseases Laboratory, Royal Veterinary College, London, Colorado, United Kingdom.,Equine Internal Medicine Department, James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, Colorado, USA
| | - William Bevin
- Oakham Veterinary Hospital, Oakham, Rutland, United Kingdom
| | - Rafael Alzola-Domingo
- Oakham Veterinary Hospital, Oakham, Rutland, United Kingdom.,Equine Emergency and Critical Care Department, James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, USA
| | - Yu-Mei Chang
- Comparative Neuromuscular Diseases Laboratory, Royal Veterinary College, London, Colorado, United Kingdom
| | - Richard J Piercy
- Comparative Neuromuscular Diseases Laboratory, Royal Veterinary College, London, Colorado, United Kingdom
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Wang RX, Henen MA, Lee JS, Vögeli B, Colgan SP. Microbiota-derived butyrate is an endogenous HIF prolyl hydroxylase inhibitor. Gut Microbes 2021; 13:1938380. [PMID: 34190032 PMCID: PMC8253137 DOI: 10.1080/19490976.2021.1938380] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 02/04/2023] Open
Abstract
The gut microbiota is essential for human health. Microbial supply of short-chain fatty acids (SCFAs), particularly butyrate, is a well-established contributor to gut homeostasis and disease resistance. Reaching millimolar luminal concentrations, butyrate is sequestered and utilized in the colon as the favored energy source for intestinal epithelia. Given the steep oxygen gradient across the anoxic lumen and the highly oxygenated lamina propria, the colon provides a particularly interesting environment to study oxygen sensing. Previous studies have shown that the transcription factor hypoxia-inducible factor (HIF) is stabilized in healthy colonic epithelia. Here we show that butyrate directly inhibits HIF prolyl hydroxylases (PHDs) to stabilize HIF. We find that butyrate stabilizes HIF in vitro despite eliminating β-oxidation and resultant oxygen consumption. Using recombinant PHD protein in combination with nuclear magnetic resonance and enzymatic biochemical assays, we identify butyrate to bind and function as a unique, noncompetitive inhibitor of PHDs relative to other SCFAs. Butyrate inhibited PHD with a noncompetitive Ki of 5.3 ± 0.5 mM, a physiologically relevant concentration. We also confirm that microbiota-derived butyrate is necessary to stabilize HIF in mice colonic tissue through antibiotic-induced butyrate depletion and reconstitution experiments. Our results suggest that the co-evolution of mammals and mutualistic microbiota has selected for butyrate to impact a critical gene regulation pathway that can be extended beyond the mammalian gut. As PHDs are a major target for drug development in the stabilization of HIF, butyrate holds great potential as a well-tolerated endogenous inhibitor with far-reaching therapeutic impact.
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Affiliation(s)
- Ruth X. Wang
- Department of Medicine, Mucosal Inflammation Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- School of Medicine, Medical Scientist Training Program, University of Colorado, Aurora, CO, USA
| | - Morkos A. Henen
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmaceutical Organic Chemistry, Mansoura University, Mansoura, Egypt
| | - J. Scott Lee
- Department of Medicine, Mucosal Inflammation Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Beat Vögeli
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sean P. Colgan
- Department of Medicine, Mucosal Inflammation Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Sarkar A, Datta D, Datta SK, John TJ. Acute encephalopathy in children in Muzaffarpur, India: a review of aetiopathogenesis. Trans R Soc Trop Med Hyg 2020; 114:704-711. [DOI: 10.1093/trstmh/traa036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/24/2020] [Accepted: 05/12/2020] [Indexed: 01/03/2023] Open
Abstract
AbstractThe acute encephalopathy occurring in children in Muzaffarpur, India, also recognised in other litchi-cultivating areas of India, Bangladesh, Vietnam and China, had previously been linked to litchi consumption. Recently, it has been identified as hypoglycaemic encephalopathy of an unusual aetiology with three key factors: undernutrition, prolonged fasting and litchi consumption. A second set of investigators has independently reconfirmed the diagnosis and the three-factor aetiology. Skipping the evening meal with an intake of large amounts of litchi in undernourished children is causative. Early-morning hypoglycaemia with an inadequate glycogen store leads to initiation of gluconeogenesis and fatty acid β-oxidation, but methylene cyclopropyl alanine and glycine present in the litchi aril block the fatty acid β-oxidation cycle. The outcomes are uncorrected hypoglycaemia and encephalopathy due to the entry of metabolic intermediates that cross the blood-brain barrier and affect neuronal function. Suggested measures include early 10% dextrose infusion. Awareness about the disease is of prime importance. The diagnosis and aetiopathogenesis are still under question from a part of the scientific community. This review was undertaken to present a comprehensive view of hypoglycaemic encephalopathy and to remove some of the lingering doubts.
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Affiliation(s)
- Abhirup Sarkar
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, IN 110029, India
| | - Debatri Datta
- Department of Dermatology, Venereology and Leprosy, Medical College and Hospital, Kolkata-700073, India
| | - Sudip Kumar Datta
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, IN 110029, India
| | - T Jacob John
- Christian Medical College, Vellore, Tamil Nadu 632004, India
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Plants with neurotoxic potential in undernourished subjects. Rev Neurol (Paris) 2019; 175:631-640. [DOI: 10.1016/j.neurol.2019.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022]
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