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Trancart M, Botta A, Le Coz C, Guatto N, Calas AG, Hanak AS. How does organophosphorus chemical warfare agent exposure affect respiratory physiology in mice? Toxicology 2024; 507:153890. [PMID: 39029734 DOI: 10.1016/j.tox.2024.153890] [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: 06/19/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
In the absence of appropriate medical care, exposure to organophosphorus nerve agents, such as VX, can lead to respiratory failure, and potentially death by asphyxiation. Despite the critical role of respiratory disturbances in organophosphorus-induced toxicity, the nature and underlying mechanisms of respiratory failure remain poorly understood. This study aimed to characterize respiratory alterations by determining their type and duration in mice exposed to a subcutaneous sublethal dose of VX. Respiratory ventilation in Swiss mice was monitored using dual-chamber plethysmography for up to 7 days post-exposure. Cholinesterase activity was assessed via spectrophotometry, and levels of inflammatory biomarkers were quantified using Luminex technology in blood and tissues involved in respiration (diaphragm, lung, and medulla oblongata). Additionally, a histological study was conducted on these tissues to ensure their structural integrity. Ventilatory alterations appeared 20-25 minutes after the injection of 0.9 LD50 VX and increased until the end of the recording, i.e., 40 minutes after intoxication. Concurrent with the occurrence of apnea, increased inspiratory and expiratory times resulted in a significant decrease in respiratory rate in exposed mice compared to controls. Ventilatory amplitude and, consequently, minute volume were reduced, while specific airway resistance significantly increased, indicating bronchoconstriction. These ventilatory effects persisted up to 24 or even 72 hours post-intoxication, resolving on the 7th day. They were correlated with a decrease in acetylcholinesterase activity in the diaphragm, which persisted for up to 72 hours, and with the triggering of an inflammatory reaction in the same tissue. No significant histologic lesions were observed in the examined tissues. The ventilatory alterations observed up to 72 hours post-VX exposure appear to result from a functional failure of the respiratory system rather than tissue damage. This comprehensive characterization contributes to a better understanding of the respiratory effects induced by VX exposure, which is crucial for developing specific medical countermeasures.
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Affiliation(s)
- Marilène Trancart
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, France
| | - Antoine Botta
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, France
| | - Christine Le Coz
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, France
| | - Nathalie Guatto
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, France
| | - André-Guilhem Calas
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, France
| | - Anne-Sophie Hanak
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, France.
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Chapman S, Lazar S, Gez R, Rabinovitz I, Yaakov G, Grauer E. Lung damage following whole body, but not intramuscular, exposure to median lethality dose of sarin: findings in rats and guinea pigs. Inhal Toxicol 2019; 31:203-211. [PMID: 31359796 DOI: 10.1080/08958378.2019.1644402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Sarin is an irreversible organophosphate cholinesterase inhibitor and a highly toxic, volatile warfare agent. Rats and guinea pigs exposed to sarin display cholinergic excitotoxicity which includes hyper-salivation, respiratory distress, tremors, seizures, and death. Here we focused on the characterization of the airways injury induced by direct exposure of the lungs to sarin vapor and compared it to that induced by the intramuscularly route. Materials and methods: Rats were exposed to sarin either in vapor (∼1LCT50, 34.2 ± 0.8 µg/l/min, 10 min) or by i.m. (∼1LD50, 80 µg/kg), and lung injury was evaluated by broncho-alveolar lavage (BAL). Results and discussion: BAL analysis revealed route-dependent effects in rats: vapor exposed animals showed elevation of inflammatory cytokines, protein, and neutrophil cells. These elevations were seen at 24 h and were still significantly higher compared to control values at 1 week following vapor exposure. These elevations were not detected in rats exposed to sarin i.m. Histological evaluation of the brains revealed typical changes following sarin poisoning independent of the route of administration. The airways damage following vapor exposure in rats was also compared to that induced in guinea pigs. The latter showed increased eosinophilia and histamine levels that constitutes an anaphylactic response not seen in rats. Conclusions: These data clearly point out the importance of using the appropriate route of administration in studying the deleterious effects of volatile nerve agents, as well as the selection of the appropriate animal species. Since airways form major target organs for the development of injury following inhalation toxicity, they should be included in any comprehensive evaluation of countermeasures efficacy.
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Affiliation(s)
- Shira Chapman
- a Department of Pharmacology, Israel Institute for Biological Research (IIBR) , Ness-Ziona , Israel
| | - Shlomi Lazar
- a Department of Pharmacology, Israel Institute for Biological Research (IIBR) , Ness-Ziona , Israel
| | - Rellie Gez
- a Department of Pharmacology, Israel Institute for Biological Research (IIBR) , Ness-Ziona , Israel
| | - Ishai Rabinovitz
- a Department of Pharmacology, Israel Institute for Biological Research (IIBR) , Ness-Ziona , Israel
| | - Guy Yaakov
- a Department of Pharmacology, Israel Institute for Biological Research (IIBR) , Ness-Ziona , Israel
| | - Ettie Grauer
- a Department of Pharmacology, Israel Institute for Biological Research (IIBR) , Ness-Ziona , Israel
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3
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Wang Y, Kim B, Walker A, Williams S, Meeks A, Lee YJ, Seo SS. Cytotoxic effects of parathion, paraoxon, and their methylated derivatives on a mouse neuroblastoma cell line NB41A3. ACTA ACUST UNITED AC 2019. [DOI: 10.2131/fts.6.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Yunbiao Wang
- Department of Chemistry and Forensic Science, Albany State University, USA
| | - ByungHoon Kim
- Department of Biological Sciences, Albany State University, USA
| | - Ashley Walker
- Department of Chemistry and Forensic Science, Albany State University, USA
| | - Shayla Williams
- Department of Biological Sciences, Albany State University, USA
| | - Ashley Meeks
- Department of Chemistry and Forensic Science, Albany State University, USA
| | - Yong-Jin Lee
- Department of Biological Sciences, Albany State University, USA
| | - Seong S. Seo
- Department of Chemistry and Forensic Science, Albany State University, USA
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Sciuto AM, Peng X. Pulmonary toxicity following inhalation exposure to VX in anesthetized rats: Possible roles for compromised immunity and oxidative stress-induced lung injury. Exp Lung Res 2019; 44:379-396. [DOI: 10.1080/01902148.2018.1519003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Alfred M. Sciuto
- Biochemical and Physiology Branch, Medical Toxicology Research Division, United States Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland, USA
| | - Xinqi Peng
- Biochemical and Physiology Branch, Medical Toxicology Research Division, United States Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland, USA
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Bloch-Shilderman E, Yacov G, Cohen L, Egoz I, Gutman H, Gez R, Rabinovitz I, Nili U. Repetitive antidotal treatment is crucial in eliminating eye pathology, respiratory toxicity and death following whole-body VX vapor exposure in freely moving rats. Arch Toxicol 2019; 93:1365-1384. [DOI: 10.1007/s00204-019-02401-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/31/2019] [Indexed: 11/29/2022]
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Swami D, Yadav R, Bhaskar ASB, Soni A, Nagar DP, Acharya J, Karade HN, Singh KP, Kumar P. Comparative evaluation of antidotal efficacy of 2-PAM and HNK-102 oximes during inhalation of sarin vapor in Swiss albino mice. Inhal Toxicol 2018; 30:287-298. [PMID: 30375901 DOI: 10.1080/08958378.2018.1520369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Efficacy of two oximes treatments evaluated during inhalation of sarin vapor (LCt50, 755.9 mg/min/m3) in simulated real scenario in vivo. Majority of mice either became moribund or died within 1-2 min during exposure to multifold-lethal concentrations of sarin vapor. Protection indices were determined by exposing to sarin vapor in two sessions, 1 min exposure followed by treatments with or without HNK-102 (56.56 mg/kg, im) or 2-PAM (30 mg/kg, im) and atropine (10 mg/kg, ip), and again exposed for remaining 14 min. Protection offered by HNK-102 was found to be four folds higher compared to 2-PAM in the same toxic environment. Secondly, sub-lethal concentration of sarin vapor (0.8 × LCt50 or 605 mg/min/m3), 24 h post investigations revealed that the oximes could not reactivate brain and serum acetylcholinesterase (AChE) activity. The treatments prevented increase in protein concentration (p < .05) and macrophages infiltration compared to sarin alone group in broncho-alveolar lavage fluid. Lung histopathology showed intense peribronchial infiltration and edema with desquamating epithelial lining and mild to moderate alveolar septal infiltration in sarin and atropine groups, respectively. Noticeable peeling-off observed in epithelial lining and sporadic mild infiltration of epithelial cells at bronchiolar region in 2-PAM and HNK-102 groups, respectively. The oximes failed to reactivate AChE activity; however, the mice survived up to 6.0 × LCt50, proved involvement of non-AChE targets in sarin toxicity. Atropine alone treatment was found to be either ineffective or increased the toxicity. HNK-102, exhibited better survivability with lung protection, can be considered as a better replacement for 2-PAM to treat sarin inhalation induced poisoning.
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Affiliation(s)
- Devyani Swami
- a Pharmacology and Toxicology Division , Defence Research & Development Establishment , Gwalior , India
| | - Ruchi Yadav
- a Pharmacology and Toxicology Division , Defence Research & Development Establishment , Gwalior , India
| | - A S B Bhaskar
- a Pharmacology and Toxicology Division , Defence Research & Development Establishment , Gwalior , India
| | - A Soni
- a Pharmacology and Toxicology Division , Defence Research & Development Establishment , Gwalior , India
| | - D P Nagar
- a Pharmacology and Toxicology Division , Defence Research & Development Establishment , Gwalior , India
| | - J Acharya
- b Process Technology Development Division , Defence Research & Development Establishment , Gwalior , India
| | - H N Karade
- b Process Technology Development Division , Defence Research & Development Establishment , Gwalior , India
| | - K P Singh
- a Pharmacology and Toxicology Division , Defence Research & Development Establishment , Gwalior , India
| | - Pravin Kumar
- a Pharmacology and Toxicology Division , Defence Research & Development Establishment , Gwalior , India
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He F, Wang J, Liu Y, Wang X, Cai N, Wu C, Gao Q. Xuebijing injection induces anti-inflammatory-like effects and downregulates the expression of TLR4 and NF-κB in lung injury caused by dichlorvos poisoning. Biomed Pharmacother 2018; 106:1404-1411. [PMID: 30119213 DOI: 10.1016/j.biopha.2018.07.111] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The mechanism in lung injury caused by acute organophosphate pesticide poisoning (AOPP) and an effective treatment remains unclear. We aim to clarify how the inflammatory lung injury caused by AOPP might be modulated by Xuebijing (XBJ) injection. METHODS AOPP-induced lung injury model was induced by dichlorvos (DDVP) subcutaneous administration in rats and XBJ injection was administered by intraperitoneal injection after DDVP challenge. The effects of XBJ injection were assessed by lung histopathological analysis and lung injury scores, lung wet-to-dry weight ratios (WDR) and oxygenation, differential immune cell count in bronchoalveolar lavage fluid (BALF), IL-6 and TNF-α levels in blood, the levels of TLR4 and NF-κB proteins in lung tissue and blood acetylcholinesterase (AChE) activity. RESULTS DDVP administration resulted in damage of lung histopathology and lower PaO2/FiO2 ratios (P < 0.05), which were notably attenuated by XBJ injection (P < 0.05). Total cell, macrophage, and neutrophils count in BALF and TNF-α and IL-6 levels in blood were significantly increased after DDVP exposure (P < 0.05), which were notably ameliorated by XBJ injection (P < 0.05). TLR4 and NF-κB protein in lung tissue expression after DDVP challenge were markedly increased (P < 0.05), and they were substantially downregulated by XBJ injection (P < 0.05). In addition, blood AChE activity was significantly decreased by DDVP administration (P < 0.05), however, there was no significant improvement after XBJ injection. CONCLUSION XBJ injection prevents DDVP poisoning induced lung injury by attenuating the inflammatory response. The protective effect appears to be mediated through downregulation of the TLR4 and NF-κB expression.
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Affiliation(s)
- Fei He
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Jun Wang
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Yao Liu
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Xiaojing Wang
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Nan Cai
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Chao Wu
- Department of Infectious Disease, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China.
| | - Qingling Gao
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
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Herbert J, Thiermann H, Worek F, Wille T. Precision cut lung slices as test system for candidate therapeutics in organophosphate poisoning. Toxicology 2017; 389:94-100. [DOI: 10.1016/j.tox.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 01/23/2023]
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Katos AM, Conti ML, Moran TS, Gordon RK, Doctor BP, Sciuto AM, Nambiar MP. Abdominal bloating and irritable bowel syndrome like symptoms following microinstillation inhalation exposure to chemical warfare nerve agent VX in guinea pigs. Toxicol Ind Health 2016; 23:231-40. [DOI: 10.1177/0748233707081720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While assessing the methylphosphonothioic acid S-(2-(bis(1-methylethyl)amino)ethyl)O-ethyl ester (VX) induced respiratory toxicity and evaluating therapeutics against lung injury, we observed that the animals were experiencing abnormal swelling in the abdominal area. Nerve agent has been known to increase salivary, nasal and gastrointestinal secretion and cause diarrhea. This study was initiated to investigate the effect of VX on the gastrointestinal tract (GI) since abdominal pathology may affect breathing and contribute to the on going respiratory toxicity. The mid-abdominal diameter and the size of the lower left abdomen was measured before and after 27.3 mg/m3 VX exposure by microinstillation and at 30min intervals up to 2h post-VX exposure. Both VX and saline exposed animals exhibited a decrease in circumference of the upper abdomen, although the decrease was slightly higher in VX-exposed animals up to 1 h. The waist diameter increased slightly in VX-exposed animals from 60 to 90min post-VX exposure but was similar to saline controls. The lower left abdomen near to the cecum, 6 cm below and 2 cm to the right of the end of the sternum, showed an increase in size at 30—60 min that was significantly increased at 90—120 min post-VX exposure. In addition, VX-exposed animals showed loose fecal matter compared to controls. Necropsy at 24 h showed an increased small intestine twisting motility in VX-exposed animals. Body tissue AChE assay showed high inhibition in the esophagus and intestine in VX-exposed animals indicating that a significant amount of the agent is localized to the GI following microinstillation exposure. These results suggest that microinstillation inhalation VX exposure induces gastrointestinal disturbances similar to that of irritable bowel syndrome and bloating.
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Affiliation(s)
- Alexandre M. Katos
- Department of Biochemical Pharmacology/Division of Biochemistry, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA,
| | - Michele L. Conti
- Department of Biochemical Pharmacology/Division of Biochemistry, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA
| | - Theodore S. Moran
- Medical Toxicology Branch/Analytical Toxicology Division, United States Army Medical Research Institute of Chemical Defense, 3100 Ricketts Point Road, Edgewood, MD 21010, USA
| | - Richard K. Gordon
- Department of Biochemical Pharmacology/Division of Biochemistry, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA
| | - Bhupendra P. Doctor
- Department of Biochemical Pharmacology/Division of Biochemistry, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA
| | - Alfred M. Sciuto
- Medical Toxicology Branch/Analytical Toxicology Division, United States Army Medical Research Institute of Chemical Defense, 3100 Ricketts Point Road, Edgewood, MD 21010, USA
| | - Madhusoodana P. Nambiar
- Department of Biochemical Pharmacology/Division of Biochemistry, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA, , Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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10
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Perkins MW, Wong B, Rodriguez A, Devorak J, Sciuto AM. Measurement of various respiratory dynamics parameters following acute inhalational exposure to soman vapor in conscious rats. Inhal Toxicol 2015. [DOI: 10.3109/08958378.2015.1068890] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Angelini DJ, Moyer RA, Cole S, Willis KL, Oyler J, Dorsey RM, Salem H. The Pesticide Metabolites Paraoxon and Malaoxon Induce Cellular Death by Different Mechanisms in Cultured Human Pulmonary Cells. Int J Toxicol 2015; 34:433-41. [PMID: 26173615 DOI: 10.1177/1091581815593933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Organophosphorus (OP) pesticides are known to induce pulmonary toxicity in both humans and experimental animals. To elucidate the mechanism of OP-induced cytotoxicity, we examined the effects of parathion and malathion and their respective metabolites, paraoxon and malaoxon, on primary cultured human large and small airway cells. Exposure to paraoxon and malaoxon produced a dose-dependent increase in cytotoxicity following a 24-hour exposure, while treatment with parathion or malathion produced no effects at clinically relevant concentrations. Exposure to paraoxon-induced caspase activation, but malaoxon failed to induce this response. Since caspases have a major role in the regulation of apoptosis and cell death, we evaluated OP-induced cell death in the presence of a caspase inhibitor. Pharmacological caspase inhibition protected against paraoxon-induced cell death but not malaoxon-induced cell death. These data suggest that caspase activation is a key signaling element in paraoxon-induced cell death, but not malaoxon-induced cellular death in the pulmonary epithelium.
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Affiliation(s)
- Daniel J Angelini
- National Research Council, Research Associates Program, Washington DC, USA Excet Inc, Springfield, VA, USA
| | - Robert A Moyer
- Chemical & Biological Technologies Department, Defense Threat Reduction Agency, Fort Belvoir, VA, USA Battelle Memorial Institute, Columbus, OH, USA
| | - Stephanie Cole
- National Research Council, Research Associates Program, Washington DC, USA Excet Inc, Springfield, VA, USA Chemical & Biological Technologies Department, Defense Threat Reduction Agency, Fort Belvoir, VA, USA
| | - Kristen L Willis
- National Research Council, Research Associates Program, Washington DC, USA Chemical & Biological Technologies Department, Defense Threat Reduction Agency, Fort Belvoir, VA, USA
| | - Jonathan Oyler
- U.S. Army Medical Command, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Russell M Dorsey
- U.S. Army Research Development and Engineering Command, Edgewood Chemical Biological Center, Aberdeen Proving Ground, MD, USA
| | - Harry Salem
- U.S. Army Research Development and Engineering Command, Edgewood Chemical Biological Center, Aberdeen Proving Ground, MD, USA Department of Homeland Security, Chemical Security Assessment Center, Aberdeen Proving Ground, MD, USA
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Hulse EJ, Davies JOJ, Simpson AJ, Sciuto AM, Eddleston M. Respiratory complications of organophosphorus nerve agent and insecticide poisoning. Implications for respiratory and critical care. Am J Respir Crit Care Med 2015; 190:1342-54. [PMID: 25419614 DOI: 10.1164/rccm.201406-1150ci] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Organophosphorus (OP) compound poisoning is a major global public health problem. Acute OP insecticide self-poisoning kills over 200,000 people every year, the majority from self-harm in rural Asia. Highly toxic OP nerve agents (e.g., sarin) are a significant current terrorist threat, as shown by attacks in Damascus during 2013. These anticholinesterase compounds are classically considered to cause an acute cholinergic syndrome with decreased consciousness, respiratory failure, and, in the case of insecticides, a delayed intermediate syndrome that requires prolonged ventilation. Acute respiratory failure, by central and peripheral mechanisms, is the primary cause of death in most cases. However, preclinical and clinical research over the last two decades has indicated a more complex picture of respiratory complications after OP insecticide poisoning, including onset of delayed neuromuscular junction dysfunction during the cholinergic syndrome, aspiration causing pneumonia and acute respiratory distress syndrome, and the involvement of solvents in OP toxicity. The treatment of OP poisoning has not changed over the last 50 years. However, a better understanding of the multiple respiratory complications of OP poisoning offers additional therapeutic opportunities.
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Affiliation(s)
- Elspeth J Hulse
- 1 Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Ophir N, Ramaty E, Rajuan-Galor I, Rosman Y, Lavon O, Shrot S, Shiyovich A, Huerta-Hartal M, Kassirer M, Vaida S, Gaitini L. Airway control in case of a mass toxicological event: superiority of second-generation supraglottic airway devices. Am J Emerg Med 2014; 32:1445-9. [PMID: 25440004 DOI: 10.1016/j.ajem.2014.08.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Early respiratory support and airway (AW) control with endotracheal intubation (ETI) are crucial in mass toxicology events and must be performed while wearing chemical personal protective equipment (C-PPE). AIM The aim of this study is to evaluate the efficiency of AW control by using second-generation supraglottic AW devices (SADs) as compared with ETI and first-generation SAD while wearing C-PPE. METHODS This is a randomized crossover trial involving 117 medical practitioners. Four AW management devices were examined: endotracheal tube, the first-generation SAD, laryngeal mask AW unique and 2 second-generation SAD, the laryngeal tube suction disposable, and supreme laryngeal mask AW (SLMA). Primary end point measured were success or failure, number of attempts, and time needed to achieve successful device insertion. Secondary end point was a subjective appraisal of the AW devices by study population. RESULTS More attempts were required to achieve AW control with endotracheal tube, with and without C-PPE (P<.001). Time to achieve AW control with ETI was, on average, 88% longer than required with other devices and improved with practice. The mean times to achieve an AW were longer when operators were equipped with C-PPE as compared with standard clothing. Subjectively, difficulty levels were significantly higher for ETI than for all other devices (P<.0001). CONCLUSIONS When compared with ETI, the use of SADs significantly shortened the time for AW control while wearing C-PPE. Second-generation SAD were superior to laryngeal mask AW unique. These finding suggest that SADs may be used in a mass toxicology event as a bridge, until definite AW control is achieved.
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Affiliation(s)
- Nimrod Ophir
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | - Erez Ramaty
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | | | - Yossi Rosman
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel.
| | - Ophir Lavon
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | - Shai Shrot
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
| | | | - Michael Huerta-Hartal
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel; Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Kassirer
- Israel Defense Forces, Medical Corps, Tel Hashomer, Israel; Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Sonia Vaida
- Anesthesiology Department, Bnai Zion Medical Center, Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Luis Gaitini
- Anesthesiology Department, Bnai Zion Medical Center, Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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Peng X, Perkins MW, Simons J, Witriol AM, Rodriguez AM, Benjamin BM, Devorak J, Sciuto AM. Acute pulmonary toxicity following inhalation exposure to aerosolized VX in anesthetized rats. Inhal Toxicol 2014; 26:371-9. [DOI: 10.3109/08958378.2014.899410] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Inhalation toxicity of soman vapor in non-anesthetized rats: A preliminary assessment of inhaled bronchodilator or steroid therapy. Chem Biol Interact 2013; 206:452-61. [DOI: 10.1016/j.cbi.2013.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/09/2013] [Accepted: 07/12/2013] [Indexed: 11/19/2022]
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16
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Angelini DJ, Dorsey RM, Willis KL, Hong C, Moyer RA, Oyler J, Jensen NS, Salem H. Chemical warfare agent and biological toxin-induced pulmonary toxicity: could stem cells provide potential therapies? Inhal Toxicol 2013; 25:37-62. [DOI: 10.3109/08958378.2012.750406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Perkins MW, Pierre Z, Rezk P, Song J, Oguntayo S, Morthole V, Sciuto AM, Doctor BP, Nambiar MP. Protective Effects of Aerosolized Scopolamine Against Soman-Induced Acute Respiratory Toxicity in Guinea Pigs. Int J Toxicol 2011; 30:639-49. [DOI: 10.1177/1091581811415874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The protective efficacy of the antimuscarinic agent scopolamine was evaluated against soman (o-pinacolyl methylphosphonofluoridate [GD])-induced respiratory toxicity in guinea pigs. Anesthetized animals were exposed to GD (841 mg/m3) by microinstillation inhalation exposure and treated 30 seconds later with endotracheally aerosolized scopolamine (0.25 mg/kg) and allowed to recover for 24 hours. Treatment with scopolamine significantly increased survival and reduced clinical signs of toxicity and body weight loss in GD-exposed animals. Analysis of bronchoalveolar lavage (BAL) fluid showed normalization of GD-induced increased cell death, total cell count, and protein following scopolamine treatment. The BAL fluid acetylcholinesterase and butyrylcholinesterase levels were also increased by scopolamine treatment. Respiratory dynamics parameters were normalized at 4 and 24 hours post–GD exposure in scopolamine-treated animals. Lung histology showed that scopolamine treatment reduced bronchial epithelial and subepithelial inflammation and multifocal alveolar septal edema. These results suggest that aerosolized scopolamine considerably protects against GD-induced respiratory toxicity.
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Affiliation(s)
- Michael W. Perkins
- Medical/Analytical Toxicology, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Zdenka Pierre
- Medical/Analytical Toxicology, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Peter Rezk
- Medical/Analytical Toxicology, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Jian Song
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Samuel Oguntayo
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Venee Morthole
- Department of Pathology, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Alfred M. Sciuto
- Medical/Analytical Toxicology, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Bhupendra P. Doctor
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Madhusoodana P. Nambiar
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Che MM, Chanda S, Song J, Doctor BP, Rezk PE, Sabnekar P, Perkins MW, Sciuto AM, Nambiar MP. Aerosolized scopolamine protects against microinstillation inhalation toxicity to sarin in guinea pigs. Toxicol Mech Methods 2011; 21:463-72. [DOI: 10.3109/15376516.2011.562258] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Perkins MW, Pierre Z, Rezk P, Song J, Oguntayo S, Sciuto AM, Doctor BP, Nambiar MP. Acute Changes in Pulmonary Function Following Microinstillation Inhalation Exposure to Soman in Nonatropenized Guinea Pigs. Int J Toxicol 2011; 30:348-57. [DOI: 10.1177/1091581810397960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Barometric whole-body plethysmography (WBP) was used to examine pulmonary functions at 4 and 24 hours postexposure to soman (GD) in guinea pigs without therapeutics to improve survival. Endotracheal aerosolization by microinstillation was used to administer GD (280, 561, and 841 mg/m3) or saline to anesthetized guinea pigs. Significant increases in respiratory frequency (RF), tidal volume (TV), and minute volume (MV) were observed with 841 mg/m3 GD at 4 hours and that were reduced at 24 hours postexposure. A dose-dependent increase in peak inspiration flow and peak expiration flow was present at 4-hour post-GD exposure that was reduced at 24 hours. Time of inspiration and expiration were decreased in all doses of GD exposure at 4 and 24 hours, with significant inhibition at 841 mg/m3. End-expiratory pause (EEP) increased at 280 and 561 mg/m3, but decreased in animals exposed 841 mg/m3 at 24 hours postexposure. Pseudo-lung resistance (Penh) and pause followed similar patterns and increased at 4 hours, but decreased at 24 hours postexposure to 841 mg/m3 of GD compared to control. These studies indicate GD exposure induces dose-dependent changes in pulmonary function that are significant at 841 mg/m3 at 4 hours and remains 24 hours postexposure. Furthermore, at 4 hours, GD induces bronchoconstriction possibly due to copious airway secretion and ongoing lung injury in addition to cholinergic effects, while at 24 hours GD induces bronchodilation a possible consequence of initial compensatory mechanisms.
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Affiliation(s)
- Michael W. Perkins
- US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Zdenka Pierre
- US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Peter Rezk
- US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Jian Song
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Samuel Oguntayo
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Alfred M. Sciuto
- US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | | | - Madhusoodana P. Nambiar
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Acute respiratory toxicity following inhalation exposure to soman in guinea pigs. Toxicol Appl Pharmacol 2010; 245:171-8. [DOI: 10.1016/j.taap.2010.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 02/18/2010] [Accepted: 02/19/2010] [Indexed: 11/17/2022]
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21
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Conti ML, Che MM, Boylan M, Sciuto AM, Gordon RK, Nambiar MP. Acute microinstillation inhalation exposure to sarin induces changes in respiratory dynamics and functions in guinea pigs. Int J Toxicol 2010; 28:436-47. [PMID: 19815847 DOI: 10.1177/1091581809344879] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigates the toxic effects of sarin on respiratory dynamics following microinstillation inhalation exposure in guinea pigs. Animals are exposed to sarin for 4 minutes, and respiratory functions are monitored at 4 hours and 24 hours by whole-body barometric plethysmography. Data show significant changes in respiratory dynamics and function following sarin exposure. An increase in respiratory frequency is observed at 4 hours post exposure compared with saline controls. Tidal volume and minute volume are also increased in sarin-exposed animals 4 hours after exposure. Peak inspiratory flow increases, whereas peak expiratory flow increases at 4 hours and is erratic following sarin exposure. Animals exposed to sarin show a significant decrease in expiratory time and inspiratory time. End-inspiratory pause is unchanged whereas end-expiratory pause is slightly decreased 24 hours after sarin exposure. These results indicate that inhalation exposure to sarin alters respiratory dynamics and function at 4 hours, with return to normal levels at 24 hours post exposure.
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Affiliation(s)
- Michele L Conti
- United States Army Medical Research Institute of Chemical Defense, Edgewood, MD, USA
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Katos AM, Conti M, Moran TS, Chon TW, Gordon RK, Sciuto AM, Doctor BP, Nambiar MP. Acute microinstillation inhalation exposure to soman induces changes in respiratory dynamics and functions in guinea pigs. Inhal Toxicol 2009; 21:1-10. [DOI: 10.1080/08958370802331217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nambiar MP, Gordon RK, Moran TS, Richards SM, Sciuto AM. A Simple Method for Accurate Endotracheal Placement of an Intubation Tube in Guinea Pigs to Assess Lung Injury Following Chemical Exposure. Toxicol Mech Methods 2008; 17:385-92. [DOI: 10.1080/15376510601094131] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Che MM, Conti M, Boylan M, Sciuto AM, Gordon RK, Nambiar MP. Blood and bronchoalveolar lavage fluid acetylcholinesterase levels following microinstillation inhalation exposure to sarin in Guinea pigs. Inhal Toxicol 2008; 20:821-8. [PMID: 18645722 DOI: 10.1080/08958370802050957] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We determined acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibition in the bronchoalveolar lavage fluid (BALF) following inhalation exposure to chemical threat nerve agent (CTNA) sarin. Age- and weight-matched male guinea pigs were exposed to five different doses of sarin (169.3, 338.7, 508, 677.4, and 846.5 mg/m(3)) using a microinstillation inhalation exposure technique for 4 min. The technique involves aerosolization of the agent in the trachea using a microcatheter with a center hole that delivers the agent and multiple peripheral holes that pumps air to aerosolize the agent at the tip. Animals exposed to higher doses of sarin occasionally developed seizures and succumbed to death within 15 min after exposure. The LCt(50) for sarin using the microinstillation technique was determined to be close to 677.4 mg/m(3). Ear blood AChE activity showed a dose-dependent inhibition at 15 min postexposure. The inhibition of blood AChE remained constant over 35 and 55 min after sarin exposure indicating that there was no lung depot effect. Cardiac blood AChE and butyrylcholinesterase (BChE) activity in surviving animals euthanized at 24 h postexposure showed a dose-dependent inhibition with an inhibition of 60% at 677.4 and 846.5 mg/m(3) sarin exposure. AChE and BChE activity in bronchoalveolar lavage fluid (BALF) showed a slight increase at 338.7 to 677.4 mg/m(3) sarin exposure but a marginal inhibition at 169.3 mg/m(3). In contrast, the AChE protein levels determined by immunoblotting showed an increase at 169.3 mg/m(3) in the BALF. The BALF protein level, a biomarker of lung injury, was increased maximally at 338.7 mg/m(3) and that increase was dropped with an increase in the dose of sarin. The BALF protein levels correlated with the AChE and BChE activity. These data suggest that sarin microinstillation inhalation exposure results in respiratory toxicity and lung injury characterized by changes in lavage AChE, BChE, and protein levels.
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Affiliation(s)
- Magnus M Che
- Division of Biochemistry, Department of Biochemical Pharmacology, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910, USA
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Rocksén D, Elfsmark D, Heldestad V, Wallgren K, Cassel G, Göransson Nyberg A. An animal model to study health effects during continuous low-dose exposure to the nerve agent VX. Toxicology 2008; 250:32-8. [DOI: 10.1016/j.tox.2008.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 05/07/2008] [Accepted: 05/25/2008] [Indexed: 11/25/2022]
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26
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Inhalation of the nerve gas sarin impairs ventilatory responses to hypercapnia and hypoxia in rats. Toxicol Appl Pharmacol 2008; 232:440-7. [PMID: 18706921 DOI: 10.1016/j.taap.2008.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/16/2008] [Accepted: 07/17/2008] [Indexed: 02/07/2023]
Abstract
Sarin, a highly toxic nerve gas, is believed to cause bronchoconstriction and even death primarily through respiratory failure; however, the mechanism underlying the respiratory failure is not fully understood. The goals of this study were to ascertain whether sarin affects baseline ventilation (VE) and VE chemoreflexes as well as airway resistance and, if so, whether these changes are reversible. Four groups of F344 rats were exposed to vehicle (VEH) or sarin at 2.5, 3.5, and 4.0 mg h m(-3) (SL, SM, and SH, respectively). VE and VE responses to hypercapnia (7% CO2) or hypoxia (10% O2) were measured by plethysmography at 2 h and 1, 2, and 5 days after VEH or sarin exposure. Total pulmonary resistance (RL) also was measured in anesthetized VEH- and SH-exposed animals 2 h after exposure. Our results showed that within 2 h after exposure 11% of the SM- and 52% of the SH- exposed groups died. Although the SM and SH significantly decreased hypercapnic and hypoxic VE to similar levels (64 and 69%), SH induced greater respiratory impairment, characterized by lower baseline VE (30%; P<0.05), and total loss of the respiratory frequency response to hypercapnia and hypoxia. VE impairment recovered within 1-2 days after sarin exposure; interestingly, SH did not significantly affect baseline RL. Moreover, sarin induced body tremors that were unrelated to the changes in the VE responses. Thus, LC50 sarin causes a reversible impairment of VE that is not dependent on the sarin-induced body tremors and not associated with changes in RL.
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Rezk PE, Graham JR, Moran TS, Gordon RK, Sciuto AM, Doctor BP, Nambiar MP. Acute toxic effects of nerve agent VX on respiratory dynamics and functions following microinsillation inhalation exposure in guinea pigs. Inhal Toxicol 2007; 19:291-302. [PMID: 17365032 DOI: 10.1080/08958370601069398] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Exposure to a chemical warfare nerve agent (CWNA) leads to severe respiratory distress, respiratory failure, or death if not treated. We investigated the toxic effects of nerve agent VX on the respiratory dynamics of guinea pigs following exposure to 90.4 mug/m3 of VX or saline by microinstillation inhalation technology for 10 min. Respiratory parameters were monitored by whole-body barometric plethysmography at 4, 24, and 48 h, 7 d, 18 d, and 4 wk after VX exposure. VX-exposed animals showed a significant decrease in the respiratory frequency (RF) at 24 and 48 h of recovery (p value .0329 and .0142, respectively) compared to the saline control. The tidal volume (TV) slightly increased in VX exposed animals at 24 and significantly at 48 h (p = .02) postexposure. Minute ventilation (MV) increased slightly at 4 h but was reduced at 24 h and remained unchanged at 48 h. Animals exposed to VX also showed an increase in expiratory (Te) and relaxation time (RT) at 24 and 48 h and a small reduction in inspiratory time (Ti) at 24 h. A significant increase in end expiratory pause (EEP) was observed at 48 h after VX exposure (p = .049). The pseudo lung resistance (Penh) was significantly increased at 4 h after VX exposure and remained slightly high even at 48 h. Time-course studies reveal that most of the altered respiratory dynamics returned to normal at 7 d after VX exposure except for EEP, which was high at 7 d and returned to normal at 18 d postexposure. After 1 mo, all the monitored respiratory parameters were within normal ranges. Bronchoalveolar lavage (BAL) 1 mo after exposure showed virtually no difference in protein levels, cholinesterase levels, cell number, and cell death in the exposed and control animals. These results indicate that sublethal concentrations of VX induce changes in respiratory dynamics and functions that over time return to normal levels.
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Affiliation(s)
- Peter E Rezk
- Department of Biochemical Pharmacology/Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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28
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Nambiar MP, Gordon RK, Rezk PE, Katos AM, Wajda NA, Moran TS, Steele KE, Doctor BP, Sciuto AM. Medical countermeasure against respiratory toxicity and acute lung injury following inhalation exposure to chemical warfare nerve agent VX. Toxicol Appl Pharmacol 2007; 219:142-50. [DOI: 10.1016/j.taap.2006.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 10/27/2006] [Accepted: 11/01/2006] [Indexed: 10/23/2022]
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