Toxic effects of chlorine gas and potential treatments: a literature review

Chloropicrin induced ocular injury: Biomarkers, potential mechanisms, and treatments

Ocular tissue, especially the cornea, is overly sensitive to chemical exposures. The availability and adoption of chemical threat agent chloropicrin (CP) is growing in the United States as a pesticide and fumigant; thereby increasing the risk of its use in warfare, terrorist attacks and non-intentional exposure. Exposure to CP results in immediate ocular, respiratory, and dermal injury; however, we lack knowledge on its mechanism of toxicity as well as of its breakdown products like chlorine and phosgene, and effective therapies are elusive. Herein, we have reviewed the recent findings on exposure route, toxicity and likely mechanisms of CP induced ocular toxicity based on other vesicating chemical warfare agents that cause ocular injury. We have focused on the implication of their toxicity and mechanistic outcomes in the ocular tissue, especially the cornea, which could be useful in the development of broad-spectrum effective therapeutic options. We have discussed on the potential countermeasures, overall hallmarks and challenges involved in studying ocular injuries from chemical threat agent exposures. Finally, we reviewed useful available technologies and methods that can assist in the identification of effective medical countermeasures for chemical threat agents related ocular injuries.

Recapitulation of human pathophysiology and identification of forensic biomarkers in a translational model of chlorine inhalation injury

Chlorine gas (Cl2) has been repeatedly used as a chemical weapon, first in World War I and most recently in Syria. Life-threatening Cl2 exposures frequently occur in domestic and occupational environments, and in transportation accidents. Modeling the human etiology of Cl2-induced acute lung injury (ALI), forensic biomarkers, and targeted countermeasures development have been hampered by inadequate large animal models. The objective of this study was to develop a translational model of Cl2-induced ALI in swine to understand toxico-pathophysiology and evaluate whether it is suitable for screening potential medical countermeasures and to identify biomarkers useful for forensic analysis. Specific pathogen-free Yorkshire swine (30-40 kg) of either sex were exposed to Cl2 (≤240 ppm for 1 h) or filtered air under anesthesia and controlled mechanical ventilation. Exposure to Cl2 resulted in severe hypoxia and hypoxemia, increased airway resistance and peak inspiratory pressure, and decreased dynamic lung compliance. Cl2 exposure resulted in increased total leucocyte and neutrophil counts in bronchoalveolar lavage fluid, vascular leakage, and pulmonary edema compared with the air-exposed group. The model recapitulated all three key histopathological features of human ALI, such as neutrophilic alveolitis, deposition of hyaline membranes, and formation of microthrombi. Free and lipid-bound 2-chlorofatty acids and chlorotyrosine-modified proteins (3-chloro-l-tyrosine and 3,5-dichloro-l-tyrosine) were detected in plasma and lung tissue after Cl2 exposure. In this study, we developed a translational swine model that recapitulates key features of human Cl2 inhalation injury and is suitable for testing medical countermeasures, and validated chlorinated fatty acids and protein adducts as biomarkers of Cl2 inhalation.NEW & NOTEWORTHY We established a swine model of chlorine gas-induced acute lung injury that exhibits several features of human acute lung injury and is suitable for screening potential medical countermeasures. We validated chlorinated fatty acids and protein adducts in plasma and lung samples as forensic biomarkers of chlorine inhalation.

Successful treatment of 1 patient with chlorine-induced ARDS using awake self-prone positioning and nasal high-flow oxygen: A case report

RATIONALE

Accidents involving chlorinated compounds in the context of cleaning are not uncommon. However, improving the treatment success rate for acute respiratory distress syndrome (ARDS) patients caused by chlorine gas presents significant challenges.

PATIENT CONCERNS

A 28-year-old female was admitted to the intensive care unit after accidental inhalation of chlorine gas resulting in ARDS.

DIAGNOSES

The patient was diagnosed with ARDS attributed to chlorine gas exposure.

INTERVENTIONS

The intervention involved utilizing a combination of awake self-prone positioning (ASPP) and high-flow nasal oxygen therapy for treatment.

OUTCOMES

After continuous ASPP and high-flow nasal oxygen therapy, the patient quickly recovered and was transferred out of the intensive care unit on the 6th day without any adverse events.

LESSONS

ASPP combined with high-flow nasal oxygen therapy can improve patients' hypoxemia, prevent the need for intubation, avoid rapid deterioration of the condition, reduce treatment complexity, and lower mortality rate.

Countermeasures against Pulmonary Threat Agents

Inhaled toxicants are used for diverse purposes, ranging from industrial applications such as agriculture, sanitation, and fumigation to crowd control and chemical warfare, and acute exposure can induce lasting respiratory complications. The intentional release of chemical warfare agents (CWAs) during World War I caused life-long damage for survivors, and CWA use is outlawed by international treaties. However, in the past two decades, chemical warfare use has surged in the Middle East and Eastern Europe, with a shift toward lung toxicants. The potential use of industrial and agricultural chemicals in rogue activities is a major concern as they are often stored and transported near populated areas, where intentional or accidental release can cause severe injuries and fatalities. Despite laws and regulatory agencies that regulate use, storage, transport, emissions, and disposal, inhalational exposures continue to cause lasting lung injury. Industrial irritants (e.g., ammonia) aggravate the upper respiratory tract, causing pneumonitis, bronchoconstriction, and dyspnea. Irritant gases (e.g., acrolein, chloropicrin) affect epithelial barrier integrity and cause tissue damage through reactive intermediates or by direct adduction of cysteine-rich proteins. Symptoms of CWAs (e.g., chlorine gas, phosgene, sulfur mustard) progress from airway obstruction and pulmonary edema to acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), which results in respiratory depression days later. Emergency treatment is limited to supportive care using bronchodilators to control airway constriction and rescue with mechanical ventilation to improve gas exchange. Complications from acute exposure can promote obstructive lung disease and/or pulmonary fibrosis, which require long-term clinical care. SIGNIFICANCE STATEMENT: Inhaled chemical threats are of growing concern in both civilian and military settings, and there is an increased need to reduce acute lung injury and delayed clinical complications from exposures. This minireview highlights our current understanding of acute toxicity and pathophysiology of a select number of chemicals of concern. It discusses potential early-stage therapeutic development as well as challenges in developing countermeasures applicable for administration in mass casualty situations.

Environmental impacts of 5-year plastic waste deposition on municipal waste landfills: A follow-up study

Depositing plastic waste has long been a prevalent method of utilization, persisting today. Plastic waste within municipal waste landfills (MWL) undergoes diverse (bio-)degradation processes, which may be a potential source of chemicals and microorganisms harmful to the environment and human health. Soil and air samples were collected from modern MWL to identify environmental contamination caused by 5 years of plastic (bio-)degradation. The pH of soil samples was higher than in the reference area (RA), which was possibly caused by alterations in soil anionic composition detected with ion chromatography. The presence of plastic additives with a toxic potential was detected in soil samples by gas chromatography coupled with tandem mass spectrometry (GC-MS/MS). With the use of thermal desorption and GC - MS, hazardous substances (phthalic anhydride, phenylmaleic anhydride, ethylbenzene, xylene) with a known impact on the human endocrine system were also detected. The number of microorganisms, both fungi, and bacteria, was highly increased in soil and air in the MWL as compared to the RA. The soil collected in the MWL area appeared to be phytotoxic, and inhibited seed germination (Phytotoxkit FTM bioassay), while acute toxicity Microtox® bioassay showed a hormetic effect towards Aliivibrio fischeri. Obtained results exhibited massive soil and air contamination, with both chemical substances and microorganisms while plastic waste undergoes (bio-)degradation. It may contribute to serious environmental contamination and pose a threat to human health.

N-acetyl cysteine mitigates lung damage and inflammation after chlorine exposure in vivo and ex vivo

The objective of this study was to explore the effects of antioxidant treatments, specifically N-acetylcysteine (NAC) and N-acetylcysteine amide (NACA), in a mouse model of chlorine (Cl2)-induced lung injury. Additionally, the study aimed to investigate the utility of pig precision-cut lung slices (PCLS) as an ex vivo alternative for studying the short-term effects of Cl2 exposure and evaluating antioxidant treatments. The toxicological responses were analyzed in Cl2-exposed mice (inflammation, airway hyperresponsiveness (AHR)) and PCLS (viability, cytotoxicity, inflammatory mediators). Airways contractions were assessed using a small ventilator for mice and electric-field stimulation (EFS) for PCLS. Antioxidant treatments were administered to evaluate their effects. In Cl2-exposed mice, NAC treatment did not alleviate AHR, but it did reduce the number of neutrophils in bronchoalveolar lavage fluid and inflammatory mediators in lung tissue. In PCLS, exposure to Cl2 resulted in concentration-dependent toxicity, impairing the lung tissue's ability to respond to EFS-stimulation. NAC treatment increased viability, mitigated the toxic responses caused by Cl2 exposure, and maintained contractility comparable to unexposed controls. Interestingly, NACA did not provide any additional treatment effect beyond NAC in both models. In conclusion, the establishment of a pig model for Cl2-induced lung damage supports further investigation of NAC as a potential treatment. However, the lack of protective effects on AHR after NAC treatment in mice suggests that NAC alone may not be sufficient as a complete treatment for Cl2 injuries. Optimization of existing medications with a polypharmacy approach may be more successful in addressing the complex sequelae of Cl2-induced lung injury.

Single-cell transcriptomes reveal heterogeneity of chlorine-induced mice acute lung injury and the inhibitory effect of pentoxifylline on ferroptosis

To investigate the effect of pentoxifylline (PTX) on Chlorine (Cl₂)-induced acute lung injury (ALI) by single-cell RNA sequencing (scRNA-seq). Female BALB/c mice were exposed to Cl₂ at 400 ppm for 15 min. H&E staining was used to observe the degree of lung injury. scRNA-seq was conducted to analysis of normal and Cl₂-exposed mice lung tissues. Immunofluorescence was used to observe genes of interest. Thirty-two mice were randomly divided into four groups: Control, Cl₂, Cl₂+Fer-1, Cl₂+PTX. TEM, WB and ELISA were used to detect ferroptosis-related indicators. The 5, 8, 10, 12, 16, 20 clusters were epithelial cells and 4, 15, 18, 19, 21 clusters were endothelial cells. Pseudo-time analysis revealed the differentiation trajectory of epithelial cells and key regulatory genes (Gclc, Bpifa1, Dnah5 and Dnah9) during the process of injury. Cell-cell communication analysis identified several important receptor-ligand complexes (Nrp1-Vegfa, Nrp2-Vegfa, Flt1-Vegfa and Flt4-Vegfa). Ferroptosis were found up-regulated in epithelial and endothelial cells by GSVA analysis. Highly expressed genes to which closely related ferroptosis were found by SCENIC analysis. PTX could significantly decrease the levels of MDA and abnormal high expression of solute carrier family 7 member 11 (SLC7A11, the key transporter of cystine) as well as increase the expression of GSH/GSSG and glutathione peroxidase 4 (GPX4) (p < 0.05). This study revealed novel molecular features of Cl₂-induced ALI. PTX may be a potential specific drug by inhibiting the process of ferroptosis in epithelial and endothelial cells.

A comprehensive review of treatments for hydrogen sulfide poisoning: past, present, and future

Hydrogen sulfide (H₂S) poisoning remains a significant source of occupational fatalities and is the second most common cause of toxic gas-induced deaths. It is a rapidly metabolized systemic toxicant targeting the mitochondria, among other organelles. Intoxication is mostly acute, but chronic or in-between exposure scenarios also occur. Some genetic defects in H₂S metabolism lead to lethal chronic H₂S poisoning. In acute exposures, the neural, respiratory, and cardiovascular systems are the primary target organs resulting in respiratory distress, convulsions, hypotension, and cardiac irregularities. Some survivors of acute poisoning develop long-term sequelae, particularly in the central nervous system. Currently, treatment for H₂S poisoning is primarily supportive care as there are no FDA-approved drugs. Besides hyperbaric oxygen treatment, drugs in current use for the management of H₂S poisoning are controversial. Novel potential drugs are under pre-clinical research development, most of which target binding the H₂S. However, there is an acute need to discover new drugs to prevent and treat H₂S poisoning, including reducing mortality and morbidity, preventing sequalae from acute exposures, and for treating cumulative pathology from chronic exposures. In this paper, we perform a comprehensive review of H₂S poisoning including perspectives on past, present, and future.

Ophthalmic Manifestations of Chlorine Gas Exposure: What Do We Know So Far?

Chlorine gas is a hazardous substance that can cause severe health effects when inhaled or exposed to the skin. It is an odorless, colorless gas in many industrial and manufacturing settings and conflict areas. While exposure to chlorine gas is generally limited to the workplace and public areas, there are instances in which people may be exposed to high levels of chlorine gas for a short period of time due to spills, mishaps on the road or railroads, or other tragedies. In addition to the general health effects of chlorine gas, this essay will focus on the effects of chlorine gas on the eyes. The eyes are particularly sensitive to chlorine gas, and exposure can cause various symptoms, ranging from mild irritation to severe damage. Symptoms of chlorine gas exposure to the eyes include redness, burning, tearing, and blurred vision. In more serious cases, exposure to chlorine gas can cause permanent damage to the eyes, including corneal ulcers, scarring, and blindness. It is important to be aware of the signs and symptoms of chlorine gas exposure and the potential long-term effects to take the necessary steps to protect oneself. In addition to the potential health effects, it is important to understand the properties of chlorine gas. Chlorine gas is heavier than air and tends to settle in low-lying areas. It is highly reactive and can react with other substances to form hazardous compounds. As such, it is important to be aware of the potential for chlorine gas to react with other environmental substances and accumulate in certain areas. Finally, it is important to understand the background of chlorine gas use in various conflict areas. Chlorine gas has been used as a chemical weapon for centuries, and its use in modern warfare has been documented in various conflicts. As such, it is important to be aware of the potential for chlorine gas to be used in war zones and to take the necessary precautions to protect oneself. In conclusion, chlorine gas is a hazardous substance that can cause severe health effects when inhaled or exposed to the skin. The eyes are particularly sensitive to chlorine gas, and exposure can cause various symptoms, ranging from mild irritation to severe damage. It is important to be aware of the signs and symptoms of chlorine gas exposure and the potential long-term effects to take the necessary steps to protect oneself. Additionally, it is important to understand chlorine gas's properties and its background use in various conflict areas.

Protective effects of pentoxifylline against chlorine-induced acute lung injury in rats

OBJECTIVE

Chlorine is a chemical threat agent that can be harmful to humans. Inhalation of high levels of chlorine can lead to acute lung injury (ALI). Currently, there is no satisfactory treatment, and effective antidote is urgently needed. Pentoxifylline (PTX), a methylxanthine derivative and nonspecific phosphodiesterase inhibitor, is widely used for the treatment of vascular disorders. The present study was aimed to investigate the inhibitory effects of PTX on chlorine-induced ALI in rats.

METHODS

Adult male Sprague-Dawley rats were exposed to 400 ppm Cl₂ for 5 min. The histopathological examination was carried out and intracellular reactive oxygen species (ROS) levels were measured by the confocal laser scanning system. Subsequently, to evaluate the effect of PTX, a dose of 100 mg/kg was administered. The activities of superoxide dismutase (SOD) and the contents of malondialdehyde (MDA), glutathione (GSH), oxidized glutathione (GSSG) and lactate dehydrogenase (LDH) were determined by using commercial kits according to the manufacturer's instructions. Western blot assay was used to detect the protein expressions of SOD1, SOD2, catalase (CAT), hypoxia-inducible factor (HIF)-1α, vascular endothelial growth factor (VEGF), occludin, E-cadherin, bcl-xl, LC 3, Beclin 1, PTEN-induced putative kinase 1 (PINK 1) and Parkin.

RESULTS

The histopathological examination demonstrated that chlorine could destroy the lung structure with hemorrhage, alveolar collapse, and inflammatory infiltration. ROS accumulation was significantly higher in the lungs of rats suffering from inhaling chlorine (P<0.05). PTX markedly reduced concentrations of MAD and GSSG, while increased GSH (P<0.05). The protein expression levels of SOD1 and CAT also decreased (P<0.05). Furthermore, the activity of LDH in rats treated with PTX was significantly decreased compared to those of non-treated group (P<0.05). Additionally, the results also showed that PTX exerted an inhibition effect on protein expressions of HIF-1α, VEGF and occludin, and increased the level of E-cadherin (P<0.05). While the up-regulation of Beclin 1, LC 3II/I, Bcl-xl, and Parkin both in the lung tissues and mitochondria, were found in PTX treated rats (P<0.05). The other protein levels were decreased when treated with PTX (P<0.05).

CONCLUSION

PTX could ameliorate chlorine-induced lung injury via inhibition effects on oxidative stress, hypoxia and autophagy, thus suggesting that PTX could serve as a potential therapeutic approach for ALI.

Lung injury and oxidative stress induced by inhaled chlorine in mice is associated with proinflammatory activation of macrophages and altered bioenergetics

Chlorine (Cl2) gas is a highly toxic and oxidizing irritant that causes life-threatening lung injuries. Herein, we investigated the impact of Cl2-induced injury and oxidative stress on lung macrophage phenotype and function. Spontaneously breathing male C57BL/6J mice were exposed to air or Cl2 (300 ppm, 25 min) in a whole-body exposure chamber. Bronchoalveolar lavage (BAL) fluid and cells, and lung tissue were collected 24 h later and analyzed for markers of injury, oxidative stress and macrophage activation. Exposure of mice to Cl2 resulted in increases in numbers of BAL cells and levels of IgM, total protein, and fibrinogen, indicating alveolar epithelial barrier dysfunction and inflammation. BAL levels of inflammatory proteins including surfactant protein (SP)-D, soluble receptor for glycation end product (sRAGE) and matrix metalloproteinase (MMP)-9 were also increased. Cl2 inhalation resulted in upregulation of phospho-histone H2A.X, a marker of double-strand DNA breaks in the bronchiolar epithelium and alveolar cells; oxidative stress proteins, heme oxygenase (HO)-1 and catalase were also upregulated. Flow cytometric analysis of BAL cells revealed increases in proinflammatory macrophages following Cl2 exposure, whereas numbers of resident and antiinflammatory macrophages were not altered. This was associated with increases in numbers of macrophages expressing cyclooxygenase (COX)-2 and inducible nitric oxide synthase (iNOS), markers of proinflammatory activation, with no effect on mannose receptor (MR) or Ym-1 expression, markers of antiinflammatory activation. Metabolic analysis of lung cells showed increases in glycolytic activity following Cl2 exposure in line with proinflammatory macrophage activation. Mechanistic understanding of Cl2-induced injury will be useful in the identification of efficacious countermeasures for mitigating morbidity and mortality of this highly toxic gas.

Heterogeneity of T cells and macrophages in chlorine-induced acute lung injury in mice using single-cell RNA sequencing

OBJECTIVE

Chlorine (Cl₂), as an asphyxiant toxicant, induced poisoning incidents and acute lung injury (ALI) occur frequently. The specific pathogenesis of Cl₂-induced ALI remains unclear. Immune cells play an important role in the process of lung damage. We used single-cell RNA sequencing (scRNA-seq) technology to explore T cells and macrophages molecular mechanism.

METHODS

Female BALB/c mice were exposed to 400 ppm Cl₂ for 15 min. scRNA-seq technology was used to observe the heterogeneity of T cells and macrophages. Hematoxylin-eosin (H&E) staining was used to evaluate the degree of lung injury. Immunofluorescence was used to verify the highly expressed genes of our interest.

RESULTS

A total of 5316 to 7742 cells were classified into eight different cell types. Several new highly expressed anti-inflammatory and pro-inflammatory genes were found in T cells and macrophages, which were further verified in vitro. Through the pseudotime analysis of macrophages, it was found that the expression of pro-inflammatory and anti-inflammatory genes showed opposite trends in the development of Cl₂-induced ALI. This study also mapped T cells-macrophage communication and identified the development of several important receptor-ligand complexes in Cl₂-induced ALI.

CONCLUSIONS

These findings are worthy of further exploration and provide new resources and directions for the study of Cl₂-induced ALI in mice, especially in immune and inflammation mechanisms.

Protocol for non-invasive assessment of spontaneous movements of group-housed animals using remote video monitoring

Frequent monitoring of laboratory animals is critical for ensuring animal welfare and experimental data collection. To minimize the adverse and confounding effects caused by current monitoring protocols and human presence, we developed a low-cost, non-invasive, remotely accessible, extensible infrared video monitoring system. This protocol describes the construction and operation of the system, followed by applying deep-learning neural networks to track group-housed, unmarked mice for objective behavioral quantification. This system can be adapted to a variety of home-cage environments and species.

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Secure, low-cost, non-invasive, remote infrared video monitoring of animals

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Tracks group-housed, unmarked mice to quantify behavior and assess drug efficacy

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Extensible and requires no advanced technological or programming skills

Elucidation of in Vitro Chlorinated Tyrosine Adducts in Blood Plasma as Selective Biomarkers of Chlorine Exposure

Chlorine is a widely available industrial chemical and involved in a substantial number of cases of poisoning. It has also been used as a chemical warfare agent in military conflicts. To enable forensic verification, the persistent biomarkers 3-chlorotyrosine and 3,5-dichlorotyrosine in biomedical samples could be detected. An important shortfall of these biomarkers, however, is the relatively high incidence of elevated levels of chlorinated tyrosine residues in individuals with inflammatory diseases who have not been exposed to chlorine. Therefore, more reliable biomarkers are necessary to distinguish between endogenous formation and exogeneous exposure. The present study aims to develop a novel diagnostic tool for identifying site-specific chlorinated peptides as a more unambiguous indicator of exogeneous chlorine exposure. Human blood plasma was exposed in vitro to various chlorine concentrations, and the plasma proteins were subsequently digested by pronase, trypsin, or pepsin. After sample preparation, the digests were analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS) and liquid chromatography high-resolution tandem mass spectrometry (LC-HRMS/MS). In line with other studies, low levels of 3-chlorotyrosine and 3,5-dichlorotyrosine were found in blank plasma samples in this study. Therefore, 50 site-specific biomarkers were identified, which could be used as more unambiguous biomarkers for chlorine exposure. Chlorination of the peptides TY*ETTLEK, Y*KPGQTVK, Y*QQKPGQAPR, HY*EGSTVPEK, and Y*LY*EIAR could already be detected at moderate in vitro chlorine exposure levels. In addition, the latter two peptides were found to have dichlorinated fragments. Especially, Y*LY*EIAR, with a distinct chlorination pattern in the MS spectra, could potentially be used to differentiate exogeneous exposure from endogenous causes as other studies reported that this part of human serum albumin is nitrated rather than chlorinated under physiological conditions. In conclusion, trypsin digestion combined with high-resolution MS analysis of chlorinated peptides could constitute a valuable technique for the forensic verification of exposure to chlorine.

Inclusive DFT insight into sensing mechanism of cyclotetrapyrole towards lung irritants

The development of smart sensing devices for toxic analytes detection especially lung irritants is much essential. The cyclic conducting polymers having infinite π-conjugation are proved to be highly sensitive for toxic analytes. Herein, by using the DFT approach, we investigated the sensing mechanism of cyclotetrapyrole (CTPy) for accurate detection of phosgene, diphosgene, chloropicrin and chlorine at the B3LYP-D3/6-31 + G (d, p) level. The calculated interaction energies show the physisorption of analytes over the CTPy surface. Natural bond orbital (NBO) and charge decomposition (CDA) analyses predict charge transfer interactions in the complexes. The reduced density gradient (RDG) approach reveals that hydrogen bonding interactions dominate in the complexes. The sensitivity of CTPy towards lung irritants is further illustrated by the reduction in HOMO-LUMO energy gaps, red shifting of [Formula: see text] in UV-Visible spectra. Density of state (DOS) analysis affirm that enhanced conductivity upon complexation is due to the origination of new energy states in occupied and virtual orbitals nearer to the Fermi level. Moreover, PDOS spectra show that CTPy primarily contributes to the energy of HOMO. The outcome of the current study depicts appreciable sensitivity of CTPy towards lung irritants. Moreover, the competing role of naturally occurring atmospheric water is also investigated. We believe that the upshot of the current findings and their forecasts will provide useful guidelines for an experimentalist to design highly sensitive sensors for toxic analytes using CTPy. HIGHLIGHTS: • The highest QNBO transfer towards the analyte (- 0.121) is seen in the chlorine@CTPy complex. • The highest reduction in Eg (61%) between occupied and virtual orbitals is noticed in chlorine@CTPy. • The orbital overlap results in a 41% red shifting of [Formula: see text] in chlorine@CTPy. • Cyclotetrapyrole is highly sensitive for chlorine.

Autophagy in Extracellular Matrix and Wound Healing Modulation in the Cornea

Autophagy is a robust cellular mechanism for disposing of harmful molecules or recycling them to cells, which also regulates physiopathological processes in cornea. Dysregulated autophagy causes inefficient clearance of unwanted proteins and cellular debris, mitochondrial disorganization, defective inflammation, organ dysfunctions, cell death, and diseases. The cornea accounts for two-thirds of the refraction of light that occurs in the eyes, but is prone to trauma/injury and infection. The extracellular matrix (ECM) is a noncellular dynamic macromolecular network in corneal tissues comprised of collagens, proteoglycans, elastin, fibronectin, laminins, hyaluronan, and glycoproteins. The ECM undergoes remodeling by matrix-degrading enzymes and maintains corneal transparency. Autophagy plays an important role in the ECM and wound healing maintenance. Delayed/dysregulated autophagy impacts the ECM and wound healing, and can lead to corneal dysfunction. Stromal wound healing involves responses from the corneal epithelium, basement membrane, keratocytes, the ECM, and many cytokines and chemokines, including transforming growth factor beta-1 and platelet-derived growth factor. Mild corneal injuries self-repair, but greater injuries lead to corneal haze/scars/fibrosis and vision loss due to disruptions in the ECM, autophagy, and normal wound healing processes. Presently, the precise role of autophagy and ECM remodeling in corneal wound healing is elusive. This review discusses recent trends in autophagy and ECM modulation in the context of corneal wound healing and homeostasis.

Early ECMO initiation in the emergency department for refractory hypoxemic respiratory failure caused by NaDCC intoxication

We describe a case of acute respiratory failure caused by inhalation of gas formed from a reaction of intentional dissolution of sodium dichloroisocyanurate (NaDCC) tablets in water. A patient had refractory respiratory failure despite the use of conventional therapy, including lung-protective mechanical ventilation. Early veno-venous extracorporeal membrane oxygenation (VV-ECMO) support was initiated in the emergency department (ED). The patient was weaned from ECMO on hospital day 6 and discharged from the ICU on hospital day 27. Cases of severe inhalation injury with acute respiratory failure refractory to conventional treatments and mechanical ventilator support may benefit from VV-ECMO. Literature on early initiation of ED-VV-ECMO in NaDCC-induced refractory respiratory failure is rare. This case may be used as a guide in the management of subsequent cases as it shows that early initiation of ED-VV-ECMO was beneficial to the patient.

Personal Passive Air Samplers for Chlorinated Gases Generated from the Use of Consumer Products

Various chlorine-based disinfectants are being used during the COVID-19 pandemic; however, only a few studies on exposure to harmful gases resulting from the use of these disinfectants exist. Previously, we developed a personal passive air sampler (PPAS) to estimate the exposure level to chlorine gas while using chlorinated disinfectants. Herein, we investigated the color development of the passive sampler corresponding to chlorine exposure concentration and time, which allows the general population to easily estimate their gas exposure levels. The uptake and reaction rate of PPAS are also explained, and the maximum capacity of the sampler was determined as 1.8 mol of chlorine per unit volume (m³) of the passive sampler. Additionally, the effects of disinfectant types on the gas exposure level were successfully assessed using passive samplers deployed in a closed chamber. It is noteworthy that the same level of chlorine gas is generated from liquid household bleach regardless of dilution ratios, and we confirmed that the chlorine gas can diffuse out from a gel-type disinfectant. Considering that this PPAS reflects reactive gas removal, individual working patterns, and environmental conditions, this sampler can be successfully used to estimate personal exposure levels of chlorinated gases generated from disinfectants.

Development of chlorine-induced lung injury in the anesthetized, spontaneously breathing pig

Chlorine is a toxic industrial chemical produced in vast quantities globally, being used in a range of applications such as water purification, sanitation and industrial processes. Its use and transport cannot be restricted; exposure may occur following accidental or deliberate releases. The OPCW recently verified the use of chlorine gas against civilians in both Syria and Iraq. Chlorine inhalation produces damage to the lungs, which may result in the development of an acute lung injury, respiratory failure and death. Treatment remains an intractable problem. Our objective was to develop a clinically relevant pre-clinical model of a moderate to severe lung injury in the pig. This would enable future assessment of therapeutic drugs or interventions to be implemented in the pre-hospital phase after exposure. Due to the irritant nature of chlorine, a number of strategies for exposing terminally anesthetized pigs needed to be investigated. A number of challenges (inconsistent acute changes in respiratory parameters; early deaths), resulted in a moderate to severe lung injury not being achieved. However, most pigs developed a mild lung injury by 12 h. Further investigation is required to optimize the model and enable the assessment of therapeutic candidates. In this paper we describe the exposure strategies used and discuss the challenges encountered in establishing a model of chlorine-induced lung injury. A key aim is to assist researchers navigating the challenges of producing a clinically relevant model of higher dose chlorine exposure where animal welfare is protected by use of terminal anesthesia.

Chronic cardiac structural damage, diastolic and systolic dysfunction following acute myocardial injury due to bromine exposure in rats

Accidental bromine spills are common and its large industrial stores risk potential terrorist attacks. The mechanisms of bromine toxicity and effective therapeutic strategies are unknown. Our studies demonstrate that inhaled bromine causes deleterious cardiac manifestations. In this manuscript we describe mechanisms of delayed cardiac effects in the survivors of a single bromine exposure. Rats were exposed to bromine (600 ppm for 45 min) and the survivors were sacrificed at 14 or 28 days. Echocardiography, hemodynamic analysis, histology, transmission electron microscopy (TEM) and biochemical analysis of cardiac tissue were performed to assess functional, structural and molecular effects. Increases in right ventricular (RV) and left ventricular (LV) end-diastolic pressure and LV end-diastolic wall stress with increased LV fibrosis were observed. TEM images demonstrated myofibrillar loss, cytoskeletal breakdown and mitochondrial damage at both time points. Increases in cardiac troponin I (cTnI) and N-terminal pro brain natriuretic peptide (NT-proBNP) reflected myofibrillar damage and increased LV wall stress. LV shortening decreased as a function of increasing LV end-systolic wall stress and was accompanied by increased sarcoendoplasmic reticulum calcium ATPase (SERCA) inactivation and a striking dephosphorylation of phospholamban. NADPH oxidase 2 and protein phosphatase 1 were also increased. Increased circulating eosinophils and myocardial 4-hydroxynonenal content suggested increased oxidative stress as a key contributing factor to these effects. Thus, a continuous oxidative stress-induced chronic myocardial damage along with phospholamban dephosphorylation are critical for bromine-induced chronic cardiac dysfunction. These findings in our preclinical model will educate clinicians and public health personnel and provide important endpoints to evaluate therapies.

Transient receptor potential channels in pulmonary chemical injuries and as countermeasure targets

The lung is highly sensitive to chemical injuries caused by exposure to threat agents in industrial or transportation accidents, occupational exposures, or deliberate use as weapons of mass destruction (WMD). There are no antidotes for the majority of the chemical threat agents and toxic inhalation hazards despite their use as WMDs for more than a century. Among several putative targets, evidence for transient receptor potential (TRP) ion channels as mediators of injury by various inhalational chemical threat agents is emerging. TRP channels are expressed in the respiratory system and are essential for homeostasis. Among TRP channels, the body of literature supporting essential roles for TRPA1, TRPV1, and TRPV4 in pulmonary chemical injuries is abundant. TRP channels mediate their function through sensory neuronal and nonneuronal pathways. TRP channels play a crucial role in complex pulmonary pathophysiologic events including, but not limited to, increased intracellular calcium levels, signal transduction, recruitment of proinflammatory cells, neurogenic inflammatory pathways, cough reflex, hampered mucus clearance, disruption of the integrity of the epithelia, pulmonary edema, and fibrosis. In this review, we summarize the role of TRP channels in chemical threat agents-induced pulmonary injuries and how these channels may serve as medical countermeasure targets for broader indications.