Fatal abrin poisoning by injection

A fatal poisoning due to consumption of crushed Abrus precatorius seeds: an autopsy case report

Abrus precatorius is an ornamental plant that belongs to the Leguminoceae family. It contains toxalbumin, named abrin, in all of its parts. However, the seeds are more toxic when consumed in crushed form. Deaths due to abrus seed poisoning are rare. We are reporting a case of suicidal ingestion of crushed abrus precatorius seeds by a 37-year-old female. She presented to the hospital with complaints of multiple episodes of vomiting and diarrhea. She was resuscitated with fluid boluses, followed by a stomach wash and activated charcoal, and referred to our tertiary hospital, where she presented with giddiness, abdominal pain, bloody diarrhea, and epigastric tenderness. On subsequent days, she developed altered sensorium, renal failure, and electrolyte imbalance. She was managed conservatively. Blood investigation revealed elevated leucocyte count, increased urea and creatinine levels, and elevated liver enzymes. She died five days after ingesting the seeds. On autopsy examination, the brain and lungs were congested and edematous. The peritoneal cavity contained around 500mL of straw-colored fluid. Petechial hemorrhages were present over the lungs, heart, and liver surfaces. The mucosa of the gastrointestinal tract was hemorrhagic, the liver showed steatosis, and the kidneys showed congestion and obscuration of the corticomedullary junction. Histopathologically, the lungs showed mild congestion with alveolar edema, the liver showed necrosis with steatosis, and the kidney showed acute tubular necrosis. The toxicology screening was positive for abrin. This case highlights not only the rare fatality following abrus precatorius poisoning but also the toxic nature of this plant.

Gaps in forensic toxicological analysis: The veiled abrin

Abrus precatorius is an herbaceous, flowering plant that is widely distributed in tropical and subtropical regions. Its toxic component, known as abrin, is classified as one of the potentially significant biological warfare agents and bioterrorism tools due to its high toxicity. Abrin poisoning can be utilized to cause accidents, suicides, and homicides, which necessitates attention from clinicians and forensic scientists. Although a few studies have recently identified the toxicological and pharmacological mechanisms of abrin, the exact mechanism remains unclear. Furthermore, the clinical symptoms and pathological changes induced by abrin poisoning have not been fully characterized, and there is a lack of standardized methods for identifying biological samples of the toxin. Therefore, there is an urgent need for further toxicopathologic studies and the development of detection methods for abrin in the field of forensic medicine. This review provides an overview of the clinical symptoms, pathological changes, metabolic changes, toxicologic mechanisms, and detection methods of abrin poisoning from the perspective of forensic toxicology. Additionally, the evidence on abrin in the field of forensic toxicology and forensic pathology is discussed. Overall, this review serves as a reference for understanding the toxicological mechanism of abrin, highlighting the clinical applications of the toxin, and aiding in the diagnosis and forensic identification of toxin poisoning.

A review of poisoning with various types of biotoxins and its common clinical symptoms

INTRODUCTION

Biotoxins are toxic substances that originate from living organisms and are harmful to humans. Therefore, we need to know the symptoms of biotoxins poisoning to manage the damage. The purpose of this study is to establish a practical diagnostic protocol for dealing with poisoned patients exposed to biotoxins.

MATERIALS AND METHODS

The present study is a review study. Our studied community is articles and books matching the title of the project and relevant keywords. First, by searching the key words sign, symptom, biotoxins, relevant articles were extracted and studied from valid databases. By reviewing the studies based on the search strategy, four groups of biotoxins that were studied the most were identified. These four groups are marine biotoxins, bacterial biotoxins, fungal biotoxins and plant biotoxins. In each of these biotoxin groups, important toxins were selected and studied.

RESULTS

A total of 1864 articles were initially identified from the databases searched in present study. After screening titles and abstracts, 26 articles were included in the systematic review. Specifically, 7 articles were included for bacterial toxins, 9 articles for marine toxins, 5 articles for plant toxins and 5 articles for fungal toxins.

CONCLUSION

The symptoms of plant biotoxins poisoning may include cardiovascular, hematologic, neurologic, respiratory, renal, and gastrointestinal symptoms, while the symptoms of fungal biotoxins poisoning may include hepatic, renal, gastrointestinal, musculoskeletal, metabolic, respiratory, neurological, and cardiovascular symptoms. marine biotoxins poisoning presents with gastrointestinal and neurological symptoms, with varying incubation periods and recovery times. bacterial biotoxins exposure can lead to a wide range of clinical symptoms, with diarrhea, vomiting, and abdominal pain being the most common, and hemoglobinuria or hematuria being a sensitive and specific clinical manifestation for diagnosing ongoing HUS in children.

Trends in the analysis of abrin poisoning for forensic purposes

Abrus precatorius is a poisonous plant known since ancient times. Accidental poisoning is more common due to the intake of plant seeds containing deadly abrin which is a highly toxic and a thermolabile plant toxalbumin. Abrin has also been reported to be a potential chemical agent that can be used as bioweapon in military or terrorism. Abrin is a ribosome inactivating protein that contains multiple isotoxic forms of protein subunits called chain A and B. The identification of this toxalbumin in the plant is important to determine cause of death in poisoning cases. Therefore, the present review focuses on the structure, mode of administration, tokicokinetics, extraction procedures and forensic analysis of abrin and other constituents. It is observed that most of the researchers have utilized immunological methods for the detection of plant components. This technique has proved to be more sensitive, reliable and accurate for the detection of extremely low concentrations of toxin.

Fatal Curiosity: A Case of Suicidal Attempt by Abrus Seeds Consumption Through Online Research

Abrus precatorius (Jequirity, Indian liquorice, rosary bead, Gunja, or rati) seeds are highly toxic and are often ingested as a means of suicide in India. Gastric symptoms like bleeding, diarrhea, vomiting, and epigastric pain are the common manifestations of this toxicity. Abrin, a toxic substance found in the seeds, is structurally and functionally similar to ricin and is considered even more fatal. We report the first case of Abrus precatorius poisoning, where the internet was utilized to procure a potentially deadly poison with the intention to commit suicide in north India. Such actions are relevant to the medical field, particularly regarding the potential risks associated with the unsupervised procurement and misuse of toxic substances. The case highlights the potentially fatal consequences of ingesting Abrus seeds and the need for prompt medical attention in such cases.

Phage Display Affibodies Combined with AuNPs@Ru(bpy)32+ for Ultra-Sensitive Electrochemiluminescence Detection of Abrin

Abrin is a cytotoxin with strong lethality, which is a serious threat to human health and public safety, and thus, highly sensitive detection methods are urgently needed. The phage display affibody has two major modules, among which, the affibody fragment, with small molecular weight, high affinity and easy preparation, can be used for the specific recognition of the target, and the phage shell, with numerous protein copies, can be used as a carrier for the massive enrichment of signal molecules, and thus is particularly suitable as a sensitive probe for signal amplification in high-sensitivity biosensors. In this study, with antibody-coated magnetic microspheres as capture probes, Ru(bpy)32+ and biotin dual-labeled phage display affibodies as the specific signal probes and AuNPs@Ru(bpy)32+ (Ru(bpy)32+-coated gold nanoparticles) as the signal amplification nanomaterials, a new electrochemiluminescence (ECL) biosensor with a four-level sandwich structure of “magnetic capture probe-abrin-phage display affibody-AuNPs@Ru(bpy)32+” was constructed for abrin detection. In this detection mode, AuNPs@Ru(bpy)32+, a gold nanocomposite prepared rapidly via electrical interaction, contained an extremely high density of signal molecules, and the phage display affibodies with powerful loading capacity were not only labeled with Ru(bpy)32+, but also enriched with AuNPs@Ru(bpy)32+ in large amounts. These designs greatly improved the detection capability of the sensor, ultimately achieving the ultra-sensitive detection of abrin. The limit of detection (LOD) was 4.1 fg/mL (3δ/S), and the quantification range was from 5 fg/mL to 5 pg/mL. The sensor had good reproducibility and specificity and performed well in the test of simulated samples. This study expanded the application of affibodies in the field of biosensing and also deeply explored the signal amplification potential of phage display technology, which is of high value for the construction of simple and efficient sensors with high sensitivity.

A Self-Driven Microfluidic Chip for Ricin and Abrin Detection

Ricin and abrin are phytotoxins that can be easily used as biowarfare and bioterrorism agents. Therefore, developing a rapid detection method for both toxins is of great significance in the field of biosecurity. In this study, a novel nanoforest silicon microstructure was prepared by the micro-electro-mechanical systems (MEMS) technique; particularly, a novel microfluidic sensor chip with a capillary self-driven function and large surface area was designed. Through binding with the double antibodies sandwich immunoassay, the proposed sensor chip is confirmed to be a candidate for sensing the aforementioned toxins. Compared with conventional immunochromatographic test strips, the proposed sensor demonstrates significantly enhanced sensitivity (≤10 pg/mL for both toxins) and high specificity against the interference derived from juice or milk, while maintaining good linearity in the range of 10–6250 pg/mL. Owing to the silicon nanoforest microstructure and improved homogeneity of the color signal, short detection time (within 15 min) is evidenced for the sensor chip, which would be helpful for the rapid tracking of ricin and abrin for the field of biosecurity.

Neutralizing Monoclonal Antibody, mAb 10D8, Is an Effective Detoxicant against Abrin-a Both In Vitro and In Vivo

Abrin is a types II ribosome-inactivating protein (RIP) isolated from Abrus precatorious seeds, which comprises a catalytically active A chain and a lectin-like B chain linked by a disulfide bond. Four isotoxins of abrin have been reported with similar amino-acid composition but different cytotoxicity, of which abrin-a is the most potent toxin. High lethality and easy availability make abrin a potential bioterrorism agent. However, there are no antidotes available for managing abrin poisoning, and treatment is only symptomatic. Currently, neutralizing antibodies remain the most effective therapy against biotoxin poisoning. In this study, we prepared, identified, and acquired a high-affinity neutralizing monoclonal antibody (mAb) 10D8 with a potent pre- and post-exposure protective effect against cytotoxicity and animal toxicity induced by abrin-a or abrin crude extract. The mAb 10D8 could rescue the mouse injected intraperitoneally with a 25 × LD₅₀ dose of abrin-a from lethality and prevent tissue damages. Results indicated that 10D8 does not prevent the binding and internalization of abrin-a to cells but inhibits the enzymatic activity of abrin-a and reduces protein synthesis inhibition of cells. The high affinity, good specificity, and potent antitoxic efficiency of 10D8 make it a promising candidate for therapeutic antibodies against abrin.

A Novel Humanized Anti-Abrin A Chain Antibody Inhibits Abrin Toxicity In Vitro and In Vivo

Abrin, a type-II ribosome inactivating protein from the seed of Abrus precatorius, is classified as a Category B bioterrorism warfare agent. Due to its high toxicity, ingestion by animals or humans will lead to death from multiple organ failure. Currently, no effective agents have been reported to treat abrin poisoning. In this study, a novel anti-abrin neutralizing antibody (S008) was humanized using computer-aided design, which possessed lower immunogenicity. Similar to the parent antibody, a mouse anti-abrin monoclonal antibody, S008 possessed high affinity and showed a protective effect against abrin both in vitro and in vivo, and protected mice that S008 was administered 6 hours after abrin. S008 was found that it did not inhibit entry of abrin into cells, suggesting an intracellular blockade capacity against the toxin. In conclusion, this work demonstrates that S008 is a high affinity anti-abrin antibody with both a neutralizing and protective effect and may be an excellent candidate for clinical treatment of abrin poisoning.

Differentiation, Quantification and Identification of Abrin and Abrus precatorius Agglutinin

Abrin, the toxic lectin from the rosary pea plant Abrus precatorius, has gained considerable interest in the recent past due to its potential malevolent use. However, reliable and easy-to-use assays for the detection and discrimination of abrin from related plant proteins such as Abrus precatorius agglutinin or the homologous toxin ricin from Ricinus communis are sparse. To address this gap, a panel of highly specific monoclonal antibodies was generated against abrin and the related Abrus precatorius agglutinin. These antibodies were used to establish two sandwich ELISAs to preferentially detect abrin or A. precatorius agglutinin (limit of detection 22 pg/mL for abrin; 35 pg/mL for A. precatorius agglutinin). Furthermore, an abrin-specific lateral flow assay was developed for rapid on-site detection (limit of detection ~1 ng/mL abrin). Assays were validated for complex food, environmental and clinical matrices illustrating broad applicability in different threat scenarios. Additionally, the antibodies turned out to be suitable for immuno-enrichment strategies in combination with mass spectrometry-based approaches for unambiguous identification. Finally, we were able to demonstrate for the first time how the developed assays can be applied to detect, identify and quantify abrin from a clinical sample derived from an attempted suicide case involving A. precatorius.