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Morningstar J, Lee J, Mahon S, Brenner M, Nath AK. Mass Spectrometric Analysis of Purine Intermediary Metabolism Indicates Cyanide Induces Purine Catabolism in Rabbits. Metabolites 2024; 14:279. [PMID: 38786756 PMCID: PMC11123099 DOI: 10.3390/metabo14050279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Purines are the building blocks of DNA/RNA, energy substrates, and cofactors. Purine metabolites, including ATP, GTP, NADH, and coenzyme A, are essential molecules in diverse biological processes such as energy metabolism, signal transduction, and enzyme activity. When purine levels increase, excess purines are either recycled to synthesize purine metabolites or catabolized to the end product uric acid. Purine catabolism increases during states of low oxygen tension (hypoxia and ischemia), but this metabolic pathway is incompletely understood in the context of histotoxic hypoxia (i.e., inhibition of oxygen utilization despite normal oxygen tension). In rabbits exposed to cyanide-a classical histotoxic hypoxia agent-we demonstrated significant increases in several concordant metabolites in the purine catabolic pathway (including plasma levels of uric acid, xanthosine, xanthine, hypoxanthine, and inosine) via mass spectrometry-based metabolite profiling. Pharmacological inhibition of the purine catabolic pathway with oxypurinol mitigated the deleterious effects of cyanide on skeletal muscle cytochrome c oxidase redox state, measured by non-invasive diffuse optical spectroscopy. Finally, plasma uric acid levels correlated strongly with those of lactic acid, an established clinical biomarker of cyanide exposure, in addition to a tissue biomarker of cyanide exposure (skeletal muscle cytochrome c oxidase redox state). Cumulatively, these findings not only shed light on the in vivo role(s) of cyanide but also have implications in the field of medical countermeasure (MCM) development.
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Affiliation(s)
- Jordan Morningstar
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Jangwoen Lee
- Beckman Laser Institute, University of California, Irvine, CA 92697, USA (S.M.); (M.B.)
| | - Sari Mahon
- Beckman Laser Institute, University of California, Irvine, CA 92697, USA (S.M.); (M.B.)
| | - Matthew Brenner
- Beckman Laser Institute, University of California, Irvine, CA 92697, USA (S.M.); (M.B.)
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Anjali K. Nath
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02215, USA
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Glyoxylate protects against cyanide toxicity through metabolic modulation. Sci Rep 2022; 12:4982. [PMID: 35322094 PMCID: PMC8943054 DOI: 10.1038/s41598-022-08803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/04/2022] [Indexed: 11/09/2022] Open
Abstract
Although cyanide's biological effects are pleiotropic, its most obvious effects are as a metabolic poison. Cyanide potently inhibits cytochrome c oxidase and potentially other metabolic enzymes, thereby unleashing a cascade of metabolic perturbations that are believed to cause lethality. From systematic screens of human metabolites using a zebrafish model of cyanide toxicity, we have identified the TCA-derived small molecule glyoxylate as a potential cyanide countermeasure. Following cyanide exposure, treatment with glyoxylate in both mammalian and non-mammalian animal models confers resistance to cyanide toxicity with greater efficacy and faster kinetics than known cyanide scavengers. Glyoxylate-mediated cyanide resistance is accompanied by rapid pyruvate consumption without an accompanying increase in lactate concentration. Lactate dehydrogenase is required for this effect which distinguishes the mechanism of glyoxylate rescue as distinct from countermeasures based solely on chemical cyanide scavenging. Our metabolic data together support the hypothesis that glyoxylate confers survival at least in part by reversing the cyanide-induced redox imbalances in the cytosol and mitochondria. The data presented herein represent the identification of a potential cyanide countermeasure operating through a novel mechanism of metabolic modulation.
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Hashem M, Wu Y, Dunn JF. Quantification of cytochrome c oxidase and tissue oxygenation using CW-NIRS in a mouse cerebral cortex. BIOMEDICAL OPTICS EXPRESS 2021; 12:7632-7656. [PMID: 35003857 PMCID: PMC8713667 DOI: 10.1364/boe.435532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/06/2021] [Accepted: 11/05/2021] [Indexed: 05/05/2023]
Abstract
We provide a protocol for measuring the absolute concentration of the oxidized and reduced state of cytochrome c oxidase (CCO) in the cerebral cortex of mice, using broadband continuous-wave NIRS. The algorithm (NIR-AQUA) allows for absolute quantification of CCO and deoxyhemoglobin. Combined with an anoxia pulse, this also allows for quantification of total hemoglobin, and tissue oxygen saturation. CCO in the cortex was 4.9 ± 0.1 μM (mean ± SD, n=6). In normoxia, 84% of CCO was oxidized. We include hypoxia and cyanide validation studies to show CCO can be quantified independently to hemoglobin. This can be applied to study oxidative metabolism in the many rodent models of neurological disease.
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Affiliation(s)
- Mada Hashem
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada T2N 4N1, Canada
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada T2N 4N1, Canada
- Experimental Imaging Centre, Cumming School of Medicine, University of Calgary, Alberta, Canada T2N 4N1, Canada
| | - Ying Wu
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada T2N 4N1, Canada
- Experimental Imaging Centre, Cumming School of Medicine, University of Calgary, Alberta, Canada T2N 4N1, Canada
| | - Jeff F. Dunn
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada T2N 4N1, Canada
- Experimental Imaging Centre, Cumming School of Medicine, University of Calgary, Alberta, Canada T2N 4N1, Canada
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Thiele RH, Ikeda K, Osuru HP, Zuo Z. Comparison of Broadband and Discrete Wavelength Near-Infrared Spectroscopy Algorithms for the Detection of Cytochrome aa3 Reduction. Anesth Analg 2020; 129:1273-1280. [PMID: 29916864 DOI: 10.1213/ane.0000000000003572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cytochrome aa3, the terminal component of the electron transport chain, absorbs near-infrared radiation (NIR) differentially depending on its oxidation state (Cytox), which can in theory be measured using near-infrared spectroscopy (NIRS) by relating light absorption at specific wavelengths to chromophore concentrations. Some NIRS algorithms use discrete wavelengths, while others analyze a band of NIR (broadband NIRS). The purpose of this study was to test the ability of discrete wavelength and broadband algorithms to measure changes in Cytox (primary outcome), and to determine whether or not a discreet wavelength NIRS algorithm could perform similarly to a broadband NIRS algorithm for the measurement of Cytox in a staged hypoxia-cyanide model (hypoxia and cyanide have oppositional effects on tissue saturation, but both cause cytochrome reduction). METHODS Twenty Sprague-Dawley rats were anesthetized with isoflurane, intubated, and instrumented. Blood pressure, end-tidal carbon dioxide, and arterial oxygen saturation were measured. A halogen light source transmitted NIR transcranially. NIR from the light source and the skull was transmitted to 2 cooled charge-coupled device spectrometers. Rats were subjected to anoxia (fraction of inspired oxygen, 0.0) until arterial oxygen saturation decreased to 70%. After recovery, 5 mg/kg sodium cyanide was injected intravenously. The cycle was repeated until cardiac arrest occurred. Relative concentrations of hemoglobin and cytochrome aa3 were calculated using discreet wavelength and broadband NIRS algorithms. RESULTS Hypoxia led to an increase in calculated deoxyhemoglobin (0.20 arbitrary units [AUs]; 95% confidence interval [CI], 0.17-0.22; P < .0001), a decrease in calculated oxyhemoglobin (-0.16 AUs; 95% CI, -0.19 to -0.14; P < .0001), and a decrease in calculated Cytox (-0.057 AUs; 95% CI, -0.073 to 0.0040; P < .001). Cyanide led to a decrease in calculated deoxyhemoglobin (-0.037 AUs; 95% CI, 0.046 to -0.029; P < .001), an increase in calculated oxyhemoglobin (0.053 AUs; 95% CI, 0.040-0.065; P < .001), and a decrease in calculated Cytox (-0.056 AUs; 95% CI, -0.064 to -0.048; P < .001). The correlations between "discreet" wavelength algorithms (using 4, 6, 8, and 10 wavelengths) and the broadband algorithm for the measurement of calculated Cytox were 0.54 (95% CI, 0.52-0.56), 0.87 (0.87-0.88), 0.88 (0.88-0.89), and 0.95 (0.95-0.95), respectively. CONCLUSIONS The broadband and 10 wavelength algorithm were able to accurately track changes in Cytox for all experiments.
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Affiliation(s)
- Robert H Thiele
- From the Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia
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Choi JH, Chou LD, Roberts TR, Beely BM, Wendorff DS, Espinoza MD, Sieck K, Dixon AT, Burmeister D, Jordan BS, Brenner M, Chen Z, Necsoiu C, Cancio LC, Batchinsky AI. Point-of-care endoscopic optical coherence tomography detects changes in mucosal thickness in ARDS due to smoke inhalation and burns. Burns 2018; 45:589-597. [PMID: 30482414 DOI: 10.1016/j.burns.2018.10.014] [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: 02/20/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence of acute respiratory distress syndrome (ARDS) in mechanically ventilated burn patients is 33%, with mortality varying from 11-46% depending on ARDS severity. Despite the new Berlin definition for ARDS, prompt bedside diagnosis is lacking. We developed and tested a bedside technique of fiberoptic-bronchoscopy-based optical coherence tomography (OCT) measurement of airway mucosal thickness (MT) for diagnosis of ARDS following smoke inhalation injury (SII) and burns. METHODS 16 female Yorkshire pigs received SII and 40% thermal burns. OCT MT and PaO2-to-FiO2 ratio (PFR) measurements were taken at baseline, after injury, and at 24, 48, and 72h after injury. RESULTS Injury led to thickening of MT which was sustained in animals that developed ARDS. Significant correlations were found between MT, PFR, peak inspiratory pressure (PIP), and total infused fluid volume. CONCLUSIONS OCT is a useful tool to quantify MT changes in the airway following SII and burns. OCT may be effective as a diagnostic tool in the early stages of SII-induced ARDS and should be tested in humans.
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Affiliation(s)
- Jae Hyek Choi
- The Geneva Foundation, Tacoma WA, United States; United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States.
| | - Li-Dek Chou
- Beckman Laser Institute, University of California Irvine, Irvine, CA, United States
| | - Teryn R Roberts
- The Geneva Foundation, Tacoma WA, United States; United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - Brendan M Beely
- The Geneva Foundation, Tacoma WA, United States; United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - Daniel S Wendorff
- The Geneva Foundation, Tacoma WA, United States; United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - Mark D Espinoza
- United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - Kyle Sieck
- The Geneva Foundation, Tacoma WA, United States; United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - Alexander T Dixon
- The Geneva Foundation, Tacoma WA, United States; United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - David Burmeister
- United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - Bryan S Jordan
- United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - Matthew Brenner
- Beckman Laser Institute, University of California Irvine, Irvine, CA, United States
| | - Zhongping Chen
- Beckman Laser Institute, University of California Irvine, Irvine, CA, United States
| | - Corina Necsoiu
- United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - Leopoldo C Cancio
- United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
| | - Andriy I Batchinsky
- The Geneva Foundation, Tacoma WA, United States; United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, United States
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Morningstar J, Lee J, Hendry-Hofer T, Witeof A, Lyle LT, Knipp G, MacRae CA, Boss GR, Peterson RT, Davisson VJ, Gerszten RE, Bebarta VS, Mahon S, Brenner M, Nath AK. Intramuscular administration of hexachloroplatinate reverses cyanide-induced metabolic derangements and counteracts severe cyanide poisoning. FASEB Bioadv 2018; 1:81-92. [PMID: 31355359 PMCID: PMC6660183 DOI: 10.1096/fba.1024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cyanide is a highly toxic industrial chemical that is widely used by manufactures. Smoke inhalation during household fires is the most common source of cyanide poisoning while additional risks to civilians include industrial accidents and terrorist attacks. Despite the risks to large numbers of individuals, an antidote capable of administration at scale adequate for a mass casualty, prehospital scenario does not yet exist. Previously, we demonstrated that intravenous cisplatin analogues accelerate recovery from cyanide poisoning in mice and rabbits. Of the dozens of platinum‐based organometallic complexes tested, hexachloroplatinate (HCP) emerged as a promising lead compound, exhibiting strong affinity for cyanide and efficacy across model systems. Here, we show HCP is an antidote to lethal cyanide exposure and is importantly effective when delivered intramuscularly. The pharmacokinetic profile of HCP exhibited bioavailability in the systemic circulation 2.5 minutes post‐treatment and subsequent renal clearance of HCP‐cyanide. HCP restored parameters of cellular physiology including cytochrome c oxidase redox state and TCA cycle metabolism. We next validated these findings in a large animal model (swine). Finally, preclinical safety studies in mice revealed minimal toxicity. Cumulatively, these findings demonstrate that HCP is a promising lead compound for development of an intramuscular injectable cyanide antidote for mass casualty scenarios.
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Affiliation(s)
- Jordan Morningstar
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Jangwoen Lee
- Beckman Laser Institute and Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Tara Hendry-Hofer
- Deparment of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Alyssa Witeof
- Deparment of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - L Tiffany Lyle
- Department of Comparative Pathology, Purdue University, West Lafayette, IN 47907, USA
| | - Gregg Knipp
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN 47907, USA
| | - Calum A MacRae
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.,Broad Institute, Cambridge, MA 02142, USA
| | - Gerry R Boss
- Deparment of Medicine, University of California, San Diego, CA 92093, USA
| | - Randall T Peterson
- Deparment of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112 USA
| | - Vincent J Davisson
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN 47907, USA
| | - Robert E Gerszten
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.,Broad Institute, Cambridge, MA 02142, USA
| | - Vikhyat S Bebarta
- Deparment of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Sari Mahon
- Beckman Laser Institute and Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Matt Brenner
- Beckman Laser Institute and Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Anjali K Nath
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.,Broad Institute, Cambridge, MA 02142, USA
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Lee J, Rockwood G, Logue B, Manandhar E, Petrikovics I, Han C, Bebarta V, Mahon SB, Burney T, Brenner M. Monitoring Dose Response of Cyanide Antidote Dimethyl Trisulfide in Rabbits Using Diffuse Optical Spectroscopy. J Med Toxicol 2018; 14:295-305. [PMID: 30094773 DOI: 10.1007/s13181-018-0680-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Cyanide (CN) poisoning is a serious chemical threat from accidental or intentional exposures. Current CN exposure treatments, including direct binding agents, methemoglobin donors, and sulfur donors, have several limitations. Dimethyl trisulfide (DMTS) is capable of reacting with CN to form the less toxic thiocyanate with high efficiency, even without the sulfurtransferase rhodanese. We investigated a soluble DMTS formulation with the potential to provide a continuous supply of substrate for CN detoxification which could be delivered via intramuscular (IM) injection in a mass casualty situation. We also used non-invasive technology, diffuse optical spectroscopy (DOS), to monitor physiologic changes associated with CN exposure and reversal. METHODS Thirty-six New Zealand white rabbits were infused with a lethal dose of sodium cyanide solution (20 mg/60 ml normal saline). Animals were divided into three groups and treated with saline, low dose (20 mg), or high dose (150 mg) of DMTS intramuscularly. DOS continuously assessed changes in tissue hemoglobin concentrations and cytochrome c oxidase redox state status throughout the experiment. RESULTS IM injection of DMTS increased the survival in lethal CN poisoning. DOS demonstrated that high-dose DMTS (150 mg) reversed the effects of CN exposure on cytochrome c oxidase, while low dose (20 mg) did not fully reverse effects, even in surviving animals. CONCLUSIONS This study demonstrated potential efficacy for the novel approach of supplying substrate for non-rhodanese mediated sulfur transferase pathways for CN detoxification via intramuscular injection in a moderate size animal model and showed that DOS was useful for optimizing the DMTS treatment.
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Affiliation(s)
- Jangwoen Lee
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA.
| | - Gary Rockwood
- Analytical Toxicology Division, US Army Medical Research Institute of Chemical Defense, 2900 Rickets Point Road, Aberdeen Proving Ground, Aberdeen, MD, 21010, USA
| | - Brian Logue
- Department of Chemistry and Biochemistry, South Dakota University, Brookings, SD, 57007, USA
| | - Erica Manandhar
- Department of Chemistry and Biochemistry, South Dakota University, Brookings, SD, 57007, USA
| | - Ilona Petrikovics
- Department of Chemistry, Sam Houston State University, Huntsville, TX, 77341, USA
| | - Changhoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Geonggi-do, 10444, South Korea
| | - Vik Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Sari B Mahon
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA
| | - Tanya Burney
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA
| | - Matthew Brenner
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA, 92868, USA
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Ghijsen M, Lentsch GR, Gioux S, Brenner M, Durkin AJ, Choi B, Tromberg BJ. Quantitative real-time optical imaging of the tissue metabolic rate of oxygen consumption. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-12. [PMID: 29575830 PMCID: PMC5866507 DOI: 10.1117/1.jbo.23.3.036013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/28/2018] [Indexed: 05/06/2023]
Abstract
The tissue metabolic rate of oxygen consumption (tMRO2) is a clinically relevant marker for a number of pathologies including cancer and arterial occlusive disease. We present and validate a noncontact method for quantitatively mapping tMRO2 over a wide, scalable field of view at 16 frames / s. We achieve this by developing a dual-wavelength, near-infrared coherent spatial frequency-domain imaging (cSFDI) system to calculate tissue optical properties (i.e., absorption, μa, and reduced scattering, μs', parameters) as well as the speckle flow index (SFI) at every pixel. Images of tissue oxy- and deoxyhemoglobin concentration ( [ HbO2 ] and [HHb]) are calculated from optical properties and combined with SFI to calculate tMRO2. We validate the system using a series of yeast-hemoglobin tissue-simulating phantoms and conduct in vivo tests in humans using arterial occlusions that demonstrate sensitivity to tissue metabolic oxygen debt and its repayment. Finally, we image the impact of cyanide exposure and toxicity reversal in an in vivo rabbit model showing clear instances of mitochondrial uncoupling and significantly diminished tMRO2. We conclude that dual-wavelength cSFDI provides rapid, quantitative, wide-field mapping of tMRO2 that can reveal unique spatial and temporal dynamics relevant to tissue pathology and viability.
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Affiliation(s)
- Michael Ghijsen
- Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
| | - Griffin R. Lentsch
- Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
| | - Sylvain Gioux
- University of Strasbourgh, ICube Laboratory, Illkirch, France
| | - Matthew Brenner
- Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, Irvine, California, United States
- University of California, Irvine Medical Center, Department of Medicine, Division of Pulmonology, Orange, California, United States
| | - Anthony J. Durkin
- Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
| | - Bruce J. Tromberg
- Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
- University of California, Irvine Medical Center, Department of Surgery, Orange, California, United States
- Address all correspondence to: Bruce J. Tromberg, E-mail:
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Brenner M, Azer SM, Oh KJ, Han CH, Lee J, Mahon SB, Du X, Mukai D, Burney T, Saidian M, Chan A, Straker DI, Bebarta VS, Boss GR. Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion. ACTA ACUST UNITED AC 2017; 7. [PMID: 28868209 PMCID: PMC5578424 DOI: 10.4172/2167-7972.1000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective Accidental or intentional cyanide ingestion is an-ever present danger. Rapidly acting, safe, inexpensive oral cyanide antidotes are needed that can neutralize large gastrointestinal cyanide reservoirs. Since humans cannot be exposed to cyanide experimentally, we studied oral cyanide poisoning in rabbits, testing oral sodium thiosulfate with and without gastric alkalization. Setting University research laboratory. Subjects New Zealand white rabbits. Interventions Seven animal groups studied; Groups 1–5 received high dose oral NaCN (50 mg, >LD100) and were treated immediately with oral (via nasogastric tube): 1) saline, 2) glycine, 3) sodium thiosulfate or 4) sodium thiosulfate and glycine, or 5) after 2 min with intramuscular injection of sodium nitrite and sodium thiosulfate plus oral sodium thiosulfate and glycine. Groups 6–7 received moderate dose oral NaCN (25 mg, LD70) and delayed intramuscular 6) saline or 7) sodium nitrite-sodium thiosulfate. Measurements and Main Results All animals in the high dose NaCN group receiving oral saline or glycine died very rapidly, with a trend towards delayed death in glycine-treated animals; saline versus glycine-treated animals died at 10.3+3.9 and 14.6+5.9 min, respectively (p=0.13). In contrast, all sodium thiosulfate-treated high dose cyanide animals survived (p<0.01), with more rapid recovery in animals receiving both thiosulfate and glycine, compared to thiosulfate alone (p<0.03). Delayed intramuscular treatment alone in the moderate cyanide dose animals increased survival over control animals from 30% to 71%. Delayed treatment in high dose cyanide animals was not as effective as immediate treatment, but did increase survival time and rescued 29% of animals (p<0.01 versus cyanide alone). Conclusions Oral sodium thiosulfate with gastric alkalization rescued animals from lethal doses of ingested cyanide. The combination of oral glycine and sodium thiosulfate may have potential for treating high dose acute cyanide ingestion and merits further investigation. The combination of systemic and oral therapy may provide further options.
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Affiliation(s)
- Matthew Brenner
- Beckman Laser Institute, University of California, Irvine, California, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, California, USA
| | - Sarah M Azer
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Kyung-Jin Oh
- Department of Urology, Chonnam National University Medical School, South Korea
| | - Chang Hoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Geonggi-do, South Korea
| | - Jangwoen Lee
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Sari B Mahon
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Xiaohua Du
- Pulmonary Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - David Mukai
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Tanya Burney
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Mayer Saidian
- Beckman Laser Institute, University of California, Irvine, California, USA.,The Institute for Drug Research, School of Pharmacy, Hebrew University of Jerusalem, Jerusalem Israel
| | - Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Derek I Straker
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Abstract
Part I of this review discussed the similarities between embryogenesis, mammalian adaptions to hypoxia (primarily driven by hypoxia-inducible factor-1 [HIF-1]), ischemia-reperfusion injury (and its relationship with reactive oxygen species), hibernation, diving animals, cancer, and sepsis, and it focused on the common characteristics that allow cells and organisms to survive in these states. Part II of this review describes techniques by which researchers gain insight into subcellular energetics and identify potential future tools for clinicians. In particular, P nuclear magnetic resonance to measure high-energy phosphates, serum lactate measurements, the use of near-infrared spectroscopy to measure the oxidation state of cytochrome aa3, and the ability of the protoporphyrin IX-triplet state lifetime technique to measure mitochondrial oxygen tension are discussed. In addition, this review discusses novel treatment strategies such as hyperbaric oxygen, preconditioning, exercise training, therapeutic gases, as well as inhibitors of HIF-1, HIF prolyl hydroxylase, and peroxisome proliferator-activated receptors.
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Affiliation(s)
- Robert H Thiele
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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Broadband near-infrared spectroscopy can detect cyanide-induced cytochrome aa 3 inhibition in rats: a proof of concept study. Can J Anaesth 2016; 64:376-384. [PMID: 28008565 DOI: 10.1007/s12630-016-0803-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/31/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Clinically available near-infrared spectroscopy (NIRS) devices use two to five wavelengths of light to measure the relative amounts of oxyhemoglobin and deoxyhemoglobin in tissue to determine tissue hemoglobin oxygen saturation (StO2). In addition to StO2, broadband NIRS devices (using hundreds of wavelengths of light) may be able to measure the oxidation state of mitochondrial cytochrome aa3 (Cytox) which reflects the subcellular energetic state. We hypothesize that broadband NIRS devices can measure Cytox independent of changes in hemoglobin saturation. METHODS In this prospective non-randomized study, 20 male Sprague-Dawley rats (300 g) were anesthetized with isoflurane, tracheally intubated, and ventilated with 100% O2 containing 2% isoflurane. They were subsequently instrumented with a broadband NIRS device that used a halogen light source coupled to an emitting fibreoptic cable. Three receiving fibreoptic cables were utilized; one analyzed the light source and the other two were directed at the base of the skull. Each receiving fibre was connected to a spectrometer to measure light intensity. Sodium cyanide (NaCN) 5 mg·kg-1 iv was injected in order to produce cytochrome aa3 reduction. Two to three minutes after injection, oxygen was eliminated and 100% nitrogen (i.e., anoxia) was used for ventilation in order to induce a reduction in both cytochrome aa3 and hemoglobin desaturation. Changes in the cytochrome oxidation state and hemoglobin oxygenation were calculated using a broadband algorithm and compared before and after both the NaCN and anoxia interventions. RESULTS The NaCN injection resulted in a decrease in median [interquartile range (IQR)] deoxyhemoglobin (-0.014 [-0.29 to -0.005] arbitrary units [AU]; P < 0.001), an increase in oxyhemoglobin (0.013 [-0.011 to 0.031] AU; P < 0.001), and a reduction in cytochrome aa3 (-0.015 [-0.020 to -0.011] AU; P < 0.001). Anoxia resulted in an increase in median [IQR] deoxyhemoglobin (0.13 [0.11 to 0.18] AU; P < 0.001), a decrease in oxyhemoglobin (-0.17 [-0.22 to -0.15] AU; P < 0.001), and a reduction in cytochrome aa3 (-0.04 [-0.06 to -0.03] AU; P < 0.001). CONCLUSION Broadband NIRS can effectively measure the directionality of changes in both Cytox and StO2 by uncoupling the cytochrome and hemoglobin signals through inhibition of the electron transport chain and anoxia.
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The Vitamin B 12 Analog Cobinamide Is an Effective Antidote for Oral Cyanide Poisoning. J Med Toxicol 2016; 12:370-379. [PMID: 27631586 DOI: 10.1007/s13181-016-0566-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/31/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Cyanide is a major chemical threat, and cyanide ingestion carries a higher risk for a supra-lethal dose exposure compared to inhalation but provides an opportunity for effective treatment due to a longer treatment window and a gastrointestinal cyanide reservoir that could be neutralized prior to systemic absorption. We hypothesized that orally administered cobinamide may function as a high-binding affinity scavenger and that gastric alkalinization would reduce cyanide absorption and concurrently increase cobinamide binding, further enhancing antidote effectiveness. METHODS Thirty New Zealand white rabbits were divided into five groups and were given a lethal dose of oral cyanide poisoning (50 mg). The survival time of animals was monitored with oral cyanide alone, oral cyanide with gastric alkalinization with oral sodium bicarbonate buffer (500 mg), and in combination with either aquohydroxocobinamide or dinitrocobinamide (250 mM). Red blood cell cyanide concentration, plasma cobinamide, and thiocyanate concentrations were measured from blood samples. RESULTS In cyanide ingested animals, oral sodium bicarbonate alone significantly prolonged survival time to 20.3 ± 8.6 min compared to 10.5 ± 4.3 min in saline-treated controls, but did not lead to overall survival. Aquohydroxocobinamide and dinitrocobinamide increased survival time to 64 ± 41 (p < 0.05) and 75 ± 16.4 min (p < 0.001), respectively. Compared to aquohydroxocobinamide, dinitrocobinamide showed greater systemic absorption and reduced blood pressure. Dinitrocobinamide also markedly increased the red blood cell cyanide concentration. Under all conditions, the plasma thiocyanate concentration gradually increased with time. CONCLUSION This study demonstrates a promising new approach to treat high-dose cyanide ingestion, with gastric alkalinization alone and in combination with oral cobinamide for treating a supra-lethal dose of orally administered cyanide in rabbits.
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Arifler D, Zhu T, Madaan S, Tachtsidis I. Optimal wavelength combinations for near-infrared spectroscopic monitoring of changes in brain tissue hemoglobin and cytochrome c oxidase concentrations. BIOMEDICAL OPTICS EXPRESS 2015; 6:933-47. [PMID: 25798316 PMCID: PMC4361446 DOI: 10.1364/boe.6.000933] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 05/19/2023]
Abstract
We analyze broadband near-infrared spectroscopic measurements obtained from newborn piglets subjected to hypoxia-ischemia and we aim to identify optimal wavelength combinations for monitoring cerebral tissue chromophores. We implement an optimization routine based on the genetic algorithm to perform a heuristic search for discrete wavelength combinations that can provide accurate concentration information when benchmarked against the gold standard of 121 wavelengths. The results indicate that it is possible to significantly reduce the number of measurement wavelengths used in conjunction with spectroscopic algorithms and still achieve a high performance in estimating changes in concentrations of oxyhemoglobin, deoxyhemoglobin, and oxidized cytochrome c oxidase. While the use of a 3-wavelength combination leads to mean recovery errors of up to 10%, these errors drop to less than 4% with 4 or 5 wavelengths and to even less than 2% with 8 wavelengths.
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Affiliation(s)
- Dizem Arifler
- Physics Group, Middle East Technical University, Northern Cyprus Campus, Kalkanli, via Mersin 10
Turkey
| | - Tingting Zhu
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT,
UK
| | - Sara Madaan
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT,
UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT,
UK
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Bale G, Mitra S, Meek J, Robertson N, Tachtsidis I. A new broadband near-infrared spectroscopy system for in-vivo measurements of cerebral cytochrome-c-oxidase changes in neonatal brain injury. BIOMEDICAL OPTICS EXPRESS 2014; 5:3450-66. [PMID: 25360364 PMCID: PMC4206316 DOI: 10.1364/boe.5.003450] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 05/02/2023]
Abstract
We present a novel lens-based broadband near-infrared spectroscopy system to simultaneously measure cerebral changes in tissue oxygenation and haemodynamics via estimation of the changes in haemoglobin concentration; in addition to oxygen utilization via the measurement of the oxidation state of cytochrome-c-oxidase (CCO). We demonstrate the use of the system in a cohort of 6 newborn infants with neonatal encephalopathy in the Neonatal Intensive Care Unit for continuous measurement periods of up to 5 days. NIRS data was collected from above the frontal lobe on the left and right hemispheres simultaneously with systemic data to allow multimodal data analysis. This allowed us to study the NIRS variables in response to global pathophysiological events and we focused our analysis to spontaneous oxygen desaturations. We identified changes from the NIRS variables during 236 oxygen desaturations from over 212 hours of data with a change from the baseline to nadir of -12 ± 3%. There was a consistent negative change in the Δ[HbD] (= oxygenated - deoxygenated haemoglobin) and Δ[oxCCO] measurements, mean decreases were 3.0 ± 1.7μM and 0.22 ± 0.11μM, and a positive change in the Δ[HbT] (= oxygenated + deoxygenated haemoglobin) measurements across all subjects, mean increase was 0.85 ± 0.58μM. We have shown with a feasibility study that the relationship between haemoglobin oxygenation changes and CCO oxidation changes during these desaturation events was significantly associated with a magnetic resonance spectroscopy (MRS)-measured biomarker of injury severity (r = 0.91, p<0.01).
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Affiliation(s)
- Gemma Bale
- Department of Medical Physics and Bioengineering, Malet Place Engineering Building, University College London, UK
| | - Subhabrata Mitra
- Institute for Women’s Health, University College London and Neonatal Unit, University College London Hospitals Trust, London, UK
| | - Judith Meek
- Institute for Women’s Health, University College London and Neonatal Unit, University College London Hospitals Trust, London, UK
| | - Nicola Robertson
- Institute for Women’s Health, University College London and Neonatal Unit, University College London Hospitals Trust, London, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Bioengineering, Malet Place Engineering Building, University College London, UK
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Lee J, Kim JG, Mahon SB, Mukai D, Yoon D, Boss GR, Patterson SE, Rockwood G, Isom G, Brenner M. Noninvasive optical cytochrome c oxidase redox state measurements using diffuse optical spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:055001. [PMID: 24788369 PMCID: PMC4006145 DOI: 10.1117/1.jbo.19.5.055001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 03/01/2014] [Accepted: 03/07/2014] [Indexed: 05/28/2023]
Abstract
A major need exists for methods to assess organ oxidative metabolic states in vivo. By contrasting the responses to cyanide (CN) poisoning versus hemorrhage in animal models, we demonstrate that diffuse optical spectroscopy (DOS) can detect cytochrome c oxidase (CcO) redox states. Intermittent decreases in inspired O2 from 100% to 21% were applied before, during, and after CN poisoning, hemorrhage, and resuscitation in rabbits. Continuous DOS measurements of total hemoglobin, oxyhemoglobin, deoxyhemoglobin, and oxidized and reduced CcO from muscle were obtained. Rabbit hemorrhage was accomplished with stepwise removal of blood, followed by blood resuscitation. CN treated rabbits received 0.166 mg/min NaCN infusion. During hemorrhage, CcO redox state became reduced concurrently with decreases in oxyhemoglobin, resulting from reduced tissue oxygen delivery and hypoxia. In contrast, during CN infusion, CcO redox state decreased while oxyhemoglobin concentration increased due to CN binding and reduction of CcO with resultant inhibition of the electron transport chain. Spectral absorption similarities between hemoglobin and CcO make noninvasive spectroscopic distinction of CcO redox states difficult. By contrasting physiological perturbations of CN poisoning versus hemorrhage, we demonstrate that DOS measured CcO redox state changes are decoupled from hemoglobin concentration measurement changes.
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Affiliation(s)
- Jangwoen Lee
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
| | - Jae G. Kim
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
- Gwangju Institute of Science and Technology, School of Information and Communications, Department of Medical System Engineering, 123 Cheomdan-gwagiro, Buk-gu, Gwangju 500-712, Republic of Korea
| | - Sari B. Mahon
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
| | - David Mukai
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
| | - David Yoon
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
| | - Gerry R. Boss
- University of California San Diego, Department of Medicine, 9500 Gilman Dr., La Jolla, California 92093
| | - Steven E. Patterson
- University of Minnesota, Department of Pharmacology, 516 Delaware Street SE, Minneapolis, Minnesota 55455
| | - Gary Rockwood
- US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010
| | - Gary Isom
- Purdue University, Department of Medicinal Chemistry and Molecular Pharmacology, 575 Stadium Mall Drive, West Lafayette, Indiana 47907
| | - Matthew Brenner
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
- University of California Irvine Medical Center, Department of Pulmonary and Critical Care, 333 West City Boulevard, Suite 400, Orange, California 92868
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Brenner M, Benavides S, Mahon SB, Lee J, Yoon D, Mukai D, Viseroi M, Chan A, Jiang J, Narula N, Azer SM, Alexander C, Boss GR. The vitamin B12 analog cobinamide is an effective hydrogen sulfide antidote in a lethal rabbit model. Clin Toxicol (Phila) 2014; 52:490-7. [PMID: 24716792 DOI: 10.3109/15563650.2014.904045] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE Hydrogen sulfide (H2S) is a highly toxic gas for which no effective antidotes exist. It acts, at least in part, by binding to cytochrome c oxidase, causing cellular asphyxiation and anoxia. We investigated the effects of three different ligand forms of cobinamide, a vitamin B12 analog, to reverse sulfide (NaHS) toxicity. METHODS New Zealand white rabbits received a continuous intravenous (IV) infusion of NaHS (3 mg/min) until expiration or a maximum 270 mg dose. Animals received six different treatments, administered at the time when they developed signs of severe toxicity: Group 1-saline (placebo group, N = 9); Group 2--IV hydroxocobalamin (N = 7); Group 3--IV aquohydroxocobinamide (N = 6); Group 4--IV sulfitocobinamide (N = 6); Group 5--intramuscular (IM) sulfitocobinamide (N = 6); and Group 6-IM dinitrocobinamide (N = 8). Blood was sampled intermittently, and systemic blood pressure and deoxygenated and oxygenated hemoglobin were measured continuously in peripheral muscle and over the brain region; the latter were measured by diffuse optical spectroscopy (DOS) and continuous wave near infrared spectroscopy (CWNIRS). RESULTS Compared with the saline controls, all cobinamide derivatives significantly increased survival time and the amount of NaHS that was tolerated. Aquohydroxocobinamide was most effective (261.5 ± 2.4 mg NaHS tolerated vs. 93.8 ± 6.2 mg in controls, p < 0.0001). Dinitrocobinamide was more effective than sulfitocobinamide. Hydroxocobalamin was not significantly more effective than the saline control. CONCLUSIONS Cobinamide is an effective agent for inhibiting lethal sulfide exposure in this rabbit model. Further studies are needed to determine the optimal dose and form of cobinamide and route of administration.
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Affiliation(s)
- M Brenner
- Beckman Laser Institute, University of California , Irvine, CA , USA
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18
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Dunne L, Hebden J, Tachtsidis I. Development of a near infrared multi-wavelength, multi-channel, time-resolved spectrometer for measuring brain tissue haemodynamics and metabolism. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 812:181-186. [PMID: 24729231 PMCID: PMC4338597 DOI: 10.1007/978-1-4939-0620-8_24] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
We present a novel time domain functional near infrared spectroscopy system using a supercontinuum laser allowing us to measure the coefficient of absorption and scattering of up to 16 multiplexed wavelengths in the near infrared region. This is a four detector system that generates up to 3 mW of light for each wavelength with a narrow 2-3 nm FWHM bandwidth between 650 and 890 nm; each measurement of 16 wavelengths per channel can be performed up to a rate of 1 Hz. We can therefore quantify absolute haemoglobin changes in tissue and are currently investigating which and how many wavelengths are needed to resolve additional chromophores in tissue, such as water and the oxidation state of cytochrome-c-oxidase.
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Affiliation(s)
- Luke Dunne
- Department of Medical Physics & Bioengineering, University College London, Malet Place Eng. Building, Gower Street, London, WC1E 6BT, UK.
| | - Jem Hebden
- Department of Medical Physics & Bioengineering, University College London, Malet Place Eng. Building, Gower Street, London, WC1E 6BT, UK
| | - Ilias Tachtsidis
- Department of Medical Physics & Bioengineering, University College London, Malet Place Eng. Building, Gower Street, London, WC1E 6BT, UK
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Kim JG, Lee J, Mahon SB, Mukai D, Patterson SE, Boss GR, Tromberg BJ, Brenner M. Noninvasive monitoring of treatment response in a rabbit cyanide toxicity model reveals differences in brain and muscle metabolism. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:105005. [PMID: 23223999 PMCID: PMC3603151 DOI: 10.1117/1.jbo.17.10.105005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 09/09/2012] [Accepted: 09/11/2012] [Indexed: 06/01/2023]
Abstract
Noninvasive near infrared spectroscopy measurements were performed to monitor cyanide (CN) poisoning and recovery in the brain region and in foreleg muscle simultaneously, and the effects of a novel CN antidote, sulfanegen sodium, on tissue hemoglobin oxygenation changes were compared using a sub-lethal rabbit model. The results demonstrated that the brain region is more susceptible to CN poisoning and slower in endogenous CN detoxification following exposure than peripheral muscles. However, sulfanegen sodium rapidly reversed CN toxicity, with brain region effects reversing more quickly than muscle. In vivo monitoring of multiple organs may provide important clinical information regarding the extent of CN toxicity and subsequent recovery, and facilitate antidote drug development.
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Affiliation(s)
- Jae G Kim
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, California 92612, USA.
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20
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Lee SW, Heidary AE, Yoon D, Mukai D, Ramalingam T, Mahon S, Yin J, Jing J, Liu G, Chen Z, Brenner M. Quantification of airway thickness changes in smoke-inhalation injury using in-vivo 3-D endoscopic frequency-domain optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2011; 2:243-54. [PMID: 21339870 PMCID: PMC3038440 DOI: 10.1364/boe.2.000243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/21/2010] [Accepted: 12/30/2010] [Indexed: 05/15/2023]
Abstract
Smoke inhalation injury is frequently accompanied by cyanide poisoning that may result in substantial morbidity and mortality, and methods are needed to quantitatively determine extent of airway injury. We utilized a 3-D endoscopic frequency-domain optical coherence tomography (FD-OCT) constructed with a swept-source laser to investigate morphological airway changes following smoke and cyanide exposure in rabbits. The thickness of the mucosal area between the epithelium and cartilage in the airway was measured and quantified. 3-D endoscopic FD-OCT was able to detect significant increases in the thickness of the tracheal walls of the rabbit beginning almost immediately after smoke inhalation injuries which were similar to those with combined smoke and cyanide poisoning.
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Affiliation(s)
- Sang-Won Lee
- Beckman Laser Institute, University of California, Irvine,1002 Health Sciences Rd. East, Irvine, CA 92612, USA
- Current address: Electronics and Telecommunications Research Institute,
138 Gajeongno, Yuseong-gu, Daejeon, 305-700, Korea
| | - Andrew E. Heidary
- OCT Medical Imaging Inc., 1002 Health Sciences Rd. East, Irvine, CA 92612, USA
| | - David Yoon
- Beckman Laser Institute, University of California, Irvine,1002 Health Sciences Rd. East, Irvine, CA 92612, USA
| | - David Mukai
- Beckman Laser Institute, University of California, Irvine,1002 Health Sciences Rd. East, Irvine, CA 92612, USA
| | | | - Sari Mahon
- Beckman Laser Institute, University of California, Irvine,1002 Health Sciences Rd. East, Irvine, CA 92612, USA
| | - Jiechen Yin
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92697, USA
| | - Joseph Jing
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92697, USA
| | - Gangjun Liu
- Beckman Laser Institute, University of California, Irvine,1002 Health Sciences Rd. East, Irvine, CA 92612, USA
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine,1002 Health Sciences Rd. East, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92697, USA
| | - Matthew Brenner
- Beckman Laser Institute, University of California, Irvine,1002 Health Sciences Rd. East, Irvine, CA 92612, USA
- Pumonary and Critical care Division, UC Irvine Medical Center, Orange, CA 92868, USA
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Brenner M, Kim JG, Lee J, Mahon SB, Lemor D, Ahdout R, Boss GR, Blackledge W, Jann L, Nagasawa HT, Patterson SE. Sulfanegen sodium treatment in a rabbit model of sub-lethal cyanide toxicity. Toxicol Appl Pharmacol 2010; 248:269-76. [PMID: 20705081 PMCID: PMC3382974 DOI: 10.1016/j.taap.2010.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/31/2010] [Accepted: 08/03/2010] [Indexed: 01/13/2023]
Abstract
The aim of this study is to investigate the ability of intramuscular and intravenous sulfanegen sodium treatment to reverse cyanide effects in a rabbit model as a potential treatment for mass casualty resulting from cyanide exposure. Cyanide poisoning is a serious chemical threat from accidental or intentional exposures. Current cyanide exposure treatments, including direct binding agents, methemoglobin donors, and sulfur donors, have several limitations. Non-rhodanese mediated sulfur transferase pathways, including 3-mercaptopyruvate sulfurtransferase (3-MPST) catalyze the transfer of sulfur from 3-MP to cyanide, forming pyruvate and less toxic thiocyanate. We developed a water-soluble 3-MP prodrug, 3-mercaptopyruvatedithiane (sulfanegen sodium), with the potential to provide a continuous supply of substrate for CN detoxification. In addition to developing a mass casualty cyanide reversal agent, methods are needed to rapidly and reliably diagnose and monitor cyanide poisoning and reversal. We use non-invasive technology, diffuse optical spectroscopy (DOS) and continuous wave near infrared spectroscopy (CWNIRS) to monitor physiologic changes associated with cyanide exposure and reversal. A total of 35 animals were studied. Sulfanegen sodium was shown to reverse the effects of cyanide exposure on oxyhemoglobin and deoxyhemoglobin rapidly, significantly faster than control animals when administered by intravenous or intramuscular routes. RBC cyanide levels also returned to normal faster following both intramuscular and intravenous sulfanegen sodium treatment than controls. These studies demonstrate the clinical potential for the novel approach of supplying substrate for non-rhodanese mediated sulfur transferase pathways for cyanide detoxification. DOS and CWNIRS demonstrated their usefulness in optimizing the dose of sulfanegen sodium treatment.
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Affiliation(s)
- Matthew Brenner
- Laser Microbeam and Medical Program, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612-1475, USA.
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Lee J, Keuter KA, Kim J, Tran A, Uppal A, Mukai D, Mahon SB, Cancio LC, Batchinsky A, Tromberg BJ, Brenner M. Noninvasive in vivo monitoring of cyanide toxicity and treatment using diffuse optical spectroscopy in a rabbit model. Mil Med 2010; 174:615-21. [PMID: 19585775 DOI: 10.7205/milmed-d-02-7408] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Currently, no reliable noninvasive methods exist for monitoring the severity of in vivo cyanide (CN) toxicity, treatment, and resulting physiological changes. We developed a broadband diffuse optical spectroscopy (DOS) system to measure bulk tissue absorption and scattering. DOS was used to optically monitor CN toxicity and treatment with sodium nitrite (NaNO2). To perform experiments, the DOS probe was placed on the hind leg of rabbits. A sodium CN solution was infused intravenously. DOS and concurrent physiologic measurements were obtained. After completion of CN infusion, NaNO2 was infused to induce methemoglobinemia (MetHb). During infusion of CN, blood gas measurements showed an increase in venous partial pressure of oxygen (pO2), and following reversal, venous pO2 values decreased. DOS measurements demonstrated corresponding changes in hemoglobin oxygenation states and redox states of cytochrome-c oxidase (CcO) during CN infusion and NaNO2 treatment. Therefore, DOS enables detection and monitoring of CN toxicity and treatment with NaNO2.
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Affiliation(s)
- Jangwoen Lee
- Laser Microbeam and Medical Program, Beckman Laser Institute, University of California, 1002 Health Sciences Road East, Irvine, CA 92612-1475, USA
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Intramuscular cobinamide sulfite in a rabbit model of sublethal cyanide toxicity. Ann Emerg Med 2010; 55:352-63. [PMID: 20045579 DOI: 10.1016/j.annemergmed.2009.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 11/19/2009] [Accepted: 12/02/2009] [Indexed: 01/01/2023]
Abstract
STUDY OBJECTIVE Exposure to cyanide in fires and industrial exposures and intentional cyanide poisoning by terrorists leading to mass casualties is an ongoing threat. Current treatments for cyanide poisoning must be administered intravenously, and no rapid treatment methods are available for mass casualty cyanide exposures. Cobinamide is a cobalamin (vitamin B(12)) analog with an extraordinarily high affinity for cyanide that is more water-soluble than cobalamin. We investigate the use of intramuscular cobinamide sulfite to reverse cyanide toxicity-induced physiologic changes in a sublethal cyanide exposure animal model and determine the ability of an intramuscular cobinamide sulfite injection to rapidly reverse the physiologic effects of cyanide toxicity. METHODS New Zealand white rabbits were given 10 mg sodium cyanide intravenously over 60 minutes. Quantitative diffuse optical spectroscopy and continuous-wave near-infrared spectroscopy monitoring of tissue oxyhemoglobin and deoxyhemoglobin concentrations were performed concurrently with blood cyanide level measurements and cobinamide levels. Immediately after completion of the cyanide infusion, the rabbits were injected intramuscularly with cobinamide sulfite (n=6) or inactive vehicle (controls, n=5). RESULTS Intramuscular administration led to rapid mobilization of cobinamide and was extremely effective at reversing the physiologic effects of cyanide on oxyhemoglobin and within deoxyhemoglobin extraction. Recovery time to 63% of their baseline values in the central nervous system occurred within a mean of 1,032 minutes in the control group and 9 minutes in the cobinamide group, with a difference of 1,023 minutes (95% confidence interval 116 to 1,874 minutes). In muscle tissue, recovery times were 76 and 24 minutes, with a difference of 52 minutes (95% confidence interval 7 to 98 minutes). RBC cyanide levels returned toward normal significantly faster in cobinamide sulfite-treated animals than in control animals. CONCLUSION Intramuscular cobinamide sulfite rapidly and effectively reverses the physiologic effects of cyanide poisoning, suggesting that a compact cyanide antidote kit can be developed for mass casualty cyanide exposures.
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Brenner M, Mahon SB, Lee J, Kim J, Mukai D, Goodman S, Kreuter KA, Ahdout R, Mohammad O, Sharma VS, Blackledge W, Boss GR. Comparison of cobinamide to hydroxocobalamin in reversing cyanide physiologic effects in rabbits using diffuse optical spectroscopy monitoring. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:017001. [PMID: 20210475 PMCID: PMC2816993 DOI: 10.1117/1.3290816] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Our purpose is to compare cobinamide to hydroxocobalamin in reversing cyanide (CN)-induced physiologic effects in an animal model using diffuse optical spectroscopy (DOS). Cyanide poisoning is a major threat worldwide. Cobinamide is a novel molecule that can bind two molecules of cyanide, has a much higher binding affinity than hydroxocobalamin, and is more water soluble. We investigated the ability of equimolar doses of cobinamide and hydroxocobalamin to reverse the effects of cyanide exposure in an animal model monitored continuously by DOS. Cyanide toxicity was induced in 16 New Zealand white rabbits by intravenous infusion. Animals were divided into three groups: controls (n=5) received saline following cyanide, hydroxocobalamin (N=6) following cyanide, and cobinamide (N=5) following cyanide. Cobinamide caused significantly faster and more complete recovery of oxy- and deoxyhemoglobin concentrations in cyanide-exposed animals than hydroxocobalamin- or saline-treated animals, with a recovery time constant of 13.8+/-7.1 min compared to 75.4+/-25.1 and 76.4+/-42.7 min, for hydroxocobalamin- and saline-treated animals, respectively (p<0.0001). This study indicates that cobinamide more rapidly and completely reverses the physiologic effects of cyanide than equimolar doses of cobalamin at the dose used in this study, and CN effects and response can be followed noninvasively using DOS.
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Affiliation(s)
- Matthew Brenner
- University of California, Beckman Laser Institute, Irvine, California 92612-1475, USA.
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Lee J, Kim JG, Mahon S, Tromberg BJ, Mukai D, Kreuter K, Saltzman D, Patino R, Goldberg R, Brenner M. Broadband diffuse optical spectroscopy assessment of hemorrhage- and hemoglobin-based blood substitute resuscitation. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:044027. [PMID: 19725738 PMCID: PMC2868523 DOI: 10.1117/1.3200932] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Hemoglobin-based oxygen carriers (HBOCs) are solutions of cell-free hemoglobin (Hb) that have been developed for replacement or augmentation of blood transfusion. It is important to monitor in vivo tissue hemoglobin content, total tissue hemoglobin [THb], oxy- and deoxy-hemoglobin concentrations ([OHb], [RHb]), and tissue oxygen saturation (S(t)O(2)=[OHb][THb]x100%) to evaluate effectiveness of HBOC transfusion. We designed and constructed a broadband diffuse optical spectroscopy (DOS) prototype system to measure bulk tissue absorption and scattering spectra between 650 and 1000 nm capable of accurately determining these tissue hemoglobin component concentrations in vivo. Our purpose was to assess the feasibility of using DOS to optically monitor tissue [OHb], [RHb], S(t)O(2), and total tissue hemoglobin concentration ([THb]=[OHb]+[RHb]) during HBOC infusion using a rabbit hypovolemic shock model. The DOS prototype probe was placed on the shaved inner thigh muscle of the hind leg to assess concentrations of [OHb], [RHb], [THb], as well as S(t)O(2). Hemorrhagic shock was induced in intubated New Zealand white rabbits (N=6) by withdrawing blood via a femoral arterial line to 20% blood loss (10-15 cckg). Hemoglobin glutamer-200 (Hb-200) 1:1 volume resuscitation was administered following the hemorrhage. These values were compared against traditional invasive measurements, serum hemoglobin concentration (sHGB), systemic blood pressure, heart rate, and blood gases. DOS revealed increases of [THb], [OHb], and tissue hemoglobin oxygen saturation after Hb-200 infusion, while blood total hemoglobin values continued did not increase; we speculate, due to hyperosmolality induced hemodilution. DOS enables noninvasive in vivo monitoring of tissue hemoglobin and oxygenation parameters during shock and volume expansion with HBOC and potentially enables the assessment of efficacy of resuscitation efforts using artificial blood substitutes.
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Affiliation(s)
- Jangwoen Lee
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612, USA.
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