1
|
McMartin K, Jacobsen D, Hovda KE. Antidotes for poisoning by alcohols that form toxic metabolites. Br J Clin Pharmacol 2024. [PMID: 39234820 DOI: 10.1111/bcp.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/06/2024] Open
Abstract
The alcohols methanol, ethylene glycol and diethylene glycol share many characteristics. The most important is that the compounds themselves are relatively nontoxic but are metabolized, initially by alcohol dehydrogenase, to various toxic intermediates. These compounds are readily available worldwide in commercial products as well as in homemade alcoholic beverages, both of which lead to most of the poisonings, from either unintentional or intentional ingestion. Although relatively infrequent, toxic alcohol poisonings do unfortunately occur in outbreaks and can result in severe morbidity and mortality. These poisonings have traditionally been treated with ethanol since it competes for the active site of alcohol dehydrogenase and decreases the formation of toxic metabolites. Although ethanol can be an effective antidote, there are substantial practical problems with its use. Therefore fomepizole, a potent competitive inhibitor of alcohol dehydrogenase, was developed for a hopefully better treatment for metabolically toxic alcohol poisonings. Fomepizole has few side effects and is easy to use in practice and it may obviate the need for haemodialysis in some, but not all, patients. Hence, fomepizole has largely replaced ethanol as the toxic alcohol antidote in many countries. Nevertheless, ethanol remains an important alternative because access to fomepizole can be limited, the cost may appear excessive or the physician may prefer ethanol due to experience.
Collapse
Affiliation(s)
- Kenneth McMartin
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA
| | - Dag Jacobsen
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- The National Poison Information Centre, National Institute of Health, Oslo, Norway
| | - Knut Erik Hovda
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- The National Poison Information Centre, National Institute of Health, Oslo, Norway
| |
Collapse
|
2
|
Malvar G, Gunasekaran D, Mehr NV, Ishibe S, Moeckel G. Thrombotic Microangiopathy and Acute Tubular Injury After Diethylene Glycol Ingestion: A Kidney Biopsy Teaching Case. Kidney Med 2024; 6:100758. [PMID: 38304581 PMCID: PMC10831151 DOI: 10.1016/j.xkme.2023.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
We present a rare and unusual case of thrombotic microangiopathy (TMA) in a patient who ingested chafing fuel containing diethylene glycol. The patient showed a typical clinical course of initial gastrointestinal symptoms followed by acute kidney injury (AKI) and peripheral sensorimotor neuropathy. A kidney biopsy showed TMA and diffuse acute tubular injury. Diethylene glycol is widely used as a solvent in numerous consumer products, including brake fluid, antifreeze, chafing fuel, and artificial fog solutions. Diethylene glycol has been implemented in mass poisonings, and the incidence of AKI in diethylene glycol poisonings is linked to high-mortality rates. TMA, a pathologic lesion observed in a wide spectrum of diseases, is triggered by endothelial injury. Our case shows that TMA should be considered as a possible life-threatening complication in the setting of acute diethylene glycol poisoning. Direct toxic injury to endothelial cells by diethylene glycol is a possible mechanism. It is therefore plausible that patients with a genetic predisposition to endothelial injury may develop TMA following diethylene glycol exposure.
Collapse
Affiliation(s)
- Grace Malvar
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | | | | | - Shuta Ishibe
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Gilbert Moeckel
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
3
|
de Almeida Araújo S, Faria BCD, Vasconcelos JC, da Cruz AF, de Souza VS, Wanderley DC, Simões-E-Silva AC. Renal toxicity caused by diethylene glycol: an overview. Int Urol Nephrol 2023; 55:2867-2875. [PMID: 37186212 DOI: 10.1007/s11255-023-03604-2] [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: 09/20/2022] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
Diethylene glycol (DEG) is nephrotoxic, potentially resulting in high morbidity and mortality. Its main nephrotoxic by-product is diglycolic acid (DGA). This narrative overview summarizes selected literature with a focus on clinical findings, pathophysiology, diagnosis including morphological features of renal biopsies, and management. The kidney injury in DEG poisoning is secondary to proximal tubular necrosis caused by DGA. Marked vacuolization and edema of epithelial cells obstruct the lumen, reducing urine flow and, consequently, resulting in anuria and uremia. The clinical alterations due to DEG poisoning are dose-dependent. Patients may present with gastrointestinal symptoms and anion gap metabolic acidosis, followed by renal failure, and, later, encephalopathy and neuropathy. Although this three-phase pattern has been described, signs and symptoms may be overlapping. Data about DEG intoxication is scarce. Sometimes the diagnosis is challenging. The management includes supportive care, gastric decontamination, correction of acid-base disorders, and hemodialysis. The understanding of the metabolic processes related to DEG poisoning may contribute to its management, preventing death, serious sequels, or irreversible lesions.
Collapse
Affiliation(s)
- Stanley de Almeida Araújo
- Instituto de Nefropatologia, Belo Horizonte, MG, Brasil
- Centro de Microscopia Eletrônica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Bárbara Caroline Dias Faria
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Avenida Alfredo Balena, 190, 2o andar, sala 281, Bairro Santa Efigênia, MG, CEP 30130-100, Brasil
| | - Júlia Cunha Vasconcelos
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Avenida Alfredo Balena, 190, 2o andar, sala 281, Bairro Santa Efigênia, MG, CEP 30130-100, Brasil
| | - Aniel Feitosa da Cruz
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Avenida Alfredo Balena, 190, 2o andar, sala 281, Bairro Santa Efigênia, MG, CEP 30130-100, Brasil
| | - Vitor Santos de Souza
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Avenida Alfredo Balena, 190, 2o andar, sala 281, Bairro Santa Efigênia, MG, CEP 30130-100, Brasil
| | - David Campos Wanderley
- Instituto de Nefropatologia, Belo Horizonte, MG, Brasil
- Centro de Microscopia Eletrônica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Ana Cristina Simões-E-Silva
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Avenida Alfredo Balena, 190, 2o andar, sala 281, Bairro Santa Efigênia, MG, CEP 30130-100, Brasil.
| |
Collapse
|
4
|
Tobin JD, Jamison CN, Robinson CN, McMartin KE. Variable sensitivity to diethylene glycol poisoning is related to differences in the uptake transporter for the toxic metabolite diglycolic acid. Clin Toxicol (Phila) 2023; 61:207-211. [PMID: 36939119 PMCID: PMC10263375 DOI: 10.1080/15563650.2022.2163659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 03/21/2023]
Abstract
INTRODUCTION/CONTEXT Poisonings with diethylene glycol are characterized by acute kidney injury and peripheral neuropathy. In animal studies on the toxicities of diethylene glycol and its metabolite diglycolic acid, remarkable differences in susceptibility to acute kidney injury were observed in identically-dosed rats. In those studies, only about 60% showed acute kidney injury, yet all rats with acute kidney injury showed marked diglycolic acid accumulation in tissues, while no diglycolic acid accumulated in rats without injury. Diglycolic acid is taken into renal cells via sodium-dependent dicarboxylate transporters. When sodium-dependent dicarboxylate transporter-1 is inhibited or knocked down in human kidney cells, diglycolic acid uptake and toxicity are reduced. We hypothesize that the variation in sensitivity to tissue diglycolic acid retention and to diethylene glycol/diglycolic acid toxicity is explained by differential expression of sodium-dependent dicarboxylate transporter-1 in rat kidneys. METHODS Using kidney tissue from previous studies, we performed rt-PCR analysis of sodium-dependent dicarboxylate transporter-1 mRNA. In those studies, Wistar-Han rats were either gavage with diethylene glycol 6 g/kg every 12 h for 7 days or with single doses of diglycolic acid 300 mg/kg. Kidney tissue was harvested after euthanasia and preserved in formalin. Tissue slices were homogenized and RNA was isolated using an RNAstorm FFPE RNA Isolation Kit. The expression of sodium-dependent dicarboxylate transporter-1 mRNA was compared between groups that showed diglycolic acid accumulation and acute renal injury with those that showed no diglycolic acid accumulation or toxicity. RESULTS Significantly higher expression of sodium-dependent dicarboxylate transporter-1 mRNA was present in the kidneys of rats with acute kidney injury and diglycolic acid accumulation compared to those in rats that had no diglycolic acid in their kidneys and no acute kidney injury. DISCUSSION The likelihood of acute kidney injury after dosing of rats with diethylene glycol or diglycolic acid is linked with an enhanced ability to take up diglycolic acid into renal cells via the sodium-dependent dicarboxylate transporter-1. The variability in diethylene glycol toxicity in humans, as reported in epidemiological studies, may also be linked with differences in tissue uptake of diglycolic acid. CONCLUSIONS Animals with acute kidney injury after exposure to diethylene glycol or diglycolic acid had higher sodium-dependent dicarboxylate transporter-1 expression and greater diglycolic acid accumulation in renal tissues than animals without acute kidney injury.
Collapse
Affiliation(s)
- Julie D Tobin
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Courtney N Jamison
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Corie N Robinson
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Kenneth E McMartin
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| |
Collapse
|
5
|
Tobin JD, Robinson CN, Luttrell-Williams ES, Landry GM, McMartin KE. Lack of efflux of diglycolic acid from proximal tubule cells leads to its accumulation and to toxicity of diethylene glycol. Toxicol Lett 2023; 379:48-55. [PMID: 36958672 DOI: 10.1016/j.toxlet.2023.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
Diethylene glycol (DEG) mass poisonings have resulted from ingestion of adulterated pharmaceuticals, leading to proximal tubular necrosis and acute kidney injury. Diglycolic acid (DGA), one of the primary metabolites, accumulates greatly in kidney tissue and its direct administration results in toxicity identical to that in DEG-treated rats. DGA is a dicarboxylic acid, similar in structure to Krebs cycle intermediates such as succinate. Previous studies have shown that DGA is taken into kidney cells via the succinate-related dicarboxylate transporters. These studies have assessed whether the DGA that is taken up by primary cultures of human proximal tubule (HPT) cells is effluxed. In addition, a possible mechanism for efflux, via organic anion transporters (OATs) that exchange external organic anions for dicarboxylates inside the cell, was assessed using transformed cell lines that actively express OAT activities. When HPT cells were cultured on membrane inserts, then loaded with DGA and treated with the OAT4/5 substrate estrone sulfate or the OAT1/3 substrate para-aminohippurate, no DGA efflux was seen. A repeat of this experiment utilizing RPTEC/TERT1 cells with overexpressed OAT1 and OAT3 had similar results. In these cells, but not in HPT cells, co-incubation with succinate increased the uptake of PAH, confirming the presence of OAT activity in the RPTEC/TERT1 cells. Thus, despite OATs stimulation in cells with OAT activity, there was little to no efflux of DGA from the cells. This study concluded that DGA is poorly transported out of cells and that stimulation of OAT transporters is not a viable target for reducing DGA accumulation in cells.
Collapse
Affiliation(s)
- Julie D Tobin
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130
| | - Corie N Robinson
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130
| | - Elliot S Luttrell-Williams
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130
| | - Greg M Landry
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130
| | - Kenneth E McMartin
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130.
| |
Collapse
|
6
|
Reed KJ, Landry GM. Diglycolic acid inhibits succinate dehydrogenase activity, depletes mitochondrial membrane potential, and induces inflammation in an SH-SY5Y neuroblastoma model of neurotoxicity in vitro. Toxicol Appl Pharmacol 2023; 463:116414. [PMID: 36754214 DOI: 10.1016/j.taap.2023.116414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
Diethylene glycol is a toxic industrial solvent resulting in a well-defined toxidrome. Diglycolic acid (DGA) has been identified as the metabolite responsible for the nephrotoxicity and hepatotoxicity. These studies assess the mechanism of DGA-induced neurotoxicity, specifically addressing the known ability of DGA to chelate calcium (Ca2+) in solution and inhibit mitochondrial complex II. SH-SY5Y cells were seeded into 96-well plates to assess intracellular Ca2+ chelation, complex II activity, mitochondrial membrane potential (ΔΨm), ATP production, and release of inflammatory cytokines TNF-α and IL-1β with 2-, 4-, 6-, 24-, and 48-h DGA exposure. Peak Ca2+ chelation occurred at 4 h in cells treated with 6.25-50 mM DGA; however, effects were transient. Complex II activity was significantly decreased at all DGA concentrations tested, with 12.5 mM DGA causing 80% inhibition and 25 and 50 mM DGA causing 97 and 100% inhibition, respectively. Subsequently, 12.5-50 mM DGA concentrations significantly decreased ΔΨm at all time points. 50 mM DGA significantly increased release of TNF-α and IL-1β after 24 and 48 h with significantly decreased ATP production observed at the same time points and concentration. These studies demonstrate that the DGA-induced mechanism of SH-SY5Y cell death involves complex II inhibition leading to mitochondrial depolarization, and subsequent ATP depletion with accompanying inflammatory cytokine release. These results indicate a direct mechanism of DGA-induced neurotoxicity in vitro, similarly observed in other DEG-affected target organs.
Collapse
Affiliation(s)
- Kristi J Reed
- Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy, Department of Pharmaceutical Sciences, Boston, MA 02115, United States
| | - Greg M Landry
- Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy, Department of Pharmaceutical Sciences, Boston, MA 02115, United States.
| |
Collapse
|
7
|
Tobin JD, Robinson CN, Luttrell-Williams ES, Landry GM, Dwyer D, McMartin KE. Role of plasma membrane dicarboxylate transporters in the uptake and toxicity of diglycolic acid, a metabolite of diethylene glycol, in human proximal tubule cells. Toxicol Sci 2022; 190:1-12. [PMID: 36087010 DOI: 10.1093/toxsci/kfac091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Diethylene glycol (DEG) mass poisonings have resulted from ingestion of pharmaceuticals mistakenly adulterated with DEG, typically leading to proximal tubular necrosis and acute kidney injury. The metabolite, diglycolic acid (DGA) accumulates greatly in kidney tissue and its direct administration results in toxicity identical to that in DEG-treated rats. DGA is a dicarboxylic acid, similar in structure to metabolites like succinate. These studies have assessed the mechanism for cellular accumulation of DGA, specifically whether DGA is taken into primary cultures of human proximal tubule (HPT) cells via sodium dicarboxylate transporters (NaDC-1 or NaDC-3) like those responsible for succinate uptake. When HPT cells were cultured on membrane inserts, sodium dependent succinate uptake was observed from both apical and basolateral directions. Pretreatment with the NaDC-1 inhibitor N-(p-amylcinnamoyl)anthranilic acid (ACA) markedly reduced apical uptakes of both succinate and DGA. Basolateral uptake of both succinate and DGA were decreased similarly following combined treatment with ACA and the NaDC-3 inhibitor 2,3-dimethylsuccinate. When the cells were pre-treated with siRNA to knockdown NaDC-1 function, apical uptake of succinate and toxicity of apically applied DGA were reduced, while the reduction in basolateral succinate uptake and basolateral DGA toxicity was marginal with NaDC-3 knockdown. DGA reduced apical uptake of succinate, but not basolateral uptake. This study confirmed that primary HPT cells retain sodium dicarboxylate transport functionality and that DGA was taken up by these transporters. This study identified NaDC-1 as a likely and NaDC-3 as a possible molecular target to reduce uptake of this toxic metabolite by the kidney.
Collapse
Affiliation(s)
- Julie D Tobin
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport Shreveport, Louisiana, 71130
| | - Corie N Robinson
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport Shreveport, Louisiana, 71130
| | - Elliot S Luttrell-Williams
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport Shreveport, Louisiana, 71130
| | - Greg M Landry
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport Shreveport, Louisiana, 71130
| | - Donard Dwyer
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport Shreveport, Louisiana, 71130.,Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Sciences Center-Shreveport Shreveport, Louisiana, 71130
| | - Kenneth E McMartin
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport Shreveport, Louisiana, 71130
| |
Collapse
|
8
|
Histopathological evidence that diethylene glycol produces kidney and nervous system damage in rats. Neurotoxicology 2022; 91:200-210. [DOI: 10.1016/j.neuro.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022]
|
9
|
Baj J, Forma A, Kobak J, Tyczyńska M, Dudek I, Maani A, Teresiński G, Buszewicz G, Januszewski J, Flieger J. Toxic and Nutritional Optic Neuropathies—An Updated Mini-Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053092. [PMID: 35270784 PMCID: PMC8910489 DOI: 10.3390/ijerph19053092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022]
Abstract
Optic neuropathies constitute a group of conditions with various etiologies and might be caused by different factors; we can distinguish the genetic and acquired causes of optic neuropathies. Even though the symptoms are not highly specific, this condition is primarily characterized by unilateral or bilateral vision loss with worsening color detection. The loss may be acute or gradual depending on the causation. In this article, we included a specification of toxic optic neuropathy (TON) mainly triggered by alcohol abuse and also the usage of other substances, including drugs or methanol, as well as intoxication by metals, organic solvents, or carbon dioxide. Nutritional deficiencies, vitamin absorption disorder, and anemia, which usually appear during excessive alcohol intake, and their effect on the etiology of the optic neuropathy have been likewise discussed.
Collapse
Affiliation(s)
- Jacek Baj
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland; (J.B.); (A.M.)
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
- Correspondence:
| | - Joanna Kobak
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Magdalena Tyczyńska
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Iga Dudek
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Amr Maani
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland; (J.B.); (A.M.)
| | - Grzegorz Teresiński
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Grzegorz Buszewicz
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Jacek Januszewski
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (J.K.); (M.T.); (I.D.); (G.T.); (G.B.); (J.J.)
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland;
| |
Collapse
|
10
|
Jamison CN, Dayton RD, Latimer B, McKinney MP, Mitchell HG, McMartin KE. Diethylene glycol produces nephrotoxic and neurotoxic effects in female rats. Clin Toxicol (Phila) 2022; 60:324-331. [PMID: 34278906 PMCID: PMC9661884 DOI: 10.1080/15563650.2021.1953049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONTEXT Diethylene glycol (DEG) is an organic compound found in household products but also as a counterfeit solvent in medicines. DEG poisonings are characterized by acute kidney injury (AKI) and by neurological sequelae such as decreased reflexes or face and limb weakness. Previous studies in male rats have demonstrated that neurotoxic effects develop only with the establishment of AKI, but the dose sensitivity of females to DEG toxicity is unknown. OBJECTIVES Assessing whether subacute administration of DEG in female rats would delineate any sex-differences in neuropathy or in kidney injury. METHODS Female Wistar-Han rats were orally administered doses of 4 - 6 g/kg DEG every 12 h and monitored for 7 days. Urine was collected every 12 h and endpoint blood and cerebrospinal fluid (CSF) were collected for renal plasma parameters and total protein estimation, respectively. Motor function tests were conducted before and after treatment. Kidney and brain tissue were analyzed for metabolite content. RESULTS Of 12 animals treated with DEG, 3 developed AKI as confirmed by increased BUN and creatinine concentrations. Renal and brain DGA contents were increased in animals that developed AKI compared to animals without AKI. Total CSF protein content in animals with AKI was markedly elevated compared to control and to treated animals without AKI. Decreases in forelimb grip strength and in locomotor and rearing activity were observed in animals with AKI compared to control and to animals without AKI. DISCUSSION Repeated dosing with DEG in a female model produced nephrotoxic effects at a dose similar to that in males. The decrease in motor function and increase in CSF protein were only present in females that developed AKI. However, kidney and neurologic effects were assessed only at the end of the treatments, thus limiting determination of which effect occurs first. Limb function and coordination were measured globally and more sensitive tests such as nerve conduction studies might offer a detailed neurotoxicity assessment of the effects of DEG. CONCLUSIONS These studies show that DEG toxicity does not appear to be sex-specific and that, in males and females, neurological symptoms are present only when DGA accumulation and kidney injury also occur.
Collapse
Affiliation(s)
- Courtney N. Jamison
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Robert D. Dayton
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Brian Latimer
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Mary P. McKinney
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Hannah G. Mitchell
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Kenneth E. McMartin
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| |
Collapse
|
11
|
Reed KJ, Freeman DT, Landry GM. Diethylene glycol and its metabolites induce cell death in SH-SY5Y neuronal cells in vitro. Toxicol In Vitro 2021; 75:105196. [PMID: 34022404 DOI: 10.1016/j.tiv.2021.105196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/04/2021] [Accepted: 05/15/2021] [Indexed: 01/07/2023]
Abstract
Diethylene glycol (DEG) intoxication results in metabolic acidosis, renal and hepatic dysfunction, and late-stage neurotoxicity. Though the renal and hepatic toxicity of DEG and its metabolites 2-hydroxyethoxyacetic acid (2-HEAA) and diglycolic acid (DGA) have been well characterized, the resultant neurotoxicity has not. SH-SY5Y neuroblastoma cells were incubated with all 3 compounds at increasing concentrations for 24, 48, or 120 h. At all 3 time points, 50 mmol/L DGA and 100 mmol/L DEG showed significant Annexin V and propidium iodide (PI) staining with additional concentrations showing similar staining patterns at 24 h (100 mmol/L DGA) and 48 h (50 mmol/L DEG, 100 mmol/L DGA). Only the 200 mmol/L 2-HEAA concentration induced SH-SY5Y cell death. Interestingly at 24 and 48 h, 100 mmol/L DEG induced significant increases in apoptotic cell death markers, which progressed to necrosis at 120 h. Similar to DEG, 50 mmol/L DGA induced significant increases in SH-SY5Y cell apoptosis and necrosis markers at both 24 and 48 h. As expected, high DGA concentrations (100 mmol/L) at 120 h induced significant SH-SY5Y cell necrosis with no apoptosis detected. However, at 120 h lower DGA concentrations (20 mmol/L) significantly increased oligonucleosome formation alone and in combination with 2-HEAA or DEG. Taken together, these results indicate that DGA and DEG at threshold concentrations induce neurotoxicity in SH-SY5Y cells.
Collapse
Affiliation(s)
- Kristi J Reed
- MCPHS University, School of Pharmacy, Department of Pharmaceutical Sciences, Boston, MA 02115, United States
| | - Dylan T Freeman
- MCPHS University, School of Pharmacy, Department of Pharmaceutical Sciences, Boston, MA 02115, United States
| | - Greg M Landry
- MCPHS University, School of Pharmacy, Department of Pharmaceutical Sciences, Boston, MA 02115, United States.
| |
Collapse
|
12
|
Jamison CN, Dayton RD, Latimer B, McKinney MP, Mitchell HG, McMartin KE. Neurotoxic effects of nephrotoxic compound diethylene glycol. Clin Toxicol (Phila) 2021; 59:810-821. [PMID: 33475432 DOI: 10.1080/15563650.2021.1874403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONTEXT Diethylene glycol (DEG) is an organic compound found in household products but also as an adulterant in medicines by acting as a counterfeit solvent. DEG poisonings have been characterized predominately by acute kidney injury (AKI), but also by delayed neurological sequelae such as decreased reflexes or face and limb weakness. OBJECTIVES Characterizing the neurological symptoms of DEG poisoning in a subacute animal model would create a clearer picture of overall toxicity and possibly make mechanistic connections between kidney injury and neuropathy. METHODS Male Wistar-Han rats were orally administered doses of 4 - 6 g/kg DEG every 12 or 24 h and monitored for 7 days. Urine was collected every 12 h and endpoint blood and cerebrospinal fluid (CSF) were collected for a renal plasma panel and total protein estimation, respectively. Motor function tests were conducted before and after treatment. Kidney and brain tissue was harvested for metabolic analysis. RESULTS Of the 43 animals treated with DEG, 11 developed AKI as confirmed by increased BUN and creatinine levels. Renal and brain DGA accumulation was markedly increased in animals that developed AKI compared to animals without AKI. The total protein content in CSF in animals with kidney injury was markedly elevated compared to control and to treated animals without AKI. Significant decreases in forelimb grip strength and decreases in locomotor and rearing activity were observed in animals with AKI compared to control and to animals without AKI. DISCUSSION Repeated dosing with DEG in an animal model produced nephrotoxic effects like those in studies with acute DEG administration. The decrease in motor function and increase in CSF protein were only present in animals that developed AKI. CONCLUSIONS These studies show development of neurotoxicity in this DEG animal model and suggest that neurological symptoms are observed only when DGA accumulation and kidney injury also occur.
Collapse
Affiliation(s)
- Courtney N Jamison
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Robert D Dayton
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Brian Latimer
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Mary P McKinney
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Hannah G Mitchell
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Kenneth E McMartin
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| |
Collapse
|
13
|
Goulart COL, Bordoni LS, Nascentes CC, Costa LM. Analysis of Diglycolic Acid After Mass Poisoning by Diethylene Glycol. J Anal Toxicol 2020; 46:64-68. [PMID: 33270110 DOI: 10.1093/jat/bkaa187] [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: 10/25/2020] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
In December 2019, unusual cases of acute renal failure with neurological changes were observed in the State of Minas Gerais, Brazil. Criminal investigations indicated cases of intoxication after consumption of beers contaminated with diethylene glycol (DEG). The elimination of DEG by the body is fast, but its metabolite, diglycolic acid (DA), may persist for a long time. To assess the level of intoxicated victims who consumed the contaminated beers, qualitative and quantitative methods were developed to determine DA in biological matrices by gas chromatography coupled to a mass spectrometer (GC-MS) and gas chromatography coupled to a mass spectrometer with triple-quadrupole mass filter (GC-MS/MS), respectively. The validated qualitative method presents good selectivity and limit of detection of 1 µg/mL (whole blood, urine, vitreous humor and cerebrospinal fluid) and 5 µg/g (liver and kidney). A quantitative method for whole blood presented satisfactory performance to determine DA. Twelve victims presented positive results for DA in whole blood, with concentrations ranging from 2 to 108 µg/mL. The toxicology laboratory of the Institute of Forensic Medicine of Minas Gerais was the first governmental agency to identify DA in whole blood, vitreous humor, cerebrospinal fluid, kidney and urine in victims affected by this contaminant. The results of this study legally supported the prohibition to the continued consumption of the beer and avoided further intoxications. Our results showed, for real cases of human intoxication, that it can still be detected in alternative matrices, even when non-detectable in blood, demonstrating the importance of collecting different kinds of samples for a proper investigation.
Collapse
Affiliation(s)
- Cristiano O L Goulart
- Instituto Médico Legal André Roquette, R. Nícias Continentino, 1291, Gameleira, 30510-160, Belo Horizonte, Brasil.,LEAQUAA, Departamento de Química - ICEx, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Brasil
| | - Leonardo S Bordoni
- Instituto Médico Legal André Roquette, R. Nícias Continentino, 1291, Gameleira, 30510-160, Belo Horizonte, Brasil.,Universidade Federal de Ouro Preto, R. Dois, Campus Morro do Cruzeiro, 35400-000, Ouro Preto, Brasil.,Faculdade de Medicina de Barbacena, Praça Presidente Antônio Carlos, 8, São Sebastião, 36202-336, Barbacena, Brasil
| | - Clésia C Nascentes
- LEAQUAA, Departamento de Química - ICEx, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Brasil
| | - Letícia M Costa
- LEAQUAA, Departamento de Química - ICEx, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Brasil
| |
Collapse
|
14
|
Farell M, Self A, Guza C, Song H, Apollon L, Gomez EW, Kumar M. Lipid-Functionalized Graphene Loaded with hMnSOD for Selective Inhibition of Cancer Cells. ACS APPLIED MATERIALS & INTERFACES 2020; 12:12407-12416. [PMID: 32077682 DOI: 10.1021/acsami.9b20070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Combination therapies utilize multiple mechanisms to target cancer cells to minimize cancer cell survival. Graphene provides an ideal platform for combination therapy due to its photothermal properties and high loading capacity for cancer-fighting molecules. Lipid functionalization of graphene extends its potential as a therapeutic platform by improving its biocompatibility and functionality. Previous studies involving graphene demonstrated its usage as a therapeutic vehicle; however, the effect of bare and engineered graphene structures on oxidative stress has not been comprehensively investigated. Because oxidative stress has been linked to cancer progression, it is vital to examine the generation of reactive oxygen species (ROS) in response to therapeutic platforms. This study functionalizes reduced graphene oxide (rGO) with lipids and the antioxidant enzyme human manganese superoxide dismutase (hMnSOD) and presents a detailed characterization of cellular responses to bare and functionalized rGO nanostructures in tumorigenic and nontumorigenic breast cell lines. Each cell type displayed distinct responses depending on whether they were normal, nonmetastatic, or metastatic cells. Bare rGO significantly reduced cell growth and substantially increased ROS production in all cell lines and instigated necrosis in metastatic breast cancer cells. Cell proliferation decreased in cancerous breast cells upon introduction of lipid-rGO, which correlated with peroxidation of lipids coating the rGO. In contrast, lipid-rGO nanostructures had minimal impact on proliferation and lipid peroxidation for normal breast cells. Lipid-rGO nanostructures with bound hMnSOD inhibited the proliferation of metastatic cancer cells while preventing necrosis and avoiding the negative side effects on normal cells associated with chemotherapeutic agents. Together, the results confirm the importance of functionalizing rGO for therapeutic applications and present an additional modality for the usage of graphene to selectively target cancer cells.
Collapse
Affiliation(s)
- Megan Farell
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Ava Self
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Christine Guza
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Hyewon Song
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Luigi Apollon
- Department of Chemistry and Biochemistry, Worcester Polytechnic Institute, Worcester, Massachusetts 01609, United States
| | - Esther W Gomez
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Manish Kumar
- Department of Chemical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
- Department of Civil, Architectural, and Environmental Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| |
Collapse
|
15
|
Godri Pollitt KJ, Kim JH, Peccia J, Elimelech M, Zhang Y, Charkoftaki G, Hodges B, Zucker I, Huang H, Deziel NC, Murphy K, Ishii M, Johnson CH, Boissevain A, O'Keefe E, Anastas PT, Orlicky D, Thompson DC, Vasiliou V. 1,4-Dioxane as an emerging water contaminant: State of the science and evaluation of research needs. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 690:853-866. [PMID: 31302550 DOI: 10.1016/j.scitotenv.2019.06.443] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
1,4-Dioxane has historically been used to stabilize chlorinated solvents and more recently has been found as a contaminant of numerous consumer and food products. Once discharged into the environment, its physical and chemical characteristics facilitate migration in groundwater, resulting in widespread contamination of drinking water supplies. Over one-fifth of U.S. public drinking water supplies contain detectable levels of 1,4-dioxane. Remediation efforts using common adsorption and membrane filtration techniques have been ineffective, highlighting the need for alternative removal approaches. While the data evaluating human exposure and health effects are limited, animal studies have shown chronic exposure to cause carcinogenic responses in the liver across multiple species and routes of exposure. Based on this experimental evidence, the U.S. Environmental Protection Agency has listed 1,4-dioxane as a high priority chemical and classified it as a probable human carcinogen. Despite these health concerns, there are no federal or state maximum contaminant levels for 1,4-dioxane. Effective public health policy for this emerging contaminant requires additional information about human health effects, chemical interactions, environmental fate, analytical detection, and treatment technologies. This review highlights the current state of knowledge, key uncertainties, and data needs for future research on 1,4-dioxane.
Collapse
Affiliation(s)
- Krystal J Godri Pollitt
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT 06510, United States.
| | - Jae-Hong Kim
- Department of Chemical & Environmental Engineering, School of Engineering & Applied Science, Yale University, New Haven, CT 06520, United States
| | - Jordan Peccia
- Department of Chemical & Environmental Engineering, School of Engineering & Applied Science, Yale University, New Haven, CT 06520, United States
| | - Menachem Elimelech
- Department of Chemical & Environmental Engineering, School of Engineering & Applied Science, Yale University, New Haven, CT 06520, United States
| | - Yawei Zhang
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT 06510, United States; Department of Surgery, School of Medicine, Yale University, New Haven, CT 06520, United States
| | - Georgia Charkoftaki
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT 06510, United States
| | - Brenna Hodges
- Department of Chemical & Environmental Engineering, School of Engineering & Applied Science, Yale University, New Haven, CT 06520, United States
| | - Ines Zucker
- Department of Chemical & Environmental Engineering, School of Engineering & Applied Science, Yale University, New Haven, CT 06520, United States
| | - Huang Huang
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT 06510, United States
| | - Nicole C Deziel
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT 06510, United States
| | - Kara Murphy
- Northeast States for Coordinated Air Use Management (NESCAUM), Boston, MA 02111, United States
| | - Momoko Ishii
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT 06510, United States
| | - Caroline H Johnson
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT 06510, United States
| | | | - Elaine O'Keefe
- Office of Public Health Practice, School of Public Health, Yale University, New Haven, CT 06510, United States
| | - Paul T Anastas
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT 06510, United States; Center for Green Chemistry and Green Engineering, Department of Chemistry, Yale School of Forestry & Environmental Studies, New Haven, CT 06511, United States
| | - David Orlicky
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO 80045, United States
| | - David C Thompson
- Department of Clinical Pharmacy, University of Colorado School of Pharmacy, Aurora, CO 80045, United States
| | - Vasilis Vasiliou
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT 06510, United States.
| |
Collapse
|
16
|
Shen ZY, Chen CY, Lee MT. Recovery of cutting fluids and silicon carbide from slurry waste. JOURNAL OF HAZARDOUS MATERIALS 2019; 362:115-123. [PMID: 30236931 DOI: 10.1016/j.jhazmat.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 06/08/2023]
Abstract
The wafer slicing process generates large amounts of slurry waste. The recovery of cutting oil and abrasives from slurry waste can reduce both the cost and environmental damage. A process combining magnetic precipitation and flocculation was developed for the recovery of cutting oil. A magnetic precipitation tank was employed for storage of the slurry and acceleration of the settlement of suspended particles. The larger particles further aggregate upon adding a non-aqueous flocculant comprising polyacrylamide (PAM) and ethylene glycol (EG). The recycled oil product is obtained by centrifugation and bag filtration. The physical properties and wafer dicing tests indicate that the recycled oil is qualified. Wafer manufacturers can thus reduce costs by using this process to produce recycled oil. A magnetic reactor with alkaline aqueous successfully recycled the SiC powder from the slurry waste by converting all the silicon species into sodium silica for further use. The results demonstrate that the magnetic reactor is able to remove most metal species and that the alkaline aqueous medium can recover all the Si substances in a sodium silicate solution, also called water glass.
Collapse
Affiliation(s)
- Zih-Yao Shen
- Department of Applied Chemistry, National Chia-Yi University, No.300 Syuefu Rd., Chia-Yi City 60004, Taiwan
| | - Chi-Yao Chen
- Department of Applied Chemistry, National Chia-Yi University, No.300 Syuefu Rd., Chia-Yi City 60004, Taiwan
| | - Maw-Tien Lee
- Department of Applied Chemistry, National Chia-Yi University, No.300 Syuefu Rd., Chia-Yi City 60004, Taiwan.
| |
Collapse
|
17
|
Lester C, Reis A, Laufersweiler M, Wu S, Blackburn K. Structure activity relationship (SAR) toxicological assessments: The role of expert judgment. Regul Toxicol Pharmacol 2018; 92:390-406. [DOI: 10.1016/j.yrtph.2017.12.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/19/2017] [Accepted: 12/31/2017] [Indexed: 12/17/2022]
|
18
|
Fowles J, Banton M, Klapacz J, Shen H. A toxicological review of the ethylene glycol series: Commonalities and differences in toxicity and modes of action. Toxicol Lett 2017; 278:66-83. [PMID: 28689762 DOI: 10.1016/j.toxlet.2017.06.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 05/23/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Abstract
This review summarizes the hazards, exposure and risk that are associated with ethylene glycols (EGs) in their intended applications. Ethylene glycol (EG; CAS RN 107-21-1) and its related oligomers include mono-, di-, tri-, tetra-, and penta-EG. All of the EGs are quickly and extensively absorbed following ingestion and inhalation, but not by the dermal route. Metabolism involves oxidation to the mono- and dicarboxylic acids. Elimination is primarily through the urine as the parent compound or the monoacid, and, in the case of EG, also as exhaled carbon dioxide. All EGs exert acute toxicity in a similar manner, characterized by CNS depression and metabolic acidosis in humans and rodents; the larger molecules being proportionally less acutely toxic on a strict mg/kg basis. Species differences exist in the metabolism and distribution of toxic metabolites, particularly with the formation of glycolic acids and oxalates (OX) from EG and diethylene glycol (DEG); OX are not formed to a significant degree in higher ethylene glycols. Among rodents, rats are more sensitive than mice, and males more sensitive than females to the acute and repeated-dose toxicity of EG. The metabolic formation of glycolic acid (GA), diglycolic acid (DGA), and OX are associated with nephrotoxicity in humans and rodents following single and repeated exposures. However, physiological and metabolic differences in the rate of formation of GA, DGA and OX and their distribution result in EG and DEG causing embryotoxicity in rats, but not rabbits. This rodent-specific sensitivity indicates that EG and its higher oligomers are not anticipated to be embryotoxic in humans at environmentally relevant doses. None of the compounds present developmental toxicity concerns at doses that do not also cause significant maternal toxicity, nor do any of the EGs cause adverse effects on fertility. The EGs are neither genotoxic nor carcinogenic. A read-across matrix is presented, which considers the common and distinct toxicological properties of each compound. It is concluded that EGs pose no risk to human health as a result of their intended use patterns.
Collapse
Affiliation(s)
| | | | | | - Hua Shen
- Shell Oil Company, Houston, TX, USA
| |
Collapse
|
19
|
Human health assessment for long-term oral ingestion of diethylene glycol. Regul Toxicol Pharmacol 2017; 87 Suppl 2:S1-S20. [DOI: 10.1016/j.yrtph.2017.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/22/2022]
|
20
|
Robinson CN, Latimer B, Abreo F, Broussard K, McMartin KE. In-vivo evidence of nephrotoxicity and altered hepatic function in rats following administration of diglycolic acid, a metabolite of diethylene glycol. Clin Toxicol (Phila) 2017; 55:196-205. [DOI: 10.1080/15563650.2016.1271128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Corie N. Robinson
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center – Shreveport, Shreveport, LA, USA
| | - Brian Latimer
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center – Shreveport, Shreveport, LA, USA
| | - Fleurette Abreo
- Department of Pathology, Louisiana State University Health Sciences Center – Shreveport, Shreveport, LA, USA
| | | | - Kenneth E. McMartin
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center – Shreveport, Shreveport, LA, USA
| |
Collapse
|
21
|
Cole JB, Olives TD, Lintner CPJ, Bangh SA, Kwon SK, Stellpflug SJ. A 15-year retrospective review of brake fluid exposures in children from a single poison center. TOXICOLOGY COMMUNICATIONS 2017. [DOI: 10.1080/24734306.2017.1412567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Jon B. Cole
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
- Minnesota Poison Control System, Minneapolis, MN, USA
| | - Travis D. Olives
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
- Minnesota Poison Control System, Minneapolis, MN, USA
| | | | | | - Shin K. Kwon
- Minnesota Poison Control System, Minneapolis, MN, USA
| | | |
Collapse
|
22
|
Conrad T, Landry GM, Aw TY, Nichols R, McMartin KE. Diglycolic acid, the toxic metabolite of diethylene glycol, chelates calcium and produces renal mitochondrial dysfunction in vitro. Clin Toxicol (Phila) 2016; 54:501-11. [DOI: 10.3109/15563650.2016.1162312] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Taylor Conrad
- Louisiana State University Health School of Medicine-Shreveport, Shreveport, LA, USA
- Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Greg M. Landry
- Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Tak Yee Aw
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Royce Nichols
- Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Kenneth E. McMartin
- Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| |
Collapse
|
23
|
McMartin K, Jacobsen D, Hovda KE. Antidotes for poisoning by alcohols that form toxic metabolites. Br J Clin Pharmacol 2016; 81:505-15. [PMID: 26551875 DOI: 10.1111/bcp.12824] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 12/20/2022] Open
Abstract
The alcohols, methanol, ethylene glycol and diethylene glycol, have many features in common, the most important of which is the fact that the compounds themselves are relatively non-toxic but are metabolized, initially by alcohol dehydrogenase, to various toxic intermediates. These compounds are readily available worldwide in commercial products as well as in homemade alcoholic beverages, both of which lead to most of the poisoning cases, from either unintentional or intentional ingestion. Although relatively infrequent in overall occurrence, poisonings by metabolically-toxic alcohols do unfortunately occur in outbreaks and can result in severe morbidity and mortality. These poisonings have traditionally been treated with ethanol since it competes for the active site of alcohol dehydrogenase and decreases the formation of toxic metabolites. Although ethanol can be effective in these poisonings, there are substantial practical problems with its use and so fomepizole, a potent competitive inhibitor of alcohol dehydrogenase, was developed for a hopefully better treatment for metabolically-toxic alcohol poisonings. Fomepizole has few side effects and is easy to use in practice and it may obviate the need for haemodialysis in some, but not all, patients. Hence, fomepizole has largely replaced ethanol as the toxic alcohol antidote in many countries. Nevertheless, ethanol remains an important alternative because access to fomepizole can be limited, the cost may appear excessive, or the physician may prefer ethanol due to experience.
Collapse
Affiliation(s)
- Kenneth McMartin
- Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, Louisiana, 71130-3932, USA
| | - Dag Jacobsen
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, NO-0424, Oslo, Norway
| | - Knut Erik Hovda
- The Norwegian CBRNe Centre of Medicine, Department of Acute Medicine, Division of Medicine, Oslo University Hospital, NO-0424, Oslo, Norway
| |
Collapse
|
24
|
Hložek T, Bursová M, Coufal P, Čabala R. Identification and quantification of acidosis inducing metabolites in cases of alcohols intoxication by GC-MS for emergency toxicology. J Pharm Biomed Anal 2015; 114:16-21. [PMID: 26001161 DOI: 10.1016/j.jpba.2015.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
Abstract
A simple, cost effective, and fast gas chromatography method with mass spectrometry detection (GC-MS) for simultaneous measurement of formic acid, glycolic acid, methoxyacetic acid, ethoxyacetic acid and 2-hydroxyethoxyacetic acid in serum and urine was developed and validated. This multi-analyte method is highly suitable for clinical and emergency toxicology laboratory diagnostic, allowing identification and quantification of five most common acidosis inducing organic acids present in cases of alcohol intoxication. Furthermore, when patients are admitted to emergency unit at late stage of toxic alcohol intoxication, the concentration of parent compound may be already low or not detectable. This new method employs a relatively less used class of derivatization agents - alkyl chloroformates, allowing the efficient and rapid derivatization of carboxylic acids within seconds. The entire sample preparation procedure is completed within 5 min. The optimal conditions of derivatization procedure have been found using chemometric approach (design of experiment). The calibration dependence of the method was proved to be quadratic in the range of 25-3000 mg L(-1), with adequate accuracy (97.3-108.0%) and precision (<12.8%). The method was successfully applied for identification and quantification of the selected compounds in serum of patients from emergency units.
Collapse
Affiliation(s)
- Tomáš Hložek
- Institute of Forensic Medicine and Toxicology, First Faculty of Medicine, Charles University in Prague and General University Hospital, 121 08 Prague 2, Czech Republic.
| | - Miroslava Bursová
- Institute of Forensic Medicine and Toxicology, First Faculty of Medicine, Charles University in Prague and General University Hospital, 121 08 Prague 2, Czech Republic; Department of Analytical Chemistry, Faculty of Science, Charles University in Prague, Albertov 6, 128 43 Prague 2, Czech Republic
| | - Pavel Coufal
- Department of Analytical Chemistry, Faculty of Science, Charles University in Prague, Albertov 6, 128 43 Prague 2, Czech Republic
| | - Radomír Čabala
- Institute of Forensic Medicine and Toxicology, First Faculty of Medicine, Charles University in Prague and General University Hospital, 121 08 Prague 2, Czech Republic; Department of Analytical Chemistry, Faculty of Science, Charles University in Prague, Albertov 6, 128 43 Prague 2, Czech Republic
| |
Collapse
|
25
|
Landry GM, Dunning CL, Abreo F, Latimer B, Orchard E, McMartin KE. Diethylene glycol-induced toxicities show marked threshold dose response in rats. Toxicol Appl Pharmacol 2014; 282:244-51. [PMID: 25545985 DOI: 10.1016/j.taap.2014.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 11/16/2022]
Abstract
Diethylene glycol (DEG) exposure poses risks to human health because of widespread industrial use and accidental exposures from contaminated products. To enhance the understanding of the mechanistic role of metabolites in DEG toxicity, this study used a dose response paradigm to determine a rat model that would best mimic DEG exposure in humans. Wistar and Fischer-344 (F-344) rats were treated by oral gavage with 0, 2, 5, or 10g/kg DEG and blood, kidney and liver tissues were collected at 48h. Both rat strains treated with 10g/kg DEG had equivalent degrees of metabolic acidosis, renal toxicity (increased BUN and creatinine and cortical necrosis) and liver toxicity (increased serum enzyme levels, centrilobular necrosis and severe glycogen depletion). There was no liver or kidney toxicity at the lower DEG doses (2 and 5g/kg) regardless of strain, demonstrating a steep threshold dose response. Kidney diglycolic acid (DGA), the presumed nephrotoxic metabolite of DEG, was markedly elevated in both rat strains administered 10g/kg DEG, but no DGA was present at 2 or 5g/kg, asserting its necessary role in DEG-induced toxicity. These results indicate that mechanistically in order to produce toxicity, metabolism to and significant target organ accumulation of DGA are required and that both strains would be useful for DEG risk assessments.
Collapse
Affiliation(s)
- Greg M Landry
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
| | - Cody L Dunning
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
| | - Fleurette Abreo
- Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
| | - Brian Latimer
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
| | - Elysse Orchard
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, United States; Division of Animal Resources, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
| | - Kenneth E McMartin
- Department of Pharmacology, Toxicology, & Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
| |
Collapse
|
26
|
Devoti E, Marta E, Belotti E, Bregoli L, Liut F, Maiorca P, Mazzucotelli V, Cancarini G. Diethylene glycol poisoning from transcutaneous absorption. Am J Kidney Dis 2014; 65:603-6. [PMID: 25445099 DOI: 10.1053/j.ajkd.2014.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/09/2014] [Indexed: 11/11/2022]
Abstract
A case of transcutaneous diethylene glycol poisoning with severe acute kidney injury, but a positive outcome, is described. A man without significant medical history was admitted to our hospital due to anuria, gastrointestinal symptoms, and hypertension. Ultrasonography excluded vascular damage and postrenal obstruction. Laboratory tests showed acute kidney injury and metabolic acidosis with increased anion gap; hemodialysis therapy was started. The brother of the patient reported that the patient had been smearing his skin with brake fluid containing diethylene glycol to treat a "dermatitis." Only supportive therapy was given due to the lack of a specific antidote. Continuous venovenous hemofiltration was performed. The kidney biopsy showed acute toxic proximal tubulonecrosis, without deposition of oxalate crystals. His neurologic condition worsened dramatically; supportive care was continued. Over time, acute kidney injury and neurologic damage gradually improved; 33 days after admission, he went to a rehabilitation unit for 5 months, with complete clinical recovery. Historically, diethylene glycol has been the cause of large-scale poisonings from ingestion of contaminated drugs. The clinical evolution is unpredictable. Treatment is not well defined; early hemodialysis treatment reduces levels of toxic metabolites, and fomepizole could be useful in cases with an early diagnosis. A comparison of the characteristics of diethylene glycol versus ethylene glycol poisoning is given.
Collapse
Affiliation(s)
- Elisabetta Devoti
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy.
| | - Elisabetta Marta
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Elena Belotti
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Laura Bregoli
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Francesca Liut
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Paolo Maiorca
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Valentina Mazzucotelli
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Giovanni Cancarini
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| |
Collapse
|
27
|
Imam YZB, Kamran S, Karim H, Elalamy O, Sokrab T, Osman Y, Deleu D. Neurological manifestation of recreational fatal and near-fatal diethylene glycol poisonings: case series and review of literature. Medicine (Baltimore) 2014; 93:e62. [PMID: 25170933 PMCID: PMC4616334 DOI: 10.1097/md.0000000000000062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diethylene glycol is a common industrial solvent which is responsible for accidental and epidemic poisoning as early as the 1930s. Due to the unavailability and unaffordability of ethanol, people in Qatar among the low income group are consuming household chemicals, some of which contain diethylene glycol, for recreational purposes.The history of ingestion is usually not volunteered and the initial clinical presentation is usually nonspecific, making it difficult to diagnose from the clinical presentation. Moreover, the biochemical profile varies with time, making the diagnosis more difficult. The neurological course and toxicity is less well characterized than its renal counterpart. Moreover, reports in the literature of such recreational poisoning is lacking particularly in the region.Three cases of recreational diethylene glycol poisoning seen in Hamad General Hospital, Doha, Qatar from 2009 to 2012 are detailed here.These illustrate the clinical course with emphasis on the neurological sequelae that include encephalopathy and multiple cranial and peripheral neuropathies with fatal and near-fatal outcomes. Neuroimaging in 2 were initially normal, but follow-up imaging showed brain atrophy. The third patient's neuroimaging showed diffuse brain edema with evidence of transtentorial herniation. Nerve conduction studies were performed in 2 of the 3 cases and showed evidence of mixed sensorimotor neuropathy. The outcomes were death in 1 and severe neurological morbidity and disability in 2 cases.Diethylene glycol is a dangerous substance when ingested and can result in mortality and severe morbidity, particularly from the renal and neurological manifestations. Whereas the mechanism of damage is less well known, the damage is likely dose related. The typical clinical pattern of evolution of the poisoning in the absence of cost-effective ways to detect it in the serum can help clinicians in making the diagnosis.Neurological manifestations may include encephalopathy and multiple cranial and peripheral neuropathies with subsequent brain atrophy. Public awareness of the danger of such recreational use should be raised.
Collapse
Affiliation(s)
- Yahia Zakaria Bashier Imam
- Neurology Section (YZI, SK, OE, TES, YO, DD); Department of Medicine (HK), Hamad Medical Corporation; and Weill Cornell Medical College in Qatar (SK, OE, TES, DD), Doha, Qatar
| | | | | | | | | | | | | |
Collapse
|
28
|
Sosa NR, Rodriguez GM, Schier JG, Sejvar JJ. Clinical, Laboratory, Diagnostic, and Histopathologic Features of Diethylene Glycol Poisoning—Panama, 2006. Ann Emerg Med 2014; 64:38-47. [DOI: 10.1016/j.annemergmed.2013.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/11/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
|
29
|
Perala AW, Filary MJ, Bartels MJ, McMartin KE. Quantitation of diethylene glycol and its metabolites by gas chromatography mass spectrometry or ion chromatography mass spectrometry in rat and human biological samples. J Anal Toxicol 2014; 38:184-93. [PMID: 24668490 DOI: 10.1093/jat/bku018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The misuse of the commonly used chemical diethylene glycol (DEG) has lead to many poisonings worldwide. Methods were developed for analysis of DEG and its potential metabolites; ethylene glycol, glycolic acid, oxalic acid, diglycolic acid and hydroxyethoxy acetic acid in human urine, serum and cerebrospinal fluid samples, collected following a DEG-associated poisoning in the Republic of Panama during 2006. In addition, methods were developed for rat blood, urine, kidney and liver tissue to support toxicokinetic analysis during the conduct of DEG acute toxicity studies in the rat. Sample analysis was conducted using two techniques; ion chromatography with suppressed conductivity and negative ion electrospray ionization with MS detection or with gas chromatography using electron impact ionization or methane negative chemical ionization with MS detection. Stable-isotope-labeled analogs of each analyte were employed as quantitative internal standards in the assays.
Collapse
Affiliation(s)
- Adam W Perala
- 1Toxicology and Environmental Research and Consulting, The Dow Chemical Company, Midland, MI, USA
| | | | | | | |
Collapse
|
30
|
Schier JG, Hunt DR, Perala A, McMartin KE, Bartels MJ, Lewis LS, McGeehin MA, Flanders WD. Characterizing concentrations of diethylene glycol and suspected metabolites in human serum, urine, and cerebrospinal fluid samples from the Panama DEG mass poisoning. Clin Toxicol (Phila) 2013; 51:923-9. [PMID: 24266434 DOI: 10.3109/15563650.2013.850504] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Diethylene glycol (DEG) mass poisoning is a persistent public health problem. Unfortunately, there are no human biological data on DEG and its suspected metabolites in poisoning. If present and associated with poisoning, the evidence for use of traditional therapies such as fomepizole and/or hemodialysis would be much stronger. OBJECTIVE To characterize DEG and its metabolites in stored serum, urine, and cerebrospinal fluid (CSF) specimens obtained from human DEG poisoning victims enrolled in a 2006 case-control study. METHODS In the 2006 study, biological samples from persons enrolled in a case-control study (42 cases with new-onset, unexplained AKI and 140 age-, sex-, and admission date-matched controls without AKI) were collected and shipped to the Centers for Disease Control and Prevention (CDC) in Atlanta for various analyses and were then frozen in storage. For this study, when sufficient volume of the original specimen remained, the following analytes were quantitatively measured in serum, urine, and CSF: DEG, 2-hydroxyethoxyacetic acid (HEAA), diglycolic acid, ethylene glycol, glycolic acid, and oxalic acid. Analytes were measured using low resolution GC/MS, descriptive statistics calculated and case results compared with controls when appropriate. Specimens were de-identified so previously collected demographic, exposure, and health data were not available. The Wilcoxon Rank Sum test (with exact p-values) and bivariable exact logistic regression were used in SAS v9.2 for data analysis. RESULTS The following samples were analyzed: serum, 20 case, and 20 controls; urine, 11 case and 22 controls; and CSF, 11 samples from 10 cases and no controls. Diglycolic acid was detected in all case serum samples (median, 40.7 mcg/mL; range, 22.6-75.2) and no controls, and in all case urine samples (median, 28.7 mcg/mL; range, 14-118.4) and only five (23%) controls (median, < Lower Limit of Quantitation (LLQ); range, < LLQ-43.3 mcg/mL). Significant differences and associations were identified between case status and the following: 1) serum oxalic acid and serum HEAA (both OR = 14.6; 95% C I = 2.8-100.9); 2) serum diglycolic acid and urine diglycolic acid (both OR > 999; exact p < 0.0001); and 3) urinary glycolic acid (OR = 0.057; 95% C I = 0.001-0.55). Two CSF sample results were excluded and two from the same case were averaged, yielding eight samples from eight cases. Diglycolic acid was detected in seven (88%) of case CSF samples (median, 2.03 mcg/mL; range, < LLQ, 7.47). DISCUSSION Significantly elevated HEAA (serum) and diglycolic acid (serum and urine) concentrations were identified among cases, which is consistent with animal data. Low urinary glycolic acid concentrations in cases may have been due to concurrent AKI. Although serum glycolic concentrations among cases may have initially increased, further metabolism to oxalic acid may have occurred thereby explaining the similar glycolic acid concentrations in cases and controls. The increased serum oxalic acid concentration results in cases versus controls are consistent with this hypothesis. CONCLUSION Diglycolic acid is associated with human DEG poisoning and may be a biomarker for poisoning. These findings add to animal data suggesting a possible role for traditional antidotal therapies. The detection of HEAA and diglycolic acid in the CSF of cases suggests a possible association with signs and symptoms of DEG-associated neurotoxicity. Further work characterizing the pathophysiology of DEG-associated neurotoxicity and the role of traditional toxic alcohol therapies such as fomepizole and hemodialysis is needed.
Collapse
Affiliation(s)
- J G Schier
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention , Atlanta, GA , USA
| | | | | | | | | | | | | | | |
Collapse
|
31
|
van Velzen A, Vermeeren Y, van Riel A, Meulenbelt J, de Vries I. Ingestion of smoke fluid: be aware of diethylene glycol. Clin Toxicol (Phila) 2013; 51:907. [DOI: 10.3109/15563650.2013.833621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
32
|
Diglycolic acid inhibits succinate dehydrogenase activity in human proximal tubule cells leading to mitochondrial dysfunction and cell death. Toxicol Lett 2013; 221:176-84. [DOI: 10.1016/j.toxlet.2013.06.231] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 11/20/2022]
|
33
|
Abstract
CONTEXT Diethylene glycol is a toxic alcohol used as an industrial solvent in various products. Human exposure to diethylene glycol has resulted in multisystem organ dysfunction and death in cases of acute intentional ingestions as well as epidemics of mass poisoning. Debate remains as to whether the parent compound or metabolite, 2-hydroxyethoxyacetic acid, is responsible for the majority of the toxicity seen in diethylene glycol poisoning. Therefore, cases of diethylene glycol poisoning create management dilemmas when deciding whether to administer alcohol dehydrogenase inhibitors, hemodialysis, or both. CASE DETAILS A 35-year-old male was presented to the emergency department reporting that he intentionally ingested brake fluid containing diethylene glycol 8 hours prior to arrival. The patient complained only of epigastric abdominal pain, had a normal physical exam, with a serum bicarbonate of 22 mmol/L, serum creatinine of 0.9 mg/dL, and an undetectable serum ethanol. The management dilemma in this case was whether to initiate fomepizole therapy, administer hemodialysis, or both given the high risk circumstances of the presentation. The decision was made not to administer any therapy other than usual supportive care. Serial basic metabolic panels were sent showing the development of no acidosis or renal dysfunction until his serum diethylene glycol concentration returned undetectable. DISCUSSION Diethylene glycol ingestion can be life threatening. This case highlights the difficulty regarding management of these cases while attempting to balance resource utilization, diagnosis, monitoring, and therapy. Due to continued debate, these decisions remain practitioner specific.
Collapse
Affiliation(s)
- Christopher O Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO 80204, USA.
| | | |
Collapse
|
34
|
McMartin KE, Sebastian CS, Dies D, Jacobsen D. Kinetics and metabolism of fomepizole in healthy humans. Clin Toxicol (Phila) 2012; 50:375-83. [DOI: 10.3109/15563650.2012.683197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
35
|
Landry GM, Martin S, McMartin KE. Diglycolic acid is the nephrotoxic metabolite in diethylene glycol poisoning inducing necrosis in human proximal tubule cells in vitro. Toxicol Sci 2011; 124:35-44. [PMID: 21856646 DOI: 10.1093/toxsci/kfr204] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Diethylene glycol (DEG), a solvent and chemical intermediate, can produce an acute toxic syndrome, the hallmark of which is acute renal failure due to cortical tubular degeneration and proximal tubular necrosis. DEG is metabolized to two primary metabolites, 2-hydroxyethoxyacetic acid (2-HEAA) and diglycolic acid (DGA), which are believed to be the proximate toxicants. The precise mechanism of toxicity has yet to be elucidated, so these studies were designed to determine which metabolite was responsible for the proximal tubule cell death. Human proximal tubule (HPT) cells in culture, obtained from normal cortical tissue and passaged 3-6 times, were incubated with increasing concentrations of DEG, 2-HEAA, or DGA separately and in combination for 48 h at pH 6 or 7.4, and various parameters of necrotic and apoptotic cell death were measured. DEG and 2-HEAA did not produce any cell death. DGA produced dose-dependent necrosis at concentrations above 25 mmol/l. DGA did not affect caspase-3 activity and increased annexin V staining only in propidium iodide-stained cells. Hence, DGA induced necrosis, not apoptosis, as corroborated by severe depletion of cellular adenosine triphosphate levels. DGA is structurally similar to citric acid cycle intermediates that are taken up by specific transporters in kidney cells. HPT cells, incubated with N-(p-amylcinnamoyl)anthranilic acid, a sodium dicarboxylate-1 transporter inhibitor showed significantly decreased cell death compared with DGA alone. These studies demonstrate that DGA is the toxic metabolite responsible for DEG-induced proximal tubular necrosis and suggest a possible transporter-mediated uptake of DGA leading to toxic accumulation and cellular dysfunction.
Collapse
Affiliation(s)
- Greg M Landry
- Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130-3932, USA
| | | | | |
Collapse
|
36
|
Besenhofer LM, McLaren MC, Latimer B, Bartels M, Filary MJ, Perala AW, McMartin KE. Role of Tissue Metabolite Accumulation in the Renal Toxicity of Diethylene Glycol. Toxicol Sci 2011; 123:374-83. [DOI: 10.1093/toxsci/kfr197] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
37
|
Lv H, Liu L, Palacios G, Chen X. Metabolomic analysis characterizes tissue specific indomethacin-induced metabolic perturbations of rats. Analyst 2011; 136:2260-9. [PMID: 21483902 DOI: 10.1039/c1an15126f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this study, the promising metabolomic approach integrating with ingenuity pathway analysis (IPA) was applied to characterize the tissue specific metabolic perturbation of rats that was induced by indomethacin. The selective pattern recognition analyses were applied to analyze global metabolic profiling of urine of rats treated by indomethacin at an acute dosage of reference that has been proven to induce tissue disorders in rats, evaluated throughout the time-course of -24-72 h. The results preliminarily revealed that modifications of amino acid metabolism, fatty acid metabolism and energetically associated metabolic pathways accounted for metabolic perturbation of the rats that was induced by indomethacin. Furthermore, IPA was applied to deeply analyze the biomarkers and their relations with the metabolic perturbations evidenced by pattern recognition analyses. Specific biochemical functions affected by indomethacin suggested that there is an important correlation of its effects in kidney and liver metabolism, based on the determined metabolites and their pathway-based analysis. The IPA correlation of the three major biomarkers, identified as creatinine, prostaglandin E2 and guanosine, suggested that the administration of indomethacin induced certain levels of toxicity in the kidneys and liver. The changes in the levels of biomarker metabolites allowed the phenotypical determination of the metabolic perturbations induced by indomethacin in a time-dependent manner.
Collapse
Affiliation(s)
- Haitao Lv
- Department of Medicine, Albert Einstein College of Medicine, 1301 Morris Park Avenue, Price Center Room 368, New York, New York 10461, USA.
| | | | | | | |
Collapse
|
38
|
Guo B, Chen Y, Lei Y, Zhang L, Zhou WY, Rabie ABM, Zhao J. Biobased Poly(propylene sebacate) as Shape Memory Polymer with Tunable Switching Temperature for Potential Biomedical Applications. Biomacromolecules 2011; 12:1312-21. [PMID: 21381645 DOI: 10.1021/bm2000378] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Baochun Guo
- Department of Polymer Materials and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Yongwen Chen
- Department of Polymer Materials and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Yanda Lei
- Department of Polymer Materials and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Liqun Zhang
- Key Laboratory of Beijing City for Preparation and Processing of Novel Polymer Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Wen You Zhou
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Hong Kong
| | - A. Bakr M. Rabie
- Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Hong Kong
| | - Jianqing Zhao
- Department of Polymer Materials and Engineering, South China University of Technology, Guangzhou 510640, China
| |
Collapse
|
39
|
Reddy NJ, Sudini M, Lewis LD. Delayed neurological sequelae from ethylene glycol, diethylene glycol and methanol poisonings. Clin Toxicol (Phila) 2011; 48:967-73. [PMID: 21192754 DOI: 10.3109/15563650.2010.532803] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Ethylene glycol, diethylene glycol and methanol are widely available chemicals and are found in a variety of common household products including antifreeze, windshield washer fluid, brake fluid and lubricants. Following ingestion of these glycols and methanol, patients frequently develop an early neurological syndrome consisting of inebriation, ataxia, and if severe, seizures and coma. Though uncommon, a neurological syndrome may also develop as a delayed complication. METHODS Using Pub Med 438 references were identified of which 45 were relevant. FEATURES Ethylene glycol poisoning has produced cranial nerve deficits (usually VII nerve dysfunction) after a delay of 5-20 days, Parkinsonism and cerebral edema. Diethylene glycol ingestion has been associated with the development of optic nerve injury, cranial nerve deficits, quadraparesis and peripheral neuropathy. Methanol poisoning has led to Parkinsonism and polyneuropathy. MECHANISMS OF TOXICITY Oxalate crystal deposition likely causes the cranial neuropathies related to ethylene glycol and 2-hydroxyethoxyacetic acid is thought to be the causal moiety in cranial neuropathies resulting from diethylene glycol toxicity. Formic acid is implicated in the optic nerve damage associated with methanol. CONCLUSIONS Uncommonly, delayed neurological syndromes may develop as complications of poisoning due to ethylene glycol, diethylene glycol and methanol; the onset of such neurological damage is often days or even weeks post-ingestion. Further research is required to explain why the facial nerve is the cranial nerve most commonly involved and why the basal ganglia are predisposed to injury.
Collapse
Affiliation(s)
- Nandi J Reddy
- Section of Clinical Pharmacology and Toxicology, Department of Medicine, Dartmouth Medical School & Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | | | | |
Collapse
|