1
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Rambabu L, Mohamed F, Dhanarisi J, Gawarammana I, Raubenheimer J, Mackenzie L, Roberts MS, Buckley N, Eddleston M. Acute phenthoate self-poisoning: a prospective case series. Clin Toxicol (Phila) 2021; 60:214-220. [PMID: 33960866 DOI: 10.1080/15563650.2021.1917596] [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: 10/21/2022]
Abstract
BACKGROUND The clinical characteristics following self-poisoning with organophosphorus (OP) insecticides differs according to the insecticide ingested. Phenthoate is a dimethoxy WHO Hazard Class II OP pesticide with limited literature on its clinical characteristics and outcome. We aimed to better understand its clinical characteristics by studying patients with phenthoate self-poisoning in Sri Lanka. METHODS We conducted a prospective cohort study of patients presenting with phenthoate self-poisoning to eight hospitals in Sri Lanka between 2002 and 2018. Clinical outcomes were recorded for each patient. Blood samples for measuring plasma phenthoate concentration, cholinesterase activity, and response to oximes were available for a very small number of patients recruited to a clinical trial. RESULTS Two hundred and ninety-two patients who ingested agricultural phenthoate formulations were included in the study. Median time to admission was 3.9 (IQR 2.4 - 6.8) h. Forty-two (14.4%) patients were intubated, mostly (30/37, 81%) within 24 h of ingestion (median time to intubation 7.2 [IQR 2.6-20.9] h). Median duration of intubation was 74.8 (IQR 26.8-232.5) h; the longest duration in a survivor was 592 h. Nineteen died (case fatality 6.5%, 95% CI 4.0-10.0); median time to death was 37 (IQR 16 - 101.7) h. Median plasma phenthoate concentration in patients with samples (n = 81) was 135 (IQR 62.7-356.5) ng/mL (0.42 µmol/mL [0.2 to 1.1 µmol/mL]). Five of six patients receiving pralidoxime chloride 2 g showed an initial increase in AChE and BuChE activity that was not sustained despite an infusion of pralidoxime. CONCLUSION Phenthoate self-poisoning has a 6.5% case fatality rate. Most patients who experience respiratory failure undergo early intubation; most deaths occurred among those patients who were intubated less than 24 h after ingestion. There was a non-sustained increase in cholinesterase activity with pralidoxime, but further studies are required to analyse the extent to which oximes are clinically effective in phenthoate self-poisoning.
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Affiliation(s)
- Lekaashree Rambabu
- National Health Service Tayside, Dundee, UK.,Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jeevan Dhanarisi
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jacques Raubenheimer
- Faculty of Medicine and Health, Discipline of Biomedical Informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, The University of Sydney, Sydney, Australia
| | - Lorraine Mackenzie
- Therapeutics Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia
| | - Michael S Roberts
- Therapeutics Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,Therapeutics Research Centre, Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Australia
| | - Nicholas Buckley
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, University of Sydney, Sydney, Australia
| | - Michael Eddleston
- Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, Edinburgh, UK.,Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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2
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Nichols RH, Chambers JE. Reactivation of organophosphate-inhibited serum butyrylcholinesterase by novel substituted phenoxyalkyl pyridinium oximes and traditional oximes. Toxicology 2021; 452:152719. [PMID: 33592259 DOI: 10.1016/j.tox.2021.152719] [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: 12/23/2020] [Revised: 01/30/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Organophosphorus compounds (OPs) include nerve agents and insecticides that potently inhibit acetylcholinesterase (AChE), an essential enzyme found throughout the nervous system. High exposure levels to OPs lead to seizures, cardiac arrest, and death if left untreated. Oximes are a critical piece to the therapeutic regimen which remove the OP from the inhibited AChE and restore normal cholinergic function. The current oximes 2-PAM, MMB-4, TMB-4, HI-6, and obidoxime (OBD) have two drawbacks: lack of broad spectrum protection against multiple OP structures and poor brain penetration to protect against OP central neurotoxicity. An alternative strategy to enhance therapy is reactivation of serum butyrylcholinesterase (BChE). BChE is stoichiometrically inhibited by OPs with no apparent toxic result. Inhibition of BChE in the serum followed by reactivation could create a pseudo-catalytic scavenger allowing numerous regenerations of BChE to detoxify circulating OP molecules before they can reach target AChE. BChE in serum from rats, guinea pigs or humans was screened for the reactivation potential of our novel substituted phenoxyalkyl pyridinium oximes, plus 2-PAM, MMB-4, TMB-4, HI-6, and OBD (100μM) in vitro after inhibition by highly relevant surrogates of sarin, VX, and cyclosarin, and also DFP, and the insecticidal active metabolites paraoxon, phorate-oxon, and phorate-oxon sulfoxide. Novel oxime 15 demonstrated significant broad spectrum reactivation of OP-inhibited rat serum BChE while novel oxime 20 demonstrated significant broad spectrum reactivation of OP-inhibited human serum BChE. All tested oximes were poor reactivators of OP-inhibited guinea pig serum BChE. The bis-pyridinium oximes were poor BChE reactivators overall. BChE reactivation may be an additional mechanism to attenuate OP toxicity and contribute to therapeutic efficacy.
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Affiliation(s)
- Royce H Nichols
- Center for Environmental Health Sciences, College of Veterinary Medicine, Mississippi State University, MS, 39762, United States
| | - Janice E Chambers
- Center for Environmental Health Sciences, College of Veterinary Medicine, Mississippi State University, MS, 39762, United States.
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3
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Noh E, Moon JM, Chun BJ, Cho YS, Ryu S, Kim D. The clinical role of serum albumin in Organophospate poisoning. Basic Clin Pharmacol Toxicol 2020; 128:605-614. [DOI: 10.1111/bcpt.13546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Eul Noh
- Emergency Department Chonnam National University Hospital Gwangju South Korea
| | - Jeong Mi Moon
- Emergency Department Chonnam National University Hwasun Hospital Hwasun‐gun South Korea
- Emergency Department Chonnam National University Medical School Gwangju South Korea
| | - Byeong Jo Chun
- Emergency Department Chonnam National University Hospital Gwangju South Korea
- Emergency Department Chonnam National University Medical School Gwangju South Korea
| | - Yong Soo Cho
- Emergency Department Chonnam National University Hospital Gwangju South Korea
| | - SeokJin Ryu
- Emergency Department Chonnam National University Hospital Gwangju South Korea
| | - Dongki Kim
- Emergency Department Chonnam National University Hospital Gwangju South Korea
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4
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Brenet A, Somkhit J, Hassan-Abdi R, Yanicostas C, Romain C, Bar O, Igert A, Saurat D, Taudon N, Dal-Bo G, Nachon F, Dupuis N, Soussi-Yanicostas N. Organophosphorus diisopropylfluorophosphate (DFP) intoxication in zebrafish larvae causes behavioral defects, neuronal hyperexcitation and neuronal death. Sci Rep 2020; 10:19228. [PMID: 33154418 PMCID: PMC7645799 DOI: 10.1038/s41598-020-76056-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/19/2020] [Indexed: 11/09/2022] Open
Abstract
With millions of intoxications each year and over 200,000 deaths, organophosphorus (OP) compounds are an important public health issue worldwide. OP poisoning induces cholinergic syndrome, with respiratory distress, hypertension, and neuron damage that may lead to epileptic seizures and permanent cognitive deficits. Existing countermeasures are lifesaving but do not prevent long-lasting neuronal comorbidities, emphasizing the urgent need for animal models to better understand OP neurotoxicity and identify novel antidotes. Here, using diisopropylfluorophosphate (DFP), a prototypic and moderately toxic OP, combined with zebrafish larvae, we first showed that DFP poisoning caused major acetylcholinesterase inhibition, resulting in paralysis and CNS neuron hyperactivation, as indicated by increased neuronal calcium transients and overexpression of the immediate early genes fosab, junBa, npas4b, and atf3. In addition to these epileptiform seizure-like events, DFP-exposed larvae showed increased neuronal apoptosis, which were both partially alleviated by diazepam treatment, suggesting a causal link between neuronal hyperexcitation and cell death. Last, DFP poisoning induced an altered balance of glutamatergic/GABAergic synaptic activity with increased NR2B-NMDA receptor accumulation combined with decreased GAD65/67 and gephyrin protein accumulation. The zebrafish DFP model presented here thus provides important novel insights into the pathophysiology of OP intoxication, making it a promising model to identify novel antidotes.
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Affiliation(s)
| | - Julie Somkhit
- NeuroDiderot, Inserm, Université de Paris, 75019, Paris, France
| | | | | | | | - Olivier Bar
- NeuroDiderot, Inserm, Université de Paris, 75019, Paris, France
| | - Alexandre Igert
- Département de toxicologie et risques chimiques, Institut de Recherche Biomédicale des Armées (IRBA), 91 220, Brétigny-sur-Orge, France
| | - Dominique Saurat
- Institut de Recherche Biomédicale des Armées (IRBA), Unité de Développements Analytiques et Bioanalyse, 91 220, Brétigny-sur-Orge, France
| | - Nicolas Taudon
- Institut de Recherche Biomédicale des Armées (IRBA), Unité de Développements Analytiques et Bioanalyse, 91 220, Brétigny-sur-Orge, France
| | - Gregory Dal-Bo
- Département de toxicologie et risques chimiques, Institut de Recherche Biomédicale des Armées (IRBA), 91 220, Brétigny-sur-Orge, France
| | - Florian Nachon
- Département de toxicologie et risques chimiques, Institut de Recherche Biomédicale des Armées (IRBA), 91 220, Brétigny-sur-Orge, France
| | - Nina Dupuis
- Département de toxicologie et risques chimiques, Institut de Recherche Biomédicale des Armées (IRBA), 91 220, Brétigny-sur-Orge, France
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5
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Eddleston M. Novel Clinical Toxicology and Pharmacology of Organophosphorus Insecticide Self-Poisoning. Annu Rev Pharmacol Toxicol 2019; 59:341-360. [DOI: 10.1146/annurev-pharmtox-010818-021842] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Organophosphorus insecticide self-poisoning is a major global health problem, killing over 100,000 people annually. It is a complex multi-organ condition, involving the inhibition of cholinesterases, and perhaps other enzymes, and the effects of large doses of ingested solvents. Variability between organophosphorus insecticides—in lipophilicity, speed of activation, speed and potency of acetylcholinesterase inhibition, and in the chemical groups attached to the phosphorus—results in variable speed of poisoning onset, severity, clinical toxidrome, and case fatality. Current treatment is modestly effective, aiming only to reactivate acetylcholinesterase and counter the effects of excess acetylcholine at muscarinic receptors. Rapid titration of atropine during resuscitation is lifesaving and can be performed in the absence of oxygen. The role of oximes in therapy remains unclear. Novel antidotes have been tested in small trials, but the great variability in poisoning makes interpretation of such trials difficult. More effort is required to test treatments in adequately powered studies.
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Affiliation(s)
- Michael Eddleston
- Pharmacology, Toxicology, and Therapeutics Unit, Centre for Cardiovascular Science, and Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
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6
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Suemizu H, Kawai K, Murayama N, Nakamura M, Yamazaki H. Chimeric mice with humanized liver as a model for testing organophosphate and carbamate pesticide exposure. PEST MANAGEMENT SCIENCE 2018; 74:1424-1430. [PMID: 29235720 PMCID: PMC5969263 DOI: 10.1002/ps.4825] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 12/03/2017] [Accepted: 12/06/2017] [Indexed: 05/16/2023]
Abstract
BACKGROUND Diagnosis of acute intoxication with organophosphate (OP) or carbamate (CM) pesticides in humans is achieved by measuring plasma butyrylcholinesterase (BuChE) activity. However, BuChE activity is not an ideal biomarker in experimental animal models. The aim of this study was to establish an experimental mouse model for evaluating exposure to OP and CM pesticides by monitoring BuChE activity using chimeric mice in which the liver was reconstituted with human hepatocytes. RESULTS A single oral administration of acephate (300 mg/kg), chlorpyrifos (10 mg/kg), fenobucarb (300 mg/kg) or molinate (250 mg/kg) in chimeric mice led to inhibition of >95%, > 95%, 28% and 60% of plasma BuChE activity after 7, 0.5, 0.5 and 7 h, respectively. Dose-dependent decreases in plasma BuChE activity were also observed for acephate and chlorpyrifos. A 5-day repeated-dose study with 10 or 30 mg/kg acephate found a constitutive reduction in plasma BuChE activity to 80% and 70% of pre-dose levels, respectively. CONCLUSION Changes in plasma BuChE activity in chimeric mice with humanized liver clearly reflected the exposure levels of OP and CM pesticides. These results suggest that the humanized-liver mouse model may be suitable for estimating levels of exposure to these pesticides in humans. © 2017 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Affiliation(s)
- Hiroshi Suemizu
- Laboratory Animal Research DepartmentCentral Institute for Experimental AnimalsKawasakiJapan
| | - Kenji Kawai
- Pathology Analysis CenterCentral Institute for Experimental AnimalsKawasakiJapan
| | - Norie Murayama
- Laboratory of Drug Metabolism and PharmacokineticsShowa Pharmaceutical UniversityMachidaJapan
| | - Masato Nakamura
- Department of Pathology and Regenerative MedicineTokai University School of MedicineIseharaJapan
| | - Hiroshi Yamazaki
- Laboratory of Drug Metabolism and PharmacokineticsShowa Pharmaceutical UniversityMachidaJapan
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7
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Whitmore C, Cook AR, Mann T, Price ME, Emery E, Roughley N, Flint D, Stubbs S, Armstrong SJ, Rice H, Tattersall JEH. The efficacy of HI-6 DMS in a sustained infusion against percutaneous VX poisoning in the guinea-pig. Toxicol Lett 2017; 293:207-215. [PMID: 29129798 DOI: 10.1016/j.toxlet.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
Post-exposure nerve agent treatment usually includes administration of an oxime, which acts to restore function of the enzyme acetylcholinesterase (AChE). For immediate treatment of military personnel, this is usually administered with an autoinjector device, or devices containing the oxime such as pralidoxime, atropine and diazepam. In addition to the autoinjector, it is likely that personnel exposed to nerve agents, particularly by the percutaneous route, will require further treatment at medical facilities. As such, there is a need to understand the relationship between dose rate, plasma concentration, reactivation of AChE activity and efficacy, to provide supporting evidence for oxime infusions in nerve agent poisoning. Here, it has been demonstrated that intravenous infusion of HI-6, in combination with atropine, is efficacious against a percutaneous VX challenge in the conscious male Dunkin-Hartley guinea-pig. Inclusion of HI-6, in addition to atropine in the treatment, improved survival when compared to atropine alone. Additionally, erythrocyte AChE activity following poisoning was found to be dose dependent, with an increased dose rate of HI-6 (0.48mg/kg/min) resulting in increased AChE activity. As far as we are aware, this is the first study to correlate the pharmacokinetic profile of HI-6 with both its pharmacodynamic action of reactivating nerve agent inhibited AChE and with its efficacy against a persistent nerve agent exposure challenge in the same conscious animal.
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Affiliation(s)
- C Whitmore
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom.
| | - A R Cook
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
| | - T Mann
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
| | - M E Price
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
| | - E Emery
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
| | - N Roughley
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
| | - D Flint
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
| | - S Stubbs
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
| | - S J Armstrong
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
| | - H Rice
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
| | - J E H Tattersall
- CBR (Chemical, Biological, Radiological), Dstl Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
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8
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Post-exposure treatment with the oxime RS194B rapidly reactivates and reverses advanced symptoms of lethal inhaled paraoxon in macaques. Toxicol Lett 2017; 293:229-234. [PMID: 29129799 DOI: 10.1016/j.toxlet.2017.10.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/18/2017] [Accepted: 10/29/2017] [Indexed: 01/02/2023]
Abstract
Fatalities from organophosphate (OP) insecticide result from both occupational and deliberate exposure; significantly impacting human health. Like nerve agents, insecticides are neurotoxins which target and inhibit acetylcholinesterases (AChE) in central and peripheral synapses in the cholinergic nervous system. Post-exposure therapeutic countermeasures generally include administration of atropine with a pyridinium aldoxime e.g. pralidoxime, to reactivate the OP-inhibited AChE. However, commonly used oximes inefficiently cross the bloodbrain barrier and are rapidly cleared and their benefit is debated. Recent findings have demonstrated the ability of a novel zwitterionic, centrally acting, brain penetrating oxime (RS194B) to reverse severe symptoms and rapidly reactivate sarin-inhibited AChE in macaques, but it has not been tested following OP pesticide poisoning. In the present study, the symptoms following a lethal dose of inhaled paraoxon (100ug/kg), were shown to mimic those in insecticide poisoned individuals and were also rapidly reversed in macaques by post-exposure IM administration of 80mg/kg of RS194B. This occurred with a concomitant reactivation of AChE to 40-100% in<1hr and BChE (40% in 8h). These findings will be used to develop a macaque model with RS194B as a post-exposure treatment for insecticide poisoning and generate efficacy data for approval under the FDA Animal rule.
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9
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Rosenberg YJ, Mao L, Jiang X, Lees J, Zhang L, Radic Z, Taylor P. Post-exposure treatment with the oxime RS194B rapidly reverses early and advanced symptoms in macaques exposed to sarin vapor. Chem Biol Interact 2017; 274:50-57. [PMID: 28693885 PMCID: PMC5586507 DOI: 10.1016/j.cbi.2017.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 01/04/2023]
Abstract
Organophosphate (OP) nerve agents and pesticides trigger a common mechanism of neurotoxicity resulting from critical targeting and inhibition of acetylcholinesterases (AChE) in central and peripheral synapses in the cholinergic nervous system. Therapeutic countermeasures have thus focused on either administering an oxime post-exposure, that can rapidly reactivate OP-inhibited AChE, or by preventing OP poisoning through administering pre-exposure treatments that scavenge OPs before they inhibit their physiological AChE targets. While several pyridinium aldoxime antidotes are currently approved, their utility is impaired due to their inability to cross the blood-brain barrier (BBB) efficiently. The present study utilized a macaque (Ma) model to demonstrate the efficacy of a novel zwitterionic and centrally acting oxime RS194B to reactivate sarin- and paraoxon-inhibited macaque AChE and butyrylcholinesterase (BChE) in vitro and to further assess the capacity of RS194B to effect a reversal of clinical symptoms following sarin inhalation in vivo. In vitro, oxime reactivation of MaAChE and MaBChE was shown to be comparable to their human orthologs, while the macaque studies indicated that IM administration of 62.5 mg/kg of RS194B and 0.28 mg/kg atropine after continuous exposure to 49.6 μg/kg sarin vapor, rapidly reactivated the inhibited AChE and BChE in blood and reversed both early and advanced clinical symptoms of sarin-induced toxicity following pulmonary exposure within 1 h. The rapid cessation of autonomic and central symptoms, including convulsions, observed in macaques bodes well for the use of RS194B as an intra- or post-exposure human treatment and validates the macaque model in generating efficacy and toxicology data required for approval under the FDA Animal rule.
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Affiliation(s)
| | | | | | | | - Limin Zhang
- Department of Pharmacology, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla 92093-0650, USA.
| | - Zoran Radic
- Department of Pharmacology, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla 92093-0650, USA.
| | - Palmer Taylor
- Department of Pharmacology, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla 92093-0650, USA.
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Rice H, Mann TM, Armstrong SJ, Price ME, Green AC, Tattersall JE. The potential role of bioscavenger in the medical management of nerve-agent poisoned casualties. Chem Biol Interact 2016; 259:175-181. [DOI: 10.1016/j.cbi.2016.04.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/18/2016] [Accepted: 04/28/2016] [Indexed: 11/25/2022]
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11
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Rehman T, Khan MM, Shad MA, Hussain M, Oyler BL, Goo YA, Goodlett DR. Detection of Carbofuran-Protein Adducts in Serum of Occupationally Exposed Pesticide Factory Workers in Pakistan. Chem Res Toxicol 2016; 29:1720-1728. [PMID: 27657490 DOI: 10.1021/acs.chemrestox.6b00222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study was conducted to investigate the protein adducts with pesticides in a cohort of 172 factory workers that were exposed to a mixture of pesticides. The 35 samples showing considerable variation in biochemical parameters, i.e., butyrylcholinestrase (BChE), serum glutamic pyruvic transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT), gamma-glutamyl transferase (GGT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase (ALP/ALKP), lactate dehydrogenase (LDH), creatine phosphokinase (CPK) enzymes, and controls were analyzed by reversed-phase nanoscale liquid chromatography tandem mass spectrometry (nLC-MS/MS) on an Orbitrap mass spectrometer employing a shotgun proteomics approach. Only protein adducts with carbofuran were found on serum proteins of these workers. These adducts were of carbofuran labeled lysine (Lys-142, Lys-183, Lys-287, and Lys-467), arginine (Arg-210, Arg-242, and Arg-256) from serum albumin, and serine (Ser-07, Ser-54, and Ser-150) from immunoglobulin proteins. The arginine residues (Arg-210, Arg-242, Arg-246, and Arg-434) from albumin were also found to be glycated in serum of workers showing a high level of glucose who also had glycated arginine (Arg-1120) modified with carbofuran in their tankyrase-1-binding protein. The number of tandem mass spectra of modified peptides increased with increasing time of exposure. This is the first report to demonstrate the presence of carbofuran-labeled albumin, immunoglobulin, and glycated arginine, which shows that lysine and arginine of human albumin and serine of immunoglobulin are covalently modified in the serum of workers that were occupationally exposed to carbofuran, and the modification is detectable by tandem mass spectrometry. These peptides modified with carbofuran can potentially be used as a biomarker of carbofuran exposure.
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Affiliation(s)
- Tanzila Rehman
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy , Baltimore, Maryland 21201, United States
| | - Mohd M Khan
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy , Baltimore, Maryland 21201, United States
| | | | | | - Benjamin L Oyler
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy , Baltimore, Maryland 21201, United States
| | - Young Ah Goo
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy , Baltimore, Maryland 21201, United States
| | - David R Goodlett
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy , Baltimore, Maryland 21201, United States
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12
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El-Ebiary AA, Elsharkawy RE, Soliman NA, Soliman MA, Hashem AA. N-acetylcysteine in Acute Organophosphorus Pesticide Poisoning: A Randomized, Clinical Trial. Basic Clin Pharmacol Toxicol 2016; 119:222-7. [DOI: 10.1111/bcpt.12554] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ahmad A. El-Ebiary
- Department of Forensic Medicine and Clinical Toxicology; Faculty of Medicine; Tanta University; Tanta Egypt
| | - Rasha E. Elsharkawy
- Department of Forensic Medicine and Clinical Toxicology; Faculty of Medicine; Tanta University; Tanta Egypt
| | - Nema A. Soliman
- Department of Medical Biochemistry; Faculty of Medicine; Tanta University; Tanta Egypt
| | | | - Ahmed A. Hashem
- Department of Forensic Medicine and Clinical Toxicology; Faculty of Medicine; Tanta University; Tanta Egypt
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13
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Eddleston M, Chowdhury FR. Pharmacological treatment of organophosphorus insecticide poisoning: the old and the (possible) new. Br J Clin Pharmacol 2015; 81:462-70. [PMID: 26366467 DOI: 10.1111/bcp.12784] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/09/2015] [Accepted: 09/11/2015] [Indexed: 01/31/2023] Open
Abstract
Despite being a major clinical and public health problem across the developing world, responsible for at least 5 million deaths over the last three decades, the clinical care of patients with organophosphorus (OP) insecticide poisoning has little improved over the last six decades. We are still using the same two antidotes - atropine and oximes - that first came into clinical use in the late 1950s. Clinical research in South Asia has shown how improved regimens of atropine can prevent deaths. However, we are still unsure about which patients are most likely to benefit from the use of oximes. Supplemental antidotes, such as magnesium, clonidine and sodium bicarbonate, have all been proposed and studied in small trials without production of definitive answers. Novel antidotes such as nicotinic receptor antagonists, beta-adrenergic agonists and lipid emulsions are being studied in large animal models and in pilot clinical trials. Hopefully, one or more of these affordable and already licensed antidotes will find their place in routine clinical care. However, the large number of chemically diverse OP insecticides, the varied poisoning they produce and their varied response to treatment might ultimately make it difficult to determine definitively whether these antidotes are truly effective. In addition, the toxicity of the varied solvents and surfactants formulated with the OP active ingredients complicates both treatment and studies. It is possible that the only effective way to reduce deaths from OP insecticide poisoning will be a steady reduction in their agricultural use worldwide.
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Affiliation(s)
- Michael Eddleston
- Pharmacology, Toxicology, & Therapeutics, University of Edinburgh, Edinburgh, UK.,National Poisons Information Service - Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Moon J, Chun B, Lee S. Variable response of cholinesterase activities following human exposure to different types of organophosphates. Hum Exp Toxicol 2015; 34:698-706. [DOI: 10.1177/0960327114558890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the red blood cell (RBC) acetylcholinesterase (AChE) activities and butyrylcholinesterase (BChE) activities at presentation to the emergency department (ED) and at 24 h after presentation following poisoning by dichlorvos, fenitrothion, or ethyl p-nitrophenol thio-benzene phosphonate (EPN). Although the patients from different groups had similar characteristics at presentation such as time interval from ingestion to presentation to the ED and the amount of organophosphate ingested, the dichlorvos group had significantly lower BChE levels than the fenitrothion group and lower RBC cholinesterase activity than the EPN group. Patients poisoned with EPN or dichlorvos had significantly higher inhibition of BChE activities from baseline than RBC AChE activities at presentation. Twenty four hours after administration of pralidoxime, RBC AChE activities had increased in patients in the dichlorvos and EPN groups, while RBC AChE activities had slightly decreased in the fenitrothion group. BChE activities increased significantly in the dichlorvos group but decreased in the EPN group. The recovery patterns of RBC AChE and BChE activities did not match in any particular individual. This study showed that the patterns of inhibition and recovery of the activities of two cholinesterases after treatment are highly variable according to the organophosphate and in different individuals.
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Affiliation(s)
- J Moon
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - B Chun
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - S Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea
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Lucyk S, Vilensky D, Fok PT, Nelson LS. Reactivation of plasma butyrylcholinesterase by pralidoxime chloride in patients poisoned by WHO class II toxicity organophosphorus insecticides. Toxicol Sci 2014; 138:482. [PMID: 24385419 DOI: 10.1093/toxsci/kft337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Scott Lucyk
- Division of Medical Toxicology, Department of Emergency Medicine, New York University School of Medicine, New York, New York 10016
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Eddleston M, Konickx LA. Plasma Butyrylcholinesterase as a Marker of Clinical Outcome in Diethyl Organophosphorus Insecticide Poisoned Patients Treated With Pralidoxime. Toxicol Sci 2014; 138:483-4. [DOI: 10.1093/toxsci/kft338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mégarbane B. [Measurement of cholinesterase activity in poisoning with an organophosphate compound: the clinical approach remains essential]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2013; 32:825-826. [PMID: 24246657 DOI: 10.1016/j.annfar.2013.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- B Mégarbane
- Inserm U1144, service de réanimation médicale et toxicologique, hôpital Lariboisière, université Paris-Diderot, 2, rue Ambroise-Paré, 75010 Paris, France.
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