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Amini H, Solaymani-Dodaran M, Ghanei M, Abolghasemi J, Salesi M, Vahedian Azimi A, Sahebkar A. Standardised mortality ratios in people exposed to sulphur mustard during the Iran-Iraq war: a retrospective study with 39-year follow-up. Public Health 2024; 227:86-94. [PMID: 38141270 DOI: 10.1016/j.puhe.2023.11.036] [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: 04/04/2023] [Revised: 10/24/2023] [Accepted: 11/23/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES Sulphur mustard (SM) is a chemical weapon agent that was extensively used by Iraqi troops during the Iran-Iraq war (1980-1988), resulting in exposure among Iranian military personnel and civilians. However, there is limited and conflicting information about the long-term mortality effects of SM exposure. This study aimed to determine the standardised mortality ratios (SMRs) in individuals exposed to SM gas during the Iran-Iraq war. STUDY DESIGN This was a retrospective follow-up study. METHODS Data were obtained from the Veterans and Martyr Affair Foundation of Iran (VMAF) regarding all confirmed individuals who were exposed to SM during the Iran-Iraq war (1980-1988) up to 30 March 2019. The mortality rate, cumulative mortality and SMR with 95 % confidence intervals (CIs) were calculated to assess mortality in chemical warfare survivors (CWS), and results were compared with the general Iranian population. Overall survival was analysed using the Kaplan-Meier curve, and the log-rank test was employed to compare survival probability across different categories. RESULTS Among the 48,067 confirmed CWS, a total of 4358 (9.1 %) individuals had died by the end of the study period (30 March 2019), with a mean age of 55.5 ± 14.4 years at the time of death. Overall, at the 39-year follow-up, the mortality rate due to all causes of death for people who were exposed to SM was lower than the general Iranian population (SMR: 0.70, 95 % CI: 0.68-0.72). However, cause-specific SMR analysis showed that the mortality rate due to liver cancer (SMR: 1.98, 95 % CI: 1.59-2.45), poisonings (SMR: 1.92, 95 % CI: 1.52-2.38), respiratory disorders (SMR: 1.59, 95 % CI: 1.46-1.73) and multiple myeloma (SMR: 1.72, 95 % CI: 1.06-2.62) were approximately twofold higher in CWS than the general population. CONCLUSIONS This study provides valuable insights into the mortality effects of SM exposure among the Iranian population affected by the Iran-Iraq war. The results emphasise the importance of continued monitoring and support for individuals exposed to SM, particularly in the context of managing and addressing the heightened risks associated with liver cancer, poisonings, respiratory disorders and multiple myeloma. Further research and interventions may be necessary to mitigate these specific health challenges in the affected population.
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Affiliation(s)
- H Amini
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - M Solaymani-Dodaran
- Minimally Invasive Surgery Research Center, Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran; Division of Epidemiology and Public Health, University of Nottingham, UK.
| | - M Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - J Abolghasemi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - M Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - A Vahedian Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - A Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Ruszkiewicz J, Endig L, Güver E, Bürkle A, Mangerich A. Life-Cycle-Dependent Toxicities of Mono- and Bifunctional Alkylating Agents in the 3R-Compliant Model Organism C. elegans. Cells 2023; 12:2728. [PMID: 38067156 PMCID: PMC10705807 DOI: 10.3390/cells12232728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
Caenorhabditis elegans (C. elegans) is gaining recognition and importance as an organismic model for toxicity testing in line with the 3Rs principle (replace, reduce, refine). In this study, we explored the use of C. elegans to examine the toxicities of alkylating sulphur mustard analogues, specifically the monofunctional agent 2-chloroethyl-ethyl sulphide (CEES) and the bifunctional, crosslinking agent mechlorethamine (HN2). We exposed wild-type worms at different life cycle stages (from larvae L1 to adulthood day 10) to CEES or HN2 and scored their viability 24 h later. The susceptibility of C. elegans to CEES and HN2 paralleled that of human cells, with HN2 exhibiting higher toxicity than CEES, reflected in LC50 values in the high µM to low mM range. Importantly, the effects were dependent on the worms' developmental stage as well as organismic age: the highest susceptibility was observed in L1, whereas the lowest was observed in L4 worms. In adult worms, susceptibility to alkylating agents increased with advanced age, especially to HN2. To examine reproductive effects, L4 worms were exposed to CEES and HN2, and both the offspring and the percentage of unhatched eggs were assessed. Moreover, germline apoptosis was assessed by using ced-1p::GFP (MD701) worms. In contrast to concentrations that elicited low toxicities to L4 worms, CEES and HN2 were highly toxic to germline cells, manifesting as increased germline apoptosis as well as reduced offspring number and percentage of eggs hatched. Again, HN2 exhibited stronger effects than CEES. Compound specificity was also evident in toxicities to dopaminergic neurons-HN2 exposure affected expression of dopamine transporter DAT-1 (strain BY200) at lower concentrations than CEES, suggesting a higher neurotoxic effect. Mechanistically, nicotinamide adenine dinucleotide (NAD+) has been linked to mustard agent toxicities. Therefore, the NAD+-dependent system was investigated in the response to CEES and HN2 treatment. Overall NAD+ levels in worm extracts were revealed to be largely resistant to mustard exposure except for high concentrations, which lowered the NAD+ levels in L4 worms 24 h post-treatment. Interestingly, however, mutant worms lacking components of NAD+-dependent pathways involved in genome maintenance, namely pme-2, parg-2, and sirt-2.1 showed a higher and compound-specific susceptibility, indicating an active role of NAD+ in genotoxic stress response. In conclusion, the present results demonstrate that C. elegans represents an attractive model to study the toxicology of alkylating agents, which supports its use in mechanistic as well as intervention studies with major strength in the possibility to analyze toxicities at different life cycle stages.
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Affiliation(s)
- Joanna Ruszkiewicz
- Molecular Toxicology Group, Department of Biology, University of Konstanz, 78457 Konstanz, Germany (A.B.)
| | - Lisa Endig
- Molecular Toxicology Group, Department of Biology, University of Konstanz, 78457 Konstanz, Germany (A.B.)
| | - Ebru Güver
- Molecular Toxicology Group, Department of Biology, University of Konstanz, 78457 Konstanz, Germany (A.B.)
| | - Alexander Bürkle
- Molecular Toxicology Group, Department of Biology, University of Konstanz, 78457 Konstanz, Germany (A.B.)
| | - Aswin Mangerich
- Molecular Toxicology Group, Department of Biology, University of Konstanz, 78457 Konstanz, Germany (A.B.)
- Nutritional Toxicology, Institute Nutritional Science, University of Potsdam, 14469 Potsdam, Germany
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Mahaling B, Sinha NR, Sokupa S, Addi UR, Mohan RR, Chaurasia SS. Mustard gas exposure instigates retinal Müller cell gliosis. Exp Eye Res 2023; 230:109461. [PMID: 37023936 PMCID: PMC10157651 DOI: 10.1016/j.exer.2023.109461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
Sulfur mustard (SM) is a chemical warfare agent (CWA) that causes severe eye pain, photophobia, excessive lacrimation, corneal and ocular surface defects, and blindness. However, SM's effects on retinal cells are relatively meager. This study investigated the role of SM toxicity on Müller glial cells responsible for cellular architecture, inner blood-retinal barrier maintenance, neurotransmitter recycling, neuronal survival, and retinal homeostasis. Müller glial cells (MIO-M1) were exposed to SM analog, nitrogen mustard (NM), at varying concentrations (50-500 μM) for 3 h, 24 h, and 72 h. Müller cell gliosis was evaluated using morphological, cellular, and biochemical methods. Real-time cellular integrity and morphological evaluation were performed using the xCELLigence real-time monitoring system. Cellular viability and toxicity were measured using TUNEL and PrestoBlue assays. Müller glia hyperactivity was calculated based on glial fibrillary acidic protein (GFAP) and vimentin immunostaining. Intracellular oxidative stress was measured using DCFDA and DHE cell-based assays. Inflammatory markers and antioxidant enzyme levels were determined by quantitative real-time PCR (qRT-PCR). AO/Br and DAPI staining further evaluated DNA damage, apoptosis, necrosis, and cell death. Inflammasome-associated Caspase-1, ASC, and NLRP3 were studied to identify mechanistic insights into NM toxicity in Müller glial cells. The cellular and morphological evaluation revealed the Müller glia hyperactivity after NM exposure in a dose- and time-dependent manner. NM exposure caused significant oxidative stress and enhanced cell death at 72 h. A significant increase in antioxidant indices was observed at the lower concentrations of NM. Mechanistically, we found that NM-treated MIO-M1 cells increased caspase-1 levels that activated NLRP3 inflammasome-induced production of IL-1β and IL-18, and elevated Gasdermin D (GSDMD) expression, a crucial component actuating pyroptosis. In conclusion, NM-induced Müller cell gliosis via increased oxidative stress results in caspase-1-dependent activation of the NLRP3 inflammasome and cell death driven primarily by pyroptosis.
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Affiliation(s)
- Binapani Mahaling
- Ocular Immunology and Angiogenesis Lab, Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Nishant R Sinha
- Ophthalmology and Molecular Medicine, Mason Eye Institute, University of Missouri, Columbia, MO, 65211, USA
| | - Sibabalo Sokupa
- Ocular Immunology and Angiogenesis Lab, Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Utkarsh Reddy Addi
- Ocular Immunology and Angiogenesis Lab, Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Rajiv R Mohan
- Ophthalmology and Molecular Medicine, Mason Eye Institute, University of Missouri, Columbia, MO, 65211, USA
| | - Shyam S Chaurasia
- Ocular Immunology and Angiogenesis Lab, Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
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Zhou S, Chen Y, Xu J, Yin Y, Yu J, Liu W, Chen S, Wang L. Supramolecular detoxification of nitrogen mustard via host-guest encapsulation by carboxylatopillar[5]arene. J Mater Chem B 2023; 11:2706-2713. [PMID: 36876404 DOI: 10.1039/d2tb02211g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Nitrogen mustard (NM), a kind of alkylating agent similar to sulfur mustard, remains a threat to public health. However, there is nearly no satisfactory antidote for nitrogen mustard. Herein, we developed a supramolecular antidote to nitrogen mustard through efficient complexation of NM by carboxylatopillar[5]arene potassium salts (CP[5]AK). The cavity of methoxy pillar[5]arene (P5A) is sufficient to encapsulate NM with an association constant of 1.27 × 102 M-1, which was investigated by 1H NMR titration, density functional theory studies and independent gradient model studies. NM degrades to the reactive aziridinium salt (2) in the aqueous phase which irreversibly alkylates DNA and proteins, causing severe tissue damage. Considering the size/charge matching with toxic intermediate 2, water-soluble CP[5]AK was selected to encapsulate the toxic aziridinium salt (2), resulting in a high association constant of 4.10 × 104 M-1. The results of protection experiments of guanosine 5'-monophosphate (GMP) by CP[5]AK indicated that the formation of a complex could effectively inhibit the alkylation of DNA. Besides, in vitro and in vivo experiments also indicated that the toxicity of the aziridinium salt (2) is inhibited with the formation of a stable host-guest complex, and CP[5]AK has a good therapeutic effect on the damage caused by NM. This study provides a new mechanism and strategy for the treatment of NM exposure-induced skin injuries.
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Affiliation(s)
- Siyuan Zhou
- The Institute for Advanced Studies, and Department of Gastroenterology, Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430072, P. R. China.
| | - Yi Chen
- The Institute for Advanced Studies, and Department of Gastroenterology, Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430072, P. R. China.
| | - Jie Xu
- School of Pharmaceutical Sciences, Wuhan University, 185 Donghu Road, Wuhan, Hubei 430072, P. R. China
| | - Yongfei Yin
- The Institute for Advanced Studies, and Department of Gastroenterology, Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430072, P. R. China.
| | - Jianqing Yu
- School of Pharmaceutical Sciences, Wuhan University, 185 Donghu Road, Wuhan, Hubei 430072, P. R. China
| | - Wei Liu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China.
| | - Shigui Chen
- The Institute for Advanced Studies, and Department of Gastroenterology, Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430072, P. R. China.
| | - Lu Wang
- The Institute for Advanced Studies, and Department of Gastroenterology, Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430072, P. R. China.
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Jiang N, Zhang P, Shen W, Zhang Y, Zhou W. Clinical and experimental research progress on neurotoxicity of sulfur mustard and its possible mechanisms. Toxicology 2023; 483:153372. [PMID: 36356660 DOI: 10.1016/j.tox.2022.153372] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/28/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022]
Abstract
Sulfur mustard (SM), an extremely reactive alkylating toxicant, which poses a continuing threat to both military and civilian populations. SM targets three major organs including skin, eyes and lungs. In recent years, more and more clinical findings have shown that cognitive and emotional disorders in veterans intoxicated with SM, such as anxiety, depression, apathy, cognitive decline and so on, which indicated the long time toxic effects on mental and neurological health of SM. The experimental studies in animal and cell models have also found neurotoxicity which are similar to clinical results. However, these neuropsychological problems are not studied well in victims of SM and the mental and neurological complications are often not subjected to treatment or undertreated. Until now, the exact mechanism of the action of SM toxicity has not been elucidated and no specific therapy for its poisoning exists. Therefore, the studies on neurotoxicity of SM should be strengthened. This review summarizes the main progress of clinical and experimental researches on neurotoxicity of SM for the past few years.
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Affiliation(s)
- Ning Jiang
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing 100850, China
| | - Pei Zhang
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing 100850, China; School of Pharmacy, Yantai University, Shandong 264005, China
| | - Wei Shen
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing 100850, China; School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Yongxiang Zhang
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing 100850, China.
| | - WenXia Zhou
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing 100850, China; School of Pharmacy, Yantai University, Shandong 264005, China.
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Cruz-Hernandez A, Roney A, Goswami DG, Tewari-Singh N, Brown JM. A review of chemical warfare agents linked to respiratory and neurological effects experienced in Gulf War Illness. Inhal Toxicol 2022; 34:412-432. [PMID: 36394251 PMCID: PMC9832991 DOI: 10.1080/08958378.2022.2147257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Over 40% of veterans from the Persian Gulf War (GW) (1990-1991) suffer from Gulf War Illness (GWI). Thirty years since the GW, the exposure and mechanism contributing to GWI remain unclear. One possible exposure that has been attributed to GWI are chemical warfare agents (CWAs). While there are treatments for isolated symptoms of GWI, the number of respiratory and cognitive/neurological issues continues to rise with minimum treatment options. This issue does not only affect veterans of the GW, importantly these chronic multisymptom illnesses (CMIs) are also growing amongst veterans who have served in the Afghanistan-Iraq war. What both wars have in common are their regions and inhaled exposures. In this review, we will describe the CWA exposures, such as sarin, cyclosarin, and mustard gas in both wars and discuss the various respiratory and neurocognitive issues experienced by veterans. We will bridge the respiratory and neurological symptoms experienced to the various potential mechanisms described for each CWA provided with the most up-to-date models and hypotheses.
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Affiliation(s)
- Angela Cruz-Hernandez
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Roney
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Dinesh G Goswami
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Neera Tewari-Singh
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Jared M Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Ghavami Shahri SH, Balali-Mood M, Heidarzadeh HR, Abrishami M. Ophthalmic Complications and Managements of Sulfur Mustard Exposure: A Narrative Review. ARCHIVES OF IRANIAN MEDICINE 2022; 25:647-657. [PMID: 37543890 PMCID: PMC10685765 DOI: 10.34172/aim.2022.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/23/2022] [Indexed: 08/07/2023]
Abstract
Sulfur mustard (SM) is a lethal chemical agent that affects many organs, particularly the eyes, respiratory system and skin. Even asymptomatic patients with documented SM vapor exposure may develop organ disorder many years later. Patients with even minor signs in the acute stage may experience late complications that necessitate surgery. Early decontamination and conservative measures could help the patients and decrease the complications. Despite decades of research, there is still no effective treatment for either acute or long-term SM-induced ocular complications. Even after multiple medications and surgical procedures, the majority of patients continue to have symptoms. For dry eye, punctual occlusion, autologous eye drops, and aggressive lubrication are used; for persistent epithelial defects (PED), tarsorrhaphy, amniotic membrane transplant, and stem cell transplantation are used; for total limbal stem cell deficiency (LSCD), living-related conjunctivolimbal allograft and keratolimbal allograft are used; for corneal vascularization, steroids, non-steroidal anti-inflammatory drugs, and anti-vascular endothelial growth factor prescribed; and for corneal opacities, corneal transplantation is done. Platelet rich plasma and topical drops containing stem cell transplantation for LSCD, photodynamic therapy paired with subconjunctival or topical anti-vascular endothelial growth factors for corneal vascularization, topical curcumin and topical ciclosporin-A for dry eye, and orbital fat-derived stem cells for PED are all alternative treatments that can be suggested. Despite the experimental and clinical research on the complications of SM exposure over the past decades, there is still no effective treatment for eye complications. However, supportive medical and surgical management has been applied with relatively good outcome.
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Affiliation(s)
| | - Mahdi Balali-Mood
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Mojtaba Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Birjand, Iran
- Ocular Oncology Service, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Canada
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Parvin S, Shahriary A, Aghamollaei H, Gh BFNM, Bagheri H, Ghanei M, Daryabari SH, Jadidi K, Arabfard M. Tear proteomics analysis of patient suffered from delayed mustard gas keratopathy. Proteome Sci 2022; 20:13. [PMID: 35948930 PMCID: PMC9364592 DOI: 10.1186/s12953-022-00195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Understanding the molecular and cellular mechanisms involved in the pathogenesis of ocular injured induced by mustard gas can help better identify complications and discover appropriate therapies. This study aimed to analyze the proteomics of tears of chemical warfare victims with mustard gas ocular injuries and compare it with healthy individuals. In this case-control research, 10 mustard gas victims with long-term ocular difficulties (Chronic) were included in the patient group, while 10 healthy persons who were age and sex matched to the patients were included in the control group. Schirmer strips were used to collect the tears of the participants. Proteomics experiments were performed using the high-efficiency TMT10X method to evaluate the tear protein profile, and statistical bioinformatics methods were used to identify the differently expressed proteins. 24 proteins had different expressions between the two groups. Among these 24 proteins, 8 proteins had increased expression in veterans' tears, while the remaining 16 proteins had decreased expression. Reactome pathways were used to look at proteins with various expressions, and 13 proteins were found to be engaged in the immune system, 9 of which were effective in the innate immune system, and 5 proteins were effective in the complement cascade. Ocular mustard gas exposure may cause a compromised immune system on the eye's surface, exposing the cornea to external and endogenous infections, and eventually causing corneal opacity and reduced vision.
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Affiliation(s)
- Shahram Parvin
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Education Office, Pasture Institute of Iran, Tehran, Iran
| | - Alireza Shahriary
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hossein Aghamollaei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - B Fatemeh Nobakht M Gh
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hasan Bagheri
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed-Hashem Daryabari
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Khosrow Jadidi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Masoud Arabfard
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Timperley CM, Forman JE, Abdollahi M, Al-Amri AS, Baulig A, Benachour D, Borrett V, Cariño FA, Curty C, Geist M, Gonzalez D, Kane W, Kovarik Z, Martínez-Álvarez R, Mourão NMF, Neffe S, Raza SK, Rubaylo V, Suárez AG, Takeuchi K, Tang C, Trifirò F, van Straten FM, Vanninen PS, Vučinić S, Zaitsev V, Zafar-Uz-Zaman M, Zina MS, Holen S, Alwan WS, Suri V, Hotchkiss PJ, Ghanei M. Advice on assistance and protection provided by the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons: Part 3. On medical care and treatment of injuries from sulfur mustard. Toxicology 2021; 463:152967. [PMID: 34619302 DOI: 10.1016/j.tox.2021.152967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/19/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022]
Abstract
Blister agents damage the skin, eyes, mucous membranes and subcutaneous tissues. Other toxic effects may occur after absorption. The response of the Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) to a request from the OPCW Director-General in 2013 on the status of medical countermeasures and treatments to blister agents is updated through the incorporation of the latest information. The physical and toxicological properties of sulfur mustard and clinical effects and treatments are summarised. The information should assist medics and emergency responders who may be unfamiliar with the toxidrome of sulfur mustard and its treatment.
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Affiliation(s)
- Christopher M Timperley
- Chair of the OPCW SAB from 2015-2018, Defence Science and Technology Laboratory (Dstl), Porton Down, Salisbury, Wiltshire, United Kingdom.
| | - Jonathan E Forman
- Science Policy Adviser and Secretary to the SAB, OPCW, The Hague, 2417, JR, the Netherlands, from 2015-2018
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, The Institute of Pharmaceutical Sciences (TIPS), and Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | | | - Augustin Baulig
- Secrétariat Général de la Défense et de la Sécurité Nationale (SGDSN), Paris, France
| | - Djafer Benachour
- LMPMP, Faculty of Technology, Ferhat Abbas University, Setif-1, Algeria
| | - Veronica Borrett
- La Trobe Institute for Agriculture and Food, La Trobe University, Victoria, 3086, Australia
| | | | | | | | - David Gonzalez
- Facultad De Química, Universidad de la República, Montevideo, Uruguay
| | | | - Zrinka Kovarik
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | | | | | | | - Syed K Raza
- Chairperson Accreditation Committee, National Accreditation Board for Testing and Calibration Laboratories (NABL), India
| | - Valentin Rubaylo
- State Scientific Research Institute of Organic Chemistry and Technology (GosNIIOKhT), Moscow, Russian Federation
| | - Alejandra Graciela Suárez
- Universidad Nacional de Rosario, Consejo Nacional de Investigaciones Científicas y Técnicas, Rosario, Argentina
| | - Koji Takeuchi
- National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
| | - Cheng Tang
- Office for the Disposal of Japanese Abandoned Chemical Weapons, Ministry of National Defence, Beijing, China
| | - Ferruccio Trifirò
- Department of Industrial Chemistry, University of Bologna, Bologna, Italy
| | | | - Paula S Vanninen
- VERIFIN, Department of Chemistry, Faculty of Science, University of Helsinki, Helsinki, Finland
| | - Slavica Vučinić
- National Poison Control Centre, Military Medical Academy, Belgrade, Serbia
| | | | | | | | - Stian Holen
- Head of Strategy and Policy at the OPCW from 2009 to 2015
| | - Wesam S Alwan
- Medicinal Chemistry Department, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, 3052, Victoria, Australia
| | - Vivek Suri
- Intern in the OPCW Office of Strategy and Policy, Summer 2018
| | - Peter J Hotchkiss
- Senior Science Policy Officer and Secretary to the SAB, OPCW, The Hague, 2417, JR, the Netherlands.
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
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Gilardoni M, Léonço D, Caffin F, Gros-Désormeaux F, Eldin C, Béal D, Ouzia S, Junot C, Fenaille F, Piérard C, Douki T. Evidence for the systemic diffusion of (2-chloroethyl)-ethyl-sulfide, a sulfur mustard analog, and its deleterious effects in brain. Toxicology 2021; 462:152950. [PMID: 34534560 DOI: 10.1016/j.tox.2021.152950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
Sulfur mustard, a chemical warfare agent known to be a vesicant of skin, readily diffuses in the blood stream and reaches internal organs. In the present study, we used the analog (2-chloroethyl)-ethyl-sulfide (CEES) to provide novel data on the systemic diffusion of vesicants and on their ability to induce brain damage, which result in neurological disorders. SKH-1 hairless mice were topically exposed to CEES and sacrificed at different time until 14 days after exposure. A plasma metabolomics study showed a strong systemic impact following a self-protection mechanism to alleviate the injury of CEES exposure. This result was confirmed by the quantification of specific biomarkers in plasma. Those were the conjugates of CEES with glutathione (GSH-CEES), cysteine (Cys-CEES) and N-acetyl-cysteine (NAC-CEES), as well as the guanine adduct (N7Gua-CEES). In brain, N7Gua-CEES could be detected both in DNA and in organ extracts. Similarly, GSH-CEES, Cys-CEES and NAC-CEES were present in the extracts until day14. Altogether, these results, based on novel exposure markers, confirm the ability of vesicants to induce internal damage following dermal exposure. The observation of alkylation damage to glutathione and DNA in brain provides an additional mechanism to the neurological insult of SM.
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Affiliation(s)
- Marie Gilardoni
- Univ. Grenoble Alpes, CEA, CNRS, IRIG, SyMMES, F-38000, Grenoble, France
| | - Daniel Léonço
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), MetaboHUB, F-91191, Gif sur Yvette, France
| | - Fanny Caffin
- Institut de Recherche Biomédicale des Armées (IRBA), Place Général Valérie André, BP 73, 91223, Brétigny-sur-Orge Cedex, France
| | - Fanny Gros-Désormeaux
- Institut de Recherche Biomédicale des Armées (IRBA), Place Général Valérie André, BP 73, 91223, Brétigny-sur-Orge Cedex, France
| | - Camille Eldin
- Univ. Grenoble Alpes, CEA, CNRS, IRIG, SyMMES, F-38000, Grenoble, France
| | - David Béal
- Univ. Grenoble Alpes, CEA, CNRS, IRIG, SyMMES, F-38000, Grenoble, France
| | - Sadia Ouzia
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), MetaboHUB, F-91191, Gif sur Yvette, France
| | - Christophe Junot
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), MetaboHUB, F-91191, Gif sur Yvette, France
| | - François Fenaille
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), MetaboHUB, F-91191, Gif sur Yvette, France
| | - Christophe Piérard
- Institut de Recherche Biomédicale des Armées (IRBA), Place Général Valérie André, BP 73, 91223, Brétigny-sur-Orge Cedex, France
| | - Thierry Douki
- Univ. Grenoble Alpes, CEA, CNRS, IRIG, SyMMES, F-38000, Grenoble, France.
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Geretto M, Ferrari M, De Angelis R, Crociata F, Sebastiani N, Pulliero A, Au W, Izzotti A. Occupational Exposures and Environmental Health Hazards of Military Personnel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5395. [PMID: 34070145 PMCID: PMC8158372 DOI: 10.3390/ijerph18105395] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Military personnel are frequently exposed to environmental pollutants that can cause a variety of diseases. METHODS This review analyzed publications regarding epidemiological and biomonitoring studies on occupationally-exposed military personnel. RESULTS The exposures include sulfur mustard, organ chlorines, combustion products, fuel vapors, and ionizing and exciting radiations. Important factors to be considered are the lengths and intensities of exposures, its proximity to the sources of environmental pollutants, as well as confounding factors (cigarette smoke, diet, photo-type, healthy warrior effect, etc.). Assessment of environmental and individual exposures to pollutants is crucial, although often omitted, because soldiers have often been evaluated based on reported health problems rather than on excessive exposure to pollutants. Biomarkers of exposures and effects are tools to explore relationships between exposures and diseases in military personnel. Another observation from this review is a major problem from the lack of suitable control groups. CONCLUSIONS This review indicates that only studies which analyzed epidemiological and molecular biomarkers in both exposed and control groups would provide evidence-based conclusions on exposure and disease risk in military personnel.
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Affiliation(s)
- Marta Geretto
- Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy;
| | - Marco Ferrari
- Texas Biomedical Research Institute, 8715 W. Military Drive, San Antonio, TX 78227, USA;
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Filippo Crociata
- General Inspectorate of Military Health, 00184 Rome, Italy; (F.C.); (N.S.)
| | - Nicola Sebastiani
- General Inspectorate of Military Health, 00184 Rome, Italy; (F.C.); (N.S.)
| | | | - William Au
- Faculty of Medicine, Pharmacy, Science and Technology University of Medicine, Pharmacy, Science and Technology, 540142 Targu Mures, Romania;
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Alberto Izzotti
- Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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12
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Toxicology of Blister Agents: Is Melatonin a Potential Therapeutic Option? Diseases 2021; 9:diseases9020027. [PMID: 33920224 PMCID: PMC8167553 DOI: 10.3390/diseases9020027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Blister or vesicant chemical warfare agents (CWAs) have been widely used in different military conflicts, including World War I and the Iran-Iraq War. However, their mechanism of action is not fully understood. Sulfur and nitrogen mustard exert toxic effects not only through the alkylation of thiol-bearing macromolecules, such as DNA and proteins, but also produce free radicals that can develop direct toxic effects in target organs such as the eyes, skin, and respiratory system. The lack of effective treatments against vesicant CWAs-induced injury makes us consider, in this complex scenario, the use and development of melatonin-based therapeutic strategies. This multifunctional indoleamine could facilitate neutralization of the oxidative stress, modulate the inflammatory response, and prevent the DNA damage, as well as the long-term health consequences mediated by vesicant CWAs-induced epigenetic mechanisms. In this context, it would be essential to develop new galenic formulations for the use of orally and/or topically applied melatonin for the prophylaxis against vesicant CWAs, as well as the development of post-exposure treatments in the near future.
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Amini H, Solaymani-Dodaran M, Mousavi B, Alam Beladi SN, Soroush MR, Abolghasemi J, Vahedian-Azimi A, Salesi M, Guest PC, Sahebkar A, Ghanei M. Long-term Health Outcomes Among Survivors Exposed to Sulfur Mustard in Iran. JAMA Netw Open 2020; 3:e2028894. [PMID: 33301016 PMCID: PMC7729433 DOI: 10.1001/jamanetworkopen.2020.28894] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE The prevalence and severity of long-term health complications after exposure to sulfur mustard are unknown. OBJECTIVE To investigate the long-term health outcomes among survivors exposed to sulfur mustard during the Iran-Iraq War. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, late-onset health complications of 64 190 Iranian survivors exposed to sulfur mustard during the Iran-Iraq War from 1980 to 1988 were investigated using descriptive statistics. Data involving affected organs and symptom severity were extracted from the Veterans and Martyr Affair Foundation (VMAF) database from 1980 to 2019. Assessments were conducted across 3 groups depending on whether survivors were (1) evacuated and admitted (EA) to a hospital; (2) not evacuated or admitted (NEA) to a hospital; or (3) evacuation or admission status was not documented. EXPOSURES Analysis of chronic symptom severity following exposure to sulfur mustard. MAIN OUTCOMES AND MEASURES Mild, moderate, or severe rankings of symptoms in lungs, eyes, and skin of survivors exposed to sulfur mustard using data from the VMAF database. RESULTS Of 64 190 chemical survivors registered in the VMAF database, 60 861 met the inclusion criteria. Of the included survivors, 98.0% were male, and the mean (SD) age was 23.5 (7.7) years. Most survivors (53 675 [88.2%]) had no symptoms or mild lesions, and 7186 survivors (11.8%) had moderate or severe complications. Moderate to severe lung (6540 [10.7%]), eye (335 [0.6%]), or skin (725 [1.2%]) injuries were documented in the exposed population. The proportion of moderate plus severe late complications in eyes was 3 times as high in male survivors compared with female survivors (0.6% [95% CI, 0.53%-0.65%] vs 0.2% [95% CI, 0.09%-0.73%]; P < .001), whereas dermal complications were significantly more common in female survivors (3.9% [95% CI, 2.92%-5.11%] vs 1.14% [95% CI, 1.06%-1.23%]; P < .001). Mild lung lesions were more prevalent in the NEA group than in the EA group (73.9% [95% CI, 73.4%-74.4%] vs 11.0% [95% CI, 10.6%-11.3%]; P < .001). In the NEA group, 83.2% (n = 23 866) developed lung injuries that were mostly mild or moderate, whereas 77% (n = 24 766) of the EA group did not develop lung injuries (P < .001). CONCLUSIONS AND RELEVANCE The present study found sex differences in the frequencies of eye and skin complications following sulfur mustard exposure, and lung complications were more prevalent years after sulfur mustard exposure than soon after exposure. Mild lung lesions were observed more frequently among sulfur mustard-exposed survivors who had not been evacuated or hospitalized than among those who had been evacuated or hospitalized. These differences may be due to physiological response or dose of exposure. Close monitoring over an extended period may be required for detection of late pulmonary complications in individuals exposed to sulfur mustard.
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Affiliation(s)
- Hossein Amini
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Solaymani-Dodaran
- Minimally Invasive Surgery Research Center, Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
- Division of Epidemiology and Public Health, the University of Nottingham, United Kingdom
| | - Batool Mousavi
- Prevention Department, Janbazan Medical and Engineering Research Center, Tehran, Iran
| | | | - Mohammad Reza Soroush
- Prevention Department, Janbazan Medical and Engineering Research Center, Tehran, Iran
| | - Jamileh Abolghasemi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahmoud Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Paul C. Guest
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, São Paulo, Brazil
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Sawyer TW. N-Acetylcysteine as a treatment for sulphur mustard poisoning. Free Radic Biol Med 2020; 161:305-320. [PMID: 32980537 PMCID: PMC7516373 DOI: 10.1016/j.freeradbiomed.2020.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/04/2020] [Accepted: 09/20/2020] [Indexed: 01/18/2023]
Abstract
In the long and intensive search for effective treatments to counteract the toxicity of the chemical warfare (CW) agent sulphur mustard (H; bis(2-chloroethyl) sulphide), the most auspicious and consistent results have been obtained with the drug N-acetylcysteine (NAC), particularly with respect to its therapeutic use against the effects of inhaled H. It is a synthetic cysteine derivative that has been used in a wide variety of clinical applications for decades and a wealth of information exists on its safety and protective properties against a broad range of toxicants and disease states. Its primary mechanism of action is as a pro-drug for the synthesis of the antioxidant glutathione (GSH), particularly in those circumstances where oxidative stress has exhausted intracellular GSH stores. It impacts a number of pathways either directly or through its GSH-related antioxidant and anti-inflammatory properties, which make it a prime candidate as a potential treatment for the wide range of deleterious cellular effects that H is acknowledged to cause in exposed individuals. This report reviews the available literature on the protection afforded by NAC against the toxicity of H in a variety of model systems, including its efficacy in treating the long-term chronic lung effects of H that have been demonstrated in Iranian veterans exposed during the Iran-Iraq War (1980-1988). Although there is overwhelming evidence supporting this drug as a potential medical countermeasure against this CW agent, there is a requirement for carefully controlled clinical trials to determine the safety, efficacy and optimal NAC dosage regimens for the treatment of inhaled H.
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Affiliation(s)
- Thomas W Sawyer
- Defence Research & Development Canada, Suffield Research Centre, Box 4000, Medicine Hat, Alberta, T1A 8K6, Canada.
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15
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Farnoosh G, Ghanei M, Khorramdelazad H, Alishiri G, Jalali Farahani A, Shahriary A, Hosseini Zijoud SR. Are Iranian Sulfur Mustard Gas-Exposed Survivors More Vulnerable to SARS-CoV-2? Some Similarity in Their Pathogenesis. Disaster Med Public Health Prep 2020; 14:826-832. [PMID: 32418550 PMCID: PMC7306405 DOI: 10.1017/dmp.2020.156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/13/2020] [Indexed: 02/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged as a health problem worldwide. It seems that COVID-19 is more lethal for Iranian veterans with a history of exposure to mustard gas. There are some similarities in the pathogenesis of SARS-CoV-2 and mustard gas in immune system disruption and pulmonary infection. SARS-CoV-2 and mustard gas inducing oxidative stress, immune system dysregulation, cytokine storm, and overexpression of angiotensin-converting enzyme II (ACE2) receptor in lungs that act as functional entry receptors for SARS-CoV-2. Moreover, Iranian survivors of mustard gas exposure are more susceptible and vulnerable to COVID-19. It is suggested that the principles of COVID-19 infection prevention and control be adhered to more stringently in Iranian survivors of mustard gas exposure than others who have not been exposed to mustard gas. Therefore, in this review, we discuss the different pathologic aspects of lung injury caused by mustard gas and also the relationship between this damage and the increased susceptibility of Iranian mustard gas exposed survivors to COVID-19.
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Affiliation(s)
- Gholamreza Farnoosh
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hossein Khorramdelazad
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Immunology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Gholamhossein Alishiri
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Alireza Shahriary
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Hosseini Zijoud
- Clinical Research Development Unit, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sadeghi S, Tapak M, Ghazanfari T, Mosaffa N. A review of Sulfur Mustard-induced pulmonary immunopathology: An Alveolar Macrophage Approach. Toxicol Lett 2020; 333:115-129. [PMID: 32758513 DOI: 10.1016/j.toxlet.2020.07.035] [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: 04/07/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/27/2022]
Abstract
Despite many studies investigating the mechanism of Sulfur Mustard (SM) induced lung injury, the underlying mechanism is still unclear. Inflammatory and subsequent fibroproliferative stages of SM-toxicity are based upon several highly-related series of events controlled by the immune system. The inhalation of SM gas variably affects different cell populations within the lungs. Various studies have shown the critical role of macrophages in triggering a pulmonary inflammatory response as well as its maintenance, resolution, and repair. Importantly, macrophages can serve as either pro-inflammatory or anti-inflammatory populations depending on the present conditions at any pathological stage. Different characteristics of macrophages, including their differentiation, phenotypic, and functional properties, as well as interactions with other cell populations determine the outcomes of lung diseases and the extent of long- or short-term pulmonary damage induced by SM. In this paper, we summarize the current state of knowledge regarding the role of alveolar macrophages and their mediators in the pathogenesis of SM in pulmonary injury. Investigating the specific cells and mechanisms involved in SM-lung injury may be useful in finding new target opportunities for treatment of this injury.
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Affiliation(s)
- Somaye Sadeghi
- Student Research Committee, Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahtab Tapak
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tooba Ghazanfari
- Immunoregulation Research Center, Shahed University, Tehran, Iran; Department of Immunology, Shahed University, Tehran, Iran.
| | - Nariman Mosaffa
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Salouti R, Ghazavi R, Rajabi S, Zare M, Talebnejad M, Abtahi MB, Parvizi M, Madani S, Asadi-Amoli F, Mirsharif ES, Gharebaghi R, Heidary F. Sulfur Mustard and Immunology; Trends of 20 Years Research in the Web of Science Core Collection: A Scientometric Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1202-1210. [PMID: 33083286 PMCID: PMC7548481 DOI: 10.18502/ijph.v49i7.3573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background We aimed to use the scientometric approach to evaluate immunological studies on the subject of sulfur mustard over the past 20 years. Methods In this scientometric study, the Web of Science Core Collection was searched on the studies about sulfur mustard. The published papers related to the field of immunology were retrieved from these papers. HistCite software and VOSviewer were the applied software packages for bibliometric analysis, information visualization, and creating bibliometric networks. Results Over the past 20 years, 741 researchers from 22 countries have published 201 scientific papers in 95 journals. Iran and the United States with 93 and 68 published articles ranked at the top. The Journal of International Immunopharmacology, with 33 published papers, 439 Total Global Citation Score (TGCS), and 105 Total Local Citation Score (TLCS) was the most productive and most influential in this regard. The paper entitled "Biomonitoring of exposure to chemical warfare agents: A review" and another paper entitled "Sardasht-Iran Cohort Study of Chemical Warfare Victims: Design and Methods" were the most influential papers in this topic with 200 TGCS and 27 TLCS, respectively. The most productive and the most influential centers were "Immunoregulation Research Center of Shahed University" and "The Janbazan Medical and Engineering Research Center (JMERC)," respectively. Conclusion The result of our report as the unique scientometric evaluation of the research on sulfur mustard and Immunology can be used as a roadmap for authors, researchers, and policymakers to define the best ways to allocate their financial and executive resources.
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Affiliation(s)
- Ramin Salouti
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Salouti Eye Research Center, Salouti Eye Clinic, Shiraz, Iran
| | - Roghayeh Ghazavi
- Vice Chancellery of Research and Technology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sattar Rajabi
- Department of Optometry, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zare
- Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Talebnejad
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Bagher Abtahi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Parvizi
- Department of Pathology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Madani
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Asadi-Amoli
- Department of Pathology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Gharebaghi
- Kish International Campus, University of Tehran, Tehran, Iran
| | - Fatemeh Heidary
- Ophthalmology Division, Taleghani Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Etemad L, Moshiri M, Balali-Mood M. Advances in treatment of acute sulfur mustard poisoning - a critical review. Crit Rev Toxicol 2020; 49:191-214. [PMID: 31576778 DOI: 10.1080/10408444.2019.1579779] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sulfur mustard (SM) is a blistering chemical warfare agent that was used during the World War I and in the Iraq-Iran conflict. The aim of this paper is to discuss and critically review the published results of experiments on the treatment of SM poisoning based on our clinical and research experience. The victims must remove from the contaminated zone immediately. The best solution for decontamination is large amounts of water, using neutral soap and 0.5% sodium hypochlorite. Severely intoxicated patients should be treated according to advanced life support protocols and intensive care therapy for respiratory disorders and the chemical burn. Sodium thiosulfate infusion (100-500 mg/kg/min) should be started up to 60 min after SM exposure. However, N-acetyle cysteine (NAC) is recommended, none of them acts as specific or effective antidote. The important protective and conservative treatment of SM-induced pulmonary injuries include humidified oxygen, bronchodilators, NAC as muculytic, rehydration, mechanical ventilation, appropriate antibiotics and respiratory physiotherapy as clinically indicated. Treatment of acute SM ocular lesions start with topical antibiotics; preferably sulfacetamide eye drop, continue with lubricants, and artificial tears. Treatment for cutaneous injuries include: moist dressing; preferably with silver sulfadiazine cream, analgesic, anti-pruritic, physically debridement, debridase, Laser debridement, followed by skin autologous split-thickness therapy as clinically indicated. The new suggested medications and therapeutic approaches include: anti-inflammatory agents, Niacinamide, Silibinin, Calmodulin antagonists, Clobetasol, full-thickness skin grafting for skin injuries; Doxycycline; Bevacizumab, and Colchicine for ocular injuries. Recommended compounds based on animal studies include Niacinamide, Aprotinin, des-aspartate-angiotensin-I, Gamma-glutamyltransferase, vitamin E, and vitamin D. In vitro studies revealed that Dimethylthiourea, L-nitroarginine, Methyl-ester, Sodium pyruvate, Butylated hydroxyanisole, ethacrynic acid, and macrolide antibiotics are effective. However, none of them, except macrolide antibiotics have been proved clinically. Avoidance of inappropriate polypharmacy is advisable.
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Affiliation(s)
- Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Mahdi Balali-Mood
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences , Birjand , Iran
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Ghazanfari T, Mostafaie A, Talebi F, Mahdavi MRV, Yarmohammadi ME, Askari N, Moaiedmohseni S, Majd AMM, Mirsharif ES, Ghazanfari Z, Hassan ZM, Shams J, Jamali D, Faghihzadeh S. Alteration in serum levels of immunoglobulins in seriously eye-injured long-term following sulfur-mustard exposure. Int Immunopharmacol 2020; 80:105895. [DOI: 10.1016/j.intimp.2019.105895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 12/11/2022]
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Abstract
It was aimed to investigate possible late cardiac effects of Sulfur mustard (SM) exposure in Iranian veterans. Thirty-eight veterans with late complications of SM exposure were investigated. Clinical history, physical examinations, 12 leads electrocardiography and transthoracic echocardiography were performed. Computed tomography coronary angiography (CTCA) was performed as clinically indicated for angiographic assessment and patients were stratified according to the CTCA findings. Incomplete right bundle branch block and right axis deviation were detected in 3 (7.9%) and 4 (10.5%) cases, respectively. Mean value of left ventricular ejection fraction was 55.7 ± 2.9%. Different degrees of right ventricular dilation was observed in seven (18.4%) patients. All the patients showed mild to moderate degrees of tricuspid regurgitation. Increased pulmonary artery pressure (PAP) was detected in 16 (42.1%) patients. Out of 18 patients who underwent CTCA, non-obstructive and obstructive coronary artery disease (CAD) were observed in three (16.66%) and eight (44.44%) patients, respectively. CAD was stratified to single vessel (5.5%), two vessels (27.8%) and three vessels disease (11.1%). Mean coronary artery calcium score was 50.91 ± 115.58. SM has cardiovascular toxicity, as a delayed complication of this chemical warfare poisoning.
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Majd AMM, Faghihzadeh S, Pourfarzam S, Eghtedardoost M, Jamali D, Mirsharif ES, Dilmaghanian R, Ghazanfari T. Serum and sputum levels of IL-17, IL-21, TNFα and mRNA expression of IL-17 in sulfur mustard lung tissue with long term pulmonary complications (28 years after sulfur mustard exposure). Int Immunopharmacol 2019; 76:105828. [DOI: 10.1016/j.intimp.2019.105828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 01/16/2023]
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Ghasemi H, Javadi MA, Ardestani SK, Mahmoudi M, Pourfarzam S, Mahdavi MRV, Yarmohammadi ME, Baradaran-Rafii A, Jadidi K, Shariatpanahi S, Rastin M, Heidary F, Safavi M, Mirsharif ES, Nasiri Z, Ghazanfari T. Alteration in inflammatory mediators in seriously eye-injured war veterans, long-term after sulfur mustard exposure. Int Immunopharmacol 2019; 80:105897. [PMID: 31685435 DOI: 10.1016/j.intimp.2019.105897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/26/2019] [Accepted: 09/06/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sulfur mustard (SM) exposure produces extensive systemic and ocular adverse effects on the victims. One of the most important effects is immunological insults that can lead to other organ damages, including the eyes. METHODS In this descriptive study, 128 SM-exposed veterans with severe eye injury were compared with 31 healthy controls. Tear levels of tumor necrosis factor (TNF)-α and serum concentrations of interleukin (IL)-1α, IL-1β, IL1Ra, IL-6, TNF-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and Fas Ligand (FasL) were compared between the two groups. RESULTS Meibomian gland dysfunction (MGD); tear breakup time (TBUT < 10″); and conjunctival, limbal, and corneal abnormalities were more frequent among the cases (MS-exposed veterans) than the controls. Ocular involvement was mild in 14.8%, moderate in 24.2%, and severe in 60.9% of the cases. Serum levels of IL-1α and FasL were significantly higher among the cases than among the controls (P < 0.001 and P = 0.037, respectively). Also, a significant decrease was observed in serum and tear levels of TNF-α in the cases as compared with controls (P < 0.001, P < 0.001, respectively). Serum levels of FasL were significantly higher in cases with severe ocular involvement than in the controls (P = 0.03). Nonetheless, serum levels of IL-1β, IL-1Ra, IL-1α/IL-1Ra, and IL-6 were not significantly different between the two groups. CONCLUSION Serum levels of IL-1α and FasL may cause different ocular surface abnormalities in SM-exposed patients. Lower tear TNF-α concentration may be due to lower serum levels of this cytokine in these patients.
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Affiliation(s)
- Hassan Ghasemi
- Department of Ophthalmology, Shahed University, Tehran 3319118651, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1983969411, Iran
| | - Sussan K Ardestani
- Department of Immunology, Institute of Biochemistry and Biophysics, University of Tehran, Tehran 1417614335, Iran.
| | - Mahmoud Mahmoudi
- Immunology Research Center, Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad 9138813944, Iran.
| | | | | | | | - Alireza Baradaran-Rafii
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, No 23, Paydarfard-9th Boostan St., Pasdaran Ave, Tehran 1666673111, Iran
| | - Khosro Jadidi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran 1435915371, Iran
| | | | - Maryam Rastin
- Immunology Research Center, Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad 9138813944, Iran.
| | - Fatemeh Heidary
- Immunoregulation Research Center, Shahed University, Tehran 3319118651, Iran
| | - Maliheh Safavi
- Department of Biotechnology, Iranian Research Organization for Science and Technology, Sh. Ehsani Rad St., Enqelab St., Parsa Sq., Ahmadabad Mostoufi Rd., Azadegan Highway, Tehran 3313193685, Iran
| | | | - Zahra Nasiri
- Immunoregulation Research Center, Shahed University, Tehran 3319118651, Iran
| | - Tooba Ghazanfari
- Immunoregulation Research Center, Shahed University, Tehran 3319118651, Iran; Department of Immunology, Shahed University, Tehran 3319118651, Iran.
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Peripheral blood mononuclear cellular viability and its correlation with long-term pulmonary complications after sulfur mustard exposure. Int Immunopharmacol 2019; 76:105814. [PMID: 31493666 DOI: 10.1016/j.intimp.2019.105814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Sulfur mustard (SM) as a chemical warfare agent has short- and long-term complications on its victims. Complications of exposure to SM depend on the level of contamination. Long-term pulmonary complications are the most serious problems. Recent evidence has shown that absorbed SM can be conducted to other tissues by the bloodstream. In this study, we evaluated the long-term effects of SM on the vital activity of peripheral blood mononuclear cells (PBMCs) in SM-exposed patients with long-term pulmonary complications. MATERIALS AND METHODS Our study samples were 110 patients with long-term pulmonary complications in the SM-exposed group and 109 unexposed individuals in the control group. After clinical examination and pulmonary function tests, the severity of pulmonary complications was classified. Also, the participants' peripheral blood was taken into EDTA-treated Vacutainer tubes. Then, the complete blood count (CBC) was calculated, and PBMCs was purified from whole blood using Ficol-Paque gradient method, finally, the vital activity was assessed by MTT assay. RESULT The vital activity of PBMCs in the SM-exposed group with the mitogen was significantly lower than that in the control group (P = 0.016). Whereas, there was no significant difference in the viability of PBMCs without the mitogen between two groups. Furthermore, hematologic findings indicated that the SM-exposed group had a significant increase in the total count of WBC, neutrophil, MCV, and HCT values but the lymphocyte count and MCHC value were significantly lower than those in the control group. CONCLUSION Exposure to SM even after a long time, can affect hematologic parameters and vital activity of PBMCs.
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Balali-Mood M, Riahi-Zanjani B, Mahmoudi M, Sadeghi M. Current status of the acquired immune system of Iranian patients with long-term complications of sulfur mustard poisoning. ACTA ACUST UNITED AC 2019; 27:43-48. [PMID: 30715678 DOI: 10.1007/s40199-019-00239-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sulfur mustard (SM) is a powerful blistering chemical warfare agent that has genotoxic effects. Cells with excessive proliferation such as lymphocytes may inherit this cellular toxicity which can lead to their malfunctions in the long-term. This study was designed to evaluate the status of acquired immunity among SM poisoned veterans around three decades after exposure. METHODS Thirty five male Iranian veterans having at least 25% disability due to SM poisoning with long-term complications in the respiratory system, skin or eyes were investigated. Non-functional/functional tests including hematological parameters, immunostaining analysis, lymphocyte proliferation assay, cytokine profile, and levels of total serum IgM, IgG and IgA were performed. RESULTS The results showed that most of the parameters of adaptive immune system of the veterans were currently within the normal ranges. However, changes in the proliferation index (PI) of lymphocytes showed problems with the lymphocytes which cannot be proliferated appropriately. PI values for PBMCs (peripheral blood mononuclear cells) in presence of PHA (Phytohemagglutinin-A) and LPS (lipopolysaccharide) mitogens were 1.16 ± 0.14 and 1.13 ± 0.07, respectively which are less than expected. CONCLUSIONS Based on the results gathered in this study, most of the parameters of acquired immunity were normal. However, the observed failure of lymphocyte functions may disrupt physiological activity of whole immune system leading to long-term complications; including recurrent respiratory tract infections. Indeed, further cellular and molecular studies with regard to lymphocytes function are required to better understand the status of adaptive immunity in these patients. Graphical abstract ᅟ.
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Affiliation(s)
- Mahdi Balali-Mood
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Bamdad Riahi-Zanjani
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmood Sadeghi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Beigi Harchegani A, Mirnam Niha M, Sohrabiyan M, Ghatrehsamani M, Tahmasbpour E, Shahriary A. Cellular and molecular mechanisms of sulfur mustard toxicity on spermatozoa and male fertility. Toxicol Res (Camb) 2018; 7:1029-1035. [PMID: 30510677 PMCID: PMC6220723 DOI: 10.1039/c8tx00062j] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/09/2018] [Indexed: 12/21/2022] Open
Abstract
Sulfur mustard (SM) is a toxic compound that can target human spermatozoa. SM induces a wide variety of pathological effects in human reproductive organs, including sexual hormone disturbance, testicular atrophy, impaired spermatogenesis, poor sperm quality, defects in embryo development, childhood physical abnormalities, and severe fertility problems. However, the molecular and cellular mechanisms of SM action on male reproductive health and human sperm function are unclear. Excessive production of reactive oxygen species and the resulting oxidative stress is likely a significant mechanism of SM action, and could be associated with sperm DNA damage, membrane lipid peroxidation, reduced membrane fluidity, mitochondrial deficiency, apoptosis, and poor sperm quality. In this review, we aim to discuss the cellular and molecular mechanisms of SM action on sperm and reproductive health, the significance of OS, and the mechanisms through which SM enhances the infertility rate among SM-exposed individuals.
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Affiliation(s)
- Asghar Beigi Harchegani
- Chemical Injuries Research Center , Systems biology and poisonings institute , Baqiyatallah University of Medical Sciences , Tehran , Iran . ; Tel: +21-82482502
| | - Mahdiyeh Mirnam Niha
- Department of Medical Radiation Engineering , Central Tehran Branch , Islamic Azad University , Tehran , Iran
| | - Milad Sohrabiyan
- Chemical Injuries Research Center , Systems biology and poisonings institute , Baqiyatallah University of Medical Sciences , Tehran , Iran . ; Tel: +21-82482502
| | - Mahdi Ghatrehsamani
- Cellular and Molecular Research Center , Shahrekord University of Medical Sciences , Shahrekord , Iran
| | - Eisa Tahmasbpour
- Laboratory of Regenerative Medicine & Biomedical Innovations , Pasteur Institute of Iran , Tehran , Iran . ; Tel: +21-9111193051
| | - Alireza Shahriary
- Chemical Injuries Research Center , Systems biology and poisonings institute , Baqiyatallah University of Medical Sciences , Tehran , Iran . ; Tel: +21-82482502
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Beigi Harchegani A, Khor A, Tahmasbpour E, Ghatrehsamani M, Bakhtiari Kaboutaraki H, Shahriary A. Role of oxidative stress and antioxidant therapy in acute and chronic phases of sulfur mustard injuries: a review. Cutan Ocul Toxicol 2018; 38:9-17. [DOI: 10.1080/15569527.2018.1495230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Asghar Beigi Harchegani
- Chemical Injuries Research Center, Systems biology and poisonings institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abolfazl Khor
- Chemical Injuries Research Center, Systems biology and poisonings institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Eisa Tahmasbpour
- Laboratory of Regenerative Medicine & Biomedical Innovations, Pasteur Institute of Iran, Tehran, Iran
| | - Mahdi Ghatrehsamani
- Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hamid Bakhtiari Kaboutaraki
- Chemical Injuries Research Center, Systems biology and poisonings institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Shahriary
- Chemical Injuries Research Center, Systems biology and poisonings institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Simons T, Steinritz D, Bölck B, Schmidt A, Popp T, Thiermann H, Gudermann T, Bloch W, Kehe K. Sulfur mustard-induced epigenetic modifications over time − a pilot study. Toxicol Lett 2018; 293:45-50. [DOI: 10.1016/j.toxlet.2017.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 01/12/2023]
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Khateri S, Balali-Mood M, Blain P, Williams F, Jowsey P, Soroush MR, Behravan E, Sadeghi M. DNA damage and repair proteins in cellular response to sulfur mustard in Iranian veterans more than two decades after exposure. Toxicol Lett 2018; 293:67-72. [DOI: 10.1016/j.toxlet.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/28/2017] [Accepted: 12/03/2017] [Indexed: 01/15/2023]
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Riahi-Zanjani B, Balali-Mood M, Mahmoudi M, Sadeghi M. Innate Immune System Status of Sulphur Mustard-Poisoned Iranian Veterans Three Decades after Exposure. Basic Clin Pharmacol Toxicol 2018; 123:635-639. [PMID: 29888462 DOI: 10.1111/bcpt.13053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022]
Abstract
Sulphur mustard (SM) is an incapacitating chemical warfare agent which causes acute and chronic toxicities in different body organs of affected individuals. The aim of this study was to investigate the innate immune status of the Iranian veterans who were exposed to SM around 30 years earlier and had more than 25% disabilities. In this regard, most functional and non-functional parameters of innate immunity were evaluated in 35 veterans. Phagocytic activity, nitroblue tetrazolium (NBT) reduction assay and haemolytic complement activity (HCA) in addition to routine haematological parameters, serum protein electrophoresis, complements C3 and C4 levels were studied. Measures of haematological parameters, serum proteins, C3 and C4 were almost within the normal range. Functional experiments such as phagocytic activity, NBT reduction assay and HCA were normal as well. However, serum protein analysis revealed a fair decrease in percentages of α1 -globulin. Mean values of the parameters of innate immune system of the veterans three decades after SM poisoning were almost within the upper and lower normal limits. Reduced α1 -globulin - maybe subsequent to a chain of SM-induced genetic disorders - may have been the result of α1 -antitrypsin deficiency which may result in prevalent respiratory complications among these veterans. As a supplementary study, measurement of serum α1 -antitrypsin in SM-poisoned veterans could be beneficial. Further studies are required to prove this hypothesis. Further investigations on the evaluation of the acquired immunity parameters as the second line of defence may reveal a better understanding of SM veterans' immune system status.
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Affiliation(s)
- Bamdad Riahi-Zanjani
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Balali-Mood
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmood Sadeghi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Khazdair MR, Boskabady MH. Long term effect of sulfur mustard exposure on hematologic and respiratory status, a case control study. Drug Chem Toxicol 2018; 42:295-299. [DOI: 10.1080/01480545.2018.1463239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mohammad Reza Khazdair
- Pharmaceutical Research Center and Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hossein Boskabady
- Neurogenic Inflammation Research Center and Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Etemad L, Moshiri M, Balali-Mood M. Delayed Complications and Long-Term Management of Sulfur Mustard Poisoning: A Narrative Review of Recent Advances by Iranian Researchers Part ІІ: Clinical Management and Therapy. IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:235-247. [PMID: 29892141 PMCID: PMC5993908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present study aimed to review and discuss the recommended and recently suggested protocols by Iranian researchers for a long-term treatment of delayed complications of sulfur mustard (DCSM) in veterans. As indicated clinically, patients who suffer from delayed ocular complications of sulfur mustard (DOCS) benefit from treatments for dry eyes, therapeutic contact lenses, amniotic membrane transplantation; blepharorrhaphy, tarsorrhaphy, limbal stem cell transplantation; corneal transplantation, topical steroids, and immunosuppressive. In spite of penetrating keratoplasty, lamellar keratoplasty and keratolimbal allograft had a good long-term survival. Delayed respiratory complications (DRCS) are the most common effects and life-threatening in Iranian veterans. The recommended treatment protocols include regular clinical evaluations, respiratory physiotherapy and rehabilitation, N-acetyl cysteine; warm humidified air, long-acting b2-agonists, and inhaled corticosteroids. Azithromycin has also been effective in improving clinical conditions, pulmonary function tests, inflammatory indexes, and life quality of the veterans. Interferon gamma (IFN-γ) and helium: oxygen combination were also used in severe DRCS with good results. Some of the delayed cutaneous complications (DCCS) such as itching affects the quality of life of victims. Regular but not frequent showering and bathing, applying sunscreen compounds, topical corticosteroids, and systemic antihistamines reduce the problems of DCCS patients. Several compounds such as capsaicin cream, pimecrolimus, IFN-γ, phenol-menthol; Aloe vera/olive oil cream, cetirizine, doxepine, and hydroxyzine were evaluated in DCCS patients with some benefits. The physicians in charge of veterans emphasize the importance of a healthy lifestyle, appropriate financial/social/cultural supports, and a degree of reassurance and supportive care on the clinical improvement of patients.
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Affiliation(s)
- Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Balali-Mood
- Medical Toxicology Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Darchini-Maragheh E, Balali-Mood M. Delayed Complications and Long-term Management of Sulfur Mustard Poisoning: Recent Advances by Iranian Researchers (Part I of II). IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:103-124. [PMID: 29749980 PMCID: PMC5936843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Chemical warfare agents are the most brutal weapons among the weapons of mass destruction. Sulfur mustard (SM) is a potent toxic alkylating agent known as "the King of the Battle Gases". SM has been the most widely used chemical weapon during the wars. It was widely used in World War I. Thereafter, it was extensively employed by the Iraqi troops against the Iranian military personnel and even civilians in the border cities of Iran and Iraq in the period between 1983 and 1988. Long-term incapacitating properties, significant environmental persistence, lack of an effective antidote, and relative ease of manufacturing have kept SM a potential agent for both terrorist and military uses. Even 3 decades after SM exposure, numerous delayed complications among Iranian victims are still being reported by researchers. The most common delayed complications have been observed in the respiratory tracts of chemically injured Iranian war veterans. Also, skin lesions and eye disorders have been observed in most Iranian SM-exposed war veterans in the delayed phase of SM intoxication. Thus, extensive research has been conducted on Iranian war veterans during the past decades. Nevertheless, major gaps still continue to exist in the SM literature. Part I of this paper will discuss the delayed complications and manifestations of exposure to SM among Iranian victims of the Iran-Iraq conflict. Part II, which will appear in the next issue of Iran J Med Sci, will discuss the long-term management and therapy of SM-exposed patients.
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Proteomic features of delayed ocular symptoms caused by exposure to sulfur mustard: As studied by protein profiling of corneal epithelium. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2017; 1865:1445-1454. [DOI: 10.1016/j.bbapap.2017.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 08/11/2017] [Accepted: 08/31/2017] [Indexed: 12/21/2022]
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Panahi Y, Abdolghaffari AH, Sahebkar A. A review on symptoms, treatments protocols, and proteomic profile in sulfur mustard‐exposed victims. J Cell Biochem 2017; 119:197-206. [DOI: 10.1002/jcb.26247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 06/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Yunes Panahi
- Chemical Injuries Research CentreBaqiyatallah University of Medical SciencesTehranIran
| | - Amir H. Abdolghaffari
- Medicinal Plants Research CenterInstitute of Medicinal Plants, ACECRKarajIran
- Gastrointestinal Pharmacology Interest Group (GPIG)Universal Scientific Education and Research Network (USERN)TehranIran
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Paraclinical findings in Iranian veterans exposed to sulfur mustard gas: A literature review. Chin J Traumatol 2017; 20:114-117. [PMID: 28356208 PMCID: PMC5392711 DOI: 10.1016/j.cjtee.2016.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 04/10/2016] [Accepted: 05/12/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Sulfur mustard (SM) causes various systemic disturbances in human beings. This study aimed to assess paraclinical changes caused by exposure to SM gas in Iranian veterans during the war between Iraq and Iran. METHODS A literature review was carried out in international and national medical databases including ISI, Medline, Scopus, Iranmedex and Irandoc. Both Farsi and English literature were searched. RESULTS Search of the literature yielded 422 medical articles related to SM poisoning. Among them, 30 relevant articles were thoroughly reviewed. The most important reported complications were leukopenia, neutropenia, lymphopenia, eosinophilia, thrombocytopenia, increased bleeding time, positive C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), decreased T helper cells, natural killer cells, IL6, and IL8 levels, elevation of serum immunoglobulins, decreased levels of T3, T4 and cortisol, increased level of adrenocorticotropic hormone (ACTH), proteinuria, hematuria, and elevated liver enzymes. Also, there were some changes in chest assessments. CONCLUSIONS SM causes profound systemic complications in victims, even years after exposure. The paraclinical changes can be observed in hematology, immune system, biochemistry, hormonal profile and some imaging studies.
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Shoeibi N, Mousavi MN, Balali-Mood M, Moshiri M, Darchini-Maragheh E, Mousavi SR, Abrishami M. Long-term complications of sulfur mustard poisoning: retinal electrophysiological assessment in 40 severely intoxicated Iranian veterans. Int J Retina Vitreous 2017; 3:7. [PMID: 28286669 PMCID: PMC5338090 DOI: 10.1186/s40942-017-0059-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The eye is one of the most sensitive organs to sulfur mustard (SM) [C4H8Cl2S], and preliminary symptoms of exposure usually become evident in the eyes. In this study we aim to evaluate the possible long-term retinal electrophysiologic complications of SM poisoning in Iranian veterans during Iran-Iraq war (1980-1988). METHODS In a cross-sectional study forty Iranian veterans who were exposed to mustard gas during the Iran-Iraq war (1980-1988) were included. All the cases underwent complete ocular exam and retinal electrophysiological evaluation, including electroretinography (ERG) and electrooculography (EOG). Data was analyzed using SPSS software. The normal distribution was checked using the Shapiro-Wilk test. Comparison of electrophysiologic values with maximum standard levels was performed using one-sample Student t-test and test of significance was one-tailed. RESULTS Foreign body sensation (70%), dry eye (50%), photophobia (30%), lacrimation (20%) and pain sensation (10%) were among the common symptoms. ERG showed significant reduced amplitude in rod response, maximal combined response, oscillatory potentials, cone response and 30 Hz flicker waves compared to normal values (p < 0.05). Implicit time of b-wave rod response ERG recording was significantly decreased (p < 0.05). Implicit time of cone response b-wave was within normal limits. In EOG, Arden ratio did not decrease (total average of 2.311 and 2.48 in right and left eyes, respectively). CONCLUSION Delayed toxic effects of SM poisoning in the veterans were observed in the retina, but not in the retinal pigment epithelium layer. As the retina is a neural tissue, long-term effects of SM on neural tissues are presumed.
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Affiliation(s)
- Nasser Shoeibi
- Retina Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Eye Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mir Naghi Mousavi
- Eye Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Balali-Mood
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Clinical Toxicology, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Emadodin Darchini-Maragheh
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Assembly, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mousavi
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Abrishami
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351 Iran
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Darchini-Maragheh E, Balali-Mood M, Malaknezhad M, Mousavi SR. Progressive delayed respiratory complications of sulfur mustard poisoning in 43 Iranian veterans, three decades after exposure. Hum Exp Toxicol 2017; 37:175-184. [DOI: 10.1177/0960327117694072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The most common delayed complication of sulfur mustard (SM) poisoning has been observed in the respiratory tracts. It was thus aimed to investigate the delayed respiratory complications in SM-exposed patients around 25 years before the study. Forty-three veterans with more than 25% disability of due to SM poisoning were investigated. Clinical examinations as well as pulmonary function test (PFT) were performed. High-resolution computed tomography (HRCT) of the lungs was done as clinically indicated. Triad of chronic cough, dyspnea, and expectoration were the most common symptoms that were recorded in 88.2%, 88.2%, and 64.7% of the patients, respectively. PFT abnormalities were detected in 44.18% of the patients. Restrictive pattern was the most common (41.86%), while pure obstructive pattern did not detect at all. Mixed pattern was significantly correlated with higher disability percentages among the veterans ( p < 0.001). Significant reverse correlation between the disability percentages and forced expiratory volume in 1 s/forced vital capacity ratio was obtained ( p = 0.010, r = −0.389). Air trapping was the most common abnormality in HRCTs (50%). Bronchiectasis (25%), pulmonary fibrosis (25%), and ground-glass attenuation (16.66%) were other common HRCT findings. Comparing with the previous studies on these patients, more restrictive and mixed pattern were observed. Moreover, bronchiolitis, bronchiectasis, and lung fibrosis were the main pathological findings in these patients.
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Affiliation(s)
- E Darchini-Maragheh
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - M Balali-Mood
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - M Malaknezhad
- Islamic Azad University, Mashhad medical campus, Mashhad, Iran
| | - SR Mousavi
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
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Balali-Mood M, Mousavi SH, Balali-Mood B. Chronic health effects of sulphur mustard exposure with special reference to Iranian veterans. EMERGING HEALTH THREATS JOURNAL 2017. [DOI: 10.3402/ehtj.v1i0.7068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- M Balali-Mood
- Medical Toxicology Research Centre and Department of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - SH Mousavi
- Medical Toxicology Research Centre and Department of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - B Balali-Mood
- Department of Chemistry, Imperial College London, London, UK
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Khan F, Niaz K, Ismail Hassan F, Abdollahi M. An evidence-based review of the genotoxic and reproductive effects of sulfur mustard. Arch Toxicol 2016; 91:1143-1156. [PMID: 28032143 DOI: 10.1007/s00204-016-1911-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/07/2016] [Indexed: 01/18/2023]
Abstract
Sulfur mustard (SM) is a chemical warfare agent which is cytotoxic in nature, and at the molecular level, SM acts as DNA alkylating agent leading to genotoxic and reproductive effects. Mostly, the exposed areas of the body are the main targets for SM; however, it also adversely affects various tissues of the body and ultimately exhibits long-term complications including genotoxic and reproductive effects, even in the next generations. The effect of SM on reproductive system is the reason behind male infertility. The chronic genotoxic and reproductive complications of SM have been observed in the next generation, such as reproductive hormones disturbances, testicular atrophy, deficiency of sperm cells, retarded growth of sperm and male infertility. SM exerts toxic effects through various mechanisms causing reproductive dysfunction. The key mechanisms include DNA alkylation, production of reactive oxygen species (ROS) and nicotinamide adenine dinucleotide (NAD) depletion. However, the exact molecular mechanism of such long-term effects of SM is still unclear. In general, DNA damage, cell death and defects in the cell membrane are frequently observed in SM-exposed individuals. SM can activate various cellular and molecular mechanisms related to oxidative stress (OS) and inflammatory responses throughout the reproductive system, which can cause decreased spermatogenesis and impaired sperm quality via damage to tissue function and structure. Moreover, the toxic effects of SM on the reproductive system as well as the occurrence of male infertility among exposed war troopers in the late exposure phase is still uncertain. The chronic effects of SM exposure in parents can cause congenital defects in their children. In this review, we aimed to investigate chronic genotoxic and reproductive effects of SM and their molecular mechanisms in the next generations.
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Affiliation(s)
- Fazlullah Khan
- International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran
| | - Kamal Niaz
- International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran
| | - Fatima Ismail Hassan
- International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran
| | - Mohammad Abdollahi
- International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran.
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Relationship Between Serum Bilirubin Concentration and Inflammatory Cytokines in Victims Exposed to Sulfur Mustard. Trauma Mon 2016. [DOI: 10.5812/traumamon.39192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Emadi SN, Shiri M, Shiri Z, Emadi SE, Mortazavi H, Nikoo A, Akhavan-Moghaddam J. Mycosis fungoides two decades after exposure to sulphur mustard: a follow-up of 1100 victims. J Eur Acad Dermatol Venereol 2016; 31:432-437. [PMID: 27699871 DOI: 10.1111/jdv.13993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 09/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sulphur mustard (SM) is an alkylating chemical warfare agent which causes acute and chronic injuries to the eyes, skin, lung and respiratory tract. OBJECTIVE We aimed to investigate the relationship between SM poisoning and Mycosis fungoides (MF) as a late consequence. MATERIAL AND METHODS In this retrospective study, the medical files of 1100 Iranian veterans confirmed to have exposure to SM agent during the Iraq-Iran war of the 1980s were reviewed. RESULTS All 10 cases with MF were confirmed by clinical and histopathological examinations. The mean age of the studied subjects was 43.3 ± 9.8 (years). In comparison to MF incidence rate in Iranian general population (0.39/100 000 person-years), we found an incidence rate of 0.799/100 000 person-years for MF among those who had short-term exposure to SM. The most common sites for SM lesions were flexural and thin skin areas. The main limitation was the retrospective design. CONCLUSION This study indicates that the risk of MF in those exposed to SM may increase over time. Therefore, their follow-up is recommended.
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Affiliation(s)
- S N Emadi
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran
| | - M Shiri
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran
| | - Z Shiri
- Faculty of Arts and Architecture, Islamic Azad University, Tehran, Iran
| | - S E Emadi
- Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - H Mortazavi
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran
| | - A Nikoo
- Department of Pathology, Tehran University of Medical Sciences, Tehran, Iran
| | - J Akhavan-Moghaddam
- Department of General Surgery, Baqiyatallah University of Iran, Tehran, Iran
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Hejazi S, Soroush M, Moradi A, Khalilazar S, Mousavi B, Firooz A, Younespour S. Skin manifestations in sulfur mustard exposed victims with ophthalmologic complications: Association between early and late phase. Toxicol Rep 2016; 3:679-684. [PMID: 28959592 PMCID: PMC5616011 DOI: 10.1016/j.toxrep.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 01/09/2023] Open
Abstract
Context Sulfur mustard (SM) was used during the Iraq-Iran war (1980–1988). Exposed veterans continue to suffer from its ocular, skin, and respiratory complications. Objective We aimed to evaluate associations between early (at the time of acute exposure) and decades later skin manifestations in individuals with severe ophthalmologic complications secondary to sulfur mustard exposure. Materials and methods One hundred forty-nine veterans with severe ocular injuries were evaluated for acute and chronic skin complications. Logistic regression models were used to examine the associations between early and late skin manifestations. Results Late skin complaints were observed in nearly all survivors who had early skin lesions (131 out of 137; 95.62%). Seven out of 12 patients (58.33%) who did not have early skin lesions ultimately developed late skin complications. There was a significant relationship between the presence of lesions at the time of exposure and developing late skin complaints (two-sided Fisher's exact test, OR = 15.59, p < 0.001). There was an association between having at least one early skin lesion and occurrence of late skin complications. Survivors with blisters at the time of chemical exposure were more likely to complain of itching (95% CI: 3.63–25.97, p < 0.001), burning (OR = 11.16; 95% CI: 2.97–41.89, p < 0.001), pigmentation changes (OR = 10.17; 95% CI: 2.54–40.75, p = 0.001), dryness (OR = 6.71, 95% CI: 1.22–37.01, p = 0.03) or cherry angioma (OR = 2.59; 95% CI:1.21–5.55, p = 0.01) during the late phase. Using multivariate logistic models, early blisters remained significantly associated with latent skin complaints. Of note, the genitalia and great flexure areas were the most involved anatomical sites for both early and late skin lesions in SM exposed survivors. Conclusion According to this study, the presence of blisters at the time of exposure to SM is the most important predictor of developing dermatologic complications decades later in patients with severe ophthalmologic complications from sulfur mustard exposure.
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Affiliation(s)
- Somayeh Hejazi
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, No 4, Maryam alley, Pashazohri St, Sadr Blvd, Tehran, Iran
| | - Mohammadreza Soroush
- Janbazan Medical and Engineering Research Center(JMERC), No.17, Farokh st, Moghadas Ardabili st, Tehran, Iran
| | - Ahmad Moradi
- Moradi Skin Laser Clinic & Chemical Warfare Victims’ Clinic, Eram building, Next to Amin Ali pharmacy, Daneshjoo square, Eram St, Shiraz, Iran
| | - Sara Khalilazar
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, No 4, Maryam alley, Pashazohri St, Sadr Blvd, Tehran, Iran
| | - Batool Mousavi
- Janbazan Medical and Engineering Research Center(JMERC), No.17, Farokh st, Moghadas Ardabili st, Tehran, Iran
- Corresponding author.
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, No. 415, Taleqani Ave., Tehran, Iran
| | - Shima Younespour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Qods Street, Enqelab Square, Tehran, Iran
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Tewari-Singh N, Agarwal R. Mustard vesicating agent-induced toxicity in the skin tissue and silibinin as a potential countermeasure. Ann N Y Acad Sci 2016; 1374:184-92. [PMID: 27326543 DOI: 10.1111/nyas.13099] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Exposure to the vesicating agents sulfur mustard (SM) and nitrogen mustard (NM) causes severe skin injury with delayed blistering. Depending upon the dose and time of their exposure, edema and erythema develop into blisters, ulceration, necrosis, desquamation, and pigmentation changes, which persist weeks and even years after exposure. Research advances have generated data that have started to explain the probable mechanism of action of vesicant-induced skin toxicity; however, despite these advances, effective and targeted therapies are still deficient. This review highlights studies on two SM analogs, 2-chloroethyl ethyl sulfide (CEES) and NM, and CEES- and NM-induced skin injury mouse models that have substantially added to the knowledge on the complex pathways involved in mustard vesicating agent-induced skin injury. Furthermore, employing these mouse models, studies under the National Institutes of Health Countermeasures Against Chemical Threats program have identified the flavanone silibinin as a novel therapeutic intervention with the potential to be developed as an effective countermeasure against skin injury following exposure to mustard vesicating agents.
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Affiliation(s)
- Neera Tewari-Singh
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rajesh Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Goswami DG, Tewari-Singh N, Agarwal R. Corneal toxicity induced by vesicating agents and effective treatment options. Ann N Y Acad Sci 2016; 1374:193-201. [PMID: 27327041 DOI: 10.1111/nyas.13121] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/04/2016] [Accepted: 05/10/2016] [Indexed: 12/20/2022]
Abstract
The vesicating agents sulfur mustard (SM) and lewisite (LEW) are potent chemical warfare agents that primarily cause damage to the ocular, skin, and respiratory systems. However, ocular tissue is the most sensitive organ, and vesicant exposure results in a biphasic injury response, including photophobia, corneal lesions, corneal edema, ulceration, and neovascularization, and may cause loss of vision. There are several reports on ocular injury from exposure to SM, which has been frequently used in warfare. However, there are very few reports on ocular injury by LEW, which indicate that injury symptoms appear instantly after exposure and faster than SM. In spite of extensive research efforts, effective therapies for vesicant-induced ocular injuries, mainly to the most affected corneal tissue, are not available. Hence, we have established primary human corneal epithelial cells and rabbit corneal organ culture models with the SM analog nitrogen mustard, which have helped to test the efficacy of potential therapeutic agents. These agents will then be further evaluated against in vivo SM- and LEW-induced corneal injury models, which will assist in the development of potential broad-spectrum therapies against vesicant-induced ocular injuries.
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Affiliation(s)
- Dinesh G Goswami
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Neera Tewari-Singh
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rajesh Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Wohlman IM, Composto GM, Heck DE, Heindel ND, Lacey CJ, Guillon CD, Casillas RP, Croutch CR, Gerecke DR, Laskin DL, Joseph LB, Laskin JD. Mustard vesicants alter expression of the endocannabinoid system in mouse skin. Toxicol Appl Pharmacol 2016; 303:30-44. [PMID: 27125198 DOI: 10.1016/j.taap.2016.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/16/2016] [Accepted: 04/20/2016] [Indexed: 12/16/2022]
Abstract
Vesicants including sulfur mustard (SM) and nitrogen mustard (NM) are bifunctional alkylating agents that cause skin inflammation, edema and blistering. This is associated with alterations in keratinocyte growth and differentiation. Endogenous cannabinoids, including N-arachidonoylethanolamine (anandamide, AEA) and 2-arachidonoyl glycerol (2-AG), are important in regulating inflammation, keratinocyte proliferation and wound healing. Their activity is mediated by binding to cannabinoid receptors 1 and 2 (CB1 and CB2), as well as peroxisome proliferator-activated receptor alpha (PPARα). Levels of endocannabinoids are regulated by fatty acid amide hydrolase (FAAH). We found that CB1, CB2, PPARα and FAAH were all constitutively expressed in mouse epidermis and dermal appendages. Topical administration of NM or SM, at concentrations that induce tissue injury, resulted in upregulation of FAAH, CB1, CB2 and PPARα, a response that persisted throughout the wound healing process. Inhibitors of FAAH including a novel class of vanillyl alcohol carbamates were found to be highly effective in suppressing vesicant-induced inflammation in mouse skin. Taken together, these data indicate that the endocannabinoid system is important in regulating skin homeostasis and that inhibitors of FAAH may be useful as medical countermeasures against vesicants.
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Affiliation(s)
- Irene M Wohlman
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, United States
| | - Gabriella M Composto
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, United States
| | - Diane E Heck
- Environmental Health Science, New York Medical College, Valhalla, NY, United States
| | - Ned D Heindel
- Department of Chemistry, Lehigh University, Bethlehem, PA, United States
| | - C Jeffrey Lacey
- Department of Chemistry, Lehigh University, Bethlehem, PA, United States
| | | | | | | | - Donald R Gerecke
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, United States
| | - Debra L Laskin
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, United States
| | - Laurie B Joseph
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, United States
| | - Jeffrey D Laskin
- Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ, United States.
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Marzony ET, Ghanei M, Panahi Y. Relationship of oxidative stress with male infertility in sulfur mustard-exposed injuries. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2015.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Shoeibi N, Balali-Mood M, Abrishami M. Sulfur Mustard Exposure and Non-Ischemic Central Retinal Vein Occlusion. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:59-63. [PMID: 26722147 PMCID: PMC4691272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 41-year-old man was referred with a complaint of visual loss in his left eye and his best corrected visual acuity was 20/80. Slit lamp examination showed arborizing conjunctival vessels and dry eye. Fundus examination and fluorescein angiography revealed a non-ischemic central retinal vein occlusion. Cardiovascular, rheumatologic, and hematologic work up showed no abnormal findings. An ascertained history of exposure to sulfur mustard during the Iran-Iraq war was documented in his medical history. Four sessions of intravitreal bevacizumab injections were done as needed. After two-year follow-up, visual acuity in his left eye improved to 20/25 and macular edema was resolved without any need for further interventions. We conclude that sulfur mustard gas exposure may be considered as a predisposing factor for central retinal vein occlusion, as was found in our patient (an Iranian war veteran) by excluding all yet known etiologies and predisposing factors.
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Affiliation(s)
- Nasser Shoeibi
- Retina Research Center, Department of Ophthalmology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Eye Research Center, Department of Ophthalmology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Balali-Mood
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Department of Clinical Toxicology, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Abrishami
- Eye Research Center, Department of Retina and Vitreous, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Mojtaba Abrishami, MD; Farabi Eye Hospital, Qazvin Square, Postcode: 1336616351, Tehran, Iran Tel: +98 21 55400003 Fax: +98 21 55418080
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Khazdair MR, Boskabady MH, Ghorani V. Respiratory effects of sulfur mustard exposure, similarities and differences with asthma and COPD. Inhal Toxicol 2015; 27:731-44. [PMID: 26635274 DOI: 10.3109/08958378.2015.1114056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Previous research has found relationships between sulfur mustard (SM) toxicity and its adverse effects. OBJECTIVE SM is highly toxic to the respiratory system, leading to hacking cough, rhinorrheachest tightness, acute pharyngitis and laryngitis, chronic bronchitis and lung fibrosis. In this review, based on the scientific literature, we provide an updated summary of information on SM exposures and their differences with asthma and COPD. METHOD Information of this review was obtained by searching Medline/PubMed, ScienceDirect, Scopus, Google Scholar, ISI Web of Knowledge and Chemical Abstracts. RESULTS SM exposure can decrease pulmonary function tests (PFTs) values. In addition, inflammatory cell accumulation in the respiratory tract and increased expression of some pro-inflammatory cytokines including tumor necrosis factor-α (TNFα), IL-1a, IL-1β, and reactive oxygen radicals due to SM exposure have been shown. Matrix metalloproteinase (MMP) which degrade extracellular matrix proteins, contributing to inflammatory cell recruitment, tissue injury and fibrosis are also up-regulated in the lung after SM exposure. In the lung, SM exposure also can cause serious pathological changes including airway inflammation, parenchymal tissue destruction and airway obstruction which can lead to asthma or chronic obstructive pulmonary disease (COPD). Following SM poisoning, DNA damage, apoptosis and autophagy are observed in the lung along with the increased expression of activated caspases and DNA repair enzymes. CONCLUSION In the present article, respiratory symptoms, changes in PFTs, lung pathology and lung inflammation due to SM exposure and the similarities and differences between them and those observed in asthma and COPD were reviewed.
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Affiliation(s)
- Mohammad Reza Khazdair
- a Pharmaceutical Research Center and Department of Physiology, School of Medicine .,b Student Research Committee , and
| | - Mohammad Hossein Boskabady
- c Neurogenic Inflammation Research Centre and Department of Physiology, School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Vahideh Ghorani
- a Pharmaceutical Research Center and Department of Physiology, School of Medicine
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Panahi Y, Gholami N, Ghojazadeh M, Moslemi F, Naghavi-Behzad M, Azami-Aghdash S, Ghaffari A, Piri R. Complications and Carcinogenic Effects of Mustard Gas - a Systematic Review and Meta-Analysis in Iran. Asian Pac J Cancer Prev 2015; 16:7567-73. [DOI: 10.7314/apjcp.2015.16.17.7567] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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50
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Layegh P, Maleki M, Mousavi SR, Yousefzadeh H, Momenzadeh A, Golmohammadzadeh S, Balali-Mood M. Epidermal hydration and skin surface lipids in patients with long-term complications of sulfur mustard poisoning. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:640-5. [PMID: 26622252 PMCID: PMC4638065 DOI: 10.4103/1735-1995.166200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Despite almost the three decades passed since the chemical attacks of Iraqi's army against the Iranian troops, some veterans are still suffering from long-term complications of sulfur mustard (SM) poisoning, including certain skin complaints specially dryness, burning, and pruritus. We thus aimed to evaluate the skin's water and lipid content in patients with a disability of >25% due to complications of SM poisoning and compare them with a matched control group. Materials and Methods: Sixty-nine male participants were included in this study; 43 SM-exposed patients, and 26 normal controls from their close relatives. The water and lipid content was measured in four different locations: Extensor and flexor sides of forearms and lateral and medial sides of legs by the Corneometer CM 820/Sebumeter SM 810. Collected data was analyzed and P ≤ 0.05 was considered as statistically significant. Results: The mean age of the patients and controls was 49.53 ± 11.34 (ranges: 40-71) and 29.08 ± 8.836 (ranges: 15-49 years), respectively. In the veterans group, the main cutaneous complaint was itching and skin dryness. Cherry angioma, dry skin, and pruritus were significantly more common in the SM-exposed cases than in the controls. (P = 0.01, 0.05, and 0.04, respectively). The moisture and lipid content of all areas were lower in the SM-exposed group, but it was only significant in skin sebum of lateral sides of legs (P = 0.02). Conclusion: Exposure to SM could decrease the function of stratum corneum and lipid production as a barrier, even after several years of its exposure.
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Affiliation(s)
- Pouran Layegh
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Maleki
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mousavi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadis Yousefzadeh
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akram Momenzadeh
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shiva Golmohammadzadeh
- Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Balali-Mood
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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