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Haouzi P, McCann M, Tubbs N, Judenherc-Haouzi A, Cheung J, Bouillaud F. Antidotal Effects of the Phenothiazine Chromophore Methylene Blue Following Cyanide Intoxication. Toxicol Sci 2020; 170:82-94. [PMID: 30907955 DOI: 10.1093/toxsci/kfz081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Our study was aimed at (1) determining the efficacy of the dye methylene blue (MB), following a rapidly lethal cyanide (CN) intoxication in un-sedated rats; (2) clarifying some of the mechanisms responsible for the antidotal properties produced by this potent cyclic redox dye. Sixty-nine awake rats acutely intoxicated by CN (IP, KCN 7 mg/kg) received saline, MB (20 mg/kg) or hydroxocobalamin (HyCo, 150 mg/kg) when in deep coma. Survival in this model was very low, reaching 9% at 60 min without any treatment. Methylene blue significantly increased survival (59%, p < .001) at 60 min, versus 37% with HyCo (p < .01). In addition, 8 urethane-anesthetized rats were exposed to a sublethal CN intoxication (KCN, 0.75 mg/kg/min IV for 4 min); they received MB (20 mg/kg, IV) or saline, 5 min after the end of CN exposure. All MB-treated rats displayed a significant reduction in hyperlactacidemia, a restoration of pyruvate/lactate ratio-a marker of NAD/NADH ratio-and an increase in CO2 production, a marker of the activity of the TCA cycle. These changes were also associated with a 2-fold increase in the pool of CN in red cells. Based on series of in vitro experiments, looking at the effects of MB on NADH, as well as the redox effects of MB on hemoglobin and cytochrome c, we hypothesize that the antidotal properties of MB can in large part be accounted for by its ability to readily restore NAD/NADH ratio and to cyclically re-oxidize then reduce the iron in hemoglobin and the electron chain complexes. All of these effects can account for the rapid antidotal properties of this dye following CN poisoning.
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Affiliation(s)
- Philippe Haouzi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Marissa McCann
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Nicole Tubbs
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Annick Judenherc-Haouzi
- Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Joseph Cheung
- Center of Translational Medicine and Department of Medicine, Lewis Katz School of Medicine of Temple University, Philadelphia, Pennsylvania
| | - Frederic Bouillaud
- Institut Cochin, INSERM U1016-CNRS UMR8104, Université Paris Descartes, Paris, France
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Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient: An Indication for Hyperbaric Oxygen Therapy. Ann Plast Surg 2019; 80:S106-S112. [PMID: 29461288 DOI: 10.1097/sap.0000000000001351] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Carbon monoxide (CO) is a small molecule poison released as a product of incomplete combustion. Carbon monoxide binds hemoglobin, reducing oxygen delivery. This effect is exacerbated in the burned pregnant patient by fetal hemoglobin that binds CO 2.5- to 3-fold stronger than maternal hemoglobin. With no signature clinical symptom, diagnosis depends on patient injury history, elevated carboxyhemoglobin levels, and alterations in mental status. The standard of care for treatment of CO intoxication is 100% normobaric oxygen, which decreases the half-life of CO in the bloodstream from 5 hours to 1 hour. Hyperbaric oxygen (HBO2) is a useful adjunct to rapidly reduce the half-life of CO to 20 minutes and the incidence of delayed neurologic sequelae. Because of the slow disassociation of CO from hemoglobin in the fetus, there is a far stronger indication for HBO2 in the burned pregnant patient than in other burn patient populations.Cyanide intoxication is often a comorbid disease with CO in inhalation injury from an enclosed fire, but may be the predominant toxin. It acts synergistically with CO to effectively lower the lethal doses of both cyanide and CO. Diagnosis is best made in the presence of high lactate levels, carboxyhemoglobin concentrations greater than 10%, injury history of smoke inhalation from an enclosed fire, and alterations in consciousness. While treatment with hydroxocobalamin is the standard of care and has the effect of reducing concomitant CO toxicity, data indicate cyanide may also be displaced by HBO2.Carbon monoxide and cyanide poisoning presents potential complications impacting care. This review addresses the mechanism of action, presentation, diagnosis, and treatment of CO and cyanide poisonings in the burned pregnant patient and the use of HBO2 therapy.
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Gorgun MF, Zhuo M, Dineley KT, Englander EW. Elevated Neuroglobin Lessens Neuroinflammation and Alleviates Neurobehavioral Deficits Induced by Acute Inhalation of Combustion Smoke in the Mouse. Neurochem Res 2019; 44:2170-2181. [PMID: 31420834 DOI: 10.1007/s11064-019-02856-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/03/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022]
Abstract
Acute inhalation of combustion smoke produces long-term neurologic deficits in survivors. To study the mechanisms that contribute to the development of neurologic deficits and identify targets for prevention, we developed a mouse model of acute inhalation of combustion smoke, which supports longitudinal investigation of mechanisms that underlie the smoke induced inimical sequelae in the brain. Using a transgenic mouse engineered to overexpress neuroglobin, a neuroprotective oxygen-binding globin protein, we previously demonstrated that elevated neuroglobin preserves mitochondrial respiration and attenuates formation of oxidative DNA damage in the mouse brain after smoke exposure. In the current study, we show that elevated neuronal neuroglobin attenuates the persistent inflammatory changes induced by smoke exposure in the mouse brain and mitigates concordant smoke-induced long-term neurobehavioral deficits. Specifically, we found that increases in hippocampal density of GFAP and Iba-1 positive cells that are detected post-smoke in wild-type mice are absent in the neuroglobin overexpressing transgenic (Ngb-tg) mice. Similarly, the smoke induced hippocampal myelin depletion is not observed in the Ngb-tg mice. Importantly, elevated neuroglobin alleviates behavioral and memory deficits that develop after acute smoke inhalation in the wild-type mice. Taken together, our findings suggest that the protective effects exerted by neuroglobin in the brains of smoke exposed mice afford protection from long-term neurologic sequelae of acute inhalation of combustion smoke. Our transgenic mouse provides a tool for assessing the potential of elevated neuroglobin as possible strategy for management of smoke inhalation injury.
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Affiliation(s)
- Murat F Gorgun
- Department of Surgery, Medical Branch, University of Texas, 301 University Boulevard, Galveston, TX, 77555, USA
| | - Ming Zhuo
- Department of Surgery, Medical Branch, University of Texas, 301 University Boulevard, Galveston, TX, 77555, USA
| | - Kelly T Dineley
- Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX, USA
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, USA
| | - Ella W Englander
- Department of Surgery, Medical Branch, University of Texas, 301 University Boulevard, Galveston, TX, 77555, USA.
- Shriners Hospitals for Children, Galveston, TX, USA.
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Gorgun MF, Zhuo M, Cortez I, Dineley KT, Englander EW. Acute inhalation of combustion smoke triggers neuroinflammation and persistent anxiety-like behavior in the mouse. Inhal Toxicol 2018; 29:598-610. [PMID: 29405081 DOI: 10.1080/08958378.2018.1432728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Acute inhalation of combustion smoke triggers neurologic sequelae in survivors. Due to the challenges posed by heterogeneity of smoke exposures in humans, mechanistic links between acute smoke inhalation and neuropathologic sequelae have not been systematically investigated. METHODS Here, using mouse model of acute inhalation of combustion smoke, we studied longitudinal neurobehavioral manifestations of smoke exposures and molecular/cellular changes in the mouse brain. RESULTS Immunohistochemical analyses at eight months post-smoke, revealed hippocampal astrogliosis and microgliosis accompanied by reduced myelination. Elevated expression of proinflammatory cytokines was also detected. Longitudinal testing in different neurobehavioral paradigms in the course of post-smoke recovery, revealed lasting anxiety-like behavior. The examined paradigms included the open field exploration/anxiety testing at two, four and six months post-smoke, which detected decreases in total distance traveled and time spent in the central arena in the smoke-exposed compared to sham-control mice, suggestive of dampened exploratory activity and increased anxiety-like behavior. In agreement with reduced open field activity, cued fear conditioning test revealed increased freezing in response to conditioned auditory stimulus in mice after acute smoke inhalation. Similarly, elevated plus maze testing demonstrated lesser presence in open arms of the maze, consistent with anxiety-like behavior, for the post-smoke exposure mice. CONCLUSIONS Taken together, our data demonstrate for the first time persistent neurobehavioral manifestations of acute inhalation of combustion smoke and provide new insights into long-term progression of events initiated by disrupted brain oxygenation that might contribute to lasting adverse sequelae in survivors of smoke inhalation injuries.
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Affiliation(s)
- Murat F Gorgun
- a Department of Surgery , University of Texas Medical Branch , Galveston , TX , USA
| | - Ming Zhuo
- a Department of Surgery , University of Texas Medical Branch , Galveston , TX , USA
| | - IbDanelo Cortez
- b Department of Neurology , University of Texas Medical Branch , Galveston , TX , USA.,c Mitchell Center for Neurodegenerative Diseases , University of Texas Medical Branch , Galveston , TX , USA.,d Center for Addiction Research , University of Texas Medical Branch , Galveston , TX , USA
| | - Kelly T Dineley
- b Department of Neurology , University of Texas Medical Branch , Galveston , TX , USA.,c Mitchell Center for Neurodegenerative Diseases , University of Texas Medical Branch , Galveston , TX , USA.,d Center for Addiction Research , University of Texas Medical Branch , Galveston , TX , USA
| | - Ella W Englander
- a Department of Surgery , University of Texas Medical Branch , Galveston , TX , USA.,e Shriners Hospitals for Children and University of Texas Medical Branch , Galveston , TX , USA
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Manifestations cardiovasculaires de l’intoxication cyanhydrique aiguë. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bhattacharya R, Singh P, Palit M, Waghmare C, Singh AK, Gopalan N, Kumar D. Time-dependent comparative evaluation of some important biomarkers of acute cyanide poisoning in rats: an aid in diagnosis. Biomarkers 2014; 19:241-51. [DOI: 10.3109/1354750x.2014.902996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rahul Bhattacharya
- Pharmacology and Toxicology Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Poonam Singh
- Pharmacology and Toxicology Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Meehir Palit
- Biochemistry Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Chandrakant Waghmare
- Biochemistry Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Anil Kumar Singh
- Vector Management Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Natarajan Gopalan
- Vector Management Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Deo Kumar
- Pharmacology and Toxicology Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
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Drieskens S, Anseeuw K, Annemans L, Fetro C. Belgian cost-effectiveness analysis of hydroxocobalamin (Cyanokit) in known or suspected cyanide poisoning. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2012-000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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