Menthol toxicity: an unusual cause of coma

Peppermint and menthol: a review on their biochemistry, pharmacological activities, clinical applications, and safety considerations

In this manuscript, we conducted a comprehensive review of the diverse effects of peppermint on human health and explored the potential underlying mechanisms. Peppermint contains three main groups of phytochemical constituents, including essential oils (mainly menthol), flavonoids (such as hesperidin, eriodictyol, naringenin, quercetin, myricetin, and kaempferol), and nonflavonoid phenolcarboxylic acids. Peppermint exhibits antimicrobial, antioxidant, anti-inflammatory, immunomodulatory, anti-cancer, anti-aging, and analgesic properties and may be effective in treating various disorders, including gastrointestinal disorders (e.g., irritable bowel syndrome, dyspepsia, constipation, functional gastrointestinal disorders, nausea/vomiting, and gallbladder stones). In addition, peppermint has therapeutic benefits for psychological and cognitive health, dental health, urinary retention, skin and wound healing, as well as anti-depressant and anti-anxiety effects, and it may improve memory. However, peppermint has paradoxical effects on sleep quality and alertness, as it has been shown to improve sleep quality in patients with fatigue and anxiety, while also increasing alertness under conditions of monotonous work and relaxation. We also discuss its protective effects against toxic agents at recommended doses, as well as its safety and potential toxicity. Overall, this review provides the latest findings and insights into the properties and clinical effects of peppermint/menthol and highlights its potential as a natural therapeutic agent for various health conditions.

Encapsulation of mint essential oil: Techniques and applications

Mint essential oil (MEO) is an outstanding antibacterial and antioxidant agent, that can be considered as a promising natural preservative, flavor, insecticide, coolant, and herbal medicine. However, the low solubility and volatility of MEO limits its extensive applications. In order to utilize MEO in different products, it is essential to develop treatments that can overcome these limitations. More recently, encapsulation technology has been developed as a promising method to overcome the shortcomings of MEO. In which, sensitive compounds such as essential oils (EOs) are entrapped in a carrier to produce micro or nanoparticles with increased stability against environmental conditions. Additionally, encapsulation of EOs makes transportation and handling easier, reduces their volatility, controls their release and consequently improves the efficiency of these bioactive compounds and extends their industrial applications. Several encapsulation techniques, such as emulsification, coacervation, ionic gelation, inclusion complexation, spray drying, electrospinning, melt dispersion, melt homogenization, and so on, have been emerged to improve the stability of MEO. These encapsulated MEOs can be also used in a variety of food, bioagricultural, pharmaceutical, and health care products with excellent performance. Therefore, this review aims to summarize the physicochemical and functional properties of MEO, recent advances in encapsulation techniques for MEO, and the application of micro/nanocapsulated MEO in different products.

Hypokinetic Activity of Menthofuran on the Gastrointestinal Tract in Rodents

The acute toxicity and hypokinetic activity induced by menthofuran on the gastrointestinal tract of rodents were investigated in the present study. An absence of acute toxicity was observed. Menthofuran delayed gastric emptying at oral doses of 25, 50, and 100 mg/kg in the experimental model of phenol red, as well as it reduced the intestinal transit at oral doses of 50 and 100 mg/kg. Interestingly, a scopolamine-similar hypokinetic effect was observed for menthofuran. In the experimental model of castor oil-induced intestinal hypermotility, menthofuran (50 and 100 mg/kg) reduced the number of loose stools as observed for the normal group. Additionally, menthofuran induced a marked concentration-dependent relaxation in rat ileum segments precontracted with KCl (EC50 = 0.059 ± 0.008 μg/mL) or carbachol (EC50 = 0.068 ± 0.007 μg/mL). These results suggest the possible decrease of calcium influx underlying the effects of menthofuran on the gastrointestinal tract, which opens the door for further study regarding this potential application for the treatment of gastrointestinal disorders, noting possible limitations of its use due to adverse effects in children.

Menthol: An underestimated anticancer agent

Menthol, a widely used natural, active compound, has recently been shown to have anticancer activity. Moreover, it has been found to have a promising future in the treatment of various solid tumors. Therefore, using literature from PubMed, EMBASE, Web of Science, Ovid, ScienceDirect, and China National Knowledge Infrastructure databases, the present study reviewed the anticancer activity of menthol and the underlying mechanism. Menthol has a good safety profile and exerts its anticancer activity via multiple pathways and targets. As a result, it has gained popularity for significantly inhibiting different types of cancer cells by various mechanisms such as induction of apoptosis, cell cycle arrest, disruption of tubulin polymerization, and inhibition of tumor angiogenesis. Owing to the excellent anticancer activity menthol has demonstrated, further research is warranted for developing it as a novel anticancer agent. However, there are limitations and gaps in the current research on menthol, and its antitumor mechanism has not been completely elucidated. It is expected that more basic experimental and clinical studies focusing on menthol and its derivatives will eventually help in its clinical application as a novel anticancer agent.

Menthol as an Ergogenic Aid for the Tokyo 2021 Olympic Games: An Expert-Led Consensus Statement Using the Modified Delphi Method

INTRODUCTION

Menthol topical application and mouth rinsing are ergogenic in hot environments, improving performance and perception, with differing effects on body temperature regulation. Consequently, athletes and federations are beginning to explore the possible benefits to elite sport performance for the Tokyo 2021 Olympics, which will take place in hot (~ 31 °C), humid (70% RH) conditions. There is no clear consensus on safe and effective menthol use for athletes, practitioners, or researchers. The present study addressed this shortfall by producing expert-led consensus recommendations.

METHOD

Fourteen contributors were recruited following ethical approval. A three-step modified Delphi method was used for voting on 96 statements generated following literature consultation; 192 statements total (96/96 topical application/mouth rinsing). Round 1 contributors voted to "agree" or "disagree" with statements; 80% agreement was required to accept statements. In round 2, contributors voted to "support" or "change" their round 1 unaccepted statements, with knowledge of the extant voting from round 1. Round 3 contributors met to discuss voting against key remaining statements.

RESULTS

Forty-seven statements reached consensus in round 1 (30/17 topical application/rinsing); 14 proved redundant. Six statements reached consensus in round 2 (2/4 topical application/rinsing); 116 statements proved redundant. Nine further statements were agreed in round 3 (6/3 topical application/rinsing) with caveats.

DISCUSSION

Consensus was reached on 62 statements in total (38/24 topical application/rinsing), enabling the development of guidance on safe menthol administration, with a view to enhancing performance and perception in the heat without impairing body temperature regulation.

Neurotoxicity of e-cigarettes

It appears that electronic cigarettes (EC) are a less harmful alternative to conventional cigarette (CC) smoking, as they generate substantially lower levels of harmful carcinogens and other toxic compounds. Thus, switching from CC to EC may be beneficial for smokers. However, recent accounts of EC- or vaping-associated lung injury (EVALI) has raised concerns regarding their adverse health effects. Additionally, the increasing popularity of EC among vulnerable populations, such as adolescents and pregnant women, calls for further EC safety evaluation. In this state-of-the-art review, we provide an update on recent findings regarding the neurological effects induced by EC exposure. Moreover, we discuss possible neurotoxic effects of nicotine and numerous other chemicals which are inherent both to e-liquids and EC aerosols. We conclude that in recognizing pertinent issues associated with EC usage, both government and scientific researchers must address this public health issue with utmost urgency.

Biochemical Responses of Wheat Seedlings on the Introduction of Selected Chiral Ionic Liquids to the Soils

In this study, new chiral ionic liquids (CILs) were obtained from the natural-origin material (1 R,2 S,5 R)-(-)-menthol. The physicochemical characteristics of the studied imidazolium salts were investigated. The obtained 3-ethyl-1-[(1 R,2 S,5 R)-(-)-menthoxy-methyl]imidazolium salts are nonvolatile, nonflammable, and stable in air, in contact with water, and in commonly used organic solvents. The influences of the obtained chiral salts on physiological and biochemical parameters were determined for wheat ( Triticum aestivum L.) seedlings. Both salts led to changes in plant metabolism, which resulted in decreased assimilation pigments, decreased fresh weight, and increased dry weight and proline in wheat seedlings. Moreover, the growth of the above-ground parts and roots was inhibited. Additionally, there was a drop in the potential and germination capacity of wheat seeds after using the highest concentrations of the ionic liquids. The salts caused oxidative stress in wheat seedlings, which was demonstrated by increased malondialdehyde content. In response, the plants engaged their defensive system against free oxygen radicals, which resulted in increased catalase and peroxidase activity and decreased H₂O₂ levels in the plants. There were no changes in the activity of superoxide dismutase. All of the changes observed in the levels of determined biomarkers of oxidative stress in the plants were linearly correlated with the increase in the concentrations of the chiral ionic liquids in the soil. The salt with hexafluorphosphate anion exhibited slightly higher toxicity toward wheat seedlings than the other salt. The CILs led to premature aging of plants, which was demonstrated by the increase in peroxidase activity and a decrease of chlorophyll in the seedlings. The experiment also showed good correlation between the increase in peroxidase activity and the decrease in chlorophyll level, which proves that the decrease in chlorophyll content resulted from not only the increase in CILs concentration in the soil but also the increased POD activity, which leads to the damage of chlorophyll particles.

Natural Brain Penetration Enhancer-Modified Albumin Nanoparticles for Glioma Targeting Delivery

The unsatisfactory therapeutic outcome for glioma is mainly due to the poor blood-brain barrier (BBB) permeability and inefficient accumulation in the glioma area of chemotherapeutic agents. The existing drug delivery strategies can increase drug transport to the brain but are restricted by side effects and/or poor delivery efficiency. In this study, potent brain penetration enhancers were screened from the active components of aromatic resuscitation drugs used in traditional Chinese medicine. A novel glioma-targeting system based on enhancer-modified albumin nanoparticles was developed to safely and efficiently deliver drugs to the glioma regions in the brain. The nanoparticles improved the transport of nanoparticles across brain capillary endothelial cell (BCEC) monolayer by increasing endocytosis in endothelial cells and causing BBB disruption. In vivo imaging studies demonstrated that the systems could enter the brain and subsequently accumulate in glioma cells with a much higher targeting efficiency than that of transferrin-modified albumin nanoparticles. Of note, the nanoparticles could be captured and penetrate through endothelial cells fenestrae in pineal gland, which is suggestive of an effective way to deliver a nanosystem to the brain by bypassing the BBB. The nanoparticles showed good biocompatibility and negligible cytotoxicity. The results reveal an efficient and safe strategy for brain drug delivery in glioma therapy.

[Menthol in the control of bladder activity: A review]

INTRODUCTION

Menthol is a natural compound, of which the known effects on human physiology are manifold (a feeling of freshness, decongestant, bowel antispasmodic). Its implication in vesico-sphincteral physiopathology has been studied since the nineties.

METHOD

Literature review of the previous studies having implied menthol in pelvi-perineal physiology through the articles indexed on the Pubmed database, with keywords menthol, menthol and bladder, menthol and toxicity, and TRPM8. Only articles in English were selected.

RESULTS

Of the 30 articles that were included, most demonstrated the existence of a micturition reflex to menthol and cold, mediated by the C-type nerve to the spine through activation of TRPM8 urothelial receptors. More recent experiments paradoxically showed an inhibitory effect of menthol on detrusor contractility, independently of TRPM8, when muscle tissue is directly exposed to the compound. However, similar effects of targeted cutaneous exposure or urothelial exposure on detrusorian function have also been demonstrated through TRPM8. This receptor also appears to be involved in interstitial cystitis and idiopathic detrusor overactivity. Lastly, the potential toxicity of menthol appears negligible. Most of the referenced studies are related to animal experiments. Of the three studies that implied humans, only one elucidates some therapeutic applications.

CONCLUSION

It seems that menthol and its receptors are involved in vesico-sphincteral physiopathology and could provide therapeutic potential in detrusorian overactivity and interstitial cystitis with reduced toxicity.

Evaluation of the immunomodulatory effects of a South African commercial traditional immune booster in human peripheral blood mononuclear cells

BACKGROUND

With the burden of HIV and AIDS still very high, South Africa has seen an increase in commercial traditional medicines claiming to have immune-enhancing effects. Because of lack of regulation of the traditional medicine sector, these products have proliferated. This study aimed to evaluate the immunomodulatory effects of uMakhonya®, a commercial traditional immune booster, using various models of normal human peripheral blood mononuclear cells (PBMCs).

METHODS

Immunosuppressed, mitogen-, and peptidoglycan (PG)-stimulated PBMCs were treated with various doses of uMakhonya® and incubated for 24 h. The treated and control samples were analyzed for cytotoxicity, secretion of 12 different inflammatory cytokines, soluble interleukin-2 receptor (sIL-2R) levels, and nitric oxide (NO) secretion.

RESULTS

In cytotoxicity assays, uMakhonya® induced dose-dependent cytotoxic effects in all three models, with IC50 values of 512.08, 500, and 487.91 μg/mL for immunosuppressed, phytohaemagglutinin (PHA)-, and PG from Staphylococcus. aureus (PG-S. aureus)-stimulated PBMCs, respectively. UMakhonya® at 100 and 10 μg/mL induced a significant (p < 0.05) increase in the secretion of IL-1α, IL-1β, IL-6, IL-10, tumor necrosis factor alpha (TNF)-α, and granulocyte-macrophage colony-stimulating factor (GM-CSF) in cyclosporine-, immunosuppressed, and PHA-stimulated PBMCs. In the same samples, there was a significant increase (p < 0.05) in sIL-2R concentration, which correlated with an increase in the secretion of inflammatory cytokines. In PBMCs stimulated with PG-S. aureus, uMakhonya® at doses of 100 and 10 μg/mL significantly (p < 0.05) suppressed the secretion of inflammatory cytokines, especially IL-1β and TNF-α. PG-S. aureus-stimulated PBMCs also showed a significant decrease (p < 0.05) in sIL-2R concentration when compared to control samples. UMakhonya® insignificantly (p > 0.05) decreased NO levels in PBMCs after PG-S. aureus stimulation.

CONCLUSIONS

These results showed that uMakhonya® can induce both pro-inflammatory and anti-inflammatory effects depending on the initial stimuli applied to immune cells.

A fatal case of menthol poisoning

Menthol is a monocyclic terpene alcohol, which is present naturally in peppermint and can be synthesized artificially as well. Generally, it is considered as very safe and has wide usage in medicine and food. There are case reports of toxicity due to excessive consumption of menthol, but a fatal intoxication has never been reported in the medical literature. We present a case of fatal menthol intoxication in a worker, who accidently got exposed when he was working in a peppermint factory. Emergency physicians must keep in mind this extremely rare manifestation of menthol poisoning. All necessary precaution should be taken to reduce its intake or exposure, as it has no specific antidote. Early recognition and supportive treatment of this poisoning is the key for a successful outcome.

Essential oils for complementary treatment of surgical patients: state of the art

Aromatherapy is the controlled use of plant essences for therapeutic purposes. Its applications are numerous (i.e., wellbeing, labour, infections, dementia, and anxiety treatment) but often they have not been scientifically validated. The aim of the present study is to review the available literature to determine if there is evidence for effectiveness of aromatherapy in surgical patients to treat anxiety and insomnia, to control pain and nausea, and to dress wound. Efficacy studies of lavender or orange and peppermint essential oils, to treat anxiety and nausea, respectively, have shown positive results. For other aspects, such as pain control, essential oils therapy has shown uncertain results. Finally, there are encouraging data for the treatment of infections, especially for tea tree oil, although current results are still inconclusive. It should also be considered that although they are, allergic reactions and toxicity can occur after oral ingestion. Therefore, while rigorous studies are being carried out, it is important that the therapeutic use of essential oils be performed in compliance with clinical safety standards.

Menthol-enhanced cytotoxicity of cigarette smoke demonstrated in two bioassay models

Background

Cigarette smoke is harmful to human health at both cellular and genetic levels. Recently, a unique bioassay for smoke cytotoxicity using air pollution-sensitive plant cells (tobacco) has been proposed.

Methods

Model plant cells (tobacco Bel-W3 cells) and human cells (alveolar epithelial A549 cells) suspended in fresh culture media were exposed to cigarette smoke sampled after lighting the tip of cigarettes (with vs. without menthol capsules) which were attached to a glass pipe connected to the cell-containing plastic tubes. Control cultures were also assessed.

Results

After exposing tobacco plant cells to cigarette smoke, cell death occurred in a dose-dependent manner. Cell death was significantly enhanced by mentholated smoke, while menthol alone was shown to be inert suggesting that menthol synergistically contributes to the enhancement of cell death, initiated by smoke-associated compounds. The enhanced toxicity of mentholated smoke was confirmed in human alveolar epithelial A549 cells.

Conclusions

Cigarette smoke cytotoxicity leading to cell death assessed in plant and human model cells was enhanced by menthol. Further research into these findings is encouraged.