Acute Cyanide Poisoning: Hydroxocobalamin and Sodium Thiosulfate Treatments with Two Outcomes following One Exposure Event

Investigating the Replacement of Carboxylates with Carboxamides to Modulate the Safety and Efficacy of Platinum(II) Thioether Cyanide Scavengers

Cyanide represents a persistent threat for accidental or malicious misuse due to easy conversion into a toxic gas and access to large quantities through several industries. The high safety index of hydroxocobalamin is a cornerstone quality as a cyanide scavenger. Unfortunately, intravenous infusion of hydroxocobalamin limits the utility in a mass casualty setting. We previously reported platinum(II) [Pt(II)] complexes with trans-directing sulfur ligands as an efficacious alternative to hydroxocobalamin when delivered by a bolus intramuscular injection in mice and rabbits. Thus, to enable Pt(II) as an alternative to hydroxocobalamin, a high safety factor is needed. The objective is to maintain efficacy and mitigate the risk for nephrotoxicity. Platinum amino acid complexes with the ability to form five- or six-membered rings and possessing either carboxylates or carboxamides are evaluated in vitro for cyanide scavenging. In vivo efficacy was evaulated in the zebrafish and mice cyanide exposure models. In addition, Pt(II) complex toxicity and pharmacokinetics were evaluated in a cyanide naive Sprague-Dawley model. Doses for toxicity are escalated to 5x from the efficacious dose in mice using a body surface area adjustment. The results show the carboxamide ligands display a time and pH dependence on cyanide scavenging in vitro and efficacy in vivo. Additionally, exchanging the carboxylate for carboxamide showed reduced indications of renal injury. A pharmacokinetic analysis of the larger bidentate complexes displayed rapid absorption by intramuscular administration and having similar plasma exposure. These findings point to the importance of pH and ligand structures for methionine carboxamide complexes with Pt(II).

Forensic implication of seized drug imitating methamphetamine with mileage in crime

Background

The increase in drug abuse a major global issue. Clandestine laboratories along with illegal drug trafficking and trade increase the menace. Increased confiscation of illicit drugs not only indicates the manifold rise in drug abuse in Delhi and its neighboring region but also signifies an escalation and proliferation in other drug-related criminal activities. Investigating agencies around the world are working hard to combat and eradicate this problem. The samples seized by these agencies are subsequently sent for forensic examination to rule out the presence of any illicit drugs. Few such seized crystalline samples such as “methamphetamine” were submitted for examination with a query for the identification of any scheduled substance. The analysis outline followed was physical, chemical, Fourier transform infrared spectrometer analysis for detection, identification, and confirmation of seized drug samples. The purpose of a detailed investigation regarding the identification of the crystalline sample was also to understand the criminal activities involved in the consistent seizures and the forensics behind it.

Results

The comprehensive examination identified the sample as an inorganic salt of sodium thiosulfate with the absence of contraband methamphetamine. The study on salt-imitating methamphetamine underlines its diverse uses as in adulteration, trafficking to camouflage narcotics drug and its involvement in numerous other illegal purposes which on the other hand has a very crucial impact on society and its well-being.

Conclusions

The novel findings will update the investigating agencies and other experts regarding the importance of the detection of sodium thiosulfate salt in seized samples and will well establish the foul play behind large seizures to justify the role of forensic science. This unique finding deals with a very sensitive issue that has immense social impact and needs exceptional thoughtfulness.

Methyl mercaptan gas: mechanisms of toxicity and demonstration of the effectiveness of cobinamide as an antidote in mice and rabbits

CONTEXT

Methyl mercaptan (CH₃SH) is a colorless, toxic gas with potential for occupational exposure and used as a weapon of mass destruction. Inhalation at high concentrations can result in dyspnea, hypoventilation, seizures, and death. No specific methyl mercaptan antidote exists, highlighting a critical need for such an agent. Here, we investigated the mechanism of CH₃SH toxicity, and rescue from CH₃SH poisoning by the vitamin B₁₂ analog cobinamide, in mammalian cells. We also developed lethal CH₃SH inhalation models in mice and rabbits, and tested the efficacy of intramuscular injection of cobinamide as a CH₃SH antidote.

RESULTS

We found that cobinamide binds to CH₃SH (K_d = 84 µM), and improved growth of cells exposed to CH₃SH. CH₃SH reduced cellular oxygen consumption and intracellular ATP content and activated the stress protein c-Jun N-terminal kinase (JNK); cobinamide reversed these changes. A single intramuscular injection of cobinamide (20 mg/kg) rescued 6 of 6 mice exposed to a lethal dose of CH₃SH gas, while all six saline-treated mice died (p = 0.0013). In rabbits exposed to CH₃SH gas, 11 of 12 animals (92%) treated with two intramuscular injections of cobinamide (50 mg/kg each) survived, while only 2 of 12 animals (17%) treated with saline survived (p = 0.001).

CONCLUSION

We conclude that cobinamide could potentially serve as a CH₃SH antidote.

The natural history of the concept of antidote

•

For several centuries, the antidote paradigm was the same as the drug paradigm.

•

However, when chemistry progressed, the concepts of a specific chemical antidote were assumed.

•

In the face of the increasing number of acute poisoning, the ideas of a universal antidote play a more critical role.

•

The development of toxicology prompts reflection on the price of civilization progress.

Over the centuries, the development of knowledge about poisons and antidotes depended on their conceptualization, however, a range of poisons and the concept of antidote evolved. With the passing of time, different substances of plant, animal, and mineral origin, moreover, man-made ones, were used deliberatively, accidentally, or unintentionally as poisons. The concept of antidote was changing in line with the progress of medicine and understanding of the mechanism of how poison works. From this perspective, the history of antidotes may be considered as the quintessence of changes within toxicology. Among the theories of antidote, the most interesting is the concept of a universal one, because it has never become obsolete. This review article focuses on the changing conceptualization of antidotes. It contains an analysis of historical toxicological treatises on antidotes and PubMed articles on the same topic.

Hydrogen Sulfide Metabolite, Sodium Thiosulfate: Clinical Applications and Underlying Molecular Mechanisms

Thiosulfate in the form of sodium thiosulfate (STS) is a major oxidation product of hydrogen sulfide (H2S), an endogenous signaling molecule and the third member of the gasotransmitter family. STS is currently used in the clinical treatment of acute cyanide poisoning, cisplatin toxicities in cancer therapy, and calciphylaxis in dialysis patients. Burgeoning evidence show that STS has antioxidant and anti-inflammatory properties, making it a potential therapeutic candidate molecule that can target multiple molecular pathways in various diseases and drug-induced toxicities. This review discusses the biochemical and molecular pathways in the generation of STS from H2S, its clinical usefulness, and potential clinical applications, as well as the molecular mechanisms underlying these clinical applications and a future perspective in kidney transplantation.

Characterisation of the Cyanate Inhibited State of Cytochrome c Oxidase

Heme-copper oxygen reductases are terminal respiratory enzymes, catalyzing the reduction of dioxygen to water and the translocation of protons across the membrane. Oxygen consumption is inhibited by various substances. Here we tested the relatively unknown inhibition of cytochrome c oxidase (CcO) with isocyanate. In contrast to other more common inhibitors like cyanide, inhibition with cyanate was accompanied with the rise of a metal to ligand charge transfer (MLCT) band around 638 nm. Increasing the cyanate concentration furthermore caused selective reduction of heme a. The presence of the CT band allowed for the first time to directly monitor the nature of the ligand via surface-enhanced resonance Raman (SERR) spectroscopy. Analysis of isotope sensitive SERR spectra in comparison with Density Functional Theory (DFT) calculations identified not only the cyanate monomer as an inhibiting ligand but suggested also presence of an uretdion ligand formed upon dimerization of two cyanate ions. It is therefore proposed that under high cyanate concentrations the catalytic site of CcO promotes cyanate dimerization. The two excess electrons that are supplied from the uretdion ligand lead to the observed physiologically inverse electron transfer from heme a₃ to heme a.

Assessing modulators of cytochrome c oxidase activity in Galleria mellonella larvae

Caterpillars of the greater wax moth, Galleria mellonella, are shown to be a useful invertebrate organism for examining mitochondrial toxicants (inhibitors of electron transport) and testing putative antidotes. Administration of sodium azide, sodium cyanide, or sodium (hydro)sulfide by intra-haemocoel injection (through a proleg) results in a dose-dependent paralysed state in the larvae lasting from <1 to ~40 min. The duration of paralysis is easily monitored, because if turned onto their backs, the larvae right themselves onto their prolegs once they are able to move again. The efficacy of putative antidotes to the three toxicants can routinely be assessed by observing shortened periods of paralysis with larvae given toxicant and antidote compared to larvae administered only the same dose of toxicant. The validity of the approach is demonstrated with agents previously shown to be antidotal towards cyanide intoxication in mice; namely, sodium nitrite and CoN₄[11.3.1] (cobalt(II/III) 2,12-dimethyl-3,7,11,17-tetraazabicyclo-[11.3.1]-heptadeca-1(7)2,11,13,15-pentaenyl cation). These same compounds are shown to be antidotal towards all three toxicants in the G. mellonella caterpillars; findings that may prove important in relation to azide and sulfide poisonings, for which there are currently no effective antidotes available. The observation that sodium nitrite ameliorates cyanide toxicity in the larvae is additionally interesting because it unambiguously demonstrates that the antidotal action of nitrites does not require the involvement of methemoglobin, contributing to the resolution of an ongoing controversy.

Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion

Objective

Accidental or intentional cyanide ingestion is an-ever present danger. Rapidly acting, safe, inexpensive oral cyanide antidotes are needed that can neutralize large gastrointestinal cyanide reservoirs. Since humans cannot be exposed to cyanide experimentally, we studied oral cyanide poisoning in rabbits, testing oral sodium thiosulfate with and without gastric alkalization.

Setting

University research laboratory.

Subjects

New Zealand white rabbits.

Interventions

Seven animal groups studied; Groups 1–5 received high dose oral NaCN (50 mg, >LD100) and were treated immediately with oral (via nasogastric tube): 1) saline, 2) glycine, 3) sodium thiosulfate or 4) sodium thiosulfate and glycine, or 5) after 2 min with intramuscular injection of sodium nitrite and sodium thiosulfate plus oral sodium thiosulfate and glycine. Groups 6–7 received moderate dose oral NaCN (25 mg, LD70) and delayed intramuscular 6) saline or 7) sodium nitrite-sodium thiosulfate.

Measurements and Main Results

All animals in the high dose NaCN group receiving oral saline or glycine died very rapidly, with a trend towards delayed death in glycine-treated animals; saline versus glycine-treated animals died at 10.3+3.9 and 14.6+5.9 min, respectively (p=0.13). In contrast, all sodium thiosulfate-treated high dose cyanide animals survived (p<0.01), with more rapid recovery in animals receiving both thiosulfate and glycine, compared to thiosulfate alone (p<0.03). Delayed intramuscular treatment alone in the moderate cyanide dose animals increased survival over control animals from 30% to 71%. Delayed treatment in high dose cyanide animals was not as effective as immediate treatment, but did increase survival time and rescued 29% of animals (p<0.01 versus cyanide alone).

Conclusions

Oral sodium thiosulfate with gastric alkalization rescued animals from lethal doses of ingested cyanide. The combination of oral glycine and sodium thiosulfate may have potential for treating high dose acute cyanide ingestion and merits further investigation. The combination of systemic and oral therapy may provide further options.