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Chen X, Jiang Z, Zhang L, Liu W, Ren X, Nie L, Wu D, Guo Z, Liu W, Yang X, Wu Y, Liang Z, Spencer P, Liu J. Protein pyrrole adducts are associated with elevated glucose indices and clinical features of diabetic diffuse neuropathies. J Diabetes 2022; 14:646-657. [PMID: 36195541 PMCID: PMC9574754 DOI: 10.1111/1753-0407.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/12/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Diabetic neuropathy is the most prevalent complication of diabetes mellitus. Although the precise etiology of this neurological disorder has yet to be defined, elevated blood glucose promotes anerobic glycolysis; this produces excess advanced glycation end-products, many of which have a pyrrole structure. Here, we test the hypothesis that protein pyrrole adducts are associated with elevated glucose indices and some clinical features of diabetic diffuse neuropathies. METHOD We investigated the levels of plasma pyrrole adducts and adjusted urinary pyrrole adducts in a group of elderly persons (n = 516, age 60-79) residing in the District of Luohu, Shenzhen, China between 2017 and 2018. Symptoms of distal symmetric polyneuropathy (DSPN) and resting heart rate, a measure of autonomic nervous system function, were collected from participants (n = 258) with elevated glucose indices. RESULT Protein pyrrole adducts showed a strong correlation with glucose indices before and after adjustment for age and estimated glomerular filtration rates. Stratified analysis showed that the medians and interquartile values of pyrrole adducts grew as glucose indices of the subgroups increased. Participants with symptoms of DSPN and sinus tachycardia presented elevated levels of plasma pyrrole adducts. CONCLUSION This study provides a novel link between glucose indices and the etiology of diabetic diffuse neuropathies.
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Affiliation(s)
- Xiao Chen
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Zhuyi Jiang
- Department of Endocrinology, Shenzhen People's Hospital (The Second Clinical Medical CollegeJinan University, The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenChina
| | - Lianjing Zhang
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
- School of Public HealthGuangdong Medical UniversityDongguanPeople's Republic of China
| | - Wei Liu
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Xiaohu Ren
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Luling Nie
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Desheng Wu
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Zhiwei Guo
- Shenzhen Luohu Hospital for Traditional Chinese MedicineShenzhen Luohu Hospital GroupShenzhenChina
| | - Weimin Liu
- Shenzhen Luohu Center for Disease Control and PreventionShenzhenChina
| | - Xifei Yang
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Yan Wu
- Department of Endocrinology, Shenzhen People's Hospital (The Second Clinical Medical CollegeJinan University, The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenChina
| | - Zhen Liang
- Department of Endocrinology, Shenzhen People's Hospital (The Second Clinical Medical CollegeJinan University, The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenChina
| | - Peter Spencer
- Department of Neurology, School of Medicine, and Oregon Institute for Occupational Health SciencesOregon Health & Science UniversityPortlandOregonUSA
| | - Jianjun Liu
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
- School of Public HealthGuangdong Medical UniversityDongguanPeople's Republic of China
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Spencer PS, Chen X. The Role of Protein Adduction in Toxic Neuropathies of Exogenous and Endogenous Origin. TOXICS 2021; 9:toxics9050098. [PMID: 33946924 PMCID: PMC8146965 DOI: 10.3390/toxics9050098] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 02/07/2023]
Abstract
The peripheral (axonal) neuropathy associated with repeated exposure to aliphatic and aromatic solvents that form protein-reactive γ-diketones shares some clinical and neuropathological features with certain metabolic neuropathies, including type-II diabetic neuropathy and uremic neuropathy, and with the largely sub-clinical nerve damage associated with old age. These conditions may be linked by metabolites that adduct and cross-link neuroproteins required for the maintenance of axonal transport and nerve fiber integrity in the peripheral and central nervous system.
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Affiliation(s)
- Peter S. Spencer
- Department of Neurology, School of Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR 97239, USA
- Correspondence:
| | - Xiao Chen
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Subject of Health Toxicology (2020–2024), Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China;
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Chen X, Liu W, Wang L, Lin D, Nie L, He K, Guo Z, Zhu F, Feng W, Liu W, Yuan J, Yang X, Spencer P, Liu J. Diabetes mellitus is associated with elevated urinary pyrrole markers of γ-diketones known to cause axonal neuropathy. BMJ Open Diabetes Res Care 2020; 8:8/1/e001575. [PMID: 32912928 PMCID: PMC7484872 DOI: 10.1136/bmjdrc-2020-001575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/03/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Progressive distal symmetrical axonal neuropathy, a complication of diabetes mellitus (DM), has an unknown cause. Normal physiological metabolism and diabetic dysmetabolism are associated with the generation of γ-diketones. γ-Diketones form pyrroles with protein amines, notably with axonal proteins required for the maintenance of nerve fiber integrity, especially elongate, large-diameter peripheral nerve fibers innervating the extremities. We tested the hypothesis that neuropathy-associated γ-diketone pyrroles are elevated in DM. RESEARCH DESIGN AND METHODS We measured the urinary concentration of γ-diketone pyrroles in age-matched and gender-matched elderly (60-84 years) persons with (n=267) or without (n=267) indicators of DM based in a community population (9411 community older adults aged ≥60 years) in Shenzhen city, Guangdong, China. We used statistical methods, including a generalized linear model, multivariate logistic regression analysis and restricted cubic splines, to assess linear and nonlinear relationships between urinary γ-diketone pyrroles and indicators of DM. RESULTS Compared with healthy controls, those with DM had significantly higher levels of fasting blood glucose, glycated hemoglobin A1c, urinary ketone bodies and urinary γ-diketone pyrroles. The median concentration of urinary γ-diketone pyrrole adducts was significantly higher (p<0.0001) in individuals with DM (7.5 (5.4) μM) compared with healthy controls (5.9 (4.3) μM). Both linear and non-linear relations were found between urinary γ-diketone pyrroles and indicators of DM. CONCLUSIONS Diabetic dysmetabolism includes increased generation and excretion of neuropathy-associated γ-diketone pyrroles. These findings form the foundation for studies to test whether γ-diketone pyrrole concentration correlates with quantitative sensory (vibration and temperature) and electrodiagnostic testing.
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Affiliation(s)
- Xiao Chen
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Subject of Health Toxicology, (2020-2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Wei Liu
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Subject of Health Toxicology, (2020-2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Lu Wang
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Subject of Health Toxicology, (2020-2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dafeng Lin
- Poison Detection Center, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, Guangdong, China
| | - Lulin Nie
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Subject of Health Toxicology, (2020-2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Kaiwu He
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Subject of Health Toxicology, (2020-2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Zhiwei Guo
- Shenzhen Luohu Hospital for Traditional Chinese Medicine, Shenzhen, Guangdong, China
| | - Feiqi Zhu
- Cognitive Impairment ward of Neurology, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Wenting Feng
- Poison Detection Center, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, Guangdong, China
| | - Weimin Liu
- Shenzhen Luohu Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Jing Yuan
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xifei Yang
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Subject of Health Toxicology, (2020-2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Peter Spencer
- Neurology, School of Medicine, and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon, USA
| | - Jianjun Liu
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Medical Key Subject of Health Toxicology, (2020-2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
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Li X, Jiang L, Yu T, Li M, Wang Q, Liu Z, Xie K. No-observed-adverse-effect level of hair pyrrole adducts in chronic n-hexane intoxication in rats. Neurotoxicology 2020; 78:11-20. [PMID: 32045579 DOI: 10.1016/j.neuro.2020.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 01/18/2020] [Accepted: 02/03/2020] [Indexed: 11/30/2022]
Abstract
n-Hexane has been reported to induce serious peripheral neuropathy in workers. Pyrrole adducts are the unique reaction products of n-hexane in organisms and have been demonstrated to be critical to n-hexane neuropathy. Our previous studies have demonstrated that pyrrole adducts could accumulate in hair and showed high correlation with neuropathy at the end of experiments in rat models. In the present study, we examined the time course of hair pyrrole adducts and behavioral changes in rats exposed to different dosages of n-hexane in both treatment (24 weeks) and recovery phases. Our results showed: 1. After treatment, 1.0, 2.0, and 4.0 g/kg dosage groups all lost weight, but the 0.5 g/kg dosage group showed no impairment; after recovery, all impaired rats regained weight. 2. After treatment, 1.0, 2.0, and 4.0 g/kg dosage groups all showed a rise in gait scores, decreased rotarod latency, and decreased motor nerve conduction velocity, whereas the 0.5 g/kg dosage group showed no impairment; after recovery, all impaired rats were completely rehabilitated. 3. After treatment, levels of pyrrole adducts in serum, urine, and hair of experimental groups increased; after recovery, serum and urine pyrrole adducts showed no difference from the control (P > 0.05), whereas hair pyrrole adducts were significantly different from the control (P < 0.01). 4. The half-lives of serum and urine pyrrole adducts were 47.8-78.0 h and 42.7-52.9 h, while the half-life of hair pyrrole adducts was 14-24 weeks. 5. During treatment and recovery, levels of serum, urine, and hair pyrrole adducts showed high correlation with gait scores (P < 0.01), and hair pyrrole adducts had the largest partial correlation coefficient. In conclusion, hair pyrrole adducts could serve as a stable and reliable biomarker for the prevention of n-hexane intoxication. Furthermore, the no-observed-adverse-effect level of hair pyrrole adducts in rats is 275.2 ± 61.5 nmol/g protein. Further studies are required for the definition of the biological exposure limit in humans.
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Affiliation(s)
- Xianjie Li
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong, 250012, China
| | - Lulu Jiang
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong, 250012, China; Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, 02118, United States
| | - Ting Yu
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong, 250012, China
| | - Ming Li
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong, 250012, China
| | - Qiong Wang
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong, 250012, China
| | - Zhidan Liu
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong, 250012, China
| | - Keqin Xie
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong, 250012, China.
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Pyrrole adducts in globin and plasma of workers exposed to hexane. Int Arch Occup Environ Health 2019; 92:873-881. [PMID: 30955093 DOI: 10.1007/s00420-019-01430-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Urinary excretion of 2,5-hexanedione is currently used to estimate the exposure levels of hexane occurring to an individual during the previous work shift. However, because hexane exposures and urinary 2,5-hexanedione levels can vary considerably from day to day, and subchronic to chronic exposures to hexane are required to produce neuropathy, this biomarker may not accurately reflect the risk of an individual for developing hexane neuropathy. This investigation examines the potential of hexane-derived pyrrole adducts produced on globin and plasma proteins as markers for integrating cumulative exposures. Because the pyrrole markers incorporate bioactivation of hexane to 2,5-hexandione and the initial step of protein adduction involved in hexane-induced neuropathy, they potentially can serve as biomarkers of effect through reflecting pathogenetic events within the nervous system. Additionally, pyrrole formation is an irreversible reaction suggesting that hexane-derived protein pyrroles can be used to assess cumulative exposures to provide a better characterization of individual susceptibilities. METHODS To examine the utility of the proposed markers, blood samples were obtained from eleven workers who used hexane for granulating metal powders in a slurry to produce metal machining die tools and four non-exposed volunteers. Globin and plasma were isolated, and the proteins were digested using pepsin, reacted with Ehrlich's reagent and the level of pyrrole adducts were determined by absorbance at 530 nm. To determine the dose-response curve and dynamic range of the assay, erythrocytes were incubated with a range of 2,5-hexanedione concentrations and the net absorbance at 530 nm of isolated globin was measured. RESULTS Pyrrole was detected in both the globin and plasma samples of the workers exposed to hexane and the levels of pyrroles in plasma were positively correlated with the levels of pyrroles in globin for most of the workers. CONCLUSIONS This investigation demonstrates that detectable levels of hexane-derived protein pyrrole adducts are produced on peripheral proteins following occupational exposures to hexane and supports the utility of measuring pyrroles for integrating cumulative exposures to hexane.
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Li X, Wang Q, Li M, Wang S, Zhang C, Xie K. Hair pyrrole adducts serve as biomarkers for peripheral nerve impairment induced by 2,5-hexanedione and n-hexane in rats. PLoS One 2018; 13:e0209939. [PMID: 30596762 PMCID: PMC6312332 DOI: 10.1371/journal.pone.0209939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/13/2018] [Indexed: 01/22/2023] Open
Abstract
Pyrrole adducts are specific reaction products of 2,5-hexadione (2,5-HD) in vivo and are considered highly relevant to the pathogenesis of peripheral nerve impairments after exposure to n-hexane, though the exact mechanism remains unclear. In this study, 40 male Wistar rats were randomly divided into three experimental groups and one control group, in which all rat’s hair were shaved completely at the beginning. The rats in three experimental groups were treated with 2,5-HD by gavage at dosages of 100, 200 and 300 mg/kg per day respectively, six times per week for 8 weeks. Abnormality of gait and changes in the rota-rod latency were surveilled. Pyrrole adducts in hair, urine and serum of all rats were measured at the endpoint. Results showed that the increased pyrrole adducts in hair, urine and serum accumulated in dose-response relationship. Spearman’s correlation analysis between pyrrole adducts and gait scores showed that hair pyrrole adducts were highly relevant to the gait scores. Moreover, we treated rats with n-hexane and succeed to verify the results aforesaid. Further, multiply linear regression analysis showed that hair pyrrole adducts have higher partial correlation coefficients than these in serum and urine in both 2,5-HD and n-hexane treated models. Our findings draw the conclusion that the hair pyrrole adducts might serve as a promising biomarker of n-hexane induced peripheral neuropathy.
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Affiliation(s)
- Xianjie Li
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Qiong Wang
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Ming Li
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Shuo Wang
- School of Pharmaceutical, Liaocheng University, Liaocheng, Shandong Province, China
| | - Cuiqin Zhang
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Keqin Xie
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong Province, China
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n-Hexane intoxication in a Chinese medicine pharmaceutical plant: a case report. J Med Case Rep 2017; 11:120. [PMID: 28454586 PMCID: PMC5410082 DOI: 10.1186/s13256-017-1280-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND n-Hexane is a well-known neurotoxicant. Polyneuropathy due to occupational n-hexane exposure has been reported worldwide, however, our case is the first report in the Chinese herb industry. CASE PRESENTATION A 25-year-old Asian man experienced progressive weakness and numbness in his hands and feet after working as an operator in a Chinese medicine pharmaceutical plant for the manufacture of Chinese herbal pain relief patches for 10 months. Electrophysiological studies indicated a reduction in nerve conduction velocity, prolongation of distal latencies, mildly positive sharp waves, and reduced recruitment with polyphasic potentials, particularly at distal sites. Demyelination with axonal degeneration caused by occupational n-hexane exposure was strongly suspected. Through investigation of our patient's workplace, the ambient n-hexane concentration in air was found to considerably exceed the permissible exposure limit/time-weighted average for n-hexane in Taiwan. His symptoms were gradually relieved after 4 months of cessation of exposure to n-hexane. He was then confirmed as a case of occupational n-hexane intoxication. Further effective control measures should be implemented as soon as possible to prevent exposure of workers to n-hexane. CONCLUSIONS Despite a typical clinical presentation, his exposure at workplace was appropriately investigated. Chemical exposure in Chinese medicine pharmaceutical plants could be an emerging issue that may affect workers' health. The lack of knowledge and management of solvents could endanger the health of workers. This case has profound educational implications for occupational health and is worthy of further follow-up for improving hazards control.
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Wang S, Li M, Wang X, Li X, Yin H, Jiang L, Han W, Irving G, Zeng T, Xie K. Diallyl trisulfide attenuated n-hexane induced neurotoxicity in rats by modulating P450 enzymes. Chem Biol Interact 2017; 265:1-7. [PMID: 28115069 DOI: 10.1016/j.cbi.2017.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/19/2017] [Indexed: 01/03/2023]
Abstract
Chronic exposure to n-hexane can induce serious nerve system impairments without effective preventive medicines. Diallyl trisulfide (DATS) is a garlic-derived organosulfur compound, which has been demonstrated to have many beneficial effects. The current study was designed to evaluate whether DATS could restrain n-hexane induced neurotoxicity in rats and to explore the underlying mechanisms. Rats were treated with n-hexane (3 g/kg, p.o.) and different doses of DATS (10, 20 and 30 mg/kg, p.o.) for 8 weeks. Behavioral assessment showed that DATS could inhibit n-hexane induced neurotoxicity, demonstrated by the improvement of the grip strength and decline of gait scores. Toxicokinetic analysis revealed that the Cmax and AUC0-t of 2,5-hexanedione (product of n-hexane metabolic activation) and 2,5-hexanedione protein adducts in serum were significantly declined in DATS-treated rats, and the levels of pyrrole adducts in tissues were significantly reduced. Furthermore, DATS activated CYP1A1 and inhibited n-hexane induced increased expression and activity of CYP2E1 and CYP2B1. Collectively, these findings indicated that DATS protected the rats from n-hexane-induced neurotoxicity, which might be attributed to the modulation of P450 enzymes by DATS.
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Affiliation(s)
- Shuo Wang
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong 250012, China
| | - Ming Li
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong 250012, China
| | - Xujing Wang
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong 250012, China
| | - Xianjie Li
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong 250012, China
| | - Hongyin Yin
- Jinan Municipal Center for Disease Control & Prevention, Jinan, Shandong Province, China
| | - Lulu Jiang
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong 250012, China
| | - Wenting Han
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong 250012, China
| | | | - Tao Zeng
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong 250012, China
| | - Keqin Xie
- Institute of Toxicology, School of Public Health, Shandong University, Jinan, Shandong 250012, China.
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