Metabolomics of Clinical Poisoning by Aconitum Alkaloids Using Derivatization LC-MS

Pharmacokinetics, safety, and efficacy of Fuqi Guben Gao in the treatment of kidney-yang deficiency syndrome: a randomized, double-blind phase I trial

Introduction: Fuqi Guben Gao (FQGBG) is a botanical drug formulation composed of FuZi (FZ; Aconitum carmichaelii Debeaux [Ranunculaceae; Aconiti radix cocta]), Wolfberry (Lycium barbarum L. [Solanaceae; Lycii fructus]), and Cinnamon (Neolitsea cassia (L.) Kosterm. [Lauraceae; Cinnamomi cortex]). It has been used to clinically treat nocturia caused by kidney-yang deficiency syndrome (KYDS) for over 30 years and warms kidney yang. However, the pharmacological mechanism and the safety of FQGBG in humans require further exploration and evaluation. Methods: We investigated the efficacy of FQGBG in reducing urination and improving immune organ damage in two kinds of KYDS model rats (hydrocortisone-induced model and natural aging model), and evaluated the safety of different oral FQGBG doses through pharmacokinetic (PK) parameters, metabonomics, and occurrence of adverse reactions in healthy Chinese participants in a randomized, double-blind, placebo-controlled, single ascending dose clinical trial. Forty-two participants were allocated to six cohorts with FQGBG doses of 12.5, 25, 50, 75, 100, and 125 g. The PKs of FQGBG in plasma were determined using a fully validated LC-MS/MS method. Results: FQGBG significantly and rapidly improved the symptoms of increased urination in both two KYDS model rats and significantly resisted the adrenal atrophy in hydrocortisone-induced KYDS model rats. No apparent increase in adverse events was observed with dose escalation. Major adverse drug reactions included toothache, thirst, heat sensation, gum pain, diarrhea, abdominal distension, T-wave changes, and elevated creatinine levels. The PK results showed a higher exposure level of benzoylhypaconine (BHA) than benzoylmesaconine (BMA) and a shorter half-life of BMA than BHA. Toxic diester alkaloids, aconitine, mesaconitine, and hypaconitine were below the lower quantitative limit. Drug-induced metabolite markers primarily included lysophosphatidylcholines, fatty acids, phenylalanine, and arginine metabolites; no safety-related metabolite changes were observed. Conclusion: Under the investigated dosing regimen, FQGBG was safe. The efficacy mechanism of FQGBG in treating nocturia caused by KYDS may be related to the improvement of the hypothalamus-pituitary-adrenal axis function and increased energy metabolism. Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=26934, identifier ChiCTR1800015840.

The Pseudotargeted Metabolomics Study on the Toxicity of Fuzi Using Ultraperformance Liquid Chromatography Tandem Mass Spectrometry

Fuzi is commonly used in traditional Chinese medicine. Clinical Fuzi poisoning cases have frequently been reported. Glycyrrhizae Radix is often used to alleviate Fuzi’s toxicity. However, the poisoning mechanism of Fuzi and the detoxication mechanism of Glycyrrhizae Radix are still not clear. We identified the chemical components of Fuzi at different decoction times (0.5, 1, 2, 4, and 6 h) using ultrahigh performance liquid chromatography quadrupole time-of-flight mass spectrometry. A total of 35 compounds were detected in the Fuzi decoction, including diester alkaloids, monoester alkaloids, amino acids, phenolic acids, organic acids, glycosides, and sugars among others. The content of diester alkaloids (i.e., subaconitine, neoaconitine, and aconitine) in the Fuzi decoction decreased after 2 h of decoction time, while the content of monoester alkaloids (i.e., benzoyl aconitine and benzoyl subaconitine) reached a peak at 2 h. A total of 32 rats were randomly divided into four groups, including 8 cases in the low-dosage Fuzi decoction group A, 8 cases in the high-dosage Fuzi decoction group B, 8 cases in the Fuzi and glycyrrhizae decoction group C, and 8 cases in the control group D. The decoction was administered orally for 7 days. Then, a serum was obtained. The metabolites’ changes were analyzed in serum metabolomics using liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Statistical analysis and pathway analysis were used to assess the effects of glycyrrhizae on the metabolic changes induced by Fuzi. The behavioral and biochemical characteristics indicated that Fuzi exhibited toxic effects on rats and their metabolic profiles changed. However, the metabolic profiles of the glycyrrhizae group became similar to those of the control group. These profiles showed that glycyrrhizae can effectively improve Fuzi poisoning rats. Our study demonstrated that the established pseudotargeted metabolomics is a powerful approach for investigating the mechanisms of herbal toxicity.

Natural plant toxins in honey: An ignored threat to human health

Consumers often believe that "natural food" is harmless, however naturally occurring toxins in food represent a health risk to humans. Honey as a natural, nutritious sweetener, is one of the most commonly consumed foods throughout the world. However, food safety concerns for honey arise when honeybees collect nectar from poisonous plants such as Rhododendron sp., Coriaria arborea, and Tripterygium wilfordii Hook F. Such honey contains natural plant toxins. Humans may develop intoxication symptoms after consuming toxic honey; in some cases, it can be fatal. As a result, toxic honey poses an often-ignored threat to public health. Typical plant toxins such as grayanotoxins, triptolides, tutin and pyrrolizidine alkaloids, have been identified in toxic honey. Although different toxic honeys elicit similar symptoms, such as vomiting, nausea, and dizziness, the mechanism of toxicity may be different. Thus, it is necessary to determine the exact toxicity mechanism of different toxins to further develop effective antidotes and cures. Another important challenge is preventing toxic honey from entering the food chain. Liquid chromatography-mass spectrometry has a wide range of applications in the detection of different toxins due to its accuracy and simplicity. More methods, however, are urgently needed to detect multiple plant-derived toxins in honey and its derivatives. Developing uniform international standards for toxin detection during quarantine using advanced techniques is critical for preventing human consumption of toxic honey.