Abrus precatorius Poisoning: A Retrospective Study of 112 Patients

Evidence for the efficacy of anti-inflammatory plants used in Brazilian traditional medicine with ethnopharmacological relevance

ETHNOPHARMACOLOGICAL RELEVANCE

When exacerbated, inflammatory processes can culminate in physical and emotional disorders and, if not stopped, can be lethal. The high prevalence of inflammation has become a public health problem, and the need for new drugs to treat this pathology is imminent. The use of medicinal plants has emerged as an alternative, and a survey of data that corroborates its application in inflammatory diseases is the starting point. Furthermore, Brazil harbors a megadiversity, and the traditional use of plants is relevant and needs to be preserved and carefully explored for the discovery of new medicines.

AIM OF THE STUDY

This review sought to survey the medicinal plants traditionally used in Brazil for the treatment of inflammatory processes and to perform, in an integrative way, a data survey of these species and analysis of their phytochemical, pharmacological, and molecular approaches.

MATERIALS AND METHODS

Brazilian plants that are traditionally used for inflammation (ophthalmia, throat inflammation, orchitis, urinary tract inflammation, ear inflammation, and inflammation in general) are listed in the DATAPLAMT database. This database contains information on approximately 3400 native plants used by Brazilians, which were registered in specific documents produced until 1950. These inflammatory disorders were searched in scientific databases (PubMed/Medline, Scopus, Web of Science, Lilacs, Scielo, Virtual Health Library), with standardization of DECS/MESH descriptors for inflammation in English, Spanish, French, and Portuguese, without chronological limitations. For the inclusion criteria, all articles had to be of the evaluated plant species, without association of synthesized substances, and full articles free available in any of the four languages searched. Duplicated articles and those that were not freely available were excluded.

RESULTS

A total of 126 species were identified, culminating in 6181 articles in the search. After evaluation of the inclusion criteria, 172 articles representing 40 different species and 38 families were included in the study. Comparison of reproducibility in intra-species results became difficult because of the large number of extraction solvents tested and the wide diversity of evaluation models used. Although the number of in vitro and in vivo evaluations was high, only one clinical study was found (Abrus precatorius). In the phytochemical analyses, more than 225 compounds, mostly phenolic compounds, were identified.

CONCLUSION

This review allowed the grouping of preclinical and clinical studies of several Brazilian species traditionally used for the treatment of many types of inflammation, corroborating new searches for their pharmacological properties as a way to aid public health. Furthermore, the large number of plants that have not yet been studied has encouraged new research to revive traditional knowledge.

Gaps in forensic toxicological analysis: The veiled abrin

Abrus precatorius is an herbaceous, flowering plant that is widely distributed in tropical and subtropical regions. Its toxic component, known as abrin, is classified as one of the potentially significant biological warfare agents and bioterrorism tools due to its high toxicity. Abrin poisoning can be utilized to cause accidents, suicides, and homicides, which necessitates attention from clinicians and forensic scientists. Although a few studies have recently identified the toxicological and pharmacological mechanisms of abrin, the exact mechanism remains unclear. Furthermore, the clinical symptoms and pathological changes induced by abrin poisoning have not been fully characterized, and there is a lack of standardized methods for identifying biological samples of the toxin. Therefore, there is an urgent need for further toxicopathologic studies and the development of detection methods for abrin in the field of forensic medicine. This review provides an overview of the clinical symptoms, pathological changes, metabolic changes, toxicologic mechanisms, and detection methods of abrin poisoning from the perspective of forensic toxicology. Additionally, the evidence on abrin in the field of forensic toxicology and forensic pathology is discussed. Overall, this review serves as a reference for understanding the toxicological mechanism of abrin, highlighting the clinical applications of the toxin, and aiding in the diagnosis and forensic identification of toxin poisoning.

A review of poisoning with various types of biotoxins and its common clinical symptoms

INTRODUCTION

Biotoxins are toxic substances that originate from living organisms and are harmful to humans. Therefore, we need to know the symptoms of biotoxins poisoning to manage the damage. The purpose of this study is to establish a practical diagnostic protocol for dealing with poisoned patients exposed to biotoxins.

MATERIALS AND METHODS

The present study is a review study. Our studied community is articles and books matching the title of the project and relevant keywords. First, by searching the key words sign, symptom, biotoxins, relevant articles were extracted and studied from valid databases. By reviewing the studies based on the search strategy, four groups of biotoxins that were studied the most were identified. These four groups are marine biotoxins, bacterial biotoxins, fungal biotoxins and plant biotoxins. In each of these biotoxin groups, important toxins were selected and studied.

RESULTS

A total of 1864 articles were initially identified from the databases searched in present study. After screening titles and abstracts, 26 articles were included in the systematic review. Specifically, 7 articles were included for bacterial toxins, 9 articles for marine toxins, 5 articles for plant toxins and 5 articles for fungal toxins.

CONCLUSION

The symptoms of plant biotoxins poisoning may include cardiovascular, hematologic, neurologic, respiratory, renal, and gastrointestinal symptoms, while the symptoms of fungal biotoxins poisoning may include hepatic, renal, gastrointestinal, musculoskeletal, metabolic, respiratory, neurological, and cardiovascular symptoms. marine biotoxins poisoning presents with gastrointestinal and neurological symptoms, with varying incubation periods and recovery times. bacterial biotoxins exposure can lead to a wide range of clinical symptoms, with diarrhea, vomiting, and abdominal pain being the most common, and hemoglobinuria or hematuria being a sensitive and specific clinical manifestation for diagnosing ongoing HUS in children.

Toll-like receptors in inflammatory bowel disease: A review of the role of phytochemicals

BACKGROUND

Inflammatory bowel disease (IBD) is a chronic inflammation within the gastrointestinal tract with a remarkable impact on patients' quality of life. Toll-like receptors (TLR), as a key contributor of immune system in inflammation, has a critical role in the pathogenesis of IBD and thus, can be a suitable target of therapeutic agents. Medicinal plants have long been considered as a source of bioactive agents for different diseases, including IBD.

PURPOSE

This review discusses current state of the art on the role of plant-derived compounds for the management of IBD with a focus on TLRs.

METHODS

Electronic database including PubMed, Web of Science, and Scopus were searched up to January 2023 and all studies in which anticolitis effects of a phytochemical was assessed via modulation of TLRs were considered.

RESULTS

Different categories of phytochemicals, including flavonoids, lignans, alkaloids, terpenes, saccharides, and saponins have demonstrated modulatory effects on TLR in different animal and cell models of bowel inflammation. Flavonoids were the most studied phytochemicals amongst others. Also, TLR4 was the most important type of TLRs which were modulated by phytochemicals. Other mechanisms such as inhibition of pro-inflammatory cytokines, nuclear factor-κB pathway, nitric oxide synthesis pathway, cyclooxygenase-2, lipid peroxidation, as well as induction of endogenous antioxidant defense mechanisms were also reported for phytochemicals in various IBD models.

CONCLUSION

Taken together, a growing body of pre-clinical evidence support the efficacy of herbal compounds for the treatment of IBD via modulation of TLRs. Future clinical studies are recommended to assess the safety and efficacy of these compounds in human.

Medicinal Plants Used in the Management of Sexual Dysfunction, Infertility and Improving Virility in the East African Community: A Systematic Review

Sexual disorders such as erectile dysfunction (ED), sterility, and sexual inappetence represent some of the complex reproductive challenges that require addressing the underlying causes. The aim of this paper was to systematically synthesize literature on the ethnobotany, phytochemistry, bioactivities, and safety of plants used as remedies for managing sexual dysfunction and infertility, and improving fertility and virility in the EAC. Through an extensive review conducted in multidisciplinary electronic databases, 171 plant species were identified to have been reported for the management of sexual inappetence (i.e., used as aphrodisiacs, 39.4%), ED (35.9%), infertility (18.7%), and increasing fertility (6.0%). The most used plants are Mondia whitei, Acalypha villicaulis, Combretum illairii, Erythrina abyssinica, Pappea capensis, Rhus vulgaris, and Warburgia ugandensis while roots (44.9%), leaves (21.8%), stem and root barks (16.7%) of shrubs (35%), trees (31%), herbs (26%), and climbers (8%) are the preferred organs for making decoctions (69%). The research strides to date indicate that Citropsis articulata, Cola acuminata, Ekebergia capensis, Plumbago zeylanica, Tarenna graveolens, Urtica massaica, and Zingiber officinale have been assessed for their bioactivity. The majority (71.4%) of the plants either increased testosterone levels and mounting frequency or elicited prosexual stimulatory effects in male rats. More studies investigating the relevant pharmacological activities (aphrodisiac, fertility, and phosphodiesterase-5 inhibitory activities), safety aspects, responsible compounds, and clinical studies are warranted to establish the pharmacological potential of the unstudied species and elucidate the mechanism of action of the bioactive compounds.

Trends in the analysis of abrin poisoning for forensic purposes

Abrus precatorius is a poisonous plant known since ancient times. Accidental poisoning is more common due to the intake of plant seeds containing deadly abrin which is a highly toxic and a thermolabile plant toxalbumin. Abrin has also been reported to be a potential chemical agent that can be used as bioweapon in military or terrorism. Abrin is a ribosome inactivating protein that contains multiple isotoxic forms of protein subunits called chain A and B. The identification of this toxalbumin in the plant is important to determine cause of death in poisoning cases. Therefore, the present review focuses on the structure, mode of administration, tokicokinetics, extraction procedures and forensic analysis of abrin and other constituents. It is observed that most of the researchers have utilized immunological methods for the detection of plant components. This technique has proved to be more sensitive, reliable and accurate for the detection of extremely low concentrations of toxin.

The traditional uses, phytochemistry and pharmacology of Abrus precatorius L.: A comprehensive review

ETHNOPHARMACOLOGICAL RELEVANCE

Abrus precatorius L. (AP) is a folk medicine with a long-term medicinal history worldwide, which is extensively applied to various ailments, such as bronchitis, jaundice, hepatitis, contraception, tumor, abortion, malaria, etc. Meanwhile, its leaves are also served as tea in China, and its roots are employed as a substitute for Glycyrrhiza uralensis or as a raw material for the extraction of glycyrrhizin in India. Thus, AP is considered to be a plant with dual values of medicine and economy as well as its chemical composition and biological activity, which are of growing interest to the scientific community.

AIM OF REVIEW

In the review, the traditional application, botany, chemical constituents, pharmacological activities, and toxicity are comprehensively and systematically summarized.

MATERIALS AND METHODS

An extensive database retrieval was conducted to gather the specific information about AP from 1871 to 2022 using online bibliographic databases Web of Science, PubMed, SciFinder, Google Scholar, CNKI, and Baidu Scholar. The search terms comprise the keywords "Abrus precatorius", "phytochemistry", "pharmacological activity", "toxicity" and "traditional application" as a combination.

RESULTS

To date, AP is traditionally used to treat various diseases, including sore throat, cough, bronchitis, jaundice, hepatitis, abdominal pain, contraception, tumor, abortion, malaria, and so on. More than 166 chemical compounds have been identified from AP, which primarily cover flavonoids, phenolics, terpenoids, steroids, alkaloids, organic acids, esters, proteins, polysaccharides, and so on. A wide range of in vitro and in vivo pharmacological functions of AP have been reported, such as antitumor, antimicrobial, insecticidal, antiprotozoal, antiparasitic, anti-inflammatory, antioxidant, immunomodulatory, antifertility, antidiabetic, other pharmacological activities. The crushed seeds in powder or paste form were comparatively toxic to humans and animals by oral administration. Interestingly, the methanolic extracts were non-toxic to adult Wistar albino rats at various doses (200 and 400 mg/kg) daily.

CONCLUSIONS

The review focuses on the traditional application, botany, phytochemistry, pharmacological activities, and toxicity of AP, which offers a valuable context for researchers on the current research status and a reference for further research and applications of this medicinal plant.

Poisonous Plants of the Indian Himalaya: An Overview

Indian Himalayan region (IHR) supports a wide diversity of plants and most of them are known for their medicinal value. Humankind has been using medicinal plants since the inception of civilization. Various types of bioactive compounds are found in plants, which are directly and indirectly beneficial for plants as well as humans. These bioactive compounds are highly useful and being used as a strong source of medicines, pharmaceuticals, agrochemicals, food additives, fragrances, and flavoring agents. Apart from this, several plant species contain some toxic compounds that affect the health of many forms of life as well as cause their death. These plants are known as poisonous plants, because of their toxicity to both humans and animals. Therefore, it is necessary to know in what quantity they should be taken so that it does not have a negative impact on health. Recent studies on poisonous plants have raised awareness among people who are at risk of plant toxicity in different parts of the world. The main aim of this review article is to explore the current knowledge about the poisonous plants of the Indian Himalayas along with the importance of these poisonous plants to treat different ailments. The findings of the present review will be helpful to different pharmaceutical industries, the scientific community and researchers around the world.

Rapid Identification of Common Poisonous Plants in China Using DNA Barcodes

Toxic plants have been a major threat to public health in China. However, identification and tracing of poisoned species with traditional methods are unreliable due to the destruction of plant morphology by cooking and chewing. DNA barcoding is independent of environmental factors and morphological limitations, making it a powerful tool to accurately identify species. In our study, a total of 83 materials from 26 genera and 31 species of 13 families were collected and 13 plant materials were subjected to simulated gastric fluid digestion. Four markers (rbcL, trnH-psbA, matK, and ITS) were amplified and sequenced for all untreated and mock-digested samples. The effectiveness of DNA barcoding for the identification of toxic plants was assessed using Basic Local Alignment Search Tool (BLAST) method, PWG-Distance method, and Tree-Building (NJ) method. Except for the matK region, the amplification success rate of the remaining three regions was high, but the sequencing of trnH-psbA and ITS was less satisfactory. Meanwhile, matK was prone to be more difficult to amplify and sequence because of simulated gastric fluid. Among the three methods applied, BLAST method showed lower recognition rates, while PWG-Distance and Tree-Building methods showed little difference in recognition rates. Overall, ITS had the highest recognition rate among individual loci. Among the combined loci, rbcL + ITS had the highest species recognition rate. However, the ITS region may not be suitable for DNA analysis of gastric contents and the combination of loci does not significantly improve species resolution. In addition, identification of species to the genus level is sufficient to aid in the clinical management of most poisoning events. Considering primer versatility, DNA sequence quality, species identification ability, experimental cost and speed of analysis, we recommend rbcL as the best single marker for clinical identification and also suggest the BLAST method for analysis. Our current results suggest that DNA barcoding can rapidly identify and trace toxic species and has great potential for clinical applications. In addition, we suggest the creation of a proprietary database containing morphological, toxicological and molecular information to better apply DNA barcoding technology in clinical diagnostics.

Isolated internal iliac artery infected pseudoaneurysm occlusion using endovascular coil embolisation

A 34-year-old man presented with painful swelling in the right gluteal region. The MRI showed right sacroiliitis and adjacent intramuscular abscess. The abscess was drained by a pigtail insertion followed by incision and drainage. The patient developed persistent bleeding from the drainage site. CT angiogram revealed a large pear-shaped pseudoaneurysm arising from the anterior branch of the right internal iliac artery. The patient had Abrus precatorius poisoning previously resulting in methicillin-resistant Staphylococcus aureus septicaemia, which incited above events. Digital subtraction angiography with coil embolisation of the right internal iliac artery was done under the cover of culture-specific antibiotics along with thorough wound debridement following which the patient's condition improved. Isolated infected pseudoaneurysms of internal iliac arteries, although rare, should be considered in cases of complicated sacroiliitis. Under antibiotic cover, endovascular coil embolisation can be considered as a treatment strategy to treat complicated infected pseudoaneurysms located in difficult anatomical locations.

Differentiation, Quantification and Identification of Abrin and Abrus precatorius Agglutinin

Abrin, the toxic lectin from the rosary pea plant Abrus precatorius, has gained considerable interest in the recent past due to its potential malevolent use. However, reliable and easy-to-use assays for the detection and discrimination of abrin from related plant proteins such as Abrus precatorius agglutinin or the homologous toxin ricin from Ricinus communis are sparse. To address this gap, a panel of highly specific monoclonal antibodies was generated against abrin and the related Abrus precatorius agglutinin. These antibodies were used to establish two sandwich ELISAs to preferentially detect abrin or A. precatorius agglutinin (limit of detection 22 pg/mL for abrin; 35 pg/mL for A. precatorius agglutinin). Furthermore, an abrin-specific lateral flow assay was developed for rapid on-site detection (limit of detection ~1 ng/mL abrin). Assays were validated for complex food, environmental and clinical matrices illustrating broad applicability in different threat scenarios. Additionally, the antibodies turned out to be suitable for immuno-enrichment strategies in combination with mass spectrometry-based approaches for unambiguous identification. Finally, we were able to demonstrate for the first time how the developed assays can be applied to detect, identify and quantify abrin from a clinical sample derived from an attempted suicide case involving A. precatorius.

Comparative therapeutic index, lethal time and safety margin of various toxicants and snake antivenoms using newly derived and old formulas

OBJECTIVE

The assessment of clinical efficacy and toxicity is very important in pharmacology and toxicology. The effects of psychostimulants (e.g. amphetamine), psychotomimetics (e.g. Cannabis sativus) and snake antivenoms are sometimes unpredictable even at lower doses, leading to serious intoxication and fatal consequences. Hence, there is need to re-assess some formulas for calculation of therapeutic index, lethal time and safety margin with a view to identifying therapeutic agents with remarkable toxicity potentials.

RESULTS

The therapeutic index formula [Formula: see text] was derived from T1 = LD50/ED50 and ED50 = [Formula: see text]. Findings have shown that, therapeutic index is a function of death reversal (s), safety factor (10-4) and weight of animal (Wa). However, the new safety margin formula [Formula: see text] derived from LT50 = [Formula: see text] and MS = [Formula: see text] shows that safety margin is a function of cube root of ratio between LT50 and LD50 and ED100th. Concentration (k) of toxicant at the receptor [Formula: see text] derived from D1 × Tn = K and LD1 = [Formula: see text] shows that therapeutic index, lethal time and safety margin is a function of drug or toxicant concentration at the receptor, the drug-receptor interaction and dose of toxicant or drug administered at a particular time.

Acute disseminated encephalomyelitis due to abrus precatorius poisoning - A case report

Abrus precatorius, commonly known as ‘Rosary pea’ or ‘Jequirity pea’ and known as ‘Shisham, Batrah-Hindi or Ain Alfreeth’ in the Middle East, grows wild in the tropical and subtropical areas of the world. The seeds of the plant contain one of the most potent toxins known to man. Poisoning with abrus seeds is a rare occurrence as the harder outer coat of the seeds generally resists digestion and such reports are scarce in the literature. We present here a case of a 22 year old lady who developed severe vomiting, diarrhoea and malena at the initial stages and later seizures and acute disseminated encephalomyelitis due to deliberate chewing and swallowing of abrus seeds. She was rescued with several sessions of membrane plasmapheresis and supportive care. The neuropathological process of acute disseminated encephalomyelitis due to abrus poisoning was reversed by plasmapheresis.