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Wang L, Qin C, Guo Q, Han Y, Du G, Li R. Transcriptome Study of Bursaphelenchus xylophilus Treated with Fomepizole Reveals a Serine/Threonine-Protein Phosphatase Gene that Is Substantially Linked with Vitality and Pathogenicity. Phytopathology 2024; 114:630-640. [PMID: 38457135 DOI: 10.1094/phyto-04-23-0113-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Bursaphelenchus xylophilus, the pine wood nematode (PWN), is the causal agent of pine wilt disease (PWD), which causes enormous economic loss annually. According to our previous research, fomepizole, as a selective inhibitor of PWN alcohol dehydrogenase (ADH), has the potential to be a preferable lead compound for developing novel nematicides. However, the underlying molecular mechanism is still unclear. The result of molecular docking showed that the stronger interactions between fomepizole and PWN ADH at the active site of ADH were attributed to hydrogen bonds. Low-dose fomepizole had a substantial negative impact on the egg hatchability, development, oviposition, and lifespan of PWN. Transcriptome analysis indicated that 2,124 upregulated genes and 490 downregulated genes in fomepizole-treated PWN were obtained. Kyoto Encyclopedia of Genes and Genomes enrichment analysis of differentially expressed genes indicated that fomepizole could be involved in controlling PWN vitality mainly by regulating key signaling pathways, such as the ribosome, hippo signaling pathway, and lysosome. Remarkably, the results of RNA interference indicated that the downregulated serine/threonine-protein phosphatase gene (stpp) could reduce the egg hatchability, development, oviposition, and lifespan of PWN, which was closely similar to the consequences of nematodes with low-dose fomepizole treatment. In addition, the silencing of stpp resulted in weakness of PWN pathogenicity, which indicated that stpp could be a potential drug target to control PWN.
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Affiliation(s)
- Linsong Wang
- College of Life Sciences, Qingdao University, Qingdao 266071, P.R. China
| | - Chenglei Qin
- College of Life Sciences, Qingdao University, Qingdao 266071, P.R. China
| | - Qunqun Guo
- College of Life Sciences, Qingdao University, Qingdao 266071, P.R. China
| | - Yi Han
- College of Life Sciences, Qingdao University, Qingdao 266071, P.R. China
| | - Guicai Du
- College of Life Sciences, Qingdao University, Qingdao 266071, P.R. China
| | - Ronggui Li
- College of Life Sciences, Qingdao University, Qingdao 266071, P.R. China
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Ma J, Lu X, Hao M, Wang Y, Guo Y, Wang Z. Real-time visualization the pH fluctuations of living cells with a ratiometric near-infrared fluorescent probe. Spectrochim Acta A Mol Biomol Spectrosc 2024; 306:123572. [PMID: 37922853 DOI: 10.1016/j.saa.2023.123572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
In situ real-time quantitative monitoring pH fluctuation in complex living systems is vitally significant. In the current work, a ratiometric near-infrared (NIR) probe (MCyOH) was developed to confront this challenge. MCyOH exhibited good sensitivity, photostability, reversibility, and an ideal pKa (pKa = 6.65). Ratiometric character of MCyOH is beneficial to accuracy detect the pH fluctuations in living cells under different stimulation. The observations showed that intracellular pH was decreased when HepG2 cells under oxidative stress or starvation conditions. In particular, HepG2 cells was acidulated after addition of ethanol, however, the acidification phenomenon was attenuated or disappeared when HepG2 cells preincubated with disulfiram or fomepizole. Finally, MCyOH was successfully applied to observe the increasement of intracellular pH when HepG2 cells treated with fomepizole individually. Overall, MCyOH would be a practical candidate to explore pH-associated physiological and pathological varieties.
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Affiliation(s)
- Jianlong Ma
- Department of Chemistry, Changzhi University, Changzhi 046011, PR China; Key Laboratory of Chemistry of Northwestern Plant Resources and Key Laboratory for Natural Medicine of Gansu Province, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, Gansu 730000, PR China
| | - Xiaofeng Lu
- Key Laboratory of Chemistry of Northwestern Plant Resources and Key Laboratory for Natural Medicine of Gansu Province, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, Gansu 730000, PR China
| | - Mingyao Hao
- Key Laboratory of Chemistry of Northwestern Plant Resources and Key Laboratory for Natural Medicine of Gansu Province, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, Gansu 730000, PR China; University of Chinese Academy of Sciences, 100049 Beijing, PR China
| | - Yumeng Wang
- Department of Chemistry, Changzhi University, Changzhi 046011, PR China
| | - Yong Guo
- Key Laboratory of Chemistry of Northwestern Plant Resources and Key Laboratory for Natural Medicine of Gansu Province, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, Gansu 730000, PR China.
| | - Zhijun Wang
- Department of Chemistry, Changzhi University, Changzhi 046011, PR China.
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Bryan A, Pingali P, Faber A, Landry J, Akakpo JY, Jaeschke H, Li H, Lee WS, May L, Patel B, Neuwelt A. High-Dose Acetaminophen with Concurrent CYP2E1 Inhibition Has Profound Anticancer Activity without Liver Toxicity. J Pharmacol Exp Ther 2024; 388:209-217. [PMID: 37918853 PMCID: PMC10765416 DOI: 10.1124/jpet.123.001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/25/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023] Open
Abstract
Acetaminophen (AAP) is metabolized by a variety of pathways such as sulfation, glucuronidation, and fatty acid amide hydrolase-mediated conversion to the active analgesic metabolite AM404. CYP2E1-mediated metabolism to the hepatotoxic reactive metabolite NAPQI (N-acetyl-p-benzoquinone imine) is a minor metabolic pathway that has not been linked to AAP therapeutic benefits yet clearly leads to AAP liver toxicity. N-acetylcysteine (NAC) (an antioxidant) and fomepizole (a CYP2E1 inhibitor) are clinically used for the treatment of AAP toxicity. Mice treated with AAP in combination with fomepizole (plus or minus NAC) were assessed for liver toxicity by histology and serum chemistry. The anticancer activity of AAP with NAC and fomepizole rescue was assessed in vitro and in vivo. Fomepizole with or without NAC completely prevented AAP-induced liver toxicity. In vivo, high-dose AAP with NAC/fomepizole rescue had profound antitumor activity against commonly used 4T1 breast tumor and lewis lung carcinoma lung tumor models, and no liver toxicity was detected. The antitumor efficacy was reduced in immune-compromised NOD-scid IL2Rgammanull mice, suggesting an immune-mediated mechanism of action. In conclusion, using fomepizole-based rescue, we were able to treat mice with 100-fold higher than standard dosing of AAP (650 mg/kg) without any detected liver toxicity and substantial antitumor activity. SIGNIFICANCE STATEMENT: High-dose acetaminophen can be given concurrently with CYP2E1 inhibition to allow for safe dose escalation to levels needed for anticancer activity without detected evidence of toxicity.
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Affiliation(s)
- Allyn Bryan
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Pavani Pingali
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Anthony Faber
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Joseph Landry
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Jephte Y Akakpo
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Hartmut Jaeschke
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Howard Li
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Won Sok Lee
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Lauren May
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Bhaumik Patel
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
| | - Alex Neuwelt
- Department of Veterans Affairs, Richmond, Virginia. (A.B., P.P., W.S.L., B.P., A.N.); Departments of Oral and Craniofacial Molecular Biology (A.F.) and Human and Molecular Genetics (J.L., L.M.), Virginia Commonwealth University, Richmond, Virginia; Department of Veterans Affairs, Charleston, South Carolina (H.L.); and Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas, Lawrence, Kansas (J.Y.A., H.J.)
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Dang DM, Hieger MA. Massive Ethylene Glycol Self-Administration With Acute Kidney Injury Treated With Fomepizole Alone. Am J Ther 2023; 30:e456-e458. [PMID: 37713692 DOI: 10.1097/mjt.0000000000001586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 02/22/2023]
Affiliation(s)
- Duc M Dang
- Department of Emergency Medicine, Wellspan Health, York Hospital, York, PA
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Shah N, Khayat M, Owshalimpur D, Banda M, Munoz J, White WC, Forster BM, Petteys SK, Sullivan SB, Watson M, King JD. Mass Poisoning From Ethylene Glycol at a U.S. Military Base. Mil Med 2023; 188:e3261-e3264. [PMID: 36562097 DOI: 10.1093/milmed/usac380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/29/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
Ethylene glycol (EG) toxicity is an important cause of toxic alcohol poisoning in the USA with over 5,000 exposures reported annually. While classically characterized by solitary accidental or intentional ingestions, mass toxic alcohol poisoning outbreaks and more rarely collective consumptions (typically of methanol) have been described. We describe an ethylene glycol poisoning from collective ingestion that involved soldiers presenting at William Beaumont Army Medical Center in El Paso, Texas. Eleven soldiers presented to the emergency department over a 12-h period after ingestion of an unknown substance. The first two patients exhibited severe neurologic symptoms, while the remainder were asymptomatic. As serum EG levels were not immediately available, treatment decisions were based on surrogate laboratory values. Two patients received immediate hemodialysis, and fomepizole (FOM) because of severe acidosis with elevated anion and osmolal gaps. These patients developed acute kidney injury with renal recovery within a 3-week period. Two patients with elevated lactate received bicarbonate-based intravenous (IV) fluids and FOM. Two patients received IV fluids only and required prolonged observation for worsening acidosis and/or acute kidney injury. Five patients with normal laboratory values were treated with IV fluids and observation. All patients received cofactors including thiamine and pyridoxine. All patients survived. The outbreak occurred in the setting of limited dialysis resources, limited FOM availability, and in a resource-limited community. Additional guidelines are needed to determine allocation of limited resources, optimal dialysis and FOM treatment course, and comorbid conditions, which may prolong recovery.
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Affiliation(s)
- Nina Shah
- Department of Medicine-Nephrology, William Beaumont Army Medical Center, El Paso, TX 79918, USA
| | - Maurice Khayat
- Department of Medicine-Nephrology, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA
| | - David Owshalimpur
- Department of Medicine-Nephrology, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA
| | - Michelle Banda
- Department of Medicine-Internal Medicine, William Beaumont Army Medical Center, El Paso, TX 79918, USA
| | - Jesus Munoz
- Department of Medicine-Internal Medicine, William Beaumont Army Medical Center, El Paso, TX 79918, USA
| | - William C White
- Department of Medicine-Internal Medicine, William Beaumont Army Medical Center, El Paso, TX 79918, USA
| | - Benjamin M Forster
- Department of Medicine-Nephrology, William Beaumont Army Medical Center, El Paso, TX 79918, USA
| | - Sarah K Petteys
- Department of Medicine-Pulmonary/Critical Care Medicine, William Beaumont Army Medical Center, El Paso, TX 79918, USA
| | - Scott B Sullivan
- Department of Medicine-Critical Care/Emergency Medicine, William Beaumont Army Medical Center, El Paso, TX 79918, USA
| | - Maura Watson
- Department of Medicine-Nephrology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Joshua D King
- Department of Toxicology-Maryland Poison Center and Department of Medicine-Nephrology, University of Maryland, Baltimore, MD 21201, USA
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Dear JW, Bateman DN. Developing new antidotes for poisons with existing effective treatments: a case study of fomepizole in paracetamol poisoning. Clin Toxicol (Phila) 2023; 61:577-580. [PMID: 37747339 DOI: 10.1080/15563650.2023.2259085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Acetylcysteine is the only effective and licensed therapy for paracetamol poisoning. However, acetylcysteine loses efficacy if treatment is delayed 8-12 hours after paracetamol ingestion, and there is also uncertainty as to whether the dose should be increased in high-risk paracetamol ingestions. Studies have identified potential therapeutic targets, including enzymes that metabolize paracetamol; the pathways causing mitochondrial toxicity via c-Jun N-terminal kinases or superoxide generation; and other specific targets, such as nuclear factor-erythroid factor 2-dependent gene induction and autophagy. With this range of potential additional therapies, how should the speciality of clinical toxicology approach the development of new antidotes for this common poisoning? HISTORICAL BACKGROUND When the first treatments for paracetamol toxicity were developed, the clinical trial and ethical basis of practice were different from today. Acetylcysteine was never subjected to placebo-controlled studies, even by the United States Food and Drug Administration, as it was presumed that the toxicity of high paracetamol concentrations was so evident that placebo-controlled studies were unethical. Thus, the absolute benefit of acetylcysteine remains unknown. In addition, no dose-ranging studies of acetylcysteine in patients were ever done. The weakness of assessing the efficacy of additional antidotes in small groups of patients with moderate poisoning is illustrated by the use of cimetidine in paracetamol poisoning. CURRENT APPROACHES TO DRUG (AND ANTIDOTE) DEVELOPMENT The approach required by regulatory authorities today relies on several important steps. First, a clear target for therapeutic effect is sought, normally in a laboratory model. Next, a 'proof of principle' study is required to demonstrate that the target is 'druggable'. Finally, clinical studies to confirm proof of principle applies in humans, followed by a controlled trial with matched patient groups with sufficient power to demonstrate the clinical outcome being sought. Such patient studies can be expensive to conduct, and non-commercial groups suffer the risk of not being funded. FOMEPIZOLE Fomepizole prevents paracetamol-induced hepatic toxicity in mice by inhibiting cytochrome P4502E1, thereby preventing the conversion of paracetamol to its toxic metabolite. Fomepizole also inhibits c-Jun N-terminal kinases, a key pathway in the downstream toxicity on the mitochondria. The present evidence of efficacy in humans is based on small case series with no control groups. The availability of a licensed indication has facilitated off-label use of fomepizole in an unproven indication. CONCLUSIONS Paracetamol poisoning is common, and randomized, controlled clinical trials are possible. The benefit of fomepizole can only be shown by such a study. As clinical trials using fomepizole as an added therapy to acetylcysteine are recruiting in the United States, these should be supported by all clinical toxicologists. In the interim, the publication of small case series using fomepizole should be discouraged by journals.
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Affiliation(s)
- James W Dear
- Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Sciences, University of Edinburgh, The Queens Medical Research Institute, Edinburgh, UK
| | - D Nicholas Bateman
- Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Sciences, University of Edinburgh, The Queens Medical Research Institute, Edinburgh, UK
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Micciche A, Johnson E, Mefford B, McCoy A, Akpunonu P, Kalani M, Maskey A. A Case of an Intraoperative Iatrogenic Methanol Exposure. Am J Case Rep 2023; 24:e937247. [PMID: 37461205 PMCID: PMC10360444 DOI: 10.12659/ajcr.937247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND ThinPrep Cytolyt is a methanol-based cell preservation solution frequently used to fix tissue samples immediately following endobronchial ultrasound-guided fine-needle aspiration. Currently, no published reports describe an iatrogenic exposure to Cytolyt. We report the only known case of an accidental intraoperative administration of a methanol solution, with corresponding plasma concentrations, and successful treatment with fomepizole. CASE REPORT A 70-year-old woman with a history of stage IIIA rectal adenocarcinoma was referred for evaluation of a newly identified lung mass. During the procedure, a bronchoalveolar lavage (BAL) of the right upper lobe was performed. After BAL, the proceduralist was informed that the syringe used to instill fluid for the BAL contained Cytolyt rather than saline. The Department of Medical Toxicology was contacted immediately, and the patient received a 15 mg/kg dose of fomepizole. The first plasma methanol level, before fomepizole administration, was elevated to 21 mg/dL. The methanol level was 13 mg/dL 3 h after fomepizole treatment and even lower thereafter; therefore, no additional fomepizole was required. The patient did not develop signs of systemic toxicity and was discharged on hospital day 3. CONCLUSIONS Following methanol exposures, patients can exhibit metabolic acidosis, with potential for blindness, hemodynamic instability, and possibly death if untreated. Fomepizole (4-methylpyrazole) inhibits alcohol dehydrogenase and is a mainstay of treatment. Preventing medical errors is key in ensuring optimal patient care and decreasing adverse events. Providers using CytoLyt and any similar products should be aware of this potential error and approach the possibility of methanol toxicity as they would other routes of methanol exposure.
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Affiliation(s)
- Andrew Micciche
- Department of Emergency Medicine, University of Kentucky, Lexington, KY, USA
| | - Eric Johnson
- Pharmacy Practice and Science Department, University of Kentucky, Lexington, KY, USA
| | - Breanne Mefford
- Pharmacy Practice and Science Department, University of Kentucky, Lexington, KY, USA
| | - Amber McCoy
- Department of Pulmonology, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY, USA
| | - Peter Akpunonu
- Department of Emergency Medicine, University of Kentucky, Lexington, KY, USA
| | - Mehboob Kalani
- Department of Pulmonology, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY, USA
| | - Ashish Maskey
- Department of Pulmonology, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY, USA
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McMartin K, Brent J. Analysis of Fomepizole Elimination in Methanol- and Ethylene Glycol-Poisoned Patients. J Med Toxicol 2022; 18:19-29. [PMID: 34697779 PMCID: PMC8758829 DOI: 10.1007/s13181-021-00862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Fomepizole is an anti-metabolite therapy that is used to diminish the toxicity from methanol or ethylene glycol. Although its elimination kinetics have been well described in healthy human subjects, the elimination in poisoned patients have only been described in a few isolated cases. This study was designed to relate the elimination of fomepizole in a series of poisoned patients to that in healthy humans. METHODS Plasma samples from 26 patients in the clinical trials of the use of fomepizole for methanol and ethylene glycol poisoning were analyzed for fomepizole concentrations. The elimination of fomepizole was assessed after individual doses, both during and without intermittent hemodialysis. RESULTS In methanol- and ethylene glycol-poisoned patients, fomepizole had a volume of distribution of 0.66-0.68 L/kg. After repeated doses of fomepizole, the minimum trough concentration averaged 86-109 µmol/L, which is 10 times higher than the minimum therapeutic concentration. In healthy human subjects, fomepizole elimination follows Michaelis-Menten kinetics and has been calculated as zero-order elimination rates. Zero-order elimination rates averaged 13 and 17 μmol/L/h in methanol and ethylene glycol patients, respectively, compared to 6-19 μmol/L/h in healthy subjects. Elimination during intermittent hemodialysis followed first-order kinetics, with a half-life of 3 h. CONCLUSIONS Plasma concentrations during the repeated dosing confirmed that the recommended dosing schedule, with and without intermittent hemodialysis, maintained therapeutic concentrations throughout the treatments. Fomepizole elimination in poisoned patients at therapeutic plasma concentrations appears be similar to that reported previously in healthy human subjects.
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Affiliation(s)
- Kenneth McMartin
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Sciences Center - Shreveport, Shreveport, LA, 71130-3932, USA.
| | - Jeffrey Brent
- School of Medicine, University of Colorado, Aurora, CO, USA
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Jones AW. Clinical and forensic toxicology of methanol. Forensic Sci Rev 2021; 33:117-143. [PMID: 34247144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Methanol has a very simple chemical structure (CH3OH) considering its potential health hazard, including the many poisoning deaths after ingestion. In countries where authentic alcoholic beverages are expensive, restricted, or banned for religious or other reasons, some people resort to purchasing alcoholic drinks made illegally. These clandestine sources of "booze" often contain high concentrations of methanol, added by the perpetrators to enhance potency and increase profits. Although an effective medical treatment for methanol poisoning exists, because most such incidents occur in socially deprived parts of the world, the hospital emergency facilities are scarce and/or inadequate. Trace amounts of methanol (median ~1.0 mg/L) are produced endogenously via certain enzymatic processes, such as one-carbon metabolism. Methanol and methyl esters are also contained in fresh fruits and vegetables as well as in alcoholic beverages. During a period of heavy drinking the blood-methanol concentration (BMC) increases and might surpass 10 mg/L, which is considered a biomarker for alcohol abuse and alcoholism. Methanol itself has a low intrinsic toxicity, but is converted in the body into two highly toxic metabolites, formaldehyde and formic acid. This metabolism is delayed by co-ingestion of ethanol, which creates a latent period of 12-24 h before toxic symptoms develop. Accordingly, when patients are admitted to hospital for diagnosis and treatment, a life-threatening metabolic acidosis has already developed and is irreversible. Symptoms of methanol poisoning include blurred vision, breathlessness, nausea, gastric pains, and acid-base disturbances and deficiency of oxygen in arterial blood. The visual disturbances might even develop into permanent blindness, owing to an interaction of toxic metabolites with the optic nerve. The minimum lethal dose of ethanol in humans is not easy to specify, because most poisonings involve co-ingestion of ethanol, which to some extent protects the patient from toxic sequelae. Effective antidotes for treatment of methanol poisoning are administration of ethanol or the therapeutic drug fomepizole (Antizol®), which is 4-methyl pyrazole (4-MP). Both treatments work by blocking the metabolism of methanol by liver alcohol dehydrogenase (ADH). The metabolic acidosis caused by the accumulation of formic acid in the body is treated with sodium bicarbonate, which helps to normalize pH in the bloodstream. Thereafter, methanol and its metabolites in the blood are removed by hemodialysis. However, the long-term prognosis for survivors of methanol poisoning is not good, because many are elderly males who are in poor health and often suffer from an alcohol-use disorder.
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Affiliation(s)
- A W Jones
- Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Östergötland, Sweden
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Helander A, Villen T, Hansson T, Nordmark Grass J. [Simplified laboratory analysis of ethylene glycol allows improved management of poisoning cases]. Lakartidningen 2020; 117:FZWM. [PMID: 32453856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Toxicological analysis constitutes an important part of the acute treatment of poisonings. Timely laboratory results are essential for the patient to be diagnosed and treated appropriately, but also to exclude poisoning and avoid unnecessary overtreatment. Ingestion of ethylene glycol may cause acute kidney injury and, in severe cases, death, unless treated early with an antidote (ethanol infusion or fomepizole) to inhibit the formation of toxic metabolites. Diagnosis of poisoning is based on detection of ethylene glycol in plasma or serum, but a challenge remains that acute toxicology service is only available at major hospital laboratories using gas chromatography. A simple enzymatic method for the quantification of ethylene glycol (Catachem) was evaluated as a complement to currently used methods and demonstrated to provide fast and accurate measurement in a clinically relevant concentration range (1-80 mmol/l) with a minimal risk of analytical interference. The method is suitable for use on several automated clinical chemistry analyzers. Use of the enzymatic method can improve availability of acute toxicology service for ethylene glycol and contribute to better healthcare from both a patient and health resource perspective.
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11
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Ng PCY, Long BJ, Davis WT, Sessions DJ, Koyfman A. Toxic alcohol diagnosis and management: an emergency medicine review. Intern Emerg Med 2018; 13:375-383. [PMID: 29427181 DOI: 10.1007/s11739-018-1799-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/01/2018] [Indexed: 11/28/2022]
Abstract
Toxic alcohols are a group of substances containing a hydroxyl group not meant to be ingested. They are the cause of a significant number of accidental and non-accidental exposures. Toxic alcohol poisoning can be associated with a significant degree of morbidity and mortality if not promptly recognized and treated. This review describes the clinical presentation and an approach to the recognition and management for toxic alcohol poisoning. Toxic alcohols classically refer to a group of alcohols not meant for ingestion. Methanol, ethylene glycol, and isopropyl alcohol are readily available in common hardware and household materials. Toxic alcohols are ingested for a variety of reasons including accidental exposures, intentional inebriation, homicide and suicide. The patient with an altered mental status or concerning history warrants consideration of this potentially deadly ingestion. Treatment considerations include alcohol dehydrogenase blockade and hemodialysis. Toxic alcohol poisoning can be an elusive diagnosis. This review evaluates toxic alcohol poisoning signs and symptoms and an approach to diagnosis and management.
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Affiliation(s)
- Patrick Chow Yuen Ng
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | - Brit J Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | - William Tyler Davis
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA.
| | - Daniel J Sessions
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
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Sommerfeld-Klatta K, Przystanowicz J, Kowalówka-Zawieja J, Zielińska-Psuja B. Effect of repeated administration of 4-methylpyrazole on renal function and lipid peroxidation products in rat kidney after ethylene glycol poisoning. Environ Toxicol Pharmacol 2017; 56:290-296. [PMID: 29091817 DOI: 10.1016/j.etap.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
Toxic effects of ethylene glycol (EG) and its metabolites are mainly related to metabolic acidosis and kidney damage. EG biotransformation involving CYP2E1 affects the oxidant-antioxidant balance. The study assessed the effect of repeated administration of 4-methylpyrazole (4MP, 15mg/kg b.w. after 2h, followed by 10mg/kg b.w. every 12h) on renal function (creatinine, urea and urinary protein levels) as well as products of kidney's lipid peroxidation (MDA and TBARS levels) in rats poisoned with EG (5745mg/kg b.w.). Serum EG and glycolic acid (GA) concentrations were measured throughout the experiment. Repeated administration of 4MP reduced the rate of EG elimination, extended the period of EG persistence in serum and significantly limited formation of GA. The study showed the temporary intensification of kidney oxidative processes that correlated with changes in kidney function. It was found that the use of 4MP in EG poisoning inhibited its biotransformation to toxic metabolites, but simultaneously intensified oxidative damages in kidneys.
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Hassanian-Moghaddam H, Zamani N. A Brief Review on Toxic Alcohols: Management Strategies. Iran J Kidney Dis 2016; 10:344-350. [PMID: 27903992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 05/14/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
The information on burden of alcohol abuse in Iran is scarce. However, the available data show that mortality rates and frequency of its use have increased in the Iranian community. In particular, Iran occupies the 1st rank in the number of outbreak incidents and victims of toxic alcohols such as methanol in the Middle East. Mortality and morbidity of toxic alcohols are high if prompt diagnosis and treatment are not initiated rapidly. On-time diagnosis, proper case finding, and standard treatment have an essential role to reduce mortality and morbidity of toxic alcohols particularly blindness and other physical and psychological disabilities. This review focuses on intoxication with methanol, ethylene glycol, and isopropanol, and their treatment.
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Affiliation(s)
- Hossein Hassanian-Moghaddam
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences; Excellence Center of Clinical Toxicology, Ministry of Health, Tehran, Iran.
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14
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Beauchamp GA, Valento M, Kim J. Toxic alcohol ingestion: prompt recognition and management in the emergency department [digest]. Emerg Med Pract 2016; 18:S1-S2. [PMID: 28745842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Identifying patients with potential toxic alcohol exposure and initiating appropriate management is critical to avoid significant patient morbidity. Sources of toxic alcohol exposure include ethylene glycol, methanol, diethylene glycol, propylene glycol, and isopropanol. Treatment considerations include the antidotes fomepizole and ethanol, and hemodialysis for removal of the parent compound and its toxic metabolites. Additional interventions include adjunctive therapies that may improve acidosis and enhance clearance of the toxic alcohol or metabolites. This issue reviews common sources of alcohol exposure, basic mechanisms of toxicity, physical examination and laboratory findings that may guide rapid assessment and management, and indications for treatment. [Points & Pearls is a digest of Emergency Medicine Practice].
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Affiliation(s)
- Gillian A Beauchamp
- Adjunct Instructor, Oregon Health & Science University, Department of Emergency Medicine; Toxicology Fellow, Oregon and Alaska Poison Centers, Portland, OR
| | - Matthew Valento
- Acting Assistant Professor, Division of Emergency Medicine, University of Washington; Interim Medical Director, Washington Poison Center, Seattle, WA
| | - Jeremy Kim
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Kawai T, Yanaka N, Richards JS, Shimada M. De Novo-Synthesized Retinoic Acid in Ovarian Antral Follicles Enhances FSH-Mediated Ovarian Follicular Cell Differentiation and Female Fertility. Endocrinology 2016; 157:2160-72. [PMID: 27022678 PMCID: PMC4870881 DOI: 10.1210/en.2015-2064] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Retinoic acid (RA) is the active form of vitamin A and is synthesized from retinol by two key enzymes, alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH). As the physiological precursor of RA, retinol impacts female reproductive functions and fertility. The expression of Adh1 and Adh5 as well as Aldh1a1 and Aldh1a7 are significantly increased in the ovaries of mice treated with equine chorionic gonadotropin/FSH. The RA receptor is expressed and localized in granulosa cells and is activated by endogenous RA as indicated by LacZ expression in granulosa cells of RA-responsive transgene-LacZ transgenic mice (RA reporter mice). Coinjection of the ADH inhibitor, 4-methylpyrazole, with equine chorionic gonadotropin significantly decreases the number and developmental competence of oocytes ovulated in response to human chorionic gonadotropin/LH as compared with controls. Injections of RA completely reverse the effects of the inhibitor of ovulation and oocyte development. When mice were fed a retinol-free, vitamin A-deficient diet that significantly reduced the serum levels of retinol, the expression of the LH receptor (Lhcgr) was significantly lower in the ovaries of the vitamin A-deficient mice, and injections of human chorionic gonadotropin failed to induce genes controlling ovulation. These results indicate that ovarian de novo biosynthesis of RA is required for the follicular expression of Lhcgr in granulosa cells and their ability to respond to the ovulatory LH surge.
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Affiliation(s)
- Tomoko Kawai
- Laboratory of Reproductive Endocrinology (T.K., M.S.) and Laboratory of Nutrition (N.Y.), Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan; and Department of Molecular and Cellular Biology (J.S.R.), Baylor College of Medicine, Houston, Texas 77030
| | - Noriyuki Yanaka
- Laboratory of Reproductive Endocrinology (T.K., M.S.) and Laboratory of Nutrition (N.Y.), Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan; and Department of Molecular and Cellular Biology (J.S.R.), Baylor College of Medicine, Houston, Texas 77030
| | - JoAnne S Richards
- Laboratory of Reproductive Endocrinology (T.K., M.S.) and Laboratory of Nutrition (N.Y.), Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan; and Department of Molecular and Cellular Biology (J.S.R.), Baylor College of Medicine, Houston, Texas 77030
| | - Masayuki Shimada
- Laboratory of Reproductive Endocrinology (T.K., M.S.) and Laboratory of Nutrition (N.Y.), Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan; and Department of Molecular and Cellular Biology (J.S.R.), Baylor College of Medicine, Houston, Texas 77030
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Affiliation(s)
- Abhishek Maiti
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Avash Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Rushchak VV, Chashchyn MO. Cytochrome P450 2E1 participation in the pathogenesis of experimental metabolic syndrome in guinea pigs. Ukr Biochem J 2016; 88:98-106. [PMID: 29227611 DOI: 10.15407/ubj88.02.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In this work the experimental metabolic syndrome on the basis of protamine sulfate modeling in
guinea pigs was reproduced and pathological processes in the liver of experimental animals were studied.
We determined the level of free radicals and markers of liver damage in the blood of experimental animals.
We investigated the liver glycogen content and K+,Na+-ATPase activity in the liver of experimental animals
as well as measured the cytochrome P450 2E1 (CY P2E1) expression – one of the main factors of oxidative
stress. Evidence of development of hepatotoxic processes, increasing of the CY P2E1 level as well as of the
free radical level in the animals with metabolic syndrome were found. Using of CY P2E1 inhibitors had shown
that the free radical level in the blood of experimental animals depended on the level of the enzyme expression
and activity. The obtained results suggest that the changes in the CY P2E1 expression play an important
role in the development of hepatotoxic processes upon experimental metabolic syndrome. It was assumed that
pharmacological correction of the enzyme expression may be an important mechanism for the influence on
the metabolic syndrome clinical course.
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18
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Kiyota K. [Antidote update]. Nihon Rinsho 2016; 74:236-240. [PMID: 26915245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In Japan, several products of the antidote for poisoning have been authorized in clinical use from some recent years. For example, Hydroxcobalamin for cyanide poisoning was introduced in 2008. In 2009, Ministry of Health, Labour and Welfare invited suggestions of demand of pharmaceutical products which is high in the need in the medical care but yet unauthorized. Japanese Society for Clinical Toxicology and Japan Poison Information Center applied some candidates including methyleneblue (MB) and fomepizole, both of them were authorized in clinical market in 2015. MB is the medicine for methemoglobinemia, caused by variety of chemical products such as nitrogen oxide. Fomepizole is the antidote for methanol and ethyleneglycol, blocking alcohol dehydrogenase.
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Pelclová D, Zakharov S. [Methanol: the threat of intoxication is still there]. Vnitr Lek 2016; 62:616-619. [PMID: 27627087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Methanol mass poisoning occurs across the world quite frequently, but the complete clinical and laboratory data of the patients are only rarely available. Approximately 138 cases of poisoning were documented in the Czech Republic, 107 patients were hospitalized. Another 31 persons died out of hospital. About 60 % of the hospitalized patients survived intoxication without consequences, one half of the remaining 40 % died and the other half survived with the CNS and/or sight impaired. The Czech study successfully used modern diagnostic methods. A positive effect of the prehospital first aid with an oral antidote has been proven and a comparable effect of ethanol and fomepizole has been reached during hospital therapy. Higher efficiency of intermittent therapy has been determined as compared to continual hemodialysis. No connection was found between cerebral hemorrhage and systemic anticoagulation during hemodialysis. Magnetic resonance imaging revealed brain lesions in more than 50 % of the examined persons. During the follow-up visits over months and years improvement regarding the damage to the optic nerve was found in patients with a lesion of mild to medium degree. Isolated cases of poisoning still occur. KEY WORDS antidote - long-term follow-up - hemodialysis - methanol - methanol intoxication - CNS damage - vision impairment.
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Zabrodskii PF, Maslyakov VV, Gromov MS. [EFFECT OF 4-METHYLPYRAZOLE ON IMMUNE RESPONSE, FUNCTION OF Th1 AND Th2 LYMPHOCYTES, AND CYTOKINE CONCENTRATION IN RAT BLOOD AFTER ACUTE METHANOL POISONING]. Eksp Klin Farmakol 2016; 79:37-40. [PMID: 27455577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
It was established in experiments on noninbred albino rats that the acute intoxication with methanol (1.0 LD50) decreased cellular and humoral immune responses, Th2-lymphocyte activity (to a greater extent as compared to the function of Th1 cells), reduced the blood concentration of immunoregulatory (IFN-g, IL-2, IL-4) and proinflammatory (TNF, IL-1b, IL-6) cytokines on the average by 36.5% (p < 0.05), and did not affect the content of anti-inflammatory cytokines (IL-10, IL-13). Methanol antidote 4-methylpyrazole (non-competitive inhibitor of alcohol dehydrogenase) administered upon acute intoxication with methanol at a dose of 1.0 DL50 partially reduces the intoxication-induced suppression of humoral and cellular immune response, activity of T-helper cells, and production of IL-4 and restores blood levels of TNF, IL-1b, IFN-γ, IL-4, IL-2, IL-6 to the control values.
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21
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Lee YS, Yi HS, Suh YG, Byun JS, Eun HS, Kim SY, Seo W, Jeong JM, Choi WM, Kim MH, Kim JH, Park KG, Jeong WI. Blockade of Retinol Metabolism Protects T Cell-Induced Hepatitis by Increasing Migration of Regulatory T Cells. Mol Cells 2015; 38:998-1006. [PMID: 26537191 PMCID: PMC4673415 DOI: 10.14348/molcells.2015.0218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 08/30/2015] [Accepted: 08/31/2015] [Indexed: 12/12/2022] Open
Abstract
Retinols are metabolized into retinoic acids by alcohol dehydrogenase (ADH) and retinaldehyde dehydrogenase (Raldh). However, their roles have yet to be clarified in hepatitis despite enriched retinols in hepatic stellate cells (HSCs). Therefore, we investigated the effects of retinols on Concanavalin A (Con A)-mediated hepatitis. Con A was injected into wild type (WT), Raldh1 knock-out (Raldh1(-/-)), CCL2(-/-) and CCR2(-/-) mice. For migration study of regulatory T cells (Tregs), we used in vivo and ex vivo adoptive transfer systems. Blockade of retinol metabolism in mice given 4-methylpyrazole, an inhibitor of ADH, and ablated Raldh1 gene manifested increased migration of Tregs, eventually protected against Con A-mediated hepatitis by decreasing interferon-γ in T cells. Moreover, interferon-γ treatment increased the expression of ADH3 and Raldh1, but it suppressed that of CCL2 and IL-6 in HSCs. However, the expression of CCL2 and IL-6 was inversely increased upon the pharmacologic or genetic ablation of ADH3 and Raldh1 in HSCs. Indeed, IL-6 treatment increased CCR2 expression of Tregs. In migration assay, ablated CCR2 in Tregs showed reduced migration to HSCs. In adoptive transfer of Tregs in vivo and ex vivo, Raldh1-deficient mice showed more increased migration of Tregs than WT mice. Furthermore, inhibited retinol metabolism increased survival rate (75%) compared with that of the controls (25%) in Con A-induced hepatitis. These results suggest that blockade of retinol metabolism protects against acute liver injury by increased Treg migration, and it may represent a novel therapeutic strategy to control T cell-mediated acute hepatitis.
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Affiliation(s)
- Young-Sun Lee
- Laboratory of Liver Research, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 305-701,
Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705,
Korea
| | - Hyon-Seung Yi
- Laboratory of Liver Research, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 305-701,
Korea
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon 305-764,
Korea
| | - Yang-Gun Suh
- Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408,
Korea
| | - Jin-Seok Byun
- Department of Oral Medicine, School of Dentistry, Kyungpook National University, Daegu 41566,
Korea
| | - Hyuk Soo Eun
- Laboratory of Liver Research, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 305-701,
Korea
| | - So Yeon Kim
- Laboratory of Liver Research, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 305-701,
Korea
| | - Wonhyo Seo
- Laboratory of Liver Research, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 305-701,
Korea
| | - Jong-Min Jeong
- Laboratory of Liver Research, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 305-701,
Korea
| | - Won-Mook Choi
- Laboratory of Liver Research, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 305-701,
Korea
| | - Myung-Ho Kim
- Laboratory of Liver Research, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 305-701,
Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705,
Korea
| | - Keun-Gyu Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu 41566,
Korea
| | - Won-Il Jeong
- Laboratory of Liver Research, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 305-701,
Korea
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22
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Barra CV, Treu-Filho O, Rocha FV, Moura TR, Netto AVG, Mauro AE, Pinheiro JC, Pinheiro RT. Experimental and DFT Study on the Compounds [PdCl2L2] (L = 4-methylpyrazole, 4-iodopyrazole). Acta Chim Slov 2015; 62:662-71. [PMID: 26454601 DOI: 10.17344/acsi.2014.1299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Theoretical molecular structures of the complexes [PdCl(2)(HmPz)(2)] (1) and [PdCl(2)(HIPz)(2)] (2) (HmPz = 4-methylpyrazole; HIPz = 4-iodopyrazole) were studied using B3LYP/DFT method. The new complex 2 and the complex 1 were synthesized and characterized by elemental analysis and IR spectroscopy. The calculated bond distances and angles showed that both compounds exhibited a slightly distorted square planar coordination environment around the palladium center. The theoretical IR spectra of C(s) symmetry (electronic state 1A') of the complexes agree well with the experimental data.
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23
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Endo Y. [ Fomepizole]. Chudoku Kenkyu 2015; 28:31-36. [PMID: 26399012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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24
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Mégarbane B, Résière D. [Toxicological analysis is mandatory to interpret elevation in blood lactate concentration in toxic alcohol poisoning]. Ann Fr Anesth Reanim 2014; 33:368-369. [PMID: 24857017 DOI: 10.1016/j.annfar.2014.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- B Mégarbane
- Inserm U1144, réanimation médicale et toxicologique, hôpital Lariboisière, université Paris-Diderot, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - D Résière
- Réanimation polyvalente, CHU de Fort-De-France, Fort-De-France, Martinique
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25
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Rietjens SJ, de Lange DW, Meulenbelt J. Ethylene glycol or methanol intoxication: which antidote should be used, fomepizole or ethanol? Neth J Med 2014; 72:73-79. [PMID: 24659589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Ethylene glycol (EG) and methanol poisoning can cause life-threatening complications. Toxicity of EG and methanol is related to the production of toxic metabolites by the enzyme alcohol dehydrogenase (ADH), which can lead to metabolic acidosis, renal failure (in EG poisoning), blindness (in methanol poisoning) and death. Therapy consists of general supportive care (e.g. intravenous fluids, correction of electrolytes and acidaemia), the use of antidotes and haemodialysis. Haemodialysis is considered a key element in the treatment of severe EG and methanol intoxication and is aimed at removing both the parent compound and its toxic metabolites, reducing the duration of antidotal treatment and shortening the hospital observation period. Currently, there are two antidotes used to block ADH-mediated metabolism of EG and methanol: ethanol and fomepizole. In this review, the advantages and disadvantages of both antidotes in terms of efficacy, safety and costs are discussed in order to help the physician to decide which antidote is appropriate in a specific clinical setting.
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Affiliation(s)
- S J Rietjens
- National Poisons Information Center, University Medical Center Utrecht, the Netherlands
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26
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Winchell GA, Mistry GC, Kari PP, Marbury T, Miller JL, Simpson RC, Rodrigues AD, Gottesdiener KM, Wagner JA. The Effect of Ketoconazole on the Pharmacokinetics of a Selective α1A-Adrenoceptor Antagonist. J Clin Pharmacol 2013; 45:699-703. [PMID: 15901753 DOI: 10.1177/0091270005275289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Darracq MA, Rentmeester LL, Clark RF, Tomaszewski CA, Schneir AB, Cantrell FL. Cost of hemodialysis versus fomepizole-only for treatment of ethylene glycol intoxication. Clin Toxicol (Phila) 2013; 51:188. [PMID: 23356815 DOI: 10.3109/15563650.2013.766750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Thomes PG, Ehlers RA, Trambly CS, Clemens DL, Fox HS, Tuma DJ, Donohue TM. Multilevel regulation of autophagosome content by ethanol oxidation in HepG2 cells. Autophagy 2013; 9:63-73. [PMID: 23090141 PMCID: PMC3542219 DOI: 10.4161/auto.22490] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Acute and chronic ethanol administration increase autophagic vacuole (i.e., autophagosome; AV) content in liver cells. This enhancement depends on ethanol oxidation. Here, we used parental (nonmetabolizing) and recombinant (ethanol-metabolizing) Hep G2 cells to identify the ethanol metabolite that causes AV enhancement by quantifying AVs or their marker protein, microtubule-associated protein 1 light chain 3-II (LC3-II). The ethanol-elicited rise in LC3-II was dependent on ethanol dose, was seen only in cells that expressed alcohol dehydrogenase (ADH) and was augmented in cells that coexpressed cytochrome CYP2E1 (P450 2E1). Furthermore, the rise in LC3-II was inversely related to a decline in proteasome activity. AV flux measurements and colocalization of AVs with lysosomes or their marker protein Lysosomal-Associated Membrane Protein 1 (LAMP1) in ethanol-metabolizing VL-17A cells (ADH (+) /CYP2E1 (+) ) revealed that ethanol exposure not only enhanced LC3-II synthesis but also decreased its degradation. Ethanol-induced accumulation of LC3-II in these cells was similar to that induced by the microtubule inhibitor, nocodazole. After we treated cells with either 4-methylpyrazole to block ethanol oxidation or GSH-EE to scavenge reactive species, there was no enhancement of LC3-II by ethanol. Furthermore, regardless of their ethanol-metabolizing capacity, direct exposure of cells to acetaldehyde enhanced LC3-II content. We conclude that both ADH-generated acetaldehyde and CYP2E1-generated primary and secondary oxidants caused LC3-II accumulation, which rose not only from enhanced AV biogenesis, but also from decreased LC3 degradation by the proteasome and by lysosomes.
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Affiliation(s)
- Paul G Thomes
- Liver Study Unit, Department of Veterans Affairs, VA Nebraska-Western Iowa Health Care System (NWIHCS), Omaha, NE, USA.
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Abstract
We are the first to report allosterism during styrene oxidation by recombinant CYP2E1 and human liver microsomes. At low styrene concentrations, oxidation is inefficient because of weak binding to CYP2E1 (K(s) = 830 μM). A second styrene molecule then binds CYP2E1 with higher affinity (K(ss) = 110 μM) and significantly improves oxidation to achieve a k(cat) of 6.3 nmol · min(-1) · nmol CYP2E1(-1). The transition between these metabolic cycles coincides with reported styrene concentrations in blood from exposed workers; thus, this CYP2E1 mechanism may be relevant in vivo. Scaled modeling of the in vitro-positive allosteric mechanism for styrene metabolism to its in vivo clearance led to significant deviations from the traditional model based on Michaelis-Menten kinetics. Low styrene levels were notably much less toxic than generally assumed. We interrogated the allosteric mechanism using the CYP2E1-specific inhibitor and drug 4-methylpyrazole, which we have shown binds two CYP2E1 sites. From the current studies, styrene was a positive allosteric effector on 4-methylpyrazole binding, based on a 10-fold increase in 4-methylpyrazole binding affinity from K(i) 0.51 to K(si) 0.043 μM. The inhibitor was a negative allosteric effector on styrene oxidation, because k(cat) decreased 6-fold to 0.98 nmol · min(-1) · nmol CYP2E1(-1). Consequently, mixtures of styrene and other molecules can induce allosteric effects on binding and metabolism by CYP2E1 and thus mitigate the efficiency of their metabolism and corresponding effects on human health. Taken together, our elucidation of mechanisms for these allosteric reactions provides a powerful tool for further investigating the complexities of CYP2E1 metabolism of drugs and pollutants.
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Affiliation(s)
- Jessica H Hartman
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Lapatto-Reiniluoto O, Ikäheimo R. [Surrogate alcohol poisonings]. Duodecim 2012; 128:2140-2148. [PMID: 23167171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Surrogate alcohols, i.e., methanol, ethylene glycol and isopropanol, still cause some dozens of deaths in Finland every year. Assessment of the severity of the intoxication is often hampered by the presence of ethanol. If ingestion of surrogate alcohol is suspected and the patient is diagnosed with metabolic acidosis, treatment should be initiated immediately, without waiting for the result of concentration analysis. Ethanol is commonly utilized as an antidote in Finland, whereas the use of a specific antidote, fomepizole, is slowly increasing. Reversal of acidosis and hemodialysis are also essential measures in the treatment of methanol and ethylene glycol poisoning.
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Bakke SA, Laursen SB. [Treatment with disulfiram can be dangerous]. Ugeskr Laeger 2011; 173:3192-3193. [PMID: 22142608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 66 year-old woman developed severe hypotension and bronchospasm as a result of disulfiram-ethanol reaction (DER). She presented with sudden onset of severe life-threatening symptoms. The clinical signs of DER were treated successfully and symptomatically with intravenous fluids, catecholamines, inhalations and benzodiazepines in the intensive care unit. Fomepizole, an alcohol dehydrogenase inhibitor, was advocated as a specific treatment for DER. This case highlights the potential danger of DER.
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Affiliation(s)
- Skule Arnesen Bakke
- Anæstesi og Operationsafdelingen, Sygehus Sønderjylland, Sydvang 1, 6400 Sønderborg, Denmark.
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Affiliation(s)
- Hossein Sanaei-Zadeh
- Department of Forensic Medicine and Toxicology, School of Medicine (Pardis Hemmat), Tehran University of Medical Sciences, Tehran, Iran.
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Ronis MJ, Korourian S, Blackburn ML, Badeaux J, Badger TM. The role of ethanol metabolism in development of alcoholic steatohepatitis in the rat. Alcohol 2010; 44:157-69. [PMID: 20116195 PMCID: PMC2831169 DOI: 10.1016/j.alcohol.2009.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 11/03/2009] [Accepted: 11/05/2009] [Indexed: 12/23/2022]
Abstract
The importance of ethanol metabolism in the development of alcoholic liver disease remains controversial. The present study examined the effects of selective inhibition of the cytochrome P450 enzyme CYP2E1 compared with the inhibition of overall ethanol metabolism on the development of alcoholic steatohepatitis. Adult male Sprague-Dawley rats were fed via total enteral nutrition for 45 days with or without 10-12g/kg/d ethanol. Some groups were given 200mg/kg/d of the CYP2E1 inhibitor diallyl sulfide (DAS). Other groups were treated with 164mg/kg/d of the alcohol dehydrogenase (ADH) inhibitor 4-methylpyrazole (4-MP) and dosed at 2-3g/kg/d ethanol to maintain similar average urine ethanol concentrations. Liver pathology scores and levels of apoptosis were elevated by ethanol (P<.05) but did not differ significantly on cotreatment with DAS or 4-MP. However, liver triglycerides were lower when ethanol-fed rats were treated with DAS or 4-MP (P<.05). Serum alanine aminotransferase values were significantly lower in ethanol-fed 4-MP-treated rats indicating reduced necrosis. Hepatic oxidative stress and the endoplasmic reticulum (ER) stress marker tribbles-related protein 3 were increased after ethanol (P<.05); further increased by DAS but partly attenuated by 4-MP. Both DAS and 4-MP reversed ethanol increases in the cytokine, tumor necrosis factor-alpha (TNF-alpha), and the chemokine CXCL-2 (P<.05). However, neither inhibitors prevented ethanol suppression of interleukins IL-4 or IL-12. Moreover, neither inhibitors prevented ethanol increases in tumor growth factor-beta mRNA. Ethanol and DAS additively induced hepatic hyperplasia (P<.05). These data suggest that a significant proportion of hepatic injury after ethanol exposure is independent of alcohol metabolism. Ethanol metabolism by CYP2E1 may be linked in part to triglyceride accumulation, to induction of TNF-alpha, and to chemokine production. Ethanol metabolism by ADH may be linked in part to oxidative and ER stress and necrotic injury.
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Affiliation(s)
- Martin J Ronis
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, 72205, USA.
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34
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Akahori F. [Application in veterinary and human clinical toxicology]. Chudoku Kenkyu 2009; 22:293-300. [PMID: 20058656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Affiliation(s)
- Leo J Schep
- National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
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González-Santiago O, Garza-Ocañas L. Fomepizole for toxic alcohol poisoning. N Engl J Med 2009; 361:1213; author reply 1213-4. [PMID: 19771605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Affiliation(s)
- Jeffrey Brent
- Toxicology Associates, University of Colorado Health Sciences Center, 2555 S. Downing St., Suite 260, Denver, CO 80210, USA.
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Blanchet B, Charachon A, Lukat S, Huet E, Hulin A, Astier A. A case of mixed intoxication with isopropyl alcohol and propanol-1 after ingestion of a topical antiseptic solution. Clin Toxicol (Phila) 2009; 45:701-4. [PMID: 17849246 DOI: 10.1080/15563650701517285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report a mixed intoxication with isopropyl alcohol and propanol-1 in a hospitalized patient who ingested, on two separate days, two 100 ml bottles of a topical antiseptic solution containing isopropyl alcohol and propanol-1. Eight hours after the second ingestion, plasma concentrations of isopropanol, propanol-1 and acetone were 37 mg/dL, <10 mg/dL, and 227 mg/dl, respectively. Despite a lack of severe toxicity, 4-methylpyrazole (fomepizole) was initiated. This case points out the need to limit access to alcohol-containing antiseptic solutions on wards where alcoholic and psychotic patients are hospitalized.
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Affiliation(s)
- Benoit Blanchet
- Laboratory of Pharmacology and Toxicology, CHU Henri Mondor, Créteil, France.
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Abstract
UNLABELLED Methanol poisoning is a potentially fatal medical emergency because of its metabolism to formic acid. The half-life of formate has been reported in the range of 2.5-12.5 hours, but the degree of inter-individual variation is not known. We studied methanol and formate kinetics in a case of late diagnosed methanol poisoning with persisting metabolic acidosis and circulatory failure. CASE REPORT A 63-year-old man was referred to our hospital with a tentative diagnosis of stroke. He was awake on admission, but he soon deteriorated in the emergency department and a metabolic acidosis was revealed. Methanol poisoning was then suspected approximately five hours after admission but in spite of intensive treatment he died after six days. RESULTS The S-methanol half-lives during treatment with fomepizole before and during hemodialysis were 49.5 and 4.1 hours, respectively, while the similar half-lives of S-formate were 77.0 and 2.9 hours. S-fomepizole was measured and found to be within the therapeutic range during treatment. DISCUSSION The patient was treated with the established dosing regimen for fomepizole and the measured S-fomepizole levels throughout the treatment were adequate; the S-methanol elimination also suggests that methanol metabolism was blocked. Hence, other explanations for this exceptionally long formate half-life include slow formate metabolism, due to small hepatic folate stores or to genetic deficiencies in formate-metabolizing enzymes, or slow formate excretion, due to renal tubular acidosis, to a non-oliguric renal failure, or to genetic deficiencies in the renal formate transporters. CONCLUSION This case report indicates that the half-life of S-formate may have greater inter-individual variation than earlier expected, being by far the longest half-life reported in the medical literature. These results support the use of hemodialysis in the treatment of such patients.
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Affiliation(s)
- Knut Erik Hovda
- Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway.
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Endo Y. [Non-approved antidotes in Japan]. Chudoku Kenkyu 2008; 21:379-386. [PMID: 19069131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
Rat liver microsomes attached to nanoparticles were used for LC-MS studies of CYP3A and 2E1 enzymes in metabolism of N-nitroso compounds. Using these biocolloids, turnover rates were measured within 2 min. Inhibitor IC(50) values for ketoconazole (KET) and 4-methylpyrazole (4-MEP) were estimated.
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Affiliation(s)
- Besnik Bajrami
- Department of Chemistry, University of Connecticut, Storrs, Connecticut 06269-3060
| | - Sadagopan Krishnan
- Department of Chemistry, University of Connecticut, Storrs, Connecticut 06269-3060
| | - James F. Rusling
- Department of Chemistry, University of Connecticut, Storrs, Connecticut 06269-3060
- Department of Cell Biology, University of Connecticut Health Center, Farmington, Connecticut 06032, U. S. A
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Jamal M, Ameno K, Ikuo U, Kumihashi M, Wang W, Ijiri I. Ethanol and acetaldehyde: in vivo quantitation and effects on cholinergic function in rat brain. ACTA ACUST UNITED AC 2008; 285:137-41; discussion 141-4, 198-9. [PMID: 17590992 DOI: 10.1002/9780470511848.ch10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
First, ethanol (EtOH) and acetaldehyde levels were determined simultaneously in the striatum of free-moving rats after administration of their major oxidative enzyme inhibitors followed by EtOH. The results showed that acetaldehyde was present in the cyanamide (CY) + EtOH, CY + 4-methylpyrazole (4-MP) + EtOH and CY + sodium azide + EtOH groups. The CY + EtOH-induced peak acetaldehyde level was 195.2 +/- 19.4 microM, and this value was significantly higher than those in the other groups. The peak EtOH level was 25.9 +/- 2.3mM in the CY + 4-MP + EtOH group, and this level was considerably higher than the value in EtOH. No significant difference in brain EtOH levels was found in any of the other groups studied. Second, the effects of EtOH and acetaldehyde on choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) were investigated in the frontal cortex and hippocampus of high acetaldehyde-producing rats using RT-PCR and Western blot. The results showed that EtOH and acetaldehyde decreased ChAT expression at 40 and 240 min after EtOH dosing in the brain. The acetaldehyde-induced reduction in ChAT expression was significantly higher than that induced by EtOH. No remarkable alteration of AChE expression was observed. The study suggested that catalase made a significant contribution to acetaldehyde formation in the rat brain, and that EtOH and acetaldehyde decreased ChAT expression at 40 and 240 min after EtOH dosing.
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Affiliation(s)
- Mostofa Jamal
- Department of Forensic Medicine, Faculty of Medicine, Kagawa Universiy, Ikenobe, Miki, Kita, Kagawa 761-0793, Japan
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Affiliation(s)
- Ranna A Rozenfeld
- Pediatric Critical Care Medicine, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Jamal M, Ameno K, Uekita I, Kumihashi M, Wang W, Ijiri I. Catalase mediates acetaldehyde formation in the striatum of free-moving rats. Neurotoxicology 2007; 28:1245-8. [PMID: 17597213 DOI: 10.1016/j.neuro.2007.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 05/02/2007] [Accepted: 05/02/2007] [Indexed: 11/29/2022]
Abstract
Using brain microdialysis, we measured both ethanol (EtOH) and acetaldehyde (AcH) levels in the striatum of free-moving rats following the inhibition of EtOH oxidation pathways. Rats received intraperitoneal EtOH (1g/kg) alone or in combination with 4-methylpyrazole (MP, 82 mg/kg, an alcohol dehydrogenase inhibitor), and/or catalase inhibitor sodium azide (AZ, 10mg/kg) or 3-amino-1,2,4-triazole (AT, 1g/kg), and/or cyanamide (CY, 50mg/kg, an aldehyde dehydrogenase inhibitor). Results revealed that both EtOH and AcH concentrations reached a plateau at 30 min after a dose of EtOH, and then gradually decreased for 4h. AcH was identified in the CY+EtOH, CY+AT/AZ+EtOH, and CY+4-MP+EtOH groups. The CY+EtOH-induced peak AcH level was 195.2+/-19.4 microM, and this level was significantly higher than the values in other groups studied. The catalase or ADH inhibitor in combination with CY lowered considerably the AcH concentration in the brain. The EtOH level reached a maximum of 25.9+/-2.3 mM in the CY+4-MP+EtOH group, and this level was markedly higher than in the EtOH group. No significant difference in brain EtOH levels was seen in any of the other groups examined. The findings strongly support the assumption that the enzyme catalase plays a significant role in AcH formation directly in the rat brain.
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Affiliation(s)
- Mostofa Jamal
- Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan.
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Green R. The management of severe toxic alcohol ingestions at a tertiary care center after the introduction of fomepizole. Am J Emerg Med 2007; 25:799-803. [PMID: 17870485 DOI: 10.1016/j.ajem.2007.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 01/15/2007] [Accepted: 01/15/2007] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Ethylene glycol and methanol ingestions are relatively uncommon but potentially lethal poisonings. Recent trials have demonstrated that fomepizole effectively blocks alcohol dehydrogenase (ADH) in toxic alcohol overdoses, and may eliminate the need for emergent hemodialysis and intensive care unit admission. However, controversy remains in the role of fomepizole in clinical practice. The purpose of this study was to describe the presentation, management and clinical course of toxic alcohol ingestions at a tertiary care referral center after the introduction of fomepizole to hospital formulary. METHODS Data was collected on all patents treated for toxic alcohol ingestions for a 1-year period in a tertiary care referral center. Patients who received fomepizole or ethanol infusions, or who underwent hemodialysis were identified by ED, pharmacy, hemodialysis and ICU databases. The patients' medical records were reviewed, and data was recorded on a predetermined computerized data collection form. RESULTS Overall, twenty (20) toxic ingestions (14 methanol; 6 ethylene glycol) were identified over the one year period. Fomepizole was used for ADH blockade in 12/20 cases; ETOH infusions in 15/20 cases (combined ETOH and fomepizole use in 7/20). The majority of toxic alcohol exposures were admitted to an intensive care unit (19/20) and received emergent hemodialysis (19/20). All patients were discharged from hospital alive. CONCLUSIONS Patients with methanol and ethylene glycol ingestions who presented to our centers had significant toxicity and received both HD and ICU admission. Further research is required to determined if the method of ADH blockade affects the need for hemodialysis or ICU admission in toxic alcohol ingestions.
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Affiliation(s)
- Robert Green
- Department of Emergency Medicine, Division of Critical Care Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 2Y9.
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Velez LI, Gracia R, Neerman MF. Ethylene Glycol Poisoning: Current Diagnostic and Management Issues. J Emerg Nurs 2007; 33:342-5. [PMID: 17643796 DOI: 10.1016/j.jen.2006.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 12/13/2006] [Accepted: 12/21/2006] [Indexed: 11/19/2022]
Affiliation(s)
- Larissa I Velez
- Division of Emergency Medicine, Toxicology Section, The University of Texas Southwestern Medical Center, Dallas, Tex, USA
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Kato-Noguchi H, Yasuda Y. Effect of low temperature on ethanolic fermentation in rice seedlings. J Plant Physiol 2007; 164:1013-8. [PMID: 16901582 DOI: 10.1016/j.jplph.2006.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 06/13/2006] [Indexed: 05/11/2023]
Abstract
Rice seedlings (Oryza sativa L.) were incubated at 5-30 degrees C for 48 h and the effect of temperature on ethanolic fermentation in the seedlings was investigated in terms of low-temperature adaptation. Activities of alcohol dehydrogenase (ADH, EC 1.1.1.1) and pyruvate decarboxylase (PDC, EC 4.1.1.1) in roots and shoots of the seedlings were low at temperatures of 20-30 degrees C, whereas temperatures of 5, 7.5 and 10 degrees C significantly increased ADH and PDC activities in the roots and shoots. Temperatures of 5-10 degrees C also increased ethanol concentrations in the roots and shoots. The ethanol concentrations in the roots and shoots at 7.5 degrees C were 16- and 12-times greater than those in the roots and shoots at 25 degrees C, respectively. These results indicate that low temperatures (5-10 degrees C) induced ethanolic fermentation in the roots and shoots of the seedlings. Ethanol is known to prevent lipid degradation in plant membrane, and increased membrane-lipid fluidization. In addition, an ADH inhibitor, 4-methylpyrazole, decreased low-temperature tolerance in roots and shoots of rice seedlings and this reduction in the tolerance was recovered by exogenous applied ethanol. Therefore, production of ethanol by ethanolic fermentation may lead to low-temperature adaptation in rice plants by altering the physical properties of membrane lipids.
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Affiliation(s)
- Hisashi Kato-Noguchi
- Department of Applied Biological Science, Faculty of Agriculture, Kagawa University, Miki, Kagawa 761-0795, Japan.
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Abstract
OBJECTIVE To report a case of co-ingestion of methanol and nitromethane in a child in order to heighten the awareness of false elevation of serum creatinine from nitromethane ingestion. DESIGN Case report. SETTING Pediatric intensive care unit. PATIENT A 4-yr-old previously healthy girl ingested an unknown quantity of "Blue Thunder" model-engine fuel, which consisted of methanol and nitromethane. The patient was treated with fomepizole for methanol ingestion using elevated creatinine level as a reason for treatment. RESULTS The patient was asymptomatic but her creatinine level increased ten-fold (from 0.4 mg/dL to 4 mg/dL) within 6 hrs. Blood urea nitrogen, anion gap, and osmolar gap remained within normal limits. When the serum creatinine level was measured with enzymatic method instead of Jaffe's method, a normal creatinine level was obtained. The falsely elevated creatinine level was due to nitromethane. CONCLUSION The falsely elevated serum creatinine levels due to nitromethane ingestion can lead to unnecessary therapeutic interventions. We intend to heighten awareness of this potential misstep by reporting this case.
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Affiliation(s)
- Charlene P Leonard
- Division of Pediatric Critical Care Medicine, Wolfson Children's Hospital, Jacksonville, FL, USA.
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Abstract
The acute administration of a first dose of ethanol (EtOH) to rat liver cells reduces the amount of Mg(2+) extruded by a second dose of EtOH or the subsequent addition of adrenergic agonists. In contrast, the Mg(2+) extrusion normally elicited by the alpha(1)-adrenergic or beta-adrenergic agonist does not impair the Mg(2+) mobilization induced by the subsequent addition of EtOH. Inhibition of EtOH metabolism by 4-methylpyrazole abolishes almost completely the Mg(2+) extrusion induced by the first dose of EtOH, and partially enlarges that elicited by the second dose of alcohol or the subsequent adrenergic stimulation. Ethanol-treated liver cells stimulated by the adrenergic agonist show a reduced level of membrane-bound Galphas as well as a reduced cellular cAMP content. Analysis of cellular Mg(2+) distribution indicates that EtOH administration decreases the Mg(2+) content of the cytoplasm, mitochondria, and endoplasmic reticulum to a comparable extent. These data indicate that acute EtOH administration directly impairs cellular Mg(2+) homeostasis and also prevents a further Mg(2+) mobilization by additional doses of alcohol or alpha(1)-adrenoceptor and beta-adrenoceptor agonist by decreasing cytosolic and intraorganelle Mg(2+) content and by affecting G-protein membrane distribution/signaling.
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MESH Headings
- Adrenergic Agonists/pharmacology
- Animals
- Dose-Response Relationship, Drug
- Ethanol/pharmacokinetics
- Fomepizole
- GTP-Binding Proteins/drug effects
- GTP-Binding Proteins/metabolism
- GTP-Binding Proteins/physiology
- Hepatocytes/drug effects
- Hepatocytes/metabolism
- Homeostasis/drug effects
- Humans
- Liver/chemistry
- Liver/drug effects
- Liver/metabolism
- Liver Diseases, Alcoholic/etiology
- Liver Diseases, Alcoholic/metabolism
- Magnesium/analysis
- Magnesium/metabolism
- Male
- Pyrazoles/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptors, Adrenergic, alpha/drug effects
- Receptors, Adrenergic, alpha/physiology
- Receptors, Adrenergic, beta/drug effects
- Receptors, Adrenergic, beta/physiology
- Signal Transduction/drug effects
- Signal Transduction/physiology
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Affiliation(s)
- Andrew Young
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106-4970, USA
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