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Park S, Mukai D, Lee J, Burney T, Boss G, Haouzi P, Lee JA, Kim MT, Fox AM, Philipopoulos G, Brenner M. Intratracheal cobinamide (vitamin B 12 analog) administration increases survivability in rabbits exposed to a lethal dose of inhaled hydrogen sulfide. Clin Toxicol (Phila) 2024; 62:94-100. [PMID: 38512020 DOI: 10.1080/15563650.2024.2314155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/30/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Hydrogen sulfide is a highly toxic, flammable, and colorless gas. Hydrogen sulfide has been identified as a potential terrorist chemical threat agent in mass-casualty events. Our previous studies showed that cobinamide, a vitamin B12 analog, effectively reverses the toxicity from hydrogen sulfide poisoning. In this study, we investigate the effectiveness of intratracheally administered cobinamide in treating a lethal dose hydrogen sulfide gas inhalation and compare its performance to saline control administration. METHODS A total of 53 pathogen-free New Zealand White rabbits were used for this study. Four groups were compared: (i) received no saline solution or drug intratracheally (n = 15), (ii) slow drip saline intratracheally (n = 15), (iii) fast drip saline intratracheally (n = 15), and (iv) slow drip cobinamide intratracheally (n = 8). Blood pressure was continuously monitored, and deoxy- and oxyhemoglobin concentration changes were monitored in real-time in vivo using continuous wave near-infrared spectroscopy. RESULTS The mean (± standard deviation) weight for all animals (n = 53) was 3.87 ± 0.10 kg. The survival rates of the slow cobinamide and the fast saline groups were 75 percent and 60 percent, respectively, while the survival rates in the slow saline and control groups were 26.7 percent and 20 percent, respectively. A log-rank (Mantel-Cox) test showed that survival in fast saline and slow cobinamide groups were significantly greater than those of no saline control and slow saline groups (P < 0.05). The slow and no saline control groups were not significantly different (P = 0.59). The slow cobinamide group did significantly better than the slow saline group (P = 0.021). DISCUSSION The ability to use intratracheal cobinamide as an antidote to hydrogen sulfide poisoning is a novel approach to mass-casualty care. The major limitations of this study are that it was conducted in a single species at a single inhaled hydrogen sulfide concentration. Repeated investigations in other species and at varying levels of hydrogen sulfide exposure will be needed before any definitive recommendations can be made. CONCLUSIONS We demonstrated that intratracheal cobinamide and fast saline drip improved survival for hydrogen sulfide gas inhalation in rabbit models. Although further study is required, our results suggest that intratracheal administration of cobinamide and fast saline may be useful in hydrogen sulfide mass-casualty events.
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Affiliation(s)
- Seungyong Park
- Beckman Laser Institute, University of CA, Irvine, CA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - David Mukai
- Beckman Laser Institute, University of CA, Irvine, CA, USA
| | - Jangweon Lee
- Beckman Laser Institute, University of CA, Irvine, CA, USA
| | - Tanya Burney
- Beckman Laser Institute, University of CA, Irvine, CA, USA
| | - Gerry Boss
- Department of Medicine, University of California, San Diego, CA, USA
| | - Phillipe Haouzi
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | - Matthew Brenner
- Beckman Laser Institute, University of CA, Irvine, CA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA, USA
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2
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Behymer MM, Mo H, Fujii N, Suresh V, Arzumanian AS, Chan A, Nath AK, McCain R, MacRae CA, Peterson R, Boss GR, Davisson VJ, Knipp GT. Investigating the Replacement of Carboxylates with Carboxamides to Modulate the Safety and Efficacy of Platinum(II) Thioether Cyanide Scavengers. Toxicol Sci 2023; 197:kfad119. [PMID: 37952247 PMCID: PMC10823771 DOI: 10.1093/toxsci/kfad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Cyanide represents a persistent threat for accidental or malicious misuse due to easy conversion into a toxic gas and access to large quantities through several industries. The high safety index of hydroxocobalamin is a cornerstone quality as a cyanide scavenger. Unfortunately, intravenous infusion of hydroxocobalamin limits the utility in a mass casualty setting. We previously reported platinum(II) [Pt(II)] complexes with trans-directing sulfur ligands as an efficacious alternative to hydroxocobalamin when delivered by a bolus intramuscular injection in mice and rabbits. Thus, to enable Pt(II) as an alternative to hydroxocobalamin, a high safety factor is needed. The objective is to maintain efficacy and mitigate the risk for nephrotoxicity. Platinum amino acid complexes with the ability to form five- or six-membered rings and possessing either carboxylates or carboxamides are evaluated in vitro for cyanide scavenging. In vivo efficacy was evaulated in the zebrafish and mice cyanide exposure models. In addition, Pt(II) complex toxicity and pharmacokinetics were evaluated in a cyanide naive Sprague-Dawley model. Doses for toxicity are escalated to 5x from the efficacious dose in mice using a body surface area adjustment. The results show the carboxamide ligands display a time and pH dependence on cyanide scavenging in vitro and efficacy in vivo. Additionally, exchanging the carboxylate for carboxamide showed reduced indications of renal injury. A pharmacokinetic analysis of the larger bidentate complexes displayed rapid absorption by intramuscular administration and having similar plasma exposure. These findings point to the importance of pH and ligand structures for methionine carboxamide complexes with Pt(II).
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Affiliation(s)
- Matthew M Behymer
- Department of Industrial and Molecular Pharmaceutics, Purdue University, West Lafayette, Indiana 47907, USA
| | - Huaping Mo
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, Indiana 47907, USA
| | - Naoaki Fujii
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, Indiana 47907, USA
| | - Vallabh Suresh
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, Indiana 47907, USA
| | - Ari S Arzumanian
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, Indiana 47907, USA
| | - Adriano Chan
- Department of Medicine, University of California, San Diego, California 92093, USA
| | - Anjali K Nath
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
| | - Robyn McCain
- Purdue Translational Pharmacology CTSI Core Facility, Purdue University, West Lafayette, Indiana, USA
| | - Calum A MacRae
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115, USA
| | - Randall Peterson
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah 84112, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, California 92093, USA
| | - Vincent Jo Davisson
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, Indiana 47907, USA
| | - Gregory T Knipp
- Department of Industrial and Molecular Pharmaceutics, Purdue University, West Lafayette, Indiana 47907, USA
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3
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Santana Maldonado C, Weir A, Rumbeiha WK. A comprehensive review of treatments for hydrogen sulfide poisoning: past, present, and future. Toxicol Mech Methods 2023; 33:183-196. [PMID: 36076319 DOI: 10.1080/15376516.2022.2121192] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Hydrogen sulfide (H2S) poisoning remains a significant source of occupational fatalities and is the second most common cause of toxic gas-induced deaths. It is a rapidly metabolized systemic toxicant targeting the mitochondria, among other organelles. Intoxication is mostly acute, but chronic or in-between exposure scenarios also occur. Some genetic defects in H2S metabolism lead to lethal chronic H2S poisoning. In acute exposures, the neural, respiratory, and cardiovascular systems are the primary target organs resulting in respiratory distress, convulsions, hypotension, and cardiac irregularities. Some survivors of acute poisoning develop long-term sequelae, particularly in the central nervous system. Currently, treatment for H2S poisoning is primarily supportive care as there are no FDA-approved drugs. Besides hyperbaric oxygen treatment, drugs in current use for the management of H2S poisoning are controversial. Novel potential drugs are under pre-clinical research development, most of which target binding the H2S. However, there is an acute need to discover new drugs to prevent and treat H2S poisoning, including reducing mortality and morbidity, preventing sequalae from acute exposures, and for treating cumulative pathology from chronic exposures. In this paper, we perform a comprehensive review of H2S poisoning including perspectives on past, present, and future.
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Affiliation(s)
| | - Abigail Weir
- Molecular Biosciences, University of California, Davis, Davis, CA, USA
| | - Wilson K Rumbeiha
- Molecular Biosciences, University of California, Davis, Davis, CA, USA
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4
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Behymer M, Mo H, Fujii N, Suresh V, Chan A, Lee J, Nath AK, Saha K, Mahon SB, Brenner M, MacRae CA, Peterson R, Boss GR, Knipp GT, Davisson VJ. Identification of Platinum(II) Sulfide Complexes Suitable as Intramuscular Cyanide Countermeasures. Chem Res Toxicol 2022; 35:1983-1996. [PMID: 36201358 PMCID: PMC9682522 DOI: 10.1021/acs.chemrestox.2c00157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The development of rapidly acting cyanide countermeasures using intramuscular injection (IM) represents an unmet medical need to mitigate toxicant exposures in mass casualty settings. Previous work established that cisplatin and other platinum(II) or platinum(IV)-based agents effectively mitigate cyanide toxicity in zebrafish. Cyanide's in vivo reaction with platinum-containing materials was proposed to reduce the risk of acute toxicities. However, cyanide antidote activity depended on a formulation of platinum-chloride salts with dimethyl sulfoxide (DMSO) followed by dilution in phosphate-buffered saline (PBS). A working hypothesis to explain the DMSO requirement is that the formation of platinum-sulfoxide complexes activates the cyanide scavenging properties of platinum. Preparations of isolated NaPtCl5-DMSO and Na (NH3)2PtCl-DMSO complexes in the absence of excess DMSO provided agents with enhanced reactivity toward cyanide in vitro and fully recapitulated in vivo cyanide rescue in zebrafish and mouse models. The enhancement of the cyanide scavenging effects of the DMSO ligand could be attributed to the activation of platinum(IV) and (II) with a sulfur ligand. Unfortunately, the efficacy of DMSO complexes was not robust when administered IM. Alternative Pt(II) materials containing sulfide and amine ligands in bidentate complexes show enhanced reactivity toward cyanide addition. The cyanide addition products yielded tetracyanoplatinate(II), translating to a stoichiometry of 1:4 Pt to each cyanide scavenger. These new agents demonstrate a robust and enhanced potency over the DMSO-containing complexes using IM administration in mouse and rabbit models of cyanide toxicity. Using the zebrafish model with these Pt(II) complexes, no acute cardiotoxicity was detected, and dose levels required to reach lethality exceeded 100 times the effective dose. Data are presented to support a general chemical design approach that can expand a new lead candidate series for developing next-generation cyanide countermeasures.
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Affiliation(s)
- Matthew
M. Behymer
- Department
of Industrial and Physical Pharmacy, Purdue
University, 575 Stadium Mall Drive, West Lafayette, Indiana47907, United States
| | - Huaping Mo
- Department
of Medicinal Chemistry and Molecular Pharmacology, Purdue University, 575
Stadium Mall Drive, West Lafayette, Indiana47907, United
States
| | - Naoaki Fujii
- Department
of Medicinal Chemistry and Molecular Pharmacology, Purdue University, 575
Stadium Mall Drive, West Lafayette, Indiana47907, United
States
| | - Vallabh Suresh
- Department
of Medicinal Chemistry and Molecular Pharmacology, Purdue University, 575
Stadium Mall Drive, West Lafayette, Indiana47907, United
States
| | - Adriano Chan
- Department
of Medicine, University of California, San Diego, California92093, United States
| | - Jangweon Lee
- Beckman
Laser Institute and Medical Clinic, Department of Medicine, University of California, Irvine, California92697, United States
| | - Anjali K. Nath
- Department
of Cardiology, Beth Israel Deaconess Medical
Center, Boston, Massachusetts02115, United States
| | - Kusumika Saha
- Division
of Cardiovascular Medicine, Brigham and
Women’s Hospital, Boston, Massachusetts02115, United States
| | - Sari B. Mahon
- Beckman
Laser Institute and Medical Clinic, Department of Medicine, University of California, Irvine, California92697, United States
| | - Matthew Brenner
- Beckman
Laser Institute and Medical Clinic, Department of Medicine, University of California, Irvine, California92697, United States
| | - Calum A. MacRae
- Division
of Cardiovascular Medicine, Brigham and
Women’s Hospital, Boston, Massachusetts02115, United States
| | - Randall Peterson
- Department
of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake
City, Utah84112, United States
| | - Gerry R. Boss
- Department
of Medicine, University of California, San Diego, California92093, United States
| | - Gregory T. Knipp
- Department
of Industrial and Physical Pharmacy, Purdue
University, 575 Stadium Mall Drive, West Lafayette, Indiana47907, United States
| | - Vincent Jo Davisson
- Department
of Medicinal Chemistry and Molecular Pharmacology, Purdue University, 575
Stadium Mall Drive, West Lafayette, Indiana47907, United
States,
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5
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Seong M, Oh Y, Park HJ, Choi WS, Kim JG. Use of Hypoxic Respiratory Challenge for Differentiating Alzheimer's Disease and Wild-Type Mice Non-Invasively: A Diffuse Optical Spectroscopy Study. BIOSENSORS 2022; 12:1019. [PMID: 36421136 PMCID: PMC9688818 DOI: 10.3390/bios12111019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Alzheimer's disease is one of the most critical brain diseases. The prevalence of the disease keeps rising due to increasing life spans. This study aims to examine the use of hemodynamic signals during hypoxic respiratory challenge for the differentiation of Alzheimer's disease (AD) and wild-type (WT) mice. Diffuse optical spectroscopy, an optical system that can non-invasively monitor transient changes in deoxygenated (ΔRHb) and oxygenated (ΔOHb) hemoglobin concentrations, was used to monitor hemodynamic reactivity during hypoxic respiratory challenges in an animal model. From the acquired signals, 13 hemodynamic features were extracted from each of ΔRHb and -ΔOHb (26 features total) for more in-depth analyses of the differences between AD and WT. The hemodynamic features were statistically analyzed and tested to explore the possibility of using machine learning (ML) to differentiate AD and WT. Among the twenty-six features, two features of ΔRHb and one feature of -ΔOHb showed statistically significant differences between AD and WT. Among ML techniques, a naive Bayes algorithm achieved the best accuracy of 84.3% when whole hemodynamic features were used for differentiation. While further works are required to improve the approach, the suggested approach has the potential to be an alternative method for the differentiation of AD and WT.
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Affiliation(s)
- Myeongsu Seong
- School of Information Science and Technology, Nantong University, Nantong 226019, China
- Research Center for Intelligent Information Technology, Nantong University, Nantong 226019, China
| | - Yoonho Oh
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea
| | - Hyung Joon Park
- School of Biological Sciences and Technology, College of Natural Sciences, College of Medicine, Chonnam National University, Gwangju 61186, Republic of Korea
- Department of Biochemistry, University of Washington, Seattle, WA 98195, USA
| | - Won-Seok Choi
- School of Biological Sciences and Technology, College of Natural Sciences, College of Medicine, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Jae Gwan Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea
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6
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Haouzi P, MacCann M, Brenner M, Mahon S, Bebarta VS, Chan A, Judenherc-Haouzi A, Tubbs N, Boss GR. Treatment of life-threatening H2S intoxication: Lessons from the trapping agent tetranitrocobinamide. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2022; 96:103998. [PMID: 36228991 DOI: 10.1016/j.etap.2022.103998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
We sought to evaluate the efficacy of trapping free hydrogen sulfide (H2S) following severe H2S intoxication. Sodium hydrosulfide solution (NaHS, 20 mg/kg) was administered intraperitoneally in 69 freely moving rats. In a first group (protocol 1), 40 rats were randomly assigned to receive saline (n = 20) or the cobalt compound tetranitrocobinamide (TNCbi) (n = 20, 75 mg/kg iv), one minute into coma, when free H2S was still present in the blood. A second group of 27 rats received TNCbi or saline, following epinephrine, 5 min into coma, when the concentration of free H2S has drastically decreased in the blood. In protocol 1, TNCbi significantly increased immediate survival (65 vs 20 %, p < 0.01) while in protocol 2, administration of TNCbi led to the same outcome as untreated animals. We hypothesize that the decreased efficacy of TNCbi with time likely reflects the rapid spontaneous disappearance of the pool of free H2S in the blood following H2S exposure.
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Affiliation(s)
- Philippe Haouzi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Pennsylvania State University, College of Medicine, Hershey, PA, USA.
| | - Marissa MacCann
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Matthew Brenner
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA, USA
| | - Sari Mahon
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Annick Judenherc-Haouzi
- Heart and Vascular Institute, Department of Medicine, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Nicole Tubbs
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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7
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Gretarsdottir J, Lambert IH, Sturup S, Suman SG. In Vitro Characterization of a Threonine-Ligated Molybdenyl-Sulfide Cluster as a Putative Cyanide Poisoning Antidote; Intracellular Distribution, Effects on Organic Osmolyte Homeostasis, and Induction of Cell Death. ACS Pharmacol Transl Sci 2022; 5:907-918. [PMID: 36268119 PMCID: PMC9578141 DOI: 10.1021/acsptsci.2c00093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Indexed: 11/28/2022]
Abstract
Binuclear molybdenum sulfur complexes are effective for the catalytic conversion of cyanide into thiocyanate. The complexes themselves exhibit low toxicity and high aqueous solubility, which render them suitable as antidotes for cyanide poisoning. The binuclear molybdenum sulfur complex [(thr)Mo2O2(μ-S)2(S2)]- (thr - threonine) was subjected to biological studies to evaluate its cellular accumulation and mechanism of action. The cellular uptake and intracellular distribution in human alveolar (A549) cells, quantified by inductively coupled plasma mass spectrometry (ICP-MS) and cell fractionation methods, revealed the presence of the compound in cytosol, nucleus, and mitochondria. The complex exhibited limited binding to DNA, and using the expression of specific protein markers for cell fate indicated no effect on the expression of stress-sensitive channel components involved in cell volume regulation, weak inhibition of cell proliferation, no increase in apoptosis, and even a reduction in autophagy. The complex is anionic, and the sodium complex had higher solubility compared to the potassium. As the molybdenum complex possibly enters the mitochondria, it is considered as a promising remedy to limit mitochondrial cyanide poisoning following, e.g., smoke inhalation injuries.
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Affiliation(s)
| | - Ian H. Lambert
- Department
of Biology, University of Copenhagen, Universitetsparken 13, 2100 Copenhagen Ø, Denmark
| | - Stefan Sturup
- Department
of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
| | - Sigridur G. Suman
- Science
Institute, University of Iceland, Dunhaga 3, 107 Reykjavik, Iceland
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8
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Bhadra S, Chan A, Hendry-Hofer TB, Boss GR, Bebarta VS, Logue BA. Analysis of bisaminotetrazole cobinamide, a next-generation antidote for cyanide, hydrogen sulfide and methanethiol poisoning, in swine plasma by liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1208:123392. [PMID: 35952445 DOI: 10.1016/j.jchromb.2022.123392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/07/2022] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
Abstract
Cyanide, hydrogen sulfide, and methanethiol are common toxic inhalation agents that inhibit mitochondrial cytochrome c oxidase and result in cellular hypoxia, cytotoxic anoxia, apnea, respiratory failure, cardiovascular collapse, seizure and potentially death. While all are occupational gas exposure hazards that have the potential to cause mass casualties from industrial accidents or acts of terrorism, only cyanide has approved antidotes, and each of these has major limitations, including difficult administration in mass-casualty settings. While bisaminotetrazole cobinamide (Cbi(AT)2) has recently gained attention because of its efficacy in treating these metabolic poisons, there is no method available for the analysis of Cbi(AT)2 in any biological matrix. Hence, in this study, a simple and rapid liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated for the analysis of Cbi(AT)2 in swine plasma. The method is extremely simple, consisting of protein precipitation, separation and drying of the supernatant, reconstitution in an aqueous solvent, and LC-MS/MS analysis. The method produced an LOD of 0.3 μM with a wide dynamic range (2 - 500 μM). Inter- and intraassay accuracies (100 ± 12 % and 100 ± 19 %, respectively) were acceptable and the precision (<12 % and < 9 % relative standard deviation, respectively) was good. The developed method was used to analyze Cbi(AT)2 from treated swine and the preliminary pharmacokinetic parameters showed impressive antidotal behavior, most notably a long estimated elimination half-life (t1/2 = 37.5 h). This simple and rapid method can be used to facilitate the development of Cbi(AT)2 as a therapeutic against toxic cyanide, hydrogen sulfide and methanethiol exposure.
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Affiliation(s)
- Subrata Bhadra
- Department of Chemistry and Biochemistry, South Dakota State University, Brookings, SD 57007, USA
| | - Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Tara B Hendry-Hofer
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Brian A Logue
- Department of Chemistry and Biochemistry, South Dakota State University, Brookings, SD 57007, USA.
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9
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Chang S, Tat J, China SP, Kalyanaraman H, Zhuang S, Chan A, Lai C, Radic Z, Abdel-Rahman EA, Casteel DE, Pilz RB, Ali SS, Boss GR. Cobinamide is a strong and versatile antioxidant that overcomes oxidative stress in cells, flies, and diabetic mice. PNAS NEXUS 2022; 1:pgac191. [PMID: 36276587 PMCID: PMC9578022 DOI: 10.1093/pnasnexus/pgac191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/12/2022] [Indexed: 01/29/2023]
Abstract
Increased oxidative stress underlies a variety of diseases, including diabetes. Here, we show that the cobalamin/vitamin B12 analog cobinamide is a strong and multifaceted antioxidant, neutralizing superoxide, hydrogen peroxide, and peroxynitrite, with apparent rate constants of 1.9 × 108, 3.7 × 104, and 6.3 × 106 M-1 s-1, respectively, for cobinamide with the cobalt in the +2 oxidation state. Cobinamide with the cobalt in the +3 oxidation state yielded apparent rate constants of 1.1 × 108 and 8.0 × 102 M-1 s-1 for superoxide and hydrogen peroxide, respectively. In mammalian cells and Drosophila melanogaster, cobinamide outperformed cobalamin and two well-known antioxidants, imisopasem manganese and manganese(III)tetrakis(4-benzoic acid)porphyrin, in reducing oxidative stress as evidenced by: (i) decreased mitochondrial superoxide and return of the mitochondrial membrane potential in rotenone- and antimycin A-exposed H9c2 rat cardiomyocytes; (ii) reduced JNK phosphorylation in hydrogen-peroxide-treated H9c2 cells; (iii) increased growth in paraquat-exposed COS-7 fibroblasts; and (iv) improved survival in paraquat-treated flies. In diabetic mice, cobinamide administered in the animals' drinking water completely prevented an increase in lipid and protein oxidation, DNA damage, and fibrosis in the heart. Cobinamide is a promising new antioxidant that has potential use in diseases with heightened oxidative stress.
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Affiliation(s)
| | | | | | | | - Shunhui Zhuang
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Cassandra Lai
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Zoran Radic
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA
| | - Engy A Abdel-Rahman
- Tumor Biology Research Program, Children’s Cancer Hospital, Cairo 57357, Egypt,Pharmacology Department, Faculty of Medicine, Assuit University, Assuit 71515, Egypt
| | - Darren E Casteel
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Renate B Pilz
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
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10
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Glyoxylate protects against cyanide toxicity through metabolic modulation. Sci Rep 2022; 12:4982. [PMID: 35322094 PMCID: PMC8943054 DOI: 10.1038/s41598-022-08803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/04/2022] [Indexed: 11/09/2022] Open
Abstract
Although cyanide's biological effects are pleiotropic, its most obvious effects are as a metabolic poison. Cyanide potently inhibits cytochrome c oxidase and potentially other metabolic enzymes, thereby unleashing a cascade of metabolic perturbations that are believed to cause lethality. From systematic screens of human metabolites using a zebrafish model of cyanide toxicity, we have identified the TCA-derived small molecule glyoxylate as a potential cyanide countermeasure. Following cyanide exposure, treatment with glyoxylate in both mammalian and non-mammalian animal models confers resistance to cyanide toxicity with greater efficacy and faster kinetics than known cyanide scavengers. Glyoxylate-mediated cyanide resistance is accompanied by rapid pyruvate consumption without an accompanying increase in lactate concentration. Lactate dehydrogenase is required for this effect which distinguishes the mechanism of glyoxylate rescue as distinct from countermeasures based solely on chemical cyanide scavenging. Our metabolic data together support the hypothesis that glyoxylate confers survival at least in part by reversing the cyanide-induced redox imbalances in the cytosol and mitochondria. The data presented herein represent the identification of a potential cyanide countermeasure operating through a novel mechanism of metabolic modulation.
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Chan A, Lee J, Bhadra S, Bortey-Sam N, Hendry-Hofer TB, Bebarta VS, Mahon SB, Brenner M, Logue B, Pilz RB, Boss GR. Development of sodium tetrathionate as a cyanide and methanethiol antidote. Clin Toxicol (Phila) 2022; 60:332-341. [PMID: 34328378 PMCID: PMC8800944 DOI: 10.1080/15563650.2021.1953517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONTEXT Hydrogen cyanide and methanethiol are two toxic gases that inhibit mitochondrial cytochrome c oxidase. Cyanide is generated in structural fires and methanethiol is released by decaying organic matter. Current treatments for cyanide exposure do not lend themselves to treatment in the field and no treatment exists for methanethiol poisoning. Sodium tetrathionate (tetrathionate), a product of thiosulfate oxidation, could potentially serve as a cyanide antidote, and, based on its chemical structure, we hypothesized it could react with methanethiol. RESULTS We show that tetrathionate, unlike thiosulfate, reacts directly with cyanide in vitro under physiological conditions, and based on rabbit studies where we monitor cyanide poisoning in real-time, tetrathionate likely reacts directly with cyanide in vivo. We found that tetrathionate administered by intramuscular injection rescues >80% of juvenile, young adult, and old adult mice from exposure to inhaled hydrogen cyanide gas that is >80% lethal. Tetrathionate also rescued young adult rabbits from intravenously administered sodium cyanide. Tetrathionate was reasonably well-tolerated by mice and rats, yielding a therapeutic index of ∼5 in juvenile and young adult mice, and ∼3.3 in old adult mice; it was non-mutagenic in Chinese Hamster ovary cells and by the Ames bacterial test. We found by gas chromatography-mass spectrometry that both tetrathionate and thiosulfate react with methanethiol to generate dimethyldisulfide, but that tetrathionate was much more effective than thiosulfate at recovering intracellular ATP in COS-7 cells and rescuing mice from a lethal exposure to methanethiol gas. CONCLUSION We conclude that tetrathionate has the potential to be an effective antidote against cyanide and methanethiol poisoning.
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Affiliation(s)
- Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jangwoen Lee
- Beckman Laser Institute, University of California, Irvine, Irvine, CA, USA
| | - Subrata Bhadra
- Department of Chemistry and Biochemistry, South Dakota State University, Brookings, SD, USA
| | - Nesta Bortey-Sam
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Vikhyat S. Bebarta
- Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Sari B. Mahon
- Beckman Laser Institute, University of California, Irvine, Irvine, CA, USA
| | - Matthew Brenner
- Beckman Laser Institute, University of California, Irvine, Irvine, CA, USA
| | - Brian Logue
- Department of Chemistry and Biochemistry, South Dakota State University, Brookings, SD, USA
| | - Renate B. Pilz
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Gerry R. Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Philipopoulos GP, Tat J, Chan A, Jiang J, Mukai D, Burney T, Doosty M, Mahon S, Patel HH, White CW, Brenner M, Lee J, Boss GR. Methyl mercaptan gas: mechanisms of toxicity and demonstration of the effectiveness of cobinamide as an antidote in mice and rabbits. Clin Toxicol (Phila) 2022; 60:615-622. [PMID: 34989638 PMCID: PMC9662850 DOI: 10.1080/15563650.2021.2017949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CONTEXT Methyl mercaptan (CH3SH) is a colorless, toxic gas with potential for occupational exposure and used as a weapon of mass destruction. Inhalation at high concentrations can result in dyspnea, hypoventilation, seizures, and death. No specific methyl mercaptan antidote exists, highlighting a critical need for such an agent. Here, we investigated the mechanism of CH3SH toxicity, and rescue from CH3SH poisoning by the vitamin B12 analog cobinamide, in mammalian cells. We also developed lethal CH3SH inhalation models in mice and rabbits, and tested the efficacy of intramuscular injection of cobinamide as a CH3SH antidote. RESULTS We found that cobinamide binds to CH3SH (Kd = 84 µM), and improved growth of cells exposed to CH3SH. CH3SH reduced cellular oxygen consumption and intracellular ATP content and activated the stress protein c-Jun N-terminal kinase (JNK); cobinamide reversed these changes. A single intramuscular injection of cobinamide (20 mg/kg) rescued 6 of 6 mice exposed to a lethal dose of CH3SH gas, while all six saline-treated mice died (p = 0.0013). In rabbits exposed to CH3SH gas, 11 of 12 animals (92%) treated with two intramuscular injections of cobinamide (50 mg/kg each) survived, while only 2 of 12 animals (17%) treated with saline survived (p = 0.001). CONCLUSION We conclude that cobinamide could potentially serve as a CH3SH antidote.
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Affiliation(s)
| | - John Tat
- Department of Medicine, University of California, San Diego, CA, USA
| | - Adriano Chan
- Department of Medicine, University of California, San Diego, CA, USA
| | - Jingjing Jiang
- Department of Medicine, University of California, San Diego, CA, USA
| | - David Mukai
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Tanya Burney
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Melody Doosty
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Sari Mahon
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Hemal H Patel
- VA San Diego Healthcare System and Department of Anesthesiology, University of California, San Diego, CA, USA
| | - Carl W White
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Matthew Brenner
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Jangwoen Lee
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, CA, USA
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Suzuki Y, Taguchi K, Kure T, Sakai H, Enoki Y, Otagiri M, Matsumoto K. Liposome-encapsulated methemoglobin as an antidote against cyanide poisoning. J Control Release 2021; 337:59-70. [PMID: 34273418 DOI: 10.1016/j.jconrel.2021.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Abstract
Cyanide induces acute lethal poisoning resulting from inhibition of cytochrome c oxidase located in the complex IV (Complex IV) of mitochondria. However, current therapies for cyanide poisoning using hydroxocobalamin and nitrous acid compounds remain a clinical issue. Here, we show that liposome-encapsulated methemoglobin (metHb@Lipo), nanosized biomimetic red blood cells, replicate the antidotal mechanism of nitrous acid compounds against cyanide poisoning, achieving superior efficacy and fast action with no adverse effects. The structure of metHb@Lipo, which consists of concentrated methemoglobin in its aqueous core and a lipid membrane resembling the red blood cell membrane, provides favorable characteristics as a cyanide antidote, such as binding properties and membrane permeability. Upon cyanide exposure, metHb@Lipo maintained the mitochondrial function in PC12 cells, resulting in a cell viability comparable to treatment with nitrous acid compounds. In a mouse model of cyanide poisoning, metHb@Lipo treatment dramatically improved mortality with a rapid recovery from the symptoms of cyanide poisoning compared to treatment with nitrous acid compounds. Furthermore, metHb@Lipo also possesses satisfactory pharmacokinetic properties without long-term bioaccumulation and toxicity. Our findings showed a novel concept to develop drugs for cyanide poisoning and provide a promising possibility for biomimetic red blood cell preparations for pharmaceutical applications.
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Affiliation(s)
- Yuto Suzuki
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Kazuaki Taguchi
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan.
| | - Tomoko Kure
- Department of Chemistry, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634-8521, Japan
| | - Hiromi Sakai
- Department of Chemistry, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634-8521, Japan
| | - Yuki Enoki
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto City, Kumamoto 860-0082, Japan; DDS Research Institute, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto City, Kumamoto 860-0082, Japan
| | - Kazuaki Matsumoto
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
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Gretarsdottir JM, Jonsdottir S, Lewis W, Hambley TW, Suman SG. Water-Soluble α-Amino Acid Complexes of Molybdenum as Potential Antidotes for Cyanide Poisoning: Synthesis and Catalytic Studies of Threonine, Methionine, Serine, and Leucine Complexes. Inorg Chem 2020; 59:18190-18204. [PMID: 33249838 DOI: 10.1021/acs.inorgchem.0c02672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Water-soluble complexes are desirable for the aqueous detoxification of cyanide. Molybdenum complexes with α-amino acid and disulfide ligands with the formula K[(L)Mo2O2(μ-S)2(S2)] (L = leu (1), met (2), thr (3), and ser (4)) were synthesized in a reaction of [(DMF)3MoO(μ-S)2(S2)] with deprotonated α-amino acids; leu, met, thr, and ser are the carboxylate anions of l-leucine, l-methionine, l-threonine, and l-serine, respectively. Potassium salts of α-amino acids (leu (1a), met (2a), thr (3a), and ser (4a)) were prepared as precursors for complexes 1-4, respectively, by employing a nonaqueous synthesis route. The ligand exchange reaction of [Mo2O2(μ-S)2(DMF)6](I)2 with deprotonated α-amino acids afforded bis-α-amino acid complexes, [(L)2Mo2O2(μ-S)2] (6-8). A tris-α-amino acid complex, [(leu)2Mo2O2(μ-S)2(μ-leu + H)] (5; leu + H is the carboxylate anion of l-leucine with the amine protonated), formed in the reaction with leucine. 5 crystallized from methanol with a third weakly bonded leucine as a bridging bidentate carboxylate. An adduct of 8 with SCN- coordinated, 9, crystallized and was structurally characterized. Complexes 1-4 are air stable and highly water-soluble chiral molecules. Cytotoxicity studies in the A549 cell line gave IC50 values that range from 80 to 400 μM. Cyclic voltammetry traces of 1-8 show solvent-dependent irreversible electrochemical behavior. Complexes 1-4 demonstrated the ability to catalyze the reaction of thiosulfate and cyanide in vitro to exhaustively transform cyanide to thiocyanate in less than 1 h.
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Affiliation(s)
| | | | - William Lewis
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Trevor W Hambley
- School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Sigridur G Suman
- Science Institute, University of Iceland, Dunhagi 3, 107 Reykjavik, Iceland
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15
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Neuromodulatory activity of trèvo on cyanide-induced neurotoxicity viz neurochemical, antioxidants, cytochrome C oxidase and p53. ADVANCES IN TRADITIONAL MEDICINE 2020. [DOI: 10.1007/s13596-020-00450-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Determination of free cyano-cobinamide in swine and rabbit plasma by liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1124:100-108. [PMID: 31185415 DOI: 10.1016/j.jchromb.2019.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/16/2019] [Accepted: 05/18/2019] [Indexed: 11/20/2022]
Abstract
In recent years, Cobinamide (Cbi) has shown promise as a therapeutic for cyanide poisoning. There are several forms of Cbi based on the identity of the ligands bound to the cobalt in Cbi and these different forms of Cbi have divergent behavior (e.g., the aquo and hydroxo forms of Cbi readily bind to proteins, limiting their distribution significantly, whereas [Cbi(CN)2] does not). While current analysis techniques only measure total Cbi, methods to elucidate the behavior of 'available' Cbi versus cyanide-complexed Cbi would be valuable for biomedical and pharmacokinetic studies. Therefore, a method was developed for the analysis of cyanide-complexed Cbi in plasma via liquid chromatography tandem mass spectrometry (LC-MS-MS). Plasma samples were prepared by denaturing proteins with 10% ammonium hydroxide in acetonitrile. The resulting mixture was centrifuged, and the supernatant was removed, dried, and reconstituted. Cyanide-complexed Cbi was then analyzed via LC-MS-MS. The limit of detection was 0.2 μM, and the linear dynamic range was between 1 and 200 μM. The accuracy was 100 ± 17% and the precision, measured by relative standard deviation (%RSD), was ≤18.5%. Carryover, a severe problem when analyzing Cbi via liquid chromatography was eliminated using a polymeric-based stationary phase (PLRP-S) and a controlled washing protocol. The method allowed evaluation of the cyanide-bound and 'available' Cbi from treated animals and, when paired with a method for total Cbi analysis, allows for estimation of Cbi utilization when treating cyanide poisoning.
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Hendry-Hofer TB, Witeof AE, Lippner DS, Ng PC, Mahon SB, Brenner M, Rockwood GA, Bebarta VS. Intramuscular dimethyl trisulfide: efficacy in a large swine model of acute severe cyanide toxicity. Clin Toxicol (Phila) 2019; 57:265-270. [PMID: 30306816 PMCID: PMC6451663 DOI: 10.1080/15563650.2018.1511800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cyanide is a deadly compound used as a terrorist agent. Current FDA approved antidotes require intravenous administration, limiting their utility in a mass casualty scenario. Dimethyl trisulfide (DMTS), a sulfur-based molecule, binds cyanide converting it to the less toxic by-product thiocyanate. Studies evaluating efficacy in rodents have been performed, but a large, clinically relevant animal model has not been reported. OBJECTIVE This study evaluates the efficacy of intramuscular DMTS on survival and clinical outcomes in a swine model of acute, severe cyanide toxicity. METHODS Anesthetized swine were instrumented for continuous monitoring of hemodynamics. Prior to potassium cyanide infusion animals were acclimated and breathing spontaneously. At 5-minutes post-apnea animals were treated with DMTS or saline. Vital signs, hemodynamics, and laboratory values were evaluated at various time points. RESULTS Baseline values and time to apnea were similar in both groups. Survival in the DMTS treated group was 83.3% and 0% in saline controls (p = .005). The DMTS group returned to breathing at a mean time of 19.3 ± 10 min after antidote, control animals did not return to breathing (CI difference 8.8, 29.8). At the end of the experiment or time of death, mean lactate was 9.41 mmol/L vs. 4.35 mmol/L (CI difference -10.94,0.82) in the saline and DMTS groups, respectively and pH was 7.20 vs. 7.37 (CI difference -0.04, 0.38). No adverse effects were observed at the injection site. CONCLUSION Intramuscular administration of DMTS improves survival and clinical outcomes in our large animal swine model of acute cyanide toxicity.
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Affiliation(s)
- Tara B. Hendry-Hofer
- Department of Emergency Medicine and Toxicology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Alyssa E. Witeof
- Department of Emergency Medicine and Toxicology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Dennean S. Lippner
- Medical Toxicology Division, Biochemistry and Physiology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD
| | - Patrick C. Ng
- Department of Emergency Medicine and Toxicology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
- Rocky Mountain Poison and Drug Center, Denver Health and Hopsital Authority
| | - Sari B. Mahon
- Beckman Laser Institute, University of California, Irvine, CA 92612
| | - Matthew Brenner
- Beckman Laser Institute, University of California, Irvine, CA 92612
| | - Gary A. Rockwood
- Medical Toxicology Division, Biochemistry and Physiology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD
| | - Vikhyat S. Bebarta
- Department of Emergency Medicine and Toxicology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
- Colonel, USAF Reserve, Office of the Chief Scientist, 59th MDW Staff, JBSA, Texas
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18
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Hendry-Hofer TB, Ng PC, Witeof AE, Mahon SB, Brenner M, Boss GR, Bebarta VS. A Review on Ingested Cyanide: Risks, Clinical Presentation, Diagnostics, and Treatment Challenges. J Med Toxicol 2018; 15:128-133. [PMID: 30539383 DOI: 10.1007/s13181-018-0688-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 12/30/2022] Open
Abstract
Cyanide, a metabolic poison, is a rising chemial threat and ingestion is the most common route of exposure. Terrorist organizations have threatened to attack the USA and international food and water supplies. The toxicokinetics and toxicodynamics of oral cyanide are unique, resulting in high-dose exposures, severe symptoms, and slower onset of symptoms. There are no FDA-approved therapies tested for oral cyanide ingestions and no approved intramuscular or oral therapies, which would be valuable in mass casualty settings. The aim of this review is to evaluate the risks of oral cyanide and its unique toxicokinetics, as well as address the lack of available rapid diagnostics and treatments for mass casualty events. We will also review current strategies for developing new therapies. A review of the literature using the PRISMA checklist detected 7284 articles, screened 1091, and included 59 articles or other reports. Articles referenced in this review were specific to risk, clinical presentation, diagnostics, current treatments, and developing therapies. Current diagnostics of cyanide exposure can take hours or days, which can delay treatment. Moreover, current therapies for cyanide poisoning are administered intravenously and are not specifically tested for oral exposures, which can result in higher cyanide doses and unique toxicodynamics. New therapies developed for oral cyanide exposures that are easily delivered, safe, and can be administered quickly by first responders in a mass casualty event are needed. Current research is aimed at identifying an antidote that is safe, effective, easy to administer, and has a rapid onset of action.
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Affiliation(s)
- Tara B Hendry-Hofer
- Department of Emergency Medicine and Toxicology, University of Colorado School of Medicine, 12700 E. 19th Ave., Aurora, CO, 80045, USA.
| | - Patrick C Ng
- Department of Emergency Medicine and Toxicology, University of Colorado School of Medicine, 12700 E. 19th Ave., Aurora, CO, 80045, USA.,Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - Alyssa E Witeof
- Department of Emergency Medicine and Toxicology, University of Colorado School of Medicine, 12700 E. 19th Ave., Aurora, CO, 80045, USA
| | - Sari B Mahon
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Matthew Brenner
- Beckman Laser Institute, University of California, Irvine, CA, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, CA, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine and Toxicology, University of Colorado School of Medicine, 12700 E. 19th Ave., Aurora, CO, 80045, USA.,Office of the Chief Scientist, USAF Reserve, 59th MDW, JB, San Antonio, TX, USA
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Ng PC, Hendry-Hofer TB, Witeof AE, Brenner M, Mahon SB, Boss GR, Bebarta VS. Characterization of a Swine ( Sus scrofa) Model of Oral Potassium Cyanide Intoxication. Comp Med 2018; 68:375-379. [PMID: 30208987 DOI: 10.30802/aalas-cm-18-000041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cyanide is a readily available and potentially lethal substance. Oral exposure can result in larger doses, compared with other routes. Currently, there are no antidotes specific for use in the treatment of oral cyanide poisoning, and studies cannot be done in humans. We report on a new large animal model of oral cyanide toxicity to evaluate potential antidotes. Six female swine (Sus scrofa; weight, 45 to 55 kg) were anesthetized, intubated, and instrumented. Animals received a KCN bolus of either 5 or 8 mg/kg delivered via orogastric tube. Time to apnea was recorded; parameters monitored included heart rate, respiratory rate, blood pressure, pulse oximetry, end-tidal CO2, arterial blood gasses, and lactate concentrations. The Welch t test was used to calculate confidence intervals, mean, and standard deviation, and a Kaplan-Meier survival curve was used to compare survival between the 2 groups. At baseline, all animals in both groups were similar. Animals in the 5-mg/kg group had a more rapid time to apnea (5.1 ± 2.1 min), longer time to death (48.5 ± 38.1 min), and a greater rate of survival than the 8-mg/kg group (apnea, 10.6 ± 10.7 min; death, 26.1 ± 5.8 min). All animals displayed signs of toxicity (acidemia, hyperlactatemia, hypotension, apnea). We here report a large animal (swine) model of oral cyanide poisoning with dose-dependent effects in regard to time to death and survival rate. This model likely will be valuable for the development of medical countermeasures for oral cyanide poisoning.
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Affiliation(s)
- Patrick C Ng
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, USA; Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Tara B Hendry-Hofer
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alyssa E Witeof
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Matthew Brenner
- Laser Microbeam and Medical Program, Beckman Laser Institute and Medical Clinic, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, California, USA
| | - Sari B Mahon
- Laser Microbeam and Medical Program, Beckman Laser Institute and Medical Clinic, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Vikhyat S Bebarta
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, USA; Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Lee J, Rockwood G, Logue B, Manandhar E, Petrikovics I, Han C, Bebarta V, Mahon SB, Burney T, Brenner M. Monitoring Dose Response of Cyanide Antidote Dimethyl Trisulfide in Rabbits Using Diffuse Optical Spectroscopy. J Med Toxicol 2018; 14:295-305. [PMID: 30094773 DOI: 10.1007/s13181-018-0680-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Cyanide (CN) poisoning is a serious chemical threat from accidental or intentional exposures. Current CN exposure treatments, including direct binding agents, methemoglobin donors, and sulfur donors, have several limitations. Dimethyl trisulfide (DMTS) is capable of reacting with CN to form the less toxic thiocyanate with high efficiency, even without the sulfurtransferase rhodanese. We investigated a soluble DMTS formulation with the potential to provide a continuous supply of substrate for CN detoxification which could be delivered via intramuscular (IM) injection in a mass casualty situation. We also used non-invasive technology, diffuse optical spectroscopy (DOS), to monitor physiologic changes associated with CN exposure and reversal. METHODS Thirty-six New Zealand white rabbits were infused with a lethal dose of sodium cyanide solution (20 mg/60 ml normal saline). Animals were divided into three groups and treated with saline, low dose (20 mg), or high dose (150 mg) of DMTS intramuscularly. DOS continuously assessed changes in tissue hemoglobin concentrations and cytochrome c oxidase redox state status throughout the experiment. RESULTS IM injection of DMTS increased the survival in lethal CN poisoning. DOS demonstrated that high-dose DMTS (150 mg) reversed the effects of CN exposure on cytochrome c oxidase, while low dose (20 mg) did not fully reverse effects, even in surviving animals. CONCLUSIONS This study demonstrated potential efficacy for the novel approach of supplying substrate for non-rhodanese mediated sulfur transferase pathways for CN detoxification via intramuscular injection in a moderate size animal model and showed that DOS was useful for optimizing the DMTS treatment.
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Affiliation(s)
- Jangwoen Lee
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA.
| | - Gary Rockwood
- Analytical Toxicology Division, US Army Medical Research Institute of Chemical Defense, 2900 Rickets Point Road, Aberdeen Proving Ground, Aberdeen, MD, 21010, USA
| | - Brian Logue
- Department of Chemistry and Biochemistry, South Dakota University, Brookings, SD, 57007, USA
| | - Erica Manandhar
- Department of Chemistry and Biochemistry, South Dakota University, Brookings, SD, 57007, USA
| | - Ilona Petrikovics
- Department of Chemistry, Sam Houston State University, Huntsville, TX, 77341, USA
| | - Changhoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Geonggi-do, 10444, South Korea
| | - Vik Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Sari B Mahon
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA
| | - Tanya Burney
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA
| | - Matthew Brenner
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA, 92868, USA
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Dereven'kov IA, Makarov SV, Bui Thi TT, Makarova AS, Koifman OI. Studies on the Reduction of Dehydroascorbic Acid by Glutathione in the Presence of Aquahydroxocobinamide. Eur J Inorg Chem 2018. [DOI: 10.1002/ejic.201800066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ilia A. Dereven'kov
- Ivanovo State University of Chemistry and Technology; Sheremetevskiy str. 7 153000 Ivanovo Russia
| | - Sergei V. Makarov
- Ivanovo State University of Chemistry and Technology; Sheremetevskiy str. 7 153000 Ivanovo Russia
| | - Thu Thuy Bui Thi
- Faculty of Chemical Engineering; Industrial University of Ho Chi Minh city; 12 Nguyen Van Bao, ward 4, Go Vap district 727010 Ho Chi Minh City Vietnam
| | - Anna S. Makarova
- G. A. Krestov Institute of Solution Chemistry of the Russian Academy of Sciences; Academicheskaya str. 1 153045 Ivanovo Russian Federation
| | - Oskar I. Koifman
- Ivanovo State University of Chemistry and Technology; Sheremetevskiy str. 7 153000 Ivanovo Russia
- G. A. Krestov Institute of Solution Chemistry of the Russian Academy of Sciences; Academicheskaya str. 1 153045 Ivanovo Russian Federation
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Cheung JY, Wang J, Zhang XQ, Song J, Tomar D, Madesh M, Judenherc-Haouzi A, Haouzi P. Methylene blue counteracts cyanide cardiotoxicity: cellular mechanisms. J Appl Physiol (1985) 2018; 124:1164-1176. [PMID: 29420146 PMCID: PMC6050200 DOI: 10.1152/japplphysiol.00967.2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 02/01/2018] [Indexed: 11/22/2022] Open
Abstract
In adult left ventricular mouse myocytes, exposure to sodium cyanide (NaCN) in the presence of glucose dose-dependently reduced contraction amplitude, with ~80% of maximal inhibitory effect attained at 100 µM. NaCN (100 µM) exposure for 10 min significantly decreased contraction and intracellular Ca2+ concentration ([Ca2+]i) transient amplitudes, systolic but not diastolic [Ca2+]i, and maximal L-type Ca2+ current ( ICa) amplitude, indicating acute alteration of [Ca2+]i homeostasis largely accounted for the observed excitation-contraction abnormalities. In addition, NaCN depolarized resting membrane potential ( Em), reduced action potential (AP) amplitude, prolonged AP duration at 50% (APD50) and 90% repolarization (APD90), and suppressed depolarization-activated K+ currents but had no effect on Na+-Ca2+ exchange current ( INaCa). NaCN did not affect cellular adenosine triphosphate levels but depolarized mitochondrial membrane potential (ΔΨm) and increased superoxide (O2·-) levels. Methylene blue (MB; 20 µg/ml) added 3 min after NaCN restored contraction and [Ca2+]i transient amplitudes, systolic [Ca2+]i, Em, AP amplitude, APD50, APD90, ICa, depolarization-activated K+ currents, ΔΨm, and O2·- levels toward normal. We conclude that MB reversed NaCN-induced cardiotoxicity by preserving intracellular Ca2+ homeostasis and excitation-contraction coupling ( ICa), minimizing risks of arrhythmias ( Em, AP configuration, and depolarization-activated K+ currents), and reducing O2·- levels. NEW & NOTEWORTHY Cyanide poisoning due to industrial exposure, smoke inhalation, and bioterrorism manifests as cardiogenic shock and requires rapidly effective antidote. In the early stage of cyanide exposure, adenosine triphosphate levels are normal but myocyte contractility is reduced, largely due to alterations in Ca2+ homeostasis because of changes in oxidation-reduction environment of ion channels. Methylene blue, a drug approved by the U.S. Food and Drug Administration, ameliorates cyanide toxicity by normalizing oxidation-reduction state and Ca2+ channel function.
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Affiliation(s)
- Joseph Y Cheung
- Center of Translational Medicine, Lewis Katz School of Medicine, Temple University , Philadelphia, Pennsylvania
- Department of Medicine, Lewis Katz School of Medicine, Temple University , Philadelphia, Pennsylvania
| | - JuFang Wang
- Center of Translational Medicine, Lewis Katz School of Medicine, Temple University , Philadelphia, Pennsylvania
| | - Xue-Qian Zhang
- Center of Translational Medicine, Lewis Katz School of Medicine, Temple University , Philadelphia, Pennsylvania
| | - Jianliang Song
- Center of Translational Medicine, Lewis Katz School of Medicine, Temple University , Philadelphia, Pennsylvania
| | - Dhanendra Tomar
- Center of Translational Medicine, Lewis Katz School of Medicine, Temple University , Philadelphia, Pennsylvania
| | - Muniswamy Madesh
- Center of Translational Medicine, Lewis Katz School of Medicine, Temple University , Philadelphia, Pennsylvania
| | - Annick Judenherc-Haouzi
- Heart and Vascular Institute, Pennsylvania State University College of Medicine , Hershey, Pennsylvania
| | - Philippe Haouzi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Pennsylvania State University College of Medicine , Hershey, Pennsylvania
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23
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Brenner M, Azer SM, Oh KJ, Han CH, Lee J, Mahon SB, Du X, Mukai D, Burney T, Saidian M, Chan A, Straker DI, Bebarta VS, Boss GR. Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion. ACTA ACUST UNITED AC 2017; 7. [PMID: 28868209 PMCID: PMC5578424 DOI: 10.4172/2167-7972.1000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective Accidental or intentional cyanide ingestion is an-ever present danger. Rapidly acting, safe, inexpensive oral cyanide antidotes are needed that can neutralize large gastrointestinal cyanide reservoirs. Since humans cannot be exposed to cyanide experimentally, we studied oral cyanide poisoning in rabbits, testing oral sodium thiosulfate with and without gastric alkalization. Setting University research laboratory. Subjects New Zealand white rabbits. Interventions Seven animal groups studied; Groups 1–5 received high dose oral NaCN (50 mg, >LD100) and were treated immediately with oral (via nasogastric tube): 1) saline, 2) glycine, 3) sodium thiosulfate or 4) sodium thiosulfate and glycine, or 5) after 2 min with intramuscular injection of sodium nitrite and sodium thiosulfate plus oral sodium thiosulfate and glycine. Groups 6–7 received moderate dose oral NaCN (25 mg, LD70) and delayed intramuscular 6) saline or 7) sodium nitrite-sodium thiosulfate. Measurements and Main Results All animals in the high dose NaCN group receiving oral saline or glycine died very rapidly, with a trend towards delayed death in glycine-treated animals; saline versus glycine-treated animals died at 10.3+3.9 and 14.6+5.9 min, respectively (p=0.13). In contrast, all sodium thiosulfate-treated high dose cyanide animals survived (p<0.01), with more rapid recovery in animals receiving both thiosulfate and glycine, compared to thiosulfate alone (p<0.03). Delayed intramuscular treatment alone in the moderate cyanide dose animals increased survival over control animals from 30% to 71%. Delayed treatment in high dose cyanide animals was not as effective as immediate treatment, but did increase survival time and rescued 29% of animals (p<0.01 versus cyanide alone). Conclusions Oral sodium thiosulfate with gastric alkalization rescued animals from lethal doses of ingested cyanide. The combination of oral glycine and sodium thiosulfate may have potential for treating high dose acute cyanide ingestion and merits further investigation. The combination of systemic and oral therapy may provide further options.
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Affiliation(s)
- Matthew Brenner
- Beckman Laser Institute, University of California, Irvine, California, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, California, USA
| | - Sarah M Azer
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Kyung-Jin Oh
- Department of Urology, Chonnam National University Medical School, South Korea
| | - Chang Hoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Geonggi-do, South Korea
| | - Jangwoen Lee
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Sari B Mahon
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Xiaohua Du
- Pulmonary Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - David Mukai
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Tanya Burney
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Mayer Saidian
- Beckman Laser Institute, University of California, Irvine, California, USA.,The Institute for Drug Research, School of Pharmacy, Hebrew University of Jerusalem, Jerusalem Israel
| | - Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Derek I Straker
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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24
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Summerhill EM, Hoyle GW, Jordt SE, Jugg BJ, Martin JG, Matalon S, Patterson SE, Prezant DJ, Sciuto AM, Svendsen ER, White CW, Veress LA. An Official American Thoracic Society Workshop Report: Chemical Inhalational Disasters. Biology of Lung Injury, Development of Novel Therapeutics, and Medical Preparedness. Ann Am Thorac Soc 2017; 14:1060-1072. [PMID: 28418689 PMCID: PMC5529138 DOI: 10.1513/annalsats.201704-297ws] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This report is based on the proceedings from the Inhalational Lung Injury Workshop jointly sponsored by the American Thoracic Society (ATS) and the National Institutes of Health (NIH) Countermeasures Against Chemical Threats (CounterACT) program on May 21, 2013, in Philadelphia, Pennsylvania. The CounterACT program facilitates research leading to the development of new and improved medical countermeasures for chemical threat agents. The workshop was initiated by the Terrorism and Inhalational Disasters Section of the Environmental, Occupational, and Population Health Assembly of the ATS. Participants included both domestic and international experts in the field, as well as representatives from U.S. governmental funding agencies. The meeting objectives were to (1) provide a forum to review the evidence supporting current standard medical therapies, (2) present updates on our understanding of the epidemiology and underlying pathophysiology of inhalational lung injuries, (3) discuss innovative investigative approaches to further delineating mechanisms of lung injury and identifying new specific therapeutic targets, (4) present promising novel medical countermeasures, (5) facilitate collaborative research efforts, and (6) identify challenges and future directions in the ongoing development, manufacture, and distribution of effective and specific medical countermeasures. Specific inhalational toxins discussed included irritants/pulmonary toxicants (chlorine gas, bromine, and phosgene), vesicants (sulfur mustard), chemical asphyxiants (cyanide), particulates (World Trade Center dust), and respirable nerve agents.
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25
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Nath AK, Shi X, Harrison DL, Morningstar JE, Mahon S, Chan A, Sips P, Lee J, MacRae CA, Boss GR, Brenner M, Gerszten RE, Peterson RT. Cisplatin Analogs Confer Protection against Cyanide Poisoning. Cell Chem Biol 2017; 24:565-575.e4. [PMID: 28416275 DOI: 10.1016/j.chembiol.2017.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/19/2017] [Accepted: 03/16/2017] [Indexed: 02/04/2023]
Abstract
Cisplatin holds an illustrious position in the history of chemistry most notably for its role in the virtual cure of testicular cancer. Here we describe a role for this small molecule in cyanide detoxification in vivo. Cyanide kills organisms as diverse as insects, fish, and humans within seconds to hours. Current antidotes exhibit limited efficacy and are not amenable to mass distribution requiring the development of new classes of antidotes. The binding affinity of the cyanide anion for the positively charged metal platinum is known to create an extremely stable complex in vitro. We therefore screened a panel of diverse cisplatin analogs and identified compounds that conferred protection from cyanide poisoning in zebrafish, mice, and rabbits. Cumulatively, this discovery pipeline begins to establish the characteristics of platinum ligands that influence their solubility, toxicity, and efficacy, and provides proof of concept that platinum-based complexes are effective antidotes for cyanide poisoning.
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Affiliation(s)
- Anjali K Nath
- Division of Cardiology, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA; Department of Systems Biology, Harvard Medical School, Boston, MA 02215, USA; Broad Institute, Cambridge, MA 02142, USA.
| | - Xu Shi
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Devin L Harrison
- Division of Cardiology, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA; Department of Systems Biology, Harvard Medical School, Boston, MA 02215, USA
| | - Jordan E Morningstar
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Sari Mahon
- Department of Medicine, Beckman Laser Institute, University of California, Irvine, CA 92697, USA
| | - Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Patrick Sips
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Jangwoen Lee
- Department of Medicine, Beckman Laser Institute, University of California, Irvine, CA 92697, USA
| | - Calum A MacRae
- Broad Institute, Cambridge, MA 02142, USA; Division of Cardiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Matthew Brenner
- Department of Medicine, Beckman Laser Institute, University of California, Irvine, CA 92697, USA
| | - Robert E Gerszten
- Broad Institute, Cambridge, MA 02142, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Randall T Peterson
- Division of Cardiology, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA; Department of Systems Biology, Harvard Medical School, Boston, MA 02215, USA; Broad Institute, Cambridge, MA 02142, USA.
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26
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Moeller BM, Crankshaw DL, Briggs J, Nagasawa HT, Patterson SE. In-vitro mercaptopyruvate sulfurtransferase species comparison in humans and common laboratory animals. Toxicol Lett 2017; 274:64-68. [PMID: 28412453 DOI: 10.1016/j.toxlet.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/13/2017] [Accepted: 04/10/2017] [Indexed: 01/18/2023]
Abstract
Cyanide is a metabolic poison that inhibits cytochrome c oxidase. Its broad applications in manufacturing and history as an agent of warfare/terror highlight the limitations in approved cyanide antidotes for mass casualties. Sulfanegen, a pre-clinical antidote for cyanide poisoning, exploits an endogenous detoxification pathway and should be amenable to mass-casualty scenarios. Because human studies are unethical, determination of appropriate animal species as models in translational studies for FDA approval under the "Animal Rule" are critical. Here, we compared the specific activities of mercaptopyruvate sulfurtransferase (MST, required for sulfanegen's activity), across common laboratory models of cyanide intoxication, and humans. Human MST activities in erythrocytes (measured as micromole pyruvate/min/106 rbc) were closest to those of Swiss-Webster mice and NZW rabbits. Similar species were selected for a more detailed tissue-specific comparison of MST activities. NZW Rabbits were closest to humans in the liver and kidney mitochondrial fractions, the Swiss-Webster mouse was closest to humans in the liver cytosolic fraction, while C57BL/6 mouse was closest in the kidney cytosolic fraction. These data comparing MST activities in animal models will help justify the use of those specific animals per the animal rule. Interestingly, statistically significant differences were found in MST activities of liver mitochondria between human smokers and non-smokers (p=0.0030).
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Affiliation(s)
- Bryant M Moeller
- Department of Pharmacology, University of Minnesota, 312 Church St SE, Minneapolis, MN 55455, United States; Center for Drug Design, University of Minnesota, 516 Delaware St SE, Minneapolis, MN 55455, United States
| | - Daune L Crankshaw
- Center for Drug Design, University of Minnesota, 516 Delaware St SE, Minneapolis, MN 55455, United States
| | - Jacquie Briggs
- Center for Drug Design, University of Minnesota, 516 Delaware St SE, Minneapolis, MN 55455, United States
| | - Herbert T Nagasawa
- Center for Drug Design, University of Minnesota, 516 Delaware St SE, Minneapolis, MN 55455, United States
| | - Steven E Patterson
- Center for Drug Design, University of Minnesota, 516 Delaware St SE, Minneapolis, MN 55455, United States.
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27
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Bebarta VS, Brittain M, Chan A, Garrett N, Yoon D, Burney T, Mukai D, Babin M, Pilz RB, Mahon SB, Brenner M, Boss GR. Sodium Nitrite and Sodium Thiosulfate Are Effective Against Acute Cyanide Poisoning When Administered by Intramuscular Injection. Ann Emerg Med 2016; 69:718-725.e4. [PMID: 28041825 DOI: 10.1016/j.annemergmed.2016.09.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE The 2 antidotes for acute cyanide poisoning in the United States must be administered by intravenous injection. In the out-of-hospital setting, intravenous injection is not practical, particularly for mass casualties, and intramuscular injection would be preferred. The purpose of this study is to determine whether sodium nitrite and sodium thiosulfate are effective cyanide antidotes when administered by intramuscular injection. METHODS We used a randomized, nonblinded, parallel-group study design in 3 mammalian models: cyanide gas inhalation in mice, with treatment postexposure; intravenous sodium cyanide infusion in rabbits, with severe hypotension as the trigger for treatment; and intravenous potassium cyanide infusion in pigs, with apnea as the trigger for treatment. The drugs were administered by intramuscular injection, and all 3 models were lethal in the absence of therapy. RESULTS We found that sodium nitrite and sodium thiosulfate individually rescued 100% of the mice, and that the combination of the 2 drugs rescued 73% of the rabbits and 80% of the pigs. In all 3 species, survival in treated animals was significantly better than in control animals (log rank test, P<.05). In the pigs, the drugs attenuated an increase in the plasma lactate concentration within 5 minutes postantidote injection (difference: plasma lactate, saline solution-treated versus nitrite- or thiosulfate-treated 1.76 [95% confidence interval 1.25 to 2.27]). CONCLUSION We conclude that sodium nitrite and sodium thiosulfate administered by intramuscular injection are effective against severe cyanide poisoning in 3 clinically relevant animal models of out-of-hospital emergency care.
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Affiliation(s)
- Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO
| | | | - Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Norma Garrett
- Medical Toxicology and the Department of Emergency Medicine, San Antonio Military Medical Center/59 MDW, San Antonio, TX
| | - David Yoon
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA
| | - Tanya Burney
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA
| | - David Mukai
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA
| | | | - Renate B Pilz
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Sari B Mahon
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA
| | - Matthew Brenner
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA
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28
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The Vitamin B 12 Analog Cobinamide Is an Effective Antidote for Oral Cyanide Poisoning. J Med Toxicol 2016; 12:370-379. [PMID: 27631586 DOI: 10.1007/s13181-016-0566-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/31/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Cyanide is a major chemical threat, and cyanide ingestion carries a higher risk for a supra-lethal dose exposure compared to inhalation but provides an opportunity for effective treatment due to a longer treatment window and a gastrointestinal cyanide reservoir that could be neutralized prior to systemic absorption. We hypothesized that orally administered cobinamide may function as a high-binding affinity scavenger and that gastric alkalinization would reduce cyanide absorption and concurrently increase cobinamide binding, further enhancing antidote effectiveness. METHODS Thirty New Zealand white rabbits were divided into five groups and were given a lethal dose of oral cyanide poisoning (50 mg). The survival time of animals was monitored with oral cyanide alone, oral cyanide with gastric alkalinization with oral sodium bicarbonate buffer (500 mg), and in combination with either aquohydroxocobinamide or dinitrocobinamide (250 mM). Red blood cell cyanide concentration, plasma cobinamide, and thiocyanate concentrations were measured from blood samples. RESULTS In cyanide ingested animals, oral sodium bicarbonate alone significantly prolonged survival time to 20.3 ± 8.6 min compared to 10.5 ± 4.3 min in saline-treated controls, but did not lead to overall survival. Aquohydroxocobinamide and dinitrocobinamide increased survival time to 64 ± 41 (p < 0.05) and 75 ± 16.4 min (p < 0.001), respectively. Compared to aquohydroxocobinamide, dinitrocobinamide showed greater systemic absorption and reduced blood pressure. Dinitrocobinamide also markedly increased the red blood cell cyanide concentration. Under all conditions, the plasma thiocyanate concentration gradually increased with time. CONCLUSION This study demonstrates a promising new approach to treat high-dose cyanide ingestion, with gastric alkalinization alone and in combination with oral cobinamide for treating a supra-lethal dose of orally administered cyanide in rabbits.
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29
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Petrikovics I, Budai M, Kovacs K, Thompson DE. Past, present and future of cyanide antagonism research: From the early remedies to the current therapies. World J Methodol 2015; 5:88-100. [PMID: 26140275 PMCID: PMC4482825 DOI: 10.5662/wjm.v5.i2.88] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/09/2015] [Accepted: 04/20/2015] [Indexed: 02/06/2023] Open
Abstract
This paper reviews milestones in antidotal therapies for cyanide (CN) spanning early remedies, current antidotal systems and research towards next generation therapies. CN has been a part of plant defense mechanisms for millions of years. It became industrially important in the nineteenth century with the advent of CN assisted gold mining and the use of CN as a pest control agent. The biochemical basis of CN poisoning was actively studied and key mechanisms were understood as early as 1929. These fundamental studies led to a variety of antidotes, including indirect CN binders that generate methemoglobin, direct CN binders such as hydroxocobalamin, and sulfur donors that convert CN to the less toxic thiocyanate. Research on blood gases at the end of the twentieth century shed new light on the role of nitric oxide (NO) in the body. The discovery of NO’s ability to compete with CN for enzymatic binding sites provided a previously missed explanation for the rapid efficacy of NO generating antidotes such as the nitrites. Presently used CN therapies include: methemoglobin/NO generators (e.g., sodium nitrite, amyl nitrite, and dimethyl aminophenol), sulfur donors (e.g., sodium thiosulfate and glutathione), and direct binding agents [(e.g., hydroxocobalamin and dicobalt salt of ethylenediaminetetraacetic acid (dicobalt edetate)]. A strong effort is being made to explore novel antidotal systems and to formulate them for rapid administration at the point of intoxication in mass casualty scenarios. New antidotes, formulations, and delivery systems are enhancing bioavailability and efficacy and hold promise for a new generation of improved CN countermeasures.
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30
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Decellularized skeletal muscle as an in vitro model for studying drug-extracellular matrix interactions. Biomaterials 2015; 64:108-14. [PMID: 26125502 DOI: 10.1016/j.biomaterials.2015.06.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 06/12/2015] [Accepted: 06/18/2015] [Indexed: 01/16/2023]
Abstract
Several factors can affect drug absorption after intramuscular (IM) injection: drug solubility, drug transport across cell membranes, and drug metabolism at the injection site. We found that potential interactions between the drug and the extracellular matrix (ECM) at the injection site can also affect the rate of absorption post-injection. Using decellularized skeletal muscle, we developed a simple method to model drug absorption after IM injection, and showed that the nature of the drug-ECM interaction could be investigated by adding compounds that alter binding. We validated the model using the vitamin B12 analog cobinamide with different bound ligands. Cobinamide is being developed as an IM injectable treatment for cyanide poisoning, and we found that the in vitro binding data correlated with previously published in vivo drug absorption in animals. Commercially available ECM products, such as collagen and GelTrex, did not recapitulate drug binding behavior. While decellularized ECM has been widely studied in fields such as tissue engineering, this work establishes a novel use of skeletal muscle ECM as a potential in vitro model to study drug-ECM interactions during drug development.
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31
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Kadjo AF, Dasgupta PK, Boss GR. Comment on "Rapid visual detection of blood cyanide" by C. Männel-Croisé and F. Zelder, Analytical Methods, 2012, 4, 2632. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2015; 7:5707-5711. [PMID: 26640525 PMCID: PMC4670041 DOI: 10.1039/c4ay00190g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cyanide poisoning from Inhaled HCN is all too common in victims of smoke inhalation in fires. While the toxic effects arise primarily from its inhibitory effects on cytochrome c oxidase, the majority of the cyanide binds to methemoglobin (metHb) in the blood. It can be considered as the detoxification mechanism: one of the antidotes used earlier was nitrite which primarily works by converting hemoglobin to metHb (normally present to the extent of ~1% of the total hemoglobin). Vitamin B12 (hydroxocobalamin) and related analogs have long been known to have high affinity for cyanide and has been used as antidotes - the binding of cyanide to many compounds in this general family also results in a significant change in color that can be used for analytical purposes. Männel Croisé and Zelder (Anal. Methods, 2012, 4, 2632) have advocated direct addition of a related compound to blood samples and isolating the colored measurand on a solid phase extraction cartridge. While they demonstrated attractive rapid measurement of cyanide in spiked blood samples, we believe that this is not a practically usable procedure regardless of the exact chromogenic reagent used. Cyanide bound to metHb dissociates too slowly for a 1 min reaction to work as suggested - we believe for reasons unknown (eg., metHb levels in their blood samples unusually low), cyanide added to their blood samples did not (have time to) bind to metHb and these samples may not resemble real situations where significant amount of the cyanide will be bound to metHb.
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Affiliation(s)
- Akinde F Kadjo
- Department of Chemistry and Biochemistry, University of Texas at Arlington, Arlington TX 76019-1065, USA
| | - Purnendu K Dasgupta
- Department of Chemistry and Biochemistry, University of Texas at Arlington, Arlington TX 76019-1065, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652, USA
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Chan A, Jiang J, Fridman A, Guo LT, Shelton GD, Liu MT, Green C, Haushalter KJ, Patel HH, Lee J, Yoon D, Burney T, Mukai D, Mahon SB, Brenner M, Pilz RB, Boss GR. Nitrocobinamide, a new cyanide antidote that can be administered by intramuscular injection. J Med Chem 2015; 58:1750-9. [PMID: 25650735 DOI: 10.1021/jm501565k] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Currently available cyanide antidotes must be given by intravenous injection over 5-10 min, making them ill-suited for treating many people in the field, as could occur in a major fire, an industrial accident, or a terrorist attack. These scenarios call for a drug that can be given quickly, e.g., by intramuscular injection. We have shown that aquohydroxocobinamide is a potent cyanide antidote in animal models of cyanide poisoning, but it is unstable in solution and poorly absorbed after intramuscular injection. Here we show that adding sodium nitrite to cobinamide yields a stable derivative (referred to as nitrocobinamide) that rescues cyanide-poisoned mice and rabbits when given by intramuscular injection. We also show that the efficacy of nitrocobinamide is markedly enhanced by coadministering sodium thiosulfate (reducing the total injected volume), and we calculate that ∼1.4 mL each of nitrocobinamide and sodium thiosulfate should rescue a human from a lethal cyanide exposure.
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Affiliation(s)
- Adriano Chan
- Departments of †Medicine, ‡Pathology, §Chemistry and Biochemistry, and ∥Anesthesiology, University of California-San Diego , La Jolla, California 92093-0652, United States
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Bebarta VS, Pitotti RL, Boudreau S, Tanen DA. Intraosseous versus intravenous infusion of hydroxocobalamin for the treatment of acute severe cyanide toxicity in a Swine model. Acad Emerg Med 2014; 21:1203-11. [PMID: 25377396 DOI: 10.1111/acem.12518] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/09/2014] [Accepted: 06/29/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Easily administrated cyanide antidotes are needed for first responders, military troops, and emergency department staff after cyanide exposure in mass casualty incidents or due to smoke inhalation during fires involving many victims. Hydroxocobalamin has proven to be an effective antidote, but cannot be given intramuscularly because the volume of diluent needed is too large. Thus, intraosseous (IO) infusion may be an alternative, as it is simple and has been recommended for the administration of other resuscitation drugs. The primary objective of this study was to compare the efficacy of IO delivery of hydroxocobalamin to intravenous (IV) injection for the management of acute cyanide toxicity in a well-described porcine model. METHODS Twenty-four swine (45 to 55 kg) were anesthetized, intubated, and instrumented with continuous mean arterial pressure (MAP) and cardiac output monitoring. Cyanide was continuously infused until severe hypotension (50% of baseline MAP), followed by IO or IV hydroxocobalamin treatment. Animals were randomly assigned to receive IV (150 mg/kg) or IO (150 mg/kg) hydroxocobalamin and monitored for 60 minutes after start of antidotal infusion. The primary outcome measure was the change in MAP after antidotal treatment from onset of hypotension (time zero) to 60 minutes. A sample size of 12 animals per group was determined by group size analysis based on power of 80% to detect a one standard deviation of the mean MAP between the groups with an alpha of 0.05. Whole blood cyanide, lactate, pH, nitrotyrosine (nitric oxide marker) levels, cerebral and renal near infrared spectrometry (NIRS) oxygenation, and inflammatory markers were also measured. Repeated-measures analysis of variance was used to determine statistically significant changes between groups over time. RESULTS At baseline and at the point of hypotension, physiologic parameters were similar between groups. At the conclusion of the study, 10 out of 12 animals in the IV group and 10 out of 12 in IO group survived (p = 1.0). Both groups demonstrated a similar return to baseline MAP (p = 0.997). Cardiac output, oxygen saturation, and systemic vascular resistance were also found to be similar between groups (p > 0.4), and no difference was detected between bicarbonate, pH, and lactate levels (p > 0.8). Cyanide levels were undetectable after the hydroxocobalamin infusion throughout the study in both groups (p = 1.0). Cerebral and renal NIRS oxygenation decreased in parallel to MAP during cyanide infusion and increased after antidote infusion in both groups. Serum nitrotyrosine increased during cyanide infusion in all animals and then decreased in both study arms after hydroxocobalamin infusion (p > 0.5). Serum cytokines increased starting at cyanide infusion and no difference was detected between groups (tumor necrosis factor-α, interleukin [IL]-1β, IL-6, and IL-10). CONCLUSIONS The authors found no difference in the efficacy of IV versus IO hydroxocobalamin in the treatment of severe cyanide toxicity in a validated porcine model.
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Affiliation(s)
- Vikhyat S. Bebarta
- Medical Toxicology San Antonio Military Medical Center, and Enroute Care Research Center U.S. Army, Institute of Surgical Research San Antonio TX
| | - Rebecca L. Pitotti
- The Department of Emergency Medicine San Antonio Military Medical Center San Antonio TX
| | - Susan Boudreau
- The Department of Emergency Medicine San Antonio Military Medical Center San Antonio TX
| | - David A. Tanen
- The David Geffen School of Medicine at UCLA Harbor–UCLA Medical Center Los Angeles CA
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Affiliation(s)
- Stephen W. Borron
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine Emergency Medicine El Paso TX
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Salnikov DS, Makarov SV, van Eldik R, Kucherenko PN, Boss GR. Kinetics and mechanism of the reaction of hydrogen sulfide with diaquacobinamide in aqueous solution. Eur J Inorg Chem 2014; 2014:4123-4133. [PMID: 25580081 PMCID: PMC4286256 DOI: 10.1002/ejic.201402082] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Indexed: 11/09/2022]
Abstract
We conducted a detailed kinetic study of the reaction of the vitamin B12 analog diaquacobinamide ((H2O)2Cbi(III)) with hydrogen sulfide in water from pH 3 to 11. The reaction proceeds in three steps: (i) formation of three different complexes between cobinamide and hydrogen sulfide, viz. (HO-)(HS-)Cbi(III), (H2O)(HS-)Cbi(III), and (HS-)2Cbi(III); (ii) inner-sphere electron transfer (ISET) in the two complexes with one coordinated HS- to form the reduced cobinamide complex [(H)S]Cbi(II); and (iii) addition of a second molecule of hydrogen sulfide to the reduced cobinamide. ISET does not proceed in the (HS-)2Cbi(III) complex. The final products of the reaction between cobinamide and hydrogen sulfide were found to be independent of pH, with the main product being a complex of cobinamide(II) with the anion-radical SSH2-.
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Affiliation(s)
- Denis S. Salnikov
- Department of Food Chemistry, Ivanovo State University of Chemistry and Technology, Sheremetevskiy str. 7, 153000 Ivanovo, Russia
- Department of Chemistry and Pharmacy, University of Erlangen – Nuremberg, Egerland strasse 1, 91058 Erlangen, Germany
| | - Sergei V. Makarov
- Department of Food Chemistry, Ivanovo State University of Chemistry and Technology, Sheremetevskiy str. 7, 153000 Ivanovo, Russia
| | - Rudi van Eldik
- Department of Chemistry and Pharmacy, University of Erlangen – Nuremberg, Egerland strasse 1, 91058 Erlangen, Germany
| | - Polina N. Kucherenko
- Department of Food Chemistry, Ivanovo State University of Chemistry and Technology, Sheremetevskiy str. 7, 153000 Ivanovo, Russia
| | - Gerry R. Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652, United States
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Lee J, Kim JG, Mahon SB, Mukai D, Yoon D, Boss GR, Patterson SE, Rockwood G, Isom G, Brenner M. Noninvasive optical cytochrome c oxidase redox state measurements using diffuse optical spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:055001. [PMID: 24788369 PMCID: PMC4006145 DOI: 10.1117/1.jbo.19.5.055001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 03/01/2014] [Accepted: 03/07/2014] [Indexed: 05/28/2023]
Abstract
A major need exists for methods to assess organ oxidative metabolic states in vivo. By contrasting the responses to cyanide (CN) poisoning versus hemorrhage in animal models, we demonstrate that diffuse optical spectroscopy (DOS) can detect cytochrome c oxidase (CcO) redox states. Intermittent decreases in inspired O2 from 100% to 21% were applied before, during, and after CN poisoning, hemorrhage, and resuscitation in rabbits. Continuous DOS measurements of total hemoglobin, oxyhemoglobin, deoxyhemoglobin, and oxidized and reduced CcO from muscle were obtained. Rabbit hemorrhage was accomplished with stepwise removal of blood, followed by blood resuscitation. CN treated rabbits received 0.166 mg/min NaCN infusion. During hemorrhage, CcO redox state became reduced concurrently with decreases in oxyhemoglobin, resulting from reduced tissue oxygen delivery and hypoxia. In contrast, during CN infusion, CcO redox state decreased while oxyhemoglobin concentration increased due to CN binding and reduction of CcO with resultant inhibition of the electron transport chain. Spectral absorption similarities between hemoglobin and CcO make noninvasive spectroscopic distinction of CcO redox states difficult. By contrasting physiological perturbations of CN poisoning versus hemorrhage, we demonstrate that DOS measured CcO redox state changes are decoupled from hemoglobin concentration measurement changes.
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Affiliation(s)
- Jangwoen Lee
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
| | - Jae G. Kim
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
- Gwangju Institute of Science and Technology, School of Information and Communications, Department of Medical System Engineering, 123 Cheomdan-gwagiro, Buk-gu, Gwangju 500-712, Republic of Korea
| | - Sari B. Mahon
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
| | - David Mukai
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
| | - David Yoon
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
| | - Gerry R. Boss
- University of California San Diego, Department of Medicine, 9500 Gilman Dr., La Jolla, California 92093
| | - Steven E. Patterson
- University of Minnesota, Department of Pharmacology, 516 Delaware Street SE, Minneapolis, Minnesota 55455
| | - Gary Rockwood
- US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010
| | - Gary Isom
- Purdue University, Department of Medicinal Chemistry and Molecular Pharmacology, 575 Stadium Mall Drive, West Lafayette, Indiana 47907
| | - Matthew Brenner
- University of California Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612
- University of California Irvine Medical Center, Department of Pulmonary and Critical Care, 333 West City Boulevard, Suite 400, Orange, California 92868
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Fry N, Boss GR, Sailor MJ. Oxidation-Induced Trapping of Drugs in Porous Silicon Microparticles. CHEMISTRY OF MATERIALS : A PUBLICATION OF THE AMERICAN CHEMICAL SOCIETY 2014; 26:2758-2764. [PMID: 25678746 PMCID: PMC4311935 DOI: 10.1021/cm500797b] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Indexed: 05/02/2023]
Abstract
An approach for the preparation of an oxidized porous silicon microparticle drug delivery system that can provide efficient trapping and sustained release of various drugs is reported. The method uses the contraction of porous silicon's mesopores, which occurs during oxidation of the silicon matrix, to increase the loading and retention of drugs within the particles. First, a porous Si (pSi) film is prepared by electrochemical etching of p-type silicon with a resistivity of >0.65 Ω cm in a 1:1 (v/v) HF/ethanol electrolyte solution. Under these conditions, the pore walls are sufficiently thin to allow for complete oxidation of the silicon skeleton under mild conditions. The pSi film is then soaked in an aqueous solution containing the drug (cobinamide or rhodamine B test molecules were used in this study) and sodium nitrite. Oxidation of the porous host by nitrite results in a shrinking of the pore openings, which physically traps the drug in the porous matrix. The film is subsequently fractured by ultrasonication into microparticles. Upon comparison with commonly used oxidizing agents for pSi such as water, peroxide, and dimethyl sulfoxide, nitrite is kinetically and thermodynamically sufficient to oxidize the pore walls of the pSi matrix, precluding reductive (by Si) or oxidative (by nitrite) degradation of the drug payload. The drug loading efficiency is significantly increased (by up to 10-fold), and the release rate is significantly prolonged (by 20-fold) relative to control samples in which the drug is loaded by infiltration of pSi particles postoxidation. We find that it is important that the silicon skeleton be completely oxidized to ensure the drug is not reduced or degraded by contact with elemental silicon during the particle dissolution-drug release phase.
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Affiliation(s)
- Nicole
L. Fry
- Department of Chemistry and Biochemistry and Department of Medicine, University of California at San Diego, La Jolla, California 92093, United States
| | - Gerry R. Boss
- Department of Chemistry and Biochemistry and Department of Medicine, University of California at San Diego, La Jolla, California 92093, United States
| | - Michael J. Sailor
- Department of Chemistry and Biochemistry and Department of Medicine, University of California at San Diego, La Jolla, California 92093, United States
- E-mail:
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Bebarta VS, Tanen DA, Boudreau S, Castaneda M, Zarzabal LA, Vargas T, Boss GR. Intravenous cobinamide versus hydroxocobalamin for acute treatment of severe cyanide poisoning in a swine (Sus scrofa) model. Ann Emerg Med 2014; 64:612-9. [PMID: 24746273 DOI: 10.1016/j.annemergmed.2014.02.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 12/12/2013] [Accepted: 02/07/2014] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE Hydroxocobalamin is a Food and Drug Administration-approved antidote for cyanide poisoning. Cobinamide is a potential antidote that contains 2 cyanide-binding sites. To our knowledge, no study has directly compared hydroxocobalamin with cobinamide in a severe, cyanide-toxic large-animal model. Our objective is to compare the time to return of spontaneous breathing in swine with acute cyanide-induced apnea treated with intravenous hydroxocobalamin, intravenous cobinamide, or saline solution (control). METHODS Thirty-three swine (45 to 55 kg) were intubated, anesthetized, and instrumented (continuous mean arterial pressure and cardiac output monitoring). Anesthesia was adjusted to allow spontaneous breathing with FiO2 of 21% during the experiment. Cyanide was continuously infused intravenously until apnea occurred and lasted for 1 minute (time zero). Animals were then randomly assigned to receive intravenous hydroxocobalamin (65 mg/kg), cobinamide (12.5 mg/kg), or saline solution and monitored for 60 minutes. A sample size of 11 animals per group was selected according to obtaining a power of 80%, an α of .05, and an SD of 0.17 in mean time to detect a 20% difference in time to spontaneous breathing. We assessed differences in time to death among groups, using Kaplan-Meier estimation methods, and compared serum lactate, blood pH, cardiac output, mean arterial pressure, respiratory rate, and minute ventilation time curves with repeated-measures ANOVA. RESULTS Baseline weights and vital signs were similar among groups. The time to apnea and cyanide dose required to achieve apnea were similar. At time zero, mean cyanide blood and lactate concentrations and reduction in mean arterial pressure from baseline were similar. In the saline solution group, 2 of 11 animals survived compared with 10 of 11 in the hydroxocobalamin and cobinamide groups (P<.001 between the 2 treated groups and the saline solution group). Time to return of spontaneous breathing after antidote was similar between hydroxocobalamin and cobinamide (1 minute 48 seconds versus 1 minute 49 seconds, respectively). Blood cyanide concentrations became undetectable at the end of the study in both antidote-treated groups, and no statistically significant differences were detected between the 2 groups for mean arterial pressure, cardiac output, respiratory rate, lactate, or pH. CONCLUSION Both hydroxocobalamin and cobinamide rescued severely cyanide-poisoned swine from apnea in the absence of assisted ventilation. The dose of cobinamide was one fifth that of hydroxocobalamin.
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Affiliation(s)
- Vikhyat S Bebarta
- Medical Toxicology, San Antonio Military Medical Center, San Antonio, TX.
| | - David A Tanen
- David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, Torrance, CA
| | - Susan Boudreau
- Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX
| | - Maria Castaneda
- Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX
| | - Lee A Zarzabal
- Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX
| | - Toni Vargas
- Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX
| | - Gerry R Boss
- University of California, San Diego, San Diego, CA
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Brenner M, Benavides S, Mahon SB, Lee J, Yoon D, Mukai D, Viseroi M, Chan A, Jiang J, Narula N, Azer SM, Alexander C, Boss GR. The vitamin B12 analog cobinamide is an effective hydrogen sulfide antidote in a lethal rabbit model. Clin Toxicol (Phila) 2014; 52:490-7. [PMID: 24716792 DOI: 10.3109/15563650.2014.904045] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE Hydrogen sulfide (H2S) is a highly toxic gas for which no effective antidotes exist. It acts, at least in part, by binding to cytochrome c oxidase, causing cellular asphyxiation and anoxia. We investigated the effects of three different ligand forms of cobinamide, a vitamin B12 analog, to reverse sulfide (NaHS) toxicity. METHODS New Zealand white rabbits received a continuous intravenous (IV) infusion of NaHS (3 mg/min) until expiration or a maximum 270 mg dose. Animals received six different treatments, administered at the time when they developed signs of severe toxicity: Group 1-saline (placebo group, N = 9); Group 2--IV hydroxocobalamin (N = 7); Group 3--IV aquohydroxocobinamide (N = 6); Group 4--IV sulfitocobinamide (N = 6); Group 5--intramuscular (IM) sulfitocobinamide (N = 6); and Group 6-IM dinitrocobinamide (N = 8). Blood was sampled intermittently, and systemic blood pressure and deoxygenated and oxygenated hemoglobin were measured continuously in peripheral muscle and over the brain region; the latter were measured by diffuse optical spectroscopy (DOS) and continuous wave near infrared spectroscopy (CWNIRS). RESULTS Compared with the saline controls, all cobinamide derivatives significantly increased survival time and the amount of NaHS that was tolerated. Aquohydroxocobinamide was most effective (261.5 ± 2.4 mg NaHS tolerated vs. 93.8 ± 6.2 mg in controls, p < 0.0001). Dinitrocobinamide was more effective than sulfitocobinamide. Hydroxocobalamin was not significantly more effective than the saline control. CONCLUSIONS Cobinamide is an effective agent for inhibiting lethal sulfide exposure in this rabbit model. Further studies are needed to determine the optimal dose and form of cobinamide and route of administration.
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Affiliation(s)
- M Brenner
- Beckman Laser Institute, University of California , Irvine, CA , USA
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Mitchell BL, Bhandari RK, Bebarta VS, Rockwood GA, Boss GR, Logue BA. Toxicokinetic profiles of α-ketoglutarate cyanohydrin, a cyanide detoxification product, following exposure to potassium cyanide. Toxicol Lett 2013; 222:83-9. [DOI: 10.1016/j.toxlet.2013.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/05/2013] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
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Dereven'kov IA, Salnikov DS, Makarov SV, Surducan M, Silaghi-Dumitrescu R, Boss GR. Comparative study of reaction of cobalamin and cobinamide with thiocyanate. J Inorg Biochem 2013; 125:32-9. [PMID: 23685470 DOI: 10.1016/j.jinorgbio.2013.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 11/24/2022]
Abstract
The interaction of Co(III) and Co(II) cobalamin (Cbl) and cobinamide (Cbi) with thiocyanate was examined with UV-vis and EPR spectra. S/N-linkage isomerism was explored on Co(III) and Co(II) Cbl and Cbi models using density functional theory (DFT; BP86, B3LYP). Performed calculations suggest the prevalence of isothiocyanato isomers over thiocyanato complexes on both Co(III) and Co(II) centers. The formation of Cbl(II) complex with thiocyanate was observed at high ligand concentrations which was proposed to be hexacoordinated. DFT data maintain the possibility of hexacoordinated Co(II) complexes with thiocyanate in which one of extra-ligands is weakly coordinated. It is found that high thiocyanate concentrations could retard cyanide binding to cobalamin but not to cobinamide.
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Affiliation(s)
- Ilia A Dereven'kov
- State University of Chemistry and Technology, Engels str. 7, 153000 Ivanovo, Russia
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Kim JG, Lee J, Mahon SB, Mukai D, Patterson SE, Boss GR, Tromberg BJ, Brenner M. Noninvasive monitoring of treatment response in a rabbit cyanide toxicity model reveals differences in brain and muscle metabolism. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:105005. [PMID: 23223999 PMCID: PMC3603151 DOI: 10.1117/1.jbo.17.10.105005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 09/09/2012] [Accepted: 09/11/2012] [Indexed: 06/01/2023]
Abstract
Noninvasive near infrared spectroscopy measurements were performed to monitor cyanide (CN) poisoning and recovery in the brain region and in foreleg muscle simultaneously, and the effects of a novel CN antidote, sulfanegen sodium, on tissue hemoglobin oxygenation changes were compared using a sub-lethal rabbit model. The results demonstrated that the brain region is more susceptible to CN poisoning and slower in endogenous CN detoxification following exposure than peripheral muscles. However, sulfanegen sodium rapidly reversed CN toxicity, with brain region effects reversing more quickly than muscle. In vivo monitoring of multiple organs may provide important clinical information regarding the extent of CN toxicity and subsequent recovery, and facilitate antidote drug development.
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Affiliation(s)
- Jae G Kim
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, California 92612, USA.
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Sharina I, Sobolevsky M, Doursout MF, Gryko D, Martin E. Cobinamides are novel coactivators of nitric oxide receptor that target soluble guanylyl cyclase catalytic domain. J Pharmacol Exp Ther 2011; 340:723-32. [PMID: 22171090 DOI: 10.1124/jpet.111.186957] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Soluble guanylyl cyclase (sGC), a ubiquitously expressed heme-containing receptor for nitric oxide (NO), is a key mediator of NO-dependent processes. In addition to NO, a number of synthetic compounds that target the heme-binding region of sGC and activate it in a NO-independent fashion have been described. We report here that dicyanocobinamide (CN2-Cbi), a naturally occurring intermediate of vitamin B(12) synthesis, acts as a sGC coactivator both in vitro and in intact cells. Heme depletion or heme oxidation does not affect CN2-Cbi-dependent activation. Deletion mutagenesis demonstrates that CN2-Cbi targets a new regulatory site and functions though a novel mechanism of sGC activation. Unlike all known sGC regulators that target the N-terminal regulatory regions, CN2-Cbi directly targets the catalytic domain of sGC, resembling the effect of forskolin on adenylyl cyclases. CN2-Cbi synergistically enhances sGC activation by NO-independent regulators 3-(4-amino-5-cyclopropylpyrimidine-2-yl)-1-(2-fluorobenzyl)-1H-pyrazolo[3,4-b]pyridine (BAY41-2272), 4-[((4-carboxybutyl){2-[(4-phenethylbenzyl)oxy]phenethyl}amino) methyl [benzoic]-acid (cinaciguat or BAY58-2667), and 5-chloro-2-(5-chloro-thiophene-2-sulfonylamino-N-(4-(morpholine-4-sulfonyl)-phenyl)-benzamide sodium salt (ataciguat or HMR-1766). BAY41-2272 and CN2-Cbi act reciprocally by decreasing the EC(50) values. CN2-Cbi increases intracellular cGMP levels and displays vasorelaxing activity in phenylephrine-constricted rat aortic rings in an endothelium-independent manner. Both effects are synergistically potentiated by BAY41-2272. These studies uncover a new mode of sGC regulation and provide a new tool for understanding the mechanism of sGC activation and function. CN2-Cbi also offers new possibilities for its therapeutic applications in augmenting the effect of other sGC-targeting drugs.
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Affiliation(s)
- Iraida Sharina
- Department of Internal Medicine, Division of Cardiology, UT Health Science Center in Houston, Medical School, 1941 East Rd., Houston, TX 77054, USA
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Chan A, Crankshaw DL, Monteil A, Patterson SE, Nagasawa HT, Briggs JE, Kozocas JA, Mahon SB, Brenner M, Pilz RB, Bigby TD, Boss GR. The combination of cobinamide and sulfanegen is highly effective in mouse models of cyanide poisoning. Clin Toxicol (Phila) 2011; 49:366-73. [PMID: 21740135 PMCID: PMC3882312 DOI: 10.3109/15563650.2011.584879] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Cyanide is a component of smoke in residential and industrial fires, and accidental exposure to cyanide occurs in a variety of industries. Moreover, cyanide has the potential to be used by terrorists, particularly in a closed space such as an airport or train station. Current therapies for cyanide poisoning must be given by intravenous administration, limiting their use in treating mass casualties. OBJECTIVE We are developing two new cyanide antidotes--cobinamide, a vitamin B(12) analog, and sulfanegen, a 3-mercaptopyruvate prodrug. Both drugs can be given by intramuscular administration, and therefore could be used to treat a large number of people quickly. We now asked if the two drugs would have an augmented effect when combined. MATERIALS AND METHODS We used a non-lethal and two different lethal models of cyanide poisoning in mice. The non-lethal model assesses neurologic recovery by quantitatively evaluating the innate righting reflex time of a mouse. The two lethal models are a cyanide injection and a cyanide inhalation model. RESULTS We found that the two drugs are at least additive when used together in both the non-lethal and lethal models: at doses where all animals died with either drug alone, the combination yielded 80 and 40% survival in the injection and inhalation models, respectively. Similarly, drug doses that yielded 40% survival with either drug alone, yielded 80 and 100% survival in the injection and inhalation models, respectively. As part of the inhalation model, we developed a new paradigm in which animals are exposed to cyanide gas, injected intramuscularly with an antidote, and then re-exposed to cyanide gas. This simulates cyanide exposure of a large number of people in a closed space, because people would remain exposed to cyanide, even after receiving an antidote. CONCLUSION The combination of cobinamide and sulfanegen shows great promise as a new approach to treating cyanide poisoning.
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Affiliation(s)
- Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
- Medicine Service, VA San Diego Healthcare System, San Diego, CA 92161
| | - Daune L. Crankshaw
- Center for Drug Design, University of Minnesota, Minneapolis, MN 55455-0213
| | - Alexandre Monteil
- Center for Drug Design, University of Minnesota, Minneapolis, MN 55455-0213
| | | | | | - Jackie E. Briggs
- Center for Drug Design, University of Minnesota, Minneapolis, MN 55455-0213
| | | | - Sari B. Mahon
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612-1475
| | - Matthew Brenner
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612-1475
| | - Renate B. Pilz
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
| | - Timothy D. Bigby
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
- Medicine Service, VA San Diego Healthcare System, San Diego, CA 92161
| | - Gerry R. Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
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Ma J, Ohira SI, Mishra SK, Puanngam M, Dasgupta PK, Mahon SB, Brenner M, Blackledge W, Boss GR. Rapid point of care analyzer for the measurement of cyanide in blood. Anal Chem 2011; 83:4319-24. [PMID: 21553921 PMCID: PMC3105183 DOI: 10.1021/ac200768t] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A simple, sensitive optical analyzer for the rapid determination of cyanide in blood in point of care applications is described. HCN is liberated by the addition of 20% H(3)PO(4) and is absorbed by a paper filter impregnated with borate-buffered (pH 9.0) hydroxoaquocobinamide (hereinafter called cobinamide). Cobinamide on the filter changes color from orange (λ(max) = 510 nm) to violet (λ(max) = 583 nm) upon reaction with cyanide. This color change is monitored in the transmission mode by a light emitting diode (LED) with a 583 nm emission maximum and a photodiode detector. The observed rate of color change increases 10 times when the cobinamide solution for filter impregnation is prepared in borate-buffer rather than in water. The use of a second LED emitting at 653 nm and alternate pulsing of the LEDs improves the limit of detection by 4 times to ~0.5 μM for a 1 mL blood sample. Blood cyanide levels of imminent concern (≥10 μM) can be accurately measured in ~2 min. The response is proportional to the mass of cyanide in the sample: smaller sample volumes can be successfully used with proportionate change in the concentration LODs. Bubbling air through the blood-acid mixture was found effective for mixing of the acid with the sample and the liberation of HCN. A small amount of ethanol added to the top of the blood was found to be the most effective means to prevent frothing during aeration. The relative standard deviation (RSD) for repetitive determination of blood samples containing 9 μM CN was 1.09% (n = 5). The technique was compared blind with a standard microdiffusion-spectrophotometric method used for the determination of cyanide in rabbit blood. The results showed good correlation (slope 1.05, r(2) 0.9257); independent calibration standards were used.
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Affiliation(s)
- Jian Ma
- Department of Chemistry and Biochemistry University of Texas, 700 Planetarium Place, Arlington, TX 76019-0065
| | - Shin-Ichi Ohira
- Department of Chemistry and Biochemistry University of Texas, 700 Planetarium Place, Arlington, TX 76019-0065
| | - Santosh K. Mishra
- Department of Chemistry and Biochemistry University of Texas, 700 Planetarium Place, Arlington, TX 76019-0065
| | - Mahitti Puanngam
- Department of Chemistry and Biochemistry University of Texas, 700 Planetarium Place, Arlington, TX 76019-0065
| | - Purnendu K. Dasgupta
- Department of Chemistry and Biochemistry University of Texas, 700 Planetarium Place, Arlington, TX 76019-0065
| | - Sari B. Mahon
- UC Irvine Medical Center, 101 The City Drive, Orange, CA 92868
| | - Matthew Brenner
- UC Irvine Medical Center, 101 The City Drive, Orange, CA 92868
| | - William Blackledge
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
| | - Gerry R. Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
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Brenner M, Kim JG, Lee J, Mahon SB, Lemor D, Ahdout R, Boss GR, Blackledge W, Jann L, Nagasawa HT, Patterson SE. Sulfanegen sodium treatment in a rabbit model of sub-lethal cyanide toxicity. Toxicol Appl Pharmacol 2010; 248:269-76. [PMID: 20705081 PMCID: PMC3382974 DOI: 10.1016/j.taap.2010.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/31/2010] [Accepted: 08/03/2010] [Indexed: 01/13/2023]
Abstract
The aim of this study is to investigate the ability of intramuscular and intravenous sulfanegen sodium treatment to reverse cyanide effects in a rabbit model as a potential treatment for mass casualty resulting from cyanide exposure. Cyanide poisoning is a serious chemical threat from accidental or intentional exposures. Current cyanide exposure treatments, including direct binding agents, methemoglobin donors, and sulfur donors, have several limitations. Non-rhodanese mediated sulfur transferase pathways, including 3-mercaptopyruvate sulfurtransferase (3-MPST) catalyze the transfer of sulfur from 3-MP to cyanide, forming pyruvate and less toxic thiocyanate. We developed a water-soluble 3-MP prodrug, 3-mercaptopyruvatedithiane (sulfanegen sodium), with the potential to provide a continuous supply of substrate for CN detoxification. In addition to developing a mass casualty cyanide reversal agent, methods are needed to rapidly and reliably diagnose and monitor cyanide poisoning and reversal. We use non-invasive technology, diffuse optical spectroscopy (DOS) and continuous wave near infrared spectroscopy (CWNIRS) to monitor physiologic changes associated with cyanide exposure and reversal. A total of 35 animals were studied. Sulfanegen sodium was shown to reverse the effects of cyanide exposure on oxyhemoglobin and deoxyhemoglobin rapidly, significantly faster than control animals when administered by intravenous or intramuscular routes. RBC cyanide levels also returned to normal faster following both intramuscular and intravenous sulfanegen sodium treatment than controls. These studies demonstrate the clinical potential for the novel approach of supplying substrate for non-rhodanese mediated sulfur transferase pathways for cyanide detoxification. DOS and CWNIRS demonstrated their usefulness in optimizing the dose of sulfanegen sodium treatment.
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Affiliation(s)
- Matthew Brenner
- Laser Microbeam and Medical Program, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612-1475, USA.
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Chan A, Balasubramanian M, Blackledge W, Mohammad OM, Alvarez L, Boss GR, Bigby TD. Cobinamide is superior to other treatments in a mouse model of cyanide poisoning. Clin Toxicol (Phila) 2010; 48:709-17. [PMID: 20704457 PMCID: PMC3119202 DOI: 10.3109/15563650.2010.505197] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Cyanide is a rapidly acting cellular poison, primarily targeting cytochrome c oxidase, and is a common occupational and residential toxin, mostly via smoke inhalation. Cyanide is also a potential weapon of mass destruction, with recent credible threats of attacks focusing the need for better treatments, as current cyanide antidotes are limited and impractical for rapid deployment in mass casualty settings. OBJECTIVE We have used mouse models of cyanide poisoning to compare the efficacy of cobinamide (Cbi), the precursor to cobalamin (vitamin B(12)), to currently approved cyanide antidotes. Cbi has extremely high affinity for cyanide and substantial solubility in water. MATERIALS AND METHODS We studied Cbi in both an inhaled and intraperitoneal model of cyanide poisoning in mice. RESULTS We found Cbi more effective than hydroxocobalamin, sodium thiosulfate, sodium nitrite, and the combination of sodium thiosulfate-sodium nitrite in treating cyanide poisoning. Compared to hydroxocobalamin, Cbi was 3 and 11 times more potent in the intraperitoneal and inhalation models, respectively. Cobinamide sulfite (Cbi-SO(3)) was rapidly absorbed after intramuscular injection, and mice recovered from a lethal dose of cyanide even when given at a time when they had been apneic for over 2 min. In range-finding studies, Cbi-SO(3) at doses up to 2000 mg/kg exhibited no clinical toxicity. DISCUSSION AND CONCLUSION These studies demonstrate that Cbi is a highly effective cyanide antidote in mouse models, and suggest it could be used in a mass casualty setting, because it can be given rapidly as an intramuscular injection when administered as Cbi-SO(3). Based on these animal data Cbi-SO(3) appears to be an antidote worthy of further testing as a therapy for mass casualties.
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Affiliation(s)
- Adriano Chan
- Medicine Service, VA San Diego Healthcare, San Diego, CA 92161
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | | | - William Blackledge
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Othman M. Mohammad
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Luis Alvarez
- Medicine Service, VA San Diego Healthcare, San Diego, CA 92161
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Gerry R. Boss
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Timothy D. Bigby
- Medicine Service, VA San Diego Healthcare, San Diego, CA 92161
- Department of Medicine, University of California, San Diego, CA 92093, USA
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Blackledge WC, Blackledge CW, Griesel A, Mahon SB, Brenner M, Pilz RB, Boss GR. New facile method to measure cyanide in blood. Anal Chem 2010; 82:4216-21. [PMID: 20420400 PMCID: PMC2889625 DOI: 10.1021/ac100519z] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cyanide, a well-known toxic substance that could be used as a weapon of mass destruction, is likely responsible for a substantial percentage of smoke inhalation deaths. The vitamin B(12) precursor cobinamide binds cyanide with high affinity, changing color and, correspondingly, its spectrophotometric spectrum in the ultraviolet/visible light range. Based on these spectral changes, we developed a new facile method to measure cyanide in blood using cobinamide. The limit of detection was 0.25 nmol, while the limit of quantitation was approximately 0.5 nmol. The method was reliable, requires minimal equipment, and correlated well with a previously established method. Moreover, we adapted it for rapid qualitative assessment of cyanide concentration, which could be used in the field to identify cyanide-poisoned subjects for immediate treatment.
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Affiliation(s)
- William C. Blackledge
- Department of Medicine, University of California, San Diego, La Jolla, CA 93093-0652
| | | | - Alexa Griesel
- Scripps Institution of Oceanography, La Jolla, CA, 92093-0230
| | - Sari B. Mahon
- Department of Medicine, University of California, Irvine
| | | | - Renate B. Pilz
- Department of Medicine, University of California, San Diego, La Jolla, CA 93093-0652
| | - Gerry R. Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA 93093-0652
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