Determination of grayanotoxins in biological samples by LC-MS/MS

Toxic Garden and Landscaping Plants

Many popular ornamental shrubs are not only beautiful but also toxic when ingested in sufficient quantities. Common toxic landscaping shrubs in North America include yew (Taxus spp), oleander (Nerium oleander), and rhododendrons and azaleas (Rhododendron spp). Horses are often exposed when plant trimmings are placed within reach or discarded in pastures. Occasionally clippings or fallen leaves contaminate hay. Some plants are unpalatable unless dried and mixed with hay or lawn clippings but others are ingested more readily. In many cases, disease can be severe and treatment unrewarding; therefore, client education is critical to preventing serious and potentially fatal poisonings.

Risks for human health related to the presence of grayanotoxins in certain honey

The European Commission asked EFSA for a scientific opinion on the risks for human health of the presence of grayanotoxins (GTXs) in 'certain honey' from Ericaceae plants. The risk assessment included all structurally related grayananes occurring with GTXs in 'certain' honey. Oral exposure is associated with acute intoxication in humans. Acute symptoms affect the muscles, nervous and cardiovascular systems. These may lead to complete atrioventricular block, convulsions, mental confusion, agitation, syncope and respiratory depression. For acute effects, the CONTAM Panel derived a reference point (RP) of 15.3 μg/kg body weight for the sum of GTX I and III based on a BMDL₁₀ for reduced heart rate in rats. A similar relative potency was considered for GTX I. Without chronic toxicity studies, an RP for long-term effects could not be derived. There is evidence for genotoxicity in mice exposed to GTX III or honey containing GTX I and III, showing increased levels of chromosomal damage. The mechanism of genotoxicity is unknown. Without representative occurrence data for the sum of GTX I and III and consumption data from Ericaceae honey, acute dietary exposure was estimated based on selected concentrations for GTX I and III reflecting concentrations measured in 'certain' honeys. Applying a margin of exposure (MOE) approach, the estimated MOEs raised health concerns for acute toxicity. The Panel calculated the highest concentrations for GTX I and III below which no acute effects would be expected following 'certain honey' consumption. The Panel is 75% or more certain that the calculated highest concentration of 0.05 mg for the sum of GTX I and III per kg honey is protective for all age groups regarding acute intoxications. This value does not consider other grayananes in 'certain honey' and does not cover the identified genotoxicity.

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

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

High resolution mass spectrometry workflow for the analysis of food contaminants: Application to plant toxins, mycotoxins and phytoestrogens in plant-based ingredients

An analytical workflow including mass spectral library, generic sample preparation, chromatographic separation, and analysis by high-resolution mass spectrometry (HRMS) was developed to gain insight into the occurrence of plant toxins, mycotoxins and phytoestrogens in plant-based food. This workflow was applied to 156 compounds including 90 plant toxins (pyrrolizidine alkaloids, tropane alkaloids, glycoalkaloids, isoquinoline alkaloids and aristolochic acids), 54 mycotoxins (including ergot alkaloids and Alternaria toxins) and 12 phytoestrogens (including isoflavones, lignans and coumestan) in plant-based protein ingredients, cereal and pseudo-cereal products. A mass spectral library was built based on fragmentation spectra collected at 10 different collision energies in both positive and negative ionisation modes for each toxin. Emphasis was put on a generic QuEChERS-like sample preparation followed by ultra-high-pressure liquid chromatography using alkaline mobile phase allowing the separation of more than 50 toxic pyrrolizidine alkaloids. HRMS acquisition comprised a full-scan event for toxins detection followed by data-dependent MS2 for toxin identification against mass spectrum. Method performance was evaluated using fortified samples in terms of sensitivity, repeatability, reproducibility and recovery. All toxins were positively identified at levels ranging from 1 µg kg-1 to 100 µg kg-1. Quantitative results obtained by a standard addition approach met SANTE/12682/2019 criteria for 132 out of 156 toxins. Such a workflow using generic, sensitive and selective multi-residue method allows a better insight into the occurrence of regulated and non-regulated toxins in plant-based foods and to conduct safety evaluation and risk assessments when needed.

The effect of different types of honey on healing infected wounds

OBJECTIVE:

To investigate the effects of treatments of 'mad honey', blossom honey and nitrofurazone on infected wound healing.

METHOD:

Male albino Wistar rats were randomly divided into four groups: 'mad honey' (MH), blossom honey (BH), nitrofurazone (N) and control (C). All rats were anaesthetised intraperitoneally. A circular skin incision was made to the back regions. Grafts containing slime-producing Staphylococcus epidermidis were placed on the incision area and then sutured to the skin. Infection in the wound area was confirmed after 48 hours. Wounds were dressed twice daily with the various treatment materials. Rats were randomly euthanised on days 7 or 14, and tissue samples taken. Tissue samples were assessed for hydroxyproline (HP), tensile strength (TS) and macroscopic measurement (area and intensity).

RESULTS:

HP levels were higher in the treatment groups (MH, BH, N) at days 7 and 14 compared with the control group. 'Group x day' interaction was found in the HP levels (p=0.015). Increases in HP levels in the MH and N groups between days 7 and 14 were significantly higher than those in the other groups (p<0.05). Intensity was significantly lower in the control group and significantly higher in group MH compared with the other groups. Significant 'group x day' interaction was observed in intensity (p=0.006). TS was significantly lower on day 7 than on day 14 (p=0.022). No marked difference was observed between the groups, nor any 'group x day' interaction, in terms of TS.

CONCLUSION:

Honey administration successfully healed infected wounds. However, there was no significant difference between the effect of MH and that of N in terms of wound healing.

Shrub establishment favoured and grass dominance reduced in acid heath grassland systems cleared of invasive Rhododendron ponticum

Rhododendron ponticum L. is a damaging invasive alien species in Britain, favouring the moist, temperate climate, and the acidic soils of upland areas. It outshades other species and is thought to create a soil environment of low pH that may be higher in phytotoxic phenolic compounds. We investigated native vegetation restoration and R. ponticum regeneration post-clearance using heathland sites within Snowdonia National Park, Wales; one site had existing R. ponticum stands and three were restoring post-clearance. Each site also had an adjacent, uninvaded control for comparison. We assessed whether native vegetation restoration was influenced post-invasion by soil chemical properties, including pH and phytotoxic compounds, using Lactuca sativa L. (lettuce) bioassays supported by liquid chromatography-mass spectroscopy (LC-MSn). Cleared sites had higher shrub and bare ground cover, and lower grass and herbaceous species cover relative to adjacent uninvaded control sites; regenerating R. ponticum was also observed on all cleared sites. No phenolic compounds associated with R. ponticum were identified in any soil water leachates, and soil leachates from cleared sites had no inhibitory effect in L. sativa germination assays. We therefore conclude that reportedly phytotoxic compounds do not influence restoration post R. ponticum clearance. Soil pH however was lower beneath R. ponticum and on cleared sites, relative to adjacent uninvaded sites. The lower soil pH post-clearance may have favoured shrub species, which are typically tolerant of acidic soils. The higher shrub cover on cleared sites may have greater ecological value than unaffected grass dominated sites, particularly given the recent decline in such valuable heathland habitats. The presence of regenerating R. ponticum on all cleared sites however highlights the critical importance of monitoring and re-treating sites post initial clearance.

Grayanotoxin levels in blood, urine and honey and their association with clinical status in patients with mad honey intoxication

Objectives

The purpose of this study was to investigate whether there is an association between grayanotoxin levels in urine and blood of patients with mad honey intoxication and in the honey consumed, and the resulting clinical picture. The pilot data acquired from this study was analysed in National Forensic Service, Daejeon Institute, South Korea and first results were published as a preliminary study.

Patients and methods

This descriptive study was conducted at a university hospital emergency department in Turkey. 25 cases diagnosed with mad honey intoxication were obtained the study. Samples of mad honey consumed by patients were obtained. Blood and urine specimens were collected at presentation to the emergency department. GTX 1 and GTX 3 levels from patients' blood, urine and honey consumed were investigated simultaneously using the LC-MS/MS system.

Results

Mean GTX 1 concentration in blood was 4.82 ng/mL and mean GTX 3 level 6.56 ng/mL. Mean GTX concentration in urine was 0.036 μg/mL and mean GTX 3 level 0.391 μg/mL. Mean GTX I concentration in honeys consumed was 8.73 μg/gr and mean GTX 3 level 27.60 μg/gr.

Conclusion

This descriptive study is show grayanotoxin levels in body fluids of patients with mad honey intoxication. No association was determined between grayanotoxin levels in blood and clinical data.

Mad honey: uses, intoxicating/poisoning effects, diagnosis, and treatment

Honey has been used as a folk medicine since 2100 BC; however, mad honey is different from normal natural or commercially available honey as it is contaminated with grayanotoxins, which leads to intoxication/poisoning upon consumption. Grayanotoxin is generally found in Rhododendron genus (family: Ericaceae) and is extracted by bees from nectar and pollens of flowers. Mad honey has been commonly used as an aphrodisiac (sexual stimulant), in alternative therapy for gastrointestinal disorders (peptic ulcer disease, dyspepsia, and gastritis), and for hypertension for a long time. Grayanotoxin acts on sodium ion channels and muscarinic receptors, leading to cardiac disorders (hypotension and different rhythm disorders including bradycardia, bradydysrhythmias, atrial fibrillation, nodal rhythm, atrioventricular block, and complete atrioventricular block) and respiratory depression. Patients may also exhibit any one symptom out of or combination of dizziness, blurred vision, diplopia, nausea, vomiting, vertigo, headache, sweating/excessive perspiration, extremity paresthesia, impaired consciousness, convulsion, hypersalivation, ataxia, inability to stand, and general weakness. Mad honey intoxication is diagnosed with honey intake history before the appearance of the signs and symptoms (clinical presentation), and the treatment is symptomatic. Prompt treatment includes intravenous infusions of atropine sulfate and fluids (saline infusions or simultaneous infusion of saline with atropine sulfate) if the patient presents bradycardia and severe hypotension. In case of a complete atrioventricular block, a temporary pacemaker is employed. Except for a single case from Lanping County (Southwest China), the prognosis for mad honey intoxication is very good, and no fatalities have been reported in modern medical literature excluding a few in the 1800s. Although fatalities are very rare, mad honey ingestion may still lead to arrhythmias, which can be life-threatening and hard to recognize. This article provides a brief introduction to honey, mad honey and its uses, the effects of mad honey intoxication/poisoning, and its diagnosis, prognosis, and treatment.

Honey has been used as a folk medicine since 2100 BC; however, mad honey is different from normal natural or commercially available honey as it is contaminated with grayanotoxins, which leads to intoxication/poisoning upon consumption.

Examination using LC-MS/MS determination of grayanotoxin levels in blood, urine, and honey consumed by patients presenting to the emergency department with mad honey intoxication and relations with clinical data: a preliminary study

BACKGROUND AND OBJECTIVE

Intoxications related to "mad honey" are frequently encountered in the Black Sea region of Turkey. Intoxication is established on the basis of whether honey was consumed when history was taken at presentation. The search for a simple and reliable method for showing the grayanotoxins (GTXs) in mad honey in body fluids and in honey consumed by patients is still at the research stage. The purpose of this preliminary study was to investigate GTX levels in blood, urine, and honey consumed by patients with mad honey intoxication and to determine whether there is an association with clinical status.

DESIGN AND SETTINGS

This descrptive study was conducted at the department of Emergency Medicine of Karadeniz Technical University Medical Faculty in Turkey. Mad honey, blood, and urine samples were obtained from patients between September 2013 and October 2014.

METHODS

Four cases presenting the Department of Emergency Medicine and diagnosed with mad honey intoxication were included in the study. GTX levels in blood, urine, and honey consumed by patients were determined using liquid chromatography-tandem mass spectrometry.

RESULTS

Patients' mean blood GTX I level was 30.62 ng/mL, GTX III level 4.917 ng/mL, urine GTX I level 0.447 mg/mL, and GTX III level 1.998 mg/mL. The mean GTX I level in the honey samples consumed was 4.683 mg/g and GTX III level 8.423 mg/g.

CONCLUSION

The present study is unique in representing the first time that GTXs have been determined in human body fluids. There is now an urgent need for a large series of studies to provide statistical evidence whether there is a relationship between levels of toxins in human body fluids and clinical picture.

Determination of grayanotoxins in honey by liquid chromatography tandem mass spectrometry using dilute-and-shoot sample preparation approach

A simple and rugged method of analysis for grayanotoxins I and III in honey using liquid chromatography triple quadrupole mass spectrometry with electrospray ionization was developed. This paper describes the first LC-MS/MS method for the quantitation and confirmation of the grayanotoxins in honey using "dilute-and-shoot" sample preparation approach. Honey sample was diluted 10-fold in methanol-water (1:4 v/v) prior to analysis. Chromatographic separation was achieved on a reversed phase HPLC column using a water-methanol gradient with 0.1% acetic acid. The method was fully validated for quantitative purposes. Overall recoveries, selectivity, overall intraday and interday repeatability, decision limit, and detection capability of the analytes was determined. The matrix effects, ruggedness, and analyte stability in standards and samples were studied. Ten real honey samples were successfully analyzed using the developed method. All the samples were found to contain residues of GTXs ranging from 0.1 to 39 mg/kg.

Mountain laurel toxicosis in a dog

OBJECTIVE

To describe a case of mountain laurel (Kalmia latifolia) toxicosis in a dog, including case management and successful outcome.

CASE SUMMARY

A dog presented for vomiting, hematochezia, bradycardia, weakness, and ataxia, which did not improve with supportive treatment. Mountain laurel ingestion was identified as cause of clinical signs after gastrotomy was performed to remove stomach contents. Supportive treatment was continued and the dog made a full recovery.

NEW OR UNIQUE INFORMATION PROVIDED

This report details a case of mountain laurel toxicosis in a dog, including management strategies and outcome, which has not been previously published in the veterinary literature.

Poisoning by mad honey: a brief review

Several plants of the Ericaceae family produce grayanotoxins which can poison humans. The best-known of these intoxications involves the eating of 'mad honey (deli bal in Turkish)' contaminated by Rhododendron nectar grayanotoxins. Accounts of mad honey intoxication date back to 401 BC. It is still one of the common food intoxications encountered for humans and livestock in Turkey. Mad honey intoxication's symptoms are dose-related. In mild form, dizziness, weakness, excessive perspiration, hypersalivation, nausea, vomiting and paresthesias are present and close follow-up is enough. However, severe intoxication may lead to life threatening cardiac complications such as complete atrioventricular block that can be treated intravenously. In this review, properties and sources of grayanotoxins, their detection methods and mad honey intoxication are discussed.

Factorial design for the development of automated solid-phase extraction in the 96-well format for determination of tesaglitazar, in plasma, by liquid chromatography-mass spectrometry

An analytical method was developed for the determination, in blood plasma, of a novel peroxisome proliferator-activated receptor (PPAR) agonist drug, tesaglitazar. The drug and the isotope labelled internal standard were isolated by solid-phase extraction (SPE) on hexylsilica, separated by reversed-phase liquid chromatography and quantified by tandem mass spectrometry. Factorial design and a robotic sample processor were employed in the exploration and optimisation of the SPE procedure in the 96-well format. This allowed rapid development of the method, notably limiting the process to four experiments before validation. The detectability was greatly improved by utilising the formation of sodium adducts in atmospheric pressure positive ionisation mass spectrometry. Absolute recovery was more than 95% with a coefficient of variation of 5% at a level of 8.7 nM. The accuracy and precision of the automated SPE method presented here matched the excellence of the previously used method based on manual liquid-liquid extraction. Furthermore, the method resulted in an increased sample throughput.