"Ricin syndrome". A possible new teratogenic syndrome associated with ingestion of castor oil seed in early pregnancy: a case report

Ricin poisoning: A review on contamination source, diagnosis, treatment, prevention and reporting of ricin poisoning

INTRODUCTION

Ricin, a toxic glycoprotein derived from the castor bean plant, is one of the most potent poisons known in the world. Ricin intoxication is a fatal and uncommon medical condition and recently its use as a potential bioterrorism agent has also been reported. This study aims to identify the main characteristics of diagnosed ricin poisoning cases worldwide in order to raise awareness of this toxin among the population and clinicians.

METHODS

A collection of human case studies of ricin intoxication in the world was produced. The databases Pubmed, Sciencedirect and Google Scholar were used to extract articles from January 1980 to June 2020.

RESULTS

Fifty ricin-intoxicated patients worldwide described in the literature have been identified. Most cases were found in Asia (19 cases), Europe (12 cases) and America (15 cases). Intoxication was mostly accidental (37 cases). Intoxication by castor bean is characterized by acute gastroenteritis-like disease as primary manifestations leading to severe fluid and electrolyte imbalance. The mechanism of death was peripheral vascular collapse and progressing multiple organ failure occurring 10h-72h after intoxication. The questioning of patients and family made it possible to retrieve an history of castor seeds or castor oil ingestion Patients received symptomatic treatment consisting mostly to rehydration with intravenous fluids and digestive decontamination performed with activated charcoal and/or gastric lavage within one day after the ingestion, to reduce gastrointestinal absorption of ricin. This decontamination treatment administered early has been very effective. Only six deaths were observed.

DISCUSSION

Currently, no antidote, vaccine, or other specific effective treatment is available for ricin poisoning or prevention. Prompt treatment with supportive care was necessary to limit morbidity and mortality. To date, patient education is essential to prevent this accidental poisoning.

CONCLUSION

Clinicians and health care professionals should have a high level of suspicion when faced with an outbreak of serious respiratory or gastrointestinal illness.

2: Final Report on the Safety Assessment of Glyceryl Ricinoleate

Glyceryl Ricinoleate is the monoester of glycerol and ricinoleic acid. Castor oil contains 87–90% Glycerol Ricinoleate. Ricinoleic acid is metabolized by both β-oxidation and α-oxidation.

Acute oral toxicity tests in mice indicated that Glyceryl Ricinoleate has an LD50greater than 25.0 ml/kg and is, at most, mildly irritating to unrinsed rabbit eyes. This ingredient was not a primary skin irritant.

Castor oil was nonmutagenic by the Ames test. Ricinoleic acid was not a carcinogen when tested in mice.

In human single-insult occlusive patch tests, no indication of skin irritation potential was observed in the two products containing 5.6% Glyceryl Ricinoleate.

The available data on Glyceryl Ricinoleate were insufficient to determine whether this ingredient, under each relevant condition of use, was either safe or not safe. The types of data required before a decision can be made include: (1) 28 day chronic dermal toxicity in guinea pigs, and (2) clinical sensitization and photosensitization studies (or an appropriate ultraviolet spectrum instead of the photosensitization data).

A systematic review: Are herbal and homeopathic remedies used during pregnancy safe?

BACKGROUND

Herbal and homeopathic remedies have been used to assist with child bearing and pregnancy for centuries. Allopathic ('Western') medicine is traditionally avoided during pregnancy because of limited drug trials and the suspected teratogenic effects of these medications. This has led to an increase in the use of herbal and homeopathic remedies, asthey are viewed to have no teratogenic effect on the developing foetus. Health providers are faced with questions from their clients regarding the safety of these remedies, but much of the evidence about these herbal and homeopathic remedies is anecdotal and few remedies havebeen tested scientifically.

OBJECTIVES

By conducting a systematic review, the primary objective was to evaluate maternal and neonatal outcomes of ingested herbal and homeopathic remedies during pregnancy.

METHOD

A systematic review was conducted to synthesise all the evidence with the purpose of evaluating the safety of herbal and homeopathic remedies based on adverse maternal and neonatal outcomes. Only randomised and quasi-randomised controlled trials that met allinclusion criteria were included in the review.

RESULTS

The ingestion of ginger for nausea and vomiting during pregnancy was shown to have no harmful maternal or neonatal effects. Ingestion of castor oil for induction of labour showed a tendency towards an increase in the incidence of caesarean section and meconiumstained liquor, warranting further research into its safety issues.

CONCLUSION

Larger randomised controlled trials need to be conducted, especially in South Africa, to establish the safety and efficacy of commonly-used remedies.

The conjugation of an AQP1-directed immunotoxin in the study of site-directed therapy within the CNS

PURPOSE

The water channel, aquaporin (AQP)1, is highly specific to the choroid plexus (CP) epithelium within the brain. It is therefore a potential target through which therapeutic agents could be selectively directed to the CP. Here we describe the conjugation of a monoclonal antibody (mAb), raised against an extra-cellular domain of AQP1, to the A chain of ricin (RCA). This reagent should allow study of a highly specific chemical lesion of the CP.

METHODS

A published method was used to couple the anti-AQP1 mAb to the A chain of ricin using an SPDP cross-linker. The conjugate was purified by Superdex S-200 chromatography. Column fractions were analysed by SDS-PAGE and Western blotting. Fractions containing conjugate were assayed for cytotoxicity on rat CP cells in culture, using a WST-1 viability assay to assess cell death.

RESULTS

SDS-PAGE and Western blotting demonstrated separation of conjugated anti-AQP1 mAb from unconjugated ricin by the Superdex column. Cultured rat CP cells were killed with an IC(50) of 1.81 μg/ml when exposed to the anti-AQP1 mAb-RCA conjugation reaction products. Selectivity of this reagent was demonstrated by the higher IC(50) exhibited by non-AQP1-expressing primary fibroblast cultures and cultures exposed to the reaction products from the non-specific IgG-RCA conjugation attempt.

CONCLUSION

We have been able to demonstrate selective cytotoxicity in vitro of an anti-AQP1 mAb-RCA conjugate. We hope that this work will generate further interest in the use of this site-specific conjugate to target the CP in conditions such as hydrocephalus, tumours that arise from here, and other AQP1-expressing tumours.

Drugs that affect the fetus and newborn infant via the placenta or breast milk

In general, drugs that are taken by a mother during pregnancy or after birth may be transferred to the fetus or the infant (through breast milk). Many factors are involved that determine the amount of drugs that are transferred and their potential effects on the fetus or infant. A careful assessment of the risk versus benefit is necessary and should be individualized. In the breastfed infant, many measures can be undertaken further so that the amount of drug transferred to the infant is minimized.

Comparative susceptibility of B cells with different lineages to cytotoxicity and apoptosis induction by translational inhibitors

The trichothecene mycotoxins, Shiga toxins (STs), and ricin are potent translational inhibitors that exert diverse mechanisms of action but all have the capacity to induce death by apoptosis. Germinal centers containing actively dividing B cells are particularly sensitive to protein synthesis inhibition, and, of these, the immature B cell is reportedly most susceptible to apoptosis. The objective of this study was to test the hypothesis that immature and mature B-cell lineages were differentially susceptible to apoptosis and cytotoxicity induction by representative trichothecene mycotoxins, ST-1, and ricin, as well as cycloheximide (CHX), a prototypical protein synthesis inhibitor commonly used to study cell signal transduction. WEHI-231 and CH31 cells were used as representatives of phenotypically immature B cells, whereas CH12.LX cells were used to model mature B cells. Resultant data suggest that Type D and Type A trichothecenes, ricin, and ST-1 were more potent inducers of apoptosis than CHX, whereas Type B and Type A trichothecene metabolites were less. CHX and the trichothecenes affected immature and mature B cells equally, thus suggesting that toxicity due to these natural toxins was lineage independent. In contrast, mature B cells were more sensitive to ricin- and ST-1-induced cytotoxicity and apoptosis than immature B cells. Taken together, these results suggest that B cells are targets of a diverse array of naturally occurring translational inhibitors. Upregulation of apoptosis in B lymphocytes may contribute to the impairment of the immune response and other symptoms described following exposure to these toxins.