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Dent MR, Rose JJ, Tejero J, Gladwin MT. Carbon Monoxide Poisoning: From Microbes to Therapeutics. Annu Rev Med 2024; 75:337-351. [PMID: 37582490 DOI: 10.1146/annurev-med-052422-020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Carbon monoxide (CO) poisoning leads to 50,000-100,000 emergency room visits and 1,500-2,000 deaths each year in the United States alone. Even with treatment, survivors often suffer from long-term cardiac and neurocognitive deficits, highlighting a clear unmet medical need for novel therapeutic strategies that reduce morbidity and mortality associated with CO poisoning. This review examines the prevalence and impact of CO poisoning and pathophysiology in humans and highlights recent advances in therapeutic strategies that accelerate CO clearance and mitigate toxicity. We focus on recent developments of high-affinity molecules that take advantage of the uniquely strong interaction between CO and heme to selectively bind and sequester CO in preclinical models. These scavengers, which employ heme-binding scaffolds ranging from organic small molecules to hemoproteins derived from humans and potentially even microorganisms, show promise as field-deployable antidotes that may rapidly accelerate CO clearance and improve outcomes for survivors of acute CO poisoning.
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Affiliation(s)
- Matthew R Dent
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; ,
| | - Jason J Rose
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA; ,
| | - Jesús Tejero
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; ,
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark T Gladwin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA; ,
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Klostranec JM, Vucevic D, Crawley AP, Venkatraghavan L, Sobczyk O, Duffin J, Sam K, Holmes R, Fedorko L, Mikulis DJ, Fisher JA. Accelerated ethanol elimination via the lungs. Sci Rep 2020; 10:19249. [PMID: 33184355 PMCID: PMC7665168 DOI: 10.1038/s41598-020-76233-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/21/2020] [Indexed: 01/11/2023] Open
Abstract
Ethanol poisoning is endemic the world over. Morbidity and mortality depend on blood ethanol levels which in turn depend on the balance between its rates of absorption and clearance. Clearance of ethanol is mostly at a constant rate via enzymatic metabolism. We hypothesized that isocapnic hyperpnea (IH), previously shown to be effective in acceleration of clearance of vapour anesthetics and carbon monoxide, would also accelerate the clearance of ethanol. In this proof-of-concept pilot study, five healthy male subjects were brought to a mildly elevated blood ethanol concentration (~ 0.1%) and ethanol clearance monitored during normal ventilation and IH on different days. IH increased elimination rate of ethanol in proportion to blood levels, increasing the elimination rate more than three-fold. Increased veno-arterial ethanol concentration differences during IH verified the efficacy of ethanol clearance via the lung. These data indicate that IH is a nonpharmacologic means to accelerate the elimination of ethanol by superimposing first order elimination kinetics on underlying zero order liver metabolism. Such kinetics may prove useful in treating acute severe ethanol intoxication.
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Affiliation(s)
- Jesse M Klostranec
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Diagnostic and Interventional Neuroradiology, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - Diana Vucevic
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Department of Materials Science and Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - Adrian P Crawley
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Lashmi Venkatraghavan
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto Western Hospital, Toronto, ON, Canada
| | | | - James Duffin
- Thornhill Medical Inc., Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, 200 Elizabeth St., Toronto, ON, M5C 2E4, Canada
| | - Kevin Sam
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Royce Holmes
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Ludwik Fedorko
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Thornhill Medical Inc., Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, 200 Elizabeth St., Toronto, ON, M5C 2E4, Canada
| | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Joseph A Fisher
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada. .,Thornhill Medical Inc., Toronto, ON, Canada. .,Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, University of Toronto, 200 Elizabeth St., Toronto, ON, M5C 2E4, Canada.
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Factors Contributing to CO Uptake and Elimination in the Body: A Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020528. [PMID: 31947671 PMCID: PMC7014120 DOI: 10.3390/ijerph17020528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Carbon monoxide (CO) poisoning is an important public health issue around the world. Research indicates that many factors may be related to the rate of CO uptake and elimination in the human body. However, some factors related to CO uptake and elimination are considered controversial. Relatively little attention has been devoted to review and synthesis of factors affecting CO uptake and elimination. PURPOSE This paper provides a critical scoping review of the factors and divides them into four aspects, including environmental, demographic, physiological and treatment factors. METHODS We searched the scientific databases for research that has proposed a mathematical equation as a synthesis of quantities related to CO poisoning, CO elimination, CO uptake, CO half-life, CO uptake and elimination and their relationships. After excluding the studies that did not meet the study criteria, there were 39 studies included in the review and the search was completed before 16 December 2019. RESULTS AND CONCLUSION This review discusses most of the factors that impact the rate of CO uptake and elimination. Several factors may be related to CO uptake and elimination, such as CO concentration, the duration of exposure to CO, age, sex, exercise, minute ventilation, alveolar ventilation, total haemoglobin mass and different treatments for CO poisoning. Although some potential factors were not included in the review, the findings are useful by presenting an overview for discussing factors affecting CO uptake and elimination and provide a starting point for further study regarding strategies for CO poisoning and the environmental standard of CO.
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