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Primate performance decrements following acute soman exposure: failure of chemical countermeasures.

Three experiments are reported: 1) a feasibility study on using laboratory primates repeatedly in behavioral toxicity studies of organophosphate (OP) agents or of chemical countermeasures against OPs; 2) a study of the efficacy of pyridostigmine pretreatment and 2-PAM therapy; and 3) a study to determine the effects of these treatments on soman-induced cholinesterase (ChE) inhibition and its recovery. In rhesus monkeys, three repeated acute low-dose (2.1 to 2.8 micrograms/kg) soman exposures, separated by intervals > 5 weeks, did not change baseline compensatory tracking performance or the soman ED50. Atropine therapy (97 micrograms/kg) alone had no effect on soman ED50. Addition of pyridostigmine pretreatment (150 micrograms/kg) and 2-PAM therapy (17 mg/kg) to atropine therapy increased the soman ED50 for a performance decrement from 2.27 micrograms/kg to 2.58 micrograms/kg, an insignificant protective effect. At the soman ED50 for behavioral decrements, pyridostigmine pretreatment increased the inhibition of serum ChE observed immediately after soman exposure, but reduced the extent of permanent inhibition. The 2-PAM therapy reduced serum ChE inhibition from about 80% to less than 70%. These effects on the time course of ChE inhibition following soman exposure appear to combine additively. These chemical countermeasures do not prevent soman-induced performance decrements, even though they are effective in protecting lives after much higher doses. The soman doses used produce only small, transient performance decrements; animals so exposed can, thus, be used repeatedly in such studies.

Animals↗

Does pralidoxime affect outcome of management in acute organophosphorus poisoning?

Acute organophosphorus (OP) poisoning is usually treated with atropine plus cholinesterase reactivators such as oximes, but controlled trials to assess the efficacy of oximes in OP poisoning have not been done. A period when the acetyl cholinesterase reactivator pralidoxime chloride was not available in Sri Lanka gave us the opportunity to compare atropine alone for treatment of moderate to severe OP poisoning (21 patients) with atropine plus pralixodime (24 patients). Outcome, as assessed clinically, was similar in the two groups. These results cast doubt on the necessity of cholinesterase reactivators for treatment of acute OP poisoning.

Adolescent↗

Successive organophosphate inhibition and oxime reactivation reveals distinct responses of recombinant human cholinesterase variants.

To explore the molecular basis of the biochemical differences among acetylcholinesterase (AChE), butyrylcholinesterase (BuChE) and their alternative splicing and allelic variants, we investigated the acylation phase of cholinesterase catalysis, using phosphorylation as an analogous reaction. Rate constants for organophosphate (DFP) inactivation, as well as for oxime (PAM)-promoted reactivation, were calculated for antibody-immobilized human cholinesterases produced in Xenopus oocytes from natural and site-directed variants of the corresponding DNA constructs. BuChE displayed inactivation and reactivation rates 200- and 25-fold higher than either product of 3'-variable AChE DNAs, consistent with a putative in vivo function for BuChE as a detoxifier that protects AChE from inactivation. Chimeric substitution of active site gorge-lining residues in BuChE with the more anionic and aromatic residues of AChE, reduced inactivation 60-fold but reactivation only 4-fold, and the rate-limiting step of its catalysis appeared to be deacylation. In contrast, a positive charge at the acyl-binding site of BuChE decreased inactivation 8-fold and reactivation 30-fold. Finally, substitution of Asp70 by glycine, as in the natural 'atypical' BuChE variant, did not change the inactivation rate yet reduced reactivation 4-fold. Thus, a combination of electrostatic active site charges with aromatic residue differences at the gorge lining can explain the biochemical distinction between AChE and BuChE. Also, gorge-lining residues, including Asp70, appear to affect the deacylation step of catalysis by BuChE. Individuals carrying the 'atypical' BuChE allele may hence be unresponsive to oxime reactivation therapy following organophosphate poisoning.

Acetylcholinesterase↗

Application of response surface methods for evaluating the interactions of soman, atropine, and pralidioxime chloride.

Response surface methods were employed to model survival data obtained in guinea pigs following subcutaneous exposure to soman (GD; 30-84.6 micrograms/kg) with various treatment regimens (i.e., atropine/pralidioxime chloride [ATR/2-PAM] combinations, given im, 1 min post-GD). The analysis of the proportions of surviving animals in the various groups revealed that the use of individual treatment agents (i.e., ATR or 2-PAM) was effective in increasing survival. The level of GD exposure altered the nature of the ATR/2-PAM interaction. Exploration of the response surface indicates that the optimal treatment combinations (greater than 94% survival) of ATR/2-PAM change as a function of GD exposure in the following manner: GD 30 micrograms/kg-ATR/2-PAM, 217 mg/kg/0 mg/kg; GD 42.4 micrograms/kg-179/29 mg/kg; mg/kg; GD 60 micrograms/kg-148/83 mg/kg; GD 84.6 micrograms/kg-168/150 mg/kg. At higher exposures of GD (greater than 42.4 micrograms/kg), therapeutic synergy was observed with the use of the treatment combinations, as compared to optimal single agent treatments. Evaluation of the apparent toxicities of treatment combinations can also be determined in this procedure. RSM is not geometrically restricted by the number of variables under consideration. A variety of experimental designs, when used in conjunction with RSM, permit the modeling of multiple responses and provide estimates of optimal therapeutic modalities subject to constraints (e.g., behavioral toxicity).

Animals↗

Assessing pyridostigmine efficacy by response surface modeling.

The therapeutic efficacy of atropine sulfate/pralidoxime chloride (ATR/2-PAM) treatment (im) therapy, and pyridostigmine bromide (PYR) pretreatment (oral) therapy were evaluated in soman-challenged guinea pigs. ATR/2-PAM efficacy was assessed as protective ratio (PR = treated soman LD50/control soman LD50); PYR efficacy was assessed both as PR and by response surface modeling (RSM) techniques. The optimal ATR/2-PAM treatment gave a PR of 3.78. PYR pretreatment (1 hr) produced a dose(log)-dependent (r = 0.96) inhibition of whole blood AChE and afforded significant (p less than 0.05) increases in PR (with doses greater than 0.12 mg/kg PYR) against soman when followed by 64 mg/kg ATR/100 mg/kg 2-PAM treatment. These PRs, however, were poorly correlated (r = 0.45) with the corresponding level of PYR-induced AChE inhibition. In contrast, RSM analysis of efficacy indicated that the optimal ATR/2-PAM dose combination varied as a function of both the soman-challenge level and the PYR pretreatment dose. Efficacy was therefore evaluated for varying PYR pretreatment doses in combination with the appropriate optimal ATR/2-PAM treatment (as determined by RSM for each soman challenge dose and PYR dose evaluated). When assessed in this manner, PYR efficacy (PYR) was found to be highly correlated (r = 0.97) with PYR-induced AChE inhibition. Since percentage of AChE inhibition was directly correlated with PYR dose (log), these results indicate that PYR pretreatment efficacy is a highly correlated, dose-dependent phenomenon, providing ATR/2-PAM treatment is optimized.

Animals↗

Pharmacokinetics and pharmacodynamics of oximes in unanesthetized pigs.

The pharmacokinetics and cardiovascular pharmacodynamics of two oximes were studied in unanesthetized pigs. Effects of 2-[(hydroxyimino)methyl]-1-methylpyridinium chloride (pralidoxime chloride; 2-PAM Cl; 50 mumol/kg) were compared with those of 1,1-methylene bis[4(hydroxyiminomethyl) pyridinium] dichloride (methoxime; MMB-4; 100 mumol/kg). Cardiopulmonary parameters were monitored and plasma concentrations of oximes were determined from arterial blood samples taken at intervals over a period of 5 hr postinjection. Plasma concentrations for both oximes were fitted to standard pharmacokinetic models using the computer program PCNONLIN. Average pharmacokinetic parameters were determined for each oxime. Only mild to moderate physiological side effects were detected following intramuscular administration. 2-PAM Cl was more rapidly absorbed and distributed in the blood than MMB-4. Although the latter had a slight lag time to attain detectable levels in the blood, retention time was longer than that of 2-PAM Cl.

Acetylcholinesterase↗

Variable effects of soman on macromolecular secretion by ferret trachea.

The purpose of this study was to examine the effect of the anticholinesterase agent, soman, on macromolecular secretion by ferret trachea, in vitro. We mounted pieces of ferret trachea in Ussing-type chambers. Secreted sulfated macromolecules were radiolabeled by adding 500 microCi of 35SO4 to the submucosal medium and incubating for 17 hr. Soman added to the submucosal side produced a concentration-dependent increase in radiolabeled macromolecular release with a maximal secretory response (mean +/- SD) of 202 +/- 125% (n = 8) relative to the basal secretion rate at a concentration of 10(-7) M. The addition of either 10(-6) M pralidoxime (acetylcholinesterase reactivator) or 10(-6) M atropine blocked the response to 10(-7) M soman. At soman concentrations greater than 10(-7) M, secretion rate decreased and was not significantly different from basal secretion. Additional experiments utilizing acetylcholine and the acetylcholinesterase inhibitor, physostigmine, suggest that inhibition of secretion by high concentrations of soman may be due to a secondary antagonistic effect of soman on muscarinic receptors.

Acetylcholine↗

Cold exposure decreases the effectiveness of atropine-oxime treatment in organophosphate intoxication in rats and mice.

1. The effect of cold environment on the acute toxicity of organophosphates (OP), without and with atropine-oxime treatment, was studied in rats and mice by exposing them to +5 and -5 degrees C temperature. The tested OPs and oximes (given intraperitoneally) were diisopropylfluorophosphate (DFP), isopropyl methylphosphonofluoridate (sarin) and dichlorovinyl phosphate (DDVP), pralidoxime (PAM) and obidoxime. 2. An exposure to low environmental temperature decreased the effectiveness of atropine-oxime therapy in OP poisoned rats and mice, evaluated by means of acute LD50 values. 3. The lowering of environmental temperature did not influence the ability of PAM to reactivate tissue cholinesterase in rats intoxicated by 0.5 x LD50 doses of DFP. 4. The acute toxicity of atropine and oximes was not affected by cold environment in rats, but in mice it was increased by 1.1-2.1 times. 5. The decrease in the effectiveness of atropine-oxime therapy at cold environment may be explained by the observation that the cold temperature sensitizes the animals to the inhibition of brain acetylcholinesterase by OP.

Animals↗

Effects of cholinesterase reactivators and atropine on fenitrothion-induced hypothermia in Bubalus bubalis.

Oral administration of fenitrothion (435 mg/kg) produced a pronounced fall in rectal temperature and erythrocyte AChE activity in buffalo calves. Treatment with DAM alone or in conjunction with atropine at the time of severe toxicity (within 1 h) significantly (P less than 0.01) reversed fenitrothion-induced hypothermia and AChE inhibition. The temperature decrease and AChE inhibition were not significantly (P greater than 0.05) altered by either 2-PAM or atropine. It is concluded that DAM may be more effective than either 2-PAM or atropine in reversing hypothermic effect of OP insecticides.

Acetylcholinesterase↗

A comparison of cholinergic effects of HI-6 and pralidoxime-2-chloride (2-PAM) in soman poisoning.

The effects of HI-6 and pralidoxime chloride (2-PAM) on soman-induced lethality, time to death and several cholinergic parameters in rats were compared to understand the beneficial action of HI-6. Treatment with atropine sulfate (ATS) or HI-6 alone protected against 1.2 and 2.5 LD50s of soman respectively, whereas 2-PAM or methylated atropine (AMN) alone afforded no protection. Addition of ATS, but not AMN, to HI-6-treated rats enhanced the protection from 2.5 to 5.5 LD50s. HI-6 increased the time-to-death, while 2-PAM had no effect; a combination of HI-6 and ATS provided the most significant increase in time-to-death. Cholinesterase (ChE) activity was not altered in any tissue by ATS, HI-6 or 2-PAM treatment individually, but was markedly inhibited in all tissues by 100 micrograms/kg of soman. In soman-poisoned rats, the HI-6, but not the 2-PAM, group had significantly higher levels of ChE in blood and other peripheral tissues than did the group given soman alone. Neither HI-6 nor 2-PAM affected soman-inhibited ChE in the brain. Additional ATS treatment had no effect on ChE activity. HI-6 and 2-PAM neither modified baseline brain acetylcholine (ACh) or choline (Ch) levels nor protected against soman-induced ACh or Ch elevation. 2-PAM exhibited a 4-fold more potent in vitro inhibition of 3H-quinuclidinyl benzilate (3H-QNB) binding and sodium-dependent high-affinity Ch uptake (HACU) than did HI-6 in brain tissues. The findings that 2-PAM is a more potent in vitro inhibitor of muscarinic receptor binding and HACU than HI-6, and yet neither elevates ChE activity in the periphery nor protects rats against soman poisoning, indicate the importance of higher ChE activity in the periphery of HI-6-treated rats. Maintenance by HI-6 of a certain amount of active ChE in the periphery appears to be important for survival after soman exposure.

Acetylcholinesterase↗

Studies of the amplification of carbaryl toxicity by various oximes.

The administration of 2-pyridine aldoxime methyl chloride (2-PAM Cl) is a standard part of the regimen for treatment of human overexposure to many organophosphorus pesticides and nerve agents. However, some literature references indicate that poisoning by carbaryl (1-naphthyl N-methyl carbamate), an insecticide in everyday use, is aggravated by the administration of 2-PAM Cl. This effect has been reported in the mouse, rat, dog and man. We have found that the inhibition of both eel acetylcholinesterase (eel AChE, EC 3.1.1.7) and human serum cholinesterase (human BuChE, EC 3.1.1.8) by carbaryl was enhanced by several oximes. Based on 95% confidence limits the rank order of potentiation with eel AChE was TMB-4 = Toxogonin > HS-6 = HI-6 > 2-PAM Cl. By the same criterion, the rank order of potentiation with human BuChE was TMB-4 > Toxogonin > HS-6 = 2-PAM Cl. Carbaryl-challenged mice also reflected a potentiation since TMB-4 exacerbated the toxicity more than 2-PAM Cl. Our hypothesis is that certain oximes act as allosteric effectors of cholinesterases in carbaryl poisoning, resulting in enhanced inhibition rates and potentiation of carbaryl toxicity.

Animals↗

Potentiometric investigation of the stability of palladium(II) complex of pralidoxime chloride in aqueous solution.

The formation of a complex between palladium(II) chloride and pralidoxime chloride (PAM-2Cl) has been studied by means of potentiometric pH measurements. The real stability constant of the complex in aqeous medium of ionic strength 0.3 M (KCl) at 25.0 degrees C was log Ks = 7.29. This value was close to that (log Ks = 7.02) obtained previously by spectrophotometric methods after appropriate correction with respect to the corresponding value of the acidic constant of PAM-2Cl (pKca = 8.05), which was also determined under the same experimental conditions.

Drug Stability↗

Spectrophotometric investigation of complex formation of an oxime PAM-4Cl with palladium (II) and its analytical application.

The colour reaction of 4-hydroxyiminomethyl-1-methylpyridinium chloride (PAM-4Cl) and palladium(II) chloride has been investigated. The optimum reaction conditions, spectral characteristics, conditional stability constant and composition of the yellow water-soluble complex have been established. A new spectrophotometric method is proposed for the microdetermination of PAM-4Cl.

Chemical Phenomena↗