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Endoneurial pressure in hexachlorophene neuropathy.

Increased endoneurial pressure of up to 17.0 cm H2O was recorded in the peripheral nerves of rats fed hexachlorophene in their laboratory diet. The pressure was measured using a micropressure transducer developed for recording pressure in the microcirculation. The results were correlated with morphologic findings. Teased nerve fibers and araldite-embedded specimens of hexachlorophene damaged sciatic nerve revealed the characteristic severe intramyelinic edema due to splits in the minor dense lines of compact myelin giving rise to wide interlamellar spaces as shown in previous studies. The endoneurial pressure of rats exposed to hexachlorophene for 11 days and subsequently fed a normal diet returned to normal (0.2-3.0 cm H2O) after 12 days, and morphologic examination showed few residual abnormalities. Prolonged exposure to hexachlorophene for up to 4 weeks caused widespread axonal degeneration in addition to intramyelinic edema. Animals treated with hexachlorophene for 21 days followed by a normal diet for 14 days showed degenerated axons, phagocytosis of myelin as well as interstitial edema and elevated endoneurial pressure. It is suggested that axonal degeneration in hexachlorophene neuropathy is caused by increased endoneurial pressure.

Animals

Hexachlorophene lesions in newborn infants.

Vacuolization of the white matter of the brain is produced by a number of disease entities and chemicals, including hexachlorophene. Brains of 135 stillborn infants and infants dying in the neonatal period were examined for vacuole formation in the white matter to determine if any hexachlorophene-like lesions could be found. A nonsignificant excess of vaculoes was found in infants bathed in hexachlorophene at birth compared with infants not bathed in it. Analysis of 11 brains for hexachlorophene showed that detectable levels were present in five, all of which showed vacuolization. None was detected in the remaining six, three of which also showed vacuolization. In two of these there was no hexachlorophene exposure.

Abnormalities, Drug-Induced

Translocation, distribution, and environmental degradation of hexachlorophene in tomatoes.

The translocation, distribution, metabolism and environmental degradation of hexachlorophene were investigated in tomato plants (Lycopersicon esculentum Mill cv. beefsteak). All plants were grown under standardized conditions and treated with leaf-applied 14C-ring-labeled hexachlorophene (HCP). Treatment time ranged from 0 to 70 days. Autoradiographic analyses were performed on all plants. Selected plant tissues were extracted and chromatographed, using thin layer (TLC) and gas liquid chromatography (GLC). Hexachlorophene was not translocated from the plant leaves. No metabolites of hexachlorophene was found. A slight, but statistically nonsignificant, amount of HCP was lost from the leaves and the inert controls. At the end of the 70-day treatment, based on TLC and regression analysis of thin layer chromatographic plates, averages of 89.5% and 75.9% of the applied HPC remained unaltered on the treated plants and controls, respectively. This indicated that 10.5% and 24.1%, respectively, of the original HCP had been altered. Differences between the treatments and controls were statistically significant after 28 days of exposure. Further analyses of the above data, using gas chromatographic methods, showed that as many as 14 peaks were found in the treated samples and the controls, including the parent material. Ultraviolet photolysis seemed to be the mechanism responsible for alteration of the hexachlorophene. Three extracted chlorinated compounds have been identified by GC-mass spectral (MS) analysis including 2,2'-dihydroxy-3,5',6,6'-tetrachlorodiphenylmethane, 2,2'-dihydroxy-3,5,5',6,6'-pentachlorodiphenylmethane, and 2,2'-dihydroxy-3,3',5,5',6,6'-hexachlorodiphenylmethane (parent HCP). Eleven other electrophylic compounds have been found in various treated plant or control extracts. Further analyses will be necessary to verify the identification of the other degradation products.

Biodegradation, Environmental

Investigation of hexachlorophene for dominant lethal effects in the mouse.

Hexachlorophene (HCP) was studied for mutagenic effects in the dominant lethal test on mice. Groups of male mice were treated with either 2.5 or 5.0 mg hexachlorophene per kg body weight as a single intraperitoneal injection. Control animals were treated with the propylene glycol vehicle. Each male was mated with 3 untreated females for each of 8 consecutive weeks with the uterus of the females examined at mid-pregnancy for signs of early embryonic death. Treatment did not alter mating capacity and fertility of the males. The administration of hexachlorophene had no influence on pre- or post-implantation losses. An increase in early resorptions among female mice bred to males treated with the reference compound, methyl methanesulfonate (MMS) given a single i.p. injection of 100 mg/kg, indicated the susceptibility of the mouse strain used to a known mutagen. It is concluded that hexachlorophene at maximally tolerated doses is not mutagenic in the dominant lethal test in mice.

Animals

Suspected link between exposure to hexachlorophene and malformed infants.

Retrospective studies, performed in 6 hospitals in Sweden, demonstrated that severe congenital malformations occurred more frequently in neonates born to mothers who used hexachlorophene soaps, 10--60 times a day by handwashing and hand-creams during at least the first trimester of pregnancy (25 severe malformations in 460 neonates), when compared to neonates born to similarly employed mothers who did not use hexachlorophene soaps (0 severe malformations in 233 neonates). Minor congenital anomalies were also more commonly noted in the hexachlorophene-exposed group when contrasted with controls. Other known adverse influences, such as age, infections during pregnancy, other drug usage, or smoking habits did not appear different in the two groups.

Abnormalities, Drug-Induced

Cell binding and growth inhibition by hexachlorophene of decanoate and their reversibility.

More than 80% of the hexachlorophene added to a Bacillus subtilis culture binds to the cells. Complete growth inhibition requires 6 x 10(5) molecules bound per cell. In contrast, more than 99% decanoate remains in solution and 3.8 x 10(7) molecules bound per cell are needed to inhibit growth. Centrifugation and resuspension of cells in growth medium removes only decanoate, whereas the addition of 1% bovine serum albumin to the growth medium removes both inhibitors from their binding sites on the cells. The addition of untreated cells to a hexachlorophene-treated culture enables the hexachlorophene molecules to redistribute among all the cells with the result that the inhibited cells can resume growth.

Bacillus subtilis

Clinical and microbiologic surveillance of neonatal staphylococcal disease. Relationship to hexachlorophene whole-body bathing.

Neonatal staphylococcal disease occurred in the nurseries of a university hospital three weeks after discontinuation of routine, daily, whole-body bathing of newborns with hexachlorophene. Of 16 infants who had clinical manifestations within a two-week period, 11 cases were confirmed bacteriologically. Shortly after onset of the outbreak, daily clinical and microbiologic surveillance and control measures on all infants and personnel were inaugurated. Clinical surveillance after the outbreak did not yield any new case. Average incidence of cultures positive for coagulase-positive Staphylococcus aureus was highest (13% per week) during the first three weeks of microbiologic surveillance (when hexachlorophene was not used). This is lower than that reported in most previous studies. These findings indicate the importance of scrupulous hand washing before and after handling each infant and of enforcement of other basic nursery techniques.

Baths

Staphylococcal bacteremia and hexachlorophene bathing. Epidemic in a newborn nursery.

An outbreak of staphylococcal bacteremia in healthy, full-term neonates occurred in the newborn nursery at a large county hospital not employing prophylactic hexachlorophene bathing. Seven infants had staphylococcal bacteremia and one had omphalitis. Two of the three isolates obtained for phage typing were type 86, and the other was 3c/71. Staphylococcal colonization rate in the nursery was 64% when the outbreak was recognized; 86% of these isolates were type 86. No predominant phage type was isolated from nursery personnel. The outbreak followed a six-month preliminary study that showed a rise in staphylococcal colonization rate from 2.2% with hexachlorophene bathing to 67% with a nonhexachlorophene-containing preparation. In a community survey of infants born during the two months prior to the epidemic, seven of eight babies with lesions were infected with Staphylococcus aureus type 86.

Axilla

Percutaneous absorption of hexachlorophene in rats, guinea pigs and pigs.

A comparative study of the percutaneous absorption of hexachlorophene (HCP) was undertaken in rats, guinea pigs and pigs. [14C]Hexachlorophene ([14C]HCP) was applied evenly over the shaved back of the animals at a dose of 40 microgram/cm2 skin surface. Urine and feces were collected at 24-h intervals for 5 days from animals kept in metabolism cages. Different methods were used for quantitating the percutaneous absorption of HCP. This study showed that skin permeability to HCP decreased in the following order: rat, guinea pig and pig. The permeability characteristics of the pig skin to topically applied HCP were comparable to the published human data. We suggest that pig may be a suitable animal model for studying the percutaneous absorption of antimicrobial drugs.

Animals

Studies on hexachlorophene-induced myelin lesions in the trigeminal root transitional region in developing and adult mice.

Hexachlorophene (HCP)-induced intramyelinic vacuolation was studied in the transitional region of the trigeminal root of suckling and adult mice. HCP produced an extensive vacuolation in the central compartment of the region in both suckling and adult mice, while in the peripheral compartment myelin lesions were only seen in mice less than 16 days of age. Gas chromatographic measurements showed that in suckling mice the blood concentration of HCP decreased with age, apparently reflecting a faster elimination of HCP from the blood. By substantially increasing the HCP dose, higher blood concentrations were obtained in adult than less the 16-day-old mice; in spite of this, PNS myelin changes occurred only in the latter. Thus, by observing the HCP effect on the transitional region, where CNS and PNS directly meet, it is concluded that CNS of both suckling and adult mice is more severely effected by HCP than PNS, and that the reaction of the PNS myelin is age-dependent during the period of myelinogenesis; it is particularly vulnerable to a cytotoxic edema inducing substance.

Age Factors

The distribution of peroxidases in the sciatic nerves of normal and hexachlorophene intoxicated developing rats.

Horseradish peroxidase (mol. wt. 40 000) or microperoxidase (mol. wt. 1900) were injected over the sciatic nerve of normal or hexachlorophene (HCP) intoxicated developing rats (3,7,14 and 21 days). Light and electron microscopic studies of nerves after histochemical staining for peroxidase revealed: a) the perineurial barrier to the two peroxidases was established in 21 day normal and HCP intoxicated rats; b) in animals 3-14 days, the perineurial barrier to both peroxidases was not formed and peroxidase staining was observed in the periaxonal space and in the space between paranodal loops of myelin; c) intramyelinic vacuoles, induced by HCP in animals 7-14 days did not show peroxidase staining. HCP-induced intramyelinic vacuolation is due to the separation of the myelin lamellae at the intraperiod line; although these vacuoles are potential extensions of the extracellular space, they are not stained with the extracellular markers horseradish or microperoxidase.

Age Factors

Effect of organotin compounds and hexachlorophene on brain adenosine cyclic 3',5'-monophosphate metabolism.

The effect of triethyltin (TET), triphenyltin (TPT), hexachlorophene (HCP) and cuprizone on adenosine cyclic 3',5'-monophosphate (cyclic AMP) production in rat brain was examined both in vitro and in vivo. TET and TPT inhibited basal adenylate cyclase activity of brain homogenate at a concentration as low as 1 microM in vitro but these compounds had no effect on norepinephrine (NE) and dopamine(DA)-stimluated enzyme activity. HCP and cuprizone failed to inhibit adenylate cyclase activity. In vivo TET given intravenously at a dose rate of 10 mg/kg decreased the cyclic AMP content of cerebrum, but not of medulla. TPT and HCP give intravenously and intraperitoneally respectively failed to decrease the cyclic AMP content of the cerebrum. In the case of TET the reduction in cyclic AMP content of the cerebrum was prevented by maintaining the rats normothermic after treatment. On the basis of these results the inhibition of adenylate cyclase produced by TET in brain homogenates in vitro would not appear to be involved in the development of nervous changes associated with acute TET toxicity, or in the production of progressive brain oedema caused by TET, HCP and cuprizone.

Adenylyl Cyclases

Effect of hexachlorophene intoxication on learning in rats.

Neurotoxicity in the form of hindlimb paralysis is known to be associated with brain lesions characterized by vacuolation of the white matter following hexachlorophene (HCP) intoxication; these paralytic and histopathological effects are reversible with time after discontinuance of HCP exposure. The rates of acquiring a bar-pressing escape and avoidance behavior were measured in female rats after recovery from paralysis following daily oral dosing with HCP (25 mg/kg). Learning deficits were seen as a delay in reaching a 90% escape performance level, as an increase in the number of sessions required to reach a 50% avoidance criterion, as an increase in training time needed to transfer from escape to avoidance responding, and by an increase in the number of sessions needed to reach a maximum level of avoidance behavior over a 35-session period. Peak responding eventually reached a level comparable to controls only after prolonged periods. Brain lesions seen 2-3 months after HCP intoxiciation correlated with the lag in learning ability but not with the maximum avoidance acquisition before sacrifice. These results indicate a long-lasting behavioral deficiency following neurotoxicity which is slowly reversible.

Animals

Vaginal absorption of hexachlorophene in the rat.

The pharmacokinetics of hexachlorophene (HCP) was studied in sexually mature virgin Wistar rats. [14C] HCP was injected either via the femoral vein, (ivn, 0.87 or 3.87 mg/kg in saline) or into the vaginal orifice (ivg, 0.87 mg/kg in corn oil). The disappearance of 14C from the blood after ivn administration followed the kinetics of a 2 compartment open model. The blood 14C profiles were superimposable, suggesting that the distribution and elimination rate constants for both doses were similar. After ivg application of [14C] HCP, 14C was detected in tail blood at 0.5 h, peaked between 2 and 4 h and disappeared slowly to 12 h but more rapidly thereafter. Less than 10% of the ivg dose of [14C] HCP remained in the vagina after 4 h. The cumulative recoveries of 14C in the faeces and urine 5 days after ivn administration were 85% and 4.6% of the dose, respectively. Comparable recoveries following ivg administration were 72% and 3.7%. The results suggest that HCP readily penetrates through the vaginal mucosa of the rat.

Absorption

Lifespan carcinogenicity studies with hexachlorophene in mice and rats.

Hexachlorophene (HCP) was tested for carcinogenicity in lifetime feeding studies in male Sprague--Dawley rats that were fed on a protein- and vitamin-deficient diet and in C57B1 and XVII/G mice that received the chemical incorporated into a complete diet. After 2 years, no significant carcinogenic effects were observed in these animals. In XVII/G mice injected subcutaneously at birth or receiving HCP via the mother's milk, the incidence of tumors was not statistically increased. No carcinogenic effect was observed in (C57B1 X C3H) F1 hybrid mice that received HCP transplacentally.

Administration, Oral

Comparison of the effects of two lipophilic acids, hexachlorophene and decanoate, on Bacillus subtilis.

The minimal growth-inhibitory amount of either hexachlorophene (HCP) or decanoate stopped growth, respiration, adenosine 5'-triphosphate synthesis, and amino acid transport of Bacillus subtilis in a culture containing amino acids and citrate as carbon sources. The electron transport system was not affected by this dose. Addition of 27.8 mM glucose or 10 mM malate to an inhibited culture did not reverse the binding of HCP or decanoate to the cells, but it allowed resumption of growth, respiration, and adenosine 5'-triphosphate synthesis, as the glucose or malate then supplied the needed carbon. The addition of glucose or malate did not reverse amino acid transport inhibition caused by decanoate, but it did reverse that due to HCP. However, if the dose of HCP was raised in the presence of glucose or malate, only growth and amino acid transport were affected; this indicates that both HCP and decanoate act at their minimal growth inhibitory doses by inhibiting substrate transport. As active transport of amino acids and ketoacids depends on the proton gradient and the membrane potential of the cells, we conclude that the primary effect of these lipophilic acids is the destruction of the proton-motive force.

Adenosine Triphosphate

Hexachlorophene in the newborn nursery. A risk-benefit analysis and review.

A critical review of the available data on the risks and benefits of hexachlorophene suggests that there is ample evidence fror the toxic potential; whereas there is no substantial evidence of its benefit in life-threatening staph 80/81 epidemics, and effective less toxic alternatives are available. In view of its limited usefulness and definite toxicity, the routine use of hexachlorphene is unjustified;

Animals