Predictors of acute kidney injury after paraquat intoxication

Weng, Cheng‐Hao; Chen, Hui-Hsiang; Hu, Ching-Chih; Huang, Wen‐Hung; Hsu, Ching‐Wei; Fu, Jen-Fen; Lin, Wey‐Ran; Wang, I-Kwan; Yen, Tzung‐Hai

doi:10.18632/oncotarget.17975

Cited by 39 publications

(46 citation statements)

References 47 publications

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“…The fatality rate of PQ poisoning is as high as 50–70% [ 2 ]. PQ absorbed through the digestive tract, skin and respiratory tract can cause multiple organ damage, in which the lung is the primary target organ [ 3 – 5 ]. It is thought that the structural similarity of PQ to lung diamines and polyamines such as putrescine, spermine, and spermidine induces the lung to accumulate PQ competitively [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Mesenchymal stem cell therapy for paraquat poisoning: A systematic review and meta-analysis of preclinical studies

He¹,

Zhou²,

Feng³

et al. 2018

PLoS ONE

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BackgroundParaquat (PQ) poisoning can cause multiple organ failure, in which the lung is the primary target organ. There is currently no treatment for PQ poisoning. Mesenchymal stem cells (MSCs), which differentiate into multiple cell types, have generated much enthusiasm regarding their use for the treatment of several diseases. The aim of this study was to systematically review and analyze published preclinical studies describing MSC administration for the treatment of PQ poisoning in animal models to provide a basis for cell therapy.MethodsThe electronic databases PubMed and CBMdisc were searched in this systematic review and meta-analysis. The MSC treatment characteristics of animal models of PQ poisoning were summarized. After quality assessment was performed, the effects of MSC transplantation were evaluated based on the survival rate, lung wet/dry weight, fibrosis scores, oxidative stress response, and inflammatory response. Publication bias was assessed.ResultsEleven controlled preclinical studies involving MSC transplantation in animal models of PQ poisoning were included in this review. MSC therapy improved the survival rate and reduced the lung wet/dry weight and histopathological fibrosis changes in most studies. MSCs decreased serum or plasma malondialdehyde levels in the acute phase after 7 and 14 d and increased serum or plasma superoxide dismutase and glutathione levels at the same time points. IL-1β, TNF-α and TGF-β1 levels in blood or lung tissues were decreased to different degrees by MSCs. Lung hydroxyproline was decreased by MSCs after 14 d. No obvious evidence of publication bias was found.ConclusionMSCs showed anti-fibrosis therapeutic effects in animal models of lung injury caused by PQ poisoning, which may be related to reduced oxidative stress and inflammatory cytokine levels. Our review indicates a potential therapeutic role for MSC therapy to treat PQ poisoning and serves to augment the rationale for clinical studies.

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Section: Introductionmentioning

confidence: 99%

Mesenchymal stem cell therapy for paraquat poisoning: A systematic review and meta-analysis of preclinical studies

He¹,

Zhou²,

Feng³

et al. 2018

PLoS ONE

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“…PQ in the blood is mainly excreted through the kidney as a prototype. The direct toxic effects of PQ on the renal tubules can cause acute kidney function impairment and delayed excretion of PQ ( 4 ). Maintaining the kidney function is very important for reducing the PQ concentration in the plasma, which can also reduce the accumulation of PQ in lung cells ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Therapy with high‑dose long‑term antioxidant free radicals for severe paraquat poisoning: A pilot study

Qiao

Yuan

et al. 2018

Exp Ther Med

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This study investigated the effects of high-dose long-term antioxidant free radicals on the mortality rate, creatinine (Cr) value, partial pressure of oxygen (PaO2), alanine aminotransferase (ALT), as well as the incidence rates of lung fibrosis and dysfunction in the treatment of patients with severe paraquat (PQ) poisoning [toxic dose, 20 ml stock solution (20% w/v)]. A total of 23 cases of severe PQ poisoning treated in Xiangyang First People's Hospital, Hubei University of Medicine were collected (group 1), and they received conventional treatments such as immunosuppressive agents and/or hemoperfusion. Six patients were given high-dose long-term antioxidant therapy on the basis of conventional treatments (group 2). After treatment, 6 out of the 23 patients in group 1 survived, and all the 6 patients in group 2 survived, with the survival rate of 26.1 vs. 100% (p<0.01). The lowest PaO2 value in group 1 was lower than that in group 2 (70.26±16.38 vs. 91.17±3.43 mmHg, p<0.01). The highest ALT value in group 1 was higher than that in group 2 (216.74±126.23 vs. 52.50±24.83 U/l, p<0.01). There was no significant difference in the incidence rate of lung fibrosis between the two groups of survived patients, but there were 6 patients that died of severe lung fibrosis in group 1. Besides, the incidence rate of lung dysfunction in patients in group 2 was significantly lower than that in survived patients in group 1 (p<0.01). High-dose long-term antioxidants are the most critical treatment option to improve the survival rate of high-dose PQ poisoning, they increase the patient's PaO2, enhance liver function, reduce lung fibrosis and refine lung dysfunction.

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“…Serum PQ concentrations have been used to diagnose the severity of poisoning [ 11 , 12 ]. Patients may recover if their serum PQ concentrations remain under 0.3 ppm at 10 h after poisoning [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…SIPP values under 10 are an indication to clinicians that poisoned patients have a higher probability of survival [ 14 ]. Different approaches to measuring PQ serum concentration are available including high-performance liquid chromatography (HPLC)/mass spectrometry (MS), gas chromatography, and photometry coupled with a sodium dithionite assay [ 11 , 15 , 16 , 17 , 18 , 19 ]. Another option reported in the literature is the use of surface-enhanced Raman spectroscopy (SERS) [ 20 , 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Rapid Simultaneous Determination of Paraquat and Creatinine in Human Serum Using a Piece of Paper

Chang

Tung

et al. 2018

Micromachines

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Paraquat intoxication is characterized by acute kidney injury and multi-organ failure, causing substantial mortality and morbidity. This study aims to develop a 2-in-1 paper-based analytical device to detect the concentrations of paraquat and creatinine in human serum, which can help clinicians diagnose patients with paraquat poisoning in a more rapid and geographically unrestricted manner. The procedure involves fabrication of a paper-based analytical device, i.e., printing of design on a filter paper, heating of wax-printed micro zone plates so as molten wax diffusing into and completely through the paper to the other side, forming hydrophobic boundaries that could act as detection zones for the paraquat colorimetric assay, and finally analysis using ImageJ software. The paper employed a colorimetric sodium dithionite assay to indicate the paraquat level in a buffer or human serum system in less than 10 min. In this study, colorimetric changes into blue color could be observed by the naked eye. By curve fitting models of sodium dithionite in normal human serum, we evaluated the serum paraquat levels for five paraquat patients. In the sodium dithionate assay, the measured serum paraquat concentrations in patients 1–5 were 22.59, 5.99, 26.52, 35.19 and 25.00 ppm, respectively. On the other hand, by curve fitting models of the creatinine assay in normal human serum, the measured serum creatinine concentrations were 16.10, 12.92, 13.82, 13.58 and 12.20 ppm, respectively. We found that the analytical performance of this device can compete with the standard of Clinical Laboratory of Chang Gung Memorial Hospital, with a less complicated sample preparation process and more rapid results. In conclusion, this 2-in-1 paper-based analytical device has the advantage of being simple and cheap, enabling rapid detection of paraquat intoxication as well as assessment of renal prognosis.

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Predictors of acute kidney injury after paraquat intoxication

Cited by 39 publications

References 47 publications

Mesenchymal stem cell therapy for paraquat poisoning: A systematic review and meta-analysis of preclinical studies

Mesenchymal stem cell therapy for paraquat poisoning: A systematic review and meta-analysis of preclinical studies

Therapy with high‑dose long‑term antioxidant free radicals for severe paraquat poisoning: A pilot study

Rapid Simultaneous Determination of Paraquat and Creatinine in Human Serum Using a Piece of Paper

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