Amanita phalloides poisoning: Mechanisms of toxicity and treatment. (December 2015)

• Record Type: Journal Article
• Authors: Garcia, Juliana; Costa, Vera M.; Carvalho, Alexandra; Baptista, Paula; de Pinho, Paula Guedes; de Lourdes Bastos, Maria; Carvalho, Félix
• Is Part Of: Food and chemical toxicology. Volume 86(2015)
• Page Start: 41
• Page End: 55
• Publication Date: 2015-12
• Subjects: Amanita phalloides -- Amatoxins -- RNA polymerase II -- Liver -- Kidney -- Therapy; ALT alanine aminotransferase -- AST aspartate aminotransferase -- CIAV antipoison information center (Centro de Informação Antivenenos) -- GI gastrointestinal -- GSH reduced glutathione -- HPLC high-performance liquid chromatography -- LD50 lethal dose 50 -- LDH lactate dehydrogenase -- MARS molecular adsorbent recirculating system -- mRNA messenger RNA -- MTT 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide -- OATP organic anion-transporting octapeptide -- RNA ribonucleic acid -- RNAP II RNA polymerase II -- ROS reactive oxygen species -- SOD superoxide dismutase -- TNF-α tumor necrosis factor alpha; Toxicology -- Periodicals; Food poisoning -- Periodicals; Food Poisoning -- Periodicals; Toxicology -- Periodicals; Toxicologie -- Périodiques; Intoxications alimentaires -- Périodiques; Food poisoning; Toxicology; Periodicals; Electronic journals; 615.9
• DOI: 10.1016/j.fct.2015.09.008
• Languages: English
• ISSNs: 0278-6915

Abstract

Abstract: Amanita phalloides, also known as 'death cap', is one of the most poisonous mushrooms, being involved in the majority of human fatal cases of mushroom poisoning worldwide. This species contains three main groups of toxins: amatoxins, phallotoxins, and virotoxins. From these, amatoxins, especially α-amanitin, are the main responsible for the toxic effects in humans. It is recognized that α-amanitin inhibits RNA polymerase II, causing protein deficit and ultimately cell death, although other mechanisms are thought to be involved. The liver is the main target organ of toxicity, but other organs are also affected, especially the kidneys. Intoxication symptoms usually appear after a latent period and may include gastrointestinal disorders followed by jaundice, seizures, and coma, culminating in death. Therapy consists in supportive measures, gastric decontamination, drug therapy and, ultimately, liver transplantation if clinical condition worsens. The discovery of an effective antidote is still a major unsolved issue. The present paper examines the clinical toxicology of A. phalloides, providing the currently available information on the mechanisms of toxicityinvolved and on the current knowledge on the treatment prescribed against this type of mushrooms. Antidotal perspectives will be raised as to set the pace to new and improved therapy against these mushrooms. Highlights: Amanita phalloides poisoning is a serious public health problem worldwide. The currently available information on the α-amanitin mechanisms of toxicity is herein reviewed. The efficacy and limitations of antidotes most commonly used against amatoxins-poisoning is herein discussed.