Advances in treatment of acute sulfur mustard poisoning – a critical review

Published on Oct 2, 2019in Critical Reviews in Toxicology5.635
· DOI :10.1080/10408444.2019.1579779
Leila Etemad13
Estimated H-index: 13
 (MUMS: Mashhad University of Medical Sciences), Mohammad Moshiri9
Estimated H-index: 9
 (MUMS: Mashhad University of Medical Sciences), Mahdi Balali-Mood5
Estimated H-index: 5
 (Birjand University of Medical Sciences)
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Abstract
AbstractSulfur mustard (SM) is a blistering chemical warfare agent that was used during the World War I and in the Iraq–Iran conflict. The aim of this paper is to discuss and critically review the ...
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Abstract A high incidence of intentional or accidental paraquat (PQ) ingestion is related to irreversible lung fibrosis and no effective therapy is currently available. Vitamin D has emerged with promising results as an immunomodulatory molecule when abrogating the inflammatory responses of lung diseases. Therefore, we have investigated the role of vitamin D treatments on PQ-induced lung fibrosis in male C57/BL6 mice. Lung fibrosis was induced by a single injection of PQ (10 mg/kg; i.p.). The co...
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Jun 1, 2018·Experimental Eye Research3.47
#1Ariel Gore (Israel Institute for Biological Research)H-Index: 7
#2Vered Horwitz (Israel Institute for Biological Research)H-Index: 9
Last. Shlomit Dachir (Israel Institute for Biological Research)H-Index: 19
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Abstract Purpose To evaluate the efficacy of ziv-aflibercept as a treatment for established corneal neovascularization (NV) and to compare its efficacy to that of bevacizumab following ocular chemical insult of sulfur mustard (SM) in the rabbit model. Methods Chemical SM burn was induced in the right eye of NZW rabbits by vapor exposure. Ziv-aflibercept (2 mg) was applied once to neovascularized eyes by subconjunctival injection while subconjunctival bevacizumab (5 mg) was administered twice a w...
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May 1, 2018·Iranian Journal of Medical Sciences
#1Leila Etemad (MUMS: Mashhad University of Medical Sciences)H-Index: 13
#2Mohammad Moshiri (MUMS: Mashhad University of Medical Sciences)H-Index: 9
Last. Mahdi Balali-Mood (MUMS: Mashhad University of Medical Sciences)H-Index: 25
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The present study aimed to review and discuss the recommended and recently suggested protocols by Iranian researchers for a long-term treatment of delayed complications of sulfur mustard (DCSM) in veterans. As indicated clinically, patients who suffer from delayed ocular complications of sulfur mustard (DOCS) benefit from treatments for dry eyes, therapeutic contact lenses, amniotic membrane transplantation; blepharorrhaphy, tarsorrhaphy, limbal stem cell transplantation; corneal transplantation...
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Apr 3, 2018·Cutaneous and Ocular Toxicology1.82
#1Lopa M. Das (Case Western Reserve University)H-Index: 7
#2Amy M. Binko (Case Western Reserve University)H-Index: 4
Last. Kurt Q. Lu (Case Western Reserve University)H-Index: 10
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AbstractObjective: Mass exposure to alkylating agents such as nitrogen mustard (NM), whether accidental or intentional as during warfare, are known to cause systemic toxicity and severe blistering from cutaneous exposure. Thus, establishing the timing and appropriate dose of any potential drug designed to reverse or impede these toxicities is critical for wound repair and survival. Our previous data demonstrates that a single intraperitoneal injection of low-dose 25-hydroxyvitamin D3 (25(OH)D) g...
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Mar 1, 2018·Iranian Journal of Medical Sciences
#1Emadodin Darchini-Maragheh (MUMS: Mashhad University of Medical Sciences)H-Index: 5
#2Mahdi Balali-Mood (MUMS: Mashhad University of Medical Sciences)H-Index: 25
Chemical warfare agents are the most brutal weapons among the weapons of mass destruction. Sulfur mustard (SM) is a potent toxic alkylating agent known as “the King of the Battle Gases”. SM has been the most widely used chemical weapon during the wars. It was widely used in World War I. Thereafter, it was extensively employed by the Iraqi troops against the Iranian military personnel and even civilians in the border cities of Iran and Iraq in the period between 1983 and 1988. Long-term incapacit...
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Oct 1, 2017·Toxicological Sciences4.85
#1Matthew D. McGraw (University of Colorado Denver)H-Index: 7
#2Christopher M. Osborne (BCM: Baylor College of Medicine)H-Index: 1
Last. Livia A. Veress (University of Colorado Denver)H-Index: 14
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: Sulfur mustard (SM) is a chemical warfare agent. When inhaled, SM causes significant injury to the respiratory tract. Although the mechanism involved in acute airway injury after SM inhalation has been well described previously, the mechanism of SM's contribution to distal lung vascular injury is not well understood. We hypothesized that acute inhalation of vaporized SM causes activated systemic coagulation with subsequent pulmonary vascular thrombi formation after SM inhalation exposure. Spra...
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Sep 12, 2017·Toxicology Letters4.37
#1Georg MenacherH-Index: 4
#2Dirk Steinritz (LMU: Ludwig Maximilian University of Munich)H-Index: 24
Last. Frank BalszuweitH-Index: 14
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Abstract Sulfur mustard (SM) is a vesicant agent who had its first military use 100 years ago, in Ypres. Since then it has been used in several conflicts like the Iran-Iraq war in the 1980s. The use of SM in Syria 2015 indicated the still existing threat. Despite decades of research no causal antidote against SM intoxication is available, so far. A SM intoxication is accompanied by necrosis, apoptosis and inflammation. To counteract the SM-induced inflammation, glucocorticoids and non-steroidal ...
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Sep 1, 2017·Journal of Burn Care & Research1.84
#1David J. BarilloH-Index: 29
#2Claire R. Croutch (MRIGlobal)H-Index: 6
Last. Julie Roseman (MRIGlobal)H-Index: 2
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Silver-based dressings are commonly used in burn care. Silver sulfadiazine use is associated with elevated blood, urine, and tissue levels of silver ion. We examined wound and tissue levels of silver ion in a two-species model of sulfur mustard chemical burn injury treated with two different silver-based dressings. Superficial dermal and moderate thickness dermal chemical burns were induced in 16 hairless guinea pigs and in 16 Gottingen minipigs by exposure to sulfur mustard vapor. After debride...
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Jun 5, 2017·Toxicology Letters4.37
#1Petr JostH-Index: 12
#2Petra FikrovaH-Index: 8
Last. Rudolf Stetina (Charles University in Prague)H-Index: 18
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Abstract The purpose of this study was to evaluate the efficacy of potential candidate molecules or their combinations against strong alkylation agent sulfur mustard (SM) on the human lung alveolar epithelial cell line A-549. Candidate molecules were chosen on the basis of their previously observed protective effects in vitro . The tested compounds, including antioxidants, sulfhydryl or other sulfur-containing molecules, nitrogen-containing molecules, PARP inhibitors and a NO synthase inhibitor,...
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Mar 2, 2021·Acta Pharmacologica Sinica6.15
#1Guanchao MaoH-Index: 2
#2Chuchu GongH-Index: 2
Last. Xiao KaiH-Index: 1
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Sulfur mustard (SM) is a highly toxic chemical warfare agent that causes acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS). There are no effective therapeutic treatments or antidotes available currently to counteract its toxic effects. Our previous study shows that bone marrow-derived mesenchymal stromal cells (BMSCs) could exert therapeutic effects against SM-induced lung injury. In this study, we explored the therapeutic potential of BMSC-derived exosomes (BMSC-Exs) aga...
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Jan 25, 2021·Archives of Toxicology5.15
#1Simone Rothmiller (University of Konstanz)H-Index: 6
#2Niklas JägerH-Index: 1
Last. Alexander Bürkle (University of Konstanz)H-Index: 67
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Wound healing is a complex process, and disturbance of even a single mechanism can result in chronic ulcers developing after exposure to the alkylating agent sulfur mustard (SM). A possible contributor may be SM-induced chronic senescent mesenchymal stem cells (MSCs), unable to fulfil their regenerative role, by persisting over long time periods and creating a proinflammatory microenvironment. Here we show that senescence induction in human bone marrow derived MSCs was time- and concentration-de...
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Jan 10, 2021·Toxicology Letters4.37
#1Ariel Gore (Israel Institute for Biological Research)H-Index: 7
#2Tamar Kadar (Israel Institute for Biological Research)H-Index: 26
Last. Vered Horwitz (Israel Institute for Biological Research)H-Index: 9
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Abstract The use of sulfur mustard (SM) in global terrorism is still a relevant threat to both civilian population and military personnel. Casualties exposed to SM may present mild, moderate or severe acute ocular lesions followed by a complete ocular resolution, chronic lesions or re-emerged ocular pathologies after a latent period. Current treatment for SM-induced ocular injury is based mainly on the clinical manifestation at the different stages of the injury and includes pharmaceutical and s...
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Jan 1, 2021·Toxicology reports
#1Alka Gupta (Sarojini Naidu Medical College)H-Index: 1
#2Rajagopalan VijayaraghavanH-Index: 51
Last. Anshoo GautamH-Index: 11
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Introduction Sulfur mustard (SM) is chemically, bis(2-chloroethyl) sulfide and a strong alkylating agent that causes cytotoxicity and blisters on skin. In laboratory animal models, SM is extremely lethal. Since no specific antidote has been proposed, decontamination upon contact is the recommended procedure. Several antidotes have been screened for SM, and in that sulfanyl compounds, N-acetyl-l-cysteine (NAC) and S-2(2-aminoethylamino) ethylphenyl sulfide (DRDE-07) showed good protection. Since ...
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Dec 1, 2020·Free Radical Biology and Medicine7.38
#1Thomas W. Sawyer (DRDC: Defence Research and Development Canada)H-Index: 14
Abstract In the long and intensive search for effective treatments to counteract the toxicity of the chemical warfare (CW) agent sulphur mustard (H; bis(2-chloroethyl) sulphide), the most auspicious and consistent results have been obtained with the drug N-acetylcysteine (NAC), particularly with respect to its therapeutic use against the effects of inhaled H. It is a synthetic cysteine derivative that has been used in a wide variety of clinical applications for decades and a wealth of informatio...
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Nov 1, 2020·Annals of the New York Academy of Sciences5.69
#1Julia Herbert (RU: Rutgers University)H-Index: 1
#2Debra L. Laskin (RU: Rutgers University)H-Index: 73
Last. Jeffrey D. Laskin (RU: Rutgers University)H-Index: 71
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The use of chemical warfare agents (CWAs) in military conflicts and against civilians is a recurrent problem. Despite ongoing CWA research using in vitro or in vivo models, progress to elucidate mechanisms of toxicity and to develop effective therapies, decontamination procedures, and general countermeasures is still limited. Novel scientific approaches to address these questions are needed to expand perspectives on existing knowledge and gain new insights. To achieve this, the use of ex vivo te...
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Aug 1, 2020·Experimental and Molecular Pathology3.36
#1Jeffrey D. Laskin (RU: Rutgers University)H-Index: 71
#2Gabriella Wahler (RU: Rutgers University)H-Index: 1
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Abstract Sulfur mustard (SM), a dermal vesicant that has been used in chemical warfare, causes inflammation, edema and epidermal erosions depending on the dose and time following exposure. Herein, a minipig model was used to characterize wound healing following dermal exposure to SM. Saturated SM vapor caps were placed on the dorsal flanks of 3-month-old male Gottingen minipigs for 30 min. After 48 h the control and SM wounded sites were debrided daily for 7 days with wet to wet saline gauze soa...
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