Cardiopulmonary effects of HI-6 treatment in soman intoxication.

The cardiopulmonary effects of HI-6, together with atropine and soman, were studied in the rat. HI-6 is an effective antidote in acute poisoning with the nerve agent soman. The therapeutic efficiency of HI-6 is still unclear and cannot be explained entirely by the HI-6 reactivating ability of acetylcholinesterase (AChE). Other non-cholinergic factors must be involved. One possible detoxifying process might be an effect of HI-6 on the blood flow to sensitive organs. The purpose of the present study was to investigate 1) whether soman per se induces changes in regional blood flow and 2) whether the blood flow to different organs is affected when HI-6 (50 mg x kg(-1) i.m.) and atropine (10 mg x kg(-1) i.m.) are given either before or immediately after soman intoxication (90 microg x kg(-1) s.c.). For regional blood flow determinations the microsphere method was used with male Wistar rats weighing 300-400 g. The rats were anaesthetised and breathed spontaneously during the experiment. Three different blood flow measurements were made in the same animal and concomitant physiological parameters such as mean arterial blood pressure and respiratory rate were recorded. The blood AChE activity was followed throughout the experiment. Our results show that when HI-6 is given after intoxication with soman, dramatic changes in blood flow occur with a significant decrease in both respiratory rate and blood AChE activity. If HI-6 is given prior to the intoxication, however, all rats are unaffected and none of the parameters measured are changed.

Toxicokinetics of soman in cerebrospinal fluid and blood of anaesthetized pigs.

The toxicokinetics of the four stereoisomers of the nerve agent C(+/-)P(+/-)-soman was analysed in cerebrospinal fluid (CSF) and blood in anaesthetized, spontaneously breathing pigs during a 90-min period after injection of soman. The pigs were challenged with different intravenous (i.v.) doses of C(+/-)P(+/-)-soman corresponding to 0.75-3.0 LD50 (4.5, 9.0 and 18 microg/kg in a bolus injection and 0.45 microg/kg per min as a slow infusion). Artificial ventilatory assistance was given if, after soman intoxication, the respiratory rate decreased below 19 breaths/min. Blood samples were taken from a femoral artery and CSF samples from an intrathecal catheter. The concentrations of the soman isomers were determined by gas chromatography coupled with high resolution mass spectrometry. All four isomers of soman were detected in both blood and CSF samples. The relatively non-toxic C(+/-)P(+) isomers disappeared from the blood stream and CSF within the first minute, whereas the levels of the highly toxic C(+/-)P(-) isomers could be followed for longer, depending on the dose. Concurrently with the soman analyses in blood and CSF, cholinesterase (ChE) activity and cardiopulmonary parameters were measured. C(+/-)P(-) isomers showed approx. 100% bioavailability in CSF when C(+/-)P(+/-)-soman was given i.v. as a bolus injection. In contrast, C(+/-)P(-) isomers displayed only 30% bioavailability in CSF after slow i.v. infusion of soman. The ChE activity in blood decreased below 20% of baseline in all groups of pigs irrespective of the soman dose. The effect of soman intoxication on the respiratory rate, however, seems to be dose-dependent and the reason for ventilatory failure and death. Artificial ventilation resulted in survival of the pigs for the time-period studied.

Pharmacokinetics and effects of HI 6 in blood and brain of soman-intoxicated rats: a microdialysis study.

The bispyridinium oxime HI 6 (1-(((4-amino-carbonyl)pyridino)methoxy)methyl)-2-(hydroxyimino )methyl)-pyridinium dichloride monohydrate), combined with atropine, is effective for treating poisoning with organophosphate nerve agents. The protective action of HI 6 in soman poisoning has been attributed mainly to its peripheral reactivation of inhibited acetylcholinesterase. In the present study we investigated whether high intramuscular doses of HI 6 can reach the brain in a sufficient amount to reactivate inhibited brain acetylcholinesterase. Microdialysis probes were implanted in the jugular vein and striatum and dialysis samples were collected simultaneously from the two sites in awake, freely moving rats. Pharmacokinetic parameters of unbound HI 6 in blood and brain were calculated after administration of HI 6 (50, 75 or 100 mg/kg i.m.) in control rats and rats injected with soman (90 microg/kg s.c., 0.9 LD50) 1 min before HI 6 treatment. We found that signs of soman poisoning correlated positively to acetylcholinesterase inhibition and negatively to the concentration of unbound HI 6 in the brain and that soman intoxication significantly decreased uptake of HI 6 into the brain.

Treatment of organophosphate poisoning in pigs: antidote administration by a new binary autoinjector.

The therapeutic effectiveness of a new binary autoinjector containing 500 mg HI-6 and 2 mg atropine sulphate was tested in anesthetized pigs poisoned by a lethal dose of soman i.v. (9 micrograms/kg per 20 min). Pharmacokinetics and pharmacodynamics of HI-6 were studied concomitantly on administration of HI-6 alone, together with atropine sulphate, or together with atropine sulphate during soman intoxication. Cardiopulmonary parameters were monitored and serum concentrations of oxime and acetylcholinesterase (AChE) were measured in blood samples taken at intervals over a 6-h period postinjection. Five minutes after the start of soman infusion, mean AChE activity was decreased to 27 +/- 4.3% of baseline and signs of poisoning appeared. The antidotes, HI-6 and atropine sulphate, were then administered i.m. One minute after this injection there was a transient significant increase in AChE activity of 76 +/- 8.2% of baseline (p < 0.01). It then again decreased and remained suppressed throughout the experiment. Mean respiratory rate was significantly decreased (p < 0.01) to 20 +/- 3.2% of baseline after 20 min of soman infusion and remained low during the rest of the experiment. The poisoning signs were counteracted 15-20 min after antidote therapy and all pigs survived soman intoxication without ventilatory assistance. Administration of either atropine or atropine and soman had no significant effect on the pharmacokinetics of HI-6 in anesthetized pigs.

Tubuglomerular feedback control in long-looped nephrons. Topical minireview.

The tubuloglomerular feedback mechanism is highly activated in juxtamedullary nephrons and considered to play a major role in intrarenal regulation of glomerular filtration rate. The vasculature of juxtamedullary nephrons is highly vasoreactive with a high ability for vasodilation. This vasoreactivity is a prerequisite for an important influence of the tubuloglomerular feedback mechanism on the medullary blood flow and its regulation.