If you’ve been fortunate to live in the parts of the US that were soggier than usually as of late – or unfortunate enough to have had flooding from hurricanes and tropical storms – then you’ve be noticing a tremendous burst of mushrooms.
For mycologists – mushroom enthusiasts – there are two classic chestnuts: “There are old mushroom collectors and bold mushrooms collectors, but there are no old, bold mushroom collectors.”
Or, in a more concise Croatian proverb, “All mushrooms are edible, but some only once.”
As such, this is the time of year that emergency rooms and regional poison centers begin to see a burst in poisonings from mushroom ingestion, due primarily to amateur misidentification of the fruiting bodies.
Just this past week, Jason McClure at Medscape Oncology News (free reg req’d) wrote about in the northeastern US and the concomitant bloom of mushroom poisonings this fall.
But “mushroom poisoning” is an imprecise diagnosis for the ER physician. The constellation of symptoms caused by toxic mushrooms is as diverse as the colors and shapes of these wonders of nature. From another Medscape article on by Dr. Rania Habal from the Emergency Medicine department of NYU:
Mushrooms are best classified by the physiologic and clinical effects of their poisons. The traditional time-based classification of mushrooms into an early/low toxicity group and a delayed/high toxicity group may be inadequate. Additionally, many mushroom syndromes develop soon after ingestion. For example, most of the neurotoxic syndromes, the Coprinus syndrome (ie, concomitant ingestion of alcohol and coprine), the immunoallergic and immunohemolytic syndromes, and most of the GI intoxications occur within the first 6 hours after ingestion.
Ingestions most likely to require intensive medical care involve mushrooms that contain cytotoxic substances such as amatoxin, gyromitrin, and orellanine. Mushrooms that contain involutin may cause a life-threatening immune-mediated hemolysis with hemoglobinuria and renal failure. Inhalation of spores of Lycoperdon species may result in bronchoalveolitis and respiratory failure that requires mechanical ventilation.
Mushrooms that contain the GI irritants psilocybin, ibotenic acid, muscimol, and muscarine may cause critical illness in specific groups of people (eg, young persons, elderly persons). Hallucinogenic mushrooms may also result in major trauma and require care in an intensive care setting. Lastly, coprine-containing mushrooms cause severe illness only when combined with alcohol (ie, Coprinus syndrome).
Among the poisonous mushrooms, Amanita phalloides is perhaps the most deadly. If you’ve spent any time in a biochemical laboratory you will have learned of the primary toxin of the mushroom, α-amanitin. This potency of this toxin comes from its remarkably high affinity for RNA polymerase II, the primary RNA polymerase for making messages that are converted into proteins.
The challenge in treating α-amanitin poisoning is that it has a relatively long half-life in the body because it is conjugated with glucuronic acid in the liver and secreted in the bile. But then microbes that normally inhabit our gut cleave the glucuronide sugar molecule off the toxin, released the toxic α-amanitin.
Throughout the history of folk medicine in the Middle East and Europe, extracts of the seeds of milk thistle (Silybum marianum) were determined to have protective effects against liver toxins. I’m still not terribly pleased with understanding the history of how this came about but answering this question is one of my liberal arts pursuits. As an aside, I should make the disclosure that my laboratory and colleagues have been investigating the anticancer effects of compounds from milk thistle and still receive NIH funding to do so; however, I do not (yet) study how milk thistle compounds prevent liver toxicity.
Nevertheless, milk thistle products are quite popular in Europe and the US for the general prevention of liver toxicity from statins, acetaminophen, and alcohol. Several of my friends have joked that one could make create a successful market for an alcoholic product containing milk thistle extract.
But one of the primary roadblocks in using milk thistle extracts or pure compounds for any indication is that the compounds have rather poor bioavailability. The seven major flavonolignans and one flavonoid in the typical extracts are very avidly conjugated by glucuronidation. In studies by collabortors at the University of Colorado, we now know that it takes daily doses of approximately 10-13 grams of milk thistle extract to achieve plasma concentrations consistent with known anticancer effects in vitro. It can be done, but it means taking much more than the typical 180 mg capsules you can buy at your local health food store.
However, an intravenous preparation of milk thistle extract has been available in Europe for over 20 years: Legalon SIL. This GMP-manufactured product is common to emergency rooms in Germany, France, and Belgium for the treatment of mushroom poisoning. The preparation is comprised of silybin A and silybin B – known collectively as silibinin – as a hemisuccinate that both improves the solubility and bioavailability of the compounds.
Two cases in the US – one in 2007 and another just this past month – have seen emergency IND approval of this European product. In 2007, Legalon was used to save four of five family members who had ingested Amanita phalloides while on a New Year’s Day picnic outside of Santa Cruz, California. And just last month, a team led by Dr. Jacqueline Laurin at Georgetown Medical Center Georgetown is now an approved referral center for this IV prep of Legalon and their efforts were greatly assisted by the Santa Cruz team who handled the 2007 cases.
Less satisfying to me is the mechanism by which silybin A and silybin B protect the liver from the effects of RNA polymerase II inhibition by α-amanitin. The literature to date seems to converge on the into hepatocytes by silibinin. A German group led by Herbert de Groot in Essen, Germany, published a highly-cited 1996 paper proposing that inhibition of inflammatory mediator release from Kupffer cells (the macrophage of the liver) might partly account for the hepatoprotective effects of silibinin. More recent work continues to address the modulation of inflammation.
Regardless, we are now seeing legitimate use of a medicine from a herbal tradition being used in clinical situations where emergency IRB approval and IND status have been given to such a product. Certainly, these stories may be used by marketers to promote use of their oral milk thistle products. But, as I mentioned earlier, such effects required ingestion of large doses of capsules. Instead, I present this story to SBM readers to illustrate that amidst the wooful promotion of herbal therapies, a few gems exist and are most worthy of our scientific investigation.
<!–<!–(1) the unusual bloom of mushrooms
(2) emergency management of mushroom poisoning
(3) successfully treated two men for accidental ingestion of Amanita.
(4) inhibition of toxin uptake
Incoming Post Search Feeds:
futurists physical therapy
liberty generator tube
Dr biochemistry gmail edu
NASA comet ison update
techno fruhstuck correspondence heart beat
petru aurelian simionescu 2013
Modern marvels regenerative medicine
latest indian mision mars
nasa nibiru 10 11 2013
- The 1975 - Medicine (Official Audio) - Video - October 31st, 2014
- The 1975 - Medicine (Lyrics On Screen) - Video - October 31st, 2014
- Kershaw Health Home Health Receive Tribute & Medicine Discount Cards by Charles Myrick of ACRX - Video - October 31st, 2014
- Lumpkin Family Connection Receive Tribute & Medicine Assistance by Charles Myrick of ACRX - Video - October 31st, 2014
- Kanawha Services in Charleston,WV Receive Tribute & Medicine Coupons by Charles Myrick of ACRX - Video - October 31st, 2014
- Chinese Herbal Medicine Guide - Video - October 31st, 2014
- Inman Varsity Football Vs. Medicine Lodge - Video - October 31st, 2014
- Midwestern Dental Receive Tribute & Medicine Help By Charles Myrick of ACRX - Video - October 31st, 2014
- St Vincent de Paul Soup Kitchen Receive Tribute & Medicine Coupons by Charles Myrick of ACRX - Video - October 31st, 2014
- Neptune Photo,Inc Receive Tribute & Medicine Help By Charles Myrick of ACRX - Video - October 31st, 2014
- St Vincent de Paul Society in Sanford,FL Receive Tribute & Medicine Coupons by Charles Myrick of AC - Video - October 31st, 2014
- Gulfport Central Middle School Receive Tribute & Medicine Help By Charles Myrick of ACRX - Video - October 31st, 2014
- Predictive, Preventive and Personalized Medicine & Molecular Diagnostics opening ceremony - Video - October 31st, 2014
- Broan-NuTone Broan-Nutone Focus 16W x 22H in. Medicine - Video - October 31st, 2014
- Aetherius Obscuritas - Black Medicine - 02 The End - Video - October 31st, 2014
- Carolina Orthopaedic & Sports Medicine Center holds ribbon cutting for new facility - October 31st, 2014
- Research and Markets: EU Vaccines For Human Medicine Market Report 2014 - October 31st, 2014
- A Field Of Medicine That Wants To Know Where You Live - October 31st, 2014
- Can we predict the future of medicine? - October 31st, 2014
- Syria ensures medicine supplies for chronic diseases - October 31st, 2014
- Dr Quinn Medicine Woman Season 4 Episode 12 Change of Heart - Video - October 30th, 2014
- Family Medicine On Air: What Med Students Need to Know About Direct Primary Care - Video - October 30th, 2014
- The upper limb, part 2, Al-Iraqia college of medicine - Video - October 30th, 2014
- Atlanta Medicine Show - Video - October 30th, 2014
- Dr Quinn Medicine Woman Season 1 Episode 17 Portraits - Video - October 30th, 2014
- Dr Quinn Medicine Woman Seasoun 4 Episode 7 Promises, Promises - Video - October 30th, 2014
- Dr Quinn Medicine Woman Season 4 Episode 5 Halloween 3 - Video - October 30th, 2014
- Dr Quinn Medicine Woman S06E21 The Fight - Video - October 30th, 2014
- Brand new 2015 GMC Sierra 1500 SLT for sale in Medicine Hat - Video - October 30th, 2014
- Dr Quinn Medicine Woman S06E22 A New Beginning - Video - October 30th, 2014
- BAD MEDICINE BON JOVI foro sol 2013 - Video - October 30th, 2014
- Testimonial 1 for Energy Medicine by Elaine: Bridging The Gap between Medical & Spiritual - Video - October 30th, 2014
- "3D in Medicine" A free 2-hour live seminar with an international panel of experts - Video - October 30th, 2014
- FDA awards grants to stimulate drug, device development for rare diseases - October 30th, 2014
- See the Birth of Modern Medicine in These Photos - October 30th, 2014
- Study Indicates Cystic Fibrosis Carrier Status in Females Not a Factor in IVF Success - October 30th, 2014
- Advances in forensic medicine discussed - October 30th, 2014
- Watch: Early Days of Modern Medicine Shown in Haunting Photos - October 30th, 2014
- IBM Watson lends analytic power to genomic medicine - October 30th, 2014
- Three-company collaboration announced for advancement of aging research - October 30th, 2014
- Old Crow Medicine Show Wagon Wheel Acoustic Cover Darius Rucker - Video - October 29th, 2014
- Medicine Cabinet Makeover WEBINAR - Video - October 29th, 2014
- Dive into Worldbuilding! Illnesses, Ailments and Medicine - Video - October 29th, 2014
- Perioperative Medicine MSc overview (2015/16 entry) - Video - October 29th, 2014
- Wagon Wheel, by The Obsoletes (Old Crow Medicine Show Cover) - Video - October 29th, 2014
- Alternative Medicine Treatment For Postherpetic Neuralgia - Video - October 29th, 2014
- Big Red Rock - The Good Medicine Band - Video - October 29th, 2014
- Science Based Medicine Workshop TAM 2013 - Video - October 29th, 2014
- EWC MEDICINE & HEALTH OCT. 2014 - Video - October 29th, 2014
- Xray REVISION FOR FAMILY MEDICINE DIPLOMA - Video - October 29th, 2014
- Download Textbook of Family Medicine Expert Consult 8th PDF - Video - October 29th, 2014
- Download SOAP for Family Medicine PDF - Video - October 29th, 2014
- Snake Oil: Fake Medicine, Recognizing It, and How to Deal With It - Video - October 29th, 2014
- Current state of personalized medicine - Video - October 29th, 2014
- Ancient Medicine + Pepper's Secret - Video - October 29th, 2014
- BK Ultrasound, Powered by Analogic, Enters Emergency Medicine Market - October 29th, 2014
- Reproductive Medicine Associates of New York Presents 12 Scientific Abstracts at 2014 ASRM Conference in Honolulu ... - October 29th, 2014
- N-of-One Selected by Intermountain Healthcare to Provide Deep Clinical Interpretation for Cancer Genomics - October 29th, 2014
- Medicine shortages - October 29th, 2014
- Erica Erwin: Medicine makes for angry cat, exasperated owner - October 29th, 2014
- Overview of Hunterdon Healthcare's Integrative Medicine Program - Video - October 27th, 2014
- Thyroid Gland Problems Hormones - Alternatives to Surgery Functional Medicine - Video - October 27th, 2014
- How To Get Prescription Safety Tips Side Effects, Health, Functional Medicine part-1 - Video - October 27th, 2014
- Download Principles of Regenerative Medicine Free PDF - Video - October 27th, 2014
- Training 2 : The Medicine Ball - Video - October 27th, 2014
- Discover Health and Medicine at Lancaster - Video - October 27th, 2014
- Medicine man 15s - Video - October 27th, 2014
- "No medicine, no life" Part 2 - Video - October 27th, 2014
- Michael Paul Caruso - good medicine - Video - October 27th, 2014
- Is your teen abusing cough medicine? - October 27th, 2014
- Drug for Rare Blood Disorder Developed at Penn Receives Orphan Drug Status from the FDA - October 27th, 2014
- TRUAGE Science Made Simple 3 , anti-aging medicine singapore, top anti aging products singapore - Video - October 27th, 2014
- Reworking Health: Translating Siloed Research into Medicine - Video - October 27th, 2014
- Robert Matthew, MD, GHC-SCW Family Medicine - Video - October 27th, 2014
- Debra Shenoi, MD, GHC-SCW Family Medicine - Video - October 27th, 2014
- Crystal Frohmader, PA-C, GHC-SCW Family Medicine - Video - October 27th, 2014
- Mark Tomaino panel - Medicine X Entrepreneurship Special Event - Video - October 27th, 2014
- RFR Featured Property: 1304 W Medicine Lake Dr, #2 - Video - October 27th, 2014
- MyMEDxHalo - Personalized Medicine, Amazing Financial Opportunity - Video - October 27th, 2014
- Equine Emergency and Critical Care Medicine Print Replica by Louise Southwood Mobi download - Video - October 27th, 2014