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:
petru aurelian simionescu 2013
liberty generator tube
nasa nibiru 10 11 2013
futurists physical therapy
ppsspp monster hunter freedom unite tablet
Dr biochemistry gmail edu
Modern marvels regenerative medicine
latest indian mision mars
techno fruhstuck correspondence heart beat
- Janis Saunders, MD - Phoenix, Arizona - Parkway Medical - Family Medicine - Video - October 25th, 2014
- Martin J. LaFollette, MD - Abrazo Medical Group Denaro - Phoenix, Arizona - Family Medicine - Video - October 25th, 2014
- Clingy pandas dont want to take their medicine (Panda Severler iin) - Video - October 25th, 2014
- MiMedx Group - Company Presentation - Video - October 25th, 2014
- Tim Hall - Professional Integrative Medicine - Video - October 25th, 2014
- simple slide show on personalized medicine - Video - October 25th, 2014
- Here I will show you how to say 'Take this medicine.' with Zira.mp4 - Video - October 25th, 2014
- Montana Medicine Show - Video - October 25th, 2014
- I'm Good - Coordinated Health Sports Medicine Spot - Video - October 25th, 2014
- The practice of family medicine is often misunderstood - October 25th, 2014
- surgery figure of eight suturing medicine - Video - October 24th, 2014
- How I Discovered Natural Medicine: Michele Burklund - Video - October 24th, 2014
- International Academy of Cardiology: Luisa Mestroni, M.D.: PERSONALIZED MEDICINE IN DILATED - Video - October 24th, 2014
- Medicine and supplies worth 300,000 sent to Africa to help fight Ebola - Video - October 24th, 2014
- The Medicine Men of Old Borneo - Video - October 24th, 2014
- Creative Gardening Ideas With A Medicine Wheel - Video - October 24th, 2014
- Duke Medicine Profiles: Karl M. Schweitzer Jr., MD - Video - October 24th, 2014
- Women in Medicine: Changing the Face of Duke Medicine - Video - October 24th, 2014
- "Good medicine" original song by Josh Geiger - Video - October 24th, 2014
- The Carver College of Medicine New Horizons Curriculum: Part 1 - Video - October 24th, 2014
- Vicks DayQuil SEVERE Cold&Flu Medicine Review~UPDATE - Video - October 24th, 2014
- Stott Pilates: Power & Stamina Medicine Ball Interval Training Vol 2 #CollageVideo - Video - October 24th, 2014
- About Compassion Medicine - Video - October 24th, 2014
- CHRISTUS Sports Medicine Center Southeast Texas - Video - October 24th, 2014
- No Sick Fish Ich Medicine For Fish - Video - October 24th, 2014
- ayurveda medicine and even cancer help from kerala - Video - October 24th, 2014
- The motivation behind Compassion Medicine | First treated child - Video - October 24th, 2014
- James Norman, M.D., '82 - 2014 UCF Professional Achievement Award - Medicine - Video - October 24th, 2014
- Acupuncture Hollywood, Acupuncture Clinic Hollywood, Chinese Medicine Hollywood - Video - October 24th, 2014
- Its Not Easy Giving Medicine To A Little Panda - Video - October 24th, 2014
- Ashoka Mukpo, Ebola Patient Released - Nebraska Medicine - Video - October 24th, 2014
- SPRI Slam Ball Medicine Balls - Video - October 24th, 2014
- Back to the Garden: spiritual and physical food as medicine - Video - October 24th, 2014
- Medicine Man Full Movie - Video - October 24th, 2014
- What is Naturopathic Medicine? - Video - October 24th, 2014
- Medicine For Ebola Virus Coming Soon - Video - October 24th, 2014
- Feed Your Soul Music Vol. 03 (Mixed by Deep Medicine) (Vocal Mix) - Video - October 24th, 2014
- Q&A - From Cowardice to Shellshock: Medicine, Psychiatry and the Great War - Video - October 24th, 2014
- smart medicine - Video - October 24th, 2014
- Here I will show you how to say 'Do you sell medicine(Question)' with Zira.mp4 - Video - October 24th, 2014
- Chinese Medicine Coral Springs, Herbal Medicine Coral Springs, Homeopathy Coral Springs - Video - October 24th, 2014
- 2014 10 23 11 02 3D Nanofiber Scaffolds for Regenerative Medicine - Video - October 24th, 2014
- Crossover Drill Continuous Medicine Ball Leg Glute Exercise - Video - October 24th, 2014
- Chan Soon-Shiong Institute for Molecular Medicine and the University of Oxford Establish Partnership to Create the ... - October 24th, 2014
- Quartet Medicine Launches with $17 Million Series A Financing - October 24th, 2014
- Cenovus donates $450,000 to Medicine Hat School District - October 24th, 2014
- University of Chicago Medicine Partners with BroadcastMed to Launch Digital Education Center for Medical Professionals - October 24th, 2014
- Chinese Patent Medicine Market Trends Analysis and 2018 Forecasts - October 24th, 2014
- Chinese medicine offers different options to treating breast cancer - October 24th, 2014
- Acupuncture and Oriental Medicine Day Open House - October 24th, 2014
- China's claims it has discovered a miricale Ebloa cure. It is a hoax? - Video - October 22nd, 2014
- News, Content and Resources on Alternative Medicine - Video - October 22nd, 2014
- Books and Resources on Alternative Medicine - Video - October 22nd, 2014
- Products and Reviews on Alternative Medicine - Video - October 22nd, 2014
- Why place and well-being are at the new frontier of medicine | Dr. Esther Sternberg | TEDxUTA - Video - October 22nd, 2014
- Family Medicine Coffee with the Residents What Makes a Good Doctor Getzin - Video - October 22nd, 2014
- Laughter is Medicine - Video - October 22nd, 2014
- Integrative Medicine What is acupuncture and how is it used - Video - October 22nd, 2014
- trainer Chris Smith's Medicine Ball Ab Workout - Video - October 22nd, 2014
- Educare de Spiritus Webinar about Alchemy, Esotericism, Meditation and Medicine Part 2 (Revisiting) - Video - October 22nd, 2014
- Cute Overload! Pandas dont want to take their medicine - Video - October 22nd, 2014
- Brand New 2015 GMC Canyon SLT for sale in Medicine Hat - Video - October 22nd, 2014
- Campania: medicine meno care dal 2015 - Video - October 22nd, 2014
- Modernizing Medicine Co-Founders Daniel Cane and Dr. Michael Sherling Honored with Leadership in Health Care Award by ... - October 22nd, 2014
- Foundation Medicine and WuXi PharmaTech Announce Strategic Collaboration to Offer Best-in-Class Comprehensive Genomic ... - October 22nd, 2014
- Ross University School of Veterinary Medicine and Ngee Ann Polytechnic Strengthen International Ties - October 22nd, 2014
- New AAFP President Emphasizes, Epitomizes Full-Scope Family Medicine - October 22nd, 2014
- Case Western Reserve University School of Medicine Dean, Department Chair Elected to Prestigious Institute of Medicine - October 22nd, 2014
- EHE International Certifies Internal Medicine Consultants of Northwest Indiana as Its Newest Partner - October 22nd, 2014
- Case Western Reserve University School of Medicine dean, department chair elected to IOM - October 22nd, 2014
- Lack of children's medicine in China - China Take - Oct 17 ,2014 - BONTV China - Video - October 21st, 2014
- SOUL MEDICINE EP1 - Video - October 21st, 2014
- Nahko & Medicine for the People- Manifesto (subttulos en espaol) - Video - October 21st, 2014
- Indian Medicine Studies Counselling Started in Chennai - Dinamalar Oct 17th News - Video - October 21st, 2014
- Download Creasy and Resnik's Maternal Fetal Medicine 7th PDF - Video - October 21st, 2014
- IT SMELLS LIKE MEDICINE - The Evil Within Part 2 - Video - October 21st, 2014
- Gem and cure Alternative Medicine - Gemstones - Video - October 21st, 2014
- Very Funny Baby Video Clip Taking Medicine ! Hahaha - Video - October 21st, 2014
- Medicine Buddha- Malika Sellami, Kalki & Synchroshakti (Prod. By Malika Sellami) - Video - October 21st, 2014
- 1: The Adventures Of Sonny & Buddy - The Medicine Show - Video - October 21st, 2014