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Grayanotoxin
From Wikipedia, the free encyclopedia
Grayanotoxins are a group of closely related
neurotoxins named after
Leucothoe grayana, a plant native to Japan originally named for 19th century American botanist
Asa Gray.
[1] Grayanotoxin I (grayanotaxane-3,5,6,10,14,16-hexol 14-acetate) is also known as
andromedotoxin,
acetylandromedol,
rhodotoxin and
asebotoxin.
[2] Grayanotoxins are produced by
Rhododendron species and other plants in the
Ericaceae family.
Honey made from the
pollen and
nectar of these plants also contains grayanotoxins and is commonly referred to as mad honey. Consumption of the plant or any of its secondary products, including mad honey, can cause a very rare poisonous reaction called grayanotoxin poisoning, mad honey disease, honey intoxication, or rhododendron poisoning.
[3] It is most frequently produced and consumed in regions of
Nepal and
Turkey as a recreational drug and traditional medicine.
[4]
Biological Effects
Prolonged sodium channel activation and cell depolarization leads to overstimulation of the
central nervous system. Physical symptoms from grayanotoxin poisoning appear after a dose-dependent latent period of several minutes to approximately three hours. The most common clinical symptoms include various cardiovascular effects,
nausea and vomiting, and a change in consciousness. The cardiovascular effects may include
hypotension (low blood pressure) and various cardiac rhythm disorders such as
sinus bradycardia (slow regular heart rhythm),
bradyarrhythmia (slow irregular heart rhythm) and partial or complete
atrioventricular block.
[5][8]
Other early-onset symptoms may include
diplopia and blurred vision, dizziness,
hypersalivation, perspiration, weakness and
paresthesia in the extremities and around the mouth. In higher doses, symptoms can include loss of coordination, severe and progressive muscular weakness,
electrocardiographic changes of
bundle branch block and/or
ST-segment elevations as seen in ischemic myocardial threat, and nodal rhythm or
Wolff-Parkinson-White syndrome.
[9]
The primary mediator of this grayanotoxin
pathophysiology is the paired
vagus nerve (tenth cranial nerve).
[5] The vagus nerve is a major component of the
parasympathetic nervous system (a branch of the
autonomic nervous system) and innervates various organs including the lungs, stomach, kidney and
heart. In one study, experimental administration of grayanotoxin to bilaterally vagotomized rats failed to induce
bradycardia, a common symptom of grayanotoxin poisoning, supporting the role of vagal stimulation.
[10] Vagal stimulation of the
myocardium, specifically, is mediated by
M2-subtype muscarinic acetylcholine receptors (mAChR).
[11] In severe cases of grayanotoxin poisoning,
atropine (a non-specific mAChR
antagonist) can be used to treat bradycardia and other heart rhythm malfunctions. In addition to correcting rhythm disorders, administration of fluids and
vasopressors can also help treat hypotension and mitigate other symptoms.
[12]
Patients exposed to low doses of grayanotoxin typically recover within a few hours. In more severe cases, symptoms may persist for 24 hours or longer and may require medical treatment (as described above). Despite the risk cardiac problems, grayanotoxin poisoning is rarely fatal in humans.
[12]
https://en.wikipedia.org/wiki/Grayanotoxin