Fatal pyrrolizidine alkaloid poisoning of infants caused by adulterated Senecio coronatus.

Senecio coronatus (known as izonkozonko and ubulibazi in Zulu) is commonly used in traditional medicine in South Africa as purification purgative and enemas for infants during weaning. We show for the first time that this species does not contain pyrrolizidine alkaloids and that reported cases of fatal hepatic sinusoidal obstruction syndrome in infants were caused by wrongly identified Senecio species containing large amounts of retrorsine-N-oxide. A validated ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method for the detection and quantitation of pyrrolizidine alkaloids is described.

Tu-San-Qi (Gynura japonica): the culprit behind pyrrolizidine alkaloid-induced liver injury in China.

Herbs and dietary supplement-induced liver injury (HILI) is the leading cause of drug-induced liver injury in China. Among different hepatotoxic herbs, the pyrrolizidine alkaloid (PA)-producing herb Gynura japonica contributes significantly to HILI by inducing hepatic sinusoidal obstruction syndrome (HSOS), a liver disorder characterized by hepatomegaly, hyperbilirubinemia, and ascites. In China, G. japonica has been used as one of the plant species for Tu-San-Qi and is often misused with non-PA-producing Tu-San-Qi (Sedum aizoon) or even San-Qi (Panax notoginseng) for self-medication. It has been reported that over 50% of HSOS cases are caused by the intake of PA-producing G. japonica. In this review, we provide comprehensive information to distinguish these Tu-San-Qi-related herbal plant species in terms of plant/medicinal part morphologies, medicinal indications, and chemical profiles. Approximately 2156 Tu-San-Qi-associated HSOS cases reported in China from 1980 to 2019 are systematically reviewed in terms of their clinical manifestation, diagnostic workups, therapeutic interventions, and outcomes. In addition, based on the application of our developed mechanism-based biomarker of PA exposure, our clinical findings on the definitive diagnosis of 58 PA-producing Tu-San-Qi-induced HSOS patients are also elaborated. Therefore, this review article provides the first comprehensive report on 2214 PA-producing Tu-San-Qi (G. japonica)-induced HSOS cases in China, and the information presented will improve public awareness of the significant incidence of PA-producing Tu-San-Qi (G. japonica)-induced HSOS and facilitate future prevention and better clinical management of this severe HILI.

Hepatotoxic Plants that Poison Livestock.

The liver is one of the most commonly affected organs by ingested toxicants. This article familiarizes veterinarians with clinical signs, serum biochemistry changes, necropsy findings, and field information found in livestock poisonings with hepatotoxic plants. The focus is on the most common plant-derived hepatotoxins important to livestock in North America. Pyrrolizidine alkaloids are covered in greater detail than the other toxins, because they are likely the most important plant-derived toxins worldwide in livestock, wildlife, and even human exposure. Additionally, many of the principles discussed regarding clinical diagnosis of pyrrolizidine alkaloid intoxication can be applied to the other poisonous plants listed.

Toxicoproteomic assessment of liver responses to acute pyrrolizidine alkaloid intoxication in rats.

A toxicoproteomic study was performed on liver of rats treated with retrorsine (RTS), a representative hepatotoxic pyrrolizidine alkaloid at a toxic dose (140 mg/kg) known to cause severe acute hepatotoxicity. By comparing current data with our previous findings in mild liver lesions of rats treated with a lower dose of RTS, seven proteins and three toxicity pathways of vascular endothelial cell death, which was further verified by observed sinusoidal endothelial cell losses, were found uniquely associated with retrorsine-induced hepatotoxicity. This toxicoproteomic study of acute pyrrolizidine alkaloid intoxication lays a foundation for future investigation to delineate molecular mechanisms of pyrrolizidine alkaloid-induced hepatotoxicity.

Presumptive chronic pyrrolizidine alkaloid poisoning in 2 pygmy goats due to ingestion of tansy ragwort (Jacobaea vulgaris) in southwestern British Columbia.

Two pygmy goats from a herd of 3 animals in British Columbia died within 24 hours of exhibiting lethargy. Histopathology revealed liver failure and tansy ragwort (Jacobaea vulgaris) was discovered in the goats' pasture. Goats are typically resistant to the toxic effects of tansy ragwort. This is the first report of presumed tansy ragwort toxicity in goats in North America.

Empoisonnement chronique présumé par l'alcaloïde de type pyrrolizidine chez 2 chèvres pygmées causé par l'ingestion du séneçon jacobée(Jacobaea vulgaris)dans le sud-ouest de la Colombie-Britannique. Deux chèvres pygmées provenant d'un troupeau de trois animaux en Colombie-Britannique sont mortes 24 heures après avoir manifesté de la léthargie. L'histopathologie a révélé une insuffisance hépatique et du séneçon jacobée (Jacobaea vulgaris) a été découvert dans le pâturage des chèvres. Les chèvres sont habituellement résistantes aux effets toxiques du séneçon jacobée. Il s'agit du premier rapport d'une toxicité présumée causée par le séneçon jacobée chez des chèvres en Amérique du Nord.(Traduit par Isabelle Vallières).

Senecio grisebachii Baker: Pyrrolizidine alkaloids and experimental poisoning in calves.

The main objectives of this study were to determine the 1,2-dehydropyrrolizidine alkaloid (DHPA) content in Senecio grisebachii Baker (Compositae), to experimentally demonstrate its toxicity in calves and to describe the main clinical and pathological findings of this toxicity. S. grisebachii plants were collected in Paysandú, Uruguay. The concentration and identification of DHPA and associated N-oxides were determined using liquid chromatography-mass spectrometry. Three calves weighing 85-89 kg received doses of 15, 24 or 45 g of dry S. grisebachii per kg of body weight for 6, 10 or 20 days of treatment, respectively. Two animals received no treatment and served as controls. The animals were clinically evaluated, and blood samples were taken to study the serum levels of gamma glutamyltransferase (GGT), aspartate aminotransferase (AST) and alkaline phosphatase (FAS). After death, necropsy was performed and organ samples were taken for histopathological examination. The concentration of DHPA in S. grisebachii was found to be 0.29% (dry weight basis) as free base and 0.08% as N-oxide for a total DHPA concentration of 0.37%. Individual alkaloids identified included seneciophylline, senecionine and retrorsine. The disease was clinically characterized by depression, anorexia, emaciation, colic, dehydration and death in the three animals. Serum concentrations of GGT, AST and FAS were higher than normal beginning on day 7 after start of treatments. Necropsy findings included generalized edema, hemorrhage, ascites and a grayish liver with increased consistency. The main histological lesions were hepatic necrosis, fibrosis, hepatomegalocytosis and bile duct proliferation. The control calves showed no clinical signs of disease.

A field investigation into a suspected outbreak of pyrrolizidine alkaloid toxicosis in horses in western Queensland.

A disease outbreak investigation was conducted in western Queensland to investigate a rare suspected outbreak of pyrrolizidine alkaloid (PA) toxicosis in horses. Thirty five of 132 horses depastured on five properties on the Mitchell grass plains of western Queensland died in the first six months of 2010. Clinical-pathological findings were consistent with PA toxicosis. A local variety of Crotalaria medicaginea was the only hepatotoxic plant found growing on affected properties. Pathology reports and departure and arrival dates of two brood mares provided evidence of a pre wet season exposure period. All five affected properties experienced a very dry spring and early summer preceded by a large summer wet season. The outbreak was characterised as a point epidemic with a sudden peak of deaths in March followed by mortalities steadily declining until the end of June. The estimated morbidity (serum IGG>50IU/L) rate was 76%. Average crude mortality was 27% but higher in young horses (67%) and brood mares (44%). Logistic regression analysis showed that young horses and brood mares and those grazing denuded pastures in December were most strongly associated with dying whereas those fed hay and/or grain based supplements were less likely to die. This is the first detailed study of an outbreak of PA toxicosis in central western Queensland and the first to provide evidence that environmental determinants were associated with mortality, that the critical exposure period was towards the end of the dry season, that supplementary feeding is protective and that denuded pastures and the horses physiological protein requirement are risk factors.

Pulmonary and hepatic lesions caused by the dehydropyrrolizidine alkaloid-producing plants Crotalaria juncea and Crotalaria retusa in donkeys.

The effects and susceptibility of donkeys to Crotalaria juncea and Crotalaria retusa poisoning were determined at high and low doses. Seeds of C. juncea containing 0.074% of dehydropyrrolizidine alkaloids (DHPAs) (isohemijunceines 0.05%, trichodesmine 0.016%, and junceine 0.008%) were administered to three donkeys at 0.3, 0.6 and 1 g/kg body weight (g/kg) daily for 365 days. No clinical signs were observed and, on liver and lung biopsies, the only lesion was a mild liver megalocytosis in the donkeys ingesting 0.6 and 1 g/kg/day. Two other donkeys that received daily doses of 3 and 5 g seed/kg showed initial respiratory signs 70 and 40 days after the start of the administration, respectively. The donkeys were euthanized following severe respiratory signs and the main lung lesions were proliferation of Clara cells and interstitial fibrosis. Three donkeys ingested seeds of C. retusa containing 5.99% of monocrotaline at daily doses of 0.025, 0.05 and 0.1 g/kg for 365 days. No clinical signs were observed and, on liver and lung biopsies, the only lesion was moderate liver megalocytosis in each of the three donkeys. One donkey that received a single dose of 5 g/kg of C. retusa seeds and another that received 1 g/kg daily for 7 days both showed severe clinical signs and died with diffuse centrilobular liver necrosis. No lung lesions were observed. Another donkey that received a single dose of 2.5 g/kg of C. retusa seeds showed no clinical signs. The hepatic and pneumotoxic effects observed are consistent with an etiology involving DHPAs. Furthermore, the occurrence of lung or liver lesions correlates with the type of DHPAs contained in the seeds. Similarly as has been reported for horses, the data herein suggest that in donkeys some DHPAs are metabolized in the liver causing liver disease, whereas others are metabolized in the lung by Clara cells causing lung disease.

Crotalariosis equorum ("jaagsiekte") in horses in southern Mozambique, a rare form of pyrrolizidine alkaloid poisoning.

Twenty-eight horses in southern Mozambique died after exhibiting severe respiratory distress. At necropsy, the overinflated lungs did not collapse, had prominent rib impressions, and were fibrotic and emphysematous. Microscopically, prominent proliferation of nonciliated epithelial (Clara) cells in the terminal bronchioles and pulmonary fibrosis were observed, indicative of chronic pneumotoxicity. Transmission electron microscopy demonstrated hyperplasia, desquamation, and apical bulging of Clara cells into the bronchiolar lumen. The outbreak was attributed to ingestion of Crotalaria dura J.M. Wood & M.S. Evans subsp. mozambica Polhill and Crotalaria monteiroi Taub. ex Baker f. var. monteiroi. Semiquantitative gas chromatography-mass spectrometry revealed the presence of pyrrolizidine alkaloids in these 2 Crotalaria species.

[Pyrrolizidine alkaloids and seneciosis in farm animals. Part 1: occurrence, chemistry and toxicology]. / Pyrrolizidinalkaloide und die Seneciose bei Tieren. Teil 1: Vorkommen, Chemie, Toxikologie.

Pyrrolizidine alkaloids belong to a class of phytotoxins which are present in more than 6000 plant species. The disease seneciosis in farm animals represents the severe poisoning by pyrrolizidine alkaloids from plants of the genus Senecio. This form of poisoning has been known since the end of the 19th century in Germany, the USA, Canada and New Zealand, and is mainly caused by Senecio jacobaea and related Senecio spp. in farm animals, including poultry. Animal poisoning by pyrrolizidine alkaloids is of worldwide importance. In Germany poisoning of horses and cattle by Senecio jacobaea, which was earlier named Schweinsberg disease, is of renewed relevance for veterinary medicine. The disease occurs almost entirely as a consequence of chronic poisoning and in general ends fatally. The ultimate cause is the formation of toxic metabolites of pyrrolizidine alkaloids in the liver, and their covalent binding to nucleic acids and proteins leading to liver cirrhosis. Because many pyrrolizidine alkaloids possess mutagenic, and a few also carcinogenic properties, European and international authorities are concerned about possible residue levels in food of animal origin. The review addresses in its first part several aspects, being the occurrence, the chemistry, and the toxicology of pyrrolizidine alkaloids as well as animal intoxications by poisonous plants. In the second part (46) clinical characteristics of animal seneciosis, the therapeutic interventions, the significant species differences and a critical assessment of so-called nontoxic amounts of Senecio plants in animal fodder with reference to cumulative lethal toxin doses are presented.

[Pyrrolizidine alkaloids and seneciosis in farm animals. Part 2: clinical signs, species-specific sensitivity, food residues, feed contamination, limit values]. / Pyrrolizidinalkaloide und die Seneciose bei Tieren. Teil 2: Klinik, Speziesunterschiede, Rückstandsverhalten, Futtermittelkontamination und Grenzwerte.

At the forefront of pyrrolizidine alkaloid (PA) poisoning is the chronic ingestion of contaminated hay, which causes liver damage resulting in an ongoing fatal liver cirrhosis or in the veno-occlusive disease in liver or lung, respectively. The symptomatology of PA-poisoning is not identical for all animal species, and also includes central nervous symptoms. In affected horses significantly elevated levels of hepatogenic serum enzymes and an increase of the retention time for bromosulfophthalein indicates the fatal outcome of the intoxication. Chronic seneciosis of horses is incurable. Rabbits, Japanese quails, and guinea pigs are regarded as poison-resistant species. Sheep and in particular goats are insensitive unless extremely high amounts of plants which exceed the animal's body weight by several-fold are ingested. In contrast, pigs, cattle, and horses as well as chicken and likewise man are very sensitive to poisonings by PA-containing plants. In sensitive animal species a very small amount of contaminated dry hay is needed to exceed the daily dose of 1µg/kg body weight PA which is taken as harmless for man by health authorities. Therefore, all feed with visible pieces of Senecio jacobaea plants are not acceptable as animal fodder and should be destroyed.

Crotalaria medicaginea associated with horse deaths in northern Australia: new pyrrolizidine alkaloids.

Crotalaria medicaginea has been implicated in horse poisoning in grazing regions of central-west Queensland, which resulted in the deaths of more than 35 horses from hepatotoxicosis in 2010. Liver pathology was suggestive of pyrrolizidine alkaloidosis, and we report here the isolation of two previously uncharacterized pyrrolizidine alkaloids from C. medicaginea plant specimens collected from pastures where the horses died. The first alkaloid was shown by mass spectometric and NMR analyses to be 1ß,2ß-epoxy-7ß-hydroxy-1α-methoxymethyl-8α-pyrrolizidine, which, like other alkaloids previously isolated from C. medicaginea, lacks the requisite functionality for hepatotoxcity. The second alkaloid isolated in this investigation was a new macrocyclic diester of otonecine, which we have named cromedine. The (1)H and (13)C NMR spectra of cromedine were fully assigned by 2D NMR techniques and allowed the constitution of the macrocyclic diester to be assigned unambiguously. C. medicaginea specimens implicated in this investigation do not belong to any of the three recognized Australian varieties (C. medicaginea var. neglecta, C. medicaginea var. medicaginea, and C. medicaginea var. linearis) and appear to be a local variant or form, referred to here as C. medicaginea (chemotype cromedine).

The ecological context of pyrrolizidine alkaloids in food, feed and forage: an overview.

Plant-produced 1,2-dehydropyrrolizidine ester alkaloids and their N-oxides (PAs) not only cause acute poisoning of humans and livestock, but also the likely harmful cryptic effects of chronic exposure pose particular food safety risks that need to be addressed for consumer protection. In natural contexts, however, PAs cause few or no problems. Rather, these plant secondary metabolites are important elements of ecosystems and plant-animal relationships; the existence and persistence of many PA-adapted organisms, in various ways, depends on the presence of PA-containing plants or even on PAs as such. PA plants are widely distributed among unrelated families of the plant kingdom; there is great structural diversity of PAs, and the amounts of PAs produced are subject to great variation due to multiple causes. These realities, coupled with many deficiencies in our scientific understanding, make the presence and roles of PAs in nature a subject with limited potential for valid generalisations and predictions, and complex and difficult to summarise. PAs, their producer plants and their users are integral parts of ecosystems worldwide, and we have to learn to live with these allelochemicals by accepting the presence of some harmful natural chemicals in the environment and by taking regulatory action to reduce health risks to humans. Regulations for consumer protection are long overdue. However, any such measures must be flexible enough to accommodate the findings of future research. Transdisciplinary efforts are required to fill gaps in the knowledge and to come up with additional means to monitor the presence of PAs in food and feed.

Plants containing pyrrolizidine alkaloids: toxicity and problems.

Pyrrolizidine alkaloids (PA) are toxic for human and livestock. They undergo a metabolic toxication process in the liver which is the first target organ for PA poisoning. Worldwide many episodes of human PA intoxications are well reported. In many cases the reason for these intoxications has been PA contamination in food. The main tools for analysing food and fodder on PA content are based on GC and HPLC separation, followed by MS(-MS) detection. Actual incidents with toxic PA are the 'Jacobaea vulgaris (syn. Senecio jacobaea) problem' in Europe and the 'Ageratum conyzoides problem' in Ethiopia.

Pyrrolizidine alkaloid toxicity in livestock: a paradigm for human poisoning?

Livestock poisoning, primarily liver damage, caused by consumption of plants containing 1,2-dehydropyrrolizidine ester alkaloids (dehydroPAs), and the corresponding N-oxides, is a relatively common occurrence worldwide. Because of the economic impact, extensive investigations of such episodes have been performed, particularly in Australia, South Africa the United States and, more recently, South America. Plant species most commonly involved are members of the families Boraginaceae, Asteraceae and Leguminosae. These may be native species that periodically flourish under particular climatic conditions or introduced species that thrive in the absence of natural control factors such as herbivory and competition. Contamination of grain crops with dehydroPA-producing plants has resulted in large-scale incidents of food poisoning in humans, with high morbidity and mortality, especially in Africa and in central and south Asia, with recent episodes in Afghanistan and possibly Ethiopia. Attention has recently focused on the potential for low levels of dehydroPAs to contaminate many food products in developed countries, possibly leading to progressive, chronic diseases that may not include overt hepatotoxicity. This overview examines the potential for better control of exposure and means of monitoring dehydroPA intake by extrapolation of knowledge gained from animal studies to the human situation.

Pyrrolizidine alkaloids in food: a spectrum of potential health consequences.

Contamination of grain with 1,2-dehydropyrrolizidine ester alkaloids (dehydroPAs) and their N-oxides is responsible for large incidents of acute and subacute food poisoning, with high morbidity and mortality, in Africa and in central and south Asia. Herbal medicines and teas containing dehydroPAs have also caused fatalities in both developed and developing countries. There is now increasing recognition that some staple and widely consumed foods are sometimes contaminated by dehydroPAs and their N-oxides at levels that, while insufficient to cause acute poisoning, greatly exceed maximum tolerable daily intakes and/or maximum levels determined by a number of independent risk assessment authorities. This suggests that there may have been cases of disease in the past not recognised as resulting from dietary exposure to dehydroPAs. A review of the literature shows that there are a number of reports of liver disease where either exposure to dehydroPAs was suspected but no source was identified or a dehydroPA-aetiology was not considered but the symptoms and pathology suggests their involvement. DehydroPAs also cause progressive, chronic diseases such as cancer and pulmonary arterial hypertension but proof of their involvement in human cases of these chronic diseases, including sources of exposure to dehydroPAs, has generally been lacking. Growing recognition of hazardous levels of dehydroPAs in a range of common foods suggests that physicians and clinicians need to be alert to the possibility that these contaminants may, in some cases, be a possible cause of chronic diseases such as cirrhosis, pulmonary hypertension and cancer in humans.

Fireweed (Senecio madagascariensis) poisoning in cattle / Intoxicação natural por Senecio madagascariensis (Asteraceae) em bovinos

In a dairy cattle herd in southern Brazil, 7 out of 554 cattle were affected and died due to Senecio madagascariensis poisoning. Clinical, pathological, and epidemiological findings in the affected cattle were indistinguishable from those usually seen in poisoning caused by other Senecio species. The plant invaded extensive areas in heavily stocked paddocks. Senecio madagascariensis had been spreading in this farm for the last three years, with no control strategy, because neither the farmers nor the local veterinarian knew about the potential risks of this Sernecio species.

Em um rebanho bovino leiteiro no Rio Grande do Sul, sete de 554 bovinos foram afetados e morreram devido à intoxicação por Senecio madagascariensis. Aspectos clínicos, patológicos e epidemiológicos observados nos bovinos afetados foram indistinguíveis daqueles usualmente observados em casos de intoxicações por outras espécies de Senecio. A planta invadiu extensas áreas em potreiros mantidos constantemente com altas lotações de bovinos. Senecio madagascariensis esteve se estabelecendo nesta propriedade pelos últimos três anos, sem que qualquer medida de controle fosse adotada pela equipe técnica do estabelecimento, que desconhecia o potencial tóxico dessa espécie de Senecio.

Poisoning of sheep by seeds of Crotalaria retusa: acquired resistance by continuous administration of low doses.

Seeds of Crotalaria retusa containing 6.84% (dry weight) of monocrotaline (MCT) were administered experimentally to sheep. Three sheep that received 136.8mg MCT/kg bw daily for 70 days had no clinical signs. Five out of six sheep ingesting single doses of 205.2 and 273.6mg MCT/kg bw died with acute (three sheep) or chronic intoxication (two sheep). Acute intoxicated sheep had periacinar liver necrosis and chronic intoxicated sheep liver fibrosis and megalocytosis. Another three sheep had no clinical signs after the ingestion of 20 daily doses of 136.8mg MCT/kg, followed by seven doses of 273.6mg MCT/kg, and one single dose of 342mg MCT/kg. These experiments demonstrated that sheep are susceptible to acute intoxication by MCT being intoxicated by a single oral dose of approximately 205.2mg/kg. In contrast, they develop strong resistance to MCT after the daily ingestion of non lethal doses (136.8mg/kg). It is suggested that chronic poisoning does not occur by the repeated ingestion of non acutely toxic doses, but probably by the ingestion of single toxic doses. It is also suggested that sheep do not become intoxicated with the ingestion of C. retusa in the vegetative non-seeding stage.