Antidotes Against Methanol Poisoning: A Review.

Methanol is the simplest alcohol. Compared to ethanol that is fully detoxified by metabolism. Methanol gets activated in toxic products by the enzymes, alcohol dehydrogenase and aldehyde dehydrogenase. Paradoxically, the same enzymes convert ethanol to harmless acetic acid. This review is focused on a discussion and overview of the literature devoted to methanol toxicology and antidotal therapy. Regarding the antidotal therapy, three main approaches are presented in the text: 1) ethanol as a competitive inhibitor in alcohol dehydrogenase; 2) use of drugs like fomepizole inhibiting alcohol dehydrogenase; 3) tetrahydrofolic acid and its analogues reacting with the formate as a final product of methanol metabolism. All the types of antidotal therapies are described and how they protect from toxic sequelae of methanol is explained.

[EFFECT OF 4-METHYLPYRAZOLE ON IMMUNE RESPONSE, FUNCTION OF Th1 AND Th2 LYMPHOCYTES, AND CYTOKINE CONCENTRATION IN RAT BLOOD AFTER ACUTE METHANOL POISONING].

It was established in experiments on noninbred albino rats that the acute intoxication with methanol (1.0 LD50) decreased cellular and humoral immune responses, Th2-lymphocyte activity (to a greater extent as compared to the function of Th1 cells), reduced the blood concentration of immunoregulatory (IFN-g, IL-2, IL-4) and proinflammatory (TNF, IL-1b, IL-6) cytokines on the average by 36.5% (p < 0.05), and did not affect the content of anti-inflammatory cytokines (IL-10, IL-13). Methanol antidote 4-methylpyrazole (non-competitive inhibitor of alcohol dehydrogenase) administered upon acute intoxication with methanol at a dose of 1.0 DL50 partially reduces the intoxication-induced suppression of humoral and cellular immune response, activity of T-helper cells, and production of IL-4 and restores blood levels of TNF, IL-1b, IFN-γ, IL-4, IL-2, IL-6 to the control values.

Ammonia displaces methanol bound to the water oxidizing complex of photosystem II in the S2 state.

Ammonia and methanol both bind to the water oxidising complex of photosystem II during its turnover, possibly at sites where water binds during the normal water oxidation process. We have investigated the interaction between these two water analogues at the S2 state of the water oxidising cycle using electron magnetic resonance techniques. We find evidence that ammonia displaces methanol from its binding site.

Inhibitory effects in the side reactions occurring during the enzymic synthesis of amoxicillin: p-hydroxyphenylglycine methyl ester and amoxicillin hydrolysis.

Penicillin G acylase immobilized on glyoxyl-agarose is used to catalyse the reaction between p -hydroxyphenylglycine methyl ester (POHPGME) and 6-aminopenicillanic acid (6-APA). Inhibitory effects affecting the side reactions that occur during the synthesis of amoxicillin have been reported and need to be considered when proposing a kinetic model for the enzymic synthesis. In this work, we present a semi-empirical kinetic model that successively includes different inhibitory effects in the rate equations. The model performance was always compared with experimental data on amoxicillin synthesis. Enzyme load and stirring rate were chosen to prevent diffusional effects. Our results indicate that POHPGME and amoxicillin were competitive inhibitors of the hydrolysis of amoxicillin and POHPGME, respectively. 6-APA was a competitive inhibitor of the hydrolysis of amoxicillin. POHPG was a competitive inhibitor and methanol a non-competitive inhibitor of the hydrolysis of both ester and antibiotic, but the action of methanol was only noticeable at very high concentrations. Adding inhibitory effects to the kinetic model led to a significant increase in the accuracy of the simulations of the overall process of synthesis.

[Bilateral optic neuropathy in acute methanol intoxication. A case report]. / Neuropathie optique bilatérale par intoxication aiguë au méthanol. A propos d'un cas.

We report a case of methanol blindness. Ophthalmoscopic examination disclosed swelling in the disc margins extending along the adjacent retinal nerve fiber layer. Although this optic neuropathy is now rare, prompt diagnosis and proper treatment in the acute phase can dramatically improve the prognosis.

Ethanol and N-acetylcysteine influence on the development of liver changes in experimental methanol intoxication.

The evaluation of ethanol and N-Acetylcysteine (NAC) influence on histopathological changes in rat liver intoxicated with 3 g of methanol/kg b.w. was conducted, based on morphological examinations in light and electron microscope. The rats received intragastrically 3.0 g of methanol/kg b.w. as a 50% solution, 10% ethanol for 24 hours before methanol and next 48 hours after methanol ingestion and NAC (150 mg/kg b.w.) after 15 min. methanol administrated. The results indicate that methanol intoxication causes pronounced morphological changes in the examined organ. Ethanol administered to methanol-intoxicated rats caused intensification of certain parameters of hepatocytes morphological damage. A simultaneous administration of methanol and NAC resulted in a lower degree of parenchymal damage.

Reversal of severe methanol-induced visual impairment: no evidence of retinal toxicity due to fomepizole.

CASE REPORT: We report a case of methanol poisoning exhibiting complete recovery from severe visual impairment following treatment with ethanol, fomepizole, and hemodialysis. An adult male presented with central blindness after ingesting methanol. Initial visual acuity was <20/800 (finger counting at 1-2 feet) with retinal edema on fundoscopy, arterial pH 7.19, methanol 97 mg/dL (30 mmol/L), formate 14.3 mmol/L, and ethanol undetectable. The patient was treated with ethanol, then fomepizole intravenously (15, 10, then 5 mg/kg), and hemodialysis. Methanol metabolism was effectively blocked by fomepizole even after ethanol had been eliminated, and the patient recovered 20/20 vision by day 14 with normal fundoscopy. This case report confirms highly efficient inhibition of alcohol dehydrogenase by fomepizole, as well as demonstrate the safety of fomepizole in a patient already exhibiting end-organ retinal toxicity. The potential for fomepizole to inhibit retinol dehydrogenase, an isoenzyme of alcohol dehydrogenase essential to vision, did not appear to be clinically significant in this symptomatic methanol-poisoned patient.

Antidotes and alcohols: has Fomepizole made Ethanol an obsolete therapy?

It discusses the positive and negative aspects of the use of Fomepizole (4-methylpyrazole), in comparison with the etanol use, as antidote against poisoning for etilenoglicol and methanol. It presents bibliographical references. Published in Internet Journal of Medical Toxicology, v.1, n.1, p.2, 1988.

Modification of methanol potentiation of CCl4 toxicity in rats by chloramphenicol and salicylate.

The mechanisms by which methanol potentiates CCl4 hepatotoxicity was studied in rats. Chloramphenicol, an inhibitor of cytochrome P-450, blocked the increase of serum glutamate-oxaloacetate transaminase activity enhanced by methanol pretreatment of rats exposed to CCl4. Chloramphenicol also decreased microsomal lipid peroxidation in both CCl4 and methanol-pretreated, CCl4-intoxicated animals when measured 30 minutes after exposure. Chloramphenicol prevented the loss of glucose 6-phosphatase activity after CCl4 and methanol. Sodium salicylate, which lowers the level of NADPH in the hepatocyte, blocked methanol potentiation of CCl4 damage as measured by the elevation of serum GOT activity. Therefore, methanol may potentiate CCl4 hepatotoxicity by stimulation of CCl4 bioactivation by cytochrome P-450 via an increase in the level of reduced NAD(P)H in the liver.

Methanol toxicity: treatment with folic acid and 5-formyl tetrahydrofolic acid.

After methanol administration to monkeys, an accumulation of formate in blood occurs coincident with the development of metabolic acidosis and a depletion of blood bicarbonate. Formate metabolism in monkeys depends upon and is regulated by a folate-dependent system; therefore, the effect of folic acid pretreatment and 5-formyl tetrahydrofolic acid administration on methanol toxicity was investigated. Treatment of monkeys with repetitive doses of either sodium folate (48, 24, 12, and 4 hr prior to methanol) or 5-formyl tetrahydrofolic acid (2 mg/kg at 0, 4, 8, 12, and 18 hr after methanol) resulted in a marked decrease in the levels of blood formate and an absence of both metabolic acidosis and depletion of blood bicarbonate following methanol administration. Also, 5-formyl tetrahydrofolic acid reversed methanol toxicity once it was established in the monkey. The results indicate that folate compounds decrease formate accumulation after methanol by stimulating formate oxidation or utilization and suggest a possible use for folates in the treatment of certain cases of human methanol poisoning.

Studies on methanol dehydrogenase from Hyphomicrobium X. Isolation of an oxidized form of the enzyme.

1. Double-reciprocal plots of initial reaction rates of methanol dehydrogenase [alcohol--(acceptor) oxidoreductase, EC 1.1.99.8] in vitro show patterns of parallel lines. The results with various methanol, ammonia and phenazine methosulphate concentrations can be described by an equation valid for a Ping Pong kinetic mechanism with three reactants. 2. The overall maximum velocity was the same for several primary alcohols, C(2)-deuterated ethanols and different electron acceptors, but it was significantly lower for C(1)-deuterated substrates. 3. Oxidation of the isolated enzyme with electron acceptors required the presence of ammonia and a high pH. The inclusion of cyanide or hydroxylamine during the incubation was essential to prevent enzyme inactivation. The absorbance spectrum of an oxidized form of the enzyme was clearly different from that of the isolated enzyme and the free radical was no longer present. On addition of substrate, the original absorption spectrum and electron-spin-resonance signal reappeared and a concomitant substrate oxidation was found. This reaction could be carried out at pH 7 and ammonia was not required. 4. Based on the activity of the enzyme with one-electron acceptors, the presence of a free radical and the kinetic behaviour, an oxidation of the enzyme via one-electron steps is proposed.

Pyrazoles as inhibitors of alcohol oxidation and as important tools in alcohol research: an approach to therapy against methanol poisoning.

4-Methylpyrazole, in a dose producing inhibition of alcohol dehydrogenase (alcohol:NAD(+) oxidoreductase, EC 1.1.1.1), was given alone or together with ethanol (10%) as sole drinking fluid to growing rats for up to 38 weeks. Their weight curves remained normal. Electron microscopy of liver, kidney, and heart revealed no changes related to treatment. Hematologic analysis showed normal values for blood and bone marrow. Several clinical chemical parameters showed no impairment of liver or kidney function, except for an enhancement of the microsomal drug-metabolizing activity after concurrent administration of 4-methylpyrazole and ethanol. A study on rats receiving 4-methylpyrazole and ethanol indicated a mutual interaction of the two compounds or the metabolites, leading to increased concentration in the blood of the compounds and reduced formation of 4-hydroxymethylpyrazole, the primary metabolite of 4-methylpyrazole. In monkeys, elimination of 4-methylpyrazole followed a linear course. 4-Hydroxymethylpyrazole accumulated to a level of at most 10% of that of 4-methylpyrazole. Concurrent administration of methanol inhibited the elimination of 4-methylpyrazole about 25%, and 4-methylpyrazole produced a profound inhibition of the oxidation of methanol. 4-Methylpyrazole, at a level in the plasma of more than 10 muM, prevented accumulation of the toxic metabolite formic acid in methanol-poisoned monkeys, and repeated injections of 4-methylpyrazole abolished methanol toxicity in monkeys receiving lethal doses of methanol. The present investigation indicates that 4-methylpyrazole, with its low toxicity and strong inhibition of alcohol oxidation, is a valuable tool for experimental studies of alcohol metabolism and its effects. It illustrates the usefulness of the monkey as a model to study 4-methylpyrazole activity and toxicity in light of its possible use for treating methanol poisoning in human beings.