シクロ[L-Asn-L-t4Hyp-[(3R,4R)-4,5-ジヒドロキシ-3-メチル-L-Nva-]-6-ヒドロキシ-L-Trp2(1)-Gly-3-メチル-L-Nva-Gly-3-オキソメルカプト(1)-L-Ala-]

Treatment is mainly supportive (gastric lavage, activated carbon, fluid resuscitation) but includes various drugs to counter the amatoxins, including intravenous penicillin and cephalosporin derivatives, and, in cases of greater ingestion, can extend to an orthotopic liver transplant. The most reliable method to treat amanitin poisoning is through having the stomach pumped immediately after ingestion; however, the onset of symptoms is generally too late for this to be an option. (A300)

...PHARMACOLOGICAL AGENTS.../HAVE/ BEEN REPORTED TO PROTECT MICE AGAINST LETHAL DOSES OF PHALLOTOXINS & AMATOXINS /INCLUDING THE AMANITINS/. THE LIST INCLUDES HIGH DOSES OF PENICILLIN, CHLORAMPHENICOL, PHENYLBUTAZONE, & MANY OTHERS... NONE OF THESE ANTIDOTES HAS RECEIVED AN ADEQUATE CLINICAL TRIAL & SO NONE CAN BE RECOMMENDED TODAY. /AMANITINS/

RNA SYNTHESIS IN HELA NUCLEI WAS STIMULATED BY METHYLMERCURY. THIS STIMULATION IS SPECIFIC FOR ALPHA-AMANITIN-SENSITIVE RNA SYNTHESIS (CATALYZED BY RNA POLYMERASE); IN CONTRAST, ALPHA-AMANITIN-RESISTANT SYNTHESIS (CATALYZED BY RNA POLYMERASES I & III) WAS INHIBITED.

Around 15% of those poisoned will die within 10 days, progressing through a comatose stage to renal failure, liver failure, hepatic coma, respiratory failure and death. Those who recover are at risk of permanent liver damage. Diagnosis is difficult, and is established by observation of the clinical symptoms as well as the presence of α-amanitin in the urine. Urine screening is generally most useful within 48 hours of ingestion. (A300)

Amanitin has an unusually strong and specific attraction to the enzyme RNA polymerase II. Upon ingestion, it binds to the RNA polymerase II enzyme, preventing mRNA synthesis and effectively causing cytolysis of hepatocytes (liver cells). (L993)

Few effects are reported within 10 hours; it is not unusual for significant effects to take as long as 24 hours after ingestion to appear, with this delay in symptoms making α-amanitin poisoning even more difficult to diagnose and all the more dangerous. By then, it is far past the time in which stomach pumping would yield an efficient result. Diarrhea and cramps are the first symptoms, but those pass, giving a false sign of remission. Typically, on the 4th to 5th day, the toxin starts to have severe effects on the liver and kidneys, leading to total system failure in both. Death usually takes place around a week from ingestion. (L993)

TOXIC GROUP FROM THE POISONOUS MUSHROOM AMANITA PHALLOIDES (FRENCH) SECR, AGARICACEAE. COMPRISED OF ALPHA-, BETA-, GAMMA-AMANITIN & AMANIN. /AMANITIN/

MANY IF NOT ALL OF THE FIVE RECOGNIZED.../TOXIC COMPONENTS IN AMANITA PHALLOIDES, INCLUDING THE AMANITINS/ ARE...PRESENT IN THE AMERICAN SUBSPECIES AMANITA VERNA (VIROSA), AMANITA BISPORIGERA, AMANITA TENUIFOLIA & PERHAPS AMANITA BRUNNESCENS. /AMANITINS/

HIGHLY TOXIC. CAUSES SALIVATION, VOMITING, BLOODY STOOLS, CYANOSIS, MUSCULAR TWITCHING, CONVULSIONS. CAN BE FATAL. /AMANITIN/

.../INHIBITS/ RNA POLYMERASE II &.../INTERFERES/ WITH THE SYNTHESIS OF MRNA. THE TOXINS DISRUPT HEPATIC CELL MEMBRANES & THE STRUCTURE OF THE ENDOPLASMIC RETICULUM. AMANITIN IS ALSO A DIRECTLY ACTING NEPHROTOXIN & CAUSES TUBULAR NECROSIS. /AMANITINS/

SYMPTOMS ARE SLOW IN ONSET, APPEARING 6 TO 24 HR AFTER INGESTION; THEY INCLUDE ABDOMINAL PAIN, HEMATURIA, & DIARRHEA. DEATH USUALLY RESULTS FROM HEPATIC OR RENAL FAILURE. /AMANITINS/

...LIVER INJURY IS USUALLY THE MAJOR LESION IN MAN. THERE APPEARS TO BE A PROMPT CESSATION OF BILE FLOW, A REDUCTION IN LIVER GLYCOGEN, HYPOGLYCEMIA WITH OR WITHOUT AN INITIAL PHASE OF HYPERGLYCEMIA, A FALL IN THE RNA CONTENT OF LIVER NUCLEI, & A FAILURE OF LIVER CELL PROTEIN SYNTHESIS, BUT WHETHER OR NOT ANY OF THESE EFFECTS IS THE PRIMARY LESION HAS NOT BEEN ESTABLISHED. /AMANITINS/

MAN IS SAID TO BE EVEN MORE SUSCEPTIBLE /THAN LAB RODENTS WHOSE MEAN LETHAL DOSE OF ALPHA-AMANITIN IS ONLY 0.1 MG/KG/. A SINGLE SPECIMEN OF AMANITA PHALLOIDES MAY CONTAIN MORE THAN ENOUGH OF THIS CONSTITUENT TO KILL A MAN.

EXPTL USE: THE SORBENT CAPACITY OF UNCOATED CHARCOAL COLUMN (DETOXYL 2, SORIN BIOMEDICA) ON ALPHA-AMANITIN WAS STUDIED BY ADDING KNOWN AMOUNTS TO FRESH HUMAN BLOOD, WHICH WAS RECIRCULATED THROUGH A CLINICAL HEMOPERFUSION CIRCUIT OVER A PERIOD OF 30 MINUTES. SUITABLE AMOUNTS OF ALPHA-AMANITIN WERE PRESENT IN THE ACID ELUATES, SHOWING AN ADSORPTION OPTIMUM FOR BLOOD CONCN RANGING FROM 50 TO 200 NG/ML. THE CLINICAL USEFULNESS OF CHARCOAL HEMOPERFUSION IN AMANITA PHALLOIDES POISONING IS DISCUSSED.