The Molecular Mechanism of Aluminum Phosphide poisoning in Cardiovascular Disease: Pathophysiology and Diagnostic Approa
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The Molecular Mechanism of Aluminum Phosphide poisoning in Cardiovascular Disease: Pathophysiology and Diagnostic Approach Seyed Farzad Hosseini1 · Mehdi Forouzesh2 · Mohsen Maleknia3,4 · Samira Valiyari2 · Mahmood Maniati5 · Azin Samimi1,6
© The Author(s) 2020
Abstract Nowadays, poisoning with metal phosphides, especially aluminum phosphide (ALP), is one of the main health threats in human societies. Patients suffer from significant complications due to this type of poisoning, and the heart is one of the main organs targeted by ALP. Therefore, in this study, we discussed the effect of phosphine on cardiac function. This study is based on data obtained from PubMed, between 2002 and 2020. The key keywords included “Aluminum phosphide,” “Oxidative Stress,” “Mitochondria,” “Cardiovascular disease,” and “Treatment.” The results showed that ALP produced reactive oxygen species (ROS) due to mitochondrial dysfunction. ROS production leads to red blood cell hemolysis, decreased ATP production, and induction of apoptosis in cardiomyocytes, which eventually results in cardiovascular disease. Since ALP has the most significant effect on cardiomyocytes, the use of appropriate treatment strategies to restore cell function can increase patients’ survival. Keywords Aluminum phosphide · Oxidative stress · Mitochondria · Cardiovascular disease · Treatment
Introduction The use of pesticides has led to an increase in the quantity and quality of agricultural products in some developing countries. However, improper use of these chemicals can lead to severe acute and chronic poisoning [1]. Poisoning Communicated by Mitzi C. Glover. * Azin Samimi [email protected] 1
Legal Medicine Research Center, Legal Medicine Organization, Ahvaz, Iran
2
Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
3
Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4
Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
5
Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran
6
Department of Toxicology, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
with pesticides can be intentional, accidental, occupational, or for murder purposes, and it leads to the deaths of about 300,000 people worldwide each year, making it a global health problem [2]. Metal phosphides make a large part of pesticides that are currently used in many countries [3]. These metal phosphides cause a wide range of effects, including electrolyte imbalances, metabolic disorders, cell toxicity, oxidative stress, inhibition of cholinesterase, circulatory failure, and damage to various organs [4]. Aluminum phosphide (ALP) is one of the most widely used metal phosphides and a highly toxic substance with a high mortality rate (40–80%) [5]. The most important causes of death are cardiac shock, severe metabolic acidosis, and hypotension [6]. ALP produces phosphine gas (PH3) after expo
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