title: Therapy against organophosphate poisoning: the importance of anticholinergic drugs with antiglutamatergic properties.
abstract: Potent cholinesterase inhibitors (e.g., soman, sarin), induce a wide range of deleterious effects including convulsions, behavioral impairments and ultimately, death. Due to the likelihood of various scenarios of military or terrorist attacks by these and other chemical weapons, research has to be aimed at finding optimal therapies. Early accumulation of acetylcholine in synaptic clefts was suggested to trigger an array of toxic events including an excessive release of glutamate, culminating in the activation of its receptors. Stimulation of the N-Methyl-D-Aspartate (NMDA) subtype of these receptors was associated with the neuronal injury that initiates organophosphate-induced brain damage. The notion of a stepwise mechanism yielded treatments based on a combination of an immediate administration of enzyme reactivators and anticholinergic drugs. This strategy dramatically increased survival rates but did not abolish convulsions and failed to prevent the ensuing cognitive dysfunction. Efforts to improve this paradigm by adding anticonvulsants or antiglutamatergic drugs with anti-epileptic characteristics produced dubious results. Under these conditions, benactyzine and caramiphen, agents with anticholinergic and antiglutamatergic properties, provided improved protection when introduced as adjunct agents to oximes, reversible cholinesterase inhibitors and/or specific antimuscarinic drugs such as atropine. In contrast, the specific antimuscarinic drug scopolamine failed to block soman-induced changes in glutamatergic and behavioral parameters even when given prophylactically. These findings along with a large number of additional reports led towards the conclusion that the therapeutic advantage of drugs such as benactyzine and caramiphen could derive from their ability to modulate central cholinergic and glutamate neurotransmission.
authors.affiliation: Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona 74100, Israel. aviw@iibr.gov.il
authors.forename: Ben Avi
authors.initials: BA
authors.lastname: Weissman
authors.forename: Lily
authors.initials: L
authors.lastname: Raveh
mesh_terms: D000818:Animals; D018680:Cholinergic Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D003517:Cyclopentanes / Q000494:pharmacology / Q000627:therapeutic use; D018691:Excitatory Amino Acid Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D005739:Gas Poisoning / Q000188:drug therapy / Q000378:metabolism / Q000517:prevention & control; D018698:Glutamic Acid / Q000378:metabolism*; D006801:Humans; D062025:Organophosphate Poisoning; D010755:Organophosphates / Q000037:antagonists & inhibitors*
chemical_list: D018680:Cholinergic Antagonists; D002800:Cholinesterase Inhibitors; D003517:Cyclopentanes; D018691:Excitatory Amino Acid Antagonists; D010755:Organophosphates; D018698:Glutamic Acid; C004519:caramiphen