title: Intramuscular cobinamide sulfite in a rabbit model of sublethal cyanide toxicity.
abstract: OBJECTIVE
  Exposure to cyanide in fires and industrial exposures and intentional cyanide poisoning by terrorists leading to mass casualties is an ongoing threat. Current treatments for cyanide poisoning must be administered intravenously, and no rapid treatment methods are available for mass casualty cyanide exposures. Cobinamide is a cobalamin (vitamin B(12)) analog with an extraordinarily high affinity for cyanide that is more water-soluble than cobalamin. We investigate the use of intramuscular cobinamide sulfite to reverse cyanide toxicity-induced physiologic changes in a sublethal cyanide exposure animal model and determine the ability of an intramuscular cobinamide sulfite injection to rapidly reverse the physiologic effects of cyanide toxicity.
  
  
  METHODS
  New Zealand white rabbits were given 10 mg sodium cyanide intravenously over 60 minutes. Quantitative diffuse optical spectroscopy and continuous-wave near-infrared spectroscopy monitoring of tissue oxyhemoglobin and deoxyhemoglobin concentrations were performed concurrently with blood cyanide level measurements and cobinamide levels. Immediately after completion of the cyanide infusion, the rabbits were injected intramuscularly with cobinamide sulfite (n=6) or inactive vehicle (controls, n=5).
  
  
  RESULTS
  Intramuscular administration led to rapid mobilization of cobinamide and was extremely effective at reversing the physiologic effects of cyanide on oxyhemoglobin and within deoxyhemoglobin extraction. Recovery time to 63% of their baseline values in the central nervous system occurred within a mean of 1,032 minutes in the control group and 9 minutes in the cobinamide group, with a difference of 1,023 minutes (95% confidence interval 116 to 1,874 minutes). In muscle tissue, recovery times were 76 and 24 minutes, with a difference of 52 minutes (95% confidence interval 7 to 98 minutes). RBC cyanide levels returned toward normal significantly faster in cobinamide sulfite-treated animals than in control animals.
  
  
  CONCLUSIONS
  Intramuscular cobinamide sulfite rapidly and effectively reverses the physiologic effects of cyanide poisoning, suggesting that a compact cyanide antidote kit can be developed for mass casualty cyanide exposures.
authors.affiliation: Laser Microbeam and Medical Program, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA, USA. mbrenner@uci.edu
authors.forename: Matthew
authors.initials: M
authors.lastname: Brenner
authors.forename: Jae G
authors.initials: JG
authors.lastname: Kim
authors.forename: Sari B
authors.initials: SB
authors.lastname: Mahon
authors.forename: Jangwoen
authors.initials: J
authors.lastname: Lee
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Kreuter
authors.forename: William
authors.initials: W
authors.lastname: Blackledge
authors.forename: David
authors.initials: D
authors.lastname: Mukai
authors.forename: Steve
authors.initials: S
authors.lastname: Patterson
authors.forename: Othman
authors.initials: O
authors.lastname: Mohammad
authors.forename: Vijay S
authors.initials: VS
authors.lastname: Sharma
authors.forename: Gerry R
authors.initials: GR
authors.lastname: Boss
mesh_terms: D000818:Animals; D000931:Antidotes / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003038:Cobamides / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003486:Cyanides / Q000506:poisoning*; D004195:Disease Models, Animal; D006454:Hemoglobins / Q000032:analysis; D007273:Injections, Intramuscular; D010108:Oxyhemoglobins / Q000032:analysis; D011817:Rabbits; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors
chemical_list: D000931:Antidotes; D003038:Cobamides; D003486:Cyanides; D006454:Hemoglobins; D010108:Oxyhemoglobins; C017142:cobinamide; C100003:deoxyhemoglobin