title: Amanita phalloides poisoning: Mechanisms of toxicity and treatment.
abstract: Amanita phalloides, also known as 'death cap', is one of the most poisonous mushrooms, being involved in the majority of human fatal cases of mushroom poisoning worldwide. This species contains three main groups of toxins: amatoxins, phallotoxins, and virotoxins. From these, amatoxins, especially α-amanitin, are the main responsible for the toxic effects in humans. It is recognized that α-amanitin inhibits RNA polymerase II, causing protein deficit and ultimately cell death, although other mechanisms are thought to be involved. The liver is the main target organ of toxicity, but other organs are also affected, especially the kidneys. Intoxication symptoms usually appear after a latent period and may include gastrointestinal disorders followed by jaundice, seizures, and coma, culminating in death. Therapy consists in supportive measures, gastric decontamination, drug therapy and, ultimately, liver transplantation if clinical condition worsens. The discovery of an effective antidote is still a major unsolved issue. The present paper examines the clinical toxicology of A. phalloides, providing the currently available information on the mechanisms of toxicityinvolved and on the current knowledge on the treatment prescribed against this type of mushrooms. Antidotal perspectives will be raised as to set the pace to new and improved therapy against these mushrooms.
authors.affiliation: UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira n° 228, 4050-313 Porto, Portugal. Electronic address: jugarcia_18@hotmail.com.
authors.forename: Juliana
authors.initials: J
authors.lastname: Garcia
authors.affiliation: UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira n° 228, 4050-313 Porto, Portugal.
authors.forename: Vera M
authors.initials: VM
authors.lastname: Costa
authors.affiliation: Department of Cell and Molecular Biology, Computational and Systems Biology, Uppsala University, Biomedical Center, Box 596, 751 24 Uppsala, Sweden.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Carvalho
authors.affiliation: CIMO/School of Agriculture, Polytechnique Institute of Bragança, Campus de Santa Apolónia, Apartado 1172, 5301-854 Bragança, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Baptista
authors.affiliation: UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira n° 228, 4050-313 Porto, Portugal.
authors.forename: Paula Guedes
authors.initials: PG
authors.lastname: de Pinho
authors.affiliation: UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira n° 228, 4050-313 Porto, Portugal.
authors.forename: Maria
authors.initials: M
authors.lastname: de Lourdes Bastos
authors.affiliation: UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira n° 228, 4050-313 Porto, Portugal. Electronic address: felixdc@ff.up.pt.
authors.forename: Félix
authors.initials: F
authors.lastname: Carvalho
mesh_terms: D000545:Amanita / Q000737:chemistry*; D006801:Humans; D009145:Mushroom Poisoning / Q000473:pathology* / Q000628:therapy; D010456:Peptides, Cyclic / Q000737:chemistry / Q000633:toxicity*; D011487:Protein Conformation; D066007:Toxicokinetics
chemical_list: D010456:Peptides, Cyclic
keywords: Amanita phalloides; Amatoxins; Kidney; Liver; RNA polymerase II; Therapy