Skip to main content
SpringerLink
Log in

New aspects of Amanita poisoning

Neue Aspekte der Knollenblätterpilzvergiftung

  • Übersichten
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Zusammenfassung

Amatoxine finden sich im grünen und in den weißen Knollenblätterpilzen, aber auch in anderen Pilzarten. Diese Gifte sind die alleinige Ursache der tödlich verlaufenden Knollenblätterpilzvergiftung. Die charakteristische, lange Latenzzeit der Vergiftung ist einerseits ein zuverlässiges Mittel zur Diagnose, fordert aber andererseits eine sofortige Behandlung, um die Toxinkonzentration im Serum rasch zu senken und damit die Zeit abzukürzen, in der z.B. die Leberzellen den Giften ausgesetzt sind. In letzter Zeit wurden mehrere biologische Assays für Amatoxine beschrieben, deren Nachweisgrenze bei etwa 0,5 ng/ml liegt. Mithilfe solcher Assays kann die Schwere einer Knollenblätterpilzvergiftung bestimmt werden, eine wichtige Voraussetzung zur Auffindung der optimalen Therapie.

Amatoxine zerstören eukaryotische Zellen durch Hemmung der Transkription von m-RNS. Betroffen sind vor allem Leberzellen, die selbst bei geringer Toxinkonzentration geschädigt werden. Leberzellen nehmen das Gift relativ schnell auf, scheiden es jedoch auch rasch wieder mit der Galle aus. Dementsprechend muß man Maßnahmen treffen, um bei der menschlichen Vergiftung den enterohepatischen Kreislauf zu unterbrechen. Obwohl Amatoxine auch durch die Niere schnell ausgeschieden werden, kann eine extrakorporale Reinigung des Blutes angezeigt sein, z.B. zur schnellen Entfernung der Gifte aus dem Kreislauf oder um die Niere nicht zu lange den Giften zu exponieren. Diese Übersicht berichtet über aktuelle Methoden zur Blutreinigung, über Chemotherapeutika zur Behandlung der Knollenblätterpilzvergiftung, sowie über den Einsatz von Faktoren zur Leberregeneration. Alle Therapiemaßnahmen, die sich entweder bewährt haben oder nach neueren Erkenntnissen empfohlen werden können, sind in einer Liste zusammengefaßt.

Summary

Amatoxins occur in the green and white Amanita species, but also in other mushroom genera. These toxins are the sole cause of fatal human Amanita intoxications. Their long latency period is a useful tool for diagnosing such cases of poisoning, but on the other hand necessitates an immediate treatment in order to rapidly decrease the toxin concentration in the serum and to shorten the time of exposure of e.g. liver cells. Various bioassays for amatoxins were reported having a limit of detection near to 0.5 ng/ml; they have become useful tools to determine the severity of an intoxication, a prerequisite for finding the optimum therapy.

Amatoxins damage eukaryotic cells by inhibiting their transcriptional process. Lesions are found particularily in the parenchymal cells of the liver, even at low toxin concentrations. These cells incorporate the toxins relatively fast, but at the same time excrete them rapidly into the bile. Accordingly, in human Amanita poisoning the enterohepatic circulation must be interrupted. Although the amatoxins easily undergo ultrafiltration in the kidney, extracorporal purification methods may be indicated for reasons such as rapid clearing of the serum or shortening the time of kidney exposure to the toxins. This review will report on extracorporal purification methods, on drugs used for chemotherapy, as well as on factors capable of inducing liver regeneration. All procedures for acute Amanita poisoning, either proved or suggested, will be listed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. All contributions to the symposium are to be published in: Amanita toxins and amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  2. Bartelheimer, H., Maring, H., Stimming, H.J.: Quantitative fraktionierte Pankreassaftuntersuchungen bei Pankreas- sowie Gallenwegs- und Lebererkrankungen. Klin. Wochenschr.33, 160 (1955)

    PubMed  Google Scholar 

  3. Bartter, F.C., Berkson, B.M., Gallelli, J., Hiranaka, P.: Thioctic acid in the treatment of poisoning with alpha-amanitin. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.), New York: Witzstrock-Publ. Comp. Inc. (in press)

  4. Bastien, P.: A general practioner's experiences of Amanita phalloides poisoning. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  5. Berkson, B.M.: Treatment of four delayed mushroom-poisoning patients with thioctic acid. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  6. Berkson, B.M.: Treatment of four delayed-mushroom-poisoning patients with thioctic acid. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.) New York: Witzstrock-Publ. Comp. Inc. (in press)

  7. Bodenmüller, H., Faulstich, H., Wieland, Th.: Distribution of amatoxins in Amanita phalloides mushrooms. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  8. Brodner, O.G., Sabbagh, M., Manke, H.G.: Assay of amatoxins by inhibition of DNA or RNA synthesis in lymphocytes, In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  9. Brodner, O.G., Wieland, Th.: Identification of the amatoxin-binding subunit of RNA polymerase B by affinity labeling experiments. Subunit B3 — the true amatoxin receptor protein of multiple RNA polymerase B. Biochem.15, 3480 (1976)

    Google Scholar 

  10. Busi, C., Fiume, L., Costantino, C.: Radioimmuno assay of amatoxins. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  11. Cessi, C., Fiume, L.: Increased toxicity of β-amanitin when bound to a protein. Toxicon6, 309 (1969)

    PubMed  Google Scholar 

  12. Cochet-Meilhac, M.: Molecular interactions of amatoxins with DNA-dependent RNA polymerases B. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th., (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  13. Cochet-Meilhac, M., Chambon, P.: Animal DNA-dependent RNA polymerases. 11. Mechanism of the inhibition of RNA polymerases B by amatoxins. Biochim. Biophys. Acta353, 160 (1974)

    PubMed  Google Scholar 

  14. Cochet-Meilhac, M., Nuret, P., Courvalin, J.C., Chambon, P.: Animal dependant RNA-polymerases. 12. Determination of the cellular number of RNA polymerase B molecules. Biochim. Biophys. Acta353, 185 (1974)

    PubMed  Google Scholar 

  15. Czygan, P., Stiehl, A., Kommerell, B.: Treatment of acute Amanita phalloides-induced hepatic failure by hemoperfusion. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B.: Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  16. Derenzini, M., Betts, C.M., Busi, C., Fiume, L.: Ultrastructural changes in β-cells of pancreatic islets in α-amanitin-poisoned mice. Virchows Arch. B Cell Path.28, 13 (1978)

    Google Scholar 

  17. Dudová, V., Kubička, J., Veselsky, J.: Thioctic acid in the treatment of Amanita phalloides intoxication. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  18. Faulstich, H.: The amatoxins. In: Progress in molecular and subcellular research. Hahn, F. et al. (eds.) (in press)

  19. Faulstich, H.: (unpubl.)

  20. Faulstich, H., Fauser, U.: Experimental intoxication with amanitin in the dog. (I) Death by hypoglycemia and importance of enterohepatic circulation (in prep.)

  21. Faulstich, H., Fauser, U.: (unpubl.)

  22. Faulstich, H., Fauser, U.: Untersuchungen zur Frage der Hämodialyse bei der Knollenblätterpilzvergiftung. Dtsch. Med. Wochenschr.98, 2258 (1973)

    PubMed  Google Scholar 

  23. Faulstich, H., Georgopoulos, D., Bloching, M., Wieland, Th.: Analysis of the toxins of amanitin-containing mushrooms. Z. Naturforsch.29c, 86 (1974)

    Google Scholar 

  24. Faulstich, H., Trischmann, H., Zobeley, S.: A radioimmunoassay for amanitin. FEBS Lett.56, 312 (1975)

    PubMed  Google Scholar 

  25. Faulstich, H., Trischmann, H., Zobeley, S.: Raising and use of antibodies against amatoxins. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  26. Faulstich, H., Walli, A.K.: (unpubl. results)

  27. Fauser, U., Faulstich, H.: Beobachtungen zur Therapie der Knollenblätterpilzvergiftung. Dtsch. Med. Wochenschr.98, 2259 (1973)

    PubMed  Google Scholar 

  28. Fauser, U., Faulstich, H.: Knollenblätterpilzvergiftung und Dialysierbarkeit der Toxine. In: Aktuelle Probleme der Dialyseverfahren und der Niereninsuffizienz. v. Dittrich, P., Skrabal, F., Stühlinger, W.D. (Hrsg.). S. 439. Friedberg/Hessen: Vlg. C. Bindernagel 1975

    Google Scholar 

  29. Fauser, U., Zimmermann, R., Faulstich, H.: Experimental intoxication with amanitin in the dog. (III). Death later than 60 hours after intoxication by hemorrhagia or uremia. (in prep.)

  30. Fischer, M., Faulstich, H., Schmahl, W., Hilber, C.: Autoradiographic localisation of amatoxins in the pig liver. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  31. Fiume, L., Busi, C., Campadelli-Fiume, G., Franceschi, C.: Production of antibodies to amanitins as the basis for their radioimmunoassay. Experientia31, 1233 (1975)

    PubMed  Google Scholar 

  32. Fiume, L., Derenzini, M., Marinozzi, V., Petazzi, F., Testoni, A.: Pathogenesis of gastro-intestinal symptomatology during poisoning by Amanita phalloides. Experientia29, 1520 (1973)

    PubMed  Google Scholar 

  33. Fiume, L., Marinozzi, V., Nardi, F.: The effects of amanitin poisoning on mouse kidney. Br. J. Exp. Pathol.50, 270 (1969)

    PubMed  Google Scholar 

  34. Fiume, L., Stirpe, F.: Decreased RNA content in mouse liver nuclei after intoxication with α-amanitin. Biochim. Biophys. Acta123, 643 (1966)

    PubMed  Google Scholar 

  35. Floersheim, G.: Chemotherapy of amanita poisoning. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  36. Jahn, W., Faulstich, H., Wieland, Th.: Pharmacokinetics of [3H] methyl-dehydroxymethyl-α-amanitin in the isolated perfused rat liver and the influence of several drugs. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.) New York: Witzstrock-Publ. Comp. Inc. (in press)

  37. Langer, M., Vesconi, S., Costantine, D., Busi, C.: Pharmacodynamics of amatoxins in human poisoning. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  38. Langescheid, C., Schmitz-Salue, H., Faulstich, H., Kramer, P., Scheler, F.: In vitro-elimination of [3H] methyl-dehydroxy-methyl-α-amanitin by four different extracorporal purification methods. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  39. Larcan, A., Lambert, H.: Homogeneous therapeutical scheme applied to a series of 39 patients poisoned by Amanita phalloides. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp., Inc., (in press)

  40. Machicao, F., Sonnenbichler, J.: Mechanism of the stimulation of RNA synthesis in rat liver nuclei by silybin. Hoppe-Seyler's Z. Physiol. Chem.358, 141 (1977)

    PubMed  Google Scholar 

  41. Manke, H.G., Neuhauser, S., Brodner, O.G.: α-Amanitin-induced changes of membrane marker protein of human lymphocytes. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  42. Pickart, L., Thaler, L., Thaler, M.M.: A synthetic tripeptide which increases survival of normal liver cells and stimulates growth in hepatoma cell. Biochim. Biophys. Res. Commun.54, 562 (1973)

    Google Scholar 

  43. Rumack, B.H.: Amanita poisoning, an examination of clinical symptoms. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  44. Schlesinger, D.H., Pickart, L., Thaler, M.M.: Growth-modulating serum tripeptide is glycyl-histidyl-lysine. Experientia33, 324 (1977)

    PubMed  Google Scholar 

  45. Seeger, R., Stijve, T.: Occurrence of toxic Amanita species. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  46. Stijve, T.: Determination of amatoxins by high performance thin-layer chromatography (HPTLC). In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  47. Usadel, K.H.: Short commun. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  48. Usadel, K.H., Wdowindski, J., Schwedes, U., Faulstich, H., Röttger, B., Hübner, K.: Effects of somatotropin, insulin, liver growth factor, and silybin on liver regeneration after α-amanitin poisoning in the rat. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  49. Vogel, G.: The anti-amanita effect of silymarin. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  50. Wieland, Th.: The chemistry of amatoxins. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th., (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  51. Wieland, Th., Fahrmeir, A.: Oxydation und Reduktion an der γ,δ-Dihydroxyisoleucin-Seitenkette des O-Methyl-α-amanitins, Methylaldoamanitin, ein ungiftiges Abbauprodukt. Liebigs Ann. Chem.736, 95 (1970)

    Google Scholar 

  52. Wieland, Th., Faulstich, H.: Amatoxins, phallotoxins, phallolysin and antamanide, the biologically active components of poisonous Amanita mushrooms. Crit. Rev. Biochem.5, 195–260 (1978)

    Google Scholar 

  53. Wieland, Th., Wieland, O.: The toxic peptides of Amanita species. In: Microbial toxins. Kadis, S., Ciegler, A., Ajl, S.J. (eds.). Vol. 8, p. 249. New York: Academic Press 1972

    Google Scholar 

  54. Zimmermann, R., Bleiler, H., Faulstich, H., Fauser, U., Andrassy, K., Kommerell, B.: Blood coagulation changes during experimental Amanita poisoning. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

  55. Zulik, R., Kassay, S.F.: The role of thioctic acid in the treatment of Amanita phalloides intoxication. In: Amanita toxins and Amanita poisoning. Faulstich, H., Kommerell, B., Wieland, Th. (eds.). New York: Witzstrock-Publ. Comp. Inc. (in press)

Download references

Author information

Authors and Affiliations

  1. Department of Natural Products, Max-Planck-Institute of Medical Research, Heidelberg

    H. Faulstich

Authors
  1. H. Faulstich
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Faulstich, H. New aspects of Amanita poisoning. Klin Wochenschr 57, 1143–1152 (1979). https://doi.org/10.1007/BF01491754

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01491754

Schlüsselwörter

Key words

Search

Navigation