Kayes Tahrima, Ho Vincent
Department of Gastroenterology and Hepatology Campbelltown Hospital, Campbelltown, NSW 2560, Australia.
School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia.
Int J Mol Sci. 2024 Dec 4;25(23):13028. doi: 10.3390/ijms252313028.
is well-established as one of the most poisonous mushrooms; toxicity from ingestion was reported as early as the first century. Although native to Europe, this ectomycorrhizal fungus has been widely spread and is responsible for liver toxicity in many parts of the world. Toxicity is characterized by delayed gastrointestinal symptoms mimicking acute gastroenteritis followed by severe hepatotoxicity and liver failure with consequent multi-organ failure. The primary mechanism of liver toxicity is considered to be the inhibition of RNA polymerase II with consequent hepatocyte apoptosis. Treatment measures include supportive measures such as rehydration and correction of electrolytes on initial presentation, activated charcoal and lavage to decrease absorption, extracorporeal purification methods such as plasmapheresis, fractionated plasma separation and adsorption, and molecular adsorbent recirculating system, as well as drug therapies including antibiotics, N-acetylcysteine, and silibinin. Liver transplantation is required in those with acute liver failure and poor prognostic features. Here, we reviewed the basic biology, pathophysiology, and molecular mechanisms of liver toxicity, as well as available treatments.
作为最毒的蘑菇之一，其毒性早已确立；早在公元一世纪就有关于摄入该蘑菇后中毒的报道。尽管这种外生菌根真菌原产于欧洲，但已广泛传播，在世界许多地区都导致肝脏毒性。其毒性特征是最初出现类似急性肠胃炎的延迟性胃肠道症状，随后是严重的肝毒性和肝功能衰竭，进而导致多器官衰竭。肝脏毒性的主要机制被认为是RNA聚合酶II受到抑制，进而导致肝细胞凋亡。治疗措施包括初始就诊时的支持性措施，如补液和纠正电解质、使用活性炭和洗胃以减少吸收、体外净化方法，如血浆置换、分级血浆分离和吸附以及分子吸附循环系统，还有药物治疗，包括抗生素、N - 乙酰半胱氨酸和水飞蓟宾。急性肝功能衰竭且预后不良的患者需要进行肝移植。在此，我们综述了肝脏毒性的基本生物学、病理生理学和分子机制以及现有的治疗方法。
