Potential therapeutic approaches in paraquat poisoning: a narrative review
,
Abstract
Paraquat dichloride (PQ) poisoning is a relatively rare yet critical medical condition that has a high case fatality rate. Lung tissue is highly susceptible to PQ-induced injury, and respiratory failure is the leading cause of death in these patients. Unfortunately, there is a lack of an effective therapeutic approach to ameliorate outcomes. It is well-known that PQ interferes with a variety of cell signaling pathways and induces the generation of reactive oxygen species (ROS), which ultimately results in cell injury. The traditional treatment decisions have not been able to significantly change the clinical course of PQ poisoning. Moreover, novel therapeutic strategies for PQ poisoning have centered on the inhibition of PQ-induced signaling pathways. In the current review, we sought to provide a bird’s-eye view of the available therapeutic approaches in patients with PQ poisoning.
1. Zhang S, Song S, Luo X, Liu J, Liu M, Li W, et al. Prognostic value of liver and kidney function parameters and their correlation with the ratio of urine-to-plasma paraquat in patients with paraquat poisoning. Basic Clin Pharmacol Toxicol. 2021;128(6):822-30.
2. Gao Y, Liu L, Li T, Yuan D, Wang Y, Xu Z, et al. A novel simple risk model to predict the prognosis of patients with paraquat poisoning. Sci Rep. 2021;11:237.
3. Chang SS, Lin CY, Lee MB, Shen LJ, Gunnell D, Eddleston M. The early impact of paraquat ban on suicide in Taiwan. Clin Toxicol (Phila). 2021:1-5.
4. Khazraei S, Marashi SM, Sanaei-Zadeh H. Ventilator settings and outcome of respiratory failure in paraquat-induced pulmonary injury. Sci Rep. 2019;9
(1):16541.
5. Yi JH, Zhang ZC, Zhang MB, He X, Lin HR, Huang HW, et al. Role of epithelial-to-mesenchymal transition in the pulmonary fibrosis induced by paraquat in rats. World J Emerg Med. 2021;12(3):214-20.
6. Gao L, Yuan H, Xu E, Liu J. Toxicology of paraquat and pharmacology of the protective effect of 5-hydroxy-1-methylhydantoin on lung injury caused by paraquat based on metabolomics. Sci Rep. 2020;10(1):1790.
7. Subbiah R, Tiwari RR. The herbicide paraquat-induced molecular mechanisms in the development of acute lung injury and lung fibrosis. Crit Rev Toxicol. 2021;51(1):36-64.
8. Wijerathna TM, Mohamed F, Gawarammana IB, Wunnapuk K, Dissanayake DM, Shihana F, et al. Cellular injury leading to oxidative stress in acute poisoning with potassium permanganate/oxalic acid, paraquat, and glyphosate surfactant herbicide. Environ Toxicol Pharmacol. 2020;80:103510.
9. Sun B, He Y. Paraquat poisoning mechanism and its clinical treatment progress. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017;29(11):1043-6. [Chinese].
10. Zhang ZD, Yang YJ, Liu XW, Qin Z, Li SH, Li JY. Aspirin eugenol ester ameliorates paraquat-induced oxidative damage through ROS/p38-MAPK-mediated mitochondrial apoptosis pathway. Toxicology. 2021;453:152721.
11. Zhang L, Wang Y, Shen H, Zhao M. Combined signaling of NF-kappaB and IL-17 contributes to mesenchymal stem cells-mediated protection for paraquat-induced acute lung injury. BMC Pulm Med. 2020;20(1):195.
12. Liu MW, Su MX, Tang DY, Hao L, Xun XH, Huang YQ. Ligustrazin increases lung cell autophagy and ameliorates paraquat-induced pulmonary fibrosis by inhibiting PI3K/Akt/mTOR and hedgehog signalling via increasing miR-193a expression. BMC Pulm Med. 2019;19(1):35.
13. Ren Y, Jian X, Zhang Z, Ning Q, Kan B, Kong L. Effects of tacrolimus on the TGF‑β1/SMAD signaling pathway in paraquat‑exposed rat alveolar type II epithelial cells. Mol Med Rep. 2020;22(5):3687-94.
14. Sun Z, Yang Z, Wang M, Huang C, Ren Y, Zhang W, et al. Paraquat induces pulmonary fibrosis through Wnt/β-catenin signaling pathway and myofibroblast differentiation. Toxicol Lett. 2020;333:170-83.
15. Iyyadurai R, Mohan J, Jose A, Das S, Johnson J, Gunasekaran K. Paraquat poisoning management. Curr Med Issues. 2019;17(2):34-7.
16. Gawarammana IB, Buckley NA. Medical management of paraquat ingestion. Br J Clin Pharmacol. 2011;72(5):745-57.
17. Pratt IS, Keeling PL, Smith LL. The effect of high concentrations of oxygen on paraquat and diquat toxicity in rats. Arch Toxicol Suppl. 1980;4:415-8.
18. Lin XH, Pan HY, Cheng FJ, Huang KC, Li CJ, Chen CC, et al. Association between liberal oxygen therapy and mortality in patients with paraquat poisoning: a multi-center retrospective cohort study. PLoS One. 2021;16(1):e0245363.
19. Hsu CW, Lin JL, Lin-Tan DT, Chen KH, Yen TH, Wu MS, et al. Early hemoperfusion may improve survival of severely paraquat-poisoned patients. PLoS One. 2012;7(10):e48397.
20. Wang HR, Pan J, Shang AD, Lu YQ. Time-dependent haemoperfusion after acute paraquat poisoning. Sci Rep. 2017;7(1):2239.
21. Rao R, Bhat R, Pathadka S, Chenji SK, Dsouza S. Golden hours in severe paraquat poisoning-the role of early haemoperfusion therapy. J Clin Diagn Res. 2017;11(2):OC06-8.
22. Yeh YT, Chen CK, Lin CC, Chang CM, Lan KP, How CK, et al. Does hemoperfusion increase survival in acute paraquat poisoning? a retrospective multicenter study. Toxics. 2020;8(4):84.
23. Sun Y, Fan Z, Zheng T, Meng Z, Yuan L, Tian Y. Efficacy of hemoperfusion combined with continuous veno-venous hemofiltration on the treatment of paraquat poisoning: a meta-analysis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020;32(6):726-31. [Chinese].
24. Chen AB, Li F, Di EM, Zhang X, Zhao QY, Wen J. Influence of strengthened hemoperfusion combined with continuous venovenous hemofiltration on prognosis of patients with acute paraquat poisoning: SHP + CVVH improve prognosis of acute PQ patients. BMC Pharmacol Toxicol. 2020;21(1):49.
25. Lin JL, Lin-Tan DT, Chen KH, Huang WH, Hsu CW, Hsu HH, et al. Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids. Intensive Care Med. 2011;37(6):1006-13.
26. Lin JL, Lin-Tan DT, Chen KH, Huang WH. Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning. Crit Care Med. 2006;34(2):368-73.
27. Xu YG, Lu YQ. Systematic review and meta-analysis of the efficacy and safety of immunosuppressive pulse therapy in the treatment of paraquat poisoning. J Zhejiang Univ Sci B. 2019;20(7):588-97.
28. Feng S, Gao J, Wang J, Li Y. Effects of prolonged methylprednisolone treatment after pulse therapy for paraquat-intoxicated rats. Hum Exp Toxicol. 2018;37(1):21-6.
29. Gao J, Feng S, Wang J, Yang S, Li Y. Prolonged methylprednisolone therapy after the pulse treatment for patients with moderate-to-severe paraquat poisoning: a retrospective analysis. Medicine (Baltimore). 2017;96(25):e7244.
30. Rodrigues da Silva M, Schapochnik A, Peres Leal M, Esteves J, Bichels Hebeda C, Sandri S, et al. Beneficial effects of ascorbic acid to treat lung fibrosis induced by paraquat. PLoS One. 2018;13(11):e0205535.
31. Awadalla EA. Efficacy of vitamin C against liver and kidney damage induced by paraquat toxicity. Exp Toxicol Pathol. 2012;64(5):431-4.
32. Farshad O, Heidari R, Zare F, Jamshidzadeh A, Ebrahimi M, Zamiri MJ, et al. Effects of cimetidine and N-acetylcysteine on paraquat-induced acute lung injury in rats: a preliminary study. Toxicol Environ Chem. 2018;100(8-10):785-93.
33. Yeh ST, Guo HR, Su YS, Lin HJ, Hou CC, Chen HM, et al. Protective effects of N-acetylcysteine treatment post acute paraquat intoxication in rats and in human lung epithelial cells. Toxicology. 2006;223(3):181-90.
34. Mitsopoulos P, Suntres ZE. Protective effects of liposomal N-acetylcysteine against paraquat-induced cytotoxicity and gene expression. J Toxicol. 2011;2011:808967.
35. Harada N, Saito S, Minakata K. Effects of vitamin E on toxicity by minute amounts of paraquat fed continuously to rats. J Nutr Sci Vitaminol (Tokyo). 1991;37(1):1-13.
36. Rashidipour N, Karami-Mohajeri S, Mandegary A, Mohammadinejad R, Wong A, Mohit M, et al. Where ferroptosis inhibitors and paraquat detoxification mechanisms intersect, exploring possible treatment strategies. Toxicology. 2020;433-434:152407.
37. Li J, Shen X. Effect of rosiglitazone on inflammatory cytokines and oxidative stress after intensive insulin therapy in patients with newly diagnosed type 2 diabetes. Diabetol Metab Syndr. 2019;11:35.
38. Kulkarni AA, Woeller CF, Thatcher TH, Ramon S, Phipps RP, Sime PJ. Emerging PPARγ-independent role of PPARγ ligands in lung diseases. PPAR Res. 2012;2012:705352.
39. Milam JE, Keshamouni VG, Phan SH, Hu B, Gangireddy SR, Hogaboam CM, et al. PPAR-gamma agonists inhibit profibrotic phenotypes in human lung fibroblasts and bleomycin-induced pulmonary fibrosis. Am J Physiol Lung Cell Mol Physiol. 2008;294(5):L891-901.
40. Zhang H, You L, Zhao M. Rosiglitazone attenuates paraquat-induced lung fibrosis in rats in a PPAR gamma-dependent manner. Eur J Pharmacol. 2019;851:133-43.
41. Zhang F, Hu L, Wu YX, Fan L, Liu WT, Wang J, et al. Doxycycline alleviates paraquat-induced acute lung injury by inhibiting neutrophil-derived matrix metalloproteinase 9. Int Immunopharmacol. 2019;72:243-51.
42. Hua XF, Li XH, Li MM, Zhang CY, Liu HJ, Sun T, et al. Doxycycline attenuates paraquat-induced pulmonary fibrosis by downregulating the TGF-β signaling pathway. J Thorac Dis. 2017;9(11):4376-86.
43. Ahmed MAE, El Morsy EM, Ahmed AAE. Protective effects of febuxostat against paraquat-induced lung toxicity in rats: impact on RAGE/PI3K/Akt pathway and downstream inflammatory cascades. Life Sci. 2019;221:56-64.
44. Xu Y, Tai W, Qu X, Wu W, Li Z, Deng S, et al. Rapamycin protects against paraquat-induced pulmonary fibrosis: activation of Nrf2 signaling pathway. Biochem Biophys Res Commun. 2017;490(2):535-40.
45. Vongphouttha C, Zhu J, Deng S, Tai W, Wu W, Li Z, et al. Rapamycin protects against paraquat‑induced pulmonary epithelial‑mesenchymal transition via the Wnt/β‑catenin signaling pathway. Exp Ther Med. 2018;15(3):3045-51.
46. Tai W, Deng S, Wu W, Li Z, Lei W, Wang Y, et al. Rapamycin attenuates the paraquat-induced pulmonary fibrosis through activating Nrf2 pathway. J Cell Physiol. 2020;235(2):1759-68.
47. Jiang F, Li S, Jiang Y, Chen Z, Wang T, Liu W. Fluorofenidone attenuates paraquat‑induced pulmonary fibrosis by regulating the PI3K/Akt/mTOR signaling pathway and autophagy. Mol Med Rep. 2021;23(6):405.
48. Wang J, Yu W, Wu N, Gitonga EN, Shen H. Efficacy of high-dose ambroxol for paraquat poisoning: a meta-analysis of randomized controlled trials. J Res Med Sci. 2020;25:67.
49. Gao Y, Hou L, Wang Y, Guo S, Yuan D, Jiang Y, et al. Octreotide alleviates pancreatic damage caused by paraquat in rats by reducing inflammatory responses and oxidative stress. Environ Toxicol Pharmacol. 2020;80:103456.
50. Yang ZN, Cao KQ, Xu CQ, He YY, Hong GL, Lu ZQ. Study on the protective effect and mechanism of somatostatin on renal injury in paraquat intoxicated mice. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020;38(6):410-5. [Chinese]
2. Gao Y, Liu L, Li T, Yuan D, Wang Y, Xu Z, et al. A novel simple risk model to predict the prognosis of patients with paraquat poisoning. Sci Rep. 2021;11:237.
3. Chang SS, Lin CY, Lee MB, Shen LJ, Gunnell D, Eddleston M. The early impact of paraquat ban on suicide in Taiwan. Clin Toxicol (Phila). 2021:1-5.
4. Khazraei S, Marashi SM, Sanaei-Zadeh H. Ventilator settings and outcome of respiratory failure in paraquat-induced pulmonary injury. Sci Rep. 2019;9
(1):16541.
5. Yi JH, Zhang ZC, Zhang MB, He X, Lin HR, Huang HW, et al. Role of epithelial-to-mesenchymal transition in the pulmonary fibrosis induced by paraquat in rats. World J Emerg Med. 2021;12(3):214-20.
6. Gao L, Yuan H, Xu E, Liu J. Toxicology of paraquat and pharmacology of the protective effect of 5-hydroxy-1-methylhydantoin on lung injury caused by paraquat based on metabolomics. Sci Rep. 2020;10(1):1790.
7. Subbiah R, Tiwari RR. The herbicide paraquat-induced molecular mechanisms in the development of acute lung injury and lung fibrosis. Crit Rev Toxicol. 2021;51(1):36-64.
8. Wijerathna TM, Mohamed F, Gawarammana IB, Wunnapuk K, Dissanayake DM, Shihana F, et al. Cellular injury leading to oxidative stress in acute poisoning with potassium permanganate/oxalic acid, paraquat, and glyphosate surfactant herbicide. Environ Toxicol Pharmacol. 2020;80:103510.
9. Sun B, He Y. Paraquat poisoning mechanism and its clinical treatment progress. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017;29(11):1043-6. [Chinese].
10. Zhang ZD, Yang YJ, Liu XW, Qin Z, Li SH, Li JY. Aspirin eugenol ester ameliorates paraquat-induced oxidative damage through ROS/p38-MAPK-mediated mitochondrial apoptosis pathway. Toxicology. 2021;453:152721.
11. Zhang L, Wang Y, Shen H, Zhao M. Combined signaling of NF-kappaB and IL-17 contributes to mesenchymal stem cells-mediated protection for paraquat-induced acute lung injury. BMC Pulm Med. 2020;20(1):195.
12. Liu MW, Su MX, Tang DY, Hao L, Xun XH, Huang YQ. Ligustrazin increases lung cell autophagy and ameliorates paraquat-induced pulmonary fibrosis by inhibiting PI3K/Akt/mTOR and hedgehog signalling via increasing miR-193a expression. BMC Pulm Med. 2019;19(1):35.
13. Ren Y, Jian X, Zhang Z, Ning Q, Kan B, Kong L. Effects of tacrolimus on the TGF‑β1/SMAD signaling pathway in paraquat‑exposed rat alveolar type II epithelial cells. Mol Med Rep. 2020;22(5):3687-94.
14. Sun Z, Yang Z, Wang M, Huang C, Ren Y, Zhang W, et al. Paraquat induces pulmonary fibrosis through Wnt/β-catenin signaling pathway and myofibroblast differentiation. Toxicol Lett. 2020;333:170-83.
15. Iyyadurai R, Mohan J, Jose A, Das S, Johnson J, Gunasekaran K. Paraquat poisoning management. Curr Med Issues. 2019;17(2):34-7.
16. Gawarammana IB, Buckley NA. Medical management of paraquat ingestion. Br J Clin Pharmacol. 2011;72(5):745-57.
17. Pratt IS, Keeling PL, Smith LL. The effect of high concentrations of oxygen on paraquat and diquat toxicity in rats. Arch Toxicol Suppl. 1980;4:415-8.
18. Lin XH, Pan HY, Cheng FJ, Huang KC, Li CJ, Chen CC, et al. Association between liberal oxygen therapy and mortality in patients with paraquat poisoning: a multi-center retrospective cohort study. PLoS One. 2021;16(1):e0245363.
19. Hsu CW, Lin JL, Lin-Tan DT, Chen KH, Yen TH, Wu MS, et al. Early hemoperfusion may improve survival of severely paraquat-poisoned patients. PLoS One. 2012;7(10):e48397.
20. Wang HR, Pan J, Shang AD, Lu YQ. Time-dependent haemoperfusion after acute paraquat poisoning. Sci Rep. 2017;7(1):2239.
21. Rao R, Bhat R, Pathadka S, Chenji SK, Dsouza S. Golden hours in severe paraquat poisoning-the role of early haemoperfusion therapy. J Clin Diagn Res. 2017;11(2):OC06-8.
22. Yeh YT, Chen CK, Lin CC, Chang CM, Lan KP, How CK, et al. Does hemoperfusion increase survival in acute paraquat poisoning? a retrospective multicenter study. Toxics. 2020;8(4):84.
23. Sun Y, Fan Z, Zheng T, Meng Z, Yuan L, Tian Y. Efficacy of hemoperfusion combined with continuous veno-venous hemofiltration on the treatment of paraquat poisoning: a meta-analysis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020;32(6):726-31. [Chinese].
24. Chen AB, Li F, Di EM, Zhang X, Zhao QY, Wen J. Influence of strengthened hemoperfusion combined with continuous venovenous hemofiltration on prognosis of patients with acute paraquat poisoning: SHP + CVVH improve prognosis of acute PQ patients. BMC Pharmacol Toxicol. 2020;21(1):49.
25. Lin JL, Lin-Tan DT, Chen KH, Huang WH, Hsu CW, Hsu HH, et al. Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids. Intensive Care Med. 2011;37(6):1006-13.
26. Lin JL, Lin-Tan DT, Chen KH, Huang WH. Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning. Crit Care Med. 2006;34(2):368-73.
27. Xu YG, Lu YQ. Systematic review and meta-analysis of the efficacy and safety of immunosuppressive pulse therapy in the treatment of paraquat poisoning. J Zhejiang Univ Sci B. 2019;20(7):588-97.
28. Feng S, Gao J, Wang J, Li Y. Effects of prolonged methylprednisolone treatment after pulse therapy for paraquat-intoxicated rats. Hum Exp Toxicol. 2018;37(1):21-6.
29. Gao J, Feng S, Wang J, Yang S, Li Y. Prolonged methylprednisolone therapy after the pulse treatment for patients with moderate-to-severe paraquat poisoning: a retrospective analysis. Medicine (Baltimore). 2017;96(25):e7244.
30. Rodrigues da Silva M, Schapochnik A, Peres Leal M, Esteves J, Bichels Hebeda C, Sandri S, et al. Beneficial effects of ascorbic acid to treat lung fibrosis induced by paraquat. PLoS One. 2018;13(11):e0205535.
31. Awadalla EA. Efficacy of vitamin C against liver and kidney damage induced by paraquat toxicity. Exp Toxicol Pathol. 2012;64(5):431-4.
32. Farshad O, Heidari R, Zare F, Jamshidzadeh A, Ebrahimi M, Zamiri MJ, et al. Effects of cimetidine and N-acetylcysteine on paraquat-induced acute lung injury in rats: a preliminary study. Toxicol Environ Chem. 2018;100(8-10):785-93.
33. Yeh ST, Guo HR, Su YS, Lin HJ, Hou CC, Chen HM, et al. Protective effects of N-acetylcysteine treatment post acute paraquat intoxication in rats and in human lung epithelial cells. Toxicology. 2006;223(3):181-90.
34. Mitsopoulos P, Suntres ZE. Protective effects of liposomal N-acetylcysteine against paraquat-induced cytotoxicity and gene expression. J Toxicol. 2011;2011:808967.
35. Harada N, Saito S, Minakata K. Effects of vitamin E on toxicity by minute amounts of paraquat fed continuously to rats. J Nutr Sci Vitaminol (Tokyo). 1991;37(1):1-13.
36. Rashidipour N, Karami-Mohajeri S, Mandegary A, Mohammadinejad R, Wong A, Mohit M, et al. Where ferroptosis inhibitors and paraquat detoxification mechanisms intersect, exploring possible treatment strategies. Toxicology. 2020;433-434:152407.
37. Li J, Shen X. Effect of rosiglitazone on inflammatory cytokines and oxidative stress after intensive insulin therapy in patients with newly diagnosed type 2 diabetes. Diabetol Metab Syndr. 2019;11:35.
38. Kulkarni AA, Woeller CF, Thatcher TH, Ramon S, Phipps RP, Sime PJ. Emerging PPARγ-independent role of PPARγ ligands in lung diseases. PPAR Res. 2012;2012:705352.
39. Milam JE, Keshamouni VG, Phan SH, Hu B, Gangireddy SR, Hogaboam CM, et al. PPAR-gamma agonists inhibit profibrotic phenotypes in human lung fibroblasts and bleomycin-induced pulmonary fibrosis. Am J Physiol Lung Cell Mol Physiol. 2008;294(5):L891-901.
40. Zhang H, You L, Zhao M. Rosiglitazone attenuates paraquat-induced lung fibrosis in rats in a PPAR gamma-dependent manner. Eur J Pharmacol. 2019;851:133-43.
41. Zhang F, Hu L, Wu YX, Fan L, Liu WT, Wang J, et al. Doxycycline alleviates paraquat-induced acute lung injury by inhibiting neutrophil-derived matrix metalloproteinase 9. Int Immunopharmacol. 2019;72:243-51.
42. Hua XF, Li XH, Li MM, Zhang CY, Liu HJ, Sun T, et al. Doxycycline attenuates paraquat-induced pulmonary fibrosis by downregulating the TGF-β signaling pathway. J Thorac Dis. 2017;9(11):4376-86.
43. Ahmed MAE, El Morsy EM, Ahmed AAE. Protective effects of febuxostat against paraquat-induced lung toxicity in rats: impact on RAGE/PI3K/Akt pathway and downstream inflammatory cascades. Life Sci. 2019;221:56-64.
44. Xu Y, Tai W, Qu X, Wu W, Li Z, Deng S, et al. Rapamycin protects against paraquat-induced pulmonary fibrosis: activation of Nrf2 signaling pathway. Biochem Biophys Res Commun. 2017;490(2):535-40.
45. Vongphouttha C, Zhu J, Deng S, Tai W, Wu W, Li Z, et al. Rapamycin protects against paraquat‑induced pulmonary epithelial‑mesenchymal transition via the Wnt/β‑catenin signaling pathway. Exp Ther Med. 2018;15(3):3045-51.
46. Tai W, Deng S, Wu W, Li Z, Lei W, Wang Y, et al. Rapamycin attenuates the paraquat-induced pulmonary fibrosis through activating Nrf2 pathway. J Cell Physiol. 2020;235(2):1759-68.
47. Jiang F, Li S, Jiang Y, Chen Z, Wang T, Liu W. Fluorofenidone attenuates paraquat‑induced pulmonary fibrosis by regulating the PI3K/Akt/mTOR signaling pathway and autophagy. Mol Med Rep. 2021;23(6):405.
48. Wang J, Yu W, Wu N, Gitonga EN, Shen H. Efficacy of high-dose ambroxol for paraquat poisoning: a meta-analysis of randomized controlled trials. J Res Med Sci. 2020;25:67.
49. Gao Y, Hou L, Wang Y, Guo S, Yuan D, Jiang Y, et al. Octreotide alleviates pancreatic damage caused by paraquat in rats by reducing inflammatory responses and oxidative stress. Environ Toxicol Pharmacol. 2020;80:103456.
50. Yang ZN, Cao KQ, Xu CQ, He YY, Hong GL, Lu ZQ. Study on the protective effect and mechanism of somatostatin on renal injury in paraquat intoxicated mice. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020;38(6):410-5. [Chinese]
| Files | ||
| Issue | Vol 6 No 1 (2022): Winter (February) | |
| Section | Review article | |
| DOI | 10.18502/fem.v6i1.7679 | |
| Keywords | ||
| Antioxidants Hemoperfusion Paraquat Poisoning Signal Transduction | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ghabousian A, Safari S, Ansari N. Potential therapeutic approaches in paraquat poisoning: a narrative review. Front Emerg Med. 2021;6(1):e7.
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