naphthoquinones and Anemia--Hemolytic

Henna is a herb that is used in traditional medicine for medical purposes as well as in the field of cosmetic. It is one of the agents that can trigger hemolytic crisis in G6PD deficient patients but it is considered safe in patients with normal G6PD enzyme. Here we present a case of non-immune hemolytic anemia occurred after ingestion of a homemade solution containing henna powder. Therapeutic plasma exchange was performed daily for 3 subsequent days and the hemoglobin levels and hemolytic markers were improved dramatically. Laboratory test revealed a normal G6PD enzyme level six weeks after recovery. We would like to emphasize the possibility of unexpected adverse effects and undefined ingredients of herbal products. Therapeutic plasma exchange can be a promising treatment option in such cases.

Topics: Adult; Anemia, Hemolytic; Humans; Male; Naphthoquinones; Plasma Exchange

Reduction of naphthoquinones by DT-diaphorase is often described as a detoxification reaction. This is true for some naphthoquinone derivatives, such as alkyl and di-alkyl naphthoquinones, but the situation with other substances, such as 2-hydroxy-1,4-naphthoquinone, is more complex. In the present study, the effect of several substances that are known to increase tissue activities of DT-diaphorase on the toxicity of 2-amino-1,4-naphthoquinone has been investigated. Like 2-hydroxy-1,4-naphthoquinone, the 2-amino-derivative was found to cause both haemolytic anaemia and renal tubular necrosis in rats. Again like 2-hydroxy-1,4-naphthoquinone, the severity of the haemolysis induced by the 2-amino derivative was increased in animals pre-treated with inducers of DT-diaphorase, but the degree of nephrotoxicity was decreased. With these substances, therefore, DT-diaphorase both activates and detoxifies the quinone, depending on the target organ. It is not possible to generalize with regard to the effects of modulation of tissue levels of DT-diaphorase on naphthoquinone toxicity in vivo, since this may change not only the severity of the toxic effects, but also the target organ specificity. In evaluating the possible therapeutic applications of such compounds, the possibility of toxic effects upon the blood and kidney must be borne in mind. In man, renal damage by compounds such as 2-hydroxy- and 2-amino-1,4-naphthoquinone may be a particular problem, because of the low level of DT-diaphorase in human liver.

Topics: Anemia, Hemolytic; Animals; Biotransformation; Butylated Hydroxyanisole; Butylated Hydroxytoluene; Dimethyl Fumarate; Disulfiram; Enzyme Induction; Ethoxyquin; Female; Fumarates; Hemolysis; Inactivation, Metabolic; Kidney; Kidney Tubular Necrosis, Acute; NAD(P)H Dehydrogenase (Quinone); Naphthoquinones; Rats; Rats, Sprague-Dawley

Henna is a traditional cosmetic agent and is used worldwide. It is used worldwide not only as a cosmetic agent to stain the hair, skin and nails but also is applied to the body on lesions in the treatment of seborrheic dermatitis or fungal infections. Different pathologies have been described as caused by henna. The aim of this study is to draw attention to the adverse effects of henna, applied over the whole body, observed in glucose-6-phosphate dehydrogenase (G6PD) enzyme deficient siblings. In the present paper, we report on two siblings with G6PD deficiency who developed haemolytic anaemia following topical application of henna to their whole body to treat skin lesions. Their parents were also found to be G6PD deficient. Even though anti-inflammatory, analgesic and antipyretic effects of henna have been shown, it may cause severe side-effects in some cases. For this reason, especially, in the regions where G6PD enzyme deficiency is common, people should be informed about the side-effects of topical henna application and clinicians should be aware of these manifestations.

Topics: Administration, Topical; Anemia, Hemolytic; Child; Dermatologic Agents; Female; Glucosephosphate Dehydrogenase Deficiency; Humans; Ichthyosis Vulgaris; Male; Naphthoquinones; Pedigree; Siblings

Lawsone (2-hydroxy-1,4-naphthoquinone) is the active ingredient of henna (Lawsonia alba), the crushed leaves of which are used as a cosmetic dye. Application of henna can induce a severe hemolytic anemia, and lawsone is thought to be the causative agent. Administration of lawsone to rats has been shown to induce a hemolytic response that is associated with oxidative damage to erythrocytes. However, direct exposure of isolated erythrocytes to lawsone did not provoke oxidative damage, suggesting that lawsone must undergo extra-erythrocytic bioactivation in vivo. In the present study, the survival of rat 51Cr-labeled erythrocytes in vivo after in vitro exposure to lawsone and its hydroquinone form, 1,2,4-trihydroxynaphthalene (THN) has been examined. Neither lawsone nor THN were directly hemolytic or methemoglobinemic, even at high concentrations (>3 mM). Lawsone had no effect on erythrocytic GSH levels, whereas THN (3 mM) induced a modest depletion (approximately 30%). Cyclic voltammetry revealed that the lack of hemotoxicity of lawsone was associated with a poor capacity to undergo redox cycling. In contrast, ortho-substituted 1,4-naphthoquinones without a 2-hydroxy group, such as 2-methyl- and 2-methoxy-1,4-naphthoquinone, were redox active, were able to deplete GSH, and were direct-acting hemolytic agents. An oxidant stress-associated hemolytic response to lawsone could be provoked, however, if it was incubated with GSH-depleted erythrocytes. The data suggest that lawsone is a weak direct-acting hemolytic agent that does not require extra-erythrocytic metabolism to cause hemotoxicity. Thus, the hemolytic response to henna may be restricted to individuals with compromised antioxidant defenses.

Topics: Anemia, Hemolytic; Animals; Cell Survival; Chromium Radioisotopes; Coloring Agents; Cytoskeletal Proteins; Electrochemistry; Glucosephosphate Dehydrogenase Deficiency; Glutathione; Hemolysis; Magnetic Resonance Spectroscopy; Male; Methemoglobin; Naphthoquinones; Oxidation-Reduction; Oxidative Stress; Pentose Phosphate Pathway; Rats; Rats, Sprague-Dawley; Reactive Oxygen Species

It has previously been shown that rats pre-treated with butylated hydroxyanisole (BHA), a well-known inducer of the enzyme DT-diaphorase, are protected against the harmful effects of 2-methyl-1,4-naphthoquinone. This is consistent with a role for diaphorase in the detoxification of this quinone, but it is not known if increased tissue levels of this enzyme give protection against other naphthoquinone derivatives. In the present study, rats were dosed with BHA and then challenged with a toxic dose of 2-hydroxy-1,4-naphthoquinone, a substance that causes haemolytic anaemia and renal damage in vivo. Pre-treatment with BHA had no effect upon the nephrotoxicity of 2-hydroxy-1,4-naphthoquinone, but the severity of the haemolysis induced by this compound was increased in the animals given BHA. DT-Diaphorase is known to promote the redox cycling of 2-hydroxy-1,4-naphthoquinone in vitro, with concomitant formation of 'active oxygen' species. The results of the present experiment suggest that activation of 2-hydroxy-1,4-naphthoquinone by DT-diaphorase may also occur in vivo and show that increased tissue levels of DT-diaphorase are not always associated with naphthoquinone detoxification.

Topics: Anemia, Hemolytic; Animals; Butylated Hydroxyanisole; Drug Interactions; Enzyme Induction; Female; Kidney; Liver; NAD(P)H Dehydrogenase (Quinone); Naphthoquinones; Rats; Rats, Sprague-Dawley; Spleen; Stomach

The short-term toxicities of 2-methyl-1,4-naphthoquinone and a series of 2,3-dialkyl-1,4-naphthoquinones have been determined in rats and compared with their ability to cause oxidative damage to erythrocytes in vitro. In accord with previous results, 2-methyl-1,4-naphthoquinone caused marked oxidative damage to erythrocytes in vitro and haemolytic anaemia in rats. The dialkylnaphthoquinones were also haemolytic agents in vivo, with 2,3-dimethyl-1,4-naphthoquinone being particularly active. Unlike the monoalkyl derivative, however, these substances caused little or no damage to red cells in vitro. The in vivo toxicity of dialkylnaphthoquinones cannot, therefore, be predicted on the basis of in vitro cytotoxicity tests.

Topics: Anemia, Hemolytic; Animals; Erythrocytes; Glutathione; In Vitro Techniques; Kidney; Liver; Naphthoquinones; Oxidation-Reduction; Oxyhemoglobins; Rats; Spleen; Superoxides; Vitamin K 3