The biochemistry and toxicity of atractyloside: A review

Atractyloside poisoning is an infrequent but often fatal form of herbal poi soning, which occurs worldwide but especially in Africa and the Mediterrane an regions. The primary mechanism of atractyloside poisoning is known to be inhibition of the mitochondrial ADP transporter. Poisoning in humans may p resent with either acute hepatic or renal pathology and it is possible that there is a second, different mechanism of toxicity to the hepatocyte. Atra ctyloside in large amounts gives rise to massive necrosis, but in vitro stu dies have shown that at lower doses cells progress to apoptosis. Simple met hods for the detection of atractyloside poisoning are at present restricted to thin-layer chromatography in urine and are useful only in the case of s evere poisoning. Immunoassays, high-performance liquid chromatography, nucl ear magnetic resonance, and a recently developed high-performance liquid ch romatogrpahy/mass spectrometry method have yet to be applied to clinical di agnoses. There is at present no treatment, but a fuller understanding of th e mechanisms of toxicity may lead to the application of a number of compoun ds that are effective in vitro.