The effect of preconditioning agents on cardiotoxicity and neurotoxicity of carbon monoxide poisoning in animal studies: a systematic review

Abstract

Background

Carbon monoxide (CO) poisoning is a common intoxication and many people die yearly due to CO poisoning and preconditioning agents attenuate brain and cardiac injury caused by intoxication. It is critical to fully understand the efficacy of new methods to directly target the toxic effect of CO, such as conditioning agents, which are currently under development. This study aims to systematically investigate current evidence from animal experiments and the effects of administration preconditions in acute and late phases after CO poisoning on cardiotoxicity and neurotoxicity.

Methods

Four databases (PubMed, Embase, Scopus, and Web of Science) were systematically searched without language restrictions, and hand searching was conducted until November 2021. We included studies that compare preconditioning agents with the control group after CO poisoning in animals. The SYRCLE RoB tool was used for risk of bias assessments.

Results

Thirty-seven studies were included in the study. Erythropoietin, granulocyte colony-stimulating factor (GCSF), hydrogen-rich saline, and N-butylphthalide (NBP) were found to have positive effects on reducing neurotoxicity and cardiotoxicity. As other preconditions have fewer studies, no valuable results can be deduced. Most of the studies were unclear for sources of bias.

Discussion

Administration of the examined preconditioning agents including NBP, hydrogen-rich saline, and GCSF in acute and late phases could attenuate neurotoxicity and cardiotoxicity of CO poisoned animals. For a better understanding of mechanisms and activities, and finding new and effective preconditioning agents, further preclinical and clinical studies should be performed to analyze the effects of preconditioning agents.

Keywords:

• Carbon monoxide
• cardiotoxicity
• neurotoxicity syndromes
• ischemic preconditioning
• animal experimentation
• carbon monoxide poisoning

Author contributions

All authors contributed to the study conception and design. Hamed Baharara and Hanieh Ghasemi independently screened and extracted the data of the articles and wrote the original draft. Sara Samadi and Bahar Roohshad revised and edited the manuscript. Vahid Jomehzadeh and Khosrow Ravankhah Moghaddam designed the search strategy and evaluated the risk of bias. Amir Hooshang Mohammadpour and Omid Arasteh resolved any discrepancies during screening and data extraction and also revised the manuscript. All authors reviewed, considered, and approved the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).