What is the mechanism of toxicity when consuming immature ackee fruit, the national fruit of Jamaica?
Hypoglycin A, found in arils of immature ackee fruit, is metabolized to methylenecyclopropane acetyl CoA (MCPA-CoA). MCPA-CoA impairs gluconeogenesis through coenzyme A dehydrogenase inhibition and may lead to hypoglycemia symptoms, vomiting, abdominal pain, hypotonia, and in severe cases encephalopathy, coma, or death. The ackee fruit is thought to be responsible for the Jamaican Vomiting Sickness which occurred between 1880 and 1955. (Surmaitis R, Hamilton RJ. Ackee Fruit Toxicity. [Updated 2019 Oct 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431101/)
Submitted by R Feldman, PharmD on behalf of the Acute and Intensive Care Special Interest Section