Atractyloside and gummiferin (carboxyatractiloside) are the toxic components of the Mediterranean thistle, Atractylis gummifera L., also called the Addad plant in Morocco. A recent report described 3 fatalities in children accidentally ingesting this plant. What is the mechanism of action of these two toxins?
The two teens in this case report reported ingestion of the root, which tasted like chewing gum. Both were symptomatic within hours and died within 12 hours with hyperthermia, transaminitis, acute kidney injury, coma and apnea. The third victim was a 7 yo. Not reported in these cases, but features reported in other human cases include seizures and hypoglycemia. Survivors of the hyper-acute toxic insult may succumb to liver failure within days. Atractyloside and gummiferin bind to ADP translocase on the inner mitochondrial membrane, preventing the transport of ADP into the mitochondrial matrix for phosphorylation to ATP, leading to mitochondrial failure and cell death. Atractyloside’s binding is competitive while that of gummiferin is non-competitive. There is no specific treatment for this poisoning and management is supportive.
- Nya S, Abouzahir H, Dami A, Saif Z, Najdi A, Belhouss A, Benyaich H. Death in Children After Atractylis gummifera L. Poisoning in Morocco-Report of Three Cases and Review of Literature. Am J Forensic Med Pathol. 2020 Oct 29. doi: 10.1097/PAF.0000000000000633.
- Stewart MJ, Steenkamp V. The biochemistry and toxicity of atractyloside: a review. Ther Drug Monit. 2000 Dec;22(6):641-9. doi: 10.1097/00007691-200012000-00001.
Submitted by: Michael Hodgman MD on behalf of the Herbal and Dietary Supplement Section