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Download File CCDN 33.Pdf Working together to eliminate cyanide poisoning, konzo, tropical ataxic neuropathy (TAN) and neurolathyrism Cassava Cyanide Diseases & Neurolathyrism Network (ISSN 1838-8817 (Print): ISSN 1838-8825 (Online) Issue Number 33, June 2019 Contents EDITORIAL EDITORIAL .................................................... 1 On the prevention of Konzo, lessons On the prevention of Konzo, lessons learned from Neurolathyrism ...................... 1 learned from Neurolathyrism ARTICLES ...................................................... 3 In line with the ideas of the editorial in the previous issue, no reports on new neurolathyrism cases were Neurolathyrism, Konzo and sulphur found while several new konzo areas are reported in metabolism .................................................... 3 this issue. A new Indian study demonstrates that Conference Report on The “2. Cassava small amounts of grass pea even during long Symposium”.................................................. 6 periods cause no harm.1 Indian authorities remain Chronic Exposure to Cyanogens in indecisive concerning the ban on the sale and Cassava: Evidence from Zambezia storage of grass pea, while Spanish authorities did Province, Mozambique (Based on lift the ban on grass pea consumption with the 2 presentation at XV1 Jornadas de Saúde, advice to mix with cereals. On the other hand, Maputo, September 2018) ............................ 7 research on Konzo is still focusing on prevention and screening of populations at risk. Apparently Konzo Disease-Democratic Republic Of there is a need for better methods for screening Congo: Cassava Poisoning ......................... 8 cyanide content in cassava foods as well as Outbreak of Cyanide Poisoning Caused by thiocyanate in the urine of people at risk. In Consumption of Cassava Flour — Kasese Mozambique, a mapping and advocacy exercise is District, Uganda, September 2017 .............. 8 underway, led by Netherlands Leprosy Relief, and even before it started the Ministry of Health decided to include konzo in the health information system. CCDNN Coordination: June 28, a symposium on Konzo was held at Zurich University, Switzerland, including a round table discussion on its prevention (see report in this issue). As we were unable to attend, we Technologiepark 122 (AA Tower – 4th floor), B-9052 summarized our views for circulation among the Gent, Belgium participants as copied below: Prof Fernand LAMBEIN, Coordinator “The clinical symptoms of konzo and neurolathyrism Phone: +32 484 417 5005 are so similar that only the history of the patient can E-mail: [email protected] or [email protected] differentiate between these two socio-economic diseases. Konzo patients in DR Congo Dr. Delphin DIASOLUA NGUDI (Pokokabaka surrounding villages) or Phone: +32 92 92 80 40 Email: [email protected] or [email protected] neurolathyrism patients in Ethiopia or Bangladesh have the same scissor gate and contraction of the Editorial Board: H. Bradbury+ - Hon. Chairman and calf muscles. In some cases the toe nails are worn founder (1926-2016), J.P. Banea, Julie Cliff, Arnaldo Cumbana, Ian Denton, from dragging their bare feet over the ground. D. Diasolua Ngudi, F. Lambein., N.L.V.Mlingi , Protective factors from the epidemiology of Humberto Muquingue, Bala Nambisan, Dulce neurolathyrism may help to design strategies for the Nhassico, S.L.N. Rao, D. Tshala -Katumbay prevention of Konzo. Both these socio-economic Country Contacts: diseases have a sudden onset Cameroon : E.E. Agbor; D.R. Congo: JP Banea & J. Nsimire Chabwine; Indonesia: A. Hidayat; Mozambique: Anabela Zacarias; 1 Nigeria: M.N. Adindu and P.N. Okafor Website: http://ipbo.vib-ugent.be/projects/ccdn The socio-economic conditions of areas with high influence these effects would be important incidence of konzo and those where, historically, information to help understanding the pathway to there was a high incidence of neurolathyrism are the development of konzo. very similar. Both diseases occur in poor rural areas, As mentioned above, konzo and neurolathyrism are mostly among illiterate people who grow cassava two socio-economic diseases. The economic (Manihot esculenta)/grass pea (Lathyrus sativus) for improvement of India and Ethiopia has made this their own consumption. During extreme poverty or disease almost a problem of the past. The market drought-triggered famine, the diet consists mainly of has also contributed to this because grass pea is Cassava in the case of konzo or grass pea in the now more expensive than rice and no longer the case of neurolathyrism. When a diet of mainly grass cheapest food available to the poor. In contrast to pea is maintained during two months, up to 6% of this development, the areas where konzo is rampant the population, mainly young males can become have slower economic development, if any. irreversibly crippled. But when the diet contains at A retired volunteer worker with extensive experience least 20% of cereals richer in sulphur amino acids, in konzo-afflicted areas in DR Congo told me: “in or when antioxidant-rich condiments such as onions villages with only cassava consumption one can find or ginger are added in the preparation, these seem konzo patients, but not when the villagers grow corn to protect against neurolathyrism.3 (Zea maïs) to mix with the cassava. When the The common feature of both cassava roots and cultivation of onions is successful, that year there grass pea seeds is the very low content of sulphur are no new patients, but when the onions fail, there amino acids methionine and cysteine. Deficiency of will be new cases”. While this needs confirmation by these amino acids can disturb the redox trained epidemiologists, these findings come very homeostasis by depletion of glutathione, creating close to those of neurolathyrism, where cereals oxidative stress. Heavy physical labour has been richer in sulphur amino acids or condiments rich in mentioned as risk factor for neurolathyrism. antioxidants are found to be protective factors. Interestingly, in the cassava growing areas in Africa, Conclusion the women do most of the labour. To link this with the higher incidence of Konzo among young -Alleviation of stress and improving the socio- women, while the incidence of neurolathyrism is economic conditions are beyond the power of higher among young men seems an attractive scientific researchers. But stressing the description hypothesis. of konzo as a socio-economic disease might be a wake-up call for responsible authorities. When young experimental animals are put under stress, the incidence of neurolathyrism-like -Screening susceptible people for high levels of thio- symptoms increases 4.6-fold in rat pups.4 There cyanate in the urine should be accompanied by should be little doubt that during famines, people simple information on better processing methods for are under considerable stress to feed their family cassava roots such as the wetting method of and themselves. The highest incidence of Bradbury. Of equal importance would be dietary neurolathyrism in history occurred in a WWII labour information for a better balanced diet, especially camp at Vapniarca where the Jewish inmates had with a better balance of essential amino acids and considerable stress. richer in antioxidants.” In very young animals, the blood/brain barrier is not References: fully developed and also under heavy stress the 1 Kumar RH., Khandare A., et al. Prolonged blood/brain barrier may lose its integrity. Under such consumption of grass pea (64 g/Cu/day) along with conditions toxic or neuro-excitatory molecules can millets and other cereals causes no neurolathyrism enter into the spinal cord. In the experiment with rat (2019) Nutritional Neuroscience pups, using β-ODAP, this occurred in the lower https://doi.org/10.1080/1028415X.2019.1642641 spinal cord along with transient haemorrhage. 2 De Oliveira D. The Scientific Committee of the The cyanogenic glucosides in cassava roots give Spanish Agency for Consumer Affairs, Food Safety rise to the mitochondrial toxin cyanide that can be and Nutrition (AECOSAN) clears Spanish gachas. detoxified by rhodanase to thiocyanate and The risk of neurolathyrism is marginal eliminated in the urine. This is analysed as a (2018).CCDNNews 32, 4-5. measure of intake of insufficiently processed 3 Getahun H., Lambein F., et al. Food-aid cereals to cassava. The transformation of cyanide into reduce neurolathyrism related to grass-pea thiocyanate needs sulphur from methionine or preparations during famine (2003) Lancet 362, cysteine, and these happen to be deficient in 1808-1810. cassava-based diet. In case of deficiency of sulphur 4 Kusama-Eguchi K., Ikegami, F. LambeinF. Is amino acids, the more toxic cyanate is formed that stress a factor in the susceptibility to can affect the nervous system. Whether stress can neurolathyrism? (2016) CCDNNews 27, 4-5. 2 Fernand Lambein and Delphin Diasolua Ngudi used the most up-to-date automatic amino acid International Plant Biotechnology Outreach (IPBO)/ analyser available for the analyses, each of which took just over 1 hour. Thus, I brought together those VIB/ Ghent University, Belgium two powerful influences from my earliest days in ARTICLES science – amino acid analysis and protein metabolism. Neurolathyrism, Konzo and sulphur metabolism The cystathionine / methionine story Citations of the paper by Tallen et al. (1958) only Introduction: Early research leading to the topic just exceeded 200 by 2019 (Google Scholar), but Early in my career I was employed in the
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