Ginkgo biloba seeds (GBS) have from ancient times been consumed in China and Japan for medicinal purposes or as food, but toxic symptoms appear if the intake of these seeds is too great. During the food shortage in Japan after the Second World War, there were many cases of toxicosis and even reports of deaths due to consumption of the seeds. Since then, there have been few such cases of poisoning, but recently some cases have occurred, mainly in children. 1,2) The principal symptoms of poisoning due to GBS are vomiting and clonic or tonic convulsions, which can at first easily be misdiagnosed as symptoms of epilepsy. The convulsions appear between 1 and 12 h after ingestion of the seeds, and in many cases attacks occur repeatedly. 3) For a long time the agent responsible for the intoxication could not be identified, but it was finally revealed by the work of Wada et al. 4) to be 4-O-methylpyridoxine (MPN). MPN competitively inhibits the action of vitamin B 6 , which is a coenzyme in the body's amino acid metabolism. Among its properties is that by inhibiting glutamate decarboxylase it inhibits the production of g-aminobutyric acid (GABA), which is an inhibitory neurotransmitter, in the brain; it is thought that it initiates convulsive attacks as a result of a relative increase in the level of glutamate, which is an excitatory neurotransmitter. 5) The pharmacokinetics of MPN in humans are not yet clearly understood, but we were interested in determining whether it was possible to predict the increase in severity of GBS poisoning from the concentration of MPN in patients' serum and from the time elapsed since the seeds were consumed. Our reasoning was that, if early prediction of severity were possible, it would also be possible to plan, on a scientific basis, the administration of preparations of the anticonvulsant diazepam and the specific MPN antagonist pyridoxal phosphate to treat recurrent convulsions. 3) The methods of determining MPN levels in the serum that have so far been reported comprise that of Yagi et al. 6) which is a reverse-phase HPLC technique using fluorescence detection; our own methods of reverse-phase HPLC using UV detection, 7) and GC/MS analysis. 8) However, since all these procedures require solid-phase extraction, it was considered that a faster method of analysis would be useful to improve the treatment approach in the clinical setting.In the present study, after simply deproteinizing serum MPN, we introduced it directly onto the HPLC column using an ion-pair reagent in the mobile phase, and thus tested the new method for rapid separation and quantitation on an ODS column. In addition, we applied the method in the analysis of the sera of 5 patients who had ingested GBS and experienced convulsions. Further, GBS were collected from the main regions of Japan where they are sold, and we investigated whether the method could be employed for the determination of MPN in GBS.
MATERIALS AND METHODSChemicals and Solutions MPN was synthesized by the method described by Harris. 9) The purity of th...