Peritoneal lavage with povidone-iodine solution in colorectal cancer–induced rats

Song, Huali; Zhang, Dongmei; Wen, Heng Ching; Wang, Meng; Zhao, Na; Gao, Yuhua; Ding, Ni

doi:10.1016/j.jss.2018.02.055

Cited by 6 publications

(10 citation statements)

References 28 publications

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“…When cells were exposed to stable solutions of PVP carrier alone or I 2 , toxicity was solely caused by I 2 (Figs 1C-E and S1A-C). Above a threshold of free I 2 at 0.5 mM, elemental iodine is an irreversible respiratory poison, likely explaining topical toxicity such as retinal degradation (Shimada et al, 2020), and clinical sudden cardiovascular and metabolic collapse upon high-level systemic exposure (Glick et al, 1985;Kanakiriya et al, 2003;Ramaswamykanive et al, 2011), confirmed in animal models (Lores et al, 1981;Song et al, 2018). To translate these findings to a 3D environment, calcein AM-labelled epithelial spheroids were exposed to PVP-I or I 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Hence, our observations indicate that clinical doses of PVP-I destroy intercellular connections, resulting in leaky linings of exposed airway, peritoneal cavity, and vasculature. They likely explain why experimental “washout” of soiled peritoneum or colon with PVP-I solution produces septicaemia in clinical practice ( Whiteside et al, 2005 ; Song et al, 2018 ).…”

Section: Resultsmentioning

confidence: 99%

“…Our data provide critical evidence for the reappraisal of PVP-I in clinical practice. Numerous reports have previously raised safety concerns about PVP-I at commonly used concentrations ( Ramaswamykanive et al, 2011 ; Kim et al, 2017 ; Song et al, 2018 ; Liang et al, 2020 ; Vercammen et al, 2021 ; Fuse et al, 2022 ). Chronic iodine excess causes thyroid toxicity ( Katagiri et al, 2017 ), yet topical toxicity and systemic overload can have severe and occasionally lethal effects ( D’Auria et al, 1990 ; Glick et al, 1985 ).…”

Section: Resultsmentioning

confidence: 99%

“…Attack on lipid rafts disrupted tight junctions, opening tissue barriers to free diffusion. These mechanisms explain long-known local and systemic toxicities ( Glick et al, 1985 ; Manfro et al, 2002 ; Ramaswamykanive et al, 2011 ; Song et al, 2018 ). The therapeutic window of PVP-I is far narrower than commonly believed.…”

Section: Introductionmentioning

confidence: 99%

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Cell death and barrier disruption by clinically used iodine concentrations

et al. 2023

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Povidone-iodine (PVP-I) inactivates a broad range of pathogens. Despite its widespread use over decades, the safety of PVP-I remains controversial. Its extended use in the current SARS-CoV-2 virus pandemic urges the need to clarify safety features of PVP-I on a cellular level. Our investigation in epithelial, mesothelial, endothelial, and innate immune cells revealed that the toxicity of PVP-I is caused by diatomic iodine (I2), which is rapidly released from PVP-I to fuel organic halogenation with fast first-order kinetics. Eukaryotic toxicity manifests at below clinically used concentrations with a threshold of 0.1% PVP-I (wt/vol), equalling 1 mM of total available I2. Above this threshold, membrane disruption, loss of mitochondrial membrane potential, and abolition of oxidative phosphorylation induce a rapid form of cell death we propose to term iodoptosis. Furthermore, PVP-I attacks lipid rafts, leading to the failure of tight junctions and thereby compromising the barrier functions of surface-lining cells. Thus, the therapeutic window of PVP-I is considerably narrower than commonly believed. Our findings urge the reappraisal of PVP-I in clinical practice to avert unwarranted toxicity whilst safeguarding its benefits.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cell death and barrier disruption by clinically used iodine concentrations

et al. 2023

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“…Toxicity and AKI have been reported post mediastinal [4,5,23,24], wound, subcutaneous or burn irrigation [13][14][15][16][17][18], lymphocele irrigation after renal transplant [6], and also after skin application in infants or oral ingestion [32][33][34]. Experimental data raise concern that iodine toxicity could follow peritoneal lavage in peritonitis, although this has not been reported in humans [35,36]. Moreover, toxicity pertains to acute kidney injury, presenting with metabolic acidosis, hyperosmolality, and hypernatraemia [6,[8][9][10]16,23,33].…”

Section: Figure 1: Computed Tomography (Ct) Scan Of the Chest And Abd...mentioning

confidence: 99%

Povidone-Iodine-Induced Acute Kidney Injury in a 23-Year-Old Woman: The First Clinical Case Report From the Republic of Cyprus

Papadopoulos¹,

Iordanou²,

Georgiou³

et al. 2022

Cureus

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Povidone-iodine (PI) is considered a generally safe broad-spectrum, antiseptic substance, which is widely used in healthcare services, mostly for burn patients, in wound treatment, surgical wound irrigation, as well as for a few gynecological indications. Although it is safe, its use on mucosa can cause toxicity due to iodine absorption and the high concentration in the serum. PI toxicity is absorption depended and has been associated with severe adverse events including acute kidney injury (AKI). To our knowledge, there are only three cases of PI-induced AKI after uterine instillation in the published literature. We report a case of severe PI-induced AKI that occurred in a 23-year-old female due to iodine systemic absorption immediately post uterine instillation, in terms of infertility evaluation.The patient was admitted to the intensive care unit (ICU), supported with mechanical ventilation and treated with renal replacement therapy (RRT). Renal function and urine output improved and the patient was discharged from ICU.Severe adverse events may be linked to internal use, therefore, PI on mucosa should be used with extreme caution. Clinicians should be aware of iodine intoxication and possible AKI.

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