The combination of cobinamide and sulfanegen is highly effective in mouse models of cyanide poisoning

Adriano Chan, Daune L. Crankshaw, Alexandre Monteil, Steven E. Patterson, Herbert T. Nagasawa, Jackie E. Briggs, Joseph A. Kozocas, Sari B. Mahon, Matthew Brenner, Renate B. Pilz, Timothy D. Bigby, Gerry R. Boss

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Context. Cyanide is a component of smoke in residential and industrial fires, and accidental exposure to cyanide occurs in a variety of industries. Moreover, cyanide has the potential to be used by terrorists, particularly in a closed space such as an airport or train station. Current therapies for cyanide poisoning must be given by intravenous administration, limiting their use in treating mass casualties. Objective. We are developing two new cyanide antidotes cobinamide, a vitamin B12 analog, and sulfanegen, a 3-mercaptopyruvate prodrug. Both drugs can be given by intramuscular administration, and therefore could be used to treat a large number of people quickly. We now asked if the two drugs would have an augmented effect when combined. Materials and methods. We used a non-lethal and two different lethal models of cyanide poisoning in mice. The non-lethal model assesses neurologic recovery by quantitatively evaluating the innate righting reflex time of a mouse. The two lethal models are a cyanide injection and a cyanide inhalation model. Results. We found that the two drugs are at least additive when used together in both the non-lethal and lethal models: at doses where all animals died with either drug alone, the combination yielded 80 and 40% survival in the injection and inhalation models, respectively. Similarly, drug doses that yielded 40% survival with either drug alone, yielded 80 and 100% survival in the injection and inhalation models, respectively. As part of the inhalation model, we developed a new paradigm in which animals are exposed to cyanide gas, injected intramuscularly with an antidote, and then re-exposed to cyanide gas. This simulates cyanide exposure of a large number of people in a closed space, because people would remain exposed to cyanide, even after receiving an antidote. Conclusion. The combination of cobinamide and sulfanegen shows great promise as a new approach to treating cyanide poisoning.

Original languageEnglish (US)
Pages (from-to)366-373
Number of pages8
JournalClinical Toxicology
Issue number5
StatePublished - Jun 2011

Bibliographical note

Funding Information:
This work was supported by three grants from the National Institutes of Health CounterACT Program: U01 NS058030, U01 NS058087, and U54 NS 063718. US patents describing the use of cobinamide and sulfanegen as cyanide antidotes have been submitted by GRB, and SEP and HEN, respectively.


  • Inhalation exposure
  • Intramuscular injection
  • Lethal model
  • Non-lethal model


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