Veratrum album

Veratrum album is a tall herbaceous perennial plant with alternate, pleated leaves. The flowers are white, marked with green on the top portion of the stalk. The fruit is a small pod containing winged seeds. The stout, simple stems are {{convert|50-175 |cm|in|abbr=on}} tall. The plants have an estimated lifespan of several centuries and often achieve dominance in wild areas as they are unpalatable to grazing herbivores.{{Cite journal|last1=Kleijn|first1=David|last2=Steinger|first2=Thomas|date=April 2002|title=Contrasting effects of grazing and hay cutting on the spatial and genetic population structure of Veratrum album, an unpalatable, long-lived, clonal plant species|journal=Journal of Ecology|language=en|volume=90|issue=2|pages=360–370|doi=10.1046/j.1365-2745.2001.00676.x|s2cid=53315227 |issn=0022-0477|doi-access=free}}

File:Protoveratrine_A.pngFile:Protoveratrine_B.png

Extracts from dried rhizomes of Veratrum album were briefly used as a pesticide against the Colorado potato beetle.{{Cite journal|last1=Aydin|first1=Tuba|last2=Cakir|first2=Ahmet|last3=Kazaz|first3=Cavit|last4=Bayrak|first4=Neslihan|last5=Bayir|first5=Yasin|last6=Taşkesenligil|first6=Yavuz|date=2014|title=Insecticidal Metabolites from the Rhizomes ofVeratrum albumagainst Adults of Colorado Potato Beetle,Leptinotarsa decemlineata|journal=Chemistry & Biodiversity|language=en|volume=11|issue=8|pages=1192–1204|doi=10.1002/cbdv.201300407|pmid=25146763|s2cid=23173957|issn=1612-1872}}

In 1890, Georg Salzberger first isolated and named the alkaloid protoveratrine.{{Cite journal|last1=Stoll|first1=A.|last2=Seebeck|first2=E.|date=1953|title=Über Protoveratrin A und Protoveratrin B. 6. Mitteilung über Veratrum-Alkaloide|journal=Helvetica Chimica Acta|language=de|volume=36|issue=3|pages=718–723|doi=10.1002/hlca.19530360326|issn=0018-019X}} Later investigation found that protoveratrine is a mixture of two closely related alkaloids, protoveratrine A and protoveratrine B.{{Cite journal|last1=Glen|first1=WL|last2=Myers|first2=GS|last3=Barber|first3=R|last4=Morozovitch|first4=P|last5=Grant|first5=GA|date=1952|title=Hypotensive Alkaloids of Veratrum album|journal=Nature|language=En|volume=170|issue=4335|pages=932|doi=10.1038/170932a0|pmid=13013269|bibcode=1952Natur.170..932G|s2cid=4178957|issn=0028-0836|doi-access=free}} During the 1940s and 1950s, Veratrum album was studied in essential hypertension, hypertension during renal dysfunction, and pre-eclampsia.{{Cite journal|last1=Barrow|first1=J. G.|last2=Sikes|first2=C. R.|date=May 1951|title=The use of purified veratrum viride alkaloids in the treatment of essential hypertension|journal=American Heart Journal|volume=41|issue=5|pages=742–748|issn=0002-8703|pmid=14829406|doi=10.1016/0002-8703(51)90263-3}}{{Cite journal|last1=Meilman|first1=Edward|last2=Krayer|first2=Otto|date=1950-02-01|title=Clinical Studies on Veratrum Alkaloids: I. The Action of Protoveratrine and Veratridine in Hypertension|journal=Circulation|language=en|volume=1|issue=2|pages=204–213|doi=10.1161/01.CIR.1.2.204|issn=0009-7322|pmid=15409589|doi-access=free}}

Veratrum album is grown as an ornamental plant. In the UK, it has gained the Royal Horticultural Society's Award of Garden Merit.{{cite web | url = https://www.rhs.org.uk/Plants/18784/i-Veratrum-album-i/Details | title = RHS Plantfinder - Veratrum album | access-date = 5 February 2019}}{{cite web | url = https://www.rhs.org.uk/plants/pdfs/agm-lists/agm-ornamentals.pdf | title = AGM Plants - Ornamental | date = July 2017 | page = 106 | publisher = Royal Horticultural Society | access-date = 5 February 2019}}

In beverages, V. album has been mistaken for the harmless yellow gentian (Gentiana lutea) or wild garlic (Allium ursinum), resulting in poisoning.{{Cite journal|last1=Zagler|first1=Bernhard|last2=Zelger|first2=Anton|last3=Salvatore|first3=Carmen|last4=Pechlaner|first4=Christoph|last5=De Giorgi|first5=Franco|last6=Wiedermann|first6=Christian J.|date=February 2005|title=Dietary poisoning with Veratrum album — a report of two cases|journal=Wiener Klinische Wochenschrift|volume=117|issue=3|pages=106–108|issn=0043-5325|pmid=15773425|doi=10.1007/s00508-004-0291-x|s2cid=38860261}}{{cite journal | last1=Gilotta | first1=Irene | last2=Brvar | first2=Miran | title=Accidental poisoning with Veratrum album mistaken for wild garlic (Allium ursinum) | journal=Clinical Toxicology| volume=48 | issue=9 | year=2010 | issn=1556-3650 | doi=10.3109/15563650.2010.533675 | pages=949–952|pmid=21171854| s2cid=207657813 }} All parts of the plant are poisonous.{{Cite book|date=2007|title=Handbook of Poisonous and Injurious Plants|language=en-gb|doi=10.1007/978-0-387-33817-0|isbn=978-0-387-31268-2}}

Symptoms of Veratrum alkaloid poisoning typically occur within thirty minutes to four hours of ingestion, and include:{{Cite web|url=http://www.thepoisongarden.co.uk/atoz/veratrum_album.htm|title=Veratrum album, white hellebore|publisher=The Poison Garden|access-date=2018-05-05}}

• vomiting
• abdominal pain
• hypotension
• bradycardia
• nausea
• drowsiness
• dizziness
• dilated pupils

Treatment for Veratrum alkaloid poisoning include supportive care and symptomatic treatments, such as fluid replacement and anti-emetics. Atropine and vasopressors act to combat bradycardia and hypotension. Duration of illness can last up to ten days but full recovery is possible within a few hours depending on dose and treatment.

Various Veratrum alkaloids were present in a German sneezing powder in 1982, resulting in the accidental poisoning of those who used it.{{Cite journal|last1=Carlier|first1=P.|last2=Efthymiou|first2=M-L.|last3=Garnier|first3=R.|last4=Hoffelt|first4=J.|last5=Fournier|first5=E.|date=April 1983|title=Poisoning with Veratrum-containing Sneezing Powders|journal=Human & Experimental Toxicology|volume=2|issue=2|pages=321–325|doi=10.1177/096032718300200224|pmid=6862477|s2cid=44786035}} Sneezing powders are commonly used to prank others. In 1983, there were nine cases of accidental poisoning as a result of these pranks due to the presence of Veratrum alkaloids in the sneezing powders.{{Cite journal|last1=Fogh|first1=Anne|last2=Kulling|first2=Per|last3=Wickstrom|first3=Elsa|date=1983|title=Veratrum Alkaloids in Sneezing-Powder a Potential Danger|journal=Journal of Toxicology: Clinical Toxicology|volume=20|issue=2|pages=175–179|doi=10.3109/15563658308990062|pmid=6887310}} The victims were nine boys aged between 11 and 18 years old in Scandinavian countries who used supplies imported from the Federal Republic of Germany. All boys had inhaled the powder and six had ingested it. Symptoms typically presented within an hour, after which calls were made to authorities. After sneezing, the victims began to develop gastrointestinal disturbances such as vomiting in all cases and epigastric pain in two. Three of the children collapsed due to low blood pressure prior to being admitted to hospital. Seven of the children had significantly decreased blood pressure and five have cases of sinus bradycardia with no other irregularities. Half of those who had ingested the powder were treated with gastric lavage. Four of the boys were given atropine to combat bradycardia and one was given activated charcoal. Atropine normalised their heart rates within minutes but did little to assist with low blood pressure. In all cases, the patients recovered within twenty-four hours.

In 2005 and 2008, there were three reported cases of accidental poisoning.{{Cite journal|last1=Grobosch|first1=T.|last2=Binscheck|first2=T.|last3=Martens|first3=F.|last4=Lampe|first4=D.|date=November 2008|title=Accidental intoxication with Veratrum album|journal=Journal of Analytical Toxicology|volume=32|issue=9|pages=768–773|issn=0146-4760|pmid=19021933|doi=10.1093/jat/32.9.768|doi-access=free}} In 2009, eleven children, aged 8 to 12 years old, accidentally ingested Veratrum album at a youth camp where they had prepared homemade tea using fresh herbs. Two children remained asymptomatic, nine developed mild gastrointestinal symptoms, six presented neurological symptoms, and three showed bradycardia; after medical care, all children recovered.{{Cite journal|last=Rauber-Luthy|first=Christine|date=February 2010|title=Low-dose exposure to Veratrum album in children causes mild effects – a case series|journal=Clinical Toxicology|volume=48|issue=3|pages=234–7|doi=10.3109/15563650903575243|pmid=20170391|doi-access=free}} Four cases of accidental poisoning were reported in 2010 after Veratrum album was mistaken for wild garlic and used in self prepared-salad and soups. All victims developed nausea, vomiting, abdominal pain, sinus bradycardia, and hypotension. Complete recovery took between twenty-four and forty-eight hours.

A debate amongst historians is centred around the cause of death of Alexander the Great. Some believe the Macedonian king died of natural causes and others believe he was poisoned. The Romance suggests that his inner circle conspired to assassinate him upon his return to Babylon.{{Cite book|title=The Greek Alexander romance|last=Pseudo-Callisthenes.|date=1991|publisher=Penguin Books|others=Stoneman, Richard.|isbn=978-0140445602|location=London, England|oclc=24810739|url-access=registration|url=https://archive.org/details/greekalexanderro00pseu}} A theory proposed by Schep in 2013 suggests that Veratrum album was used to kill Alexander the Great.{{Cite journal|last=Schep|first=Leo|date=August 2013|title=Was the death of Alexander the Great due to poisoning? Was it Veratrum album?|journal=Clinical Toxicology|volume=54|issue=1|pages=72–77|doi=10.3109/15563650.2013.870341|pmid=24369045|s2cid=20804486}} Schep argues that the usual suspects thought to be the culprit, such as arsenic and strychnine, would have acted too quickly to correlate with historical accounts. Alexander was ill for twelve days and suffered symptoms synonymous with Veratrum album poisoning. Notably, the theory is furthered by the proposal that Alexander drank wine poisoned with Veratrum album. Accounts from Diodorus detail that the king was struck with pain after drinking a large bowl of unmixed wine in honor of Hercules.{{Cite news|url=https://www.independent.co.uk/news/science/mystery-of-alexander-the-greats-death-solved-ruler-was-killed-by-toxic-wine-claim-scientists-9054625.html |archive-url=https://ghostarchive.org/archive/20220811/https://www.independent.co.uk/news/science/mystery-of-alexander-the-greats-death-solved-ruler-was-killed-by-toxic-wine-claim-scientists-9054625.html |archive-date=11 August 2022 |url-access=subscription |url-status=live|title=Mystery of Alexander the Great's death solved? Ruler was 'killed by|date=2014-01-12|work=The Independent|access-date=2018-05-05|language=en-GB}}

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Veratrum album contains over fifty steroidal alkaloids called {{'}}Veratrum alkaloids', including O-acetyljervine, cevadine, cryptenamine, cyclopamine (11-deoxojervine), cycloposine, germitrine, germidine, jervine, muldamine, protoveratrine (A&B), veratramine, veratridine, and veriloid.{{Cite journal|last1=Chen|first1=K. K.|last2=Henderson|first2=F. G.|last3=Anderson|first3=R. C.|date=August 1950|title=The cardiac action of Helleborus glycosides and their aglycones|journal=The Journal of Pharmacology and Experimental Therapeutics|volume=99|issue=4|pages=325–400|issn=0022-3565|pmid=15437315}}{{Cite journal|last1=Freis|first1=E. D.|last2=Stanton|first2=J. R.|last3=Moister|first3=F. C.|date=February 1950|title=Assay in man of the chemical fractions of Veratrum Viride, and identification of the pure alkaloids germitrine and germidine as potent hypotensive principles derived from the drug|journal=The Journal of Pharmacology and Experimental Therapeutics|volume=98|issue=2|pages=166–173|issn=0022-3565|pmid=15422510}}{{Cite journal|last=Marchetti|first=G.|date=January 1954|title=[Effect of two new alkaloids of Veratrum viride on the circulatory apparatus]|journal=Archivio Italiano di Scienze Farmacologiche|volume=4|issue=1|pages=15–27|pmid=13159580}} Some of the principal toxins have a modified steroid template while others differ in their esterified acid moieties.{{Cite journal|last1=Schep|first1=Leo J.|last2=Schmierer|first2=David M.|last3=Fountain|first3=John S.|date=2006-06-01|title=Veratrum Poisoning|journal=Toxicological Reviews|language=en|volume=25|issue=2|pages=73–78|doi=10.2165/00139709-200625020-00001|pmid=16958554|s2cid=42124743|issn=1176-2551}} In general, Veratrum alkaloids act by increasing the permeability of the sodium channels of nerve cells, causing them to fire continuously. Increased stimulation, associated with the vagus nerve, results in the Bezold-Jarisch reflex: hypotension, bradycardia and apnoea.

The neurotoxicity of Veratrum alkaloids derives from their effect on the sodium ion channels of nerve cells. They activate receptor site 2 of the voltage-dependent Na⁺ channel in membranes by prolonging its open state.{{Cite journal|last1=Ujvary|first1=Istvan|last2=Eya|first2=Bryan K.|last3=Grendell|first3=Richard L.|last4=Toia|first4=Robert F.|last5=Casida|first5=John E.|date=October 1991|title=Insecticidal activity of various 3-acyl and other derivatives of veracevine relative to the veratrum alkaloids veratridine and cevadine|journal=Journal of Agricultural and Food Chemistry|language=en|volume=39|issue=10|pages=1875–1881|doi=10.1021/jf00010a039|issn=0021-8561}} The alkaloids depolarize nerves by enhancing exchange of Na⁺ and K⁺ across the membrane.{{Cite journal|date=1972-04-18|title=Studies on the mechanism of action of local anesthetics with phospholipid model membranes|journal=Biochimica et Biophysica Acta (BBA) - Reviews on Biomembranes|language=en|volume=265|issue=2|pages=169–186|doi=10.1016/0304-4157(72)90001-9|issn=0304-4157|last1=Papahadjopoulos|first1=D.|pmid=4555469}}

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{{Commons-inline|Veratrum album}}

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album

Category:Flora of Europe

Category:Flora of temperate Asia

Category:Medicinal plants

Category:Plants described in 1753

Category:Taxa named by Carl Linnaeus