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ARTICLE: Alice S. Chen-Plotkin, Keith A. Vossel, Martin A. Samuels, and Ming Hui Chen Encephalopathy, stroke, and myocardial infarction with DMSO use in stem cell transplantation Neurology 2007; 68: 859-861 [Abstract] [Full text] [PDF]

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Encephalopathy, stroke, and myocardial infarction with DMSO use in stem cell transplantation

Heikki Savolainen   (1 April 2007)

Reply from the authors

Alice S. Chen-Plotkin, Keith A. Vossel, Martin A. Samuels, Ming Hui Chen   (1 April 2007)

Encephalopathy, stroke, and myocardial infarction with DMSO use in stem cell transplantation 1 April 2007
Heikki Savolainen, Dept. of Occupational Safety & Health POB 536, FIN-33200 Tampere, Finland Send Correspondence to journal: Re: Encephalopathy, stroke, and myocardial infarction with DMSO use in stem cell transplantation heikki.savolainen{at}stm.fi Heikki Savolainen	This topical report by Chen-Plotkin et al shows the probable role of DMSO in complications due to stem cell transplantation. [1] This is analogous to encephalopathy induced by propylene glycol-containing IV drugs. [2] In the case of DMSO, this could have been caused by metabolic formation of sulfite which is harmful, for example to mitochondria and heme synthesis. [3] With new therapeutic methods, the toxicity of excipients should be further investigated so that the positive effects of treatment are not lost. References 1. Chen-Plotkin AS, Vossel KA, Samuels MA, et al. Encephalopathy, stroke and myocardial infarction with DMSO use in stem cell transplantation. Neurology 2007;68:859-861. 2. Wilson KC, Reardon C, Theodore AC, et al. Propylene glycol toxicity: A severe iatrogenic illness in ICU patients receiving IV benzodiazepines. Chest 2005;128:1674-1681. 3. Savolainen H, Tenhunen R, Inhibition of heme synthase in brain and liver by low-level peroral sulfite exposure. Res Commun Chem Pathol Pharmacol 1982;36:511-514. Disclosure: The authors report no conflicts of interest.
Reply from the authors 1 April 2007
Alice S. Chen-Plotkin, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA Dept of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, Keith A. Vossel, Martin A. Samuels, Ming Hui Chen Send Correspondence to journal: Re: Reply from the authors aschen{at}partners.org Alice S. Chen-Plotkin, et al.	We thank Dr. Savolainen for the comments on our article. The phenomenon we described of profound encephalopathy during or shortly after DMSO infusion implies a toxic effect without indicating a clear mechanism. However, the myocardial and cerebral infarcts suggest additional vascular ischemic causes, which are different from the metabolic effects described in propylene glycol toxicity. Work in an animal model using selective injections of various solvents into the swine equivalent of the carotid artery (rete mirabile) has demonstrated that DMSO, more than similar solvents (DMI, ethyl lactate, glycofurol 74, NMP, and solketal) may cause prolonged vasospasm. [4] We postulate that this vasospasm, in turn, may result in ischemia and infarction of tissue. Reference 4. Dudeck O, Jordan O, Hoffmann KT, et al. Organic solvents as vehicles for precipitating liquid embolics: a comparative angiotoxicity study with superselective injections of swine rete mirabile. Am J Neuroradiol 2006;27:1900-1906. Disclosure: The authors report no conflicts of interest.