ArticlesThe Biochemistry and Toxicity of Atractyloside: A ReviewStewart, Michael J.; Steenkamp, VanessaAuthor Information Department of Chemical Pathology, South African Institute for Medical Research, University of the Witwatersrand, Johannesburg, South Africa Received March 24, 2000; accepted May 18, 2000. Address correspondence and reprint requests to Dr M. J. Stewart, Department of Chemical Pathology, University of the Witwatersrand Medical School, 7 York Rd., Parktown 2193, Gauteng, South Africa. Therapeutic Drug Monitoring: December 2000 - Volume 22 - Issue 6 - p 641-649 Buy Abstract Atractyloside poisoning is an infrequent but often fatal form of herbal poisoning, which occurs worldwide but especially in Africa and the Mediterranean regions. The primary mechanism of atractyloside poisoning is known to be inhibition of the mitochondrial ADP transporter. Poisoning in humans may present with either acute hepatic or renal pathology and it is possible that there is a second, different mechanism of toxicity to the hepatocyte. Atractyloside in large amounts gives rise to massive necrosis, but in vitro studies have shown that at lower doses cells progress to apoptosis. Simple methods for the detection of atractyloside poisoning are at present restricted to thin-layer chromatography in urine and are useful only in the case of severe poisoning. Immunoassays, high-performance liquid chromatography, nuclear magnetic resonance, and a recently developed high-performance liquid chromatogrpahy/mass spectrometry method have yet to be applied to clinical diagnoses. There is at present no treatment, but a fuller understanding of the mechanisms of toxicity may lead to the application of a number of compounds that are effective in vitro. © 2000 Lippincott Williams & Wilkins, Inc.