Abstract
Purpose Studies have demonstrated that star fruit consumption by nephropathic patients triggers severe neurotoxic effects that can lead to convulsions or even death. Brain areas likely susceptible to star fruit poisoning have not been investigated. The objective of the present study was to map possible epileptogenic areas susceptible to star fruit intoxication in nephropathic rats.Methods The study analyzed 25 rats (5 groups). Rats in the experimental group underwent bilateral ureteral obstruction surgery and orogastric gavages with star fruit juice. An electroencephalogram was used to confirm convulsive seizures. Urea and creatinine levels were used to confirm the uremia model. Immunohistochemical analysis was used to map cells with c-Fos protein (c-Fos+ cells) to identify brain areas with increased neuronal activity. Control groups included non-nephropathic and nephropathic rats that did not receive star fruit.Results A statistically significant increase (p<0.01) in c-Fos+ cells was noted in nephropathic animals receiving star fruit juice compared to control groups, in brain areas commonly related to epileptogenic neural circuits including the hippocampus, amygdala, rhinal cortex, anterior cingulate area, piriform area, and medial dorsal thalamus.Conclusion These data corroborate the neurotoxic capacity of star fruit in nephropathic patients.
Highlights
Star fruit (Averrhoa carambola) is a species of fruit tree that belongs to the Oxalidaceae family
Since no studies have so far identified the neural sites involved in seizures in experimental models under these conditions, the objective of this study was to identify brain areas possibly involved in convulsions resulting from the neurotoxic effect triggered by carambola juice intake in nephropathic rats
This disorganization was generalized, and it was not possible to visually identify any propagation between the cortical leads or between the cortical and the hippocampal leads, which suggests that the origin of the epileptic activity was multifocal
Summary
Star fruit (Averrhoa carambola) is a species of fruit tree that belongs to the Oxalidaceae family. Star fruit can be consumed as a fruit in its natural form or as a juice[1,2]. In the 1980s, the first report of neurotoxic effects originated from administration of constant intracerebroventricular injections of star fruit juice in healthy rats, inducing seizures and suggesting the existence of a neurotoxic compound in the fruit[3]. Several case reports were described in uremic patients who had ingested star fruit or its juice[3,4,5,6,7,8,9]. Fang et al.[9] showed that nephrectomized rats that received star fruit or oxalate extract developed myoclonic or tonic-clonic seizures
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