The strategy of using heme proteins and synthetic porphyrins as injectable antidotes for fire gas poisoning

Abstract During fire accidents, 2 highly toxic components of fire smoke, carbon monoxide (CO) and hydrogen cyanide (HCN), are produced simultaneously, and more than 50% of fire-related deaths can be attributed to the inhalation of these toxic gases. Despite the different CO and HCN detoxification mechanisms, oxygen (O2) ventilation is currently the primary clinical treatment, and no alternative methods are available at present. In this review, the toxicological mechanisms of CO and HCN are investigated with an emphasis on the toxic effects of their combination. On the basis of these toxic mechanisms, the advantages and disadvantages of the current clinical detoxification methods are analyzed and discussed. We also summarize the latest advancements in the development of CO- and HCN-scavenging antidotes, highlighting the strategy of using synthetic iron porphyrins that have been synthesized mainly in our laboratory as water-soluble synthetic hemoglobin biomimetics.