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Colchicine, podophyllotoxin, and the vinca alkaloids exert their primary toxicity by binding to tubulin and interfering with microtubule structure and function. The ubiquitous nature of microtubules within human cells and the heavy reliance on them for maintenance of normal cell functions present numerous opportunities for these xenobiotics to cause dysfunction at a cellular, organ, and organ system level in a dose-dependent fashion.

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History and Epidemiology

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The origins of colchicine and its history in poisoning can be traced back to Greek mythology. Medea was the evil daughter (and a known poisoner) of the king of Colchis, a country that lay east of the Black Sea in Asia Minor. After being betrayed by her husband Jason (of Jason and the Argonauts), she killed their children and her husband's lover. Medea often used plants of the Liliaceae family, of which Colchicum autumnale is a member, to poison her victims.17,134,176 The use of colchicum for medicinal purposes is also reported in Pedanius Dioscorides De Materia Medica, an ancient medical text, written in the first century A.D.17,134,176 and subsequently in the 6th century A.D. by Alexander of Trallis, who recommended it for arthritic conditions.17,30,110,176 However, colchicum fell out of favor, perhaps because of its pronounced gastrointestinal (GI) effects, until it was introduced for dropsy and various other nonrheumatic conditions in 1763.17,176 In the late 18th century, a colchicum-containing product known as Eau Medicinale appeared, which reportedly had strong anti-gout effects.176 Colchicine, the active alkaloidal component in colchicum, was isolated in 1820 and rapidly became popular as an anti-gout medication.134,176 Benjamin Franklin reportedly had gout and is credited with introducing colchicine in the United States.134 Colchicine is still used in the treatment of gout and has been used in a multitude of other disorders, including amyloidosis, Behçet 's syndrome, familial Mediterranean fever, pericarditis, arthritis, pulmonary fibrosis, vasculitis, biliary cirrhosis, pseudogout, certain spondyloarthropathies, calcinosis, and scleroderma.7,17,122,127 Systematic data supporting the efficacy of colchicine therapy in many of these other diseases are lacking.

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Colchicine is derived from two plants of the Liliaceae family, C. autumnale (autumn crocus, meadow saffron, wild saffron, naked lady, son-before-the-father) and Gloriosa superba (glory lily).176 The autumn crocus may contain different amounts of colchicine by weight, depending on the plant part (bulb, 0.8%; flowers, 0.1%; seeds, 0.8%; and the corm or underground stem, 0.6%).110,134,159 Colchicine concentrations within the plant peak during the summer months.134 The leaves of C. autumnale closely resemble those of the Allium ursinum or wild garlic and have been mistaken for them.33,34,98 The tubers of G. superba may be confused with Ipomoea batatas (sweet potatoes).176

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There is a lack of good epidemiologic data on colchicine poisoning. The American Association of Poison Control Centers records several hundred ...

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