Theranostics 2019; 9(11):3107-3121. doi:10.7150/thno.34947 This issue

Research Paper

Supramolecular therapeutics to treat the side effects induced by a depolarizing neuromuscular blocking agent

Xiangjun Zhang1, Qian Cheng1, Lanlan Li2, Liqing Shangguan3, Chenwen Li2, Shengke Li1,4, Feihe Huang3✉, Jianxiang Zhang2✉, Ruibing Wang1✉

1. State Key Laboratory of Quality Research in Chinese Medicine, and Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China.
2. Department of Pharmaceutics, College of Pharmacy, Third Military Medical University, Chongqing 400038, China.
3. State Key Laboratory of Chemical Engineering, Center for Chemistry of High-Performance & Novel Materials, Department of Chemistry, Zhejiang University, Hangzhou 310027, P. R. China.
4. School of Materials Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license ( See for full terms and conditions.
Zhang X, Cheng Q, Li L, Shangguan L, Li C, Li S, Huang F, Zhang J, Wang R. Supramolecular therapeutics to treat the side effects induced by a depolarizing neuromuscular blocking agent. Theranostics 2019; 9(11):3107-3121. doi:10.7150/thno.34947. Available from

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Graphic abstract

Succinylcholine (Sch) is the only depolarizing neuromuscular blocking agent widely used for rapid sequence induction in emergency rooms. Unfortunately, a variety of (sometimes lethal) adverse effects, such as hyperkalemia and cardiac arrest, are associated with its use, and currently there are no specific antidotes to reverse Sch or to treat these side-effects.

Methods: The binding behaviors of Sch and several synthetic receptors, including cucurbit[7]uril, sulfo-calix[4]arene and water-soluble carboxylatopillar[6]arene (WP[6]), were first investigated. With a mouse model, a leathal dose of Sch was selected for evaluation of the antidotal effects of these synthetic receptors on Sch induced mortality. The antidotal effects of a selected synthetic receptor, WP[6], on Sch induced cardiac arrhythmias, hyperkalemia, rhabdomyolysis and paralysis were subsequently evaluated with rat and mouse models. The reversal mechanism was also investigated at a cellular level.

Results: All of these macrocyclic molecules exhibited relatively high binding affinities with Sch in vitro. In a Sch-overdosed mouse model, immediate injection of these synthetic receptors right after Sch administration increased the overall survival rate, with WP[6] standing out with the most effective antidotal effects. In addition, administration of WP[6] also reversed the paralysis induced by Sch in a mouse model. Moreover, infusion of WP[6] to Sch-overdosed rats reduced the incidence of cardiac arrhythmia, inhibited the otherwise abnormally high serum potassium levels, and relieved the muscular damage. At the cellular level, WP[6] reversed the Sch induced depolarization and reduced the efflux of intracellular potassium.

Conclusion: Synthetic receptors, particularly WP[6], exhibited high binding affinities towards Sch, and presented a significant potential as supramolecular therapeutics to treat the various side effects of Sch by specifically sequestering Sch in vivo.

Keywords: succinylcholine, neuromuscular blocking agent, host-guest chemistry, pillararene, antidote