Brain hemorrhages in cocaine-exposed human fetuses

Structural brain imaging in children and adolescents following prenatal cocaine exposure: preliminary longitudinal findings

The brain morphometry of 21 children, who were followed from birth and underwent structural brain magnetic resonance imaging at 8-10 years, was studied. This cohort included 11 children with prenatal cocaine exposure (CE) and 10 noncocaine-exposed children (NCE). We compared the CE versus NCE groups using FreeSurfer to automatically segment and quantify the volume of individual brain structures. In addition, we created a pediatric atlas specifically for this population and demonstrate the enhanced accuracy of this approach. We found an overall trend towards smaller brain volumes among CE children. The volume differences were significant for cortical gray matter, the thalamus and the putamen. Here, reductions in thalamic and putaminal volumes showed a robust inverse correlation with exposure levels, thus highlighting effects on dopamine-rich brain regions that form key components of brain circuitry known to play important roles in behavior and attention. Interestingly, head circumferences (HCs) at birth as well as at the time of imaging showed a tendency for smaller size among CE children. HCs at the time of imaging correlated well with the cortical volumes for all subjects. In contrast, HCs at birth were predictive of the cortical volume only for the CE group. A subgroup of these subjects (6 CE, 4 NCE) was also scanned at 13-15 years of age. In subjects who were scanned twice, we found that the trend for smaller structures continued into teenage years. We found that the differences in structural volumes between the CE and NCE groups are largely diminished when the HCs are controlled for or matched by study design. Participants in this study were drawn from a unique longitudinal cohort and, while the small sample size precludes strong conclusions regarding the longitudinal findings reported, the results point to reductions in HCs and in specific brain structures that persist through teenage years in children who were exposed to cocaine in utero.

Deleterious effects of polynuclear aromatic hydrocarbon on blood vascular system of the rat fetus

BACKGROUND

Polynuclear aromatic hydrocarbons (PAH), benzo[alpha]pyrene (B[alpha]P) and 7,12-dimethylbenz[alpha]anthracene (DMBA) are toxic environmental agents distributed widely. The relative deleterious effects of these agents on growth and blood vasculature of fetus and placental tissues of the rat were studied.

METHODS

Pregnant rats (Day 1 sperm positive) with implantation sites confirmed by laparotomy were treated intraperitoneally (i.p.) on Pregnancy Days 10, 12, and 14 with these agents dissolved in corn oil at cumulated total doses 50, 100, and 200 mg/kg/rat, and control with corn oil only (3-20 dams/group). Fetal growth, tissue hemorrhage, and placental pathology were evaluated by different parameters on Pregnancy Day (PD) 20 in treated and control rats.

RESULTS

DMBA was relatively more deleterious compared to B[alpha]P indicated by increased lethality and progressive reduction of body weight of the mother with increasing doses. At 200 mg/kg/rat doses of these agents, maternal survival was 45% and 100% and body weight reduced 24% and 52% of controls, respectively. The fetal survival rates in live mothers were similar to that of controls. They induced marked fetal growth retardation and necrosis of placental tissues. B[alpha]P and DMBA produced significant toxicity to differentiating fetal blood vascular system as exhibited by rupture of blood vessels and hemorrhage, especially in the skin, cranial, and brain tissues.

CONCLUSIONS

Maternal PAH exposure induced placental toxicity and associated adverse fetal development and hemorrhage in different parts of the fetal body, in particular, marked intradermal and cranial hemorrhage, showing that developing fetal blood vasculature is a target of PAH toxicity.

Inhibition of nitric oxide synthase enhances cocaine's developmental toxicity: vascular and CNS effects

Ischemia and/or reperfusion injury from free radicals may cause cocaine's toxicity, including its effect upon neurobehavioral development. We previously used salicylate to measure hydroxyl free radicals in chick embryos exposed to cocaine. The combination was more toxic than cocaine alone. We postulated that salicylate enhanced the vasoconstriction and toxicity via inhibition of compensatory processes (eg by inhibition of the synthesis of vasodilatory prostanoids and/or nitric oxide). A nontoxic dose of N(G)-nitro-L-arginine methyl ester (L-NAME) was used to inhibit nitric oxide synthase to test this hypothesis. In one experiment, cocaine was injected every 1.5 h (total dose =67.5 mg/kg egg) on day 15 of development, 1 h after injection of L-NAME (200 mg/kg egg) to determine viability and hatchability, which are measures of toxicity. Another experiment measured diameters of blood vessels after L-NAME injection, followed by NaCl or cocaine infusion (0.23 mg/egg/min; total dose=67.5 mg/kg egg) at 15 and 5 min afterwards. Lastly, brains of embryos pretreated with L-NAME before cocaine injections were analyzed for nitric oxide synthase activity. Cocaine decreased viability and hatchability. L-NAME enhanced cocaine's effect upon both parameters. Blood vessel diameters were decreased by cocaine after 15 min of infusion. L-NAME+cocaine caused a decrease in vessel diameter as soon as 5 min into the infusion and was greater with time, compared with other groups. Enzyme activity in brains was decreased only in the L-NAME+cocaine group. Thus, inhibition of nitric oxide synthesis interferes with the embryos' capacity to mount a compensatory vasodilatory response.

A “deficient environment” in prenatal life may compromise systems important for cognitive function by affecting BDNF in the hippocampus

The intrauterine environment has the capacity to mold the prenatal nervous system. Particularly, recent findings show that an adverse prenatal environment produces structural defects of the hippocampus, a critical area sub-serving learning and memory functions. These structural changes are accompanied by a disruption in the normal expression pattern of brain-derived neurotrophic factor (BDNF) and its cognate tyrosine kinase B (TrkB) receptor. The important role that the BDNF system plays in neural modeling and learning and memory processes suggests that fetal exposure to unfavorable intrauterine conditions may compromise proper cognitive function in adult life. These findings have implications for disorders that involve a dysfunction in the BDNF system and are accompanied by cognitive deficits.

Vasoconstriction caused by cocaine is enhanced by sodium salicylate: is inducible nitric oxide synthase mRNA related?

We have previously found that sodium salicylate (NaSal), injected into chicken eggs at nontoxic doses used for quantifying hydroxyl free radicals in hearts and brains of embryos, caused or exacerbated hemorrhages and dramatically reduced hatchability when combined with cocaine (Coc). It has also been reported that inducible nitric oxide synthase (iNOS) gene expression is altered in brain in response to vascular damage and inflammation. In this study we measured diameters of membrane-bound blood vessels (BV) before and after pretreatment with saline (NaCl) or NaSal (100 mg/kg egg), followed by infusion of either NaCl or Coc HCl (total of 67.5 mg/kg egg) during 15 min. Brains and hearts of the embryos were then analyzed for iNOS messenger RNA (mRNA) concentrations. Coc caused vasoconstriction that was significant 5 min postinfusion (5 min PI) of the entire dose (ie after 67.5 mg/kg egg). Significant vasoconstriction was evident within 5 min in the group injected with NaSal followed by infusion with Coc (ie after 22.5 mg Coc/kg egg). Expression of iNOS mRNA was significantly increased only in the brains of the group exposed to NaSal plus Coc, and the increase was inversely related to BV diameter. These data are discussed in relation to effects of salicylate upon prostanoid synthesis and/or nitric oxide synthesis via iNOS inhibition and their possible relationship to Coc-associated cerebral vascular and/or cardiovascular events in abusing humans.

Fetal effects of cocaine: an updated meta-analysis

BACKGROUND

A very large number of women in the reproductive age group consume cocaine, leading to grave concerns regarding the long term health of millions of children after in utero exposure. The results of controlled studies have been contradictory, leading to confusion, and, possible, misinformation and misperception of teratogenic risk.

OBJECTIVE

To systematically review available data on pregnancy outcome when the mother consumed cocaine.

METHODS

A meta-analysis of all epidemiologic studies based on a priori criteria was conducted. Comparisons of adverse events in subgroups of exposed vs. unexposed children were performed. Analyses were based on several exposure groups: mainly cocaine, cocaine plus polydrug, polydrug but no cocaine, and drug free.

RESULTS

Thirty three studies met our inclusion criteria. For all end points of interest (rates of major malformations, low birth weight, prematurity, placental abruption, premature rupture of membrane [PROM], and mean birth weight, length and head circumference), cocaine-exposed infants had higher risks than children of women not exposed to any drug. However, most of these adverse effects were nullified when cocaine exposed children were compared to children exposed to polydrug but no cocaine. Only the risk of placental abruption and premature rupture of membranes were statistically associated with cocaine use itself.

CONCLUSIONS

Many of the perinatal adverse effects commonly attributed to cocaine may be caused by the multiple confounders that can occur in a cocaine using mother. Only the risk for placental abruption and PROM could be statistically related to cocaine. For other adverse effects, additional studies will be needed to ensure adequate statistical power.

Cocaine: effects of in utero exposure on the fetus and neonate

In North America, an increasing number of babies are prenatally exposed to cocaine, yet the implications of cocaine use during pregnancy are not fully understood. The effects of cocaine are exerted primarily by its influence on aminergic receptors in the central and peripheral nervous systems. Developmental, physiological, and behavioral problems in infants and children are likely outcomes of maternal cocaine abuse, but these findings are confounded by concomitant use of other drugs such as marijuana and cocaine and by factors such as time, dosage, and route of cocaine intake. Different screening options exist for cocaine and its metabolites, including sampling of neonatal urine, hair and meconium need to be considered, as do the sensitivity and the ethical implications of such testing. Clinical management of cocaine-exposed infants requires attention to several issues, including: central nervous system irritation, cardiac anomalies, apnea, and feeding difficulties, as well as infant safety and follow-up postdischarge. Early detection and intervention remain the primary objectives of caring for cocaine-exposed infants.

Effect of cocaine, 95% oxygen and ellagic acid on the development and antioxidant status of cultured rat embryos

Prenatal exposure to cocaine has been associated with adverse developmental effects and current data suggest cocaine induced malformations are caused by ischemic-reperfusion injury. This study was undertaken to assess a new in vitro model which uses a routine rat whole embryo culture system that incorporates a change in oxygen status, and to examine the effects of altered oxygen status and pretreatment with ellagic acid (EA), an anti-oxidant, after cocaine exposure. Embryos were evaluated by determining a developmental score and by measuring tissue reduced glutathione (GSH) levels. Following re-oxygenation with 95% O2 for the last 6 h of culture, embryos treated with cocaine had reduced developmental scores and GSH levels. Embryos treated with cocaine and not re-oxygenated with 95% O2 did not have reduced developmental scores. EA blocked the effects of cocaine on developmental score and GSH level. These data support ischemia-reperfusion injury as the mechanism of cocaine developmental toxicity.

Cocaine in pregnancy. Recent data on maternal and fetal risks

Cocaine continues to be abused during pregnancy, creating increased demands on the health care system. Epidemiology and basic science research have identified and confirmed risks of adverse maternal and fetal effects when cocaine is used during pregnancy. These effects of cocaine in pregnant women often are influenced by a number of confounding variables. This article reviews those cocaine effects as well as recent data, which examine in greater detail the risks of adverse outcomes of prenatal cocaine exposure during pregnancy.

Evidence for increased seizure susceptibility in rats exposed to cocaine in utero

Clinical observations indicate that cocaine use during pregnancy is a major health concern in the United States and may result in seizure-like behavior in the offspring. In the present study, we investigated whether prenatal cocaine exposure altered seizure thresholds measured in Sprague-Dawley rats, 60-90 days postnatal. In vitro postnatal studies, focusing on hippocampal tissue, revealed a reduced threshold for both electrical stimulation- and potassium-induced epileptiform discharges in slices from cocaine-exposed animals. Modest elevation of extracellular potassium concentration from 3 to 6 mM KCl elicited spontaneous epileptiform discharges in the majority of slices from cocaine-exposed animals (13/20) but rarely in slices from saline-exposed animals (2/18). In vivo studies on awake, freely behaving adult rats indicated a significant reduction in thresholds for both flurothyl- and kainic acid-induced seizures in cocaine-exposed animals. Video-EEG monitoring during administration of kainic acid revealed reduced latencies to first 'electrographic seizure' and first 'electrographic seizure with behavior' in rats exposed to cocaine in utero compared to saline-treated controls. These studies provide strong experimental evidence that adult animals exposed to cocaine during gestation are at high risk for the development of seizure activity.

Effects of prenatal cocaine exposure on the developing hippocampus: intrinsic and synaptic physiology

A variety of neurological complications has been reported in infants exposed to cocaine during gestation. In the present study, intrinsic cell properties of hippocampal neurons from CA1, CA3, and dentate gyrus regions were measured and compared in tissue from neonatal rats exposed to saline or cocaine in utero. Synaptic properties of the CA1 pyramidal cell region were analyzed at postnatal day (P) 20 with the use of extracellular and intracellular recording techniques. In vitro intracellular recordings (n = 223) obtained at P10, P15 and P20 in tissue from cocaine- and saline-exposed animals revealed no differences in standard cell properties such as resting membrane potential, input resistance, time constant, and action potential amplitude or duration. Hippocampal slices from cocaine-exposed animals exhibited a marked reduction of spike frequency adaptation for all three types of principal hippocampal neurons (e.g., CA1, CA3, and granule cells). The amplitudes of afterhyperpolarizations following a spike train were also decreased in CA1 and CA3 cells in tissue from cocaine-exposed animals. Extracellular and intracellular recordings in the CA1 pyramidal cell region at P20 were obtained to assess and compare synaptic function in tissue from cocaine- and saline-exposed animals. In hippocampal slices from cocaine-exposed animals, synaptic responses in the CA1 region were characterized by multiple population spike activity and reduced inhibitory postsynaptic potentials. The reduction in fast inhibitory postsynaptic potential conductance was not associated with a change in reversal potential. These results suggest that gestational cocaine exposure induces significant changes in intrinsic and synaptic electrophysiological properties of hippocampal neurons in the developing animal. The cell and synaptic features are consistent with an increase in hippocampal excitability, which may contribute to the neurobehavioral deficits and epileptogenic predisposition reported in this infant population. As such, this in utero drug exposure model may provide a useful system in which to elucidate and study the basic cellular mechanisms underlying neurological complications associated with maternal cocaine abuse.

Teratogenic potential of cocaine

Cocaine has been implicated as a potential cause of congenital abnormalities since the mid 1980s. Clinical studies have reported an increased risk of cardiovascular and central nervous system abnormalities as well as an increased incidence of limb reduction defects and intestinal atresias. The published data have not established an unequivocal link between cocaine and these abnormalities. The most compelling evidence for the role of cocaine as a teratogen is the increased risk of genitourinary tract defects. Although animal models have also yielded contradictory conclusions, it is intriguing to note that the abnormalities observed in these models are similar to those seen clinically. This review summarizes the clinical and basic research relating to the teratogenic potential of cocaine.

Effects of cocaine on human platelet aggregation in vitro

BACKGROUND

A temporal relationship has been established between cocaine ingestion and myocardial infarction, and a cocaine-induced increase in platelet aggregation has been suggested as a possible explanation. However, the mechanisms of cocaine associated coronary thrombosis have yet to be completely elucidated. For this reason, we examined the in vitro effect of cocaine and its metabolites on platelet aggregation.

METHODS

Platelet aggregation was tested by obtaining platelet rich plasma from 42 healthy volunteers and incubating the platelet rich plasma in six concentrations of cocaine (ranging from 1.47 to 2940 nmol) for 10 minutes prior to aggregation with ADP 1 microM. The same procedure was used to test the effect of two cocaine metabolites, benzoylecgonine and ecgonine methyl ester, on platelet aggregation. Abnormal results were confirmed by inducing aggregation with ADP at higher concentrations (2.4 and 10 microM) and with arachidonic acid (624 microM).

RESULTS

At increasing concentrations, cocaine progressively inhibited ADP and arachidonic acid induced platelet aggregation. No effect was seen with benzoyl ecgonine or ecgonine methyl ester as compared to saline.

CONCLUSIONS

These data suggest that under certain conditions cocaine may negatively affect hemostasis by decreasing platelet aggregation.

Selective neuronal toxicity of cocaine in embryonic mouse brain cocultures

Cocaine exposure in utero causes severe alterations in the development of the central nervous system. To study the basis of these teratogenic effects in vitro, we have used cocultures of neurons and glial cells from mouse embryonic brain. Cocaine selectively affected embryonic neuronal cells, causing first a dramatic reduction of both number and length of neurites and then extensive neuronal death. Scanning electron microscopy demonstrated a shift from a multipolar neuronal pattern towards bi- and unipolarity prior to the rounding up and eventual disappearance of the neurons. Selective toxicity of cocaine on neurons was paralleled by a concomitant decrease of the culture content in microtubule-associated protein 2 (MAP2), a neuronal marker measured by solid-phase immunoassay. These effects on neurons were reversible when cocaine was removed from the culture medium. In contrast, cocaine did not affect astroglial cells and their glial fibrillary acidic protein (GFAP) content. Thus, in embryonic neuronal-glial cell cocultures, cocaine induces major neurite perturbations followed by neuronal death without affecting the survival of glial cells. Provided similar neuronal alterations are produced in the developing human brain, they could account for the qualitative or quantitative defects in neuronal pathways that cause a major handicap in brain function following in utero exposure to cocaine.

Cocaine-induced embryonic cardiovascular disruption in mice

The purpose of this study was to determine whether vascular disruption is a feature of cocaine-induced teratogenicity in early murine organogenesis. The embryotoxic effects of cocaine were assessed: (1) in vivo, (2) in embryos cultured in the presence of cocaine (in vitro), and (3) after cocaine was administered in vivo and the embryos subsequently cultured in the absence of cocaine (in vivo-in vitro). When cocaine (78 mg/kg) was administered in vivo on day 8 and embryos were assessed on day 10, significant vascular perturbations, in the form of vasodilation and hemorrhage, as well as neural defects, were observed. In the in vitro system, day 8 embryos were cultured for 48 hr in the presence of 0, 10, 20, 33, and 66 micrograms/ml cocaine. At 10 and 20 micrograms/ml, vascular perturbation was not seen, while at higher cocaine concentrations, development of the yolk sac vasculature was inhibited. Hemorrhage was not a feature of in vitro cocaine embryotoxicity. However, significantly increased incidences of neural defects were seen at concentrations of 20 micrograms/ml or greater. Finally, in the in vivo-in vitro system, 78 mg/kg cocaine was administered on day 8 in vivo and embryos were dissected after 15 min and cultured for 48 hr. Marked cardiovascular perturbation, as well as neural defects, were produced using this protocol. With cocaine treatment, only 26.6% of embryos had a functioning heartbeat and yolk sac circulation, compared to 85.6% of controls. This cardiovascular disruption was associated with pooling of blood in the embryo, with 59.9% of embryos exhibiting marked vasodilation and hemorrhage compared to 12.5% in controls. Additional manifestations of cardiovascular perturbation were edema and blisters observed in cocaine-treated embryos. Neural tube defects, including open neural tube (8.3%) and microcephaly/hypoplastic prosencephalon (30.0%), were also significantly increased in cocaine-treated embryos. The cardiovascular and neural effects produced by cocaine were dose-dependent (40, 20 mg/kg). Thus, administration of cocaine in the in vivo or in vivo-in vitro systems produced marked cardiovascular effects, while in vitro treatment did not. These results suggest that cocaine may elicit cardiovascular toxicity through a maternally mediated mechanism.

Role of oxygen free radicals in cocaine-induced vascular disruption in mice

To test the hypothesis that cocaine-induced embryonic vascular disruption is mediated by oxygen free radicals, the antioxidants 2-oxothiazolidine-4-carboxylate (OTC) and alpha-phenyl-N-t-butyl nitrone (PBN) were employed. When cocaine (78 mg/kg) was administered on day 8 of gestation to ICR mice and embryos evaluated on day 10 (in vivo), 62.3% of cocaine-treated embryos showed increased vasodilation compared to 4.9% for controls, and 33.1% of the cocaine-exposed embryos showed marked hemorrhage compared to 3.3% for controls. In addition, cocaine increased the incidence of neural defects, in the form of open neural tube, hypoplastic prosencephalon, and microcephaly. Administration of OTC (0.25 and 0.5 mmol/kg) or PBN (300 mg/kg) prior to cocaine significantly reduced cocaine-induced vasodilation and hemorrhage, while not preventing neural defects. When cocaine (78 mg/kg) was administered in vivo on day 8 of gestation and embryos were dissected 15 min later and subsequently cultured for 48 hr in the absence of cocaine (in vivo-in vitro), marked vascular disruption was observed: normal yolk circulation/heartbeat was decreased to 26.6%, while edema/blisters and vasodilation/hemorrhage were increased to 45.6% and 59.6%, respectively. Administration of PBN (300 mg/kg) prior to cocaine completely prevented cocaine-induced vascular disruption. When cocaine was administered in vivo and PBN (300 micrograms/ml) was incubated with cultured embryos in vitro, the antioxidant only partially prevented cocaine-induced cardiovascular defects in this model. Neural defects produced by cocaine were not significantly affected by PBN, administered either in vivo or in vitro. Cocaine (78 mg/kg) administered in vivo stimulated lipid peroxidation maximally after 3 hr in both day 8 and day 9 embryos. When cocaine was incubated in vitro during embryo culture at 33 micrograms/ml, a concentration that produces nonspecific inhibition of growth and development, embryonic lipid peroxidation on day 9 was not affected. Finally, when PBN (300 mg/kg) was administered prior to cocaine (78 mg/kg) on day 8 of gestation, stimulation of lipid peroxidation by cocaine was prevented. These results suggest that cocaine-induced vascular disruption in early development is mediated by maternal production of oxygen free radicals.

Structural anomalies resulting from vascular disruption

A diverse yet distinctive group of disorders and structural anomalies result from vascular disruption of embryonic and fetal blood vessels. The extent of damage, timing in gestation, and the mechanism of vascular disruption all determine the nature of the resultant structural anomalies. The developing human remains susceptible throughout pregnancy to teratogenic agents and events that alter uterine, placental, and embryonic or fetal circulation.

Antagonism of cocaine-induced fetal anomalies by prazosin and diltiazem in mice

Cocaine-induced uteroplacental and fetal vasoconstriction have been observed to cause fetal hypoxemia. The ability of cocaine to elevate norepinephrine (NE) levels has been proposed as one mechanism to explain the effect of cocaine on fetal development. Prazosin, a selective antagonist of alpha-1 adrenergic receptors, and diltiazem, a calcium channel blocker, were used to determine if antagonism of NE-induced vasoconstriction would reduce the effects of chronic cocaine administration on fetal development. The dose-response relationship of cocaine with fetal development was established in CF-1 mice by administering cocaine sc on days 5 to 18 of gestation followed by teratologic evaluation. Cocaine 2 mg/kg/day produced a significant incidence of fetal anomalies without significantly affecting food consumption or maternal and fetal weight gain. In subsequent experiments, prazosin (0.03, 0.3 mg/kg) or diltiazem (1.7, 5.1 mg/kg) were administered po 2 h prior to 2 mg/kg cocaine sc (gestation days 5 to 18) followed by teratologic evaluation. Diltiazem (5.1 mg/kg) produced a significant increase, whereas prazosin (0.3 mg/kg) produced a significant reduction, in the incidence of fetal anomalies compared with saline controls. While data from the pretreatment studies were inconclusive, comparisons between cocaine alone and the cocaine groups pretreated with the high doses of either prazosin or diltiazem seem worthy of further study with larger sample sizes.

Fetal brain damage in the rat following prenatal exposure to cocaine

The aim of this study was to identify fetal brain damage induced by 1) prenatal cocaine exposure or 2) physical procedures causing temporary constriction or occlusion of the uterine vessels in pregnant rats. Brains were examined from rat fetuses killed 48 hours after the dam was given one or more intraperitoneal doses of cocaine (50-70 mg/kg) on day 16 of gestation. Only brains from fetuses with hemorrhage in the extremities were examined, as this indicated they had undergone a circulatory disturbance. Four of the 10 brains examined showed bilateral necrosis and cavitation in the cerebral cortex. There were also hemorrhage and ectopic outgrowths in the corpus striatum, bilateral cavitation in the brainstem and vacuolization in the lens of the eye. A similar type and distribution of damage was seen in rat fetal brains from dams treated by temporary occlusion of the uterine vessels or direct handling of the pregnant uterus on day 16 of gestation and examined 48 hours later. It is proposed that the procedures act through the common mechanism of constriction/occlusion of the uterine vessels. The damage to the fetuses appears to be due to hemorrhage from the fetal vessels and ischemia. These findings are discussed in relation to cocaine use during human pregnancy.