In vivo pharmacokinetics and in vitro production of cocaethylene in pregnant guinea pigs

Increased toxicity of cocaine on human hepatocytes induced by ethanol: role of GSH

Increased toxicity of cocaine to human hepatocytes is observed when cells are simultaneously incubated with ethanol. Ethanol might exacerbate cocaine hepatocyte toxicity by three different pathways: a) by increasing the oxidative metabolism of cocaine and hence the oxidative damage; b) by the formation of a more toxic metabolite, namely cocaethylene; or c) by decreasing the defence mechanisms of the cell (i.e. GSH). In the present study, experiments were conducted to investigate the feasibility of these hypotheses. In hepatocytes preincubated for 48 hr with ethanol, neither significant changes in cocaine metabolism nor cytotoxicity were found despite differences in hepatocyte p-nitrophenol hydroxylase (largely CYP2E1 activity). Cocaethylene, the transesterification product of cocaine and ethanol, was found to be more toxic than cocaine for human hepatocytes (3x). However, the small amount formed when human hepatocytes were incubated with cocaine and ethanol would hardly explain the increased toxicity observed. On the other hand, the simultaneous presence of cocaine and ethanol caused a sustained decline in the intracellular GSH content that was larger than that observed in cocaine- or ethanol-treated cultures. Parallel to this phenomenon, a significant increase in lipid peroxidation was observed, as compared to cells treated with equimolar amounts of cocaine, ethanol, or cocaethylene. Finally, depletion of hepatocyte GSH with diethylmaleate down to levels similar to those found in ethanol-treated cells made hepatocytes more susceptible to cocaine. Taken together, the results of this research suggest that by decreasing GSH levels, ethanol makes human hepatocytes more sensitive to cocaine-induced oxidative damage.

The disposition of cocaethylene in rat maternal, placental, and fetal compartments

OBJECTIVE

The aim of this project was to examine the disposition of maternally administered cocaethylene in the fetus.

STUDY DESIGN

Pregnant rats with long-term catheter placement received an intravenous infusion of cocaethylene during a period of 30 minutes. At either the completion of the infusion or 6 hours after the infusion the fetuses were delivered by hysterotomy. Maternal and fetal blood and major tissue samples were obtained for assays of cocaethylene and its metabolites.

RESULTS

Cocaethylene was present in all samples obtained at the end of the infusion, but after 6 hours it was no longer detectable in the maternal and fetal systemic circulations. However, a substantial amount of cocaethylene was still present in the placenta on both the maternal and fetal sides, with the concentration on the maternal side being higher, indicating that the placenta stores cocaethylene. At the end of the infusion benzoylecgonine was found in all samples and the maternal concentrations were higher than the corresponding fetal concentrations. This order was reversed 6 hours after infusion. Extremely high concentrations of cocaethylene and benzoylecgonine were found in the amnion.

CONCLUSIONS

These results suggest that the placenta limits the transfer of cocaethylene to the fetus. The high affinity of this compound for extraplacental sites cannot be ignored.

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.