Cocaine reduces macrophage killing by inhibiting reactive nitrogen intermediates

Alteration of superoxide- and nitric oxide-mediated antimicrobial function of macrophages by in vivo cocaine exposure

Cocaine is a popular drug of abuse and despite impressive advances in the understanding of its physiological, pharmacological, and toxic effects, its mechanism of immunosuppression at the cellular level is not well understood. In this paper we report the role of effector molecules like superoxide and nitric oxide in the antibacterial function of macrophages exposed to acute and chronic doses of cocaine in vivo. Bacterial killing by acute cocaine-exposed macrophages (ACE-Mphis) increased significantly, with a concomitant rise in respiratory burst and generation of superoxide and nitric oxide, compared with control macrophages. In contrast, chronic cocaine-exposed macrophages (CCE-Mphis) exhibited limited antimicrobial activity, which correlated closely with diminished respiratory burst and reduced production of superoxide and nitric oxide. Further, a killing assay was carried out in the presence of N(G)-methyl-L-arginine acetate, an inhibitor of iNOS, to evaluate the role of nitric oxide in the killing process. The results obtained indicate that while about 30% killing of input bacteria by control and ACE-Mphis was attributable to NO-mediated killing, only about 6% killing from NO was found with CCE-Mphis. The findings indicate that acute exposure to cocaine possibly caused upregulation of enzymes responsible for the generation of ROI (reactive oxygen intermediates) and RNI (reactive nitrogen intermediates), leading to enhanced antimicrobial function. On the other hand, chronic exposure to cocaine impaired the oxygen-dependent microbicidal capacity of macrophages, possibly through impaired expression of enzymes responsible for ROI and RNI formation. Proinflammatory cytokines may play a key role in cocaine-mediated immunosuppression, since exposure of macrophages to cocaine impairs the ability of the cells to produce these cytokines.

Mechanisms for impaired effector function in alveolar macrophages from marijuana and cocaine smokers

Lung macrophages provide a first line of host defense against inhaled pathogens and their function is impaired in the lungs of inhaled substance abusers. In order to investigate the mechanism for this impairment, alveolar macrophages (AM) were recovered from nonsmokers (NS), regular tobacco smokers (TS), marijuana smokers (MS), or crack cocaine smokers (CS), and evaluated for their production of nitric oxide (NO) and the role of NO as an antimicrobial effector molecule. AM from NS and TS efficiently killed Staphylococcus aureus and their antibacterial activity correlated closely with the production of nitrite and the expression of mRNA encoding for inducible nitric oxide synthase (iNOS). In contrast, AM collected from MS and CS exhibited limited antimicrobial activity that was not affected by an inhibitor of iNOS, or associated with expression of iNOS. Treatment with either granulocyte/macrophage colony-stimulating factor (GM-CSF) or interferon-gamma restored the ability of these cells to produce NO and to kill bacteria. These findings confirm a significant role for NO as an antibacterial effector molecule used by normal human AM and suggest that this host defense mechanism is suppressed by habitual exposure to inhaled marijuana or crack cocaine in vivo.

Cocaine causes increased type I interferon secretion by both L929 cells and murine macrophages

Cocaine has been demonstrated to have a number of different effects on immune cell functions. We have reported alterations of cellular functions by macrophages (Mphi) exposed to cocaine in vitro, including the inhibition of mouse hepatitis virus replication. Here, we present evidence that cocaine stimulates the secretion of an antiviral product that is neutralized by anti-interferon (anti-IFN). A dose-dependent increase in the secretion of IFN by both Mphi and L929 cells incubated with cocaine, with a concomitant decrease in virus replication, is also reported. The increase in IFN secretion was most pronounced when cells were cultured in the presence of the IFN inducer poly(I.C). The effect of cocaine on IFN production was found to be primarily at the transcript level in both Mphi and L929 cells. These findings further support our previous research demonstrating an antiviral activity of cocaine in vitro. The relevance of this activity to viral infections in general remains to be determined.

Chronic inhaled cocaine abuse may predispose to the development of pancreatic adenocarcinoma

BACKGROUND

The acute and chronic effects of cocaine over various organ systems have been well documented. A more recent approach to the effects of this drug has focused on the immunological consequences of its exposure, with results that indicate a possible carcinogenic effect.

METHODS

A chart review was made in order to search for young pancreatic adenocarcinoma patients (arbitrarily defined as younger than 40) who made use of inhaled cocaine. This age was chosen because of a higher probability of cocaine addiction than at older ages.

RESULTS

Of the 198 patients with pancreatic adenocarcinoma, 13 were younger than 40 years (range 19 to 37) and 5 of these had abused inhaled cocaine for about a decade. One patient had abused marijuana, and there was no information on drug usage in the other 7 patient charts.

CONCLUSION

Although this is a very small series, we believe there might be a possibility that chronic cocaine exposure predisposes to the development of pancreatic adenocarcinoma. Further studies are necessary.

Acute and chronic effects of cocaine on the immune system and the possible link to AIDS

The pathogenesis of AIDS is a complex and prolonged process that is affected by a variety of cofactors, including the abuse of both intravenous and smoked (crack) cocaine. The exact mechanisms by which cocaine facilitates this disease are yet to be proven, but likely include a combination of increased risk due to cocaine-related social behaviours, a wide-ranging capacity for cocaine to suppress the immune system, and an effect of cocaine on the infectivity and replication of HIV. While sometimes contradictory, both human and animal studies document that cocaine alters the function of natural killer (NK) cells, T cells, neutrophils and macrophages, and alters the ability of these cells to secrete immunoregulatory cytokines. In addition to these effects on the immune system, cocaine also enhances the infectivity and/or replication of HIV when tested using human cells in vitro.

Marijuana and cocaine impair alveolar macrophage function and cytokine production

Use of marijuana and cocaine is on the rise in the United States. Although pulmonary toxicity from these drugs has occasionally been reported, little is known about their effects on the lung microenvironment. We evaluated the function of alveolar macrophages (AMs) recovered from the lungs of nonsmokers and habitual smokers of either tobacco, marijuana, or crack cocaine. AMs recovered from marijuana smokers were deficient in their ability to phagocytose Staphylococcus aureus (p < 0.01). AMs from marijuana smokers and from cocaine users were also severely limited in their ability to kill both bacteria and tumor cells (p < 0.01). Studies using NG-monomethyl-L-arginine monoacetate, an inhibitor of nitric oxide synthase, suggest that AMs from nonsmokers and tobacco smokers were able to use nitric oxide as an antibacterial effector molecule, while AMs from smokers of marijuana and cocaine were not. Finally, AMs from marijuana smokers, but not from smokers of tobacco or cocaine, produced less than normal amounts of tumor necrosis factor-alpha, granulocyte-macrophage colony-stimulating factor, and interleukin-6 when stimulated in culture with lipopolysaccharide. In contrast, the production of transforming growth factor-beta, an immunosuppressive cytokine, was similar in all groups. These findings indicate that habitual exposure of the lung to either marijuana or cocaine impairs the function and/or cytokine production of AMs. The ultimate outcome of these effects may be an enhanced susceptibility to infectious disease, cancer, and AIDS.

Suppression of splenic T lymphocyte proliferation by acute cocaine administration

We have recently demonstrated that cocaine administration has a limited effect on mitogen-stimulated T lymphocyte proliferation. The present study investigated the effect of cocaine on splenic T cell response to alloantigens. Rats received intraperitoneal injections of cocaine HCI, and splenocytes were isolated either thirty minutes or three hours post-administration. In the thirty minute exposure group, cocaine at 10.0 and 25.0 mg/Kg/B.Wt. suppressed (p<0.05) T cell proliferation in mixed lymphocyte cultures. Compared to control data, proliferation was decreased by 46.6% and 56.4%, respectively. However, this effect was not as pronounced in cells isolated three hours post-administration, indicating a transient inhibition of T cell function by cocaine. The decrease in splenic T cell proliferation in response to alloantigens in the thirty minute exposure group did not reflect alterations in calcium influx or IL-2 production. Although this study did not ascertain the exact mechanism of inhibition, these results demonstrate that short-term cocaine exposure can alter T cell reactivity to alloantigens, suggesting a reduction in the functional status of these cells.

Suppression of macrophage reactive intermediates by cocaine

The in vivo or in vitro effects of cocaine on the production of hydrogen peroxide (H2O2), superoxide (O2-), and nitrite (NO2-) by sodium periodate-elicited macrophages were studied. Hydrogen peroxide and superoxide productions were suppressed by both in vitro treatments and in vivo administrations of cocaine. The H2O2 and O2- production partially recovered after 150 min in vitro. However, cocaine inhibited NO2- production only in vitro, failing to suppress it through in vivo administration.

Cocaine blunts human CD4+ cell activation

Cocaine is reported to be immunotoxic. The biochemical mechanisms responsible for the immunopharmacological outcomes of cocaine in vivo and in vitro remain, however, to be fully elucidated. Our experimental data confirm that exposure of normal human T cells to micromolar concentrations of cocaine modulates T-cell responses to stimulation by a variety of stimuli, and indicate that cocaine impairs early activation events during CD4+ but not CD4- T-cell stimulation. Pre-incubation of enriched CD4+ T-cell subpopulations that express the homing receptor CD62L with nanomolar concentrations of the endogenous opioid peptide beta-endorphin leads to a more severe impairment of activation than that noted following pre-incubation with micromolar concentrations of cocaine alone. These findings begin to elucidate the molecular and cellular mechanisms of the immunopathology of cocaine. Our data support the proposition that cocaine abuse may place cocaine-abuser HIV-seropositive individuals at increased risk of opportunistic infections.

The effects of cocaine and its metabolites on the production of reactive oxygen and reactive nitrogen intermediates

Cocaine, a naturally occurring alkaloid, is known to affect the immune system. The present authors have demonstrated that peritoneal macrophages, isolated from mice injected with cocaine, have an increased capacity for the production of reactive oxygen intermediates (ROI) and a decreased capacity for the production of reactive nitrogen intermediates (RNI). The present studies were done to determine the effects of certain cocaine metabolites on the induction of ROI and RNI by peritoneal macrophages. C57BL/6 mice were injected i.p. with either saline or 5 mg/kg of one of the following: cocaine, norcocaine, benzoylecgonine, ecgonine methyl ester HCl or ecgonine HCl. The ROI were measured using a chemiluminescence assay and the RNI were measured as nitrite secretion following exposure of isolated M phi to interferon gamma and LPS. Isolated peritoneal M phi from mice injected i.p. with cocaine, norcocaine and benzoylecgonine exhibited an increase in the production of ROI and a concomitant decrease in the production of RNI. However, injections of either ecgonine methylester HCl or ecgonine HCl had no effect on the induction of either ROI or RNI by murine peritoneal M phi. The cocaine metabolites, norcocaine and benzoylecgonine, have been reported to cause hepatic and/or cerebral toxicity. The present study also demonstrated that injection of these metabolites in vivo, also altered M phi functions which were measured in vitro.