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Lo JO, Hedges JC, Chou WH, Tager KR, Bachli ID, Hagen OL, Murphy SK, Hanna CB, Easley CA. Influence of substance use on male reproductive health and offspring outcomes. Nat Rev Urol 2024; 21:534-564. [PMID: 38664544 DOI: 10.1038/s41585-024-00868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/30/2024]
Abstract
The prevalence of substance use globally is rising and is highest among men of reproductive age. In Africa, and South and Central America, cannabis use disorder is most prevalent and in Eastern and South-Eastern Europe, Central America, Canada and the USA, opioid use disorder predominates. Substance use might be contributing to the ongoing global decline in male fertility, and emerging evidence has linked paternal substance use with short-term and long-term adverse effects on offspring development and outcomes. This trend is concerning given that substance use is increasing, including during the COVID-19 pandemic. Preclinical studies have shown that male preconception substance use can influence offspring brain development and neurobehaviour through epigenetic mechanisms. Additionally, human studies investigating paternal health behaviours during the prenatal period suggest that paternal tobacco, opioid, cannabis and alcohol use is associated with reduced offspring mental health, in particular hyperactivity and attention-deficit hyperactivity disorder. The potential effects of paternal substance use are areas in which to focus public health efforts and health-care provider counselling of couples or individuals interested in conceiving.
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Affiliation(s)
- Jamie O Lo
- Department of Urology, Oregon Heath & Science University, Portland, OR, USA.
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA.
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
| | - Jason C Hedges
- Department of Urology, Oregon Heath & Science University, Portland, OR, USA
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Wesley H Chou
- Department of Urology, Oregon Heath & Science University, Portland, OR, USA
| | - Kylie R Tager
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, USA
| | - Ian D Bachli
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, USA
| | - Olivia L Hagen
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Carol B Hanna
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Charles A Easley
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, USA
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Le HH, Shorey-Kendrick LE, Hinds MT, McCarty OJT, Lo JO, Anderson DEJ. Effects of in utero exposure to Δ-9-tetrahydrocannabinol on cardiac extracellular matrix expression and vascular transcriptome in rhesus macaques. Am J Physiol Heart Circ Physiol 2024; 327:H701-H714. [PMID: 39028280 PMCID: PMC11442028 DOI: 10.1152/ajpheart.00181.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/27/2024] [Accepted: 07/07/2024] [Indexed: 07/20/2024]
Abstract
Delta-9-tetrahydrocannabinol (THC), the psychoactive component of cannabis, remains a schedule I substance, thus safety data regarding the effects on the cardiovascular and prenatal health are limited. Importantly, there is evidence showing prenatal cannabis exposure can negatively impact fetal organ development, including the cardiovascular system. THC can cross the placenta and bind to cannabinoid receptors expressed in the developing fetus, including on endothelial cells. To understand the impact of prenatal THC exposure on the fetal cardiovascular system, we used our rhesus macaque model of prenatal daily edible THC consumption. Before conception, animals were acclimated to THC (2.5 mg/7 kg/day, equivalent to a heavy medical cannabis dose) and maintained on this dose daily throughout pregnancy. Fetal tissue samples were collected at gestational day 155 (full term is 168 days). Our model showed that in utero THC exposure was associated with a decreased heart weight-to-body weight ratio in offspring, warranting further mechanistic investigation. Histological examination of the fetal cardiac and vascular tissues did not reveal any significant effect of THC exposure on the maturity of collagen within the fetal heart or the aorta. Total collagen III expression and elastin production and organization were unchanged. However, bulk RNA-sequencing of vascular cells in the umbilical vein, umbilical artery, and fetal aorta demonstrated that THC alters the fetal vascular transcriptome and is associated with upregulated expression of genes involved in carbohydrate metabolism and inflammation. The long-term consequences of these findings are unknown but suggest that prenatal THC exposure may affect cardiovascular development in offspring.NEW & NOTEWORTHY Prenatal cannabis use is increasing and despite the public health relevance, there is limited safety data regarding its impact on offspring cardiovascular health outcomes. We used a translational, nonhuman primate model of daily edible Δ-9-tetrahydrocannabinol (THC) consumption during pregnancy to assess its effects on the fetal cardiovascular system. THC-exposed fetal vascular tissues displayed upregulation of genes involved in cellular metabolism and inflammation, suggesting that prenatal THC exposure may impact fetal vascular tissues.
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Affiliation(s)
- Hillary H Le
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Lyndsey E Shorey-Kendrick
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
| | - Monica T Hinds
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
- Center for Developmental Health, Oregon Health & Science University, Portland, Oregon, United States
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, United States
- Division of Metabolic Health and Disease, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
| | - Owen J T McCarty
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
| | - Jamie O Lo
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, United States
| | - Deirdre E J Anderson
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States
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Moellmer SA, Hagen OL, Farhang PA, Duke VR, Fallon ME, Hinds MT, McCarty OJT, Lo JO, Nakayama KH. Effects of in utero delta-9-tetrahydrocannabinol (THC) exposure on fetal and infant musculoskeletal development in a preclinical nonhuman primate model. PLoS One 2024; 19:e0306868. [PMID: 39083456 PMCID: PMC11290632 DOI: 10.1371/journal.pone.0306868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/17/2024] [Indexed: 08/02/2024] Open
Abstract
The endocannabinoid system (ECS) plays a major role in the maintenance of bodily homeostasis and adaptive response to external insults. It has been shown to regulate crucial physiological processes and behaviors, spanning nervous functions, anxiety, cognition, and pain sensation. Due to this broad activity, the ECS has been explored as a potential therapeutic target in the treatment of select diseases. However, until there is a more comprehensive understanding of how ECS activation by exogenous and endogenous ligands manifests across disparate tissues and cells, discretion should be exercised. Previous work has investigated how endogenous cannabinoid signaling impacts skeletal muscle development and differentiation. However, the effects of activation of the ECS by delta-9-tetrahydrocannabinol (THC, the most psychoactive component of cannabis) on skeletal muscle development, particularly in utero, remain unclear. To address this research gap, we used a highly translational non-human primate model to examine the potential impact of chronic prenatal THC exposure on fetal and infant musculoskeletal development. RNA was isolated from the skeletal muscle and analyzed for differential gene expression using a Nanostring nCounter neuroinflammatory panel comprised of 770 genes. Histomorphological evaluation of muscle morphology and composition was also performed. Our findings suggest that while prenatal THC exposure had narrow overall effects on fetal and infant muscle development, the greatest impacts were observed within pathways related to inflammation and cytokine signaling, which suggest the potential for tissue damage and atrophy. This pilot study establishes feasibility to evaluate neuroinflammation due to prenatal THC exposure and provides rationale for follow-on studies that explore the longer-term implications and functional consequences encountered by offspring as they continue to mature.
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Affiliation(s)
- Samantha A. Moellmer
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States of America
| | - Olivia L. Hagen
- Division of Reproduction and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, United States of America
| | - Parsa A. Farhang
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Victoria R. Duke
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States of America
| | - Meghan E. Fallon
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine, New Haven, CT, United States of America
| | - Monica T. Hinds
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States of America
| | - Owen J. T. McCarty
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States of America
| | - Jamie O. Lo
- Division of Reproduction and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Karina H. Nakayama
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States of America
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Bhattacharya I, Sharma SS, Majumdar SS. Etiology of Male Infertility: an Update. Reprod Sci 2024; 31:942-965. [PMID: 38036863 DOI: 10.1007/s43032-023-01401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
Spermatogenesis is a complex process of germ cell division and differentiation that involves extensive cross-talk between the developing germ cells and the somatic testicular cells. Defective endocrine signaling and/or intrinsic defects within the testes can adversely affect spermatogenic progression, leading to subfertility/infertility. In recent years, male infertility has been recognized as a global public health concern, and research over the last few decades has elucidated the complex etiology of male infertility. Congenital reproductive abnormalities, genetic mutations, and endocrine/metabolic dysfunction have been demonstrated to be involved in infertility/subfertility in males. Furthermore, acquired factors like exposure to environmental toxicants and lifestyle-related disorders such as illicit use of psychoactive drugs have been shown to adversely affect spermatogenesis. Despite the large body of available scientific literature on the etiology of male infertility, a substantial proportion of infertility cases are idiopathic in nature, with no known cause. The inability to treat such idiopathic cases stems from poor knowledge about the complex regulation of spermatogenesis. Emerging scientific evidence indicates that defective functioning of testicular Sertoli cells (Sc) may be an underlying cause of infertility/subfertility in males. Sc plays an indispensable role in regulating spermatogenesis, and impaired functional maturation of Sc has been shown to affect fertility in animal models as well as humans, suggesting abnormal Sc as a potential underlying cause of reproductive insufficiency/failure in such cases of unexplained infertility. This review summarizes the major causes of infertility/subfertility in males, with an emphasis on infertility due to dysregulated Sc function.
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Affiliation(s)
- Indrashis Bhattacharya
- Department of Zoology, Central University of Kerala, Periye Campus, Kasaragod, 671320, Kerala, India.
| | - Souvik Sen Sharma
- National Institute of Animal Biotechnology, Hyderabad, 500 032, Telangana, India
| | - Subeer S Majumdar
- National Institute of Animal Biotechnology, Hyderabad, 500 032, Telangana, India.
- Gujarat Biotechnology University, Gandhinagar, GIFT City, Gandhinagar, 382355, Gujarat, India.
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Burch FC, Leung PY, McDonald E, Jensen J, Mishler E, Piekarski N, Mendes CM, Sylwester A, Hanna CB. Establishing the normal range of sperm DNA fragmentation index (% DFI) for rhesus macaques. Sci Rep 2023; 13:20016. [PMID: 37974016 PMCID: PMC10654681 DOI: 10.1038/s41598-023-46928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
The Sperm Chromatin Structure Assay (SCSA) is a robust test with high repeatability and precision. It is a clinically accepted assay that defines risk for infertility in men by measuring the degree of DNA fragmentation (% DFI) in sperm. The objective of this study was to adapt and validate the SCSA for rhesus macaques (Macaca mulatta) and establish a range for % DFI in fertile males. Sperm samples from two different males were used to produce a % DFI validation curve before establishing a range using additional samples from n = 11 males. Sperm labeled with acridine orange were analyzed by flow cytometry to measure green fluorescence (native or intact DNA) and red fluorescence (fragmented DNA). Data were exported to FlowJo software to determine the % DFI for each sample. DNA fragmentation ranged from 0.1 to 2.4% DFI, with a mean ± SD = 1.1 ± 0.7% DFI (validation curve optimized to R2 > 0.95). In conclusion, we were able to successfully validate the SCSA in our institution and establish the first normal range for sperm DNA fragmentation in rhesus macaques. Our study provides a quantitative baseline for future evaluations to assess macaque fertility through the SCSA test.
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Affiliation(s)
- Fernanda C Burch
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA.
| | - Philberta Y Leung
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Eric McDonald
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, OR, USA
| | - Jared Jensen
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Emily Mishler
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Nadine Piekarski
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Camilla M Mendes
- College of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil
| | - Andrew Sylwester
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, OR, USA
| | - Carol B Hanna
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
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da Silva J, Dochez-Arnault J, Desdoits-Lethimonier C, Dejucq-Rainsford N, Gely-Pernot A. The Acute Exposure of Human Adult Testis Tissue to Cannabinoids THC and CBD Does Not Impact Testosterone Production Nor Germ Cell Lineage. World J Mens Health 2023; 41:928-939. [PMID: 37118951 PMCID: PMC10523127 DOI: 10.5534/wjmh.220210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 03/11/2023] Open
Abstract
PURPOSE While an increased risk of developing germ cell tumors has been established in regular cannabis consumers, there is conflicting evidence about an association between cannabis use and testosterone levels in those regular consumers. In this context, we aimed to determine whether Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the two major and best-studied cannabinoids present in cannabis, also the most used for therapeutic applications, can directly impact the steroidogenic function and germ cell lineage of the human adult testis. MATERIALS AND METHODS We used our well-characterized organotypic culture of human testis, in which adult testis explants were exposed to CBD, THC, or CBD/THC [ratio 1:1] from 10-9 to 10-5 M for up to either 48 hours or 9 days of culture. The testes were obtained from multi-organ donors (n=13; mean age: 55.15±5.62 y). RESULTS The testosterone production and the spatial distribution of Leydig cells did not change upon CBD and/or THC exposure versus controls after 48 hours or 9 days. The overall tissue morphology of the cannabinoids-exposed testis explants was similar to their control upon 24 hours or 9 days of exposure, a finding confirmed by morphometric analyses on short-term cultures. In line, the number of apoptotic cells was not affected by either 48 hours or 9 days of cannabinoids treatment versus mock. Cannabinoids had no impact on the number of proliferating cells nor on mRNA expression of genes encoding proteins involved in germ cell differentiation, meiosis, or Sertoli and Leydig functions after 24 hours exposure. CONCLUSIONS Altogether, these findings show an absence of acute direct effects of exposure to cannabis-derived cannabinoids THC and CBD on testicular testosterone production and germ cells ex vivo. Further studies are warranted to explore an indirect impact of cannabinoids on testis functions through the hypothalamic-pituitary-testis axis, as well as the potential effects of long-term exposures.
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Affiliation(s)
- Janaina da Silva
- Institut National de la Santé et de la Recherche Médicale (Inserm), Ecole des Hautes Etudes en Santé Publique (EHESP), Institut de Recherche en Santé, Environnement et Travail (Irset), Université de Rennes, UMR_S1085, Rennes, France
| | - Juliette Dochez-Arnault
- Institut National de la Santé et de la Recherche Médicale (Inserm), Ecole des Hautes Etudes en Santé Publique (EHESP), Institut de Recherche en Santé, Environnement et Travail (Irset), Université de Rennes, UMR_S1085, Rennes, France
| | - Chritèle Desdoits-Lethimonier
- Institut National de la Santé et de la Recherche Médicale (Inserm), Ecole des Hautes Etudes en Santé Publique (EHESP), Institut de Recherche en Santé, Environnement et Travail (Irset), Université de Rennes, UMR_S1085, Rennes, France
| | - Nathalie Dejucq-Rainsford
- Institut National de la Santé et de la Recherche Médicale (Inserm), Ecole des Hautes Etudes en Santé Publique (EHESP), Institut de Recherche en Santé, Environnement et Travail (Irset), Université de Rennes, UMR_S1085, Rennes, France
| | - Aurore Gely-Pernot
- Institut National de la Santé et de la Recherche Médicale (Inserm), Ecole des Hautes Etudes en Santé Publique (EHESP), Institut de Recherche en Santé, Environnement et Travail (Irset), Université de Rennes, UMR_S1085, Rennes, France.
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Larson ER, Moussa-Tooks AB, Tullar RL, Bolbecker AR, O'Donnell BF, Hetrick WP, Wisner KM. Sex differences in neuroendocrine, sympathetic nervous system, and affect responses to acute stress in cannabis users. Psychopharmacology (Berl) 2023; 240:1805-1821. [PMID: 37367968 DOI: 10.1007/s00213-023-06400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023]
Abstract
RATIONALE Cannabis is the most widely used illicit substance in the USA and is often reportedly used for stress reduction. Indeed, cannabinoids modulate signaling of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. However, the role of biological sex in this interaction between cannabis use and stress is poorly understood, despite sex differences in neurobiological stress responsivity, endocannabinoid signaling, and clinical correlates of cannabis use. OBJECTIVE The study aims to examine the role of biological sex in multisystem stress responsivity in cannabis users. METHODS Frequent cannabis users (> 3 times/week, n = 48, 52% male) and non-users (n = 41, 49% male) participated in an acute psychosocial stress paradigm. Saliva was collected at eight timepoints and analyzed for hypothalamic-pituitary-adrenal (cortisol) and sympathetic (alpha-amylase) indices of stress responsivity, and basal estradiol. Subjective ratings of negative affect, including distress, were collected at three timepoints. RESULTS Cannabis users showed blunted pre-to-post-stress cortisol reactivity. Female cannabis users demonstrated greater blunted cortisol reactivity than their male counterparts. Sex moderated the effect of cannabis use on alpha-amylase responsivity over time, wherein female cannabis users showed flattened alpha-amylase responses across the stressor compared to male cannabis users and both non-user groups. Qualitatively, female cannabis users demonstrated the greatest pre-to-post-stress change in subjective distress. Differences in stress responding were not explained by estradiol or distress intolerance. CONCLUSIONS Biological sex impacts multisystem stress responding in cannabis users. Paradoxically, female cannabis users showed the least physiological, but greatest subjective, responses to the stressor. Further research into sex differences in the effects of cannabis use is warranted to better understand mechanisms and clinical implications.
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Affiliation(s)
- Eric R Larson
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St, Bloomington, IN, 47405, USA.
- Program in Neuroscience, Indiana University, Bloomington, IN, USA.
| | - Alexandra B Moussa-Tooks
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St, Bloomington, IN, 47405, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rachel L Tullar
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St, Bloomington, IN, 47405, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amanda R Bolbecker
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St, Bloomington, IN, 47405, USA
| | - Brian F O'Donnell
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St, Bloomington, IN, 47405, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William P Hetrick
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St, Bloomington, IN, 47405, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Krista M Wisner
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St, Bloomington, IN, 47405, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
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Shorey-Kendrick LE, Roberts VHJ, D'Mello RJ, Sullivan EL, Murphy SK, Mccarty OJT, Schust DJ, Hedges JC, Mitchell AJ, Terrobias JJD, Easley CA, Spindel ER, Lo JO. Prenatal delta-9-tetrahydrocannabinol exposure is associated with changes in rhesus macaque DNA methylation enriched for autism genes. Clin Epigenetics 2023; 15:104. [PMID: 37415206 PMCID: PMC10324248 DOI: 10.1186/s13148-023-01519-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND With the growing availability of cannabis and the popularization of additional routes of cannabis use beyond smoking, including edibles, the prevalence of cannabis use in pregnancy is rapidly increasing. However, the potential effects of prenatal cannabis use on fetal developmental programming remain unknown. RESULTS We designed this study to determine whether the use of edible cannabis during pregnancy is deleterious to the fetal and placental epigenome. Pregnant rhesus macaques consumed a daily edible containing either delta-9-tetrahydrocannabinol (THC) (2.5 mg/7 kg/day) or placebo. DNA methylation was measured in 5 tissues collected at cesarean delivery (placenta, lung, cerebellum, prefrontal cortex, and right ventricle of the heart) using the Illumina MethylationEPIC platform and filtering for probes previously validated in rhesus macaque. In utero exposure to THC was associated with differential methylation at 581 CpGs, with 573 (98%) identified in placenta. Loci differentially methylated with THC were enriched for candidate autism spectrum disorder (ASD) genes from the Simons Foundation Autism Research Initiative (SFARI) database in all tissues. The placenta demonstrated greatest SFARI gene enrichment, including genes differentially methylated in placentas from a prospective ASD study. CONCLUSIONS Overall, our findings reveal that prenatal THC exposure alters placental and fetal DNA methylation at genes involved in neurobehavioral development that may influence longer-term offspring outcomes. The data from this study add to the limited existing literature to help guide patient counseling and public health polices focused on prenatal cannabis use in the future.
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Affiliation(s)
- Lyndsey E Shorey-Kendrick
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA.
| | - Victoria H J Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
| | - Rahul J D'Mello
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Elinor L Sullivan
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, 97239, USA
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 27701, USA
| | - Owen J T Mccarty
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Danny J Schust
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 27701, USA
| | - Jason C Hedges
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
- Department of Urology, Oregon Health and Science University, Portland, OR, 97239, USA
| | - A J Mitchell
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
| | - Jose Juanito D Terrobias
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
| | - Charles A Easley
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, 30602, USA
| | - Eliot R Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
| | - Jamie O Lo
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, 97006, USA
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Oregon Health and Science University, Portland, OR, 97239, USA
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9
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Leng QL, Lo JO, Rakshe S, Hildebrand AD, Doyle OJ, Seghete KM, Graham A. The association between preconception cannabis use and depression and anxiety during pregnancy. Gen Hosp Psychiatry 2023; 83:148-155. [PMID: 37196406 PMCID: PMC10428863 DOI: 10.1016/j.genhosppsych.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Cannabis use among individuals of reproductive age has increased with cannabis legalization and heightened stress during the COVID-19 pandemic. Our study provides data on preconception cannabis use and cannabis use disorder (CUD) during the pandemic and models the association between preconception cannabis use and depression and anxiety during pregnancy. METHODS Data on substance use and depression and anxiety symptoms were collected from questionnaires and the Structured Clinical Interview for DSM-5 (SCID-5) from pregnant individuals in Oregon in 2019-2022. Linear regression was used to model the association between the frequency of preconception cannabis use and scores on the Center for Epidemiological Studies of Depression-Revised (CESD-R) and Beck Anxiety Inventory (BAI). RESULTS The prevalence of preconception cannabis use was 27.8% among 227 study participants. CUD was diagnosed in 19% of cannabis users, or 5.3% of the overall sample. Daily cannabis use, compared to rare/never use, was associated with increases in CESD-R (β = 6.22, p 0.029) and BAI (β = 4.71, p 0.045) scores. CONCLUSIONS Cannabis use and CUD are common among individuals of reproductive age. Given the association between preconception cannabis use and depression and anxiety during pregnancy, more attention is needed on screening and counseling of cannabis use among people of reproductive age.
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Affiliation(s)
- Qian Liya Leng
- Center for Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA.
| | - Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University; Portland, OR, USA
| | - Shauna Rakshe
- Knight Cancer Institute Biostatistics Shared Resource and OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Andrea D Hildebrand
- Biostatistics & Design Program, OHSU/PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Olivia J Doyle
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | | | - Alice Graham
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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10
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Hedges JC, Hanna CB, Shorey-Kendrick LE, Boniface ER, Bash JC, Rice-Stitt TL, Burch FC, D'Mello R, Morgan TK, Lima AC, Terrobias JJD, Graham JA, Mishler EC, Jensen JV, Hagen OL, Urian JW, Spindel ER, Easley CA, Murphy SK, Lo JO. Cessation of chronic delta-9-tetrahydrocannabinol use partially reverses impacts on male fertility and the sperm epigenome in rhesus macaques. Fertil Steril 2023; 120:163-174. [PMID: 36990913 PMCID: PMC10293074 DOI: 10.1016/j.fertnstert.2023.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To determine whether discontinuation of delta-9-tetrahydrocannabinol (THC) use mitigates THC-associated changes in male reproductive health using a rhesus macaque model of daily THC edible consumption. DESIGN Research animal study. SETTING Research institute environment. PATIENT(S) Adult male rhesus macaques (age, 8-10 years; n = 6). INTERVENTION(S) Chronic daily THC edible administration at medically and recreationally relevant contemporary doses followed by cessation of THC use. MAIN OUTCOME MEASURE(S) Testicular volume, serum male hormones, semen parameters, sperm deoxyribonucleic acid (DNA) fragmentation, seminal fluid proteomics, and whole genome bisulfite sequencing of sperm DNA. RESULT(S) Chronic THC use resulted in significant testicular atrophy, increased gonadotropin levels, decreased serum sex steroid levels, changes in seminal fluid proteome, and increased DNA fragmentation with partial recovery after discontinuation of THC use. For every increase of 1 mg/7 kg/day in THC dosing, there was a significant decrease in the total testicular volume bilaterally by 12.6 cm3 (95% confidence interval [CI], 10.6-14.5), resulting in a 59% decrease in volume. With THC abstinence, the total testicular volume increased to 73% of its original volume. Similarly, with THC exposure, there were significant decreases in the mean total testosterone and estradiol levels and a significant increase in the follicle-stimulating hormone level. With increasing THC dose, there was a significant decrease in the liquid semen ejaculate volume and weight of coagulum; however, no other significant changes in the other semen parameters were noted. After discontinuing THC use, there was a significant increase in the total serum testosterone level by 1.3 ng/mL (95% CI, 0.1-2.4) and estradiol level by 2.9 pg/mL (95% CI, 0.4-5.4), and the follicle-stimulating hormone level significantly decreased by 0.06 ng/mL (95% CI, 0.01-0.11). Seminal fluid proteome analysis revealed differential expression of proteins enriched for processes related to cellular secretion, immune response, and fibrinolysis. Whole genome bisulfite sequencing identified 23,558 CpGs differentially methylated in heavy-THC vs. pre-THC sperm, with partial restoration of methylation after discontinuation of THC use. Genes associated with altered differentially methylated regions were enriched for those involved in the development and function of the nervous system. CONCLUSION(S) This is the first study demonstrating that discontinuation of chronic THC use in rhesus macaques partially restores adverse impacts to male reproductive health, THC-associated sperm differentially methylated regions in genes important for development, and expression of proteins important for male fertility.
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Affiliation(s)
- Jason C Hedges
- Department of Urology, Oregon Health & Science University; Portland, Oregon; Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center; Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Carol B Hanna
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center
| | - Lyndsey E Shorey-Kendrick
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon
| | - Emily R Boniface
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Jasper C Bash
- Department of Urology, Oregon Health & Science University; Portland, Oregon
| | - Travis L Rice-Stitt
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Fernanda C Burch
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center
| | - Rahul D'Mello
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Terry K Morgan
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Ana Cristina Lima
- Division of Genetics, Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon
| | | | - Jason A Graham
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center
| | - Emily C Mishler
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center
| | - Jared V Jensen
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center
| | - Olivia L Hagen
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center
| | - J Wes Urian
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Eliot R Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon
| | - Charles A Easley
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, Georgia
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Jamie O Lo
- Department of Urology, Oregon Health & Science University; Portland, Oregon; Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center; Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon.
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11
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Roberts VHJ, Schabel MC, Boniface ER, D'Mello RJ, Morgan TK, Terrobias JJD, Graham JA, Borgelt LM, Grant KA, Sullivan EL, Lo JO. Chronic prenatal delta-9-tetrahydrocannabinol exposure adversely impacts placental function and development in a rhesus macaque model. Sci Rep 2022; 12:20260. [PMID: 36424495 PMCID: PMC9691736 DOI: 10.1038/s41598-022-24401-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
Cannabis use in pregnancy is associated with adverse perinatal outcomes, which are likely mediated by the placenta. However, the underlying mechanisms and specific vasoactive effects of cannabis on the placenta are unknown. Our objective was to determine the impact of chronic prenatal delta-tetrahydrocannabinol (THC, main psychoactive component of cannabis) exposure on placental function and development in a rhesus macaque model using advanced imaging. Animals were divided into two groups, control (CON, n = 5) and THC-exposed (THC, n = 5). THC-exposed animals received a THC edible daily pre-conception and throughout pregnancy. Animals underwent serial ultrasound and MRI at gestational days 85 (G85), G110, G135 and G155 (full term is ~ G168). Animals underwent cesarean delivery and placental collection at G155 for histologic and RNA-Seq analysis. THC-exposed pregnancies had significantly decreased amniotic fluid volume (p < 0.001), placental perfusion (p < 0.05), and fetal oxygen availability (p < 0.05), all indicators of placental insufficiency. Placental histological analysis demonstrated evidence of ischemic injury with microinfarctions present in THC-exposed animals only. Bulk RNA-seq demonstrated that THC alters the placental transcriptome and pathway analysis suggests dysregulated vasculature development and angiogenesis pathways. The longer-term consequences of these adverse placental findings are unknown, but they suggest that use of THC during pregnancy may deleteriously impact offspring development.
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Affiliation(s)
- Victoria H J Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Matthias C Schabel
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Emily R Boniface
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L458, Portland, OR, 97239, USA
| | - Rahul J D'Mello
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L458, Portland, OR, 97239, USA
| | - Terry K Morgan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Juanito Jose D Terrobias
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Jason A Graham
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Laura M Borgelt
- Department of Clinical Pharmacy and Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathleen A Grant
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Elinor L Sullivan
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Jamie O Lo
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA.
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L458, Portland, OR, 97239, USA.
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12
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Yang W, Cui H, Chai Z, Zou P, Shi F, Yang B, Zhang G, Yang H, Chen Q, Liu J, Cao J, Ling X, Ao L. Benzo[a]pyrene inhibits testosterone biosynthesis via NDUFA10-mediated mitochondrial compromise in mouse Leydig cells: Integrating experimental and in silico toxicological approaches. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 244:114075. [PMID: 36108438 DOI: 10.1016/j.ecoenv.2022.114075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
Benzo[a]pyrene (B[a]P), a representative of polycyclic aromatic hydrocarbons (PAHs), is ubiquitously spread in the environment and showing deleterious impacts on male steroidogenesis, including testosterone synthesis disorder. However, the precise mechanisms involved in B[a]P-induced steroidogenesis perturbation remains obscure. In the present study, we integrated in vivo tests, transcriptome profiling, in vitro assays, and conjoint in silico toxicological approaches to delineate the detailed mechanisms. In mouse models, we observed that B[a]P administration remarkably inhibited testosterone synthesis accompanied by ultrastructural impairments of mitochondria and mitophagosome formation in mouse Leydig cells. Transcriptome profiling showed that B[a]P down-regulated the expression of Ndufa9, Ndufa6, Ndufa10, and Ndufa5 in mouse testes, which are identified as critical genes involved in the assembly and functionality of mitochondrial complex I. In the in vitro tests, the bioactive B[a]P metabolite BPDE induced perturbation of testosterone synthesis by NDUFA10-mediated mitochondrial impairment, which was further exacerbated by mitophagy in TM3 Leydig cells. The findings of in silico toxicological analyses were highly consistent with the experimental observations and further unveiled that B[a]P/BPDE-involved PPARα activation could serve as a molecular initiating event to trigger the decline in Ndufa10 expression and testosterone synthesis. Overall, we have shown the first evidence that mitochondrial compromise in Leydig cells is the extremely crucial target in B[a]P-induced steroidogenesis perturbation.
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Affiliation(s)
- Wang Yang
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Haonan Cui
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Zili Chai
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Peng Zou
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Fuquan Shi
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Binwei Yang
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Guowei Zhang
- Department of Environmental Health, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Huan Yang
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Qing Chen
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Jinyi Liu
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China
| | - Jia Cao
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China.
| | - Xi Ling
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China.
| | - Lin Ao
- Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China.
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13
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Lo JO, Hedges JC, Girardi G. Impact of cannabinoids on pregnancy, reproductive health and offspring outcomes. Am J Obstet Gynecol 2022; 227:571-581. [PMID: 35662548 DOI: 10.1016/j.ajog.2022.05.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
Abstract
Cannabis is the most commonly used federally illegal drug in the United States and world, especially among people of reproductive age. In addition, the potency of cannabis products has increased significantly in the past decade. This is concerning because the available evidence suggests an adverse effect from cannabis exposure on male and female reproductive health. Exposure to cannabinoids may have differential impacts on female reproductive health across a woman's lifespan, from preconception to pregnancy, throughout lactation, and during menopause. Even more, cannabis use has been associated an adverse effect on fetal outcomes, and longer-term offspring health and developmental trajectories. Despite the prevalence of cannabis use, there is limited available evidence regarding its safety, especially in regard to reproductive health, pregnancy and lactation. The biological effects of cannabis are mediated by the endocannabinoid system and studies have reported the presence of cannabinoid receptors in the male and female reproductive tract, on sperm and the placenta, suggesting the endocannabinoid system plays a role in regulating reproduction. Cannabis use can impact male and female fertility and has been associated with altered reproductive hormones, menstrual cyclicity and semen parameters. Use of cannabis in males has also been associated with erectile dysfunction, abnormal spermatogenesis, and testicular atrophy. In females, cannabis use has been associated with infertility and abnormal embryo implantation and development. The main psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), can also cross the placenta and has been detected in breastmilk. Maternal cannabis use during pregnancy and lactation has been associated with adverse effects including small for gestational age infants, preterm birth, fetal neurodevelopmental consequences, and impaired offspring sociobehavioral and cognitive development. The prevalence of cannabis use to alleviate menopausal symptoms has also increased despite the limited information on its benefits and safety. As cannabis use is on the rise, it is critical to understand its impact on reproductive health and offspring developmental outcomes. This is an understudied, but timely subject, with much needed information to guide healthcare providers and those interested in conceiving, or that are pregnant and lactating, as well as those at the end of their reproductive time span.
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