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Islam MR, Aktar S, Pervin J, Rahman SM, Rahman M, Rahman A, Ekström EC. Maternal betel quid use during pregnancy and child growth: a cohort study from rural Bangladesh. Glob Health Action 2024; 17:2375829. [PMID: 38979658 PMCID: PMC11234907 DOI: 10.1080/16549716.2024.2375829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/29/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Chewing betel quid (BQ) - a preparation commonly containing areca nut and slaked lime wrapped in betel leaf - is entrenched in South Asia. Although BQ consumption during pregnancy has been linked to adverse birth outcomes, its effect on postnatal growth remains largely unexplored. OBJECTIVE We examined the associations of BQ use during pregnancy with children's height-for-age and body mass index-for-age z-scores (HAZ and BAZ, respectively) and fat and fat-free mass along with sex-based differences in association in rural Bangladesh. METHODS With a prospective cohort design, we assessed BQ use among mothers enrolled in the Preterm and Stillbirth Study, Matlab (n = 3140) with a structured questionnaire around early third trimester. Children born to a subset of 614 women (including 134 daily users) were invited to follow-up between October 2021 and January 2022. HAZ and BAZ were calculated from anthropometric assessment, and fat and fat-free mass were estimated using bioelectric impedance. Overall and sex-specific multiple linear regression models were fitted. RESULTS Growth data were available for 501 children (mean age 4.9 years): 43.3% of them were born to non-users, 35.3% to those using prior to or less-than-daily during the survey, and 21.3% to daily users. No statistically significant associations were observed after adjusting for sex, parity, maternal height and education, and household wealth. CONCLUSIONS There was no effect of BQ use during pregnancy on postnatal growth in this study. Longitudinal studies following up those born to heavy users beyond childhood are warranted for capturing long-term implications of prenatal BQ exposure.
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Affiliation(s)
- Mohammad Redwanul Islam
- Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Shaki Aktar
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Syed Moshfiqur Rahman
- Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Monjur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anisur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Eva-Charlotte Ekström
- Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Hung CC, Ko YC, Chen PH, Chung CM. Impact of MAOA Gene Polymorphism on the Efficacy of Antidepressant Treatment and Craving Severity for Betel Quid Use Disorder. Int J Mol Sci 2024; 25:9221. [PMID: 39273170 PMCID: PMC11394840 DOI: 10.3390/ijms25179221] [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: 07/31/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
Betel quid (BQ) use disorder (BUD) is prevalent in many Asian countries, impacting approximately 600 million people. We conducted a randomized clinical trial to analyze the impact of MAOA genetic variations on the severity of BQ craving. This was measured using DSM-5 criteria and the Yale-Brown Obsessive-Compulsive Scale modified for betel quid use (Y-BOCS-BQ). Participants were grouped according to the severity of BUD and MAOA gene single-nucleotide polymorphism (SNP) rs5953210 genotypes. The Y-BOCS-BQ scores were assessed at baseline (week 0) and during follow-up at weeks 2, 4, 6, and 8. The AA genotype group showed significantly greater reductions in Y-BOCS-BQ at weeks 2 (p = 0.0194), 4 (p = 0.0078), 6 (p = 0.0277), and 8 (p = 0.0376) compared to the GG genotype group. Additionally, within the antidepressant group, the AA genotype showed significant reductions in the Y-BOCS-BQ scores at weeks 2 (p = 0.0313), 4 (p = 0.0134), 6 (p = 0.0061), and 8 (p = 0.0241) compared to the GG genotype. The statistical analysis revealed a significant interaction between the treatment and placebo groups based on MAOA genotypes, with the AA genotype in the treatment group exhibiting a more pronounced decrease in Y-BOCS-BQ score (p interaction <0.05) at week 6. Our study highlights the importance of considering genetic factors when developing personalized treatment plans for BUD.
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Affiliation(s)
- Chung-Chieh Hung
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Ying-Chin Ko
- Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Ping-Ho Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Center for Medical Informatics and Statistics, Office of Research and Development, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chia-Min Chung
- Department of Medical Research, China Medical University Hospital, Taichung 40447, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
- Department of Psychiatry and Center for Addiction and Mental Health, China Medical University Hospital, Taichung 40447, Taiwan
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Yang YH. Current advances of oral cancer in Taiwan. Oral Dis 2024. [PMID: 39072913 DOI: 10.1111/odi.15076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 07/01/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES To provide updated statistics of oral cancer incidence and mortality in Taiwan, and to describe recent developments for oral cancer control to reduce oral cancer incidence and mortality. METHODS The Taiwan Cancer Registry Annual Report 2023, the Taiwan Cancer Registry Online Interactive Search System, and the 2023 Health Promotion Administration Annual Report are consulted and summarized. A literature search using PubMed was also conducted to identify Taiwan oral cancer control-related studies. RESULTS Taiwan, with a long history of areca/betel quid chewing, has battled with oral cancer for decades. In 2021, the male lip and oral cavity cancer incidence is 29.77 (per 100,000 persons) and mortality is 11.25. Over these years, the male chewing prevalence was reduced to 6.2% in 2018. Taiwan has a sustained national oral cancer screening programme provided to high-risk groups biennially. CONCLUSIONS Although the age-standardized incidence rates have been slowly decreasing since 2009, due to Taiwan's ageing population, the actual oral cancer burden is still stringent. The collaboration of multi-ministries and agencies on promoting areca nut and betel quid control, improving oral cancer awareness, and delivering cancer care remains essential to prevent oral cancer and reduce oral cancer deaths.
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Affiliation(s)
- Yi-Hsin Yang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
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Li S, Li Z, Chen J, Wang F, Ou Y, Huang Y, Li Z. Brief psychotic disorder related to areca nut use: a case report. Front Psychiatry 2024; 15:1360493. [PMID: 38803675 PMCID: PMC11128668 DOI: 10.3389/fpsyt.2024.1360493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/12/2024] [Indexed: 05/29/2024] Open
Abstract
Background Areca Nut (AN) is the fourth most commonly abused drug after nicotine, ethanol, and caffeine, due to its psychoactive properties provided by bioactive substances. Although previous studies have demonstrated AN's anxiolytic-like activity and potential benefits in ameliorating symptoms of depression and schizophrenia, there remains limited awareness regarding its association with brief psychotic disorder. Case presentation This case report presents the clinical profile of a 30-year-old male patient with a history of betel nut chewing for the past 2 years, who exhibited sudden onset delusions, hallucinations, and disorganized speech and behavior upon increasing the dosage of betel nut consumption. The patient displayed a positive response to antipsychotic treatment, and symptoms resolved upon discontinuation of betel nut consumption. However, one month after discharge, the patient experienced a recurrence of auditory hallucinations upon resuming betel nut chewing. Through counseling and support, the importance of abstaining from betel nut use and maintaining medication compliance was emphasized, resulting in no recurrence of psychotic symptoms during the six-month follow-up. Conclusions This case report highlights the related role of betel nut with brief psychotic disorder, especially when the chewing dosage is abruptly increased. It underscores the importance of considering betel nut as a potential precipitant related to acute psychiatric disorders in clinical settings.
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Affiliation(s)
- Sixun Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Zhixiong Li
- The Third Department of Clinical Psychology, Karamay Municipal People’s Hospital, Karamay, Xinjiang, China
| | - Juan Chen
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Feng Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Ying Ou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Yi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
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Hung CC, Ko YC, Chung CM. Association between Single Nucleotide Polymorphisms in Monoamine Oxidase and the Severity of Addiction to Betel Quid. Curr Issues Mol Biol 2024; 46:1010-1019. [PMID: 38392182 PMCID: PMC10887354 DOI: 10.3390/cimb46020064] [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: 12/14/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Betel quid (BQ) is the fourth most popular psychoactive substance in the world, and BQ use disorder (BUD) is prevalent in Asian countries. Although the mechanisms underlying BUD remain unclear, studies have reported influences from monoamine oxidase inhibitor. We enrolled 50 patients with BUD and assessed their BQ consumption habits, emotional conditions, and the clinical severity of addiction-assessed using the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition] (DSM-5) criteria, Substance Use Severity Rating Scale, and Yale-Brown Obsessive Compulsive Disorder Rating Scale for BQ. Patients were categorized into the severe group when showing six or more symptoms defined by DSM-5. A genome-wide association study was conducted for single nucleotide polymorphisms in BRCA1, COL9A1, NOTCH1, HSPA13, FAT1, and MAOA by using patients' blood samples. More severe BUD symptoms were associated with younger age of using BQ and poor oral hygiene and with severe craving for and more anxiety toward BQ use. The MAOA rs5953210 polymorphism was significantly associated with severe BUD (odds ratio, 6.43; 95% confidence interval, 5.12-7.74; p < 0.01) and might contribute to BQ-associated cancer risk. Further studies are required to investigate the addictive properties of BQ and the development of novel diagnostic tools and pharmacotherapeutic alternatives to BUD treatment.
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Affiliation(s)
- Chung-Chieh Hung
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Ying-Chin Ko
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 106216, Taiwan
| | - Chia-Min Chung
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
- Department of Psychiatry and Center for Addiction and Mental Health, China Medical University Hospital, Taichung 404327, Taiwan
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Penjor T, Gurung MS, Robson MG, Siriwong W. Prevalence of Current Areca Nut Use and Its Associated Factors among Bhutanese Aged 15-69 Years: Analysis of the Nationally Representative STEPS Survey 2019. WHO South East Asia J Public Health 2024; 13:35-39. [PMID: 39167134 DOI: 10.4103/who-seajph.who-seajph_181_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/06/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Areca nut (AN) use receives less global attention than tobacco use. Studies have linked AN consumption to a range of adverse health effects, including oral cavity and pharyngeal cancers, periodontal diseases, cardiovascular diseases, diabetes, hypertension, and addiction. The masticatory use of AN is rampant in Bhutan. There is a paucity of local evidence and limited empirical studies to understand the factors associated with current AN use in Bhutan. METHODS This analysis uses secondary data from the Bhutan STEPS Survey 2019 that included 5575 participants aged 15-69 years, selected using multistage stratified cluster sampling. The outcome variable of interest was current AN use. Weighted analysis was done to calculate the prevalence of AN use. Factors associated with AN use were assessed using multivariable logistic regression models. RESULTS The prevalence of current AN use was 56.82% (95% confidence interval [CI]: 54.27-59.33). A significantly higher prevalence of 63.58% (95% CI: 60.58-66.48) was found in the age group of 25-39 years. Tobacco users were 17% more likely to use AN as compared to those who do not consume tobacco (adjusted odds ratio: 1.17, 95% CI: 1.08-1.26). Current alcohol consumers were 45% more likely to consume AN as compared to lifetime alcohol abstainers. CONCLUSIONS Age, alcohol use, and tobacco use were associated with current AN use in Bhutan. There is a need to regulate access to AN while targeting young and middle-aged individuals with public health and behavioral interventions.
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Affiliation(s)
- Tashi Penjor
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
- Policy and Planning Division, Ministry of Health, Thimphu, Bhutan
| | | | - Mark G Robson
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
- Department of Plant Biology, School of Environmental and Biological Sciences Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Wattasit Siriwong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Ko AMS, Tu HP, Ko YC. Systematic Review of Roles of Arecoline and Arecoline N-Oxide in Oral Cancer and Strategies to Block Carcinogenesis. Cells 2023; 12:1208. [PMID: 37190117 PMCID: PMC10137008 DOI: 10.3390/cells12081208] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Betel quid and areca nut are complex mixture carcinogens, but little is known about whether their derived single-agent arecoline or arecoline N-oxide (ANO) is carcinogenic, and the underlying mechanisms remain unclear. In this systematic review, we analyzed recent studies on the roles of arecoline and ANO in cancer and strategies to block carcinogenesis. In the oral cavity, flavin-containing monooxygenase 3 oxidizes arecoline to ANO, and both alkaloids conjugate with N-acetylcysteine to form mercapturic acid compounds, which are excreted in urine, reducing arecoline and ANO toxicity. However, detoxification may not be complete. Arecoline and ANO upregulated protein expression in oral cancer tissue from areca nut users compared to expression levels in adjacent normal tissue, suggesting a causal relationship between these compounds and oral cancer. Sublingual fibrosis, hyperplasia, and oral leukoplakia were diagnosed in mice subjected to oral mucosal smearing of ANO. ANO is more cytotoxic and genotoxic than arecoline. During carcinogenesis and metastasis, these compounds increase the expression of epithelial-mesenchymal transition (EMT) inducers such as reactive oxygen species, transforming growth factor-β1, Notch receptor-1, and inflammatory cytokines, and they activate EMT-related proteins. Arecoline-induced epigenetic markers such as sirtuin-1 hypermethylation, low protein expression of miR-22, and miR-886-3-p accelerate oral cancer progression. Antioxidants and targeted inhibitors of the EMT inducers used reduce the risk of oral cancer development and progression. Our review findings substantiate the association of arecoline and ANO with oral cancer. Both of these single compounds are likely carcinogenic to humans, and their mechanisms and pathways of carcinogenesis are useful indicators for cancer therapy and prognosis.
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Affiliation(s)
- Albert Min-Shan Ko
- Department of Biomedical Sciences, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
- Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- Health Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Ying-Chin Ko
- Department of Medical Research, China Medical University Hospital, China Medical University, No. 2 Yu-Der Road, Taichung 40447, Taiwan
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 106216, Taiwan
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Stokes C, Pino JA, Hagan DW, Torres GE, Phelps EA, Horenstein NA, Papke RL. Betel quid: New insights into an ancient addiction. Addict Biol 2022; 27:e13223. [PMID: 36001424 PMCID: PMC9552247 DOI: 10.1111/adb.13223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/27/2022]
Abstract
The use of areca nuts (areca) in the form of betel quids constitutes the fourth most common addiction in the world, associated with high risk for oral disease and cancer. Areca is a complex natural product, making it difficult to identify specific components associated with the addictive and carcinogenic properties. It is commonly believed that the muscarinic agonist arecoline is at the core of the addiction. However, muscarinic receptor activation is not generally believed to support drug-taking behaviour. Subjective accounts of areca use include descriptions of both sedative and stimulatory effects, consistent with the presence of multiple psychoactive agents. We have previously reported partial agonism of α4-containing nicotinic acetylcholine receptors by arecoline and subsequent inhibition of those receptors by whole areca broth. In the present study, we report the inhibition of nicotinic acetylcholine receptors and other types of neurotransmitter receptors with compounds of high molecular weight in areca and the ability of low molecular weight areca extract to activate GABA and glutamate receptors. We confirm the presence of a high concentration of GABA and glutamate in areca. Additionally, data also indicate the presence of a dopamine and serotonin transporter blocking activity in areca that could account for the reported stimulant and antidepressant activity. Our data suggest that toxic elements of high molecular weight may contribute to the oral health liability of betel quid use, while two distinct low molecular weight components may provide elements of reward, and the nicotinic activity of arecoline contributes to the physical dependence of addiction.
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Affiliation(s)
- Clare Stokes
- Department of Pharmacology and Therapeutics, University of Florida, PO Box 100267 Gainesville, FL 32610
| | - Jose A. Pino
- Department of Medicine, School of Medicine, University of Atacama, Copiapó, Chile
| | - D. Walker Hagan
- Department of Biomedical Engineering University of Florida, PO Box 100267 Gainesville, FL 32611
| | - Gonzalo E. Torres
- Department of Molecular, Cellular, and Biomedical Sciences, City University of New York School of Medicine at City College, New York, NY 10031
| | - Edward A. Phelps
- Department of Biomedical Engineering University of Florida, PO Box 100267 Gainesville, FL 32611
| | - Nicole A. Horenstein
- Department of Chemistry, University of Florida, PO Box 117200, Gainesville, FL 32611-7200
| | - Roger L. Papke
- Department of Pharmacology and Therapeutics, University of Florida, PO Box 100267 Gainesville, FL 32610
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Effects of DSM-5 Betel-Quid-Related Symptoms, Pathological Behaviors, and Use Disorder on Oral Squamous Cell Carcinoma Risk. Cancers (Basel) 2022; 14:cancers14163974. [PMID: 36010966 PMCID: PMC9406538 DOI: 10.3390/cancers14163974] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/07/2022] [Accepted: 08/15/2022] [Indexed: 01/08/2023] Open
Abstract
Simple Summary This is the first study using psychometrics to investigate the association of the DSM-5 betel-quid (BQ)-related symptoms, pathological behaviors, and BQ use disorder (BUD) severity with the risk of oral squamous cell carcinoma (OSCC). This study presents data demonstrating that the symptoms of unsuccessful cutdown of BQ consumption, neglecting major roles, social or interpersonal problems, abandoning or limiting activities, hazardous use, and continued use despite awareness of the dangers were associated with the risk of OSCC. Pathological behavior of risky BQ use enhanced OSCC risk in chewers with moderate-to-severe BUD. BQ chewing is a major risk factor for oral cavity cancers; however, the risk can be mitigated by reducing pathological use. Our study indicates that targeting BUD and establishing a BUD-based strategy is a promising new direction for the prevention of OSCC. Abstract The neuroactive alkaloids in betel quid (BQ) can induce BQ addiction. We conducted a case–control study to investigate the effects of BQ-associated DSM-5 symptoms, pathological behaviors, and BQ use disorder (BUD) on oral squamous cell carcinoma (OSCC) risk. A total of 233 patients with newly diagnosed and histopathologically confirmed OSCC and 301 sex- and age-matched controls were included. BQ-related DSM-5 symptoms in the 12 months prior to disease onset were used to measure psychiatric characteristics and BUD. Compared with nonchewers, chewers with the symptoms of unsuccessful cutdown of BQ consumption, neglecting major roles, social or interpersonal problems, abandoning or limiting activities, hazardous use, and continued use despite the awareness of the dangers had a 54.8-, 49.3-, 49.9-, 40.4-, 86.2-, and 42.9-fold higher risk of developing OSCC, respectively. Mild-to-moderate and severe BUD were, respectively, associated with a 8.2–8.5- and 42.3-fold higher OSCC risk, compared with BQ nonuse. Risky BQ use of pathological behavior was associated with a 12.5-fold higher OSCC risk in chewers with no BUD or mild BUD and a 65.0-fold higher risk in chewers with moderate-to-severe BUD (p for risk heterogeneity between the two BUD groups, 0.041). In conclusion, BQ-associated DSM-5 symptoms, pathological behaviors, and BUD severity are associated with the impact of BQ chewing on OSCC development. The pathological behavior of risky BQ use enhances OSCC risk in chewers with moderate-to-severe BUD. Preventing BUD in new BQ users and treating BUD in chewers who already have the disorder are two priorities in areas where BQ chewing is prevalent.
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10
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Lan Q, Guan P, Huang C, Huang S, Zhou P, Zhang C. Arecoline Induces an Excitatory Response in Ventral Tegmental Area Dopaminergic Neurons in Anesthetized Rats. Front Pharmacol 2022; 13:872212. [PMID: 35548350 PMCID: PMC9081529 DOI: 10.3389/fphar.2022.872212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/08/2022] [Indexed: 12/21/2022] Open
Abstract
Arecoline is the principle psychoactive alkaloid in areca nuts. Areca nuts are chewable seeds of Areca catechu L., which are epidemic plants that grow in tropical and subtropical countries and cause dependency after long-term use. However, the mechanisms underlying such dependency remain largely unclear, and therefore, no effective interventions for its cessation have been developed. The present study aimed to examine the effects of arecoline on neurons of the ventral tegmental area (VTA). After rats were anesthetized and craniotomized, electrophysiological electrodes were lowered into the VTA to obtain extracellular recordings. The mean firing rate of dopaminergic and GABAergic neurons were then calculated and analyzed before and after arecoline treatment. The burst characteristics of the dopaminergic neurons were also analyzed. The results showed that arecoline evoked a significant enhancement of the firing rate of dopaminergic neurons, but not GABAergic neurons. Moreover, arecoline evoked remarkable burst firings in the dopaminergic neurons, including an increase in the burst rate, elongation in the burst duration, and an enhancement in the number of spikes per burst. Collectively, the findings revealed that arecoline significantly excited VTA dopaminergic neurons, which may be a mechanism underlying areca nut dependency and a potential target for areca nut cessation therapy.
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Affiliation(s)
- Qinghui Lan
- School of Educational Sciences, Lingnan Normal University, Zhanjiang, China
| | - Peiqing Guan
- School of Educational Sciences, Lingnan Normal University, Zhanjiang, China
| | - Chunzheng Huang
- School of Educational Sciences, Lingnan Normal University, Zhanjiang, China
| | - Shile Huang
- Western Guangdong Characteristic Biology and Medicine Engineering and Research Center, School of Chemistry and Chemical Engineering, Lingnan Normal University, Zhanjiang, China
| | - Peiling Zhou
- School of Educational Sciences, Lingnan Normal University, Zhanjiang, China
- *Correspondence: Changzheng Zhang, ; Peiling Zhou,
| | - Changzheng Zhang
- School of Educational Sciences, Lingnan Normal University, Zhanjiang, China
- *Correspondence: Changzheng Zhang, ; Peiling Zhou,
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Huang W, Liu T, Chen H, Fu Q, Fu L, Xu X, Liu L, Guo Y, Balasubramanian PS, Chen F. Mapping white matter structural and network alterations in betel quid-dependent chewers using high angular resolution diffusion imaging. Front Psychiatry 2022; 13:1036728. [PMID: 36545042 PMCID: PMC9760978 DOI: 10.3389/fpsyt.2022.1036728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To evaluate brain white matter diffusion characteristics and anatomical network alterations in betel quid dependence (BQD) chewers using high angular resolution diffusion imaging (HARDI). METHODS The current study recruited 53 BQD chewers and 37 healthy controls (HC) in two groups. We explored regional diffusion metrics alternations in the BQD group compared with the HC group using automated fiber quantification (AFQ). We further employed the white matter (WM) anatomical network of HARDI to explore connectivity alterations in BQD chewers using graph theory. RESULTS BQD chewers presented significantly lower FA values in the left and right cingulum cingulate, the left and right thalamic radiation, and the right uncinate. The BQD has a significantly higher RD value in the right uncinate fasciculus than the HC group. At the global WM anatomical network level, global network efficiency (p = 0.008) was poorer and Lp (p = 0.016) was greater in the BQD group. At the nodal WM anatomical network level, nodal efficiency (p < 0.05) was lower in the BQD group. CONCLUSION Our findings provide novel morphometric evidence that brain structural changes in BQD are characterized by white matter diffusivity and anatomical network connectivity among regions of the brain, potentially leading to the enhanced reward system and impaired inhibitory control.
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Affiliation(s)
- Weiyuan Huang
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Tao Liu
- Department of Geriatric Center, Hainan General Hospital, Hainan, China
| | - Huijuan Chen
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Qingqing Fu
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Lili Fu
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Xiaolin Xu
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Liting Liu
- Department of Radiology, Yueyang Central Hospital, Shanghai, China
| | - Yihao Guo
- Department of Radiology, Hainan General Hospital, Hainan, China
| | - Priya S Balasubramanian
- Department of Electrical and Computer Engineering, Cornell University, Ithaca, NY, United States
| | - Feng Chen
- Department of Radiology, Hainan General Hospital, Hainan, China
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Chen X, He Y, Deng Y. Chemical Composition, Pharmacological, and Toxicological Effects of Betel Nut. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:1808081. [PMID: 34457017 PMCID: PMC8387188 DOI: 10.1155/2021/1808081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/07/2021] [Indexed: 01/18/2023]
Abstract
Betel nut, the fruit of Areca catechu L, has a long medical history in Southeast Asia. It is native to Malaysia and is cultivated and processed extensively in subtropical regions, such as South China and India. Betel nut almost appears as a "snack" in various occasions in most parts of China. Clinically, betel nut can play a certain pharmacology role and was used in malaria, ascariasis, arthritis, enterozoic abdominalgia, stagnation of food, diarrhea, edema, and beriberi. The nervous excitement of betel nut chewing has made it gradually become popular. However, chewing betel nut can induce oral submucosal fibrosis (OSF) and oral cancer (OC). At the same time, long-term chewing of betel nut also causes inhaled asthma, sperm reducing, betel quid dependence (BQD), and uterine and esophageal cancers. The main components of processed betel nut are the goal of this review. This study will mainly start from the pharmacological activity and toxicology study of betel nut in recent years, aiming to seek its advantages and disadvantages. In the meantime, this study will analyze and emphasize that betel nut and arecoline are the high-risk factors for oral cancer, which should arouse attention and vigilance of the public.
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Affiliation(s)
- Xiaoxiao Chen
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yongzhi He
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yanru Deng
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
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Genetic and Proteinic Linkage of MAO and COMT with Oral Potentially Malignant Disorders and Cancers of the Oral Cavity and Pharynx. Cancers (Basel) 2021; 13:cancers13133268. [PMID: 34209963 PMCID: PMC8268107 DOI: 10.3390/cancers13133268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The prevention and treatment of cancers of the oral cavity and pharynx are currently important issues for national health. Currently, the incidence of oral cavity and pharynx cancers is globally the highest in Taiwanese men. Regarding the occurrence of oral cavity and pharynx cancers and oral potentially malignant disorders (OPMD), no report has ascertained how betel quid (BQ) can induce the expression of monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT). We aimed to explore the role and clinical significance of specific markers of BQ exposure and human susceptibility to MAO and COMT. Our findings highlight the association of MAO and COMT biomarkers to risks of oral and pharyngeal cancers and OPMD. These novel findings will provide important strategies for disease prevention, early clinical diagnosis, and treatment effectiveness, and will offer a strong foundation to reduce BQ-related cancers of the oral cavity and pharynx and OPMD. Abstract Betel quid (BQ), a group I human carcinogen, strongly contributes to an increased risk of oral potentially malignant disorders (OPMD) and cancers of the oral cavity and pharynx. This study was conducted to discover whether monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) variants play a potential role in the risk assessment of oral cavity and pharynx cancers and OPMD, particularly among BQ users. We applied a case–control study to confirm the polymorphism of MAO and COMT using single-nucleotide polymorphisms. We used qRT-PCR, Western blotting, and immunohistochemistry (IHC) to determine MAO and COMT expression. Carriers of the MAOA rs6323 G-allele, MAOB rs6324 G-allele, and COMT rs4633 C/C-genotype had a prominently increased risk of oral cavity and pharynx cancers (AOR = 56.99; p < 0.001). Compared to adjacent noncancerous tissues, a significant downregulation of MAO and COMT expression was exhibited in cancerous tissues (p < 0.01). Furthermore, in different cell models, MAO and COMT expression was significantly downregulated with an increased dose of arecoline (p < 0.01). In personalized preventive medicine for oral and pharyngeal cancers, our findings are the first to demonstrate the potential role of lower MAO and COMT expression levels, with the risk polymorphisms utilized as clinical biomarkers.
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Chung CM, Kuo TM, Yeh KT, Lee CH, Ko YC. Reduction in and Preventive Effects for Oral-Cancer Risk with Antidepressant Treatment. J Pers Med 2021; 11:jpm11070591. [PMID: 34201475 PMCID: PMC8307663 DOI: 10.3390/jpm11070591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/17/2022] Open
Abstract
Areca nut (AN) was identified as carcinogenic to humans. Around 600 million people globally use AN in some form, yet no effective therapeutic drug is available to overcome AN addiction. This preclinical study examines the effects of antidepressants on AN use with animal models. We produced AN powder and dissolved it into drinking water, training 55 C57BL/6 mice in free self-selection to drink AN water or normal water. Then, the mice were randomly divided into four groups. Selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants (TCAs) were given as three treatment groups and one placebo group for four weeks. In the follow-up period, the preference and amount of free selection of AN and normal water, and oral pathological change were evaluated. There was a significant decrease in preference for AN drinking during the first four weeks, and the 36th week after drug withdrawal in the MAOI and SSRI groups (all p < 0.05). The drug-reducing effect of AN water in the 1–4-week period was significant in the MAOI group (p < 0.0001) and was also significant in the 3–4-week period in the SSRI group (p = 0.03). The TCA group did not show a decrease effect. At the endpoint (60 weeks), oral mucosal fibrosis (OSF) levels and risk in the SSRI (p = 0.0081) and MAOI (p = 0.01) groups were significantly lower than those in the control group. Antidepressant drugs MAOIs and SSRIs could reduce the amount of AN use and decrease the early stage of oral fibrosis in mice, but SSRIs may need to be boosted again.
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Affiliation(s)
- Chia-Min Chung
- Center for Drug Abuse and Addiction, China Medical University Hospital, Taichung 40447, Taiwan;
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40447, Taiwan
- Environment-Omics-Diseases Research Centre, China Medical University Hospital, China Medical University, No. 2 Yude Road, Taichung 40447, Taiwan;
| | - Tzer-Min Kuo
- Environment-Omics-Diseases Research Centre, China Medical University Hospital, China Medical University, No. 2 Yude Road, Taichung 40447, Taiwan;
| | - Kun-Tu Yeh
- Department of Pathology, Changhua Christian Hospital, Changhua 50006, Taiwan;
| | - Chien-Hung Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Ying-Chin Ko
- Environment-Omics-Diseases Research Centre, China Medical University Hospital, China Medical University, No. 2 Yude Road, Taichung 40447, Taiwan;
- Correspondence: or ; Tel.: +886-4-2205-2121 (ext. 2028)
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Sumithrarachchi SR, Jayasinghe R, Warnakulasuriya S. Betel Quid Addiction: A Review of Its Addiction Mechanisms and Pharmacological Management as an Emerging Modality for Habit Cessation. Subst Use Misuse 2021; 56:2017-2025. [PMID: 34396897 DOI: 10.1080/10826084.2021.1963990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Areca-nut (AN) and added smokeless-tobacco (SLT) are considered agents that may cause addiction to betel-quid (BQ). However, the primary addictive substance in AN is not clearly understood. Objective: The present review evaluates possible addictive chemicals in AN with their mechanisms of action for progression to BQ dependence, as it is essential to overcome barriers in BQ cessation. It also identifies innovative treatment modalities in BQ cessation including the scope for research on pharmacotherapy using Monoamine-oxidase Inhibitors, Selective Serotonin Re-uptake Inhibitors and Norepinephrine Dopamine Reuptake Inhibitors. Methods: This is a narrative review on addictive properties of BQ and trials undertaken to promote cessation of SLT or AN use. Results: Twenty interventional studies, three by behavioral therapy and seventeen using pharmacotherapy were reviewed. There was heterogeneity in reported follow up times, most studies reporting data at 12 weeks with abstinence rates of 45-55% for SLT cessation and at 8 weeks with abstinence rates around 35% for AN cessation. Conclusion: Even though literature reveals a few cessation programs through behavioral support for BQ addiction, its success has been limited in certain instances mainly due to addictive properties of AN, resulting in withdrawal and relapse. Hence, in line with pharmacotherapy in tobacco smoking cessation, potential pharmacological agents to assist in cessation of SLT and AN require more attention. Several clinical trials for SLT cessation have been carried out with varying levels of success using Nicotine Replacement Therapy and Varenicline while trials on antidepressants for SLT and AN cessation are also emerging.
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Affiliation(s)
| | - Ruwan Jayasinghe
- Centre for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Kandy, Sri Lanka.,Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Kandy, Sri Lanka
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,WHO Collaborating Centre for Oral Cancer, London, UK
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Liu T, Liu L, Chen HJ, Fu Q, Fu L, Huang W, Chen F. Altered Topological Organization of Functional Brain Networks in Betel Quid Dependence: A Resting-State Functional MRI Study. Front Psychiatry 2021; 12:779878. [PMID: 35046854 PMCID: PMC8762206 DOI: 10.3389/fpsyt.2021.779878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Betel quid dependence (BQD) is associated with abnormalities in the widespread inter-regional functional connectivity of the brain. However, no studies focused on the abnormalities in the topological organization of brain functional networks in chewers in Mainland China. Methods: In the current study, resting-state functional magnetic resonance images were acquired from 53 BQD individuals and 37 gender- and age-matched healthy controls (HCs). A functional network was constructed by calculating the Pearson correlation coefficients among 90 subregions in the human Brainnetome Atlas. The topological parameters were compared between BQD individuals and HCs. Results: The results showed that BQD individuals presented a small-world topology, but the normalized characteristic path length (λ) increased compared with HCs (0.563 ± 0.030 vs. 0.550 ± 0.027). Compared to HCs, BQ chewers showed increased betweenness centrality (Be) in the right supplementary motor area, right medial superior frontal gyrus, right paracentral lobule, right insula, left posterior cingulate gyrus, right hippocampus, right post-central gyrus, right superior parietal gyrus, and right supramarginal gyrus, while decreased Be was found in the orbitofrontal area and temporal area, which is associated with reward network, cognitive system, and default mode network. The area under the curve (AUC) value of λ displayed a positive correlation with the duration of BQ chewing (r = 0.410, p = 0.002). Conclusions: The present study revealed the disruption of functional connectome in brain areas of BQD individuals. The findings may improve our understanding of the neural mechanism of BQD from a brain functional network topological organization perspective.
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Affiliation(s)
- Tao Liu
- Department of Neurology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Liting Liu
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Hui Juan Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Qingqing Fu
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Lili Fu
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Weiyuan Huang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
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Genetic toxicology and toxicokinetics of arecoline and related areca nut compounds: an updated review. Arch Toxicol 2020; 95:375-393. [PMID: 33097969 DOI: 10.1007/s00204-020-02926-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 01/13/2023]
Abstract
Areca nut (AN) is consumed by more than 600 million of individuals, particularly in some regions of South Asia, East Africa, and tropical Pacific, being classified as carcinogenic to humans. The most popular way of exposure consists of chewing a mixture of AN with betel leaf, slaked lime, and other ingredients that may also contain tobacco named betel quid (BQ). Arecoline is the principal active compound of AN, and, therefore, has been systematically studied over the years in several in vitro and in vivo genotoxicity endpoints. However, much of this information is dispersed, justifying the interest of an updated and comprehensive review article on this topic. In this sense, it is thus pertinent to describe and integrate the genetic toxicology data available as well as to address key toxicokinetics aspects of arecoline. This review also provides information on the effects induced by arecoline metabolites and related compounds, including other major AN alkaloids and nitrosation derivatives. The complexity of the chemicals involved renders this issue a challenge in genetic toxicology. Overall, positive results in several endpoints have been reported, some of them suggesting a key role for arecoline metabolites. Nevertheless, some negative genotoxicity findings for this alkaloid in short-term assays have also been reported in the literature. Finally, this article also collates information on the potential mechanisms of arecoline-induced genotoxicity, and suggests further approaches to tackle this important toxicological issue.
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Betel-Quid Chewing, Heart Failure, and Premature Ventricular Contractions in Patients with Cardiopulmonary Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207472. [PMID: 33066687 PMCID: PMC7602392 DOI: 10.3390/ijerph17207472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
Betel-quid (BQ) is a commonly used psychoactive substance that renders a specific cardiotoxicity. The purpose of this study was to investigate the association between BQ chewing and premature ventricular contractions (PVC) in patients with cardiopulmonary symptoms, and examine the potential influences of cardiovascular and chronic diseases on such relationship. Participants were 146 patients with cardiopulmonary symptoms who participated in 24-h Holter electrocardiogram monitoring during 2012–2018 in a hospital serving residents that lived in a BQ high prevalence area. Data on substance uses and medical histories for cardiovascular and chronic diseases were collected. Baron–Kenny method was employed to evaluate possible mediation. In patients with cardiopulmonary symptoms, 36.3% were BQ users and 63.7% were nonusers. Adjusting for covariates, BQ chewing was significantly associated with heart failure and diabetes mellitus (adjusted odds ratio (aOR) = 3.4 and 2.3, respectively), but only heart failure was significantly correlated with a low and high level of PVC. Additionally controlling for the effect of heart failure, the risk of high PVC for BQ users reduced from 3.60 to 2.88; however, the risk for BQ chewers remained significant (95% CI: 1.06–7.84). Heart failure was found to explain 27.7% of the excessive effect of BQ use on high PVC. In conclusion, BQ use is directly associated with an elevated risk of high PVC in patients with cardiopulmonary symptoms. The higher risk might be elevated among patients who suffered heart failure. Given several research limitations, the findings from this study offer future opportunities for validation.
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