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Casartelli A, Dacome L, Tessari M, Pascali J, Bortolotti F, Trevisan MT, Bosco O, Cristofori P, Tagliaro F. Cocaine-associated increase of atrial natriuretic peptides: an early predictor of cardiac complications in cocaine users? HEART ASIA 2014; 6:100-7. [PMID: 27326180 DOI: 10.1136/heartasia-2013-010482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/26/2014] [Accepted: 06/15/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Cocaine is known to produce life-threatening cardiovascular complications, and the investigation of the causes of death may be challenging in forensic medicine. The increasing knowledge of the cardiac function biomarkers and the increasing sensitivity of assays provide new tools in monitoring the cardiac life-threatening pathological conditions and in the sudden death investigation in chronic abusers. In this work, cardiac dysfunction was assessed in an animal model by measuring troponin I and natriuretic peptides as biomarkers, and considering other standard endpoints used in preclinical toxicology studies. METHODS Lister Hooded rats were treated with cocaine in chronic self-administration studies. Troponin I (cTnI) and atrial natriuretic peptide (ANP) were evaluated at different time points and heart weight and histopathology were assessed at the end of the treatment period. Furthermore, cocaine and its main metabolites were measured in the rat fur to assess rats' cocaine exposure. All the procedures and endpoints considered were designed to allow an easy and complete translation from the laboratory animals to human beings, and the same approach was also adopted with a group of 10 healthy cocaine abuse volunteers with no cardiac pathologies. RESULTS Cardiac troponin I values were unaffected, and ANP showed an increasing trend with time in all cocaine-treated animals considered. Similarly, in the healthy volunteers, no changes were observed in troponin serum levels, whereas the N-terminal brain natriuretic pro-peptide (NT proBNP) showed variations comparable with the changes observed in rats. CONCLUSIONS In conclusion, natriuretic peptides could represent an early indicator of heart dysfunction liability in chronic cocaine abusers.
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Affiliation(s)
- Alessandro Casartelli
- Toxicology and Pathology Department, Aptuit Medicine Research centre, Verona, Italy; Faculty of Medicine and Surgery, Public Health and Community Medicine Department, University of Verona, Verona, Italy
| | - Lisa Dacome
- Toxicology and Pathology Department , Aptuit Medicine Research centre , Verona , Italy
| | - Michela Tessari
- Toxicology and Pathology Department , Aptuit Medicine Research centre , Verona , Italy
| | - Jennifer Pascali
- Faculty of Medicine and Surgery, Public Health and Community Medicine Department , University of Verona , Verona , Italy
| | - Federica Bortolotti
- Faculty of Medicine and Surgery, Public Health and Community Medicine Department , University of Verona , Verona , Italy
| | | | | | | | - Franco Tagliaro
- Faculty of Medicine and Surgery, Public Health and Community Medicine Department , University of Verona , Verona , Italy
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2
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Diercks DB, Fonarow GC, Kirk JD, Jois-Bilowich P, Hollander JE, Weber JE, Wynne J, Mills RM, Yancy C, Peacock WF. Illicit stimulant use in a United States heart failure population presenting to the emergency department (from the Acute Decompensated Heart Failure National Registry Emergency Module). Am J Cardiol 2008; 102:1216-9. [PMID: 18940295 DOI: 10.1016/j.amjcard.2008.06.045] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/17/2008] [Accepted: 06/17/2008] [Indexed: 12/01/2022]
Abstract
Illicit stimulant drug use may have a profound clinical impact in acute decompensated heart failure (ADHF). The chronic use of cocaine and methamphetamine may lead to overt cardiomyopathy and ADHF. The Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM) collected data on patients presenting to emergency departments with ADHF at 83 geographically dispersed hospitals in the United States. This registry was queried to determine the rate of self-reported illicit drug use in emergency department patients presenting with ADHF and compare these patients with those without illicit drug use. The registry enrolled 11,258 patients with ADHF with drug use data from January 2004 to March 2006. Of these patients, 594 (5.3%) self-reported current or past stimulant drug use. Compared with nonusers, these patients were more likely to be younger (median age 49.7 vs 76.1 years), to be African American (odds ratio 11.9, 95% confidence interval 9.8 to 14.4), and to have left ventricular ejection fractions <40% (odds ratio 3.4, 95% confidence interval 2.8 to 4.2). Admitted users had no difference in mortality (adjusted odds ratio 0.83, 95% confidence interval 0.25 to 2.72) compared with nonusers. In conclusion, data from ADHERE-EM suggest that a clinically important percentage of patients with ADHF report the use of illicit stimulant drugs. Although these patients are younger with a greater degree of LV dysfunction, they did not have greater risk-adjusted mortality.
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Affiliation(s)
- Deborah B Diercks
- University of California, Davis, Medical Center, Sacramento, California, USA.
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3
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Substance Abuse and the Heart. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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4
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Abstract
Cardiac hypertrophy occurs in as many as 47% of normotensive individuals who chronically use cocaine. We investigated the effects of cocaine, in concentrations commonly found in chronic cocaine users, on calcium/calmodulin kinase (CaMK), and whether cocaine can activate CaMK, increase cardiac myocyte protein expression, and cause cardiac hypertrophy in this manner. In series I to III, 0 (control) or cocaine in concentrations of 10 to 10 mol/L was added to cultured adult rat cardiac ventricular myocytes to determine by Western blots and by P incorporation the optimal treatment time and the optimal dose for CaMK activation. In series I, cocaine, 10 mol/L, increased myocyte CaMKII translocation from myocyte soluble to particulate fractions by > or =73 +/- 9% (P < 0.01) in comparison with controls but did not cause the translocation of CaMKI or CaMKIV. In series II and III, cocaine treatment of myocytes for 15 minutes increased maximal CaMKII activity by 86.5 +/- 13.3% (P < 0.001) and a cocaine dose of 5 x 10 mol/L increased CaMKII activity by 169.5 +/- 18.1% (P < 0.001). In series IV we measured by silver staining beta-myosin heavy chain protein (beta-MHC) expression in myocytes before and after cocaine and also CaMK inhibition with KN-62 (1-[N,O-bis-(5-isoquinolinesulfonyl)-N-methyl-L-tyrosyl]-4-phenylpiperazine). In these experiments, cocaine, 5x10 mol/L, increased myocyte protein concentration by 29.2 +/- 2.8%, and beta-MHC by 93.2 +/- 8.8% (P < 0.001). In series V and VI, cocaine effects on calcium currents (ICa) and intracellular Ca ([Ca]i) were determined before and after CaMK inhibition with KN-62 in rat myocytes. Cocaine, 10 mol/L, enhanced ICa peak amplitude in a voltage-dependent manner (by 173.9 +/- 14.9% at -20 mV and by 38.4 +/- 6.9% at 0 mV P < 0.01). Cocaine, 10 to 10 mol/L, in series VI promoted Ca transients from myocyte sarcoplasmic reticulum and increased [Ca]i to 607 +/- 141 x 10 mol/L (P < 0.05). KN-62 decreased cocaine-induced myocyte protein expression by 76.6%, and beta-MHC by 66.2% (P < 0.01) and significantly decreased cocaine-induced Ca transients and [Ca]i. We conclude that CaMKII activation is an important mechanism whereby cocaine can cause myocyte hypertrophy.
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Affiliation(s)
- Robert J Henning
- Department of Medicine, University of South Florida College of Medicine and the James A. Haley VA Hospital, Tampa, Florida 33612, USA.
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5
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Abstract
Cocaine-associated chest pain is a clinical entity that crosses all socioeconomic groups and hence will be encountered by many physicians. The initial evaluation and treatment of cocaine-induced chest pain are similar to those of patients who have non-cocaine-induced chest pain, but there are several notable exceptions. This article reviews the pathophysiology, evaluation, management, and disposition decisions unique to patients presenting with cocaine-induced chest pain.
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Affiliation(s)
- James H Jones
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Abstract
The pathophysiology of cocaine leading to myocardial ischemia is multifactorial. Given the paucity of well-designed clinical studies, treatment is directed toward the potential mechanisms involved in the development of myocardial ischemia. Fortunately, morbidity and mortality in this patient population are low, and the vast majority of patients will not suffer AMI or other cardiac complications. Long-term prognosis is excellent for those who abstain from continued cocaine use.
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Affiliation(s)
- James H Jones
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Affiliation(s)
- G Van Camp
- Department of Cardiology, AZ-VUB, Brussels.
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Gutkowska J, Jankowski M, Pawlak D, Mukaddam-Daher S, Izdebski J. The cardiovascular and renal effects of a highly potent mu-opioid receptor agonist, cyclo[N epsilon,N beta-carbonyl-D-Lys2,Dap5]enkephalinamide. Eur J Pharmacol 2005; 496:167-74. [PMID: 15288587 DOI: 10.1016/j.ejphar.2004.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2003] [Revised: 06/02/2004] [Accepted: 06/08/2004] [Indexed: 10/26/2022]
Abstract
Investigation of the acute cardiovascular and renal effects of cyclo[Nepsilon,Nbeta-carbonyl-D-Lys2,Dap5]enkephalinamide (cUENK6), the most potent mu-opioid receptor agonist, revealed dose-related effects, but most pronounced during the first hour post i.v. injections. During first hour, cUENK6 (3 microg/rat) stimulated (P<0.001) excretion of urine (1.1+/-0.2 vs. 3.3+/-0.3 ml/h), sodium (60+/-10 vs. 124+/-12 microeq/h), potassium and cGMP (1.76+/-0.19 vs. 4.92+/-0.80 nmol/h). These effects were inhibited by naloxone (4 mg/kg i.v.), but not by naloxonazine (35 mg/kg s.c.), or 4 mg/kg i.v. naloxone methiodide. cUENK6 stimulated urinary atrial natriuretic peptide (ANP)-like activity (113+/-12 vs. 167+/-20 pg/h, P<0.02) and the effect was totally abolished by naloxone. cUENK6 also suppressed the transient stress-induced elevation in blood pressures and heart rate that occurred over the first 30-min post-injection, an effect attenuated by naloxone. Plasma ANP increased 2-h post-injection (123+/-11 vs. 192+/-21 pg/ml, P<0.005), and was associated with augmented ANP mRNA levels in right atria and left ventricles. Thus, cUENK6 evokes renal effects by enhancing activity of the renal natriuretic peptide system.
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Affiliation(s)
- Jolanta Gutkowska
- Laboratory of Peptides, Department of Chemistry, University of Warsaw, Warsaw, Poland
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Moritz F, Monteil C, Mulder P, Derumeaux G, Bizet C, Renet S, Lallemand F, Richard V, Thuillez C. Prolonged Cardiac Dysfunction After Withdrawal of Chronic Cocaine Exposure in Rats. J Cardiovasc Pharmacol 2003; 42:642-7. [PMID: 14576513 DOI: 10.1097/00005344-200311000-00010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cocaine abuse causes myocardial dysfunction and induces oxidative stress. However, the reversibility of these effects is unknown. We evaluated myocardial function and oxidative stress after cocaine withdrawal, in a rat model of chronic cocaine exposure. Standard echocardiography and Doppler tissue imaging were performed after 4 weeks (W4) of cocaine administration (2 x 7.5 mg/kg/d, i.p.) and 4 weeks after interruption (W8). At these time points, redox state (reduced glutathione GSH, oxidized glutathione GSH, and GSH/GSSG) as well as activities of GSH peroxidase (GPX), superoxide dismutase (SOD), and catalase were determined in the left ventricle (LV). At W4, LV fractional shortening, posterior wall thickening, systolic myocardial ventricular gradient (SMVG), dP/dt(max), and dp/dt(min) were decreased, compared with control values while LV myocardial thickness was increased. At W8, even though dP/dtmax and dp/dt(min) were restored, myocardial function was still impaired as demonstrated by the decrease in posterior wall thickening, and systolic myocardial velocity gradient. At W4, CAT and GPX activities as well as GSH/GSSG ratio were reduced while SOD activity was increased. Antioxidant markers and redox ratio remained altered 4 weeks after the last injection. Thus, these data demonstrate the persistence of LV dysfunction after cocaine withdrawal, which occurs in a context of a deficit in antioxidant defenses.
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Affiliation(s)
- Fabienne Moritz
- INSERM E 9920, IFRMP no. 23, University Medical School, Rouen, France
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10
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Abstract
BACKGROUND Chronic cocaine users can have as much as a 69% increase in left ventricular muscle mass without associated increases in arterial blood pressure, heart rate, renin, aldosterone, or cortisol. We determined whether cocaine directly increases cardiomyocyte protein content and whether protein kinase C is important in this process. METHODS AND RESULTS Adult rat cardiomyocytes were isolated and grown in cultures. In Series I experiments, cocaine, 10(-8) to 10(-6) M, or vehicle, in the absence or presence of phentolamine or metoprolol, was added to each culture and the cells were subsequently harvested. In Series II, cocaine, 10(-6) M, cocaine, 10(-6) M, plus bisindolylmaleimide, 10(-6) M, a protein kinase C inhibitor, or vehicle were added to each culture and the cells subsequently harvested. We determined the total protein content, the content of alpha-myosin and fetal beta-myosin heavy-chain protein, and the presence of protein kinase C isoforms in the cardiomyocyte soluble and particulate fractions. Protein kinase C translocation from the soluble to particulate fraction is indicative of activation. In Series III, we determined the cocaine effects on ERK, SAPK/JNK, and p38. In Series I, cocaine, 10(-8) to 10(-6) M, dose-dependently increased myocyte protein content by as much as 28%+/-2% (P<.001) and fetal beta-myosin heavy-chain protein content by 80%+/-2% (P<.001). Neither phentolamine nor metoprolol inhibited this process. In Series II, we determined that ventricular myocytes contain alpha (alpha), beta (beta), delta (delta), epsilon (epsilon), and zeta (zeta) protein kinase C isoforms. Cocaine, 10(-6) M, caused a 45+/-5% increase (P<.001) in protein kinase Calpha in the particulate fraction. The addition of a protein kinase C inhibitor to the myocyte cultures prevented the cocaine-induced translocation of protein kinase Calpha and limited the increase in beta-myosin heavy-chain protein content by >75% (P<.001). However, cocaine did not increase the phosphorylation of ERK, SAPK/JNK or p38 in Series III. CONCLUSIONS Cocaine increases adult cardiomyocyte protein content by protein kinase Calpha-dependent mechanisms, and this process can contribute to the cardiac hypertrophy and cardiomyopathy that results from chronic cocaine use.
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Affiliation(s)
- Robert J Henning
- Department of Medicine, University of South Florida College of Medicine and the James A. Haley Hospital, Tampa, Florida, USA.
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Tan Y, Gan Q, Knuepfer MM. Central alpha-adrenergic receptors and corticotropin releasing factor mediate hemodynamic responses to acute cold stress. Brain Res 2003; 968:122-9. [PMID: 12644270 DOI: 10.1016/s0006-8993(03)02226-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Behavioral stress is likely to contribute to the development of hypertension in susceptible individuals. We reported that hemodynamic response patterns to acute startle vary and that those patterns predict the predisposition of rats to sustained stress-induced elevations in arterial pressure. Since considerable evidence suggests that central catecholamines and corticotropin releasing factor (CRF) contribute to the regulation of arterial pressure and the development of hypertension, we investigated the role of central alpha-adrenergic receptors and CRF in mediating different hemodynamic response patterns to acute cold water stress in conscious rats. Rats were instrumented for arterial pressure, heart rate and cardiac output determination and for intracerebroventricular (icv) administration of selective antagonists. After acclimation to a water tight cage, ice water (1 cm deep) was rapidly added then drained 1 min later. Although the early startle response to cold water stress elicited a pressor response in all rats, the hemodynamic response pattern varied between rats. Vascular responders (n=19) had an initial considerable increase in systemic vascular resistance and a decrease in cardiac output. In contrast, mixed responders (n=11) had a smaller increase in vascular resistance and an increase in cardiac output. Pretreatment with phentolamine (30 microgram/5 microliter, icv, n=8), prazosin (10 microgram/5 microliter, icv, n=12) or alpha-helical CRF(9-41) (10 microgram/5 microliter, icv, n=9) prevented the decrease in cardiac output elicited by acute cold water stress in vascular responders without affecting mixed responders. Yohimbine (3 microgram/5 microliter, icv, n=8) pretreatment did not alter hemodynamic responses. Therefore, we conclude that central alpha(1)-adrenoceptors and CRF mediate the specific hemodynamic response patterns to acute startle and may be responsible for the predisposition to develop hypertension in vascular responders.
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Affiliation(s)
- Yun Tan
- Department of Pharmacological Science, Saint Louis University School of Medicine, 1402 S. Grand Blvd, 63104, Saint Louis, MO, USA
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12
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Abstract
Cocaine produces a pattern of cardiovascular responses that are associated with apparent myocardial ischemia, arrhythmias, and other life-threatening complications in some individuals. Despite recent efforts to better understand the causes of cocaine-induced cardiovascular dysfunction, there remain a number of unanswered questions regarding the specific mechanisms by which cocaine elicits hemodynamic responses. This review will describe the actions of cocaine on the cardiovascular system and the evidence for the mechanisms by which cocaine elicits hemodynamic and pathologic responses in humans and animals. The emphasis will be on experimental data that provide the basis for our understanding of the mechanisms of cardiovascular toxicity associated with cocaine. More importantly, this review will identify several controversies regarding the causes of cocaine-induced cardiovascular toxicity that as yet are still debated. The evidence supporting these findings will be described. Finally, this review will outline the obvious deficits in our current concepts regarding the cardiovascular actions of cocaine in hope of encouraging additional studies on this grave problem in our society.
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Affiliation(s)
- Mark M Knuepfer
- Department of Pharmacological and Physiological Science, St. Louis University School of Medicine, 1402 S. Grand Boulevard, St. Louis, MO 63104, USA.
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13
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Affiliation(s)
- R A Lange
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75390-9047, USA
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14
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Henning RJ, Silva J, Reddy V, Kamat S, Morgan MB, Li YX, Chiou S. Cocaine increases beta-myosin heavy-chain protein expression in cardiac myocytes. J Cardiovasc Pharmacol Ther 2000; 5:313-22. [PMID: 11150401 DOI: 10.1054/jcpt.2000.19331] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND As many as 47% of chronic cocaine users develop cardiac ventricular hypertrophy. The presence and degree of cocaine-induced ventricular hypertrophy is not correlated with the use of other substances of abuse such as alcohol or cigarettes. Moreover, this hypertrophy occurs in individuals without sustained increases in arterial blood pressure or heart rate, or increases in the plasma concentration of renin, aldosterone, norepinephrine, or cortisol. Therefore, we investigated whether cocaine, in concentrations commonly found in cocaine users, has any direct effects on the protein content in cardiac ventricular myocytes. We compared the effects of cocaine with norepinephrine, which increases the total protein content, especially beta-myosin heavy-chain contractile protein (beta-MHC), in cardiac ventricular myocytes. METHODS Experiments were performed on 30-day-old rat ventricular myocytes suspended in culture media and cultured in flasks. In 12 suspension-culture experiments, cocaine or norepinephrine, in doses of 0 (control) or 10(-6) mol/L was added to each culture and the cells were harvested on day 5. In 16 flask-culture experiments, cocaine or norepinephrine was added to each culture on day 7 in doses of 0 (control-vehicle), 10(-7), or 10(-6) mol/L and the cells were harvested on day 10. The total protein content and the myosin protein expression of the myocytes in each culture were determined. Juvenile and adult rat cardiac myosin protein is predominately alpha-myosin heavy-chain protein (alpha-MHC), whereas beta-MHC occurs primarily in fetal rat hearts. RESULTS In the suspension-culture experiments, cocaine, 10(-6) mol/L, increased the cardiomyocyte total protein concentration by 29% +/- 2% (P <.001) and the beta-MHC expression by 81% +/- 10% (P <.01) in comparison with the control myocytes. Cocaine slightly decreased cardiomyocyte alpha-MHC. Norepinephrine increased the total protein concentration by 21% +/- 3% (P <.001) and the beta-MHC expression by 59% +/- 10% (P <.01), but did not increase alpha-MHC expression. In the flask-culture experiments, cocaine, 10(-6) mol/L, maximally increased the total protein concentration by 28% (P <.001), the protein/cell ratio by 57% +/- 10% (P <.01), and the beta-MHC expression by 85% +/- 8% (P <.01). Cocaine slightly decreased alpha-MHC. Norepinephrine, 10(-6) mol/L, maximally increased the total protein concentration by 35%, the protein/cell ratio by 63% +/- 9% (P <.01), and the expression of beta-MHC by 78% +/- 11% (P <. 01). Norepinephrine did not increase alpha-MHC expression. In 18 separate flask-culture experiments, cocaine, 10(-6) mol/L, was added to the cardiomyocyte cultures after the addition of phentolamine (n = 9), in concentrations of 10(-7) to 10(-5) mol/L, or metoprolol (n = 9), in concentrations of 10(-7) to 10(-5) mol/L. Neither phentolamine nor metoprolol inhibited the cocaine-induced increase in cardiomyocyte total protein content or the expression of beta-MHC. CONCLUSION Cocaine, similar to norepinephrine, significantly increases the total protein content and the expression of beta-MHC in cardiac ventricular myocytes. In this manner, cocaine may cause cardiac ventricular hypertrophy. This process is not inhibited by alpha- or beta-adrenergic receptor blockade.
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Affiliation(s)
- R J Henning
- University of South Florida College of Medicine, Tampa, FL 33612, USA
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15
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Phillis BD, Irvine RJ, Kennedy JA. Combined cardiac effects of cocaine and the anabolic steroid, nandrolone, in the rat. Eur J Pharmacol 2000; 398:263-72. [PMID: 10854839 DOI: 10.1016/s0014-2999(00)00294-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite reports of an increase in the incidence of simultaneous cocaine and anabolic steroid abuse, potential adverse interactions between these two drugs on the cardiovascular system are largely unquantified. Cocaine has been reported to induce coronary vasoconstriction, cardiac arrhythmias and conduction delays. Anabolic steroids have been associated with cardiac hypertrophy and hypertension. Utilising both in vivo (radiotelemetry) and in vitro (isolated Langendorff-perfused heart) techniques, our aim was to determine whether anabolic steroids cause cardiac hypertrophy and alter cardiac function, and consequently alter the response of the heart to cocaine. It was found that 15 days of treatment of rats with nandrolone decanoate (20 mg/kg, s.c.) was not sufficient to cause hypertrophy, alter cardiac function or the spread of electrical activity through the heart. However, nandrolone pretreatment was found to significantly potentiate the heart rate response to cocaine (45 mg/kg, i.p.) in vivo. This study indicates that nandrolone significantly elevates the heart rate response to high dose cocaine without changing heart morphology. The mechanism of this interaction remains uncertain.
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Affiliation(s)
- B D Phillis
- Department of Clinical and Experimental Pharmacology, University of Adelaide, Frome Road, 5000, Adelaide, Australia
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Blaho K, Winbery S, Park L, Logan B, Karch SB, Barker LA. Cocaine metabolism in hyperthermic patients with excited delirium. ACTA ACUST UNITED AC 2000; 7:71-6. [PMID: 16083654 DOI: 10.1054/jcfm.1999.0344] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The half-life of cocaine in clinical experiments has been reported to range from 60 to 90 min. It has been previously suggested that elevated temperature may accelerate the metabolism of cocaine. However, there is no clinical data to indicate the presence of hyperthermia like that seen in excited delirium alters the half-life of cocaine. We report the results of half-life determinations from serial cocaine concentrations in two patients with excited delirium. Both patients presented to the emergency department with classic findings of excited delirium that included hyperthermia, agitation, and cardiovascular aberrations. One patient died despite aggressive therapeutic intervention. Cocaine and metabolite concentrations were determined by an extractive alkylation mass spectrometry procedure. Presenting cocaine concentrations in patient 1 and patient 2 were 0.387 and 0.266 mg/L respectively. Results from pharmacokinetic modeling of the serial concentrations show that the half-life of cocaine was not significantly accelerated, despite the presence of hyperthermia. Data from these two cases provide further evidence that catastrophic reactions to cocaine are independent of amount or route of administration, and that the metabolism of cocaine, at least in these patients, was not altered by hyperthermia.
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Affiliation(s)
- K Blaho
- Department of Emergency Medicine and Clinical Toxicology, UT Medical Group, Memphis, USA
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Abstract
This study was designed to determine the direct cytotoxic effect of cocaine on human coronary artery endothelial cells (HCAECs). Cocaine treatment of cultured HCAECs induced a time- and dose-dependent increase in apoptotic cell death in HCAECs. Cocaine-induced surface exposure of phosphatidylserine in HCAECs was seen as early as at 6 h. With prolonged treatment < or =72 h, cocaine (10-500 microM) produced a dose-dependent increase in apoptosis in the cells. Corresponding DNA fragmentation induced by cocaine was demonstrated in situ by terminal deoxynucleotidyl transferase (Tdt) UTP nick end-labeling TUNEL assay and by electrophoresis of labeled DNA fragments, showing the characteristic apoptotic ladders. Both caspase-9 (Z-LEHD-FMK) and caspase-3 (Ac-DEVD-CHO) inhibitors blocked cocaine-induced apoptosis. In addition, cyclosporin A inhibited cocaine-induced apoptosis in a concentration-dependent manner with a median inhibitory concentration (IC50) of 0.3 microM. The maximum of 62% inhibition was obtained with 3 microM cyclosporin A. Cocaine-induced apoptosis also was blocked by naloxone and nifedipine in a dose-dependent manner. These findings suggest that cocaine induces apoptosis in cultured HCAECs, which may be mediated by opioid receptors. The release of cytochrome c from the mitochondria and its subsequent activation of caspase-9 and caspase-3 may play a key role in cocaine-induced apoptosis.
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Affiliation(s)
- J He
- Department of Pharmacology, Loma Linda University School of Medicine, California 92350, USA
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