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Kumari S, Pal B, Sahu SK, Prabhakar PK, Tewari D. Adverse events of clenbuterol among athletes: a systematic review of case reports and case series. Int J Legal Med 2023:10.1007/s00414-023-02996-1. [PMID: 37062796 DOI: 10.1007/s00414-023-02996-1] [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: 11/23/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
Clenbuterol is a potent beta-2 agonist widely misused by professional athletes and bodybuilders. Information on clenbuterol associated adverse events is present in case reports and case series, though it may not be readily available. This systematic review aimed to critically evaluate the evidence of adverse events associated with clenbuterol among athletes. The search strategy was in accordance with PRISMA guidelines. Databases such as PubMed, Science Direct, Scopus, and Google Scholar were searched from 1990 to October 2021 to find out the relevant case reports and case series. There were 23 included studies. Using a suitable scale, the included studies' methodological quality analysis was evaluated. In total, 24 athletes experienced adverse events. Oral ingestion of clenbuterol was the most preferred route among them. The daily administered dose of clenbuterol was ranging from 20 µg to 30 mg. Major adverse events experienced by athletes were supraventricular tachycardia, atrial fibrillation, hypotension, chest pain, myocardial injury, myocarditis, myocardial ischemia, myocardial infarction, cardiomyopathy, hepatomegaly, hyperglycemia, and death. The cardiac-related complications were the most commonly occurring adverse events. Clenbuterol is notorious to produce life-threatening adverse events including death. Lack of evidence regarding the performance-enhancing effects of clenbuterol combined with its serious toxicities questions the usefulness of this drug in athletes.
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Affiliation(s)
- Sweta Kumari
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
| | - Biplab Pal
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
| | - Sanjeev Kumar Sahu
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
| | - Pranav Kumar Prabhakar
- School of Allied Medical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India
| | - Devesh Tewari
- Department of Pharmacognosy and Phytochemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, 110017, India.
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Li X, Zang M, Li D, Zhang K, Zhang Z, Wang S. Meat food fraud risk in Chinese markets 2012-2021. NPJ Sci Food 2023; 7:12. [PMID: 37012259 PMCID: PMC10070328 DOI: 10.1038/s41538-023-00189-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/22/2023] [Indexed: 04/05/2023] Open
Abstract
Food fraud is a major concern worldwide, and the majority of cases include meat adulteration or fraud. Many incidences of food fraud have been identified for meat products both in China and abroad over the last decade. We created a meat food fraud risk database compiled from 1987 pieces of information recorded by official circular information and media reports in China from 2012 to 2021. The data covered livestock, poultry, by-products, and various processed meat products. We conducted a summary analysis of meat food fraud incidents by researching fraud types, regional distribution, adulterants and categories involved, categories and sub-categories of foods, risk links and locations, etc. The findings can be used not only to analyze meat food safety situations and study the burden of food fraud but also help to promote the efficiency of detection and rapid screening, along with improving prevention and regulation of adulteration in the meat supply chain markets.
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Affiliation(s)
- Xiaoman Li
- Beijing Key Laboratory of Meat Processing Technology, China Meat Research Center, Beijing Academy of Food Sciences, 100068, Beijing, China
| | - Mingwu Zang
- Beijing Key Laboratory of Meat Processing Technology, China Meat Research Center, Beijing Academy of Food Sciences, 100068, Beijing, China.
| | - Dan Li
- Beijing Key Laboratory of Meat Processing Technology, China Meat Research Center, Beijing Academy of Food Sciences, 100068, Beijing, China
| | - Kaihua Zhang
- Beijing Key Laboratory of Meat Processing Technology, China Meat Research Center, Beijing Academy of Food Sciences, 100068, Beijing, China
| | - Zheqi Zhang
- Beijing Key Laboratory of Meat Processing Technology, China Meat Research Center, Beijing Academy of Food Sciences, 100068, Beijing, China
| | - Shouwei Wang
- Beijing Key Laboratory of Meat Processing Technology, China Meat Research Center, Beijing Academy of Food Sciences, 100068, Beijing, China
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HAYASHI T, HAMASE K. Simultaneous Determination of Seven β<sub>2</sub>-Agonists in Livestock Products Using an LC-MS/MS System. CHROMATOGRAPHY 2022. [DOI: 10.15583/jpchrom.2022.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Kenji HAMASE
- Graduate School of Pharmaceutical Sciences, Kyushu University
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HAYASHI T, HAMASE K. Determination of Clenbuterol in Various Edible Parts of Livestock Products by LC-MS/MS and LC-MS/MS/MS Methods. CHROMATOGRAPHY 2021. [DOI: 10.15583/jpchrom.2020.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Takako HAYASHI
- Kanagawa Prefectural Institute of Public Health
- Graduate School of Pharmaceutical Science, Kyushu University
| | - Kenji HAMASE
- Graduate School of Pharmaceutical Science, Kyushu University
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Jędrejko K, Lazur J, Muszyńska B. Risk Associated with the Use of Selected Ingredients in Food Supplements. Chem Biodivers 2021; 18:e2000686. [PMID: 33410585 DOI: 10.1002/cbdv.202000686] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/05/2021] [Indexed: 12/30/2022]
Abstract
This review focuses on four new product categories of food supplements: pre-workout, fat burner/thermogenic, brain/cognitive booster, and hormone/testosterone booster. Many food supplements have been shown to be contaminated with unauthorized substances. In some cases, the ingredients in the new categories of dietary supplements were medicinal products or new synthetic compounds added without performing clinical trials. Some of the new ingredients in dietary supplements are plant materials that are registered in the pharmacopoeia as herbal medicines. In other cases, dietary supplements may contain plant materials that have no history of human use and are often used as materials to 'camouflage' stimulants. In the European Union, new ingredients of dietary supplements, according to European Food Safety Authority or unauthorized novel food. Furthermore, selected ingredients in dietary supplements may be prohibited in sports and are recognized as doping agents by World Anti-Doping Agency.
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Affiliation(s)
- Karol Jędrejko
- Jagiellonian University Medical College, Faculty of Pharmacy, Department of Pharmaceutical Botany, Medyczna 9 Street, PL, 30-688, Kraków, Poland
| | - Jan Lazur
- Jagiellonian University Medical College, Faculty of Pharmacy, Department of Pharmaceutical Botany, Medyczna 9 Street, PL, 30-688, Kraków, Poland
| | - Bożena Muszyńska
- Jagiellonian University Medical College, Faculty of Pharmacy, Department of Pharmaceutical Botany, Medyczna 9 Street, PL, 30-688, Kraków, Poland
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Lehmann S, Thomas A, Schiwy-Bochat KH, Geyer H, Thevis M, Glenewinkel F, Rothschild MA, Andresen-Streichert H, Juebner M. Death after misuse of anabolic substances (clenbuterol, stanozolol and metandienone). Forensic Sci Int 2019; 303:109925. [DOI: 10.1016/j.forsciint.2019.109925] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/18/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023]
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Wang Y, Lau K, Lau F. Clenbuterol Food Poisoning from Snake Meat Consumption: An Outbreak of 13 Cases. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a documented outbreak of clenbuterol food poisoning involving 13 patients who consumed snake meat in Shenzhen. They developed headache, palpitation, tachycardia, hypokalaemia and other symptoms within first 3 hours after exposure. They were initially treated with gastric lavage, fluid and potassium replacement and other supportive measures. All of them completely recovered after admission for up to 48 hours. Public health investigation identified clenbuterol compound in four victims' urine and the food source of snake meat they consumed. (Hong Kong j.emerg.med. 2015;22:46-49)
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Affiliation(s)
- Yj Wang
- Beijing University Shenzhen Hospital, Department of Emergency Medicine, Shenzhen, China
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Affiliation(s)
- Nik Žlak
- Department of Internal medicine, University Medical Centre Ljubljana, General hospital Trbovlje, Trbovlje, Slovenia
| | - Daniel Košuta
- Department of Internal medicine, University Medical Centre Ljubljana, General hospital Trbovlje, Trbovlje, Slovenia
| | - Maja Potisek
- Department of Internal medicine, University Medical Centre Ljubljana, General hospital Trbovlje, Trbovlje, Slovenia
| | - Živojin Stevanović
- Department of Internal medicine, University Medical Centre Ljubljana, General hospital Trbovlje, Trbovlje, Slovenia
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Luo L, Hu P, Miao C, Ma A, Wang T. Clenbuterol Attenuates hERG Channel by Promoting the Mature Channel Degradation. Int J Toxicol 2017; 36:314-324. [PMID: 28535735 DOI: 10.1177/1091581817710786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Clenbuterol, a β2-selective adrenergic receptor agonist, is illicitly used in weight loss and performance enhancement and animal production. Increasing evidence demonstrates that clenbuterol induces various kinds of arrhythmias and QTc interval prolongation. However, little is known about the underlying mechanism. Most drugs are associated with QTc prolongation through interfering with human ether-a-go-go-related gene (hERG) K+ channels. The present study aims to investigate the effects and underlying mechanisms of clenbuterol on the hERG channel. HEK 293 cells were transfected with wild type and Y652A or F656A mutants of the hERG channel and treated with clenbuterol. The hERG current was recorded using whole-cell patch-clamp technique, and protein level was evaluated by Western blot. We found that clenbuterol decreases the mature form of the hERG protein at the cell membrane in a concentration- and time-dependent manner, without affecting the immature form. Correspondingly, clenbuterol chronic treatment reduced hERG current to a greater extent compared to acute treatment. In the presence of Brefeldin A (BFA), which was used to block hERG channel trafficking to cell membrane, clenbuterol reduced hERG on plasma membrane to a greater extent than BFA alone. In addition, the hERG channel's drug binding sites mutant Y652A and F656A abolished clenbuterol-mediated hERG reduction and current blockade. In conclusion, clenbuterol reduces hERG channel expression and current by promoting the channel degradation. The effect of clenbuterol on the hERG channel is related to the drug-binding sites, Tyr-652 and Phe-656, located on the S6 domain. This biophysical mechanism may underlie clenbuterol-induced QTc prolongation or arrhythmia.
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Affiliation(s)
- Ling Luo
- 1 Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Peijing Hu
- 1 Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Changqing Miao
- 1 Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Aiqun Ma
- 1 Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,2 Key Laboratory of Molecular Cardiology, Shaanxi, China.,3 Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Tingzhong Wang
- 1 Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,2 Key Laboratory of Molecular Cardiology, Shaanxi, China.,3 Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
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Waight M, McGuinness W. Case of low dose clenbuterol toxicity. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-215157. [PMID: 27084902 DOI: 10.1136/bcr-2016-215157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of acute clenbuterol toxicity following ingestion of 20 μg of clenbuterol, resulting in symptoms of sympathetic activation, sinus tachycardia and electrolyte derangement. The patient was managed conservatively with fluid resuscitation, electrolyte replacement and monitoring, and discharged following a 5-day stay in hospital.
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11
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Grimmer NM, Gimbar RP, Bursua A, Patel M. Rhabdomyolysis Secondary to Clenbuterol Use and Exercise. J Emerg Med 2016; 50:e71-4. [DOI: 10.1016/j.jemermed.2015.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/11/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022]
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Quinley KE, Chen HY, Yang HS, Lynch KL, Olson KR. Clenbuterol causing non-ST-segment elevation myocardial infarction in a teenage female desiring to lose weight: case and brief literature review. Am J Emerg Med 2016; 34:1739.e5-7. [PMID: 26873408 DOI: 10.1016/j.ajem.2015.12.086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kelly E Quinley
- Department of Emergency Medicine, Highland Hospital Alameda Health System, Oakland, CA 94602.
| | - Hsien-Yi Chen
- Department of Emergency Medicine, Chang-Gung Memorial Hospital, Taoyuan, Taiwan; San Francisco Division of California Poison Control System,San Francisco, CA.
| | - He S Yang
- Department of Laboratory Medicine, University of California San Francisco, 1001 Potrero Ave, NH2M16, San Francisco, CA 94110.
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California San Francisco, 1001 Potrero Ave, NH2M16, San Francisco, CA 94110.
| | - Kent R Olson
- San Francisco Division of the California Poison Control System, University of California San Francisco, San Francisco, CA 94143-1369.
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Abstract
Recent studies of inherited disorders of phosphate metabolism have shed new light on the understanding of phosphate metabolism. Phosphate has important functions in the body and several mechanisms have evolved to regulate phosphate balance including vitamin D, parathyroid hormone and phosphatonins such as fibroblast growth factor-23 (FGF23). Disorders of phosphate homeostasis leading to hypo- and hyperphosphataemia are common and have clinical and biochemical consequences. Notably, recent studies have linked hyperphosphataemia with an increased risk of cardiovascular disease. This review outlines the recent advances in the understanding of phosphate homeostasis and describes the causes, investigation and management of hypo- and hyperphosphataemia.
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Affiliation(s)
- P Manghat
- Department of Chemical Pathology, Darent Valley Hospital, Dartford, UK
| | - R Sodi
- Department of Biochemistry, NHS Lanarkshire, East Kilbride, UK
| | - R Swaminathan
- Department of Chemical Pathology, St. Thomas Hospital, London, UK
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Zhuang Z, Zhao Y, Wu Q, Li M, Liu H, Sun L, Gao W, Wang D. Adverse effects from clenbuterol and ractopamine on nematode Caenorhabditis elegans and the underlying mechanism. PLoS One 2014; 9:e85482. [PMID: 24465573 PMCID: PMC3897430 DOI: 10.1371/journal.pone.0085482] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/27/2013] [Indexed: 01/06/2023] Open
Abstract
In the present study, we used Caenorhabditis elegans assay system to investigate in vivo toxicity from clentuberol and ractopamine and the possible underlying mechanism. Both acute and prolonged exposures to clentuberol or ractopamine decreased brood size and locomotion behavior, and induced intestinal autofluorescence and reactive oxygen species (ROS) production. Although acute exposure to the examined concentrations of clentuberol or ractopamine did not induce lethality, prolonged exposure to 10 µg/L of clentuberol and ractopamine reduced lifespan. At relatively high concentrations, ractopamine exhibited more severe toxicity than clentuberol on nematodes. Overexpression of sod-2 gene encoding a Mn-SOD to prevent induction of oxidative stress effectively inhibited toxicity from clentuberol or ractopamine. Besides oxidative stress, we found that clentuberol might reduce lifespan through influencing insulin/IGF signaling pathway; however, ractopamine might reduce lifespan through affecting both insulin/IGF signaling pathway and TOR signaling pathway. Ractopamine more severely decreased expression levels of daf-16, sgk-1, skn-1, and aak-2 genes than clentuberol, and increased expression levels of daf-2 and age-1 genes at the examined concentration. Therefore, the C. elegans assay system may be useful for assessing the possible toxicity from weight loss agents, and clentuberol and ractopamine may induce toxicity through different molecular mechanisms.
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Affiliation(s)
- Ziheng Zhuang
- School of Pharmaceutical Engineering and Life Sciences, Changzhou University, Changzhou, China
| | - Yunli Zhao
- Key Laboratory of Environmental Medicine Engineering in Ministry of Education, Medical School of Southeast University, Nanjing, China
| | - Qiuli Wu
- Key Laboratory of Environmental Medicine Engineering in Ministry of Education, Medical School of Southeast University, Nanjing, China
| | - Min Li
- School of Pharmaceutical Engineering and Life Sciences, Changzhou University, Changzhou, China
- Key Laboratory of Environmental Medicine Engineering in Ministry of Education, Medical School of Southeast University, Nanjing, China
| | - Haicui Liu
- Xiuli Biological Technology Co., Ltd. Changzhou, China
| | - Lingmei Sun
- Key Laboratory of Environmental Medicine Engineering in Ministry of Education, Medical School of Southeast University, Nanjing, China
| | - Wei Gao
- Jiangsu Province Product Quality Supervision and Inspection Institute, Nanjing, China
| | - Dayong Wang
- Key Laboratory of Environmental Medicine Engineering in Ministry of Education, Medical School of Southeast University, Nanjing, China
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Dose-effects of aorta-infused clenbuterol on spinal cord ischemia-reperfusion injury in rabbits. PLoS One 2013; 8:e84095. [PMID: 24391890 PMCID: PMC3877193 DOI: 10.1371/journal.pone.0084095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/11/2013] [Indexed: 01/17/2023] Open
Abstract
Background The β2 adrenergic receptor (β2AR) plays an important role in ischemia-reperfusion (I/R) injury in various organs. Recently, a selective β2AR agonist clenbuterol was suggested to protect against cerebral I/R injury. This study was designed to investigate changes of β2ARs after spinal cord I/R injury and dose-effects of aorta-infused clenbuterol on spinal cord I/R injury in rabbits. Methods Spinal cord ischemia was induced in New Zealand white rabbits by infrarenal abdominal aortic occlusion with a balloon catheter for 30 minutes except the sham group. During occlusion, nothing (I/R group), normal saline (NS group) or clenbuterol at different doses of 0.005, 0.01, 0.05, 0.1, 0.5, or 1 mg/kg (C0.005, C0.01, C0.05, C0.1, C0.5, and C1 groups) was infused into the occluded aortic segments. The hemodynamic data, blood glucose and serum electrolytes were measured during experimental period. Neurological function was assessed according to the modified Tarlov scales until 48 hours after reperfusion. After that, the lumbar spinal cord was harvested for β2AR immunohistochemistry and histopathologic evaluation in the anterior horns. Results The β2AR expression in the anterior horns of the spinal cord was significantly higher in the I/R group than in the sham group. Tarlov scores and the number of viable α-motor neurons were higher in C0.01-C0.5 groups than in the NS group, C0.005 and C1 groups and were highest in the C0.1 group. Hypotension and hyperglycemia were found in the C1 group. Conclusion β2ARs in the anterior horn were upregulated after spinal cord I/R injury. Aortic-infused clenbuterol (0.01–0.5 mg/kg) can attenuate spinal cord I/R injury dose-dependently during the ischemic period. The Optimal dosage was 0.1 mg/kg. Activation of β2AR could be a new therapeutic strategy for the treatment of spinal cord I/R injury.
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Bertone J. Accidental zilpaterol toxicity, food for thought. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Bertone
- College of Veterinary MedicineWestern University of Health Sciences Pomona California USA
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Hepworth‐Warren KL, Alcott CJ. Treatment and resolution of zilpaterol hydrochloride toxicity in a
Q
uarter
H
orse gelding. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. L. Hepworth‐Warren
- Lloyd Veterinary Medical CenterCollege of Veterinary MedicineIowa State University Ames Iowa USA
| | - C. J. Alcott
- Lloyd Veterinary Medical CenterCollege of Veterinary MedicineIowa State University Ames Iowa USA
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Barry AR, Graham MM. Case report and review of clenbuterol cardiac toxicity. J Cardiol Cases 2013; 8:131-133. [PMID: 30546764 DOI: 10.1016/j.jccase.2013.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022] Open
Abstract
Clenbuterol is an oral β2-agonist utilized as an illicit substance for performance-enhancement or weight loss. We report a case of a 23-year-old male who presented with anxiety and chest tightness after intentional ingestion of 5000 μg of clenbuterol (125 times the recommended adult dose) to lose weight. His electrocardiogram showed sinus tachycardia and diffuse nonspecific repolarization abnormalities with mild inferolateral ST-segment depression. Bloodwork revealed a potassium of 2.0 mmol/L, peak lactate of 9.4 mmol/L, and peak troponin of 5.39 μg/L. A transthoracic echocardiogram was normal except for hyperdynamic left ventricular function. He was treated with intravenous fluids and oral metoprolol. His tachycardia and electrocardiogram abnormalities resolved after 48 h. Clenbuterol has gained notoriety in recent years as a drug of abuse and cases of toxicity will likely continue to increase due to its relative attainability and readily accessible online dosing information. Patients often present with agitation, palpitations, tachycardia, hypokalemia, and hyperglycemia. Treatment is supportive with intravenous fluids, β-blockers, and potassium supplementation. <Learning objective: Clenbuterol, an oral β2-agonist, can be utilized as an illicit substance for performance-enhancement or weight loss. Cardiac toxicity and type II myocardial infarction can occur with clenbuterol overdoses. Associated symptoms include agitation, palpitations, tachycardia, hypokalemia, and hyperglycemia. Treatment is supportive primarily with intravenous fluid, β-blockers, and potassium supplementation.>.
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Affiliation(s)
- Arden R Barry
- Pharmacy Services, Mazankowski Alberta Heart Institute, 0G1.01 WMC, 8440 - 112 Street NW, Edmonton, Alberta T6G 2B7, Canada
| | - Michelle M Graham
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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20
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Myocardial Ischemia Associated with Clenbuterol Abuse: Report of Two Cases. J Emerg Med 2013; 44:444-9. [DOI: 10.1016/j.jemermed.2012.02.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 11/30/2011] [Accepted: 02/25/2012] [Indexed: 11/17/2022]
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Drake S, Hansen L, Harris C, Lewis W, Miller E, Moranville B, Blyzka M, Bergen W, McKeever K, Hausman G, Dodson M. Effects of clenbuterol on horses. COMPARATIVE EXERCISE PHYSIOLOGY 2013. [DOI: 10.3920/cep13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Clenbuterol was intended as a treatment for respiratory diseases in horses, but has been used in multiple species, including humans, for its repartitioning of fat to lean effects (free fatty acids are released from adipose tissue to be used by tissues of higher priority). In the horse industry clenbuterol application is restricted to the treatment of chronic obstructive pulmonary disease and reactive airway disease (heaves). Negative effects of clenbuterol exposure include a decrease in maximum oxygen intake and increased muscle fatigue upon exercise. As a result of these and other negative effects, clenbuterol remains strictly controlled by the US Food and Drug Administration.
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Affiliation(s)
- S.D. Drake
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | - L.E. Hansen
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | - C. Harris
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | - W.C. Lewis
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | - E. Miller
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
| | | | | | - W.G. Bergen
- Program in Cellular and Molecular Biosciences/Department of Animal Sciences, Auburn University, Auburn, AL 36849, USA
| | - K.H. McKeever
- Department of Animal Science, Rutgers the State University of New Jersey, New Brunswick, NJ 08901-8525, USA
| | - G.J. Hausman
- Department of Animal Science, University of Georgia, Athens, GA 30602-2771, USA
| | - M.V. Dodson
- Department of Animal Sciences, Washington State University, 139 Clark Hall, Pullman, WA 99164, USA
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Wang L, He L, Wang Z, Wang X, Shu J, Yang J, Zhang G, Zeng Z. Selection of a representative matrix for the multiresidue analysis of nine β-agonists in animal tissues and urine with LC-MS/MS. Analyst 2013; 138:4579-84. [DOI: 10.1039/c3an36806h] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ohnuki Y, Umeki D, Cai W, Kawai N, Mototani Y, Shiozawa K, Jin HL, Fujita T, Tanaka E, Saeki Y, Okumura S. Role of Masseter Muscle β2-Adrenergic Signaling in Regulation of Muscle Activity, Myosin Heavy Chain Transition, and Hypertrophy. J Pharmacol Sci 2013; 123:36-46. [DOI: 10.1254/jphs.12271fp] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Yang LH, Lin HD, Xi QY, Ding JH, Liu XL, Shu G, Jiang QY, Wang XQ, Zhang YL. Polyantibody against β2-adrenergic receptor extracellular domain act as an agonist to this receptor in porcine model. Livest Sci 2012. [DOI: 10.1016/j.livsci.2012.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION With the rise of the obesity epidemic in the United States over the last several decades and the medical complications seen with it, weight loss and dieting have become a national public health concern. DISCUSSION Because of their increased use and availability through internet sales, several different dieting agents were reviewed for potential toxicity. These included: syrup of ipecac, cathartics, human chorionic gonadotropin hormone, 2,4 Dinitrophenol, guar gum, phenylpropanolamine, ma huang/ ephedra, caffeine, clenbuterol, fenfluramine, sibutramine, thyroid hormone, orlistat and cannabinoid antagonists. CONCLUSIONS With the internet making even banned products readily accessible, healthcare providers need to be aware of the potential toxicities of a wide range of weight loss agents. Our review covered topics we thought to be most historically significant as well as pertinent to the practice of medical toxicology today.
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Acute Clenbuterol Induces Hypotension, Atrioventricular Block and Cardiac Asystole in the Rabbit. Cardiovasc Toxicol 2012; 13:85-90. [DOI: 10.1007/s12012-012-9185-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Thompson JA, Eades SC, Chapman AM, Paulsen DB, Barker SA, McConnico RS. Effects of clenbuterol administration on serum biochemical, histologic, and echocardiographic measurements of muscle injury in exercising horses. Am J Vet Res 2012; 73:875-83. [PMID: 22620703 DOI: 10.2460/ajvr.73.6.875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effects of clenbuterol, at a dosage of up to 3.2 μg/kg for 14 days, PO, on skeletal and cardiac muscle in healthy horses undergoing treadmill exercise. ANIMALS 12 healthy horses from 3 to 10 years old. PROCEDURES Horses were randomly assigned to a control group (n = 6) or clenbuterol group (6) and received either saline (0.9% NaCl) solution or clenbuterol, PO, every 12 hours for 14 days. Horses were subjected to submaximal treadmill exercise daily during treatment. Muscle biopsy specimens were collected before and after treatment for determination of apoptosis. Echocardiographic measurements, serum clenbuterol and cardiac troponin I concentrations, and serum activities of creatine kinase and aspartate aminotransferase were measured before, during, and after treatment. Jugular venous blood samples were collected every 3 days during treatment. Echocardiography was repeated every 7 days after beginning treatment. Response variables were compared between treatment groups and across time periods. RESULTS No significant effect of clenbuterol or exercise on response variables was found between treatment and control groups at any time point or within groups over time. CONCLUSIONS AND CLINICAL RELEVANCE Results did not reveal any adverse effects of treatment with an approved dose of clenbuterol on equine cardiac or skeletal muscle in the small number of horses tested.
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Affiliation(s)
- Jessica A Thompson
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803
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Thompson JA, Mirza MH, Barker SA, Morgan TW, Bauer RW, McConnico RS. Clenbuterol toxicosis in three Quarter Horse racehorses after administration of a compounded product. J Am Vet Med Assoc 2011; 239:842-9. [DOI: 10.2460/javma.239.6.842] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Manini A, Labinson RM, Kirrane B, Hoffman RS, Rao R, Stajic M, Nelson LS. A novel neuromuscular syndrome associated with clenbuterol-tainted heroin. Clin Toxicol (Phila) 2010; 46:1088-92. [DOI: 10.1080/15563650802139948] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ryall JG, Lynch GS. The potential and the pitfalls of β-adrenoceptor agonists for the management of skeletal muscle wasting. Pharmacol Ther 2008; 120:219-32. [DOI: 10.1016/j.pharmthera.2008.06.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 06/04/2008] [Indexed: 01/08/2023]
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Dimaano JQ, Burda AM, Korah JE, Wahl M. Street Drugs Possibly Tainted With Clenbuterol. J Emerg Nurs 2008; 34:582-3. [DOI: 10.1016/j.jen.2008.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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A Descriptive Study of an Outbreak of Clenbuterol-Containing Heroin. Ann Emerg Med 2008; 52:548-53. [DOI: 10.1016/j.annemergmed.2008.04.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Revised: 03/16/2008] [Accepted: 04/22/2008] [Indexed: 11/20/2022]
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Ramos BP, Colgan LA, Nou E, Arnsten AF. Beta2 adrenergic agonist, clenbuterol, enhances working memory performance in aging animals. Neurobiol Aging 2008; 29:1060-9. [PMID: 17363115 PMCID: PMC3154024 DOI: 10.1016/j.neurobiolaging.2007.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Revised: 01/29/2007] [Accepted: 02/05/2007] [Indexed: 11/29/2022]
Abstract
Previous studies using a mixed beta1 and beta2 adrenergic antagonist, propanolol, have indicated that beta adrenoceptors have little effect on the cognitive functioning of the prefrontal cortex. However, recent studies have suggested that endogenous stimulation of beta1 adrenoceptors impairs working memory in both rats and monkeys. Since propanolol has no effect on cognition, we hypothesized that activation of beta2 adrenoceptors might improve performance in a working memory task. We tested this hypothesis by observing the effects of the beta2 agonist, clenbuterol, on spatial working memory performance. Clenbuterol was either infused directly into the prefrontal cortex (rats) or administered systemically (monkeys). Results demonstrated that clenbuterol improved performance in many young and aged rats and monkeys who performed poorly under control conditions. Actions at beta2 adrenoceptors were confirmed by challenging the clenbuterol response with the beta2 adrenergic antagonist, ICI 118,551. The effects of clenbuterol were not universal and depended on the cognitive status of the animal: the drug moderately improved only a subset of animals with working memory impairment.
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Affiliation(s)
- Brian P. Ramos
- Yale University School of Medicine, Department of Neurobiology, SHM C-300, 333 Cedar Street, New Haven, CT 06510, USA
| | - Leslie A. Colgan
- Yale University School of Medicine, Department of Neurobiology, SHM C-300, 333 Cedar Street, New Haven, CT 06510, USA
| | - Eric Nou
- Yale University School of Medicine, Department of Neurobiology, SHM C-300, 333 Cedar Street, New Haven, CT 06510, USA
| | - Amy F.T. Arnsten
- Yale University School of Medicine, Department of Neurobiology, SHM C-300, 333 Cedar Street, New Haven, CT 06510, USA
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Daubert GP, Mabasa VH, Leung VWY, Aaron C. Acute clenbuterol overdose resulting in supraventricular tachycardia and atrial fibrillation. J Med Toxicol 2008; 3:56-60. [PMID: 18072161 DOI: 10.1007/bf03160909] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We are presenting a case illustrating the complex metabolic and rhythm disturbances associated with acute clenbuterol intoxication. BACKGROUND Clenbuterol is a long-acting beta2-adrenergic agonist primarily used in veterinary medicine in the United States. It has become a common drug of abuse by body builders because of its reported anabolic and lipolytic properties. In this case report, a body builder using veterinary clenbuterol developed significant electrolyte and cardiac manifestations. CASE REPORT A 31-year-old man presented to the emergency department approximately 30 minutes after ingesting 1.5 ml (a tenfold dosing error) of Ventipulmin syrup (72.5 mcg/ml clenbuterol HCl). The product was brought to the emergency department (ED) by the patient. He reported no current use of anabolic steroids. He presented in an anxious state with complaints of palpitations and shortness of breath. Vital signs upon examination were as follows: BP, 122/77 mmHg (16.3/10.3 kPa); HR 254 bpm; RR, 22 bpm; Temperature, 97.1 degrees F (36 degrees C); and oxygen saturation, 100% on ambient air. His electrocardiogram (ECG) demonstrated supraventricular tachycardia with a ventricular rate of 254 bpm. Esmolol was recommended for rate control after the unsuccessful use of adenosine and diltiazem. Laboratory studies showed potassium, 2.1 mmol/L; magnesium, 1.3 mg/dL (0.54 mmol/L); phosphorus, 1.0 mg/dL (0.32 mmol/L); serum glucose, 209 mg/dL (11.6 mmol/L); creatinine, 0.8 mg/dL (70.7 micromol/L); AST, 20 U/L; ALT, 55 U/L; hemoglobin, 12.6 g/dL (126 g/L); CPK total, 87 U/L; and troponin I, 0.23 mug/L. The patient's urine was negative for any drugs of abuse. Clenbuterol levels were not obtained. A second ECG, 16 hours post ingestion, reflected atrial fibrillation with a ventricular rate of 125 to 147 bpm. On hospital day 3, he was electively cardioverted to sinus rhythm; heart rate and rhythm returned to normal, and he was discharged with oral metoprolol. DISCUSSION Clenbuterol is approved for use in countries outside the U.S. as a bronchodilator for the treatment of acute asthma exacerbations in humans. Although clenbuterol is not a steroid hormone, it possesses anabolic properties that increase muscle mass. Its longer duration of action compared to other beta2-agonists (such as albuterol) make it a desired agent for body-building because of its high and prolonged serum level. The mechanism for the short and long-term cardiovascular complications of clenbuterol is complex. The anabolic effects of clenbuterol are associated with its beta2-adrenoreceptor agonist activity on striated skeletal muscles. In addition, clenbuterol promotes lipolysis through adipocyte beta3-adrenoreceptors. CONCLUSION Considering the significant number of body-building enthusiasts, physicians will continue to encounter clenbuterol abuse in their clinical practices.
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Affiliation(s)
- G Patrick Daubert
- Department of Emergency Medicine, University of California, Davis, Medical Center, Sacramento, CA 95817, USA.
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Nury D, Doucet C, Coux O. Roles and potential therapeutic targets of the ubiquitin proteasome system in muscle wasting. BMC BIOCHEMISTRY 2007; 8 Suppl 1:S7. [PMID: 18047744 PMCID: PMC2106371 DOI: 10.1186/1471-2091-8-s1-s7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Muscle wasting, characterized by the loss of protein mass in myofibers, is in most cases largely due to the activation of intracellular protein degradation by the ubiquitin proteasome system (UPS). During the last decade, mechanisms contributing to this activation have been unraveled and key mediators of this process identified. Even though much remains to be understood, the available information already suggests screens for new compounds inhibiting these mechanisms and highlights the potential for pharmaceutical drugs able to treat muscle wasting when it becomes deleterious. This review presents an overview of the main pathways contributing to UPS activation in muscle and describes the present state of efforts made to develop new strategies aimed at blocking or slowing muscle wasting. Publication history: Republished from Current BioData's Targeted Proteins database (TPdb; ).
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Affiliation(s)
- David Nury
- CRBM-CNRS UMR5237, IFR22, 1919 route de Mende, 34000 Montpellier, France.
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Pompeo A, Nepa A, Maddestra M, Feliziani V, Genovesi N. Thyrotoxic hypokalemic periodic paralysis: An overlooked pathology in western countries. Eur J Intern Med 2007; 18:380-90. [PMID: 17693226 DOI: 10.1016/j.ejim.2007.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 03/12/2007] [Accepted: 03/16/2007] [Indexed: 11/26/2022]
Abstract
Thyrotoxic hypokalemic periodic paralysis (THPP) is a complication of hyperthyroidism that is mostly diagnosed in Asian populations; consequently, it can be difficult to recognize in western populations. THPP represents an endocrine emergency that can result in respiratory insufficiency, cardiac arrhythmias, and death. Its differential diagnosis from the other more common forms of hypokalemic paralysis is important to avoid inappropriate therapy. Here, we discuss the main pathogenetic hypotheses, clinical features, and therapies of this disease. We also report an example of THPP management in our primary care unit.
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Affiliation(s)
- Arsenio Pompeo
- Division of Internal Medicine, "Floraspe Renzetti" Hospital, A.S.L. 103 Lanciano-Vasto, via del Mare, 1. 66034 Lanciano (Ch), Italy
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Schechter E, Hoffman RS, Stajic M, McGee MP, Cuevas S, Tarabar A. Pulmonary edema and respiratory failure associated with clenbuterol exposure. Am J Emerg Med 2007; 25:735.e1-3. [PMID: 17606110 DOI: 10.1016/j.ajem.2006.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Accepted: 12/24/2006] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elissa Schechter
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Mazzanti G, Di Sotto A, Daniele C, Battinelli L, Brambilla G, Fiori M, Loizzo S, Loizzo A. A pharmacodynamic study on clenbuterol-induced toxicity: beta1- and beta2-adrenoceptors involvement in guinea-pig tachycardia in an in vitro model. Food Chem Toxicol 2007; 45:1694-9. [PMID: 17449161 DOI: 10.1016/j.fct.2007.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 02/21/2007] [Accepted: 03/05/2007] [Indexed: 11/27/2022]
Abstract
Beta(2)-receptor adrenergic agonists as clenbuterol and analogues are illegally used as growth promoters in cattle, in Europe, as well as in other countries. Following consumption of meat or liver, intoxication cases were described, and cardiovascular toxic effects (tachycardia, hypertension) were of clinical relevance. Therefore, we investigated whether heart rate increase induced by clenbuterol could depend upon stimulation of beta(1)- and/or beta(2)-adrenergic receptors, and in which ratio. We used in vitro guinea-pig atria, a model in which beta(1)-/beta(2)-receptors ratio is similar to that found in men. In our experiments both beta(1)- and beta(2)-receptors contributed to clenbuterol-induced heart rate increase, but with a different potency. The selective beta(2)-antagonist ICI-118,551 competitively antagonized responses to clenbuterol with high affinity (pA(2) 9.47+/-0.28, SchildSlope 0.98+/-0.20 not significantly different from unity, K(B) 0.34 nM). The selective beta(1)-antagonist atenolol antagonized clenbuterol with a relatively lower affinity (pA(2)=7.59+/-0.14), the SchildSlope=1.97+/-0.33 was significantly different from unity (P<0.05). Results show that clenbuterol stimulates guinea-pig heart rate by acting chiefly on beta(2)-adrenoceptor, although responses to clenbuterol apparently are mediated by an inter-play between both beta-adrenoceptors. Further experiments are necessary to understand which beta-adrenergic antagonists are of effectiveness to counteract cardiovascular effects in case of intoxication following clenbuterol, or other beta-adrenergic stimulants.
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Affiliation(s)
- Gabriela Mazzanti
- Department of Human Physiology and Pharmacology, University La Sapienza, P.le Aldo Moro, 5-00185 Rome, Italy
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Barbosa J, Cruz C, Martins J, Silva JM, Neves C, Alves C, Ramos F, Da Silveira MIN. Food poisoning by clenbuterol in Portugal. ACTA ACUST UNITED AC 2005; 22:563-6. [PMID: 16019830 DOI: 10.1080/02652030500135102] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper describes the occurrence of four cases of acute food poisoning, involving a total of 50 people, due to the ingestion of lamb and bovine meat containing residues of clenbuterol. Symptoms shown by the intoxicated people may be generally described as gross tremors of the extremities, tachycardia, nausea, headaches and dizziness. Analytical methodology developed for the determination of clenbuterol in meat, liver and blood samples is described. Procedures are described which should be followed when the described symptoms are evident in a group of people who have ingested contaminated meat, and particularly liver of ruminants.
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Affiliation(s)
- Jorge Barbosa
- Laboratório Nacional de Investigação Veterinária, Lisboa, Portugal
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Abstract
A case of non-Q myocardial infarction in a previously healthy 17-year-old body builder, who used clenbuterol, a long-acting beta(2) adrenergic agonist with anabolic and lipolytic effects, is reported. Only 1 case report of myocardial infarction associated with the use of clenbuterol was found in a literature review and that case was, however, associated with anabolic steroid use. This is the first case report to describe myocardial infarction in a young male body builder only taking clenbuterol.
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Affiliation(s)
- Beata Kierzkowska
- Department of Paediatric Cardiology, Institute of Paediatrics, Medical University Łodź, Poland
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Busquets S, Figueras MT, Fuster G, Almendro V, Moore-Carrasco R, Ametller E, Argilés JM, López-Soriano FJ. Anticachectic effects of formoterol: a drug for potential treatment of muscle wasting. Cancer Res 2004; 64:6725-31. [PMID: 15374990 DOI: 10.1158/0008-5472.can-04-0425] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In cancer cachexia both cardiac and skeletal muscle suffer an important protein mobilization as a result of increased proteolysis. Administration of the beta2-agonist formoterol to both rats and mice bearing highly cachectic tumors resulted in an important reversal of the muscle-wasting process. The anti-wasting effects of the drug were based on both an activation of the rate of protein synthesis and an inhibition of the rate of muscle proteolysis. Northern blot analysis revealed that formoterol treatment resulted in a decrease in the mRNA content of ubiquitin and proteasome subunits in gastrocnemius muscles; this, together with the decreased proteasome activity observed, suggest that the main anti-proteolytic action of the drug may be based on an inhibition of the ATP-ubiquitin-dependent proteolytic system. Interestingly, the beta2-agonist was also able to diminish the increased rate of muscle apoptosis (measured as DNA laddering as well as caspase-3 activity) present in tumor-bearing animals. The present results indicate that formoterol exerted a selective, powerful protective action on heart and skeletal muscle by antagonizing the enhanced protein degradation that characterizes cancer cachexia, and it could be revealed as a potential therapeutic tool in pathologic states wherein muscle protein hypercatabolism is a critical feature such as cancer cachexia or other wasting diseases.
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MESH Headings
- Adrenergic beta-Agonists/pharmacology
- Animals
- Cachexia/drug therapy
- Cachexia/metabolism
- Cachexia/pathology
- Carcinoma, Lewis Lung/metabolism
- Carcinoma, Lewis Lung/pathology
- Disease Models, Animal
- Eating/drug effects
- Ethanolamines/pharmacology
- Formoterol Fumarate
- Liver Neoplasms, Experimental/metabolism
- Liver Neoplasms, Experimental/pathology
- Male
- Mice
- Mice, Inbred C57BL
- Muscle Proteins/metabolism
- Muscle, Skeletal/drug effects
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/pathology
- Neoplasms, Experimental/metabolism
- Neoplasms, Experimental/pathology
- Rats
- Rats, Wistar
- Sarcoma, Yoshida/metabolism
- Sarcoma, Yoshida/pathology
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Affiliation(s)
- Sílvia Busquets
- Cancer Research Group, Departament de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
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Lakie MD, Hayes NR, Combes N, Langford N. Is postural tremor size controlled by interstitial potassium concentration in muscle? J Neurol Neurosurg Psychiatry 2004; 75:1013-8. [PMID: 15201362 PMCID: PMC1739132 DOI: 10.1136/jnnp.2003.022749] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether factors associated with postural tremor operate by altering muscle interstitial K(+). METHODS An experimental approach was used to investigate the effects of procedures designed to increase or decrease interstitial K(+). Postural physiological tremor was measured by conventional means. Brief periods of ischaemic muscle activity were used to increase muscle interstitial K(+). Infusion of the beta(2) agonist terbutaline was used to decrease plasma (and interstitial) K(+). Blood samples were taken for the determination of plasma K(+). RESULTS Ischaemia rapidly reduced tremor size, but only when the muscle was active. The beta(2) agonist produced a slow and progressive rise in tremor size that was almost exactly mirrored by a slow and progressive decrease in plasma K(+). CONCLUSIONS Ischaemic reduction of postural tremor has been attributed to effects on muscle spindles or an unexplained effect on muscle. This study showed that ischaemia did not reduce tremor size unless there was accompanying muscular activity. An accumulation of K(+) in the interstitium of the ischaemic active muscle may blunt the response of the muscle and reduce its fusion frequency, so that the force output becomes less pulsatile and tremor size decreases. When a beta(2) agonist is infused, the rise in tremor mirrors the resultant decrease in plasma K(+). Decreased plasma K(+) reduces interstitial K(+) concentration and may produce greater muscular force fluctuation (more tremor). Many other factors that affect postural tremor size may exert their effect by altering plasma K(+) concentration, thereby changing the concentration of K(+) in the interstitial fluid.
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Affiliation(s)
- M D Lakie
- Applied Physiology Research Group, School of Sport and Exercise Sciences, University of Birmingham, Birmingham, UK.
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Mazzanti G, Daniele C, Boatto G, Manca G, Brambilla G, Loizzo A. New beta-adrenergic agonists used illicitly as growth promoters in animal breeding: chemical and pharmacodynamic studies. Toxicology 2003; 187:91-9. [PMID: 12699899 DOI: 10.1016/s0300-483x(03)00059-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Clenbuterol and beta-adrenergic receptor agonist drugs are illegally used as growth promoters in animal production. Pharmacologically active residues in edible tissues led to intoxication outbreaks in several countries. Pressure of official controls pulsed synthesis of new compounds to escape analytical procedures. We report two new compounds named 'A' and 'G4', found in feeding stuffs. Chemical structure was studied through nuclear magnetic resonance-imaging and infrared spectroscopy, and beta(1)- and beta(2)-adrenergic activity was evaluated on isolated guinea-pig atrium and trachea in comparison with clenbuterol. Both compounds share with clenbuterol an halogenated aromatic ring with a primary amino group. Main modifications consisted of substitution of secondary amino group with an alkyl chain in compound A and substitution of the ter-butyl group with a benzene ring in compound G4. In guinea-pig trachea these compounds showed myorelaxant potency lower than clenbuterol (EC(50) was 43.8 nM for clenbuterol, 11700 nM for compound A, 2140 nM for G4). On the contrary, in the guinea-pig atrium (heart-beat rate stimulant effect) the compounds were more potent than clenbuterol (EC(50) was 15.2 nM for clenbuterol, 3.4 nM for compound A, 2.8 nM for G4). These pharmacodynamic properties, and stronger lipophilic properties shown by the two compounds may result in increased cardiovascular risk for consumers of illicitly treated animals.
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Affiliation(s)
- Gabriela Mazzanti
- Dipartimento di Farmacologia delle Sostanze Naturali e Fisiologia Generale, University of Roma La Sapienza, P.zale Aldo Moro, Italy.
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