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Rakotoarivelo V, Mayer TZ, Simard M, Flamand N, Di Marzo V. The Impact of the CB 2 Cannabinoid Receptor in Inflammatory Diseases: An Update. Molecules 2024; 29:3381. [PMID: 39064959 PMCID: PMC11279428 DOI: 10.3390/molecules29143381] [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: 06/18/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
The emergence of inflammatory diseases is a heavy burden on modern societies. Cannabis has been used for several millennia to treat inflammatory disorders such as rheumatism or gout. Since the characterization of cannabinoid receptors, CB1 and CB2, the potential of cannabinoid pharmacotherapy in inflammatory conditions has received great interest. Several studies have identified the importance of these receptors in immune cell migration and in the production of inflammatory mediators. As the presence of the CB2 receptor was documented to be more predominant in immune cells, several pharmacological agonists and antagonists have been designed to treat inflammation. To better define the potential of the CB2 receptor, three online databases, PubMed, Google Scholar and clinicaltrial.gov, were searched without language restriction. The full texts of articles presenting data on the endocannabinoid system, the CB2 receptor and its role in modulating inflammation in vitro, in animal models and in the context of clinical trials were reviewed. Finally, we discuss the clinical potential of the latest cannabinoid-based therapies in inflammatory diseases.
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Affiliation(s)
- Volatiana Rakotoarivelo
- Centre de Recherche de l’Institut Universitaire De Cardiologie Et De Pneumologie de Québec, Département of Médecine, Université Laval, Québec City, QC G1V 4G5, Canada
- Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND), Université Laval, Québec City, QC G1V 0V6, Canada
| | - Thomas Z. Mayer
- Centre de Recherche de l’Institut Universitaire De Cardiologie Et De Pneumologie de Québec, Département of Médecine, Université Laval, Québec City, QC G1V 4G5, Canada
- Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND), Université Laval, Québec City, QC G1V 0V6, Canada
- Institut sur la Nutrition et les Aliments Fonctionnels, and Centre NUTRISS, École de Nutrition, Université Laval, Québec City, QC G1V 0V6, Canada
| | - Mélissa Simard
- Centre de Recherche de l’Institut Universitaire De Cardiologie Et De Pneumologie de Québec, Département of Médecine, Université Laval, Québec City, QC G1V 4G5, Canada
- Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND), Université Laval, Québec City, QC G1V 0V6, Canada
| | - Nicolas Flamand
- Centre de Recherche de l’Institut Universitaire De Cardiologie Et De Pneumologie de Québec, Département of Médecine, Université Laval, Québec City, QC G1V 4G5, Canada
- Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND), Université Laval, Québec City, QC G1V 0V6, Canada
| | - Vincenzo Di Marzo
- Centre de Recherche de l’Institut Universitaire De Cardiologie Et De Pneumologie de Québec, Département of Médecine, Université Laval, Québec City, QC G1V 4G5, Canada
- Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND), Université Laval, Québec City, QC G1V 0V6, Canada
- Institut sur la Nutrition et les Aliments Fonctionnels, and Centre NUTRISS, École de Nutrition, Université Laval, Québec City, QC G1V 0V6, Canada
- Joint International Unit between the CNR of Italy and Université Laval on Chemical and Biomolecular Research on the Microbiome and Its Impact on Metabolic Health and Nutrition (UMI-MicroMeNu), Québec City, QC G1V 0V6, Canada
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Cretu B, Zamfir A, Bucurica S, Scheau AE, Savulescu Fiedler I, Caruntu C, Caruntu A, Scheau C. Role of Cannabinoids in Oral Cancer. Int J Mol Sci 2024; 25:969. [PMID: 38256042 PMCID: PMC10815457 DOI: 10.3390/ijms25020969] [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: 11/29/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Cannabinoids have incited scientific interest in different conditions, including malignancy, due to increased exposure to cannabis. Furthermore, cannabinoids are increasingly used to alleviate cancer-related symptoms. This review paper aims to clarify the recent findings on the relationship between cannabinoids and oral cancer, focusing on the molecular mechanisms that could link cannabinoids with oral cancer pathogenesis. In addition, we provide an overview of the current and future perspectives on the management of oral cancer patients using cannabinoid compounds. Epidemiological data on cannabis use and oral cancer development are conflicting. However, in vitro studies assessing the effects of cannabinoids on oral cancer cells have unveiled promising anti-cancer features, including apoptosis and inhibition of cell proliferation. Downregulation of various signaling pathways with anti-cancer effects has been identified in experimental models of oral cancer cells exposed to cannabinoids. Furthermore, in some countries, several synthetic or phytocannabinoids have been approved as medical adjuvants for the management of cancer patients undergoing chemoradiotherapy. Cannabinoids may improve overall well-being by relieving anxiety, depression, pain, and nausea. In conclusion, the link between cannabinoid compounds and oral cancer is complex, and further research is necessary to elucidate the potential risks or their protective impact on oral cancer.
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Affiliation(s)
- Brigitte Cretu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (B.C.); (A.Z.)
| | - Alexandra Zamfir
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (B.C.); (A.Z.)
| | - Sandica Bucurica
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Gastroenterology, “Carol Davila” University Central Emergency Military Hospital, 010825 Bucharest, Romania
| | - Andreea Elena Scheau
- Department of Radiology and Medical Imaging, Fundeni Clinical Institute, 022328 Bucharest, Romania;
| | - Ilinca Savulescu Fiedler
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine and Cardiology, Coltea Clinical Hospital, 030167 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.)
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (B.C.); (A.Z.)
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
| | - Cristian Scheau
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.)
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Bhat TA, Kalathil SG, Goniewicz ML, Hutson A, Thanavala Y. Not all vaping is the same: differential pulmonary effects of vaping cannabidiol versus nicotine. Thorax 2023; 78:922-932. [PMID: 36823163 PMCID: PMC10447384 DOI: 10.1136/thorax-2022-218743] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
RATIONALE Vaping has become a popular method of inhaling various psychoactive substances. While evaluating respiratory effects of vaping have primarily focused on nicotine-containing products, cannabidiol (CBD)-vaping is increasingly becoming popular. It currently remains unknown whether the health effects of vaping nicotine and cannabinoids are similar. OBJECTIVES This study compares side by side the pulmonary effects of acute inhalation of vaporised CBD versus nicotine. METHODS In vivo inhalation study in mice and in vitro cytotoxicity experiments with human cells were performed to assess the pulmonary damage-inducing effects of CBD or nicotine aerosols emitted from vaping devices. MEASUREMENTS AND MAIN RESULTS Pulmonary inflammation in mice was scored by histology, flow cytometry, and quantifying levels of proinflammatory cytokines and chemokines. Lung damage was assessed by histology, measurement of myeloperoxidase activity and neutrophil elastase levels in the bronchoalveolar lavage fluid and lung tissue. Lung epithelial/endothelial integrity was assessed by quantifying BAL protein levels, albumin leak and pulmonary FITC-dextran leak. Oxidative stress was determined by measuring the antioxidant potential in the BAL and lungs. The cytotoxic effects of CBD and nicotine aerosols on human neutrophils and human small airway epithelial cells were evaluated using in vitro air-liquid interface system. Inhalation of CBD aerosol resulted in greater inflammatory changes, more severe lung damage and higher oxidative stress compared with nicotine. CBD aerosol also showed higher toxicity to human cells compared with nicotine. CONCLUSIONS Vaping of CBD induces a potent inflammatory response and leads to more pathological changes associated with lung injury than vaping of nicotine.
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Affiliation(s)
- Tariq A Bhat
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Suresh G Kalathil
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Alan Hutson
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Yasmin Thanavala
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Preteroti M, Wilson ET, Eidelman DH, Baglole CJ. Modulation of pulmonary immune function by inhaled cannabis products and consequences for lung disease. Respir Res 2023; 24:95. [PMID: 36978106 PMCID: PMC10043545 DOI: 10.1186/s12931-023-02399-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
The lungs, in addition to participating in gas exchange, represent the first line of defense against inhaled pathogens and respiratory toxicants. Cells lining the airways and alveoli include epithelial cells and alveolar macrophages, the latter being resident innate immune cells important in surfactant recycling, protection against bacterial invasion and modulation of lung immune homeostasis. Environmental exposure to toxicants found in cigarette smoke, air pollution and cannabis can alter the number and function of immune cells in the lungs. Cannabis (marijuana) is a plant-derived product that is typically inhaled in the form of smoke from a joint. However, alternative delivery methods such as vaping, which heats the plant without combustion, are becoming more common. Cannabis use has increased in recent years, coinciding with more countries legalizing cannabis for both recreational and medicinal purposes. Cannabis may have numerous health benefits owing to the presence of cannabinoids that dampen immune function and therefore tame inflammation that is associated with chronic diseases such as arthritis. The health effects that could come with cannabis use remain poorly understood, particularly inhaled cannabis products that may directly impact the pulmonary immune system. Herein, we first describe the bioactive phytochemicals present in cannabis, with an emphasis on cannabinoids and their ability to interact with the endocannabinoid system. We also review the current state-of-knowledge as to how inhaled cannabis/cannabinoids can shape immune response in the lungs and discuss the potential consequences of altered pulmonary immunity. Overall, more research is needed to understand how cannabis inhalation shapes the pulmonary immune response to balance physiological and beneficial responses with potential deleterious consequences on the lungs.
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Affiliation(s)
- Matthew Preteroti
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Emily T Wilson
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - David H Eidelman
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Carolyn J Baglole
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada.
- Department of Pathology, McGill University, Montreal, QC, Canada.
- Department of Medicine, McGill University, Montreal, QC, Canada.
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.
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5
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Herrera-Imbroda J, Flores-López M, Ruiz-Sastre P, Gómez-Sánchez-Lafuente C, Bordallo-Aragón A, Rodríguez de Fonseca F, Mayoral-Cleríes F. The Inflammatory Signals Associated with Psychosis: Impact of Comorbid Drug Abuse. Biomedicines 2023; 11:biomedicines11020454. [PMID: 36830990 PMCID: PMC9953424 DOI: 10.3390/biomedicines11020454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Psychosis and substance use disorders are two diagnostic categories whose association has been studied for decades. In addition, both psychosis spectrum disorders and drug abuse have recently been linked to multiple pro-inflammatory changes in the central nervous system. We have carried out a narrative review of the literature through a holistic approach. We used PubMed as our search engine. We included in the review all relevant studies looking at pro-inflammatory changes in psychotic disorders and substance use disorders. We found that there are multiple studies that relate various pro-inflammatory lipids and proteins with psychosis and substance use disorders, with an overlap between the two. The main findings involve inflammatory mediators such as cytokines, chemokines, endocannabinoids, eicosanoids, lysophospholipds and/or bacterial products. Many of these findings are present in different phases of psychosis and in substance use disorders such as cannabis, cocaine, methamphetamines, alcohol and nicotine. Psychosis and substance use disorders may have a common origin in an abnormal neurodevelopment caused, among other factors, by a neuroinflammatory process. A possible convergent pathway is that which interrelates the transcriptional factors NFκB and PPARγ. This may have future clinical implications.
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Affiliation(s)
- Jesús Herrera-Imbroda
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Facultad de Medicina, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
| | - María Flores-López
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Facultad de Psicología, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
| | - Paloma Ruiz-Sastre
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Facultad de Medicina, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
- Correspondence: (P.R.-S.); (C.G.-S.-L.)
| | - Carlos Gómez-Sánchez-Lafuente
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Facultad de Psicología, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
- Correspondence: (P.R.-S.); (C.G.-S.-L.)
| | - Antonio Bordallo-Aragón
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Fernando Rodríguez de Fonseca
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Fermín Mayoral-Cleríes
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
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Nayak AP, Loblundo C, Bielory L. Immunomodulatory Actions of Cannabinoids: Clinical Correlates and Therapeutic Opportunities for Allergic Inflammation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:449-457. [PMID: 36280137 PMCID: PMC9918686 DOI: 10.1016/j.jaip.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
Endogenously produced cannabinoids as well as phytocannabinoids broadly exhibit anti-inflammatory actions. Recent emergence of cannabis for multiple medical issues combined with reports on potent immunomodulatory actions of distinct components has underscored the therapeutic potential of cannabis. Although synthetic cannabinoids that are based on structural similarities to the existing class of cannabinoids have been on the rise, their application in therapeutics have been limited owing to toxicity concerns. Herein, we review the current literature that details the immunomodulatory actions of cannabinoids. Further, we highlight the complexities of cannabinoid biology and examine the potential inflammatory risks associated with the use of cannabis including potential for toxic interactions between distinct constituents of cannabis.
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Affiliation(s)
- Ajay P Nayak
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine; Division of Pulmonary Allergy and Critical Care Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, Pa.
| | - Cali Loblundo
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine; Division of Pulmonary Allergy and Critical Care Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, Pa
| | - Leonard Bielory
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pa; Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ; Rutgers University Center for Environmental Prediction, New Brunswick, NJ; Center for Aerobiological Research, Kean University, Union, NJ.
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7
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Wiese BM, Alvarez Reyes A, Vanderah TW, Largent-Milnes TM. The endocannabinoid system and breathing. Front Neurosci 2023; 17:1126004. [PMID: 37144090 PMCID: PMC10153446 DOI: 10.3389/fnins.2023.1126004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/16/2023] [Indexed: 05/06/2023] Open
Abstract
Recent changes in cannabis accessibility have provided adjunct therapies for patients across numerous disease states and highlights the urgency in understanding how cannabinoids and the endocannabinoid (EC) system interact with other physiological structures. The EC system plays a critical and modulatory role in respiratory homeostasis and pulmonary functionality. Respiratory control begins in the brainstem without peripheral input, and coordinates the preBötzinger complex, a component of the ventral respiratory group that interacts with the dorsal respiratory group to synchronize burstlet activity and drive inspiration. An additional rhythm generator: the retrotrapezoid nucleus/parafacial respiratory group drives active expiration during conditions of exercise or high CO2. Combined with the feedback information from the periphery: through chemo- and baroreceptors including the carotid bodies, the cranial nerves, stretch of the diaphragm and intercostal muscles, lung tissue, and immune cells, and the cranial nerves, our respiratory system can fine tune motor outputs that ensure we have the oxygen necessary to survive and can expel the CO2 waste we produce, and every aspect of this process can be influenced by the EC system. The expansion in cannabis access and potential therapeutic benefits, it is essential that investigations continue to uncover the underpinnings and mechanistic workings of the EC system. It is imperative to understand the impact cannabis, and exogenous cannabinoids have on these physiological systems, and how some of these compounds can mitigate respiratory depression when combined with opioids or other medicinal therapies. This review highlights the respiratory system from the perspective of central versus peripheral respiratory functionality and how these behaviors can be influenced by the EC system. This review will summarize the literature available on organic and synthetic cannabinoids in breathing and how that has shaped our understanding of the role of the EC system in respiratory homeostasis. Finally, we look at some potential future therapeutic applications the EC system has to offer for the treatment of respiratory diseases and a possible role in expanding the safety profile of opioid therapies while preventing future opioid overdose fatalities that result from respiratory arrest or persistent apnea.
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Affiliation(s)
- Beth M. Wiese
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
| | - Angelica Alvarez Reyes
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Todd W. Vanderah
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
| | - Tally M. Largent-Milnes
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
- *Correspondence: Tally M. Largent-Milnes,
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8
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Sharma P, Mathews DB, Nguyen QA, Rossmann GL, A Patten C, Hammond CJ. Old Dog, New Tricks: A Review of Identifying and Addressing Youth Cannabis Vaping in the Pediatric Clinical Setting. Clin Med Insights Pediatr 2023; 17:11795565231162297. [PMID: 36993933 PMCID: PMC10041590 DOI: 10.1177/11795565231162297] [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: 09/01/2022] [Accepted: 02/20/2023] [Indexed: 03/31/2023] Open
Abstract
Cannabis vaping has emerged as a predominant mode of cannabis use among United States (US) adolescents and young adults (AYA) primarily due to the popularity of modifiable designs of vaping devices coupled with changes in cannabis policies and increased availability of cannabinoid products. New methods for cannabis vaping by e-liquid/oil vaping, dry plant vaping, and cannabis concentrate vaping (ie, dabbing) have had high uptake among American youth with unclear long-term health implications. Issues with contamination, mislabeling, and expansion of the vaped cannabis market to include not only delta-9-tetrahydrocannabinol (delta-9-THC) and cannabidiol (CBD) but also delta-9-THC analogs (eg, delta-8 and delta-10) sold as hemp-derived "legal highs" further complicated this healthcare space. Recent research suggests that cannabis/THC vaping carries distinct and overlapping risks when compared to cannabis smoking and may be associated with greater risk for acute lung injuries, seizures, and acute psychiatric symptoms. Primary care clinicians providing care for AYA are in an ideal position to identify cannabis misuse and intervene early to address cannabis vaping. To improve public health outcomes, a need exists for pediatric clinicians to be educated about different ways/methods that youth are vaping cannabinoid products and associated risks related to cannabinoid vaping. Further, pediatric clinicians need to be trained how to effectively screen for and discuss cannabis vaping with their youth patients. In the current article, we present a clinically focused review of cannabis vaping among young people with 3 main aims to: (1) identify and describe the cannabis vaping products commonly used by American youth; (2) review the health correlates of youth cannabis vaping; and (3) discuss clinical considerations related to identifying and treating youth who vape cannabis.
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Affiliation(s)
- Pravesh Sharma
- Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Division of Child and Adolescent Psychiatry, Mayo Clinic Health System, Eau Claire, WI, USA
- Pravesh Sharma, Department of Psychiatry and Psychology, Division of Child and Adolescent Psychiatry, Mayo Clinic Health System, 1221 Whipple St., Eau Claire, WI 54703, USA.
| | | | - Quang Anh Nguyen
- Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
| | | | - Christi A Patten
- Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
| | - Christopher J Hammond
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
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9
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Stolz D, Mkorombindo T, Schumann DM, Agusti A, Ash SY, Bafadhel M, Bai C, Chalmers JD, Criner GJ, Dharmage SC, Franssen FME, Frey U, Han M, Hansel NN, Hawkins NM, Kalhan R, Konigshoff M, Ko FW, Parekh TM, Powell P, Rutten-van Mölken M, Simpson J, Sin DD, Song Y, Suki B, Troosters T, Washko GR, Welte T, Dransfield MT. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet 2022; 400:921-972. [PMID: 36075255 PMCID: PMC11260396 DOI: 10.1016/s0140-6736(22)01273-9] [Citation(s) in RCA: 202] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022]
Abstract
Despite substantial progress in reducing the global impact of many non-communicable diseases, including heart disease and cancer, morbidity and mortality due to chronic respiratory disease continues to increase. This increase is driven primarily by the growing burden of chronic obstructive pulmonary disease (COPD), and has occurred despite the identification of cigarette smoking as the major risk factor for the disease more than 50 years ago. Many factors have contributed to what must now be considered a public health emergency: failure to limit the sale and consumption of tobacco products, unchecked exposure to environmental pollutants across the life course, and the ageing of the global population (partly as a result of improved outcomes for other conditions). Additionally, despite the heterogeneity of COPD, diagnostic approaches have not changed in decades and rely almost exclusively on post-bronchodilator spirometry, which is insensitive for early pathological changes, underused, often misinterpreted, and not predictive of symptoms. Furthermore, guidelines recommend only simplistic disease classification strategies, resulting in the same therapeutic approach for patients with widely differing conditions that are almost certainly driven by variable pathophysiological mechanisms. And, compared with other diseases with similar or less morbidity and mortality, the investment of financial and intellectual resources from both the public and private sector to advance understanding of COPD, reduce exposure to known risks, and develop new therapeutics has been woefully inadequate.
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Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Alvar Agusti
- Respiratory Institute-Hospital Clinic, University of Barcelona IDIBAPS, CIBERES, Barcelona, Spain
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global health, University of Melbourne, Melbourne, VIC, Australia
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
| | - MeiLan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Kalhan
- Department of Preventive Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Konigshoff
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fanny W Ko
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Trisha M Parekh
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jodie Simpson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Don D Sin
- Centre for Heart Lung Innovation and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Respiratory Research Institute, Shanghai, China; Jinshan Hospital of Fudan University, Shanghai, China
| | - Bela Suki
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
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10
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Tashkin DP, Tan WC. Inhaled Marijuana and the Lung. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2822-2829. [PMID: 35609784 DOI: 10.1016/j.jaip.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Although vaping has recently increased as a mode of inhaling marijuana and has been associated with numerous and sometimes fatal cases of acute severe lung injury, smoking remains the most common method of inhaling marijuana and has been studied more extensively. Smoking marijuana has been shown to produce modest but significant short-term bronchodilation both in healthy subjects and those with asthma. Long-term effects of habitual marijuana smoking include the following: 1) symptoms of chronic bronchitis (increased cough, sputum production and wheezing); 2) modest effects on lung function in cross-sectional studies (no significant decrease in forced expired volume in 1 second [FEV1) but mild reductions in FEV1/forced vital capacity ratio [FEV1/FVC], an increase in FVC and other lung volumes, reductions in specific airway conductance, and variable effects of maximal mid-expiratory flow rates and diffusing capacity; and 3) variable effects on age-related decline in FEV1 in longitudinal studies. Most cohort and case-control studies have failed to show that marijuana smoking is a significant risk-factor for lung cancer despite the presence of pro-carcinogenic components in marijuana smoke, although further study is warranted. The question whether marijuana smoking is associated with asthma is unclear and requires further investigation. Although delta-9 tetrahydrocannabinol (THC), the principal psychoactive component of marijuana, has immunomodulatory properties that hypothetically could increase the risk of pneumonia, the few available studies in marijuana smokers have failed to find an increased risk of pneumonia in immunocompetent users, although effects in immunosuppressed individuals have been variable.
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Affiliation(s)
- Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA Health Sciences, Los Angeles, CA 90095, USA
| | - Wan-Cheng Tan
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, V6Z 1Y6, Canada
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11
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Zhao X, Zhang F, Kandel SR, Brau F, He JJ. HIV Tat and cocaine interactively alter genome-wide DNA methylation and gene expression and exacerbate learning and memory impairments. Cell Rep 2022; 39:110765. [PMID: 35508123 PMCID: PMC9615417 DOI: 10.1016/j.celrep.2022.110765] [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: 11/28/2021] [Revised: 03/16/2022] [Accepted: 04/07/2022] [Indexed: 11/03/2022] Open
Abstract
Cocaine use is a major comorbidity of HIV-associated neurocognitive disorder (HAND). In this study, we show that cocaine exposure worsens the learning and memory of doxycycline-inducible and brain-specific HIV Tat transgenic mice (iTat) and results in 14,838 hypermethylated CpG-related differentially methylated regions (DMRs) and 15,800 hypomethylated CpG-related DMRs, which are linked to 52 down- and 127 upregulated genes, respectively, in the hippocampus of iTat mice. These genes are mostly enriched at the neuronal function-, cell morphology-, and synapse formation-related extracellular matrix (ECM) receptor-ligand interaction pathway and mostly impacted in microglia. The accompanying neuropathological changes include swollen dendritic spines, increased synaptophysin expression, and diminished glial activation. We also find that sex (female) and age additively worsen the behavioral and pathological changes. These findings together indicate that chronic cocaine and long-term Tat expression interactively contribute to HAND, likely involving changes of DNA methylation and ECM receptor-ligand interactions.
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Affiliation(s)
- Xiaojie Zhao
- Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University, North Chicago, IL 60064, USA; Center for Cancer Cell Biology, Immunology and Infection, Rosalind Franklin University, North Chicago, IL 60064, USA; School of Graduate and Postdoctoral Studies, Rosalind Franklin University, North Chicago, IL 60064, USA
| | - Fan Zhang
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Suresh R Kandel
- Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University, North Chicago, IL 60064, USA; Center for Cancer Cell Biology, Immunology and Infection, Rosalind Franklin University, North Chicago, IL 60064, USA
| | - Frédéric Brau
- Université Côte d'Azur, CNRS, IPMC, Sophia-Antipolis 06560, France
| | - Johnny J He
- Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University, North Chicago, IL 60064, USA; Center for Cancer Cell Biology, Immunology and Infection, Rosalind Franklin University, North Chicago, IL 60064, USA; School of Graduate and Postdoctoral Studies, Rosalind Franklin University, North Chicago, IL 60064, USA.
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12
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Vozoris NT, Zhu J, Ryan CM, Chow CW, To T. Cannabis use and risks of respiratory and all-cause morbidity and mortality: a population-based, data-linkage, cohort study. BMJ Open Respir Res 2022; 9:9/1/e001216. [PMID: 35760496 PMCID: PMC9240874 DOI: 10.1136/bmjresp-2022-001216] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/30/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Although cannabis is frequently used worldwide, its impact on respiratory health is characterised by controversy. OBJECTIVE To evaluate the association between cannabis use and respiratory-related emergency room (ER) visits and hospitalisations. METHODS A retrospective, population-based, cohort study was carried out, linking health survey and health administrative data for residents of Ontario, Canada, aged 12-65 years, between January 2009 and December 2015. Individuals self-reporting cannabis use within the past year were matched to control individuals (people who reported never using cannabis, or used cannabis only once, and more than 12 months ago) in upwards of a 1:3 ratio on 31 different variables, using propensity score matching methods. Respiratory-related and all-cause ER visits or hospitalisations, and all-cause mortality, were evaluated up to 12 months following the index date. RESULTS We identified 35 114 individuals who had either used cannabis in the past year or were controls, of whom 6425 (18.3%) used cannabis in the past year. From this group, 4807 (74.8%) were propensity-score matched to 10 395 control individuals. In the propensity score matched cohort, there was no significant difference in odds of respiratory-related ER visit or hospitalisation between cannabis users and the control group (OR 0.91, 95% CI 0.77 to 1.09). Compared with control individuals, cannabis users had significantly increased odds of all-cause ER visit or hospitalisation (OR 1.22, 95% CI 1.13 to 1.31) and there was no significant difference with respect to all-cause mortality (OR 0.99, 95% CI 0.49 to 2.02). CONCLUSIONS Although no significant association was observed between cannabis use and respiratory-related ER visits or hospitalisations, the risk of an equally important morbidity outcome, all-cause ER visit or hospitalisation, was significantly greater among cannabis users than among control individuals. Therefore, cannabis use is associated with increased risk for serious adverse health events and its recreational consumption is not benign.
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Affiliation(s)
- Nicholas T Vozoris
- Airways Disease Group, Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada .,ICES (formerly known as Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada.,Division of Respirology, Department of Medicine, St. Michael's Hospital at Unity Health, Toronto, Ontario, Canada.,Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jingqin Zhu
- ICES (formerly known as Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Clodagh M Ryan
- Airways Disease Group, Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Chung-Wai Chow
- Airways Disease Group, Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- Airways Disease Group, Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES (formerly known as Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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13
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Khoury M, Cohen I, Bar-Sela G. “The Two Sides of the Same Coin”—Medical Cannabis, Cannabinoids and Immunity: Pros and Cons Explained. Pharmaceutics 2022; 14:pharmaceutics14020389. [PMID: 35214123 PMCID: PMC8877666 DOI: 10.3390/pharmaceutics14020389] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023] Open
Abstract
Cannabis, as a natural medicinal remedy, has long been used for palliative treatment to alleviate the side effects caused by diseases. Cannabis-based products isolated from plant extracts exhibit potent immunoregulatory properties, reducing chronic inflammatory processes and providing much needed pain relief. They are a proven effective solution for treatment-based side effects, easing the resulting symptoms of the disease. However, we discuss the fact that cannabis use may promote the progression of a range of malignancies, interfere with anti-cancer immunotherapy, or increase susceptibility to viral infections and transmission. Most cannabis preparations or isolated active components cause an overall potent immunosuppressive impact among users, posing a considerable hazard to patients with suppressed or compromised immune systems. In this review, current knowledge and perceptions of cannabis or cannabinoids and their impact on various immune-system components will be discussed as the “two sides of the same coin” or “double-edged sword”, referring to something that can have both favorable and unfavorable consequences. We propose that much is still unknown about adverse reactions to its use, and its integration with medical treatment should be conducted cautiously with consideration of the individual patient, effector cells, microenvironment, and the immune system.
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Affiliation(s)
- Mona Khoury
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel; (M.K.); (I.C.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200002, Israel
| | - Idan Cohen
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel; (M.K.); (I.C.)
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, Afula 1834111, Israel; (M.K.); (I.C.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200002, Israel
- Oncology & Hematology Division, Emek Medical Center, Yitshak Rabin Boulevard 21, Afula 1834111, Israel
- Correspondence: ; Tel.: +972-4-6495725; Fax: +972-4-6163992
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14
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Sonti S, Tyagi K, Pande A, Daniel R, Sharma AL, Tyagi M. Crossroads of Drug Abuse and HIV Infection: Neurotoxicity and CNS Reservoir. Vaccines (Basel) 2022; 10:vaccines10020202. [PMID: 35214661 PMCID: PMC8875185 DOI: 10.3390/vaccines10020202] [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: 12/15/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 01/27/2023] Open
Abstract
Drug abuse is a common comorbidity in people infected with HIV. HIV-infected individuals who abuse drugs are a key population who frequently experience suboptimal outcomes along the HIV continuum of care. A modest proportion of HIV-infected individuals develop HIV-associated neurocognitive issues, the severity of which further increases with drug abuse. Moreover, the tendency of the virus to go into latency in certain cellular reservoirs again complicates the elimination of HIV and HIV-associated illnesses. Antiretroviral therapy (ART) successfully decreased the overall viral load in infected people, yet it does not effectively eliminate the virus from all latent reservoirs. Although ART increased the life expectancy of infected individuals, it showed inconsistent improvement in CNS functioning, thus decreasing the quality of life. Research efforts have been dedicated to identifying common mechanisms through which HIV and drug abuse lead to neurotoxicity and CNS dysfunction. Therefore, in order to develop an effective treatment regimen to treat neurocognitive and related symptoms in HIV-infected patients, it is crucial to understand the involved mechanisms of neurotoxicity. Eventually, those mechanisms could lead the way to design and develop novel therapeutic strategies addressing both CNS HIV reservoir and illicit drug use by HIV patients.
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Affiliation(s)
- Shilpa Sonti
- Center for Translational Medicine, Thomas Jefferson University, 1020 Locust Street, Philadelphia, PA 19107, USA; (S.S.); (A.L.S.)
| | - Kratika Tyagi
- Department of Biotechnology, Banasthali Vidyapith, Vanasthali, Jaipur 304022, Rajasthan, India;
| | - Amit Pande
- Cell Culture Laboratory, ICAR-Directorate of Coldwater Fisheries Research, Bhimtal, Nainital 263136, Uttarakhand, India;
| | - Rene Daniel
- Farber Hospitalist Service, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Adhikarimayum Lakhikumar Sharma
- Center for Translational Medicine, Thomas Jefferson University, 1020 Locust Street, Philadelphia, PA 19107, USA; (S.S.); (A.L.S.)
| | - Mudit Tyagi
- Center for Translational Medicine, Thomas Jefferson University, 1020 Locust Street, Philadelphia, PA 19107, USA; (S.S.); (A.L.S.)
- Correspondence: ; Tel.: +1-215-503-5157 or +1-703-909-9420
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15
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Abstract
Cannabis use in the United States is growing at an unprecedented pace. Most states in the United States have legalized medical cannabis use, and many have legalized nonmedical cannabis use. In this setting, health care professionals will increasingly see more patients who have questions about cannabis use, its utility for medical conditions, and the risks of its use. This narrative review provides an overview of the background, pharmacology, therapeutic use, and potential complications of cannabis.
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Affiliation(s)
- Deepika E Slawek
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Susanna A Curtis
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrSusieC2
| | - Julia H Arnsten
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrArnsten
| | - Chinazo O Cunningham
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrChinazo
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16
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Morcuende A, Navarrete F, Nieto E, Manzanares J, Femenía T. Inflammatory Biomarkers in Addictive Disorders. Biomolecules 2021; 11:biom11121824. [PMID: 34944470 PMCID: PMC8699452 DOI: 10.3390/biom11121824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
Substance use disorders are a group of diseases that are associated with social, professional, and family impairment and that represent a high socio-economic impact on the health systems of countries around the world. These disorders present a very complex diagnosis and treatment regimen due to the lack of suitable biomarkers supporting the correct diagnosis and classification and the difficulty of selecting effective therapies. Over the last few years, several studies have pointed out that these addictive disorders are associated with systemic and central nervous system inflammation, which could play a relevant role in the onset and progression of these diseases. Therefore, identifying different immune system components as biomarkers of such addictive disorders could be a crucial step to promote appropriate diagnosis and treatment. Thus, this work aims to provide an overview of the immune system alterations that may be biomarkers of various addictive disorders.
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Affiliation(s)
- Alvaro Morcuende
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda. de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (A.M.); (F.N.); (E.N.); (J.M.)
| | - Francisco Navarrete
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda. de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (A.M.); (F.N.); (E.N.); (J.M.)
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
| | - Elena Nieto
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda. de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (A.M.); (F.N.); (E.N.); (J.M.)
| | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda. de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (A.M.); (F.N.); (E.N.); (J.M.)
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
| | - Teresa Femenía
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda. de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (A.M.); (F.N.); (E.N.); (J.M.)
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-965-919-553
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17
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Braun IM, Abrams DI, Blansky SE, Pergam SA. Cannabis and the Cancer Patient. J Natl Cancer Inst Monogr 2021; 2021:68-77. [PMID: 34850899 DOI: 10.1093/jncimonographs/lgab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
Session 2 of the National Cancer Institute's Cannabis, Cannabinoids, and Cancer Research Workshop opened with testimony from a lymphoma survivor who detailed medicinal cannabis-related improvements in nausea, low appetite, insomnia, and mental health and the limited clinical counsel she received regarding cannabis use. Discussion next turned to the evolution of the legal landscape of cannabis in the United States, one in which state and federal laws frequently conflict and the Controlled Substance Act renders cannabis Schedule I. This legal climate creates conundrums for US medicinal cannabis researchers who contend with limited funding opportunities, avenues to source trial drug, and procedural red tape and for oncology clinicians who recommend medicinal cannabis to patients with some frequency while perceiving themselves as ill equipped to make such clinical recommendations. Ultimately, it creates challenges for cancer patients who find themselves turning to nonmedical and anecdotal information sources. The risks of cannabis use by the cancer patient were discussed next. These include infection, pharmacodynamic and pharmacokinetic drug-botanical interactions, cyclic nausea and vomiting, e-cigarette or vaping product use-associated illness, legal issues, and high cost. The session concluded with a broad survey of the research supporting oncologic cannabinoid use, conclusive evidence for chemotherapy-induced nausea and vomiting, and suggestive evidence for cancer-related pain.
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Affiliation(s)
- Ilana M Braun
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Donald I Abrams
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Stacey E Blansky
- School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
| | - Steven A Pergam
- University of Washington School of Medicine, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
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18
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Meehan-Atrash J, Rahman I. Cannabis Vaping: Existing and Emerging Modalities, Chemistry, and Pulmonary Toxicology. Chem Res Toxicol 2021; 34:2169-2179. [PMID: 34622654 PMCID: PMC8882064 DOI: 10.1021/acs.chemrestox.1c00290] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) has been cause for concern to the medical community, particularly given that this novel illness has coincided with the COVID-19 pandemic, another cause of severe pulmonary illness. Though cannabis e-cigarettes tainted with vitamin E acetate were primarily associated with EVALI, acute lung injuries stemming from cannabis inhalation were reported in the literature prior to 2019, and it has been suggested that cannabis components or additives other than vitamin E acetate may be responsible. Despite these concerning issues, novel cannabis vaporizer ingredients continue to arise, such as Δ8-tetrahydrocannabinol, Δ10-tetrahydrocannabinol, hexahydrocannabinol, and cannabichromene. In order to address cannabis e-cigarette safety and vaping in an effective manner, we provide a comprehensive knowledge of the latest products, delivery modes, and ingredients. This perspective highlights the types of cannabis vaping modalities common to the United States cannabis market, with special attention to cartridge-type cannabis e-cigarette toxicology and their involvement in the EVALI outbreak, in particular, acute lung injurious responses. Novel ingredient chemistry, origins, and legal statuses are reviewed, as well as the toxicology of known cannabis e-cigarette aerosol components.
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Affiliation(s)
- Jiries Meehan-Atrash
- Department of Environmental Medicine, University of Rochester Medical Center, Box 850, 601 Elmwood Avenue, Rochester 14642, NY, United States
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Box 850, 601 Elmwood Avenue, Rochester 14642, NY, United States
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19
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Satish S, Freeman C, Culhane J. Urine drug screen positive for cocaine and amphetamine is not an adverse risk factor for cardiovascular morbidity or mortality in trauma. Trauma Surg Acute Care Open 2021; 6:e000749. [PMID: 34514174 PMCID: PMC8383867 DOI: 10.1136/tsaco-2021-000749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/03/2021] [Indexed: 02/04/2023] Open
Abstract
Background Urine drug screening (UDS) is a component of trauma workup and of perioperative risk evaluation. Illicit stimulant use has been associated with cardiovascular complications. This study investigates the impact of stimulant use and its interaction with surgery on cardiovascular complications in trauma patients. Methods Patients were identified from the 2017 National Trauma Data Bank. Univariate and multivariate analyses were used to evaluate the effect of amphetamine and cocaine on mortality, myocardial infarction (MI), and stroke. We evaluated three subsets: all screened patients, those who underwent surgery, and those whose surgery was immediate. Significance was tested with χ2 test for categorical variables, Student’s t-test for continuous variables, and logistic regression for multivariate analysis. Results 317 688 (32.1%) patients underwent UDS. Multivariate analysis showed protective association between cocaine and mortality OR 0.9 (p=0.028). Cocaine was a non-significant predictor of MI and stroke: OR 0.63 (p=0.065) and 0.91 (p=0.502), respectively. Amphetamine was a non-significant predictor of mortality, MI, and stroke: OR 0.97 (p=0.405), 0.80 (p=0.283), and 1.02 (p=0.857), respectively. On univariate analysis, amphetamine showed a protective association with MI for all screened patients: relative risk (RR) 0.58 (p=0.005), and for surgical patients: RR 0.58 (p=0.019). Amphetamine showed a protective association with mortality for all three subsets: RR 0.83 (p<0.001), 0.78 (p<0.001), and 0.71 (p<0.001), respectively. Cocaine showed a protective association with MI for all screened patients: RR 0.45 (p=0.001), and for surgical patients: RR 0.44 (p=0.005). Cocaine showed a protective association with mortality for all three subsets: RR 0.76 (p<0.001), 0.71 (p<0.001), and 0.63 (p<0.001), respectively. Discussion UDS positive for cocaine or amphetamine is not an adverse risk factor in trauma, including trauma patients who underwent surgery. The apparent protective effects of illicit drugs warrant further investigation. Level of evidence Therapeutic/care management, level IV.
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Affiliation(s)
| | - Carl Freeman
- Trauma, Saint Louis University, Saint Louis, Missouri, USA
| | - John Culhane
- Trauma, Saint Louis University, Saint Louis, Missouri, USA
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20
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Blinick R, Chaya N, Zalta B, Haramati LB, Shmukler A. Cracking the Opium Den: Cardiothoracic Manifestations of Drug Abuse. J Thorac Imaging 2021; 36:W16-W31. [PMID: 32102017 DOI: 10.1097/rti.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recreational drug use is increasing worldwide, with emergency room visits and total deaths from drug overdose rising in recent years. Complications from prescription and recreational drug use may result from the biochemical effects of the drugs themselves, impurities mixed with substances, or from causes related to the method of drug administration. The presentation of drug overdose may be complex due to multisubstance abuse, including cigarette smoking and alcoholism, and can impact any organ system. Patients may present without history, and radiologists may be the first clinicians to suggest the diagnosis. We aim to explore the cardiothoracic manifestations of drug abuse and their multimodality imaging manifestations.
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Affiliation(s)
| | - Nathan Chaya
- Montefiore Medical Center, Bronx
- Staten Island University Hospital, Staten Island, NY
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21
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Gunasekaran K, Voruganti DC, Singh Rahi M, Elango K, Ramalingam S, Geeti A, Kwon J. Trends in Prevalence and Outcomes of Cannabis Use Among Chronic Obstructive Pulmonary Disease Hospitalizations: A Nationwide Population-Based Study 2005-2014. Cannabis Cannabinoid Res 2021; 6:340-348. [PMID: 33998884 DOI: 10.1089/can.2020.0133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality in the United States. Due to the ongoing legalization of cannabis, its acceptance, availability, and use in the in-patient population are on the rise. In this retrospective study, we investigated the association of cannabis use with important outcomes in COPD hospitalizations. Methods: The National Inpatient Sample (NIS) data were analyzed from 2005 to 2014. The primary outcome of interest was the trends and outcomes of cannabis use among COPD hospitalizations, including in-hospital mortality, pneumonia, sepsis, and respiratory failure. Results: We identified 6,073,862 hospitalizations, 18 years of age or older, with COPD using hospital discharge codes. Of these, 6,049,316 (99.6%) were without cannabis use, and 24,546 (0.4%) were admitted with cannabis use. The majority of COPD hospitalizations with cannabis use were aged 50-64 (60%). Cannabis use was associated with lower odds of in-hospital mortality (odds ratio [OR] 0.624 [95% confidence interval (CI) 0.407-0.958]; p=0.0309) and pneumonia (OR 0.882 [95% CI 0.806-0.964]; p=0.0059) among COPD hospitalizations. Cannabis use also had lower odds of sepsis (OR 0.749 [95% CI 0.523-1.071]; p=0.1127) and acute respiratory failure (OR 0.995 [95% CI 0.877-1.13]; p=0.9411), but it was not statistically significant. Conclusions: Among hospitalized patients with a diagnosis of COPD, cannabis users had statistically significant lower odds of in-hospital mortality and pneumonia compared to noncannabis users. The association between cannabis use and these favorable outcomes deserves further study to understand the interaction between cannabis use and COPD.
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Affiliation(s)
- Kulothungan Gunasekaran
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Dinesh C Voruganti
- Division of Cardiovascular Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mandeep Singh Rahi
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Kalaimani Elango
- Division of Cardiology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | | | - Adiba Geeti
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Jeff Kwon
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, USA
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22
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Breijyeh Z, Jubeh B, Bufo SA, Karaman R, Scrano L. Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses. Toxins (Basel) 2021; 13:117. [PMID: 33562446 PMCID: PMC7915118 DOI: 10.3390/toxins13020117] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
For thousands of years, Cannabis sativa has been utilized as a medicine and for recreational and spiritual purposes. Phytocannabinoids are a family of compounds that are found in the cannabis plant, which is known for its psychotogenic and euphoric effects; the main psychotropic constituent of cannabis is Δ9-tetrahydrocannabinol (Δ9-THC). The pharmacological effects of cannabinoids are a result of interactions between those compounds and cannabinoid receptors, CB1 and CB2, located in many parts of the human body. Cannabis is used as a therapeutic agent for treating pain and emesis. Some cannabinoids are clinically applied for treating chronic pain, particularly cancer and multiple sclerosis-associated pain, for appetite stimulation and anti-emesis in HIV/AIDS and cancer patients, and for spasticity treatment in multiple sclerosis and epilepsy patients. Medical cannabis varies from recreational cannabis in the chemical content of THC and cannabidiol (CBD), modes of administration, and safety. Despite the therapeutic effects of cannabis, exposure to high concentrations of THC, the main compound that is responsible for most of the intoxicating effects experienced by users, could lead to psychological events and adverse effects that affect almost all body systems, such as neurological (dizziness, drowsiness, seizures, coma, and others), ophthalmological (mydriasis and conjunctival hyperemia), cardiovascular (tachycardia and arterial hypertension), and gastrointestinal (nausea, vomiting, and thirst), mainly associated with recreational use. Cannabis toxicity in children is more concerning and can cause serious adverse effects such as acute neurological symptoms (stupor), lethargy, seizures, and even coma. More countries are legalizing the commercial production and sale of cannabis for medicinal use, and some for recreational use as well. Liberalization of cannabis laws has led to increased incidence of toxicity, hyperemesis syndrome, lung disease cardiovascular disease, reduced fertility, tolerance, and dependence with chronic prolonged use. This review focuses on the potential therapeutic effects of cannabis and cannabinoids, as well as the acute and chronic toxic effects of cannabis use on various body systems.
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Affiliation(s)
- Zeinab Breijyeh
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Al-Quds University, Jerusalem Abu Dis P144, Palestine; (Z.B.); (B.J.)
| | - Buthaina Jubeh
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Al-Quds University, Jerusalem Abu Dis P144, Palestine; (Z.B.); (B.J.)
| | - Sabino A. Bufo
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy
- Department of Geography, Environmental Management & Energy Studies, University of Johannesburg, Johannesburg 2092, South Africa
| | - Rafik Karaman
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Al-Quds University, Jerusalem Abu Dis P144, Palestine; (Z.B.); (B.J.)
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy
| | - Laura Scrano
- Department of European Cultures (DICEM), University of Basilicata, 75100 Matera, Italy;
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23
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Zippi M, Toma A, Maccioni F, Pica R. Candida Albicans Lung Abscess in an Illicit Drugs User With Hepatitis C Virus Chronic Infection. Cureus 2021; 13:e13117. [PMID: 33728135 PMCID: PMC7935243 DOI: 10.7759/cureus.13117] [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] [Indexed: 02/07/2023] Open
Abstract
Illicit substances are widely used all over the world. Among them, crack cocaine results to be the most used drug for the fact that it can be taken in different ways, such as inhaled or intravenous. Pulmonary complications are well known in people snorting it, mostly due to contamination with other substances contained in the objects able to infuse the drug. Herein, we present a case of lung candida abscess related to nasal insufflation of cocaine in an abuser patient suffering from hepatitis C virus (HCV) and not immunocompromised.
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Affiliation(s)
- Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
| | - Antonella Toma
- Unit of Urgent Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
| | - Francesca Maccioni
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Policlinico Umberto I, Rome, ITA
| | - Roberta Pica
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
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24
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Fantauzzi MF, Aguiar JA, Tremblay BJM, Mansfield MJ, Yanagihara T, Chandiramohan A, Revill S, Ryu MH, Carlsten C, Ask K, Stämpfli M, Doxey AC, Hirota JA. Expression of endocannabinoid system components in human airway epithelial cells: impact of sex and chronic respiratory disease status. ERJ Open Res 2020; 6:00128-2020. [PMID: 33344628 PMCID: PMC7737429 DOI: 10.1183/23120541.00128-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
Cannabis smoking is the dominant route of delivery, with the airway epithelium functioning as the site of first contact. The endocannabinoid system is responsible for mediating the physiological effects of inhaled phytocannabinoids. The expression of the endocannabinoid system in the airway epithelium and contribution to normal physiological responses remains to be defined. To begin to address this knowledge gap, a curated dataset of 1090 unique human bronchial brushing gene expression profiles was created. The dataset included 616 healthy subjects, 136 subjects with asthma, and 338 subjects with COPD. A 32-gene endocannabinoid signature was analysed across all samples with sex and disease-specific analyses performed. Immunohistochemistry and immunoblots were performed to probe in situ and in vitro protein expression. CB1, CB2, and TRPV1 protein signal is detectable in human airway epithelial cells in situ and in vitro, justifying examining the downstream endocannabinoid pathway. Sex status was associated with differential expression of 7 of 32 genes. In contrast, disease status was associated with differential expression of 21 of 32 genes in people with asthma and 26 of 32 genes in people with COPD. We confirm at the protein level that TRPV1, the most differentially expressed candidate in our analyses, was upregulated in airway epithelial cells from people with asthma relative to healthy subjects. Our data demonstrate that the endocannabinoid system is expressed in human airway epithelial cells with expression impacted by disease status and minimally by sex. The data suggest that cannabis consumers may have differential physiological responses in the respiratory mucosa.
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Affiliation(s)
- Matthew F Fantauzzi
- Firestone Institute for Respiratory Health - Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | | | | | - Michael J Mansfield
- Genomics and Regulatory Systems Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Japan
| | - Toyoshi Yanagihara
- Firestone Institute for Respiratory Health - Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Abiram Chandiramohan
- Firestone Institute for Respiratory Health - Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Spencer Revill
- Firestone Institute for Respiratory Health - Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Min Hyung Ryu
- Division of Respiratory Medicine, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Carlsten
- Division of Respiratory Medicine, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kjetil Ask
- Firestone Institute for Respiratory Health - Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Martin Stämpfli
- Firestone Institute for Respiratory Health - Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Andrew C Doxey
- Firestone Institute for Respiratory Health - Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,Dept of Biology, University of Waterloo, Waterloo, ON, Canada
| | - Jeremy A Hirota
- Firestone Institute for Respiratory Health - Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada.,Dept of Biology, University of Waterloo, Waterloo, ON, Canada.,Division of Respiratory Medicine, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
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25
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Underner M, Peiffer G, Perriot J, Jaafari N. Republication de : Complications pulmonaires chez les consommateurs de cocaïne. JOURNAL EUROPÉEN DES URGENCES ET DE RÉANIMATION 2020. [DOI: 10.1016/j.jeurea.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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26
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Gibson CL, Nia AB, Spriggs SA, DeFrancisco D, Swift A, Perkel C, Zhong X, Mazumdar M, Fernandez N, Patel M, Kim-Schulze S, Hurd YL. Cannabinoid use in psychotic patients impacts inflammatory levels and their association with psychosis severity. Psychiatry Res 2020; 293:113380. [PMID: 32818918 PMCID: PMC8292796 DOI: 10.1016/j.psychres.2020.113380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/21/2022]
Abstract
Inflammatory abnormalities are well-documented in individuals with chronic psychotic disorders. Particular attention has focused on interleukin-6 (IL-6) and its correlation with psychotic symptom severity. Cannabis use is associated with an increased risk of psychosis and also has immunomodulating properties. It has been hypothesized that inflammatory disturbances are a common underlying pathology between cannabis use and psychosis. We measured inflammatory markers in individuals admitted to a psychiatric unit with acute psychosis who had toxicology positive for natural and/or synthetic cannabinoids (n = 59) compared to patients with negative cannabinoid toxicology (n = 60). Psychosis severity was assessed using the Positive and Negative Syndrome Scale (PANSS). While PANSS scores were similar between groups, cannabinoid-positive participants were more likely to receive pro re nata (PRN or as-needed) medications for agitation in the psychiatric emergency room, particularly synthetic cannabinoid-positive participants. In unadjusted models, cannabinoid-positive participants had lower interferon-γ (IFN-γ) levels (p = 0.046), but this finding was not significant after adjusting for covariates and multiple comparisons. Among cannabinoid-positive participants, IL-6 levels negatively correlated with PANSS total score (p = 0.040), as well as positive (p = 0.035) and negative (p = 0.024) subscales. Results suggest inflammatory alterations among psychotic individuals with comorbid cannabinoid use.
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Affiliation(s)
- Claire L. Gibson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Anahita Bassir Nia
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Sharron A. Spriggs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Daniel DeFrancisco
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Amy Swift
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Charles Perkel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Xiaobo Zhong
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Madhu Mazumdar
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Nicolas Fernandez
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Manishkumar Patel
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Seunghee Kim-Schulze
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Department of Oncological Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Yasmin L. Hurd
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA,Addiction Institute at Mount Sinai, New York City, NY, USA,Corresponding Author: Dr. Yasmin L. Hurd, 1470 Madison Avenue, Hess building for Science and Medicine, 10-105, New York, NY 10029, Phone: (212)824-9314; Fax: (646)-537-9598,
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27
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Wenger DS, Triplette M, Shahrir S, Akgun KM, Wongtrakool C, Brown ST, Kim JW, Soo Hoo GW, Rodriguez-Barradas MC, Huang L, Feemster LC, Zifodya J, Crothers K. Associations of marijuana with markers of chronic lung disease in people living with HIV. HIV Med 2020; 22:92-101. [PMID: 33022830 DOI: 10.1111/hiv.12966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The relationship between marijuana use and markers of chronic lung disease in people living with HIV (PLWH) is poorly understood. METHODS We performed a cross-sectional analysis of the Examinations of HIV-Associated Lung Emphysema (EXHALE) study, including 162 HIV-positive patients and 138 participants without HIV. We modelled marijuana exposure as: (i) current daily or weekly marijuana smoking vs. monthly or less often; or (ii) cumulative marijuana smoking (joint-years). Linear and logistic regression estimated associations between marijuana exposure and markers of lung disease, adjusted for tobacco smoking and other factors. RESULTS In PLWH, current daily or weekly marijuana use was associated with a larger forced vital capacity (FVC), larger total lung capacity and increased odds of radiographic emphysema compared with marijuana non-smokers in adjusted models; these associations were not statistically significant in participants without HIV. Marijuana joint-years were associated with higher forced expiratory volume in 1 s and FVC in PLWH but not with emphysema. CONCLUSIONS In PLWH, marijuana smoking was associated with higher lung volumes and potentially with radiographic emphysema. No consistently negative associations were observed between marijuana and measures of chronic lung health.
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Affiliation(s)
- D S Wenger
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - M Triplette
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S Shahrir
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - K M Akgun
- Department of Internal Medicine, Veterans Affairs (VA) Connecticut Healthcare System and Yale University School of Medicine, New Haven, CT, USA
| | - C Wongtrakool
- Atlanta VA Medical Center and Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - S T Brown
- Department of Medicine, James J. Peters VA Medical Center, Bronx, NY, USA.,Department of Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - J W Kim
- Department of Medicine, James J. Peters VA Medical Center, Bronx, NY, USA
| | - G W Soo Hoo
- VA Greater Los Angeles Healthcare System and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - M C Rodriguez-Barradas
- Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L Huang
- Center for AIDS Research, University of California at San Francisco, San Francisco, CA, USA
| | - L C Feemster
- VA Puget Sound Healthcare System, University of Washington, Seattle, WA, USA
| | - J Zifodya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - K Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.,VA Puget Sound Healthcare System, University of Washington, Seattle, WA, USA
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28
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Kumar PS. Interventions to prevent periodontal disease in tobacco-, alcohol-, and drug-dependent individuals. Periodontol 2000 2020; 84:84-101. [PMID: 32844411 DOI: 10.1111/prd.12333] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Substance abuse affects more than one sixth of the world's population. More importantly, the nature of the abuse and the type of addictive substances available to individuals is increasing exponentially. All substances with abusive potential impact both the human immuno-inflammatory system and oral microbial communities, and therefore play a critical role in the etiopathogenesis of periodontal diseases. Evidence strongly supports the efficacy of professionally delivered cessation counseling. Dentists, dental therapists, and hygienists are ideally placed to deliver this therapy, and to spearhead efforts to provide behavioral and pharmacologic support for cessation. The purpose of this review is to examine the biologic mechanisms underlying their role in disease causation, to understand the pharmacologic and behavioral basis for their habituation, and to investigate the efficacy of population-based and personalized interventions in prevention of periodontal disease.
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Affiliation(s)
- Purnima S Kumar
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, USA
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29
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Underner M, Peiffer G, Perriot J, Jaafari N. [Asthma and cannabis, cocaine or heroin use]. Rev Mal Respir 2020; 37:572-589. [PMID: 32653338 PMCID: PMC7345369 DOI: 10.1016/j.rmr.2020.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/09/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The use of cannabis, cocaine or heroin can be responsible for many respiratory complications including asthma. OBJECTIVES The aim of this systematic literature review of data was to expose the relations between cannabis, cocaine or heroin use and asthma. RESULTS Cannabis, cocaine or heroin use by inhalation may be responsible for respiratory symptoms (cough, wheezing), asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or deaths related to asthma. Lower adherence to asthma treatment is also observed. Cannabis induces a rapid bronchodilator effect. In contrast, its chronic use may induce a decrease in specific airway conductance. Studies on forced expiratory volume in one second (FEV1) reduction or decline are discordant. CONCLUSION Cannabis, cocaine or heroin use must be considered in cases of acute respiratory symptoms or asthma exacerbation in young persons and practitioners must help illicit substance users to stop their consumption.
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Affiliation(s)
- M Underner
- Consultation de tabacologie, unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - J Perriot
- Dispensaire Émile-Roux, CLAT 63, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Consultation de tabacologie, unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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30
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Vujanovic V, Korber DR, Vujanovic S, Vujanovic J, Jabaji S. Scientific Prospects for Cannabis-Microbiome Research to Ensure Quality and Safety of Products. Microorganisms 2020; 8:E290. [PMID: 32093340 PMCID: PMC7074860 DOI: 10.3390/microorganisms8020290] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 01/06/2023] Open
Abstract
Cannabis legalization has occurred in several countries worldwide. Along with steadily growing research in Cannabis healthcare science, there is an increasing interest for scientific-based knowledge in plant microbiology and food science, with work connecting the plant microbiome and plant health to product quality across the value chain of cannabis. This review paper provides an overview of the state of knowledge and challenges in Cannabis science, and thereby identifies critical risk management and safety issues in order to capitalize on innovations while ensuring product quality control. It highlights scientific gap areas to steer future research, with an emphasis on plant-microbiome sciences committed to using cutting-edge technologies for more efficient Cannabis production and high-quality products intended for recreational, pharmaceutical, and medicinal use.
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Affiliation(s)
- Vladimir Vujanovic
- Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, SK S7N 5A8, Canada;
| | - Darren R. Korber
- Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, SK S7N 5A8, Canada;
| | - Silva Vujanovic
- Hospital Pharmacy, CISSS des Laurentides and Université de Montréal-Montreal, QC J8H 4C7, Canada;
| | - Josko Vujanovic
- Medical Imaging, CISSS-Laurentides, Lachute, QC J8H 4C7, Canada;
| | - Suha Jabaji
- Plant Science, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada;
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31
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Dinu AR, Rogobete AF, Bratu T, Popovici SE, Bedreag OH, Papurica M, Bratu LM, Sandesc D. Cannabis Sativa Revisited-Crosstalk between microRNA Expression, Inflammation, Oxidative Stress, and Endocannabinoid Response System in Critically Ill Patients with Sepsis. Cells 2020; 9:E307. [PMID: 32012914 PMCID: PMC7072707 DOI: 10.3390/cells9020307] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 02/06/2023] Open
Abstract
Critically ill patients with sepsis require a multidisciplinary approach, as this situation implies multiorgan distress, with most of the bodily biochemical and cellular systems being affected by the condition. Moreover, sepsis is characterized by a multitude of biochemical interactions and by dynamic changes of the immune system. At the moment, there is a gap in our understanding of the cellular, genetic, and molecular mechanisms involved in sepsis. One of the systems intensely studied in recent years is the endocannabinoid signaling pathway, as light was shed over a series of important interactions of cannabinoid receptors with biochemical pathways, specifically for sepsis. Furthermore, a series of important implications on inflammation and the immune system that are induced by the activity of cannabinoid receptors stimulated by the delta-9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) have been noticed. One of the most important is their ability to reduce the biosynthesis of pro-inflammatory mediators and the modulation of immune mechanisms. Different studies have reported that cannabinoids can reduce oxidative stress at mitochondrial and cellular levels. The aim of this review paper was to present, in detail, the important mechanisms modulated by the endocannabinoid signaling pathway, as well as of the molecular and cellular links it has with sepsis. At the same time, we wish to present the possible implications of cannabinoids in the most important biological pathways involved in sepsis, such as inflammation, redox activity, immune system, and epigenetic expression.
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Affiliation(s)
- Anca Raluca Dinu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.R.D.); (A.F.R.); (S.E.P.); (M.P.); (L.M.B.); (D.S.)
| | - Alexandru Florin Rogobete
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.R.D.); (A.F.R.); (S.E.P.); (M.P.); (L.M.B.); (D.S.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 325100 Timisoara, Romania
| | - Tiberiu Bratu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.R.D.); (A.F.R.); (S.E.P.); (M.P.); (L.M.B.); (D.S.)
| | - Sonia Elena Popovici
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.R.D.); (A.F.R.); (S.E.P.); (M.P.); (L.M.B.); (D.S.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 325100 Timisoara, Romania
| | - Ovidiu Horea Bedreag
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.R.D.); (A.F.R.); (S.E.P.); (M.P.); (L.M.B.); (D.S.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 325100 Timisoara, Romania
| | - Marius Papurica
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.R.D.); (A.F.R.); (S.E.P.); (M.P.); (L.M.B.); (D.S.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 325100 Timisoara, Romania
| | - Lavinia Melania Bratu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.R.D.); (A.F.R.); (S.E.P.); (M.P.); (L.M.B.); (D.S.)
| | - Dorel Sandesc
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.R.D.); (A.F.R.); (S.E.P.); (M.P.); (L.M.B.); (D.S.)
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 325100 Timisoara, Romania
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Kelly R, Joers V, Tansey MG, McKernan DP, Dowd E. Microglial Phenotypes and Their Relationship to the Cannabinoid System: Therapeutic Implications for Parkinson's Disease. Molecules 2020; 25:molecules25030453. [PMID: 31973235 PMCID: PMC7037317 DOI: 10.3390/molecules25030453] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease is a neurodegenerative disorder, the motor symptoms of which are associated classically with Lewy body formation and nigrostriatal degeneration. Neuroinflammation has been implicated in the progression of this disease, by which microglia become chronically activated in response to α-synuclein pathology and dying neurons, thereby acquiring dishomeostatic phenotypes that are cytotoxic and can cause further neuronal death. Microglia have a functional endocannabinoid signaling system, expressing the cannabinoid receptors in addition to being capable of synthesizing and degrading endocannabinoids. Alterations in the cannabinoid system—particularly an upregulation in the immunomodulatory CB2 receptor—have been demonstrated to be related to the microglial activation state and hence the microglial phenotype. This paper will review studies that examine the relationship between the cannabinoid system and microglial activation, and how this association could be manipulated for therapeutic benefit in Parkinson’s disease.
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Affiliation(s)
- Rachel Kelly
- Pharmacology & Therapeutics, National University of Ireland, H91 W5P7 Galway, Ireland; (R.K.); (D.P.M.)
| | - Valerie Joers
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL 32611, USA; (V.J.); (M.G.T.)
| | - Malú G. Tansey
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL 32611, USA; (V.J.); (M.G.T.)
- Center for Translation Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL 32611, USA
| | - Declan P. McKernan
- Pharmacology & Therapeutics, National University of Ireland, H91 W5P7 Galway, Ireland; (R.K.); (D.P.M.)
| | - Eilís Dowd
- Pharmacology & Therapeutics, National University of Ireland, H91 W5P7 Galway, Ireland; (R.K.); (D.P.M.)
- Correspondence:
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Underner M, Peiffer G, Perriot J, Jaafari N. [Pulmonary complications in cocaine users]. Rev Mal Respir 2019; 37:45-59. [PMID: 31883817 DOI: 10.1016/j.rmr.2019.11.641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023]
Abstract
Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.
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Affiliation(s)
- M Underner
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - G Peiffer
- Pneumologie, CHR Metz-Thionville, CHR Mercy, 57085 Metz cedex 3, France
| | - J Perriot
- Dispensaire Émile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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HENDERSON LJ, JOHNSON TP, SMITH BR, REOMA LB, SANTAMARIA UA, BACHANI M, DEMARINO C, BARCLAY RA, SNOW J, SACKTOR N, MCARTHUR J, LETENDRE S, STEINER J, KASHANCHI F, NATH A. Presence of Tat and transactivation response element in spinal fluid despite antiretroviral therapy. AIDS 2019; 33 Suppl 2:S145-S157. [PMID: 31789815 PMCID: PMC11032747 DOI: 10.1097/qad.0000000000002268] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to measure the protein concentration and biological activity of HIV-1 Tat in cerebrospinal fluid (CSF) of individuals on suppressive antiretroviral therapy (ART). DESIGN CSF was collected from 68 HIV-positive individuals on ART with plasma viral load less than 40 copies/ml, and from 25 HIV-negative healthy controls. Duration of HIV infection ranged from 4 to more than 30 years. METHODS Tat levels in CSF were evaluated by an ELISA. Tat protein and viral RNA were quantified from exosomes isolated from CSF, followed by western blot or quantitative reverse transcription PCR, respectively. Functional activity of Tat was assessed using an LTR transactivation assay. RESULTS Tat protein was detected in 36.8% of CSF samples from HIV-positive patients. CSF Tat concentration increased in four out of five individuals after initiation of therapy, indicating that Tat was not inhibited by ART. Similarly, exosomes from 34.4% of CSF samples were strongly positive for Tat protein and/or TAR RNA. Exosomal Tat retained transactivation activity in a CEM-LTR reporter assay in 66.7% of samples assayed, which indicates that over half of the Tat present in CSF is functional. Presence of Tat in CSF was highly associated with previous abuse of psychostimulants (cocaine or amphetamines; P = 0.01) and worse performance in the psychomotor speed (P = 0.04) and information processing (P = 0.02) cognitive domains. CONCLUSION Tat and TAR are produced in the central nervous system despite adequate ART and are packaged into CSF exosomes. Tat remains biologically active within this compartment. These studies suggest that Tat may be a quantifiable marker of the viral reservoir and highlight a need for new therapies that directly inhibit Tat.
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Affiliation(s)
- Lisa J. HENDERSON
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Tory P. JOHNSON
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan R. SMITH
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Lauren Bowen REOMA
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Ulisses A. SANTAMARIA
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Muzna BACHANI
- Translational Neuroscience Center, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda Maryland
| | - Catherine DEMARINO
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas Virginia
| | - Robert A. BARCLAY
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas Virginia
| | - Joseph SNOW
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ned SACKTOR
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin MCARTHUR
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Scott LETENDRE
- University of California San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, San Diego California
| | - Joseph STEINER
- Translational Neuroscience Center, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda Maryland
| | - Fatah KASHANCHI
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas Virginia
| | - Avindra NATH
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Manuzak JA, Gott TM, Kirkwood JS, Coronado E, Hensley-McBain T, Miller C, Cheu RK, Collier AC, Funderburg NT, Martin JN, Wu MC, Isoherranen N, Hunt PW, Klatt NR. Heavy Cannabis Use Associated With Reduction in Activated and Inflammatory Immune Cell Frequencies in Antiretroviral Therapy-Treated Human Immunodeficiency Virus-Infected Individuals. Clin Infect Dis 2019; 66:1872-1882. [PMID: 29471387 DOI: 10.1093/cid/cix1116] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/22/2017] [Indexed: 01/07/2023] Open
Abstract
Background Cannabis is a widely used drug in the United States, and the frequency of cannabis use in the human immunodeficiency virus (HIV)-infected population is disproportionately high. Previous human and macaque studies suggest that cannabis may have an impact on plasma viral load; however, the relationship between cannabis use and HIV-associated systemic inflammation and immune activation has not been well defined. Methods The impact of cannabis use on peripheral immune cell frequency, activation, and function was assessed in 198 HIV-infected, antiretroviral-treated individuals by flow cytometry. Individuals were categorized into heavy, medium, or occasional cannabis users or noncannabis users based on the amount of the cannabis metabolite 11-nor-carboxy-tetrahydrocannabinol (THC-COOH) detected in plasma by mass spectrometry. Results Heavy cannabis users had decreased frequencies of human leukocyte antigen (HLA)-DR+CD38+CD4+ and CD8+ T-cell frequencies, compared to frequencies of these cells in non-cannabis-using individuals. Heavy cannabis users had decreased frequencies of intermediate and nonclassical monocyte subsets, as well as decreased frequencies of interleukin 23- and tumor necrosis factor-α-producing antigen-presenting cells. Conclusions While the clinical implications are unclear, our findings suggest that cannabis use is associated with a potentially beneficial reduction in systemic inflammation and immune activation in the context of antiretroviral-treated HIV infection.
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Affiliation(s)
- Jennifer A Manuzak
- Department of Pharmaceutics, University of Washington.,Washington National Primate Research Center
| | - Toni M Gott
- Department of Pharmaceutics, University of Washington.,Washington National Primate Research Center
| | | | - Ernesto Coronado
- Department of Pharmaceutics, University of Washington.,Washington National Primate Research Center
| | - Tiffany Hensley-McBain
- Department of Pharmaceutics, University of Washington.,Washington National Primate Research Center
| | - Charlene Miller
- Department of Pharmaceutics, University of Washington.,Washington National Primate Research Center
| | - Ryan K Cheu
- Department of Pharmaceutics, University of Washington.,Washington National Primate Research Center
| | - Ann C Collier
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle
| | - Nicholas T Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, College of Medicine, Ohio State University, Columbus
| | - Jeffery N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Michael C Wu
- Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Peter W Hunt
- Department of Medicine, University of California, San Francisco
| | - Nichole R Klatt
- Department of Pharmaceutics, University of Washington.,Washington National Primate Research Center
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Bailey KL, Wyatt TA, Katafiasz DM, Taylor KW, Heires AJ, Sisson JH, Romberger DJ, Burnham EL. Alcohol and cannabis use alter pulmonary innate immunity. Alcohol 2019; 80:131-138. [PMID: 30419300 DOI: 10.1016/j.alcohol.2018.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/19/2018] [Accepted: 11/03/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Cannabis use is increasing due to recent legislative changes. In addition, cannabis is often used in conjunction with alcohol. The airway epithelium is the first line of defense against infectious microbes. Toll-like receptors (TLR) recognize airborne microbes and initiate the inflammatory cytokine response. The mechanism by which cannabis use in conjunction with alcohol affects pulmonary innate immunity mediated by TLRs is unknown. METHODS Samples and data from an existing cohort of individuals with alcohol use disorders (AUDs), along with samples from additional participants with cannabis use alone and with AUD were utilized. Subjects were categorized into the following groups: no alcohol use disorder (AUD) or cannabis use (control) (n = 46), AUD only (n = 29), cannabis use-only (n = 39), and AUD and cannabis use (n = 29). The participants underwent bronchoscopy with bronchoalveolar lavage (BAL) and airway epithelial brushings. We measured IL-6, IL-8, TNF⍺, and IL-10 levels in BAL fluid, and performed real-time PCR for TLR1-9 on the airway epithelial brushings. RESULTS We found significant increases in TLR2 with AUD alone, cannabis use alone, and cannabis use with AUD, compared to control. TLR5 was increased in cannabis users compared to control, TLR6 was increased in cannabis users and cannabis users with AUD compared to control, TLR7 was increased in cannabis users compared to control, and TLR9 was increased in cannabis users compared to control. In terms of cytokine production, IL-6 was increased in cannabis users compared to control. IL-8 and IL-10 were increased in AUD only. CONCLUSIONS AUD and cannabis use have complex effects on pulmonary innate immunity that promote airway inflammation.
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Affiliation(s)
- Kristina L Bailey
- University of Nebraska Medical Center, Internal Medicine/Pulmonary, Critical Care Sleep and Allergy, Omaha, NE 68198, United States; Veterans Affairs, Nebraska Western-Iowa Healthcare System, Omaha, NE 68105, United States.
| | - Todd A Wyatt
- University of Nebraska Medical Center, Internal Medicine/Pulmonary, Critical Care Sleep and Allergy, Omaha, NE 68198, United States; Veterans Affairs, Nebraska Western-Iowa Healthcare System, Omaha, NE 68105, United States; Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Dawn M Katafiasz
- University of Nebraska Medical Center, Internal Medicine/Pulmonary, Critical Care Sleep and Allergy, Omaha, NE 68198, United States
| | - Keenan W Taylor
- University of Nebraska Medical Center, Internal Medicine/Pulmonary, Critical Care Sleep and Allergy, Omaha, NE 68198, United States
| | - Art J Heires
- University of Nebraska Medical Center, Internal Medicine/Pulmonary, Critical Care Sleep and Allergy, Omaha, NE 68198, United States
| | - Joseph H Sisson
- University of Nebraska Medical Center, Internal Medicine/Pulmonary, Critical Care Sleep and Allergy, Omaha, NE 68198, United States
| | - Debra J Romberger
- University of Nebraska Medical Center, Internal Medicine/Pulmonary, Critical Care Sleep and Allergy, Omaha, NE 68198, United States; Veterans Affairs, Nebraska Western-Iowa Healthcare System, Omaha, NE 68105, United States
| | - Ellen L Burnham
- University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, United States
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Slawek D, Meenrajan SR, Alois MR, Comstock Barker P, Estores IM, Cook R. Medical Cannabis for the Primary Care Physician. J Prim Care Community Health 2019; 10:2150132719884838. [PMID: 31646929 PMCID: PMC6820188 DOI: 10.1177/2150132719884838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Medical cannabis use is common in the United States and increasingly more socially acceptable. As more patients seek out and acquire medical cannabis, primary care physicians will be faced with a growing number of patients seeking information on the indications, efficacy, and safety of medical cannabis. We present a case of a patient with several chronic health conditions who asks her primary care provider whether she should try medical cannabis. We provide a review of the pharmacology of medical cannabis, the state of evidence regarding the efficacy of medical cannabis, variations in the types of medical cannabis, and safety monitoring considerations for the primary care physician.
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Affiliation(s)
- Deepika Slawek
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | | | | | | | - Robert Cook
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Tashkin DP, Roth MD. Pulmonary effects of inhaled cannabis smoke. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:596-609. [PMID: 31298945 DOI: 10.1080/00952990.2019.1627366] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The smoke generated from cannabis delivers biologically active cannabinoids and a number of combustion-derived toxins, both of which raise questions regarding the impact of cannabis smoking on lung function, airway inflammation and smoking-related lung disease.Objectives: Review the potential effects of cannabis smoking on respiratory symptoms, lung function, histologic/molecular alterations in the bronchial mucosa, smoking-related changes in alveolar macrophage function and the potential clinical impact of cannabis smoking on chronic obstructive pulmonary disease, lung cancer and pulmonary infections.Methods: Focused literature review.Results: The carcinogens and respiratory toxins in cannabis and tobacco smoke are similar but the smoking topography for cannabis results in higher per-puff exposures to inhaled tar and gases. The frequency of chronic cough, sputum and wheeze and the presence of airway mucosal inflammation, goblet cell and vascular hyperplasia, metaplasia and cellular disorganization are similar between cannabis smokers and tobacco smokers. Cannabis smoke has modest airway bronchodilator properties but of unclear clinical significance. While clear evidence exists for progression to obstructive lung disease and emphysema in chronic tobacco smokers, the effects from habitual cannabis use are less clear. Evidence suggests that alveolar macrophages from cannabis smokers have deficits in cytokine production and antimicrobial activity not present in cells from tobacco smokers.Conclusions: Solid conclusions regarding the respiratory consequences of regular cannabis smoking are difficult to make due to a relative paucity of literature, confounding by concurrent tobacco smoking and reports of conflicting outcomes. Additional well-controlled clinical studies on the pulmonary consequences of habitual cannabis use are needed.
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Affiliation(s)
- Donald P Tashkin
- Department of Medicine, Division of Pulmonary & Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael D Roth
- Department of Medicine, Division of Pulmonary & Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Awad OGAN. Impact of habitual marijuana and tobacco smoke on severity of chronic rhinosinusitis. Am J Otolaryngol 2019; 40:583-588. [PMID: 31109805 DOI: 10.1016/j.amjoto.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Health concerns around cannabis (marijuana) use have focused on the possible relationship with psychosis and lower airway health, however; the effect of cannabis smoking on upper airway health has received less attention. The aim of this study is to investigate difference between exclusive tobacco cigarettes smoking compared with tobacco plus cannabis smoking regarding severity of chronic rhinosinusitis (CRS). MATERIAL AND METHODS A prospective cross-sectional study with two groups of CRS patients recruited (Group 1: tobacco cigarettes smokers; 100 patients and group 2: tobacco cigarettes smokers and also cannabis users; 100 patients). Recruitment occurred in a general practice in Egypt. Cannabis use was recorded by self-report. Severity of CRS was assessed and compared between 2 groups using SNOT-20 questionnaire, Lund-Mackay CT score and Lund-Kennedy (LK) endoscopy Score. RESULTS Group 2 patients (tobacco plus cannabis smokers) had significantly higher mean of assessment cores (SNOT-20 (P = 0.005), Lund-Mackay CT score (P = 0.006) and Lund-Kennedy (LK) endoscopy Score (P = 0.005)). Group 2 patients also had significantly higher mean of facial pain/pressure, difficulty sleep, and wake at night, lack of sleep, wake up tired, fatigue, reduced productivity, reduced concentration, frustration/restless/irritable, sad and embarrassed compared to patients in group 1. CONCLUSION Adult patients who smoked tobacco cigarettes plus cannabis mixed with tobacco had greater health related quality of life burden and more severe CRS compared to patients who smoked tobacco cigarettes only.
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Underner M, Perriot J, Peiffer G, Jaafari N. [Asthma and cocaine use]. Rev Mal Respir 2019; 36:610-624. [PMID: 31201016 DOI: 10.1016/j.rmr.2018.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 08/19/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Cocaine use can be responsible for many respiratory complications including asthma. OBJECTIVES Systematic literature review of data on asthma in cocaine users. DOCUMENTARY SOURCES PubMed/Medline search, on the period 1980-2017 with the following keywords: "asthma*" or "bronchospasm" and "cocaine" or "freebase*" or "crack", limits "title/abstract"; the selected languages were English or French. Among 108 articles, 43 abstracts underwent dual reading to select 22 studies. RESULTS In four case reports of asthma associated with cocaine use including 11 patients (mean age: 28.3 years [22-33 years]; sex-ratio: 2.5 [males: 71.5%]), cocaine was sniffed [snorted] (9%), smoked (36.5%) or both sniffed and smoked (54.5%). A medical history of childhood asthma was observed in 45.4% of the cases. Acute respiratory failure, requiring intubation and mechanical ventilation, was observed in 45.4% of the cases. Outcome was rapidly favorable in 82%; 9/11, progressively favorable in one patient, and fatal in another patient. Other studies included 6 cross-sectional studies, 4 case-control studies and 8 longitudinal studies (7 retrospective studies and one prospective study). The mean age was 36.6 years (women: 44.7%). Twenty percent of the subjects used cocaine exclusively, and 80% used cocaine combined with other addictive drugs (cocaine and heroin: 62%). The prevalence of cocaine users was higher in asthmatic subjects and the prevalence of asthma was higher in cocaine users. Cocaine use can be responsible for asthma onset and acute asthma exacerbation. In the case of asthma exacerbation, cocaine users were more likely to be admitted in intensive care units and to require intubation and invasive ventilation. Asthma exacerbations may be fatal in spite of resuscitation measures. Asthma treatment observance was lower in cocaine users. CONCLUSION Cocaine use may be responsible for asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or death related to asthma. Cocaine use must be systematically considered in the case of asthma exacerbation and practitioners must help cocaine users to stop their consumption.
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Affiliation(s)
- M Underner
- Service de pneumologie, unité de tabacologie, centre hospitalier Henri Laborit, CHU La Milétrie, rue de la Milétrie, Pavillon René Beauchant, BP 577, avenue Jacques Cœur, 86021 Poitiers, France; Addictologie, dispensaire Emile Roux, 63100 Clermont-Ferrand, France; Pneumologie, centre hospitalier de Metz, Metz, France; Unité de recherche clinique, centre hospitalier Henri Laborit, 86021 Poitiers, France.
| | - J Perriot
- Service de pneumologie, unité de tabacologie, centre hospitalier Henri Laborit, CHU La Milétrie, rue de la Milétrie, Pavillon René Beauchant, BP 577, avenue Jacques Cœur, 86021 Poitiers, France; Addictologie, dispensaire Emile Roux, 63100 Clermont-Ferrand, France; Pneumologie, centre hospitalier de Metz, Metz, France; Unité de recherche clinique, centre hospitalier Henri Laborit, 86021 Poitiers, France
| | - G Peiffer
- Service de pneumologie, unité de tabacologie, centre hospitalier Henri Laborit, CHU La Milétrie, rue de la Milétrie, Pavillon René Beauchant, BP 577, avenue Jacques Cœur, 86021 Poitiers, France; Addictologie, dispensaire Emile Roux, 63100 Clermont-Ferrand, France; Pneumologie, centre hospitalier de Metz, Metz, France; Unité de recherche clinique, centre hospitalier Henri Laborit, 86021 Poitiers, France
| | - N Jaafari
- Service de pneumologie, unité de tabacologie, centre hospitalier Henri Laborit, CHU La Milétrie, rue de la Milétrie, Pavillon René Beauchant, BP 577, avenue Jacques Cœur, 86021 Poitiers, France; Addictologie, dispensaire Emile Roux, 63100 Clermont-Ferrand, France; Pneumologie, centre hospitalier de Metz, Metz, France; Unité de recherche clinique, centre hospitalier Henri Laborit, 86021 Poitiers, France
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Inhibition of ATM kinase upregulates levels of cell death induced by cannabidiol and γ-irradiation in human glioblastoma cells. Oncotarget 2019; 10:825-846. [PMID: 30783513 PMCID: PMC6368233 DOI: 10.18632/oncotarget.26582] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/29/2018] [Indexed: 12/18/2022] Open
Abstract
Despite advances in glioblastoma (GBM) therapy, prognosis of the disease remains poor with a low survival rate. Cannabidiol (CBD) can induce cell death and enhance radiosensitivity of GBM but not normal astrocytes. Inhibition of ATM kinase is an alternative mechanism for radiosensitization of cancer cells. In this study, we increased the cytotoxic effects of the combination of CBD and γ-irradiation in GBM cells through additional inhibition of ATM kinase with KU60019, a small molecule inhibitor of ATM kinase. We observed in GBM cells treated by CBD, γ-irradiation and KU60019 high levels of apoptosis together with strong upregulation of the percentage of G2/M-arrested cells, blockade of cell proliferation and a massive production of pro-inflammatory cytokines. Overall, these changes caused both apoptotic and non-apoptotic inflammation-linked cell death. Furthermore, via JNK-AP1 activation in concert with active NF-κB, CBD upregulated gene and protein expression of DR5/TRAIL-R2 and sensitize GBM cells to TRAIL-induced apoptosis. In contrast, CBD notably decreased in GBM surface levels of PD-L1, a critical immune checkpoint agent for T-lymphocytes. We also used in the present study TS543 human proneural glioma cells that were grown as spheroid culture. TS543 neurospheres exhibited dramatic sensitivity to CBD-mediated killing that was additionally increased in combination with γ-irradiation and KU60019. In conclusion, treatment of human GBM by the triple combination (CBD, γ-irradiation and KU60019) could significantly increase cell death levels in vitro and potentially improve the therapeutic ratio of GBM.
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Lorenz DR, Uno H, Wolinsky SM, Gabuzda D. Effect of marijuana smoking on pulmonary disease in HIV-infected and uninfected men: a longitudinal cohort study. EClinicalMedicine 2019; 7:55-64. [PMID: 30854514 PMCID: PMC6402353 DOI: 10.1016/j.eclinm.2019.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Lung disease is a common comorbidity in people with HIV/AIDS, independent of smoking status. The effects of marijuana smoking on risk of lung disease in HIV-infected individuals are unclear. METHODS In this prospective cohort study, we quantified lung disease risk among men enrolled in the Multicenter AIDS Cohort Study (MACS), a long-term observational cohort of HIV-infected and uninfected men who have sex with men. Eligible participants were aged ≥30 years with self-reported marijuana and tobacco smoking data from biannual study visits between 1996 and 2014. Pulmonary diagnoses were obtained from self-report and medical records. Analyses were performed using Cox models and Generalized Estimating Equations adjusted for tobacco smoking, CD4 T cell count, and other risk factors. FINDINGS 1,630 incident pulmonary diagnoses were reported among 1,352 HIV-seropositive and 1,352 HIV-seronegative eligible participants matched for race and baseline age (53,794 total person-visits, median follow-up 10.5 years). 27% of HIV-infected participants reported daily or weekly marijuana smoking for one or more years in follow-up, compared to 18% of uninfected participants (median 4·0 and 4·5 years daily/weekly use, respectively). HIV-infected participants had an increased likelihood of infectious or non-infectious pulmonary diagnoses compared to uninfected participants (33·2% vs. 21·5%, and 20·6% vs. 17·2%, respectively). Among HIV-infected participants, recent marijuana smoking was associated with increased risk of infectious pulmonary diagnoses and chronic bronchitis independent of tobacco smoking and other risk factors for lung disease (hazard ratio [95% confidence interval] 1·43 [1·09-1·86], and 1·54 [1·11-2·13], respectively); these risks were additive in participants smoking both substances. There was no association between marijuana smoking and pulmonary diagnoses in HIV-uninfected participants. INTERPRETATION In this longitudinal study, long-term marijuana smoking was associated with lung disease independent of tobacco smoking and other risk factors in HIV-infected individuals. These findings could be used to reduce modifiable risks of lung disease in high-risk populations.
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Affiliation(s)
- David R. Lorenz
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hajime Uno
- Center for Population Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steven M. Wolinsky
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA
- Corresponding author at: Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215, USA.
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Daya Attie M, Anderson IA, Portnof J. Mandibular Osteomyelitis Associated with Candida Albicans in Marijuana and Heroin Abusers. Ann Maxillofac Surg 2018; 8:355-357. [PMID: 30693264 PMCID: PMC6327820 DOI: 10.4103/ams.ams_83_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Osteomyelitis of the mandible is most commonly caused by bacterial infections and is rarely linked to fungal infections. In 2003, Friedman et al. studied the relationship of multiple drugs including marijuana, opioids, nicotine, and alcohol and its effect on the immune system. It is important to consider potential risks and complications of patients who are immunocompromised and present a history of substance abuse. These complications include infections and osteomyelitis which can be associated with multiple microorganisms; some of the most common microorganisms isolated in mandibular osteomyelitis include Streptococcus, Eikenella, and Candida. Candida albicans is commonly found in the skin and mucosa of healthy individuals; however, it has been proven to cause disease in individuals who are immunocompromised. Two cases of mandibular osteomyelitis after routine dental extractions and a history of drug abuse, including heroin and marijuana, are presented in this case series. These specific infections were resistant to multiple antibiotic therapy and grew C. albicans species in cultures collected. These cases were treated with irrigation and debridement or mandibular resection in combination with antimicrobial treatment and fluconazole with complete resolution. Although osteomyelitis is most commonly caused by bacterial infections, special attention must be given to patients with medical histories of immunosuppression and intravenous drug use. Patients who do not respond to broad-spectrum antibiotics might benefit from bacterial and fungal cultures and sensitivity. Antifungal treatment with an antifungal agent, such as oral fluconazole, is indicated if fungal organisms are yielded in the culture.
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Affiliation(s)
- Mikhail Daya Attie
- Broward Health Medical Center, Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | - Jason Portnof
- Department of Oral and Maxillofacial Surgery, Joe DiMaggio Children's Hospital, Nova Southeastern University, Fort Lauderdale, FL, USA
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Gurmeet Singh A, Chaturvedi P. Smoking and other addictions related to cancer of the head and neck. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Madden K, van der Hoek N, Chona S, George A, Dalchand T, Baldawi H, Mammen G, Bhandari M. Cannabinoids in the Management of Musculoskeletal Pain. JBJS Rev 2018; 6:e7. [DOI: 10.2106/jbjs.rvw.17.00153] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
As marijuana smoking prevalence increases in the United States, concern regarding its potential risks to lung health has also risen, given the general similarity in the smoke contents between marijuana and tobacco. Most studies have found a significant association between marijuana smoking and chronic bronchitis symptoms after adjustment for tobacco. Although reports are mixed regarding associations between marijuana smoking and lung function, none have shown a relationship to decrements in FEV1 and few have found a relationship to a decreased ratio of FEV1/FVC, possibly related to an association between marijuana and an increased FVC. A few studies have found a modest reduction in specific airway conductance in relation to marijuana, probably reflecting endoscopic evidence of bronchial mucosal edema among habitual marijuana smokers. Diffusing capacity in marijuana smokers has been normal, and two studies of thoracic high-resolution CT scan have not shown any association of marijuana smoking with emphysema. Although bronchial biopsies from habitual marijuana smokers have shown precancerous histopathologic changes, a large cohort study and a pooled analysis of six well-designed case-control studies have not found evidence of a link between marijuana smoking and lung cancer. The immunosuppressive effects of delta-9 tetrahydrocannabinol raise the possibility of an increased risk of pneumonia, but further studies are needed to evaluate this potential risk. Several cases series have demonstrated pneumothoraces/pneumomediastinum and bullous lung disease in marijuana smokers, but these associations require epidemiologic studies for firmer evidence of possible causality.
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Lamas CC, Coelho LE, Grinsztejn BJ, Veloso VG. Community-acquired lower respiratory tract infections in HIV-infected patients on antiretroviral therapy: predictors in a contemporary cohort study. Infection 2017; 45:801-809. [PMID: 28660356 PMCID: PMC5873951 DOI: 10.1007/s15010-017-1041-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/21/2017] [Indexed: 01/17/2023]
Abstract
Community-acquired pneumonia represents the most frequent bacterial infection in patients with HIV/AIDS. PURPOSE We aimed to assess variables associated with lower respiratory tract infection (LRTI) among HIV-infected adults using ART. METHODS A cohort study of HIV-infected patients aged ≥18 years, enrolled from 2000 to 2015, on ART for at least 60 days, with primary outcome as the 1st episode of LRTI during follow-up. The independent variables included were sex at birth, age, race/skin color, educational level, tobacco smoking, alcohol use, cocaine use, diabetes mellitus, CD4 count, HIV viral load, influenza and pneumococcal vaccination. Extended Cox proportional hazards models accounting for time-updated variables were fitted to assess LRTI predictors. RESULTS 2669 patients were included; median follow-up was 3.9 years per patient. LRTI was diagnosed in 384 patients; incidence rate was 30.7/1000 PY. In the unadjusted Cox extended models, non-white race [crude hazard ratio (cHR) 1.28, p = 0.020], cocaine use (cHR 2.01, p < 0.001), tobacco smoking (cHR 1.34, p value 0.007), and HIV viral load ≥400 copies/mL (cHR 3.40, p < 0.001) increased the risk of LRTI. Lower risk of LRTI was seen with higher educational level (cHR 0.61, p < 0.001), rise in CD4 counts (cHR 0.81, p < 0.001, per 100 cells/mm3 increase), influenza (cHR 0.60, p = 0.002) and pneumococcal vaccination (cHR 0.57, p < 0.001). In the adjusted model, aHR for CD4 count was 0.86, for cocaine use 1.47 and for viral load ≥400 copies 2.20. CONCLUSIONS LRTI has a high incidence in HIV-infected adults using ART. Higher CD4 counts and undetectable viral loads were protective, as were pneumococcal and influenza vaccines.
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Affiliation(s)
- Cristiane C Lamas
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro, RJ, CEP 21.040-900, Brazil.
- Universidade do Grande Rio, Rio de Janeiro, Brazil.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro, RJ, CEP 21.040-900, Brazil
| | - Beatriz J Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro, RJ, CEP 21.040-900, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro, RJ, CEP 21.040-900, Brazil
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Mohite PN, Zeriouh M, Sáez DG, Popov AF, Sabashnikov A, Zych B, Padukone A, Fazekas L, Ananiadou O, De Robertis F, Soresi S, Reed A, Carby M, Simon AR. Influence of history of cannabis smoking in selected donors on the outcomes of lung transplantation. Eur J Cardiothorac Surg 2017; 51:142-147. [PMID: 28077504 DOI: 10.1093/ejcts/ezw255] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/22/2016] [Accepted: 06/06/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cannabis is the most commonly abused illicit drug and the smokers are at the risk of lung infections, bullous emphysema and lung cancer. However, no evidence about the outcomes of lung transplantation (LTx) utilizing the lungs from such donors is available in the literature. METHODS We retrospectively analysed lung 'organ offers' and LTx at our centre between January 2007 and November 2013. The outcomes of LTx utilizing lungs from donors with a history of cannabis smoking were compared with the outcomes of those with no such history using unadjusted model as well as propensity score matching. RESULTS A total of 302 LTxs were performed during this period and were grouped depending on the history of cannabis smoking in donors-'cannabis' (n = 19) and control group (n = 283). All the donors in 'cannabis' group were tobacco smokers compared with 43% in the control group. Preoperative characteristics in recipients in both groups were comparable. Intraoperative and post-LTx variables including 1- and 3-year survivals were comparable in both groups. CONCLUSIONS The history of donor cannabis smoking does not appear to affect early and mid-term outcomes after LTx and potentially improve the donor pool. As it does not seem to negatively affect the outcomes after LTx, it should not be per se considered a contraindication for lung donation.
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Affiliation(s)
- Prashant N Mohite
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Mohamed Zeriouh
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Diana G Sáez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Bartlomiej Zych
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Ashok Padukone
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Levente Fazekas
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Olga Ananiadou
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Simona Soresi
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Anna Reed
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Martin Carby
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - André R Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
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Underner M, Perriot J, Peiffer G, Jaafari N. [Asthma and heroin use]. Presse Med 2017; 46:660-675. [PMID: 28734637 PMCID: PMC7126345 DOI: 10.1016/j.lpm.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/11/2017] [Accepted: 06/21/2017] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Heroin use can be responsible for many respiratory complications including asthma. OBJECTIVES Systematic literature review of data on asthma in heroin users. DOCUMENTARY SOURCES Medline®, on the period 1980-2017 with the following keywords: keywords: "asthma" or "bronchospasm" and "heroin" or "opiate" or "opiates", limits "title/abstract"; the selected languages were English or French. Among 97 articles, 67 abstracts have given use to a dual reading to select 23 studies. RESULTS The seven case reports included 21 patients (mean age: 28 years [19-46 years]; sex-ratio: 2.5 [males: 71.5%]). Heroin was inhaled (71.4%), sniffed (19%) or injected by intravenous route (9.5%). Associated addictive substances were tobacco (81%), cannabis (38%), alcohol (4.7%) and cocaine (4.7%). Outcome was fatal in 3 subjects (14.3%). Other studies included one cross-sectional study, 3 case-control studies and 12 longitudinal studies (11 retrospective studies and one prospective study). The proportion of heroin users was higher in asthmatic subjects and the prevalence of asthma and bronchial hyperreactivity was higher in heroin users. Heroin use can be responsible for asthma onset, with a temporal relationship between the onset of heroin use and asthma onset in 28 to 31% of subjects. A positive association between inhaled heroin use and acute asthma exacerbation was observed. Asthma treatment observance was lower in heroin users. In case of asthma exacerbation, heroin users were more likely to seek care in the emergency department, to be admitted in intensive care units and to require intubation and invasive ventilation. Asthma deaths related to heroin use mainly occurred following an intravenous injection (especially in the case of overdose), but also following heroin use by nasal (sniff) or pulmonary route. CONCLUSION Heroin use may be responsible for asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or deaths related to asthma. Heroin use must be sought in case of asthma exacerbation in young persons and practitioners must help heroin users to stop their consumption.
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Affiliation(s)
- Michel Underner
- Université de Poitiers, unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - Jean Perriot
- Centre de tabacologie, dispensaire Émile-Roux, 63100 Clermont-Ferrand, France
| | - Gérard Peiffer
- CHR Metz-Thionville, service de pneumologie, 57038 Metz, France
| | - Nematollah Jaafari
- Université de Poitiers, unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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Khwaja S, Yacoub A, Cheema A, Rihana N, Russo R, Velez AP, Nanjappa S, Sandin RL, Bohra C, Gajanan G, Greene JN. Marijuana Smoking in Patients With Leukemia. Cancer Control 2017; 23:278-83. [PMID: 27556668 DOI: 10.1177/107327481602300311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Worldwide, marijuana (cannabis) is a widely used drug. The incidence of marijuana smoking is increasing and is second only to tobacco as the most widely smoked substance in the general population. It is also the second most commonly used recreational drug after alcohol. Some adverse effects of marijuana smoking have been documented; however, the number of studies on the pulmonary effects of marijuana in individuals with leukemia is limited. In our case series, we report on 2 men with acute myeloid leukemia with miliary nodular lung patterns on computed tomography of the chest due to heavy marijuana use. We also report on 2 patients with acute lymphocytic leukemia who had a history of smoking marijuana and then developed lung opacities consistent with mold infection.
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Affiliation(s)
- Sara Khwaja
- Department of Infectious Diseases and Tropical Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA.
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