1
|
Ma DD, Shi WJ, Li SY, Zhang JG, Lu ZJ, Long XB, Liu X, Huang CS, Ying GG. Ephedrine and cocaine cause developmental neurotoxicity and abnormal behavior in zebrafish. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2023; 265:106765. [PMID: 37979497 DOI: 10.1016/j.aquatox.2023.106765] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
Ephedrine (EPH) and cocaine (COC) are illegal stimulant drugs, and have been frequently detected in aquatic environments. EPH and COC have negative effects on the nervous system and cause abnormal behaviors in mammals and fish at high concentrations, but their mechanisms of neurotoxicity remain unclear in larvae fish at low concentrations. To address this issue, zebrafish embryos were exposed to EPH and COC for 14 days post-fertilization (dpf) at 10, 100, and 1000 ng L-1. The bioaccumulation, development, behavior, cell neurotransmitter levels and apoptosis were detected to investigate the developmental neurotoxicity (DNT) of EPH and COC. The results showed that EPH decreased heart rate, while COC increased heart rate. EPH caused cell apoptosis in the brain by AO staining. In addition, behavior analysis indicated that EPH and COC affected spontaneous movement, touch-response, swimming activity and anxiety-like behaviors. EPH and COC altered the levels of the neurotransmitters dopamine (DA) and γ-aminobutyric acid (GABA) with changes of the transcription of genes related to the DA and GABA pathways. These findings indicated that EPH and COC had noticeable DNT in the early stage of zebrafish at environmentally relevant concentrations.
Collapse
Affiliation(s)
- Dong-Dong Ma
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Wen-Jun Shi
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China; Anti-Drug Technology Center of Guangdong Province and National Anti-Drug Laboratory Guangdong Regional Center, Guangdong Provincial Key Laboratory of Psychoactive Substances Monitoring and Safety, Guangzhou 510230, China.
| | - Si-Ying Li
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Jin-Ge Zhang
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Zhi-Jie Lu
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Xiao-Bing Long
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Xin Liu
- Anti-Drug Technology Center of Guangdong Province and National Anti-Drug Laboratory Guangdong Regional Center, Guangdong Provincial Key Laboratory of Psychoactive Substances Monitoring and Safety, Guangzhou 510230, China
| | - Chu-Shu Huang
- Anti-Drug Technology Center of Guangdong Province and National Anti-Drug Laboratory Guangdong Regional Center, Guangdong Provincial Key Laboratory of Psychoactive Substances Monitoring and Safety, Guangzhou 510230, China
| | - Guang-Guo Ying
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China; Anti-Drug Technology Center of Guangdong Province and National Anti-Drug Laboratory Guangdong Regional Center, Guangdong Provincial Key Laboratory of Psychoactive Substances Monitoring and Safety, Guangzhou 510230, China.
| |
Collapse
|
2
|
Chojnacki MR, Thorndike EB, Partilla JS, Rice KC, Schindler CW, Baumann MH. Neurochemical and Cardiovascular Effects of 4-Chloro Ring-Substituted Synthetic Cathinones in Rats. J Pharmacol Exp Ther 2023; 385:162-170. [PMID: 36669877 PMCID: PMC10201577 DOI: 10.1124/jpet.122.001478] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 01/22/2023] Open
Abstract
Synthetic cathinones are a class of new psychoactive substances that display psychomotor stimulant properties, and novel cathinone analogs continue to emerge in illicit drug markets worldwide. The aim of the present study was to characterize the pharmacology of 4-chloro ring-substituted cathinones that are appearing in illicit drug markets compared with the effects of 4-methylmethcathinone (mephedrone). Synaptosomes were prepared from rat caudate for dopamine transporter (DAT) assays or from whole brain minus caudate and cerebellum for norepinephrine transporter (NET) and serotonin transporter (SERT) assays. Findings from transporter uptake inhibition and release assays showed that mephedrone and 4-chloromethcathinone (4-CMC) function as substrates at DAT, NET, and SERT, with similar potency at all three transporters. In contrast, 4-chloro-α-pyrrolidinopropiophenone (4-CαPPP) was an uptake inhibitor at DAT and NET, with similar potency at each site, but had little activity at SERT. 4-Chloroethcathinone (4-CEC) was a low-potency uptake inhibitor at DAT and NET but a substrate at SERT. In rats implanted with telemetry transmitters, mephedrone and 4-CMC increased blood pressure, heart rate, and locomotor activity to a similar extent. 4-CEC and 4-CαPPP were less potent at increasing blood pressure and had modest stimulatory effects on heart rate and activity. 4-CMC also transiently decreased temperature at the highest dose tested. All three 4-chloro ring-substituted cathinones are biologically active, but only 4-CMC has potency comparable to mephedrone. Collectively, our findings suggest that 4-CMC and other 4-chloro cathinones may have abuse potential and adverse effects in humans that are analogous to those associated with mephedrone. SIGNIFICANCE STATEMENT: The 4-chloro ring-substituted cathinones all produced significant cardiovascular stimulation, with 4-chloromethcathinone (4-CMC) showing potency similar to mephedrone. All of the drugs are likely to be abused given their effects at the dopamine transporter, particularly 4-CMC.
Collapse
Affiliation(s)
- Michael R Chojnacki
- Designer Drug Research Unit (M.R.C., J.S.P., C.W.S., M.H.B.) and Preclinical Pharmacology Section (E.B.T., C.W.S.), National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland; and Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism Intramural Research Programs, Rockville, Maryland (K.C.R.)
| | - Eric B Thorndike
- Designer Drug Research Unit (M.R.C., J.S.P., C.W.S., M.H.B.) and Preclinical Pharmacology Section (E.B.T., C.W.S.), National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland; and Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism Intramural Research Programs, Rockville, Maryland (K.C.R.)
| | - John S Partilla
- Designer Drug Research Unit (M.R.C., J.S.P., C.W.S., M.H.B.) and Preclinical Pharmacology Section (E.B.T., C.W.S.), National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland; and Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism Intramural Research Programs, Rockville, Maryland (K.C.R.)
| | - Kenner C Rice
- Designer Drug Research Unit (M.R.C., J.S.P., C.W.S., M.H.B.) and Preclinical Pharmacology Section (E.B.T., C.W.S.), National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland; and Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism Intramural Research Programs, Rockville, Maryland (K.C.R.)
| | - Charles W Schindler
- Designer Drug Research Unit (M.R.C., J.S.P., C.W.S., M.H.B.) and Preclinical Pharmacology Section (E.B.T., C.W.S.), National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland; and Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism Intramural Research Programs, Rockville, Maryland (K.C.R.)
| | - Michael H Baumann
- Designer Drug Research Unit (M.R.C., J.S.P., C.W.S., M.H.B.) and Preclinical Pharmacology Section (E.B.T., C.W.S.), National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland; and Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism Intramural Research Programs, Rockville, Maryland (K.C.R.)
| |
Collapse
|
3
|
Dykxhoorn DM, Wang H, Da Fonseca Ferreira A, Wei J, Dong C. MicroRNA-423-5p Mediates Cocaine-Induced Smooth Muscle Cell Contraction by Targeting Cacna2d2. Int J Mol Sci 2023; 24:6584. [PMID: 37047559 PMCID: PMC10094933 DOI: 10.3390/ijms24076584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Cocaine abuse increases the risk of atherosclerotic cardiovascular disease (CVD) and causes acute coronary syndromes (ACS) and hypertension (HTN). Significant research has explored the role of the sympathetic nervous system mediating the cocaine effects on the cardiovascular (CV) system. However, the response of the sympathetic nervous system alone is insufficient to completely account for the CV consequences seen in cocaine users. In this study, we examined the role of microRNAs (miRNAs) in mediating the effect of cocaine on the CV system. MiRNAs regulate many important biological processes and have been associated with both response to cocaine and CV disease development. Multiple miRNAs have altered expression in the CV system (CVS) upon cocaine exposure. To understand the molecular mechanisms underlying the cocaine response in the CV system, we studied the role of miRNA-423-5p and its target Cacna2d2 in the regulation of intracellular calcium concentration and SMC contractility, a critical factor in the modulation of blood pressure (BP). We used in vivo models to evaluate BP and aortic stiffness. In vitro, cocaine treatment decreased miR-423-5p expression and increased Cacna2d2 expression, which led to elevated intracellular calcium concentrations and increased SMC contractility. Overexpression of miR-423-5p, silencing of its target Cacna2d2, and treatment with a calcium channel blocker reversed the elevated SMC contractility caused by cocaine. In contrast, suppression of miR-423-5p increased the intracellular calcium concentration and SMC contractibility. In vivo, smooth muscle-specific overexpression of miR-423-5p ameliorated the increase in BP and aortic stiffness associated with cocaine use. Thus, miR-423-5p regulates SMC contraction by modulating Cacna2d2 expression increasing intracellular calcium concentrations. Modulation of the miR-423-5p-Cacna2d2-Calcium transport pathway may represent a novel therapeutic strategy to improve cocaine-induced HTN and aortic stiffness.
Collapse
Affiliation(s)
- Derek M. Dykxhoorn
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Huilan Wang
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Andrea Da Fonseca Ferreira
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jianqin Wei
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chunming Dong
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Section of Cardiology, Miami VA Health Systems, Miami, FL 33136, USA
- Biomedical Research Building, Suite 812, 1501 NW 10th Avenue, Miami, FL 33136, USA
| |
Collapse
|
4
|
Short- and Long-Term Effects of Cocaine on Enteric Neuronal Functions. Cells 2023; 12:cells12040577. [PMID: 36831246 PMCID: PMC9954635 DOI: 10.3390/cells12040577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cocaine is one of the most consumed illegal drugs among (young) adults in the European Union and it exerts various acute and chronic negative effects on psychical and physical health. The central mechanism through which cocaine initially leads to improved performance, followed by addictive behavior, has already been intensively studied and includes effects on the homeostasis of the neurotransmitters dopamine, partly mediated via nicotinic acetylcholine receptors, and serotonin. However, effects on the peripheral nervous system, including the enteric nervous system, are much less understood, though a correlation between cocaine consumption and gastrointestinal symptoms has been reported. The aim of the present study was to gain more information on the effects of cocaine on enteric neuronal functions and the underlying mechanisms. For this purpose, functional experiments using an organ bath, Ussing chamber and neuroimaging techniques were conducted on gastrointestinal tissues from guinea pigs. Key results obtained are that cocaine (1) exhibits a stimulating, non-neuronal effect on gastric antrum motility, (2) acutely (but not chronically) diminishes responses of primary cultured enteric neurons to nicotinic and serotonergic stimulation and (3) reversibly attenuates neuronal-mediated intestinal mucosal secretion. It can be concluded that cocaine, among its central effects, also alters enteric neuronal functions, providing potential explanations for the coexistence of cocaine abuse and gastrointestinal complaints.
Collapse
|
5
|
Janardhan N, Roy PG, Vyas AK. Impact of maternal substance use on offspring's cardiovascular health. Toxicol Appl Pharmacol 2022; 450:116164. [PMID: 35842136 DOI: 10.1016/j.taap.2022.116164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
Abstract
Substance use (SU) during pregnancy is on the rise, posing significant risks to the developing fetus. The adverse impact of maternal alcohol and nicotine use during the perinatal period on offspring health has been well established, including their associations with adverse cardiovascular health in offspring. However, limited studies examine the impact of other well-known SU utilized during pregnancy on offspring's cardiovascular health. This review summarizes the proposed mechanism of action of four commonly utilized substances: cocaine, marijuana, methamphetamine, and opioids, and their cardiovascular impact. Furthermore, we will review the current understanding of the adverse impact of substance use during pregnancy on offspring's cardiovascular system based on existing studies. This review will also highlight possible molecular mechanisms underlying the in-utero adverse programming of offspring's cardiovascular system secondary to SU in pregnancy and address the gaps in current understanding of how SU adversely impacts the developing cardiovascular system of offspring in utero.
Collapse
Affiliation(s)
- Nitya Janardhan
- College of Medicine, California Northstate University, Elk Grove, CA, United States of America
| | - Pritha Ghosh Roy
- College of Medicine, California Northstate University, Elk Grove, CA, United States of America
| | - Arpita Kalla Vyas
- College of Medicine, California Northstate University, Elk Grove, CA, United States of America.
| |
Collapse
|
6
|
O'Keefe EL, Dhore A, Lavie CJ. Early Onset Cardiovascular Disease from Cocaine, Amphetamines, Alcohol, and Marijuana. Can J Cardiol 2022; 38:1342-1351. [PMID: 35840019 DOI: 10.1016/j.cjca.2022.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 01/16/2023] Open
Abstract
Cardiovascular disease (CVD), a disease typically associated with aging and the definitive leading cause of death worldwide, now threatens the young and middle-aged populations. Recreational abuse of alcohol, marijuana, cocaine and amphetamine-type stimulants has been an escalating public health problem for decades, but now use of these substances has become a significant contributor to early onset CVD. While this remains a global phenomenon, the epicenter of substance abuse is rooted in North America where it has been exacerbated by the COVID-19 pandemic. For the first time in history, the United States (US) crossed 100,000 overdose-related deaths in a calendar year. Sadly, Canada's recreational drug abuse problem closely mirrors that of the US. This is indicative of the larger public health crisis unfolding, as we now know that these substances are cardiotoxic and are contributing to the rising levels of premature chronic CVD, including hypertension, arrhythmias, heart failure, stroke, myocardial infarction, arterial dissection, sudden cardiac death and early mortality.
Collapse
Affiliation(s)
| | | | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA.
| |
Collapse
|
7
|
Chang S, Ryu Y, Bang SK, Jang HB, Ahn D, Kim HK, Lee H, Kim SC, Lee BH, Kim HY. An Increase in Peripheral Temperature following Cocaine Administration Is Mediated through Activation of Dopamine D2 Receptor in Rats. Life (Basel) 2022; 12:life12020143. [PMID: 35207431 PMCID: PMC8880706 DOI: 10.3390/life12020143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 11/16/2022] Open
Abstract
Drug addiction has become a worldwide problem, affecting millions of people across the globe. While the majority of mechanistic studies on drug addiction have been focused on the central nervous system, including the mesolimbic dopamine system, the peripheral actions of drugs of abuse remain largely unknown. Our preliminary study found that the systemic injection of cocaine increased peripheral skin temperature. This led us to our present study, which investigated the mechanisms underlying the increase in peripheral temperature following cocaine injection. Male Sprague Dawley rats were anesthetized with pentobarbital sodium, and peripheral skin temperature measurements were taken using a thermocouple needle microprobe and an infrared thermal camera. Cocaine injection caused an acute rise in peripheral body temperature, but not core body temperature, about 10 min after injection, and the temperature increases were occluded by systemic injection of dopamine D2 receptor antagonist L741,626, but not D1 receptor antagonist SCH23390. In addition, systemic administration of bromocriptine, a dopamine D2 receptor agonist, significantly increased peripheral temperature. Infrared thermal imaging showed that the thermal increases following cocaine injection were predominantly in the distal areas of the forelimbs and hindlimbs, relative to core body temperature. Treatment with cocaine or bromocriptine decreased the size of skin blood vessels without affecting the expression of dopamine D2 receptors. These results suggest that increased peripheral temperature in skin following cocaine injection is associated with the activation of the dopamine D2 receptor.
Collapse
Affiliation(s)
- Suchan Chang
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Korea; (S.C.); (H.B.J.); (D.A.); (H.K.K.); (B.H.L.)
| | - Yeonhee Ryu
- Korean Medicine Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea; (Y.R.); (S.K.B.)
| | - Se Kyun Bang
- Korean Medicine Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea; (Y.R.); (S.K.B.)
| | - Han Byeol Jang
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Korea; (S.C.); (H.B.J.); (D.A.); (H.K.K.); (B.H.L.)
| | - DanBi Ahn
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Korea; (S.C.); (H.B.J.); (D.A.); (H.K.K.); (B.H.L.)
| | - Hyung Kyu Kim
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Korea; (S.C.); (H.B.J.); (D.A.); (H.K.K.); (B.H.L.)
| | - Hubert Lee
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA;
| | - Sang Chan Kim
- Medical Research Center, College of Korean Medicine, Daegu Haany University, Gyeongsan 38610, Korea;
| | - Bong Hyo Lee
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Korea; (S.C.); (H.B.J.); (D.A.); (H.K.K.); (B.H.L.)
| | - Hee Young Kim
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu 42158, Korea; (S.C.); (H.B.J.); (D.A.); (H.K.K.); (B.H.L.)
- Correspondence:
| |
Collapse
|
8
|
Grubb AF, Greene SJ, Fudim M, Dewald T, Mentz RJ. Drugs of Abuse and Heart Failure. J Card Fail 2021; 27:1260-1275. [PMID: 34133967 DOI: 10.1016/j.cardfail.2021.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
Substance use is common among those with heart failure (HF) and is associated with worse clinical outcomes. Alcohol, tobacco, cannabis, and cocaine are commonly abused substances that can contribute to the development and worsening of HF. Heavy alcohol consumption can lead to dilated cardiomyopathy, whereas moderate intake may decrease incident HF. Tobacco increases the risk of HF through coronary artery disease and coronary artery disease-independent mechanisms. Continued smoking worsens outcomes for those with HF and cessation is associated with an improved risk of major adverse cardiac events. Cannabis has complex interactions on the cardiovascular system depending on the method of consumption, amount consumed, and content of cannabinoids. Delta-9-tetrahydrocannabinol can increase sympathetic tone, cause vascular dysfunction, and may increase the risk of myocardial infarction. Cannabidiol is cardioprotective in preclinical studies and is a potential therapeutic target. Cocaine increases sympathetic tone and is a potent proarrhythmogenic agent. It increases the risk of myocardial infarction and can also lead to a dilated cardiomyopathy. The use of beta-blockers in those with HF and cocaine use is likely safe and effective. Future studies are needed to further elucidate the impact of these substances both on the development of HF and their effects on those who have HF.
Collapse
Affiliation(s)
- Alex F Grubb
- Department of Medicine, Duke University Hospital, Durham, North Carolina.
| | - Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Tracy Dewald
- Department of Medicine, Division of Clinical Pharmacology Durham, North Carolina
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
9
|
Greve D, Funke J, Khairi T, Montagner M, Starck C, Falk V, Sá MPBO, Kurz SD. Cocaine-Related Aortic Dissection: what do we know? Braz J Cardiovasc Surg 2020; 35:764-769. [PMID: 33118742 PMCID: PMC7598981 DOI: 10.21470/1678-9741-2020-0333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Cocaine use is known to be associated with an increased risk for vascular diseases. It is likely to trigger or increase the risk for an aortic dissection. We conducted an analysis of 45 cases of cocaine-related aortic dissection to further characterize the clinical features and outcomes of this patient cohort. Methods Our study cohort of 45 patients consisted of 11 cases from our institutional database and 34 published case reports. Results The observed cases of acute aortic dissection related to cocaine use showed a high proportion of young (41.3±8.67 years) and male (88.9%) patients. Most of the cases (75%) were classified as Stanford type A. Also, in 75% of the cases, cocaine use was prevalent for more than one year. Median time from last cocaine use to onset of symptoms was one hour. In-hospital mortality was 21.4%, while additional 11.9% of the cases died before arriving at the hospital. Conclusion Acute aortic dissection related to cocaine use occurs in predominantly young male patients and has a dismal outcome when compared to all comer series.
Collapse
Affiliation(s)
- Dustin Greve
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joana Funke
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Tiam Khairi
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Matteo Montagner
- German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christoph Starck
- German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Berlin Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.,Swiss Federal Institute of Technology Department of Health Science and Technology Zurich Switzerland Department of Health Science and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Michel Pompeu B O Sá
- Universidade de Pernambuco (UPE) Pronto-Socorro Cardiológico de Pernambuco (PROCAPE) Division of Cardiovascular Surgery Recife Brazil Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Universidade de Pernambuco (UPE), Recife, Brazil
| | - Stephan D Kurz
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| |
Collapse
|
10
|
Park K, Chen W, Volkow ND, Allen CP, Pan Y, Du C. Hemodynamic and neuronal responses to cocaine differ in awake versus anesthetized animals: Optical brain imaging study. Neuroimage 2018; 188:188-197. [PMID: 30513396 DOI: 10.1016/j.neuroimage.2018.11.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/29/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022] Open
Abstract
Cocaine is a highly addictive drug with complex pharmacological effects. Most preclinical imaging studies investigating the effects of cocaine in the brain have been performed under anesthesia, which confounds findings. To tackle this problem, we used optical imaging to compare the effects of cocaine in the awake versus the anesthetized states. For this purpose, we customized an air floating mobile cage to fit the multi-wavelength spectral and laser speckle optical imaging system and implanted a multi-layer cranial window over the mouse somatosensory cortex. Results showed significant differences in neuronal activity and hemodynamics at baseline and in response to cocaine between the awake and the anesthetized states (isoflurane anesthesia). Specifically, 1) at baseline isoflurane dilated cerebral vessels, increased cerebral blood flow and depressed neuronal Ca2+ activity compared to the awake state; 2) acute cocaine (1 mg/kg iv) vasoconstricted blood vessels (arteries and veins) and decreased cerebral blood flow and oxygenated hemoglobin in the anesthetized state but not in the awake condition; 3) cocaine increased the accumulation of mean intracellular Ca2+ in neurons in the anesthetized state but not in the awake condition; and 4) in the awake state acute cocaine increased neuronal activities (increased the frequency of Ca2+ transients) and increased neuronal synchronization. We also corroborated that in the awake state cocaine also disrupted neurovascular coupling. These findings indicate that both vascular and neuronal responses to cocaine are influenced by isoflurane anesthesia, which highlights the importance of imaging awake animals when studying the effects of cocaine or other drugs in the brain.
Collapse
Affiliation(s)
- Kicheon Park
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Wei Chen
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Nora D Volkow
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20857, USA
| | - Craig P Allen
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Yingtian Pan
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Congwu Du
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA.
| |
Collapse
|
11
|
Zhu W, Wang H, Wei J, Sartor GC, Bao MM, Pierce CT, Wahlestedt CR, Dykxhoorn DM, Dong C. Cocaine Exposure Increases Blood Pressure and Aortic Stiffness via the miR-30c-5p-Malic Enzyme 1-Reactive Oxygen Species Pathway. Hypertension 2018; 71:752-760. [PMID: 29483230 DOI: 10.1161/hypertensionaha.117.10213] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 08/28/2017] [Accepted: 12/14/2017] [Indexed: 02/07/2023]
Abstract
Cocaine abuse increases the risk of cardiovascular mortality and morbidity; however, the underlying molecular mechanisms remain elusive. By using a mouse model for cocaine abuse/use, we found that repeated cocaine injection led to increased blood pressure and aortic stiffness in mice associated with elevated levels of reactive oxygen species (ROS) in the aortas, a phenomenon similar to that observed in hypertensive humans. This ROS elevation was correlated with downregulation of Me1 (malic enzyme 1), an important redox molecule that counteracts ROS generation, and upregulation of microRNA (miR)-30c-5p that targets Me1 expression by directly binding to its 3'UTR (untranslated region). Remarkably, lentivirus-mediated overexpression of miR-30c-5p in aortic smooth muscle cells recapitulated the effect of cocaine on Me1 suppression, which in turn led to ROS elevation. Moreover, in vivo silencing of miR-30c-5p in smooth muscle cells resulted in Me1 upregulation, ROS reduction, and significantly suppressed cocaine-induced increases in blood pressure and aortic stiffness-a similar effect to that produced by treatment with the antioxidant N-acetyl cysteine. Discovery of this novel cocaine-↑miR-30c-5p-↓Me1-↑ROS pathway provides a potential new therapeutic avenue for treatment of cocaine abuse-related cardiovascular disease.
Collapse
Affiliation(s)
- Wei Zhu
- From the Interdisciplinary Stem Cell Institute (W.Z., H.W., J.W., M.M.B., C.T.P., C.D.), Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences (G.C.S., C.R.W.), and Department of Human Genetics, John P. Hussman Institute for Human Genomics (D.M.D.), University of Miami Miller School of Medicine, FL
| | - Huilan Wang
- From the Interdisciplinary Stem Cell Institute (W.Z., H.W., J.W., M.M.B., C.T.P., C.D.), Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences (G.C.S., C.R.W.), and Department of Human Genetics, John P. Hussman Institute for Human Genomics (D.M.D.), University of Miami Miller School of Medicine, FL
| | - Jianqin Wei
- From the Interdisciplinary Stem Cell Institute (W.Z., H.W., J.W., M.M.B., C.T.P., C.D.), Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences (G.C.S., C.R.W.), and Department of Human Genetics, John P. Hussman Institute for Human Genomics (D.M.D.), University of Miami Miller School of Medicine, FL
| | - Gregory C Sartor
- From the Interdisciplinary Stem Cell Institute (W.Z., H.W., J.W., M.M.B., C.T.P., C.D.), Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences (G.C.S., C.R.W.), and Department of Human Genetics, John P. Hussman Institute for Human Genomics (D.M.D.), University of Miami Miller School of Medicine, FL
| | - Michelle Meiqi Bao
- From the Interdisciplinary Stem Cell Institute (W.Z., H.W., J.W., M.M.B., C.T.P., C.D.), Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences (G.C.S., C.R.W.), and Department of Human Genetics, John P. Hussman Institute for Human Genomics (D.M.D.), University of Miami Miller School of Medicine, FL
| | - Clay T Pierce
- From the Interdisciplinary Stem Cell Institute (W.Z., H.W., J.W., M.M.B., C.T.P., C.D.), Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences (G.C.S., C.R.W.), and Department of Human Genetics, John P. Hussman Institute for Human Genomics (D.M.D.), University of Miami Miller School of Medicine, FL
| | - Claes R Wahlestedt
- From the Interdisciplinary Stem Cell Institute (W.Z., H.W., J.W., M.M.B., C.T.P., C.D.), Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences (G.C.S., C.R.W.), and Department of Human Genetics, John P. Hussman Institute for Human Genomics (D.M.D.), University of Miami Miller School of Medicine, FL
| | - Derek M Dykxhoorn
- From the Interdisciplinary Stem Cell Institute (W.Z., H.W., J.W., M.M.B., C.T.P., C.D.), Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences (G.C.S., C.R.W.), and Department of Human Genetics, John P. Hussman Institute for Human Genomics (D.M.D.), University of Miami Miller School of Medicine, FL
| | - Chunming Dong
- From the Interdisciplinary Stem Cell Institute (W.Z., H.W., J.W., M.M.B., C.T.P., C.D.), Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences (G.C.S., C.R.W.), and Department of Human Genetics, John P. Hussman Institute for Human Genomics (D.M.D.), University of Miami Miller School of Medicine, FL.
| |
Collapse
|
12
|
Havakuk O, Rezkalla SH, Kloner RA. The Cardiovascular Effects of Cocaine. J Am Coll Cardiol 2017; 70:101-113. [PMID: 28662796 DOI: 10.1016/j.jacc.2017.05.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/26/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
Cocaine is the leading cause for drug-abuse-related visits to emergency departments, most of which are due to cardiovascular complaints. Through its diverse pathophysiological mechanisms, cocaine exerts various adverse effects on the cardiovascular system, many times with grave results. Described here are the varied cardiovascular effects of cocaine, areas of controversy, and therapeutic options.
Collapse
Affiliation(s)
- Ofer Havakuk
- Department of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Cardiology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shereif H Rezkalla
- Department of Cardiology and Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Robert A Kloner
- Department of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Huntington Medical Research Institute, Los Angeles, California.
| |
Collapse
|
13
|
Bachi K, Mani V, Jeyachandran D, Fayad ZA, Goldstein RZ, Alia-Klein N. Vascular disease in cocaine addiction. Atherosclerosis 2017; 262:154-162. [PMID: 28363516 PMCID: PMC5757372 DOI: 10.1016/j.atherosclerosis.2017.03.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 12/11/2022]
Abstract
Cocaine, a powerful vasoconstrictor, induces immune responses including cytokine elevations. Chronic cocaine use is associated with functional brain impairments potentially mediated by vascular pathology. Although the Crack-Cocaine epidemic has declined, its vascular consequences are increasingly becoming evident among individuals with cocaine use disorder of that period, now aging. Paradoxically, during the period when prevention efforts could make a difference, this population receives psychosocial treatment at best. We review major postmortem and in vitro studies documenting cocaine-induced vascular toxicity. PubMed and Academic Search Complete were used with relevant terms. Findings consist of the major mechanisms of cocaine-induced vasoconstriction, endothelial dysfunction, and accelerated atherosclerosis, emphasizing acute, chronic, and secondary effects of cocaine. The etiology underlying cocaine's acute and chronic vascular effects is multifactorial, spanning hypertension, impaired homeostasis and platelet function, thrombosis, thromboembolism, and alterations in blood flow. Early detection of vascular disease in cocaine addiction by multimodality imaging is discussed. Treatment may be similar to indications in patients with traditional risk-factors, with few exceptions such as enhanced supportive care and use of benzodiazepines and phentolamine for sedation, and avoiding β-blockers. Given the vascular toxicity cocaine induces, further compounded by smoking and alcohol comorbidity, and interacting with aging of the crack generation, there is a public health imperative to identify pre-symptomatic markers of vascular impairments in cocaine addiction and employ preventive treatment to reduce silent disease progression.
Collapse
Affiliation(s)
- Keren Bachi
- Brain Imaging Center (BIC), Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Venkatesh Mani
- Translational Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Devi Jeyachandran
- Pathology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Zahi A Fayad
- Translational Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Rita Z Goldstein
- Brain Imaging Center (BIC), Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Nelly Alia-Klein
- Brain Imaging Center (BIC), Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
| |
Collapse
|
14
|
Stankowski RV, Kloner RA, Rezkalla SH. Cardiovascular consequences of cocaine use. Trends Cardiovasc Med 2015; 25:517-26. [DOI: 10.1016/j.tcm.2014.12.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/03/2014] [Accepted: 12/17/2014] [Indexed: 11/28/2022]
|
15
|
Mersereau EJ, Poitra SL, Espinoza A, Crossley DA, Darland T. The effects of cocaine on heart rate and electrocardiogram in zebrafish (Danio rerio). Comp Biochem Physiol C Toxicol Pharmacol 2015; 172-173:1-6. [PMID: 25847362 PMCID: PMC4458413 DOI: 10.1016/j.cbpc.2015.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Abstract
Zebrafish (Danio rerio) have been used as a model organism to explore the genetic basis for responsiveness to addictive drugs like cocaine. However, very little is known about how the physiological response to cocaine is mediated in zebrafish. In the present study electrocardiograms (ECGs) were recorded from adult zebrafish treated with cocaine. Treatment with cocaine resulted in a bell-shaped dose response curve with a maximal change in heart rate seen using 5mg/L cocaine. Higher doses resulted in a higher percentage of fish showing bradycardia. The cocaine-induced tachycardia was blocked by co-treatment with propranolol, a β-adrenergic antagonist, but potentiated by co-treatment with phentolamine, an α-adrenergic antagonist. Co-treatment with atropine, a classic cholinergic antagonist, had no effect on cocaine-induced tachycardia. Cocaine treatment of adult fish changed the ECG of treated fish, inducing a dose-dependent increase in QT interval after adjusting for heart rate (QTc), while not affecting the PR or QRS intervals. The acute effects of cocaine on heart rate were examined in 5-day old embryos to see if zebrafish might serve as a suitable model organism to study possible links of embryonic physiological response to subsequent adult behavioral response to the drug. Cocaine treatment of 5-day old zebrafish embryos also resulted in a bell-shaped dose response curve, with maximal tachycardia achieved with 10mg/L. The response in embryonic fish was thus comparable to that in adults and raises the possibility that the effects of embryonic exposure to cocaine on the developing cardiovascular system can be effectively modeled in zebrafish.
Collapse
Affiliation(s)
- Erik J Mersereau
- University of North Dakota, Biology Department, Grand Forks, ND 58202-9019, USA
| | - Shelby L Poitra
- University of North Dakota, Biology Department, Grand Forks, ND 58202-9019, USA
| | - Ana Espinoza
- University of Arizona, Department of Ecology and Evolutionary Biology, Tucson, AZ 85721, USA
| | - Dane A Crossley
- University of North Texas, Department of Biological Sciences, Denton, TX 76203, USA
| | - Tristan Darland
- University of North Dakota, Biology Department, Grand Forks, ND 58202-9019, USA.
| |
Collapse
|
16
|
Affiliation(s)
- Bryan G Schwartz
- Heart Institute, Good Samaritan Hospital, 1225 Wilshire Blvd, Los Angeles, CA 90017-2395, USA
| | | | | |
Collapse
|
17
|
Li W, Su J, Sehgal S, Altura BT, Altura BM. Cocaine-induced relaxation of isolated rat aortic rings and mechanisms of action: possible relation to cocaine-induced aortic dissection and hypotension. Eur J Pharmacol 2004; 496:151-8. [PMID: 15288586 DOI: 10.1016/j.ejphar.2004.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Revised: 05/27/2004] [Accepted: 06/08/2004] [Indexed: 10/26/2022]
Abstract
Cocaine HCl is well known for its toxic effects on the cardiovascular system, but little is known about its effects on different regional blood vessels. We designed experiments to determine if cocaine HCl could influence the tension of isolated aortic rings, i.e., induce contraction or relaxation. Surprisingly, cocaine HCl (1 x 10(-5) to 6 x 10(-3) M) relaxed isolated aortic rings precontracted by phenylephrine in a concentration-dependent manner. No significant differences were found between intact or denuded isolated aortic rings (P>0.05). The maximal % relaxations of intact vs. denuded isolated aortic rings were 108.9+/-24.3% vs. 99.5+/-8.3% (P>0.05). Cocaine HCl, 2 x 10(-3) M, was found to inhibit contractions by phenylephrine; EC50s were increased (P<0.01) and Emax's were decreased (51.3+/-16.4% vs. 89.8+/-10.6%, P<0.01). A variety of amine antagonists could not inhibit the relaxant effects of cocaine HCl (P>0.05). The cyclooxygenase-1 inhibitor, indomethacin, also failed to inhibit relaxations induced by cocaine HCl (P>0.05). Neither L-arginine, NG-monomethyl-L-arginine (L-NMMA), nor methylene blue could inhibit the relaxations induced by cocaine HCl (P>0.05), suggesting cocaine HCl does not relax isolated aortic rings by inducing the synthesis or release of nitric oxide (NO) or prostanoids from either endothelial or vascular muscle cells. Inhibitors of cAMP, cGMP and protein kinase G (PKG) also failed to inhibit cocaine-induced relaxations. Cocaine HCl (1 x 10(-5) to 6 x 10(-3) M) could also relax isolated aortic rings precontracted by phenylephrine in high K+ depolarizing buffer. Surprisingly, calyculin A, an inhibitor of myosin light chain (MLC) phosphatase, inhibited cocaine-induced relaxations in a concentration-dependent manner, suggesting the probable importance of cocaine-induced MLC phosphatase activation in rat aortic smooth muscle cells. It was also found that cocaine HCl could dose-dependently inhibit Ca2+-induced contractions of isolated aortic rings in high K+-Ca2+-free buffer, suggesting that cocaine HCl may inhibit Ca2+ influx and/or intracellular release.
Collapse
Affiliation(s)
- Wenyan Li
- Department of Physiology and Pharmacology, State University of New York, Downstate Medical Center, Box 31, 450 Clarkson Avenue, Brooklyn, NY 11203-2056, USA
| | | | | | | | | |
Collapse
|
18
|
Frishman WH, Del Vecchio A, Sanal S, Ismail A. Cardiovascular manifestations of substance abuse part 1: cocaine. HEART DISEASE (HAGERSTOWN, MD.) 2003; 5:187-201. [PMID: 12783633 DOI: 10.1097/01.hdx.0000074519.43281.fa] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Substance abuse with cocaine is associated with multiple cardiovascular conditions, including myocardial infarction, dissection, left ventricular hypertrophy, arrhythmias, sudden death, and cardiomyopathy. Cocaine has effects to potentiate the physiologic actions of catecholamines and has direct effects on voltage-dependent sodium ion channels related to local anesthetic properties. The effects of cocaine can be augmented with concomitant alcohol consumption. Acute myocardial ischemia caused by cocaine may be related to in situ thromboisis and/or coronary vasospasm. Treatment strategies for cocaine-induced myocardial infarction would include antiplatelet therapy, thrombolysis, and vasodilators (eg, nitrates, nifedipine). Beta-adrenergic blockers should not be used unless concomitant vasodilator therapy is given.
Collapse
Affiliation(s)
- William H Frishman
- Departments of Medicine, The New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA
| | | | | | | |
Collapse
|
19
|
Sharma AK, Hamwi SM, Garg N, Castagna MT, Suddath W, Ellahham S, Lindsay J. Percutaneous interventions in patients with cocaine-associated myocardial infarction: a case series and review. Catheter Cardiovasc Interv 2002; 56:346-52. [PMID: 12112887 DOI: 10.1002/ccd.10210] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cocaine-associated myocardial infarction (CAMI) is a well-reported entity. Most previous reports on CAMI have been limited to conservative care utilizing benzodiazepines, aspirin, nitroglycerin, calcium channel blockers, and thrombolytics. Current guidelines on CAMI advocate immediate use of angiography and angioplasty if available rather than routine administration of thrombolytics. However, based on literature search from 1966 to 2001 (using keywords "cocaine," "myocardial infarction," and "angioplasty"), there have been only two case reports of percutaneous coronary intervention (PCI) in patients with cocaine-associated myocardial infarction. Both were notable for complications either during or immediately after the procedure. We report a series of 10 patients with cocaine-associated myocardial infarction who were treated with percutaneous interventions, which included angioplasty, stenting, and AngioJet mechanical extraction of thrombus. Despite the different arteriopathic process involved, our findings suggest that PCI can be performed safely and with a high degree of procedural success in patients with CAMI.
Collapse
Affiliation(s)
- Arvind K Sharma
- Section of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
| | | | | | | | | | | | | |
Collapse
|
20
|
Ishiguro Y, Morgan JP. Effect of endogenous catecholamine on myocardial stunning in a simulated ischemia model. Fundam Clin Pharmacol 2001; 15:111-6. [PMID: 11468020 DOI: 10.1046/j.1472-8206.2001.00015.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During ischemia, large amounts of catecholamine are released to the myocardium from the sympathetic nerve endings in the heart. It has not been clearly shown whether the released catecholamine has detrimental or beneficial effects on postischemic myocardial contractile function. The aim of the present study was to investigate the effect of endogenous catecholamine released during ischemia on myocardial contractile function, using ferret papillary muscles in a stimulated ischemia model. Papillary muscles were excised and mounted in organ baths containing oxygenated physiological salt solution at 37 degrees C. In order to eliminate the effect of endogenous catecholamine, a subset of animals was reserpinized for 2 days prior to the experiments. Muscles were stabilized for 1 h, and stretched to the length at which maximal isometric tension developed. Ischemia was simulated by changing the solution to liquid fluorocarbon bubbled with 95% N2 and 5% CO2. After 20 min of ischemia, the bathing medium was replaced with oxygenated physiological salt solution and developed tension was measured for 60 min. Pharmacologic agents with specific effects on myocardial autonomic pathways were used to investigate the cellular mechanisms of the observed effects. Tension recovery of reserpinized muscles was significantly better than control muscles (65.5 +/- 2.8% vs. 54.9 +/- 5.0%, P < 0.01). Exogenously administered beta-adrenergic antagonists did not attenuate stunning in control muscles; whereas forskolin and carbachol exacerbated stunning. These results indicate that catecholamine released during ischemia exacerbates myocardial stunning and overrides the effect of clinically relevant concentrations of beta-adrenergic antagonists, which may limit their ability to protect myocardium from acute ischemic insult. The effect of endogenous catecholamine was simulated by forskolin, but not attenuated by carbachol, which suggests that changes in the contractile apparatus activated by excess cyclic AMP were relevant to the mechanical dysfunction that developed.
Collapse
Affiliation(s)
- Y Ishiguro
- Department of Anesthesia and Critical Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | | |
Collapse
|
21
|
Zugibe FT, Breithaupt M, Costello J. Cardiotoxic mechanisms and interrelationships of cocaine: including a single case depicting several of these mechanisms. ACTA ACUST UNITED AC 1998; 5:140-6. [PMID: 15335536 DOI: 10.1016/s1353-1131(98)90034-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The underlying mechanisms of myocardial infarction as a result of cocaine abuse appear to be multifactorial. The various cardiotoxic mechanisms and interrelationships of cocaine are fully reviewed, and a chart has been reconstructed to give the reader a clearer understanding of them. Moreover, an unusual case of a 29-year-old male cocaine abuser is presented because it illustrates many of the reported cardiotoxic effects, all of which are present in the same individual.
Collapse
Affiliation(s)
- F T Zugibe
- University College of Physicians and Surgeons, New York, USA
| | | | | |
Collapse
|
22
|
Hurd WW, Betz AL, Dombrowski MP, Fomin VP. Cocaine augments contractility of the pregnant human uterus by both adrenergic and nonadrenergic mechanisms. Am J Obstet Gynecol 1998; 178:1077-81. [PMID: 9609587 DOI: 10.1016/s0002-9378(98)70551-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our purpose was to evaluate the mechanisms of cocaine's effect on both spontaneous and agonist-induced contractility of pregnant human myometrium. STUDY DESIGN Myometrium was obtained from 42 women at term who were undergoing cesarean section. Myometrial strips were suspended in contraction baths and isometric contractions were measured. Tissue was exposed to various combinations of cocaine, prazosin, desipramine, benzoylecgonine, and procaine. Spontaneous contractility and the contractile responses to increasing concentrations of methoxamine and oxytocin were measured and compared. RESULTS Cocaine increased spontaneous myometrial contractility by more than threefold. Prazosin, an alpha-adrenergic antagonist, blocked this effect only for the first 35 minutes of exposure. The cumulative concentration-response to the alpha-adrenergic agonist methoxamine was increased by cocaine in terms of both sensitivity and maximal response. The maximal response to oxytocin, but not the sensitivity, was increased by cocaine by an effect that could not be blocked by prazosin. CONCLUSION Cocaine augments spontaneous and agonist-induced contractility of pregnant human myometrium by mechanisms that appear to be both alpha-adrenergic and nonadrenergic in nature.
Collapse
Affiliation(s)
- W W Hurd
- Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, USA
| | | | | | | |
Collapse
|
23
|
Ishiguro Y, Morgan JP. Biphasic inotropic effects of methamphetamine and methylphenidate on ferret papillary muscles. J Cardiovasc Pharmacol 1997; 30:744-9. [PMID: 9436813 DOI: 10.1097/00005344-199712000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Methamphetamine and methylphenidate are structurally related agents that have direct negative inotropic (NIEs) and indirect positive inotropic effects (PIEs) in cardiac tissues. This study was designed to determine and compare cellular mechanisms of the NIEs of methamphetamine and methylphenidate by using a mammalian animal model. Isometric tension was measured in ferret papillary muscles in physiologic salt solution. A subset of muscles was loaded with the bioluminescent calcium indicator, aequorin. Further, to investigate the NIE of methamphetamine, the dose-response relations to isoproterenol, histamine, and calcium were measured with or without methamphetamine (2 x 10(-4) M), after adrenergic neuronal blockade with reserpine. Both methamphetamine and methylphenidate had direct NIEs at higher doses (>10(-4) M). A shift in the slope of the isoproterenol dose-response curve suggested involvement of the beta-adrenoceptor pathways. The direct NIE of methylphenidate was more prominent. Our results suggest that the negative inotropic effects of methamphetamine and methylphenidate may be important with clinically used and abused concentrations of these drugs and may be difficult to reverse with beta-adrenergic inotropic agents in cases of toxicity.
Collapse
Affiliation(s)
- Y Ishiguro
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
| | | |
Collapse
|
24
|
Pitts WR, Lange RA, Cigarroa JE, Hillis LD. Cocaine-induced myocardial ischemia and infarction: pathophysiology, recognition, and management. Prog Cardiovasc Dis 1997; 40:65-76. [PMID: 9247556 DOI: 10.1016/s0033-0620(97)80023-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
As cocaine abuse has become widespread, it has been associated with various cardiovascular complications, including angina pectoris, myocardial infarction, and sudden cardiac death. Cocaine's principal effects on the cardiovascular system are mediated via alpha-adrenergic stimulation and include (1) an increase in the determinants of myocardial oxygen demand (heart rate and systemic arterial pressure), and (2) a concomitant decrease in myocardial oxygen supply (caused by vasoconstriction of the epicardial coronary arteries). beta-adrenergic blocking agents may exacerbate cocaine-induced coronary arterial vasoconstriction, thereby increasing the magnitude of myocardial ischemia. In contrast, nitroglycerin and verapamil reverse cocaine-induced hypertension and coronary arterial vasoconstriction; therefore, they are the agents of choice in treating patients with cocaine-associated chest pain.
Collapse
Affiliation(s)
- W R Pitts
- Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center, Dallas 75235-9047, USA
| | | | | | | |
Collapse
|
25
|
Laporte R, DeRoth L. Modulation of the effects of norepinephrine uptake inhibitors on the norepinephrine-induced contractile response of the porcine uterine artery during early pregnancy. CANADIAN JOURNAL OF VETERINARY RESEARCH = REVUE CANADIENNE DE RECHERCHE VETERINAIRE 1997; 61:214-20. [PMID: 9243002 PMCID: PMC1189406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effects of norepinephrine (NE) uptake inhibitors on the porcine uterine artery's contractile response to NE and their potential alteration during early pregnancy (Day 13 postcoitus; day of coitus = Day 0) in comparison with the end of the luteal phase (Days 11-14; first day of behavioral estrus = Day 0) was investigated. This pregnancy time point is characterized by a transient increase in resting uterine blood flow dependent on the presence of blastocysts, an increased endometrial vascular permeability, and the beginning of the endometrial attachment of the blastocysts. A cumulative concentration-response curve (CCRC) to NE was produced in isometrically-mounted rings. Cocaine (5 microM) was used to inhibit neuronal NE uptake and hydrocortisone (30 microM) was used to inhibit extraneuronal NE uptake. Either drug alone induced a leftward shift of the CCRC to NE without affecting the maximal response. This shift had the same amplitude at the end of the luteal phase and in early pregnancy. However, the leftward shift induced by cocaine was larger than that induced by hydrocortisone only in early pregnancy, and the leftward shift induced by exposure to both hydrocortisone and cocaine was larger in early pregnancy than at the end of the luteal phase. These results suggest that a significant sensitization of the contractile response of the porcine uterine artery to NE is induced by neuronal and extraneuronal uptake inhibitors and that this effect is altered in early pregnancy, possibly reflecting the existence of a mechanism protecting the uterine artery against excessive sympathetic stimulation.
Collapse
Affiliation(s)
- R Laporte
- Départment de biomédecine vétérinaire, Faculté de médecine vétérinaire, Université de Montréal, Saint Hyacinthe (Québec)
| | | |
Collapse
|
26
|
Salom JB, Torregrosa G, Barberá MD, Jover T, Ortí M, Alborch E. Effects of cocaine on human and goat isolated cerebral arteries. Drug Alcohol Depend 1996; 42:65-71. [PMID: 8889405 DOI: 10.1016/0376-8716(96)01264-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cocaine abuse has been increasingly associated with cerebrovascular disease. We have studied the vasoactive properties of cocaine in branches of human middle cerebral artery and in goat middle cerebral artery isolated in an organ bath for isometric tension recording. Cocaine (10(-5) - 3 x 10(-4) M) induced small contractions, while higher concentrations (10(-3) - 3 x 10(-3) M) induced relaxation of human arteries at resting tension. In human arteries precontracted with KCl (50 mM), prostaglandin F- (10(-5) M) or endothelin-1(10(-9) M), cocaine (10(-6) - 3 x 10(-3) M) induced concentration-dependent relaxations which differed in terms of EC50 or maximum effect (Emax). With regard to goat arteries, cocaine (10(-6) - 3 x 10(-3) M) induced almost negligible changes in resting tension, and induced concentration-dependent relaxations of the arterial tone induced with KCl (50 mM). By contrast, goat arteries precontracted with prostaglandin F2 alpha (10(-5) M) or endothelin-1 (10(-9) M) showed biphasic concentration-response curves with concentration-dependent contractions to cocaine (10(-5) - 10(-3) M) and relaxation to the highest concentration (3 x 10(-3) M). Preincubation with cocaine (10(-4) - 10(-3) M) inhibited the contractile responses to CaCl2 (10(-6) - 10(-2) M) in depolarizing, Ca(2+)-free medium, and this inhibition was reversed by preincubation with the Ca2+ entry activator Bay K8644 (10(-10) - 10(-8) M). Therefore, cocaine induces tension changes in cerebral arteries which depend on the species, the arterial tone and the contractile agent inducing it. The relaxant effects could be attributed to the interference of cocaine with the role of Ca2+ in the maintenance of arterial tone, at least in part by blocking Ca2+ entry through membrane channels.
Collapse
Affiliation(s)
- J B Salom
- Centro de Investigación, Hospital Universitario La Fe, Valencia, Spain
| | | | | | | | | | | |
Collapse
|
27
|
Eisenberg MJ, Yakel DL, Mendelson J, Redberg RF, Jones RT, Foster E. Immediate effects of intravenous cocaine on the thoracic aorta and coronary arteries. A transesophageal echocardiographic study. Chest 1996; 110:147-54. [PMID: 8681619 DOI: 10.1378/chest.110.1.147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED STUDY OBJECTIVES AND DESIGN: Arterial vasoconstriction is thought to play a role in the etiology of cocaine-induced cardiovascular complications, but little is known about the immediate effects of cocaine on the thoracic aorta and coronary arteries. To examine these effects, we used transesophageal echocardiography to examine the thoracic aorta and coronary arteries before and immediately after intravenous (i.v.) cocaine (1.2 mg/kg) in 15 subjects. MEASUREMENTS AND RESULTS Immediately after cocaine infusion, average heart rate, systolic BP, and double product were increased compared with baseline (22%, 15%, 35%, respectively). There was no significant change in the diameters of the ascending aorta (27.5 vs 27.1 mm; p = 0.85), the descending aorta (19.8 vs 20.4 mm; p = 0.62), or the left main coronary artery (4.3 vs 4.7 mm; p = 0.15). However, there was a trend for an increase in coronary blood flow immediately after cocaine (226 vs 309 mL/min; p = 0.10). CONCLUSIONS We conclude that in the 15 subjects studied, there was no evidence of thoracic aorta of coronary artery vasoconstriction immediately after i.v. cocaine. Instead, we found that the diameters of the thoracic aorta and the left main coronary artery were unchanged, and that there was a trend for augmentation of coronary artery blood flow.
Collapse
Affiliation(s)
- M J Eisenberg
- Department of Medicine, John Henry Mills Echocardiography Laboratory, University of California, San Francisco 94143-0984, USA
| | | | | | | | | | | |
Collapse
|
28
|
Wang SY, Nunez BD, Morgan JP, Dai HB, Ross JN, Sellke FW. Cocaine and the porcine coronary microcirculation: effects of chronic cocaine exposure and hypercholesterolemia. J Cardiothorac Vasc Anesth 1995; 9:290-6. [PMID: 7669962 DOI: 10.1016/s1053-0770(05)80323-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine the acute effect of cocaine on the coronary microcirculation and whether chronic cocaine administration with or without a concomitant high-cholesterol diet affects beta-adrenoceptor and endothelial functions in the coronary microcirculation. DESIGN Prospective experimental study. SETTING Laboratory and animal research facility. PARTICIPANTS Yorkshire pigs. INTERVENTIONS Pigs were fed a high (2%)-cholesterol diet or a regular diet for 3 months. Animals in both groups received cocaine chronically (7 mg/kg/day, IM). Control animals were fed a regular diet. MEASUREMENTS AND MAIN RESULTS Responses of the porcine coronary arterioles (90 to 190 microns in diameter) were examined in vitro in a pressurized (40 mmHg) no-flow state using a video-imaging apparatus. Acute application of cocaine caused a significant contraction with a mean maximal diameter decrease of 14% +/- 5%, which was markedly reduced by muscarinic blockade but not significantly affected by alpha 1-adrenergic blockade. Lidocaine or procainamide had no vasoconstrictor effect. Chronic exposure of animals to cocaine diminished contractile responses to cocaine and reduced relaxation responses to the nonselective beta-adrenergic receptor agonist isoproterenol. Phenylephrine caused a minimal (< 4%) contraction of vessels in all groups. Chronic cocaine administration with concomitant high-cholesterol feeding attenuated endothelium-dependent relaxations to serotonin, whereas endothelium-dependent relaxations to bradykinin were unaffected. Endothelium-independent relaxations to sodium nitroprusside were similar in all groups. CONCLUSIONS These results suggest that cocaine can exert a direct vasoconstrictor effect on the porcine coronary microcirculation via a muscarinic mechanism. Chronic exposure to cocaine significantly decreases beta-adrenoceptor-mediated relaxation and blunts endothelium-dependent relaxation to a small degree.
Collapse
Affiliation(s)
- S Y Wang
- Department of Surgery, Beth Israel Hospital, Boston, MA 02215, USA
| | | | | | | | | | | |
Collapse
|
29
|
Affiliation(s)
- A H Mouhaffel
- Department of Medicine, Medical College of Ohio, Toledo 43699-0008, USA
| | | | | | | |
Collapse
|
30
|
Sato N, Brum JM, Mitsumoto H, DeBoer GE. Effect of cocaine on the contracture response to 1% halothane in patients undergoing diagnostic muscle biopsy for malignant hyperthermia. Can J Anaesth 1995; 42:158-62. [PMID: 7720160 DOI: 10.1007/bf03028270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Two case reports have cited the recreational use of cocaine as possible trigger of a malignant hyperthermia (MH) crisis. We evaluated whether toxic concentrations of cocaine altered the in vitro muscle response to halothane during contracture tests for MH. Twenty-two patients were studied. Muscle biopsies were obtained and first tested for MH susceptibility with 3% halothane and caffeine contracture testing. Ten patients were diagnosed as MH-susceptible and 12 as MH non-susceptible, in accordance with the North American Malignant Hyperthermia Group protocol. Then, muscle strips were exposed to 1% halothane in the presence and absence of 0.1 mmol.L-1 cocaine. Cocaine alone did not affect baseline muscle tension in either group. With 1% halothane, MH non-susceptible muscle showed no contracture with or without cocaine. In contrast, in the presence of 1% halothane, MH-susceptible muscle showed either no change in contracture (six patients), an increase (two patients), or a decrease (two patients) when exposed to cocaine. However, the overall effect of cocaine on muscle contracture in the presence of 1% halothane was insignificant in both groups. We conclude that cocaine, even at toxic levels, does not have a direct effect on skeletal muscle contractility and thus is safe for MH-susceptible patients.
Collapse
Affiliation(s)
- N Sato
- Division of Anesthesiology, Cleveland Clinic Foundation, OH 44195, USA
| | | | | | | |
Collapse
|
31
|
Abstract
It has become increasingly apparent that cocaine abuse can provoke lethal cardiac events, including myocardial infarction and ventricular fibrillation. The mechanisms responsible for these cardiotoxic actions of cocaine largely remain to be determined. Cocaine has two primary pharmacological properties that can adversely affect the heart and vasculature. Cocaine acts both as a local anesthetic (sodium and potassium channel blockade) and as a powerful cardiac stimulant that accentuates the actions of the sympathetic nervous system (inhibition of central and peripheral neuronal catecholamine uptake). The local anesthetic properties could impair impulse conduction, as well as elicit inhomogeneities in repolarization (refractory period), which creates an ideal substrate for reentrant arrhythmias. In addition, high doses of cocaine can depress contractile function due to inhibition of sodium/calcium exchange that results from decreased sodium influx (local anesthetic action). These actions are particularly obvious when sympathomimetic effects of cocaine are blunted. In a similar manner, the cocaine-induced accumulation of catecholamines potentiates the activation of alpha- and beta-adrenergic receptors, which can provoke coronary vasospasm (myocardial ischemia and infarction), increased contractile force (increased metabolic demand), and cardiac arrhythmias. The activation of adrenergic receptors will elicit a cascade of second messengers, ultimately provoking an increase in cytosolic calcium. These elevations in cytosolic calcium can provoke oscillations in membrane potential, triggering sustained action potential generation and extrasystoles. In particular, activation of the alpha IA-adrenergic receptor subtype and corresponding increase in calcium influx via voltage sensitive (L type) channels may play a critical role in the genesis of malignant arrhythmias. Thus, the adrenergic and local anesthetic properties of cocaine could act synergistically to elicit toxic actions on the heart.
Collapse
Affiliation(s)
- G E Billman
- Department of Physiology, Ohio State University, Columbus, USA
| |
Collapse
|
32
|
Madden JA, Konkol RJ, Keller PA, Alvarez TA. Cocaine and benzoylecgonine constrict cerebral arteries by different mechanisms. Life Sci 1995; 56:679-86. [PMID: 7869849 DOI: 10.1016/0024-3205(94)00501-i] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study was designed to determine possible mechanisms underlying the vasoconstrictor activity of cocaine and its principal metabolite, benzoylecgonine (BE) in cat isolated cerebral arteries. The arteries constricted significantly in response to single doses of cocaine, BE and norepinephrine (NE; (P < 0.05). After 6-OHDA treatment to remove adrenergic nerve endings, NE-induced constrictions were essentially unchanged from those before treatment. Denervated arteries exposed to cocaine dilated significantly (P < 0.05) but those exposed to BE constricted as much as before denervation. Following exposure to prazosin and yohimbine, arterial constrictions to NE and cocaine were significantly reduced from control (P < 0.05) but the BE-induced constriction was unchanged. Ryanodine eliminated the cocaine-induced contraction (P < 0.05) whereas verapamil eliminated the BE response (P < 0.05). These data suggest that while cocaine's vasoconstrictor action may be significantly mediated through adrenergic transmission, BE may act through a mechanism involving calcium (Ca2+) channels. Cocaine levels peak and decline in the body more rapidly than BE levels which can remain detectable for days. This study suggests there may also be different pharmacological mechanisms as well as temporal differences underlying the vasoreactivity of these two substances. Our findings may have implications for pharmacological management of cocaine-induced toxic vascular events.
Collapse
Affiliation(s)
- J A Madden
- Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | | | | | | |
Collapse
|
33
|
Byg AM, Bund S, Mulvany MJ, Aalkjaer C. The effect of cocaine and desipramine on neuronal uptake of [3H]-noradrenaline and sensitivity to noradrenaline of rat mesenteric resistance arteries. Clin Exp Pharmacol Physiol 1994; 21:623-30. [PMID: 7813121 DOI: 10.1111/j.1440-1681.1994.tb02563.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
1. The effects of cocaine and desipramine (DMI) on neuronal uptake (uptake1) of [3H]-noradrenaline (NA) and isometric tension development to exogenous NA were assessed in mesenteric resistance arteries of Wistar rats. 2. Both drugs concentration-dependently inhibited [3H]-NA uptake1, DMI being more potent than cocaine. The maximum inhibition produced by each drug was the same as that produced by denervation with 6-hydroxydopamine. In denervated vessels there was no effect of cocaine on [3H]-NA uptake1. 3. Cocaine, in the same concentration range which caused inhibition of uptake1, increased the sensitivity to NA, while DMI, in a concentration range which inhibited uptake1, did not increase the sensitivity to NA and at high concentrations reduced the sensitivity and maximal response to NA. Since DMI affected responses to NA but not responses to vasopressin and potassium its effect is probably related to blockade of alpha 1-adrenoceptors. 4. We conclude that the effect of cocaine on the sensitivity to NA reflects inhibition of uptake1 in rat resistance arteries, while DMI cannot be used to assess the functional effect of uptake1 in this preparation.
Collapse
Affiliation(s)
- A M Byg
- Department of Medicine, University of Manchester, UK
| | | | | | | |
Collapse
|
34
|
Negus BH, Willard JE, Hillis LD, Glamann DB, Landau C, Snyder RW, Lange RA. Alleviation of cocaine-induced coronary vasoconstriction with intravenous verapamil. Am J Cardiol 1994; 73:510-3. [PMID: 8141094 DOI: 10.1016/0002-9149(94)90684-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- B H Negus
- Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center, Dallas 75235-9047
| | | | | | | | | | | | | |
Collapse
|
35
|
Kolodgie FD, Wilson PS, Cornhill JF, Herderick EE, Mergner WJ, Virmani R. Increased prevalence of aortic fatty streaks in cholesterol-fed rabbits administered intravenous cocaine: the role of vascular endothelium. Toxicol Pathol 1993; 21:425-35. [PMID: 8115819 DOI: 10.1177/019262339302100501] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Several recent postmortem studies suggest an increased prevalence of atherosclerosis in young habitual cocaine abusers. However, little is known about the effects of cocaine abuse on the vascular endothelium and its relationship to atherosclerosis. Therefore, the consequence of chronic administration of intravenous cocaine on the induction of aortic sudanophilia was examined. Male New Zealand White rabbits were fed a 0.5% cholesterol diet for 10 wk. During this period, animals were randomized to receive either cocaine-hydrochloride (0.25 mg/kg) intravenously (n = 17) twice daily; or an equivalent volume of 0.9% physiologic saline, control group (n = 16). Mean values for total circulating leukocytes and platelets and total plasma cholesterol and triglycerides were similar in both groups throughout the protocol. At the completion of the study, aortic sudanophilia was measured and expressed as a percentage of regional involvement (R1 = proximal 4 cm, R2 = middle 6 cm, and R3 = distal 10 cm). Statistical significance among groups was achieved in the proximal thoracic aorta (p = 0.057). No significant differences in sudanophilia were noted in the middle and distal segments. When animals were placed in subgroups according to percent total plaque involvement, there was a significant increased distribution of rabbits with a greater extent of sudanophilia in the cocaine-treated group as compared with control (p = 0.01, chi-square analysis). Immunocytochemical studies using the macrophage-specific and muscle actin-specific monoclonal antibodies demonstrated that sudanophilic areas in both groups were predominantly composed of macrophage-derived foam cells. Evaluation of plaque morphology showed an increase in intimal plaque thickness and in the number of macrophages and smooth muscle cells in cocaine-treated animals; however, group differences were not statistically significant. Because no significant differences were found in the cellular composition of atherosclerotic plaques between groups, further studies were performed to assess the effects of cocaine on the permeability function of cultured endothelial cell monolayers as a possible mechanism of increased sudanophilia. Cocaine (100 microM)-treated endothelial cell monolayers demonstrated an increased permeability to horseradish peroxidase during all time intervals studied (0-6 hr). Permeability differences were statistically significant at 30 min and 1 hr (p = 0.003 and 0.02, respectively). Collectively, these observations suggest that administration of cocaine to cholesterol-fed rabbits increases the prevalence of aortic sudanophilia via at least one possible mechanism involving enhanced vascular permeability.
Collapse
Affiliation(s)
- F D Kolodgie
- Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, D.C. 20306
| | | | | | | | | | | |
Collapse
|
36
|
Watanabe C, Yamamoto H, Kobayashi S, Kanaide H. Extracellular Ca(2+)-dependent potentiation by cocaine of serotonin- and norepinephrine-induced contractions in rat vascular smooth muscle. Circ Res 1993; 72:1191-201. [PMID: 8495549 DOI: 10.1161/01.res.72.6.1191] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Using front-surface fluorometry, we determined the effects of cocaine on force and cytosolic Ca2+ concentration ([Ca2+]i) in the rat aorta. We also examined the effects of cocaine on 45Ca2+ influx. Cocaine (10(-7) to 10(-4) M) alone did not alter the resting level of [Ca2+]i and force. Cocaine (< 10(-4) M), in a concentration-dependent manner, potentiated the 10(-6) M serotonin (5-HT)-induced or 10(-8) M norepinephrine (NE)-induced sustained increase in [Ca2+]i and force in the presence of extracellular Ca2+, whereas it had no potentiating effects in Ca(2+)-free solution. Similar potentiating effects of cocaine were observed in pharmacologically denervated strips. Cocaine (10(-5) M) produced a leftward shift of concentration-response curves for both 5-HT- and NE-induced increases in [Ca2+]i and force with no effect on the maximal response or the relations between [Ca2+]i and force. Cocaine (10(-5) M also accelerated the 45Ca2+ influx during activation by 10(-6) M 5-HT or by 10(-8) M NE. Cocaine (> 10(-3) M) inhibited 5-HT-, NE-, and high-K+ depolarization-induced contractions accompanied by decreases in [Ca2+]i in normal physiological salt solution and 5-HT- or NE-induced transient increase in [Ca2+]i and force in Ca(2+)-free physiological salt solution. Thus, low concentrations of cocaine potentiate NE- or 5-HT-induced contraction by augmenting the increase in [Ca2+]i. These potentiating effects may derive from either an increase in the affinity of the receptors to agonists or an increase in the Ca2+ influx. On the other hand, high concentrations of cocaine (> 10(-3) M) have a relaxant effect on vascular smooth muscle, as a result of a decrease in [Ca2+]i.
Collapse
Affiliation(s)
- C Watanabe
- Division of Molecular Cardiology, Research Institute of Angiocardiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
| | | | | | | |
Collapse
|
37
|
Mehta SK, Finkelhor RS, Anderson RL, Harcar-Sevcik RA, Wasser TE, Bahler RC. Transient myocardial ischemia in infants prenatally exposed to cocaine. J Pediatr 1993; 122:945-9. [PMID: 8501575 DOI: 10.1016/s0022-3476(09)90025-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This prospective study examined whether neonates of pregnant women who used cocaine during pregnancy are at a risk for the development of transient myocardial ischemia and altered autonomic function, as in adults. We studied 21 of 35 infants with a history of prenatal exposure to cocaine. The ST segment changes and heart rate variability were evaluated from three-channel Holter monitors within 48 hours of birth. The data were compared with those on 20 control infants with similar birth weight, gestational age, and postnatal age. Six infants (29%) who were exposed to cocaine in utero had transient ST segment elevation, versus only one infant (5%) from the control group (odds ratio = 7.6; 95% confidence interval, 1.14, 50.64). Heart rates, results of total power and low-frequency power spectral analyses for heart rate variability, and arrhythmias were not significantly different in the two groups. However, a lower ratio of low-to high-frequency power reflected increased vagal activity in cocaine-exposed infants. We conclude that cocaine use in pregnant mothers is associated with transient ST segment abnormalities in their infants. These abnormalities are consistent with transient myocardial ischemia.
Collapse
Affiliation(s)
- S K Mehta
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Liu CP, Tunin C, Kass DA. Transient time course of cocaine-induced cardiac depression versus sustained peripheral vasoconstriction. J Am Coll Cardiol 1993; 21:260-8. [PMID: 8417069 DOI: 10.1016/0735-1097(93)90746-n] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The goal of this study was to define in vivo the magnitude and temporal course of cocaine-induced cardiac depression separate from peripheral vascular loading changes. BACKGROUND Cocaine administration immediately alters arterial pressure, ventricular filling, contractility and heart rate. These combined changes have complicated previous analyses of the cardiac effects of cocaine, because routine measures of function are influenced by all these factors. METHODS Pressure-volume loops and relations were measured by conductance catheter technique in 10 intact chest anesthetized dogs before and up to 30 min after administration of cocaine (3 mg/kg intravenously). Heart rate was kept constant by atrial pacing, and data were obtained before and after ganglionic blockade. RESULTS Cocaine decreased ejection fraction, cardiac output and maximal rate of rise of left ventricular pressure (dP/dtmax) and increased arterial vascular resistance (all p < 0.05). The maximal change occurred by 2 min and was fully sustained for the next 30 min. In contrast, contractile indexes based on pressure-volume analysis (e.g., end-systolic pressure-volume relation) decreased only briefly at 2 min (by -19%) and returned to control value after 5 to 10 min. Reflex blockade with hexamethonium eliminated cocaine-induced vasoconstriction, but the magnitude and brevity of cardiac depression were unaltered. Ejection fraction, dP/dtmax and cardiac output now also decreased transiently, suggesting that the sustained changes observed before blockade in these variables were load related. Analogous load effects also explained changes in peak filling rate. CONCLUSIONS Cocaine induces brief direct cardiac depression that is temporally dissociated from more sustained peripheral vasoconstriction. This dissociation is not measured by traditional left ventricular function analysis because of simultaneous load change. The transience of cardiac depression suggests that it probably does not play a major role in late adverse sequelae of cocaine administration.
Collapse
Affiliation(s)
- C P Liu
- Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | | | | |
Collapse
|
40
|
Abstract
It is clear that cocaine has cardiotoxic effects. Acute doses of cocaine suppress myocardial contractility, reduce coronary caliber and coronary blood flow, induce electrical abnormalities in the heart, and in conscious preparations increase heart rate and blood pressure. These effects will decrease myocardial oxygen supply and may increase demand (if heart rate and blood pressure rise). Thus, myocardial ischemia and/or infarction may occur, the latter leading to large areas of confluent necrosis. Increased platelet aggregability may contribute to ischemia and/or infarction. Young patients who present with acute myocardial infarction, especially without other risk factors, should be questioned regarding use of cocaine. As recently pointed out by Cregler, cocaine is a new and sometimes unrecognized risk factor for heart disease. Acute depression of LV function by cocaine may lead to the presence of a transient cardiomyopathic presentation. Chronic cocaine use can lead to the above problems as well as to acceleration of atherosclerosis. Direct toxic effects on the myocardium have been suggested, including scattered foci of myocyte necrosis (and in some but not all studies, contraction band necrosis), myocarditis, and foci of myocyte fibrosis. These abnormalities may lead to cases of cardiomyopathy. Left ventricular hypertrophy associated with chronic cocaine recently has been described. Arrhythmias and sudden death may be observed in acute or chronic use of cocaine. Miscellaneous cardiovascular abnormalities include ruptured aorta and endocarditis. Most of the cardiac toxicity with cocaine can be traced to two basic mechanisms: one is its ability to block sodium channels, leading to a local anesthetic or membrane-stabilizing effect; the second is its ability to block reuptake of catecholamines in the presynaptic neurons in the central and peripheral nervous system, resulting in increased sympathetic output and increased catecholamines. Other potential mechanisms of cocaine cardiotoxicity include a possible direct calcium effect leading to contraction of vessels and contraction bands in myocytes, hypersensitivity, and increased platelet aggregation (which may be related to increased catecholamine). The correct therapy for cocaine cardiotoxicity is not known. Calcium blockers, alpha-blockers, nitrates, and thrombolytic therapy show some promise for acute toxicity. Beta-Blockade is controversial and may worsen coronary blood flow. In patients who develop cardiomyopathy, the usual therapy for this entity is appropriate.
Collapse
Affiliation(s)
- R A Kloner
- Heart Institute Research Department, Hospital of the Good Samaritan, Los Angeles, Calif. 90017
| | | | | | | |
Collapse
|
41
|
Zavecz JH, Anderson WM. Chronic cocaine administration decreases norepinephrine-induced phosphoinositide hydrolysis in rat aorta. Life Sci 1992; 51:1675-81. [PMID: 1331639 DOI: 10.1016/0024-3205(92)90312-d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The effect of chronic cocaine administration on norepinephrine stimulated hydrolysis of inositol 1,4,5-trisphosphate from the membrane phosphatidylinositol phosphate pool in isolated rat aorta was investigated. Rats received saline (controls), or 10 or 20 mg/kg cocaine once a day for 15 days. This treatment resulted in a dose-dependent reduction in norepinephrine (0.36 microM) stimulated phosphoinositide hydrolysis. The effect of acute cocaine was determined by adding 30 microM cocaine to the in vitro incubation solution. When aortas were exposed to cocaine and norepinephrine simultaneously, in vitro, inositol phosphate formation doubled. By itself, cocaine did not affect phosphoinositide hydrolysis. Contraction of aortic helical strips by norepinephrine decreased in tissues from rats chronically treated with 20 mg/kg cocaine. In vitro cocaine shifted the norepinephrine concentration/response curve to the left and increased the maximum response. Neither acute nor chronic cocaine treatment affected prazosin's apparent dissociation constant, suggesting that cocaine did not affect receptor affinity. These data suggest that chronic, but not acute cocaine administration may interfere with pharmacomechanical coupling in rat aorta.
Collapse
Affiliation(s)
- J H Zavecz
- Department of Pharmacology, Louisiana State University Medical Center, Shreveport 71130
| | | |
Collapse
|