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Paz-Ramos MI, Violante-Soria V, Browne T, Cruz SL. Effects of fentanyl and the adulterant levamisole on the rewarding and locomotor effects of methamphetamine in rats. Drug Alcohol Depend 2024; 256:111098. [PMID: 38266573 DOI: 10.1016/j.drugalcdep.2024.111098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND People who use psychostimulant substances can be exposed to unknown adulterants, such as the synthetic opioid fentanyl (FEN) and the anthelmintic cholinergic agent levamisole (LEV). This work explores the rewarding and locomotor effects of methamphetamine (METH) in combination with FEN or LEV. METHODS We used adult male Wistar rats in the conditioned-place preference (CPP) paradigm (conditioning, extinction, and reinstatement phases) and in the open field test to study effective doses of METH, FEN, or LEV, or ineffective doses of METH+FEN or METH+LEV in combination. RESULTS METH and LEV, at 1mg/kg METH each, and 30µg/kg FEN produced CPP. Extinction to METH- or LEV-induced CPP occurred after eight saline injections, but it took 8-26 sessions to extinguish FEN-induced CPP. A challenge dose of 0.5mg/kg METH reinstated CPP. The same occurred with 15µg/kg FEN but not with 0.5 or 1mg/kg LEV. Training animals with ineffective doses of METH (0.01mg/kg) combined with either FEN (0.3µg/kg) or LEV (0.01mg/kg) produced CPP. Sub-effective doses of METH or FEN alone did not induce reinstatement after extinction. However, animals challenged with LEV, METH+FEN, or METH+LEV mixtures did it. Combining FEN (3µg/kg) with 0.1mg/kg METH increased locomotor activity. CONCLUSION Ineffective FEN and LEV doses mixed with METH produce effects larger than would be expected based on the effects of either drug alone. This outcome suggests a supra-additive interaction, which could increase the risk of developing a METH use disorder.
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Affiliation(s)
| | | | - Thom Browne
- Colombo Plan Secretariat, Drug Advisory Program, Colombo, Sri Lanka
| | - Silvia L Cruz
- Center for Research and Advanced Studies, Mexico City, Mexico.
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Idoko ND, Chukwuma IF, Nworah FN, Mba SE, Joshua PE, Nwodo OFC, Abusudah WF, Almohmadi NH, de Waard M. Immunomodulatory effects of epiphytic Loranthus micranthus leaf extracts collected from two host plants: Psidium guajava and Parkia biglobosa. BMC Complement Med Ther 2024; 24:7. [PMID: 38166988 PMCID: PMC10759741 DOI: 10.1186/s12906-023-04282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Immunological abnormalities are implicated in the pathogenesis of many chronic diseases. Due to the drug-related adverse effects of currently available orthodox immunomodulators, natural immunomodulators are being looked upon as potential agents to replace them in therapeutic regimens. This research aimed to investigate the immunomodulatory potential of L. micranthus extracts epiphytic on Psidium guajava (LMPGE) and Parkia biglobosa (LMPBE). METHODS Phytochemical screening and acute toxicity testing were carried out to identify the phytoconstituents and safety profiles of the extracts. The extracts' innate and adaptive immunomodulatory potentials were determined in experimental animals using in vivo leucocyte mobilization, delayed-type hypersensitivity (DTH) response, hemagglutination antibody titre, and cyclophosphamide-induced myelosuppression models. Levamisole was used as the standard drug throughout the study. RESULTS Compared to LMPBE, LMPGE contained significantly (p < 0.05) more tannins, cyanogenic glycosides, saponins, reducing sugars, glycosides, flavonoids, and alkaloids. Furthermore, the groups treated with the extracts had a significant (p < 0.05) increase in the total number of leucocytes, neutrophils, basophils, and antibody titers relative to the untreated control. In the same way, the treatment raised TLC in cyclophosphamide-intoxicated rats, with 250 mg/kg b. w. of LMPGE and LMPBE recording 9712.50 ± 178.00 and 8000.00 ± 105.00 × 109 /L, respectively, compared to 3425.00 ± 2 5.00 × 109 /L in the untreated group. Overall, LMPGE was more effective. CONCLUSIONS The findings from this study suggest that L. micranthus epiphytic in Psidium guajava and Parkia biglobosa has possible immune stimulating potential.
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Affiliation(s)
- Ngozi Dorathy Idoko
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka, Nigeria
| | - Ifeoma Felicia Chukwuma
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka, Nigeria.
| | - Florence Nkechi Nworah
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka, Nigeria
| | | | - Parker Elijah Joshua
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka, Nigeria
| | - Okwesilieze Fred Chiletugo Nwodo
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, College of Medicine Enugu State University of Science and Technology, Enugu, Nigeria
| | - Wafaa Fouzi Abusudah
- Clinical Nutrition Department, College of Applied Medical Sciences, UMM AL-QURA University, Makkah, 24381, Saudi Arabia
| | - Najlaa Hamed Almohmadi
- Clinical Nutrition Department, College of Applied Medical Sciences, UMM AL-QURA University, Makkah, 24381, Saudi Arabia
| | - Michel de Waard
- Smartox Biotechnology, 6 rue des Platanes, 38120, Saint-Egrève, France
- L'institut du thorax, INSERM, CNRS, Univ nantes, F-44007, Nantes, France
- Université de Nice Sophia-Antipolis, LabEx «Ion Channels, Science & Therapeutics, F-06560, Valbonne, France
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3
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Bavato F, Kexel AK, Kluwe-Schiavon B, Maceski A, Baumgartner MR, Seifritz E, Kuhle J, Quednow BB. A Longitudinal Investigation of Blood Neurofilament Light Chain Levels in Chronic Cocaine Users. Mol Neurobiol 2023; 60:3935-3944. [PMID: 37000398 DOI: 10.1007/s12035-023-03327-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
The identification of a blood marker of brain pathology that is sensitive to substance-induced neurotoxicity and dynamically responds to longitudinal changes in substance intake would substantially improve clinical monitoring in the field of substance use and addiction. Here, we explored the hypothesis that plasma levels of neurofilament light chain (NfL), a promising marker of neuroaxonal pathology, are elevated in chronic cocaine users and longitudinally associated with changes in cocaine use. Plasma NfL levels were determined using single molecule array (SIMOA) technology at baseline and at a 4-month follow-up. Substance use was subjectively assessed with an extensive interview and objectively measured via toxicological analysis of urine and 4-month hair samples. In a generalized linear model corrected for sex, age, and body mass index, NfL plasma levels were elevated in cocaine users (n=35) compared to stimulant-naïve healthy controls (n=35). A positive correlation between cocaine hair concentration and NfL levels was also found. Changes in cocaine hair concentration (group analysis of increasers vs. decreasers) over the 4-month interval predicted NfL levels at follow-up, indicating a rise in NfL with increased cocaine use and a reduction with decreased use. No associations between use or change of use of other substances (including the neurotoxic cocaine adulterant levamisole) and NfL levels were found. Our findings demonstrate that NfL is a sensitive marker for assessing cocaine-related neuroaxonal pathology, supporting the utility of blood NfL analysis in addiction research but also suggesting the detailed assessment of substance use in neurological studies and diagnostics.
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Affiliation(s)
- Francesco Bavato
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, CH-8032, Zurich, Switzerland.
| | - Ann-Kathrin Kexel
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, CH-8032, Zurich, Switzerland
| | - Bruno Kluwe-Schiavon
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, CH-8032, Zurich, Switzerland
| | - Aleksandra Maceski
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Markus R Baumgartner
- Center of Forensic Hairanalytics, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, CH-8032, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
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Tollens N, Post P, Martins Dos Santos M, Niggemann P, Warken M, Wolf J. Multifocal leukoencephalopathy associated with intensive use of cocaine and the adulterant levamisole in a 29-year old patient. Neurol Res Pract 2022; 4:38. [PMID: 35909197 PMCID: PMC9341090 DOI: 10.1186/s42466-022-00202-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractLevamisole is a common adulterant of cocaine and has been associated with reversible leukoencephalopathy in cocaine users. We report a case of two episodes with severe neurological symptoms and multifocal white matter lesions with brainstem and cerebellar involvement in a 29-year-old man after sporadic cocaine consumption. A urinalysis was positive for levamisole. Neurological deficits as well as MRI presentation improved after cessation of levamisole exposure and two courses of intravenous high-dose glucocorticoid therapy. Early diagnosis of levamisole-induced multifocal leukoencephalopathy and treatment with corticosteroids without delay is essential for a good recovery from neurological symptoms. Although cocaine is one of the most prevalent abused illicit drugs, cocaine- and levamisole-induced multifocal leukoencephalopathy is underdiagnosed as this disorder is not often described in the literature and anamnesis of drug abuse is not admitted by the patient. Therefore, an additional screening for cocaine and levamisole in clinical practice is useful in similar cases to support the diagnosis.
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Michels L, Moisa M, Stämpfli P, Hirsiger S, Baumgartner MR, Surbeck W, Seifritz E, Quednow BB. The impact of levamisole and alcohol on white matter microstructure in adult chronic cocaine users. Addict Biol 2022; 27:e13149. [PMID: 35394690 PMCID: PMC9287079 DOI: 10.1111/adb.13149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 11/16/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
Previous brain imaging studies with chronic cocaine users (CU) using diffusion tensor imaging (DTI) mostly focused on fractional anisotropy to investigate white matter (WM) integrity. However, a quantitative interpretation of fractional anisotropy (FA) alterations is often impeded by the inherent limitations of the underlying tensor model. A more fine-grained measure of WM alterations could be achieved by measuring fibre density (FD). This study investigates this novel DTI metric comparing 23 chronic CU and 32 healthy subjects. Quantitative hair analysis was used to determine intensity of cocaine and levamisole exposure-a cocaine adulterant with putative WM neurotoxicity. We first assessed the impact of cocaine use, levamisole exposure and alcohol use on group differences in WM integrity. Compared with healthy controls, all models revealed cortical reductions of FA and FD in CU. At the within-patient group level, we found that alcohol use and levamisole exposure exhibited regionally different FA and FD alterations than cocaine use. We found mostly negative correlations of tract-based WM associated with levamisole and weekly alcohol use. Specifically, levamisole exposure was linked with stronger WM reductions in the corpus callosum than alcohol use. Cocaine use duration correlated negatively with FA and FD in some regions. Yet, most of these correlations did not survive a correction for multiple testing. Our results suggest that chronic cocaine use, levamisole exposure and alcohol use were all linked to significant WM impairments in CU. We conclude that FD could be a sensitive marker to detect the impact of the use of multiple substances on WM integrity in cocaine but also other substance use disorders.
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Affiliation(s)
- Lars Michels
- Department of NeuroradiologyUniversity Hospital ZurichZurichSwitzerland
- Neuroscience Center ZurichUniversity of Zurich and Swiss Federal Institute of Technology ZurichZurichSwitzerland
| | - Marius Moisa
- Zurich Center for Neuroeconomics, Department of NeuroeconomicsUniversity of ZurichZurichSwitzerland
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Sarah Hirsiger
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Markus R. Baumgartner
- Center of Forensic Hair Analytics, Institute of Forensic MedicineUniversity of ZurichZurichSwitzerland
| | - Werner Surbeck
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Erich Seifritz
- Neuroscience Center ZurichUniversity of Zurich and Swiss Federal Institute of Technology ZurichZurichSwitzerland
- Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Boris B. Quednow
- Neuroscience Center ZurichUniversity of Zurich and Swiss Federal Institute of Technology ZurichZurichSwitzerland
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
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Rasgado-Toledo J, Shah A, Ingalhalikar M, Garza-Villarreal EA. Neurite orientation dispersion and density imaging in cocaine use disorder. Prog Neuropsychopharmacol Biol Psychiatry 2022; 113:110474. [PMID: 34758367 DOI: 10.1016/j.pnpbp.2021.110474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/01/2023]
Abstract
Cocaine use disorder (CUD) is characterized by a compulsive search for cocaine. Several studies have shown that cocaine users exhibit cognitive deficits, including lack of inhibition and decision-making as well as brain volume and diffusion-based white-matter alterations in a wide variety of brain regions. However, the non-specificity of standard volumetric and diffusion-tensor methods to detect structural micropathology may lead to wrong conclusions. To better understand microstructural pathology in CUD, we analyzed 60 CUD participants (3 female) and 43 non-CUD controls (HC; 2 female) retrospectively from our cross-sectional Mexican SUD neuroimaging dataset (SUDMEX-CONN), using multi-shell diffusion-weighted imaging and the neurite orientation dispersion and density imaging (NODDI) analysis, which aims to more accurately model microstructural pathology. We used Viso values of NODDI that employ a three-compartment model in white (WM) and gray-matter (GM). These values were also correlated with clinical measures, including psychiatric severity status, impulsive behavior and pattern of cocaine and tobacco use in the CUD group. We found higher whole-brain microstructural pathology in WM and GM in CUD patients than controls. ROI analysis revealed higher Viso-NODDI values in superior longitudinal fasciculus, cingulum, hippocampus cingulum, forceps minor and Uncinate fasciculus, as well as in frontal and parieto-temporal GM structures. We also found correlations between significant ROI and impulsivity, onset age of cocaine use and weekly dosage with Viso-NODDI. However, we did not find correlations with psychopathology measures. Overall, although their clinical relevance remains questionable, microstructural pathology seems to be present in CUD both in gray and white matter.
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Affiliation(s)
- Jalil Rasgado-Toledo
- Instituto de Neurobiología, Universidad Nacional Autónoma de México campus Juriquilla, Querétaro, Mexico
| | - Apurva Shah
- Symbiosis Center for Medical Image Analysis, Symbiosis Institute of Technology, Symbiosis International University, Pune, Maharashtra, India
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis, Symbiosis Institute of Technology, Symbiosis International University, Pune, Maharashtra, India
| | - Eduardo A Garza-Villarreal
- Instituto de Neurobiología, Universidad Nacional Autónoma de México campus Juriquilla, Querétaro, Mexico.
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7
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Deleterious effects of levamisole, a cocaine adulterant, in rabbit aorta. Vascul Pharmacol 2022; 144:106992. [DOI: 10.1016/j.vph.2022.106992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
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8
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Laurentino AOM, Solómon J, Tonietto BD, Cestonaro LV, Dos Santos NG, Piton YV, Izolan L, Marques D, Costa-Valle MT, Garcia SC, Sebben V, Dallegrave E, Schaefer PG, Barros EJ, Arbo MD, Leal MB. Levamisole, a cocaine cutting agent, induces acute and subchronic systemic alterations in Wistar rats. Toxicol Appl Pharmacol 2021; 426:115649. [PMID: 34273407 DOI: 10.1016/j.taap.2021.115649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 12/31/2022]
Abstract
The use of the anthelmintic levamisole as a cocaine adulterant has been increasing worldwide. Complications caused by this association include systemic vasculitis, agranulocytosis, neutropenia, tissue necrosis, pulmonary hemorrhage, and renal injury. Data about toxicity of levamisole are scarce, therefore the aim of this study was to evaluate the acute and subchronic toxic effects of levamisole in rats. Male Wistar rats received saline or levamisole by intraperitoneal route at the doses of 12, 24 and 36 mg/kg in the acute toxicity test; and at 3, 6 and 12 mg/kg in the subchronic toxicity test. Toxicity was evaluated using behavioral, cognitive, renal, hematological, biochemical and histopathological parameters. Acute administration of levamisole caused behavioral and histopathological alterations. Subchronic administration caused behavioral, cognitive and hematological alterations (p < 0.0001 and p < 0.05, respectively), impairment of liver and kidney functions (p < 0.05), and changes of antioxidant defenses (p ≤ 0.0001). Both administrations produced toxic effects of clinical relevance, which make levamisole a dangerous cutting agent. Furthermore, the knowledge of these effects can contribute to the correct diagnosis and treatment of cocaine dependents with unusual systemic alterations.
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Affiliation(s)
- Ana Olívia Martins Laurentino
- Programa de Pós-Graduação em Ciências Biológicas, Farmacologia e Terapêutica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Janaína Solómon
- Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Ducatti Tonietto
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Larissa Vivan Cestonaro
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Nícolas Guimarães Dos Santos
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Yasmin Vendruscolo Piton
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Izolan
- Programa de Pós-Graduação em Ciências Biológicas: Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/209, 90046-900 Porto Alegre, Rio Grande do Sul, Brazil
| | - Douglas Marques
- Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/209, 90046-900 Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Tuerlinckx Costa-Valle
- Departamento de Farmacociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Solange Cristina Garcia
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Viviane Sebben
- Centro de Informação Toxicológica, Av. Ipiranga, 5400, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil
| | - Eliane Dallegrave
- Departamento de Farmacociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Guilherme Schaefer
- Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2350, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil
| | - Elvino José Barros
- Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2350, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcelo Dutra Arbo
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia - Anexo I, Universidade Federal do Rio Grande do Sul (UFRGS), Rua São Luis, 150/3° andar, 90620-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752/1° andar, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil.
| | - Mirna Bainy Leal
- Programa de Pós-Graduação em Ciências Biológicas, Farmacologia e Terapêutica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Farmacologia e Toxicologia Neurocomportamental, Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/305, 90050-170 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite, 500/209, 90046-900 Porto Alegre, Rio Grande do Sul, Brazil.
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9
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White CM, Browne T, Nafziger AN. Inherent Dangers of Using Non-US Food and Drug Administration-Approved Substances of Abuse. J Clin Pharmacol 2021; 61 Suppl 2:S129-S141. [PMID: 34396559 DOI: 10.1002/jcph.1860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022]
Abstract
Use of US Food and Drug Administration-approved substances of abuse has innate risks due to pharmacologic and pharmacokinetic properties of the medications, but the risk when using nonapproved drug products is much greater. Unbeknownst to the user, the dose of active ingredients in substances of abuse can vary substantially between different products because of manufacturing practices or improper storage. Even naturally occurring substances of abuse can have extensive dosage variability because of effects of the growing season and conditions, or differences in harvesting, storage, or manufacture of the finished products. Many illicit substances are adulterated, to make up for intentional underdosing or to enhance the effect of the intended active ingredient. These adulterants can be dangerous and produce direct cardiovascular, neurologic, hematologic, or dermatologic reactions or obscure adverse effects. Finally, an illicit substance can be contaminated or substituted for another one during its manufacture, leading to differences in adverse events, adverse event severity, or the drug interaction profile. Substances can be contaminated with microbes that induce infections or heavy metals that can damage organs or cause cancer. This milieu of undisclosed substances can also induce drug interactions. For reasons that are discussed, individuals who use substances of abuse are at increased risk of morbidity or mortality if they develop coronavirus disease 2019. Health professionals who treat patients with acute, urgent events associated with substances of abuse, or those treating the chronic manifestations of addiction, need to appreciate the complex and variable composition of substances of abuse and their potential health effects.
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Affiliation(s)
- C Michael White
- Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA.,HOPES Research Group, UConn and Hartford Hospital, Hartford, Connecticut, USA
| | - Thom Browne
- Rubicon Global Enterprises & Colombo Plan Secretariat, Huachuca City, Arizona, USA
| | - Anne N Nafziger
- Bertino Consulting, Schenectady, New York, USA.,Department of Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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Campillo JT, Eiden C, Boussinesq M, Pion SDS, Faillie JL, Chesnais CB. Adverse reactions with levamisole vary according to its indications and misuse: a systematic pharmacovigilance study. Br J Clin Pharmacol 2021; 88:1094-1106. [PMID: 34390273 PMCID: PMC9293185 DOI: 10.1111/bcp.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022] Open
Abstract
AIM Levamisole was initially prescribed for the treatment of intestinal worms. Because of immunomodulatory properties, levamisole has been used in inflammatory pathologies and in cancers in association with 5-fluorouracil. Levamisole is misused as a cocaine adulterant. Post-marketing reports have implicated levamisole in the occurrence of adverse drug reactions (ADRs) and its use is now limited in Europe and North America. In contrast, all other parts of the World continue to use single-dose as an anthelmintic. The aim of this study was to identify ADRs reported after levamisole exposure in VigiBase, the WHO's pharmacovigilance database, and analyze their frequency compared to other drugs and according to levamisole type of use. METHODS All levamisole-related ADRs were extracted from VigiBase®. Disproportionality analyses were conducted to investigate psychiatric, hepatobiliary, renal, vascular, nervous, blood, skin, cardiac, musculoskeletal and general ADRs associated with levamisole and other drugs exposure. In secondary analyses, we compared the frequency of ADRs between levamisole and mebendazole and between levamisole type of use. RESULTS Among the 1763 levamisole-related ADRs identified, psychiatric disorders (Reporting Odds-Ratio with 95% confidence intervals: 1.4 [1.2-2.6]), hepatobiliary disorders (2.4 [1.9-4.3]), vasculitis (6.5 [4.1-10.6]), encephalopathy (22.5 [17.4-39.9]), neuropathy (4.3 [2.9-7.1]), hematological disorders, mild rashes and musculoskeletal disorders were more frequently reported with levamisole than with other drug. The majority of levamisole-related ADRs occurred when the drug was administrated for a non-anti-infectious indication. CONCLUSION The great majority of the levamisole-related ADRs concerned its immunomodulatory indication and multiple doses regimen. Our results suggest that single-dose treatments for anthelmintic action have a good safety profile.
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Affiliation(s)
- Jérémy T Campillo
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Céline Eiden
- Department of medical pharmacology and toxicology, CHU Montpellier, Montpellier, France
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Sébastien D S Pion
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Jean-Luc Faillie
- Department of medical pharmacology and toxicology, CHU Montpellier, Montpellier, France.,Desbrest Institute of Epidemiology and Public Health UMR UA11 INSERM, University of Montpellier, Montpellier, France
| | - Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
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11
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Al-Khafaji M, Podbicanin S, Ghaghda D, Basi S, Punekar S. Simultaneous multifocal intracranial haemorrhage (ICH) and subarachnoid haemorrhage (SAH) in the setting of long-term cocaine usage. BMJ Case Rep 2021; 14:14/6/e241311. [PMID: 34140326 DOI: 10.1136/bcr-2020-241311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 45-year-old Caucasian man was admitted to hospital following a collapse at home. On admission, this patient was noted to have a Glasgow Coma Scale (GCS) Score of 9 out of 15, fever and tachypnoea. The patient was identified to have bilateral limb weakness, predominately on the left side, with associated dysphagia. Radiological imaging demonstrated bilateral multifocal intracranial haemorrhage and subarachnoid haemorrhage. Neurosurgical input was sought; the outcome of this was a decision to manage the patient conservatively, without surgical intervention. Of note, his urine drug testing revealed a positive result for a cocktail of drugs including cocaine, benzoylecgonine (cocaine metabolite), methadone, heroin, norbuprenorphine and benzodiazepine. Throughout the admission, the patient was monitored in an intensive care setting. The patient received support with feeding, speech and mobilisation. The patients' GCS improved throughout the admission. Following a 30-day admission, the patient walked home.
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Affiliation(s)
| | | | - Deep Ghaghda
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Saajan Basi
- General Internal Medicine, Royal Derby Hospital, Derby, UK
- Acute Stroke Department, King's Mill Hospital, Sutton-in-Ashfield, UK
| | - Shuja Punekar
- Sherwood Forest Hospitals NHS Trust, Nottinghamshire, UK
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12
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Bittencourt AML, Bampi VF, Sommer RC, Schaker V, Juruena MFP, Soder RB, Franco AR, Sanvicente-Vieira B, Grassi-Oliveira R, Ferreira PEMS. Cortical thickness and subcortical volume abnormalities in male crack-cocaine users. Psychiatry Res Neuroimaging 2021; 310:111232. [PMID: 33621927 DOI: 10.1016/j.pscychresns.2020.111232] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 02/05/2023]
Abstract
Crack-cocaine offers a higher risk of abuse than intranasal and intravenous use of cocaine. Yet, current treatments remain disappointing and our understanding of the mechanism of crack-cocaine neurotoxicity is still incomplete. Magnetic resonance images studies on brain changes of crack-cocaine addicts show divergent data. The present study investigated gray matter (GM) abnormalities in crack-cocaine dependents (n = 18) compared to healthy controls (n = 17). MRI data was analysed using FreeSurfer and voxel-based morphometry (VBM). FreeSurfer analysis showed that CD had decreased cortical thickness (CT) in the left inferior temporal cortex (lTC), left orbitofrontal cortex (lOFC) and left rostro frontal cortex (lRFC), enlargement in left inferior lateral ventricle, and smaller GM volume in right hippocampus and right ventral diencephalon. VBM analysis showed that CD had significantly decreased GM volume in left Putamen and left nucleus accumbens. Furthermore, we found a negative correlation between duration of crack-cocaine use and lTC CT. These results provide compelling evidence for GM abnormalities in CD and also suggest that duration of crack-cocaine use may be associated with CT alterations.
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Affiliation(s)
- Augusto Martins Lucas Bittencourt
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Medicine and Health Sciences - Neuroscience, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil.
| | - Vinicius Faccin Bampi
- SW - Adult Community Mental Health Service, Hertfordshire Partnership University NHS Foundation Trust, St, AL3 5TQ St Albans, United Kingdom
| | - Rafael Canani Sommer
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, 90619900, Porto Alegre, Brasil
| | - Vanessa Schaker
- Federal University of Rio Grande do Sul, 90040-060, Porto Alegre, Brazil
| | | | - Ricardo Bernardi Soder
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, 90619900, Porto Alegre, Brasil
| | - Alexandre Rosa Franco
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeberg, NY, 10962, USA; Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA; Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Breno Sanvicente-Vieira
- Lab of Individual Differences and Psychopathology (LaDIP), Psychology Department - Pontifical Catholic University of Rio de Janeiro (PUC-Rio), 22453900, Rio de Janeiro, Brazil
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Medicine and Health Sciences - Neuroscience, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil; Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, 90619900, Porto Alegre, Brasil
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13
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Conrad F, Hirsiger S, Winklhofer S, Baumgartner MR, Stämpfli P, Seifritz E, Wegener S, Quednow BB. Use of levamisole-adulterated cocaine is associated with increased load of white matter lesions. J Psychiatry Neurosci 2021; 46:E281-E291. [PMID: 33844483 PMCID: PMC8061741 DOI: 10.1503/jpn.200057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Cocaine use has been associated with vascular pathologies, including cerebral white matter hyperintensities. Street cocaine is most often adulterated with levamisole, an anthelminthic drug that may also be associated with vascular toxicity. However, whether levamisole exposure from cocaine consumption further accelerates the development of white matter lesions remains unknown. Methods We investigated the association of cocaine and levamisole exposure with white matter hyperintensities in 35 chronic cocaine users and 34 healthy controls. We measured cocaine and levamisole concentrations in hair samples, which reflected exposure up to 6 months previously. We assessed the number and total surface area of the white matter hyperintensities using structural MRI (FLAIR sequence). Using generalized linear models, we analyzed the contributions of cocaine and levamisole to the number and area of white matter hyperintensities, accounting for several confounding factors. Results Analysis using generalized linear models revealed that cocaine users had more white matter hyperintensities in terms of total surface area, but not in terms of number. Further generalized linear models that included cocaine and levamisole hair concentrations (instead of group) as predictors indicated that levamisole exposure was strongly associated with more and larger white matter hyperintensities, suggesting that the elevated white matter hyperintensities in cocaine users were driven mainly by levamisole exposure. Finally, white matter hyperintensities in levamisole-exposed cocaine users were located primarily in the periventricular and juxtacortical white matter. Limitations The sample size was moderate, and blood pressure was not systematically assessed. Conclusion As an adulterant of cocaine, levamisole appears to increase the risk of white matter injury.
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Affiliation(s)
- Florian Conrad
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Sarah Hirsiger
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Sebastian Winklhofer
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Markus R Baumgartner
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Philipp Stämpfli
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Erich Seifritz
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Susanne Wegener
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Boris B Quednow
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
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14
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Belova AN, Solovieva VS, Rasteryaeva MV, Belova EM. [Multifocal inflammatory levamisole-induced leukoencephalopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:89-96. [PMID: 32844637 DOI: 10.17116/jnevro202012007289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Levamisole (L) is an anthelmintic agent that is widely used in clinical practice. L can enter the human organism during the treatment of helminthiasis as well as during the using the contaminated cocaine. Multifocal inflammatory levamisole-induced leukoencephalopathy (MILL) is one of the most serious complications of L use. The article discusses the clinical and radiological features of MILL which have a number of similarities of multiple sclerosis (MS) appearance. The disease has a favorable prognosis if started early, but the diagnosis of this rare form of leukoencephalopathy can cause difficulties. The case of MILL in patient with mistaken diagnosis of MS is descrThe case of MILL in patient with mistaken diagnosis of MS is descraibed.ibed.
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Affiliation(s)
- A N Belova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - V S Solovieva
- City Clinical Hospital No. 3, Nizhny Novgorod, Russia
| | - M V Rasteryaeva
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - E M Belova
- City Clinical Hospital No. 3, Nizhny Novgorod, Russia
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15
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De Baerdemaeker K, Mabiglia C, Hantson P, Di Fazio V, Duprez T, Kozyreff A, van Pesch V, Sellimi A. Acute Susac Syndrome in a Recent User of Adulterated Cocaine: Levamisole as a Triggering Factor? Case Rep Neurol 2020; 12:78-83. [PMID: 32231548 PMCID: PMC7098328 DOI: 10.1159/000506043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022] Open
Abstract
Susac syndrome (SS) is a central nervous system vasculitis characterized by the clinical triad of encephalopathy, sensorineural hearing loss, and visual disturbance caused by branch retinal artery occlusion. It is considered as an inflammatory disorder, and an autoimmune etiology is suggested. A 29-year-old man with a history of recent cocaine abuse developed the clinical features of SS. Toxicological analysis including hair testing revealed that cocaine had been adulterated with levamisole. After an initial clinical improvement following corticosteroid therapy, the introduction of mycophenolate mofetil was justified a few weeks later by the progression (or relapse) of the retinal injury, followed by complete recovery. The presence of levamisole has been documented in patients with multifocal inflammatory leukoencephalopathy (MIL). Further investigations are needed to determine if levamisole as an adulterant of cocaine could also play a role in the development of rapidly progressive leukoencephalopathy in young men, with Susac or Susac-like syndromes as possible variants of MIL.
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Affiliation(s)
- Klara De Baerdemaeker
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Chiara Mabiglia
- Department of Neuroradiology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Di Fazio
- National Institute for Criminology and Criminalistics, Brussels, Belgium
| | - Thierry Duprez
- Department of Neuroradiology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Alexandra Kozyreff
- Department of Ophthalmology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Amina Sellimi
- Department of Neurology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
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16
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Sensitivity to gains during risky decision-making differentiates chronic cocaine users from stimulant-naïve controls. Behav Brain Res 2020; 379:112386. [PMID: 31778734 DOI: 10.1016/j.bbr.2019.112386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/04/2019] [Accepted: 11/24/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic cocaine use has been consistently associated with decision-making impairments that contribute to the development and maintenance of drug-taking. However, the underlying cognitive processes of risk-seeking behaviours observed in chronic cocaine users (CU) have so far remained unclear. Here we therefore tested whether CU differ from stimulant-naïve controls in their sensitivity to gain, loss, and probability of loss information when making decisions under risk. METHOD A sample of 96 participants (56 CU and 40 controls) performed the no-feedback version of the Columbia Card Task, designed to assess risk-taking in relation to gain, loss, and probability of loss information. Additionally, cognitive performance and impulsivity were determined. Current and recent substance use was objectively assessed by toxicological urine and hair analysis. RESULTS Compared to controls, CU showed increased risk-seeking in unfavourable decision scenarios in which the loss probability was high and the returns were low, and a tendency for increased risk aversion in more favourable decision scenarios. In comparison to controls, CU were less sensitive to gain, but similarly sensitive to loss and probability of loss information. Further analysis revealed that individual differences in sensitivity to loss and probability of loss information were related to cognitive performance and impulsivity. CONCLUSION Reduced sensitivity to gains in people with CU may contribute to their propensity for making risky decisions. While these alterations in gain sensitivity might directly relate to cocaine use per se, the individual psychopathological profile of CU might moderate sensitivity to loss information.
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17
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Kluwe-Schiavon B, Viola TW, Sanvicente-Vieira B, Lumertz FS, Salum GA, Grassi-Oliveira R, Quednow BB. Substance related disorders are associated with impaired valuation of delayed gratification and feedback processing: A multilevel meta-analysis and meta-regression. Neurosci Biobehav Rev 2019; 108:295-307. [PMID: 31778679 DOI: 10.1016/j.neubiorev.2019.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 11/13/2019] [Accepted: 11/23/2019] [Indexed: 02/08/2023]
Abstract
Across numerous studies, individuals with substance use disorders (SUDs) differed from non-using controls regarding valuation of delayed gratification and feedback processing. However, it remains unclear whether the magnitude of the effect sizes is different across these two cognitive processes and how specific SUDs as well as demographic and clinical moderators influence these effects. In this study we thus performed multilevel linear mixed-effects meta-analyses and meta-regressions to examine the effects of SUDs on the Delay Discounting Task (DD) and on the Iowa Gambling Task (IGT). We found a moderate to large effect for SUD on both, the IGT and DD. While the effect on the DD was generalized to all substance classes, a smaller effect for cannabis-related disorder when compared to other SUDs was found with regard to the IGT. Early onset of substance use and psychiatric comorbidities were associated with stronger effects on the DD. Our findings suggest that feedback processing is more vulnerable to specific substance effects, while valuation of delayed gratification depends more on developmental and clinical factors.
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Affiliation(s)
- B Kluwe-Schiavon
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, CH-8032, Zurich, Switzerland; Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - T W Viola
- Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - B Sanvicente-Vieira
- Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - F S Lumertz
- Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - G A Salum
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos Street, 2350 - Santa Cecilia, Porto Alegre, RS 90035-007, Brazil.
| | - R Grassi-Oliveira
- Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - B B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, CH-8032, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Rämistrasse 101, CH-8092 Zürich, Switzerland.
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18
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Hirsiger S, Hänggi J, Germann J, Vonmoos M, Preller KH, Engeli EJE, Kirschner M, Reinhard C, Hulka LM, Baumgartner MR, Chakravarty MM, Seifritz E, Herdener M, Quednow BB. Longitudinal changes in cocaine intake and cognition are linked to cortical thickness adaptations in cocaine users. NEUROIMAGE-CLINICAL 2019; 21:101652. [PMID: 30639181 PMCID: PMC6412021 DOI: 10.1016/j.nicl.2019.101652] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/04/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cocaine use has been consistently associated with decreased gray matter volumes in the prefrontal cortex. However, it is unclear if such neuroanatomical abnormalities depict either pre-existing vulnerability markers or drug-induced consequences. Thus, this longitudinal MRI study investigated neuroplasticity and cognitive changes in relation to altered cocaine intake. METHODS Surface-based morphometry, cocaine hair concentration, and cognitive performance were measured in 29 cocaine users (CU) and 38 matched controls at baseline and follow-up. Based on changes in hair cocaine concentration, CU were classified either as Decreasers (n = 15) or Sustained Users (n = 14). Surface-based morphometry measures did not include regional tissue volumes. RESULTS At baseline, CU displayed reduced cortical thickness (CT) in lateral frontal regions, and smaller cortical surface area (CSA) in the anterior cingulate cortex, compared to controls. In Decreasers, CT of the lateral frontal cortex increased whereas CT within the same regions tended to further decrease in Sustained Users. In contrast, no changes were found for CSA and subcortical structures. Changes in CT were linked to cognitive performance changes and amount of cocaine consumed over the study period. CONCLUSIONS These results suggest that frontal abnormalities in CU are partially drug-induced and can recover with decreased substance use. Moreover, recovery of frontal CT is accompanied by improved cognitive performance confirming that cognitive decline associated with cocaine use is potentially reversible.
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Affiliation(s)
- Sarah Hirsiger
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | - Jürgen Hänggi
- Division Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jürgen Germann
- Cerebral Imaging Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Matthias Vonmoos
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Katrin H Preller
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Etna J E Engeli
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Caroline Reinhard
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Lea M Hulka
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Markus R Baumgartner
- Center of Forensic Hairanalytics, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Mallar M Chakravarty
- Cerebral Imaging Center, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada; Departments of Psychiatry and Biomedical and Biological Engineering, McGill University, Montreal, QC, Canada
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Marcus Herdener
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland.
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