Guilty or not guilty? - False positive results of common medicines in drug tests: review and practical guide.

Drug-abuse detection tests are becoming increasingly commonplace in patient care today and provide a rapid and effective method for identifying illicit substances. Occasionally, they may yield a positive result, indicating the presence of a substance, even though the individual has not consumed the suspected drug what sometimes can significantly impact both medical and legal decisions. The study outlines the substances that can lead to false-positive drug test results for amphetamines, cannabinoids, and benzodiazepines. The study's findings have revealed pivotal insights for patients receiving chronic treatment and their primary care physicians. Notably, amphetamine assays appear to be most prone to cross-reactivity with other substances. The beta-blocker group of medications, confirmed by various studies to interfere with amphetamine assays, could pose a substantial challenge in drug screening given its widespread use. Efavirenz also warrants mention, as it frequently triggers positive results for both benzodiazepine and cannabinoid assays among its users. This research helps highlight new areas for further investigation and aims to guide clinicians in their daily practice, especially when interpreting questionable positive drug-abuse test results. This comprehensive review serves as a valuable resource for clinicians to navigate false-positive scenarios effectively and maintain the highest standard of patient care.

Plasma proteome alterations in prediabetic, obese Zucker rats - possible cardiovascular risk implications.

Hyperphagia and obesity, which underlie metabolic syndrome, have been linked to multiple health complications and increased mortality. Here, we investigate the differences in plasma proteome between obese and lean Zucker rats in order to identify circulating proteins involved in obesity-related conditions. Plasma samples of male Zucker fatty (obese) rats carrying fatty fa/fa mutation (-/-) and their lean controls were enriched using ProteoMiner technology and labeled with isobaric tags (iTRAQ) for mass spectrometry-based quantitation. We found elevation in levels of coagulation factors whereas levels of serine protease inhibitors were decreased. Levels of acute phase proteins were also altered, as well as complement components. We also noticed differences in the abundance of apolipoproteins. In summary, quantitative proteomic assessment of plasma protein composition in obese Zucker rats revealed a profound landscape of changes, reflecting altered hemostasis, disturbed metabolic processes involving insulin resistance and lipid metabolism and ongoing low-grade inflammation.

LC/MS/MS assessment of changes in placental angiotensin I metabolism in preeclampsia.

BACKGROUND: Preeclampsia (PE) is a condition characterized by high blood pressure and significant proteinuria in pregnant women. It affects about 7% pregnancies and can be cause of fetal and maternal morbidity and mortality. During pregnancy, a physiological overexpression of the Renin-Angiotensin System (RAS) components is observed, including increased plasma Ang II level. Dysregulation of RAS in placenta may contribute to preeclampsia and uterine growth retardation. The aim of the study was to evaluate the Ang I metabolism in human preeclamptic placentas and to compare to normal pregnancies condition. METHOD: Fragments of placental tissues were collected right after ceasarian section from PE and physiological pregnancies. Tissues were incubated in Krebs buffer in the presence of Ang I. Evaluation of Ang I metabolites in incubating fluid was performed by LC/MS/MS method. mRNA expression of main RAS components was measured by RT-PCR. RESULTS: Pattern of angiotensin metabolites did not differ between groups. The main products were Ang 1-7 and Ang II. Comparing to control group, more than 3-fold lower production of Ang II and Ang 1-7 in preeclampsia was observed. mRNA expressions of ACE and AT1 were significantly decreased in pre- eclamptic placentas, whereas higher expression of mRNA of ACE2 and MAS receptor were observed. CONCLUSIONS: Production of Ang 1-7 by PE placentas was significantly lower than in control group. Significantly decreased mRNA expression of ACE and AT1 receptor and lower production of Ang II in placentas of PE patients suggest that placental Ang II/ACE/AT1r pathway could be less important than Ang 1-7/ACE-2/MASr pathway in development of preeclampsia, but this requires further investigations.

Diminazene Aceturate Stabilizes Atherosclerotic Plaque and Attenuates Hepatic Steatosis in apoE-Knockout Mice by Influencing Macrophages Polarization and Taurine Biosynthesis.

Atherosclerosis and nonalcoholic fatty liver disease are leading causes of morbidity and mortality in the Western countries. The renin-angiotensin system (RAS) with its two main opposing effectors, i.e., angiotensin II (Ang II) and Ang-(1-7), is widely recognized as a major regulator of cardiovascular function and body metabolic processes. Angiotensin-converting enzyme 2 (ACE2) by breaking-down Ang II forms Ang-(1-7) and thus favors Ang-(1-7) actions. Therefore, the aim of our study was to comprehensively evaluate the influence of prolonged treatment with ACE2 activator, diminazene aceturate (DIZE) on the development of atherosclerotic lesions and hepatic steatosis in apoE-/- mice fed a high-fat diet (HFD). We have shown that DIZE stabilized atherosclerotic lesions and attenuated hepatic steatosis in apoE-/- mice fed an HFD. Such effects were associated with decreased total macrophages content and increased α-smooth muscle actin levels in atherosclerotic plaques. Moreover, DIZE changed polarization of macrophages towards increased amount of anti-inflammatory M2 macrophages in the atherosclerotic lesions. Interestingly, the anti-steatotic action of DIZE in the liver was related to the elevated levels of HDL in the plasma, decreased levels of triglycerides, and increased biosynthesis and concentration of taurine in the liver of apoE-/- mice. However, exact molecular mechanisms of both anti-atherosclerotic and anti-steatotic actions of DIZE require further investigations.

Prospective plasma proteome changes in preterm infants with different gestational ages.

BACKGROUND: In this study, we aimed to analyze time-resolved plasma proteome changes in preterm neonates stratified by their gestational age to detect malfunctioning pathways that derive from the systemic immaturity of the neonate and to highlight those that are differentially regulated during the early development. METHODS: Preterm newborns were enrolled in three subgroups with different gestational ages: before 26 weeks of gestation (group 1), between 27 and 28 weeks of gestation (group 2), and between 29 and 30 (group 3) weeks of gestation. Plasma protein abundances were assessed at two time points (at preterm delivery and at the 36th week of post-menstrual age) by quantitative proteomics. RESULT: The quantitative analysis of plasma proteome in preterm infants revealed a multitude of time-related differences in protein abundances between the studied groups. We report protein changes in several functional domains, including inflammatory domains, immunomodulatory factors, and coagulation regulators as key features, with important gestational age-dependent hemopexin induction. CONCLUSION: The global trend emerging from our data, which can collectively be interpreted as a progression toward recovery from the perinatal perturbations, highlights the profound impact of gestation duration on the ability to bridge the gap in systemic homeostasis after preterm labor.

The influence of angiotensin-(1-7) Mas receptor agonist (AVE 0991) on mitochondrial proteome in kidneys of apoE knockout mice.

Excessive action of angiotensin II on mitochondria has been shown to play an important role in mitochondrial dysfunction, a common feature of atherogenesis and kidney injury. Angiotensin-(1-7)/Mas receptor axis constitutes a countermeasure to the detrimental effects of angiotensin II on AT1 receptors. The aim of the study was to assess the effects of angiotensin-(1-7) peptidomimetic AVE0991 on the kidney mitochondrial proteome in widely used animal model of atherosclerosis (apoE(-/-) mice). Proteins changed in apoE(-/-) mice belonged to the groups of antioxidant enzymes, apoptosis regulators, inflammatory factors and metabolic enzymes. Importantly, AVE0991 partially reversed atherosclerosis-related changes in apoE(-/-) mice.

Deficient hippocampal insulin signaling and augmented Tau phosphorylation is related to obesity- and age-induced peripheral insulin resistance: a study in Zucker rats.

BACKGROUND: Insulin signaling and Tau protein phosphorylation in the hippocampi of young and old obese Zucker fa/fa rats and their lean controls were assessed to determine whether obesity-induced peripheral insulin resistance and aging are risk factors for central insulin resistance and whether central insulin resistance is related to the pathologic phosphorylation of the Tau protein. RESULTS: Aging and obesity significantly attenuated the phosphorylation of the insulin cascade kinases Akt (protein kinase B, PKB) and GSK-3ß (glycogen synthase kinase 3ß) in the hippocampi of the fa/fa rats. Furthermore, the hyperphosphorylation of Tau Ser396 alone and both Tau Ser396 and Thr231 was significantly augmented by aging and obesity, respectively, in the hippocampi of these rats. CONCLUSIONS: Both age-induced and obesity-induced peripheral insulin resistance are associated with central insulin resistance that is linked to hyperTau phosphorylation. Peripheral hyperinsulinemia, rather than hyperglycemia, appears to promote central insulin resistance and the Tau pathology in fa/fa rats.

Assessment of angiotensin I metabolism in the human placenta using an LC/MS method.

The local renin-angiotensin system (RAS) in the placenta plays a very important role in placental development. It is well known that during normal pregnancy most of the circulating and local RAS components are over-expressed and any disruption of this new balance may cause pregnancy complications. The aim of this study was to assess the metabolism of Ang I in placentas from normal pregnancy, in an ex vivo model, using an LC/MS method. The obtained results suggest that placental tissue is able to produce many angiotensin peptides but the main metabolite is Ang-(1-7).

Elevated interleukin-1ß serum level after chronic peripheral salsolinol administration.

The catechol isoquinoline derivatives are endogenous compounds present in the mammalian brain and the representative one is referred to as salsolinol. It may be formed from aromatic amines leading to neurotoxic N-methyltetrahydroquinolinium ions that may play a role in the etiology of Parkinson's disease (PD). Neuroinflammation and apoptosis is thought to be a major contributor to the neuronal degeneration in PD. The alteration of inflammatory cytokines in the brain, cerebral spinal fluid and plasma of PD patients supports the existence of functional interconnections between the immune and nervous systems. In animal studies, chronic administration of salsolinol induced parkinsonian-like symptoms, both peripherally and centrally. However, still little has been known about the effects of salsolinol on the pro-inflammatory cytokine production or mast cells activation in the gastrointestinal tract. Male Wistar rats were subjected to continuous intraperitoneal dosing of salsolinol (200 mg/kg in total) with osmotic mini-pumps for two or four weeks and fed with either standard or high fat diet. An equivalent group of rats served as the appropriate controls. At the end of the experiment animals were decapitated and blood samples as well as tissue fragments were collected. Serum samples were assayed immunoenzymatically for IL-11ß and by liquid chromatography-mass spectrometry for histamine. Tissue fragments from gastric antrum, duodenum and proximal colon were formalin fixed, paraffin-embedded and stained with either hematoxylin and eosin or toluidine blue. Once activated, mast cells might secrete a range of neurosensitizing and pro-inflammatory molecules, increasing gut-blood and blood-brain barrier permeability. Cytokines mediate the activity of immune cells and may affect brain neurochemistry. The results of the present work serve as an additional support for the existence of an interrelationship between the nervous and immune system.

A fatal case of poisoning with a cathinone derivative: α-PiHP and its postmortem distribution in body fluids and organ tissues.

New psychoactive substances continue to appear on the drug market, and alpha-pyrrolidinoisohexanophenone (α-PiHP) is one of the most popular cathinone derivatives. In this article, we report a case of death caused by α-PiHP. Based on the toxicological results of the studied case along with autopsy, histopathological findings and crime-scene information, fatal intoxication with α-PiHP was accepted as the final cause of death. α-PiHP and its metabolite (OH-α-PiHP) were detected and quantified in all postmortem materials (blood collected from the heart, the femoral vein and the dural venous sinuses; vitreous humor; cerebrospinal fluid; cerebral cortex; brainstem; cerebellum; bile; liver; kidney; heart; pancreas; spleen; thyroid gland; lung; adipose tissue; stomach and intestine). To date, this is the first case of determination of α-PiHP and its metabolite in postmortem specimens. In our opinion, α-PiHP and its metabolite concentration database can be helpful in the interpretation of fatal cases.

Beneficial effect of amantadine on postoperative pain reduction and consumption of morphine in patients subjected to elective spine surgery.

OBJECTIVE: To analyze the effect of coadministration of morphine and amantadine on postoperative pain reduction and morphine consumption in patients after elective spine surgery. METHODS: In double-blinded study, 60 patients (ASA physical status I-II) were randomized into two groups. Group A was given oral amantadine 50 or 100 mg 1 hour before surgery and 8, 20, 32 hours after operation. Group P received placebo at identical times. Pain was assessed using numerical rating scale before first administration of morphine and in 2, 3, 4, 6, 24, and 48 hours after operation. The amounts of morphine consumed were recorded up to 48 hours after surgery. Blood samples were taken twice in 2 hours after surgery and plasma levels of morphine and its main metabolites were measured. RESULTS: As compared with placebo, amantadine significantly reduced intra-operative Fentanyl use and sensation of postoperative pain. Up to 48 hours after operation, the cumulative consumption of morphine was 25% lower in the amantadine group. Moreover, intensity of nausea and vomiting tended to be lower in A group. Starting from 12th hour after surgery, the level of postoperative sedation was lower in patients who received amantadine, as compared with placebo group. No significant differences in plasma levels of morphine ant its metabolites were observed between A and P groups. CONCLUSIONS: Pre- and postoperative administration of amantadine significantly reduced fentanyl use during operation, as well as reduced the postoperative pain and decreased morphine consumption in young patients undergoing orthopedic surgery.

The influence of salsolinol on basic rat metabolism.

Parkinson's disease (PD) is associated with a broad spectrum of non-motor symptoms, which are poorly understood and foremost, may precede motor impairment. These symptoms include weight changes and gastrointestinal dysregulation. In our experiment, we applied salsolinol given peripherally and continuously in rats to induce changes in the enteric nervous system, which might be similar to those observed in PD patients. Surprisingly, we noted decrease in body weight and alteration in body fat contents of the animals during salsolinol exposure. The blood glucose levels, lipid profile and hepatic enzymes levels were assessed as well. While lipid profile, postprandial blood glucose and hepatic enzymes levels remained indifferent, postprandial triglyceridemia was significantly lower in all salsolinol-treated rats in comparison with the control, which might be related to disturbed absorption. We also suggest that diminished body weight gain and lower adipose tissue accumulation in salsolinol-treated animals were due to delayed gastric emptying together with disturbed gut function resulting in absorptive dysfunction.

[Metformin--an inhibitor of early stages of protein glycation]. / Metformina--inhibitor wczesnych etapów glikacji bialek.

Nonenzymatic glycation of proteins is associated with the long-term diabetes complication. The aim of this work was to examine in vitro the infuence of metformin on glycated proteins formation by mass spectrometry (ESI/MS, LC/MS/MS) and spectrofluorimetric method. Obtained results suggest that metformin dose-dependently inhibits early stage of Maillard reaction, although with the weaker potency than known glycation inhibitor aminoguanidine.

Comparative two time-point proteome analysis of the plasma from preterm infants with and without bronchopulmonary dysplasia.

BACKGROUND: In this study, we aimed to analyze differences in plasma protein abundances between infants with and without bronchopulmonary dysplasia (BPD), to add new insights into a better understanding of the pathogenesis of this disease. METHODS: Cord and peripheral blood of neonates (≤ 30 weeks gestational age) was drawn at birth and at the 36th postmenstrual week (36 PMA), respectively. Blood samples were retrospectively subdivided into BPD(+) and BPD(-) groups, according to the development of BPD. RESULTS: Children with BPD were characterized by decreased afamin, gelsolin and carboxypeptidase N subunit 2 levels in cord blood, and decreased galectin-3 binding protein and hemoglobin subunit gamma-1 levels, as well as an increased serotransferrin abundance in plasma at the 36 PMA. CONCLUSIONS: BPD development is associated with the plasma proteome changes in preterm infants, adding further evidence for the possible involvement of disturbances in vitamin E availability and impaired immunological processes in the progression of prematurity pulmonary complications. Moreover, it also points to the differences in proteins related to infection resistance and maintaining an adequate level of hematocrit in infants diagnosed with BPD.

[Evaluation of morphine metabolism in presence of amantadine and dextromethorphan in human serum by high performance liquid chromatography coupled with mass spectrometry (LC/MS) method]. / Metabolizm morfiny w obecnosci amantadyny i dekstrometorfanu u ludzi--ocena metoda wysokosprawnej chromatografii cieczowej sprzezonej ze spektrometria mas (LC/MS).

In the present study we assessed by LC/MS method the influence of amantadine and dextromethorphan on morphine metabolism in humans in order to explain clinically observed phenomenon of amplification of analgesic action of morphine by these drugs. Neither dextromethorphan nor amantadine influenced the rate of morphine degradation and concentration of morphine metabolites. Thus, our results suggest pharmacodynamical, not pharmacokinetic mechanism of interaction.

An iTRAQ-Based Quantitative Proteomic Analysis of Plasma Proteins in Preterm Newborns With Retinopathy of Prematurity.

Purpose: Retinopathy of prematurity (ROP) is a vision-threatening complication of a premature birth, in which the etiology still remains unclear. Importantly, the molecular processes that govern these effects can be investigated in a perturbed plasma proteome composition. Thus, plasma proteomics may add new insights into a better understanding of the pathogenesis of this disease. Methods: The cord and peripheral blood of neonates (≤30 weeks gestational age) was drawn at birth and at the 36th postmenstrual week (PMA), respectively. Blood samples were retrospectively subdivided into ROP(+) and ROP(-) groups, according to the development of ROP. Results: The quantitative analysis of plasma proteome at both time points revealed 30 protein abundance changes between ROP(+) and ROP(-) groups. After standardization to gestational age, children who developed ROP were characterized by an increased C3 complement component and fibrinogen level at both analyzed time points. Conclusions: Higher levels of the complement C3 component and fibrinogen, present in the cord blood and persistent to 36 PMA, may indicate a chronic low-grade systemic inflammation and hypercoagulable state that may play a role in the development of ROP.

Plasma proteome changes in cord blood samples from preterm infants.

OBJECTIVE: In the presented study, we aimed to systematically analyze plasma proteomes in cord blood samples from preterm infants stratified by their gestational age to identify proteins and related malfunctioning pathways at birth, possibly contributing to the complications observed among preterm infants. STUDY DESIGN: Preterm newborns were enrolled of three subgroups with different gestation age: newborns born ≤26 (group 1), between 27 and 28 (group 2) and between 29 and 30 (group 3) weeks of gestation, respectively, and compared to the control group of healthy, full-term newborns in respect to their plasma proteome composition. RESULT: Preterm delivery is associated with multiple protein abundance changes in plasma related to a plethora of processes, including inflammation and immunomodulation, coagulation, and complement activation as some key features. CONCLUSION: Plasma proteome analysis revealed numerous gestation-age-dependent protein abundance differences between term and preterm infants, which highlight key dysregulated pathways and potential new protein treatment targets.

Postmortem toxicology of carbamazepine.

The study focuses on a series of 16 fatal cases in which carbamazepine and its two major metabolites (10,11-epoxide and 10,11-dihydroxycarbamazepine) were detected in body fluids and tissues collected at autopsy. The drug may be implicated in a number of deaths; however, most of these are multiple-drug intoxications with a particular contribution of ethanol. The investigations concerning toxicological findings are a source of toxicological postmortem data and show the differences in metabolism rate as depending on the concentration level of carbamazepine and xenobiotics found in the autopsy specimen during the postmortem investigation of a body.

[Amphetamine and derivatives related death in the aspect of forensic toxicology]. / Amfetamina i pochodne w opiniowaniu sadowo--lekarskim przypadków smiertelnych.

Amphetamine and derivatives are the crucial theme in the problems of forensic toxicology. The paper is based on the study of 20 cases of deaths in which amphetamine and/or derivatives were involved as the cause of death. Toxicological examinations of the autopsy specimens were performed with the use of HPLC/MS method in chemical positive ionization mode (APCI) after liquid--liquid extraction. The toxicological findings obtained in particular cases indicate that the majority of cases under consideration were complex. Among all 20 cases only two, probably suicidal deaths, were a result of amphetamine abuse. Some of them which were violent deaths (murder, gun-shot, hanging, drowning) of people under the influence of drugs. The majority of cases which were probably fatal accidents caused by the interaction of various mixtures of xenobiotics which included also opiates, cocaine, benzodiazepines besides amphetamine and derivatives. The concentrations of xenobiotics detected in these cases fit a relatively large range. One case is worth mentioning. This is a death of a permanent amphetamine user who survived two weeks with hematoma in brain in which amphetamine was detected postmortem. The report also discuss amphetamine and derivatives metabolic problems and contains useful data for medico-legal purposes.

GTP cyclohydrolase I gene polymorphisms are associated with endothelial dysfunction and oxidative stress in patients with type 2 diabetes mellitus.

BACKGROUND: The genetic background of atherosclerosis in type 2 diabetes mellitus (T2DM) is complex and poorly understood. Studying genetic components of intermediate phenotypes, such as endothelial dysfunction and oxidative stress, may aid in identifying novel genetic components for atherosclerosis in diabetic patients. METHODS: Five polymorphisms forming two haplotype blocks within the GTP cyclohydrolase 1 gene, encoding a rate limiting enzyme in tetrahydrobiopterin synthesis, were studied in the context of flow and nitroglycerin mediated dilation (FMD and NMD), intima-media thickness (IMT), and plasma concentrations of von Willebrand factor (vWF) and malondialdehyde (MDA). RESULTS: Rs841 was associated with FMD (p = 0.01), while polymorphisms Rs10483639, Rs841, Rs3783641 (which form a single haplotype) were associated with both MDA (p = 0.012, p = 0.0015 and p = 0.003, respectively) and vWF concentrations (p = 0.016, p = 0.03 and p = 0.045, respectively). In addition, polymorphism Rs8007267 was also associated with MDA (p = 0.006). Haplotype analysis confirmed the association of both haplotypes with studied variables. CONCLUSIONS: Genetic variation of the GCH1 gene is associated with endothelial dysfunction and oxidative stress in T2DM patients.