γ-Hydroxybutyric Acid: Pharmacokinetics, Pharmacodynamics, and Toxicology.

Gamma-hydroxybutyrate (GHB) is a short-chain fatty acid present endogenously in the brain and used therapeutically for the treatment of narcolepsy, as sodium oxybate, and for alcohol abuse/withdrawal. GHB is better known however as a drug of abuse and is commonly referred to as the "date-rape drug"; current use in popular culture includes recreational "chemsex," due to its properties of euphoria, loss of inhibition, amnesia, and drowsiness. Due to the steep concentration-effect curve for GHB, overdoses occur commonly and symptoms include sedation, respiratory depression, coma, and death. GHB binds to both GHB and GABAB receptors in the brain, with pharmacological/toxicological effects mainly due to GABAB agonist effects. The pharmacokinetics of GHB are complex and include nonlinear absorption, metabolism, tissue uptake, and renal elimination processes. GHB is a substrate for monocarboxylate transporters, including both sodium-dependent transporters (SMCT1, 2; SLC5A8; SLC5A12) and proton-dependent transporters (MCT1-4; SLC16A1, 7, 8, and 3), which represent significant determinants of absorption, renal reabsorption, and brain and tissue uptake. This review will provide current information of the pharmacology, therapeutic effects, and pharmacokinetics/pharmacodynamics of GHB, as well as therapeutic strategies for the treatment of overdoses. Graphical abstract.

Safety and tolerability of sustained exogenous ketosis using ketone monoester drinks for 28 days in healthy adults.

Throughout history, the only way humans could raise their blood ketone levels was by several days of fasting or by following a strict low-carb, high-fat diet. A recently developed, dietary source of ketones, a ketone monoester, elevates d-ß-hydroxybutyrate (ßHB) to similar concentrations within minutes, with ßHB remaining raised for several hours. To date, the longest human safety study of the exogenous ketone ester was for 5 days, but longer consumption times may be desired. Here we report results for 24 healthy adults, aged 18-70 years, who drank 25 ml (26.8 g) of the ketone monoester, (R)-3-hydroxybutyl (R)-3-hydroxybutyrate, three times a day for 28 days (a total of 2.1 L). Anthropomorphic measurements, plus fasting blood and urine analyses were made weekly. It was found that elevating blood ßHB concentrations from 0.1 to 4.1 (±1.1) mM three times a day for 28 days had no effect on body weights or composition, fasting blood glucose, cholesterol, triglyceride or electrolyte concentrations, nor blood gases or kidney function, which were invariably normal. Mild nausea was reported following 6 of the 2,016 drinks consumed. We conclude that sustained exogenous ketosis using a ketone monoester is safe and well-tolerated by healthy adults.

Biodegradable and Petroleum-Based Microplastics Do Not Differ in Their Ingestion and Excretion but in Their Biological Effects in a Freshwater Invertebrate Gammarus fossarum.

Research on the uptake and effects of bioplastics by aquatic organisms is still in its infancy. Here, we aim to advance the field by comparing uptake and effects of microplastic particles (MPP) of a biodegradable bioMPP (polyhydroxybutyrate (PHB)) and petroleum-based MPP (polymethylmethacrylate (PMMA)) in the freshwater amphipod Gammarus fossarum. Ingestion of both MPP in different particle sizes (32-250 µm) occurred after 24 h, with highest ingestion of particles in the range 32-63 µm and almost complete egestion after 64 h. A four-week effect-experiment showed a significant decrease of the assimilation efficiency in amphipods exposed to the petroleum-based MPP from week two onwards. The petroleum-based PMMA affected assimilation efficiency significantly in contrast to the biodegradable PHB, but overall differences in direct comparison of MPP types were small. Both MPP types led to a significantly lower wet weight gain relative to the control treatments. After four weeks, differences between both MPP types and silica, used as a natural particle control, were detected. In summary, these results suggest that both MPP types provoke digestive constraints on the amphipods, which go beyond those of natural non-palatable particles. This highlights the need for more detailed research comparing environmental effects of biodegradable and petroleum-based MPP and testing those against naturally occurring particle loads.

Evaluation of gamma-hydroxybutyric acid for genotoxicity in the mouse micronucleus assay.

Gamma-hydroxybutyric acid (GHB) is an endogenous compound found in the brain and other tissues of mammals. Neurotransmitter/neuromodulator functions have been ascribed to GHB, which has lately become a drug of abuse. In this study, we tested GHB for genotoxicity by measuring its ability to induce micronuclei in polychromatic erythrocytes (reticulocytes) in the peripheral blood of mice. Intraperitoneal injection with a dose of 25 mg/kg/day for 3 days or 50 mg/kg/day x 3 days resulted in a significant (by Dunnett's test) increase of 1.9- to 2.1-fold in micronuclei. However, because increases were small and because no consistent dose-dependent increase in induced micronuclear frequency could be demonstrated, our results do not conclusively show that GHB is an in vivo genotoxicant in mammals.

Pathway-specific action of gamma-hydroxybutyric acid in sensory thalamus and its relevance to absence seizures.

The systemic injection of gamma-hydroxybutyric acid (GHB) elicits spike and wave discharges (SWDs), the EEG hallmark of absence seizures, and represents a well established, widely used pharmacological model of this nonconvulsive epilepsy. Despite this experimental use of GHB, as well as its therapeutic use in narcolepsy and its increasing abuse, however, the precise cellular mechanisms underlying the different pharmacological actions of this drug are still unclear. Because sensory thalamic nuclei play a key role in the generation of SWDs and sleep rhythms, and because direct injection of GHB in the ventrobasal (VB) thalamus elicits SWDs, we investigated GHB effects on corticothalamic EPSCs and GABAergic IPSCs in VB thalamocortical (TC) neurons. GHB (250 microm-10 mm) reversibly decreased the amplitude of electrically evoked EPSCs and GABAA IPSCs via activation of GABAB receptors; however, approximately 60% of the IPSCs were insensitive to low (250 microm-1.0 mm) GHB concentrations. The putative GHB receptor antagonist NSC 382 applied alone had a number of unspecific effects, whereas it either had no action on, or further increased, the GHB-elicited effects on synaptic currents. Low GHB concentrations (250 microm) were also effective in increasing absence-like intrathalamic oscillations evoked by cortical afferent stimulation. These results indicate that low concentrations of GHB, similar to the brain concentrations that evoke SWDs in vivo, differentially affect excitatory and inhibitory synaptic currents in TC neurons and promote absence-like intrathalamic oscillations. Furthermore, the present data strengthen previous suggestions on the GHB mechanism of sleep promotion and will help focus future studies on the cellular mechanisms underlying its abuse.

Contact dermatitis to Alstroemeria.

A study was carried out on 50 workers in a floriculture centre to evaluate the incidence of contact dermatitis to Alstroemeria. 3 subjects gave positive reactions to aqueous and ethanolic extracts of cut flowers, stems and leaves. By column chromatography, the allergen was isolated and its chemical structure identified as 6-tuliposide A by proton magnetic resonance and carbon-13 magnetic resonance. Only 6-tuliposide A was isolated from cut flowers, and this gave positive reactions when patch tested at 0.01%; a-methylene-gamma-butyrolactone at 10(-5) (v/v) was positive in the same 3 subjects. Other lactones (gamma-methylene-gamma-butyrolactone, alantolactone, isoalantolactone) were negative at all concentrations used.