Institute of Legal Medicine, University Hospital Düsseldorf, 40225, Düsseldorf, Germany.
Departement of Trauma Surgery, Hand Surgery and Orthopedics, Petrus Hospital Wuppertal, 42283, Wuppertal, Germany.
Int J Legal Med. 2024 May;138(3):823-831. doi: 10.1007/s00414-023-03146-3. Epub 2024 Jan 12.
Synthetic cannabinoids become increasingly popular as a supposedly safe and legal alternative to cannabis. In order to circumvent the German New Psychoactive Substances Law, producers of so-called herbal mixtures rapidly design new substances with structural alterations that are not covered by the law. Acting as full agonists not only at the cannabinoid receptors 1 and 2, synthetic cannabinoids might have not only desired mental but also serious physical adverse effects. However, knowledge of adverse effects of specific substances is sparse and incomplete. This also accounts for 5F-Cumyl-PEGACLONE, a synthetic cannabinoid, which has been detected regularly in Germany in recent years. By using an animal model, the isolated perfused Langendorff heart, the study at hand aimed on finding out more about possible cardiovascular adverse effects of 5F-Cumyl-PEGACLONE. Hearts of male Wistar rats, which were excised postmortem, were exposed to two different concentrations of 5F-Cumyl-PEGACLONE: 13 hearts were exposed to 50 ng/ml and 12 hearts were exposed to 100 ng/ml. Thirteen control hearts were merely exposed to an additional amount of buffer solution. Functional parameters heart rate, minimal and maximum left ventricular pressure and coronary flow were documented at pre-defined time points during and after the administration of 5F-Cumyl-PEGACLONE/additional buffer solution. Electrocardiograms (ECGs) were documented throughout the experiments and evaluated afterwards. Kruskal-Wallis analysis was performed for each functional parameter as well as for the duration of the QRS complexes and the duration of RR intervals as derived from the ECGs. Furthermore, a multivariate analysis, comprising all functional and ECG parameters, was performed. Kruskal-Wallis analysis revealed only single significant p-values for QRS duration and minimum left ventricular pressure that did not pass a Bonferroni test. The results of the multivariate approach were also comparably homogeneous, but still the model correctly recognized hearts exposed to 100 ng/ml of 5F-Cumyl-PEGACLONE more often than hearts exposed to the low concentration of 5F-Cumyl-PEGACLONE or additional buffer solution. Evaluation of the ECGs presented single cases of ST depression and QT prolongation. Though certainly not unambiguous, these findings support the assumption that 5F-Cumyl-PEGACLONE can cause severe, if not lethal, cardiac adverse effects like arrhythmias or myocardial infarctions especially if it is consumed in combination with other drugs like alcohol or if the consumer suffers from pre-existing heart diseases.
合成大麻素作为大麻的一种据称安全且合法的替代品越来越受欢迎。为了规避德国新精神活性物质法,所谓草药混合物的生产商迅速设计出具有结构改变的新物质,这些物质不受法律的约束。作为大麻素受体 1 和 2 的完全激动剂,合成大麻素不仅可能产生预期的精神影响,还可能产生严重的身体不良影响。然而,对于特定物质的不良反应知之甚少且不完整。这也适用于近年来在德国经常检测到的合成大麻素 5F-Cumyl-PEGACLONE。本研究使用离体灌流 Langendorff 心脏动物模型,旨在研究 5F-Cumyl-PEGACLONE 可能对心血管系统产生的不良反应。从死后取出的雄性 Wistar 大鼠心脏被暴露于两种不同浓度的 5F-Cumyl-PEGACLONE:13 个心脏暴露于 50ng/ml,12 个心脏暴露于 100ng/ml。13 个对照心脏仅暴露于额外的缓冲溶液。在给予 5F-Cumyl-PEGACLONE/额外缓冲溶液期间和之后的预定义时间点记录心功能参数心率、左心室最小和最大压力以及冠状血流。整个实验过程中记录心电图(ECG),并在实验结束后进行评估。对每个功能参数以及 ECG 得出的 QRS 复合体持续时间和 RR 间隔持续时间进行 Kruskal-Wallis 分析。此外,还进行了包含所有功能和 ECG 参数的多变量分析。Kruskal-Wallis 分析仅显示 QRS 持续时间和左心室最小压力的单个显著 p 值,这些 p 值未通过 Bonferroni 检验。多变量方法的结果也相当一致,但该模型仍然更经常地识别出暴露于 100ng/ml 5F-Cumyl-PEGACLONE 的心脏,而不是暴露于低浓度 5F-Cumyl-PEGACLONE 或额外缓冲溶液的心脏。ECG 的评估呈现出单个 ST 段压低和 QT 延长的病例。虽然肯定不是明确的,但这些发现支持以下假设,即 5F-Cumyl-PEGACLONE 可能导致严重的心脏不良反应,甚至致命的心脏不良反应,如心律失常或心肌梗死,特别是如果它与其他药物(如酒精)一起使用,或者如果消费者患有先前存在的心脏病。