Cannabinoid hyperemesis syndrome: genetic susceptibility to toxic exposure.

IF 3.6 Q2 TOXICOLOGY Frontiers in toxicology Pub Date : 2024-10-23 eCollection Date: 2024-01-01 DOI:10.3389/ftox.2024.1465728
Ethan B Russo, Venetia L Whiteley
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Abstract

Cannabinoid hyperemesis syndrome presents as a complex of symptoms and signs encompassing nausea, vomiting, abdominal pain, and hot water bathing behavior, most typically in a heavy cannabis user. Its presentation is frequently associated with hypothalamic-pituitary-adrenal axis activation with stress and weight loss. Recent investigation has identified five statistically significant mutations in patients distinct from those of frequent cannabis users who lack the symptoms, affecting the TRPV1 receptor, two dopamine genes, the cytochrome P450 2C9 enzyme that metabolizes tetrahydrocannabinol, and the adenosine triphosphate-binding cassette transporter. The syndrome is associated with escalating intake of high potency cannabis, or alternatively, other agonists of the cannabinoid-1 receptor including synthetic cannabinoids. Some patients develop environmental triggers in scents or foods that suggest classical conditioned responses. Various alternative "causes" are addressed and refuted in the text, including exposure to pesticides, neem oil or azadirachtin. Nosological confusion of cannabinoid hyperemesis syndrome has arisen with cyclic vomiting syndrome, whose presentation and pathophysiology are clearly distinct. The possible utilization of non-intoxicating antiemetic cannabis components in cannabis for treatment of cannabinoid hyperemesis syndrome is addressed, along with future research suggestions in relation to its genetic foundation and possible metabolomic signatures.

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大麻素剧吐症综合征:遗传易感性毒性暴露。
大麻素催吐综合征是一种症状和体征复杂的疾病,包括恶心、呕吐、腹痛和热水澡行为,最典型的表现是大量吸食大麻。其表现通常与压力和体重下降导致的下丘脑-垂体-肾上腺轴激活有关。最近的调查发现,患者体内有五种具有统计学意义的突变,这些突变影响了 TRPV1 受体、两个多巴胺基因、代谢四氢大麻酚的细胞色素 P450 2C9 酶以及三磷酸腺苷结合盒转运体,这些突变与那些经常吸食大麻但没有上述症状的患者不同。该综合征与高浓度大麻或大麻素-1 受体的其他激动剂(包括合成大麻素)的摄入量不断增加有关。有些患者会在气味或食物中出现环境诱因,这表明他们出现了典型的条件反射。文中讨论并驳斥了各种替代 "原因",包括接触杀虫剂、楝树油或氮芥。大麻素催吐综合征与周期性呕吐综合征在命名上产生了混淆,后者的表现和病理生理学明显不同。本研究探讨了利用大麻中的非致毒止吐成分治疗大麻素催吐综合征的可能性,以及有关其遗传基础和可能的代谢组特征的未来研究建议。
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来源期刊
CiteScore
3.80
自引率
0.00%
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0
审稿时长
13 weeks
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