几项研究表明,快克可卡因使用者在精神病和心理社会问题上的患病率更高,具有侵略性的吸毒模式。然而,很少有实验研究试图验证可卡因暴露后的神经毒性,特别是与其他可卡因给药途径相比。本系统综述旨在验证体外和/或体内可卡因暴露是否比可卡因暴露(吸食或注射)更具神经毒性。在PubMed中进行了搜索,EMBASE,Scopus,WebofScience,和LILACS数据库,用于对大鼠或小鼠进行的体外和体内毒理学研究,在性别或年龄方面没有区别。其他方法,包括BioRxiv,BDTD,学术谷歌,引文搜索,并通过了专家咨询。两名独立研究人员筛选了检索到的研究的标题和摘要,随后进行了全文阅读和数据提取。通过毒理学数据可靠性评估工具(ToxRTool)评估纳入研究的质量。研究方案已在前瞻性系统评价注册中心(PROSPERO;CRD4202232250)注册。在包括的12项研究中,三个是体外研究,九个是体内研究。根据ToxRTool的说法,大多数研究被认为是可靠的,无论有没有限制,没有人被认为是不可靠的。研究发现了神经致畸作用,癫痫发作的阈值降低,精神分裂症样症状,和认知缺陷与可卡因暴露有关。此外,体外和体内研究都报道了由脱水秋黄碱甲酯(AEME)引起的可卡因神经毒性作用的恶化,可卡因的主要热解产物,这与可卡因使用更具侵略性的模式是一致的。这项系统评价表明,可卡因暴露比其他可卡因给药途径更具神经毒性。然而,在缺乏关于这个主题的研究之前,进一步的毒理学研究是必要的。
Several studies suggest that crack cocaine users exhibit higher prevalence of both psychiatric and psychosocial problems, with an aggressive pattern of drug use. Nevertheless, few experimental studies attempted to verify the
neurotoxicity after crack cocaine exposure, especially when compared with other routes of cocaine administration. This systematic
review aimed to verify whether in vitro and/or in vivo crack cocaine exposure is more neurotoxic than cocaine exposure (snorted or injected). A search was performed in the PubMed, EMBASE, Scopus, Web of Science, and LILACS databases for in vitro and in vivo toxicological studies conducted with either rats or mice, with no distinction with regard to sex or age. Other methods including BioRxiv, BDTD, Academic Google, citation searching, and specialist consultation were also adopted. Two independent investigators screened the titles and abstracts of retrieved studies and subsequently performed full-text reading and data extraction. The quality of the included studies was assessed by the Toxicological data Reliability assessment Tool (ToxRTool). The study protocol was registered with the Prospective Registry of Systematic Reviews (PROSPERO; CRD42022332250). Of the twelve studies included, three were in vitro and nine were in vivo studies. According to the ToxRTool, most studies were considered reliable either with or without restrictions, with no one being considered as not reliable. The studies found neuroteratogenic effects, decreased threshold for epileptic seizures, schizophrenic-like symptoms, and cognitive deficits to be associated with crack cocaine exposure. Moreover, both in vitro and in vivo studies reported a worsening in cocaine neurotoxic effect caused by the anhydroecgonine methyl ester (AEME), a cocaine main pyrolysis product, which is in line with the more aggressive pattern of crack cocaine use. This systematic
review suggests that crack cocaine exposure is more neurotoxic than other routes of cocaine administration. However, before the scarcity of studies on this topic, further toxicological studies are necessary.