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One Minute of Marijuana Secondhand Smoke Exposure Substantially Impairs Vascular Endothelial Function

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One Minute of Marijuana Secondhand Smoke Exposure Substantially Impairs Vascular Endothelial Function UCSF UC San Francisco Previously Published Works Title One Minute of Marijuana Secondhand Smoke Exposure Substantially Impairs Vascular Endothelial Function. Permalink https://escholarship.org/uc/item/1t46k2kj Journal Journal of the American Heart Association, 5(8) ISSN 2047-9980 Authors Wang, Xiaoyin Derakhshandeh, Ronak Liu, Jiangtao et al. Publication Date 2016-07-27 DOI 10.1161/jaha.116.003858 Peer reviewed eScholarship.org Powered by the California Digital Library University of California ORIGINAL RESEARCH One Minute of Marijuana Secondhand Smoke Exposure Substantially Impairs Vascular Endothelial Function Xiaoyin Wang, MD; Ronak Derakhshandeh, MS; Jiangtao Liu, MD; Shilpa Narayan, BS;* Pooneh Nabavizadeh, MD; Stephenie Le, BA;† Olivia M. Danforth, BS;‡ Kranthi Pinnamaneni, MD; Hilda J. Rodriguez, AS; Emmy Luu, BS; Richard E. Sievers, BS; Suzaynn F. Schick, PhD; Stanton A. Glantz, PhD; Matthew L. Springer, PhD Background-—Despite public awareness that tobacco secondhand smoke (SHS) is harmful, many people still assume that marijuana SHS is benign. Debates about whether smoke-free laws should include marijuana are becoming increasingly widespread as marijuana is legalized and the cannabis industry grows. Lack of evidence for marijuana SHS causing acute cardiovascular harm is frequently mistaken for evidence that it is harmless, despite chemical and physical similarity between marijuana and tobacco smoke. We investigated whether brief exposure to marijuana SHS causes acute vascular endothelial dysfunction. Methods and Results-—We measured endothelial function as femoral artery flow-mediated dilation (FMD) in rats before and after exposure to marijuana SHS at levels similar to real-world tobacco SHS conditions. One minute of exposure to marijuana SHS impaired FMD to a comparable extent as impairment from equal concentrations of tobacco SHS, but recovery was considerably slower for marijuana. Exposure to marijuana SHS directly caused cannabinoid-independent vasodilation that subsided within 25 minutes, whereas FMD remained impaired for at least 90 minutes. Impairment occurred even when marijuana lacked cannabinoids and rolling paper was omitted. Endothelium-independent vasodilation by nitroglycerin administration was not impaired. FMD was not impaired by exposure to chamber air. Conclusions-—One minute of exposure to marijuana SHS substantially impairs endothelial function in rats for at least 90 minutes, considerably longer than comparable impairment by tobacco SHS. Impairment of FMD does not require cannabinoids, nicotine, or rolling paper smoke. Our findings in rats suggest that SHS can exert similar adverse cardiovascular effects regardless of whether it is from tobacco or marijuana. ( J Am Heart Assoc. 2016;5:e003858 doi: 10.1161/JAHA.116.003858) Key Words: artery • cannabis • endothelium • flow-mediated dilation • marijuana • nitric oxide synthase • secondhand smoke • smoking • vasodilation here is widespread belief that, unlike tobacco smoke, each year, with 46 000 from cardiovascular disease,6–8 and T marijuana smoke is benign.1 While the psychoactive implementation of laws prohibiting smoking in public places substance in marijuana is tetrahydrocannabinol (THC) rather and workplaces is followed by drops in hospital admissions for than nicotine, marijuana smoke is still the result of biomass acute myocardial infarction, other cardiac events, stroke, and combustion and contains many of the same toxins as tobacco pulmonary diseases.9 However, due to the illegality of mari- smoke,2 including fine particles that cause cardiovascular juana, it has been difficult to prospectively study the effects of morbidity and mortality.3–5 Tobacco secondhand smoke (SHS) marijuana smoke, and the rare secondhand marijuana smoke alone is responsible for 50 000 deaths in the United States studies have focused on whether exposed people test positive From the Cardiovascular Research Institute (X.W., R.D., S.N., O.M.D., K.P., S.A.G., M.L.S.), Division of Cardiology (J.L., S.N., P.N., S.L., H.J.R., E.L., R.E.S., S.A.G., M.L.S.), Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research (H.J.R., M.L.S.), and Division of Occupational and Environmental Medicine (S.F.S.), University of California, San Francisco; Department of Cardiovascular Surgery & Electro-chemotherapy, China-Japan Friendship Hospital, Beijing, People’s Republic of China (J.L.). *Ms Shilpa Narayan is currently located at Drexel University College of Medicine, Philadelphia, PA. †Ms Stephenie Le is currently located at Albany Medical College, Albany, NY. ‡Ms Olivia M. Danforth is currently located at Rush Medical College, Chicago, IL. Correspondence to: Matthew L. Springer, PhD, Division of Cardiology, University of California, San Francisco, 513 Parnassus Ave, Box 0124, San Francisco, CA 94143. E-mail: [email protected] Received May 6, 2016; accepted June 2, 2016. ª 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. DOI: 10.1161/JAHA.116.003858 Journal of the American Heart Association 1 Downloaded from http://jaha.ahajournals.org/ at CONS CALIFORNIA DIG LIB on July 27, 2016 Vascular Impairment by Marijuana Secondhand Smoke Wang et al ORIGINAL RESEARCH on drug tests.10–12 The increasing number of states legalizing 200 to 250 g. Rats were anesthetized under ketamine/ medicinal and recreational marijuana, and increasing potential xylazine with intraperitoneal injection. Starting doses were for corporate expansion within the cannabis industry,13 make it ketamine (100 mg/kg)/xylazine (5 mg/kg). Repeated injec- important to understand the health consequences of second- tions were required with one third to one half doses at a time hand exposure to marijuana smoke. (approximately every 30 minutes). Experiments were terminal. Vascular health can be evaluated by measuring arterial flow- All procedures were approved by the University of California, mediated dilation (FMD), the extent to which arteries vasodilate San Francisco Institutional Animal Care and Use Committee. in response to increased blood flow.14–16 FMD ensures sufficient blood flow to peripheral tissues and the heart. Decline in FMD precedes the development of atherosclerosis FMD Measurement and is likely important in its pathogenesis.14,16–19 FMD is FMD was measured in living rats as we have described quantified in humans by ultrasound as the percent vasodilation previously in detail32 by an investigator blinded to the of the brachial artery in response to restoration of blood flow exposure condition when 2 or more groups were compared. after transient occlusion.14 Brachial artery FMD is a well- As described in the Results section, some groups were added established clinical prognostic indicator of endothelial function to the experiment afterward for confirmatory purposes and that correlates with endothelium-dependent vasodilation of the those could not be blinded, but the diameter measurement coronary arteries17 and other measures of cardiovascular was performed by an automated system. Briefly, after surgical health.14,16,19,20 Decreased brachial FMD correlates with isolation of the common iliac artery, an arterial loop occluder adverse cardiovascular outcomes that are increased by consisting of a 5–0 Prolene filament was positioned under the cigarette smoke, including myocardial infarction and artery and passed through 15-cm PE-90 tubing to enable atherosclerosis.21–23 FMD is impaired in tobacco smokers transient occlusion of blood flow. After a 15-minute equili- relative to nonsmokers.24 People who report frequent SHS bration, the artery was transiently occluded for 5 minutes, exposure exhibit poor FMD even when smoke is not present followed by release of the occluder and reperfusion of the during the testing,24,25 and a 30-minute exposure to SHS at artery. A series of diameter images of the femoral artery and real-world levels impairs FMD in humans.26–28 The nicotine in accompanying Doppler blood flow images were recorded with tobacco is not responsible for the entire adverse effect of a 35-MHz ultrasound transducer (Vevo660, VisualSonics, tobacco smoke on FMD,29 and vasodilatory function is also Toronto, Canada) before transient surgical occlusion (base- impaired by diesel exhaust and by smoke from incense and line), immediately after blood reflow, and then every 30 s until candles.30,31 These observations, along with the similar chem- 5 minutes. Diameter measurement was performed offline ical composition of tobacco and marijuana smoke,2 led us to from the recorded loops using an automated system (Brachial hypothesize that marijuana smoke would also impair FMD. Analyzer 5; Medical Imaging Applications, Coralville, IA).32 All We developed an animal model that uses micro-ultrasound diameter readings were taken at diastole. FMD was calculated and a simple reversible surgical occlusion of blood flow to the leg as % change: (peak diameterpostischemiaÀdiameterbaseline)/ 32 to measure FMD in the femoral arteries of living rats, diameterbaseline9100. The rats were kept at 37°Cona analogous to the measurement of brachial artery FMD in thermal blanket throughout to avoid inconsistent vasodilation humans. We extensively validated this technique physiologically from anesthesia-induced hypothermia.
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