A case of fatal ephedra intake associated with lipofuscin accumulation, caspase activation and cleavage of myofibrillary proteins

Abstract

Ephedra, a herb reported to suppress appetite and stimulate the sympathetic nervous system as well as cardiac performance, has recently been related to several adverse events, including seizure, stroke, hypertension, myocardial infarction, and sudden death. Here, we describe the case of a 45-year-old woman who died of cardiovascular collapse while taking ephedra. Tissue analysis revealed non-specific degenerative alterations in the myocardium (lipofuscin accumulation, basophilic degeneration and vacuolation of myocytes, as well as myofibrillary loss), associated with myocyte apoptosis, caspase activation, and extensive cleavage of miofibrillary proteins a-actin, a-actinin, and cardiac troponin T. Healthcare professionals are therefore urged to warn their patients about the risk of serious adverse effects, which may follow ephedra intake.

Functional and clinical repercussions of myocyte apoptosis in the multifaceted damage by ischemia/reperfusion injury: old and new concepts after 10 years of contributions

“…93 In line with these findings, cardiac broad myofibrillary loss, together with extensive myocyte activation of caspase-9 and -3, largely independent of DNA fragmentation, was also documented in a case of sudden death temporally related to ephedra intake. 94 Since caspase activation was also detected during relatively short periods of ischemia alone, in the absence of DNA cleavage, 13,18 it is possible that activated caspases may contribute to cardiac dysfunction also in the early phase of ischemia, inducing precocious breakdown of myofilaments with subsequent contractile impairment, before the completion of the apoptotic process, and independently from necrotic cell death. Considering the massive requirement for mitochondrial ATP production in the heart, it is worth noting that caspase activation can impair mitochondrial respiration.…”

Peer review and the process of publishing of adverse drug event reports

“…The two case reports summarized below were published late in 2005. 5,6 The authors clearly believe their reports demonstrate a cause and effect relationship, and no data that might conflict with their conclusion appeared to be referred to.…”

Risk Factors for Heart Failure in Young Adults

“…Ephedra intake has been associated with hypertension, myocardial infarction, and death, potentially via enhanced release of sympathomimetic amines causing apoptosis [52]. Cancer treatments, including chemotherapy and mediastinal radiation, can cause HF.…”