Selected markers of hepatotoxicity in a group of patients taking mephedrone with other psychoactive substances

On December 2, 2010, the Council of the European Union, based on the report of the European Commission of August 3, 2010, decided to subject mephedrone to control measures and to subject it to criminal sanctions provided for by national legislation in the European Union (20101759 / EU). Despite the introduction of appropriate statutory regulations, the number of hospitalizations of patients taking mephedrone with other psychoactive substances is increasing year by year in Poland [1]. The articles published by me in the last 2 years indicate that one of the factors increasing the risk of subsequent hospitalization may be liver dysfunction [2]. The conducted analyzes showed, among others, that it is not mephedrone but HCV infection in this group of patients that is a factor that increases the level of liver enzymes. As a result of taking mephedrone with other drugs, and the concomitant HCV infection, the parenchymal cells of the liver are damaged. This results in increased release of transaminases from the liver into the blood and an increase in their concentration [3]. However, they are non-specific markers of liver damage because they are found in many types of cells, and they increase with damage to almost any organ. For this reason, more specific markers of hepatotoxicity should be investigated, such as: keratin 18 (K18), glutamate dehydrogenase GLDH, α-glutathione-transferase (αGST), tumor necrosis factor alpha (TNF-α) and interleukin 1-Beta [4]. Patients with no co-infection with HCV taking mephedrone with alcohol or mephedrone with heroin (15 in each group) would be enrolled in the study. My research to date shows that patients do not take mephedrone alone, but combine it with other psychoactive substances [1]. For this reason, the comparison group would consist of patients addicted to heroin alone (n = 30), alcohol (n = 30), as well as healthy people (n = 30). The study would exclude patients with disease entities that could affect the obtained results of liver parameters, which would be measured in biological material collected immediately after admission to the hospital. Future studies would include a larger group of people, including patients with HCV co-infection. The obtained preliminary results would also allow the identification of groups of patients for whom supplementation with liver regenerating preparations, i.e. containing S-Adenosylmethionine (SAM), would be necessary.  S-adenosylmethionine affects the metabolism of important neurotransmitters in the central nervous system, has a positive effect on the functioning of the liver and determines the production of glutathione, which is why it is classified as an indirect antioxidant [5]. Future research would include, inter alia, the effect of S-adenosylmethionine supplementation on the above-mentioned hepatotoxicity biomarkers. However, the first step is to investigate advanced markers of hepatotoxicity in a group of HCV uninfected mephedrone patients. Conducting these studies would allow to determine whether taking mephedrone with heroin or alcohol is actually hepatotoxic, or whether future studies should focus more on HCV infection in this group of patients. The obtained results would be related to the quality of life measured with appropriate questionnaires. Reducing the number of concomitant psychotropic drugs in patients taking mephedrone by introducing additional supplementation with a preparation regenerating the liver, could also contribute to reducing the number of hospitalizations, and thus lowering the costs incurred by the state generated by the use of polypharmacy.