A review on the mitochondrial toxicity of "ecstasy" (3,4-methylenedioxymethamphetamine, MDMA)

João Paulo Capela; Félix Dias Carvalho

doi:10.1016/j.crtox.2022.100075

A review on the mitochondrial toxicity of "ecstasy" (3,4-methylenedioxymethamphetamine, MDMA)

Curr Res Toxicol. 2022 May 19:3:100075. doi: 10.1016/j.crtox.2022.100075. eCollection 2022.

Authors

João Paulo Capela^{1

2

3}, Félix Dias Carvalho^{1

2}

Affiliations

¹ UCIBIO, Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal.
² Associate Laboratory i4HB, Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal.
³ FP-I3ID, Faculty of Health Sciences, University Fernando Pessoa, 4020-150 Porto, Portugal.

Abstract

3,4-Methylenedioxymethamphetamine (MDMA or "ecstasy") is a drug of abuse used by millions worldwide. MDMA human abuse and dependence is well described, but addictive properties are not always consistent among studies. This amphetamine is a substrate type releaser, binding to monoamine transporters, leading to a pronounced release of serotonin and noradrenaline and to a minor extent dopamine. The toxicity of MDMA is well studied at the pre-clinical level, with neurotoxicity and hepatotoxicity being particularly described. In this review, we describe the most relevant MDMA effects at the mitochondrial level found in in vitro and in vivo models, these later conducted in mice and rats. Most of these reports focus on the mitochondria of brain or liver. In in vitro models, MDMA causes depletion of ATP levels and inhibition of mitochondrial complex I and III, loss in mitochondrial membrane potential (ΔΨm) and induction of mitochondrial permeability transition. The involvement of mitochondria in the apoptotic cell death evoked by MDMA has also been shown, such as the release of cytochrome c. Additionally, MDMA or its metabolites impaired mitochondrial trafficking and increased the fragmentation of axonal mitochondria. In animal studies, MDMA decreased mitochondrial complex I activity and decreased ATP levels. Moreover, MDMA-evoked oxidative stress has been shown to cause deletion on mitochondrial DNA and impairment in mitochondrial protein synthesis. Although the concentrations and doses used in some studies do not always correlate to the human scenario, the mitochondrial abnormalities evoked by MDMA are well described and are in part responsible for its mechanism of toxicity.

Keywords: 3,4-Methylenedioxymethamphetamine; 5-HT, Serotonin; Drug of Abuse; Hepatotoxicity; MAO, Monoamine oxidase; MDMA, 3,4-Methylenedioxymethamphetamine; MPT, Mitochondrial permeability transition; Mitochondrial membrane potential; Mitochondrial toxicity; Mitochondrial trafficking; NA, Noradrenaline; Neurotoxicity; PST, Post-traumatic stress disorder; ROS, Reactive oxygen species; SERT, Serotonin transporter; UCP-3, Uncoupling protein-3; ΔΨm, Mitochondrial membrane potential.