title: 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 alpha-actin, alpha-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.
authors.affiliation: Division of Cardiology, VA Medical Center, University of Michigan, Ann Arbor, MI, USA. cchensc@med.umich.edu
authors.forename: Carol
authors.initials: C
authors.lastname: Chen-Scarabelli
authors.forename: Siân E
authors.initials: SE
authors.lastname: Hughes
authors.forename: Giorgio
authors.initials: G
authors.lastname: Landon
authors.forename: Peter
authors.initials: P
authors.lastname: Rowley
authors.forename: Zuhair
authors.initials: Z
authors.lastname: Allebban
authors.forename: Noel
authors.initials: N
authors.lastname: Lawson
authors.forename: Louis
authors.initials: L
authors.lastname: Saravolatz
authors.forename: Julius
authors.initials: J
authors.lastname: Gardin
authors.forename: David
authors.initials: D
authors.lastname: Latchman
authors.forename: Tiziano M
authors.initials: TM
authors.lastname: Scarabelli
mesh_terms: D017209:Apoptosis / Q000502:physiology; D015153:Blotting, Western; D053148:Caspase 3; D053453:Caspase 9; D020169:Caspases / Q000378:metabolism*; D029789:Ephedra / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D008062:Lipofuscin / Q000378:metabolism*; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D032383:Myocytes, Cardiac / Q000378:metabolism* / Q000473:pathology; D020107:Troponin T / Q000378:metabolism
chemical_list: D008062:Lipofuscin; D020107:Troponin T; C505407:CASP3 protein, human; C506433:CASP9 protein, human; D053148:Caspase 3; D053453:Caspase 9; D020169:Caspases