3,4-Methylenedioxymethamphetamine (MDMA) neurotoxicity in rats: a reappraisal of past and present findings

Rationale3,4-Methylenedioxymethamphetamine (MDMA) is a widely abused illicit drug. In animals, high-dose administration of MDMA produces deficits in serotonin (5-HT) neurons (e.g., depletion of forebrain 5-HT) that have been interpreted as neurotoxicity. Whether such 5-HT deficits reflect neuronal damage is a matter of ongoing debate.ObjectiveThe present paper reviews four specific issues related to the hypothesis of MDMA neurotoxicity in rats: (1) the effects of MDMA on monoamine neurons, (2) the use of “interspecies scaling” to adjust MDMA doses across species, (3) the effects of MDMA on established markers of neuronal damage, and (4) functional impairments associated with MDMA-induced 5-HT depletions.ResultsMDMA is a substrate for monoamine transporters, and stimulated release of 5-HT, NE, and DA mediates effects of the drug. MDMA produces neurochemical, endocrine, and behavioral actions in rats and humans at equivalent doses (e.g., 1–2 mg/kg), suggesting that there is no reason to adjust doses between these species. Typical doses of MDMA causing long-term 5-HT depletions in rats (e.g., 10–20 mg/kg) do not reliably increase markers of neurotoxic damage such as cell death, silver staining, or reactive gliosis. MDMA-induced 5-HT depletions are accompanied by a number of functional consequences including reductions in evoked 5-HT release and changes in hormone secretion. Perhaps more importantly, administration of MDMA to rats induces persistent anxiety-like behaviors in the absence of measurable 5-HT deficits.ConclusionsMDMA-induced 5-HT depletions are not necessarily synonymous with neurotoxic damage. However, doses of MDMA which do not cause long-term 5-HT depletions can have protracted effects on behavior, suggesting even moderate doses of the drug may pose risks.

[1]  The contribution of drug research to investigating the nature of endogenous depression. , 1976, Pharmakopsychiatrie, Neuro-Psychopharmakologie.

[2]  M. Gobbi,et al.  Carrier‐dependent and Ca2+‐dependent 5‐HT and dopamine release induced by (+)‐amphetamine, 3,4‐methylendioxy‐methamphetamine, p‐chloroamphetamine and (+)‐fenfluramine , 1997, British journal of pharmacology.

[3]  W. Slikker,et al.  Behavioral and neurochemical effects of orally administered MDMA in the rodent and nonhuman primate. , 1989, Neurotoxicology.

[4]  R. Roth,et al.  MDMA (3,4-methylenedioxymethamphetamine) inhibits the firing of dorsal raphe neurons in brain slices via release of serotonin. , 1989, European journal of pharmacology.

[5]  G. Aghajanian,et al.  Serotonergic and non-serotonergic neurons of the dorsal raphe: reciprocal changes in firing induced by peripheral nerve stimulation , 1978, Brain Research.

[6]  C. J. Schmidt,et al.  Neurotoxicity of the psychedelic amphetamine, methylenedioxymethamphetamine. , 1987, The Journal of pharmacology and experimental therapeutics.

[7]  T. Monks,et al.  Serotonergic neurotoxicity of 3,4-(+/-)-methylenedioxyamphetamine and 3,4-(+/-)-methylendioxymethamphetamine (ecstasy) is potentiated by inhibition of gamma-glutamyl transpeptidase. , 2001, Chemical research in toxicology.

[8]  D. E. Nichols,et al.  Effects of certain hallucinogenic amphetamine analogues on the release of [3H]serotonin from rat brain synaptosomes. , 1982, Journal of medicinal chemistry.

[9]  A. Cho,et al.  Disposition of methylenedioxymethamphetamine and three metabolites in the brains of different rat strains and their possible roles in acute serotonin depletion. , 1996, Biochemical pharmacology.

[10]  G. Battaglia,et al.  MDMA-induced neurotoxicity: Parameters of degeneration and recovery of brain serotonin neurons , 1988, Pharmacology Biochemistry and Behavior.

[11]  Joseph A Banken,et al.  Drug Abuse Trends among Youth in the United States , 2004, Annals of the New York Academy of Sciences.

[12]  R. Rothman,et al.  1-(m-Chlorophenyl)piperazine (mCPP) Dissociates In Vivo Serotonin Release from Long-Term Serotonin Depletion in Rat Brain , 2001, Neuropsychopharmacology.

[13]  F. Vollenweider,et al.  Which neuroreceptors mediate the subjective effects of MDMA in humans? A summary of mechanistic studies , 2001, Human psychopharmacology.

[14]  A Frazer,et al.  Delayed pharmacological effects of antidepressants , 2002, Molecular Psychiatry.

[15]  R. Dafters Hyperthermia following MDMA administration in rats: Effects of ambient temperature, water consumption, and chronic dosing , 1995, Physiology & Behavior.

[16]  B. Yamamoto,et al.  Modulation of methylenedioxymethamphetamine-induced striatal dopamine release by the interaction between serotonin and gamma-aminobutyric acid in the substantia nigra. , 1995, The Journal of pharmacology and experimental therapeutics.

[17]  E. D. De Souza,et al.  3,4-Methylenedioxymethamphetamine and 3,4-methylenedioxyamphetamine destroy serotonin terminals in rat brain: quantification of neurodegeneration by measurement of [3H]paroxetine-labeled serotonin uptake sites. , 1987, The Journal of pharmacology and experimental therapeutics.

[18]  J. Cadet,et al.  Methylenedioxymethamphetamine (MDMA, Ecstasy) neurotoxicity: cellular and molecular mechanisms , 2003, Brain Research Reviews.

[19]  D. Olton,et al.  3,4-Methylenedioxymethamphetamine, serotonin and memory. , 1993, The Journal of pharmacology and experimental therapeutics.

[20]  J. O'Callaghan,et al.  Mapping toxicant-induced nervous system damage with a cupric silver stain: a quantitative analysis of neural degeneration induced by 3,4-methylenedioxymethamphetamine. , 1993, NIDA research monograph.

[21]  E. D. De Souza,et al.  Pharmacologic profile of amphetamine derivatives at various brain recognition sites: selective effects on serotonergic systems. , 1989, NIDA research monograph.

[22]  M. Colado,et al.  A review of the mechanisms involved in the acute MDMA (ecstasy)-induced hyperthermic response. , 2004, European journal of pharmacology.

[23]  R. Doblin A Clinical Plan for MDMA (Ecstasy) in the Treatment of Posttraumatic Stress Disorder (PTSD): Partnering with the FDA , 2002, Journal of psychoactive drugs.

[24]  B. Blough,et al.  N-Substituted Piperazines Abused by Humans Mimic the Molecular Mechanism of 3,4-Methylenedioxymethamphetamine (MDMA, or ‘Ecstasy’) , 2005, Neuropsychopharmacology.

[25]  L. Reneman Designer drugs: how dangerous are they? , 2003, Journal of neural transmission. Supplementum.

[26]  A. Pert,et al.  Effects of 5,7‐dihydroxytryptamine depletion of tissue serotonin levels on extracellular serotonin in the striatum assessed with in vivo microdialysis: Relationship to behavior , 1999, Synapse.

[27]  G. Hanson,et al.  Immediate and long-term effects of 3,4-methylenedioxymethamphetamine on serotonin pathways in brain of rat , 1987, Neuropharmacology.

[28]  S. Butcher,et al.  Behavioural analysis of the acute and chronic effects of MDMA treatment in the rat , 1999, Psychopharmacology.

[29]  R. Rothman,et al.  3,4‐methylenedioxymethamphetamine (MDMA) administration to rats decreases brain tissue serotonin but not serotonin transporter protein and glial fibrillary acidic protein , 2004, Synapse.

[30]  R. Oberlender,et al.  Drug discrimination studies with MDMA and amphetamine , 2004, Psychopharmacology.

[31]  G. Gerra,et al.  Long-lasting effects of (±)3,4-methylene-dioxymethamphetamine (Ecstasy) on serotonin system function in humans , 2000, Biological Psychiatry.

[32]  G. Battaglia,et al.  Methylenedioxyamphetamine (MDA) and methylenedioxymethamphetamine (MDMA) cause selective ablation of serotonergic axon terminals in forebrain: immunocytochemical evidence for neurotoxicity , 1988, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[33]  M. Colado,et al.  The relationship between the degree of neurodegeneration of rat brain 5-HT nerve terminals and the dose and frequency of administration of MDMA (`ecstasy') , 1998, Neuropharmacology.

[34]  L. Matuszewich,et al.  Altered forebrain neurotransmitter responses to immobilization stress following 3,4-methylenedioxymethamphetamine , 2002, Neuroscience.

[35]  F. Vollenweider,et al.  Acute Psychological Effects of 3,4-Methylenedioxymethamphetamine (MDMA, “Ecstasy”) are Attenuated by the Serotonin Uptake Inhibitor Citalopram , 1999, Neuropsychopharmacology.

[36]  G. Gudelsky,et al.  Carrier‐Mediated Release of Serotonin by 3,4‐Methylenedioxymethamphetamine: Implications for Serotonin‐Dopamine Interactions , 1996, Journal of neurochemistry.

[37]  L S Seiden,et al.  Biochemical and histological evidence that methylenedioxymethylamphetamine (MDMA) is toxic to neurons in the rat brain. , 1987, The Journal of pharmacology and experimental therapeutics.

[38]  T. Robinson,et al.  Effects of Cortical Serotonin Depletion Induced by 3,4-Methylenedioxymethamphetamine (MDMA) on Behavior, Before and After Additional Cholinergic Blockade , 1993, Neuropsychopharmacology.

[39]  E. Meririnne,et al.  The Acute Effects of Amphetamine Derivatives on Extracellular Serotonin and Dopamine Levels in Rat Nucleus Accumbens , 1998, Pharmacology Biochemistry and Behavior.

[40]  D. Campbell Extrapolation from animals to man. The integration of pharmacokinetics and pharmacodynamics. , 1996, Annals of the New York Academy of Sciences.

[41]  M. Morgan,et al.  Ecstasy (MDMA): a review of its possible persistent psychological effects , 2000, Psychopharmacology.

[42]  G. Wakonigg,et al.  Methylenedioxymethamphetamine (MDMA, ‘Ecstasy‘) Serves as a Robust Positive Reinforcer in a Rat Runway Procedure , 2003, Pharmacology.

[43]  F. Vollenweider,et al.  Psychological and Cardiovascular Effects and Short-Term Sequelae of MDMA (“Ecstasy”) in MDMA-Naïve Healthy Volunteers , 1998, Neuropsychopharmacology.

[44]  E. Gouzoulis-Mayfrank,et al.  Neuroendocrine abnormalities in recreational ecstasy (MDMA) users: is it ecstasy or cannabis? , 2002, Biological Psychiatry.

[45]  K. Rice,et al.  Amphetamine‐type central nervous system stimulants release norepinephrine more potently than they release dopamine and serotonin , 2001, Synapse.

[46]  V. Moser The functional observational battery in adult and developing rats. , 2000, Neurotoxicology.

[47]  W. Lovenberg,et al.  In vitro and in vivo neurochemical effects of methylenedioxymethamphetamine on striatal monoaminergic systems in the rat brain. , 1987, Biochemical pharmacology.

[48]  I. McGregor,et al.  Increased anxiety and impaired memory in rats 3 months after administration of 3,4-methylenedioxymethamphetamine ("ecstasy"). , 2001, European journal of pharmacology.

[49]  M. Tancer,et al.  Reinforcing, subjective, and physiological effects of MDMA in humans: a comparison with d-amphetamine and mCPP. , 2003, Drug and alcohol dependence.

[50]  M. Morales,et al.  (±)-3,4-Methylenedioxymethamphetamine Administration to Rats Does Not Decrease Levels of the Serotonin Transporter Protein or Alter Its Distribution between Endosomes and the Plasma Membrane , 2005, Journal of Pharmacology and Experimental Therapeutics.

[51]  D. BRUCE CAMPBELL,et al.  Extrapolation from Animals to Man , 1996 .

[52]  R. Glennon,et al.  3,4-Methylenedioxymethamphetamine (MDMA): Stereoselective interactions at brain 5-HT1 and 5-HT2 receptors , 2004, Psychopharmacology.

[53]  R. de la Torre,et al.  Non-linear pharmacokinetics of MDMA ('ecstasy') in humans. , 2000, British journal of clinical pharmacology.

[54]  James H Brown,et al.  Allometric scaling of metabolic rate from molecules and mitochondria to cells and mammals , 2002, Proceedings of the National Academy of Sciences of the United States of America.

[55]  K. Rice,et al.  Neurochemical neutralization of amphetamine-type stimulants in rat brain by the indatraline analog (−)-HY038 , 2000, Brain Research Bulletin.

[56]  M. Shankaran,et al.  A neurotoxic regimen of MDMA suppresses behavioral, thermal and neurochemical responses to subsequent MDMA administration , 1999, Psychopharmacology.

[57]  H. Steinbusch,et al.  Distribution of serotonin-immunoreactivity in the central nervous system of the rat—Cell bodies and terminals , 1981, Neuroscience.

[58]  Craig R. White,et al.  Allometric scaling of mammalian metabolism , 2005, Journal of Experimental Biology.

[59]  A Frazer,et al.  Effects of Chronic Antidepressant Treatments on Serotonin Transporter Function, Density, and mRNA Level , 1999, The Journal of Neuroscience.

[60]  E. Sellers,et al.  Interactions of amphetamine analogs with human liver CYP2D6. , 1997, Biochemical pharmacology.

[61]  K. Boone,et al.  Abnormal ACTH and prolactin responses to fenfluramine in rats exposed to single and multiple doses of MDMA , 1997, Psychopharmacology.

[62]  I. McGregor,et al.  Increased Anxiety 3 Months after Brief Exposure to MDMA (‘Ecstasy’) in Rats: Association with Altered 5-HT Transporter and Receptor Density , 2003, Neuropsychopharmacology.

[63]  A. Poling,et al.  MDMA and Learning Effects of Acute and Neurotoxic Exposure in the Rat , 2000, Pharmacology Biochemistry and Behavior.

[64]  L. Schmued Demonstration and localization of neuronal degeneration in the rat forebrain following a single exposure to MDMA , 2003, Brain Research.

[65]  J. O'Callaghan,et al.  Comparative study of fluoxetine, sibutramine, sertraline and dexfenfluramine on the morphology of serotonergic nerve terminals using serotonin immunohistochemistry , 2000, Brain Research.

[66]  M. Tancer,et al.  Discriminative stimulus effects of 3,4-methylenedioxymethamphetamine (MDMA) in humans trained to discriminate among d-amphetamine, meta-chlorophenylpiperazine and placebo. , 2006, Drug and alcohol dependence.

[67]  L. Kirby,et al.  Effect of destruction of serotonin neurons on basal and fenfluramine‐induced serotonin release in striatum , 1995, Synapse.

[68]  S. Kish How strong is the evidence that brain serotonin neurons are damaged in human users of ecstasy? , 2002, Pharmacology Biochemistry and Behavior.

[69]  J. Kelly,et al.  Some behavioural and neurochemical aspects of subacute (±)3,4-methylenedioxymethamphetamine administration in rats , 1995, Pharmacology Biochemistry and Behavior.

[70]  K. Fone,et al.  Reduced social interaction following 3,4-methylenedioxymethamphetamine is not associated with enhanced 5-HT2C receptor responsivity , 2003, Neuropharmacology.

[71]  Michelle N Lafrance A Bitter Pill , 2007, Journal of health psychology.

[72]  M. Ansseau,et al.  Polymorphisms in the CYP 2D6 Gene: Association with Plasma Concentrations of Fluoxetine and Paroxetine , 2003, Therapeutic drug monitoring.

[73]  K. Fone,et al.  Decreased social behaviour following 3,4-methylenedioxymethamphetamine (MDMA) is accompanied by changes in 5-HT2A receptor responsivity , 2004, Neuropharmacology.

[74]  M. D. Schechter Serotonergic-dopaminergic mediation of 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”) , 1988, Pharmacology Biochemistry and Behavior.

[75]  M. Geyer,et al.  Stimulant and hallucinogenic behavioral profiles of 3,4-methylenedioxymethamphetamine and N-ethyl-3,4-methylenedioxyamphetamine in rats. , 1988, The Journal of pharmacology and experimental therapeutics.

[76]  J. O'Callaghan,et al.  Quantification of reactive gliosis as an approach to neurotoxicity assessment. , 1993, NIDA research monograph.

[77]  J. O'Callaghan,et al.  Quantitative aspects of drug and toxicant-induced astrogliosis , 1995, Neurochemistry International.

[78]  J. Mendelson,et al.  Subjective and hormonal effects of 3,4-methylenedioxymethamphetamine (MDMA) in humans , 2002, Psychopharmacology.

[79]  R. Poland Diminished corticotropin and enhanced prolactin responses to 8-hydroxy-2(DI-n-propylamino)tetralin in methylenedioxymethamphetamine pretreated rats , 1990, Neuropharmacology.

[80]  G. Gerra,et al.  Serotonergic function after (±)3,4‐methylene-dioxymethamphetarnine (‘Ecstasy’) in humans , 1998, International clinical psychopharmacology.

[81]  B. Yamamoto,et al.  Acute and subchronic effects of methylenedioxymethamphetamine [(±)MDMA] on locomotion and serotonin syndrome behavior in the rat , 1989, Pharmacology Biochemistry and Behavior.

[82]  George S. Yacoubian Tracking Ecstasy Trends in the United States with Data from Three National Drug Surveillance Systems , 2003, Journal of drug education.

[83]  S. E. Gartside,et al.  Behavioural and neuroendocrine responses to D-fenfluramine in rats treated with neurotoxic amphetamines , 1995, Journal of psychopharmacology.

[84]  M. Ramírez,et al.  Alpha-lipoic acid prevents 3,4-methylenedioxy-methamphetamine (MDMA)-induced neurotoxicity. , 1999, Neuroreport.

[85]  A. Carlssen The Contribution of Drug Research to Investigating the Nature of Endogenous Depression* , 1976 .

[86]  J. O'Callaghan,et al.  Glial fibrillary acidic protein and related glial proteins as biomarkers of neurotoxicity , 2005, Expert opinion on drug safety.

[87]  J. Langston,et al.  Orally administered MDMA causes a long-term depletion of serotonin in rat brain , 1988, Brain Research.

[88]  D E Nichols,et al.  An integrated hypothesis for the serotonergic axonal loss induced by 3,4-methylenedioxymethamphetamine. , 1998, Neurotoxicology.

[89]  M. Colado,et al.  The Pharmacology and Clinical Pharmacology of 3,4-Methylenedioxymethamphetamine (MDMA, “Ecstasy”) , 2003, Pharmacological Reviews.

[90]  I Mahmood,et al.  Allometric issues in drug development. , 1999, Journal of pharmaceutical sciences.

[91]  P. O'cain,et al.  Cardiovascular and sympathetic responses and reflex changes elicited by MDMA , 2000, Physiology & Behavior.

[92]  V. Sánchez,et al.  A comparative study on the acute and long‐term effects of MDMA and 3,4‐dihydroxymethamphetamine (HHMA) on brain monoamine levels after i.p. or striatal administration in mice , 2005, British journal of pharmacology.

[93]  J H Lin,et al.  Applications and limitations of interspecies scaling and in vitro extrapolation in pharmacokinetics. , 1998, Drug metabolism and disposition: the biological fate of chemicals.

[94]  F. Artigas,et al.  Basal and stimulated extracellular serotonin concentration in the brain of rats with altered serotonin uptake , 1998, Synapse.

[95]  L. Kar,et al.  Monoaminergic Regulation of Neuroendocrine Function and Its Modification by Cocaine , 1994, Frontiers in Neuroendocrinology.

[96]  M. Colado,et al.  The pharmacology of the acute hyperthermic response that follows administration of 3,4‐methylenedioxymethamphetamine (MDMA, ‘ecstasy’) to rats , 2002, British journal of pharmacology.

[97]  T. Monks,et al.  The Role of Metabolism in 3,4-(±)-Methylenedioxyamphetamine and 3,4-(±)-Methylenedioxymethamphetamine (Ecstasy) toxicity , 2004, Therapeutic drug monitoring.

[98]  R. Rothman,et al.  (MDMA) Administration to Rats Decreases Brain Tissue Serotonin but not Serotonin Transporter Protein and Glial Fibrillary Acidic Protein , 2004 .

[99]  L. Seiden,et al.  Small Changes in Ambient Temperature Cause Large Changes in 3,4-Methylenedioxymethamphetamine (MDMA)-Induced Serotonin Neurotoxicity and Core Body Temperature in the Rat , 1998, The Journal of Neuroscience.

[100]  V. Setola,et al.  3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") induces fenfluramine-like proliferative actions on human cardiac valvular interstitial cells in vitro. , 2003, Molecular pharmacology.

[101]  H. Meltzer,et al.  Elevation of serum prolactin and corticosterone concentrations in the rat after the administration of 3,4-methylenedioxymethamphetamine. , 1988, The Journal of pharmacology and experimental therapeutics.

[102]  J. Swettenham,et al.  Long-term changes in social interaction and reward following repeated MDMA administration to adolescent rats without accompanying serotonergic neurotoxicity , 2002, Psychopharmacology.

[103]  M. P. Johnson,et al.  Effects of the enantiomers of MDA, MDMA and related analogues on [3H]serotonin and [3H]dopamine release from superfused rat brain slices. , 1986, European journal of pharmacology.

[104]  H. Lilienthal,et al.  Extrapolation from animals to humans: scientific and regulatory aspects. , 1992, Toxicology letters.

[105]  M. Pallàs,et al.  Different glial response to methamphetamine- and methylenedioxymethamphetamine-induced neurotoxicity , 2003, Naunyn-Schmiedeberg's Archives of Pharmacology.

[106]  S. E. Gartside,et al.  Acute effects of 3,4-methylenedioxymethamphetamine (MDMA) on 5-HT cell firing and release: Comparison between dorsal and median raphe 5-HT systems , 1997, Neuropharmacology.

[107]  H. Sumnall,et al.  The pre-clinical behavioural pharmacology of 3,4-methylenedioxymethamphetamine (MDMA) , 2003, Neuroscience & Biobehavioral Reviews.

[108]  D. Campbell Are interspecies comparisons in the toxicity of centrally acting drugs valid without brain concentrations? A commentary , 1995, Neurochemistry International.

[109]  A. Parrott Is ecstasy MDMA? A review of the proportion of ecstasy tablets containing MDMA, their dosage levels, and the changing perceptions of purity , 2004, Psychopharmacology.

[110]  M. Colado,et al.  Acute and long-term effects of MDMA on cerebral dopamine biochemistry and function , 2004, Psychopharmacology.

[111]  G. Rudnick,et al.  From synapse to vesicle: the reuptake and storage of biogenic amine neurotransmitters. , 1993, Biochimica et biophysica acta.

[112]  A. Saria,et al.  Reinforcing Effects of MDMA (‘Ecstasy’) in Drug-Naive and Cocaine-Trained Rats , 2001, Pharmacology.

[113]  J. Docherty,et al.  Investigation of the prejunctional α2‐adrenoceptor mediated actions of MDMA in rat atrium and vas deferens , 1999 .

[114]  R. Switzer Application of Silver Degeneration Stains for Neurotoxicity Testing , 2000, Toxicologic pathology.

[115]  M. Hajós,et al.  A 5-hydroxytryptamine lesion markedly reduces the incidence of burst-firing dorsal raphe neurones in the rat , 1996, Neuroscience Letters.

[116]  M. Forsling,et al.  The effect of 3,4‐methylenedioxymethamphetamine (MDMA, ?ecstasy?) and its metabolites on neurohypophysial hormone release from the isolated rat hypothalamus , 2002, British journal of pharmacology.

[117]  J. Fitzgerald,et al.  Interactions of methylenedioxymethamphetamine with monoamine transmitter release mechanisms in rat brain slices , 1993, Naunyn-Schmiedeberg's Archives of Pharmacology.

[118]  E. Azmitia,et al.  The substituted amphetamines 3,4-methylenedioxymethamphetamine, methamphetamine, p-chloroamphetamine and fenfluramine induce 5-hydroxytryptamine release via a common mechanism blocked by fluoxetine and cocaine. , 1992, European journal of pharmacology.

[119]  R. Glennon,et al.  Investigation of MDMA-related agents in rats trained to discriminate MDMA from saline , 1992, Pharmacology Biochemistry and Behavior.

[120]  M. Kleiber Body size and metabolism , 1932 .

[121]  R. Rothman,et al.  Functional Consequences of Central Serotonin Depletion Produced by Repeated Fenfluramine Administration in Rats , 1998, The Journal of Neuroscience.

[122]  O. Berenfeld,et al.  From Mouse to Whale: A Universal Scaling Relation for the PR Interval of the Electrocardiogram of Mammals , 2004, Circulation.

[123]  M. Wilson,et al.  Neurotoxicity of MDMA and Related Compounds: Anatomic Studies a , 1990, Annals of the New York Academy of Sciences.

[124]  I. McGregor,et al.  Increased anxiety in rats after 3,4-methylenedioxymethamphetamine: association with serotonin depletion. , 2002, European journal of pharmacology.

[125]  D. Gittings,et al.  Development, maintenance and temporal pattern of self-administration maintained by ecstasy (MDMA) in rats , 2003, Psychopharmacology.

[126]  R. de la Torre,et al.  Human pharmacology of MDMA: pharmacokinetics, metabolism, and disposition. , 2004, Therapeutic drug monitoring.

[127]  A. Parrott,et al.  Recreational Ecstasy/MDMA, the serotonin syndrome, and serotonergic neurotoxicity , 2002, Pharmacology Biochemistry and Behavior.

[128]  A. Somogyi,et al.  Acute Toxicity of 3,4-Methylenedioxymethamphetamine (MDMA) in Sprague–Dawley and Dark Agouti Rats , 1999, Pharmacology Biochemistry and Behavior.

[129]  R. de la Torre,et al.  Neurotoxicity of MDMA (ecstasy): the limitations of scaling from animals to humans. , 2004, Trends in pharmacological sciences.

[130]  U. McCann,et al.  (±)3,4-Methylenedioxymethamphetamine (‘Ecstasy’)-Induced Serotonin Neurotoxicity: Studies in Animals , 2000, Neuropsychobiology.

[131]  M. Geyer Serotonergic functions in arousal and motor activity , 1995, Behavioural Brain Research.

[132]  Miller Db,et al.  Quantification of reactive gliosis as an approach to neurotoxicity assessment. , 1993 .

[133]  R. Rothman,et al.  Therapeutic and adverse actions of serotonin transporter substrates. , 2002, Pharmacology & therapeutics.

[134]  L. D. van de Kar Neuroendocrine pharmacology of serotonergic (5-HT) neurons. , 1991, Annual review of pharmacology and toxicology.

[135]  J. Fitzgerald,et al.  Sympathomimetic Actions of Methylenedioxymethamphetamine in Rat and Rabbit Isolated Cardiovascular Tissues , 1994, The Journal of pharmacy and pharmacology.

[136]  Fabrizio Schifano,et al.  A bitter pill. Overview of ecstasy (MDMA, MDA) related fatalities , 2004, Psychopharmacology.

[137]  R. Dafters,et al.  Persistent loss of thermoregulation in the rat induced by 3,4-methylenedioxymethamphetamine (MDMA or “Ecstasy”) but not by fenfluramine , 1998, Psychopharmacology.

[138]  P. Cowen,et al.  p-Chloroamphetamine (PCA), 3,4-methylenedioxymethamphetamine (MDMA) andd-fenfluramine pretreatment attenuatesd-fenfluramine-evoked release of 5-HT in vivo , 1994, Psychopharmacology.

[139]  K. Cunningham,et al.  3,4-Methylenedioxymethamphetamine (MDMA) as a unique model of serotonin receptor function and serotonin-dopamine interactions. , 2001, The Journal of pharmacology and experimental therapeutics.

[140]  J. Cadet,et al.  High‐dose fenfluramine administration decreases serotonin transporter binding, but not serotonin transporter protein levels, in rat forebrain , 2003, Synapse.

[141]  L. Schmued,et al.  Fluoro-Jade B: a high affinity fluorescent marker for the localization of neuronal degeneration , 2000, Brain Research.

[142]  R. de la Torre,et al.  Cardiovascular and neuroendocrine effects and pharmacokinetics of 3, 4-methylenedioxymethamphetamine in humans. , 1999, The Journal of pharmacology and experimental therapeutics.

[143]  J. Docherty,et al.  Investigation of the prejunctional alpha2-adrenoceptor mediated actions of MDMA in rat atrium and vas deferens. , 1999, British Journal of Pharmacology.

[144]  J L Katz,et al.  Serotonergic recovery after (+/-)3,4-(methylenedioxy) methamphetamine injury: observations in rats. , 1993, The Journal of pharmacology and experimental therapeutics.

[145]  A. Grace,et al.  Compensations after lesions of central dopaminergic neurons: some clinical and basic implications , 1990, Trends in Neurosciences.

[146]  F. Peters,et al.  Toxicokinetics and analytical toxicology of amphetamine-derived designer drugs ('Ecstasy'). , 2000, Toxicology letters.

[147]  J. Lin,et al.  Species similarities and differences in pharmacokinetics. , 1995, Drug metabolism and disposition: the biological fate of chemicals.