The Evolving Overdose Epidemic: Synthetic Opioids And Rising Stimulant-Related Harms

The opioid overdose epidemic is typically described as having occurred in three waves, with morbidity and mortality accruing over time principally from prescription opioids (1999-2010), heroin (2011-2013) and illicit fentanyl and other synthetic opioids (2014-present). However, the increasing presence of synthetic opioids mixed into the illicit drug supply, including with stimulants such as cocaine and methamphetamine, as well as rising stimulant-related deaths, reflects the rapidly evolving nature of the overdose epidemic posing urgent and novel public health challenges. We synthesize the evidence underlying these trends, consider key questions such as where and how concomitant exposure to fentanyl and stimulants is occurring, and identify actions for key stakeholders regarding how these emerging threats, and continued evolution of the overdose epidemic, can best be addressed.

Innate Biomineralization

In vertebrates, biomineralization is a feature considered unique to mature osteoblasts and odontoblasts by which they synthesize hydroxyapatite (HAP), which is deposited in the collagen matrix to construct endoskeleton. For many decades, the mechanisms that modulate differentiation and maturation of these specialized cells have been sought as a key to understanding bone-remodeling defects. Here, we report that biomineralization is an innate ability of all mammalian cells, irrespective of cell type or maturation stage. This innate biomineralization is triggered by the concomitant exposure of living cells to three indispensable elements: calcium ion, phosphoester salt, and alkaline phosphatase. Any given somatic cell, including undifferentiated mononuclear cells, can undergo a biomineralization process to produce calcium-phosphate agglomerates. The biologically generated minerals under such conditions are composed of genuine HAP crystallites of Ca10(PO4)6(OH)2 and 5–10 nanometer (nm) in size. This discovery will profoundly improve our understanding of bone metabolism and ectopic calcifications.

Immunogenic Cell Death: An opportunity for Clinical Oncology?

Apoptosis was initially seen as a kind of silent cell death with non-induction of the immune response 1. However, in the recent past, it has been seen that death induced by either infections or actions of certain agents can elicit a specific immune response, namely immunogenic cell death (ICD)2. This ICD activates the immune system against antigens associated with deceased cells with the concomitant exposure and releasing of the so-called damage-associated molecular patterns (DAMPs) by dying cells3. Four principal DAMPs related to ICD have been identified (but not limited to): the endoplasmic reticulum (ER) chaperone calreticulin (CRT), heat shock proteins (HSPs), adenosine triphosphate (ATP) and high mobility group box-1 (HMGB-1)4.