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Background <p>Cannabinoid hyperemesis syndrome (CHS) is a paradoxical and increasingly prevalent disorder characterized by recurrent vomiting in people with chronic cannabis use. Despite its growing clinical impact, the underlying mechanisms remain poorly understood.</p> Methods <p>Genome-wide RNA sequencing was used to characterize transcriptomic differences and identify potential pathways involved in CHS pathogenesis. In this pilot study, whole blood RNA sequencing was performed on 7 patients with suspected CHS and 7 matched controls. Differentially expressed genes (DEGs) were identified, annotated and analyzed by automated and manual analysis. RNA sequences were further analyzed by digital isotyping for HLA Class I and II allele usage.</p> Results <p>Suspected CHS was associated with marked activation of the adaptive immune system, including upregulation of B-cell related immunoglobin transcripts and altered expression of T cell, monocyte, and neutrophil-related transcripts. DEGs also suggested increased matrix degradation, and reduced adhesion and protease inhibitor transcripts. Digital HLA isotyping revealed increased MHC Class I expression, Class II allele restriction, and down-regulation of IgE receptor transcripts, a known response to elevated IgE levels in allergic hypersensitivity.</p> Conclusions <p>Together, these preliminary findings identify immune-related signals in ED patients with suspected CHS, and lay the groundwork for future studies with larger, prospectively phenotyped cohorts to identify biomarkers, clarify immune triggers, and develop targeted therapies.</p> Graphical Abstract <p></p>

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Whole-blood transcriptomic findings in emergency department patients with suspected cannabinoid hyperemesis syndrome: a pilot study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月23日

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  • Andrew Meltzer,
  • Ziva D. Cooper,
  • Ryan Heidish,
  • Aditya Loganathan,
  • Tarun Loganathan,
  • Taylor Bolden,
  • Isabella Lagunazad,
  • John Perkins,
  • Kevin Jaatinen,
  • Jacob Adelman,
  • Joseph Miller,
  • Stephanie A. Eucker,
  • Eileen Phillips,
  • Timothy A. McCaffrey

摘要

Background

Cannabinoid hyperemesis syndrome (CHS) is a paradoxical and increasingly prevalent disorder characterized by recurrent vomiting in people with chronic cannabis use. Despite its growing clinical impact, the underlying mechanisms remain poorly understood.

Methods

Genome-wide RNA sequencing was used to characterize transcriptomic differences and identify potential pathways involved in CHS pathogenesis. In this pilot study, whole blood RNA sequencing was performed on 7 patients with suspected CHS and 7 matched controls. Differentially expressed genes (DEGs) were identified, annotated and analyzed by automated and manual analysis. RNA sequences were further analyzed by digital isotyping for HLA Class I and II allele usage.

Results

Suspected CHS was associated with marked activation of the adaptive immune system, including upregulation of B-cell related immunoglobin transcripts and altered expression of T cell, monocyte, and neutrophil-related transcripts. DEGs also suggested increased matrix degradation, and reduced adhesion and protease inhibitor transcripts. Digital HLA isotyping revealed increased MHC Class I expression, Class II allele restriction, and down-regulation of IgE receptor transcripts, a known response to elevated IgE levels in allergic hypersensitivity.

Conclusions

Together, these preliminary findings identify immune-related signals in ED patients with suspected CHS, and lay the groundwork for future studies with larger, prospectively phenotyped cohorts to identify biomarkers, clarify immune triggers, and develop targeted therapies.

Graphical Abstract