1
|
Rice LJ, Cannon L, Dadlani N, Cheung MMY, Einfeld SL, Efron D, Dossetor DR, Elliott EJ. Efficacy of cannabinoids in neurodevelopmental and neuropsychiatric disorders among children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:505-526. [PMID: 36864363 PMCID: PMC10869397 DOI: 10.1007/s00787-023-02169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
A better understanding of the endocannabinoid system and a relaxation in regulatory control of cannabis globally has increased interest in the medicinal use of cannabinoid-based products (CBP). We provide a systematic review of the rationale and current clinical trial evidence for CBP in the treatment of neuropsychiatric and neurodevelopmental disorders in children and adolescents. A systematic search of MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Trials was performed to identify articles published after 1980 about CBP for medical purposes in individuals aged 18 years or younger with selected neuropsychiatric or neurodevelopmental conditions. Risk of bias and quality of evidence was assessed for each article. Of 4466 articles screened, 18 were eligible for inclusion, addressing eight conditions (anxiety disorders (n = 1); autism spectrum disorder (n = 5); foetal alcohol spectrum disorder (n = 1); fragile X syndrome (n = 2); intellectual disability (n = 1); mood disorders (n = 2); post-traumatic stress disorder (n = 3); and Tourette syndrome (n = 3)). Only one randomised controlled trial (RCT) was identified. The remaining seventeen articles included one open-label trial, three uncontrolled before-and-after trials, two case series and 11 case reports, thus the risk of bias was high. Despite growing community and scientific interest, our systematic review identified limited and generally poor-quality evidence for the efficacy of CBP in neuropsychiatric and neurodevelopmental disorders in children and adolescents. Large rigorous RCTs are required to inform clinical care. In the meantime, clinicians must balance patient expectations with the limited evidence available.
Collapse
Affiliation(s)
- Lauren J Rice
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia.
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia.
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia.
| | - Lisa Cannon
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Navin Dadlani
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Melissa Mei Yin Cheung
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Stewart L Einfeld
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Daryl Efron
- Department of General Paediatrics, Health Services, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David R Dossetor
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| |
Collapse
|
2
|
Montagner PSS, Medeiros W, da Silva LCR, Borges CN, Brasil-Neto J, de Deus Silva Barbosa V, Caixeta FV, Malcher-Lopes R. Individually tailored dosage regimen of full-spectrum Cannabis extracts for autistic core and comorbid symptoms: a real-life report of multi-symptomatic benefits. Front Psychiatry 2023; 14:1210155. [PMID: 37671290 PMCID: PMC10475955 DOI: 10.3389/fpsyt.2023.1210155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023] Open
Abstract
Autism Spectrum Disorders (ASD) may significantly impact the well-being of patients and their families. The therapeutic use of cannabis for ASD has gained interest due to its promising results and low side effects, but a consensus on treatment guidelines is lacking. In this study, we conducted a retrospective analysis of 20 patients with autistic symptoms who were treated with full-spectrum cannabis extracts (FCEs) in a response-based, individually-tailored dosage regimen. The daily dosage and relative proportions of cannabidiol (CBD) and tetrahydrocannabinol (THC) were adjusted based on treatment results following periodic clinical evaluation. Most patients (80%) were treated for a minimum of 6 months. We have used a novel, detailed online patient- or caregiver-reported outcome survey that inquired about core and comorbid symptoms, and quality of life. We also reviewed patients' clinical files, and no individual condition within the autistic spectrum was excluded. This real-life approach enabled us to gain a clearer appraisal of the ample scope of benefits that FCEs can provide for ASD patients and their families. Eighteen patients started with a CBD-rich FCE titrating protocol, and in three of them, the CBD-rich (CBD-dominant) FCE was gradually complemented with low doses of a THC-rich (THC-dominant) FCE based on observed effects. Two other patients have used throughout treatment a blend of two FCEs, one CBD-rich and the other THC-rich. The outcomes were mainly positive for most symptoms, and only one patient from each of the two above-mentioned situations displayed important side effects one who has used only CBD-rich FCE throughout the treatment, and another who has used a blend of CBD-Rich and THC-rich FCEs. Therefore, after FCE treatment, 18 out of 20 patients showed improvement in most core and comorbid symptoms of autism, and in quality of life for patients and their families. For them, side effects were mild and infrequent. Additionally, we show, for the first time, that allotriophagy (Pica) can be treated by FCEs. Other medications were reduced or completely discontinued in most cases. Based on our findings, we propose guidelines for individually tailored dosage regimens that may be adapted to locally available qualified FCEs and guide further clinical trials.
Collapse
Affiliation(s)
| | - Wesley Medeiros
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasília, Brazil
| | - Leandro Cruz Ramires da Silva
- Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Brazilian Association of Medical Cannabis Patients, Ama-Me, Belo Horizonte, Brazil
| | - Clarissa Nogueira Borges
- Specialized Educational Care Division for Gifted Students of the Department of Education of the Federal District, Brasília, Brazil
| | | | - Vinícius de Deus Silva Barbosa
- Medical Cannabis Center–Syrian-Lebanese Hospital, São Paulo, Brazil
- National Association for Inclusion of the Autistic People, São Paulo, Brazil
| | - Fabio V. Caixeta
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasília, Brazil
| | - Renato Malcher-Lopes
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasília, Brazil
| |
Collapse
|
3
|
Dorsey SG, Mocci E, Lane MV, Krueger BK. Rapid effects of valproic acid on the fetal brain transcriptome: Implications for brain development and autism. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.01.538959. [PMID: 37205520 PMCID: PMC10187231 DOI: 10.1101/2023.05.01.538959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
There is an increased incidence of autism among the children of women who take the anti-epileptic, mood stabilizing drug, valproic acid (VPA) during pregnancy; moreover, exposure to VPA in utero causes autistic-like symptoms in rodents and non-human primates. Analysis of RNAseq data obtained from fetal mouse brains 3 hr after VPA administration revealed that VPA significantly [p(FDR) ≤ 0.025] increased or decreased the expression of approximately 7,300 genes. No significant sex differences in VPA-induced gene expression were observed. Expression of genes associated with neurodevelopmental disorders such as autism as well as neurogenesis, axon growth and synaptogenesis, GABAergic, glutaminergic and dopaminergic synaptic transmission, perineuronal nets, and circadian rhythms was dysregulated by VPA. Moreover, expression of 400 autism risk genes was significantly altered by VPA as was expression of 247 genes that have been reported to play fundamental roles in the development of the nervous system, but are not linked to autism by GWAS. The goal of this study was to identify mouse genes that are: (a) significantly up- or down-regulated by VPA in the fetal brain and (b) known to be associated with autism and/or to play a role in embryonic neurodevelopmental processes, perturbation of which has the potential to alter brain connectivity in the postnatal and adult brain. The set of genes meeting these criteria provides potential targets for future hypothesis-driven approaches to elucidating the proximal underlying causes of defective brain connectivity in neurodevelopmental disorders such as autism.
Collapse
|
4
|
Efron D, Taylor K. Medicinal Cannabis for Paediatric Developmental, Behavioural and Mental Health Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085430. [PMID: 37107712 PMCID: PMC10138057 DOI: 10.3390/ijerph20085430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Parents of children with developmental, behavioural and mental health disorders are increasingly asking whether medicinal cannabis might be a therapeutic option for their child. This paper presents the current evidence for medicinal cannabis in this population. Preliminary evidence from open-label studies suggests the potential for medicinal cannabis to ameliorate some symptoms in children with autism spectrum disorder. However, only one double-blind placebo-controlled trial has been completed, with inconclusive findings. Synthetic, transdermal cannabidiol gel has demonstrated efficacy for reducing social avoidance in a sub-group of children with Fragile X syndrome. Studies of medicinal cannabis are planned or underway for children and/or adolescents with autism, intellectual disability, Tourette's syndrome, anxiety, psychosis, anorexia nervosa and a number of specific neurodevelopmental syndromes. High quality evidence from double-blind placebo-controlled trials is needed to guide clinical practice.
Collapse
Affiliation(s)
- Daryl Efron
- Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia;
- The Royal Children’s Hospital, 50 Flemington Rd, Parkville, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Correspondence:
| | - Kaitlyn Taylor
- Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia;
| |
Collapse
|
5
|
Hacohen M, Stolar OE, Berkovitch M, Elkana O, Kohn E, Hazan A, Heyman E, Sobol Y, Waissengreen D, Gal E, Dinstein I. Children and adolescents with ASD treated with CBD-rich cannabis exhibit significant improvements particularly in social symptoms: an open label study. Transl Psychiatry 2022; 12:375. [PMID: 36085294 PMCID: PMC9461457 DOI: 10.1038/s41398-022-02104-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/15/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
In recent years there has been growing interest in the potential benefits of CBD-rich cannabis treatment for children with ASD. Several open label studies and one double-blind placebo-controlled study have reported that CBD-rich cannabis is safe and potentially effective in reducing disruptive behaviors and improving social communication. However, previous studies have mostly based their conclusions on parental reports without the use of standardized clinical assessments. Here, we conducted an open label study to examine the efficacy of 6 months of CBD-rich cannabis treatment in children and adolescents with ASD. Longitudinal changes in social communication abilities and restricted and repetitive behaviors (RRB) were quantified using parent report with the Social Responsiveness Scale and clinical assessment with the Autism Diagnostic Observation Schedule (ADOS). We also quantified changes in adaptive behaviors using the Vineland, and cognitive abilities using an age-appropriate Wechsler test. Eighty-two of the 110 recruited participants completed the 6-month treatment protocol. While some participants did not exhibit any improvement in symptoms, there were overall significant improvements in social communication abilities as quantified by the ADOS, SRS, and Vineland with larger improvements in participants who had more severe initial symptoms. Significant improvements in RRB were noted only with parent-reported SRS scores and there were no significant changes in cognitive scores. These findings suggest that treatment with CBD-rich cannabis can yield improvements, particularly in social communication abilities, which were visible even when using standardized clinical assessments. Additional double-blind placebo-controlled studies utilizing standardized assessments are highly warranted for substantiating these findings.
Collapse
Affiliation(s)
- Micha Hacohen
- grid.7489.20000 0004 1937 0511Azrieli National Centre for Autism and Neurodevelopment Research, Ben Gurion University, Beer Sheva, Israel ,grid.7489.20000 0004 1937 0511Cognitive and Brain Sciences Department, Ben Gurion University, Beer Sheva, Israel ,grid.430432.20000 0004 0604 7651The Academic College of Tel Aviv Yaffo, Tel Aviv, Israel
| | - Orit E. Stolar
- ALUT Autism Center, Shamir Medical Center, Zerifin, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, Israel ,grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Odelia Elkana
- grid.430432.20000 0004 0604 7651The Academic College of Tel Aviv Yaffo, Tel Aviv, Israel
| | - Elkana Kohn
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, Israel ,grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ariela Hazan
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, Israel
| | - Eli Heyman
- grid.413990.60000 0004 1772 817XDepartment of Pediatric Neurology, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Yael Sobol
- grid.412686.f0000 0004 0470 8989Preschool Psychiatry Unit, Soroka Medical Center, Be’er Sheva, Israel
| | - Danel Waissengreen
- grid.7489.20000 0004 1937 0511Azrieli National Centre for Autism and Neurodevelopment Research, Ben Gurion University, Beer Sheva, Israel
| | - Eynat Gal
- grid.18098.380000 0004 1937 0562Occupational Therapy Department, University of Haifa, Haifa, Israel
| | - Ilan Dinstein
- grid.7489.20000 0004 1937 0511Azrieli National Centre for Autism and Neurodevelopment Research, Ben Gurion University, Beer Sheva, Israel ,grid.7489.20000 0004 1937 0511Cognitive and Brain Sciences Department, Ben Gurion University, Beer Sheva, Israel
| |
Collapse
|
6
|
Lipid-Based Molecules on Signaling Pathways in Autism Spectrum Disorder. Int J Mol Sci 2022; 23:ijms23179803. [PMID: 36077195 PMCID: PMC9456412 DOI: 10.3390/ijms23179803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
The signaling pathways associated with lipid metabolism contribute to the pathophysiology of autism spectrum disorder (ASD) and provide insights for devising new therapeutic strategies. Prostaglandin E2 is a membrane-derived lipid molecule that contributes to developing ASD associated with canonical Wnt signaling. Cyclooxygenase-2 plays a key role in neuroinflammation and is implicated in the pathogenesis of neurodevelopmental diseases, such as ASD. The endocannabinoid system maintains a balance between inflammatory and redox status and synaptic plasticity and is a potential target for ASD pathophysiology. Redox signaling refers to specific and usually reversible oxidation–reduction reactions, some of which are also involved in pathways accounting for the abnormal behavior observed in ASD. Redox signaling and redox status-sensitive transcription factors contribute to the pathophysiology of ASD. Cannabinoids regulate the redox balance by altering the levels and activity of antioxidant molecules via ROS-producing NADPH oxidase (NOX) and ROS-scavenging superoxide dismutase enzymes. These signaling cascades integrate a broad range of neurodevelopmental processes that may be involved in the pathophysiology of ASD. Based on these pathways, we highlight putative targets that may be used for devising novel therapeutic interventions for ASD.
Collapse
|
7
|
Topuz RD, Gorgulu Y, Kyazim Uluturk M. Could serum endocannabinoid and N-acylethanolamine levels be important in bipolar disorder? World J Biol Psychiatry 2022; 24:314-320. [PMID: 35950574 DOI: 10.1080/15622975.2022.2111713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES The endocannabinoid system (ECS) is a critical important neuromodulatory system that interacts with many neurohormonal and neurotransmitter systems in the brain. It plays a pivotal role in emotional responses and mood regulation. The ECS is related with psychotic disorders, depression, anxiety and autism. In this study, we aimed to investigate whether there is any relationship between endocannabinoid and N-acylethanolamine levels with bipolar disorder. METHODS Seventy-nine patients with bipolar disorder diagnosis, who are in the euthymic period, were included in the study. Clinical characteristics, symptoms and serum endocannabinoid and N-acylethanolamine levels were compared. Endocannabinoid and N-acylethanolamine levels were evaluated using liquid chromatography-tandem mass spectrometry. RESULTS In total of 79 patients, 44 (55.69%) were females and 35 (44.30%) were males. The mean age of the patients was 42.40 ± 1.10 years. Palmitoylethanolamide (PEA) levels were higher and oleoylethanolamide and 2-arachidonyl glycerol levels were lower in patients who had at least one depressive episode during their life-time illness than in patients who had no depressive episode while arachidonyl ethanolamide levels were unchanged. CONCLUSIONS PEA levels were correlated with the history and frequency of depressive episodes and the history of depressive symptoms in patients with bipolar disorder.
Collapse
Affiliation(s)
- Ruhan Deniz Topuz
- Department of Medical Pharmacology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Yasemin Gorgulu
- Department of Psychiatry Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Milkibar Kyazim Uluturk
- Department of Psychiatry Faculty of Medicine, Trakya University, Edirne, Turkey.,Department of Psychiatry, Can State Hospital, Canakkale, Turkey
| |
Collapse
|
8
|
Ishiguro H, Kibret BG, Horiuchi Y, Onaivi ES. Potential Role of Cannabinoid Type 2 Receptors in Neuropsychiatric and Neurodegenerative Disorders. Front Psychiatry 2022; 13:828895. [PMID: 35774086 PMCID: PMC9237241 DOI: 10.3389/fpsyt.2022.828895] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/02/2022] [Indexed: 12/12/2022] Open
Abstract
The endocannabinoid system (ECS) is composed of the two canonical receptor subtypes; type-1 cannabinoid (CB1R) and type 2 receptor (CB2R), endocannabinoids (eCBs) and enzymes responsible for the synthesis and degradation of eCBs. Recently, with the identification of additional lipid mediators, enzymes and receptors, the expanded ECS called the endocannabinoidome (eCBome) has been identified and recognized. Activation of CB1R is associated with a plethora of physiological effects and some central nervous system (CNS) side effects, whereas, CB2R activation is devoid of such effects and hence CB2Rs might be utilized as potential new targets for the treatment of different disorders including neuropsychiatric disorders. Previous studies suggested that CB2Rs were absent in the brain and they were considered as peripheral receptors, however, recent studies confirmed the presence of CB2Rs in different brain regions. Several studies have now focused on the characterization of its physiological and pathological roles. Studies done on the role of CB2Rs as a therapeutic target for treating different disorders revealed important putative role of CB2R in neuropsychiatric disorders that requires further clinical validation. Here we provide current insights and knowledge on the potential role of targeting CB2Rs in neuropsychiatric and neurodegenerative disorders. Its non-psychoactive effect makes the CB2R a potential target for treating CNS disorders; however, a better understanding of the fundamental pharmacology of CB2R activation is essential for the design of novel therapeutic strategies.
Collapse
Affiliation(s)
- Hiroki Ishiguro
- Department of Clinical Genetics, Graduate School of Medical Science, University of Yamanashi, Kofu, Japan
- Department of Neuropsychiatry, Graduate School of Medical Science, University of Yamanashi, Kofu, Japan
| | - Berhanu Geresu Kibret
- Department of Biology, College of Science and Health, William Paterson University, Wayne, NJ, United States
| | - Yasue Horiuchi
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Emmanuel S. Onaivi
- Department of Biology, College of Science and Health, William Paterson University, Wayne, NJ, United States
| |
Collapse
|
9
|
Monje-Reyna D, Manzo Denes J, Santamaria F. Effects of environmental enrichment and sexual dimorphism on the expression of cerebellar receptors in C57BL/6 and BTBR + Itpr3tf/J mice. BMC Res Notes 2022; 15:175. [PMID: 35562810 PMCID: PMC9103090 DOI: 10.1186/s13104-022-06062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Environmental enrichment is used to treat social, communication, and behavioral deficits and is known to modify the expression of synaptic receptors. We compared the effects of environmental enrichment in the expression of glutamate and endocannabinoid receptors, which are widely expressed in the cerebellar cortex. These two receptors interact to regulate neuronal function and their dysregulation is associated with behavioral changes. We used BTBR + Itpr3tf/J mice, a strain that models behavioral disorders, and C57BL/6 mice for comparison. We studied the effects of genetic background, sex, environmental conditions, and layer of the cerebellar cortex on the expression of each receptor. RESULTS The influence of genetic background and environmental enrichment had the same pattern on glutamate and endocannabinoid receptors in males. In contrast, in females, the effect of environmental enrichment and genetic background were different than the ones obtained for males and were also different between the glutamate and endocannabinoid receptors. Furthermore, an analysis of both receptors from tissue obtained from the same animals show that their expression is correlated in males, but not in females. Our results suggest that environmental enrichment has a receptor dependent and sexual dimorphic effect on the molecular expression of different receptors in the cerebellar cortex.
Collapse
Affiliation(s)
- Daniela Monje-Reyna
- Department of Neuroscience, Developmental and Regenerative Biology, University of Texas at San Antonio, San Antonio, TX 78249 US
| | - Jorge Manzo Denes
- Brain Research Institute, Veracruzana University, Xalapa, Veracruz México
| | - Fidel Santamaria
- Department of Neuroscience, Developmental and Regenerative Biology, University of Texas at San Antonio, San Antonio, TX 78249 US
| |
Collapse
|
10
|
Colizzi M, Bortoletto R, Costa R, Bhattacharyya S, Balestrieri M. The Autism-Psychosis Continuum Conundrum: Exploring the Role of the Endocannabinoid System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5616. [PMID: 35565034 PMCID: PMC9105053 DOI: 10.3390/ijerph19095616] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 02/07/2023]
Abstract
Evidence indicates shared physiopathological mechanisms between autism and psychosis. In this regard, the endocannabinoid system has been suggested to modulate neural circuits during the early stage of neurodevelopment, with implications for both autism and psychosis. Nevertheless, such potential common markers of disease have been investigated in both autism and psychosis spectrum disorders, without considering the conundrum of differentiating the two groups of conditions in terms of diagnosis and treatment. Here, we systematically review all human and animal studies examining the endocannabinoid system and its biobehavioral correlates in the association between autism and psychosis. Studies indicate overlapping biobehavioral aberrancies between autism and schizophrenia, subject to correction by modulation of the endocannabinoid system. In addition, common cannabinoid-based pharmacological strategies have been identified, exerting epigenetic effects across genes controlling neural mechanisms shared between autism and schizophrenia. Interestingly, a developmental and transgenerational trajectory between autism and schizophrenia is supported by evidence that exogenous alteration of the endocannabinoid system promotes progression to inheritable psychosis phenotypes in the context of biobehavioral autism vulnerability. However, evidence for a diametral association between autism and psychosis is scant. Several clinical implications follow from evidence of a developmental continuum between autism and psychosis as a function of the endocannabinoid system dysregulation.
Collapse
Affiliation(s)
- Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Riccardo Bortoletto
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy;
| | - Rosalia Costa
- Community Mental Health Team, Friuli Centrale University Health Service (ASUFC), 33057 Palmanova, Italy;
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
| |
Collapse
|
11
|
Cavalheiro EKFF, Costa AB, Salla DH, da Silva MR, Mendes TF, da Silva LE, Turatti CDR, de Bitencourt RM, Rezin GT. Cannabis sativa as a Treatment for Obesity: From Anti-Inflammatory Indirect Support to a Promising Metabolic Re-Establishment Target. Cannabis Cannabinoid Res 2022; 7:135-151. [PMID: 34242511 PMCID: PMC9070748 DOI: 10.1089/can.2021.0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Obesity is defined as an excess of accumulation of fat that can be harmful to health. Storage of excess fat in the adipose tissue triggers an inflammatory process, which makes obesity a low-grade chronic inflammatory disease. Obesity is considered a complex and multifactorial disease; hence, no intervention strategy appears to be an ideal treatment for all individuals. Therefore, new therapeutic alternatives are often studied for the treatment of this disease. Currently, herbal medicines are gaining ground in the treatment of obesity and its comorbidities. In this context, much attention is being paid to Cannabis sativa derivatives, and their therapeutic functions are being widely studied, including in treating obesity. Objective: Highlight the pharmacological properties of Δ9-tetrahydrocannabivarin (THCV), Δ9-tetrahydrocannabidinol (THC), and cannabidiol (CBD), the predominant isolated components of Cannabis sativa, as well as its therapeutic potential in the treatment of obesity. Methods: This is a narrative review that shows the existing scientific evidence on the clinical application of Cannabis sativa as a possible treatment for obesity. Data collection was performed in the PubMed electronic database. The following word combinations were used: Cannabis and obesity, Cannabis sativa and obesity, THCV and obesity, THC and obesity, CBD and obesity, and Cannabis sativa and inflammation. Results: Evidence shows that Cannabis sativa derivatives have therapeutic potential due to their anti-inflammatory properties. In addition, people who use cannabis have a lower body mass index than those who do not, making the plant an option to reduce and reverse inflammation and comorbidities in obesity. Conclusion: It is concluded that phytocannabinoids derived from Cannabis sativa have therapeutic potential due to its anti-inflammatory, antioxidant, and neuroprotective properties, making the plant a study option to reduce and reverse inflammation and comorbidities associated with obesity.
Collapse
Affiliation(s)
| | - Ana Beatriz Costa
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Brazil
| | - Daniéle Hendler Salla
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Brazil
| | - Mariella Reinol da Silva
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Brazil
| | - Talita Farias Mendes
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Brazil
| | - Larissa Espindola da Silva
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Brazil
| | - Cristini da Rosa Turatti
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Brazil
| | - Rafael Mariano de Bitencourt
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Brazil
- Laboratory of Behavioral Neuroscience, Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Brazil
| | - Gislaine Tezza Rezin
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Brazil
| |
Collapse
|
12
|
Carreira LD, Matias FC, Campos MG. Clinical Data on Canabinoids: Translational Research in the Treatment of Autism Spectrum Disorders. Biomedicines 2022; 10:biomedicines10040796. [PMID: 35453548 PMCID: PMC9024565 DOI: 10.3390/biomedicines10040796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 12/11/2022] Open
Abstract
Translational research made with Cannabis sativa L. and its biocompounds provides data for some targeted diseases, as also symptoms associated with Autism Spectrum Disorders (ASDs). The main compounds ∆9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are capable of modulating the endocannabinoid system since its dysregulation interferes with the pathophysiology of ASDs there are clinical evidence for its potential use in the treatment of the disease. Conventional therapy still has limitations, as it does not always treat the central symptoms, and there are many patients who do not respond to treatment, which demands more research on new therapies. Through the analysis of published literature on this topic, it is verified that cannabinoids, in particular CBD, improves symptoms associated with common comorbidities in ASDs. Some studies also demonstrate the therapeutic potential of these compounds in the treatment of central symptoms of autism. In addition, cannabinoid therapy to ASDs is associated with low adverse effects and a reduction in concomitant medication. Although it appears to be promising, it is essential to do the translation of this data into clinical research and some of its potential and critical gaps are discussed in this review pointing to large-scale and long-term clinical trials that should include more patients and homogeneous samples.
Collapse
Affiliation(s)
- Laura D. Carreira
- Observatory of Drug-Herb Interactions, Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
| | - Francisca C. Matias
- Coimbra Institute for Biomedical Imaging and Translational Research, Institute of Nuclear Sciences Applied to Health (ICNAS), Health Sciences Campus, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
| | - Maria G. Campos
- Observatory of Drug-Herb Interactions, Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
- Coimbra Chemistry Centre (CQC, FCT Unit 313) (FCTUC), University of Coimbra, Rua Larga, 3004-535 Coimbra, Portugal
- Correspondence: ; Tel.: +351-239-488-400
| |
Collapse
|
13
|
Kibret BG, Ishiguro H, Horiuchi Y, Onaivi ES. New Insights and Potential Therapeutic Targeting of CB2 Cannabinoid Receptors in CNS Disorders. Int J Mol Sci 2022; 23:975. [PMID: 35055161 PMCID: PMC8778243 DOI: 10.3390/ijms23020975] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/22/2022] Open
Abstract
The endocannabinoid system (ECS) is ubiquitous in most human tissues, and involved in the regulation of mental health. Consequently, its dysregulation is associated with neuropsychiatric and neurodegenerative disorders. Together, the ECS and the expanded endocannabinoidome (eCBome) are composed of genes coding for CB1 and CB2 cannabinoid receptors (CB1R, CB2R), endocannabinoids (eCBs), and the metabolic enzyme machinery for their synthesis and catabolism. The activation of CB1R is associated with adverse effects on the central nervous system (CNS), which has limited the therapeutic use of drugs that bind this receptor. The discovery of the functional neuronal CB2R raised new possibilities for the potential and safe targeting of the ECS for the treatment of CNS disorders. Previous studies were not able to detect CB2R mRNA transcripts in brain tissue and suggested that CB2Rs were absent in the brain and were considered peripheral receptors. Studies done on the role of CB2Rs as a potential therapeutic target for treating different disorders revealed the important putative role of CB2Rs in certain CNS disorders, which requires further clinical validation. This review addresses recent advances on the role of CB2Rs in neuropsychiatric and neurodegenerative disorders, including, but not limited to, anxiety, depression, schizophrenia, Parkinson's disease (PD), Alzheimer's disease (AD), Huntington's disease (HD) and addiction.
Collapse
Affiliation(s)
- Berhanu Geresu Kibret
- Department of Biology, College of Science and Health, William Paterson University, Wayne, NJ 07470, USA
| | - Hiroki Ishiguro
- Department of Neuropsychiatry and Clinical Ethics, Graduate School of Medical Science, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan;
| | - Yasue Horiuchi
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo 156-8506, Japan;
| | - Emmanuel S. Onaivi
- Department of Biology, College of Science and Health, William Paterson University, Wayne, NJ 07470, USA
| |
Collapse
|
14
|
Oubraim S, Wang R, Hausknecht KA, Shen RY, Haj-Dahmane S. Tonic Endocannabinoid Signaling Gates Synaptic Plasticity in Dorsal Raphe Nucleus Serotonin Neurons Through Peroxisome Proliferator-Activated Receptors. Front Pharmacol 2021; 12:691219. [PMID: 34262460 PMCID: PMC8273699 DOI: 10.3389/fphar.2021.691219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/14/2021] [Indexed: 12/27/2022] Open
Abstract
Endocannabinoids (eCBs), which include 2-arachidonoylglycerol (2-AG) and anandamide (AEA) are lipid signaling molecules involved in the regulation of an array of behavioral and physiological functions. Released by postsynaptic neurons, eCBs mediate both phasic and tonic signaling at central synapses. While the roles of phasic eCB signaling in modulating synaptic functions and plasticity are well characterized, very little is known regarding the physiological roles and mechanisms regulating tonic eCB signaling at central synapses. In this study, we show that both 2-AG and AEA are constitutively released in the dorsal raphe nucleus (DRN), where they exert tonic control of glutamatergic synaptic transmission onto serotonin (5-HT) neurons. The magnitude of this tonic eCB signaling is tightly regulated by the overall activity of neuronal network. Thus, short term in vitro neuronal silencing or blockade of excitatory synaptic transmission abolishes tonic eCB signaling in the DRn. Importantly, in addition to controlling basal synaptic transmission, this study reveals that tonic 2-AG, but not AEA signaling, modulates synaptic plasticity. Indeed, short-term increase in tonic 2-AG signaling impairs spike-timing dependent potentiation (tLTP) of glutamate synapses. This tonic 2-AG-mediated homeostatic control of DRN glutamate synapses is not signaled by canonical cannabinoid receptors, but by intracellular peroxisome proliferator-activated receptor gamma (PPARγ). Further examination reveals that 2-AG mediated activation of PPARγ blocks tLTP by inhibiting nitric oxide (NO), soluble guanylate cyclase, and protein kinase G (NO/sGC/PKG) signaling pathway. Collectively, these results unravel novel mechanisms by which tonic 2-AG signaling integrates network activities and controls the synaptic plasticity in the brain.
Collapse
Affiliation(s)
- Saida Oubraim
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Ruixiang Wang
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Kathryn A Hausknecht
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Roh-Yu Shen
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States.,Neuroscience Program, University at Buffalo, Buffalo, NY, United States
| | - Samir Haj-Dahmane
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States.,Neuroscience Program, University at Buffalo, Buffalo, NY, United States
| |
Collapse
|
15
|
da Silva EA, Medeiros WMB, Torro N, de Sousa JMM, de Almeida IBCM, da Costa FB, Pontes KM, Nunes ELG, da Rosa MD, de Albuquerque KLGD. Cannabis and cannabinoid use in autism spectrum disorder: a systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 44:e20200149. [PMID: 34043900 PMCID: PMC9887656 DOI: 10.47626/2237-6089-2020-0149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/13/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction, associated with the presence of restricted and repetitive patterns of behavior, interests, or activities. Cannabis has been used to alleviate symptoms associated with ASD. METHOD We carried out a systematic review of studies that investigated the clinical effects of cannabis and cannabinoid use on ASD, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA checklist). The search was carried out in four databases: MEDLINE/PubMed, Scientific Electronic Library Online (SciELO), Scopus, and Web of Science. No limits were established for language during the selection process. Nine studies were selected and analyzed. RESULTS Some studies showed that cannabis products reduced the number and/or intensity of different symptoms, including hyperactivity, attacks of self-mutilation and anger, sleep problems, anxiety, restlessness, psychomotor agitation, irritability, aggressiveness perseverance, and depression. Moreover, they found an improvement in cognition, sensory sensitivity, attention, social interaction, and language. The most common adverse effects were sleep disorders, restlessness, nervousness and change in appetite. CONCLUSION Cannabis and cannabinoids may have promising effects in the treatment of symptoms related to ASD, and can be used as a therapeutic alternative in the relief of those symptoms. However, randomized, blind, placebo-controlled clinical trials are necessary to clarify findings on the effects of cannabis and its cannabinoids in individuals with ASD. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), code 164161.
Collapse
Affiliation(s)
- Estácio Amaro da Silva
- Departamento de PsicologiaUniversidade Federal da ParaíbaJoão PessoaPBBrazil Departamento de Psicologia, Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil.
| | - Wandersonia Moreira Brito Medeiros
- Departamento de PsicologiaUniversidade Federal da ParaíbaJoão PessoaPBBrazil Departamento de Psicologia, Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil.
| | - Nelson Torro
- Departamento de PsicologiaUniversidade Federal da ParaíbaJoão PessoaPBBrazil Departamento de Psicologia, Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil.
| | | | | | | | | | - Eliane Lima Guerra Nunes
- Sociedade Brasileira de Estudo da Cannabis Sativa Sociedade Brasileira de Estudo da Cannabis Sativa.
| | - Marine Diniz da Rosa
- Departamento de FonoaudiologiaUFPBJoão PessoaPBBrazil Departamento de Fonoaudiologia, UFPB, João Pessoa, PB, Brazil.
| | | |
Collapse
|
16
|
Nezgovorova V, Ferretti CJ, Taylor BP, Shanahan E, Uzunova G, Hong K, Devinsky O, Hollander E. Potential of cannabinoids as treatments for autism spectrum disorders. J Psychiatr Res 2021; 137:194-201. [PMID: 33689997 DOI: 10.1016/j.jpsychires.2021.02.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 01/04/2023]
Abstract
Current treatments for autism spectrum disorders (ASD) are limited in efficacy and are often associated with substantial side effects. These medications typically ameliorate problem behaviors associated with ASD, but do not target core symptom domains. As a result, there is a significant amount of research underway for development of novel experimental therapeutics. Endocannabinoids are arachidonic acid-derived lipid neuromodulators, which, in combination with their receptors and associated metabolic enzymes, constitute the endocannabinoid (EC) system. Cannabinoid signaling may be involved in the social impairment and repetitive behaviors observed in those with ASD. In this review, we discuss a possible role of the EC system in excitatory-inhibitory (E-I) imbalance and immune dysregulation in ASD. Novel treatments for the core symptom domains of ASD are needed and phytocannabinoids could be useful experimental therapeutics for core symptoms and associated domains.
Collapse
Affiliation(s)
- V Nezgovorova
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - C J Ferretti
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - B P Taylor
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - E Shanahan
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - G Uzunova
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - K Hong
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - O Devinsky
- New York University Comprehensive Epilepsy Center, New York, NY, USA
| | - E Hollander
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA.
| |
Collapse
|
17
|
Papariello A, Taylor D, Soderstrom K, Litwa K. CB 1 antagonism increases excitatory synaptogenesis in a cortical spheroid model of fetal brain development. Sci Rep 2021; 11:9356. [PMID: 33931678 PMCID: PMC8087674 DOI: 10.1038/s41598-021-88750-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/09/2021] [Indexed: 02/02/2023] Open
Abstract
The endocannabinoid system (ECS) plays a complex role in the development of neural circuitry during fetal brain development. The cannabinoid receptor type 1 (CB1) controls synaptic strength at both excitatory and inhibitory synapses and thus contributes to the balance of excitatory and inhibitory signaling. Imbalances in the ratio of excitatory to inhibitory synapses have been implicated in various neuropsychiatric disorders associated with dysregulated central nervous system development including autism spectrum disorder, epilepsy, and schizophrenia. The role of CB1 in human brain development has been difficult to study but advances in induced pluripotent stem cell technology have allowed us to model the fetal brain environment. Cortical spheroids resemble the cortex of the dorsal telencephalon during mid-fetal gestation and possess functional synapses, spontaneous activity, an astrocyte population, and pseudo-laminar organization. We first characterized the ECS using STORM microscopy and observed synaptic localization of components similar to that which is observed in the fetal brain. Next, using the CB1-selective antagonist SR141716A, we observed an increase in excitatory, and to a lesser extent, inhibitory synaptogenesis as measured by confocal image analysis. Further, CB1 antagonism increased the variability of spontaneous activity within developing neural networks, as measured by microelectrode array. Overall, we have established that cortical spheroids express ECS components and are thus a useful model for exploring endocannabinoid mediation of childhood neuropsychiatric disease.
Collapse
Affiliation(s)
- Alexis Papariello
- Department of Pharmacology and Toxicology, Brody School of Medicine at East Carolina University, Greenville, NC, 27834, USA
| | - David Taylor
- Department of Pharmacology and Toxicology, Brody School of Medicine at East Carolina University, Greenville, NC, 27834, USA
| | - Ken Soderstrom
- Department of Pharmacology and Toxicology, Brody School of Medicine at East Carolina University, Greenville, NC, 27834, USA.
| | - Karen Litwa
- Department of Anatomy and Cell Biology, Brody School of Medicine at East Carolina University, Greenville, NC, 27834, USA.
| |
Collapse
|
18
|
Joshi N, Onaivi ES. Psychiatric Disorders and Cannabinoid Receptors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1264:131-153. [PMID: 33332008 PMCID: PMC10810008 DOI: 10.1007/978-3-030-57369-0_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
With the increasing global use of medical and adult recreational use of cannabis and cannabinoids, this chapter provides overview of evidence from animal and human studies on psychiatric disorders and cannabinoid receptors. We review and present evaluation of the relationship between changes in the ECS and psychiatric disorders. Evidence suggests the existence of a relationship between changes in components of the ECS, and some of the symptoms present in psychiatric disorders. Both CB1Rs and CB2Rs are components of the endocannabinoid system with different cellular and tissue localization patterns that are differentially expressed in the CNS and PNS and are emerging targets for the treatment of number psychiatric disorders. As cannabis preparations are widely used for recreation globally, it is predictable that cannabis use disorders (CUDs) will increase and there is currently no available treatment for CUDs. Although major advances have been reported from cannabinoid and ECS research, there are gaps in scientific knowledge on long-term consequences of cannabis use. Adolescent and cannabis use during pregnancy presents further challenges, and more research will uncover the signaling pathways that couple the gut microbiota with the host ECS. Development of cannabis and cannabinoid nanomedicine for nanotherapy will certainly overcome some of the shortcomings and challenges in medicinal and recreational use of cannabis and cannabinoids. Thus, nanotechnology will allow targeted delivery of cannabinoid formulations with the potential to elevate their use to scientifically validated nanotherapeutic applications as the field of cannabis nanoscience matures.
Collapse
Affiliation(s)
- Neal Joshi
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | | |
Collapse
|
19
|
Healing autism spectrum disorder with cannabinoids: a neuroinflammatory story. Neurosci Biobehav Rev 2020; 121:128-143. [PMID: 33358985 DOI: 10.1016/j.neubiorev.2020.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/28/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with a multifactorial etiology. Latest researches are raising the hypothesis of a link between the onset of the main behavioral symptoms of ASD and the chronic neuroinflammatory condition of the autistic brain; increasing evidence of this connection is shedding light on new possible players in the pathogenesis of ASD. The endocannabinoid system (ECS) has a key role in neurodevelopment as well as in normal inflammatory responses and it is not surprising that many preclinical and clinical studies account for alterations of the endocannabinoid signaling in ASD. These findings lay the foundation for a better understanding of the neurochemical mechanisms underlying ASD and for new therapeutic attempts aimed at exploiting the renowned anti-inflammatory properties of cannabinoids to treat pathologies encompassed in the autistic spectrum. This review discusses the current preclinical and clinical evidence supporting a key role of the ECS in the neuroinflammatory state that characterizes ASD, providing hints to identify new biomarkers in ASD and promising therapies for the future.
Collapse
|
20
|
Haspula D, Clark MA. Cannabinoid Receptors: An Update on Cell Signaling, Pathophysiological Roles and Therapeutic Opportunities in Neurological, Cardiovascular, and Inflammatory Diseases. Int J Mol Sci 2020; 21:E7693. [PMID: 33080916 PMCID: PMC7590033 DOI: 10.3390/ijms21207693] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/16/2022] Open
Abstract
The identification of the human cannabinoid receptors and their roles in health and disease, has been one of the most significant biochemical and pharmacological advancements to have occurred in the past few decades. In spite of the major strides made in furthering endocannabinoid research, therapeutic exploitation of the endocannabinoid system has often been a challenging task. An impaired endocannabinoid tone often manifests as changes in expression and/or functions of type 1 and/or type 2 cannabinoid receptors. It becomes important to understand how alterations in cannabinoid receptor cellular signaling can lead to disruptions in major physiological and biological functions, as they are often associated with the pathogenesis of several neurological, cardiovascular, metabolic, and inflammatory diseases. This review focusses mostly on the pathophysiological roles of type 1 and type 2 cannabinoid receptors, and it attempts to integrate both cellular and physiological functions of the cannabinoid receptors. Apart from an updated review of pre-clinical and clinical studies, the adequacy/inadequacy of cannabinoid-based therapeutics in various pathological conditions is also highlighted. Finally, alternative strategies to modulate endocannabinoid tone, and future directions are also emphasized.
Collapse
Affiliation(s)
- Dhanush Haspula
- Molecular Signaling Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA;
| | - Michelle A. Clark
- Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| |
Collapse
|
21
|
Bartoll A, Toledano-Zaragoza A, Casas J, Guzmán M, Schuchman EH, Ledesma MD. Inhibition of fatty acid amide hydrolase prevents pathology in neurovisceral acid sphingomyelinase deficiency by rescuing defective endocannabinoid signaling. EMBO Mol Med 2020; 12:e11776. [PMID: 33016621 PMCID: PMC7645369 DOI: 10.15252/emmm.201911776] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 01/05/2023] Open
Abstract
Acid sphingomyelinase deficiency (ASMD) leads to cellular accumulation of sphingomyelin (SM), neurodegeneration, and early death. Here, we describe the downregulation of the endocannabinoid (eCB) system in neurons of ASM knockout (ASM‐KO) mice and a ASMD patient. High SM reduced expression of the eCB receptor CB1 in neuronal processes and induced its accumulation in lysosomes. Activation of CB1 receptor signaling, through inhibition of the eCB‐degrading enzyme fatty acid amide hydrolase (FAAH), reduced SM levels in ASM‐KO neurons. Oral treatment of ASM‐KO mice with a FAAH inhibitor prevented SM buildup; alleviated inflammation, neurodegeneration, and behavioral alterations; and extended lifespan. This treatment showed benefits even after a single administration at advanced disease stages. We also found CB1 receptor downregulation in neurons of a mouse model and a patient of another sphingolipid storage disorder, Niemann–Pick disease type C (NPC). We showed the efficacy of FAAH inhibition to reduce SM and cholesterol levels in NPC patient‐derived cells and in the brain of a NPC mouse model. Our findings reveal a pathophysiological crosstalk between neuronal SM and the eCB system and offer a new treatment for ASMD and other sphingolipidoses.
Collapse
Affiliation(s)
- Adrián Bartoll
- Centro Biologia Molecular Severo Ochoa (CSIC-UAM), Madrid, Spain
| | | | | | - Manuel Guzmán
- Department of Biochemistry and Molecular Biology, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Instituto Universitario de Investigación Neuroquímica (IUIN), Complutense University, Madrid, Spain
| | - Edward H Schuchman
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | | |
Collapse
|
22
|
Monday HR, Bourdenx M, Jordan BA, Castillo PE. CB 1-receptor-mediated inhibitory LTD triggers presynaptic remodeling via protein synthesis and ubiquitination. eLife 2020; 9:54812. [PMID: 32902378 PMCID: PMC7521925 DOI: 10.7554/elife.54812] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 09/08/2020] [Indexed: 01/03/2023] Open
Abstract
Long-lasting forms of postsynaptic plasticity commonly involve protein synthesis-dependent structural changes of dendritic spines. However, the relationship between protein synthesis and presynaptic structural plasticity remains unclear. Here, we investigated structural changes in cannabinoid-receptor 1 (CB1)-mediated long-term depression of inhibitory transmission (iLTD), a form of presynaptic plasticity that involves a protein-synthesis-dependent long-lasting reduction in GABA release. We found that CB1-iLTD in acute rat hippocampal slices was associated with protein synthesis-dependent presynaptic structural changes. Using proteomics, we determined that CB1 activation in hippocampal neurons resulted in increased ribosomal proteins and initiation factors, but decreased levels of proteins involved in regulation of the actin cytoskeleton, such as ARPC2 and WASF1/WAVE1, and presynaptic release. Moreover, while CB1-iLTD increased ubiquitin/proteasome activity, ubiquitination but not proteasomal degradation was critical for structural and functional presynaptic CB1-iLTD. Thus, CB1-iLTD relies on both protein synthesis and ubiquitination to elicit structural changes that underlie long-term reduction of GABA release.
Collapse
Affiliation(s)
- Hannah R Monday
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, United States
| | - Mathieu Bourdenx
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, United States.,Institute for Aging Studies, Albert Einstein College of Medicine, Bronx, United States
| | - Bryen A Jordan
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, United States.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, United States
| | - Pablo E Castillo
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, United States.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, United States
| |
Collapse
|
23
|
Cannabinoids for People with ASD: A Systematic Review of Published and Ongoing Studies. Brain Sci 2020; 10:brainsci10090572. [PMID: 32825313 PMCID: PMC7563787 DOI: 10.3390/brainsci10090572] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 12/22/2022] Open
Abstract
The etiopathogenesis of autism spectrum disorder (ASD) remains largely unclear. Among other biological hypotheses, researchers have evidenced an imbalance in the endocannabinoid (eCB) system, which regulates some functions typically impaired in ASD, such as emotional responses and social interaction. Additionally, cannabidiol (CBD), the non-intoxicating component of Cannabis sativa, was recently approved for treatment-resistant epilepsy. Epilepsy represents a common medical condition in people with ASD. Additionally, the two conditions share some neuropathological mechanisms, particularly GABAergic dysfunctions. Hence, it was hypothesized that cannabinoids could be useful in improving ASD symptoms. Our systematic review was conducted according to the PRISMA guidelines and aimed to summarize the literature regarding the use of cannabinoids in ASD. After searching in Web of KnowledgeTM, PsycINFO, and Embase, we included ten studies (eight papers and two abstracts). Four ongoing trials were retrieved in ClinicalTrials.gov. The findings were promising, as cannabinoids appeared to improve some ASD-associated symptoms, such as problem behaviors, sleep problems, and hyperactivity, with limited cardiac and metabolic side effects. Conversely, the knowledge of their effects on ASD core symptoms is scarce. Interestingly, cannabinoids generally allowed to reduce the number of prescribed medications and decreased the frequency of seizures in patients with comorbid epilepsy. Mechanisms of action could be linked to the excitatory/inhibitory imbalance found in people with ASD. However, further trials with better characterization and homogenization of samples, and well-defined outcomes should be implemented.
Collapse
|
24
|
Abioye A, Ayodele O, Marinkovic A, Patidar R, Akinwekomi A, Sanyaolu A. Δ9-Tetrahydrocannabivarin (THCV): a commentary on potential therapeutic benefit for the management of obesity and diabetes. J Cannabis Res 2020; 2:6. [PMID: 33526143 PMCID: PMC7819335 DOI: 10.1186/s42238-020-0016-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/19/2020] [Indexed: 01/06/2023] Open
Abstract
Δ9-Tetrahydrocannabivarin (THCV) is a cannabis-derived compound with unique properties that set it apart from the more common cannabinoids, such as Δ9-tetrahydrocannabinol (THC). The main advantage of THCV over THC is the lack of psychoactive effects. In rodent studies, THCV decreases appetite, increases satiety, and up-regulates energy metabolism, making it a clinically useful remedy for weight loss and management of obesity and type 2 diabetic patients. The distinctions between THCV and THC in terms of glycemic control, glucose metabolism, and energy regulation have been demonstrated in previous studies. Also, the effect of THCV on dyslipidemia and glycemic control in type 2 diabetics showed reduced fasting plasma glucose concentration when compared to a placebo group. In contrast, THC is indicated in individuals with cachexia. However, the uniquely diverse properties of THCV provide neuroprotection, appetite suppression, glycemic control, and reduced side effects, etc.; therefore, making it a potential priority candidate for the development of clinically useful therapies in the future. Hopefully, THCV could provide an optional platform for the treatment of life-threatening diseases.
Collapse
Affiliation(s)
- Amos Abioye
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida, USA
| | | | | | - Risha Patidar
- Saint James School of Medicine, The Quarter, Anguilla
| | | | | |
Collapse
|
25
|
Yu Q, He Z, Zubkov D, Huang S, Kurochkin I, Yang X, Halene T, Willmitzer L, Giavalisco P, Akbarian S, Khaitovich P. Lipidome alterations in human prefrontal cortex during development, aging, and cognitive disorders. Mol Psychiatry 2020; 25:2952-2969. [PMID: 30089790 PMCID: PMC7577858 DOI: 10.1038/s41380-018-0200-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/26/2018] [Accepted: 06/11/2018] [Indexed: 12/27/2022]
Abstract
Lipids are essential to brain functions, yet they remain largely unexplored. Here we investigated the lipidome composition of prefrontal cortex gray matter in 396 cognitively healthy individuals with ages spanning 100 years, as well as 67 adult individuals diagnosed with autism (ASD), schizophrenia (SZ), and Down syndrome (DS). Of the 5024 detected lipids, 95% showed significant age-dependent concentration differences clustering into four temporal stages, and resulting in a gradual increase in membrane fluidity in individuals ranging from newborn to nonagenarian. Aging affects 14% of the brain lipidome with late-life changes starting predominantly at 50-55 years of age-a period of general metabolic transition. All three diseases alter the brain lipidome composition, leading-among other things-to a concentration decrease in glycerophospholipid metabolism and endocannabinoid signaling pathways. Lipid concentration decreases in SZ were further linked to genetic variants associated with disease, indicating the relevance of the lipidome changes to disease progression.
Collapse
Affiliation(s)
- Qianhui Yu
- grid.9227.e0000000119573309Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031 China ,grid.419092.70000 0004 0467 2285CAS Key Laboratory of Compstudy has been deposited in the National Omics Datautational Biology, CAS-MPG Partner Institute for Computational Biology, SIBS, CAS, Shanghai, 200031 China
| | - Zhisong He
- grid.419092.70000 0004 0467 2285CAS Key Laboratory of Compstudy has been deposited in the National Omics Datautational Biology, CAS-MPG Partner Institute for Computational Biology, SIBS, CAS, Shanghai, 200031 China ,grid.454320.40000 0004 0555 3608Skolkovo Institute of Science and Technology, Moscow, 143028 Russia
| | - Dmitry Zubkov
- grid.454320.40000 0004 0555 3608Skolkovo Institute of Science and Technology, Moscow, 143028 Russia
| | - Shuyun Huang
- grid.419092.70000 0004 0467 2285CAS Key Laboratory of Compstudy has been deposited in the National Omics Datautational Biology, CAS-MPG Partner Institute for Computational Biology, SIBS, CAS, Shanghai, 200031 China ,grid.440637.20000 0004 4657 8879ShanghaiTech University, Shanghai, 200031 China
| | - Ilia Kurochkin
- grid.454320.40000 0004 0555 3608Skolkovo Institute of Science and Technology, Moscow, 143028 Russia
| | - Xiaode Yang
- grid.9227.e0000000119573309Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031 China ,grid.419092.70000 0004 0467 2285CAS Key Laboratory of Compstudy has been deposited in the National Omics Datautational Biology, CAS-MPG Partner Institute for Computational Biology, SIBS, CAS, Shanghai, 200031 China
| | - Tobias Halene
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Lothar Willmitzer
- grid.418390.70000 0004 0491 976XMax Planck Institute for Molecular Plant Physiology, Am Mühlenberg 1, Potsdam, 14476 Germany
| | - Patrick Giavalisco
- Max Planck Institute for Molecular Plant Physiology, Am Mühlenberg 1, Potsdam, 14476, Germany.
| | - Schahram Akbarian
- Department of Psychiatry and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Philipp Khaitovich
- Skolkovo Institute of Science and Technology, Moscow, 143028, Russia. .,ShanghaiTech University, Shanghai, 200031, China. .,Max Planck Institute for Evolutionary Anthropology, Leipzig, 04103, Germany. .,Comparative Biology Group, CAS-MPG Partner Institute for Computational Biology, SIBS, CAS, Shanghai, 200031, China.
| |
Collapse
|
26
|
Agarwal R, Burke SL, Maddux M. Current state of evidence of cannabis utilization for treatment of autism spectrum disorders. BMC Psychiatry 2019; 19:328. [PMID: 31664964 PMCID: PMC6819459 DOI: 10.1186/s12888-019-2259-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/26/2019] [Indexed: 02/07/2023] Open
Abstract
The core symptoms and co-morbidities associated with autism spectrum disorders (ASD) affect daily living and quality of life. Existing pharmacological interventions are only able to attenuate some related symptoms but are unable to address the underlying etiologies associated with ASD. Anecdotal evidence, which claims benefit from the use of cannabis to treat symptoms among this population, has been gaining popularity as families seek solutions.This paper analyzed recent peer-reviewed literature to identify the current state of evidence regarding cannabis use for the ASD population. Systematic reviews, reports, and experimental studies were assessed to understand the current extent and nature of the evidence on the risks and benefits of cannabis use for ASD. At this time, three large-scale clinical trials are currently at varying stages of progress and publication of results. Only five small studies were identified that have specifically examined cannabis use in ASD. Given the sparse state of evidence directly assessed in this population, studies which examined effects of cannabis on shared pathological symptoms of ASD such as hyperactivity, sleep disorders, self-injury, anxiety, behavioral problems, and communication were also reviewed.Studies revealed mixed and inconclusive findings of cannabis effects for all conditions, except epilepsy. Adverse outcomes were also reported, which included severe psychosis, increased agitation, somnolence, decreased appetite, and irritability. In addition, a wide range of cannabis compositions and dosage were identified within the studies, which impact generalizability.There is currently insufficient evidence for cannabis use in ASD, which creates an urgent need for additional large-scale controlled studies to increase understanding of risks and benefits and also to examine the impact of "entourage effects." This will support discussions of treatment options between health care providers and ASD patients and their families. Evidence may lead to a desired new line of treatment or prevent adverse outcomes from unsubstantiated use amongst families aiming for symptom reduction.
Collapse
Affiliation(s)
- Rumi Agarwal
- 0000 0001 2110 1845grid.65456.34FIU Embrace Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA ,0000 0001 2110 1845grid.65456.34BRAINN Lab, Florida International University School of Social Work, 11200 SW 8th Street, Miami, FL 33199 USA ,0000 0001 2110 1845grid.65456.34Florida International University School of Public Health Robert Stempel College of Public Health and Social Work Health Promotion and Disease Prevention, 11200 S.W. 8th Street, Miami, FL 33199 USA
| | - Shanna L. Burke
- 0000 0001 2110 1845grid.65456.34BRAINN Lab, Florida International University School of Social Work, 11200 SW 8th Street, Miami, FL 33199 USA ,0000 0001 2110 1845grid.65456.34Florida International University School of Social Work Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5 585, Miami, FL 33199 USA
| | - Marlaina Maddux
- 0000 0001 2110 1845grid.65456.34FIU Embrace Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA ,0000 0001 2110 1845grid.65456.34BRAINN Lab, Florida International University School of Social Work, 11200 SW 8th Street, Miami, FL 33199 USA ,Easterseals Blake Foundation, 750 E Broadway Blvd, Tucson, AZ 85710 USA
| |
Collapse
|
27
|
Zou M, Li D, Li L, Wu L, Sun C. Role of the endocannabinoid system in neurological disorders. Int J Dev Neurosci 2019; 76:95-102. [PMID: 30858029 DOI: 10.1016/j.ijdevneu.2019.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 01/13/2023] Open
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that begins in infancy. Although the etiology and pathogenesis are poorly understood, many studies have shown that ASD is closely related to structural and functional defects in the nervous system, especially synaptic transmission. The endocannabinoid (eCB) system is an important regulatory system of the central nervous system that regulates neurotransmission and synaptic plasticity and plays an important role in emotional and social responses and cognitive function. The relationship between eCB system and ASD has attracted increasing attention from scholars. In this review, we discuss the complex lipid signaling network of the eCB system, intracellular transport pathways, abnormal expression and association with various neurological diseases, and direct and indirect evidence for the link between eCB and ASD. Collectively, the findings to date indicate that the eCB system plays a key role in the pathophysiology of ASD and can provide new insights into potential interventions and rehabilitation strategies for ASD.
Collapse
Affiliation(s)
- Mingyang Zou
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China
| | - Dexin Li
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China
| | - Ling Li
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China
| | - Lijie Wu
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China
| | - Caihong Sun
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin, 150081, China
| |
Collapse
|
28
|
Schultz S, Siniscalco D. Endocannabinoid system involvement in autism spectrum disorder: An overview with potential therapeutic applications. AIMS MOLECULAR SCIENCE 2019. [DOI: 10.3934/molsci.2019.1.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
29
|
Kuo HY, Liu FC. Molecular Pathology and Pharmacological Treatment of Autism Spectrum Disorder-Like Phenotypes Using Rodent Models. Front Cell Neurosci 2018; 12:422. [PMID: 30524240 PMCID: PMC6262306 DOI: 10.3389/fncel.2018.00422] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder with a high prevalence rate. The core symptoms of ASD patients are impaired social communication and repetitive behavior. Genetic and environmental factors contribute to pathophysiology of ASD. Regarding environmental risk factors, it is known that valproic acid (VPA) exposure during pregnancy increases the chance of ASD among offspring. Over a decade of animal model studies have shown that maternal treatment with VPA in rodents recapitulates ASD-like pathophysiology at a molecular, cellular and behavioral level. Here, we review the prevailing theories of ASD pathogenesis, including excitatory/inhibitory imbalance, neurotransmitter dysfunction, dysfunction of mTOR and endocannabinoid signaling pathways, neuroinflammation and epigenetic alterations that have been associated with ASD. We also describe the evidence linking neuropathological changes to ASD-like behavioral abnormalities in maternal VPA-treated rodents. In addition to obtaining an understanding of the neuropathological mechanisms, the VPA-induced ASD-like animal models also serve as a good platform for testing pharmacological reagents that might be use treating ASD. We therefore have summarized the various pharmacological studies that have targeted the classical neurotransmitter systems, the endocannabinoids, the Wnt signal pathway and neuroinflammation. These approaches have been shown to often be able to ameliorate the ASD-like phenotypes induced by maternal VPA treatments.
Collapse
Affiliation(s)
- Hsiao-Ying Kuo
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Chin Liu
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
30
|
Vigli D, Cosentino L, Raggi C, Laviola G, Woolley-Roberts M, De Filippis B. Chronic treatment with the phytocannabinoid Cannabidivarin (CBDV) rescues behavioural alterations and brain atrophy in a mouse model of Rett syndrome. Neuropharmacology 2018; 140:121-129. [DOI: 10.1016/j.neuropharm.2018.07.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/30/2018] [Accepted: 07/24/2018] [Indexed: 12/26/2022]
|
31
|
Melancia F, Schiavi S, Servadio M, Cartocci V, Campolongo P, Palmery M, Pallottini V, Trezza V. Sex-specific autistic endophenotypes induced by prenatal exposure to valproic acid involve anandamide signalling. Br J Pharmacol 2018; 175:3699-3712. [PMID: 29968249 DOI: 10.1111/bph.14435] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/05/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Autism spectrum disorder (ASD) is more commonly diagnosed in males than in females. Prenatal exposure to the antiepileptic drug valproic acid (VPA) is an environmental risk factor of ASD. Male rats prenatally exposed to VPA show socio-emotional autistic-like dysfunctions that have been related to changes in the activity of the endocannabinoid anandamide. Here, we have investigated if prenatal VPA induced sex-specific autistic endophenotypes involving anandamide signalling. EXPERIMENTAL APPROACH We studied sex-specific differences in the ASD-like socio-emotional, cognitive and repetitive symptoms displayed during development of Wistar rats of both sexes, prenatally exposed to VPA. The involvement of anandamide was followed by Western blotting of cannabinoid CB1 receptors and by inhibiting its metabolism. KEY RESULTS Female rats were less vulnerable to the deleterious effects of prenatal VPA exposure on social communication, emotional reactivity and cognitive performance than male rats. Conversely, as observed in male rats, prenatal VPA exposure induced selective deficits in social play behaviour and stereotypies in the female rat offspring. At the neurochemical level, prenatal VPA exposure altered phosphorylation of CB1 receptors in a sex-specific, age-specific and tissue-specific manner. Enhancing anandamide signalling through inhibition of its degradation reversed the behavioural deficits displayed by VPA-exposed animals of both sexes. CONCLUSIONS AND IMPLICATIONS These findings highlight sexually dimorphic consequences of prenatal VPA exposure that may be related to sex-specific effects of VPA on endocannabinoid neurotransmission in the course of development and introduce a new therapeutic target for reversing autistic-like symptoms in both sexes.
Collapse
Affiliation(s)
- Francesca Melancia
- Department of Science, Section of Biomedical Sciences and Technologies, University 'Roma Tre', Rome, Italy
| | - Sara Schiavi
- Department of Science, Section of Biomedical Sciences and Technologies, University 'Roma Tre', Rome, Italy
| | - Michela Servadio
- Department of Science, Section of Biomedical Sciences and Technologies, University 'Roma Tre', Rome, Italy
| | - Veronica Cartocci
- Department of Science, Section of Biomedical Sciences and Technologies, University 'Roma Tre', Rome, Italy
| | - Patrizia Campolongo
- Department of Physiology and Pharmacology 'V. Erspamer', Sapienza University of Rome, Rome, Italy
| | - Maura Palmery
- Department of Physiology and Pharmacology 'V. Erspamer', Sapienza University of Rome, Rome, Italy
| | - Valentina Pallottini
- Department of Science, Section of Biomedical Sciences and Technologies, University 'Roma Tre', Rome, Italy
| | - Viviana Trezza
- Department of Science, Section of Biomedical Sciences and Technologies, University 'Roma Tre', Rome, Italy
| |
Collapse
|
32
|
Leimuranta P, Khiroug L, Giniatullin R. Emerging Role of (Endo)Cannabinoids in Migraine. Front Pharmacol 2018; 9:420. [PMID: 29740328 PMCID: PMC5928495 DOI: 10.3389/fphar.2018.00420] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/10/2018] [Indexed: 01/03/2023] Open
Abstract
In this mini-review, we summarize recent discoveries and present new hypotheses on the role of cannabinoids in controlling trigeminal nociceptive system underlying migraine pain. Individual sections of this review cover key aspects of this topic, such as: (i) the current knowledge on the endocannabinoid system (ECS) with emphasis on expression of its components in migraine related structures; (ii) distinguishing peripheral from central site of action of cannabinoids, (iii) proposed mechanisms of migraine pain and control of nociceptive traffic by cannabinoids at the level of meninges and in brainstem, (iv) therapeutic targeting in migraine of monoacylglycerol lipase and fatty acid amide hydrolase, enzymes which control the level of endocannabinoids; (v) dual (possibly opposing) actions of cannabinoids via anti-nociceptive CB1 and CB2 and pro-nociceptive TRPV1 receptors. We explore the cannabinoid-mediated mechanisms in the frame of the Clinical Endocannabinoid Deficiency (CECD) hypothesis, which implies reduced tone of endocannabinoids in migraine patients. We further discuss the control of cortical excitability by cannabinoids via inhibition of cortical spreading depression (CSD) underlying the migraine aura. Finally, we present our view on perspectives of Cannabis-derived (extracted or synthetized marijuana components) or novel endocannabinoid therapeutics in migraine treatment.
Collapse
Affiliation(s)
- Pinja Leimuranta
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Leonard Khiroug
- Neurotar Ltd., Helsinki, Finland.,Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Rashid Giniatullin
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Laboratory of Neurobiology, Kazan Federal University, Kazan, Russia
| |
Collapse
|
33
|
Karhson DS, Krasinska KM, Dallaire JA, Libove RA, Phillips JM, Chien AS, Garner JP, Hardan AY, Parker KJ. Plasma anandamide concentrations are lower in children with autism spectrum disorder. Mol Autism 2018; 9:18. [PMID: 29564080 PMCID: PMC5848550 DOI: 10.1186/s13229-018-0203-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/05/2018] [Indexed: 11/22/2022] Open
Abstract
Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by restricted, stereotyped behaviors and impairments in social communication. Although the underlying biological mechanisms of ASD remain poorly understood, recent preclinical research has implicated the endogenous cannabinoid (or endocannabinoid), anandamide, as a significant neuromodulator in rodent models of ASD. Despite this promising preclinical evidence, no clinical studies to date have tested whether endocannabinoids are dysregulated in individuals with ASD. Here, we addressed this critical gap in knowledge by optimizing liquid chromatography-tandem mass spectrometry methodology to quantitatively analyze anandamide concentrations in banked blood samples collected from a cohort of children with and without ASD (N = 112). Findings Anandamide concentrations significantly differentiated ASD cases (N = 59) from controls (N = 53), such that children with lower anandamide concentrations were more likely to have ASD (p = 0.041). In keeping with this notion, anandamide concentrations were also significantly lower in ASD compared to control children (p = 0.034). Conclusions These findings are the first empirical human data to translate preclinical rodent findings to confirm a link between plasma anandamide concentrations in children with ASD. Although preliminary, these data suggest that impaired anandamide signaling may be involved in the pathophysiology of ASD.
Collapse
Affiliation(s)
- Debra S. Karhson
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305 USA
| | - Karolina M. Krasinska
- Vincent Coates Foundation Mass Spectrometry Laboratory, Stanford University, 333 Campus Dr., Stanford, CA 94305 USA
| | - Jamie Ahloy Dallaire
- Department of Comparative Medicine, Stanford University, 287 Campus Dr., Stanford, CA 94305 USA
| | - Robin A. Libove
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305 USA
| | - Jennifer M. Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305 USA
| | - Allis S. Chien
- Vincent Coates Foundation Mass Spectrometry Laboratory, Stanford University, 333 Campus Dr., Stanford, CA 94305 USA
| | - Joseph P. Garner
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305 USA
- Department of Comparative Medicine, Stanford University, 287 Campus Dr., Stanford, CA 94305 USA
| | - Antonio Y. Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305 USA
| | - Karen J. Parker
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305 USA
| |
Collapse
|
34
|
Freitas HR, Isaac AR, Malcher-Lopes R, Diaz BL, Trevenzoli IH, De Melo Reis RA. Polyunsaturated fatty acids and endocannabinoids in health and disease. Nutr Neurosci 2017; 21:695-714. [PMID: 28686542 DOI: 10.1080/1028415x.2017.1347373] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Polyunsaturated fatty acids (PUFAs) are lipid derivatives of omega-3 (docosahexaenoic acid, DHA, and eicosapentaenoic acid, EPA) or of omega-6 (arachidonic acid, ARA) synthesized from membrane phospholipids and used as a precursor for endocannabinoids (ECs). They mediate significant effects in the fine-tune adjustment of body homeostasis. Phyto- and synthetic cannabinoids also rule the daily life of billions worldwide, as they are involved in obesity, depression and drug addiction. Consequently, there is growing interest to reveal novel active compounds in this field. Cloning of cannabinoid receptors in the 90s and the identification of the endogenous mediators arachidonylethanolamide (anandamide, AEA) and 2-arachidonyglycerol (2-AG), led to the characterization of the endocannabinoid system (ECS), together with their metabolizing enzymes and membrane transporters. Today, the ECS is known to be involved in diverse functions such as appetite control, food intake, energy balance, neuroprotection, neurodegenerative diseases, stroke, mood disorders, emesis, modulation of pain, inflammatory responses, as well as in cancer therapy. Western diet as well as restriction of micronutrients and fatty acids, such as DHA, could be related to altered production of pro-inflammatory mediators (e.g. eicosanoids) and ECs, contributing to the progression of cardiovascular diseases, diabetes, obesity, depression or impairing conditions, such as Alzheimer' s disease. Here we review how diets based in PUFAs might be linked to ECS and to the maintenance of central and peripheral metabolism, brain plasticity, memory and learning, blood flow, and genesis of neural cells.
Collapse
Affiliation(s)
- Hércules Rezende Freitas
- a Laboratory of Neurochemistry, Institute of Biophysics Carlos Chagas Filho , Universidade Federal do Rio de Janeiro, Cidade Universitária , Ilha do Fundão, Rio de Janeiro , RJ 21941-902 , Brazil
| | - Alinny Rosendo Isaac
- a Laboratory of Neurochemistry, Institute of Biophysics Carlos Chagas Filho , Universidade Federal do Rio de Janeiro, Cidade Universitária , Ilha do Fundão, Rio de Janeiro , RJ 21941-902 , Brazil
| | | | - Bruno Lourenço Diaz
- c Laboratory of Inflammation, Institute of Biophysics Carlos Chagas Filho , Universidade Federal do Rio de Janeiro, Cidade Universitária , Ilha do Fundão, Rio de Janeiro , RJ 21941-902 , Brazil
| | - Isis Hara Trevenzoli
- d Laboratory of Molecular Endocrinology, Institute of Biophysics Carlos Chagas Filho , Universidade Federal do Rio de Janeiro, Cidade Universitária , Ilha do Fundão, Rio de Janeiro , RJ 21941-902 , Brazil
| | - Ricardo Augusto De Melo Reis
- a Laboratory of Neurochemistry, Institute of Biophysics Carlos Chagas Filho , Universidade Federal do Rio de Janeiro, Cidade Universitária , Ilha do Fundão, Rio de Janeiro , RJ 21941-902 , Brazil
| |
Collapse
|
35
|
Doenni VM, Gray JM, Song CM, Patel S, Hill MN, Pittman QJ. Deficient adolescent social behavior following early-life inflammation is ameliorated by augmentation of anandamide signaling. Brain Behav Immun 2016; 58:237-247. [PMID: 27453335 PMCID: PMC5461973 DOI: 10.1016/j.bbi.2016.07.152] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/15/2016] [Accepted: 07/20/2016] [Indexed: 11/18/2022] Open
Abstract
Early-life inflammation has been shown to exert profound effects on brain development and behavior, including altered emotional behavior, stress responsivity and neurochemical/neuropeptide receptor expression and function. The current study extends this research by examining the impact of inflammation, triggered with the bacterial compound lipopolysaccharide (LPS) on postnatal day (P) 14, on social behavior during adolescence. We investigated the role that the endocannabinoid (eCB) system plays in sociability after early-life LPS. To test this, multiple cohorts of Sprague Dawley rats were injected with LPS on P14. In adolescence, rats were subjected to behavioral testing in a reciprocal social interaction paradigm as well as the open field. We quantified eCB levels in the amygdala of P14 and adolescent animals (anandamide and 2-arachidonoylglycerol) as well as adolescent amygdaloid cannabinoid receptor 1 (CB1) binding site density and the hydrolytic activity of the enzyme fatty acid amide hydrolase (FAAH), which metabolizes the eCB anandamide. Additionally, we examined the impact of FAAH inhibition on alterations in social behavior. Our results indicate that P14 LPS decreases adolescent social behavior (play and social non-play) in males and females at P40. This behavioral alteration is accompanied by decreased CB1 binding, increased anandamide levels and increased FAAH activity. Oral administration of the FAAH inhibitor PF-04457845 (1mg/kg) prior to the social interaction task normalizes LPS-induced alterations in social behavior, while not affecting social behavior in the control group. Infusion of 10ng PF-04457845 into the basolateral amygdala normalized social behavior in LPS injected females. These data suggest that alterations in eCB signaling following postnatal inflammation contribute to impairments in social behavior during adolescence and that inhibition of FAAH could be a novel target for disorders involving social deficits such as social anxiety disorders or autism.
Collapse
Affiliation(s)
- V M Doenni
- Hotchkiss Brain Institute, Cumming School of Medicine, Mathison Center for Mental Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Neuroscience, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
| | - J M Gray
- Hotchkiss Brain Institute, Cumming School of Medicine, Mathison Center for Mental Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - C M Song
- Hotchkiss Brain Institute, Cumming School of Medicine, Mathison Center for Mental Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - S Patel
- Department of Psychiatry, Vanderbilt School of Medicine, Vanderbilt Brain Institute, Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, United States
| | - M N Hill
- Hotchkiss Brain Institute, Cumming School of Medicine, Mathison Center for Mental Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Q J Pittman
- Hotchkiss Brain Institute, Cumming School of Medicine, Mathison Center for Mental Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| |
Collapse
|
36
|
Karhson DS, Hardan AY, Parker KJ. Endocannabinoid signaling in social functioning: an RDoC perspective. Transl Psychiatry 2016; 6:e905. [PMID: 27676446 PMCID: PMC5048207 DOI: 10.1038/tp.2016.169] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/18/2016] [Indexed: 12/25/2022] Open
Abstract
Core deficits in social functioning are associated with various neuropsychiatric and neurodevelopmental disorders, yet biomarker identification and the development of effective pharmacological interventions has been limited. Recent data suggest the intriguing possibility that endogenous cannabinoids, a class of lipid neuromodulators generally implicated in the regulation of neurotransmitter release, may contribute to species-typical social functioning. Systematic study of the endogenous cannabinoid signaling could, therefore, yield novel approaches to understand the neurobiological underpinnings of atypical social functioning. This article provides a critical review of the major components of the endogenous cannabinoid system (for example, primary receptors and effectors-Δ9-tetrahydrocannabinol, cannabidiol, anandamide and 2-arachidonoylglycerol) and the contributions of cannabinoid signaling to social functioning. Data are evaluated in the context of Research Domain Criteria constructs (for example, anxiety, chronic stress, reward learning, motivation, declarative and working memory, affiliation and attachment, and social communication) to enable interrogation of endogenous cannabinoid signaling in social functioning across diagnostic categories. The empirical evidence reviewed strongly supports the role for dysregulated cannabinoid signaling in the pathophysiology of social functioning deficits observed in brain disorders, such as autism spectrum disorder, schizophrenia, major depressive disorder, posttraumatic stress disorder and bipolar disorder. Moreover, these findings indicate that the endogenous cannabinoid system holds exceptional promise as a biological marker of, and potential treatment target for, neuropsychiatric and neurodevelopmental disorders characterized by impairments in social functioning.
Collapse
Affiliation(s)
- D S Karhson
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - A Y Hardan
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - K J Parker
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|