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Soliman NA, El Dahmy SI, Khamis T, Sameh R, Alashqar SM, Hussein S. The potential protective and therapeutic effects of cannabidiol oil on experimental Leukemia induced by DMBA in male rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:2389-2400. [PMID: 37837474 DOI: 10.1007/s00210-023-02737-6] [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: 07/29/2023] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND 7,12-Dimethylbenzanthracene (DMBA) is a member of the polycyclic aromatic hydrocarbon family. It is a member of the polycyclic aromatic hydrocarbon family. It is a mutagenic, carcinogenic, and immunosuppressor agent. Cannabidiol (CBD) is a phytocannabinoid. It has anticonvulsant, anti-inflammatory, anti-anxiety, antioxidant, and anti-cancer properties. The purpose of this study was to investigate the possible protective and therapeutic benefits of CBD oil in DMBA-induced leukemia in rats. METHOD Experimental animals were divided into six groups of five rats each. Group 1 (normal control) included healthy rats. Group 2 included normal rats that received olive oil. Group 3 included normal rats that received CBD. Group 4 included the DMBA-induced leukemic group. Group 5 (prophylactic group) included rats that received CBD as a prophylaxis before IV injection with DMBA. Group 6 (treated group) included DMBA-induced leukemic rats that received CBD as treatment. Liver functions (total, direct and indirect bilirubin, alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST), albumin, globulin, and albumin globulin ratio) were measured. Superoxide dismutase (SOD) and catalase (CAT) were also measured. Total RNA extraction followed by-real time qRT-PCR gene expression of LC3-II, Beclin, mTOR, and P62 was performed. Histopathological examination of liver and spleen tissues was performed. RESULTS Administration of CBD in groups 5 and 6 resulted in a significant improvement of the levels of liver functions compared to the leukemic untreated rats. Also, the levels of catalase and SOD significantly increased after treatment with CBD compared to the leukemic group. After treatment with CBD in groups 5 and 6, there were downregulations in the expression of all studied genes compared to leukemic untreated rats. Treatment with CBD was more statistically effective than prophylactic use. CONCLUSION Administration of CBD resulted in a significant improvement in the biochemical, antioxidant status, morphological, and molecular measures in DMBA-induced leukemia in adult male rats. The therapeutic use was more effective than the prophylactic one.
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Affiliation(s)
- Nabil A Soliman
- Department of Zoology, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - Samih I El Dahmy
- Department of Pharmacognosy, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Tarek Khamis
- Department of Pharmacology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Reham Sameh
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Samia Hussein
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
- Department of Basic Medical Sciences, Ibn Sina University for Medical Sciences, Amman, Jordan.
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Kwon IS, Hwang YN, Park JH, Na HH, Kwon TH, Park JS, Kim KC. Metallothionein Family Proteins as Regulators of Zinc Ions Synergistically Enhance the Anticancer Effect of Cannabidiol in Human Colorectal Cancer Cells. Int J Mol Sci 2023; 24:16621. [PMID: 38068944 PMCID: PMC10705991 DOI: 10.3390/ijms242316621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Cannabidiol (CBD) is a chemical obtained from Cannabis sativa; it has therapeutic effects on anxiety and cognition and anti-inflammatory properties. Although pharmacological applications of CBD in many types of tumors have recently been reported, the mechanism of action of CBD is not yet fully understood. In this study, we perform an mRNA-seq analysis to identify the target genes of CBD after determining the cytotoxic concentrations of CBD using an MTT assay. CBD treatment regulated the expression of genes related to DNA repair and cell division, with metallothionein (MT) family genes being identified as having highly increased expression levels induced by CBD. It was also found that the expression levels of MT family genes were decreased in colorectal cancer tissues compared to those in normal tissues, indicating that the downregulation of MT family genes might be highly associated with colorectal tumor progression. A qPCR experiment revealed that the expression levels of MT family genes were increased by CBD. Moreover, MT family genes were regulated by CBD or crude extract but not by other cannabinoids, suggesting that the expression of MT family genes was specifically induced by CBD. A synergistic effect between CBD and MT gene transfection or zinc ion treatment was found. In conclusion, MT family genes as novel target genes could synergistically increase the anticancer activity of CBD by regulating the zinc ions in human colorectal cancer cells.
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Affiliation(s)
- In-Seo Kwon
- Department of Biological Sciences, College of Natural Sciences, Kangwon National University, Chuncheon 24341, Kangwon, Republic of Korea; (I.-S.K.); (Y.-N.H.); (J.-H.P.); (H.-H.N.)
| | - Yu-Na Hwang
- Department of Biological Sciences, College of Natural Sciences, Kangwon National University, Chuncheon 24341, Kangwon, Republic of Korea; (I.-S.K.); (Y.-N.H.); (J.-H.P.); (H.-H.N.)
| | - Ju-Hee Park
- Department of Biological Sciences, College of Natural Sciences, Kangwon National University, Chuncheon 24341, Kangwon, Republic of Korea; (I.-S.K.); (Y.-N.H.); (J.-H.P.); (H.-H.N.)
| | - Han-Heom Na
- Department of Biological Sciences, College of Natural Sciences, Kangwon National University, Chuncheon 24341, Kangwon, Republic of Korea; (I.-S.K.); (Y.-N.H.); (J.-H.P.); (H.-H.N.)
- Kangwon Center for System Imaging, Chuncheon 24341, Kangwon, Republic of Korea
| | - Tae-Hyung Kwon
- Chuncheon Bioindustry Foundation, Chuncheon 24232, Kangwon, Republic of Korea;
| | - Jin-Sung Park
- Korean Pharmacopuncture Institute, Seoul 07525, Republic of Korea;
| | - Keun-Cheol Kim
- Department of Biological Sciences, College of Natural Sciences, Kangwon National University, Chuncheon 24341, Kangwon, Republic of Korea; (I.-S.K.); (Y.-N.H.); (J.-H.P.); (H.-H.N.)
- Kangwon Center for System Imaging, Chuncheon 24341, Kangwon, Republic of Korea
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Zhivikj Z, Shutevska K, Bajatovska AM, Sofronievska S, Karapandzova M, Cvetkovikj Karanfilova I, Davkova I, Petrushevska-Toz L, Stefkov G, Kadifkova Panovska T. Cytotoxic screening of selected Cannabis cultivars using brine shrimp lethality assay. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Zoran Zhivikj
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Applied Biochemistry, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Kristina Shutevska
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Applied Biochemistry, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Ana Marija Bajatovska
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Applied Biochemistry, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Sevda Sofronievska
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Applied Biochemistry, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Marija Karapandzova
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Pharmacognosy, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Ivana Cvetkovikj Karanfilova
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Pharmacognosy, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Iskra Davkova
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Pharmacognosy, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Lidija Petrushevska-Toz
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Applied Biochemistry, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Gjoshe Stefkov
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Pharmacognosy, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Tatjana Kadifkova Panovska
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Institute of Applied Biochemistry, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
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The Cytotoxic Effects of Cannabidiol and Cannabigerol on Glioblastoma Stem Cells May Mostly Involve GPR55 and TRPV1 Signalling. Cancers (Basel) 2022; 14:cancers14235918. [PMID: 36497400 PMCID: PMC9738061 DOI: 10.3390/cancers14235918] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022] Open
Abstract
Glioblastoma (GBM) is one of the most aggressive cancers, comprising 60-70% of all gliomas. The large G-protein-coupled receptor family includes cannabinoid receptors CB1, CB2, GPR55, and non-specific ion receptor protein transporters TRPs. First, we found up-regulated CNR1, GPR55, and TRPV1 expression in glioma patient-derived tissue samples and cell lines compared with non-malignant brain samples. CNR1 and GPR55 did not correlate with glioma grade, whereas TRPV1 negatively correlated with grade and positively correlated with longer overall survival. This suggests a tumour-suppressor role of TRPV1. With respect to markers of GBM stem cells, preferred targets of therapy, TRPV1 and GPR55, but not CNR1, strongly correlated with different sets of stemness gene markers: NOTCH, OLIG2, CD9, TRIM28, and TUFM and CD15, SOX2, OCT4, and ID1, respectively. This is in line with the higher expression of TRPV1 and GPR55 genes in GSCs compared with differentiated GBM cells. Second, in a panel of patient-derived GSCs, we found that CBG and CBD exhibited the highest cytotoxicity at a molar ratio of 3:1. We suggest that this mixture should be tested in experimental animals and clinical studies, in which currently used Δ9-tetrahydrocannabinol (THC) is replaced with efficient and non-psychoactive CBG in adjuvant standard-of-care therapy.
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Green R, Khalil R, Mohapatra SS, Mohapatra S. Role of Cannabidiol for Improvement of the Quality of Life in Cancer Patients: Potential and Challenges. Int J Mol Sci 2022; 23:ijms232112956. [PMID: 36361743 PMCID: PMC9654506 DOI: 10.3390/ijms232112956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/23/2022] Open
Abstract
There is currently a growing interest in the use of cannabidiol (CBD) to alleviate the symptoms caused by cancer, including pain, sleep disruption, and anxiety. CBD is often self-administered as an over-the-counter supplement, and patients have reported benefits from its use. However, despite the progress made, the mechanisms underlying CBD’s anti-cancer activity remain divergent and unclear. Herein, we provide a comprehensive review of molecular mechanisms to determine convergent anti-cancer actions of CBD from pre-clinical and clinical studies. In vitro studies have begun to elucidate the molecular targets of CBD and provide evidence of CBD’s anti-tumor properties in cell and mouse models of cancer. Furthermore, several clinical trials have been completed testing CBD’s efficacy in treating cancer-related pain. However, most use a mixture of CBD and the psychoactive, tetrahydrocannabinol (THC), and/or use variable dosing that is not consistent between individual patients. Despite these limitations, significant reductions in pain and opioid use have been reported in cancer patients using CBD or CBD+THC. Additionally, significant improvements in quality-of-life measures and patients’ overall satisfaction with their treatment have been reported. Thus, there is growing evidence suggesting that CBD might be useful to improve the overall quality of life of cancer patients by both alleviating cancer symptoms and by synergizing with cancer therapies to improve their efficacy. However, many questions remain unanswered regarding the use of CBD in cancer treatment, including the optimal dose, effective combinations with other drugs, and which biomarkers/clinical presentation of symptoms may guide its use.
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Affiliation(s)
- Ryan Green
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
- James A Haley VA Hospital, Tampa, FL 33612, USA
| | - Roukiah Khalil
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Shyam S. Mohapatra
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
- James A Haley VA Hospital, Tampa, FL 33612, USA
- Correspondence: (S.S.M.); (S.M.)
| | - Subhra Mohapatra
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
- James A Haley VA Hospital, Tampa, FL 33612, USA
- Correspondence: (S.S.M.); (S.M.)
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Analysis of Anti-Cancer and Anti-Inflammatory Properties of 25 High-THC Cannabis Extracts. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27186057. [PMID: 36144796 PMCID: PMC9506243 DOI: 10.3390/molecules27186057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 12/24/2022]
Abstract
Cannabis sativa is one of the oldest cultivated plants. Many of the medicinal properties of cannabis are known, although very few cannabis-based formulations became prescribed drugs. Previous research demonstrated that cannabis varieties are very different in their medicinal properties, likely due to the entourage effect-the synergistic or antagonistic effect of various cannabinoids and terpenes. In this work, we analyzed 25 cannabis extracts containing high levels of delta-9-tetrahydrocannabinol (THC). We used HCC1806 squamous cell carcinoma and demonstrated various degrees of efficiency of the tested extracts, from 66% to 92% of growth inhibition of cancer cells. Inflammation was tested by induction of inflammation with TNF-α/IFN-γ in WI38 human lung fibroblasts. The efficiency of the extracts was tested by analyzing the expression of COX2 and IL6; while some extracts aggravated inflammation by increasing the expression of COX2/IL6 by 2-fold, other extracts decreased inflammation, reducing expression of cytokines by over 5-fold. We next analyzed the level of THC, CBD, CBG and CBN and twenty major terpenes and performed clustering and association analysis between the chemical composition of the extracts and their efficiency in inhibiting cancer growth and curbing inflammation. A positive correlation was found between the presence of terpinene (pval = 0.002) and anti-cancer property; eucalyptol came second, with pval of 0.094. p-cymene and β-myrcene positively correlated with the inhibition of IL6 expression, while camphor correlated negatively. No significant correlation was found for COX2. We then performed a correlation analysis between cannabinoids and terpenes and found a positive correlation for the following pairs: α-pinene vs. CBD, p-cymene vs. CBGA, terpenolene vs. CBGA and isopulegol vs. CBGA. Our work, thus, showed that most of high-THC extracts demonstrate anti-cancer activity, while only certain selected extracts showed anti-inflammatory activity. Presence of certain terpenes, such as terpinene, eucalyptol, cymene, myrcene and camphor, appear to have modulating effects on the activity of cannabinoids.
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Colvin EK, Hudson AL, Anderson LL, Kumar RP, McGregor IS, Howell VM, Arnold JC. An Examination of the Anti-Cancer Properties of Plant Cannabinoids in Preclinical Models of Mesothelioma. Cancers (Basel) 2022; 14:cancers14153813. [PMID: 35954477 PMCID: PMC9367527 DOI: 10.3390/cancers14153813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Mesothelioma is a deadly disease with few treatment options. Phytocannabinoids derived from the cannabis plant are garnering interest for their anti-cancer properties, however very little is known about their effects in mesothelioma. We aimed to assess whether phytocannabinoids have anti-cancer effects in mesothelioma and potential modes of action. We showed that several phytocannabinoids inhibited growth of mesothelioma cells, with two phytocannabinoids, cannabidiol (CBD) and cannabigerol (CBG), being the most potent. CBD and CBG also inhibited mesothelioma cell migration and invasion. Gene expression analysis highlighted signalling pathways that play a role in how CBD and CBG may exert their anti-cancer effects. CBD and CBG were unable to increase survival in a rat model of mesothelioma but this may be due to limitations in the drug delivery method. Abstract Mesothelioma is an aggressive cancer with limited treatment options and a poor prognosis. Phytocannabinoids possess anti-tumour and palliative properties in multiple cancers, however their effects in mesothelioma are unknown. We investigated the anti-cancer effects and potential mechanisms of action for several phytocannabinoids in mesothelioma cell lines. A panel of 13 phytocannabinoids inhibited growth of human (MSTO and H2452) and rat (II-45) mesothelioma cells in vitro, and cannabidiol (CBD) and cannabigerol (CBG) were the most potent compounds. Treatment with CBD or CBG resulted in G0/G1 arrest, delayed entry into S phase and induced apoptosis. CBD and CBG also significantly reduced mesothelioma cell migration and invasion. These effects were supported by changes in the expression of genes associated with the cell cycle, proliferation, and cell movement following CBD or CBG treatment. Gene expression levels of CNR1, GPR55, and 5HT1A also increased with CBD or CBG treatment. However, treatment with CBD or CBG in a syngeneic orthotopic rat mesothelioma model was unable to increase survival. Our data show that cannabinoids have anti-cancer effects on mesothelioma cells in vitro and alternatives of drug delivery may be needed to enhance their effects in vivo.
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Affiliation(s)
- Emily K. Colvin
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, St Leonards 2065, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Amanda L. Hudson
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, St Leonards 2065, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
- Correspondence: (A.L.H.); (J.C.A.); Tel.: +61-2-9926-4722 (A.L.H.); +61-2-9351-0812 (J.C.A.)
| | - Lyndsey L. Anderson
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney 2050, Australia
- Department of Pharmacology, Sydney Pharmacy School, University of Sydney, Sydney 2006, Australia
- Brain and Mind Centre, University of Sydney, Sydney 2050, Australia
| | - Ramyashree Prasanna Kumar
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney 2052, Australia
| | - Iain S. McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney 2050, Australia
- Brain and Mind Centre, University of Sydney, Sydney 2050, Australia
| | - Viive M. Howell
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, St Leonards 2065, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Jonathon C. Arnold
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney 2050, Australia
- Department of Pharmacology, Sydney Pharmacy School, University of Sydney, Sydney 2006, Australia
- Brain and Mind Centre, University of Sydney, Sydney 2050, Australia
- Correspondence: (A.L.H.); (J.C.A.); Tel.: +61-2-9926-4722 (A.L.H.); +61-2-9351-0812 (J.C.A.)
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Cannabidiol Antiproliferative Effect in Triple-Negative Breast Cancer MDA-MB-231 Cells Is Modulated by Its Physical State and by IGF-1. Int J Mol Sci 2022; 23:ijms23137145. [PMID: 35806150 PMCID: PMC9266539 DOI: 10.3390/ijms23137145] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 12/10/2022] Open
Abstract
Cannabidiol (CBD) is a non-psychoactive phytocannabinoid that has been discussed for its safety and efficacy in cancer treatments. For this reason, we have inquired into its use on triple-negative human breast cancer. Analyzing the biological effects of CBD on MDA-MB-231, we have demonstrated that both CBD dosage and serum concentrations in the culture medium influence its outcomes; furthermore, light scattering studies demonstrated that serum impacts the CBD aggregation state by acting as a surfactant agent. Pharmacological studies on CBD in combination with chemotherapeutic agents reveal that CBD possesses a protective action against the cytotoxic effect exerted by cisplatin on MDA-MB-231 grown in standard conditions. Furthermore, in a low serum condition (0.5%), starting from a threshold concentration (5 µM), CBD forms aggregates, exerts cytostatic antiproliferative outcomes, and promotes cell cycle arrest activating autophagy. At doses above the threshold, CBD exerts a highly cytotoxic effect inducing bubbling cell death. Finally, IGF-1 and EGF antagonize the antiproliferative effect of CBD protecting cells from harmful consequences of CBD aggregates. In conclusion, CBD effect is strongly associated with the physical state and concentration that reaches the treated cells, parameters not taken into account in most of the research papers.
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Valenti C, Billi M, Pancrazi GL, Calabria E, Armogida NG, Tortora G, Pagano S, Barnaba P, Marinucci L. Biological Effects of Cannabidiol on Human Cancer Cells: Systematic Review of the Literature. Pharmacol Res 2022; 181:106267. [DOI: 10.1016/j.phrs.2022.106267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 12/12/2022]
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