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Haidar Z, Traboulsi H, Eidelman DH, Baglole CJ. Differential inflammatory profile in the lungs of mice exposed to cannabis smoke with varying THC:CBD ratio. Arch Toxicol 2023; 97:1963-1978. [PMID: 37179517 PMCID: PMC10183104 DOI: 10.1007/s00204-023-03514-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Cannabis contains cannabinoids including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC causes the psychoactive effects of cannabis, and both THC and CBD are thought to be anti-inflammatory. Cannabis is typically consumed by inhaling smoke that contains thousands of combustion products that may damage the lungs. However, the relationship between cannabis smoke exposure and alterations in respiratory health is poorly defined. To address this gap in knowledge, we first developed a mouse model of cannabis smoke exposure using a nose-only rodent inhalation exposure system. We then tested the acute effects of two dried cannabis products that differ substantially in their THC-CBD ratio: Indica-THC dominant (I-THC; 16-22% THC) and Sativa-CBD dominant (S-CBD; 13-19% CBD). We demonstrate that this smoke exposure regime not only delivers physiologically relevant levels of THC to the bloodstream, but that acute inhalation of cannabis smoke modulates the pulmonary immune response. Cannabis smoke decreased the percentage of lung alveolar macrophages but increased lung interstitial macrophages (IMs). There was also a decrease in lung dendritic cells as well as Ly6Cintermediate and Ly6Clow monocytes, but an increase in lung neutrophils and CD8+ T cells. These immune cell changes were paralleled with changes in several immune mediators. These immunological modifications were more pronounced when mice were exposed to S-CBD compared to the I-THC variety. Thus, we show that acute cannabis smoke differentially affects lung immunity based on the THC:CBD ratio, thereby providing a foundation to further explore the effect of chronic cannabis smoke exposures on pulmonary health.
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Affiliation(s)
- Zahraa Haidar
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd (EM22248), Montreal, QC, H4A3J1, Canada
- Meakins-Christie Laboratories, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Hussein Traboulsi
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd (EM22248), Montreal, QC, H4A3J1, Canada
- Meakins-Christie Laboratories, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - David H Eidelman
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd (EM22248), Montreal, QC, H4A3J1, Canada
- Meakins-Christie Laboratories, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Carolyn J Baglole
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd (EM22248), Montreal, QC, H4A3J1, Canada.
- Meakins-Christie Laboratories, Montreal, QC, Canada.
- Department of Medicine, McGill University, Montreal, QC, Canada.
- Department of Pathology, McGill University, Montreal, QC, Canada.
- Department of Pharmacology & Therapeutics, McGill University, Montreal, QC, Canada.
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2
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Aloufi N, Namkung Y, Traboulsi H, Wilson ET, Laporte SA, Kaplan BL, Ross MK, Nair P, Eidelman DH, Baglole CJ. Standardized Cannabis Smoke Extract Induces Inflammation in Human Lung Fibroblasts. Front Pharmacol 2022; 13:852029. [PMID: 35418857 PMCID: PMC8996138 DOI: 10.3389/fphar.2022.852029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Cannabis (marijuana) is the most commonly used illicit product in the world and is the second most smoked plant after tobacco. There has been a rapid increase in the number of countries legalizing cannabis for both recreational and medicinal purposes. Smoking cannabis in the form of a joint is the most common mode of cannabis consumption. Combustion of cannabis smoke generates many of the same chemicals as tobacco smoke. Although the impact of tobacco smoke on respiratory health is well-known, the consequence of cannabis smoke on the respiratory system and, in particular, the inflammatory response is unclear. Besides the combustion products present in cannabis smoke, cannabis also contains cannabinoids including Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD). These compounds are hydrophobic and not present in aqueous solutions. In order to understand the impact of cannabis smoke on pathological mechanisms associated with adverse respiratory outcomes, the development of in vitro surrogates of cannabis smoke exposure is needed. Therefore, we developed a standardized protocol for the generation of cannabis smoke extract (CaSE) to investigate its effect on cellular mechanisms in vitro. First, we determined the concentration of Δ9-THC, one of the major cannabinoids, by ELISA and found that addition of methanol to the cell culture media during generation of the aqueous smoke extract significantly increased the amount of Δ9-THC. We also observed by LC-MS/MS that CaSE preparation with methanol contains CBD. Using a functional assay in cells for CB1 receptors, the major target of cannabinoids, we found that this CaSE contains Δ9-THC which activates CB1 receptors. Finally, this standardized preparation of CaSE induces an inflammatory response in human lung fibroblasts. This study provides an optimized protocol for aqueous CaSE preparation containing biologically active cannabinoids that can be used for in vitro experimentation of cannabis smoke and its potential impact on various indices of pulmonary health.
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Affiliation(s)
- Noof Aloufi
- Meakins-Christie Laboratories, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program at the Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Pathology, McGill University, Montreal, QC, Canada
- Department of Medical Laboratory Technology, Applied Medical Science, Taibah University, Medina, Saudi Arabia
| | - Yoon Namkung
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Hussein Traboulsi
- Meakins-Christie Laboratories, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program at the Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Emily T. Wilson
- Meakins-Christie Laboratories, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program at the Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Stephane A. Laporte
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Barbara L.F. Kaplan
- Department of Comparative Biomedical Sciences, Mississippi State University, Mississippi State, MS, United States
| | - Matthew K. Ross
- Department of Comparative Biomedical Sciences, Mississippi State University, Mississippi State, MS, United States
| | - Parameswaran Nair
- Department of Medicine, McMaster University and St Joseph’s Healthcare, Hamilton, ON, Canada
| | - David H. Eidelman
- Meakins-Christie Laboratories, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program at the Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Carolyn J. Baglole
- Meakins-Christie Laboratories, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program at the Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Pathology, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
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3
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Barman B, Bora K, Nongpiur A, Phukan P, Sarma K, Nath CK. Marijuana smoking: a possible cause of diffuse alveolar hemorrhage. AUTOPSY AND CASE REPORTS 2020; 10:e2020174. [PMID: 33344298 PMCID: PMC7703314 DOI: 10.4322/acr.2020.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Bhupen Barman
- North Eastern Indira Gandhi Regional Institute of health and Medical Sciences (NEIGRIHMS), Department of General Medicine. Shillong, Meghalaya, India
| | - Kaustubh Bora
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Department of Biochemistry. Shillong, Meghalaya, India.,Regional Medical Research Centre (ICMR), North East Region Dibrugarh, Assam, India
| | - Arvind Nongpiur
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Department of Psychiatry. Shillong, Meghalaya, India
| | - Pranjal Phukan
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Department of Radiology. Shillong, Meghalaya, India
| | - Kalyan Sarma
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Department of Radiology. Shillong, Meghalaya, India
| | - Chandan Kumar Nath
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Department of Biochemistry. Shillong, Meghalaya, India
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4
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Campeny E, López-Pelayo H, Nutt D, Blithikioti C, Oliveras C, Nuño L, Maldonado R, Florez G, Arias F, Fernández-Artamendi S, Villalbí JR, Sellarès J, Ballbè M, Rehm J, Balcells-Olivero MM, Gual A. The blind men and the elephant: Systematic review of systematic reviews of cannabis use related health harms. Eur Neuropsychopharmacol 2020; 33:1-35. [PMID: 32165103 DOI: 10.1016/j.euroneuro.2020.02.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/17/2020] [Indexed: 01/24/2023]
Abstract
Cannabis is the third most used psychoactive substance worldwide. The legal status of cannabis is changing in many Western countries, while we have very limited knowledge of the public health impact of cannabis-related harms. There is a need for a summary of the evidence of harms and risks attributed to cannabis use, in order to inform the definition of cannabis risky use. We have conducted a systematic review of systematic reviews, aiming to define cannabis-related harms. We included systematic reviews published until July 2018 from six different databases and following the PRISMA guidelines. To assess study quality we applied the AMSTAR 2 tool. A total of 44 systematic reviews, including 1,053 different studies, were eligible for inclusion. Harm was categorized in three dimensions: mental health, somatic harm and physical injury (including mortality). Evidence shows a clear association between cannabis use and psychosis, affective disorders, anxiety, sleep disorders, cognitive failures, respiratory adverse events, cancer, cardiovascular outcomes, and gastrointestinal disorders. Moreover, cannabis use is a risk factor for motor vehicle collision, suicidal behavior and partner and child violence. Cannabis use is a risk factor for several medical conditions and negative social consequences. There is still little data on the dose-dependency of these effects; evidence that is essential in order to define, from a public health perspective, what can be considered risky use of cannabis. This definition should be based on quantitative and qualitative criteria that informs and permits the evaluation of current approaches to a regulated cannabis market.
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Affiliation(s)
- E Campeny
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain.
| | - H López-Pelayo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - D Nutt
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, London W12 0NN, UK
| | - C Blithikioti
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - C Oliveras
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - L Nuño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - R Maldonado
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - G Florez
- Hospital Universitario de Ourense, Ourense, Spain
| | - F Arias
- Hospital Doce de Octubre, Madrid, Spain
| | | | - J R Villalbí
- Public Health Agency of Barcelona, Barcelona, Spain
| | - J Sellarès
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - M Ballbè
- Catalan Institute of Oncology, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - J Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, (CAMH), Canada; Campbell Family Mental Health Research Institute, CAMH, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto (UofT), Canada; Department of Psychiatry, Faculty of Medicine, UofT, Canada; Epidemiological Research Unit, Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - M M Balcells-Olivero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
| | - A Gual
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Grup Recerca Addiccions Clinic (GRAC-GRE) Psychiatry Department, Neurosciences Institute, Hospital Clínic, Universitat de Barcelona, Spain
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5
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Vanishing Lung Syndrome: Fifteen Years After Bullectomy. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Affiliation(s)
- Julia Kastner
- University of Maryland School of Medicine, Baltimore, MD
| | - Rydhwana Hossain
- University of Maryland School of Medicine, Cardiothoracic Imaging, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD
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7
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Chatkin JM, Zani-Silva L, Ferreira I, Zamel N. Cannabis-Associated Asthma and Allergies. Clin Rev Allergy Immunol 2019; 56:196-206. [PMID: 28921405 DOI: 10.1007/s12016-017-8644-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inhalation of cannabis smoke is its most common use and the pulmonary complications of its use may be the single most common form of drug-induced pulmonary disease worldwide. However, the role of cannabis consumption in asthma patients and allergic clinical situations still remains controversial. To review the evidence of asthma and allergic diseases associated with the use of marijuana, we conducted a search of English, Spanish, and Portuguese medical using the search terms asthma, allergy, marijuana, marihuana, and cannabis. Entries made between January 1970 and March 2017 were retrieved. Several papers have shown the relationship between marijuana use and increase in asthma and other allergic diseases symptoms, as well as the increased frequency of medical visits. This narrative review emphasizes the importance to consider cannabis as a precipitating factor for acute asthma and allergic attacks in clinical practice. Although smoking of marijuana may cause respiratory symptoms, there is a need for more studies to elucidate many aspects in allergic asthma patients, especially considering the long-term use of the drug. These patients should avoid using marijuana and be oriented about individual health risks, possible dangers of second-hand smoke exposure, underage use, safe storage, and the over smoking of marijuana.
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Affiliation(s)
- J M Chatkin
- Division of Respiratory Diseases, School of Medicine Pontificia Universidade Catolica do Rio Grande do Sul, Av Ipiranga 6680 Room 501, Porto Alegre, 90610-000, Brazil.
| | - L Zani-Silva
- Division of Respiratory Diseases, School of Medicine Pontificia Universidade Catolica do Rio Grande do Sul, Av Ipiranga 6680 Room 501, Porto Alegre, 90610-000, Brazil
| | - I Ferreira
- Respirology Division, McMaster University, 399 Bathurst St, Toronto, ON, M5T2S8, Canada
| | - N Zamel
- Department of Medicine, Division of Respiratory Diseases, University of Toronto, 399 Bathurst St, Toronto, ON, M5T2S8, Canada
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8
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Sales MPU, Araújo AJD, Chatkin JM, Godoy ID, Pereira LFF, Castellano MVCDO, Tanni SE, Almeida AÁD, Chatkin G, Silva LCCD, Gonçalves CMC, Botelho C, Santos UP, Viegas CADA, Sestelo MR, Meireles RHS, Correa PCRP, Oliveira MEMD, Reichert J, Lima MS, Silva CARD. Update on the approach to smoking in patients with respiratory diseases. J Bras Pneumol 2019; 45:e20180314. [PMID: 31271604 PMCID: PMC6715029 DOI: 10.1590/1806-3713/e20180314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 02/26/2023] Open
Abstract
Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.
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Affiliation(s)
| | - Alberto José de Araújo
- . Núcleo de Estudos e Tratamento do Tabagismo, Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | - José Miguel Chatkin
- . Escola de Medicina. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Irma de Godoy
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | | | | | - Suzana Erico Tanni
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | | | - Gustavo Chatkin
- . Escola de Medicina. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Luiz Carlos Côrrea da Silva
- . Pavilhão Pereira Filho da Santa Casa, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Clóvis Botelho
- . Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá (MT) Brasil
- . Centro Universitário de Várzea Grande - UNIVAG - Várzea Grande (MT) Brasil
| | - Ubiratan Paula Santos
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | - Ricardo Henrique Sampaio Meireles
- . Faculdade de Medicina, Universidade Estácio de Sá, Rio de Janeiro, (RJ), Brasil
- . Instituto Estadual de Doenças do Tórax Ary Parreiras - IETAP - Secretaria Estadual de Saúde do Rio de Janeiro, Niterói (RJ) Brasil
| | | | | | - Jonatas Reichert
- . Secretaria de Saúde do Paraná - SESA-PR - Curitiba (PR) Brasil
| | - Mariana Silva Lima
- . Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP) Brasil
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Davies MJ, Birkett JW, Bolton H, Moore A. The influence of cannabis smoke and cannabis vapour on simulated lung surfactant function under physiologically relevant conditions. SURF INTERFACE ANAL 2019. [DOI: 10.1002/sia.6620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Michael J. Davies
- Faculty of Health and Social Care/Medical SchoolEdge Hill University Ormskirk Lancashire L39 4QP UK
| | - Jason W. Birkett
- The School of Pharmacy and Biomolecular SciencesLiverpool John Moores University Liverpool L3 3AF UK
| | - Hannah Bolton
- The School of Pharmacy and Biomolecular SciencesLiverpool John Moores University Liverpool L3 3AF UK
| | - Andrea Moore
- The School of Pharmacy and Biomolecular SciencesLiverpool John Moores University Liverpool L3 3AF UK
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Pedrozo-Pupo JC, Castañeda NP, Campo-Arias A. COPD secondary or associated with cannabis dependence. Respir Med Case Rep 2019; 28:100902. [PMID: 31338289 PMCID: PMC6626119 DOI: 10.1016/j.rmcr.2019.100902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/28/2019] [Accepted: 07/07/2019] [Indexed: 11/17/2022] Open
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