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Braun IM, Bohlke K, Abrams DI, Anderson H, Balneaves LG, Bar-Sela G, Bowles DW, Chai PR, Damani A, Gupta A, Hallmeyer S, Subbiah IM, Twelves C, Wallace MS, Roeland EJ. Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:1575-1593. [PMID: 38478773 DOI: 10.1200/jco.23.02596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
PURPOSE To guide clinicians, adults with cancer, caregivers, researchers, and oncology institutions on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives; single, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis. METHODS A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and cohort studies on the efficacy and safety of cannabis and cannabinoids when used by adults with cancer. Outcomes of interest included antineoplastic effects, cancer treatment toxicity, symptoms, and quality of life. PubMed and the Cochrane Library were searched from database inception to January 27, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 13 systematic reviews and five additional primary studies (four RCTs and one cohort study). The certainty of evidence for most outcomes was low or very low. RECOMMENDATIONS Cannabis and/or cannabinoid access and use by adults with cancer has outpaced the science supporting their clinical use. This guideline provides strategies for open, nonjudgmental communication between clinicians and adults with cancer about the use of cannabis and/or cannabinoids. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. Cannabis and/or cannabinoids may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. Whether cannabis and/or cannabinoids can improve other supportive care outcomes remains uncertain. This guideline also highlights the critical need for more cannabis and/or cannabinoid research.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Ilana M Braun
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Donald I Abrams
- University of California San Francisco Osher Center for Integrative Health, San Francisco, CA
| | | | | | | | | | | | - Anuja Damani
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Eric J Roeland
- Oregon Health and Science University, Knight Cancer Institute, Portland, OR
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2
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Qian L, Beers JL, Jackson KD, Zhou Z. CBD and THC in Special Populations: Pharmacokinetics and Drug-Drug Interactions. Pharmaceutics 2024; 16:484. [PMID: 38675145 PMCID: PMC11054161 DOI: 10.3390/pharmaceutics16040484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Cannabinoid use has surged in the past decade, with a growing interest in expanding cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) applications into special populations. Consequently, the increased use of CBD and THC raises the risk of drug-drug interactions (DDIs). Nevertheless, DDIs for cannabinoids, especially in special populations, remain inadequately investigated. While some clinical trials have explored DDIs between therapeutic drugs like antiepileptic drugs and CBD/THC, more potential interactions remain to be examined. This review summarizes the published studies on CBD and THC-drug interactions, outlines the mechanisms involved, discusses the physiological considerations in pharmacokinetics (PK) and DDI studies in special populations (including pregnant and lactating women, pediatrics, older adults, patients with hepatic or renal impairments, and others), and presents modeling approaches that can describe the DDIs associated with CBD and THC in special populations. The PK of CBD and THC in special populations remain poorly characterized, with limited studies investigating DDIs involving CBD/THC in these populations. Therefore, it is critical to evaluate potential DDIs between CBD/THC and medications that are commonly used in special populations. Modeling approaches can aid in understanding these interactions.
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Affiliation(s)
- Lixuan Qian
- Department of Chemistry, York College, City University of New York, Jamaica, NY 11451, USA;
| | - Jessica L. Beers
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA (K.D.J.)
| | - Klarissa D. Jackson
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA (K.D.J.)
| | - Zhu Zhou
- Department of Chemistry, York College, City University of New York, Jamaica, NY 11451, USA;
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Stöllberger C, Finsterer J. Cannabidiol's impact on drug-metabolization. Eur J Intern Med 2023; 118:6-13. [PMID: 37541924 DOI: 10.1016/j.ejim.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
IMPORTANCE Products containing cannabidiol(CBD) are easily accessible. CBD is reported to inhibit the drug-metabolizing proteins(DMP) Cytochrome P450(CYP)3A4/5, CYP2C9, CYP2B6, CYP2D6, CYP2E1, CYP1A2, CYP2C19, carboxylesterase 1(CES1), uridine 5'diphospho-glucoronosyltransferase(UGT)1A9, UGT2B7, P-glycoprotein(P-gp) and Breast Cancer Resistance Protein(BCRP). The relevance of CBD-drug interactions is largely unknown. Aim of the study was to identify drugs, potentially interacting with orally ingested CBD, to assess whether CBD-drug interactions have been reported, and if substrates of DMP are frequently prescribed drugs. OBSERVATIONS Identified were 403 drugs as substrates of DMP. CBD-drug interactions were reported for 53/403 substrates in humans (n = 25), in vivo (n = 13) or in vitro (n = 15). In 31/53 substrates, CBD induced an increase, in 1/53 a decrease, in 4/53 no change in the substrate level. For 5/53 substrates, the results were controversial, and in 12/53 no substrate levels were reported. Among the 30 most frequently prescribed drugs in Germany were 67% substrates of DMP and among the 50 most frequently prescribed drugs in the USA 68%. RELEVANCE AND CONCLUSIONS There is an urgent need for pharmacologic studies on CBD-drug interactions. Patients should be educated on the potential risk and awareness should be increased among physicians. Regulatory authorities should become aware of the problem and start an initiative on an international level to increase the safety of CBD.
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Berg BB, Linhares AFS, Martins DM, Rachid MA, Cau SBDA, Souza GGD, Carvalho JCSD, Sorgi CA, Romero TRL, Pinho V, Teixeira MM, Castor MGME. Anandamide reduces the migration of lymphocytes to the intestine by CB2 activation and reduces TNF-α in the target organs, protecting mice from graft-versus-host disease. Eur J Pharmacol 2023; 956:175932. [PMID: 37536622 DOI: 10.1016/j.ejphar.2023.175932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
Graft-versus-host disease (GVHD) is a serious inflammatory illness that often occurs as a secondary complication of bone marrow transplantation. Current therapies have limited effectiveness and fail to achieve a balance between inflammation and the graft-versus-tumor effect. In this study, we investigate the effects of the endocannabinoid anandamide on the complex pathology of GVHD. We assess the effects of an irreversible inhibitor of fatty acid amine hydrolase or exogenous anandamide and find that they increase survival and reduce clinical signs in GVHD mice. In the intestine of GVHD mice, treatment with exogenous anandamide also leads to a reduction in the number of CD3+, CD3+CD4+, and CD3+CD8+ cells, which reduces the activation of CD3+CD4+ and CD3+CD8+ cells, as assessed by enhanced CD28 expression, a T cell co-stimulatory molecule. Exogenous AEA was also able to reduce TNF-α and increase IL-10 in the intestine of GVHD mice. In the liver, exogenous AEA reduces injury, TNF-α levels, and the number of CD3+CD8+ cells. Interestingly, anandamide reduces Mac-1α, which lowers the adhesion of transplanted cells in mesenteric veins. These effects are mimicked by JWH133-a CB2 selective agonist-and abolished by treatment with a CB2 antagonist. Furthermore, the effects caused by anandamide treatment on survival were related to the CB2 receptor, as the CB2 antagonist abolished it. This study shows the critical role of the CB2 receptor in the modulation of the inflammatory response of GVHD by treatment with anandamide, the most prominent endocannabinoid.
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Affiliation(s)
- Bárbara Betônico Berg
- Graduate Program in Biological Sciences: Physiology and Pharmacology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Flávia Santos Linhares
- Graduate Program in Biological Sciences: Physiology and Pharmacology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | - Carlos Arterio Sorgi
- Chemistry Department, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, São Paulo, Brazil
| | | | - Vanessa Pinho
- Morphology Department, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mauro Martins Teixeira
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Creanga-Murariu I, Filipiuc LE, Cuciureanu M, Tamba BI, Alexa-Stratulat T. Should oncologists trust cannabinoids? Front Pharmacol 2023; 14:1211506. [PMID: 37521486 PMCID: PMC10373070 DOI: 10.3389/fphar.2023.1211506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Cannabis enjoyed a "golden age" as a medicinal product in the late 19th, early 20th century, but the increased risk of overdose and abuse led to its criminalization. However, the 21st century have witnessed a resurgence of interest and a large body of literature regarding the benefits of cannabinoids have emerged. As legalization and decriminalization have spread around the world, cancer patients are increasingly interested in the potential utility of cannabinoids. Although eager to discuss cannabis use with their oncologist, patients often find them to be reluctant, mainly because clinicians are still not convinced by the existing evidence-based data to guide their treatment plans. Physicians should prescribe cannabis only if a careful explanation can be provided and follow up response evaluation ensured, making it mandatory for them to be up to date with the positive and also negative aspects of the cannabis in the case of cancer patients. Consequently, this article aims to bring some clarifications to clinicians regarding the sometimes-confusing various nomenclature under which this plant is mentioned, current legislation and the existing evidence (both preclinical and clinical) for the utility of cannabinoids in cancer patients, for either palliation of the associated symptoms or even the potential antitumor effects that cannabinoids may have.
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Affiliation(s)
- Ioana Creanga-Murariu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- Oncology Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Leontina Elena Filipiuc
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Magda Cuciureanu
- Pharmacology Department, Clinical Pharmacology and Algesiology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Bogdan-Ionel Tamba
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- Pharmacology Department, Clinical Pharmacology and Algesiology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
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Dominiak HSH, Hasselsteen SD, Nielsen SW, Andersen JR, Herrstedt J. Prevention of Taste Alterations in Patients with Cancer Receiving Paclitaxel- or Oxaliplatin-Based Chemotherapy-A Pilot Trial of Cannabidiol. Nutrients 2023; 15:3014. [PMID: 37447339 DOI: 10.3390/nu15133014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Taste alteration is a common adverse effect of chemotherapy. This study aimed to investigate the effect of cannabidiol (CBD) on Lean Body Mass (LBM), and taste alterations during oxaliplatin- or paclitaxel-based chemotherapy. METHODS LBM was estimated by bioelectrical impedance analysis (BIA), and taste perception was evaluated by a randomized sensory test of six samples: sweet, salt, and umami, all in weak and strong concentrations. Taste perceptions were scored on visual analog scales. Patients in the intervention group received oral CBD 300 mg/day for 8 days; patients in the control group did not. Patients were followed for three cycles of chemotherapy. RESULTS Twenty-two/ten patients (intervention/control group) were eligible. No effects on LBM were demonstrated. At baseline, the control group was able to differentiate between weak and strong saltiness and weak and strong sweetness but lost this ability after three cycles of chemotherapy. At baseline, the intervention group was unable to differentiate between the concentrations but gained the ability to significantly differentiate between weak and strong sweetness (p = 0.03) and weak and strong saltiness (p = 0.04) after three cycles of chemotherapy and treatment with CBD. CONCLUSIONS CBD may improve patients' ability to differentiate taste strengths during chemotherapy.
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Affiliation(s)
- Helena S H Dominiak
- Department of Clinical Oncology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Frederiksberg, Denmark
| | - Simone D Hasselsteen
- Department of Clinical Oncology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Frederiksberg, Denmark
| | - Sebastian W Nielsen
- Department of Clinical Oncology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Frederiksberg, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology, Zealand University Hospital, 4000 Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 2200 Frederiksberg, Denmark
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O'Sullivan SE, Jensen SS, Nikolajsen GN, Bruun HZ, Bhuller R, Hoeng J. The therapeutic potential of purified cannabidiol. J Cannabis Res 2023; 5:21. [PMID: 37312194 DOI: 10.1186/s42238-023-00186-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/30/2023] [Indexed: 06/15/2023] Open
Abstract
The use of cannabidiol (CBD) for therapeutic purposes is receiving considerable attention, with speculation that CBD can be useful in a wide range of conditions. Only one product, a purified form of plant-derived CBD in solution (Epidiolex), is approved for the treatment of seizures in patients with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. Appraisal of the therapeutic evidence base for CBD is complicated by the fact that CBD products sometimes have additional phytochemicals (like tetrahydrocannabinol (THC)) present, which can make the identification of the active pharmaceutical ingredient (API) in positive studies difficult. The aim of the present review is to critically review clinical studies using purified CBD products only, in order to establish the upcoming indications for which purified CBD might be beneficial. The areas in which there is the most clinical evidence to support the use of CBD are in the treatment of anxiety (positive data in 7 uncontrolled studies and 17 randomised controlled trials (RCTs)), psychosis and schizophrenia (positive data in 1 uncontrolled study and 8 RCTs), PTSD (positive data in 2 uncontrolled studies and 4 RCTs) and substance abuse (positive data in 2 uncontrolled studies and 3 RCTs). Seven uncontrolled studies support the use of CBD to improve sleep quality, but this has only been verified in one small RCT. Limited evidence supports the use of CBD for the treatment of Parkinson's (3 positive uncontrolled studies and 2 positive RCTs), autism (3 positive RCTs), smoking cessation (2 positive RCTs), graft-versus-host disease and intestinal permeability (1 positive RCT each). Current RCT evidence does not support the use of purified oral CBD in pain (at least as an acute analgesic) or for the treatment of COVID symptoms, cancer, Huntington's or type 2 diabetes. In conclusion, published clinical evidence does support the use of purified CBD in multiple indications beyond epilepsy. However, the evidence base is limited by the number of trials only investigating the acute effects of CBD, testing CBD in healthy volunteers, or in very small patient numbers. Large confirmatory phase 3 trials are required in all indications.
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Banerjee A, Hayward JJ, Trant JF. "Breaking bud": the effect of direct chemical modifications of phytocannabinoids on their bioavailability, physiological effects, and therapeutic potential. Org Biomol Chem 2023; 21:3715-3732. [PMID: 36825573 DOI: 10.1039/d3ob00068k] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the two "major cannabinoids". However, their incorporation into clinical and nutraceutical preparations is challenging, owing to their limited bioavailability, low water solubility, and variable pharmacokinetic profiles. Understanding the organic chemistry of the major cannabinoids provides us with potential avenues to overcome these issues through derivatization. The resulting labile pro-drugs offer ready cannabinoid release in vivo, have augmented bioavailability, or demonstrate interesting pharmacological properties in their own right. This review identifies and discusses a subset of these advanced derivatization strategies for the major cannabinoids, where the starting material is the pure phytocannabinoid itself, and the final product either a cannabinoid pro-drug, or a novel pharmacoactive material.
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Affiliation(s)
- Abhinandan Banerjee
- Department of Chemistry and Biochemistry, University of Windsor, 401 Sunset Ave., Windsor, ON N9B 3P4, Canada.
| | - John J Hayward
- Department of Chemistry and Biochemistry, University of Windsor, 401 Sunset Ave., Windsor, ON N9B 3P4, Canada.
| | - John F Trant
- Department of Chemistry and Biochemistry, University of Windsor, 401 Sunset Ave., Windsor, ON N9B 3P4, Canada.
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9
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A Systemic Review of Medical Cannabinoids Dosing in Human. Clin Ther 2022; 44:e39-e58. [DOI: 10.1016/j.clinthera.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
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10
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Cherkasova V, Wang B, Gerasymchuk M, Fiselier A, Kovalchuk O, Kovalchuk I. Use of Cannabis and Cannabinoids for Treatment of Cancer. Cancers (Basel) 2022; 14:5142. [PMID: 36291926 PMCID: PMC9600568 DOI: 10.3390/cancers14205142] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 07/26/2023] Open
Abstract
The endocannabinoid system (ECS) is an ancient homeostasis mechanism operating from embryonic stages to adulthood. It controls the growth and development of many cells and cell lineages. Dysregulation of the components of the ECS may result in uncontrolled proliferation, adhesion, invasion, inhibition of apoptosis and increased vascularization, leading to the development of various malignancies. Cancer is the disease of uncontrolled cell division. In this review, we will discuss whether the changes to the ECS are a cause or a consequence of malignization and whether different tissues react differently to changes in the ECS. We will discuss the potential use of cannabinoids for treatment of cancer, focusing on primary outcome/care-tumor shrinkage and eradication, as well as secondary outcome/palliative care-improvement of life quality, including pain, appetite, sleep, and many more factors. Finally, we will complete this review with the chapter on sex- and gender-specific differences in ECS and response to cannabinoids, and equality of the access to treatments with cannabinoids.
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Affiliation(s)
- Viktoriia Cherkasova
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Bo Wang
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Marta Gerasymchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Anna Fiselier
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Olga Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Igor Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
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Arnold JC, McCartney D, Suraev A, McGregor IS. The safety and efficacy of low oral doses of cannabidiol: An evaluation of the evidence. Clin Transl Sci 2022; 16:10-30. [PMID: 36259271 PMCID: PMC9841308 DOI: 10.1111/cts.13425] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023] Open
Abstract
Global interest in the non-intoxicating cannabis constituent, cannabidiol (CBD), is increasing with claims of therapeutic effects across a diversity of health conditions. At present, there is sufficient clinical trial evidence to support the use of high oral doses of CBD (e.g., 10-50 mg/kg) in treating intractable childhood epilepsies. However, a question remains as to whether "low-dose" CBD products confer any therapeutic benefits. This is an important question to answer, as low-dose CBD products are widely available in many countries, often as nutraceutical formulations. The present review therefore evaluated the efficacy and safety of low oral doses of CBD. The review includes interventional studies that measured the clinical efficacy in any health condition and/or safety and tolerability of oral CBD dosed at less than or equal to 400 mg per day in adult populations (i.e., ≥18 years of age). Studies were excluded if the product administered had a Δ9 -tetrahydrocannabinol content greater than 2.0%. Therapeutic benefits of CBD became more clearly evident at doses greater than or equal to 300 mg. Increased dosing from 60 to 400 mg/day did not appear to be associated with an increased frequency of adverse effects. At doses of 300-400 mg, there is evidence of efficacy with respect to reduced anxiety, as well as anti-addiction effects in drug-dependent individuals. More marginal and less consistent therapeutic effects on insomnia, neurological disorders, and chronic pain were also apparent. Larger more robust clinical trials are needed to confirm the therapeutic potential of lower (i.e., <300 mg/day) oral doses of CBD.
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Affiliation(s)
- Jonathon C. Arnold
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia,Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia,Faculty of Medicine and Health, Discipline of Pharmacology, Sydney Pharmacy SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Danielle McCartney
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia,Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia,Faculty of Science, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Anastasia Suraev
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia,Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia,Faculty of Science, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Iain S. McGregor
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia,Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia,Faculty of Science, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
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Nielsen SW, Hasselsteen SD, Dominiak HSH, Labudovic D, Reiter L, Dalton SO, Herrstedt J. Oral cannabidiol for prevention of acute and transient chemotherapy-induced peripheral neuropathy. Support Care Cancer 2022; 30:9441-9451. [PMID: 35933415 DOI: 10.1007/s00520-022-07312-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To assess the safety, dosing, and preventive effects of cannabidiol (CBD) on chemotherapy-induced peripheral neuropathy (CIPN) in patients receiving oxaliplatin- or paclitaxel-based chemotherapy. METHODS Patients with cancer scheduled to undergo treatment with carboplatin and paclitaxel (Carbo-Tax) or capecitabine and oxaliplatin (CAPOX) received 150 mg CBD oil twice daily (300 mg/daily) for 8 days beginning 1 day before initiation of chemotherapy. Ten CIPN-specific patient-reported outcome (PRO) measures were captured at baseline and each day after the first cycle of chemotherapy for 8 days. Multi-frequency vibrometry (MF-V) was captured at baseline and day 4 ± 1 after initiation of chemotherapy. Controls were obtained from a similar patient cohort that did not receive CBD. Adverse events were captured using the CTCAE ver. 4.03. RESULTS From March to December 2021, 54 patients were recruited. CBD-treated patients were significantly older (p = 0.013/0.037, CAPOX/Carbo-Tax) compared to controls. Patients receiving CBD and CAPOX or Carbo-Tax showed significantly lower (better) change in Z-scores in high-frequency MF-V (125 and 250 Hz) compared to controls. This difference was most pronounced for patients receiving Carbo-Tax (- 1.76, CI-95 = [- 2.52; - 1.02] at 250 Hz). CAPOX patients treated with CBD had significantly lower peak baseline-adjusted difference in three PRO items on cold sensitivity to touch, discomfort swallowing cold liquids, and throat discomfort (- 2.08, - 2.06, and - 1.81, CI-95 = [- 3.89; - 0.12], NRS 0-10). No significant differences in PRO items were found for patients receiving Carbo-Tax. Possible side effects included stomach pain (grades 1-2) for patients receiving CAPOX. CONCLUSION CBD attenuated early symptoms of CIPN with no major safety concerns. Long-term follow-up is ongoing. Results should be confirmed in a larger, randomized study. TRIAL REGISTRATION NUMBER NCT 04,167,319 (U.S National Library of Medicine; ClinicalTrials.gov). Date of registration: November 18, 2019.
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Affiliation(s)
- Sebastian W Nielsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.
| | - Simone Dyring Hasselsteen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark
| | - Helena Sylow Heilmann Dominiak
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark
| | - Dejan Labudovic
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark
| | - Lars Reiter
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark
| | - Susanne Oksbjerg Dalton
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.,Survivorship & Inequality in Cancer, Danish Cancer Society Research Center, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark
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Vinette B, Côté J, El-Akhras A, Mrad H, Chicoine G, Bilodeau K. Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review. BMC Cancer 2022; 22:319. [PMID: 35331185 PMCID: PMC8953058 DOI: 10.1186/s12885-022-09378-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Some patients diagnosed with cancer use medical cannabis to self-manage undesirable symptoms, including nausea and pain. To improve patient safety and oncological care quality, the routes of administration for use of medical cannabis, patients' reasons, and prescribed indications must be better understood. METHODS Based on the Joanna Briggs Institute guidelines, a scoping review was conducted to map the current evidence regarding the use of medical cannabis in oncological settings based on the experiences of patients diagnosed with cancer and their healthcare providers. A search strategy was developed with a scientific librarian which included five databases (CINAHL, Web of Science, Medline, Embase, and PsycINFO) and two grey literature sources (Google Scholar and ProQuest). The inclusion criteria were: 1) population: adults aged 18 and over diagnosed with cancer; 2) phenomena of interest: reasons for cannabis use and/or the prescribed indications for medical cannabis; 3) context: oncological setting. French- or English-language primary empirical studies, knowledge syntheses, and grey literature published between 2000 and 2021 were included. Data were extracted by two independent reviewers and subjected to a thematic analysis. A narrative description approach was used to synthesize and present the findings. RESULTS We identified 5,283 publications, of which 163 met the eligibility criteria. Two main reasons for medical cannabis use emerged from the thematic analysis: limiting the impacts of cancer and its side effects; and staying connected to others. Our results also indicated that medical cannabis is mostly used for three approved indications: to manage refractory nausea and vomiting, to complement pain management, and to improve appetite and food intake. We highlighted 11 routes of administration for medical cannabis, with oils and oral solutions the most frequently reported. CONCLUSION Future studies should consider the multiple routes of administration for medical cannabis, such as inhalation and edibles. Our review highlights that learning opportunities would support the development of healthcare providers' knowledge and skills in assessing the needs and preferences of patients diagnosed with cancer who use medical cannabis.
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Affiliation(s)
- Billy Vinette
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada.
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada.
- Center for Innovation in Nursing Education, Montreal, QC, Canada.
| | - José Côté
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Ali El-Akhras
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Hazar Mrad
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Gabrielle Chicoine
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Karine Bilodeau
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
- Research Center of the Centre Intégré Universitaire de Santé Et de Services Sociaux de L'Est-de-L'Île-de-Montréal, Montreal, QC, Canada
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14
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Olivas-Aguirre M, Torres-López L, Villatoro-Gómez K, Perez-Tapia SM, Pottosin I, Dobrovinskaya O. Cannabidiol on the Path from the Lab to the Cancer Patient: Opportunities and Challenges. Pharmaceuticals (Basel) 2022; 15:ph15030366. [PMID: 35337163 PMCID: PMC8951434 DOI: 10.3390/ph15030366] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 01/18/2023] Open
Abstract
Cannabidiol (CBD), a major non-psychotropic component of cannabis, is receiving growing attention as a potential anticancer agent. CBD suppresses the development of cancer in both in vitro (cancer cell culture) and in vivo (xenografts in immunodeficient mice) models. For critical evaluation of the advances of CBD on its path from laboratory research to practical application, in this review, we wish to call the attention of scientists and clinicians to the following issues: (a) the biological effects of CBD in cancer and healthy cells; (b) the anticancer effects of CBD in animal models and clinical case reports; (c) CBD’s interaction with conventional anticancer drugs; (d) CBD’s potential in palliative care for cancer patients; (e) CBD’s tolerability and reported side effects; (f) CBD delivery for anticancer treatment.
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Affiliation(s)
- Miguel Olivas-Aguirre
- Laboratory of Immunobiology and Ionic Transport Regulation, Centro Universitario de Investigaciones Biomédicas, Universidad de Colima, Colima 28045, Mexico; (M.O.-A.); (L.T.-L.); (K.V.-G.)
| | - Liliana Torres-López
- Laboratory of Immunobiology and Ionic Transport Regulation, Centro Universitario de Investigaciones Biomédicas, Universidad de Colima, Colima 28045, Mexico; (M.O.-A.); (L.T.-L.); (K.V.-G.)
| | - Kathya Villatoro-Gómez
- Laboratory of Immunobiology and Ionic Transport Regulation, Centro Universitario de Investigaciones Biomédicas, Universidad de Colima, Colima 28045, Mexico; (M.O.-A.); (L.T.-L.); (K.V.-G.)
| | - Sonia Mayra Perez-Tapia
- Unidad de Desarrollo e Investigación en Bioterapeúticos (UDIBI), Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional (ENCB-IPN), Mexico City 11340, Mexico;
| | - Igor Pottosin
- Laboratory of Immunobiology and Ionic Transport Regulation, Centro Universitario de Investigaciones Biomédicas, Universidad de Colima, Colima 28045, Mexico; (M.O.-A.); (L.T.-L.); (K.V.-G.)
- Correspondence: (I.P.); (O.D.)
| | - Oxana Dobrovinskaya
- Laboratory of Immunobiology and Ionic Transport Regulation, Centro Universitario de Investigaciones Biomédicas, Universidad de Colima, Colima 28045, Mexico; (M.O.-A.); (L.T.-L.); (K.V.-G.)
- Correspondence: (I.P.); (O.D.)
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15
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Odieka AE, Obuzor GU, Oyedeji OO, Gondwe M, Hosu YS, Oyedeji AO. The Medicinal Natural Products of Cannabis sativa Linn.: A Review. Molecules 2022; 27:1689. [PMID: 35268790 PMCID: PMC8911748 DOI: 10.3390/molecules27051689] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/27/2023] Open
Abstract
Cannabis sativa is known among many cultures for its medicinal potential. Its complexity contributes to the historical application of various parts of the plant in ethno-medicines and pharmacotherapy. C. sativa has been used for the treatment of rheumatism, epilepsy, asthma, skin burns, pain, the management of sexually transmitted diseases, difficulties during child labor, postpartum hemorrhage, and gastrointestinal activity. However, the use of C. sativa is still limited, and it is illegal in most countries. Thus, this review aims to highlight the biological potential of the plant parts, as well as the techniques for the extraction, isolation, and characterization of C. sativa compounds. The plant produces a unique class of terpenophenolic compounds, called cannabinoids, as well as non-cannabinoid compounds. The exhaustive profiling of bioactive compounds and the chemical characterization and analysis of C. sativa compounds, which modern research has not yet fully achieved, is needed for the consistency, standardization, and the justified application of Cannabis sativa products for therapeutic purposes. Studies on the clinical relevance and applications of cannabinoids and non-cannabinoid phenols in the prevention and treatment of life-threatening diseases is indeed significant. Furthermore, psychoactive cannabinoids, when chemically standardized and administered under medical supervision, can be the legal answer to the use of C. sativa.
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Affiliation(s)
- Anwuli Endurance Odieka
- Department of Chemical and Physical Sciences, Walter Sisulu University, Mthatha 5099, South Africa;
| | - Gloria Ukalina Obuzor
- Department of Pure and Industrial Chemistry, University of Port Harcourt, Port Harcourt 500004, Rivers State, Nigeria;
| | | | - Mavuto Gondwe
- Department of Human Biology, Walter Sisulu University, Mthatha 5099, South Africa;
| | - Yiseyon Sunday Hosu
- Department of Economics and Business Sciences, Walter Sisulu University, Mthatha 5099, South Africa;
| | - Adebola Omowunmi Oyedeji
- Department of Chemical and Physical Sciences, Walter Sisulu University, Mthatha 5099, South Africa;
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16
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Butler TW, Hande K, Ryan M, Raman R, McDowell MR, Cones B, Jackson HJ, Cortez M, Murphy BA. Cannabidiol: Knowledge, Beliefs, and Experiences of Patients With Cancer. Clin J Oncol Nurs 2021; 25:405-412. [PMID: 34269337 DOI: 10.1188/21.cjon.405-412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cannabidiol (CBD) is purported to work for a variety of therapeutic indications. Interest in CBD products has significantly increased as patients with cancer seek ways to improve symptom control and quality of life. OBJECTIVES The purpose of this study was to explore patients' knowledge of and experience with CBD. METHODS A panel of oncology nurse practitioners, an oncologist, and oncology pharmacy specialists developed a survey to capture information about patient knowledge and use of CBD. The initial survey was pilot tested and further refined, resulting in the final item survey. The final survey was administered to 100 participants undergoing or having completed cancer treatment and being followed in a supportive oncology care clinic at a large academic medical center. FINDINGS Most patients learned about CBD through a family member or friend. The majority of patients had never tried CBD. The most common reported indications were pain, anxiety, and nausea. Of those who had not tried CBD, the most common reasons included lack of knowledge about CBD and providers not recommending CBD.
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17
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Learning to mellow out GVHD. Blood 2021; 137:1142-1143. [PMID: 33661292 DOI: 10.1182/blood.2020009315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Irrera N, Bitto A, Sant’Antonio E, Lauro R, Musolino C, Allegra A. Pros and Cons of the Cannabinoid System in Cancer: Focus on Hematological Malignancies. Molecules 2021; 26:molecules26133866. [PMID: 34202812 PMCID: PMC8270322 DOI: 10.3390/molecules26133866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/09/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022] Open
Abstract
The endocannabinoid system (ECS) is a composite cell-signaling system that allows endogenous cannabinoid ligands to control cell functions through the interaction with cannabinoid receptors. Modifications of the ECS might contribute to the pathogenesis of different diseases, including cancers. However, the use of these compounds as antitumor agents remains debatable. Pre-clinical experimental studies have shown that cannabinoids (CBs) might be effective for the treatment of hematological malignancies, such as leukemia and lymphoma. Specifically, CBs may activate programmed cell death mechanisms, thus blocking cancer cell growth, and may modulate both autophagy and angiogenesis. Therefore, CBs may have significant anti-tumor effects in hematologic diseases and may synergistically act with chemotherapeutic agents, possibly also reducing chemoresistance. Moreover, targeting ECS might be considered as a novel approach for the management of graft versus host disease, thus reducing some symptoms such as anorexia, cachexia, fatigue, anxiety, depression, and neuropathic pain. The aim of the present review is to collect the state of the art of CBs effects on hematological tumors, thus focusing on the essential topics that might be useful before moving into the clinical practice.
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Affiliation(s)
- Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (N.I.); (A.B.); (R.L.)
| | - Alessandra Bitto
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (N.I.); (A.B.); (R.L.)
| | | | - Rita Lauro
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (N.I.); (A.B.); (R.L.)
| | - Caterina Musolino
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98125 Messina, Italy;
| | - Alessandro Allegra
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98125 Messina, Italy;
- Correspondence: ; Tel.: +390902212364
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19
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Vaitla PK, Thongprayoon C, Hansrivijit P, Kanduri SR, Kovvuru K, Rivera FHC, Cato LD, Garla V, Watthanasuntorn K, Wijarnpreecha K, Chewcharat A, Aeddula NR, Bathini T, Koller FL, Matemavi P, Cheungpasitporn W. Epidemiology of cannabis use and associated outcomes among kidney transplant recipients: A meta-analysis. J Evid Based Med 2021; 14:90-96. [PMID: 32558277 DOI: 10.1111/jebm.12401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Cannabis is the most commonly used recreational drug in the United States, and transplant acceptability for cannabis using candidates varies among transplant centers. However, the prevalence and impact of cannabis use on outcomes of kidney transplant recipients remain unclear. This study aimed to summarize the prevalence and impact of cannabis use on outcomes after kidney transplantation. METHODS A literature search was performed using Ovid MEDLINE, EMBASE, and The Cochrane Library Databases from inception until September 2019 to identify studies assessing the prevalence of cannabis use among kidney transplant recipients, and reported adverse outcomes after kidney transplantation. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. RESULTS A total of four cohort studies with a total of 55 897 kidney transplant recipients were enrolled. Overall, the pooled estimated prevalence of cannabis use was 3.2% (95% CI 0.4%-20.5%). While the use of cannabis was not significantly associated with all-cause allograft failure (OR = 1.31, 95% CI 0.70-2.46) or mortality (OR = 1.52, 95% CI 0.59-3.92), the use of cannabis among kidney transplant recipients was significantly associated with increased death-censored graft failure with pooled OR of 1.72 (95% CI 1.13-2.60). CONCLUSIONS The overall estimated prevalence of cannabis use among kidney transplant recipients is 3.2%. The use of cannabis is associated with increased death-censored graft failure, but not mortality after kidney transplantation.
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Affiliation(s)
- Pradeep K Vaitla
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center Jackson, Mississippi
| | | | - Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, Pennsylvania
| | - Swetha R Kanduri
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center Jackson, Mississippi
| | - Karthik Kovvuru
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center Jackson, Mississippi
| | - Franco H Cabeza Rivera
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center Jackson, Mississippi
| | - Liam D Cato
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vishnu Garla
- Division of Endocrinology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Narothama Reddy Aeddula
- Division of Nephrology, Department of Medicine, Deaconess Health System, Evansville, Indiana
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, Arizona
| | - Felicitas L Koller
- Department of Transplant and Hepatobiliary Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Praise Matemavi
- Department of Transplant and Hepatobiliary Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center Jackson, Mississippi
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20
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Berg BB, Soares JS, Paiva IR, Rezende BM, Rachid MA, Cau SBDA, Romero TRL, Pinho V, Teixeira MM, Castor MGME. Cannabidiol Enhances Intestinal Cannabinoid Receptor Type 2 Receptor Expression and Activation Increasing Regulatory T Cells and Reduces Murine Acute Graft-versus-Host Disease without Interfering with the Graft-versus-Leukemia Response. J Pharmacol Exp Ther 2021; 377:273-283. [PMID: 33658314 DOI: 10.1124/jpet.120.000479] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/22/2021] [Indexed: 01/05/2023] Open
Abstract
Cannabidiol (CBD) is a highly lipidic phytocannabinoid with remarkable anti-inflammatory effects. The aim of this study was to evaluate CBD's effects and mechanisms of action in the treatment of mice subjected to acute graft-versus-host disease (aGVHD). aGVHD was induced by the transplantation of bone marrow cells and splenocytes from C57BL-6j to Balb-c mice. The recipient mice were treated daily with CBD, and the treatment reduced mouse mortality by decreasing inflammation and injury and promoting immune regulation in the jejunum, ileum, and liver. Analysis of the jejunum and ileum showed that CBD treatment reduced the levels of C-C motif chemokine ligand (CCL) 2, CCL3, CCL5, tumor necrosis factor α, and interferon γ (IFNγ). CCL3 and IFNγ levels were also decreased in the liver. Mechanistically, CBD also increased the number of cannabinoid receptor type 2 (CB2) receptors on CD4+ and forkhead box P3+ cells in the intestine, which may explain the reduction in proinflammatory cytokines and chemokines. Antagonists of the CB2 receptor reduced the survival rates of CBD-treated mice, suggesting the participation of this receptor in the effects of CBD. Furthermore, treatment with CBD did not interfere with the graft-versus-leukemia response. CBD treatment appears to protect aGVHD mice by anti-inflammatory and immunomodulatory effects partially mediated by CB2 receptor interaction. Altogether, our study suggests that CBD represents an interesting approach in the treatment of aGVHD, with potential therapeutic applications in patients undergoing bone marrow transplantation. SIGNIFICANCE STATEMENT: This study provides for the first time a mechanism by which cannabidiol, a phytocannabinoid with no psychoactive effect, induces immunomodulation in the graft-versus-host disease. Enhancing intestinal cannabinoid receptor type 2 (CB2) receptor expression on CD4+ and forkhead box P3+ cells and increasing the number of these regulatory cells, cannabidiol decreases proinflammatory cytokines and increases graft-versus-host disease mice survival. This effect is dependent of CB2 receptor activation. Besides, cannabidiol did not interfere with graft-versus-leukemia response, a central response to avoid primary disease relapse.
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Affiliation(s)
- Bárbara Betônico Berg
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Jaqueline Silva Soares
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Isabela Ribeiro Paiva
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Barbara Maximino Rezende
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Milene Alvarenga Rachid
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Stêfany Bruno de Assis Cau
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Thiago Roberto Lima Romero
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Vanessa Pinho
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Mauro Martins Teixeira
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
| | - Marina Gomes Miranda E Castor
- Departamento de Farmacologia-ICB/UFMG (B.B.B., J.S.S., I.R.P., S.B.d.A.C., T.R.L.R., M.G.M.e.C.); Programa de Pós-graduação em Fisiologia e Farmacologia da UFMG (B.B.B., I.R.P., S.B.d.A.C., T.R.L.R., M.M.T., M.G.M.e.C.); Departamento de Enfermagem Básica da Escola de Enfermagem da UFMG (B.M.R.); Departamento de Patologia Geral do Instituto de Ciências Biológicas da UFMG (M.A.R.); Departamento de Morfologia - CPDF-ICB/UFMG (V.P.); and Departamento de Bioquímica e Imunologia, CPDF-ICB/UFMG (M.M.T.), Belo Horizonte, Brazil
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Melaragno JI, Bowman LJ, Park JM, Lourenco LM, Doligalski CT, Brady BL, Descourouez JL, Chandran MM, Nickels MW, Page RL. The Clinical Conundrum of Cannabis: Current Practices and Recommendations for Transplant Clinicians: An Opinion of the Immunology/Transplantation PRN of the American College of Clinical Pharmacy. Transplantation 2021; 105:291-299. [PMID: 32413017 DOI: 10.1097/tp.0000000000003309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cannabis, or marijuana, comprises many compounds with varying effects. It has become a treatment option for chronic diseases and debilitating symptoms, and evidence suggests that it has immunomodulatory and antiinflammatory properties. Transplant centers are more frequently facing issues about cannabis, as indications and legalization expand. As of February 2020, 33 states and the District of Columbia have legalized medical cannabis, and 14 have legalized recreational cannabis. Moreover, 8 states have passed legislation prohibiting the denial of transplant listing solely based on cannabis use. Studies demonstrate the potential for significant pharmacokinetic and pharmacodynamic interactions between cannabis and immunosuppression. Additionally, safety concerns include increased risk of myocardial infarction, ischemic stroke, tachyarrhythmias, malignancy, neurocognitive deficits, psychosis, other neuropsychiatric disorders, cannabis use disorder, respiratory symptoms, and infection. A recent retrospective database study found a negative association between documented cannabis use disorder and graft survival, but little additional evidence exists evaluating this relationship. In the absence of robust clinical data, transplant centers need a clear, reasoned, and systematic approach to cannabis. The results of our national survey, unfortunately, found little consensus among institutions. As both recreational and medicinal cannabis become more ubiquitous nationwide, transplant centers will need to develop comprehensive policies to address its use.
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Affiliation(s)
| | | | - Jeong M Park
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Laura M Lourenco
- Department of Pharmacy Services, University of Chicago Medicine, Chicago, IL
| | | | - Bethany L Brady
- Department of Pharmacy, Indiana University Health University Hospital, Indianapolis, IN
| | | | - Mary M Chandran
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO
| | - Mark W Nickels
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Robert L Page
- Department of Clinical Pharmacy, University of Colorado, Aurora, CO
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Melaragno JI, Bowman LJ, Park JM, Lourenco LM, Doligalski CT, Brady BL, Descourouez JL, Chandran MM, Nickels MW, Page RL. The Clinical Conundrum of Cannabis: Current Practices and Recommendations for Transplant Clinicians: An Opinion of the Immunology/Transplantation PRN of the American College of Clinical Pharmacy. Transplantation 2021. [DOI: https:/doi.org.10.1097/tp.0000000000003309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Sharma DS, Paddibhatla I, Raghuwanshi S, Malleswarapu M, Sangeeth A, Kovuru N, Dahariya S, Gautam DK, Pallepati A, Gutti RK. Endocannabinoid system: Role in blood cell development, neuroimmune interactions and associated disorders. J Neuroimmunol 2021; 353:577501. [PMID: 33571815 DOI: 10.1016/j.jneuroim.2021.577501] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/03/2021] [Accepted: 01/24/2021] [Indexed: 12/19/2022]
Abstract
The endocannabinoid system (ECS) is a complex physiological network involved in creating homeostasis and maintaining human health. Studies of the last 40 years have shown that endocannabinoids (ECs), a group of bioactive lipids, together with their set of receptors, function as one of the most important physiologic systems in human body. ECs and cannabinoid receptors (CBRs) are found throughout the body: in the brain tissues, immune cells, and in the peripheral organs and tissues as well. In recent years, ECs have emerged as key modulators of affect, neurotransmitter release, immune function, and several other physiological functions. This modulatory homoeostatic system operates in the regulation of brain activity and states of physical health and disease. In several research studies and patents the ECS has been recognised with neuro-protective properties thus it might be a target in neurodegenerative diseases. Most immune cells express these bioactive lipids and their receptors, recent data also highlight the immunomodulatory effects of endocannabinoids. Interplay of immune and nervous system has been recognized in past, recent studies suggest that ECS function as a bridge between neuronal and immune system. In several ongoing clinical trial studies, the ECS has also been placed in the anti-cancer drugs spotlight. This review summarizes the literature of cannabinoid ligands and their biosynthesis, cannabinoid receptors and their distribution, and the signaling pathways initiated by the binding of cannabinoid ligands to cannabinoid receptors. Further, this review highlights the functional role of cannabinoids and ECS in blood cell development, neuroimmune interactions and associated disorders. Moreover, we highlight the current state of knowledge of cannabinoid ligands as the mediators of neuroimmune interactions, which can be therapeutically effective for neuro-immune disorders and several diseases associated with neuroinflammation.
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Affiliation(s)
- Durga Shankar Sharma
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India
| | - Indira Paddibhatla
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India
| | - Sanjeev Raghuwanshi
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India
| | - Mahesh Malleswarapu
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India
| | - Anjali Sangeeth
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India
| | - Narasaiah Kovuru
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India
| | - Swati Dahariya
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India
| | - Dushyant Kumar Gautam
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India
| | - Aditya Pallepati
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India
| | - Ravi Kumar Gutti
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Gachibowli, Hyderabad 500046, Telangana, India.
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Abu-Amna M, Salti T, Khoury M, Cohen I, Bar-Sela G. Medical Cannabis in Oncology: a Valuable Unappreciated Remedy or an Undesirable Risk? Curr Treat Options Oncol 2021; 22:16. [PMID: 33439370 DOI: 10.1007/s11864-020-00811-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 01/11/2023]
Abstract
OPINION STATEMENT The use of the cannabis plant by cancer patients has been rising significantly in the past few years worldwide, primarily driven by public demand. There is an obvious need for more reliable scientific data, pharmacology information, a better understanding of its mode of action, and available clinical evidence supporting its robust use. Physicians must complete a thorough medical assessment, screening for potential drugs, or treatment contraindications before allowing its consumption. In light of the growing popularity of cannabis usage, it is highly essential that, in the near future, the medical community will be able to provide practical recommendations and explicit guidelines, including doses, and that cannabinoid concentrations in the used products are defined regarding its prescription before any medical procedure involving its usage is authorized. Here, we review and describe the favorable outcomes demonstrating the benefits of cannabis as an adjunctive treatment to conventional medicines for chemotherapy-induced nausea, vomiting, and cancer-related pain (primarily refractory chronic or neuropathic pain). Although not yet substantial enough, the treatment of anorexia, insomnia, depression, and anxiety is also seemingly favorable. To date, reports regarding its anti-neoplastic effects or its potent immunosuppressive properties influencing response to immunotherapy are still very conflicting and controversial. Thus, with the current state of evidence, cannabis use is not advisable as initial treatment, as an adjunct or an advanced line of care. In the coming years, we expect that preclinical data and animal models will shift to the clinical arena, and more patients will be recruited for clinical trials, and their reports will advance the field. Thus, physicians should prescribe cannabis only if careful clarification and consideration is provided together with a follow-up response evaluation.
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Affiliation(s)
- Mahmoud Abu-Amna
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
| | - Talal Salti
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Mona Khoury
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel
| | - Idan Cohen
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel. .,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 320002, Haifa, Israel.
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Britch SC, Babalonis S, Walsh SL. Cannabidiol: pharmacology and therapeutic targets. Psychopharmacology (Berl) 2021; 238:9-28. [PMID: 33221931 PMCID: PMC7796924 DOI: 10.1007/s00213-020-05712-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/10/2020] [Indexed: 12/24/2022]
Abstract
RATIONALE Cannabidiol (CBD) products lacking regulatory approval are being used to self-treat a myriad of conditions and for their unsubstantiated health benefits. The scientific evidence supporting these claims largely arises not from controlled clinical trials, but from the recognition that CBD has numerous biological targets. Yet, CBD is commonly consumed and often in over-the-counter products that are unapproved and of unknown composition. Epidiolex® is the only product that has undergone rigorous pharmacokinetic assessment and testing in clinical trials; it was approved as a non-scheduled drug by the U.S. Food and Drug Administration for the treatment of intractable childhood-onset seizures. However, studies investigating CBD for other medical conditions are limited in number and often lack the scientific rigor, controls, or sample sizes required to draw clinically meaningful conclusions. Although Epidiolex® is safe for human consumption, recent changes in regulation of commercially available CBD products have resulted in limited quality control and products marketed with unknown CBD bioavailability. Even scientifically rigorous studies have used different sources of CBD and different suspension vehicles for administration, making it difficult to compare results among studies and resolve mixed outcomes. OBJECTIVES This paper reviews the molecular targets, pharmacokinetics, and safety and abuse liability of CBD; additionally, the extant evidence on its potential therapeutic effects for neurological disorders, pain, inflammation, conditions related to immune function, psychiatric disorders, and substance use are described.
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Affiliation(s)
- Stevie C Britch
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA.
- Department of Behavioral Science, University of Kentucky, Lexington, KY, 40508, USA.
| | - Shanna Babalonis
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, 40508, USA
| | - Sharon L Walsh
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, 40508, USA
- Department of Pharmacology, University of Kentucky, Lexington, KY, 40508, USA
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY, 40508, USA
- Department of Psychiatry, University of Kentucky, Lexington, KY, 40508, USA
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Aydogan Kirmizi D, Baser E, Doganyigit Z. The Activation of Cannabinoid Type-2 Receptor with JWH-133 Protects Uterine Ischemia/Reperfusion-Induced Damage. Pharmacology 2020; 106:106-113. [PMID: 33105141 DOI: 10.1159/000511457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Uterus transplantation is a complex surgical procedure. Uterine ischemia/reperfusion (IR) damage occurring in this process may cause loss of function in the uterus. Cell damage must be prevented for a healthy uterine function and successful transplantation. Cannabinoids, with their increasing clinical use, are substances with strong anti-inflammatory and antioxidative effects and have a role in immune system regulation. However, their efficacy in uterine IR damage is still unknown. This study provides information on the potential applications cannabinoids agonist JWH-133 in uterine IR damage and, hence, in the transplant process. METHODS Rats were divided into 4 groups (n = 8), performed uterine IR, and treated 2 groups with JWH-133. After anesthesia, ischemia was applied for 1 h to the uterus while reperfusion was applied for 3 h. After the experiment, malondialdehyde (MDA) levels and phosphorylated nuclear factor-kappa B (p-NF-κB) expression were examined in the tissue samples. Also, cell damage was evaluated by histopathological imaging and TUNEL staining. RESULTS In the uterine IR group, NF-κB expression and MDA levels were detected at high levels. Histopathological examinations and TUNEL staining revealed extensive cell damage. On the other hand, in groups treated with JWH-133, dose-dependent NF-κB expression and MDA levels decreased (p < 0.05). Depending on the dose, the rate of surviving cells increased in TUNEL staining results. CONCLUSION The results showed that JWH-133 was effective in reducing uterine IR damage. Cannabinoids may be a new alternative that may be used in the transplantation process in the future.
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Affiliation(s)
- Demet Aydogan Kirmizi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey,
| | - Emre Baser
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Zuleyha Doganyigit
- Department of Histology and Embryology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
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Salami SA, Martinelli F, Giovino A, Bachari A, Arad N, Mantri N. It Is Our Turn to Get Cannabis High: Put Cannabinoids in Food and Health Baskets. Molecules 2020; 25:E4036. [PMID: 32899626 PMCID: PMC7571138 DOI: 10.3390/molecules25184036] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/15/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022] Open
Abstract
Cannabis is an annual plant with a long history of use as food, feed, fiber, oil, medicine, and narcotics. Despite realizing its true value, it has not yet found its true place. Cannabis has had a long history with many ups and downs, and now it is our turn to promote it. Cannabis contains approximately 600 identified and many yet unidentified potentially useful compounds. Cannabinoids, phenolic compounds, terpenoids, and alkaloids are some of the secondary metabolites present in cannabis. However, among a plethora of unique chemical compounds found in this plant, the most important ones are phytocannabinoids (PCs). Over hundreds of 21-22-carbon compounds exclusively produce in cannabis glandular hairs through either polyketide and or deoxyxylulose phosphate/methylerythritol phosphate (DOXP/MEP) pathways. Trans-Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) are those that first come to mind while talking about cannabis. Nevertheless, despite the low concentration, cannabinol (CBN), cannabigerol (CBG), cannabichromene (CBC), tetrahydrocannabivarin (THCV), cannabidivarin (CBDV), cannabinodiol (CBND), and cannabinidiol (CBDL) may have potentially some medical effects. PCs and endocannabinoids (ECs) mediate their effects mainly through CB1 and CB2 receptors. Despite all concerns regarding cannabis, nobody can ignore the use of cannabinoids as promising tonic, analgesic, antipyretic, antiemetic, anti-inflammatory, anti-epileptic, anticancer agents, which are effective for pain relief, depression, anxiety, sleep disorders, nausea and vomiting, multiple sclerosis, cardiovascular disorders, and appetite stimulation. The scientific community and public society have now increasingly accepted cannabis specifically hemp as much more than a recreational drug. There are growing demands for cannabinoids, mainly CBD, with many diverse therapeutic and nutritional properties in veterinary or human medicine. The main objective of this review article is to historically summarize findings concerning cannabinoids, mainly THC and CBD, towards putting these valuable compounds into food, feed and health baskets and current and future trends in the consumption of products derived from cannabis.
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Affiliation(s)
- Seyed Alireza Salami
- Faculty of Agricultural Science and Engineering, University of Tehran, Karaj 31587, Iran
| | - Federico Martinelli
- Department of Biology, University of Florence, Via Madonna del Piano, 6, Sesto Fiorentino, 50019 Firenze, Italy;
| | - Antonio Giovino
- Council for Agricultural Research and Economics (CREA), Research Centre for Plant Protection and Certification (CREA-DC), 90011 Bagheria (PA), Italy;
| | - Ava Bachari
- School of Science, RMIT University, Melbourne, Bundoora, VIC 3083, Australia; (A.B.); (N.M.)
| | - Neda Arad
- School of Plant Sciences, The University of Arizona, Tucson, AZ 85721, USA;
| | - Nitin Mantri
- School of Science, RMIT University, Melbourne, Bundoora, VIC 3083, Australia; (A.B.); (N.M.)
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Almogi-Hazan O, Or R. Cannabis, the Endocannabinoid System and Immunity-the Journey from the Bedside to the Bench and Back. Int J Mol Sci 2020; 21:ijms21124448. [PMID: 32585801 PMCID: PMC7352399 DOI: 10.3390/ijms21124448] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
The Cannabis plant contains numerous components, including cannabinoids and other active molecules. The phyto-cannabinoid activity is mediated by the endocannabinoid system. Cannabinoids affect the nervous system and play significant roles in the regulation of the immune system. While Cannabis is not yet registered as a drug, the potential of cannabinoid-based medicines for the treatment of various conditions has led many countries to authorize their clinical use. However, the data from basic and medical research dedicated to medical Cannabis is currently limited. A variety of pathological conditions involve dysregulation of the immune system. For example, in cancer, immune surveillance and cancer immuno-editing result in immune tolerance. On the other hand, in autoimmune diseases increased immune activity causes tissue damage. Immuno-modulating therapies can regulate the immune system and therefore the immune-regulatory properties of cannabinoids, suggest their use in the therapy of immune related disorders. In this contemporary review, we discuss the roles of the endocannabinoid system in immunity and explore the emerging data about the effects of cannabinoids on the immune response in different pathologies. In addition, we discuss the complexities of using cannabinoid-based treatments in each of these conditions.
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29
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Comparative efficacy of 20 graft-versus-host disease prophylaxis therapies for patients after hematopoietic stem-cell transplantation: A multiple-treatments network meta-analysis. Crit Rev Oncol Hematol 2020; 150:102944. [DOI: 10.1016/j.critrevonc.2020.102944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/08/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
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Abstract
PURPOSE OF REVIEW Cannabis (marijuana, weed, pot, ganja, Mary Jane) is the most commonly used federally illicit drug in the United States. The present review provides an overview of cannabis and cannabinoids with relevance to the practice of nephrology so that clinicians can best take care of patients. RECENT FINDINGS Cannabis may have medicinal benefits for treating symptoms of advanced chronic kidney disease (CKD) and end-stage renal disease including as a pain adjuvant potentially reducing the need for opioids. Cannabis does not seem to affect kidney function in healthy individuals. However, renal function should be closely monitored in those with CKD, the lowest effective dose should be used, and smoking should be avoided. Cannabis use may delay transplant candidate listing or contribute to ineligibility. Cannabidiol (CBD) has recently exploded in popularity. Although generally well tolerated, safe without significant side effects, and effective for a variety of neurological and psychiatric conditions, consumers have easy access to a wide range of unregulated CBD products, some with inaccurate labeling and false health claims. Importantly, CBD may raise tacrolimus levels. SUMMARY Patients and healthcare professionals have little guidance or evidence regarding the impact of cannabis use on people with kidney disease. This knowledge gap will remain as long as federal regulations remain prohibitively restrictive towards prospective research.
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Affiliation(s)
- Joshua L Rein
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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31
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Almogi-Hazan O, Khuja I, Ritter S, Or R. The Highs and Lows of Cannabis in Cancer Treatment and Bone Marrow Transplantation. Rambam Maimonides Med J 2020; 11:RMMJ.10391. [PMID: 32017682 PMCID: PMC7000158 DOI: 10.5041/rmmj.10391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In the last decade, we have observed an increased public and scientific interest in the clinical applications of medical cannabis. Currently, the application of cannabinoids in cancer patients is mainly due to their analgesic and anti-emetic effects. The direct effects of phyto-cannabinoids on cancer cells are under intensive research, and the data remain somewhat inconsistent. Although anti-proliferative properties were observed in vitro, conclusive data from animal models and clinical trials are lacking. Since immunotherapy of malignant diseases and bone marrow transplantation are integral approaches in hemato-oncology, the immuno-modulatory characteristic of cannabinoids is a fundamental aspect for consideration. The effect of cannabinoids on the immune system is presently under investigation, and some evidence for its immuno-regulatory properties has been shown. In addition, the interaction of cannabinoids and classical cytotoxic agents is a subject for further investigation. Here we discuss the current knowledge of cannabinoid-based treatments in preclinical models and the limited data in oncological patients. Particularly, we address the possible contradiction between the direct anti-tumor and the immune-modulatory effects of cannabinoids. Better understanding of the mechanism of cannabinoids influence is essential to design therapies that will allow cannabinoids to be incorporated into the clinic.
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Affiliation(s)
- Osnat Almogi-Hazan
- Laboratory of Immunotherapy and Bone Marrow Transplantation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Iman Khuja
- Laboratory of Immunotherapy and Bone Marrow Transplantation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Reuven Or
- Laboratory of Immunotherapy and Bone Marrow Transplantation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- To whom correspondence should be addressed. E-mail:
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Affiliation(s)
- Alex Straiker
- Department of Psychological & Brain Sciences, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, Indiana University, Bloomington, IN, USA
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Abstract
Research in the cannabinoid field, namely on phytocannabinoids, the endogenous cannabinoids anandamide and 2-arachidonoyl glycerol and their metabolizing and synthetic enzymes, the cannabinoid receptors, and anandamide-like cannabinoid compounds, has expanded tremendously over the last few years. Numerous endocannabinoid-like compounds have been discovered. The Cannabis plant constituent cannabidiol (CBD) was found to exert beneficial effects in many preclinical disease models ranging from epilepsy, cardiovascular disease, inflammation, and autoimmunity to neurodegenerative and kidney diseases and cancer. CBD was recently approved in the United States for the treatment of rare forms of childhood epilepsy. This has triggered the development of many CBD-based products for human use, often with overstated claims regarding their therapeutic effects. In this article, the recently published research on the chemistry and biological effects of plant cannabinoids (specifically CBD), endocannabinoids, certain long-chain fatty acid amides, and the variety of relevant receptors is critically reviewed.
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Affiliation(s)
- Pal Pacher
- Laboratory of Cardiovascular Physiology and Tissue Injury and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland 20852, USA;
| | - Natalya M Kogan
- Institute for Drug Research, Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel;
| | - Raphael Mechoulam
- Institute for Drug Research, Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel;
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Millar S, Stone N, Bellman Z, Yates A, England T, O'Sullivan S. A systematic review of cannabidiol dosing in clinical populations. Br J Clin Pharmacol 2019; 85:1888-1900. [PMID: 31222854 PMCID: PMC6710502 DOI: 10.1111/bcp.14038] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Cannabidiol (CBD) is a cannabis-derived medicinal product with potential application in a wide-variety of contexts; however, its effective dose in different disease states remains unclear. This review aimed to investigate what doses have been applied in clinical populations, in order to understand the active range of CBD in a variety of medical contexts. METHODS Publications involving administration of CBD alone were collected by searching PubMed, EMBASE and ClinicalTrials.gov. RESULTS A total of 1038 articles were retrieved, of which 35 studies met inclusion criteria covering 13 medical contexts. Twenty-three studies reported a significant improvement in primary outcomes (e.g. psychotic symptoms, anxiety, seizures), with doses ranging between <1 and 50 mg/kg/d. Plasma concentrations were not provided in any publication. CBD was reported as well tolerated and epilepsy was the most frequently studied medical condition, with all 11 studies demonstrating positive effects of CBD on reducing seizure frequency or severity (average 15 mg/kg/d within randomised controlled trials). There was no signal of positive activity of CBD in small randomised controlled trials (range n = 6-62) assessing diabetes, Crohn's disease, ocular hypertension, fatty liver disease or chronic pain. However, low doses (average 2.4 mg/kg/d) were used in these studies. CONCLUSION This review highlights that CBD has a potential wide range of activity in several pathologies. Pharmacokinetic studies as well as conclusive phase III trials to elucidate effective plasma concentrations within medical contexts are severely lacking and highly encouraged.
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Affiliation(s)
- S.A. Millar
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
| | - N.L. Stone
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
| | - Z.D. Bellman
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
| | | | - T.J. England
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
| | - S.E. O'Sullivan
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
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Golay H, Jurkovic Mlakar S, Mlakar V, Nava T, Ansari M. The Biological and Clinical Relevance of G Protein-Coupled Receptors to the Outcomes of Hematopoietic Stem Cell Transplantation: A Systematized Review. Int J Mol Sci 2019; 20:E3889. [PMID: 31404983 PMCID: PMC6719093 DOI: 10.3390/ijms20163889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 01/04/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) remains the only curative treatment for several malignant and non-malignant diseases at the cost of serious treatment-related toxicities (TRTs). Recent research on extending the benefits of HSCT to more patients and indications has focused on limiting TRTs and improving immunological effects following proper mobilization and engraftment. Increasing numbers of studies report associations between HSCT outcomes and the expression or the manipulation of G protein-coupled receptors (GPCRs). This large family of cell surface receptors is involved in various human diseases. With ever-better knowledge of their crystal structures and signaling dynamics, GPCRs are already the targets for one third of the current therapeutic arsenal. The present paper assesses the current status of animal and human research on GPCRs in the context of selected HSCT outcomes via a systematized survey and analysis of the literature.
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Affiliation(s)
- Hadrien Golay
- Platform of Pediatric Onco-Hematology research (CANSEARCH Laboratory), Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Bâtiment La Tulipe, Avenue de la Roseraie 64, 1205 Geneva, Switzerland
| | - Simona Jurkovic Mlakar
- Platform of Pediatric Onco-Hematology research (CANSEARCH Laboratory), Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Bâtiment La Tulipe, Avenue de la Roseraie 64, 1205 Geneva, Switzerland
| | - Vid Mlakar
- Platform of Pediatric Onco-Hematology research (CANSEARCH Laboratory), Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Bâtiment La Tulipe, Avenue de la Roseraie 64, 1205 Geneva, Switzerland
| | - Tiago Nava
- Platform of Pediatric Onco-Hematology research (CANSEARCH Laboratory), Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Bâtiment La Tulipe, Avenue de la Roseraie 64, 1205 Geneva, Switzerland
- Department of Women-Children-Adolescents, Division of General Pediatrics, Pediatric Onco-Hematology Unit, Geneva University Hospitals (HUG), Avenue de la Roseraie 64, 1205 Geneva, Switzerland
| | - Marc Ansari
- Platform of Pediatric Onco-Hematology research (CANSEARCH Laboratory), Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Bâtiment La Tulipe, Avenue de la Roseraie 64, 1205 Geneva, Switzerland.
- Department of Women-Children-Adolescents, Division of General Pediatrics, Pediatric Onco-Hematology Unit, Geneva University Hospitals (HUG), Avenue de la Roseraie 64, 1205 Geneva, Switzerland.
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36
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Ryan JE, Noeder M, Burke C, Stubblefield SC, Sulieman S, Miller EG. Denying renal transplantation to an adolescent medical cannabis user: An ethical case study. Pediatr Transplant 2019; 23:e13467. [PMID: 31124250 PMCID: PMC6671627 DOI: 10.1111/petr.13467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/26/2018] [Accepted: 03/30/2019] [Indexed: 11/28/2022]
Abstract
Medical cannabis is now legal in over half of the United States. As more patients adopt this unconventional therapy, it is inevitable that potential transplant recipients will disclose their cannabis use during transplant evaluation. Transplant teams are tasked with the decision to utilize a pressure resource, often with little guidance from international and national professional organizations. Many healthcare providers remain uniformed or misinformed about the risks of cannabis use and organ transplantation. In order to illustrate the multifaceted and complex evaluation of transplant patients using medical cannabis, this article presents the case of a 20-year-old woman recommended for renal transplant who was originally denied active listing due to her medical cannabis use. A review of the literature explores the perceived and actual risks of cannabis use in the immunocompromised patient. Furthermore, a discussion of the ethics of medical cannabis use and organ transplantation is included with recommendations for multidisciplinary transplant teams.
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Affiliation(s)
- Jennie E. Ryan
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Maia Noeder
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Christine Burke
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Samuel C. Stubblefield
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Salwa Sulieman
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elissa G. Miller
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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37
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Baron EP. Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science. Headache 2019; 58:1139-1186. [PMID: 30152161 DOI: 10.1111/head.13345] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Comprehensive literature reviews of historical perspectives and evidence supporting cannabis/cannabinoids in the treatment of pain, including migraine and headache, with associated neurobiological mechanisms of pain modulation have been well described. Most of the existing literature reports on the cannabinoids Δ9 -tetrahydrocannabinol (THC) and cannabidiol (CBD), or cannabis in general. There are many cannabis strains that vary widely in the composition of cannabinoids, terpenes, flavonoids, and other compounds. These components work synergistically to produce wide variations in benefits, side effects, and strain characteristics. Knowledge of the individual medicinal properties of the cannabinoids, terpenes, and flavonoids is necessary to cross-breed strains to obtain optimal standardized synergistic compositions. This will enable targeting individual symptoms and/or diseases, including migraine, headache, and pain. OBJECTIVE Review the medical literature for the use of cannabis/cannabinoids in the treatment of migraine, headache, facial pain, and other chronic pain syndromes, and for supporting evidence of a potential role in combatting the opioid epidemic. Review the medical literature involving major and minor cannabinoids, primary and secondary terpenes, and flavonoids that underlie the synergistic entourage effects of cannabis. Summarize the individual medicinal benefits of these substances, including analgesic and anti-inflammatory properties. CONCLUSION There is accumulating evidence for various therapeutic benefits of cannabis/cannabinoids, especially in the treatment of pain, which may also apply to the treatment of migraine and headache. There is also supporting evidence that cannabis may assist in opioid detoxification and weaning, thus making it a potential weapon in battling the opioid epidemic. Cannabis science is a rapidly evolving medical sector and industry with increasingly regulated production standards. Further research is anticipated to optimize breeding of strain-specific synergistic ratios of cannabinoids, terpenes, and other phytochemicals for predictable user effects, characteristics, and improved symptom and disease-targeted therapies.
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Affiliation(s)
- Eric P Baron
- Department of Neurology, Center for Neurological Restoration - Headache and Chronic Pain Medicine, Cleveland Clinic Neurological Institute, Cleveland, OH, 44195, USA
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38
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Milando R, Friedman A. Cannabinoids: Potential Role in Inflammatory and Neoplastic Skin Diseases. Am J Clin Dermatol 2019; 20:167-180. [PMID: 30542832 DOI: 10.1007/s40257-018-0410-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The endocannabinoid system is a complex and nearly ubiquitous network of endogenous ligands, enzymes, and receptors that can also be stimulated by exogenous compounds such as those derived from the marijuana plant, Cannabis sativa. Recent data have shown that the endocannabinoid system is fully functional in the skin and is responsible for maintaining many aspects of skin homeostasis, such as proliferation, differentiation, and release of inflammatory mediators. Because of its role in regulating these key processes, the endocannabinoid system has been studied for its modulating effects on both inflammatory disorders of the skin and skin cancer. Although legal restrictions on marijuana as a Schedule I drug in the USA have made studying cannabinoid compounds unfavorable, an increasing number of studies and clinical trials have focused on the therapeutic uses of cannabinoids. This review seeks to summarize the current, and rapidly expanding field of research on the broad potential uses of cannabinoids in inflammatory and neoplastic diseases of the skin.
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Affiliation(s)
- Rose Milando
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Adam Friedman
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Department of Dermatology, The George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue NW, Suite 2B-430, Washington, DC, 20037, USA.
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Cannabinoids Reduce Inflammation but Inhibit Lymphocyte Recovery in Murine Models of Bone Marrow Transplantation. Int J Mol Sci 2019; 20:ijms20030668. [PMID: 30720730 PMCID: PMC6387311 DOI: 10.3390/ijms20030668] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
Abstract
Cannabinoids, the biologically active constituents of Cannabis, have potent neuronal and immunological effects. However, the basic and medical research dedicated to medical cannabis and cannabinoids is limited. The influence of these treatments on hematologic reconstitution and on the development of graft versus host disease (GVHD) after bone marrow transplantation (BMT) is largely unknown. In this research, we compared the influence of D9 tetrahydrocannabinol (THC) and cannabidiol (CBD) on lymphocyte activation in vitro and in murine BMT models. Our in vitro results demonstrate that these treatments decrease activated lymphocyte proliferation and affect cytokine secretion. We also discovered that CBD and THC utilize different receptors to mediate these effects. In vivo, in a syngeneic transplantation model, we demonstrate that all treatments inhibit lymphocyte reconstitution and show the inhibitory role of the cannabinoid receptor type 2 (CB2) on lymphocyte recovery. Although pure cannabinoids exhibited a superior effect in vitro, in an allogeneic (C57BL/6 to BALB/c) BMT mouse model, THC-high and CBD-high cannabis extracts treatment reduced the severity of GVHD and improved survival significantly better than the pure cannabinoids. Our results highlights the complexity of using cannabinoids-based treatments and the need for additional comparative scientific results.
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Turgeman I, Bar-Sela G. Cannabis for cancer - illusion or the tip of an iceberg: a review of the evidence for the use of Cannabis and synthetic cannabinoids in oncology. Expert Opin Investig Drugs 2018; 28:285-296. [PMID: 30572744 DOI: 10.1080/13543784.2019.1561859] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION A flowering plant of variegated ingredients and psychoactive qualities, Cannabis has long been used for medicinal and recreational purposes. Regulatory approvals have been gained across a broad range of palliative and therapeutic indications, and in some cases, included in standard treatment guidelines. AREAS COVERED The use of Cannabis and cannabinoid-based-medicines in oncology is summarized in this article. Cannabinoids are classified according to natural and synthetic subtypes and their mechanisms of action expounded. The variability of available products is discussed in the clinical context and data regarding chemotherapy-induced nausea and vomiting, cancer-related pain, anorexia, insomnia, and anxiety are presented. Moreover, immunological and antineoplastic effects in preclinical and clinical trials are addressed. Concepts such as synergism or opposition with conventional treatment modalities, the sequence of administration and dosage, molecular cross-talk and malignancy-cannabinoid congruence, are explored. Finally, side-effects, limitations in trial design and legislation barriers are related. EXPERT OPINION Sufficient evidence supports the use of Cannabis for palliative indications in oncology; however, patients should be carefully selected, guided and followed. Promising research suggests the potent antineoplastic activity, but more data must be accrued before conclusions can be drawn.
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Affiliation(s)
- Ilit Turgeman
- a Division of Oncology , Rambam Health Care Campus , Haifa , Israel
| | - Gil Bar-Sela
- b Center for Malignant Diseases , Emek Medical Center , Afula , Israel.,c Faculty of Medicine , Technion-Israel Institute of Technology , Haifa , Israel
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41
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Bar-Lev Schleider L, Abuhasira R, Novack V. Medical cannabis: aligning use to evidence-based medicine approach. Br J Clin Pharmacol 2018; 84:2458-2462. [PMID: 29859014 DOI: 10.1111/bcp.13657] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/22/2022] Open
Abstract
During the past decade we have been witnessing a rise in medical cannabis use, yet the evidence for the safety and efficacy of the various cannabinoid compounds is scarce. The State of Israel has always been at the forefront of clinical and translational research in support of Evidence Based Medicine. With respect to cannabis Israel has created a medical and regulatory environment that enables clinical studies with cannabis which may lead to improved Evidence Based use of these compounds. This opinion paper discusses selected studies into the safety and effects of cannabis derived products.
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Affiliation(s)
- Lihi Bar-Lev Schleider
- Cannabis Clinical Research Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Ran Abuhasira
- Cannabis Clinical Research Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Victor Novack
- Cannabis Clinical Research Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
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Brown MRD, Farquhar-Smith WP. Cannabinoids and cancer pain: A new hope or a false dawn? Eur J Intern Med 2018; 49:30-36. [PMID: 29482740 DOI: 10.1016/j.ejim.2018.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 02/08/2023]
Abstract
The endocannabinoid system is involved in many areas of physiological function and homeostasis. Cannabinoid receptors are expressed in the peripheral and central nervous system and on immune cells, all areas ideally suited to modulation of pain processing. There are a wealth of preclinical data in a number of acute, chronic, neuropathic and cancer pain models that have demonstrated a potent analgesic potential for cannabinoids, especially in patients with cancer. However, although there are some positive results in pain of cancer patients, the clinical evidence for cannabinoids as analgesics has not been convincing and their use can only be weakly recommended. The efficacy of cannabinoids seems to have been 'lost in translation' which may in part be related to using extracts of herbal cannabis rather than targeted selective full agonists at the cannabinoid CB1 and CB2 receptors.
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Affiliation(s)
- Matthew R D Brown
- Department of Anaesthetics, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom.
| | - W Paul Farquhar-Smith
- Department of Anaesthetics, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom.
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43
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Oláh A, Szekanecz Z, Bíró T. Targeting Cannabinoid Signaling in the Immune System: "High"-ly Exciting Questions, Possibilities, and Challenges. Front Immunol 2017; 8:1487. [PMID: 29176975 PMCID: PMC5686045 DOI: 10.3389/fimmu.2017.01487] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/23/2017] [Indexed: 12/21/2022] Open
Abstract
It is well known that certain active ingredients of the plants of Cannabis genus, i.e., the "phytocannabinoids" [pCBs; e.g., (-)-trans-Δ9-tetrahydrocannabinol (THC), (-)-cannabidiol, etc.] can influence a wide array of biological processes, and the human body is able to produce endogenous analogs of these substances ["endocannabinoids" (eCB), e.g., arachidonoylethanolamine (anandamide, AEA), 2-arachidonoylglycerol (2-AG), etc.]. These ligands, together with multiple receptors (e.g., CB1 and CB2 cannabinoid receptors, etc.), and a complex enzyme and transporter apparatus involved in the synthesis and degradation of the ligands constitute the endocannabinoid system (ECS), a recently emerging regulator of several physiological processes. The ECS is widely expressed in the human body, including several members of the innate and adaptive immune system, where eCBs, as well as several pCBs were shown to deeply influence immune functions thereby regulating inflammation, autoimmunity, antitumor, as well as antipathogen immune responses, etc. Based on this knowledge, many in vitro and in vivo studies aimed at exploiting the putative therapeutic potential of cannabinoid signaling in inflammation-accompanied diseases (e.g., multiple sclerosis) or in organ transplantation, and to dissect the complex immunological effects of medical and "recreational" marijuana consumption. Thus, the objective of the current article is (i) to summarize the most recent findings of the field; (ii) to highlight the putative therapeutic potential of targeting cannabinoid signaling; (iii) to identify open questions and key challenges; and (iv) to suggest promising future directions for cannabinoid-based drug development.
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Affiliation(s)
- Attila Oláh
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szekanecz
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Bíró
- Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Abstract
PURPOSE OF REVIEW Physicians of all disciplines must rapidly adjust their clinical practices following the expansion of marijuana legalization across the country. Organ transplantation teams are uniquely struggling in this gray zone with eight states having passed laws explicitly banning the denial of transplant listing based on a patient's use of medical marijuana. In this review, we examine the clinical evidence of marijuana use in transplant patients to enable psychiatric providers to meaningfully contribute to the relevant medical and psychiatric aspects of this issue in a unique patient population. RECENT FINDINGS There is no consensus among experts regarding marijuana use in transplantation patients. There are extant case reports of post-transplant complications attributed to marijuana use including membranous glomerulonephritis, ventricular tachycardia, and tacrolimus toxicity. However, recent studies suggest that the overall survival rates in kidney, liver, lung, and heart transplant patients using marijuana are equivalent to non-users. Transplant teams should not de facto exclude marijuana users from transplant listing but instead holistically evaluate a patient's candidacy, integrating meaningful medical, psychiatric, and social variables into the complex decision-making process. Psychiatric providers can play a key role in this process. Appropriate stewardship over donor organs, a limited and precious resource, will require a balance of high-clinical standards with inclusive efforts to treat as many patients as possible.
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Affiliation(s)
- Harinder Singh Rai
- University of Michigan Department of Psychiatry, 9D 9816 University Hospital, 1500 E. Medical Center Dr. SPC 5118, Ann Arbor, MI, 48109-5118, USA
| | - Gerald Scott Winder
- University of Michigan Department of Psychiatry, 9D 9816 University Hospital, 1500 E. Medical Center Dr. SPC 5118, Ann Arbor, MI, 48109-5118, USA.
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45
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Pacher P, Steffens S, Haskó G, Schindler TH, Kunos G. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol 2017; 15:151-166. [DOI: 10.1038/nrcardio.2017.130] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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46
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Russo EB, Marcu J. Cannabis Pharmacology: The Usual Suspects and a Few Promising Leads. ADVANCES IN PHARMACOLOGY 2017; 80:67-134. [PMID: 28826544 DOI: 10.1016/bs.apha.2017.03.004] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The golden age of cannabis pharmacology began in the 1960s as Raphael Mechoulam and his colleagues in Israel isolated and synthesized cannabidiol, tetrahydrocannabinol, and other phytocannabinoids. Initially, THC garnered most research interest with sporadic attention to cannabidiol, which has only rekindled in the last 15 years through a demonstration of its remarkably versatile pharmacology and synergy with THC. Gradually a cognizance of the potential of other phytocannabinoids has developed. Contemporaneous assessment of cannabis pharmacology must be even far more inclusive. Medical and recreational consumers alike have long believed in unique attributes of certain cannabis chemovars despite their similarity in cannabinoid profiles. This has focused additional research on the pharmacological contributions of mono- and sesquiterpenoids to the effects of cannabis flower preparations. Investigation reveals these aromatic compounds to contribute modulatory and therapeutic roles in the cannabis entourage far beyond expectations considering their modest concentrations in the plant. Synergistic relationships of the terpenoids to cannabinoids will be highlighted and include many complementary roles to boost therapeutic efficacy in treatment of pain, psychiatric disorders, cancer, and numerous other areas. Additional parts of the cannabis plant provide a wide and distinct variety of other compounds of pharmacological interest, including the triterpenoid friedelin from the roots, canniprene from the fan leaves, cannabisin from seed coats, and cannflavin A from seed sprouts. This chapter will explore the unique attributes of these agents and demonstrate how cannabis may yet fulfil its potential as Mechoulam's professed "pharmacological treasure trove."
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Affiliation(s)
| | - Jahan Marcu
- Americans for Safe Access, Patient Focused Certification, Washington, DC, United States
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47
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Iffland K, Grotenhermen F. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis Cannabinoid Res 2017; 2:139-154. [PMID: 28861514 PMCID: PMC5569602 DOI: 10.1089/can.2016.0034] [Citation(s) in RCA: 361] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction: This literature survey aims to extend the comprehensive survey performed by Bergamaschi et al. in 2011 on cannabidiol (CBD) safety and side effects. Apart from updating the literature, this article focuses on clinical studies and CBD potential interactions with other drugs. Results: In general, the often described favorable safety profile of CBD in humans was confirmed and extended by the reviewed research. The majority of studies were performed for treatment of epilepsy and psychotic disorders. Here, the most commonly reported side effects were tiredness, diarrhea, and changes of appetite/weight. In comparison with other drugs, used for the treatment of these medical conditions, CBD has a better side effect profile. This could improve patients' compliance and adherence to treatment. CBD is often used as adjunct therapy. Therefore, more clinical research is warranted on CBD action on hepatic enzymes, drug transporters, and interactions with other drugs and to see if this mainly leads to positive or negative effects, for example, reducing the needed clobazam doses in epilepsy and therefore clobazam's side effects. Conclusion: This review also illustrates that some important toxicological parameters are yet to be studied, for example, if CBD has an effect on hormones. Additionally, more clinical trials with a greater number of participants and longer chronic CBD administration are still lacking.
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48
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Mechoulam R. Cannabis - the Israeli perspective. J Basic Clin Physiol Pharmacol 2017; 27:181-7. [PMID: 26426888 DOI: 10.1515/jbcpp-2015-0091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/15/2022]
Abstract
Short overviews are presented on the historical uses of cannabis in the Middle East and on the more recent scientific and medical research on phytocannabinoids and the endocannabinoid system, with emphasis on research contributions from Israel. These are followed by examples of research projects and clinical trials with cannabinoids and by a short report on the regulation of medical marijuana in Israel, which at present is administered to over 22,000 patients.
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49
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Le Boisselier R, Alexandre J, Lelong-Boulouard V, Debruyne D. Focus on cannabinoids and synthetic cannabinoids. Clin Pharmacol Ther 2016; 101:220-229. [PMID: 27861784 DOI: 10.1002/cpt.563] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 02/06/2023]
Abstract
The recent emergence of a multitude of synthetic cannabinoids (SCs) has generated a wealth of new information, suggesting the usefulness of state-of-the-art on lato sensu cannabinoids. By modulating a plurality of neurotransmission pathways, the endocannabinoid system is involved in many physiological processes that are increasingly explored. SCs desired and adverse effects are considered to be more intense than those observed with cannabis smoking, which is partly explained by the full agonist activity and higher affinity for cannabinoid receptors. Neurological and cardiovascular side effects observed after cannabinoid poisoning generally respond to conventional supportive care, but severe outcomes may occur in a minority of cases, mainly observed with SCs. The likelihood of severe abuse and addiction produced by SCs are of concern for the scientific community also interested in the potential therapeutic value of cannabinoids.
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Affiliation(s)
- R Le Boisselier
- University Hospital Centre Côte de Nacre, Centre for Evaluation and Information on Pharmacodependance - Addictovigilance (CEIP-A), F-14033, Caen, France.,University Hospital Centre Côte de Nacre, Department of Pharmacology, Caen, France
| | - J Alexandre
- University Hospital Centre Côte de Nacre, Department of Pharmacology, Caen, France.,Normandy University, UNICAEN, University Hospital Centre Côte de Nacre, Caen, France
| | - V Lelong-Boulouard
- University Hospital Centre Côte de Nacre, Department of Pharmacology, Caen, France.,Normandy University, UNICAEN, University Hospital Centre Côte de Nacre, Inserm U 1075 COMETE Caen, France
| | - D Debruyne
- University Hospital Centre Côte de Nacre, Centre for Evaluation and Information on Pharmacodependance - Addictovigilance (CEIP-A), F-14033, Caen, France.,University Hospital Centre Côte de Nacre, Department of Pharmacology, Caen, France.,Medical School, Normandy University, Caen, France
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50
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Ligresti A, De Petrocellis L, Di Marzo V. From Phytocannabinoids to Cannabinoid Receptors and Endocannabinoids: Pleiotropic Physiological and Pathological Roles Through Complex Pharmacology. Physiol Rev 2016; 96:1593-659. [DOI: 10.1152/physrev.00002.2016] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Apart from having been used and misused for at least four millennia for, among others, recreational and medicinal purposes, the cannabis plant and its most peculiar chemical components, the plant cannabinoids (phytocannabinoids), have the merit to have led humanity to discover one of the most intriguing and pleiotropic endogenous signaling systems, the endocannabinoid system (ECS). This review article aims to describe and critically discuss, in the most comprehensive possible manner, the multifaceted aspects of 1) the pharmacology and potential impact on mammalian physiology of all major phytocannabinoids, and not only of the most famous one Δ9-tetrahydrocannabinol, and 2) the adaptive pro-homeostatic physiological, or maladaptive pathological, roles of the ECS in mammalian cells, tissues, and organs. In doing so, we have respected the chronological order of the milestones of the millennial route from medicinal/recreational cannabis to the ECS and beyond, as it is now clear that some of the early steps in this long path, which were originally neglected, are becoming important again. The emerging picture is rather complex, but still supports the belief that more important discoveries on human physiology, and new therapies, might come in the future from new knowledge in this field.
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Affiliation(s)
- Alessia Ligresti
- Endocannabinoid Research Group, Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Comprensorio Olivetti, Pozzuoli, Italy
| | - Luciano De Petrocellis
- Endocannabinoid Research Group, Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Comprensorio Olivetti, Pozzuoli, Italy
| | - Vincenzo Di Marzo
- Endocannabinoid Research Group, Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Comprensorio Olivetti, Pozzuoli, Italy
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