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Glatt S, Shohat S, Yam M, Goldstein L, Maidan I, Fahoum F. Cannabidiol-enriched oil for adult patients with drug-resistant epilepsy: Prospective clinical and electrophysiological study. Epilepsia 2024; 65:2270-2279. [PMID: 38808601 DOI: 10.1111/epi.18025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Cannabidiol-enriched oil (CBDO) is being used increasingly to improve seizure control in adult patients with drug-resistant epilepsy (DRE), despite the lack of large-scale studies supporting its efficacy in this patient population. We aimed to assess the effects of add-on CBDO on seizure frequency as well as on gait, cognitive, affective, and sleep-quality metrics, and to explore the electrophysiological changes in responder and non-responder DRE patients treated with add-on CBDO. METHODS We prospectively recruited adult DRE patients who were treated with add-on CBDO. Patients were evaluated prior to treatment and following 4 weeks of a maintenance daily dose of ≈260 mg CBD and ≈12 mg Δ9-tetrahydrocannabinol (THC). The outcome measures included seizure response to CBDO (defined as ≥50% decrease in seizures compared to pre-CBDO baseline), gait testing, Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS), and sleep-quality questionnaire assessments. Patients underwent electroencephalography (EEG) recording during rest as well as event-related potentials (ERPs) during visual Go/NoGo task while sitting and while walking. RESULTS Nineteen patients were recruited, of which 16 finished pre- and post-CBDO assessments. Seven patients (43.75%) were responders demonstrating an average reduction of 82.4% in seizures, and nine patients (56.25%) were non-responders with an average seizure increase of 30.1%. No differences in demographics and clinical parameters were found between responders and non-responders at baseline. However, responders demonstrated better performance in the dual-task walking post-treatment (p = .015), and correlation between increase in MoCA and seizure reduction (r = .810, p = .027). Post-CBDO P300 amplitude was lower during No/Go-sitting in non-responders (p = .028) and during No/Go-walking in responders (p = .068). SIGNIFICANCE CBDO treatment can reduce seizures in a subset of patients with DRE, but could aggravate seizure control in a minority of patients; yet we found no specific baseline clinical or electrophysiological characteristics that are associated with response to CBDO. However, changes in ERPs in response to treatment could be a promising direction to better identify patients who could benefit from CBDO treatment.
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Affiliation(s)
- Sigal Glatt
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sophie Shohat
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Mor Yam
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lilach Goldstein
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Maidan
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Firas Fahoum
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zebbakh H, Imrani K, Benbrahim F, Moatassim Billah N, Nassar I. Acute toxic hippocampal encephalopathy in heavy cannabis users: A case report. Radiol Case Rep 2024; 19:1913-1916. [PMID: 38425776 PMCID: PMC10904197 DOI: 10.1016/j.radcr.2024.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Cannabis use is increasing rapidly among young people worldwide despite the deleterious effects of this toxic substance on health. We report a case of acute hippocampal encephalopathy in a heavy cannabis user (8-10 joints/d for 6 years) who presented with a nonfebrile status epilepticus. Brain magnetic resonance imaging revealed bilateral and symmetrical high-signal abnormalities in the hippocampal regions. The damage to these regions is often severe, long-lasting, and sometimes irreversible. Therefore, every doctor (emergency doctor, resuscitator, neurologist...) is asked to request a brain MRI in case of neurological signs in a young cannabis user.
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Affiliation(s)
- Hajar Zebbakh
- Hajar Zebbakh, Radiology, Ibn Sina University Hospital, Rabat, Morocco
| | - Kaoutar Imrani
- Hajar Zebbakh, Radiology, Ibn Sina University Hospital, Rabat, Morocco
| | | | | | - Ittimade Nassar
- Hajar Zebbakh, Radiology, Ibn Sina University Hospital, Rabat, Morocco
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Izquierdo-Luengo C, Ten-Blanco M, Ponce-Renilla M, Perezzan R, Pereda-Pérez I, Berrendero F. Adolescent exposure to the Spice/K2 cannabinoid JWH-018 impairs sensorimotor gating and alters cortical perineuronal nets in a sex-dependent manner. Transl Psychiatry 2023; 13:176. [PMID: 37225721 DOI: 10.1038/s41398-023-02469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023] Open
Abstract
The consumption of synthetic cannabinoids during adolescence is reported to be a risk factor for the appearance of psychiatric disorders later in life. JWH-018 was identified as one of the primary psychoactive components present in Spice/K2 preparations. This study evaluated the short- and long-term consequences of exposure to JWH-018 during the adolescence in anxiety-like behavior, fear extinction, and sensorimotor gating in male and female mice. Alterations in anxiety varied depending on the time interval between treatment and behavioral analysis along with sex, while no changes were observed in the extinction of fear memory. A decrease in prepulse inhibition of the startle reflex was revealed in male, but not female, mice at short- and long-term. This behavioral disturbance was associated with a reduction in the number of perineuronal nets in the prelimbic and infralimbic regions of the prefrontal cortex in the short-term. Furthermore, adolescent exposure to JWH-018 induced an activation of microglia and astrocytes in the prefrontal cortex of male mice at both time intervals. A transitory decrease in the expression of GAD67 and CB2 cannabinoid receptors in the prefrontal cortex was also found in male mice exposed to JWH-018. These data reveal that the treatment with JWH-018 during the adolescence leads to long-lasting neurobiological changes related to psychotic-like symptoms, which were sex-dependent.
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Affiliation(s)
- Cristina Izquierdo-Luengo
- Instituto de Investigaciones Biosanitarias, Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Marc Ten-Blanco
- Instituto de Investigaciones Biosanitarias, Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - María Ponce-Renilla
- Instituto de Investigaciones Biosanitarias, Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ramiro Perezzan
- Instituto de Investigaciones Biosanitarias, Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Inmaculada Pereda-Pérez
- Instituto de Investigaciones Biosanitarias, Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Fernando Berrendero
- Instituto de Investigaciones Biosanitarias, Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain.
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Sayson LV, Ortiz DM, Lee HJ, Kim M, Custodio RJP, Yun J, Lee CH, Lee YS, Cha HJ, Cheong JH, Kim HJ. Deletion of Cryab increases the vulnerability of mice to the addiction-like effects of the cannabinoid JWH-018 via upregulation of striatal NF-κB expression. Front Pharmacol 2023; 14:1135929. [PMID: 37007015 PMCID: PMC10060981 DOI: 10.3389/fphar.2023.1135929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Synthetic cannabinoids have exhibited unpredictable abuse liabilities, especially self-administration (SA) responses in normal rodent models, despite seemingly inducing addiction-like effects in humans. Thus, an efficient pre-clinical model must be developed to determine cannabinoid abuse potential in animals and describe the mechanism that may mediate cannabinoid sensitivity. The Cryab knockout (KO) mice were recently discovered to be potentially sensitive to the addictive effects of psychoactive drugs. Herein, we examined the responses of Cryab KO mice to JWH-018 using SA, conditioned place preference, and electroencephalography. Additionally, the effects of repeated JWH-018 exposure on endocannabinoid- and dopamine-related genes in various addiction-associated brain regions were examined, along with protein expressions involving neuroinflammation and synaptic plasticity. Cryab KO mice exhibited greater cannabinoid-induced SA responses and place preference, along with divergent gamma wave alterations, compared to wild-type (WT) mice, implying their higher sensitivity to cannabinoids. Endocannabinoid- or dopamine-related mRNA expressions and accumbal dopamine concentrations after repeated JWH-018 exposure were not significantly different between the WT and Cryab KO mice. Further analyses revealed that repeated JWH-018 administration led to possibly greater neuroinflammation in Cryab KO mice, which may arise from upregulated NF-κB, accompanied by higher expressions of synaptic plasticity markers, which might have contributed to the development of cannabinoid addiction-related behavior in Cryab KO mice. These findings signify that increased neuroinflammation via NF-κB may mediate the enhanced addiction-like responses of Cryab KO mice to cannabinoids. Altogether, Cryab KO mice may be a potential model for cannabinoid abuse susceptibility.
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Affiliation(s)
- Leandro Val Sayson
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, Seoul, Republic of Korea
| | - Darlene Mae Ortiz
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, Seoul, Republic of Korea
| | - Hyun Jun Lee
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, Seoul, Republic of Korea
| | - Mikyung Kim
- Department of Chemistry and Life Science, Sahmyook University, Seoul, Republic of Korea
| | - Raly James Perez Custodio
- Department of Ergonomics, Leibniz Research Centre for Working Environment and Human Factors—IfADo, Dortmund, Germany
| | - Jaesuk Yun
- College of Pharmacy and Medical Research Center, Chungbuk National University, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Chae Hyeon Lee
- Medicinal Chemistry Laboratory, Department of Fundamental Pharmaceutical Sciences, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Sup Lee
- Medicinal Chemistry Laboratory, Department of Fundamental Pharmaceutical Sciences, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
| | - Hye Jin Cha
- College of Veterinary Medicine, Gyeongsang National University, Jinju, Gyeongsangnam–do, Republic of Korea
| | - Jae Hoon Cheong
- Institute for New Drug Development, School of Pharmacy, Jeonbuk National University, Jeonju, Jeollabuk-do, Republic of Korea
- *Correspondence: Jae Hoon Cheong, ; Hee Jin Kim,
| | - Hee Jin Kim
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, Seoul, Republic of Korea
- *Correspondence: Jae Hoon Cheong, ; Hee Jin Kim,
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Correction to: The Potential Proconvulsant Effects of Cannabis: a Scoping Review. J Med Toxicol 2023; 19:54-60. [PMID: 36322377 PMCID: PMC9813313 DOI: 10.1007/s13181-022-00915-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Wilson CD, Zheng F, Fantegrossi WE. Convulsant doses of abused synthetic cannabinoid receptor agonists AB-PINACA, 5F-AB-PINACA, 5F-ADB-PINACA and JWH-018 do not elicit electroencephalographic (EEG) seizures in male mice. Psychopharmacology (Berl) 2022; 239:3237-3248. [PMID: 35933518 DOI: 10.1007/s00213-022-06205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
RATIONALE Synthetic cannabinoid receptor agonists (SCRAs) are found in illicit smoking products, such as "K2" or "Spice." Convulsions are commonly reported adverse effects of SCRAs but are poorly understood. OBJECTIVES We determined convulsant effects of SCRAs AB-PINACA, and 5F-ADB-PINACA in adult male NIH Swiss mice, and then determined if convulsant effects of AB-PINACA, 5F-AB-PINACA, 5F-ADB-PINACA, and JWH-018 elicited seizure-like effects using EEG. METHODS Mice were administered SCRAs or pentylenetetrazole (PTZ) and placed in observation chambers where convulsant effects were scored. The capacity of the CB1R antagonist rimonabant, the benzodiazepine diazepam, or the non-specific CYP450 inhibitor 1-aminobenzotriazole (1-ABT) to attenuate convulsant effects was determined. Other mice were prepared with EEG headmounts to ascertain whether observed convulsions occurred concurrently with seizure-like effects by assessing root-mean-square (RMS) power, high amplitude EEG spike analysis, and videography. RESULTS Mice receiving AB-PINACA or 5F-ADB-PINACA exhibited dose-dependent convulsant effects that were blocked by 10 mg/kg rimonabant pretreatment but not by pretreatment with 10 mg/kg diazepam; these convulsant effects were not altered in the presence of 100 mg/kg 1-ABT. Repeated administration of 10 mg/kg AB-PINACA and 3 mg/kg 5F-ADB-PINACA produced partial tolerance to convulsant effects but did not lead to cross-tolerance to PTZ-induced convulsions. In EEG studies, convulsant doses of AB-PINACA, 5F-AB-PINACA, 5F-ADB-PINACA, and JWH-018 did not produce seizures concomitantly with convulsions. CONCLUSIONS These data extend previous findings of convulsant effects of SCRAs and suggest that convulsant effects of AB-PINACA, 5F-AB-PINACA, 5F-ADB-PINACA, and JWH-018 are CB1R-mediated but are not associated with electroencephalographic seizures. These results further suggest that benzodiazepines may not effectively treat convulsions elicited by SCRA use in humans.
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Affiliation(s)
- Catheryn D Wilson
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
| | - Fang Zheng
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
| | - William E Fantegrossi
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA.
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Zirotti Rosenberg A, Méndez-Ruette M, Gorziglia M, Alzerreca B, Cabello J, Kaufmann S, Rambousek L, Iturriaga Jofré A, Wyneken U, Lafourcade CA. Behavioral and Molecular Responses to Exogenous Cannabinoids During Pentylenetetrazol-Induced Convulsions in Male and Female Rats. Front Mol Neurosci 2022; 15:868583. [PMID: 36147210 PMCID: PMC9488559 DOI: 10.3389/fnmol.2022.868583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is a disabling, chronic brain disease,affecting ~1% of the World’s population, characterized by recurrent seizures (sudden, uncontrolled brain activity), which may manifest with motor symptoms (e.g., convulsions) or non-motor symptoms. Temporal lobe epilepsies (TLE) compromising the hippocampus are the most common form of focal epilepsies. Resistance in ~1/3 of epileptic patients to the first line of treatment, i.e., antiepileptic drugs (AEDs), has been an important motivation to seek alternative treatments. Among these, the plant Cannabis sativa (commonly known as marihuana) or compounds extracted from it (cannabinoids) have gained widespread popularity. Moreover, sex differences have been proposed in epilepsy syndromes and in cannabinoid action. In the hippocampus, cannabinoids interact with the CB1R receptor whose membrane levels are regulated by β-Arrestin2, a protein that promotes its endocytosis and causes its downregulation. In this article, we evaluate the modulatory role of WIN 55,212-2 (WIN), a synthetic exogenous cannabinoid on behavioral convulsions and on the levels of CB1R and β-Arrestin2 in female and male adolescent rats after a single injection of the proconvulsant pentylenetetrazol (PTZ). As epilepsies can have a considerable impact on synaptic proteins that regulate neuronal toxicity, plasticity, and cognition, we also measured the levels of key proteins markers of excitatory synapses, in order to examine whether exogenous cannabinoids may prevent such pathologic changes after acute seizures. We found that the exogenous administration of WIN prevented convulsions of medium severity in females and males and increased the levels of phosphorylated CaMKII in the hippocampus. Furthermore, we observed a higher degree of colocalization between CB1R and β-Arrestin2 in the granule cell layer.
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Affiliation(s)
| | - Maxs Méndez-Ruette
- Centro de investigación e innovación Biomédica (CiiB), Laboratorio de Neurociencias, Universidad de Los Andes, Santiago, Chile
| | - Mario Gorziglia
- Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
| | | | - Javiera Cabello
- Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
| | - Sofía Kaufmann
- Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
| | - Lukas Rambousek
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | | | - Ursula Wyneken
- Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
| | - Carlos A. Lafourcade
- Department of Biological Sciences, Xi’an Jiaotong-Liverpool University (XJTLU), Suzhou, China
- *Correspondence: Carlos A. Lafourcade
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The Potential Proconvulsant Effects of Cannabis: a Scoping Review. J Med Toxicol 2022; 18:223-234. [PMID: 35352276 PMCID: PMC9198115 DOI: 10.1007/s13181-022-00886-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cannabis' effect on seizure activity is an emerging topic that remains without consensus and merits further investigation. We therefore performed a scoping review to identify the available evidence and knowledge gaps within the existing literature on cannabis product exposures as a potential cause of seizures in humans. METHODS A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews guidelines. The PubMed and Scopus databases were searched over a 20-year period from the date of the database query (12/21/2020). Inclusion criteria were (1) English language original research articles, (2) inclusion of human subjects, and (3) either investigation of seizures as a part of recreational cannabinoid use OR of exogenous cannabinoids as a cause of seizures. RESULTS A total of 3104 unique articles were screened, of which 68 underwent full-text review, and 13 met inclusion/exclusion criteria. Ten of 11 studies evaluating acute cannabis exposures reported a higher seizure incidence than would be expected based on the prevalence of epilepsy in the general and pediatric populations (range 0.7-1.2% and 0.3-0.5% respectively). The remaining two studies demonstrated increased seizure frequency and/or seizure-related hospitalization in recreational cannabis users and those with cannabis use disorder. CONCLUSIONS This scoping review demonstrates that a body of literature describing seizures in the setting of cannabis exposure exists, but it has several limitations. Ten identified studies showed a higher than expected incidence of seizures in populations exposed to cannabis products. Based on the Bradford Hill criteria, delta-9 tetrahydrocannabinol (THC) may be the causative xenobiotic for this phenomenon.
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Lott J, Jutkiewicz EM, Puthenveedu MA. The Synthetic Cannabinoid WIN55,212-2 Can Disrupt the Golgi Apparatus Independent of Cannabinoid Receptor-1. Mol Pharmacol 2022; 101:371-380. [PMID: 35236771 PMCID: PMC9092469 DOI: 10.1124/molpharm.121.000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/22/2022] [Indexed: 11/22/2022] Open
Abstract
The synthetic cannabinoid WIN55,212-2 (WIN) is widely used as a pharmacological tool to study the biologic activity of cannabinoid receptors. In contrast to many other cannabinoid agonists, however, WIN also causes broad effects outside of neurons, such as reducing inflammatory responses, causing cell cycle arrest, and reducing general protein expression. How exactly WIN causes these broad effects is not known. Here we show that WIN partially disrupts the Golgi apparatus at nanomolar concentrations and fully disperses the Golgi apparatus in neuronal and non-neuronal cells at micromolar concentrations. WIN55,212-3, the enantiomer of WIN; JWH-018, a related alkylindole; or 2-arachidonoylglycerol, an endocannabinoid, did not cause Golgi disruption, suggesting that the effect was specific to the chirality of WIN. WIN treatment also perturbed the microtubule network. Importantly, WIN disrupted the Golgi in primary cortical neurons derived from mice where cannabinoid receptor-1 (CB1) was genetically knocked out, indicating that the effects were independent of CB1 signaling. The Golgi dispersion could not be explained by WIN's action on peroxisome proliferator-activated receptors. Our results show that WIN can disrupt the Golgi apparatus independent of CB1 in cultured cells. These effects could contribute to the unique physiologic effects that WIN exhibits in neuronal behavior, as well as its role as an antiproliferative and anti-inflammatory agent. SIGNIFICANCE STATEMENT: The synthetic cannabinoid WIN55,212-2 (WIN), widely used to investigate the cannabinoid system, also shows unique broader effects at cellular and organismal levels compared to endogenous cannabinoids. Our study shows that WIN can disrupt the Golgi apparatus and the microtubule network in multiple cell types, independent of cannabinoid receptors. These results could explain how WIN reduces surface levels of proteins and contributes to the unique physiological effects observed with WIN.
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Affiliation(s)
- Joshua Lott
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emily M Jutkiewicz
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan
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Phillips HN, Tormoehlen L. Toxin-Induced Seizures ∗Adapted from “Toxin-Induced Seizures” in Neurologic Clinics, November 2020. Emerg Med Clin North Am 2022; 40:417-430. [DOI: 10.1016/j.emc.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Treves N, Mor N, Allegaert K, Bassalov H, Berkovitch M, Stolar OE, Matok I. Efficacy and safety of medical cannabinoids in children: a systematic review and meta-analysis. Sci Rep 2021; 11:23462. [PMID: 34873203 PMCID: PMC8648720 DOI: 10.1038/s41598-021-02770-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/09/2021] [Indexed: 01/06/2023] Open
Abstract
Despite the increased use of medical cannabinoids, the efficacy and safety of the treatment among children remain uncertain. The objective was to study the efficacy and safety of medical cannabinoids in children. The search included studies through 11-May-2020. Selection criteria included studies evaluating efficacy and safety outcomes of medical cannabinoids (tetrahydrocannabinol, cannabidiol and other cannabis derivatives) versus control in children, independently assessed by two reviewers. Eight studies were included, all of which are randomized controlled trials. Cannabidiol is associated with 50% reduction in seizures rate (Relative Risk (RR) = 1.69, 95% CI [1.20-2.36]) and caregiver global impression of change (Median Estimated difference = (- 1), 95%CI [- 1.39-(- 0.60)]) in Dravet syndrome, compared to placebo. While cannabidiol was associated with a reduction in reported seizure events (RR = 0.59, 95% CI [0.36-0.97]), no association was found in products contained also tetrahydrocannabinol (RR = 1.35, 95% CI [0.46-4.03]). Higher dose of cannabidiol was associated with decreased appetite (RR = 2.40, 95% CI [1.39-4.15]). A qualitative assessment suggests that medical cannabinoids might be associated with adverse mental events. In conclusion, cannabidiol is associated with clinical improvement in Dravet syndrome. However, cannabidiol is also associated with decreased appetite. Adverse mental events were reported as well, however, more research should be performed to assess well this outcome.
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Affiliation(s)
- Nir Treves
- Division of Clinical Pharmacy, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noa Mor
- Division of Clinical Pharmacy, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Matitiahu Berkovitch
- Clinical Pharmacology Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Orit E Stolar
- The Autism Center, Alut, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Ilan Matok
- Department of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy and the David R. Bloom Center of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Roebuck AJ, Greba Q, Smolyakova AM, Alaverdashvili M, Marks WN, Garai S, Baglot SL, Petrie G, Cain SM, Snutch TP, Thakur GA, Hill MN, Howland JG, Laprairie RB. Positive allosteric modulation of type 1 cannabinoid receptors reduces spike-and-wave discharges in Genetic Absence Epilepsy Rats from Strasbourg. Neuropharmacology 2021; 190:108553. [PMID: 33845076 DOI: 10.1016/j.neuropharm.2021.108553] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 01/30/2023]
Abstract
Childhood Absence Epilepsy (CAE) accounts for approximately 10% of all pediatric epilepsies. Current treatments for CAE are ineffective in approximately 1/3 of patients and can be associated with severe side effects such as hepatotoxicity. Certain cannabinoids, such as cannabidiol (CBD), have shown promise in the treatment of pediatric epilepsies. However, CBD remains limited or prohibited in many jurisdictions, and has not been shown to have efficacy in CAE. Modulation of the type 1 cannabinoid receptor (CB1R) may provide more desirable pharmacological treatments. Genetic Absence Epilepsy Rats from Strasbourg (GAERS) model many aspects of CAE, including cortical spike and wave discharges (SWDs). We have recently demonstrated that Δ9-tetrahydrocannabinol (THC) increases SWDs in GAERS whereas CBD decreases these events. Here, we characterized aspects of the endocannabinoid system in brain areas relevant to seizures in GAERS and tested whether positive allosteric modulators (PAMs) of CB1R reduced SWDs. Both female and male GAERS had reduced (>50%) expression of CB1R and elevated levels of the endocannabinoid 2-AG in cortex compared to non-epileptic controls (NEC). We then administered the CB1R PAMs GAT211 and GAT229 to GAERS implanted with cortical electrodes. Systemic administration of GAT211 to male GAERS reduced SWDs by 40%. Systemic GAT229 administration reduced SWDs in female and male GAERS. Intracerebral infusion of GAT229 into the cortex of male GAERS reduced SWDs by >60% in a CB1R-dependent manner that was blocked by SR141716A. Together, these experiments identify altered endocannabinoid tone in GAERS and suggest that CB1R PAMs should be explored for treatment of absence seizures.
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Affiliation(s)
- Andrew J Roebuck
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada; School of Liberal Arts, Yukon University, Whitehorse, YT, Y1A 5K4, Canada
| | - Quentin Greba
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Anna-Maria Smolyakova
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 2Z4, Canada
| | - Mariam Alaverdashvili
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 2Z4, Canada
| | - Wendie N Marks
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Sumanta Garai
- Department of Pharmaceutical Sciences, Northeastern University, Boston, MA, 02115, United States
| | - Samantha L Baglot
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Gavin Petrie
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Stuart M Cain
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Terrance P Snutch
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Ganesh A Thakur
- Department of Pharmaceutical Sciences, Northeastern University, Boston, MA, 02115, United States
| | - Matthew N Hill
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - John G Howland
- Department of Anatomy, Physiology, and Pharmacology, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada.
| | - Robert B Laprairie
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 2Z4, Canada; Department of Pharmacology, College of Medicine, Dalhousie University, Halifax, NS, Canada, B3H 4R2.
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Genetic deletion of dopamine D1 receptors increases the sensitivity to cannabinoid CB1 receptor antagonist-precipitated withdrawal when compared with wild-type littermates: studies in female mice repeatedly exposed to the Spice cannabinoid HU-210. Psychopharmacology (Berl) 2021; 238:551-557. [PMID: 33410990 DOI: 10.1007/s00213-020-05704-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
RATIONALE The emergence of the consumption of highly potent synthetic cannabinoid receptor agonists (spice drugs) that produce important neurological symptoms has prompted the research on the consequences of acute and chronic use of these new psychoactive substances. Most studies on cannabinoid dependence have been performed in male animals, and there is a need of studies using female subjects. OBJECTIVES In the present study, we evaluated only in female animals the role of dopamine D1 receptors in the behavioral responses induced by acute and repeated stimulation of cannabinoid CB1 receptors, including the development of physical dependence, since cannabinoid CB1 receptors are co-localized with dopamine D1 receptors on GABAergic neurons projecting to the substantia nigra. METHODS To this end, female dopamine D1 receptor-deficient mice and wild-type littermates were treated with HU-210, a potent synthetic cannabinoid agonist. RESULTS Mutant mice displayed an enhanced response to acute motor and hypothermic effects to HU-210 when compared with wild-type females. The administration of SR141716A precipitated behavioral signs of withdrawal in mice treated subchronically with HU-210. Severity of cannabinoid withdrawal syndrome was potentiated in dopamine D1-deficient female mice. Indeed, 4 of 6 abstinence signs were increased in mutant mice. CONCLUSIONS These results support for a role of dopamine D1 receptors in the acute, chronic, and withdrawal actions of spice drugs.
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Abstract
New toxins are emerging all the time. In this article, the authors review common toxins that cause seizure, their mechanisms, associated toxidromes, and treatments. Stimulants, cholinergic agents, gamma-aminobutyric acid antagonists, glutamate agonists, histamine and adenosine antagonists, and withdrawal states are highlighted. Understanding current mechanisms for common toxin-induced seizures can promote understanding for future toxins and predicting if seizure may occur as a result of toxicity.
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Affiliation(s)
- Haley N Phillips
- Department of Neurology, Indiana University, Indiana University Neuroscience Center, 355 West 16th Street, Suite 4700, Indianapolis, IN 46202, USA.
| | - Laura Tormoehlen
- Department of Neurology, Indiana University, Indiana University Neuroscience Center, 355 West 16th Street, Suite 4700, Indianapolis, IN 46202, USA; Department of Emergency Medicine-Toxicology, Indiana University, Indiana University Neuroscience Center, 355 West 16th Street, Suite 4700, Indianapolis, IN 46202, USA
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15
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Lourenço DM, Ribeiro-Rodrigues L, Sebastião AM, Diógenes MJ, Xapelli S. Neural Stem Cells and Cannabinoids in the Spotlight as Potential Therapy for Epilepsy. Int J Mol Sci 2020; 21:E7309. [PMID: 33022963 PMCID: PMC7582633 DOI: 10.3390/ijms21197309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 01/18/2023] Open
Abstract
Epilepsy is one of the most common brain diseases worldwide, having a huge burden in society. The main hallmark of epilepsy is the occurrence of spontaneous recurrent seizures, having a tremendous impact on the lives of the patients and of their relatives. Currently, the therapeutic strategies are mostly based on the use of antiepileptic drugs, and because several types of epilepsies are of unknown origin, a high percentage of patients are resistant to the available pharmacotherapy, continuing to experience seizures overtime. Therefore, the search for new drugs and therapeutic targets is highly important. One key aspect to be targeted is the aberrant adult hippocampal neurogenesis (AHN) derived from Neural Stem Cells (NSCs). Indeed, targeting seizure-induced AHN may reduce recurrent seizures and shed some light on the mechanisms of disease. The endocannabinoid system is a known modulator of AHN, and due to the known endogenous antiepileptic properties, it is an interesting candidate for the generation of new antiepileptic drugs. However, further studies and clinical trials are required to investigate the putative mechanisms by which cannabinoids can be used to treat epilepsy. In this manuscript, we will review how cannabinoid-induced modulation of NSCs may promote neural plasticity and whether these drugs can be used as putative antiepileptic treatment.
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Affiliation(s)
- Diogo M. Lourenço
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (D.M.L.); (L.R.-R.); (A.M.S.); (M.J.D.)
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Leonor Ribeiro-Rodrigues
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (D.M.L.); (L.R.-R.); (A.M.S.); (M.J.D.)
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Ana M. Sebastião
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (D.M.L.); (L.R.-R.); (A.M.S.); (M.J.D.)
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Maria J. Diógenes
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (D.M.L.); (L.R.-R.); (A.M.S.); (M.J.D.)
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Sara Xapelli
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (D.M.L.); (L.R.-R.); (A.M.S.); (M.J.D.)
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
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16
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Nguyen QTR, Gravier A, Lesoil C, Bedet A, Petit-Hoang C, Mahevas M, Mekontso-Dessap A, Hodel J, Bachoud-Lévi AC, Cleret de Langavant L. Acute Hippocampal Encephalopathy in Heavy Cannabis Users: About 2 Cases. Am J Med 2020; 133:e360-e364. [PMID: 31877268 DOI: 10.1016/j.amjmed.2019.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cannabis use is increasing worldwide despite the various health effects of this substance. METHODS We report 2 cases of acute hippocampal encephalopathy in heavy cannabis users (>10 joints/d). RESULTS In both male patients, acute encephalitis was suspected. Brain magnetic resonance imaging (MRI) diffusion-weighted sequences showed bilateral high signal abnormalities in hippocampal regions. Patients had renal dysfunction, rhabdomyolysis, and inflammatory syndrome. Investigations showed no evidence of infectious or autoimmune encephalitides. Repeated electroencephalograms revealed no epileptic activity. Clinical, biological, and magnetic resonance imaging acute abnormalities improved within weeks. New exposure to cannabis yielded a new episode of encephalopathy. In both patients, severe long-lasting episodic memory impairment associated with hippocampal atrophy were observed several months later. CONCLUSIONS Health professionals should be aware of this cannabis-related syndrome given its severe and long-lasting effects.
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Affiliation(s)
- Quang Tuan Rémy Nguyen
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Neurologie, Créteil, France; INSERM U955 Equipe E01, Institut Mondor de recherche biomédicale, Neuropsychologie Interventionnelle, Créteil, France; Département d'Etudes Cognitives, Ecole Normale Supérieure, PSL University, Paris, France; Université Paris Est, Faculté de Médecine, Créteil, France
| | - Alban Gravier
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Neurologie, Créteil, France
| | - Constance Lesoil
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Neurologie, Créteil, France
| | - Alexandre Bedet
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Médecine Intensive Réanimation, Créteil, France
| | - Camille Petit-Hoang
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Neurologie, Créteil, France
| | - Matthieu Mahevas
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Médecine interne, Créteil, France
| | - Armand Mekontso-Dessap
- Université Paris Est, Faculté de Médecine, Créteil, France; Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Médecine Intensive Réanimation, Créteil, France
| | - Jérôme Hodel
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Neurologie, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France
| | - Anne-Catherine Bachoud-Lévi
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Neurologie, Créteil, France; INSERM U955 Equipe E01, Institut Mondor de recherche biomédicale, Neuropsychologie Interventionnelle, Créteil, France; Département d'Etudes Cognitives, Ecole Normale Supérieure, PSL University, Paris, France; Université Paris Est, Faculté de Médecine, Créteil, France
| | - Laurent Cleret de Langavant
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, service de Neurologie, Créteil, France; INSERM U955 Equipe E01, Institut Mondor de recherche biomédicale, Neuropsychologie Interventionnelle, Créteil, France; Département d'Etudes Cognitives, Ecole Normale Supérieure, PSL University, Paris, France; Université Paris Est, Faculté de Médecine, Créteil, France; Global Brain Health Institute, UCSF, San Francisco, California, USA.
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17
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Ferreira C, Couceiro J, Família C, Jardim C, Antas P, Santos CN, Outeiro TF, Tenreiro S, Quintas A. The synthetic cannabinoid JWH-018 modulates Saccharomyces cerevisiae energetic metabolism. FEMS Yeast Res 2020; 19:5521208. [PMID: 31329229 DOI: 10.1093/femsyr/foz042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/18/2019] [Indexed: 02/07/2023] Open
Abstract
Synthetic cannabinoids are a group of novel psychoactive substances with similar properties to Δ9-THC. Among the vast number of synthetic cannabinoids, designed to be tested in clinical trials, JWH-018 was the first novel psychoactive substance found in the recreational drug marketplace. The consumption of JWH-018 shows typical effects of CB1 agonists including sedation, cognitive dysfunction, tachycardia, postural hypotension, dry mouth, ataxia and psychotropic effects, but appeared to be more potent than Δ9-THC. However, studies on human cells have shown that JWH-018 toxicity depends on the cellular line used. Despite these studies, the underlying molecular mechanisms to JWH-018 action has not been clarified yet. To understand the impact of JWH-018 at molecular and cellular level, we used Saccharomyces cerevisiae as a model. The results showed an increase in yeast growth rate in the presence of this synthetic cannabinoid due to an enhancement in the glycolytic flux at expense of a decrease in pentose phosphate pathway, judging by 2D-Gel proteomic analysis, qRT-PCR experiments and ATP measurements. Overall, our results provide insights into molecular mechanisms of JWH-018 action, also indicating that Saccharomyces cerevisiae is a good model to study synthetic cannabinoids.
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Affiliation(s)
- Carla Ferreira
- Molecular Pathology and Forensic Biochemistry Laboratory, Centro de Investigação Interdisciplinar Egas Moniz, P-2825-084 Caparica, Portugal.,Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário - Quinta da Granja, Monte de Caparica, P-2825-084 Caparica, Portugal.,Faculty of Medicine of Porto University, Al. Prof. Hernâni Monteiro, P-4200-319 Porto, Portugal
| | - Joana Couceiro
- Molecular Pathology and Forensic Biochemistry Laboratory, Centro de Investigação Interdisciplinar Egas Moniz, P-2825-084 Caparica, Portugal.,Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário - Quinta da Granja, Monte de Caparica, P-2825-084 Caparica, Portugal
| | - Carlos Família
- Molecular Pathology and Forensic Biochemistry Laboratory, Centro de Investigação Interdisciplinar Egas Moniz, P-2825-084 Caparica, Portugal.,Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário - Quinta da Granja, Monte de Caparica, P-2825-084 Caparica, Portugal
| | - Carolina Jardim
- Instituto de Biologia Experimental e Tecnológica, Apartado 12, P-2780-901 Oeiras, Portugal.,Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Av. da República, P-2780-157 Oeiras, Portugal
| | - Pedro Antas
- CEDOC - Chronic Diseases Research Center, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, P-1150-082 Lisboa, Portugal
| | - Cláudia N Santos
- Instituto de Biologia Experimental e Tecnológica, Apartado 12, P-2780-901 Oeiras, Portugal.,Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Av. da República, P-2780-157 Oeiras, Portugal.,CEDOC - Chronic Diseases Research Center, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, P-1150-082 Lisboa, Portugal
| | - Tiago F Outeiro
- CEDOC - Chronic Diseases Research Center, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, P-1150-082 Lisboa, Portugal.,Department of Experimental Neurodegeneration, Center for Nanoscale Microscopy and Molecular Physiology of the Brain, University Medical Center Göttingen, Waldweg 33. Göttingen P37073, Germany.,Institute of Neuroscience, Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne P-NE1 7RU, UK.,Max Planck Institute for Experimental Medicine, Hermann Rein Street 3. P-37075 Göttingen, Germany
| | - Sandra Tenreiro
- CEDOC - Chronic Diseases Research Center, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, P-1150-082 Lisboa, Portugal
| | - Alexandre Quintas
- Molecular Pathology and Forensic Biochemistry Laboratory, Centro de Investigação Interdisciplinar Egas Moniz, P-2825-084 Caparica, Portugal.,Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Campus Universitário - Quinta da Granja, Monte de Caparica, P-2825-084 Caparica, Portugal
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18
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Aliferis KA, Bernard-Perron D. Cannabinomics: Application of Metabolomics in Cannabis ( Cannabis sativa L.) Research and Development. FRONTIERS IN PLANT SCIENCE 2020; 11:554. [PMID: 32457786 PMCID: PMC7225349 DOI: 10.3389/fpls.2020.00554] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/14/2020] [Indexed: 05/18/2023]
Abstract
Cannabis (Cannabis sativa L.) is a complex, polymorphic plant species, which produces a vast array of bioactive metabolites, the two major chemical groups being cannabinoids and terpenoids. Nonetheless, the psychoactive cannabinoid tetrahydrocannabinol (Δ 9 -THC) and the non-psychoactive cannabidiol (CBD), are the two major cannabinoids that have monopolized the research interest. Currently, more than 600 Cannabis varieties are commercially available, providing access to a multitude of potent extracts with complex compositions, whose genetics are largely inconclusive. Recently introduced legislation on Cannabis cultivation in many countries represents a great opportunity, but at the same time, a great challenge for Cannabis research and development (R&D) toward applications in the pharmaceutical, food, cosmetics, and agrochemical industries. Based on its versatility and unique capabilities in the deconvolution of the metabolite composition of complex matrices, metabolomics represents an ideal bioanalytical tool that could greatly assist and accelerate Cannabis R&D. Among others, Cannabis metabolomics or cannabinomics can be applied in the taxonomy of Cannabis varieties in chemovars, the research on the discovery and assessment of new Cannabis-based sources of bioactivity in medicine, the development of new food products, and the optimization of its cultivation, aiming for improvements in yield and potency. Although Cannabis research is still in its infancy, it is highly foreseen that the employment of advanced metabolomics will provide insights that could assist the sector to face the aforementioned challenges. Within this context, here, the current state-of-the-art and conceptual aspects of cannabinomics are presented.
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Affiliation(s)
- Konstantinos A. Aliferis
- Laboratory of Pesticide Science, Agricultural University of Athens, Athens, Greece
- Department of Plant Science, McGill University, Montreal, QC, Canada
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19
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Sachdev S, Banister SD, Santiago M, Bladen C, Kassiou M, Connor M. Differential activation of G protein-mediated signaling by synthetic cannabinoid receptor agonists. Pharmacol Res Perspect 2020; 8:e00566. [PMID: 32101383 PMCID: PMC7043210 DOI: 10.1002/prp2.566] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022] Open
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are new psychoactive substances associated with acute intoxication and even death. However, the molecular mechanisms through which SCRAs may exert their toxic effects remain unclear-including the potential differential activation of G protein subtypes by cannabinoid receptor type 1 (CB1), a major target of SCRA. We measured CB1-mediated activation of Gαs and Gαi/o proteins by SCRAs by examining stimulation (pertussis toxin, PTX treated) as well as inhibition (non-PTX treated) of forskolin (FSK)-induced cyclic adenosine monophosphate (cAMP) accumulation in human embryonic kidney (HEK) cells stably expressing CB1. Real-time measurements of stimulation and inhibition of cAMP levels were made using a BRET biosensor. We found that the maximum concentration of SCRAs tested (10 µmol L-1 ), increased cAMP levels 12%-45% above that produced by FSK alone, while the phytocannabinoid THC did not significantly alter cAMP levels in PTX-treated HEK-CB1 cells. All SCRAs had greater potency to inhibit FSK-induced cAMP levels than to stimulate cAMP levels. The rank order of potencies for SCRA stimulation of cAMP (Gαs ) was PB-22 > 5F-MDMB-PICA > JWH-018 ≈ AB-FUBINACA > XLR-11. By contrast, the potency of SCRAs for inhibition of cAMP (Gαi/o ) was 5F-MDMB-PICA > AB-FUBINACA > PB-22 > JWH-018 > XLR-11. The different rank order of potency and EMax of the SCRAs to stimulate Gαs -like signaling compared to Gαi/o signaling suggests differences in G protein preference between SCRAs. Understanding the apparent differences among these drugs may contribute to unravelling their complex effects in humans.
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Affiliation(s)
- Shivani Sachdev
- Department of Biomedical SciencesMacquarie UniversitySydneyNSWAustralia
| | - Samuel D. Banister
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind CentreThe University of SydneySydneyNSWAustralia
- School of ChemistryThe University of SydneySydneyNSWAustralia
| | - Marina Santiago
- Department of Biomedical SciencesMacquarie UniversitySydneyNSWAustralia
| | - Chris Bladen
- Department of Biomedical SciencesMacquarie UniversitySydneyNSWAustralia
| | - Michael Kassiou
- School of ChemistryThe University of SydneySydneyNSWAustralia
| | - Mark Connor
- Department of Biomedical SciencesMacquarie UniversitySydneyNSWAustralia
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20
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The Endocannabinoid System and Synthetic Cannabinoids in Preclinical Models of Seizure and Epilepsy. J Clin Neurophysiol 2020; 37:15-27. [PMID: 31895186 DOI: 10.1097/wnp.0000000000000633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Cannabinoids are compounds that are structurally and/or functionally related to the primary psychoactive constituent of Cannabis sativa, [INCREMENT]-tetrahydrocannabinol (THC). Cannabinoids can be divided into three broad categories: endogenous cannabinoids, plant-derived cannabinoids, and synthetic cannabinoids (SCs). Recently, there has been an unprecedented surge of interest into the pharmacological and medicinal properties of cannabinoids for the treatment of epilepsies. This surge has been stimulated by an ongoing shift in societal opinions about cannabinoid-based medicines and evidence that cannabidiol, a nonintoxicating plant cannabinoid, has demonstrable anticonvulsant activity in children with treatment-refractory epilepsy. The major receptors of the endogenous cannabinoid system (ECS)-the type 1 and 2 cannabinoid receptors (CB1R, CB2R)-have critical roles in the modulation of neurotransmitter release and inflammation, respectively; so, it is not surprising therefore that the ECS is being considered as a target for the treatment of epilepsy. SCs were developed as potential new drug candidates and tool compounds for studying the ECS. Beyond the plant cannabinoids, an extensive research effort is underway to determine whether SCs that directly target CB1R, CB2R, or the enzymes that breakdown endogenous cannabinoids have anticonvulsant effects in preclinical rodent models of epilepsy and seizure. This research demonstrates that many SCs do reduce seizure severity in rodent models and may have both positive and negative pharmacodynamic and pharmacokinetic interactions with clinically used antiepilepsy drugs. Here, we provide a comprehensive review of the preclinical evidence for and against SC modulation of seizure and discuss the important questions that need to be addressed in future studies.
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21
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The other side of the leaf: Seizures associated with synthetic cannabinoid use. Epilepsy Behav 2020; 104:106901. [PMID: 31958643 DOI: 10.1016/j.yebeh.2020.106901] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 01/19/2023]
Abstract
There has recently been a marked rise in the medicinal use of cannabis for epilepsy and multiple other conditions. While seizures have been reported in association with synthetic cannabinoids, the clinical features and prognosis have not been studied. Thirty patients with a history of seizures occurring within 24 h of synthetic cannabinoid use were identified from a first seizure clinic database in Perth, Western Australia between 2011 and 2016. Eight had a prior history of seizures, three related to synthetic cannabinoid use, with an additional three patients having risk factors for seizures. The presenting event was a tonic-clonic seizure in 27 patients (90%). "Kronic" was the synthetic cannabinoid used by 16 patients. Absorption was via smoking in all cases, with seizures occurring within 30 min of inhalation in 14 patients (46%). Electroencephalography (EEG) showed epileptiform abnormalities in 11%, and neuroimaging revealed epileptogenic lesions in 12%. Nine of 24 patients with follow-up had subsequent seizures, occurring in the setting of further synthetic cannabinoid use in two patients. This seizure recurrence rate is similar to seizures provoked by other acute systemic insults. In conclusion, smoking of some synthetic cannabinoids is associated with seizures, and this may relate to an intrinsic proconvulsant effect.
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22
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Breivogel CS, Wells JR, Jonas A, Mistry AH, Gravley ML, Patel RM, Whithorn BE, Brenseke BM. Comparison of the Neurotoxic and Seizure-Inducing Effects of Synthetic and Endogenous Cannabinoids with Δ 9-Tetrahydrocannabinol. Cannabis Cannabinoid Res 2020; 5:32-41. [PMID: 32322674 PMCID: PMC7173680 DOI: 10.1089/can.2019.0003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introduction: Synthetic cannabinoids (SCs) are commonly found in preparations used as recreational drugs. Although severe adverse health effects are not generally associated with cannabis use, a rising number of studies document seizures and even death after SC use. In this study, a mouse model is used to investigate the hypothesis that SCs are more toxic than Δ9-tetrahydrocannabinol (THC), the principal psychoactive constituent of cannabis. Materials and Methods: Beginning with the SCs, JWH-073 and AM-2201, dose–response curves were generated to find the dose of each drug that was similarly efficacious to 50 mg/kg THC. Mice were given daily intraperitoneal (IP) injections of vehicle, 50 mg/kg THC, 30 mg/kg JWH-073, or 1 mg/kg AM-2201 until tolerance to the antinociceptive and hypothermic effects was complete, and then were assessed for spontaneous and antagonist-precipitated withdrawal and potential organ damage. No differences in tolerance were noted, but AM-2201 showed more rearing in the spontaneous and antagonist-precipitated withdrawal phases than either vehicle or the other two drug treatments. Histopathological examination of these mice revealed no drug-induced lesions. In a subsequent set of experiments, various doses of THC, methanandamide (mAEA), and of a variety of SCs (HU-210, CP55940, JWH-073, AM-2201, and PB-22) were given IP, and convulsions and change in body temperature were quantified. Discussion: The treatments yielded varying numbers of convulsions and a range of changes in body temperature. JWH-073 and AM-2201 produced significantly more convulsions than THC, HU-210, mAEA, or cannabidiol (CBD) (the latter two producing none). HU-210, CP55940, JWH-073, and mAEA produced greater hypothermia than THC or CBD. Convulsions and hypothermia induced by several agonists were prevented by pretreatment with a CB1 antagonist, but not a CB2 antagonist. Conclusions: In agreement with human studies and case reports, this study found that SCs generally produced more seizures than THC. Of particular significance was the finding that mAEA produced far greater hypothermia than THC (similar to most SCs), but unlike the SCs and THC, produced no seizures.
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Affiliation(s)
- Chris S Breivogel
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Jacob R Wells
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Amreen Jonas
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Artik H Mistry
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Morgan L Gravley
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina
| | - Rajul M Patel
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina
| | - Brianna E Whithorn
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina
| | - Bonnie M Brenseke
- School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina
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23
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Sachdev S, Vemuri K, Banister SD, Longworth M, Kassiou M, Santiago M, Makriyannis A, Connor M. In vitro determination of the efficacy of illicit synthetic cannabinoids at CB 1 receptors. Br J Pharmacol 2019; 176:4653-4665. [PMID: 31412133 DOI: 10.1111/bph.14829] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/10/2019] [Accepted: 08/05/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The morbidity and mortality associated with recreational use of synthetic cannabinoid receptor agonists (SCRAs) may reflect strong activation of CB1 receptors and is a major health concern. The properties of SCRA at CB1 receptors are not well defined. Here we have developed an assay to determine acute CB1 receptor efficacy using receptor depletion with the irreversible CB1 receptor antagonist AM6544, with application of the Black and Leff operational model to calculate efficacy. EXPERIMENTAL APPROACH Receptor depletion in mouse AtT-20 pituitary adenoma cells stably expressing human CB1 receptors was achieved by pretreatment of cells with AM6544 (10 μM, 60 min). The CB1 receptor-mediated hyperpolarisation of AtT-20 cells was measured using fluorescence-based membrane potential dye. From data fit to the operational model, the efficacy (τ) and affinity (KA ) parameters were obtained for each drug. KEY RESULTS AM6544 did not affect the potency or maximal effect of native somatostatin receptor-induced hyperpolarization. The τ value of ∆9 -THC was 80-fold less than the reference CB receptor agonist CP55940 and 260-fold less than the highest efficacy SCRA, 5F-MDMB-PICA. The operational efficacy of SCRAs ranged from 233 (5F-MDMB-PICA) to 28 (AB-PINACA), with CP55940 in the middle of the efficacy rank order. There was no correlation between the τ and KA values. CONCLUSIONS AND IMPLICATIONS All SCRAs tested showed substantially higher efficacy at CB1 receptors than ∆9 -THC, which may contribute to the adverse effects seen with these drugs but not ∆9 -THC.
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Affiliation(s)
- Shivani Sachdev
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
| | - Kiran Vemuri
- Center for Drug Discovery, Department of Pharmaceutical Sciences and Chemical Biology, Northeastern University, Boston, Massachusetts
| | - Samuel D Banister
- The Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,School of Chemistry, The University of Sydney, NSW, Australia
| | | | - Michael Kassiou
- School of Chemistry, The University of Sydney, NSW, Australia
| | - Marina Santiago
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alexandros Makriyannis
- Center for Drug Discovery, Department of Pharmaceutical Sciences and Chemical Biology, Northeastern University, Boston, Massachusetts
| | - Mark Connor
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
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24
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Kevin RC, Anderson L, McGregor IS, Boyd R, Manning JJ, Glass M, Connor M, Banister SD. CUMYL-4CN-BINACA Is an Efficacious and Potent Pro-Convulsant Synthetic Cannabinoid Receptor Agonist. Front Pharmacol 2019; 10:595. [PMID: 31191320 PMCID: PMC6549035 DOI: 10.3389/fphar.2019.00595] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/09/2019] [Indexed: 01/07/2023] Open
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are the largest class of new psychoactive substances (NPS). New examples are detected constantly, and some are associated with a series of adverse effects, including seizures. CUMYL-4CN-BINACA (1-(4-cyanobutyl)-N-(2-phenylpropan-2-yl)indazole-3-carboxamide) is structurally related to potent, cumylamine-derived SCRAs such as 5F-CUMYL-PINACA, but is unusual due to a terminal aliphatic nitrile group not frequently encountered in SCRAs or pharmaceuticals. We report here that CUMYL-4CN-BINACA is a potent CB1 receptor agonist (K i = 2.6 nM; EC50 = 0.58 nM) that produces pro-convulsant effects in mice at a lower dose than reported for any SCRA to date (0.3 mg/kg, i.p). Hypothermic and pro-convulsant effects in mice could be reduced or blocked, respectively, by pretreatment with CB1 receptor antagonist SR141716, pointing to at least partial involvement of CB1 receptors in vivo. Pretreatment with CB2 receptor antagonist AM-630 had no effect on pro-convulsant activity. The pro-convulsant properties and potency of CUMYL-4CN-BINACA may underpin the toxicity associated with this compound in humans.
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Affiliation(s)
- Richard C. Kevin
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, NSW, Australia
| | - Lyndsey Anderson
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, NSW, Australia
- Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Iain S. McGregor
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, NSW, Australia
| | - Rochelle Boyd
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jamie J. Manning
- Department of Pharmacology and Toxicology, The University of Otago, Dunedin, New Zealand
| | - Michelle Glass
- Department of Pharmacology and Toxicology, The University of Otago, Dunedin, New Zealand
| | - Mark Connor
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Samuel D. Banister
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, NSW, Australia
- School of Chemistry, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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25
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26
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Sabioni P, Le Foll B. Psychosocial and Pharmacological Interventions for the Treatment of Cannabis Use Disorder. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2019; 17:163-168. [PMID: 32021586 DOI: 10.1176/appi.focus.17202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from Sabioni P and Le Foll B. Psychosocial and pharmacological interventions for the treatment of cannabis use disorder [version 1; referees: 3 approved]. F1000Research 2018, 7(F1000 Faculty Rev):173 (https://doi.org/10.12688/f1000research.11191.1)).
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27
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Abdel-Salam OME, Sleem AA, Mohamed Sayed MAEB, Youness ER, Shaffie N. Neuroprotective Effects of Low Dose Anandamide in Pentylenetetrazole-Induced Kindling in Rats. ACTA ACUST UNITED AC 2019. [DOI: 10.13005/bpj/1610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Anandamide (N-arachidonoylethanolamine) is an endogenous cannabinoid receptor CB1 ligand that exhibits neuroprotective effects in the brain. In this study, the effect of exogenously given anandamide on pentylenetetrazole (PTZ)-induced chemical kindling oxidative stress and brain damage in rats was studied. Rats were intraperitoneally (i.p.) injected with 35 mg/kg PTZ once every 48 hours for 12 times to induce seizures. Anandamide was i.p. given. 30 min prior to PTZ injection at 100 or 200 mg/kg. Injections of PTZ induced significant increase in brain lipid peroxidation (malondialdehyde: MDA), and nitric oxide associated with marked decrease in brain reduced glutathione (GSH). There were also significant decrements in acetylcholinesterase (AChE) concentration, butyrylcholinesterase (BChE) and paraoxonase-1 (PON-1) activities in brain tissue of PTZ injected rats. Meanwhile, there was no significant effect for PTZ on the concentration of brain neutrophil elastase. Anandamide administered at 100 and 200 mg/kg significantly decreased MDA and increased GSH contents and at 200 mg/kg significantly decreased nitric oxide in brain of PTZ-treated rats. The drug also caused significant increments in AChE concentration and PON-1 activity but had no significant effect on BChE or neutrophil elastase in rats treated with PTZ. Anandamide given at the dose of 200mg/kg significantly decreased the mean seizure scores over the study period by 22.3% and the frequency of myoclonic jerks and rearing (stage 3) by 56.7% compared with the vehicle-treated group. Anandamide given at 100 and 200 mg/kg completely inhibited the development of generalized tonic-clonic seizures (stage 5). It is concluded that in the PTZ-induced seizures, the cannabinoid receptor CB1 agonist anandamide decreases brain oxidative stress, neuronal injury, and exerts an antiepileptic activity.
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Affiliation(s)
| | - Amany A. Sleem
- Department of Pharmacology, National Research Centre, Cairo, Egypt
| | | | - Eman R. Youness
- Department of Medical Biochemistry, National Research Centre, Cairo, Egypt
| | - Nermeen Shaffie
- Department of Pathology, National Research Centre, Cairo, Egypt
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28
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Gamage TF, Farquhar CE, McKinnie RJ, Kevin RC, McGregor IS, Trudell ML, Wiley JL, Thomas BF. Synthetic Cannabinoid Hydroxypentyl Metabolites Retain Efficacy at Human Cannabinoid Receptors. J Pharmacol Exp Ther 2019; 368:414-422. [PMID: 30552295 PMCID: PMC6374541 DOI: 10.1124/jpet.118.254425] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/12/2018] [Indexed: 01/26/2023] Open
Abstract
Synthetic cannabinoids (SCs) are novel psychoactive substances that are easily acquired, widely abused as a substitute for cannabis, and associated with cardiotoxicity and seizures. Although the structural bases of these compounds are scaffolds with known affinity and efficacy at the human cannabinoid type-1 receptor (hCB1), upon ingestion or inhalation they can be metabolized to multiple chemical entities of unknown pharmacological activity. A large proportion of these metabolites are hydroxylated on the pentyl chain, a key substituent that determines receptor affinity and selectivity. Thus, the pharmacology of SC metabolites may be an important component in understanding the in vivo effects of SCs. We examined nine SCs (AB-PINACA, 5F-AB-PINACA, ADB/MDMB-PINACA, 5F-ADB, 5F-CUMYL-PINACA, AMB-PINACA, 5F-AMB, APINACA, and 5F-APINACA) and their hydroxypentyl (either 4-OH or 5-OH) metabolites in [3H]CP55,940 receptor binding and the [35S]GTPγS functional assay to determine the extent to which these metabolites retain activity at cannabinoid receptors. All of the SCs tested exhibited high affinity (<10 nM) and efficacy for hCB1 and hCB2 The majority of the hydroxypentyl metabolites retained full efficacy at hCB1 and hCB2, albeit with reduced affinity and potency, and exhibited greater binding selectivity for hCB2 These data suggest that phase I metabolites may be contributing to the in vivo pharmacology and toxicology of abused SCs. Considering this and previous reports demonstrating that metabolites retain efficacy at the hCB1 receptor, the full pharmacokinetic profiles of the parent compounds and their metabolites need to be considered in terms of the pharmacological effects and time course associated with these drugs.
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Affiliation(s)
- Thomas F Gamage
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Charlotte E Farquhar
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Ryan J McKinnie
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Richard C Kevin
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Iain S McGregor
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Mark L Trudell
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Jenny L Wiley
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
| | - Brian F Thomas
- RTI International, Research Triangle Park, North Carolina (T.F.G., C.E.F., J.L.W., B.F.T.); Department of Chemistry, University of New Orleans, New Orleans, Louisiana (R.J.M., M.L.T.); and School of Psychology, University of Sydney, Sydney, New South Wales, Australia (R.C.K., I.S.M.)
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29
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Carvalho A, Evans-Gilbert T. The Pathophysiology of Marijuana-induced Encephalopathy and Possible Epilepsy after Ingestion in Children: A Case Series. INNOVATIONS IN CLINICAL NEUROSCIENCE 2019; 16:16-18. [PMID: 31214478 PMCID: PMC6538397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: Ingestion of marijuana in children presents primarily with encephalopathy and potentially, in severe cases, seizures. There is a growing body of evidence supporting the benefit of medical marijuana as an anticonvulsant treatment for intractable seizures. However, there are limited data regarding its proconvulsant effects after ingestion. In this case series, we review the pathophysiology of marijuana encephalopathy and potential seizures after ingestion of marijuana in infants and young children. Case presentation: We summarized the cases of six children who were admitted to the hospital with neurological symptoms and a positive urine test for tetrahydrocannabinol (THC) between 2016 and 2018. The primary symptom was excessive drowsiness, with two children progressing to an unarousable state. Two cases presented after ingesting a marijuana confectionery, and the caregivers in four cases were unaware that marijuana exposure was responsible for the clinical presentation. All cases resolved without sequelae and were investigated by social services. In one case, a 6-year-old child with developmental delay and a previous episode of seizures presented with recurrent seizures and evidence of marijuana exposure. Marijuana was considered a probable cause due its proconvulsant effects, but a subsequent seizure episode with a negative urine THC ruled this out. Conclusion: Physicians should consider the possibility of ingestion of marijuana in infants and young children who present with symptoms of unexplained drowsiness. Marijuana products have the potential to provoke seizures and affect the developing brain of a child. Self-medication with marijuana products should be dissuaded, particularly in households with young children.
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Affiliation(s)
- Alister Carvalho
- Drs. Carvalho and Evans-Gilbert are with the Department of Pediatrics at the Cornwall Regional Hospital in Montego Bay, Jamaica
- Dr. Evans-Gilbert is also with the University of the West Indies, Western Campus, in Montego Bay, Jamaica
| | - Tracy Evans-Gilbert
- Drs. Carvalho and Evans-Gilbert are with the Department of Pediatrics at the Cornwall Regional Hospital in Montego Bay, Jamaica
- Dr. Evans-Gilbert is also with the University of the West Indies, Western Campus, in Montego Bay, Jamaica
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30
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Wilson CD, Tai S, Ewing L, Crane J, Lockhart T, Fujiwara R, Radominska-Pandya A, Fantegrossi WE. Convulsant Effects of Abused Synthetic Cannabinoids JWH-018 and 5F-AB-PINACA Are Mediated by Agonist Actions at CB1 Receptors in Mice. J Pharmacol Exp Ther 2019; 368:146-156. [PMID: 30420360 PMCID: PMC6323622 DOI: 10.1124/jpet.118.251157] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/07/2018] [Indexed: 01/29/2023] Open
Abstract
Convulsant effects of abused synthetic cannabinoid (SCB) drugs have been reported in humans and laboratory animals, but the mechanism of these effects is not known. We compared convulsant effects of partial CB1R agonist ∆9-tetrahydrocannabinol (THC), full CB1R agonist SCBs JWH-018 and 5F-AB-PINACA, and classic chemical convulsant pentylenetetrazol (PTZ) using an observational rating scale in mice. THC did not elicit convulsions, but both SCBs did so as effectively as and more potently than PTZ. SCB-elicited convulsions were attenuated by the CB1R antagonist rimonabant or by THC, or by dose regimens of THC and JWH-018, which downregulate and desensitize CB1Rs. None of these treatments altered the convulsant effects of PTZ, although diazepam attenuated PTZ-elicited convulsions without altering SCB-induced convulsant effects. Repeated administration of a subthreshold dose of PTZ kindled convulsant effects, but this was not observed with the SCBs, and no cross-kindling was observed. Repeated administration of the SCBs resulted in tolerance to convulsant effects, but no cross-tolerance to PTZ was observed. Inhibition on Phase I metabolism via nonselective inhibition of CYP450s with 1-aminobenzotriazole potentiated the hypothermic effects of the SCBs and protected against the convulsant effects of JWH-018, but not those of 5F-AB-PINACA or PTZ. Incubation of human liver microsomes with the SCBs showed that JWH-018 is eliminated via oxidation, whereas 5F-AB-PINACA is not. These studies suggest that SCB-elicited convulsions are mediated by high intrinsic efficacy at CB1Rs and that benzodiazepines may not be effective treatments. Finally, drug metabolism may dramatically modulate the convulsant effects of some, but not all, SCBs.
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Affiliation(s)
- Catheryn D Wilson
- Departments of Pharmacology and Toxicology (C.D.W., S.T., L.E., J.C., T.L., W.E.F.) and Biochemistry and Molecular Biology (R.F., A.R.-P.), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sherrica Tai
- Departments of Pharmacology and Toxicology (C.D.W., S.T., L.E., J.C., T.L., W.E.F.) and Biochemistry and Molecular Biology (R.F., A.R.-P.), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Laura Ewing
- Departments of Pharmacology and Toxicology (C.D.W., S.T., L.E., J.C., T.L., W.E.F.) and Biochemistry and Molecular Biology (R.F., A.R.-P.), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jasmine Crane
- Departments of Pharmacology and Toxicology (C.D.W., S.T., L.E., J.C., T.L., W.E.F.) and Biochemistry and Molecular Biology (R.F., A.R.-P.), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Taylor Lockhart
- Departments of Pharmacology and Toxicology (C.D.W., S.T., L.E., J.C., T.L., W.E.F.) and Biochemistry and Molecular Biology (R.F., A.R.-P.), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ryochi Fujiwara
- Departments of Pharmacology and Toxicology (C.D.W., S.T., L.E., J.C., T.L., W.E.F.) and Biochemistry and Molecular Biology (R.F., A.R.-P.), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Anna Radominska-Pandya
- Departments of Pharmacology and Toxicology (C.D.W., S.T., L.E., J.C., T.L., W.E.F.) and Biochemistry and Molecular Biology (R.F., A.R.-P.), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - William E Fantegrossi
- Departments of Pharmacology and Toxicology (C.D.W., S.T., L.E., J.C., T.L., W.E.F.) and Biochemistry and Molecular Biology (R.F., A.R.-P.), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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31
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Cannabinoid signalling in the immature brain: Encephalopathies and neurodevelopmental disorders. Biochem Pharmacol 2018; 157:85-96. [DOI: 10.1016/j.bcp.2018.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/09/2018] [Indexed: 12/19/2022]
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32
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Uttl L, Szczurowska E, Hájková K, Horsley RR, Štefková K, Hložek T, Šíchová K, Balíková M, Kuchař M, Micale V, Páleníček T. Behavioral and Pharmacokinetic Profile of Indole-Derived Synthetic Cannabinoids JWH-073 and JWH-210 as Compared to the Phytocannabinoid Δ 9-THC in Rats. Front Neurosci 2018; 12:703. [PMID: 30405327 PMCID: PMC6206206 DOI: 10.3389/fnins.2018.00703] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022] Open
Abstract
Synthetic cannabinoid compounds are marketed as “legal” marijuana substitutes, even though little is known about their behavioral effects in relation to their pharmacokinetic profiles. Therefore, in the present study we assessed the behavioral effects of systemic treatment with the two synthetic cannabinoids JWH-073 and JWH-210 and the phytocannabinoid Δ9-THC on locomotor activity, anxiety-like phenotype (in the open field) and sensorimotor gating (measured as prepulse inhibition of the acoustic startle response, PPI), in relation to cannabinoid serum levels. Wistar rats were injected subcutaneously (sc.) with JWH-073 (0.1, 0.5, or 5 mg/kg), JWH-210 (0.1, 0.5, or 5 mg/kg), Δ9-THC (1 or 3 mg/kg) or vehicle (oleum helanti) in a volume of 0.5 ml/kg and tested in the open field and PPI. Although JWH-073, JWH-210, Δ9-THC (and its metabolites) were confirmed in serum, effects on sensorimotor gating were absent, and locomotor activity was only partially affected. Δ9-THC (3 mg/kg) elicited an anxiolytic-like effect as suggested by the increased time spent in the center of the open field (p < 0.05). Our results further support the potential anxiolytic-like effect of pharmacological modulation of the endocannabinoid system.
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Affiliation(s)
- Libor Uttl
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czechia.,Department of Physiology, Faculty of Science, Charles University, Prague, Czechia
| | - Ewa Szczurowska
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czechia
| | - Kateřina Hájková
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czechia.,Forensic Laboratory of Biologically Active Compounds, Department of Chemistry of Natural Compounds, University of Chemistry and Technology Prague, Prague, Czechia
| | - Rachel R Horsley
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czechia
| | - Kristýna Štefková
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czechia
| | - Tomáš Hložek
- Institute of Forensic Medicine and Toxicology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Klára Šíchová
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czechia
| | - Marie Balíková
- Institute of Forensic Medicine and Toxicology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Martin Kuchař
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czechia.,Forensic Laboratory of Biologically Active Compounds, Department of Chemistry of Natural Compounds, University of Chemistry and Technology Prague, Prague, Czechia
| | - Vincenzo Micale
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czechia.,Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Catania, Italy
| | - Tomáš Páleníček
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Psychiatric Clinic, Charles University, Prague, Czechia
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M.E. Abdel-Salam O, A. Sleem A, Abd El Baset Mohamed Sayed M, A. Khadrawy Y, A. Morsy F. Cannabis sativa Increases Seizure Severity and Brain Lipid Peroxidation in Pentylenetetrazole-Induced Kindling in Rats. ACTA ACUST UNITED AC 2018. [DOI: 10.13005/bpj/1480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The effect of Cannabis sativa extract on chemical kindling induced in rats by the repeated intraperitoneal (ip) injections of pentylenetetrazole (PTZ) was studied. Rats were treated with PTZ (35 mg/kg) once every 48 hours for 12 times alone or with ip Cannabis sativa (20 mg/kg expressed as Δ9-THC content) 30 min prior to PTZ injection. Seizures were recorded for 20 minutes. Control rats received ip saline. Cannabis treatment caused significant elevation of mean seizure score as compared to PTZ only group after the 5th, 6th and 7th PTZ repeated injections during seizure development. In particular, cannabis caused significant elevation in the frequency of myoclonic jerks, rearing (stage 3), turn over onto one side position and back position (stage 4), and generalized tonic-clonic seizures (stage 5) compared with the PTZ only group. PTZ caused significant elevations in brain lipid peroxidation (malondialdehyde), and nitric oxide along with deceased reduced glutathione level. In addition, brain acetylcholinesterase (AChE) activity significantly decreased compared to control value after PTZ treatment. Cannabis given to PTZ treated rats caused significant increase in brain malondialdehyde and AChE activity compared to PTZ only group. Reduced glutathione level was restored by cannabis. Histopathological studies indicated the presence of spongiform changes, degenerated and necrotic neurons, inflammatory cells, and gliosis in cerebral cortex and degeneration of some Purkinje cells in the cerebellum in both PTZ- and cannabis-PTZ-treated groups. It is concluded that in an epilepsy model induced by repeated PTZ administration, cannabis increased lipid peroxidation and mean seizure score.
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Affiliation(s)
| | | | | | | | - Fatma A. Morsy
- Department of Pathology, National Research Centre, Cairo, Egypt
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34
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The ongoing challenge of novel psychoactive drugs of abuse. Part I. Synthetic cannabinoids (IUPAC Technical Report). PURE APPL CHEM 2018. [DOI: 10.1515/pac-2017-0605] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
In the past decade, the world has experienced a large increase in the number of novel compounds appearing on the illicit drug market for recreational purposes. Such substances are designed to circumvent governmental regulations; the illegal drug manufacturers take a known psychoactive compound reported in the scientific literature and slightly modify its chemical structure in order to produce analogues that will mimic the pharmacological activity of the original substance. Many of these novel substances are sold via the Internet. Among the various chemical classes, synthetic cannabinoid receptor modulators, commonly referred to as “synthetic cannabinoids” have been at the forefront, as demonstrated by the frequency of drug seizures, numerous severe toxic effects, and fatalities associated with some of these substances. This review presents the chemical structures of relevant synthetic cannabinoids and describes their mechanism of action, pharmacological features, metabolic pathways, and structure-activity relationships. It illustrates the approaches used in forensic testing, both for bulk analysis (drug seizures) and for analytical toxicology (biological matrices) and discusses aspects of regulation surrounding this drug class. This report is intended to provide pertinent information for the purposes of informing scientific, medical, social, and governmental bodies about this ever-evolving recreational drug class and the challenges it poses worldwide.
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Gamage TF, Farquhar CE, Lefever TW, Marusich JA, Kevin RC, McGregor IS, Wiley JL, Thomas BF. Molecular and Behavioral Pharmacological Characterization of Abused Synthetic Cannabinoids MMB- and MDMB-FUBINACA, MN-18, NNEI, CUMYL-PICA, and 5-Fluoro-CUMYL-PICA. J Pharmacol Exp Ther 2018; 365:437-446. [PMID: 29549157 DOI: 10.1124/jpet.117.246983] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/06/2018] [Indexed: 12/29/2022] Open
Abstract
Synthetic cannabinoids are a class of novel psychoactive substances that exhibit high affinity at the cannabinoid type-1 (CB1) receptor and produce effects similar to those of Δ-9-tetrahydrocannabinol (THC), the primary psychoactive constituent of cannabis. Illicit drug manufacturers are continually circumventing laws banning the sale of synthetic cannabinoids by synthesizing novel structures and doing so with little regard for the potential impact on pharmacological and toxicological effects. Synthetic cannabinoids produce a wide range of effects that include cardiotoxicity, seizure activity, and kidney damage, and they can cause death. Six synthetic cannabinoids, recently detected in illicit preparations, MMB-FUBINACA, MDMB-FUBINACA, CUMYL-PICA, 5F-CUMYL-PICA, NNEI, and MN-18 were assessed for: 1) receptor binding affinity at the human CB1 and human CB2 receptors, 2) function in [35S]GTPγS and cAMP signaling, and 3) THC-like effects in a mouse drug discrimination assay. All six synthetic cannabinoids exhibited high affinity for human cannabinoid receptors type-1 and type-2 and produced greater maximal effects than THC in [35S]GTPγS and cAMP signaling. Additionally, all six synthetic cannabinoids substituted for THC in drug discrimination, suggesting they probably possess subjective effects similar to those of cannabis. Notably, MDMB-FUBINACA, a methylated analog of MMB-FUBINACA, had higher affinity for CB1 than the parent, showing that minor structural modifications being introduced can have a large impact on the pharmacological properties of these drugs. This study demonstrates that novel structures being sold and used illicitly as substitutes for cannabis are retaining high affinity at the CB1 receptor, exhibiting greater efficacy than THC, and producing THC-like effects in models relevant to subjective effects in humans.
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Affiliation(s)
| | | | | | | | | | | | - Jenny L Wiley
- RTI International, Research Triangle Park, North Carolina
| | - Brian F Thomas
- RTI International, Research Triangle Park, North Carolina;
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Sabioni P, Le Foll B. Psychosocial and pharmacological interventions for the treatment of cannabis use disorder. F1000Res 2018; 7:173. [PMID: 29497498 PMCID: PMC5811668 DOI: 10.12688/f1000research.11191.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/24/2022] Open
Abstract
Cannabis use has been continuously increasing, and cannabis use disorder (CUD) has become a public health issue. Some psychosocial interventions have demonstrated the ability to reduce cannabis use; however, there are no pharmacotherapies approved for the treatment of CUD. Some drugs have shown limited positive effects on use and withdrawal symptoms, but no controlled studies have been able to show strong and persistent effects on clinically meaningful outcomes. The aim of this review is to synthesize the evidence from the available literature regarding the effectiveness of psychosocial and pharmacological treatments for CUD among adults (that is, 18 years old or older). An analysis of the evidence shows that the current best psychosocial intervention to reduce cannabis use is the combination of motivational enhancement therapy and cognitive-behavioral therapy, preferably accompanied by a contingency management approach. In regard to pharmacological interventions, there are mostly unclear findings. Some drugs, such as CB1 agonists, gabapentin, and N-acetylcysteine, have been shown to produce improvements in some symptoms of CUD in single studies, but these have not been replicated. Other classes of medications, including antidepressants and antipsychotics, have been unsuccessful in producing such effects. There is an imminent need for more clinical trials to develop more effective treatments for CUD.
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Affiliation(s)
- Pamela Sabioni
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto, Ontario , M5S 2S1, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto, Ontario , M5S 2S1, Canada.,Addiction Medicine Service, Centre for Addiction and Mental Health, Toronto, Ontario, M6J 1H4, Canada.,Department of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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