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Aderinto N, Olatunji G, Kokori E, Ajayi YI, Akinmoju O, Ayedun AS, Ayoola OI, Aderinto NO. The efficacy and safety of cannabidiol (CBD) in pediatric patients with Dravet Syndrome: a narrative review of clinical trials. Eur J Med Res 2024; 29:182. [PMID: 38500226 PMCID: PMC10949818 DOI: 10.1186/s40001-024-01788-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Dravet Syndrome (DS) is a rare and severe form of childhood epilepsy that is often refractory to conventional antiepileptic drugs. Emerging evidence suggests that Cannabidiol (CBD) offer therapeutic benefits for DS. This review aims to evaluate the efficacy and safety of CBD in pediatric patients with DS based on data from ten clinical trials. METHODS A review was conducted to identify clinical trials assessing the efficacy and safety of CBD in pediatric patients diagnosed with DS. PubMed, MEDLINE, Scopus, Web of Science, and relevant grey literature were systematically searched for relevant articles up to October 2023, and clinical trials within the last 10 years were included. The search strategy incorporated controlled vocabulary terms and keywords related to "Cannabidiol," "Dravet Syndrome," and "pediatric patients." RESULTS The analysis revealed promising efficacy outcomes. Notably, CBD demonstrated substantial reductions in seizure frequency, with some patients achieving seizure freedom. The findings emphasised the consistency of CBD's efficacy across different patient subgroups. The safety profile of CBD was generally acceptable, with adverse events often being manageable. CONCLUSION This review consolidates evidence from multiple clinical trials, affirming the potential of CBD as a promising treatment option for pediatric patients with DS. While further research is needed to address existing knowledge gaps, CBD's efficacy and acceptable safety profile make it a valuable addition to the therapeutic tools for DS.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria.
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, PMB 5000, Ogbomosho, Nigeria.
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Yusuf Ismaila Ajayi
- Department of Medicine and Surgery, Obafemi Awolowo University Teaching Hospital, Ife, Nigeria
| | - Olumide Akinmoju
- Department of Medicine and Surgery, University of Ibadan, Ibadan, Nigeria
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Omotayo OP, Lemmer Y, Mason S. A narrative review of the therapeutic and remedial prospects of cannabidiol with emphasis on neurological and neuropsychiatric disorders. J Cannabis Res 2024; 6:14. [PMID: 38494488 PMCID: PMC10946130 DOI: 10.1186/s42238-024-00222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The treatment of diverse diseases using plant-derived products is actively encouraged. In the past few years, cannabidiol (CBD) has emerged as a potent cannabis-derived drug capable of managing various debilitating neurological infections, diseases, and their associated complications. CBD has demonstrated anti-inflammatory and curative effects in neuropathological conditions, and it exhibits therapeutic, apoptotic, anxiolytic, and neuroprotective properties. However, more information on the reactions and ability of CBD to alleviate brain-related disorders and the neuroinflammation that accompanies them is needed. MAIN BODY This narrative review deliberates on the therapeutic and remedial prospects of CBD with an emphasis on neurological and neuropsychiatric disorders. An extensive literature search followed several scoping searches on available online databases such as PubMed, Web of Science, and Scopus with the main keywords: CBD, pro-inflammatory cytokines, and cannabinoids. After a purposive screening of the retrieved papers, 170 (41%) of the articles (published in English) aligned with the objective of this study and retained for inclusion. CONCLUSION CBD is an antagonist against pro-inflammatory cytokines and the cytokine storm associated with neurological infections/disorders. CBD regulates adenosine/oxidative stress and aids the downregulation of TNF-α, restoration of BDNF mRNA expression, and recovery of serotonin levels. Thus, CBD is involved in immune suppression and anti-inflammation. Understanding the metabolites associated with response to CBD is imperative to understand the phenotype. We propose that metabolomics will be the next scientific frontier that will reveal novel information on CBD's therapeutic tendencies in neurological/neuropsychiatric disorders.
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Affiliation(s)
- Oluwadara Pelumi Omotayo
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Yolandy Lemmer
- Council for Scientific and Industrial Research (CSIR), Next Generation Health, Pretoria, South Africa
- Preclinical Drug Development Platform, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Shayne Mason
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa.
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Gastmeier K, Ihlenfeld A, Gastmeier A, Hirt G, Landschaft A, Wirz S. [Patient-reported outcomes in chronic diseases under treatment with cannabis medicines : Analysis of the results of the Copeia survey]. Schmerz 2024:10.1007/s00482-024-00802-4. [PMID: 38451340 DOI: 10.1007/s00482-024-00802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND The survey of Copeia captured early 2022 patient-reported outcomes (PRO) in Germany under cannabis medicinal product (CAM) therapy, with particular attention to symptoms, symptom changes, indications, side effects, dosages, and cost bearers. GOAL This study investigated the question of whether associations emerge from the results that could play a role in the indication and treatment monitoring of CAM in chronically ill patients. MATERIALS AND METHODS A standardized questionnaire was administered online nationwide in dialogue form over a 15-week period to collect itemized symptoms and PRO. Recruitment was supported by pharmacies, prescribing physicians, and patient associations. Inclusion criteria included physician-prescribed CAM therapy. RESULTS AND DISCUSSION Of 1582 participants, 1030 data sets (65%) could be completely analyzed. There was a heterogeneous patient population, whose common feature was disease chronicity. The frequency distribution of symptoms showed a homogeneous pattern for the respective indications, in which the most frequent six (pain 71%, sleep disturbance 64%, stress/tension 52%, inner restlessness 52%, depressive mood 44% and muscle tension 43%) seem to have a special significance. According to subjective assessment, quality of life improved significantly in 84% of all participating patients. CONCLUSION A symptom matrix (SMX) composed of different symptoms seems to play a special role in CAM therapy to improve the quality of life of chronically ill patients, regardless of the underlying disease. The SMX could contribute to the identification of an indication and to targeted treatment monitoring.
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Affiliation(s)
- Knud Gastmeier
- Praxis für Spezialisierte Ambulante Palliativmedizin, Potsdam, Deutschland
| | | | - Anne Gastmeier
- Praxis für Lungenheilkunde und Allgemeinmedizin, Kleinmachnow, Deutschland
| | | | | | - Stefan Wirz
- Abteilung für Anästhesie, Intensivmedizin, Schmerzmedizin/Palliativmedizin - Zentrum für Schmerzmedizin, Weaningzentrum, Cura Krankenhaus - eine Betriebsstätte der GFO Kliniken Bonn, Schülgenstr. 15, 53604, Bad Honnef, Deutschland.
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Chao KY, Liu SH, Chou CC, Chen CI, Cheng W. Legalization of marijuana or not? Opinions from over 38,000 residents in Taiwan. BMC Public Health 2023; 23:1954. [PMID: 37814243 PMCID: PMC10563234 DOI: 10.1186/s12889-023-16834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Marijuana is legal in many Western countries and Thailand. In Taiwan, Marijuana remains a category-2 narcotic; however, some legislative candidates recently advocated legalization of medical marijuana. This study surveyed a large sample of Taiwanese to gain a better understanding of the public's knowledge and attitudes towards legalizing marijuana. METHODS This cross-sectional mixed-methods study included demographic data and responses to a survey questionnaire, "Knowledge and Attitudes of Legalizing Marijuana" (KALM). The survey included 15 statements about four categories: public health, social impact, medical applications of THC (Δ9-tetrahydrocannabinol), and legal and tax consequences; and two yes/no questions about medical use and legalization of marijuana. Knowledge was scored as disagree = 0, no knowledge = 2, or agree = 4; attitude was scored from 0 = very unimportant to 4 = very important. Responses to an open-ended question asking for additional comments/concerns were analysed with content analysis. The survey was conducted from February 15 to March 1, 2023. RESULTS Data were analysed from 38,502 respondents, aged 15 to > 56 years. Most were female (67.1%) and parents (76.4%). Scores were higher for respondents who were parents, religious, ≥ 36 years of age, had a high-income status, no history of substance abuse, knowledge of medical marijuana, and did not support legalization of marijuana. Medical personnel had greater knowledge of marijuana, but their attitude indicated they viewed legalization as less important. In the open-ended question, many respondents requested more information about marijuana be provided to the public before considering legalization. CONCLUSIONS Taiwanese respondents considered legalization of marijuana a significant concern, especially as it relates to impacts on public health.
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Affiliation(s)
- Kuo-Yu Chao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Hsiang Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chih-Chiang Chou
- Department of Psychiatry, Centro Hospitalar Conde de São Januário, Macau SAR, China
| | - Ching-I Chen
- Department of Psychiatry, Kee-Lung Hospital, Ministry of Health and Welfare, KeeLung, Taiwan
| | - Wei Cheng
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
- Department of Pathology, Kee-Lung Hospital, Ministry of Health and Welfare, 268, Xin 2nd Road, Xinyi District, KeeLung, 201203, Taiwan.
- Department of Nursing, Deh Yu College of Nursing and Health, Kee-Lung, Taiwan.
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Johnson K, Barnes JP, Dial H, DeClercq J, Choi L, Shah NB, Reddy S, Zuckerman AD. Therapy outcomes associated with prescription cannabidiol use at 12 months post-initiation. Epilepsy Behav 2023; 147:109412. [PMID: 37666204 DOI: 10.1016/j.yebeh.2023.109412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/11/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE This study evaluated prescription cannabidiol (CBD) outcomes during the first 12 months of therapy. METHODS A single-center, prospective cohort study was performed including patients prescribed CBD from January 2019 - April 2020, excluding clinical trial patients and those using external specialty pharmacy services. The primary outcome wasepilepsy-related emergency healthcare service (EHS) use within 12 months of initation. Secondary outcomes included prescription CBD discontinuation rate and reason and concomitant anti-seizure medication (ASM) use. A multiple logistic regression model evaluated the odds of EHS use, adjusting for initial concomitant ASM count, age, and insurance type. RESULTS The 136 patients included were 85% white, 50% female, and 68% pediatric. EHS utilization occurred in 37% (n = 50) of patients; 29 patients (21%, n = 20 pediatric, n = 9 adult) had at least one emergency department (ED) visit, 9 patients (7%) had two or more; 30 patients (22%, n = 22 pediatric, n = 8 adult) had at least one hospitalizaion. Median time to first ED and hospitalization was 69 (IQR 31-196) and 104 (IQR 38-179) days, respectively. Prescription CBD was discontinued in 31 patients (23%, n = 18 pediatric, n = 13 adult), due to major side effects (n = 12, 39%), common side effects (n = 11, 36%), and unsatisfactory response (n = 11, 36%). There was no significant change in concomitant ASM use. CONCLUSION Despite potential benefits of prescription CBD, many patients utilize EHSs in the first 12 months of treatment with minimal changes in concomitant ASM use.
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Affiliation(s)
- Kayla Johnson
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, 1211 Medical Center Dr, Nashville, TN 37232, USA.
| | - Jessica P Barnes
- Lipscomb University College of Pharmacy, 1 University Park Dr, Nashville, TN 37204, USA.
| | - Holly Dial
- Lipscomb University College of Pharmacy, 1 University Park Dr, Nashville, TN 37204, USA.
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.
| | - Nisha B Shah
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, 1211 Medical Center Dr, Nashville, TN 37232, USA.
| | - Shilpa Reddy
- Department of Pediatric Neurology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA.
| | - Autumn D Zuckerman
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, 1211 Medical Center Dr, Nashville, TN 37232, USA.
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Gournay LR, Ferretti ML, Bilsky S, Vance E, Nguyen AM, Mann E, Williams P, Leen-Feldner EW. The effects of cannabidiol on worry and anxiety among high trait worriers: a double-blind, randomized placebo controlled trial. Psychopharmacology (Berl) 2023; 240:2147-2161. [PMID: 37552290 DOI: 10.1007/s00213-023-06437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
RATIONALE Evidence suggests cannabidiol (CBD) displays broad therapeutic potential in the context of anxiety; however, no study has examined the effects of CBD on worry, a defining, cognitive feature of anxiety. Additionally, no study has examined the effects of an acute, single dose of CBD compared to repeated CBD administration. OBJECTIVES Within a sample of 63 individuals with elevated trait worry, the current study aimed to assess the effects of an empirically-derived high dose of CBD (i.e., 300mg) compared to a commercially-derived dose of CBD (i.e., 50mg) versus placebo on worry severity and anxiety symptoms after an acute dose and after a 2-week administration period. RESULTS Results indicated no effect of acute CBD dosing on worry severity or anxiety symptoms. Repeated CBD administration similarly did not impact worry severity; however, 300mg of CBD reduced anxiety symptoms across the 2-week administration period compared to placebo. CONCLUSIONS Taken together, these findings suggest 300mg of oral CBD does not attenuate cognitive symptoms of anxiety (i.e., worry), following both acute and repeated administration. Some evidence for repeated administration of 300mg on physical symptoms of anxiety was obtained. Findings from the current study suggest CBD's modest anxiolytic effects may be specific to the physical aspects of anxious arousal.
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Affiliation(s)
- L Riley Gournay
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA.
| | - Morgan L Ferretti
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
| | | | - Emily Vance
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
| | - Anna Marie Nguyen
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
| | - Eric Mann
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
- Laureate Institute for Brain Research, Tulsa, USA
| | - Parker Williams
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
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Ferrera G, Ricci E, Vignoli A, Savini MN, Viganò I, Chiesa V, Caputo D, Zambrelli E, La Briola F, Turner K, Canevini MP. Highly purified cannabidiol in the treatment of drug-resistant epilepsies: A real-life impact on seizure frequency, quality of life, behavior, and sleep patterns from a single Italian center. Epilepsy Behav 2023; 147:109409. [PMID: 37677907 DOI: 10.1016/j.yebeh.2023.109409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/22/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
Seizure frequency in treatment-resistant epilepsies seems to be decreased by cannabidiol (CBD), but contrasting data are available on its effect on sleep, behavior, and quality of life (QoL), and no data is reported on its effect on parental stress in patients with epilepsy (PWE). Thus, we conducted a retrospective study on a cohort of children and adults with drug-resistant epilepsy (DRE) who had been treated with highly purified, pharmaceutical-grade CBD to evaluate its effects on seizure frequency, QoL, behavior, parental stress, and sleep. Eighteen patients (12 adults and 6 children) were included in the cohort and followed for a median of 9 months. At the last follow-up (Tn), nine patients (50%) were considered CBD responders with at least a 50% decrease in seizure frequency. No serious adverse effects were found. No statistically significant differences were found concerning sleep, including daytime sleepiness, and no statistically significant effect was found on parental stress at Tn. An improvement was found for social interaction in quality of life (p < 0.05) for all patients. Our results demonstrate that CBD is a safe and effective antiseizure medication (ASM). CBD doesn't seem to affect sleep measures in adults and children or worsen daytime sleepiness. However, CBD improves specific QoL measures, which could indicate a possible use of CBD for other childhood disabilities. No impact of CBD was seen on parental stress, which could possibly be due to the limited follow-up or could mean that parental stress is not dependent on seizure frequency.
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Affiliation(s)
- G Ferrera
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy
| | - E Ricci
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy.
| | - A Vignoli
- Department of Health Sciences, University of Milan, Milan, Italy; Child Neuropsychiatry Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M N Savini
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy
| | - I Viganò
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy
| | - V Chiesa
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy
| | - D Caputo
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy
| | - E Zambrelli
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy
| | - F La Briola
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy
| | - K Turner
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy
| | - M P Canevini
- Regional Center for Epilepsy- Sleep Medicine, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy
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Stats AK, Sweat KG, Masson RN, Conrow KD, Frazier AE, Leung MCK. The Desert Whale: the boom and bust of hemp in Arizona. J Cannabis Res 2023; 5:19. [PMID: 37291630 DOI: 10.1186/s42238-023-00187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/04/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND This paper examines the factors that led to the collapse of hemp grown for cannabidiol (CBD) in Arizona, the United States of America (USA), and particularly in Yuma County, which is a well-established agricultural area in the state. METHODS This research uses a combination of mapping analysis along with a survey of hemp farmers to assess the reasons why the hemp industry collapsed as well as to foster solutions to these problems. RESULTS In 2019, 5430 acres were sown with hemp seed in Arizona with 3890 acres inspected by the state to determine if they could be harvested. By 2021, there were only 156 acres planted, and only 128 of those acres were inspected by the state for compliance. (Crop mortality accounts for the difference between acres sown and acres inspected.) CONCLUSIONS: A lack of knowledge about the hemp life cycle greatly contributed to the failure of high CBD hemp crops in Arizona. Other problems included noncompliance with tetrahydrocannabinol limits, poor sources for seeds and inconsistent genetics of the hemp varieties sold to farmers, and diseases that hemp plants were susceptible to such as Pythium crown and root rot and beet curly top virus. Addressing these factors will go far in making hemp a profitable and widespread crop in Arizona. Additionally, hemp grown for other traditional uses (e.g., fiber or seed oil) as well as new applications (e.g., microgreens, hempcrete, and phytoremediation) offers other pathways for successful hemp agriculture in this state.
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Affiliation(s)
| | - Ken G Sweat
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University, 4701 W Thunderbird Rd, Glendale, AZ, 85306, USA.
| | - Robert N Masson
- Cooperative Extension, the University of Arizona, Tucson, USA
| | - Kendra D Conrow
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University, 4701 W Thunderbird Rd, Glendale, AZ, 85306, USA
| | - Amy E Frazier
- School of Geographical Sciences & Urban Planning, Tempe, USA
| | - Maxwell C K Leung
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University, 4701 W Thunderbird Rd, Glendale, AZ, 85306, USA.
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Karoly HC, Drennan ML, Prince MA, Zulic L, Dooley G. Consuming oral cannabidiol prior to a standard alcohol dose has minimal effect on breath alcohol level and subjective effects of alcohol. Psychopharmacology (Berl) 2023; 240:1119-1129. [PMID: 36939855 PMCID: PMC10622182 DOI: 10.1007/s00213-023-06349-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/26/2023] [Indexed: 03/21/2023]
Abstract
RATIONALE Cannabidiol (CBD) is found in the cannabis plant and has garnered attention as a potential treatment for alcohol use disorder (AUD). CBD reduces alcohol consumption and other markers of alcohol dependence in rodents, but human research on CBD and alcohol is limited. It is unknown whether CBD reduces drinking in humans, and mechanisms through which CBD could impact behavioral AUD phenotypes are unknown. OBJECTIVES This study explores effects of oral CBD on breath alcohol level (BrAC), and subjective effects of alcohol in human participants who report heavy drinking. METHODS In this placebo-controlled, crossover study, participants consumed 30 mg CBD, 200 mg CBD, or placebo CBD before receiving a standardized alcohol dose. Participants were blind to which CBD dose they received at each session and completed sessions in random order. Thirty-six individuals completed at least one session and were included in analyses. RESULTS Differences in outcomes across the three conditions and by sex were explored using multilevel structural equation models. BrAC fell fastest in the placebo condition, followed by 30 mg and 200 mg CBD. Stimulation decreased more slowly in the 200 mg CBD condition than in placebo (b = - 2.38, BCI [- 4.46, - .03]). Sedation decreased more slowly in the 30 mg CBD condition than in placebo (b = - 2.41, BCI [- 4.61, - .09]). However, the magnitude of condition differences in BrAC and subjective effects was trivial. CONCLUSIONS CBD has minimal influence on BrAC and subjective effects of alcohol. Further research is needed to test whether CBD impacts alcohol consumption in humans, and if so, what mechanism(s) may explain this effect.
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Affiliation(s)
- Hollis C Karoly
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO, 80523-1876, USA.
| | - Meggan L Drennan
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO, 80523-1876, USA
| | - Mark A Prince
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO, 80523-1876, USA
| | - Leila Zulic
- Department of Psychology, Colorado State University, 1876 Campus Delivery, Fort Collins, CO, 80523-1876, USA
| | - Gregory Dooley
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, 80523-1601, USA
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Bawa Z, Saini B, McCartney D, Bedoya-Pérez M, McLachlan AJ, McGregor IS. A cross-sectional survey exploring the knowledge, experiences and attitudes of Australian pharmacists toward medicinal cannabis. Int J Clin Pharm 2023; 45:375-386. [PMID: 36446995 PMCID: PMC9708126 DOI: 10.1007/s11096-022-01519-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Australian pharmacists currently dispense a wide range of prescription-only cannabis-based medicines. Recent regulatory changes will expand the role of pharmacists, allowing certain low-dose cannabidiol products to be supplied without a prescription in pharmacies. This harmonises Australia with many other countries where cannabidiol products are readily available to consumers. AIM To examine Australian pharmacists' experience, knowledge and attitudes towards medicinal cannabis and their preparedness to supply over-the-counter low-dose cannabidiol products. METHOD We conducted a cross-sectional study using a 51-item on-line questionnaire that was informed by previous surveys of health professionals and assessed for face validity. Australian pharmacists were recruited to complete the survey between May and December 2021, primarily through professional pharmacy organisations. Pharmacists were included in the final dataset if they completed the demographic characteristics section and at least one additional section of the questionnaire. Data were analysed using descriptive and relational statistical tests. RESULTS There were 272 attempts to complete this survey and 217 responses included in the final dataset. Over half of the respondents (60.0%, 130/217) had dispensed at least one medicinal cannabis prescription during their career and 58.5% (127/217) had received at least one medicinal cannabis enquiry in the last fortnight. Only around half (53.9%, 117/217) felt comfortable supplying medicinal cannabis products and fewer (39.3%, 79/201) were confident discussing cannabis-related enquiries. More than half of the respondents (58.7%, 118/201) supported the provision of low-dose cannabidiol products through pharmacies. Two-thirds (67.8%, 80/118) of respondents achieved relatively low scores (< 60%) in the knowledge component of the survey. Most respondents (94.2%, 178/189) endorsed a need for further training in this area. CONCLUSION Australian pharmacists tended to support medicinal cannabis availability and improved access to low-dose cannabidiol products via pharmacies. However, results highlight a need for improved training and education of pharmacists around cannabis-based medicines.
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Affiliation(s)
- Zeeta Bawa
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - Bandana Saini
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Danielle McCartney
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Miguel Bedoya-Pérez
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia.
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Dowd AN, Zamarripa CA, Sholler DJ, Strickland JC, Goffi E, Borodovsky JT, Weerts EM, Vandrey R, Spindle TR. A cross-sectional survey on cannabis: Characterizing motives, opinions, and subjective experiences associated with the use of various oral cannabis products. Drug Alcohol Depend 2023; 245:109826. [PMID: 36871378 PMCID: PMC10044512 DOI: 10.1016/j.drugalcdep.2023.109826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Cannabis-infused products available for oral consumption include food and drink items (i.e., edibles) (e.g., baked goods, gummy-, chocolate-, and hard-candies, beverages/drinks) as well as non-food formulations (e.g., oils/tinctures, pills/capsules). This study characterized the motives, opinions, and subjective experiences associated with the use of these seven subtypes of oral cannabis products. METHODS This web-based survey collected cross-sectional, self-report data from a convenience sample of 370 adults regarding various use-motives, self-reported cannabinoid content, subjective experiences, and opinions related to ingesting oral cannabis products with alcohol and/or food. Advice participants had received about modifying oral cannabis product effects, in general, was also collected. RESULTS Participants reported consuming cannabis baked goods and gummy candies most frequently over the past year (68% and 63%, respectively). Participants were less likely to use oils/tinctures for enjoyment/desire relative to other product types and more likely to use oils/tinctures for therapeutic purposes (e.g., medication-replacement). Self-reported cannabinoid content was highly variable across participants and within product subtype. Participants reported feeling stronger and longer-lasting effects when consuming oral cannabis products on an empty stomach and 43% received advice to "eat a snack or meal" to mitigate effects that are too strong, which contrasts with controlled studies. Finally, 43% of participants reported modifying their experiences with alcohol at least some of time. CONCLUSIONS These findings underscore the need to further evaluate use-motives as well as the interaction between dietary factors, cannabinoid pharmacokinetics, and subjective drug effects and the interactive effects of oral cannabis products and alcohol in a controlled laboratory setting.
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Affiliation(s)
- Ashley N Dowd
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
| | - C Austin Zamarripa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Dennis J Sholler
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Elia Goffi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Jacob T Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Elise M Weerts
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Tory R Spindle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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12
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Rodríguez-Martínez J, Sánchez-Martín MJ, Valiente M. Efficient controlled release of cannabinoids loaded in γ-CD-MOFs and DPPC liposomes as novel delivery systems in oral health. Mikrochim Acta 2023; 190:125. [PMID: 36894805 DOI: 10.1007/s00604-023-05692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023]
Abstract
Olivetol (OLV), as a cannabidiol (CBD) analog, was incorporated in γ-cyclodextrin metal-organic frameworks (γ-CD-MOFs) and 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) liposomes as potential analgesic drug delivery systems (DDS) for dental hypersensitivity (DH) treatment. These DDS have been scarcely employed in oral health, being the first time in case of MOFs loaded with cannabinoids. In vitro experiments using bovine teeth were performed to verify if the drug is able to reach the dentin, where it can flow to the pulp tissues and exert its analgesic effect; enamel and dentin regions were analyzed by synchrotron radiation-based FTIR microspectroscopy. Principal component analysis (PCA) was used to process the spectroscopic data as a powerful chemometric tool, and it revealed a similar behavior in both regions. The studied DDS have been characterized by different techniques, and is was demonstrated that DDS is an efficient way to carry the drug through dental tissues without compromising their structure.
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13
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Prasad KN. A micronutrient mixture with collagen peptides, probiotics, cannabidiol, and diet may reduce aging, and development and progression of age-related alzheimer's disease, and improve its treatment. Mech Ageing Dev 2023; 210:111757. [PMID: 36460123 DOI: 10.1016/j.mad.2022.111757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
Human aging involves gradual decline in organ functions leading to organ specific age-related chronic diseases such as Alzheimer's disease (AD). Although advances in the development of new drugs, novel surgical procedures, improved diet and lifestyle, have resulted in doubling of lifespan of humans, the quality of life in many cases remains poor because of increased incidence of age-related chronic diseases. Using experimental models of accelerated aging, several cellular defects associated with aging and AD have been identified. Some cellular defects due to increased oxidative stress, chronic inflammation, autophagy defects, mitochondrial dysfunction, and imbalances in the composition probiotics in favor of harmful bacteria over beneficial bacteria are common to both aging and AD, while others such as telomere attrition, loss of collagen, elastin, and hyaluronic acid, failure of DNA repair system, and impaired immune function are unique to aging; and some such as increased production of beta-amyloids, hyperphosphorylation of tau protein, and abnormal behaviors are unique to AD. It is suggested that supplementation with a micronutrient mixture, probiotics, collagen peptides, CBD, and modifications in the diet and lifestyle may reduce the aging processes, and the development, progression of AD, and improve the treatments of this disease.
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Affiliation(s)
- Kedar N Prasad
- Engage Global, Inc. 245 El Faisan Dr., San Rafael, CA 94903, USA.
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14
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Gerigk M, Dargó G, Könczöl Á, Luca SV, Minceva M. Nonlinear liquid-liquid chromatography: Beyond a constant distribution coefficient. J Chromatogr A 2023; 1691:463824. [PMID: 36709549 DOI: 10.1016/j.chroma.2023.463824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 01/25/2023]
Abstract
Liquid-liquid chromatography (LLC) is a technique in which the separation of mixture components is achieved due to their different distribution between the two phases of a pre-equilibrated biphasic solvent system. In this work, the LLC operation in the nonlinear range of the distribution isotherm was systematically examined for the first time. The influence of the feed concentration on the elution profiles of a model component (cannabidiol, CBD) was studied in three LLC units of different types and sizes ranging from ∼20 mL to ∼2 L. A series of pulse injections with CBD concentrations varying from 1 to 300 mg/mL was performed with n-hexane/methanol/water 5/4/1 (v/v/v) in descending mode (lower phase as the mobile phase). The elution profiles were simulated using the equilibrium-cell model and an anti-Langmuir-like equation for describing the CBD distribution equilibria. The distribution equilibria equation parameters were fitted to the CBD elution profiles using the peak fitting method. The model was validated and provided good predictions of the CBD elution profiles in the entire concentration range for all three LLC units.
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Affiliation(s)
- Melanie Gerigk
- Biothermodynamics, Department of Life Science Engineering, TUM School of Life Sciences, Technical University of Munich, 85354 Freising, Germany
| | - Gergő Dargó
- Rotachrom Technologies LLC, 6000 Kecskemét, Hungary
| | | | - Simon Vlad Luca
- Biothermodynamics, Department of Life Science Engineering, TUM School of Life Sciences, Technical University of Munich, 85354 Freising, Germany
| | - Mirjana Minceva
- Biothermodynamics, Department of Life Science Engineering, TUM School of Life Sciences, Technical University of Munich, 85354 Freising, Germany.
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15
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Upadhyay G, Fihurka O, Habecker C, Patel P, Sanchez-Ramos J. Measurement of Δ 9THC and metabolites in the brain and peripheral tissues after intranasal instillation of a nanoformulation. J Cannabis Res 2023; 5:3. [PMID: 36750917 PMCID: PMC9903512 DOI: 10.1186/s42238-022-00171-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/12/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Comparative bioavailability of cannabinoids following their administration by dosing routes has been studied previously, but there are no quantitative reports of distribution of Δ9THC, nor its metabolites, across various brain regions following intranasal (i.n.) administration. The aim of the present study was to determine the time course of Δ9THC transport from nose to brain and to quantify the distribution of Δ9THC and its metabolites in four brain regions. METHODS Δ9THC was formulated as a lipophilic nano-emulsion and instilled i.n. to three groups of adult mice and euthanized after 2, 4, and 8 h. Brains were dissected into 4 regions. Sensitive analytical methods (HPLC-MS) were utilized to quantify levels of Δ9THC and metabolites in brain regions and peripheral tissues. Data was expressed as mean concentrations (± SEM) of Δ9THC and metabolites in brain regions, blood, plasma, urine, and liver. Two-way analysis of variance was performed followed by post hoc multiple comparisons. RESULTS Peak concentrations of Δ9THC were reached at 2 h in the brain (15.9 ng/mg), blood (4.54 μg/mL), and plasma (4.56 μg /mL). The percentage of administered dose of Δ9THC transported to the brain (5.9%) was greater than in blood (1.7%), plasma (1.6%), urine (0.4%), and liver (0.1%). Concentrations of Δ9THC and its THC-COOH metabolite in the liver reached their highest levels at 8 h. DISCUSSION The present study is the first to report the uptake and distribution across brain regions of Δ9THC and its principal metabolites following i.n. administration. The systemic bioavailability (absorption into the blood) of intranasal Δ9THC was 1.7% of the administered dose, much lower than that reported by others after oral ingestion (7-10%) and inhalation (20-35%), but those prior studies did not measure the transport of Δ9THC into brain regions. Others have reported Δ9THC in the whole brain following i.n. instillation in a different species (rats) to be twice (5.9%) that following i.p. injections, while metabolites of Δ9THC in rat brain were lower after i.n. administration. CONCLUSIONS The intranasal route of a Δ9THC nanoformulation is an effective way to deliver cannabinoids to the brain, especially in those who cannot take the medication orally. Going forward, a metered dosing nasal spray will provide accurate and consistent doses.
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Affiliation(s)
| | - Oksana Fihurka
- grid.170693.a0000 0001 2353 285XDepartment of Neurology, University of South Florida, Tampa, FL USA
| | - Connor Habecker
- grid.170693.a0000 0001 2353 285XDepartment of Neurology, University of South Florida, Tampa, FL USA
| | - Pranav Patel
- SGN Nanopharma, Inc, 3720 Spectrum Blvd, Tampa, FL USA
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16
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Lorenzetti V, Gaillard A, Thomson D, Englund A, Freeman TP. Effects of cannabinoids on resting state functional brain connectivity: A systematic review. Neurosci Biobehav Rev 2023; 145:105014. [PMID: 36563921 DOI: 10.1016/j.neubiorev.2022.105014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Cannabis products are widely used for medical and non-medical reasons worldwide and vary in content of cannabinoids such as delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Resting state functional connectivity offers a powerful tool to investigate the effects of cannabinoids on the human brain. We systematically reviewed functional neuroimaging evidence of connectivity during acute cannabinoid administration. A pre-registered (PROSPERO ID: CRD42020184264) systematic review of 13 studies comprising 318 participants (mean age of 25 years) was conducted and reported using the PRISMA checklist. During THC and THCv exposure vs placebo reduced connectivity with the NAcc was widely reported. Limited evidence shows that such effects are offset by co-administration of CBD. NAcc-frontal region connectivity was associated with intoxication levels. Cannabis intoxication vs placebo was associated with lower striatal-ACC connectivity. CBD and CBDv vs placebo were associated with both higher and lower connectivity between striatal-prefrontal/other regions. Overall, cannabis and cannabinoids change functional connectivity in the human brain during resting state as a function of the type of cannabinoid examined.
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Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Australia.
| | - Alexandra Gaillard
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Australia
| | - Diny Thomson
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Australia; Turner Institute for Brain and Mental Health, School of Psychological Science, Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Tom P Freeman
- Addiction and Mental Health Group, Department of Psychology, Faculty of Humanities and Social Sciences, University of Bath, UK
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17
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Franz S, Herzog J, Skopp G, Musshoff F. Will tetrahydrocannabinol be formed from cannabidiol in gastric fluid? An in vivo experiment. Int J Legal Med 2023; 137:79-87. [PMID: 36190564 DOI: 10.1007/s00414-022-02896-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/19/2022] [Indexed: 01/10/2023]
Abstract
Cannabidiol (CBD) products have ascribed an uprising trend for their health-promoting effects worldwide. In contrast to Δ9-tetrahydrocannabinol (THC), CBD exhibits no state of euphoria. Since conversion of CBD into THC in an acidic environment has been reported, it has not been proved whether this degradation will also occur in human gastric fluid. A total of 9 subjects ingested 400 mg CBD as a water-soluble liquid together with lecithin as an emulsifier and ethanol as a solubilizer. Blood samples were taken up to 4 h, and urine samples were submitted up to 48 h. THC, 11-hydroxy-Δ9-THC (THC-OH), 11-nor-9-carboxy-Δ9-THC (THC-COOH), CBD, 7-hydroxy cannabidiol (7-OH-CBD), and 7-carboxy cannabidiol (7-CBD-COOH) were determined in blood and THC-COOH and 7-CBD-COOH in urine by LC-MS/MS. Neither THC, THC-OH, nor THC-COOH were detectable in any serum specimen. Only two urine samples revealed THC-COOH values slightly above the threshold of 10 ng/ml, which could also be caused by trace amounts of THC being present in the CBD liquid. It can be concluded that negative consequences for participants of a drug testing program due to a conversion of CBD into THC in human gastric fluid appear unlikely, especially considering a single intake of dosages of less than 400 mg. Nevertheless, there is a reasonable risk for consumers of CBD products being tested positive for THC or THC metabolites. However, this is probably not caused by CBD cyclization into THC in human gastric fluid but is most likely due to THC being present as an impurity of CBD products.
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Affiliation(s)
- Simon Franz
- Forensic Toxicological Center (FTC) Munich, Dessauerstr. 13-15, 80992, Munich, Germany.
| | - Josefine Herzog
- Forensic Toxicological Center (FTC) Munich, Dessauerstr. 13-15, 80992, Munich, Germany
| | - Gisela Skopp
- Forensic Toxicological Center (FTC) Munich, Dessauerstr. 13-15, 80992, Munich, Germany
| | - Frank Musshoff
- Forensic Toxicological Center (FTC) Munich, Dessauerstr. 13-15, 80992, Munich, Germany
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18
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Clouse G, Penman S, Hadjiargyrou M, Komatsu DE, Thanos PK. Examining the role of cannabinoids on osteoporosis: a review. Arch Osteoporos 2022; 17:146. [PMID: 36401719 DOI: 10.1007/s11657-022-01190-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/11/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Prior research studies have shown that the endocannabinoid system, influenced by CBD and THC, plays a role in bone remodeling. As both the research on cannabis and use of cannabis continue to grow, novel medicinal uses of both its constituents as well as the whole plant are being discovered. This review examines the role of cannabinoids on osteoporosis, more specifically, the endocannabinoid system and its role in bone remodeling and the involvement of the cannabinoid receptors 1 and 2 in bone health, as well as the effects of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), and synthetic cannabinoids on bone. METHODS A comprehensive literature search of online databases including PUBMED was utilized. RESULTS A total of 29 studies investigating the effects of cannabis and/or its constituents as well as the activation or inactivation of cannabinoid receptors 1 and 2 were included and discussed. CONCLUSION While many of the mechanisms are still not yet fully understood, both preclinical and clinical studies show that the effects of cannabis mediated through the endocannabinoid system may prove to be an effective treatment option for individuals with osteoporosis.
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Affiliation(s)
- Grace Clouse
- Behavioral Neuropharmacology and Neuroimaging Laboratory On Addictions (BNNLA), Research Institute On Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA
| | - Samantha Penman
- Behavioral Neuropharmacology and Neuroimaging Laboratory On Addictions (BNNLA), Research Institute On Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA
| | - Michael Hadjiargyrou
- Department of Biological and Chemical Sciences, New York Institute of Technology, Old Westbury, NY, USA
| | - David E Komatsu
- Department of Orthopedics, Stony Brook University, Stony Brook, NY, USA
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory On Addictions (BNNLA), Research Institute On Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA. .,Department of Psychology, University at Buffalo, Buffalo, NY, 14203, USA.
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19
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Vitetta L, Sikali JF, Fletcher C, Henson JD. Comment on: Cannabis use among Danish patients with cancer: a cross‑sectional survey of sociodemographic traits, quality of life, and patient experiences. Support Care Cancer 2022; 30:8619-8621. [PMID: 35312856 DOI: 10.1007/s00520-022-06995-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/16/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Luis Vitetta
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Research Department, Medlab Clinical, Sydney, Australia.
| | - Jason F Sikali
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Research Department, Medlab Clinical, Sydney, Australia
| | | | - Jeremy D Henson
- Research Department, Medlab Clinical, Sydney, Australia.,Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
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20
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Leen-Feldner EW, Bynion TM, Eglit GML, Bonn-Miller MO, Gournay LR, Feldner MT. A double-blind, randomized, placebo-controlled test of the effects of cannabidiol on fear elicited by a 10% carbon dioxide-enriched air breathing challenge. Psychopharmacology (Berl) 2022:10.1007/s00213-022-06258-7. [PMID: 36241853 DOI: 10.1007/s00213-022-06258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A single administration of cannabidiol (CBD) can reduce anxiety during social anxiety inductions. No study, however, has evaluated the impact of CBD on fear responding among humans. METHOD A double-blind, randomized, placebo-controlled trial was undertaken to address this gap in the literature. Specifically, the current study tested a single oral administration of CBD (either 150 mg, 300 mg, or 600 mg), compared to placebo, for reducing fear reactivity to a well-established 5-min administration of 10% carbon dioxide (CO2)-enriched air biological challenge. CBD was administered 90 min prior to the challenge. Participants were 61 healthy young adults who self-reported fear continuously during the challenge. Heart rate also was continuously monitored, and panic symptoms were self-reported using the Diagnostic Sensations Questionnaire immediately following the procedure. RESULTS Results indicated no effect of condition on self-reported fear, panic symptoms, or heart rate. CONCLUSION This is the first study to document that CBD does not reduce fear reactivity in humans, thereby representing an important extension to research on the effects of CBD.
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Affiliation(s)
| | - Teah-Marie Bynion
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
| | | | | | - L Riley Gournay
- University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA
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21
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Abstract
ABSTRACT Cannabidiol (CBD) is a nonpsychoactive phytocannabinoid and hemp derivative increasingly used in food. Illegal in food at the U.S. federal level, but legal in some states, the CBD-infused food product market has grown substantially, prompting government concerns regarding potential safety risks. CBD foods are a growing market that is driven by increasing demand from producers and consumers and that is governed by an inconsistent and evolving legal framework. This systematic review of research and regulations identified how legality relates to safety. The research also included an emphasis on dose, a key factor for determining safety in foods. Statutes and guidance documents were reviewed from a selection of jurisdictions with existing or proposed legalized CBD in food to determine what restrictions are used relative to safety, including dose and related standards for food. A search of scientific literature was conducted to evaluate what is known about safe dose in food applications and determine what information is still needed to inform a standard or regulated limit. Findings were analyzed to determine risks and what research and regulations are needed to address them. Legal jurisdictions do little to safeguard consumers against potential risks associated with CBD in food because they focus primarily on warnings and prohibiting health claims. Warning and labeling requirements lack consistency. More concerning is the absence of standards for dose in food or for the composition of the CBD used. Further, there is limited and incomplete information to inform such standards. HIGHLIGHTS
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Affiliation(s)
- Colleen R Nyland
- Online Food Safety Program, Michigan State University, East Lansing, Michigan 48824.,Kane County Health Department, Aurora, Illinois 60506, USA
| | - Douglas C Moyer
- Online Food Safety Program, Michigan State University, East Lansing, Michigan 48824.,Division of Public Health, Michigan State University, East Lansing, Michigan 48824
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22
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Harpaz D, Bernstein N, Namdar D, Eltzov E. Portable biosensors for rapid on-site determination of cannabinoids in cannabis, a review. Biotechnol Adv 2022; 61:108031. [PMID: 36058440 DOI: 10.1016/j.biotechadv.2022.108031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/12/2022] [Accepted: 08/26/2022] [Indexed: 11/02/2022]
Abstract
Recent studies highlight the therapeutic virtues of cannabidiol (CBD). Furthermore, due to their molecular enriched profiles, cannabis inflorescences are biologically superior to a single cannabinoid for the treatment of various health conditions. Thus, there is flourishing demand for Cannabis sativa varieties containing high levels of CBD. Additionally, legal regulations around the world restrict the cultivation and consumption of tetrahydrocannabinol (THC)-rich cannabis plants for their psychotropic effects. Therefore, the use of cannabis varieties that are high in CBD is permitted as long as their THC content does not exceed a low threshold of 0.3%-0.5%, depending on the jurisdiction. These chemovars are legally termed 'hemp'. This controlled cannabinoid requirement highlights the need to detect low levels of THC, already in the field. In this review, cannabis profiling and the existing methods used for the detection of cannabinoids are firstly evaluated. Then, selected valuable biosensor technologies are discussed, which suggest portable, rapid, sensitive, reproducible, and reliable methods for on-site identification of cannabinoids levels, mainly THC. Recent cutting-edge techniques of promising potential usage for both cannabis and hemp analysis are identified, as part of the future cultivation and agricultural improvement of this crop.
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Affiliation(s)
- Dorin Harpaz
- Institute of Postharvest and Food Science, Department of Postharvest Science, Volcani Institute, Agricultural Research Organization, Rishon LeZion 7505101, Israel; Institute of Biochemistry, Food Science and Nutrition, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 76100, Israel.
| | - Nirit Bernstein
- Institute of Soil Water and Environmental Sciences, Volcani Institute, Agricultural Research Organization, POBox 6, Bet-Dagan 50250, Israel.
| | - Dvora Namdar
- Institute of Soil Water and Environmental Sciences, Volcani Institute, Agricultural Research Organization, POBox 6, Bet-Dagan 50250, Israel.
| | - Evgeni Eltzov
- Institute of Postharvest and Food Science, Department of Postharvest Science, Volcani Institute, Agricultural Research Organization, Rishon LeZion 7505101, Israel.
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23
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St Blanc MP, Chapman AM, Keowen ML, Garza F, Liu CC, Gray L, Andrews FM. Effects of a supplement containing Cannabidiol (CBD) on sedation and ataxia scores and health: Effects of Cannabidiol on Sedation and Ataxia. J Equine Vet Sci 2022; 117:104085. [PMID: 35882292 DOI: 10.1016/j.jevs.2022.104085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
Supplements containing Cannabidiol (CBD) are available for horses, however, few studies have been published on their effects on behavior and health parameters. The purpose of this study was to determine if a daily oral supplement containing CBD would cause sedation, ataxia or alterations in other health parameters during administration for 56 days. Twenty clinically healthy adult Thoroughbred horses were housed in stalls. Before treatment was initiated, a complete physical examination, complete blood count (CBC) and biochemical panel were evaluated. In addition, horses were examined for sedation and ataxia using standard scoring systems. Horses were randomly divided into two treatment groups, treated (supplement pellets containing CBD as Hemp Extract, 150 mg) or control (supplement pellets without CBD). Horses were treated daily and sedation and ataxia scores were assigned by two masked observers once weekly for 56 days. Horses were monitored daily for clinical signs or adverse events and body weights were recorded weekly. A CBC and biochemical panel were repeated on days 28 and 56, two hours after administration of the supplement. The supplement was readily consumed by the horses and no adverse effects were seen over the treatment period. Sedation and ataxia scores ranged from 0 to 2 for all horses during the weekly examinations and there was no statistical difference between treatment groups. There were no treatment effects on blood values, including indicators of anemia and blood proteins, liver enzymes, kidney values, electrolytes or calcium. Body weight significantly increased in all horses, by Day 56 compared to Day 0 but no treatment by day effect was noted. The CBD supplement (150 mg) was readily consumed and safe and did not result in changes in mentation, gait, or other health parameters, and no adverse clinical signs were observed during 56 days of oral administration.
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Affiliation(s)
| | | | | | - Frank Garza
- Equine Health Studies Program, Baton Rouge, LA, USA
| | - Chin-Chi Liu
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
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Zaizar ED, Papini S, O'Connor P, Telch MJ. Impact of cannabidiol-rich hemp extract oil on reconsolidation disruption of naturalistic interoceptive aversive memory in humans: Protocol for a randomized clinical trial. Contemp Clin Trials 2022; 119:106847. [PMID: 35811050 DOI: 10.1016/j.cct.2022.106847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preclinical experiments with rodents demonstrate that cannabidiol (CBD), the non-psychotomimetic constituent of the Cannabis sativa plant, disrupts reconsolidation of aversive memories conditioned in the laboratory when administered within the memory reconsolidation window (< 6 h. post-retrieval) by indirectly activating cannabinoid type-1 (CB1) receptors in the dorsal anterior cingulate cortex (dACC). Based on these findings, we aim to test whether administration of 300 mg CBD-rich hemp extract oil following fear reactivation of an aversive interoceptive threat memory can disrupt reconsolidation of naturalistic aversive memories in humans. More specifically, naturalistic interoceptive aversive memories, a form of transdiagnostic fear memory that contributes to the pathogenesis of fear-related disorders such as panic disorder, posttraumatic stress disorder (PTSD), and illness anxiety disorder. METHODS For this proof-of-concept, placebo-controlled double-blind trial, volunteers (n = 99) reporting elevated fears of somatic sensations will be stratified on biological sex and randomized to one of three intervention arms: (a). CBD-rich oil administered within the reconsolidation window, (b) Placebo oil administered within the reconsolidation window; or (c) CBD-rich oil administered outside of the reconsolidation window. Change in emotional reactivity to a 35% CO2 challenge from baseline to two-week follow-up will serve as our primary outcome. CONCLUSION Study findings may contribute towards the development of a novel brief transdiagnostic intervention guided by reconsolidation theory for individuals prone to fear-related psychiatric disorders. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04726475.
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Affiliation(s)
- Eric D Zaizar
- Department of Psychology, The University of Texas at Austin, USA; Institute for Mental Health Research, The University of Texas at Austin, USA
| | - Santiago Papini
- Division of Research, Kaiser Permanente Northern California, USA
| | - Patrick O'Connor
- Department of Psychology, The University of Texas at Austin, USA; Institute for Neuroscience, The University of Texas at Austin, USA
| | - Michael J Telch
- Department of Psychology, The University of Texas at Austin, USA; Institute for Mental Health Research, The University of Texas at Austin, USA; Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, USA.
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Greenwood LM, Broyd SJ, van Hell HH, Todd J, Jones A, Murray RM, Croft RJ, Michie PT, Solowij N. Acute effects of Δ(9)-tetrahydrocannabinol and cannabidiol on auditory mismatch negativity. Psychopharmacology (Berl) 2022; 239:1409-24. [PMID: 34719731 DOI: 10.1007/s00213-021-05997-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE Mismatch negativity (MMN) is a candidate endophenotype for schizophrenia subserved by N-methyl-D-aspartate receptor (NMDAR) function and there is increasing evidence that prolonged cannabis use adversely affects MMN generation. Few human studies have investigated the acute effects of cannabinoids on brain-based biomarkers of NMDAR function and synaptic plasticity. OBJECTIVES The current study investigated the acute effects of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) alone and in combination on the mismatch negativity (MMN). METHODS In a randomised, double-blind, crossover placebo-controlled study, 18 frequent and 18 less-frequent cannabis users underwent 5 randomised drug sessions administered via vaporiser: (1) placebo; (2) THC 8 mg; (3) CBD 400 mg; (4) THC 8 mg + CBD 4 mg [THC + CBDlow]; (5) THC 12 mg + CBD 400 mg [THC + CBDhigh]. Participants completed a multifeature MMN auditory oddball paradigm with duration, frequency and intensity deviants (6% each). RESULTS Relative to placebo, both THC and CBD were observed to increase duration and intensity MMN amplitude in less-frequent users, and THC also increased frequency MMN in this group. The addition of low-dose CBD added to THC attenuated the effect of THC on duration and intensity MMN amplitude in less-frequent users. The same pattern of effects was observed following high-dose CBD added to THC on duration and frequency MMN in frequent users. CONCLUSIONS The pattern of effects following CBD combined with THC on MMN may be subserved by different underlying neurobiological interactions within the endocannabinoid system that vary as a function of prior cannabis exposure. These results highlight the complex interplay between the acute effects of exogenous cannabinoids and NMDAR function. Further research is needed to determine how this process normalises after the acute effects dissipate and following repeated acute exposure.
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Sakal C, Lynskey M, Schlag AK, Nutt DJ. Developing a real-world evidence base for prescribed cannabis in the United Kingdom: preliminary findings from Project Twenty21. Psychopharmacology (Berl) 2022; 239:1147-55. [PMID: 33970291 DOI: 10.1007/s00213-021-05855-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
The therapeutic potential of medical cannabis to treat a variety of conditions is becoming increasingly recognised. Globally, a large number of countries have now legalised cannabis for medical uses and a substantial number of patients are able to access their medications. Yet in the UK, where medical cannabis was legalised in November 2018, only a handful of NHS prescriptions have been written, meaning that most patients are unable to access the medicine. Reasons for this are manyfold and include the perceived lack of clinical evidence due to the challenges of studying medical cannabis through randomised controlled trials. In order to develop the current evidence base, the importance of incorporating real-world data (RWD) to assess the effectiveness and efficacy of medical cannabis has gradually become recognised. The current paper provides a detailed outline of Project Twenty21 (T21), the UK's first medical cannabis registry, launched in August 2020. We provide the rationale for T21 and describe the methodology before reporting the characteristics of the 'first patients' enrolled in the registry. We describe the health status of all patients enrolled into the project during its first 7 months of operation and the sociodemographic characteristics and primary presenting conditions for these patients, as well as details of the medical cannabis prescribed to these individuals. By 12th March 2021, 678 people had been enrolled into T21; the majority (64%) were male and their average age was 38.7 years (range = 18-80). The most commonly reported primary conditions were chronic pain (55.6%) and anxiety disorders (32.0%) and they reported high levels of multi-morbidity, including high rates of insomnia and depression. We also present preliminary evidence from 75 patients followed up after 3 months indicating that receipt of legal, prescribed cannabis was associated with a significant increase in self-reported health, assessed using the visual analogue scale of the EQ-5D-5L (Cohen's d = .77, 95% CI = .51-1.03). Our initial findings complement reports from other large-scale databases globally, indicating that the current RWD is building up a pattern of evidence. With many clinicians demanding better and faster evidence to inform their decisions around prescribing medical cannabis, the current and future results of T21 will expand the existing evidence base on the effectiveness of cannabis-based medical products (CBMPs).
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Trivedi MK, Mondal S, Gangwar M, Jana S. Anti-inflammatory potential of cannabidiol (CBD) on combination of caecal slurry, LPS, and E. coli-induced systemic inflammatory response syndrome (SIRS) in Sprague Dawley Rats. Inflammopharmacology 2022; 30:225-232. [PMID: 34997430 DOI: 10.1007/s10787-021-00901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objective was to evaluate the therapeutic effect of cannabidiol (CBD) on a combination of caecal slurry, lipopolysaccharide (LPS), and Escherichia coli (E. coli)-induced systemic inflammatory response syndrome (SIRS) in male Sprague Dawley rats. METHODS The therapeutic activity was monitored in behavioral tests and inflammatory biomarkers by the enzyme-linked immune sorbent assay (ELISA) method. RESULTS Behavioral tasks were significantly increased like a tail flick response by 73.84% (p ≤ 0.001), grip strength by 33.56% (p ≤ 0.028), locomotor activity by 20.71% (p = 0.034) in the CBD (60 mg/kg) group compared to disease control (DC) group. Levels of inflammatory serum biomarkers like interleukin-1β (IL-1β), matrix metallopeptidase-9 (MMP-9), IL-6, and tumor necrosis factor-alpha (TNF-α) were significantly decreased by 29.56 (p = 0.041), 71.20 (p ≤ 0.001), 35.05 (p ≤ 0.001), and 75.56% (p = 0.002), respectively, in the CBD-60 compared with DC. Inflammatory cytokines levels, viz. IL-1β, MMP-9, IL-6, and TNF-α, in the liver were significantly (p ≤ 0.001) decreased by 81.01, 40.41, 22.84, and 69.46%, respectively, in CBD-60 to DC. Similarly, levels of inflammatory cytokines such as IL-1β and MMP-9 in the kidney were significantly (p ≤ 0.001) decreased by 80.90 and 43.93%, respectively, in CBD-60 compared to DC. CONCLUSION Taken together, results suggest that CBD treatment significantly improved behavioral tasks and decreased the level of inflammatory cytokines under SIRS conditions that might provide an opportunity to manage acute and chronic inflammatory disorders.
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Affiliation(s)
| | - Sambhu Mondal
- Trivedi Science Research Laboratory Pvt. Ltd., Thane, Maharashtra, India
| | - Mayank Gangwar
- Trivedi Science Research Laboratory Pvt. Ltd., Thane, Maharashtra, India
| | - Snehasis Jana
- Trivedi Science Research Laboratory Pvt. Ltd., Thane, Maharashtra, India.
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Abstract
The use of natural products has been increasing at a rapid pace, worldwide, with the aim to maintain a healthy lifestyle and to modify one's dietary habits. Ayurveda is a domain that has numerous wealth of information concerning medicinal plants and its part in controlling numerous ailments, such as neoplastic, cardiovascular, neurological plus immunological ailments. The use of such medicinal plants is important for preventing such diseases, especially "cancer" which is the succeeding foremost cause of mortality collectively. Even though abundant developments have been made in the management and control of cancer progression, substantial deficits and scope for advancement still continue to be unchanged. Several lethal adjacent consequences occur throughout the course of chemotherapy. Natural treatments, such as the use of plant-derived products in the treatment of cancer, might reduce the hostile side effects. Presently, a few plant-based products and its phytoconstituents are being utilized for the management of cancer. Here we have focused on numerous plant-derived phytochemicals and promising compounds from these plants to act as anticancer agents, along with their mechanisms of action.
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Affiliation(s)
- Nikhil Pandey
- Department of Medicinal Chemistry, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Y B Tripathi
- Department of Medicinal Chemistry, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
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Sermet S, Li J, Bach A, Crawford RB, Kaminski NE. Cannabidiol selectively modulates interleukin (IL)-1β and IL-6 production in toll-like receptor activated human peripheral blood monocytes. Toxicology 2021; 464:153016. [PMID: 34740670 DOI: 10.1016/j.tox.2021.153016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 12/12/2022]
Abstract
Cannabidiol (CBD) is a major non-euphoric cannabis-derived compound that has become popular in its over-the-counter use. CBD possesses low affinity for cannabinoid receptors, while the primary molecular target(s) by which it mediates biological activity remain poorly defined. Individuals commonly self-medicate using CBD products with little knowledge of its specific immunopharmacological effects on the human immune system; however, research has established primarily in rodent models that CBD possesses immune modulating properties. The objective of this study was to evaluate whether CBD modulates the innate immune response by human primary monocytes activated through toll-like receptors (TLR) 1-9. Monocytes were activated through each TLR and treated with CBD (0.5-10 μM) for 22 h. Monocyte secretion profiles for 13 immune mediators were quantified including: IL-4, IL-2, IP-10, IL-1β, TNFα, MCP-1, IL-17a, IL-6, IL-10, IFNγ, IL-12p70, IL-8, and TGF-β1. CBD treatment significantly suppressed secretion of proinflammatory cytokine IL-1β by monocytes activated through most TLRs, apart from TLRs 3 and 8. Additionally, CBD treatment induced significant modulation of IL-6 production by monocytes activated through most TLRs, except for TLRs 1 and 3. Most other monocyte-derived factors assayed were refractory to CBD modulation. Overall, CBD selectively altered monocyte-derived IL-1β and IL-6 when activated through most TLRs. This study is of particular importance as it provides a direct and comprehensive assessment of the effects of CBD on TLR-activated primary human monocytes at a time when CBD containing products are being widely used by the public.
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Affiliation(s)
- Sera Sermet
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States
| | - Jinpeng Li
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Center for Research on Ingredient Safety, Michigan State University, East Lansing, MI, 48824, United States
| | - Anthony Bach
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Center for Research on Ingredient Safety, Michigan State University, East Lansing, MI, 48824, United States
| | - Robert B Crawford
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States
| | - Norbert E Kaminski
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Center for Research on Ingredient Safety, Michigan State University, East Lansing, MI, 48824, United States.
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Grayson L, Ampah S, Hernando K, Kankirawatana P, Gaston T, Cutter G, Szaflarski JP, Martina Bebin E. Longitudinal impact of cannabidiol on EEG measures in subjects with treatment-resistant epilepsy. Epilepsy Behav 2021; 122:108190. [PMID: 34273739 DOI: 10.1016/j.yebeh.2021.108190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the longitudinal impact of highly purified cannabidiol (CBD) on the electroencephalogram (EEG) of children and adults. METHODS Participants received an EEG prior to starting CBD, after approximately 12 weeks of CBD (FU1) and after approximately one year of CBD therapy (FU2). Longitudinal changes in five EEG measures (background frequency, focal slowing, reactivity, frequency of interictal, and ictal discharges) were examined following CBD exposure. Data were compared between pediatric and adult groups at two follow-up time points and within groups over time. Population-averaged models with generalized estimation equations or linear mixed effects models were used to analyze data where appropriate. Correlation analysis was used to assess any association between changes in seizure frequency and changes in EEG interictal discharge (IED) frequency. An alpha level of 5% was used to assess statistical significance. RESULTS At FU1, the adult group showed significant decrease in IED/minute (IDR 0.07, 95% CI [0.04, 0.14], P < 0.001); a nonsignificant decrease was observed among children (IDR 0.87, 95% CI [0.47, 0.64], P = 0.67). The difference in changes over time between participant groups was significant after adjusting for last CBD dose (IDR 11.8, 95% CI [4.86, 28.65], P < 0.0001). At FU2 both groups showed significant reduction from baseline after controlling for last CBD dose. This decrease was more pronounced in children (IDR 15.38, 95% CI [4.93, 47.99], P < 0.001). There was no significant correlation between changes in seizure frequency and EEG IED frequency at each timepoint (P = 0.542, 0.917 and 0.989 from baseline to FU1, FU1 to FU2 and baseline to FU2, respectively). SIGNIFICANCE This longitudinal EEG study shows that highly-purified plant-derived CBD has positive effects on interictal epileptiform discharge frequency but no effects on other EEG measures. The effect of CBD does not appear to be dose or treatment-duration dependent.
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Affiliation(s)
- Leslie Grayson
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Steve Ampah
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathleen Hernando
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pongkiat Kankirawatana
- Division of Neurology, Children's of Alabama and University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tyler Gaston
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Departments of Neurosurgery and Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Martina Bebin
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Leen-Feldner EW, Bynion TM, Gournay R, Bonn-Miller MO, Feldner MT. Practical considerations for testing the effects of cannabidiol on human anxiety. J Anxiety Disord 2021; 82:102429. [PMID: 34058457 DOI: 10.1016/j.janxdis.2021.102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/16/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022]
Abstract
Empirical evidence continues to accumulate suggesting cannabidiol (CBD) may have potential as an anxiolytic. Yet, research in the area is insufficient to support strong inferences. Accordingly, there is a need for additional empirical investigation. Research on the effects of CBD and anxiety requires a working knowledge of both. Understanding of contemporary CBD and anxiety research methods is critical to safely and convincingly test predictions regarding potential anxiolytic effects of CBD. The current paper outlines major design, methods, and safety considerations pertinent both to CBD administration and measuring effects on anxiety outcomes in order to facilitate needed research in this domain.
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Affiliation(s)
| | | | | | | | - Matthew T Feldner
- University of Arkansas, United States; Canopy Growth Corporation, United States.
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Ahmed B, Hijri M. Potential impacts of soil microbiota manipulation on secondary metabolites production in cannabis. J Cannabis Res 2021; 3:25. [PMID: 34217364 PMCID: PMC8254954 DOI: 10.1186/s42238-021-00082-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/22/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cannabis growing practices and particularly indoor cultivation conditions have a great influence on the production of cannabinoids. Plant-associated microbes may affect nutrient acquisition by the plant. However, beneficial microbes influencing cannabinoid biosynthesis remain largely unexplored and unexploited in cannabis production. OBJECTIVE To summarize study outcomes on bacterial and fungal communities associated with cannabis using high-throughput sequencing technologies and to uncover microbial interactions, species diversity, and microbial network connections that potentially influence secondary metabolite production in cannabis. MATERIALS AND METHOD A mini review was conducted including recent publications on cannabis and their associated microbiota and secondary metabolite production. RESULTS In this review, we provide an overview of the potential role of the soil microbiome in production of cannabinoids, and discussed that manipulation of cannabis-associated microbiome obtained through soil amendment interventions of diversified microbial communities sourced from natural forest soil could potentially help producers of cannabis to improve yields of cannabinoids and enhance the balance of cannabidiol (CBD) and tetrahydrocannabinol (THC) proportions. CONCLUSION Cannabis is one of the oldest cultivated crops in history, grown for food, fiber, and drugs for thousands of years. Extension of genetic variation in cannabis has developed into wide-ranging varieties with various complementary phenotypes and secondary metabolites. For medical or pharmaceutical purposes, the ratio of CBD to THC is key. Therefore, studying soil microbiota associated with cannabis and its potential impact on secondary metabolites production could be useful when selecting microorganisms as bioinoculant agents for enhanced organic cannabinoid production.
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Affiliation(s)
- Bulbul Ahmed
- Institut de Recherche en Biologie Végétale, Université de Montréal, 4101 Sherbrooke Est, Montréal, Québec, H1X 2B2, Canada
| | - Mohamed Hijri
- Institut de Recherche en Biologie Végétale, Université de Montréal, 4101 Sherbrooke Est, Montréal, Québec, H1X 2B2, Canada.
- African Genome Center, Mohammed VI Polytechnic University (UM6P), Lot 660, Hay Moulay Rachid, 43150, Ben Guerir, Morocco.
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Buckley MC, Kumar A, Swaminath A. Inflammatory Bowel Disease and Cannabis: A Practical Approach for Clinicians. Adv Ther 2021; 38:4152-61. [PMID: 34110607 DOI: 10.1007/s12325-021-01805-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/24/2021] [Indexed: 12/11/2022]
Abstract
Although still not approved at the federal level for medical or adult recreational use, cannabis has been approved in the United States (USA) by individual states for both of these purposes. A total of 15 states now regulate cannabis for adult use and 36 states for medical use. In more recent years, cannabis has gained popularity for the treatment of chronic conditions, inflammatory bowel disease (IBD) being one of them. However, the exact role of cannabis in the treatment of IBD remains uncertain. While cannabis may help in some instances with symptom management, it has not been proven to help with inflammation or to fundamentally correct underlying disease processes. Additionally, along with the perceived symptom benefits of cannabis come concerning issues like dosing inconsistencies, dependence, and cannabinoid hyperemesis syndrome. In this review article, we explore the nuanced relationship between cannabis and the treatment of IBD by summarizing the current research. We also use clinical vignettes to discuss the more practical considerations surrounding its use.
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Nkune NW, Kruger CA, Abrahamse H. Possible Enhancement of Photodynamic Therapy (PDT) Colorectal Cancer Treatment when Combined with Cannabidiol. Anticancer Agents Med Chem 2021; 21:137-148. [PMID: 32294046 DOI: 10.2174/1871520620666200415102321] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/23/2019] [Accepted: 02/04/2020] [Indexed: 11/22/2022]
Abstract
Colorectal Cancer (CRC) has a high mortality rate and is one of the most difficult diseases to manage due to tumour resistance and metastasis. The treatment of choice for CRC is reliant on the phase and time of diagnosis. Despite several conventional treatments available to treat CRC (surgical excision, chemo-, radiationand immune-therapy), resistance is a major challenge, especially if it has metastasized. Additionally, these treatments often cause unwanted adverse side effects and so it remains imperative to investigate alternative combination therapies. Photodynamic Therapy (PDT) is a promising treatment modality for the primary treatment of CRC, since it is non-invasive, has few side effects and selectively damages only cancerous tissues, leaving adjacent healthy structures intact. PDT involves three fundamentals: a Photosensitizer (PS) drug localized in tumour tissues, oxygen, and light. Upon PS excitation using a specific wavelength of light, an energy transfer cascade occurs, that ultimately yields cytotoxic species, which in turn induces cell death. Cannabidiol (CBD) is a cannabinoid compound derived from the Cannabis sativa plant, which has shown to exert anticancer effects on CRC through different pathways, inducing apoptosis and so inhibiting tumour metastasis and secondary spread. This review paper highlights current conventional treatment modalities for CRC and their limitations, as well as discusses the necessitation for further investigation into unconventional active nanoparticle targeting PDT treatments for enhanced primary CRC treatment. This can be administered in combination with CBD, to prevent CRC secondary spread and enhance the synergistic efficacy of CRC treatment outcomes, with less side effects.
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Affiliation(s)
- Nkune W Nkune
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Cherie A Kruger
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Heidi Abrahamse
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Satpute Janve V, Anderson LL, Bahceci D, Hawkins NA, Kearney JA, Arnold JC. The Heat Sensing Trpv1 Receptor Is Not a Viable Anticonvulsant Drug Target in the Scn1a +/- Mouse Model of Dravet Syndrome. Front Pharmacol 2021; 12:675128. [PMID: 34079465 PMCID: PMC8165383 DOI: 10.3389/fphar.2021.675128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Cannabidiol has been approved for the treatment of drug-resistant childhood epilepsies including Dravet syndrome (DS). Although the mechanism of anticonvulsant action of cannabidiol is unknown, emerging data suggests involvement of the transient receptor potential cation channel subfamily V member 1 (Trpv1). Pharmacological and genetic studies in conventional seizure models suggest Trpv1 is a novel anticonvulsant target. However, whether targeting Trpv1 is anticonvulsant in animal models of drug-resistant epilepsies is not known. Thus, we examined whether Trpv1 affects the epilepsy phenotype of the F1.Scn1a +/- mouse model of DS. We found that cortical Trpv1 mRNA expression was increased in seizure susceptible F1.Scn1a +/- mice with a hybrid genetic background compared to seizure resistant 129.Scn1a +/- mice isogenic on 129S6/SvEvTac background, suggesting Trpv1 could be a genetic modifier. Previous studies show functional loss of Trpv1 is anticonvulsant. However, Trpv1 selective antagonist SB-705498 did not affect hyperthermia-induced seizure threshold, frequency of spontaneous seizures or survival of F1.Scn1a +/- mice. Surprisingly, Trpv1 deletion had both pro- and anti-seizure effects. Trpv1 deletion did not affect hyperthermia-induced seizure temperature thresholds of F1.Scn1a +/- ; Trpv1 +/- at P14-16 but was proconvulsant at P18 as it reduced seizure temperature thresholds. Conversely, Trpv1 deletion did not alter the frequency of spontaneous seizures but reduced their severity. These results suggest that Trpv1 is a modest genetic modifier of spontaneous seizure severity in the F1.Scn1a +/- model of DS. However, the opposing pro- and anti-seizure effects of Trpv1 deletion and the lack of effects of Trpv1 inhibition suggest that Trpv1 is unlikely a viable anticonvulsant drug target in DS.
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Affiliation(s)
- Vaishali Satpute Janve
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, Sydney, NSW, Australia.,Discipline of Pharmacology, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lyndsey L Anderson
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, Sydney, NSW, Australia.,Discipline of Pharmacology, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dilara Bahceci
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, Sydney, NSW, Australia.,Discipline of Pharmacology, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicole A Hawkins
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jennifer A Kearney
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jonathon C Arnold
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, Sydney, NSW, Australia.,Discipline of Pharmacology, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Pelletti G, Barone R, Giorgetti A, Garagnani M, Rossi F, Fais P, Pelotti S. "Light cannabis" consumption in a sample of young adults: Preliminary pharmacokinetic data and psychomotor impairment evaluation. Forensic Sci Int 2021; 323:110822. [PMID: 33971503 DOI: 10.1016/j.forsciint.2021.110822] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In 2019, the Italian Supreme Court established that hemp cannot be commercialized for human use, when the "psychotropic effect" of the product or its "offensiveness" can be demonstrated. The aim of the present study is to assess Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) blood concentrations after smoking cannabis with a low percentage of Δ9-THC, also referred as "light cannabis", and its effects on young adults' vigilance, cognitive and motor skills. MATERIALS AND METHODS Eighteen young adults consumed three light cannabis cigarettes containing 400 mg of inflorescences each, with a percentage of 0.41% of Δ9-THC and of 12.41% of CBD. Blood samples were collected before the experiment (t0), after each light cannabis cigarette (t1→t3), 60 (t4) and 120 (t5) minutes after the beginning of the experiment. Five performance tasks and a subjective scale were employed for measuring cognitive and psychomotor performances the day before the experiment (TT0) and after the third cigarette (TT1). RESULTS Mean (SD) concentrations (ng/ml) were 1.0 (0.8) in t1, 1.2 (0.9) in t2, 1.0 (0.8) in t3, 0.6 (0.4) in t4 and 0.3 (0.3) in t5 for Δ9-THC; 10.5 (10.3) in t1, 10.3 (13.2) in t2, 15.1 (14.8) in t3, 9.9 (9.2) in t4 and 5.7 (5.7) in t5 for CBD. No significant differences were observed between TT0 and TT1 for all performed psychomotor performance task. None of the subjects declared to feel "high" after the experiment. DISCUSSION All study participants reported that a higher number of cigarettes, corresponding in this study to 1200 mg of herbal product, could hardly be consumed by smoking in a recreational setting. Δ9-THC and CBD concentrations showed a high inter-subject variability, and the average concentrations were lower than those previously reported. Toxicological results showed a decrease of Δ9-THC and CBD after the third light cannabis cigarette, and a Δ9-THC /CBD ratio always<1 was observed. The lack of impairment observed in our participants can be interpreted as a consequence of the very low concentrations detectable in the blood.
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Affiliation(s)
- Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Rossella Barone
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Arianna Giorgetti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Francesca Rossi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
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Schlag AK, O'Sullivan SE, Zafar RR, Nutt DJ. Current controversies in medical cannabis: Recent developments in human clinical applications and potential therapeutics. Neuropharmacology 2021; 191:108586. [PMID: 33940011 DOI: 10.1016/j.neuropharm.2021.108586] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022]
Abstract
Knowledge about the therapeutic potential of medical cannabis has greatly improved over the past decade, with an ever-increasing range of developments in human clinical applications. A growing body of scientific evidence supports the use of medical cannabis products for some therapeutic indications, whilst for others, the evidence base remains disputed. For this narrative review, we incorporate areas where the current evidence base is substantial, such as intractable childhood epilepsy and multiple sclerosis, as well as areas where the evidence is still controversial, such as PTSD and anxiety. We provide a high-level summary of current developments using findings from recent major reviews, as well as real world evidence (RWE), including global database registries and other patient reported outcomes (PROs). On the one hand, our strongest empirical data supports the use of cannabis-based medicinal products (CBMPs) for conditions with relatively small patient numbers. Yet on the other hand, the conditions, where the highest patient numbers present, often have debatable clinical evidence but good RWE, incorporating PROs of 1000s of patients. The discord between PROs and the respective strength of the evidence from randomised controlled trials (RCTs) highlights the urgent need for further research. The scientific literature examining the efficacy of medical cannabis for many conditions is still developing, whilst large numbers of patients globally have been successfully using medical cannabis to treat a broad range of conditions. We conclude on the importance of systematically developing RWE databases to supplement RCTs and to bridge the current evidence gaps.
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Affiliation(s)
- Anne Katrin Schlag
- Drug Science, London, UK; Imperial College London, Du Cane Road, London, W12 0NN, UK.
| | | | - Rayyan R Zafar
- Drug Science, London, UK; Imperial College London, Du Cane Road, London, W12 0NN, UK.
| | - David J Nutt
- Drug Science, London, UK; Imperial College London, Du Cane Road, London, W12 0NN, UK.
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Qi X, Liu C, Li G, Luan H, Li S, Yang D, Zhou Z. Investigation of in vitro odonto/osteogenic capacity of cannabidiol on human dental pulp cell. J Dent 2021; 109:103673. [PMID: 33872753 DOI: 10.1016/j.jdent.2021.103673] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Vital pulp treatment (VPT) maintains tooth vitality with certain dental materials by protecting pulp from noxious stimulation and promoting repair through enhancing cell proliferation/differentiation, migration, and inducing odontogenesis. As a non-psychotropic cannabis constituent, cannabidiol (CBD) possesses the properties of analgesic, anti-inflammation, and osteogenesis. Therefore, we hypothesize that CBD may induce the odonto/osteogenesis of human dental pulp cells (HDPCs), a critical feature using as effective pulp capping agent for VPT. MATERIALS AND METHODS In this in vitro study, the cytotoxicity of CBD on HDPCs was determined by MTT assay. Scratch assay was performed to analyze HDPC migration. The biomineralization was examined by collagen synthesis and calcium nodule formation and related odonto/osteogenic and angiogenic genes. Cannabinoid receptor (CB) specificity was evaluated by Western blotting and Von Kossa staining using specific antagonists AM251 for cannabinoid receptor 1 (CB1) and AM 630 targeted at cannabinoid receptor 2 (CB2). In addition, the underlying molecular mechanism of CBD-induced biomineralization were investigated by examining CB-dependent MAPK signaling pathways. RESULTS CBD demonstrated bi-phasic effects on HDPC viability in tested concentrations. We found CBD significantly promoted cell migration, enhanced collagen synthesis and mineralized deposits in HDPCs when treated by 1 μM CBD supplemented in the differentiation media. RT-PCR revealed CBD increased the expression of angiogenic and odontogenic genes, such as DSPP, DMP-1, OPN, ALP, Runx2, VEGFR1 and ICAM-1. These effects were via MAPK activation in a manner mainly mediated by CB2. CONCLUSION The results from this study suggested that CBD can induce odonto/osteogenesis from HDPCs and has the potential to develop new therapeutics in VPT in dentistry.
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Affiliation(s)
- Xia Qi
- Graduate Periodontics, School of Dentistry, University of Detroit Mercy, Detroit, MI, 48208, USA; Department of Periodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chunyan Liu
- Graduate Periodontics, School of Dentistry, University of Detroit Mercy, Detroit, MI, 48208, USA; Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Guohua Li
- Graduate Periodontics, School of Dentistry, University of Detroit Mercy, Detroit, MI, 48208, USA
| | - Haipei Luan
- Graduate Periodontics, School of Dentistry, University of Detroit Mercy, Detroit, MI, 48208, USA
| | - Shujuan Li
- Department of Periodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dongru Yang
- Department of Periodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Zheng Zhou
- Graduate Periodontics, School of Dentistry, University of Detroit Mercy, Detroit, MI, 48208, USA.
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Golliher AE, Tenorio AJ, Dimauro NO, Mairata NR, Holguin FO, Maio W. Using (+)-Carvone to access novel derivatives of (+)- ent-Cannabidiol: the first asymmetric syntheses of (+)- ent-CBDP and (+)- ent-CBDV. Tetrahedron Lett 2021; 67:152891. [PMID: 34658452 PMCID: PMC8513745 DOI: 10.1016/j.tetlet.2021.152891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
(-)-Cannabidiol [(-)-CBD] has recently gained prominence as a treatment for neuro-inflammation and other neurodegenerative disorders; interest is also developing in its synthetic enantiomer, (+)-CBD, which has a higher affinity to CB1 / CB2 receptors than the natural stereoisomer. We have developed an inexpensive, stereoselective route to access ent-CBD derivatives using (+)-carvone as a starting material. In addition to (+)-CBD, we report the first syntheses of (+)-cannabidivarin, (+)-cannabidiphorol as well as C-6 / C-8 homologues.
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Affiliation(s)
- Alexandra E. Golliher
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, NM 88003
| | - Antonio J. Tenorio
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, NM 88003
| | - Nina O. Dimauro
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, NM 88003
| | - Nicolas R. Mairata
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, NM 88003
| | - F. Omar Holguin
- Department of Plant and Environmental Sciences, New Mexico State University, Las Cruces, NM 88003
| | - William Maio
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, NM 88003
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Tiboni M, Tiboni M, Pierro A, Del Papa M, Sparaventi S, Cespi M, Casettari L. Microfluidics for nanomedicines manufacturing: An affordable and low-cost 3D printing approach. Int J Pharm 2021; 599:120464. [PMID: 33713759 DOI: 10.1016/j.ijpharm.2021.120464] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/17/2022]
Abstract
During the last decade, an innovative lab on a chip technology known as microfluidics became popular in the pharmaceutical field to produce nanomedicines in a scalable way. Nevertheless, the predominant barriers for new microfluidics users are access to expensive equipment and device fabrication expertise. 3D printing technology promises to be an enabling new field that helps to overcome these drawbacks expanding the realm of microfluidics. Among 3D printing techniques, fused deposition modeling allows the production of devices with relatively inexpensive materials and printers. In this work, we developed two different microfluidic chips designed to obtain a passive micromixing by a "zigzag" bas-relief and by the presence of "split and recombine" channels. Computational fluid dynamics studies improved the evaluation of the mixing potential. A fused deposition modeling 3D printer was used to print the developed devices with polypropylene as manufacturing material. Then, two different model nanocarriers (i.e., polymeric nanoparticles and liposomes), loading cannabidiol as model drug, were formulated evaluating the influence of manufacturing parameters on the final nanocarrier characteristics with a design of experiments approach (2-level full factorial design). Both the chips showed an effective production of nanocarriers with tunable characteristics and with an efficient drug loading. These polypropylene-based microfluidic chips could represent an affordable and low-cost alternative to common microfluidic devices for the effective manufacturing of nanomedicines (both polymer- and lipid-based) after appropriate tuning of manufacturing parameters.
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Montoya ZT, Uhernik AL, Smith JP. Comparison of cannabidiol to citalopram in targeting fear memory in female mice. J Cannabis Res 2020; 2:48. [PMID: 33526146 PMCID: PMC7819293 DOI: 10.1186/s42238-020-00055-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022] Open
Abstract
Background Cannabidiol (CBD) and selective serotonin reuptake inhibitors (SSRIs) are currently used to treat post-traumatic stress disorder (PTSD). However, these drugs are commonly studied after dosing just prior to extinction training, and there are gaps in our understanding of how they affect fear memory formation, their comparative effects on various types of memory, and of sexual dimorphisms in effects. Also, more studies involving female subjects are needed to balance the gender-inequality in the literature. Therefore, the purpose of this study was to directly compare the effects of CBD to citalopram in affecting the formation of auditory cued, contextual, and generalized fear memory, and to evaluate how extinction of these different memories was altered by pre-acquisition treatment in female mice. We also evaluated the impact of the estrous cycle on each of these. Methods Auditory-cued trace fear conditioning was conducted shortly after dosing female C57BL/6 mice, with either CBD or citalopram (10 mg/kg each), by pairing auditory tones with mild foot shocks. Auditory-cued, contextual, and generalized fear memory was assessed by measuring freezing responses, with an automated fear conditioning system, 24 h after conditioning. Each memory type was then evaluated every 24 h, over a 4-day period in total, to create an extinction profile. Freezing outcomes were statistically compared by ANOVA with Tukey HSD post hoc analysis, N = 12 mice per experimental group. Evaluation of sexual dimorphism was by comparison to historical data from male mice. Results Auditory cue-associated fear memory was not affected with CBD or citalopram; however, contextual memory was reduced with CBD by 11%, p < 0.05, but not citalopram, and generalized fear memory was reduced with CBD and citalopram, 20% and 22%, respectively, p < 0.05. Extinction learning was enhanced with CBD and citalopram, but, there was considerable memory-type variability between drug effects, with freezing levels reduced at the end of training by 9 to 17% for CBD, and 10 to 12% with citalopram. The estrous cycle did not affect any outcomes. Conclusions Both drugs are potent modifiers of fear memory formation; however, there is considerable divergence in their targeting of different memory types which, overall, could support the use of CBD as an alternative to SSRIs for treating PTSD in females, but not males. A limitation of the study was that it compared data from experiments done at different times to evaluate sexual dimorphism. Overall, this suggests that more research is necessary to guide any therapeutic approach involving CBD.
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Affiliation(s)
- Zackary T Montoya
- Colorado State University-Pueblo, 2200 Bonforte Blvd, Pueblo, CO, 81001, USA
| | - Amy L Uhernik
- Colorado State University-Pueblo, 2200 Bonforte Blvd, Pueblo, CO, 81001, USA
| | - Jeffrey P Smith
- Colorado State University-Pueblo, 2200 Bonforte Blvd, Pueblo, CO, 81001, USA.
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Takashina S, Igarashi Y, Takahashi M, Kondo Y, Inoue K. Screening Method for the Quality Evaluation of Cannabidiols in Water-based Products Using Liquid Chromatography Tandem Mass Spectrometry. ANAL SCI 2020; 36:1427-1430. [PMID: 32713900 DOI: 10.2116/analsci.20n015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/15/2020] [Indexed: 08/09/2023]
Abstract
A sensitive, useful and preliminary screening method was proposed to quantitate the containable cannabinoids most commonly included in mineral water and gummi candy products, specifically cannabidiol (CBD), cannabinol (CBN), 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCA), cannabigerol (CBG), and cannabidiolic acid (CBDA), using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) for quality evaluations. Based on the electrospray positive ion mode, the limit of detection and the limit of quantification values were 0.2 to 0.5 ng/mL and 0.8 and 2.0 ng/mL. Samples (0.5 g) were diluted by water/methanol (50/50), to which stable isotope internal standards were added; the recovery results appeared in range from 91.3 to 101.2%. This method was applied to evaluate CBD products (6 kinds) from the Japanese market. Our survey found obvious discrepancies between the labeling and the results were overserved in products. In addition, CBN, THCA, CBG, and CBDA were not detected in full-spectrum products that contained various cannabinoids that naturally occur in the cannabis plant. Thus, it is necessary to be able to verify the accurate concentration and impurity in various CBD products from the Japanese market as quickly as possible.
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Affiliation(s)
- Shiori Takashina
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Yuki Igarashi
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Miki Takahashi
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Yukie Kondo
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Koichi Inoue
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga, 525-8577, Japan.
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Thompson MD, Martin RC, Grayson LP, Ampah SB, Cutter G, Szaflarski JP, Bebin EM. Cognitive function and adaptive skills after a one-year trial of cannabidiol (CBD) in a pediatric sample with treatment-resistant epilepsy. Epilepsy Behav 2020; 111:107299. [PMID: 32759071 DOI: 10.1016/j.yebeh.2020.107299] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Cannabidiol (CBD) is a nonpsychoactive derivative of cannabis. Studies indicate that it is safe and effective in treating certain types of epilepsy. The present study examined the presence of adverse or beneficial cognitive or functional adaptive effects associated with CBD in the treatment of children, adolescents, and teenagers with treatment-resistant epilepsy (TRE) as part of an ongoing prospective, open-label safety study. METHODS Participants (N = 38) between the age of 3 and 19 years with TRE were enrolled in an open-label study of a pharmaceutical formulation of CBD (Epidiolex®; GW Research Ltd.) as an add-on treatment. In addition to baseline physical, neurological, and laboratory testing, cognitive assessment was completed prior to initiating CBD and after one year, both using the NIH Toolbox Cognition Battery (NIHTB-CB). Many participants were unable to complete the NIHTB-CB because of the magnitude of their cognitive impairment (n = 24), and in these cases, the participant's caregiver was asked to complete the Adaptive Behavior Assessment System - Second Edition (ABAS-II) as a measure of functional adaptive skills. RESULTS There were no statistically significant changes in cognitive function, as measured by the NIHTB-CB, in those participants who were able to complete such testing, but there was a nonsignificant trend toward improvement in some cognitive domains. For participants who were unable to complete formal standardized cognitive testing because of the magnitude of their cognitive impairment, their functional adaptive skills, as measured by the ABAS-II, were unchanged after a one-year trial of CBD. SIGNIFICANCE Our findings suggest that CBD, as an add-on drug for TRE in a pediatric sample, does not appear to cause adverse effects (AEs) involving cognition or adaptive function over one year of treatment.
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Affiliation(s)
- Matthew D Thompson
- Children's of Alabama, 1600 7th Avenue South, Birmingham, AL 35233, USA.
| | - Roy C Martin
- University of Alabama at Birmingham, Department of Neurology, 1720 7th Avenue South, Birmingham, AL 35233, USA
| | - Leslie P Grayson
- University of Alabama at Birmingham, Department of Neurology, 1720 7th Avenue South, Birmingham, AL 35233, USA
| | - Steve B Ampah
- University of Alabama at Birmingham, Department of Biostatistics, 1665 University Boulevard #327, Birmingham, AL 35233, USA
| | - Gary Cutter
- University of Alabama at Birmingham, Department of Biostatistics, 1665 University Boulevard #327, Birmingham, AL 35233, USA
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham, Department of Neurology, 1720 7th Avenue South, Birmingham, AL 35233, USA
| | - E Martina Bebin
- University of Alabama at Birmingham, Department of Neurology, 1720 7th Avenue South, Birmingham, AL 35233, USA
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Szaflarski M, McGoldrick P, Currens L, Blodgett D, Land H, Szaflarski JP, Segal E. Attitudes and knowledge about cannabis and cannabis-based therapies among US neurologists, nurses, and pharmacists. Epilepsy Behav 2020; 109:107102. [PMID: 32442891 DOI: 10.1016/j.yebeh.2020.107102] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
Use of cannabinoid therapies is on the rise in the United States, but responses of healthcare professionals and their knowledge of these therapies have been mixed. More information is needed about factors associated with healthcare professionals' attitudes and knowledge about medical cannabis. We conducted an online survey of US-based neurologists, nurse practitioners (NPs)/nurses, and pharmacists in August-September of 2018 (n = 451). We constructed perceived knowledge and attitudes scales and a knowledge index from multiple items and assessed state cannabis laws, participant's sociodemographics, workplace type and policies, and patient population. We used ordinary least-squares regression to examine associations among study variables. Over 80% of participants supported use and legalization of medical cannabis, especially cannabidiol (CBD) for epilepsy and when prescribed by a medical provider, but 40-50% (depending on item) felt unfamiliar with cannabinoid pharmacology and clinical applications. A total of 43% favored legal recreational cannabis. Pharmacists scored higher on the knowledge test than neurologists and NPs/nurses, but NPs/nurses had more favorable attitudes than neurologists and higher perceived knowledge than pharmacists. Both knowledge indicators predicted attitudes. State cannabis access and favorable workplace policies were associated with higher knowledge and more favorable attitudes. Healthcare professionals see potential in cannabis therapies but report significant knowledge gaps. Professional cannabinoid education is needed to address growing patient and provider demand for knowledge about cannabinoid therapies.
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Affiliation(s)
- Magdalena Szaflarski
- Department of Sociology, University of Alabama at Birmingham (UAB), HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152, USA.
| | - Patricia McGoldrick
- Division of Child Neurology and Epilepsy, Boston Children's Health Physicians of Westchester and Maria Fareri Children's Hospital, Valhalla, NY, 141 South Central Ave, Hartsdale, NY 10530, USA
| | - Lauryn Currens
- Department of Neurology, University of Massachusetts, 55 Lake Ave North, Worcester, MA 01655, USA.
| | - Dustin Blodgett
- Department of Psychiatry, University of Kentucky, 245 Fountain Court, Lexington, KY 40509, USA.
| | - Hunter Land
- Canopy Health Innovations, Smiths Falls, Ontario, Canada
| | - Jerzy P Szaflarski
- UAB Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, 312 Civitan International Research Center (CIRC 312), 1720 2nd Avenue South, Birmingham, AL 35294-0021, USA.
| | - Eric Segal
- Northeast Regional Epilepsy Group, Hackensack University Medical Center and Hackensack Meridian School of Medicine, 20 Prospect Avenue, Suite 800, Hackensack, NJ 07601, USA.
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Abstract
BACKGROUND Cannabis was used for cancer patients as early as about 2500 years ago. Experimental studies demonstrated tumor-inhibiting activities of various cannabinoids more than 40 years ago. In view of the status of tetrahydrocannabinol (THC) as a regulated substance, non-psychotomimetic cannabidiol (CBD) is of particular importance. OBJECTIVES Efficacy of pure CBD in various animal models as well as initial results (case reports) from patients. METHODS Review of the literature on animal experiments and observations in humans. RESULTS Preclinical studies, particularly recent ones, including numerous animal models of tumors, unanimously suggest the therapeutic efficacy of CBD. In isolated combination studies, synergistic effects were generally observed. In addition, CBD may potentially play a role in the palliative care of patients, especially concerning symptoms such as pain, insomnia, anxiety, and depression. Further human studies are warranted.
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Gherzi M, Milano G, Fucile C, Calevo MG, Mancardi MM, Nobili L, Astuni P, Marini V, Barco S, Cangemi G, Manfredini L, Mattioli F, De Grandis E. Safety and pharmacokinetics of medical cannabis preparation in a monocentric series of young patients with drug resistant epilepsy. Complement Ther Med 2020; 51:102402. [PMID: 32507423 DOI: 10.1016/j.ctim.2020.102402] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/24/2020] [Accepted: 04/04/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To evaluate safety and pharmacokinetic parameters (PK) of medical cannabis in add-on for children and young adults with drug-resistant epilepsy. DESIGN, SETTING Ten patients (4 females, 6 males, age 2.5-23.2 years) were enrolled in a prospective open trial with a galenic preparation (decoction) of Italian cannabis (FM2, ratio THC:CBD = 3:5, range THC 5.2-7.2 %; CBD 8.2-11.1 %). Patients received the first dose in Hospital, progressively augmented by CBD dose titration (from 1 to 4 mg/kg/day). OUTCOME MEASURES In order to assess safety, blood parameters, heart rates and electrocardiograms (ECGs) were evaluated before the enrollment and during the follow up. The PK study was performed measuring THC and CBD concentrations by UHPLC-MS/MS in plasma samples collected during the first administration and at each follow-up visit. RESULTS Two out of ten patients stopped the treatment for adverse events (detected in 6/10: gastroenteric, sleep or behavioral disorders) and difficulties in drug supply. We observed minor ECG alterations in two patients and asymptomatic transient reductions of fibrinogen after 6 months of therapy. The PK study during follow-up revealed statistically significant correlations between THC-CBD blood concentrations and: volumes of decoction, FM2 and THC-CBD daily dosages. CONCLUSIONS The present study, although with some limitations, shows a good safety profile of medical cannabis in children and young patients with drug-resistant epilepsy and encourages the possibility of further studies with oral cannabis-based drugs. The correlations between THC-CBD plasma concentrations and their administered dosages underline the need of a therapeutic drug monitoring for cannabinoids therapy.
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Li H, Liu Y, Tian D, Tian L, Ju X, Qi L, Wang Y, Liang C. Overview of cannabidiol (CBD) and its analogues: Structures, biological activities, and neuroprotective mechanisms in epilepsy and Alzheimer's disease. Eur J Med Chem 2020; 192:112163. [PMID: 32109623 DOI: 10.1016/j.ejmech.2020.112163] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 01/05/2023]
Abstract
Herein, 11 general types of natural cannabinoids from Cannabis sativa as well as 50 (-)-CBD analogues with therapeutic potential were described. The underlying molecular mechanisms of CBD as a therapeutic candidate for epilepsy and neurodegenerative diseases were comprehensively clarified. CBD indirectly acts as an endogenous cannabinoid receptor agonist to exert its neuroprotective effects. CBD also promotes neuroprotection through different signal transduction pathways mediated indirectly by cannabinoid receptors. Furthermore, CBD prevents the glycogen synthase kinase 3β (GSK-3β) hyperphosphorylation caused by Aβ and may be developed as a new therapeutic candidate for Alzheimer's disease.
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Affiliation(s)
- Han Li
- School of Food and Bioengineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Yuzhi Liu
- School of Food and Bioengineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Danni Tian
- School of Food and Bioengineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Lei Tian
- School of Food and Bioengineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Xingke Ju
- School of Food and Bioengineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Liang Qi
- School of Food and Bioengineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Yongbo Wang
- School of Food and Bioengineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Chengyuan Liang
- School of Food and Bioengineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China.
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48
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Khan R, Naveed S, Mian N, Fida A, Raafey MA, Aedma KK. The therapeutic role of Cannabidiol in mental health: a systematic review. J Cannabis Res 2020; 2:2. [PMID: 33526132 PMCID: PMC7819291 DOI: 10.1186/s42238-019-0012-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022] Open
Abstract
Background The therapeutic application of cannabidiol (CBD) is gaining interest due to expanding evidence for its use. Objective To summarize the clinical outcomes, study designs and limitations for the use of CBD and nabiximols (whole plant extract from Cannabis sativa L. that has been purified into 1:1 ratio of CBD and delta-9-tetrahydrocannabinol) in the treatment of psychiatric disorders. Materials and method A systematic review was conducted including case reports, case series, open-label trials, non-randomized and randomized controlled trials (RCTs). The search resulted in 23 relevant studies on CBD and nabiximols in the treatment of a wide range of psychiatric disorders. The quality of evidence was judged by using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence that ranges from Level 1 to Level 5 based on the quality and study design. These levels of evidence help in grading the recommendations, including Grade A (strong), Grade B (moderate), Grade C (weak), and Grade D (weakest). Results CBD and CBD-containing compounds such as nabiximols were helpful in alleviating psychotic symptoms and cognitive impairment in patients with a variety of conditions, and several studies provided evidence of effectiveness in the treatment of cannabis withdrawal and moderate to severe cannabis use disorder with Grade B recommendation. There is Grade B recommendation supporting the use of CBD for the treatment of schizophrenia, social anxiety disorder and autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). Grade C recommendation exists for insomnia, anxiety, bipolar disorder, posttraumatic stress disorder, and Tourette syndrome. These recommendations should be considered in the context of limited number of available studies. Conclusion CBD and CBD-containing compounds such as nabiximols were helpful in alleviating symptoms of cannabis-related disorders, schizophrenia, social anxiety disorder, and comorbidities of ASD, and ADHD with moderate recommendation. However, there is weaker evidence for insomnia, anxiety, bipolar disorder, posttraumatic stress disorder, and Tourette syndrome. The evidence for the use of CBD and CBD-containing compounds for psychiatric disorders needs to be explored in future studies, especially large-scale and well-designed RCTs.
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Affiliation(s)
- Rabia Khan
- Dow University of Health Science, Karachi, Pakistan
| | - Sadiq Naveed
- Psychiatry and Behavioral Sciences, Kansas University Medical Center, 3901 Rainbow Blvd, Kansas City, KS, KS 66160, USA.
| | | | - Ania Fida
- King Edward Medical University, Lahore, Pakistan
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Sharma AA, Nenert R, Allendorfer JB, Gaston TE, Grayson LP, Hernando K, Szaflarski JP. A preliminary study of the effects of cannabidiol (CBD) on brain structure in patients with epilepsy. Epilepsy Behav Rep 2019; 12:100341. [PMID: 32322816 PMCID: PMC7170322 DOI: 10.1016/j.ebr.2019.100341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 11/25/2022] Open
Abstract
Cannabis use is associated with changes in brain structure and function; its neurotoxic effects are largely attributed to Δ9-tetrahydrocannabidiol. Whether such effects are present in patients with epilepsy exposed to a highly-purified cannabidiol isolate (CBD; Epidiolex®; Greenwich Biosciences, Inc.) has not been investigated to date. This preliminary study examines whether daily CBD dose of 15-25 mg/kg produces cerebral macrostructure changes and, if present, how they relate to changes in seizure frequency. Twenty-seven patients with treatment-resistant epilepsy were recruited from the University of Alabama at Birmingham CBD Program. Participants provided seizure frequency diaries (SF), completed the Chalfont Seizure Severity Scale (CSSS) and Adverse Events Profile (AEP), and underwent MRI before CBD (baseline) and after achieving a stable CBD dosage (on-CBD). We examined T1-weighted structural images for gray matter volume (GMV) and cortical thickness changes from baseline to on-CBD in 18 participants. Repeated measures t-tests confirmed decreases in SF [t(17) = 3.08, p = 0.0069], CSSS [t(17) = 5.77, p < 0.001], and AEP [t(17) = 3.04, p = 0.0074] between the two time-points. Voxel-level paired samples t-tests did not identify significant changes in GMV or cortical thickness between these two time-points. In conclusion, short-term exposure to highly purified CBD may not affect cortical macrostructure.
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Affiliation(s)
- Ayushe A Sharma
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA
| | - Tyler E Gaston
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA.,Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Leslie P Grayson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA.,Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Kathleen Hernando
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA
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Martin RC, Gaston TE, Thompson M, Ampah SB, Cutter G, Bebin EM, Szaflarski JP. Cognitive functioning following long-term cannabidiol use in adults with treatment-resistant epilepsy. Epilepsy Behav 2019; 97:105-110. [PMID: 31220785 DOI: 10.1016/j.yebeh.2019.04.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
Cognitive dysfunction is a common comorbidity in adults with treatment-resistant epilepsy (TRE). Recently, cannabidiol (CBD) has demonstrated efficacy in epilepsy treatment. However, our understanding of CBD's cognitive effects in epilepsy is limited. We examined long-term cognitive effects of CBD in adults with TRE as part of an ongoing prospective, open-label safety study. Twenty-sevenadults with TRE (mean age: 34[SD +14], female 52%) enrolled in the UAB CBD program completed standardized cognitive testing (NIH Toolbox Cognition Battery (NIHTB-CB)) at pre-CBD administration baseline and at one-yearfollow-up. Participants were receiving stable CBD dose at the time of one-year testing (mean=36.5mg/kg/day). The NIHTB-CB consisted of two global composite scales (Fluid and Crystallized) and seven individual tests measuring aspects of working memory, episodic memory, executive function, processing speed, and language. All participants had recorded Chalfont Seizure Severity Scale (CSSS) scores at each visit. Statistical analyses consisted of t-test, Pearson correlation coefficient, and linear regression. At baseline, cognitive test performance was below average for both global composite scales (Fluid: 71 [±18] range: 46-117) and Crystallized (76 [±15] range: 59-112)]. Longitudinal analysis revealed no significant group change across the two global composite scales. Of the seven individual cognitive tests, none changed significantly over time. No correlation was found between the cognitive change scores and CBD dose (all P's≥0.21). Change in cognitive test performance was not associated change in seizure severity rating. These findings are encouraging and indicate that long-term administration of pharmaceutical grade CBD is overall cognitively well-tolerated in adults with TRE.
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Affiliation(s)
- Roy C Martin
- University of Alabama at Birmingham, Department of Neurology, Birmingham, AL, USA.
| | - Tyler E Gaston
- University of Alabama at Birmingham, Department of Neurology, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
| | | | - Steve B Ampah
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, AL, USA
| | - Gary Cutter
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, AL, USA
| | - E Martina Bebin
- University of Alabama at Birmingham, Department of Neurology, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham, Department of Neurology, Birmingham, AL, USA
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