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Ma L, Liu M, Liu C, Zhang H, Yang S, An J, Qu G, Song S, Cao Q. Research Progress on the Mechanism of the Antitumor Effects of Cannabidiol. Molecules 2024; 29:1943. [PMID: 38731434 PMCID: PMC11085351 DOI: 10.3390/molecules29091943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Cannabidiol (CBD), a non-psychoactive ingredient extracted from the hemp plant, has shown therapeutic effects in a variety of diseases, including anxiety, nervous system disorders, inflammation, and tumors. CBD can exert its antitumor effect by regulating the cell cycle, inducing tumor cell apoptosis and autophagy, and inhibiting tumor cell invasion, migration, and angiogenesis. This article reviews the proposed antitumor mechanisms of CBD, aiming to provide references for the clinical treatment of tumor diseases and the rational use of CBD.
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Affiliation(s)
- Li Ma
- Department of Immunology, School of Basic Medical Sciences, Binzhou Medical University, Yantai 264003, China; (L.M.); (M.L.); (C.L.); (H.Z.)
| | - Mengke Liu
- Department of Immunology, School of Basic Medical Sciences, Binzhou Medical University, Yantai 264003, China; (L.M.); (M.L.); (C.L.); (H.Z.)
| | - Chuntong Liu
- Department of Immunology, School of Basic Medical Sciences, Binzhou Medical University, Yantai 264003, China; (L.M.); (M.L.); (C.L.); (H.Z.)
| | - Huachang Zhang
- Department of Immunology, School of Basic Medical Sciences, Binzhou Medical University, Yantai 264003, China; (L.M.); (M.L.); (C.L.); (H.Z.)
| | - Shude Yang
- Department of Edible Mushrooms, School of Agriculture, Ludong University, Yantai 264025, China;
| | - Jing An
- Division of Infectious Diseases and Global Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA 92037, USA;
| | - Guiwu Qu
- Department of Traditional Chinese Medicine, School of Pharmacy, Binzhou Medical University, Yantai 264003, China;
| | - Shuling Song
- Department of Immunology, School of Basic Medical Sciences, Binzhou Medical University, Yantai 264003, China; (L.M.); (M.L.); (C.L.); (H.Z.)
| | - Qizhi Cao
- Department of Immunology, School of Basic Medical Sciences, Binzhou Medical University, Yantai 264003, China; (L.M.); (M.L.); (C.L.); (H.Z.)
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Papoutsis I, Hatzidouka V, Ntoupa SP, Angelis A, Dona A, Sakelliadis E, Spiliopoulou C. Determination of Δ 9-tetrahydrocannabinol, 11-nor-carboxy-Δ 9-tetrahydrocannabinol and cannabidiol in human plasma and urine after a commercial cannabidiol oil product intake. Forensic Toxicol 2024:10.1007/s11419-024-00686-0. [PMID: 38592642 DOI: 10.1007/s11419-024-00686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Cannabidiol (CBD) products are widely used for pain relief, sleep improvement, management of seizures etc. Although the concentrations of Δ9-tetrahydrocannabinol (Δ9-THC) in these products are low (≤0.3% w/w), it is important to investigate if its presence and/or that of its metabolite 11-nor-carboxy-Δ9-THC, is traceable in plasma and urine samples of individuals who take CBD oil products. METHODS A sensitive GC/MS method for the determination of Δ9-THC, 11-nor-carboxy-Δ9-THC and CBD in plasma and urine samples was developed and validated. The sample preparation procedure included protein precipitation for plasma samples and hydrolysis for urine samples, solid-phase extraction and finally derivatization with N,O-bis(trimethylsilyl)trifluoroacetamide) with 1% trimethylchlorosilane. RESULTS For all analytes, the LOD and LOQ were 0.06 and 0.20 ng/mL, respectively. The calibration curves were linear (R2 ≥ 0.992), and absolute recoveries were ≥91.7%. Accuracy and precision were within the accepted range. From the analysis of biologic samples of 10 human participants who were taking CBD oil, it was realized that Δ9-THC was not detected in urine, while 11-nor-carboxy-Δ9-THC (0.69-23.06 ng/mL) and CBD (0.29-96.78 ng/mL) were found in all urine samples. Regarding plasma samples, Δ9-THC (0.21-0.62 ng/mL) was detected in 10, 11-nor-carboxy-Δ9-THC (0.20-2.44 ng/mL) in 35, while CBD (0.20-1.58 ng/mL) in 25 out of 38 samples, respectively. CONCLUSION The results showed that Δ9-THC is likely to be found in plasma although at low concentrations. In addition, the detection of 11-nor-carboxy-Δ9-THC in both urine and plasma samples raises questions and concerns for the proper interpretation of toxicological results, especially considering Greece's zero tolerance law applied in DUID and workplace cases.
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Affiliation(s)
- Ioannis Papoutsis
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Vasiliki Hatzidouka
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Division of Pharmaceutical Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatina-Panagoula Ntoupa
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolis Angelis
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Artemisia Dona
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Sakelliadis
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Birenboim M, Brikenstein N, Duanis-Assaf D, Maurer D, Chalupowicz D, Kenigsbuch D, Shimshoni JA. In Pursuit of Optimal Quality: Cultivar-Specific Drying Approaches for Medicinal Cannabis. PLANTS (BASEL, SWITZERLAND) 2024; 13:1049. [PMID: 38611577 PMCID: PMC11013261 DOI: 10.3390/plants13071049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
A limited number of studies have examined how drying conditions affect the cannabinoid and terpene content in cannabis inflorescences. In the present study, we evaluated the potential of controlled atmosphere drying chambers for drying medicinal cannabis inflorescence. Controlled atmosphere drying chambers were found to reduce the drying and curing time by at least 60% compared to traditional drying methods, while preserving the volatile terpene content. On the other hand, inflorescences subjected to traditional drying were highly infested by Alternaria alternata and also revealed low infestation of Botrytis cinerea. In the high-THC chemovar ("240"), controlled N2 and atm drying conditions preserved THCA concentration as compared to the initial time point (t0). On the other hand, in the hybrid chemovar ("Gen12") all of the employed drying conditions preserved THCA and CBDA content. The optimal drying conditions for preserving monoterpenes and sesquiterpenes in both chemovars were C5O5 (5% CO2, 5% O2, and 90% N2) and pure N2, respectively. The results of this study suggest that each chemovar may require tailored drying conditions in order to preserve specific terpenes and cannabinoids. Controlled atmosphere drying chambers could offer a cost-effective, fast, and efficient drying method for preserving cannabinoids and terpenes during the drying process while reducing the risk of mold growth.
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Affiliation(s)
- Matan Birenboim
- Department of Food Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, P.O. Box 15159, Rishon LeZion 7505101, Israel
- Department of Plant Science, The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot 7610001, Israel
| | - Nimrod Brikenstein
- Department of Food Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, P.O. Box 15159, Rishon LeZion 7505101, Israel
- Department of Plant Science, The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot 7610001, Israel
| | - Danielle Duanis-Assaf
- Department of Food Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, P.O. Box 15159, Rishon LeZion 7505101, Israel
| | - Dalia Maurer
- Department of Postharvest Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | - Daniel Chalupowicz
- Department of Postharvest Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | - David Kenigsbuch
- Department of Postharvest Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion 7505101, Israel
| | - Jakob A. Shimshoni
- Department of Food Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, P.O. Box 15159, Rishon LeZion 7505101, Israel
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Javadzadeh Y, Santos A, Aquilino MS, Mylvaganam S, Urban K, Carlen PL. Cannabidiol Exerts Anticonvulsant Effects Alone and in Combination with Δ 9-THC through the 5-HT1A Receptor in the Neocortex of Mice. Cells 2024; 13:466. [PMID: 38534310 DOI: 10.3390/cells13060466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
Cannabinoids have shown potential in drug-resistant epilepsy treatment; however, we lack knowledge on which cannabinoid(s) to use, dosing, and their pharmacological targets. This study investigated (i) the anticonvulsant effect of Cannabidiol (CBD) alone and (ii) in combination with Delta-9 Tetrahydrocannabinol (Δ9-THC), as well as (iii) the serotonin (5-HT)1A receptor's role in CBD's mechanism of action. Seizure activity, induced by 4-aminopyridine, was measured by extracellular field recordings in cortex layer 2/3 of mouse brain slices. The anticonvulsant effect of 10, 30, and 100 µM CBD alone and combined with Δ9-THC was evaluated. To examine CBD's mechanism of action, slices were pre-treated with a 5-HT1A receptor antagonist before CBD's effect was evaluated. An amount of ≥30 µM CBD alone exerted significant anticonvulsant effects while 10 µM CBD did not. However, 10 µM CBD combined with low-dose Δ9-THC (20:3 ratio) displayed significantly greater anticonvulsant effects than either phytocannabinoid alone. Furthermore, blocking 5-HT1A receptors before CBD application significantly abolished CBD's effects. Thus, our results demonstrate the efficacy of low-dose CBD and Δ9-THC combined and that CBD exerts its effects, at least in part, through 5-HT1A receptors. These results could address drug-resistance while providing insight into CBD's mechanism of action, laying the groundwork for further testing of cannabinoids as anticonvulsants.
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Affiliation(s)
- Yasaman Javadzadeh
- Krembil Research Institute, University Health Network, Toronto, ON M5S 0T8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Alexandra Santos
- Krembil Research Institute, University Health Network, Toronto, ON M5S 0T8, Canada
| | - Mark S Aquilino
- Krembil Research Institute, University Health Network, Toronto, ON M5S 0T8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Shanthini Mylvaganam
- Krembil Research Institute, University Health Network, Toronto, ON M5S 0T8, Canada
| | | | - Peter L Carlen
- Krembil Research Institute, University Health Network, Toronto, ON M5S 0T8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine (Neurology), University Health Network, Toronto, ON M5G 2C4, Canada
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Chandy M, Nishiga M, Wei TT, Hamburg NM, Nadeau K, Wu JC. Adverse Impact of Cannabis on Human Health. Annu Rev Med 2024; 75:353-367. [PMID: 37582489 PMCID: PMC10947506 DOI: 10.1146/annurev-med-052422-020627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Cannabis, the most commonly used recreational drug, is illicit in many areas of the world. With increasing decriminalization and legalization, cannabis use is increasing in the United States and other countries. The adverse effects of cannabis are unclear because its status as a Schedule 1 drug in the United States restricts research. Despite a paucity of data, cannabis is commonly perceived as a benign or even beneficial drug. However, recent studies show that cannabis has adverse cardiovascular and pulmonary effects and is linked with malignancy. Moreover, case reports have shown an association between cannabis use and neuropsychiatric disorders. With growing availability, cannabis misuse by minors has led to increasing incidences of overdose and toxicity. Though difficult to detect, cannabis intoxication may be linked to impaired driving and motor vehicle accidents. Overall, cannabis use is on the rise, and adverse effects are becoming apparent in clinical data sets.
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Affiliation(s)
- Mark Chandy
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA;
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Western University, London, Ontario, Canada;
| | - Masataka Nishiga
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA;
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Tzu-Tang Wei
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA;
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Naomi M Hamburg
- Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine and Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kari Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA;
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
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Murni W, Umar TP, Tandarto K, Simatupang A, Hasugian AR, Purwoko RY, Idaiani S, Stevanny B, Oktarina C, Jonlean R, Tango T, Kusuma KS, Sugiyono SP, Putra A. Efficacy and safety of medical cannabinoids in children with cerebral palsy: a systematic review. EINSTEIN-SAO PAULO 2023; 21:eRW0387. [PMID: 37991091 PMCID: PMC10691312 DOI: 10.31744/einstein_journal/2023rw0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/19/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION The increasing popularity of cannabinoids for treating numerous neurological disorders has been reported in various countries. Although it reduces tetrahydrocannabinol psychoactivity, it helps patients tolerate higher doses and complements the anti-spasmodic effects of tetrahydrocannabinol. One of the most important potential of cannabinoids are related to its potential to help children with cerebral palsy, a contributor of lifelong disability. Therefore, this systematic review aimed to assess the efficacy and safety of medical cannabinoids in children with cerebral palsy. METHODS This review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 guidelines. Seven databases, namely, Scopus, PubMed, EBSCO Host, ProQuest, Google Scholar, Semantic Scholar, and JSTOR, were used to identify relevant studies. Studies examining pediatric patients with cerebral palsy and reporting the efficacy and safety of medical cannabinoids through clinical trials, observational cross-sectional studies, or cohort designs were included. The outcomes of the studies included the efficacy of medical cannabinoids administered for spasticity, motor components, pain control, sleep difficulties, adverse effects, and seizure control. RESULTS Of 803 identified articles, only three met the inclusion criteria for data synthesis. One study exhibited a moderate risk-of-bias. A total of 133 respondents, mainly from Europe, were investigated. Overall effectiveness and safety were considered good. However, the results are inconsistent, especially regarding spasticity treatment variables. CONCLUSION The anti-spasticity, anti-inflammatory, and anti-seizure properties of cannabinoids might be beneficial for patients with cerebral palsy, although their effectiveness has not been widely studied. Further studies with larger sample sizes and various ethnicities are warranted. Prospero database registration: (www.crd.york.ac.uk/prospero) under ID CRD42022358383.
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Affiliation(s)
- Widya Murni
- Jakarta Anti-Aging Center ClinicJakartaIndonesia Jakarta Anti-Aging Center Clinic , Jakarta , Indonesia .
| | - Tungki Pratama Umar
- Faculty of MedicineSriwijaya UniversityPalembangIndonesia Faculty of Medicine , Sriwijaya University , Palembang , Indonesia .
| | - Kevin Tandarto
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia Faculty of Medicine and Health Sciences , Atma Jaya Catholic University of Indonesia , Jakarta , Indonesia .
| | - Abraham Simatupang
- Department of Pharmacology and TherapyFaculty of MedicineUniversitas Kristen IndonesiaJakartaIndonesia Department of Pharmacology and Therapy , Faculty of Medicine , Universitas Kristen Indonesia , Jakarta , Indonesia .
| | - Armedy Ronny Hasugian
- Indonesia National Research and Innovation AgencyJakartaIndonesia Indonesia National Research and Innovation Agency , Jakarta , Indonesia .
| | - Reza Yuridian Purwoko
- Indonesia National Research and Innovation AgencyJakartaIndonesia Indonesia National Research and Innovation Agency , Jakarta , Indonesia .
| | - Sri Idaiani
- Indonesia National Research and Innovation AgencyJakartaIndonesia Indonesia National Research and Innovation Agency , Jakarta , Indonesia .
| | - Bella Stevanny
- Faculty of MedicineSriwijaya UniversityPalembangIndonesia Faculty of Medicine , Sriwijaya University , Palembang , Indonesia .
| | - Caroline Oktarina
- Faculty of MedicineUniversity of IndonesiaJakartaIndonesia Faculty of Medicine , University of Indonesia , Jakarta , Indonesia .
| | - Reganedgary Jonlean
- Faculty of MedicineUniversity of IndonesiaJakartaIndonesia Faculty of Medicine , University of Indonesia , Jakarta , Indonesia .
| | - Tamara Tango
- Faculty of MedicineUniversity of IndonesiaJakartaIndonesia Faculty of Medicine , University of Indonesia , Jakarta , Indonesia .
| | - Kevin Surya Kusuma
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia Faculty of Medicine and Health Sciences , Atma Jaya Catholic University of Indonesia , Jakarta , Indonesia .
| | - Sagita Pratiwi Sugiyono
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia Faculty of Medicine and Health Sciences , Atma Jaya Catholic University of Indonesia , Jakarta , Indonesia .
| | - Aditya Putra
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia Faculty of Medicine and Health Sciences , Atma Jaya Catholic University of Indonesia , Jakarta , Indonesia .
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Felker L. CBD oil: Your patients are using it. Here's what you need to know. JAAPA 2023; 36:29-33. [PMID: 37668478 DOI: 10.1097/01.jaa.0000944604.27500.5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
ABSTRACT Cannabinoid (CBD) oil is a trend in self-care management. In this digital age, patients have access to products from across the globe, and these products may not be regulated. Healthcare providers must be at the forefront of the latest trends in medicine and alternative therapies to better serve patients' needs. This article reviews various medical conditions for which CBD oil already is being used, its other medicinal uses, major adverse reactions, and what patients should know before they decide to consume CBD oil.
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Affiliation(s)
- Lori Felker
- Lori Felker is director of the PA program at Widener University in Chester, Pa. The author has disclosed no potential conflicts of interest, financial or otherwise
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Dominiak HSH, Hasselsteen SD, Nielsen SW, Andersen JR, Herrstedt J. Prevention of Taste Alterations in Patients with Cancer Receiving Paclitaxel- or Oxaliplatin-Based Chemotherapy-A Pilot Trial of Cannabidiol. Nutrients 2023; 15:3014. [PMID: 37447339 DOI: 10.3390/nu15133014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Taste alteration is a common adverse effect of chemotherapy. This study aimed to investigate the effect of cannabidiol (CBD) on Lean Body Mass (LBM), and taste alterations during oxaliplatin- or paclitaxel-based chemotherapy. METHODS LBM was estimated by bioelectrical impedance analysis (BIA), and taste perception was evaluated by a randomized sensory test of six samples: sweet, salt, and umami, all in weak and strong concentrations. Taste perceptions were scored on visual analog scales. Patients in the intervention group received oral CBD 300 mg/day for 8 days; patients in the control group did not. Patients were followed for three cycles of chemotherapy. RESULTS Twenty-two/ten patients (intervention/control group) were eligible. No effects on LBM were demonstrated. At baseline, the control group was able to differentiate between weak and strong saltiness and weak and strong sweetness but lost this ability after three cycles of chemotherapy. At baseline, the intervention group was unable to differentiate between the concentrations but gained the ability to significantly differentiate between weak and strong sweetness (p = 0.03) and weak and strong saltiness (p = 0.04) after three cycles of chemotherapy and treatment with CBD. CONCLUSIONS CBD may improve patients' ability to differentiate taste strengths during chemotherapy.
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Affiliation(s)
- Helena S H Dominiak
- Department of Clinical Oncology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Frederiksberg, Denmark
| | - Simone D Hasselsteen
- Department of Clinical Oncology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Frederiksberg, Denmark
| | - Sebastian W Nielsen
- Department of Clinical Oncology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Frederiksberg, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology, Zealand University Hospital, 4000 Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 2200 Frederiksberg, Denmark
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Yau GTY, Tai W, Arnold JC, Chan HK, Kwok PCL. Cannabidiol for the Treatment of Brain Disorders: Therapeutic Potential and Routes of Administration. Pharm Res 2023; 40:1087-1114. [PMID: 36635488 PMCID: PMC10229467 DOI: 10.1007/s11095-023-03469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
The use of cannabidiol (CBD) for treating brain disorders has gained increasing interest. While the mechanism of action of CBD in these conditions is still under investigation, CBD has been shown to affect numerous different drug targets in the brain that are involved in brain disorders. Here we review the preclinical and clinical evidence on the potential therapeutic use of CBD in treating various brain disorders. Moreover, we also examine various drug delivery approaches that have been applied to CBD. Due to the slow absorption and low bioavailability with the current oral CBD therapy, more efficient routes of administration to bypass hepatic metabolism, particularly pulmonary delivery, should be considered. Comparison of pharmacokinetic studies of different delivery routes highlight the advantages of intranasal and inhalation drug delivery over other routes of administration (oral, injection, sublingual, buccal, and transdermal) for treating brain disorders. These two routes of delivery, being non-invasive and able to achieve fast absorption and increase bioavailability, are attracting increasing interest for CBD applications, with more research and development expected in the near future.
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Affiliation(s)
- Grace Tsz Yan Yau
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Waiting Tai
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Jonathon Carl Arnold
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2050, Australia
- Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Hak-Kim Chan
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Philip Chi Lip Kwok
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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Ma L, Zhang H, Liu C, Liu M, Shangguan F, Liu Y, Yang S, Li H, An J, Song S, Cao Q, Qu G. A novel mechanism of cannabidiol in suppressing ovarian cancer through LAIR-1 mediated mitochondrial dysfunction and apoptosis. ENVIRONMENTAL TOXICOLOGY 2023; 38:1118-1132. [PMID: 36810933 DOI: 10.1002/tox.23752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Cannabidiol (CBD) is a nonpsychoactive cannabinoid compound. It has been shown that CBD can inhibit the proliferation of ovarian cancer cells, but the underlying specific mechanism is unclear. We previously presented the first evidence for the expression of leukocyte-associated immunoglobulin-like receptor 1 (LAIR-1), a member of the immunosuppressive receptor family, in ovarian cancer cells. In the present study, we investigated the mechanism by which CBD inhibits the growth of SKOV3 and CAOV3 ovarian cancer cells, and we sought to understand the concurrent role of LAIR-1. In addition to inducing ovarian cancer cell cycle arrest and promoting cell apoptosis, CBD treatment significantly affected the expression of LAIR-1 and inhibited the PI3K/AKT/mTOR signaling axis and mitochondrial respiration in ovarian cancer cells. These changes were accompanied by an increase in ROS, loss of mitochondrial membrane potential, and suppression of mitochondrial respiration and aerobic glycolysis, thereby inducing abnormal or disturbed metabolism and reducing ATP production. A combined treatment with N-acetyl-l-cysteine and CBD indicated that a reduction in ROS production would restore PI3K/AKT/mTOR pathway signaling and ovarian cancer cell proliferation. We subsequently confirmed that the inhibitory effect of CBD on the PI3K/AKT/mTOR signal axis and mitochondrial bioenergy metabolism was attenuated by knockdown of LAIR-1. Our animal studies further support the in vivo anti-tumor activity of CBD and suggest its mechanism of action. In summary, the present findings confirm that CBD inhibits ovarian cancer cell growth by disrupting the LAIR-1-mediated interference with mitochondrial bioenergy metabolism and the PI3K/AKT/mTOR pathway. These results provide a new experimental basis for research into ovarian cancer treatment based on targeting LAIR-1 with CBD.
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Affiliation(s)
- Li Ma
- School of Basic Medical Sciences, Binzhou Medical University, Shandong Province, China
- Fungal Laboratory, Jining First People's Hospital, Jining, Shandong Province, China
| | - Huachang Zhang
- School of Basic Medical Sciences, Binzhou Medical University, Shandong Province, China
| | - Chuntong Liu
- School of Basic Medical Sciences, Binzhou Medical University, Shandong Province, China
| | - Mengke Liu
- School of Basic Medical Sciences, Binzhou Medical University, Shandong Province, China
| | - Fugen Shangguan
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Liu
- School of Basic Medical Sciences, Binzhou Medical University, Shandong Province, China
- Yantai Key Laboratory of Sports Injury and Rehabilitation, Health Commission of Shandong Province of Medicine and Health Key Laboratory of Sports Injury and Rehabilitation, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong Province, China
| | - Shude Yang
- Department of Edible Mushrooms, School of Agriculture, Ludong University, Yantai, Shandong Province, China
| | - Hua Li
- Department of Gynecology, The Affiliated Taian City Central Hospital of Qingdao University, Taian, Shandong Province, China
| | - Jing An
- Division of Infectious Diseases and Global Health, School of Medicine, University of California, San Diego (UCSD), La Jolla, California, USA
| | - Shuling Song
- School of Gerontology, Binzhou Medical University, Shandong Province, China
| | - Qizhi Cao
- School of Basic Medical Sciences, Binzhou Medical University, Shandong Province, China
| | - Guiwu Qu
- School of Gerontology, Binzhou Medical University, Shandong Province, China
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11
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Birenboim M, Kenigsbuch D, Shimshoni JA. Novel fluorescence spectroscopy method coupled with N-PLS-R and PLS-DA models for the quantification of cannabinoids and the classification of cannabis cultivars. PHYTOCHEMICAL ANALYSIS : PCA 2023; 34:280-288. [PMID: 36597766 DOI: 10.1002/pca.3205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Cannabis sativa L. inflorescences are rich in secondary metabolites, particularly cannabinoids. The most common techniques for elucidating cannabinoid composition are expensive technologies, such as high-pressure liquid chromatography (HPLC). OBJECTIVES We aimed to develop and evaluate the performance of a novel fluorescence spectroscopy-based method coupled with N-way partial least squares regression (N-PLS-R) and partial least squares discriminant analysis (PLS-DA) models to replace the expensive chromatographic methods for preharvest cannabinoid quantification. METHODOLOGY Fresh medicinal cannabis inflorescences were collected and ethanol extracts were prepared. Their excitation-emission spectra were measured using fluorescence spectroscopy and their cannabinoid contents were determined by HPLC-PDA. Subsequently, N-PLS-R and PLS-DA models were applied to the excitation-emission matrices (EEMs) for cannabinoid concentration prediction and cultivar classification, respectively. RESULTS The N-PLS-R model was based on a set of EEMs (n = 82) and provided good to excellent quantification of (-)-Δ9-trans-tetrahydrocannabinolic acid, cannabidiolic acid, cannabigerolic acid, cannabichromenic acid, and (-)-Δ9-trans-tetrahydrocannabinol (R2 CV and R2 pred > 0.75; RPD > 2.3 and RPIQ > 3.5; RMSECV/RMSEC ratio < 1.4). The PLS-DA model enabled a clear distinction between the four major classes studied (sensitivity, specificity, and accuracy of the prediction sets were all ≥0.9). CONCLUSIONS The fluorescence spectral region (excitation 220-400 nm, emission 280-550 nm) harbors sufficient information for accurate prediction of cannabinoid contents and accurate classification using a relatively small data set.
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Affiliation(s)
- Matan Birenboim
- Department of Food Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, Israel
- Department of Plant Science, The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot, Israel
| | - David Kenigsbuch
- Department of Postharvest Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, Israel
| | - Jakob A Shimshoni
- Department of Food Science, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, Israel
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12
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Naim-Feil E, Elkins AC, Malmberg MM, Ram D, Tran J, Spangenberg GC, Rochfort SJ, Cogan NOI. The Cannabis Plant as a Complex System: Interrelationships between Cannabinoid Compositions, Morphological, Physiological and Phenological Traits. PLANTS (BASEL, SWITZERLAND) 2023; 12:493. [PMID: 36771577 PMCID: PMC9919051 DOI: 10.3390/plants12030493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Maintaining specific and reproducible cannabinoid compositions (type and quantity) is essential for the production of cannabis-based remedies that are therapeutically effective. The current study investigates factors that determine the plant's cannabinoid profile and examines interrelationships between plant features (growth rate, phenology and biomass), inflorescence morphology (size, shape and distribution) and cannabinoid content. An examination of differences in cannabinoid profile within genotypes revealed that across the cultivation facility, cannabinoids' qualitative traits (ratios between cannabinoid quantities) remain fairly stable, while quantitative traits (the absolute amount of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), cannabichromene (CBC), cannabigerol (CBG), Δ9-tetrahydrocannabivarin (THCV) and cannabidivarin (CBDV)) can significantly vary. The calculated broad-sense heritability values imply that cannabinoid composition will have a strong response to selection in comparison to the morphological and phenological traits of the plant and its inflorescences. Moreover, it is proposed that selection in favour of a vigorous growth rate, high-stature plants and wide inflorescences is expected to increase overall cannabinoid production. Finally, a range of physiological and phenological features was utilised for generating a successful model for the prediction of cannabinoid production. The holistic approach presented in the current study provides a better understanding of the interaction between the key features of the cannabis plant and facilitates the production of advanced plant-based medicinal substances.
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Affiliation(s)
- Erez Naim-Feil
- Agriculture Victoria, AgriBio, Centre for AgriBioscience, Melbourne, VIC 3083, Australia
- School of Applied Systems Biology, La Trobe University, Melbourne, VIC 3086, Australia
| | - Aaron C. Elkins
- Agriculture Victoria, AgriBio, Centre for AgriBioscience, Melbourne, VIC 3083, Australia
| | - M. Michelle Malmberg
- Agriculture Victoria, AgriBio, Centre for AgriBioscience, Melbourne, VIC 3083, Australia
| | - Doris Ram
- Agriculture Victoria, AgriBio, Centre for AgriBioscience, Melbourne, VIC 3083, Australia
| | - Jonathan Tran
- Agriculture Victoria, AgriBio, Centre for AgriBioscience, Melbourne, VIC 3083, Australia
- School of Applied Systems Biology, La Trobe University, Melbourne, VIC 3086, Australia
| | - German C. Spangenberg
- Agriculture Victoria, AgriBio, Centre for AgriBioscience, Melbourne, VIC 3083, Australia
- School of Applied Systems Biology, La Trobe University, Melbourne, VIC 3086, Australia
| | - Simone J. Rochfort
- Agriculture Victoria, AgriBio, Centre for AgriBioscience, Melbourne, VIC 3083, Australia
- School of Applied Systems Biology, La Trobe University, Melbourne, VIC 3086, Australia
| | - Noel O. I. Cogan
- Agriculture Victoria, AgriBio, Centre for AgriBioscience, Melbourne, VIC 3083, Australia
- School of Applied Systems Biology, La Trobe University, Melbourne, VIC 3086, Australia
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13
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Luz-Veiga M, Azevedo-Silva J, Fernandes JC. Beyond Pain Relief: A Review on Cannabidiol Potential in Medical Therapies. Pharmaceuticals (Basel) 2023; 16:155. [PMID: 37259306 PMCID: PMC9958812 DOI: 10.3390/ph16020155] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 07/30/2023] Open
Abstract
The phytocannabinoid cannabidiol (CBD) is receiving increasing attention due to its pharmacological properties. Although CBD is extracted from Cannabis sativa, it lacks the psychoactive effects of Δ9-tetrahydrocannabinol (THC) and has become an attractive compound for pharmacological uses due to its anti-inflammatory, antioxidant, anticonvulsant, and anxiolytic potential. The molecular mechanisms involved in CBD's biological effects are not limited to its interaction with classical cannabinoid receptors, exerting anti-inflammatory or pain-relief effects. Several pieces of evidence demonstrate that CBD interacts with other receptors and cellular signaling cascades, which further support CBD's therapeutic potential beyond pain management. In this review, we take a closer look at the molecular mechanisms of CBD and its potential therapeutic application in the context of cancer, neurodegeneration, and autoimmune diseases.
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Affiliation(s)
- Mariana Luz-Veiga
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - João Azevedo-Silva
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - João C. Fernandes
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
- Amyris Bio Products Portugal, Unipessoal Lda, 4169-005 Porto, Portugal
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14
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Espinosa-Jovel C. Cannabinoids in epilepsy: clinical efficacy and pharmacological considerations. Neurologia 2023; 38:47-53. [PMID: 34824031 DOI: 10.1016/j.nrleng.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/16/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Advances in the development of drugs with novel mechanisms of action have not been sufficient to significantly reduce the percentage of patients presenting drug-resistant epilepsy. This lack of satisfactory clinical results has led to the search for more effective treatment alternatives with new mechanisms of action. DEVELOPMENT The aim of this study is to examine epidemiological aspects of the use of cannabis-based products for the treatment of epilepsy, with particular emphasis on the main mechanisms of action, indications for use, clinical efficacy, and safety. We conducted a narrative review of articles gathered from the PubMed, EMBASE, and Google Scholar databases and from the reference sections of relevant publications. CONCLUSIONS In recent years there has been growing interest in the use of cannabis-based products for the treatment of a wide range of diseases, including epilepsy. The cannabis plant is currently known to contain more than 100 terpenophenolic compounds, known as cannabinoids. The 2 most abundant are delta-9-tetrahydrocannabinol and cannabidiol. Studies of preclinical models of epilepsy have shown that these cannabinoids have anticonvulsant properties, and 100% purified cannabidiol and cannabidiol-enriched cannabis extracts are now being used to treat epilepsy in humans. Several open-label studies and randomised controlled clinical trials have demonstrated the efficacy and safety of these products.
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Affiliation(s)
- C Espinosa-Jovel
- Programa de Epilepsia, Servicio de Neurología, Hospital Occidente de Kennedy, Bogotá, Colombia; Posgrado de Neurología, Universidad de La Sabana, Chía, Colombia.
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15
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Li J, Areal CC, Toffa DH, Citherlet D, Deacon C, Jutras-Aswad D, Keezer MR, Nguyen DK. Use of non-medical cannabis in epilepsy: A scoping review. Front Neurol 2023; 14:1132106. [PMID: 36949852 PMCID: PMC10025318 DOI: 10.3389/fneur.2023.1132106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
Objective The use of medical cannabis among people with epilepsy (PWE) has been garnering increasing interest. In this scoping review, we aimed to summarize the literature on recreational/non-medical cannabis (NMC) use in PWE, focusing on the experience, habits, and beliefs of PWE regarding NMC. Methods Four databases (OVID Medline, OVID Embase, Ovid APA PsycInfo, and Web of Science) were searched for studies describing NMC use in PWE. NMC was defined as cannabis products procured from sources other than by prescription. Studies that consisted in original research and that detailed the experience, habits, and/or beliefs of PWE regarding NMC use were included in the analysis. Data pertaining to study identification, demographics, NMC use, and epilepsy characteristics were extracted. Descriptive statistical analyses and reflexive thematic analyses were performed to map these data. Results In total, 3,228 records were screened, and 66 were included for analysis: 45 had mainly adult samples, whereas 21 had mainly pediatric samples. Most studies were published after 2010, originated from the USA, and were cross-sectional. The median number of PWE using cannabis in these studies was 24.5 (1-37,945). No studies showcased elderly PWE, and most had predominantly Caucasian samples. The lifetime prevalence of NMC use in PWE was variable, ranging between 0.69 and 76.8%. Factors frequently associated with NMC use in PWE were male sex, younger adult age, and lower education status. Children with epilepsy took NMC primarily for seizure control, using high CBD/THC ratios, and only orally. Adults with epilepsy took NMC for various reasons including recreationally, using variable CBD/THC ratios, and predominantly through smoking. The majority of PWE across all studies perceived that NMC aided in seizure control. Other aspects pertaining to NMC use in PWE were rarely reported and often conflicting. Conclusion The literature on NMC use in PWE is sparse and heterogeneous, with many salient knowledge gaps. Further research is necessary to better understanding the experience, habits, and beliefs of PWE pertaining to NMC.
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Affiliation(s)
- Jimmy Li
- Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- *Correspondence: Jimmy Li
| | - Cassandra C. Areal
- Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Dènahin Hinnoutondji Toffa
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
| | - Daphné Citherlet
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Charles Deacon
- Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Didier Jutras-Aswad
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, QC, Canada
| | - Mark Robert Keezer
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- School of Public Health, Université de Montréal, Montreal, QC, Canada
- Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Dang Khoa Nguyen
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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16
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Birenboim M, Kengisbuch D, Chalupowicz D, Maurer D, Barel S, Chen Y, Fallik E, Paz-Kagan T, Shimshoni JA. Use of near-infrared spectroscopy for the classification of medicinal cannabis cultivars and the prediction of their cannabinoid and terpene contents. PHYTOCHEMISTRY 2022; 204:113445. [PMID: 36165867 DOI: 10.1016/j.phytochem.2022.113445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Cannabis sativa L. is used to treat a wide variety of medical conditions, in light of its beneficial pharmacological properties of its cannabinoids and terpenes. At present, the quantitative chemical analysis of these active compounds is achieved through the use of laborious, expensive, and time-consuming technologies, such as high-pressure liquid-chromatography- photodiode arrays, mass spectrometer detectors (HPLC-PDA or MS), or gas chromatography-mass spectroscopy (GC-MS). Hence, we aimed to develop a simple, accurate, fast, and cheap technique for the quantification of major cannabinoids and terpenes using Fourier transform near infra-red spectroscopy (FT-NIRS). FT-NIRS was coupled with multivariate classification and regression models, namely partial least square-discriminant analysis (PLS-DA) and partial least squares regression (PLS-R) models. The PLS-DA model yielded an absolute major class separation (high-THC, high-CBD, hybrid, and high-CBG) and perfect class prediction. Using only three latent variables (LVs), the cross-validation and prediction model errors indicated a low probability of over-fitting the data. In addition, the PLS-DA model enabled the classification of chemovars with genetic-chemical similarities. The classification of high-THCA chemovars was more sensitive and more specific than the classifications of the remaining chemovars. The prediction of cannabinoid and terpene concentrations by PLS-R yielded 11 robust models with high predictive capabilities (R2CV and R2pred > 0.8, RPD >2.5 and RPIQ >3, RMSECV/RMSEC ratio <1.2) and additional 15 models whose performance was acceptable for initial screening purposes (R2CV > 0.7 and R2pred < 0.8, RPD >2 and RPIQ <3, 1.2 < RMSECV/RMSEC ratio <2). Our results confirm that there is sufficient information in the FT-NIRS to develop cannabinoid and terpene prediction models and major-cultivar classification models.
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Affiliation(s)
- Matan Birenboim
- Department of Food Safety, Institute for Postharvest and Food Sciences, Agricultural Research Organization (ARO), Volcani Center, P.O. Box 15159, Rishon LeZion, 7505101, Israel; Department of Plant Science, The Robert H Smith Faculty of Agriculture, Food and Environment, Rehovot, 7610001, Israel
| | - David Kengisbuch
- Department of Food Quality, Institute for Postharvest and Food Sciences, Agricultural Research Organization (ARO), Volcani Center, P.O. Box 15159, Rishon LeZion, 7505101, Israel
| | - Daniel Chalupowicz
- Department of Food Quality, Institute for Postharvest and Food Sciences, Agricultural Research Organization (ARO), Volcani Center, P.O. Box 15159, Rishon LeZion, 7505101, Israel
| | - Dalia Maurer
- Department of Food Quality, Institute for Postharvest and Food Sciences, Agricultural Research Organization (ARO), Volcani Center, P.O. Box 15159, Rishon LeZion, 7505101, Israel
| | - Shimon Barel
- Kimron Veterinary Institute, Department of Toxicology, Bet Dagan, 50250, Israel
| | - Yaira Chen
- Department of Food Safety, Institute for Postharvest and Food Sciences, Agricultural Research Organization (ARO), Volcani Center, P.O. Box 15159, Rishon LeZion, 7505101, Israel
| | - Elazar Fallik
- Department of Food Safety, Institute for Postharvest and Food Sciences, Agricultural Research Organization (ARO), Volcani Center, P.O. Box 15159, Rishon LeZion, 7505101, Israel
| | - Tarin Paz-Kagan
- French Associates Institute for Agriculture and Biotechnology of Dryland, The Jacob Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Sede Boqer Campus, 8499000, Israel
| | - Jakob A Shimshoni
- Department of Food Safety, Institute for Postharvest and Food Sciences, Agricultural Research Organization (ARO), Volcani Center, P.O. Box 15159, Rishon LeZion, 7505101, Israel.
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17
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Tzadok M, Hamed N, Heimer G, Zohar-Dayan E, Rabinowicz S, Ben Zeev B. The Long-Term Effectiveness and Safety of Cannabidiol-Enriched Oil in Children With Drug-Resistant Epilepsy. Pediatr Neurol 2022; 136:15-19. [PMID: 36049378 DOI: 10.1016/j.pediatrneurol.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/15/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several retrospective studies on pediatric epilepsy reported positive effects of cannabidiol-enriched artisanal cannabis oil and pure cannabidiol oil on seizure reduction. METHODS This is a retrospective study of children and adolescents with refractory epilepsy caused by various etiologies who were treated with artisanal cannabis oil during January 2014 to June 2019, with at least one year follow-up. RESULTS Of 114 patients, 84 (73.3%) reported some improvement in seizure frequency at some point during treatment. Fifty-one (59%) of the 86 patients who continued treatment for at least one year showed >50% improvement in seizure frequency. Seizure etiology, seizure type, and patients' age and sex were not found to be associated with the response to cannabidiol-enriched cannabis oil. Side effects were minor, and positive effects beyond seizure reduction were noted. CONCLUSIONS Artisanal cannabidiol-enriched cannabis may be an effective and safe long-term treatment for refractory epilepsy.
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Affiliation(s)
- Michal Tzadok
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nasrin Hamed
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Heimer
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Zohar-Dayan
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Rabinowicz
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bruria Ben Zeev
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Garcia-Romeu A, Elmore J, Mayhugh RE, Schlienz NJ, Martin EL, Strickland JC, Bonn-Miller M, Jackson H, Vandrey R. Online survey of medicinal cannabis users: Qualitative analysis of patient-level data. Front Pharmacol 2022; 13:965535. [PMID: 36147312 PMCID: PMC9485457 DOI: 10.3389/fphar.2022.965535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Aim: To characterize perceived benefits and challenges experienced by medicinal cannabis users. Methods: An anonymous online survey collected demographics, health information, and open-ended responses from medicinal cannabis users regarding perceptions, motivations, and experience of treatment. Qualitative open-ended responses were thematically analyzed. Results: Respondents (N = 808) were predominantly White (79%), female (63%), with a mean (SD) age of 38 (20). Two hundred eighty-four (35%) respondents provided data on a dependent family member (e.g., child; 22% of total sample). Most used cannabidiol (CBD)-dominant products (58%), primarily for neurological disorders (38%) or pain (25%). Primary motivations for medicinal cannabis use were based on beliefs that traditional treatments were ineffective and/or had intolerable side effects (51%), positive scientific or media portrayals of the safety/efficacy of cannabis as a therapeutic (29%), or preference for “natural” treatments over pharmaceuticals (21%). A majority of respondents (77%) attributed positive effects to the medicinal use of cannabis/cannabinoids. These included physical symptom improvements such as reduced pain (28%), improved sleep (18%), and seizure reduction (18%), and mental health improvements including reduced anxiety (22%) and improved mood (11%). Additionally, respondents reported reduced use of other medications (e.g., opioids) (12%), and improved quality of life (14%). Problems associated with use were cited by 41% of respondents, and included unwanted side effects (16%), lack of information or medical support (16%), prohibitive costs (12%), and legal concerns (10%). Conclusion: Most participants reported benefits from cannabis use for a variety of conditions where traditional treatments were ineffective or unacceptable. Concerns regarding cannabis side effects, legality, lack of information, and cost were raised. Data indicate greater research and education on the safety and efficacy of medicinal cannabis/cannabinoid use is warranted.
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Affiliation(s)
- Albert Garcia-Romeu
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Albert Garcia-Romeu,
| | - Joshua Elmore
- University of Colorado Boulder, Boulder, CO, United States
| | | | | | - Erin L. Martin
- Medical University of South Carolina, Charleston, SC, United States
| | | | | | - Heather Jackson
- Realm of Caring Foundation, Colorado Springs, Colorado, CO, United States
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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19
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Lin CH, Chan CH. Cannabis-induced psychosis presenting to a psychiatric emergency department: a case series. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2021.1968967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chia-Heng Lin
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan
| | - Chia-Hsiang Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan
- Department of Addiction Psychiatry, Taoyuan Psychiatry Center, Taoyuan, Taiwan
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20
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Birenboim M, Chalupowicz D, Maurer D, Barel S, Chen Y, Fallik E, Paz-Kagan T, Rapaport T, Sadeh A, Kengisbuch D, Shimshoni JA. Multivariate classification of cannabis chemovars based on their terpene and cannabinoid profiles. PHYTOCHEMISTRY 2022; 200:113215. [PMID: 35483556 DOI: 10.1016/j.phytochem.2022.113215] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
Cannabis is used to treat various medical conditions, and lines are commonly classified according to their total concentrations of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Based on their ratio of total THC to total CBD, cannabis cultivars are commonly classified into high-THC, high-CBD, and hybrid classes. While cultivars from the same class have similar compositions of major cannabinoids, their levels of other cannabinoids and their terpene compositions may differ substantially. Therefore, a more comprehensive and accurate classification of medicinal cannabis cultivars, based on a large number of cannabinoids and terpenes is needed. For this purpose, three different chemometric-based classification models were constructed using three sets of chemical profiles. We examined those models to determine which provides the most accurate "chemovar" classification. This was done by analyzing profiles of cannabinoids, terpenes, and the combination of these substances using the partial least square-discriminant analysis multivariate (PLS-DA) technique. The chemical profiles were selected from the three major classes of medicinal cannabis that are most commonly prescribed to patients in Israel: high-THC, high-cannabigerol (CBG), and hybrid. We studied the correlations between cannabinoids and terpenes to identify major bio-indicators representing the plant's terpene and cannabinoid content. All three PLS-DA models provided highly accurate classifications, utilizing six to nine latent variables with an overall accuracy ranging from 2 to 11% CV. The PLS-DA model applied to the combined cannabinoid-and-terpene profile did the best job of differentiating between the chemovars in terms of misclassification error, sensitivity, specificity, and accuracy. The combined cannabinoid-and-terpene PLS-DA profile had cross-validation and prediction misclassification errors of 4% and 0%, respectively. This is the first study to demonstrate the highly accurate classification of samples of medicinal cannabis based on their cannabinoid and terpene profiles, as compared to cannabinoid profiles alone. Furthermore, our correlation analysis indicated that 11 cannabinoids and terpenes might serve as bio-indicators for 32 different active compounds. These findings suggest that the use of multivariate statistics could assist in breeding studies and serve as a tool for minimizing the mislabeling of cannabis inflorescences.
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Affiliation(s)
- Matan Birenboim
- Department of Food Safety, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, 7505101, Israel & Department of Plant Science, The Robert H. Smith Faculty of Agriculture, Food and Environment, Rehovot, 7610001, Israel
| | - Daniel Chalupowicz
- Department of Food Quality, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, 7505101, Israel
| | - Dalia Maurer
- Department of Food Quality, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, 7505101, Israel
| | - Shimon Barel
- Kimron Veterinary Institute, Department of Toxicology, Bet Dagan, 50250, Israel
| | - Yaira Chen
- Department of Food Safety, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, 7505101, Israel & Department of Plant Science, The Robert H. Smith Faculty of Agriculture, Food and Environment, Rehovot, 7610001, Israel
| | - Elazar Fallik
- Department of Food Quality, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, 7505101, Israel
| | - Tarin Paz-Kagan
- Department of Sensing, Information and Mechanization Systems, Institute of Agricultural Engineering, Agricultural Research Organization (ARO), Volcani Center, Israel
| | - Tal Rapaport
- Department of Sensing, Information and Mechanization Systems, Institute of Agricultural Engineering, Agricultural Research Organization (ARO), Volcani Center, Israel
| | - Alona Sadeh
- Department of Food Quality, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, 7505101, Israel
| | - David Kengisbuch
- Department of Food Quality, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, 7505101, Israel.
| | - Jakob A Shimshoni
- Department of Food Quality, Institute for Postharvest and Food Sciences, Agricultural Research Organization, Volcani Center, Rishon LeZion, 7505101, Israel.
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Mirlohi S, Bladen C, Santiago MJ, Arnold JC, McGregor I, Connor M. Inhibition of human recombinant T-type calcium channels by phytocannabinoids in vitro. Br J Pharmacol 2022; 179:4031-4043. [PMID: 35342937 DOI: 10.1111/bph.15842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE T-type Ca channels (ICa ) regulate neuronal excitability and contribute to neurotransmitter release. The phytocannabinoids Δ9 -tetrahydrocannabinol and cannabidiol effectively modulate T-type ICa , but effects of other biologically active phytocannabinoids on these channels are unknown. We thus investigated the modulation of T-type ICa by low abundance phytocannabinoids. EXPERIMENTAL APPROACH A fluorometric (FLIPR) assay was used to investigate modulation of human T-type ICa (CaV 3.1, 3.2 and 3.3) stably expressed in FlpIn-TREx HEK293 cells. The biophysical effects of some compounds were examined using whole-cell patch clamp recordings from the same cells. KEY RESULTS In the FLIPR assay, all eleven phytocannabinoids tested modulated T-type ICa , with most inhibiting CaV 3.1 and CaV 3.2 more effectively than CaV 3.3. Cannabigerolic acid was the most potent inhibitor of CaV 3.1 (pIC50 6.1 ± 0.6) and CaV 3.2 (pIC50 6.4 ± 0.4); in all cases phytocannabinoid acids were more potent than their corresponding neutral forms. In patch clamp recordings, cannabigerolic acid inhibited CaV 3.1 and 3.2 with similar potency to the FLIPR assay, the inhibition was associated with significant hyperpolarizing shift in activation and steady state inactivation of these channels. In contrast, cannabidiol, cannabidivarin and cannabigerol only affected channel inactivation. CONCLUSION AND IMPLICATIONS Modulation of T-type calcium channels is a common property of phytocannabinoids, which all increase steady state inactivation at physiological membrane potentials, with some also affecting channel activation. Thus, T-type ICa may be a common site of action for phytocannabinoids, and the diverse actions of phytocannabinoids on channel gating may provide insight into structural requirement for selective T-type ICa modulators.
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Affiliation(s)
- Somayeh Mirlohi
- Department of Biomedical Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney
| | - Chris Bladen
- Department of Biomedical Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney
| | - Marina J Santiago
- Department of Biomedical Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney
| | - Jonathon C Arnold
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Pharmacology, Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Connor
- Department of Biomedical Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney
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22
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Harte S, Singh Y, Malone S, Heussler H, Wallace G. Cannabidiol and refractory epilepsy: parental and caregiver perspectives of participation in a compassionate access scheme. BMC Health Serv Res 2022; 22:173. [PMID: 35144615 PMCID: PMC8832815 DOI: 10.1186/s12913-022-07592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background The Compassionate Access Scheme (CAS) being delivered through the Queensland Children’s Hospital is designed to allow access to an investigational purified Cannabidiol oral solution to paediatric patients with severe refractory epilepsy. The objectives of this study were to conduct semi-structured interviews to: 1. Understand families’ expectations and attitudes about the use of an investigational cannabinoid product for their child’s seizures; 2. Understand families’ perceptions of Cannabidiol’s efficacy for their child’s seizures; and other aspects of their child’s behaviour, quality of life and/or cognition. Methods Children aged 2-18 years had been enrolled in, or were enrolled in a compassionate access scheme for Cannabidiol at the time of the study. Semi-structured interviews (n = 19) with parents or caregivers (n = 23) of children diagnosed with refractory epilepsy were voice-recorded, transcribed and analysed to generate common themes. Results Key themes emerged relating to seizure activity, family and school engagement, drug safety and legal access, efficacy, clinical support, social acceptance of the medication and program delivery. The use of Cannabidiol was perceived to have benefits in relation to reducing the severity and frequency of seizure activity for almost a third of patients experiencing refractory epilepsy. Participants described other benefits including improved social engagement, wakefulness and a reduction of side effects related to a reduction of conventional medication dosage. Conclusion This study provided unique perspectives of families’ experiences managing untreatable epilepsy, their experiences with conventional and experimental pharmacological treatments and health services. Whilst families’ perceptions showed the use of Cannabidiol did not provide a therapeutic reduction in the seizure activity for all patients diagnosed with refractory epilepsy, it’s use as an additional pharmacological agent was perceived to provide other benefits by some patient families.
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Affiliation(s)
- S Harte
- The University of Queensland, School of Medicine, Brisbane, Australia.
| | - Y Singh
- Queensland Children's Hospital, South Brisbane, Australia
| | - S Malone
- Queensland Children's Hospital, South Brisbane, Australia
| | - H Heussler
- Queensland Children's Hospital, South Brisbane, Australia.
| | - G Wallace
- Queensland Children's Hospital, South Brisbane, Australia
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Miller OS, Elder EJ, Jones KJ, Gidal BE. Analysis of cannabidiol (CBD) and THC in nonprescription consumer products: Implications for patients and practitioners. Epilepsy Behav 2022; 127:108514. [PMID: 34998268 DOI: 10.1016/j.yebeh.2021.108514] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Cannabidiol products remains largely unregulated in the US. Unlike the Rx formulation of CBD [EpidiolexR], little information is available regarding labeling accuracy (does the product contain what the label says it does), lot to lot variability, nor long-term product stability. Understanding these properties are fundamental if these products are to be used in patients with epilepsy, where product variability of traditional AEDs has been suspected to result in inadequate seizure control. Therefore, we analyzed commercial CBD products, including oils, aqueous products (i.e., beverages), and various Other products for cannabinoid content vs label claims and stability under United States Pharmacopeia (USP) standards. METHOD Samples were diluted and analyzed by HPLC for CBD, THC, and CBN concentrations in order to assess product label accuracy. Products with <90% of label claim CBD were denoted over-labeled, products with >110% of label claim CBD were denoted under-labeled, and products between 90% and 110% of label claim CBD were denoted appropriately labeled, per USP standards. RESULTS Among commercial CBD Oils (n = 11), mean CBD concentration vs label claim was 91.56% [95% CI, 66.02-117.10%], although 18.18% of oils (n = 2) made nonspecific label claims of "hemp extract" in lieu of CBD. Among all oils, 36.36% (n = 4) were appropriately labeled, another 36.4% (n = 4) of all oils were under-labeled, maximum 128.3% label claim, and finally, 9.09% (n = 1) of oils were over-labeled. The remaining 18.18% (n = 2) of oils lacked specific CBD label claims, minimum of 0.3 mg CBD per 1-ml "dose". THC was detected in 54.55% (n = 6) of oils with a maximum concentration of 0.2% w/v and a minimum concentration of 0.036% w/v. Cannabinol was detectable in only 9.1% (n = 1) of products at a concentration of 0.00465% w/v. Among aqueous products (n = 21) tested, only 66.67% (n = 14) gave specific CBD label claims, with mean CBD concentration vs label claim of 59.93% [95% CI, 38.24-81.63%]. Only 7.14% (n = 1) of aqueous products with a label claim were appropriately labeled, 14.29% (n = 2) were found to be under-labeled, and 78.57% (n = 11) over-labeled. THC was detected in 23.81% (n = 5) of aqueous products tested with a maximum THC concentration of 0.0005% w/v, and a minimum concentration of 0.0002% w/v. Cannabinol was detected in 9.52% (n = 2) of aqueous products, both at a concentration of 0.0015% w/v. "Other" products (n = 7) tested ranged from chocolate bars to transdermal patches. Some 42.86% (n = 3) gave specific CBD label claims, with mean CBD concentration vs label claim of 67.01% [95% CI, 0.87-133.14%]. Among these three "Other" products with specific label claims, 33% (n = 1) was appropriately labeled, and 66.67% (n = 2) were over-labeled, with CBD concentrations vs label claim ranging from a minimum of 39.30% to a maximum of 101.99%. The remaining 57.14% (n = 5) of "Other" products tested made nonspecific CBD label claims, denoting CBD content in terms of "full spectrum hemp extract" or "activated cannabinoids". One such product was labeled with a "40-50-mg CBD" range instead of a single, specific value. Tetrahydrocannabinol was detected in 71.43% (n = 5) of Other products tested with a maximum concentration of 0.0046% w/w, and a minimum concentration of 0.0008% w/w. Cannabinol was detected in 14.3% (n = 1) of Other products at a concentration of 0.0001% w/w. CONCLUSION We demonstrate that commercial CBD products, especially aqueous beverages, can show inconsistent labeling, vary largely from their label claims should they make them, and show lot-to-lot variability making dosing unpredictable.
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Affiliation(s)
- Owen S Miller
- University of Wisconsin, School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States.
| | - Edmund J Elder
- University of Wisconsin, School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States; University of Wisconsin - Zeeh Pharmaceutical Experiment Station, 777 Highland Ave, Madison, WI 53705-2222, United States.
| | - Karen J Jones
- University of Wisconsin - Zeeh Pharmaceutical Experiment Station, 777 Highland Ave, Madison, WI 53705-2222, United States.
| | - Barry E Gidal
- University of Wisconsin, School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States.
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24
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Pinto JS, Martel F. Effects of Cannabidiol on Appetite and Body Weight: A Systematic Review. Clin Drug Investig 2022; 42:909-919. [PMID: 36180814 PMCID: PMC9525229 DOI: 10.1007/s40261-022-01205-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Cannabidiol, one of the main components of the Cannabis sativa plant, is a non-psychotropic cannabinoid that has recently drawn the attention of researchers and clinicians for its potential therapeutic applications. In this systematic review, we aim to describe the possible effects of cannabidiol in appetite and body weight. METHODS Both authors independently ran a thorough search in both PubMed and Cochrane databases up to 31 July, 2022 and included every peer-reviewed, original randomized controlled clinical trial that reported data on either of the said outcomes. Risk of assessment bias was performed with Cochrane's risk of bias tool and results were summarized in tables. RESULTS A total of 11 trials were included in this review. Of these, the majority reported on cannabidiol reducing appetite and/or body weight whilst some have found no significant changes and one trial described an increase in appetite. CONCLUSIONS This systematic review suggests that cannabidiol has an anorexigenic effect, correlated with a decrease in body weight. However, most of the studies included in the present review raised some concerns in terms of risk of bias. We believe further research is needed in order to clarify potential mechanisms involved in the effect of cannabidiol on feeding/appetite.
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Affiliation(s)
| | - Fátima Martel
- Department of Biomedicine, Unit of Biochemistry, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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25
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Pérez Montilla CA, Schaiquevich PS, Cáceres Guido P, Caraballo RH, Reyes Valenzuela G, Cruz CV, García Bournissen F. An Ultrafast Ultrahigh-Performance Liquid Chromatography Coupled With Tandem Mass Spectrometry Method for Cannabidiol Monitoring in Pediatric Refractory Epilepsy. Ther Drug Monit 2021; 43:712-717. [PMID: 33346629 DOI: 10.1097/ftd.0000000000000846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cannabidiol (CBD) is a nonpsychoactive natural product that has been increasingly used as a promising new drug for the management of neurological conditions such as refractory epilepsy. Development of rapid and sensitive methods to quantitate CBD is essential to evaluate its pharmacokinetics in humans, particularly in children. The objective of this work was to develop and validate an ultrafast ultrahigh-performance liquid chromatography coupled with tandem mass spectrometry (UHPLC-MS/MS) method for CBD quantitation that is capable of detecting major CBD and tetrahydrocannabinol (THC) metabolites in the plasma of pediatric refractory epilepsy patients. METHODS Eight-point CBD calibration curves were prepared using 60 µL of plasma from healthy volunteers. Samples were analyzed in a Shimadzu Nexera X2 UHPLC system, which was coupled to a Sciex QTRAP 6500 mass spectrometer. Chromatography was optimized in acetonitrile (ACN)/water with a 70%-90% gradient of ACN in 2 minutes. Multiple reaction monitoring transitions of major CBD and THC metabolites were optimized in patient plasma. RESULTS The optimized UHPLC-MS/MS method was validated for the linear range (1-300 ng/mL) of CBD (r2 = 0.996). The limit of quantification and limit of detection were 0.26 and 0.86 ng/mL, respectively. Accuracy and precision met the acceptable validation limits. CBD recovery and matrix effects were 83.9 ± 13.9% and 117.4 ± 4.5%, respectively. The method was successfully applied to quantify CBD and detect the major CBD and THC metabolites in clinical samples. 7-COOH-CBD was the most intensely detected metabolite followed by glucuronide conjugates. CONCLUSIONS A simple and sensitive method for rapidly monitoring CBD and identifying relevant metabolites was developed. Its applicability in samples from children treated for epilepsy was demonstrated, making it an excellent alternative for performing pharmacokinetic studies.
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Affiliation(s)
- Carlos A Pérez Montilla
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP-CONICET), Hospital de Niños "Dr. Ricardo Gutiérrez," Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Paula S Schaiquevich
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
- Medicina de Precisión, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina
- Unidad de Farmacocinética Clínica, Área Farmacia, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina
| | - Paulo Cáceres Guido
- Unidad de Farmacocinética Clínica, Área Farmacia, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina
| | - Roberto H Caraballo
- Servicio de Neurología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina
| | | | - Cintia V Cruz
- Laboratorio de estadística aplicada a ciencias de la salud, Departamento de Toxicología y Farmacología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; and
| | - Facundo García Bournissen
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
- Division of Paediatric Clinical Pharmacology, Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
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Karaźniewicz-Łada M, Główka AK, Mikulska AA, Główka FK. Pharmacokinetic Drug-Drug Interactions among Antiepileptic Drugs, Including CBD, Drugs Used to Treat COVID-19 and Nutrients. Int J Mol Sci 2021; 22:ijms22179582. [PMID: 34502487 PMCID: PMC8431452 DOI: 10.3390/ijms22179582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 12/22/2022] Open
Abstract
Anti-epileptic drugs (AEDs) are an important group of drugs of several generations, ranging from the oldest phenobarbital (1912) to the most recent cenobamate (2019). Cannabidiol (CBD) is increasingly used to treat epilepsy. The outbreak of the SARS-CoV-2 pandemic in 2019 created new challenges in the effective treatment of epilepsy in COVID-19 patients. The purpose of this review is to present data from the last few years on drug–drug interactions among of AEDs, as well as AEDs with other drugs, nutrients and food. Literature data was collected mainly in PubMed, as well as google base. The most important pharmacokinetic parameters of the chosen 29 AEDs, mechanism of action and clinical application, as well as their biotransformation, are presented. We pay a special attention to the new potential interactions of the applied first-generation AEDs (carbamazepine, oxcarbazepine, phenytoin, phenobarbital and primidone), on decreased concentration of some medications (atazanavir and remdesivir), or their compositions (darunavir/cobicistat and lopinavir/ritonavir) used in the treatment of COVID-19 patients. CBD interactions with AEDs are clearly defined. In addition, nutrients, as well as diet, cause changes in pharmacokinetics of some AEDs. The understanding of the pharmacokinetic interactions of the AEDs seems to be important in effective management of epilepsy.
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Affiliation(s)
- Marta Karaźniewicz-Łada
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 60-781 Poznań, Poland; (M.K.-Ł.); (A.A.M.)
| | - Anna K. Główka
- Department of Bromatology, Poznan University of Medical Sciences, 60-354 Poznań, Poland;
| | - Aniceta A. Mikulska
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 60-781 Poznań, Poland; (M.K.-Ł.); (A.A.M.)
| | - Franciszek K. Główka
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 60-781 Poznań, Poland; (M.K.-Ł.); (A.A.M.)
- Correspondence: ; Tel.: +48-(0)61-854-64-37
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Serum Proteomic Analysis of Cannabis Use Disorder in Male Patients. Molecules 2021; 26:molecules26175311. [PMID: 34500744 PMCID: PMC8434053 DOI: 10.3390/molecules26175311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/18/2022] Open
Abstract
Cannabis use has been growing recently and it is legally consumed in many countries. Cannabis has a variety of phytochemicals including cannabinoids, which might impair the peripheral systems responses affecting inflammatory and immunological pathways. However, the exact signaling pathways that induce these effects need further understanding. The objective of this study is to investigate the serum proteomic profiling in patients diagnosed with cannabis use disorder (CUD) as compared with healthy control subjects. The novelty of our study is to highlight the differentially changes proteins in the serum of CUD patients. Certain proteins can be targeted in the future to attenuate the toxicological effects of cannabis. Blood samples were collected from 20 male individuals: 10 healthy controls and 10 CUD patients. An untargeted proteomic technique employing two-dimensional difference in gel electrophoresis coupled with mass spectrometry was employed in this study to assess the differentially expressed proteins. The proteomic analysis identified a total of 121 proteins that showed significant changes in protein expression between CUD patients (experimental group) and healthy individuals (control group). For instance, the serum expression of inactive tyrosine protein kinase PEAK1 and tumor necrosis factor alpha-induced protein 3 were increased in CUD group. In contrast, the serum expression of transthyretin and serotransferrin were reduced in CUD group. Among these proteins, 55 proteins were significantly upregulated and 66 proteins significantly downregulated in CUD patients as compared with healthy control group. Ingenuity pathway analysis (IPA) found that these differentially expressed proteins are linked to p38MAPK, interleukin 12 complex, nuclear factor-κB, and other signaling pathways. Our work indicates that the differentially expressed serum proteins between CUD and control groups are correlated to liver X receptor/retinoid X receptor (RXR), farnesoid X receptor/RXR activation, and acute phase response signaling.
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Chronic cannabidiol (CBD) administration induces anticonvulsant and antiepileptogenic effects in a genetic model of epilepsy. Epilepsy Behav 2021; 119:107962. [PMID: 33887676 DOI: 10.1016/j.yebeh.2021.107962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022]
Abstract
Cannabidiol (CBD) is a marijuana compound implicated in epilepsy treatment in animal models and pharmacoresistant patients. However, little is known about chronic CBD administration's effects in chronic models of seizures, especially regarding its potential antiepileptogenic effects. In the present study, we combined a genetic model of epilepsy (the Wistar Audiogenic Rat strain - WARs), a chronic protocol of seizures (the audiogenic kindling - AuK), quantitative and sequential behavioral analysis (neuroethology), and microscopy imaging to analyze the effects of chronic CBD administration in a genetic model of epilepsy. The acute audiogenic seizure is characterized by tonic-clonic seizures and intense brainstem activity. However, during the AuK WARs can develop limbic seizures associated with the recruitment of forebrain and limbic structures. Here, chronic CBD administration, twice a day, attenuated brainstem, tonic-clonic seizures, prevented limbic recruitment, and suppressed limbic (kindled) seizures, suggesting CBD antiepileptogenic effects. Additionally, CBD prevented chronic neuronal hyperactivity, suppressing FosB immunostaining in the brainstem (inferior colliculus and periaqueductal gray matter) and forebrain (basolateral amygdala nucleus and piriform cortex), structures associated with tonic-clonic and limbic seizures, respectively. Chronic seizures increased cannabinoid receptors type 1 (CB1R) immunostaining in the hippocampus and the BLA, while CBD administration prevented changes in CB1R expression induced by the AuK. The neuroethological analysis provided details about CBD's protective effects against brainstem and limbic seizures associated with FosB expression. Our results strongly suggest chronic CBD anticonvulsant and antiepileptogenic effects associated with reduced chronic neuronal activity and modulation of CB1R expression. We also support the chronic use of CBD for epilepsies treatments.
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Krishnan A, Agwu JC, Kallappa C, Pandey R. Development of central precocious puberty following cannabinoid use for paediatric epilepsy: causal or coincidence? BMJ Case Rep 2021; 14:14/4/e239678. [PMID: 33858879 PMCID: PMC8055150 DOI: 10.1136/bcr-2020-239678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Research suggests a role for cannabidiol oil in managing certain forms of paediatric onset epilepsy. However, studies on the impact of cannabis on the hypothalamo-pituitary-gonadal (HPG) axis have conflicting results. Delta-9-tetrahydrocannabinol (Δ9-THC) acutely inhibits gonadotropin-releasing hormone in the hypothalamus, reducing testosterone levels by 65% in rhesus monkeys. Additionally, there have been reports of pubertal arrest and delayed puberty in male cannabis users. In contrast, other studies have reported higher testosterone levels following long-term cannabis use.A 2-year-old boy presented with testicular enlargement, increased penile length and growth of coarse pubic hair developing over 6 months. His mother procured cannabidiol oil online, which he started taking 7 months earlier for severe epilepsy refractory to medical management. Subsequent investigations confirmed central precocious puberty. While it is unclear whether the precocious puberty is a direct consequence of HPG axis activation by Δ9-THC, this case demonstrates a temporal association between cannabis use and development of precocious puberty.
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Affiliation(s)
- Aditya Krishnan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Juliana Chizo Agwu
- Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
| | - Chetana Kallappa
- Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
| | - Rajesh Pandey
- Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
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Gibbard M, Mount D, Rassekh SR, Siden HH. Family attitudes about and experiences with medical cannabis in children with cancer or epilepsy: an exploratory qualitative study. CMAJ Open 2021; 9:E563-E569. [PMID: 34021014 PMCID: PMC8177908 DOI: 10.9778/cmajo.20200212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cannabis is legal for recreational and medical use in Canada. Our aim was to explore family experiences using medical cannabis for children with severe conditions in the context of legalization. METHODS We conducted a qualitative study using semistructured interviews between April and July 2019. Participants were parents of children attending BC Children's Hospital oncology or palliative care clinics, recruited through posters, emails or referral. Participants were included if they spoke English and their child used any type of cannabis for medical purposes. Interviews included open-ended questions about the child's cannabis use. Interviews were recorded and transcribed, and thematic analysis was performed using qualitative description. RESULTS Ten interviews were completed with 9 mothers and 1 mother-father pair. The age range of the children was 22 months to 16 years. The primary reasons for cannabis use were epilepsy (6 children) or chemotherapy management (4 children). Five major themes were identified. 1) Child and family context, and cannabis as a last resort: children were seen as severely ill; parents sought cannabis out of desperation and responsibility to their child. 2) Varied information sources informed decision-making: parents lacked resources from health care providers and sought support from social media, industry and other families. 3) Cannabis as an ambiguous medicine: cannabis was viewed as both a serious drug that doctors should prescribe and as a natural alternative health product, safe to pursue alone. 4) Perceived effects: parents perceived medical benefits with few concerns about adverse effects. 5) Legal and financial challenges: parents were willing to obtain cannabis despite high costs and uncertain legality. INTERPRETATION Parents of children with severe conditions pursued medical cannabis despite obstacles and needed unbiased information to access alone. Scientific investigation is needed to develop pediatric medical guidelines to inform decisions.
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Affiliation(s)
- Marissa Gibbard
- BC Children's Hospital Research Institute (Gibbard, Mount); Department of Pediatrics (Gibbard, Mount, Rassekh, Siden), Faculty of Medicine, University of British Columbia; BC Children's Hospital (Rassekh, Siden), Vancouver, BC
| | - Dawn Mount
- BC Children's Hospital Research Institute (Gibbard, Mount); Department of Pediatrics (Gibbard, Mount, Rassekh, Siden), Faculty of Medicine, University of British Columbia; BC Children's Hospital (Rassekh, Siden), Vancouver, BC
| | - Shahrad R Rassekh
- BC Children's Hospital Research Institute (Gibbard, Mount); Department of Pediatrics (Gibbard, Mount, Rassekh, Siden), Faculty of Medicine, University of British Columbia; BC Children's Hospital (Rassekh, Siden), Vancouver, BC
| | - Harold Hal Siden
- BC Children's Hospital Research Institute (Gibbard, Mount); Department of Pediatrics (Gibbard, Mount, Rassekh, Siden), Faculty of Medicine, University of British Columbia; BC Children's Hospital (Rassekh, Siden), Vancouver, BC
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Szkudlarek HJ, Rodríguez-Ruiz M, Hudson R, De Felice M, Jung T, Rushlow WJ, Laviolette SR. THC and CBD produce divergent effects on perception and panic behaviours via distinct cortical molecular pathways. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110029. [PMID: 32623021 DOI: 10.1016/j.pnpbp.2020.110029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 12/17/2022]
Abstract
Clinical and pre-clinical evidence demonstrates divergent psychotropic effects of THC vs. CBD. While THC can induce perceptual distortions and anxiogenic effects, CBD displays antipsychotic and anxiolytic properties. A key brain region responsible for regulation of cognition and affect, the medial prefrontal cortex (PFC), is strongly modulated by cannabinoids, suggesting that these dissociable THC/CBD-dependent effects may involve functional and molecular interplay within the PFC. The primary aim of this study was to investigate potential interactions and molecular substrates involved in PFC-mediated effects of THC and CBD on differential cognitive and affective behavioural processing. Male Sprague Dawley rats received intra-PFC microinfusions of THC, CBD or their combination, and tested in the latent inhibition paradigm, spontaneous oddity discrimination test, elevated T-maze and open field. To identify local, drug-induced molecular modulation in the PFC, PFC samples were collected and processed with Western Blotting. Intra-PFC THC induced strong panic-like responses that were counteracted with CBD. In contrast, CBD did not affect panic-like behaviours but blocked formation of associative fear memories and impaired latent inhibition and oddity discrimination performance. Interestingly, these CBD effects were dependent upon 5-HT1A receptor transmission but not influenced by THC co-administration. Moreover, THC induced robust phosphorylation of ERK1/2 that was prevented by CBD, while CBD decreased phosphorylation of p70S6K, independently of THC. These results suggest that intra-PFC infusion of THC promotes panic-like behaviour associated with increased ERK1/2 phosphorylation. In contrast, CBD impairs perceptive functions and latent inhibition via activation of 5-HT1A receptors and reduced phosphorylation of p70S6K.
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Affiliation(s)
- Hanna J Szkudlarek
- Addiction Research Group, University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario N6A 5C1, Canada.
| | - Mar Rodríguez-Ruiz
- Addiction Research Group, University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Roger Hudson
- Addiction Research Group, University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Marta De Felice
- Addiction Research Group, University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Tony Jung
- Addiction Research Group, University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Walter J Rushlow
- Addiction Research Group, University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Psychiatry. Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Steven R Laviolette
- Addiction Research Group, University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Psychiatry. Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario N6A 5C1, Canada.
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Koo CM, Kim SH, Lee JS, Park BJ, Lee HK, Kim HD, Kang HC. Cannabidiol for Treating Lennox-Gastaut Syndrome and Dravet Syndrome in Korea. J Korean Med Sci 2020; 35:e427. [PMID: 33372424 PMCID: PMC7769699 DOI: 10.3346/jkms.2020.35.e427] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND For the first time in Korea, we aimed to study the efficacy and safety of cannabidiol (CBD), which is emerging as a new alternative in treating epileptic encephalopathies. METHODS This study was conducted retrospectively with patients between the ages of 2-18 years diagnosed with Lennox-Gastaut syndrome (LGS) or Dravet syndrome (DS) were enrolled from March to October 2019, who visited outpatient unit at 3 and 6 months to evaluate medication efficacy and safety based on caregiver reporting. Additional evaluations, such as electroencephalogram and blood tests, were conducted at each period also. CBD was administered orally at a starting dose of 5 mg/kg/day, and was maintained at 10 mg/kg/day. RESULTS We analyzed 34 patients in the LGS group and 10 patients in the DS group between the ages of 1.2-15.8 years. In the 3-month evaluation, the overall reduction of seizure frequency in the LGS group was 52.9% (>50% reduction in 32.3% of the cases), and 29.4% in the 6-month evaluation (more than 50% reduction in 20.6%). In DS group, the reduction of seizure frequency by more than 50% was 30% and 20% in the 3-month and 6-month evaluation, respectively. Good outcomes were defined as the reduction of seizure frequency by more than 50% and similar results were observed in both LGS and DS groups. Adverse events were reported in 36.3% of total patients of which most common adverse events were gastrointestinal problems. However, no life-threatening adverse event was reported in both LGS and DS during the observation period. CONCLUSION In this first Korean study, CBD was safe and tolerable for use and could be expected to potentially reduce the seizure frequency in pediatric patients with LGS or DS.
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Affiliation(s)
- Chung Mo Koo
- Division of Pediatric Emergency, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hee Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- National Academy of Medicine of Korea, Seoul, Korea
| | - Hae Kook Lee
- National Academy of Medicine of Korea, Seoul, Korea
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Hoon Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- National Academy of Medicine of Korea, Seoul, Korea.
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Chopra SS. Infantile Spasms and West Syndrome - A Clinician's Perspective. Indian J Pediatr 2020; 87:1040-1046. [PMID: 32557136 DOI: 10.1007/s12098-020-03279-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/20/2020] [Indexed: 01/26/2023]
Abstract
Infantile spasms, though long recognised, are still a cause of significant morbidity in children. The knowledge of their etiology and pathogenesis is still evolving. Even the management strategies vary among different centres. Hormonal treatments and vigabatrin have been recognised as effective but controversies prevail on the exact protocols that best balance the risk benefit ratio. Collaborative studies have begun to provide some clarity on some of the management issues but further large scale studies that further standardise protocols are a felt need. This article attempts to provide a clinically relevant summary of the current knowledge.
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Affiliation(s)
- Saurabh S Chopra
- Max Smart Hospital, Saket, New Delhi, India.
- Max Hospital, Patparganj, New Delhi, India.
- Children's Neurology Centre, Indirapuram, Ghaziabad, India.
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Molecular Targets of Cannabidiol in Experimental Models of Neurological Disease. Molecules 2020; 25:molecules25215186. [PMID: 33171772 PMCID: PMC7664437 DOI: 10.3390/molecules25215186] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
Cannabidiol (CBD) is a non-psychoactive phytocannabinoid known for its beneficial effects including antioxidant and anti-inflammatory properties. Moreover, CBD is a compound with antidepressant, anxiolytic, anticonvulsant and antipsychotic effects. Thanks to all these properties, the interest of the scientific community for it has grown. Indeed, CBD is a great candidate for the management of neurological diseases. The purpose of our review is to summarize the in vitro and in vivo studies published in the last 15 years that describe the biochemical and molecular mechanisms underlying the effects of CBD and its therapeutic application in neurological diseases. CBD exerts its neuroprotective effects through three G protein coupled-receptors (adenosine receptor subtype 2A, serotonin receptor subtype 1A and G protein-coupled receptor 55), one ligand-gated ion channel (transient receptor potential vanilloid channel-1) and one nuclear factor (peroxisome proliferator-activated receptor γ). Moreover, the therapeutical properties of CBD are also due to GABAergic modulation. In conclusion, CBD, through multi-target mechanisms, represents a valid therapeutic tool for the management of epilepsy, Alzheimer’s disease, multiple sclerosis and Parkinson’s disease.
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Yu Y, Yang Z, Jin B, Qin X, Zhu X, Sun J, Huo L, Wang R, Shi Y, Jia Z, Shi YS, Chu S, Kong D, Zhang W. Cannabidiol inhibits febrile seizure by modulating AMPA receptor kinetics through its interaction with the N-terminal domain of GluA1/GluA2. Pharmacol Res 2020; 161:105128. [DOI: 10.1016/j.phrs.2020.105128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
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Klotz KA, Schönberger J, Nakamura L, San Antonio-Arce V, Bast T, Wiemer-Kruel A, Schubert-Bast S, Borggraefe I, Syrbe S, Jacobs J. Expectations and knowledge of cannabidiol therapy for childhood epilepsy - A German caregiver survey. Epilepsy Behav 2020; 111:107268. [PMID: 32645621 DOI: 10.1016/j.yebeh.2020.107268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cannabidiol (CBD) has gained popularity among parents of children with epilepsy, even before evidence of efficacy and safety was available. The aim of our survey was to gain information about parental attitude to CBD, as well as expectations and knowledge of CBD for treatment of their child's epilepsy. METHODS A survey using an open-access online questionnaire for parents or caregivers of children with epilepsy within German-speaking countries from March to June 2019 was used. RESULTS Of 378 complete questionnaires (mean age of children: 11.1 (standard deviation [SD] 7.4) years), 28% (n = 106) reported previous or current CBD treatment over a mean time of 17.31 months (SD: 19.74), whereas 72% had no personal experience with CBD. Treatment was proposed by parents and not by physicians in 83% of cases and was mainly carried out with prescription-only products (71%, n = 67). Nevertheless, 29% used unregulated, artisanal products. Of all parents with previous experience, n = 77 (73%) reported that they expected CBD to be more efficient than the common antiseizure drugs (ASDs) at the beginning. Forty-five percent reported that their expectations were not met during therapy. Consistently, lack of seizure reduction was the most common reason to discontinue CBD (12/26). Of those responders without CBD experience, 93% would consider CBD for their child. However, the self-reported level of information was considered to be poor or very poor regarding efficacy (76%, n = 177), tolerance (83%, n = 191), interaction with other medication (91%, n = 211), and potential long-term effects (87%, n = 212). CONCLUSIONS There is a huge interest in CBD but includes potentially unrealistic expectations of its efficacy and tolerance combined with a low level of information. Neuropediatricians should address parents of children with epilepsy regarding potential motivation and expectations of CBD. In addition, parental education, especially on interactions and potential side effects, is strongly recommended.
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Affiliation(s)
- Kerstin Alexandra Klotz
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany; Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany.
| | - Jan Schönberger
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany; Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany.
| | - Lea Nakamura
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany.
| | - Victoria San Antonio-Arce
- Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany.
| | - Thomas Bast
- Epilepsy Center Kork, Kehl-Kork, Landstraße 1, 77694 Kork, Germany; Faculty of Medicine, University of Freiburg, Germany.
| | | | - Susanne Schubert-Bast
- Department of Child Neurology, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; Epilepsy Center Frankfurt Rhine Main, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.
| | - Ingo Borggraefe
- Epilepsy Center, Ludwig-Maximilians-University, Lindwurmstr, 4, 80337 München, Germany.
| | - Steffen Syrbe
- Division of Paediatric Epileptology, Department of General Paediatrics, Center for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.
| | - Julia Jacobs
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Canada
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Raucci U, Pietrafusa N, Paolino MC, Di Nardo G, Villa MP, Pavone P, Terrin G, Specchio N, Striano P, Parisi P. Cannabidiol Treatment for Refractory Epilepsies in Pediatrics. Front Pharmacol 2020; 11:586110. [PMID: 33117180 PMCID: PMC7550750 DOI: 10.3389/fphar.2020.586110] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/09/2020] [Indexed: 12/31/2022] Open
Abstract
Cannabis extracts in oil are becoming increasingly available, and, during the last years, there has been growing public and scientific interest about therapeutic properties of these compounds for the treatment of several neurologic diseases, not just epilepsy. The discovered role of the endocannabinoid system in epileptogenesis has provided the basis to investigate the pharmacological use of exogenously produced cannabinoids, to treat epilepsy. Although, physicians show reluctance to recommend Cannabis extracts given the lack of high-quality safety available data, from literature data cannabidiol (CBD) results to be a promising and safe anticonvulsant drug with low side-effect. In particular, according to early studies, CBD can reduce the frequency of seizures and lead to improvements in quality of life in children affected by refractory epilepsy. So, for these reasons, the detailed study of the interactions between CBD and anticonvulsant drugs (AEDs) administered simultaneously in polytherapy, is arousing increasing interest, to clarify and to assess the incidence of adverse effects and the relation between dose escalation and quality of life measures. To date, in pediatric age, CBD efficacy and safety is not supported by well-designed trials and strong scientific evidence are not available. These studies are either retrospective or small-scale observational and only during the last years Class I evidence data for a pure form of CBD have been available, as demonstrated in placebo-controlled RCTs for patients affected by Lennox-Gastaut syndrome and Dravet syndrome. It is necessary to investigate CBD safety, pharmacokinetics and interaction with other AEDs alongside performing double-blinded placebo-controlled trials to obtain conclusive data on its efficacy and safety in the most frequent epilepsies in children, not just in the epileptic encephalopathy. This review was aimed to revise the available data to describe the scientific evidence for CBD in Pediatric Epilepsies.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Nicola Pietrafusa
- Rare and Complex Epilepsy Unit, Department of Neuroscience and Neurorehabilitation, Member of European Reference Network EpiCare, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Maria Chiara Paolino
- Child Neurology, Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Giovanni Di Nardo
- Child Neurology, Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Maria Pia Villa
- Child Neurology, Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Paediatrics & Child Neuropsychiatry, Catania University, Catania, Italy
| | - Gianluca Terrin
- Department of Gynecological Obstetric and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience and Neurorehabilitation, Member of European Reference Network EpiCare, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 'G. Gaslini' Institute, Genova, Italy
| | - Pasquale Parisi
- Child Neurology, Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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Fernández-Ruiz J, Galve-Roperh I, Sagredo O, Guzmán M. Possible therapeutic applications of cannabis in the neuropsychopharmacology field. Eur Neuropsychopharmacol 2020; 36:217-234. [PMID: 32057592 DOI: 10.1016/j.euroneuro.2020.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/08/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
Abstract
Cannabis use induces a plethora of actions on the CNS via its active chemical ingredients, the so-called phytocannabinoids. These compounds have been frequently associated with the intoxicating properties of cannabis preparations. However, not all phytocannabinoids are psychotropic, and, irrespective of whether they are psychotropic or not, they have also shown numerous therapeutic properties. These properties are mostly associated with their ability to modulate the activity of an intercellular communication system, the so-called endocannabinoid system, which is highly active in the CNS and has been found altered in many neurological disorders. Specifically, this includes the neuropsychopharmacology field, with diseases such as schizophrenia and related psychoses, anxiety-related disorders, mood disorders, addiction, sleep disorders, post-traumatic stress disorder, anorexia nervosa and other feeding-related disorders, dementia, epileptic syndromes, as well as autism, fragile X syndrome and other neurodevelopment-related disorders. Here, we gather, from a pharmacological and biochemical standpoint, the recent advances in the study of the therapeutic relevance of the endocannabinoid system in the CNS, with especial emphasis on the neuropsychopharmacology field. We also illustrate the efforts that are currently being made to investigate at the clinical level the potential therapeutic benefits derived from elevating or inhibiting endocannabinoid signaling in animal models of neuropsychiatric disorders.
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Affiliation(s)
- Javier Fernández-Ruiz
- Instituto Universitario de Investigación en Neuroquímica, Departamento de Bioquímica y Biología Molecular, Universidad Complutense, Ciudad Universitaria s/n, 28040 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
| | - Ismael Galve-Roperh
- Instituto Universitario de Investigación en Neuroquímica, Departamento de Bioquímica y Biología Molecular, Universidad Complutense, Ciudad Universitaria s/n, 28040 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Onintza Sagredo
- Instituto Universitario de Investigación en Neuroquímica, Departamento de Bioquímica y Biología Molecular, Universidad Complutense, Ciudad Universitaria s/n, 28040 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Manuel Guzmán
- Instituto Universitario de Investigación en Neuroquímica, Departamento de Bioquímica y Biología Molecular, Universidad Complutense, Ciudad Universitaria s/n, 28040 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
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Fiani B, Sarhadi KJ, Soula M, Zafar A, Quadri SA. Current application of cannabidiol (CBD) in the management and treatment of neurological disorders. Neurol Sci 2020; 41:3085-3098. [PMID: 32556748 DOI: 10.1007/s10072-020-04514-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
Cannabidiol (CBD), which is nonintoxicating pharmacologically relevant constituents of Cannabis, demonstrates several beneficial effects. It has been found to have antioxidative, anti-inflammatory, and neuroprotective effects. As the medicinal use of CBD is gaining popularity for treatment of various disorders, the recent flare-up of largely unproven and unregulated cannabis-based preparations on medical therapeutics may have its greatest impact in the field of neurology. Currently, as lot of clinical trials are underway, CBD demonstrates remarkable potential to become a supplemental therapy in various neurological conditions. It has shown promise in the treatment of neurological disorders such as anxiety, chronic pain, trigeminal neuralgia, epilepsy, and essential tremors as well as psychiatric disorders. While recent FDA-approved prescription drugs have demonstrated safety, efficacy, and consistency enough for regulatory approval in spasticity in multiple sclerosis (MS) and in Dravet and Lennox-Gastaut Syndromes (LGS), many therapeutic challenges still remain. In the current review, the authors have shed light on the application of CBD in the management and treatment of various neurological disorders.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | | | - Marisol Soula
- New York University School of Medicine, New York, NY, USA
| | - Atif Zafar
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Syed A Quadri
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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Inglet S, Winter B, Yost SE, Entringer S, Lian A, Biksacky M, Pitt RD, Mortensen W. Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature. Ann Pharmacother 2020; 54:1109-1143. [DOI: 10.1177/1060028020930189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To compile and synthesize the available literature describing medical cannabis use across various disease states. Data Sources: PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords. Study Selection and Data Extraction: Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019. Data Synthesis: Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care. Relevance to Patient Care and Clinical Practice: Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria. Conclusions: As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.
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Affiliation(s)
| | | | | | | | - Anh Lian
- Intermountain Healthcare, Taylorsville, UT, USA
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Velíšek L, Velíšková J. Modeling epileptic spasms during infancy: Are we heading for the treatment yet? Pharmacol Ther 2020; 212:107578. [PMID: 32417271 DOI: 10.1016/j.pharmthera.2020.107578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/07/2020] [Indexed: 12/22/2022]
Abstract
Infantile spasms (IS or epileptic spasms during infancy) were first described by Dr. William James West (aka West syndrome) in his own son in 1841. While rare by definition (occurring in 1 per 3200-3400 live births), IS represent a major social and treatment burden. The etiology of IS varies - there are many (>200) different known pathologies resulting in IS and still in about one third of cases there is no obvious reason. With the advancement of genetic analysis, role of certain genes (such as ARX or CDKL5 and others) in IS appears to be important. Current treatment strategies with incomplete efficacy and serious potential adverse effects include adrenocorticotropin (ACTH), corticosteroids (prednisone, prednisolone) and vigabatrin, more recently also a combination of hormones and vigabatrin. Second line treatments include pyridoxine (vitamin B6) and ketogenic diet. Additional treatment approaches use rapamycin, cannabidiol, valproic acid and other anti-seizure medications. Efficacy of these second line medications is variable but usually inferior to hormonal treatments and vigabatrin. Thus, new and effective models of this devastating condition are required for the search of additional treatment options as well as for better understanding the mechanisms of IS. Currently, eight models of IS are reviewed along with the ideas and mechanisms behind these models, drugs tested using the models and their efficacy and usefulness. Etiological variety of IS is somewhat reflected in the variety of the models. However, it seems that for finding precise personalized approaches, this variety is necessary as there is no "one-size-fits-all" approach possible for both IS in particular and epilepsy in general.
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Affiliation(s)
- Libor Velíšek
- Departments of Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA; Departments of Pediatrics, New York Medical College, Valhalla, NY, USA; Departments of Neurology, New York Medical College, Valhalla, NY, USA.
| | - Jana Velíšková
- Departments of Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA; Departments of Neurology, New York Medical College, Valhalla, NY, USA; Departments of Obstetrics & Gynecology, New York Medical College, Valhalla, NY, USA
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Pawliuk C, Chau B, Rassekh SR, McKellar T, Siden HH. Efficacy and safety of paediatric medicinal cannabis use: A scoping review. Paediatr Child Health 2020; 26:228-233. [PMID: 34131459 DOI: 10.1093/pch/pxaa031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 01/14/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The use of medicinal cannabis in the paediatric age group is increasing despite the lack of evidence for its efficacy or safety. Objective To map the available evidence on the efficacy and safety of medicinal cannabis in children and adolescents. Methods We conducted a scoping review and searched six electronic databases and grey literature. A study was eligible for inclusion when it investigated the efficacy or safety of medicinal cannabis for any condition, more than half of the participants were 0 to 18 years old, and had any study design except single case reports. Results We included 36 studies in our final analysis, 32 of which investigated the efficacy or safety of cannabis in treatment-resistant epilepsy. The remaining 4 studies examined patients with cancer, dysautonomia, Epidermolysis Bullosa, and motor disorders. Conclusions There is a lack of evidence on the efficacy and safety of medicinal cannabis in most paediatric conditions.
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Affiliation(s)
- Colleen Pawliuk
- Department of Paediatrics, BC Children's Hospital Research Institute, Vancouver, British Columbia
| | - Briana Chau
- Department of Paediatrics, BC Children's Hospital Research Institute, Vancouver, British Columbia
| | - S Rod Rassekh
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Terri McKellar
- Physiotherapy Association of British Columbia, Vancouver, British Columbia
| | - Harold Hal Siden
- Department of Paediatrics, BC Children's Hospital Research Institute, Vancouver, British Columbia.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
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Espinosa-Jovel C. Cannabinoids in epilepsy: Clinical efficacy and pharmacological considerations. Neurologia 2020; 38:S0213-4853(20)30040-2. [PMID: 32317123 DOI: 10.1016/j.nrl.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/16/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Advances in the development of drugs with novel mechanisms of action have not been sufficient to significantly reduce the percentage of patients presenting drug-resistant epilepsy. This lack of satisfactory clinical results has led to the search for more effective treatment alternatives with new mechanisms of action. DEVELOPMENT The aim of this study is to examine epidemiological aspects of the use of cannabis-based products for the treatment of epilepsy, with particular emphasis on the main mechanisms of action, indications for use, clinical efficacy, and safety. We conducted a narrative review of articles gathered from the PubMed, EMBASE, and Google Scholar databases and from the reference sections of relevant publications. CONCLUSIONS In recent years there has been growing interest in the use of cannabis-based products for the treatment of a wide range of diseases, including epilepsy. The cannabis plant is currently known to contain more than 100 terpenophenolic compounds, known as cannabinoids. The 2 most abundant are delta-9-tetrahydrocannabinol and cannabidiol. Studies of preclinical models of epilepsy have shown that these cannabinoids have anticonvulsant properties, and 100% purified cannabidiol and cannabidiol-enriched cannabis extracts are now being used to treat epilepsy in humans. Several open-label studies and randomised controlled clinical trials have demonstrated the efficacy and safety of these products.
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Affiliation(s)
- C Espinosa-Jovel
- Programa de Epilepsia, Servicio de Neurología, Hospital Occidente de Kennedy, Bogotá, Colombia; Posgrado de Neurología, Universidad de La Sabana, Chía, Colombia.
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Vaillancourt R, Moreno M, Pouliot A, Sell E. Cannabis Use for Therapeutic Purposes by Children and Youth at a Tertiary Teaching Hospital in Canada: A Retrospective Chart Review. Can J Hosp Pharm 2020; 73:105-115. [PMID: 32362667 PMCID: PMC7182376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The study of the use of cannabis for therapeutic purposes in the pediatric population is increasing, yet data on efficacy and safety are limited. Characterization of pediatric cannabis use for therapeutic purposes will improve understanding of the circumstances under which it occurs and the associated outcomes. OBJECTIVE To describe the use of cannabis for therapeutic purposes, regardless of authorization, in a pediatric tertiary teaching hospital. METHODS A retrospective chart review was completed for patients 18 years of age or younger who used cannabis for therapeutic purposes, regardless of authorization, between May 1, 2014, and May 1, 2017. Patients whose cannabis use was documented as recreational were excluded. RESULTS In total, 300 patients were identified, of whom 37 met the inclusion criteria. Of these, 30 patients had documentation of medically supervised cannabis use. Most were using cannabis for seizures (n = 28), and many of these (n = 23) were patients with seizures described as intractable or refractory. Of the 27 patients who were experiencing seizures at initiation of medical cannabis, 21 had documentation of a decrease in seizure frequency. This decrease was transient for 16 patients, with a mean duration of 130.4 days (standard deviation 99.1 days). Seven patients self-medicated with cannabis. They obtained cannabis without authorization and used it for chronic pain (n = 5) and/or anxiety (n = 5). CONCLUSIONS Medically supervised cannabis use occurred most often in patients with intractable or refractory seizures. According to these data, seizure response is variable, and initial decreases may be transient for pediatric patients using cannabis. To ensure greater consistency and rigour in the conduct of prospective research and thus to generate better-quality research on the therapeutic effects of medical cannabis, development of a standardized care record is needed.
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Affiliation(s)
- Régis Vaillancourt
- , OMM, CD, BPharm, PharmD, FCSHP, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, PharmD, is with the Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, PhD, was, at the time this study was conducted, with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, MD, is with the Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Maria Moreno
- , OMM, CD, BPharm, PharmD, FCSHP, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, PharmD, is with the Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, PhD, was, at the time this study was conducted, with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, MD, is with the Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Annie Pouliot
- , OMM, CD, BPharm, PharmD, FCSHP, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, PharmD, is with the Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, PhD, was, at the time this study was conducted, with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, MD, is with the Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Erick Sell
- , OMM, CD, BPharm, PharmD, FCSHP, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, PharmD, is with the Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, PhD, was, at the time this study was conducted, with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, MD, is with the Faculty of Medicine, University of Ottawa, Ottawa, Ontario
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Abstract
Introduction: Cannabidiol (CBD) as Epidiolex® (GW Pharmaceuticals) was recently approved by the U.S. Food and Drug Administration (FDA) to treat rare forms of epilepsy in patients 2 years of age and older. Together with the increased societal acceptance of recreational cannabis and CBD oil for putative medical use in many states, the exposure to CBD is increasing, even though all of its biological effects are not understood. Once such example is the ability of CBD to be anti-inflammatory and immune suppressive, so the purpose of this review is to summarize effects and mechanisms of CBD in the immune system. It includes a consideration of reports identifying receptors through which CBD acts, since the “CBD receptor,” if a single one exists, has not been definitively identified for the myriad immune system effects. The review then provides a summary of in vivo and in vitro effects in the immune system, in autoimmune models, with a focus on experimental autoimmune encephalomyelitis, and ends with identification of knowledge gaps. Conclusion: Overall, the data overwhelmingly support the notion that CBD is immune suppressive and that the mechanisms involve direct suppression of activation of various immune cell types, induction of apoptosis, and promotion of regulatory cells, which, in turn, control other immune cell targets.
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Affiliation(s)
- James M Nichols
- Department of Basic Sciences, Center for Environmental Health Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Barbara L F Kaplan
- Department of Basic Sciences, Center for Environmental Health Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
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Abstract
PURPOSE OF REVIEW Since the federal ban on hemp products was lifted in December 2018, cannabidiol (CBD), a nonpsychoactive cannabinoid derived from hemp, has become increasingly popular and accessible. CBD is sold in the form of oils, tablets, and foods in locations including gas stations, cafés, and drug stores. Despite a lack of reliable evidence, many parents praise its purported therapeutic effects on a variety of childhood ailments. RECENT FINDINGS Epidiolex was the first CBD-based medication to be approved by the US Food and Drug Administration in 2018 for the treatment of two rare and severe forms of epilepsy, known as Lennox-Gastaut and Dravet syndrome, in patients of at least 2 years of age. Its efficacy was assessed through three randomized, double blind, and placebo-controlled trials in a sample of 516 patients with either Lennox-Gastaut syndrome or Dravet syndrome. Despite this development, there are few or no large-scale, rigorous studies concerning the effects of CBD on any other pediatric conditions that parents have tried to alleviate with CBD. The purpose of this review is to explore recent literature regarding the efficacy and safety of CBD in treating various health conditions in children; the risks of consuming CBD products, and the role of pediatricians in helping parents navigate often-confusing information about CBD. SUMMARY Although CBD use has dramatically increased in recent years, both its potential to treat conditions and its risks have not yet been subjected to rigorous study. Pediatricians should be aware of the risks posed by poor-quality standards and labeling practices for cannabinoid products. Due to the confusing nature of the numerous sources of information about CBD, pediatricians are in a position to provide and clarify information about CBD to parents and understand the risks it poses to children.
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Abstract
In recent years, cannabis has been gaining increasing interest in both the medical research and clinical fields, with regard to its therapeutic effects in various disorders. One of the major fields of interest is its role as an anticonvulsant for refractory epilepsy, especially in the pediatric population. This paper presents and discusses the current accumulated knowledge regarding artisanal cannabis and Epidiolex®, a United States Food and Drug Administration (FDA)-approved pure cannabidiol (CBD), in epilepsy management in pediatrics, by reviewing the literature and raising debate regarding further research directions.
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Affiliation(s)
- Bruria Ben-Zeev
- Pediatric Neurology Department, The Edmond and Lilly Safra Pediatric Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- E-mail:
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Synthetic pharmaceutical grade cannabidiol for treatment of refractory infantile spasms: A multicenter phase-2 study. Epilepsy Behav 2020; 102:106826. [PMID: 31816477 DOI: 10.1016/j.yebeh.2019.106826] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/04/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Limited data suggest that cannabidiol (CBD) may be effective for treatment of refractory infantile spasms (IS). This study was designed to more rigorously evaluate the efficacy and safety of synthetic CBD in the treatment of IS. METHODS Children six to 36 months of age with IS that failed treatment with both adrenocorticotropic hormone (ACTH) and vigabatrin (VGB) were eligible for enrollment. Children receiving clobazam were excluded. After baseline overnight video-electroencephalography (vEEG) to confirm diagnosis and ascertain hypsarrhythmia, patients were treated with synthetic CBD oral solution (20 mg/kg/day). Overnight video-EEG was repeated after 14 days, and both baseline and repeat video-EEGs were completely de-identified and reviewed in a pairwise fashion by an independent, blinded pediatric electroencephalographer. The primary efficacy endpoint was freedom from spasms and hypsarrhythmia on day 14. RESULTS Nine patients were enrolled, comprising an older (median age = 23 months) cohort with long-standing IS (median duration = 13 months) and numerous prior treatment failures (median = 6). One patient responded to therapy and eight patients exhibited neither clinical nor electrographic response. CONCLUSIONS The immediate but temporary response in a single patient suggests that CBD oral solution is not particularly effective in highly refractory cases, but may, nevertheless, be effective in younger patients with shorter durations of IS. Further study, examining both short- and long-term outcomes, is warranted to further evaluate the efficacy and safety of CBD oral solution in the treatment of IS.
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Cannabis-based products for pediatric epilepsy: An updated systematic review. Seizure 2019; 75:18-22. [PMID: 31865133 DOI: 10.1016/j.seizure.2019.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To provide an up-to-date summary of the benefits and harms of cannabis-based products for epilepsy in children. METHODS We updated our earlier systematic review, by searching for studies published up to May 2019. We included randomized controlled trials (RCTs) and non-randomized studies (NRS) involving cannabis-based products administered to children with epilepsy. Outcomes were seizure freedom, seizure frequency, quality of life, sleep, status epilepticus, death, gastrointestinal adverse events, and emergency room visits. RESULTS Thirty-five studies, including four RCTs, have assessed the benefits and harms of cannabis-based products in pediatric epilepsy (12 since April 2018). All involved cannabis-based products as adjunctive treatment, and most involved cannabidiol. In the RCTs, there was no statistically significant difference between cannabidiol and placebo for seizure freedom (relative risk 6.77, 95 % confidence interval [CI] 0.36-128.38), quality of life (mean difference [MD] 0.6, 95 %CI -2.6 to 3.9), or sleep disruption (MD -0.3, 95 %CI -0.8 to 0.2). Data from both RCTs and NRS suggest that cannabidiol reduces seizure frequency and increases treatment response; however, there is an increased risk of gastrointestinal adverse events. CONCLUSION Newly available evidence supports earlier findings that cannabidiol probably reduces the frequency of seizures among children with drug-resistant epilepsy. PROSPERO CRD42018084755.
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