Making a joint decision: Cannabis as a potential substitute for opioids in obstetrics and gynecology

There is a growing body of evidence that cannabis may be effective as an analgesic with potential to reduce opioid usage in chronic pain. This review synthesizes the available literature to elucidate the possible role that cannabis might play in reducing opioid use in gynecological disorders that may potentially lead to a recommendation of substituting opioids with cannabis. With reports of a decrease in opioid use after cannabis initiation, an opioid-sparing effect has been seen in gynecologic malignancies such as ovarian, uterine, endometrial, and cervical cancers, in addition to chronic pelvic pain (CPP). Though many studies have found an association between cannabis and various adverse maternal and neonatal outcomes, there is a lack of randomized controlled trials making it difficult to claim a directly causal relationship between cannabis and these adverse outcomes. Additionally, with increased use of cannabis during pregnancy, the evidence of possible benefits and risks to mothers and fetuses is examined.     

The ameliorating effect of cannabinoid type 2 receptor activation on brain,lung, liver and heart damage in cecal ligation and puncture-induced sepsis model in rats

Uncontrolled infection and increased inflammatory mediators might cause systemic inflammatory response. It is already known that Cannabinoid Type 2 (CB2) receptors, which are commonly expressed in immune cells and in many other tissues, have an effect on the regulation of immune response. In the present study of ours, the effects of CB2 receptor agonist JWH-133 was investigated on cecal ligation and puncture (CLP)-induced polymicrobial sepsis model in rats. In the present study, Sprague-Dawley rats were divided into 5 groups (i.e. the Sham, CLP, JWH-133 0.2 mg/kg, JWH-133 1 mg/kg, and JWH-133 5 mg/kg Groups). Except for the Sham Group, the CLP-induced sepsis model was applied to all groups. The histopathological damage in brain, lung, liver and, heart was examined and the caspase-3, p-NF-κB, TNF-α, IL-1β and IL-6 levels were determined immunohistochemically. The serum TNF-α, IL-1β, IL-6, IL-10 levels were examined with the ELISA Method. The JWH-133 treatment decreased the histopathological damage in brain, heart, lung, and liver and reduced the caspase-3, p-NF-κB, TNF-α, IL-1β, IL-6 levels in these tissues. In addition to this, JWH-133 treatment also decreased the serum TNF-α, IL-1β, IL-6 levels, which were increased due to CLP, and increased the anti-inflammatory cytokine IL-10 levels. In the present study, it was determined that the CB2 receptor agonist JWH-133 decreases the CLP-induced inflammation, and reduces the damage in brain, lung, liver and heart. Our findings show the therapeutic potential of the activation of CB2 receptors with JWH-133 in sepsis.     

Intracerebral microinjections of Δ-tetrahydrocannabinol: search for the impairment of spatial memory in the eight-arm radial maze in rats

The purpose of this study was to identify brain sites that contribute to the delta(9)-tetrahydrocannabinol (delta(9)-THC)-induced impairment of spatial memory in rats. Rats were tested in the eight-arm radial maze after microinjections of delta(9)-THC into one of 14 different brain regions. The bilateral microinjection of delta(9)-THC (20 microg/side) impaired spatial memory when injected into the dorsal hippocampus (DH), ventral hippocampus (VH) or dorsomedial thalamus nucleus (DMT). However, rats treated with delta(9)-THC into DMT produced preseverative behavior which has not been observed by systemic administration of delta(9)-THC. On the other hand, spatial memory was unaffected by microinjections of delta(9)-THC into the other 11 areas examined: frontal (FC) and frontoparietal (FPC) cortex, central (ACE) and basolateral (ABL) amygdaloid nucleus, medial caudate putamen (CPM), lateral hypothalamus (LH), mammillary body (MB), basal forebrain (BF), medial septal nucleus (SEP) and dorsal (DR) and median (MR) raphe nucleus. These results suggest that DH and VH may be important brain sites for the delta(9)-THC-induced impairment of spatial memory.     

The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS)

Objective: To test whether cannabinoids reduce urge incontinence episodes without affecting voiding in patients with multiple sclerosis. This was part of the multicentre trial of the Cannabinoids in Multiple Sclerosis (CAMS) study. Subjects and methods: The CAMS study randomised 630 patients to receive oral administration of cannabis extract, Δ⁹-tetrahydrocannabinol (THC) or matched placebo. For this substudy subjects completed incontinence diaries. Results: All three groups showed a significant reduction, p<0.01, in adjusted episode rate (i.e. correcting for baseline imbalance) from baseline to the end of treatment: cannabis extract, 38%; THC, 33%; and placebo, 18%. Both active treatments showed significant effects over placebo (cannabis extract, p=0.005; THC, p=0.039). Conclusion: The findings are suggestive of a clinical effect of cannabis on incontinence episodes in patients with MS. This is in contrast to the negative finding of the CAMS study, where no difference was seen in the primary outcome of spasticity.     

Down-regulation of cannabinoid receptor agonist-stimulated [S]GTPγS binding in synaptic plasma membrane from chronic ethanol exposed mouse

In our previous study, we demonstrated that chronic ethanol (EtOH) exposure down-regulated the cannabinoid receptors (CB1) in mouse brain synaptic plasma membrane (SPM) (Basavarajappa et al., Brain Res. 793 (1998) 212–218). In the present study, we investigated the effect of chronic EtOH (4-day inhalation) on the CB1 agonist stimulated guanosine-5′-O-(3-[³⁵S]thio)-triphosphate ([³⁵S]GTPγS) binding in SPM from mouse. Our results indicate that the net CP55,940 stimulated [³⁵S]GTPγS binding was increased with increasing concentrations of CP55,940 and GDP. This net CP55,940 (1.5 μM) stimulated [³⁵S]GTPγS binding was reduced significantly (−25%) in SPM from chronic EtOH group (175±5.25%, control; 150±8.14%, EtOH; P<0.05). This effect occurs without any significant changes on basal [³⁵S]GTPγS binding (152.1±10.7 for control, 147.4±5.0 fmol/mg protein for chronic EtOH group, P>0.05). Non-linear regression analysis of net CP55,940 stimulated [³⁵S]GTPγS binding in SPM showed that the B_max of cannabinoid stimulated binding was significantly reduced in chronic EtOH exposed mouse (B_max=7.58±0.22 for control; 6.42±0.20 pmol/mg protein for EtOH group; P<0.05) without any significant changes in the G-protein affinity (K_d=2.68±0.24 for control; 3.42±0.31 nM for EtOH group; P>0.05). The pharmacological specificity of CP55,940 stimulated [³⁵S]GTPγS binding in SPM was examined with CB1 receptor antagonist, SR141716A and these studies indicated that CP55,940 stimulated [³⁵S]GTPγS binding was blocked by SR141716A with a decrease (P<0.05) in the IC₅₀ values in the SPM from chronic EtOH group. These results suggest that the observed down-regulation of CB1 receptors by chronic EtOH has a profound effect on desensitization of cannabinoid-activated signal transduction and possible involvement of CB1 receptors in EtOH tolerance and dependence.     

CB1 and TRPV1 receptors mediate protective effects on colonic electrophysiological properties in mice

CB1 and TRPV1 receptors modulate enteric neurotransmission and colonic inflammation. This study investigates early electrophysiological changes in distal colon of wild-type and receptor deficient mice after an inflammatory insult set by dinitrobenzene sulfonic acid (DNBS). Colitis was induced by DNBS in CB1^−/− mice, TRPV1^−/− mice, and their respective wild-type littermates. Electrophysiological properties consisting of membrane potentials and electrically induced inhibitory junction potentials (IJP) of circular smooth muscle cells were evaluated at different time points. Additionally a histological colitis severity score was evaluated in CB1^+/+ and CB1^−/− mice 24 h after DNBS. Inflammation caused spontaneous atropine insensitive rhythmic action potentials in CB1^−/− and TRPV1^−/− mice but not in wild-type animals. This indicates that membrane stability is disturbed, which in turn indicates a lack of protective mechanisms. Focal electrical neuronal stimulation of the myenteric plexus induced IJP in the smooth muscle cells. Twenty-four hours after initiation of inflammation, the duration of the IJP is prolonged in all animals, indicating disturbances within neuromuscular interaction. In CB1^−/− mice, it is interesting that the duration of IJP was significantly extended, as compared to CB1^+/+ mice pointing toward missing protective mechanisms in the CB1^−/− mice. Inflammatory insults in the mouse colon induce reproducible changes in the electrophysiological properties and such changes correlate with duration of colitis. In mutants, these electrophysiological changes display different patterns, suggesting the lack of protective properties for neuromuscular interactions and membrane stability.     

Changed accumbal responsiveness to alcohol in rats pre-treated with nicotine or the cannabinoid receptor agonist WIN 55,212-2

Alcohol, nicotine, and cannabinoid acutely increase the activity of the mesolimbic dopamine (DA) pathway. Although polysubstance consumption is a common pattern of abuse in humans, little is known about dopamine release following pre-exposure to these drugs. The purpose of this study was to test whether alcohol-induced dopamine release into the nucleus accumbens (NAc) shell is modified by different pre-treatments: water (i.g.), alcohol (1 g/kg, i.g.), nicotine (0.4 mg/kg, s.c.), and WIN 55,212-2 (1 mg/kg, s.c.). Male Wistar rats were treated (i.g.) for 14 days with either water or alcohol. In the following 5 days rats were injected (s.c.) with vehicle, nicotine, or WIN 55,212-2. Finally, a cannula was surgically implanted into the NAc shell and alcohol-induced extracellular dopamine release was monitored in freely moving rats. Alcohol (1 g/kg; i.g.) only increased the release of dopamine when animals were previously treated with water. This DA increase was markedly inhibited by (subchronic) treatment (5 days) with nicotine or WIN 55-212-2 as well as by previous (chronic) exposure to alcohol (14 days). These data demonstrate that pre-treatment with nicotine and the cannabinoid agonist WIN 55,212-2 is able to change the sensitivity of the NAc shell in response to a moderate dose of alcohol. Therefore, cannabinoid and nicotine exposure may have important implications on the rewarding effects of alcohol, because these drugs lead to long-lasting changes in accumbal dopamine transmission.     

Cannabinoid CB(1) receptor expression and affinity in the rat hippocampus following bilateral vestibular deafferentation

Numerous studies have shown that bilateral vestibular deafferentation (BVD) results in spatial memory deficits and hippocampal dysfunction in rats and humans. Since cannabinoid CB(1) receptors are well known to regulate synaptic plasticity in the hippocampus, we investigated whether BVD resulted in changes in CB(1) receptor expression and affinity in the rat hippocampus at 1, 3 and 7 days post-surgery, using a combination of Western blotting and radioligand binding. Using Western blotting, we found that CB(1) receptor expression was significantly lower in BVD animals compared to sham controls only in the CA3 area across the 3 time points (P=0.03). CB(1) receptor expression decreased significantly over time for both the BVD and sham animals (P=0.000). The radioligand binding assays showed no significant change in the IC(50) of the CB(1) receptor for the cannabinoid CB(1)/CB(2) receptor agonist, WIN55,212-2. These results suggest that the CB(1) receptor down-regulates in the CA3 region of the hippocampus following BVD, but with no changes in the affinity of the CB(1) receptor for WIN55,212-2.     

Cardiovascular actions of cannabinoids and their generation during shock

Marijuana is a widely abused recreational drug well known for its psychoactive properties. Cannabinoids, the active ingredients of marijuana, elicit their neurobehavioral effects by interacting with the CB₁ cannabinoid receptor subtype, expressed primarily in the brain but also present in some peripheral tissues. A second receptor subtype, the CB₂ receptor, is expressed on cells of the immune system and is thought to be responsible for the immunosuppressant effects of cannabinoids. Recently, endogenous lipidlike substances have been identified, including arachidonyl ethanolamide (anandamide) and 2-arachidonyl glyceride, that bind to cannabinoid receptors and mimic many of the neurobehavioral effects of plant-derived cannabinoids. Both plant-derived cannabinoids and the endogenous ligands have been shown to elicit hypotension and bradycardia via activation of peripherally located CB₁ receptors. Possible underlying mechanisms include presynaptic CB₁ receptor mediated inhibition of norepinephrine release from peripheral sympathetic nerve terminals, and/or direct vasodilation via activation of vascular cannabinoid receptors. The latter may also be the target of endocannabinoids of vascular endothelial origin. Recent studies indicate that a peripheral endogenous cannabinoid system in circulating macrophages and platelets is activated in hemorrhagic and septic shock and may contribute to the hypotension associated with these conditions via activation of vascular cannabinoid receptors. The potential role of this mechanism in human shock conditions is under investigation. Received: 20 May 1998 / Accepted: 24 August 1998     

基于PPARs信号通路探索CB1对脂质代谢的调节作用

目的 研究CB1对PPARs信号通路在高脂饮食诱导肥胖小鼠脂质代谢的调节作用.方法 构建小鼠肥胖模型,观察给予CB1抑制剂利莫那班后小鼠体重、肝脏重量及血清生化指标的变化,并检测CB1、PPARα、PPAR β和PPARγ基因在各组织mRNA水平的表达情况.结果 利莫那班降低了小鼠的体重和肝脏重量(P＜ 0.05);改善了血清生化指标(P＜0.05);各组织中CB1基因mRNA水平的表达降低(P＜ 0.05);PPARα、PPARγ基因在皮下脂肪、内脏脂肪、肝脏组织mRNA水平的表达显著增高(P＜ 0.05);PPAR 3基因在各组织mRNA水平表达情况差异无统计学意义.结论 CB1通过作用于PPARα、PPARγ调节脂质代谢,为临床上脂质代谢紊乱的治疗提供了另一个可靠的理论依据.