Effect of Cannabis sativa L. extracts, phytocannabinoids and their acetylated derivates on the SHSY-5Y neuroblastoma cells' viability and caspases 3/7 activation.

BACKGROUND: There is a need for novel treatments for neuroblastoma, despite the emergence of new biological and immune treatments, since refractory pediatric neuroblastoma is still a medical challenge. Phyto cannabinoids and their hemisynthetic derivatives have shown evidence supporting their anticancer potential. The aim of this research was to examine Phytocannabinoids or hemisynthetic cannabinoids, which reduce the SHSY-5Y, neuroblastoma cell line's viability. METHODS: Hexane and acetyl acetate extracts were produced starting with Cannabis sativa L. as raw material, then, 9-tetrahidrocannabinol, its acid counterpart and CBN were isolated. In addition, acetylated derivatives of THC and CBN were synthesized. The identification and purity of the chemicals was determined by High Performance Liquid Chromatography and 1H y 13C Magnetic Nuclear Resonance. Then, the capacity to affect the viability of SHSY-5Y, a neuroblastoma cell line, was examined using the resazurin method. Finally, to gain insight into the mechanism of action of the extracts, phytocannabinoids and acetylated derivatives on the examined cells, a caspase 3/7 determination was performed on cells exposed to these compounds. RESULTS: The structure and purity of the isolated compounds was demonstrated. The extracts, the phytocannabinoids and their acetylated counterparts inhibited the viability of the SHSY 5Y cells, being CBN the most potent of all the tested molecules with an inhibitory concentration of 50 percent of 9.5 µM. CONCLUSION: Each of the evaluated molecules exhibited the capacity to activate caspases 3/7, indicating that at least in part, the cytotoxicity of the tested phytocannabinoids and their hemi-synthetic derivatives is mediated by apoptosis.

THC improves behavioural schizophrenia-like deficits that CBD fails to overcome: a comprehensive multilevel approach using the Poly I:C maternal immune activation.

Prenatal infections and cannabis use during adolescence are well-recognized risk factors for schizophrenia. As inflammation and oxidative stress (OS) contribute to this disorder, anti-inflammatory drugs have been proposed as potential therapies. This study aimed to evaluate the association between delta-9-tetrahydrocannabinol (THC) and schizophrenia-like abnormalities in a maternal immune activation (MIA) model. Additionally, we assessed the preventive effect of cannabidiol (CBD), a non-psychotropic/anti-inflammatory cannabinoid. THC and/or CBD were administered to Saline- and MIA-offspring during periadolescence. At adulthood, THC-exposed MIA-offspring showed significant improvements in sensorimotor gating deficits. Structural and metabolic brain changes were evaluated by magnetic resonance imaging, revealing cortical shrinkage in Saline- and enlargement in MIA-offspring after THC-exposure. Additionally, MIA-offspring displayed enlarged ventricles and decreased hippocampus, which were partially reverted by both cannabinoids. CBD prevented THC-induced reduction in the corpus callosum, despite affecting white matter structure. Post-mortem studies revealed detrimental effects of THC, including increased inflammation and oxidative stress. CBD partially reverted these pro-inflammatory alterations and modulated THC's effects on the endocannabinoid system. In conclusion, contrary to expectations, THC exhibited greater behavioural and morphometric benefits, despite promoting a pro-inflammatory state that CBD partially reverted. Further research is needed to elucidate the underlying mechanisms involved in the observed benefits of THC.

Beneficio clínico del tratamiento con cannabinoides para el dolor crónico no oncológico

Introducción: los cannabinoides pueden ser una opción válida para el tratamiento del dolor crónico no oncológico de acuerdo a los estudios publicados hasta el momento y a nuestra experiencia clínica. Objetivo: valorar el beneficio clínico de preparados de cannabis medicinal (CM) para dolor crónico no oncológico en pacientes que consultaron en la Clínica de Endocannabinología del Uruguay (CEDU). Material y método: estudio descriptivo, observacional, longitudinal, de una población atendida en un centro privado de salud. Se trata de una cohorte de 438 pacientes que consultaron espontáneamente en CEDU desde septiembre de 2016 a marzo de 2020. El motivo de consulta fue dolor crónico no oncológico que no respondió al tratamiento estándar. Resultados: en la cohorte estudiada predominaron las mujeres (74%), promedio 69 años, que se asisten en el sistema privado de salud en el 95% de los casos, en su mayoría con instrucción secundaria. El tipo de dolor más frecuente fue el dolor osteoarticular. El quimiotipo de CM más usado fue cannabidiol (CBD) al 5%, con buena respuesta al tratamiento en el descenso del nivel del dolor y suspensión o disminución de uso de opioides (y derivados) y antiinflamatorios no esteroideos (AINES). Se observaron escasos y leves efectos adversos (EA) en la gran mayoría de los pacientes. Abandonaron el tratamiento 12 pacientes (menos del 3%). Conclusiones: esta investigación retrospectiva mostró una caída del nivel del dolor de 3,14 (valor p ≤ 0,0001), indicando que el CM puede ser una opción para el tratamiento del dolor crónico no oncológico. Se requieren más estudios para demostrar la efectividad y seguridad de los cannabinoides. Esto depende de muchos factores (leyes que faciliten la accesibilidad a variedad de productos de CM de grado médico, incentivos a la ciencia e investigación). De todas formas, podemos afirmar que los resultados presentados son prometedores en relación con su potencial terapéutico.

Introduction: Cannabinoids can be a valid option for the treatment of chronic non-cancer pain, according to the studies published to date and our clinical experience. Objectives: To evaluate the clinical benefit of medicinal cannabis preparations (MCPs) for chronic non-cancer pain in patients seen at the Endocannabinology Clinic of Uruguay (CEDU). Method: Descriptive, observational, longitudinal study of a population treated at a private healthcare center. This involves a cohort of 438 patients who spontaneously consulted at CEDU from September 2016 to March 2020. The reason for consultation was chronic non-cancer pain that did not respond to standard treatment. Results: in the studied cohort, women prevailed and accounted for 74% of patients. Average age was 69 years old and 95% of them sought care within the private healthcare system. Most women had completed secondary school education. The most frequent type of pain was osteoarticular pain. The most used chemovar of Medicinal Cannabis (MC) was 5% cannabidiol (CBD), showing a favorable treatment response in reducing pain levels and the discontinuation or reduction of opioid and non-steroidal anti-inflammatory drug (NSAID) usage. Few and mild adverse effects (AE) were observed in the vast majority of patients. Twelve patients (less than 3%) discontinued the treatment. Conclusions: This retrospective study demonstrated a reduction in pain level of 3.14 (p-value ≤ 0.0001) indicating that MC could be an option for the treatment of non-oncological chronic pain. Further studies are needed to demonstrate the effectiveness and safety of cannabinoids. This depends on many factors (laws facilitating accessibility to a variety of medical-grade MC products, incentives for science and research). Nevertheless, we can assert that the presented results are promising in consideration of their therapeutic potential.

Introdução: os canabinoides podem ser uma opção válida para o tratamento da dor crônica não oncológica de acordo com estudos publicados até o momento e nossa experiência clínica. Objetivos: avaliar o benefício clínico das preparações de Cannabis Medicinal (CM) para dor crônica não oncológica em pacientes que consultaram a Clínica de Endocanabinologia do Uruguai (CEDU). Método: estudo descritivo, observacional, longitudinal de uma população atendida em um centro de saúde privado. Esta é uma coorte de 438 pacientes que consultaram espontaneamente no CEDU no período setembro de 2016 - março de 2020. O motivo da consulta foi dor crônica não oncológica que não respondeu ao tratamento padrão. Resultados: na coorte estudada, 74% eram mulheres, a idade média foi 69 anos, 95% frequentam a rede privada de saúde e a maioria com ensino médio. O tipo de dor mais frequente foi a osteoarticular. O quimiotipo de MC mais utilizado foi o Canabidiol 5% (CBD), com boa resposta ao tratamento em termos de redução do nível de dor e suspensão ou redução do uso de opioides (e derivados) e anti-inflamatórios não esteroides (AINEs). A grande maioria dos pacientes apresentou poucos e leves efeitos adversos (EAs). Menos de 3% dos 12 pacientes abandonou o tratamento. Conclusões: Esta investigação retrospectiva mostrou uma queda no nível de dor de 3,14 (valor de p ≤ 0,0001), indicando que o MC pode ser uma opção para o tratamento da dor crônica não oncológica. São necessários mais estudos para demonstrar a eficácia e segurança dos canabinoides. Isso depende de muitos fatores (leis que facilitem o acesso a uma variedade de produtos CM de grau médico, incentivos para ciência e pesquisa). De qualquer forma, podemos afirmar que os resultados apresentados são promissores em relação ao seu potencial terapêutico.

Cannabinoides en epilepsia: eficacia clínica y aspectos farmacológicos / Cannabinoids in epilepsy: Clinical efficacy and pharmacological considerations

Introducción: Los avances en el desarrollo de medicamentos con mecanismos de acción novedosos no han sido suficientes para modificar de manera significativa el porcentaje de pacientes con epilepsia refractaria. Esa falta de resultados clínicos satisfactorios nos ha llevado a buscar alternativas terapéuticas más eficaces y con mecanismos de acción diferentes a los convencionales.DesarrolloEl objetivo de este artículo es profundizar en los aspectos epidemiológicos relacionados con el uso de productos a base de cannabis para el tratamiento de la epilepsia, haciendo énfasis en los principales mecanismos de acción, las indicaciones de uso, la eficacia clínica y la seguridad. Para lo anterior, se realizó una revisión narrativa mediante la búsqueda de artículos en PubMed, EMBASE, Google Scholar y a través de la revisión exhaustiva de la bibliografía relevante.ConclusionesEn los últimos años ha crecido el interés relacionado con el uso de cannabis medicinal para el tratamiento de diferentes enfermedades, incluyendo la epilepsia. En la actualidad, sabemos que las plantas de cannabis contienen más de 100 compuestos terpenofenólicos que se han denominado cannabinoides. Los 2 más abundantes son el delta-9-tetrahidrocannabinol y el cannabidiol. Diferentes modelos preclínicos de epilepsia han demostrado que estos cannabinoides tienen propiedades anticonvulsivas, por ello se ha comenzado a utilizar cannabidiol purificado al 100% y extractos de cannabis enriquecidos con cannabidiol para el tratamiento de la epilepsia en humanos. La eficacia y la seguridad de estos productos han quedado demostradas en diferentes estudios abiertos y ensayos clínicos controlados y aleatorizados. (AU)

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.DevelopmentThe 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.ConclusionsIn 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. (AU)

Cannabinoids in epilepsy: clinical efficacy and pharmacological considerations.

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.

El uso terapéutico del cannabis y los cannabinoides / The therapeutic use of cannabis and cannabinoids

Los cannabinoides se dirigen principalmente al sistema endocannabinoide (ECS), que surge como un objetivo terapéutico potencialmente interesante debido a su importante papel en la modulación de procesos biológicos clave en todo el organismo. Como tal, los cannabinoides ya se han propuesto como, por ejemplo, antieméticos, agentes antiespásticos, estimulantes del apetito, antiepilépticos, analgésicos, depresores de la presión intraocular o como agentes para controlar los trastornos del movimiento en el síndrome de Tourette. Aquí revisamos las pruebas de investigación disponibles sobre el uso del cannabis y los cannabinoides para un conjunto de aplicaciones terapéuticas sugeridas, y abordamos algunos de los riesgos a corto y largo plazo que se han correlacionado con el uso de estas sustancias. Encontramos escasas pruebas científicas que apoyen el uso de productos basados en el cannabis para la mayoría de las aplicaciones sugeridas, así como ninguna necesidad médica no satisfecha que no esté ya abordada por los medicamentos existentes (algunos basados en cannabinoides) en el mercado. En este escenario, los riesgos potenciales asociados al uso crónico de estas sustancias pueden disuadir su uso médico. (AU)

Cannabinoids mainly target the endocannabinoid system, which emerges as a potentially interesting therapeutical target due to its major role in modulating key biological processes throughout the body. As such, cannabinoids have already been proposed as, for example, anti-emetics, antispasticity agents, appetite stimulants, anti-epileptic, analgesic, depressants of intraocular pressure or as agents to control movement disorders in Tourette syndrome. Here, we reviewed the research evidence available regarding the use of cannabis and cannabinoids for a set of suggested therapeutical applications, and addressed some of the short- and long-term risks that have been correlated with the use of these substances.We found scarce scientific evidence supporting the use of cannabis-based products for most of the suggested applications, as well as no unmet medical need that is not already tackled by existing medicines (some cannabinoid-based) in the market. In such a scenario, the potential risks associated with the chronic use of these substances may deter their medical use. (AU)

The therapeutic use of cannabis and cannabinoids / El uso terapéutico del cannabis y los cannabinoides

Cannabinoids mainly target the endocannabinoid system, which emerges as a potentially interesting therapeutical target due to its major role in modulating key biological processes throughout the body. As such, cannabinoids have already been proposed as, for example, anti-emetics, antispasticity agents, appetite stimulants, anti-epileptic, analgesic, depressants of intraocular pressure or as agents to control movement disorders in Tourette syndrome. Here, we reviewed the research evidence available regarding the use of cannabis and cannabinoids for a set of suggested therapeutical applications, and addressed some of the short- and long-term risks that have been correlated with the use of these substances.We found scarce scientific evidence supporting the use of cannabis-based products for most of the suggested applications, as well as no unmet medical need that is not already tackled by existing medicines (some cannabinoid-based) in the market. In such a scenario, the potential risks associated with the chronic use of these substances may deter their medical use. (AU)

Los cannabinoides se dirigen principalmente al sistema endocannabinoide (ECS), que surge como un objetivo terapéutico potencialmente interesante debido a su importante papel en la modulación de procesos biológicos clave en todo el organismo. Como tal, los cannabinoides ya se han propuesto como, por ejemplo, antieméticos, agentes antiespásticos, estimulantes del apetito, antiepilépticos, analgésicos, depresores de la presión intraocular o como agentes para controlar los trastornos del movimiento en el síndrome de Tourette. Aquí revisamos las pruebas de investigación disponibles sobre el uso del cannabis y los cannabinoides para un conjunto de aplicaciones terapéuticas sugeridas, y abordamos algunos de los riesgos a corto y largo plazo que se han correlacionado con el uso de estas sustancias. Encontramos escasas pruebas científicas que apoyen el uso de productos basados en el cannabis para la mayoría de las aplicaciones sugeridas, así como ninguna necesidad médica no satisfecha que no esté ya abordada por los medicamentos existentes (algunos basados en cannabinoides) en el mercado. En este escenario, los riesgos potenciales asociados al uso crónico de estas sustancias pueden disuadir su uso médico. (AU)

Cannabis. Usos y aplicaciones en la práctica odontológica diaria: revisión de la literatura / Cannabis. Uses and applications in daily dental practice: a review of the literature

La evidencia científica presente en la literatura indica que el cannabis puede ser utilizado con fines terapéuticos para tratar distintas afecciones odontológicas. Dado el acceso sencillo a la cavidad bucal, las distintas formulaciones de cannabis pueden aplicarse de forma tópica. La aplicación local de dosis bajas de cannabis ha demostrado alta efectividad para tratar distintas afecciones bucales, constituyendo un tratamiento seguro con baja probabilidad de generar repercusiones sistémicas indeseadas. En la actualidad, está siendo incorporado a materiales convencionales de uso e higiene odontológica con la finalidad de aprovechar sus efectos terapéuticos. El cannabis tiene múltiples usos en odontología: como componen-te de enjuagues bucales y soluciones para la desinfección de conductos radiculares, en tratamientos de trastornos de ansiedad bucal, como complemento en terapias oncológicas, como analgésico para atenuar el dolor inflamatorio y el neuropático, como miorrelajante y condroprotector para tratar trastornos de articulación témporomandibular (ATM) y bruxismo, como osteomodulador para el tratamiento de patologías que comprometen la integridad ósea, como la enfermedad periodontal y la osteoporosis, y para la cicatrización ósea asociada a fracturas, extracciones dentarias e implantes, y como inmunomodulador con potencial terapéutico para tratar patologías autoinmunes como las enfermedades reumáticas. El trata-miento local con cannabis es efectivo, bien tolerado por el paciente y con pocos efectos adversos. Por lo tanto, se puede concluir que el cannabis aporta un enorme abanico de posibilidades terapéuticas para tratar distintas afecciones odontológicas, aunque aún se requiere mayor cantidad de estudios científicos que avalen su utilización en cada situación fisiopatológica particular (AU)

The scientific evidence present in the literature indicates that cannabis can be used for therapeutic purposes to treat different dental conditions. Given the easy access to the oral cavity, the different cannabis formulations can be applied topically. The local application of low doses of cannabis has shown high effectiveness in treating different oral conditions, constituting a safe treatment with a low probability of generating unwanted systemic repercussions. It is currently being incorporated into conventional materials for dental use and hygiene in order to take advantage of its therapeutic effects. Cannabis has multiple uses in dentistry: as a component of mouthwashes and solutions for disinfecting root canals, in the treatment of oral anxiety disorders, as a complement in oncological therapies, as an analgesic to reduce inflammatory and neuropathic pain, as a muscle relaxant and chondroprotective to treat temporomandibular joint disorders and bruxism, as an osteomodulator for the treatment of pathologies that compromise bone integrity, such as periodontal disease and osteoporosis, and or bone healing associated with fractures, dental extractions and implants, and as immunomodulator with therapeutic potential to treat autoimmune pathologies such as rheumatic diseases. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Therefore, it can be concluded that cannabis provides an enormous range of therapeutic possibilities to treat different dental conditions, although more scientific studies are still required to support its use in each particular pathophysiological situation (AU)

Efficacy of cannabinoids in fibromyalgia: a literature review / Eficacia de los cannabinoides en la fibromialgia: revisión de la literatura

Abstract Fibromyalgia is a chronic disease of unclear etiology, involving a neural oversensitization and impaired pain modulation, in addition to a clinical deficiency of the endocannabinoid system. Fibromyalgia is associated with a number of somatic and psychological disorders and hence multiple pharmacological approaches have been used, including opioids, antidepressants, antiepileptics, and more recently medical cannabis. This narrative review comprises a review of the current literature on the efficacy of cannabinoids in fibromyalgia. The studies describe a possible influence of cannabis on pain control in patients with fibromyalgia, with positive effects on quality of life and sleep. The use of cannabis seems to be beneficial in patients with fibromyalgia; however, more robust studies are still needed to establish is actual efficacy in pain management, quality of life and improvement of associated symptoms.

Resumen La fibromialgia es una enfermedad crónica, cuya etiología no es clara, en la que se involucra una sobresensibilización neural y disminución de la modulación del dolor, así como una deficiencia clínica del sistema endocannabinoide. Está asociada a una variedad de trastornos somáticos y psicológicos, por lo cual se han utilizado múltiples abordajes farmacológicos, entre ellos opioides, antidepresivos, antiepilépticos y, recientemente, cannabis medicinal. En esta revisión narrativa se hace una reseña de la literatura actual relacionada con la eficacia de los cannabinoides en la fibromialgia. Los estudios describen una posible influencia del cannabis sobre el control del dolor en pacientes con fibromialgia, con efectos positivos sobre la calidad de vida y el sueño. El uso del cannabis parece tener beneficios en los pacientes con fibromialgia; sin embargo, aún se requieren estudios más robustos para establecer su verdadera eficacia en el manejo del dolor, calidad de vida y mejoría de los síntomas asociados.

Cannabinoids in epilepsy: Clinical efficacy and pharmacological considerations. / Cannabinoides en epilepsia: eficacia clínica y aspectos farmacológicos.

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.

Determinación y comparación cualitativa de cannabinoides presentes en productos naturales comerciales del departamento del Cauca, Colombia / Determination and qualitative comparison of cannabinoids present in commercial natural products of the Cauca Department-Colombia

RESUMEN Actualmente, hay un creciente interés por el estudio de Cannabis sativa y sus componentes ya que se le atribuye propiedades terapéuticas en el tratamiento de enfermedades. En Colombia y específicamente en el departamento del Cauca se comercializan productos de cannabis tanto para fines no medicinales como terapéuticos. En consecuencia, es necesario el análisis de estos productos de manera que se pueda conocer la composición de los mismos y el posible efecto que pueda tener sobre la salud. El análisis de los componentes de estos productos se llevó a cabo empleando la cromatografía líquida de alta resolución (CLAR) y espectrometría de masas (EM), de tal manera que permitieron la identificación de las principales especies cannabinoides; Δ9-tetra hidrocannabinol (THC), cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG). La separación de los analitos se llevó a cabo mediante la implementación de una columna analítica C18 de fase reversa, elución isocrática 1 mL/ min, presión del sistema 800 PSI, una mezcla de acetonitrilo ACN y buffer fosfato (KHPO4) en relación 65/35 como fase móvil, volumen de inyección de 10 µL, un tiempo de análisis de 15 min, y detección a 220 nm.

SUMMARY Cannabis sativa has now experienced an increasing interest in the study of its components since it is attributed therapeutic properties in the treatment of diseases. In Colombia and specifically in the Cauca Department, Cannabis products are marketed both for non-medicinal and therapeutic purposes. Consequently, it is necessary to analyze these products in such a way that the composition of the products and their possible effect on health can be known. The analysis ofthe components of these products was carried out using high performance liquid chromatog-raphy (HPLC) and mass spectrometry (MS), in such a way that they allowed the identification of the main cannabinoid species; Δ9-tetra hydrocannabinol (THC), cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG). The separation of the analytes was carried out by means of the implementation of a reverse phase C18 analytical column, isocratic elution 1 mL/min, system pressure 800 PSI, a mixture of acetonitrile ACN and phosphate buffer (KHPO4) in relation 65/35 as mobile phase, injection volume of10 µL, analysis time of15 min, and detection at 220 nm.

Aplicaciones terapéuticas por acción de los cannabinoides.

The interest on cannabinoids became evident between the 1940 and 1950 decades. Although the active substance of the plant was not known, a series of compounds with cannabinomimetic activity were synthesized, which were investigated in animals and clinically. The most widely tested was Δ6a, 10a-THC hexyl. Δ6a, 10a-THC dimethylheptyl (DMHP) antiepileptic effects were studied in several children, with positive results being obtained in some cases. DMHP differs from sinhexyl in that its side chain is DMHP instead of n-hexyl. The first cannabinoid isolated from Cannabis sativa was cannabinol, although its structure was correctly characterized several years later. Cannabidiol was isolated some years later and was subsequently characterized by Mechoulam and Shvo. In 2013, the National Academy of Medicine and the Faculty of Medicine of the National Autonomous University of Mexico, through the Seminar of Studies on Entirety, decided to carry out a systematic review on a subject that is both complex and controversial: the relationship between marijuana and health. In recent years, studies have been conducted with cannabis in several diseases: controlled clinical trials on spasticity in multiple sclerosis and spinal cord injury, chronic, essentially neuropathic, pain, movement disorders (Gilles de Latourette, dystonia, levodopa dyskinesia), asthma and glaucoma, as well as non-controlled clinical trials on Alzheimer's disease, neuroprotection, intractable hiccups, epilepsy, alcohol and opioid dependence and inflammatory processes.

El interés por los cannabinoides se hizo evidente entre las décadas de 1940 y 1950. Aunque no se conocía el principio activo de la planta, se sintetizaron compuestos con actividad cannabinomimética, los cuales fueron investigados en animales y en la clínica. El más probado fue el ∆6a,10a-THC hexilo. Las acciones antiepilépticas del ∆6a,10a-THC dimetilheptil fueron estudiadas en varios niños; en algunos casos se obtuvieron resultados positivos. El ∆6a,10a-THC dimetilheptil se diferencia del sinhexil en que su cadena lateral es dimetilheptilo en vez de n-hexilo. El primer cannabinoide aislado de Cannabis sativa fue el cannabinol, si bien su estructura fue correctamente caracterizada varios años después. El cannabidiol fue aislado algunos años más tarde y caracterizado posteriormente por Mechoulam y Shvo. Durante 2013, la Academia Nacional de Medicina y la Facultad de Medicina de la Universidad Nacional Autónoma de México, a través del Seminario de Estudios sobre la Globalidad, decidieron realizar una revisión sistemática sobre un tema tan complejo como controvertido: la relación entre la marihuana y la salud. En los últimos años se han realizado estudios con cannabis en varias enfermedades: ensayos clínicos controlados sobre espasticidad en esclerosis múltiple y sobre lesiones medulares, dolor crónico fundamentalmente neuropático y trastornos del movimiento (Gilles de Latourette, distonía, discinesia por levodopa), asma y glaucoma, así como ensayos clínicos no controlados sobre Alzheimer, neuroprotección, hipo intratable, epilepsia, dependencia al alcohol y opioides y procesos inflamatorios.

Cannabis poisoning under the age of 3 years. / Intoxicación por cannabis en menores de 3 años.

EN: The increased use of cannabis among adults and the general perception that cannabis is harmless has been accompanied by a rise in the number of acute poisoning cases among children. We present a retrospective, descriptive study of patients aged 3 years or younger who were treated for cannabis poisoning in a pediatric emergency department between 2012 and 2017. Epidemiologic and clinical data as well as toxicologic findings are reported. We found 10 cases of cannabis poisoning in our records. Nine of the patients had diminished consciousness. Only 2 families initially reported exposure to cannabis when interviewed. Repeated exposure was demonstrated by analysis of hair from 2 patients. We conclude that cannabis poisoning should be included in the differential diagnosis of young children with acute neurologic symptoms of unknown origin. When cannabis is detected in urine samples collected in the pediatric emergency department, more specific diagnostic techniques should be used to assess the possibility of repeated exposure.

ES: El aumento en el consumo de cannabis y su trivialización por la población adulta se han traducido en un aumento de los casos de intoxicaciones agudas en niños. Se presenta un estudio observacional retrospectivo de los pacientes menores de 3 años intoxicados por cannabis entre 2012 y 2017 en un servicio de urgencias pediátricas (SUP). Se recogieron datos epidemiológicos, clínicos y toxicológicos. Se detectaron 10 intoxicaciones por cannabis. Nueve pacientes presentaron alteración en el nivel de conciencia. Solo en 2 casos la familia refirió la exposición al tóxico en la anamnesis inicial. La detección en cabello demostró exposición repetida en 2 pacientes. En conclusión, es necesario incluir la intoxicación por cannabis dentro del diagnóstico diferencial de los niños con clínica neurológica aguda no filiada. Ante la detección de cannabis en orina en el SUP, se debe solicitar la confirmación mediante técnicas específicas y valorar la posibilidad de exposiciones repetidas.

Validación de un método para cuantificar ácido-11-nor-9-carboxi-delta 9-tetrahidrocannabinol en orina por cromatografía gaseosa-espectrometría de masas previa extracción en fase sólida / Validation of a method for quantify 11-nor-9-carboxy-delta 9-tetrahydrocannabinol in human urine using solid phase extraction and gas chromatography-mass spectrometry

El cannabis es una de las drogas ilegales más usadas a nivel mundial. Su consumo se relaciona con diferentes hechos en el ámbito forense, laboral, deportivo y clínico. Para su detección se utilizan métodos con diferentes fundamentos y alcances (inmunológicos, cromatográficos). En este trabajo se describe un método preciso, reproducible y validado, para la cuantificación del principal metabolito urinario del Δ9-tetrahidrocannabinol, el ácido-11-nor-9-carboxi- Δ 9-tetrahidrocannabinol (THC-COOH), por cromatografía gaseosa-espectrometría de masas (GC-MS). Se efectuó una extracción en fase sólida (SPE) a partir de la orina, previa hidrólisis alcalina. Se utilizó el análogo deuterado (THC-COOH D3) como estándar interno. El análisis por GC-MS se realizó en modo SIM. La curva de calibración fue lineal en el rango de trabajo (10-100 ng/ml, r > 0,999) y el límite de cuantificación fue de 10 ng/ml. La recuperación absoluta estuvo comprendida entre el 91,0 y 99,0 %. La precisión intra e inter ensayo fue de 1,06 a 1,26 y 3,59 a 9,80 %, respectivamente. El método fue aplicado a muestras reales, positivas por test inmunológico, resultando ser muy útil y fiable en el análisis de rutina de THC-COOH en orina humana con fines toxicológicos.

Cannabis is one of the most widely used illegal drug in the world. Its consumption is related to different forensic, work, sports and clinical events. In order to determinate the presence of cannabis, different methods with distinct fundamentals and scopes (immunoassay and chromatography) are applied. This report described an accurate, reproducible, and validated gas chromatography-mass spectrometry (GC-MS) method for the quantitation of 11-nor-9-carboxy- Δ9-tetrahydrocannabinol (THCCOOH), the major metabolite of Δ9-tetrahydrocannabinol in urine. A solid phase extraction (SPE), previous alkaline hydrolysis, was performed on the urine sample. Its deuterated analog (THC-COOH D3) was used as internal standard. The GC-MS analysis made by selected ion monitoring (SIM). Calibration curve was linear over the specified range (10 -100 ng/ml; r > 0.999) and limit of quantitation was 10 ng/ml. Absolute recoveries ranged from 91.0 to 99.0. Intra-assay and inter assay precision ranged from 1.06 to 1.26 and 3.59 to 9.80 %, respectively. The method has been applied to real samples, positive to immunological screening test, resulting to be very useful and reliable in routine analysis of THC-COOH in human urine for toxicological purposes.

Cannabinoid Receptor 2 Participates in Amyloid-ß Processing in a Mouse Model of Alzheimer's Disease but Plays a Minor Role in the Therapeutic Properties of a Cannabis-Based Medicine.

The endogenous cannabinoid system represents a promising therapeutic target to modify neurodegenerative pathways linked to Alzheimer's disease (AD). The aim of the present study was to evaluate the specific contribution of CB2 receptor to the progression of AD-like pathology and its role in the positive effect of a cannabis-based medicine (1:1 combination of Δ9-tetrahidrocannabinol and cannabidiol) previously demonstrated to be beneficial in the AßPP/PS1 transgenic model of the disease. A new mouse strain was generated by crossing AßPP/PS1 transgenic mice with CB2 knockout mice. Results show that lack of CB2 exacerbates cortical Aß deposition and increases the levels of soluble Aß40. However, CB2 receptor deficiency does not affect the viability of AßPP/PS1 mice, does not accelerate their memory impairment, does not modify tau hyperphosphorylation in dystrophic neurites associated to Aß plaques, and does not attenuate the positive cognitive effect induced by the cannabis-based medicine in these animals. These findings suggest a minor role for the CB2 receptor in the therapeutic effect of the cannabis-based medicine in AßPP/PS1 mice, but also constitute evidence of a link between CB2 receptor and Aß processing.

In vitro and in vivo evaluation of Δ9-tetrahidrocannabinol/PLGA nanoparticles for cancer chemotherapy.

Nanoplatforms can optimize the efficacy and safety of chemotherapy, and thus cancer therapy. However, new approaches are encouraged in developing new nanomedicines against malignant cells. In this work, a reproducible methodology is described to prepare Δ(9)-tetrahidrocannabinol (Δ(9)-THC)-loaded poly(d,l-lactide-co-glycolide) (PLGA) nanoparticles against lung cancer. The nanoformulation is further improved by surface functionalization with the biodegradable polymers chitosan and poly(ethylene glycol) (PEG) in order to optimize the biological fate and antitumor effect. Mean nanoparticle size (≈ 290 nm) increased upon coating with PEG, CS, and PEG-CS up to ≈ 590 nm, ≈ 745 nm, and ≈ 790 nm, respectively. Surface electrical charge was controlled by the type of polymeric coating onto the PLGA particles. Drug entrapment efficiencies (≈ 95%) were not affected by any of the polymeric coatings. On the opposite, the characteristic sustained (biphasic) Δ(9)-THC release from the particles can be accelerated or slowed down when using PEG or chitosan, respectively. Blood compatibility studies demonstrated the adequate in vivo safety margin of all of the PLGA-based nanoformulations, while protein adsorption investigations postulated the protective role of PEGylation against opsonization and plasma clearance. Cell viability studies comparing the activity of the nanoformulations against human A-549 and murine LL2 lung adenocarcinoma cells, and human embryo lung fibroblastic MRC-5 cells revealed a statistically significant selective cytotoxic effect toward the lung cancer cell lines. In addition, cytotoxicity assays in A-549 cells demonstrated the more intense anticancer activity of Δ(9)-THC-loaded PEGylated PLGA nanoparticles. These promising results were confirmed by in vivo studies in LL2 lung tumor-bearing immunocompetent C57BL/6 mice.

Clinical experiences with cannabinoids in spasticity management in multiple sclerosis.

INTRODUCTION: Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. METHODS: Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression. RESULTS: Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). CONCLUSIONS: THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile.

Valoración de los efectos fisiológicos y neuroquímicos de altas concentraciones de tetrahidrocannabinol en modelos biológicos / Assessment physiological and neurochemical effects of high concentrations of tetrahydrocannabinol in biological models

El objetivo de esta investigación fue evaluar los efectos fisiológicos y neuroquímicos en 60 ratones machos cepas Naval Medical Research Institute (NMRI) en edad adulto-joven con pesos promedios de 25,45 ± 3,05 g, sometidos durante seis semanas a dosis del principio psicoactivo de la marihuana el Δ-9-tetrahidrocannabinol en concentraciones entre 4 - 20%. Se realizaron tomas de sangre retroorbital para evaluar parámetros hematológicos y bioquímicos antes, durante y post experiencia. Se monitorearon medidas tales como: peso, ingesta de agua, alimentos, actividad locomotora horizontal y vertical, entre otros. Al final de la experiencia se realizo autopsia y toma de muestras de regiones cerebrales, para medir niveles de neurotransmisores aminoacidicos y dopamina. Estos resultados permiten concluir que altas concentraciones del principio psicoactivo de la marihuana hacen más dependiente al consumidor con los consecuentes daños fisiológicos y neurológicos. Esto lleva a que cada vez se necesite más droga para producir el mismo efecto.

The objective of this research was to evaluate the physiological and neurochemical effects in 60 (Naval Medical Research Institute) NMRI male mice strains in young adult - age average weight 25.45 ± 3.05 g, underwent six weeks at doses of the psychoactive ingredient in marijuana the Δ -9-tetrahydrocannabinol in concentrations between 4-20 %. Retroorbital blood shots were conducted to evaluate hematological and biochemical parameters before, during and post experience. Weight, water intake, food, horizontal and vertical locomotors activity include: measures such as monitored. At the end of the experience autopsy was conducted and sampling of brain regions to measure levels of amino acid neurotransmitters and dopamine. These results suggest that high concentrations of the psychoactive ingredient in marijuana consumers become more dependent with consequent physiological and neurological damage. This leads to more and more drugs is needed to produce the same effect.

Assessment of the abuse potential of MDMA in the conditioned place preference paradigm: role of CB1 receptors.

Numerous reports have highlighted the role of the endocannabinoid system in the addictive potential of MDMA (3,4-methylenedioxy-methamphetamine). A previous report showed that CB1 knockout (KOCB1) mice do not acquire MDMA self-administration, despite developing conditioned place preference (CPP). This contradiction could be due to the particular procedure of place conditioning used. The present work compares MDMA-induced CPP in KOCB1 mice using unbiased and biased procedures of place conditioning. In the unbiased procedure, MDMA induced CPP and reinstatement of the extinguished preference in wild type (WT) mice, but not in KOCB1 mice. In contrast, in a biased protocol of CPP, MDMA produced preference in both types of mice. The anxiolytic response induced by MDMA in the elevated plus maze (EPM) was observed only in KOCB1 mice and may have been responsible, at least partially, for the CPP in the biased procedure. A neurochemical analysis revealed that KOCB1 mice presented higher striatal DA and DOPAC levels in response to MDMA, but no alterations in their levels of monoamine transporters. In line with previous self-administration studies, our data suggest that CB1 receptors play an important role in the reinforcing effects of MDMA, and that the experimental procedure of CPP employed should be taken into account when drawing conclusions.