ArticlePDF AvailableLiterature Review


Neurodegenerative diseases represent, nowadays, one of the main causes of death in the industrialized country. They are characterized by a loss of neurons in particular regions of the nervous system. It is believed that this nerve cell loss underlies the subsequent decline in cognitive and motor function that patients experience in these diseases. A range of mutant genes and environmental toxins have been implicated in the cause of neurodegenerative disorders but the mechanism remains largely unknown. At present, inflammation, a common denominator among the diverse list of neurodegenerative diseases, has been implicated as a critical mechanism that is responsible for the progressive nature of neurodegeneration. Since, at present, there are few therapies for the wide range of neurodegenerative diseases, scientists are still in search of new therapeutic approaches to the problem. An early contribution of neuroprotective and antiinflammatory strategies for these disorders seems particularly desirable because isolated treatments cannot be effective. In this contest, marijuana derivatives have attracted special interest, although these compounds have always raised several practical and ethical problems for their potential abuse. Nevertheless, among Cannabis compounds, cannabidiol (CBD), which lacks any unwanted psychotropic effect, may represent a very promising agent with the highest prospect for therapeutic use.
Cannabidiol: A Promising Drug for Neurodegenerative Disorders?
Teresa Iuvone1,
, Giuseppe Esposito2, Daniele De Filippis1,
, Caterina Scuderi2& Luca Steardo2
1 Department of Experimental Pharmacology, Faculty of Pharmacy, University of Naples “Federico II,” Naples, Italy
2 Department of Physiology and Pharmacology “V. Erspamer,” University of Rome “La Sapienza”, Piazzale Aldo Moro, Rome, Italy
Endocannabinoid Research Group
Alzheimer disease; Cannabinoid; Movement
disorders; Multiple sclerosis; Parkinson disease.
Prof. Teresa Iuvone, Department of
Experimental Pharmacology, Faculty of
Pharmacy, University of Naples “Federico II,”
Via D. Montesano, 49 80131 Naples, Italy.
Tel.: +39-081-678429;
Fax: +39-081-678403;
doi: 10.1111/j.1755-5949.2008.00065.x
Neurodegenerative diseases represent, nowadays, one of the main causes of
death in the industrialized country. They are characterized by a loss of neurons
in particular regions of the nervous system. It is believed that this nerve cell loss
underlies the subsequent decline in cognitive and motor function that patients
experience in these diseases. A range of mutant genes and environmental tox-
ins have been implicated in the cause of neurodegenerative disorders but the
mechanism remains largely unknown. At present, inflammation, a common
denominator among the diverse list of neurodegenerative diseases, has been
implicated as a critical mechanism that is responsible for the progressive na-
ture of neurodegeneration. Since, at present, there are few therapies for the
wide range of neurodegenerative diseases, scientists are still in search of new
therapeutic approaches to the problem. An early contribution of neuropro-
tective and antiinflammatory strategies for these disorders seems particularly
desirable because isolated treatments cannot be effective. In this contest, mar-
ijuana derivatives have attracted special interest, although these compounds
have always raised several practical and ethical problems for their potential
abuse. Nevertheless, among Cannabis compounds, cannabidiol (CBD), which
lacks any unwanted psychotropic effect, may represent a very promising agent
with the highest prospect for therapeutic use.
In the present article, the current literature regarding
CBD use in preclinical and clinical studies has been re-
vised, underlying the potential of CBD in the prevention
of the main neurodegenerative disorders and the clini-
cal management of symptoms related to these patholo-
gies. Although the range of its clinical effect is impressive;
however, to date, the molecular mechanisms through
which CBD exerts its action remain elusive. As a result,
this phytocannabinoid may represent a lead compound
for the development of therapeutics that are able to exert
neuroprotection as well as to operate against neuroinfla-
mmatory component of neurodegenerative disorders.
Neurodegenerative Disorders
Neurodegenerative diseases, from Greek vευρo-, n´
, “nerval” and Latin d¯
are, “to decline”, are char-
acterized by a slow progressive neuronal loss in specific
brain areas, which leads to the observed clinical man-
ifestations [1]. Although they have different etiologies,
most of them share similar histomorphological features,
such as neuronal loss, gliosis, and the presence of aggre-
gates of misfolded or aberrant proteins [2,3]. Neurode-
generative diseases are characterized by cognitive, motor,
and/or behavioral dysfunctions. This clinical heterogene-
ity is in large part attributable to pathological variability
and the characteristic topographic pattern of central ner-
vous system (CNS) involvement, displayed by each par-
ticular disease entity, the latter being determined by the
selective vulnerability of brain cells to the disease pro-
cess. Neurodegenerative diseases may be crudely divided
into two major groups according to phenotypic features:
conditions causing problems with movements, or condi-
tions affecting memory and related to dementia [2]. Neu-
rodegenerative disorders usually extend over a decade.
Neurodegeneration begins long before patients experi-
ence any symptoms, which are noticed only when many
cells are irreversibly damaged and cease to function, so
CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd 65
Cannabidiol and Neurodegeneration T. Iuvone et al.
that the actual onset of disease precedes clinical manifes-
tations by many years.
The mechanism that drives chronic progression of neu-
rodegenerative diseases remains elusive. Clearly, if a driv-
ing force persists actively, therapeutic strategies aimed
at neurorescue, replacement, or regeneration might un-
derperform. Recently, neuroinflammation, a prominent
feature shared by various neurodegenerative diseases,
has been increasingly implicated in the mechanisms that
are responsible for such disorders, so that it is now re-
garded as a double-edged sword [4]. In fact, without
neuroinflammation, removal of offending materials and
recovery from injuries become impossible, whereas an
uncontrolled neuroinflammation can become devastat-
ing, since overactivated microglia and astrocytes produce
a myriad of neurotoxic substances that are responsible
for a vicious self-propagating cycle that drives to chronic
progression of neurodegenerative diseases [5,6]. The clas-
sical division between degenerative and inflammatory
CNS disorders is vanishing, as accumulating evidence
shows that inflammatory processes are important in the
pathophysiology of primarily degenerative disorders, and
neurodegeneration complicates primarily inflammatory
diseases of the brain and spinal cord. In fact, Alzheimer
disease (AD), Parkinson disease (PD), and amyotrophic
lateral sclerosis (ALS) are among the best examples of
neurodegenerative disorders that are precociously asso-
ciated with intense inflammation, whereas multiple scle-
rosis (MS) is an inflammatory disease in which neurode-
generation may occur as a very early event [7,8]
Such evidence imposes reconsideration of the per-
ceived relationship between neuroinflammation and
neurodegeneration, suggesting that one is not simply
a culmination of the other, since they may occur in
parallel. On the basis of these considerations, an early
combination of antiinflammatory and neuroprotective
strategies, irrespective of the nature of the primary in-
sult, appears as a rationale and desirable approach, since
focusing on only one process might also worsen the
other. Therefore, in view of the emerging role of the ac-
tivated glia in contributing to neurodegeneration, in re-
cent years, the importance to finely tune a protracted glial
overactivation as a novel disease-modifying approach to
counteract neurodegenerative disorders has been high-
lighted and it offers hope for a successful therapy.
Because of the vicious cycle and the disappointing fail-
ure of the present treatments, drugs with multiple ac-
tions, addressed at both inflammatory and noninflam-
matory mechanisms, may represent the most promising
therapeutic strategies for neurodegenerative diseases.
Along this line, a unique opportunity to improve neu-
roinflammation and neurodegeneration simultaneously
could be offered by pharmacological agents affecting the
endocannabinoids system (ECS) [9,10]. In the last few
years, Cannabis derivatives have attracted much atten-
Cannabinoids or, Even Better,
The anecdotal use of Cannabis for therapeutical aim dates
back to about 5000 years, although the introduction of
its derivatives in the Western medicine belongs to the
nineteenth century, reaching a peak of interest in 1960s,
when 9- tetrahydrocannabinol (9-THC), the main psy-
chotropic component of marijuana, was identified and
synthesized [11].
At present, “cannabinoids” (CBs) can be separated
into three different groups: endogenous (endocannabi-
noids), synthetic, and phytocannabinoids. The latter
group includes terpenophenolic substances extracted
from Cannabis sativa,suchas9-THC and cannabidiol
(CBD). Two membrane receptors for CBs, both coupled to
Giprotein, and named CB1and CB2,have been identified
so far [12]. It is now commonly accepted that CB1recep-
tors are located primarily in the central and peripheral
neurons, whereas CB2receptors are most abundant in
cells of the immune system [13]. However, CB1receptors
are also expressed by some nonneuronal cells, including
immune cells, whereas CB2has been recognized on some
neuronal cells, either within or outside the brain, even
if its role remains to be better clarified [14,15]. More-
over, two orphan G protein-coupled receptors, GPR119
and GPR55, possibly activated by multiple different CB
ligands, have been recently proposed as novel CB recep-
tors [16].
Cannabis pharmacology is constantly growing up, and
therapeutic properties of CB receptor agonists and an-
tagonists have been suggested for the treatment of dif-
ferent human disorders by preclinical and clinical obser-
vations in which interactions at CB1and/or CB2sites
appear to affect molecular mechanisms that are respon-
sible for disease onset or progression [17]. Along this
line, a particular interest was raised by the discovery that
these agents may be protective in some CNS disorders.
In fact, CB receptors are present in the senile plaques
from postmortem human brain, together with markers
of microglial activation, as well as in AD patients, al-
though the number of CB1-positive neurons has been
found to be drastically reduced [18]. Moreover, it has
been reported that CB1agonism was able to prevent tau
hyperphosphorylation in cultured neurons [19] and an-
tagonize cellular changes and behavioral consequences
in β-amyloid-induced rodents [18,20]. On the contrary,
CB2antagonists resulted to be protective in in vivo ex-
periments by downregulating reactive gliosis occurring in
66 CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd
T. Iuvone et al.Cannabidiol and Neurodegeneration
β-amyloid-injected animals [21]. The protective role of
CBs has been recognized not only in AD models but also
in other experimental paradigms of neurodegenerative
disorders, such as 1-Methyl 4-Phenil 1,2,3,6 Tetrahydro-
Piridine (MPTP) and HIV-1/Tat protein neurotoxicity
[22,23]. Finally, there are growing evidence that CB1,
and possibly CB2, receptor interactions could affect neu-
ropathology and disease progression in rodent model of
both MS [24] and ALS [25,26].
Despite the emerging evidence regarding putative ther-
apeutical activities of CBs, their effective introduction in
the clinical use is still controversial and strongly limited
by unavoidable psychotropic effects, exhibited by many
of them. In this scenario, CBD, which constitutes up to
40% of the Cannabis extract, may represent the most
promising candidate for clinical utilization due to its re-
markable lack of any cognitive and psychoactive actions,
in addition to its excellent tolerability profile in humans
Because of its very low toxicity in humans, a large
number of trials have been performed to assess the clini-
cal efficacy of CBD in different pathologies. Most of these
trials have been executed utilizing Sativex R(GW Phar-
maceuticals, Salisbury, UK), the only commercially avail-
able preparation containing CBD/9-THC. Four different
formulations of Sativex Rare currently under investiga-
tion: high THC extract (Tetranabinex R; GW Pharmaceu-
ticals), THC:CBD (narrow ratio), THC:CBD (broad ratio),
and high CBD extract (Nabidiolex R; GW Pharmaceuti-
cals) [28]. Three Sativex Rdelivery systems exist: oro-
mucosal spray, sublingual tablets, and inhalated (but not
smoked) dosage forms.
In 2005, the oromucosal spray administration of
Sativex Rhas been agreed to for MS symptoms treatment
It has been established that coadministration of CBD
and 9-THC may modify the pharmacological effect of
the latter, potentiating some of its reputed benefits,
whereas attenuating some of its negative effects [30–
CBD Pharmacology
CBD is a natural compound isolated across the 1930s
and 1940s from marijuana, but its structure and absolute
configuration were fully elucidated only in the 1960s by
Mechoulam et al. [33].
()CBD isomer is the major nonpsychotropic con-
stituent naturally present in Cannabis sativa. Molecular
pharmacology of CDB is not well defined, and little is
known about a possible CBD-dependent signaling path-
way. At first glance, at the chemical structure, it is easy to
recognize CBD antioxidant properties due to the presence
of two hydroxilic groups [33]. Since its antioxidant prop-
erties cannot account for the wide spectrum of biological
effects displayed in both preclinical and clinical investi-
gations, several studies have been carried on in order to
identify other mechanisms through which CBD exerts its
actions. Up to date, no evidence has been provided that,
at least, the natural isomer fully binds to any known re-
ceptor site, so that such an interaction might be regarded
as responsible for some or all the biological effects ob-
served. In fact, CBD, even if it belongs to the CB “fam-
ily”, exhibits only a weak ability to remove 3[H]CP55940,
a not selective ligand for CB receptors from both CB1and
CB2receptor sites, being required for this effect concen-
trations in the micromolar range [34,35]. However, re-
cently, evidence has emerged pointing out that, despite
its low affinity for CB receptors, CBD could work as an in-
verse agonist at CB2receptor, at concentration values in
low nanomolar range, in both mouse whole-brain mem-
branes and membranes from CHO cells transfected with
hCB2receptors [36]. In any case, even if the relevance
of CBD interactions at CB receptors still remains con-
troversial, its influence on the endocannabinoid signal-
ing system appears convincingly demonstrated. Indeed,
although CBD does not seems to clearly operate at CB re-
ceptors; however, it has been observed that it is able to
potentiate the endocannabinoid signaling system, work-
ing at different levels. Indeed, CBD increases anandamide
(AEA, the first endocannabinoid identified) levels by in-
hibiting its reuptake and degradation, blunting both the
expression and the activity of fatty acid amide hydrolase
(FAAH) [37,38], the enzyme involved in the breakdown
of AEA. It should be noted, however, that the concentra-
tions of CBD required for the inhibition of AEA reuptake
and hydrolysis are quite high (>20 μM) [37]. Moreover,
further interactions between CBD and ECS have been
reported to occur in the hippocampal tissue. Indeed, by
enhancing the levels of endocannabinoids, either by ex-
ogenous application or by a stimulated upregulation,
CBD-induced calcium responses appeared strongly de-
creased. In this case, CBD responses, observed both in the
neurons and in the glia, were not dependent on classical
CB receptor [39] but potentially mediated through an un-
characterized postsynaptic CB-like receptor coupled to a
Gq/11 protein.
Moreover, CBD and its (+) enantiomer interact with
the transient potential vanilloid receptor type-1 (TPVR-
50 estimated between 3.2 and 3.5 μMand
a maximal effect similar to that exhibited by the natural
agonist capsaicin, both in vitro [37] and in a rat model
of acute inflammation [40]. Looking for sites possibly re-
sponsible for CBD activity, it has been reported the ability
of CBD to interact at the 5-HT1A serotonin receptor [41],
CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd 67
Cannabidiol and Neurodegeneration T. Iuvone et al.
as well as to allosterically modulate μand δopioid recep-
tors in rat cerebral cortex membrane homogenates [42].
Finally, CBD has been observed to significantly antago-
nize the orphan receptor GPR55 [16].
To date, although CBD pharmacodynamic remains, in
many aspects, still unclear, yet, its pharmacokinetics ap-
pears better defined. Once orally given, in consequence
of a marked first-pass effect, CBD bioavailability ranges
between values of 13 and 19%, making for this reason
the intravenous administration preferable [43]. Once in-
jected, CBD is rapidly distributed and easily passes the
blood–brain barrier (BBB), considering its lipophilicity,
which in turn provides CBD a prolonged elimination
Metabolism of CBD showed biotransformation routes
typically observed for phytocannabinoids [44,45]. Al-
though different metabolic pathways have been observed
in different animal species, including human, overall
CBD metabolism displays common features. Indeed, CBD
undergoes multiple hydroxylations, oxidations to car-
boxylic acids, beta-oxidation, conjugation, and epoxida-
tion [45,46]. Finally, CBD is preferentially excreted from
urine, both in the free state and as its glucuronide, with a
half-life of 9 h [47].
Encouraged by the lack of any unwanted psychotropic
effects, and in view of its potential therapeutic use, ef-
forts have been made to delineate its toxicological profile.
In this regard, CBD has been found to exert a very low
toxicity, both in human and in other species, exhibiting
an LD50 of 212 mg/kg when intravenously injected into
rhesus monkey [48]. Moreover, CBD does not display
teratogenic as well as mutagenic activities [49]. How-
ever, CBD appears to impair hepatic drug metabolism
of same drugs in different animal species [50] through
the inactivation of specific cytochrome P450s belonging
to the 2C and 3A subfamilies. These interactions de-
serve to be taken into the right account in case of CBD
CBD: Mechanism of Cell Protection
and Antiischemic Effect
CBD exhibits a wide spectrum of interesting biological ef-
fects either in vitro or in vivo. A special attention merits
the ability of CBD to regulate both cell cycle and cell sur-
vival fate. The antiproliferative effects of CBD, described
in leukemia, breast cancer, and glioma [51,52], together
with its property to induce tumor regression and inhibi-
tion of glioma cell invasion observed in rats [53], support
a key role of CBD in the control of tumor development
and progression.
A similar proapoptotic potential was also exhibited by
CBD in primary cells of the immune system [54]. All this,
in concert with a strong inhibition of neutrophil chemo-
taxis and proliferation [55], would be considered, at least
in part, as the basis of its great efficacy as an antiin-
flammatory drug, described both in models of acute and
chronic inflammation [56].
Further effects of CBD on immune cells include the
modulation of tumour necrosis factor (TNF)-α,inter-
leukin (IL)-1, and interferon (IFN)-γby mononuclear
cells [57,58] and the suppression of chemokine produc-
tion by human B cells [59].
The antiinflammatory effects of CBD have not been re-
stricted to the control of the peripheral inflammatory pro-
cess since interesting results have also been observed in
the prevention of the neuroinflammation [60], an effect
that may justify the emerging role, described for CBD, as
a potential neuroprotective agent.
The nonpsychoactive marijuana-constituent CBD was
found to prevent both glutamate neurotoxicity and
radical oxygen species (ROS)-induced cell death. Neu-
roprotection was unaffected by CB receptor antag-
onism, suggesting CBD as a useful therapeutic ef-
fect, independent of psychoactive effects mediated
by receptor interactions. CBD was able to antago-
nize glutamate toxicity in cortical neurons with po-
tency, regardless of whether the insult was operated
through N-methyl-D-aspartate (NMDA), 2-amino-3-(4-
butyl-3-hydroxyisoxazol-5-yl)propionic acid (AMPA), or
kainate receptors, pointing out that CBD antagonizes
all three receptors with similar affinity or, more likely,
that its site of action remains downstream of initial re-
ceptor activation [61]. In an in vitro model of neu-
rodegeneration, the neuroprotective effect of CBD in-
volved the attenuation of the excessive production of
peroxynitrites induced by glutamate, thus preventing
apoptosis [62]. In addition, CBD was found to possess
antioxidant properties, since it attenuated ROS-induced
neurotoxicity, being more protective than either ascor-
bate or α-tocopherol [61,63].
Pre- and posttreatments with CBD were reported to
significantly diminish the infarct size in a mouse model
of brain ischemia. This effect was not inhibited by CB re-
ceptor antagonism. CBD also suppressed the decrease in
cerebral blood flow (CBF) due to the failure of cerebral
microcirculation after reperfusion, as well as it blunted
metalloperoxidase activity after reperfusion for up to
3 days, showing potent and long-lasting neuroprotec-
tant and antiiflammatory effects mediated through a CB-
independent mechanism [64,65].
Interestingly, these CBD neuroprotective effects were
inhibited by the 5-HT1A antagonist, W100135, but not
by the TPVR-1 antagonist, capszepine. Furthermore, the
68 CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd
T. Iuvone et al.Cannabidiol and Neurodegeneration
increased CBF induced by CBD was in part decreased by
5-HT1A antagonism, pointing out that CBD may exert a
neuroprotective effect toward brain ischemia, at least in
part, via 5-HT1A receptor [66].
Finally, in order to identify the mechanisms involved
in CBD neuroprotective actions, it cannot be excluded
that this phytocannabinoid operates its beneficial effects
also through the uncloned postsynaptic CB-like receptor
coupled to Gq/11, since mice deficient in this site were
found to display an impaired ability to activate neuropro-
tective mechanisms [67].
CBD and Experimental Model of ADs
The substantial and well-documented antioxidant, an-
tiinflammatory, and neuroprotective properties of CBD
have prompted researchers to test its effects in models
of neurotoxicity and neurodegenerative disorders. In this
context, very promising results have been achieved in
the control of β-amyloid-induced toxicity. Although, to
date, it is not fully elucidated if β-amyloid plaque deposi-
tion and the neurofibrillary tangles, found in postmortem
brain of AD patients, are the cause or the consequence of
the disease; however, the pivotal role of β-amyloid in in-
ducing neuronal damage and mediating neuroinflamma-
tion is evident. In investigations aimed at exploring CBD
effects on β-amyloid-induced neurotoxicity, this phyto-
cannabinoid was found to be able to protect differenti-
ated PC12 neuronal cells from the detrimental action in-
duced by peptide exposure through a combination of its
antioxidant, antiinflammatory, and antiapoptotic proper-
ties [64,68,69]. Indeed, CBD antioxidant effects account
mainly for the survival of cultured neurons, with a po-
tency higher than that exhibited by α-tocopherol [63],
also attenuating β-amyloid-induced molecular changes
possibly through additional mechanisms that are not dis-
played by classical antioxidants [69]. In fact, CBD resulted
in being able to weaken β-amyloid-induced GSK-3βacti-
vation, the key enzyme of wingless gene (WNT)/β-catenin
pathway, thus preventing tau protein hyperphosphoryla-
tion and the consequent neurofibrillary tangle formation
It has also been demonstrated that CBD decreased
phosphorylation of the stress-activated protein kinase,
P38 mitogen activated protein kinase (MAPK), thus pre-
venting the translocation of nuclear factor (NF)-κBinto
the nucleus and the subsequent transcription of impor-
tant proinflammatory genes, including those encoding for
inducible nitric oxide synthase (iNOS) protein [68].
The beneficial effects of CBD were also confirmed in a
mouse model of AD-related neuroinflammation induced
by the intrahippocampal injection of the human Aβ
(1–42) fragment, where CBD inhibited reactive gliosis
by attenuating glial cell activation and proinflammatory
mediator release in a dose-dependent manner [70].
These encouraging results emphasize the relevance of
CBD as a novel, very promising pharmacological tool ca-
pable of mitigating β-amyloid-evoked neuroinflamma-
tory and neurodegenerative responses.
CBD and Control of Movement
Disorders: ALS and Parkinson
and Huntington Disease
Anecdotal evidence has supported the notion that CBD
can exert beneficial role, alone or in combination with
9-THC, in different neurodegenerative disease, such as
PD and Huntington’s disease (HD), two chronic disorders
provoked by degenerative processes implicating specific
nuclei of the basal ganglia, responsible for abnormal reg-
ulation of movements. Both disorders have been scantly
investigated from the clinical point of view, whereas, at
preclinical level, accumulated findings appear more ex-
haustive and convincing for a possible medical utiliza-
tion of CBD to improve symptoms and/or delay dis-
ease progression. According to recent preclinical find-
ings, plant-derived CBs were able to prevent neuronal
damage induced by 6-hydroxydopamine unilateral injec-
tion into the nigra pars compacta [71]. This effect ap-
peared to not involve CB receptor mediation, whereas,
more likely, it might implicate the antioxidant activ-
ity, possibly combined with the capability to modulate
glial responses, relevant to neural survival. In rodents
with hemiparkinsonism, induced by the intranigral ad-
ministration of 6-hydroxydopamine, neuroprotective ef-
fects exerted by CBD antagonized dopaminergic transmis-
sion impairment by attenuating dopaminergic cell death,
rather than by increasing the functional turnover of the
surviving neurons [71]. Early human reports showed a
dose-related improvement (ranging from 20 to 50%) in
parkinsonian patients treated with oral doses of CBD
(100–600 mg/day over a 6-week period) [72]. On the
contrary, in a more recent controlled trial, a mixture
of 9-THC/CBD (2.5 mg/1.25 mg per capsule) failed to
exhibit any beneficial effect either on parkinsonism or
on levodopa-induced dyskinesias [73]. Unfortunately, no
subsequent trials were performed to elucidate such con-
troversial findings. Certainly, in comparison to the rele-
vance of rodent results, the limited clinical evidence sug-
gests performance of human studies to verify for good the
possible future clinical use of CBD in PD.
Similarly, founded on anecdotal accounts and results
of preliminary clinical reports, CBD was regarded as
a compound with therapeutical potential also against
hyperkinetic disorders. Indeed, CBD was found to
CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd 69
Cannabidiol and Neurodegeneration T. Iuvone et al.
reduce apomorphine-induced turning behavior in 6-
hydroxydopamine-injected rats, an animal model of hy-
perkinetic movement disorders, whereas, on the con-
trary, it was able to potentiate hypokinesia generated by
tetrabenazine [74]. More recently, it was demonstrated
that CBD prevents in striatal neurons the toxicity of 3-
nitropropionic acid, a mitochondrial toxin that is able to
induce some biochemical alterations similar to those oc-
curring in HD [75].
CBD was investigated to prove its efficacy in HD, alone
or as an add-on drug to the approved therapy with
neuroleptics [76]. CBD, at an average daily dose of 10
mg/kg/day for 6 weeks, was neither symptomatically ef-
fective nor toxic compared with placebo in neuroleptic-
free patients with HD. Considering the negative results
on both the therapeutic and the safety measures, there is
a question about the dose as well as the duration of the
trial. Since such findings cannot be considered conclu-
sive, further clinical investigations, utilizing CBD alone
or in combination with 9-THC, have to be carried out
to estimate the actual antihyperkinetic value of these
molecules in a clinical setting.
ALS is a fatal neurodegenerative disease that is charac-
terized by selective loss, implicating motoneurons in the
cortex, brainstem, and spinal cord. Since recent studies
substantiate the relevance of neuroinflammation and ox-
idative stress in the pathophysiology of ALS [77], then it
is possible to suggest that CBD, because of its antiinflam-
matory and antioxidative properties, could be a promis-
ing tool to treat disturbances and prolong survival in ALS
patients. This is strongly supported by the report that 9-
THC was able to slow progression and prolong survival in
a mouse transgenic model of ALS, and that similar results
were obtained when cannabinol was utilized [78]. Fur-
thermore, these results have to be weighed up with the
anecdotal reports that recreational smoking of marijuana
does ameliorate symptomatology in ALS subjects.
CBD and MS
MS is considered the leading cause of neurological disabil-
ity among young and middle-aged people in the north-
ern industrialized countries. MS is considered to be an
autoimmune, demyelinating disease that has a complex
pathophysiology [79]. There is now clear evidence that:
(i) The immune response drives lesion formation and
relapsing-remitting clinical attacks. (ii) The progressive
stages of MS result from neurodegenerative processes,
which do not appear to respond to immunotherapy [80–
83]. (iii) These, distinct but related, disease elements both
produce nerve/loss that results in altered neurotransmis-
sion which leads to the development of a number of signs
of the disease, such as spasticity, pain, and bladder dys-
function [79]. The inability of available medicines to con-
trol such symptoms has prompted people with MS to self-
medicate and perceive benefit by taking Cannabis [84].
They also perceived an effect on relapsing disease sugges-
tive of immunosuppressive capabilities [84]. This latter
aspect is hard to predict, and disease activity may natu-
rally slow down at a time when residual symptoms are
becoming increasingly apparent and people may be tak-
ing Cannabis for symptom control [79,82]. Although the
ability of some CBs to exhibit immunosuppressive poten-
tial has been shown by several studies in MS models [85–
88], current Cannabis trials in MS for symptom control
have, so far, failed to demonstrate a significant reduction
of relapse, indicative of immunosuppressive properties in
humans [89]. Recently, accumulating evidence from pre-
clinical observations supports the notion that CBs may be
of more relevance in neuroprotection that in immuno-
suppression [90], and this is currently being investigated
in trials of a long-term administration of THC/CBD in pro-
gressive MS. Conversely, CBs have been reported to exert
a marked symptom control in MS.
Cannabis has long been proposed as a muscle relaxant
drug, with the first report of chronic motor handicaps
remarkably improved following marijuana smoking de-
scribed almost 30 years ago [91].
Since then, extensive preclinical findings have rein-
forced the notion deduced from the anecdotal observa-
tions that Cannabis derivatives may have a role in reliev-
ing symptoms in MS subjects. [92], offering the rationale
for performing randomized, controlled trials of Cannabis-
based medicine in MS-associated symptomatology.
The clinical trials focused on Sativex Refficacy in the
treatment of symptoms of MS, notably spasticity and neu-
ropathic pain. Beneficial results in placebo-controlled tri-
als were obtained when Sativex Rwas administered as
an add-on therapy in these indications, supporting the
view that Sativex Ris efficacious and well tolerated in the
treatment of these symptoms [93]. Additional trials con-
firmed that the CBD/THC combination is able to reduce
pain and sleep disturbance in patients with MS-related
central neuropathic pain and that this treatment is mostly
well tolerated [94].
Finally, a recent meta-analysis of Cannabis-based treat-
ment for neuropathic pain has concluded that the
CBD/THC buccal spray (Sativex R) was effective in alle-
viating MS-related pain [95].
For bladder dysfunctions occurring in MS patients,
anecdotal reports have suggested that Cannabis deriva-
tives may mitigate lower urinary tract symptoms. More
specifically, the results of a pilot study, utilizing THC/CBD
combination, have demonstrated a significant decrease
in urinary urgency and a reduction in the number and
volume of incontinence episodes, as well as a reduction
70 CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd
T. Iuvone et al.Cannabidiol and Neurodegeneration
in the frequency of nocturia. The daily total voided
and catheterized volume and urinary incontinence pad
weights were also significantly decreased, whereas pa-
tients reported significant improvements in spasticity,
the quality of sleep, and the level of pain (measured
by patient self-assessment) [96]. Large, multicenter,
randomized, placebo-controlled trials are underway, al-
though no results are available at the moment. All these
data taken together suggest that although, until few years
ago, there was little consensus in the scientific literature
regarding phytocannabinoid utilization in current neuro-
logical therapy, presently, the majority of studies focus-
ing on this topic are oriented to suggest CBD, alone or in
combination, as a useful option in the treatment of MS,
at least in a subset of individuals.
CBD and Prion Diseases
Prion diseases are transmissible neurodegenerative disor-
ders that are characterized by the accumulation in the
CNS of the protease-resistant prion protein (PrPres), a
structurally misfolded isoform of its physiological coun-
terpart PrPsen. Both neuropathogenesis and prion infec-
tivity are related to PrPres formation [97]. CBD inhibited
PrPres accumulation in both mouse and sheep scrapie-
infected cells. Moreover, after intraperitoneal infection
with murine scrapie, peripheral injection of CBD lim-
ited cerebral accumulation of PrPres and significantly in-
creased the survival time of the infected mice. CBD inhib-
ited the neurotoxic effects of PrPres and affected PrPres-
induced microglial cell migration in a concentration-
dependent manner [97]. Therefore, CBD may protect
neurons against the multiple molecular and cellular fac-
tors involved in the different steps of the neurodegener-
ative process, which takes place during prion infection.
This evidence, together with CBD’s ability to specifically
target the brain and its lack of toxic side effects, makes
CBD a promising drug, also to be used in Prion diseases,
although the high concentration of CBD needed to ob-
tain the survival effect and the absence of an effect if CBD
is administered after infection have to be taken into the
right account, considering, at the moment, the lack of an
early diagnosis of this diseases in humans.
The present review summarized a growing number of ev-
idences, indicating an emerging role for CBD in the pre-
vention and management of the main neurodegenerative
disorders. CBD, in fact, resulted in being able to protect
neuronal and nonneural cells against several detrimen-
tal insults, such as β-amyloid or 6-hydroxydopamine and
glutamate [62,70,71], which are considered to be the ba-
sis of disorders such as AD and PD. The protective effects
of CBD have been, moreover, evidenced in several animal
models of neurodegeneration, and very interestingly, im-
portant clinical trials have confirmed the potential phar-
macological activity of CBD in the management of clin-
ical symptoms and the slow-down of the progression of
a variety of pathologies, including AD, MS, PD, and ASL.
Unfortunately, despite CBD promising therapeutic value,
the actual mechanism responsible for its action still re-
mains to be fully elucidated. In fact, although its antiox-
idant structure is evident, if truth be told, it would be
limited to restrict all CBD actions to a simple antioxidant
mechanism, since CBD has revealed to possess not only
an effectiveness higher than that of the classical antiox-
idant compounds but also some special activity unfamil-
iar to them [98]. In fact, in almost all the clinical stud-
ies performed, CBD has strongly enhanced the effects of
THC, underlining that at least some biological and clini-
cal action is stoutly linked to the enhancement of endo-
cannabinoid and endovanilloid signaling system.
Until now, the best results with CBD were reached by
the use of Sativex R, a combination of THC and CBD,
thanks to the mutual benefit capitalized by one from the
other active marijuana components. The medical litera-
ture on the topic seems to reinforce the view that CBD
achieves synergy with THC [99,100], consisting of poten-
tiation of benefits, antagonism of adverse effects, sum-
mation (entourage effects), and pharmacokinetics advan-
tages (CBD suppression of 11-hydroxylation of THC).
The great therapeutic value of CBD, either given alone
or in association with THC, derives from the considera-
tion that it represents a rare, if not unique, compound
that is capable of affording neuroprotection by the com-
bination of different types of properties (e.g., antigluta-
matergic effects, antiinflammatory action, and antioxi-
dant effects) that almost cover all spectra of neurotoxic
mechanisms that operate in neurodegenerative disor-
ders (excitotoxicity, inflammatory events, oxidative in-
jury, etc.).
The reported data here, taken together with the evi-
dence of the CBD’s almost absolute absence of side ef-
fects, including psychotropicity, suggest its great efficacy
and open new horizons for the treatment of the main
neurodegenerative disorders. However, in the near fu-
ture, further clinical trials, well designed, carefully exe-
cuted, and powered for efficacy, are crucial to definitively
assess the clinical values of CBD, alone or in combina-
tion, in the management of neurodegenerative diseases,
also in comparison to the other therapeutic approaches.
This will allow the promising expectations to move from
the present promising, although limited, results toward
incontrovertible evidence.
CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd 71
Cannabidiol and Neurodegeneration T. Iuvone et al.
This work was supported by FIRB 2006.
Conflict of Interest
All authors disclose any potential conflicts of interest, in-
cluding all relevant financial interests (e.g. employment,
significant share ownership, patent rights, consultancy,
research funding) in any company or institution that
might benefit from the publication.
1. Skovronsky DM, Lee VM, Trojanowski JQ.
Neurodegenerative diseases: New concepts of
pathogenesis and their therapeutic implications. Annu Rev
Pathol 2006;1:151–170.
2. Yankner BA, Lu T, Loerch P. The aging brain. Annu Rev
Pathol 2008;3:41–66.
3. Soto C, Estrada LD. Protein misfolding and
neurodegeneration. Arch Neurol 2008;65:184–189.
4. Skaper SD. The brain as a target for inflammatory
processes and neuroprotective strategies. Ann N Y Acad Sci
5. DeLegge MH, Smoke A. Neurodegeneration and
inflammation. Nutr Clin Pract 2008;23:35–41.
6. Di Filippo M, Sarchielli P, Picconi B, Calabresi P.
Neuroinflammation and synaptic plasticity: Theoretical
basis for a novel, immune-centred, therapeutic approach
to neurological disorders. Trends Pharmacol Sci 2008;29:
7. Maragakis NJ, Rothstein JD. Mechanisms of disease:
Astrocytes in neurodegenerative disease. Nat Clin Pract
Neurol 2006;2:679–689.
8. Zipp F, Aktas O. The brain as a target of inflammation:
Common pathways link inflammatory and
neurodegenerative diseases. Trends Neurosci
9. Centonze D, Finazzi-Agr `
The endocannabinoid system in targeting inflammatory
neurodegenerative diseases. Trends Pharmacol Sci
10. de Lago E, Fern´
andez-Ruiz J. Cannabinoids and
neuroprotection in motor-related disorders. CNS Neurol
Disord Drug Targets 2007;6:377–387.
11. Mechoulam R. Marihuana chemistry. Science
12. Pacher P, B´
atkai S, Kunos G. The endocannabinoid
system as an emerging target of pharmacotherapy.
Pharmacol Rev 2006;58:389–462.
13. Pertwee RG. Cannabinoid pharmacology: The first 66
years. Br J Pharmacol 2006;147(Suppl. 1):S163–S171.
14. Van Sickle MD, Duncan M, Kingsley PJ, Mouihate A,
Urbani P, Mackie K, Stella N, Makriyannis A, Piomelli D,
Davison JS, et al Identification and functional
characterization of brainstem cannabinoid CB2 receptors.
Science 2005;310:329–332.
15. Gong JP, Onaivi ES, Ishiguro H, Liu QR, Tagliaferro PA,
Brusco A, Uhl GR. Cannabinoid CB2 receptors:
Immunohistochemical localization in rat brain. Brain Res
16. Brown AJ. Novel cannabinoid receptors. Br J Pharmacol
17. Di Marzo V. Targeting the endocannabinoid system: To
enhance or reduce? Nat Rev Drug Discov 2008;7:
18. Ramirez BG, Blazquez C, Gomez del Pulgar T, Guzman
M, de Ceballos ML. Prevention of Alzheimer’s disease
pathology by cannabinoids: Neuroprotection mediated by
blockade of microglial activation. J Neurosci
19. Esposito G, De Filippis D, Steardo L, Scuderi C, Savani C,
Cuomo V, Iuvone T. CB1 receptor selective activation
inhibits beta-amyloid-induced iNOS protein expression
in C6 cells and subsequently blunts tau protein
hyperphosphorylation in co-cultured neurons. Neurosci
Lett 2006;404:342–346.
20. Van Der Stelt M, Mazzola C, Esposito G, Matias I,
Petrosino S, De Filippis D, et al. Endocannabinoids and
beta-amyloid-induced neurotoxicity in vivo: Effect of
pharmacological elevation of endocannabinoid levels. Cell
Mol Life Sci 2006;63:1410–1424.
21. Esposito G, Iuvone T, Savani C, Scuderi C, De Filippis D,
Papa M, et al. Opposing control of cannabinoid receptor
stimulation on amyloid-beta-induced reactive gliosis: In
vitro and in vivo evidence. J Pharmacol Exp Ther
22. Iuvone T, Esposito G, De Filippis D, Bisogno T, Petrosino
S, Scuderi C, et al. Cannabinoid CB(1) receptor
stimulation affords neuroprotection in MPTP-induced
neurotoxicity by attenuating S100B up-regulation in
vitro. JMolMed2007;85:1379–1392.
23. EspositoG,LigrestiA,IzzoAA,BisognoT,RuvoM,Di
Rosa M, et al. The endocannabinoid system protects rat
glioma cells against HIV-1 Tat protein-induced
cytotoxicity. Mechanism and regulation. J Biol Chem
24. Trapp BD, Nave KA. Multiple sclerosis: An immune or
neurodegenerative disorder? Annu Rev Neurosci
25. Shoemaker JL, Seely KA, Reed RL, Crow JP, Prather PL.
The CB2 cannabinoid agonist AM-1241 prolongs survival
in a transgenic mouse model of amyotrophic lateral
sclerosis when initiated at symptom onset. J Neurochem
26. Bilsland LG, Dick JR, Pryce G, Petrosino S, Di Marzo V,
Baker D, Greensmith L. Increasing cannabinoid levels by
pharmacological and genetic manipulation delay disease
progression in SOD1 mice. FASEB J 2006;20:1003–1005.
72 CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd
T. Iuvone et al.Cannabidiol and Neurodegeneration
27. Mechoulam R, Hanus L. Cannabidiol: An overview of
some chemical and pharmacological aspects. Part I:
chemical aspects. Chem Phys Lipids 2002;121:35–43.
28. No author listed. Cannabis-based medicines–GW
pharmaceuticals: High CBD, high THC, medicinal
Cannabis–GW pharmaceuticals, THC:CBD. Drugs RD
29. Perras C. Sativex for the management of multiple sclerosis
symptoms. Issues Emerg Health Technol 2005;72:1–4.
30. Karniol IG, Shirakawa I, Kasinski N, Pfeferman A, Carlini
EA. Cannabidiol interferes with the effects of delta 9-
tetrahydrocannabinol in man. Eur J Pharmacol
31. Zuardi AW, Shirakawa I, Finkelfarb E, Karniol IG. Action
of cannabidiol on the anxiety and other effects produced
by delta 9-THC in normal subjects. Psychopharmacology
(Berl) 1982;76:245–250.
32. Russo E, Guy GW. A tale of two cannabinoids: The
therapeutic rationale for combining tetrahydrocannabinol
and cannabidiol. Med Hypotheses 2006;66:234–246.
33. Mechoulam R, Shani A, Edery H, Grunfeld Y. Chemical
basis of hashish activity. Science 1970;169:611–612.
34. Thomas BF, Gilliam AF, Burch DF, Roche MJ, Seltzman
HH. Comparative receptor binding analyses of
cannabinoid agonists and antagonists. J Pharmacol Exp
Ther 1998;285:285–292.
35. Griffin G, Atkinson PJ, Showalter VM, Martin BR, Abood
ME. Evaluation of cannabinoid receptor agonists and
antagonists using the
guanosine-5’-O-(3-35S]thio)-triphosphate binding assay
in rat cerebellar membranes. J Pharmacol Exp Ther
36. Thomas A, Baillie GL, Phillips AM, Razdan RK, Ross RA,
Pertwee RG. Cannabidiol displays unexpectedly high
potency as an antagonist of CB1 and CB2 receptor
agonists in vitro. Br J Pharmacol 2007;150:613–623.
37. Bisogno T, Hanus L, De Petrocellis L, Tchilibon S, Ponde
DE, Brandi I, et al. Molecular targets for cannabidiol and
its synthetic analogues: Effect on vanilloid VR1 receptors
and on the cellular uptake and enzymatic hydrolysis of
anandamide. Br J Pharmacol 2001;134:845–852.
38. De Filippis D, Iuvone T, D’Amico A, Esposito G, Steardo
L, Herma AG, et al. Effect of cannabidiol on
sepsis-induced motility disturbances in mice:
Involvement of CB1 receptors and fatty acid amide
hydrolase. Neurograstroenterol Motil 2008;20:919–927.
39. Ryan D, Drysdale AJ, Pertwee RG, Platt B. Interactions
of cannabidiol with endocannabinoid signalling in
hippocampal tissue. Eur J Neurosci 2007;25:2093–
40. Costa B, Giagnoni G, Franke C, Trovato AE, Colleoni M.
Vanilloid TRPV1 receptor mediates the antihyperalgesic
effect of the nonpsychoactive cannabinoid, cannabidiol,
in a rat model of acute inflammation. Br J Pharmacol
41. Russo EB, Burnett A, Hall B, Parker KK. Agonistic
properties of cannabidiol at 5-HT1A receptors. Neurochem
Res 2005;30:1037–1043.
42. Kathmann M, Flau K, Redmer A, Tr¨
ankle C, Schlicker E.
Cannabidiol is an allosteric modulator at mu- and
delta-opioid receptors. Naunyn Schmiedebergs Arch
Pharmacol 2006;372:354–361.
43. Grotenhermen F. Pharmacokinetics and
pharmacodynamics of cannabinoids. Clin Pharmacokinet
44. Samara E, Bialer M, Harvey DJ. Metabolism of
cannabidiol by the rat. Eur J Drug Metab Pharmacokinet
45. Harvey DJ, Mechoulam R. Metabolites of cannabidiol
identified in human urine. Xenobiotica 1990;20:
46. Samara E, Bialer M, Harvey DJ. Identification of glucose
conjugates as major urinary metabolites of cannabidiol in
the dog. Xenobiotica 1990;20:177–183.
47. Samara E, Bialer M, Harvey DJ. Pharmacokinetics of
urinary metabolites of cannabidiol in the dog. Biopharm
Drug Dispos 1990;11:785–795.
48. Rosenkrantz H, Fleischman RW, Grant RJ. Toxicity of
short-term administration of cannabinoids to rhesus
monkeys. Toxicol Appl Pharmacol 1981;58:118–131.
49. Rosenkrantz H, Hayden DW. Acute and subacute
inhalation toxicity of Turkish marihuana,
cannabichromene, and cannabidiol in rats. Toxicol Appl
Pharmacol 1979;48:375–386.
50. Samara E, Brown NK, Harvey DJ. Microsomal
metabolism of the 1”,1”-dimethylheptyl analogue of
cannabidiol: Relative percentage of monohydroxy
metabolites in four species. Drug Metab Dispos
51. Ligresti A, Moriello AS, Starowicz K, Matias I, Pisanti S,
De Petrocellis L, et al. Antitumor activity of plant
cannabinoids with emphasis on the effect of cannabidiol
on human breast carcinoma. J Pharmacol Exp Ther
52. Ligresti A, Bisogno T, Matias I, De Petrocellis L, Cascio
MG, Cosenza V, et al. Possible endocannabinoid control
of colorectal cancer growth. Gastroenterology
53. Vaccani A, Massi P, Colombo A, Rubino T, Parolaro D.
Cannabidiol inhibits human glioma cell migration
through a cannabinoid receptor-independent mechanism.
Br J Pharmacol 2005;144:1032–1036.
54. McKallip RJ, Jia W, Schlomer J, Warren JW, Nagarkatti
PS, Nagarkatti M. Cannabidiol-induced apoptosis in
human leukemia cells: A novel role of cannabidiol in the
regulation of p22phox and Nox4 expression. Mol
Pharmacol 2006;70:897–908.
55. Sacerdote P, Martucci C, Vaccani A, Bariselli F, Panerai
AE, Colombo A, et al. The nonpsychoactive component of
marijuana cannabidiol modulates chemotaxis and IL-10
CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd 73
Cannabidiol and Neurodegeneration T. Iuvone et al.
and IL-12 production of murine macrophages both in
vivo and in vitro. J Neuroimmunol 2005;159:97–105.
56. Costa B, Colleoni M, Conti S, Parolaro D, Franke C,
Trovato AE, et al. Oral anti-inflammatory activity of
cannabidiol, a non-psychoactive constituent of Cannabis,
in acute carrageenan-induced inflammation in the rat
paw. Naunyn Schmiedebergs Arch Pharmacol
57. Formukong EA, Evans AT, Evans FJ. Analgesic and
antiinflammatory activity of constituents of Cannabis
sativa L. Inflammation 1988;12:361–371.
58. Watzl B, Scuderi P, Watson RR. Marijuana components
stimulate human peripheral blood mononuclear cell
secretion of interferon-gamma and suppress interleukin-1
alpha in vitro. Int J Immunopharmacol 1991;13:1091–1097.
59. Srivastava MD, Srivastava BI, Brouhard B. Delta9
tetrahydrocannabinol and cannabidiol alter cytokine
production by human immune cells. Immunopharmacology
60. Walter L, Franklin A, Witting A, Wade C, Xie Y, Kunos G,
et al. Nonpsychotropic cannabinoid receptors regulate
microglial cell migration. J Neurosci 2003;23:1398–1405.
61. Hampson AJ, Grimaldi M, Axelrod J, Wink D.
Cannabidiol and ()delta9-tetrahydrocannabinol are
neuroprotective antioxidants. Proc Natl Acad Sci U S A
62. El-Remessy AB, Khalil IE, Matragoon S, Abou-Mohamed
G, Tsai NJ, Roon P, Caldwell RB, et al. Neuroprotective
effect of (-)delta9-tetrahydrocannabinol and cannabidiol
in N-methyl-D-aspartate-induced retinal neurotoxicity:
Involvement of peroxynitrite. Am J Pathol
63. Iuvone T, Esposito G, Esposito R, Santamaria R, Di Rosa
M, et al. Neuroprotective effect of cannabidiol, a
non-psychoactive component from Cannabis sativa,on
beta-amyloid-induced toxicity in PC12 cells. J Neurochem
64. Hayakawa K, Mishima K, Nozako M, Hazekawa M, Irie K,
Fujioka M, et al. Delayed treatment with cannabidiol has
a cerebroprotective action via a cannabinoid
receptor-independent myeloperoxidase-inhibiting
mechanism. J Neurochem 2007;102:1488–1496.
65. Hayakawa K, Mishima K, Abe K, Hasebe N, Takamatsu F,
Yasuda H, Ikeda T, Inui K, Egashira N, Iwasaki K, et al
Cannabidiol prevents infarction via the non-CB1
cannabinoid receptor mechanism. Neuroreport
66. Mishima K, Hayakawa K, Abe K, Ikeda T, Egashira N,
Iwasaki K, Fujiwara M. Cannabidiol prevents cerebral
infarction via a serotonergic 5-hydroxytryptamine1A
receptor-dependent mechanism. Stroke
67. Wettschureck N, Van Der Stelt M, Tsubokawa H, Krestel
H, Moers A, Petrosino S, Sch ¨
Offermanns S. Forebrain-specific inactivation of Gq/G11
family G proteins results in age-dependent epilepsy and
impaired endocannabinoid formation. Mol Cell Biol
68. Esposito G, De Filippis D, Maiuri MC, De Stefano D,
Carnuccio R, Iuvone T. Cannabidiol inhibits inducible
nitric oxide synthase protein expression and nitric oxide
production in beta-amyloid stimulated PC12 neurons
through p38 MAP kinase and NF-kappaB involvement.
Neurosci Lett 2006;399:91–95.
69. Esposito G, De Filippis D, Carnuccio R, Izzo AA, Iuvone T.
The marijuana component cannabidiol inhibits
beta-amyloid-induced tau protein hyperphosphorylation
through Wnt/beta-catenin pathway rescue in PC12 cells.
70. Esposito G, Scuderi C, Savani C, Steardo L Jr, De Filippis
D, Cottone P, et al. Cannabidiol in vivo blunts
beta-amyloid induced neuroinflammation by suppressing
IL-1beta and iNOS expression. Br J Pharmacol
71. Lastres-Becker I, Molina-Holgado F, Ramos JA,
Mechoulam R, Fern´
andez-Ruiz J. Cannabinoids provide
neuroprotection against 6-hydroxydopamine toxicity in
vivo and in vitro: Relevance to Parkinson’s disease.
Neurobiol Dis 2005;19:96–107.
72. Consroe P, Sandyk R, Snider SR. Open label evaluation of
cannabidiol in dystonic movement disorders. Int J Neurosci
73. Carroll CB, Bain PG, Teare L, Liu X, Joint C, Wroath C,
Parkin SG, Fox P, Wright D, Hobart J, et al Cannabis for
dyskinesia in Parkinson disease: A randomized
double-blind crossover study. Neurology
74. Consroe P, Musty R, Conti L. Effects of cannabidiol in
animal models of neurological dysfunctions. In:Chester G,
Consroe P, Musty R, editors. Marijuana: An International
Research Report: Proceedings of the Melbourne Symposium on
Cannabis. Canberra: Australian Government Publishing
Service, 1988; 147–151.
75. Sagredo O, Ramos JA, Decio A, Mechoulam R,
andez-Ruiz J. Cannabidiol reduced the striatal
atrophy caused 3-nitropropionic acid in vivo by
mechanisms independent of the activation of
cannabinoid, vanilloid TRPV1 and adenosine A2A
receptors. Eur J Neurosci 2007;26:843–851.
76. Consroe P, Laguna J, Allender J, Snider S, Stern L,
Sandyk R, Kennedy K, Schram K. Controlled clinical trial
of cannabidiol in Huntington’s disease. Pharmacol Biochem
Behav 1991;40:701–708.
77. Turner BJ, Talbot K. Transgenics, toxicity and
therapeutics in rodent models of mutant SOD1-mediated
familial ALS. Prog Neurobiol 2008;85:94–134.
78. Weydt P, Hong S, Witting A, M ¨
oller T, Stella N, Kliot M.
Cannabinol delays symptom onset in SOD1 (G93A)
transgenic mice without affecting survival. Amyotroph
Lateral Scler Other Motor Neuron Disord 2005;6:182–184.
74 CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd
T. Iuvone et al.Cannabidiol and Neurodegeneration
79. Compston A, Coles A. Multiple sclerosis. Lancet
80. Coles AJ, Cox A, Le Page E, Jones J, Trip SA, Deans J,
Seaman S, Miller DH, Hale G, Waldmann H, et al The
window of therapeutic opportunity in multiple sclerosis:
Evidence from monoclonal antibody therapy. J Neurol
81. Polman C, Schellekens H, Killestein J. Neutralizing
antibodies to interferon-beta may persist after cessation of
therapy: What impact could they have? Mult Scler
82. Confavreux C, Vukusic S. Natural history of multiple
sclerosis: A unifying concept. Brain 2006;129:606–616.
83. Metz I, Lucchinetti CF, Openshaw H, Garcia-Merino A,
Lassmann H, Freedman MS, Atkins HL, Azzarelli B, Kolar
OJ, Br ¨
uck W. Autologous haematopoietic stem cell
transplantation fails to stop demyelination and
neurodegeneration in multiple sclerosis. Brain
84. Consroe P, Musty R, Rein J, Tillery W, Pertwee R. The
perceived effects of smoked Cannabis on patients with
multiple sclerosis. Eur Neurol 1997;38:44–48.
85. Ni X, Geller EB, Eppihimer MJ, Eisenstein TK, Adler MW,
Tuma RF. Win 55212–2, a cannabinoid receptor agonist,
attenuates leukocyte/endothelial interactions in an
experimental autoimmune encephalomyelitis model.
Mult Scler 2004;10:158–164.
86. Cabranes A, Venderova K, de Lago E, Fezza F, S´
anchez A,
Mestre L, Valenti M, Garc´
ıa-Merino A, Ramos JA, Di
Marzo V, et al Decreased endocannabinoid levels in the
brain and beneficial effects of agents activating
cannabinoid and/or vanilloid receptors in a rat model of
multiple sclerosis. Neurobiol Dis 2005;20:207–217.
87. S´
anchez AJ, Gonz´
erez P, Galve-Roperh I,
ıa-Merino A. R-(+)-2,3-dihydro-5-methyl-3-(4-
yl]-1-naphtalenylmethanone (WIN-2) ameliorates
experimental autoimmune encephalomyelitis and
induces encephalitogenic T cell apoptosis: Partial
involvement of the CB(2) receptor. Biochem Pharmacol
88. Maresz K, Pryce G, Ponomarev ED, Marsicano G,
Croxford JL, Shriver LP, Ledent C, Cheng X, Carrier EJ,
Mann MK, et al Direct suppression of CNS autoimmune
inflammation via the cannabinoid receptor CB1 on
neurons and CB2 on autoreactive T cells. Nat Med
89. Zajicek JP, Sanders HP, Wright DE, Vickery PJ, Ingram
WM, Reilly SM, Nunn AJ, Teare LJ, Fox PJ, Thompson
AJ. Cannabinoids in multiple sclerosis (CAMS) study:
Safety and efficacy data for 12 months follow up. J Neurol
Neurosurg Psychiatry 2005;76:1664–1669.
90. Croxford JL, Pryce G, Jackson SJ, Ledent C, Giovannoni
G, Pertwee RG, Yamamura T, Baker D.
Cannabinoid-mediated neuroprotection, not
immunosuppression, may be more relevant to multiple
sclerosis. J Neuroimmunol 2008;193:120–129.
91. Meinck HM, Schonle PW, Conrad B. Effect of
cannabinoids on spasticity and ataxia in multiple
sclerosis. J Neurol 1989;236:120–122.
92. Rog DJ, Nurmikko TJ, Young CA. Oromucosal
delta9-tetrahydrocannabinol/cannabidiol for neuropathic
pain associated with multiple sclerosis: An uncontrolled,
open-label, 2-year extension trial. Clin Ther
93. Collin C, Davies P, Mutiboko IK, Ratcliffe S, for the
Sativex Spasticity in MS Study Group. Randomized
controlled trial of Cannabis-based medicine in spasticity
caused by multiple sclerosis. Eur J Neurol
94. Russo EB, Guy GW, Robson PJ. Cannabis, pain, and sleep:
Lessons from therapeutic clinical trials of Sativex, a
Cannabis-based medicine. Chem Biodivers
95. Iskedjian M, Bereza B, Gordon A, Piwko C, Einarson TR.
Meta-analysis of Cannabis-based treatments for
neuropathic and multiple sclerosis-related pain. Curr Med
Res Opin 2007;23:17–24.
96. Brady CM, DasGupta R, Dalton C, Wiseman OJ, Berkley
KJ, Fowler CJ. An open-label pilot study of
Cannabis-based extracts for bladder dysfunction in
advanced multiple sclerosis. Mult Scler 2004;10:425–
97. Dirikoc S, Priola SA, Marella M, Zs ¨
urger N, Chabry J.
Nonpsychoactive cannabidiol prevents prion
accumulation and protects neurons against prion toxicity.
J Neurosci 2007;27:9537–9544.
98. Hampson AJ, Grimaldi M, Lolic M, Wink D, Rosenthal R,
Axelrod J. Neuroprotective antioxidants from marijuana.
Ann N Y Acad Sci 2000;899:274–282.
99. Hayakawa K, Mishima K, Hazekawa M, Sano K, Irie K,
Orito K, et al. Cannabidiol potentiates pharmacological
effects of delta(9)-tetrahydrocannabinol via CB(1)
receptor-dependent mechanism. Brain Res
100. Whittle BA, Guy GW, Robson P. Prospects for new
Cannabis-based prescription medicines. J Cannabis Therap
CNS Neuroscience & Therapeutics 15 (2009) 65–75 c
2009 Blackwell Publishing Ltd 75
... Selain itu, antara faedah lain yang diketahui, CBD juga bertindak sebagai agen anti-psikotik, anti-loya, neuroprotektif, anti-kanser dan antidiabetes, semuanya tanpa mengakibatkan kesan sampingan yang terlalu kuat (Aizpuruaolaizola et al., 2016;Rock et al., 2011). Terdapat bukti bahawa CBD berpotensi untuk dieksploitasi dalam rawatan dan melegakan pelbagai gejala yang berkaitan dengan gangguan neurologi seperti epilepsi dan sawan (Hofmann dan Frazier, 2013;Jones et al., 2010), psikosis (Leweke et al., 2016), kebimbangan (Bergamaschi et al., 2011) dan gangguan pergerakan (contohnya, penyakit Huntington dan sklerosis lateral amyotrophic) (de Lago dan Fernandez-Ruiz, 2007;Iuvone et al., 2009). Manakala migrain, gastrik, alahan, sakit tulang belakang dan asma merupakan penyakit biasa/gejala yang biasa dirawat dengan hemp (Ware et al., 2005). ...
Artikel ini menganalisis hukum penanaman kanabis atau ganja yang kerap diperbincangkan sejak kebelakangan ini khususnya dari segi manfaat terhadap keperluan perubatan kesihatan. Antara spesis kanabis yang dipercayai mengandungi manfaat kesihatan ialah hemp (Cannabis Sativa L.). Hemp dipercayai mampu bertindak sebagai terapi bagi pesakit gangguan saraf, autisme, kemurungan, parkinson dan kanser. Namun menurut undang-undang Malaysia, kanabis disenaraikan dalam Akta Dadah Berbahaya 1952 yang mengharamkan penanaman, pengeluaran, pengedaran, import, eskport, pemilikan dan penyalahgunaannya. Artikel ini juga bertujuan untuk meneliti asas-asas keharusan penanaman pokok tersebut daripada sudut pertimbangan maslahah dan mafsadah dalam konteks penjagaan maqasid syariah yang lebih luas. Sebagai sebuah kajian kualitatif, metod analisis kandungan akan digunakan bagi memperoleh pandangan fuqaha Islam mengenai hukum penanaman hasyish (ganja), khasykhasy (popi), tabg (tembakau) dan dan fatwa-fatwa semasa yang berkaitan daripada pelbagai institusi hukum yang berautoriti. Bagi menentukan hukumnya pada masa kini, aspek maslahah dan mafsadah perlu dipertimbangkan dengan mengambilkira ketetapan undang-undang negara. Seterusnya, kajian ini telah mendapati bahawa spesis hemp adalah suci dan tidak dianggap najis namun keharusan penanamannya tertakluk kepada beberapa garis panduan bagi mengelak timbulnya kesan kemudaratan kepada masyarakat. This article analyses the ruling regarding the cultivation of cannabis or ganja which has often been discussed in recent times, particularly in terms of its benefits for medical health needs. Hemp is one of the varieties of cannabis thought to have health advantages (Cannabis Sativa L.). Patients with cancer, Parkinson's disease, depression, anxiety disorders, and autism may benefit from using hemp as a therapy. However, as per the Dangerous Drugs Act 1952 in Malaysia, cannabis is prohibited from being cultivated, produced, distributed, imported, exported, possessed, or abused. This article also aims to examine the fundamentals of the necessity of planting cannabis from the point of view of maslahah and mafsadah in the context of taking care of the wider shariah maqasid. As a qualitative study, the content analysis method will be employed to obtain the views of Islamic jurists regarding the legality of cultivating hasyish (marijuana), khasykhasy (poppy), tabg (tobacco) as well as the pertinent current fatwas from multiple reputable legal institutions. Today, the maslahah and mafsadah aspects must be taken into consideration while determining the law, keeping in mind the provisions of national law. Next, this study has shown that although the hemp species is sacred and not regarded as impure, its cultivation needs to adhere to a number of rules in order to prevent negative effects on the community
... CBD has been reported to decrease neuronal damage and to promote growth and development of new neurons [10,35]. Cannabinoids with antiinflammatory and anti-oxidative properties have been tested in a variety of preclinical models with promising neuroprotective benefits [36,37]. CBD has favorable pharmacological actions, but its clinical application is limited due to its poor solubility in water and reduced stability. ...
Full-text available
A major obstacle to fulfilling the therapeutic promise of gene therapies for hereditary brain diseases, such as Huntington’ Disease (HD), is the requirement for viral vectors and/or an invasive delivery system (stereotaxic injection into brain or infusion into the intrathecal space). HD is an autosomal dominant neurodegenerative disease for which several clinical trials have demonstrated gene-lowering effects following intrathecal administration. These technical limitations have given impetus to the development of alternative non-invasive delivery systems for gene therapy of brain diseases. The overall objective of this review is to discuss the key features in the design of nanocarriers for intranasal administration of gene-therapy for HD, focusing primarily on our series of published work on the use of nanocarriers for gene therapy. Design and development of nanocarriers packaged with gene-lowering agents represents a significant advance towards non-invasive nose-to-brain delivery of gene therapy for HD and other hereditary brain disorders.
... Herein, we report on the effects of oral cannabinoids on systemic inflammation, markers of gut mucosal damage, lymphoid and myeloid immune cell subsets, and markers of HIV persistence in PWH under suppressive ART. Given their synergistic effect, and the fact that CBD tends to improve the tolerability of THC when administered together [51][52][53][54], a THC:CBD combination was selected for one arm of this study. A formulation containing only CBD was also selected, in order to document effects related to the use of CBD in isolation. ...
Full-text available
Chronic HIV infection is characterized by persistent inflammation despite antiretroviral therapy (ART). Cannabinoids may help reduce systemic inflammation in people with HIV (PWH). To assess the effects of oral cannabinoids during HIV, ten PWH on ART were randomized (n = 5/group) to increasing doses of oral Δ9-tetrahydrocannabinol (THC): cannabidiol (CBD) combination (2.5:2.5–15:15 mg/day) capsules or CBD-only (200–800 mg/day) capsules for 12 weeks. Blood specimens were collected prospectively 7–21 days prior to treatment initiation and at weeks 0 to 14. Plasma cytokine levels were determined via Luminex and ELISA. Immune cell subsets were characterized by flow cytometry. HIV DNA/RNA were measured in circulating CD4 T-cells and sperm by ultra-sensitive qPCR. Results from both arms were combined for statistical analysis. Plasma levels of IFN-γ, IL-1β, sTNFRII, and REG-3α were significantly reduced at the end of treatment (p ˂ 0.05). A significant decrease in frequencies of PD1+ memory CD4 T-cells, CD73+ regulatory CD4 T-cells, and M-DC8+ intermediate monocytes was also observed (p ˂ 0.05), along with a transient decrease in CD28–CD57+ senescent CD4 and CD8 T-cells. Ki-67+ CD4 T-cells, CCR2+ non-classical monocytes, and myeloid dendritic cells increased over time (p ˂ 0.05). There were no significant changes in other inflammatory markers or HIV DNA/RNA levels. These findings can guide future large clinical trials investigating cannabinoid anti-inflammatory properties.
... 13 CBD treatment of neurological diseases has shown promising effect in the treatment of multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer's disease, and chronic neurological pain. 12,14 Mental health conditions such as anxiety and post-traumatic stress disorder (PTSD) have also shown promising results in clinical trials with cannabinoids. CBD anxiety trials have shown efficacy in reducing subjective anxiety and increasing mental sedation. ...
Background: Parkinson's disease (PD) is a serious neurodegenerative condition impacting many individuals worldwide. There is a need for new non-invasive treatments of PD. Cannabinoids in the form of cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) may offer utility as treatment, and our objective was hence to conduct a systematic review regarding the clinical evidence for the efficacy and safety of cannabinoids in treating PD. Methods: Screening, data extraction, and quality assessments were all conducted by multiple reviewers, with discrepancies resolved by consensus. Results: After conducting searches in 4 different databases, 673 articles were screened. Thirteen articles were deemed eligible for inclusion in this review. It was shown that cannabis, CBD, and nabilone (a synthetic form of THC) were capable of consistently improving motor symptoms more than a placebo. All treatments improved various non-motor symptoms, particularly with cannabis improving pain intensity, and CBD improving psychiatric symptoms in a dose-dependent manner. Adverse effects were usually minor, and, in the case of CBD, rare (except at very high doses). Conclusion: Cannabinoids have been shown to safely offer important potential in treating motor symptoms in PD and some non-motor symptoms. More large-scale randomized control trials for specific forms of cannabinoid treatments are required to determine their overall efficacy.
Most teenagers mix up various psychoactive cocktail substances in combinations to get intoxicated. The role of the mixture combination of codeine (CDE), tramadol (TMD), and Cannabis sativa (CNB) on brain cognition, purinergic, cholinergic, and antioxidant enzyme activities remains unknown. This study sought to assess the mechanism of action of combinations of CDE+ TMD+ CNB on the function and activities of the brain of male Wistar rats. Forty-eight male Wistar rats were divided into 8 groups, n = 6. Group 1 served as a control, groups 2, 3, and 4 were exposed to CDE (2mg/kg bw), TMD (10mg/kg bw), and CNB (200mg/kg bw), while groups 5, 6, 7, and 8 were co-administered with CDE+TMD, CNB+ TMD, CNB+CDE, and CNB+TMD+CDE orally for 28 days. This study revealed the effect of prolonged administration of CNB, TMD, and CDE on the suppression of cognitive function, acetyl-cholinesterase (AChE), butyl-cholinesterase (BChE), monoamine oxidase (MAO) enzyme activities, and antioxidant enzyme activities in rats' brains when compared against control rats (P< 0.05). However, the activities of ectonucleosides (NTPdase), adenosine deaminase (ADA), and malondialdehyde levels produced in the brain of rats were significantly elevated (P< 0.05). This study reported the mechanism behind the neurotoxicity of CNB, TMD, and CDE on rats' cognitive, cholinergic, purinergic, and antioxidant enzymes as a consequence of the drastic reduction in cholinesterase enzyme activities leading to neurotransmitter poisoning.
(-)-Cannabidiol is a class of non-psychoactive plant cannabinoids derived from cannabis plants. Currently, Epidiolex (Cannabidiol) has been approved by the FDA for the treatment of two rare and severe forms of epilepsy related diseases, namely Lennox-Gastaut syndrome (LGS) and Dravet (DS). In addition, Cannabidiol and its structural analogues have received increasing attention due to their potential therapeutic effects such as neuroprotection, anti-epilepsy, anti-inflammation, anti-anxiety, and anti-cancer. Based on literature review, no comprehensive reviews on the synthesis of Cannabidiol and its derivatives have been found in recent years. Therefore, this article summarizes the published synthesis methods of Cannabidiol and the synthesis routes of Cannabidiol derivatives, and introduces the biological activities of some Cannabidiol analogues that have been studied extensively and have significant activities.
Full-text available
Kenevir ve sağlık
Epilepsy (EP) is a long-term neurological disorder characterized by neuroinflammatory responses, neuronal apoptosis, imbalance between excitatory and inhibitory neurotransmitters, and oxidative stress in the brain. Autophagy is a process of cellular self-regulation to maintain normal physiological functions. Emerging evidence suggests that dysfunctional autophagy pathways in neurons are a potential mechanism underlying EP pathogenesis. In this review, we discuss current evidence and molecular mechanisms of autophagy dysregulation in EP and the probable function of autophagy in epileptogenesis. Moreover, we review the autophagy modulators reported for the treatment of EP models, and discuss the obstacles to, and opportunities for, the potential therapeutic applications of novel autophagy modulators as EP therapies. Teaser: Defective autophagy affects the onset and progression of epilepsy, and many anti-epileptic drugs have autophagy-modulating effects.
Full-text available
Objective: To test the effectiveness and long term safety of cannabinoids in multiple sclerosis (MS), in a follow up to the main Cannabinoids in Multiple Sclerosis (CAMS) study. Methods: In total, 630 patients with stable MS with muscle spasticity from 33 UK centres were randomised to receive oral D9-tetrahydrocannabinol (D9-THC), cannabis extract, or placebo in the main 15 week CAMS study. The primary outcome was change in the Ashworth spasticity scale. Secondary outcomes were the Rivermead Mobility Index, timed 10 metre walk, UK Neurological Disability Score, postal Barthel Index, General Health Questionnaire-30, and a series of nine category rating scales. Following the main study, patients were invited to continue medication, double blinded, for up to12 months in the follow up study reported here. Results: Intention to treat analysis of data from the 80% of patients followed up for 12 months showed evidence of a small treatment effect on muscle spasticity as measured by change in Ashworth score from baseline to 12 months (D9-THC mean reduction 1?82 (n=154, 95% confidence interval (CI) 0.53 to 3.12), cannabis extract 0.10 (n=172, 95% CI 20.99 to 1.19), placebo 20.23 (n=176, 95% CI 21.41 to 0.94); p=0.04 unadjusted for ambulatory status and centre, p=0.01 adjusted). There was suggestive evidence for treatment effects of D9-THC on some aspects of disability. There were no major safety concerns. Overall, patients felt that these drugs were helpful in treating their disease. Conclusions: These data provide limited evidence for a longer term treatment effect of cannabinoids. A long term placebo controlled study is now needed to establish whether cannabinoids may have a role beyond symptom amelioration in MS.
Full-text available
Cannabis is now emerging from a period of prohibition and being revisited as a potential source of treatments for conditions ill served by synthetic substances. Previous research focussed primarily on effects produced by synthetic cannabinoids such as THC, or cannabis of unknown cannabinoid content. Chemovars of cannabis characterized by high content of specific cannabinoids (primarily, but not only THC and CBD) have been developed. Clinical research using defined extracts from these chemovars is now underway in the UK.Many diseases are multifactorial; a variety of receptors need to be targeted to produce a therapeutic effect. A defined botanical may better achieve this than a single synthetic compound as the components can act synergistically. A new generation of cannabis based medicinal products takes advantage of increasing understanding of the mode of action of cannabinoids, evidence-based research on clinical uses and new technology for realization of products, in anti-diversionary presentations.
Full-text available
In glaucoma, the increased release of glutamate is the major cause of retinal ganglion cell death. Cannabinoids have been demonstrated to protect neuron cultures from glutamate-induced death. In this study, we test the hypothesis that glutamate causes apoptosis of retinal neurons via the excessive formation of peroxynitrite, and that the neuroprotective effect of the psychotropic Delta9-tetrahydroxycannabinol (THC) or nonpsychotropic cannabidiol (CBD) is via the attenuation of this formation. Excitotoxicity of the retina was induced by intravitreal injection of N-methyl-D-aspartate (NMDA) in rats, which also received 4-hydroxy-2,2,6,6-tetramethylpiperidine-n-oxyl (TEMPOL,a superoxide dismutase-mimetic), N-omega-nitro-L-arginine methyl ester (L-NAME, a nitric oxide synthase inhibitor), THC, or CBD. Retinal neuron loss was determined by TDT-mediated dUTP nick-end labeling assay, inner retinal thickness, and quantification of the mRNAs of ganglion cell markers. NMDA induced a dose- and time-dependent accumulation of nitrite/nitrate, lipid peroxidation, and nitrotyrosine (foot print of peroxynitrite), and a dose-dependent apoptosis and loss of inner retinal neurons. Treatment with L-NAME or TEMPOL protected retinal neurons and confirmed the involvement of peroxynitrite in retinal neurotoxicity. The neuroprotection by THC and CBD was because of attenuation of peroxynitrite. The effect of THC was in part mediated by the cannabinoid receptor CB1. These results suggest the potential use of CBD as a novel topical therapy for the treatment of glaucoma.
Multiple sclerosis is primarily an inflammatory disorder of the brain and spinal cord in which focal lymphocytic infiltration leads to damage of myelin and axons. Initially, inflammation is transient and remyelination occurs but is not durable. Hence, the early course of disease is characterised by episodes of neurological dysfunction that usually recover. However, over time the pathological changes become dominated by widespread microglial activation associated with extensive and chronic neurodegeneration, the clinical correlate of which is progressive accumulation of disability. Paraclinical investigations show abnormalities that indicate the distribution of inflammatory lesions and axonal loss (MRI); interference of conduction in previously myelinated pathways (evoked electrophysiological potentials); and intrathecal synthesis of oligoclonal antibody (examination by lumbar puncture of the cerebrospinal fluid). Multiple sclerosis is triggered by environmental factors in individuals with complex genetic-risk profiles. Licensed disease modifying agents reduce the frequency of new episodes but do not reverse fixed deficits and have questionable effects on the long-term accumulation of disability and disease progression. We anticipate that future studies in multiple sclerosis will provide a new taxonomy on the basis of mechanisms rather than clinical empiricism, and so inform strategies for improved treatment at all stages of the disease.
Multiple sclerosis is the prototype inflammatory autoimmune disorder of the central nervous system and, with a lifetime risk of one in 400, potentially the most common cause of neurological disability in young adults. As with all complex traits, the disorder results from an interplay between as yet unidentified environmental factors and susceptibility genes. Together, these factors trigger a cascade of events, involving engagement of the immune system, acute inflammatory injury of axons and glia, recovery of function and structural repair, post-inflammatory gliosis, and neurodegeneration. The sequential involvement of these processes underlies the clinical course characterised by episodes with recovery, episodes leaving persistent deficits, and secondary progression. The aim of treatment is to reduce the frequency, and limit the lasting effects, of relapses, relieve symptoms, prevent disability arising from disease progression, and promote tissue repair. Despite limited success in each of these categories, everyone touched by multiple sclerosis looks for a better dividend from applying an improved understanding of the pathogenesis to clinical management.
The object of the experiment was to verify whether cannabidiol (CBD) reduces the anxiety provoked by ?9-TCH in normal volunteers, and whether this effect occurs by a general block of the action of ?9-TCH or by a specific anxiolytic effect. Appropriate measurements and scales were utilized and the eight volunteers received, the following treatments in a double-blind procedure: 0.5 mg/kg ?9-TCH, 1 mg/kg CBD, a mixture containing 0.5 mg/kg ?9-TCH and 1 mg/kg CBD and placebo and diazepam (10 mg) as controls. Each volunteer received the treatments in a different sequence. It was verified that CBD blocks the anxiety provoked by ?9-TCH, however this effect also extended to marihuanalike effects and to other subjective alterations induced by ?9-TCH. This antagonism does not appear to be caused by a general block of ?9-TCH effects, since no change was detected in the pulse-rate measurements. Several further effects were observed typical of CBD and of an opposite nature to those of ?9-TCH.
Neurodegenerative diseases as diverse as Alzheimer's, Parkinson's, and Creutzfeldt-Jakob disease share a common pathogenetic mech- anism involving aggregation and deposition of misfolded proteins, which leads to progressive central nervous system disease. Although the type of aggregated protein and the regional and cellular distribu- tion of deposition vary from disease to disease, these disorders may all be linked by similar pathways of protein aggregation with fibril formation and amyloid deposition. This perspective on pathogene- sis suggests that a wide variety of neurodegenerative diseases can be grouped mechanistically as brain amyloidoses, an outlook that yields novel insights into potential therapeutic approaches that may be ap- plicable across the broad spectrum of neurodegenerative disease.
GW Pharmaceuticals is undertaking a major research programme in the UK to develop and market distinct cannabis-based prescription medicines [THC:CBD, High THC, High CBD] in a range of medical conditions. The cannabis for this programme is grown in a secret location in the UK.It is expected that the product will be marketed in the US in late 2003. GW's cannabis-based products include selected phytocannabinoids from cannabis plants, including D9 tetrahydrocannabinol (THC) and cannabidiol (CBD). The company is investigating their use in three delivery systems, including sublingual spray, sublingual tablet and inhaled (but not smoked) dosage forms. The technology is protected by patent applications. Four different formulations are currently being investigated, including High THC, THC:CBD (narrow ratio), THC:CBD (broad ratio) and High CBD. GW is also developing a specialist security technology that will be incorporated in all its drug delivery systems. This technology allows for the recording and remote monitoring of patient usage to prevent any potential abuse of its cannabis-based medicines.GW plans to enter into agreements with other companies following phase III development, to secure the best commercialisation terms for its cannabis-based medicines. In June 2003, GW announced that exclusive commercialisation rights for the drug in the UK had been licensed to Bayer AG. The drug will be marketed under the Sativex® brand name. This agreement also provides Bayer with an option to expand their license to include the European Union and certain world markets. GW was granted a clinical trial exemption certificate by the Medicines Control Agency to conduct clinical studies with cannabis-based medicines in the UK. The exemption includes investigations in the relief of pain of neurological origin and defects of neurological function in the following indications: multiple sclerosis (MS), spinal cord injury, peripheral nerve injury, central nervous system damage, neuroinvasive cancer, dystonias, cerebral vascular accident and spina bifida, as well as for the relief of pain and inflammation in rheumatoid arthritis and also pain relief in brachial plexus injury. The UK Government stated that it would be willing to amend the Misuse of Drugs Act 1971 to permit the introduction of a cannabis-based medicine.GW stated in its 2002 Annual Report that it was currently conducting five phase III trials of its cannabis derivatives, including a double-blind, placebo-controlled trial with a sublingual spray containing High THC in more than 100 patients with cancer pain in the UK. Also included is a phase III trial of THC:CBD (narrow ratio) being conducted in patients with severe pain due to brachial plexus injury, as are two more phase III trials of THC:CBD (narrow ratio) targeting spasticity and bladder dysfunction in multiple sclerosis patients. Another phase III trial of THC:CBD (narrow ratio) in patients with spinal cord injury is also being conducted. Results from the trials are expected during 2003.Three additional trials are also in the early stages of planning. These trials include a phase I trial of THC:CBD (broad ratio) in patients with inflammatory bowel disease, a phase I trial of High CBD in patients with psychotic disorders such as schizophrenia, and a preclinical trial of High CBD in various CNS disorders (including epilepsy, stroke and head injury).GW Pharmaceuticals submitted an application for approval of cannabis-based medicines to UK regulatory authorities in March 2003. Originally GW hoped to market cannabis-based prescription medicines by 2004, but is now planning for a launch in the UK towards the end of 2003.Several trials for GW's cannabis derivatives have also been completed, including four randomised, double-blind, placebo-controlled phase III clinical trials conducted in the UK. The trials were initiated by GW in April 2002, to investigate the use of a sublingual spray containing THC:CBD (narrow ratio) in the following medical conditions: pain in spinal cord injury, pain and sleep in MS and spinal cord injury, neuropathic pain in MS and general neuropathic pain (presented as allodynia). Results from these trials show that THC:CBD (narrow ratio) caused statistically significant reductions in neuropathic pain in patients with MS and other conditions. In addition, improvements in other MS symptoms were observed as well.Phase II studies of THC:CBD (narrow ratio) have also been completed in patients with MS, spinal cord injury, neuropathic pain and a small number of patients with peripheral neuropathy secondary to diabetes mellitus or AIDS. A phase II trial of THC:CBD (broad ratio) has also been completed in a small number of patients with rheumatoid arthritis, as has a trial of High CBD in patients with neurogenic symptoms. A phase II trial has also been evaluated with High THC in small numbers of