Crohn’s & IBD
Medical Cannabis Use Patterns And Adverse Effects In Inflammatory Bowel Disease
Ruby Greywoode, MD MS, Chinazo Cunningham, MD MS, Maegan Hollins, BS, Olga Aroniadis, MD MS (October 2022)
Of 236 respondents, overall IBD disease activity was mild-to-moderate. Most respondents (61.0%) took a biological. Median frequency of MC use was at least once within the past week. Most respondents used products with high Δ9-tetrahydrocannabinol content (87.5%) through vape pens/cartridges (78.6%). Respondents reported fewer emergency room visits in the 12 months after versus before MC use (35.2 vs 41.5%, P<0.01) and less impact of symptoms on daily life. Most respondents reported euphoria with MC use (75.4%). The other common side effects were feeling drowsy, groggy, or with memory lapses (4.2%), dry mouth/eyes (3.4%), and anxiety/depression or paranoia (3.4%). Few respondents reported MC diversion (1.3%).
MC users with IBD perceive symptom benefits and report decreased emergency room visits without serious adverse effects. Further studies are needed to confirm these results with objective measures of healthcare utilization and disease activity.
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The Effect of Medical Cannabis in Inflammatory Bowel Disease: Analysis from the UK Medical Cannabis Registry
Nishaanth Dalavaye, Simon Erridge, Martha Nicholas, Manaswini Pillai, Lara Bapir, Carl Holvey, Ross Coomber, James J Rucker, Jonathan Hoare & Mikael H. Sodergren (September 2022)
Initiation of CBMPs (cannabis-based medicinal products) was associated with an improvement in HRQoL (health-related quality of life) in the short term, with statistically significant improvements in IBD-specific and general HRQoL outcomes at 1 and 3 months after initiating treatment. Participants who previously consumed cannabis had greater improvements in HRQoL and fewer adverse events compared to naïve individuals. These findings highlight the potential utility of CBMPs as an adjunctive therapeutic option in the short term, especially in patients who continue to experience debilitating symptoms despite maximal medical therapy.
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Impact Of Cannabis Use On Inpatient Inflammatory Bowel Disease Outcomes In Two States Legalizing Recreational Cannabis
Antoinette Pusateri, MD, Ahmad Anaizi, MD, Laura Nemer, MD, Alice Hinton, PhD, Luis Lara, MD, Anita Afzali, MD, MPH, FACG (April 2022)
Few studies have explored the impact of cannabis use on inpatient IBD outcomes. Mbachi et al found that while only 1.4% of patients in the National Inpatient Sample (NIS) were coded as cannabis users, they were less likely to develop Crohn’s disease (CD)-related complications.11 Our study aim was to evaluate the impact of cannabis legalization and use on inpatient disease outcomes among adult patients with ulcerative colitis (UC) or CD, in 2 states before and after legalization of recreational cannabis.
Reported cannabis use increased after legalization (1.2% vs 4.2%, P < .001). On multivariable analysis, in 2011, cannabis users were less likely to need total parenteral nutrition (odds ratio 0.12, P = .038), and in 2015 had less hospital charges ($−8418, P = .024).
Cannabis users had less TPN (total parenteral nutrition) use than nonusers before legalization, and total hospital costs were significantly less among cannabis users after legalization.
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Cannabidiol Isolated From Cannabis sativa L. Protects Intestinal Barrier From In Vitro Inflammation And Oxidative Stress
Veronica Cocetta, Paolo Governa, Vittoria Borgonetti, Mattia Tinazzi, Gregorio Peron, Daniela Catanzaro, Massimiliano Berretta, Fabrizio Manetti, Stefano Dall’Acqua, Monica Montopoli (April 2021)
The gastrointestinal epithelium forms the body’s larger interface between the external environment providing a functional epithelial barrier that regulates the bi-directional flow of water, ions and macromolecules between the lumen and the host. The barrier selectively allows absorption of water and nutrients, while limiting the permeation of toxins and antigens (Schmitz et al., 1999; Ahmad et al., 2017). A breach in the mucosal barrier incites mucosal inflammation leading to a wide array of non-intestinal and intestinal disorders including clinically diagnosed inflammatory bowel disease (IBD). The selective barrier is regulated by both transcellular and paracellular transport mechanisms but is the paracellular pathway that has received the most attention for its role in regulation of mucosal permeability (D’Incà et al., 1999; Su et al., 2009) and initial clinical observation indicate that intestinal epithelium of IBD patients is more permeable to paracellular-permeable traces molecules (Hering, et al., 2012). These findings, also confirmed in mouse models, support a correlation between the mucosal leakiness and mucosal inflammatory conditions, suggesting that deregulation of intestinal barrier functions by dietary, microbial and immunological factors might precede the clinical IBD manifestation.
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Oral CBD-Rich Cannabis Induces Clinical But Not Endoscopic Response in Patients with Crohn’s Disease, a Randomised Controlled Trial
Timna Naftali, Lihi Bar-Lev Schleider, Schlomo Almog, David Meiri, Fred M. Konikoff (April 2021)
Eight weeks of CBD-rich cannabis treatment induced significant clinical and QOL improvement without significant changes in inflammatory parameters or endoscopic scores. The oral CBD-rich cannabis extract was well absorbed. Until further studies are available, cannabis treatment in Crohn’s disease should be used only in the context of clinical trials.
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Cannabis Is Associated With Clinical But Not Endoscopic Remission In Ulcerative Colitis: A Randomized Controlled Trial
Timna Naftali, Lihi Bar-Lev Schleider, Fabiana Scklerovsky Benjaminov, Fred Meir Konikoff, Shelly Tartakover Matalon, Yehuda Ringel (February 2021)
Cannabis is often used by patients with ulcerative colitis, but controlled studies are few. We aimed to assess the effect of cannabis in improving clinical and inflammatory outcomes in ulcerative colitis patients. Short term treatment with THC rich cannabis induced clinical remission and improved quality of life in patients with mild to moderately active ulcerative colitis. However, these beneficial clinical effects were not associated with significant anti-inflammatory improvement in the Mayo endoscopic score or laboratory markers for inflammation.
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If you proceed to article you will be leaving the CB1 Capital Management website to access a website hosted by a party unrelated to CB1 Capital Management. CB1 Capital Management assumes no responsibility for the accuracy of any of these studies nor does CB1 assume any obligation to update any of these studies based on subsequent research.
Intestinal P-glycoprotein exports endocannabinoids to prevent inflammation and maintain homeostasis
Rose L. Szabady, Christopher Louissaint, Anneke Lubben, Bailu Xie, Shaun Reeksting, Christine Tuohy, Zachary Demma, Sage E. Foley, Christina S. Faherty, Alejandro Llanos-Chea, Andrew J. Olive, Randall J. Mrsny, and Beth A. McCormick (August 2018)
Neutrophil influx into the intestinal lumen is a critical response to infectious agents, but is also associated with severe intestinal damage observed in idiopathic inflammatory bowel disease. The chemoattractant hepoxilin A3, an eicosanoid secreted from intestinal epithelial cells by the apically restricted efflux pump multidrug resistance protein 2 (MRP2), mediates this neutrophil influx. Information about a possible counterbalance pathway that could signal the lack of or resolution of an apical inflammatory signal, however, has yet to be described. We now report a system with such hallmarks. Specifically, we identify endocannabinoids as the first known endogenous substrates of the apically restricted multidrug resistance transporter P-glycoprotein (P-gp) and reveal a mechanism, which we believe is novel, for endocannabinoid secretion into the intestinal lumen. Knockdown or inhibition of P-gp reduced luminal secretion levels of N-acyl ethanolamine–type endocannabinoids, which correlated with increased neutrophil transmigration in vitro and in vivo. Additionally, loss of CB2, the peripheral cannabinoid receptor, led to increased pathology and neutrophil influx in models of acute intestinal inflammation. These results define a key role for epithelial cells in balancing the constitutive secretion of antiinflammatory lipids with the stimulated secretion of proinflammatory lipids via surface efflux pumps in order to control neutrophil infiltration into the intestinal lumen and maintain homeostasis in the healthy intestine.
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If you proceed to article you will be leaving the CB1 Capital Management website to access a website hosted by a party unrelated to CB1 Capital Management. CB1 Capital Management assumes no responsibility for the accuracy of any of these studies nor does CB1 assume any obligation to update any of these studies based on subsequent research.
Cannabis for the treatment of Crohn’s disease
Tahir S Kafil, Tran M Nguyen, John K MacDonald, Nilesh Chande (November 2017)
Usual treatment options for CD include anti-inflammatory and immunosuppressant agents (Friedman 2012). Commonly used drugs are 5-ASA, sulfasalazine, corticosteroids, thiopurine drugs, methotrexate and biologic therapies such as anti-TNF-α agents (Friedman 2012). Management includes control of acute exacerbations, induction of remission, and maintenance of remission. It is important to do this review to evaluate the strength of evidence for the use of cannabis and cannabinoids as treatment for CD. It will help clarify if this therapy leads to objective physiological improvement beyond subjective and psychotropic scores. Further, we hope to evaluate various modes of consumption and assess for adverse effects.
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If you proceed to article you will be leaving the CB1 Capital Management website to access a website hosted by a party unrelated to CB1 Capital Management. CB1 Capital Management assumes no responsibility for the accuracy of any of these studies nor does CB1 assume any obligation to update any of these studies based on subsequent research.
Cannabinoid Receptor-2 Ameliorates Inflammation in Murine Model of Crohn’s Disease
Kristina L Leinwand, Ashleigh A Jones, Rick H Huang, Paul Jedlicka, Daniel J Kao, Edwin F de Zoeten, Soumita Ghosh, Ruin Moaddel, Jan Wehkamp, Maureen J Ostaff, Jutta Bader, Carol M Aherne and Colm B Collins (October 2017)
In summary, the endocannabinoid system is induced in murine ileitis but is downregulated in chronic murine and human intestinal inflammation, and CB2R activation attenuates murine ileitis, establishing an anti-inflammatory role of the endocannabinoid system.
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Modulation of the Endocannabinoid System by the Fatty Acid Amide Hydrolase, Monoacylglycerol and Diacylglycerol Lipase Ihibitors as an Attractive Target for Secretory Diarrhoea Therapy
A. Wasilewski, A. Misicka, M. Sacharczuk, J. Fichna (August 2017)
Secretory diarrhoea is a leading cause of mortality and morbidity worldwide. Our aim was to characterize the effect of inhibition of selected enzymes involved in the synthesis or degradation of endocannabinoids on electrolyte equilibrium in the mouse colonic tissue. The aim of this study was to evaluate the effects of PF-3845, JZL-184 and RHC-80267, as inhibitors of fatty acid amide hydrolase (FAAH), monoacylglycerol (MAGL) and diacylglycerol lipase (DAGL), respectively on epithelial ion transport in isolated mouse colon stimulated by forskolin (FSK), veratridine (VER) and bethanechol (BET).
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If you proceed to article you will be leaving the CB1 Capital Management website to access a website hosted by a party unrelated to CB1 Capital Management. CB1 Capital Management assumes no responsibility for the accuracy of any of these studies nor does CB1 assume any obligation to update any of these studies based on subsequent research.
G protein-coupled receptor 55 (GPR55) expresses differently in patients with Crohn’s disease and ulcerative colitis
Marcin Włodarczyk, Aleksandra Sobolewska-Włodarczyk, Adam I. Cygankiewicz, Damian Jacenik, Wanda M. Krajewska, Krystyna Stec-Michalska, Aleksandra Piechota-Polańczyk, Maria Wiśniewska-Jarosińska and Jakub Fichna (March 2017)
Different patterns of GPR55 expression at mRNA level were observed in IBD patients. We speculate that GPR55 is crucial for the mucosal inflammatory processes in IBD, particularly in CD and its expression may affect disease severity, and response to treatment. The GPR55 receptors may become an attractive target for novel therapeutic strategies in IBD.
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Manipulation of the Endocannabinoid System in Colitis: A Comprehensive Review
Kristina L. Leinwand, DO; Mark E. Gerich, MD; Edward J. Hoffenberg, MD; Colm B. Collins, PhD (February 2017)
Although manipulation of the endocannabinoid system in murine colitis has proven to be largely beneficial in attenuating inflammation, there is a paucity of human study data. Further research is essential to clearly elucidate the specific mechanisms driving this anti-inflammatory effect for the development of therapeutics to target inflammatory disease such as IBD.
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If you proceed to article you will be leaving the CB1 Capital Management website to access a website hosted by a party unrelated to CB1 Capital Management. CB1 Capital Management assumes no responsibility for the accuracy of any of these studies nor does CB1 assume any obligation to update any of these studies based on subsequent research.
The endocannabinoid system in inflammatory bowel diseases: from pathophysiology to therapeutic opportunity
Alhouayek, M; Muccioli, GG (July 2012)
Anandamide and 2-arachidonoylglycerol are endogenous bioactive lipids that bind to and activate the cannabinoid receptors, and together with the enzymes responsible for their biosynthesis and degradation [fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL)] constitute the endocannabinoid system (ECS). The ECS is implicated in gut homeostasis, modulating gastrointestinal motility, visceral sensation, and inflammation, as well as being recently implicated in IBD pathogenesis. Numerous subsequent studies investigating the effects of cannabinoid agonists and endocannabinoid degradation inhibitors in rodent models of IBD have identified a potential therapeutic role for the ECS.
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If you proceed to article you will be leaving the CB1 Capital Management website to access a website hosted by a party unrelated to CB1 Capital Management. CB1 Capital Management assumes no responsibility for the accuracy of any of these studies nor does CB1 assume any obligation to update any of these studies based on subsequent research.