An observational postmarketing safety registry of patients in the UK, Germany, and Switzerland who have been prescribed Sativex® (THC:CBD, nabiximols) oromucosal spray.

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“The global exposure of Sativex®9-tetrahydrocannabinol [THC]:cannabidiol [CBD], nabiximols) is estimated to be above 45,000 patient-years since it was given marketing approval for treating treatment-resistant spasticity in multiple sclerosis (MS).

An observational registry to collect safety data from patients receiving THC:CBD was set up following its approval in the UK, Germany, and Switzerland, with the aim of determining its long-term safety in clinical practice.

Twice a year, the Registry was opened to prescribing physicians to voluntarily report data on patients’ use of THC:CBD, clinically significant adverse events (AEs), and special interest events. The Registry contains data from 941 patients with 2,213.98 patient-years of exposure.

Within this cohort, 60% were reported as continuing treatment, while 83% were reported as benefiting from the treatment. Thirty-two percent of patients stopped treatment, with approximately one third citing lack of effectiveness and one quarter citing AEs.

Psychiatric AEs of clinical significance were reported in 6% of the patients, 6% reported falls requiring medical attention, and suicidality was reported in 2%. Driving ability was reported to have worsened in 2% of patients, but improved in 7%.

AEs were more common during the first month of treatment. The most common treatment-related AEs included dizziness (2.3%) and fatigue (1.7%).

There were no signals to indicate abuse, diversion, or dependence.

The long-term risk profile from the Registry is consistent with the known (labeled) safety profile of THC:CBD, and therefore supports it being a well-tolerated and beneficial medication for the treatment of MS spasticity.

No evidence of new long-term safety concerns has emerged.”

https://www.ncbi.nlm.nih.gov/pubmed/27956834

Cannabinoid 2 Receptor Agonist Improves Systemic Sensitivity to Insulin in High-Fat Diet/Streptozotocin-Induced Diabetic Mice.

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“The endocannabinoid signalling (ECS) system has been known to regulate glucose homeostasis.

Previous studies have suggested that the cannabinoid 2 (CB2) receptor may play a regulatory role on insulin secretion, immune modulation and insulin resistance.

Given that diabetes and insulin resistance are attributable to elevated inflammatory tone, we investigated the role of CB2 receptor on glucose tolerance and insulin sensitivity in high-fat diet (HFD)/streptozotocin (STZ)-induced mice.

Our data suggest a lipolytic role of SER601 in HFD/STZ-induced diabetic mice, which results in significant improvement of systemic insulin sensitivity.

Thus, the CB2 receptor may be considered a promising target for therapeutic development against insulin resistance and obesity-related diabetes.”

https://www.ncbi.nlm.nih.gov/pubmed/27960161

Fetal Syndrome of Endocannabinoid Deficiency (FSECD) In Maternal Obesity.

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“The theory of a fetal origin of adult diseases links many pathological conditions to very early life events and is known as a “developmental programming” phenomenon. The mechanisms of this phenomenon are not quite understood and have been explained by inflammation, stress, etc. In particular the epidemic of obesity, with more than 64% of women being overweight or obese, has been associated with conditions in later life such as mental disorders, diabetes, asthma, and irritable bowel syndrome.

Interestingly, these diseases were classified a decade ago as Clinical Syndrome of Endocannabinoid Deficiency (CECD), which was first described by Russo in 2004.

Cannabinoids have been used for the treatment of chronic pain for millenniums and act through the mechanism of “kick-starting” the components of the endogenous cannabinoid system (ECS).

ECS is a pharmacological target for the treatment of obesity, inflammation, cardiovascular and neuronal damage, and pain.

We hypothesize that the deteriorating effect of maternal obesity on offspring health is explained by the mechanism of Fetal Syndrome of Endocannabinoid Deficiency (FSECD), which accompanies maternal obesity. Here we provide support for this hypothesis.”

https://www.ncbi.nlm.nih.gov/pubmed/27959272

Tolerability of dronabinol alone, ondansetron alone and the combination of dronabinol plus ondansetron in delayed chemotherapy-induced nausea and vomiting.

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“Dronabinol (Marinol), the synthetic version of tetrahydrocannabinol, is used to treat nausea and vomiting following cancer chemotherapy (CINV).

It has a unique mechanism of action (cannabinoid receptor binding) compared to the more frequently used serotonin receptor antagonists. Tolerability of dronabinol versus ondansetron and the combination of dronabinol plus ondansetron was explored in subjects with delayed CINV.

Dronabinol was well tolerated and resulted in few terminations due to adverse events. The low rate of CNS-related adverse events following D treatment may make it a suitable alternative to serotonin antagonist therapy for delayed CINV.”

https://www.ncbi.nlm.nih.gov/pubmed/27946950

Dronabinol treatment of delayed chemotherapy-induced nausea and vomiting (CINV).

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“Dronabinol (MARINOL), synthetic tetrahydrocannabinol, binds to cannabinoid receptors and has antiemetic activity. To explore if this novel mechanism would be of benefit in delayed CINV, dronabinol was added to the prophylactic regimen for acute CINV and continued after chemotherapy.

Efficacy at Endpoint (LOCF) Conclusions: Dronabinol (D) was comparable to ondansetron (O) in total response and but was more effective in reducing nausea intensity and vomiting/retching. Results for the combination of DO were similar to either agent alone.

These results support conducting a larger study since D could become an attractive alternative to serotonin receptor antagonists in treating delayed CINV.”

https://www.ncbi.nlm.nih.gov/pubmed/27946578

Compensatory activation of cannabinoid CB2 receptor inhibition of GABA release in the rostral ventromedial medulla (RVM) in inflammatory pain.

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“The rostral ventromedial medulla (RVM) is a relay in the descending pain modulatory system and an important site of endocannabinoid modulation of pain.

These studies demonstrate that endocannabinoid signaling to CB1- and CB2-receptors in adult RVM is altered in persistent inflammation.

The emergence of CB2 receptor function in the RVM provides additional rationale for the development of CB2 receptor-selective agonists as useful therapeutics for chronic inflammatory pain.”

https://www.ncbi.nlm.nih.gov/pubmed/27940994

Tamoxifen Isomers and Metabolites Exhibit Distinct Affinity and Activity at Cannabinoid Receptors: Potential Scaffold for Drug Development.

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“Tamoxifen (Tam) is a selective estrogen receptor (ER) modulator (SERM) that is an essential drug to treat ER-positive breast cancer. Aside from known actions at ERs, recent studies have suggested that some SERMs like Tam also exhibit novel activity at cannabinoidsubtype 1 and 2 receptors (CB1R and CB2Rs).

Collectively, these results suggest that the SERMs Tam, 4OHT and End elicit ER-independent actions via CBRs in an isomer-specific manner.

As such, this novel structural scaffold might be used to develop therapeutically useful drugs for treatment of a variety of diseases mediated via CBRs.”

Paradoxical increase in synthetic cannabinoid emergency-related presentations after a citywide ban: Lessons from Houston, Texas.

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“Synthetic cannabinoids (SCs) have become a major drug of abuse associated with severe hospital presentations. There have been a variety of legislative efforts to regulate these drugs: The authors focus on trends in SC-related hospitalizations at Ben Taub General Hospital before and after a ban enacted by the city of Houston.

Data from all consults seen by Ben Taub’s Licensed Chemical Dependency Counselor were examined for changes in SC-related presentations before and after the ban. The findings were compared alongside other reports of current SC use.

A significant increase was found in the prevalence of SC-related presentations at Ben Taub Hospital following Houston’s citywide ban. These findings are consistent with other state and national data.

Houston’s ordinance was expected to decrease harmful effects of SC in the community; however, the data suggest an increase in presentations since the legislation was passed.

While further study is needed, it initially appears that the threat of SCs is still considerable despite policy efforts. These results suggest the need for further monitoring of SC use and continued collaboration toward effective public health measures.”

https://www.ncbi.nlm.nih.gov/pubmed/27936903

AM251 Suppresses Epithelial-Mesenchymal Transition of Renal Tubular Epithelial Cells.

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“Epithelial-mesenchymal transition (EMT) of renal tubular epithelial cells is one of the causative mechanisms of kidney fibrosis.

In our study, we screened lipophilic compounds using a lipid library including approximately 200 lipids to identify those that suppressed EMT induced by a transforming growth factor (TGF)-β1 stimulus.

Our findings regarding the effects of AM251 on the TGF-β signaling pathway may inform development of a novel therapeutic agent suppressing EMT, thus preventing kidney fibrosis.”

https://www.ncbi.nlm.nih.gov/pubmed/27936102

From adolescent to elder rats: Motivation for palatable food and cannabinoids receptors.

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“To analyze motivation, food self-administration and decision-making was evaluated in adolescent, adult and aged rats.

Adolescent rats exhibited low expression of CB1R in the NAcc and low expression of both CB1R and CB2R in the PFC compared to adult and aged rats.

Adolescent rats display higher motivation for palatable food and an indiscriminate seeking behavior suggesting involvement of both homeostatic and hedonic systems in their decision-making processes.”

https://www.ncbi.nlm.nih.gov/pubmed/27935269