Revealing the therapeutic potential of synthetic cannabinoids: a systematic review of cannabinoid receptor binding dynamics and their implications for cancer therapy

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“Background: Cancer remains a major global health issue, prompting the need for innovative treatment approaches that extend beyond conventional methods such as chemotherapy and radiation. The endocannabinoid system (ECS), primarily the cannabinoid receptors CB1R and CB2R, presents a promising opportunity for cancer therapy by selectively targeting cell signaling pathways. This systematic review intends to explore the mode of action of synthetic cannabinoids as potential anticancer agents and their impact on tumor growth in various cancer cell lines.

Methods: Of the 287 articles identified between January 1990 and July 2024, 27 studies met strict criteria focusing on their anticancer effects. Data extraction and quality assessment were conducted using GRADE criteria and the Cochrane Risk of Bias tool, ensuring robust evaluation of the studies’ reliability.

Results: Various pharmacological actions of synthetic cannabinoids function as agonists, antagonists, and inverse agonists at the CB1R and CB2R receptors. Key findings indicate that CB2R agonists significantly reduce cancer cell proliferation through diverse mechanisms, with selective CB2R agonists effectively inhibiting cancer cell growth and survival. Studies involving CB1R antagonists, particularly in conjunction with CB2R agonists, highlight their role in blocking CB1R to either validate or enhance the efficacy of CB2R agonists in mitigating tumor growth. Inverse agonists targeting CB2R have shown moderate success in inducing cancer cell death by disrupting survival pathways. Notably, synthetic cannabinoid agonists display significant potential in targeting CB1 and CB2 receptors to inhibit tumor proliferation and promote apoptosis across various cancer types.

Conclusion: The systematic review concludes that CB2R agonists can effectively inhibit tumor growth while inducing apoptosis in various cancers. Although CB1R agonists show potential in modulating cancer pathways, there is a notable lack of research on CB1 inverse agonists, emphasizing the need for further investigation. Additionally, the study advocates for greater exploration of mixed receptor agonist and receptor mode of action to validate these promising therapeutic approaches.”

https://pubmed.ncbi.nlm.nih.gov/40483537/

“Phytocannabinoids, which are the natural cannabinoids found in Cannabis sativa, have been extensively studied for their potential anticancer effects. These compounds act as agonists for cannabinoid receptor 1 and cannabinoid receptor 2, facilitating their therapeutic applications through the activation of these CBRs. By activating CB1R and CB2R, phytocannabinoids produce various therapeutic effects, including anti-nociception, anti-inflammation, anticonvulsant, and anti-emetic properties.”

https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-025-00289-5

Sativex (nabiximols) for the treatment of Agitation & Aggression in Alzheimer’s dementia in UK nursing homes: a randomised, double-blind, placebo-controlled feasibility trial

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“Background: Alzheimer’s Disease (ad) patients often experience clinically significant agitation, leading to distress, increased healthcare costs and earlier institutionalisation. Current treatments have limited efficacy and significant side effects. Cannabinoid-based therapies, such as the nabiximols oral spray (Sativex®; 1:1 delta-9-tetrahydrocannabinol and cannabidiol), offer potential alternatives. We aimed to explore the feasibility and safety of nabiximols as a potential treatment for agitation in ad.

Methods: The ‘Sativex® for Agitation & Aggression in Alzheimer’s Dementia’ (STAND) trial was a randomised, double-blind, placebo-controlled, feasibility study conducted in UK care homes. Participants with probable ad and predefined clinically significant agitation were randomised to receive placebo or nabiximols for 4 weeks on an up-titrated schedule, followed by a 4-week observation period. To be considered feasible, we prespecified the following thresholds that needed to be met: randomising 60 participants within 12 months, achieving a ≥ 75% follow-up rate at 4 weeks, maintaining ≥80% adherence to allocation and estimating a minimum effect size (Cohen’s d ≥ 0.3) on the Cohen-Mansfield Agitation Inventory. This trial is registered with ISRCTN 7163562.

Findings: Between October 2021 and June 2022, 53 candidates were assessed; 29 met eligibility criteria and were randomised. No participants withdrew, and adherence was high (100%) and was generally feasible to deliver. The intervention was well tolerated (0 adverse reactions), with no safety concerns reported.

Interpretation: Despite significant COVID-19 pandemic related challenges, administering nabiximols through oral mucosa to advanced ad patients with agitation demonstrated feasibility and safety. These findings support a larger confirmatory efficacy trial to evaluate the potential therapeutic efficacy of nabiximols for agitation in ad.”

https://pubmed.ncbi.nlm.nih.gov/40479610/

“In conclusion, this study demonstrates the feasibility of a pilot randomised, placebo-controlled trial of nabiximols oral spray for agitation in AD patients in care homes, with no safety concerns observed.”

“Low-dose mixed delta-9-tetrahydrocannabinol and cannabidiol showed favourable safety profile and high tolerability.”

https://academic.oup.com/ageing/article/54/6/afaf149/8158002?login=false

Motor-Related Neural Dynamics are Modulated by Regular Cannabis Use Among People with HIV

“Recent work has shown that people with HIV (PWH) exhibit deficits in cognitive control and altered brain responses in the underlying cortical networks, and that regular cannabis use has a normalizing effect on these neural responses.

However, the impact of regular cannabis use on the neural oscillatory dynamics underlying motor control deficits in PWH remains less understood. Herein, 102 control cannabis users, control nonusers, PWH who regularly use cannabis, and PWH who do not use cannabis performed a motor control task with and without interference during high-density magnetoencephalography. The resulting neural dynamics were examined using whole-brain, voxel-wise statistical analyses that examined the impact of HIV status, cannabis use, and their interaction on the neural oscillations serving motor control, spontaneous activity during the baseline period, and neurobehavioral relationships.

Our key findings revealed cannabis-by-HIV group interactions in oscillatory gamma within the prefrontal cortices, higher-order motor areas, and other regions, with the non-using PWH typically exhibiting the strongest gamma interference responses. Cannabis-by-HIV interactions were also found for oscillatory beta in the dorsal premotor cortex. Spontaneous gamma during the baseline was elevated in PWH and suppressed in cannabis users in all regions exhibiting interaction effects and the left primary motor cortex, with spontaneous levels being correlated with behavioral performance.

These findings suggest that regular cannabis use has a normalizing effect on the neural oscillations serving motor control and the abnormally elevated spontaneous gamma activity that has been widely replicated in PWH, which may suggest that cannabis has at least some therapeutic utility in PWH.”

https://pubmed.ncbi.nlm.nih.gov/40473990/

“Further, these findings corroborate multiple recent studies showing elevated spontaneous gamma activity in PWH, and that regular cannabis use is associated with a marked suppression in such spontaneous activity.”

https://link.springer.com/article/10.1007/s11481-025-10219-0

THC Reverses SIV-Induced Senescence in Astrocytes: Possible Compensatory Mechanism Against HIV Associated Brain Injury?

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“Despite effective combination antiretroviral therapy (cART), chronic neuroinflammation and glial dysfunction continues to be an important yet understudied issue with people living with HIV (PLWH).

The endocannabinoid system is increasingly recognized as a potential therapeutic target for modulating neuroimmune environments, given its role in regulating synaptic plasticity, immune responses, and neuroinflammatory cascades. However, the extent to which cannabinoids influence HIV-associated neuroinflammation remains unclear.

This study investigates the impact of Δ9-tetrahydrocannabinol (THC) on astrocyte growth characteristics, viability, and senescence-associated cytokine release following exposure to HIV Tat protein using primary mixed glial cultures derived from rhesus macaques. Real-time impedance-based cellular integrity assessments were conducted using the xCELLigence system, while morphological analyses and cytokine quantification were performed using phase-contrast microscopy and multiplex immunoassays.

Treatment of macaques with THC protected the astrocytes from virus-induced senescence.

Further, THC facilitated a rapid recovery from Tat-induced decline in astrocyte adhesion, suggesting a compensatory effect. THC promoted glial process elongation and morphological complexity, indicative of a shift toward a neuroprotective phenotype. Furthermore, THC significantly reduced inflammatory cytokine secretion, including TNF-α, IL-6, and IL-1β, in an apparently dose-dependent manner.

These findings suggest that THC may modulate neuroinflammation in PLWH by promoting astrocytic survival, suppressing inflammatory cytokine secretion, and enhancing neurotrophic signaling. However, prolonged exposure to high-dose THC may negatively impact glial survival.

The results underscore the complexity of cannabinoid signaling in the CNS and highlight the potential of cannabinoid-based interventions to mitigate HIV-associated neuroinflammation.”

https://pubmed.ncbi.nlm.nih.gov/40475423/

https://www.biorxiv.org/content/10.1101/2025.05.16.654476v1

“Senescence, in both cellular and organismal contexts, refers to the process of aging and decline.”

Patterns of Use and Patient-Reported Effects of Cannabinoids in People With PD: A Nationwide Survey

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“Background: People with Parkinson’s disease (PD) may use cannabis-based products for symptom management. In France, products containing tetrahydrocannabinol (THC) are prohibited, while cannabidiol (CBD)-products are readily available. However, data on cannabinoid use in French people with PD are lacking. 

Objectives: To identify correlates of the use of cannabis-based products and to document their patterns of use and perceived effects. Methods: A French nationwide online survey was conducted from May to July 2023. Regression analyses helped identify factors associated with current cannabis and CBD use (regardless of their form). Patterns of use and self-reported effects were also documented. 

Results: The study sample comprised 1136 participants, with a median age of 68 years. Six percent (5.9%) and 17.9% reported using cannabis and CBD, respectively. Both substances were associated with better knowledge of cannabinoids and a poor self-perceived household economic situation. The most common routes of cannabis administration were oral ingestion (44.8%) and smoking (41.4%); for CBD, they were oral ingestion (82.8%) and smoking (6.4%). Users reported that cannabis and CBD were very effective for sleep disorders, pain, and rigidity/cramps. The satisfaction level for both substances was also high. 

Conclusion: Cannabis and CBD use among people with PD was associated with better knowledge about cannabinoids and a poor self-perceived household economic situation. Furthermore, users reported high levels of satisfaction for both substances. An enhanced communication with healthcare providers and facilitated access to safe cannabis/CBD products are needed in France to enable people with PD to maximize the benefits of cannabinoids when clinically appropriate.”

https://pubmed.ncbi.nlm.nih.gov/40470397/

“Users commonly reported improvements in sleep disorders, pain, and rigidity/cramps. An enhanced communication with healthcare providers and facilitated access to safe products are needed in France so that people with PD can maximize the benefits of cannabinoids when clinically appropriate.”

https://onlinelibrary.wiley.com/doi/10.1155/padi/2979089

Innovations in Cannabis Delivery Systems: A Patent Review (2012-2024)

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“Introduction: Cannabis sativa has been cultivated for over 11,700 years, originating in Central and Southeast Asia, and has been used for medical, recreational, and religious purposes. Among its therapeutic potentials, it is notable for its capacity to alleviate pain, nausea, anxiety, and more. The plant’s primary secondary metabolites are cannabinoids, which interact with the endocannabinoid system to produce these effects. However, due to the dosage variability and the secondary effects associated with a lack of targeted action, their medical use is limited, creating the need for effective delivery systems.

Methodology: This systematic patent review on cannabis drug delivery systems was conducted using patents retrieved from the Espacenet database. The search employed the keywords “Cannabis” and “Delivery,” along with the IPC classification code A61, to filter patents filed between 2012 and 2024. This initial search yielded 99 patents, which were further screened to identify 15 patents that met the inclusion criteria.

Results: Of the selected patents, most originated from the United States, followed by Canada, international patents (WIPO), and China. A notable increase in patent filings occurred in 2022, coinciding with the peak in scientific publications on the topic. This trend indicates a growing interest in the design of cannabis delivery systems.

Discussion: The historical importance and therapeutic potential of Cannabis sativa are welldocumented, yet modern medical use remains restricted due to pharmacokinetic limitations. Delivery systems such as extracellular vesicles, microneedles, and emulsions have been developed to improve the bioavailability and stability of cannabinoids. Extracellular vesicles facilitate targeted, noninvasive delivery of cannabinoids to the central nervous system. Microneedles offer a painless method for transdermal administration, overcoming skin barrier limitations. Emulsions improve the solubility and bioavailability of lipophilic cannabinoids, making them suitable for various administration routes.

Conclusion: Since 2012, there has been considerable growth in patents and publications related to cannabis drug delivery systems, driven by the therapeutic potential of cannabinoids. Innovations in delivery systems like emulsions, microneedles, and extracellular vesicles aim to improve the pharmacokinetics and therapeutic efficacy of cannabis-derived compounds, representing a shift towards medical cannabis applications.”

https://pubmed.ncbi.nlm.nih.gov/40454502/

https://www.eurekaselect.com/article/148648

19 patients report seizure freedom with medical cannabis oil treatment for drug-resistant epilepsy: a case series

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“Purpose: Seizure freedom (SF) is the primary goal of epilepsy treatment. More treatments that produce SF in drug-resistant epilepsy (DRE) are needed. Cannabis-based products for medicinal use (CBPMs) containing cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC), administered as oils, have been shown to induce SF in DRE. However, there remains a paucity of published real-world evidence in both pediatrics and adults on SF resulting from CBPM therapy.

Methods: This is a retrospective case series at an outpatient neurology clinic in Toronto, Canada, on patients with DRE who experienced significant SF during CBPM treatment. All patients were treated via the clinic’s stepwise treatment protocol with CBPM oils only. The study describes clinical features of patients and their CBPM-related SF.

Results: We report 19 DRE cases that experienced SF; 15 pediatric, 4 adults. The median cumulative SF duration was 245 days, split between continuous SF periods lasting at least 90 days. Five patients had continuous SF periods lasting ≥ 1 year. Most patients used CBD+THC regimens. Three patients weaned all concomitant ASMs. Adverse events (AEs) were reported by half of the patients.

Conclusion: The results of the study support prioritizing CBPMs in cases of DRE. It also supports research into identifying clinical and biological biomarkers for DRE cases that may achieve SF under CBPM treatment. Lastly, the study supports improving the accessibility of CBPMs, using SF as a primary outcome in future CBPM epilepsy trials, and assessing the role of THC in reducing seizures.”

https://pubmed.ncbi.nlm.nih.gov/40458487/

“A promising treatment for DRE are cannabis-based products for medicinal use (CBPMs) containing variations of cannabinoids, such as cannabidiol (CBD), Δ-9-tetrahydrocannabinol (THC) and other cannabis plant products in an oil formulation.”

“This study reports Real World Evidence from 19 patients with Drug Resistant Epilepsy who experienced Seizure Freedom due to Cannabis based medicinal products therapy. The SF rates observed in this study complement existing literature that reports rates of at least 4%, higher than the 1% observed with established ASMs.”

https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2025.1570531/full

Cannabidiol and microRNAs: shared cellular targets and new insights for developing anti-seizure modalities

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“Cannabidiol (CBD) and 9-tetrahydrocannabinol (THC) are the two main components of cannabis that provide its therapeutic benefits.

CBD has been extensively studied for its role in reducing seizures, among its many other uses. While the exact mechanisms by which CBD works to relieve seizures have not yet been fully determined, it is evident that CBD effectively diminishes seizure activity and is now being used as an approved treatment for severe forms of non-responsive epilepsy.

As essential components of several biological processes, microRNAs (miRNAs) are crucial for achieving optimal cellular functioning. During the past few years, there has been an increasing interest in elucidating the functional significance of microRNAs in epilepsy. Yet, there is still considerable ambiguity regarding the precise mechanisms by which miRNAs are involved in seizure disorders and also their direct interaction with CBD.

Herein, we seek to present an overview of the varying mechanisms by which CBD offers therapeutic benefits concerning seizures. Accordingly, we highlighted the shared molecular targets between microRNAs and CBD in alleviating seizure symptoms to shed light on the ways in which new therapeutic and diagnostic modalities could be shaped in the future.”

https://pubmed.ncbi.nlm.nih.gov/40461016/

https://academic.oup.com/jpp/advance-article-abstract/doi/10.1093/jpp/rgaf039/8156016?redirectedFrom=fulltext&login=false

Beyond Cannabidiol: The Contribution of Cannabis sativa Phytocomplex to Skin Anti-Inflammatory Activity in Human Skin Keratinocytes

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“Background:Cannabis sativa L. (C. sativa) has a long history of medicinal use. Its inflorescences contain bioactive compounds like non-psychotropic cannabidiol (CBD), which is well known for its anti-inflammatory potential in skin conditions such as psoriasis, and psychotropic Δ-9-tetrahydrocannabinol (THC). Keratinocytes, the main cells in the epidermis, are crucial for regulating skin inflammation by producing mediators like IL-8 when stimulated by agents like TNFα. 

Methods: This study explores the anti-inflammatory effects of a standardized C. sativa extract (CSE) with 5% CBD and less than 0.2% THC in human keratinocytes challenged by TNFα. The aim of this study is to analyze the specific contributions of the main constituents of CSE to inflammatory responses in human keratinocytes by fractionating the extract and examining the effects of its individual components. 

Results: MTT assays showed that CSE was non-toxic to HaCaT cells up to 50 μg/mL. CSE inhibited NF-κB activity and reduced IL-8 secretion in a concentration-dependent manner, with mean IC50 values of 28.94 ± 10.40 μg/mL and 20.06 ± 2.78 μg/mL (mean ± SEM), respectively. Fractionation of CSE into four subfractions revealed that the more lipophilic fractions (A and B) were the most effective in inhibiting NF-κB, indicating that cannabinoids and cannflavins are key contributors. Pure CBD is one of the most active cannabinoids in reducing NF-κB-driven transcription (together with THC and cannabigerol), and due to its abundance in CSE, it is primarily responsible for the anti-inflammatory activity. 

Conclusions: This study highlights CBD’s significant role in reducing inflammation in human keratinocytes and underscores the need to consider the synergistic interactions of several molecules within C. sativa extracts for maximum efficacy. Standardized extracts are essential for reproducible results due to the variability in responses.”

https://pubmed.ncbi.nlm.nih.gov/40430467/

“In conclusion, the results of this study on CSE underscore the significant role of CBD in exerting anti-inflammatory effects in human keratinocytes.”

https://www.mdpi.com/1424-8247/18/5/647

Role of Endocannabinoids in Glaucoma: A Review

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“Aims: A review of the published literature was done to understand the role of endocannabinoids in glaucoma.

Background: As evidence mounts that intraocular pressure (IOP) is not the only factor in the pathogenesis and progression of glaucoma, a look into other aspects is the need of the hour. From the first instance of a drop in IOP linked to marijuana in the 1970s to the present, research has been ongoing, mostly in animals and in vitro models, with a scarcity of human studies, to delve into the world of the endocannabinoid system (ECS).

Methods: PubMed, ScienceDirect, and Google Scholar were searched for studies relating to endocannabinoids and their role in glaucoma.

Results: The ECS comprises ligands, receptors, and the synthesizing and degrading enzymes and is ubiquitous throughout the human body, including the visual system, from the eye to the occipital lobe. Apart from the IOP-lowering effect of the system, another property being investigated and implicated as an attribute of its receptors is neuroprotection. This neuroprotection seems to be mediated by excitotoxicity reduction and changes in vascular tone by acting on cannabinoid receptors.

Conclusion: The possibilities are indeed immense, and further research into the complex relationship between ECS and glaucoma is imperative to enable us to develop therapies for this otherwise chronic, progressive neuropathy, where the only armament in our hands is early diagnosis and maintenance therapy.

Clinical significance: We still do not have drugs for the prevention of retinal ganglion cell loss and for neuroprotection in glaucoma. Drugs that target cannabinoid receptors can revolutionize glaucoma management owing to their IOP-lowering action and neuroprotective effects. Based on the findings, we argue that further studies on the ECS and its implications in glaucoma are warranted to develop newer, effective, and better-targeted treatment strategies.”

https://pubmed.ncbi.nlm.nih.gov/40417140/

“Currently, no drugs can target the loss of RGCs in glaucoma.
Therefore, drugs that can target CB1 receptors can change the
course of glaucoma treatment, as they can exert hypotensive
and neuroprotective effects in conjunction.”

https://www.jocgp.com/doi/pdf/10.5005/jp-journals-10078-1467