Cannabis and viruses, the whole picture!

Cannabis is one of the most complex plants used in modern medicine, producing thousands of different secondary metabolites in response to abiotic and biotic stresses (Seaman 2021; Flores- Sanchez & Verpoorte, 2008). These include the well-known cannabinoids, terpenes, flavonoids, fatty acids, Lignanamides, stil-benoids, lignans, and alkaloids. These compounds have an array of effects on the plant itself helping to defend it from attack from insects, mammals, and microbes along with irreversible environmental stress damage such as UV light, heat and drought. Many of these compounds have medicinal properties within humans and animals.

The major constituents of cannabis medication are the phytocannabinoids, particularly Delta-9 -Tetrahydrocannabinol (THC) and Cannabidiol (CBD). Within the plant they are found in the acid form which has a much lower affinity for the CB receptors and require decarboxylation to become highly active within the body. This involves the loss of a carboxylic acid group from the cannabinoid and is achieved through heating. It is the endocannabinoid system (ENS) which regulates the balances between the central nervous system and the immune system that is the mode of action these phytocompounds interact with.

Many of these compounds produced by cannabis interact with the ECS and within humans is subject dependent, as the maintenance of homeostasis between the immune system and nervous system differs from individual to individual. Differences between species has also been documented, with canine subjects having less CB1 receptor in the brain than humans (Hartsel et al 2019; Silver 2019).

Cannabis based medicines come in many forms, from flower which is vaped to oils which can be made into tinctures, capsules, sprays, topicals and suppositories. The process of making the oils involve extraction such as distillation, sub-critical CO2, ethanol, chromatography, heated press and sonication (Hazekamp 2007). All these methods will produce different types of products with varying concentrations and ratios of each compound. The type of extract and the number of compounds present is also important as there is strong evidence of what is know as the entourage effect.

Cannabis extracts can be spilt into Full plant extracts, full spectrum, Broad spectrum, and isolates. Full plant extract will contain all the cannabinoids including the THC, which is one of the controlled cannabinoids. This type of extract will also contain terpenes, flavonoids, fatty acids and lignans in much lower concentrations than the cannabinoids, however they are still present. These compounds have been shown to improve and alter the effectiveness of the cannabinoids in what is known as the Entourage effect (Russo, 2019). Studies in Canada by Dr. Evan Lewis at the Neurotology Centre of Toronto found that lower concentration of cannabinoids was required when a full plant extracted was used to treat children with refractory epilepsy in comparison to and isolate cannabinoid products, which often have greater side effects.

Cannabis products and their efficacy against viral disease has come under scrutiny from the medical community, with much of the information on the internet coming from marketing material put out by retailers and manufacturers. In the last 5 years with more countries changing legislation surround cannabis and the availability of prescribed products, there has been an increase acceptance as it as a medicine and published peer review work.

A literature review performed by Tague 2020, specifically looking at Cannabidiol (CBD), as an isolate and its effects on viral disease. Giving the title Cannabidiol for viral disease: Hype of Hope and really delving into the published literature. The search found that preclinical studies had been performed on hepatitis, Kaposi sarcoma, shingles, Ebola, herpes and HIV. Within this review they found that CBD had a direct antiviral effect against hepatitis C but not against hepatis B. It was also more effective as a post infection treatment against Ebola and is more of the antiinflammatory effects of CBD as appose to the antiviral effects that helped with the treatment of viral infections.

Studies on the antiviral effects of individual terpenes, not just in cannabis has been well documented (Ibrahim et al 2021, Loizzo, 2008; Booth & Bohlmann, 2019). A study performed by Ilbrahim et al 2021, using fennel extract demonstrated antiviral activity against Hepatitis C Virus (HCV). Limonene and ocimene were two of the major active found in the fennel extracts which were most effective. These terpenes are also found in cannabis sativa L, which display antiviral properties (Lowe 2021).

Compounds specific to cannabis which have shown promising results include the flavonoid Caflanone, have been shown to be Phyto antiviral, specifically to the human coronavirus OC43 (HCoVOC43) also known as SARS-CoV-2 which cause serve acute respiratory disease (Ngwa et al 2020). This in-vitro study published by Ngwa et al 2020, showed that caflanone had a strong bin-ding affinity to two proteases (PLpro and 3CLpro) which are essential in the replication of SARS-CoV-2 in humans. It was also theorised that caflanone also help prevent the entry into the respirtory system by inhibit the angiotensinconverting enzyme 2 (ACE2).

Other studies support this theory that cannabis based medicines block the entry of SARS- CoV-2, with van Breenman et al, focusing on cannabinoids blocking cellular entry of into respiratory cells (van Breenman 2022). Interestingly another study on the efficacy of cannabis-based products as a potential treatment for covid looked at how cannabinoids could possible quell the cytokine storm created by the virus, but concluded that more studies and trial were needed. (Onaivi 2020) In the UK Drug Sciences are currently conducting work with Dr Liz Iveson on Feasibility of Cannabidiol for the Treatment of Long COVID.

Cannabis not only treats the virus itself but has help to alleviate the symptoms from mental trauma and issued faced by many patients. The pandemic has brought challenging times, which paid its toll on the mental health of many individuals. During the Pandemic 2020-2021 a study was conducted in Australia of 1634 women internationally who used cannabis to treat endometriosis (Armour2022). The study found that the most common reason for consuming cannabis during the Pandemic was due to stress and anxiety (59%).

Cannabis based medicines are not the silver bullet we are all hoping will save the world in the fight against viruses, however they can certainly lend a helping hand in the recovery and treatment of viral infections!

Sources:

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