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Stephen Cital · Katherine Kramer · Liz Hughston · James S. Gaynor  Editors

Cannabis Therapy in Veterinary Medicine

A Complete Guide

CannabisTherapyinVeterinaryMedicine

Editors

CannabisTherapy inVeterinaryMedicine

ACompleteGuide

Editors

StephenCital VeterinaryCannabinoidAcademy SanJose,CA,USA

HowardHughesMedical Institute/StanfordUniversity PaloAlto,CA,USA

LizHughston VeterinaryCannabinoidAcademy SanJose,CA,USA

VetTechXpert SanJose,CA,USA

KatherineKramer VCACanadaVancouverAnimalWellness Hospital Vancouver,BC,Canada

JamesS.Gaynor PeakPerformanceVeterinaryGroup Breckenridge,CO,USA

ISBN978-3-030-68316-0ISBN978-3-030-68317-7(eBook) https://doi.org/10.1007/978-3-030-68317-7

© TheEditor(s)(ifapplicable)andTheAuthor(s),underexclusivelicensetoSpringerNatureSwitzerland AG2021

Thisworkissubjecttocopyright.AllrightsaresolelyandexclusivelylicensedbythePublisher,whether thewholeorpartofthematerialisconcerned,specificallytherightsoftranslation,reprinting,reuseof illustrations,recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,and transmissionorinformationstorageandretrieval,electronicadaptation,computersoftware,orby similarordissimilarmethodologynowknownorhereafterdeveloped.

Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevant protectivelawsandregulationsandthereforefreeforgeneraluse.

Thepublisher,theauthors,andtheeditorsaresafetoassumethattheadviceandinformationinthis bookarebelievedtobetrueandaccurateatthedateofpublication.Neitherthepublishernortheauthorsor theeditorsgiveawarranty,expressedorimplied,withrespecttothematerialcontainedhereinorforany errorsoromissionsthatmayhavebeenmade.Thepublisherremainsneutralwithregardtojurisdictional claimsinpublishedmapsandinstitutionalaffiliations.

ThisSpringerimprintispublishedbytheregisteredcompanySpringerNatureSwitzerlandAG. Theregisteredcompanyaddressis:Gewerbestrasse11,6330Cham,Switzerland

Dedicatedtomymother,grandmother,Mary EllenGoldberg,andalltheotherpowerful womeninmylife S.Cital

DedicatedtoAugustWest,whoinitiatedme intotheworldofveterinarycannabis,andto allmypets,clients,andpatientsfromwhomI continuetolearnaboutthemyriadbenefitsof thisplant thankyou.Thisbookwouldnot existwithoutthetirelesseffortsofourlead editor,StephenCital.Thankyou,Stephen,for yourpassion,foryourdedicationtoour profession,andforyourguidancethroughout thisprocess.Youdraggedmekickingand screamingintoeditorshipandIappreciate youmorethanyouknow.Thankyouforallof theopportunitiesyou’vegivenme,andfor alwayshavingmyback L.Hughston

DedicatedtomybelovedAlexandtomy patientsandtheirfamilies,whohavetaughtme somuchaboutmedicine...andlife K.Kramer

Dedicatedtoallmyanimalpatientsand colleaguesfromwhomIhavelearnedsomuch aboutcannabinoidmedicine,andtomyfamily andfriendsfortheirsupportand encouragementduringthepreparationofthis book J.Gaynor

Foreword

CannabinoidTherapyinVeterinaryMedicine:History andPerspective

Asahumanpediatricandadultneurologist,a24-yearstudentofcannabisandthe endocannabinoidsystem(ECS),andthesonandbrotherofveterinarians,Iam delightedtohavetheopportunitytointroducethistimelytomeonveterinary “cannabinology.”

Theendocannabinoidsystemisabasicandfundamentalhomeostaticregulatorof physiology(Russo2011).Itishundredsofmillionsofyearsancient,andhasbeen phylogeneticallywidespread,includingexpressioninallchordatesfromtunicates onward,notablymissingafewmajorcladessuchasinsects(McPartlandetal.2001; McPartland2004),perhapsexplainingwhytheylackasenseofhumor.

Incontrast, Cannabissativa,thecannabisplant,isabout27.8millionyearsold (McPartland2018),dispellingtheanthropomorphicnotionthatitwasplacedon God’sGreenEarthforhumandiversionorveterinaryapplications;rather,itstherapeuticutilityinthoseareasisahappyaccidentofNatureforus,ourpets,and domesticatedworkanimals.

Anexaminationofthetherapeuticuseofcannabisclearlyrevealsthat,priortoits prohibition,ithadalwaysbeenpartoftheveterinarypharmacopeia.ThisisparticularlythecaseinIndia,thearchetypalbaseofcannabismedicine,wheretheancient veterinaryusesdatefromatleastthetwelfthcentury(Dwarakanath1965)andhave persistedintomoderntimes(IndianHempDrugsCommission1894;Russo2005). By1957,cannabiswasstillutilizedtotreatdiarrheainlivestock,asananthelmintic, for “footsoredisease,increasingmilk-flowincows,andpacifyingthem,butalsowas administeredtobullocksasatonic,torelievefatigueandtoimpartstayingpower” (ChopraandChopra1957,p.9).Thelatteruseofcannabisasaphysicalworkaid parallelssimilarclaimsinhumanworkersinJamaica(Dreher1982).

ThesetraditionalusesinIndialeddirectlytoawatershedmomentinthescienti fic investigationofcannabis,asWilliamBrookeO’Shaughnessy,anIrishphysicianin India,appliedtheteachingsofAyurvedicmedicinetothe firstmodernsystematic researchontheplant’stherapeuticproperties(Russo2017).Henotedthenarcotic effectoftheelectuaryformofcannabiscalledmajoonasreportedbyhisinformants andthenproceededtoexperimentondogsandanexpandedmenagerieofother creaturestodifferentiatetheirreactions.Theresultsaffirmedbothsedativeand appetitestimulationeffectsofcannabis,alongwithstaticataxiaathigherdoses (videinfra),allofwhichpassedwithoutnotablesequelaeafterafewhours.He observed: “—whilecarnivorousanimalsand fish,dogs,cats,swine,vultures,crow andadjutants[militaryadministrators],invariablyexhibitedtheintoxicatinginfluenceofthedrug,thegraminivorous[grasseaters],suchasthehorse,deer,monkey, goat,sheep,andcow,experiencebuttrivialeffectsfromanydoseweadministered” (O’Shaughnessy1838–1840,p.363).Theseobservationscompleted, O’Shaughnessypressedforwardwiththerapeuticapplicationsofcannabisinrecalcitranthumanconditionsrangingfromrheumatismtotetanus,choleraconvulsions, andevenrabies.HisteachingsrapidlyspreadtoEurope,wherehispioneeringwork ledtosuccessfultreatmentof4of5tetanuscasesinhorses,providedanantidoteto strychninepoisoning(Ley1843),andsubsequentlysetafoundationforourtherapeuticcannabisknowledgebasethatpersistsafternearlytwocenturies.

Cannabisdevelopedastrongfootholdsubsequentlyinveterinarypracticein Europe,NorthAmerica,andelsewhere.InFrance,theseedoilwasutilizedtotreat chancresindogs’ ears,andasapurgativeincattle(Tabourin1875).InItaly,theoil wassuggestedinveterinarypracticeforcolicandurinarytractpain(Chiapperoand Bassi1879).InScotland,humansuccesswith “Indianhemp” asananalgesic, hypnotic,andantispasmodicequaltoopiumwascitedasevidenceforveterinary application(Dun1880).InSouthAfrica,bowelinflammation,equinecough,and caninechoreawereaddedtotheindications(Gresswelletal.1886).InEngland,the listexpandedtoincludeasthma,convulsions,cough,cystitis,andtetanus(Banham 1887).AcrossthepondinNewYorkatCornellUniversity,besidestetanusand cystitis,cannabiswasadvancedasatreatmenttocontrolexcitementinazoturia (Hassloch1896),currentlyknownasequineexertionalrhabdomyolysis.Atthe UniversityofPennsylvaniainPhiladelphia,E.StantonMuirperformedextensive experimentswithcannabisasasedativeinhorses, findingitquitesafe(Muir1900), aswellasanalgesic,antispasmodic,andhypnotic(Muir1904).IntheVeterinary SchoolofHarvardUniversity,cannabiswasobservedtoleadtosurvivalinhalfthe casesoftetanusinpractice(Winslow1901).

Thesesameindicationsforcannabispersistedintheliteratureovertheensuing decades,withvariousnewobservations.Cannabiswasnotedasapowerfulnarcotic withoutconstipation(Sayre1907),asatreatmentformelancholiainhorseswith pneumonia(Quitman1912),asaliniment(BrumleyandSnook1913),fortherelief ofspasmandnervousirritabilityandanarcoticforequineoperations(Milks1917), forhobblinghorses(Udall1917),andfortreatmentofdeliriumassociatedwith

parturientapoplexy(WinslowandEichhorn1919).Subsequenteditionsofthese veterinarytextbooksrepeatedsimilarobservationsintheUSA(MilksandEichhorn 1936,1940),untiltheAmericanprohibitionof1937stoppedsupply.InEurope, cannabisusagecontinuedabitlongeralongtraditionallines(GreigandBoddie 1942;Ironside1946),addingindicationssuchasvolvulusandenteritis(Greig1939).

Thisextensiveutilizationofcannabisintheveterinarycontextmayhavefallen outofvogueduetopoliticalmisadventures,butsupportiveevidenceremainsnot onlyinthesemolderingtextsbutalsoinpreservedmedicinebottles.Thepersistence ofsuchproductsmanufacturedfordecadesisatestamenttotheirlikelyefficacy:In centuriespast,afarmer ’sgoodmoneywouldnotlikelybespentforsentimental reasons:eitherthemedicineworkedoravaluableanimalwaslost.

Patentmedicinesalsoexistedfordogs,including “SecurityCough,Coldand DistemperRemedy” whichcost$1in1906(equivalentto$28today)containing Cannabisindica: “Willrelievetheworstcough,chillorfever,Influenzaormucous membranesaffectionsoftheanimal’sthroat,nose,eyes,mouthorairpassages” (Wirtshafter2016,p.26).Insomeareasoftheworld,hempseedpersistsas fishbait/ fishfoodandremainsafavoriteseedofsongbirds.

In1938,RobertP.Waltonpublishedthedefinitivetomeoftheeraoncannabis anditsmedicalandveterinaryapplications(Walton1938),citingmanyoftheuses describedabove,justintimefortheinitiationofcannabisprohibition.Healso summarizedandexpandedontheveterinarybioassaysavailabletoassesscannabis potency,mostparticularlyindogs.Agradualsedationwithoutdistresswasaninitial sign,followedbyaprogressivestaticataxiathatforeshadowedlaterknowledgeof cannabinoidreceptordensitydata(videinfra),andeventualsleep.Whensubjects wereexposedtoooftenoratelevateddoses,tolerancetotheintoxicationwas observed.ThesamephenomenonwasobservedlaterbyaGreekveterinarianwriting inFrench(Cardassis1951)whorelatedthecaseofalambthatseeminglydeveloped acompulsiontograzeoncannabispresentedaftereachfeedingwithgaietyandpanic butrepeatingtheexposureitcontinueddevelopingandfatteningnormally.Readers mayquestionhowcannabisplantsinthe fieldwouldbepsychoactiveatall,since mostwouldharbornon-intoxicatingcannabinoidacids,butmodernliquidchromatographytechniquesalwaysshowatleastsomeneutralcannabinoidssuchasTHCin fresh flowermaterial(Lewisetal.2018).

Beyondthepatentmedicinesofthepreviousera,manymainstreampharmaceuticalcompaniesincludingUpjohn,Lilly,andSharpandDohmemarketedtheirown productsof Cannabisamericana,aspuriousappellationforahybridspeciesof domesticagriculture(Wirtshafter2016).Thesecompaniestypicallyutilizedcanine subjectstotitratemedicinebatchesandjudgeproductconsistency.UnitedStates Pharmacopoeia(USP)standarddosesweredeveloped(Walton1938)butcannotbe quanti fiedwithcertaintytodaygivenourignoranceoftheoriginalconcentrationsof thepreparations.

Waltonalsodescribedeffectsofcornealanesthesiainrabbits,swayingand decreasedtonusincats,andprofoundandprolongednarcosisinfrogs(Walton 1938).Finally,effectsinmiceincludedcornealanesthesia(analgesia),catalepsy, andhypnosis,providingthreeofthefourcomponentsofthecannabinoidtetrad

(alongwithhypothermia)utilizedtodayinthatspeciesforassayingcannabinoid activityoftestcompounds(Smithetal.1994).Ultimately,Waltonopinedthatlethal dosesinanimalsweremorelikelyattributabletoalcoholcontent,stating, “When consideredintermsoftheminimallyactivedoses,thedrughasanextraordinarily highrangeofsafety” (Walton1938,p.175).

Thelatterstatementissupportedbymorerecentreportsofaccidentalpoisonings withcannabis,particularlyareviewof213cannabistoxicosiscasesafteroral ingestionindogs(Janczyketal.2004).Dosesrangedfrom0.5to90g,withvirtually allthepatientsdemonstratingneurologicaleffectssuchassedation,ataxiaand coordinationimpairment,andemesisinabout5%within3h,andlastingvariable durationsupto4days.Withdecontamination, fluidreplacement,anddiazepam (insomeinstances),alltheanimalscompletelyrecovered,however.

Inall,asidefromtheirincreasedsusceptibilitytoataxia,theeffectsofcannabisin dogsarecloselyrelatedtothoseinhumans.Thisishighlightedbythe findingsofone ofthelandmarkstudiesofcannabinoidreceptorCB1 distributioninthebrainshortly afterthediscoveryoftheendocannabinoidsystem(Herkenhametal.1990). Throughoutmammalianspecies,bindingofcannabinoidligandswasgreatestin thebasalganglia,hippocampus,andthecerebellum,thelatterbeingparticularly prevalentinthecerebellarmolecularlayerindogs,highlightingtheirsensitivityto ataxiaafterexposuretotetrahydrocannabinolwithdosesaslowas0.5mg/kg.Asin humans,apaucityofreceptordensityinlowerbrainstemcentersmediatingcardiovascularandrespiratoryfunctionsexplainstherelativesafetyofcannabisineven extremeoverdoses.Observed Ki valuesandpotenciesofcannabinoidagonistsin testsofcanineataxiaandhumansubjectivereportswerehighlycorrelated, supportingthesimilareffectsofsuchdrugsinthetwospecies.

Consideringthisbriefsurvey,whattrendsandsuggestionsmaybeputforward? Firstly,fromtheearliestmodernscientificstudiesofcannabis,analogousconditions shouldbequiteamenabletocannabistherapeuticsacrossmammalianspecies.An examinationofrecentreviews(NationalAcademiesofSciencesEngineeringand Medicine(U.S.).CommitteeontheHealthEffectsofMarijuana:anEvidence ReviewandResearchAgenda2017;MacCallumandRusso2018),foremost amongtheseindicationswouldbetreatmentofchronicpain,whetherneuropathic orcancer-related,emesisassociatedwithchemotherapy,spasticity,sleepdisorders, andepilepsy,especiallywithcannabidiolintheinstanceofthelatter.However,the possibilitiesdonotendthere.Theweightofhistory,basicresearch,andaconsiderablebodyofanecdotalevidencesupportmanyadditionalindicationsforcannabis inautoimmuneconditions,obesity,neurobehavioraldisorders,degenerativeneurologicalconditions,andobstetricsandgynecology(Russo2002,2016,2018).

Americanfamiliesspent$61.4billionontheirpetsin2011,1%oftotalexpenditures,orabout$500perhousehold(Henderson2013).Thisauthorandmanyofhis cohortsexpendconsiderablymoreinveterinarybillsthanontheirownmedicalcare. Moderntrendsindicatethatcannabishasalargeandincreasinglyimportantroleto playinsuchtreatment.Itisequallyclearthatthedisciplinesofveterinaryandhuman medicinehavevaluableinsightstoshareandthatapropercourseofactionwouldbe acoordinationofbasicandappliedclinicalresearcheffortstoproduceamutual

synergythatwillexpeditetherapeuticadvancesandbringcannabis-basedmedicines ofhighquality,safety,efficacy,andconsistencytoourcompanionanimalsandthe peoplewholovethem.

References

Banham,G.A.(1887). Tablesofveterinaryposologyandtherapeutics,withweights,measures,etc. fortheuseofstudentsandpractitioners .London:Baillière,Tindall,andCox. Brumley,O.V.,&Snook,J.H.(1913). Bookofveterinaryposologyandprescriptions (Revised ed.).Columbus,OH:R.G.Adams. Cardassis,J.(1951).Intoxicationdeséquidéspar Cannabisindica.RecueildeMedecine Veterinaire,137(Dec),971–973. Chiappero,F.,&Bassi,R.(1879). Compendiodifarmacologiaveterinaria (3rded.).Torino: TipographiaGiulioSpeiranieFigli. Chopra,I.C.,&Chopra,R.W.(1957).TheuseofcannabisdrugsinIndia. BulletinonNarcotics, 9, 4–29.

Dreher,M.C.(1982). Workingmenandganja:MarihuanauseinruralJamaica.Philadelphia: InstitutefortheStudyofHumanIssues.

Dun,F.(1880). Veterinarymedicines:Theiractionsanduses (1stAmericaned.).NewYork: WilliamR.Jenkins.

Dwarakanath,C.(1965).UseofopiumandcannabisinthetraditionalsystemsofmedicineinIndia. BulletinonNarcotics, 17,15–19.

Greig,J.R.(1939). Hoare’sveterinarymateriamedica&therapeutics (5thed.).London:Baillière, TindallandCox.

Greig,J.R.,&Boddie,G.F.(1942). Hoare’sveterinarymateriamedicaandtherapeutics (6thed.). London:Baillière,TindallandCox.

Gresswell,G.,Gresswell,C.,&Gresswell,A.(1886). Theveterinarypharmacopoeia,materia medica,andtherapeutics.London:Baillière,TindallandCox. Hassloch,A.C.(1896). Acompendofveterinarymateriamedicaandtherapeutics.NewYork: WilliamR.Jenkins.

Henderson,S.(2013).Spendingonpets: “Tails” fromtheconsumerexpendituresurvey. Beyondthe Numbers:UnitedStatesBureauofLaborStatistics,2(16),1–6.

Herkenham,M.,Lynn,A.B.,Little,M.D.,Johnson,M.R.,Melvin,L.S.,deCosta,B.R.,&Rice, K.C.(1990).Cannabinoidreceptorlocalizationinbrain. ProceedingsoftheNationalAcademy ofSciencesoftheUSA,87(5),1932–1936. IndianHempDrugsCommission.(1894). ReportoftheIndianHempDrugsCommission,1893–94 Simla:Govt.CentralPrint.Office.

Ironside,W.J.(1946). Banham’sveterinaryposologyandotherinformationfortheusestudents andpractitioners (Reprinteded.).London:Baillière,TindallandCox. Janczyk,P.,Donaldson,C.W.,&Gwaltney,S.(2004).Twohundredandthirteencasesof marijuanatoxicosesindogs. VeterinaryandHumanToxicology,46(1),19–21.

Lewis,M.A.,Russo,E.B.,&Smith,K.M.(2018).PharmacologicalfoundationsofCannabis chemovars. PlantaMedica,84(4),225–233. https://doi.org/10.1055/s-0043-122240 Ley,W.(1843).Observationsonthe Cannabisindica, orIndianhemp. ProvincialMedicalJournal andRetrospectoftheMedicalSciences,5,487–489.

MacCallum,C.A.,&Russo,E.B.(2018).Practicalconsiderationsinmedicalcannabisadministrationanddosing. EuropeanJournalofInternalMedicine,49,12–19. https://doi.org/10.1016/j. ejim.2018.01.004

McPartland,J.,DiMarzo,V.,DePetrocellis,L.,Mercer,A.,&Glass,M.(2001).Cannabinoid receptorsareabsentininsects. TheJournalofComparativeNeurology,436(4),423–429. McPartland,J.M.(2004).Phylogenomicandchemotaxonomicanalysisoftheendocannabinoid system. BrainResearch.BrainResearchReviews,45(1),18–29.

McPartland,J.M.(2018). Cannabis systematicsatthelevelsoffamily,genusandspecies. CannabisandCannabinoidResearch,3(1),203–212. https://doi.org/10.1089/can.2018.0039

Milks,H.J.(1917). Practicalveterinarypharmacologyandtherapeutics.NewYork:MacMillan. Milks,H.J.,&Eichhorn,A.(1936). Practicalveterinarypharmacology,materiamedicaand therapeutics (3rded.).Chicago:AlexanderEger.

Milks,H.J.,&Eichhorn,A.(1940). Practicalveterinarypharmacology,materiamedicaand therapeutics (4thed.).Chicago:AlexanderEger.

Muir,E.S.(1900).Theactionofcertainsomnifacientsonthehorse. JournalofComparative MedicineandVeterinaryArchives (April–May),278–283.

Muir,E.S.(1904). Manualofmateriamedicaandpharmacy (3rded.).Philadelphia:F.A.Davis. NationalAcademiesofSciencesEngineeringandMedicine(U.S.).CommitteeontheHealth EffectsofMarijuana:AnEvidenceReviewandResearchAgenda.(2017). Thehealtheffects ofcannabisandcannabinoids:Thecurrentstateofevidenceandrecommendationsfor research.

O’Shaughnessy,W.B.(1838–1840).OnthepreparationsoftheIndianhemp,orgunjah (Cannabis indica);Theireffectsontheanimalsysteminhealth,andtheirutilityinthetreatmentoftetanus andotherconvulsivediseases. TransactionsoftheMedicalandPhysicalSocietyofBengal,71–102,421–461.

Quitman,E.L.(1912). Synopsisofveterinarymateriamedica,therapeuticsandtoxicology (3rd ed.).Chicago:AlexanderEger.

Russo,E.(2002).Cannabistreatmentsinobstetricsandgynecology:Ahistoricalreview. Journalof CannabisTherapeutics,2(3–4),5–35.

Russo,E.B.(2005).CannabisinIndia:Ancientloreandmodernmedicine.InR.Mechoulam(Ed.), Cannabinoidsastherapeutics (pp.1–22).Basel:BirkhäuserVerlag.

Russo,E.B.(2011).TamingTHC:Potentialcannabissynergyandphytocannabinoid-terpenoid entourageeffects. BritishJournalofPharmacology,163(7),1344–1364. https://doi.org/10. 1111/j.1476-5381.2011.01238.x

Russo,E.B.(2016).Currenttherapeuticcannabiscontroversiesandclinicaltrialdesignissues. FrontiersinPharmacology,7,309. https://doi.org/10.3389/fphar.2016.00309

Russo,E.B.(2017).Historyofcannabisasmedicine:NineteenthcenturyIrishphysiciansand correlationsoftheirobservationstomodernresearch.In:S.Chanda,H.Lata,&M.Elsohly (Eds.), CannabissativaL.:Botanyandbiotechnology (pp.63–78).Cham:Springer.

Russo,E.B.(2018).Cannabistherapeuticsandthefutureofneurology. FrontiersinIntegrative Neuroscience,12,1–11. https://doi.org/10.3389/fnint.2018.00051

Sayre,L.E.(1907). Amanualoforganicmateriamedicaandpharmacognosy (3rded.).Philadelphia:P.Blakiston’s. Smith,P.B.,Compton,D.R.,Welch,S.P.,Razdan,R.K.,Mechoulam,R.,&Martin,B.R.(1994). Thepharmacologicalactivityofanandamide,aputativeendogenouscannabinoid,inmice. JournalofPharmacologyandExperimentalTherapeutics,270(1),219–227. Tabourin,M.F.(1875). Nouveautraitédematièremédicaledethérapeutiqueetdepharmacie vétérinaires (3rded.).Paris:P.Asselin. Udall,D.H.(1917). Veterinarian’shandbookofmateriamedicaandtherapeutics.NewYork: MacMillan. Walton,R.P.(1938). Marihuana,America’snewdrugproblem.Asociologicquestionwithits basicexplanationdependentonbiologicandmedicalprinciples.Philadelphia:J.B.Lippincott. Winslow,K.(1901). Veterinarymateriamedicaandtherapeutics.NewYork:WilliamR.Jenkins. Winslow,K.,&Eichhorn,A.(1919). Veterinarymateriamedicaandtherapeutics (8thed.). Chicago:AmericanVeterinary. Wirtshafter,D.(2016). Compendium:Thecannabismuseum:Collectionofcannabisartifacts (1st ed.).Athens,OH. www.cannabismuseum.com

AboutthisBook

Thistextwaswrittenasaguideforveterinarypractitionersinterestedintheuseof phytocannabinoidsasatherapyforcompanionanimals.Thepaceatwhichresearch isbeingpublishedonthistopicandamidregulatoryoverhaulsworldwidemadethe publicationofthistextcriticalandtimelytopracticeveterinarymedicinesafelyasit pertainstothetherapeuticuseofthesecompoundsgivenclientinterestandthe surmountingscientificevidencefortheirutility.Duetothespeedatwhichregulatory changesareoccurringinregardtocannabis(hempandmarijuana)andfearof publishingoutofdatematerial,thistextfocusesonthescientificandclinicalaspects ofcannabinoidsinpredominatelydogs,cats,andhorses.Theauthorsofthistext wrotetheirchapterstoofferwhatevidenceexistsontheirrespectiveareaoffocusto helpyoumakeamoreinformedclinicaldecision.Aswithmanythingsinveterinary medicine,wemustbepreparedtoextrapolateinformationfromotherspecies, preclinicalstudies,andanecdotecombinedwithourownclinicaljudgmenttobest careforourpatients.

Contents

1TheEndocannabinoidSystemandEndocannabinoidome ........1 RobertSilver

2ThePharmacologyofCannabinoids ........................17 GregCopas,ErikAmazonas,andSarahBrandon

3Toxicology ............................................61 AhnaBrutlag

4TerpenesandFlavonoids:CannabisEssentialOil ..............85 LizHughstonandMelissaConarton

5CannabinoidsforPainManagement ........................117 CorneliaMosley,JamesGaynor,StephenCital,andJamieBrassard

6CannabinoidsforNeurologicalConditions ...................143 BayeG.Williamson,JoliJarboe,andChristineWeaver

7WellBeing ............................................171 JamiePeyton,KatherineKramer,BrookQuesnell,andStephenCital

8CannabinoidsforGastrointestinalHealth ....................193 MickiMcCabeandStephenCital

9Dermatology:EndocannabinoidsandRelatedN-Acylethanolamines intheSkin ............................................207 VincenzoMiragliottaandChiaraNoli

10CannabinoidsinOncologyandImmuneResponse .............231 Louis-PhilippedeLorimier,TrinaHazzah,ErikAmazonas, andStephenCital

11NutritionalAnalysisofCannabis ...........................271 RobertSilver,JosephWakshalg,SusanWynn,andKatherineKramer xv

13ProductSelectionandDosingConsiderations

Contributors

ErikAmazonas CenterforVeterinaryCannabinoidMedicine,FederalUniversity ofSantaCatarina(UFSC),Curitibanos,SC,Brazil

SarahBrandon CannaCompanion,Seattle,WA,USA

JamieBrassard CanadianAssociationofVeterinaryCannabinoidMedicine,Ajax, ON,Canada

AhnaBrutlag PetPoisonHelplineandSafetyCallInternational,Minneapolis, MN,USA

DepartmentofVeterinaryandBiomedicalSciences,CollegeofVeterinary Medicine,UniversityofMinnesota,St.Paul,MN,USA

MelissaConarton AcademyofPhysicalRehabilitationVeterinaryTechnicians& VeterinaryMedicalCenterofCentralNewYork,EastSyracuse,NY,USA

GregCopas CannaCompanion,Seattle,WA,USA

TrinaHazzah VeterinaryCannabisSociety,LosAngeles,CA,USA

JoliJarboe BushVeterinaryNeurologyService,Frederick,MD,USA

Louis-PhilippedeLorimier CentreVétérinaireRive-Sud,UnedivisionduGroupe Vétéri-MédicInc.,Laval,QC,Canada

DanielleLoughton TurningLeafConsultations,LasVegas,NV,USA

ChelseaLuedke HeritageEquineClinic,Berthoud,CO,USA VetCSLLC,Centennial,CO,USA

MickiMcCabe IntegrativeMedicineDepartment,SchoolofVeterinaryMedicine, LouisianaStateUniversity,BatonRouge,LA,USA

VincenzoMiragliotta DepartmentofVeterinarySciences,UniversityofPisa,Pisa, Italy xvii

CorneliaMosley CanadianAssociationofVeterinaryCannabinoidMedicine, Ajax,ON,Canada

ChiaraNoli ServiziDermatologiciVeterinari,Peverago(CN),Italy

JamiePeyton IntegrativeMedicineService,UCDavisSchoolofVeterinary Medicine,Davis,CA,USA

BrookQuesnell WestVetEmergencyandSpecialtyCenter,GardenCity,ID,USA

EthanRusso CReDOScience,Seattle,WA,USA

SarahSilcox CanadianAssociationofVeterinaryCannabinoidMedicine,Ajax, ON,Canada

RobertSilver CollegeofVeterinaryMedicine,LincolnMemorialUniversity, Harrogate,TN,USA

RxVitamins,Boulder,CO,USA

JosephWakshalg CornellUniversity,Ithaca,NY,USA ElleVetSciences,S.Portland,ME,USA

ChristineWeaver BushVeterinaryNeurologyService,Frederick,MD,USA

TrishWilhelm OperationsforVetCS,Centennial,CO,USA

BayeG.Williamson NeurologyDepartment,MedVetSiliconValley,SanJose, CA,USA

SusanWynn InstinctPetFood,StLouis,MO,USA

Chapter1

TheEndocannabinoidSystem andEndocannabinoidome

1.1Introduction

The “EndocannabinoidSystem” (ECS)wasnotdiscovereduntilearlyinthe1990s, asaresultofresearchtounderstandtheactionsof Δ9-THC(THC)onthenervous system.SomeofthisworkdeterminedthatTHCworksbybindingtotwoendogenousmembranereceptorsthathadnotbeenidentifiedprior.Theseendogenous membranereceptorswereidentifiedasG-proteincoupledreceptors(GPCR)and namedCannabinoidReceptor1(CB1)andCannabinoidReceptor2(CB2).Afterthe discoveryofthesereceptors,itwasashortpathto findtheendogenousligandsthat pairwiththesereceptors(Panagisetal. 2014).

Theendogenousligandsareendocannabinoids,whicharederivativesof, andmanufacturedfrom,thefattyacidarachidonicacidinthecellularmembrane. Thetwoendocannabinoids,arachidonoylethanolamide(AEA)and 2-arachidonoylglycerol(2-AG)werediscoveredfollowingthediscoveryofthe cannabinoidreceptorsin1992and1995,respectively.Biosyntheticenzymessynthesizetheseendocannabinoidsinthecellmembrane,adhoc,triggeredbyspeci fic stimuli.Degradativeenzymesplayaroleinendocannabinoiddeactivation,with AEAdeactivatedmainlybyfattyacidamidehydrolase(FAAH)and2-AG deactivatedbymonoacyl-glycerollipases(MAGLs)(ZouandKumar 2018;Lu andMackie 2016).

Thedefined classic ECSistheensembleoftheGPCR’sCB1andCB2receptors andendogenousmoleculesinvolvedwithcannabinoidsignalingalongwithcatalyzingandhydrolyzingenzymes: R.Silver(*)

CollegeofVeterinaryMedicine,LincolnMemorialUniversity,Harrogate,TN,USA

RxVitamins,Boulder,CO,USA

e-mail: rsilver@drsilverdvm.com

© TheAuthor(s),underexclusivelicensetoSpringerNatureSwitzerlandAG2021 S.Citaletal.(eds.), CannabisTherapyinVeterinaryMedicine, https://doi.org/10.1007/978-3-030-68317-7_1

1.Primaryendogenousligands,althoughothershavebeendescribed,are endocannabinoidsAEA&2-AG

2.Endogenouscannabinoidreceptors(CB1&CB2)

3.Metabolicenzymesofbiosynthesisandhydrolysis(DAGL;FAAH; MAGL;NAPE)

1.2TheEndogenousLigands

Anandamide(AEA)and2-AGaretheprimaryendogenoustriggerstoactivate cannabinoidreceptorsignaling,butotherendogenousmoleculessuchas palmitoylethanolamine(PEA)andoleoylethanolamide(OEA)alsoexert cannabimimeticeffects(Veilleuxetal. 2019).

AEAand2-AGbindorthostericallytothecannabinoidreceptors.Theyactivate thesereceptorsatthecellularlevel.Unliketheotherneurotransmitters,likenorepinephrineoracetylcholinewhicharehydrophilicandstoredinintracellularvesicles, endocannabinoidligandsarelipophilicandproducedondemandfromarachidonic acidinthecellularmembranewiththehelpoftheirbiosyntheticenzymes.Inthe nervoussystem,bothendocannabinoidsareproducedinthepostsynapticmembrane andtravelretrogradeacrossthesynapticclefttothepresynapticmembranewhere theybindtoCB1orCB2receptorsandmodulatepresynapticneurotransmitter release.Theevidencefor2-AGretrogradetransmissionisgreaterthanforAEA, butthesemechanismshavenotyetfullybeenelucidated(Mechoulametal. 2014).

Thistransient “on-demand” activityofendocannabinoidsguaranteesthat endocannabinoidsignalingistightlycontrolledinthelocalareaofactivityandhas ashortdurationofactivity(Abramovicietal. 2018).

Theproductionofendocannabinoidsinthepostsynapticmembraneistriggered byanintracellularcalcium(Ca2+)concentrationincreasesecondarytoeithera depolarizationsignal,physiological,orpathologicalstimulus.Theseligandscan alsosignalothercannabinoidreceptor-independentpathways,suchastheTRPV1 andHT51membranereceptorsystems.

Allostericantagonistsornegativeallostericmodulators,alsoknownas “noncompetitive” antagonists,canblockactivationofG-proteinreceptorssuchasCB1& CB2throughbindingtoanallostericsiteonthereceptor.Thisallostericaffinity modulatesthebindingoftheorthostericligand,whichthenblocksfullactivationof thatreceptor(Howlettetal. 2011).

AEAisapartialagonistofCB1andCB2withlessaffinityforCB2thanCB1.On theotherhand,2-AGshowsgreaterpotencyandefficiencyasanagonistforCB1 thanAEAaswellasgreaterpotencythanAEAfortheCB2asanagonist.Bothof theseendocannabinoidshavealsobeenshowntohaveactionswith non-endocannabinoidreceptorsandionchannels.

Polyunsaturatedfattyacidsareknowntodirectlyinfluenceinputinto endocannabinoidsignalingpathways.DietaryintakeofomegafattyacidsisnecessaryfortheregulationofECStone(Lafourcadeetal. 2011).TheECSisintimately involvedintheregulationofmostaspectsofanimalphysiology.TheCB1

cannabinoidreceptoristhemostcommonGPCRinthehumanbrainandmanyother organs.Todate,theseanatomicallocationsfortheCB1receptorincludeheart,blood vessels,liver,lungs,digestivesystem,fat,andspermcells(Mackie 2008).

1.3TheEndogenousReceptors

TheidentificationoftheG-proteincoupledreceptorfamily,aswellasthediscovery oftheendocannabinoidreceptors,wasmadepossibleduetotheadventofchromatographicanalyticaltechnologyinthelate1970stoearly1980s.Morespeci fic examplesofG-proteincoupledreceptorsaretheopioid,muscarinic,cholinergic,and α-adrenergicreceptors,andtheyallholdincommontheabilitytoinhibitthe productionofadenylylcyclase.Thenewlydiscoveredcannabinoidreceptor(CB1) inhibitedthisenzymeaswell,whichidentifieditasamemberofthisfamilyof G-proteincoupledmembranereceptors.Theidentificationseveralyearslaterofthe CB2receptorwasaccomplishedthroughsequencehomology(Elphick 2012).

Eachofthesetwocannabinoidreceptorshasadistinctanduniqueanatomical spatialdistributionwithindividualspeciesvariations.BothCB1andCB2arepresent insomeofthesametissuessimultaneously,althoughprovidingdifferentbutsynergisticeffects.

Generally,theCB1receptorislocatedprimarilyintheCNSbutisalsopresentin muchlowerconcentrationsinmosttissuesandcelltypesperipherally.Todate,the anatomicallocationsidentifiedfortheCB1receptorincludeheart,bloodvessels, liver,lungs,digestivesystem,fat,andspermcells(Mackie 2008).

TheCB2receptorhasthehighestconcentrationsintheimmuneandhematopoieticsystems.IdentificationofCB2receptorswerefoundinthebrain,thegut, myocardium,endothelial,vascularsmoothmuscle,Kupffercell,exocrineandendocrinepancreas,bone,reproductiveorgansandcells,andalsoinvarioustumors (Pacheretal. 2006;Gardner 2013).

CB2receptorsintheimmunesystemcanmodulatethereleaseofcytokines. InhibitionofadenylylcyclaseresultsfromtheactivationoflymphocyteCB2 receptorsbycannabinoids.Inturn,thiswillreducethecellularandhumoral responsestoanimmunechallenge(DePetrocellisetal. 1999).CB1andCB2 receptorsdecreaseadenylylcyclaseactivityanddown-regulatethecAMPpathway. Activationoflymphocytesresultsinmitogen-activatedproteinkinasecascades (MAPK),ionchannelmodulation,andmodi ficationofintracellularcalciumlevels. PotassiumchannelactivationisalsoasignalingmechanismfortheCB2receptor (Grif finetal. 1999;Hoetal. 1999).

1.4TheBiosyntheticandDegradativeMetabolicEnzymes

TheformationofAEAisatwo-stepprocessthatinvolvesaCa2+-dependent N-acyltransferasetransferofarachidonicacidfromphosphatidylcholinetophosphatidylethanolaminetoyieldN-arachidonoylphosphatidylethanolamine(NAPE) whichisthenhydrolyzedbyaNAPE-specificphospholipaseD(NAPE-PLD)into AEA.Thisprocessistheprimarybiosyntheticroute,althoughtherearealternate routesofsynthesisavailabletomanufactureAEA.

Multiplepathwayswithredundantprecursorsindicatetheimportanceofthis endocannabinoidtothephysiologyofhomeostasis.RaphaelMechoulamhas observedthatmostbiochemicalmechanismsinnaturewilluseredundantprecursors andpathways.Mechoulamcallsthis: “Thestinginessofnature.” Heexplainsthat “If natureknowshowtodosomething,chancesareitwilldoitagainwithsmallchanges soitwillnothavetolearnnewthings.” (Gardner 2013).

2-AGisprincipallysynthesizedthroughphospholipaseCβ-mediatedhydrolysis ofphosphatidylinositol-4,5-bisphosphate,witharachidonicacidonthe sn-2 position,toyielddiacylglycerol(DAG).DAGisthenhydrolyzedto2-AGby diacylglycerollipase(DAGL).ItisimportanttonotethatalthoughbothAEAand 2-AGarederivedfromarachidonicacid,theirbiosyntheticpathwaysarenotthe sameasthebiosyntheticpathwaysfortheproductionofeicosanoids(Abramovici etal. 2018).

1.4.1DegradationofEndocannabinoids

Fattyacidamidehydrolase(FAAH)andmonoacylglycerollipase(MAGL)terminatethebindingofAEAand2-AG,respectively,totheendocannabinoidreceptors. FAAHislocalizedprimarilypost-synapticallyandpreferentiallydegradesanandamide;MAGLisprimarilylocalizedpre-synaptically,nearthepresynapticmembrane,anddegrades2-AG.Therapidterminationoftheendocannabinoidsignal guaranteesthatbiologicalactivitiesdependentuponthesesignalsareappropriately regulated.Withprolongedsignalingactivity,suchascanbefoundwiththeuseof exogenouscannabinoids(bothsyntheticandplant-derived),problematicadverse eventsmayoccur(Abramovicietal. 2018).

Locatedontheendoplasmicreticulum(ER),FAAHisinthecytoplasmofthe cell.MAGLisfoundinthecellmembraneandisalsosoluble.Becausethe extracellularspacethatbridgesthesynapticgapandsurroundsallcellsisanaqueous environment,highlylipophilicmolecules(suchastheendocannabinoids)needtobe transportedtothecellularmembraneandintothecytoplasmbyspeci ficmolecules capableofcarryingalipophilicsubstancethroughanaqueousenvironment.The activityofthesedegradativeenzymesisdependentonthetransportoftheirlipophilic substrates(AEAand2-AG)tothecellmembranewhere2-AGcanbedegradedby

MAGLandintotheaqueousenvironmentofthecytoplasmtotheERwhereFAAH candegradeAEA.

1.4.2TransportofEndocannabinoidsforActivation andDegradation

FattyAcidBindingProtein(FABP)isthetransportproteinmoleculeneededtocarry lipophilicmoleculessuchasfattyacidsandendocannabinoidstotheirsitesof activityanddegradation.2-AGusesFABPsforitsretrogradetransporttotheCB1 receptoronthepresynapticmembrane(Deutsch 2016).

FABPsalsohaveanaffinityforthehighlylipophilicphytocannabinoidssuchas CBDandTHCandareresponsiblefortransportingthemtothecannabinoidreceptors.Thismoleculetransportationmechanism,inpart,ishowCBDandTHCcan competeforanandamideuptakebyFABP,andinsodoing,canincreasetheserum half-lifeoftheendocannabinoids.Thisisthemechanismthatdocumentstheability ofCBD/THCtoboostthebody’sendocannabinoidsignaling.FAPBsarealso responsiblefortransportingthephytocannabinoidsintothecell,wheretheycan themselvesbedegradedenzymaticallybyP450cytochromeenzymes(Elmesetal. 2015, 2019).

InbiochemicalstudiesitwasfoundthatCBD,andpotentiallyother phytocannabinoids,canenhanceAEAsignalingindirectlybyinhibitingAEAdegradationcatalyzedbyFAAH.(Lewekeetal. 2012,PapagianniandStevenson 2019).

1.5TheEndocannabinoidome

Thegroupofmoleculesandreceptorsthatcomprisetheclassicendocannabinoid systemarepartofalargerfamilyofsignalingmoleculesandreceptorpromiscuity termedthe “Endocannabinoidome”.Thesearecompoundsthatarenotspecifically partoftheendocannabinoidsystembuthaveacross-signalingeffectwiththeECS. Theyarefoundtoactonseveralreceptortargets(GPR55,GPR18,GPR119,TRPA1, CB1,CB2,TRPV1,TRPA1,opioid,dopamine,andserotonin(5-HT)andglycine receptors)andnon-receptortargetswithintheECS.Theindividualmoleculesofthe endocannabinoidometermed “entouragecompounds” or “endocannabinoid-like molecules” includetheacylethanolamidesdetailedbelow(Ngo, 2019).

Endocannabinoid-likemoleculesthathavenotbeenshowntobindtothecannabinoidreceptorshavebindingaffinitytothenuclearreceptor/transcriptionfactor peroxisomeproliferator-activatedreceptor(PPAR α & γ).Thesemoleculesarefatty acylethanolamidessuchaspalmitoylethanolamide(PEA)andoleoylethanolamide (OEA).Theseendogenousethanolamidescanpotentiateanandamide’seffect throughthecompetitiveinhibitionofFAAH,similarlyseenwithCBD.These

ethanolamideshaveanallostericmodulatoryeffectonanotherreceptorsystem,the transientreceptorpotentialvanilloid(TRPV)channel.Theeffectthesemolecules haveontheendocannabinoidsystemtopotentiatetheactionsorserumlevelsof endocannabinoidshasbeentermedthe “EntourageEffect”.Thedefinitionofthe entourageeffectextendstoincludetheinteractionoftheactivecomponentsof Cannabissativa L.,namely,thephytocannabinoids,terpenes,and flavonoids,and theendocannabinoidsystem(Abramovicietal. 2018).

Mechoulam,inhis2012addresstotheInternationalCannabinoidResearch SocietyinFreiberg,Germany(Gardner 2013),discussedthecriticalrolethatfatty acidsboundtoaminoacids, “FAAA”s,playinintercellularsignaling.TheseFAAAs arefoundinclustersthatincludetheirprecursormoleculesandtheirderivativesand arefoundinlargenumbersinthecentralnervoussystem,especiallyinthebrain. AEAand2-AGarejusttwoofthesetypesofmolecules.Thesetypesofmolecules areconstituentsoftheendocannabinoidome,andMechoulambelievesthesewillbe thesubjectofextensivestudyinthesearchformoleculartherapiesandpharmaceuticalinterventionsinthefuture.

Furtherexamplesofthesemoleculesincludearachidonoylserine(AraS),which canregulatevasoconstrictionandtheeffectsofbraintrauma.Arachidonoylglycine, ontheotherhand,canlowerpainsensations.Oleamideisasleep-inducinglipid,and oleoylserinecanbeusefulforosteoporosis.Oneoftheseentouragecompounds, palmitoylethanolamide(PEA),concentratesinthebrainwheninjured.Thereare hundredsoftheseentouragecompoundsinthebrain,amongothertissues. Mechoulamconcludedthatidentifyingandunderstandingthefunctionsofthe FAAAswillelucidatemechanismsofdiseaseandprovidebothdiagnosticand interventionaltoolsformedicineinthefuture.

1.6EndocannabinoidTone

Gprotein-coupledreceptors(GPCR)respondtoactivationbyanagonist,suchas AEAor2-AG,bystimulationofproteinactivation,inhibitionofadenylylcyclase, activationofmitogen-activatedproteinkinase(MAPK),orregulationofanion channel.Competitiveantagonistscanblocktheactivityoftheseagoniststhrough competitionwithbindingsitesbutfailtoactivatearesponsefromtheGPCR.

Constitutiveactivityoccurswhenareceptorisactivatedwithoutdirectstimulationbyanagonist.Thisresultsfromotherreceptorsthathavebeenstimulatedby theirendogenousagonistsandcanbeeitherautocrine(fromthesamecellasthe GPCR)orparacrine(fromanearbycell)innature.Thesumtotalofthisactivityis consideredtobethe ‘basaltone’ ofatissue.

Allostericornon-competitiveagonistswillblockGPCRsignalingbybindingto anallostericsitewhichblockstheconformationalchangeassociatedwiththe bindingoftheagonistatitsorthostericsite,thusblockingactivationofthat GPCR.TheconstitutiveactivationoftheGPCRcanbeblockedbyaninverse

agonist,which,liketheallostericantagonist,blockstheconstitutiveactivationofthe receptorbytheautocrineorparacrinesignals.

Thesereceptorinteractionscanbequitecomplex,andoftenoverlappingin definitionsandactivity. “Tonic” signalingisthebasalsignaling,speci fictoa giventissueintheabsenceofagonistbinding; “phasic” signalingresultsfromthe directbindingoftheagonistattheorthostericsite.AEAistheendocannabinoidthat regulatesthebasalsynapticsignaling,and2-AGisthephasicsignalingagonist molecule(Matiasetal. 2005).

Theendocannabinoidtone,fromalargerperspective,resultsfromanindividual’s levelofAEAand2-AG,basedontheirsynthesis,degradation,andthespatial densityofendocannabinoidreceptorsinthebody.Thelevelsofthese endocannabinoidsmaintainhomeostasisandregulatepain,metabolism,andnearly everyotherprocessinthebody.Withdecreasedendocannabinoidtone,clinical problemscanresult.

1.6.1ClinicalEndocannabinoidDeficiencySyndrome (CEDS)

• ChronicMigraine

• Fibromyalgia

• IrritableBowelSyndrome(IBS)

• PostTraumaticStressDisorder(PTSD)

Russohaspostulated(2004,2016),andevidenceexiststosupporthishypothesis, thatseveralchronicconditionsmaybeduetodeficienciesinendocannabinoid signaling(Russo 2016a, b):

LikeCEDS,manyotherneurologicaldisordersarerelativetoneurotransmitter deficiencies:

• Acetylcholine(Alzheimer ’sDisease)

• Dopamine(Parkinson’sDisease)

• SerotoninandNorepinephrine(ClinicalDepression)

Itisbeyondthescopeofthischaptertodiscusstheendocannabinoidsystem relativetospeci ficdiseases.However,itisworthwhiletonotethatthesyndromes thathavebeenmostcloselyassociatedwithanendocannabinoiddeficiency(PTSD, ChronicMigraine,Fibromyalgia,IBS)haveobjective findingsthatsupporttheir inclusioninthissyndrome.

Thegenevariantsthatencodeendocannabinoidproduction,activityofECS receptors,andgenevariantsresponsibleforenzymeproductionareonlyjustbeginningtoberesearchedbuthelpexplainpartofthegeneticcomponentofthese diseases.Moreover,theconstitutivetoneorsystemiclevelofendocannabinoidsis affectedbysomepharmaceuticals,suchasNSAIDsandacetaminophen,anddiseases 1TheEndocannabinoidSystemandEndocannabinoidome7

thatcandepleteendocannabinoidlevelsorinterferewithendocannabinoidproduction. HumanpatientswithmutationsinCNR1andDAGLAgenesshowsignsofCEDS. HumanIBSpatientswithmutationsintheCNR1genewerefoundtohavealteredrates ofcolonictransit.ImpairedfearextinctionhasbeenidentifiedwithPTSDpatientswho arehomozygousforaCNR1mutation(Smithetal. 2017;Camillerietal. 2013; Heitlandetal. 2012).

Thesedisordersallhaveincommonmarkedlydecreasedsystemiclevelsof endocannabinoids.Circulatingendocannabinoiddeficienciesarealsoinverselycorrelatedwithanxiety-likebehaviors.ChronicenvironmentalstressorscandownregulateCB1receptorsandreducelevelsofbothAEAand2-AG(Hilletal. 2009).

Asofthispublication,theCEDShasnotbeenidentifiedordefinedinour veterinaryspecies.

1.7TheEvolutionoftheEndocannabinoidSystem

Nearlyallanimals,includingvertebrates(mammals,birds,reptiles,and fish)and invertebrates(seaurchins,leeches,mussels,nematodes,andothers),havebeen foundtohaveendocannabinoidsystems.TheECSisfoundinnearlyallanimals, frommammalstothemoreprimitivephyla.TheearlyemergenceoftheECSinthe phylogenyindicatesitsbiologicalimportance.Anunderstandingoftheroleofthe endocannabinoidsysteminhealthanddiseaseiscrucialfordeveloping pharmacotherapeuticinterventions.

1.7.1InvertebrateEndocannabinoidSystems

TheHydra(H.vulgaris),acnidarianintheclassHydrozoa,isoneofthe firstanimals withaneuralnetwork.TheprimaryfunctionoftheECSinthisprimitiveanimalisto controlitsfeedingresponse(DePetrocellisetal. 1999).SubsequentstudiesidentifiedendocannabinoidreceptorsandthepresenceofaFAAH-likeamidaseintheSea squirtanddeterminedanassociationwithabehavioralresponse(Matiasetal. 2005). Asystematicreviewwasconductedofexistingpublishedresearchdetailingthe presenceofECSreceptorsininvertebrates.Thisliteraturewasemployedinthe identificationofsubgroupsofinvertebratestoconducttritiatedligandbindingassays inthegroupofinvertebratesthathadnotbeenstudiedprior.Sevenspeciesof invertebrateswereexaminedusingatritiatedligandbindingassay.Cannabinoid receptorswereidentifiedinthefollowingspecies:

• Cionaintestinalis Seasquirt(Deuterostomia)

• Lumbricusterrestris Earthworm(Lophotrochozoa)

• Peripatoidesnovae-zealandiae Velvetworm(Onychophora)

• Jasusedwardi Rocklobster(Crustacea),

1TheEndocannabinoidSystemandEndocannabinoidome9

Panagrellusredivivus Beermatnematode(Nematoda)

• Actinothoealbocincta Whitestripedanemone(Cnidaria)

• Tethyaaurantium OrangePuffballsponge(Porifera).

Noevidenceofcannabinoidbindingwasdetectedineithertheseaanemone (A.albocincta)orthesponge(T.aurantium).Intheotherorganismstested,CB1 receptorsweredetected,butCB2receptorswerenotdetected.Theearthworm (L.terrestris),velvetworm(P.novae-zealandiae),andmatnematode (P.redivivus)werecomparedtoastandardCB1orthologinratcerebellartissue andwerefoundtohaveastrongbindingaffinity.

Fromthisdata,itwasconcludedthatcannabinoidreceptorsevolvedinthelast commonancestorofthebilateriansbuthadasecondlossininsectsandotherclades. Cannabinoidreceptorshavebeenidentifiedinseaurchins,leeches,earthworms, hydra,lobster(H.americanus and J.edwardi),andthebeermatnematode (P.redivivus),butnotthenematode(C.elegans)(McPartlandetal. 2006).

Insects(Apismellifera [westernhoneybee]), Drosophilamelanogaster [common fruit fly], Gerrismarginatus [waterstrider], Spodopterafrugiperda [fallarmyworm mothlarva],and Zophobasatratus [darklingbeetle])havenotbeenfoundtocontain cannabinoidreceptors.Noothermammalianneuroreceptorhasbeenfoundtobe lackingininsects.Thisistheonlycaseincomparativeneurobiologythatamammalianneuroreceptorisabsentininsects(Ecdysozoa).Onehypothesisforthis absenceofcannabinoidreceptorsininsectsistheverylowlevelsof endocannabinoidligandsmeasured.However,2-AGhasbeenfoundinmoresignificantamountsthanAEA,andFAAH-likemoleculeswerenotidentifiedinthefruit fly(Drosophilamelanogaster).Historically,cannabisextractshavebeenfoundto createbehavioralchangesininsects,butfromthisstudy,itappearsthiseffectisnot mediatedbyendocannabinoidreceptors.Endocannabinoidreceptorshavebeen identifiedinanimalsphylogeneticallyolderthaninsects,suchastheHydra (McPartlandetal. 2001).

1.7.2VertebrateEndocannabinoidSystems

Studiesoftheendocannabinoidsystemofvertebrateshavefoundevidencethatitis presentinallspecies.Fromtheevidencethattheendocannabinoidsystemexistsin invertebratespeciesasearlyphylogeneticallyastheCnidarians,exceptforinsects, onecaninferthatitiscommontoalllifebecauseofitsvitalroleinmanycrucial biologicalactivities.

Theanatomicalsitesandspatialdensityofcannabinoidreceptorshaveboth interspeciesandintraspeciesdifferencesinvertebratespecies.Forinstance, endocannabinoidreceptorsinhumansaresparseinthebrainstemandmedulla oblongata,whichareresponsibleforthecontrolofvitalautonomicfunctionssuch asrespirationandheartrate.Thisfactiswhycannabishassuchasafeprofilein humans.Thepublishedevidenceindicatesthatcannabismaynothaveassafea

profileforveterinaryspeciessuchasthedog,duetothehighspatialdensityofCB1 receptorsinthedogcerebellumandmedullaoblongata(Deweyetal. 1972).

DifferencesintheproteinsequencesoftheCB2receptorhavebeenidentifiedin thehuman,rat,andcaninereceptors.Thesedifferencesareacuriousoccurrence despitethehighlyconservedstructureoftheCB1receptoramongallmammalian species.EndogenousligandbindingaffinitiesforthecanineCB2receptorare measuredtobeabout30timeslessthanhumanandratCB2receptors(Ndong etal. 2011).

1.8Canine

Comparedtohumans,thenumberofCB1receptorsinhindbrainstructuresinthe dogfarexceedthosefoundinthehumananimal.Radioligandstudiesfoundthat largenumbersofcannabinoidreceptorsarelocatedinthecerebellum,brainstem, andmedullaoblongatainthedog(Herkenhametal. 1930). “Staticataxia,” whichis auniqueneurologicalreactiontoTHCinthedog,isexplainedbythishigh concentrationofCBreceptorsinthecerebellum.Staticataxiawas firstdescribed in1899byDixoninhispharmacologicstudyofIndianhempinavarietyofspecies, includinghumans(Dixon 1899).CB1receptorsinsalivaryglands(Dall’Aglioetal. 2010),hairfollicles(Mercatietal. 2012),skin,andthehippocampusindogshave beenalsobeendescribed(Camporaetal. 2012).

1.8.1CannabinoidReceptorSpatialDistributioninaVariety ofTissuesandOrgans

TheanatomicallocalizationoftheCB1receptorinthenormalcaninenervous systemhasbeendeterminedthroughtheuseofimmunohistochemicalanalysis. Nervoussystemsfromhealthydogsat4months,6months,and10-year-olddogs havebeenevaluatedpost-mortem.Neutrophilsofthecerebralcortex,cornu ammonis(CA),dentategyrusofthehippocampus,midbrain,cerebellum,medulla oblongata,andgraymatterofthespinalcordwerefoundtohavestrongimmunoreactivity.DenseCB1expressionwasfoundinthe fibersoftheglobuspallidusand substantianigra.Theseimmunoreactivelocationsweresurroundedbyneuronswith noimmunoreactivity.

Aconsistent findingofpositiveimmunoreactivityinastrocyteswasrecordedin alloftheexaminedregions.Intheperipheralnervoussystem,CB1stainingwas localizedintheneuronsandinthesatellitecellsofthemyelinatingSchwanncells anddorsalrootganglia.

Incomparingtheyoungerdognervoussystemtotheolderdognervoussystem, lowerCB1expressionwasfoundinthebraintissueoftheolderanimal.Thiswasless

thantheexpressionofreceptorimmunohistochemistryfoundinhumanfetaland neonatalbraintissue.Reducedreceptorexpressionhasbeenmeasuredinagedrats, localizedtothecerebellum,cerebralcortex,andbasalganglia,butlessprevalentin thehippocampus.Theolderdoginthisstudywasalsofound,liketheagedrats,to havereducedmeasurementsofCB1receptorexpressioncomparedtotheyounger dogs’ nervoussystemsexamined(Ndongetal. 2011).

Canineclaustrumsampleswereobtainedfromnecropsyspecimensofneurologicallyhealthydogs.TheywereexaminedbyimmunohistochemicalandmorphohistologicalanalysisforCB1receptorsandfattyacidamidehydrolase(FAAH).The resultsofthisanalysisrevealedaspatialdistributionofthisreceptorandenzyme consistentwithpreviousstudiesreportedforotheranimalspecies.TheCB1receptor waslocatedonpresynapticmembranesandtheFAAHwasfoundinthecellular bodyanddendritesoftheneurons(Pironeetal. 2016).

Inanotherstudy,samplesofthecervical(C6–C8)sensorygangliaandrelated spinalcordwereharvestedpost-mortemfromneurologicallyhealthydogs.Immunohistochemicalanalysisofthistissuedetailedthespatialdistributionofthecannabinoidandcannabinoid-relatedreceptors,CB1CB2,GPR55,PPAR α,andTRPV1 inthecervicaldorsalgangliontissueexamined.50%oftheneuronalpopulationhad weaktomoderateCB1immunostainingandTRPV1receptorimmunoreactivity while100%ofthepopulationwaspositiveforCB2.Schwanncells,bloodvessel smoothmusclecells,andpericyte-likecellsalsodemonstratedCB2immunoreactivity.Nearly40%ofcellshadGPR55receptorsinthissameneuronalpopulation. Endothelialcellsand50%ofsatelliteglialcells(SGC)werepositiveforPPAR α. SGCcellswerepositiveforTRPVstaining,butthiswasonlyinolderdogs (Chiocchettietal. 2019).

A30-dayoldcanineembryowasexaminedusingimmunohistochemistryto localizeitsCB1receptors.Immunoreactivitywasidentifiedmainlyinepithelial tissuesandincludedmoststructuresofthecentralandperipheralnervoussystem, innerear,olfactoryepithelium,andrelatedstructures,eyes,andthyroidgland (Pironeetal. 2015).

HomogeneousdistributionofbothCB1andCB2receptorsinclinicallyhealthy dogsandcatsarefoundthroughoutalllayersoftheepidermis.CB1andCB2 receptorsarepresentbothinhealthydogepidermisandindogswithatopicdermatitis(Campora 2012).

Thereisafundamentalanatomicaldifferencebetweenhumanandcanineepidermalarchitecture,withcanineepidermiscontaining2–3nucleatedlayersofcells.In contrast,thehumanepidermiscontains6–7nucleatedlayersofcells.Dogsdiagnosedwithatopicdermatitishaveahyperplasticepidermis.Suprabasalkeratinocytes possessstrongimmunoreactivityforboththeCB1andCB2receptors,whereasbasal keratinocyteshaveshownweakCB1butstongCB2immunoreactivity.Thisisa strongindicationthatthesereceptorsareupregulatedduringepidermalinflammation.AgoniststobothCB1andCB2receptorshavebeenfoundtoreducemastcell degranulation,whichisanimportantstepinthedevelopmentofhypersensitivity reactions.

Inanexvivostudydesignedtolocalizethedistributionofbothcannabinoid receptors,GPR55,andPPARα inthecaninegastrointestinaltract,CB1immunoreactivitywasfoundinthelaminapropriaandepithelialcells.TheCB2receptor immunoreactivitywasobservedinlaminapropriamastcellsandimmunocytes, bloodvessels,andsmoothmusclecells.Thereisnotablefaintreactivityofthe CB2receptorinneuronsandtheglialcellsofthesubmucosalplexus.PPARα receptorimmunoreactivitywaslocatedinbloodvessels,smoothmusclecells,and theglialcellsofthemyentericplexus.GPR55receptorimmunoreactivitywas localizedinthemacrophagesofthelaminapropriaandsmoothmusclecells.A widedistributionofthecannabinoidreceptorensemblewasfoundinseveralcellular typesfromalllayersinthegastrointestinaltractofthedogsevaluatedinthisstudy (Galiazzoetal. 2018).

CanineDegenerativeMyelopathy(DM)isconsideredtobeadiseasemodelfor amyotrophiclateralsclerosis(LouGehrig’sDiseaseorALS).CB2receptorshave beenfoundtoprovideneuroprotectiveeffectsinamutantmousemodelofALAin partbytheirupregulationinthatmodel.Exvivopostmortemspinalcordsofhealthy dogsanddogsconfirmeddiagnosedwithdegenerativemyelopathywereharvested. PCRanalysiswasusedtoexaminetheendocannabinoidgeneexpressionforboththe healthyandaffecteddogs.Nodifferencebetweenthetwogroupswasnotedforthe CB1receptor,confirmedbyimmunostaining.However,dogswithconfirmedDM hadsigni ficantelevationsofCB2receptorlevelsspatiallylocalizedtotheastrocytes, confirmedviaimmunostaining(Fernandez-Traperoetal. 2017).

Currently,studiesareunderwayusingpolymerasechainreaction(PCR)technologytolocalizeandquantifycannabinoidreceptorsincaninetissue,butthatdatais, asyet,unpublished.Early,butlimited, findingsinthisunpublisheddataused immunohistochemistryandcomparedthattoPCRtechnology.Selectivestaining wasverifiedbywesternblottestingfrom35tissuesamplesderivedexvivo,from adultdogspresentedtotheAuburnUniversityCollegeofVeterinaryMedicine SurgeryDepartmentforproceduresrelatedtothetissuessubmitted.

ResultsincludeddarkstainingofCB2receptorsintheendothelialcellmembranesofmosttissuessubmitted.Other findingssawlesssigni ficantstaininglocalizedmicroscopicallytocellmembranesfromcellslocatedinthetissueparenchyma. HighexpressionoftheCB1genewaslocatedinblood,brain,testicles,ovary,and uterus.Therewaslowexpressioninthekidney,lung,liver,andlymphnode.CB2 expressionwaslimitedbuthadhighexpressioninbloodandlymphnodes.This studyconfirmedmanyearlier findingsusingimmunohistochemistry,suchasahigh concentrationofCB1ingreymatterandCB2inbloodandlymphnodes.Unexpected findings,basedonthepriorimmunohistochemicalstudies,werehighquantitiesofCB2inbothmaleandfemalegonadsandlowlevelsofCB2expressionin lungandliver,ascomparedtohumanandmousemodels(Miller 2017).

TheimmunohistochemicaldistributionofCB1andfattyacidhydrolasewereexaminedexvivoinfelineovariesandoviductsharvestedduringspayingofhealthycats duringdiestrus.Theovarieshadprimordial,primary,secondary,tertiary,and pre-ovulatoryfolliclesinadditiontoactivecorporalutea.CB1immunoreactivity wasnotobservedinimmaturefolliclesbutwasseeninthetertiaryfolliclegranulosa cells.StainingforFAAHdistributeddifferentlythanCB1.Itspresencewasdetected inovarianpre-antralfollicles,oocytecytoplasm,andingranulosacellsofallstages offolliculardevelopment,andinthecalcellsofsecondaryandtertiaryfollicles. LutealcellswereimmunoreactiveforbothCB1andFAAH.These findingssuggest thatlate-stagefolliclesandcorporalutea(CL)couldrespondtoendocannabinoidor entouragecompoundintervention.

OviductsexhibitedCB1stainingonlyonciliatedcells,whereasFAAHstaining wasfoundonbothciliatedandnon-ciliatedcells.ItisknownthattheECSinfluences sperm-oviductinteraction.AEAhasbeenfoundtoinhibitbovinespermbindingand inducesspermreleasefromoviductalepithelialcells.Astudyinewestreatedwitha CB1/CB2agonistnegativelyaffectedlutealprogesteronesecretion.Hypothetically, fertilitycouldbereducedbytargetingtheCLwithendocannabinoidsorentourage compounds.PregnantmiceexposedtoanAEAanalogorTHCexperiencedpregnancylosswithembryoretentionintheoviduct.Anotherstudyfoundthatsystemic andlocal(oviduct)AEAlevelspositivelycorrelatedwithectopicpregnancy.

ThisinformationsuggeststhatmodificationoftheECSduringpregnancyby pharmacologicinterventionortheuseofphytocannabinoidsmayadverselyaffect fertilityandpregnancy.Furtherstudiesareindicated,thedatasuggestsitwouldbe wisetoavoiduseofsuchagentsinreproductiveanimals(Pironeetal. 2017).

FelineswithhypersensitivitydermatitiswerefoundtohaveaproliferationofCB receptorsandPPAR-α receptors.Distributionthroughoutthehealthyfelineskinwas mainlyintheepithelialcompartment.InallergiccatsECSreceptorexpression increasedsigni ficantlywiththemainchangesbeingsuprabasalforCB1anddermal forCB2andmarkedexpressionofPPAR-α inhyperplasticepidermisand perivascularinfiltrate(Miragliotta 2018).

1.10Summary

Fromtheresearchpresentedinthischapter,itisclearthattheendocannabinoid systemispresentinnearlyallanimalsandplaysanintegralroleinmaintaining homeostasisforseveralvitalorgansystems.Theendocannabinoidsystemmodulates thenervousandimmunesystemsandotherorgansystemsthroughanelegantand sophisticatedsystemofreceptorsandchemicalsignalingmoleculestorelievepain andinflammation,modulatemetabolismandneurologicfunction,promotehealthy digestiveprocesses,andsupportreproductivefunctionandembryologic

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I n h a l t : Gurlitt: Kunst und Kirche Schmidt: Der sächs Kirchenbau bis auf Georg Bähr Bestelmeyer: Baukünstl Aufgab der ev Kirche in der Gegenwart Gurlitt: Kirchl Denkmalspflege Berling: Die Sonderausstellung kirchl Kleinkunst Högg: Friedhofskunst

D i e R e n a i s s a n c e i n F l o r e n z u n d

R o m

8 Vorträge von Prof. Dr. K . B r a n d i . 4. Aufl. Geh. M. 5.—, geb. M. 6.—

„...

Meisterhaft sind die Erscheinungen von Politik, Gelehrsamkeit, Dichtung, bildender Kunst zum klaren Entwicklungsgebilde geordnet, mit großem Takte die Persönlichkeiten gezeichnet, aus freier Distanz die Ideen der Zeit betrachtet. Die Ausstattung des Buches dürfte zum Geschmackvollsten der neueren deutschen Typographie gehören.“

(H i s t . J a h r b u c h . )

S c h r i f t e n v o n J o h a n n G e o r g , H e r z o g z u S a c h s e n

Streifzüge durch die Kirchen und Klöster Ägyptens. Mit 239 Abb.

Geh. M. 8.—. Tagebuchblätter aus Nordsyrien. Mit 85 Abb. Geh. M. 4.80 Das Katharinenkloster am Sinai. Mit 43 Abb. auf 12 Taf.

Geh. M. 3.20

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