Care and Feeding of the Endocannabinoid System: A Systematic Review of Potential Clinical Interventions that Upregulate the Endocannabinoid SystemReport as inadecuate




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Background

The -classic- endocannabinoid eCB system includes the cannabinoid receptors CB1 and CB2, the eCB ligands anandamide AEA and 2-arachidonoylglycerol 2-AG, and their metabolic enzymes. An emerging literature documents the -eCB deficiency syndrome- as an etiology in migraine, fibromyalgia, irritable bowel syndrome, psychological disorders, and other conditions. We performed a systematic review of clinical interventions that enhance the eCB system—ways to upregulate cannabinoid receptors, increase ligand synthesis, or inhibit ligand degradation.

Methodology-Principal Findings

We searched PubMed for clinical trials, observational studies, and preclinical research. Data synthesis was qualitative. Exclusion criteria limited the results to 184 in vitro studies, 102 in vivo animal studies, and 36 human studies. Evidence indicates that several classes of pharmaceuticals upregulate the eCB system, including analgesics acetaminophen, non-steroidal anti-inflammatory drugs, opioids, glucocorticoids, antidepressants, antipsychotics, anxiolytics, and anticonvulsants. Clinical interventions characterized as -complementary and alternative medicine- also upregulate the eCB system: massage and manipulation, acupuncture, dietary supplements, and herbal medicines. Lifestyle modification diet, weight control, exercise, and the use of psychoactive substances—alcohol, tobacco, coffee, cannabis also modulate the eCB system.

Conclusions-Significance

Few clinical trials have assessed interventions that upregulate the eCB system. Many preclinical studies point to other potential approaches; human trials are needed to explore these promising interventions.



Author: John M. McPartland , Geoffrey W. Guy, Vincenzo Di Marzo

Source: http://plos.srce.hr/



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