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(Last modification16. November 2010)

 

Sorry: It will be much work to get a good German version

 

Cannabinoids in Hemp (Cannabis sativa)

 

You might want to look at some Wikipedia pages which will provide you with lots of interesting information (note: often the English and German versions are quite different: if you can, look at both):

Cannabis (English - German);  Cannabinoids (English - German);  Tetrahydrocannabinol (THC) (English - German);

 

A few pictures, taken from Wikipedia

 

Leaf of Cannabis sativa

Trichomes of Cannabis sativa

The Hash Marihuana & Hemp
 Museum in Amsterdam

Some explanation for the picture to the left (from Franz Eugen Köhler's "Medizinal-Pflantzen"), text in German (unfortunately, it is a bit difficult in the orginal to see the numbers and therefore I enlarged them a bit):
Hanfpflanze. A blühende männliche und B fruchtende weibliche Pflanze; 1 männliche Blüthe, vergrössert; 2 und 3 Staubbeutel von verschiedenen Seiten, desgl.; 4 Pollenkorn, desgl.; 5 weibliche Blüthe mit Schutzblatt, desgl.; 6 dieselbe ohne Schutzblatt, desgl.; 7 Fruchtknoten im Längsschnitt, desgl.; 8 Frucht mit Schutzblatt, desgl.; 9 dieselbe ohne Schutzblatt, desgl.; 10 Same, desgl.; 11 derselbe im Querschnitt, desgl.; 12 derselbe im Längsschnitt, desgl.; 13 Same ohne Samenschale, desgl..

 

Some Reviews

Pertwee, 2010; Gertsch et al., 2010; Pertwee, 2005;  Taura et al.,  2007b, Flores-Sanchez and  Verpoorte, 2008b; Clarke and Watson, 2007; Mechoulam et al., 2007; Ross, 2005; Turner et al., 1980

 

Content of this page


 

The legal Situation in the U.S.A.

 

Introduction paragraph from an Internet article of the National Institute of Drug Abuse (NIDA) (further reading).
    'Marijuana is the most commonly abused illicit drug in the United States. A dry, shredded green/brown mix of flowers, stems, seeds, and leaves of the hemp plant Cannabis sativa, it usually is smoked as a cigarette (joint, nail), or in a pipe (bong). It also is smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, often in combination with another drug. It might also be mixed in food or brewed as a tea.
    As a more concentrated, resinous form it is called hashish and, as a sticky black liquid, hash oil. Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor. There are countless street terms for marijuana including pot, herb, weed, grass, widow, ganja, and hash, as well as terms derived from trademarked varieties of cannabis, such as Bubble Gum, Northern Lights, Fruity Juice, Afghani #1, and a number of Skunk varieties.'

 

It is an illegal drug in most countries, including the U.S.A. In view of this, I found it a bit unexpected that there is in the U.S.A. a University dedicated to teaching how to grow and market Marihuana: the Oaksterdam University (a mixture of Oakland and Amsterdam) that was founded in 2007, with the main location in downtown Oakland, California (there are also campuses in Los Angeles, Sebastopol, and Michigan). The official mission is: "to legitimize the business and work to change the law to make cannabis legal". More details are in the Wikipedia page.
Oaksterdam is a cultural district on the north end of downtown Oakland, California, where medical cannabis in a variety of competitively priced smokeable and edible preparations is available for purchase in multiple cafes, clubs, and patient dispensaries. Oaksterdam is located on the north end of downtown Oakland, between downtown proper, the Lakeside, and the financial district. It is roughly bordered by 14th Street on the southwest, Harrison Street on the southeast, 19th Street on the northeast, and Telegraph Avenue on the northwest. Since 2005, cannabis has been legally available to patients with patient identification and physician recommendation at a busy dispensary in the neighborhood, one of Oakland's four officially licensed dispensaries under the current municipal ordinance. According to Proposition 215, a statewide voter initiative which amended the California Health and Safety Code, marijuana used for medical purposes is legal to possess, cultivate and donate for. Dispensaries require a doctor's note in order to obtain medical cannabis, which is legal under California Law but illegal under the federal Controlled Substances Act.
Interestingly, there is a renewed effort to make hemp legal, at least in California: more...

Very briefly: on November 2 (2010) there will be a statewide ballot. The vote on Proposition 19 (also known as "Regulate, Control and Tax Cannabis Act of 2010") will possibly make important changes: it wants to legalize various marijuana-related activities, allow local governments to regulate these activities, permit local governments to impose and collect marijuana-related fees and taxes, and authorize various criminal and civil penalties. In March 2010 it qualified to be on the November statewide ballot. It requires a simple majority in order to pass, and would take effect the day after the election.Yes on 19 is the official advocacy group for the initiative.

Update 03.11.2010: proposition 19 was refuted: 57% of the people participating in the vote did not want to legalize Cannabis.

 

In this context, you might also want to have a look at the Drug Policy of the Netherlands: more...

There is really no need to add details here: the website is very detailed, and you find leads to everything you want (well, almost!).

 

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The main cannabinoids

 

   Cannabis sativa (Indian hemp) is an annual herb indigenous to Central and Western Asia; it is cultivated now in many other parts of the world. Main interests are: the fibre (hemp), the seed (seed oil), and the use as psychoactive compound, which is probably for many people the most well-known application (Marijuana, Hashish). The possession and consumption of the drug is illegal in most countries of the world, although there has been a lot of debate whether it might be less harmful than other drugs, e.g. alcohol or cigarettes. The Wikipedia sites give you more information, e.g. in English (Tetrahydrocannabinol) or German (Tetrahydrocannabinol). The contents of the two sites are not identical, and therefore you might look at both.

   More than 60 cannabinoids have been isolated from the leaves, and their pharmacological properties were extensively investigated. Fig. 1.  shows the major compounds. It is important to note here that the carboxylated forms are predominant in the living plant; the removal of the carboxyl group occurs non-enzymatically in vitro during storage and processing of the drug (Yamauchi et al., 1967; Kimura and Okamoto, 1970). However, many people routinely use the names of the decarboxylated forms: it is easier, and that is what you get after the standard preparations / processing.

 

Fig. 1.

Major cannabinoids in Cannabis sativa. Note: The predominant forms in the plant are carboxylated (R = COOH). The carboxyl group is non-enzymatically removed during preparation of the drugs, or by heating ("smoking"). Careful: the numbering of the atoms in THC cannot be used with the other molecules: it is totally different, see the Wikipedia page. It doesn't get easier by the fact that various authors  sometimes used different numbering systems (e.g.  Δ9-THC is  Δ1-THC in  another numbering system which seems to be obsolete now).
 

According to the presence / absence of Δ9-THC (Δ9-Tetrahydrocannabinol), basically two chemical phenotypes can be distinguished:

  • Drug-type: this contains predominantly Δ9-Tetrahydrocannabinolic acid (Δ9-THCA, the precursor of Δ9-THC, Δ9-Tetrahydrocannabinol, the psycho-active compound). THC activates two cannabinoid receptors in the brain (CB1 and CB2); the drug mimics naturally present ligands ('endocannabinoids'), e.g. Anandamide (N-arachidonoylethanolamine) and 2-arachidonoylglycerol (see below: endocannabinoids). THC was already identified in the mid-sixties (Gaoni and Mechoulam, 1964a; Yamauchi et al., 1967).

  • Fiber-type: These plants contain predominantly Cannabidiolic acid (CBDA), the precursor of CBD, Cannabidiol, (described first by Adams et al., 1940), or Cannabigerolic acid (CBGA), the precursor of Cannabigerol (desribed first by Gaoni and Mechuolam, 1964b). Both do not bind to the critical cannabinoid receptor CB1, but nevertheless have interesting pharmacological properties (see for example Hampson et al., 1998, 2000).

CBCA, Cannabichromenic acid, the precursor of CBC (Cannabichromene) is a special case. It is apparently present in all plants and was detected very early (Gaoni and Mechoulam, 1966; Shoyama et al., 1968). Its expression is differently regulated, it seems to be mostly developmental specific: a fairly high content is found in young plants ("juvenile expression"), regardless of whether the plant is THC- or non-THC-type, and its percentage of the total cannabinoid content declines with maturation of the plants (see for example Rowan and Fairbairn, 1977; Vogelmann et al. 1988; Morimoto et al. 1997, 1998. There are also controls by light (Valle et al., 1978; Mahlberg and Hemphill, 1983). It has interesting biological activities (Turner et al., 1981)

 

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The Biosynthesis

 

Olivetolic acid synthase
 

     My initial interest in tetrahydrocannabinol (THC) was the polyketide synthase that is the starting point of the biosynthesis.  It seems quite clear that it should be by a polyketide synthase (PKS) reaction that involves hexanoyl-CoA as starter, three condensations with malonyl-CoA, and a stilbenecarboxylate-type (STCS) ring-folding to the pentylresorcylic acid (olivetolic acid). Stilbene synthase (STS) type ring-folding with retention of the terminal carboxyl group (STCS) is known from other plants, see in this website: Hydrangea macrophylla and Marchantia polymorpha, and they are postulated in the biosynthesis of anacardic acid and urushiols (more...). However, there is one important difference: In those cases the reaction sequence to the carboxylated end product contains a reduction step. That is not the case in the biosynthesis of olivetolic acid; this is potentially important because it has been argued that reduction and retention of carboxylic group may be linked: more.... Fig. 2 summarizes the proposed reaction. The available evidence for the reaction in Cannabis sativa is discussed here: In summary, it is pretty miserable, so far. To the best of my knowledge, not even the enzyme reaction has been demonstrated yet in vitro (October 2010).

 

Fig. 2

Proposed type III PKS reaction in the biosynthesis of olivetolic acid in Cannabis sativa.

The polyketide synthase reaction uses hexanoyl-CoA as starter and performs three condensations which are followed by a stilbenecarboxylate (STCS)-type ring-closure, i.e. with retention of the terminal carboxyl group. The colours indicate the carbon atoms introduced by the three condensation reactions.

 

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Prenylation

 

   The next step is the prenylation of olivetolic acid (Fig. 3). The enzyme was characterized in Zenk's group (Fellermeier and Zenk, 1998), and has some interesting properties. Unlike many other prenyltransferases in secondary metabolism it is a soluble enzyme, not membrane-bound. The enzyme accepted not only geranyl-pyrophosphate (GPP), but also neryl-pyrophosphate (NPP). The activity with GPP was higher, consistent with  a report that CBGA is more abundant than CBNA (Taura et al., 1995a). It was tempting to assume that CBNA would be the preferred precursor for cannabidiolic acid (CBDA, Fig. 1), but that was not the case, as discussed below with the cannabinoid synthases. The carboxyl group was essential for the prenyltransferase activity; olivetol was not a substrate for the enzyme. It is interesting to note that  the terpenoid moiety is biosynthesized entirely or predominantly (> 98%) via the deoxyxylulose phosphate pathway (Fellermeier and Zenk, 2001).

 

Fig. 3.

Prenylation of Olivetolic acid.  GPP = Geranylpyrophosphate, NPP = Nerylpyrophosphate

 

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Cannabinoid synthases

 

    This turned out be a very interesting story: the three main cannabinoids are actually predominantly synthesized from a single precursor, CBGA, and the fourth, cannabigerol, is a simple decarboxylation product of CBGA. The reactions are summarized in Fig. 4. They are really quite interesting! If you get lost or confused by the use of the abbreviations (cannot easily be avoided): you are not the only one. This is what the figure should be good for: you can always have another look!

 

Fig. 4.

Biosynthesis of the major cannabinoids by different enzymes, but from the same substrate.
Note: The carboxyl group from CBGA is retained in the products; it is only removed during storing/processing of the plant/crude drug preparations.

 

  • Reaction (A)
    THCA, the precursor of THC, is the major constituent in the drug-type Cannabis sativa.
    The THCA synthase was the first enzyme activity identified (Taura et al., 1995b), and cDNA clones were obtained (
    Sirikantaramas et al., 2004). Experiments with the enzyme purified from transgenic insect cultures showed that it does not require any addition of divalent metal ions or other cofactors; however, it does contain a FAD covalently bound to a specific histidine residue, and that is essential for the enzyme activity. The sequence revealed a surprising similarity of the protein to the berberine bridge enzyme (Dittrich and Kutchan, 1991) which is known to be a covalently flavinylated protein (Kutchan and Dittrich, 1995). Interestingly, the enzyme could also use CBNA (the product of the geranyltransferase with nerylpyrophosphate, see Fig. 3), but the comparison of the substrate preferences suggested that this is likely a minor route to THCA. First crystals were obtained (Shoyama et al., 2005), and the comparison with the other two cannabinoid synthases at that level should give some fascinating insights into the reaction mechanisms. Transgenic expression via A. rhizogenes mediated DNA transfer was established, and the transformed hairy root cultures actually produced THCA when supplied with the substrate, CBGA (Sirikantaramas et al., 2004). A transgenic expression with the methylotrophic yeast Pichia pastoris as a host was also developed (Taura et al., 2007a). In the plants, the enzyme is probably synthesized in the glandular trichomes, and it is seems to be first enzyme known to be sorted into the secretory cavity (Sirikantaramas et al., 2005).

  • Reaction (B)  
    CBDA is the dominant compound in the fiber type plant
    .
    Leaf buds from such plants were used to purify and characterize the
    CBDA synthase (Taura et al., 1996); and cDNA clones were obtained (Taura et al., 2007c). The enzyme is also covalently flavinylated, and like THCA synthase, it also accepts CBNA (see Fig. 3) as substrate, but again this is thought to be a minor route (although from the structure one could speculate that CBNA might be a better substrate than CBGA). The similarities go much further: THCA and CBDA synthase are closely related: they are more than 80% identical in their protein sequences. 

  • Reaction (C)
    CBCA is a component in both Cannabis types.
    As discussed above, CBCA is a "juvenile" cannabinoid; the percentage of this drug decreases with age of the plant. The activity for its biosynthesis, the CBCA synthase, was first identified in young leaves (Morimoto et al., 1997), and then purified to homogeneity (Morimoto et al., 1998). The general properties are very similar to those of the THCA and CBDA synthases, including the acceptance of both CBGA and CBNA as substrates. Although sequence data do not seem available at present (October 2010), one is tempted to speculate that this protein might be closely related to the THCA and CBDA synthases. 

These three enzymes represent a very nice example where most likely the product specificities of closely related proteins can be traced to specific aminoacid residues.

And how about cannabigerol, the fourth compound? It appears that it is a decarboxylation product from cannabigerolic acid, in absence of the three other reactions.

 

Genetic work

De Meijer et al., 2005, 2009a, 2009b; Mandolino et al.,  2003.

There are some very interesting studies on the genes controlling these conversions. Apparently, the formation of THC (Locus BT) and Cannabidiol (Locus BT) are controlled by two alleles of a single gene (called B). The conversion into CBG reflects the inactivity of both alleles (Locus  B0). CBG accumulating plants have so far been found in European fibre hemp populations that are generally composed of BD/BD plants, and the observation that the  B0 allele possesses a residual ability to convert small amounts of CBG into CBD, make it plausible that this B0 is a mutation of normally functional BD. Therefore, B0 is considered as a member of the BD allelic series encoding a CBD synthase isoform with greatly weakened substrate affinity and/or catalytic capacity. The formation of the "juvenile cannabinoid" CBC is apparently controlled by a different gene (although the protein may be similar).
This work is the basis of a detailed breeding progam of the company GW Pharmaceuticals in the UK: more...

 

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Isopropyl Cannabinoids

 

This is an interesting line that only recently really came to my attention: there are a number of natural cannabinoids that do not contain an isopentenyl but an isopropyl side chain. The most important compounds are show in Fig. 5. It is an easy suggestion that the biosynthesis should start with butyryl-CoA rather than with hexanoyl-CoA, but that all the subsequent steps are the same as with the isopentyl type cannabinoids; most likely the reactions are catalyzed by the same enzymes (reviewed in Clarke and Watson, 2007).

These compounds were identified and characterized already in the early 70' of the last century (Gill, 1971; Merkus 1971; De Zeeuw et al., 1972) and reviews were established already several decades ago (e.g. Turner et al., 1980). It appears that high levels of these cannabinoids are specific to certain varieties (e.g. Cannabis indica) (Hillig and Mahlberg, 2004). By the way, the systematics of Cannabis and its varieties is seemingly not trivial, and a two-species origin of Cannabis was considered (C. sativa and C. indica)  (Hillig and Mahlberg, 2004).

What makes these cannabinoids so interesting? Without going into the complex details: the pharmacological properties are very different. THCV, for example, blocks the effects of THC (see for example: Thomas et al., 2005; Pertwee et al., 2007). This by itself of course makes them potentially very important for medical applications. There is also a very interesting overview comparing the pharmacology of THCV with cannabidiol and THC: Pertwee, 2008.

 

Fig. 5. Isopropyl Cannabinoids: the initial reaction starts with butyryl-CoA, but all the subsequent reactions seem to be the same as with hexanoyl-CoA as starter.

 

An interesting question, at least for those fascinated by polyketide synthases, is: what is the reason for the preference for isopropyl or isopentenyl cannabinoids? One or two enzymes? Considering the promiscuity of  type III PKS (more...), one would think that both reactions could be very well done by a single enzyme. The apparent starter preference could be due to substrate channeling in a metabolic network. Actually, something like that must be postulated for almost any complex pathway, in particular in those cases where specialized organs like the trichomes in Cannabis are involved. One example, in this case with specialized root hairs, is the type III PKS in sorgoleone biosynthesis in Hordeum vulgare which is discussed in this website: the substrate preferences in vitro do not correspond to those in vivo (more...) Substrate channeling is likely the reason why in vitro experiments in most cases do not reflect the substrate use in vivo. One well-known example is flavonoid biosynthesis: although all chalcone synthases will accept many different substrates in vitro, the substrate use in vivo is exceptionally specific: it appears that the enzyme has only access to 4-coumaroyl-CoA, and this is a well-known example for pathway channeling (reviewed in Winkel-Shirley, 1999).

As to the situation in Cannabis: as noted above, it has not even be possible to demonstrate the enzyme activity in vitro, and the genetic basis in C. sativa needs further investigation (De Meijer et al., 2009b).

Interestingly, the situation in the closely related hop (Humulus lupulus) appears to be quite similar. There are two types of bitter acids, humulone and lupulone (more...). The initial reaction is by a type III PKS that uses either isovaleryl-CoA (-> humulone) or isobutyryl-CoA (-> lupulone), and I am not aware of any claim that two different enzymes are responsible. Actually, the problem was even more confounding: the reactions in humulone and lupulone biosynthesis are the same as performed by chalcone synthase, and there was for a long time considerable confusion on  the question: which enzyme is responsible for what pathway? Several of the cloned proteins had both activities in vitro, and there are even ideas that a single enzyme serves both pathways (Okada et al., 2001).

 

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Receptors, endocannabinoids, and a bit more...

 

Cannabinoid receptors

See also the page in Wikipedia: more... 

One of the interesting questions after identification of the cannabinoids, e.g. THC, was of course whether they acted in some way nonspecifically or whether there were true receptors. That was resolved in the eighties/nineties of the last century: receptors were functionally identified in membranes (Devane et al., 1988) and it was shown that they likely operated by modulation of cAMP concentrations (Bidaut-Russell et al., 1990); this was suggestive of G protein coupled receptors. The receptors were called cannabinoid receptors (CB) because endogenous effectors were unknown.

The cloning of the first receptor (CB1, cannabinoid receptor 1) was reported already in 1990; it was characterized as G protein-coupled receptor found in rat brain and neural cell lines (Matsuda et al., 1990). However, this strict specificity had to be relaxed later, as expression was also detected in lung, liver, and kidneys. A year later followed the description of human CB1 (Gerard et al., 1991); the rat and human proteins were 97% identical.

A few years later a second receptor named CB2 was cloned; it was clearly different from CB1 (48% protein identity), and most importantly, the expression pattern was really different: it was predominant in peripheral tissues (e.g. the immune system), and notably absent from most normal nervous tissues (Munro et al., 1993).
Both CB1 and CB2 have in common the presenced of seven transmembrane spanning domains, consistent with biochemical and cellular determinations of signal transductions via G proteins and cAMP.

Endocannabinoids

The next fascinating question was whether there were natural substances binding to these receptors: indeed there are. They are now summarily described as endocannabinoids, and the International Union of Pharmacology in 2002 stuck to this definition (Howlett et al., 2002) because at least at that time it was not clear whether the two or three eicosanoid molecules most analyzed (see below, e.g. anandamide) are the primary endogenous receptor agonists.

Arachidonylethanolamide (named: Anandamide, apparently from "ananda", the Sanskrit word for "bliss") was identified in a screen of membrane fractions for endogenous ligands for the cannabinoid receptor (Devane et al., 1992). The function was confirmed by many experiments, e.g. Vogel et al., 1993; Felder et al., 1993. A second major compound binding to the cannabinoid receptors, 2-Arachidonoylglycerol, was identified and characterized a few years later (Mechoulam et al., 1995; Sugiura et al., 1995; Stella et al., 1997). However, there are several more arachidonic acid derivatives that are less characterized.

Figure 6 shows a simple summary of the structures of the main molecules and the likely routes of synthesis and degradation. If you look in the Internet for the structure, you’ll find different  ways of drawing them: I used the proposal which suggested that anandamide and its congeners adopt tightly curved U/J-shaped conformations at CB1 (Barnett-Norris et al., 2002).

Fig. 6. A simplified overview of two endocannabinoids based on arachidonic acid (Anandamide, 2-Arachidonoylglycerol), and the most plausible biosynthesis and degradation: see below for a brief discussion of the complexities. Abbreviations: NAPE-PLD (N-acylphosphatidylethanolamine-hydrolyzing phospholipase D); FAAH, Fatty acid amide hydrolase; MAGL, monoacylglycerol lipase.

 

A very short overview on endocannabinoid metabolism

  • Both endocannabinoids are biosynthesized via a phospholipid-dependent pathway, in the case of Anandamide (AEA) by the action of N-acyl-phosphatidylethanolamine-specific phospholipase D (NAPE-PLD). 2-AG is produced by hydrolysis of diacylglycerol in the 2-position (DAG lipase).

  • It is likely that anandamide and 2-arachidonoylglycerol both function as neurotransmitters  or neuromodulators and that one of their roles maybe to serve as retrograde synaptic messengers.There is evidence that they are synthesized by neurons “on demand”, that they can undergo depolarization-induced release from neurons.

  • After their release, they are rapidly removed from the extracellular space by a membrane transport process not fully understood. Once within the cell, anandamide is hydrolyzed to arachidonic acid and ethanolamine by a microsomal enzyme, fatty acid amide hydrolase (FAAH). 2-Arachidonoylglycerol is also hydrolyzed enzymatically, by FAAH and by other enzymes.

Beyond that grand overview, nothing appears to be simple

  • AEA and 2AG are not the only endocannabinoids; there are several congeners also containing arachidonic acid, but other side chains. Moreover, there appear to be a fairly large number of acyl-derivatives of unclear function; however they may be able to modulate the inactivation of AEA and 2AG, possibly by competition at the inactivating enzymes. See Howlett et al., 2002, for overview.

  • CB1 and CB2 are not the only receptors, see for example Van der Stelt et al., 2004. The others are not very well characterized, but they may be important in the physiological context.

  • Complexities in the biosynthesis and degradation of AEA and 2-AG, see for example Di Marzo, 2006. It appears that there are multiple pathways, and one is a bit overwhelmed by the large number of publications. Granted that these are complex pathway in a complicated regulatory network, but nevertheless I was a bit surprised that I found nowhere the terms ‘pathway channeling’ and ‘intracellular compartmentation’. Frankly, I find it difficult to believe that this should play no role in such important regulatory networks; after all, cells are not just bags of enzymes, but highly structured and organized entities. I wished somebody would critically look at all the experiments which measure activities in crude homogenates, soluble enzyme fractions, or simple membrane fractions: what is the evidence that they have any significance in vivo?

  • Uptake into the cells. There seems to be for years a considerable debate and confusion whether the endocannabinoids get into the cells by simple diffusion or protein-facilitated transport. This is possibly not a trivial question, because it is relevant whether inhibitors aiming at increasing endocannabinoid concentrations target a transporter or the inactivating enzyme, FAAH. There is an interesting review on this topic: Glaser et al., 2005.

I will not even try to go into  the pharmacology; the topic is much too complicated. If you want to study the details: here are some recent reviews; some of them also summarize the complex pharmacology (which is impossible to cover here): more...

 

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A bit on Prescription Drugs based on cannabinoids

  •  Sativex: Cannabidiol plus THC
    Cannabidiol is a major constituent of marijuana, in some cases it is up to 40% of the total cannabinoids. It appears to be safe and non-psychotropic. It does not bind to the known cannabinoid receptors CB1 and CB2, but nevertheless has important therapeutic uses. It is part of a  medicine officially licensed in several countries (more: http://en.wikipedia.org/wiki/Sativex). In brief (text mostly taken from the Wikipedia page cited here): Sativex is an oromucosal (mouth) spray developed by the UK company GW Pharmaceuticals for multiple sclerosis patients, who can use it to alleviate neuropathic pain, spasticity, overactive bladder, and other symptoms. Sativex is also being prescribed to alleviate pain due to cancer and has been researched in various models of peripheral and central neuropathic pain. Sativex is distinct from all other pharmaceutically produced cannabinoids currently available because it is derived from botanical material, rather than a solely synthetic process. Sativex is a pharmaceutical product standardised in composition, formulation, and dose. Its principal active cannabinoid components are tetrahydrocannabinol (THC) and cannabidiol (CBD). The product is formulated as an oromucosal spray which is administered by spraying into the mouth. Each spray of Sativex delivers a fixed dose of 2.7 mg THC and 2.5 mg CBD.
    A few interesting review articles on the pharmacology: Pertwee, 2008; Mechoulam et al., 2007.

  • A  few other interesting prescription drugs:
    Nabilone
    , (Cesamet in Canada, the U:S.A, U:K, and Mexico):  a synthetic cannabinoid  (http://en.wikipedia.org/wiki/Nabilone),
    Dronabinol (prescription drug = Marinol): which is synthetic THC in a pure form; you have to search for Dronabinol in these Wikipedia pages: (English, German

  • The story of Rimonabant
    Marijuana stimulates appetite, and thus it seemed to make sense to devlop a CB1 antagonist, in hope to find a potential antiobesity drug. By 1994 the first CB1 antagonist, Rimonabant (Acomplia, by Sanofi-Aventis; it is a bit strange because that name was created only 2004), had been developed. The clinical trials were very promising, Text from Di Marzo and Despres, 2009In June 2006, the European Medicines Agency (EMEA) allowed marketing of rimonabant as a treatment for obesity (Body-Mass-Index, Bmi ≥30 kg/m2) and for overweight individuals (Bmi ≥27 kg/m2 and <30 kg/m2) with metabolic complications such as T2Dm (type 2 diabetes mellitus) and dyslipidemia. EMEA approval led to the commercialization of rimonabant in over 60 countries, within and outside the European Union. However, in June 2007, a panel of FDA experts decided unanimously against the approval of rimonabant for the treatment of obesity in the U.S.A. This rejection was made on the basis of concerns about psychiatric adverse effects (namely, increased anxiety and depression or suicidal intentions).
    As a consequence, Merck discontinued the clinical development of its CB1 antagonist. Shortly after that, in October 2008, the EMEA committee concluded that the benefits no longer outweighed the risks. As a consequence, Sanofi-Aventis interrupted its clinical program with rimonabant. However, as usual, the situation is much more complicated than indicated by the simplified story given here. If you would like to read a critical discussion of problems with the policies of both the company and the EMEA: the review by Di Marzo and Despres, 2009 is very worthwhile to read! It gives you a glimpse on how complicated admissions of new prescription drugs are.

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File History:

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