What's the Hype? Cannabinoid Therapy for COVID-19

[:en]Vector modern flat online medicine banner template illustration. Doctor with stethoscope standing in laptop screen on fluid blue shape on white. Design element for web, hospital, clinic, infographic[:]

The world is in the midst of an unprecedented global pandemic. Governments, research centers, and international health organizations are throwing everything they have at finding a solution to the newly discovered coronavirus disease (COVID-19). With 30 million total cases and counting, there is a pressing need for a vaccine and an effective treatment. Two such treatment proposals are cannabis and cannabinoid-based therapies.

 

Several sensationalized headlines have crudely characterized new cannabis strains and terpene formulations as treatment options. These headlines have triggered both excitement and skepticism. But while the attention-grabbing headlines may have inaccurately depicted the early research, the results are indeed worth true evaluation.

 

For the public, and perhaps even some industry insiders, cannabis for COVID-19 seems an almost ludicrous idea. How could cannabis treat chronic respiratory disease? Yet long before COVID-19 shut down the world, researchers had already identified two fundamental properties in cannabis that are now immensely more valuable — its antiviral and antiinflammatory characteristics.

 

The Hype Around Cannabis for COVID-19

 

In Canada, broadcasters published the headline, “Are new cannabis strains key to fighting COVID-19? These Alta. researchers think so.” South of the border, in the US, there have been similar trending stories, like “Researchers look into cannabis as a potential COVID-19 treatment” from CBS and “Cannabis May Reduce Deadly COVID-19 Lung Inflammation: Researchers Explain Why” from Forbes.

 

But like much reporting on scientific research, the headlines fail to explain the essential details. Cannabis is far from a cure for COVID-19. The research is still in vitro and hypotheticals. As of August 2020, there were several ongoing projects investigating cannabinoid and terpene therapy for COVID-19, but all are in the preclinical stages. Many research projects are also solely educated assumptions based on previous studies on similar pathogens or lung conditions. 

 

According to an analysis by Prohibition Partners, published in August 2020, 16 different teams are working with cannabis and cannabinoid-based therapies for the novel coronavirus. Half of these projects were still in the planning stages, and the remainder may have demonstrated positive in vitro results, but none had gone on to clinical trials. Prohibition Partners reported on several research targets: cannabidiol (CBD), tetrahydrocannabinol (THC), cannabis flower, and unidentified cannabinoid extracts. In addition to this, it’s worth mentioning an Israel project working with a patented terpene formulation for a condition related to COVID-19. 

 

The Promise of Cannabinoid Therapy for COVID-19

 

But what’s triggered this hype around cannabis for COVID-19? The predominant cannabinoids in cannabis, THC, and CBD, have properties with real potential to treat the symptoms of COVID-19. Cannabis’ antiviral and antiinflammatory properties could reduce the severity and duration of some comorbidities related to COVID-19, given the preliminary study results.

 

For example, there has been substantial work done on CBD’s antiviral capabilities. There are three studies of particular importance. The first examined CBD against both the hepatitis C virus and hepatitis B virus. At least in the Petri dish, CBD reduced cell proliferation of hepatitis C by 86.4 percent (but had no measurable impact on hepatitis B). 

 

A second study pitted CBD against Kaposi’s sarcoma-associated herpesvirus (KSHV), a type of herpes commonly associated with HIV. Once again, the in vitro results indicated CBD could reduce the proliferation of infected cells. 

 

The third study of CBD’s antiviral potential looked at a mouse model for viral-induced paralysis and multiple sclerosis called Theiler’s murine encephalomyelitis virus. During the later stages of this condition, CBD improved motor symptomatology and neuroinflammation.

 

These three studies outline CBD’s potential to target virus-related inflammatory conditions, which has immediate implications for COVID-19. In June 2020, researcher Kevin P. Hill affirmed this therapeutic trajectory to Cannabis and Cannabinoid Research: “THC or CBD may be beneficial in viral infections where the host inflammatory response is pathogenic.” Although Hill confirms there has not yet been a study about cannabis for any virus within the coronavirus family, this seems the next logical step.

 

Cannabinoids for A Cytokine Storm

 

Early on in the COVID-19 outbreak, medical centers began reporting a serious and potentially fatal complication: acute respiratory distress syndrome (ARDS). This condition developed following a COVID-19-triggered cytokine storm. Lung damage caused during this chronic inflammatory response seems to develop into ARDS. 

 

In the words of Jennifer R. Tisoncik Marcus J. Korth, et al., “The term ‘cytokine storm’ calls up vivid images of an immune system gone awry and an inflammatory response flaring out of control.” Cytokines are small proteins produced by the human body for intercellular communication. Part of this role is to regulate the inflammatory response. When they “storm,” these tiny proteins spill over from the localized infection site to create system-wide problems. With no off switch, these proteins run amuck, triggering a cycle of inflammatory damage. This damage lays the groundwork for ARDS and other acute lung injuries. 

 

According to the National Heart, Lung, and Blood Institute, ARDS is “a serious lung condition that causes low blood oxygen” where “fluid builds up inside the tiny air sacs of the lungs, and surfactant breaks down.” With no surfactant, it becomes difficult to fill the lungs and keep oxygen moving throughout the body. 

 

Although recent comparisons have found subtle differences between ARDS related to COVID-19 and the condition related to other diseases, ARDS remains a fatality risk for patients hit hardest by the infection.

 

So how does cannabinoid therapy come into play for COVID-19-related cytokine storms and the risk of ARDS? As Hill outlined in his review, cannabis is a potent anti inflammatory, and it “could possibly be a part of a treatment regimen, with nonsteroidal antiinflammatory drugs (NSAIDs) and other medications that target immune pathways, that could downregulate the cytokine storm.” Cannabinoids could be the off switch to an aggressive inflammatory response, thereby reducing the risk of ARDS.

 

A research partnership out of Israel provides recent (if preliminary) proof of cannabis’ ability to target cytokine storms. Eybna (a manufacturer of terpene-based medicines) and CannaSoul Analytics found positive results from a unique CBD-terpene formula for treating in vitro cytokine storms. This team assessed several options including CBD, their proprietary terpene blend, and a conventional pharmaceutical, Dexamethasone. 

 

The most effective formula for inhibiting cytokine activity was a combination of CBD with the proprietary terpene blend. These results strongly suggest that CBD could play a role in COVID-19-related cytokine storms. The project discussed initial findings with Forbes in July, although the final results were unavailable at the time of writing.

 

Another study coming out of the University of Lethbridge supports the results of the Israeli study. The research team tested seven strain-specific extracts and found that three cannabis-derived extracts profoundly downregulated the expression of the specific proteins responsible for the cytokine storm. However, this research is still in preprint The authors propose, “The extracts of our novel C. sativa lines may be used to modulate the expression of pro-inflammatory cytokines and pathways involved in inflammation and fibrosis.” 

 

Real Potential Beyond the Hype, But a Long Way to Go

 

The media tends to ignore the most important caveats buried within exciting new scientific developments. The publicity around cannabis for COVID-19 is no different. But, for those interested in the details, the hype of cannabinoids as antiviral and antiinflammatory therapies does hold up under closer inspection.

 

Currently, all research into THC, CBD, or terpenes for COVID-19 sits in Petri dishes. The evolution of this study into animal models and humans will take a long time, especially considering the legal status in many countries. But, should cannabinoids continue to reduce cytokine storms and the risk of ARDS in future research, medical cannabis could finally break into conventional medicine at a global scale.