Baratta, Francesca

Ben-Shabat, Shimon

Brusa, Paola

Collino, Massimo

English

Institutional Research Information System University of Turin

Editorial: Medicinal Cannabis:Evolution of therapeutic use,future approaches and otherimplicationsPaola Brusa1, Francesca Baratta1*, Massimo Collino2 andShimon Ben -Shabat31Department of Drug Science and Technology, University of Turin, Torino, Italy, 2Department ofNeurosciences Rita Levi Montalcini, University of Turin, Turin, Piedmont, Italy, 3Department of ClinicalBiochemistry and Pharmacology, Ben-Gurion University of the Negev, Beersheba, Southern, IsraelKEYWORDSCannabis, formulations, effectiveness, medical use, clinical trialsEditorial on the Research TopicMedicinal Cannabis: Evolution of Therapeutic Use, Future Approachesand Other ImplicationsCannabis has been used in even the oldest traditional medicines available. In the lastcentury, negative attention has prevailed regarding the psychotropic and abuse potential.For this reason, Cannabis has been banned and declared illegal in many countries. Inrecent years, however, there has been a more in-depth evaluation of the legalization ofcannabinoids for medical use in several countries following heightened media attentionand reports of effectiveness, although not always thoroughly backed up by scientificevidence. The official introduction of pharmaceutical-grade Cannabis inflorescences formedicinal purposes has allowed physicians and pharmacists, to prescribe and prepareseveral Cannabis preparations legally. Such products are currently being administered topatients without their efficacy being evaluated in controlled studies: for each patient thecomposition and route of administration may differ. In addition, many advancedadministration systems have been developed or are still under development, but fewclinical trials have been completed.In this context, this Research Topic focused on the in-depth analysis of the legal,technological and pharmacological aspects related to the medical use of Cannabis-basedformulations.Anil et al. have directed their research specifically on the activity of Cannabis formedical use in the context of inflammatory processes. Although activities in this area areplausible, the high number of active molecules produced by Cannabis and simultaneouslyadministered through the extractive products normally used in therapy, has not yet madeit possible to identify their specific mechanisms of action. Once the modalities of action ofOPEN ACCESSEDITED AND REVIEWED BYHeike Wulff,University of California, Davis,United States*CORRESPONDENCEFrancesca Baratta,francesca.baratta@unito.itSPECIALTY SECTIONThis article was submitted toExperimental Pharmacology and DrugDiscovery,a section of the journalFrontiers in PharmacologyRECEIVED 20 July 2022ACCEPTED 25 July 2022PUBLISHED 25 August 2022CITATIONBrusa P, Baratta F, Collino M andBen -Shabat S (2022), Editorial:Medicinal Cannabis: Evolution oftherapeutic use, future approaches andother implications.Front. Pharmacol. 13:999068.doi: 10.3389/fphar.2022.999068COPYRIGHT© 2022 Brusa, Baratta, Collino and Ben-Shabat. This is an open-access articledistributed under the terms of theCreative Commons Attribution License(CC BY). The use, distribution orreproduction in other forums ispermitted, provided the originalauthor(s) and the copyright owner(s) arecredited and that the originalpublication in this journal is cited, inaccordance with accepted academicpractice. No use, distribution orreproduction is permitted which doesnot comply with these terms.Frontiers in Pharmacology frontiersin.org01TYPE EditorialPUBLISHED 25 August 2022DOI 10.3389/fphar.2022.999068the active molecules have been clarified, it might be of interest touse purified mixtures to obtain a more significant activitypotentially (Anil et al.).Specific literature reviews were then done for somepathologies such as when Xin et al. investigated the potentialtherapeutic effect of CBD in bone diseases. Even in this case,further studies are needed to evaluate the benefits and risks ofcannabinoids’ use (Xin et al.).A large part of the clinical research relating to Cannabis formedical use concerns its use in the context of diseases of thecentral nervous system. Ortiz et al. examined evidencesupporting the therapeutic utility of cannabinoids for treatingneurodegenerative diseases, pain, mood disorders, and substanceuse disorders. Important considerations were also made on themethods of formulation and the routes of administration (Ortizet al.). Lacroix et al. Also considered Cannabis in neurologicaldisorders stressing that currently most of the scientific datasupports the potential therapeutic use of Cannabis but, asmuch as patients request it, the knowledge is still too little in-depth. It is therefore certainly urgent to manage clinical trials toprovide stronger and safer evidence (Lacroix et al.).Procaccia et al. discussed how phytocannabinoid profilesdiffered between plants according to chemovar types andexamined the main factors influencing the accumulation ofsecondary metabolites in the plant, including genotype, growingconditions, processing, storage and the delivery route; the authorshighlighted how these factors make the use of Cannabis in therapyhighly complex (Procaccia et al.).In addition to the more well-known compounds such as THCand CBD, Cannabis produces over 120 other phytocannabinoids.The use of THC is associated with acute psychotropic effects thatcould potentially be avoided considering that minor cannabinoidsand their chemical counterparts could offer the same potentialbenefits without the same adverse effects. In this regard, Walshet al. reviewed the literature to provide an overview of theendocannabinoid system, phytocannabinoid biosynthesis and adiscussion on molecular pharmacology. Potential therapeutic usesof minor cannabinoids underlining that future studies will have torigorously evaluate these compounds’ risk/benefit ratio (Walsh et al.).The interest in molecules other than cannabinoids such asterpenes is certainly relevant. This interest has grown evengreater since the possibility of an “entourage” effect betweenthe active molecules of Cannabis has been postulated.Accordingly, Finlay et al. in their study examined whethersome terpenes acted directly on cannabinoid receptors. Fromthe results obtained, it was not possible to exclude the existence ofan entourage effect. Still, this cannot be linked to a direct action ofthe terpenes on the cannabinoid receptors. However, thepharmacological mechanism underlying this substancesactivity remains to be thoroughly investigated (Finlay et al.).Maayah et al. pointed out that full-spectrum Cannabisextracts have been used in clinical trials to treat variousdiseases. However, despite their efficacy, their potential use intherapymay be limited by possible behavioural side effects. Theseresearchers then successfully worked on experimental animals toidentify a panel of blood metabolites predicting behaviouraleffects (Maayah et al.).Pennypacker et al. have evaluated whether the productsavailable on the market in the United States of America areconsistent in the concentration of cannabinoids, with theliterature indications for use in therapy. Overall, the results ofthis study have been defined by the authors as alarming ascurrent product offerings do not reflect scientific evidence(Pennypacker et al.).In the regulatory context MacPhail et al. have analysed the trendof prescriptions inAustralia over the last 5 years, noting a substantialincrease in prescriptions over time that does not actually reflect aworsening of the pathological conditions of the population butrather a greater prescription linked to greater knowledge andacceptance of this type of therapy (MacPhail et al.).As regards the use in therapy of medical Cannabis, the currentregulations have been analysed by Baratta et al. in those countrieswhere clinical studies have recently been conducted. The results ofthe trials have been crossed with the pathologies for which thecurrent legislation provides that it is possible to prescribe Cannabisallowing relevant considerations (Baratta et al.).From all the publications collected, it is clear that there is agreat interest in the enormous potential of Cannabis in themedical field but also a widespread awareness of the extremeneed to conduct in-depth research that clarifies the mechanismsof action of the quantity of components present in thephytocomplex of this plant species.Author contributionsAll authors listed have made a substantial, direct, andintellectual contribution to the work and approved it forpublication.Conflict of interestThe authors declare that the research was conducted in theabsence of any commercial or financial relationships that couldbe construed as a potential conflict of interest.Publisher’s noteAll claims expressed in this article are solely those of theauthors and do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors and thereviewers. Any product that may be evaluated in this article, orclaim that may be made by its manufacturer, is not guaranteed orendorsed by the publisher.Frontiers in Pharmacology frontiersin.org02Brusa et al. 10.3389/fphar.2022.999068

Editorial: Medicinal Cannabis: Evolution of therapeutic use, future approaches and other implications

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Editorial: Medicinal Cannabis: Evolution of therapeutic use, future approaches and other implications

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