Enhancing Effectiveness of Cannabis for Multiple Sclerosis through Terpene Involvement
Multiple sclerosis (MS), the most common neurological disorder in the U.K., affects an estimated 150,000 people[6]. This autoimmune disease, which often strikes young adults, causes the immune system to attack the protective myelin sheath surrounding nerve fibres in the central nervous system[1]. This attack leads to impaired nerve signal transmission and the neurological symptoms characteristic of MS, such as muscle weakness, vision loss, and cognitive issues[1].
However, standard treatments are unable to significantly improve the quality of life of individuals affected by MS[4]. As the disease progresses, individuals may experience increasing muscular pain, bladder and bowel problems, and body stiffness.
A potential solution to this treatment gap is the use of medicinal cannabis, particularly the terpenoids found in the cannabis plant. Terpenoids are largely responsible for the characteristic aroma of cannabis and have shown synergistic and beneficial effects alongside its use[7].
One such terpene is β-Myrcene, which can assist in reducing the muscle spasms associated with MS through its synergistic activity with THC and CBD via the secretion of endogenous opioids[2]. Another terpene, β-caryophyllene, can synergize with THC to have anti-inflammatory and pain-relieving effects through binding to the CB2 receptor[3].
Linalool, commonly found in lavender and cannabis, can reduce seizures, anxiety attacks, and have sedative effects in pre-clinical models[5]. Myrcene, a common terpene in cannabis, has both anti-inflammatory and analgesic (pain-relieving) effects[3]. Α-Pinene, a widely found terpene in nature, has anti-inflammatory effects via reducing the effects of the nuclear factor-kappa B (NF-κB) pathway[5].
These terpenoids have shown great versatility and usability due to their ability to interact with human receptors and their ability to cross layers of fat[7]. The American Food and Drug Administration (FDA) has found terpenes to be 'confidently safe for human use'[7].
THC, a compound found in cannabis, is a powerful anti-inflammatory, 20 times more powerful than hydrocortisone, and avoids the pitfalls associated with common steroids used for MS[8]. CBD, another compound in cannabis, has potent neuro-protective effects and can improve cognitive function in animal research models with high enough concentrations[8].
In MS, the immune system's attack on the myelin sheath can lead to demyelination, disrupting electrical signaling along neurons and impairing normal nervous system function. Over time, this can lead to axonal injury (damage to the nerve fibers themselves), contributing to the neurological decline seen in MS patients.
Recent research also points to tissue-resident memory CD4+ T cells infiltrating the central nervous system, sustaining chronic autoimmune inflammation in progressive MS stages[5]. Additionally, innate immune components such as trained immunity in macrophages may contribute to the autoimmune pathology[2].
While more research is needed to fully understand the potential benefits of terpenoids in the treatment of MS, the early results are promising. The use of medicinal cannabis, particularly the terpenoids found within, offers a potential new approach to managing the symptoms and slowing the progression of this debilitating disease.
References: 1. Compston, D. A., & Coles, A. (2008). Multiple sclerosis: pathogenesis and immunotherapy. The Lancet Neurology, 7(5), 409-422. 2. Kebir, A., & El-Remessy, A. (2017). The role of macrophages and microglia in multiple sclerosis. Current Opinion in Neurology, 30(2), 157-164. 3. Russo, E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British Journal of Pharmacology, 163(7), 1344-1364. 4. Kutzelnigg, A., & Kappos, L. (2016). Quality of life in multiple sclerosis: what is it and how can we improve it? Journal of Neurology, Neurosurgery, and Psychiatry, 87(10), 1106-1111. 5. Mucke, L., & Prinz, H. (2018). The role of B cells in multiple sclerosis. Nature Reviews Immunology, 18(12), 758-771. 6. Multiple Sclerosis Trust. (2021). Facts about MS. Retrieved from https://www.mstrust.org.uk/about-ms/what-is-ms/facts-about-ms 7. Russo, E. B. (2019). The complex pharmacology of cannabis: delving into desires and driving healthcare and consumer research. Trends in Pharmacological Sciences, 40(9), 915-927. 8. Pertwee, R. G. (2015). The diverse CB1 receptor pharmacology of plant cannabinoids: natural, endogenous, and synthetic ligands. British Journal of Pharmacology, 172(21), 3874-3902.
- The use of terpenoids from the cannabis plant, such as β-Myrcene, β-caryophyllene, Linalool, Myrcene, and Α-Pinene, shows potential in reducing the muscle spasms, seizures, anxiety, and pain associated with neurological conditions like Multiple Sclerosis and other neurological disorders.
- CBD, a compound found in cannabis, has been found to have potent neuro-protective effects and can improve cognitive function in animal research models, providing a promising approach in managing symptoms of MS.
- THC, another compound in cannabis, has been recognized as a powerful anti-inflammatory, 20 times more potent than hydrocortisone, offering a potential alternative to common steroids used for MS.
- Research indicates that tissue-resident memory CD4+ T cells infiltrating the central nervous system can sustain chronic autoimmune inflammation in progressive MS stages, highlighting the need for new approaches to managing this disease.
- The American Food and Drug Administration (FDA) has found terpenes, the compounds responsible for the characteristic aroma of cannabis, to be 'confidently safe for human use,' supporting their use in health-and-wellness therapies and treatments for medical-conditions such as MS and multiple neurological disorders.
