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Cannabis Research - Amyotrophic Lateral Sclerosis (ALS)

Cannabis and Amyotrophic Lateral Sclerosis: Hypothetical and Practical Applications, and a Call for Clinical Trials

Abstract American Journal of Hospice & Palliative Medicine 000(00) 1-10 a The Author(s) 2010 Reprints and permission: DOI: 10.1177/1049909110369531 Significant advances have increased our understanding of the molecular mechanisms of amyotrophic lateral sclerosis (ALS), yet this has not translated into any greatly effective therapies. It appears that a number of abnormal physiological processes occur simultaneously in this devastating disease. Ideally, a multidrug regimen, including glutamate antagonists, antioxidants, a centrally acting anti-inflammatory agent, microglial cell modulators (including tumor necrosis factor alpha [TNF-a] inhibitors), an antiapop- totic agent, 1 or more neurotrophic growth factors, and a mitochondrial function-enhancing agent would be required to com- prehensively address the known pathophysiology of ALS. Remarkably, cannabis appears to have activity in all of those areas. Preclinical data indicate that cannabis has powerful antioxidative, anti-inflammatory, and neuroprotective effects. In the G93A- SOD1 ALS mouse, this has translated to prolonged neuronal cell survival, delayed onset, and slower progression of the disease. Cannabis also has properties applicable to symptom management of ALS, including analgesia, muscle relaxation, bronchodilation, saliva reduction, appetite stimulation, and sleep induction. With respect to the treatment of ALS, from both a disease modifying and symptom management viewpoint, clinical trials with cannabis are the next logical step. Based on the currently available sci- entific data, it is reasonable to think that cannabis might significantly slow the progression of ALS, potentially extending life expec- tancy and substantially reducing the overall burden of the disease.

Keywords cannabis, endocannabinoids, amyotrophic lateral sclerosis, clinical trials, motor neuron disease

Gregory T. Carter, MD, MS1, Mary E. Abood, PhD2, Sunil K. Aggarwal, PhD3, and Michael D. Weiss, MD1,4,5