Targeting the endocannabinoid system to reduce nociception

Pain of various etiologies (e.g., visceral, inflammatory) can be a debilitating disorder that presents a problem of clinical relevance. While it is known that ∆9-tetrahydrocannabinol (THC) the primary psychoactive constituent found in marijuana produces analgesia in various rodent models of pain, its pharmacological properties are overshadowed by its psychomimetic effects. THC is the primary phytocannabinoid found in marijuana though other prevalent constituents such as the phytocannabinoids (e.g., cannabidiol (CBD), cannabinol (CBN), cannabichromene (CBC), tetrahydrocannabivarin (THCV)) may possess antinociceptive actions without the psychomimetic effects associated with THC. Indeed, these phytocannabinoids act upon the endocannabinoid system (ECS) that is comprised of the CB1 and CB2 cannabinoid receptors, endogenous ligands (anandamide (AEA), 2-arachidonoyolglycerol (2-AG)), and endocannabinoid biosynthetic and catabolic enzymes. We hypothesize that phytocannabinoids as well as endocannabinoid catabolic enzyme inhibitors reduce nociception preclinical models of pain. In the first series of studies, the antinociceptive effects of prevalent phytocannabinoids were evaluated in the acetic acid stretching test, a rodent visceral pain model. While CBN and THC both produced antinociceptive effects via a CB1 mechanism of action, CBC, and CBD had no effect on nociception. Conversely, THCV antagonized the antinociceptive effects of THC. These results suggest that various constituents of marijuana may interact in a complex manner to modulate pain. Since the THC and CBN displayed their effects via specific endogenous cannabinoid receptors, we investigated whether increasing endocannabinoids block nociceptive behavior. Blockade of the catabolic enzyme fatty acid amide hydrolase (FAAH) elevates AEA levels and elicits antinociceptive effects, without psychomimetic issues associated with THC. Similarly, blockade of another endocannabinoid catabolic enzyme monoacylglycerol lipase (MAGL) elevates (2-AG) and elicits antinociceptive effects. Therefore, we tested the hypothesis that FAAH and/or MAGL inhibition blocks nociception in the acetic acid abdominal stretching model, and the LPS-induced allodynia (i.e. painful response to a non-noxious stimuli) model of inflammation. Genetic deletion or pharmacological blockade of FAAH or pharmacological blockade of MAGL significantly reduced the total number of abdominal stretches in the visceral pain model. Additionally, blockade of both enzymes simultaneously produced an enhanced antinociceptive effect versus blocking the enzymes individually. These effects were mediated through CB1 receptors. However, in the LPS-induced allodynia model, FAAH inhibited anti-allodynic effects through a CB1 and CB2 receptor mechanismn. In both assays other potential targets of FAA substrates (i.e., mu-opioid, TRPV1, and PPAR-alpha receptors) did not play an apparent role in FAAH inhibited antinociceptive responses. Taken together, these results illustrate that targeting the endocannabinoid system via direct acting agonists such as the phytocannabinoids, or indirect methods (i.e. inhibiting degradative enzymes of the endogenous cannabinoids), represents a promising strategy to treat pain