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Cannabinoids and Lupus: Exploring Therapeutic Potential
Introduction
Systemic lupus erythematosus (SLE) is a multifaceted autoimmune disease, marked by immune system dysregulation that can cause inflammation across multiple organs. While current treatments focus on reducing immune activity, recent research suggests that cannabinoids, such as CBD (cannabidiol) and CBG (cannabigerol), may have targeted effects that could help manage lupus symptoms and improve quality of life. This article examines how these cannabinoids may interact with key immune pathways in lupus, focusing on mechanisms that contribute to their potential therapeutic effects.
Understanding Lupus Pathophysiology: Where Cannabinoids Might Help
Lupus is characterized by a combination of innate and adaptive immune dysregulation. Specific immune cells like T cells, B cells, and plasmacytoid dendritic cells (pDCs) contribute to chronic inflammation through the production of inflammatory cytokines such as IFN-γ and IL-6 (Robinson et al., 2021; Dörner & Furie, 2019). The endocannabinoid system (ECS), including CB₁ and CB₂ receptors and endogenous cannabinoids like anandamide and 2-arachidonoylglycerol (2-AG), plays an integral role in regulating inflammation and immune response.
Cannabinoids derived from Cannabis sativa can interact with ECS receptors and other immune pathways, potentially providing therapeutic benefits in SLE. Dysregulation of the ECS is increasingly implicated in autoimmune diseases, including lupus (Cristino et al., 2020; Friedman et al., 2019; Navarini et al., 2018; Chiurchiù et al., 2015). Here, we’ll explore the roles of CBG, CBD, CBDA, and CBGA in modulating lupus-related immune pathways.
Cannabigerol (CBG): CBG is a precursor molecule to other cannabinoids, known for its interaction with both CB₁ and CB₂ receptors, as well as with additional non-cannabinoid targets, such as TRP channels and PPAR receptors. Although studies on CBG and lupus are limited, CBG’s known effects suggest multiple mechanisms through which it may alleviate SLE symptoms.
Cannabidiol (CBD): CBD is one of the most extensively studied cannabinoids, with known anti-inflammatory, analgesic, and immunosuppressive properties. While CBD does not have strong affinity for CB₁ or CB₂ receptors, it influences them indirectly through other mechanisms.
Cannabidiolic Acid (CBDA): CBDA is the acidic precursor of CBD, and given CBDA’s effects on COX-2 and TRPV1, it could hypothetically provide dual anti-inflammatory and analgesic benefits in lupus, particularly for pain management and inflammation reduction.
Cannabigerolic Acid (CBGA): CBGA, the precursor to CBG, CBD, and THC, is noted for its broad anti-inflammatory potential. Although direct studies on CBGA and lupus are scarce, its known interactions suggest it may play a role in lupus treatment through cytokine reduction and immunomodulation support.
Modulating Immune Cell Activation through CB₂ Receptor Pathways
The CB₂ receptor, predominantly found on immune cells, plays a crucial role in regulating immune response. Activation of CB₂ reduces inflammation by downregulating pro-inflammatory cytokines and T cell activity, both of which are elevated in lupus.
CBG and CB₂ Receptor Activation: CBG has been shown to activate CB₂ receptors, which are heavily expressed in immune cells like macrophages, T cells, and B cells. CB₂ receptor activation is associated with reduced inflammation by inhibiting cytokine release and T cell activation - critical steps in lupus pathogenesis. Studies have shown that 2-AG, an endogenous cannabinoid with similar CB₂ affinity, can downregulate IFN-γ production in T cells, which plays a significant role in lupus progression (Navarini et al., 2022; Rahaman et al., 2019; Gasperi et al., 2014). CBG could potentially exert similar immunomodulatory effects through CB₂ activation, making it a promising candidate for reducing lupus-related inflammation. This mechanism could potentially alleviate systemic inflammation and organ damage, including that found in the kidneys and skin.
CBD and CB₂ Indirect Modulation: Although CBD doesn’t bind directly to CB₂, it influences CB₂ pathways indirectly, promoting an anti-inflammatory response that could benefit lupus patients by reducing disease activity and inflammatory flare-ups. IFN-γ is a key cytokine in lupus that promotes inflammation and autoantibody production. CBD has been observed to lower IFN-γ production by T cells, potentially reducing lupus disease activity. This effect could complement other immune therapies, allowing patients to reduce their reliance on immunosuppressive drugs (Navarini et al., 2022).
CBGA and CB₂ Indirect Modulation: As a precursor to other cannabinoids, CBGA is thought to exhibit indirect CB₂-mediated effects on immune modulation. Its ability to reduce pro-inflammatory markers in other models suggests it might help in reducing immune overactivity seen in lupus (Sarzi-Puttini et al., 2019).
Patient-Friendly Explanation: Think of the CB₂ receptor as a “dial” on immune cell activity. Cannabinoids like CBG and CBD can turn down the immune response in lupus, potentially easing inflammation and reducing symptom severity.
Inflammatory Cytokine Suppression
T Cell Regulation and Balance of Th17/Treg Cells
Oxidative Stress and Organ Protection
Joint and Muscle Pain Management
Patient Profile
Patient: Female; 40-50yo
Lupus Diagnosis: 10 years
Symptoms: Chronic open sores, severe pain, inflammation, fatigue, muscle spasms, chronic idiopathic urticaria (hives), and IBS attributed to prior medication use
Medications: Hydroxychloroquine, escitalopram, montelukast, rabeprazole, IBSRELA, Xolair, gradually reducing naltrexone, discontinued muscle relaxants
Cannabinoid Treatment Regimen:
CBD: One 25mg capsule in the morning
CBDA: Four 15mg capsules daily (2 in the morning, 2 at night)
CBG: One 50mg capsule at night
CBD Balm: Applied to affected areas three times daily
Progress Summary
Over several months, the patient experienced remarkable improvements, including substantial pain reduction, significant healing of open sores on her hands, and improved energy levels, which enabled her to return to regular workouts and her business activities. She attributes these changes to the combination of cannabinoids, particularly CBDA, CBD, and CBG, and has observed improvements in her physical and mental well-being, allowing her to taper off certain medications.
In Her Own Words...
August 26th, 2024 I heard about your product through a friend at yoga. I have open sores from lupus, and I am in pain. Can I buy the product from you?
October 19th, 2024 I have some updates for you. My pain is close to nothing, sometimes I don't have any pain. My hand is almost completely healed… which is amazing after I battled with these sores for 5 to 6 years. It is unbelievable, I have not seen my hand heal this much in six years at all, I tried everything and nothing works. With the Lupus, all my systems got damaged, so I add more illnesses as we go on this journey...The list of medications that I sent you used to be bigger. A long time ago, I decided to quit a bunch of the pills, because what they do is give us all these kinds of pills that don’t work. I tried all the creams in the alphabet with steroids.
I have IBS because of the medicine that they gave me in the beginning. A lot of my illnesses started after I began taking all these chemicals that they pumped me up with. Like day one, diagnosed with lupus, they pump you up with so much medicine and steroids it not even funny. But, because you don’t know anything about it, they’ll take advantage of it, and once you have been in this fight for so many years, you pay attention to what the doctors are doing to you. They want to help, know that, but they don’t always know there are better ways to help. So, to find something made me feel this way that allows me to work out every day. I’m working out every day. Working on my two little businesses, went back to them because they weren’t abandoned… I’m able to do more here at home, more energetic, even my private life is better, if you know what I mean. My hand is almost completely healed. It is a great product for [lupus patients], especially for the pain and for the sores, because every patient with lupus has sores everywhere. We get them in our privates, we get them in the nose, our skin, everywhere. This is the first time I have no sores open in six years.
October 29, 2024 I thought you would like to see this full recovery! I feel so much better but also my mental state is improving tremendously. I’ll keep you updated on my progress. I’m so happy thank you so much, have a blessed day.
Integrating Cannabinoid-Based Therapies into Lupus Treatment
As research advances, cannabinoids like CBG, CBD, CBDA, and CBGA may become valuable additions to lupus treatment by targeting specific pathways related to immune balance, inflammation, oxidative stress, and pain perception. However, given the complexity of lupus and varying patient needs, it is essential to approach cannabinoid treatment on an individualized basis while clinical evidence is still emerging.
Clinicians should balance potential benefits with patient-specific factors such as disease severity, organ involvement, and concurrent medications. Controlled clinical trials are necessary to establish safe dosing guidelines and long-term effects, especially considering mixed findings like CBD’s potential to exacerbate proteinuria in lupus nephritis models (Katz-Talmor, Kivity, et al., 2018).
General Recommendations and Safety Tips
Dosing Adjustments: Begin with the lowest recommended doses, especially for those new to cannabinoids. Gradually increase only if needed and based on tolerance.
Combination Strategy: For patients with multi-symptom involvement, a combination of oral and topical cannabinoids can provide targeted relief.
Monitoring: Patients should track symptom response and consult with their healthcare provider regularly to adjust doses as needed. Consider checking inflammatory markers at baseline and periodically to assess the impact.
Sample Protocols for Lupus Patients Using Cannabinoid Products
Below are suggested protocols that can be adjusted according to patient response and tolerance. Begin with low doses, monitor clinical markers, and assess patient response to cannabinoid therapy as an adjunct to traditional lupus treatments.
NOTE: Cannabinoids should be integrated cautiously alongside traditional lupus medications, with regular monitoring for potential interactions. This information is for educational purposes only and does not constitute medical advice. If you or a loved one have lupus, speak with your medical provider before starting or changing medications.
General Inflammation and Immune Modulation
CBG Oral Capsules: Start with 1 capsule (50mg) daily, ideally taken in the morning with a high-fat meal.
CBD Oral Capsules: Add 1 capsule (25mg) daily in the evening.
Monitoring: Evaluate after two weeks. If well-tolerated, consider increasing to two capsules daily for each capsule.
Severe Inflammation and Organ Protection
CBG Oral Capsules: Start with 1 capsule (50mg), ideally taken in the morning with a high-fat meal. Consider increasing to two doses daily after one week if well-tolerated.
CBGA Oral Capsules: Add 1 capsule (25mg) daily to help counter oxidative stress and protect against organ damage, particularly useful for patients with kidney or skin involvement.
CBDA Oral Capsules: Add 1 capsule (15mg) daily for patients with high levels of inflammation, particularly where COX-2 pathways may be involved. This may also support gastrointestinal comfort in patients sensitive to NSAIDs.
Monitoring: Monitor inflammatory markers before and after starting cannabinoid treatment. Evaluate for two weeks before adding in additional cannabinoids. Consider increasing doses if well-tolerated and patient showing improvement.
Joint and Muscle Pain
CBD Topical Balm: Apply a thin layer to affected joints or muscles, using approximately 1g of balm (20mg CBD) per application. This can be repeated daily as needed.
CBG Topical Balm: For enhanced relief, apply alongside the CBD balm or in alternating applications. CBG’s local anti-inflammatory effects and antibacterial properties may help with pain and skin lesions.
CBD Oral Capsules: Start with 1 capsule (25mg) daily, ideally taken in the evening with a high-fat meal.
CBDA Oral Capsules: Add 1 capsule (15mg) daily in the evening.
Monitoring: Evaluate after two weeks. If well-tolerated, consider increasing to two capsules daily for each capsule. Monitor and evaluate, some patients may need a higher or lower ratio of CBD : CBDA depending on endocannabinoid system needs.
Fatigue and Mood Balance
CBD Oral Capsules: Take 1 capsule (25mg) in the evening with a high-fat meal to help regulate mood and promote relaxation, potentially alleviating stress-related flares.
CBG Oral Capsules: Consider adding 1 capsule (50mg) taken in the morning with a high-fat meal for mild energy support due to CBG’s potential effects on alertness and well-being.
Monitoring: Evaluate after two weeks. If well-tolerated, consider increasing to two capsules daily for each capsule.