Department of Oncology and Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences (UAMS), BioMed II, 238-2, Little Rock, AR, USA.
Sci Rep. 2024 Mar 9;14(1):5782. doi: 10.1038/s41598-024-56220-0.
To test the hypothesis that genetic and pharmacological modulation of the classical cannabinoid type 1 (CB) and 2 (CB) receptors attenuate cancer-induced bone pain, we searched Medline, Web of Science and Scopus for relevant skeletal and non-skeletal cancer studies from inception to July 28, 2022. We identified 29 animal and 35 human studies. In mice, a meta-analysis of pooled studies showed that treatment of osteolysis-bearing males with the endocannabinoids AEA and 2-AG (mean difference [MD] - 24.83, 95% confidence interval [CI] - 34.89, - 14.76, p < 0.00001) or the synthetic cannabinoid (CB) agonists ACPA, WIN55,212-2, CP55,940 (CB-non-selective) and AM1241 (CB-selective) (MD - 28.73, CI - 45.43, - 12.02, p = 0.0008) are associated with significant reduction in paw withdrawal frequency. Consistently, the synthetic agonists AM1241 and JWH015 (CB-selective) increased paw withdrawal threshold (MD 0.89, CI 0.79, 0.99, p < 0.00001), and ACEA (CB-selective), AM1241 and JWH015 (CB-selective) reduced spontaneous flinches (MD - 4.85, CI - 6.74, - 2.96, p < 0. 00001) in osteolysis-bearing male mice. In rats, significant increase in paw withdrawal threshold is associated with the administration of ACEA and WIN55,212-2 (CB-non-selective), JWH015 and AM1241 (CB-selective) in osteolysis-bearing females (MD 8.18, CI 6.14, 10.21, p < 0.00001), and treatment with AM1241 (CB-selective) increased paw withdrawal thermal latency in males (mean difference [MD]: 3.94, CI 2.13, 5.75, p < 0.0001), confirming the analgesic capabilities of CB ligands in rodents. In human, treatment of cancer patients with medical cannabis (standardized MD - 0.19, CI - 0.35, - 0.02, p = 0.03) and the plant-derived delta-9-THC (20 mg) (MD 3.29, CI 2.24, 4.33, p < 0.00001) or its synthetic derivative NIB (4 mg) (MD 2.55, CI 1.58, 3.51, p < 0.00001) are associated with reduction in pain intensity. Bioinformatics validation of KEGG, GO and MPO pathway, function and process enrichment analysis of mouse, rat and human data revealed that CB and CB receptors are enriched in a cocktail of nociceptive and sensory perception, inflammatory, immune-modulatory, and cancer pathways. Thus, we cautiously conclude that pharmacological modulators of CB receptors show promise in the treatment of cancer-induced bone pain, however further assessment of their effects on bone pain in genetically engineered animal models and cancer patients is warranted.
为了验证以下假说,即经典大麻素 1 型(CB1)和 2 型(CB2)受体的遗传和药理学调节可以减轻癌症引起的骨痛,我们检索了 Medline、Web of Science 和 Scopus 数据库,以获取截至 2022 年 7 月 28 日的骨骼和非骨骼癌症相关研究。我们共鉴定出 29 项动物研究和 35 项人类研究。在小鼠中,一项汇总研究的荟萃分析显示,用内源性大麻素 AEA 和 2-AG (平均差[MD] - 24.83,95%置信区间[CI] - 34.89,- 14.76,p < 0.00001)或合成大麻素(CB)激动剂 ACPA、WIN55,212-2、CP55,940(CB-非选择性)和 AM1241(CB-选择性)(MD - 28.73,CI - 45.43,- 12.02,p = 0.0008)治疗骨溶解的雄性小鼠,可显著降低足底回缩频率。同样,合成激动剂 AM1241 和 JWH015(CB-选择性)增加了足底回缩阈值(MD 0.89,CI 0.79,0.99,p < 0.00001),而 ACEA(CB-选择性)、AM1241 和 JWH015(CB-选择性)减少了骨溶解雄性小鼠的自发性抽搐(MD - 4.85,CI - 6.74,- 2.96,p < 0.00001)。在大鼠中,在骨溶解的雌性大鼠中,给予 ACEA 和 WIN55,212-2(CB-非选择性)、JWH015 和 AM1241(CB-选择性)可显著增加足底回缩阈值(MD 8.18,CI 6.14,10.21,p < 0.00001),给予 AM1241(CB-选择性)可增加雄性大鼠的足底回缩热潜伏期(平均差异[MD]:3.94,CI 2.13,5.75,p < 0.0001),证实了 CB 配体在啮齿动物中的镇痛能力。在人类中,用医用大麻(标准化 MD - 0.19,CI - 0.35,- 0.02,p = 0.03)和植物源性 delta-9-THC(20 mg)(MD 3.29,CI 2.24,4.33,p < 0.00001)或其合成衍生物 NIB(4 mg)(MD 2.55,CI 1.58,3.51,p < 0.00001)治疗癌症患者,可降低疼痛强度。对小鼠、大鼠和人类数据的 KEGG、GO 和 MPO 通路的生物信息学验证,以及功能和过程富集分析表明,CB 和 CB 受体富集于伤害感受和感觉感知、炎症、免疫调节和癌症等多种途径。因此,我们谨慎地得出结论,CB 受体的药理学调节剂在治疗癌症引起的骨痛方面具有潜力,但是,有必要在遗传工程动物模型和癌症患者中进一步评估它们对骨痛的影响。